{
    "Contributors": "MIMIC",
    "Source": "MIMIC-IV",
    "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/",
    "Categories": [
        "Summarization"
    ],
    "Definition": [
        "Summarize the CT imaging diagnostics' detailed findings for the Chest into a concise conclusion."
    ],
    "Reasoning": [],
    "Input_language": [
        "English"
    ],
    "Output_language": [
        "English"
    ],
    "Instruction_language": [
        "English"
    ],
    "Domains": [
        "Medicine",
        "Clinical Reports",
        "CT",
        "Chest"
    ],
    "Positive Examples": [],
    "Negative Examples": [],
    "Instances": [
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No axillary\nlymphadenopathy.  The known para-aortic lymph node has slightly increased in\nsize and now measures 29 x 16 mm, as compared to 24 x 15 mm on the previous\nexamination.  Stable appearance of the cardiac structures.  The no pericardial\neffusion.  The posterior mediastinum is unremarkable.  No change in appearance\nof upper abdominal organs.  Stable appearance of the vertebral bodies and the\nother bony constituents of the chest wall.  There is no evidence of cortical\ndisruption.  Stable 2-3 mm solid right upper lobe nodule (5, 76).  The known\nleft lateral chest wall lesion is overall unchanged in size and morphology. \nThe lesion continues to be heterogeneous, with a large interface with both the\npericardium and the chest wall.  The local pleura is thickened, but there is\nno reliable evidence for chest wall invasion.  Likewise, no pericardial\neffusion is seen.  A previous nodular component of the lesion, extending into\nthe pre pericardial fat (5, 217) is stable.  There are no new or growing\nnodules.",
            "output": "Stability in size and morphology of the known left lung mass, with large\ninterfaces to the pericardium and the left chest wall.  Stable appearance of a\nnodular component extending into the pre pericardial fat.  No change in\nappearance of the right upper lobe nodule.  Minimal increase in size of a\npre-existing right para-aortic lymph node."
        },
        {
            "input": "The patient has undergone on bloc chest wall and lung resection on the right,\nthere are expected air collections in the left soft tissues.  The large\nmediastinal vessels are intact.  No incidental pulmonary embolism.  No\nevidence of bleeding.  Postoperative chest tube in situ.  Several partly\nloculated pleural fluid collections with air-fluid levels, partly drained by\nthe chest tube.  The suture lines are surrounded by collapsed lung parenchyma,\nwithout typical contrast enhancement pattern for atelectasis.  The basal areas\nof the pleural effusion contains several high attenuation circular structures,\nlikely reflecting hematomas.  No changes in the right lung.",
            "output": "Extensive postoperative soft tissue air collections.  Partially drained\nloculated fluid or pneumothorax is on the right.  The lung parenchyma\nsurrounding the staple lines could include areas of developing pneumonia. \nCoagulated blood in the posterior aspect of the pleural effusion, but no\nevidence of active bleeding."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal.  There\nis no pericardial effusion.  There is interval almost complete resolution of\nleft pleural effusion with still present small amount of predominantly basal\nfluid as well as fluid adjacent to the area of our surgical resection, series\n2, image 42.\n\nImage portion of the upper abdomen demonstrates 3 x 1.7 cm nodule, in the left\nupper abdomen, series 2, image 59, not seen on the previous examination. \nAlternatively it might represent fluid collection.\n\nAirways are patent to the subsegmental level bilaterally.  Postsurgical\nchanges in the left lung are present, with minimal soft tissue thickening\nalong the surgical fissure.  No new nodules demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nIn addition to the resected rib, series 2, image 35 there is rib fracture,\nseries 2, image 24 involving posterolateral aspect of left fifth rib, seen on\nthe previous examination but with no evidence of healing, potentially\npathologic.",
            "output": "Substantial improvement since previous examination in the postsurgical changes\nin the left lung with no evidence of new nodules masses or consolidations.\n\nNodule versus collection in the superior left upper abdomen, correlation with\nultrasound of the abdomen or potentially CT abdomen is to be considered."
        },
        {
            "input": "Stable right pectoral Port-A-Cath.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar areas.  No change in appearance of the large\nmediastinal vessels.  No incidental pulmonary embolism.  Stable appearance of\nthe cardiac structures.  No pericardial effusion.  The posterior mediastinum\nis unremarkable.  No abnormalities are noted in the upper abdomen. No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable small sclerotic lesions in the lower thoracic spine (8, 73).\nStable moderate apical scarring.  The soft tissue formations surrounding the\nleft basal staple line have slightly decreased in the interval.  The local\neffects of traction are also stable.  Finally, a nodular component of the\nchanges located in the left lower lobe (5, 188) is also stable.  No evidence\nof new or suspicious lesions.  No evidence of growing lesions.  No pleural\neffusion.  Stable left basal pleural thickening (5, 199).",
            "output": "Stable postoperative morphology at the bases of the left lung.  No new or\ngrowing nodules.  The airways are patent.  No adenopathy.  No diffuse lung\ndisease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level in the right into the proximal segmental level on the left\nwithout filling defect to indicate a pulmonary embolus.  Evaluation of the\ndistal segmental and subsegmental pulmonary arteries on the left is limited by\nextensive motion artifact and severe underinflation secondary to atelectasis,\nwith equivocal areas of attenuation, which could represent small pulmonary\nemboli (301:66, 301:132).  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits.  There is no pericardial effusion is\nseen.  There is a right chest Port-A-Cath with tip terminating within the\nright atrium\n\nAXILLA, HILA, AND MEDIASTINUM: ___ mediastinal pleural fluid is noted along\nthe left superior mediastinum.  There is prominent, heterogeneous\nopacification in the subcarinal station, which demonstrates high attenuation,\nwhich may be postsurgical.  No axillary, mediastinal, or hilar lymphadenopathy\nis present.  No mediastinal mass.\n\nLUNGS/AIRWAYS AND PLEURAL SPACES: The patient is status post pleurectomy with\nextensive irregularity along the pleura demonstrating high attenuation with\nmultiple foci of air (301:73).  Additional multi loculated areas of\nhydropneumothorax is noted along the fissure as well as anteriorly along the\npleura, consistent with hemopneumothorax.  High attenuation within the fluid\ncomponents is most suggestive of hemorrhage.  A convex lesion along the\nposterior and inferior pleural is equivocal in most likely represents\nhemorrhage, but underlying lesion cannot be definitively excluded (301:154). \nThe patient is status post left upper lobe and left lower lobe wedge resection\nwith expected postsurgical anatomy.  There is extensive atelectasis involving\nthe left lung.  There is no definite focal parenchymal consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nCHEST WALL AND BONES: There is multiple foci of air within the left anterior\nchest wall with a moderate amount of hemorrhage, likely postsurgical.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism in the main, lobar, and proximal\nsegmental pulmonary arteries bilaterally.  Extensive motion artifact and\nunderinflation secondary to atelectasis limits evaluation of the left distal\nsegmental and subsegmental pulmonary arteries.  Equivocal areas of\nhypoattenuation within the left subsegmental pulmonary arteries are\nnonspecific, but may represent small pulmonary emboli.\n2. Status post thoracotomy and pleurectomy with extensive high attenuation\nirregularity along the pleura likely representing hemorrhage in the immediate\npostoperative setting.  Moderate multiloculated hydropneumothorax and\nhemopneumothorax is noted, most prominent along the fissure and anterior\npleura.  Surveillance for tumor recurrence will have to be deferred until the\npostoperative changes have resolved.\n3. Prominent, heterogeneous opacification within the subcarinal mediastinum is\nof unclear etiology, but may be postsurgical.  Attention on follow-up imaging\nis recommended.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:40 am, 1\nminutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Patient is status post left upper and lower lobe wedge\nresections with postoperative changes again demonstrated including parenchymal\nscarring and chain sutures.  No suspicious mass or nodules in the bilateral\nlung parenchyma.  Scattered centrilobular and ___ opacities in the\nposterior right upper lobe could represent infection or inflammation.  No\nfocal consolidation in the left lung.\n\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  The patient is status post left pleurectomy for section of pleural\nmetastatic deposits.  When compared to ___, the left\nhemopneumothorax demonstrates decreased fluid and increased air, raising\nconcern for bronchopleural fistula.  There are multiple areas of pleural\nnodularity, for example on series 5, image 206, 250, and 267 the pleural\nnodules demonstrate enhancement.  These pleural nodules may be previously\nobscured by postoperative changes.  They are concerning for recurrence or\nresidual metastatic deposits.  Loculated high-density fluid within the left\nmajor fissure has decreased.  No right pleural effusion or pneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable\nexcept for scattered nonobstructive subcentimeter stones in bilateral\nkidneys..",
            "output": "1. Status post left pleurectomy with interval decreased high density\npostoperative fluid and increased air in the left pleural space, raising\nconcern bronchopleural fistula.  Infection is considered less likely given the\ndegree of air.  Multiple enhancing left pleural nodules, which might have been\npreviously obscured by postoperative fluid, are concerning for recurrent or\nresidual disease.\n2. Stable post surgical changes status post left upper and lower lobe wedge\nresections.\n3. Scattered centrilobular and ___ opacities in the right posterior\nupper lobe could represent inflammation or infection.\n\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:46 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "There are filling defects in posterior segmental and subsegmental branches of\nthe left lower lobe pulmonary artery.  There are irregular opacities in the\nleft lung base consistent with subsegmental atelectasis and or scarring.  The\nheart and mediastinal structures are unremarkable.  No lymphadenopathy is\nidentified.  There is a calcified granuloma in the left upper lobe.  Chest\nwall structures appear intact.  Degenerative changes are present in the spine.",
            "output": "Pulmonary embolism left lower lobe.  Subsegmental atelectasis lower left lung.\n\nResults called to the urgent care physician caring for the patient 12:55."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  All visible mediastinal lymph nodes (2,\n20) Are normal in size.  Mild coronary calcifications, mild aortic valve\ncalcifications, no pericardial effusion.  Small hiatal hernia.  No acute\nabnormalities in the upper abdomen, only the uppermost part of the kidneys is\nvisualized, with a potentially minimally dilated left renal collecting system\n(2, 62).  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\n2 mm calcified left upper lobe granuloma (4, 30).\nNew 4 mm posterior solid right upper lobe nodule (4, 90).\nThe previously 6 mm right upper lobe solid nodule has decreased in size and\nnow measures 2-3 mm in diameter (4, 100).\nNew 3 mm subpleural middle lobe nodule (4, 132).\nNew 3 mm right lower lobe nodule (4, 149).\nMinimal scarring in the medial aspect of the right middle lobe.\nNo pleural effusions.  The airways are patent.",
            "output": "As compared to ___, a pre described right upper lobe nodule has\nslightly decreased in size, but in the interval several new nodules have\nappeared, notably in the right upper lobe and the right lower lobe.  CT\nfollowup in ___ month is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No enlarged supraclavicular or axillary lymph nodes.  Left\ngreater than right gynecomastia is present.\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen pelvis report\nfrom on the same date for subdiaphragmatic findings.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  Aortic valvular calcifications\nare mild.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\nPARENCHYMA:\n\nNo focal consolidation or mass.\n\nUnchanged left upper lobe calcified granuloma (04:46).\n\n5 mm ground-glass nodule in the right upper lobe is unchanged (04:52).\n\nMultiple nodules have resolved including the previously seen 4 mm right upper\nlobe nodule, the 3 mm right upper lobe nodule, 3 mm subpleural right middle\nlobe nodule and 3 mm right lower lobe nodule.\n\nAIRWAYS:  Airways are patent to the subsegmental level.\n\nVESSELS:  The main, right and left pulmonary arteries are normal in caliber. \nAlthough this study is not optimized for the evaluation of pulmonary\nvasculature, no central pulmonary embolism is detected.  The thoracic aorta is\nnormal in caliber.\n\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesion or acute fracture.\nDegenerative changes of the thoracic spine are noted.",
            "output": "Interval resolution of multiple previously seen nodules.5 mm right upper lobe\nground-glass nodule is unchanged since ___.  No new nodules.\n\nLeft greater than right gynecomastia.  Mammography or ultrasound is\nrecommended for complete characterization.\n\nPlease see the separately dictated CT abdomen and pelvis from the same date\nfor a description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Mammography or ultrasound for complete characterization of\nprobable left gynecomastia."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small bilateral layering pleural effusions.\n\nLUNGS/AIRWAYS: There is mild compressive atelectasis of the dependent lung\nbases bilaterally.  The remainder of the lung parenchyma is otherwise clear\nexcept for a nonspecific 7 mm ground-glass opacity within the right upper lobe\n(2:24, 601:37). The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a 7 mm hypodense nodule within the left thyroid lobe.\n\nABDOMEN:  Included portion of the upper abdomen is notable for peripherally\ncalcified gallstone within the gallbladder.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small bilateral pleural effusions.\n3. 7 mm ground-glass opacity within the right upper lobe is indeterminate,\nlikely infectious or inflammatory.\n4. 7 mm left thyroid nodule."
        },
        {
            "input": "Borderline mediastinal lymph nodes are stable in size and number compared to\n___ chest CT.  Hilar nodes are difficult to measure on this\nunenhanced CT and are grossly unchanged within the limitations of this\nassessment.  Heart size is normal, and coronary artery calcifications are\npresent.  No pericardial or pleural effusion is evident.\n\nExam was not tailored to evaluate subdiaphragmatic region, and note is made of\na incompletely imaged low-density lesion and the upper pole of the left\nkidney.  Remaining imaged upper abdomen is unremarkable.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nwithin the spine.\n\nWithin the lungs, a subpleural and basilar predominant distribution of\ninterstitial lung disease is present, characterized by reticulation, adjacent\nground-glass opacity, and extensive traction bronchiectasis and\nbronchiolectasis without definitive honeycombing.  In comparison to the ___ chest CT this is somewhat difficult to compare due to motion\nartifact on the prior exam but has apparently progressed in the interval. \nIncidental calcified granulomas are present, predominantly in the left lower\nlobe.\n\nHeterogeneity of the right lobe of the thyroid gland is grossly unchanged from\nthe prior study and is not fully characterized by CT.  Recent thyroid\nultrasound of ___ described subcentimeter nodules without\nconcerning features.",
            "output": "1. Subpleural and basilar predominant fibrotic interstitial lung disease,\nwhich may represent a fibrotic subtype of NSIP or possible UIP.  Recommend\ncorrelation with pulmonary function testing and pulmonary consultation, if\nwarranted clinically.\n\n2.  Coronary artery calcifications.\n\n3.  Intrathoracic lymph nodes are likely hyperplastic in the setting of\ndiffuse lung disease.\n\n4.  Incompletely imaged cystic left upper pole renal lesion, most likely a\ncyst.  If warranted clinically, this could be more fully characterize by\ndedicated renal ultrasound."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Heterogeneity of the right lobe of\nthe thyroid gland visualized.  Previous left thyroidectomy.  No\nsupraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  Persistent mild gastric distention over several\nstudies with air locules seen with in the gastric content .  No adrenal\nlesions.\n\nMEDIASTINUM: All the previously noted mediastinal lymph nodes are\nsubcentimeter and show interval decrease in size.\n\nHILA: Hilar lymph nodes also demonstrate interval decrease in size.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Moderate LAD calcification.  Mild circumflex\ncalcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  The subpleural and basilar predominant interstitial lung disease\nconsists of reticulation and traction bronchiectasis and bronchiolectasis\nwithout definitive honeycombing.  In comparison to the previous study done ___ there is decrease in bronchial wall thickening as well as previous\nground-glass changes (for example right lower lobe 7, 210) suggesting that the\ninflammatory component has improved, but some architectural distortion and\ntraction bronchiectasis may be fibrotic and irreversible.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  Not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nlesions.  No distal clavicular erosions.",
            "output": "There has been interval improvement in the subpleural and basilar predominant\ninterstitial lung disease as evidenced by improvement in the ground-glass\nchanges (acute inflammatory component), but the background architectural\ndistortion and bronchiectasis (fibrotic component) is unchanged. The imaging\nfeatures suggest improving NSIP.\n\nInterval improvement in the intrathoracic lymph nodes.\n\nCoronary artery calcifications again noted.\n\nThere is persistent mild gastric distention over several studies with air\nlocules seen with in the gastric content suggesting a gastric bezoar and if\nthere is correlating clinical symptoms a surgical referral is advised."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid abnormalities warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged.  There\nis no soft tissue abnormality in the imaged chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.\n\nCARDIO-MEDIASTINUM:Wide esophageal hiatus transmits only subphrenic fat. \nEsophagus is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels but is present in at least left anterior descending and\ncircumflex coronary arteries.  Aorta and cardiac chambers are normal size. \nPericardium is physiologic.  Right pulmonary artery is mildly enlarged, 29 mm,\npreviously 27 mm.  Main and left pulmonary arteries are top-normal size.\n\n\nTHORACIC LYMPH NODES: Numerous subcentimeter central lymph nodes are neither\npathologically enlarged nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: The profusion of interstitial pulmonary abnormality\nhas improved, best appreciated in the region of greatest involvement, the left\nlower lobe, compare 4:168 today with 24:438 in ___..  Septal thickening is\nless pronounced.  Incidental note is made of punctate calcifications in the\nleft lower lobe which may be due to osseous metaplasia sometimes seen with\ninterstitial lung disease.\n\nThere are no focal pulmonary abnormalities of consequence.\n\nMild generalized bronchial wall thickening, probably unrelated to the\ninterstitial abnormality is unchanged.  There is no bronchiectasis or\nretention of secretions.\n\nCHEST CAGE: Unremarkable",
            "output": "Mild, improved infiltrative lung disease.\n\nContinued mild generalized bronchial inflammation.\n\nAtherosclerotic coronary calcification.  No evidence of cardiac decompensation\nand no radiographic findings to suggest respiratory decline"
        },
        {
            "input": "Please note that this study is somewhat limited by respiratory motion\nartifact.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.  No\nevidence of thoracic aortic dissection or intramural hematoma.  An area of\nulcerative atherosclerotic plaque is seen at the aortic arch.  The heart is\nenlarged. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Numerous prominent, although not technically\nenlarged mediastinal and bilateral hilar lymph nodes are present, and may be\nreactive.  No axillary or supraclavicular lymphadenopathy by CT size criteria.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Assessment of the lung bases is markedly limited due to the\nsignificant respiratory motion artifact for lying fills limitation, there is\ndependent atelectasis, and the suggestion of diffuse ground-glass opacities\nseen within the bilateral bases.  A 2 mm ground-glass nodule seen in the right\nupper lobe.\n\nBASE OF NECK:  1 4 x 1.3 cm heterogeneous nodule is seen in the right lobe of\nthyroid gland.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Please note that this study is somewhat limited by respiratory motion\nartifact.\n\n1.  No evidence of pulmonary embolism or aortic dissection.\n\n2.  Small area of ulcerated atherosclerotic plaque is seen at the aortic arch.\n\n3.  Apparent ground-glass opacities within the bilateral bases may relate to\nrespiratory motion artifact, however infection or aspiration could also be\nconsidered in the appropriate clinical setting.\n\n4.  1.4 cm heterogeneous right thyroid nodule.  Recommend nonemergent\ndedicated thyroid ultrasound for further evaluation, if not already performed.\n\nRECOMMENDATION(S):  1.4 cm heterogeneous right thyroid nodule.  Recommend\nnonemergent dedicated thyroid ultrasound for further evaluation, if not\nalready performed."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and,\naside from breasts which require mammography for evaluation, there are no soft\ntissue abnormalities in the chest cage suspicious for malignancy. Findings\nbelow the diaphragm will be reported separately.  Thyroid is unremarkable.\nAtherosclerotic calcification is not apparent in head and neck vessels or in\nthe coronary arteries. Aorta and pulmonary arteries are normal size. There is\nno pleural or pericardial abnormality. Esophagus is unremarkable.\n\nMediastinal and hilar lymph nodes are not enlarged and there is no adenopathy\nin the internal mammary, diaphragmatic, or retrocrural stations.\n\nFocal lung lesions are as follows:\n\nPunctate nodules right upper lobe, 8: 100, 153,\n\nPunctate nodule, right lower lobe, 8:170. And the\n\n5 mm nodule, left upper lobe, 8:160.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "5 mm left upper lobe nodule and a handful of smaller lung nodules are\nindeterminate, though unlikely to be metastases.  The 5 mm lesion should be\nre-evaluated with chest CT in 6 months.\n\nRECOMMENDATION(S):  Repeat chest CT, 6 months."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  No pericardial\npleural effusion is seen.  Image portion of the upper abdomen demonstrate\nliver hypodensity, unchanged and otherwise is unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  All the previously\nseen pulmonary nodules are stable, series 4 image 39, 4.7 mm, 53, 65, 95, 121.\nNo new nodules masses or consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Stable appearance of the chest was no evidence of intrathoracic metastatic\ndisease.  Reassessment of the patient in ___ for documentation of\nstability is recommended."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic annular calcification.  Mild LAD calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Biapical pleural-parenchymal scarring.  New suspicious soft\ntissue pulmonary nodule measuring 9 mm in diameter in the left upper lobe (6,\n146).  Indeterminate 2 mm nodule in the right lower lobe (6, 189).  The other\nmillimetric pre-existing pulmonary nodules are unchanged.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "New suspicious soft tissue nodule in the left upper lobe measuring 9 mm in\ndiameter suggesting a metastatic pulmonary nodule.\nIndeterminate 2 mm nodule right lower lobe.\n\nFor abdominal findings please see abdominal CT report."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities elsewhere in the chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal abnormality.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head neck vessels or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.  There is no pleural abnormality.\n\nLymph nodes:\n\nThoracic lymph nodes are not enlarged.\n\nLungs:\n\n5 mm right lower lobe nodule, 4:158.  Was 2 mm on ___.  2 x 4 mm\ncrescentic right upper lobe nodule, 4:64, unchanged.\n\nPunctate right middle lobe nodule, 4:105, unchanged.\n\n3 mm nodule superior segment right lower lobe, 4:124, unchanged.\n\nLeft upper lobes site of subtotal resection has a normal postoperative\nappearance.\n\nLeft lower lobe clear.",
            "output": "5 mm right lower lobe nodule, new and 2 mm on ___, concerning for\nmetachronous or metastatic malignancy.\n\nNormal postoperative appearance left upper lobe segmentectomy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Azygos lobe, a normal anatomical variant.  No\nenlarged lymph nodes in the mediastinum or at the level of the hilar\nstructures.  Mild aortic wall calcifications, mild coronary calcifications, no\npericardial effusion.  No abnormalities at the level of the large mediastinal\nvessels.  No abnormalities in the upper abdomen.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  No osteolytic lesions\nat the level of the vertebral bodies, the ribs, or the sternum.\nThere is again minimal growth of the 5-6 mm nodule in the right lower lobe (4,\n167).\nAll other pre-existing small pulmonary nodules are stable.\nThe areas of right upper lobe resection are also stable.\nStable bilateral apical scarring.",
            "output": "Minimal but continued growth of a right lower lobe nodule, which makes this\nlesion suspicious for metastatic disease.  All other pre-existing pulmonary\nnodules are stable.  Stable scarring of the right upper lobe segmentectomy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: A 2.6 mm hypodensity in the hepatic dome is too small\naccurately characterize (5:219).  The other imaged abdominal viscera are\nunremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal size without evidence of\npericardial effusion.  The ascending and descending aorta are normal caliber.\nPLEURA: There has been interval increase in a left-sided small pleural\neffusion.  No right pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is biapical scarring.  A 7 x 6 mm nodule in the major\nfissure and near the left upper lobe surgical site previously measured by 6 x\n5 mm (5:130).  A 6 x 5 cm spiculated right lower lobe nodule (5:181), is\nunchanged since at least ___.\nA 6 x 4 mm right lower lobe nodule (5:121) is unchanged from prior but\nslightly increased from ___.\nA 3 mm right upper nodule right upper lobe nodule (5:106), is unchanged from\nprior.\nA 2 mm right upper lobe nodule (5:117) is unchanged from prior.\nA 2 mm right lower lobe posterior nodule (5:143) is unchanged.\n2. AIRWAYS:  The airways are patent.\n3. VESSELS:  The main pulmonary artery is normal caliber.  Previously seen\npulmonary emboli are not visualized on this exam.  This study is not been\nCHEST CAGE: No suspicious osseous lesions.  No acute fractures.",
            "output": "1.  Slight increase in a 7 x 6 mm nodule we near the left upper lobe surgical\nsite from prior.  Slight increase in a 6 x 4 mm right lower lobe nodule from\n___.\n\n2.  Multiple other small nodules are unchanged in size as described above.\n\n3.  Previously seen pulmonary emboli are not visualized on this exam."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  Large\nintramuscular lipoma left upper paramedian back has grown since ___,\n41 x ___ mm at the level of greatest cross-sectional area, previously 30 x 98\nmm in ___.  There are no soft tissue elements to suggest that this is a\nlow-grade sarcoma.  Adjacent musculature is attenuated and displaced but the\nribs are intact.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal abnormality.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels or in the coronary arteries. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Numerous subcentimeter paratracheal and measurable right\nhilar lymph nodes mediastinal lymph nodes are smaller today than in ___. \nLeft hilar contour is unchanged and does not suggest growing adenopathy, but\nthe lower pole of the right hilus is slightly larger today presumably due to\nadenopathy.  No measurable lymph nodes elsewhere in the chest are\npathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: There are scores of subcentimeter pulmonary nodules,\nscattered in both lungs, 2 or 3 times as many as there were in ___ and\n___.  Few nodules are stable in size over ___ year but most are new or\nlarger ranging in diameter up to 10 mm, most under 7 mm.\n\nThe only lesion with bronchial involvement that obliterates a subsegmental\nbronchus in the lateral segment of the right middle lobe, 6 x 14 mm, 5:130,\nwas one/3 that size in ___.\n\nCHEST CAGE: Unremarkable",
            "output": "Great increase in the number of small pulmonary nodules since ___ could be\ndue to progressive sarcoidosis but metastasis is a distinct possibility,\npresumably from an extrathoracic primary lesion.  For that assessment and to\ndetect possible concurrent primary bronchogenic malignancy, FDG PET scanning\nshould be performed.  However because of the small size of the nodules, even a\nmalignant one my not be FDG avid.\n\nThe only suggestion for growing lymph node enlargement is in the lower pole of\nthe right hilum.\n\nEnlarging intramuscular lipoma left upper back, probably benign."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable thyroid gland.  No\naxillary, supraclavicular lymphadenopathy.  No abnormal findings in the chest\nwall.\nUPPER ABDOMEN: Mild fatty replacement of the pancreatic parenchyma.  Tiny\nhypodensity in the left hepatic lobe segment 4, could represent a small cyst\nhowever is too small to characterize optimally.  3.1 simple appearing cyst in\nthe midpole of the left kidney.  Multiple nonenlarged lymph nodes are seen in\nthe retroperitoneum and mesentery.  Colonic diverticulosis.\nMEDIASTINUM: Multiple normal sized   lymph nodes in the subcarinal space.\nHILA: Right hilar adenopathy measures 2.2 x 2.6 cm.  Punctate calcifications\nin the right hilar lymph nodes may be  related to prior granulomatous disease.\nNo left hilar lymphadenopathy.\nHEART and PERICARDIUM: Heart is normal in size.  Atherosclerotic plaques are\nseen in the coronary arteries.  There is no pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Diffuse ground-glass opacities, most pronounced in the lower\nlungs with hyperinflation of both lower lungs.  Punctate granulomas noted in\nthe right lower lobe.\n2. AIRWAYS: Airways are patent to subsegmental level however there is\nbronchial wall thickening bilaterally.  No bronchiectasis or mucus plugging.\n3. VESSELS: Thoracic aorta is normal in size.  No filling defects in the\npulmonary vasculature.\nCHEST CAGE: No abnormal findings in the osseous structures of the chest.",
            "output": "1. Bilateral lower lobe dependent atelectasis.\n2. Right hilar lymphadenopathy measuring up to 2.6 cm with punctate foci of\ncalcification may be related to prior granulomatous disease.\n\nRECOMMENDATION(S):  3 month follow up Chest CT may be performed to assess\nstability of hilar lymphadenopathy ."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not\nenlarged.There are no soft tissue abnormalities elsewhere in the chest wall\nconcerning for malignancy.\n\nA 10 mm hypodensity in the left hepatic lobe, unchanged, is a likely cyst. \nAdditional subcentimeter hepatic hypodensities are too small to characterize.\n\nCARDIO-MEDIASTINUM: The esophagus is unremarkable.  There are no findings in\nthe thyroid warranting further imaging evaluation.\nModerate atherosclerotic calcifications are present in the aorta.  The aortic\nvalve is heavily calcified.  Coronary arteries are without calcifications. \nThe aorta, pulmonary arteries, and cardiac chambers are normal size.\nNo pericardial effusion.\n\nTHORACIC LYMPH NODES:  Previously noted right hilar node is decreased size now\nmeasuring 2.4 x 1.9 cm, previously 3.0 x 2.6 cm (02:29). Left hilar and\nmediastinal nodes are also smaller, no longer pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Previously noted bilateral ground-glass opacities are\nnearly resolved, with minimal ground-glass opacities noted in the right upper\nlobe.  Mild bilateral peripheral reticular opacities are more notable in the\nlower lobes.  Punctate calcified granulomas in the right upper lobe are\nunchanged.  Mild bronchial thickening is improved from the previous referenced\nstudy.  The tracheobronchial tree is patent and normal to the subsegmental\nlevels.\nNo pleural abnormality.\n\nCHEST CAGE: Multilevel degenerative changes with large anterior osteophytes. \nOtherwise, no pathologic or compression fractures or destructive bone lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "1.  Improved right hilar lymphadenopathy and decreased size of left hilar and\nmediastinal nodes, presumably reactive to previous alveolitis.\n2.  Near complete resolution of ground-glass opacities and peribronchial\nthickening.\n3.  Mild bilateral peripheral reticular opacities, lower lobe dominant, could\nbe age related."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy or\ninfection.  Findings below the diaphragm, including induration the soft tissue\nof the right flank will be reported separately.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head and neck vessels or\ncoronary arteries.  Left pulmonary artery is enlarged, 35 mm,Although the\nstudy is not designed for pulmonary artery evaluation there is no large\ncentral filling defect.  Aorta and cardiac chambers are normal size. Very\nsmall pericardial effusion is new.\n\nPleura:\n\nSmall nonhemorrhagic bilateral pleural effusions layer posteriorly, left\nunchanged, right larger today than on ___ prior to percutaneous liver\ndrainage procedure. There is no subphrenic fluid collection to explain it.  a\nnew small left pleural collection in the left major fissure superiorly could\nbe loculated.  No pleural surfaces enhance to suggest active empyema\ncurrently, however pleural connections could develop from progressively\nabscessed lung in the anterior segment of the left upper lobe and along the\nlateral aspect of the left lower lobe which has progressed since ___.\n\nLungs:\n\nThe largest region of pulmonary abnormality is the progressively necrotizing\nconsolidation in the anterior segment of the left upper lobe, 304:84-127,\nwhich is now contiguous with the mediastinal pleura of the prevascular space\nabove the level of the pulmonary artery and the upper reflection of the\npericardium, 02:32.  Second large region of necrotizing pneumonia in the left\nlower lobe involves the superior segment and portions of the anteromedial and\nlateral basal segments.  It has grown larger and more confluent since ___.  A similar small region has progressed in the lingula, 304:121.\n\nHandful of small abscesses in both upper lobes,, right middle and right lower\nlobes are stable but there is a new region of consolidation at the left lung\napex, 304:58.\n\nLymph nodes:\n\nCentral adenopathy in the left lower paratracheal and prevascular mediastinum\nis unchanged.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Relatively small increase in volume of small to moderate pleural effusions,\nincluding new loculation in the upper aspect of the left major fissure.  There\nis no pleural in hands min to suggest empyema currently.  On the other hand\nthere are areas of progressive necrotizing pneumonia where the fluid contents\nof the cavitated lungs, predominantly left upper and lower lobes may become\ncontiguous with the pleura locally.\n\nIn addition to multiple small lung abscesses in 3 lobes, there is a new small\narea of infection in the left upper lobe which raises the possibility of a\nsecond pathogen."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  Numerous extensive partially visualized left supraclavicular\nlymphadenopathy are similar to slightly decreased compared to prior.  There is\na mediastinal drain terminating in the right epicardial region without\nadjacent fluid collection around the tip.  There is mild-to-moderate bilateral\nlateral wall edema.  There is no right axillary lymphadenopathy.  Left\naxillary lymphadenopathy measuring up to 1.5 cm in short axis (3; 16) is\nsimilar to prior.  A right lateral intercostal approach chest tube just\nsuperior to the tenth rib and the left lateral approach chest tube superior to\nthe tenth rib are noted.\n\nUPPER ABDOMEN: Please see separate dictated report on CT abdomen pelvis\nperformed on the same day regarding subdiaphragmatic findings.\n\nMEDIASTINUM: There is an anterior mediastinal mass measuring up to 11.7 x 8.6\nx 9.4 cm, similar to prior extending superiorly beyond the thoracic inlet. \nThere is encasement of the great vessels, and aorta without significant\ndecrease in caliber.  There is attenuation of the left brachiocephalic vein\n(2; 16).  The SVC is severely attenuated (2; 24).  There is no mass effect on\nthe trachea.  Mass encroaches the anterior wall of the right pulmonary artery\n(2; 23).  There is left internal mammary lymphadenopathy measuring up to 1.0\ncm in short axis (2; 23).  There is extensive mediastinal lymphadenopathy\nincluding 1.7 cm precarinal lymph node (2; 17, similar to prior.  Stable 1.0\ncm pre-pericadial lymph node also noted.\n\nHILA: There is extensive bilateral hilar lymphadenopathy with extension of the\nmediastinal mass into the right hila and left hilar 1.2 cm lymph node (2; 19).\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is near interval\nresolution of prior pericardial effusion status post interval drain placement.\n\nPLEURA: Small left pleural effusion and trace right pleural effusion have\nsignificantly decreased compared to prior.  There is a small right\npneumothorax and trace left apical pneumothorax, consistent with recent\nintervention.\n\nLUNG:\n\n1. PARENCHYMA:  There is mild bibasilar compressive atelectasis.  Evaluation\nof the parenchyma is limited by respiratory motion.  Tiny 2 mm pulmonary\nnodules are noted bilaterally (302; 30, 43, 49, 140).  No suspicious pulmonary\nnodules.\n2. AIRWAYS:  Airways are patent to the segmental level bilaterally.\n3. VESSELS:  Intrathoracic aorta is in caliber.  There is mild attenuation of\nthe right pulmonary artery.There is no evidence of central pulmonary embolism.\nCHEST CAGE: There is no acute fracture or suspicious lytic or sclerotic\nosseous lesions.",
            "output": "1. 11.7 cm anterior mediastinal mass with severe attenuation of the SVC and\nleft brachiocephalic vein and mild attenuation of the right pulmonary artery.\n2. Extensive incompletely visualized bilateral supraclavicular\nlymphadenopathy, left axillary lymphadenopathy, mediastinal lymphadenopathy,\nleft internal mammary lymphadenopathy.\n3. No suspicious pulmonary nodules.\n4. Small bilateral right greater than left pneumothoraces, consistent with\nrecent intervention.\n5. Bilateral chest tubes with interval decrease in size of bilateral small\nleft and trace right pleural effusions.\n6. Mediastinal drain with interval significant decrease and near resolution of\npericardial effusion."
        },
        {
            "input": "The patient is asymmetrically positioned in the scanner gantry.  No incidental\nthyroid findings.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the mediastinum or at the level\nof the hilar structures.  Borderline diameter of the ascending aorta (4, 24). \nModerate coronary calcifications, mild aortic valve calcifications.  No\npericardial effusion.  The posterior mediastinum is unremarkable.  Large\npartly calcified gallstone (4, 57).  Osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate to severe degenerative\nvertebral disease.\nNo suspicious pulmonary nodules or masses.  No pleural thickening, no pleural\neffusions.  The airways are patent.  No diffuse lung disease.  No other\nparenchymal abnormalities.",
            "output": "No evidence of metastatic disease to the thorax.  No lymphadenopathy.  No\nsuspicious pulmonary nodules or masses.  No pleural abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Stable bilateral hilar, mediastinal, and left\naxillary adenopathy from ___, consistent with underlying\nsarcoidosis.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is mild bronchial wall thickening most prominent in the\nlung bases.  A 2 mm left upper lobe nodule is stable from ___ and does not\nrequire follow up.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Post\ncholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Stable intrathoracic lymphadenopathy since ___, consistent with history of\nsarcoidosis.\n3. Mild bronchial wall thickening may suggest small airways disease."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable\n\nUPPER ABDOMEN: Please see separate CT report from the same day for description\nof intra abdominal findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  The patient is intubated with\nthe ET tube in appropriate position.  An enteric tube is seen with its tip in\nthe stomach.  There is increased stranding of the mediastinal fat.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No pleural effusion.  A right-sided PICC line is seen\nwith its tip at the cavoatrial junction.\nPLEURA: Small bilateral pleural effusions are noted.\n\nLUNG:  There are extensive symmetrical consolidations and ground-glass\nopacities involving the dependent lung zones bilaterally, with air\nbronchograms.  No evidence of pneumothorax.\n\nBONES:  No significant bony abnormalities.",
            "output": "1. Extensive bilateral dependent consolidation and ground-glass opacities are\nconcerning for pneumonia possibly secondary to aspiration.\n2.  Please see separate CT abdomen report from the same day for description of\nintra-abdominal findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy. \nNonspecific stranding is noted in the right axilla (05:33).  Measurable\nsupraclavicular lymph nodes are not enlarged by CT size criteria.  0.9 cm\nsubcarinal lymph node is not enlarged by CT size criteria attention on\nfollow-up is recommended (5:106).  There is no definite hilar lymphadenopathy\nwithin the limitation of an unenhanced exam.  There is no mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 4 mm solid pulmonary nodule in the right lower lobe\n(5:159).  There is linear atelectasis in the right lower lobe.  Mild bronchial\nwall thickening seen diffusely.  Otherwise, lungs are clear without masses or\nareas of parenchymal opacification and the are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThyroid gland is unremarkable.  Incidental note is made of an 8 mm\nsubmandibular lymph node.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates\ncholelithiasis.  Previously described large mixed solid and cystic\nintraperitoneal masses are partially visualized, better evaluated on the CT\nabdomen pelvis dated ___.  Ascites is again seen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. 4 mm left lower lobe pulmonary nodule is indeterminate.\n2. Previously described intraperitoneal masses are better evaluated on the CT\nabdomen pelvis dated ___."
        },
        {
            "input": "CHEST PERIMETER: 8 mm well-circumscribed low-attenuation lesion in the left\nthyroid lobe, of uncertain chronicity could been present but not apparent on\nthe noncontrast chest CT ___.  No adjacent nodules in the soft\ntissue of the thoracic outlet and no local lymph node enlargement.  Axillary\nnodes are not enlarged.  No soft tissue abnormalities in the chest wall.\n\nCARDIO-MEDIASTINUM:Lower esophagus is patulous.  Esophagus elsewhere is\nunremarkable.  Atherosclerotic calcification is mild in head and neck vessels,\nnot apparent in coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size, aortic valve is not calcified, and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: 14 x 16 mm right hilar lymph node cluster, 3:123, is\nprobably unchanged since noncontrast chest CT, ___, 5:157.  No lymph\nnodes elsewhere in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Previous bibasilar atelectasis has nearly resolved. \n5 x 5 mm mm solid right lower lobe lung nodule, 3:129, looks slightly larger\nthan it was in ___, even though its diameters, as remeasured, were 4\nx 5 mm, 5:159.  There are no new lung nodules or other focal findings of\nconsequence.\n\nNo lung nodule or other focal lung lesions of consequence.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "There is no strong evidence of active intrathoracic malignancy.  However the 5\nx 5 mm right lower lobe lung nodule and borderline ipsilateral hilar lymph\nnode enlargement, even though neither was PET avid, on 2 subsequent FDG PET CT\nscans should be kept under surveillance.  I would recommend a repeat chest CT\nin 3 months, with intravenous contrast agent if tolerated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is heterogeneous with small hypodense nodules, unchanged.  No\nenlarged lymph nodes in either axilla or thoracic inlet.  No abnormalities on\nthe chest wall.  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  Stable right hilar lymph node\nmeasuring 1.5 x 1.4 cm (3:128).  No left hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Stable 5 mm nodule in the right\nlower lobe (3:130).  No new nodules.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___.  Stable right\nhilar lymphadenopathy and 5 mm nodule in the right lower lobe.  No new or\ngrowing lung nodules, lymphadenopathy or osseous lesions."
        },
        {
            "input": "Multiple thyroid nodules.  No supraclavicular, infraclavicular, or axillary\nlymphadenopathy.  Borderline sized right hilar lymph node of unchanged\nmorphology (5, 20).  No abnormality at the level of the large mediastinal\nvessels.  No incidental pulmonary embolism.  No pericardial effusion.  Upper\nabdominal findings are reported in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nThe 5 mm solid right lower lobe nodule (6, 142) is stable.  Stable platelike\nscarring in the right lower lobe (6, 148).  Minimal non characteristic\nscarring at the bases of the right and left lower lobe.  No pleural\nthickening, no pleural effusions.  The airways are patent.",
            "output": "Stable borderline sized right hilar lymph node.  Stable 5 mm non-growing right\nlower lobe pulmonary nodule.  No new or growing nodules.  No pleural\nabnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nMultiple subcentimeter bilateral hypodense thyroid nodules, require no further\nimaging.  Stable small axillary and thoracic inlet lymph nodes.  No chest wall\nabnormalities.  Moderate atherosclerotic calcification at the proximal right\nsubclavian artery.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Unchanged size and morphology of the right hilar\n17 x 12 mm lymph node conglomerate (6:148).  No enlarged left hilar lymph\nnodes.  Mediastinal lymph nodes ranging from 5-9 mm are stable, the largest\none in the left lower paratracheal station measuring 9 mm (6:95).\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\nascending aorta.  Aorta is normal in caliber throughout.  Pulmonary artery is\ndilated measuring 32 mm.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Stable right lower lobe 4 mm\nsolid nodule (6:148).  No focal consolidations.  No pleural effusions or\nthickening.  Stable small bilateral lower lobe subsegmental atelectasis and\nscarring.  Mild biapical pleuroparenchymal scarring.  Accessory fissure\nseparating the lingula from the left upper lobe.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  Small sclerotic focus in the\nvertebral body of T7 is stable since at least ___, most likely\nbone island.  No lytic or sclerotic lesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Unchanged size and morphology of the right hilar 17 x 12 mm lymph node\nconglomerate.\n\nStable 4 mm right lower lobe solid nodule.  No new nodules.\n\nStable enlarged pulmonary artery measuring 32 mm."
        },
        {
            "input": "The lungs are fairly well expanded without focal consolidation or\npneumothorax.  There is a small left pleural effusion with adjacent\natelectasis.  There is bronchial wall thickening with peribronchiolar\nnodularity suggestive of small airways disease.  No concerning pulmonary\nnodule or mass is identified.  There is mild dependent atelectasis\nbilaterally.\n\nThe thyroid gland is unremarkable.  There is no axillary, supraclavicular,\nmediastinal, or hilar lymph node enlargement by CT size criteria.  The heart\nis normal in size, without pericardial effusion.  An aortic valve replacement\nand coronary artery calcifications are noted.  The great vessels are normal in\ncaliber and configuration.  Esophageal varices are noted, as is a small hiatal\nhernia.\n\nPlease see the dedicated CT abdomen/pelvis report from the same day for\ndetailed evaluation of infra diaphragmatic structures.\n\nThere is no focal lytic or sclerotic osseous lesion suggestive of neoplasm or\ninfection.  A chronic left rib deformities noted.",
            "output": "No focal consolidation to suggest pneumonia.  Small left pleural effusion with\nadjacent atelectasis.  Findings compatible with small airways disease."
        },
        {
            "input": "CHEST:\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nMEDIASTINUM: Several sub cm lymph nodes in the mediastinum, not pathologically\nenlarged.\nIn this noncontrast study there is no evidence of gross hilar lymphadenopathy.\n\nSmall sliding hiatal hernia, the esophagus is patulous containing residues of\noral contrast. There is mild wall thickening of its lower portion with no\nextravasation of oral contrast to suggest esophageal perforation.\n\nHEART and PERICARDIUM: There is no cardiomegaly.  The left atrium is enlarged,\nmeasuring 5 cm.\nHypodensity of cardiac chambers relative to the septum indicates minimal\nanemia.\nSevere extensive general coronary calcifications with moderate calcifications\nalong the normal caliber thoracic aorta.\nMinimal pericardial effusion, enlarged in comparison to prior.\n\nPLEURA and LUNG: Small bilateral layering low-density pleural effusions with\nadjacent compressive atelectasis, enlarged since prior.  Left pleural effusion\nextends into the major fissure.\nIn the atelectasis of the lower lobes scattered calcified granulomas,\nadditional tiny calcified granulomas in both upper lobes (302:16).\nNo consolidations to suggest pneumonia.\nMinimal interstitial line thickening suggest mild congestion.\n Major airways are patent, mild secretions in the carina.\n\nABDOMEN:\nStomach is collapsed.\nPrevious small bowel obstruction resolved.  Minimal residual bowel wall\nthickening is noted in the previously dilated bowel loops.  There is no bowel\nwall dilatation and oral contrast extending the small bowel, large bowel and\nrectum.\nNo free fluid in the abdomen or pelvis.\n\nLiver is homogeneous, no evidence of focal findings in this no enhanced\ncontrast study.\nThere is no intra or extra hepatic biliary dilatation and gallbladder is\nunremarkable.\nPancreas, spleen, adrenals and kidneys are unremarkable.\nThe prostate is enlarged, 5.5 cm.\nFoley catheter balloon in almost empty bladder.\nExtensive atherosclerotic calcifications along the abdominal aorta and its\nbranches.\n\nHealed left ___ rib fractures.  Grade 1 retrolisthesis of L2 on L3.\nDegenerative changes with thoracic vertebra prominent osteophytes.\nNo evidence of bony destructive lesions.",
            "output": "No evidence of esophageal perforation.\nSmall bilateral layering low-density pleural effusions with mild interstitial\nline thickening and minimal pericardial effusion all enlarged and suggest\nvolume overload.\nPreviously demonstrated small bowel obstruction is resolved with oral contrast\nextending to the rectum."
        },
        {
            "input": "CHEST:\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nMEDIASTINUM: Several sub cm lymph nodes in the mediastinum, not pathologically\nenlarged.\nIn this noncontrast study there is no evidence of gross hilar lymphadenopathy.\n\nSmall sliding hiatal hernia, the esophagus is patulous containing residues of\noral contrast. There is mild wall thickening of its lower portion with no\nextravasation of oral contrast to suggest esophageal perforation.\n\nHEART and PERICARDIUM: There is no cardiomegaly.  The left atrium is enlarged,\nmeasuring 5 cm.\nHypodensity of cardiac chambers relative to the septum indicates minimal\nanemia.\nSevere extensive general coronary calcifications with moderate calcifications\nalong the normal caliber thoracic aorta.\nMinimal pericardial effusion, enlarged in comparison to prior.\n\nPLEURA and LUNG: Small bilateral layering low-density pleural effusions with\nadjacent compressive atelectasis, enlarged since prior.  Left pleural effusion\nextends into the major fissure.\nIn the atelectasis of the lower lobes scattered calcified granulomas,\nadditional tiny calcified granulomas in both upper lobes (302:16).\nNo consolidations to suggest pneumonia.\nMinimal interstitial line thickening suggest mild congestion.\n Major airways are patent, mild secretions in the carina.\n\nABDOMEN:\nStomach is collapsed.\nPrevious small bowel obstruction resolved.  Minimal residual bowel wall\nthickening is noted in the previously dilated bowel loops.  There is no bowel\nwall dilatation and oral contrast extending the small bowel, large bowel and\nrectum.\nNo free fluid in the abdomen or pelvis.\n\nLiver is homogeneous, no evidence of focal findings in this no enhanced\ncontrast study.\nThere is no intra or extra hepatic biliary dilatation and gallbladder is\nunremarkable.\nPancreas, spleen, adrenals and kidneys are unremarkable.\nThe prostate is enlarged, 5.5 cm.\nFoley catheter balloon in almost empty bladder.\nExtensive atherosclerotic calcifications along the abdominal aorta and its\nbranches.\n\nHealed left ___ rib fractures.  Grade 1 retrolisthesis of L2 on L3.\nDegenerative changes with thoracic vertebra prominent osteophytes.\nNo evidence of bony destructive lesions.",
            "output": "No evidence of esophageal perforation.\nSmall bilateral layering low-density pleural effusions with mild interstitial\nline thickening and minimal pericardial effusion all enlarged and suggest\nvolume overload.\nPreviously demonstrated small bowel obstruction is resolved with oral contrast\nextending to the rectum."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Numerous subcentimeter mediastinal\nlymph nodes do not meet CT size criteria.  Suboptimal assessment of the hila\ndue to the absence of IV contrast.  However hilar enlargement appears related\nto vascular enlargement rather than lymph nodes.  No pathologically enlarged\nsupraclavicular, or axilla lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta is non aneurysmal.  The pulmonary arteries\nare enlarged measuring up to 3.6 cm and the main pulmonary artery and 2.9 of\nthe left and 3.2 of the right pulmonary artery.  The heart is enlarged with\ntriple lead defibrillator with the tips in the right atrium right ventricle\nand coronary sinus.  Prior median sternotomy.  No pericardial effusion.\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild diffuse\nbronchial wall thickening with linear bands of atelectasis, most pronounced in\nthe lower lobes.  Geographic lobular areas of hyperlucency may reflect air\ntrapping, although incompletely assessed on this inspiratory scan. \nMillimetric nodules in the right uppper, right lower lobe, and left upper lobe\nare statistically likely benign series 5 image 71, 115, and 142.  Calcified\ngranuloma in the right lower lobe.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Although this study is not designed for the evaluation of\nsubdiaphragmatic structures, the imaged upper abdomen demonstrates trace\nperihepatic ascites.",
            "output": "Pulmonary artery enlargement can be seen with pulmonary hypertension and the\ncause for hilar enlargement on chest radiograph.\n\nMulti chamber cardiac enlargement.\n\n Multiple millimetric pulmonary nodules are statistically likely benign. In\nthe absence known malignancy or significant smoking history, no imaging\nfollow-up is required. Otherwise follow-up CT thorax in ___ years time is\nsuggested."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, ascending aorta and descending\naorta are within normal limits.  The main pulmonary artery measures 3.3 cm in\ngreatest dimension which may suggest pulmonary artery hypertension.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is dense opacification of the lingula consistent with\npneumonia.  Mild bibasilar atelectasis is noted.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolism nor acute aortic syndrome.\n2. Left upper lobe pneumonia.\n3. Mild dilation of the main pulmonary artery up to 3.3 cm raises possibility\nof pulmonary artery hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid unremarkable no axillary or\nthoracic inlet lymphadenopathy.\n\nUPPER ABDOMEN: Partially visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: Dilated ascending thoracic aorta measuring up to 4.5 cm, similar\nto prior.  Scattered prominent mediastinal lymph node, likely reactive.\n  HILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is mild-to-moderately enlarged.  No\npericardial effusion.\nPLEURA: No pleural effusion.  No pneumothorax.  Right apical pleural scarring\nwith foci of calcifications.\nLUNG:\n\n1. PARENCHYMA:  Mild upper lobes predominant paraseptal and centrilobular\nemphysema.  Near complete resolution of the previously noted right upper lobe\nconsolidative opacity.  Persistent lingular scarring/atelectatic changes along\nthe left major fissure.  Multifocal areas of scarring are noted, without\nsignificant interval change, for example: Subpleural posterior right lower\nlobe (image 139, series 4), in addition to unchanged bibasilar\natelectasis/pleural scarring.  No new or developing consolidation.\n2. AIRWAYS:  Trachea and mainstem bronchi are patent.\nCHEST CAGE: Degenerative changes of the thoracic spine.  No displaced\nfractures.",
            "output": "1. Near complete resolution of the previously noted right upper lobe\nconsolidative opacity.  No new or developing consolidation.\n2. Unchanged ectatic ascending thoracic aorta measuring up to 4.5 cm."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary or supraclavicular\nlymphadenopathy.  There is mediastinal lymphadenopathy with an enlarged\nprecarinal lymph node measuring up to 1.3 cm (series 4, image 66), likely\nreactive.  Within limitations of this noncontrast study there is no definite\nhilar lymphadenopathy.  No mediastinal mass or hematoma.  Calcified granuloma\nis seen within the right upper lobe.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bronchocentric ill-defined ground-glass nodular opacities are\nseen within the right upper, right middle, and right lower lobes, as well as\nwithin the left upper lobe.  Mosaic attenuation of the upper lobes likely\nreflects a degree of air-trapping given the slight expiratory phase of\nimaging.  Central airways are patent..\n\nBASE OF NECK: The thyroid contains a 1.7 cm hypodense nodule on the left.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nPatient is status post cholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Bilateral upper lobe, right middle lobe, and right lower lobe\nground-glass, ill-defined nodular opacities, compatible with multifocal\npneumonia.\n2.  Reactive mediastinal lymphadenopathy.\n3.  1.7 cm hypodense left thyroid nodule.  Nonemergent ultrasound is suggested\nfor further assessment, as noted in the recommendation section.\n\nRECOMMENDATION(S):   Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "CTA chest:\nThere are multiple right lower segmental pulmonary emboli.  No findings of\nright ventricular stranding.  Small bilateral pleural effusions are seen. \nOther than subsegmental compressive atelectasis, no consolidation is seen.  No\nadenopathy in the visualized chest.  There is mild subcutaneous soft tissue\nedema and emphysema in the anterolateral left chest wall.\n\nCT of the abdomen and pelvis:\nThe liver, spleen, pancreas, adrenal glands and gallbladder are unremarkable. \nThere are bilateral cysts and hypodense lesions too small to characterize in\nthe kidneys.  The kidneys are otherwise unremarkable.  No hydronephrosis.\n\nThere is no intestinal obstruction or ascites.  The 7 cm pelvic hematoma has\nevolved and is now displaced to the left secondary to a loculated,\ncompartmentalized abscess containing gas in the right hemipelvis measuring 7\ncm, just superior to the vaginal cuff.  Additional pockets of loculated fluid\nwithin the hematoma are also present.  Hysterectomy changes are again noted.\n\nThe osseous structures are unchanged.",
            "output": "1. Post hysterectomy and 7 cm abscess containing gas in the right hemipelvis\njust superior to the vaginal cuff.\n2. Displaced evolved pelvic abscess to the left, not significantly changed in\nsize accounting for redistribution.\n3.   Segmental right lower pulmonary emboli and small bilateral pleural\neffusions.\n\nNOTIFICATION:  The findings were discussed with Dr.  ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:11 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with moderate coronary artery calcifications. There is no\npericardial effusion.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is no\nfocal consolidation. No new suspicious pulmonary nodule detected.  Stable\nfindings compatible with interstitial lung disease, with subpleural\ndistribution, architectural distortion, bronchiectasis most prominent in the\nbilateral lower lobes, also present in the lingula, anterior bilateral upper\nlobes.  Scattered areas of ground-glass opacities are stable.  There are areas\nof subpleural honeycombing, stable since prior.  Surgical material is\nidentified in the right lower lobe, compatible with prior lung biopsy. \nPreviously described left upper lobe nodule is not well visualized this exam.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures.  No abnormalities identified in the partially visualized upper\nabdomen.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Mild multilevel degenerative changes of the thoracic spine are\nunchanged.",
            "output": "Unchanged appearance of patient's known interstitial lung disease, with mid to\nlower lung ___ distribution of bronchiectasis, architectural distortion, areas\nof ground-glass opacity and small areas of honeycombing."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Of note, evaluation of hilar lymph nodes is limited\ndue to the lack of IV contrast.  Aorta and pulmonary arteries are normal size.\nCardiac configuration is normal and there is mild calcification in all\ncoronary arteries.  There is no pleural or pericardial effusion.\nSuperimposed on chronic interstitial reticulation, bronchiectasis,\nbronchiolectasis, architectural distortion and honeycombing, that predominates\nin the subpleural regions and lower lobes there are new extensive ground-glass\nopacities throughout the lungs mainly in the left upper lobe but also in the\nlower lobes and right middle lobe. This new extensive ground-glass opacities\nis most consistent with acute exacerbation of chronic interstitial lung\ndisease if the patient has no symptoms of infection.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "New extensive ground-glass opacities is most consistent with acute\nexacerbation of known severe chronic interstitial lung disease if the patient\nhas no symptoms of infection"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary or hilar lymphadenopathy.  Mediastinal\nnodes, the largest in the pretracheal station, are borderline enlarged.  The\nthyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nDiffuse interstitial changes, with subpleural opacities, traction\nbronchiectasis and microcystic honeycombing, are better evaluated on\nhigh-resolution chest CT on ___ The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2.  Please refer to separate report of HRCT chest performed on the same day\nfor further description of the parenchymal findings.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 2:10 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is not clearly\nidentified.  No supraclavicular or axillary adenopathy.  No gross breast\nlesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.\n\nHILA: Subcentimeter hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  Trace\npericardial fluid.  Mild to moderate left and right coronary artery\ncalcification.  Moderate calcification of the aortic annulus.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Pulmonary findings in keeping with severe fibrotic interstitial\nlung disease as evidenced by predominantly subpleural increased lung\nattenuation, architectural distortion, microcystic honeycombing and\nbronchiectasis in the anterior aspect of the upper lobes and posterior and\nbasal aspects of the lower lobes.  Associated ground-glass opacity. \nGeographic areas of lungs sparing/ mild air trapping for example in the left\nlower lobe (5, 148).  The fibrotic lung disease is stable to mildly progressed\ncompared to previous imaging done ___.  Surgical material in the right\nlower lobe in keeping with previous lung biopsy.  Indeterminate 3 mm pulmonary\nnodules in the left upper lobe (5, 60) is new.\n-AIRWAYS:  The airways are patent to the subsegmental level.  Widespread\ncylindrical/mild varicoid bronchiectasis in relation to the fibrosis as\ndescribed above\n-VESSELS:  The pulmonary artery measures 27 mm in diameter (pulmonary\nhypertension should be excluded in the setting of interstitial lung disease).\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Severe fibrotic interstitial lung disease as evidenced by increased background\nlung attenuation, architectural distortion, bronchiectasis and microcystic\nhoneycombing in a subpleural distribution predominantly in the anterior\naspects of the upper lobes and posterior basal aspects of the lower lobes. \nAssociated ground-glass opacity suggests an active inflammatory component. \nThe extent of the fibrotic lung disease is stable to mildly progressed\ncompared to initial imaging done ___.\n\nNew indeterminate 3 mm nodule in the left upper lobe.\n\nMildly dilated pulmonary artery in the setting of interstitial lung disease\nsuggest pulmonary arterial hypertension.\n\nRECOMMENDATION(S):  Low risk patients have minimal or absent history of\nsmoking or other known risk factors for primary lung neoplasm. High risk\npatients have a history of smoking or other known risk factors for primary\nlung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation of the pulmonary vasculature is limited to\nthe segmental level due to respiratory motion and streak artifact.  There is a\npotential filling defect in a right lower lobe segmental branch, although felt\nlikely to be due to motion artifact (3:100).  No additional filling defects\nare identified.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  There is a common origin of the innominate\nartery and the left common carotid (\"bovine arch\", normal variant). The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: A prevascular lymph node measures 10 mm, and\nthere are several prominent diaphragmatic lymph nodes measuring up to 11 mm\n(2:61).  There is probably an enlarged subcarinal lymph node measuring 15 mm\n(02:39).  The distal esophagus is thickened.\n\nPLEURAL SPACES: There is a moderate to large right pleural effusion with\nadjacent passive atelectasis of nearly the entire right lower lobe.  Left\npleural effusion is small.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is nearly complete atelectasis of the right lower lobe. \nThe right upper lobe is clear.  There is passive atelectasis of the left lower\nlobe.  The remainder of the left lung is grossly clear.  Airways are patent to\nthe subsegmental level bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please see the separately dictated CT abdomen and pelvis from ___ for a description of subdiaphragmatic findings and peritoneal\nnodularity.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Moderately limited study due to patient motion and streak artifact.\n2. No central pulmonary embolism.  Possible filling defect in a right lower\nlobe segmental pulmonary artery is likely related to motion artifact.\n3. Moderate to large right and small left pleural effusions.\n4. Nearly complete atelectasis of the right lower lobe.\n5. Enlarged lower mediastinal/diaphragmatic lymph nodes are concerning for\ninvolvement of malignancy."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  Trace pericardial fluid is\nwithin physiologic limits.  The thoracic aorta is normal in caliber. \nCalcified atherosclerosis is minimal.  Incidental note is made of a common\norigin of the left common carotid and innominate arteries.  No evidence of\naortic dissection.  The main pulmonary artery is normal in caliber.  No\ncentral pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal and subdiaphragmatic\nlymphadenopathy has improved since 3 months prior.  A prevascular lymph node\nnow measures up to 7 mm in short axis, previously 10 mm (series 4, image 15). \nThe largest diaphragmatic lymph node measures up to 6 mm in short axis,\npreviously 11 mm (series 4, image 33).  Subcarinal lymph nodes measure up to 7\nmm in short axis (series 4, image 20).  No hilar or axillary lymphadenopathy.\n\nPLEURAL SPACES: Interval resolution of previously moderate right and small\nleft pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: Interval resolution of right greater than left basilar\natelectasis.  There is now minimal dependent atelectasis.  There are multiple\nscattered apical dominant centrilobular ground-glass micro nodules.  No\nsignificant pulmonary nodule or consolidation.  The airways are patent to the\nsubsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nIncidental small left parascapular lipoma measures up to 1.3 cm (series 4,\nimage 20).",
            "output": "1. Interval decrease in size of mediastinal and diaphragmatic lymphadenopathy.\nNo new evidence of metastasis in the thorax.\n2. Interval resolution of bilateral pleural effusions.\n3. Apical dominant centrilobular ground-glass micro nodules raise the\npossibility of respiratory bronchiolitis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Previously visualized mediastinal bilateral hilar lymph nodes\nhave further regressed and a barely perceptible on the prior study.  The the\nright pericardial lymph node had also significantly decreased in size..  Heart\nsize is normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are unremarkable\nPLEURA: There is no pleural effusion\n\nLUNG: There is minimal bibasilar atelectasis.  No lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows ascites. \nPlease refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "Further decrease in size of the mediastinal hilar and further decrease in size\nof the mediastinal hilar and diaphragmatic adenopathy.\n\nAscites.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  In pretracheal location, a pre-existing lymph node\nhas substantially increased in size (3, 15) and is now approximately 15 mm in\ndiameter.  Also substantially increased is a subcarinal lymph node, with an\napproximate diameter of 30 mm.  Stable appearance of the large mediastinal\nvessels.  Minimal coronary calcifications.  Minimal new left pleural effusion.\nSubstantial perihepatic and perisplenic ascites.  No pericardial effusion. \nSmall hiatal hernia.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  In the lung parenchyma, there is.  Stable 3\nmm perifissural left lower lobe nodule (4, 98).  No other pulmonary nodules\nare visualized.  The airways are patent.",
            "output": "Increase in size of at least 2 mediastinal lymph nodes that are now clearly\nenlarged.  Lower lobe predominant ground-glass opacities, likely caused by\ninfection or aspiration.  Stable 3 mm perifissural left lower lobe nodule."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are multiple prominent axillary lymph\nnodes bilaterally measuring up to 9 mm.  There are numerous enlarged\nmediastinal lymph nodes including a prevascular lymph node measuring\napproximately 2.2 x 1.1 cm (series 2, image 17).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Along the left anterior mediastinum, to the left of midline,\nthere is a spiculated soft tissue density structure measuring approximately\n3.0 x 1.7 cm.  This corresponds with the abnormality seen on the recent chest\nradiograph.  This may represent mediastinal lymphadenopathy, but pulmonary\ninvolvement is difficult to exclude.  Delineation is difficult without IV\ncontrast.  There is subtle minimal septal thickening within the upper lobes\nbilaterally, left greater than right, possibly representing mild interstitial\nedema.  There are also multiple subcentimeter nodular opacities bilaterally,\nfor example (series 4, image 35 and 76), which are doubtful clinical\nsignificance in a patient of this age, but could be inflammatory.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion within the limitation of an unenhanced\nscan.There is no perihepatic free fluid.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  There may be a small amount of sludge\nlayering dependently within the gallbladder, however there is no evidence of\ncholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion within the limitation of an unenhanced scan.  There\nis a 1.5 cm splenule inferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  The colon and rectum are within normal limits.  The appendix\nis not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 3.0 cm soft tissue structure along adjacent the anterior mediastinum to the\nleft of midline.  Findings may represent lymphadenopathy or other mediastinal\nmass, although pulmonary involvement is difficult to exclude.  Difficult to\ndelineate given lack of IV contrast.  MRI would be helpful for further\nassessment or contrast-enhanced CT if renal function allows.\n2. Numerous enlarged mediastinal and axillary lymph nodes, which raises the\nquestion of a lymphoproliferative disorder, in conjunction with the above\nfinding.\n3. Scattered subcentimeter nodular opacities within the lungs bilaterally,\nnonspecific, but could relate to inflammatory or infectious small airways\nprocess.\n\nRECOMMENDATION(S):  MRI or contrast-enhanced CT (if/when renal function\nallows)."
        },
        {
            "input": "MEDIASTINUM:  The imaged thyroid is normal.  A left-sided supraclavicular\nlymph node measures 1.1 x 1 cm, similar to prior.  A para-aortic mediastinal\nlymph node measures 1.8 x 0.9 cm.  Additional mediastinal lymph nodes appear\nenlarged, similar to prior.  Enlarged bilateral axillary lymphadenopathy\nmeasures up to 1.2 x 1.2 cm on the right and 1.5 x 1 cm on the left. Soft\ntissue density within the left hilum appears similar to prior, allowing for\ndifferences in technique, and likely represents adenopathy. A right hilar\nlymph node measures 1 x 1.2 cm.   The aorta and pulmonary arteries are normal\nin size.   The heart size is normal. Small pericardial effusion is stable.\n\nPLEURA:  There is no pneumothorax.  Pleural effusions are large on the left\nand small on the right.\n\nLUNGS: There is near complete collapse of the left lower lobe, and compressive\natelectasis at the right base.  Areas of mucous plugging are most prominent\nwithin the left lower lobe.\n\nPatient is status post left upper lobe wedge resection.  Soft tissue\nnodularity and ground-glass opacity surrounding the suture site is most\nconsistent with postsurgical change.  Low-density fluid in the anterior\nmediastinum and adjacent to the surgical site containing multiple foci of gas\nis also most consistent with postsurgical change.  Fluid within the\ncardiophrenic space appears slightly more complex, but is also likely\npostoperative.  Innumerable small new centrilobular nodules are present.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen. Within\nthese limitations no gross abnormality is seen.  Nasogastric tube is partially\nimaged coursing into the stomach.",
            "output": "1.  Postsurgical changes from recent prior left upper lobe VATS wedge\nresection.\n2.  Grossly unchanged supraclavicular, mediastinal, hilar, and axillary\nlymphadenopathy.\n3.  Innumerable new small centrilobular nodules are present, concerning for an\ninfectious process.\n4.  New pleural effusions are large on the left and small on the right.\n5.  There is near complete collapse of the left lower lobe with mucous\nplugging in left lower lobe segmental and subsegmental bronchi.\n\n This preliminary report was reviewed with Dr. ___\nradiologist."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are enlarged  bilateral axillary,\nmediastinal and a left hilar lymph nodes, unchanged compared to previous.  A\nright-sided PICC line seen with its tip terminating at the cavoatrial\njunction.\n\nPLEURAL SPACES:  There is no pneumothorax.  A moderate left-sided pleural\neffusion is noted, decreased in size compared to previous.  A right-sided\npleural effusion has resolved.\n\nLUNGS/AIRWAYS:  The patient is status post left upper lobe wedge resection.   \nPostsurgical changes are again seen surrounding the suture site.  There is a\nfluid collection the anterior mediastinum adjacent to the suture site which\ndemonstrates resolution of small air pockets and mild peripheral enhancement.\nThere is improved aeration of left lower lobe with residual atelectasis at the\nlung bases.  Small nodular opacities are again seen in the right lower lobe\n(series 2 AA: 43).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  A small accessory spleen is noted.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  An enteric tube is seen with\nits tip near the gastric antrum.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  The colon and rectum are\nwithin normal limits.  The appendix is not visualized.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of pulmonary emboli.\n2.  Improved aeration of the left lower lobe with improvement of bilateral\npleural effusions.\n3.  Small fluid collection adjacent to the site of the prior wedge resection\nin the left upper lobe."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the chest wall (2, 14)\nare normal in size.  No hilar or mediastinal lymphadenopathy.  Mild aortic\nwall calcifications, mild aortic valve calcifications, no pericardial\neffusion.  Small hiatal hernia.  Otherwise unremarkable posterior mediastinum.\nSeveral small liver cysts.  The soft tissues of the chest wall, including the\nbreast tissue, is unremarkable.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Mild bilateral apical scarring.\n1 mm calcified right upper lobe subpleural granuloma (5, 46).  Millimetric\nsubpleural 1 mm left lower lobe nodule (5, 103).  3-4 mm nodular ground-glass\nopacity in the middle lobe (5, 181).  No other pulmonary nodules or masses. \nThe airways are patent.  No pleural thickening, no pleural effusions.",
            "output": "Several small non suspicious pulmonary nodules, including a 3 mm ground-glass\nnodule in the middle lobe.  Per recommendations of the ___ Society,\nnone of these nodules requires further follow-up, unless the patient is at an\nincreased risk for lung cancer."
        },
        {
            "input": "LUNGS:  The new spiculated 1.5 cm peripheral left apical lung nodule seen on\nthe prior study has significantly changed in morphology, now appearing linear\nand scar-like, with interval reduction of the nodular component (5:72, 7:34). \nThis 6 x 9 mm spiculated medial right apical nodule noted as new on the prior\nexamination has resolved (5:72). In the short interval since the prior study,\nthere is a new 5 mm right apical nodule (5:75). A scar from the ___ nodule\nresection in the right apex is unchanged. Focal peribronchial scarring in the\nperipheral right lower lobe is also unchanged (5:251). A 4 mm left upper\nnodule is unchanged from ___ (5:141). Severe emphysema is again noted. There\nis diffuse bronchial wall thickening and mucus plugging of small airways.\nThere is significant bronchiectasis and volume loss in the right middle lobe.\n\nMEDIASTINUM: Prominent upper pretracheal lymph nodes are unchanged since ___\nand were not FDG-avid on the PET-CT from ___ (03:21). There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The aorta\nand pulmonary arteries are normal in size.   The heart size is normal and\nthere is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen. Within\nthese limitations no gross abnormality is seen.",
            "output": "1. The dominant left apical nodule seen on the prior study has significantly\ndecreased in size and appears to be associated with linear opacities\nconsistent with scarring.  Infectious etiology is suspected.\n2. Interval resolution of a 6 x 9 mm spiculated right apical nodule also\nsuggest infectious etiology."
        },
        {
            "input": "LUNGS:  The linear left apical scar has further significantly decreased in\nthickness and attenuation (4:77). The previously described 5 mm right apical\nnodule (4:57) has significantly decreased.  A scar from the ___ nodule\nresection in the right apex is unchanged.  Focal peribronchial scarring in the\nperipheral right lower lobe is also unchanged (04:19 8). A 4 mm left upper\nnodule is unchanged from ___ (4:114). Severe emphysema is again noted. There\nis diffuse bronchial wall thickening and mucus plugging of small airways.\nThere is significant bronchiectasis and volume loss in the right middle lobe.\n\nMEDIASTINUM:There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  The aorta and pulmonary arteries are normal in size.   The\nheart size is normal and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen.  Stable\nrenal cysts and hepatic cysts.",
            "output": "1.  Further interval decrease in the linear left apical scar likely post\ninfectious.\n\n2. Scar from the ___ nodule resection in the right apex is unchanged.\n\n3.  Chronic a middle lobe bronchiectasis and volume loss are stable.\n\n4.  No evidence of active infection in the thorax."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.  7 mm hypodense lesion in\nsegment 7 of the liver most likely representing hepatic cyst.  Mild increase\nin hepatic density.\n\nMEDIASTINUM: Prevascular soft tissue mass measuring 22 x 16 mm (4, 77) and 40\n___.  This lesion is unchanged in size compared to prior imaging done ___.  Adjacent 7 mm lymph node between the right brachiocephalic artery and\nleft common carotid artery (4, 79) is unchanged compared to prior imaging.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Hyperdensity in relation to the right coronary\nartery (4, 182) may represent a stent or calcification.  Mild dilatation of\nthe ascending aorta (not aneurysmal).\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Pulmonary overinflation and severe emphysema in keeping with\nCOPD.  Bronchiectasis, bronchial wall thickening and significant volume loss\nof the right middle lobe.  There is a single new pulmonary nodule in the\nlateral aspect of the right upper lobe (4, 183) measuring 3 mm in diameter. \nPre-existing nodules (04:56, 106, 112, 147 and 199 and 227) are unchanged. \nScarring in bilateral upper lobes (4:78 and 80) are unchanged.\n-AIRWAYS:  Saber sheath deformity of the intrathoracic trachea suggesting\nCOPD.  Retained secretions seen dependently in the superior trachea (4, 75)\nand right main bronchus (4, 197).  Mild, diffuse bronchial dilatation (for\nexample right lower lobe 4, 181).\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "The soft tissue mass in the superior mediastinum (prevascular) is unchanged in\nsize compared to previous imaging done ___ and ___. \nThis favors a benign lesion and a thymoma is considered high on the\ndifferential diagnosis.\n\nThere is a single new 3 mm pulmonary nodule in the right upper lobe as\ndescribed above.\n\nAll the pre-existing pulmonary nodules are unchanged.\nBronchiectasis and volume loss of the right middle lobe is unchanged.\nThe mild, but diffuse bronchiectasis is unchanged with minimal secretions seen\nin the trachea and right main bronchus.\n\nRECOMMENDATION(S):   The ___ pulmonary nodule recommendations\nare intended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed.\n\nIn the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12\nmonths and if no change, no further imaging needed. For high risk patients,\ninitial follow-up CT at ___ months and then at ___ months if no change.\n\nIn the case of nodule size >6 - 8 mm: For low risk patients, initial follow-up\nCT at ___ months and then at ___ months if no change. For high risk\npatients - initial follow-up CT at ___ months and then at ___ and 24 months\nif no change.\n\nIn the case of nodule size > 8 mm: Follow-up CTs at around 3, 9, and 24 months\nor consider dynamic contrast enhanced CT, PET, and / or biopsy"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Stable soft tissue structure in the anterior\nmediastinum (2, 17), probably reflecting a benign thymoma.  Normal and\nborderline sized mediastinal lymph nodes (2, 25) are also stable.  Stable\nappearance of the large mediastinal vessels.  No substantial coronary\ncalcifications.  No pericardial effusion, no valvular calcifications.  The\nposterior mediastinum is unremarkable, with the exception of a small hiatal\nhernia.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nThe lung parenchyma continues to show severe emphysematous changes.  There is\na new irregular 8 mm spiculated nodule in the right upper lobe (4, 47). \nStatus post wedge resection.  New 2 mm left upper lobe nodule (4, 47).  New 5\nmm left lower lobe nodule (4, 60).  Other small pulmonary nodules are overall\nstable.  Severe pulmonary emphysema and moderate chronic airways disease.  New\n15 mm ill-defined and irregular nodule in the anterior portions of the left\nupper lobe (4, 135).  Stable scars and bronchiectasis at the level of the\nmiddle lobe.  No pleural effusions.  (4, 128).",
            "output": "Several new pulmonary nodules, the most suspicious of which are located in the\nanterior portion of the right upper lobe as well as in the right upper lobe\napex.  Tissue sampling is strongly recommended.  Other pulmonary nodules are\nstable, no pleural effusions.  Stable severe pulmonary emphysema and\naccompanying airways disease."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  The heart size is normal.  The pericardium is intact without\nevidence of an effusion.  The esophagus is normal however note is made of a\nsmall hiatal hernia.  Stable soft tissue structure in the anterior\nmediastinum, may be secondary to thymoma is unchanged compared to the prior\nexam.\n\nThe irregular, spiculated 9 mm nodule within the right upper lobe, series 5,\nimage 69 is unchanged compared to the prior exam.  The patient is status post\nwedge resection.  A 2 mm left upper lobe nodule, series 5, image 66 is\nunchanged compared to the prior exam.  A spiculated left upper lobe nodule\nmeasuring 7 mm left upper lobe nodule, series 5, image 70 appears new compared\nto the prior exam.  A 5 mm left lower lobe nodule, series 5, image 81 is\nunchanged compared to the prior exam.  An 8 mm ill-defined irregular nodule in\nthe anterior portion of the right upper lobe appears improved compared to the\nprior exam.  Severe pulmonary emphysema and moderate chronic airways disease\nis seen.  Stable scarring and bronchiectasis at the level of the middle lobe\nis unchanged.  A 3 mm nodule within the right upper lobe, series 5, image 142\nappears new compared to the prior exam.\n\nA 3 mm right lower lobe nodule, series 5, image 192 is stable.\n\nThere is no pleural effusion or pneumothorax.  A left upper lobe nodule,\nseries 5, image 134 measures 6 mm however is unchanged compared to the prior\nexam.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however note is made of a hypodensity within the right hepatic\nlobe measuring 1.1 cm x 1.3 cm, likely secondary to a cyst/biliary hamartoma. \nHypodense lesions within the kidneys bilaterally are incompletely evaluated on\nthis exam.  Punctate nonobstructive calculus is seen within the superior pole\nof the left kidney.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "1. New spiculated left upper lobe nodule measuring up to 7 mm (5;70).\n2. Interval decrease in size of the anterior right upper lobe nodule, now\nmeasuring up to 8 mm, which was previously biopsied and measured up to 15mm.\n3. Stable spiculated 9 mm nodule within the right upper lobe (5;69).\n\nRECOMMENDATION(S):\n1. PET CT may be helpful for further evaluation of the nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. 1.9 x 2.4 cm lobular soft tissue density in the\nsuperior anterior mediastinum is unchanged compared to prior and may represent\na thymoma as mentioned previously (2; 27).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Re-demonstration of spiculated 7 mm right upper lobe nodule,\nunchanged compared to prior. Patient is status post right upper lobe wedge\nresection.  Additional bilateral pulmonary nodules, for example right upper\nlobe nodules measuring 3 mm and 7 mm are similar to prior (3; 89, 128) and 6\nmm left upper lobe pulmonary nodule (3; 38) is also unchanged compared to\nprior.  New ___ nodules in the dependent portion of the left upper\nlobe and in bilateral lower lobes likely represents small airways infection or\ninflammation, including aspiration (3; 98).\n\nStable scarring and bronchiectasis noted in the right middle lobe with volume\nloss.  There is severe bilateral centrilobular pulmonary emphysema.\n\nThere is diffuse bronchial wall thickening consistent with bronchitis,\nincreased compared to prior with endobronchial secretions and mucous plugging,\nmost pronounced in the bilateral lower lobes, right middle lobe, and lingula.\n\nBASE OF NECK: Thyroid appears unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates subcentimeter\nhypodense lesion in the liver, similar to prior, likely hepatic cyst. \nBilateral subcentimeter hypodense lesions in the kidneys are too small to\ncharacterize but likely represents renal cysts.  Hepatic vasculature appears\nconventional.  Small hiatal hernia similar to prior.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n0.5 cm lucency in the left clavicle is unchanged since ___.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Worsening diffuse bronchial wall thickening with extensive mucous plugging,\nespecially in the lower lobes, compared to ___, consistent with\nincreased airways inflammation.\n3. New ___ nodules especially in the left upper lobe and bilateral\nlower lobe likely represents small airways infectious or inflammatory disease\nincluding aspiration.\n4. Severe emphysema.\n5. Redemonstration of spiculated nodules in both upper lobes, as seen on prior\nchest CT."
        },
        {
            "input": "Aorta and pulmonary arteries are overall normal in diameter.  No\npathologically enlarged mediastinal, hilar or axillary lymphadenopathy is\npresent.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Endobronchial\nsecretions and diffuse bronchial wall thickening are extensive, severe but\nimproved compared to previous examination including atelectatic right middle\nlobe.  There is new right lower lobe ground-glass opacity most likely\ninfectious in etiology, series 4 image 195.  Previously seen ___\nopacities have resolved as well as right upper lobe subpleural nodule seen on\nprevious examination.  Right upper lobe nodule is stable, series 4, image 44\nas well as postsurgical changes anterior mediastinal soft tissue lesion, 1.4 x\n2 cm, series 4, image 70 is demonstrated, better characterized on the current\nstudy compared to previous examination can be seen dating back to ___.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval improvement in still severe evidence of chronic bronchitis with\nresolution of previously seen ground-glass nodules but new right lower lobe\nground-glass nodule most likely infectious in origin\n\nSeveral stable pulmonary nodules\n\nSevere emphysema\n\nAnterior mediastinal soft tissue, that can be demonstrated dating back to ___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: The study was not tailored for evaluation of the\nsubdiaphragmatic structures.  Unchanged 1.3 cm hypodense lesion in the dome of\nthe liver likely represents a simple hepatic cyst.\n\nMEDIASTINUM: Again seen is a bilobed soft tissue mass in the anterior\nmediastinum measuring 1.2 x 2.0 cm, previously 1.4 x 2.0 cm (series 5, image\n86), which remains stable back to at least ___.  Scattered mediastinal lymph\nnodes appear mildly prominent however not enlarged by CT size criteria and are\nstable over multiple prior exams (for example, series 5, image 49).\n\nHILA: No hilar lymphadenopathy, although study is limited by the absence of\nintravenous contrast.\n\nHEART and VASCULATURE: The heart is normal in size.  No pericardial effusion\nis identified.  Minimal coronary artery calcifications and mild aortic arch\nand descending thoracic aorta calcification.  Thoracic aorta and pulmonary\narteries are normal in caliber.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG and AIRWAYS: Airways are patent to the subsegmental level.  Mild\nendobronchial thickening, improved from prior.  Postsurgical changes from\nprevious right-sided wedge resection are stable.  Severe upper lobe\npredominant centrilobular emphysematous changes are stable.  Numerous\npulmonary nodule nodules including:\n\n4 mm subpleural right upper lobe nodule (series 5, image 134), unchanged.\n6 mm right upper lobe nodule (series 5, image 63), unchanged.\n8 mm ground-glass nodule in the right lower lobe (series 5, image 252),\nunchanged.\n6 mm nodule in the left upper lobe (series 5, image 29), unchanged.\n3 mm calcified granuloma in the left upper lobe, unchanged.\n5 mm nodule in the left upper lobe (series 5, image 63), unchanged.\n\nCHEST CAGE: No suspicious osseous lesions are identified.There are mild\nmultilevel degenerative changes of the thoracic spine.",
            "output": "Numerous pulmonary nodules, described above, are unchanged in size and\nappearance compared to prior.  Given smoking history, enrollment into low-dose\nradiation lung cancer screening program may be appropriate if the patient\nqualifies.\n\nSevere emphysema.\n\nBilobed anterior mediastinal soft tissue mass, stable dating back to at least\n___, is consistent with thymic hyperplasia or much less likely a low-grade\nthymoma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Normal thyroid gland. No enlarged\nor growing supraclavicular or axillary lymph nodes.  No soft tissue chest wall\nabnormality.  Minimal atherosclerotic calcification of the imaged neck\narteries.\n\nUPPER ABDOMEN: This examination is not tailored for subdiaphragmatic\nassessment.  Allowing for this; small hiatus hernia.  15 mm hypodensity in the\nright lobe of liver, stable and likely representing a simple hepatic cyst or\nbiliary hamartoma.  11 mm right simple renal cyst, stable.  Moderate\natherosclerotic calcification of the imaged upper abdominal aorta.  The imaged\nupper abdominal structures are otherwise normal.\n\nMEDIASTINUM: Normal esophagus.  Bilobed anterior mediastinal soft tissue mass\nmeasuring 2.9 cm x 1.7 cm (3:31), stable compared with the prior CT, however\nslowly growing over time, for example the lesion measured 2.2 cm x 1.7 cm in\n___..  No enlarged or growing mediastinal lymph nodes.  No\nmediastinal mass.  The thoracic aorta and pulmonary arteries are normal in\ncaliber.  Moderate atherosclerotic calcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size. Mild coronary artery calcification. \nNo cardiac valve calcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax. Mild biapical pleuroparenchymal\nscarring.\n\nLUNG:\n\n1. PARENCHYMA: Severe upper lobe predominant emphysema, stable.  New 4 mm\nright upper lobe nodule (5:111), stable.  3 mm left upper lobe nodule (5:79),\nstable.  3 mm left upper lobe ground-glass nodule (5:113), stable.  3 mm left\nupper lobe calcified granuloma (5:125), stable.  2 mm left lower lobe nodule\n(5:155), stable.  5 mm right lower lobe nodule (5:261), stable as remeasured. \n4 mm right upper lobe nodule (5:70), stable.  Bilateral upper lobe linear\nscarring and atelectasis, stable.  Small volume middle lobe with\nbronchiectasis, stable.  No consolidation.\n2. AIRWAYS: Scattered mild mucous plugging.  The tracheobronchial tree is\notherwise patent to the subsegmental level.  Diffuse bronchial wall\nthickening, most marked in the middle lobe.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  No fracture.  Mild spondylosis.",
            "output": "-New 4 mm right upper lobe nodule.  Otherwise stable pulmonary nodules\nmeasuring up to 5 mm.\n-Severe upper lobe predominant emphysema, stable.\n-Small, bronchiectatic middle lobe, stable.\n-Scattered mild mucous plugging.\n-Bilobed anterior mediastinal mass, stable compared with the prior study but\nslowly growing over several years.  The differential includes thymic\nhyperplasia and low-grade thymoma.  The lesion does not demonstrate any\naggressive features.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "THORACIC INLET: There are multiple enlarged right supraclavicular lymph nodes\nmeasuring up to 13 mm.  The thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are multiple enlarged mediastinal lymph nodes.  A right\nupper paratracheal node measures 10 mm.  The subcarinal node measures 12 mm. \nThere is a right hilar mass occluding the right upper lobe bronchus with\ncomplete atelectasis of the right upper lobe.  There is a postobstructive\nchanges within the right upper lobe with evidence of irregular thick-walled\ncavity.  There are multiple enlarged right hilar lymph nodes.  The irregular\nmass also protrudes into the bronchus intermedius.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is complete atelectasis of the right upper lobe with a cavitary\nlesion within it with irregular thick-walled cavity.  A right lower lobe\nnodule measures 8 mm (5, 102).\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a left adrenal\nnodule measuring 11 mm",
            "output": "Right hilar mass with extension into the bronchus intermedius and complete\npart of of the right upper lobe bronchus with complete atelectasis of the\nright upper lobe with a cavitary lesion within it.  The cavity has irregular\nthick walls.  The appearance is highly concerning for primary bronchogenic\ncarcinoma, could represent a squamous cell carcinoma.  Additional nodule in\nthe superior segment the right lower lobe measuring 12 mm concerning for\nmetastasis.\n\nMultiple enlarged right supraclavicular, mediastinal right hilar lymph nodes.\n\n11 mm left adrenal nodule\n\n\nRECOMMENDATION(S):  Thoracic surgery consultation is recommended\n\nNOTIFICATION:  The findings and recommendations were communicated to the\nreferring physician via email at 9:19 am on ___."
        },
        {
            "input": "THORACIC INLET: There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Small right hilar\nnodes are also unchanged.  There is a stable small left hilar lymph node. \nThese nodes were not avid on the prior recent PET-CT.  Done on ___\nthere is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The dominant right upper lobe mass with evidence of cavitation seen on\nthe prior CT has significantly decreased in size and the cavitation is no\nlonger perceptible.  There is complete atelectasis of the right upper lobe. \nThe soft tissue induration extends along the right mainstem bronchus bronchus\nhowever the endobronchial component seen on the prior CT done on ___ has resolved in the interim.  The right lower lobe pulmonary nodule\nmeasuring 4 mm in the superior segment the right lower lobe has decreased in\nsize and most likely represents metastasis.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen",
            "output": "Decrease in size of the right upper lobe mass with complete atelectasis of the\nright upper lobe and stable induration along the right upper lobe bronchus\nextending up to the takeoff of the right upper lobe bronchus the.\n\nStable small mediastinal lymph nodes.\n\nDecrease in size of the nodule in the superior segment of the right lower lobe\nwhich most likely represents metastasis.  No new or growing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall.  Mild to moderate\natherosclerotic calcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  The right upper lobe mass has increased in\nsize growing into the mediastinum, causing total occlusion of the right upper\nand middle lobe bronchi with the consequent collapse of these two lobes.  The\nright mainstem bronchus lumen diameter is also reduced, now measuring 6 mm in\nits AP diameter, before was 9 mm (5:103).  The lower lobe bronchus is now\nnarrowed at the hilum but patent to the subsegmental level.\nThe superior vena cava is also narrowed at the level of the carina due to\nexternal compression from mass extension into the mediastinum.\nMediastinal lymphadenopathy has also worsened in the interval, for example a\nleft upper paratracheal lymph node measuring 17 x 13 mm (04:13), another left\nlower paratracheal measuring 11 x 13 mm (04:17).  Similar narrowing of the\nSVC.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion.  Severe\natherosclerotic calcifications in the coronary arteries, none in the cardiac\nvalves or aorta. The aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nLUNGS AND PLEURA:\nThe airways are patent to the subsegmental levels. A new focal consolidation\nis noted in the medial basal segment of the right lower lobe.  The nodule in\nthe superior segment of the right lower is again decreased in size, now\nmeasuring 2 mm.  The left lung remains well expanded and clear.  No pleural\neffusions. Mild bilateral apical scarring.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Overall progression of disease, now with increased invasion to the hila and\nmediastinum causing collapse of the upper and middle lobes and causing severe\nnarrowing of the right mainstem bronchus and the right lower lobe bronchus.\n\nNew small consolidation in the medial basal segment of the right lower lobe is\nconcerning for metastatic disease or infectious process, follow up in ___\nweeks is recommended.\n\nWorsened mediastinal lymphadenopathy.\n\nAgain is noted decreased in size in the superior segment of the right lower\nlobe nodule.  No new or growing nodule\n\nRECOMMENDATION(S):  ___ weeks chest CT follow-up to assess the right lower\nlobe new focal consolidation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.  The partially visualized thyroid is unremarkable.  No\nsuspicious chest wall masses.\n\nUPPER ABDOMEN: Diverticulosis of the partially visualized colon without acute\ndiverticulitis.  Otherwise, the unenhanced portion of the abdomen is\nunremarkable.\n\nMEDIASTINUM AND HILA: Without intravenous contrast, distinguishing the right\nupper lobe mass from collapsed lung is difficult.  Taken together, there is no\nsubstantial change in size of the mass and atelectasis measuring 7.9 x 3.6 cm\nin greatest axial dimension, previously 8.6 x 3.3 cm.  Extension to the right\nhilum appears similar as well.  Right upper paratracheal lymphadenopathy/mass\nextension (___) is grossly unchanged.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion. \nThere are moderate coronary artery calcifications.  The thoracic aorta is\nnormal in caliber and course.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is increased ground-glass and nodular opacification of\nthe right upper lobe with probable interlobular septal thickening.  In the\nposterior right upper lobe there is an ovoid 6.8 x 4.0 cm area of ground-glass\nopacification with hyperdense rim of consolidation (3 a: 100).\n2. AIRWAYS:  Total occlusion of the right upper and middle lobar bronchi is\nagain seen.  The right lower lobar bronchi are at least moderately narrowed\nwith new bronchial wall thickening and peribronchial vascular opacities\nsuggestive of malignant progression.  Elsewhere, the trachea and left lung\nbronchi are patent to the segmental level.\n\nCHEST CAGE: Interval increase in size of 1.5 cm lytic lesion within the right\naspect of the T2 vertebra with probable epidural extension (___).  No acute\nfracture.",
            "output": "1. New regions of ground-glass with surrounding rim consolidation, the largest\nmeasuring 6.8 cm in the right upper lobe, differential diagnosis includes\nfungal or bacterial infection or disease progression.  Post radiation changes\nis less likely.\n2. Although difficult to distinguish the right upper lobe mass from collapsed\nlung, there is no substantial change in size of the right upper lobe mass and\natelectasis when measured together.  However, increased peribronchovascular\nopacification which extends from the right hilum into the right lower lobe is\nconcerning for infection or disease progression.\n3. Interval increase in size of 1.5 cm lytic lesion within the T2 vertebra\nwith probable small component of epidural extension concerning for metastatic\ndisease.\n4. Right lower lobe bronchial wall inflammation."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM: No good evidence for esophageal abnormality. \nAtherosclerotic calcification is not apparent in head and neck vessels, but is\nscattered in at least left anterior descending and circumflex coronary\narteries.  It aorta and pulmonary arteries are normal size until the right\npulmonary artery is virtually occluded in right hilar mass.\n\nNo pericardial abnormality.\n\nTHORACIC LYMPH NODES: As follows:\n\nRight lower paratracheal mediastinum, 14 mm, unchanged since ___.\n\nSubcarinal mediastinum, 24 mm, unchanged.\n\nRight hilum, inseparable from primary mass and lobar collapse, 37 mm in\naggregate diameter, unchanged.\n\n\nLUNGS, AIRWAYS, PLEURAE: Bronchial stent, right bronchial tree from the carina\nto the origin of the lower lobe superior segmental bronchus, unchanged in\nposition since ___, now free of internal material.  Right upper lobe\nbronchus still collapsed.  Aeration of the right middle lobe is uncertain. \nExtent of consolidation in the right lower lobe has decreased substantially\nsince ___.  Large abscess is residual of previous necrotizing pneumonia\nin the superior segment.  Tiny right right lower lobe nodules could be\ninflammatory or malignant.\n\nLeft lung grossly clear.\n\nNo left pleural effusion.  Right pleural effusion is minimal.\n\nCHEST CAGE: Although there are no pathologic or compression fractures, there\nare large lytic lesions in at least the upper 3 thoracic vertebral bodies are\ngrowing.  For example, in T2, 8 x 16 mm today, 7:71, previously 9 x 9 mm, with\ngreater destruction of the posterior cortex suggesting invasion of the\nvertebral canal.  Evaluation neurologic involvement would require MRI imaging.\nRadionuclide studies are more sensitive in detecting early osseous metastases\nthan chest CT..",
            "output": "Right bronchial stent in place unchanged in position, but now clear of debris\ncompared to ___.\n\nRight upper lobe bronchus and right hilar pulmonary artery still occluded by\nlarge right hilar mass.  Right upper lobe and possibly right middle lobe still\ncollapsed.\n\nSubstantial decrease in postobstructive pneumonia right lower lobe, with the\nresidual large abscess in place of previous necrotizing pneumonia.\n\nNo appreciable pleural effusion.\n\nLytic metastases, T1-T3 vertebral bodies, larger today than on ___ with\npossible invasion of the upper thoracic vertebral canal.\n\nRECOMMENDATION(S):  Consider spinal MRI for assessment of tumor involvement of\nthe vertebral canal, anticipating local radiation therapy."
        },
        {
            "input": "HEART AND VASCULATURE: Severe narrowing of the mid to distal right main\npulmonary artery (3:88)appears similar to the study performed ___,\nbut remains patent distally.  The right upper lobar pulmonary artery is\nchronically occluded.  Pulmonary vasculature is otherwise well opacified to\nthe subsegmental level without filling defect to indicate a pulmonary embolus.\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The SVC is focally narrowed to 9 mm between the right\nupper lobe mass and aortic arch (2:38), but remains patent.  The heart is\nnormal in size.  Moderate coronary artery calcifications are again seen.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present.  Few\nmildly enlarged lower paratracheal lymph nodes are difficult to measure but\nappear grossly similar.  Evaluation for right hilar lymphadenopathy is\nlimited.  No axillary lymphadenopathy.  Prominent left hilar node measures up\nto 8 mm.\n\nPLEURAL SPACES: There is trace right pleural effusion.  No pneumothorax\nelsewhere.\n\nLUNGS/AIRWAYS: There is near complete collapse of the right lung, which\nremains partially aerated within the right middle lobe, with expected\nrightward mediastinal shift.  Right upper lobe hypodense heterogeneous mass is\ndifficult to distinguish given near complete collapse of the right lung,\nalthough what is distinguishable from enhancing lung parenchyma appears\ngrossly similar from the apex to the right hilum.  In the region of prior\nground-glass opacification with rim consolidation, likely within the superior\nsegment of the right lower lobe, there is a nonenhancing region which is\npartially air-filled cavitary region with interstitial thickening measuring\n7.1 x 2.8 cm (2:43), likely necrotizing pneumonia.  Status post stenting of\nthe right mainstem bronchus which is patent proximally but completely occluded\nwith intermediate density fluid distally (3:87).  No definite bronchi are\npatent within the right bronchial tree, although a portion of the right middle\nlobe is not collapsed.  The trachea and left bronchial tree is patent to the\nsubsegmental level.  Multiple new ___ nodular opacities in the left\nlower lobe and lingula centrally but most prominent about the lower lobe\nsuggesting aspiration/infection.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: 1.5 cm lytic lesion within the right aspect of the T2 vertebra with\nprobable epidural extension appears similar to prior.  There is no acute\nfracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Interval development of partially air-filled, nonenhancing lung in the\nregion of prior ground-glass opacification suggestive of necrotizing\npneumonia.  Given relatively rapid time course, cavitating, necrotic tumor is\nconsidered much less likely.\n3. Occlusion of the right mainstem bronchus stent with near complete collapse\nof the right lung and expected rightward mediastinal shift.  The trachea and\nleft bronchial tree is patent.\n4. New left lower lung ___ opacities are suggestive of or.\n5. Trace right pleural effusion.\n6. Patent SVC with focal narrowing measuring 9 mm between the right upper lobe\nmass and aortic arch.\n7. Severe narrowing of the distal right main pulmonary artery appears similar\nto prior.  Occlusion of the right upper lobar pulmonary artery is chronic.\n8. Stable 1.5 cm lytic lesion within the T2 vertebra."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta and main pulmonary artery are normal\nin caliber.  The distal right pulmonary artery is essentially completely\noccluded by the known right hilar mass (5:21), progressed from prior. Mild\ncalcific atherosclerosis of the LAD and circumflex arteries. The heart,\npericardium, and remaining great vessels are otherwise within normal limits.\nNo pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nMediastinal lymphadenopathy is not substantially changed, as exemplified by a\n1.4 cm right lower paratracheal node (5:18) and 1.9 cm subcarinal node (5:22).\nHeterogeneously enhancing right hilar infiltrative mass measuring at least 6.9\nx 4.2 x 8.3 (AP x TV x CC) cm is not substantially changed.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The trachea is patent. The right upper and middle lobes remain\ncollapsed. A patent bronchial stent extends from the carina to the origin of\nthe right lower lobe superior segmental bronchus.\n\nRedemonstration of intraparenchymal abscess within the superior right lower\nlobe (6:90), measuring up to 6.7 cm, slightly decreased in size and wall\nthickness from prior.  No pulmonary nodules or additional mass.  A 7 mm solid\nnodule within the left lower lobe (6:149) is new from multiple priors.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: Osteolytic lesion within the posterior aspect of the T2 vertebral body\nhas slightly increased in size from prior, measuring 2.2 x 1.6 cm (5:6),\npreviously 1.4 x 1.7 cm.  Of note, the enlarging soft tissue component appears\nto narrow the spinal canal.  A smaller osteolytic lesion within the posterior\nT3 vertebral body measures 1.2 x 1 cm (5:10), similar in size from prior.\n\nRedemonstration stable appearing osteolytic lesions in the posterior aspect of\nthe T2 and T3 vertebral bodies.\n\nABDOMEN:  Please refer to same day report on CT abdomen and pelvis for\ndescription of subdiaphragmatic findings.",
            "output": "1. Overall similar appearance of the known right hilar mass with persistent\nobstruction of the right upper and middle lobes.  However, the mass exhibits\nprogressive mass-effect on the distal right main pulmonary artery, which is\nnow nearly completely occluded. The right lower lobe remains aerated secondary\nto a patent bronchial stent.\n2. New 7 mm solid nodule within the left lower lobe is concerning for\nprogressive metastatic disease.\n3. Superior right lower lobe abscess demonstrates interval decrease in size\nand wall thickness, consistent with progressive resolution.\n4. Enlarging lytic lesion within the posterior T2 vertebral body appears to\nfurther narrow the spinal canal.  Osteolytic lesion within the T3 verterbal\nbody is similar in size from prior.\n5. Please refer to same day report on CT abdomen and pelvis for description of\nsubdiaphragmatic findings.\n\nRECOMMENDATION(S):  Further evaluation of thoracic spine with MRI as well as\nclinical correlation with physical exam recommended."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged,\nranging in diameter up to 7 mm in the right axilla, 6:68, and 9 mm in the left\naxilla with a a lymph node that has benign hilar fat.  There are no soft\ntissue lesions in the chest wall suspicious for malignancy. Findings below the\ndiaphragm will be reported separately.\n\nThyroid is unremarkable. Atherosclerotic calcification is not evident in head\nand neck vessels or in the coronaries. Aorta and pulmonary artery are normal\nsize. Small pericardial effusion is physiologic. There is no pleural effusion.\n\n\nThere are numerous measurable lymph nodes in virtually all mediastinal\nstations. The largest nodes are in the in the right lower paratracheal\nstation, 12 x 16 mm, 06: 136, previously 12 x 18 mm, and subcarinal station,\n13 mm in short axis diameter, 06:12 54, previously 18 mm.  Left lower\nparatracheal, prevascular, and hilar nodes are smaller than these.\n\nAside from scarring at the left apex and mild apical paraseptal emphysema, the\nlungs are essentially clear.\n\nThe the right transverse process of T4 is heterogeneous and mildly expansile. \nIt appears to be new since a skeletal survey in ___, and therefore\nconcerning for a malignant lesion. I see no other bone lesions in the chest\ncage suspicious for malignancy.",
            "output": "Mild mediastinal adenopathy may have decreased since the PET scan in ___.  No lung or pleural lesions.\n\nSolitary blastic bone lesion, right transverse process, T4 could be malignant."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis bilaterally.  Lungs are otherwise\nclear.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Base of the neck is not imaged.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Examination is compared to ___.\nA pre-existing tracheal structure adherent to the tracheal wall is no longer\nvisible and likely reflected mucous (4, 73).  On today's examination, more was\nis seen only in the upper most parts of the trachea. In almost unchanged\nmanner the airways are patent but show thickened walls as well as\nirregularities and a thickened carry bronchial a interstitium, all signs\nsuggestive of moderate to severe chronic airways disease.  A pre-existing\nirregularity in the left main bronchus is no longer visualized.\nIn the lung parenchyma, the areas of emphysema as well as the pre-existing\nscarring at the middle lobe, the right lower lobe and the lingular as well as\nthe rounded atelectasis in the right lower lobe are unchanged. Also unchanged\nare the pre-existing millimetric and subpleural pulmonary nodules.  No nodules\nhave newly appeared.\nNo pleural thickening, no pleural effusions.  A subpleural nodule in the right\nupper lobe (4, 73) is completely unchanged in size and morphology.  No lung\nnodules have newly appeared. The known normal and borderline sized hilar and\nmediastinal lymph nodes, particularly in pretracheal location and in the\naortopulmonary window are all constant.  No new enlarged lymph nodes are\nidentified.  The relatively extensive areas of parenchymal scarring at the\nlung apices are unchanged (4, 27).",
            "output": "No relevant change as compared to ___. Extensive apical and mild\nbasal scarring.  A pre-existing trachea lesion is completely resolved and\nlikely reflected mucous.  No pleural effusion, no pleural thickening. All\npre-existing pulmonary nodules are unchanged.  No newly appeared pulmonary\nnodules. Signs of moderate to severe chronic airways disease."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular or\nhilar lymphadenopathy.  A left-sided axillary lymph node has somewhat rounded\nappearance, and has increased slightly in size, now measuring 12 mm in short\naxis (3:15). Prominent mediastinal lymph nodes appear similar to the prior\nstudy from ___.  The aorta and pulmonary arteries are normal in\nsize.   The heart size is normal and there is no pericardial effusion.\nCoronary artery calcifications are mild.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS:  Dependently positioned soft tissue density material in the lower\ntrachea likely represents mucous.  Otherwise the airways are patent to the\nsubsegmental level.  Biapical scarring, scar in the bilateral lower lobes and\nlingula, and moderate to severe centrilobular emphysema are unchanged. \nPulmonary nodules measuring up to 4 mm (5:48, 115, 116) are stable from\n___.  A 2 mm nodule in the right lower lobe adjacent to the major\nfissure (5:243) is new, and may represent lymphoid aggregate.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen.  There is\na small hiatal hernia.  The common bile duct is mildly prominent.",
            "output": "1.  Stable biapical scarring, as well as scarring in the bilateral lower lobes\nand lingula.\n\n2.  Multiple pulmonary nodules, measuring up to 4 mm, unchanged for at least\nsix months.  A new 2 mm pulmonary nodule in the right lower lobe adjacent to\nthe major fissure may represent lymphoid aggregate.\n\n3.  Dependently positioned soft tissue density material in the lower trachea\nlikely represents mucus.\n\n4.  Left axillary lymph node, measuring 12 mm in short axis, has increased in\nsize since ___."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation, or other soft tissue abnormality at the thoracic inlet. \nSupraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall concerning for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal mass.\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nthere is mild in head neck vessels and scattered in coronary arteries.  Aorta\nand pulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES:\nLymph nodes up to a cm in the left lower paratracheal and prevascular\nmediastinal lymph nodes at the level of the aortopulmonic window, 302:113, are\nunchanged since at least ___.\n\n12 mm subcarinal nodes are not pathologically enlarged, or changed.\n\nCluster of left hilar lymph nodes as large is 12 mm are measurably larger\ntoday than in ___.  Bronchi are not compromised.  Right hilar lymph nodes are\nnot enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.  Scarring, right upper lobe\nperiphery is unchanged, 302:64.\n\nSeveral foci of inflammatory bronchial wall thickening and bronchiolar nodules\nin the lung periphery, right upper lobe, 302:104, right lower lobe 302:\n125-142, are new.  Rounded atelectasis posterior segments both lower lobes,\n302:218 and 234 are stable.\n\nNodular 5 by 8 mm left upper lobe lung lesion, 302:84 is new, and the only\nfinding concerning for malignancy.\n\nSecretions in left lower lobe segmental bronchi reflect bronchial inflammation\nand may be responsible for reactive mild left hilar lymph node enlargement.\n\nExtensive pleural thickening in the lower chest bilaterally is stable.  There\nis no pleural effusion or dominant pleural mass concerning for malignancy.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.",
            "output": "The only finding concerning for malignancy is a small left upper lobe nodular\nlung lesion which could also be inflammatory.  Suggest follow-up chest CT in 6\nmonths.\n\nSevere emphysema.  Multifocal bronchial inflammation is generally stable, but\nthere are clusters of new inflammatory bronchiolar nodules in the right upper\nlobe and increased secretion in the left lower lobe since previous study,\nresponsible for mild ipsilateral hilar adenopathy.\n\nExtensive bilateral pleural thickening and secondary rounded lower lobe\natelectasis unchanged."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.  There is a small hiatus hernia.  The aorta and\npulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a right upper lobe mass measuring 16 x 8 mm which is concerning\nfor malignancy.  There is moderate upper lobe predominant emphysema.  Minimal\nperipheral fibrosis.  No other lung nodules.\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the lumbar spine with evidence of internal fixation of the lumbar\nspine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a left adrenal\nnodule measuring 28 x 22 mm the.  The right adrenal nodule measures 9 x 7 mm. \nThe multiple hypodense liver lesions, too small to adequately characterize.",
            "output": "Dominant right upper lobe nodule measuring 16 x 8 mm concerning for primary\nlung cancer.\n\nBilateral adrenal nodules indeterminate the left measures 28 x 22 mm could\nrepresent metastasis or adenoma."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are small left supraclavicular\nlymph nodes the largest measuring 4 mm.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are well expanded and clear.  No nodules or consolidations are\nseen.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows pneumobilia. \nA stent is seen within the biliary tree.  Please refer to dedicated report on\nabdomen which has been dictated separately.",
            "output": "No evidence of metastasis to the chest.\n\nPneumobilia.  Please refer to dedicated report on abdomen which has been\ndictated separately for further details regarding the abdomen."
        },
        {
            "input": "Aorta and pulmonary arteries are within normal limits.  No pathologically\nenlarged mediastinal, hilar or axillary lymphadenopathy is demonstrated. \nThere is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules concerning for infection or neoplasm demonstrated.  Centrilobular\nnodules in the upper lobes might be consistent with smoking history and is\npretty bronchiolitis, please correlate clinically.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately..\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.  Potentially respiratory\nbronchiolitis please correlate with patient history of smoking\n\nPlease review CT abdomen pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portions of the thyroid\ngland are unremarkable.  There are no supraclavicular or axillary\nlymphadenopathy.  Right-sided Port-A-Cath terminates in the cavoatrial\njunction.\n\nUPPER ABDOMEN: Partially imaged upper abdomen shows a stent in the CBD with\nsubsequent pneumobilia and air in the gallbladder.  There is no pancreatic\nduct dilation.  Please refer to separately reported abdomen/pelvis CT\nperformed on the same day.\n\nMEDIASTINUM: There are no lymphadenopathy or masses within the mediastinum.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Lung parenchyma is clear without nodules or masses.\n2. AIRWAYS:  There was a patent to subsegmental level.\n3. VESSELS:  Thoracic aorta and pulmonary artery are within normal limits of\nsize and configuration.  No filling defects are noted in the pulmonary\nvasculature.\nCHEST CAGE: No worrisome osseous lesions are identified within the chest or\nthoracic spine.",
            "output": "No abnormal thoracic findings.\nPlease refer to separately reported abdomen/pelvis CT performed on the same\nday for further abdominopelvic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla lower\nthoracic inlet.  Right anterior port with tip in the cavoatrial junction.  No\nabnormalities on the chest wall.  No atherosclerotic calcifications in the\nhead and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No suspicious lung nodules or\nmasses.  No consolidations or atelectasis.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No evidence of intrathoracic metastatic disease.  No suspect lung nodules,\nlymphadenopathy or osseous lesions."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is normal.  The\nthere is no axillary lymphadenopathies.\n\nUPPER ABDOMEN: Please refer to the separately reported CT of the abdomen and\npelvis performed today.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mass.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is normal.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion.  There is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There are mild the hypoventilatory changes, but there is no\nsuspicious nodule or infiltrate.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No bronchial\nwall thickening.\n3. VESSELS:  Pulmonary arteries and aorta within normal limits.  A PICC line\nis inserted from the right upper extremity terminating at the superior\ncavoatrial junction.\nCHEST CAGE: There is no concerning osseous lesion.",
            "output": "No evidence of intrathoracic metastatic disease.  No suspicious lung nodule,\nlymphadenopathy or osseous lesions."
        },
        {
            "input": "HEART AND VASCULATURE: Right chest wall Port-A-Cath terminates in the low SVC.\nThe thoracic aorta is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Punctate calcified granuloma within the left lower lobe. \nOtherwise, the lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of metastatic disease within the chest.\n2. Please refer to the CT abdomen and pelvis dated ___ for evaluation\nof the subdiaphragmatic structures."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum or at the level of the hilar structures.  No\nvascular abnormalities.  In particular no incidental pulmonary embolism.  Mild\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  Newly occurred mild ascites and\nother abdominal findings are reported in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  Mild respiratory motion artifacts.  No suspicious\npulmonary nodules or masses.  Dependent areas of atelectasis.",
            "output": "No metastatic disease to the thorax."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Small axillary and thoracic inlet lymph nodes are\nstable.  No chest wall abnormalities.  Right PICC line ending at the lower\nSVC.  No atherosclerotic calcifications in head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Small mediastinal lymph nodes are stable.  No\nenlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  Aorta and pulmonary artery are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels, no bronchial wall\nthickening, bronchiectasis or mucus plugging.  No lung nodules or masses.  No\nfocal consolidations.  No pleural effusions or thickening.  Mild biapical\npleuroparenchymal scarring.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "UPPER ABDOMEN: Please refer to same day CT abdomen and pelvis report for\ndetails of intra-abdominal findings.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Tiny hypodensities within both\nthyroid lobes, unchanged.  No supraclavicular, infraclavicular, or axillary\nlymphadenopathy.  No atherosclerotic calcification of the head neck vessels.\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.  Right pectoral Port-A-Cath terminates within the distal SVC.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.  The esophagus is normal.\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  The coronary arteries and\naortic valve and annulus are not calcified. No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: No focal consolidations, fibrotic lung disease, or suspicious\npulmonary nodules.  Millimetric left lower lobe nodule (3:123), stable.\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber.  No incidental\npulmonary emboli on this non-dedicated study.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "1. No evidence of metastatic disease within the thorax.\n2. Please refer to same day CT abdomen and pelvis report for details of\nintra-abdominal findings."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The esophagus is normal without evidence of wall thickening or a\nhiatal hernia.  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nIll-defined ground-glass changes are seen within the right lower lobe.\n-2 mm subpleural left lower lobe nodule (5; 48), is unchanged compared to\nprior exam.\n\nThere is no pleural effusion or pneumothorax.  No concerning new or growing\npulmonary nodules are identified.",
            "output": "-Stable milli metric left lower lobe nodule without evidence of concerning new\nor growing pulmonary nodules.\n-Ill-defined ground-glass changes within the right lower ___ be\ninfectious/inflammatory in etiology."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The right chest wall Port-A-Cath enters the right subclavian\nvein and terminates in the cavoatrial junction.  The thoracic aorta is normal\nin course and caliber without significant atherosclerotic calcifications.  The\nheart is normal in size and shape without pericardial effusion.  No\nsignificant coronary artery calcification.  The main pulmonary artery is\nnormal in size.  There is no filling defect seen within the branches of the\npulmonary arterial tree to suggest the presence of a pulmonary embolism. \nThere is no mediastinal, hilar, or axillary lymphadenopathy.  The airways\ncentrally patent.  The esophagus is unremarkable.\n\nThere is no new or growing pulmonary nodule.  Tiny subpleural pulmonary nodule\nin the left lower lobe is unchanged and best seen on series 5, image 181. \nPreviously seen nonspecific ground-glass opacities in the right lower lobe\nappear less conspicuous on today's exam.\n\nPlease refer to separately dictated CT of the abdomen pelvis for findings\nbelow the diaphragm.\n\nBones: There is no worrisome lytic or blastic osseous lesion.",
            "output": "No evidence of metastatic disease within the chest.  Please refer to\nseparately dictated CT of the abdomen pelvis for findings below the diaphragm."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged lower thyroid need any further\nimaging evaluation.  No supraclavicular or axillary lymph node enlargement. \nBreast evaluation reserved exclusively for breast imaging.  No soft tissue\nabnormality elsewhere in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nnot apparent in head and neck or coronary arteries.  Aorta and pulmonary\narteries and cardiac chambers are normal size, aortic valve is not calcified\nand pericardium is physiologic.  Right central venous catheter ends just above\nthe superior cavoatrial junction, free of thrombosis.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing measurable lung nodules. \nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities.\n\nCHEST CAGE: No pathological compression fractures or destructive bone lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.  Period",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is normal in size, without a pericardial\neffusion.  Multifocal native coronary calcifications are noted, with evidence\nof prior CABG.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary adenopathy.  There is no\nmediastinal mass or adenopathy by size criteria.  No evidence of hilar\nadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Airways are patent to the segmental bronchi.  Mild diffuse\nbronchial wall thickening is likely due to chronic inflammation.  There is\nmild upper lobe predominant paraseptal emphysema.  Bibasilar dependent\natelectasis is noted.  No other focal consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Right adrenal gland is normal in size and shape.  Medial limb of the\nleft adrenal gland is thickened, but there is no discrete nodule identified.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis.  Bilateral subcentimeter renal hypodensities are too small\nto characterize, but statistically likely represent cysts.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is evidence of prior\nsmall bowel resection, with intact anastomosis.  Several prominent loops of\nsmall bowel in the left lower abdomen measure up to 3 cm, without evidence of\na distinct transition point (series 300, image 26).  Wall thickness and\nenhancement is normal.  However, note is made of mild adjacent mesenteric\nedema surrounding these prominent loops of small bowel, suggesting at least an\ninflammatory process.  There is sigmoid diverticulosis, with the prior colonic\nanastomosis appearing intact (2:187).  Appendix is not visualized, but there\nare no secondary signs of acute appendicitis.  No frank ascites.  No\npneumoperitoneum.\n\nPELVIS:\n\nEvaluation of the pelvic structures is slightly limited by streak artifact\nfrom adjacent hip arthroplasty.  The urinary bladder and distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:\nThoracic aorta is normal in caliber, with mild calcified and noncalcified\nplaque.  Abdominal aorta is ectatic, measuring up to 2.4 cm, without frank\naneurysm.  There is no dissection or intramural hematoma.\n\nCeliac artery, SMA, and ___ are patent.  Bilateral renal arteries are patent. \nCommon, internal and external iliac arteries are patent.\n\nThere are linear filling defects in the right anterior, right posterior, and\nleft portal vein, concerning for nonocclusive thrombus.  The splenic vein and\nsuperior mesenteric vein are patent.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Grade 1 anterolisthesis of L4 on L5.  Note is made of a\nremote left anterolateral sixth rib fracture.  Patient is status post median\nsternotomy and total hip arthroplasty on the right.  The abdominal and pelvic\nwall is within normal limits.",
            "output": "1. No aortic dissection.\n2. Prominent loops of small bowel in the left lower abdomen measuring up to 3\ncm with surrounding mesenteric edema, which may represent a nonspecific\nenteritis, potentially infectious, inflammatory, but ischemia or vasculitis\ncannot be excluded.\n3. Non-occlusive portal vein thrombosis.\n4. Incidental intrathoracic findings of mild upper lobe predominant paraseptal\nemphysema and chronic small airways inflammation.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:19 pm, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "Heart is borderline in size.  Aorta is normal in caliber.  Central pulmonary\narteries are also normal in caliber.\n\nNo filling defects are found among pulmonary arterial branches.\n\nThere are medium-sized bilateral pleural effusions.  No pericardial effusion\nis present.  Mildly prominent bilateral hilar and mediastinal lymph nodes are\nlikely reactive.  Largest is a prevascular lymph node which measures up to 12\nmm in short dimension, mildly enlarged.\n\nThere are extensive cavitating lesions, ranging from small to large, within\neach lung, in addition to mixed attenuation consolidations that are extensive\nand multifocal.  Some of the left basilar opacification is probably due to\natelectasis.\n\nThe abdomen is reported separately.\n\nThere are no suspicious bone lesions.",
            "output": "Concordant with the radiographic findings from earlier on the same day,\nconsolidations and cavitating nodules are widespread in each lung and most\nconsistent with septic emboli.  Medium-sized bilateral pleural effusions.  No\nevidence of pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a right IJ line with its\ntip in the proximal right atrium.  The visualized thyroid gland appears within\nnormal limits.  There are subcentimeter bilateral axillary lymph nodes.  There\nare no suspicious chest wall lesions.  There is an ET tube with its tip 3.5 cm\nabove the carina.\n\nUPPER ABDOMEN: Evaluation of the upper abdomen is limited due to low dose and\nlack of contrast.  There are prominent celiac axis lymph nodes, better seen on\nCT of the chest from ___. There is mild thickening of the left\nadrenal gland.  The right adrenal gland is normal in size.\n\nMEDIASTINUM: Subcentimeter mediastinal nodes are not enlarged by CT size\ncriteria, and have decreased in size compared to CT of the chest from ___.  For example, a 6 mm short axis prevascular lymph node\npreviously measured 10 mm (series 3, image 21).  Enteric tube courses through\nthe esophagus and into the stomach, tip not imaged.\n\nHILA: Absence of intravenous contrast limits evaluation of the hila.\n\nHEART and PERICARDIUM: Heart size is within normal limits.  There is a small\npericardial effusion.\nPLEURA: There is interval decrease in size of the bilateral pleural effusions,\nwith near complete resolution on the right, and small residual effusion on the\nleft, with bibasilar tubes in place.  There is a small amount of gas about the\nleft pigtail.\nLUNG:\n\n1. PARENCHYMA:  Again seen are multiple bilateral pulmonary nodules and\ncavitary lesions, compatible with septic emboli in this patient with known\nendocarditis.  Some have slightly decreased in size, for example the dominant\n8 cm cavitary lesion in the right upper lobe (series 6, image 46) previously\nmeasured 8.8 cm, and a representative 2.7 cm lesion in the left upper lobe\n(series 5, image 93) previously measured 3.1 cm.  There is overall improvement\nof bilateral consolidations compared to prior.  Consolidations in the\nbilateral lower lobes remain extensive but appear more organized.\n2. AIRWAYS:  Central airways are patent.\n3. VESSELS: The thoracic aorta and main pulmonary are normal in caliber.\n\nCHEST CAGE: There are no suspicious osseous lesions.",
            "output": "1. Interval decrease in size of the bilateral pleural effusions, with near\ncomplete resolution on the right, and small residual effusion on the left,\nwith bibasilar chest tubes in place.\n2.  Redemonstration of multiple bilateral pulmonary nodules and cavitary\nlesions, some of which have slightly decreased in size compared to CT of the\nchest from ___, compatible with septic emboli in this patient\nwith known endocarditis.\n3.  Overall improvement of bilateral consolidations compared to prior. \nConsolidations in the bilateral lower lobes remain extensive but appear more\norganized.\n4.  Small pericardial effusion."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes are unchanged and are most likely\nreactive.  There is no pericardial effusion.  There is a right-sided PICC line\nwith its tip in the right atrium.  The study is not designed to evaluate for\npulmonary emboli.  There is no filling defect in the central pulmonary are\narteries concerning for pulmonary embolism.  Evaluation for segmental and\nsubsegmental branches is limited.  The known vegetations on the aortic and\ntricuspid valves cannot be assessed as the study was not gated.\n\nPLEURA: There are small bilateral pleural effusions the right is partially\nloculated.  The left is also associated with minimal pleural thickening\n\nLUNG: There are multiple bilateral pulmonary nodules some of which show\ncavitation 2 different degrees consistent with known septic emboli. \nEvaluation for new emboli is limited due to extensive nature of the previously\nvisualized pulmonary emboli.  Previously visualized consolidative opacities in\nboth lower lobes have improved, most likely represents improving atelectasis. \nThe ground-glass opacification within the right middle lobe and right upper\nlobe has also improved since the prior study.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.  No obvious\nosteomyelitis is seen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows heterogeneous\nopacification of the liver and spleen.  There is evidence of artifact\nbilaterally due to arms by the side of the patient.",
            "output": "Study is limited due to beam hardening artifact by the patient's arms by the\nside.  No evidence of obvious central pulmonary embolism although the study\nwas not designed to evaluate pulmonary emboli.\n\nNo significant interval change in the multiple bilateral pulmonary nodules\nwith different degrees of cavitation consistent with evolving pulmonary septic\nemboli.  Evaluation for new or smaller emboli is limited due to extensive the\npreviously visualized abnormality.\n\nImproving consolidation in both lower lobes with improving bilateral pleural\neffusions most likely represents resolving atelectasis in both lower lobes. \nImproved atelectasis in the right middle lobe and right upper lobe.\n\nModerate cardiomegaly.\n\nEvaluation is limited for known 6 vegetations on the aortic and tricuspid\nvalves as the study was not gated.\n\nNo pericardial effusion.\n\nStable small mediastinal lymph nodes which are most likely reactive.\n\nRight-sided PICC line projects with its tip to the right atrium."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no- thyroid lesions that\nwarrant further imaging.\nSmall cervical and axillary lymph nodes measuring up to 6 mm.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Mildly patulous esophagus with fluid content up to its lower\nhalf.  Small mediastinal and hilar lymph nodes, measuring up to 1.3 cm.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: Moderate bilateral pleural effusions, nonhemorrhagic and homogeneous..\nLUNG:\n\n1. PARENCHYMA:  Compressive atelectasis of both lower lobes. \nPeribronchovascular nodules seen throughout both lungs measuring up to 2.0 cm,\nnoting a large formed in the lingula (302:100) surrounded by ground-glass..\nMild centrilobular pulmonary emphysema.\n2. AIRWAYS:  Moderate bronchial wall thickening with the cylindrical\nbronchiectasis in the middle lobe..\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: Old healed fractures in lateral ninth, posterior ninth through\neleventh ribs.  No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "Peribronchovascular nodules in the context of diverticulitis are suspicious\nfor septic emboli.\nModerate bilateral pleural effusions.\nBronchial wall thickening with mild bronchiectasis in the middle lobe is\nlikely associated to chronic airway disease.\nMediastinal, hilar, cervical and axillary small lymph nodes are likely\nreactive.\nMild pulmonary emphysema.\n\nRECOMMENDATION(S):  Follow-up CT in ___ weeks for assessment of pulmonary\nnodules resolution.\n\nNOTIFICATION:  The findings were discussed with Dr ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:01 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The tip of a right internal jugular\ncentral venous catheter extends to the distal SVC, as does a left internal\njugular central venous catheter.  An endotracheal tube and gastric tube are\nappropriately position.\n\nThe visualized thyroid is unremarkable.  There is no axillary or\nsupraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to the report from the concurrent CT scan of the\nabdomen and pelvis for abdominopelvic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is a 1.6 cm right hilar lymph node, minimally increased in size\nsince prior.\n\nHEART and PERICARDIUM: Unremarkable apart from a left cardiophrenic angle\nlymph node measuring 8 mm.\nPLEURA: Bilateral basal pleural catheters are present.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  The diffuse bilateral ground-glass consolidations arm proved\nsince prior.  Multiple cavitary and non cavitary nodules are again seen\nthroughout the lungs bilaterally and involving all lobes..\n2. AIRWAYS:  The central airways are patent.  Fluid/debris is seen within\nsegmental and subsegmental left lower lobe airways.\n3. VESSELS:  Unremarkable\nCHEST CAGE: There is a healing left posterior ninth through eleventh rib\nfractures.  No new acute fractures identified.  No suspicious osseous lesion.",
            "output": "Interval decrease in extent of the diffuse bilateral ground-glass\nconsolidations.  New cavitary and non cavitary nodules are seen throughout\nboth lungs highly suspicious for septic emboli.\n\nFluid/debris within the left lower lobe airways."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.  Thyroid is unremarkable.\n\nUPPER ABDOMEN: 3.0 cm wedge-shaped splenic lesion, suggestive of an infarct,\nis unchanged from ___.  Limited assessment of the abdomen is\notherwise grossly unremarkable.\n\nMEDIASTINUM: Prominent mediastinal lymph nodes measure at the upper limits are\nnot enlarged by CT size criteria, but appear slightly increased from prior.\n\nHILA: Right hilar lymph nodes are not enlarged by CT size criteria but measure\nat the upper limits of normal.\n\nHEART and PERICARDIUM: No pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Moderate pulmonary emphysema with large atypical bullae at the\nright lung apex, appears similar to prior.  Thick-walled, fluid-filled\ncavities in the right upper lobe are re-demonstrated but appear decreased in\nsize from prior examination.  For example the dominant lesion measures 2.5 x\n2.1 cm (previously 2.7 x 2.7 cm) (series 302, image 80).  Diffuse ground-glass\nopacities throughout both lungs, are present but appear significantly\nimproved.\n2. AIRWAYS:  There is moderate to extensive mucous plugging throughout the\nlung bases and worsened from prior.\n3. VESSELS:  Aorta and main pulmonary artery are normal in size.\nCHEST CAGE: No evidence of osseous malignancy or infection.",
            "output": "1.  Thick-walled, regular air and fluid-filled right upper lobe cavities are\nmildly decreased in size from ___.  Similarly, diffuse\nground-glass airspace opacities throughout both lungs, appear significantly\nimproved.\n2.  Increased secretions are seen within the distal airways, most conspicuous\nat the lung bases.\n3.  Wedge-shaped splenic hypodensity, suggestive of infarct, unchanged from\nprior examination."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout. \nNo aortic dissection, penetrating atherosclerotic ulcers or aneurysmal\ndilations.  Small filling defect in the subsegmental branches of the right\ninferior pulmonary artery (6:169 and 164).  No other filling defects are noted\nin the main pulmonary artery throughout its other subsegmental branches.  No\nevidence of right heart strain.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation.  The\npatient is intubated and the ET tube is appropriately placed.  Severe\npulmonary emphysema with large apical bullae to the right.  Thick walled,\nfluid-filled cavities are noted in the right upper lobe the largest measuring\n2.6 cm (6:96) with very irregular walls.  Diffuse ground-glass opacities are\nnoted in the remaining lobes.  Partial atelectasis is noted in the left lower\nlobe.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show wedge-shaped lesion in the\nspleen (6:242).",
            "output": "Evidence of a small subsegmental pulmonary emboli in the right lower lobe. \nThere is no associated right heart strain or evidence of pulmonary infarct.\n\nMultiple cavities in the right upper lobe with thick irregular walls are\nsuggestive of pulmonary abscesses.  Diffuse ground-glass opacities are noted\nthroughout the lungs with suggestion of smaller cavities in the left lower\nlobe.  Findings are concerning for multifocal necrotizing pneumonia.\n\nHypodense wedge-shaped lesion, suggestive and a splenic infarct.\n\nRECOMMENDATION(S):  Recommend imaging follow-up of the right upper lobe\ncavities until resolution.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:00 am."
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the subsegmental\nlevel without filling defect to suggest pulmonary embolism. Pulmonary arteries\nare normal in caliber.\n\nModerate emphysematous changes are seen at the lung apices.  Mild bibasilar\natelectasis is noted.  There is minimal, diffuse airways thickening.  There is\nno pleural effusion or pneumothorax. The airways are patent to the\nsubsegmental level.\n\nThe heart is unremarkable.  There is no pericardial effusion.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  A 6 mm\nhypodense nodule is seen in the left lobe of the thyroid (series 2, image 14).\nThe right thyroid lobe is prominent, containing a 3 mm hypodense nodule\ninferiorly (series 2, image 9).\n\nThere is a moderate hiatal hernia.  A benign- appearing cyst is seen in the\nupper pole of the right kidney.  The included portions of the upper abdomen\nare otherwise unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is  wedge compression deformity at T6 and T7 and evidence of prior\nkyphoplasty at T10.  Severe compression deformity is seen at T12.  These are\nlikely chronic given lack of surrounding hematoma or soft tissue swelling.",
            "output": "1.  No pulmonary embolus or acute aortic abnormality.\n2.  Moderate-sized hiatal hernia.\n3.  Wedge compression deformities at T6, T7, and T12, of unknown chronicity.\n4.  Moderate pulmonary emphysema."
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is no mediastinal\nhematoma.  There is no pericardial effusion.  There is no lymphadenopathy. \nThe imaged thyroid is normal.\n\nAreas of linear and more consolidative opacities are seen in the bilateral\nupper lobes and lower lobes.  Airways are patent to the subsegmental level. \nEndotracheal tube is in satisfactory position.  There is no evidence of\ncontusion or laceration.  There is no pneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is normal\nin course and caliber with widely patent major branches.  No lymphadenopathy\nor free air.  A 2 x 1.8 cm focus of free fluid in the mesentery in the left\nupper quadrant measures simple density (2:153).  A second adjacent smaller\nfocus of simple fluid is also seen the left upper quadrant (2:145) adjacent to\na loop of normal appearing small bowel.\n\nThe stomach and small bowel are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  The\ncolon is unremarkable. The bladder is decompressed by a Foley catheter.  There\nis no pelvic free fluid.  The prostate and seminal vesicles are normal.\n\nBONES AND SOFT TISSUES:  Fractures are seen involving the posterior and\nsuperior right acetabulum, with a 5.3 cm displaced bony fragment located\napproximately perpendicular to the posterior acetabulum.  There is associated\nintramuscular hematoma within the right piriformis muscle, and within the\nright gluteal musculature and quadratus femoris.  The right femoral head\nappears in anatomic alignment with the acetabulum.  Nondisplaced fracture of\nthe anterior left fifth rib, and minimally displaced fractures of the anterior\nleft sixth and seventh ribs.",
            "output": "1. Fractures of the posterior and superior right acetabulum, with a 5.3 cm\ndisplaced bony fragment located approximately perpendicular to the posterior\nacetabulum.\n2. Nondisplaced anterior left fifth rib fracture, and minimally displaced\nanterior left sixth and seventh rib fractures.\n3. Areas of atelectasis are seen in the bilateral upper and lower lobes. \nSuperimposed aspiration is not excluded.\n4. A 2 cm focus of fluid in the mesentery of the left upper quadrant measures\nsimple density.  A second small focus of simple fluid is located in a slightly\ncranial position.  These are felt to be unlikely related to trauma, and may\nrepresent mesenteric cysts, for which 6 month follow-up CT is recommended.  If\nthere is concern for small bowel or mesenteric injury, recommend\nshort-interval (1 day) follow-up CT to assess for interval change.\n\nRECOMMENDATION(S):  A 2 cm focus of fluid in the mesentery of the left upper\nquadrant measures simple density.  A second small focus of simple fluid is\nlocated in a slightly cranial position. These are felt to be unlikely related\nto trauma, and may represent mesenteric cysts, for which 6 month follow-up CT\nis recommended.  If there is concern for small bowel or mesenteric injury,\nrecommend short-interval (1 day) follow-up CT to assess for interval change.\n\nNOTIFICATION:\nUpdated impression was discussed with Dr. ___ by Dr. ___ telephone at\n08:19 on ___, approximately 25 min after discovery."
        },
        {
            "input": "HEART AND VASCULATURE: The main pulmonary artery is borderline dilated\nmeasuring 2.9 cm which may suggest pulmonary hypertension.  Pulmonary\nvasculature is well opacified to the subsegmental level without filling defect\nto indicate a pulmonary embolus.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart is severely\nenlarged and demonstrates disproportionate enlargement of the right atrium and\nright ventricle.  Tip of a right PICC terminates in the lower SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  However, multiple mediastinal and hilar lymph\nnodes are partially calcified which may suggest prior granulomatous disease or\ncould represent sequela of prior treated malignancy.  No mediastinal mass.\n\nPLEURAL SPACES: There are moderate right and small left nonhemorrhagic pleural\neffusions.  Tip of a catheter terminates in the right lower lobe just outside\nof the pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar compression and relaxation atelectasis.\nThere are few nodules measuring up to 5 mm, the largest in the right lower\nlobe (7:140).  Lungs are clear without masses the airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Reflux of intravenous contrast into the hepatic veins is likely due\nto heart failure.  Otherwise, included portion of the upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Severe cardiomegaly with disproportionate enlargement of the right atrium\nand right ventricle which may suggest right heart strain.  No definite\npulmonary embolism is seen, especially one large enough for hemodynamic\nsignificance.\n2. Borderline dilatation of the main pulmonary artery may suggest pulmonary\nhypertension.\n3. No aortic abnormality.\n4. Bilateral nonhemorrhagic pleural effusions, moderate on the right and small\non the left.  Tip of a right chest catheter terminates in the right lower lobe\noutside of the pleural effusion.  Correlation with intended positioning\nrecommended.\n5. Partially calcified mediastinal and hilar lymph nodes may suggest prior\ngranulomatous disease or could represent sequela of prior treated malignancy. \nClinical correlation recommended."
        },
        {
            "input": "There are no enlarged mediastinal, axillary or hilar lymph nodes.  Heart is\nupper limits of normal in size, and there is no pericardial or pleural\neffusion.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.\n\nAssessment of the lungs is limited due to inadvertent expiratory phase of\nrespiration, reducing the sensitivity of CT for detecting small pulmonary\nnodules and subtle interstitial lung abnormalities.  Note is made of tiny\ncalcified granulomas at the lung bases, as well as a 2 mm noncalcified nodules\nin the right upper lobe (52, 67) and left upper lobe (78), series 4).  A\ncluster of nonspecific peribronchiolar ground-glass opacities is present in\nthe right upper lobe anteriorly.",
            "output": "1.  No CT evidence of intrathoracic lymphadenopathy.\n\n2.  Limited assessment of the lungs due to expiratory phase of respiration. \nTiny right upper lobe nodules are statistically most likely benign, but could\nbe followed up by CT in ___ year if the patient has risk factors for primary\nlung cancer\n\n3.  Peribronchial ground-glass opacities in right upper lobe are likely\ninflammatory or infectious.\n\n4.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\ncoronary artery calcification.  The heart, pericardium, and great vessels are\notherwise within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are multiple prominent, though\nnonenlarged, mediastinal lymph nodes.  No axillary or mediastinal\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Right basilar atelectasis.  Lungs are otherwise clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  There is a 2.2 cm hypodense lesion in the left lateral segment on\nseries 4, ___ 267.  This measures 3 ___ and is consistent with a cyst.\n\nBONES:  There is a right eighth rib fracture (___).  No other fractures are\nidentified.  No suspicious osseous abnormality is seen.?",
            "output": "Right eighth posterolateral rib fracture, as seen on chest radiographs from ___ and ___.  No other fractures are identified.\n\nRight basilar atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber, noting dense\nperipheral atherosclerotic calcifications.  There are extensive coronary\nartery calcifications.  The heart is mildly enlarged but otherwise\nunremarkable.  The pericardium and great vessels are unremarkable based on an\nunenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  A 7 x 5 mm right middle lobe pulmonary nodule is unchanged\nsince ___.  There is mild bibasilar atelectasis.  Lungs are otherwise clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates a\nsmall hiatal hernia and extensive atherosclerotic calcification involving the\nceliac trunk and splenic artery.\n\nBONES:  There are consecutive nondisplaced anterior left sixth, seventh, and\neighth rib fractures.  No additional acute fractures are seen.  Chronic height\nloss of the T1 and T2 vertebral bodies is unchanged.  There are severe right\nglenohumeral degenerative changes.\n\nSOFT TISSUES:  There is a 2.0 x 1.5 cm right subscapularis lipoma, unchanged\ncompared to ___.",
            "output": "1. Consecutive nondisplaced anterior left sixth, seventh, and eighth rib\nfractures.  No pleural effusion or pneumothorax.\n2. A 7 mm right middle lobe pulmonary nodule is unchanged since ___ and\nwarrants no further follow-up.\n3. Severe right glenohumeral degenerative changes."
        },
        {
            "input": "Thyroid is unremarkable.  Tracheostomy tube well positioned.  There is no\naxillary or supraclavicular adenopathy.  Mediastinal lymph nodes wall not\npathologically enlarged are numerous and measure up to 9 mm in the right upper\nparaesophageal station (series 2, image 14).  Heart size is enlarged.  A\nprosthetic aortic valve is noted.  A small hemorrhagic pericardial effusion\nhas not significantly changed.  Coronary artery calcifications are severe. \nMain pulmonary trunk is severely dilated.\n\nThere is a small apical pneumothorax.  Airways are patent to the segmental\nlevel bilaterally.  There is a small right and trace left nonhemorrhagic\npleural effusion with associated bibasilar opacities, increased on the right\nbut decreased on the left compared to ___.  A left basilar chest tube\nis in place.  Pulmonary nodules include two 2 mm left upper lobe nodules\n(series 4, image 48, 58).\n\nThere is minimal debris within the esophagus.  Limited views of the upper\nabdomen demonstrate small volume intra-abdominal ascites with a cirrhotic\nappearance of the liver.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.  Median sternotomy\nwires are intact.  While there is no fluid collection or air in the region of\nthe median sternotomy wires there is soft tissue stranding which has increased\nfrom ___ particularly in the sub xiphoid region (series 2, image 47).",
            "output": "1. Increased soft tissue stranding in the subxiphoid region since ___,\nmore than expected for 1 month postop, suspicious for infection.  No drainable\ncollection.\n2. Small left apical pneumothorax.\n3. Small right and trace left pleural effusions, mildly increased on the right\nbut decreased on the left compared to ___.\n4. Bibasilar airspace opacities most consistent with atelectasis.\n5. Small hemorrhagic pericardial effusion, unchanged from ___.\n6. Small volume intra-abdominal ascites with cirrhotic liver morphology."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland is unremarkable.\n\nUPPER ABDOMEN: Limited portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal or hilar lymphadenopathy.\n\nHILA:\n\nHEART and PERICARDIUM: Heart size is normal.  There is trace pericardial\nfluid.  There are mild coronary artery and aortic annulus calcifications.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Patchy areas of ___ opacification and bronchiectasis\nin the left upper and lower lobes is consistent with ___ infection.  Calcified\ngranulomas are seen bilaterally (4; 132, 139, 226).  There are no suspicious\npulmonary nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nThere is mild mucous plugging and bronchiectasis.\n3. VESSELS:  The thoracic aorta is of normal caliber with mild atherosclerotic\ncalcifications.  The main, left, right pulmonary arteries are of normal\ncaliber.\nCHEST CAGE: There is S shaped scoliosis.  There is no acute fracture or\naggressive osseous lesion.",
            "output": "___ opacification with associated bronchiectasis in the left upper and\nlower lobes is suggestive ___ infection.  No evidence of intrathoracic\nmalignancy.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:47 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: The heart is mildly enlarged.  Coronary calcification\nis moderate.  There is a trace pericardial effusion.  Mural calcification\nalong the thoracoabdominal aorta is moderate.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent. No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Calcified pleural\nplaques are seen in the left upper lobe (series 302, image 22).\n\nLUNGS/AIRWAYS: Centrilobular emphysematous changes are moderately severe. \nRight middle lobe is mostly collapsed with some thickening of the right middle\nlobe airways suggesting inflammation.  Minor linear atelectasis seen in the\nleft lower lobe.  There is a small calcified granuloma in the right lower lobe\n(series 302, image 150).  The central airways are patent but medium-sized\nairways show wall thickening in some cases, particularly in the right lower\nlobe, with patchy areas of mucous plugging noted in each lower lobe.  This\nsuggests inflammatory disease of lower airways.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates small\nlayering stones within the gallbladder lumen.\n\nBONES: No suspicious osseous abnormality is seen.? A nondisplaced non healed\nleft posterolateral eighth rib fracture is noted.  Bones appear demineralized.",
            "output": "1. Moderate centrilobular emphysema.\n2. Mostly collapsed right middle lobe with probably inflammatory thickening of\nright middle lobe airways.  More generally, thickened airways with mucous\nplugging suggesting inflammatory disease of airways.\n3.  Moderate vascular calcification along the aorta.  Mildly enlarged heart. \nCoronary calcification.\n4. Gallbladder sludge"
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Moderate\ncalcified atherosclerosis involving the thoracic aorta, left subclavian\nartery, and coronary arteries, unchanged.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild biapical scarring, unchanged.  Mild bibasilar atelectasis. \nInterval resolution of right middle lobe atelectasis.  Lungs are clear without\nmasses or areas of parenchymal opacification.  Moderate upper lobe predominant\ncentrilobular emphysema, unchanged.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture. \nChronic fracture to the posterior left ninth rib (4:164), stable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable except for\nmoderate calcific atherosclerosis of the abdominal aorta.",
            "output": "1. Interval resolution of right middle lobe atelectasis compared to ___.\n2. Moderate centrilobular emphysema.\n3. Moderate vascular calcifications along the aorta."
        },
        {
            "input": "Sub- carinal lymph nodes have increased in size from 8 mm short axis to 14 mm\nshort axis (53, 5).  Additional subcentimeter lymph nodes in the bilateral\nparatracheal, prevascular and pericardial nodal stations have overall\nincreased in number and slightly increased in size but do not meet individual\nsize criteria for enlargement.  Borderline right hilar nodes are similar to\nthe prior exam.  Heart size is normal, and focal coronary artery\ncalcifications are present.\n\nSkeletal structures are remarkable for previous partial right rib resection. \nNo new suspicious lytic or blastic lesions are detected in the thorax.\n\nWithin the lungs, inadvertent expiratory phase of respiration reduces\nsensitivity for detecting small nodules and subtle interstitial abnormalities.\nA 3 mm diameter nodular opacity in the right lower lobe anteriorly is\napparently new (163, 6).  Additionally, located within dependent ground-glass\nopacities in the right lower lobe posteriorly are solid broad-based densities\nmeasuring up to 1.6 cm (125, 6).  Focal nodular thickening along the left\nmajor fissure is unchanged as well as a tiny subpleural nodule in the right\nupper lobe (66, 6).  Exam is otherwise remarkable for minimal paraseptal\nemphysema and nonspecific biapical nodular scarring.  The latter is somewhat\ndifficult to compare to the prior study due to differences in slice thickness\nbut is likely unchanged accounting for this factor.",
            "output": "1.  Enlarged subcarinal lymph nodes have increased in size since ___. \nAdditional subcentimeter intrathoracic lymph nodes have increased in size and\nnumber.\n\n2.  New 3 mm right lower lobe lung nodule is a nonspecific finding that may be\nreassessed by followup CT in 3 months to exclude the possibility of a new\nmetastatic focus.  Larger, nonspherical, broad-based opacities in the right\nlower lobe dependently are potentially due to dependent nodular atelectasis or\nconsolidation and could be reassessed by limited prone images to assess for\nresolution.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Ascending aortic dilatation up to 4.3 cm is stable.  The size of the pulmonary\narteries is unremarkable.  Multiple mediastinal lymph nodes.  Are unchanged in\nnumber and size.  Aortic valve calcifications are noted, they might dynamic or\nsignificance is unclear.  Heart size is normal.  There is no pericardial or\npleural effusion.\n\nImage portion of the upper abdomen reveals nodular appearance of the liver\nconsistent with known cirrhosis as well as calcifications potentially related\nto the treatment of HCC no substantial difference demonstrated as compared to\nprevious examination on ___ but note is made that this study is a\nlimited due to lack of IV contrast and not designated for assessment of\nintra-abdominal: content.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Minimal compression deformity of the mid thoracic vertebral\nbody is unchanged.\n\nAirways are patent to the subsegmental level bilaterally.  Apical paraseptal\nemphysema is minimal.  Several pulmonary nodules are stable, series 5, image\n37, 43, 46, 49, 77, 87, 92, 225.  There is new cluster of centrilobular\nnodules and bronchial wall thickening in the right middle lobe, series 5,\nimage 173, 203, most likely consistent with infectious process.  Pre-existing\nsubpleural nodular consolidation, series 5, image 169 at the posterior aspect\nof the right lower lobe appears to be unchanged 1.8 x 2.7 cm.  No new nodules\ndemonstrated.",
            "output": "Several stable pulmonary nodules.\n\nNew focus of infection in the right middle lobe.\n\nNodular atelectasis or consolidation that as previously suggested should be\nassessed with prone imaging.\n\nLimited assessment of the upper abdomen due to lack of IV contrast with no\nspecific characterization of the liver lesion B impossible to provide but\nevidence of cirrhosis and previous treatment with subsequent calcifications."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest wall suspicious for malignancy.  Findings\nbelow the diaphragm, demonstrated by an abdomen MR earlier today are reported\nseparately.\n\nThere are no thyroid lesions warranting further evaluation.  Atherosclerotic\ncalcification is mild in the head and neck vessels, not apparent in coronary\narteries.  Aortic valvular calcification is mild, unchanged.  Fusiform\ndilatation of the ascending thoracic aorta to maximum diameter of 47 mm was 46\nmm in ___.  Pulmonary arteries and cardiac chambers are normal size. \nEvaluation of the heart would require dedicated cardiac imaging such as\nechocardiography.\n\nPericardium is physiologic.  There is no pleural effusion.\n\nSub cm mediastinal lymph nodes and 15 mm subcarinal mediastinal nodes, are\nstable and not pathologically enlarged.  Low prevascular/ midline\ndiaphragmatic lymph nodes are also not pathologically enlarged but larger\ntoday than in ___.  This lymph node station can reflect\nabnormalities in the liver and is therefore radiographically indeterminate\nwith respect to malignancy or inflammatory reaction.\n\nA region of abnormality in the subpleural superior segment of the right lower\nlobe has a nodular character superiorly, unchanged in size at 18 mm across,\n5:157 but at its inferior extreme there is now a thick walled ring shadow,\n5:165 either a cavity or more likely bronchiectasis which would explain the\nnodular appearance more superiorly.  Persistence of over 5 months suggests\nthat this is an active though indolent infection.  Punctate nodules elsewhere\nin the lungs are stable and there is no evidence elsewhere of infection.\n\nMinimal loss of height upper thoracic vertebral body, 7b:76, is unchanged. \nThere are no bone finding suspicious for malignancy or infection.",
            "output": "Progressive bronchiectasis or new cavitation since ___, in the otherwise\nstable right lower lobe region of indolent but active infection. No evidence\nof infection elsewhere or bronchogenic spread.\n\nMinimal interval increase in caliber of sub cm right diaphragmatic or\nprevascular mediastinal nodes, significance indeterminate, but probably\nrelated to activity in the liver, including ablation or inflammation, not\nnecessarily malignancy.\n\nFusiform dilatation ascending thoracic aorta, 47 mm, not appreciably changed. \nAortic valvular calcification is mild, hemodynamic significance indeterminate."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest wall suspicious for malignancy.  This study\nis not appropriate for subdiaphragmatic diagnosis.\n\nThyroid is unremarkable.  Atherosclerotic calcification is mild in head and\nneck vessels, minimal in coronary arteries.  Aortic valvular calcification is\nmild to moderate.  A ascending thoracic aorta is dilated in a fusiform fashion\nto maximum diameter of 45 mm unchanged since ___.\nThere is no pericardial or pleural effusion.\n\n13 mm left lower paratracheal mediastinal lymph node, 5:114, was 9 mm on ___.  16 mm subcarinal nodes are stable and other numerous sub cm mediastinal\nnodes are stable, such as sub cm diaphragmatic nodes, or slightly larger.\nHilar contours on this noncontrast study do not suggest adenopathy.\n\nLungs:\n\nFocal, well circumscribed heterogeneous, partially cavitary lesion in the\nsuperior segment of the right lower lobe is unchanged since ___,,\ncharacteristic diameter 20 mm, 5:160, was 16 mm in ___, and not\ncavitated There are no other pulmonary abnormalities.  Tracheobronchial tree\nis normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic metastasis.\n\nRight lower lobe lung lesion is most likely indolent infection, although\nprimary bronchogenic adenocarcinoma is possible.\n\nAortic valvular calcification, hemodynamic significance indeterminate.  Mild\npoststenotic dilatation ascending thoracic aorta stable since ___.\n\n\nRECOMMENDATION(S):   Consider transthoracic CT-guided needle aspiration,\npersistent right lower lobe lung lesion."
        },
        {
            "input": "The known small hypodense thyroid nodules are not well seen on this exam.\nThere are no pathologically enlarged supraclavicular, mediastinal, hilar or\naxillary lymph nodes.\n\nHeart size is top-normal with no pericardial effusion.  Extensive mitral\nannular calcifications are present.  The main pulmonary artery and thoracic\naorta are within age-appropriate size limits. The right pulmonary artery is\nborderline enlarged, which is of indeterminate clinical significance.\n\nEvaluation of the lungs is limited by respiratory motion artifact. However,\nscattered bilateral subsegmental ground-glass opacities may be due to\ninfection or aspiration. A roughly 4 mm right upper lobe subpleural opacity is\nnot appreciably changed since ___ (4, 58). A focal right middle lobe\nband-like consolidation may be due to atelectasis or infection (4, 136). There\nis no central endobronchial lesion. Mild heterogeneity of the lung parenchyma\nmay be due to air trapping.\n\nImages of the upper abdomen show two simple left renal cysts, a small hiatal\nhernia, and colonic diverticulosis without evidence for diverticulitis.\n\nThere is severe generalized osteopenia. Old healed bilateral rib fractures are\nidentified. A severe compression fracture of the T12 vertebral body\ncontributes to severe kyphosis. There is mild loss of height at the L1 through\nL3 vertebral bodies as well. No lytic or sclerotic bone lesions are\nidentified.",
            "output": "No evidence of intrathoracic lymphoma or other malignancy.\n\nScattered subsegmental ground-glass opacities may be due to aspiration or\ninfection.\n\nSevere generalized osteopenia with multilevel lower thoracic and lumbar spine\ncompression fractures, with the most severe loss of height at T12.\n\nSmall hiatal hernia.\n\nColonic diverticulosis without evidence for diverticulitis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes at the hilar and\nmediastinal level are normal in size.  Mild to moderate coronary\ncalcifications.  No substantial valvular calcifications.  No pericardial\neffusion.  Several normal sized pericardial lymph nodes are visualized.  No\nrelevant abnormalities in the upper abdomen.  Mild elongation of the\ndescending aorta.  No osteolytic lesions at the level of the ribs, the sternum\nor the vertebral bodies.  Moderate degenerative vertebral disease.\n\nPre-existing left lower lobe mucous plugging of the airways, with surrounding\nperibronchial opacities have almost completely resolved.  However, there is\nminimal remnant peribronchial nodularity (series 4, image 157) as well as\nminimal mucous plugging open (series 4, image 167).  Newly appeared similar\nbut substantially more subtle lesions are now seen in the lingular (series 4,\nimage 164).  In unchanged manner, several pure ground-glass nodules are\nvisualized in the lung parenchyma, for example in the left lower lobe apex\n(series 4, image 103).  No pleural thickening.  No pleural effusions.  No\nevidence of diffuse lung disease.",
            "output": "Near complete resolution of an infectious focus in the left lower lobe, with\nminimal remnant bronchial and parenchymal changes.  The new appearance of a\nsimilar focus in the lingular as well as the waxing and waning presence of\npure ground-glass nodules suggests chronic aspiration or recurrent infection. \nBecause of the presence of ground-glass nodules, yearly CT follow-ups should\nbe performed, to rule out the theoretical possibility of slow growing\nadenocarcinoma."
        },
        {
            "input": "The thyroid gland is homogeneous in attenuation without a focal lesion.  There\nis no axillary or mediastinal adenopathy. Central nodes are not pathologically\nenlarged. The esophagus is unremarkable.\n\nHeart size is normal.  The ascending aorta is non aneurysmal.  The main\npulmonary artery is within normal limits in caliber.  Moderate focal coronary\nartery calcifications involve the most prominent left anterior descending\ncoronary artery and left circumflex coronary artery.  There are no aortic\nvalvular calcifications present. Trace pericardial fluid is physiologic. \nCoarse calcifications involving the lateral aortic arch.\n\nAirways are patent to the subsegmental level.  Minimal focal paraseptal\nemphysema involves the left apex.  A calcified punctate nodule within the\nright upper lobe (04:34) is consistent with a calcified granuloma.  Several\npure ground-glass nodules are present, stable in size.  A ground-glass nodule\nwithin the right upper lobe posteriorly measures 4 mm (4:68).  A 5 mm\nground-glass opacity is located within the left upper lobe peripherally\n(4:74).  A 6 mm ground-glass opacity is located within the right middle lobe\n(4:164).  The largest purely ground-glass opacity measures 11 mm within the\nsuperior aspect of the left lower lobe (4:99).  A previous 3 mm nodule within\nthe left lower lobe is decreased in size currently 2 mm (4:132).  Within the\nright middle lobe, there a pulmonary nodule which measures 5 mm in greatest\ndimension (4:152), likely inflammatory in etiology.  Previously present left\nlower lobe mucous plugging and peribronchiolar nodularity as described on CT\ndated ___ is no longer present. Tubular opacity within the\ninferior lingular segment (4:133) appears increased in caliber relative to\nprior examination dated ___, a contrast enhanced study on which this\nlesion did not show enhancement. There is no pleural effusion or abnormal\nthickening.\n\nThere are no bony lesions worrisome for malignancy or infection within the\nchest cage.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, imaged\nportions of the upper abdomen are unremarkable.",
            "output": "1. Resolution of previously present left lower lobe mucous plugging and\nperibronchiolar nodularity.\n\n2. Multiple ground glass  nodular opacities measure up to 11mm in largest\ndimension for which follow up CT in ___ is advised to document\nstability.\n\n3. Tubular opacity within the inferior lingular segment which did not enhance\non prior CT dated ___ and appears relatively increased in caliber on\ncurrent examination,; findings favor a focal mucoid impaction rather than a\nvascular anomaly. Reassessment on follow up CT or alternatively direct\nevaluation with bronchoscopy can be performed if clinically warranted.\n\n4. New peribronciolar opacity within the right middle lobe is felt likely\ninflammatory for which attention on follow up is warranted to ensure\nresolution."
        },
        {
            "input": "MEDIASTINUM/HEART:  The visualized thyroid is unremarkable. A subcarinal node\nmeasures up to 10 mm in short axis, not enlarged by CT size criteria. \nHowever, right hilar nodes measure up to 12 mm (5:29, 38).  Supraclavicular,\naxillary, and hilar lymph nodes are also non enlarged. The aorta and main\npulmonary artery are normal in size. No incidental central pulmonary arterial\nfilling defect identified. Heart size is normal with moderate coronary artery\ncalcifications. No pericardial effusion.\n\nLUNGS/AIRWAYS:  Compared to the prior study, there is a new consolidation with\nair bronchograms involving the medial and posterior basal segments of the\nright lower lobe.  Airways still appear patent to the subsegmental level.  No\neffusions or pneumothorax.  Minimal focal paraseptal emphysema involving the\nleft lung apex is unchanged.  Unchanged punctate right upper lobe granuloma\n(06:47).\n\nSeveral ground-glass nodules/opacities are unchanged since ___.  4\nmm ground-glass nodules in the right upper lobe and left upper lobe are stable\n(6:90, 99).  The 7 mm ground-glass opacity in the right middle lobe is also\nunchanged (6:203).  The largest ground-glass opacity measures 1.2 cm in the\nsuperior segment of the left lower lobe (6:135), unchanged.\n\nPreviously described inflammatory nodule in the right middle lobe is no longer\npresent.  A 3 mm right lower lobe nodule is unchanged (6:165).  The left lower\nlobe 3 mm nodule is not visualized on the current study, likely due to\ninadvertent expiratory phase.  Previous tubular opacity in the inferior\nlingular segment has slightly cleared, with a residual thickened bronchiole\n(6:170).  No new or growing pulmonary nodule detected.\n\nUPPER ABDOMEN:  Please refer to the dedicated CT abdomen and pelvis report of\nthe same date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: A small sclerotic focus involving the T10 vertebral body\nis unchanged since at least ___. Mild multilevel degenerative\nchanges of the thoracic spine are unchanged.",
            "output": "1.  New consolidation involving the medial and posterior basal segments of the\nright lower lobe with air bronchograms is concerning for pneumonia.  This was\nnot seen on ___.  Given the patient's clinical history, followup\nimaging is recommended in approximately ___ weeks to evaluate for resolution.\n\n2.  Right hilar lymphadenopathy.\n\n3.  1.2 cm ground-glass opacity in the left lower lobe is unchanged since ___.\n\n4.  Please refer to the dedicated CT abdomen and pelvis report of the same\ndate for the subdiaphragmatic findings.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 9:52 ___, 15 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is top-normal with no pericardial effusion. Moderate mitral/aortic\nannular and extensive coronary artery calcifications are present. The main\npulmonary artery is mildly dilated to 3.5 cm. There is also mild fusiform\ndilatation of the thoracic aorta to 4.4 cm in greatest transverse dimension.\nOf note, aortic valvular calcification is minimal. Mild calcific\natherosclerosis diffusely involves the mildly tortuous thoracic aorta and its\nbranches.\n\nThere is no pulmonary nodule, mass or consolidation. Mild left lower lobe\nground-glass opacities are most likely due to aspiration. Left lower lobe\nlinear atelectasis or scarring is also incidentally noted. There is no pleural\neffusion.\n\nThere is a large hiatal hernia containing fat and a significant portion of the\nstomach.\n\nGeneralized osteopenia and multilevel spinal degenerative changes contribute\nto marked thoracic spine kyphosis. No acute compression fracture is\nidentified. Bilateral shoulder degenerative changes, including a moderate\nright shoulder joint effusion, are also present. There are no bony lesions in\nthe thorax worrisome for infection or malignancy.",
            "output": "No pulmonary nodule identified. Mild left lower lobe ground-glass opacities\nare most likely due to aspiration.\n\nDilatation of the main pulmonary artery suggests pulmonary arterial\nhypertension.\n\nFusiform dilatation of the thoracic aorta, 4.4 cm wide.\n\nLarge hiatal hernia."
        },
        {
            "input": "CHEST:\nThe ETT terminates approximately 2.7 cm above the carina.\n\nHEART AND VASCULATURE:  Dense atherosclerotic calcifications at the aortic\narch, the origin of the head and neck vessels, as well as the coronary\narteries.  Dense calcifications of the aortic valve.  The thoracic aorta is\nnormal in caliber without evidence of acute injury.  Moderate cardiac\nenlargement is noted.  Otherwise, the heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Numerous prominent mediastinal and left hilar\nlymph nodes measuring up to 9 mm in short axis (series 2, image 16, 18) may be\nreactive in nature.  No axillary lymphadenopathy.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES:  There are small bilateral pleural effusions, left greater\nthan right.  No pneumothorax.\n\nLUNGS/AIRWAYS:  There is near complete occlusion of the bilateral lower lobe\nbronchi.  There are dense bilateral lower lobe consolidations, which raise\nconcern for aspiration or multifocal pneumonia.  However, some of these\nopacities appear nodular (series 2, image 14, 25, 29), and an underlying\nmalignancy cannot entirely be excluded.\n\nBASE OF NECK:  The thyroid is heterogeneous with multiple small calcified and\nnoncalcified nodules measuring up to 8 mm, none of which require follow-up in\na patient of this age per ACR guidelines.\n\nABDOMEN:\n\nHEPATOBILIARY: A 1.9 x 1.8 cm hypodensity within the right lobe of the liver\n(series 2, image 45) is stable since at least ___, likely benign, possibly a\nhemangioma.  Otherwise, the liver demonstrates homogenous attenuation\nthroughout.  There is no evidence of focal lesion or laceration.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple hypodensities within the kidneys bilaterally, some of which\nare consistent with simple cysts, others which are too small to characterize,\nbut also likely represent simple cysts.  Otherwise, the kidneys are of normal\nand symmetric size with normal nephrogram.  There is no evidence of enhancing\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is large hiatal hernia.  The enteric tube terminates\nin the hiatal hernia.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The colon and rectum are within normal\nlimits.  The appendix is not visualized.  There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:  The bladder is decompressed by Foley, and cannot be adequately\nevaluated on this examination.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Enlarged portacaval lymph node measures approximately 1.5 x 1.4\ncm (series 2, image 51), unchanged.  There are multiple prominent periaortic\nretroperitoneal lymph nodes measuring up to 8 mm in short axis (series 2,\nimage 56).  A right common iliac lymph node measures up to 9 mm in short axis,\nwhich is new (series 2, image 76).\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nExtensive atherosclerotic disease is noted.  A right femoral venous catheter\nis partially visualized.\n\nBONES: The patient is status post right shoulder arthroplasty without evidence\nof hardware complication. There is no acute fracture.  No focal suspicious\nosseous abnormality.  Extensive degenerative changes with grade 1\nanterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Complete occlusion of the bilateral lower lobe bronchi with dense lower\nlobe consolidations, which likely represents aspiration or multifocal\ninfection.  However, there are nodular opacities within the lower lobes\nbilaterally, which could also be due to infection though followup will be\nnecessary to exclude the possibility of an underlying malignancy.\n2. Small bilateral pleural effusions.\n3. Large hiatal hernia.  The NG tube terminates in the hiatal hernia.\n4. Multi nodular thyroid.\n\nRECOMMENDATION(S):  Follow-up chest CT to ensure resolution of the nodular\nopacities."
        },
        {
            "input": "HEART AND VASCULATURE: The pulmonary arteries are normal in caliber without\ncentral filling defect identified.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  Right-sided Port-A-Cath is in place with tip terminating in\nthe cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: There is nodular soft tissue attenuation\ninvolving the left hilum/infrahilar lung best appreciated on series 302 image\n94 and 601 image 42 measuring approximately 1.7 x 1.5 x 2.9 cm with minimally\nprominent left hilar lymph nodes seen on series 302, image 83 and series 601,\nimages 41 measuring approximately 12 mm which could represent sequela to prior\ntreated malignancy or residual/recurrent malignancy.  No additional\nsignificant mediastinal or hilar mass/adenopathy.  No axillary adenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bronchial wall thickening involving the lingula\nand superior segment of the left lower lobe with adjacent ground-glass\nopacities presumably sequela to prior treatment change.  There are more focal\nnodular opacities noted within the lingula (series 302, image 58) and left\nlower lobe series 302, image 109 and series 601, image 39) which also could\nrepresent post treatment change or residual/recurrent lung carcinoma.  Minimal\ndependent ground-glass opacities within the right upper lobe presumably\nrepresenting subsegmental atelectasis and/or scarring.  No consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: See separate CT abdomen report.\n\nBONES: Partial visualization of internal fixation hardware right clavicle. \nMultiple old healed right-sided rib fractures.  Degenerative change of the\nspine.  No acute fracture or suspicious osseous lesion identified.",
            "output": "Nodular soft tissue attenuation involving the left hilum/infrahilar lung with\nadditional ground-glass and nodular airspace opacities within the lingula and\nsuperior segment of the left lower lobe as detailed above.  It is uncertain if\nthis represents sequela to patient's prior radiation therapy (although this is\nconsidered most likely) or represent residual/recurrent lung carcinoma. \nComparison to outside imaging would be useful to assess for interval change.\n\nNo additional acute or significant findings within the chest.\n\nRECOMMENDATION(S):  Recommend comparison to outside CT images/reports if\navailable."
        },
        {
            "input": "THORACIC INLET: There are multiple small left supraclavicular lymph nodes, new\nsince the prior study the largest measuring 11 mm.  The thyroid is\nunremarkable.\n\nBREAST AND AXILLA  : There are multiple small bilateral axillary lymph nodes\nnot enlarged by size criteria.  There is diffuse stranding of the fat in the\nleft axilla also new since the prior study.  The largest left axillary node\nmeasures 14 mm.\n\nMEDIASTINUM: There are multiple enlarged mediastinal lymph nodes.  The right\nparatracheal node measures 12 mm.  The pre-vascular node measures 10 mm.  The\nleft paratracheal node measures 14 mm.  There is a small subcarinal node\nmeasuring 10 mm.  There are small bilateral hilar lymph nodes, new since the\nprior study.  Lack of intravenous contrast limits exact measurements.  There\nis a small pericardial effusion with associated pericardial thickening, new\nsince the prior study.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: No discrete lung nodules are seen.  There is mild interstitial\nprominence in the right lower lobe.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  There is mild endplate sclerosis involving and L1-L2\nvertebral body, is degenerative.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows right-sided\nhydronephrosis.  Both adrenals are mildly thickened.  Both kidneys have not\nbeen completely imaged.  There is evidence of perinephric stranding",
            "output": "Small supraclavicular, mediastinal right hilar lymph nodes, concerning for\nmetastasis, new since the prior study.\n\nSmall pericardial effusion with associated pericardial thickening is\nindeterminate.\n\nEvidence of hydronephrosis bilaterally, both kidneys have not been completely\nimaged.  Evidence of perinephric stranding."
        },
        {
            "input": "Thyroid goiter with substernal extension is noted.  Nonspecific mildly\nenlarged mediastinal lymph nodes measure up to 9 mm in short axis (4, 80 and\n83). No supraclavicular or axillary lymphadenopathy is identified.\n\nA tunneled dialysis catheter extends into the inferior right atrium. There is\nmild cardiomegaly with multichamber enlargement.  Extensive coronary artery\nand aortic valve calcifications are present. There is no pericardial effusion.\nThe main pulmonary artery and thoracic aorta are normal in caliber, however\ncalcific atherosclerotic disease diffusely involves the thoracic aorta and its\nbranches.\n\nEvaluation of the lungs demonstrates scattered bilateral branching tubular\n___ opacities and punctate nodules in a predominantly biapical\nsubpleural distribution. No central endobronchial lesion is identified. There\nare scattered areas of linear and subsegmental atelectasis bilaterally.\nModerate bilateral pleural effusions result in partial bilateral lower lobe\npassive atelectasis.\n\nImages of the upper abdomen are notable only for dense splenic artery\ncalcifications, and an indeterminate coarse calcification posterior to the\nleft spleen.\n\nNo destructive osseous lesions are identified.",
            "output": "Moderate bilateral pleural effusions resulting in partial bilateral lower lobe\npassive atelectasis.\n\nMild likely infectious small airways disease.\n\nThyroid goiter with substernal extension."
        },
        {
            "input": "The ascending aorta is mildly dilated at 4.9 x 4.6 cm but without evidence of\ndissection, mural hematoma, or penetrating ulcer. Aortic valve calcifications\nare present. Major branch vessels of the thoracic aorta are patent. The main\npulmonary artery is mildly dilated at 3.6 cm.\n\nHeart size is normal. There is no pericardial effusion. No lymph nodes meeting\ncriteria for pathologic enlargement are seen within the thorax. A prominent\nright hilar lymph node on series 2 image 29 is nonspecific, most likely\nreactive.\n\nTwo round, noncalcified nodules measuring up to 7 mm are identified in the\nleft lower lobe abutting the pleura (02:40). A similar subpleural nodule is\nidentified along the pleura in the right upper lobe (02:12). There no pleural\neffusions. Airways are patent to the subsegmental level.\n\nThe thyroid gland appears unremarkable. Chronic degenerative changes are noted\nin the thoracic spine.\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nPlease refer to separate report for abdomen and pelvis findings.",
            "output": "1. Total of 3 subpleural nodules up to 7 mm are indeterminate for malignancy.\nThese can be followed with chest CT in ___ months, depending on the outcome of\nmalignancy workup. No other findings of malignant disease in the chest.\n2. Ascending aortic aneurysm, 4.9 cm at maximum."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Right hilar lymphadenopathy is likely reactive.\nNo axillary or mediastinal lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are heterogeneous consolidating opacities within the\ndependent aspects of the bilateral lower lobes, which in the setting of\ndiffuse bilateral small airway wall thickening with areas of mucous impaction,\nsuggests aspiration and/or multifocal pneumonia (2:51).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Heterogeneous consolidating opacities within the dependent aspects of the\nbilateral lower lobes, in the setting of diffuse bilateral small airway wall\nthickening with areas of mucous impaction, suggests bilateral aspiration\nand/or multifocal pneumonia."
        },
        {
            "input": "The thyroid is normal. There is no mediastinal, hilar, axillary, or\nsupraclavicular lymphadenopathy.  Aorta and pulmonary arteries are normal\nsize. No evidence of aortic dissection or pulmonary embolism.  Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nGreat vessels are unremarkable.\n\nNote is made of circumferential esophageal wall thickening in the mid and\nlower portions with a small hiatal hernia. Additionally, the esophagus is\nfluid filled in the regions of esophageal wall thickening. These findings are\ncompatible with esophagitis.  No pneumomediastinum or focal fluid collection\nis identified.\n\nAirways are patent to the subsegmental levels. There is no pulmonary\nparenchymal abnormality aside from mild dependent atelectatic changes. There\nis no focal consolidation concerning for pneumonia.  No pleural effusion or\npneumothorax is identified.\n\nThe upper abdomen is unremarkable in appearance. There is no suspicious\nosseous lesion. Bilateral breast implants are noted.",
            "output": "1.  Circumferential wall thickening of the mid and lower esophagus, which is\nfluid filled, consistent with esophagitis. Correlation with recent biopsy is\nrecommended.\n2.  No other acute process in the chest.\n3.  Small hiatal hernia."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is normal.\nAtherosclerotic calcifications are seen within the thoracic aorta and coronary\narteries.  There is no pericardial effusion.\n\nThere is persistent, small, nonhemorrhagic right pleural effusion with\nadjacent atelectasis. There is no left pleural effusion or pneumothorax\nidentified. The airways are patent to subsegmental levels.\n\nWithin the lungs, the patient is status post right upper lobectomy with a\nstable appearing right bronchial stump and adjacent postsurgical changes.\nAdjacent fibrotic changes and traction bronchiectasis are likely secondary to\nprior radiation, stable from the prior examination. Multiple, bilateral\npulmonary nodules are unchanged as compared to the prior examination. For\nexample, a 3 mm solid left upper lobe nodule (5:85) and a 4 mm mixed\nground-glass and solid nodule within the right upper lobe (5:52) are both\nunchanged stable. Moderate, bilateral centrilobular emphysematous changes are\nnoted, predominantly affecting the upper lobes.\n\nOSSEOUS STRUCTURES:  There are no destructive focal osseous lesions concerning\nfor malignancy identified within the imaged thoracic skeleton.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. Within this limitation, there is a small hiatal hernia and a 1.0\ncm splenic hypodensity, both unchanged from prior examination. The imaged\nportion of an infrarenal abdominal aortic aneurysm is unchanged in size,\nmeasuring up to 3.6 cm in the greatest diameter (5:329). The extrahepatic CBD\nand pancreatic duct are increasingly prominent as compared to the prior\nexamination. No pancreatic mass is identified on this nondedicated\nexamination.",
            "output": "1.  Status post right upper lobectomy and radiation with postsurgical and post\nradiation changes. No evidence of recurrent or metastatic disease.\n2.  Stable, small nonhemorrhagic right pleural effusion.\n3. Increasingly prominent pancreatic duct measuring up to 5 mm, previously up\nto 4 mm.\n4. Minimally changed, incompletely imaged infrarenal abdominal aortic\naneurysm, measuring up to 3.6 cm."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Unchanged moderate aortic wall calcifications.  No\nincidental pulmonary embolism.  Mild coronary calcifications, no valvular\ncalcifications.  No pericardial effusion.  A right basal pouch with pleural\nfluid (2, 46) is unchanged, unchanged 10 mm hypodense lesion in the spleen. \nNo adrenal lesions A predescribed infra renal aortic aneurysm is not included\non today's examination.  No evidence of osteolytic lesions at the level of the\nribs, the sternum or the vertebral bodies.  No vertebral impression fractures.\nMild degenerative vertebral disease.\nThe patient is of the right upper lobectomy.  Stability in size and morphology\nof a right upper lung part solid nodule (4, 42).  Unchanged right posterior\nnon solid nodule (4, 115).  No new or growing pulmonary nodules.  The\nlobectomy stump is unchanged and without evidence of local recurrence. \nUnchanged anterior subpleural fibrotic consolidations (4, 113).  The airways\nare patent and show signs of mild chronic airways disease.  Mild to moderate\npulmonary emphysema.",
            "output": "No change as compared to ___.  No evidence of recurrence of the\nright upper lobectomy.  Pre-existing parenchymal nodules on the right are\nunchanged in size and morphology.  No new or growing nodules.  Unchanged\nappearance of the pleural pouch at the lateral and basal aspect of the right\nhemithorax."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Status post right upper lobectomy and postoperative\nradiation and chemotherapy.  The appearance of the pleural pouch (3, 44) is\nstable.  No evidence of adrenal lesions.  Stable postoperative appearance of\nthe mediastinal structures, including the stump and the fibrotic para\nmediastinal mass (3, 24).  The vessels are also unchanged.  There is no\nevidence of incidental pulmonary embolism.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Several pre-existing\npulmonary nodules, for example a ground-glass nodule in the right lung (5, 48)\nas well as a part solid nodule in the left upper lobe (5, 81) are stable. \nStable extensive pulmonary emphysema, stable post therapy scarring in the\nright anterior lung (5, 151).  No new or growing pulmonary nodules.  The\nairways are patent.",
            "output": "Stable appearance of the right upper lobectomy and radiation and chemotherapy.\nSeveral pre-existing pulmonary nodules are stable.  No new or growing nodules.\nNo lymphadenopathy.  Stable extensive pulmonary emphysema."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged. \nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.\n\nCARDIO-MEDIASTINUM: This been no change in the appearance of the esophagus. \nWall is thickened both superiorly and in the distal esophagus and at the level\nof the carina where the esophagus is inseparable from treated adenopathy. \nThere are no findings to suggest that the esophagus is compromised.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head neck vessels and scattered in at\nleast left main, anterior descending and right coronary arteries.  Aorta and\npulmonary arteries are normal size and free of filling defects.  Extent of\nintimal calcification and non calcified plaque in the lower thoracic aorta is\nstable.\n\nSmall pericardial effusion is stable.\n\n\n\n\n\nTHORACIC LYMPH NODES: Treated lower paratracheal and subcarinal mediastinal\nnodal tissue is stable.  There is no new lymph node enlargement in the chest.\n\n\nLUNGS, AIRWAYS, PLEURAE: Right hilus and bronchial stump have a normal post\ntreatment appearance following right upper lobectomy and radiation therapy. \nModerate size right pleural effusion loculated inferiorly is unchanged.\n\nRight paramediastinal radiation fibrosis and small regions rounded atelectasis\nin the right lower lobe are stable.\n\nThere are no new or growing lung nodules.  Adjacent 3 and 2 mm left upper lobe\nnodules, 4:78, are unchanged since ___, and the larger is unchanged\nsince ___.\n\nEmphysema is moderately severe.\n\nCHEST CAGE: Unremarkable",
            "output": "No evidence of new or recurrent intrathoracic malignancy.\n\nStable expected postoperative appearance, right upper lobectomy and right\nhilar and mediastinal lymph node radiation and chemotherapy.  Stable small\npericardial and moderate right pleural effusions are probably not clinically\nactive.\n\nCoronary atherosclerosis.\n\n\nRECOMMENDATION(S):  Continued and CT surveillance, yearly."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Endotracheal tube is noted in\nplace.\n\nUPPER ABDOMEN: Please refer to dedicated abdominal CT performed concurrently.\n\nMEDIASTINUM: Left subclavian line has its tip terminateing in the distal SVC. \nThere are subcentimeter mediastinal lymph nodes.  NG tube has its tip within\nthe stomach.\n\nHILA: Absence of IV contrast limits evaluation of the hila.\n\nHEART and PERICARDIUM: There is trace pericardial effusion.\nPLEURA: There are small bilateral pleural effusions.\nLUNG:\n\n-PARENCHYMA:  Mild diffuse ground-glass opacities throughout both lungs could\nbe due to mild interstitial pulmonary edema.  Consolidative opacities in both\nlower lobes could be due to passive atelectasis however superimposed infection\ncannot be excluded.  There is upper lobe predominant centrilobular emphysema.\n-AIRWAYS:  Patent\nCHEST CAGE: No suspicious osseous lesion is seen.",
            "output": "1.  Mild diffuse bilateral ground-glass opacities throughout both lungs could\nbe due to mild interstitial pulmonary edema.\n2.  Small bilateral pleural effusion with consolidative opacities within both\nlower lobes that could represent passive atelectasis, however superimposed\ninfection cannot be excluded.  Please correlate clinically."
        },
        {
            "input": "THE PATIENT IS INTUBATED WITH APPROPRIATE POSITION OF THE ET TUBE.  AORTA AND\nPULMONARY ARTERIES ARE NORMAL IN DIAMETER.  NO PERICARDIAL EFFUSION IS SEEN. \nHEART SIZE IS NORMAL.  NEW IMAGE PORTION OF THE UPPER ABDOMEN WILL BE REVIEWED\nSEPARATELY IN CORRESPONDING REPORT WILL BE ISSUED.\n\nPLEURAL EFFUSION ON THE RIGHT IS PRESENT WITH ENHANCEMENT OF THE PLEURA, NEW,\nLOCULATED, SMALL TO MODERATE.  THERE IS A RIGHT LOWER LOBE CONSOLIDATION,\nHETEROGENEOUS IN APPEARANCE, CONCERNING FOR PNEUMONIA, POTENTIALLY WITH FOCI\nOF NECROSIS, SERIES 2, IMAGE 37, 42, 48.  NO ASSESSMENT OF THE PULMONARY\nVASCULATURE CAN'T BE DONE BUT NO CENTRAL PULMONARY EMBOLISM PRESENT.\n\nAIRWAYS ARE PATENT BILATERALLY EXCEPT FOR RIGHT LOWER LOBE.\n\nRIGHT UPPER LOBE NODULAR CONSOLIDATION, SERIES 4, IMAGE 89 IS 2.3 X 1.6 CM,\nSIMILAR OR MINIMALLY INCREASED IN SIZE AS COMPARED TO PREVIOUS STUDY FROM ___.  NO ADDITIONAL PULMONARY LESIONS DEMONSTRATED.\n\nTHERE ARE NO LYTIC OR SCLEROTIC LESIONS WORRISOME FOR INFECTION OR NEOPLASM. \nLYTIC LESION IN THE RIGHT GLENOID IS UNCHANGED, MOST LIKELY DEGENERATIVE IN\nNATURE.",
            "output": "LOCULATED RIGHT PLEURAL EFFUSION WITH PLEURAL ENHANCEMENT AND RIGHT LOWER LOBE\nCONSOLIDATION CONCERNING FOR MALIGNANCY.  WITH FOCAL AREAS OF DECREASED\nENHANCEMENT, FINDING CONCERNING FOR EMPYEMA AND NECROTIZING RIGHT LOWER LOBE\nPNEUMONIA\n\nRIGHT UPPER LOBE SPICULATED NODULAR CONSOLIDATION, UNCHANGED A MINIMALLY\nINCREASED SINCE THE PRIOR STUDY,"
        },
        {
            "input": "Since the prior study there is substantial interval decrease in mediastinal\nlymphadenopathy with no pathologically enlarged lymph nodes currently seen. \nAorta and pulmonary arteries are normal in diameter.  Center venous line tip\nterminates at the level of cavoatrial junction.  NG tube tip terminates in the\nstomach.\n\nThere is no pericardial effusion.  There is substantial interval decrease in\nright pleural effusion, currently minimal.\n\nImage portion of the upper abdomen demonstrate substantial splenomegaly and\nevidence of previous liver transplantation.\n\nAirways are patent to the subsegmental level bilaterally.  There is\nsubstantial improvement of right lower lobe consolidation as well as decrease\nin size in the right upper lobe nodular opacity, series 5 image 158 which\ncurrently represented cysts most likely a pneumatosis a L after infectious\nprocess.  Rounded atelectasis in the right lower lobe is present.\n\nThere a new opacities in the left upper lobe, primarily ground-glass with some\nnodularity, series 5, image 82, 90, 98, 100 and 2, 109, as well is in the\nanterior aspect of the right upper lobe, for example series 5, image 144. \nBows are new as compared to previous study.  Left lower lobe is not involved.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Substantial interval improvement in the right lower lobe consolidation, right\nupper lobe nodular consolidation with post infectious pneumatoceles and\ndecrease in right pleural effusion.\n\nNew left upper lobe and to substantially less extend right upper lobe\nopacities, primarily ground-glass with some nodularity with\nperibronchovascular appearance.  The findings might represent new infectious\nprocess such is viral or atypical mycobacterial.  Cryptogenic organizing\npneumonia would be is a possibility as well.  Correlation with some bronchial\nbiopsy might be considered\n\nSplenomegaly and evidence of previous liver transplantation, with slight\nincrease in splenomegaly as compared to previous examination."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nMild atherosclerotic calcification of the aorta is noted.  The main, right,\nand left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Previously seen diffuse left upper lobe and anterior\nright upper lobe ground-glass opacities are no longer visualized. The\npreviously seen cavitary lesion  in the right upper lobe now appears solid and\nspiculated (5:130).  An 8 mm spiculated nodular opacity in the posterior right\nupper lobe is new since prior chest CT in ___ (04:25).  Two adjacent\nround nodules in the right lower, measuring 1.1 and 1.3 cm, are increased in\nsize compared to prior study (5:256).  Atelectasis versus residual from\nprevious consolidation is also noted at the right lung base.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nDegenerative changes of bilateral shoulders noted.  Bilateral gynecomastia is\nnoted.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, there is evidence of prior liver transplant, the\ngallbladder is surgically absent, and the partially imaged spleen is\nsignificantly enlarged.",
            "output": "1. Previously seen left upper lobe and and anterior right upper lobe\nground-glass opacities are no longer visualized, likely representing\nresolution of prior infection.\n2. Previously seen cavitary lesion in the right upper lobe now appears solid\nand spiculated.  Previously seen 2 adjacent nodules in the right lower lobe\nare increased in size.  A new 8 mm spiculated nodule in the posterior right\nupper lobe is also noted.  Findings are concerning for a new infectious\nprocess versus metastatic disease.  Recommend biopsy of the nodules in the\nright lower lobe to assess etiology of findings.\n3. Bilateral Gynecomastia.\n4. Splenomegaly.\n\nRECOMMENDATION(S):  Lung biopsy.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 14:40 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "FINDINGS:\n\nNoncontrast examination limits evaluation of the mediastinal and vascular\nstructures.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  No\nsupraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: A few mediastinal lymph nodes are demonstrated, none are enlarged\nby CT criteria.\n\nHILA: Limited evaluation for hilar lymphadenopathy given lack of IV contrast\nbut no obvious lymphadenopathy is demonstrated.\n\nHEART and PERICARDIUM: Coronary artery calcification.  Thoracic aorta and\npulmonary arteries are normal caliber.\n\nPLEURA: No pleural effusion.\n\nLUNG:\n\n-PARENCHYMA:  Area of architectural distortion noted in the right upper lobe\nis consistent with scarring and unchanged in appearance since the CT of ___ (5:123).  In the medial right lung base, the two adjacent\nnodules previously demonstrated is more confluent and larger compared to prior\nmeasuring 1.9 x 2.5 cm, previously measuring 1.3 x 2.1 cm.  Consolidation\nposterior within the right lung base is similar in appearance.  New\nground-glass opacity is also noted in the left lung base.\n-AIRWAYS:  Airways are widely patent.\nCHEST CAGE: Bones are unremarkable aside from degenerative change of the\nshoulder joints bilaterally.\n\nUPPER ABDOMEN: Multiple surgical clips are noted in the porta hepatis,\nconsistent with liver transplantation. Markedly enlarged spleen, again noted",
            "output": "1. Previously demonstrated nodular opacity in the medial right lung base is\nlarger and more confluent on today's examination.  New ground-glass opacity is\nalso noted in the left lung base.  Given the increase in size over a short\ntime interval, an infectious or inflammatory process is favored but a\nneoplastic etiology cannot be completely excluded, in the background of the\npatient being on immunosuppression.\n2. Splenomegaly, partially visualized.\n3. Transplant liver, within limitations of a non contrast-enhanced scan is\nwithin normal limits.\n\nRECOMMENDATION(S):  Either a close interval follow-up chest CT, in 3 months to\nassess resolution of these findings or if clinically concerned a biopsy of the\nnodular right lower lobe lesion is a consideration.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 16:00, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The airways are patent to the segmental level.  There is mild centrilobular\nemphysema.  Again seen is atelectasis involving the in bilateral lower lungs\nas well as scarring in the right upper lobe (5:117).  Ground-glass opacity in\nthe posterior right upper lobe (05:10 5) is significantly increased compared\nto ___, but similar in appearance compared to ___. \nPeribronchiolar and centrilobular nodularity in the right lower lobe, with a\nmore nodular appearing focus (5:201-208), is new.\n\nA medial basal segment right lower lobe nodule is slightly increased in size\ncompared to ___, now measuring 2.4 x 3.5 cm (5:228, previously 1.9 x 2.5\ncm).  In the setting of a recent biopsy, this could be related to post biopsy\nhemorrhage, however due to insufficient sample on the biopsy malignancy or\naspergilloma cannot be excluded.  In the left upper lobe, peribronchiolar\nground-glass nodularity and a 3 mm nodule (05:59) are unchanged.  There is no\npneumothorax or pleural effusion.\n\nThere is no axillary or supraclavicular lymph node enlargement by CT size\ncriteria.  A left paratracheal mediastinal lymph node remains mildly enlarged,\nmeasuring 1.1 cm (5:130).  The heart is normal in size, without pericardial\neffusion.  The great vessels are normal in caliber.\n\nThis exam is not optimized for evaluation of subdiaphragmatic structures. \nWithin these limitations, the visualized upper abdomen is remarkable only for\nclips in the of right upper abdomen, splenomegaly, and mild vascular\ncalcifications.  The chest wall is grossly unremarkable, apart from\ngynecomastia.\n\nThere is no focal lytic or sclerotic osseous lesion to suggest neoplasm or\ninfection.",
            "output": "1. Increased size of a 2.4 x 3.5 cm medial basal segment right lower lobe mass\ncompared to ___ when it was measuring 1.9 x 2.5 cm.  Prior biopsy was\ninconclusive therefore repeat biopsy can be performed to rule out malignancy\nversus aspergilloma.\n2. New peribronchiolar and centrilobular nodularity in the right lower lobe,\nwith a more nodular appearing focus medially.  This likely reflects an\ninfectious or inflammatory process.\n3. Unchanged left upper lobe peribronchiolar ground-glass nodularity and 3 mm\nnodule.  Unchanged right upper lobe scar and right greater than left\natelectasis.\n4. Splenomegaly.\n This preliminary report was reviewed with Dr. ___\nradiologist.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:35 ___, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The thyroid is normal.  A 1.1 cm subcarinal node is not significantly changed\n(4:121).  There are no pathologically enlarged supraclavicular, axillary, or\nhilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates mild coronary artery calcifications. There is no\npericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Scarring in the right upper lobe is not significantly\nchanged (4:100).  There is new peribronchiolar nodularity in the posterior\nright upper lobe, in a region of previously seen ground-glass (4:92).  There\nhas been interval near complete resolution of bronchial wall thickening and\nnodularity in the right lower lobe compared with prior.  The nodule in the\nmedial basal segment of the right lower lobe is decreased in size from prior,\nmeasuring 1.9 x 1.6 cm, compared with 3.5 x 2.4 cm previously, likely\nreflecting resolution of post biopsy hemorrhage (4:202).  A 3 mm left upper\nlobe nodule is stable (4:59).  There is new peribronchiolar nodularity in the\nleft upper lobe (4:50).  There is right basilar atelectasis, similar to prior.\n\nSevere degenerative changes in the shoulders, right greater than left, are\nsimilar to prior.  No osseous lesions suspicious for infection or malignancy\nare identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the partially visualized liver transplant\ndoes not appear significantly changed.  Splenomegaly is stable. The included\nportions of the upper abdomen are otherwise grossly unremarkable.",
            "output": "1. Interval decrease in size of a 1.9 cm right lower lobe nodule, likely\nreflecting a resolution of post biopsy hemorrhage.\n2. Near complete resolution of bronchial wall thickening and nodularity in the\nright lower lobe compared with ___, with new peribronchiolar\nnodularity in the posterior right upper lobe, in a region of previously seen\nground-glass, and in the left upper lobe, most likely active infection. \nUnless the timing of antibiotics is consistent with the recurrence of the same\npathogen seen on CT ___, these new areas in the right upper and left\nupper lobe suggest a second opportunistic infection with another pathogen.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:32 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "The thyroid gland is unremarkable.  Axillary, supraclavicular, mediastinal,\nand hilar lymph nodes are not enlarged.  The aorta and pulmonary vessels are\nnormal in caliber.  Atherosclerotic calcifications of the aortic arch in the\ncoronary arteries are mild.  The heart is top-normal in size.  There is no\npericardial effusion.\n\nThe airways are patent to the subsegmental level.  There has been significant\ninterval improvement in the peribronchiolar nodularity in the posterior right\nupper lobe with just very faint focus of ground-glass opacity remaining (04:10\n2).  Large nodule in the medial basal segment of the right lower lobe has also\nimproved significantly with just a small amount of ground-glass opacity\nremaining (4:113).  The peribronchiolar nodularity in the left upper lobe seen\non the prior study has also improved.  3 mm nodule in the left upper lobe\n(4:67) and a 3 mm nodule in the right lower lobe (4:121) are all unchanged. \nThere is persistent atelectasis/scarring at the right lung base.  No large\nconsolidation, pleural effusion, or pneumothorax.\n\nThe study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate an enlarged spleen\nmeasuring up to 18.9 cm, unchanged in appearance since the prior study.  Post\ntransplant appearance of the liver is again noted.  Cluster of cystic lesions\nat the pancreatic tail is largely unchanged from the MRI performed on ___ and statistically represent side branch IPMNs.\n\nNo suspicious lytic or sclerotic lesion is identified.  Bilateral gynecomastia\nis noted.",
            "output": "1.  Significant interval improvement in the peribronchiolar nodularity in the\nposterior right upper lobe and left upper lobe with just faint ground-glass\nopacity remaining compatible with resolution of prior inflammatory/infectious\ncauses.\n\n2.  Continued evolution of nodule in the right lower lobe compatible with\nresolution of previous post biopsy hemorrhage.\n\n3.  Splenomegaly, cystic pancreatic tail lesions are unchanged."
        },
        {
            "input": "5 and 6 mm left supraclavicular lymph nodes, 2:3, 7, minimally larger today\nthan in ___. right supraclavicular and axillary lymph nodes are\nunremarkable.  There are no soft tissue abnormalities in the chest wall\nsuspicious for malignancy.  Severe gynecomastia is symmetric and stable.  This\nstudy is not appropriate for subdiaphragmatic diagnosis last evaluated with CT\nof the abdomen on ___.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels, but is\npresent in at least the left main, and left anterior descending coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.  There is no pleural effusion.  Mediastinal, hilar\ncommon other thoracic lymph nodes are not pathologically enlarged.\n\nDistal esophagus is patulous, but not sufficiently dilated to indicate\ndysmotility or the propensity to reflux.\n\nLungs:\n\nRegion of scarring, right upper lobe, 4:122, unchanged since ___.\n\nSmall area of pinpoint bronchiolar nodulation and ground-glass opacification\nin the superior segment of the right lower lobe, 4:140 ___, is new; even\nsmaller region in the left lower lobe superior segment is also new, 4:148.\n\nThe scarring at the periphery of the right lung base primarily anterior and\nposterior basal segments is unchanged.\n\nLungs are otherwise clear.\n\nThere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, but it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "Scarring, right upper and both lower lobes is all that remains of prior\nAspergillus infection.  No evidence of recurrence or new established\ninfection.\n\nNew mild bronchiolar inflammation in the superior segments of both lower lobes\nsuggests aspiration, although early lower respiratory tract infection is not\nexcluded of course.\n\nRECOMMENDATION(S):  Consider clinical inquiry about gastroesophageal reflux\nand aspiration."
        },
        {
            "input": "The patient is asymmetrically position.  The thyroid is unremarkable.  There\nis no axillary, supraclavicular, or mediastinal adenopathy.\n\nHeart size is normal.  There is no pericardial effusion.  Main pulmonary trunk\nand thoracic aorta are normal in caliber.  There is mild coronary artery\ncalcification.\n\nThe airways are notable for mild bronchial wall thickening.  Small areas of\nnodular opacity in the posterior aspect of the right upper lobe are new with a\nsecond area of increased opacification more superiorly (series 5, image 131,\n120).  Regions of scarring in the right upper lobe and at the lung base are\nstable.  The left lung is clear.  There is no pleural effusion or\npneumothorax.\n\nThe thoracic esophagus is unremarkable.  Views of the upper abdomen\ndemonstrate severe splenomegaly.  Appearance of the transplant liver grossly\nunchanged.  There is severe gynecomastia.\n\nOSSEOUS STRUCTURES: There are no suspicious bony lesions.",
            "output": "New small area of nodular opacity in the posterior right upper lobe concerning\nfor acute infection, likely bacterial.  The appearance would be highly\natypical for fungal infection.  Otherwise, there is no interval change in the\nappearance of the chest."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  The heart size is normal.  Moderate to severe coronary\ncalcifications are seen.  The pericardium is intact without evidence of an\neffusion.\n\nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.\n\nThere has been interval improvement of the previously noted small area of\nnodular opacity in the right upper lobe, however with new areas of nodular\nopacity along the lateral segment of the right upper lobe, series 5, image 72.\nA focal mixed ground-glass/solid lesion within the right lower lobe, series 5,\nimage 168 measuring approximately 8 mm appears new compared to the prior exam.\nAdditional ill-defined ground-glass changes within the medial aspect of the\nright lower lobe, series 5, image 190 are also new compared to the prior exam.\nPeribronchovascular nodularity along the right lung base appears new compared\nto the prior exam.\n\nThe left lung is grossly unremarkable.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however note is made of massive splenomegaly as well as extensive\nsplenic and periportal varices.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "1. Overall, compared to the prior exam from ___, there has been\ninterval improvement of the previously seen nodular opacities in the posterior\nright upper lobe, however now with new areas of ill-defined ground-glass\nchanges within the right lower lobe as well as a mixed subsolid 8 mm right\nlower lobe lesion.  Additional new areas of nodular opacity are seen along the\nlateral segment of the right upper lobe (5;72).  Findings could be secondary\nto an evolving infectious/inflammatory process.\n2. Note is made of severe splenomegaly, hepatic transplant as well as\nperiportal and perisplenic varices, incompletely evaluated on this exam.\n\nRECOMMENDATION(S):  Recommend ___ month follow-up after treatment with chest\nCT to ensure interval resolution."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with mild coronary artery calcifications. There is no\npericardial effusion. The main pulmonary artery and thoracic aorta are normal\ncaliber.  No incidental pulmonary embolus is identified.\n\nThere is no pulmonary nodule, mass or consolidation.  No endobronchial lesion\nor pleural effusion is identified.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThe bones are unremarkable.\n\nSubstantial bilateral gynecomastia may have improved.",
            "output": "No evidence of intrathoracic metastases."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue lesions in the chest wall suspicious for malignancy. Findings\nbelow the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck vessels, but is present in the coronaries in at least the left\nmain and anterior descending branches.  Aorta and pulmonary arteries are\nnormal size.  There is no pleural or abnormality.\n\nCentral lymph nodes are not pathologically enlarged.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nCoronary atherosclerosis."
        },
        {
            "input": "MEDIASTINUM/HEART:  The visualized thyroid is unremarkable. Supraclavicular,\naxillary, mediastinal and hilar lymph nodes are not enlarged by CT size\ncriteria. Aorta and pulmonary arteries are normal in size. No pulmonary artery\nfilling defect identified. Heart size is normal with mild coronary artery\ncalcifications. A small pericardial effusion is slightly larger than on ___.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. A 2.1 x 1.6\ncm marginated soft tissue nodule in the posterior basal segment of the right\nlower lobe with associated local interstitial septal thickening is new since\nthe chest CT of ___, and worrisome for malignancy (5:262).  In the\nlateral subsegment of the posterior segment of the right upper lobe, an\nirregular area of peribronchovascular consolidation and thickening, with\nassociated bronchiectasis, is also new since the prior chest CT, and\nmorphologically dissimilar from the right lower lobe pulmonary nodule.  This\nfinding is more compatible with an infectious process. No pleural effusions\ndetected.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, a hypodensity in the pancreas measures 0.8 cm\nan was per characterized on the MRI abdomen of ___.  Surgical clips\ndenote prior cholecystectomy, and the bilateral adrenal glands are\nunremarkable.\n\nSOFT TISSUES/BONES: No chest cage lesion concerning for malignancy. \nSignificant bilateral gynecomastia is unchanged.",
            "output": "1.  A new 2.1 x 1.6 cm soft tissue nodule in the posterior basal segment of\nthe right lower lobe, with associated local interstitial septal thickening, is\nconcerning for malignancy.  This lesion would be amenable to percutaneous\ntissue sampling.\n\n2.  The new area of irregular peribronchovascular consolidation and\nbronchiectasis in the right upper lobe is morphologically dissimilar from the\nright lower lobe process and more compatible with an infectious entity.  If\nsampling is required, this would be best approached with bronchoscopy.\n\n3.  No lymphadenopathy detected.\n\nNOTIFICATION:  The above findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ at 10:05 on ___, 1 min\nafter discovery."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Moderate basilar atelectasis.  Otherwise, the lungs are clear\nwithout masses or areas of parenchymal opacification.  There is mild bronchial\nwall thickening, likely due to chronic inflammation.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nPatient is s/p thyroidectomy.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild diffuse bronchial wall thickening."
        },
        {
            "input": "HEART AND VASCULATURE: The main pulmonary artery is prominent, difficult to\nmeasure accurately given pulsation.  Pulmonary vasculature is well opacified\nto the segmental level without filling defect to indicate a pulmonary embolus.\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart size is at the upper limits of normal. No\npericardial effusion is seen.  A catheter is seen in the superior vena cava.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  The lung apices are not\nvisualized.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis.  Visualized portions of the\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  The main pulmonary\nartery is prominent, however, difficult to measure accurately given pulsation.\nCorrelate clinically."
        },
        {
            "input": "HEART AND VASCULATURE: There is a small, nonocclusive filling defect within a\nsegmental pulmonary artery supplying the right lower lobe (series 3, image\n71).  Main pulmonary artery is enlarged measuring 3.4 cm, similar to the\nprevious exam.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart is mildly enlarged, unchanged. \nPericardium and great vessels are within normal limits.  Left superior\nintercostal vein is incidentally noted.  A central venous catheter terminates\nin the right atrium\n\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis is present.  Lungs are otherwise clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Small, nonocclusive segmental pulmonary embolism in the right lower lobe. \nNo evidence of right heart strain.\n2. Enlargement of the main pulmonary artery measuring 3.4 cm may reflect\npulmonary arterial hypertension."
        },
        {
            "input": "HEART AND VASCULATURE: There is mild motion at the lung bases limiting\nevaluation.  Pulmonary vasculature is well opacified to the subsegmental level\nwithout filling defect to indicate a pulmonary embolus.  The previously seen\nright lower lobe pulmonary embolism is not visualized.  The main pulmonary\nartery is prominent, measuring 3.0 cm.  The pericardium and great vessels are\nwithin normal limits.\n\nRight chest wall port is in situ with tip seen terminating the lower SVC.  No\ngross abnormalities seen at the chest port site.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Mild residual soft tissue\nin the anterior mediastinum is consistent with remnant thymus in a patient of\nthis age.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Possible 10 mm splenic vein varix (series 2, image 99), partially\nvisualized.  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Mild motion at the lung bases.  Within this limitation, no evidence of\npulmonary embolism.\n2. Right chest wall port with tip terminating at the lower SVC.  No overt\nthrombosis, an unremarkable appearance of the port site.\n3. Mildly prominent main pulmonary artery measuring 3 cm.  This could be seen\nin setting of pulmonary hypertension."
        },
        {
            "input": "Thoracic aorta is normal in course and caliber without appreciable\natherosclerotic calcification.  There is no evidence of aortic dissection or\naneurysm.  The main pulmonary artery is normal in caliber.  There is no\nfilling defect seen within the branches of the pulmonary arterial tree to\nsuggest the presence of a pulmonary embolism.  There is soft tissue density in\nthe anterior mediastinal space likely representing residual thymic tissue.  No\nadenopathy.  The heart appears normal in size and shape without pericardial\neffusion.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.\n\nNo acute abnormality seen within the imaged portion of the upper abdomen.\n\nBones: There is no worrisome lytic or blastic osseous lesion.",
            "output": "No pulmonary embolism or other acute process in the chest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The thoracic aorta is normal in course in caliber\nwithout atherosclerotic calcifications.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is soft tissue density in the anterior\nmediastinal space which is likely residual thymic tissue.  There are multiple\nsmall, non pathologically enlarged axillary lymph nodes.  No mediastinal, or\nhilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  Lungs are otherwise clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nH shaped vertebra in the thoracic spine are compatible with history of sickle\ncell disease.",
            "output": "No evidence of pulmonary embolism or acute aortic pathology."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  The aortic root\nmeasures 3.1 cm.  There is no evidence of penetrating atherosclerotic ulcer or\naortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is residual thymic tissue seen in the anterior mediastinum.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.  There is minimal dependent atelectasis\ngreater on the left.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "1 diffuse enlargement of the thyroid gland is present. No mediastinal, hilar\nor axillary lymphadenopathy seen. Heart size is top-normal. Coronary\ncalcifications are extensive. No pericardial pleural fluid is demonstrated.\nImaged portion of the upper abdomen is unremarkable.\n\nAnd airways are patent to the subsegmental level bilaterally.  No lytic or\nsclerotic lesions worrisome for infection or neoplasm present\n\nMild centrilobular emphysema is predominantly affecting the upper lobes with\nsome focal areas of moderate severity. Bi-basal atelectasis areas are present,\nsmall. No masses or consolidations worrisome for infection or neoplasm\ndemonstrated.\n\nDynamic expiration demonstrate no evidence of substantial decrease in the\ntracheal area all bronchi diameter and thus no evidence of substantial\ntracheobronchomalacia demonstrated.",
            "output": "Mild to moderate centrilobular emphysema.\n\nNo tracheal bronchomalacia demonstrated.\n\nSevere coronary artery calcifications.\n\nDiffuse thyroid enlargement with no discrete nodules, correlation with thyroid\nultrasound recommended\n\nBibasal mild linear areas of atelectasis"
        },
        {
            "input": "THORACIC INLET: The thyroid is enlarged arch but unchanged.  There are tiny\nhypodense lesions within the left lobe of thyroid.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are postsurgical changes within the upper and outer\nquadrant of the left breast adjacent to the surgical clips.  There is diffuse\nthickening overlying the left breast which could be related to prior radiation\ntherapy.  There are enlarged left axillary lymph nodes.  The largest measuring\n2.4 x 2.1 cm.  Other smaller left axillary lymph nodes are also seen.  There\nare small left subpectoral lymph nodes the largest measuring 8 mm.  There are\nsmall right axillary lymph nodes measuring up to 6 mm.  There are no enlarged\ninternal mammary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is moderate upper lobe predominant emphysema.  There is a 3 mm\nnodule in the left lower lobe (6, 2 1 salmon close).  There is a 2 mm nodule\nin the right upper lobe (6, 129).\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is an 8 mm hypodense lesion within the pancreas.  Please refer\nto dedicated report on abdomen which has been dictated separately.",
            "output": "Postsurgical changes in the upper and outer quadrant of the left breast with\nevidence of skin thickening overlying the left breast which could be related\nto prior radiation therapy however recurrent malignancy within the skin cannot\nbe excluded.  Correlation with inspection in history is recommended.\n\nEnlarged left axillary, left subpectoral lymph nodes as described above\nconcerning for metastasis.\n\nTiny pulmonary nodules measuring 2-3 mm are indeterminate and bear watching.\n\nPlease refer to a dedicated report on abdomen which has been dictated\nseparately for details regarding the abdomen."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric sleeve with postsurgical\nchanges.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  The colon and rectum are within normal limits.  The\nappendix is normal.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 3.0 x 4.7 x 3.8 cm fat containing lesion\nappearing to extend from the right ovary which may represent a dermoid cyst. \nThere is a gravid uterus with a single intrauterine fetus in vertex position. \nThe placenta is anterior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: At the lateral aspect of the right breast there appears to be\nasymmetric glandular tissue versus hematoma.  The lateral aspect of the left\nbreast is not visualized for point of comparison.  The abdominal and pelvic\nwall is within normal limits.",
            "output": "1. No acute intra-abdominal injury is seen.  No fractures are identified.  No\nevidence of hemoperitoneum\n2. At the lateral aspect of the right breast there appears to be asymmetric\nglandular tissue although correlation with physical exam is recommended to\nevaluate for the possibility of an underlying hematoma.\n3. Gravid uterus.\n4. Fat containing right adnexal lesion which may represent a dermoid cyst and\ncorrelation with prior pelvic ultrasounds or future nonurgent ultrasound can\nbe obtained as clinically indicated.\n\nNOTIFICATION:  Update of right breast and right adnexal findings were\nsubsequently discussed with Dr. ___ by Dr. ___ on the day of exam."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: There is a questionable 1.5 cm left thyroid\nnodule (series 4, image 18), versus streak artifact.  Supraclavicular and\naxillary lymph nodes are not enlarged.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART: Heart size is normal.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis mild dependent atelectasis in the bilateral lower lobes.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: There are mildly displaced rib fractures involving the\nright anterolateral fifth through eighth ribs (4: 89, 108, 129, 148).  There\nis a subtle nondisplaced fracture of the lateral left sixth rib (4:88).  There\nis no sternal fracture.  There is no worrisome lytic or sclerotic lesion. \nThere are mild multilevel endplate degenerative changes of the thoracic spine.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for mild\nthickening of the medial limb of the left adrenal gland (4:147).  There is a\nsmall hiatal hernia.",
            "output": "1. Minimally displaced right anterolateral fifth through eighth rib fractures\nand subtle nondisplaced left lateral sixth rib fracture.  No sternal fracture.\nNo pneumothorax.\n2. Questionable 1.5 cm left thyroid nodule, versus streak artifact.  Further\nevaluation with thyroid ultrasound is recommended.\n\nRECOMMENDATION(S):  Thyroid ultrasound is recommended, if not already\nperformed elsewhere."
        },
        {
            "input": "BASE OF NECK: The thyroid is within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary adenopathy.  Numerous enlarged\nmediastinal lymph nodes with the largest being a left paratracheal lymph node\nmeasuring 1.3 cm.  Lack of IV contrast limits evaluation of the hilum.\n\nHEART AND VASCULATURE:  The heart is normal size.  No pericardial effusion. \nCalcifications of the aortic and mitral valve.  Moderate coronary artery\ndisease.  Mild atherosclerotic calcifications of the thoracic aorta right PICC\nterminates in the distal SVC\n\nPLEURAL SPACES: Small to moderate right greater left pleural effusions with\noverlying compressive atelectasis.  No pneumothorax.\n\nLUNGS/AIRWAYS: Tracheostomy tube terminates 4 cm above the carina.  There are\npredominantly basilar reticulonodular opacification in the left greater than\nright lung base.  There are patchy areas of consolidative change with\nground-glass periphery all lungs predominantly the left lower and upper lobe\nand to a lesser extent in the right lung.  There are areas of smooth septal\nthickening with dot few ground-glass opacification which is suggestive of mild\npulmonary vascular congestion and interstitial edema.\n\nABDOMEN:  Partially visualized gastrostomy tube is seen.  The upper abdomen is\notherwise unremarkable.\n\nBONES: Degenerative changes of the spine.  No suspicious osseous lesion",
            "output": "1. Multifocal pneumonia with superimposed mild interstitial lung.\n2. Suspected mild superimposed pulmonary vascular congestion and interstitial\nedema.\n3. Small to moderate bilateral pleural effusions.\n4. Mediastinal adenopathy measuring up to 1.3 cm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.  Mild symmetric\ngynecomastia is noted.\n\nUPPER ABDOMEN: Limited view of the upper abdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy within limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart is of normal size.  There are extensive coronary\nartery calcifications.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild apical predominant paraseptal emphysema. \nMultiple nodules bilaterally are unchanged compared to prior exam in ___\n(5:64, 91, 176, 179, 168, 171,, 138, 209, 213, 157).  No new or growing\npulmonary nodules.\n2. AIRWAYS:  Airways are patent subsegmental levels bilaterally.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are of normal caliber. \nThere are mild atherosclerotic calcifications of the aortic arch and of the\nneck vessels.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "Several year stability of multiple bilateral pulmonary nodules for which no\nfurther imaging follow-up is required.  Consider enrollment in CT lung cancer\nscreening program if warranted by smoking history."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is mildly dilated, measuring up to 3.4 cm, previously\n3.0 cm.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart is mildly enlarged.  The\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are multiple bilateral pulmonary nodules, not\nsubstantially changed from prior (for example, 03:48, 67, 92, 114, 142). \nFocal ground-glass opacity is noted in the right upper lobe (3: 44, 80), which\nis new since prior, nonspecific, and may be infectious or inflammatory in\netiology.  There is mild septal thickening.  There is mild bilateral dependent\natelectasis.  There is mild apical predominant paraseptal emphysema.  The\nairways are patent to the level of the segmental bronchi bilaterally with mild\nbronchial wall thickening centrally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. There is mild dilation of the main pulmonary artery, which is nonspecific,\nthough can be seen with pulmonary arterial hypertension.\n3. The heart is mildly enlarged, and there is mild septal thickening,\nsuggestive of pulmonary edema.\n4. Multiple bilateral pulmonary nodules are not significantly changed from\nprior.\n5. Ground-glass opacities which are new since ___, nonspecific,\npotentially infectious or inflammatory."
        },
        {
            "input": "Mild calcified atherosclerotic plaques are noted with throughout the imaged\nthoracic aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThe thyroid gland appears unremarkable.  The heart is mildly enlarged.  There\nis no evidence of pericardial effusion. There is no pleural effusion.\n\nExtensive right hilar soft tissue and confluent lymphadenopathy is noted,\nmeasuring approximately 6.6 x 4.8 x 2.3 cm (2:51, 601b:36).  This causes\nsignificant mass-effect on, and stenosis of, the right lower lobe bronchus\n(02:54).\n\nModerate centrilobular emphysema is noted predominantly within the bilateral\nupper lobes.  Right basilar atelectasis is noted.  There are 4 mm subpleural\npulmonary nodules noted within the right upper lobe (02:45) and left upper\nlobe (3:67).\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  Large, confluent right hilar lymphadenopathy versus underlying soft tissue\nmass causing compression of the right lower lobe bronchus.  Findings are\nhighly concerning for malignancy, and biopsy/bronchoscopy is recommended for\ndefinitive diagnosis.\n3.  Multiple, 4 mm bilateral solid pulmonary nodules, as above.\n\nRECOMMENDATION(S):  Large, confluent right hilar lymphadenopathy versus\nunderlying soft tissue mass causing compression of the right lower lobe\nbronchus.  Findings are highly concerning for malignancy, and\nbiopsy/bronchoscopy is recommended for definitive diagnosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and excluding the\nbreasts which require mammography for evaluation, there are no lesions in the\nimaged chest wall suspicious for malignancy.  Findings below the diaphragm\nwill be reported separately.\n\nThe right thyroid lobe is enlarged, maximum coronal diameter 23 mm, compared\nto 32 mm in ___.  As before it it is heterogeneous in texture,\nsuggesting discrete lesions as large as 12 mm across, 04:21, but the imaging\npartially compromised by contrast artifact.  If not already performed, the\nthyroid should be evaluated by ultrasound.\n\nAtherosclerotic calcification is mild to moderate in the head and neck vessels\nparticularly left common carotid and subclavian arteries proximally, and\nsevere in the coronary arteries in all branches.  Left atrium and left\nventricle are probably enlarged.  There is no pericardial or pleural effusion.\n\nLarge right hilar mass invades the mediastinum locally into the subcarinal\nlymph node station, enlarging lymph nodes to 19 mm, 4:88, previously 17mm. \nThe lesion is difficult to separate from this adjacent atelectasis.  At levels\nwhere it is clearly measurable and comparable, it is 52 x 22 mm, 02:24, 45 x\n23 mm in ___, and 23 x 39 mm, 02:29, previously 26 x 30 mm.  There is also\ngreater flattening of the posterior wall of the left atrium, but since that\nregion is devoid of pericardium, it is unclear whether there is epicardial\ninvasion.  Pericardium elsewhere is unremarkable.  9 mm left hilar lymph node\nis unchanged.  A 17 x 12 mm right retrocrural soft tissue nodule, presumably a\nmalignant lymph node, is unchanged since ___.  Measurable lymph nodes in\nthe upper and lower paratracheal and prevascular mediastinal stations are\nnumerous, but not pathologically enlarged or clearly changed since ___,\nexcept for a  8 x 13 mm left upper paratracheal node, 04:39, which is stable.\n\nSince since ___ the bronchial stent is been removed from the right main\nbronchus and bronchus intermedius.  Mass encases but does not appreciably\nnarrow the upper lobe bronchus.  Bronchial narrowing more distally however is\nsevere, including The bronchus intermedius and the basal trunk bronchus, both\nnarrowed to probe patency, 4:99, 112.  Secretions have cleared from much of\nthe right lower lobe bronchial tree, and aeration has returned to the superior\nsegment and periphery of the basal segments.  The arterial supply to the right\nlower lobe is also encased, but not as severely compromised and there is no\nevidence of gangrene in the lower lobe.\n\nEmphysema is moderate, upper lobe predominant.  A solitary 5 mm left upper\nlobe is unchanged.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Interval growth since ___, right hilar mass with local extension to the\nsubcarinal mediastinum, has noted.\n\nImproved aeration, previously collapsed, right lower lobe, following removal\nof bronchial stent.  Bronchus intermedius and lower lobe basal trunk bronchus\nare still nearly occluded."
        },
        {
            "input": "A right central venous catheter ends at the SVC-RA junction.  The thoracic\naorta is normal in caliber without evidence of dissection.  Moderate focal\natherosclerotic calcifications are unchanged.  The main, left, right pulmonary\narteries are normal in caliber.  No incidental central pulmonary emboli\nidentified.  The heart is mildly enlarged, unchanged.  Scattered common\ndiffuse extensive coronary artery calcifications are overall unchanged.  No\npericardial effusion.\n\nNo axillary or supraclavicular lymphadenopathy by CT size criteria.  A large\nright hilar mass with extension into the right mediastinal nodal stations\naround the right pulmonary artery persists but overall slightly decreased,\nalthough its maximal AP dimension measures approximately 5 cm, similar the\nprior exam.  The mass does not appear to obstruct the pulmonary vessels that\ncourse through it. The mass encases and occludes the basal trunk of the right\nlower lobe bronchus and narrows but does not occlude the right middle lobe\nbronchus, the bronchus intermedius, or the right upper lobe bronchus, similar\nto the prior exam. Minimal left hilar lymphadenopathy is unchanged.  Scattered\nparatracheal lymph nodes are overall unchanged. A 1-mm posterior mediastinal\nlymph node has increased in the interim (series 6, image 208).\n\nThe right lower lobe has now re-expanded with minimal residual atelectasis. \nNo definite new suspicious pulmonary nodule or mass.  A 3-mm left upper lobe\nsubpleural nodule has slightly decreased in the interim, previously measuring\nup to 5 mm (series 5, image 20).  Emphysema is unchanged.  No pleural effusion\nor pneumothorax.\n\nThe thyroid is diffusely enlarged with several small hypodense nodules,\noverall unchanged from the prior exam.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of the below the diaphragm findings.",
            "output": "1.  Persistent large right hilar soft tissue conglomerate, slightly decreased\nin size from the prior exam with persistent extension into the mediastinum,\nencasing the right pulmonary artery without occluding it, and encasing and\nnarrowing but not occluding the right bronchial with the exception of now\ncomplete occlusion of the basal trunk of the right lower lobe bronchus.\n\n2.  (Paradoxical) interval improvement right lower lobe aeration, despite\nocclusion of the basal trunk bronchus.\n\n3.  No new obvious suspicious pulmonary nodules.\n\n4.  Emphysema.\n\n5.  Enlarged thyroid with multiple nodules, unchanged.\n\n6.  Please refer to the dedicated CT abdomen and pelvis report from the same\nday for a description of the below the diaphragm findings."
        },
        {
            "input": "A multinodular thyroid is better assessed on prior thyroid ultrasounds. \nSupraclavicular, axillary, mediastinal, and hilar lymph nodes are not\nenlarged. Aorta and pulmonary arteries are normal size. Cardiac configuration\nis normal with extensive coronary calcification.  A right pectoral Port-A-Cath\ntip terminates within the right atrium.\n\nThe large right hilar mass with extension into the right mediastinal nodal\nstations encases but does not occlude the right lower lobe pulmonary arteries.\nThe size of this lesion is difficult to measure in the setting of new right\nlower lobe collapse but appears larger than in ___.  This lesion\nencases and significantly narrows the major right-sided bronchi.  The right\nlower lobe bronchus is completely obstructed with worsened, near complete\ncollapse of the right lower lobe and associated bronchial impaction.  Multiple\nsmall pulmonary nodules measuring up to 5 mm are stable from the prior study\n(4:65, 68, 80, 92, 130, 131, 136).  Moderate centrilobular emphysema is\nunchanged.\n\nThere is no lytic or sclerotic osseous lesion suspicious for malignancy.  Mild\ndegenerative changes are present.  A 1.7 x 1.7 cm left subcutaneous metastatic\ndeposit has increased compared with ___ (4:210), previously\nmeasuring 1.4 x 1.2 cm.\n\nPlease see separately submitted report of CT Abdomen and Pelvis from the same\ndate for description of subdiaphragmatic findings.",
            "output": "1. Mild growth since ___ of large right hilar soft tissue conglomerate\ninvading mediastinum, attenuating the right lung pulmonary arteries and\nbronchi, and obstructing the right lower lobe bronchi causing new near\ncomplete right lower lobe collapse with associated bronchial impaction.\n2. Multiple pulmonary nodules measuring up to 5 mm stable from ___.\n3. Interval increase in size of a soft tissue metastasis in the left body\nwall.\n4. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcification is mild to moderate.  The\nheart, pericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nA right central venous catheter terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary  lymphadenopathy is present.  There\nis redemonstration of a large a right hilar mass with extension into the right\nmediastinal nodal stations centered around the right pulmonary artery.  The\nmass appears slightly increased in size in AP dimension, now measuring\napproximately 6.4 cm, although exact measurement is difficult to determine due\nto surrounding pulmonary collapse.  The mass does not appear to obstruct the\npulmonary vessels that course through it, however there is persistent\nocclusion of the right lower lobe bronchus with new occlusion of the right\nmiddle lobe bronchus, causing complete collapse of the right lower and right\nmiddle lobes.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is no new pulmonary nodule or mass.  There is\nredemonstration of a 4 mm left upper lobe nodule (series 2, image 39).  There\nis moderate central emphysema.\n\nBASE OF NECK:  The thyroid gland is diffusely enlarged with several small\nhypodense nodules, better seen on prior CT examination.\n\nABDOMEN:  A 1.1 cm posterior mediastinal lymph node appears grossly stable\n(series 3, image 157).  A left adrenal nodule is increased in size, now\nmeasuring 2.6 x 1.9 cm, previously 1.1 x 1.4 cm.  An incompletely imaged\nenhancing left flank soft tissue nodule is increased in size measuring 2.1 x\n2.0 cm, previously 1.5 x 1.6 cm (series 2, image 105).\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Persistent right hilar soft tissue mass which appears slightly increased in\nsize since the prior examination, although exact measurement is difficult to\nobtain, due to new surrounding right middle and persistent right lower lobe\ncollapse.\n2.  Heterogeneity of the collapsed lungs could be secondary to progression of\nhilar mass.  However post obstructive pneumonia is not excluded.\n3. No evidence of pulmonary embolism or aortic abnormality. Pulmonary arteries\nremain encased by the mass but are not occluded.\n4.  Incompletely imaged known lesion in the left abdominal soft tissues\nappears increased in size.\n5. Interval increase in size of a left adrenal lesion.\n\nNOTIFICATION:  Final report discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 7:54 ___, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Right thyroid gland is asymmetrically enlarged, and contains several hypodense\nlesions, not significantly changed from the prior study in ___.\n\nBilateral axillary lymph nodes measure up to 7 mm in short axis on the left\n(2:26).  Sub-carinal lymphadenopathy is slightly difficult to differentiate\nfrom infiltrating mass.  Right hilar lymph nodes are slightly larger than the\nleft. No new lymphadenopathy.\n\nEvaluation of the parenchyma reveals mild background centrilobular emphysema,\nunchanged.  There is a known heterogeneous right hilar mass with extension\nmedially into the mediastinum.  Its borders are difficult to measure, but\nappears overall smaller compared to ___.  Previously noted\ncomplete right mainstem bronchus collapse has resolved.  There is still\nresidual soft tissue infiltration and mild attenuation of the posterior right\nmainstem bronchus.  The soft tissue continues to extend inferiorly and\nperipherally, narrowing the bronchus intermedius and proximal right/lower lobe\nbronchi.  Right lower lobe atelectasis persists, although substantially\nimproved.\n\nA 4mm nodule in the posterior segment right upper lobe is new from ___\n(4:104). The following pulmonary nodules are unchanged:\n- 3 mm right upper lobe (4:105)\n- 2 mm subpleural nodule in the right upper lobe (4:86)\n- 5 mm subpleural right middle lobe (4:145)\n- 4 mm left upper lobe subpleural nodule (4:92)\n\nNo pleural effusion or pneumothorax.\n\nHeart size is top-normal.  A right-sided Port-A-Cath terminates in the right\natrium.  No pericardial effusion.  Coronary calcifications are diffuse. \nThoracic aorta is normal in course and caliber, containing mild to moderate\natherosclerotic calcifications along its course.  Main pulmonary trunk is\nnormal in caliber.  Attenuation of the right lower lobe pulmonary artery\npersists as it courses through the right lower lobe mass (4:129), without\nluminal occlusion. Note is made of a filling defect in the segmental branches\nof the right upper lobe pulmonary arteries (4: 89, 93, 96), new from the\nrecent chest CT on ___, consistent with pulmonary embolism.\n\nNo lytic or sclerotic lesions concerning for malignancy.  Degenerative changes\nthroughout the thoracic spine are mild.\n\nChest wall is unremarkable.\n\nSubdiaphragmatic findings are dictated separately.",
            "output": "1. Incidental finding of pulmonary embolism in the segmental right upper lobe\nbranches.\n2. Slight interval decrease in size of infiltrative right hilar mass since\n___, with improved post-obstructive atelectasis.\n3. 4 mm right upper lobe nodule new from ___.  Other nodules\nmeasuring up to 5 mm are unchanged.\n4. Mild background centrilobular emphysema.\n5. Coronary calcifications.\n6. Multinodular thyroid gland is better assessed on prior thyroid ultrasound.\n7. CT abdomen/pelvis dictated separately.\n\nNOTIFICATION:   The findings regarding the incidental pulmonary embolism was\ndiscussed with ___, M.D. by ___, M.D. on the telephone on ___\nat 2:56 ___, 10 minutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary\nsupraclavicular lymphadenopathy.  There is no soft tissue lesion in chest\nwall.  There is a 9 mm hypoattenuating focus in the right lobe of the thyroid\n(3:1)\n\nMEDIASTINUM: There are multiple enlarged mediastinal lymph nodes.  The largest\nis in the right lower paratracheal station measuring 1.9 cm (03:23.\n\nHILA: There is a right upper hilar mass measuring 2.7 x 2.2 x 4.2 cm. \n(302:72, 601:31) with compression of some of the traversing airways.\n\nHEART and PERICARDIUM: Heart is normal size.  There is no coronary arterial\ncalcifications.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG PARENCHYMA AND AIRWAYS:\nThere are multiple lung nodules, some of which are subpleural, largest of\nwhich is a subpleural nodule abutting the right upper lobe (302:60, 65, 90,\n136, 195).  There is mild dependent atelectasis in the bilateral lower lobes. \nThere are severe paraseptal and centrilobular emphysematous changes in the\nbilateral lungs, worse at the lung apices, with large bullae noted in the left\nupper lobe measuring 5.1 x 3.1 cm (302:80)\n\nVESSELS:  The main and right pulmonary arteries are not enlarged.  The\nthoracic aorta is not enlarged.\n\nCHEST CAGE: There is no suspicious osseous lesion.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen pelvis report on same day\nfor subdiaphragmatic findings.",
            "output": "1. Right upper hilar mass measuring 2.7 x 2.2 x 4.2 cm suspicious for a\nprimary lung neoplasm.\n2. Mediastinal lymphadenopathy, the largest of which is a right lower\nparatracheal lymph node measuring 1.9 cm.\n3. Multiple lung nodules, some of which are subpleural, measuring up to 1.0 cm\nin the right upper lobe.\n4. Severe emphysematous changes of both lungs, worse at the lung apices.\n5. 9 mm hypoattenuating nodule in the right lobe of the thyroid."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  Trace pericardial fluid is\nwithin physiologic limits.  The thoracic aorta is normal in caliber.  No\npenetrating atherosclerotic ulcer formation or evidence of dissection.  The\nmain pulmonary artery is normal in caliber.  No central pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: Right upper paratracheal lymph nodes are\nunchanged compared to ___, but slightly larger compared to ___, measuring up to 1.0 cm in short axis (series 3, images ___ and ___).  A\n1.0 cm precarinal lymph node is unchanged since ___ (series 3, image\n20).  A 0.9 cm subcarinal lymph node is unchanged since ___ (series 3,\nimage 27).  Subcentimeter AP window lymph nodes are unchanged since ___, but new since ___.  A 1.0 cm prevascular lymph node is unchanged\nsince ___, but increased since ___, when it measured 0.7 cm\n(series 3, image 11).  A 1.3 cm axillary lymph node is unchanged since\n___, but increased in size since ___, when it measured 1.0 cm\n(series 3, image 25).  No axillary lymphadenopathy.\n\nPLEURAL SPACES: Smooth pleural thickening abutting the posterior basal segment\nof the right lower lobe has slowly increased since ___.  No pleural\neffusion.\n\nLUNGS/AIRWAYS: Mild diffuse bronchial wall thickening and irregularity\ncompatible with chronic inflammation.  A 3.6 x 2.5 cm right upper lobe mass\nwith spiculated margins and a broad base to the adjacent minor fissure is\nunchanged since ___, but significantly increased in size since ___, when it measured 2.4 x 1.8 cm (series 5, image 132).  An 8 mm left lower\nlobe medial basal segment pulmonary nodule is unchanged since ___\n(series 5, image 197).  A 3 mm micronodule between the left lower lobe\nanterior and lateral basal segments is new (series 5, image 179).  A 4 mm left\nlower lobe lateral basal segment pulmonary nodule is unchanged since ___ (series 5, image 141).  Scattered ground-glass opacities predominantly in\nthe right upper lobe are mostly slightly improved.  Focal ground-glass\nopacities in the left upper lobe anterior segment is new (series 5, image\n114).  Calcified granuloma in the anterior segment of the left upper lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Incidental\nreplaced right hepatic artery arising from the superior mesenteric artery.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. A 3.6 cm right upper lobe mass with spiculated margins and a broad base to\nthe adjacent minor fissure is not significantly changed since ___,\nbut significantly increased in size since ___.  Given increased size\nand spiculated margins, malignancy is a strong consideration despite prior\ndiagnosis of organizing pneumonia.  Given broad base to the adjacent minor\nfissure, fibrous tumor is an alternative consideration.  Recommend re-biopsy\nfor further evaluation.\n2. Borderline mediastinal lymph nodes are unchanged since ___,\nminimally increased since ___.\n3. A 3 mm micronodule between the left lower lobe anterior and lateral basal\nsegments is new since ___. Otherwise, small scattered nodules and\nmicro nodules are unchanged.  For incidentally detected multiple solid\npulmonary nodules smaller than 6mm, no CT follow-up would be recommended in a\nlow-risk patient, and an optional CT follow-up in 12 months would be\nrecommended in a high-risk patient.\n4. Slowly increased posterior right lower pleural thickening which was not\npreviously FDG avid.  This could be reassessed on future imaging.\n5. Predominantly improved multifocal ground-glass opacities most prominent in\nthe right upper lobe, possibly sequela of reported recent influenza.\n6. Chronic small airway inflammation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: This study was not tailored for evaluation of subdiaphragmatic\nsections however it shows cholecystectomy surgical clips.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  Mediastinal and hilar lymph nodes are\nsignificantly smaller than in ___, none pathologically enlarged now by\nsize criteria.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\n\nPLEURA: Small right pleural effusion, unchanged.\nLUNG:\n\n1. PARENCHYMA:  Suture lines in right upper lobe with surrounding soft tissue\nscarring.\nCalcified granuloma left upper lobe (5:76).  Stable appearance of solid\nnodules in the left lower lobe (5:150 and 149) measuring up to 5 mm.\n2. AIRWAYS:  Patent to the subsegmental levels.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: Surgical anchors in left humeral head.  Mild dorsal spondylosis. \nNo acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "Status post wedge resection in the right upper lobe.\nStable appearance of left lower pulmonary nodules since ___."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Normal stable sized lymph nodes are seen in the\nmediastinum (3, 13).  Stable mild aortic wall calcifications.  No coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable.  Status post cholecystectomy.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  Status post left humeral surgery (5, 1).  Status post resection of\na right upper lobe mass.  The soft tissue lesions surrounding the suture line\nthe right upper lobe (5, 117) has substantially increased in size. A soft\ntissue lesions surrounding the posterior aspect of the suture line (5, 139) is\nstable.  A calcified granuloma in the left upper lobe as well as 2 small\npulmonary nodules in the left lower lobe (5, 161) are unchanged.  Stable small\narea of dorsal pleural thickening at the bases of the right lower lobe.  No\nevidence of pulmonary fibrosis.",
            "output": "The solid soft tissue lesion surrounding the anterior portions of the suture\nline in the right upper lobe has substantially increased in size, whereas the\nposterior aspect of the soft tissue structure is stable.  Biopsy should be\nstrongly considered to exclude recurrence.  The pre-existing pulmonary nodules\nand the calcified granuloma in the left upper lobe are stable."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, or dissection.  Mild fusiform dilatation of the mid\ndescending thoracic aorta is noted.  There is mild-to-moderate atherosclerotic\ndisease of the great vessels.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is supraclavicular, mediastinal, and hilar lymphadenopathy, seen\nmeasuring up to 1.9 x 1.2 cm in size at the sub-carinal lymph node chain\n(series 5; image 57) and 2-cm x 1.6-cm in the precarinal region (5;53). The\nthyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There are bilateral,\nnonhemorrhagic, pleural effusions, right greater than left.\n\nThere is evidence of underlying centrilobular and paraseptal emphysema. \nCompressive bibasilar atelectasis is appreciated immediately adjacent to\nabove-mentioned pleural effusions.  In the right lower lobe, there is a 2.9 x\n1.9 cm soft tissue density mass (series 5; image 61) which causes occlusion of\nthe posterior basal segment bronchus as well as narrowing of the lateral and\nmedial basal segment bronchi.  The right lower lobe pulmonary vein and artery\nabut this mass without definite evidence of occlusion.  There is some\nsuggestion of surrounding consolidation, which may be postobstructive in\nnature.  Additionally there is a ground-glass opacity in the bilateral lower\nlobes which is suggestive of a mild pulmonary edema.  0.6 cm nodule is\nappreciated in the left upper lobe (series 5; image 68).  The airways are\notherwise patent to the subsegmental level.\n\nLimited images of the upper abdomen show a 4.1 x 3.5 cm hypodensity at the\nliver dome, which is incompletely characterized on this exam, but may\nrepresent hemangioma.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nUnchanged comminuted fracture the proximal left humerus involving the surgical\nneck and greater tuberosity.",
            "output": "1. No evidence of pulmonary embolism.\n2. 2.9 x 1.9 cm soft tissue density mass in the right lower lobe causing\nobstruction of the right posterior basal segmental and narrowing of the medial\nand lateral basal segmental bronchi.  Surrounding opacification may be\nsuggestive of early postobstructive pneumonia.  Significant supraclavicular,\nmediastinal, and hilar adenopathy, measuring up to 2-cm in size.  Bilateral\npleural effusions, right greater than left.  All these findings on a\nbackground of significant emphysema are concerning for neoplastic process. \nPET-CT is recommended for further evaluation of these findings.\n3. 4.1 x 3.5 cm hypodensity at the liver dome is incompletely characterized on\nthis exam, but may represent hemangioma.\n4. Unchanged chronic comminuted fracture of the proximal left humerus with\nsurrounding callus formation.\n5. Mild aneurysmal dilatation of the low to mid descending thoracic aorta is\nincidentally noted.\n\nRECOMMENDATION(S):  Recommend PET-CT for further evaluation of right lower\nlobe lung mass and associated findings.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:42 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Extensive\natherosclerotic calcifications of the great vessels, ascending aorta, aortic\narch, thoracic aorta, and coronary arteries appear unchanged.  Otherwise, the\nheart, pericardium, and great vessels are unremarkable based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Supraclavicular, mediastinal and hilar\nlymphadenopathy appears similar to prior; for example, a 1.2 cm subcarinal\nnode is unchanged (5:95).  No axillary lymphadenopathy is present.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Severe centrilobular and paraseptal emphysema is\nredemonstrated.   In the right lower lobe, a 3.0 x 1.9 cm soft tissue density\narea (5:123), correlating with the patient's suspected malignancy, appears to\nocclude the posterior basal segmental bronchus and narrow the lateral basal\nsegmental bronchus, similar to prior.  Aeration in the right lower lobe\nappears improved from prior with residual mild bilateral lower lobe\natelectasis.  An approximately 6 mm left upper lobe pulmonary nodule (5:120)\nis unchanged.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: An approximately 4.4 cm x 3.4 cm hepatic cyst in the right lobe\nappears unchanged.  Otherwise, the included portion of the unenhanced upper\nabdomen is unremarkable.\n\nBONES: No acute fracture is identified.  Rib deformities of the right anterior\nfourth and fifth and left anterior third through fifth ribs are likely\nchronic.  Chronic fracture of the proximal left humerus appears similar to\nprior.  The bones appear diffusely osteopenic.  Multilevel degenerative\nchanges of the cervical and thoracic spine.  No suspicious osseous abnormality\nis seen.?",
            "output": "1. No acute intrathoracic abnormality.  No acute rib fractures.\n2. Unchanged proximal left humerus fracture and multiple, bilateral rib\ndeformities.\n3. Approximately 3.0 x 1.9 cm soft tissue density in the right lower lobe,\nwith persistent occlusion of the posterior basal segmental bronchus and\nnarrowing of the lateral basal segmental bronchus, with improved aeration of\nthe right lower lobe.  This density appears similar to prior and is suspicious\nfor malignancy."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There are\nmild scattered atherosclerotic calcifications about the aortic arch, including\nthe proximal left subclavian artery, and the descending thoracic aorta.  There\nis a normal variant common origin of the left common carotid and right\nbrachiocephalic arteries.  Linear tram track calcifications in the\ndistribution of the right coronary artery may represent stent or\natherosclerotic disease.  Otherwise, there are extensive coronary artery\ncalcifications throughout.  The heart is normal in size.  There is trace\npericardial fluid.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lungs are mildly hyperexpanded and the diaphragms are\nflattened, consistent with known chronic pulmonary disease.  Lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: A 1.9 cm ovoid density posterior to the right thyroid lobe\n(05:31) is indeterminate but may represent an exophytic thyroid nodule\n(05:31).  An ill-defined hypodensity in the right thyroid lobe measuring\napproximately 1.3 cm is also noted.\n\nABDOMEN: The partially visualized gallbladder contains numerous layering\ngallstones without evidence of wall thickening or pericholecystic fluid where\nseen.  There are numerous oval hypodense structures measuring up to 9.0 cm\n(5:326) exhibit scant peripheral calcifications and contain simple fluid, and\nare presumably renal cysts.  Multiple exophytic hypodensities throughout the\npartially visualized right kidney measures simple fluid attenuation and likely\nrepresent cysts as well.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Mild atherosclerotic calcification about the aortic arch and descending\nthoracic aorta.\n2. Extensive coronary artery disease with linear calcifications in the\ndistribution of the right coronary artery which may represent stenting or\natherosclerotic disease.\n3. Hyperexpanded lungs in keeping with known chronic obstructive pulmonary\ndisease.\n4. Trace pericardial fluid may be within physiologic limits.  No cardiomegaly.\n5. Cholelithiasis.  No evidence of acute cholecystitis where the gallbladder\nis visualized.\n6. Numerous partially visualized fluid containing structures in the left upper\nquadrant are presumably renal cysts which measure up to 9.0 cm where seen.  If\nnot previously known, non urgent ultrasound may be obtained for further\nevaluation."
        },
        {
            "input": "The aortic valve is heavily calcified, and diffuse severe coronary artery\ncalcifications are also present. The thoracic aorta is ectatic, measuring up\nto 3.9 cm in the ascending aorta. Atheromatous calcifications are mild in the\nascending aorta, marked in the aortic arch with extension in to the great\nvessels, and severe in the descending thoracic aorta. Severe abdominal aortic\ncalcifications are also present.\n\n\nHeart is moderately enlarged with particular prominence of the left ventricle,\nand there is no evidence of pericardial effusion. Central pulmonary arteries\nare enlarged. Moderate right and small dependent left pleural effusions are\npresent. Moderate hiatal hernia is noted.\n\nWithin the lungs, smoothly thickened septal lines and ground-glass\nopacification are consistent with hydrostatic edema. There is also a\nsuggestion of subpleural reticulation in the upper lobes, most likely due to a\nnonspecific scarring.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of a calcified gallstone within the gallbladder and diffuse vascular\ncalcifications\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine\n\n.",
            "output": "1.  Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis. Ectatic thoracic aorta measuring up to 3.9 cm in the ascending\nregion.  Atheromatous calcifications as described.  These images are available\nfor preoperative review.\n\n2.  Severe diffuse coronary artery calcifications.  Enlarged central pulmonary\nartery suggestive of pulmonary arterial hypertension\n\n3.  Hydrostatic pulmonary edema and bilateral pleural effusions, right greater\nthan left.\n\n4. Moderate hiatal hernia and calcified gallstone."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Atherosclerotic\ncalcifications vs cardiac stents noted within the left anterior descending\ncoronary artery.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Bibasilar atelectasis is present.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is unremarkable.\nSupraclavicular and axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: An irregular nodular mass along the medial right pleural surface\nis noted adjacent to the mediastinum, measuring approximately 5.6 x 1.9 x 5.3\ncm (7:120).  No definite invasion into the mediastinum is detected.  There is\nno other mediastinal lymphadenopathy.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with extensive coronary artery calcifications. There is no\npericardial effusion.\n\nPLEURA: The known small to moderate right-sided pneumothorax is identified.  A\npigtail catheter terminates in the right lower pleural space.  There is a\nsmall nonhemorrhagic pleural effusion on the right.\n\nThere are several heterogeneously enhancing pleural-based nodular soft tissue\nmasses on the right, concerning for metastatic deposits.  A large\nconglomeration measures approximately 6.7 x 3.3 cm in the anterior right lower\npleural space (7:240).  Superiorly at the lung apex, there is a 2.7 x 1.9 cm\nenhancing pleural mass (07:42).  Similar masses along the lateral right chest\nwall measure up to 3.1 x 1.3 cm.  Finally, an enhancing pleural mass along the\nright posterior chest wall measures up to 5.4 x 2.2 cm (7:221).\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Nodularity\nalong the right major fissure is new, measuring up to 7 mm (7:156).  Bibasilar\natelectasis is noted.  More focal consolidation in the right lower lobe is\nidentified, for which superimposed infection is considered in the appropriate\nclinical setting (7:234). The left lung is grossly clear, except for minimal\nbasilar atelectasis.\n\nUPPER ABDOMEN:  Please refer to the dedicated CT abdomen and pelvis report of\nthe same date for the subdiaphragmatic findings.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Moderate multilevel degenerative changes of the thoracic spine are\nagain seen.",
            "output": "1.  Since ___, numerous heterogeneously enhancing pleural-based\nsoft tissue masses on the right are new and are concerning for metastatic\ndeposits.  These measure up to 6.7 cm in the anterior right lower pleural\nspace, and 5.6 cm adjacent to the mediastinum.  Nodularity along the right\nmajor fissure is new.\n\n2.  Small area of dense consolidation in the right lower lobe with air\nbronchograms, for which superimposed infection is considered in the\nappropriate clinical setting.  Alternatively, this could be due to aspiration.\n\n3.  Small to moderate right pneumothorax, with pigtail catheter in place in\nthe right lower pleural space.\n\n4.  Small nonhemorrhagic right pleural effusion.\n\n5.  Please refer to dedicated CT abdomen and pelvis report for the\nsubdiaphragmatic findings.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 12:25 on ___, 5 min after discovery."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The right\npulmonary artery is mildly enlarged up to 2.7 cm, in the main pulmonary artery\nis borderline enlarged up to 2.9 cm.  The heart is stably enlarged with\ndiffuse coronary artery calcifications.  Patient is status post TAVR.  No\npericardial effusion is seen.  A left chest wall pacemaker has leads\nterminating in the right atrium and right ventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple subcentimeter anterior mediastinal\nlymph nodes are not significantly changed.  There is new anterior mediastinal\nstranding which is likely secondary to recent surgery.  No axillary or\nmediastinal lymphadenopathy is present.  No mediastinal mass or hematoma. \nThere is stranding in the left axilla around the left subclavian and axillary\nveins with multiple subcentimeter adjacent lymph nodes, likely due to\ncongestion from known central venous thrombosis in the left upper extremity.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is unchanged reticular changes in the bilateral lungs\nsuggestive of interstitial lung disease.  No new focal consolidation.  A 4 mm\nright apical pulmonary nodule is stable (302:27).  There is diffuse mild\nbronchial wall thickening, similar to prior.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is cholelithiasis without evidence of acute cholecystitis. \nMild hepatic steatosis.  Slight hypodensity along the falciform ligament is\nlikely due to focal fat deposition or sparring.  There is fatty atrophy of the\nvisualized portion of the pancreas.  There are colonic diverticula without\nevidence of acute diverticulitis.\n\nBONES: There are severe degenerative changes of the bilateral shoulders.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Unchanged reticulation in the bilateral lungs suggestive of interstitial\nlung disease. No focal consolidation.\n2. New anterior mediastinal stranding, possibly secondary to recent\nintervention.\n3. Stranding in the left axilla surrounding the left subclavian and axillary\nveins, with multiple adjacent subcentimeter axillary lymph nodes, likely\nsecondary to congestion from known left upper extremity deep venous thrombus.\n4. Cholelithiasis.\n5. Stable 4 mm right apical pulmonary nodule.  See follow-up recommendations\nbelow.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE:\n\nMotion artifact limits evaluation.  Within this limitation, the heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  Coronary artery calcifications are noted.  There is\nmoderate atherosclerotic calcification, with notable calcification at the\npartially visualized origin of the celiac axis.  There are extensive upper\nextremity collaterals.  There is narrowing of the left brachiocephalic and\nleft subclavian veins.  Patient is status post TAVR.\n\nMain pulmonary artery is borderline enlarged, measuring up to 2.8 cm, similar\nprior.  Pulmonary vasculature is well opacified to the subsegmental level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Paratracheal and prevascular lymph nodes measure\nup to 0.7 cm, similar to prior.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Motion artifact limits evaluation.  Within this limitation,\nthere is suggestion of air trapping, which could also be related to expiratory\nphase scanning.  There is mild bibasilar atelectasis.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a small hiatal\nhernia.  There is cholelithiasis without evidence of acute cholecystitis.\n\nBONES: Partially visualized right glenohumeral joint is notable for severe\ndegenerative changes, including subchondral sclerosis and cyst formation,\njoint space narrowing with inferomedial bone-on-bone configuration, and\nmultiple osseous fragments (for example, 03:29, 3:61).  There is kyphosis of\nthe cervical lumbar spine with multilevel moderate to severe degenerative\nchange.\n\nCHEST WALL: Left chest wall pacemaker seen.",
            "output": "1. Motion artifact limits evaluation. Within this limitation, there is no\nevidence of pulmonary embolism or acute aortic abnormality.  Status post TAVR\nwhich appears patent.  Narrowing of the left brachiocephalic and and possibly\nthe left subclavian vein with extensive upper chest/extremity collaterals.\n2. Severe degenerative change at the partially visualized right glenohumeral\njoint.  Loose body seen adjacent to the shoulder joint.\n3. Additional findings as described above."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  Left ICD is in stable position.  There are no chest wall\nabnormalities.  Mild atherosclerotic calcifications in the distal\nbrachiocephalic trunk and proximal left subclavian arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Multiple central mediastinal lymph nodes ranging\nfrom 5-20 mm are larger than in the immediate prior study, most likely\nreactive, for example 1 in the lower paratracheal station is 20 mm, previously\nwas 13 mm (4:87).  Hilar contours show no evidence of enlarged lymph nodes\nwithin the limitations of a noncontrast study.  Increased attenuation of the\nmediastinal fat reflects soft tissue edema.\n\nHEART, PERICARDIUM AND VASCULATURE:\nMild cardiomegaly is stable.  Unchanged appearance of the aortic valve\nprosthesis.  No pericardial effusion.  Stable moderate atherosclerotic\ncalcifications in the coronary arteries, specially in the LAD. Aorta and\npulmonary arteries are top normal in caliber.\n\nLUNGS, AIRWAYS, AND PLEURA:\nSubstantial motion artifact limits the proper assessment of the pulmonary\nparenchyma, within these limitations new multiple pulmonary nodules ranging\nfrom 2-15 mm (12:107, 140) are most likely infectious in nature.  Associated\nmultifocal peribronchovascular consolidations more evident in the left upper\nlobe (12: 51, 56) but also present in the right middle lobe (12:128) are\nattributed to multifocal pneumonia\n\nBackground ground-glass opacities and interlobular septal thickening reflect\npulmonary edema.  The airways are patent to the subsegmental levels without\nevidence of mucous plugging.  No pleural effusion.\n\nCHEST CAGE:\nNo acute fractures.  Moderate dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Partially imaged adrenal glands are unremarkable.",
            "output": "Multiple bilateral pulmonary nodules and peribronchovascular consolidations\nare attributed to multifocal pneumonia.\n\nConcurrent mild pulmonary edema.  No pleural effusion.\n\nMultiple enlarged mediastinal lymph nodes are most likely reactive."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Previous edema in\nthe chest wall has resolved, and there is no discrete soft tissue abnormality\nin the chest wall.  This study is not appropriate for subdiaphragmatic\ndiagnosis.  No adrenal abnormality or subphrenic collection.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in the head neck vessels, more severe in the coronary arteries,\nespecially LAD.  T AVR in place, with no associated abnormality.  Atrial\nventricular pacer leads also in expected locations.  Moderate cardiomegaly\nunchanged.  Pericardium physiologic.  Echocardiography would be needed for\ncardiac assessment and evaluation of mild pulmonary artery dilatation. \nPrevious edema in the mediastinum has resolved\n\nTHORACIC LYMPH NODES: Moderate enlargement of numerous mediastinal lymph\nnodes, in all stations, prevascular, upper and lower paratracheal, posterior\nparaesophageal ranging up to 18 mm has not changed appreciably since ___.  No vital structures are compromised.\n\nLUNGS, AIRWAYS, PLEURAE: Once again, respiratory motion obscures fine detail,\nbut previous background of pulmonary edema has improved in the upper lungs,\nthough it persists at the lung bases.  Venous engorgement persists in the\nright upper lobe.\n\nPrevious regions of consolidation in the left upper lung are smaller, 5:39\ntoday compared to 4:54 on ___ compared to 4:62.  Minimal\nbronchiectasis  in the right upper lung, 5:104 could be the residual of\ninfection, mild previous right upper lobe consolidation is also resolving\nslowly, 5:118 compared to 4:111.  There is no appreciable pleural effusion.\n\nCHEST CAGE: Unremarkable",
            "output": "Previous moderate pulmonary edema has nearly resolved in the upper lungs,\npersistent in the lower.\n\nPrevious multifocal pneumonia, predominantly upper lobe is improving.  Stable\nmoderate central adenopathy.\n\nSevere coronary artery calcification, LAD."
        },
        {
            "input": "Study is markedly degraded by motion.  Within these limitations:\n\nHEART AND VASCULATURE: The pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  There\nis mild atherosclerotic disease in the thoracic aorta.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\npatient is status post aortic valve repair.  There are mild coronary artery\ncalcifications.  Partially visualized is a left pectoral pacemaker with leads\nin the right atrium and right ventricle.  The heart, pericardium, and great\nvessels are otherwise within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are multiple mildly enlarged mediastinal\nlymph nodes including a 1.0 cm prevascular lymph node and a 1.0 cm precarinal\nlymph node, which are likely reactive and decreased in size compared to prior.\nNo axillary or hilar lymphadenopathy is present.  No mediastinal mass. An\nenteric tube terminates within the distal esophagus proximal to the\ngastroesophageal junction.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multifocal/multilobar airspace opacity appears slightly\ndecreased in size and density compared to the most recent prior study.  The\ntip of the endotracheal tube projects approximately 7 mm above the level of\nthe carina, near the origin of the right mainstem bronchus.  There are a small\namount of secretions within the proximal left mainstem bronchus.  There is\nbackground interstitial thickening and bronchiectasis, suggestive of\nunderlying interstitial lung disease.  Motion artifact obscures evaluation of\nthe lung bases and limits evaluation of small nodules and fine interstitial\nchanges.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for small hiatal\nhernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Compared to ___, there has been slight interval improvement in\nmultifocal pneumonia.\n2. Within the limits of this motion degraded study, no evidence of pulmonary\nembolus.\n3. The tip of the endotracheal tube is approximately 7 mm above the level the\ncarina, near the origin the right mainstem bronchus.  Slight retraction is\nadvised.\n4. The tip of the enteric tube terminates within the distal esophagus,\nproximal to the gastroesophageal junction.\n5. Background interstitial thickening and bronchiectasis are suggestive of\nunderlying interstitial lung disease.  Recommend high-resolution chest CT\nfollowing resolution of the acute episode.\n\nRECOMMENDATION(S):  HRCT for evaluation of suspected underlying interstitial\nlung disease\n\nNOTIFICATION:  The updated findings and recommendation were discussed with\n___, M.D. by ___, M.D. on the telephone on ___ at\n10:08 am, 5 minutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  There is no axillary or supraclavicular lymphadenopathy.  Right\nPICC terminates in the cavoatrial junction.  Right atrial and ventricular\npacer leads are seen contiguous with a left chest wall generator.\n\nUPPER ABDOMEN: Visualized portion of the upper abdomen demonstrates\ncholelithiasis without evidence of gallbladder wall thickening or edema. \nThere is fatty atrophy of the partially visualized pancreas .  There is a\nsmall hiatal hernia.\n\nMEDIASTINUM: Stable mildly prominent mediastinal lymph nodes measuring up to\n1.0 cm in short axis (5; 17) in the right paratracheal region.\n\nHILA: There is no evidence of hilar lymphadenopathy within limits of this\nnoncontrast scan.\n\nHEART and PERICARDIUM: There is mild cardiomegaly.  There is no pericardial\neffusion.  Moderate coronary artery calcifications are seen.  Patient is\nstatus post aortic valve replacement.\nPLEURA: There is a trace right pleural effusion.  There is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the pulmonary parenchyma is limited by\nrespiratory motion.  Within this limitation, there are bilateral nodular\nopacities, overall slightly decreased compared to prior suggestive of\nimproving multifocal pneumonia.  There are bilateral ground-glass opacities\nwith interstitial thickening suggestive of component of pulmonary edema. \nOpacities in the right lower lobe may suggest component of aspiration.  There\nare subpleural fibrotic changes predominantly in the right lower lobe, which\nmay be age related fibrosis with possible component of post infectious\nscarring and persistent bronchiectasis most notable in the right lower lobe. \nThere is mild air trapping within the right middle lobe.\n2. AIRWAYS:  There is bronchial wall thickening suggestive of mild\ninflammation.\n3. VESSELS:  There is moderate atherosclerotic calcification of the aortic\narch thoracic aorta.\n\nCHEST CAGE: Bilateral severe degenerative changes are seen in the glenohumeral\njoint.  Mild multilevel degenerative changes are seen in the spine.  No\nsuspicious osseous lesion is seen.",
            "output": "1. Study is limited by respiratory motion.\n2. Respiratory failure is likely multifactorial with findings suggestive of\npulmonary edema, peripheral right lower lobe predominant fibrotic changes, and\nopacities in the right lower lobe suggestive of aspiration.\n3. Continued improvement in bilateral multifocal opacities consistent with\nimproving multifocal pneumonia.\n4. Mild cardiomegaly.\n5. Cholelithiasis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  Main\npulmonary artery diameter is top normal; right and left pulmonary arteries are\ndilated.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.\n\nThe heart is enlarged.  Coronary artery calcifications are severe.  No\npericardial effusion.  Post aortic valve replacement changes are noted.  Lead\nwires from a left-sided pacemaker device terminate in the right atrium and\nventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: Several borderline mediastinal lymph nodes\nmeasuring up to 1.2 cm short axis (4:55) are unchanged.  No mediastinal mass.\n\nPLEURAL SPACES: Trace dependent bilateral pleural effusions are new.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Detailed evaluation is limited by respiratory motion.  There\nare worsened multifocal ground-glass opacities and areas of focal\nconsolidation in the bilateral lungs, most notable in the bilateral lower\nlobes, compatible with worsening multifocal infection.  There are similar\nsubpleural fibrotic changes, predominantly in the right lower lobe, which may\nrepresent fibrosis or scarring.\n\nMild bronchial wall thickening and bronchiectasis, predominantly in the\nbilateral lower lobes, is similar.  The endotracheal tube tip terminates\napproximately 3 cm above the carina.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the stomach.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon and rectum are within normal limits.  There is no free intraperitoneal\nfluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Grade 1 anterolisthesis of L4 on L5 and prominent posterior\ndisc bulge at this level is unchanged.  The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. No evidence of pulmonary embolism to the segmental level or acute aortic\nabnormality.\n2. Worsened multifocal pneumonia compared to ___, most prominent\nin the bilateral lower lobes.\n3. Dilated right and left pulmonary arteries, nonspecific but suggestive of\npulmonary hypertension.\n4. No acute findings in the abdomen or pelvis.\n5. Gallstones."
        },
        {
            "input": "MEDIASTINUM:  Heterogeneous thyroid without discrete nodule. No pathologically\nenlarged supraclavicular, axillary, hilar or mediastinal lymph nodes.  Small\nhiatal hernia\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Multifocal,\nclustered micronodules throughout the lungs with right apical scarring are\nlikely related to prior granulomatous exposure.  For example right middle lobe\nnumerous clustered peribronchial nodules are seen series 5, image 163 and left\nupper lobe series 5 image 110.  Multiple perifissural nodules along the right\nmajor fissure are likely lymphoid aggregate.  No suspicious pulmonary nodules\nor masses.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "Numerous, clustered micronodules scattered throughout the lungs with right\napical scarring, have the imaging appearance of prior granulomatous exposure\nrather than metastatic disease.  No lymphadenopathy, pleural or bony disease. \nNo evidence of active intrathoracic infection"
        },
        {
            "input": "MEDIASTINUM: A hyper enhancing right thyroid nodule (2:1) measures 9 mm, is\nunchanged compared to the prior study.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta is normal in size. The\npulmonary arteries are top normal in size.  The heart is mildly enlarged, and\nthere is a small pericardial effusion, similar in extent compared to the prior\nstudy.\n\nPLEURA:  Large nonhemorrhagic bilateral pleural effusions are again seen.  ,\nwith adjacent atelectasis of the bilateral lower lobes, right greater than\nleft, similar in appearance compared to the prior.\n\nLUNGS: An endotracheal tube is in place. Upper lobe predominant interstitial\ninflammatory changes in ground-glass of the aerated portions of the bilateral\nlungs is similar in extent compared to the prior study, with background\nemphysema which is moderate and worst at the apices. A focal area of more\nconsolidated appearing opacity in the right middle lobe is new (601b:22).\n\nBONES: Multiple healed right rib fractures are noted. No focal osseous lesion\nsuspicious for malignancy or infection is identified in the chest cage.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately.",
            "output": "1. Extensive background interstitial fibrosis and inflammatory disease, with\nemphysema primarily affecting the bilateral upper lobes is similar in extent\ncompared to the prior study.\n2. Small focal consolidation in the right middle lobe may represent\natelectasis, however new or worsening infection cannot be excluded.\n3. Large bilateral pleural effusions and small pericardial effusion are\nunchanged."
        },
        {
            "input": "CTA Chest:  Evaluation is limited by motion artifact. There is no filling\ndefect in the main, left, right, lobar, and segmental pulmonary arteries to\nsuggest pulmonary embolism. The subsegmental arteries are not well evaluated.\nThe thoracic aorta and main pulmonary trunk are of normal caliber.  Mild\natherosclerotic calcifications are seen along the aortic arch however there is\nno evidence of aortic dissection or aneurysm.\n\nCT Chest: Axillary, mediastinal, and hilar lymph nodes do not meet CT size\ncriteria for lymphadenopathy.  Calcified right hilar and peribronchial lymph\nnodes are likely sequelae of prior granulomatous disease. Heart is normal\nsize. There is no pericardial effusion. Moderate coronary artery\ncalcifications are predominantly present in the LAD.\n\nThe airways are patent to subsegmental level.  Evaluation of lung parenchyma\nis severely limited by motion artifact. Mild dependent bibasilar opacities are\ncompatible with atelectasis. There is no large consolidation.  No pleural\neffusion or pneumothorax.\n\nLimited view of the upper abdomen is notable for numerous punctate calcific\ndensities in the liver and spleen consistent with granulomas.\n\nNo concerning lytic or sclerotic osseous lesion is present.",
            "output": "1.  Limited by motion artifact. No evidence of pulmonary embolism to the\nsegmental level.\n\n2.  Calcified right hilar and peribronchial lymph nodes and numerous punctate\ncalcified densities in the liver and spleen are consistent with prior history\nof granulomatous disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a moderate volume right-sided pleural effusion and a\nsmall left-sided pleural effusion.\n\nLUNGS/AIRWAYS: There is compressive atelectasis of both lower lung lobes. \nThere is an area of linear atelectases in the left lower lobe.  There is a 1.5\ncm ground-glass opacity in the right apex (series 2, image 13.  Slightly\nsuperior to is a 1.1 cm focal area of subpleural consolidation (image 44)\n\nThere is a 1 point 5 cm no concerning lung mass or nodule is seen in the\natelectatic lung lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Within the partially imaged liver, there is a 2.9 cm arterially\nhyperenhancing lesion in segment 2 and a another arterially hyperenhancing\nlesion measuring 2.7 cm in segment 8.  These have the impression of a\nnonenhancing central scar and most likely represent FNH is.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolism.\n2. 1.5 cm right upper lobe ground-glass opacity, likely infectious or\ninflammatory.  Follow-up imaging in ___ weeks to demonstrate resolution\nrecommended.\n3. Moderate right and small left pleural effusions, likely related to\npatient's ovarian hyperstimulation syndrome\n4. Two hepatic lesions, incompletely characterized but favoring FNH based on\ntheir imaging appearance.  Further characterization with MRI with Eovist is\nrecommended."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The there are small mediastinal lymph nodes, most likely\nreactive.  There is a prominent right superior pericardial recess.  Esophagus\nis mildly patulous.  There is mild cardiomegaly.  Moderate coronary artery\ncalcification is also seen.\n\n\nPLEURA: There are small bilateral pleural effusions right greater than left.\n\nLUNG: There is subsegmental atelectasis in both lower lobes right greater than\nleft.  There is mild interstitial edema.\n\nMild upper lobe predominant emphysema.  No lung nodules\n\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows diffuse\nbilateral adrenal thickening.  Please refer to dedicated report on abdomen\nwhich has been dictated separately.",
            "output": "No evidence of lymphoma within the chest.\n\nBilateral pleural effusions right greater than left with bibasilar\natelectasis.\n\nSmall mediastinal lymph nodes not enlarged by size criteria."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified and without filling defect. The remaining great vessels are\nnormal in appearance.\n\nCT CHEST WITH CONTRAST:\n\nThe imaged thyroid is normal. There is no axillary, supraclavicular,\nmediastinal, or hilar lymphadenopathy by CT size criteria.  There is a\ncalcified carinal lymph node. The heart is structurally normal and there is no\npericardial effusion. Aside from trace dependent atelectasis, the lungs are\nclear without parenchymal or interstitial abnormality. The airways are patent.\nThere are no concerning pulmonary nodules. There is no pneumothorax or pleural\neffusion.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No pulmonary embolism or acute aortic syndrome.  No acute process in the\nchest."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  A PICC\nline is seen with its tip at the cavoatrial junction.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nFoci of calcification is seen below the carina which may represent a calcified\nsubcarinal lymph node.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Subsegmental\natelectasis is seen at the dependent lung bases. The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is not well assessed due to shallow\ninspiration.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No enlarged mediastinal lymph nodes.  Bilateral\nhilar lymph nodes are not pathologically enlarged, but increased in size\ncompared to the CTA from ___.  A calcified subcarinal node indicates\nprior granulomatous disease.\n\nMultiple enlarged bilateral axillary lymph nodes are noted measuring up to 0.9\ncm on the right (series 4, image 46) and 1.6 cm on the left (series 4, image\n33), new compared to ___.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Central airways are patent.  Evaluation of the lungs is limited\nby incomplete expansion.  Apparent mosaic attenuation is likely secondary to\nmild air trapping, less likely ground-glass opacities.  Of note, the\nseparately acquired abdominal/pelvic CT demonstrates better aeration of the\nlung bases than the chest CTA, and the lung bases appear clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffusely heterogenous contrast\nenhancement.  There is no evidence of focal lesions.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\nsurgically absent.  There is mild periportal edema.\n\nPANCREAS: The pancreas demonstrates normal bulk without dilatation of the main\nduct.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  There is ileocolic anastomosis in the\nright lower quadrant which is intact.  The remaining colon rectum are\nunremarkable.  The appendix is not visualized.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD is noted.  No gross adnexal abnormality.\n\nLYMPH NODES: The retroperitoneal mesenteric lymph nodes are not enlarged. \nThere are bilateral prominent, though not pathologically enlarged external\niliac and inguinal lymph nodes.  For example, the largest right inguinal lymph\nnodes measure 1.2 cm (series 5, image 83).  The largest left inguinal lymph\nnodes measures 1.1 cm (series 5, image 83) the largest pelvic lymph nodes\nmeasure 0.8 and 0.7 cm on the right and left respectively.  The inguinal lymph\nnodes are grossly unchanged while the pelvic lymph nodes may be slightly\nsmaller compared to ___.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.",
            "output": "1. No evidence for pulmonary embolism or acute aortic syndrome.  No evidence\nfor other acute abnormalities in the chest, abdomen, or pelvis.\n2. Bilateral axillary lymphadenopathy, new compared to chest CT from ___.  Bilateral nonenlarged hilar lymph nodes have increased in size since\n___.  Bilateral prominent external iliac lymph nodes have slightly\ndecreased in size compared to the abdominal CT from ___, and bilateral\nprominent nonenlarged inguinal lymph nodes are stable.  While inflammatory\netiologies could be considered, lymphoma cannot be excluded.  Tissue diagnosis\nis recommended.\n3. The liver demonstrates diffusely heterogenous contrast enhancement.  Please\ncorrelate clinically (including laboratory data) regarding the possibility of\nhepatitis, versus congestive hepatopathy in the setting of periportal edema.\n\nRECOMMENDATION(S):\n1. Tissue diagnosis of new axillary and possibly also of the persistent\ninguinal lymphadenopathy should be considered.\n2. Recommend clinical correlation, including laboratory data, regarding the\npossibility of hepatitis, versus congestive hepatopathy in the setting of\nperiportal edema.\n\nNOTIFICATION:  The updated impression 3 and 4 findings were discussed with\n___, M.D. by ___, M.D. on the telephone on ___ at\n9:06 am, 2 minutes after discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: New since ___ is a filling defect is seen\nin the right interlobar pulmonary artery extending into the segmental and\nsubsegmental branches of the anterior basal and lateral basal segments of the\nright lower lobe.  A small filling defect is also seen in the subsegmental\nbranch of the medial basal segment of the right lower lobe.  An additional\nfilling defect is also noted in the segmental branch to the apical segment of\nthe right upper lobe.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The pulmonary artery is normal\nin size.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.  There is no evidence of right heart strain.\n\nAXILLA, HILA, AND MEDIASTINUM: A prominent right hilar lymph node measuring 9\nmm is unchanged.  Bilateral axillary adenopathy measure up to 1.2 cm on the\nright, unchanged from prior.  No mediastinal adenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse bibasilar dependent ground-glass opacities, more\nprominent in the lateral basal segment of the right lower lobe.  No\nparenchymal abnormalities suggestive of pulmonary infarction at this time. \nThe airways are patent to the level of the segmental bronchi bilaterally with\nperibronchial thickening predominantly in the right lower lobe could be\nsecondary to vascular congestion.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. New pulmonary emboli in the right interlobar pulmonary artery extending\ninto segmental and subsegmental branches of the right lower lobe, and in the\napical segmental pulmonary artery of the right upper lobe.  No pulmonary\nhypertension or signs of right heart strain.\n2. Bibasilar ground-glass opacities, most prominent in the right lower lobe,\nhowever no definitive pulmonary infarction at this time.\n3. Unchanged bilateral axillary adenopathy."
        },
        {
            "input": "CHEST: The imaged base of neck is unremarkable.  The thoracic aorta is normal\nin course and caliber without significant atherosclerotic calcification.  The\nheart is normal in size with trace pericardial effusion.  The main pulmonary\nartery is enlarged measuring up to 3.2 cm, please correlate for pulmonary\narterial hypertension.  There is no filling defect seen within the branches of\nthe pulmonary arterial tree to suggest the presence of a pulmonary embolism. \nThe airways centrally patent.  There is no pleural effusion.  Hypoventilatory\nchanges in the lungs noted without worrisome nodule, mass, or consolidation. \nPlease note, on series 5, images through the lung bases demonstrate clear well\nexpanded lower lungs.\n\n Multiple enlarged axillary nodes have slightly increased since the prior\nstudy from ___, now measuring up to 1.7 cm in short axis (3:50). \nThere is no mediastinal or hilar lymphadenopathy.\n\nA lead from a left-sided AICD device terminates in the midline chest.\n\nABDOMEN: The liver enhances normally without concerning focal lesion.  A\ncalcified granuloma is noted in the liver posterior to the IVC on series 5,\nimage 19.  The spleen is normal in size.  The adrenal glands are normal\nbilaterally.  The kidneys enhance symmetrically without worrisome lesion or\nhydronephrosis.  The pancreas appears normal.  There is mild fullness of the\nright renal pelvis and right ureter without ureteral stone.  The abdominal\naorta is normal in course and caliber with mild atherosclerotic calcification.\nThere is no retroperitoneal lymphadenopathy.  No lymphadenopathy in the mid to\nupper abdomen.  There is a small hiatal hernia.  The stomach and duodenum\nappear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nileocolic anastomosis within the right lower quadrant appears uncomplicated. \nThe remaining colon and rectum are within normal limits.  No bowel\nobstruction.  There is no free intraperitoneal fluid or free air.  The urinary\nbladder is unremarkable.  There is no free fluid in the pelvis.  An IUD is\nwithin the uterus.  No adnexal mass.\n\nProminent to enlarged pelvic nodes measuring up to 1 cm in short axis are\nunchanged.  Prominent to enlarged bilateral inguinal nodes measuring up to 1.3\ncm in short axis have also not substantially changed.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Postsurgical changes within the anterior abdominal wall.",
            "output": "1.  No pulmonary embolism or acute aortic process.\n2.  Mildly enlarged main pulmonary artery up to 3.2 cm, please correlate for\npulmonary arterial hypertension.\n3.  Similar enlargement of axillary, pelvic and inguinal lymph nodes.  As\nrecommended on prior, biopsy should be considered in the absence of prior\nworkup.\n4.  Mild fullness of the right ureter and right renal pelvis without distal\nobstructing lesion.  Please correlate clinically."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy no enlarged lymph nodes in the mediastinum or in the\nhilar compartments.  Normal appearance of the cardiac structures.  No coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  Superior\npersistent left vena cava (anatomical variant).  Relatively patulous\nesophagus.  No abnormality at the level of the ribs, the sternum or the\nvertebral bodies.  New the airways are patent.  No pleural effusions.  No\npleural thickening.  No diffuse or focal parenchymal lung disease.  No\nabnormalities at the level of the larger airways.",
            "output": "No evidence of lung parenchymal or other thoracic abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nFew sub cm, not pathologically enlarged lymph nodes in the supraclavicular\nstations.\nNo axillary lymphadenopathy.\nChest wall subcutaneous edema is increased.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the abdomen and\npelvis.\n\nMEDIASTINUM: Multiple borderline lymph nodes in the mediastinum slightly\nenlarged in comparison to prior, left lower paratracheal 1.3 cm, in prior 1 cm\n(6:151), another example is subcarinal 1.4 x 2.4 cm common prior 0.8 x 1.2 cm.\nThere is no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly and no pericardial effusion.\nMild hypodensity of the cardiac chambers relative to the septum suggests\nanemia.  Scattered calcified plaques of the pericardium are unchanged.\nMinimal atherosclerotic calcifications of the coronaries, aortic valve annulus\nwith moderate calcifications along the normal caliber thoracic aorta.\nMain pulmonary artery within normal size.\n\nLUNG and PLEURA: Endotracheal tube in good position, terminate 4.5 cm from the\ncarina.\nNew bilateral small pleural effusions, left greater than right.\nNew extensive heterogeneous multilobar consolidations containing air\nbronchograms affecting predominantly the left upper and lower lobes.\n\nBilateral subtle small line thickening is more evident in the lower lobes, new\nin comparison to prior suggesting new mild vascular congestion.\n\nModerate right upper lobe and left upper lobe/lingula bronchiectasis with mild\nwall thickening and scattered mucous impactions are unchanged in comparison to\nprior.\nBranching bronchial opacities adjacent to the bronchiectasis also unchanged.\n\nCHEST CAGE: Multilevel degenerate changes in spine.\nNo suspicious bony sclerotic or lytic lesions suggesting metastases or\ninfection.",
            "output": "Multilobar pneumonia affecting both lungs, more extensively the left lower\nlobe.\nSmall bilateral pleural effusions, left greater than right are also new and\nmost probably reactive.\nMild bronchiectasis and bronchial inflammation."
        },
        {
            "input": "Aorta and pulmonary arteries demonstrate normal opacification.  Main pulmonary\nartery is normal but right pulmonary artery is mildly dilated, nonspecific. \nHeart size is normal.  There is no pericardial or pleural effusion.  Coronary\ncalcifications are present.  Bilateral hilar lymph nodes approaching 1 cm.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nThe study was obtained with expiratory effort, airways are patent but\nnarrowing of the bronchus intermedius is demonstrated as well as mild\nnarrowing of the right upper lobe bronchus and left main bronchus with no\nfrank bronchomalacia.  Right upper lobe cavitary lesion, series 5, image 45 is\n14 x 20 mm in diameter with a thickened and irregular walls and is associated\nwith adjacent pleural thickening.  Severe emphysema is present.  Extensive\nsecretions in the airways are noted.  Note is made that this study is slightly\ndegraded by motion does small pulmonary no more nodules might be overlooked. \nLeft lower lobe subpleural opacity, series 5, image 123 is approximately 6 mm\nin diameter and might represent pulmonary nodule versus atelectasis.  Extent\nof emphysema is similar between the lower and upper lobes with potential\npredominance of the lower lobes.  There is a 3 mm subpleural right middle lobe\nnodule (series 5, image 158)\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\nwithin the thorax.  .",
            "output": "Right upper lobe cavitary lesion on the background of severe emphysema with\npresence of bilateral, right more than left hilar lymph nodes, borderline but\nprominent.\n\nExtensive secretions within the airways.\n\n2 pulmonary nodules as described.\n\nFindings are nonspecific and although the a right apical finding might\nrepresent malignancy, infectious possibility such as tuberculosis cannot be\nentirely excluded.  Correlation with tissue sampling and or sampling of the\nsputum is to be considered."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal.  There are scattered axillary and mediastinal lymph\nnodes but none that are pathologically enlarged.  The heart and mediastinum\nare normal.  Coronary artery calcifications are moderate.  The pericardium is\nintact without effusion.\n\nThe airways are patent to the subsegmental level bilaterally with multiple\nareas of mucous plugging. Mosaic attenuation of the lungs is again seen, and\nlikely related to small airways disease. There is no focal consolidation,\npneumothorax, pleural effusion, were pneumomediastinum. There is mild\nbibasilar atelectasis, right greater than left.\n\nThe esophagus is unremarkable. Views of the upper abdomen demonstrate a 14 mm\nsimple cyst in the left lobe of the liver, unchanged.  Other subcentimeter\nhypodensities scattered throughout the liver are too small to characterize,\nbut also likely represent simple cysts. The superficial soft tissues are\nnormal.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism.\n2. Mucous plugging, mild bronchial wall thickening, and mosaic attenuation of\nthe lungs, consistent with small airways disease."
        },
        {
            "input": "CT CHEST WITH CONTRAST: The partially visualized thyroid is unremarkable.\nThere is no supraclavicular, axillary, hilar or mediastinal lymphadenopathy.\nThe esophagus is grossly normal without hiatal hernia.\n\nHeart size is normal without pericardial effusion. There is leftward bowing of\nthe intraventricular septum and relative enlargement of the right ventricle\nwith respect to the left ventricle. The aorta and main thoracic vessels are\nnormal in caliber and well opacified. The main pulmonary arteries are dilated\nup to 3.2 cm. There is a moderate-size saddle embolism extending across right\nand left main pulmonary arteries joining bulky emboli in the bilateral main\npulmonary arteries which extend into the lobar and subsegmental branches of\nall the lobes.\n\nThere is no pleural effusion or pneumothorax. Lung volumes are low with\nbibasilar dependent changes.\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions. There is\nno acute fracture.\n\nUPPER ABDOMEN: This study is not designed for evaluation of the\nsubdiaphragmatic structures however the partially visualized solid organs and\nstomach are grossly normal.",
            "output": "Saddle pulmonary embolism extending into lobar and segmental branches of all\nthe lobes. There is evidence of right heart strain with leftward bowing of the\ninterventricular septum."
        },
        {
            "input": "Enteric tube is noted traversing below the diaphragm within the gastric lumen\nwith tip projecting out of the field of view of this exam.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of lung parenchyma is mildly limited due to\nexpiratory phase of imaging, particularly at the lung bases.  Within these\nlimitations, there is bibasilar atelectasis without focal consolidation or\nnodularity within the lung parenchyma.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized thyroid gland is partially obscured due to streak\nartifact.  Within these limitations, there is no large nodule for which\nfollow-up would be indicated.\n\nABDOMEN:  Included portion of the upper abdomen shows hyperdense gallbladder\nlumen, likely due gallbladder sludge. There is no surrounding stranding or\nwall thickening.  Otherwise, visualized upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.\n2. Expiratory phase of imaging limits evaluation of lung parenchyma.  Within\nthese limitations, no concerning parenchymal opacification or nodularity."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without evidence of\nfocal injury, dissection, or aneurysm.  There is no mediastinal hematoma.  The\nairways centrally patent.  The main pulmonary artery and central branches\nappear patent.  The heart is normal in size and shape.  No pleural or\npericardial effusion is seen.\n\nThere is diffuse thickening of the esophagus with mild surrounding fat\nstranding concerning for esophagitis.  There is no pneumomediastinum.\n\nLungs are clear bilaterally without focal contusion, laceration or\npneumothorax.  No worrisome nodule, mass, or consolidation.\n\nABDOMEN: The liver appears markedly hypodense concerning for steatosis though\nadditional forms of liver disease not excluded on the basis of this\nappearance.  Main portal vein is patent.  No discrete focal liver lesion is\nidentified.  Gallbladder is normal.  No biliary ductal dilation.  The pancreas\nand spleen appear intact.  Adrenals are normal.  The kidneys enhance\nsymmetrically.  No retroperitoneal hematoma.  The abdominal aorta is mildly\ncalcified and normal in course and caliber.  No adenopathy, free air or free\nfluid.  The stomach and duodenum appear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction.  There\nis no evidence of bowel or mesenteric contusion.  The appendix is normal. \nColonic diverticulosis is noted without evidence of diverticulitis.  The\nurinary bladder is partially distended appearing normal.  The prostate and\nseminal vesicles appear normal.  No pelvic sidewall or inguinal adenopathy.\n\nBONES:  There is anterior inferior dislocation of the right humeral head\nrelative to the glenoid fossa.  There is soft tissue swelling at the right\nshoulder without large hematoma.  The humeral head abuts the right axillary\nartery with mild attenuation of the artery and without occlusion.  No definite\nfracture though mild ___ deformity at the humeral head not excluded. \nThe remainder of the imaged bony structures appear intact.",
            "output": "1.  Right anterior inferior glenohumeral dislocation with possible mild\n___ impaction injury.  Associated soft tissue swelling at the right\nshoulder without large hematoma.\n2.  Diffuse esophageal thickening and adjacent fat stranding concerning for\nacute esophagitis.\n3.  Hypodense appearance of the hepatic parenchyma may be due to steatosis\nthough other forms of liver disease not excluded.\n\nNOTIFICATION:  Discussed with Dr. ___ at the time of initial\nreview."
        },
        {
            "input": "CHEST PERIMETER: Only the lower portion of the thyroid is imaged.  It is\nnormal.  Right axillary lymph node, 14 x 22 mm, 05:48, is substantially larger\nthan numerous other cm size and subcentimeter supraclavicular and axillary\nnodes.  Breast evaluation is reserved exclusively for mammography no soft\ntissue abnormalities in the chest wall concerning for malignancy or infection,\nbut edema is present in the generally fat depleted tissues.\n\nFindings below the diaphragm will be reported separately.\n\n\n\nCARDIO-MEDIASTINUM:Nasogastric tube enters the stomach.  Esophagus is\nunremarkable.  Atherosclerotic calcification is not apparent head and neck\nvessels or in the coronary arteries.  Aorta and pulmonary arteries are normal\nsize.  Cardiac evaluation would require echocardiography.  Pericardium is\nphysiologic.\n\n\nTHORACIC LYMPH NODES: Enlarged as follows:\n\nPrevascular mediastinum, numerous lymph nodes ranging up to 13 mm, 5:61.\n\nMediastinum right lower paratracheal station, up to 10 mm.\n\nRight hilus, upper pole, 16 mm, 5:80.\n\n\nLUNGS, AIRWAYS, PLEURAE: Both lower lobes are densely and relatively\nsymmetrically consolidated involving nearly the entire volume of both lobes. \nAttenuation values very widely, from 8 ___, superior segment right lower lobe,\n5:75 47 ___, left lower lobe, 5:88 58 ___, right lower lobe, 5:106 62 ___, right\nlower lobe, 5:159.  There is no frank cavitation.\n\nNonsegmental consolidation is also scattered in the right upper lobe, and\nthere is large scale ground-glass opacification and some consolidation in the\nmiddle lobe and lingula.\n\nBronchi are widely patent.\nThere is no appreciable pleural effusion.\n\n\nCHEST CAGE: No evidence of the infection.  Relatively mild central a\nimpression endplate impressions are scattered through the thoracic spine has. \nNo pathologic fractures.",
            "output": "Extremely severe bilateral lower lobe consolidation and less confluent areas\nof both consolidation and scattered ground-glass opacification.  Relative low\nattenuation values in some of the areas of consolidation suggest compromised\nperfusion.  This can be seen in pneumonia, which must be considered, but the\nother features, especially the bilateral lower lobe symmetry are reported in\nreviews of sickle cell patients with acute chest syndrome.  I believe that is\nthe major diagnosis.\n\nAxillary and central adenopathy are probably features of sickle cell anemia\nrather than reactive to infection or lympho proliferative disorder."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  Multiple\nsubcentimeter left axillary lymph nodes are unchanged in size.  An enlarged\nright axillary lymph node is also unchanged, measuring 1.3 x 2.0 cm,\npreviously 1.4 x 2.2 cm (05:21).\n\nMEDIASTINUM:  A subcentimeter prevascular lymph node is decreased in size, now\nmeasuring up to 0.8 cm, previously 1.3 cm (5:66).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is enlarged.  There is no coronary arterial calcification. \nThere is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Bilateral lower lobe consolidative opacities are\nfavored to represent atelectasis or focal scarring, although mild superimposed\ninfection cannot be excluded.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There are small, bilateral, nonhemorrhagic pleural effusions.\n\nCHEST WALL AND BONES: Similar to prior, there are multilevel central endplate\nimpressions throughout the thoracic spine in keeping with patient's history of\nsickle cell.  There is chronic sclerosis of the humeral heads, which is\nconsistent with avascular necrosis.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Small bilateral, nonhemorrhagic pleural effusions.\n2. Bilateral lower lobe consolidative opacities are favored to represent\natelectasis or focal scarring, although mild superimposed infection cannot be\nexcluded.\n3. Stable axillary lymphadenopathy.\n4. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Right-sided Swan-Ganz catheter tip projects in\nthe right main pulmonary artery.  The left-sided central line projects over\nthe cavoatrial junction.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The ET tube and NG tube are in acceptable position.  There is\nmoderate to large cardiomegaly.  There is moderate coronary artery\ncalcification.  There is evidence of prior cardiac surgery.  There is no\npericardial effusion.  Note is also made of epicardial pacer leads.  There are\nsmall mediastinal lymph nodes\n\nPLEURA: There are trace bilateral pleural effusions.\n\nLUNG: Consolidative opacities in both lower lobes most likely represents\nasymmetric pulmonary edema however superimposed aspiration pneumonia cannot be\nexcluded.  There is evidence of prior wedge resection the right lower lobe.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.  Patient status post\nmedian sternotomy.  Sternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nsplenomegaly.  Visualized liver is unremarkable.",
            "output": "Diffuse bilateral parenchymal opacities predominantly within both lower lobes\nright greater than left most likely represents resolving pulmonary edema\nsuperimposed over interstitial lung disease.  Small mediastinal lymph nodes\nare most likely reactive.\n\nThe ET tube, NG tube and Swan-Ganz catheter are in acceptable position.\n\nSmall bilateral effusions.\n\nModerate cardiomegaly.\n\nStatus post prior cardiac surgery"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The lymph nodes in the mediastinum have overall\nslightly decreased in size.  For example, a reference lesion in the thoracic\ninlet (4, 14) Has decreased from 18 to 11 mm in diameter.  A second reference\nlesion in pretracheal location (4, 19) Has decreased from 27-18 mm.  Likewise,\nthe para-aortic, right paratracheal, as well as subcarinal and bilateral hilar\nareas of lymphadenopathy have also decreased in size.  The posterior\nmediastinum is of stable appearance.  The upper abdomen is reported in detail\nin the dedicated abdominal CT report, but there is no evidence of adrenal\nlesions.  The soft tissue lesions in the posterior left-sided chest wall have\nnot substantially changed in size.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  The pre-existing pulmonary\nnodules show a mixed response.  Whereas some nodules, for example in the right\nupper lobe (6, 126) have substantially decreased in size, from approximately 9\nto approximately 3 mm in diameter, other nodules, for example in the apical\nportions of the right and left upper lobe (6, 71 and 57) are virtually\nunchanged.  Other nodules that have substantially decreased in size are\nlocated in the left lower lobe (6, 222).  There is no evidence of new\npulmonary nodules.  No nodules have grown.  No pleural effusions.  No fibrotic\nlung parenchymal changes.",
            "output": "Interval decrease in size of the stable borderline to slightly enlarged\nmediastinal lymph nodes.  Decrease in size of the majority of the pre-existing\npulmonary nodules, although some nodules continue to be stable.  No new or\ngrowing nodules.  No pleural abnormalities."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The size of the mediastinal lymph nodes has further\ndecreased, the lymph nodes are now all within normal size ranges, the just\ncontinue to be a PICC in minimally increased in number.  2 left posterior\nwell-circumscribed chest wall lesions (2, 35) are stable in size and\nmorphology.  Stable moderate coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  No adrenal abnormalities.  Stable multiple small liver cysts.\nStable moderate bilateral apical scarring.\n\nMost of the pre-existing pulmonary nodules have decreased in size, for example\nthe previous solid nodule with pleural attachment in the right lower lobe (3,\n183), the solid nodule in the right upper lobe (3, 16) (previously 3, now 1 mm\nin diameter), and the previous part solid nodule in the right upper lobe (3,\n83) (previously 12 mm, now 6 mm in diameter).  The previously largest\nreference lesion in the left lower lobe, measuring 15 mm in diameter on the\nprevious scan, now measures 8 mm in diameter on the current scan (3, 187).\nOther nodules, like for example in the left upper lobe (3, 57) are stable in\nsize and morphology.",
            "output": "The vast majority of pulmonary nodules has decreased in size, this decreases\nis illustrated in the reference lesion in the left lower lobe.  A minority of\nthe pre-existing pulmonary nodules is stable.  All mediastinal lymph nodes are\nnow normal in size."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is unremarkable.  Supraclavicular and axillary lymph\nnodes are not enlarged.  No soft tissue abnormalities in the chest wall. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification\nmild in head and neck vessels is substantial left anterior descending and\nmilder in left circumflex and right coronary arteries.  Aorta and pulmonary\narteries and cardiac chambers are normal size.  Small pericardial effusion is\nphysiologic, though slightly larger today than in ___.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Lung nodules as follows:\n\nLeft upper lobe, 11 mm, 302:38, unchanged.\n\nRight upper lobe, 8 mm, previously 7 mm.\n\nRight upper lobe mixed density lesion, previously 11 mm overall, now has only\na 5 mm soft tissue component, previously 3 mm, 302: 40-44.\n\nLeft lower lobe, 3 mm, 302:134 unchanged; 4 mm, 302:136, previously 7 mm.\n\nNo new lung nodules.\n\nTracheobronchial tree is normal to subsegmental levels and there is no pleural\nabnormality.\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No new or growing lung nodules.  2 lung nodules are stable; 4 lung nodules are\nsmaller, some substantially so.\n\nNo adenopathy or pleural abnormality.\n\nAtherosclerotic coronary calcification heaviest in the LAD."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  Minimal gynecomastia, otherwise there are no chest wall abnormalities.\nMild atherosclerotic calcifications in the supra-aortic vessels.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Stable small mediastinal lymph nodes.  No enlarged\nhilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Severe\natherosclerotic calcifications in the coronary arteries, none in the cardiac\nvalves or aorta.  Aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  Secretions are noted in\nthe distal trachea just above the carina (3:110).  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Multiple bilateral metastatic\nnodules ranging up to 9 mm are unchanged in the interval (3: 63, 78, 108, 163,\n202, 220).  No new or growing nodules.  No pleural effusions or thickening. \nMild biapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis. No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Multiple bilateral metastatic nodules ranging up to 9 mm are stable in the\ninterval.  No new or growing nodules.\n\nNo enlarged mediastinal or hilar lymph nodes.\n\nSevere coronary artery atherosclerotic disease."
        },
        {
            "input": "Heart is borderline in size.  Coronary artery calcification is detected. \nGreat vessels are unremarkable.\n\nThere is no lymphadenopathy in the chest.  No pleural or pericardial effusion.\n\nMajor airways appear widely patent.\n\nLung nodules are stable.\n\nAbdomen is reported separately.\n\nThere are no suspicious bone lesions.",
            "output": "Stable appearance of the chest."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  Heart size\nis normal.  Hyperdense myocardium might be suggestive of anemia.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally. Mild centrilobular\nemphysema is bilateral in the upper lobes.  4 mm right lower lobe subpleural\npulmonary nodule is demonstrated as well as 5 mm right middle lobe pulmonary\nnodule, both solid.  No additional nodules masses or consolidations noted.\n\n11 mm sclerotic lesion in the posterolateral aspect of 6 rib is consistent\nwith bone island.  No additional sclerotic or lytic lesions concerning for\nneoplasm or infection demonstrated.",
            "output": "Sclerotic focus in the left 6 rib most likely consistent with bone island\n\n2 sub 6 mm pulmonary nodules\n\nMinimal emphysema.\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nEvaluation of the subsegmental pulmonary arteries is limited due to artifact\nfrom respiratory motion.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart is enlarged.  The\npericardium and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  There are several\nborderline enlarged mediastinal lymph nodes, for example a 1.0 cm left lower\nparatracheal lymph node (series 2: 39).  No hilar lymphadenopathy by CT size\ncriteria.  No mediastinal mass.\n\nPLEURAL SPACES: Trace right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is somewhat limited due to\nrespiratory motion, however there are consolidative opacities in the right\nupper lobe (series 2:39).  Additionally there is mosaic attenuation in the\nlungs which could reflect air trapping.  There are numerous bilateral\npulmonary nodules measuring up to 5 mm (see series 2: 33, 40, 46, 56, 60). \nThere is diffuse mild bronchial wall thickening suggesting bronchial\ninflammation.  There is mild subpleural cystic change particularly the right\nupper lobe (series 2:36).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  A left chest generator device and transvenous\npacer/defibrillator lead is unremarkable.",
            "output": "1. No evidence of pulmonary embolism centrally through the segmental pulmonary\narteries.  Evaluation of the subsegmental pulmonary arteries is limited due to\nartifact from respiratory motion.\n2. Right upper lobe consolidative opacities are potentially\ninfection/pneumonia in the appropriate clinical setting.  If prior imaging\nfrom outside hospital is available, comparison could be made to evaluate for\npossible sarcoidosis related chronic consolidation.\n3. Borderline enlarged mediastinal lymph nodes up to 1.0 cm, which could be\nreactive or related to known sarcoidosis."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pericardial pleural\neffusion is seen.  Central venous line tip is in the right atrium.\n\nLarge right thyroid nodule is 3 x 2.7 cm, series 5, image 6.  There is no\nchange in its appearance.\n\nInterval increase in mediastinal lymph nodes as demonstrated: Pre-vascular\nlymph node has increased from 4 mm x 12 mm to 10 mm x 17 mm, sub-carinal lymph\nnode has increased from 11 mm to 22 mm.  Dot there is no left hilar\nlymphadenopathy but right hilar lymph node has increased from 3-11 mm, series\n5, image 32.  No supraclavicular lymphadenopathy is present.\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval progression of mediastinal and right hilar lymphadenopathy concerning\nfor progression of metastatic disease\n\nUnchanged large right thyroid lesion that should be assessed with thyroid\nultrasound if clinically warranted."
        },
        {
            "input": "Large right hypodense thyroid lesion spanning approximately 20 mm appears\ngrossly unchanged compared to the prior exam given differences in acquisition\ntechnique.  There is no axillary or supraclavicular lymphadenopathy.  A large\nsubcarinal lymph node measures approximately 21 mm x 25 mm, series 6, image\n143 not significantly changed compared to the prior exam.  An enlarged right\nhilar lymph node measuring 14 mm x 11 mm appears slightly improved compared to\nthe prior exam, now measuring 13 mm x 8 mm, series 6, image 155.  There is no\nleft hilar lymphadenopathy.  A previously seen pretracheal lymph node has\nimproved in size, now measuring 6 mm, previously measuring up to 13 mm, series\n6 image 80.  There is no supraclavicular lymphadenopathy.  The heart size is\nnormal.  There is no pericardial effusion.  The aorta is normal in caliber. \nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.  The main pulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on the same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nMild ___ nodularity measuring up to 2 mm within the right middle lobe,\nseries 6, image 195 appears new compared to the prior exam.  2 mm left upper\nlobe nodule, series 6, image 83 appears new compared to the prior exam.  8 mm\nleft upper lobe opacity, series 6, image 118 appears new compared to the prior\nexam.  There is no pleural effusion or pneumothorax.",
            "output": "-Overall, interval improvement is seen involving the mediastinal and right\nhilar lymphadenopathy compared to the exam from ___.\n-New ___ nodularity within the right middle lobe as well as opacities\nwithin left lung measuring up to 8 mm, could be infectious/inflammatory in\netiology.  Recommend continued attention on follow-up imaging."
        },
        {
            "input": "Hypodense right thyroid lesion measures 15 mm x 12 mm, grossly unchanged in\nappearance compared to the prior exam.  There is no axillary or\nsupraclavicular lymphadenopathy.  A large enhancing subcarinal lymph node\nmeasures 19 mm by 15 mm, series 5, image 132, improved in size compared to the\nprior exam at which time this measured up to 25 mm.  There has also been\ninterval improvement of a right hilar lymph node, now measuring up to 7 mm,\npreviously measuring up to 13 mm.  There is no left hilar lymphadenopathy.  A\n4 mm pretracheal lymph node has improved in size compared to the prior exam at\nwhich time this measured up to 6 mm.  No new lymphadenopathy is identified.\n\nHeart size is normal.  There is no pericardial effusion.  The esophagus is\nnormal without evidence of wall thickening.  The aorta is normal in caliber. \nThe main pulmonary artery is normal in caliber.  The\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nOverall, there has been interval improvement of the previously seen\n___ nodularity of the right middle lobe as well as left lung opacities\nmeasuring up to 8 mm.  No concerning new or growing pulmonary nodules are\nidentified.  There is no pleural effusion or pneumothorax.\n\n5 mm left upper lobe nodule, series 5, image 85 is unchanged compared to the\nprior exam.",
            "output": "Overall, interval improvement of the known mediastinal and right hilar\nlymphadenopathy compared to the exam from ___.  No concerning new\nor growing pulmonary nodules identified."
        },
        {
            "input": "THORACIC INLET: There is a right-sided Port-A-Cath with its tip in the right\natrium.  The thyroid has a diffusely low-density, could be related to\nthyroiditis.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal hilar lymph nodes not enlarged\nby size criteria.  Heart size is normal.  There is no pericardial effusion. \nThe aorta and pulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is minimal bibasilar atelectasis.  Stable 5 mm left upper lobe\npulmonary nodule (5, 102).  No new pulmonary nodules..\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  No focal liver lesions.",
            "output": "Stable 5 mm left upper lobe pulmonary nodule.  Stable small mediastinal lymph\nnodes.  No new pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "BASE OF NECK: The thyroid demonstrates diffusely low attenuation, with a\nhypodense nodule measuring 0.7 x 0.9 cm (302:14), similar to ___. This\ndoes not meet ACR criteria for further ultrasound evaluation.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  Distal tip of a right Port-A-Cath terminates in the\ncavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nInterval enlargement of a right lower paratracheal lymph node now measuring\n1.5 x 1.0 cm (302:77).  Subcarinal lymphadenopathy (302:107) is unchanged from\n___.  No mediastinal mass.  No hilar lymphadenopathy by CT size\ncriteria.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild biapical scarring.  4 mm ground-glass nodule in the left\nupper pole (302:78) is unchanged. Lungs are clear without masses or areas of\nparenchymal opacification.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.\n\nABDOMEN:  Please refer to same day report on CT abdomen and pelvis for\ndescription of subdiaphragmatic findings.",
            "output": "1. Interval development of new right lower paratracheal lymphadenopathy. \nPersistent subcarinal lymphadenopathy, unchanged from ___.  Close\ninterval follow-up is recommended.\n2. Stable 4 mm ground-glass nodule in the left upper pole.  No new pulmonary\nnodules or mass.\n3. Please refer to same day report on CT abdomen and pelvis for description of\nsubdiaphragmatic findings.\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months."
        },
        {
            "input": "THORACIC INLET: Right-sided Port-A-Cath tip projects to the right atrium.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes have increased in size since the\nprior study.  There is a 17 mm anterior mediastinal lymph node which was not\nseen on the prior study.  The right paratracheal lymph node now measures 18 mm\nit previously measured 14 mm.  The subcarinal lymph node measures 15 mm as\ncompared to 13 mm on the prior study.  The right hilar node measures 10 mm and\nis unchanged.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is biapical pleuroparenchymal scarring.  A 2 mm nodule in the left\nupper lobe (3, 77) is unchanged.  The no new pulmonary nodules.  Minimal\nbibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "Increase in size of mediastinal lymph nodes the the hilar nodes are unchanged\nin size.\n\nStable 2 mm left upper lobe pulmonary nodule.  No new pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "CHEST PERIMETER: 10 mm wide low-attenuation conglomerate lesion in the right\nthyroid lobe was last evaluated by thyroid ultrasound in ___. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography, including a a is 10 x 16 mm nodular\ntissue at the lateral periphery of the left breast, 3:141, present since at\nleast ___.\n\nNo soft tissue abnormalities elsewhere in the imaged chest wall.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Mid esophagus is only mildly patulous, clinically\ninsignificant..  Atherosclerotic calcification is not apparent in head neck\nvessels or in the coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Some central lymph nodes are larger, others previously\nenlarged are smaller:\n\nThoracic outlet, 7 mm, 3:28, 3-4 mm in ___.\n\nRight lower paratracheal mediastinum,d 10 x 14 mm, 3:78, previously 14 x 18\nmm.\n\nPrevascular mediastinum, 10 mm, unchanged.\n\nUpper pole right hilum, 16 x 16 mm, 3:91, previously 8 mm.\n\nPrevious inter pole right hilum, 13 mm, not measurable today.\n\nRight posterior paraesophageal mediastinum, 9 x 17 mm, previously 19 x 29 mm.\n\n\nLUNGS, AIRWAYS, PLEURAE: Multifocal, mild bronchial wall thickening, slightly\nmore pronounced today than in ___.  No bronchiectasis or retained\nsecretions or bronchiolar nodules.\n\n3-4 mm nodule, left upper lobe, 3:76, unchanged since ___ and ___.\n\nNo new or growing measurable lung nodules or any other focal lung lesion of\nconsequence.  No pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitiv\n\nE in detecting early osseous pathology than chest CT scanning.",
            "output": "No good evidence for intrathoracic malignancy.  Stable tiny solitary lung\nnodule.\n\nContinued fluctuation in central adenopathy is presumably reactive, likely to\nchemotherapy.\n\nMild bronchial inflammation could also be reaction to chemotherapy."
        },
        {
            "input": "1 aorta and pulmonary arteries are well enhanced.  Heart size is normal. \nThere is no pericardial or pleural effusion.\n\nSeveral mediastinal lymph nodes are present, ranging up to 9 mm, similar or\ndecreased since previous examination, for example pre-vascular lymph node, 5\nmm as compared to 10 mm, series 5, image 20, right lower paratracheal lymph\nnode, 5 mm as compared to 11 mm, series 5, image 22.  No new hilar,\nmediastinal axillary or supraclavicular lymph nodes demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe 4\nmm nodule, series 6, image 104 is stable.  There are no new nodules masses or\nconsolidations.  Image portion of the upper abdomen will be reviewed\nseparately as part of the CT abdomen and pelvis in corresponding report will\nbe issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease progression\n\nInterval decrease in size in mediastinal lymph nodes as described\n\nStable left upper lobe pulmonary nodule, 4 mm."
        },
        {
            "input": "For subdiaphragmatic findings, please refer to the separate abdominopelvic CT\nreport from same date.\n\nCHEST PERIMETER: There is a 9 mm hypoattenuating nodule within the isthmus of\nthe partially imaged thyroid, better evaluated on ultrasound of the thyroid\ndated ___.  Right-sided chest Port-A-Cath with the catheter tip\nterminating in the cavoatrial junction.  1.7 x 1.2 cm round soft tissue\ndensity in the left breast is nonspecific.  In retrospect, this appeared\nsimilar on CT dated ___ and CT dated ___.  Further\ncharacterization is exclusively limited to breast imaging techniques.  There\nis no axillary or supraclavicular lymphadenopathy.\n\nCARDIO-MEDIASTINUM: The heart size is normal.  The pericardium is physiologic.\nThere are no significant coronary artery calcifications.  The caliber of the\naorta and the pulmonary arteries is within normal limits.  Within the\nlimitations of this examination, there are no pulmonary arterial filling\ndefects.  There are multiple subcentimeter mediastinal lymph nodes, the\nlargest of which measures 7 mm in the left upper paratracheal station and 9 mm\nin the right lower paratracheal station (2:36), unchanged from previous.  The\nesophagus is mildly patulous, but distended with air.\n\nTHORACIC LYMPH NODES: No thoracic lymphadenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: The tracheobronchial tree is clear to the\nsubsegmental level.  Stable 4 mm nodule in the left upper lobe (302:70). \nOtherwise, there are no new pulmonary nodules or masses.  The lungs are\notherwise clear bilaterally.  The pleural surfaces are normal aside from mild\nbiapical pleuroparenchymal scarring.\n\nCHEST CAGE: There are no concerning lytic or sclerotic osseous lesions. \nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No new or growing pulmonary nodules or definitive sign of intrathoracic\nmalignancy.\n\n1.7 x 1.2 cm round soft tissue density in the left breast is nonspecific,\nbetter evaluated via breast imaging technique, such as mammography.\n\n9 mm isthmic nodule within the partially imaged thyroid does not warrant\nfollow-up imaging, last imaged via ultrasound of the thyroid in ___.\n\nRECOMMENDATION(S):  Dedicated breast imaging to further evaluate soft tissue\ndensity within the left breast.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:47 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, axillary, mediastinal, and hilar\nlymph nodes are not pathologically enlarged.  Thoracic aorta and main\npulmonary artery are normal size.  There is no coronary artery calcification. \nNo pericardial effusion is identified.  The small amount of hazy soft tissue\nstructure in the anterior mediastinum is consistent with thymus.\nThe 4.6 x 5.7 x 8.3 cm (AP by TV by SI) round cystic lesion is identified\nadjacent into the right of the esophagus, compressing and mildly displacing\nthe esophagus to the left.  Fluid- fluid level is identified within the lesion\nwith superior portion measuring simple fluid and dependent inferior layering\nportion measuring 46 ___ (6:64).\n\nRight pleural effusion is small.  Airways are patent to subsegmental levels. \nBilateral lower lobe atelectasis is minimal.\n\nNo concerning bone or soft tissue lesion is identified.  Multiple Schmorl's\nnodes are noted in the spine.\n\nLimited evaluation of the upper abdomen is notable for hyperdense material in\nthe gallbladder, likely excreted IV contrast.",
            "output": "1. 4.6 x 5.7 x 8.3 cm mediastinal cystic lesion is identified adjacent and to\nthe right of the esophagus.\n2. Fluid-fluid level within the cystic lesion may reflect debris or\nhemorrhagic contents.\n3. Small right pleural effusion, that might be potentially related to the\nprocedure, although no pneumothorax/pneumomediastinum identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The imaged thyroid gland is homogeneous without\nfocal nodularity.  The chest wall is unremarkable.  The esophagus is mildly\npatulous.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen and pelvis report from\nthe same day for complete details on subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is normal.  There is no significant\nvalvular calcifications.  Coronary calcifications are mild to moderate.\n\nPLEURA: There is no pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA:  In the right upper lobe, there is mild inflammatory\nperibronchial infiltration (4:120).  There is no suspicious pulmonary nodule. \nThe lungs are otherwise clear.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The ascending and descending aorta are not aneurysmal.  The main\nand right pulmonary arteries are normal in caliber.\nCHEST CAGE: Multiple rib fractures are again seen.  Some demonstrate interval\nhealing.  The right anterior second rib nondisplaced fracture appears new. \nThe sternal fracture at the level of the expansile lytic lesion is stable. \nMultiple severe compression deformities of the thoracic spine is unchanged\nfrom prior exam.  There is stable over 50% compression fracture involving L1\nand L2.  No new vertebral body fracture is seen in the thoracic spine.",
            "output": "-Widespread myeloma infiltrating the chest cage with multiple fractures, some\nof which demonstrate interval healing.  Likely new nondisplaced fracture of\nthe right second rib.\n-No new or enlarging suspicious pulmonary nodule or lymphadenopathy.\n-Please refer to the dedicated CT abdomen pelvis report from the same day for\ncomplete detail on subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nhomogeneous in attenuation without focal nodularity.  There is no\nsupraclavicular or axillary lymphadenopathy.  There is asymmetric left breast\nsoft tissue stranding measuring 1.5 x 1.0 cm (4:94), new since ___.\n\nUPPER ABDOMEN: Imaged portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\npericardial effusion.  Dense coronary calcifications are severe.  No\nsignificant valvular calcifications are seen.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  New since ___, there is a focal atelectasis in the\nright middle lobe measuring 2.1 x 2.2 cm along the minor fissure (4:97). \nThere are no new suspicious nodules.  Minimal ground-glass opacities likely\nrepresent mild peribronchial inflammation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.  However,\nthere is diffuse bronchial wall thickening, mildly more prominent compared to\nprior exam on ___.  In addition, there is increased dilation of the\ndistal bronchi, suggestive of acute bronchitis.\n3. VESSELS:  The ascending and descending aorta remain non aneurysmal.  The\nmain pulmonary artery is top-normal in size.\nCHEST CAGE: Upper sternal fracture is not significantly changed since ___.  Again seen are multiple healing rib fractures with more periosteal\nreaction compared to ___.  Multiple vertebral body height loss is\nstable.  No acute fractures.",
            "output": "-Peribronchial wall thickening and dilation of the distal bronchi, likely\nrepresenting acute bronchitis.\n-Atelectasis in the right middle lobe along the minor fissure, possibly\nrelated to splinted breathing due to known sternal fracture.\n-Asymmetric soft tissue stranding in the left breast, new since ___.\nUltrasound is recommended for further evaluation of possible asymmetric\ngynecomastia.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:01 pm, 10 minutes after discovery\nof the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Aortic arch\nand great vessel origin calcifications are mild.  Coronary artery\ncalcifications are moderate.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild inferolateral lingular atelectasis.  Right middle\nlobe atelectasis has resolved.  A 2 mm right lower lobe pulmonary nodule is\nunchanged (series 4, image 81).  A punctate right lower lobe pulmonary nodule\nis unchanged (series 4, image 58).  Lungs are clear without masses or areas of\nparenchymal opacification.  Diffuse moderate to severe bronchial wall\nthickening with interval worsening.  There are scattered secretions at the\nlevel of the carina extending through the bilateral mainstem bronchi to the\nlevel of the subsegmental airways.  Tiny centrilobular nodular opacities are\nnoted in keeping with small airways disease.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Nonobstructing left lower pole nephrolithiasis measuring up to 3 mm\n(series 2, image 52).\n\nBONES: There is a washed out, mottled appearance of the osseous structures in\nkeeping with diagnosis of multiple myeloma.  New cortical angularity along the\nanterior aspect of the lower manubrium suggests interval fracture.  A known\nfracture of the superior aspect of the sternum demonstrates new minimal\nposterior displacement since ___.  There is a very small amount of\nadjacent edema/hematoma.  A lower sternum fracture appears essentially\nunchanged.  An anterior right second rib fracture demonstrates increased\nbridging callus formation.  Lateral right eighth through tenth rib fractures\nappear healed and unchanged.  An anterolateral left second rib fracture\nappears unchanged multiple lower left posterior rib fractures appear\nunchanged.  A lateral left L1 transverse process fracture appears unchanged. \nExtensive compression fractures throughout the thoracic spine and visualized\nupper lumbar spine, some levels bordering on vertebral plana, are unchanged. \nRetropulsion and posterior bowing of the vertebral bodies at L1 and L2 with\nspinal canal stenosis appears unchanged.  Patient status post vertebroplasty\nwithin the lower thoracic spine unchanged.",
            "output": "1. New lower manubrium fracture.  A known fracture of the superior aspect of\nthe sternum demonstrates new minimal posterior displacement since ___.\n2. Minimally changed rib, lower sternum, and spine fractures.\n3. Diffuse bronchial wall thickening and bronchial secretions suggest\npersistent moderate to severe bronchitis superimposed on chronic small airways\ndisease with interval worsening compared to prior examination ___. \nNo focal consolidation.\n4. Nonobstructing left lower pole nephrolithiasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Scattered mediastinal lymph nodes are unchanged compared to ___.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber. \nAtherosclerotic calcifications in the aortic arch is mild.\n\nPULMONARY PARENCHYMA: The evaluation pulmonary parenchyma is limited by\nrespiratory motion.  Bronchial wall thickening is diffuse.  There is nodular\nopacity in a peribronchial distribution.  Findings are consistent with\nbronchitis/bronchiolitis, worse compared to ___.  There is more\nconfluent opacities in the bilateral lower lobes, more on the left.  This is\nconcerning for superimposed pneumonia or possible aspiration.  There is no\nemphysema.\n\nAIRWAYS:  Diffuse bronchial wall thickening as described above.  Otherwise the\nairways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are severe.  Multiple compression deformities\nare again demonstrated.  No new acute fractures.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is remarkable for\npatulous esophagus.",
            "output": "1. Diffuse bronchial wall thickening with nodular opacities in a peribronchial\ndistribution, consistent with bronchitis/bronchiolitis, worse compared ___.\n2. More confluent opacities in the bilateral lower lobes, worse on the left is\nconcerning for superimposed pneumonia or possible aspiration.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:03 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nCoronary arterial calcifications are mild.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is bibasilar bronchiectasis, bronchial wall thickening, with adjacent\nground-glass opacification and peribronchial nodular opacification, right\ngreater than left.  Findings are worse when compared with ___. \nGround-glass opacifications are also identified in the bilateral upper lobes,\nwith a nodular opacity that is new in the peripheral right upper lobe (3:54).\n\nLimited images of the upper abdomen are unremarkable, except noting a\nhypodensity in the right kidney.\n\nMultiple compression deformities of the thoracic spine, and post kyphoplasty\nstatus, again noted.  Chronic fracture of the sternum again noted.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Diffuse bronchial wall thickening and bibasilar bronchiectasis with\nnodular opacities in a peribronchial distribution, compatible with\nbronchitis/bronchiolitis, worse when compared with ___.\n3.  More confluent opacities in the bilateral lower lobes is concerning for\nsuperimposed pneumonia or aspiration."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: This study is not optimally tailored for evaluation of\nsubdiaphragmatic findings, however within this limitation there are no acute\nabnormalities identified.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  The\nthoracic aorta is normal in caliber.  There is mild atherosclerotic\ncalcification of the aortic arch.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Ground-glass opacification and peribronchial nodular\nopacification is slightly worse compared to prior study, most notably\ninvolving the lower lobes.  There is increase in size of focal ground-glass\nopacities in the right upper lobe, most notably seen in the anterolateral\nperiphery and posteriorly on series 5, image 69.\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.There is\ndiffuse bronchial wall thickening with bibasilar bronchiectasis, slightly\nworse compared to prior study.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  While this study is not optimized for the detection of pulmonary\nemboli, no central filling defect is seen.\nCHEST CAGE: Chronic fracture of the sternum is again demonstrated.  Multiple\ncompression deformities are again noted in the thoracic spine, status post\nkyphoplasty changes in the lower thoracic spine.",
            "output": "1. Increased ground-glass opacities and peribronchial nodular opacification,\nmost notably involving the bilateral lower lobes and right upper lobe,\nconsistent with worsening multifocal pneumonia.\n2. Interval worsening of diffuse bronchial wall thickening, bibasilar\nbronchiectasis, and nodular peribronchial opacities, compatible with worsening\nbronchitis/bronchiolitis."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis, but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM:Lower esophagus is moderately patulous but distended only\nwith air.  There is no mass or evidence of obstruction.  Is assessment of\nfunction would require a contrast swallow.\n\nAtherosclerotic calcification is not apparent in head and neck vessels but is\nscattered in all major coronary segments.  Aorta and pulmonary arteries and\ncardiac chambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No measurable lymph nodes are pathologically enlarged or\ngrowing.  Hilar contours on this noncontrast study do not suggest adenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: Extensive multifocal pulmonary abnormalities with\nvarying configurations suggest more than one active process\n\nThe most long-standing is peripheral consolidation most pronounced in the\nlower lobes which was developing between ___ and ___ and is more\nextensive now, traversed by mildly dilated bronchi.  A region of ground-glass\nopacity in the periphery of the right upper lobe in ___ has progressed to more\ndense peribronchial consolidation today, 7:98, also with mild intrinsic\nbronchial dilatation suggesting ground-glass infiltration was the precursor to\nthis peripheral consolidation.  The long course excludes infection and favors\ninstead eosinophilic or cryptogenic pneumonia, perhaps drug related.\n\nThere have been other dramatic changes since ___, most striking is\nground-glass opacification in the left upper lobe involving more than half the\nvolume of that lobe.  At its periphery is large region of consolidation. \nSmaller regions of ground-glass opacification and small areas of more\nconsolidative peribronchial infiltration are scattered throughout the right\nlung.\n\nBased on comparison with the conventional chest radiographs on ___ and\n___ of these, the left upper lobe ground-glass component is definitely\nnew since ___ and, I presume, so are the smaller ground-glass\ncomponents elsewhere.  These are more suggestive of acute infection, perhaps\nwith pulmonary hemorrhage.  Unfortunately, the findings are not typical are\nnot diagnostic for any pathogen, including possible fungal infection.\n\nCHEST CAGE: Extensive myomatous infiltration throughout the chest cage is\ngrossly unchanged since ___, including many is moderate and severe thoracic\nvertebral compression fractures and healing pathologic fracture through the\nupper sternal body and multiple ribs.",
            "output": "Acute multifocal pneumonia, pathogen indeterminate, includes possible fungal\ninfection.  Possibility of associated pulmonary hemorrhage, particularly in\nthe left upper lobe should be considered.\n\nProgressive chronic predominantly peripheral pneumonia, presumably not\ninfectious and attributable instead to organizing pneumonia possibly drug\nrelated, or progressive chronic eosinophilic pneumonia.  No adenopathy or\npleural effusion.\n\nWidespread atherosclerotic coronary calcification.\n\nWidespread myeloma throughout the chest cage.  Multiple moderate and severe\nbut, compared to ___, stable thoracic vertebral compression fractures and\npathologic sternal and rib fractures."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.  The esophagus is mildly patulous.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nThere is minimal diffuse ground-glass opacification which is most likely\nexpiratory.  There is minimal subsegmental atelectasis in the left upper lobe\nand both lung bases.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.  There are multiple\nbilateral healing rib fractures.  The multiple lucencies within both the axial\nand appendicular skeleton.  Bones are severely osteopenic with multiple wedge\ncompressions involving the thoracic and lumbar vertebral bodies with decrease\nin height to less than 50%.  The vertebral compressions and osteopenia is\nunchanged the since the prior study a evidence of a kyphoscoliosis, most\nlikely secondary to diffuse osteopenia and severe wedge compressions involving\nvertebral bodies\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "The severe osteopenia with multiple wedge compression involving the thoracic\nvertebral body, unchanged.  The multiple lytic lesions throughout the axial\nand ventricular skeleton consistent with known myeloma.  Multiple healing\nbilateral rib fractures.\n\nBands of atelectasis in both upper lobes.\n\nLow lung volumes.\n\nPatulous esophagus most likely related to motility disorder\n\nKyphoscoliosis, unchanged ."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.  Right anterior port with tip in\nthe right atrium.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion.  Severe\natherosclerotic calcifications in the coronary arteries, none in the cardiac\nvalves or aorta. The aorta is normal in caliber throughout.  The pulmonary\narteries enlarged measuring 3.6 cm approximately.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening within areas of mucous secretions, for example in the right main\nbronchus (4:99).  No suspicious lung nodules or masses.  Linear atelectasis in\nboth lung bases and left upper lobe..\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  2 mm calculus in the left kidney, nonobstructive (03:54). \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding.  The\nrectum is unremarkable.  Small fat containing paraumbilical hernia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\n\nBONES:\nRedemonstration of diffuse osteolytic lesions in the entire visualized\nskeleton with a chronic mildly displaced fracture in the mid sternum but with\na superimposed more recent nondisplaced fracture since the prior study as well\n(07:39).\n\nMultiple thoracolumbar compression deformities appear unchanged. \nVertebroplasty/kyphoplasty changes in T11.\n\nSoft tissue mass associated with a right posterior eleventh rib fracture\nappears increased. New callus along the anterolateral third, third and sixth\nright ribs as well as increased callus along right lateral seventh through\nninth ribs.\n\nNew callus along the left posterior tenth rib. New callus along the\nanterolateral left seventh rib and more faint new callus along the left\nlateral eighth rib.\n\nPrior surgery to the right femur.  Increased lysis in soft tissue mass along\nthe anterior left iliac crest.",
            "output": "1.   Extensive bone disease associated with multiple myeloma, mostly similar\nalthough with a couple instances where increased soft tissue masses are\nobserved suggesting progressing disease.\n\n2.  New/increased callus among a number of ribs, right greater than left\nassociated with healing response to pathological fractures.  No new acute\ndisplaced fractures visualized among ribs, but a new sternal fracture has\ndeveloped."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.  Right anterior port with tip in\nthe right atrium.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion.  Severe\natherosclerotic calcifications in the coronary arteries, none in the cardiac\nvalves or aorta. The aorta is normal in caliber throughout.  The pulmonary\narteries enlarged measuring 3.6 cm approximately.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening within areas of mucous secretions, for example in the right main\nbronchus (4:99).  No suspicious lung nodules or masses.  Linear atelectasis in\nboth lung bases and left upper lobe..\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  2 mm calculus in the left kidney, nonobstructive (03:54). \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding.  The\nrectum is unremarkable.  Small fat containing paraumbilical hernia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\n\nBONES:\nRedemonstration of diffuse osteolytic lesions in the entire visualized\nskeleton with a chronic mildly displaced fracture in the mid sternum but with\na superimposed more recent nondisplaced fracture since the prior study as well\n(07:39).\n\nMultiple thoracolumbar compression deformities appear unchanged. \nVertebroplasty/kyphoplasty changes in T11.\n\nSoft tissue mass associated with a right posterior eleventh rib fracture\nappears increased. New callus along the anterolateral third, third and sixth\nright ribs as well as increased callus along right lateral seventh through\nninth ribs.\n\nNew callus along the left posterior tenth rib. New callus along the\nanterolateral left seventh rib and more faint new callus along the left\nlateral eighth rib.\n\nPrior surgery to the right femur.  Increased lysis in soft tissue mass along\nthe anterior left iliac crest.",
            "output": "1.   Extensive bone disease associated with multiple myeloma, mostly similar\nalthough with a couple instances where increased soft tissue masses are\nobserved suggesting progressing disease.\n\n2.  New/increased callus among a number of ribs, right greater than left\nassociated with healing response to pathological fractures.  No new acute\ndisplaced fractures visualized among ribs, but a new sternal fracture has\ndeveloped."
        },
        {
            "input": "CHEST PERIMETER: No thyroid abnormality is require further imaging evaluation.\nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormality in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nnot apparent in head and neck vessels is present in left main, anterior\ndescending, circumflex and right coronary arteries.  Central venous infusion\ncatheter ends in the tricuspid valve, previously in the low right atrium.\n\nAorta and pulmonary arteries and cardiac chambers normal size.  Pericardium is\nphysiologic.  Aortic valve is not calcified.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Large regions of ground-glass opacification have\ndeveloped since ___ throughout all lobes, more pronounced in the non\ndependent upper and midlung zones, but also present in the left lower lobe. \nNumerous smaller ground-glass opacities suggest bronchiolar and acinar\ninvolvement.  Dense consolidation around long-standing bronchial inflammation\nin the posterior segment of the right lower lobe.\n\nPleural abnormality is limited to local extrusion of tumor from lytic rib\nlesions and displacement by callus at the site of healing pathologic\nfractures..\n\n\n\nCHEST CAGE: Numerous severe thoracic vertebral compression fractures due to\nprimarily lytic multiple myeloma are grossly stable.  There are no pronounced\nretropulsion fracture fragments.  Widespread lytic involvement throughout the\nrest of the chest cage is responsible for multiple pathologic fractures of the\nribs in various stages of healing, and a severe overriding of fracture in the\nmid body of the sternum, grossly unchanged since ___.",
            "output": "New, severe multifocal alveolitis throughout the lungs, accompanied by\nabnormalities of smaller sub units-bronchioles and acini.  This is most likely\ndue to infection, more likely viral than fungal.  Diffuse pulmonary hemorrhage\ncould produce the same findings.\n\nNew consolidation in region of chronic bronchial inflammation, right lower\nlobe, posterior basal segment suggests chronic aspiration and acute pneumonia,\nprobably a different pathogen than that responsible for the findings described\nabove.\n\nGlobal chest cage osseous myeloma responsible for multiple severe thoracic\ncompression and pathologic fractures in various stages of healing not grossly\nchanged since ___.\n\nNo appreciable pleural effusion."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter. No mediastinal, hilar or\naxillary lymphadenopathy is present. Heart size is normal.  Coronary\ncalcifications are extensive.  No pericardial pleural effusion is seen.\n\nImage portion of the upper abdomen demonstrate liver hypodensity consistent\nwith CT infiltration.\n\nAirways are patent to the subsegmental level bilaterally. Right upper lobe\natelectasis is minimal, series 4, image 36. Diffuse centrilobular nodules are\nminimal but might represent respiratory bronchiolitis in the appropriate\nclinical setting. Right basal atelectasis, series 4, image 135 is present.  No\nfocal consolidations to suggest infectious process demonstrated.\n\n Multiple compression fractures of the mid and lower thoracic spine are\nsimilar to previous examination, severe.  No interval progression or\nretropulsion demonstrated. Severe fracture of the sternum is old as well.\nPotentially new fracture is demonstrated in the second left rib, series 2,\nimage 8 multiple old fractures are demonstrated bilaterally with no new\nadditional fractures seen.",
            "output": "No evidence of intrathoracic infectious process.\n\nNew fracture of the second left rib at its lateral portion.\n\nUnchanged multiple severe fractures of the thoracic spine, sternum and ribs.\n\nFatty infiltration of the liver."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  Filling defects are demonstrated in the right lower lobar\npulmonary artery with segmental and subsegmental acute appearing pulmonary\nemboli in the basal segments (3:118, 130, 148).  Linear filling defects are\nalso seen within the left lower lobar and segmental branches (3:106, 117). \nThe right pulmonary artery measures up to 2.8 cm, which is top-normal.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is normal.  Coronary artery calcifications\nare moderate along the left anterior descending artery.  No pericardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Left hemidiaphragm is elevated.  Opacities in the right lower\nlobe peripherally distal to occluded pulmonary arteries are concerning for\npulmonary infarct (3:163, 199).  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 14 cm.  There are scattered\nhypodensities measuring up to 1.5 cm (2:122).\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable with\nthe exception of coarse calcifications in the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Mild compression deformity of the T12 vertebral body\nis noted.  There is a fat containing left inguinal hernia.  There is a small\nfat containing umbilical hernia.",
            "output": "1. Acute pulmonary emboli in the right lower lobar, segmental and subsegmental\npulmonary arteries.\n2. Left lower lobar, segmental and subsegmental pulmonary emboli.\n3. Peripheral ground-glass opacities at the right lung base are suspicious for\npulmonary infarcts especially given that they are downstream to occluded\npulmonary arteries.\n4. Top-normal right pulmonary artery diameter is equivocal for elevated\npulmonary arterial pressures.  No CT evidence of right ventricular strain.\n5. Splenomegaly with numerous hypodensities corresponds with hyperechoic\nlesions found on abdominal ultrasound of the same date.  These may reflect\nhemangiomas.  If there is clinical concern for lymphoma, consider an MRI on an\noutpatient basis.\n6. Mild compression deformity of the T12 vertebral body is age indeterminate\nas there is no prior imaging for comparison time.  Recommend correlation with\nhistory of trauma and physical examination and comparison with prior\nexaminations if available.\n\nRECOMMENDATION(S):  MRI abdomen as an outpatient basis if there is clinical\nconcern for splenic lymphoma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:\n\nRight-sided Port-A-Cath terminates in the right atrium.\n\nAxillary lymph nodes are not pathologically enlarged by CT size criteria and\nare unchanged in size as compared to chest CT ___.\n\nRe-demonstrated are hypoattenuated nodules in the thyroid, the larger of which\nmeasures 2.1 x 1.1 cm (4:9) in the right lobe, better evaluated on thyroid\nultrasound ___, and grossly unchanged in size, when accounting\nfor differences in technique between studies.\n\nUPPER ABDOMEN: Please refer to same day CTA abdomen and pelvis for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  Aortic annular\ncalcifications are moderate.  Coronary arterial calcifications are moderate to\nsevere.\n\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  6 mm nodule in the superior segment of the right lower lobe\nand 3 mm nodule in left upper lobe (04:26) are unchanged as compared to ___.  There is no new or enlarging pulmonary nodule.  There is no\nconsolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal caliber.\nCHEST CAGE: There is no suspicious osseous abnormality.",
            "output": "1. 6 mm right lower lobe and 3 mm left upper lobe lung nodules are unchanged\nas compared to chest CT ___.\n2. Hypoattenuated thyroid nodules are grossly unchanged and better evaluated\non thyroid ultrasound ___.\n3. Please refer to same day CTA abdomen and pelvis report for subdiaphragmatic\nfindings."
        },
        {
            "input": "THORACIC INLET: There are multiple hypodense lesions within both lobes of\nthyroid.  There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pleural effusion.  Heart size is normal.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The 6 mm nodule in the right lower lobe (3, 110) is unchanged.  A 3 mm\nleft upper lobe pulmonary nodule (3, 56) is also unchanged.  There is a new 3\nmm right upper lobe pulmonary nodule (3, 56).  Another subpleural 4 mm right\nupper lobe pulmonary nodule (3, 56) is also new.  A subpleural left lower lobe\npulmonary nodule (3, 83) measuring 3 3 mm is also new.  2 mm right lower lobe\npulmonary nodule (3, 100) is also new.  Minimal bibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\npneumobilia.  No adrenal masses.",
            "output": "Previously visualized 6 mm right lower lobe pulmonary nodule is unchanged. \nSeveral 2-3 mm subpleural bilateral pulmonary nodules are new since the prior\nstudy and bear watching.  Three-month follow-up is recommended.\n\nPlease refer to dedicated report on abdomen which has been dictated separately\nfor further details."
        },
        {
            "input": "CHEST PERIMETER: 18 mm wide right thyroid nodule, was 24 mm in ___, 20\nmm in ___.\n\nSubcentimeter left thyroid nodule stable.\n\nNo growing supraclavicular or axillary adenopathy.  Breast evaluation is\nreserved for mammography exclusively.  No soft tissue abnormalities elsewhere\nin the chest wall.\n\nFindings in the abdomen will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels.  Right supraclavicular central venous\ninfusion catheter ends in the right atrium, with no evidence of thrombosis. \nCoronary calcification is extensive in all major branches.  Aortic valvular\ncalcification is mild.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and pericardium is physiologic.  Small aortic ductus diverticulum\nis unchanged, not clinically significant.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Lung nodules:\n\n3-4 mm, right lower lobe, 3:104, unchanged since ___.\n\n3 x 4 mm ground-glass nodule, left upper lobe, 3:68, slightly more conspicuous\ntoday than in ___.\n6 x 11 mm ground-glass nodule, left upper lobe, 3:81, new since ___ mm left upper lobe nodule, 03:52, stable.\n\nPrevious right upper lobe 3 mm nodule, 03:56, has resolved.\n\n\n\nAside from mild scattered bronchial wall thickening, tracheobronchial tree is\nnormal to subsegmental levels and there is no appreciable pleural abnormality.\n\nCHEST CAGE: Unremarkable",
            "output": "New ground-glass lesion left upper lobe is more likely inflammatory than\nmalignant because of its development during so short a surveillance interval.\n\nTreatment response as follows: 2 tiny solid lung nodules are stable since\n___.  A third solid nodule which was new in ___ has resolved.  A tiny\nground-glass nodule is more readily visible but not necessarily changed. \nRight thyroid nodule continues to shrink.\n\nHeavy atherosclerotic coronary calcification."
        },
        {
            "input": "Stable bilateral thyroid nodules.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Stable\nappearance of the large mediastinal vessels.  No incidental pulmonary\nembolism.  Stable severe coronary calcifications.  No pericardial effusion. \nThe posterior mediastinum is unremarkable.  Upper abdominal organs are\ndescribed in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nModerate degenerative vertebral disease.  No vertebral compression fractures.\nStable 4 mm right lower lobe nodule (5, 134).\nStable 3 mm left upper lobe ground-glass nodule (5, 101).\nResolution of a pre-existing left upper lobe ground-glass nodule.\nNo new or growing nodules.  Minimal dependent atelectasis.  No pleural\nthickening, no pleural effusions.  The airways are patent.  No diffuse lung\ndisease.",
            "output": "Resolution of a pre-existing left upper lobe ground-glass nodule. All other\npulmonary nodules are stable.  No new or growing nodules.  No pleural\nabnormalities.  The airways are patent.  No adenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nStable thyroid 9 mm left lobe and 6 mm right lobe hypodense nodules.  Stable\nsmall axillary and thoracic inlet lymph nodes.  There are no chest wall\nabnormalities.  Right Port-A-Cath ending at the right atrium.  Mild\natherosclerotic calcifications of the origin of the bilateral vertebral\narteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is mildly patulous.  Stable small mediastinal lymph nodes.  No\nenlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nHeart is normal in size and shape.  Stable severe atherosclerotic\ncalcification in the coronary arteries, mild aortic annulus calcifications. \nAorta and pulmonary artery normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nNew left lower lobe 3 mm nodule (5:241).  Three nodules are increased in size,\nfor example two in the right lower lobe (5:155, 137) now measuring 4 mm, were\n2 mm before, and another in the right upper lobe now measuring 4 mm,\npreviously was 2 mm as well (5:95).  Remaining nodules are stable (5:42, 72,\n127).\n\nThe airways are patent to the subsegmental levels.  Mild bronchial wall\nthickening and scattered mucoid impaction.  No bronchiectasis.  No focal\nconsolidations.  No pleural effusion or thickening.  Mild biapical\npleuroparenchymal scarring\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "New left lower lobe 3 mm nodule and mild increase in size of the 3  nodules in\nthe right upper and lower lobes are concerning for progressive metastatic\ndisease. Remaining multiple bilateral pulmonary nodules ranging from 2-5 mm\nare stable.\n\nSevere coronary artery atherosclerotic disease.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A 12 mm left thyroid nodule and\nsmaller bilateral thyroid nodules are stable.  There is also a coarse\ncalcification in the right lobe of the thyroid gland which is stable.  No\nenlarged supraclavicular lymph nodes.  No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes are appreciated.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There are coronary artery\ncalcifications.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Overall, there has been disease progression.  For example, a 7\nmm nodule at the left lung base (302:182) previously measured 3 mm.  A 6 mm\nnodule in the right lower lobe adjacent to the fissure (302:127) previously\nmeasured 4 mm.  An 8 mm right lower lobe nodule (302:47) previously measured 4\nmm.  Additional pulmonary nodules have also enlarged.\n2. AIRWAYS:  The central airways are clear.\n3. VESSELS:  The thoracic aorta is normal in caliber with heavy\natherosclerotic calcifications.  The main pulmonary artery is normal in\ncaliber.\n\nUPPER ABDOMEN: The study is not tailored to subdiaphragmatic evaluation. \nPlease see the same day CT report for additional details.\n\nCHEST CAGE: No suspicious lytic or sclerotic lesions.",
            "output": "Progressive disease with enlarging pulmonary nodules."
        },
        {
            "input": "The left thyroid lobe demonstrates a 11 mm hypodensity, unchanged in\nappearance compared to the prior exam.  A 6 mm hypodensity is seen within the\nright thyroid lobe.  There is no supraclavicular, mediastinal, or hilar\nlymphadenopathy.  The heart size is normal.  There is no pericardial effusion.\nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.  The aorta is normal in caliber.  The main pulmonary artery is normal\nin caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nOverall, there has been interval increase in diffuse metastatic disease\nthroughout the lungs bilaterally.\n\nThere has been interval increase in the extent of the solid component of the\nlesion within the right upper lobe (6; 62), now measuring up to 11 mm x 8 mm,\npreviously measuring no more than 8 mm2 x 6 mm.\n\n-a 6 mm x 6 mm lesion within the right upper lobe (6; 71), has also increase\nin the extent of the soft tissue component of the lesion.\n\n-there has been an interval increase in soft tissue component of the lesions\nwithin the left upper lobe, now measuring up to 9 mm x 11 mm (6; 78)\n\n-a 10 mm x 10 mm lesion within the right upper lobe (6; 99), has increased in\nsize compared to the prior exam also demonstrating interval increase in soft\ntissue component.\n\nThere is no pleural effusion or pneumothorax.",
            "output": "Overall, interval progression in the extent of metastatic disease within the\nlungs bilaterally compared to the exam from ___."
        },
        {
            "input": "CHEST PERIMETER: 2.5 cm low-density lesion in the right thyroid lobe\ndisplacing the trachea to the left and a smaller lesion in the left lobe\nshould be evaluated by ultrasound.\n\nThere is no abnormal soft tissue or enlargement of either supraclavicular or\naxillary lymph nodes.  Evaluation of the breasts is specifically reserved for\nmammography.  There are no soft tissue abnormalities elsewhere in the chest\nwall concerning for malignancy.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM:Esophagus is moderately patulous at several levels,\notherwise unremarkable.  Atherosclerotic calcification is generally moderate\nin the head and neck vessels, but most severe in the vertebral arteries, and\nsevere in left anterior descending and circumflex among calcifications in all\nmajor coronary arteries.  Aorta and pulmonary arteries are normal size and\npericardium is physiologic..\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\nLargely solid nodule, 6 mm, left lower lobe 4:121.\n\nSolid nodule, 3 mm, left upper lobe, 4:60.\n\nLungs otherwise clear.  Tracheobronchial tree normal.  No pleural abnormality.\n\n\nCHEST CAGE: Unremarkable.  Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning..",
            "output": "2 small lung nodules, could be benign or malignant.  Follow-up based on\nconsiderations regarding pancreatic carcinoma.  Guidelines for isolated lung\nnodules, as follows:\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nBilateral thyroid lesions should be evaluated with ultrasound.\n\nSignificant atherosclerosis, coronaries and vertebral arteries.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "Large thyroid mass predominantly involving left thyroid lobe but also to a\nlesser extent right appears to be very similar to ___, please review\nthyroid ultrasound from ___.  Aorta and pulmonary arteries are\nnormal in diameter.  Large hiatal hernia is re- demonstrated.  At appears to\nbe increased in size.  No mediastinal, hilar or axillary lymphadenopathy is\ncurrently present.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and pelvis and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Mild bibasal\nbronchiectasis are noted, unchanged.  Deviation of the trachea to the right\nand mild compression bite the goiter is unchanged.  Old pre-existing pulmonary\nnodules are stable with no new O increasing pulmonary nodules seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nDegenerative changes in the lower thoracic vertebral body are similar to\nprevious examination.",
            "output": "No definitive evidence of intrathoracic metastatic disease.\n\nBibasal bronchiectasis that might reflect aspiration giving the presence of\nlarge hiatal hernia\n\nUnchanged diffuse massive enlargement of the thyroid gland consistent with\nconfluent multinodular goiter"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Large predominantly left thyroid\nmultinodular goiter is unchanged in size or appearance since ___,\npreviously assessed with thyroid ultrasound ___.  There is narrowing and\ndisplacement of the esophagus within the goiter, which could be causing\naspiration.  No axillary or thoracic wall lymphadenopathy.\n\nUPPER ABDOMEN: Moderate sliding hiatal hernia, decreased in size from ___. \nMild left adrenal hypertrophy.  Other imaged intra-abdominal viscera are\nwithin normal limits.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: A new moderate pericardial effusion is new from ___,\nfollow-up echocardiography is recommended.  Moderate cardiomegaly with\nmoderate atherosclerotic calcification of the coronary arteries and aortic\nvalve.  The ascending and descending aorta are normal caliber, with mild\natherosclerotic calcification.\nPLEURA: Large right and moderate left pleural effusions, new from previous\nimaging.\nLUNG:\n\n1. PARENCHYMA:  Right middle and lower lobe consolidation, likely due to\ncompression versus from underlying pleural effusion.  Left lower lobe\nelevation with parenchymal opacification concerning for pneumonia possibly\nfrom aspiration.\nMultiple bilateral calcified nodules likely representing benign granulomas.\nThere is a new 3 mm right upper lobe nodule (4:42).\nThere is a new 6 mm perifissural pulmonary nodule in the right lower lobe\n(4:131).  There is a 3 mm left lower lobe nodule, which may be stable from\nprevious chest CT, however due to displacement left lung by pleural effusion\ncorrelation is limited.\n2. AIRWAYS:  The airway is patent to the level of the subsegmental bronchi\nbilaterally.\n3. VESSELS:  The main pulmonary artery is normal caliber, the pulmonary\nvessels within the limits of the subsegmental branches bilaterally.\nCHEST CAGE: Degenerative disease in the thoracolumbar spine, most prominent at\nT7-10.",
            "output": "1.  Left lower lobe pneumonia, possibly from aspiration, with a moderate left\npleural effusion.\n2.  Large right pleural effusion with overlying atelectatic partial lung\ncollapse of the right lower and middle lobes.\n3.  Compression and displacement of upper esophagus by stable multinodular\ngoiter combined with moderate sliding hiatal hernia may predispose the patient\nto aspiration.\n4.  New pericardial effusion, for which echocardiography is recommended.\n5.  Multiple new lung nodules, the largest measuring 6 mm for which follow-up\nchest CT is recommended.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n\nRecommend echocardiography to further evaluate the pericardial effusion.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:00 pm, 45 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:  The heart is not enlarged.  Coronary artery calcifications are mild. \nFilling defect is seen in segmental and subsegmental branches of left lower\nlobe pulmonary arteries (3:59).  There is no mediastinal hematoma.  There is\nno pericardial effusion.  There is no lymphadenopathy.  Left lower thyroid\nnodule measures up to 1.6 cm.\n\nDependent bile consolidations are likely atelectasis.  There is mild\nparaseptal emphysema.  The lungs are otherwise clear without worrisome nodule\nor mass.  Airways are patent to the subsegmental level.  There is no evidence\nof contusion or laceration.  There is no pneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is non\naneurysmal but measures up to 2.8 cm TRV with scattered, moderate\natherosclerotic calcifications.  Major branches are patent.  Accessory left\nrenal artery is noted.  No lymphadenopathy, free air, or free fluid.  The\nright common iliac artery is aneurysmal up to 3.3 cm.  The left common iliac\nartery measures up to 1.5 cm.   The right internal iliac artery measures up to\n1.2 cm.  The right common femoral artery is dilated up to 1.6 cm.\n\nThe stomach and small bowel are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  Diverticulosis of the sigmoid\ncolon is seen without evidence of diverticulitis.  The appendix is normal. \nUrinary catheter is seen in the bladder.  There is no pelvic free fluid.\n\nBONES:  There is no acute fracture.  No focal suspicious osseous abnormality.",
            "output": "1. No acute traumatic injury.\n2. Segmental and subsegmental left lower lobe pulmonary embolism.\n3. Right common iliac artery aneurysm.\n4. Left lower thyroid nodule measures up to 1.6 cm.\n\nRECOMMENDATION(S):  Nonemergent thyroid ultrasound is recommended.\n\nNOTIFICATION:  Finding of pulmonary embolism was discussed with Dr. ___ in\nperson at time of initial review immediately after scan was performed."
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the segmental\nlevel with significant respiratory motion artifact, but without filling defect\nto suggest pulmonary embolism. Pulmonary arteries are normal in caliber.\n\nMultifocal consolidations and ground-glass opacities particularly in the\ndependent right lung.  Minimal right greater than left apical cystic changes\nand scarring.  There is no pleural effusion or pneumothorax. The airways are\npatent to the subsegmental level.\n\nCoronary artery calcifications noted.  Scattered atherosclerotic\ncalcifications of the aortic arch.  There is no pericardial effusion. \nProminent mediastinal lymph nodes, likely reactive, but no pathological\nenlargment. There is no supraclavicular, axillary, or hilar lymphadenopathy.\nIncluded portion of the thyroid is unremarkable.\n\nIncluded portion of the upper abdomen is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere is no fracture.",
            "output": "1. Limited exam secondary to respiratory and motion artifact, however no\nevidence of pulmonary embolism to the segmental level or aortic abnormality.\n2. Multifocal consolidations and ground-glass opacities particularly in the\ndependent right lung, concerning for combination aspiration/pneumonia and\natelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  The thoracic aorta is normal in\ncaliber.  No appreciable calcified coronary or aortic atherosclerosis.  The\nmain pulmonary artery is normal in caliber.  The pulmonary arteries are patent\nto the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a trace nonhemorrhagic right pleural effusion.  No\nleft pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Soft tissue thickening is seen surrounding the bronchus\nintermedius which is significantly narrowed intermedius resulting in at least\n50% luminal narrowing.  Per report, patient is known to have a biopsy-proven\nneuroendocrine tumor.  There is collapse of the right middle and lower lobes\nthough partial aeration of the bronchi within these lobes is noted.  Upper\nlobe predominant emphysema is noted.  No discrete nodule within the lungs.\n\nBASE OF NECK: There is an 8 mm enhancing left lower pole thyroid nodule.\n\nABDOMEN: The hepatic parenchyma is diffusely hypoattenuating consistent with\nhepatic steatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Soft tissue encasement of the bronchus intermedius resulting in significant\nnarrowing with collapse of the right middle and lower lobes.  Please note,\npatient is known to have a biopsy-proven neuroendocrine tumor in this region. \nTrace right pleural effusion.\n3. No signs of pulmonary hemorrhage.\n4. 8 mm left thyroid lobe pulmonary nodule.  On the basis of size, no\nfollow-up imaging is recommended, per ACR guidelines on incidentally\ndiscovered pulmonary nodules.\n\nNOTIFICATION:  Updated findings discussed with ___ resident at 20:56 on\n___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A left jugular central venous line\nterminates within the mid to distal SVC.  A chest tube is seen entering\nthrough the right chest wall, which appears to terminate within the\npericardial fat, abutting the right atrium.  Echocardiography is recommended\nfor evaluation of the exact location of the tube tip.  There is associated\nsubcutaneous emphysema of the right chest wall.\n\nThe imaged thyroid is unremarkable.  There is no supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Please see separate report of same day abdominal/pelvic CT scan\nfor full description of intra-abdominal findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: A single pacing wire terminates within the right\nventricle.  The heart size is normal, without significant pericardial\neffusion.  Mild coronary artery calcifications are noted.  The ascending and\ndescending aorta is normal caliber.\nPLEURA: There is a tiny right apical pneumothorax.  There are bilateral small\npleural effusions, left larger than the right.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar consolidations likely represent compressive\natelectasis overlying bilateral pleural effusions, with the left greater than\nthe right.  However, a superimposed infectious cause or aspiration cannot be\ncompletely excluded.  Mild interstitial septal thickening bilaterally, which\nmay indicate pulmonary edema.\n2. AIRWAYS:  An endotracheal tube terminates approximately 3.0 cm above the\nlevel of the carina.  Secretions are noted within the right mainstem bronchus,\notherwise patent airway to the level of the subsegmental bronchi bilaterally.\n3. VESSELS:  The main, right and left pulmonary arteries are normal caliber.\nCHEST CAGE: There is a possible subtle nondisplaced fracture of the distal\nmanubrium, consistent with history of recent chest compressions.  No\nsuspicious osseous lesions.  Possible left fifth rib fracture, chronicity\nundetermined.",
            "output": "1.  Right-sided chest tube likely terminating within the pericardial fat and\nabutting the right atrium.  Confirmation of chest tube location is recommended\nwith echocardiography.\n\n2.  Tiny right apical pneumothorax.\n\n3.  Bilateral small pleural effusions with overlying consolidations likely\nreflecting compressive atelectasis.  However, superimposed infectious causes\nor aspiration cannot be completely excluded.  Mild interstitial septal\nthickening bilaterally may indicate pulmonary edema.\n\n4.  Possible subtle nondisplaced distal manubrial fracture.  Possible left\nfifth rib fracture of undetermined chronicity.\n\nRECOMMENDATION(S):  Echocardiography to determine location of right sided\nchest tube.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:50 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CTA THORAX: The aorta and main thoracic vessels are well opacified. The\ncaliber of the intrathoracic aorta is smaller than average, likely congenital\nvariant. There is no intramural hematoma or dissection. The pulmonary arteries\nare opacified to the subsegmental level. There is no filling defect in the\nmain, right, left, lobar or subsegmental pulmonary arteries. No arteriovenous\nmalformation is seen.\n\nCT OF THE THORAX: The thyroid is unremarkable. The airways are patent to the\nsubsegmental level. There is no mediastinal, hilar or axillary lymph node\nenlargement by CT size criteria. The heart, pericardium, and great vessels are\nwithin normal limits.  There is a small hiatal hernia.\n\nLungs are clear.  No pleural effusion or pneumothorax is present.  There is\nmild diffuse bronchial wall thickening with minimal air trapping most\nprominent at the left lower lobe. These findings are suggestive of small\nairways disease.  A calcified granuloma seen in the left lower lobe.  No\nsignificant emphysema is seen.\n\nAlthough this study is not designed for assessment of intra-abdominal\nstructures, the visualized solid organs and the stomach are unremarkable.\n\nOSSEOUS STRUCTURES: No focal osseous lesion concerning for malignancy.",
            "output": "1.  No pulmonary embolism.\n\n2. Mild diffuse bronchial wall thickening and minimal air trapping, most\nprominent at the left lower lobe, suggestive of small airways disease, likely\nrelated to smoking history."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, or segmental\npulmonary arteries.  There is suboptimal evaluation of the subsegmental\nbranches on the left due to respiratory motion, but appear patent on the\nright.  The main and right pulmonary arteries are normal in caliber, and there\nis no evidence of right heart strain.\n\nThere is no axillary lymphadenopathy.  Mediastinal lymph nodes are not\nenlarged by size criteria.  There is a borderline enlarged right hilar node,\nwhich may be reactive (02:26).\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nEvaluation of the lung parenchyma is notable for mild subsegmental atelectasis\nat the lung bases bilaterally.  The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  Right greater than\nleft bibasilar subsegmental atelectasis."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.  There is a large\nhiatal hernia a contain fat, essentially the entire stomach and portions of\nthe splenic flexure and pancreatic tail are herniating into the chest.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nThe heart size is normal and there is no pericardial effusion. Mild\natherosclerotic calcifications of the thoracic aorta and of the coronary\narteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild centrilobular\nemphysema.  Diffuse moderate bronchial wall thickening and irregularity. \nPeribronchial linear bands of opacification in the lingula and in the lower\nlobes bilaterally abutting the large hiatal hernia are likely a combination of\natelectasis and scar.  In the left lower lobe within the peribronchial\nopacities there is a localized rounded region that is relative hypodense and\nadjacent abrupt cut off of the bronchus.  Mixed dystrophic calcifications are\nwithin this opacities series 4a, image 120.  Mild bronchiectasis in the lower\nlobes bilaterally in a posteromedial location can be related to chronic\naspiration.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, there is a large hiatal hernia a containing fat, essentially the\nentire stomach and portions of the splenic flexure and pancreatic tail are\nherniating into the chest.  Uncomplicated cholelithiasis.",
            "output": "1. Large hiatal hernia containing the stomach and adjacent fat, as well as\nportions of the splenic flexure and pancreatic tail are herniating into the\nchest.\n2.  Adjacent bibasilar atelectasis.  Within the left lower lobe, a localized\nrounded region that is relative hypodense is associated with adjacent abrupt\ncut off of the bronchus.  These region is poorly assessed due to the absence\nof IV contrast and an underlying neoplastic or infectious pulmonary lesion\ncannot be excluded.\n\n\nRECOMMENDATION(S):  Repeat CT thorax with IV contrast is recommended.  If the\npatient has a contraindication to intravenous contrast, this region could be\nassessed with MRI."
        },
        {
            "input": "The examination is compared to ___.  The previously rounded opacity at\nthe left lung base is decreased in extent.  However, more inferiorly, a new\nparenchymal opacity has appeared.  The changes are consistent with areas of\natelectasis.  There is no indication for the presence of a neoplasm or a\nlarger infectious lesion.  Otherwise, the examination is essentially\nunchanged.",
            "output": "The examination is compared to ___. The previously rounded opacity at\nthe left lung base is decreased in extent. However, more inferiorly, a new\nparenchymal opacity has appeared. The changes are consistent with areas of\natelectasis. There is no indication for the presence of a neoplasm or a larger\ninfectious lesion."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Several mediastinal lymph\nnodes are present, none of them pathologically enlarged but them multiple,\nwith the aortopulmonic window lymph node being 5 mm in diameter, the largest. \nNo hilar or axillary pathologically enlarged lymph nodes present.\n\nHeart size is normal.  There is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal solid\nbeading bronchiectasis and subpleural opacities might be consistent with\nchronic aspiration.  Right middle lobe nodule seen on the previous study, 5 mm\nin diameter, series 102, image 188 is stable.  Left upper lobe nodule, 3.5 mm,\nseries 102, image 137 was not included in the field of view of the previous\nexamination.  No other nodules masses or consolidations identified.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable right middle lobe nodule.  Additional nodule that was not included on\nthe previous examination.\n\nReassessment of the patient in ___ to document ___ year stability is\nrecommended.\n\nPotential recurrent aspiration giving the presence of bibasal mild cylindrical\nbronchiectasis, please correlate clinically."
        },
        {
            "input": "This study is somewhat limited due to patient body habitus and bolus timing.\n\nThe aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the subsegmental\nlevel without filling defect to suggest pulmonary embolism. Pulmonary arteries\nare normal in caliber.\n\nThere is no evidence of pulmonary parenchymal abnormality. There is no pleural\neffusion or pneumothorax. The airways are patent to the subsegmental level.\n\nHeart is unremarkable.  There is no pericardial effusion.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy. Included\nportion of the thyroid is unremarkable.\n\nIncluded portion of the upper abdomen is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere is no fracture.  Degenerative changes are seen throughout the spine.",
            "output": "No acute findings.  No evidence of pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  A tracheostomy tube is well positioned, with a significant\namount of fluid superior and around the tube..  A small fluid collection is\nseen lateral to the right tracheal wall.  No atherosclerotic calcifications in\nthe head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  No identifiable tracheal esophageal fistula is\nevident.  No pneumomediastinum.  Small lymph nodes, not pathologically\nenlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nIs minimal left pleural effusion.  Mild bilateral apical scarring.\n\nLUNGS:\nConsolidations in both lower lobes, left greater than right, somewhat\nheterogeneous and associated to mild air bronchograms.  No lung nodules or\natelectasis.  The airways are otherwise patent to subsegmental levels.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show large right hepatic cyst\nmeasuring 5.6 cm approximately.",
            "output": "Bilateral consolidations in both lower lobes, left greater than right,\nassociated to a small pleural effusion likely represent aspiration related\npneumonia.\n\nSmall fluid correction lateral to the right tracheal wall with an air-fluid\nlevel with no clear communication with the trachea.\n\nThe tracheostomy tube is well positioned however fluid in seen inside the\ntrachea, around and superior to this tube.  There is no clear evidence for a\ntracheoesophageal fistula.  If clinical concern remains, a fluoroscopic\nswallow study could be considered."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nMildly prominent right hilar lymph node measures 8 mm in short axis, not\nenlarged by CT size criteria.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nExam is mildly motion limited.  There is no evidence of pulmonary parenchymal\nabnormality. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen demonstrate cholelithiasis.\n\nCT chest: The thyroid is enlarged without the nodules. There is no\nsupraclavicular lymph node enlargement. The airways are patent to the\nsubsegmental level. There is no mediastinal, hilar or axillary lymph node\nenlargement by CT size criteria. Heart, pericardium and great vessels are\nwithin normal limits. No hiatal hernia is present. The lobulated\ntriangular-shaped soft tissue density lesion in the anterior mediastinum is\nconsistent with thymic hyperplasia in the setting of Graves disease. There are\nno concerning features such as nodularity or loss of fat planes.\n\nA 6 mm triangular subpleural nodule in the right middle lobe (5:174) and a 5\nmm triangular subpleural nodule in the left lower lobe (5:190) may reflect an\nintrapulmonary lymph nodes. There are 3 mm right lower lobe nodules (5:172 and\n159) and a right lower lobe perifissural nodule (5:142).  No pleural effusion\nor pneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "1. Anterior mediastinal mass consistent with thymic hyperplasia in the setting\nof Graves disease without concerning features.\n2. Multiple pulmonary nodules measuring up to 6 mm as described above.\nRecommend followup CT in 6 months to evaluate stability."
        },
        {
            "input": "The thyroid is normal.  ET tube is in standard position NG tube tip is in the\nstomach.  Supraclavicular, axillary, mediastinal and hilar lymph nodes are not\nenlarged. Aorta and pulmonary arteries are normal size.  Moderate cardiomegaly\nis a stable.  There is mild calcification of the circumflex coronary arteries\nas before.  There is mild calcification of the mitral annulus\nThere is almost complete collapse of the right lower lobe.  Minimal\nground-glass opacities in the lingula could represent aspiration.  There is\nmild upper lobe predominant centrilobular emphysema.  There are minimal\natelectasis in the left lower lobe\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy\nRight large central catheter tip is in the right atrium.",
            "output": "There is almost complete collapse of the right lower lobe.  Minimal\nground-glass opacities in the lingula could represent aspiration .\nMild emphysema"
        },
        {
            "input": "New since the previous study of ___ and the presence of complete\nright lung collapse due to extensive mucous plugging.  Previously, the right\nlower lobe with nearly completely collapsed but the right middle and right\nupper lobes were well aerated.  Small right pleural effusion is also new, as\nwell as a trace left pleural effusion.  The cardiomediastinal structures are\nshifted to the right of midline and are otherwise unchanged in appearance\nsince the recent CT of ___.\n\nEndotracheal tube is in standard position, and a nasogastric tube terminates\nin the distal stomach.\n\nAssessment of the left lung is limited due to respiratory motion, particularly\nin the mid and lower lung.  With this limitation in mind, subtle ground-glass\nopacities in the lingula and left lower lobe are stable to slightly improved\nsince of ___.  No new areas of consolidation are identified. \nMinimal emphysema in the left upper lobe is unchanged.\n\nSkeletal structures of the thorax are unchanged since recent CT ___",
            "output": "1. Complete right lung collapse secondary to extensive mucous plugging.  New\nsmall right pleural effusion and trace left pleural effusion.\n\n2. Limited assessment of left lung due to motion artifact, with stable to\nslight improvement of ground-glass opacification in the lingula and left lower\nlobe.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___  on the ___ ___ at 11:19 AM, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "Chest:  The imaged portion of the thyroid gland is normal. The thoracic aorta\nis normal in course and caliber without dissection, aneurysm for\natherosclerosis. The heart is normal in size and shape. The pulmonary arterial\ntree opacifies normally without filling defect to suggest the presence of a\npulmonary embolism. No hilar, mediastinal, or axillary lymphadenopathy is\nseen. No mediastinal hematoma or mass lesion. No pneumomediastinum. No\npneumothorax.\n\nThe lungs are clear bilaterally without worrisome nodule, mass, or\nconsolidation. The airways patent through the subsegmental level. There is\nmild left basal atelectasis.\n\nAbdomen: The liver enhances normally without focal lesion. The gallbladder is\nmostly decompressed. The pancreas, adrenal glands appear normal. The spleen is\nnormal without signs of focal lesion or infarct. The kidneys enhance\nsymmetrically and excrete contrast promptly without focal lesion or\nhydronephrosis. The abdominal aorta is normal in course in caliber with widely\npatent major branches. No retroperitoneal lymphadenopathy.\n\nThe stomach and duodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. The\nappendix is clearly visualized and is normal. There is moderate fecal loading\nof the colon without wall thickening or signs of acute inflammation. Uterine\nfibroids are noted, the largest of which measures 8.3 x 5.8 cm. Additional\nsmaller fibroids are present. There are no adnexal masses. Trace free fluid is\nlikely physiologic. Right ureteral jet is demonstrated. The visualized portion\nof the left ureter is normal. No pelvic sidewall lymphadenopathy is seen.\n\nBones: Normal.",
            "output": "Uterine fibroids. Otherwise normal. No PE. No signs of splenic infarct or\nother acute findings to account for left upper quadrant pain."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. No\nevidence of pulmonary infarct or right heart strain.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits.  No evidence\nof pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a small right and moderate left pleural effusion.  No\npneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis with moderate volume loss in the\nleft lower lobe, minimal on the right.  No evidence of obstructing mass.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to same day report on CT abdomen and pelvis for\ndescription of subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild degenerative changes of the imaged spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate left pleural effusion with corresponding volume loss in the lower\nlobe, which may explain the patient's presentation.  Small right pleural\neffusion with minimal atelectasis.\n3. Please refer to same day report on CT abdomen and pelvis for description of\nsubdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is a 2 mm calcified granuloma in the left lower lobe\n(301:162).  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for postoperative\nchanges status post Roux-en-Y gastric bypass and cholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Visualized portions of the thyroid gland are unremarkable in appearance.  No\nsupraclavicular or axillary lymphadenopathy.\n\nA pectus excavatum is incidentally noted.  There is mild atherosclerotic\ncalcification in the aortic arch.  No aneurysmal dilatation, no aortic\ndissection seen.  The main pulmonary artery is not grossly enlarged.  No\nmediastinal lymphadenopathy seen.  There are calcified small lymph nodes seen\nat the right hilum, in addition there is a noncalcified 1 cm node (03:33) with\nadjacent smaller subcentimeter nodes at the right hilum.\n\nAs seen on the prior radiographs there is consolidation in the right upper\nlobe abutting the minor fissure (06:53).  This is somewhat ill-defined with\nmultiple air bronchograms adjacent ground-glass opacities most consistent with\npneumonia however given the provided history a neoplastic process cannot be\nexcluded.  In addition there are small areas of mild bronchiectasis extending\nthrough this area of consolidation (03:31).  Multiple calcified pulmonary\nnodules are seen consistent with prior granulomatous disease (03:55, 40).\n\nThere is mild apical pleural scarring.\n\nThis study is not tailored for evaluation of the subdiaphragmatic structures. \nUnchanged hepatic cyst in segment 7 (5:275).  No new attic lesion seen. \nVisualized portions of the pancreas, bilateral adrenal glands, bilateral\nkidneys and spleen are unremarkable in appearance.  There is moderate\natherosclerotic calcification in the abdominal aorta an apparent stenosis at\nthe origin of the celiac artery.\n\nBony structures: No destructive lytic or sclerotic bone lesions seen.  Mild\ndegenerative changes in the thoracic spine.",
            "output": "1. Consolidation in the right upper lobe has features most suggestive of\npneumonia, however given the provided history difficult to exclude a\nneoplastic lesion particularly in the more superior more solid-appearing\ncomponent.  This is a clinical concern and it will alter clinical management,\nPET-CT may be helpful to differentiate.\n2. Mildly enlarged right hilar nodes, likely reactive.\n3. Calcified pulmonary nodules with small calcified hilar lymph nodes\nconsistent with prior granulomatous disease.\n4. Apparent narrowing at the origin of the celiac plexus\n5. Pectus excavatum."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable.\n\nUPPER ABDOMEN: The study is not tailored for evaluation of subdiaphragmatic\nstructures.  Within these confines, small, bilateral, left greater than right,\nBochdalek hernias are stable.  A 1.2 cm hypodensity within the right hepatic\nlobe (5:274) appears stable, likely a cyst.  Otherwise, the imaged upper\nabdomen appears unremarkable.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: A prominent right hilar node appears stable (5:161).  Calcified right\nhilar nodes are redemonstrated.  There is no left hilar adenopathy.  No hilar\nmass.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.  Atherosclerotic calcifications of\nthe thoracic aorta.  Mild coronary artery calcifications.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Within the right upper lobe are mild linear opacities, likely\nscarring, surrounding mildly dilated airways.  The previously seen right upper\nlobe consolidation has significantly improved, with scattered remnant\n___ opacities.  No new focal consolidations.  Mild biapical\npleuroparenchymal scarring.  Multiple right-sided pulmonary nodules, some\nintraparenchymal nodes, measure up to 4 mm (5:66), stable from prior.  No new\nor growing pulmonary nodules.  Multiple bilateral calcified granulomas.\n2. AIRWAYS: Mildly dilated airways are in a similar distribution within the\nright upper lobe.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n3. VESSELS:  The main pulmonary artery is top-normal in size.  Suboptimal\nevaluation of the pulmonary vasculature demonstrates no evidence of central\npulmonary embolism.\nCHEST CAGE: The bones are diffusely osteopenic.  Pectus excavatum.  No\nworrisome osseous lesions are identified. There is no acute fracture.",
            "output": "1. Near complete resolution of the right upper lobe consolidation, with mild\nbronchial dilatation, probable residual scarring, and remnant, scattered\n___ opacities.  No new consolidations.\n2. Stable multiple right-sided pulmonary nodules, some intraparenchymal nodes,\nmeasuring up to 4 mm.  No new or growing pulmonary nodules.\n3. Stable, enlarged right hilar nodes, likely reactive."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan.  Cardiomegaly is noted with coronary artery calcifications seen.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Calcified right hilar lymph nodes are present. \nNo axillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Again visualized ground-glass opacities linear scarring in the\nright upper lobe and ___ ground-glass nodularity distribution more\ninferiorly in the right upper lobe, slightly improved from the prior, and\nreflective of improving infection.  There are multiple bilateral calcified\ngranulomas.  Seen again is a right apical 5 mm pulmonary nodule (4, 10),\nstable from prior.  The airways are patent to the level of the segmental\nbronchi bilaterally.  Mild cylindrical bronchiectasis is again noted.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No acute traumatic injury identified.  No fracture.\n2.  Continued improving right upper lobe ground-glass opacities and\n___ nodularity in the inferior right upper lobe compatible with\nimproving infection.\n3.  Evidence of prior granulomas disease."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nstable moderate cardiomegaly with coronary artery calcifications.  Trace\npericardial fluid is unchanged.\n\nAXILLA, HILA, AND MEDIASTINUM: Calcified right hilar lymph nodes are again\nseen.  There is no axillary or mediastinal lymphadenopathy is present.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: Mild biapical pleuroparenchymal scarring is again seen.  No\npleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There has been interval increase in patchy peribronchovascular\nand ___ nodularity within the right upper lobe (4:120).  No cavitary\nlesions.  There is mild bibasilar atelectasis.  Multiple calcified granulomas\nare seen throughout the bilateral lungs.  A right apical 5 mm pulmonary nodule\n(03:12) is stable from prior.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Mild bronchiectasis is again seen.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Interval increase in patchy peribronchovascular and ___\nnodularities in the right upper lobe which are likely infectious or\ninflammatory.  Given the history, an atypical infection such as tuberculosis\nis difficult to entirely exclude.\n2. Evidence of prior granulomatous disease."
        },
        {
            "input": "HEART AND VASCULATURE: The pulmonary vasculature is well opacified without\nevidence of filling defect to indicate a pulmonary embolus. The thoracic aorta\nis normal in caliber and appearance within limitations of a non-gated study. \nThere is mild to moderate calcified atherosclerotic plaque involving the\naortic arch and descending thoracic aorta.  Prominent LAD territory coronary\nartery calcifications are noted.  No pericardial effusion.  Heart size is\nslightly enlarged.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary, mediastinal or hilar\nadenopathy.  Prominent hilar nodes are nonspecific and likely reactive. \nCalcified nodes at the right hilus likely reflect prior granulomatous\nexposure.\n\nPLEURAL SPACES: Mild apical pleuroparenchymal scarring.  Irregular pleural\nthickening at the right lung base is similar from prior. No pneumothorax.\n\nLUNGS/AIRWAYS: There are diffuse consolidative and ground-glass opacities in\nthe right upper lobe.  Scattered ground-glass opacities also noted right lower\nlobe.  No evidence of cavitary lesion or pulmonary abscess.  Central airways\nare clear aside from some central bronchial wall thickening which is likely\nreactive.  There are multiple calcified granulomas.  A 5 mm calcified\npulmonary nodule in the right lung apex is unchanged (2:22).  There is a 3 mm\npleural based nodule in the right middle lobe, unchanged (2:82).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Marked narrowing of the proximal celiac artery appear similar\ncompared to prior imaging.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is a mild pectus deformity of the anterior chest wall.",
            "output": "1. Right upper lobe pneumonia.  No pulmonary abscess or cavitary lesion.\n2. Of note, a right upper lobe pneumonia was seen on the prior CT chest dated\n___ however no obstructing lesions are identified on the current\nexam.  Follow-up imaging to ensure resolution is recommended.\n3. No pleural effusion.\n4. No evidence of pulmonary embolism or aortic abnormality.\n5. Coronary calcifications as described above.\n6. Evidence of prior granulomatous exposure.\n\nRECOMMENDATION(S):  Follow-up imaging to ensure resolution"
        },
        {
            "input": "HEART AND VASCULATURE:  The there is severe cardiomegaly.  Patient appears\nstatus-post CABG with median sternotomy wires and mediastinal clips.  Native\ncoronary calcifications are severe.  The aorta is normal in caliber.  Aortic\narch and great vessel origin calcifications are moderate to severe.\n\nMEDIASTINUM: The mediastinal portion of a large retropharyngeal hematoma\nappears no larger than the earlier same day head and neck CTA.  The hematoma\nis smaller at the level of thoracic inlet than it is either superiorly or\ninferiorly.  Inferior to the level of thoracic inlet, the hematoma spans 6.2 x\n3.7 cm, terminating approximately 1 cm superior to the carina (series 602,\nimage 64).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The mediastinal hematoma exerts mild mass effect on the\nposterior wall of the trachea, though no significant narrowing is noted. An\nendotracheal tube tip terminates approximately 2 cm above the level of the\ncarina.  There is a somewhat nodular area of probable atelectasis in the\nanterior right lower lobe abutting the major fissure (series 302, image 158). \nThere is linear atelectasis or scarring elsewhere at lung bases.  There is\nmild pleural thickening and punctate pleural calcifications.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a 1.6 cm cyst in hepatic segment VII.  An enteric catheter\ncourses below the diaphragm and outside the field of view, at least to the\nlevel of the gastric body.\n\nBONES: No thoracic spine rib fractures visualized.  The known cervical spine\nfracture was not included within the field of view on this examination.",
            "output": "1. A large retropharyngeal hematoma extends into the superior mediastinum, not\nappreciably changed compared to the earlier same day neck CTA.  There is mild\nmass effect on the posterior wall of the trachea, but no significant luminal\nnarrowing.\n2. Somewhat nodular opacification focally within the anterior right lower lobe\nprobably reflects atelectasis.  However, recommend three-month follow-up chest\nCT to assess stability.\n\nRECOMMENDATION(S):  Somewhat nodular opacification focally within the anterior\nright lower lobe probably reflects atelectasis. However, recommend three-month\nfollow-up chest CT to assess stability."
        },
        {
            "input": "A right IJ access dialysis catheter is noted terminating in the right atrium. \nThe imaged base of neck notable for a mildly enlarged thyroid gland with\nsubtle heterogeneity better assessed on prior thyroid ultrasound.  The\nthoracic aorta is normal in course and caliber without appreciable\natherosclerotic calcification.  A tiny amount of residual thymic tissue is\nnoted in the anterior mediastinal space.  The heart is normal in size and\nshape.  There is no pericardial effusion.  The main pulmonary artery is normal\nin size.  No lymphadenopathy is noted in the chest.  Subtle tracheobronchial\ntree calcifications are noted.  The airways centrally patent.  Esophagus is\ndecompressed.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  There\nis a right upper lobe pulmonary nodule in the periphery of the right mid lung\nseen on series 4, image 109 measuring 3 mm.  No evidence of chronic\ngranulomatous disease.\n\nWithin the imaged portion of the upper abdomen, the partially visualized left\nkidney appears atrophic.  No additional findings of concern.\n\nCHEST CAGE: No worrisome bony lesions.",
            "output": "1. 3 mm right upper lobe pulmonary nodule.\n2. No evidence of chronic lung disease.\n3. Right IJ access dialysis catheter terminates in the right atrium.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Stable moderate enlargement of the thyroid, with several thyroid nodules (5,\n9).  No supraclavicular, infraclavicular or axillary lymphadenopathy.  The\nlymph node size in the mediastinum has substantially increased.  For example,\n2 pretracheal lymph nodes have increased from 2-8 mm in diameter (5, 20). \nStable appearance of the large mediastinal vessels.  Moderate cardiomegaly\npersists.  In the interval, the patient has developed a mild left pleural\neffusion.  The upper abdomen is reported in detail in the dedicated abdominal\nCT report.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.  Degenerative vertebral disease.  No vertebral\ncompression fractures.\nMild bilateral apical scarring.  Diffuse upper lobe predominant ground-glass\nopacities that could reflect mild pulmonary edema.  A previously seen 3 mm\nright upper lobe subpleural nodule is stable in size and morphology and likely\nrepresents an intrapulmonary lymph node.  Minimal atelectasis at the left lung\nbasis.",
            "output": "Substantial interval enlargement of the mediastinal lymph nodes.  Development\nof a left pleural effusion.  Left atelectasis, mild in severity.  Diffuse and\nsubtle ground-glass opacities could reflect mild pulmonary edema.  Stability\nof a 3 mm right upper lobe nodule."
        },
        {
            "input": "Diffuse enlargement of the thyroid gland is demonstrated.  Is unchanged since\nprevious examination.\n\nCentral venous line tip terminates in the right atrium.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  Heart size is\nenlarged.  There is minimal left pericardial effusion and small amount of\nbilateral pleural effusion.  There is ascites, similar to previous examination\npartially imaged.  A trophic kidneys are noted, bilateral.\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\nnew ground-glass opacities are concerning for infectious process in might\nrepresent pneumonia.  More subtle diffuse ground-glass opacities might reflect\nevidence of drug reaction or hypersensitivity, new as compared to previous\nexamination.  Alternatively edema is another possibility.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive lymphadenopathy\n\nRight lower lobe suspected pneumonia with some involvement of the right middle\nlobe\n\nSevere cardiomegaly\n\nAtrophic kidneys\n\nDiffuse ground-glass in particular in the upper lobes that might reflect\nhypersensitivity reaction or chronic volume overload."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid contains small thyroid\nnodules with the largest in the right lobe measuring up to 1.7 cm (302:10). \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged but are mildly\nincreased in number, likely reactive.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive severe coronary\narterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is increased\nwith the ascending aorta measuring up to 4.4 cm in greatest diameter\n(302:101).  The main, right, and left pulmonary arteries are also mildly\nincreased in caliber with the main pulmonary artery measuring up to 3.7 cm.. \nA right pectoral single lead pacemaker is noted.  A left IJ approach central\nvenous catheter terminates in the brachiocephalic vein.\n\nPULMONARY PARENCHYMA:  There is dependent atelectasis associated with\nbilateral pleural effusions.  Superimposed consolidations in these regions are\ndifficult to exclude.  In addition, there is irregular airspace consolidation\nof the right upper lobe and right middle lobe with areas of ground-glass\nopacity bilaterally that likely represent superimposed mild volume overload. \nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.  The\nendotracheal tube terminates 2.4 cm from the carina.\n\nPLEURA:  Pleural effusions are small to moderate on the right and small on the\nleft with associated atelectasis.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Bilateral substantial gynecomastia\nis noted.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable with\nan enteric tube extending below the diaphragm within the esophagus.",
            "output": "1. Areas of airspace consolidation in the right upper and right middle lobes\nconcerning for infectious or inflammatory etiology.\n2. Mild to moderate volume overload as evidence by bilateral pleural effusions\nwith associated atelectasis and biapical ground-glass opacities most\nconsistent with mild pulmonary edema.\n3. Thyroid nodules measuring up to 1.7 cm for which dedicated nonemergent\nthyroid ultrasound is recommended, if not already performed elsewhere.\n4. Left IJ central venous catheter terminates in the brachiocephalic vein.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:55 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  7 mm AP window lymph node is stable aorta and\npulmonary arteries are normal size. Cardiac configuration is normal and there\nis no appreciable coronary calcification.\n3 mm nodules in the left lower lobe are stable since ___ (5:273,\n195)\n3 mm likely intrapulmonary lymph node in the left lower lobe is stable (5:229)\n2 mm nodule in the right middle lobe is an impacted bronchi (5:218)\nFocal nodularity in the medial aspect of the right lower lobe (5:235) has\nmildly increased from prior studies, could correspond to an area of fibrosis\nor scarring, but warrants a follow-up in ___ months to assess stability. \nThere are no new lung nodules.\nThere is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation the upper\nabdomen is normal\nThere are no bone findings of malignancy",
            "output": "Several millimetric lung nodules are stable.  No new lung nodules identified.\nA focal area of irregular nodularity in the right lower lobe has increased\nfrom prior studies.  Could correspond to an area of scar but followup in ___\nmonths is recommended to assess stability\n\nRECOMMENDATION(S):  Follow-up study in ___ months to re-evaluate nodular\nabnormality in the right lower lobe"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland demonstrates\nnormal morphology.  There is no supraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: The study is not tailored for subdiaphragmatic evaluation. \nThere are no adrenal nodules.  Vascular calcification is evident.  There is an\nincompletely imaged meta device in the right flank.\n\nMEDIASTINUM: There is no mediastinal adenopathy.\n\nHILA: No hilar adenopathy is appreciated on today's noncontrast examination.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There are no pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  There is a stable left lower lobe 3 mm nodule, series 5, image\n236. there is a stable 3 mm nodule at the left lung base, series 5, image 278.\nFocal nodularity in the medial aspect of the right lower lobe with adjacent\nstranding appears essentially unchanged when allowing for differences in plane\nof sectioning.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The aorta maintains normal caliber.  Atherosclerotic changes are\nevident involving the aorta.  The main pulmonary artery demonstrates normal\ncaliber.\nCHEST CAGE: Degenerative changes are evident in the spine.",
            "output": "Stable pulmonary parenchymal nodules measuring up to 3 mm in size.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The partially imaged thyroid gland is unremarkable. There are no\npathologically enlarged supraclavicular, mediastinal, hilar or axillary lymph\nnodes.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber. Aortic valvular calcifications are\nmild.\n\nSeveral pulmonary nodules measuring up to 7 mm in the right lower lobe are\nstable since at least ___, and are presumed benign (04: 23, 47, 53,\n77, 87, 103, 105, 106, 125, 128, 162, 166, 169, 172). A number of calcified\ngranulomas are also present bilaterally. Two sub 5 mm purely ground-glass\nnodules in both upper lobes are also stable, and do not require specific\nfollowup imaging due to their small size (04: 36 and 44). No new nodules are\nidentified. There is stable bilateral lower lobe bronchial wall thickening,\nlinear atelectasis and scarring. Mild posterior pleural fatty hypertrophy is\nunchanged.  Previous studies documented tracheobronchomalacia, which is not\nappreciably changed on this non-dynamic study.\n\nThere is persistent mild bilateral symmetric gynecomastia.\n\nImages of the upper abdomen show a stable 2.1 cm right adrenal adenoma (2,\n60). The patient has had prior Roux-en-Y gastric bypass.",
            "output": "Several pulmonary nodules measuring up to 7 mm in the right lower lobe are\nstable since at least ___, and are presumed benign.  No further\nfollowup of these nodules as indicated. No new nodules identified.\n\nStable 2.1 cm right adrenal adenoma."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal.  There is no axillary,\nmediastinal, or hilar lymphadenopathy.  The heart is normal in size. There is\nno pericardial effusion.  The thoracic aorta is normal in caliber without\nevidence of an aneurysm.  There is mild atherosclerotic plaque.  The main\npulmonary arteries trunks are normal in diameter.  This exam is not tailored\nto evaluate for pulmonary embolism, though no central filling defect is\nidentified.\n\nA right central venous catheter is present with the tip in the low SVC.\n\nAn endotracheal tube is in satisfactory position, approximately 3 cm from the\ncarina.  The airways are patent to the segmental levels.  There are bibasilar\nconsolidations with air bronchograms, which are associated with volume loss. \nThis most likely represents severe atelectasis.  The entire right lobe is\nessentially collapsed, and there is partial collapse of the left lower lobe. \nAdditionally, there is plate like atelectasis in the right upper lobe (5, 28).\nA component of infection within these consolidations is difficult to\ncompletely exclude.\n\nThe bilateral upper lobes are clear.  Several tiny subpleural 2 mm nodules are\nnoted in the upper lobes (6; 40, 45, 55, and 131), and stable since at least\n___.  The larger nodules seen on the prior exam in ___ are not visualized\ndue to the surrounding atelectasis.  No new or concerning nodules are\nidentified.\n\nThere are no concerning osseous lesions.  Minimal multilevel degenerative\nchanges are noted in the thoracic spine.  There is no fracture.  A small\namount of bilateral symmetric gynecomastia is noted.  The soft tissues are\notherwise unremarkable.\n\nPlease see the abdominal CT report for complete subdiaphragmatic findings.",
            "output": "Significant volume loss in the bilateral lower lobes, with near complete\ncollapse of the right lower lobe and partial collapse of the left lower lobe. \nA small component of infection cannot be completely excluded within these\nconsolidations."
        },
        {
            "input": "HEART AND VASCULATURE: Thoracic aorta is normal in caliber.  Scattered\ncalcifications are noted about the aortic arch and in the distal thoracic\naorta.  Main pulmonary artery is normal caliber.  Scattered calcifications are\nnoted about the aortic valve and in the LAD coronary artery territory.  The\nheart, pericardium and great vessels are otherwise within normal limits based\non unenhanced scan.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The 2.4 cm lung, wedge-shaped soft tissue opacity with angular\nmargins in the right middle lobe with extension to the diaphragmatic pleural\nsurface (302:60) contains mildly dilated bronchi and several small\ncalcifications..  It has been present since at least ___  and\nwhile it has grown progressively slightly larger over more than ___ years, this\nis attributable to progressive atelectasis from persistent post infectious or\npost aspiration occlusion of subsegmental bronchi, rather than active\ninfection or malignancy.\n\nThere is a moderate amount of inflammatory, bronchiolar nodulation in the lung\nbases, left greater than right left more pronounced today than on ___.  Free-standing 7 mm right lower and 5 mm left lower lobe nodules are\nalso stable from ___ and can be considered benign.  The central airways are\npatent.\n\nBASE OF NECK: Imaged portions of the base of the neck show no abnormality.\n\nABDOMEN: Patient has had partial gastrectomy.  Surgical clip is seen in the\nleft upper quadrant.  The imaged, unenhanced upper abdomen is otherwise\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPosterior fusion hardware noted in the distal cervical and proximal thoracic\nspine\n\nSOFT TISSUES: Note is made of bilateral gynecomastia, unchanged.",
            "output": "Post infectious or post aspiration atelectasis, medial segment, right middle\nlobe has been present since ___, slightly more pronounced today.\n\nMild bronchial inflammation, often due to chronic aspiration or\nnon-tuberculous mycobacterial infection.\n\nBenign subcentimeter lung nodules stable since at least ___ can be considered\nbenign."
        },
        {
            "input": "Diffuse lung disease with a mid and lower lung predominance is similar to the\nprior CTA of ___. It involves all lobes of both lungs and is\ncharacterized by ground-glass opacification, reticulation, and extensive\ntraction bronchiectasis and bronchiolectasis without definitive honeycombing. \nAdditionally, multiple hyperlucent secondary pulmonary lobules are identified,\ncorresponding to regions of expiratory air trapping on to and expiratory\nimaging.\n\nLungs are otherwise remarkable for a 4 mm diameter noncalcified lung nodules\nlocated in the right lower lobe (177),\n\nSubcentimeter mediastinal lymph nodes are likely hyperplastic in the setting\nof diffuse lung disease and do not appear appreciably changed from the prior\nstudy. Heart size is normal, and severe diffuse coronary artery calcifications\nare present as well as aortic valvular calcifications. Diffuse calcifications\nare also present in the thoracic aorta and branch vessels, and note is made of\nan aberrant right subclavian artery, a normal variant. There is no pericardial\nor pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but adrenal\nglands are well visualized and normal in appearance.\n\nSkeletal structures demonstrate multilevel degenerative changes throughout the\nspine.",
            "output": "1. Diffuse interstitial lung disease with mid and lower lung predominance with\nextensive traction bronchiectasis, but no definitive honeycombing.  Associated\nhyperlucent lobules with expiratory air trapping. Overall appearance is\nsimilar to ___, except for apparent increase in extent of the\nground-glass and reticulation in the upper lungs. The presence of expiratory\nair trapping and change in upper lobes since ___ favor\nhypersensitivity pneumonitis over a fibrotic subtype of NSIP.\n\n2. Severe diffuse coronary artery calcifications.\n\n3. 4 mm right lower lobe lung nodule is statistically most likely benign, but\nfollowup CT is recommended in ___ to confirm ___ year stability."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Small hilar and mediastinal lymph nodes measure\nup to 8 mm and are not pathologically enlarged by CT size criteria (03:56). \nNo axillary lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Millimetric bilateral pulmonary nodules are identified:\n\n-4 mm left upper lobe pulmonary nodule (3:74).\n-3 mm right lower lobe perifissural nodule (3:92).\n-4 mm right lower lobe subpleural nodule (3:113).\nThere is mild bibasilar atelectasis.  No areas of abnormal parenchymal\nopacification are identified.  There is mild-to-moderate predominantly\nbibasilar bronchial wall thickening with mucous plugging.  The airways are\notherwise patent to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES/SOFT TISSUES: No suspicious osseous abnormality is seen.? There is no\nacute fracture.  A 1.5 x 1.1 cm soft tissue density in the posterior soft\ntissues of the left breast is incompletely evaluated (___:15).",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild to moderate bronchial wall thickening and mucous plugging suggestive\nof small airways disease.\n3. Bilateral pulmonary nodules measure up to 4 mm.  Please refer to ___\ncriteria below for follow-up recommendations.\n4. 1.5 cm soft tissue density in the posterior left breast is incompletely\nevaluated.  Recommend correlation with physical exam and dedicated breast\nimaging.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Several borderline sized lymph nodes are seen in\nthe thoracic inlet and the upper mediastinum (2, 11).  Other lymph nodes in\nthe lower areas of the mediastinum, notably in paratracheal location (2, 21)\nare markedly enlarged.  Normal appearance of the large mediastinal vessels. \nMinimal aortic valve calcifications, no substantial coronary calcifications,\nno abnormalities in the posterior mediastinum.  No pericardial effusion.  The\nupper abdomen is described in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.\nNo diffuse lung disease.  No pleural thickening, no pleural effusions.  The\nairways are patent.  No suspicious pulmonary nodules or masses.  No evidence\nof infectious parenchymal processes.",
            "output": "No evidence of metastatic disease to the thorax.  No pleural abnormalities, no\nadenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Right supraclavicular lymph nodes\ndo not meet CT criteria for enlargement.  The visualized thyroid gland is\nunremarkable.  There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are scattered borderline enlarged mediastinal lymph nodes\nincluding in the right paratracheal station measuring up to 12 mm which are\nunchanged compared to the prior study.\n\nHILA: Evaluation for hilar lymphadenopathy is limited without intravenous\ncontrast.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is no pericardial\neffusion.\nPLEURA: No pleural effusion is noted.\nLUNG:\n\n1. PARENCHYMA:  The lungs are clear.  No definite pulmonary nodule is\nidentified.\n2. AIRWAYS:  The central airways are patent.\n3. VESSELS:  There is mild atherosclerotic calcification of a normal caliber\nthoracic aorta.  The main pulmonary artery is normal in caliber.\n\nUPPER ABDOMEN: The study is not tailored to subdiaphragmatic evaluation.  The\nliver is nodular in contour.  LiLipiodiol uptake from prior treatment is again\nnoted.  Evaluation for focal liver lesions is limited without intravenous\ncontrast.  Area of hypodensity within the right hepatic lobe is appreciated\nand liver parenchyma was best assessed on MRI dated ___.  The\nspleen appears enlarged.\n\nCHEST CAGE: No suspicious lytic or sclerotic lesions.",
            "output": "1.  Stable borderline enlarged mediastinal lymph nodes.\n\n2.  No new pulmonary nodules."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Stable normal sized lymph nodes in the mediastinum.\nMild coronary calcifications, no valvular calcifications, no pericardial\neffusion.  The posterior mediastinum is unremarkable.  No osteolytic lesions\nat the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.\nMinimal bilateral apical scarring.  Minimal bilateral paraseptal pulmonary\nemphysema.  Several calcified granulomas are unchanged as compared to the\nprevious examination.  Minimal right upper lobe ground-glass nodule (5, 73)\nlikely inflammatory in origin.  Minimal thickening any irregularities of the\nairway walls.  No pleural thickening, no pleural effusions.  No diffuse lung\ndisease.",
            "output": "Stable calcified granulomas.  New subtle right upper lobe ground-glass nodule,\nlikely inflammatory in origin.  Stable normal sized mediastinal lymph nodes."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  A normal sized anterior mediastinal lymph\nnode (3, 24) is stable.  Mild coronary calcifications.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  No osteolytic lesions\nat the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.\nStable right apical calcified granuloma.  Stable 2 mm pleural left upper lobe\nnodule (5, 92).  Stable 2 mm calcified left lower lobe granuloma (5, 140). \nCalcified 2 mm middle lobe granuloma.  No suspicious pulmonary nodules or\nmasses.  No pleural effusions.  No evidence of airways disease.",
            "output": "Stable calcified granulomas.  Stable 2 mm left upper lobe nodule. No\nsuspicious or growing nodules.  No adenopathy.  No pleural abnormalities."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The pulmonary arteries are\nnormal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a stable 2 mm calcified nodule in the right upper lobe (4, 48).\nAnother 1 mm calcified granuloma seen in the right upper lobe (4, 110).  A 2\nmm calcified nodule in the lingula (4, 116).  Another nodule in the left lower\nlobe is also unchanged.  No new or growing pulmonary nodules.  Several other\nscattered calcified nodules bilaterally.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.  No lytic or sclerotic\nlesions concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "Multiple scattered 1-2 mm calcified pulmonary nodules.  No new or growing\npulmonary nodules."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Anterior mediastinal\nsmall lymph nodes ranging up to 7 mm and the sub-carinal lymph node is up to 9\nmm, does not pathologically enlarged.  No supraclavicular carinal, axillary or\nhilar lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Several calcified\nnodules are present, series 4, image 44, 113, 124, 156, 235.  No noncalcified\nnodules seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of metastatic disease.  The presence of calcified\nnodules might represent previous granulomatous disease but in the presence of\nknown sarcoma, close attention to exclude the possibility of calcified\nmetastatic disease is recommended with repeat radiograph in 3 months."
        },
        {
            "input": "CHEST:\nThe heart is moderately enlarged, without pericardial effusion.  Main\npulmonary trunk is prominent measuring up to 3.4 cm in diameter (3a: 32),\nwhich can be seen in the setting of pulmonary arterial hypertension.  Several\nmediastinal lymph nodes measuring up to 9 mm in short axis are likely\nreactive.  No hilar lymphadenopathy by size criteria.\n\nAirways are patent to the subsegmental levels. A 2 mm subpleural nodule in the\nanterior right middle lobe (3a: 49) is unchanged from ___.   A small\nright pleural effusion with associated pleural thickening at the right lung\nbase is again noted.  There is also a crescentic shaped fluid collection at\nthe right lung base which is stable.  There is no pleural effusion on the\nleft.  Extensive pleural calcifications are present at the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 5 mm hyperdense lesion in segment VI (3a: 97), which likely\nrepresents a flash filling hemangioma.  No other hepatic lesions are\nidentified.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.  Hypodensity in the main and right portal veins is\nlikely due to mixing.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES:  No acute fractures. Old left rib fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nCTA Torso with run-offs:\nStatus post TAVR.  The thoracic aorta is normal in course and caliber, and\ncontains atherosclerotic calcifications.  Abdominal aorta is normal in course\nand caliber.  Mild narrowing of the celiac axis at its origin (3a: 103), but\nthe vessel is widely patent distally.  Similar mild narrowing of the SMA at\nits origin.\n\nRight pelvis: Right common, external and internal iliac arteries are patent.\n\nLeft pelvis: Left common iliac artery is patent.  There is abrupt disruption\nof flow in the left external iliac artery (3a: 186), concerning for acute\nthrombus.  There is reconstitution of flow distally at the level of the common\nfemoral artery, likely from collateralization.\n\nRight lower extremity CTA:  Only minimal flow is demonstrated within the right\nfemoral popliteal bypass graft.  Popliteal artery is patent.  Right peroneal\nand posterior tibial arteries are patent.  Severe atherosclerotic disease in\nthe anterior tibial artery, with minimal flow seen to the level of the mid\ncalf.\n\nLeft lower extremity CTA:  The common femoral artery is patent.  Deep femoral\nartery is patent.  Proximal and mid-portions of the superficial femoral artery\nare patent, although there is likely chronic occlusion distally with evidence\nof collateralization.  Some segments of the left popliteal artery are severely\nstenotic (3a:362), although with normal flow distally.  The posterior tibialis\nand peroneal arteries are patent to the level of the foot.  Left anterior\ntibial artery is also severely stenotic, with only minimal flow seen to the\nlevel of the ankle.",
            "output": "1. Acute thrombus in a segment of the left external iliac artery, with\nreconstitution of flow distally likely from collateralization.\n2. Right lower extremity CTA:  Severe stenosis throughout the right anterior\ntibial artery, with minimal flow to the mid calf. Patent peroneal and\nposterior tibial arteries.\n3. Left lower extremity CTA:  Severely stenotic left anterior tibial artery,\nwith minimal flow to the level of the ankle.  Patent peroneal and posterior\ntibial arteries.\n4. Probable chronic occlusion of the distal left superficial femoral vein,\nwith collateralization.\n5. Cholelithiasis.\n6. 5mm hepatic segment VI hyperdensity, likely a flash filling hemangioma.\n7. 2 mm right lower lobe pulmonary nodule, unchanged from ___."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged in appearance including mild\ndilatation of the main pulmonary artery.  The patient is after aortic stent\nplacement.  Heart size is normal.  There is no pericardial effusion.\n\nThere is interval minimal change in extensive calcified pleural plaques and\npleural thickening, with calcifications being predominantly seen on the left\nand pleural thickening being predominantly seen on the right, series 3, image\n46.  No definitive evidence of new pleural effusion or additional pleural\nthickening demonstrated\n\nImage portion of the upper abdomen demonstrate multiple calcified gallstones.\n\nAirways are patent to the subsegmental level bilaterally\n\nThere are no lytic or sclerotic lesions,  potentially the culprit for pleural\ncalcifications and not necessarily asbestos exposure giving the pleural\ncalcifications being along the multiple fractures.\n\nScattered sub 5 mm pulmonary nodules are unchanged except the largest ones in\nthe left lower lobe/lingula, series 5, image 241 which is 7 mm, new as\ncompared to ___ and ___ chest CT.",
            "output": "Stable appearance of the pleural thickening and pleural calcifications\n\nNew lingular nodule that should be reassessed in 3 months for documentation of\nstability."
        },
        {
            "input": "The thyroid is unremarkable.  There are no enlarged supraclavicular lymph\nnodes.  There are no enlarged axillary lymph nodes.\n\nSmall mediastinal nodes are stable.  There is evidence of prior cardiac\nsurgery and a prosthetic aortic valve is in place.  There is stable mild\ncardiomegaly.  There is no pericardial effusion.\n\nThere is no pleural effusion.\n\nPleural thickening seen posteriorly in the right lower hemithorax is\nunchanged.\n\nThere are densely calcified bilateral and noncalcified pleural plaques which\nare related to prior asbestos exposure.\n\nThere is no evidence of asbestosis.  There is subsegmental atelectasis in both\nlung bases.  The previously visualized 7 mm lingular nodule is not seen on the\ncurrent study.  2 mm calcified granuloma in the right upper lobe (92, 4) is\nunchanged.  There is bibasilar atelectasis.  Scattered sub 5 mm pulmonary\nnodules are unchanged.  No new pulmonary nodules\n\nReview of bones shows degenerative changes involving the thoracic spine.\n\nLimited sections through the upper abdomen shows multiple small upper\nabdominal lymph nodes.",
            "output": "Stable appearance of pleural thickening and pleural calcification, most likely\nrelated to prior asbestos exposure.  No evidence of asbestosis.\n\nPreviously visualized 7 mm lingular nodule is not seen on the current study. \nAll the other sub 5 mm pulmonary nodules are unchanged.  No new pulmonary\nnodules"
        },
        {
            "input": "CTA thorax: Pulmonary emboli are noted within the large anterior and posterior\nsegmental branches of the right upper lobe pulmonary artery. There is no\nevidence of right heart strain, pulmonary infarct, pulmonary hemorrhage, or\npulmonary effusions. There are subsegmental right lower lobe pulmonary artery\nbranch opacification is, which could be due to motion artifact. There is no\nevidence of pulmonary embolism in the left pulmonary circulation. The aorta\nand main thoracic vessels are well opacified.  The aorta demonstrates normal\ncaliber throughout the thorax without intramural hematoma or dissection.\n\nCT thorax:  Bibasilar atelectasis is visualized. The airways are patent to the\nsubsegmental level.There is no mediastinal, hilar, or axillary lymph node\nenlargement by CT size criteria.The heart, pericardium, and great vessels are\nwithin normal limits.No hiatal hernia or other esophageal abnormality is\npresent.No focal opacity, pleural effusion, or pneumothorax is identified.\n\nOsseous structures: No focal osseous lesion concerning for malignancy is\npresent.  The patient is status post T1 the T8 laminectomy, with surgical\nstaples visualized.  No residual fluid collections are visualized. Two small\nhyperdense foci in the region of the right biceps tendon could be tendinous\ncalcifications or loose bodies.\n\nAlthough this study is not designed for the assessment of intra-abdominal\nstructures, there is noted hepatic steatosis.  The remainder of the visualized\nabdominal organs and stomach are unremarkable.",
            "output": "Pulmonary emboli within the anterior and posterior segmental branches the\nright upper lobe pulmonary artery, without evidence of right heart strain or\npulmonary infarct.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 17:01 on ___, 2 min after\ndiscovery.  Dr. ___ was also notified of these results via telephone\nat 17:34 on the same date."
        },
        {
            "input": "CTA THORAX: The aorta and main thoracic vessels are well opacified. The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection. There is redemonstration of pulmonary emboli within the\nanterior and posterior segmental branches of the right upper lobe pulmonary\nartery.  No definite new pulmonary emboli identified, however somewhat limited\nat the subsegmental level due to motion artifact and atelectasis.\n\nCT OF THE THORAX: The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nThe heart, pericardium, and great vessels are within normal limits. There is\nmild elevation the right hemidiaphragm. Linear platelike atelectasis is noted\nat the bases bilaterally.\n\nLung windows otherwise do not demonstrate any focal opacity. No pleural\neffusion or pneumothorax is present.\n\nAlthough this study is not designed for assessment of intra-abdominal\nstructures, the visualized solid organs and the stomach are unremarkable.\n\nOSSEOUS STRUCTURES: No focal osseous lesion concerning for malignancy. \nPatient is status post T1 through T8 laminectomy with surgical staples again\nseen. There is surrounding fat stranding and soft tissue swelling. However no\nfluid collections are identified.",
            "output": "Redemonstration of pulmonary emboli within the anterior and posterior\nsegmental branches of the right upper lobe pulmonary artery. No definite new\npulmonary emboli identified, however somewhat limited examination of the\nsubsegmental arteries due to motion artifact and atelectasis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Stable normal sized para-aortic lymph node (3, 18).\nNormal dimension of the main pulmonary artery.  Mild coronary calcifications,\nno valvular calcifications, no pericardial effusion.  On today's examination,\nthere is no evidence for the presence of pulmonary emboli.  The posterior\nmediastinum shows a moderate hiatal hernia.  Decreased attenuation of the\nliver parenchyma.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Moderate degenerative vertebral disease. \nNo vertebral compression fractures.\nMild respiratory motion artifacts.  New scarring at the bases of the left\nupper lobe (5, 120).  Similar scarring (stable) is noted in the middle lobe\n(5, 134).  Minimal stable lingular scarring (5, 164).  Minimal stable scarring\nat the bases of the right lower lobe (5, 252).  Stable atelectasis at the\nbases of the left lower lobe (5, 218).  No pleural effusions.  No evidence of\npneumonia.  No diffuse lung disease.  The airways are patent.",
            "output": "The parenchymal abnormalities detected on this examination and likely\nreflecting the changes seen on a previous chest x-ray (unavailable) are a\ncombination of atelectasis and parenchymal scarring.  No evidence of\ninfectious process.  No airways disease.  No diffuse lung disease.  No pleural\nabnormalities.  No adenopathy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is mild central bronchial wall thickening.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Partially imaged right lobe liver cyst measures up to 2.8 cm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is a left posterior rib bone island.\n\nSurgical clips are seen in the left breast.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Mild central bronchial wall thickening may be due to airway inflammation."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nmild to moderate atherosclerotic disease in the aortic arch and in the\ndescending thoracic aorta.  There are extensive coronary artery\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits based on an unenhanced scan. No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a prominent, 6 mm right hilar lymph\nnode (8:116), likely reactive.  Subcentimeter mediastinal lymph nodes are not\npathologically enlarged by CT size criteria.  There is no axillary\nlymphadenopathy.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate centrilobular and paraseptal emphysema, most\npronounced in the right upper lobe.  There is biapical pleuroparenchymal\nscarring with nodularity.  There is a 2 mm sub solid nodule in the left upper\nlobe (8:84).  Subpleural nodule in the right upper lobe (8:69, 107) may\nrepresent atelectasis or focal scarring.  Incidentally noted is a small\ntracheal diverticulum measuring up to 1.2 cm (08:47).  There are multiple\nscattered punctate calcified granulomas throughout the left lung.  There is\nmild bibasilar dependent atelectasis.  There is mild traction bronchiectasis\nin the posterior right lower lobe adjacent to an area of scarring.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There is a 5 mm hypoattenuating nodule in the left thyroid gland\n(08:34).  Otherwise, the visualized portions of the base of the neck show no\nabnormality.\n\nABDOMEN:  Please see separate report for concurrently performed CT Abdomen and\nPelvis for findings below the diaphragm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pneumonia or infection in the chest.\n2. A 2 mm sub solid nodule in the left upper lobe.  See recommendations below.\n3. Moderate centrilobular and paraseptal emphysema, most pronounced in the\nright upper lobe.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild atherosclerotic calcifications affecting thoracic\naorta.  Otherwise, the heart, pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  There is\nextensive mediastinal and hilar lymphadenopathy, likely reactive in nature. \nFor example, a lower right paratracheal lymph node measures 13 mm in short\naxis (series 3, image 82).  A right hilar lymph node measures 14 mm in short\naxis (series 3, image 111).  No mediastinal mass.\n\nPLEURAL SPACES: Moderate left and small right nonhemorrhagic pleural effusions\nwith associated atelectasis.  No pneumothorax.\n\nLUNGS/AIRWAYS: Atelectasis affecting the dependent portion of the lower lobes\nbilaterally.  No other focal consolidations.  Calcified granuloma within the\nright upper lobe.  There are multiple punctate nodules throughout the lungs\nbilaterally, for example series 3, images 47, 78, 125.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small amount of perihepatic ascites.  Large rim enhancing\nperipancreatic fluid collection is partially imaged, better characterized on\nthe CT dated ___.  1.6 cm left adrenal nodule (series 3, image\n231).\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate left and small right pleural effusions without associated\ncompressive atelectasis.\n3. Mediastinal and bilateral hilar lymphadenopathy, likely reactive.\n4. A few punctate nodules within the lungs bilaterally, which do not require\nfollow-up in a low risk patient.\n5. Large rim enhancing peripancreatic fluid collection is partially imaged,\nbetter characterized on the CT dated ___.\n6. 1.6 cm left adrenal nodule.  Adrenal protocol CT or MRI is recommended on\nan outpatient basis.\n\nRECOMMENDATION(S):  Adrenal protocol CT or MRI on an outpatient basis.\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  Small hypodense left adrenal lesion (3, 55) most\nlikely representing a lipid rich adenoma.  Nonobstructing calculi in the upper\npole of the left kidney measuring 2 mm in diameter (3, 61).\n\nMEDIASTINUM: No mediastinal adenopathy.  Calcified subcarinal lymph nodes.\n\nHILA: Calcified bilateral hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Mild left and right coronary artery\ncalcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  The spiculated nodule in the superior segment of the left lower\nlobe (5, 138) is stable to slightly decreased in size currently measuring 16 x\n6 mm (previously 16 x 9 mm) and slightly increased in density (however this\nmay be secondary to technical factors). Scarring in relation to the previous\nwedge resection in the left upper lobe (5, 73) is unchanged.   Millimetric\nnodules (5, 125 and 186) unchanged.  Ground-glass nodule in the left upper\nlobe (5, 147) measuring 7 x 8 mm is unchanged.  Ground-glass densities in the\nlingula (5, 159, 161), left lower lobe (5, 173) are unchanged.  There is mild\ncylindrical bronchiectasis in the lower lobes bilateral with associated mosaic\nattenuation pattern of the pulmonary parenchyma.  Calcified granuloma in the\nright lower lobe (5, 212).\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is mildly enlarged measuring 32 mm in diameter\nsuggesting pulmonary arterial hypertension.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "The spiculated nodule/ consolidation in the superior segment of the left lower\nlobe is stable or possibly mildly decreased in size.  The nodule demonstrates\nslightly increased in density (this is most likely technical in nature).\nThe ground-glass nodule in the left upper lobe is unchanged (increase in\ndensity is most likely technical in nature).\nMild bronchiectasis with associated mosaic attenuation of the pulmonary\nparenchymal pattern in the lower lobes is again noted and may be related to\nchronic aspiration.\n\nRECOMMENDATION(S):  This case was discussed at a multidisciplinary conference:\nPET-CT and tissue sampling of the spiculated nodule in the superior segment of\nthe left lower lobe is advised."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No appreciable coronary\natherosclerosis.  The main pulmonary artery is mildly enlarged and measures\n3.2 cm in diameter.  No central pulmonary embolus.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Status-post left lower lobe superior segmentectomy.  No\nsuspicious soft tissue along the resection margin.  Mild bibasilar\nbronchiectasis and mosaic ground-glass attenuation of the associated lower\nlobe parenchyma is unchanged.  Mosaic ground-glass attenuation of the lingula\nis slightly increased. Mild bibasilar atelectasis.  New left hemidiaphragm\nelevation related to volume loss from a superior segmentectomy. A calcified\nright lower lobe nodule is unchanged (series 5, image 226).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Hepatic steatosis with focal sparing adjacent to the gallbladder. \nBilateral nonobstructive nephrolithiasis.  A 1.5 x 1.0 cm left adrenal nodule\nis unchanged since ___, at which time it is characterized as an adenoma\n(7.6 Hounsfield units).  Unchanged thickening of the right adrenal gland. \nIncidental small accessory spleen.\n\nBONES: No suspicious osseous abnormality is seen.? new lateral left fifth rib\nfracture with some periosteal reaction (series 3, image 24), likely related to\nthoracotomy.  No other fracture identified.",
            "output": "1. No evidence of focal recurrence or distant metastasis.\n2. Minimally changed bilateral lower lobe mosaic ground-glass attenuation with\nbronchiectasis.  Slightly increased lingula mosaic ground-glass attenuation. \nThese findings may reflect sequelae of chronic aspiration, as mentioned\npreviously.\n3. Hepatic steatosis.\n4. Stable left adrenal adenoma.\n5. Bilateral nonobstructive nephrolithiasis.\n6. Enlarged main PA which may reflect pulmonary hypertension.  Please\ncorrelate clinically."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.  The esophagus is patulous.\n\nUPPER ABDOMEN: Hepatic steatosis.  Bilateral nephrolithiasis.  Stable 1.5 cm x\n1.0 cm adrenal nodule, most likely an adenoma.  Small accessory spleen. \nPlease note the chest CT is not designed for subdiaphragmatic\ncharacterization.\n\nMEDIASTINUM: No mediastinal mass. A prevascular node at the level of the AP\nwindow (4:90) is slightly, although not pathologically, larger than the prior\nstudy.  Otherwise, no significant mediastinal lymphadenopathy.\n\nHILA: No hilar mass or lymphadenopathy.  Small right hilar node granulomatous\ncalcification.\n\nHEART and PERICARDIUM: Heart size is normal. The thoracic aorta is normal in\ncaliber. No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Normal, postoperative appearance of the superior segmentectomy\nof the left lower lobe. Scattered, mild, ground-glass micronodulation in the\nright upper lobe is due to bronchiolar inflammation rather than malignancy.  A\nperipheral, low-attenuation nodular density near the site of the chain suture\non the left lower lobe (4:129) measures approximately 1.3 cm x 1.6 cm and is\nnew.  Scattered, ground-glass attenuation, left greater than right and\nincluding the lingula, is largely unchanged from the prior study and most\nlikely due to chronic aspiration. Unchanged 5.8 mm calcified right lower lobe\npulmonary nodule (4:168).\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS: The main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE AND THORACIC SPINE: No osseous lesions.  Healing left lateral fifth\nrib fracture (4:96).  Otherwise, no acute fractures.",
            "output": "A new, peripheral, low-attenuation nodular density measuring approximately 1.3\ncm x 1.6 cm is concerning for pleural thickening or a subpleural lung lesion,\nless likely atelectasis due to the low attenuation.  Recommended monitoring\nwith repeat chest CT in 3 months.\n\nUnchanged, scattered, left greater than right, ground-glass attenuation most\nlikely due to chronic aspiration.\n\nScattered, mild, right upper lobe ground-glass micronodules are most likely\ndue to bronchiolar inflammation.\n\nStable calcified right lower lobe pulmonary nodule.\n\nPatulous esophagus.\n\nHepatic steatosis.\n\nBilateral nephrolithiasis.\n\nStable, probable adrenal adenoma.\n\nHealing, left lateral fifth rib fracture.\n\nRECOMMENDATION(S):  The impression and recommendation above was entered by Dr.\n___ on ___ at 13:49 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not\npathologically enlarged and there is no soft tissue abnormality in the imaged\nchest wall suspicious for malignancy.  Findings below the diaphragm will be\nreported separately.\n\n\nCARDIO-MEDIASTINUM:Esophagus and thyroid are unremarkable.  Atherosclerotic\ncalcification is not apparent head and neck vessels or coronary arteries. \nCentral venous infusion catheter ends in the mid right atrium.  Aorta and\npulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: None pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs clear.  Tracheobronchial tree is normal to\nsubsegmental levels.  There is no pleural abnormality.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy present.  Several small mediastinal lymph nodes are\nnot pathologically enlarged in all of them are stable.  Paraesophageal lymph\nnodes are stable as well.  There is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear in\nterms of pulmonary nodules or masses.  Minimal by lateral scarring is\nunchanged.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease\n\nPlease review the separately provided report on CT abdomen and pelvis."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall concerning for malignancy. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels and in the coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic.\n\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere is no pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging.  Supraclavicular\nand axillary lymph nodes are not enlarged and there is no soft tissue\nabnormality in the imaged chest wall concerning for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Lower esophagus is moderately patulous but filled with air.\nThere is no evidence of obstruction.\n\nAtherosclerotic calcification is minimal in head and neck vessels, not\napparent coronary arteries.  Aorta and pulmonary arteries is and cardiac\nchambers are normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Aside from linear subpleural atelectasis, right lung\nis clear.  Left lung is clear.  Tracheobronchial tree is normal to\nsubsegmental levels.  No pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, mediastinal, hilar, or\nsupraclavicular lymphadenopathy.  The heart size is normal.  There is no\npericardial effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nNo concerning new or growing pulmonary nodules are identified.  There is no\npleural effusion or pneumothorax.",
            "output": "No concerning new or growing pulmonary nodules identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nAt the heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, of note 3 periesophageal lymph\nnodes measuring up to 8 mm (103:181), unchanged.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Scattered punctate calcified\ngranulomas, for example in the right lung base (103:209).\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___.\nNo evidence of intrathoracic metastatic disease.\nNo suspicious lung nodules, lymphadenopathy or osseous lesions."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion. \nThoracic aorta is normal in caliber and mildly calcified.  No evidence of\ndissection or penetrating atherosclerotic ulcer formation.  The main pulmonary\nartery is normal in caliber.  No central pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 5 mm right upper lobe subpleural pulmonary nodule is\ngradually increased in size since ___ (series 6, image 87).  A 5 mm\nright upper lobe pulmonary nodule adjacent to the major fissure has gradually\nincreased in size since ___ (series 6, image 126).  A couple of\npunctate micro nodules and calcified granulomas are unchanged.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Two right upper lobe pulmonary nodules measuring 5 mm have gradually increased\nin size since in ___ concerning for metastases.  No mediastinal\nlymphadenopathy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum (5, 28)\nAre normal in size.  Normal appearance of the large mediastinal vessels.  No\nincidental PE.  Minimal coronary calcifications, no valvular calcifications,\nno pericardial effusion.  Stable small paraesophageal lymph node (5, 95).  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.\n\nMinimal millimetric increase in size of a 6 mm pleural right upper lobe nodule\n(301, 77).\nObvious increase in size from a previously 5 mm pulmonary nodule in the right\nupper lobe to now 8 mm (301, 115).\nNew fissural 1 mm solid right lower lobe nodule (301, 118).\n2 mm calcified right lower lobe granuloma (301, 207).\n2 mm calcified right lower lobe granuloma (301, 225).\n\nThe airways are patent.  No pleural abnormalities.",
            "output": "Ongoing increase in size of 2 pre-existing right upper lobe pulmonary nodules.\n1 millimetric new pulmonary nodule.  No lymphadenopathy.  No pleural\nabnormalities."
        },
        {
            "input": "The large right perihilar mass adjacent to the right upper lobe bronchus has\nsignificantly decreased in size, from 8.6 x 8.4 cm to 2.0 x 1.9 cm (4:28). The\npathologic subcarinal lymph node has decreased from 5.1 x 2.7 cm to 1.8 x 0.8\ncm (4:30). Multiple additional masses in the right upper lobe in perivascular\ndistribution, presumably representing satellite lesions, have also markedly\ndecreased in size.\n\nThere is no supraclavicular or axillary lymphadenopathy. The aorta and\npulmonary arteries are normal in size.  The heart size is normal and there is\nno pericardial effusion. There is no pneumothorax.  There is no pleural\neffusion.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Dramatic interval improvement in disease with substantial decrease in the\nsize of the primary right perihilar mass, satellite lesions in the right upper\nlobe, and mediastinal lymphadenopathy.\n2. Please see separate report for findings within the abdomen and pelvis."
        },
        {
            "input": "The examination is compared to ___.\nThe known right perihilar mass (2, 26) has further decreased in size, from 18\nx 20 mm to now 12 x 11 mm.\nAlso substantially decreased are the peribronchial areas of soft tissue\nattenuation that pre existed on the previous examination (2, 25).\nFinally the number and size of the pre-existing nodular satellite lesions in\nthe right upper lobe has substantially decreased (2, 19), some of the lesions\nare barely visible on today's examination.\nDecrease in size of the pre-existing sub carinal lymph node, this lymph node\nis now normal.\n\nOtherwise the appearance of the lung parenchyma is unchanged. There is no\nevidence of new nodules or masses.  Unchanged appearance of the pulmonary\nvasculature, no incidental pulmonary embolism.  No pleural effusions. No\npleural thickening.  Unchanged appearance of the adrenal glands.  No evidence\nof other enlarged mediastinal or hilar lymph nodes.  A small sclerotic rib\nlesion (600b, 62) is not substantially changed.",
            "output": "Further reduction in size of the right mediastinal and perihilar malignancy.\nDecrease in size of the associated lymphadenopathy and off the satellite\nparenchymal lesions.  Unchanged sclerotic rib lesion."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion.  The main pulmonary artery\nis normal caliber.  No incidental pulmonary embolus is identified.  The\nthoracic aorta is mildly ectatic measuring 4.0 cm at the level of the right\npulmonary artery.\n\nThe known dominant left hilar mass is not appreciably changed measuring 16 x\n16 mm, previously 15 x 17 mm (remeasured: 6, 140). Right upper lobe satellite\nlesions with irregular borders are unchanged (6: 76, 78, 90, 97, 101, 117).  A\nband of secretions traverses the trachea. There is no pleural effusion. \nModerate upper lobe predominant centrilobular emphysema is unchanged. \nModerate diffuse bronchial wall thickening is also unchanged, and is most\nextensive in the right upper lobe.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "Interval stability of dominant left hilar mass and its right upper lobe\nsatellite lesions as compared to ___.\n\nNo lymphadenopathy.\n\nStable moderate upper lobe predominant centrilobular emphysema.\n\nStable moderate diffuse bronchial inflammation."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, and mediastinal lymph nodes\nare not enlarged.  The pulmonary arteries are normal size.  The ascending\naorta is borderline enlarged, with a maximum diameter 3.9 cm.  Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nAirways are patent to subsegmental levels.  Bronchial wall thickening in the\nright lower lung is similar to the prior study.\n\nRight hilar soft tissue mass narrowing the right upper lobe bronchus is\nminimally smaller compared to the most recent prior study (series 3, image\n113).  This lesion now measures 18 x 16 mm, previously (remeasured) 19 x 19 mm\n(series 8, image 123).  Right upper lobe satellite lesions are also present,\nwith stable appearance of previously present nodules, but interim development\nof at least 1 new nodule (series 8, image 50).\n\nNew areas of mild bronchiectasis and ground-glass in the anterior left upper\nlobe and peripheral left upper lobe (series 8, images 136, 169) are consistent\nwith an infection.  More subtle ground-glass opacity of the left lower lobe is\nalso present (series 8, image 25).  An area of pleural thickening or\nsubpleural atelectasis in the left lower lobe posterior costal space is new\n(series 7, image 43).  There are no additional lesions suspicious for\nmalignancy.\n\nPlease refer to concurrent CT abdomen pelvis report for discussion of findings\nin the upper abdomen.  Diffuse heterogeneity with sclerosis of the T1\nvertebral body is concerning for metastatic disease.  Heterogeneity of T10 is\nconsistent with treated metastatic disease.  Right lower lateral rib\nheterogeneities consistent with treatment effect.  Chronic healed fractures of\nleft lower lateral rib ribs is also noted.",
            "output": "1. Similar appearance of right hilar mass, narrowing the right upper lobe\nbronchus.\n2. Interim development of new satellite nodules in the right upper lobe.\n3. Treated vertebral body and right rib metastases.\n4. Multifocal ground-glass opacification and near-consolidation in the left\nlung, which are most consistent with multifocal pneumonia.  It is unclear from\nthe medical record whether the patient received radiation treatment to this\narea or  to the left chest wall which  could instead induce radiation\npneumonia."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy by CT size criteria.  The imaged thyroid is\nheterogeneous with possible 8 mm hypodensity in the right lobe (2:8).  The\nimaged chest wall is grossly unremarkable.\n\nUPPER ABDOMEN: The imaged upper abdomen demonstrate marked distension of the\nstomach, filled with ingested material.  There is moderate amount of\nnonhemorrhagic ascites.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.  Of\nnote is marked distension of the esophagus with heterogeneous density.  There\nis suggestion of intraluminal soft tissue with minimal rim enhancement\nmeasuring 1.7 x 2.0 x 9.3 cm (2:21, 602:60) .  There is air-fluid level within\nthe distal esophagus.  The most distal portion of the esophagus is relatively\ndecompressed but appears circumferentially thick walled.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.  Calcification at\nthe right hilum artery may represent calcified granuloma or lymph node, likely\nrelated to prior granulomatous exposure (302:122).\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\npericardial effusion.  Moderate amount of calcifications are noted in the\naortic valve.  Minimal coronary calcifications are noted.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild pleuroparenchymal scarring at the apices.  There\nis apical predominant moderate centrilobular emphysema.  In addition, the\nlungs are hyperinflated with flattened diaphragms, suggestive of chronic\nobstructive process.  A calcified granuloma is seen in the right upper lobe\n(302:126).  8 mm ground-glass opacity in the left lower lobe is nonspecific\n(302:149).  10 mm opacity in the lingula likely represents focal atelectasis\n(302:204).\n2. AIRWAYS:  The airways are patent to the subsegmental levels.  There is mild\nperibronchial wall thickening especially in the lower lobes, likely due to\nbronchitis.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is not dilated.  While this exam is not tailored for\nevaluation of pulmonary embolism, no filling defects are seen in the central\npulmonary arteries.\nCHEST CAGE: There is no suspicious osseous abnormalities concerning for\nmetastatic disease or acute fracture.",
            "output": "1. Intraluminal soft tissue density within the esophagus measuring 1.2 x 2.0 x\n9.3 cm with minimal rim enhancement.  The finding is nonspecific and may\nrepresent ingested material versus polypoid mass.  Distal esophagus is also\ncircumferentially thick walled.  Direct visualization with endoscopy is\nrecommended for further evaluation.\n2. Marked distension of the stomach with ingested material and non dependent\nair, likely related to gastroparesis.\n3. Moderate amount of nonhemorrhagic ascites.\n4. Right thyroid lobe hypodensity does not meet criteria for further\nevaluation.\n5. 8 mm ground-glass opacity in the left lower lobe.  For an incidentally\ndetected single ground-glass nodule bigger than 6mm, CT follow-up in 6 to 12\nmonths is recommended to confirm persistence. If persistent, CT follow-up\nevery ___ years until ___ years after initial detection are recommended.\n\nRECOMMENDATION(S):\n-Intraluminal soft tissue density within the esophagus measuring 1.2 x 2.0 x\n9.3 cm with minimal rim enhancement.  The finding is nonspecific and may\nrepresent ingested material versus polypoid mass.  Distal esophagus is also\ncircumferentially thick walled.  Direct visualization with endoscopy is\nrecommended for further evaluation.\n-8 mm ground-glass opacity in the left lower lobe.  For an incidentally\ndetected single ground-glass nodule bigger than 6mm, CT follow-up in 6 to 12\nmonths is recommended to confirm persistence. If persistent, CT follow-up\nevery ___ years until ___ years after initial detection are recommended.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:34 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Streak artifact from contrast bolus limits evaluation\nof the upper right lung fields.  Pulmonary vasculature is well opacified to\nthe segmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  No parenchymal masses within the limitation of motion artifact\nfrom breathing.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Right-sided Port-A-Cath tip\nprojects to the SVC.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  These arm not enlarged\nby size criteria.  There is moderate coronary artery calcification.  The\ndescending thoracic aorta is mildly dilated and tortuous.  There is no\npericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nThere is subsegmental atelectasis in the right lung base.  There is a\ncalcified granuloma in the right lower lobe.  Evaluation of the lung\nparenchyma is somewhat limited by respiratory motion.  No evidence of\npneumonia.  Mild bronchiectasis in the left lower lobe.  There is upper lobe\npredominant emphysema\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No evidence of pneumonia.\n\nMild bronchiectasis in the left lobe lower lobe.\n\nModerate cardiomegaly.\n\nModerate coronary artery calcification and aorta annulus calcification.\n\nCalcified granuloma in the right lower lobe"
        },
        {
            "input": "The thyroid is normal.  The heart size is normal.  There is no evidence of a\npericardial effusion.  The esophagus is normal without evidence of wall\nthickening, or a hiatal hernia.  Coronary calcifications are seen.\n\nThere is no axillary lymphadenopathy.  An enlarged right hilar lymph node is\nseen measuring 1.3 cm x 1.1 cm.  Mildly prominent mediastinal lymph nodes are\nseen measuring up to 0.6 cm in short axis.  There is no supraclavicular\nlymphadenopathy.\n\nModerate bilateral pleural effusions are seen, right greater than left with\nadjacent atelectasis.\n\nWithin the proximal trachea, a soft tissue density with gas is seen within the\nleft lateral/dependent aspect of the trachea, series 6, image 45, likely\nsecondary to tracheal secretions.  The airways are otherwise patent to the\nsubsegmental levels.\n\nThe bases of lungs demonstrate nodularity and interstitial thickening, which\nmay be secondary to inflammation/aspiration.  Diffuse centrilobular emphysema\nis seen bilaterally.\n\nA 0.2 cm nodule is seen within the right middle lobe, series 6, image 157.  A\n0.3 cm nodule is seen within the left upper lobe, series 6, image 65.  A 0.4\ncm nodule seen within the left lung base, series 6, image 174\n\nFor evaluation of the abdomen, please refer to dedicated CT of the abdomen\nperformed on same day.\n\nOsseous structures: A focal lucent lesion is seen within the T11 vertebral\nbody, measuring up to 0.7 cm.",
            "output": "1. Bilateral lung nodules are seen measuring up to 0.4 cm.\n2. Moderate bilateral pleural effusions are seen, right greater than left with\nadjacent atelectasis.  Additional consolidations at the lung bases, may be\nsecondary to aspiration/infection.\n3. Right hilar lymphadenopathy and mildly prominent mediastinal lymph nodes,\nmay be reactive in etiology.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART AND VESSELS: The heart is normal in size.  No pericardial effusion is\nidentified.  Right-sided Port-A-Cath is seen terminating in the cavoatrial\njunction.\n\nPLEURA: Mild biapical pleural scarring.  Trace bilateral pleural effusions.\n\nAIRWAYS/LUNG: Mild bilateral atelectasis.  There is a 3 mm calcified granuloma\nin the right lower lung (series 5, image 137).  There are additional scattered\npulmonary nodules measuring up to 3 mm, for example in the lingula (series 5,\nimage 169) and in the left lower lobe (series 5, image 209).  Mild\ncentrilobular emphysematous changes.  The airways patent to the subsegmental\nlevel bilaterally.  There is no large focal consolidation or opacities noted.\n\nBONES: No suspicious osseous lesions are identified.\n\nSOFT TISSUES: No soft tissue abnormality.\n\nUPPER ABDOMEN: The study was not tailored for evaluation of the\nsubdiaphragmatic structures.  Small hiatal hernia.  Otherwise, no gross\nabnormalities.",
            "output": "1. No evidence of infection.\n2. Trace bilateral pleural effusions and mild atelectasis.\n3. Several scattered pulmonary nodules measuring up to 3 mm.  Please see\nrecommendation below.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThere are no filling defects seen within the main, segmental or proximal\nsubsegmental pulmonary arteries.  The main, right, and left pulmonary arteries\nare normal caliber.\n\nPULMONARY PARENCHYMA:  The patient is post left lower lobectomy as well as the\nwedge resection of the left upper lobe.  Breathing motion somewhat limits\nevaluation for small pulmonary nodules.  Diffuse, predominantly peripheral\nareas of ground-glass opacity are seen bilaterally, presumably reflecting\ninflammatory change secondary to the recent surgery.  A subpleural\nground-glass opacity in the right upper lobe seen on the prior PET-CT is not\ndiscretely seen on the current study given the above described diffuse\nground-glass opacities.  An enhancing consolidation in the right lower lobe\nlikely reflect atelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is a trace simple left pleural effusion as well as a small\nanterior pneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Edematous/thickened left serratus\nmusculature, likely secondary to recent surgery.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for a 2.2\ncm right hepatic lobe cyst as well as a small hiatal hernia.",
            "output": "1. No acute pulmonary embolism.\n2. Diffuse predominantly peripheral ground-glass opacities are presumably\ninflammatory and related to recent surgery.  Right lower lobe atelectasis.\n3. Small left anterior pneumothorax."
        },
        {
            "input": "Large hypodense right thyroid nodule.  Extensive diffuse lymphadenopathy in\nintra and extra thoracic location, the lymph nodes reach sizes of 4 cm and\nsome of them show necrotic centers (2, 19).  Minimal coronary calcifications,\nmild dilatation of the lower esophagus.  Borderline size of the heart.  No\npericardial effusion.  Bilateral areas of dorsal atelectasis.  Mild\ndegenerative vertebral disease.  No osteolytic lesions.  Moderate respiratory\nmotion are defects.  Platelike atelectasis at the bases of the right upper\nlobe (4, 98).  Areas of atelectasis are also noted in the dorsal portions of\nthe lingular (4, 119).  No pleural effusions.  The airways are patent.",
            "output": "Known thyroid mass and right-sided thyroid nodule.  Extensive intra and extra\nthoracic lymphadenopathy.  Some of the lymph nodes have necrotic centers."
        },
        {
            "input": "Unchanged nodular enlargement of the left thyroid.  At the site of a lymph\nnode biopsy in the right axillary region, a 7 x 9 cm hematoma has developed\n(3, 19).  They hematoma is extensive than adjacent to the right subclavian\nvein.  The right subclavian artery is patent.  Unchanged severe\nlymphadenopathy.\nAlso new is embolic material in at least 2 subsegmental arteries of the right\nlower lobe (5, 149).  No evidence of right heart strain.  Unchanged size of\nthe heart.  Mild decrease in extent of the pre-existing right lower lobe\nparenchymal opacity.  The left parenchymal opacities stable and shows contrast\nenhancement pattern suggestive of atelectasis.",
            "output": "Post biopsy hematoma and the right axilla.  Interval occurrence of right lower\nlobe pulmonary embolism.\n\nNOTIFICATION:  At the time of dictation and observation, 08:20, on the ___, the referring physician ___ was paged for notification and\nthe findings were discussed 1 min later over the telephone."
        },
        {
            "input": "A pre-existing and previously large left thyroid mass is only incompletely\nimaged but the mass appears to have substantially decreased in size.  Decrease\nin size of a pre-existing right axillary lymph node conglomerate (2, 14).  No\nenlarged hilar or mediastinal lymph nodes.  Mild coronary calcifications, mild\ncardiomegaly.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  Mild tortuosity of the descending aorta.  Upper abdominal\nfindings are described in detail in the dedicated abdominal CT report.  Stable\ndegenerative changes at the level of the spine, with height loss of multiple\nvertebral bodies (602 B, 44).  Several millimetric pulmonary nodules are all\nstable in size and morphology.  No new or growing nodules.",
            "output": "Decrease in size of the partially imaged left thyroid lesion.  Mild decrease\nin size of a right axillary lymph node conglomerate.  No suspicious pulmonary\nnodules or masses.  No evidence of infectious lung disease."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No acute fracture or worrisome osseous lesion.\n\nSOFT TISSUES: Thoracic soft tissues are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Incidental note is made of a\nsmall duodenal diverticulum.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout.  Moderate colonic stool. \nOtherwise, the colon and rectum are within normal limits.  The appendix is not\ndefinitively visualized, however there are no secondary signs of acute\nappendicitis.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Small pockets of subcutaneous air in the anterior abdomen likely\nsequelae of prior injections.  Otherwise, the abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. No acute thoracic, or abdominopelvic process.\n2. No evidence of malignancy within the chest, abdomen or pelvis."
        },
        {
            "input": "There is diffuse ground-glass opacity and septal thickening, compatible with\nmild pulmonary edema.  Mosaic attenuation may reflect air trapping versus\nsequela of pulmonary hypertension.  Subpleural reticulation, architectural\ndistortion, and bronchiectasis bilaterally, right greater than left, is\ncompatible with interstitial lung disease, likely NSIP.  There are multiple\npulmonary nodules bilaterally, measuring up to 7 mm on the right (4:130) and 8\nmm on the left (4:114).  A tubular opacity in the left lower lobe (4:171)\nlikely reflects small airway mucous impaction.  There is no pleural effusion\nor pneumothorax.\n\nA hyperdense nodule with central hypodensity and a small calcification in the\nleft lobe of the thyroid gland measures 1.1 x 1.4 cm (4:10).  Axillary and\nsupraclavicular lymph nodes are visualized, but not pathologically enlarged. \nMediastinal lymph nodes are enlarged, measuring up to 1.0 cm in the\nprevascular station, 1.3 cm in the right lower paratracheal station, and 1.6\ncm in the paraesophageal station.  Hilar lymph nodes are not well evaluated on\nthis noncontrast exam.\n\nThe heart is top-normal in size.  Severe atherosclerotic calcification of the\ncoronary arteries is noted.  There is severe calcification of the aortic and\nmitral valves.  Multiple areas of calcification are noted in the ascending\naorta and aortic arch, particularly near the origins of the vessels.  The very\nproximal ascending aorta is severely calcified.  The first area without heavy\ncalcification is approximately 4.9 cm from the plane of the aortic valve, at\nthe approximate level of the roof of the left pulmonary artery.  The aorta is\nnormal in caliber.  The pulmonary artery is slightly enlarged, measuring 3.5\ncm.\n\nThere is heavy atherosclerotic calcification of the visualized abdominal\naorta, with narrowing of the ostium of the celiac artery.  Marked splenic\nartery calcifications are also noted.  Low density nodules in the left adrenal\ngland are compatible with adrenal adenomas. The visualized upper abdomen is\notherwise unremarkable.\n\nNo focal lytic or sclerotic osseous lesion to suggest neoplasm or infection.",
            "output": "1. Multiple areas of calcification noted in the ascending aorta and aortic\narch, particularly near the origins of the vessels and with severe\ncalcification of the very proximal ascending aorta.  The first area without\nheavy calcification is approximately 4.9 cm from the plane of the aortic\nvalve, approximately at the level of the roof of the left pulmonary artery.\n2. Heavy atherosclerotic calcifications of the visualized abdominal aorta,\nwith narrowing of the celiac artery ostium.\n3. Mild enlargement of the pulmonary artery.  This is suggestive, but not\ndiagnostic, of pulmonary hypertension.\n4. Severe coronary artery and aortic and mitral valve calcification.\n5. Mild pulmonary edema and right greater than left interstitial lung disease,\nlikely NSIP.  Small airway mucous impaction in the left lower lobe.\n6. Multiple pulmonary nodules bilaterally, measuring up to 7 mm on the right\nand 6 mm on the left.\n7. Hyperdense nodule with central hypodensity in a small calcification in the\nleft lobe of the thyroid gland, measuring 1.1 x 1.4 cm.\n8. Mild mediastinal lymphadenopathy.\n\nRECOMMENDATION(S):\n1. Multiple bilateral pulmonary nodules should be followed up with dedicated\nCT chest in ___ months.\n2. A thyroid nodule can be further evaluated with dedicated ultrasound.\n\nNOTIFICATION:  The recommendation above was entered by Dr. ___ on\n___ at 15:49 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "BASE OF NECK: The thyroid is within normal limits.  Calcifications are noted\nin the head and neck vessels.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, hilar, or mediastinal adenopathy. \nSubcarinal lymph nodes are not pathologically enlarged measuring up to 11 mm.\n\nHEART AND VASCULATURE:  The heart is normal size.  No pericardial effusion. \nLeft-sided pacemaker with nonfractured leads terminating in the right atrium\nand right ventricle.  Marked widely distributed coronary artery disease. \nCalcifications of the aortic valve.  Mild atherosclerotic calcifications of\nthe thoracic aorta.\n\nPLEURAL SPACES: Small bilateral pleural effusions.  No pneumothorax\n\nLUNGS/AIRWAYS: Mild relaxation atelectasis of the lower lobes.  Minimal right\napical paraseptal emphysema.  4 mm pulmonary nodule in the right lung apex\n(___).  Diffuse mild bronchial wall thickening likely represents\ngeneralized bronchial inflammation.  No evidence of impaction.\n\nABDOMEN:  Status post cholecystectomy.  Calcifications of the splenic artery. \nUpper abdomen is otherwise unremarkable.\n\nBONES: Degenerate changes of the spine.  No suspicious osseous lesion.",
            "output": "1. Small bilateral pleural effusions.\n2. Marked, widespread coronary artery disease and atherosclerotic\ncalcifications of the aortic valve.\n3. Generalized bronchial inflammation.\n4. 4 mm pulmonary nodule in the right lung apex ___: 27).  See\nrecommendations below.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is normal.  No\npericardial effusion.  There are moderate coronary artery calcifications.\n\nThe airways are patent to subsegmental levels.There is mild bronchial wall\nthickening. The lungs are clear.  No focal consolidation, pleural effusion, or\npneumothorax.\n\nThere is cholelithiasis with no evidence of cholecystitis.  Remainder of the\nvisualized upper abdominal contents are within normal limits.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Moderate coronary artery calcifications, significantly more than usually seen\nin a patient of this age.\n\nNo focal consolidation.  Mild bronchial wall thickening suggests inflammation\nor chronic airways disease.  No pathologic lymphadenopathy."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Heart,\npericardium and great vessels are within normal limits within limitation of an\nunenhanced study. No pericardial effusion\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax. Mild biapical\npleuroparenchymal scarring.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification. Note is made of a small tracheal diverticulum (04:13). The\nairways are patent to the level of the segmental bronchi bilaterally. There is\nmild lower lobe predominant bronchiectasis. There is bibasilar atelectasis. A\n9 mm pleural based opacity in the right lower lobe may represent rounded\natelectasis or subpleural nodule (04:25).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nUPPER ABDOMEN: Note is made of cholelithiasis without evidence of\ncholecystitis.\n\nBONES: No suspicious osseous abnormality. No evidence of rib fracture. Height\nloss of the T5 and L1 vertebral bodies are without CT evidence of acuity.",
            "output": "1. No evidence of right-sided rib fractures.\n2. Height loss of the L5 and L1 vertebral bodies are of indeterminate age but\nlikely chronic.  Clinical correlation is advised.\n3. 9 mm pleural based opacity in the right lower lobe is favored to represent\nminimal pleural thickening.\n4. Cholelithiasis."
        },
        {
            "input": "CHEST:  Mediastinal great vessels appear normal in overall course and caliber\nwithout intramural aortic hematoma seen.  No mediastinal hematoma. Heart is\nnormal in size and shape.  No pleural or pericardial effusion.  No\npneumothorax.  There is no lymphadenopathy.  The imaged thyroid is normal.\n\nThe lungs are notable for hypoventilatory changes without worrisome nodule,\nmass, or consolidation.  No signs of lung injury.\n\nABDOMEN:  The unenhanced liver appears intact.  The spleen, adrenal glands,\npancreas, gallbladder, and kidneys are also intact.  A 1.8 cm hypodensity is\npresent in the upper pole of the right kidney (02:52), likely a cyst.  The\nabdominal aorta is normal in course and caliber with widely patent major\nbranches.  No lymphadenopathy, free air, or free fluid.\n\nThe stomach and small bowel are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is normal.  The bladder is unremarkable.  There is no pelvic free\nfluid.\n\nBONES:  There is no acute fracture.  No focal suspicious osseous abnormality.",
            "output": "No acute sequelae of trauma."
        },
        {
            "input": "The thyroid is normal.  Supraclavicular and axillary lymph nodes are not\nenlarged.  Prevascular lymph nodes measuring up to 15 mm were 10 mm (2, 21),\nright upper paratracheal station 9 mm lymph node was 4 mm (2:15), 8mm left\nlower paratracheal station lymph node was 5 mm (2, 22), right hilar lymph node\nmeasuring 13 mm was 7 mm (2:24), more distal in the right hilum a conglomerate\nof lymph nodes measuring 16 x 25 mm were 11 x 20 mm (2, 29) 12 mm subcarinal\nlymph node was 8 mm,  left hilar lymph nodes measuring up to 8 mm were 5 mm.\nModerate to severe upper lobe predominant centrilobular emphysema is minimally\nworse.  Previously seen subpleural fibrosis is obscured by new diffuse\nbilateral multifocal areas of peribronchial consolidations, nodules and\nmasslike opacities largest in anterior right upper lobe and lingula\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is mild calcification in the LAD.\nThere is no pleural effusion.  There is trace pericardial effusion. There is a\nsmall hiatal hernia.\nThis examination is not tailored for subdiaphragmatic evaluation the upper\nabdomen is normal\nThere are no bone findings of malignancy",
            "output": "Multifocal pneumonia. Followup in 3 months is recommended to assess for\nresolution\nEmphysema\nIncrease in size of mediastinal lymph nodes likely reactive\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:41 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "MEDIASTINUM/HEART:  The visualized thyroid is unremarkable. Supraclavicular,\nmediastinal and hilar lymph nodes are not enlarged by CT size criteria. \nProminent axillary lymph nodes demonstrate normal fatty hila. The aorta is\ndilated to 4.2 cm, and the main pulmonary artery is top normal at 3.2 cm. \nHyperdense material reflects the prior subannular commisuroplasty (2:30). In\naddition, another focus of hyperdense material in the proximal aortic arch\nreflects the prior site of cannulation (2:16)  Heart size is normal with no\nappreciable coronary artery calcifications or pericardial effusion.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Minimal\ncentrilobular emphysema is identified. Incidental note is made of two separate\n2 mm subpleural nodules in the right lower lobe (5:179, 217).  No pleural\neffusions or focal consolidation detected.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the visualized portions of the liver, spleen,\npancreas, and bilateral adrenal glands are unremarkable.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Median sternotomy wires are intact.",
            "output": "1.  No evidence of aortic or coronary artery calcifications.\n\n2.  Sequela of the prior subannular commisuroplasty, as described above.\n\n3.  Minimal centrilobular emphysema.\n\n4.  Two separate 2 mm subpleural nodules in the right lower lobe.\n\nRECOMMENDATION(S):  If the patient is low risk (no history of smoking), then\nno imaging followup for the subpleural nodules is recommended.  However, the\npatient is high risk, then follow-up chest CT in ___ year is recommended to\nre-evaluate the pulmonary nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nDilatation of the main pulmonary artery up to 4.0 cm is increased, previously\n3.4 cm.  The left and right main pulmonary arteries are normal in caliber.\n\nThe ascending thoracic aorta is dilated up to 4.0 cm is unchanged.  There is\nno evidence of dissection or intramural hematoma.\n\nHeart size is normal.  There are no significant coronary artery\ncalcifications.  Patient is post aortic valve replacement, which appears in\nappropriate position.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is trace dependent atelectasis.  There are no focal\nconsolidations or suspicious nodules.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPost median sternotomy changes are noted.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. dilatation of the ascending thoracic aorta up to 4.0 cm is similar from\n___.\n3. Dilatation of the main pulmonary artery up to 4.0 cm is increased,\npreviously 3.4 cm.\n4. Post aortic valve replacement, which appears in appropriate position."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymphadenopathy has increased in size and extent. \nFor example, a prevascular lymph node (series 6, image 79) measures 1.4 cm. \nLeft paratracheal lymph node (series 6, image 81) measures 0.8 cm.  A\npretracheal lymph node (series 6, image 86) measures 0.9 cm.  Another\npretracheal lymph node (series 6, image 95) measures 1.2 cm.\n\nHILA:  There are 2 enlarged left hilar lymph nodes measuring 1 cm (series 6,\nimage 106 and 122).\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Extensive consolidation with air bronchogram involving\nthe majority of the apical posterior segment of the left upper lobe and\nportions of the anterior segment of the left upper lobe are new compared to ___.  The previously seen spiculated mass in the left upper lobe is not\nclearly visualized due to the extensive consolidation.  Multiple new\nperibronchial nodules are noted in the left upper and lower lobes.  Presumably\nthese are also infectious, however some are more discrete including:\n\n1.4 x 1.1 cm left lower nodule (series 6, image 132).\n1.0 cm left lower lobe nodule (series 6, image 128).\n0.8 cm left lower lobe nodule (series 6, image 132)\n0.7 cm nodule in the left lower lobe (series 6, image 118) has increased in\nsize\n0.7 cm right upper lobe pulmonary nodule (series 6, image 120) has increased\nin size\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  No acute fractures.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Extensive consolidation with air bronchogram involving the majority of the\napical posterior segment of the left upper lobe and portions of the anterior\nsegment of the left upper lobe, concerning for infection.  Please note that\natypical infections including tuberculosis are within the differential.\n2. Multiple new peribronchial nodules some of which are more discrete. \nPresumably this also reflects an infectious process.  A follow-up chest CT in\n3 months after treatment should be performed to exclude malignancy.\n3. Worsening mediastinal lymphadenopathy likely reactive.\n4. Please see separate report performed on same day for detailed evaluation of\nthe abdomen and pelvis.\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months to ensure resolution and\nexclude malignancy.\n\nNOTIFICATION:  Findings discussed with Dr. ___ on ___ @ 18:16 pm\nby telephone."
        },
        {
            "input": "Large right pleural effusion contributes to left mediastinal shift and right\nlower lobe atelectasis.  The effusion has substantially increased as compared\nto CT abdomen from ___ and chest radiograph from ___ where\nsmall to moderate amount of pleural fluid was noted.\n\nWithin the limitations of this noncontrast enhanced CT there is no evidence of\nmediastinal hilar or axillary lymphadenopathy.  Calcified mediastinal lymph\nnodes are consistent with prior granulomatous exposure.  Heart size is normal.\nThere is no pericardial effusion.  Aorta and pulmonary arteries are normal in\ndiameter.  No pulmonary nodules masses or consolidations demonstrated.\n\nLeft thyroid nodule is most likely present, 22 mm in diameter.",
            "output": "Substantial interval increase in right pleural effusion with left mediastinal\nshift\n\nLeft thyroid enlargement that should be correlated with thyroid ultrasound\n\nCalcified mediastinal lymph nodes consistent with prior granulomatous\nexposure."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid demonstrates a large\nheterogeneous left thyroid nodule measuring approximately 2.8 cm. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  Calcified mediastinal\nlymph nodes compatible with history of granulomatous disease.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Right lower lobe collapse in the setting of large right\npleural effusion.  Linear consolidation along the right middle lobe (602:55)\nmay represent atelectasis versus an infectious process.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is a large right pleural effusion, similar in size compared to\nthe prior study from ___.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\nascites, cholelithiasis, and cirrhotic liver.",
            "output": "1. Large right pleural effusion and right lower lobe collapse, not\nsignificantly changed compared to the prior study.\n2. Linear consolidation along the right middle lobe may represent atelectasis\nversus an infectious process.\n3. Heterogeneous left thyroid nodule, increased in size since the prior study.\nRecommend further evaluation with thyroid ultrasound if not previously worked\nup.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 3.2 cm nodule in the left lobe of\nthe thyroid is unchanged, should be evaluated by ultrasound.\nRight supraclavicular 0.6 cm lymph node (05:23), is not pathologically\nenlarged and unchanged.  There is no axillary lymphadenopathy.\n\nCHEST CAGE: Diffuse demineralization of the vertebra with no evidence of\nosteo-destructive lesions in chest cage.\n\nUPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: 0.8 cm lymph node in the right upper paratracheal station (05:54)\nis not pathologically enlarged per size criteria.  Small partially calcified\nlymph nodes in the mediastinum and right hilum are stable.\nIn this non enhanced study there is no evidence of gross hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Mild hypodensity of cardiac\nchambers is suggestive of mild anemia.  Pericardium is physiologic.  Minimal\ncalcifications of aortic annulus.  Thoracic aorta and main pulmonary artery\nare normal in diameter.\n\nPLEURA and LUNG: Right moderate partially loculated pleural effusion is in\nsmaller in comparison to ___.  Its distribution has changed, with\na larger anterior component and subsequent right middle lobe partial\natelectasis.  Right lower lobe is almost completely collapsed and unchanged.\nThere is no left pleural effusion.\n\nTracheobronchial tree is patent to the subsegmental level.\nNo measurable lung nodules.\nPrevious left lower lobe consolidation has resolved.",
            "output": "-Right partial loculated pleural effusion has decreased, now in moderate\nquantity.\n-Previous left lower lobe consolidation has resolved and there is no left\npleural effusion.\n-Unchanged 3.2 cm nodule in the left lobe of the thyroid.\n\nRECOMMENDATION(S):  Thyroid ultrasound if not recently performed."
        },
        {
            "input": "Neck/cardiomediastinum:  The thyroid is unremarkable.  There is no axillary or\nsupraclavicular lymphadenopathy.  Sub cm right upper paratracheal lymph nodes\nmeasure up to 8 mm, stable.  Numerous subcarinal lymph nodes measure up to 8\nmm.  Left lower peritracheal lymph nodes measure up to 5 mm.  The right hilum\nhas a lymph node conglomerate measuring 1.2 x 1.9 cm (07:126), previously 1.6\nx 1.2 cm (4:90), without discrete lymph nodes.  Left hilar lymph nodes measure\nup to 7 mm.  The heart is normal in size.  The ascending aorta is normal in\ncaliber.  The main pulmonary artery is enlarged measuring 3.2 cm, raising the\npossibility of pulmonary hypertension.  There is no pericardial effusion.\n\nLung/airways:  Subpleural and basilar predominant fibrosis is re-\ndemonstrated, not appreciably changed since prior.  The airways are patent to\nthe subsegmental level.  There are no concerning lung lesions.\n\nAbdomen:  Please see same-day CT abdomen/ pelvis for infra diaphragmatic\nfindings.\n\nBones/soft tissues:  Degenerative changes are re- demonstrated.  There are no\nlesions suspicious for malignancy or infection.",
            "output": "1. No evidence of intrathoracic malignancy.  Please see same-day CT\nabdomen/pelvis for infra diaphragmatic findings.\n2. Stable pulmonary fibrosis in a pattern suggestive of UIP.\n3. Enlarged main pulmonary artery measuring 3.2 cm, would be consistent with\npulmonary hypertension."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No calcification of the head and\nneck vessels.  Thyroid gland is homogeneous without discrete nodule.  There is\nno supraclavicular, infraclavicular or axillary lymphadenopathy.  Soft tissues\nof chest wall are unremarkable without evidence of metastatic involvement.\n\nUPPER ABDOMEN: Please see separate, same-day CT chest report for description\nof intra-abdominal and intrapelvic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There are no coronary arterial\ncalcifications.  No aortic valve or mitral valve annular calcifications.  No\npericardial effusion.\nPLEURA: There is no pleural effusion.  No pleural thickening.\nLUNG:\n\n-PARENCHYMA:  No confluent airspace consolidation.  No new or enlarging\npulmonary nodules or masses.  No diffuse lung disease.\n-AIRWAYS:  Airways are patent down to the subsegmental level bilaterally.\n-VESSELS:  Aorta and pulmonary arteries are normal size.\nCHEST CAGE: No osseous lesions suspicious for malignancy.\n\nSPINE:  1.7 x 1.4 cm round hypodensity within the T11 vertebral body with\nthickened vertebral trabeculae is consistent with a vertebral hemangioma.  No\nosseous lesions suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.  No new or growing pulmonary nodules.\nNo lymphadenopathy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  All visible mediastinal lymph nodes (9,\n36) are normal in size.  Normal appearance of the cardiac structures.  No\npericardial effusion.  No abnormalities in the posterior mediastinum.  The\nupper abdomen is reported in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Known and stable rounded lytic lesion with sclerotic border in T11. \nNo diffuse lung disease.  No pleural thickening.  No pleural effusions. \nStable 1-2 mm ground-glass nodule in the left lower lobe (10, 157).  No\nsuspicious or new pulmonary nodules.",
            "output": "No evidence of metastatic disease to the lungs.  Stable 1-2 mm ground-glass\nnodule in the left lower lobe.  Known lytic lesion with sclerotic border in\nT11."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are small bilateral pleural effusions.  There is no\npneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is no pulmonary infarct.  There is bibasilar compressive\natelectasis.  Otherwise, the airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is partial visualization of a large, heterogeneous hepatic mass\ncentered in hepatic segment 4, better characterized on CT abdomen and pelvis\nperformed ___.  Additional hyperdense lesion within the right\nhepatic lobe is better characterized on prior MRI dated ___. \nOtherwise, included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Small bilateral pleural effusions with associated compressive atelectasis.\n3. Partially imaged hepatic lesions are better evaluated on prior dedicated CT\nand MRI studies."
        },
        {
            "input": "HEART AND VASCULATURE: Study is moderately limited by motion artifact and not\ntailored for evaluation of the pulmonary vasculature.  Within these\nlimitations, the pulmonary vasculature appears well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild atherosclerotic calcification along the aortic arch\nand descending thoracic aorta.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Scattered ground-glass opacities within the bilateral lungs,\npredominantly involving the upper lobes, concerning for multifocal infection. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  The stomach\nappears moderately distended.  Few subcentimeter hypodensities in the\nbilateral kidneys are too small to characterize, likely compatible with simple\ncysts.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Scattered ground-glass opacities within the bilateral lungs, predominantly\ninvolving the upper lobes, concerning for multifocal infection though unusual\nform of aspiration pneumonitis is possible.\n2. No evidence of acute intrathoracic injury identified."
        },
        {
            "input": "Sub solid nodule in the right apex has increased in size and attenuation when\ncompared to ___.  The nodule now measuring 20 x 10 mm previously 18 x 6\nmm with the solid component measuring up to 6 mm and extends to the pleura.\n\nParaspinal ground-glass and nodular opacities, series 4, image 122, may\nreflect paraspinal fibrosis, and have increased.\n\nNumerous punctate pulmonary nodules are stable, index pulmonary nodules as\nfollows :\nRight upper lobe, 3-mm nodule (4; 48).\nSuperior segment of left lower lobe, 3-mm nodule (4; 60).\nSubpleural nodule in the left upper lobe  mm (4; 105).\n8 mm ground-glass nodule right upper lobe series 4, image 70\n5 mm ground-glass nodule in the superior segment of the left lower lobe series\n4, image 116 unchanged.\n\n\n3 mm nodules in the right middle lobe has marginally increased since ___.\n\nThe airways are patent.  Mild air trapping most pronounced in the lung bases. \nMinimal basilar atelectasis.  Mild bronchiolectasis in subpleural opacities\nlikely reflect age related fibrosis has progressed ___.\n\nNo pleural effusion or pneumothorax.  Multiple calcified pleural plaques\nare present, consistent with prior asbestos exposure.\n\nThe heart is normal in size and configuration.  Within the anterior\nmediastinum, there is a 1.1 x 1.9 cm well-marginated soft tissue-density\ncollection which measures approximately 33 Hounsfield units.  The aorta is non\naneurysmal with mild calcifications.  The pulmonary artery is top normal. \nSevere coronary artery calcifications.\n\nHeterogeneous enlargement of the thyroid with calcifications in nodules. \nThere is deviation of the trachea to the right and the multinodular goiter has\nincreased.\n\nAlthough this exam is not tailored for the evaluation of infradiaphragmatic\nstructures, left kidney is not visualized, consistent with history of pelvic\nkidney.  A left adrenal adenoma is unchanged in appearance from CT performed\n___.  Gallstones are present within the gallbladder, without\nevidence of acute cholecystitis.  The liver is diffusely fatty in attenuation,\nwithout focal lesions.\n\nThere is no concerning lytic or blastic osseous lesion.  Note is made of\nmultilevel degenerative change of the thoracic spine and a heterogeneous\nappearance of the vertebral bodies likely related to reduced bone mineral\ndensity",
            "output": "Interval increase in the part-solid nodule in the right apex when compared to\n___ concerning for adenocarcinoma.  The ___ scan from ___ is not\navailable at this time, however slow growth of this lesion is concerning for\nmalignancy and tissue sampling should be considered.\n\n5 mm ground-glass nodule in the left lower lobe is stable in size and\nmorphology.\n\nParaspinal ground-glass and nodular opacities in the left lower lobe, should\nhave continued attention on follow-up imaging in ___ years time.\n\n\nAdditional solid and ground-glass pulmonary nodules are also stable.\n\nStable anterior mediastinal presumed cyst containing proteinaceous material\n\nRECOMMENDATION(S):  Increasing part solid nodule in the right apex, tissue\nsampling should be considered.\n\nFollow-up CT thorax in ___ years time for left lower lobe nodular opacities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Bilateral heterogeneous thyroid\nnodules containing coarse calcifications are unchanged, largest measuring 3.8\nx 3.6 cm within the right thyroid lobe causing rightward tracheal deviation\n(3:8).  Supraclavicular and left axillary lymph nodes are not enlarged. \nTop-normal right axillary lymph node is unchanged prior examination.\n\nUPPER ABDOMEN:  Diffuse hepatic steatosis as well as gallstones are again\nnoted. 2.7 x 2.4 cm left adrenal lesion is unchanged since ___,\npreviously documented as an adrenal adenoma.  Additional visualized solid\norgans are unremarkable.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes are unchanged since prior\nexamination.  Representative lower paratracheal lymph node measures 0.7 cm\n(previously 0.7 cm) (03:22).  Within the anterior mediastinum again seen is a\n2 x 1.2 cm (03:24) (previously 2 x 1.1 cm with subtle differences in size\nrelated to slice selection) with well marginated soft tissue density lesion\nwhich measures approximately 52 Hounsfield units, unchanged since ___ and\nprobably an indolent thymoma.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion. \nSevere coronary artery calcifications primarily involving the left anterior\ndescending artery.  The ascending aorta is normal in caliber without\naneurysmal dilatation.  Moderate atherosclerotic calcifications are noted.\n\nPLEURA: No pleural effusion or irregular pleural thickening.  Pleural\ncalcifications are consistent with prior asbestos exposure.  No pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  Minimal bibasilar atelectasis is noted.  Right apical sub solid\nnodule measures 1.1 x 0.9 cm (previously 1.1 x 0.5 cm) and has slightly\nchanged in shape which may account for increase in one diameter measurement. \nIf lesion has been biopsied this change may be related to biopsy related\nbleeding (05:40).  New subtle left lower lobe and lingular ground-glass\nopacity with a 0.6 x  0.5 cm nodular component is noted (05:20 2).  Minimal\nsubpleural bibasilar ground-glass abnormality is unchanged since prior and is\nmost likely related to atelectasis.  Additional millimetric pulmonary nodules\nare unchanged since ___ (05:57, 63, 82, 85, 92, 108, 129, 137, 139,\n180).\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The main pulmonary artery is normal in caliber.\nCHEST CAGE:  Soft tissues are unremarkable.  No focal lytic or blastic lesions\nworrisome for malignancy.  No acute fracture.",
            "output": "1.  New left lower lobe and lingular pneumonia/aspiration pneumonia with 0.6\ncm nodular component which is likely infectious in etiology althought\nmalignancy would be similar in appearance.\n2. Subtle change in right apical sub solid nodule measuring 1.1 cm may be\nrelated to post biopsy changes.  No lymphadenopathy.\n3.  Additional mm pulmonary nodules are stable since ___.\n4.  Minimal bibasilar subpleural ground-glass abnormality most consistent with\natelectasis.  If concern for interstitial disease consider prone imaging.\n5.  Stable 2 cm anterior mediastinal lesion likely an indolent thymoma or\nthymic cyst, unchanged since ___.\n6.  Chronic findings including cholelithiasis, left adrenal adenoma, and\ndiffuse hepatic steatosis.\n7.  Persistent thyroid goiter with dominant left thyroid nodule and rightward\ntracheal deviation.\n\nRECOMMENDATION(S):  Recommend follow-up CT chest in 3 months to assess for\ninterval change in left lower lobe ground-glass and nodular opacity.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 11:13 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "HEART AND VASCULATURE: Severe atherosclerotic calcifications throughout the\nthoracic aorta, at the origin of the head and neck vessels, and of the\ncoronary arteries.  Mild aortic annular calcification.  The thoracic aorta is\nnormal in caliber.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits based on an unenhanced scan. No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: A triangular soft tissue density within the\nanterior mediastinum (series 2, image 23) is unchanged since at least ___\nmeasuring approximately 1.9 x 1.2 cm.  Stable small mediastinal lymph nodes\nmeasuring up to 8 mm in short axis at the right paratracheal station.  No new\naxillary or mediastinal lymphadenopathy is present.\n\nPLEURAL SPACES: Stable pleural calcifications bilaterally, likely relating to\nasbestos exposure.  No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild upper lobe predominant centrilobular emphysema. \nPreviously biopsied solid right apical lung nodule is unchanged measuring 10 x\n9 mm with surrounding ground-glass opacity (series 4, image 31).  Numerous\nadditional solid nodules throughout the lungs bilaterally, all of which are\nunchanged compared to ___.  The largest within the right middle\nlobe measures 3 mm (series 4, image 137).  Stable 3 mm ground-glass opacity\nwithin the right upper lobe (series 4, image 68).  Calcified granuloma within\nthe right lower lobe.  No new suspicious lung nodules.  No focal\nconsolidations.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: The thyroid gland is severely enlarged with coarse central\ncalcifications, left greater than right, with rightward deviation of the\ntrachea, unchanged.\n\nABDOMEN: A left adrenal adenoma is partially imaged.  No other abnormalities\nwithin the partially imaged upper abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Previously biopsied right apical lung nodule measuring up to 10 mm with\nsurrounding ground-glass opacity is stable since ___ and was\nlarger in ___.  Numerous additional stable lung nodules bilaterally.  No new\nor growing lung nodules.  No lymphadenopathy.\n2. Triangular soft tissue density within the anterior mediastinum, possibly a\nindolent thymoma, stable since ___.\n3. Pleural calcifications likely related to asbestos exposure.  No evidence of\npulmonary fibrosis.\n4. Other stable incidental findings include a diffusely enlarged thyroid gland\nwith stable rightward deviation of the trachea and a left adrenal adenoma.\n\nRECOMMENDATION(S):   If the patient is ___ years old, has a smoking history\nof greater than 30 pack-years and has smoked within the past ___ years, the\npatient meets criteria for annual lung cancer screening with low-dose chest\nCT, now available at this hospital.  Study can be ordered on POE or OMR."
        },
        {
            "input": "CHEST CTA:\nNo evidence of pulmonary embolism within the main pulmonary artery, right or\nleft pulmonary arteries.  The main pulmonary artery is chronically enlarged,\nmeasuring 3.5cm, which is unchanged since the ___ examination.  The\nascending aorta measures 4.3 x 4.2 cm (axial, 2:49), which is slightly smaller\nin diameter compared to the prior examination (previously measuring 4.5 x 4.6\ncm).  Mild atherosclerosis of the thoracic aorta.  Again seen is the common\norigin of the brachiocephalic artery and the left common carotid artery.  The\nstent within the left brachiocephalic vein is compressed with occlusion of the\nvein.  The stent in the right subclavian vein is patent.  Intrathoracic\ntrachea is enlarged and measures up to 2.8cm.  Multiple rounded lucencies seen\ndiffusely throughout bilateral lungs, likely representing emphysema.  Focal\npatchy densities within bilateral lung bases, which may be due to atelectasis\nversus infectious process. There are multiple bilateral pulmonary nodules that\nhave remained stable since the prior examination; the largest RUL nodule\nmeasures 3.5mm (axial 2:16), and the largest LUL nodule also measures 3.5 mm\n(axial, 3:46).  The RUL calcified granuloma is unchanged.  No pleural\neffusions.  Prominent right hilar lymph node measuring 11.4mm. Multiple\ntubular soft tissue densities are noted within the anterior chest wall, likely\ncollateral veins.\n\nCARDIAC: The heart is enlarged.  No pericardial effusion.\n\nABDOMEN:  There is limited visualization of the abdominal organs. Multiple\ncalcified granulomas within the spleen, likely secondary to prior\ngranulomatous disease.  The visualized portions of the liver and stomach are\nunremarkable.\n\nOSSEOUS STRUCTURES:  Diffuse increased sclerosis of the visualized bones that\nis similar to the prior study, and may be related to renal osteodystrophy.",
            "output": "1. No evidence of pulmonary embolism.\n2. New focal patchy densities in bilateral lung bases, which may be due to\natelectasis versus infection.  Correlate clinically with signs of pneumonia.\n3. Stable pulmonary nodules.  Recommend follow-up in 12 months.\n4. There is a prominent right hilar lymph node measuring 11.4 mm, similar to\nthe prior CT.\n5. Occlusion of left subclavian vein stent, unchanged.\n6.  Enlarged pulmonary artery, which may be due to pulmonary hypertension.\n7.  Dilation of the ascending aorta, slightly smaller in diameter compared to\n___.\n8. Enlarged intrathoracic trachea, unchanged."
        },
        {
            "input": "Thyroid is unremarkable.  A right subclavian and left brachiocephalic stents\noverlaps at the superior SVC and are collapsed at the free ends, as before. \nThoracic aorta is dilated up to 44 mm and main pulmonary artery is dilated up\nto 38 mm.  Heart is mildly enlarged.  Coronary artery calcification is severe.\nTrace pericardial effusion is physiologic.  Focus of pericardial calcification\nis noted.\n\nThe airways are patent to the subsegmental level bilaterally.  Numerous small\ncysts of variable size are scattered in bilateral lungs.  Numerous pulmonary\nnodules are stable. For example, a 3 mm nodule in the right upper lobe (4:\n53).  A 4 mm nodule left upper lobe (4:  61) and A 3 mm nodule in the left\nupper lobe (4:  113) are all stable.  No new nodule is identified.  Left lung\nbase scarring is stable.\n\nBONES/ SOFT TISSUE:  Diffuse sclerotic changes of the bones is as before and\nlikely due to renal osteodystrophy.  No focal worrisome lesion is identified.\n\nABDOMEN: This study was not designed for subdiaphragmatic evaluation.  Limited\nassessment of upper abdominal organs is notable for numerous foci of\ncalcification in the spleen as well as calcified retroperitoneal and\nmesenteric lymph nodes.  Bilateral kidneys are atrophic.",
            "output": "1.  Numerous millimetric pulmonary nodules have been stable since ___. \nFindings are likely benign given the stability.  No new nodule is identified.\n\n2.  Numerous small cysts in bilateral lungs could be due to lymphocytic\ninterstitial pneumonia.\n\n3.  Enlarged ascending aorta and main pulmonary artery, indicating pulmonary\nhypertension, are stable.\n\n4.  Diffuse bony sclerosis is unchanged and compatible with renal\nosteodystrophy."
        },
        {
            "input": "The thyroid is normal.\n\nScattered mediastinal lymph nodes are not pathologically enlarged. There are\nno enlarged axillary or supraclavicular lymph nodes.  The within the left\naxilla, there is a linear area of soft tissue density superficially, which is\nunchanged dating back to ___, and is therefore of likely clinical\nsignificance.\n\nThe main pulmonary artery is stably enlarged. There is also a stable mild\nenlargement of the ascending aorta measuring approximately 4.5 cm (series 3,\nimage 34). There is minimal calcification of the thoracic aorta.\n\nThe heart is enlarged. There is a small, physiologic, pericardial effusion.\n\nBoth right subclavian and left brachiocephalic stents are stably positioned\nwith unchanged collapse of the right-sided stent as it enters the thorax and\nof the proximal left stent.\n\nMild bullous emphysema is most pronounced at the lung apices.\n\nWhile the airways are patent to the subsegmental level there is diffuse\nbronchial wall thickening and bronchiectasis, most pronounced at the lung\nbases. While a single bronchus in the right lower lobe posterior basal segment\nlooks better compared the most recent prior prior, findings have overall\nprogressed. Additionally, there are linear bibasilar and right middle lobe\nperipheral opacities, likely representing a combination of atelectasis and\nchanges related to small airways disease. There is no evidence of interstitial\nlung disease. There is no pleural effusion, pneumothorax, or\npneumomediastinum.\n\nMultiple pulmonary nodules including the largest right and left upper lobe\npulmonary nodules which measure 3 and 4 mm respectively, are unchanged (series\n5, image 69). There are no new pulmonary nodules seen.\n\nThe esophagus is unremarkable. Limited views of the abdomen demonstrates\nextensive calcified granulomas in the spleen. There is a calcified left\nretrocrural lymph node.\n\nOSSEOUS STRUCTURES:  Diffuse, increased sclerosis of the bones is present and\nlikely secondary to renal osteodystrophy. There are no focal concerning bony\nlesions.",
            "output": "1. Bronchial wall thickening and bronchiectasis most pronounced in the lower\nlobes overall worse compared to prior, findings are compatible with widespread\ndissemination of endobronchial infection.\n2. Enlarged pulmonary arteries, likely sequela of pulmonary artery\nhypertension.\n3. Stable bilateral pulmonary nodules, dating back to ___, given their\n___ year stability, findings are likely benign.\n4. Mild emphysema.\n5. Diffuse bony sclerosis, most compatible with renal osteodystrophy."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection.  There is fusiform dilatation of the\nascending aorta measuring up to 4.2 cm.   There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.  There is a left\nsubclavian vein stent in place which is narrowed, though incompletely\nevaluated on this study.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  There is dilatation of the main, right, and\nleft pulmonary arteries with main pulmonary artery measuring up to 3.9 cm. \nThis appears not significantly changed compared to examination from ___.  The right heart is dilated concerning for right heart strain, as seen\non clinical exam.\n\nThere are prominent mediastinal hilar lymph nodes.  The thyroid gland appears\nunremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere are multifocal nodular, ground-glass, and more confluent opacities\nthroughout the lungs consistent with multifocal pneumonia. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate numerous calcified granulomas\nin the spleen.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nDiffuse sclerosis of the osseous structures is again seen.",
            "output": "1.  No evidence of pulmonary embolus.  Dilated right heart concerning for\nright or strain.\n2.  Multifocal ground-glass, nodular, and more confluent opacities throughout\nthe lungs highly concerning for multifocal pneumonia.\n3.  Emphysema with pulmonary hypertension similar to prior.\n4.  Narrowed left subclavian vein stent which is incompletely evaluated on\nthis study.\n5.  Abdominal and splenic calcified granulomas consistent with patient's\nhistory prior disseminated tuberculosis."
        },
        {
            "input": "Examination is mildly limited by motion artifact.\n\nLINES/TUBES:  Tracheostomy remains in appropriate\nposition.  An ascending central venous catheter traverses the IVC\nterminates at the mid SVC.  A PEG tube terminates in the stomach.\n\nHEART AND VASCULATURE:  There is no central or segmental pulmonary embolism.\nThe ascending aortic aneurysm is unchanged in size from earlier today without\nevidence of dissection, pseudoaneurysm, or intramural hematoma.\nThe pulmonary trunk is enlarged.  No pericardial effusion.\n\nPartially occlusive thrombus is seen in the right subclavian vein stent\n(02:11) extending into the right brachiocephalic vein stent (06:25), and the\nSVC (02:23), new from ___.  The stenosed left subclavian vein stent is\noccluded by thrombus, unchanged from ___ (2:17, 7:58). Numerous left chest\nwall collaterals are present, also seen in ___.\n\nAXILLA, HILA, AND MEDIASTINUM:  Right hilar and mediastinal lymphadenopathy is\nunchanged from ___.\n\nPLEURAL SPACES:  A small left nonhemorrhagic pleural effusion is better\ndelineated with intravenous contrast and slightly increased in size from ___.  No pneumothorax.\n\nLUNGS/AIRWAYS:  The subglottic trachea is narrowed by ___ to ___ starting 15\nmm below the vocal cords, extending almost to the carina (___).  It is\nimpossible to delineate esophagus from possible extension of the neck mass in\nthis region.\n\nConsolidation at the right base with prominent retained secretions, mucous\nplugging, and bronchial wall thickening is unchanged from examination earlier\ntoday.  Atelectasis at the left base appears unchanged adjacent to the small\npleural effusion.\n\nNumerous randomly distributed spiculated opacities are unchanged from\nexamination earlier today.  They have developed between ___ and\n___ of this year.  Some are increased in size since ___, some new, some\nnow with cavitations.\n\nBackground centrilobular and paraseptal emphysema is severe.\n\nBASE OF NECK:  Soft tissue mass is substantially larger than in ___. Please\nsee report from same day neck CT for further description.\n\nABDOMEN:  Study is not tailored for subdiaphragmatic evaluation. \nCalcifications are seen in the spleen are unchanged.\n\nBONES:  The bones are disc diffusely sclerotic consistent with renal\nosteodystrophy without evidence of focal lesion or acute fracture.",
            "output": "1. Partially occlusive thrombus in the right subclavian vein stent (02:11)\nextending into the right brachiocephalic vein stent (06:25), and the SVC\n(02:23), new since ___.  Left subclavian vein stent stenosis and occlusion,\nunchanged from ___ (2:17, 7:58).\n2. Subglottic trachea is narrowed by ___ to ___ starting 15 mm below the vocal\ncords, extending almost to the carina (___).  It is impossible to\ndelineate esophagus from possible extension of the neck mass in this region.\n3. Consolidation at the right lung base increased since ___ is likely due\nto combination of aspiration, postobstructive atelectasis from mucous\nplugging/aspiration, and pneumonia.\n4. Progression of multifocal spiculated nodules since ___ consistent with\nseptic emboli or metastases.  Stable mediastinal and hilar lymphadenopathy\nsince ___. Right neck mass is substantially larger than in ___.  Please see report\nfrom same day neck CT for further description.\n6. Small left pleural effusion increased from ___. Ascending aortic aneurysm, maximally 43 mm, unchanged from ___. Findings suggestive of pulmonary hypertension.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:41 ___, 2 minutes after\ndiscovery of the findings.\n\n The findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 11:16 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "Patient is cachectic.  Subject to imaging limitations in the absence of body\nfat, there is no pathologic enlargement of supraclavicular or axillary lymph\nnodes, or any soft tissue abnormality in the chest wall suspicious for\nmalignancy.  This study is not designed for subdiaphragmatic diagnosis. \nAdrenal glands are not enlarged.\n\nThyroid is unremarkable.  Atherosclerotic calcification in head and neck\nvessels is mild more pronounced in the coronaries in at least the LAD.  Aortic\nvalvular calcification is at least mild.  Small pericardial effusion is of\nuncertain clinical significance.  Small Bochdalek's diaphragmatic hernias\ntransmits only subphrenic fat.\n\nAscending thoracic aorta and pulmonary arteries are top-normal size.  There is\nno filling defect in the central pulmonary arteries but this study is not\nadequate to assess the peripheral pulmonary circulation.\n\nScattered pleural calcifications and left anterior costal pleural plaque are\ndue to prior asbestos exposure.  There is no pleural mass, appreciable\nnodularity or pleural effusion, and no interstitial abnormality to suggest\npulmonary asbestosis.  .\n\nCentral lymph nodes in the mediastinum and hila are not pathologically\nenlarged.  Nodular thickened mucosa on the upper wall of the mid to distal\nleft upper lobe bronchus, 5:152, 8: 65- 59, could be inflammatory glandular\nhypertrophy or tumor en plaq.  More distally, the bronchial tree shows wall\nthickening, mild bronchiectasis and impaction impaction, for example right\nmiddle lobe, 5:164, right lower lobe posterior basal segment, 5:267.  Small\nareas of peripheral consolidation or atelectasis in the right middle lobe,\n5:234 - 250, and right lower lobe, 5:301, most likely reflect chronic\nbronchial inflammation.\n\nEmphysema is mild in the upper lobes, less pronounced elsewhere.\n\nThere are no bone lesions in the chest wall suspicious for malignancy.",
            "output": "Thickened mucosa, left main bronchus could be inflammatory or bb malignant. \nThere is no discrete lung mass or central adenopathy.\n\nAsbestos related pleural plaques.  No evidence of Ms. ___ fairly ___ or\npulmonary asbestosis.\n\nGeneralized bronchial inflammation consisting of bronchial wall thickening\nimpaction and mild bronchiectasis and small areas of peripheral consolidation\nor atelectasis.\n\nMild to moderate emphysema.\n\nRECOMMENDATION(S):  Consider bronchoscopic evaluation of the left bronchus."
        },
        {
            "input": "There is enlargement of the left thyroid lobe with nodularity, consistent with\ngoiter.  There is mass-effect on the trachea which is slightly deviated to the\nright as result of the left thyroid goiter.  Thoracic aorta is normal in\ncourse and caliber without appreciable atherosclerosis.  No dissection.  A\nbovine arch configuration is noted.  There is residual thymic tissue in the\nanterior mediastinal space.  No mediastinal mass or adenopathy.  The main\npulmonary artery is normal in caliber.  There is no filling defect within the\nbranches of the pulmonary arterial tree to suggest the presence of a pulmonary\nembolism.  The heart is normal in size and shape without pericardial effusion.\nHypoventilatory changes are noted within the lungs.  There is no worrisome\nnodule, mass, or consolidation.\n\nWithin the imaged portion of the upper abdomen, a right lobe hepatic\nhypodensity is noted which is most suggestive of a simple cyst.  Otherwise,\nunremarkable.\n\nBones: Unremarkable.",
            "output": "1. No pulmonary embolism or aortic dissection.\n2. Left thyroid goiter"
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart size\nis normal, and note is made of a very small pericardial effusion.\n\n\nLongitudinally oriented, irregularly marginated, solid nodular opacity in\nanterior segment of right lower lobe measures 3.4 cm x 1 cm in diameter (179,\n8).  It contains internal dilated and ectatic bronchi.  The anterior border of\nthis lesion directly abuts the right major fissure which appears distorted at\nthe site of contact.  Additionally, a pleural tag extends from the lateral\nmargin of this opacity.\n\n\nLungs are otherwise remarkable for focal tubular opacities in the superior\nsegment right lower lobe (152, 8) and lateral segment right middle lobe (239,\n8), suggestive of focal mucoid impaction of peripheral airways.  2 mm\nnoncalcified nodule is present in the superior segment right lower lobe (135,\n8).  Minimal biapical scarring is present as well as scattered linear areas of\nscar atelectasis in the mid and lower lungs.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions within the thorax.",
            "output": "1.  3.4 cm diameter irregularly marginated right lower lobe nodular opacity\nhas imaging features concerning for primary lung adenocarcinoma.  Considering\nthe size and solid nature of the lesion, further evaluation with PET-CT may be\nhelpful for initial further evaluation.  Differential diagnosis includes\norganizing pneumonia and localized infectious pneumonia.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings.\n\nRECOMMENDATION:  Consider PET-CT for further assessment of suspicious right\nlower lobe nodular opacity."
        },
        {
            "input": "Postoperative it changes in the right hemi thorax are similar to ___ except for near resolution of a right pleural effusion.  Subcentimeter\nmediastinal lymph nodes are similar in size and number. Heart size remains\nnormal.\n\nExam was not tailored to evaluate the sub- diaphragmatic region, but no new\nconcerning findings are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.\n\nWithin the lungs, a 4 mm nodular opacity in the right lower lobe is unchanged\n(234, 4) as well as a 2 mm left lower lobe nodule (237, 4).  No new or growing\nnodules are detected.  Minimal centrilobular emphysema is noted as well as\nmild biapical scarring.",
            "output": "Near resolution of postoperative right pleural effusion.  Otherwise stable\npost operative appearance of the chest compared to ___."
        },
        {
            "input": "Mediastinal lymph nodes involving the right lower paratracheal lymph node\nstations have slightly increased in size and number, although not meet CT size\ncriteria.  There are no enlarged hilar or axillary lymph nodes. Heart size\nis normal, and with pericardial effusion.\n\n\nThe patient is status post right lower lobectomy.  The bronchial stump appears\nunremarkable.  New moderate, nonhemorrhagic pleural effusion that does not\ndemonstrate enhancement or nodularity and mild loculation is likely related to\nrecent surgery.\n\nMinimal biapical scarring is present as well as scattered linear areas of\nscar atelectasis in the left lower lobe, right upper and middle lobes. \nPunctate nodule in the right upper lobe (4:140) and focal mucoid impaction\nwith ground-glass opacities in the right middle lobe are stable.  Stable\npunctate nodule in the left lower lobe measuring 2 mm (series 4, image 161). \nNo new suspicious nodules in the left lung.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions within the thorax.\n\nPlease refer to the separate CT report of the abdomen and pelvis.",
            "output": "1. Status post right lower lobectomy with moderate right-sided pleural\neffusion.\n\n2. No concerning osseous/paraspinal lesions in the thorax.\n\n3.  Slight increase in size and number mediastinal lymph nodes, although not\npathologically enlarged by CT size criteria.  These may be reassessed at the\nnext scheduled postoperative surveillance CT.\n\n4. Please refer to the separate CT report of the abdomen and pelvis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: A subcentimeter nodule is seen in\nthe left lobe of the thyroid, also seen on prior imaging.\n\nUPPER ABDOMEN: The examination is not tailored to evaluate the upper abdomen. \nHowever, no significant abnormalities are seen in the subdiaphragmatic region.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes are identified.\n\nHILA: No enlarged hilar lymph nodes are identified, though evaluation is\nsomewhat difficult given the lack of intravenous contrast.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  Biapical scarring is stable. The patient has undergone prior\nright lower lobectomy.  Postsurgical changes are noted, not significantly\nchanged since the prior examination.  An apparently branching nodularity on\nthe right (5:  282), now measures nearly 5 mm, increased since the prior\nexamination.  While this may be related to the adjacent impacted bronchus, a\ngrowing nodule is not excluded.  An apparent new, 3 mm nodule is seen in the\nright as well (5:274).\n-AIRWAYS:  The airways are patent to the subsegmental level.  Possible\nscattered secretions are seen.\n-VESSELS:  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.  No significant atherosclerotic calcifications are noted.\nCHEST CAGE: No suspicious bony abnormalities are identified.  There is no\nevidence of acute fracture.  There is evidence of a prior right sided rib\nfracture.",
            "output": "Minimal increase in size of right lower lobe nodular opacities may be related\nto overlapping opacity from adjacent impacted bronchus.  Nonetheless,\nthree-month follow-up examination is recommended to document\nstability/resolution."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no evidence of supraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: The native kidneys are atrophic.  There is mild diffuse\nbulkiness of the bilateral adrenal glands without focal nodularity.  There is\ncholelithiasis.\n\nMEDIASTINUM: A 9 mm para-aortic node is likely reactive.  There is no\nworrisome mediastinal adenopathy.\n\nHILA: Unremarkable within the limits of unenhanced CT.\n\nHEART and PERICARDIUM: Trace pericardial effusion.  Multivessel coronary\ncalcifications.\nPLEURA: Small bilateral pleural effusions, slightly greater on right than\nleft.\nLUNG:\n\n1. PARENCHYMA:  There is patchy airspace consolidation within the right middle\nlobe and lingula as demonstrated radiographically.  There are associated\nground-glass opacities, most in the lingula.  There is milder patchy\nconsolidation in the bilateral upper lobes.  There is mild posterior basal\natelectasis in both lower lobes associated with effusions.\n2. AIRWAYS:  Major airways are patent.\n3. VESSELS:  The pulmonary trunk is mildly dilated at 3.2 cm, which can be\nassociated with pulmonary hypertension.  The thoracic aorta is normal caliber.\nMild calcified atherosclerotic plaque is noted.\nCHEST CAGE: No aggressive bone lesions are demonstrated.",
            "output": "Patchy bilateral airspace consolidation, nonspecific but most likely\nrepresenting infection, including atypical such as fungal in the setting of\nimmunosuppression.  Clinical correlation is recommended."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive Coronary\ncalcifications are re-demonstrated.  Heart size is normal.  There is no\npericardial effusion.  There is interval resolution of pleural effusion.\n\n2 severe calcifications of the mitral annulus are noted.\n\nImage portion of the upper abdomen demonstrate a trophic kidneys bilaterally.\n\nMild bilateral left more than right gynecomastia is present.\n\nAirways are patent to the subsegmental level bilaterally.  Substantial\ninterval improvement in right middle lobe consolidation is demonstrated with\nonly minimal opacities currently present reflecting sequela of previous\ninfection.  Similar improvement is noted in the lingula.  No new nodules\nmasses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Substantial interval improvement of bilateral consolidations and resolution of\nbilateral pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is an 8 mm peripherally\ncalcified nodule in the right lobe of the thyroid.  There is no\nsupraclavicular or axillary lymphadenopathy.  Bilateral gynecomastia is noted.\n\nUPPER ABDOMEN: There is significant perihepatic and perisplenic ascites.\n\nMEDIASTINUM: There are multiple prominent mediastinal lymph nodes, likely\nreactive.  A right paratracheal lymph node measures 1.2 cm (02:19).  A\nprevascular lymph node measures up to 13 mm (02:19 the right paraesophageal\nlymph node measures up to 17 mm (02:30).\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is within normal limits there is no pericardial\neffusion.  There is mild coronary artery calcifications.  There are mild\ncalcifications of the aortic valve.\nPLEURA: There are moderate nonhemorrhagic bilateral pleural effusions.  There\nis no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There are multifocal parenchymal consolidations and opacities\nwith areas of associated interstitial thickening and ground-glass opacity. \nThere is slight biapical predominance to these lesions which occur throughout\nboth lungs.\n2. AIRWAYS:  Airways are patent to the segmental level bilaterally.\n3. VESSELS:  The main pulmonary artery measures up to 3.1 cm in diameter\nsuggestive of pulmonary hypertension.  There are mild calcifications of the\naortic arch.\nCHEST CAGE: Old right and left rib fractures are noted.  There are moderate\ndegenerative changes of the thoracic spine.",
            "output": "1. Multifocal parenchymal consolidations with a biapical predominance\nconcerning for multifocal pneumonia.\n2. Moderate bilateral pleural effusions.\n3. Intra-abdominal ascites."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple mediastinal lymph nodes are top normal in size with the\nlargest measuring 0.9 cm in the pretracheal station (series 5, image 110).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial and\ndense aortic valvular and mitral annular calcifications.  There is no\npericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main pulmonary artery is top normal in\nsize.  The right and left pulmonary arteries are normal caliber.  Severe\natherosclerotic calcifications in proximal left subclavian artery (series 3,\nimage 8) and proximal right brachiocephalic trunk (series 3, image 11) cause\nmarked stenosis.  No substantial atherosclerotic calcifications are seen in\nthe ascending thoracic aorta.  Extensive calcified plaques are seen in the\naortic arch and descending thoracic aorta.\n\n\nPULMONARY PARENCHYMA:  There are no focal consolidation to suggest pneumonia. \nThere are right upper lobe and lingular atelectasis/scarring.  There is a 3 mm\nright upper lobe pulmonary nodule (series 5, image 99).  There is a 4 mm right\nmiddle lobe subpleural pulmonary nodule (series 5, image 172).  Another 4 mm\npulmonary nodule is seen in the right lower lobe (series 5, image 213). \nAdditional scattered sub-2 mm micro nodules are seen throughout the lungs. \nScattered calcified granulomas are also noted.  Moderate emphysema is noted.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nEvidence of healed bilateral rib fractures.  Multilevel degenerative changes\nare moderate.  Postsurgical changes in the left breast with scattered coarse\ncalcifications.  Scattered coarse calcifications are also seen in the right\nbreast.\n\nUPPER ABDOMEN:  Limited evaluation of the upper abdomen is unremarkable except\nfor extensive vascular calcifications with attention to the severe calcified\nplaques in the base of the SMA (series 3, image 55) causing severe SMA\nstenosis.",
            "output": "1. No acute cardiopulmonary process.\n2. Severe atherosclerotic calcifications in the coronary arteries, proximal\nleft subclavian artery and proximal right brachiocephalic trunk, and in the\nabdomen, superior mesenteric artery with resultant marked stenosis.\n3. Calcifications in the aortic valve and also mitral annulus are extensive\nenough to be hemodynamically significant.\n4. No substantial atherosclerotic calcifications in the ascending thoracic\naorta.  Extensive calcified plaques in the aortic arch and descending thoracic\naorta.\n5. 4 mm pulmonary nodules in the right upper, middle, lower lobes.  Additional\nscattered sub 2 mm micro nodules.\n6. Severe atherosclerotic calcifications in the base of the SMA with resultant\nsevere stenosis.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 7:38 am."
        },
        {
            "input": "The thyroid is unremarkable.\n\nThe patient is status post aortic valve repair and median sternotomy. The\nsternal wires are intact. A few residual locules of air are seen, likely\nwithin normal limits postoperatively. There is no sternal callus formation.\n\nPostoperative changes are seen within the anterior mediastinum, with no fluid\ncollection or gas to suggest infection. There is a large midline skin defect\nanterior to the inferior aspect of the sternum, extending to the upper\nabdomen, measuring 3.5 cm wide and 0.9 cm deep, with a craniocaudal length of\n10.2 cm.\n\nMildly enlarged mediastinal lymph nodes are seen within upper mediastinum,\nmeasuring up to 1.4 cm in right paratracheal location, likely reactive.\n\nThere is severe atherosclerotic calcification of the thoracic aorta.  There is\ncalcification of the mitral annulus.\n\nThere is no pleural effusion. There is no evidence of pericardial effusion.\n\nThere is subsegmental atelectasis within the lung bases.  No focal mass or\nconsolidation.\n\nNo nodules 6 mm or greater identified. Stable 3 mm nodule in the right upper\nlobe, series 5, image 120. A calcified granuloma seen in the right middle\nlobe.  Stable 3 mm subpleural nodule in the right middle lobe, image 29.\nStable right lower lobe subpleural nodule measuring 4 mm, image 225.\n\nFor incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nThere is a background of diffuse moderate centrilobular emphysema as before.\n\nThere is mild mucous plugging within the right lower and left lower lobe\nbronchi.\n\nLimited images of the upper abdomen demonstrate extensive vascular\ncalcifications, with narrowing of the superior mesenteric artery due to\ncalcified plaques.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nModerate degenerative disc disease is seen worse in the lower thoracic spine.\nA few subacute rib fractures are seen, involving the left first and fifth ribs\nand the right ___ and 6th ribs. Macrocalcifications are seen within the left\nbreast.",
            "output": "1. No evidence of fluid collection within the anterior mediastinum.  Increased\nattenuation in fat is not specific but consistent with anticipated\npostoperative change.\n\n2. Large midline anterior skin defect as described above, corresponding to the\ndehisced sternal wound."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  As before, the patient is status post aortic valve repair and\nmedian sternotomy.  There has been interval removal of multiple median\nsternotomy wires.  Re-demonstrated are multiple enlarged mediastinal nodes. \nFor example is a 1.1 cm node in the right paratracheal station (5:79) as well\nas a 1.3 cm node in the precarinal station (5:103), unchanged and likely\nreactive.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\nand mitral annular calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There is significant respiratory motion.  Within these\nlimitations, there is bilateral bibasilar dependent atelectasis, left greater\nthan right.  There is moderate diffuse centrilobular emphysema.  There is a\npunctate calcified granuloma in the right lung apex as well as in the right\nmiddle lobe.  There is a 4 mm pleural based nodule in the anterior right\nmiddle lobe (5:165), and a 3 mm subpleural right lower lobe nodule (5:182)\nunchanged.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is a small left pleural effusion which is new.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  Postsurgical changes are again\nnoted overlying the sternum.  There is similar mild soft tissue stranding\nwithout a drainable fluid collection.  Healing fractures of the right fifth\nthrough seventh anterior ribs and left first rib are again noted.  There is a\nsmall linear focus of air in the anterior chest wall overlying the manubrium\non the left.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable\naside from extensive atherosclerotic calcification in abdominal aorta and at\nthe origin of the SMA.\n\nThere are changes in the left breast with soft tissue attenuation,\ncalcifications and surgical clips, presumably post treatment related though\nnot fully assessed on CT.",
            "output": "1. Postsurgical changes are again noted overlying the sternum and manubrium. \nThere is similar mild soft tissue stranding without a drainable fluid\ncollection.  There is a small linear focus of air in the anterior chest wall\noverlying the left manubrium, which is of uncertain significance.  Although no\ndefinite tract is identified, this may be postsurgical versus from ongoing\ninfection.\n2. New small left pleural effusion.\n3. Moderate diffuse centrilobular emphysema.\n4. Changes in the left breast, potentially post treatment related to be\ncorrelated clinically."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nExtensive Coronary calcifications are re- demonstrated in this patient after\nCABG.  There is no pericardial pleural effusion.  Small hiatal hernia is\npresent.\n\nImage portion of the upper abdomen reveals distended stomach, partially\nimaged.  Bibasal cylindrical bronchiectasis are noted.\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules masses or consolidations seen.\n\nExtensive degenerative changes in the spine including prominent osteophyte\ncorresponding to the abnormality demonstrated on the chest radiograph are\npresent, series 2, image 25, with no lytic or sclerotic lesions worrisome for\ninfection or neoplasm.",
            "output": "Thoracic spine osteophytes correspond to abnormality seen on the chest\nradiograph.\n\nBibasal to ___ bronchiectasis and minimal opacity posteriorly in conjunction\nwith hiatal hernia might represent recurrent aspiration.\n\nExtensive Coronary calcifications in the patient after prior CABG"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Small mediastinal lymph nodes are seen which do\nnot meet the CT size criteria for lymphadenopathy and are nonspecific.  No\naxillary or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild degenerative endplate spurring are seen in the mid thoracic spine.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "LUNGS: Once again, severe emphysema bilaterally.  Left lower lobe spiculated\n2.4 x 1.9 cm nodule again identified.  An additional 8 mm left upper lobe\nnodule is also present (02:29). A millimetric nodule is noted in the right low\nlower lobe (603:30) and a granuloma is noted in the right middle lobe (03:46).\nNo pleural effusion.  Biapical pulomary scarring is present.\n\nMEDIASTINUM: Scattered lymph nodes do not meet CT criteria for enlargement\nsuch as a right heart paratracheal node measuring 8 mm.  Heart is of normal\nsize.  Coronary artery calcifications are noted.  Aortic calcifications,\nparticularly of the descending aorta and aortic knob are present.  Anular\nectasis of the aortic root (601:58) measuring up to 4.5 cm.\n\nUPPER ABDOMEN: Abdomen was completely imaged 2 days prior.  Please refer that\nreport for full details.\n\nBONES: There is anterior wedging deformity of the T8 vertebral body (602:78)",
            "output": "1.   2.4 cm spiculated nodule in the left lower lobe. Additional 8 mm lung\nnodule in the left upper lobe. Severe centrilobular emphysema.\n\n2. Unchanged mild anterior wedging deformity of the T8 vertebral body.\n\n3. Anular ectasia of the aortic root.  Consider an echocardiogram for further\nevaluation."
        },
        {
            "input": "Again noted is a spiculated nodule in the left lower lobe.  A fiducial marker\nis identified approximately 1 cm from the superior lateral margin of the\nspiculated mass and 6 mm from the pleura. There is a loculated pneumothorax in\nthe region of the fiducial CT measuring 0.5 cm in depth. There is an anterior\npneumothorax of about 1.6 cm. This is loculated over an area of 5.6 cm in\ntransverse dimension. There is underlying emphysema.\n\nThere are calcifications in the coronary arteries. No lymphadenopathy on the\ndepicted images. On bone windows there are no concerning osteolytic or osteo\nsclerotic lesions.",
            "output": "1. Fiducial marker approximately 1 cm from the superior lateral margin of the\nspiculated mass in the left lower lobe.\n2.  Loculated small pneumothoraces in the region of the seed placement\nposteriorly as well as anterior to the left lower lobe as described above"
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen\npelvis CT to report dictated on clip ___\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level.  Small\nmediastinal lymph nodes do not meet CT size criteria for pathologic\nenlargement and are unchanged from prior. There is no mediastinal, hilar or\naxillary lymph node enlargement by CT size criteria. Heart, pericardium and\ngreat vessels are within normal limits. Moderate coronary artery\ncalcifications are unchanged. No hiatal hernia is present.\n\nMultiple small pleural and fissural based nodules are unchanged (5:158, 188\nand 198).  No pleural effusion or pneumothorax is present.\n\nOsseous structures:  Extensive mixed lytic and sclerotic lesions in the\nthoracic spine, sternum and bilateral ribs appear similar to the prior study.",
            "output": "1. Stable appearance of multiple small nodules as described above. No new\nnodules identified.\n\n2.  Extensive osseous metastases are not significantly changed from prior."
        },
        {
            "input": "No supraclavicular, axillary, mediastinal, or hilar lymph node enlargement by\nCT size criteria.The thyroid gland is unremarkable.\n\nThe heart size is normal without pericardial effusion. Atherosclerotic\ncalcifications are seen within the thoracic aorta, coronary arteries, and\nmitral annulus. The aorta and its major branch vessels are patent without\nevidence of stenosis, occlusion, dissection, or aneurysmal formation. The\npulmonary arteries are well opacified to the subsegmental level, with no\nfilling defect to suggest pulmonary embolism. Interval increase in a 1.9 x 1.5\ncm (02:42) (previously 1.5 x 0.7 cm) fluid collection along the posterior\nsubcutaneous tissue with extension to the skin at approximately the level of\nT9.\n\nNo pleural effusion.No pneumothorax.  Within the right upper lobe there it is\na stable short segment of central bronchiectasis (4:65) without obstructing\nlesion. The airways are patent to the subsegmental level.\n\nA stable 0.3 cm (04:51) calcified granuloma is seen within the right upper\nlobe. Bilateral lower lobe atelectasis is present. Stable 0.4 x 0.4 cm (4:111)\npartially solid left lower lobe nodule is present. Stable 0.4 x 0.3 cm (4:144)\n(previously 0.4 x 0.4 cm) left lower lobe pleural-based solid nodule. No new\npulmonary nodule or mass seen within the lungs.\n\nOSSEOUS STRUCTURES: Again seen are multiple mixed lytic and sclerotic osseous\nlesions of thoracic spine, sternum, right scapula, and ribs as well as a\nsevere pathologic compression fracture of T3 vertebral body which is stable\nsince ___. A large Schmorl's node is seen within the L3 vertebral\nbody, unchanged since previous examination. Multilevel degenerative changes\nare again prominent within the lumbar spine. Rib mixed lytic and sclerotic\nlesions are seen within right lateral twelfth and fifth ribs. No new lytic or\nblastic lesions concerning for malignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.For further details,\nplease see the concomitant dedicated CT abdomen and pelvis.",
            "output": "1. Stable small pulmonary nodules within the left lower lobe.  Given history\nof malignancy 3 month followup CT is recommended to assess for interval\nchange.  No new pulmonary nodule or mass within the lungs.\n2.  Stable appearance of mixed lytic and sclerotic lesions within the thoracic\nspine, right scapula, sternum, and ribs with stable T3 vertebral body\ncompression fracture consistent with metastatic disease.\n3.  Interval increase in size of a 1.9 cm fluid collection along posterior\nsubcutaneous tissue at level of T9 vertebral body which may represent a\nsebaceous cyst. Correlation with clinical exam and if concern a dedicated\nultrasound can be obtained to assess lesion.\n4.  Focal area of bronchiectasis within right upper lobe without obstructing\nlesion, stable since ___.\n5.  Please refer to separate CT abdomen/ pelvis for detailed findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. However, a right axillary lymph node is round in\nmorphology, which is concerning (series 5, image 21). Multiple small\nmediastinal lymph nodes are noted, similar to the prior exam. Multiple\nretrocrural lymph nodes are concerning due to their number rather than size.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is mild coronary calcification.\n\nAirways are patent to subsegmental levels. Again seen is a focal area\nbronchiectasis in the right upper lobe with a small opacity in the bronchus,\nconsistent with bronchial infection (series 6, image 94). There is a nearby\narea of increased soft tissue density adjacent to a small bronchus and vessel,\nlikely representing a small nodule, measuring 6 mm (series 6, image 110).\nMultiple millimetric nodules are again noted, including: 1 mm nodule in the\nright upper lobe (series 6, image 64), calcified granuloma in the right upper\nlobe (series 6, image 67) 2 mm subpleural nodule in the left upper lobe\n(series 6, image 78), 1 mm subpleural nodule in the right upper lobe (series\n6, image 81), and millimetric subpleural nodule in the right upper lobe\n(series 6, image 143). A linear subpleural opacity in the right upper lobe is\nalso stable (series 6, image 177). There is no pleural effusion or\npneumothorax.  Atelectasis at the lung bases is increased compared to prior.\n\nMultiple lytic lesions are consistent with metastatic disease. Stable lesions\nare noted in the right scapula, sternum, T3 vertebral body, T4 vertebral body,\nright lateral rib four, and left lateral rib 5. Compression fracture of T3 is\nstable. Increased lucency in the T1 vertebral body is more conspicuous on the\ncurrent exam, concerning for metastatic involvement. There is also a new area\nof involvement in the right scapula (series 5, image 7). There is been\ninterval resolution of the subcutaneous fluid density lesion in the posterior\nsoft tissues at the T9 level.",
            "output": "1. No new or enlarging pulmonary nodule or mass. Stable small nodules, as\ndescribed above.  Follow up on routine oncologic imaging is recommended.\n2. Progression of osseous metastatic disease, with new or more conspicious\nlesions at the right scapula and T1. Additional foci of osseous metastatic\ndisease are stable."
        },
        {
            "input": "Soft tissues: The thyroid is homogeneous. No axillary, mediastinal or hilar\nlymphadenopathy.  Heart size is normal, as is the caliber of the ascending\naorta and main pulmonary artery.  No pericardial or pleural effusion.  The\nesophagus is normal in course and contour.  Please see a separate report\ndiscussing the subdiaphragmatic findings.\n\nLungs: The airways are patent the subsegmental level bilaterally.  There is\nmild lower lobe predominant bronchiectasis without endobronchial secretions or\nbronchial wall thickening.  There is no focal consolidation, pleural effusion,\nor pneumothorax.  Calcified granuloma at the right apex (6:61) as well as\npunctate subpleural nodules in the upper lobes bilaterally (6:84, 146, 180)\nare stable.  No new or concerning nodule is seen.\n\nBones: Compression deformity of T3 and invaginating lucency at the inferior\naspect of T4 are unchanged from the prior examination of ___.  Lucent\nappearance of the T1 vertebral body is essentially unchanged.  Sclerotic foci\nof multiple left-sided ribs may be from prior metastatic disease versus healed\nrib fractures.  Similarly, sclerotic focus of the right tenth rib laterally is\nagain noted and stable.\nLytic focus in the coracoid process of the right scapula (06:37) appears\nslightly larger than on the prior study.  Additionally, lytic lucencies are\nseen in the right glenoid (6:65), and mixed sclerotic and lytic lucencies are\nseen in the manubrium and sternum (6:80, 192).",
            "output": "1. Equivocal interval enlargement of right scapular (coracoid process) lytic\nlesion.  Remaining osseous metastases in the chest cage in unchanged.\n2. Stable millimetric bilateral pulmonary nodules.\n3. No new lymphadenopathy or pulmonary masses.\n4. Mild lower lobe predominent bronchiectasis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  No\nhilar lymphadenopathy.  The large mediastinal vessels are unremarkable.  Mild\nto moderate coronary calcifications.  No valvular calcifications.  No evidence\nof pericardial effusion.  The upper abdomen is reported in detail in the\ndedicated abdominal CT report.  The soft tissues of the chest wall appear\nnormal.  There is no CT evidence of subcutaneous lesions at the level of the\nthorax.  A lytic process in the right scapular (6, 12) is not substantially\nchanged.  The known vertebral lesions (9, 41) are also constant.  No evidence\nof new osteolytic spots.  Minimal bilateral apical scarring.  Pre-existing\nmillimetric pulmonary nodules, most of which are in subpleural location, are\nunchanged in size and morphology.  Mild chronic airways disease persists. \nMinimal atelectasis at the lung bases.  No pleural effusions.  No pleural\nthickening.",
            "output": "The lytic bony processes are stable.  No lymphadenopathy.  No pleural\neffusions.  No newly appeared pulmonary nodules or"
        },
        {
            "input": "The thyroid is normal.  Multiple normal appearing axillary and mediastinal\nlymph nodes are noted.  No supraclavicular or hilar lymphadenopathy is seen. \nMultiple normal sized para-aortic lymph nodes are stable since ___.\n\nThe aorta and pulmonary arteries are normal size.  The pulmonary arteries are\nwell opacified to the subsegmental level without evidence of occlusion or\nemboli. Cardiac configuration is normal.  Note is made of coronary\ncalcifications.\n\nA calcified granuloma is seen in the right upper lung.  There is no evidence\nof active tuberculosis infection. Mild bibasilar atelectasis is identified.  A\n4 mm subpleural nodule is seen in the right middle lobe (6:159) and a 2 mm\nsubpleural nodule is seen in the left upper lobe (6:171), both of which are\nunchanged compared to prior exam.  No new pulmonary nodules are seen.\n\nLytic lesions in the left ___ anterior rib, likely metastatic, is unchanged\ncompared to prior exam.  The sclerotic ___ lateral rib may be from an old\nhealed fracture. The known lytic focus in the coracoid process of the right\nscapula, manubrium, and lower sternum are all similarly unchanged.  The known\nupper thoracic spine compression fracture is stable appearing.  Although there\nis no evidence of central canal invasion, it should be noted that this exam is\nnot very sensitive for evaluation of central canal contents and, if there is\nany clinical concern, will need dedicated neuroimaging for full evaluation.  \nNo new lytic or sclerotic lesions are identified.\n\nPlease refer to same day CT Abdomen and Pelvis for full description of\nsubdiaphragmatic findings.",
            "output": "1. No evidence of lymphadenopathy.  No new pulmonary nodules concerning for\nmetastatic spread.\n2. Known lytic lesions in the left ___ anterior rib, coracoid process of the\nright scapula, manubrium, and lower sternum are all unchanged compared to\nprior exam from ___.  No evidence of central canal invasion on this\nlimited exam.  If there is any clinical concern for central canal invasion,\ndedicated neuroimaging will need to be obtained.\n3. Please refer to CT Abdomen and Pelvis for full description of\nsubdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible hilar and mediastinal lymph nodes are\nnormal in size.  Stable appearance of the large mediastinal vessels.  Mild\ncoronary calcifications, no valvular calcifications, borderline size of the\nheart.  No pericardial effusion.  No posterior mediastinal abnormalities.  The\nupper abdominal findings are described in detail in the dedicated abdominal CT\nreport.  The pre-existing lytic lesions in the second anterior rib as well as\na sclerotic 10 lateral rib lesion and the known sternal lesions are stable. \nThe spine compression fracture also appears stable.  There is no evidence of\nnewly appeared bony metastasis.  The lung parenchyma shows a new subpleural\nright upper lobe soft tissue nodule (6, 55).  Known calcified right upper lobe\ngranuloma.  The soft tissue component of the anterior rib lesion on the left\n(6, 97) is progressive.  No pleural effusions.  No pleural thickening.  Areas\nof atelectasis in the dependent lung regions.",
            "output": "Progression of the soft tissue component of the left anterior rib destruction.\nNew right apical up soft tissue nodule, suspicious for a solitary lung\nmetastasis.  The other lytic and sclerotic bone lesions are stable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  The thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN:  1.3 cm accessory spleen is unchanged.  Additional visualized\nsolid organs are unremarkable.\n\nMEDIASTINUM:  Mildly enlarged mediastinal lymph nodes are unchanged from ___.  Representative precarinal node measures 1.3 x 1.5 cm (02:24)\n(previously 1.3 x 1.4 cm).  No mediastinal hematoma or mass.\n\nHILA: Hilar lymph nodes are nonenlarged.\n\nHEART and PERICARDIUM:  In comparison to prior examination there is new\nleftwards mediastinal shift which is expected post left thoracentesis.  The\nheart is otherwise normal in size with trace pericardial effusion which likely\nphysiologic.  Mild coronary calcifications are present.  The ascending aorta\nis normal in caliber without aneurysmal dilatation.\n\nLUNG:\n\n-PARENCHYMA/ PLEURA:  In comparison to ___ there has been\ninterval placement of a pleural drainage catheter which terminates along the\nleft lateral pleura with significant decrease in size of left pleural effusion\nand near complete re-expansion of the left lung.  There is persistent left\nlower lobe atelectasis with a small left pleural effusion and diffuse\nirregular left pleural thickening. New linear smooth streak like opacities\nwithin the left lower lobe likely represent re-expansion pulmonary edema or\npassive lymphatic congestion due to pleural effusion.  New moderate\nhydropneumothorax is present.  Along the lower left medial pleural surface is\na nodular 1.4 x 0.9 cm apparent mass (4:182).  No large loculation.  Biapical\npleuroparenchymal scarring is noted.  Progression of right lower lobe\natelectasis involving the posterobasal and anterobasal segments is present.\n-AIRWAYS:  Mild oropharyngeal secretions are present.  The airways are\notherwise patent to the subsegmental level.  Bilateral lower lobe\nbronchiectasis is noted.\n-VESSELS:  The main pulmonary artery is normal in caliber without dilatation.\nCHEST CAGE:  No subcutaneous emphysema.  The bones are diffusely\ndemineralized.  No focal lytic or blastic lesions worrisome for malignancy. \nMild multilevel degenerative changes of the thoracic spine are noted with\nanterior osteophytes and disc space narrowing.  Superior endplate compression\ndeformities of T10 and T11 are chronic given large anterior bridging\nosteophytes.  No retropulsion.",
            "output": "1.  Status post left chest tube with significant decrease in size of left\npleural effusion, near complete re-expansion of left lung, and expected left\nlung pulmonary edema or passive lymphatic congestion due to pleural effusion. \nNo large loculated pleural effusion.\n2.  Diffuse irregular left pleural thickening with apparent 1.4 cm\njuxtapleural medial left mass.  Differential includes atelectasis or\nmalignancy.\n3.  New moderate left hydropneumothorax.\n4.  Mediastinal lymphadenopathy measuring up to 1.5 cm is likely reactive or\nrelated to pleural abnormality.\n5.  Chronic mild superior endplate compression fractures of T10 and T11.  No\nretropulsion.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:30 ___, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe study is limited by respiratory motion.  Apparent defects in the lingula\nand left lower lobe are likely from motion.  No definite pulmonary embolus is\nseen.\n\nProminent mediastinal lymph nodes measure up to 1.1 cm.  Bilateral hilar lymph\nnodes are prominent but not enlarged by CT size criteria.  The thyroid gland\nis not imaged.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No acute pulmonary embolus or acute aortic abnormality.\n2.  Prominent hilar and mediastinal lymph nodes, possibly reactive."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Mild cardiomegaly.  Moderate coronary artery\ncalcification with an apparent left anterior descending artery stent,\nalternatively severe calcification.  The thoracic aorta is normal in caliber. \nAortic atherosclerosis is mild.  No evidence of dissection or penetrating\nulcer formation.  The main pulmonary artery is normal in caliber.  The\npulmonary arteries are patent to the subsegmental level.  Pacemaker leads\nterminate in the right atrium and right ventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent mediastinal lymph nodes measure up to\napproximately 9 mm in the AP window, left lower paratracheal, and subcarinal\nstations (series 2, images 45, 47, and 57), unchanged.  No axillary\nlymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis.  There is mild diffuse bronchial\nwall thickening worst in the lower lobes consistent with chronic small airway\ninflammation.  The airways are patent to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhypoattenuating lesion in the posterior aspect of hepatic segment VI is too\nsmall to completely characterize, likely a cyst or biliary hamartoma.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  The colon and rectum are\nwithin normal limits.  The appendix is normal.  There is no evidence of\nmesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.  Incidental note is made of a\nreplaced common hepatic artery arising from the superior mesenteric artery.\n\nBONES: There is no acute fracture.  Mild anterior T11 vertebral body height\nloss is unchanged since at least ___, possibly congenital.  No\nfocal suspicious osseous abnormality.\n\nSOFT TISSUES: Soft tissue thickening, more likely a small fluid collection the\nmidline upper anterior abdominal wall appears perhaps minimally decreased in\nsize since ___ (series 3, image 267).",
            "output": "1. No aortic dissection.  Moderate atherosclerotic disease includes the\ncoronary arteries.\n2. Soft tissue thickening or a small fluid collection in the midline anterior\nabdominal wall appears minimally changed, possibly slightly is decreased in\nsize compared to ___.  Recommend correlation with physical\nexamination.\n3. Small hiatal hernia.\n4. Small airways inflammation."
        },
        {
            "input": "Aorta is normal in diameter.  Main pulmonary artery is distended up to 3.6 cm\nthat might be consistent with pulmonary hypertension.  Heart size is normal. \nThere is no pericardial pleural effusion.  Small hiatal hernia is present.\n\nAirways are patent to the subsegmental level bilaterally.  Mild centrilobular\nemphysema predominantly affecting upper lobes.  Several sub 3 mm pulmonary\nnodules are primarily seen in the upper lobes, but also seen in the lung\nbases: Series 302, image 28, 55, 60, 62, 91, 92, 96, 100 and 4, 100 and 8,\n159, 210.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nNo ascending aortic calcifications are present.  There is no pericardial\npleural effusion.  No mediastinal, hilar or axillary lymphadenopathy is\npresent.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Multiple pulmonary nodules but small.  In the presence of emphysema that\nshould be reassessed in ___ year for stability.  If patient qualifies,\nenrollment in the lung cancer annual screening program is to be considered\n\nDistended pulmonary artery concerning for pulmonary hypertension potentially\nrelated to the provided history of mitral valve regurgitation."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere has been interval reduction in the caliber of the main pulmonary artery\nand the main left and right pulmonary arteries status post recent MVR.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax.  A moderate layering right pleural effusion\nis seen with adjacent compressive atelectasis.\n\nLUNGS/AIRWAYS: Again seen are multiple tiny nodules, unchanged from prior. \nThere are no new or growing nodules.  The airways are patent to the level of\nthe segmental bronchi bilaterally.  Re-demonstration of mild central lobar\nemphysema, predominantly affecting the upper lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia.  A 1.1 cm hypodensity is seen in the dome of the liver (2:72),\nincompletely characterized, grossly unchanged from prior.  A 2 cm right\nadrenal nodule is unchanged from prior (2:111).  Based on Hounsfield unit\nmeasurements from prior noncontrast CT abdomen pelvis study, it likely\nrepresents an adenoma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMultilevel degenerative changes are noted in the thoracic spine.\n\nSOFT TISSUES: Mild stranding is seen at the site of recent intervention in the\nright lateral thoracic wall.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Re-demonstration of multiple tiny bilateral pulmonary nodules.  Per\nrecommendation of prior CT chest, recommend re-evaluation in ___ year.\n\nNOTIFICATION:  The findings were discussed with ___, P.A. by ___\n___, M.D. on the telephone on ___ at 11:06 am, 3 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:  A right chest wall Port-A-Cath terminates at cavoatrial junction. \nExtensive streak artifact through the right chest from right shoulder\nprosthesis noted.  The imaged thyroid gland appears normal.  Thoracic aorta is\nmildly calcified though normal in caliber.  Small mediastinal lymph nodes are\npresent.  No axillary adenopathy.  Main pulmonary artery is normal in caliber\nwith central patent branches.  The heart is normal in size and shape without\npericardial effusion.  The esophagus appears thickened along the mid to distal\nsegment in this patient with known esophageal cancer.  No pneumomediastinum.\nAirspace consolidation in the right lung mostly localized to the right upper\nlobe is compatible with pneumonia.  Pleural thickening/scarring and\natelectasis along the lateral aspect of the left mid and lower lung is grossly\nunchanged from prior examination.  Airways are patent to the subsegmental\nlevel.  There is no evidence of contusion or laceration.  There is no\npneumothorax or pleural effusion.\n\nABDOMEN:\n\nLIVER: No focal liver lesion.  Main portal vein patent.  Mild intrahepatic\nbiliary ductal dilation likely due to prior cholecystectomy.  CBD is normal in\ncaliber.\nSPLEEN:  Normal.\nPANCREAS:  Normal.\nADRENALS:  Normal.\nKIDNEYS:  Symmetric enhancement and prompt excretion without worrisome focal\nlesion, pyelonephritis or hydronephrosis.\nAORTA:  Aortic calcification is significant.  There is an outpouching of the\ninfrarenal segment of the abdominal aorta with medialized intimal\ncalcification best seen on series 2, image 68 concerning for chronic\npseudoaneurysm.  Aneurysm measures approximately 2.4 x 2.1 cm which is\nunchanged from prior CT.  No periaortic hematoma.\nGI:  PEG tube is seen positioned appropriately in the mid gastric body.  The\nstomach is decompressed.  The duodenum appears normal.  Loops of small bowel\ndemonstrate no signs of ileus or obstruction.  The colon contains a mild fecal\nload and is without wall thickening or signs of acute inflammation. \nDiverticulosis without diverticulitis is noted.  No lymphadenopathy, free air,\nor free fluid.  Appendix not visualized though there are no secondary signs of\nappendicitis.\n\nPELVIS:  The bladder is collapsed around a Foley catheter.  There is no pelvic\nfree fluid.  No pelvic sidewall or inguinal adenopathy is seen.\n\nBONES:  There is no acute fracture.  A T6 vertebral body hemangioma is noted. \nNo destructive osseous lytic or sclerotic lesion is identified.",
            "output": "1. Right upper lobe pneumonia.\n2. Esophageal thickening which may reflect known esophageal malignancy,\ndifficult to exclude concurrent esophagitis.\n3. Stable chronic pseudoaneurysm of the abdominal aorta, unchanged from at\nleast ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  There is no\nsupraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see report from dedicated CT of the abdomen and pelvis\nfor infra diaphragmatic findings.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes are identified.  Distal\nesophageal wall thickening appears unchanged.\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  Scattered coronary\natherosclerotic calcifications are noted.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  There is a background of mild centrilobular emphysema.  No focal\nconsolidation or suspicious nodules are identified.  Patient's right upper\nlobe pneumonia has resolved since the prior examination.\n-AIRWAYS:  The airways are diffusely thickened.\n-VESSELS:  The aorta and main pulmonary artery are normal in caliber.\nCHEST CAGE: No suspicious bony lesions are identified.  A hemangioma is seen\nin the T6 vertebral body.  Fracture of the T5 spinous process is not well seen\non the current examination.",
            "output": "No evidence of thoracic metastatic disease.\n\nSimilar appearance of distal esophageal wall thickening.\n\nPlease see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Moderate atherosclerotic calcifications of the thoracic\naorta and at the origin of the head and neck vessels.  Mild coronary\ncalcifications.  There also mild calcifications of the aortic annulus.  The\nthoracic aorta is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits.  There is a moderate pericardial effusion,\nwhich is new since ___.\n\nAXILLA, HILA, AND MEDIASTINUM: Small mediastinal lymph nodes are stable\nmeasuring up to 8 mm at the precarinal station (series 2, image 25).  No new\naxillary, mediastinal, or hilar lymphadenopathy is present.  No mediastinal\nmass.\nCircumferential thickening of the distal esophageal wall is similar compared\nto prior.\n\nPLEURAL SPACES: Trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited by motion\nartifact, particularly at the right apex.  Within these limitations: Mild\ncentrilobular emphysema.  Multiple tiny solid pulmonary nodules bilaterally\nwhich are unchanged compared to prior (series 4, image 104, 109).  No new\nsuspicious lung nodules.  No focal consolidations.  Subpleural atelectasis\nwithin the left lower lobe is unchanged.  Diffuse bronchial wall thickening\nlikely reflects mild chronic airways disease.  Otherwise, the airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: Total reverse shoulder arthroplasty on the right without evidence of\nhardware complication.  A hemangioma is seen within the T6 vertebral body\n(series 602b, image 39).  No suspicious osseous abnormality is seen.? There is\nno acute fracture.",
            "output": "1. Moderate pericardial effusion, which is new since ___.  Trace\nleft pleural effusion.\n2. Evaluation of the lung parenchyma is limited by motion artifact.  Within\nthese limitations: No new suspicious lung nodules.  Stable small mediastinal\nlymph nodes measuring up to 8 mm, but no new lymphadenopathy.\n3. Stable circumferential thickening of the distal esophageal wall.\n4. Please refer to the abdominal CT with the same date for evaluation of the\nintra-abdominal structures."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\nAtherosclerotic calcifications in the head and neck vessels.\nNo axillary or supraclavicular a enlarged pathological lymph node.\nNo abnormalities in the chest wall.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT for subdiaphragmatic\nfindings.\n\nMEDIASTINUM: Numerous mediastinal lymph nodes are seen, some of which are\nenlarged, the largest 1 measuring 12 mm in short axis diameter, paratracheal\nExcentric circumferential thickening of the lower half of the esophagus,\npatulous in the superior half.\n\nHILA: No hilar lymphadenopathies.\n\nHEART and PERICARDIUM: Heart is normal in size and appearance.  Minimal\npericardial effusion.\nModerate atherosclerotic calcifications in the thoracic aorta, coronary\narteries and aortic valve.\nPLEURA: Slight increase in moderate pleural effusion to the right and mild to\nthe left, determined compressive atelectasis to the adjacent parenchyma. \nBilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Mild central lobular emphysema.\n2. Multiple solid lung nodules, measuring up to 5 mm, most of which are\nunchanged there are some new solid nodules, for example 6: 169 and 1:146.\n3. AIRWAYS:  Bronchial wall thickening, with some mucus plugs in the left\nlower lobe.\n4. VESSELS:  Pulmonary arteries are normal in size.\nCHEST CAGE: Right humeral arthroplasty.  Severe dorsal spondylosis.",
            "output": "Mediastinal lymph nodes are enlarged compared to previous exam of ___. \nNew lung nodules are also seen in the present exam.  These results indicate\nmetastatic progression.\nPleural effusions are larger than compared to previous exam."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no suspicious thyroid\nnodules.  There is no axillary lymphadenopathy.  No chest wall abnormality is\nidentified.\n\nUPPER ABDOMEN: No acute abnormality is identified in the visualized portion of\nthe upper abdomen.\n\nMEDIASTINUM: Mediastinal lymphadenopathy is similar to ___.  An\nenteric tube is in place, and there is fluid surrounding the tube within the\nupper esophagus.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size with a small pericardial\neffusion which is unchanged in size.  Coronary artery calcifications are again\nnoted.\nPLEURA: There is a moderate right pleural effusion and trace left pleural\neffusion, both of which are not significantly changed since ___.\nLUNG:\n\n1. PARENCHYMA: Mild to moderate centrilobular emphysema is again appreciated. \nThere are new ground-glass opacities throughout both lungs, accompanied by\nparaseptal thickening and fluid within the fissures.  These findings suggest\npulmonary edema.  However, superimposed pneumonia cannot be excluded.  There\nis compressive atelectasis in both lungs related to pleural effusions.  A\nsolid nodule in the right middle lobe has increased in size, now measuring up\nto 1.2 cm (5: 171).  Additional smaller nodules seen on the prior exam are not\nas well visualized on today's exam due to the new consolidations.\n2. AIRWAYS:  The patient is intubated.  The airways are clear to at least to\nthe segmental level.\n3. VESSELS:  A right PICC is in place with its tip in the distal SVC. \nModerate atherosclerotic calcifications are again noted within the thoracic\naorta.\nCHEST CAGE: Orthopedic hardware is again appreciated in the right humerus. \nSevere degenerative changes in the thoracic spine are unchanged.  A hemangioma\nis noted in the T6 vertebral body.",
            "output": "1. Enteric and endotracheal tubes in place.\n2. Right PICC in place with tip in the distal SVC.\n3. New bilateral ground-glass opacities with associated paraseptal thickening\nand bilateral pleural effusions.  Findings are consistent with pulmonary\nedema. Superimposed pneumonia cannot be excluded.\n4.  Interval increase in size of a solid nodule in the right middle lobe. \nAdditional previously described nodules are not as well visualized on this\nexam.  These can be re-evaluated with a chest CT after resolution of symptoms.\n5. Mediastinal lymphadenopathy not significantly changed since ___.\n\nRECOMMENDATION(S):  Follow-up CT chest after resolution of symptoms to ensure\ncomplete resolution of consolidations and re-evaluate pulmonary nodules."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild mosaic attenuation of the lung parenchyma, likely due to\nphysiologic air trapping.  4 mm lung nodule is seen in the right lower lobe\n(3:80).  Dependent atelectasis is mild bilaterally.  The airways are patent to\nthe subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "-No evidence of acute pulmonary embolism.\n-4 mm right lower lobe nodule.  No further follow up is needed."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are well under cross-sectional criteria for adenopathy.  Moderate aortic\natherosclerotic calcifications are noted throughout the thoracic aorta and\ncoronary vessels.  The heart size is normal.  There is moderate mitral annular\nand aortic valvular calcification.\n\nThere are no pulmonary nodules or masses.  There is minimal dependent\natelectasis.  There is no pneumothorax or pleural effusion.\n\nThere are no osseous lesions concerning for malignancy or infection.\n\nPlease see report from dedicated CT of the abdomen and pelvis for\nsubdiaphragmatic findings.",
            "output": "No intrathoracic lymphadenopathy.  No acute intrathoracic process."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is mild stranding and thickening\nimmediately inferior to the sternal fracture.  No hematoma.  No axillary,\nmediastinal, or hilar lymphadenopathy is present.  No mediastinal mass\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Oblong fatty pleural\nbased lesion at the right lung base laterally measuring 1.1 x 4.8 cm is\ncompatible with a lipoma.\n\nLUNGS/AIRWAYS: No masses or suspicious nodules.  Linear opacities at the lung\nbases are most likely atelectasis, left greater than right.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe visualized portion of the thyroid is within normal limits.\n\nABDOMEN: The visualized abdominal viscera are unremarkable.\n\nBONES: There is an oblique, minimally displaced fracture of the mid sternum\n(series 602, image 72).  No other fractures are identified.  No aggressive\nosseous lesions.\n\nSOFT TISSUES: The chest wall is within normal limits.",
            "output": "Oblique, minimally displaced fracture of the mid sternum with mild stranding\nposteriorly.  No associated cardiac, vascular or pulmonary injury is\ndemonstrated."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Atherosclerotic disease in\nthe descending aorta with mild dilatation is unchanged.  No mediastinal, hilar\nor axillary lymphadenopathy is present.\n\nImage portion of the upper abdomen demonstrate calcified gallstones and\notherwise is unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is moderate.  There is interval resolution of right apical post\nsurgical hydro pneumothorax.  There is also resolution of previously seen\nground-glass opacities and unremarkable appearance of the surgical stump.  No\nnew pulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Unremarkable appearance after surgery.\n\nInterval resolution of right pneumothorax and bilateral consolidations.\n\nEmphysema.\n\nNo evidence of new pulmonary nodules or masses.\n\nAtherosclerosis involving the aorta.\n\nGallstones no evidence of cholecystitis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There is stable shift of mediastinum to the right.\n\nNODES: There are no enlarged mediastinal hilar lymph nodes.\n\nHEART, VESSELS and PERICARDIUM: There is moderate cardiomegaly.  Mild\natherosclerotic calcification involving the aortic annulus is again seen. \nThere is also atherosclerotic calcification involving the descending thoracic\naorta.  There are no enlarged hilar lymph nodes\n\nPLEURA: There is no pleural effusion\n\nLUNG:\nPatient is status post right middle and right lower lobectomy with stable\npostsurgical changes.  There is no evidence of local recurrence.  There is\nmoderate upper lobe predominant centrilobular emphysema.\n\n\nBONES AND CHEST WALL : Review of bones shows evidence of right-sided\nthoracotomy.  No lytic or sclerotic lesions concerning for metastasis are\nseen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows gallstones. \nNo adrenal masses are seen.  No focal liver lesions are seen.",
            "output": "Stable postsurgical changes following right middle and lower lobectomy.  No\nevidence of local recurrence.  No evidence of metastasis to the chest.\n\nModerate upper lobe predominant emphysema.\n\nStable moderate cardiomegaly."
        },
        {
            "input": "The pulmonary trunk is within normal limits by size.  There is a\nlinear lucency within a segmental branch of the left interlobar pulmonary\nartery, which is most compatible with a pulmonary web, likely from old or \nchronic embolus.  No acute pulmonary thromboembolic disease.  Thoracic aorta\nis normal caliber without aneurysmal dilatation or dissection.  Heart size is\nwithin normal limits without pericardial effusion.  There is no mediastinal or\nhilar lymphadenopathy.  There is a 5-mm juxtafissural nodule in the right\nupper lobe posterior segment (series 3, image 18).  Respiratory motion limits\nevaluation. No pulmonary mass or confluent consolidation.  Tracheobronchial\ntree is normal without endoluminal lesion.  No pleural effusion or\npneumothorax.\n\nABDOMEN: Incidental note of a hemangioma in the right hepatic dome. Remaining\nvisible upper abdominal organs are normal.\n\nBONES AND SOFT TISSUES:  No acute fracture or destructive osseous process. \nSoft tissues of the chest wall are normal.  Multiple small conspicuous\nbilateral axillary lymph nodes do not meet CT criteria for pathologic\nenlargement.  There is a 1.0 cm x 0.7 cm, nodular soft tissue structure in the\nretroglandular tissues of the left breast (series 3, image 52).",
            "output": "1.  Linear lucency in a superior segmental branch of the left lower lobe\nlikely represents a vascular web, perhaps sequela from chronic embolus.  No\nacute pulmonary thromboembolic disease.  Normal caliber pulmonary trunk.\n2.  5-mm juxtafissural nodule in the posterior segment of the right upper lobe\nis indeterminate. If the patient is at low risk for bronchogenic carcinoma,\nrecommend followup unenhanced CT chest at 12 months.  If the patient is at\nhigh risk for bronchogenic carcinoma, followup CT chest should be obtained in\nsix months.\n3.  Nodular soft tissue structure in the retroglandular tissues of the left\nbreast may represent a small lymph node versus a fibroadenoma.  Mammographic\ncorrelation may be helpful in further evaluation."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Minimal atherosclerotic calcifications are noted.  The\nheart, pericardium, and great vessels are within normal limits.  Coronary\narterial calcifications are present.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild bronchial wall thickening is seen throughout the lungs. \nMultiple millimetric nodules are identified bilaterally.  The larger nodules\nmeasure up to 4 mm, including a subpleural nodule in the left upper lobe\n(3:52), which remains stable.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A focus of arterial enhancement in hepatic segment 8 (3:173) may\nrelate to perfusion changes.  No anatomic correlate is noted on recent\nabdominal ultrasound of ___.  There is a small hiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Stable 4 mm subpleural nodule in the left upper lobe.  Multiple bilateral\n2-3 mm nodules are identified, some of which are new since examination of\n___.\n3.  A focus of arterial hyperenhancement in segment 8 of the liver is\nincompletely assessed.  No anatomic correlate is identified on recent\nabdominal ultrasound ___.  If there is clinical concern, a limited\nUS of the liver can be obtained for further evaluation.\n4.  Small hiatal hernia."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged and\nthere is no soft tissue abnormality in the imaged chest wall concerning for\nmalignancy or infection, including the area left pectoral subcutaneous cardiac\ndevice.  This study is not appropriate for subdiaphragmatic diagnosis,\nespecially hepatic evaluation were a well-circumscribed 2 cm low attenuation\nregion in the right lobe is incompletely imaged and does not meet criteria for\nsimple cysts on this study. It was diagnosed as a cyst on an abdomen CT one\n___ and does not require further imaging.\n\nCARDIO-MEDIASTINUM:Esophagus is moderately patulous throughout, with no\nassociated mass or good evidence for obstruction.  Dysmotility is suspected. \nClinical correlation advised.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is heavy in head and neck vessels, particularly\nthe origin of the left subclavian artery, and in all major coronary arteries. \nAortic valvular calcification is moderate to heavy, and may contribute to\nvalvular stenosis.  Moderate pericardial effusion is slightly smaller, and has\nattenuation characteristics of serous effusion.\n\nTHORACIC LYMPH NODES: None pathologically enlarged\n\nLUNGS, AIRWAYS, PLEURAE: Previous pleural effusions have resolved entirely and\nthere is no pleural thickening or nodulation..\n\nPrevious severe pulmonary edema and possible concurrent consolidation has\nresolved.  Residual heterogeneity in the background density lung could be due\nto small airway obstruction or residual edema, mild hemosiderin deposition or\nminimal pulmonary hemorrhage.  Other than mild retention of secretions in the\nupper tracheal lung the back wall, the tracheobronchial tree is normal to\nsubsegmental levels, absent any endobronchial lesions, mucosal thickening, or\nbronchiectasis.\n\n\n\nCHEST CAGE: No evidence infection or malignancy in the chest cage.",
            "output": "Previous pulmonary edema and pleural effusions have resolved.  Small to\nmoderate serous pericardial effusion remains.  No focal pulmonary or\ntracheobronchial abnormality is present to explain hemoptysis.  Very mild\nparenchymal pulmonary hemorrhage could be present, but the mild generalized\nheterogeneity in background lung density is more likely due to either\nhemosiderin deposition, minimal residual edema, or small airway obstruction.\n\nHeavy atherosclerosis, head and neck and coronary arteries.\n\nAortic valvular calcification is substantial enough to be hemodynamically\nsignificant."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are small mediastinal lymph nodes which are most likely\nreactive.  The aorta is normal in caliber.  There is moderate coronary artery\ncalcification.  There is moderate cardiomegaly.  There is a small pericardial\neffusion.  The descending thoracic aorta is heavily calcified.\n\n\nPLEURA: There are small bilateral pleural effusions right greater than left\n\nLUNG: There is diffuse bilateral ground-glass opacification which most likely\nrepresents pulmonary edema.  More confluent opacity in the right lower lobe\ncould represent atelectasis however superimposed pneumonia cannot be excluded.\nThere is bibasilar atelectasis\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nliver lesion which most likely represents a cyst.  There are bilateral renal\ncysts.  There are nonobstructing calculi in the right kidney.  The spleen is\nmildly enlarged.",
            "output": "Small bilateral pleural effusions with bibasilar atelectasis.  Diffuse\npulmonary edema.\n\nConsolidative opacity in the right lower lobe could represent atelectasis\nhowever superimposed pneumonia cannot be excluded.\n\nModerate cardiomegaly.  Moderate coronary artery calcification.  Moderate\natherosclerotic calcification involving the aorta.  Trace pericardial\neffusion.\n\nMild splenomegaly.\n\nExtensive degenerative changes involving the thoracic spine."
        },
        {
            "input": "Extensive consolidative opacities involves the bilateral lungs, lower lobes\ngreater than upper lobes.  These consolidations appear to be dependent,\nsuggestive of a combination of pulmonary edema and atelectasis or ARDS. \nHowever, a superimposed infection cannot be excluded.  Bilateral small simple\npleural effusions are noted.  There is no pneumothorax.  Airways appear patent\nto at least the segmental level.  The endotracheal tube terminates in the mid\nthoracic trachea.  Secretions are noted proximal to the endotracheal tube\ncuff.\n\nThe visualized thyroid gland is unremarkable.  There is no supraclavicular or\naxillary lymphadenopathy.  Mediastinal lymph nodes are measurable, but not\npathologically enlarged.  The heart is mildly enlarged, with extensive\ncoronary artery, aortic valve, and mitral annular calcification.  There is\ntrace pericardial effusion.  The left internal jugular catheter terminates in\nthe brachiocephalic vein, and appears caught again the wall of the vessel.\n\nThis exam is not optimized for the evaluation of infra diaphragmatic\nstructures.  A hepatic hypodensity in segment 7 appears increased in size\ncompared to ___, but likely represents a simple cyst or biliary\nhamartoma.  The remainder of the abdomen is unremarkable.  The nasoenteric\ntube terminates within the stomach.\n\nNo focal lytic or sclerotic osseous lesion distress neoplasm or infection. \nExtensive degenerative disease of the thoracic spine.",
            "output": "1. Extensive consolidative opacities involving the bilateral lungs, lower\nlobes greater than upper lobes, likely reflect a combination of pulmonary\nedema and atelectasis or ARDS.  A superimposed infection cannot be excluded in\nthe right clinical setting.\n2. The left internal jugular catheter terminates in the brachiocephalic vein,\nand appears caught again the wall of the vessel.\n3. Bilateral small simple pleural effusions.\n4. Trace pericardial effusion.\n\nNOTIFICATION:  These findings were communicated via telephone by Dr. ___\n___ to Dr. ___ at 19:05 on ___, approximately 55 minutes\nafter discovery.  Updated findings were communicated via telephone to Dr.\n___ at 2225 on the same day."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a stable 6 mm right lower lobe pulmonary nodule (5, 255).  No\nother pulmonary nodules\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "Stable 6 mm right lower lobe pulmonary nodule, could represent\nintraparenchymal lymph node.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Trace left basilar atelectasis.  Lungs are clear without masses\nor areas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  Excluding the breast tissue which\nrequires mammography for evaluation, there are no soft tissue abnormalities in\nthe chest wall.  Right prepectoral Port-a-Cath and right internal jugular\ncentral venous catheters terminate in the cavoatrial junction and right\natrium.  Assessment for catheter associated venous thrombosis is limited due\nto contrast administration through the central venous line.  No\natherosclerotic calcifications in the head and neck arteries.\n\nCHEST CAGE:\nNo acute fractures.  No worrisome lytic or sclerotic lesions.\n\nHEART AND VASCULATURE:\nThe heart is borderline enlarged.  No pericardial effusion. No atherosclerotic\ncalcifications in the coronary arteries, cardiac valves or aorta. The aorta\nand pulmonary arteries are normal in caliber throughout.\n\nThere is a filling defect in a segmental right lower lobe pulmonary artery\nconsistent with an acute segmental pulmonary embolism (series 5; 150). \nAdditional filling defects consistent with multiple subsegmental pulmonary\nemboli in the left upper lobe (series 5; 118).  There is no evidence of\nparenchymal infarction or right heart strain.\n\nMEDIASTINUM AND HILA:\nThe esophagus is normal without thickening or hiatal hernia.  Small\nmediastinal lymph nodes, none pathologically enlarged by CT size criteria. No\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions or pneumothorax.\n\nLUNGS:\nThe tracheobronchial airways are patent to the subsegmental levels. No\nbronchial wall thickening, bronchiectasis or mucus plugging. No suspicious\nlung nodules or masses. Mild bibasilar atelectasis.  No focal consolidation.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "1. Acute occlusive thrombosis of the segmental right lower lobe pulmonary\nartery and multiple left upper lobe subsegmental thrombi consistent with acute\nsegmental and subsegmental pulmonary embolism.\n2.\n\nNOTIFICATION:  The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 12:04 pm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is normal.  No enlarged lymph nodes in either axilla or thoracic\ninlet. A right-sided chest port is unremarkable with tip in the right atrium. \nExcluding the breast tissue which requires mammography for evaluation,there\nare no abnormalities on the chest wall. No atherosclerotic calcifications in\nthe head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta is normal in caliber throughout.  The main pulmonary artery\nis dilated to 3.5 cm, increased from the prior study on ___\ncommon possibly reflecting pulmonary hypertension.  Please note, the study is\nnot optimized for evaluation of the segmental and subsegmental pulmonary\narteries, however a filling defect is again seen in a right lower lobe\nsegmental pulmonary artery (series 6:150).  The pulmonary vasculature is\nbetter evaluated on CTA chest from 7 days prior.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThere is subtle diffuse ground glass opacity in the dependent lung\nbilaterally, likely hypoventilatory.The airways are patent to the subsegmental\nlevels. No bronchial wall thickening, bronchiectasis or mucus plugging. \nSeveral pulmonary nodules measure up to 4 mm (series 5:111, 90, 84, 70). \nThere is moderate subsegmental atelectasis in the lower lobes bilaterally and\nlingula.  No focal consolidation to suggest pneumonia.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. There are no bone findings in the\nchest cage suspicious for malignancy or infection but it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous metastases than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to separate report for CT abdomen and pelvis acquired on the same\nday for findings below the diaphragm.",
            "output": "1. No specific evidence of infection within the chest.\n2. Dilatation of the main pulmonary artery to 3.5 cm is mildly increased from\nprior and suggests pulmonary hypertension.\n3. Please note this study is not optimized for evaluation of the segmental and\nsubsegmental pulmonary arteries. The pulmonary vasculature is better evaluated\non CTA chest from 7 days prior.\n4. Multiple pulmonary nodules measuring less than 4 mm.  Please see\nrecommendation below.\n5. Please refer to separate report for CT abdomen and pelvis acquired on the\nsame day for findings below the diaphragm.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Evaluation of the pulmonary arterial tree is limited on\nthis nondedicated study.  There is no evidence of central pulmonary embolism\nthrough the lobar level.  Opacification is inadequate for reassessing small\nsegmental emboli seen on CT of the chest from ___.  The main\npulmonary artery is borderline dilated, measuring 3.3 cm, similar to prior. \nThe thoracic aorta is normal in caliber.  Tips of a right prepectoral port\nvenous catheter and right IJ venous catheter both terminate in the proximal\nright atrium.  Heart size is normal.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary or mediastinal\nlymphadenopathy..  There is mild confluent right hilar lymphadenopathy, likely\nreactive.  No mediastinal mass.\n\nPLEURAL SPACES: There is a new small nonhemorrhagic pleural effusion on the\nright and trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse interlobular septal thickening, compatible\nwith moderate interstitial edema, new from prior.  Bandlike consolidation in\nthe bilateral lower lobes is concerning for infection.  Central airways are\npatent.  There is marked bronchial wall thickening in the bilateral lower\nlobes.\n\nBASE OF NECK: Visualized portions of the base of the neck are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal lesions.  There is mild fullness of the left\nrenal collecting system.  There is no hydronephrosis.  There is mild\nnonspecific bilateral perinephric stranding, which appears slightly improved\ncompared to CT of the abdomen/pelvis from ___.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops are normal\nin caliber.  There is mild sigmoid diverticulosis without evidence of acute\ndiverticulitis.  The colon is otherwise unremarkable.  Specifically, there is\nno cecal wall thickening or surrounding fat stranding to suggest typhlitis. \nThe appendix is not visualized.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS:\n\nThere is persistent mild circumferential wall thickening of the bladder and\nperivesical stranding, improved from prior.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis seen.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Scattered small subcutaneous nodular foci with air and\nstranding in the ventral abdominal wall are presumably injection sites.",
            "output": "1. New moderate interstitial edema with small nonhemorrhagic right pleural\neffusion and trace left pleural effusion.\n2. Bandlike consolidation and marked bronchial wall thickening in the\nbilateral lower lobes is concerning for infection.\n3. Limited evaluation of the segmental and subsegmental pulmonary arteries on\nthis nondedicated study.  No central pulmonary embolism through the lobar\nlevel.\n4. No evidence of typhlitis or other bowel inflammation.\n5. Persistent mild circumferential wall thickening of the bladder and\nperivesical stranding, compatible with cystitis, improved from prior.\n6. Scattered small subcutaneous nodular foci with air and stranding in the\nventral abdominal wall are presumably injection sites.  Clinical correlation\nrecommended."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Evaluation of the pulmonary arterial tree is limited on\nthis nondedicated study.  There is no evidence of central pulmonary embolism\nthrough the lobar level.  Opacification is inadequate for reassessing small\nsegmental emboli seen on CT of the chest from ___.  The main\npulmonary artery is borderline dilated, measuring 3.3 cm, similar to prior. \nThe thoracic aorta is normal in caliber.  Tips of a right prepectoral port\nvenous catheter and right IJ venous catheter both terminate in the proximal\nright atrium.  Heart size is normal.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary or mediastinal\nlymphadenopathy..  There is mild confluent right hilar lymphadenopathy, likely\nreactive.  No mediastinal mass.\n\nPLEURAL SPACES: There is a new small nonhemorrhagic pleural effusion on the\nright and trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse interlobular septal thickening, compatible\nwith moderate interstitial edema, new from prior.  Bandlike consolidation in\nthe bilateral lower lobes is concerning for infection.  Central airways are\npatent.  There is marked bronchial wall thickening in the bilateral lower\nlobes.\n\nBASE OF NECK: Visualized portions of the base of the neck are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal lesions.  There is mild fullness of the left\nrenal collecting system.  There is no hydronephrosis.  There is mild\nnonspecific bilateral perinephric stranding, which appears slightly improved\ncompared to CT of the abdomen/pelvis from ___.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops are normal\nin caliber.  There is mild sigmoid diverticulosis without evidence of acute\ndiverticulitis.  The colon is otherwise unremarkable.  Specifically, there is\nno cecal wall thickening or surrounding fat stranding to suggest typhlitis. \nThe appendix is not visualized.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS:\n\nThere is persistent mild circumferential wall thickening of the bladder and\nperivesical stranding, improved from prior.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis seen.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Scattered small subcutaneous nodular foci with air and\nstranding in the ventral abdominal wall are presumably injection sites.",
            "output": "1. New moderate interstitial edema with small nonhemorrhagic right pleural\neffusion and trace left pleural effusion.\n2. Bandlike consolidation and marked bronchial wall thickening in the\nbilateral lower lobes is concerning for infection.\n3. Limited evaluation of the segmental and subsegmental pulmonary arteries on\nthis nondedicated study.  No central pulmonary embolism through the lobar\nlevel.\n4. No evidence of typhlitis or other bowel inflammation.\n5. Persistent mild circumferential wall thickening of the bladder and\nperivesical stranding, compatible with cystitis, improved from prior.\n6. Scattered small subcutaneous nodular foci with air and stranding in the\nventral abdominal wall are presumably injection sites.  Clinical correlation\nrecommended."
        },
        {
            "input": "THORACIC INLET: There are no enlarged supraclavicular lymph nodes. \nRight-sided Port-A-Cath tip projects over the distal SVC.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: Enlarged mediastinal hilar lymph nodes.  Heart size is normal. \nThere is no pericardial effusion.  The aorta and pulmonary arteries are normal\nin caliber.\n\n\nPLEURA: Bilateral pleural effusions have increased in volume in a now moderate\nvolume.\n\nLUNG: There is near completely atelectasis of both lower lobes, secondary to\nthe increasing pleural effusions.  There is diffuse bilateral ground-glass\nopacification superimposed over mild septal thickening within both upper lobes\nright greater than left which most likely represents worsening pulmonary\nedema.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "Significant increase in volume bilateral pleural effusions which are now\nmoderate volume with near complete atelectasis of both lower lobes secondary\nto the increasing effusions.\n\nDiffuse bilateral ground-glass opacification superimposed over mild septal\nthickening bilaterally most likely represents worsening pulmonary edema.\n\nOverall constellation of findings related to volume overload rather than\npneumonia.\n\nRight-sided Port-A-Cath tip projects to the distal SVC, unchanged"
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The\ninterventricular septum appears small hyperdense relative to the blood pool\nwithin the ventricles suggesting presence of underlying anemia.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n2 central venous catheters terminate near the right atrium.\n\nThe unenhanced main pulmonary artery is dilated at 3.6 cm, that may represent\nunderlying mild pulmonary arterial hypertension.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There are bilateral small pleural effusions, right greater\nthan left.\n\nLUNGS/AIRWAYS: Substantial improvement in a now trace right pleural effusion. \nPossible trace left pleural effusion.  There is ground-glass and nodular\nopacity at the right lung base with additional septal thickening and minimal\nground-glass nodular opacity at the left lung base and left upper lobe. \nFindings are consistent with persistent pneumonia.  The central airways are\nclear bilaterally.  No large airway obstruction is demonstrated.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please see separately dictated report.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. New ground-glass and nodular opacities and consolidation within the right\nlower lobe concerning for right lower lobe pneumonia associated with a small\nsyn-pneumonic effusion.  Similar ground-glass opacities and atelectasis are\nalso noted in the left lower lobe with a trace left pleural effusion, also\nconcerning for left lower lobe pneumonia.  No mediastinal lymphadenopathy.\n2. Mildly dilated main pulmonary artery similar to the prior study, concerning\nfor mild underlying pulmonary arterial hypertension.\n3. Right-sided central venous catheter terminates at the cavoatrial junction."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.  Mediastinal and right hilar\ncalcifications may be secondary to prior granulomatous disease.\n\nHEART:  The heart is mildly enlarged.  Aortic valve calcifications are seen. \nThere is a trace pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Upper lobe predominant septal thickening and scattered\nground-glass opacity may represent mild pulmonary interstitial edema.  There\nis a calcified granuloma in the right lower lobe as well as a 5 mm\npleural-based nodule in the right upper lobe (03:41).  There is mild dependent\nbibasilar atelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  Biapical pleuroparenchymal scarring is\nnoted.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  There is mild retrolisthesis of\nT10 on T11.  There are minimally displaced fractures in the posterolateral\ntenth through twelfth ribs.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\ngallstones without gallbladder wall thickening or adjacent fat stranding. \nThere is a 1.0 cm hypodensity in the anterior margin of the spleen (02:45)\nwhich is nonspecific but may represent small cyst versus prior infarct. \nPossible bilateral parapelvic renal cysts are noted, not well assessed.",
            "output": "1. Minimally displaced fractures of the posterolateral right tenth through\ntwelfth ribs.  No pneumothorax.\n2. Upper lobe predominant septal thickening and scattered ground-glass opacity\nmay represent mild pulmonary edema.\n3. Cholelithiasis without evidence of acute cholecystitis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the imaged chest wall concerning for malignancy or\ninfection.  This study is not appropriate for subdiaphragmatic evaluation, but\nshows right posterior diaphragmatic hernia transmitting only sub costal fat,\nand normal adrenal glands.\n\nEsophagus is mildly patulous.  There are no thyroid lesions warranting further\nimaging evaluation.  Atherosclerotic calcification is moderate in head and\nneck vessels and native coronary arteries.  Patient has just had coronary\nbypass graft surgery.  Sternal fragments are closely apposed.  Small gas and\nfluid collections in the prevascular mediastinum, still drained by a sub\nxiphoid drainage tube that extends into the left pleural space, are expected. \nTiny nonhemorrhagic left pleural effusion layers posteriorly and a very small\npneumothorax is mostly anterior, with very small apical and infero posterior\ncomponents.  No right pneumothorax.  Right pleural effusion is miniscule.\n\nAorta and pulmonary arteries are normal size.  Pericardial effusion is\nminimal.  Hypoattenuation of cardiac contents indicates anemia.\n\nThoracic lymph nodes:\n\nSubcentimeter nodes in the mediastinum are numerous.  Hilar contours on this\nnoncontrast study do not suggest adenopathy.\n\nLungs and airways:\n\nEmphysema is moderate to severe in the upper lobes, milder elsewhere.\n\nThere is no appreciable atelectasis, no consolidation or any lung nodules of\nconcern..",
            "output": "Small left pneumothorax, probably not loculated.  Drainage tube traverses the\nlow prevascular mediastinum and left lower hemithorax anteriorly."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild atherosclerotic calcification.  The\npatient is status post CABG.  The heart, pericardium, and great vessels are\notherwise within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple subcentimeter mediastinal lymph node\nare overall similar to ___.  No axillary or hilar lymphadenopathy is\npresent.  No mediastinal mass.  Minimal residual pneumomediastinum and\nstranding from recent surgery has decreased in the interim.  Prior mediastinal\nchest tube is no longer visualized.\n\nPLEURAL SPACES: There is a new large partially pleural effusion on the left\nwith a small loculated component laterally.  Left-sided chest tube is\ndemonstrated coursing superiorly with the tip partially imaged.  There is no\npneumothorax.\n\nLUNGS/AIRWAYS: The bilateral lung apices and bases are not imaged.  Dependent\natelectasis is seen in the right lung.  There is compressive atelectasis in\nthe left lower lobe.  Moderate emphysematous changes are seen in the bilateral\nupper lobes.  Mild emphysematous changes are seen in other lobes of the lungs.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMidline sternotomy wires are intact",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Large left partially loculated pleural effusion with left lower lobe\ncompressive atelectasis.  Pigtail catheter in the left hemithorax coursing\nsuperiorly with its tip partially imaged.\n3.  Moderate emphysematous changes in the bilateral upper lobes, milder in\nother lobes."
        },
        {
            "input": "Supraclavicular and numerous bilateral axillary lymph nodes are not\npathologically enlarged and there is no soft tissue abnormality in the imaged\nchest wall suspicious for malignancy or infection, including no subcutaneous\nfluid collection associated with course of the lateral entry left basal\npleural drainage catheter.This study is not appropriate for subdiaphragmatic\ndiagnosis but shows no adrenal mass.\n\nMid and lower esophagus are mildly patulous.  Small pericardial effusion is\nminimally larger today.  Previously large left pleural effusion is small,\npartly fissural, and otherwise restricted to the lung base, medial to the\nindwelling left basal pleural pigtail drainage catheter.  Small amount of\npleural fluid and pleural thickening extends superiorly along the upper\nposterior costal pleural surfaces.  There is no pneumothorax.\n\nThyroid is unremarkable.  Atherosclerotic calcification is moderately severe\nin the head and neck vessels, more pronounced in the major coronaries.\n\nPatient has had median sternotomy. Sternal fragments are closely applied and\nnot demineralized.  Retrosternal fluid volume is minimal, too small to drain,\nnot appreciably changed since ___.\n\n\nAorta and pulmonary are normal size.  Hypoattenuation of cardiac contents\nreflects anemia.\n\nThoracic lymph nodes:\nBorderline enlarged thoracic lymph nodes primarily in the prevascular and both\nlower paratracheal stations are minimally larger today.\n\nLungs and airways: Chest cage:\n\nEmphysema is severe, generalized.  No lung nodules.  No evidence of infection.\n\nChest cage:\n\nUnremarkable.",
            "output": "Substantial decrease in previous moderate size left pleural effusion now\nlargely subpulmonic and fissural, following insertion of a lateral entry left\nbasal pigtail pleural drainage catheter."
        },
        {
            "input": "The quality of the study is degraded by significant motion artifact. There is\ndiffuse bronchial wall thickening, suggestive of possible bronchitis. The\nlungs are otherwise clear. There is no nodule, mass, or consolidation.  The\nairways are patent to the subsegmental levels bilaterally. No pathologically\nenlarged axillary, mediastinal, or hilar lymph nodes are identified.  There is\nno pleural or pericardial effusion.  The heart and pericardium are within\nnormal limits.  A probable deep brain stimulator is noted.\n\nThe study is not tailored for subdiaphragmatic evaluation, but the visualized\nintra-abdominal organs are unremarkable.\n\nBONE WINDOWS:  Heterogeneous mottling of the bones is noted.",
            "output": "1. Diffuse bronchial wall thickening, suggestive of possible bronchitis.\n\n2.  Heterogeneous mottled appearance of the bones. Recommend correlation with\nlabs to rule out multiple myeloma."
        },
        {
            "input": "The thyroid gland is only partially imaged though appears enlarged without\nfocal discrete lesion.  Please correlate clinically.  Thoracic aorta is normal\nin course and caliber.  The heart is normal in size and shape.  There is\nresidual thymic tissue in the anterior mediastinal space.  The main pulmonary\nartery and central branches appear patent.  There is no mediastinal, hilar or\naxillary lymphadenopathy.  No pleural or pericardial effusion is seen.  There\nis no pneumothorax.\n\nWithin the lungs, there is no worrisome nodule, mass, or consolidation.  There\nis mild bibasilar atelectasis.\n\nIn the imaged portion of the upper abdomen, no discrete abnormality is seen.\n\nBones:  Unremarkable.",
            "output": "Mild prominence of the thyroid gland which is not fully imaged, without focal\nnodule.  Please correlate clinically.  Otherwise unremarkable exam."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged,\nranging in diameter up to 6 mm in the left axilla.  There are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nThe right thyroid lobe is slightly larger than the left, but neither contains\nany lesions warranting further imaging evaluation.\n\nAtherosclerotic calcification is mild in head neck vessels and present in at\nleast left main anterior descending and circumflex coronary arteries.  Aorta\nand pulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\nMeasurable central lymph nodes are numerous but not  pathologically enlarged,\nranging in diameter up to 7 mm in the right hilus, 6:190.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nAlthough there are no bone lesions in the chest cage suspicious for\nmalignancy, it should be noted that radionuclide bone and FDG PET scanning are\nmore sensitive in detection of early metastases than chest CT.",
            "output": "Mild predominantly left sided coronary artery atherosclerotic calcification.\n\nOtherwise normal chest CT.  No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is homogeneous.  No\nevidence of lymphadenopathy.\n\nUPPER ABDOMEN: Please see same-day separately dictated CT abdomen and pelvis\nfor description of subdiaphragmatic findings.\n\nMEDIASTINUM: There are few prominent, though nonenlarged, mediastinal lymph\nnodes.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is three-vessel coronary\nartery calcification.  No valvular calcifications.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild upper lobe predominant centrilobular emphysema.\n2. AIRWAYS:  There is mild mucus in the right mainstem bronchus.\n3. VESSELS:  No evidence of pulmonary embolism on this non PE protocol study\nCHEST CAGE: No fractures.  There are multilevel degenerative changes of the\nvisualized spine.  There is a right lateral sixth rib sclerotic focus (___),\nnew compared to ___.  There is a sclerotic focus in the left lateral\nsixth rib (___).  Previously seen foci of uptake of the right tenth rib and\nlateral aspect of the right scapula on prior bone scan are not well visualized\non the study.",
            "output": "1. Compared to ___, 2 foci of new sclerotic foci in the right\nlateral sixth rib and left lateral sixth rib.  Notably, the left sixth rib\ndemonstrated uptake on recent bone scan from ___.  Recommend\ncorrelation with follow-up bone scan.\n2. No pulmonary lesions or lymphadenopathy.\n\nRECOMMENDATION(S):   Recommend correlation with follow-up bone scan."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous in\nattenuation without focal nodularity.  There is no supraclavicular or axillary\nlymphadenopathy by CT size criteria.  The largest lymph node at the thoracic\ninlet measures up to 4 mm at the tracheoesophageal groove on the right\n(02:12).  The chest wall is unremarkable.  There is a small amount of oral\ncontrast within the distal esophagus (304b:130).\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen and pelvis report for\ndetails on subdiaphragmatic findings.\n\nMEDIASTINUM: Multiple scattered mediastinal lymph nodes are not pathologic by\nCT size criteria, though enlarged since ___, the largest\nmeasuring up to 4 mm in the left lower paratracheal station (304:100).\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.  Right hilar\nlymph node measures up to 7 mm, not significantly changed compared to prior\nexam (02:30).\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\npericardial effusion.  There is no significant valvular calcifications. \nModerate coronary calcifications are seen in the LAD and circumflex arteries.\nPLEURA: There is no pleural effusion.  There is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild bibasilar subpleural atelectasis. There are no\ndominant lung nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental levels, aside from\nsmall amount of layering secretions in the right mainstem bronchus, mildly\nincreased since ___ (304:115).\n3. VESSELS:  The ascending and descending aorta are not aneurysmal.  The right\nand main pulmonary arteries are normal in caliber.  Calcification at the\naortic arch and the origin of the head and neck vessels are moderate.\nCHEST CAGE: As previously, the vertebral bodies and ribs are heterogeneous\nwith multiple areas of sclerosis and lucency, not significantly changed\ncompared to prior exam in compatible with history of osseous metastatic\ndisease.  However new since ___, there is increased lucency in\nthe left posterior aspect of the T5 vertebral body (304:81), mildly enhancing\nsoft tissue component encroaching on the spinal canal and minimally indenting\nthe thecal sac, also new since ___.  There is no significant\nnarrowing of the spinal canal.",
            "output": "-New osseous lesion in the left posterior aspect of T5 vertebral body with\nenhancing component encroaching and indenting the thecal sac, but not\nsignificantly narrowing the canal.  If clinically indicated, this area would\nbe better evaluated on MRI.\n-Small amount of layering secretions in the right mainstem bronchus.\n-No suspicious lung nodules.\n\nNOTIFICATION:  The findings were discussed with ___ , M.D. by\n___, M.D. on the telephone on ___ at 3:27 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:  The imaged base of neck including the imaged portion of the thyroid is\nunremarkable.  The thoracic aorta is moderately calcified, appears intact, is\nslightly tortuous though is normal in caliber.  The main pulmonary artery is\nnormal in size with patent central branches.  There is no mediastinal hematoma\nor mass.  The heart is moderately enlarged with biatrial chamber enlargement. \nThere is aortic valvular calcification as well as coronary artery\ncalcification which is moderate to severe in extent.  No pericardial effusion\nis seen.  There is a right pleural effusion which is moderate in size.  A tiny\nleft pleural effusion is also noted.  There is no evidence of acute lung\ninjury.  No pneumothorax.  There is compressive atelectasis in the right lower\nlobe.  There is mild compressive atelectasis in the left lower lobe.  No\nworrisome nodule, mass, or consolidation is seen within the lungs.\n\nABDOMEN:  The liver enhances normally and appears intact.  Main portal vein is\npatent.  There is mild periportal edema likely reflecting aggressive\nhydration.  The gallbladder is normal.  The spleen is intact and is normal in\nsize.  The adrenals are normal bilaterally.  The kidneys enhance symmetrically\nwithout concerning lesion, hydronephrosis or signs of acute injury.  No\nretroperitoneal hematoma is seen.  There is a cystic lesion within or abutting\nthe pancreatic head best seen on series 2, image 126 measuring approximately\n10 x 10 x 14 mm, series 2, image 126, possibly a side-branch IPMN.  The\nabdominal aorta is densely calcified though normal in caliber.  There is no\nretroperitoneal lymphadenopathy.  The stomach is decompressed.  The duodenum\nappears normal.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThere is a large fecal load within the colon.  The appendix is not seen.  No\nsigns of bowel or mesenteric injury.  No free air or free fluid is seen.  The\nuterus is not visualized and may be surgically absent.  No adnexal mass is\nseen.  The urinary bladder is only partially distended though appears intact. \nThere is pelvic floor descent.  No pelvic sidewall or inguinal adenopathy is\nseen.\n\nBONES:  No rib fracture.  Multilevel degenerative changes are noted within the\nthoracolumbar spine.  There is grade 1 anterolisthesis of L3 relative to L4. \nNo compression fracture is seen.  The sternum is intact.  The bony pelvic ring\nis intact and the bilateral femoral necks are also intact.  Sacral Tarlov\ncysts are incidentally noted.\n\nSoft tissues: There is diffuse body wall edema.",
            "output": "1.  No acute sequelae of trauma.\n2.  Cardiomegaly with bilateral pleural effusions right greater than left with\nassociated compressive lower lobe atelectasis.\n3.  Diffuse body wall edema and periportal edema could reflect aggressive\nhydration.\n4.  Large fecal load within the colon."
        },
        {
            "input": "The partially imaged thyroid is unremarkable.  The esophagus is within normal\nlimits.  There is no hiatus hernia.  The aorta and pulmonary artery are normal\nin caliber.  There is no significant thoracic aortic or coronary artery\ncalcification.  The heart and pericardium are unremarkable.  There is no\npericardial effusion.  There is no mediastinal, axillary, or discernible hilar\nlymphadenopathy.\n\nA small, subcentimeter polypoid density arises from the superior wall of the\nleft mainstem bronchus (series 5, image 121), seen on a background of a mildly\nundulating superior surface of the left main bronchus (series 10, image 35),\nnonspecific but likely airway secretions.  The major airways are patent to\nsubsegmental levels.  Respiratory motion artifact somewhat limits evaluation\nof the lung parenchyma, especially in the lower lobes.  A 2 mm subpleural\nnodule is seen in the peripheral left lower lobe (series 5, image 193). \nOtherwise, the lungs appear clear.  There is no pneumothorax or pleural\neffusion.\n\nThere is mild, multilevel thoracic spine degenerative change.  Alignment is\nnormal.  No concerning focal lytic or sclerotic osseous lesions are\nidentified.\n\nAn ill-defined 8 mm hypodensity in the peripheral right hepatic lobe (series\n5, image 260) is too small to characterize, and suboptimally evaluated on the\ncurrent examination.  Otherwise, the partially imaged solid and hollow viscous\norgans of the upper abdomen are unremarkable.",
            "output": "1. A nonspecific subcentimeter nodular density arising from the superior wall\nof the left mainstem bronchus is likely benign, possibly polypoid secretions.\n2. 2 mm subpleural left lower lobe pulmonary nodule.\n3. 8 mm hypodensity in the right hepatic lobe is too small to characterize.\n\nRECOMMENDATION(S):  Six-month follow-up chest CT to evaluate for stability of\n2 mm left lower lobe pulmonary nodule and to confirm resolution of left\nmainstem bronchus polypoid density."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: A few hypodensities throughout the liver measuring up to\n1 cm are not significantly changed since ___ ___.\n\nMEDIASTINUM:  No mediastinal mass or lymphadenopathy.\n\nHILA:  Evaluation is limited without IV contrast, but is grossly unremarkable.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  4 mm right lower lobe nodule (5:155) is unchanged since ___.  No focal consolidation.\n2. AIRWAYS:  The previously reported polypoid density in the left main\nbronchus and mildly undulating superior surface are no longer seen.  Mild\ncentral bronchial wall thickening is similar to ___.  The airways\nare patent to subsegmental levels.\n3. VESSELS:  The great vessels are normal caliber.\nCHEST CAGE: No concerning lytic or sclerotic lesion.  No acute fracture.  Mild\nmultilevel vertebral body compression deformities are unchanged since ___.",
            "output": "1. The previously reported 2 mm left lower lobe nodule is not seen on this\nexam.\n2. Interval resolution of left main bronchus abnormality which were likely\nsecretions.\n3. 4 mm right lower lobe nodule is unchanged since ___.\n\nRECOMMENDATION(S):\n1. If this patient is a smoker, consider enrollment in lung cancer screening. \nOtherwise, see below.\n2. For incidentally detected single solid pulmonary nodule smaller than 6 mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommend in a high-risk patient.\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  There is no enlarged supraclavicular lymph nodes.  There are no\nenlarged axillary lymph nodes.  CT is not optimal for evaluation of breast\ntissue and dedicated routine mammogram should be performed.  Right IJ central\nline terminates in the lower SVC.\n\nUPPER ABDOMEN: Please see separate report for CT abdomen pelvis for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: None the heart is not enlarged.  There is no\npericardial effusion.  There is no significant coronary artery calcifications.\nPLEURA: There is no pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  A 3 mm pulmonary nodule in the right lower lobe is new since\n___ (302; 0 8).  A 2 mm pulmonary nodule just adjacent (302; 106) is\nunchanged since ___.\n2. AIRWAYS:  Bilateral airways are patent to the subsegmental level.\n3. VESSELS:  The aorta and pulmonary artery appears normal in caliber.  There\nis no significant atherosclerotic calcifications.\nCHEST CAGE: There are no suspicious sclerotic or lytic osseous lesions. \nMild-to-moderate multilevel degenerative changes are noted in the thoracic\nspine with loss of disc space and osteophyte formation.",
            "output": "New 3 mm right lower lobe pulmonary nodule, consider follow-up in 3 months\ngiven suspicion for malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular and no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Few small hypodense lesions in the liver could represent cyst\nor hemangioma, unchanged and detailed in the CT of the abdomen and pelvis\n___.  Stable cystic lesion in the left upper quadrant.  Remaining\nunenhanced included upper abdominal organs are unremarkable.\n\nMEDIASTINUM: There is no mediastinal and no gross hilar lymphadenopathy.\nThe esophagus is mildly patulous, particularly the lower third suggesting\npossible esophageal dysmotility.\n\nHEART and PERICARDIUM: Heart and major vessels are within normal size.  Mild\ncalcifications of the coronaries as well as along thoracic aorta.  Mild\nhypodensity of cardiac chambers relative to the septum suggests mild anemia. \nThere is no pericardial effusion.\n\nPLEURA: Mild biapical pleuroparenchymal fibrosis is stable.  There is no\npleural effusion.\n\nLUNG: Airways are patent to the subsegmental level.\n0.3 cm nodule in the right lower lobe unchanged in comparison to ___ (5:155).  Remaining 0.3 nodule in the right lower lobe and Micronodule in\nthe right upper lobe unchanged since ___ (5:126, 159).  No new lung\nnodules.\n\nCHEST CAGE: A mild multilevel degenerative change of the spine with no\nevidence of osteo-destructive lesions in the sternum, ribs, vertebral bodies.",
            "output": "-Pre-existing small pulmonary nodules are unchanged and there are no new lung\nnodules of consequence.\n-Mildly patulous esophagus suggesting possible esophageal dysmotility.\n\nRECOMMENDATION(S):  Findings do not indicate the need for radiographic\nfollow-up.\n\nHowever, if the patient is ___ years old, has a smoking history of greater\nthan 30 pack-years and has smoked within the past ___ years, the patient meets\ncriteria for annual lung cancer screening with low-dose chest CT, now\navailable at this hospital.  Study can be ordered as a CT, specified as CT LOW\nDOSE LUNG SCREENING (not a routine chest CT) on POE or OMR."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: 9 mm hypodense lesion in the right\nlobe of thyroid unchanged.  No supraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\naortic valve or coronary artery calcifications.  No pericardial effusion. \nLeft-sided prepectoral Port-A-Cath in situ with the tip in the distal SVC.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Multiple pre-existing millimetric nodules unchanged.  No new or\nenlarging pulmonary nodules or masses.  No confluent airspace consolidation. \nPostradiation changes in the subpleural aspect of the right upper lobe\nunchanged.  Nonspecific interstitial thickening seen in the medial aspect of\nthe left upper lobe (6, 57) which shows mild progression compared to previous\nimaging.  Mild interstitial thickening seen in the left lung base unchanged\ncompared to prior imaging.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is not enlarged.  No filling defects.\nCHEST CAGE: No lytic/ destructive bony lesions.",
            "output": "No new or enlarging pulmonary nodules or masses.\n\nThe pre-existing millimetric pulmonary nodules are unchanged.\n\nNonspecific interstitial thickening seen in the medial aspect of the left\nupper lobe which shows mild interval progression.  Although morphologically\nthis raises the concern for lymphangitic spread of cancer, the focal\ndistribution is unusual for breast cancer.  Recommend monitoring of this\nregion at the next scheduled surveillance CT."
        },
        {
            "input": "Previously identified 9 mm nodule in the right thyroid lobe is much smaller\nand now measures 3 mm (5:5).  Axillary, supraclavicular, mediastinal, and\nhilar lymph nodes are not enlarged.  The aorta and pulmonary artery are normal\nin caliber.  No incidental large pulmonary embolism identified.  No\nsignificant atherosclerotic disease is present.  The heart is normal in size. \nThere is no pericardial effusion.\n\nThe airways are patent to the subsegmental level.  There are post radiation\nfibrosis in the subpleural region in the right upper lobe, unchanged. \nBiapical scarring is also unchanged.  The area of interstitial thickening at\nthe medial aspect of the left upper lobe is unchanged.  Scattered pulmonary\nnodules are noted measuring up to 3-4 mm (6:63, 64, 181), are also unchanged\nsince the prior exam.  No new or suspicious pulmonary nodules identified.  No\nlarge consolidation, pleural effusion, or pneumothorax.\n\nPlease refer to separate report on CT abdomen and pelvis performed on the same\nday for discussion of sub- diaphragmatic findings.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  A left chest\nPort-A-Cath terminates in the proximal right atrium.",
            "output": "Millimetric micronodules are unchanged and not concerning for metastases.  No\nevidence of metastatic disease within the chest."
        },
        {
            "input": "The thyroid gland is homogeneous in attenuation without focal nodularity. \nThere is no axillary adenopathy.  A left chest port terminates at or just\nbelow the superior cavoatrial junction.  There is no supraclavicular,\nmediastinal, or hilar adenopathy.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Heart size is normal.  There is no pericardial\neffusion.  There are no appreciable coronary artery calcifications.\n\nThe tracheobronchial tree is patent to the subsegmental level.  Biapical\npleuroparenchymal scarring is symmetric and mild.  Subpleural reticulation in\nthe right upper lobe anteriorly reflects prior image changes.  A calcified\ngranuloma in the right lower lobe is unchanged as expected (6:229). \nMillimetric nodules in the right upper lobe (6:86) and the left upper lobe\n(6:91) remain stable.  There are no new or growing pulmonary nodules.  There\nis no consolidation or mass.  There is no pleural effusion or pleural\nabnormality.\n\nThere are no osseous lesions worrisome for malignancy or infection in the\nchest cage.  Please refer to bone scan performed on the same date for complete\nfindings.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "Millimetric nodules remain stable, not concerning for metastatic disease.  No\nnew or growing pulmonary nodules.  No evidence of active infection or\nmalignancy within the chest.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  A left chest port\nterminates at the cavoatrial junction.\n\nUPPER ABDOMEN: Please refer to separate report for same day CT abdomen pelvis\nfor discussion of findings below the diaphragm.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy is identified.\n\nHILA: No hilar mass or lymphadenopathy is identified.\n\nHEART and PERICARDIUM: Heart size is normal.  The caliber of the thoracic\naorta is within normal limits.  There is no pericardial effusion.  There are\nno appreciable coronary artery calcifications.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: A small calcified granuloma in the right lower lobe is\nunchanged (6:230).  A 3 mm right lower lobe solid nodule is unchanged (6:202).\nA 2 mm right upper lobe nodule is unchanged (6:74).  A 2 mm left upper lobe\nsolid nodule is unchanged (6:77).  No new or enlarging nodules are seen. \nRe-demonstration of mild biapical pleuroparenchymal scarring.  Subpleural\nreticulation in the right upper lobe anteriorly reflects prior radiation\ntreatment (6:121).\n2. AIRWAYS:  Airways are patent to the level of the subsegmental bronchi\nbilaterally.\n3. VESSELS:  The diameter of the main pulmonary artery is within normal\nlimits.  Evaluation of the pulmonary vasculature to the subsegmental level\ndemonstrates no evidence of pulmonary embolism.\nCHEST CAGE: No acute fracture.  No worrisome osseous lesions are identified.",
            "output": "1. No evidence of metastatic disease in the chest.\n2. Unchanged millimetric pulmonary nodules, as described above.  Attention on\nfollow-up surveillance imaging recommended.\n3. Please refer to separate report for same day CT abdomen pelvis for\ndiscussion of findings below the diaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.\n0.5 cm lymph node in the left supraclavicular station is unchanged and not\npathologically enlarged (05:22).  There is no axillary lymphadenopathy.\nExcluding the breast which must be evaluated by mammography there are no\nconcerning soft tissue abnormalities in the chest wall.\nLeft pectoral Port-A-Cath terminates in the right atrium.\n\nUPPER ABDOMEN: Detailed in the concurrent CT of the abdomen and pelvis.\n\nMEDIASTINUM: There is no mediastinal and no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart and major vessels are within normal size.  No\nappreciable atherosclerotic calcifications of the coronaries or major vessels.\nThere is no pericardial effusion.\n\nPLEURA: No pleural effusion.  mild biapical pleuroparenchymal fibrosis, right\ngreater than left is stable.\n\nLUNG: Airways are patent to the subsegmental level.  Heterogeneous\nconsolidations in the left upper lobe, predominantly posterior and apical\nsegments, is associated with ground-glass opacities and interstitial line\nthickening.  In prior studies nonspecific interstitial line thickening was\ndemonstrated in this area.\nNo discrete lung masses identified.\n0.3 cm nodule in the right lower lobe is unchanged since ___ (5:181).\nSubpleural reticulation in the right upper lobe anteriorly reflect\npostradiation changes and is unchanged.\n\nCHEST CAGE: No evidence of osteo-destructive lesions in the ribs, sternum or\nvertebral bodies.",
            "output": "In the left upper lobe new heterogeneous consolidations and interstitial line\nthickening is concerning for malignancy with lymphangitic carcinomatosis,\nalthough infectious and drug reaction remain low in the differential.\n\nRECOMMENDATION(S):  ___ month short follow-up is recommended or evaluation by\nbronchoscopy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nare subcentimeter left supraclavicular lymph nodes which are unchanged ovoid\n(for example 05:28).  There is no axillary lymphadenopathy.  The soft tissues\nof the chest wall are unremarkable.\n\nUPPER ABDOMEN: Limited evaluation of the abdomen abnormalities.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged since the prior.\n\nHILA: There is prominent left hilar nodal tissue, measuring 21.7 x 1.2 cm,\npreviously 1.3 x 1.1 cm (5:111).  Prominent right hilar nodal tissue measuring\nup to 1.1 cm (5:119) is also unchanged.\n\nHEART and PERICARDIUM: .  The heart is normal in size.  Minimal pericardial\nfluid is noted.\nPLEURA: There is no pleural effusion or pneumothorax\nLUNG:\n\n1. PARENCHYMA:  Re-demonstrated is heterogeneous, nodular consolidation in the\nposterior aspect of the apical posterior segment of the left upper lobe,\nprogressed since the most recent prior, with associated, irregular\ninterlobular septal thickening, highly concerning for metastatic disease with\nlymphangitic carcinomatosis.  There is a similar appearance in the middle\nlobe, progressed since the prior study, with minimal, irregular interlobular\nseptal thickening and now, hazy ground-glass opacity (5:188, 172).  Subpleural\nreticulation in the right upper lobe is unchanged since prior examinations,\nand compatible with radiation fibrosis.  Scattered calcified granulomas are\nnoted.  A 3 mm nodule in the right lower lobe (5:185) is unchanged since at\nleast ___.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal in\ncaliber.\nCHEST CAGE: No convincing suspicious osseous lesions or acute fractures are\nidentified",
            "output": "1.  Progression of nodular consolidation in the posterior aspect of the\nposteroapical segment of the left upper lobe with associated irregular\ninterlobular septal thickening is concerning for metastatic disease with\nlymphangitic carcinomatosis.  Further evaluation with bronchoscopy is\nrecommended.\n2.  Irregular interlobular septal thickening in the middle lobe, more\nprominent on the current examination than on the prior, is also concerning for\ndisease involvement.\n\nRECOMMENDATION(S):  Bronchoscopic washings or biopsy to diagnose left upper\nlobe abnormality..\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 11:46 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "BASE OF NECK: The visualized thyroid is unremarkable.  No supraclavicular\nlymphadenopathy is identified.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  Left pectoral infusion catheter is\nvisualized with the catheter tip terminating in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The previously visualized nodular consolidation in the\nposterior aspect of the left upper lobe as well as the interlobular septal\nthickening with associated ground-glass opacities in the right middle lobe\nhave resolved compatible with interval resolution of previous infectious\nprocess.  A 3 mm right lower lung pulmonary nodule is re-demonstrated (6:193)\nin stable in appearance from prior.  No new nodules are identified.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nFor further evaluation of subdiaphragmatic findings please see same day CT\nabdomen pelvis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Interval resolution of previously demonstrated infectious nodular\nconsolidation in the posterior aspect of the left upper lobe and multifocal\ninterlobular septal thickening of the right middle lobe.\n2. No new focal consolidations or pulmonary nodules identified."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient is asymmetrically positioned within the\nscanner.  Left pectoral Port-A-Cath.  No hilar or mediastinal lymphadenopathy.\nNo cardiac abnormalities.  No pericardial effusion.  The posterior mediastinum\nis unremarkable, the upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild bilateral apical scarring.  Stable\nminimal scarring at the lateral aspect of the left upper lobe.  Status post\nradiation of the right breast (3, 92).  Stable 3 mm right lower lobe solid\nnodule (3, 149).  No pleural effusions.  No diffuse lung disease.  No new or\ngrowing nodules.",
            "output": "Stable examination of the thorax without evidence of new or growing nodules. \nNo pleural abnormalities.  The airways are patent.  No adenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in the axilla or\nthoracic inlet.  Left anterior port with tip in the cavoatrial junction.  No\natherosclerotic calcifications in the head and neck arteries.  No\nabnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  The\npulmonary arteries and aorta are normal in caliber throughout.  No\natherosclerotic calcifications in the aorta, cardiac valves or coronary\narteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Nodal tissue in the right hilum, larger than\nprior study, for example series 6, image 142 now measuring 14 x 7 mm and\nseries 6, image 120 now measuring 16 x 13 mm (previously 10 x 6 mm) no\nenlarged mediastinal lymph nodes by CT size criteria..\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nNew irregular interstitial septal thickening, mildly nodular, seen throughout\nboth lungs, is most pronounced in the right upper lobe but .  This is\nassociated with mild peribronchial cuffing and mild ground-glass opacities.\n\nCHEST CAGE:\nOld rib fractures in the left posterior ninth and tenth ribs.  No acute\nfractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "New ground-glass opacities spread throughout both lungs superimposed to\nirregular nodular interstitial septal thickening and peribronchial cuffing,\nassociated with larger nodal tissue in the right hilum, suggestive of\nlymphangitic carcinomatosis of known breast cancer.\n\nNo new suspicious osseous lesions.  Please note that a PET-CT or a bone scan\nare more sensitive for the evaluation of micrometastasis.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 12:12 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No findings in the partially imaged thyroid warrant any\nfurther imaging.  Supraclavicular and axillary lymph nodes are not enlarged. \nBreast evaluation is reserved exclusively for mammography, but there is no\nsoft tissue abnormality elsewhere in the chest wall.\n\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck or coronary arteries.  Central venous\ninfusion catheter ends in the upper right atrium with no associated\nthrombosis.\n\nAorta and pulmonary arteries and cardiac chambers are normal size and\npericardium is physiologic.\n\nTHORACIC LYMPH NODES: Right hilar nodal cluster has decreased in diameter from\n13 to 8 mm.  No lymph nodes in the chest are pathologically enlarged or\ngrowing.\n\nLUNGS, AIRWAYS, PLEURAE: Excessive respiratory motion on the scan precluded\nevaluation of some of the previous subtle pulmonary abnormalities.\n\nFollowing findings are seen on the supplementary scanning performed ___:\n\nLUNGS, AIRWAYS, PLEURAE: Multifocal lung findings have responded variably. \nPreviously extensive multifocal nodulation and septal thickening attributed to\ncarcinomatosis has improved substantially in left upper lobe, both anterior\nand segment, 04:59 and lingula, 4: 4:138, improved modestly in the right\nmiddle lobe, 4:168.\n\nHowever there is a new substantially larger infiltrative lesion in the\napicoposterior segment of the left upper lobe, 8 x 14 mm at the level of its\ngreatest bulk, but infiltrating segmental bronchi just above the left hilum,\n4:69-79.  The central part of the lesion was less radiodense and no more than\n6 x 8 mm in ___.\n\nPleural nodularity anterior segment right upper lobe is stable, 4:95, pattern\nfrequently seen following prior tangential breast radiation.\n\n\n\nCHEST CAGE: No pathologic or compression fracture or large destructive bone\nlesion. Although there are no bone lesions in the imaged chest cage suspicious\nfor malignancy or infection, it should be noted that radionuclide bone and FDG\nPET scanning are more sensitive in detecting early osseous pathology than\nchest CT scanning.",
            "output": "The original scan was incomplete.  The following Impression incorporates\nfindings of both the original and the supplementary scan performed on ___.\n\nPrevious mild lymph node enlargement, right hilum has involuted and all other\nlymph nodes are unremarkable.\n\nInfiltrative nodule, left upper lobe, substantially larger since ___\nprobably metastatic breast carcinoma.\n\nMultiple other foci of micro nodulation and septal infiltration due to\ncarcinomatosis have improved since ___.\n\nStable pleural nodularity, along the anterior segment right upper lobe\nsuggests local prior tangential breast radiation."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  There is a left-sided Port-A-Cath with its tip\nin the SVC.  There is mild skin thickening overlying the right breast.\n\nBREAST AND AXILLA  : The patient has history of known right breast cancer.  No\nobvious breast mass or adenopathy seen\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  2 mm left apical\npulmonary nodule is unchanged.  Previously visualized focal septal thickening\nin the left upper lobe medially has resolved.  There is stable post radiation\nchanges to the anterior aspect of the right upper lobe.  No new pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable post radiation changes to the right breast.\n\nPreviously visualized focal nodular opacity in the left upper lobe has\nresolved.  Stable 2 mm left upper lobe pulmonary nodule.  No new pulmonary\nnodules."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Left pectoral Port-A-Cath.  The breast tissue is of\nstable appearance.  Punctate calcification in the right axillary soft tissues\n(4, 19).  Stable normal appearance of the large mediastinal vessels.  No\nincidental pulmonary embolism.  No coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  15 mm left kidney cyst, not visualized on the previous\nexamination.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.\nMild bilateral apical scarring.  New non characteristic small linea opacity in\nthe left upper lobe (5, 95).  Postradiation changes on the right (5, 108).  No\nother pulmonary nodules or masses.  Stable 2 mm solid left upper lobe nodule\n(5, 61).  No pleural thickening, no pleural effusions.  The airways are\npatent.",
            "output": "New non characteristic small linea opacity in the left upper lobe.  No other\nchanges to the lung parenchyma.  No pleural abnormalities.  No diffuse lung\ndisease.  The airways are patent."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable. \nThere are no supraclavicular or axillary lymphadenopathy.  Soft tissues of the\nchest wall are unremarkable.\n\nUPPER ABDOMEN: Please refer to separately reported same-day CT abdomen pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal adenopathy or masses.  Esophagus is unremarkable.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Left-sided Port-A-Cath\nterminates in the superior cavoatrial junction.  No pericardial effusion. \nThoracic aorta and pulmonary arteries are normal in size and configuration. \nNo significant coronary artery disease.\nPLEURA: No pleural effusion or pneumothorax.  There continues to be nodularity\nalong the anterior aspect of the right pleura, which is likely related to\nradiotherapy changes.\n\nLUNG:\n\n1. PARENCHYMA:  Multifocal bilateral lesions are seen in bronchovascular\ndistribution, with the dominant lesion in the left upper lobe where previously\nthere was a small area of opacity, presents as a complex irregular\npredominantly consolidative centrally with surrounding ill-defined\nground-glass opacity. The consolidative component measures 5.3 x 2.2 cm.  In\nspite of wide contact with the pleura there is no pleural thickening or fluid.\nOther lesions in the left lower lobe (3:142), right lower lobe and right\nmiddle lobe show different degree of similar components.\n2. AIRWAYS:  Airways are patent to subsegmental level, without significant\nbronchiectasis, without mucous plugging or bronchial wall thickening.\nCHEST CAGE: No suspicious bony lesions or acute fractures.",
            "output": "Interval development of multifocal complex lesions in bronchovascular\ndistribution, with a dominant lesion being in the left upper lobe. The\nground-glass opacities surrounding the lesions are likely perifocal reaction. \nThese lesions could represent organizing pneumonia or inflammation related to\ntreatment, less likely infectious process.  The morphology of the changes are\nnot typical of metastatic spread."
        },
        {
            "input": "UPPER ABDOMEN: Please refer to the dedicated CT abdomen pelvis report from the\nsame day for details of intra-abdominal findings.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  No\nsupraclavicular, infraclavicular, or axillary lymphadenopathy.  Minimal\natherosclerotic calcification of the neck and upper thorax large vessels. \nThere is a left pectoral port with the tip terminating at the caval atrial\njunction. Specifically excluding the breasts which require mammography for\nevaluation, there are no soft tissue abnormalities elsewhere in the chest wall\nconcerning for malignancy.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.  Esophagus is normal.\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal size. Coronary arteries are not\ncalcified. No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.  Mild nodularity of the right\nupper posterolateral pleura likely post radiation changes, stable (7:116).\n\n1. PARENCHYMA:  Compared to the most recent study of ___,\nincreased septal thickening with new multifocal areas of ground-glass\nopacification of the right upper lobe.  Previously mentioned complex,\nirregular consolidation with ill-defined peripheral ground-glass opacification\nwithin the left upper lobe is increased in size with the consolidative\ncomponent now measuring 4.4 x 6.0 cm in the largest axial dimension.  New\nright lower lobe complex consolidation with surrounding ground-glass\nopacification and septal thickening measures 2.2 x 3.3 cm.  Prior foci of\nground-glass opacification and septal thickening in the anterior right upper\nlobe is more consolidative and measures 2.2 x 3.7 cm.\n\nUnchanged 2-3 mm right upper lobe solid pulmonary nodule (7:42).  New 2-3 mm\nright upper lobe pulmonary nodule (7:67).\n\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.  Degenerative disease of the vertebral column.\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "1. Large areas of complex consolidation, 2 of which have grown substantially\nwith a new right lower lobe component compared to the most recent study of ___.  The pattern is atypical of malignancy and may represent\ncryptogenic organizing pneumonia or other infectious etiology.  Please see\nrecommendations below\n2. Additional areas of septal thickening and micronodularity consistent with\nmetastatic disease.\n3. Please see the dedicated CT abdomen pelvis from the same day for details of\nintra-abdominal findings.\n\nRECOMMENDATION(S):  Consider bronchoscopy and possible sampling.\n\nNOTIFICATION:  The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 1:52 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  Breast evaluation\nreserved exclusively for mammography.  No soft tissue abnormality elsewhere in\nthe chest wall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent head neck vessels or coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size and the pericardium is physiologic. \nCentral venous infusion catheter ends close to the superior cavoatrial\njunction with no contiguous thrombus.  Relatively low attenuation contents of\nthe right atrium anteriorly, 5:150-170, could be unopacified blood, or chronic\nthrombus accounting for low no more than 10% the volume of the atrium; this\nhas been present to varying degrees on the 4 preceding chest CT scans with\ncontrast.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Septal thickening and local edema in the right apex\nnearly resolved.  Pleural/subpleural nodularity, anterior periphery of the\nanterior segment of the right upper lobe is less pronounced.  Previous large\nregions of mass like consolidation, superior segment right lower lobe, medial\nsegment right middle lobe, and posterior left upper lobe all have nearly\nresolved.  There are no measurable lung nodules elsewhere.  Tracheobronchial\ntree is normal to subsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE: No pathological compression fractures.  Although there are no bone\nlesions in the imaged chest cage suspicious for malignancy or infection, it\nshould be noted that radionuclide bone and FDG PET scanning are more sensitive\nin detecting early osseous pathology than chest CT scanning.",
            "output": "Marked progression of all previous pulmonary abnormalities, including large\nregions of masslike consolidation in 3 lobes, lympho venous engorgement in the\nright lung apex, pleural or subpleural nodularity, right upper lobe.\n\nNo new foci of malignancy or infection.\n\nPossible chronic right atrial thrombus. Echocardiography might be able to\ndiagnose with certainty."
        },
        {
            "input": "A 5 mm hypodense right thyroid lobe nodule is stable. There is no\nsupraclavicular, mediastinal, hilar or axillary lymphadenopathy.\n\nA left chest wall MediPort extends into the right atrium. Heart size is normal\nwith no pericardial effusion.  The main pulmonary artery and thoracic aorta\nare normal caliber.  No incidental pulmonary embolus is identified.\n\nMild septal thickening and scarring in the subpleural regions of the right\nupper lobe anteriorly are unchanged, and presumed related to prior radiation\ntherapy. A few punctate pre-existing pulmonary nodules are stable dating back\nto ___ (6: 87, 91, 216). A punctate calcified right lower lobe\ngranuloma is incidentally noted (6, 247). There is mild residual left lower\nlobe interlobular septal and bronchial wall thickening, which likely represent\nsequelae of prior pneumonia. No new ground-glass opacities or consolidations\nare present to suggest active infection. There is no endobronchial lesion or\npleural effusion.\n\nThe bones are unremarkable.\n\nFor a detailed discussion of the upper abdomen, including a small hiatal\nhernia, please refer to the separate report from the CT abdomen/pelvis\nperformed concurrently.",
            "output": "Several subcentimeter pulmonary nodules are stable dating back to ___, and presumed benign. No new pulmonary nodules identified.\n\nMild right lung radiation fibrosis.\n\nMild left lower lobe septal thickening and bronchial wall thickening likely\nrepresents scarring from prior pneumonia."
        },
        {
            "input": "MEDIASTINUM: There is a stable 7 mm nodule in the right lobe of the thyroid\ngland (05:11).  There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  The aorta and pulmonary arteries are normal in size.   The\nheart size is normal and there is no pericardial effusion. The catheter of a\nleft chest wall infusion port terminates at the cavoatrial junction.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  There several stable millimetric\npulmonary nodules (6:90, 91, 217).  A calcified granuloma in the right lower\nlobe is also unchanged (6:251). There is minimal subpleural radiation fibrosis\nalong the anterior right upper lobe.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "No evidence thoracic metastatic disease."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nBreast evaluation requires mammography. Otherwise soft tissue abnormalities in\nthe chest wall suspicious for malignancy. Findings below the diaphragm will be\nreported separately.\n\nSubcentimeter cyst or nodule in the right lobe of the thyroid gland is\nunchanged and leads since at least ___ and too small to warrant\nfurther evaluation.\n\nLeft subclavian infusion catheter passes as far as the mid SVC, with no\nevidence of associated thrombus, and is obscured beyond that point by contrast\nagent.\n\nAtherosclerotic calcification is not apparent. Aorta and pulmonary arteries\nare normal size. There is no pleural effusion. Tiny pericardial effusion is\nphysiologic.\n\nThere are no lung lesions of concern for malignancy. Mild fibrosis right\nanterior lung suggest prior tangential breast radiation.\n\nTracheobronchial tree is normal to subsegmental levels. There are no bone\nlesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of an intra thoracic malignancy or obvious axillary or chest wall\ntumor recurrence. Mammographic followup is essential."
        },
        {
            "input": "A 6 mm nodule in the right lobe of the thyroid is stable (series 3, image 7). \nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nVery small mediastinal lymph nodes along the AP window and right lower\nparatracheal stations are unchanged.  A left chest port is present with tip\nterminating in the right atrium.  Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification. There is no pericardial effusion.\n\nAirways are patent to subsegmental levels bilaterally.  A 3 mm nodule in the\nleft upper lobe is stable since ___ (series 5, image 68).  Subpleural\nopacity in the right upper lobe anteriorly is stable and likely represents\npostradiation changes.  Incidental note is made of a calcified granuloma in\nthe right lower lobe (series 5, image 224).  There is no pleural effusion or\npneumothorax.\n\nPlease refer to concurrent CT abdomen pelvis report for discussion of findings\nin the upper abdomen.  There is no lytic or blastic osseous lesions suspicious\nfor malignancy or infection.",
            "output": "3 mm nodule in the left upper lobe, stable since ___. Attention on\nroutine oncologic follow-up is recommended."
        },
        {
            "input": "5 mm hypodense lesion in the right lobe of the thyroid is a stable. .\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.  Subpleural 2 mm nodule in\nthe left upper lobe is unchanged (5:92).  Minimal interstitial subpleural\nirregularity in the right upper lobe is consistent with postradiation changes.\nOtherwise the lungs are clear.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in enhancement and diameter.  No\nmediastinal, hilar or axillary lymphadenopathy is present.  Heart size is\nnormal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\npostradiation changes in subpleural location, series 6, image 108 are stable. \nNo pulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\nwithin the chest.",
            "output": "No interval development of metastatic disease in the chest.\n\nStable appearance of previously demonstrated thyroid nodule, 2 mm nodule in\nthe left upper lobe and postradiation changes in the left upper lobe in\nsubpleural location."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nRight base of neck 0.5 cm lymph node is not pathologically enlarged and\nunchanged (05:15) and there is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Reported separately in the same day MRI of the liver.\n\nMEDIASTINUM: Pre-vascular lymph node measuring up to 0.7 cm is unchanged in\ncomparison prior with no mediastinal or hilar lymphadenopathy.\n 0.8 cm epicardial lymph nodes and remeasured 1.0 cm retrocrural lymph node\nare unchanged.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nModerate calcifications of the coronaries.\nMajor vessels within normal size.\nNo evidence of incidental central pulmonary emboli.\n\nLUNG and PLEURA: Major airways are patent.\nMinimal to moderate centrilobular emphysema affecting predominantly the right\nupper lobe.\n\nNew right lower lobe subpleural 0.5 cm nodule (5:191).\n\nUnchanged micro nodules, part of them calcified (5:223, 222, 197, 167).\nThere is no pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "Small right lower lobe lung nodule is new.  Remaining micro nodules and\nseveral borderline mediastinal lymph nodes are unchanged.\n\nRECOMMENDATION(S):  Follow-up in 6 months is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is with small unchanged\nhypodensities, of insufficient size to warrant further imaging.\n0.6 cm right supraclavicular lymph node is stable (05:31).  There is no\naxillary pathologic enlargement of lymph nodes.\n\nCHEST CAGE: Mild multilevel spondylosis, there is no evidence of lytic ro\nsclerotic osteo-destructive lesions in the chest cage.\n\nUPPER ABDOMEN: Partially imaged large ill-defined heterogeneous intrahepatic\nmass involving both lobes as well as the hila area, better evaluated on ___ MRI of the liver.\n\nMEDIASTINUM: Para-aortic lymph nodes up to 1.1 cm are stable (5:247, 258).  9\ncm lymph node caudal to the left inferior pulmonary vein is stable (5:95). \nSubcarinal lymph node up to 1 cm and few pericardial lymph nodes are stable as\nwell (05:38).\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  Dense calcifications are predominantly of the left coronaries. \nThoracic aorta is normal in diameter.  Suboptimal pulmonary vasculature\nopacification reveal no central filling defects.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  Minimal\ncentrilobular emphysema is worse in the right upper lobe.\nRight lower lobe subpleural nodule is smaller since prior, measuring 0.2 cm\n(5:115), in prior 0.5 cm. Right upper lobe 0.4 cm nodule is stable (5:177).",
            "output": "Right lower lobe subpleural pulmonary nodule is smaller, likely intrapulmonary\nlymph node or mild atelectasis.\nRemaining 0.4 cm right upper lobe nodule and posterior mediastinal\nlymphadenopathy is stable."
        },
        {
            "input": "The thyroid is not visualized.  . Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged.  Mediastinal lymph nodes measure up to 7\nmm in the right upper paratracheal station, 9 mm in the subcarinal station and\n7 mm in the AP window\nThe ascending aorta measures 3.4 cm in maximum diameter has moderate amount of\ncalcification.  There is dense calcifications in the aortic arch and moderate\nto dense calcifications throughout the descending thoracic aorta.  The aortic\nvalve is densely calcified.  There is dense calcification in all coronary\narteries.  The main pulmonary artery is enlarged measures 3.3 cm\nThere is no pleural or pericardial effusion\nThere are innumerable scattered tiny calcified granulomas.  Multifocal areas\nof ground-glass opacities associated with interlobular septal thickening in\nthe upper lobes suggests mild interstitial pulmonary edema.  There are\nscattered soft tissue micro nodules, could represent noncalcified granulomas. \nBilateral perifissural nodule likely correspond to an intrapulmonary lymph\nnodes (4:152, 104).  Bibasilar atelectasis are larger on the left.  There are\nmultiple impacted bronchi in the lower lobes.  Irregular peribronchial\nopacities in the right middle lobe could be infectious in etiology.  There is\ndiffuse bronchial wall thickening mainly in the lower lobes.  There is mild\nparaseptal emphysema in the upper lobes.\nThis examination is not tailored for subdiaphragmatic evaluation, a nodule in\nthe left adrenal gland represents an adenoma given the density.  There is\ndiverticulosis without evidence of acute diverticulitis.  There is a small\nhiatal hernia\nThere are no bone findings of malignancy.  There are several healed rib\nfractures",
            "output": "Right middle lobe peribronchial opacities could be infectious in etiology\nMild interstitial pulmonary.\nCoronary calcifications\nDense calcification of the aortic valve\nCalcifications through the thoracic aorta\nEnlargement of the pulmonary artery suggests the presence of pulmonary\nhypertension\nLeft adrenal adenoma\nDiverticulosis without evidence of acute diverticulitis\nEvidence of prior granulomatous infection\nEmphysema"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is trace pericardial effusion.  The heart is normal in size.  Small\nbilateral, left greater than right, non hemorrhagic pleural effusions are\nnoted.\n\nLeft upper lobe and bilateral lower lobe perihilar patchy ground-glass\nopacities are present.  There is a 0.8 cm left lower lobe pulmonary nodule\n(2:67) as well as a 0.9 cm left lower lobe ground-glass nodule is noted (2:61)\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild pulmonary edema with small bilateral pleural effusions, trace\npericardial effusion and patchy bilateral ground-glass opacities.\n3. 0.9 and 0.8 cm left lower lobe pulmonary nodules are likely inflammatory.\n\nRECOMMENDATION(S):  Consider short interval follow-up CT chest in 3 months to\nassess for resolution of pulmonary nodules."
        },
        {
            "input": "Left IJ ___ catheter is in place, the tip terminates within the distal\nright pulmonary artery.\n\nThere is a left chest wall dual lead pacemaker, tips terminate in the right\natrium and right ventricle.\n\nStatus post CABG.  Prosthetic aortic valve is noted.  There is heavy coronary\nartery calcifications.  Heart is enlarged.  Enlarged right atrium, right\nventricle, reflux of contrast into the distended IVC, hepatic veins,\nconsistent with cardiac dysfunction.  Main pulmonary artery diameter is 3.4\ncm, consistent with pulmonary artery hypertension.\n\nThe aorta is of normal caliber without evidence of aneurysm.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.  The left atrium is enlarged.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Severe coronary artery\ncalcification is noted.  There are small bilateral pleural effusions.  There\nis mild bibasilar atelectasis with dependent changes at the lung bases lung\nbases.\n\n The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is\nidentified.Diffuse osteopenia.  There are degenerative changes of the thoracic\nspine.  There are sternotomy wires in place.  Incompletely evaluated are\nbilateral shoulder arthroplasties.\n\nRight superior pulmonary vein ostium at the left atrium measures 1.7 cm\nRight inferior pulmonary vein ostium at the left atrium measures 1.3 cm\nLeft superior pulmonary vein ostium at the left atrium measures 1.4 cm\nLeft inferior pulmonary vein ostium measures 1.5 cm",
            "output": "Pulmonary vein calibers as described above.\n\nThere are small bilateral pleural effusions with bibasilar atelectasis,\npneumonitis unlikely.\n\nCardiac enlargement, with enlarged right heart, suggestion of pulmonary artery\nhypertension, and reflux of contrast into distended IVC, hepatic veins."
        },
        {
            "input": "NECK: Thyroid gland is unremarkable.  No supraclavicular adenopathy.\n\nCHEST:\nAIRWAYS: Major airways are clear with no endotracheal or endobronchial\nlesions.\n\nMEDIASTINUM: There is marked arterial calcifications.  There is no\ncardiomegaly or pericardial effusion.  There is no acute aortic syndrome. \nProximal pulmonary arteries are patent.  There is no mediastinal or hilar\nadenopathy.\n\nLUNGS: There are minimal basal atelectatic changes.  There is no pulmonary\ncontusion or consolidation.  There are no suspicious pulmonary masses.  There\nare scattered areas of tree in ___ opacities, likely secondary to chronic\nairway disease.\n\nPLEURA: There is no pleural effusion, pneumothorax.  There are scattered\ncalcified pleural plaques.\n\n\nABDOMEN:\nHEPATOBILIARY: There is homogeneous hepatic enhancement.  There are no\nsuspicious masses.  Gallbladder appears unremarkable.\n\nPANCREAS: There is a 1.3 cm simple-appearing pancreatic body cystic lesion,\nlikely representing a side-branch IPMN.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS:   Adrenal glands appear unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis.  There are renal\ncortical hypodensities, likely representing cysts.  There is a right\ninterpolar renal cortical scar.\n\nGASTROINTESTINAL: There is no bowel obstruction.  Stomach appears under\ndistended.  Extensive sigmoid diverticulosis with diffuse sigmoid colonic wall\nthickening, may represent sequela of chronic fibromuscular hyperplasia related\nto chronic diverticulitis.  However with the mild fat stranding acute\ndiverticulitis can't be excluded.\n\nPERITONEUM: There is no free air or free fluid.  There is no peritoneal\nstranding.\n\nLYMPH NODES: There are no abdominal pelvic lymph nodes.\n\nVASCULAR: The infrarenal abdominal aorta is mildly aneurysmal.  Otherwise,\nintra-abdominal branches are patent.\n\nPELVIS: Bladder is distended, appears otherwise unremarkable.  Prostate gland\nis enlarged.  There is moderate amount of rectal stool.\n\nBONES:There is diffuse osteopenia.  However, there are no definite acute\nfractures identified.  S-shaped scoliotic curvature of the distal\nthoracolumbar spine with extensive degenerative changes.  There is a mid\nthoracic compression deformity that is likely chronic.  There is grade 1\nanterolisthesis of L4 on L5 and grade 1 retrolisthesis of L3 on L4 with severe\ndegenerative changes.\n\nSOFT TISSUES: Soft tissues are unremarkable.",
            "output": "1. No acute intrathoracic, intra-abdominal or intrapelvic abnormalities.\n2. There is a mid thoracic compression deformity probably of chronic nature,\nhowever recommend palpation for focal area of tenderness to exclude the acute\nfracture given the absence of priors.\n3. Changes of a likely resolving/chronic diverticulitis.  However, with the\nmild fat stranding acute diverticulitis can't be entirely excluded."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  However, borderline sized lymph nodes are seen in\nboth the left and the right axillary region.  The large mediastinal vessels\nappear unremarkable.  There is a persistent left superior vena cava as an\nanatomic variant.  No hilar or mediastinal lymphadenopathy.  Moderate\ndilatation of the main pulmonary artery.  Moderate coronary calcifications, no\nincidental pulmonary embolism.  No pericardial effusion.  Small hiatal hernia.\nNo acute abnormalities are noted in the upper abdomen.  No osteolytic lesions\nat the level of the ribs, the sternum, or the vertebral bodies.  Wedge-shaped\ndeformity of a single vertebral body (8, 60).  Moderate scoliosis.  Calcified\nright apical granuloma (5, 36).  Calcified millimetric right lower lobe nodule\n(5, 238).  2 mm right perifissural nodule (5, 177).  Several millimetric\nsubpleural pulmonary nodules.  None of which is suspicious in size and\nmorphology.  Mild dilatation of the airways.  No diffuse lung disease.  No\nsuspicious lung lesions or masses.  No pleural thickening, no pleural\neffusions.",
            "output": "No evidence of suspicious, malignant, or chronic infectious disease in the\nthorax."
        },
        {
            "input": "The partially imaged thyroid gland is enlarged but demonstrates homogeneous\nenhancement, better evaluated on prior thyroid ultrasound.  The esophagus is\nwithin normal limits.  There is no hiatus hernia.  The aorta and pulmonary\nartery are normal in caliber.  Major aortic arch branches are widely patent\nand unremarkable.  There is no significant thoracic aortic or coronary artery\ncalcification.  The heart and pericardium are unremarkable.  There is no\npericardial effusion.  Minimal anterior mediastinal soft tissue likely relates\nto residual thymus.  There is no mediastinal, hilar, or axillary\nlymphadenopathy.\n\nMajor airways are patent to subsegmental levels.  A left upper lobe subpleural\n2 mm nodule is noted (series 6, image 60).  There is a 3 mm nodule at the left\nlung apex (series 6, image 24).  Streaky opacities at the lung bases are\nconsistent with atelectasis.  Otherwise, aside from respiratory motion\nartifact at the lung bases which obscures evaluation for small nodules, the\nlungs are clear.  There is no pleural or pericardial effusion.\n\nThe imaged subcutaneous soft tissues of the chest wall are unremarkable.  The\nimaged thoracolumbar vertebral bodies are normally aligned.  Vertebral body\nheights are preserved.  No concerning focal lytic or sclerotic osseous lesions\nare identified.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Incidentally noted left upper lobe pulmonary nodules measuring up to 3 mm. \nIf patient has high risk features, recommend followup in 12 months to ensure\nstability.  If no risk factors, no followup indicated.\n3. Enlarged thyroid gland without discrete nodule.\n4. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis.\n\nRECOMMENDATION(S):  The ___ society pulmonary nodule recommendations\nare intended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneous.  No\naxillary or supraclavicular lymphadenopathy.  Mild atherosclerotic\ncalcification of the aortic arch and head and neck vessels.\n\nUPPER ABDOMEN: The right kidney contains a few simple cysts.  Otherwise, apart\nfrom atherosclerotic calcification of the aorta, imaged portions of the upper\nabdomen are unremarkable.\n\nMEDIASTINUM: No lymphadenopathy or mass.\n\nHILA:   No lymphadenopathy.\n\nHEART and PERICARDIUM: The ascending aorta is ectatic, measuring 4.3 cm,\nunchanged from ___.  Heart size is normal.  No pericardial\neffusion.  Few punctate left intraventricular calcifications.  There is\nmoderate atherosclerotic calcification of the coronary arteries.  Probable\ninterval increase in moderate aortic valvular calcification.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  0.2 cm nodule in the right lower lobe (___).  0.2 cm nodule\nin the left lower lobe (___).  Otherwise, lungs are clear.  No CT findings\nto explain 2.4 cm rounded opacity on prior chest radiograph.  1.5 cm focus of\nground-glass opacity in the right upper lobe, likely postinflammatory (___).\n2. AIRWAYS:  Interval increase in moderate, diffuse bronchial wall thickening,\nlikely representing chronic airways disease.\n3. VESSELS:  The main pulmonary artery is mildly enlarged, measuring 3.3 cm. \nNo evidence of pulmonary embolism on this noncontrast study\nCHEST CAGE: No suspect osseous lesions.  No fractures.  Moderate multilevel\ndegenerative changes of the imaged spine and at the rib -sternum interfaces,\nworst at the anterior right first rib, corresponding to the abnormality seen\non chest radiograph.",
            "output": "1. No evidence of lung parenchymal finding to explain chest radiograph\nabnormality.\n2. Moderate multilevel degenerative changes of the imaged spine and at the rib\n-sternum interfaces, worst at the anterior right first rib, corresponding to\nthe abnormality seen on chest radiograph.\n3. The main pulmonary artery is mildly enlarged, which can be seen in patients\nwith pulmonary arterial hypertension.\n4. Compared to ___, unchanged ectasia of the ascending aorta,\nmeasuring 4.3 cm.\n5. Probable interval increase in moderate aortic valvular calcification. \nConsider clinical evaluation.\n6. Two 0.2 cm nodules in the right lower lobe and left lower lobe,\nrespectively.  No follow-up is required in nodules of this size.\n\nRECOMMENDATION(S):  Consider clinical evaluation of interval increase in\nmoderate aortic valvular calcification.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:28 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet.  Right anterior port with tip in the cavoatrial junction. \nMild atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is enlarged with a dilated left atrium.  No pericardial effusion. \nStents are noted in the LAD and circumflex arteries.  Mild atherosclerotic\ncalcifications in the coronary arteries and aorta, none in the cardiac valves.\nThe aorta is normal in caliber throughout.  The main pulmonary artery is\nmildly enlarged measuring 3.3 cm.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Borderline\nenlarged mediastinal and hilar lymph nodes, for example in the right lower\nparatracheal station measuring 1.4 cm in short axis diameter (4:124).\n\nPLEURA:\nModerate bilateral pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation. The\nairways are patent to the subsegmental levels.  Compressive atelectasis is\nnoted in both lower lobes.  Interlobular septal thickening associated with\nsuperimposed ground-glass opacities.  Coarse calcified granulomas are noted in\nboth lower lobes, the largest in the right lung base (4:243).  There is no\nlarge suspicious lung nodules or masses.  Possible mild subpleural fibrosis\nalthough difficult to evaluate as the study is deteriorated by respiratory\nmotion artifacts.\n\nCHEST CAGE:\nNo acute fractures.  Compression deformities are noted in T7 through T9.  Mild\ndorsal spondylosis. No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show coarse calcification is noted\nin the left hepatic lobe (4:62), likely sequela of prior granulomatous disease\nexposure.",
            "output": "Moderate bilateral pleural effusions associated to mild pulmonary edema.\nPossible mild peripheral fibrosis.  If there is clinical concern recommend non\nurgent elective chest CT evaluation.\n Ectasia of the main pulmonary artery which may be related to pulmonary\nhypertension.  If there is clinical concern for such, consider correlation\nwith an echocardiogram."
        },
        {
            "input": "Diagnostic evaluation is limited due to motion related to respiration.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is limited evaluation of the distal segmental and subsegmental pulmonary\narteries due to motion.  There is no evidence of filling defects within the\npulmonary arteries to the proximal segmental level to suggest a pulmonary\nembolism.  The main and right pulmonary arteries are normal in caliber, and\nthere is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nA right lower paratracheal lymph node measuring 5 mm across shortest diameter\n(02:44) is not pathologically enlarged by CT size criteria.  The thyroid\nappears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild centrilobular emphysema.  There is consolidation and\nground-glass change in the inferior aspect of the left upper lower lobe\n(02:50).  There are 2 other smaller areas  of consolidation in the left lower\nlobe (2:84, 90).   There is mild bronchial wall thickening diffusely.\n\nLimited images of the upper abdomen are unremarkable.\n\nThere is a compression deformity of the T6 vertebral body (602b:29) without\nassociated prevertebral soft tissue thickening nor fracture line identified. \nDextroscoliosis of the thoracolumbar spine is noted.",
            "output": "1.  Multiple consolidations involving the left upper and left lower lobes\ncompatible with multifocal pneumonia.\n\n2.  Diffuse bronchial wall thickening likely representing inflammation it may\nbe compatible with bronchitis.\n\n3.  Limited due to patient motion but there is no evidence of central\npulmonary embolism.\n\n4.  T6 vertebral body compression deformity without associated prevertebral\nsoft tissue thickening likely representing a chronic compression fracture"
        },
        {
            "input": "CHEST PERIMETER: The visualized portion of the thyroid is unremarkable.  There\nis no supraclavicular or infraclavicular lymphadenopathy. The thoracic inlet\nis normal in appearance.  No axillary lymphadenopathy.  No soft tissue lesions\nidentified.  Please refer to separate report of CT abdomen and pelvis\nperformed on the same day for description of intra-abdominal findings\n\nCARDIO-MEDIASTINUM: Heart size is normal.  There is no pericardial effusion. \nThe thoracic aorta is normal in caliber.  There is mild calcification of the\nthoracic aorta.  The main pulmonary artery is normal in caliber.  There is no\ncentral filling defect.\n\nTHORACIC LYMPH NODES: No mediastinal or hilar lymphadenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: There is mild subsegmental atelectasis of the left\nlower lobe.  Otherwise, the lungs are well expanded and clear.  Several\npulmonary nodules are noted, including two adjacent 2 mm nodules in the mid\nright lower lobe (series 305: Image 121), unchanged.  A 2 mm nodule in the\nleft lower lobe (series 305: Image 90), unchanged.  There is a 5 mm nodule\nalong the left major fissure (series 305: Image 115), unchanged.  This likely\nrepresents fissural pleural thickening or a lymphoid aggregate.  No measurable\nnew or enlarging nodules.  The airways are patent to the subsegmental level\nbilaterally.  No pleural effusion.  No pneumothorax.\n\nCHEST CAGE: No evidence of suspicious lytic or sclerotic lesion.  Mild\ndegenerative changes throughout the thoracic spine are unchanged.",
            "output": "1. No definitive evidence of malignancy within the thorax.\n2. No measurable new or enlarging nodules.\n3. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for intra-abdominal findings."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation.  No\nsupraclavicular or axillary lymph node enlargement.  Breast evaluation\nreserved exclusively for breast imaging.  No soft tissue abnormality elsewhere\nin the chest wall.  Abdomen will be evaluated by dedicated MRI performed today\nand reported separately.\n\nCARDIO-MEDIASTINUM: The the appearance of the gastroesophageal junction is\nbulky, as before, but ___ have not changed, 22 mm in transverse\ndiameter today, 3:81 end 21 mm in ___.  Stomach was described as\nunremarkable on MR ___.  Esophagus is unremarkable.  Atherosclerotic\ncalcification is not apparent in the head neck vessels or in the coronary\narteries.  Aorta and pulmonary arteries are normal size, aortic valve is not\ncalcified and there is no pericardial abnormality.\n\nBed of the right pectoral infusion port reservoir is unremarkable and the\ncatheter ends low in the right atrium with no associated thrombus.\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\n\nLUNGS, AIRWAYS, PLEURAE: 2 x 4 mm nodule, right upper lobe, 5:101 may have\ngrown slightly since ___, 305:91.\n\nPunctate fissural thickening or sub fissural nodule, right lower lobe, 5:153\nunchanged.\n\nSub 3 mm nodule, right lower lobe, 5:165 unchanged\n\nNodular fissural thickening or subpleural nodule, right middle lobe, 5:207\nunchanged.\n\nPunctate nodule, left upper lobe, 5:109 unchanged.\n\n4 x 6 mm pleural nodule or subpleural left upper lobe nodule, slightly larger\ntoday than in ___.\n\nLungs otherwise clear, tracheobronchial tree is normal to subsegmental levels\nand there are no other pleural abnormalities.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No good evidence for actively growing metastases.  The hand full of tiny lung\nor pleural nodules not reliably changed since ___ are\nindeterminate.  The need for followup imaging depends on staging and\nmanagement considerations regarding the patient's extrathoracic malignancy. \nOtherwise ___ guidelines for management of incidentally discovered\npulmonary nodules would apply.  See RECOMMENDATIONS below.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Normal partially imaged thyroid\ngland. No enlarged or growing supraclavicular or axillary lymph nodes.  There\nis a right-sided chest port, with the tip in the right ventricle.  Breast\nassessment is reserved for dedicated breast imaging.  Excluding the breasts,\nno soft tissue chest wall abnormality. No atherosclerotic calcification of the\nimaged neck arteries.\n\nUPPER ABDOMEN: This examination is not tailored for subdiaphragmatic\nassessment.  Allowing for this; the patient is status post cholangiocarcinoma\nresection.  Stable postsurgical changes.  The liver is better assessed on the\nmost recent liver MR dated ___.  Splenomegaly, measuring up to 12.9\ncm, unchanged.  Bulky appearance at the gastroesophageal junction, measuring\n23 mm in diameter, unchanged compared with the ___ CT.  Mild\natherosclerotic calcification of the imaged upper abdominal vessels.  There is\nmild atherosclerotic calcification of the imaged upper abdominal vessels.\n\nMEDIASTINUM: Normal esophagus.  No enlarged or growing mediastinal lymph\nnodes.  No mediastinal mass.  The thoracic aorta and pulmonary arteries are\nnormal in caliber.  No atherosclerotic calcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size. No coronary artery or cardiac valve\ncalcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax. Mild biapical pleuroparenchymal\nscarring, stable.\n\nLUNG:\n\n1. PARENCHYMA: 3 mm peripheral subpleural right lower lobe nodule (5:151),\nstable.  5 mm subpleural right lower lobe nodule (5:221), stable.  Focal\n___ nodularity peripherally in the right upper lobe (5:121), slightly\nincreased compared with prior.  Change nodularity along the left major\nfissure, with nodules measuring up to 6 mm (5:137).  3 mm right lower lobe\nnodule (5:175), stable.  No new or enlarging lung nodule or mass.  Mild\ndiffuse mosaic attenuation of the lung parenchyma, likely representing\nmultifocal air trapping secondary to small airways disease.  No consolidation.\n2. AIRWAYS: Unchanged mucus plugging in a subsegmental right upper lobe\nbronchus (5:114).  The tracheobronchial tree is otherwise patent to the\nsubsegmental level.  No bronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  No fracture.  Mild spondylosis.  Stable mild dextroscoliosis of\nthe lower thoracic spine.",
            "output": "-No good evidence of intrathoracic malignancy.  Stable pulmonary nodules\nmeasuring up to 6 mm.  Slight increase in the focal ___ nodularity in\nthe right upper lobe, likely infective or inflammatory in etiology.\n-Mild diffuse mosaic attenuation of the lung parenchyma, likely representing\nmultifocal air trapping secondary to small airways disease.\n-Status post cholangiocarcinoma resection.  Stable postsurgical changes.\n-Splenomegaly, measuring up to 12.9 cm, unchanged.\n-Unchanged bulky appearance at the gastroesophageal junction, measuring 23 mm\nin diameter.\n\n\n\nRECOMMENDATIONS:\n\n The need for followup imaging depends on staging and management\nconsiderations regarding the patient's extrathoracic malignancy.  Otherwise\n___ guidelines for management of incidentally discovered pulmonary\nnodules would apply.  See RECOMMENDATIONS below.\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL\n\nAxial lymph nodes are not pathologically enlarged by CT size criteria. \nRight-sided Port-A-Cath terminates in the right atrium.\n\nThere is a left lateral approach catheter which terminates in the left-sided\nhydropneumothorax.  There is subcutaneous emphysema along the catheter tract\nin the left side of the chest.\n\nUPPER ABDOMEN: There are probable accessory spleens in the left upper quadrant\nand both adrenal glands are grossly unremarkable.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged and\nunchanged as compared to outside hospital CTA chest ___.\n\nHILA: Limited without intravenous contrast but conglomerate left hilar\nlymphadenopathy is decreased in size as compared to PET-CT ___.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is a moderate\npericardial effusion which is unchanged in size as compared to outside\nhospital chest CT ___.\n\nPLEURA: There is a moderate left-sided hydropneumothorax, decreased in size as\ncompared to ___.  Left lateral approach catheter terminates within\nthis pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: There is severe emphysema.  Ill-defined mass in the left upper\nlobe is decreased in size from ___.  Multiple ground-glass nodules\nmeasuring up to 9 mm in right upper lobe (4:49, 112, 122, and 124) are\nunchanged dating back to ___. 3 mm nodule in the right middle lobe\n(4:166) was not visualized in ___.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal in\ncaliber.\nCHEST CAGE: There is severe degenerative changes at T6-T7 with loss of height\nof the superior endplate of T7, unchanged as compared to ___.",
            "output": "1. Moderate left-sided hydropneumothorax is decreased in size from outside\nhospital CTA chest ___.  Left lateral approach chest tube\nterminates within this hydropneumothorax.\n2. Multiple nodules measuring up to 9 mm in the right upper lobe are grossly\nunchanged dating back to PET-CT ___, when accounting for\ndifferences in technique between studies.\n3. Moderate pericardial effusion is unchanged from ___."
        },
        {
            "input": "THORACIC INLET: There are stable postsurgical changes post resection of part\nof the right lobe of thyroid.  Right-sided Port-A-Cath tip projects to the\nright atrium.\n\nBREAST AND AXILLA  : There are no enlarged supraclavicular lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  There is a stable\nsmall pericardial effusion.  The left hilar consolidative opacity representing\npost radiation changes is again noted.  Unenhanced aorta and pulmonary\narteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion.  There is minimal subsegmental\natelectasis in the left lung base.  There is a moderate-sized left\npneumothorax.  A new left-sided chest tube has been placed in the interim\nwhich extends anteriorly, the tip terminating along the mediastinal surface of\nthe pleura (2, 22).\n\nLUNG: The consolidative opacity in the left perihilar region is unchanged. \nThere is evidence of subsegmental atelectasis in the left lung base.  The\nsecond a pleural based mass in the left upper lobe abutting the ribs\nposteriorly (2, a 15) is also unchanged.  There is moderate upper lobe\npredominant emphysema.  The right middle lobe pulmonary nodule measuring 11 mm\nis unchanged.  Another 4 mm nodule in the right middle lobe is also unchanged.\nMinimal subsegmental atelectasis in the right lung base.  Airway valves are\nseen within the segmental bronchi in the left upper lobe.  There is a small\npleural effusion with high-density material layering posteriorly.\n\nBONES AND CHEST WALL : Review of bones shows stable sclerotic appearance of\nthe posterior aspect of the second and third and fourth ribs on the left.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a left adrenal\nnodule.",
            "output": "Stable post radiation changes to the left perihilar region.  No significant\ninterval change in the moderate-sized left pneumothorax.\n\nSmall left pleural effusion with high-density material within it along the\nposterior aspect which could be related to pleurodesis.\n\nSmall pericardial effusion is unchanged.\n\nAll the previously visualized pulmonary nodules on the right are also\nunchanged.\n\nLeft-sided chest tube projects close to the left hilar region.\n\nThe soft tissue mass seen posteriorly in the left upper lobe abutting the ribs\nis also unchanged.\n\nStable mottled appearance of several ribs on the left.\n\nAirway valves seen within the segmental bronchi of the left upper lobe.\n\nLeft adrenal nodule."
        },
        {
            "input": "Aorta and pulmonary arteries are partially imaged due to lack of IV contrast\nbut the main pulmonary arteries substantially distended up to 4 cm concerning\nfor pulmonary hypertension.  Coronary calcifications are extensive. There is\nno pericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are present, series 4, images 47, 131 condyloma 152, 180, the largest\n1, 7 mm, series 4, image 217.  Nodules are noncalcified and solid.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Dilated main pulmonary artery concerning for pulmonary hypertension.\n\nSeveral pulmonary nodules as described.\n  For incidentally detected multiple solid pulmonary nodules measuring 6 to\n8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk patient,\nwith an optional CT follow-up in 18 to 24 months. In a high-risk patient, both\na CT follow-up in 3 to 6 months and in 18 to 24 months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Mild diverticulosis of splenic and hepatic flexures, no signs\nof inflammation.\nIn the left kidney, large parapelvic cyst is partially imaged, better\nevaluated by renal ultrasound of ___.\nRemaining included upper abdominal organs are unremarkable.\n\nMEDIASTINUM: Sub cm, not pathologically enlarged lymph node in the\nmediastinum, unchanged.\nThere is no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly.\nCoronary calcifications are extensive with stent in the LAD.\nMain pulmonary artery within normal size, 2.6 cm (672: 81), right main\npulmonary artery mildly dilated, 3.4  Cm.\nSpeck of calcifications along the normal caliber thoracic aorta.\n\nPLEURA: No pleural thickening or effusion.\n\nLUNG: Mild biapical pleural parenchymal fibrosis is unchanged.\nFew bilateral lung nodules are again demonstrated, unchanged, for example the\nlarger left lower lobe subpleural 0.7 cm (4: 200).\n0.4 mm nodule in the right middle lobe and 0.7 cm in the right lower lobe also\nunchanged (4:181, 133).\nNo new lung nodules or masses.\n\nCHEST CAGE: Degenerative changes and increased kyphosis with prominent\nosteophytes of mid thoracic vertebra.",
            "output": "Several subcentimeter pulmonary nodules unchanged since ___.\n\nRECOMMENDATION(S):  CT follow up in ___ year is recommended."
        },
        {
            "input": "CTA:  The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary trunk is top normal in\nsize.\n\nCT CHEST:  There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  The thyroid gland appears unremarkable.  Heart size is\nnormal.  Coronary artery calcifications are moderate.  There is no pericardial\neffusion.\n\nThe airways are patent to the segmental level bilaterally.  There bibasilar\nenhancing airspace opacities which are most consistent with atelectasis. \nThere is no pleural effusion, pneumothorax, or pneumomediastinum.\n\nThe thoracic esophagus is unremarkable.  Views of the upper abdomen\ndemonstrate trace perihepatic ascites.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.",
            "output": "1. No evidence of pulmonary embolism or acute aortic syndrome.\n2. Bibasilar enhancing airspace opacities, most consistent with atelectasis.\n3. Trace perihepatic ascites."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy or\ninfection.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head and neck vessels, but\nlarge calcified plaques are seen in all major coronary branches.  Aorta and\npulmonary arteries are normal size.  Pericardium is physiologic.  There is no\npleural abnormality.\n\nMeasurable central lymph nodes are numerous, but none is pathologically\nenlarged or bigger today than in ___.\n\nLungs:\n\nLinear scarring or subsegmental atelectasis in the right middle lobe is new. \nWidespread, mild bronchial wall thickening is most pronounced in the middle\nlobe.  Mild peripheral ground-glass opacification in the right upper lobe and\nmild centrilobular ground-glass opacification in the mid and upper lung zones\nare both unchanged since ___, not an indication of an active pulmonary\nabnormality.  Larger areas of peripheral ground-glass opacification have\nappeared at the lung bases.  Their clinical significance depends upon\npertinent history, but could be due to recent aspiration.  There are no\nnodules or other findings raising concern about malignancy.  To be concerned\nabout malignancy.\n\n Patient has had cervical thoracic and lumbar laminectomy and stabilization\nprocedures and resection of the distal right first rib.  There are no bone\nlesions in the chest cage suspicious for malignancy or infection.  Posterior\nfracture left tenth rib is well-healed with no associated soft tissue\nabnormality.",
            "output": "Aside from previous upper and lower back surgery involving laminectomy in\nstabilization, there are no findings to explain chronic back pain.  Given more\nprecise history regarding local findings, I would be happy to re-evaluate this\nstudy.\n\nMild bronchial wall thickening and bibasilar ground-glass opacification are\nconsistent with aspiration, though nonspecific.  Chronic small airway changes\nin the upper lungs, stable since ___ do not suggest an active process. \nPatient may have had dust exposure at an earlier time; there are no findings\nto suggest that this was asbestos.  Graft coronary atherosclerosis."
        },
        {
            "input": "6 mm right thyroid nodule (5, 5).  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  However, borderline sized lymph nodes are seen in\nthe thoracic inlet (5, 11).  And enlarged lymph nodes are present in the\nmediastinum (5, 21) in particular the paratracheal and subcarinal area (5,\n25).  .  There is evidence of moderate enlargement of the main pulmonary\nartery.  Small hiatal hernia.  Presence of multiple highly suspicious\nhypodense liver lesions.\n\nThe most important finding, however, is the presence of a large, at least 4-5\ncm PICC mass in the left lower lobe (6, 119) adjacent to the posterior aspect\nof the left pulmonary artery and in continuation with all bronchial and\nvascular structures of the left hilus.  The mass grows downwards along the\ninferior left hilar structures and is connected to a second 2 cm satellite\nlesion in the left lower lobe (6, 177.  The conglomerate also has contact with\nfissural structures and causes lateral fissural thickening (6, 198) as well as\na unilateral pleural effusion.\nThere is evidence of countless ipsilateral and contralateral pulmonary nodules\n(for example series 6, image 141) that could reflect metastatic disease.\n\nPotentially lytic areas are visualized in several vertebral bodies, for\nexample L4, L1, as well as T7 and T6.  Finally, a larger lytic zone is\nvisualized in T1 (9, 41).",
            "output": "Large multifocal left lower lobe malignancy, with likely vascular and\nbronchial as well as pleural invasion.  Diffuse ipsilateral and contralateral\npulmonary metastasis.  Ipsilateral pleural effusion.  Mediastinal adenopathy. \nMultisegmental lytic lesions in the spine.  Highly suspicious hypodense liver\nlesions."
        },
        {
            "input": "The thyroid gland appears normal.  There is no supraclavicular, axillary, or\nmediastinal lymphadenopathy.  The heart is normal in size, with heavy coronary\nartery and aortic valve calcification.  The main pulmonary artery is enlarged,\nsuggestive but not diagnostic of pulmonary hypertension.   No pericardial\neffusion is present.  There is a small to moderate hiatal hernia.\n\nAirways are patent, but at end-expiration there is complete collapse of the\ntrachea at the level of the carina and bronchus intermedius as well as\nnarrowing of the bilateral mainstem bronchi.  There are scattered ground-glass\nopacities in the bilateral lungs (for example, 6:88, 130, 74, 145).  Bronchial\nwall thickening and bronchiectasis is more prominent in the bilateral lower\nlobes and right middle lobe (for example, 6:76, 102, 115).  There are\nsubpleural interstitial reticular opacities with peripheral prominence,\nwithout honeycombing or fibrosis.  There is a 5 mm nodular opacity in the\nright lower lobe (6:117).  A perifissural nodular opacity in the left lower\nlobe measures 3 mm (6:134).  Scattered calcified granulomas are noted.  No\npleural effusion or pneumothorax is present.\n\nThere is no osseous lesion concerning for neoplasm or infection.  A healed\nfracture of the right seventh rib is noted.\n\nThis exam is not designed for the evaluation of the infra diaphragmatic\nstructures.  Other than cholelithiasis, the visualized upper abdomen is\nunremarkable.",
            "output": "1. Findings consistent with severe tracheobronchomalacia, as described above.\n2. Scattered ground-glass opacities, bronchial wall thickening, and\nbronchiectasis in the bilateral lungs without fibrosis.  These findings are\nmost consistent with NSIP.\n3. Please note that parenchymal findings are relatively subtle compared to\nsevere tracheobronchomalacia."
        },
        {
            "input": "CHEST:HEART AND VASCULATURE: The ascending thoracic aorta is of normal\ncaliber.  The main pulmonary artery is dilated up to 3.6 cm, unchanged since\n___ (02:41).  Evaluation of the lung bases is limited by respiratory\nmotion artifact.  Apparent areas of intraluminal hypoattenuation in the\nsubsegmental branches of the right and left main pulmonary arteries (for\nexample 2:60, 66, 67) are likely due to respiratory motion and may in fact be\nwithin pulmonary venous branches rather than pulmonary arterial branches.  No\nconvincing evidence of a pulmonary embolus.  There is no evidence of right\nheart strain.  Coronary artery calcifications are mild.  There are moderate to\nsevere aortic valve calcifications.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is near complete collapse of the trachea with the\nbilateral segmental and subsegmental branches appearing somewhat narrowed on\nthis expiration phase exam.  There is mild bronchiectasis, worst in the lower\nlobes.  Findings are likely in keeping with patient's known\ntracheobronchomalacia.  Subpleural interstitial reticular opacities are\ndemonstrated without evidence of honeycombing.  A 4 mm right upper lobe\npulmonary nodule does not appear substantially changed since ___ (02:38).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is atrophic without evidence of focal lesions or\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal cortical hypodensities measure up to 2.0 x 1.8 cm in\nthe left upper lobe kidney and are most compatible with simple renal cysts\n(2:105).  No evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The esophagus is severely patulous.  There is a small hiatal\nhernia.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding.  The appendix is not\nvisualized.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: Chronic fracture deformities involving the lateral right seventh rib\nand posterior right eleventh rib are unchanged since at least ___. \nAnterolisthesis of L5 on S1 is likely degenerative in nature.  There is no\nacute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Dilated main pulmonary artery up to 3.6 cm is unchanged since ___ and\nmay reflect underlying pulmonary hypertension.  Equivocal intraluminal defects\nwithin the subsegmental levels of the right and left main pulmonary arteries\nare likely artifactual as outlined above.  There is no evidence of right heart\nstrain or pulmonary infarction.\n2. Imaging findings are compatible with known history of\ntracheobronchomalacia.\n3. Interstitial reticular opacities are compatible with nonspecific\ninterstitial pneumonia, similar to ___.\n4. 4 mm right upper lobe pulmonary nodules unchanged since ___.\n5. Severely patulous thoracic esophagus may reflect underlying dysmotility.\n6. Cholelithiasis without imaging evidence to suggest cholecystitis.\n7. No acute fractures or evidence of active extravasation in the chest,\nabdomen, or pelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is heterogeneous with a 2.1 x 1.2 cm nodule in the left lobe\n(05:24).  No enlarged lymph nodes in either axilla or thoracic inlet. No\nabnormalities on the chest wall. No atherosclerotic calcifications in the head\nand neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging. No suspicious lung nodules or\nmasses.  Linear bibasilar atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No evidence of intrathoracic metastatic disease.  No suspicious lung nodules,\nlymphadenopathy or osseous lesions.\nLarge heterogeneous nodule in the left thyroid lobe for which correlation with\nthyroid ultrasound is recommended."
        },
        {
            "input": "Technically adequate study with no evidence of pulmonary embolism identified.\n\nNo acute aortic syndrome.\n\nNo pleural or pericardial effusions.\n\nA and no suspicious mediastinal, hilar, or axillary lymphadenopathy.\n\nBibasilar atelectatic change. Within this atelectatic change there are 2 6 mm\nnodular areas in the right lower lobe, for which follow-up in 6 months is\nrecommended.  No other definite suspicious pulmonary nodules are seen.\nAtelectatic changes noted in the lingula and to a lesser extent the right\nmiddle lobe.\n\nLimited images of the upper abdominal structures demonstrate standard\nappearing calcification in the liver, segment 8, unchanged from prior.  No\nother significant abnormality identified.\n\nNo suspicious bony lesion or fracture.",
            "output": "Technically adequate study with no evidence of pulmonary embolism or acute\naortic syndrome.\n\nTwo 6 mm right lower lobe nodules will require follow-up CT chest in 6 months\ntime.\n\nRECOMMENDATION(S):  Follow-up CT chest in 6 months.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:51 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Supraclavicular and subcentimeter axillary lymph nodes slightly more numerous\ntoday than in ___ are not pathologically enlarged.  Specifically excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis, but shows no adrenal mass.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head neck vessels or in the\ncoronary arteries.  Aorta and pulmonary arteries are normal size.  Small\npericardial effusion is slightly larger today than in ___.  There is no\npleural effusion.\n\nMediastinal nodes are not enlarged and hilar contours on this noncontrast\nstudy do not suggest adenopathy.\n\nLungs:\n\n4 x 5 mm and 3 x 4 mm right lower lobe nodules, 5:222, 268 are unchanged since\nat least ___.\n\n5 x 7 mm right lower lobe nodule, 5:234, is unchanged in size since ___,\nbut new since ___.\n\n4 mm subpleural right lower lobe nodule, 5:240, is roughly unchanged since ___, also new since ___.\n\nA nodular region of the peribronchial thickening in the anteromedial basal\nsegment of the left lower lobe, 5:213, is unchanged since ___.\n\nSmall region of subsegmental atelectasis or scarring in the lingula is also\nstable since then.\n\nThere are no bone lesions in the chest cage suspicious for malignancy. \nDegenerative endplate irregularity at multiple levels in the mid and lower\nthoracic spine, disc space narrowing and osteophyte formation are essentially\nunchanged since ___.",
            "output": "2 subcentimeter right lower lobe lung nodules developed between ___ and ___, subsequently stable, should be kept under surveillance for a total of ___\nyears.  2 other subcentimeter right lower lobe nodules, and a nodular lesion\nin the left lower lobe, stable since ___, can be considered benign.\n\n\n\n\nRECOMMENDATION(S):  Chest CT, in one year to evaluate two right lower lobe\nlung nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular\naxillary lymphadenopathy.  The thyroid gland demonstrates normal morphology.\n\nUPPER ABDOMEN: The study is not tailored for subdiaphragmatic assessment\nhowever there is no adrenal mass.  Calcifications are noted in the liver,\nunchanged.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes are appreciated on today's noncontrast\nstudy.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is trace\npericardial fluid.\nPLEURA: There are no pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  There is a stable since ___ 4 x 5 mm right lower lobe nodule,\nseries 3 image 45.  There is a stable since ___ 3 x 4 mm right lower lobe\nnodule, series 3, image 54.  There is a stable since ___ 5 x 7 mm right lower\nlobe nodule, series 3 image 48.  A previously described 4 mm subpleural nodule\nin the right lower lobe is no longer evident today, possibly due to the small\nsize.  A hazy nodular density in the left lower lobe, series 3, image 44, is\nunchanged in size but is decreased in density compared to prior.  Subsegmental\natelectasis versus scarring is again noted in the lingula.  There is a stable\nsince ___ 2 mm left lower lobe nodule, series 3, image 49.  There are several\nadditional scattered punctate, 1-2 mm, pulmonary parenchymal nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The aorta maintains normal caliber.  The main pulmonary artery\ndemonstrates normal caliber.\nCHEST CAGE: Degenerative changes are evident in the spine.",
            "output": "Multiple pulmonary parenchymal nodules measuring up to 7 mm in diameter.  This\nlargest nodule has developed in the interim since ___ and ___ while several\nof the smaller nodules are documented as stable since ___.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen demonstrate splenic coarse calcifications,\nunchanged and otherwise is unremarkable.\n\nThere is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Minimal\nbronchiectasis in the lingula are similar to previous examination as well as\nin the right middle lobe.  Multiple pulmonary nodules are all stable, in the\nright lower lobe (the largest nodule, 7 x 5 mm, series 4, image 156), in the\nright lower lobe, series 4, image 168, in the right lower lobe, series 4 image\n168\n\nIn the right lower lobe, series 4, image 172, in the right lower lobe, series\n4, image 195, 6 mm, not seen on the study from ___\n\nIn the left upper lobe, series 4, image 60\n\nIn the left lower lobe, series 4, image 149, in the left lower lobe, series 4,\nimage 163\n\nIn left lower lobe, series 4, image 164.  No new nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Multiple stable pulmonary nodules as described\n\nGiving the fact that the largest nodule was demonstrated to be new on ___\nscan it reassessment in ___ is recommended for documentation of\nstability."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  There is a trace\npericardial effusion.  There are no enlarged hilar lymph nodes PE\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Mild bronchiectasis with peribronchial thickening in both lower lobes is\nunchanged.  There is subsegmental atelectasis in the inferior lingula.  The\nright lower lobe nodule measuring 8 mm (4, 231) is unchanged.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows calcified\nlesions within the liver.",
            "output": "Stable 8 mm right lower lobe pulmonary nodule.  No new or growing pulmonary\nnodules\n\nRECOMMENDATION(S):  12 month follow-up is recommended"
        },
        {
            "input": "THORACIC INLET: The thyroid is within normal limits.\n\nBREAST AND AXILLA  : There is no axillary lymphadenopathy.\n\nMEDIASTINUM: There are scattered small mediastinal lymph nodes which are not\nenlarged by CT size criteria.  There is no hilar lymphadenopathy.  The heart\nis normal in size.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG: New from prior, there is an ill-defined ground-glass subpleural opacity\nin the left lower lobe measuring approximately 9 mm (04:167), which may be\ninfectious or inflammatory in etiology.  There is mild bronchiectasis with\nperibronchial thickening, most pronounced in the bilateral lower lobes.  There\nis subsegmental atelectasis in the lingula.  Scattered pulmonary nodules are\nagain seen, the largest located in the right lower lobe measuring 8 mm, not\nsubstantially changed compared to prior (04:189).  Two small punctate\nhyperdense lesions  in the anterior right upper lobe (04:125-127) are\nunchanged and likely represent calcified granulomas.  There are no new or\ngrowing pulmonary nodules.\n\nBONES AND CHEST WALL : There are mild multilevel degenerative changes in the\nthoracic spine.  There is no soft tissue abnormality within the chest wall.\n\nUPPER ABDOMEN: Redemonstrated are calcified lesions in the anterior right lobe\nof the liver, not significantly changed.  Otherwise, the partially visualized\nupper abdomen is unremarkable.",
            "output": "1. Stable 8 mm nodule in the posterior right lower lobe with no new or growing\npulmonary nodules identified.\n2. New ill-defined subpleural ground-glass opacity in the left lower lobe may\nbe infectious or inflammatory in etiology.  Attention on follow-up is\nrecommended."
        },
        {
            "input": "THORACIC INLET: The imaged thyroid gland is grossly homogeneous.  No\nsupraclavicular lymphadenopathy is seen.\n\nBREAST AND AXILLA  : No axillary lymphadenopathy is seen.  Scattered axillary\nlymph nodes are small in size.\n\nMEDIASTINUM: No mediastinal or hilar lymphadenopathy is seen.\n\nHEART, VESSELS and PERICARDIUM: There is no pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax is seen.\n\nLUNG: Respiratory motion through the lower lobes makes the study somewhat\nsuboptimal.  Medial right lower lobe 6 mm pulmonary nodule, series 4, image\n170 is stable to slightly smaller in size.  Lateral right lower lobe pulmonary\nnodule, series 4, image 150, today measures 6 x 5 mm compared to today's\nmeasurement of the prior study of 8 x 5 mm (4, 178).  Inferior right lower\nlobe pulmonary nodule on series 4, image 200 today measures 5 x 3 mm, compared\nto today's measurement of the prior study of 5 x 4 mm.\n\n6-7 mm left lower lobe pulmonary nodule on series 4, image 149, is similar\ncompared to the prior study.  New ground-glass opacity reported on the prior\nstudy is not as well appreciated on the current study, although there is\nrespiratory motion through this region.\n\nPunctate subpleural left upper lobe likely calcified granuloma is stable.  To\nlateral right upper lobe calcified granulomas are re-demonstrated, series 4,\nimage 118.\n\nBONES : No concerning osteoblastic or lytic lesion is seen.\n\nUPPER ABDOMEN: The partially imaged upper abdomen again demonstrates areas of\ncalcification in the superior liver.  Re-demonstrated is also a subcentimeter\nhypodensity in the left lobe of the liver, series 4, image 191, not fully\ncharacterized on this study, but possibly a cyst.",
            "output": "Stable to slightly smaller pulmonary nodules.\n\nPreviously reported ill-defined subpleural ground-glass opacity in the left\nlower lobe on the prior study from ___ is not as well appreciated\non the current study, although there is respiratory motion through this\nregion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is mildly enlarged with mild coronary artery\ncalcifications.  The main pulmonary artery and right pulmonary arteries are\ndilated up to 3.4 and 2.5 cm respectively, suggestive of pulmonary arterial\nhypertension.  No pericardial effusion is seen.  There is reflux of contrast\ninto the IVC, suggestive of right heart failure.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is linear likely atelectasis in the lingula.  There is\nmild septal thickening at the lung bases.  There are mild areas of\nground-glass opacity, predominantly at the lung bases, but also in the left\nupper lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUES: There is asymmetric breast tissue in the left upper outer breast\nspanning approximately 2.7 cm (3:40)..",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild cardiomegaly with reflux of contrast into the IVC, suggestive of right\nheart failure.\n3. Mild septal thickening and ground-glass opacities at the lung bases, may be\ndue to mild edema.  No pleural effusion.\n4. Enlargement of the pulmonary arteries suggestive of pulmonary arterial\nhypertension.\n5. Asymmetric breast tissue in the left upper outer breast spanning\napproximately 2.7 cm, for which outpatient diagnostic mammogram is\nrecommended.\n\nRECOMMENDATION(S):  Outpatient diagnostic mammogram."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\ndilation of the main pulmonary artery.  No pericardial effusion is seen. \nStable moderate cardiomegaly.  Postsurgical changes from prior CABG surgery. \nSevere calcifications of the native coronary arteries.  Mild aortic valve\ncalcification.\n\nAXILLA, HILA, AND MEDIASTINUM: Several borderline and enlarged lymph nodes in\nthe mediastinum, for example one measuring 1.8 cm on series 4, image 207. \nAdditional lymph nodes ranging from 0.9 to 1.7 cm (4; 114, 79, 70).\n\nPLEURAL SPACES: No evidence of pneumothorax.  Mild bilateral pleural\neffusions, right greater than left.\n\nLUNGS/AIRWAYS: No worrisome nodules in the lung parenchyma.  Massive ground\ngrass opacities with peripheral areas of air trapping.  There small peripheral\nconsolidations in the left upper lung lobe as well as the left lower lobe (4;\n287 and 138).  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThyroid is unremarkable.  The thoracic inlet is normal.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is scoliosis and degenerative vertebral disease.  Sternotomy wires are\nintact.",
            "output": "1.  Massive generalized ground-glass opacities could be consistent with\ninfectious process, including PCP or ___ pneumonia, as well as\nhypersensitivity pneumonitis.\n2.  Generalized lymphadenopathy is nonspecific and may be related to cardiac\ndisease, however chronic infectious process cannot be excluded given lung\nparenchymal findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Limited view of the upper abdomen is unremarkable.\n\nMEDIASTINUM:  Multiple mediastinal surgical clips are seen suggestive of prior\nCABG.  There are multiple borderline enlarged mediastinal lymph nodes, similar\nto prior, for example a 1.1 right paratracheal node and a 1.1 cm subcarinal\nnode (3; 22, 33).\n\nHEART and PERICARDIUM: The heart is enlarged.  There are dense coronary artery\ncalcifications.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Compared to prior there are new areas of patchy peribronchial\nopacification in the right lung involving the right apex, right lower lobe,\nand right middle lobe (5; 50, 152, 161) there is a stable patchy area of\nperipheral opacification in the left upper lobe which is unchanged compared to\nprior (5; 142).  There is diffuse ground-glass abnormality throughout\nbilateral lungs which has not changed compared to prior.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta is of normal caliber with mild atherosclerotic\ncalcifications.  The main pulmonary artery is enlarged measuring 3.7 cm.\nCHEST CAGE: The patient is status post median sternotomy.  Moderate\ndegenerative changes are seen throughout the thoracic spine.",
            "output": "1. New peribronchial opacification in the right lung on a background of\ndiffuse bilateral ground glass opacification concerning for worsening\ninfection.  Recommend follow up in 3 months following completion of treatment.\n2. Stable prominent mediastinal lymph nodes.\n3. Enlarged main pulmonary artery, a finding which can be seen in pulmonary\nartery hypertension.\n\nRECOMMENDATION(S):  Recommend follow up CT  in 3 months following completion\nof treatment."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There is stable small left\nsupraclavicular lymph nodes\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  There are stable\nsmall hilar lymph nodes there is evidence of prior cardiac surgery.  There is\nmoderate coronary artery calcification.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Previously visualized right upper lobe nodule and nodular opacity has\nresolved.  The right middle lobe consolidation has also resolved.  The\nlingular subpleural nodule (5, 26)measuring 9 mm in the lingula (6, 26) Is\nunchanged.  There is diffuse bilateral mosaic attenuation which is most likely\nrelated to small airway disease.\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nThere are degenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  No focal liver lesions are seen.",
            "output": "Complete resolution of the right upper lobe nodule and right middle lobe\npneumonia.  Stable subpleural nodule measuring 9 mm in the lingula (6, ___).\n\nMosaic attenuation bilaterally is most likely related to small airway disease.\nNo new pulmonary nodules.\n\nStable small mediastinal bilateral hilar lymph nodes are most likely reactive.\n\nModerate cardiomegaly.  Moderate coronary artery calcification."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: There is area of infiltrate and consolidation in the\nleft lower lobe, worrisome for pneumonia.  There is area of nodular opacity in\nthe lingula,.  Images are partially compromised by patient motion.  There are\nfew small nodular opacities in the left lung apex, cluster adjacent to each\nother, likely infectious or inflammatory.  Adjacent linear band of\natelectasis.  There are minimal secretions in the proximal lingular bronchus. \nThere are mild dependent areas of atelectasis bilateral lower lobes adjacent\nto pleural effusions.\nVessels:  Ascending aorta measures 4.2 cm in diameter, which is at the upper\nlimits of normal. Main pulmonary artery is normal in size.\n\nMediastinum and Hila: Few sub cm mediastinal lymph nodes, likely reactive.\n\nHeart and Pericardium: Heart is mildly enlarged.  There are three-vessel\ncoronary artery calcifications.  There is no pericardial effusion\n\nPleura: There are mild bilateral pleural effusions\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: There is a right PICC line, with\ntip in the low SVC.  .  There is no mass or adenopathy.\n\nUpper Abdomen: There is long segment mild diffuse circumferential wall\nthickening of the esophagus, consider esophagitis, less likely neoplasm. \nPlease see separate report of the CT abdomen pelvis for findings below\ndiaphragm.\n\nChest Cage: There is very dense calcification in the proximal left humerus,\nmost likely benign bone island.  There are degenerative changes in the lower\ncervical spine",
            "output": "There is area of infiltrate, consolidation the left lower lobe, most\nconsistent with pneumonitis.  Nodular opacity in the lingula, indeterminate,\nmay represent atelectasis.  Follow-up chest PA and lateral in 6 weeks\nrecommended to document resolution of the above findings.\n\nThere are mild bilateral pleural effusions, adjacent atelectasis.\n\nLong segment wall thickening of the esophagus, consider esophagitis, less\nlikely neoplasm\n\nRECOMMENDATION(S):  Chest PA and lateral in 6 weeks"
        },
        {
            "input": "There is no filling defect within the pulmonary arterial tree to suggest the\npresence of a pulmonary embolism. The thoracic aorta is normal in course and\ncaliber without evidence of dissection.  Residual thymic tissue is noted in\nthe anterior mediastinal space.  There is no lymphadenopathy. The airway is\ncentrally patent. No pleural or pericardial effusion is seen.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.\n\nThe imaged portion of the upper abdomen is unrevealing.\n\nBones: Unremarkable.",
            "output": "No pulmonary embolism or other acute process in the chest."
        },
        {
            "input": "THORACIC INLET:Interval increase in size of the left thyroid gland which\nappears heterogeneous (2:1).  There are no pathologically enlarged\nsupraclavicular lymph nodes.\n\n\nTHORACIC LYMPH NODES:  No axillary lymphadenopathy.  Multiple small\nmediastinal lymph nodes are not enlarged by CT size criteria, the largest\nmeasuring up to 6 mm (02:14).  No evidence pathologically enlarged hilar lymph\nnodes,\n\nHEART, VESSELS and PERICARDIUM: The heart is not enlarged.  There are no\nappreciable coronary artery calcifications.  There is no pericardial effusion.\nThe ascending aorta measures 2.9 cm and is normal in caliber.  The main\npulmonary artery measures 3.2 cm.  The right pulmonary artery measures 2.7 cm\nand is mildly enlarged but unchanged compared to most recent prior.  Tiny\nhiatal hernia\n\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Suture material in the left lower lobe is consistent with\npatient's history of prior VATS procedure.  There are no new or enlarging\npulmonary nodules.  Multiple bilateral pulmonary nodules are unchanged since\nat least ___, for example: A left upper lobe pulmonary nodule\nmeasures 2.5 mm and is stable (4:61).  A 3 mm right upper lobe pulmonary\nnodule is unchanged (4:150). Two right lower lobe pulmonary nodules measuring\n3 mm and 4 mm respectively are also unchanged (4:229, 184).  A 4 mm right\nmiddle lobe pulmonary nodule is also unchanged compared to ___\n(4:132).\n2. AIRWAYS: Airways are patent to the level of the segmental bronchi\nbilaterally.\nCHEST WALL AND BONES: No abnormalities are visualized in the chest wall. \nMammography is required for breast evaluation.  There is no worrisome lytic or\nsclerotic lesion.\n\nUPPER ABDOMEN: The study is not tailored for evaluation of the abdomen. \nAllowing for this, the partially visualized upper abdomen demonstrates a\nsurgically absent gallbladder and left kidney.",
            "output": "1. No evidence of intrathoracic malignancy.  Multiple bilateral pulmonary\nnodules are stable since at least ___ and can be considered benign.\n2. No intrathoracic lymphadenopathy."
        },
        {
            "input": "THORACIC INLET: There is stable enlargement left lobe of thyroid with the 3.6\ncm hypodense lesion.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  The aorta and\npulmonary arteries are normal in caliber.  There is mild coronary artery\ncalcification.  There is no pericardial effusion.  Heart size is normal.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: All the previously visualized pulmonary nodules are unchanged in number\nsize and morphology since the prior study.  (4, 47 72, 101, 131, 158, 165). \nNo new pulmonary nodules\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nleft nephrectomy.  Patient status post cholecystectomy",
            "output": "Stable pulmonary nodules ranging in size from 2-3 mm.  No new or growing\npulmonary nodules.\n\nContinued follow-up in view of history of malignancy is recommended.\n\nStable hypodense lesion within the right lobe of thyroid."
        },
        {
            "input": "BASE OF NECK: Partially imaged hypodense left thyroid lesion measures 2.9 x\n1.8 cm (05:17), decreased from ___ when it measured up to 3.6 cm.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Mild thoracic\narch, coronary artery, and aortic annular calcifications, unchanged. The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nMultiple subcentimeter mediastinal lymph nodes do not meet CT size criteria\nfor lymphadenopathy.  No mediastinal mass.  Small hiatal hernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Postsurgical changes are noted within the inferior lingula with\nmild scarring and bronchiectasis. The airways are patent to the level of the\nsegmental bronchi bilaterally.  Multiple tiny pulmonary nodules, less than 3\nmm, are stable from ___.  For example, in the right upper lobe (5:68,\n5:121), right middle lobe (5:117, 5:154), right lower lobe (5:191, 5:202),\nleft upper lobe (5:68).  No concerning new or growing pulmonary nodules or\nmass.  Scattered calcified granulomas are suggestive of prior granulomatous\nexposure.  Mild background emphysema is unchanged.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.  Mild\ndegenerative changes of the bilateral glenohumeral joints and thoracic spine.\n\nABDOMEN:  Included portion of the upper abdomen is notable for prior left\nnephrectomy and cholecystectomy. Mild calcific atherosclerosis of the\nabdominal aorta.",
            "output": "1. Multiple pulmonary nodules, less than 3 mm, are stable from ___.  No\nnew or growing pulmonary nodules.  Continued surveillance in view of history\nof malignancy is recommended.\n2. Hypodense left thyroid lesion, measuring up to 2.9 cm, is slightly\ndecreased from ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Redemonstration of the 2.8 cm left\nlower pole thyroid nodule, similar to prior (3; 1).  There is no axillary\nlymphadenopathy.  There is no supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please see separate report for MRI renal performed on same day\nfor description of subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There's no pericardial\neffusion.  No significant coronary artery calcifications are seen.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Postsurgical changes are again demonstrated in the inferior\nlingula from prior left upper lobe wedge resection for pulmonary nodules\ndemonstrating sarcoid.  There is no focal consolidation.  There is a 7 mm\nground-glass left lower lobe pulmonary nodule that is stable (5; 158) with an\nadjacent 3 mm ground glass nodule.  There is redemonstration of multiple\nbilateral ground-glass and solid peribronchovascular pulmonary nodules\nmeasuring up to 7 mm, similar to prior.  No new or growing nodules are\nidentified.\n2. AIRWAYS:  There is moderate bilateral bronchial wall thickening and\nextensive mucous plugging bilaterally (5; 59).\n3. VESSELS:  The main pulmonary artery measures 3.3 cm in caliber, similar to\nprior.  The thoracic aorta is normal in caliber.  There is mild\natherosclerotic calcification aortic arch.\n\nCHEST CAGE: Severe right glenohumeral degenerative changes are noted.  No\nsuspicious osseous lesion is identified.  Mild multilevel degenerative changes\nof the thoracic spine are noted.",
            "output": "1. Multiple bilateral ground glass and solid pulmonary nodules measuring up to\n7 mm are stable.  No new or growing pulmonary nodules.\n2. Stable postsurgical changes from left upper lobe wedge resection.\n3. Bilateral bronchial wall thickening and mucous plugging consistent with\ninflammation.\n4. Stable partially visualized left lower pole 2.8 cm thyroid nodule."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is severe cardiomegaly.  No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are enlarged mediastinal lymph nodes,\nwhich were present on CTA head and neck from ___.  There is a\nright paratracheal lymph nodes measuring up to 1.3 cm (series 3, image 71). \nThere is an elongated preaortic lymph node measuring 0.8 cm in short axis. \nProminent subcarinal lymph node.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis is noted.  There is diffuse ground-glass\nopacities.  Otherwise, lung fields are clear.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Partially imaged upper abdomen demonstrates partially imaged reflux\nof IV contrast into the IVC and hepatic veins.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Cardiomegaly, reflux of contrast into the hepatic veins, and diffuse\nground-glass opacities.  Findings are most compatible with acute on chronic\ncongestive heart failure.\n3. Prominent mediastinal lymph nodes are nonspecific."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary, supraclavicular, or\nenlarged mediastinal lymph nodes.  Heart size is normal.  There is no\npericardial effusion.  The main pulmonary trunk is normal in caliber. \nAlthough not optimized for evaluation no incidental central pulmonary embolus\nis noted.  The thoracic aorta is notable for mild to moderate atherosclerotic\ndisease without aneurysmal dilation.  There is no evidence of dissection. \nCoronary artery calcifications are moderate.\n\nThe airways are patent to the segmental level bilaterally with mucous plugging\nat the left lung base.  There is mild bronchial wall thickening suggesting\nsmall airways disease.  There is a mild diffuse peripheral interstitial\nabnormality seen in the periphery of the lungs, which may represent mild\nbackground fibrotic change.  There is a heterogeneously enhancing left basilar\nconsolidative opacity.  More linear right basilar opacity likely mostly\nrepresents atelectasis.  There is a small left pleural effusion and trace\nright pleural effusion.\n\nThe thoracic esophagus is fluid-filled and dilated.  Note is made of a small\nhiatal hernia.  Please see same-day dictation for intra-abdominal details.\n\nThere is an incompletely characterized 1.7 x 1.9 cm right upper breast nodule\n(series 305, image 123).  There are no suspicious bony lesions.\n\nThere are acute mildly displaced fractures of the right anterior first,\nsecond, third ribs.  Nondisplaced fractures noted of the anterior right\nfourth, fifth, and sixth ribs.  There is also acute mildly displaced fractures\nof the left anterior first and second rib.  There are nondisplaced fractures\nthrough the left anterior third, fourth, fifth, sixth, seventh ribs.",
            "output": "1. Findings concerning for left lower lobe pneumonia.\n2. Small left pleural effusion.\n3. Multiple bilateral anterior rib fractures including mildly displaced\nfractures of the right first through third and left first and second ribs. \nPlease see above for detailed description.\n4. Dilated fluid-filled esophagus, which may increase the risk of aspiration.\n5. Incompletely characterized 1.7 cm right breast nodule, recommend\ncorrelation with dedicated breast imaging.\n\nRECOMMENDATION(S):  Correlation with dedicated breast imaging."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  No pericardial effusion is seen.  Coronary artery\ncalcifications are seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a hyperattenuating heterogeneous mass in the inferior\npole of the left thyroid gland, previously seen on CT head and neck and\nmeasures approximately 7.3 x 5.2 cm in the axial dimension, previously\nmeasured 6.5 x 4.4 cm.  There is mass effect on the trachea which is deviated\nto the right.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are multiple hypoattenuating lesions in bilateral kidneys which likely\nrepresent simple renal cysts. The largest of these in the upper pole the right\nkidney and measures 6.4 x 7.1 cm (series 2, image 37).  No hydronephrosis is\nseen.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively collapsed.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding.  The appendix is normal.  There is no evidence\nof mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  There are multilevel degenerative changes\nof the lumbar spine including grade 1 retrolisthesis of L1 on L2 and L2 on L3\nand L3 on L4, likely degenerative in nature.  There are degenerative changes\nof the thoracic spine, including multilevel disc space narrowing and anterior\nbridge osteophyte formation from T9-T12.  There is moderate to severe\nnarrowing of the central canal at L1-L2 and moderate narrowing at L2-L3, due\nto posterior osteophytes.\n\nSOFT TISSUES: There is a 3.9 x 3.1 x 2.4 cm fat containing umbilical hernia,\nwith haziness of the fatty contents of the hernia sac.  The neck of the hernia\nmeasures 1 cm.",
            "output": "1. Opacity in right lung apex reported on chest x-ray"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  No pericardial effusion is seen.  Coronary artery\ncalcifications are seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a hyperattenuating heterogeneous mass in the inferior\npole of the left thyroid gland, previously seen on CT head and neck and\nmeasures approximately 7.3 x 5.2 cm in the axial dimension, previously\nmeasured 6.5 x 4.4 cm.  There is mass effect on the trachea which is deviated\nto the right.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are multiple hypoattenuating lesions in bilateral kidneys which likely\nrepresent simple renal cysts. The largest of these in the upper pole the right\nkidney and measures 6.4 x 7.1 cm (series 2, image 37).  No hydronephrosis is\nseen.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively collapsed.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding.  The appendix is normal.  There is no evidence\nof mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  There are multilevel degenerative changes\nof the lumbar spine including grade 1 retrolisthesis of L1 on L2 and L2 on L3\nand L3 on L4, likely degenerative in nature.  There are degenerative changes\nof the thoracic spine, including multilevel disc space narrowing and anterior\nbridge osteophyte formation from T9-T12.  There is moderate to severe\nnarrowing of the central canal at L1-L2 and moderate narrowing at L2-L3, due\nto posterior osteophytes.\n\nSOFT TISSUES: There is a 3.9 x 3.1 x 2.4 cm fat containing umbilical hernia,\nwith haziness of the fatty contents of the hernia sac.  The neck of the hernia\nmeasures 1 cm.",
            "output": "1. Opacity in right lung apex reported on chest x-ray"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Aortic valve, mitral annular, and coronary artery\ncalcifications.  The heart, pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nBilateral shoulder arthroplasties are noted.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially imaged thyroid is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Diffuse hypodensity of the liver suggest hepatic steatosis.\nRemaining unenhanced upper abdominal organs are unremarkable.  There is no\nhiatal hernia and the esophagus is collapsed.\n\nMEDIASTINUM: There is no mediastinal or gross hilar lymphadenopathy.  0.7 cm\npre-vascular lymph node is not pathologically enlarged.\nPhysiologic thymus.\n\nHEART and PERICARDIUM: Heart and major vessels are normal in size.  No\nappreciable atherosclerotic calcifications of the coronaries, thoracic aorta\nor head and neck vessels.\nThere is no pericardial effusion.\n\nPLEURA: No pleural effusion, no thickening or pneumothorax.\n\nLUNG: Airways are patent to the subsegmental level.  Tiny calcified granuloma\nin the left lower ___ the lungs are clear.\n\nCHEST CAGE: Unremarkable, no evidence of fractures or osteo destructive\nlesions.",
            "output": "-No radiologic findings to explain chest pain.\n-Hepatic steatosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is mild calcification of the aortic arch and the origin\nof the left subclavian and common carotid arteries.  There is no pericardial\neffusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main pulmonary artery is normal caliber.\n\nPULMONARY PARENCHYMA AND PLEURA:  There is no evidence of infection or\nmalignancy.  A 3 mm calcified granuloma in the left upper lobe.  Multiple\npleural irregularities are noted.  There is no emphysema.  Small right pleural\neffusion with associated atelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "There is a small right pleural effusion with associated atelectasis."
        },
        {
            "input": "CHEST CTA: At the base of neck, the imaged portion of the thyroid appears\nsomewhat small bilaterally.  The aorta and its major branch vessels are\npatent, with no evidence of stenosis, occlusion, dissection, or aneurysmal\nformation.  There is no evidence of penetrating atherosclerotic ulcer or\naortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main is within normal limits.  The\nbilateral pulmonary branches are normal in caliber, and there is no evidence\nof right heart strain.\n\nProminent mediastinal nodes are likely reactive in nature.  No hilar,\nsupraclavicular or axillary lymphadenopathy.  The thyroid gland appears\nunremarkable.\n\nThere is no evidence of pericardial effusion.  The heart is mildly displaced\nleftward.  There is no pleural effusion.\n\nRight hemidiaphragmatic eventration noted with significant right middle or\nlower lobe atelectasis.  Mild left lower lobe atelectasis is also noted. \nThere ways are centrally patent.\n\nABDOMEN CTA: There is prominent pericholecystic fat stranding, with a large\ngallstone demonstrated at the neck of the gallbladder, also seen on same-day\nultrasound.  CBD better assessed on same-day ultrasound.  A 1.1 cm right\nhepatic cyst is demonstrated.\n\nThere are prominent portacaval and celiac lymph nodes, which are likely\nreactive.  A left renal cortical hypodensity is too small to characterize by\nCT but likely represents a simple cyst.\n\nBones: No lytic or blastic osseous lesion suspicious for malignancy is\nidentified.  There is a 2.0 cm hemangioma within the body of T11 (series 602,\nimage 42).",
            "output": "1. Cholelithiasis with moderately distended gallbladder and pericholecystic\nstranding concerning for acute cholecystitis.\n2. No evidence of pulmonary embolism or aortic abnormality\n3. Significant atelectasis in the right middle and lower lobes with right\nhemidiaphragmatic eventration."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate postsurgical changes from\nsleeve gastrostomy..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nPlease note that this exam is not tailored for evaluation of the breast\nparenchyma.  However, there are 2 nodular densities in the right breast,\nmeasuring 0.7 cm and 1.4 cm (3:90, 89).",
            "output": "1. No evidence of acute pulmonary embolism.\n2. Postsurgical changes from sleeve gastrectomy.\n3. 2 nodules in the right breast measuring 0.7 cm and 1.4 cm.  Please note\nthat this exam is not tailored for evaluation of the breast parenchyma. \nFindings would be further evaluated at a dedicated breast care center/breast\nimaging center."
        },
        {
            "input": "HEART AND VASCULATURE:\nHeart size is normal.  No pericardial effusion.  The thoracic aorta and main\npulmonary artery are normal in caliber.  The pulmonary arterial tree is\nadequately opacified through the proximal subsegmental level, without filling\ndefect indicate the presence of pulmonary embolism.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe partially imaged thyroid is unremarkable.  No axillary lymphadenopathy. \nSoft tissue structures of the chest wall are unremarkable.\n\nMEDIASTINUM AND HILA:\nSubcentimeter mediastinal and bilateral hilar lymph nodes are not enlarged by\nCT size criteria.\n\nPLEURA:\nModerate bilateral pleural effusions.\n\nLUNGS:\nCentral airways are patent.  No bronchial wall thickening, bronchiectasis or\nmucus plugging. No suspicious lung nodules or masses.  Scattered ground-glass\nopacities in the right upper lobe (6:63, 26) and in the left upper lobe (6:48)\ncould be infectious or inflammatory in nature, or reflect residual edema. \nBilateral compressive atelectasis of both lower lobes.\n\nCHEST CAGE:\nMild diffuse sclerosis of the visualized osseous structures.  Biconcave\nappearance of a few lower thoracic vertebral bodies.  Findings are in keeping\nwith history of HbSC disease.  Heterogeneous appearance of both humeral heads\nin keeping with known diagnosis of osteonecrosis.\n\nUPPER ABDOMEN:\nVisualized upper abdominal structures are unremarkable.",
            "output": "1. No evidence of pulmonary embolism.\n2. Moderate bilateral pleural effusions with associated compressive\natelectasis.\n3. Scattered ground-glass opacities in the bilateral upper lobes could be\ninfectious or inflammatory nature, or reflect residual edema."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Gynecomastia is\nmild and symmetric.  There are no soft tissue abnormalities in the imaged\nchest wall suspicious for malignancy.  This study is not appropriate for\nsubdiaphragmatic diagnosis.\n\nEsophagus is unremarkable.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels or in the\ncoronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.  Pericardium is physiologic.  There is no pleural abnormality.\n\nMediastinal lymph nodes:\n\nCm size pericaval periesophageal nodes in the posterior mediastinum just above\nthe diaphragm are unchanged since at least ___, 5: 221-232.  No lymph\nnodes elsewhere in the chest or pathologically enlarged.\n\nLungs and airways:\n\nAside from a calcified granuloma in the right apex, lungs are clear.  Mild\nwall thickening of segmental and smaller bronchi is unchanged.\n\nChest cage:\n\nUnremarkable.",
            "output": "Mild chronic bronchial inflammation.  Solitary calcified pulmonary granuloma. \nNo evidence of active infection or intrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Normal\nappearance of the large mediastinal vessels.  No coronary calcifications, no\nvalvular calcifications, no pericardial effusion.  The posterior mediastinum\nis unremarkable, with the exception of stable pre esophageal lymph nodes of\nborderline diameter (2, 47).  Moderate degenerative vertebral disease.  No\nvertebral compression fractures.\nMinimal bilateral apical scarring.  Known calcified right apical granuloma\n(302, 28).  Stable 2 mm right upper lobe ground-glass nodule (302, 54). \nStable moderate thickening any irregularities of the airway walls, no mucoid\nimpaction.  No diffuse lung disease.  No pleural thickening, no pleural\neffusions.",
            "output": "Stable small pulmonary nodules.  No growing or suspicious nodules.  No pleural\nabnormalities.  Stable borderline sized pre esophageal lymph nodes."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings in the\nimaged thyroid.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.\n\nCHEST CAGE: Moderate degenerative vertebral disease.  No vertebral compression\nfractures.\n\nUPPER ABDOMEN: S/p multiple TACE of right hepatic lobe lesions, which are not\nwell evaluated on this non-enhanced study.  Vicarious excretion through the\ngallbladder.\n\nMEDIASTINUM: No enlarged lymph nodes in the mediastinum. The posterior\nmediastinum is unremarkable, with the exception of stable pre esophageal lymph\nnodes of unchanged borderline diameter (302:176).\nThere is no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  No coronary calcifications,\nno valvular calcifications, no pericardial effusion.\n\nPLEURA: Minimal bilateral apical scarring.  Known calcified right apical\ngranuloma (302: 19).\n\nLUNG: Few ground-glass micro nodules in the right upper lobe are unchanged\nsince ___ and there are no new lung nodule (302:34, 48).  Mild\ncentrilobular emphysema affecting predominantly the upper lobes.  Stable\nmoderate thickening any irregularities of the airway walls suggest chronic\nairway disease, no mucoid impaction.",
            "output": "-Stable ground-glass micro nodules with no new lung nodules.\n-Chronic mild bronchitis and emphysema."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no evidence of supraclavicular or axillary\nlymphadenopathy.  Bilateral gynecomastia is noted.\n\nUPPER ABDOMEN: The patient is status post TACE in right hepatic lobe lesions. \nThere is a 1.7 cm hypodensity within hepatic segment 7 incompletely evaluated.\nPlease refer to the concurrent MRI of the liver for further details.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: No large hilar adenopathy given the limitations of this noncontrast\nexam.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There are no coronary or\nvalvular calcifications.  No pericardial effusion.  The size of the thoracic\naorta and main pulmonary artery are within normal limits.  2 right\ncardiophrenic angle lymph nodes are present measuring 1 cm and 0.6 cm in short\naxis (4:172).  These are slightly increased in size since prior.  2 lymph\nnodes anterior to the esophagus measure 0.7 and 1.0 cm (4:180).  A left para\nesophageal lymph node measures 0.7 cm, similar to prior.\n\nPLEURA: There is no pleural effusion, abnormal pleural thickening or\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular emphysema, most pronounced in the upper\nlobes is re-demonstrated.  There is no focal consolidation or suspicious\npulmonary lesions.  Unchanged ground-glass micronodules in the right upper\nlobe (04:44, 56).\n2. AIRWAYS:  The airways are clear through the subsegmental levels.  Unchanged\nsmooth thickening of the airway walls suggests chronic airway disease,\nunchanged.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are unremarkable.\nCHEST CAGE: There is no suspicious osseous lesion identified.  No acute\nfracture.  Mild degenerative changes are noted in the midthoracic spine.",
            "output": "1. No new or suspicious lung nodules.\n2. Mildly increased size of right cardiophrenic angle and paraesophageal lymph\nnodes.\n3. Stable chronic mild bronchitis and emphysema."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Stable appearance of the large mediastinal\nvessels.  No ___ a mass tear.  No pericardial effusion.  Several normal size\nlymph nodes are seen at the level of the lower periesophageal compartment (3,\n45).  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  Stable calcified right upper lobe granuloma.  The\nairways are patent.  No pleural effusions.  No pleural thickening.  No diffuse\nlung disease.  No suspicious pulmonary nodules or masses.",
            "output": "Stable CT of the thorax, no evidence of metastatic disease.  Stable mild lower\nparaesophageal lymphadenopathy."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged portion of the lower thyroid need\nany further imaging evaluation.  Supraclavicular and axillary lymph nodes are\nnot enlarged.  Mild gynecomastia is symmetric.  No soft tissue abnormalities\nelsewhere in the chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis but shows no mass in the imaged portion of the\nadrenals or any subphrenic collection.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in the head and neck vessels, not apparent coronary arteries.  Aorta\nand cardiac chambers are normal size and the pericardium is physiologic.\n\nPULMONARY ARTERIES:\n\nPulmonary arteries are normal size.  No filling defects or other findings to\nsuggest recent or remote pulmonary emboli.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.  Handful of subcentimeter lower paraesophageal lymph nodes just\nabove the diaphragm are stable.\n\nLUNGS, AIRWAYS, PLEURAE: Inflammatory micro nodules at multiple locations in\nthe lungs, most prominent in the apices, are more pronounced.  A cluster of\nbronchiolar nodules in the right lower lobe, 301:150 one-153 are generally\nsmaller.  Infection is unlikely.  Findings, accompanied by mild the wall\nthickening of small bronchi, absent any bronchiectasis or retained secretions,\nsuggest bronchiolar inflammation, seen in cigarette smokers in some patients\nwith severe allergies.  There are no measurable or enlarging soft tissue\nnodules to suggest metastasis.\n\nSolitary calcified granuloma, right upper lobe, 301:20 is not accompanied by\nany findings to suggest active infection.\n\nNo pleural abnormality is present.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No evidence of intrathoracic malignancy.\n\nIncreased bronchiolar inflammation, usually seen in cigarette smokers or\npatients with severe allergies.\n\nI see no radiographic explanation for chest pain, but I am happy to review\nthis study again, if the referring physician can specify ___ region of focal\ntenderness."
        },
        {
            "input": "HEART AND VASCULATURE: Study is moderately limited in the setting of motion\nartifact.  Within these limitations, the pulmonary vasculature is well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Few subcentimeter lower paraesophageal lymph\nnodes just above the diaphragm are unchanged.\n\nPLEURAL SPACES: No pneumothorax.  New small nonhemorrhagic right pleural\neffusion with adjacent compressive atelectasis.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Diffuse symmetric bronchial wall thickening with peribronchial\ncuffing, findings which can be seen in the setting of smoking history, or\npossibly in the setting of pulmonary edema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please note that the current study is not tailored for\nsubdiaphragmatic evaluation.  Cirrhotic liver with post treatment changes in\nthe right hepatic lobe and multiple additional known lesions, better assessed\non prior MRI liver from ___.\n\nBONES AND CHEST WALL: No suspicious osseous abnormality is seen.? There is no\nacute fracture.  Mild gynecomastia is symmetric.",
            "output": "1. Study is moderately limited in the setting of motion artifact.  Within\nthese limitations, no evidence of pulmonary embolism or acute aortic\nabnormality.\n2. New small right pleural effusion with adjacent compressive atelectasis.\n3. Diffuse symmetric bronchial wall thickening with peribronchial cuffing,\nfindings which can be seen in the setting of smoking history, or possibly in\nthe setting of pulmonary edema."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged. There is no soft\ntissue abnormality in the chest wall suspicious for malignancy. This study is\nnot appropriate for subdiaphragmatic diagnosis.\n\nThere are no thyroid abnormalities warranting further imaging evaluation.\nAtherosclerotic calcification is not apparent head neck vessels or the\ncoronary arteries. Aorta and pulmonary arteries and cardiac chambers are\nnormal size. Pericardium is physiologic. There is no pleural abnormality.\n\nLymph nodes:\n\nThe only enlarged lymph nodes in the chest are at the level of the diaphragm,\nanterior to the inferior vena cava, ranging in diameter up to 9 x 14 mm, and\nmedial to the inferior vena cava ranging in diameter up to 9 x 13 mm, not\nappreciably changed since ___.\n\nLungs:\n\nMild bronchial wall thickening and minimal bronchiolar nodulation, right lower\nlobe, 4:212 are inflammatory, usually due to aspiration, viral infection, or\nallergies.  These are not findings suggesting opportunistic infection.\n\nNo lung nodules concerning for metastasis\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Mild bronchial inflammation.\n\nBorderline enlarged diaphragmatic lymph nodes unchanged since ___\ncould be either inflammatory or malignant.  No other evidence of intrathoracic\nmalignancy or opportunistic infection."
        },
        {
            "input": "Endotracheal tube is in standard position than.  Left-sided central venous\ncatheter ends at the superior cavoatrial junction.  Esophageal drainage tube\nis coiled in the stomach which contains a moderate amount of fluid.  Findings\nbelow the diaphragm will be reported separately.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\n\nThere are no thyroid lesions large enough to warrant further imaging\nevaluation.  Aorta is normal size.  Main pulmonary artery is mildly enlarged,\n33 mm suggesting elevation of pulmonary arterial pressure.\n\nPericardial effusion is small.  Right pleural effusion is minimal.\n\nCm size lymph nodes are present in the lower paratracheal and paraesophageal\nstations.  Hilar contours on this noncontrast study do not suggest adenopathy.\n\nLungs:\n\nRespiratory motion obscures fine detail, but nothing significant.\n\nScattered areas of ground-glass opacity in the upper lungs could be the\nresidual of edema or infection.\n\nLarge areas of consolidation are present in the right lower lobe, superior and\nposterior basal segments and to a smaller degree in the equivalent segments in\nthe left lower lobe, where there is also acinar nodulation.  The left lower\nlobe findings are more typical of residual pneumonia.  Findings on the right\ncould be pneumonia as well or, alternatively atelectasis.  There is no central\nbronchial obstruction, but in the peripheral consolidation, particularly in\nthe right lower lobe some sub segmental bronchi are collapsed probably due to\nmalacia induced by long-term consolidation and retained secretions.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Consolidation, large scale on the right lower lobe, less pronounced on the\nleft.  Left lower lobe findings are probably residual pneumonia, on the right\natelectasis is more likely.  No central bronchial obstruction.  No appreciable\npleural or pericardial effusion.\n\nMild residual pulmonary edema, less likely widespread infection or hemorrhage.\n\nPossible   pulmonary arterial hypertension"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  There is a partially visualized, at least 1.0\ncm hypodensity in the left lobe of the thyroid Supraclavicular and axillary\nlymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Atherosclerotic disease is\nheavy.  Aortic caliber is normal.  The main pulmonary artery measures 3.7 cm,\nconcerning for pulmonary hypertension.  Assessment for subsegmental pulmonary\nemboli is limited by patient motion.  No pulmonary emboli are seen.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis mild to upper emphysema worse at the lung apices.  There is a 4 mm\npulmonary nodule at the left lung base (series 3, image 141).  There is mild\nscarring at the bilateral lung bases.\n\nAIRWAYS:  There is a small amount of secretions in the dependent portion of\nthe mid trachea (series 3, image 47).  There is mild bronchial wall thickening\nin the right lower lobe The airways are patent to the subsegmental level\nbilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  Multiple chronic left lateral mid thoracic rib\nfractures are healed.  Multilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.  A\nsub cm hypodensity in the dome of the liver is too small to characterize but\nlikely represents a simple cyst.  An aortic graft is partially visualized.",
            "output": "1. No pulmonary embolism.  Mild to moderate emphysema.\n2. Pulmonary nodules measure up to 4 mm.\n\nRECOMMENDATION(S):   The ___ pulmonary nodule recommendations\nare intended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed.\n\nIn the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12\nmonths and if no change, no further imaging needed. For high risk patients,\ninitial follow-up CT at ___ months and then at ___ months if no change.\n\nIn the case of nodule size >6 - 8 mm: For low risk patients, initial follow-up\nCT at ___ months and then at ___ months if no change. For high risk\npatients - initial follow-up CT at ___ months and then at ___ and 24 months\nif no change.\n\nIn the case of nodule size > 8 mm: Follow-up CTs at around 3, 9, and 24 months\nor consider dynamic contrast enhanced CT, PET, and / or biopsy"
        },
        {
            "input": "CTA CHEST WITH CONTRAST: Right internal jugular central venous catheter\nterminates in the low SVC.  There is no supraclavicular, axillary, hilar, or\nmediastinal lymphadenopathy.  Esophagus is grossly normal.\n\nThere are large bilateral pulmonary emboli involving the right upper, middle\nand lower lobar branches extending into segmental and subsegmental branches.\nOn the left there is embolism in the main pulmonary artery extending into\nupper, lingular and lower lobar, segmental and subsegmental branches.\n\nThe right atrium and ventricle are enlarged with bowing of the\ninterventricular septum towards the left and reflux of contrast into the\nhepatic veins compatible with elevated right heart pressures and right heart\nstrain. The main pulmonary artery is dilated to 3.5 cm. Small pericardial\neffusion is noted.\n\nThere is a small right nonhemorrhagic pleural effusion. Atelectasis at the\nlung bases is mild. There is no pneumothorax.\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions.\n\nUPPER ABDOMEN: Partially visualized solid organs and stomach are grossly\nnormal.",
            "output": "1. Extensive bilateral pulmonary emboli with evidence of right heart strain.\n2. Small right pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is\nunremarkable.  There is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Patient is with a gastrostomy tube, which appears in situ. \nOtherwise, partially visualized upper abdomen appears unremarkable.\n\nMEDIASTINUM: There are multiple enlarged mediastinal lymph nodes, largest in a\nright pretracheal station, measuring 1.2 cm in short axis (series 302; image\n83), likely reactive.\n\nHILA: There are multiple prominent hilar lymph nodes.  Formal evaluation is\nlymph nodes is limited due to lack of intravenous contrast.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  Mild-to-moderate coronary artery calcifications are identified.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: There is moderate centrilobular and paraseptal emphysema,\nsimilar to prior.  Multiple ground-glass opacities are noted scattered\nthroughout the lungs, most prominent in the upper lobes, some of which appear\nnew compared to ___.  These findings are suggestive of aspiration.\nNo bronchiectasis is seen.\n2. AIRWAYS:  There is soft tissue thickening of the wall of the trachea at the\nlevel of the sternum with wall irregularity and a short segment of severe\nstenosis, likely from prior tracheostomy (series 302; image 27).  Trachea\nappears to narrow to approximately 0.6 cm in diameter, but remains patent\nthroughout its course.\n3. VESSELS:  Main, right, and left pulmonary arteries appear normal in size. \nThe\nCHEST CAGE: No concerning lytic or sclerotic lesions.  No acute compression\ndeformity of the thoracic spine.",
            "output": "1. Scattered ground-glass opacities throughout the lungs, most prominent in\nthe upper lobes appear new compared to ___.  These findings are\nsuggestive of aspiration.  Superimposed infection is difficult to exclude.  No\nbronchiectasis is seen.\n2. Severe, short segment tracheal stenosis is again seen, likely due to prior\ntracheostomy.\n3. Multiple enlarged mediastinal lymph nodes, likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\nGas foci in the upper left anterior chest wall, probably procedure related.\nCatheter inserted in the left subclavian vein with ends in the right atrium.\nAnterior upper mediastinal drain is tunneled in the right paramedian chest. \nChest inferior to the sternal notch is a roughly 4 cm wide high attenuation\ncollection, 2:4, probably hematoma, should be evident on physical examination.\n\nUPPER ABDOMEN: Midline epigastric hernia contains much of the mid stomach.\n\nMEDIASTINUM: Transesophageal drainage tube ends in the region of the pylorus.\nThere are multiple enlarged mediastinal lymph nodes, the largest subcarinal\nmeasuring 1.5 cm in short axis, unchanged since ___.\n\nThere is no mediastinal collection or pneumomediastinum associated with the\ntrachea.\n\nHILA: Borderline enlarged hilar lymph nodes are unchanged.\n\nHEART and PERICARDIUM: Mild calcifications in the aortic arch and ramus. \nHeart is normal in size.  There is no pericardial effusion.\n\nPLEURA: Mild thickening in the posterior aspect of the right upper half.  Tiny\nright pleural effusion layers posteriorly in the upper chest.\nLUNG: Respiratory motion impairs the evaluation of the lungs.\n\n1. PARENCHYMA:  Mild centrilobular and paraseptal emphysema, similar to prior.\nPrevious multifocal ground-glass opacities have resolved.\n2. Subsegmental middle lobe atelectasis.\n3. AIRWAYS: The previous 1.5 cm long upper tracheal stricture, 5 by 7 mm at\nthe level of greatest narrowing has been resected.  Mild postoperative\nnarrowing for length of one cm measures 11 x 12 mm, 302:13.  The remainder of\nthe tracheobronchial tree is normal to subsegmental levels.\n4. VESSELS:  The pulmonary arteries are normal in size.\nCHEST CAGE: Healed fracture, mid sternum.\nSevere degenerative changes in the lower thoracic spine.",
            "output": "No signs of leak following tracheal resection.\n\nSuperficial upper midline chest wall hematoma.\n\nMild postoperative narrowing at the tracheal anastomosis; greatly improved\ntracheal diameter.\n\nNo evidence of aspiration."
        },
        {
            "input": "CTA thorax:\nThe aorta and main thoracic vessels are well opacified.  The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection.The pulmonary arteries are opacified to the segmental level,\nwithout filling defect to suggest pulmonary embolism.  There are several early\nfilling collateral vessels along the right chest wall, as well as early\nfilling phrenic collaterals which feed directly into the upper IVC.  There is\nocclusion of the SVC.  The right brachiocephalic vein is attenuated but\npatent.\n\nCT thorax: The airways are patent to the segmental level.  There is diffuse\nbronchial wall thickening, right greater than left.  A 6 mm nodular opacity in\nthe right upper lobe (03:54) could represent nodular atelectasis, but is\nincompletely characterized.  A moderate right pleural fluid collection is\nslightly hyperdense, suggestive of a hemorrhagic component.  There is no\nsupraclavicular, mediastinal, or hilar lymph node enlargement by CT size\ncriteria.  Left axillary lymph nodes are enlarged, measuring up to 1.6 cm,\npossibly reactive given left upper extremity fistula and recent\nintervention.The heart, pericardium, and great vessels are within normal\nlimits.There is no hiatal hernia.  The esophagus is significantly dilated and\nthick-walled, predisposing this patient to aspiration.There is no\npneumothorax.\n\nOsseous structures: No focal osseous lesion concerning for malignancy is\npresent.\n\nThis exam is not designed for the assessment of intra-abdominal structures. \nPerfusional differences in the liver are likely related to the multiple\ncollateral vessels in the left chest wall and collateral from phrenic vessels\nfeeding directly into the superior IVC.  The remainder of the visualized upper\nabdomen is unremarkable.\n\nOsteomalacia is consistent with chronic renal failure.",
            "output": "1. No evidence of acute pulmonary embolism.\n2. Numerous early filling collateral vessels along the right chest wall, as\nwell as early filling phrenic collaterals which feed directly into the upper\nIVC because of SVC occlusion.\n3. Moderate right pleural effusion, likely hemorrhagic.\n4. Abnormal enhancement of the liver, likely perfusional differences related\nto collateral vessels as described above."
        },
        {
            "input": "MEDIASTINUM: A 1.2 cm hypodense nodule is seen in the right lobe of the\nthyroid.   There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  The aorta and pulmonary arteries are normal in size.   The\nheart size is normal and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  Mild\napical scarring is seen bilaterally.  No concerning pulmonary nodules are\nidentified.  Small calcified granuloma is seen in the right middle lobe.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division. There is small hiatal hernia.",
            "output": "1.  There is a 1.2 cm hypodense nodule in the right lobe of the thyroid. \nRecommend non-urgent thyroid ultrasound for further evaluation, if this has\nnot already been performed.\n\n2.  No concerning pulmonary nodules identified.\n\n3.  Small hiatal hernia.\n\n4.  Findings within the abdomen and pelvis will be reported separately by the\nAbdominal Radiology division.\n\nRECOMMENDATION(S):\nThere is a 1.2 cm hypodense nodule in the right lobe of the thyroid. \nRecommend non-urgent thyroid ultrasound for further evaluation, if this has\nnot already been performed."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Left upper lobe\ncalcified granuloma.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  No consolidation\nwithin the lung."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild calcification of the aorta is noted, similar to the\nprior examination.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Again noted is mild centrilobular emphysema.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is significant for bilateral\nrenal cortical scarring, possibly from prior infection or other insult..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic dissection."
        },
        {
            "input": "Supraclavicular lymph nodes are not enlarged.  Bilateral axillary lymph nodes\nranging in diameter up to 10 x 13 mm on the left, 10 x 14 mm on the right, are\nsmaller today than in ___.  Specifically excluding the breasts which\nrequire mammography for evaluation, elsewhere in the imaged portions of chest\nthere are no soft tissue abnormalities concerning for malignancy or infection.\n\nFindings below the diaphragm will be reported separately.\n\nThere are no thyroid lesions large enough to warrant further imaging\nevaluation.  Atherosclerotic calcification is not apparent head neck vessels\nor coronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.  Pericardium is physiologic.  There is no pleural abnormality. \nEsophagus is unremarkable.\n\n\nIntrathoracic lymph nodes are numerous, but not pathologically enlarged,\nranging in diameter up to 7 mm in the prevascular station, previously 11 mm.\n\nLungs:\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\n There are no bone lesions in the chest cage concerning for malignancy or\ninfection.",
            "output": "Previous mild central adenopathy and more severe axillary adenopathy have\nimproved.  No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 2.2 x 1.6 cm lymph node in the\nright axillary, partially imaged in ___, is larger in comparison to\n___ when it measured 1.6 x 1.1 cm (3:83).\nOtherwise multiple pre-existing, enlarged bilateral axillary lymph nodes are\nunchanged, measuring up to 0.4 x 1.3 cm in the right axillary (02: 17) and 1.6\nx 1 cm in the left axilla (02:23).  None is necrotic.\nThere is no supraclavicular lymphadenopathy.\nExcluding the breasts which must be evaluated by mammography there are no soft\ntissue abnormalities in the chest wall.\nThyroid is unremarkable.\n\nUPPER ABDOMEN: Included upper abdominal organs are unremarkable.\n\nMEDIASTINUM: Scattered subcentimeter lymph nodes in the anterior mediastinum\nare unchanged and not pathologically enlarged per size criteria.  There is no\nhilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart and major vessels are within normal size.  Specks\nof calcifications in the coronaries.  There is no pericardial effusion.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  The lungs\nare clear.\n\nCHEST CAGE: No evidence of osteo destructive lesions concerning for malignancy\nor infection.",
            "output": "Right axillary lymph node is mildly larger in comparison to ___, partially\nimaged in ___, otherwise the bilateral axillary lymphadenopathy is unchanged.\n\nNo evidence of intrathoracic malignancy or lymphadenopathy."
        },
        {
            "input": "The number and size of the pre-existing bilateral axillary lymph nodes has not\nsubstantially changed.  A reference node in the right axilla continues to\nmeasure approximately 18 mm in largest diameter.  There is no evidence of new\nlymph nodes in the soft tissues.  Also overall unchanged is the size of the\nnormal mediastinal lymph nodes.  No new or growing hilar or mediastinal lymph\nnodes.  Stable appearance of the normal cardiac structures.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  Stable minimal hiatal\nhernia.  Status post cholecystectomy.  No acute changes in the upper abdomen. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  The lung parenchyma continues to be unremarkable.  There is no\nevidence of diffuse or focal lung disease.  No suspicious pulmonary nodules or\nmasses.  The airways are patent.  No pleural thickening, no pleural effusions.",
            "output": "Stable bilateral axillary lymphadenopathy.  Stable normal sized lymph nodes in\nthe mediastinum.  No new or growing lymph nodes.  Stable normal appearance of\nthe lung parenchyma."
        },
        {
            "input": "Moderately severe enlargement of the thyroid persists, but produces only\nminimal tracheal narrowing.  There is no discrete lesion warranting further\nimaging evaluation.\n\nSupraclavicular and multiple axillary lymph nodes are not enlarged.  Previous\nbilateral hypervascular axillary adenopathy has resolved.\n\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy or infection.  This study is not appropriate for subdiaphragmatic\ndiagnosis but shows no adrenal mass.\n\nAtherosclerotic calcification is not apparent in head neck vessels or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nThere is no pericardial or pleural abnormality.\n\nLymph nodes:\n\nHandful of prevascular mediastinal lymph nodes ranging in maximum diameter up\nto 11 mm, 5:88, were previously all substantially smaller.\n\nNo other mediastinal lymph or lymph nodes elsewhere in the chest are enlarged\nand hilar contours on this noncontrast study do not suggest adenopathy.\n\nEsophagus is unremarkable.\n\nLungs:\n\nTriangular 3 mm right lower lobe nodule, 5:162, has the configuration of a\nbenign lymphoid aggregate, and is unchanged since ___.\n\nSpherical 3 mm right lower lobe solid nodule, 5:207, is also unchanged..\n\nLungs are otherwise clear.\n\nChest cage.\n\nNo noteworthy findings.",
            "output": "2 tiny right lung nodules stable since ___ are benign and do not\nwarrant further imaging evaluation.\n\nPrevious axillary adenopathy has resolved.  Minimal lymph node enlargement has\ndeveloped in the prevascular mediastinum.  We generally do not recommend\nimaging follow-up unless referable signs or symptoms or adenopathy elsewhere\noccur.  Clinical follow-up is advised rather than repeat imaging.\n\nModerate thyromegaly is chronic and should be evaluated clinically.\n\nRECOMMENDATION(S):  Clinical evaluation for chronic thyromegaly and previous\naxillary adenopathy and current minimal mediastinal lymph node enlargement. \nImaging is not indicated at this time."
        },
        {
            "input": "Cm size left supraclavicular lymph nodes are slightly larger today, 2:6, than\non ___, presumably reactive.  8 mm left axillary nodes are stable.  There\nis no soft tissue abnormality in the chest wall suspicious for malignancy or\nnew infection.  A very small subcutaneous fluid collection in the right flank,\n02:56- 62, was present prior to pleural drainage on ___, probably\nunrelated to either the procedure or infection in the right chest.\n\nAtherosclerotic calcification in the subclavian, innominate, and all major\ncoronaries is substantial.  Fusiform dilatation of the ascending thoracic\naorta are to a maximum diameter between 43 and 45 mm has been present since at\nleast ___ but difficult to measure precisely in the absence of gating. \nAortic valvular calcification is mild.  Pulmonary arteries are not enlarged. \nVery small pericardial effusion is the minimally larger today than on the\npreceding 3 studies.\n\nThe course of a right pleural drainage catheter, through posterior chest wall\nmusculature, a headed superiorly in call curled along the posterior right mid\nchest is unremarkable.  There is no associated bleeding or fluid collection in\nthe chest wall or pleural space.  Catheter resides anterolateral to the very\nsmall volume of residual high attenuation right pleural collection,\nsubstantially smaller today than on ___ which lies mostly posterior to the\nlargely consolidated right lower lobe.\n\nNumerous measurable central lymph nodes range in diameter up to 12 mm in the\nleft lower paratracheal and right lower paratracheal and 14 mm in the sub-\ncarinal stations of the mediastinum.  Slight changes in the sizes of these\nlymph nodes probably reflects variation in growth of reactive lymph nodes. \nThere is no bronchial obstruction, although secretions are pooling in the\ntrachea.\n\nAside from generally low volume in the left lower lobe and subpleural\natelectasis there, left lung is clear.\n\nThe chest CT on ___, performed with intravenous contrast agent suggested a\n19 mm wide circumscribed lesion in the otherwise consolidative right lower\nlobe, 2:160.  This could be a lung abscess or mass.\n\nThis study is not designed for subdiaphragmatic diagnosis.  However it shows a\nlarge gallbladder, with no good evidence for acute cholecystitis although this\nis not a sensitive study in that regard.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\n\n\n\n\n\n\n.",
            "output": "Substantial decrease since ___ in the residual volume of small largely\ndependent right pleural exudate.  Although the pigtail pleural drainage\ncatheter in the right lateral costal pleural space is not contiguous with\nsmall posterior pleural collection, the collection might be accessible to that\ncatheter.\n\nRight lower lobe collapse is not due to bronchial obstruction, more likely\nhypoventilation and pleural restriction.  Small mass or abscess may be present\nin the right lower lobe.\n\nSevere atherosclerosis, including coronaries.  Mild aortic valvular\ncalcification.\n\nModerate central adenopathy, probably reactive."
        },
        {
            "input": "Soft tissues:  Left-sided central venous line terminates in the mid SVC. \nThyroid gland is unchanged.  Mediastinal lymphadenopathy is slightly small,\nparticularly the subcarinal node, overall likely reactive.  Ascending aorta is\nenlarged at 43 mm and main pulmonary artery measures 31 mm, enlarged. Heart\nsize is mildly enlarged with severe diffuse coronary artery calcification and\nmoderate aortic annular calcification.  No pericardial effusion.  Two pleural\ncatheters are in the right pleural space with the new right basilar pleural\ncatheter demonstrating some adjacent air.  Since ___, there is minimal\ndecrease in the loculated posterior basal right pleural effusion.  Small\nhydropneumothoraces along the superior lateral pleural surface are from\ncatheter placement.  This study is not dedicated for subdiaphragmatic\nevaluation and the limited images of the upper abdomen demonstrate low density\nof the hepatic parenchyma compatible with hepatic steatosis.\n\nLungs: The central airways are patent.  There is minimal paraseptal emphysema.\nThe consolidation at the right lung base has overall decreased in extent,\nparticularly at its inferior aspect. Lingular ground-glass nodule (4:156) is\nunchanged from the prior studies and aside from left basilar atelectasis, the\nleft lung is clear.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Minimal decrease in loculated right basilar pleural effusion following\nrecent catheter placement.\n2.  Interval improvement in right lower lobe consolidation."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  The\nheart is enlarged and there is extensive aortic valvular and coronary arterial\ncalcification.\n\nThere is a large right pleural effusion which has increased significantly in\nsize from the prior examination, with a configuration that suggests\nloculation, particularly given its mass effect on the adjacent lung parenchyma\nand the separate collection at the apex (series 602b, image 50).  There is\nessentially total collapse of the right lower lobe with an area of\nhypoenhancement consistent with pneumonia and a 1.8 cm rounded fluid\ncollection consistent with a lung abscess (series 602b, image 32).  There is\nno left-sided pleural effusion.  There is minimal left lower lobe atelectasis.\nThe left lung is clear.  There is no large pulmonary embolism.  The liver is\ndiffusely hypoattenuating, consistent with significant steatosis.\n\nThere are no focal osseous lesions concerning for malignancy or infection. \nThere are multiple old lower anterior rib fractures bilaterally.",
            "output": "1. Large loculated right pleural effusion, much increased from prior study. \nRight lower lobe collapse from compressive atelectasis.  Persistent right\nlower lobe pneumonia with small lung abscess.\n2. Significant hepatic steatosis.\n\nRECOMMENDATION(S):  Thoracentesis is recommended for diagnostic and\ntherapeutic value."
        },
        {
            "input": "The thyroid is homogeneous.  There are multiple prominent bilateral\nmediastinal lymph nodes that do not meet strict size criteria for pathologic\nenlargement but are probably reactive given the increased number, overall\nunchanged compared to the prior examination.  Heart is normal size.  There is\nno pericardial effusion.  Extensive three vessel coronary artery\ncalcifications are again noted.\n\nThe airways are patent to subsegmental level.  There is interval placement of\na pigtail pleural catheter terminating in the right lateral mid-upper chest. \nRight pleural effusion has slightly decreased but remains moderate in size. \nPreviously noted pleural fluid at the right apex has resolved.  Persistent\nheterogeneous opacification at the right base is likely a combination of\npassive atelectasis and pneumonia; although assessment is limited by lack of\nintravenous contrast.  Mild paraseptal emphysema is noted in the upper lobes,\nright more than left.  On the left, there is minimal dependent atelectasis but\nno pleural effusion.\n\nThis study is not optimized for evaluation of subdiaphragmatic structures\nhowever, limited noncontrast view of the upper abdomen is unremarkable.\n\nNo lytic or sclerotic osseous lesion concerning for malignancy identified.",
            "output": "Interval placement of pigtail pleural drain terminating in the right lateral\nmid-upper chest.  The right pleural effusion has slightly decreased but\nremains moderate in size.  Lack of intravenous contrast limits assessment for\nloculation."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nLeft PICC line is in place with tip coiled within right brachiocephalic vein\n\nThe contrast bolus timing is suboptimal.  The pulmonary arteries are opacified\nto the segmental level, with no evidence of filling defect within the main,\nright, left, lobar or segmental pulmonary arteries.  Evaluation of the\nsubsegmental vessels is limited.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere are prominent mediastinal lymph nodes measuring up to 9 mm in short\naxis.  There is an enlarged right hilar lymph node measuring up to 1.4 cm in\nshort axis.\n\nThere is no evidence of pericardial effusion.  There are small bilateral\npleural effusions.\n\nThere are areas of dependent and bandlike bilateral lower lobe atelectasis\nwith mild volume loss.  There is an area of bandlike lingular atelectasis. \nAdjacent patchy ground-glass changes in both lower lobes may be related to\ndependent atelectasis or edema.  However, a superimposed pneumonia should be\nexcluded clinically. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a 1.8 x 1.3 cm hypodensity in\nthe spleen which was not clearly seen on prior exams, including ___.  .  This is adjacent to an area of\ninfarct seen on the prior CT from ___.  This could represent new\ninfarct, or development of a cystic lesion, including abscess.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism.\n2. There is basilar atelectasis.  Areas of ground-glass opacity at both lung\nbases may be related to atelectasis and dependent edema.  However,\nsuperimposed pneumonia should be excluded clinically.  There are no pulmonary\nseptic emboli.\n3. Prominent mediastinal and right hilar lymph nodes may be reactive.\n4. Hypodensity in the superior aspect of the spleen which was not clearly seen\non prior exams.  This may represent a new area of splenic infarct or\ndevelopment of cystic lesion including an abscess.\n5. Left PICC line tip is coiled within right brachiocephalic vein.  1"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is moderate to severe coronary\ncalcifications.\n\nThe central airways are patent.  There are severe emphysematous changes. \nIncreased interstitial markings in the right upper lobe appear chronic (series\n22, image 30).  Bibasilar peribronchiolar opacities are noted, at least some\nof which represent mucous plugging (series 4, image 223.).  Tree in ___\nopacities are also present at the lung bases bilaterally.  Atelectasis is also\npresent at the lung bases bilaterally.  A 6 mm right lower lobe nodule is\nnoted (series 4, image 182).  Additionally, a 10 mm right middle lobe nodule\nis present (series 4, image 195).  Respiratory motion limits assessment of\nthese nodules.  There is no pleural effusion or pneumothorax.\n\nThe visualized portions of the liver, spleen, pancreas, adrenal glands, and\nbowel are unremarkable in appearance.  Left hydronephrosis versus peripelvic\ncysts, likely the latter, are incompletely visualized (series 2, image 74).  A\nnonobstructing 4 mm stone is visualized within the upper pole the right kidney\n(series 2, image 69).  Infrarenal stent graft is noted in the abdominal aorta.\nNo osseous lesion suspicious for infection or malignancy are present.",
            "output": "1.  Two pulmonary nodules, measuring up to 10 mm.  Short-term follow-up with\nCT in 3 months or consideration to PET-CT is recommended according to\n___ society guidelines.\n2.  Severe emphysema.\n3.  Mucous plugging at the lung bases bilaterally with small consolidations. \n___ opacities at the lung bases bilaterally indicative of small\nairways infection or inflammation.  Bibasilar atelectasis.\n4.  Left hydronephrosis or peripelvic cysts, likely the latter, are\nincompletely visualized.  Renal ultrasound could be considered for further\nevaluation.\n5.  Nonobstructing 4 mm right renal stone.\n\nRECOMMENDATION(S):  Dr. ___ the recommendations with Dr. ___\ntelephone at 7:57 ___ on ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  A prosthetic aortic valve is seen with postsurgical\nchanges of the aorta.  Otherwise, the heart and great vessels are within\nnormal limits.  There is a moderate pericardial effusion.  The attenuation of\nthe pericardial effusion is difficult to measure given the extensive streak\nartifact in this region due to the patient's arms being down by her side.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy is present.  No mediastinal mass.  There are several,\nprominent right lower paratracheal lymph nodes, measuring up to 1 cm along the\nshort axis.\n\nPLEURAL SPACES:  There is no pneumothorax.  There is a small, simple left\npleural effusion.\n\n\nLUNGS/AIRWAYS:  There is mild bibasilar atelectasis, worse on the left.  There\nis a focus of linear atelectasis in the left lower lobe.  There is a 4 mm,\nsolid nodule in the left lower lobe (3, 122).  The airways are patent to the\nlevel of the segmental bronchi bilaterally. Incidental note is made of a right\nazygos fissure.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Apparent heterogeneity of the spleen may be secondary to early\narterial enhancement.  Otherwise, the included portion of the upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPatient is status post median sternotomy and sternal wires appear intact.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Expected postsurgical changes status post aortic valve replacement.\n3. Moderate pericardial effusion.\n4. Small, left pleural effusion.\n5. 4 mm, solid nodule in the left lower lobe.\n\nRECOMMENDATION(S):  The ___ Society guidelines for pulmonary nodules\nsuggests that for pulmonary nodules less than or equal to 4 mm, no follow-up\nis needed in low-risk patients, and 12 month follow-up is needed in high-risk\npatients."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size. \nThe heart size is mildly enlarged and there is no pericardial effusion. Mild\natherosclerotic calcifications of the thoracic aorta and of the coronary\narteries.\n\nPLEURA:  There is no pneumothorax.  Small right-sided effusion.  No left\npleural abnormalities.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Biapical thickening\nis moderate.  Mild diffuse bronchiectasis and irregularity.  Peripheral,\nmasslike consolidation in the posterior segment of the left lower lobe\nmeasuring approximately 6.5 x 4.6 cm.  There is central relative hypo density\nwith air-fluid level suggesting necrosis and/or abscess.  Substantial\nbronchial wall thickening and plugging of the right lower lobe bronchi leading\nup to this large opacity.  There is adjacent pleural effusion.  No local\ninvasion into the chest wall.  Mild smooth interlobular septal thickening most\npronounced in the lung bases suggestive of mild edema.  Geographic lobular\nareas of hyperlucency suggestive of air trapping and small airways disease. \nNo suspicious nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton. \nModerate scoliosis with multilevel degenerative changes.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen demonstrates top-normal spleen measuring\nup to 14 cm, and has not substantially changed since ___.  Patulous esophagus\nwith substantial secretions with small hiatal hernia The remaining visualized\nabdomen is unremarkable",
            "output": "Large centrally necrotic consolidation in the right lower lobe with adjacent\nsmall effusion with substantial bronchial wall thickening and plugging of the\nright lower lobe.  The differential includes cavitary bacterial infection\nincluding (Staph, gram-negative bacteria from aspiration given posteromedial\nlocation) or tuberculous infection in the appropriate clinical setting given\nthe weight loss and night sweats.  Imaging features are more suggestive of\ninfection/inflammation rather than malignancy, however close imaging follow up\nis recommended with repeat imaging in 4 weeks.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:00 ___, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "Although no iodinated thyroid is seen, the 22 x 30mm well-circumscribed lesion\nat the thoracic inlet, with an enhancing perimeter, 05:46 is nevertheless a\nlong-standing thyroid nodule ; in ___, when there was recognizable\nthyroid, it was 21 x 28 mm and originated in the right thyroid lobe.  There is\nprobably no supraclavicular or axillary adenopathy.  Subcutaneous tissue of\nthe chest wall is severely fat depleted.  There are no lesions in the chest\nwall suspicious for malignancy or infection.  This study is not appropriate\nfor subdiaphragmatic diagnosis but shows no adrenal mass.\n\nNew there is no enlargement of a hilar or mediastinal, diaphragmatic or\nretrocrural lymph nodes.\n\nAtherosclerotic coronary calcification is present in the LAD.  Aorta and\npulmonary arteries are normal size.  Evaluation of a moderately enlarged heart\nwould require dedicated cardiac imaging such as echocardiography.  .  Small\npericardial effusion is still physiologic.  Tiny left pleural effusion is new.\nSmall nonhemorrhagic layering right pleural effusion is slightly larger today.\n\nModerate, symmetric biapical pleural parenchymal scarring is unchanged. \nResidual consolidation in the superior and posterior basal segments of the\nright lower lobe, including the region of the small persistent cavity, 5:174,\nis much smaller today.\n\n4 mm nodule, left lower lobe, 5:233, 03:47, is unchanged since the torso CT on\n___, 2 08:51.  Lungs are otherwise clear of significant abnormality.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Resolving cavitary pneumonia, right lower lobe.  Stable small associated right\npleural effusion.\n\nChronic right thyroid nodule.  Absence of iodinated thyroid could indicate a\ncondition of hypothyroidism.  Clinical correlation advised.\n\nRECOMMENDATION(S):  Evaluate possible thyroid abnormality."
        },
        {
            "input": "Examination is somewhat limited secondary to made patient respiratory motion\nartifact.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer.\n\nEvaluation of subsegmental pulmonary arteries is somewhat limited. The\npulmonary arteries are well opacified, with no evidence of filling defect\nwithin the main, right, left, lobar, or segmental pulmonary arteries. The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThere is no evidence of pericardial effusion. The heart is normal in size.\nThere are moderate coronary artery calcifications.\n\nMultifocal patchy consolidations occupying the right upper lobe, right lower\nlobe, lingula and left upper lobe are most concerning for multifocal\npneumonia. There is moderate paraseptal and centrilobular emphysema. There are\nsmall bilateral pleural effusions.  The airways are patent to the subsegmental\nlevel.\n\nThere is no supraclavicular, axillary or hilar lymphadenopathy.  Small\nmediastinal lymph nodes do not meet CT size criteria for lymphadenopathy and\nare likely reactive in nature. The thyroid gland appears unremarkable.\n\nLimited images of the upper abdomen show a tiny hypodensity in the left\nkidney, not fully imaged. Otherwise, the visualized upper abdominal organs are\nwithin normal limits.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nOld fracture is seen in the posterior aspect of the left seventh rib.",
            "output": "1.  Limited examination secondary to patient respiratory motion artifact. No\nlarge central pulmonary embolism. Evaluation of subsegmental pulmonary\narteries is somewhat limited.\n\n2. Multifocal pneumonia.\n\n3. Small bilateral pleural effusions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is biatrial enlargement, right greater than left\nwith moderate cardiomegaly.  The pericardium, and great vessels are within\nnormal limits.  Trace pericardial effusion likely physiologic.  Mild coronary\nartery calcifications are noted.  There is reflux of contrast into the IVC.\n\nAXILLA, HILA, AND MEDIASTINUM: Mildly enlarged bilateral axillary lymph nodes\nmeasuring up to 0.9 cm in short axis.  Prominent mediastinal lymph nodes are\nlikely reactive measuring up to 0.9 cm in short axis (2; 49).  There is an\nenlarged right hilar lymph node measuring 2.0 x 3.4 cm (2; 54).  Enlarged left\nhilar lymph node measuring 1.7 cm in short axis also noted.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  There is scarring and\nsignificant bronchiectasis and airspace opacification in the right upper lobe.\nSeptal thickening of the right upper lobe can be seen in the fluid overload. \nMultiple pulmonary nodules are noted: 5 mm right lower lobe (3; 186), right\nmiddle lobe nodules measuring up to 3 mm, a triangular shaped 5 mm nodule in\nRML (3; 143), a RLL 5 mm nodules (3; 175), 5 mm RLL nodule (3; 117), 2 mm\nnodule left upper lobe (3; 123), 3 mm left apical nodule (3; 32), and a 5 mm\nmedial left lower lobe subpleural nodule (3; 121).  There is bilateral\ncentrilobular and paraseptal emphysema.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild multilevel degenerative changes are noted, most notable at C7-T1.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Right upper lobe findings of bronchiectasis with airspace opacities and\nbilateral hilar adenopathy can be seen in setting of infectious process,\natypical mycobacterial infectious process/tuberculosis, and sarcoidosis can be\nconsidered.\n3. Extensive mediastinal and hilar lymphadenopathy may be reactive in\netiology.\n4. Bilateral septal thickening in the right greater than left lung can be seen\nwith mild fluid overload.\n5. Bilateral pulmonary nodules measuring up to 5 mm are noted, see below for\n___ criteria.\n\nRECOMMENDATION(S):\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 3:04 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid moderately enlarged\nwith multiple nodules, including several partially calcified nodules (2:1). \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Numerous mediastinal lymph nodes are likely reactive.  None meet\nCT size criteria for pathologic enlargement.  Biventricular pacemaker/ICD\nnoted.\n\nHILA:  Left hilar lymph nodes are not enlarged.  The right hilum is obscured\nby the underlying parenchymal process.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is a small to moderate pericardial effusion.  A left\npectoral dual-chamber pacemaker and its leads are in appropriate position.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Extensive airspace opacification involves nearly the\nentirety of the right lung.  Superiorly this appears to be a combination of\npulmonary edema and consolidation, while inferiorly there is relatively\nuniform fluid density with scattered central punctate calcifications.  The\npulmonary vasculature can be seen traversing the relatively homogeneous right\nlower lung zone suggesting dense consolidation or collapse.\n\nAIRWAYS:  There is near complete occlusion of the right bronchus intermedius\nwith very little air seen in any of the distal segmental or subsegmental\nbronchi (4:126).  The right upper lobe bronchi and the left-sided bronchial\ntree remains patent to the subsegmental level.\n\nPLEURA:  There is a moderate loculated hydropneumothorax on the right with the\nlargest component of air seen anteriorly (04:11 147).  There is no left\npleural effusion.\n\nCHEST WALL AND BONES:  A focal nonexpansile lucent lesion in the proximal left\nfifth rib may represent fibrous dysplasia in the absence of known underlying\nmalignancy (02:21).  An area of nodular sclerosis within the lateral right\nthird rib may represent a small cluster of bone islands (02:17).  Multilevel\ndegenerative changes are mild.  Extensive subcutaneous edema is noted along\nthe right chest wall related to the right chest tube.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\ncholelithiasis and moderate porta hepatis lymphadenopathy.",
            "output": "1. Extensive opacification of the right lung is difficult to fully evaluate\nwithout the use of IV contrast.  There is likely a combination of extends\nright lung consolidation and collapse, most likely postobstructive in the\nsetting of near complete collapse of the bronchus intermedius.\n2. Moderate anteriorly loculated hydropneumothorax is similar to prior chest\nradiographs with minimal pleural fluid laterally and posteriorly.\n3. Small to moderate pericardial effusion.\n4. Enlarged multinodular thyroid gland for which nonemergent thyroid\nultrasound is recommended.\n5. Mediastinal adenopathy may be reactive.\n6. Indeterminate focal bone lesions are likely benign incidental findings. \nAttention on follow-up imaging is recommended.\n7. Cholelithiasis.\n\nRECOMMENDATION(S):\n1. Consider chest CT with contrast to further evaluate the parenchymal and\nhilar abnormalities described above.\n2. Nonemergent thyroid ultrasound is recommended.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:47 ___, 8 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Both lobes of the thyroid gland are substantially enlarged, but there is no\nappreciable compromise of tracheal lumen and there are no thyroid findings\nwarranting further imaging evaluation.\n\nSupraclavicular and axillary stations are partially obscured by a pacemaker\nimaging artifact, but no adenopathy is detected.  Gynecomastia is mild to\nmoderate and symmetric.  There are no soft tissue abnormalities in the chest\nwall suspicious for malignancy.  This study is not appropriate for\nsubdiaphragmatic diagnosis but shows no adrenal mass.\n\nAtherosclerotic calcification is heavy in head neck vessels and the right\ncoronary arteries.  Aortic valvular calcification is moderate.  Aorta is\nnormal size.  Pulmonary arteries are enlarged, right 34 mm, previously 33 mm.\n\nThere is no pericardial effusion.  Small right pleural effusion, largely\ndependent, is nonhemorrhagic, traversed by pleural drainage tube common\nsubstantially smaller today than it was on ___.  At the medial aspect of\nthe right lung base along the spine, 4:205, there is either a small region of\npersistent subpleural atelectasis or mild pleural nodulation.  Elsewhere,\nthere is no pleural thickening or enhancement to suggest either malignancy or\ncontinuing inflammation.\n\nSub cm mediastinal lymph nodes are numerous, but neither mediastinal, hilar,\ninternal mammary, diaphragmatic or retrocrural lymph nodes are pathologically\nenlarged.\n\nThere are no lung lesions concerning for malignancy.  Bronchial wall\nthickening is mild.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No good evidence for intrathoracic malignancy.  Questionable nodular pleural\nthickening or subpleural atelectasis, is extremely limited.  Profile of\npleural fluid should help determine whether there is real concern for\nmalignancy.\n\n\nCoronary atherosclerosis.\n\nAortic valvular calcification is sufficient to be hemodynamically significant\nand, along with Possible pulmonary arterial hypertension, should be evaluated.\n\n\nRECOMMENDATION(S):  Evaluate possible aortic stenosis and possible pulmonary\narterial hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 6 mm hypodense nodule in the left\nlobe of the thyroid gland, stable.  Otherwise normal thyroid gland. No\nenlarged or growing supraclavicular or axillary lymph nodes.  Breast\nassessment is reserved for dedicated breast imaging.  Excluding the breasts,\nno soft tissue chest wall abnormality.  Moderate atherosclerotic calcification\nof the imaged neck arteries.\n\nUPPER ABDOMEN: Please see the CT abdomen and pelvis report dated the same day\nfor evaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Normal esophagus.  No enlarged or growing mediastinal lymph\nnodes.  No mediastinal mass.  The thoracic aorta and pulmonary arteries are\nnormal in caliber.  Moderate atherosclerotic calcification of the thoracic\naorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size.  Fatty infiltration of the\ninteratrial septum, with a possible 10 mm atrial septal defect.  This would be\nbetter evaluated on echocardiography.  The cardiac chambers are of normal\nsize.  Moderate coronary artery calcification.  Right coronary artery stent\nnoted.  No cardiac valve calcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax. Mild biapical pleuroparenchymal\nscarring.\n\nLUNG:\n\n1. PARENCHYMA: No lung nodule or mass. No consolidation.  Unchanged mild\ninterstitial abnormality at the lung bases, left greater than right, with\nseptal thickening and heterogenous ground-glass opacification, which may\nrepresent residual mild pulmonary edema or early non-specific interstitial\npneumonia. Moderate predominantly centrilobular emphysema, stable.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nNo bronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE: 3 mm sclerotic focus in the anterior aspect of T4 vertebral body\n(602:81), stable and likely representing a bone island.  No lytic or sclerotic\nlesion concerning for infection or malignancy.  No fracture.  Mild\nspondylosis.",
            "output": "-No lung nodule or mass.  No evidence of intrathoracic malignancy.\n-Unchanged mild interstitial abnormality at the lung bases, left greater than\nright, with septal thickening and heterogenous ground-glass opacification,\nwhich may represent residual mild pulmonary edema or early non-specific\ninterstitial pneumonia.\n-Moderate predominantly centrilobular emphysema, stable.\n-Fatty infiltration of the interatrial septum, with a possible 10 mm atrial\nseptal defect.  Echocardiography is advised for further evaluation.  The\ncardiac chambers are of normal size.\n\nRECOMMENDATION(S):  Echocardiography should be considered for further\nevaluation of a possible atrial septal defect."
        },
        {
            "input": "CHEST PERIMETER: Hypodensity in the left thyroid lobe is too small to justify\nfurther imaging evaluation.  Supraclavicular and axillary lymph nodes are not\nenlarged.  Breast evaluation is reserved exclusively for mammography.  No soft\ntissue abnormalities elsewhere in the chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification is\nmoderate to heavy in the head and neck vessels and in coronary arteries. \nThere may be a right coronary stent.  Fatty infiltration of the interatrial\nseptum is noted, but is usually not clinically significant.  Aortic valve is\nnot calcified.  Aorta and pulmonary arteries and cardiac chambers are normal\nsize and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE: No lung nodules or other focal lung lesions of\nconsequence.  Mild bronchial dilatation in the lower lobes is not accompanied\nby appreciable bronchial wall thickening or peribronchial infiltration.  There\nis a mild interstitial abnormality at the base of the left lung consisting of\nseptal thickening and heterogeneous ground-glass opacification.  This could be\neither residual mild pulmonary edema or early nonspecific interstitial\npneumonia.\n\nCHEST CAGE: Small densely blastic nodule anterior aspect upper thoracic\nvertebral body, 302:58 is probably benign.  Although there are no bone lesions\nin the imaged chest cage suspicious for malignancy or infection, it should be\nnoted that radionuclide bone and FDG PET scanning are more sensitive in\ndetecting early osseous pathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nHeavy atherosclerotic calcification including head and neck and coronary\narteries.\n\nInterstitial abnormality left lower lobe could be residual edema or early NS\nIP, should be evaluated clinically."
        },
        {
            "input": "HEART AND VASCULATURE:  The main pulmonary artery measures mildly enlarged at\n3.4 cm which can be seen in the setting of pulmonary arterial hypertension. \nThe thoracic aorta is normal in caliber.  The heart and pericardium are within\nnormal limits.  Moderate to severe atherosclerotic calcification is seen in\nthe coronary arteries.  There is mild atherosclerotic calcification of the\naortic valve as well as the thoracic aorta.  There is note of cardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is right hilar lymphadenopathy with a\nreference 1.1 cm lymph node seen on ___:70.  No axillary or mediastinal\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  There is no pneumothorax.  There is a trace right pleural\neffusion.\n\n\nLUNGS/AIRWAYS:  The central airways are patent.  There are extensive\nground-glass and airspace opacities throughout the entire right lung, as seen\non the chest x-ray from earlier today.  There are a few 2 mm pulmonary micro\nnodules in the left upper lobe and left lower lobe (___:11 and 24).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is significant for\nsurgical absence of the gallbladder.  Punctate calcifications within the\nspleen as are compatible with granulomas related to prior granulomatous\ndisease.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Extensive ground-glass and airspace opacities throughout the entire right\nlung, as seen on the chest x-ray from earlier today, is compatible with\npneumonia.  Trace right pleural effusion is likely reactive\n2. Pulmonary artery measures mildly dilated at 3.4 cm which can be seen in\nsetting of pulmonary arterial hypertension.\n3. There are three 2 mm pulmonary micro nodules in the left upper lobe and\nleft lower lobe.  The ___ society pulmonary nodule recommendations are\nintended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm. In\nthe case of nodule size <= 4 mm: No follow-up needed in low-risk patients. For\nhigh risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed.\n4. Status post cholecystectomy.\n This preliminary report was reviewed with Dr. ___\nradiologist."
        },
        {
            "input": "Aortic arch anatomy is conventional. The thoracic aorta is normal in caliber.\nThe main, left, and right pulmonary arteries are normal in caliber without\nevidence of a filling defect indicate the presence of any incidental large\ncentral pulmonary embolus.  Coronary artery calcifications are mild. The heart\nis normal in size. No evidence of a pericardial effusion. The left subclavian\nvein is attenuated across the first rib.\n\nNo pathologically enlarged axillary or mediastinal lymph nodes. A right hilar\nlymph node is slightly  enlarged,  13 mm in short axis (series 5, image 25). \nThe thyroid enhances normally and is not enlarged. No evidence of thyroid\nmasses.\n\nA right lower lobe solid pulmonary nodule is 5 mm (series 6, image 137; series\n10, image 29).  Bibasilar dependent atelectasis is mild. The left lung is\notherwise clear. No  pleural effusion or pneumothorax.\n\nNo osseous lesions concerning for malignancy or infection.  Multi-level\ndegenerative changes in the thoracic spine are moderate with findings\nconsistent with diffuse idiopathic skeletal hyperostosis.  Degenerative\nchanges in the lower posterior sternum are moderate.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "Indeterminate 5-mm right lower lobe pulmonary nodule and mild ipsilateral \nadenopathy. The nodule is too small for accurate assessment with PET-CT.\nConsider follow-up chest CT in 3 months, although the absence of interval\ngrowth at 3 months would not exclude malignancy since GIST can be slow\ngrowing.\n\nRECOMMENDATION(S):  Consider chest CT in 3 months for indeterminate 5 mm right\nlower lobe pulmonary nodule follow-up.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 15:23 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.  This study\nwas not tailored to evaluate the subdiaphragmatic organs.\n\nUPPER ABDOMEN: No hiatal hernia.  No adrenal lesions.  Asymmetry of the\nkidneys with a hypotrophic appearance of the left kidney.\n\nMEDIASTINUM: No new or enlarging mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve or coronary artery calcification.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  7 mm pulmonary nodule right lower lobe (5, 137) appear similar\ncompared to prior imaging (previously measured as 5 mm, but I measured it as 7\nmm on the previous and current studies).  No other pulmonary nodules or\nmasses.  No confluent airspace consolidation.  No diffuse lung disease.\n2. AIRWAYS:  Mild asymmetry of the vocal cords (mild medialisaton of the right\ncord).  The airways are patent to the subsegmental level.  No bronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Stable imaging findings of the chest.\n\nSmall pulmonary nodule in the right lower lobe is unchanged compared to prior\nimaging."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nBreathing motion artifacts degrade the images and limits the evaluation of the\nsegmental and subsegmental pulmonary arteries.  No  evidence of filling defect\nwithin the main, right, left and lobar, pulmonary arteries.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nMultinodular goiter is redemonstrated, with multiple heterogeneous thyroid\nnodules.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nHeterogeneously enhancing consolidations in the bilateral lower lobes are\nsuggestive of a combination of pneumonia and atelectasis.  Additionally there\nare focal areas of airspace disease in the bilateral upper lobes suggesting\nmultifocal pneumonia.  Multiple ___ nodules are also noted. The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen shows a small hiatal hernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  Consolidations in the bilateral lower lobes along with airspace opacities\nin the bilateral upper lobes and ___ nodules, in keeping with\nmultifocal pneumonia.  Follow-up to complete resolution is recommended.\n2.  Breathing motion artifacts limit the evaluation of the segmental and\nsubsegmental pulmonary arteries.  Within this limitation, no evidence of\npulmonary embolus.\n3.  Multinodular goiter is redemonstrated with multiple heterogeneous thyroid\nnodules.  Follow-up with thyroid ultrasound is recommended.\n\nRECOMMENDATION(S):  Please see recommendations above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:34 pm, 5\nminutes after discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcifications are re-demonstrated\notherwise the heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Atelectasis is visualized at the lung bases bilaterally. \nAdditionally focal opacities are visualized in the left lower lobe which may\nrepresent sequelae of aspiration.  Are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: An enlarged multinodular thyroid is re-demonstrated with\nmultiple subcentimeter thyroid nodules bilaterally, as on prior.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a Bochdalek's\nhernia as well as diffuse colonic diverticulosis without associated focal\nbowel wall thickening or adjacent fatty stranding.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bibasilar atelectasis with left lower lobe opacities which may represent\nsequelae of aspiration."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: A hypodense nodule in the left\nthyroid lobe measures 8 mm (4:20).  Axillary and supraclavicular nodes are not\npathologically enlarged by size criteria.\n\nUPPER ABDOMEN: A simple cyst in the right lobe of the liver measures 58 x 58\nmm.Included images of the upper abdomen are otherwise unremarkable.\n\nMEDIASTINUM: Multiple mediastinal lymph nodes are all sub-cm in size, the\nlargest measuring 6 mm in the left prevascular station (4:92).  Esophagus is\npatulous.\n\nHILA: There is prominent lymphoid tissue in the bilateral hila, measuring up\nto 18 mm on the right (4:110).\n\nHEART and PERICARDIUM: Heart is normal in size.  Trace pericardial effusion.\nPLEURA: No pneumothorax.  Trace pleural effusions, left greater than right.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar subsegmental atelectasis likely explains the opacity\nseen on the recent radiograph performed ___.  No other pulmonary nodules\nor concerning opacities.\n2. AIRWAYS:  Airways are patent.  Mild diffuse bronchial wall thickening,\nlikely reflecting chronic small airways inflammation.\n3. VESSELS:  Normal caliber thoracic aorta, without notable atherosclerotic\ncalcifications.  Pulmonary arteries are normal in caliber.\nCHEST CAGE: No concerning lytic or sclerotic lesions suspicious for\nmalignancy.",
            "output": "1. Bibasilar subsegmental atelectasis, likely explaining the opacity seen on\nthe recent CXR.\n2. Mild diffuse bronchial wall thickening, suggestive of chronic small airways\ninflammation.\n3. Trace pericardial and left greater than right pleural effusions,\nunexplained.\n4. Prominent hilar lymphoid tissue, may be reactive.\n5. 8 mm left thyroid nodule for which no further followup is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nUnchanged 1.2 cm hypodense cyst in the right thyroid lobe (03:16).  No\nenlarged lymph nodes in either axilla or thoracic inlet.  Left anterior port\nwith tip in the cavoatrial junction.  No atherosclerotic calcifications in the\nhead and neck arteries.  No abnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Small\nmediastinal lymph nodes, none pathologically enlarged by CT size criteria.  No\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Small scattered calcified\ngranulomas, for example the left lower lobe (3:127).  Stable micronodule in\nthe right lower lobe (3:109).  No new nodules.\n\nCHEST CAGE:\nNo suspicious lytic or sclerotic lesions.  No acute fractures.  Mild\ncompression deformity in T9, unchanged.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___ with no definitive\nevidence of intrathoracic metastatic disease."
        },
        {
            "input": "Right thyroid nodule is 11 mm, series 3, image 4.  Aorta and pulmonary\narteries are normal in diameter.  No mediastinal, hilar or axillary\nlymphadenopathy is present.  Heart size is normal.  There is no pericardial\npleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Apical scarring is\nsymmetric, bilateral.  No pulmonary nodules masses or consolidations\nconcerning for metastatic disease or infection demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis and corresponding report will be issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nCompression fractures of T11 and T9 a demonstrated, mild to moderate,\nchronicity and clear.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal and intrapelvic pathology."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes. Heart size\nis normal and focal coronary artery calcifications are present. There is no\npericardial or pleural effusion.\n\nWithin the lungs, a dominant 12 mm nodule in the right lower lobe (image 248,\nseries 8) is similar in size when compared to images of the lung bases from\nabdominal CT of ___. This nodule demonstrates internal low density\nsuggestive of necrosis with peripheral enhancement. Several additional 2-3 mm\ndiameter nodules are seen bilaterally, with representative examples located in\nthe right apex (___), posterior right upper lobe (126), left upper lobe (141),\nright middle lobe (166), left lower lobe (167). A nonspecific sub solid\nopacity in the superior segment of the right lower lobe measures 7 mm (119, 8)\n\nThere are no suspicious lytic or blastic skeletal lesions in the thorax.\nBilateral mild gynecomastia is noted in the chest wall.",
            "output": "1. Dominant 12 mm right lower lobe lung nodule is similar to recent abdominal\nCT of ___.  Additional subcentimeter bilateral nodules are also\nsuspicious for pulmonary metastases.\n\n2. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Chest CT with contrast was performed at the recommendation of the report of\nthe ___ study specifically to better assess an area of presumed\nround atelectasis in the right middle lobe.  Its current measurements of 3.1 x\n2.9 cm are slightly greater than on the recent CT, possibly due to slight\nincrease in size of the right pleural effusion in the interval.  Its\nenhancement pattern is similar to that of for region of atelectatic lung in\nthe right lower lobe.\n\nMultiloculated hydro pneumothoraces are again demonstrated with overall\nincreased in fluid and decrease in gas component of the major loculated hydro\npneumothorax component.  Ground-glass opacification and interstitial\nthickening persist in the right lower lobe as well as a region of atelectasis\nadjacent to the pleural effusion.\n\nOther previously described findings in the thorax and upper abdomen are\nunchanged since the recent study of 1 day earlier.",
            "output": "Slight increase in size of rounded opacity in right middle lobe, which\nprobably represents increased atelectasis in response to slight increased size\nof adjacent right pleural effusion.  Exam is otherwise unchanged since recent\nstudy of 1 day earlier.\n\nRECOMMENDATION:\n\nFollowup chest CT in 3 months to reassess the right middle lobe opacity in\norder to exclude the possibility of malignancy at this site."
        },
        {
            "input": "Mediastinal fat stranding is extensive, and appears to be even more pronounced\nthan on the previous study.  There is interval increase in pericardial\neffusion.  Mediastinal lymph nodes have increased in the interim.  Bilateral\npleural effusions with loculations and in case meant on the right are\nunchanged as well as associated right basal rounded atelectasis, right\nsubstantially more than left.  Endobronchial secretions are extensive but no\ndefinitive bronchial obstruction is seen.  The largest area of secretions is\nat the level of the distal trachea at the bifurcation.  No pulmonary nodules\nmasses are consolidations demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.",
            "output": "No change in loculated right-sided pleural effusion with pleural thickening\nthe finding might represent empyema as previously stated.  No change since\nprior study demonstrated.\n\nInterval increase in pericardial effusion.\n\nMediastinal lymphadenopathy that has increased in the interim.  Increased in\nmediastinal fat stranding the might be concerning for medius to 9 is.\n\nCardiomegaly, unchanged."
        },
        {
            "input": "Mild enlargement of the right thyroid lobe with presence of a difficult to\ndelineate hypodense nodule is stable, resulting in mild leftward deviation of\nthe cervical trachea.  There is no supraclavicular, mediastinal, or obvious\nhilar lymphadenopathy. Multiple prominent bilateral axillary lymph nodes\nmeasure up to 1.5 x 2.1 cm on the right (2, 13).  The appearance is not\nsignificantly changed since ___.\n\nModerate cardiomegaly with multichamber enlargement is unchanged. There is no\npericardial effusion. The main pulmonary artery and thoracic aorta are normal\ncaliber.\n\nA large nonhemorrhagic right pleural effusion has increased since ___, resulting in near right lower lobe collapse. No endobronchial lesion is\nidentified.  There is no definite pleural thickening or nodularity. There is\nno pulmonary nodule, mass or consolidation.\n\nModerate bilateral symmetric gynecomastia has increased.\n\nThere are mildly expansile lytic lesions involving the right fifth and sixth\nanterolateral ribs (4, 126 and 147) and left fourth lateral rib (4, 70). There\nis a healing nondisplaced fracture of the right nineth lateral rib with\nassociated callus formation (4, 211). There are also lytic lesions involving\nthe bilateral scapulae (04: 15 and 52). These are all new since the prior CT\nfrom ___. Anchoring screws at the partially imaged right humeral\nhead denote prior rotator cuff repair.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Increased large nonhemorrhagic right pleural effusion results in new severe\nright lower lobe passive atelectasis.  A repeat CT scan following drainage is\nsuggested to exclude right lower lobe malignancy or other acute pathology.\n\nMultiple new expansile lytic lesions involving the right fifth, right sixth\nand left fourth ribs, as well as the bilateral scapulae, are new since\n___. The differential diagnosis includes metastases, multiple\nmyeloma and brown tumors."
        },
        {
            "input": "The thyroid is unremarkable.  Scattered mildly enlarged mediastinal lymph\nnodes measuring up to 11 mm in the right upper paratracheal station are\nunchanged.  Heart size is severely enlarged.  There is no pericardial\neffusion.  The main pulmonary trunk is dilated up to 33 mm.  There is no\nthoracic aortic aneurysm.  There are no Coronary artery or aortic valvular\ncalcifications.\n\nThe airway is patent to the segmental level bilaterally.  There is a moderate\nmultiloculated right sided hydropneumothorax, nonhemorrhagic.  There is\nassociated atelectasis with a more nodular area of consolidation in the right\nmiddle lobe measuring 30 x 24 mm  (series 6b, image 76).  There is septal\nthickening at the right lung base which likely reflects mild re-expansion\npulmonary edema.  There is a trace left pleural effusion.\n\nThe thoracic esophagus is tortuous.  Limited views of the upper abdomen\ndemonstrate a hypodensity in segment III of the liver previously characterized\nas a cyst (series 3, image 50).  The gallbladder is mildly dilated.\n\nOSSEOUS STRUCTURES/SOFT TISSUES:  Multiple healed right rib fractures are\npresent.  Irregularity of the sternum is likely artifactual.  There are no\nsuspicious bony lesions.  There are multilevel degenerative changes.  There is\nfluid within the subacromial subdeltoid bursa on the left, unchanged.  In\naddition, there are loose bodies within the right glenohumeral joint.",
            "output": "1. Small to moderate multiloculated right hydropneumothorax with associated\natelectasis.\n2. Rounded area of consolidation in the right middle lobe, likely\ncorresponding to findings on chest radiograph from ___, while this\nfinding likely represents rounded atelectasis, without IV contrast is\ndifficult to exclude underlying malignancy or abscess.  When clinically able\nthe patient should return to radiology for a chest CT with contrast.\n3. Cardiomegaly.\n\nRECOMMENDATION(S):  Please see impression # 2 Regarding chest CT with\ncontrast.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 5:21 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, or dissection. Diffuse thoraco abdominal aortic aneurysm\nis re- demonstrated. Maximum ___ of the ascending aorta measures\nroughly 44 x 43 mm at the approximate level of the main pulmonary artery,\nsimilar to prior study. Maximum axial ___ of the descending aorta at\napproximately the T10 level measures 65 x 46 mm, unchanged from the prior\nstudy. There is moderate calcified and noncalcified atheromatous burden with\nprominent areas seen again at the level of the left main pulmonary artery the\nwith quite a large noncalcified atheroma at the thoracoabdominal junction.\nAbdominal aorta is only seen prior to the celiac axis take-off.\n\nThe pulmonary arteries are well opacified to the segmental level without\nevidence of embolus.  The distal pulmonary arterial tree is not well evaluated\ndue to contrast timing. The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion.  Heart size is normal.\n\nBy apical scarring is mild. Linear scarring is noted in the anterior segment\nof the right upper lobe and superior lingular segment. 3 mm nodule in the\nanterior segment of the right upper lobe (6:173) is unchanged. Another 2 mm\nnodule in the anterior segment of the right upper lobe was seen just caudally\nis stable (6:176). Another 2 mm in the posterior segment of the right upper\nlobe (6:1 L4) is stable. 3 mm nodule in the posterior segment of the right\nupper lobe is stable (6:80). 1 mm nodule at the left lung base (6:226) is\nstable. There is no growing, dominant or new nodule. Subtle areas of\nperipheral predominant, peribronchovascular ground-glass is new. There is no\npleural effusion. The airways are patent to the subsegmental level. Diffuse\nbronchial wall thickening is re- demonstrated.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe imaged thyroid gland appears unremarkable.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Stable diffuse thoracic aortic aneurysm with similar appearance of\ncalcified and noncalcified atherosclerotic plaque burden. Areas of\nnonocclusive thrombus appears similar.\n3. New, quite subtle areas of peripheral predominant ground-glass in the\nbackground of bronchial wall thickening, nonspecific, suggestive of\ninflammatory or infectious change in the background of bronchiolitis.\n4. Stable sub 4 mm nodules, as above. These do not require further\nsurveillance in low risk patients; if high risk factors such as smoking are\npresent, surveillance examination is advised in 12 months per ___\nsociety recommendation."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta is normal size.  The main pulmonary artery is\nminimally increasing size measuring 3.3 cm. There is mild cardiomegaly and\nminimal calcifications in the aortic valve.\nThere is mild air trapping.\nRespiratory motion artifact limits the evaluation of the lungs.\nLung nodules are as follows:\nIn the right upper lobe: 5 mm (06:57)\nRight middle lobe 2 mm (6:119) 3 mm (6:146, 151) 1 mm subpleural (6:154)\nIn the lingula 3 mm (6:139)\nIn the right lower lobe 5 mm (6:159)\nThere are no pleural pericardial effusions\nThere is a small hiatal hernia\nThis examination is not tailored for subdiaphragmatic evaluation: The upper\nabdomen is unremarkable.\nThere are no bone findings of malignancy.",
            "output": "Multiple lung nodules as above followup in ___ year is recommended\nMild air trapping\n\nRECOMMENDATION(S):  Followup in ___ year is recommended"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.\n\nThe aorta is normal in size.  The pulmonary arteries are mildly enlarged at\n3.3 cm. Cardiac configuration is normal.  Coronary and aortic valve\ncalcifications are again noted.\n\nThe previously described lung nodules are measured as follows:\nRight upper lobe:  5 mm (5:74), previously measured 5 mm in ___.\nRight middle lobe:  3 mm (5:165), previously measured 2 mm.  2 subpleural\nnodules measuring 3 mm (5:194, 201), previously both 3 mm.  Lastly, unchanged\n1 mm subpleural nodule (5:206).\nIn the right lower lobe: 5 mm nodule (5: 189), previously 5 mm.\nIn the lingula:  4 mm (5:184), previously 3 mm.\nIn the left lower lung:  New 4 mm (5:176) nodule in an area of new\natelectasis, may be due to focal lung collapse but will need to be followed up\nin 3 months.\n\nThe airways are patent to the subsegmental level.  Some tracheal collapse is\nnoted, which may represent tracheomalacia.  Mild dependent bilateral\natelectasis is noted.\n\nModerate degenerative changes are seen in the visualized spine, particularly\nin the cervical spine.  No lytic or sclerotic osseous lesions concerning for\nmalignancy are identified.\n\nA small hiatal hernia is again seen.  The esophagus appears somewhat thickened\nbut is unchanged compared to previous exam..  The limited views of the upper\nabdomen are grossly unremarkable.",
            "output": "1. Redemonstrated multiple known pulmonary nodules as well as a new left lower\nlobe nodule as measured in detail above.\n2. Tracheal collapse is noted, possible representing tracheomalacia.\n\nRECOMMENDATION(S):  Follow up is recommended in ___ for evaluation of\npossible new pulmonary nodule.\nA CT Tracheomalacia exam can be obtained for further evaluation of the\ntrachea."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Increased hepatic density measuring 72 ___ (55\n___ is normal.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Cardiomegaly.  No\npericardial effusion.  Mild aortic valve calcification.  Mild left coronary\nartery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Please note that despite a repeat study motion artifact obscures\nthe lower lung zones.  The pre-existing pulmonary nodules are unchanged with\nthe largest nodule measuring 5 mm in the right lower lobe (14, 191).  No new\nor enlarging pulmonary nodules or masses.  No diffuse lung disease.  Mild\nsubpleural micro atelectasis and lobular air trapping.\n-AIRWAYS:  Patent to the subsegmental level.  The study was performed during\nexpiration.\n-VESSELS:  The pulmonary artery is slightly dilated measuring 34 mm in\ndiameter.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "The pre-existing pulmonary nodules are unchanged.  There has been 18 months of\nstability.  These nodules should be considered benign, no further follow-up\nsuggested.\n\nDilated pulmonary arteries suggesting pulmonary hypertension.\n\nMild hyperdensity of the liver."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.  Right anterior port with tip in\nthe lower SVC with surrounding fat stranding and increased soft tissue density\n(302: 11).\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications of the coronary arteries, mild in the aorta and\nnone in the cardiac valves.  The pulmonary arteries and aorta are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nEnteric tube passing through the esophagus, which is unremarkable, ending in\nthe stomach.  Small mediastinal lymph nodes, none pathologically enlarged by\nCT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe patient is intubated.  The airways are patent to the subsegmental levels. \nConsolidations in the left lower lobe, posterior dependent segment of the\nright lower lobe and to a lesser extent to the right upper lobe and lingula.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show vicarious contrast excretion of\nthe gallbladder and retained contrast in the kidneys, compatible with\ncompromised kidney function.",
            "output": "Fat stranding and soft tissue surrounding the right jugular catheter, either\nbleeding or local infection.\nScattered consolidations throughout all lung lobes, suggestive of multifocal\npneumonia.\nThere is likely a component of superimposed atelectasis in the left lower\nlobe.\nAppropriate placement of the endotracheal and enteric tubes.\n\nNOTIFICATION:  The findings were discussed with Dr ___, M.D. by\n___, M.D. on the telephone on ___ at 10:55 am."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Bilateral axillary lymphadenopathy is\ndemonstrated with the largest node in the left axilla measuring up to 11 mm. \nProminent AP window lymph node measures up to 7 mm, though no mediastinal\nlymph nodes are pathologically enlarged by CT criteria.  No hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild paraseptal and centrilobular upper lobe predominant\nemphysema is noted.  Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Incidental\nnote is made of a replaced left hepatic artery.\n\nBONES: Subacute fracture of the left anterior third rib has callus formation. \nHeterogeneous sclerotic appearance of the left anterior fourth rib is noted\n(301:110) with minimal adjacent periosteal reaction.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral axillary lymphadenopathy in keeping with patient's history of\nCLL.\n3. Heterogeneous area of sclerosis involving the left anterior fourth rib with\nminimal adjacent periosteal reaction could be neoplastic given the patient's\nhistory of CLL.\n4. Subacute left anterior third rib fracture noted."
        },
        {
            "input": "The thyroid is unremarkable.  Patient is status post CABG.  There is mild\ncalcification of the aortic arch and descending aorta.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in size. \nVery mild stranding of the prevascular fat likely represents postoperative\nchange.  There are no fluid collections in the mediastinum to suggest\ninfection.  There is no supraclavicular, axillary, mediastinal, or hilar\nadenopathy.\n\nAirways are patent to the subsegmental level bilaterally.  There is minimal,\nbiapical scarring.  Scattered, small foci of low-attenuation with\nimperceptible walls bilaterally in a centrilobular distribution is consistent\nwith emphysema.  There is diffuse, mild bronchial wall thickening.  There is a\nsmall, calcified granuloma at the left base (4, 205).\n\nThe study is not tailored for subdiaphragmatic diagnosis.  Within these\nlimitations, the visualized portion of the upper abdomen is unremarkable.\n\nMedian sternotomy wires appear intact.  There are no adjacent soft tissue\nfluid collections to suggest abscess formation.  There is no evidence of\nosteomyelitis.  There are no suspicious osseous lesions.",
            "output": "1.  No evidence of sternal wire fracture, sternal osteomyelitis, or\nmediastinal or anterior subcutaneous soft tissue infection.\n2.  Bilateral emphysematous changes and diffuse, mild bronchial wall\nthickening, consistent with chronic obstructive pulmonary disease."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : Axillary lymph nodes.\n\nMEDIASTINUM: Patient status post median sternotomy.  Sternal sutures are\nintact.  There is no evidence of sternal dehiscence.  There evolving\npostsurgical changes to the mediastinum.  There is moderate coronary artery\ncalcification.  There is evidence of CABG surgery.  There is a small\nlow-density collection in the retrosternal region measuring 5.2 x 1.9 cm.\n\n\nPLEURA: There is no pleural effusion.  No pericardial effusion is seen.\n\nLUNG: There is a 1 mm left lower lobe pulmonary nodule (301, 33)..  There is\nsubsegmental atelectasis in the lingula.\n\nBONES AND CHEST WALL : There is ulceration of the skin overlying the sternum,\nrelated to recent surgery with evidence of packing material.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\ngastric banding.",
            "output": "Status post median sternotomy with evolving postsurgical changes. 5 point 2 x\n1.9 cm hypodense lesion collection in the retrosternal region most likely\nrepresents loculated postsurgical fluid, no evidence of sternal dehiscence. \nSkin the skin overlying the sternum is ulcerated with evidence of packing\nmaterial.\n\nEvidence of gastric banding.\n\n1 mm left lower lobe pulmonary nodule is indeterminate.  Subsegmental\natelectasis in the left lung base."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest cage suspicious for malignancy.\nEvaluation of the breasts requires mammography. This study is not designed for\nsubdiaphragmatic diagnosis but shows normal-size adrenal glands.\n\nThyroid is unremarkable. Atherosclerotic calcification is not apparent. Aorta\nand pulmonary arteries are normal size. Pericardium is physiologic. There is\nno pleural abnormality.\n\nCentral lymph nodes are not pathologically enlarged.\n\nLungs are clear. Bronchial wall thickening is generally mild in scattered.\nMost severe in the left lower lobe were outline the only retained secretions,\n4:173.\n\nBones of the chest cage are grossly normal.",
            "output": "Multi focal bronchial wall thickening, generally mild, moderately severe left\nlower lobe, indicating bronchial inflammation, is a possible source of fever.\nNo pneumonia or other pulmonary abnormality."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Right pectoral Port-A-Cath, not present on previous\nexamination.  No enlarged lymph nodes in the mediastinum and at the level of\nthe hilar structures.  Normal sized mediastinal lymph nodes (2, 21).  No\ncoronary or valvular calcifications.  No pericardial effusion.  The posterior\nmediastinum is unremarkable.  No osteolytic lesions at the level of the ribs,\nthe sternum, or the vertebral bodies.  Mild degenerative vertebral disease. \nNo vertebral compression fractures.\n\nMild bilateral apical scarring.  Mild upper lobe predominant ground-glass\nnodularity (3, 71) suggestive of respiratory bronchiolitis.  Mild thickening\nany irregularities of the airway walls.  Several subtle lower lobe predominant\nground-glass opacities (3, 156).  Similar but less severe findings are seen in\nthe left lower lobe (3, 190).  No pleural effusions.  No pulmonary fibrosis. \nThe airways are patent.",
            "output": "Upper lobe predominant ground-glass nodularity suggesting respiratory\nbronchiolitis.  In addition, peribronchial ground-glass opacities are noted in\nthe right and in the left lower lobe.  Overall the severity of the changes is\nvery mild and most likely infectious or inflammatory nature.  No pleural\neffusions.  No adenopathy.  No airways disease."
        },
        {
            "input": "CHEST PERIMETER: No thyroid lesions need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.\n\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels or coronary arteries.  Aorta and pulmonary\narteries and cardiac chambers are normal size.  Hypoattenuation of cardiac\ncontents is usually an indication of anemia.  Central venous infusion port\ncatheter ends at the inferior cavoatrial junction.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Extensive pulmonary abnormality has progressed\nsubstantially since ___.\n\nThis includes generalized septal thickening, with extensive ground-glass\nopacification.  And in many areas, especially the upper lobes there is new\ninflammatory micro nodulation.  Overall findings suggest a widespread\ninflammatory abnormality, especially viral infection.  Miliary tuberculosis is\nof concern as well.\n\nCHEST CAGE: Unremarkable.",
            "output": "Substantial progression since ___ of widespread inflammatory process\ninvolving pulmonary interstitium, and air spaces.  The development of\ninflammatory micro nodulation is consistent with progressive bronchiolitis,\nespecially due to viral infection, but raises possibility of miliary\ninfection, including tuberculosis, although that is usually accompanied by\ndevelopment of central adenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No abnormalities seen in the lower\nneck.  The thyroid gland appears atrophic.\n\nUPPER ABDOMEN: Limited views of the lower abdomen appear unremarkable.\n\nMEDIASTINUM: Small mediastinal lymph nodes are noted without meeting CT size\ncriteria for adenopathy.\n\nHILA: Evaluation of the hila is limited on this non contrast enhanced exam. \nWithin these limitations, there is no definite hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The cardiac size is not enlarged.  There is no evidence\nof pericardial effusion.  A right Port-A-Cath tip is seen in the right atrium.\nPLEURA: No evidence of pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild upper lobe predominance of centrilobular\nemphysema.  Previously seen widespread ground-glass opacification of bilateral\nlung fields from ___ is resolved.  There are multiple diffuse\ncentrilobular micronodules, likely inflammatory.  No focal consolidation\nconcerning for pneumonia is identified.\n2. AIRWAYS:  The airways appear patent to the subsegmental level.\n3. VESSELS:  Evaluation of the vasculature is limited on this noncontrast\nstudy.  However within these limitations, the thoracic aorta is normal in\ncaliber without aneurysmal dilatation.  The main pulmonary artery is\nnonenlarged.\nCHEST CAGE: No concerning osseous lesion is identified.",
            "output": "Previously seen widespread ground-glass opacification of bilateral lung fields\nfrom ___ appears resolved.  No new focal consolidation concerning for\npneumonia."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Bilateral axillary lymph nodes\nmeasure up to 6 mm, not significantly changed in size from ___ (series 2: \nImage 24).  No supraclavicular lymph nodes are pathologically enlarged.\n\nUPPER ABDOMEN: There is hazy appearance of the upper abdomen mesentery with\nmesenteric lymph nodes measuring up to 5 mm, possibly reflecting mesenteric\npanniculitis (series 2:image 70).  Otherwise, the imaged upper abdomen is\nwithin normal limits.\n\nMEDIASTINUM: No mediastinal lymph nodes are pathologically enlarged by CT size\ncriteria.  An aortopulmonary window lymph node is top-normal in size measuring\n9 mm, increased from prior exam (series 2:image 25).  There is also mildly\nenlarged subcarinal lymph node measuring 2.3 x 1.2 cm (series 2:image 29). \nPrevascular lymph nodes measure up to 4 mm.  Mediastinal surgical clips\nreflect prior CABG.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The heart is normal in size.  Trace pericardial fluid\nis noted.\nPLEURA: Trace left pleural effusion.  No right pleural effusion or\npneumothorax.\nLUNG:\n\n-PARENCHYMA:  The lungs are clear of pulmonary nodules or masses.  Mild left\nlower lobe ground-glass opacity may be due to re-expansion edema.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The main pulmonary artery is normal in caliber.\nCHEST CAGE: The patient is status post median sternotomy, and there is mild\ndehiscence of the sternotomy and incomplete healing.  No concerning focal\nosseous lesion is noted to be suggestive of malignancy.",
            "output": "1.  Mildly enlarged 2.3 x 1.2 cm subcarinal lymph node and smaller top-normal\nin size mediastinal lymph nodes.\n2.  Trace left pleural effusion."
        },
        {
            "input": "HEART AND VASCULATURE: There is a filling defect in a anterolateral right\nlower lobe segmental/subsegmental branch (3:135, 400:24).  No evidence of\nassociated complications which is pulmonary infarct or right heart strain. \nThe remaining pulmonary vasculature is well opacified to the subsegmental\nlevel without filling defect to indicate a pulmonary embolus.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild scattered centrilobular emphysema.  Lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen renal cysts and likely hepatic\nsteatosis but otherwise unremarkable.\n\nBONES: There is mild loss of height of several mid thoracic vertebral bodies,\nstable compared to ___.  No suspicious acute osseous abnormality is seen.?\nThere is no acute fracture.",
            "output": "1. Right lower lobe segmental/subsegmental branch pulmonary embolism.  No\nevidence of associated complications.\n2. Mild centrilobular emphysema.\n3. Hepatic steatosis."
        },
        {
            "input": "CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.  A Port-A-Cath\nterminates at the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: Numerous top-normal mediastinal lymph nodes are\nmost likely reactive.\nAxillary and hilar lymph nodes are not enlarged.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Extensive bilateral peribronchial are ground-glass opacities\nare most severe near the lung apices, but involve all lobes bilaterally, and\nis most concerning for a diffuse infectious process.  Airways are patent to\nthe subsegmental level bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSeveral nonenhancing hepatic hypodensities are too small to characterize, but\nmost likely reflect simple cysts or biliary hamartomas, for example in\nsegments III and VII 7 (5:67, 5:64).  There are no suspicious hepatic lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.  A punctate calcified granuloma is\npresent in the superior splenic body.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nMild degenerative changes of the lumbar spine are noted.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Diffuse peribronchial opacities are most suggestive of a diffuse infectious\nprocess, which could be an atypical bacterial infection or viral infection.\n2. No evidence of infection in the abdomen or pelvis."
        },
        {
            "input": "CHEST:  The thyroid is normal.  Axillary, supraclavicular, mediastinal, and\nhilar lymph nodes are not pathologically enlarged.  Right and left hilar lymph\nnodes are stable over the interval (5:132, 5:133). The great vessels are\nnormal caliber. The heart size is normal.  Small nonhemorrhagic pericardial\neffusion has decreased in size since ___. No pneumomediastinum.\n\nThe patient is status post right upper lobectomy with evolution of the\nexpected postoperative changes within the right hilus and bronchial stump. Old\nhemorrhage in the right perifissural region has decreased over the interval\n(5:124). There are two sub 3 mm calcified granulomas left lower lobe (5:178,\n5:180). No new nodules are identified.\n\nThere is a small hiatal hernia. The 2 cm right hepatic lobe cyst is unchanged.\nOther tiny hypodensities in liver are too small to characterize, but are also\nunchanged. Stable splenic calcifications suggest prior granulomatous disease.\nLeft-sided parapelvic cysts are unchanged. The remaining visualized solid\norgans and stomach are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Thoracic spine compression deformities are unchanged from ___.",
            "output": "1.  Expected evolution of postoperative changes status post right upper\nlobectomy, without evidence of disease recurrence.\n\n2.  Decreased size of nonhemorrhagic pericardial effusion.\n\n3. Stable thoracic spine compression deformities."
        },
        {
            "input": "The patient is status post right upper lobe resection, with stable ct\nappearance of the lobectomy site. Tiny, 2 mm nodule adjacent to the upper most\nportion of the left major fissure is unchanged (6, 10).\n\nNo new or enlarging mediastinal, hilar, or axillary lymph nodes.  Heart size\nis normal, and there is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning findings are evident in the upper abdomen on this limited\nassessment. Cystic lesion and posterior segment right lobe of liver is\nunchanged (47, 3).\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1.  Stable postoperative appearance following right upper lobe resection, with\nno evidence of local recurrence at the operative site.\n\n2. Unchanged 2 mm left apical lung nodule."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Axillary lymph nodes are\nmultiple and slightly increased since the prior study but no interval increase\nin mediastinal lymphadenopathy is present.  Heart size is normal.  There is\nslight interval increase in pericardial effusion, still within physiological\nlimits.\n\nHeart size is normal.  Image portion of the upper abdomen demonstrate liver\nhypodensity, stable and otherwise is unremarkable\n\nAirways are patent to the subsegmental level bilaterally.  The patient is\nafter right upper lobectomy.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nCompression fractures are noted throughout the thoracic spine.  Appearance of\nthe right lung is stable including thickening of the fissure.  Right hilar\nlymph node is stable, series 4, image 96.  No local recurrence is\ndemonstrated.  No new pulmonary nodules seen.",
            "output": "Stable postoperative appearance following right upper lobe resection.\n\nSlight interval increase in axillary lymph nodes bilaterally, reassessment in\n3 months with chest CT would be recommended.\n\nUnchanged 2 mm left apical lung nodule."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The pre described axillary enlarged lymph nodes are\nno longer visualized.  Normal enhancement of the large mediastinal vessels. \nNo substantial coronary calcifications.  The upper abdomen is stable in\nappearance, no evidence of adrenal lesions.  No osteolytic lesions at the\nlevel of the ribs, the sternum or the vertebral bodies.  Unchanged mild\nimpression of a upper thoracic lumbar vertebral body (8, 70).  Mild bilateral\napical scarring.  The right postoperative lesions are stable.  No evidence of\nlocal recurrence.  Small pre-existing millimetric pulmonary nodules are\nunchanged.  No pleural thickening or pleural effusions.  Unchanged minimal non\ncharacteristic subpleural scarring in both lower lobes.",
            "output": "No relevant change as compared to ___.  No evidence of local\nrecurrence of the multiple right lung surgeries.  No pleural effusions.  No\nadenopathy.  Pre-existing millimetric nodules are stable."
        },
        {
            "input": "Sub cm axillary nodes are numerous, slightly larger today than on ___. \nSupraclavicular nodes are not enlarged.  Excluding the breasts which require\nmammography for evaluation, elsewhere in the chest wall there are no soft\ntissue abnormalities concerning for malignancy.  This study is not appropriate\nfor subdiaphragmatic.  There is no adrenal mass.\n\nThere are no thyroid lesions warranting further evaluation.  Atherosclerotic\ncalcification is not apparent in head neck vessels or coronary arteries. \nAortic valve is not calcified.  Aorta and pulmonary arteries are normal size. \nEvaluation of the heart would require dedicated cardiac imaging.  The\npericardium is physiologic.  There is no pleural abnormality.\n\nMediastinal and hilar lymph nodes are not enlarged.  Right hilus, bronchial\nstump common right lung have a normal postoperative appearance following right\nupper lobectomy.  Left lung is clear.  Tracheobronchial tree is normal to\nsubsegmental levels.\n\nMultiple compressions of thoracic vertebral bodies, severe at 2, moderate at 5\n8 and 10, are all unchanged since at least ___.  there are no bone\nlesions in the chest cage suspicious for active malignancy.",
            "output": "No evidence of new or recurrent intrathoracic malignancy.\n\n4 moderate or severe severe thoracic vertebral compressions, unchanged since\n___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nPatient is status post right upper lobectomy, the stump is unremarkable. \nThere are few calcified granulomas.  Several micro nodules are stable (5:41,\n43, 52, 170). Minimal thickening in the right fissure is stable. There are no\nnew or enlarging lung nodules.  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation liver cysts\nand probably left parapelvic renal cysts are again noted.  There is a\ncalcified granuloma in the spleen\nThere are no bone findings of malignancy.  Wedge-shaped compression fractures\nin several thoracic vertebral bodies are stable",
            "output": "Stable appearance of the chest with a stable micro nodules.  Right upper\nlobectomy, the stump is unremarkable.  No new or enlarging lung nodules.\nLimited evaluation of the abdomen reveals liver cysts and partially imaged\nparapelvic cysts in the left kidney"
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There is stable small bilateral axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal  lymph nodes.  Heart size is\nnormal.  Small left hilar nodes are unchanged in size.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Patient status post right upper lobectomy with stable postsurgical\nchanges.  Triangular soft tissue along the surgical sutures (3, 19) Is\nunchanged.  No new pulmonary nodules.  Minimal bibasilar atelectasis.  Several\ntiny micro nodules, left upper lobe (4, 24) tiny right upper lobe pulmonary\nnodule (4, 32).  No new nodules.\n\nBONES AND CHEST WALL : Review of bones shows wedge compression involving T10\nvertebral body with decrease in height to less than 50%, unchanged.  There is\nalso decrease in height of T7 vertebral body which is also unchanged.  No new\nlytic or sclerotic lesions concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions.  No adrenal masses are seen.",
            "output": "Status post right upper lobectomy with stable postsurgical changes.  No\nevidence of local recurrence.  Stable soft tissue surrounding the surgical\nsutures in the right middle lobe.\n\n3 tiny pulmonary nodules.  No new pulmonary nodules."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Normal sized axillary lymph nodes.  Normal sized\nmediastinal lymph nodes (3, 18).  No enlarged mediastinal lymph nodes.  No\nabnormalities at the level of the large mediastinal vessels.  No incidental\npulmonary embolism.  No coronary or valvular calcifications.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  No adrenal\nabnormalities.  Stable liver cyst (3, 49).  No osteolytic lesions at the level\nof the ribs, the sternum, or the vertebral bodies.  The moderate degenerative\nvertebral disease.  Stable wedge like deformity of an upper thoracic vertebral\nbody (7, 92).  Mild bilateral apical scarring that is stable.  Status post\nright upper lobectomy.  The stump is stable.  There is no evidence of\nrecurrence.  No suspicious soft tissue structures along the resection lines. \nNo suspicious pulmonary nodules or masses.  Several stable micro nodules. \nMinimal right basal scarring.  No evidence of diffuse lung disease.  The\nairways are patent.  No pleural thickening or pleural effusions.",
            "output": "Stable morphology after right upper lobectomy.  No evidence of recurrence.  No\npleural abnormalities.  No airways disease."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE:  Fusiform ascending thoracic aortic aneurysm measures\n4.5 x 4.5 cm (3:57), which is relatively unchanged compared to exams dating\nback to ___.  There is no evidence of dissection or intramural hematoma. \nModerate atherosclerotic disease is seen throughout the thoracic aorta with\nulcerative plaque noted in the descending thoracic aorta and upper abdominal\naorta.   Coronary calcifications are present.  No pericardial effusion is\nseen.  The heart is normal in size.  The pericardium and great vessels are\notherwise unremarkable.  Main pulmonary artery is not dilated.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Mild dependent atelectasis is seen in the bilateral lungs. \nOtherwise, the lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK:  A subcentimeter hypodensity is noted in the left lobe of\nthyroid gland, likely a millimetric thyroid nodule (3:14).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right adrenal gland is normal in size and shape.  The left\nadrenal gland is mildly thickened without discrete nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Mild bowel wall\nthickening is seen in the ascending colon along the hepatic flexure with\nminimal surrounding fat stranding, suggestive of a mild colitis (601b:32). \nColonic diverticula are seen within the descending and sigmoid colon without\nacute diverticulitis.  Rectum is unremarkable.  The appendix is normal.  There\nis no free intraperitoneal fluid or free air.\n\nPELVIS: Patient is status post left inguinal hernia repair with postsurgical\nchanges seen surrounding the Gore plug (3:215) in the left lower quadrant\nwhich contains locular subcu gas. A simple appearing fluid collection\nmeasuring 3.8 cm is identified in the left inguinal region (3:225) without\nperipheral enhancement. Minimal amount of nonhemorrhagic fluid is also seen\nsurrounding the left spermatic cord (3:240). The urinary bladder and distal\nureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:  The upper abdominal aorta demonstrates fusiform aneurysmal\ndilatation measuring up to 4.6 x 3.9 cm (3:101), at the level of the\nthoracoabdominal junction, and 3.3 x 3.6 cm at the suprarenal level (3:113). \nSevere mixed atherosclerotic disease of the thoracic and abdominal aorta is\nseen with ulcerative plaque noted in the descending thoracic to upper\nabdominal aorta.  Chronic dissection is noted in the proximal celiac artery\n(601b:33) which otherwise appear is patent.  Additionally, there appears to be\na chronic focal dissection versus penetrating ulcer along the left posterior\naspect of the abdominal aorta (3:126) which is unchanged.  Extensive\natherosclerotic disease is seen throughout the vasculature without high-grade\nnarrowing of the celiac, SMA, bilateral renal arteries, or inferior mesenteric\nartery.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.",
            "output": "1. Chronic dissection within the proximal celiac artery and focal chronic\ndissection versus penetrating ulcer in the abdominal aorta appear unchanged. \nNo new aortic dissection or intramural hematoma.\n2. Ascending thoracic aortic aneurysm measuring up to 4.5 cm, stable compared\nto prior exams. Abdominal aneurysms measuring 4.6 x 3.9 cm at the\nthoracoabdominal junction and 3.3 x 3.6 cm at the suprarenal level, also\nunchanged compared to ___.\n3. Mild bowel wall thickening is seen in the hepatic flexure with minimal\nsurrounding fat stranding, suggestive of mild colitis.  This may be infectious\nor inflammatory, and ischemic colitis is unlikely given the location.\n4. Postsurgical changes from prior left inguinal hernia repair with adjacent\nsubcutaneous seroma measuring up to 3.8 cm.\n5. Severe coronary artery calcification.   Severe mixed atherosclerotic\ndisease of the thoracic and abdominal aorta is seen with ulcerative plaque\nnoted in the descending thoracic to upper abdominal aorta."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere are multiple prominent bilateral axillary lymph nodes measuring up to\n1.1 cm which are unchanged from prior study.\n\nUPPER ABDOMEN: This study is not intended for subdiaphragmatic purposes. \nWithin this limitation, no acute abnormality is detected in the visualized\nportion of the upper abdomen.\n\nMEDIASTINUM: There are multiple prominent mediastinal lymph nodes, which are\nunchanged.  The largest is subcarinal and measures 1 cm.\n\nHILA: Small right hilar lymph nodes are noted which do not meet CT size\ncriteria for lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is a small pericardial\neffusion.  Mild coronary artery calcifications are noted.\n\nPLEURA: There are small bilateral pleural effusions, left greater than right,\nwith subjacent atelectasis.\n\nLUNG:\n\n1. PARENCHYMA:  Biapical pleuroparenchymal scarring is noted.  There is\nmoderate paraseptal emphysema.  There is diffuse septal thickening throughout\nbilateral lungs suggestive of pulmonary edema.  A calcified granuloma is seen\nat the right lung base (302; 174).  No suspicious pulmonary nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nThere is mild bronchial wall thickening.\n3. VESSELS:  The thoracic aorta, main, left, and right pulmonary arteries are\nwithin normal limits.\nCHEST CAGE: There are multiple sclerotic and lytic foci involving the\nvertebral bodies, sternum, and bilateral ribs, similar to prior.  Moderate\ndegenerative changes are seen throughout the thoracic spine.",
            "output": "1. No specific findings to suggest a primary pulmonary malignancy.\n2. Stable diffuse sclerotic and lucent osseous lesions concerning for\nmetastatic disease.\n3. Diffuse septal thickening consistent with pulmonary edema.\n4. Interval decrease in size of a right pleural effusion.  Stable left pleural\neffusion.\n5. Small pericardial effusion, similar to prior.\n6. Stable prominent axillary and subcarinal lymph nodes."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Left anterior port with\ntip in the lower SVC.  Mild atherosclerotic calcifications in the head and\nneck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  Small pericardial effusion, smaller\nthan prior study.  Moderate atherosclerotic calcifications in the coronary\narteries, mild in the aorta and none in the cardiac valves.  The pulmonary\narteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nThe left pleural effusion has resolved after drainage prior pleural catheter\nsitting in the left lung base, passing through the left lateral eighth\nintercostal space.  The right has increased and is now moderate.  Mild\nbilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucous plugging.  Mild paraseptal emphysema, upper lobe\npredominant.  Partial compressive atelectasis of both lower lobes, right\ngreater than left.  No suspicious lung nodules or masses.\n\nCHEST CAGE:\nSeveral sclerotic lesions are noted throughout the chest cage, notably in the\nthoracic spine, for example the largest in T10 (09:36), new compared to prior\nstudy.  No acute or pathological fractures are identified.  Severe dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Improvement of the left-sided pleural effusion, currently being drained by a\npleural catheter.\nThe right pleural effusion is larger, now moderate.\nImprovement of the small pericardial effusion, now minimal.\nNew sclerotic lesions in the entire chest cage which could represent\nmetastatic disease response to treatment."
        },
        {
            "input": "Extensive involvement of the skeleton by sclerotic metastatic disease is\nsimilar to previous examination.  No pathological fractures identified.\n\nAorta and pulmonary arteries are well enhanced.  Heart size is normal.  No\npathologically enlarged mediastinal, supraclavicular hilar or axillary lymph\nnodes demonstrated.  There is interval decrease in still large right pleural\neffusion.  Left pleural effusion has minimally increased, small with left\npleural catheter in place.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal findings that will be issued separately.\n\nAirways are patent to the subsegmental level bilaterally.  Septal thickening\nin the lung bases is relatively small with and might represent lymphatic\nengorgement not necessarily due to lymphangitic spread of tumor but due to\nlongstanding pleural effusions although it cannot be entirely excluded.  No\ndiscrete nodules are present but new right upper lobe subpleural nodular\nopacity, 13 x 10 mm, series 6, image 75 might represent pleural thickening\nversus pulmonary nodule.",
            "output": "Interval decrease in the right pleural effusion.\n\nInterval minimal increase in left pleural effusion with pleural catheter in\nplace\n\nQuestionable nodule versus atelectasis in the right upper lobe that should be\nassessed in 3 months for documentation of stability\n\nSclerotic metastatic disease in the inter image portion of the skeleton\n\nPlease review CT abdomen and pelvis in corresponding report for assessment of\nintra-abdominal pathology."
        },
        {
            "input": "No discrete lung nodule or mass is identified in the region of the recent\nchest radiographic abnormality. However, subsegmental atelectasis of the\nmedial segment right middle lobe may have contributed to this radiographic\nappearance.  Assessment of the right middle lobe airways demonstrates abrupt\nnarrowing and termination of the lateral branch following the first\nbifurcation of the medial segment bronchus (image 205, series 6). No discrete\nendobronchial lesion is detected. Assessment of the lungs is otherwise\nremarkable for scattered calcified granulomas and bandlike scarring or\natelectasis in the right lower lobe.\n\nThere are no enlarged mediastinal or axillary lymph nodes. Borderline right\nhilar lymph nodes are present.  Heart is upper limits of normal in size, and\nthere is no pericardial or pleural effusion. Small hiatal hernia is\nincidentally noted.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of a large cyst in the upper pole portion of the left kidney measuring\n4.6 cm.  Left adrenal gland is thickened without a definitive mass.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.",
            "output": "Medial segment right middle lobe subsegmental atelectasis with associated\nbronchial abnormality as described above with associated borderline right\nhilar lymph node. Initial further evaluation with a 2 month followup CT may be\nhelpful to assess for resolution. If persistent or worsening at the time of\nfollowup CT, direct visualization with bronchoscopy would be recommended to\nexclude an occult endobronchial or peribronchial malignancy."
        },
        {
            "input": "MEDIASTINUM: A partially calcified nodule is seen in the left lobe of thyroid\ngland, similar to the prior study.  There is no supraclavicular, axillary,\nhilar or mediastinal lymphadenopathy.   The aorta and pulmonary arteries are\nnormal in size. There is no large central pulmonary embolism.  The heart is\nmildly enlarged and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There are no findings of diffuse lung disease.\nThere are no concerning pulmonary nodules.  The right middle lobe airways\nappear patent, with near complete interval resolution of the previously\ndescribed abrupt narrowing and termination of the airway.  Mild residual\nnarrowing of a distal-most bronchus (5:199) and a small area of distal\natelectasis are seen in the right middle lobe.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  There is a small hiatal hernia.  Left adrenal thickening\nwithout focal nodularity is unchanged.  Multiple hypodensities in the\nbilateral kidneys.  Appear similar to the prior study, and are most consistent\nwith simple cysts.  Incidental note is made of multiple accessory spleen.",
            "output": "Near complete interval resolution of the previously described abrupt narrowing\nand termination of the right middle lobe airway, with only mild residual\nnarrowing of a distal-most bronchus in the right middle lobe and small\nassociated area of distal atelectasis."
        },
        {
            "input": "Abdominal CT performed the same day will be reported separately.\n\nFINDINGS:\n\n\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially calcified nodule within\nthe left lobe of the thyroid is unchanged in appearance.  No supraclavicular\nor axillary lymphadenopathy.\n\nMEDIASTINUM: There are multiple aortopulmonary window, pretracheal, subcarinal\nand bilateral hilar lymph nodes measuring up to 1.2 cm in short axis (5:99).\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiomegaly is demonstrated.  Pacemaker overlying the\nleft chest with pacemaker wires noted within the right atrium and right\nventricle.  Thoracic aorta and pulmonary arteries are normal caliber.\n\nPLEURA: No pleural effusion.\n\nLUNG:\n\n-PARENCHYMA:  Linear opacities are noted in the lung bases bilaterally,\nconsistent with atelectasis.  There is a 10 mm nodule abutting the mediastinal\npleura, located in the right middle lobe (5:169) unchanged in size dating back\nto ___\n-AIRWAYS:  Airways are widely patent.\n-VESSELS:\nCHEST CAGE: No acute osseous abnormality.  Multilevel degenerative changes are\nnoted of the thoracic spine.  Gynecomastia bilaterally.",
            "output": "1. Mediastinal lymph nodes measuring up to 1.2 cm in short axis.\n2. Evaluation of the lung parenchyma, especially in the right middle and\nbilateral lower lobes is severely restricted by motion artifact.  Within this\nlimitation, there is a 10 mm nodule in the right middle lobe abutting the\nmediastinal pleura, unchanged in size since ___.   More linear\nopacities in the bilateral lower lobes, basal segments are likely subsegmental\natelectasis."
        },
        {
            "input": "Patient is status post pacemaker revision.  A dual lead pacemaker is seen with\nthe leads terminating in the right atrium and right ventricular apex. There is\nassociated subcutaneous emphysema and postoperative fat stranding surrounding\nthe pacemaker.\n\nA 1.2 cm peripherally calcified hypodensity is seen in the left thyroid lobe.\n\nMinimally enlarged paratracheal and right hilar lymph nodes are seen measuring\nup to 1.4 cm. These are likely reactive. No enlarged axillary lymph nodes are\nseen.\n\nThere is mild atherosclerotic calcifications of the thoracic aorta and the\ncoronary arteries.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is a small right pleural effusion, with associated subsegmental\natelectasis.\n\nThere is a moderate to large left hydropneumothorax, with associated complete\ncollapse of the left lower lobe. No evidence of loculation.  No evidence of\nempyema.\n\nThere is no evidence of pericardial effusion.\n\nThere is mild centrilobular emphysema.\n\nPeripheral opacity along the mediastinal pleura, seen on series 302, image\n178, has enlarged, but is consistent with atelectasis. A stable 4 mm nodule is\nseen in the right apex, series 302, image 43. A calcified granuloma seen in\nthe right apex.\n\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable, except for bilateral\nrenal upper pole hypodensities, likely representing cortical cysts, previously\nseen on a CT chest from ___.  Mildly prominent upper abdominal nodes\nare unchanged since at least ___.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMild degenerative disc disease is seen, worse in the lower thoracic spine and\nvisualized upper lumbar spine.\n\nUnchanged gynecomastia.",
            "output": "1. Moderate to large left hydropneumothorax, with associated complete collapse\nof the left lower lobe. Small right pleural effusion, with associated\nsubsegmental atelectasis.\n\n2. Status post pacemaker revision with postoperative changes in the left\nanterior chest wall.\n\n3. Other incidental findings as detailed above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is enlarged measuring 3.3 cm.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nright heart is dilated and there is reflux of contrast into the IVC,\nsuggesting component of right heart failure.  Coronary artery atherosclerotic\ncalcifications are noted.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Subcarinal, paratracheal and right hilar lymph\nnodes measuring up to 1.5 cm (series 3, image 114, 108).  No axillary\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse bronchial wall thickening bilaterally consistent with\nsmall airway inflammation.  Smooth septal thickening consistent with pulmonary\nedema.  ___ nodularity in the right upper and left upper lobes\nconcerning for aspiration or small airways infection/inflammation.  Lingular\nconsolidation is seen, which could be due to pneumonia.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen d demonstrates a partially\nimaged cystic structure in the left retroperitoneum, likely arising from the\nleft kidney, and measuring at least 5.6 x 3.7 cm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. ___ nodularity in the right middle and left upper lobes and diffuse\nbronchial wall thickening is concerning for aspiration or small airways\ninf22ection/inflammation.\n2. Lingular consolidation may represent pneumonia.\n3. Mild pulmonary edema.\n4. Moderate right pleural effusion and trace left pleural effusion.\n5. Enlargement of the main pulmonary artery suggestive of pulmonary\nhypertension. The right heart is dilated and there is reflux of contrast into\nthe IVC, suggesting component of right heart failure.\n6. No evidence of pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  No\nsupraclavicular or axillary lymphadenopathy.\n\nThe previously noted widespread, mild central lymph node enlargement is\ngrossly similar to the prior CT on ___.  For example, the lymph node\nat the medial aspect of the left hilum is grossly similar in size and\nmorphology previously measuring 18 mm, now 19 mm (3, 145).  The bronchus\nremains uncompromised.  The right lower paratracheal lymph node previously\nmeasuring 14 mm is unchanged in size (3, 119).  Enlarged, subcentimeter lymph\nnodes in the para-aortic station are unchanged.\n\nUPPER ABDOMEN: Severe calcification of the splenic artery without evident\naneurysm.  There is clinically insignificant interposition of the colon\nanterior to the liver.\n\nHEART and PERICARDIUM: Moderate cardiomegaly is stable.  No pericardial\neffusion.  Severe atherosclerotic calcification lies throughout all major\ncoronary arteries.  Thoracic aorta is normal in caliber and course.  Mild\natherosclerotic calcifications extend from the aortic arch to the extent of\nimaging at the SMA.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Extensive reticulated interstitial thickening with\nhoneycombing and traction bronchiectasis is grossly similar to the previous\nstudy on ___.  Low lung volumes are similar as well.  No evidence of\nsignificant air trapping on expiratory images.  No apparent pulmonary nodules\nor concerning opacification within the background of extensive interstitial\nand parenchymal disease.\n2. AIRWAYS:  The airways are patent to the level of the bilateral segmental\nbronchi.\n3. VESSELS:  The main pulmonary artery is unchanged in diameter, measuring 34\nmm, and given its similar to slightly wider diameter than the aorta, this\nlikely indicates pulmonary hypertension.\nCHEST CAGE: Sclerosis within the posterolateral right fifth rib is unchanged,\nand likely represents a bone island.  No acute fractures.",
            "output": "1.  Severe, grossly stable fibrosing interstitial lung disease.\n2.  Likely reactive adenopathy is stable.\n3.  Stable evidence of pulmonary hypertension.\n4.  Severe coronary atherosclerosis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal nodes unchanged since the prior study.  The right\nparatracheal node measures 8 mm.  The pre-vascular lymph node also measures 8\nmm.  There is atherosclerotic calcification involving the aorta.  There is\nmoderate cardiomegaly.  Moderate coronary artery calcification is again seen. \nThere is no pericardial effusion.  The aorta is normal in caliber.  The\npulmonary artery is mildly enlarged, most likely related to pulmonary arterial\nhypertension.\nLUNG:\nThe interstitial abnormality comprising of diffuse ground-glass opacification\nand peripheral reticular linear opacities with evidence of a bronchiolectasis\nand bronchiectasis without evidence of honeycombing has progressed since the\nprior study.  Both the alveolar component and the fibrotic component has\nprogressed.  Lung volumes have slightly decreased since the prior study.  No\nnew pulmonary nodules\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows tiny hypodense\nas splenic lesions, unchanged.  No adrenal masses are seen.",
            "output": "The interstitial abnormality has progressed.  Both the fibrotic and the\nalveolar components have increased since the prior study.  No evidence of\nhoneycombing.\n\nNo new pulmonary nodules.\n\nStable small mediastinal lymph nodes are most likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is bibasal atelectasis and trace left pleural\neffusion.  There is no evidence of infection or malignancy.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.",
            "output": "1. There is no evidence of acute pulmonary embolism\n2. There is bibasilar atelectasis with trace left pleural effusion."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The appearance of the heart and the large\nmediastinal vessels is unchanged as compared to the previous examination.  No\npericardial effusion.  Small hiatal hernia.  Unchanged appearance of the upper\nabdominal structures, including a large right kidney cyst.  The examination is\nlimited by severe respiratory motion are defects.  The soft tissue density\ndorsal to the fiducial marker in the right upper lobe (3, 21 is unchanged in\ndiameter.  A second related posterior rounded consolidation in epihilar\nlocation on the right is also unchanged.  Finally, smaller nodules in the\nright upper lobe (3, 27) and in the middle lobe (3, 39) have not substantially\nchanged.  Mild paravertebral fibrosis.  No pleural thickening, no pleural\neffusions.  Unchanged bilateral Bochdalek hernias.",
            "output": "No relevant change of the CyberKnife in the right upper lobe. The soft tissue\ncomponent posterior to the fiducial marker is constant in size.  No newly\nappeared or growing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  The right upper lobe mass associated with the fiducial\nmarker and extending into the right epihilar region has increased in size,\nmeasuring up to 4.3 x 2.7 cm (4:69), compared with 3.0 x 2.2 cm previously. \nNumerous additional pulmonary nodules are new or increased in size compared\nwith prior studies.  A representative right lower lobe pulmonary nodule\nmeasures 9 x 6 mm, previously 5 x 4 mm (4:172).  A representative left upper\nlobe nodule has increased in size and density, measuring 9 x 7 mm, previously\n8 x 6 mm (4:72).  There is minimal centrilobular emphysema.\n\nAIRWAYS:  The right upper lobe mass infiltrates and obstructs an anterior\nright upper lobe bronchus (4:84).\n\nPLEURA:  A small right pleural effusion is new.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate to severe.  A chronically\nnonunited fracture of the right second rib is unchanged from prior studies\nwith periosteal new bone formation (04:42).  This may represent a pathologic\nfracture in the setting of extensive soft tissue density in this region, or\npotentially the sequelae of prior radiation therapy.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Interval enlargement of the soft tissue mass in the right upper lobe with\ninfiltration obstruction of a right upper lobe bronchus and marked interval\nincrease in size and number of numerous satellite pulmonary nodules\nbilaterally.\n2. New small right pleural effusion."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient is asymmetrically positioned in the\nscanner and respiratory motion limits the interpretation of the examination. \nThe extent of the known right pleural effusion has increased.  The dimension\nof the treated right upper lobe mass (2, 13) is stable.  The main pulmonary\nartery remains moderately dilated.  Mild coronary calcifications.  No\npericardial effusion.  No abnormalities in the posterior mediastinum.  The pre\ndescribed mediastinal lymph nodes are stable in size, including the lymph node\nconglomerate at the level of the right hilus (2, 15). No evidence of rib\nlesions.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.  Multiple pre-existing pulmonary nodules, both solid and non solid\n(4, 54) have not substantially changed in size, although a direct comparison\nis difficult for technical reasons.  The lung windows show the presence of a\npredominantly ventral small pneumothorax, with maximum diameter of\napproximately 3.5 cm.  Currently, there is no visualization of a right-sided\nchest tube.  Based on the coronal reconstructions, the presence of tension is\nunlikely.",
            "output": "Stable treated right lung mass with conglomerate hilar lymphadenopathy. \nStable multiple bilateral pulmonary nodules and stable moderate pleural\neffusion on the right.  Right-sided mild to moderate ventral pneumothorax\nwithout evidence of tension.  No chest tube is visualized."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThyroid is not imaged.  Atherosclerotic calcification is mild in head and neck\nvessels, not apparent in coronary arteries.  Aorta is normal size.  Pulmonary\narteries are dilated, main 36 mm, right 33 mm, previously 39 mm and 34 mm\nrespectively.  Mild generalized cardiomegaly is stable, would require\nechocardiography for assessment.  There is no pericardial or left pleural\nabnormality.  Small to moderate nonhemorrhagic right pleural effusion layering\nposteriorly is essentially unchanged in size.  Previous anterior pneumothorax\nhas resolved.  No pleural drainage tube is seen.\n\nCm size mediastinal lymph nodes in the lower paratracheal stations, right\n02:13, left 02:18, are newly borderline enlarged.  .  Other mediastinal lymph\nnodes are not enlarged.\n\nRight hilar adenopathy and adjacent right upper lobe lung mass measured in\naggregate are smaller, 29 x 48 mm, 04:51, previously 34 x 56 mm, but tumor\nstill occludes the right upper lobe anterior segmental bronchus.\n\nLungs:\n\nPrevious subcentimeter lung nodules most numerous in the right middle lobe are\nfewer and smaller.  There are no new lung nodules.  Nonobstructive relaxation\natelectasis persists in the right lower lobe.  No consolidation or appreciable\natelectasis on the left.\n\nA new 12 mm lytic lesion with a sclerotic rim is appeared in the lateral\naspect of the left eighth rib, 602b:77.  There are no other clear lytic\nlesions, pathologic or compression fractures.",
            "output": "Positive treatment response consisting of decrease in size of primary right\nupper lobe lung mass and contiguous hilar adenopathy, and small pulmonary\nmetastases, predominantly in the right middle lobe.\n\nNew lytic lesion, left eighth rib, presumably metastasis.  Slight interval\ngrowth of borderline enlarged mediastinal lymph nodes could be reactive or\nearly metastasis.\n\nLarge goiter chronic and unchanged.\n\nProbable pulmonary arterial hypertension.\n\nRight pneumothorax resolved.  Small to moderate right pleural effusion\nnonhemorrhagic, layering, unchanged since ___."
        },
        {
            "input": "The imaged thyroid gland is without focal nodularity but enlarged.  There is\nno axillary or supraclavicular adenopathy.  There is no mediastinal\nadenopathy.\n\nThe ascending aorta is mildly aneurysmal measuring up to 4.2 cm (02:16),\nstable.  The main pulmonary artery is mildly dilated measuring 33 mm (02:16),\nsuggestive of although not diagnostic for pulmonary hypertension.  Heart size\nis enlarged with predominantly biatrial enlargement.  Trace pericardial fluid\nis physiologic.  There are no appreciable coronary artery calcifications.\n\nA nonhemorrhagic and layering right pleural effusion has decreased in volume\nsince ___.  A right upper lobe lung mass is in contiguity with\nright hilar adenopathy, measures 2.5 x 3.0 cm, previously 3.4 x 2.8 cm at\napproximately the same level.  Scattered nodular opacities in the right middle\nlobe are subcentimeter, unchanged.  Subcentimeter nodules in the right lower\nlobe are not appreciably changed.  There is no consolidation in the left lung.\nLeft upper lobe nodules are less conspicuous.  There is no pneumothorax. \nThere is no left pleural effusion.  Bronchiectasis is mild involving the lower\nlobe airways.\n\nThere are no osseous lesions in the chest cage worrisome for malignancy or\ninfection.  Previously described lytic lesion in the left eighth rib with\nsclerotic rim is not clearly identified.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "Continued treatment response with decrease in size of primary right upper lobe\nlung mass and contiguous hilar adenopathy.  Numerous smaller pulmonary nodules\nbilaterally, either inflammatory changes and/or metastases, are slightly less\nconspicuous.\n\nStable ascending aortic aneurysm measuring 4.2 cm.  Probable pulmonary\narterial hypertension, unchanged.\n\nNonhemorrhagic and layering right pleural effusion is decreased in volume\nsince ___.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___."
        },
        {
            "input": "Aorta and pulmonary arteries are not pathologically enlarged.  Right upper\nlobe lesion, series 2, image 15 with fiducial marker is unchanged, 3 x 2 cm in\ndiameter.  Interstitial changes are similar to previous examination.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules all stable with no new nodules masses or consolidations or\nincreasing of the size of the pre-existing nodules.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Interval unchanged appearance of the dominant right upper lobe perihilar mass\n\nUnchanged pulmonary nodules\n\nUnchanged appearance of the dilated main pulmonary artery\n\nPlease review CT abdomen pelvis and the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.9 cm left supraclavicular lymph\nnode is unchanged (4:7).  There is no axillary lymphadenopathy.\nExcluding the breast which must be evaluated by mammography there are no soft\ntissue abnormalities in the chest wall.\n\nUPPER ABDOMEN: Included upper abdominal organs are unremarkable and will be\nreported separately in the same day CT of the abdomen and pelvis.  Small\nhiatal hernia, esophagus is collapsed and unremarkable.\n\nMEDIASTINUM: There is no mediastinal or hilar lymphadenopathy.  0.9 cm sub\ncarinal and right lower 1 cm paratracheal lymph nodes are not pathologically\nenlarged and unchanged.\n\nHEART and PERICARDIUM: Mild cardiomegaly with predominantly biatrial\nenlargement is unchanged, there is no pericardial effusion.\nNo appreciable atherosclerotic calcifications in the coronaries.\nAscending aorta mildly aneurysmal up to 4.1 cm, unchanged.\nMain pulmonary artery, 4 cm, concerning for pulmonary hypertension.\n\nPLEURA: There is no pleural effusion, no pneumothorax.\n\nLUNG: Major airways are patent.\nRight upper lobe lung mass with fiducial marker surrounded by post radiation\nchanges, 4.3 x 1.6 cm in the coronal reconstruction(601:47) is unchanged since\n___.  Obstruction of the right upper lobe anterior segment bronchus\nand right chest wall invasion is unchanged.\n\nSignificant respiratory motion artifacts limit evaluation of lung bases. \nscattered pre-existing nodular opacities are all sub cm and unchanged.  For\nexample stable 0.3 cm in the right middle lobe or 0.5 cm nodule in the right\nupper lobe (04: 113, 59).\nNo new lung or enlarging lung nodules or masses.\n\nCHEST CAGE: Multilevel degenerative change of the spine are unchanged with no\nnew compression fractures and no evidence of lytic or sclerotic bony\ndestructive lesions.",
            "output": "Dominant right upper lobe lung mass with local chest wall invasion and\npre-existing scattered bilateral sub cm nodules are unchanged since ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nascending thoracic aorta is mildly ectatic measuring 3.7 cm in diameter.  The\nmain pulmonary artery is prominent measuring 3.6 cm, similar to prior\nsuggestive of chronic pulmonary hypertension.  There is reflux of contrast\ninto the IVC.\n\nAXILLA, HILA, AND MEDIASTINUM: Stable 0.9 cm left supraclavicular lymph node\n(5; 15).  No axillary, mediastinal, or hilar lymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The dominant right upper lobe mass adjacent to the fiducial\nmarker with extension to the chest wall measures 2.0 x 1.9 x 3.9 cm, similar\nto ___.   An adjacent 0.7 cm right upper lobe pulmonary nodule is\nunchanged compared to prior.  Additional subcentimeter bilateral pulmonary\nnodules are similar to ___.\n\nPostobstructive atelectasis of the right upper lobe anterior segment bronchus\nis again seen (5; 84).\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a moderate hiatal\nhernia.\n\nBONES: No suspicious osseous abnormality.",
            "output": "1. No evidence of pulmonary embolism.\n2. No change in disease burden in the chest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThe patient is status post aortic dissection repair.  The proximal component\nof the anterior ascending aortic dissection is unchanged in size and\nmorphology.  In the thoracic aortic arch there ulcerative plaques not\nsignificantly changed since the prior study. No intramural hematoma.  No new\naneurysmal dilatation is noted.  There is stable chronic dissection of the\nabdominal aorta beginning immediately proximal to the diaphragmatic hiatus. \nThe distal extent of this is not included in the current examination.\n\nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Upper lobes dominant emphysematous changes.  There is also\nbibasilar atelectasis.  No focal consolidation is present.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Multilevel degenerative changes of the thoracic spine are noted. \nSternotomy wires appear intact.  No suspicious osseous abnormality is seen.?\nThere is no acute fracture.",
            "output": "-No acute aneurysmal dilatation of the ascending descending thoracic aorta.\n-Status post aortic repair with largely unchanged appearance of ascending and\ndescending aorta.\n-Stable ulcerative plaque at the aortic arch.\n-  Stable partially visualized abdominal aortic dissection"
        },
        {
            "input": "There is no supraclavicular or axillary adenopathy or any soft tissue lesion\nin the imaged chest wall suspicious for malignancy. This study is not designed\nfor subdiaphragmatic diagnosis but shows normal-size adrenal gland and\nbilateral renal cysts, particularly large in the right upper pole.\n\nLarge heterogeneous mass in the left lobe of the thyroid gland extends roughly\n5 cm from the normal location of the thyroid alongside the cricoid cartilage,\ninto the upper mediastinum just above the left brachiocephalic vein. Its\nmaximum diameters, 41 x 54 mm, 3:6, have increased from 38 x 45 mm in ___. It produces a stable degree of moderate right tracheal deviation, and a\nslight increase in tracheal narrowing at the thoracic inlet. Long-standing\nlarge thyroid masses like this are known to produce tracheomalacia, a\nphenomenon that is not assessed by this CT. The distal 6 cm of trachea is\nperfectly normal.\n\nAnatomic detail in the upper mediastinal on the previous study is obscured by\ncontrast artifact. The enlarged mediastinal lymph nodes, including the 18 mm\nright lower paratracheal node, 13 mm subcarinal node, and sub cm lymph nodes\nin the upper paratracheal stations, 03:13 and prevascular mediastinum, 03:18,\nare unchanged.  Enlargement of the pulmonary arteries, main 37 mm, right 28\nmm, is unchanged. Coronary atherosclerosis it is heavy and widespread.\n\nAortic valve is severely calcified. Calcification extends in to the annulus\nand approximately 1 cm above the right coronary ostium, but is minimal\nelsewhere in the ascending thoracic aorta which reaches a maximum transverse\ndiameter of 37 mm at the level of the intra pericardial right pulmonary\nartery. Calcification in the aorta is heavier in the arch, descending, and\nabdominal portions, and considerable at the origin of the celiac artery\n\nSmall to moderate nonhemorrhagic layering pleural effusions are present again.\nThere is no pericardial effusion.\n\nThere are no lung nodules of concern for malignancy. clusters of inflammatory\nnodules in the right upper lobe, 5:88 and left upper lobe, 5:129, are probably\nnew. Several punctate, free-standing nodules, like to in the left upper lobe,\n5:100, are too small to warrant additional followup. Atelectasis in the\nlingula is mild, though more pronounced today than in ___, but not due to\nbronchial obstruction. Tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious malignancy vertebral\nbody heights are maintained in the chest cage. The most marked disk\ndegeneration is in the lumbar spine but there are degenerative osteophytes\nthroughout.",
            "output": "Normal caliber, minimally calcified, ascending thoracic aorta distal to heavy\naortic valvular calcification, and severe atherosclerotic coronary\ncalcification.\n\nChronic enlarging goiter produces mild upper tracheal narrowing at end\ninspiration. Tracheomalacia should be kept in mind.\n\nChronic or recurrent small to moderate nonhemorrhagic layering bilateral\npleural effusion.  No pulmonary edema or pericardial effusion.\n\nMinimal focal bronchiolitis."
        },
        {
            "input": "CHEST: Endotracheal tube terminates above the carina. Central venous catheter\nterminates at the superior cavoatrial junction. Esophageal temperature probe\nand enteric tubes are noted in the esophagus, with a temperature probe\nterminating at the gastroesophageal junction and the enteric tube terminating\nin the body of stomach.  The heart is normal in size with no pericardial\neffusion or coronary artery calcifications. The great vessels opacified\nnormally. Main pulmonary artery is normal in caliber.  The right lobe of the\nthyroid is heterogeneous with a 7 mm hypodense nodule (2:7). The left lobe of\nthe thyroid is normal.  There are no pathologically enlarged mediastinal or\nhilar lymph nodes.\nThe pulmonary parenchyma demonstrates scattered dependent atelectasis and\nsmall bilateral pleural effusions. No concerning pulmonary nodules identified.\nNo consolidative opacity.\n\nABDOMEN:\nThe liver parenchyma is normal in attenuation with no focal hepatic lesions on\nthis single phase contrast scan. There is diffuse periportal edema. The\ngallbladder demonstrates significant wall edema. The pancreas enhances\nhomogeneously without focal lesions. Spleen is normal in size and attenuation.\nThe kidneys enhance and excrete contrast symmetrically with no hydronephrosis\nor cysts. A transient intussusception of the small bowel is seen in the pelvis\nwithout obstruction or mass. The distal esophagus stomach, and small bowel are\nnormal in caliber. The large bowel is unobstructed, mostly decompressed. No\nmesenteric or retroperitoneal lymphadenopathy. There is congestion of the\nmesenteric, however no free fluid in the abdomen.  Body wall edema is\nindicative of anasarca.\n\nPELVIS:  The urinary bladder contains a Foley catheter and air from recent\ncatheterization.  The uterus enhances homogeneously. No adnexal masses are\nseen. There is a small amount of free fluid in the pelvis which is likely\nphysiologic.\n\nVESSELS:  The abdominal aorta is normal in caliber with no calcium burden. The\nceliac axis, SMA, ___ and ___ renal arteries bilaterally are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Normal heart size with no pericardial effusion. Clear lungs with no\nconcerning nodule.\n2. 7 mm right thyroid nodule.\n3. Homogeneously enhancing liver, pancreas, kidneys, spleen, and adrenal\nglands on this single phase CT.\n4. Normal appearance of the uterus and adnexa, with small amount of simple\nfree fluid in the pelvis, which is likely physiologic.\n5. Normal caliber abdominal aorta with patent major branches."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere are extensive diffuse filling defects extending from the right and left\nmain pulmonary arteries extending into the lobar, segmental and subsegmental\nbranches of lobes bilaterally.  The main pulmonary artery measures 3.7 cm in\ndiameter, possibly reflecting pulmonary artery hypertension.  There is\nrelative enlargement of the right ventricle compared to the left ventricle\nwith bowing of the interventricular septum concerning for right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a trace right pleural\neffusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nThere is partially visualized mesenteric stranding, calcifications and\nsurgical clips along the pancreatic tail.  An adjacent fat infarction is\nnoted.  The visualized liver, gallbladder, right adrenal gland and right\nkidney are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Massive pulmonary embolism with right heart strain."
        },
        {
            "input": "CTA:  The aorta is normal in course and caliber.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nCHEST:  There is a sub cm left thyroid nodule.  Thyroid otherwise\nunremarkable.  There are scattered axillary lymph nodes, but none that are\npathologically enlarged.  There is no supraclavicular adenopathy.  Scattered\nmediastinal lymph nodes have not significantly changed from prior.  Heart size\nis normal.  Main pulmonary trunk is top-normal measuring 30 mm.  Thoracic\naorta is normal in caliber.  There is mild atherosclerotic calcification.\n\nThe airways are notable for diffuse wall thickening of the lower lobe bronchi.\nThere is biapical scarring.  There is bibasilar atelectasis.  There is no\nfocal lung consolidation.  There are no suspicious pulmonary nodules.\n\nThe thoracic esophagus is unremarkable.  Views of the upper abdomen are better\nevaluated on same-day abdomen and pelvis CTA.\n\nThere are no suspicious bony lesions.  The superficial soft tissues are\nnormal.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.  Previously\nseen extensive pulmonary emboli have resolved.\n2. Mildly enlarged main pulmonary trunk suggestive of pulmonary hypertension."
        },
        {
            "input": "No incidental thyroid findings.  All supraclavicular, infraclavicular and\naxillary lymph nodes are normal in size.  In the mediastinum however, massive\nlymphadenopathy is noted (3, 24) the lymph nodes have hypodense centers. The\nlargest lymph nodes are located at the level of both hilar (3, 27) as well as\nin pretracheal and para-aortic location (3, 23). These lymph nodes measure\napproximately 3.5 cm in diameter.  There is no lymphadenopathy in the\nposterior mediastinum.  The upper abdomen is described in detail in the\nabdominal CT report.  Normal appearance of the heart.  No incidental pulmonary\nembolism. Enlargement of the main pulmonary artery (3, 27).  No osteolytic\nlesions at the level of the ribs, the sternum or the vertebral bodies.\n\nMild bilateral apical scarring.  In the lung parenchyma, with upper lobe\npredominance, diffuse interstitial micronodules are noted.  These nodules\nfollow strict perilymphatic distribution.  Additional micronodules are located\naround the fissures.  No pleural effusions. No suspicious lung nodules or\nmasses.  The airways are patent.",
            "output": "The morphology and distribution of the pulmonary micronodules is highly\nsuggestive of sarcoidosis, notably in combination with the very extensive\nhilar and mediastinal lymphadenopathy.  Other differential diagnoses are\nunlikely."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There is a right-sided pacemaker.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes\n\nMEDIASTINUM: There are small mediastinal hilar lymph nodes.  There is\nextensive atherosclerotic calcification involving the aorta.  There is also\nextensive calcification involving the mitral annulus and coronary arteries. \nThere is a left-sided pacemaker with 1 lead coiled up within the right atrium\nand the second lead extending through the left ventricle into the mediastinal\nfat.\n\nPLEURA: There are small bilateral pleural effusions.\n\nLUNG: There are postsurgical changes following wedge resection the right upper\nlobe.  No other lung nodules.  Minimal bibasilar atelectasis\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Sections through the upper abdomen shows gallstones.  No\nadrenal masses.",
            "output": "Small bilateral pleural effusions with bibasilar atelectasis.\n\nRight-sided pacemaker with 1 lead free-floating the right atrium and the\nsecond lead extending through the left ventricle wall and the tip projects\nover the mediastinal fat.\nPostsurgical changes following wedge resection the right upper lobe.\n\n\nRECOMMENDATION(S):\n The findings and recommendations were communicated to the referring physician\nvia telephone with Dr. ___ at 3:54 pm on ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is stable in size and contour without evidence of dissection or\nintramural hematoma.  Major branching vessels are patent there is a stent\nvisualized within the origin of the left subclavian artery which is also\npatent.  Internal mammary arteries are patent and normal in caliber.\n\nThere are extensive atherosclerotic calcifications again noted including\ncoronary artery and valvular calcifications.  Stable multichamber cardiomegaly\nwith left ventricular hypertrophy.  Dual lead cardiac pacer is again noted\nwith 1 lead free floating in the right atrium and the second lead extending to\nthe ventricular wall with its tip projecting into the mediastinal fat.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace bilateral pleural effusions again noted.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Stable postsurgical changes related to right upper lobe wedge\nresection.  Lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is without acute Findings.\n\nBONES: Stable degenerative change without fracture or suspicious osseous\nlesion.",
            "output": "No acute intrathoracic process identified or significant change from prior\nimaging.\n\nNo evidence of pulmonary embolism or acute aortic injury.\n\nBilateral internal mammary arteries are patent and normal in caliber.\n\nPatient's left subclavian artery stent is patent."
        },
        {
            "input": "Soft tissues: The thyroid is homogeneous.  There is a 6 x 5 mm (5:116)\nepipericardial lymph node with partial calcification and a peridiaphragmatic\nlymph node at the left lung base, with partial calcification, which may\nsuggest prior granulomatous infection.  There are no pathologically enlarged\nmediastinal, hilar, or axillary lymph nodes.  Prominent pericardial lymph node\nmeasures 1.2 x 0.6 cm (5:160).  The heart is normal in size and there is no\npericardial effusion.  Mild coronary artery calcification is noted in the left\nanterior descending. The aorta and main pulmonary artery are normal in\ncaliber. Please see a separate dictation discussing the subdiaphragmatic\nfindings.\n\nLungs: The airways are patent to the subsegmental level bilaterally. There is\nno focal consolidation, pleural effusion, or pneumothorax.  The following\npulmonary nodules are identified:\n3 mm partially calcified right lower lobe (5:81)\n4 mm right middle lobe (5:121)\n4 mm subpleural right middle lobe (5:152)\n4 mm lingular (5:148)\n4 mm left lower lobe (5:148)\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1. Handful of sub 5 mm pulmonary nodules as noted above warrant ___ year\nfollowup chest CT.\n2. Hyperdense nodules at the left lung base, and at the epipericardial region\nmay represent partially calcified lymph nodes which would suggest prior\ngranulomatous infection, however hypervascular metastases could have a similar\nappearance.\n\nRECOMMENDATION(S):\n1. ___ year followup chest CT to evaluate interval change in pulmonary nodules."
        },
        {
            "input": "Left upper paratracheal lymph node is 15 mm in diameter, substantially\nenlarged as compared to 7 mm back on ___.  Additional multiple small\nmediastinal lymph nodes are unchanged.  Sub-carinal lymph node has increased\nin size from 3 by 11 mm to 8 x 18.5 mm.  No hilar or axillary lymphadenopathy\nis present.\n\nAorta and pulmonary arteries are overall within normal limits.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed as part of the CT abdomen\nand pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules represent metastatic disease, series 10, images 52, 59, 62, 69, 105,\n108, 128, 150, 151 (largest nodule, 12 mm) 153, 180, 190, 194, 199.  All those\nnodules are new since ___.  When compared to CT abdomen from ___ the lower lobe nodules, specifically in the left lower lobe,\nseries 10, image 151 has increased in size from 8 to 12 mm, in the right\nmiddle lobe from 8-10 mm, in right middle lobe from 7-12 mm, series 10, image\n180, and in the left lower lobe from 6-8 mm, series 10, image 199.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Multiple pulmonary nodules concerning for metastatic disease.  The a new\ncompared to chest CT from ___ and the lung bases nodules appear to be\nat least slightly increased since ___\n\nInterval increase in mediastinal lymphadenopathy when compared to ___ also\npotentially representing metastatic disease.\n\nPlease review CT abdomen and pelvis and the corresponding report for\nassessment of the intra-abdominal and intrapelvic findings."
        },
        {
            "input": "No focal consolidation.  No pleural effusion pneumothorax.  There is mild\nbilateral dependent atelectasis.  The central tracheobronchial tree is patent.\n\nThe thyroid gland is unremarkable.  There is a 3 vessel aortic arch.  The\naorta is normal course and caliber without aneurysmal dilatation.  There is\nmild atherosclerotic calcification of the aortic arch.  No pericardial\neffusion.  No axillary, hilar, or mediastinal lymphadenopathy by CT size\ncriteria.\n\nEvaluation of the upper abdomen is grossly unremarkable, however, please refer\nto dedicated CT abdomen pelvis performed the same day for more detailed\nevaluation.\n\nNo suspicious osteolytic or osteoblastic bone lesions.  There is evidence of\nmild calcific tendinitis of the bilateral shoulders right worse than left.",
            "output": "No evidence of metastatic disease."
        },
        {
            "input": "MEDIASTINUM:  Slightly asymmetric aeration of the right piriform sinus and a\nsmall diverituclum just above the level of the vocal cords is noted. The\nthyroid is normal. There is no pathologic supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy. The aorta and pulmonary arteries are\nnormal in size. Mild arthrosclerotic calcifications are noted in the coronary\narteries (03:37). The heart size is normal and there is no pericardial\neffusion. Esophageal wall thickening in the lower esophageal segment (03:50)\nhas improved since the prior, however there is no evidence of\npneumomediastinum, or surrounding inflammatory fat stranding or fluid.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS: Bilateral upper lobe and right lower lobe subpleural interstitial\nreticulation is unchanged compared to the prior study from ___, along with\nmoderate background centrilobular emphysema, predominantly affecting the\nbilateral upper lobes. There is no airspace consolidation. A 2 mm left upper\nlobe pulmonary nodule (05:127), and a 6 mm right lung base pulmonary nodule\n(5:255), are stable since ___. No new or concerning pulmonary nodules or\nmasses are identified.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN: Although this study is not specifically tailored for evaluation\nof subdiaphragmatic structures, multiple gallstones are again noted, with no\nsecondary signs of acute cholecystitis (3:  68). A small hiatal hernia is\npresent.",
            "output": "1. Improved distal esophageal wall thickening, compatible with known history\nof intramucosal carcinoma status post multiple endoscopic interventions\nincluding mucosal resection and cryoablation. No pneumomediastinum or other\nspecific signs of esophageal perforation are identified.\n2. No pathologic lymphadenopathy. Multiple small mediastinal lymph nodes are\nstable.\n3. Stable upper lobe predominant moderate centrilobular emphysema with\nsubpleural interstitial inflammatory changes.\n4. Pulmonary nodules ranging up to 5 mm in size are stable since ___.\n5. Cholelithiasis with no evidence of cholecystitis."
        },
        {
            "input": "The thyroid gland is mildly enlarged and not fully characterized by CT.\n\nBorderline mediastinal and left hilar nodes are present as well as enlarged\nright hilar nodes measuring up to 1.9 cm x 2.2 cm .\n\nHeart size is normal, and there is no pericardial effusion.  Bilateral small\ndependent pleural effusions are present.\n\nWithin the lungs, atelectasis is present at both lung bases adjacent to the\ndependent pleural effusions, an additional linear atelectasis or scarring is\npresent in the mid and lower lungs bilaterally.  Motion artifact and\ninadvertent expiratory phase of respiration reduces sensitivity of CT for\ndetecting small pulmonary nodules such as the ground-glass nodule described in\nthe provided history.  It also reduces sensitivity for subtle interstitial\nlung abnormalities.\n\nSkeletal structures demonstrate widespread predominantly sclerotic lesions\nthroughout the spine with lesser lytic component.  The chest wall is\nremarkable for bilateral gynecomastia.",
            "output": "1.  Technically limited CT of the lungs due to motion artifact and inadvertent\nexpiratory phase of respiration.  This reduces sensitivity for detecting small\nnodules, particularly ground-glass nodules.\n\n2.  Enlarged right hilar lymph nodes measuring up to 2.2 cm.  Borderline\nmediastinal and left hilar nodes.\n\n3. Small bilateral pleural effusions with adjacent bibasilar atelectasis.\n\n4.  Skeletal metastases.\n\n5. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: There are small subsegmental pulmonary emboli in the\nmedial right lower lobe (2:90, 2:79).  Pulmonary vasculature is otherwise well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.  Coronary\nartery calcifications are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: A right axillary lymph node measuring up to 1.1\ncm in short axis, previously 0.9 cm in ___.  Interval improvement in\nmediastinal lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is extensive osseous metastatic disease involving all visualized\nosseous structures, increased in sclerosis since ___.  Sternal\nlesions, humerus lesions, and scapular lesions were not definitely seen on the\nprior examination and may be new.  Multiple numerous ribs rib lesions\ndemonstrate new soft tissue components abutting or extending into the pleura. \nThe largest such lesion arises from the posterior right seventh rib and\nmeasures 3.2 x 1.2 cm (series 2, image 54).  Multiple levels of superior\nendplate fractures, new at T4, unchanged T6, and unchanged at T11.  No\nretropulsion of any osseous fragments into the spinal canal.",
            "output": "1. Subsegmental medial right lower lobe pulmonary emboli.\n2. Progression of osseous metastatic disease since ___ which now\nincludes soft tissue extension of multiple rib lesions, new/more clear\nsternal, scapular, and proximal humerus lesions, and new superior endplate\nfracture at T4.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:09 pm, less than 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart is mildly enlarged. The pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal hematoma.  There is a rounded\nfatty and soft tissue density in the anterior mediastinum measuring 1.3 x 1.6\ncm (2:31), which could represent hypertrophic thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild centrilobular and paraseptal emphysema noted in the\nbilateral, right greater than left, lung fields.  Lungs are clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.  Mild bibasilar atelectasis is\npresent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\npatient is status post partial resection of the left lobe.  The liver\ndemonstrates a nodular contour, raising the possibility of chronic underlying\nliver disease.  There is a 1.8 x 1.4 cm hypodensity in segment 8 of the liver\nlikely a cyst.  Additional subcentimeter hypodensities are too small to\ncharacterize.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout without pancreatic\nductal dilatation. There is a small, 5 mm hypodensity in the pancreatic body\n(2:100) which likely represents a side branch IPMN.  Pancreas divisum is\nnoted.  There is no peripancreatic stranding. Heterogeneous soft tissue\ndensity (2:18) medial to the duodenum, abutting the uncinate process of the\npancreas contains areas of high density, likely hyperenhancement, measures 2.3\nx 2.4 cm.  There is no clear fat plane between the pancreas and the lesion,\nwhich also extends superiorly and is indistinguishable from a superior\nportacaval lymph node.  Of note, a duodenal diverticulum is also possible\ngiven the location of the lesion.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple subcentimeter hypodensities in the left kidney are too small to\ncharacterize, but likely represent simple cysts.  There is no evidence of\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal (2:175).  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged contains multiple calcified\nfibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.  A partially calcified splenic aneurysm\nmeasures 1.2 x 0.5 cm (601:50).\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: There is a small fat containing incisional hernia to the right\nof the umbilicus with a fascial defect measuring 1.2 cm (2:147).  Incidentally\nnoted is a soft tissue nodule in the left lateral breast measuring 1.9 x 1.5\ncm (02:37).",
            "output": "1.  No acute traumatic injury in the chest, abdomen or pelvis. No fractures\nidentified.\n2.  Heterogeneous, partially enhancing soft tissue lesion adjacent to the\nduodenum and abutting the pancreatic uncinate process could represent a\npancreatic lesion, abnormal lymph node or duodenal diverticulum.  Recommend\nfurther evaluation with MRI, unless prior imaging exists to which the lesion\ncan be compared.\n3.  Nodular contour of the liver suggests presence of chronic liver disease. \nOf note, the patient is status post partial left lobe resection.\n4.  Rounded soft tissue density in the anterior mediastinum could represent\nhypertrophic thymic tissue, however, correlation with history and prior\nimaging is recommended.\n5.  1.9 x 1.5 cm soft tissue nodule in the left lateral breast.  Recommend\nfurther evaluation with mammography not already performed.\n6.  5 mm hypodensity the body of the pancreas is likely a side branch IPMN. \nConsider further evaluation on additional imaging or compare to prior imaging\nto determine long-term stability.\n7.  Cholelithiasis without evidence of acute cholecystitis.\n8.  Partially calcified splenic artery aneurysm measuring 1.2 x 0.5 cm.\n\nRECOMMENDATION(S):  1. Breast imaging to further characterize left breast\nlesion if not already performed.\n2.  If lesion adjacent to the pancreas is not characterized on prior exam\nperformed elsewhere, MRI suggested to follow-up this lesion as well as a\npresumable IPMN in the pancreatic body."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  The image portion of the upper abdomen\nwill be reviewed separately as part of the CT abdomen pelvis in corresponding\nreport will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal linear\nopacities represent atelectasis but no pulmonary nodules masses or\nconsolidations to be worrisome for infection or neoplasm demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease or, malignancy or infection\n\nPlease review CT abdomen and pelvis and the corresponding report that will be\nissued separately."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  There are no\npathologically enlarged mediastinal, hilar or axillary lymph nodes.\n\nAirways are patent to the subsegmental level bilaterally.  There are no lytic\nor sclerotic lesions worrisome for infection or neoplasm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nLungs are clear.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Right pectoral Port-A-Cath in stable\nposition.  Normal appearance of the large mediastinal vessels.  No evidence of\npulmonary embolism.  No coronary or valvular calcifications, no pericardial\neffusion.  The posterior mediastinum is unremarkable.  The upper abdomen is\nreported in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nMinimal degenerative vertebral disease.  No vertebral compression fractures.\nThe lung parenchyma shows normal structure and attenuation values.  No\nevidence of diffuse or focal lung disease, in particular no evidence of\nnodular changes suspicious of metastatic disease.  No pleural thickening or\npleural effusions.  The airways are patent.",
            "output": "Stable examination of the thorax.  No evidence of metastatic thoracic disease."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There is a right-sided Port-A-Cath\nwith its tip in the SVC.  There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are well expanded with minimal bibasilar atelectasis.  Mm\ncalcified granuloma in the left lower lobe (6, 222).\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  Please refer to dedicated report on\nabdomen which has been dictated separately.",
            "output": "No evidence of metastasis to the chest.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A right chest wall\nPort-A-Cath terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Minimal soft tissue in the anterior mediastinum\nlikely reflects thymic hyperplasia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  2 mm left lower\nlobe granuloma (series 4, image 151).  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Status post resection of the left lateral hepatic segment,\nunchanged compared to the prior exam.  Otherwise, the liver demonstrates\nhomogenous attenuation throughout.  There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Intact colonic\nsutures are seen at the splenic flexure and sigmoid colon.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: Status post retroperitoneal lymph node dissection with multiple\nsurgical clips.  No enlarged retroperitoneal lymph nodes are identified.  The\npreviously seen lymphocele in the left retroperitoneum is no longer visualized\non today's exam.  No mesenteric lymphadenopathy.  No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Small umbilical and supraumbilical hernia containing small\nbowel is slightly larger compared to the prior exam.",
            "output": "1. No evidence of metastatic disease in the chest, abdomen, or pelvis.\n2. No evidence of pulmonary embolism or acute aortic abnormality.\n3. Otherwise, no acute findings in the chest, abdomen, or pelvis to account\nfor patient's symptoms."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: The there is no large pleural effusion, noting that the\nbilateral costophrenic angles have been excluded from view.\n\nLUNGS/AIRWAYS: The lung apices and bilateral costophrenic angles have been\nexcluded from view, per CTA protocol which only covers the pulmonary arterial\ntree.  There are scattered ground-glass and ___ opacities in the\nbilateral lower lobes (3:80, 87, 90, 102, 115), left greater than right.\n\nThere is a large amount of secretions in the left mainstem, upper and lower\nlobar bronchi, with minimal aeration of distal segmental and subsegmental\nbranches.  There is diffuse central bronchial wall thickening.  Taken\ntogether, findings are concerning for bronchopneumonia or aspiration.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The upper abdomen is only minimally imaged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Scattered ground-glass and ___ opacities in the bilateral lower\nlobes, left greater than right.  Large amount of secretions in the left\nmainstem and upper and lower lobar bronchi, with minimal aeration of distal\nsegmental and subsegmental branches.  Diffuse central bronchial wall\nthickening. Taken together, findings are concerning for bronchopneumonia or\naspiration."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta is not aneurysmal and pulmonary arteries\nare slightly enlarged with the main pulmonary artery measuring 3.1 cm. No\nlarge central filling defects in the pulmonary arteries. The heart size is\nenlarged and there is no pericardial effusion. Mild atherosclerotic\ncalcifications of the thoracic aorta and no appreciable coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There are trace bilateral pleural\neffusions.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild dependent\natelectasis in the lung bases.  No suspicious pulmonary nodules.  Calcified\ngranuloma in the left lower lobe\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "No evidence of active intrathoracic infection or malignancy.\n\nMild pulmonary artery enlargement and cardiomegaly.\n\nTrace pleural effusions."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable. \nBilateral axillary lymphadenopathy is demonstrated.  A dominant lymph node on\nthe right measures 2.5 x 2.9 cm.  On the left, a dominant lymph node measures\nup to 1.3 cm (06:23).  An enhancing mass with a metallic biopsy clip in the\nright breast measuring approximately 2.6 x 2.1 cm likely corresponds to the\nprimary tumor (7:127).\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen and pelvis from\nthe same date for subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  No focal consolidation or mass.  Centrilobular micronodular\nappearance of the lung parenchyma can be seen in patients who smoke.  No\nsuspicious pulmonary nodules.\n2. AIRWAYS:  Patent to the subsegmental level.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  This study is not optimized for evaluation of pulmonary vasculature,\nhowever no central pulmonary embolism is demonstrated. The thoracic aorta is\nnormal in caliber.\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesions or acute\nfracture.",
            "output": "1. Primary right breast tumor with extensive right axillary lymphadenopathy is\ndemonstrated.  There are also numerous prominent left axillary lymph nodes\nmeasuring up to 1.3 cm are suspicious for disease involvement.\n2. No pulmonary nodules concerning for metastases.\n3. Please see the separately dictated CT abdomen and pelvis report from the\nsame date for evaluation of subdiaphragmatic structures."
        },
        {
            "input": "The imaged thyroid gland is homogeneous.  There are no pathologically enlarged\nmediastinal, hilar, or axillary lymph nodes.  There is a single prominent\nepicardial lymph node (5:173), which is not pathologically enlarged.  Heart\nsize is normal and there is no pericardial effusion.  The esophagus is\npatulous with fluid up to the level of the upper esophagus, which predisposes\nthe patient to aspiration.  Limited images of the upper abdomen demonstrate a\nhiatal hernia with surgical suture material indicative of gastric bypass, as\nwell as partially imaged central mesenteric lymphadenopathy better evaluated\non the CT abdomen pelvis performed 1 day prior.\n\nThe airways are patent to the subsegmental level bilaterally.  There is no\nfocal consolidation, pleural effusion, or pneumothorax.  No pulmonary nodules\nare seen.\n\nThere are no concerning osseous lesions in the chest cage.  No acute fracture.",
            "output": "1. No evidence of intrathoracic malignancy or infection.\n2. Patulous esophagus with fluid to the level of the upper esophagus,\npredisposing the patient to aspiration."
        },
        {
            "input": "8 mm left supraclavicular lymph nodes, 5:9, 21, are unchanged.  Right\nsupraclavicular nodes are not enlarged.  Numerous, left axillary nodes are\nnewly enlarged or larger, up to 12 x 19 mm, 5:67, previously 5 x 14 mm.  There\nare no enlarged right axillary nodes, and no masses in the imaged chest wall\nsuspicious for malignancy, excluding the breasts which require mammography for\nevaluation.  Findings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck or coronary arteries.  Small pericardial effusion has increased.\nLarge layering, nonhemorrhagic left pleural effusion and tiny right pleural\neffusion are new, perhaps related to new isointense ascites.  .\n\nTrans subclavian central venous catheter ends at the superior cavoatrial\njunction.  Aorta and pulmonary arteries and cardiac chambers are normal size.\n\nEsophagus is moderately distended with air and ingested contrast agent to the\nlevel of the gastroesophageal junction which is closed.  Functional assessment\nwould require a contrast swallow.\n\nMediastinal lymph nodes are not pathologically enlarged.  Hilar contours do\nnot suggest adenopathy. 16 x 20 mm right diaphragmatic lymph node was 10 x 13\nmm on ___.  Retrocrural lymph nodes are not enlarged.\n\nMany regions of new ground-glass opacification have appeared in non dependent\nanterior regions of both upper and middle lobe.  This is an unlikely\ndistribution for aspiration, and is therefore infection, perhaps viral, is\nhemorrhage or pulmonary drug reaction.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection. Or\n\n\n\n\n.",
            "output": "These findings are difficult to connect:  New substantial left axillary\nadenopathy, new large nonhemorrhagic layering left pleural effusion, and non\nconsolidative alveolar opacification in the non dependent upper lungs.\n\nSince the large left pleural effusion is isointense with new ascites, I\npresume they are related, either by a common inflammatory process,\nhypoalbuminemia, or by trans diaphragmatic migration of a primary abdominal\nprocess.\n\nThe differential diagnosis of the new pulmonary findings is discussed above.\n\nUnilateral axillary adenopathy is unexplained.  If there is concern for\nmalignancy, it might be accessible to ultrasound localization for needle\naspiration"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection.  There\nis moderate atherosclerosis in the aorta. The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.  There are\ncoronary artery calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Opacity in the right middle and bilateral lower lobes is\nlocated posteriorly.  The airways are patent to the level of the segmental\nbronchi bilaterally.  There is evidence of emphysema and bilateral bronchial\nwall thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Deformity in calcifications in the spleen likely from prior trauma,\nthese findings are unchanged since ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere are small anterior vertebral body osteophytes and degenerative changes\nin the bilateral glenohumeral joints.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Opacities in the right middle and bilateral lower lobes concerning for\naspiration or pneumonia."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts, incompletely imaged, which would require mammography for evaluation,\nelsewhere in the chest wall there are no findings suspicious for malignancy or\ninfection.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, but shows there\nis no adrenal mass, gallstones and milk of calcium bile are present in and non\ndilated gallbladder with no evidence of acute cholecystitis, multiple renal\ncortical cysts, but incompletely evaluated.\n\nThere are no thyroid lesions warranting further investigation. \nAtherosclerotic calcification is moderately heavy in head and neck vessels, in\nall major coronary branches, and in the normal size thoracic aorta,\nparticularly the descending portion, extending into the upper abdominal aorta,\nalso normal caliber.  Main, right, and left pulmonary arteries are all\ndilated, 35 mm, 29 mm, 30 mm unchanged since ___, reflecting pulmonary\narterial hypertension.\n\nRight paraesophageal mediastinal lymph nodes are mildly enlarged, 12 mm, 4:97.\nOther mediastinal lymph nodes are not pathologically enlarged ranging in\ndiameter up to 8 mm in the prevascular station.\n\n\nEmphysema is mild.  Collapse of the right lateral and posterior basal segments\nin the right lower lobe and worsened subsegmental atelectasis at the left base\nmay explain desaturation.  The superior segment is well aerated despite\nretained secretions obstructing the lumen and in the posterior basal segment\nof the left lower lobe.  The right lower lobe lateral and posterior basal\nbronchi are patent.\n\nThere are no lung lesions concerning for pneumonia or malignancy.\n\nThere no bone lesions in the chest cage suspicious for malignancy or active\ninfection.  Fusion of low thoracic intervertebral disc space may be due to\nremote infection or trauma, 602b:78.",
            "output": "New segmental and subsegmental atelectasis, both lower lobes only partially\ndue to retained secretions, may explain hypoxia.\n\nPulmonary arterial hypertension is out of proportion to the relatively mild\nextent of emphysema.\n\n\nSevere coronary atherosclerosis.\n\nCalcific cholelithiasis.  No evidence of biliary obstruction or cholecystitis."
        },
        {
            "input": "There is no axillary, supraclavicular, mediastinal or hilar adenopathy. The\nheart is within normal limits in size. There is no pericardial effusion. The\naorta and pulmonary arteries are within normal limits in caliber.\nCalcifications within coronary arteries are moderate. No esophageal\nabnormality is detected.\n\nPatient is status post tracheostomy.  The subglottic airway appears somewhat\nnarrowed although not beyond the inferior margin of the tracheostomy tube.\n\nA pleural-based 2 mm nodule within the upper lobe posteriorly is identified\n(2:57).  A 4 mm nodule is additionally noted within the left lung base\n(4:143). Diffuse bronchial wall thickening and secretions predominately within\nthe areas of the upper lobes (4:47) reflect chronic small airways disease.\nEvaluation of the bases is limited secondary to motion. Bibasilar atelectasis\nis mild. There is no pleural effusion or pleural abnormality.\n\nAlthough study not tailored for subdiaphragmatic evaluation, image portions of\nthe upper abdomen demonstrate no acute abnormality. A gastrostomy tube is\nnoted. Calcifications within the splenic artery are identified.\n\nOsseous structures: Deformities of the posterior left eleventh, tenth, ninth,\nand eighth are identified which demonstrate remodeling changes, felt to be\nchronic.  Several left anterolateral third, fourth, fifth and seventh rib\ndeformities also demonstrate remodeling and sclerosis to suggest chronic age. \nAdditionally, rib fractures appear to have been present on radiograph dated &\n___.  A fracture of the second left rib is nondisplaced, which may be\nacute, not definitely present on aforementioned studies although in context it\nmay also represent a more chronic abnormality.  Degenerative changes within\nthe thoracic changes are noted.",
            "output": "1. Multiple left-sided rib deformities. These involve the posterior aspects of\nthe lower ribs and anterior aspects of the upper and mid left ribs.  The\nsecond left rib fracture may be acute, not definitely present on prior chest\nradiograph dated ___, although other findings suggest it is more\nlikely part of older coinciding injuries.  Remodeling of the posterior and\nseveral anterior rib fractures is consistent with chronic age and prior\nhealing. No consolidation within the lung is identified suggestive of\ncontusion. There is no pleural effusion.\n\n2. Diffuse bronchial wall thickening and secretions is mild but suggestive of\nchronic small airways disease.\n\n3. Status post tracheostomy and gastrostomy.  Subglottic airway appears mildly\nnarrowed.\n\n4. Pulmonary nodules measure up to 4 mm in size within the left lower lobe. \nAccording to ___ criteria, Follow up CT in 12 months time in a low risk\npatient is advised.  In patients of high risk, follow up at ___ months time\nis advised."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, elsewhere in\nthe chest wall there are no soft tissue abnormalities concerning for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThyroid is enlarged and narrows the subglottic trachea from side to side where\nthere is still a segment of moderately severe stricture, less than 5 mm in\nlength, cross-sectional area 109 mm2, 04:30 at the site of previous\ntracheostomy where the lumen was almost occluded in ___.  There are no\nthyroid lesions warranting further imaging evaluation.  Atherosclerotic\ncalcification is mild in head and neck vessels, but is severe in the coronary\narteries particularly left main anterior descending and circumflex branches. \nAorta is normal caliber, valve is not calcified, pulmonary arteries and\ncardiac chambers not grossly enlarged.  There may be left ventricular\nhypertrophy.  Esophagus is unremarkable.\n\nMediastinal, hilar common other thoracic lymph nodes are not pathologically\nenlarged.\n\nCentrilobular emphysema is moderate.  The bronchial wall thickening is\nminimal, improved since ___.\n\n5 mm of left lower lobe lung nodule, 4:139, is the only lesion of significant\nsize, and it is stable since ___.  There are no new or growing lung\nnodules.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy or infection.  No new or growing lung\nnodules.  Solitary 5 mm left lower lobe lung nodule stable since ___ can be\nconsidered benign.\n\nSevere coronary atherosclerosis.\n\n5 mm along subglottic tracheal stricture at the site of previous near\nocclusion in ___, when a tracheostomy tube was in place."
        },
        {
            "input": "The aorta and its major branch vessels are patent.The pulmonary arteries are\nwell opacified to the segmental level.  Apparent eccentric filling defects in\nthe left lower lung field (for example, series 3; image 141) is thought to\nrepresent areas of motion degradation, as the vessels are opacified distally. \nNo findings of right heart strain.\n\nThere are a few prominent a borderline enlarged mediastinal and hilar lymph\nnodes, for instance right paratracheal measuring 1.1 cm and right hilar\nmeasuring 1.3 cm.\n\nThere is no pericardial effusion.  There is a small right pleural effusion\nwith adjacent compressive atelectasis.  There is diffuse consolidation\nthroughout the right upper lobe (series 2; image 51, series 601; image 18)\nconsistent with pneumonia.  These findings are on a background of moderate\ncentrilobular emphysema.\n\nLimited images of the upper abdomen show nonspecific prominent lymph nodes in\nthe porta hepatis, which are nonspecific.  Otherwise, visualized upper abdomen\nis unremarkable.\n\nNo aggressive osseous lesions.",
            "output": "1. Mildly motion degraded exam.  No definite pulmonary embolism to segmental\nlevel as described.\n2. Multiple areas opacification throughout the right upper lobe are consistent\nwith pneumonia.\n3. Small right pleural effusion with adjacent compressive atelectasis. \nBorderline and prominent mediastinal and right hilar lymph nodes are possibly\nreactive.\n\nRECOMMENDATION(S):  6 week follow-up chest radiograph to assess resolution."
        },
        {
            "input": "CHEST:\n\nThe thyroid is normal.  Axillary, supraclavicular, mediastinal, and hilar\nlymph nodes are not pathologically enlarged by CT size criteria. The great\nvessels are unremarkable. The heart and mediastinum are normal. The\npericardium is intact without effusion. The airways are patent to the\nsubsegmental levels. The esophagus is unremarkable.\n\nThere is a 1.1 cm partially calcified pulmonary nodule is seen within the\nright upper lobe (2:18). There is no evidence of pleural effusion or\npneumothorax.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal suspicious abnormality.  A\nsubcentimeter hypodensity is seen within segment ___ of the liver, too small\nto characterize.  The portal venous system is patent. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder, pancreas,\nspleen, and bilateral adrenal glands are normal. The kidneys enhance\nsymmetrically and are without suspicious solid mass.  Bilateral renal\nhypodensities are too small to characterize but likely cysts.\n\nThe stomach is normal. The small and large bowel are unremarkable in\nappearance without dilation or wall thickening.  The appendix isnormal. There\nis no retroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and its major branches contain\ncalcifications and are grossly patent.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES:  There is no evidence of acute fracture. A well-corticated\nosseous fragment is seen adjacent to the posterior aspect of the right\nacetabulum, likely reflecting an os acetabulum. No focal lytic or sclerotic\nlesion concerning for malignancy. Degenerative changes noted at L4-L5 and\nL5-S1.",
            "output": "1. No evidence of acute intrathoracic or intra-abdominal process.\n2. Incidentally noted 1.1 cm right upper lobe partially calcified pulmonary\nnodule. Recommend followup with dedicated by PET or HRCT in 3 months.\n\nNOTIFICATION:  Updated findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 21:53 on ___."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The only visible lymph node in the chest wall is\nborderline in size and located in the left axilla (5, 18).  No enlarged hilar\nor mediastinal lymph nodes.  No substantial coronary calcifications.  No\npericardial effusion.  The upper abdomen is reported in detail in the\ndedicated abdominal CT report.  No hilar or mediastinal lymphadenopathy. \nSingle vertebral hemangioma.  No osteolytic lesions at the level of the ribs,\nthe sternum or the vertebral bodies.  Mild bilateral apical scarring.  No\npleural effusions.  No pleural thickening.  The airways are patent.  Minimal\nscarring at the left and right lung basis.  No suspicious pulmonary nodules or\nmasses.",
            "output": "Currently there is no evidence for thoracic malignancy.  No suspicious lung\nnodules."
        },
        {
            "input": "The thyroid is normal.  Left subclavian and left brachiocephalic veins are\nthrombosed.  7 mm left axillary lymph node was almost 9 mm (04:11).  Enlarged\nprevascular lymph nodes measure up to 13 mm in the AP window, this lymph node\nwas 4 mm, other mediastinal and hilar lymph nodes do not meet CT criteria for\npathologic enlargement.  Left supraclavicular lymph nodes are enlarged\nmeasuring up to 12 mm.  Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is stable and there is no appreciable coronary calcification.. \nThere is no pericardial effusion.  Moderate right pleural effusion with\nadjacent atelectasis is new\nNew extensive bilateral mainly peripheral ground-glass opacities are likely\natelectasis\n4 mm nodule in the left upper lobe is stable (5:64)\nLarger and denser peribronchial consolidations in the right lower and right\nmiddle lobe also likely atelectases.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "New right pleural effusion\nExtensive bilateral atelectasis throughout the lungs\nStable left upper lobe lung nodule\nIncrease in size of prevascular and left supraclavicular lymph nodes\nGrossly stable left axillary lymph node\nLeft subclavian and brachycephalic vein new thrombosis\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:24 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider. \nAfter attempt to contact Dr. ___  Was unsuccessful"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  There is stable left\nsubclavian and left brachiocephalic vein thrombosis with significant venous\ncolor is station through the scapular and paraspinal veins, which drains into\nthe azygous vein and SVC.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is stable left axillary lymphadenopathy,\nmeasuring up to 1.0 cm (2 08:15).  The right axillary lymph node measures up\nto 9 mm (to a: 24).  Supraclavicular and lower cervical lymph nodes are not\nwell-seen due to streak artifacts from the injected contrast.  As previously,\nthe prevascular lymph node is markedly enlarged, measuring up to 1.4 x 3.1 cm,\npreviously 1.0 x 2.9 cm (2a:27).  The para-aortic lymph node measures up to 9\nmm (2a: 25), stable.  1.1 cm noted at the carina previously measured 8 mm\n(2z:30).  No mediastinal mass.\n\nPLEURAL SPACES:  There is stable moderate right pleural effusion and new small\nleft pleural effusion.\n\nLUNGS/AIRWAYS:  There is interval worsening of dependent bilateral\nground-glass opacities, likely atelectasis.  Again seen are denser\nperibronchial consolidation seen the right lower and middle lobe and left\nlower lobe, also likely atelectasis.  Previously demonstrated 4 mm nodule in\nthe left upper lobe is not well seen on today's exam due to motion and\natelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  There is mild periportal edema.  Mild\nincrease in pericholecystic fluid may be secondary to third spacing.  The\ngallbladder is not distended and within normal limits.  The common hepatic\nduct demonstrate mild rim enhancement, increased compared to prior exam, which\nmay be reactive.  Perihepatic ascites has increased since ___, now\nmoderate.  Multiple epiphrenic lymph nodes are prominently enlarged, though\nnonpathologic by CT size criteria.  Left anterior epiphrenic nodule measures 8\nmm (2b:95), previously measuring up to 5 mm.  Gastrohepatic ligament node\nmeasures 1.1 x 1.9 cm (2:100), previously 1.1 x 1.3 cm.  A periportal node\nmeasures 8 mm, stable.  Previously noted anterior peritoneal thickening at the\ninferior liver edge is slightly more prominent on today's exam (2b:124),\nreported to be a peritoneal metastatic disease.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN:  A soft tissue nodule superior to the spleen measures 4.8 x 1.3 cm\n(2b:90), previously 4.0 x 1.4 cm in ___.  A second soft tissue nodule\nbetween the spleen and the greater curvature of the stomach measures 1.5 x 0.8\ncm, previously 1.2 x 0.9 cm (2b:93).  The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen are multiple bilateral hypodensities in the kidneys, including to\nintermediate density in the left kidney, unchanged in size compared to prior\nexam.  There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nmoderate amount of free fluid in the pelvis, increased from prior exam.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Retroperitoneal lymph nodes have increased in number and size. \nFor example, 9 mm cavoatrial noted is new since prior exam (2b:116).  Multiple\npara-aortic lymph nodes are increased in size and number compared to prior\nexam, the largest measuring up to 7 mm (2b:125).  Bilateral iliac nodes are\nstably enlarged measuring up to 8 mm (2b:138, 135).  Multiple scattered pelvic\nand inguinal lymph nodes are not pathologic by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Patient is status post left femoral venous and arterial access. \n1.4 x 0.8 cm fluid collection adjacent to the access site may be a small\nhematoma.  (2b:169).\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Again seen are multiple ill-defined soft tissue densities in\nthe posterior subcutaneous tissues, stable from prior exam.",
            "output": "1. No pulmonary embolism or acute aortic syndrome.\n2. New small left pleural effusion.  Stable right moderate pleural effusion.\n3. Interval worsening of bibasilar atelectasis.\n4. Interval worsening of mediastinal lymphadenopathy.\n5. Interval progression of disease with increased peritoneal thickening and\nincreased soft tissue nodule near the spleen.\n6. Moderate ascites, increased compared to prior.\n7. Retroperitoneal and intraperitoneal lymphadenopathy, progressed compared to\nprior exam.\n8. Stable multiple ill-defined soft tissue densities seen the bilateral\nposterior subcutaneous tissues.\n9. Stable renal hypodensities."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal course and caliber.  Atherosclerotic changes are seen\nat the aortic arch.  There is mild cardiomegaly.  No pericardial effusion is\nseen.  Left chest wall cardiac conduction device is seen with leads\nterminating in the right atrium and right ventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a small hiatal\nhernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Imaged upper abdomen.  The stomach is collapsed and not well\nassessed.  6 mm hypodensity left lobe of the liver is again seen, not fully\ncharacterized on this study, but previously characterized as a cyst.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "Thyroid is not imaged.  Supraclavicular and axillary lymph nodes are not\npathologically enlarged ranging in diameter up to the size of numerous\naxillary nodes 6-8 mm across.  There are no soft tissue abnormalities in the\nchest wall suspicious for malignancy.  This study is not designed for\nsubdiaphragmatic diagnosis but shows normal-size adrenal glands and severe\nsteatosis of the liver.\n\nAtherosclerotic calcification is not evident. Aorta and pulmonary arteries are\nnormal size. There is no pleural or pericardial effusion. Hiatus hernia is\nsmall. Small peripheral plaque like opacities, for example right lower lobe,\n4:  93 and 157 could be either pleural plaques or subpleural atelectasis. The\nthere is no pleural mass or calcification. Patient should be questioned about\npossible asbestos exposure.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged. A superior\npericardial recess should not be mistaken for right upper paratracheal lymph\nnode, 04:46.\n\nAn eccentric 12 mm long well-circumscribed expansile cortical or subcortical\nlucency in the upper aspect of the right nineth rib laterally has a benign\nappearance.",
            "output": "No lung nodule or finding suspicious for malignancy. Chest radiographs showing\na lung nodule should be obtained so we can review them side-by-side with this\nstudy.\n\nSmall hiatus hernia.\n\nPossible plaque-like pleural thickening or nodular subpleural atelectasis,\nconfined to the right chest. Patient should be questioned about any prior\nenvironmental exposure to asbestos. No evidence of pleural malignancy,\ninflammation, or pulmonary asbestosis.\n\nBenign appearing right ninth rib lesion should be evaluated further only if\npatient has focal clinical findings."
        },
        {
            "input": "The visualized thyroid is unremarkable.  No axillary adenopathy.\n\nThere is a large left paramediastinal mass extending from the level of the\nleft sternoclavicular joint to the left hilum, with encasement of the left\nhilar bronchovascular structures resulting in attenuation of the pulmonary\narterial branches and significant attenuation of the left upper lobe bronchial\ntree.  Given hemoptysis, vascular invasion is suspected though there is no\nevidence of pseudoaneurysm or contrast blush.  Approximate measurements of\nthis mass: 8.5 x 6.4 x 4.4 cm.  Branches of the left upper lobe bronchial tree\nappear opacified.  There is prevascular mediastinal lymphadenopathy. For\nexample, there is a dominant 19 x 16 mm prevascular lymph node (series 2,\nimage 35).  Difficult to exclude subtle mediastinal invasion. A 2 mm pulmonary\nnodule at the right lung apex (series 3, image 36) is noted.  Multiple\ngranulomas are scattered throughout the lungs.  Severe emphysema is noted.\n\nThe main pulmonary artery is normal in caliber with patent pulmonary arterial\ntree.  Thoracic aorta is mildly calcified and normal in course and caliber. \nThe main pulmonary artery and thoracic aorta are within normal limits.  Heart\nis normal in size and shape without pericardial effusion.  No pleural\neffusion.\n\nIMAGED UPPER ABDOMEN: A 1.6 cm left splenic hypodensity likely represents a\ncyst.  Otherwise, limited images of the upper abdomen are unremarkable.\n\nCHEST WALL: The superficial soft tissues unremarkable.  There is a deformity\nof the sternum, which may represent an old healed fracture (series 602, image\n32).  No evidence of osseous metastatic disease.",
            "output": "1. Large left upper lobe and perihilar mass, detailed above, concerning for\nprimary lung cancer.  Encasement of central pulmonary arterial and left upper\nlobe bronchial tree with significant attenuation and left upper lobe bronchial\nopacification.  Mediastinal lymphadenopathy.\n2. No pulmonary embolus.\n3. Severe emphysema."
        },
        {
            "input": "There is no filling defect within the pulmonary arterial tree to suggest the\npresence of a pulmonary embolism. The thoracic aorta is normal in course and\ncaliber without evidence of dissection. There is no lymphadenopathy. The\nairway is centrally patent. No pleural or pericardial effusion is seen. Clips\nin the left thyroid bed reflect prior left thyroid lobectomy. Small right\nthyroid nodules are noted measuring up to 11 mm. Consider ultrasound to\nfurther assess.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  Mild\ndependent atelectasis is noted.\n\nThe imaged portion of the upper abdomen is unrevealing.  Nonspecific tiny\nsubcentimeter hypodensity near the hepatic dome is stable from prior.\n\nBones: Unremarkable.",
            "output": "1. No pulmonary embolism or other acute process in the chest.\n2. Status post left thyroid lobectomy. Small thyroid nodules measure up to 11\nmm for which ultrasound may be performed to further assess."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular\nlymphadenopathy.  Multiple subcentimeter hypodensities throughout the thyroid\nare too small to warrant further evaluation.  There is no axillary\nlymphadenopathy.  There are innumerable small lower cervical lymph nodes\npartially visualized.\n\nUPPER ABDOMEN: Limited images of the upper abdomen are notable for innumerable\nhypodense hepatic lesions throughout the liver concerning for metastases. \nThere simple cysts in the kidneys bilaterally measuring up to 7.6 cm in the\nupper pole the left kidney.\n\nMEDIASTINUM: There are numerous small mediastinal lymph nodes are not\npathologically enlarged.  Largest paratracheal lymph node is on the right side\nand measures 0.8 cm (4:80).  Largest subcarinal lymph node measures 0.8 cm\n(4:135).  Largest prevascular lymph node measures up to 0.8 cm (4:81).\n\nHILA: Small hilar lymph nodes are not pathologically enlarged.  The largest on\nthe right side measures up to 0.8 cm (04:12).\n\nHEART and PERICARDIUM: There is borderline cardiomegaly.  There are mild\natherosclerotic coronary artery calcifications.  There is small pericardial\neffusion.\nPLEURA: There is small left pleural effusion.  There is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Mass in the left lower lobe measuring approximately 4.2 x 3.4\ncm, infiltrates the left hilus, occludes the left inferior  pulmonary vein and\nextends into the mediastinum where it is inseparable from the esophagus. \nThere are scores of pulmonary nodules throughout the lungs predominating in\nthe lower lobes bilaterally.  There is also nodular interstitial thickening\nreflecting lymphangitic carcinomatosis.\n2. AIRWAYS:  Airways are patent to the subsegmental levels bilaterally.\n3. VESSELS:  There is normal caliber thoracic aorta.  Main pulmonary artery is\nnormal caliber.  Segmental left lower lobe branch of the left pulmonary artery\nappears compressed but not occluded by the mass described above.\nCHEST CAGE: There are no aggressive osseous lesions.",
            "output": "1. Left lower lobe mass measuring up to 4.2 cm with extension into the\nmediastinum occluding the inferior left pulmonary vein and is inseparable from\nthe distal esophagus concerning for primary lung malignancy.\n2. Widespread pulmonary carcinomatosis..\n3. Numerous hepatic metastases noted in the partially imaged upper abdomen..\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:01 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged.  There are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  This study is not\ndesigned for subdiaphragmatic diagnosis but shows no adrenal mass or\nheterogeneity in the imaged portion of the unenhanced liver.  Gallbladder wall\nthickening is mild and not surrounded by edema.  The thyroid is mildly\nheterogeneous but there are no lesions warranting further evaluation for mass.\n\nAtherosclerotic calcification is not apparent in head and neck vessels and is\nmild in the coronaries involving at least the origin of the left anterior\ndescending.  The apex of the left ventricle is protruding but this study is\nnot capable of distinguishing a normal variant from an apical aneurysm.  A\nmetallic prosthetic ring is present in the mitral valve position.  Dystrophic\ncalcification is present in posterior mitral leaflet.  Identification of the\nvalve will be provided by MRI staff.  Sternotomy is well-healed.\n\nPericardial effusion is small.  There is no pleural effusion.\n\nMediastinal nodes are not enlarged and hilar contours do not suggest\nadenopathy.\n\nThe largest nodule in a small cluster of inflammatory nodules surrounded by\nground-glass opacity, in the right upper lobe is 4 mm, 04:33.  Punctate\nbronchiolar nodules are found elsewhere in the right upper lobe, but more\nmarked in the superior left lung is grossly clear and the tracheobronchial\ntree normal to subsegmental levels.  And posterior basal segments of the right\nlower lobe.\n\nIn in one of several upper and midthoracic vertebral bodies with striations\nand hypo density, is a large region of bony lucency with punctate\nossifications, typical of a hemangioma or lymphangioma.  There is no\nassociated loss of height in that vertebral body, but mild endplate\nimpressions are seen at several levels, presumably degenerative.  There are no\nbone lesions suspicious for malignancy or infection.",
            "output": "Metallic ring of prosthetic mitral valve.  Identification and MRI\ncompatibility will be provided by MRI staff.\n\nSuggest cardiac ultrasound to excluded possible left ventricular apical\naneurysm .\n\nRECOMMENDATION(S):  Suggest cardiac ultrasound to excluded possible left\nventricular apical aneurysm"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The study is not designed for subdiaphragmatic diagnoses.  A\nsubcentimeter hypodensity is seen in the liver, which is too small to\ncharacterize.  The gallbladder contains sludge and gallstones.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy, mass, or hematoma.\n\nHILA: Evaluation of the hila is limited without intravenous contrast, within\nthis limitation there is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is no pericardial\neffusion.  Coronary artery calcifications are moderate.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is no focal consolidation or mass.  Right upper lobe\npulmonary nodules measuring less than 4 mm are stable (4; 81, 85, 90).  There\nis mild scarring in the left lower lobe.  There is no diffuse lung disease.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta, main, left, and right pulmonary arteries are\nof normal caliber.  There is mild atherosclerotic disease along the thoracic\naorta.\nCHEST CAGE: No acute fracture or aggressive osseous lesion.",
            "output": "1. No evidence of parenchymal abnormality to suggest infection.\n2. Stable pulmonary nodules.\n3. Cholelithiasis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.  Unenhanced aorta and pulmonary arteries are normal in\ncaliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The 4 mm right upper lobe pulmonary nodule (4; 104) is unchanged.  The\nother previously visualized pulmonary nodules are not well seen..  No evidence\nof pneumonia or organizing pneumonia or bronchiectasis.  No evidence to\nsuggest cryptogenic organizing pneumonia in the lungs.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows gallstones. \nNo adrenal mass is seen.  No liver lesions are seen.",
            "output": "No evidence of pneumonia.  No evidence of cryptogenic organizing pneumonia or\nGVHD in the lung.\n\nStable 4 mm right upper lobe pulmonary nodule.  All the other previously\nvisualized pulmonary nodules have resolved in the interim.  No new pulmonary\nnodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria. Mild left\ngynecomastia.\n\nMEDIASTINUM, HIILA: Few mildly prominent lymph nodes, largest measures 0.9 cm\nalong the right margin of the trachea.  .\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with mild coronary artery calcifications. There is no pericardial\neffusion.\n\nPLEURA: Trace right pleural effusion with compressive atelectasis.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is no\nfocal consolidation. There is small cluster of centrilobular tiny micronodules\nlateral segment right middle lobe series 6, image 211, 219.  Similar findings\nmedial margin right lower lobe image 201, 218.  Findings may be  infectious or\nendobronchial mucoid impaction.  Mild atelectasis posterior right costophrenic\nangle, adjacent to small right pleural effusion.\n\nBONES:  No focal abnormalities.  Mild degenerative changes spine.  .\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is normal.  No peripancreatic stranding.\n\nSPLEEN: Spleen size at the upper limits are normal measures 14.0 cm, no focal\nabnormalities.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  .  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The transverse\nand descending colon are collapsed.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative change lumbar spine, hips.\n\nSOFT TISSUES: Small fat only containing right inguinal hernia.",
            "output": "1. 2 small clusters of tiny centrilobular nodules, may represent infection or\nendobronchial impaction.  No consolidations.  .\n2. Small right pleural effusion.  Trace free pelvic fluid.\n3. No abscess."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria. Mild left\ngynecomastia.\n\nMEDIASTINUM, HIILA: Few mildly prominent lymph nodes, largest measures 0.9 cm\nalong the right margin of the trachea.  .\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with mild coronary artery calcifications. There is no pericardial\neffusion.\n\nPLEURA: Trace right pleural effusion with compressive atelectasis.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is no\nfocal consolidation. There is small cluster of centrilobular tiny micronodules\nlateral segment right middle lobe series 6, image 211, 219.  Similar findings\nmedial margin right lower lobe image 201, 218.  Findings may be  infectious or\nendobronchial mucoid impaction.  Mild atelectasis posterior right costophrenic\nangle, adjacent to small right pleural effusion.\n\nBONES:  No focal abnormalities.  Mild degenerative changes spine.  .\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is normal.  No peripancreatic stranding.\n\nSPLEEN: Spleen size at the upper limits are normal measures 14.0 cm, no focal\nabnormalities.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  .  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The transverse\nand descending colon are collapsed.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative change lumbar spine, hips.\n\nSOFT TISSUES: Small fat only containing right inguinal hernia.",
            "output": "1. 2 small clusters of tiny centrilobular nodules, may represent infection or\nendobronchial impaction.  No consolidations.  .\n2. Small right pleural effusion.  Trace free pelvic fluid.\n3. No abscess."
        },
        {
            "input": "The thyroid gland is normal.  The esophagus is within normal limits.  There is\nno hiatus hernia.  The aorta and pulmonary artery normal in caliber.  There is\nmild aortic arch calcification.  Major aortic arch branch vessels are grossly\npatent and within normal limits.  There is a right IJ central venous catheter\nwith distal tip in the low SVC.  The heart is normal in size.  There is mild\ncoronary artery calcification.  There is no pericardial effusion.  Patent\ncentral pulmonary arteries.\n\nThere is borderline right paratracheal, subcarinal lymph node, stable.  There\nis no discernible hilar lymphadenopathy.  No additional mediastinal lymph\nnodes demonstrate prominence or enlargement.  There is no visible\nsupraclavicular, axillary, subpectoral lymphadenopathy.\n\nMajor airways are patent to subsegmental levels bilaterally.  Re- demonstrated\nare bilateral, multifocal areas of primarily bronchovascular clustered nodular\nopacities, some of which demonstrate ___ morphology.  There are few\nmore prominent nodules, some centrilobular, ___ pattern opacities,\nexample in the right lateral costophrenic angle, left lateral costophrenic\nangle since ___, suggesting infection, endobronchial impaction. \nThere is no pneumothorax or pleural effusion.\n\nThere is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality.  The imaged thoracic vertebral bodies are normally aligned. There\nis mild multilevel degenerative change. Vertebral body heights are preserved.\nNo concerning focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. Bilateral, multifocal areas of clustered nodular opacities, some which\ndemonstrate ___ morphology, which remains concerning for infection,\nfew areas of nodularity are new since prior.  Consider typical and atypical\norganisms.\n2. Few borderline mediastinal lymph nodes, likely reactive\n3. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is normal.  There\nis no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: Minimally increased size of a right paratracheal lymph node,\nmeasuring 2.0 x 1.1 cm (previously 0.7 x 2.0 cm).  A subcarinal lymph node\nmeasures 1.9 x 0.9 cm, also minimally increased in size.  No new lymph nodes\nare visualized.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.  Minimal coronary arterial\ncalcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Re- demonstrated are bilateral multifocal areas of nodular\nopacities some of which demonstrate ___ morphology.  No significant\ninterval change in the size or number of the nodular opacities.  No\npneumothorax.\n2. AIRWAYS:  Patent to the subsegmental levels\n3. VESSELS:  The aorta and its major branch vessels are patent.  No filling\ndefects within the central pulmonary arteries.  The tip of a central venous\ncatheter extends to the cavoatrial junction.\nCHEST CAGE: No suspicious osseous lesions.",
            "output": "Bilateral multifocal clustered nodular opacities, overall unchanged since the\nprior CT scan.  Differential considerations again include infection with\ntypical or atypical organisms.\n\nMinimal increase in size of a right paratracheal and subcarinal lymph node."
        },
        {
            "input": "The base of neck including thyroid gland appear normal.  Thoracic aorta\ncontains minimal atherosclerotic calcification and is normal in course and\ncaliber.  The main pulmonary artery is normal in size with patent central\nbranches.  The heart is normal in size and shape with mild left coronary\nartery calcification noted.  No pleural or pericardial effusion is seen. \nSmall mediastinal lymph nodes are similar in size to prior with the largest in\nthe pre carinal station measuring 1 cm in short axis, unchanged.\n\nThere is persistent peribronchovascular opacity in the bilateral lower lobes\nwith increased peripheral nodularity concerning for pulmonary tuberculosis in\nthe setting of positive AFB sputum.  There is a small focus of peripheral\nnodular opacity in the right upper lobe on series 3, image 16 and series 3\nimage 21 in the left upper lobe also suggesting pulmonary tuberculosis with\nfoci increase in overall conspicuity from the prior exam.  Nodular cluster in\nthe posteromedial aspect of the right lower lobe is not significantly changed\nthough the overall size of the peripheral nodules appears slightly increased\nfrom the prior exam suggesting progression.  No pleural effusion.\n\nIn the imaged portion of the upper abdomen, no discrete abnormality is seen.\n\nBones:  No worrisome lytic or blastic osseous lesion is seen.",
            "output": "Lower lobe predominant peribronchovascular opacities with peripheral\nnodularity is concerning for pulmonary TB, given history of positive PPD and\npositive AFB sputum.  Overall pattern of consolidative opacity is slightly\nprogressed from prior exam."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  Top-normal lymph\nnodes are likely reactive, with the largest in the right lower paratracheal\nstation measuring up to 9 mm in short axis (5:121).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  A right\ninternal jugular central venous catheter is unchanged with the tip terminating\nin the cavoatrial junction.\n\nPULMONARY PARENCHYMA:  Bilateral lower lobe predominant peribronchovascular\nopacities have increased slightly compared with the immediate prior CT dated ___.  There are no discrete new areas of involvement, but\npre-existing areas are slightly increased in size.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "Slight interval increase in extent of basilar predominant peripheral\nperibronchovascular opacities consistent with provided history of MAC\ninfection.  No new areas of involvement."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  A right lower paratracheal mediastinal lymph node measuring 1.4\ncm, previously measured 9 mm in short axis (05:101).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is a small pericardial effusion.    A right central line\nterminates in the distal SVC.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Bilateral lower lobe predominant peribronchovascular\nnodular opacities appear similar to the prior study from ___.  No\nnew areas of involvement.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental 1level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates gall\nstones.",
            "output": "1. Bilateral lower lobe predominant peribronchovascular nodular opacities\nappear similar to the prior study from ___.  No new areas of\ninvolvement.\n2. Right lower peritracheal mediastinal lymph node measuring 1.4 cm is\nincreased in size compared to the prior study.\n3. Gall stones"
        },
        {
            "input": "The imaged base of neck is unremarkable including the imaged thyroid.  There\nis a right IJ central venous catheter with its tip terminating in the low SVC.\nThoracic aorta contains mild atherosclerotic calcification and is normal in\ncourse and caliber.  The heart is mildly enlarged with mild Coronary artery\ncalcification noted.  Hypodense appearance of the intracardiac blood pool\nsuggests anemia.  No pericardial or pleural effusion is seen.  A right lower\nparatracheal lymph node is again seen remaining prominent measuring 1 cm in\nshort axis.  No additional sites of adenopathy detected.  Airway is centrally\npatent.\n\nA similar overall pattern of peripheral ___ consolidation with a lower\nlobe predominant pattern is again seen.  Scattered peripheral nodules are also\nnot significantly changed, with a peribronchovascular ___ distribution\nand lower lobe predominant pattern.  Additionally, there is peripheral\nsubpleural consolidation subpleural consolidation in the superior segment of\nthe right lower lobe is again noted on series 5, image 149 as well as a left\nupper lobe subpleural consolidation on series 5 image 100.  No associated\neffusions.  Findings remain concerning for infection and given the\ndistribution and appearance, bacterial infection, possibly septic emboli is of\nconcern.  Of note, no central cavitation is seen.  Please correlate with blood\nculture in possible echocardiogram.  Given the distribution, in etiology of\natypical mycobacterial infection is less favored.\n\nNo acute findings are seen in the imaged upper abdomen.\n\nBony structures are intact.",
            "output": "Persistent lower lobe predominant peribronchovascular opacities without\ncavitation or associated pleural effusion.  Differential considerations favor\nbacterial infection with hematogenous spread, please consider septic emboli."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There are\nmild atherosclerotic calcifications of the thoracic aorta and coronary\narteries.  There is a small pericardial effusion, increased from comparisons\nstudy.\n\nAXILLA, HILA, AND MEDIASTINUM: A conglomerate of right lower paratracheal\nlymph nodes measures 1.1 cm in short diameter (02:26), unchanged from\ncomparisons study.  There is no axillary, supraclavicular, or hilar\nlymphadenopathy.  PLEURAL SPACES: There are small right-greater-than-left\nbilateral pleural effusions, new since comparisons study.\n\nLUNGS/AIRWAYS:\n\nThere is a peripheral airspace consolidation and surrounding ground-glass\nchange in the left upper lobe (5:101), minimally changed from comparisons\nstudy.  There is consolidative and ground-glass change in the superior segment\nof the right lower lobe (5:151), minimally changed.  There are diffuse\ncentrilobular nodular opacities in the bilateral left-greater-than-right lower\nlobes which have increased  since the comparison study. A subpleural nodule in\nthe right upper lobe measuring 5 mm (5:135) is unchanged.  Airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Worsening centrilobular nodular opacities in the left-greater-than-right\nlower lobes the bilateral lungs as compared to chest CT ___\nsuspicious for a progressing infectious process.\n\n2. Peripheral airspace consolidation and ground glass change in the left lower\nand right upper lobes are unchanged.\n\n3.  Small pericardial effusion is increased in size.\n\n4.  New bilateral pleural effusions."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Several borderline sized lymph nodes (2, 19) Are\nvisualized in the mediastinum.  Moderate coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  Normal appearance of the posterior\nmediastinum.  No acute abnormalities in the upper abdomen.  Stable appearance\nof the bony structures.  Moderate respiratory motion.  The bilateral lower\nlobe predominant partly nodular and partly ___ opacities seen on the\nprevious examination have only minimally improved.  However, the bilateral\npleural effusions have almost completely resolved.  The morphology of the\nchanges is consistent with the bacterial or viral infection rather than with a\nfungal infection.  No diffuse lung disease. No substantial mucous plugging. \nThe large airways are patent.",
            "output": "Almost complete resolution of the pre-existing pleural effusions. Only minimal\ndecrease in extent of the lower lobe predominant bilateral ___ and\nperipheral nodularity is, the distribution and morphology of which is\nconsistent with a bacterial or viral origin, rather than with a fungal\ninfection."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular adenopathy.  No axillary adenopathy.  Mild gynecomastia. \nRight-sided central line in situ with the tip at the cavoatrial junction.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  No adrenal lesions.  Minimal perihepatic and\nperisplenic free fluid.\n\nMEDIASTINUM: Borderline (reactive) mediastinal lymph nodes.\n\nHILA: Subcentimeter hilar lymph nodes.\n\nHEART and PERICARDIUM: Small to moderate pericardial effusion measuring 15 mm\nadjacent to the right ventricle.  No cardiomegaly.  Normal cardiac\nconfiguration.  Relative hypodensity of the blood pool suggesting anemia.  No\naortic valve calcification.  No aneurysmal dilatation of the ascending aorta. \nMild to moderate coronary artery calcification.  Mild calcification of the\naortic arch.\nPLEURA: Small left-sided pleural effusion.  Small to moderate right-sided\npleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild interstitial septal thickening suggesting mild\ninterstitial pulmonary edema.  Scattered small pulmonary nodules appears\nslightly improved compared to prior.  Please note that the predominance of\nperibronchial nodules on the previous study was in the lower lobes and\ncurrently the posterior basal aspects of the lower lobes are obscured by\natelectasis, thus it is difficult in commenting on these nodules.  Atelectasis\nin the posterior basal aspects in the lower lobes adjacent to the effusions\nare mild.  No new confluent airspace consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "The significant interval change is third-spacing of fluid as evidenced by\ninterval development of small to moderate pleural effusions and a small to\nmoderate pericardial effusion.  Mild adjacent atelectasis in the lung bases\nbilateral.  Minimal perihepatic and perisplenic free fluid also noted.\n\nNo new areas of airspace consolidation to suggest new pneumonia. The\nperibronchial nodules in the mid to upper lung zones appear slightly improved\ncompared to prior.  Please note that it is difficult to comment on the\npreviously noted peribronchial pulmonary nodules in the lower lobes as these\nareas are now obscured by atelectasis.\n\nRelative hypodensity of the blood pool suggesting anemia."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is homogeneous\nin attenuation without focal nodularity.  There is no supraclavicular or\naxillary lymphadenopathy.  There is mild left gynecomastia, unchanged from\nprior exam.  Otherwise, the imaged chest wall is unremarkable.\n\nUPPER ABDOMEN: The imaged upper abdomen is unremarkable, other than layering\nhyperdensity within the gallbladder, which may represent sludge.  There is no\nsignificant gallbladder-wall edema.  Trace ascites.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.  The\nlargest mediastinal lymph node measures up to 8 mm in the lower pretracheal\nstation (03:20).\n\nHILA: Evaluation of hilar lymphadenopathy is limited on noncontrast exam.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  Small amount\nof pericardial effusion is smaller from ___.  Stable heart size. \nCoronary artery calcifications.  As previously, relative hypodensity of the\nblood pool suggests anemia.\nPLEURA: Moderate bilateral pleural effusions have increased.\nLUNG:\n\n1. PARENCHYMA:  Compared to prior exam, the degree of bilateral lower lobe\natelectasis has increased and is moderate.  In addition, there is increased\ndependent atelectasis of the left upper, right right middle upper lobes and\nlingula compared to prior exam.  Mild pulmonary edema.  Few tiny nodules are\nagain seen in the right upper lobe, left upper lobe posteriorly, right middle\nlobe, similar to prior.  Component of pneumonia or aspiration in the posterior\nleft upper lobe cannot be excluded.\n2. AIRWAYS:  There is minimal aerosolized debris within the right mainstem\nbronchus.  Otherwise, the airways are patent to the subsegmental levels.\n3. VESSELS:  The pulmonary arteries are not enlarged.  The ascending and\ndescending aorta are normal in caliber.  Due to lack of IV contrast,\nevaluation for pulmonary embolism is limited.\nCHEST CAGE: There are no worrisome osseous lesions for malignancy or\ninfection.  Degenerative changes of the thoracic spine is stable.  Mild\ngynecomastia.",
            "output": "-Small nodules are again seen and are stable.  Worsened atelectasis\nbilaterally, moderate in the lower lobes.  Component of aspiration or\npneumonia in the posterior left upper lobe cannot be excluded..\n-Moderate pleural effusions have worsened.."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nLeft PICC line in situ with the tip in the proximal right atrium.  No\nsupraclavicular adenopathy.  No axillary adenopathy.  Asymmetrical moderate\nleft gynecomastia.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Hyperdense sludge present in the gallbladder\n(suspected vicarious excretion of contrast).  Hyperdense appearance of the\nliver.\n\nMEDIASTINUM: No mediastinal adenopathy.  Mildly patulous appearance of the\nesophagus.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Small pericardial effusion measuring 1 cm in diameter\nappearing similar compared to prior.  Relative hypodensity of the blood pool\nsuggesting anemia.  No aortic valve calcification.  Moderate coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.\nPLEURA: Moderate bilateral pleural effusions, slightly decreased in size\ncompared to prior.\nLUNG:\n\n1. PARENCHYMA:  The previously noted interstitial thickening (interstitial\nedema) has resolved.  Almost complete atelectasis of both lower lobes has\nworsened.  A few scattered sub 4 mm broncho centric nodules are decreased in\nnumber compared to prior.\n2. AIRWAYS:  Minimal secretions present in the proximal trachea (2, 8).  The\nairways are patent to the subsegmental level.  No bronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: No lytic/destructive bony lesions.  Mild spondylotic changes of\nthe thoracic spine.",
            "output": "No evidence of infection in the lungs.\n\nInterval resolution of prior mild interstitial pulmonary edema.\n\nIncreased moderate bilateral pleural effusions and worsened bilateral lower\nlobe near collapse.\n\nModerate coronary artery calcification\n\nHyperdense appearance of the liver could be due to iron replacement therapy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid unremarkable. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  Mild upper esophageal\nwall thickening.  The esophagus less patulous compared to ___.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA: Few right upper lobe pulmonary nodules measuring less\nthan 4 mm are unchanged in size compared to ___ (4: 94, 97, 103). \nThere is no evidence of infection or malignancy.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  No pneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates the\ngallbladder with multiple high-density stones without evidence of wall\nthickening.  Hyperdense appearance of the liver is unchanged compared to ___.  The bilateral adrenal glands are unremarkable.",
            "output": "1. No evidence of parenchymal abnormalities to suggest infection in the lungs.\n2. Small right upper lobe pulmonary nodules measuring under 4 mm are stable\nsince at least ___, can be considered benign.\n3. Moderate coronary artery calcifications are stable since ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is moderate atherosclerotic disease of the\nthoracic aorta.  Post CABG changes and a mitral prosthetic valve is noted. \nMedian sternotomy wires are noted.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary, mediastinal, or hilar\nlymphadenopathy.  Evaluation of supraclavicular lymphadenopathy is limited due\nto streak artifact from left shoulder arthroplasty.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is dependent atelectasis in the bilateral right greater\nthan left lower lungs.  There is no airspace consolidation.  Lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.  There is persistent\nelevation of the right hemidiaphragm, unchanged as compared to CT abdomen\npelvis ___.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Mild prominence of the pancreatic duct and common bile duct is\ngrossly stable as compared to CT abdomen pelvis ___.  Bilateral\nadrenal glands are unremarkable.\n\nBONES: There is mild height loss of the T8 vertebral body which looks grossly\nunchanged as compared to chest radiograph ___.  Mild to moderate\ndegenerative changes of the thoracic spine is noted.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Persistent elevation of the right hemidiaphragm is unchanged as compared to\nCT abdomen pelvis ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nPlease note that evaluation of the vessels in the right lung base is limited\nsecondary to prominent volume loss and atelectasis.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nthoracic aorta is markedly calcified.  Note is made of a prostatic mitral\nvalve.  There are coronary artery calcifications.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy,\nevaluation of the left axilla is limited secondary to left shoulder\narthroplasty.  Conspicuous mediastinal nodes are not enlarged by CT size\ncriteria, and are possibly reactive.  No definite hilar lymphadenopathy.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a patchy nonenhancing consolidative process in the\nmedial segment of the left lower lobe (3:69), compatible with pneumonia. \nThere is compressive atelectasis at the lung bases, right prominent in the\nmedial segment of the right lower lobe secondary to a chronically elevated\nright hemidiaphragm.  Central airways are heavily calcified but patent.  There\nis diffuse bronchial wall thickening distally compatible with small airway\ndisease.  There are moderate centrilobular emphysematous changes.  Mild\nthickening is seen along the left pleural fissures.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is unchanged prominence of the main pancreatic duct.  Partially\nvisualized abdomen is otherwise unremarkable.\n\nBONES: Height loss of the T8 vertebral body is similar to prior.  There are\nmultilevel mild to moderate degenerative changes.  Median sternotomy wires are\nnoted.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Non-enhancing consolidative process in the medial segment of the left lower\nlobe is compatible with pneumonia.\n3. Bibasilar atelectasis, near complete in the medial segment of the right\nlower lobe secondary to chronic elevated right hemidiaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Several left peripectoral lymph\nnodes, 8-11 mm in diameter, 1.1 cm (6:111).  There is no right axillary\nlymphadenopathy.\nSeveral fiducial markers in the left breast which its evaluation reserved for\nmammography.\nImage thyroid is with no focal findings.  There is no supraclavicular\npathologic enlargement of lymph nodes.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.\nS shaped scoliosis.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings..\n\nMEDIASTINUM: There is no pathologic enlargement of lymph nodes in mediastinum\nor hila.  Posterior mediastinum is unremarkable with the exception of mildly\npatulous lower esophagus.\n\nHEART and PERICARDIUM: Heart is normal in size.  No appreciable\natherosclerotic calcifications.  Thoracic aorta and main pulmonary artery are\nnormal in caliber.  Pericardium is physiologic.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level and the lungs\nare clear.",
            "output": "Possible lymphadenopathy in the left axilla.  No evidence of pulmonary or\nother metastatic foci."
        },
        {
            "input": "CT CHEST WITH CONTRAST:  Right port-a-cath is present. The partially imaged\nthyroid appears normal. No supraclavicular or axillary lymphadenopathy. \nMultiple surgical clips are seen in the left axilla. Small mediastinal lymph\nnodes are not pathologically enlarged by CT size criteria. For example, 9 mm\nright lower paratracheal node (04:20).\n\nHeart size is normal without pericardial effusion. Aorta and main thoracic\nvessels are well opacified and normal in caliber. The main pulmonary arteries\nare normal in caliber.\n\nThe tracheobronchial tree is patent to the subsegmental level. There is no\npleural effusion or pneumothorax. There approximately one dozen pulmonary\nnodules in each lungs are evenly distributed between the upper and lower lung\nzones. Several of the largest representative nodules are detailed below:\n\n-1.2 x 1.2 cm right upper lobe nodule (04:23).\n-0.9 x 0.9 cm right upper lobe peripheral nodule (04:21)\n-1 x 0.8 cm right upper lobe subpleural nodule (04:23)\n-1.4 x 1.4 cm right upper lobe nodule abutting the pericardium (04:29)\n\n-0.9 x 0.7 cm right middle lobe nodule (04:38)\n\n-1 x 0.9 cm right lower lobe nodule (04:37)\n-0.9 x 0.8 cm right lower lobe nodule (04:46)\n\n-1 x 1 cm left upper lobe nodule (04:18)\n-1.2 x 0.9 cm left upper lobe nodule (04:25)\n-0.9 x 0.4 cm left upper lobe anterior subpleural nodule (04:32)\n\n-0.8 x 0.6 cm left lower lobe nodule (04:29)\n-0.6 x 0.5 cm left base nodule (04:50)\nOSSEOUS STRUCTURES:  Posterior cervical and thoracic spinal fusion hardware is\npartially imaged.\n\nPlease note CT of the abdomen will be reported separately.",
            "output": "1. Numerous metastatic pulmonary nodules as detailed above.\n2. Please note CT of the abdomen will be reported separately."
        },
        {
            "input": "Exam is moderate to severely limited due to patient motion and suboptimal\ncontrast bolus timing.\n\nHEART AND VASCULATURE: Within the above limitations, there is no large central\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a small hiatal\nhernia as well as a patulous thoracic esophagus, which may represent\nesophageal dysmotility.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild right basilar atelectasis, and moderate to severe\natelectasis/collapse at the left lung base.  No definite, nonenhancing focal\nconsolidation is seen within the lung parenchyma.  No large areas of\nnodularity are appreciated, although evaluation of the remaining lung\nparenchyma is significantly limited due to respiratory motion.  There is\nbronchial wall thickening bilaterally with mild mucous plugging of the right\nlower lobe and severe narrowing of the left lower lobe bronchi.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is moderate to severe degenerative change of the thoracic spine with\nevidence of DISH.",
            "output": "1. Moderate to severely limited exam due to patient motion and suboptimal\nbolus timing.  Within these limitations no large central pulmonary embolus.\n2. Bibasilar atelectasis/collapse without pleural effusion or definite\nnonenhancing focal consolidation.  Bronchial wall thickening bilaterally with\nmild mucous plugging at the right lower lobe and severe narrowing of the left\nlower lobe bronchi."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits.  No pericardial\neffusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 0.4 cm nodule in the right upper lobe (___).  There\nis scattered pleural thickening in the bilateral upper lobes.  Lungs are\notherwise clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Incidentally noted 0.4 cm hypodensity in the left thyroid lobe,\nof indeterminate clinical significance.  Visualized portions of the base of\nthe neck otherwise show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen again demonstrates\nthe 1.6 x 1.3 cm solid appearing exophytic lesion arising from the upper pole\nof the left kidney.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. There is a 0.4 cm nodule in the right lung apex of indeterminate clinical\nsignificance.  Attention on follow up imaging is recommended as per clinical\nprotocol.\n2. Again seen is a 1.6 x 1.3 cm solid appearing exophytic lesion arising from\nthe upper pole of the left kidney.  As recommended on the ___ study,\nrecommend renal ultrasound for further evaluation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is heterogeneous with small\nhypodense nodules.\n No enlarged lymph nodes are seen in the thoracic inlet.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show large calcified\ngallstones, hepatic cysts, signs of polycystic kidney disease in widespread\natherosclerosis in the abdominal vessels, unchanged since prior abdominal CT\nof ___..\n\nMEDIASTINUM: Indwelling tube in size the esophagus.  Esophagus is otherwise\nunremarkable.  No enlarged mediastinal hilar lymph nodes by CT size criteria.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  Severe\natherosclerotic calcifications in coronary arteries, mitral annulus and\nmoderate to the thoracic aorta in aortic valve.\nPLEURA: Large bilateral pleural effusions, right greater than left,\nnonhemorrhagic.\nLUNG:\n\n1. PARENCHYMA:  Collapse of the right lower lobe.  New complete compressive\natelectasis to left lower lobe.  The remainder lobes are clear.\n2. AIRWAYS:  Airways are patent to subsegmental levels.\n3. VESSELS:  Pulmonary artery significantly enlarged measuring 4.7 cm.\nCHEST CAGE: Old bilateral healed rib fractures.  Moderate dorsal spondylosis. \nIntact sternotomy wires.",
            "output": "Apparently stable large nonhemorrhagic bilateral pleural effusions causing\ncollapse of the right lower lobe in significant compressive atelectasis of the\nleft lower lobe compared to abdominal CT dated ___.\nPulmonary artery is severely enlarged, larger than in the abdominal CT of ___, for which correlation with an echocardiogram is advised for\nassessment of pulmonary hypertension."
        },
        {
            "input": "No supraclavicular, axillary, mediastinal, or hilar lymph node enlargement by\nCT size criteria.The thyroid gland is unremarkable.\n\nThe heart size is normal without pericardial effusion. Atherosclerotic\ncalcifications are seen within the thoracic aorta. The great vessels are\nnormal caliber.\n\nNo pleural effusion.No pneumothorax.  The airways are patent to the\nsubsegmental level.\n\nFollowing pulmonary nodules are stable since ___: 4 mm (4:44) right\napical partially solid nodule, 3 mm (4:52) right upper lobe nodule, 2 mm\n(4:127) left upper lobe nodule, and 7 x 3 mm (4: 111) left lower lobe nodule.\nStable 3 mm (4: 167) right middle lobe nodule with pleural tag is consistent\nwith a intrapulmonary lymph node, unchanged since ___.\n\nMinimal increase in 3 mm (4: 135) right upper lobe pulmonary nodule since\n___.\n\nNew 4 mm (4:157) linear right lower lobe density.\n\nInterval increase in a 2.6 x 2.4 cm (4:95) (previously 2.4 x 2.1 cm) left\nupper lobe ground-glass nodule which is stable in density in comparison to\n___ and is worrisome for a slow growing adenocarcinoma.\n\nOSSEOUS STRUCTURES: No lytic or blastic osseous lesions concerning for\nmalignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is notable for a 1 x 0.7 cm (02:40)\nsegment 5 hepatic cyst, stable since ___ further details, please\nsee the concomitant dedicated CT abdomen and pelvis.",
            "output": "1.  Interval increase in size of left upper lobe ground-glass nodule worrisome\nfor slow growing adenocarcinoma.\n2.  New 4 mm linear right lower lobe density. Close attention on followup is\nrecommended\n3.  Minimal increase in 3 mm right upper lobe pulmonary nodule since ___.\n4.  Multiple millimetric right pulmonary nodules are stable since ___."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  The ascending aorta is top-normal\nin size measuring 3.7 x 3.7 cm.  The pulmonary artery is of normal caliber. \nThere is relative hypodensity of the blood pool relative to the myocardium may\nbe due to anemia. Otherwise, the heart and pericardium are unremarkable and\nthere is no pericardial effusion.  The airways are patent to the subsegmental\nlevels.\n\nThe left upper lobe ground-glass nodule is unchanged since ___\nallowing for differences in measurement technique.  This measures 2.5 x 2.2 cm\n(series 4, image 121) previously 2.4 x 2.3 cm.  Multiple pulmonary nodules are\nunchanged including a  4 mm right upper lobe nodule (series 4, image 63), a 2\nmm right upper lobe nodule (series 4, image 65) and a 4 mm perifissural nodule\non the right (series 4, image 151).  Calcified subpleural nodule in the right\nupper lobe (series 4, image 180) is unchanged.  There are no new nodules or\nmasses.\n\nThis study is not tailored for evaluation of subdiaphragmatic structures. \nPlease see the dedicated CT abdomen report for further details.\n\nThere are no bony lesions worrisome for malignancy.",
            "output": "1. 2.4 cm left upper lobe ground-glass nodule most likely representing\nadenocarcinoma is stable since ___.\n2. Stable millimetric bilateral pulmonary nodules."
        },
        {
            "input": "CHEST:\nAorta and great vessels are unremarkable without dissection or aneurysm.\nEvaluation for pulmonary embolism is limited due to timing of the bolus. \nWithin these limits the pulmonary arteries are well opacified to the segment\nlevel without filling defect to suggest pulmonary embolism. The pulmonary\narteries are top normal in caliber.\n\nHeart size is normal. There is no pericardial effusion.\n\nThere is no consolidation, pleural effusion or pneumothorax. The airways are\npatent to the subsegmental level.\n\nScattered left supraclavicular, axillary and mediastinal lymph nodes are\nmildly enlarged, measuring up to 8 mm (02:8, 14, 22,).  There is no pathologic\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is a 6 mm hypodensity in the left lobe of the thyroid.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo suspicious osseous lesions identified. There is no acute fracture.  Nodular\ndensities in the left breast are likely correlating with the previously seen\nfibrocystic changes, which are better assessed on mammography.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is mild fullness of the intrahepatic. \nThe common bile duct measures up to 1 cm and tapers gradually. The gallbladder\nis within normal limits.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  The main pancreatic duct is mildly prominent.  There is no\nperipancreatic stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right adrenal gland is normal in size and shape.  2\nheterogeneously enhancing left adrenal masses, measuring 3.2 x 2.1 cm and 1.6\nx 1.2 cm are grossly unchanged since ___, though indeterminate in\nenhancement pattern.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is defect in the left upper, posterior renal cortex, unchanged since ___, likely a sequela of prior infection or infarct.  Bilateral renal\nhypodensities are seen, some are too small to characterize by CT, though are\nlikely to be simple cysts.  There is no evidence of hydronephrosis. There is\nno perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix is not visualized. There is no evidence of mesenteric\nlymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:  The partially imaged urinary bladder and distal ureters are\nunremarkable. There is no evidence of pelvic lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged with a right large posterior\nsubserosal fibroid.\n\nBONES AND SOFT TISSUES:\n\nDegenerative changes are seen in the lumbar spine. There is no fracture. \nAbdominal and pelvic wall is within normal limits.",
            "output": "1.  No evidence of abdominal aortic dissection.\n2. Stable left adrenal masses.\n3. Mild prominence of the intrahepatic biliary ducts with CBD measuring up to\n9 mm without evidence of focal lesions.  Correlation with LFTs is recommended.\n4. The uterus is enlarged and there is a fundal fibroid.\n5. Small left thyroid nodule or cyst.  Correlation prior ultrasound would be\nrecommended if available.  If not, then ultrasound should be considered."
        },
        {
            "input": "There is technical limitation due to respiratory motion, body habitus and beam\nhardening artifact from the arms.  Right-sided pacemaker with 2 leads. \nLeft-sided Port-A-Cath terminates in the mid SVC.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan.  There is trace pericardial fluid.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a mildly prominent 1 cm right hilar\nnode, likely reactive.  Otherwise no enlarged lymph nodes are identified\nwithin the limits of unenhanced CT.  The\n\nPLEURAL SPACES: There appears to be a tiny left basal pleural effusion, but\nevaluation is limited by beam hardening.  There is no evidence of right\npleural effusion.\n\nLUNGS/AIRWAYS: Endotracheal tube terminates in the trachea.  Evaluation is\nlimited due to respiratory motion artifact.  There is significant atelectasis\ninvolving portions of the basal left lower lobe all, and a component of\nconsolidation is not entirely excluded.  There is milder atelectasis in the\nbasal right lower lobe.  The there is patchy ground-glass opacity in the\nperihilar regions and bilateral upper lobes, greater on left than right.  This\nis likely inflammatory and could potentially represent pneumonia, and\ncomponent of mild edema.  An endotracheal tube is present.\n\nABDOMEN: The note is again made of hepatic steatosis.  The tip of an NG tube\nis just beyond the gastroesophageal junction.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nNote is again made of bilateral elastofibroma dorsi.",
            "output": "Bibasal atelectasis. Patchy bilateral ground-glass opacity is nonspecific but\ncould be due to an overlying inflammatory process such as pneumonia, with\npossible component of mild pulmonary edema.\n\nNG tube tip just beyond the GE junction.  Consider advancement."
        },
        {
            "input": "CT CHEST:\n\nThe distal tip of the endotracheal tube is 3.7 cm above the carina. The distal\ntip of the right transvenous dual lead pacemaker terminates at the right\natrium and right ventricular apex.  The distal tip of the left Port-A-Cath\nterminates in the superior vena cava.\n\nThe thyroid is unremarkable.\n\nThere is no size significant supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.\n\nThere is minimal atherosclerotic calcification.\n\nSmall bilateral pleural effusions, with associated subsegmental atelectasis.\nThere is no evidence of pericardial effusion.\n\nNo focal mass or consolidation within the lung parenchyma. Retained secretions\nare seen within the trachea. There is almost complete collapse of the left\nlower lobe.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nCT ABDOMEN AND PELVIS:\n\nLiver: The liver is homogeneous with a smooth contour.  No suspicious liver\nlesion.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation.\nUnchanged position of the cholecystostomy tube with distal tip terminating in\nthe fundus.  The gallbladder is collapsed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: The urinary bladder is collapsed and contains a Foley catheter.  The\ndistal ureters are unremarkable. There is a small amount of ascites.\n\nGastrointestinal: The distal tip of the enteric tube is in the gastric body.\nThere is colonic diverticulosis, with no evidence of diverticulitis.  There is\nno evidence of bowel dilatation or obstruction.  A duodenal diverticulum is\nagain seen.  A rectal tube is seen.\n\nVascular: There are minimal atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: There is no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. Mild degenerative\nchanges at L5-S1. Unchanged size of the small hematoma in the subcutaneous fat\nof the anterior abdominal wall on the right.",
            "output": "1. No source of infection is identified within the chest, abdomen or pelvis.\n\n2. Small bilateral pleural effusions and small volume ascites."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart is mildly enlarged. No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are patchy ground-glass opacities throughout the\nbilateral lungs which may represent a degree of air trapping. There is\ndependent bilateral atelectasis at the lung bases. Lungs no focal\nconsolidations are identified.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small\naccessory spleen.  There is a partially imaged cholecystostomy tube.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral pulmonary air-trapping without focal consolidations."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\ninterlobar level without filling defect to indicate a pulmonary embolus.  The\nsegmental and subsegmental pulmonary arteries are not well opacified and\ncannot be evaluated.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.\n\nThe heart is mildly enlarged, unchanged from prior exam.  The pericardium is\nwithin normal limits. No pericardial effusion is seen.  There is a pacemaker\nembedded in the right chest wall with distal leads in the right atrium and\nright ventricle.  There is a left-sided Port-A-Cath with distal tip in the\nright atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are trace bilateral pleural effusions with associated\natelectasis.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  No pulmonary nodule or consolidation noted.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrated cholecystostomy\ntube.  There is hepatic steatosis.  There is a small splenule adjacent to\nspleen\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThe bones are demineralized.  Old fracture deformities of the posterior left\neighth through tenth ribs noted.  There is extensive kyphosis of the thoracic\nspine noted similar to prior exam.",
            "output": "Trace bilateral pleural effusions with associated atelectasis.\nStable cardiomegaly.\nNo evidence of pulmonary embolism in the main, lobar and interlobar pulmonary\narteries.\nHepatic steatosis.\nStable marked thoracic kyphosis."
        },
        {
            "input": "HEART AND VASCULATURE: Respiratory motion limits evaluation of the pulmonary\narteries to the segmental level.  Within this limitation, there is no evidence\nof pulmonary embolism.  The main and right pulmonary artery remain mildly\ndilated.  Severe cardiomegaly is stable.  Right subclavian approach pacemaker\nwires terminate in the right atrium and ventricle, as before.  Left subclavian\napproach Port-A-Cath tip is in the mid SVC.  There is no pericardial effusion.\nThe thoracic aorta is normal in caliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace bilateral pleural effusions are similar.  No\npneumothorax.  Pleural scarring is more severe on the right.\n\nLUNGS/AIRWAYS: The lungs are clear with the exception of bibasilar dependent\natelectasis.  Airways are patent to the subsegmental level.\n\nABDOMEN:  Included portion of the upper abdomen is notable for severe, diffuse\nhepatic steatosis as before. A percutaneous cholecystostomy tube is partially\nimaged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nChronic left anterior second rib deformity is re-demonstrated.  Chronic right\nlateral eighth rib fracture is noted.  Bilateral elastofibroma dorsi are\nredemonstrated.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Stable severe cardiomegaly."
        },
        {
            "input": "Partially visualized thyroid is unremarkable.  The esophagus is within normal\nlimits.  The aorta demonstrates normal caliber throughout the chest without\ncalcification.  Pulmonary artery is normal in caliber.  Heart is normal in\nsize.  No pericardial effusion or coronary artery calcification. \nTriangular-shaped soft tissue density in the anterior/prevascular mediastinum\nlikely represents remnant/residual thymic tissue.  There are no pathologically\nenlarged mediastinal, discernible hilar, supraclavicular, or subpectoral lymph\nnodes.  Scattered bilateral axillary lymph nodes are slightly increased in\nnumber but not individually enlarged.\n\nMajor airways are patent to subsegmental levels bilaterally.  In the posterior\nsegment of the right upper lobe, the inferior lingula, and the basilar\nsegments of left lower lobe, there are clustered foci of peribronchial\nconsolidative and ground-glass opacities, likely representing an\nairways-centered multifocal infectious process, possibly due to chronic\naspiration (for example see series 4, images 79, 142, 146, 206, and 222).  5\nmm intrapulmonary lymph node is seen at the left lung base (4:252).  No focal\nlung nodule or mass.  No pleural effusion or pneumothorax.\n\nThe imaged soft tissues of the chest wall are grossly unremarkable on limited\nevaluation.  No concerning focal lytic or sclerotic osseous lesions are seen.\n\nThe partially imaged solid and hollow viscous organs of the upper abdomen are\nwithout acute focal abnormality on limited noncontrast evaluation.",
            "output": "Multifocal peribronchial consolidative and ground-glass opacities worst at\nleft lung base but also involving the inferior lingula and posterior segment\nof the right upper lobe, consistent with an airways-centered multifocal\ninfectious process, possibly related to chronic aspiration.  Recommend\nfollow-up chest imaging to resolution.\n\nRECOMMENDATION(S):  Recommend follow-up serial chest radiographs to\nresolution."
        },
        {
            "input": "There is no CT evidence of hilar, mediastinal, or axillary lymphadenopathy. \nHeart size is normal, and there is no pericardial or substantial pleural\neffusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning abnormalities are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions within the thorax.  Within the breasts, an asymmetrical poorly defined\ndensity is present deep within the right breast medially measuring about 9 mm\n\nWithin the lungs, there are no focal areas of consolidation to suggest the\npresence of pneumonia.  Airways are notable for mild diffuse bronchial wall\nthickening.",
            "output": "1.  No CT evidence of intrathoracic lymph node enlargement.\n\n2.  Mild diffuse bronchial wall thickening, which may represent acute or\nchronic bronchial inflammation."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Severe\ncoronary calcifications are visualized.  Otherwise, the heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  A right hilar node is prominent measuring 9 mm\n(4:148).  Additional right bronchopulmonary nodes are noted.  No mediastinal\nmass.  The esophagus is patulous and filled with debris throughout.\n\nPLEURAL SPACES: There are small bilateral nonhemorrhagic pleural effusions\nwith associated atelectasis.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is bronchial wall thickening affecting the dependent\nportion of the lower lobes bilaterally.  There is a focus of rounded\nopacification within right lower lobe surrounding an air-filled bronchus\n(series 2, image 46), which is likely infectious or inflammatory in nature\nhowever neoplastic process cannot be definitively excluded on the current\nstudy.  There are also ill-defined opacities within the lower lobes\nbilaterally, also likely representing infection or inflammation.  Aspiration\nis a consideration.  No additional focal consolidations are visualized. \nHowever, there are numerous solid pulmonary nodules, predominantly on the\nright (series 2, image 33, 39, 40, 43, 45).  The largest is within the right\nlower lobe and subpleural in location measuring 12 mm (series 2, image 44). \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Although not completely imaged, the spleen appears enlarged. \nOtherwise, the included portion of the upper abdomen is unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  Punctate calcification within the left breast.",
            "output": "1. Focus of rounded opacification within the right lower lobe surrounding an\nair-filled bronchus with ill-defined opacities and bronchial wall thickening\nwithin the lower lobes bilaterally, likely infectious or inflammatory in\nnature.  Given the patulous esophagus filled with debris, aspiration should be\nconsidered.  A neoplastic process cannot be definitely excluded, therefore\nfollow-up recommended as below.\n2. Multiple solid pulmonary nodules measuring up to 12 mm.\n3. Small bilateral nonhemorrhagic pleural effusions.\n4. Although not completely imaged, the spleen appears enlarged.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nbigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk\npatient, with an optional CT follow-up in 18 to 24 months. In a high-risk\npatient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  The posterior mediastinum is unremarkable.\nNo relevant abnormalities are seen in the upper abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Mild\nupper lobe predominant pulmonary emphysema.  Moderate thickening and\nirregularities of the airway walls.  Mild scarring at the right lower lobe\nbase (4, 239).  6 mm left lower lobe pulmonary nodule (4, 238).\n\nMild calcifications of the ascending aorta. Mild calcifications of the aortic\narch. No calcifications of the descending aorta.  At the level of the main\npulmonary artery, the ascending aorta has a diameter of 40 3 times 43 mm.  At\nthe same anatomical level, the descending aorta has a diameter of 29 x 27 mm. \nAt the level of the aortic root, the aorta has a diameter of 34 x 33 mm.  The\naortic valve is heavily calcified.  No substantial coronary calcifications. \nNo pericardial effusion.",
            "output": "Solitary left lower lobe pulmonary nodule.  Aortic ___ are reported\nabove.  Mild chronic airways disease.\n\nRECOMMENDATION:  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show no significant\nabnormal findings.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  Small mediastinal and hilar lymph\nnodes, none pathologically enlarged by size criteria.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.  No\natherosclerotic calcifications in thoracic aorta or coronary arteries.  Aortic\nvalve replacement.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular paraseptal pulmonary emphysema.\nSpiculated solid nodule in the left lower lobe, previously seen in ___,\nnow larger measuring approximately 1.8 x 1.4 x 1.3 cm.\nRight apical tenuous ground-glass surrounding small emphysematous bulla,\nunchanged since ___.  Subpleural micronodule in the right upper lobe\n(5:64), unchanged.\n2. AIRWAYS:  Moderate diffuse bronchial thickening.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: Stable postoperative appearance of midline sternotomy with intact\nwires.  No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "Spiculated solid lesion in the left lower lobe, larger than in ___,\nsuspicious for primary lung cancer.  No apparent mediastinal or hilar\nlymphadenopathy.  A surgical consult and PET-CT scan are advised."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The\nascending aorta is ectatic and measures 4.5 cm, unchanged since the prior\nstudy.  An aortic valve is in place.  There is no pericardial effusion.  The\npulmonary arteries normal in caliber.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The left lower lobe mass has increased in size since the prior study,\nhas spiculated margins and a somewhat circular morphology.  The the medial and\nsuperior nodule has also increased in size since the prior study.  The mass\nnow measures 1.8 x 1.2 x 1.7 cm as compared to the prior measurements of 1.4 x\n0.9 by 1.5 cm.  No new pulmonary nodules.  Stable mild diffuse bronchiectasis\nwith peribronchial thickening in both lower lobes.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Sternal sutures are intact.  The sternum has a mottled\nappearance, unchanged since the prior study.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Progressive increase in size of the dominant left lower lobe mass which\nremains concerning for primary lung cancer.  No new pulmonary nodules.\n\nSurgical consultation is recommended ."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  Diffuse gas foci scattered throughout the chest\nwall.  No enlarged lymph nodes in either axilla or thoracic inlet.  Mild\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Status post\naortic valve replacement.  No atherosclerotic calcifications in the coronary\narteries or aorta.  Ectasia of the main pulmonary artery measuring 4.3 cm,\nstable.  The pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nExtensive pneumomediastinum.  Small hiatal hernia.  The esophagus is otherwise\nunremarkable.  No enlarged lymph nodes in either axilla or thoracic inlet.  No\nhilar lymphadenopathy.\n\nPLEURA:\nSmall left pleural effusion with a left pneumothorax, being drained by a chest\ntube passing through the left lateral fourth intercostal space some of these\nchest 2 side ports are positioned in the soft tissues of the left lateral\nchest wall (302:84 and 77.\n\nLUNGS:\nStatus post basilar segmentectomy of the left lower lobe with unremarkable\nbronchus stump.  Tubular structure is noted in the superior segment lower lobe\n(302:110) with indwelling gas foci.  A nodular similar finding is noted in the\nlingula (302:186 and 601: 93), both new compared to prior CT of ___.  Mild edema in the lingula and left lower lobe.  Mild paraseptal and\ncentrilobular emphysema.  The right lung is clear.  Mild secretions are noted\nin the brain bronchus.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  Stable appearance of midline sternotomy.  No\nacute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "S/p basilar segmentectomy of the left lower lobe due to a likely lung\nmalignancy.\nLeft hydropneumothorax with a chest tube in the pleural cavity.  Please note\nthat some of these tube side ports are out of the pleural space, within the\nleft lateral chest wall, as noted above.\nExtensive pneumomediastinum and gas foci in the subcutaneous tissues.\nTubular structures with indwelling gas foci are noted in the remaining\nsuperior segment of the left lower lobe and in the lingula suspicious for\npulmonary lacerations.\n\nDilation of the main pulmonary artery, likely reflecting pulmonary\nhypertension.  Correlation with echocardiogram findings is recommended, if not\nalready performed.\n\nNOTIFICATION:  The findings were discussed with Dr ___, M.D. by\n___, M.D. on the telephone on ___ at 5:19 pm."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There is a stable hypodense\nlesion in the upper posterior back measuring 1 cm which most likely represents\na sebaceous cyst.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.  A prosthetic aortic valve is in place.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Patient is status post basilar segmentectomy of the left lower lobe with\nstable postsurgical changes.  No evidence of local recurrence.  No new or\ngrowing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nSternal sutures are intact.  No evidence of lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen stable hypodense\nlesion within the left lobe of liver.",
            "output": "Stable postsurgical changes following left lower lobe basilar segmentectomy. \nNo evidence of local recurrence.  No evidence of metastasis to the chest\n\nStable small left pleural effusion/pleural thickening, which is most likely\npostsurgical.\n\nEvidence of prior cardiac surgery.  Prosthetic aortic valve in place.\n\nStable  hypodense lesion in the left lobe of liver could represent cysts or\nhemangiomas."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  A\nprosthetic aortic valve is in place.  There is no pericardial effusion.  The\naorta and pulmonary arteries are normal in caliber.  Evidence of prior cardiac\nsurgery prosthetic aortic valve in place.\n\n\nPLEURA: Previously visualized a small left pleural effusion has resolved. \nMinimal pleural thickening on the left is most likely postsurgical.\n\nLUNG: There is evidence of paraseptal and centrilobular emphysema.  Stable\npostsurgical changes following basilar segmentectomy in the left lower lobe. \nNo evidence of local recurrence.  No new pulmonary nodules.  Mild\nbronchiectasis with peribronchial thickening in both lower lobes.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Sternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  Stable hypodense lesion in the left lobe of liver which could\nrepresent a cyst or hemangioma.",
            "output": "Stable postsurgical changes following basilar segmentectomy in the left lower\nlobe.  No evidence of local recurrence.\n\nNo new pulmonary nodules.\n\nPreviously visualized small left pleural effusion has resolved.  Pleural\nthickening is also minimally improved and is most likely postsurgical.\n\nRECOMMENDATION(S):  Continued follow-up in view of history of malignancy is\nrecommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Normal thyroid.  No enlarged or\ngrowing supraclavicular or axillary lymph nodes.  Minimal atherosclerotic\ncalcification of imaged neck arteries.  No soft tissue chest wall abnormality.\n\nUPPER ABDOMEN: Please see the CT abdomen and pelvis report dated the same day\nfor evaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Normal esophagus.  Mild hiatus hernia.  No enlarged or growing\nmediastinal lymph nodes.  Mildly ectatic ascending aorta, measuring 4.3 cm,\nstable.  The pulmonary arteries are normal caliber.  Mild atherosclerotic\ncalcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Status post aortic valve replacement.  Normal heart\nsize.  No coronary artery or mitral valve calcification.  The pericardium is\nphysiologic.\n\nPLEURA: No pleural effusion or pneumothorax.  Minimal left-sided pleural\nthickening is likely postsurgical in nature.\n\nLUNG:\n\n1. PARENCHYMA: Status post left lower lobe basilar segmentectomy.  Expected\npostsurgical changes.  No evidence of local recurrence.  2 mm right upper lobe\nsubpleural nodule (4:64), stable dating back to ___.  No new or\nenlarging pulmonary nodules.  Mild upper lobe predominant centrilobular and\nparaseptal emphysema.  Mild bibasal linear atelectasis.\n2. AIRWAYS: The tracheobronchial tree is patent to the subsegmental level. \nMild diffuse bronchial wall thickening. Mild bronchiectasis in both lower\nlobes, stable.\n3. VESSELS:  Allowing for the nondedicated nature of the scan, no filling\ndefects in the pulmonary arteries.\n\nCHEST CAGE: Sternotomy wires noted.  No lytic or sclerotic osseous lesions to\nsuggest malignancy or infection.  No fracture.  Spondylosis.",
            "output": "Status post left lower lobe basilar segmentectomy.  Expected postsurgical\nchanges.  No evidence of local recurrence.  No evidence of intrathoracic\nmalignancy."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is normal, and\ndiffuse coronary artery calcifications are present.  No pericardial or pleural\neffusion is evident.\n\nSkeletal structures of the thorax demonstrate evidence of previous sternotomy\nas well as multilevel degenerative changes throughout the spine.\n\nWithin the lungs, diffuse subpleural reticular opacities are present with\nassociated traction bronchiectasis and bronchiolectasis without evidence of\ndiscrete honeycombing.  4 mm diameter right middle lobe lung nodule (171, 7)\nas well as 3 mm and 2 mm nodules  in the right lower lobe (200, 7).",
            "output": "1.  3 small nodules in the right lower and right middle lobe.  Considering\nhistory of colon cancer, three-month followup CT may be considered to assess\nfor stability and exclude the possibility of small pulmonary metastases.\n\n2.  Diffuse interstitial lung abnormality has been present by chest\nradiography since ___ and is most suggestive of NSIP.  Chronic\nhypersensitivity pneumonitis is an additional consideration in the appropriate\nclinical setting.\n\n3. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is heterogeneous\nin appearance but no overtly suspicious nodules are identified.  Subcentimeter\nsupraclavicular lymph nodes.  Subcentimeter axillary lymph nodes are most\nlikely reactive.\n\nUPPER ABDOMEN: Small sliding hiatal hernia.  No focal adrenal lesion\nidentified.  Subcentimeter hypodense hepatic lesion (series 3, image 51) most\nlikely represents a biliary hamartoma/hepatic cyst.  There is partially\nvisualized hyperdensity surrounding the superior pole of the left kidney,\nwhich most likely represents a perinephric hematoma related to recent renal\nbiopsy.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: Difficult to assess for hilar adenopathy on a noncontrast study.\n\nHEART and PERICARDIUM: Small-moderate pericardial effusion measuring 11 mm in\ndiameter.  Mild coronary artery calcification.  No aneurysmal malformation of\nthe aorta.\n\nPLEURA: Trace pleural effusions bilateral.\n\nLUNG:\n\n1. PARENCHYMA:  There is multilobar, fairly extensive peribronchovascular\nground glass opacities with some associated micro nodules.  Mild septal\nthickening, but the ground-glass opacification predominates.  Couple of\nthin-walled pulmonary cysts are nonsuspicious.  No cavitary lesions.  Mild\natelectasis in the dependent aspect of the upper and lower lobes.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary artery measures at the upper limits of normal (33\nmm).\nCHEST CAGE: Degenerative changes of the thoracic spine. Flowing vertebral body\nosteophytes may represent DISH. No lytic/destructive bony lesions.",
            "output": "1.  Fairly extensive peribronchovascular ground-glass opacities with some\nassociated micro nodules, which are nonspecific.  These findings may represent\ninfection or inflammation.  Pulmonary hemorrhage should also be considered in\nthe differential diagnosis (which may be secondary to vasculitis).  It is felt\nthat the ground-glass opacities predominates over interstitial thickening\nmaking pulmonary edema less likely.\n2.  Moderate pericardial effusion.\n3.  Partially visualized hyperdensity surrounding the superior pole of the\nleft kidney, which most likely represents a perinephric hematoma related to\nrecent renal biopsy.  Renal ultrasound is recommended for further evaluation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nStable heterogeneous appearance of the thyroid gland without any nodules.  No\nenlarged lymph nodes in the axilla or thoracic inlet.  No atherosclerotic\ncalcifications in the head and neck arteries.  No chest wall abnormalities.\nPartially visualized right IJ central line ending at the right atrium.  No\nchest wall abnormalities\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable, small sliding hiatal hernia is again noted.  No\nmediastinal or hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  Persistent mildly increased\npericardial effusion now measuring 16 mm in its maximum diameter.  Mild\natherosclerotic calcifications in the coronary arteries, none in the cardiac\nvalves or aorta.  Aorta and pulmonary artery are normal in caliber throughout.\nThe low density of the blood pool suggests underlying anemia.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental level.  Diffuse scattered\nthin-walled cysts, the dominant (4:169) in subpleural location measuring 34 mm\nin its largest diameter, all stable in appearance.  A right lower lobe cyst\n(4:180) is surrounded by small calcified nodules which could be reflection of\nthe vasculitis, however these warrant follow-up.  The multiple ground-glass\nopacities visualized in the prior study have resolved in the interval.  No\npleural effusion or thickening.\n\nCHEST CAGE:\nNo acute fractures.  Moderate dorsal spondylosis is stable in appearance.  No\nlytic or sclerotic bone lesions\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Mildly increased pericardial effusion when compared to prior study.\n\nCalcified nodules in the right lower lobe could be reflection of the\nunderlying vasculitis, less likely amyloidosis however, three-month follow-up\nis recommended.\n\nInterval resolution of the pulmonary ground-glass opacities same bronchial\nwall thickening from previous CT.\n\nRECOMMENDATION(S):  Three-month follow-up chest CT for right lower lobe\ncalcified nodules assessment.\nEchocardiography for increased pericardial effusion assessment.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:46 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no suspicious thyroid\nlesions.  There is no supraclavicular axillary lymphadenopathy.  There are no\nsuspicious chest wall lesions.\n\nUPPER ABDOMEN: There is redemonstration of a subcentimeter hypodense lesion in\nhepatic segment 7, unchanged and too small to characterize (5:277). \nOtherwise, the imaged portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  There is no mediastinal\nmass.  The esophagus is unremarkable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The thoracic aorta is normal in caliber with minimal\natherosclerotic calcifications along the aortic arch.  There are moderate\ncoronary artery atherosclerotic calcifications.  There is a small amount of\npericardial fluid, decreased from prior study and likely physiologic. \nOtherwise, the heart is within normal limits.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is redemonstration of diffuse scattered thin wall cysts,\nthe largest in the right middle lobe measuring 3.3 cm, unchanged (5:210). \nThere is redemonstration of a right lower lobe cyst surrounded by multiple\nsmall calcified nodules measuring up to 5 mm, unchanged from prior study\n(5:231 and 5:220).  There are multiple additional tiny bilateral solid\npulmonary nodules measuring up to 4 mm, all unchanged from prior study (5:190,\n5:124, 5:109, 5:85).  Otherwise, there are no new or enlarging pulmonary\nnodules.  There are no areas of focal parenchymal consolidation or\nground-glass opacities.\n2. AIRWAYS:  The airways are patent to the subsegmental bronchi bilaterally.\n3. VESSELS:  The main pulmonary artery is mildly dilated measuring 3 cm,\nunchanged from prior study (5:130).  Otherwise, the pulmonary vasculature is\nunremarkable within the limitations of a nonenhanced scan.\n\nCHEST CAGE: There are no lytic or sclerotic osseous lesions.  There is no\nacute fracture.  Moderate degenerative changes of the thoracic spine is\nunchanged.",
            "output": "Multiple stable calcified nodules in the right lower lobe.  Multiple\nadditional tiny solid pulmonary nodules measuring up to 4 mm are all unchanged\nfrom prior study.  No new or enlarging pulmonary nodules."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  No evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect to suggest pulmonary embolism.  The main and right\npulmonary arteries are normal in caliber.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The\nvisualized portion of the thyroid appears unremarkable.\n\nA tiny 2-mm right perifissural micronodule is of doubtful clinical\nsignificance (series 3, image 84), likely lymph node.  Bibasilar atelectasis\nis mild. The airways are patent to the subsegmental level.  No pneumothorax or\npleural effusion.\n\nThis exam is not dedicated for imaging of the upper abdomen.  Within this\nlimitation, the attenuation of the hepatic parenchyma appears slightly\ndecreased throughout, suggesting steatosis.  The spleen may be mildly\nenlarged, measuring up to 15 cm on axial images.  A prominent periportal node\nmeasures up to 7 mm in short axis.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nDegenerative changes in the thoracic spine are mild.  No fracture.",
            "output": "1.    No evidence of pulmonary embolism or aortic abnormality.\n2.    Probable hepatosteatosis and mild splenomegaly."
        },
        {
            "input": "No adenopathy demonstrated in the chest.  There are small to moderate\nbilateral pleural effusions with bibasilar consolidation, likely compression\natelectases.  There is mild interlobular septal thickening which could due to\npulmonary edema.  A few centrilobular nodules, likely infectious/inflammatory.\n\nExtensive vascular calcifications including calcifications in the coronary\narteries and in the aortic root are noted.  No pericardial effusion.\n\nParaseptal emphysematous changes are noted in the bilateral upper lobes.  A 5\nmm nodule is noted in the right lung apex (___).  There is a 3 mm nodule in\nthe right major fissure (4:176) likely representing a perifissural lymph node.\n\nMild degenerative changes of the thoracic spine.  No aggressive osseous\nlesions.  The upper abdomen is better assessed on recent CT abdomen and\npelvis.",
            "output": "Moderate bilateral pleural effusions with near complete collapse of the lower\nlobes.  A few centrilobular pulmonary nodules are likely\ninfectious/inflammatory.  Given the lack of intravenous contrast medium,\nconsider pneumonia in the appropriate clinical setting.\n\nParaseptal emphysematous changes of bilateral upper lobes.  Less than 5 mm\npulmonary nodules.  CT chest is recommended for follow-up in ___ year.\n\nPlease see separate abdomen and pelvis CT report for additional findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  Multiple\nbilateral axillary and subpectoral lymph nodes measure up to 1.2 cm on the\nleft (301:10).  Visualized lower cervical lymph nodes are increased in number,\nthough none are large in size.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is a small pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Replaced aortic valve is\nnoted.  The main, right, and left pulmonary arteries are normal caliber. \nAtherosclerotic calcification of the aorta noted.\n\nPULMONARY PARENCHYMA: An ill-defined opacity in the right upper lobe extending\napproximately 5.0 cm (302:79), new since the prior study from ___.\nLeft lower lobe collapse as seen on the prior study.  Near complete right\nlower lobe collapse insert prior study.  Partial collapse of the left upper\nlobe is new since the prior study.  Again seen are paraseptal emphysematous\nchanges in the upper lobes bilaterally.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  Large bilateral pleural effusions, left greater than right, have\nincreased since the prior study.\n\nCHEST WALL AND BONES:  Median sternotomy is noted.  Multilevel degenerative\nchanges are mild.  Chronic left tenth posterior rib fracture noted.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\nextensive calcification of the splenic artery.  Several nonspecific hypodense\nlesions are again seen within the spleen.",
            "output": "1. Ill-defined central opacity in the right upper lobe is new since the prior\nstudy and may represent infectious process.\n2. Large bilateral pleural effusions, left greater than right, increased in\nsize since the prior study with collapse of the left lower lobe, partial\ncollapse of the left upper lobe, and increased near complete collapse of the\nright lower lobe.\n3. Shotty left-greater-than-right axillary, subpectoral and lower cervical\nlymphadenopathy may be reactive in nature.\n4. Nonspecific hypodense lesions throughout the spleen, similar to the prior\nexamination, with some areas affecting the periphery, likely representing a\ncombination of cysts and splenic infarcts as seen previously."
        },
        {
            "input": "THORACIC INLET:Visualized thyroid is unremarkable.  Multiple left-sided\nsupraclavicular lymph nodes are not markedly changed compared to most recent\nCT and measure approximately 1.2 cm and 1 cm (2:5).\n\n\nTHORACIC LYMPH NODES:  Axillary lymphadenopathy does not appear dramatically\nchanged compared to most recent prior (02:13).  Mediastinal and hilar lymph\nnodes are not pathologically enlarged.\n\n\nHEART, VESSELS and PERICARDIUM: Moderate-sized, non hemorrhagic, pericardial\neffusion is not appreciably changed compared to CT chest performed ___.  There is no evidence of tamponade physiology, e.g., right atrium at the\nlevel of the aortic valve is unchanged and measures 5 cm, previously 6 cm.  \nAlthough left ventricular aneurysm has been previously reported on prior\nechocardiogram, this study is not tailored for such evaluation.  Again\ndemonstrated are an aortic valve replacement and significant coronary artery\ncalcifications.  The aortic caliber is unchanged.  The main pulmonary artery\ncaliber is unchanged.  Atherosclerotic calcification of the descending aorta\nis mild.\n\n\nLUNG AND PLEURA: Since ___ the persistent moderate, partially\nhemorrhagic, left pleural effusion is somewhat smaller, with better aeration\nof the left lung and no evidence of new bleeding.  Left apical pneumothorax is\nsmall.  Left lower lobe is still collapsed due to substantial residual of\nbasal pleural fluid with large clots, not due to bronchial obstruction. \nHowever moderate right pleural effusion is larger, probably multi-loculated,\nbut not hemorrhagic.  For example, a posterolateral component extending into\nthe major fissure is 5 x 11 cm, previously 7 x 3 cm (02:31).  Two other\nnondependent fluid collections are also larger, the more superior is 7 x 6 cm,\npreviously 5 x 4 cm (02: 22, 26).  Right lung is secondarily much more\natelectatic, even though the airways are patent to the segmental bronchi.\n\nCHEST WALL AND BONES: There are chronic bilateral healing rib deformities of\nthe first, second, and third ribs.  Sternal fragments are closely apposed but\nstill unfused, with no associated fluid collection or osteolysis to suggest\ninfection.\n\nUPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially imaged upper abdomen shows extensive, chronic\nsplenic artery calcification.",
            "output": "1. Compared to ___, there is no new pleural or chest wall bleeding. \nPrevious, partially hemorrhagic left pleural effusion is smaller; small apical\npneumothorax is new.\n2. Moderate to large, probably multi-loculated right pleural effusion is\nlarger, responsible for increase in severe atelectasis.\n3. Stable moderate-size pericardial effusion, without evidence of tamponade.\n4. Current study is not optimized for assessing reported left ventricular\naneurysm, shown by echocardiography."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable. \nExtensive chest wall edema is most severe along left chest wall.  Multiple\nsubcentimeter and borderline lymph nodes in the left supraclavicular and both\naxilla up to 1 cm.\n\nCHEST CAGE: Old bilateral rib fractures (4:66, 121 for example).  Patient is\nstatus post sternotomy.  Sternal wires are intact and aligned.  Sternal\nsurgical fractures with no findings to suggest osteomyelitis.  Multilevel mild\ndegenerative changes of the vertebra.\n\nUPPER ABDOMEN: NG tube terminates in the stomach.  Included unenhanced\nparenchymal organs with no gross findings.  Minimal quantity of ascites in the\nupper abdomen.\n\nMEDIASTINUM: Multiple subcentimeter lymph nodes in the mediastinum measure up\nto 0.7 cm in the right lower paratracheal station.  No gross right hilar\nlymphadenopathy.\nThere is no pneumomediastinum.\n\nHEART and PERICARDIUM: Patient is status post aortic valve replacement, Small\nquantity of pericardial effusion. Minimal quantity of retrosternal fluid, not\nadequate for drainage (4:106).  There are severe extensive calcifications of\nthe coronaries as well as along the normal caliber thoracic aorta and main\nbranches.\n\nRoughly 10 cm, saccular aneurysmal bulging inferolaterally form the left\nventricle represents has increased its volume since ___ (available\nin patient's previous MRN ___.\n\nA very large left hemothorax  partially loculated, completely collapses the\nleft lung and shifts the mediastinum to the right, under sufficient pressure\nto deform the descending aorta.  Chest radiographs over the preceding 24 hours\nshow the hemothorax developed over 12 hours and has continued to grow; the\nlarge left ventricle aneurysm should be presumed to have ruptured into the\nleft pleural space until shown otherwise.\n\nSmall, layering pleural effusion extends into the major and minor fissures. \nThe right lower lobe is subsequently partially atelectatic.  Peribronchial\ncentrilobular nodules in the right lung, more pronounced in the upper lobe\nreflect multilobar pneumonia.",
            "output": "-Large left ventricle aneurysm, markedly enlarged since ___, is\npresumed to have ruptured into the left pleural space causing massive, rapidly\nenlarging left hemothorax.\n-Bronchopneumonia in the right lung is more pronounced in the upper lobe.\n\nNOTIFICATION:  The critical findings requiring urgent attention were discussed\nwith ___ , M.D. by ___, M.D. on the telephone on\n___ at 3:52 pm, 2 minutes after discovery of the findings and by Dr\n___ with the ___ Physician, Dr ___, minutes later."
        },
        {
            "input": "There are tiny subcentimeter thyroid nodules which do not require additional\nfollow-up.  There are no pathologically enlarged supraclavicular, axillary,\nmediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  There is no central\npulmonary embolism.  Evaluation of the segmental and subsegmental branches is\nlimited due to motion artifact.  The heart is mildly enlarged and demonstrates\nsevere coronary artery calcifications.  There is no pericardial effusion.\n\nSmall bilateral pleural effusions.  No pneumothorax.  The airways are patent\nto the subsegmental level.  There is mild compressive atelectasis at the lung\nbases.  There are small ground-glass opacities at the right lung base and in\nthe posterior left upper lobe and at the right apex, may be due to aspiration\nor infection.\n\nThere are degenerative changes in the spine.  An anterior wedge compression\ndeformity of T12 is unchanged.  No osseous lesions suspicious for infection or\nmalignancy are identified.\n\nPlease see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "1. Small bilateral pleural effusions and adjacent mild compressive atelectasis\nat the lung bases.\n2. Ground-glass opacities at the right lung base, in the posterior left upper\nlobe, and at the right lung apex may be due to aspiration or infection.\n3. No central pulmonary embolism, with evaluation of the segmental and\nsubsegmental branches limited by respiratory motion.\n4. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is mild calcified and non calcified atherosclerotic plaque along the\naortic arch and descending thoracic aorta.  Otherwise, the thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a 1.8 x 1.4 cm left axillary lymph\nnode which is new compared to prior exam (02:22).  More inferiorly a 2.2 x 1.9\ncm soft tissue density in the left breast tissue is also new(02:40). \nOtherwise no mediastinal or hilar lymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 5 mm right perifissural nodule is difficult to determine if\npresent on prior exam secondary to respiratory motion artifact (3:115). \nOtherwise, the lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Limited evaluation of the base of the neck secondary to streak\nartifact demonstrates no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a partially\nimaged left renal cyst.\n\nBONES: Sclerotic foci in the lower T-spine are unchanged compared to ___.  No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. 2.2 cm soft tissue density in the left breast tissue, may represent an\nenlarged lymph node or other lesion, and a neoplastic process is not excluded.\nAssociated 1.8 x 1.4 cm in left axillary lymph node, new compared to the prior\nstudy.  Recommend further assessment with dedicated breast imaging, the breast\nclinic.\n3. 5 mm right perifissural nodule.  See recommendations section.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nDedicated breast imaging, in the breast clinic."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A left pacemaker is seen with leads\nappropriately positioned positions, unchanged since prior.  Status post median\nsternotomy with appropriately aligned sternal wires.  .  No axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Mild thickening of the adrenal glands bilaterally without focal\nnodules.\n\nMEDIASTINUM: There are multiple enlarged mediastinal lymph nodes, for example\na precarinal lymph node measures 12 mm in short axis diameter (series 2, image\n22), stable from prior. A prevascular lymph node measures 17 mm (series 2,\nimage 27), slightly smaller from prior.  These are nonspecific and could be\nreactive in nature.\n\nHEART and PERICARDIUM:   Extensive atherosclerotic calcifications throughout\nthe thoracic aorta. Aberrant right subclavian artery passing posterior to the\nesophagus.  Mild cardiomegaly, stable from prior.  There is enlargement of the\nmain pulmonary artery measuring 3.3 cm, compatible with pulmonary arterial\nhypertension.  The thoracic aorta is normal in caliber.\n\nPLEURA: There has been slight interval improvement of the previously seen\nlarge right pleural effusion, now moderate in size. Stable moderate left\npleural effusion.  No pneumothorax.\nLUNG:\n\n-PARENCHYMA: Bilateral centrilobular emphysema, stable from prior.  Re-\ndemonstration of a masslike opacity in the right perihilar region (series 2,\nimage 26) containing a small air bronchogram (series 2, image 23), narrowing\nwith the right upper lobe bronchus, stable in size from prior.  There is loss\nof fat fat plane with the adjacent mediastinum raising suspicion for invasion.\nInvasion into the vessels is limited given lack of IV contrast.  There is\nbilateral compressive atelectasis, left greater than right, slightly worsened\nsince prior study.  Bilateral peripheral ground-glass opacities in the lower\nlobes, slightly worse on the right which could reflect pulmonary edema.\n-AIRWAYS: There is diffuse peribronchial wall thickening, however the airways\nare patent to the segmental levels.\n\nCHEST CAGE: Unchanged minimally displaced fractures of the anterolateral left\nthird through fifth ribs. No suspicious osseous abnormality seen.",
            "output": "1. Unchanged masslike opacity in the right perihilar region causing narrowing\nof the right upper lobe bronchus stable in size from prior raising suspicion\nfor neoplastic process. There is loss of fat plane with the adjacent\nmediastinum concerning for invasion. Evaluation of  invasion into the vessels\nis limited given lack of IV contrast.\n2.  Slight improvement of previously seen large right pleural effusion, now\nmoderate  . There is also stable moderate left pleural effusion."
        },
        {
            "input": "A left pectoral pacemaker is seen with leads appropriately positioned within\nthe right atrium, right ventricle, and coronary sinus.  Sternotomy wires are\nintact and appropriately aligned.  Mediastinal clips are seen compatible with\nprior surgery.\n\nHEART AND VASCULATURE:  Extensive atherosclerotic calcifications are seen\nthroughout the thoracic aorta, at the origin of the head and neck vessels, and\nthroughout the coronary arteries.  Incidental note is made of an aberrant\nright subclavian artery passing posterior to the esophagus (02:12).  The heart\nis mildly enlarged.  There is enlargement of the main pulmonary artery\nmeasuring 3.5 cm, suggesting pulmonary arterial hypertension.  The thoracic\naorta is normal in caliber.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  No axillary lymphadenopathy.  No mediastinal\nmass or hematoma.  There are multiple enlarged mediastinal lymph nodes.  For\ninstance, a prevascular lymph nodes measures 1.9 cm in short axis (series 2,\nimage 29), which is nonspecific, but may be reactive in nature.\n\nPLEURAL SPACES:  There are bilateral pleural effusions, large on the right,\nmoderate on the left.  No evidence of pneumothorax.\n\n\nLUNGS/AIRWAYS:  Mild upper lobe predominant centrilobular emphysema.  There is\na masslike opacity in the right perihilar region (series 2, image 25, 30),\nthis contains a single air bronchogram (02:26) which may represent pneumonia\nin the appropriate clinical setting however a neoplastic lesion cannot be\nexcluded on this noncontrast study.  There is also patchy opacification within\nthe lower lobes bilaterally, left greater than right, which may due to be due\nto compressive atelectasis from the adjacent effusions, however superimposed\ninfection cannot be excluded.  No other focal consolidations, however there\nare numerous foci of ground-glass opacification (series 2, image 18, 23)\nthroughout the lungs, which may reflect edema, or additional foci of\ninfection.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  There is extensive calcification of the abdominal aorta and\nessentially all of the visualized branch vessels.  Numerous simple cysts are\nseen within the kidneys bilaterally.\n\nBONES:  There are acute minimally displaced fractures of the anterolateral\nleft third through fifth ribs.  No suspicious osseous abnormality is seen.?\nthere is minimal retrolisthesis of T10 on T11, and T11 on T12.",
            "output": "1. A masslike opacity in the right perihilar region, could reflect pneumonia\nin the appropriate clinical setting.  However, this appears slightly rounded\nand a neoplastic lesion cannot be excluded, recommend CT with contrast for\nfurther evaluation.\n2. Multiple additional foci of ground-glass opacification throughout the lungs\nbilaterally, which may represent an aspect of superimposed edema, or\nadditional foci of infection.\n3. Multiple enlarged mediastinal lymph nodes measuring up to 1.9 cm,\nnonspecific, but likely reactive in nature.\n4. Bilateral nonhemorrhagic pleural effusions, larger on the right, moderate\non the left.\n5. Acute minimally displaced third through fifth rib fractures on the left.\n\nRECOMMENDATION(S):  CT chest with contrast is recommended for further\nevaluation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive LAD and moderate left\ncircumflex arterial calcifications.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There are multiple small subcentimeter nodules in both\nlungs including a 2 mm nodule in the right upper lobe (5, 49), a 2 mm nodule\nin the right upper lobe (5, 125), and a 2 mm nodule in the left lower lobe (5,\n227).  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  The upper abdomen is not fully visualized on this study.  The\nmedial limb of the right adrenal appears minimally enlarged, which is an\nincidental finding and unlikely to be of clinical significance.  There is\nasymmetric thickness of the esophageal wall at the level of the\ngastroesophageal junction, which or could represent a collapsed hiatal hernia.\nHowever, esophageal mass cannot be definitively excluded.",
            "output": "1.  No evidence of diaphragmatic abnormalities.\n2. Moderate to extensive calcifications involving the left anterior descending\nand left circumflex arteries.\n3. Multiple small subcentimeter nodules in bilateral lungs, likely benign in\nthe absence of extrathoracic malignancy.\n4. Minimally enlarged right adrenal gland, incompleteley imaged.  Suggest\nevaluation with ultrasound rather than additional CT.\n5. Asymmetric thickening of the esophageal wall at the level of the\ngastroesophageal junction.  Esophageal mass cannot be definitively excluded. \nBarium swallow is recommended for further evaluation.\n\nRECOMMENDATION(S):  Ultrasound to see if right adrenal is abnormal."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.  Right-sided Port-A-Cath terminates in the\nright atrium.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  The esophagus is\npatulous\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There are moderate coronary\narterial calcifications.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA: New peribronchial and nodular bronchiolar opacities in the left\nlower lobe, (5:156) since the PET-CT ___ are inflammatory.  There is\nminimal atelectasis in the lingula and right middle lobe.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental levels.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are not enlarged. \nThere are moderate atherosclerotic calcifications of the aortic arch.\nCHEST CAGE: There is no suspicious osseous abnormality.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Mild bronchiolar inflammation, left lower lobe usually due to recent\ninfection or aspiration.\n3. Please refer to dedicated CT abdomen and pelvis report on same day for\nsubdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Right anterior port with tip ending in the right atrium.  No\nabnormalities on the chest wall.  Mild atherosclerotic calcifications in the\nhead neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  The entire\naorta is normal in caliber.  Mild atherosclerotic calcifications in the\ncoronary arteries.  The pulmonary arteries are normal caliber.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  New necrotic left hilar lymph\nnodes (302:124), the largest measuring 1.4 x 0.9 cm..\n\nPLEURA:\nNo pleural effusions.  No apical scarring.\n\nLUNGS:\nAirways are patent to subsegmental levels.  Calcified granuloma in the left\nupper lobe (302:60), unchanged.\n7 mm solid nodule with a small cavity in the lingula (302:135) is larger when\ncompared to prior study (previously 4 mm).  No consolidations are seen.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Compared to prior study of ___, the small lingular nodule has grown, now\nshowing a small cavity, and the left hilar lymph nodes are new, mildly\nenlarged and show necrotic component.  These are suggestive of metastatic\ndisease.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 15:13 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Right prepectoral Port-A-Cath in\nsitu with the tip in the mid to distal SVC.  No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  No adrenal lesions.  Presumed bilateral renal\nperipelvic cysts (incompletely imaged).  Hyperdense sludge/ small gallstones\npresent in the neck of the gallbladder.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nNo cardiomegaly.  Moderate calcification of the aortic annulus valve.  Mild\ncalcification of the LAD and right coronary artery.  Presumed stent in situ in\nthe left circumflex coronary artery.  Mild fusiform aneurysmal dilatation of\nthe ascending aorta measuring 42 mm in diameter.  Azygos vein demonstrating an\naberrant course in the azygos fissure.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Pre-existing pulmonary nodules in the right lower lobe is\nunchanged (the largest measuring 5 mm in diameter 4, 133).  No new or\nenlarging pulmonary nodules or masses.  No confluent airspace consolidation. \nNo diffuse lung disease.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Stable imaging findings of the chest.  No findings to suggest intrathoracic\nmetastatic disease.\n\nThe pre-existing pulmonary nodules are unchanged.\n\nFusiform aneurysmal dilatation of the ascending aorta measuring 42 mm in\ndiameter.\n\nCholelithiasis, but no features of cholecystitis."
        },
        {
            "input": "Right central venous line terminates at the lower SVC.  Ascending aorta is\nmildly dilated up to 4.3 cm, unchanged from previous examination.  Coronary\ncalcifications are minimal.  No mediastinal, hilar or axillary lymphadenopathy\nis present.  Image portion of the upper abdomen reveals no appreciable\nabnormality except for calcified gallstones and multiple parapelvic cysts\nbilaterally.\n\nAirways are patent to the subsegmental level bilaterally.  Previously seen\npulmonary nodules all stable.  No new nodules masses or consolidations\ndemonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm identified.",
            "output": "Stable appearance of the chest was no evidence of interval disease\nprogression.  .\n\nFusiform aneurysmal dilatation of the ascending aorta, unchanged\n\nGallstones, no CT findings to suggest cholecystitis\n\n___ parapelvic cysts."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.  The right chest\nport central venous catheter tip ends in the low SVC.  The esophagus is\nnormal.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is dense left circumflex, LAD and\nRCA calcification.  There is also mild aortic annular calcification.  There is\nno pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  The ascending aorta is\nagain mildly dilated up to 4.3 cm, unchanged from previous examination.  The\nmain, right, and left pulmonary arteries are normal caliber.  There are small\nfoci calcifications in the aortic arch, descending aorta and right subclavian\nartery, consistent with atherosclerotic plaque.\n\nPULMONARY PARENCHYMA: An azygous lobe is noted. A small, 2.9 mm calcified\ngranuloma (4:113) in the superior portion of the right lower lobe is\nunchanged.  A 3.1 mm nodule (4:123) adjacent to the left minor fissure is\nstable.  2.3 mm (4:131) and 1.9 mm (4:130) nodules adjacent to the major\nfissure are unchanged.  A 4.6 mm nodule (4:137) in the right lower lobe is\nstable.  A 3.8 cm nodule (4:144) in the right lower lobe is unchanged.  The\n3.1 mm anterior right middle lobe nodule (4:148) is also unchanged.  A 2.9 mm\nnodule in the right middle lobe (4:163) is stable.  Two 3.2 mm nodules in the\nright lower lobe (4:188) are unchanged.\n\nA 3.7 mm nodule in the right lower lobe (4:162) is new from the prior study.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: A focal sclerotic lesion measuring 11 mm x 6.3 mm in the\nleft ninth rib is stable from the prior examination.  Multilevel degenerative\nchanges are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\ncalcified gallstones, unchanged from previous examination as well as multiple\nparapelvic cysts bilaterally, which are also unchanged.",
            "output": "1. New 3.7 mm nodule in the right lower lobe.  The remainder of the nodules\nare stable.\n2. Stable fusiform aneurysmal dilatation of the ascending aorta.\n3. Calcified gallstones, but no CT findings to suggest acute cholecystitis.\n4. Bilateral parapelvic cysts, unchanged.\n\nRECOMMENDATION(S):  Recommend follow-up CT in ___ months to assess for\ninterval progression of pulmonary nodules."
        },
        {
            "input": "The thyroid is normal.\nSupraclavicular, axillary and mediastinal lymph nodes are not enlarged.  Right\nhilar node (series 2: Image 29) is larger since ___ measuring 1.1 x 1.9\ncm was 0.8 x 1.3 cm.  Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal, patient has had stenting of the left circumflex\ncoronary artery.\n\nThere is no pericardial or pleural effusion.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  6 mm subpleural nodules\nin the superior segment of the left lower lobe (series 4: Image 117) is new\nsince CT of ___. This nodules warrants a short term followup in 3 months\nto assess interval changes. All the reminder nodules are stable since ___ and not concerning for malignancy (series 4: Images 124, 127, 128, 137,\n143, 145, 186).\n\n\n\nUPPER ABDOMEN\nEven though this exam is not tailored for abdominal imaging, it shows stable\nbilateral large parapelvic kidney cysts (2:63). There are gallbladder stones\nwithout evidence of cholecystitis and fatty liver. Small right adrenal adenoma\nis unchanged since ___ (02:58).\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. New 6 mm subpleural nodule in the superior segment of the left lower lobe\nwarrants a short term followup 3 months to assess interval changes.\n2. Interval increase of right hilar lymph node since ___ might be\ncorrelated to new appearance of left lower lobe nodule.  Close follow up or\ntransbronchial tissue sampling might be considered.\n3. All remainder lung nodules are all stable since ___ and not\nconcerning for malignancy."
        },
        {
            "input": "The 6 mm nodule in the superior segment of the right lower lobe (incorrectly\ndescribed in the left lower lobe on the prior report) has resolved. The\nremaining pulmonary nodules are unchanged from ___ on and are most likely\nbenign.  The two largest measure 6 mm (5:117, 127) and the remaining scattered\nnodules are all less than 4 mm (5:112, 113, 135, 138, 152, 177).  Punctate\ngranulomas are again noted. There are no new lung nodules. Axillary lymph\nnodes remain prominent but do not meet criteria for pathologic enlargement.\nThere is no supraclavicular or central lymphadenopathy.\n\nThe trachea is normal caliber.  Secretions are seen within the lingular\nbronchus without distal atelectasis. Otherwise, the airways are patent to the\nsubsegmental level. There is no bronchial wall thickening or bronchiectasis.\nThere is no pleural effusion, pneumothorax or evidence of active infection.\n\nThe included thyroid is normal. The heart is normal size. There is a trace,\nphysiologic pericardial effusion.  Focal coronary artery and aortic valve\ncalcifications are mild to moderate. A coronary stent is seen within the\ncircumflex artery.  The aorta is mildly dilated to 4.4 cm, increased from\n___.  The main pulmonary artery are normal in caliber. A left central\ncatheter terminates in the low SVC.  Included views of the unenhanced liver,\nspleen, left adrenal gland and pancreas are unremarkable. The right adrenal\nadenoma is unchanged. Large parapelvic cysts are again noted within both\nkidneys.  There is cholelithiasis without evidence of cholecystitis.  There\nare no lytic or blastic osseous lesions.",
            "output": "1. Resolution of the 6 mm right lower lobe pulmonary nodule, which was\npresumably infectious/inflammatory in etiology. Remaining nodules are\nunchanged from ___ and are most likely benign. No new nodules and no\nlymphadenopathy.  2.  Smooth dilation of the ascending aorta to 4.4 cm,\nincreased from ___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Pulmonary arteries are normal size. Cardiac\nconfiguration is normal.  Coronary artery calcifications are redemonstrated.\nAn infusion port is in the right anterior chest with tip terminating in the\nlow superior vena cava.\n\nThe central airways are patent to the subsegmental level. Bilateral pulmonary\nnodules are unchanged, largest measuring 6 mm (05:150,153).  The remaining\nnodules are unchanged and found in the right lung (5: 120, 140, 154, 158, 169,\n178, 211).  Left lung nodules measuring up to 5 mm are unchanged (5:144, 167).\nThere is no new nodule. There is no area of consolidation or pneumothorax.\nThere is no pleural or pericardial effusion.\n\nThere is no bone lesion suspicious for infection or malignancy. Anterior\nflowing osteophytes in the thoracic spine are suggestive of DISH.\n\n This study is not designed for subdiaphragmatic diagnosis but shows no\nadrenal mass or abnormality in the imaged portions of the unenhanced solid\norgans in the upper abdomen.  Peripancreatic lymph nodes are unchanged in size\nconfiguration. Left parapelvic cysts are unchanged.  Dependent gallbladder\nsludge versus small gallstones are unchanged.",
            "output": "Unchanged bilateral pulmonary nodules, largest measuring 6 mm, stable since\n___. No new pulmonary nodule."
        },
        {
            "input": "Several subcentimeter pulmonary nodules measuring up to 6 mm in the superior\nsegment of the right lower lobe appear unchanged, located in the right lower\nlobe (image 229, 177, and 168), right upper lobe (182), right middle lobe\n(155, 166, 202), and lingula (161), all on series 5.  Incidental calcified\ngranuloma is noted in the right lower lobe superior segment.  Diffuse\nbronchial wall thickening is again demonstrated as well as mild, cylindrical\nbronchial dilation with lower lung predominance.\n\nNo enlarged intrathoracic lymph nodes are evident.  Numerous subcentimeter\nbilateral axillary lymph nodes are similar in appearance to the prior scan. \nHeart size is normal, and coronary artery calcifications are present as well\nas an apparent coronary artery stent.  There is no pericardial or pleural\neffusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of calcified gallstones within the liver.  Bilateral peripelvic renal\ncysts are present as well as contrast material within the collecting systems,\npresumably due to gadolinium related to MRI exam performed prior to this\nnoncontrast CT.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.",
            "output": "1. Continued CT stability of subcentimeter pulmonary nodules with no new or\ngrowing lung nodules.\n\n2. Coronary artery calcifications.\n\n3.  Cholelithiasis."
        },
        {
            "input": "The thyroid is normal.  Scattered small mediastinal nodes, the largest\nmeasuring 9 mm and the right paratracheal station, are not significantly\nchanged (3:26).  There is no significant increase in size or number of\nbilateral axillary lymph nodes.  There are no pathologically enlarged\nsupraclavicular, axillary, mediastinal or hilar lymph nodes.\n\nThe ascending aorta is dilated to 4.4 cm.  The pulmonary arteries are normal\nin size.  The heart is normal in size.  There are mild coronary artery\ncalcifications and coronaries stents. There is no pericardial effusion.  A\nright-sided central venous catheter terminates in the low SVC.\n\nNo pneumothorax or pleural effusion is identified.  Diffuse bronchial wall\nthickening is similar to prior.  The airways are patent to the subsegmental\nlevel.  There are scattered tiny calcified granulomas.  Multiple pulmonary\nnodules measuring up to 6 mm are stable since ___.  For reference, three\nright lower lobe nodules measuring 6 mm, 5 mm and 3 mm are all stable (5: 166,\n227, 173).  A previously seen 4 mm right upper lobe nodule is not visualized. \nThree perifissural nodes measuring up to 3 mm in the right middle lobe are\nstable (5:150, 161, 181).  A 4 mm left perifissural nodule is stable (5:162). \nA 3 mm left upper lobe nodule is stable (5:147).\n\nA benign appearing 1.3 cm sclerotic focus in the left lateral ninth rib is\nunchanged since at least ___, and likely represents a bone island (8:149). \nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, there are gallstones/sludge, with no\nevidence of acute cholecystitis.  Large bilateral peripelvic renal cysts are\nprior.  The included portions of the upper abdomen are otherwise grossly\nunremarkable.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Multiple pulmonary nodules measuring up to 6 mm are stable since ___.\nNo new pulmonary nodules.\n3. Cholelithiasis, with no evidence of acute cholecystitis."
        },
        {
            "input": "HEART AND VASCULATURE: The heart appears normal in size and shape without\npericardial effusion.  Thoracic aorta is normal in course and caliber without\nappreciable atherosclerosis.  The main pulmonary artery is normal in size with\npatent central branches.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Subtle upper lower lobe predominant emphysema noted. Right\nupper lobe nodule measures 2 mm (04:51).  Otherwise, no nodule, mass, or\nworrisome consolidation.  There is platelike atelectasis in the lower lobes. \nThere is mild prominence of the segmental bronchi which in the correct\nclinical setting could reflect a mild bronchiectasis in the setting of chronic\nairways inflammation.  Please correlate clinically.  No definite mucoid\nimpaction or bronchial wall thickening is seen.  No signs of interstitial lung\ndisease.\n\nBASE OF NECK: Partially visualized thyroid is unremarkable.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No signs of interstitial lung disease.\n2. Mild upper lobe predominant emphysema.\n3. Minimal prominence of the segmental bronchi which could reflect\nbronchiectasis in the setting of chronic airways inflammation.  Please\ncorrelate clinically.  No mucoid bronchial impaction or evidence of bronchial\nwall thickening.\n4. 2 mm pulmonary nodule in the right upper lobe.  Please refer to the\nrecommendation section for follow-up.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "As compared to the previous examination, the large soft tissue mass at the\nlevel of the left thoracic inlet has substantially increased in size.  The\nconglomerate mass now measures 7 x 5 cm, as compared to 3 x 3 cm on the\nprevious examination and shows signs of invasion into DHS and soft tissue\nstructures.  The mass also extends into the thorax, as seen previously, but is\nsubstantially larger than before (4, 13).  An extension into the anterior\nmediastinum (4, 14) is new.  Also new is an extensive left pleural effusion\nand a moderate right pleural effusion.  The pre-existing mass in the\naortopulmonary window has also increased in size, from previously 25 x 42 mm\nto now 40 x 50 mm (4, 27).  There is extensive atelectasis and moderate\nascites.  Stable appearance of the bony structures.  In the lung parenchyma,\nall of the pre-existing pulmonary nodules have massively increased in size. \nFor example, a reference lesion in the left upper lobe, previously 2 mm in\ndiameter, is now approximately 9 mm in diameter (5, 89).  The patient has also\ndeveloped new pleural metastatic disease (5, 107).  A large cystic subpleural\nlesion in the right lower lobe is overall stable in appearance.",
            "output": "Massive progression since ___, with massive increase in size of a\npre-existing left cervical and left thoracic inlet mass, increase in size of a\npre-existing mediastinal mass, newly occurred moderate right and severe left\npleural effusions, as well as increase in size of pre-existing pulmonary\nmetastasis has and development of new pleural and parenchymal metastasis."
        },
        {
            "input": "The thyroid is normal.\nLeft supraclavicular heterogeneous heterogeneously enhancing lymph node\nmeasures 3 x 3.1 cm.  There are multiple enlarged mediastinal lymph nodes the\nto the left of a main vessels measuring 14 mm in the left lower paratracheal\nstation measuring 4.3 x 2.6 cm right lower paratracheal station lymph measures\n10 mm.  There are several calcified lymph nodes throughout the mediastinum.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there are moderate calcifications in all coronary arteries.\nThere is mild biapical pleural thickening.  There is mild to moderate upper\nlobe predominant centrilobular and paraseptal emphysema\nThere are multiple lung nodules measuring up to 4 mm (04:29, 38, 39, 56, 57,\n67, 79, 89, 84, 86, 94, 106, 111, 120, 126, 131, 132, 139, 140, 178).\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal finding.\nThere are no bone findings of malignancy",
            "output": "1.Large supraclavicular and mediastinal lymph nodes consistent with metastasis\n2.multiple small lung nodules\n3.Emphysema\n4.  Evidence of prior granulomatous infection\n5.  Coronary calcifications"
        },
        {
            "input": "NECK AND THORACIC INLET: No incidental thyroid findings.  No supraclavicular\nand infraclavicular lymphadenopathy.\n\nAXILLAE, CHEST WALL, AND BONES: No axillary lymphadenopathy, no evidence of\nosteolytic lesions at the level of the vertebral bodies, the sternum, and the\nribs.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART: Status post CABG. Severe coronary calcifications.  Moderate\ncardiomegaly. Minimal aortic valve calcifications.  No mitral valve\ncalcifications.  No pericardial effusion.\n\nLUNG:\n\n-PARENCHYMA:  Several not characteristic areas of scarring.  No evidence of\nlung nodules or masses suspicious for metastatic disease.\n-AIRWAYS:  Mild thickening and irregularities of the airway walls, suggestive\nof mild chronic airways disease.\n-VESSELS:  No abnormalities at the level of the pulmonary vessels.\nPLEURA: No pleural thickening, no pleural effusions. Several pleural based\nzones of apparent pleural thickening in the dependent lung regions are in fact\nareas of atelectasis.\n\nUPPER ABDOMEN: Upper abdominal findings are described in detail in the\ndedicated abdominal CT examination report.",
            "output": "No relevant change as compared to ___.  No evidence of intrathoracic\nmetastatic disease.  Unchanged status post CABG and severe coronary\ncalcifications.\n\nRECOMMENDATION:  No specific recommendations are given."
        },
        {
            "input": "Soft tissues: Tip of the central infusion catheter originating in the left\nchest wall is in the high right atrium. The thyroid is homogeneous. No\npathologically enlarged axillary, mediastinal, or hilar lymph node is present.\nThe heart is normal in size and there is no pericardial effusion.  There is\nevidence of prior CABG and coronary artery calcifications are extensive.\nAortic valve annular calcifications are mild.  The aorta and main pulmonary\nartery are normal in caliber.Please see a separate report discussing findings\nwithin the abdomen and pelvis.\n\nLungs:The airways are patent to the subsegmental level bilaterally. No large\nconsolidation, mass, or pneumothorax. No pulmonary nodules are identified.\nMild irregularity of the posterior pleural surface of the left lower lobe is\nstable.\n\nBones:There is evidence of prior sternotomy with intact median sternal wires. \nNo blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nA left pectoral MediPort terminates in the right atrium.  Heart size is normal\nwith no pericardial effusion. Extensive coronary artery calcifications are\nstable.  The main pulmonary artery and thoracic aorta are normal caliber. The\npatient has had CABG with median sternotomy.\n\nA handful of retrospectively seen punctate pulmonary nodules measuring no more\nthan 2 mm are stable since at least ___ (4: 84, 110, 114). A few\npunctate calcified nodules are also noted (4: 73, 81, 169). No new or\nworrisome pulmonary nodules are identified. There is no endobronchial lesion\nor pleural effusion.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nNo lytic or sclerotic bone lesions are identified.",
            "output": "Several retrospectively seen pulmonary micronodules, some of which are\ncalcified, are stable since at least ___.  No new pulmonary nodules\nidentified.  Follow up imaging is not indicated."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere is no soft tissue abnormality in the imaged chest wall suspicious for\nmalignancy. Findings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerosis is",
            "output": "Calcified atherosclerotic plaque is found in the right innominate artery, and\nnative CT coronaries. Patient has had coronary bypass grafting. A left central\nvenous catheter ends in the right upper right atrium.\n\nAorta and pulmonary arteries are normal size. Pericardium is physiologic.\nThere is no pleural abnormality. There are no lung nodules of concern for\nmalignancy. Central lymph nodes in the mediastinum and hilar not\npathologically enlarged ranging in diameter up to only 5 mm in the right lower\nparatracheal station 3:116.\n\nThere are no bone lesions in the chest cage suspicious for infection.\n\nNOTIFICATION:  No evidence of intrathoracic malignancy primary or metastatic."
        },
        {
            "input": "Left pectoral Port-A-Cath.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No incidental thyroid findings. Unchanged appearance of the\nlarge mediastinal vessels. No hilar or mediastinal lymphadenopathy.  Status\npost CABG.  No pericardial effusion.  No abnormalities in the posterior\nmediastinum.  Abdominal findings are described in detail in the 's dedicated\nabdominal CT examination report.\nNo osteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.\nMinimal bilateral apical scarring, symmetrical in distribution.  No suspicious\nlung nodules or masses.  No pleural thickening or pleural effusions. The\nairways are patent. Minimal unchanged not characteristic scarring at the bases\nof the left lower lobe (4, 208).",
            "output": "Unchanged to ___.  No metastatic lung disease.  No\nlymphadenopathy.  No pleural effusions."
        },
        {
            "input": "There are no enlarged mediastinal, axillary or hilar lymph nodes.  Heart size\nis normal, and diffuse calcifications of the native coronary arteries are\npresent in this patient status post previous coronary bypass surgery.  There\nis no pleural effusion.\n\nSkeletal structures of the thorax demonstrate evidence of previous sternotomy.\nNo suspicious new lytic or blastic skeletal lesions are detected.\n\nWithin the lungs, no new or growing nodules are detected. Mild lower lobe\nbronchiectasis is noted.",
            "output": "1. No CT evidence of intrathoracic metastatic disease.\n\n2. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings"
        },
        {
            "input": "There are no enlarged axillary, mediastinal or hilar lymph nodes. 6 mm short\naxis paraesophageal lymph node just above the level of the diaphragm is\napparently new (45, 2).\n\nHeart size is normal. Extensive calcification of native coronary arteries is\npresent in this patient status post median sternotomy and coronary bypass\nsurgery.  There is no pericardial or pleural effusion.\n\nNo new suspicious lytic or blastic skeletal lesions are detected within the\nthorax.\n\nWithin the lungs, no new or growing nodules are detected. Linear right basilar\natelectasis is noted.",
            "output": "1.  New subcentimeter lower paraesophageal lymph node, of uncertain\nsignificance.  Attention to this region on neck surveillance CT is recommended\nto help exclude a focus of metastatic disease.\n\n2. Otherwise, no new or progressive abnormalities suggest intrathoracic\nmetastatic disease.\n\n3. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. A\nlinear hypodensity within a subsegmental branch in the left lower lobe likely\nrepresents a branch point (3; 140).  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  There is moderate\natherosclerotic calcification of the thoracic aorta.  The heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen. \nModerate coronary artery calcifications are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate centrilobular emphysema.  No focal\nconsolidation is seen.  A calcified granuloma seen in the right lower lobe (2;\n87).  There is minimal septal thickening at the lung apices, suggestive of\nmild fluid overload.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Multilevel degenerative changes of the thoracic spine.  Bridging\ncalcifications along the anterior longitudinal ligament R consistent with\nDISH.  No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Moderate centrilobular emphysema.\n3. Minimal septal thickening at the lung apices may represent mild fluid\noverload."
        },
        {
            "input": "Pulmonary vasculature is well opacified to the subsegmental level without\nfilling defect to indicate a pulmonary embolus.  The pulmonary artery is\nmarkedly dilated, measuring 4.2 cm in maximum diameter; suggestive of\npulmonary hypertension.\n\nThe aortic root and ascending aorta is markedly dilated, measuring 5.3 cm in\nmaximum diameter.  The aortic arch and descending aorta is normal in caliber.\n\nThe major branching vessels of the aorta are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is moderate to severe cardiomegaly.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nBronchial wall thickening suggests small airway disease. There is a minimal\nbibasilar atelectasis. The airways are patent to the subsegmental level.\n\nThere is trace pericardial effusion.  There is no pleural effusion.",
            "output": "1. No evidence of acute pulmonary embolism.\n2. Severe cardiomegaly with markedly dilated aortic root and ascending aorta,\nmeasuring 5.3 cm.\n3. Markedly dilated pulmonary artery, measuring 4.2 cm, suggestive of\npulmonary hypertension.\n4. Small airway disease.\n5. Trace pericardial effusion."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes. Heart size\nis normal, and severe diffuse coronary artery calcifications are present. \nThere is no pericardial or substantial pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, note is made of\na cirrhotic appearing liver.  The patient's known hepatic lesions are seen to\nbetter detail on the recent outside MRI of the abdomen dated ___.\n\nWithin the lungs, marked upper lobe predominant emphysema is present with\ncombined centrilobular and paraseptal features.  Several nonspecific thickened\nseptal lines are present at the lung bases, right greater than left. \nIncidentally noted are calcified granulomas in the right upper and left lower\nlobes. Additional punctate in 1-2 mm diameter nodules without definitive\ncalcification are seen within the left lower lobe (131, right middle lobe\n(134, right upper lobe (137, and right middle lobe (155), on series 8.\n\nSkeletal structures demonstrate compression fractures at approximately the T9\nand T12 vertebral body levels, similar in appearance to lateral outside chest\nradiograph of ___.",
            "output": "1.  Several tiny lung nodules may represent noncalcified granulomas in the\nsetting of small calcified granulomas elsewhere in the lungs, but followup CT\nin 6 months may be helpful to exclude the possibility of early metastases\ngiven history of hepatic cellular carcinoma.\n\n2.  Cirrhosis. Known hepatic lesions have been more fully characterized by\noutside MRI.\n\n3.  Compression fractures at T9 and T12 are similar in appearance to outside\nchest radiograph of ___.\n\n4.  Severe coronary artery calcifications.\n\n5. Emphysema"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged\nranging up to 8 mm in the left axilla, unchanged since at least ___. \nThere are no soft tissues abnormalites in the chest wall suspicious for\nmalignancy.  This study is not designed for subdiaphragmatic diagnosis, but\nshows normal size adrenal glands.\n\nTrans jugular left-sided central venous catheter ends in the right atrium,\nwith no indication of associated thrombus.   Atherosclerotic calcification is\nmild in the head and neck vessels, very severe in the coronaries which some of\nwhich are stented.\n\nAorta and pulmonary arteries are normal size and subject of the technical\nlimitations of this non gated study, free of filling defects.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged.\n\nSmall hiatus hernia is unchanged since ___.\n\nBullous emphysema is severe in the right upper lobe, milder elsewhere.\n\nPunctate perifissural nodule in the right lung, 5:168, is stable and too small\nto warrant further evaluation.  Calcified granulomas, unchanged since previous\nstudy, are the only indication of prior granulomatous infection.  There are no\nlung lesions concerning for malignancy.\n\nThere are no new bone lesions in the chest cage suspicious for malignancy or\ninfection, however severe compression of the T9 vertebral body including deep\ndisc intrusions, and nearly as severe compression of T12, with extremely\nirregularity of the upper endplate, are both stable since ___.",
            "output": "No evidence of primary or metastatic intrathoracic malignancy.\n\nSevere coronary atherosclerosis.\n\nModerate bullous emphysema, most pronounced, right upper lobe.\n\n2 moderate to severe, chronic, compression, fractures, T9 and T12, both\nunchanged since ___."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes. \nSubcentimeter nodes are similar to the prior study.  Heart size remains\nnormal, and coronary artery calcifications are present.  There is no\npericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of cirrhosis and tiny calcified gallstone in the gallbladder.  Post RFA\nsite is roughly similar in size to ___ MRI abdomen but is not\nwell evaluated in the absence of intravenous contrast.  This and other\nsubdiaphragmatic findings will be more fully evaluated by today's concurrent\nMRI.  .\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.  High-grade compression deformities at the T9 and T12 are\nsimilar to the prior study as well as a small bone island at approximately the\nT4 vertebral body level.\n\nWithin the lungs, severe upper lobe predominant emphysema is again\ndemonstrated as well as incidental calcified granulomas bilaterally.  Diffuse\nbronchial wall thickening and bronchial irregularity are also noted.  No new\nor growing nodules are evident.",
            "output": "1. Stable CT appearance of the chest compared to ___, with no new\nor growing pulmonary nodules to suggest the presence of pulmonary metastases.\n\n2.  Unchanged T9 and T12 compression fractures.\n\n\n3.  Severe coronary artery calcifications.\n\n4.  Please see separately dictated MRI of the abdomen for more complete\nassessment of the subdiaphragmatic region, including the hepatic 2RFA site."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Subcentimeter mediastinal\nand hilar nodes are similar to ___.  Heart size is normal, and\ncoronary artery calcifications are again demonstrated.  No pericardial or\npleural effusion is identified.\n\nExam was not tailored to evaluate the subdiaphragmatic region, which will be\nmore fully assessed by separately dictated MRI of the abdomen from the same\ndate.  Again demonstrated is a cirrhotic liver with a post-RFA site and small\ndependent calcified gallstones.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.  High-grade compression fractures at T9 and T12 are again\ndemonstrated.\n\nWithin the lungs, upper lobe predominant emphysema is again demonstrated as\nwell as diffuse bronchial wall thickening.  No new or growing pulmonary\nnodules are detected.  A 2 mm right upper lobe lung nodule (90, 5) is\nunchanged and likely represents a calcified granuloma based on appearance on\n___ CT scan.  2 mm nodule along the left major fissure within the\nleft lower lobe (139, 5) is also unchanged as well as a 2 mm subpleural nodule\nin the lateral segment of the left lower lobe (181, 5) and a 2 mm nodule along\nthe right major fissure within the right lower lobe (149, 5).",
            "output": "1. Stable CT appearance of the chest with no new or growing pulmonary nodules\nto suggest the presence of pulmonary metastases.\n\n2. Please see separately dictated MRI of the abdomen for complete description\nof subdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  No axillary adenopathy.\n\nUPPER ABDOMEN: Not tailored to evaluate the subdiaphragmatic organs.  No\nhiatal hernia.  No adrenal lesions.  Contrast seen in the renal collecting\nsystems in keeping with the MRI done the same day.  No hydronephrosis.  Small\nsubcentimeter calcified gallstone.  No features of cholecystitis.  Small liver\nwith a nodular surface contour as well as hypertrophy of the caudate segment\nand segments 2 and 3 in keeping with history of cirrhosis.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Severe calcification of the left coronary artery. \nRight coronary artery stent in situ.  No pericardial effusion.  Normal cardiac\nconfiguration.  Moderate calcification of the aortic annulus.  Moderate\ncalcification of the aortic arch and the supra-aortic vessels.  Left pectoral\nPort-A-Cath in situ with the tip in the distal SVC.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  Multiple punctate 2 mm nodules (4:  84, 92, 116, 132, 139, 143,\n150, 215, 219, 233) are unchanged.  Multiple 1-2 mm calcified pulmonary\ngranulomas are unchanged.  No new nodules.  Marked centrilobular emphysematous\nchanges.  Mild bronchial wall thickening suggestive of chronic small airways\ndisease.  No confluent airspace consolidation\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery measures 24 mm in diameter (nondilated).\nCHEST CAGE: Marked spondylotic changes of the thoracic spine with wedge type\ncompression fractures of the T12 and T9 vertebral bodies appearing similar\ncompared to imaging done ___.  No lytic/ destructive bony lesions. \nSclerotic punctate T5 lesion appears similar compared to previous imaging.",
            "output": "No new or enlarging pulmonary nodules or masses.\n\nMarked centrilobular emphysema.\n\nCirrhotic liver:  Please refer to MRI abdominal report done on the same day."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Port-A-Cath catheter\nterminates at the level of mid SVC.  Extensive coronary calcifications are\npresent.  Heart size is normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be described in details as part of the\nMRI of the liver and the corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening might be consistent with chronic infection of the airways or\nchronic inflammation.\n\nCentrilobular emphysema is moderate, unchanged.  Pre-existing pulmonary\nnodules all stable, in the right middle lobe, series 5, image 167, in the\nlingula, series 5, image 211, in the left lower lobe, series 5, image 237.  No\nnew nodules demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nCompression fractures of the mid and lower thoracic vertebral bodies are\nsevere but unchanged.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nExtensive coronary calcifications.\n\nCompression fracture of the 2 to thoracic vertebral bodies, unchanged\n\nEmphysema"
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  No mediastinal, hilar or axillary lymphadenopathy present. \nHeart size is normal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMRI abdomen and pelvis in corresponding report will be provided.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular and\npanlobular emphysema is severe diffuse bronchial wall thickening is unchanged.\nNo new pulmonary nodules masses or consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Multiple compression fractures are unchanged.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease\n\nUnchanged multiple compression fractures of thoracic vertebral bodies\n\nExtensive coronary calcifications."
        },
        {
            "input": "Included views of thyroid are within normal limits.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nSince the previous CT examination from ___, there has been\ninterval coronary bypass.  Sternotomy wires are intact.  Postsurgical changes\nare noted along the anterior mediastinum (series 302, image 72).  There is no\npericardial effusion.  Extensive coronary vascular calcifications are\ndemonstrated throughout the native vessels (series 302, image 100).  The heart\nsize remains normal.\n\nA central venous catheter terminates at the caval atrial junction (series 302,\nimage 102).\n\nThe great vessels are normal in caliber.\n\nThe airways are patent to the subsegmental levels.\n\nThere is a moderate bilateral centrilobular emphysema with an upper lobe\npredominance (series 302, image 57).  A left lower lobe calcified granuloma is\nunchanged (series 302, image 123).  No pulmonary nodule or mass is detected. \nThere is no focal consolidation or pneumothorax.  There is no pleural\neffusion.\n\nHyperdense contrast material is seen within the bilateral collecting systems\n(series 302, image 268), likely from recent MR examination.  Please refer to\nthe MR examination regarding intra-abdominal findings.  Ventral hernia tacks\npartially visualized (series 302, image 258).\n\nThere are no osseous lesions concerning for malignancy or infection.  A\nsubcentimeter T5 bone island is unchanged (series 602, image 77).  Severe\ncompression deformities of T12 and T9 are unchanged since the ___ study (series 602, image 70).",
            "output": "1. No intrathoracic lymphadenopathy or metastasis.\n2. Moderate centrilobular emphysema.\n3. Unchanged severe compression deformities of T9 and T12.\n4. Postoperative changes associated with interval CABG.\n5. Please refer to the separate MRI dictation regarding intra-abdominal\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable.  Normal appearing\nthyroid gland.\n\nUPPER ABDOMEN: Cholecystectomy clips noted.  The rest of the visualized upper\nabdominal organs are within normal limits.\n\nMEDIASTINUM:\nNo mediastinal lymphadenopathy.\nThere is a lobulated nonenhancing hypoattenuating fluid (6.7) ___ lesion\nmeasuring 10.1 x 7.0 x 5.4 cm (2:36, 601:57) abutting the right cardiac\nborder, located at the right cardiophrenic angle.  No enhancing rim, or solid\nenhancing septations/nodules identified.\n\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal heart size.  No pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No parenchymal opacities or pulmonary nodules.\n2. AIRWAYS:  Patent to the subsegmental level.\n3. VESSELS:  Patent.  No significant atherosclerotic disease.\nCHEST CAGE: No aggressive osseous lesions.",
            "output": "1. Soft tissue opacity seen on the chest radiograph dated ___\ncorresponds to a nonenhancing 10.1 cm simple cystic lesion within the middle\nmediastinum just to the right of the right heart border, given its location\nthis likely represents a large pericardial cyst.\n2. No mediastinal lymphadenopathy or lung parenchymal abnormalities noted."
        },
        {
            "input": "There is no pulmonary embolism to the segmental level.  Evaluation of the\nsubsegmental levels is limited due to timing of the contrast bolus. The aorta\nis unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  Mild cardiomegaly and interventricular septal hypertrophy is\nstable since at least ___.\n\nThere is no evidence of pulmonary parenchymal abnormality. There is no pleural\neffusion or pneumothorax. The airways are patent to the subsegmental level.\n\nHeart is unremarkable.  There is no pericardial effusion.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy. Included\nportion of the thyroid is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney demonstrates small upper and lower pole\nhypodensities, too small to characterize, but likely cysts.  The left kidney\nhas several hypodensities, the largest is exophytic arising from the\ninterpolar region, measuring up to 7.9 cm, decreased since ___,\nand compatible with a cyst.  Both kidneys enhance symmetrically without\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is a small fat containing umbilical hernia.",
            "output": "1. There is no pulmonary embolism to the segmental level.  Evaluation of the\nsubsegmental levels limited due to suboptimal opacification.\n2. No acute aortic abnormality.\n3. Interventricular septal hypertrophy and mild cardiomegaly, unchanged since\n___.\n4. No acute intra-abdominal or pelvic process."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is mildly enlarged.  No pericardial effusion.  Mild atherosclerotic\ncalcifications in the coronary arteries and aorta, none in the cardiac valves.\nThe main pulmonary artery is dilated measuring 4.2 cm.  The aorta is normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, the largest in the right lower\nparatracheal station measuring up to 1.0 cm (302:67).  No hilar\nlymphadenopathy..\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Subpleural nodule like\nconsolidations, notably in the right lower (302:199) and left upper lobe\n(302:70).  Other subpleural areas of mixed ground-glass opacities and\nconsolidations are also noted in the left lower and right upper lobes.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show status post cholecystectomy. \nPartially imaged large left renal cyst (302:249).",
            "output": "Several subpleural areas of mixed ground-glass opacities and consolidations\nconcerning for multifocal pneumonia.\nBorderline enlarged mediastinal lymph nodes are likely reactive.\n\nRECOMMENDATION(S):  Chest radiograph in ___ week to document complete\nresolution of the infectious process.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:20 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Large calcified left thyroid nodule (2, 5).  Left pectoral pacemaker.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  At the level of\nthe main pulmonary artery, the ascending aorta has a diameter of 34 x 37 mm. \nAt the same anatomical level, the descending aorta has a diameter of 25 x 30\nmm.  Severe coronary calcifications, moderate aortic valve calcifications,\nmoderate cardiomegaly with minimal pleural effusion.  The descending aorta is\nmildly elongated.  Severe calcifications of the upper abdominal arteries.  No\nacute upper abdominal abnormalities.  Status post cholecystectomy.  Moderate\ndegenerative vertebral disease.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild bilateral apical scarring. \nCalcified right upper lobe granuloma (4, 91).  Severe thickening any\nirregularities of the airway walls, areas of mucous plugging in the lower\nlobes. Areas of atelectasis in the dependent lung regions (4, 184).  No\npleural effusions.  No diffuse lung disease.  No suspicious lung nodules or\nmasses.",
            "output": "Severe cardiomegaly.  Aortic ___ are reported above.  Calcified right\nupper lobe granuloma.  No pleural effusions.  Severe chronic airways disease\nwith substantial mucous plugging."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere peribronchovascular opacities in the right lower lobe (3:108).  There is\na 1.5 x 1.7 cm pulmonary nodule in the right lower lobe abutting the major\nfissure with popcorn like calcifications and apparent lipid components\nconsistent with a pulmonary hamartoma (3:151).  There is a 2 mm left upper\nlobe pulmonary nodule (3:60).  There is no evidence of pulmonary parenchymal\nabnormality. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Right lower lobe findings are concerning for infection.\n2. No evidence of pulmonary embolism or aortic abnormality.\n3. A 2 mm left upper lobe pulmonary nodule warrants follow-up chest CT in ___\nyear if the patient is high risk, per ___ Society recommendations.\n4. Right lower lobe pulmonary hamartoma.  No follow-up required.\n\nRECOMMENDATION(S):  A 2 mm left upper lobe pulmonary nodule warrants follow-up\nchest CT in ___ year if the patient is high risk, per ___ Society\nrecommendations."
        },
        {
            "input": "Please note evaluation of the lung bases and upper abdomen is limited given\nimaging coverage.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level with filling defects demonstrated in the segmental branches\nof the right upper lobe pulmonary arteries and subsegmental branches of the\nleft upper lobe consistent with pulmonary embolus.  No findings of right heart\nstrain are identified.  There is narrowing of the right upper lobe superior\nsegmental pulmonary artery due to underlying mass described below.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Extensive right hilar and mediastinal\nlymphadenopathy is demonstrated with a right hilar nodal conglomerate\ncontaining calcifications measuring up to 2.5 cm attenuating the right middle\nand upper lobe bronchi.  The largest mediastinal lymph node measures 1.3 cm in\nthe subcarinal station.  Enlarged AP window node: Vomited is also noted.  No\nleft hilar or axillary lymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A large right upper lobe mass measures approximately 7.1 x 3.8\nx 5.4 cm (3:48 and 601:30) extending from the chest wall to the mediastinum. \nAdjacent interlobular septal thickening at the right lung apex may represent\nlymphangitic spread of tumor.  Additionally subcentimeter pulmonary nodules\nare demonstrated throughout the lungs bilaterally with involvement in all\nlobes (for example see series 3 images 127, 136, 102, 74, 69, and 76).  With\nthe exception of the right upper and middle lobe airway narrowing, the airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The visualized thyroid is unremarkable.  Supraclavicular\nlymphadenopathy is demonstrated measuring up to 1 cm (03:21).\n\nABDOMEN:  Included portion of the upper abdomen is limited, though\nunremarkable.\n\nBONES: A lytic and destructive soft tissue lesion is demonstrated in the right\nfifth rib along the lateral chest wall measuring up to 1.7 cm (3:95).  Subtle\nlucency also seen at the posterior-lateral aspect of the left fourth rib\n(03:41).  No suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "1. Segmental pulmonary emboli of the right and left upper lobes.  No findings\nof right heart strain demonstrated.\n2. Large right upper lobe mass with mediastinal lymphadenopathy resulting in\nairway narrowing of the right upper and middle lobes, as well as innumerable\nsubcentimeter pulmonary nodules throughout all lobes bilaterally, as well as a\nlytic right fifth rib lesion, consistent with malignancy.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:00 pm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet.  Bilateral breast prostheses.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout. \nRedemonstration of several segmental filling defects in pulmonary artery\nbranches of the right and left upper lobes, best depicted in the prior chest\nCTA from ___.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Multiple enlarged mediastinal lymph nodes are\nnoted, for example in the left lower paratracheal station measuring 1.1 cm in\nshort axis diameter (302:86).  Multiple enlarged lymph nodes are also noted in\nthe right hilum, for example a necrotic lymph node measuring approximately 2.3\nx 1.7 cm (302:77).  No left lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nLarge heterogeneous mass in the right upper lobe measuring approximately 7.7 x\n3.2 x 5.2 cm (302:41, 601:33).  This mass is in contact with the lateral wall\nof the right hemithorax with apparent pleural invasion.  It is also in contact\nwith the adjacent mediastinum, extending to the hilar structures.  The mass\nexerts external compression on the right main and right upper bronchi. \nSeveral small 5 mm nodules are seen scattered throughout all lobes, for\nexample in the left upper lobe (302:142) in the left upper lobe (302:83), in\nthe right lower lobe (302:121) and in the right upper lobe (302:71).\n\nCHEST CAGE:\nLarge expansile lytic mass in the right lateral fifth rib (302:92).  No acute\nfractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "When compared to the CT chest performed yesterday, there is no significant\ninterval change.\n\nLarge mass in the right upper lobe concerning for a primary lung malignancy. \nThis is associated with mediastinal and hilar lymphadenopathy as well as\nmultiple small nodules in the remaining lung lobes and a large lytic lesion in\nthe right fifth rib, all concerning for metastatic disease spread.\n\nRedemonstration of several segmental pulmonary emboli."
        },
        {
            "input": "Chest:\n\nPort terminates shortly below cavoatrial junction is seen previously. \nBilateral silicone breast implants are present.\n\nThe heart is normal in size.\n\nThe aorta is normal in caliber. Mild atherosclerotic change along the aorta.\nNo evidence of acute\naortic syndrome.\n\nThere are several small subsegmental pulmonary emboli in each lung.\n\nA mildly enlarged right hilar lymph node appears similar in size.  Mediastinal\nlymph nodes are considerably smaller than in ___.  Largest is a\nprecarinal node measuring 9 mm in short dimension.  Unchanged borderline left\nhilar lymph node.\n\nThere is no pleural or pericardial effusion.  No pneumothorax.\n\nAlthough there is still mild soft tissue thickening along the right mainstem\nbronchus, this has decreased substantially.\n\nRight upper lobe mass is considerably smaller.  Regional carcinomatosis is\nalso less striking.\n However, shrinkage of the mass reveals some satellite nodules of\nindeterminant chronicity.\n\nThere are many more nodules in the right lung than the left.  Some of the\nprevious identified nodules in each lung are decreased or no longer\ndetectable.  However, this study shows a number of new small nodules that were\nnot present in ___ for example a left apical nodule measuring 4 mm\n(4:39). Since the more recent CT of the abdomen there is no clear-cut change\nover the short term at the visualized lung bases.\n\nAbdomen:\n\nEven since the main comparison study for the abdomen and pelvis, from late\n___, liver metastases have substantially worsened.  Metastatic disease is\nnow nearly confluent.  A number of stones are found in the gallbladder. \nPancreas appears normal.  A new splenic infarct has occurred since the recent\nstudy. In addition, new hypoattenuating mass along the inferior margin of the\nspleen measuring 37 x 21 mm in axial ___ (5:21) seems more likely to\nrepresent a metastatic mass than infarct, newly apparent over the short\ninterval.  Right adrenal is unremarkable.  Small but increased left adrenal\nnodule suggesting metastatic disease, measuring 10 mm, previously 8 mm. \nHowever there is a new hypodense defect along the left upper pole.  Although\nmetastatic disease could be considered, small infarcts seems most likely to\nexplain it.  No evidence for hydronephrosis, stones, solid masses involving\neither kidney.\n\nStomach is not nondistended.  Small bowel is nondilated.  Mildly prominent\nstool content is identified throughout the colon.\n\nPelvis:\n\nBladder appears normal.  Small enhancing foci suggests fibroids in the uterus.\nNo adnexal masses are identified.\n\nInfrarenal inferior vena cava filter is in place.  Although given the contrast\ntiming, systemic veins are somewhat difficult to assess, expansile\nheterogeneous hypodense appearance of the visualized systemic veins, including\nextending from visualized bilateral superficial femoral veins through the into\nfor renal inferior vena cava, shows heterogeneous expansile appearance\nincluding surrounding stranding suggesting extensive acute thrombosis. \nAlthough veins are fairly flat above the filter, renal veins and upper in from\nhepatic inferior vena cava appear patent.\n\nSomewhat infiltrative appearance along the fat of the lesser sac may reflect\nmetastatic disease.  Right retroperitoneal nodules are also metastatic and new\nor increased (for example a new left periaortic nodule measuring 17 x 12 mm\n(5:24).  No ascites.\n\nBones:\n\nMixed lytic and sclerotic bone metastases show no change in the abdomen and\npelvis since ___.  Regarding the chest, where comparison is to ___, a number of new sclerotic bone metastases have appeared.  However a\nmetastasis with substantial soft tissue component along the right lateral\nchest wall involving the right lateral fifth rib has mostly resolved.",
            "output": "1.  Several very small bilateral subsegmental pulmonary emboli.\n\n2.  Although incompletely characterized, findings suggest extensive, probably\nocclusive, and likely acute at least to some extent, venous thrombosis\ninvolving visualized bilateral superficial femoral veins through the inferior\nvena cava, extending up to an inferior vena cava filter.\n\n3.  New hypodense area in the spleen suggesting small infarct.  New small\nhypodense focus along the upper pole of the left kidney, also thought to\nrepresent infarct, more likely than metastasis.\n\n4.  New and increased metastatic lung nodules despite evidence for significant\ntreatment response involving previously noted disease.\n\n5.  Short-term increase in metastatic disease in the abdomen."
        },
        {
            "input": "CHEST PERIMETER: None of the multiple low-density lesions in both thyroid\nlobes is large enough to warrant further imaging evaluation.  Thyroid lobes\nare not enlarged the trachea is not compromised.  Surrounding soft tissue at\nthe thoracic inlet is unremarkable.  No supraclavicular or axillary lymph node\nenlargement.  Breast evaluation is reserved exclusively for mammography.  No\nsoft tissue abnormality elsewhere in the chest wall side from mild dependent\nsubcutaneous soft tissue edema.  No evidence of chest wall infection. \nCollapsed breast prostheses noted.\n\n\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification\nmoderate in head and neck vessels and at least left anterior descending\ncoronary artery.  Aorta and pulmonary arteries are normal size, aortic valve\nis not calcified and the pericardium is physiologic.  Supraclavicular central\nvenous infusion catheter ends in the mid right atrium.  No associated\nthrombus.\n\nTHORACIC LYMPH NODES: Lymph nodes in the mediastinum top normal size right\nlower paratracheal and right posterior paraesophageal stations.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderately severe.  3 regions of\nheterogeneous infiltration in the right upper lobe, the largest in the\nposterior segment, 302:90 are probably residual of prior pneumonia.  Right\nbasal consolidation is due to relaxation atelectasis.\n\nNo bronchial obstruction.  No lung nodules.  Left lower lobe collapse and\natelectasis of the inferior subsegment of the lingula are also attributable to\ndisplacement and compromised ventilation by small to moderate nonhemorrhagic\nlayering left pleural effusion.\n\nVery small layering nonhemorrhagic right pleural effusion is higher in\nattenuation, not hemorrhagic, probably a chronic effusion.  No pleural mass.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Small areas of infection, right upper lobe, not necessarily active.\n\nModerate nonhemorrhagic left pleural effusion responsible for left lower lobe\ncollapse and atelectasis in the lingula.  Very small right pleural effusion\ncontributes to right lower lobe basal segmental atelectasis.\n\nMild reactive mediastinal lymph node enlargement.\n\nAtherosclerotic calcification, moderate right head neck vessels, mild coronary\narteries."
        },
        {
            "input": "CHEST PERIMETER: 16 mm low-density lesion, in the right thyroid lobe, the\nlargest of several in both lobes, is unchanged since ___ in should\nbe evaluated by ultrasound if not recently performed.  Supraclavicular and\nleft axillary lymph nodes are not enlarged.  Lymph nodes and/or abscesses in\nthe right upper in the right axilla in ___ have been resected, and soft\ntissue at the surgical site has a normal postoperative appearance.  There is\nhowever an intramuscular spherical, well-circumscribed fluid collection,\neither abscess or necrotic mass in the right upper arm, 5: 9.  Since the\nregion was not imaged previously the chronicity of this lesion is\nindeterminate.\n\nEvaluation of the breasts is reserve for mammography.\n\nAt the lowest level of chest imaging there is a 4 cm wide heterogeneous\nopacification in the soft tissues of the right posterior upper abdominal wall,\n05:53, incompletely imaged.  This and other findings below the diaphragm will\nbe reported separately.\n\nCARDIO-MEDIASTINUM:Lower esophagus is patulous.  Posterior to the mid\nesophagus, roughly at the level of the left main bronchus is a 25 long by 21 x\n14 mm elliptical lesion with attenuation ___ ___.  The lesion may have grown\nslightly since ___, and although abnormalities like this are usually nor\nenteric or other mediastinal cysts, this could be a necrotic lymph node.\n\nAtherosclerotic calcification is moderately heavy in head and neck vessels,\nbut relatively mild in coronary arteries.  Aortic valvular calcification is\nmoderate.  Aorta and pulmonary arteries and cardiac chambers are normal size\nand pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Other than the retroesophageal abnormality described\nabove, there are no pathologically enlarged lymph nodes in the chest.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\nNew lung nodules are likely metastases:\n\nPunctate, right upper lobe, 6:112\n\n7 mm, right lower lobe, 6:178\n\nPunctate, right lower lobe 6:204\n\nPunctate, left upper lobe, 6:93\n\n5 mm, left lower lobe, 6:211\n\nTracheobronchial tree is normal to subsegmental levels.  Small areas of\npleural irregularity are indeterminate, probably subpleural atelectasis rather\nthan pleural tumor.  There is no appreciable pleural effusion.\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Handful of small lung nodules new since ___ are quite likely\nmetastases.\n\nPrevious right axillary adenopathy is been resected.  New or newly apparent\nsmall necrotic mass or abscess, right upper arm.\n\nPossible retroesophageal mediastinal cyst or metastatic lymph node, slightly\nlarger today than in ___.\n\nModerately severe aortic valvular calcification could be hemodynamically\nsignificant.\n\nPossible thyroid nodules.  Thyroid ultrasound recommended.\n\nAtherosclerotic calcification moderately heavy in head and neck vessels,\nsparing the coronary arteries."
        },
        {
            "input": "Atherosclerotic disease of the aortic arch is demonstrated.  Pulmonary\narteries are within normal limits.  Heart size is normal.  There is no\npericardial or pleural effusion.\n\nExtensive bulky lymphadenopathy in the right axilla is demonstrated with at\nleast 2 necrotic lymph nodes, 4 x 2.5 and 3 x 3 cm demonstrated with a smaller\nlymph node of a cm in diameter present.  Series 3, image 17.  No left\naxillary, mediastinal or hilar lymphadenopathy is present.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nNo definitive lytic or sclerotic lesions worrisome for infection or neoplasm\npresent.\n\nThyroid nodules are bilateral, the largest on the right approaching 12 mm.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules masses or consolidations demonstrated.",
            "output": "Bulky right axillary lymphadenopathy with necrotic lymph nodes concerning for\nmetastatic spread\n\nNo pulmonary nodules or other evidence of intrathoracic metastatic disease\n\nAtherosclerotic disease of the aorta\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal pathology."
        },
        {
            "input": "GENERAL: Slightly limited exam secondary to respiratory motion.\n\nHEART AND VASCULATURE: Thoracic aorta and main pulmonary artery are normal in\ncaliber.  Pulmonary arteries are well opacified to the subsegmental level\nwithout evidence of pulmonary embolism. Mild cardiomegaly. No pericardial\neffusion. Few scattered coronary calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, supraclavicular, mediastinal or\nhilar adenopathy.\n\nPLEURAL SPACES: No pleural effusion. No pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Minimal bibasilar atelectasis.  Tiny scattered pulmonary\nnodules are noted without suspicious features.  For example, a 3 mm nodule in\nthe left lower lobe (series 6, image 26).  There is scattered bronchial wall\nthickening (series 6, image 155).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Exophytic, enhancing mass arising from the upper pole of the right\nkidney measures 21 mm, previously 17 mm on the PET-CT ___ (series 6,\nimage 268).  The lesion was noted to demonstrate low level FDG avidity on the\nprior exam.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Enhancing exophytic mass arising from the upper pole of the right kidney\nsuspicious for renal cell carcinoma. The lesion is incompletely visualized but\nmeasures up to 21 mm and is likely larger in comparison to the PET-CT dated ___.\n3. Small pulmonary nodules measuring up to 3 mm in the left lower lobe.\n4. Multifocal mild bronchial wall thickening is nonspecific but may reflect\nsmall airways disease.\n\nRECOMMENDATION(S):  Further evaluation of the right renal mass with a renal\nMRI with and without contrast as well as urologic consultation."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are low volume with minimal bibasilar atelectasis.  There is no\nevidence of pneumonia pulmonary edema or interstitial abnormality.  A 3 mm\nleft lower lobe nodule (2, 74) is unchanged.  No new pulmonary nodules.  Tiny\n1 mm nodule adjacent to the left major fissure in the left upper lobe (2, 20)\nis also unchanged\n\nBONES AND CHEST WALL : Review of bones shows diffuse osteopenia.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No evidence of pulmonary embolism.\n\nStable 3 mm left lower lobe pulmonary nodule and 1 mm left upper lobe\npulmonary nodule.  No new pulmonary nodules.\n\nNo obvious fractures.  Diffuse osteopenia in keeping with patient's known\nmultiple myeloma."
        },
        {
            "input": "There is respiratory motion limiting evaluation for segmental and subsegmental\npulmonary emboli, particularly at the left lung base.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild bibasilar, left greater than right, atelectasis.  Lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Respiratory motion makes evaluation of some segmental and subsegmental\npulmonary arterial branches suboptimal, vertically at the left lower lobe. \nWithin these limitations, there are no large pulmonary emboli identified.\n2. Mild bibasilar atelectasis, left greater than right."
        },
        {
            "input": "CTA: The pulmonary arteries are well opacified to the subsegmental level\nbilaterally.  There is a subsegmental right lower lobe pulmonary embolus\nidentified (series 3, image 134, 150).  Tiny non enhancing opacity in this\nregion may represent a small pulmonary infarct.  Thoracic aorta is normal in\ncaliber without evidence of dissection.  No significant atherosclerotic\nchanges.\n\nCHEST: The thyroid is unremarkable.  There is no axillary, supraclavicular, or\nmediastinal adenopathy.  There is a prominent right hilar lymph node measuring\n11 mm, nonspecific (series 2, image 46).  Heart size is normal.  No\npericardial effusion.  No significant coronary artery calcifications.\n\nThe airways are patent to the subsegmental level bilaterally.  There is no\npleural effusion or pneumothorax.  There is mild bibasilar atelectasis.  There\nis mild biapical scarring.\n\nThe thoracic esophagus is notable for diffuse mild wall thickening, likely\nrelated to reflux.  Limited views of the upper abdomen are normal.  No\nsuperficial soft tissue abnormality.\n\nOSSEOUS STRUCTURES: No suspicious bony lesion.",
            "output": "Right lower lobe subsegmental pulmonary emboli."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nAside from minimal apical scarring, there is no evidence of pulmonary\nparenchymal abnormality.  Mild peribronchial wall thickening in the lower\nlobes have improved from ___.  Tiny subpleural nodule in the left\nlower lobe is unchanged from prior, likely a small subpleural lymph node.  The\nairways are patent to the subsegmental level.  There is mild peribronchial\nwall thickening, likely due to inflammation.\n\nLimited images of the upper abdomen 6 mm hyperenhancement in the spleen was\npreviously not imaged in may represent a hemangioma (3:225).  Otherwise, the\nimaged upper abdomen is unremarkable..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of acute or residual pulmonary embolism.\n2. Mild peribronchial wall thickening is attributable to inflammation."
        },
        {
            "input": "There is moderate respiratory motion artifact.\n\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is moderately enlarged but there is no\npericardial effusion.  There are dual-chamber pacemaker/ICD leads in\nappropriate position.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is enlarged AP window lymph node,\nmeasuring up to 12 mm (02:45).  There is no hilar lymphadenopathy.\n\n\nPLEURAL SPACES:  There is a large right and a moderate left pleural effusion\nwith adjacent compressive atelectasis.  No pneumothorax.\n\n\nLUNGS/AIRWAYS:  The aerated portions of the lungs are difficult to evaluate\ndue to significant respiratory motion artifact.  There is moderate, upper lobe\npredominant centrilobular emphysema and scattered ground-glass opacities\nconsistent with pulmonary edema.\n\nBASE OF NECK:  The visualized portion of the neck base demonstrates a\nposteriorly projecting goiter from the left lobe of the thyroid measuring 4.1\nx 3.2 cm (02:17), unchanged since ___.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nSternal wires are intact.",
            "output": "1. Limited evaluation for pulmonary embolism due to respiratory motion\nartifact, however no large central, lobar, or segmental filling defect is\nappreciated.\n2. Large right and moderate left pleural effusions with adjacent compressive\natelectasis.\n3. Moderate cardiomegaly.\n4. Moderate pulmonary edema.\n5. 4.1 x 3.2 cm left lobe thyroid mass, stable since the CT C spine from ___.  If warranted, this could be evaluted by thyroid ultrasound on an\noutpatient basis.\n\nRECOMMENDATION(S):  4.1 x 3.2 cm left lobe thyroid mass, stable since the CT C\nspine from ___.  If warranted, this could be evaluted by thyroid\nultrasound on an outpatient basis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Bilateral, small pleural\neffusions with associated compressive atelectasis of the lower lobes.  There\nis diffuse ground glass opacities throughout the lungs which may reflect\npulmonary edema or normal expiration.\n\nLeft apical emphysematous changes and scarring.  Atelectasis of both lower\nlobes. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.   No evidence of pulmonary embolism or aortic abnormality.\n2. Small bilateral pleural effusions with compressive atelectasis.\n3.  Diffuse ground glass opacities may reflect pulmonary edema or changes from\nexpiration."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged, ranging in diameter up to\n9 mm on the left, 6:93.  Excluding the breasts which require mammography for\nevaluation, there are no soft tissue abnormalities in the chest wall\nsuspicious for malignancy.  Findings below the diaphragm will be reported\nseparately.  Small lucent areas in the thyroid, not exceeding 9 mm, are not\nlarge enough to warrant further imaging evaluation for possible neoplasm.\n\nAtherosclerotic calcification is not apparent in head neck vessels, and is\nmild in the coronaries in at least the left anterior descending artery and\nbranches.  Mild cardiomegaly is exaggerated by an narrow AP diameter,\ninvolving all chambers.  There is no pericardial or pleural effusion.\n\nAorta and pulmonary arteries are normal size and free of central filling\ndefects.\n\nMediastinal and hilar lymph nodes are not enlarged.\n\nModerate biapical pleural parenchymal scarring is symmetric.\n\nA cluster of broncho centric nodules, some soft tissue in density others\nground-glass is found in the lateral segment of the right middle lobe,\n6:124-138.  The largest is 9 mm wide, 6:136, and because of its size is this\nlesion at least warrants imaging followup although it is likely because of the\nclustering of these lesions that they are all inflammatory.  There are no\nfocal abnormalities in the left lung.  Tracheobronchial tree is normal to\nsubsegmental levels.\n\nThere no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Even though the sub cm nodules clustered in a small region of the anterior\nsegment of the right lower lobe are probably inflammatory, some are of\nsufficient size to warrant followup in order to exclude malignancy.\n\nCoronary atherosclerosis."
        },
        {
            "input": "Again seen are 1 x 0.7 cm and 0.5 x 0.5 cm right and left thyroid lobe nodules\nrespectively, which are unchanged since prior examination(2:4).  No\nsupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is mild coronary artery calcification.\n\nThere is interval increase in small bilateral non hemorrhagic pleural\neffusions with associated compressive atelectasis.  Left pleural effusion is\nintermediate density measuring 31 Hounsfield units suggestive of an exudative\ncomponent.  The lungs are notable for bilateral lower lobe opacities.\n\nThe soft tissues are unremarkable.  Patient is status post gastrectomy, and\nthe esophagus is mildly dilated and fluid-filled.  A 0.7 x 0.6 cm (4:160)\nwell-circumscribed hyperdensity adjacent to the GE junction with preserved fat\nplane between the esophagus is consistent with a small lymph node.\n\nVisualized osseous structures are notable for degenerative changes throughout\nthe thoracic spine with disc space narrowing, subchondral sclerosis, and\nanterior osteophyte formation.  A chronic left acromion fracture is noted.  No\nacute fracture.\n\nPlease refer to separate CT chest for dedicated findings within the\nabdomen/pelvis.",
            "output": "1.  Status post gastrectomy with associated postsurgical changes and mildly\ndilated fluid-filled esophagus.  Of note patient is at increased risk for\naspiration.\n2.  New small bilateral pleural effusions with possible exudative left pleural\neffusion.\n3.  Bilateral lower lobe opacities are most consistent with atelectasis,\nclinical correlation recommended to assess for superimposed infection.\n4.  Persistent bilateral thyroid lobe nodules largest measuring 1 cm within\nthe right thyroid lobe.  If clinically indicated and not previously assessed,\nconsider dedicated thyroid ultrasound for further evaluation."
        },
        {
            "input": "Known 6 mm left thyroid nodule.  Normal enhancement of the large mediastinal\nvessels.  No evidence of extra thoracic or intra thoracic adenopathy. Moderate\nbilateral pleural effusions, minimally increased since the previous\nexamination, with adjacent areas of atelectasis.  No evidence of pneumonia. \nUpper abdominal organs are described in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum or the\nvertebral bodies.  Mild degenerative vertebral disease.  Assessment of the\nlung parenchyma is limited by respiratory motion are defects.  The well\nventilated areas of the lung parenchyma show no evidence of focal or diffuse\nabnormalities.  The airways appear patent.",
            "output": "Slightly increasing bilateral pleural effusions, adjacent areas of\natelectasis.  No pneumonia, no lymphadenopathy."
        },
        {
            "input": "Known 6 mm left thyroid nodule.  Normal enhancement of the large mediastinal\nvessels.  No evidence of extra thoracic or intra thoracic adenopathy. \nModerate bilateral pleural effusions, minimally increased since the previous\nexamination, with adjacent areas of atelectasis.  No evidence of pneumonia. \nUpper abdominal organs are described in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum or the\nvertebral bodies.  Mild degenerative vertebral disease.  Assessment of the\nlung parenchyma is limited by respiratory motion are defects.  The well\nventilated areas of the lung parenchyma show no evidence of focal or diffuse\nabnormalities.  The airways appear patent.",
            "output": "Slightly increasing bilateral pleural effusions, adjacent areas of\natelectasis.  No pneumonia, no lymphadenopathy."
        },
        {
            "input": "MEDIASTINUM:  Bilateral thyroid subcentimeter nodules are stable. No\npathologically enlarged supraclavicular, axillary, hilar or mediastinal lymph\nnodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries.  The heart is\nmildly enlarged with right atrial and ventricular enlargement. No pericardial\neffusion.  Mild atherosclerotic calcifications of the thoracic aorta and\nmoderate coronary arteries.  Right-sided central venous line with the tip in\nthe right atrium.\n\nPLEURA: There is no pneumothorax.  Bilateral pleural effusions moderate to\nlarge on the left and moderate on the right have increased since the prior\nexamination. No peripheral enhancement or significant convexity to suggest\nempyema.\n\nLUNGS AND TRACHEOBRONCHIAL TREE:  Tracheostomy tube in good position.  Mild\nsecretions throughout the trachea.  Bilateral moderate to large pleural\neffusions with adjacent significant bilateral lower lobe and right middle lobe\ncollapse. New mild ground glass opacities throughout the lungs with anterior\nmild nodular opacities in the upper lobes bilaterally are likely a combination\nof mild edema and atelectasis.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton. \nDiffuse body wall edema has not substantially changed.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "No evidence of active intrathoracic infection.\n\nMinimal pulmonary edema.\n\nModerate to large pleural effusion have increased since ___ with\nadjacent significant lower lobe atelectasis.\n\nRight-sided central venous line with the tip in the right atrium."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is enlarged.  No pericardial effusion. \nThere is at least moderate coronary artery calcification.  The thoracic aorta\nis normal in caliber and moderately calcified.  No penetrating atherosclerotic\nulcer or dissection.  The main pulmonary artery is top normal in caliber.  No\nevidence of pulmonary embolism to the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: There is mild mediastinal lymphadenopathy.  A\nright upper paratracheal lymph node measures 1.0 cm (series 2, image 15).  A\nright lower paratracheal lymph node measures 1.2 cm (series 2, image 25).  A\nleft lower paratracheal lymph node measures 1.4 cm (series 2, image 38).  A\nsubcarinal lymph node measures up to approximately 1.6 cm (series 2, image\n49).  Hilar lymph nodes are top normal in size.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: There are trace bilateral pleural effusions.\n\nLUNGS/AIRWAYS: Endotracheal tube tip terminates 3.5 cm proximal to the carina.\nThere is a heterogeneous left lower lobe consolidation with air bronchograms. \nThere is a somewhat linear heterogeneous consolidation in the posterior left\nupper lobe.  There are less confluent ground-glass and consolidative opacities\nin the right lower lobe (series 301, image 114).  There are few scattered\nsmall ground-glass pulmonary nodules, likely infectious/inflammatory.  There\nare multiple punctate calcified granulomas.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: An endotracheal tube terminates in the stomach.  Trace perihepatic\nand perisplenic ascites.\n\nBONES: No suspicious osseous abnormality is seen.? multiple bilateral\nanterolateral nondisplaced rib fractures are noted..  There is a partially\nimaged right deltoid intramuscular lipoma.",
            "output": "1. Multifocal pneumonia.\n2. Mild mediastinal lymphadenopathy is likely reactive.\n3. Trace bilateral pleural effusions.\n4. No evidence of pulmonary embolism.\n5. Trace upper abdominal ascites.\n6. Evidence of prior granulomatous inflammation.\n7. Multiple bilateral nondisplaced anterolateral rib fractures.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by\n___, M.D. on the telephone on ___ at 10:01 pm, less than 5\nminutes after discovery of the findings."
        },
        {
            "input": "Pulmonary arteries are substantially enlarged up to 4 cm. Aortic arch is\ncalcified. Heart size is enlarged. Extensive Coronary calcifications and\nsevere aortic valve calcifications are present. Heart size enlargement\ninvolves of 4 jumper's\n\nLarge right pleural effusion is present. Minimal left pleural effusion is\nseen. No pathologically enlarged mediastinal or hilar lymph nodes are noted.\nSevere calcifications of the left hilus are present.\n\nImage portion of the upper abdomen demonstrate diffuse thickening of the left\nadrenal, 20 Hounsfield units in density, nonspecific.\n\nAssessment of the aorta demonstrate no evidence of ascending aortic\ncalcifications or aortic dilatation\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\nExtensive degenerative changes are noted throughout the spine.  Diffuse\nground-glass opacities with minimal septal thickening are most likely\nrepresenting resolving or developing pulmonary edema. Infection would be\nsubstantially less likely. No masses or consolidations are noted except for\nright middle lobe atelectasis and lingular atelectasis. There is also a right\nlower lobe atelectasis due to pleural effusion. Small hiatal hernia is noted.",
            "output": "Cardiomegaly\n\nSevere aortic valve calcifications consistent with provided history of aortic\nstenosis\n\nModerate to large right pleural effusion\n\nResolving/ developing pulmonary edema versus less likely infection\n\nSmall hiatal hernia."
        },
        {
            "input": "The thyroid gland is unremarkable.  There is no supraclavicular, mediastinal,\nhilar or internal mammary lymph nodes.  Mildly prominent bilateral axillary\nlymph nodes measure up to 9 x 12 mm on the right (5:18).\n\nHeart size is normal with no pericardial effusion.  The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolus is\nidentified. The left vertebral artery arises directly from the aortic arch,\nwhich is a normal anatomic variant.\n\nMild apical predominant emphysema is present.  A calcified right lower lobe\ngranuloma is incidentally noted. There is no endobronchial lesion or pleural\nabnormality.\n\nThe patient is status post bilateral mastectomies with reconstruction.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "No evidence of pulmonary metastases.\n\nBorderline bilateral axillary lymph nodes."
        },
        {
            "input": "The thyroid gland is unremarkable. The airways are patent to the subsegmental\nlevel. There is no supraclavicular lymphadenopathy. There is no axillary,\nmediastinal or hilar lymphadenopathy by CT size criteria. The esophagus is\nnormal without hiatal hernia or other esophageal abnormality. The heart is\nmarkedly enlarged with a small pericardial effusion. Cardiac pacer leads\nterminate in appropriate position in the right atrium and ventricle. There is\ndilation of the ascending thoracic aorta measuring 4.6 cm in diameter (2:27).\n\nThe lungs are clear of focal consolidation, pleural effusion or pneumothorax.\nThere is dependent atelectasis in the right lower lobe. Emphysema is noted.\n\nBones:  There are no suspicious lytic or sclerotic osseous lesions concerning\nfor malignancy. Old fracture of the sternum is noted (602b:66). A Schmorl's\nnode is seen in the superior endplate of the T12 vertebral body (601b:70).  A\nfracture of the right humeral surgical neck is noted.  Old right rib posterior\ndeformities are also seen.\n\nUpper abdomen:  Although this exam is not tailored for evaluation of the\nintra-abdominal organs, there is a partially visualized right renal simple\ncyst (2:51). The other visualized abdominal organs are within normal limits.",
            "output": "1.  Right humeral neck fracture.\n2.  Marked cardiomegaly with small pericardial effusion.\n3.  Dilation of the ascending thoracic aorta measuring 4.6 cm in diameter."
        },
        {
            "input": "MEDIASTINUM:  Heterogeneous appearance of the thyroid with bilateral hypodense\nnodules measuring up to 2 cm. No pathologically enlarged supraclavicular,\naxillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are top normal in\nsize.  The heart size is normal and there is no pericardial effusion. Mild\natherosclerotic calcifications of the thoracic aorta and of the  coronary\narteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent minimal secretions in\nthe upper trachea.  Mild centrilobular and paraseptal emphysema in the upper\nlobes.  Centrilobular ground-glass nodules in the upper lobes with mild\nbronchial wall thickening can be respiratory bronchiolitis if there is a\nsmoking history.  2 mm perifissural nodule in the right middle lobe is likely\nintraparenchymal lymph node.  1 x 1 mm subpleural nodule in the right middle\nlobe.  No suspicious nodules or masses\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Although this study is not designed for the evaluation of\nsubdiaphragmatic structures, the imaged upper abdomen demonstrates a small\nhiatal hernia.",
            "output": "1.   Heterogeneous thyroid with multiple cystic lesions measuring up to 2 cm. \nSuggest correlation with ultrasound.\n\n2.  A 1 mm nodule in the right middle lobe is statistically very likely\nbenign.  Given the history of smoking, follow-up CT thorax in ___ years time is\nrecommended.\n\n3. Mild emphysema with associated findings suggestive of respiratory\nbronchiolitis.\n\nRECOMMENDATION(S):  Follow-up CT thorax in ___ years time, for right middle lobe\nnodule.\n\nThyroid ultrasound for right thyroid nodule."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Small remnant thymus.  Normal appearance of the\nheart.  No lymphadenopathy in the hilar or mediastinal regions.  Normal\nposterior mediastinum.  Unremarkable appearance of the upper abdomen.  No\nevidence of osteolytic lesions at the level of the ribs, the sternum and the\nvertebral bodies.  No pulmonary nodules or masses.  No pleural effusions or\npleural thickening.  The pleural surfaces are even.  No diffuse lung\nparenchymal abnormalities.  The airways are patent.",
            "output": "Normal thoracic CT, no evidence of intra thoracic malignancy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. No\naortic dissection or intramural hematoma.  Ascending thoracic aorta is mildly\ndilated up to 3.7 cm.  The descending thoracic aorta is normal in caliber. \nThe patient is status post CABG.  The heart are moderately enlarged. There is\nmoderate coronary artery calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No focal consolidation to suggest pneumonia.  There is\nbilateral dependent atelectasis.  Subpleural reticulation most consistent with\nfibrotic changes are noted.  There is mild diffuse bronchial wall thickening,\nwhich could represent inflammation/infection.  Otherwise, the airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited evaluation of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nT12 deformity is unchanged compared to ___.  Median sternotomy\nwires are intact.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Status post CABG with mildly dilated ascending thoracic aorta up to 3.7\ncm.\n3.  Mild diffuse bronchial wall thickening which could represent\ninflammation/infection.\n4.  Mild subpleural fibrotic changes."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nTracheostomy is in a standard position. Superior to the entry of the\ntracheostomy tube there is a coarse calcifications in the right side tracheal\nwall\nThere are scattered linear atelectasis. No worrisome lung nodules.\nCentral catheter tip is in the right atrium. There is no pleural or\npericardial effusion\nThere is a small hiatal hernia.  The esophagus is patulous.\nThis examination is not tailored for subdiaphragmatic evaluation the upper\nabdomen is unremarkable\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy.\nPatulous esophagus with dilatation of the distal esophagus, if further\nevaluation is needed swallow study could be performed"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThe heart is top-normal in size.  A left Port-A-Cath is noted with the tip\nterminating in the right atrium.  There is no evidence of pericardial\neffusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  A tracheostomy is\nin place with the tip terminating 2.8 cm above the level of the carina.  Mild\nsecretions are noted within the main stem bronchi.  The airways are otherwise\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate several hepatic hypodensities\nwhich are incompletely characterized but likely cysts or biliary hamartomas.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality.\n\nRECOMMENDATION(S):  No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nProminent axillary nodes demonstrate normal morphology.\n\nThe heart size is top normal.  A left Port-A-Cath tip terminates in the right\natrium, unchanged.  No evidence of pericardial or pleural effusions.\n\nClusters of centrilobular ground-glass nodular opacities involving the right\nmiddle lobe and both lower lobes (3:78, 102, 105) along with bronchial wall\nthickening in the bilateral lower lobes, are compatible with small airways\ndisease, likely infectious or inflammatory in etiology.  The tracheostomy is\nin place with tip terminating 2.4 cm above the carina.  Mild secretions in the\nmainstem bronchi are noted.  The airways are otherwise patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen reveal an unchanged subcentimeter hepatic\nhypodensity, incompletely characterized, but likely a hepatic cyst or biliary\nhamartoma (3:115).\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Clusters of centrilobular ground-glass nodular opacities involving the\nright middle lobe and both lower lobes along with bronchial wall thickening in\nthe lower lobes bilaterally, are compatible with small airways disease, likely\ninfectious or inflammatory in etiology."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is top normal, as before.  There is a\npartially visualized left port catheter with tip in the right atrium.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Again seen are clusters of centrilobular ground-glass nodular\nopacities involving the right middle lobe.  Again seen is bronchial wall\nthickening, compatible with small airways disease, likely infectious or\ninflammatory.  As before, there is a tracheostomy present with tip 3.2 cm\nabove the carina.  Please note that the inferior most aspects of the bilateral\nlungs are excluded from the field-of-view.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Compared to ___, similar appearance of clusters of centrilobular\nground-glass nodular opacities involving the right middle lobe with bronchial\nwall thickening, consistent with small airways disease, likely infectious or\ninflammatory."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Calcifications are noted within the coronary arteries. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusions bilaterally.  There are tiny foci of air\nadjacent to acute angulated right second rib fracture, compatible with a trace\npneumothorax (series 4: Image 43).\n\nLUNGS/AIRWAYS: Mild diffuse bronchiolar wall thickening with areas of mucous\nplugging and clustered centrilobular nodularity compatible with small airway\ninflammation/infection.  There is mild bibasilar atelectasis.  No masses or\nareas of parenchymal opacification.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is a hypodense round lesion in the tail of the pancreas\nmeasuring 1.7 cm x 1.3 cm (series 5: Image 22).  Otherwise, the pancreas has\nnormal attenuation throughout.  There is no evidence of pancreatic ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape.  In the medial\nlimb of the left adrenal gland there is a 1.5 cm x 1.2 cm nodule that is\nincompletely characterized this contrast enhanced exam (series 5: Image 16).\n\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 4.8 cm x 4.2 cm cyst with a thin internal septation in the lower\npole of the left kidney.  There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is noted in the stomach.  Otherwise, the\nstomach is unremarkable.  Small bowel loops are mildly prominent throughout\nthe abdomen with air-fluid levels.  There is no distinct transition point. \nWall thickness and enhancement throughout are normal.  The distal colon is\ndecompressed.  There is diverticulosis without diverticulitis.  A thermometer\nis seen within the rectum.  The appendix is not visualized.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder is decompressed with a Foley catheter in place.  The\ndistal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  A right femoral vein catheter is visualized with\nsurrounding intraluminal air.\n\nBONES AND SOFT TISSUES: There is an acute fracture of the right second rib\nwith significant displacement and surrounding soft tissue edema.  There are 2\nareas of acute fracture within the third, fourth, and fifth right ribs.  Mild\ndisplacement is associated with the right fourth and sixth rib fractures as\nwell.  In addition, acute fracture without angulation is demonstrated in the\nright seventh rib.  An additional subacute/chronic fracture is demonstrated of\nthe right fifth rib.  On the left, second, third, fourth, fifth, sixth, and\nseventh acute rib fractures are demonstrated with mild angulation along the\nanterior margins.  Multiple chronic left-sided rib fractures are seen as well.\nThere is a nondisplaced sternal fracture along the anterior cortex with\nassociated fat stranding (series 602: Image 39).  There is no evidence of\nworrisome osseous lesions.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n2. Bilateral acute second through seventh rib fractures as detailed above. \nThere is significant displacement of the second right rib with an adjacent\ntiny pneumothorax.\n3. Mild diffuse bronchial wall thickening with areas of endoluminal debris\ncompatible with small airway inflammation/infection with possible component of\naspiration.\n4. Fluid filled loops of small bowel without evidence of obstruction.\n5. Incidental 1.7 cm hypodense round lesion in the tail of the pancreas for\nwhich nonurgent MRCP is recommended if clinically warranted.\n6. 1.5 cm left adrenal nodule.  Please see recommendation below.\n\nRECOMMENDATION(S):\n-Incidentally discovered adrenal lesion without prior studies for comparison\nmeasuring 1-2 cm. If there is no history of malignancy, this is probably\nbenign. Follow up dedicated adrenal CT in 12 months could be considered. If\nthere is a history of malignancy, a dedicated adrenal CT is\nrecommended.Recommendations based on ___ ACR guidelines:\n___\n-Non urgent MRCP for incidentally found 1.7 cm lesion in the tail of the\npancreas if clinically warranted.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 10:35 am, 1 minutes after discovery of the findings."
        },
        {
            "input": "Images are degraded secondary to motion.\n\nNECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nRe-demonstrated is severe atrophy of the right teres minor and subscapularis\nmuscles.  There is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis moderate centrilobular emphysema.  There is new volume loss in the left\nlower lobe.\n\nAIRWAYS:  There is new mucous plugging involving the left lower lobe bronchi\nand extending distally likely the cause of the left lower lobe atelectasis. \nOpacification of the left upper lobe bronchus is also noted however the distal\nbranches appear patent.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. No evidence of a pulmonary embolism.\n2. New mucous plugging involving the left upper and left lower lobe bronchi\nwith resulting left lower lobe volume loss.  Superimposed aspiration would be\nhard to exclude."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is severe atrophy of the teres minor and subscapularis\nmuscles on the right.  No axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: See CT abdomen pelvis from the same date.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Coronary calcifications are extensive.\nPLEURA: No pleural thickening or pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Moderate centrilobular emphysema.  Evaluation of the lung\nparenchyma is mildly limited by respiratory motion.  Mild scarring of the lung\nbases, bilaterally.  No suspicious pulmonary nodules or focal consolidation.\n2. AIRWAYS:  Airways are patent the subsegmental level.\n3. VESSELS:  Aorta and main pulmonary artery are normal in size.\nCHEST CAGE: No evidence of osseous malignancy or infection within the chest. \nNo acute fracture.",
            "output": "1.  No evidence of malignancy within the chest.\n2.  Moderate centrilobular emphysema.\n3.  Severe right teres minor and subscapularis muscle atrophy."
        },
        {
            "input": "Intrathoracic aorta demonstrates calcified atherosclerotic disease without\nassociated aneurysmal changes.  The main pulmonary arteries enlarged to 4 cm. \nHeart is top-normal in size with trace pericardial effusion.  Moderately\nsevere coronary artery calcifications are noted.  Great vessels are\nunremarkable.  There are scattered mediastinal lymph nodes, which not meet CT\nsize criteria for pathologic enlargement.  There is no axillary\nlymphadenopathy.  There are  large left and small right non hemorrhagic\npleural effusions.  Left lower lobe consolidation most likely reflects\ncompressive atelectasis.  Small consolidation in the right lower lobe is also\nseen.\n\nOsseous structures:  No suspicious lytic or sclerotic bony lesion is seen.",
            "output": "1.  Large left and small right non hemorrhagic pleural effusions.\n2.  Bibasilar consolidations most likely represent atelectasis, however\nsuperimposed infection cannot be excluded.\n3.  The main pulmonary artery is enlarged to 4 cm, suggestive of possible\nunderlying pulmonary hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland is homogeneous.  Tip of an\nendotracheal tube is seen approximately 4 cm above the carina.\n\nUPPER ABDOMEN:  Enteric tube terminates in the stomach.  Limited views of the\nupper abdomen are remarkable for wedge shape hyperdensities along both\nkidneys, which are not well appreciated on the prior study due to adjacent\nartifact during the prior scan, concerning for infarct.\n\nMEDIASTINUM: A few mediastinal lymph nodes appear mildly conspicuous,\nmeasuring up to 7 mm (302:75).  There is no mediastinal mass.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The cardiac size is not enlarged.  Extensive\natherosclerotic calcifications are seen along the coronary arteries.  No\npericardial effusion.\nPLEURA: There is a new small left and trace right dependent, layering,\nnonhemorrhagic pleural effusion with associated volume loss.\nLUNG:\n\n1. PARENCHYMA:  New lower lobe volume loss is seen on the left as compared to\nthe prior study from ___.  Diffuse tiny ___ nodules\nbilaterally are concerning for multifocal bacterial or atypical mycobacterial\npneumonia.\n2. AIRWAYS:  There is diffuse bronchial wall thickening, likely reactive.\n3. VESSELS:  The main pulmonary artery is mildly enlarged, measuring up to 3.4\ncm.  There is mild enlargement of the ascending thoracic aorta, measuring up\nto 4.0 cm (302:101).\nCHEST CAGE: There is no suspicious lytic or sclerotic osseous lesion.",
            "output": "1. Diffuse tiny ___ nodules bilaterally are concerning for multifocal\nbacterial or atypical mycobacterial pneumonia\n2. New small left and trace right dependent, layering, nonhemorrhagic pleural\neffusion with associated lower lobe volume loss.\n3. Limited views of the upper abdomen are remarkable for partially viewed\nwedge-shaped hyperdensities along both kidneys, not well appreciated on the\nprior exam due to adjacent artifact during that scan, which is concerning for\ninfarcts.\n\nRECOMMENDATION(S):  A dedicated CT abdomen and pelvis could be obtained for\ndetailed evaluation of potential renal infarcts.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 11:01 am, 1 minutes after discovery of\nthe findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild calcification of the aortic annulus.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis.  Additionally, there is some\nsuggestion of subtle, peripheral ___ opacifications, which may\nrepresent a mild bronchiolitis.  Lungs are clear of masses or large\nparenchymal consolidation.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  However, there is diffuse bronchial wall\nthickening, which may suggest a mild bronchitis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Tiny hypodensity at the inferior\naspect of the liver is too small to characterize, but likely represents cyst\nversus biliary hamartoma.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Tiny,\ncortically based renal hypodensity in the superior pole of the right kidney is\ntoo small to characterize, but likely represents a small cyst.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolus or acute aortic pathology.  Findings are suggestive of\na mild bronchitis/bronchiolitis.  No definite etiology identified for chest\npain.\n2. No etiology identified for abdominal pain.  No small bowel obstruction. \nNormal appendix.  Normal gallbladder."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in appearance within\nlimitation of a non-gated examination. There are coronary artery\ncalcifications in all three coronary artery territories.  No pericardial\neffusion.  There is no evidence of pulmonary embolism.  The left main\npulmonary artery is dilated to 3.4 cm a nonspecific finding which can be seen\nin setting of pulmonary arterial hypertension (5:62).\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy. \nProminent hilar soft tissues likely reactive without discrete nodularity.\n\nPLEURAL SPACES: No pneumothorax.  No pleural effusion.\n\nLUNGS/AIRWAYS: The central airways are patent.  There is diffuse bronchial\nwall thickening.  There is no focal consolidation or mass.  There is bibasilar\natelectasis.  No suspicious pulmonary nodule.  There is a punctate calcified\ngranuloma in the left lower lobe.  There is a probable cyst intrapulmonary\nlymph node in the right lung base (7:61).\n\nBASE OF NECK: There is a heterogeneous nodule in the left lobe of the thyroid\nmeasuring up to 2.5 cm (5:18).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nA sclerotic focus in the lateral eighth rib is likely a bone island (5:99).",
            "output": "1. No evidence of pulmonary embolism.\n2. Diffuse bronchial wall thickening, nonspecific possibly infectious or\ninflammatory.\n3. The left main pulmonary artery is dilated to 3.4 cm, nonspecific finding\nwhich can be seen in the setting of pulmonary arterial hypertension.\n4. Coronary artery calcifications.\n5. Heterogeneous 2.5 cm nodule in the left lobe of the thyroid.  Follow-up\nultrasound is recommended per ACR criteria outlined below.\n\nRECOMMENDATION(S):  Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No axillary or supraclavicular\nadenopathy.  Thyroid is unremarkable.\n\nUPPER ABDOMEN: Atrophic pancreas noted.  Upper abdomen is otherwise\nunremarkable.\n\nMEDIASTINUM: Prominent, likely reactive mediastinal lymph nodes are noted,\nwhich do not meet size criteria for adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: The heart is enlarged, with extensive coronary artery\natherosclerotic calcifications.\nPLEURA: Extensive pleural plaques are suggestive of prior asbestos exposure. \nThere are small bilateral pleural effusions.\nLUNG:\n\n-PARENCHYMA:  Batwing ground-glass opacities are seen, throughout the lungs,\nin perihilar distribution favoring the left upper lobe.  These findings most\nlikely represent pulmonary edema in the setting of congestive heart failure. \nAtypical infection is not excluded.\n-AIRWAYS:  The central tracheobronchial tree is patent.\n-VESSELS:  The main pulmonary artery is enlarged, suggestive of pulmonary\narterial hypertension.\nCHEST CAGE: The bones are diffusely osteopenic.  No suspicious osteolytic or\nosteoblastic lesions, noting limitations in the setting of osteopenia.",
            "output": "1.  Ground-glass opacities in a batwing configuration, favoring the left upper\nlobe, with bilateral pleural effusions, likely representing pulmonary edema in\nthe setting of congestive heart failure.  Atypical infection is not excluded.\n2.  Enlarged main pulmonary artery, suggestive of pulmonary arterial\nhypertension.\n3.  Calcified pleural plaques, consistent with prior asbestos exposure."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Study is slightly limited evaluation for pulmonary\nembolism due to timing of contrast bolus.  Pulmonary vasculature is well\nopacified to the lobar level without filling defect to indicate a pulmonary\nembolus.  Evaluation of the segmental and subsegmental branches limited.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is normal in size.  There are moderate\ncoronary artery calcifications in the LAD.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is trace left basilar atelectasis.  No focal\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is a small amount of portal\nvenous gas in the liver.  There is also small amount of gas within the\nmesenteric vasculature adjacent to the transverse colon (05:22, 30).  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal (05:55).  There is no\nfree intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There are mild multilevel degenerative changes in the\nthoracolumbar spine.  There is no evidence of worrisome osseous lesions or\nacute fracture.",
            "output": "1. Limited exam due to timing of contrast bolus. No central pulmonary embolism\nor other acute process in the chest\n2. Small amount of portal venous gas in the liver and within mesenteric\nbranches adjacent to the transverse colon, of uncertain etiology.  No evidence\nof pneumatosis or other evidence of bowel ischemia.\n\nRECOMMENDATION(S):  The updated findings were discussed by Dr. ___ with\nDr. ___ on the telephone on ___ at 6:13 pm, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "The observed abnormality on recent chest radiograph corresponds to a 2 cm x\n1.9 cm diameter polygonal shaped opacity within the inferior segment of the\nlingula, which contains internally dilated bronchi, small calcified\ngranulomas, and is associated with adjacent volume loss.  Small\nperibronchiolar clustered nodules adjacent to this region are consistent with\nsmall airways disease.\n\nAssessment of the remainder of the lungs is somewhat limited due to extensive\nrespiratory motion artifact.  Scattered from bronchiolar opacities are present\npredominantly in the right upper lobe posterior segment, and note is made\ndiffuse bronchial wall thickening and irregularity with bilaterally.  Biapical\nfibronodular scarring is present with associated small calcified granulomas. \nThe latter appear unchanged compared to images of the lung apices from a neck\nCT ___.\n\nThe aortic valve is heavily calcified, consistent with history of severe\naortic stenosis.  Diffuse severe coronary artery calcifications are also\npresent.  Heart is mildly enlarged, and there is no pericardial or pleural\neffusion.  A small hiatal hernia is incidentally noted.\n\nThoracic aorta is normal in caliber and demonstrates atheromatous\ncalcifications at the root of the ascending aorta, as well as mild\ncalcifications in the aortic arch and mild to moderate calcifications in the\ndescending thoracic aortic region.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of a low-density 1.8 cm diameter lesion within the left lobe of the liver\nwith fluid density most suggestive of a cyst.  Diffuse hyperdensity of the\nliver compared to the spleen raises the possibility of amiodarone therapy.\n\nSkeletal structures demonstrate multilevel degenerative changes in the spine.",
            "output": "1.  The abnormality on recent chest radiograph corresponds to a region of\nfocal lingular scarring, likely the sequela of previous granulomatous\ninfection considering associated calcified granulomas and traction\nbronchiectasis.  Foci of small airways disease in the adjacent lingula and in\nthe posterior right upper lobe may be due to inflammatory secretions, but the\npossibility of active infection, including chronic atypical mycobacterial\ninfection or less likely post-primary TB, is not fully excluded on the basis\nof imaging findings.  Correlation with PPD and sputum assessment may be\nhelpful.\n\n2.  Heavily calcified aortic valve, in keeping with severe aortic stenosis. \nDiffuse severe coronary artery calcifications.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 8:23 AM, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "Right pectoral Port-A-Cath.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  Several right-sided axillary lymph nodes (4, 15) are\nborderline in size.  There is a postoperative breast defect on the left (4,\n26).  The right breast is only partially imaged.  No coronary calcifications,\nno valvular calcifications, no pericardial effusion.  The posterior\nmediastinum is unremarkable.  There is a status post cholecystectomy. \nOtherwise the upper abdomen appears unremarkable.  The bone window reveals\nmultiple predominantly sclerotic lesions in the vertebral bodies (8, 75) as\nwell as in the ribs (8, 26).  In addition, a slightly displaced potentially\npathologic rib fracture is visualized (8, 35).\nModerate bilateral apical scarring.  Diffusely increased lung attenuation in\nthe lung apices, with larger predominantly subpleural ground-glass nodules (6,\n81).  An area of ground-glass opacities also seen on the right in\nparamediastinal location (6, 113).  There is mild thickening and\nirregularities of the airway walls.  In the right lower lobe, a 1 cm cyst is\nnoted (6, 174).  There is no evidence of suspicious solid pulmonary nodules or\nmasses.  No pleural thickening, no pleural effusions.",
            "output": "Several right upper lobe predominant larger ground-glass opacities,\npotentially as a result of radiation.  Signs of right upper lobe predominant\nrespiratory bronchiolitis and accompanying mild chronic airways disease.  No\nsuspicious solid pulmonary masses or nodules.  No pleural thickening, no\npleural effusions.  Diffuse predominantly sclerotic bone lesions, likely\nreflecting diffuse metastatic disease."
        },
        {
            "input": "The thyroid is normal. There is no supraclavicular, or axillary\nlymphadenopathy. There has been an interval increase in mediastinal\nlymphadenopathy. For example a right peritracheal lymph node at the level of\nthe upper SVC measures approximately 0.9 cm in short axis, previously\nmeasuring no more than 0.7 cm, series 5, image 15. A pre carinal lymph node\nmeasures approximately 1.2 cm x 1.2 cm, increased in size compared to the\nprior exam at which time this measured no more than 0.7 cm series 5, image 20\na subcarinal lymph node measures 1.7 cm x 2.5 cm, increased in size compared\nto the prior exam from the ___ at which time this measured no more than 1.3\ncm. There has also been an interval increase in hilar lymphadenopathy, for\nexample a right hilar lymph node measures 1.7 cm x 1.5 cm, increased in size\ncompared to the prior exam from ___ at which time this measured no more than\n0.7 cm.\n\nThe heart size is normal. There is no evidence pericardial effusion. The aorta\nis normal without evidence of focal dissection or aneurysm. The main pulmonary\nartery is normal.\n\nThere is a small hiatal hernia with distention of the esophagus, filled with\nfluid. There is no evidence of esophageal wall thickening.\n\nThe lungs demonstrate diffuse ill-defined opacities bilaterally, measuring up\nto 1.4 cm at the right upper lobe. There is diffuse bilateral peribronchiolar\nthickening, however no definite evidence of interstitial thickening. There is\nno pleural effusion or pneumothorax.\n\nFor details of the abdomen please refer to the dedicated CT of the abdomen\nperformed on the same day.\n\nOsseous structures: No lytic or blastic lesions concerning for malignancy\nidentified.",
            "output": "1. Interval increase in mediastinal and hilar lymphadenopathy, compared to the\nprior exam from ___. Given the diffuse ill-defined opacities within the lungs\nbilaterally, this may be reactive secondary to an infectious process; however\nrecurrence of lymphoma cannot be excluded. Short interval followup in 6 weeks\nis recommended for further evaluation.\n\n2. Diffuse ill-defined opacities are seen in a peribronchiolar distribution\nthroughout the lungs bilaterally. In the context of bronchiolitis, this may be\nsecondary to a diffuse infectious process. No evidence of pulmonary edema.\n\nNOTE: Short-term interval followup in 6 weeks is recommended.\n\nNOTIFICATION:  ___ were d/w Dr. ___, by Dr. ___ by phone at 3p\non the day of the exam."
        },
        {
            "input": "The thyroid gland is normal. There is no axillary or supraclavicular\nadenopathy. The previously present right upper paratracheal nodes are\ndecreased in size, the largest 6 mm in size. A right lower paratracheal node\nis stable measuring 1.2 x 1.1 cm (3:20).  A right hilar node is decreased in\nsize measuring 1.4 x 1.1 cm (3:24).  A subcarinal node is additionally\ndecreased in size currently 7 mm and previously 9 mm.\n\nHeart size is normal. The aorta and pulmonary artery are within normal limits\nin caliber. There is no pericardial effusion. No appreciable coronary artery\ncalcifications are identified. A moderate hiatal hernia is unchanged.\n\nThe tracheobronchial tree is patent to the subsegmental level. When compared\nto prior examination dated ___, a previously identified opacity\nwithin the right upper lobe is no longer present. There does persist bilateral\ndiffuse ground-glass opacities though much decreased in extent and less\nconspicuous. Bibasilar atelectasis is unchanged.  There is no pleural\nabnormality or effusion.\n\nAlthough study not tailored for subdiaphragmatic evaluation, a 1.3 cm\nhypodensity within the right hepatic lobe is incompletely characterized though\ndescribe ___ CT dated ___ and stable.\n\n\nNo suspicious osseous lesion is identified.",
            "output": "1.  Decreased mediastinal adenopathy with persistent though much less\nconspicuous diffuse ground glass opacities most compatible with resolving\npneumonia.\n2.  Moderate hiatal hernia."
        },
        {
            "input": "The thyroid is normal.  Multiple prominent but not pathologically enlarged\nmediastinal, hilar and paraesophageal lymph nodes are not significantly\nchanged compared with ___.  There are no pathologically enlarged\nsupraclavicular, axillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  There is no central\npulmonary embolism.  The heart is normal in size and demonstrates no\nappreciable coronary artery calcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  There is a large consolidation with air bronchograms\nin the right upper lobe.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThere is a hiatal hernia, similar to prior.  There is a 1.3 cm low-density\nsubmucosal lesion in the left anterolateral distal esophageal wall (3:156).\n\nPlease see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "1. Right upper lobe pneumonia.  Follow-up to resolution is recommended by\nradiograph as this is visible on scout images.\n2. 1.3 cm low-density submucosal lesion in the distal esophagus is possibly a\nmucosal retention cyst.  If patient is symptomatic EGD could be performed,\notherwise attention on follow-up is recommend.\n3. Multiple prominent but not pathologically enlarged mediastinal, hilar and\nparaesophageal lymph nodes are not significantly changed compared with ___.\n4. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Follow-up radiographs to resolution of right upper lobe\npneumonia.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 4:27 pm, 1 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is homogeneously\nattenuating without nodules or masses.  No supraclavicular ,infraclavicular or\naxillary lymphadenopathy.  No calcified atherosclerosis involving the\nvasculature of the thoracic inlet and superior mediastinum.\n\nUPPER ABDOMEN: The study is not tailored for evaluation of the abdomen. \nAllowing for this, the partially visualized upper abdomen demonstrates stable\npostsurgical changes following cholecystectomy.  Small hiatus hernia is\nunchanged.  The previously described submucosal lesion at the left anterior\ndistal esophagus wall is not well demonstrated on current study due to lack of\nintravenous contrast.\n\nMEDIASTINUM: There is a subcarinal in measures up to 13 mm short axis.\n\nHILA: No evidence of hilar lymphadenopathy\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion.  No\ncalcified atherosclerosis involving the coronary arteries.  The vascular\ncalibers of the ascending aorta, descending aorta aortic arch and main\npulmonary artery are within normal limits.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: There has been interval resolution of the dense opacification\nat the right upper lobe.  A 5 mm perifissural pulmonary nodule at the major\nleft fissure, (series 5, image 73) is unchanged.\nThere are subtle geographic areas of ground-glass opacification throughout the\nlungs most pronounced at the left upper lobe (series 5, image 76) which is\nconcerning for chronic aspiration.\n2. AIRWAYS:  The airways are patent to the subsegmental level with some mild\nmucous plugging, bronchiectasis bronchial wall thickening.\n\nCHEST CAGE: No fracture.  No concerning sclerotic or lytic osseous lesions.",
            "output": "1. Interval resolution of prior infectious process at the right upper lobe.\n2. Large areas of ground-glass opacification in both lungs a left  upper lobe\npredominance suggests chronic aspiration.  Alternative considerations include\nhypersensitivity pneumonitis.\n3. Mediastinal lymphadenopathy.\n4. A 5 mm perifissural pulmonary nodule at the left major fissure is\nunchanged.\n5. The lower esophageal walls are asymmetrically thickened which is unchanged\nbut remains concerning.\n6. The previously visualized submucosal lesion at the left anterior distal\nesophagus wall is not well demonstrated on current study due to lack of\nintravenous contrast.\n\nRECOMMENDATION(S):  Follow-up upper GI endoscopy is recommended to further\ncharacterize the thickened esophageal walls and previously described\nsubmucosal lesion at the left anterior distal esophagus."
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\nThe thyroid is normal. Enlarged mediastinal lymph nodes including a\nprevascular lymph node (05:39) measuring 1 cm, as well numerous right lower\nparatracheal lymph nodes (05:44).  Right hilar lymph node measures 1.3 x 1.1\ncm (5:69). The heart is moderately enlarged with dual chamber pacemaker leads\nin standard location. The pericardium is intact without effusion.\n\nThere is an ill-defined the left hilar mass measuring approximately 5.8 x 4.5\ncm, encasing the left lower lobe bronchus and partially of the lingular\nbronchus. The mass also encases the left lower lobe pulmonary artery.  Second\nmass lesion in the left upper lobe (05:25) measures 2.6 x 2.4 cm and is\nill-defined. The lungs demonstrate diffuse subpleural reticulation compatible\nwith scarring.\n\nScattered nodules are noted, the largest in the lingula measuring 9 x 8 mm,\nlikely metastatic lesion.  Additional nodules include a right upper lobe\n(05:44) measuring 6 mm, right upper lobe (05:57) measuring 4 mm, and the right\nmiddle lobe (5:67) measuring 5 mm. There is no pleural effusion or\npneumothorax.\n\nThe esophagus and visualized upper abdominal organs demonstrate a fluid filled\nstomach.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n2. 5.8 x 4.5 cm poorly defined left hilar mass with other smaller lesions in\nthe left upper lobe and lingula, are concerning for primary lung malignancy\nwith metastases. Contralateral hilar and mediastinal lymphadenopathy is\nconcerning for neoplastic involvement.\n3. Moderate cardiomegaly."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified without central\nfilling defect to indicate a pulmonary embolus.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Atelectasis is noted in the dependent lungs.  Nonspecific\nground-glass opacities are seen in the lower lobes, likely due to poor\ninspiration.  Calcified granulomas are incidentally seen, likely sequela of\nprior granulomatous infection.  No focal parenchymal opacification is\nidentified.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to the same day dedicated CT abdomen and pelvis exam for\nfull description of subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of intrathoracic metastatic disease, specifically, no\nlymphadenopathy or suspicious pulmonary lesion is identified.\n2. Please refer to the same day dedicated CT abdomen and pelvis exam for full\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Central venous line (Port-A-Cath) terminates in the right atrium.  Aorta and\npulmonary arteries are normal in appearance.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally previously seen right\nmiddle lobe pulmonary nodule is stable, series 6, image 176.  No new nodules\nmasses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of progression of the\ndisease within the thorax\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nprovided separately."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The pulmonary vasculature is well opacified to the\nsubsegmental level without evidence of filling defect indicated pulmonary\nembolus.  The thoracic aorta is normal caliber.  There is no evidence of\ndissection or intramural hematoma.  The heart and pericardium are within\nnormal limits.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Remnant thymic tissue is seen.  There is no\naxillary, mediastinal or hilar lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable although not well assessed on CT. \nProximal small bowel loops demonstrate normal caliber, wall thickness and\nenhancement throughout.  However, the terminal ileum demonstrates wall\nthickening with mucosal hyperenhancement and associated fat stranding.  There\nis diffuse wall thickening stranding throughout the entirety of the sigmoid\ncolon which is fluid and stool filled. This wall thickening and stranding\nextends to the mid distal descending colon (5:73, 05:54).  There is no\nevidence of obstruction.  There is no free air.  Appendix is not definitively\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No lymphadenopathy within the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.  Visualized branches of the SMA appear patent.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Findings compatible with an acute flare of inflammatory bowel disease\ninvolving the terminal ileum, sigmoid colon and portions of the descending\ncolon.\n2. No evidence of pulmonary embolism."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Stable paratracheal borderline sized lymph nodes, 1\nof which is located in the aortopulmonary window (2, 26). Stable appearance of\nthe large mediastinal vessels.  Stable mild coronary calcifications.  No\npericardial effusion.  Stable appearance of the posterior mediastinum,\nincluding a small hiatal hernia.  Status post cholecystectomy.  Stable\nappearance of the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.\nModerate bilateral apical predominant paraseptal emphysema.  The morphology\nand the size of the spiculated left upper lobe nodule (4, 57) is stable. \nStable centrilobular emphysema.  Stable anterior paramediastinal subpleural\nbulla (4, 87).  Mild irregularities and thickening of the airway walls. \nStable left perifissural nodule (4, 116).  Mild lower lobe predominant\nbronchiectasis.  No pleural thickening or pleural abnormalities.",
            "output": "Stability of a spiculated left upper lobe nodule, stability in size and\nmorphology is not documented over ___ years.  Moreover, the nodule is PET\nnegative.  No other suspicious lesions.  Moderate apical predominant\nparaseptal and centrilobular pulmonary emphysema.  Moderate chronic airways\ndisease."
        },
        {
            "input": "Left supraclavicular lymph nodes range in diameter up to 15 mm.  Right\nsupraclavicular lymph nodes and axillary nodes are not pathologically\nenlarged.  Patient has had bilateral mastectomy.  There are no soft tissue\nabnormalities in the chest wall concerning for malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis but shows normal size adrenal\nglands and spleen.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead neck vessels or coronary arteries.\n\nExtensive infiltrative adenopathy in the mediastinum is predominantly\nparatracheal, also extending around the main bronchi  moderately narrowed and\ninto both hila.  Bronchial narrowing is most pronounced around the bronchus\nintermedius, bronchi to the middle lobe, right lower lobe superior segment and\nbasal trunk, but no bronchi are occluded.  Bulky peribronchial tissue extends\nfrom the right hilus into the anterior segment of the right upper lobe, and\nthe middle and lower lobes.\n\nExtensive coarse nodular interstitial reticulation is most pronounced in the\nright middle and lower lobes, responsible for restricted lung volume.\n\nThere is no pleural effusion, but there is a moderate size pericardial\neffusion.  There is no evidence of cardiac tamponade.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection but it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting osseous metastasis than chest CT.",
            "output": "Extensive infiltrative adenopathy in the mediastinum and hilus, extending into\nthe right lung, and widespread nodular lymphangitis, right lung.  Findings are\nmost consistent with disseminated carcinoma, particularly if the patient has a\nhistory of breast cancer, alternatively lymphoma, less likely sarcoidosis.\n\nModerate size pericardial effusion does not currently have features of\ntamponade.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:32 ___, 1 minutes after discovery of\nthe findings."
        },
        {
            "input": "CT CHEST WITH CONTRAST:  The partially imaged thyroid is unremarkable.  Right\nsupraclavicular lymphadenopathy measuring up to 10 mm (5:5) is unchanged. \nThere is no right axillary lymphadenopathy.  The left axilla is obscured by\nstreak artifact from an intravenous contrast.  There is extensive infiltrative\nthoracic inlet, paratracheal adenopathy, infiltrating about great vessels,\nextending along the length of the trachea, consistent with disease\nprogression, worsened since prior exam.  Subcarinal adenopathy has worsened. \nRight hilar adenopathy is difficult to judge secondary to adjacent the right\nmiddle lobe consolidation and probably similar.  Minimal worsened left hilar\nadenopathy.  Prevascular adenopathy has worsened.  Internal mammary chain\nadenopathy on the left stable.  Similar paraesophageal adenopathy.  5 cm x 2\ncm masslike fullness anteromedial right upper lobe, abutting mediastinum, has\nminimally enlarged.\n\nPerihilar soft tissue causes narrowing of the carina, mainstem and segmental\nbronchi bilaterally.  There is new complete occlusion of the proximal right\nmiddle lobe bronchus with complete collapse of the right middle lobe.  There\nis worsening narrowing of the right lower lobe bronchus with progressive\natelectasis and consolidation.  There is worsening of bronchovascular\nthickening, reticulation, with areas of micro nodularity in perilymphatic\ndistribution, most severe in the right lower lobe.  There also nodular\nopacities in the left lung, and interlobular septal thickening.  Some nodules\nin the lingula, in few nodules in the right lung may have centrilobular\ndistribution, raising possibility of superimposed infection.  Clinically\ncorrelate.  There may be component of interstitial edema.  There is an\nenlarging nonhemorrhagic moderate right pleural effusion.\n\nHeart size is normal.  However there is a moderate nonhemorrhagic pericardial\neffusion unchanged in size.  There may be mild flattening of the\nintraventricular septum (5:194) similar compared with the prior study although\nnot well assessed on this nongated study.  There is mild right pleural\neffusion, worsened.  There is no reflux of contrast into the IVC.  The main\npulmonary arteries are well opacified and normal in caliber without central\nfilling defect.  The thoracic aorta and proximal great vessels are well\nopacified and normal in caliber.\n\nAgain, bilateral breast prostheses are incidentally noted.\n\nOSSEOUS STRUCTURES:  Metastasis involving T3 vertebral body, probably similar.\nThere are mild multilevel degenerative changes in the thoracic spine with\nmarginal spurring.\n\nUPPER ABDOMEN:  This study is not optimized for evaluation of the\nintra-abdominal structures, however the partially visualized stomach and solid\norgans are grossly normal.  Incidentally, there is an accessory left hepatic\nartery.  There is a small hiatal hernia.",
            "output": "1. Unchanged moderate nonhemorrhagic pericardial effusion.  Possible subtle\nflattening of the interventricular septum, similar.\n2. Tumor progression.  Worsened adenopathy.  Worsened lymphangitic tumor\nspread.  Worsened areas of bronchial narrowing, with new complete occlusion of\nthe proximal right middle lobe bronchus with complete collapse of the right\nmiddle lobe.  Single bone metastasis.\n3. Increased narrowing of the right lower lobe bronchus with worsening right\nlower lobe atelectasis.\n4. Few lung nodules might be in centrilobular distribution, might be\ninfectious if this is clinically suspected ; this is minor component of\noverall picture.\n5. Enlarging nonhemorrhagic mild right pleural effusion."
        },
        {
            "input": "HEART AND VASCULATURE: The right central venous catheter terminates in the\nright atrium.  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits.  Small pericardial\neffusion, which has significantly decreased in size compared to ___.\n\nAXILLA, HILA, AND MEDIASTINUM: There is infiltrative soft tissue throughout\nthe mediastinum, surrounding the trachea throughout its course.  The proximal\nesophagus is distended with debris.  There is a radiopaque object within the\nmidesophagus, likely an ingested pill.  There is infiltrative soft tissue\nsurrounding the entirety of distal esophagus, and its margins are difficult to\ndetermine, which is concerning for malignant obstruction.  Numerous\nmediastinal and hilar lymph nodes have decreased in size compared to ___.  For instance, a left hilar lymph node conglomerate measures 2.3 cm on\ntoday's examination, previously measuring up to 3.3 cm (series 3, image 47). \nNo axillary lymphadenopathy.\n\nPLEURAL SPACES: A moderate right pleural effusion has increased in size\ncompared to ___.  Small left pleural effusion, new.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Smooth septal thickening throughout the right lung has\ndecreased compared to ___, but increased throughout the left lung\nlikely due to a combination of lymphatic congestion and lymphangitic\ncarcinomatosis.  A 6 mm solid nodule within the lingula has increased in size\n(series 3, image 39).  Additional sub cm solid nodules within the right lower\nlobe have also increased in size (series 3, image 57, 62).  Persistent\nocclusion of the right middle lobe bronchus.  Otherwise, the airways are\npatent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES AND SOFT TISSUES: Bilateral blast implants.  Increased size and number\nof foci within the right clavicle, sternum, multiple thoracic vertebral\nbodies, and multiple ribs bilaterally likely due to treated metastatic\ndisease.  No new destructive lesions.  No acute fracture.",
            "output": "1. Infiltrative soft tissue throughout the mediastinum.  The proximal\nesophagus is distended with debris with infiltrative soft tissue completely\nsurrounding the distal esophagus with indistinct margins, which raises concern\nfor malignant obstruction.  Barium esophagram should be considered.\n2. Mediastinal and hilar lymphadenopathy has decreased since ___.\n3. Solid pulmonary nodules within the left lung have increased in size.\n4. Decreased smooth septal thickening within the right lung, and increased\nseptal thickening within the left lung, likely due to a combination of\nlymphatic congestion and lymphangitic carcinomatosis.\n5. Increased bilateral pleural effusions, moderate on the right, small on the\nleft.  Decreased pericardial effusion, now small.\n6. Increased size and number of sclerotic foci throughout the thoracic\nskeleton, likely due to treated metastatic disease.  No new destructive bone\nlesions.\n\nRECOMMENDATION(S):   Barium esophagram."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.\n\nRight-sided Port-A-Cath with its tip in the right atrium.\n\n\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is no\npericardial effusion. There are extensive atherosclerotic calcifications\nthroughout the aortic arch as well as severe coronary artery calcifications,\nparticularly in the LAD and left circumflex. Heart size is top-normal in size.\n\n\nPLEURA: Trace bilateral pleural effusions\n\nLUNG:There is a background of mild to moderate emphysema. There is\nsubsegmental atelectasis at the lung bases, but no consolidation to suggest\npneumonia.\n\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No evidence of pulmonary embolism.\n\nTrace bilateral pleural effusions with bibasilar atelectasis.  Mild to\nmoderate upper lobe predominant emphysema.\n\nExtensive atherosclerotic calcification involving the aortic arch as well as\nsevere coronary artery calcification involving the LAD and left circumflex\narteries.\n\nRight-sided Port-A-Cath with its tip in the right atrium."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nSupraclavicular lymph nodes are measurable, measuring up to 6 mm, but are not\npathologically enlarged.  Similarly, axillary lymph nodes measure up to 7 mm\nin the right axilla and 6 mm in left axilla, but are not pathologically\nenlarged.  There is mild bilateral gynecomastia.\n\nUPPER ABDOMEN: Please see the separate report for the same day CT abdomen and\npelvis for subdiaphragmatic findings.\n\nMEDIASTINUM: A subcarinal lymph node is borderline enlarged measuring 9-10 mm.\nRemaining mediastinal lymph nodes are small.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion. \nCoronary artery calcifications are moderate.  Aortic valve calcifications are\nmild.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild upper lobe predominant centrilobular and\nparaseptal emphysema.  There is no focal consolidation or pulmonary mass. \nThere is eventration of the right hemidiaphragm with overlying atelectasis. \nSubsegmental atelectasis/scarring is seen at the left lung base.  Punctate\ncalcifications at the right lung base are likely calcified granulomas (6:279,\n287, 298).  A calcified granuloma is seen in the right upper lobe (6:43). \nLeft upper lobe pulmonary nodules measure up to 3 mm (6:63, 134).\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally with\nmild lower lobe bronchial wall thickening.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are of normal\ncaliber.  There is no central pulmonary embolism.\n\nCHEST CAGE: A chronic anterolateral right second rib fracture is noted.  A\nchronic left clavicular fracture is noted.  There is no acute fracture or\naggressive osseous lesion.",
            "output": "1. 3 mm left upper lobe pulmonary nodules.  Recommend comparison to prior\nimaging for stability.  In the absence of prior imaging, follow-up can be\ndetermined based on the patient's extra thoracic malignancy or per the\n___ criteria as detailed below.\n2. No intrathoracic lymphadenopathy.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nScattered vascular calcifications are consistent with atherosclerotic change.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\nGround-glass opacities in the lingula are likely related to infectious or\ninflammatory process.  No focal consolidation.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nModerate multilevel degenerative changes of the visualized spine.  Multiple\nanterior flowing osteophytes are compatible with diffuse idiopathic skeletal\nhyperostosis (DISH).",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Lingular ground-glass opacities are related to an infectious or\ninflammatory process.  No focal consolidation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Bilateral supraclavicular lymph\nnodes measuring up to 8 mm in short axis, nonspecific.  Left axillary lymph\nnodes measuring up to 6 mm in short axis, also nonspecific by size criteria. \nThese are unchanged.  Incidental note is made of a right sternalis muscle. \nThere is a tiny pocket of gas seen within a vessel coursing along the right\nanterior chest wall (series 304 image 69), likely related to intravenous\naccess.\n\nUPPER ABDOMEN: Please see separate report from the CT abdomen and pelvis.\n\nMEDIASTINUM: No size significant mediastinal lymphadenopathy.  7 mm right\nparatracheal lymph node, nonspecific.  A right-sided central line is seen\nterminating at the cavoatrial junction.\n\nHILA: Mild prominence of a right hilar lymph node measuring up to 1.2 cm in\nshort axis, unchanged.\n\nHEART and PERICARDIUM: There are no pericardial effusions.  The heart is not\nenlarged.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Band atelectatic changes in the right lower lobe.  Minimal\nsubsegmental atelectatic changes are also present in the lingula and left\nlower lobe.  No focal consolidations.\n2. AIRWAYS:  Patent down to the subsegmental branches.\n3. VESSELS:  Unremarkable.  There is no thoracic aortic aneurysm.  No central\nor proximal segmental pulmonary emboli.\nCHEST CAGE: There are no suspicious bone lesions.",
            "output": "No evidence of focal pneumonia in the chest.\n\nStable appearance of a mildly prominent right hilar lymph node, possibly\nreactive."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient has undergone esophageal replacement\ntherapy.  All visible lymph nodes in the mediastinum in the hilar areas are\nnormal in size.  Only 1 normal to borderline sized lymph node is seen in\nprecarinal location (3, 22).  Mild coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The postsurgical esophagus appears\nunremarkable, the posterior mediastinum is otherwise normal.  Severe scoliosis\nwith moderate secondary degenerative changes.  No osteolytic lesions at the\nlevel of the ribs, the sternum or the vertebral bodies.  In the lung\nparenchyma, areas of scarring are noted around the postsurgical esophagus. \nMinimal scarring is also noted at the basis of the right lower lobe.  Minimal\nright pleural effusion with adjacent atelectasis.  No suspicious pulmonary\nnodules or masses.  No diffuse lung disease.  The airways are patent.",
            "output": "Borderline sized precarinal lymph node.  No lymphadenopathy.  Normal\nappearance after esophageal replacement.  Minimal right pleural effusion with\nadjacent atelectasis.  No suspicious lung nodules or masses."
        },
        {
            "input": "Imaged thyroid is unremarkable.  No supraclavicular, axillary, mediastinal or\nhilar lymphadenopathy by CT size criteria.  Heart size is normal, and there is\nno pericardial effusion.  No aortic valvular calcifications.  Thoracic aorta\nis normal in course and caliber.  Main pulmonary trunk is normal in caliber. \nPulmonary arteries are well opacified to the subsegmental levels, without\nevidence of pulmonary embolism.\n\nCentral airways are patent.  Hypoventilatory changes noted with lower lung\natelectasis.  No pneumonia or edema.  No pneumothorax or pleural effusion.\n\nWithin the imaged portion of the upper abdomen, a nodular cirrhotic liver with\nenlarged left hepatic lobe is noted with large volume ascites and apparent\nsplenomegaly.\n\nNo lytic or sclerotic lesions concerning for malignancy.  No acute fracture. \nChest wall is unremarkable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Hypoventilatory changes with lower lung atelectasis.\n3. Cirrhotic liver morphology.\n4. Sequela of portal hypertension including large volume upper abdominal\nascites and splenomegaly."
        },
        {
            "input": "Aorta and pulmonary arteries are normal.  No pathologically enlarged\nmediastinal, hilar or axillary lymphadenopathy is present.  Coronary\ncalcifications are extensive.  Heart size is normal.  There is no pericardial\nor pleural effusion.\n\nSmall hiatal hernia is noted.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nconsolidations or opacities to suggest pneumonia demonstrated.  No discrete\npulmonary nodules demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic source of infection or other abnormality\ndemonstrated.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "The thyroid is normal.\n\nThere are multiple enlarged mediastinal lymph nodes, some of which are\ncentrally hypodense suggesting necrosis including the prevascular,\npretracheal, precarinal and subcarinal stations. For example there is a 1.5 cm\ncentrally necrotic subcarinal lymph node (series 3, image 124), and a 1.8 x\n1.1 precarinal node (series 3, image 98).  A heterogeneous centrally hypodense\nenlarged left hilar lymph node measures 2.5 x 2.3 cm (series 3, image 138). \nNo axillary or supraclavicular lymphadenopathy is identified.\n\nThere is a 5.4 x 4.5 x 6.4 cm heterogeneously enhancing mass (series 3, image\n120) in the superior segment of the left lower lobe which bulges the major\nfissure and causes narrowing of the adjacent left lower lobe bronchus\nconcerning for primary lung cancer.\n\nBronchiectasis is seen within both lower lobes and right middle lobe with\nbronchial wall thickening identified. For focal consolidative opacities within\nthe right middle lobe and right lower lobe as well as centrilobular nodules in\nthe right lower lobe and right upper lobe likely reflect areas of aspiration,\na component of which is likely chronic. There is mild centrilobular emphysema.\nThere is a small left pleural effusion.  Secretions are noted within the\ntrachea.\n\nThe great vessels are normal caliber.  There is no evidence of pulmonary\nembolism to the subsegmental level.  The thoracic aorta is normal caliber\nthroughout without evidence of dissection or intramural hematoma.\n\nThe heart is normal in size. There is a small pericardial effusion.\n\n\nThere is a 0.9 x 0.6 cm hyper enhancing lesion in segment 2 of the liver as\nwell as a a 0.6 x 0.4 cm lesion in segment 6, which are not fully\ncharacterized and could be further evaluated with MRI.  Additionally,\nbilateral adrenal nodules, not previously seen on PET-CT from ___\nare worrisome for metastatic disease. Imaged portions of the kidneys show\nmultiple, bilateral renal cysts.  Partially imaged is a percutaneous\ngastrostomy catheter.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. 5.4 x 4.5 x 6.4 cm mass in the superior segment of the left lower lobe\nconcerning for primary lung cancer with mediastinal and left hilar metastatic\nlymphadenopathy.\n2. Bronchiectasis within the right middle lobe and both lower lobes, with\nfindings compatible with aspiration pneumonia involving the right upper lobe,\nright middle lobe, and both lower lobes, a component which is likely chronic.\n3. Small left pleural effusion and small pericardial effusion.\n4. At least 2, small hyperenhancing lesions within the liver which may be\nperfusional, but are not fully characterized.  This can be further assessed\nwith MRI.\n5. Bilateral adrenal nodules, not previously seen on PET-CT on ___\nworrisome for metastatic disease.\n6. No evidence of pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: There is a 1.5 x 1.3 cm right thyroid lobe\nnodule.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple prominent to mildly enlarged lymph nodes are noted. \nFor example, an AP window node measures 0.9 cm with central hypo density.  A\nsubcarinal measures 0.9 cm (series 302, image 22) also demonstrating central\nhypodensity.\n\nHILA:  1.7 cm right hilar lymph node is noted.  Prominent left hilar lymph\nnode measuring up to 0.9 cm (series 302, image 23) is also noted.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Innumerable subcentimeter pulmonary nodules are seen\nthroughout the lungs, concerning for metastatic disease.  Representative\nnodules are listed below:\n\n-Right upper lobe: Series 302, image 54 and 64\n-Right middle lobe series 302, image 79 and 82\n-Right lower lobe: Series 302 image 145 and 171\n-Left upper lobe: Series 302, image 38 and 54\n-Left lower lobe: Series 302, image 125 and 180\nNo focal consolidation.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  No suspicious osseous lesion or acute fracture. Diffuse\nosteopenia.   Multilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Innumerable subcentimeter pulmonary nodules and multiple prominent to\nenlarged mediastinal and bilateral hilar lymph nodes, consistent with\nmetastatic disease.\n2. No acute process within the chest.\n3. 1.5 x 1.3 cm right thyroid lobe nodule.  Non urgent thyroid ultrasound can\nprovide further assessment if clinically indicated and not previously\nperformed."
        },
        {
            "input": "CHEST PERIMETER: New vascularity in previous low-attenuation right thyroid\nnodule suggests it may be a metastasis.  Adjacent soft tissue the thoracic\noutlet is unremarkable and there is no supraclavicular or axillary adenopathy.\nChest wall is unremarkable.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head neck vessels or coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: Previous central adenopathy is improved as follows:\n\nThoracic outlet, 9 x 11 mm, previously 13 x 12 mm.\n\nRight hilum upper pole, 16 x 27 mm, previously 21 x 32 mm.\n\nSubcarinal mediastinum\n\nRight posterior paraesophageal mediastinum, 8 mm, previously 9 mm.\n\nRight hilum, lower pole, 9 mm, previously 15 mm, remeasured.\n\nHowever, 17 mm right diaphragmatic lymph node, 6:184, was only 14 mm in\n___.\n\nLUNGS, AIRWAYS, PLEURAE: Size and number of the scores of persistent pulmonary\nmetastases have both decreased somewhat.\n\nFor example perifissural nodules in the right lung, are fewer in number and\nlargest, 5 mm across, 6:102, was 8 mm in ___.\n\nA 7-8 mm left lower lobe nodule in ___, is 5 mm today, 6:170.\n\nTracheobronchial tree is normal to subsegmental levels and there is no pleural\nabnormality.\n\nCHEST CAGE: New, blastic focus in an upper thoracic vertebral body is a\ntreatment phenomenon, 09:48.  No compression or pathologic fractures or large\ndestructive bone lesions.  Radionuclide bone or FDG PET scanning is more\nsensitive in detecting osseous metastasis than routine chest CT.",
            "output": "Treatment response since ___ consisting of involution of previously\nenlarged central lymph nodes and a decrease in size and number of scores of\nsmall pulmonary metastases.\n\nThe only indications of progression of malignancy in the chest is interval\ngrowth of a right diaphragmatic lymph node, and new vascularity in previously\navascular right thyroid nodule."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nStable heterogeneous thyroid with a large heterogeneous nodule in the right\nlobe.  No enlarged lymph nodes in either axilla or thoracic inlet.  No\nabnormalities on the chest wall.  No atherosclerotic calcifications in the\nhead and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, none in the aorta or\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Larger lymph node in the right\nsubdiaphragmatic fat pad, now measuring 19 mm, previously 15 mm (6: 197). \nOther smaller mediastinal lymph nodes, none pathologically enlarged by CT size\ncriteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Numerous new pulmonary nodules,\nfor example in the middle lobe measuring 7 mm (6:118), surrounded by a ground\nglass halo, and growth of several other pre-existing nodules, for example in\nthe left lung base (6:241) measuring 6 mm, previously 2 mm.\n\nCHEST CAGE:\nThe pre-existing sclerotic lesions in the thoracic spine are more dense on\ntoday's scan, for example in T3 (6: 62 and 10:48).  No acute fractures.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Compared to ___, multiple pre-existing lung nodules have grown and\nseveral other new lung nodules have developed in the interim.  There is also\ninterval growth of a lymphadenopathy in the right supradiaphragmatic region. \nThese findings are suggestive of metastatic disease progression.\nPreviously small sclerotic lesions in the chest cage are more dense now,\nprobably as a response to chemotherapy.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 11:03 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nHeterogeneous thyroid with a large mixed density nodule in the right lobe\nmeasuring at least 1.8 cm (05:37), unchanged.  No enlarged lymph nodes in\neither axilla or thoracic inlet.  Right anterior port with tip in the\ncavoatrial junction.  No atherosclerotic calcifications in the head and neck\narteries.  No abnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  Minimal atherosclerotic calcifications\nin the coronary arteries, none in the aorta or cardiac valves.  The pulmonary\narteries and aorta are normal caliber throughout.  No incidental pulmonary\nembolism noted in the main pulmonary artery or its proximal branches.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Stable right diaphragmatic lymph node\nmeasuring 2.0 cm (5:209).  Other smaller mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, are unchanged.  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening but no bronchiectasis or mucus plugging.  Multiple bilateral lung\nnodules which have grown compared to prior study, for example in the right\nupper lobe (5:94) measures 1.4 cm, previously 0.6 cm and in the left lower\nlobe (5:206) measuring 1.3 cm previously 0.6 cm.  Again noted are thickened\ninterlobular septi in the left lower lobe, slightly more prominent and now\nassociated to mild ground-glass opacities.\n\nCHEST CAGE:\nStable well-defined sclerotic foci in the left lateral seventh rib.  No acute\nfractures.  Mild dorsal spondylosis.  Stable sclerotic lesions in the thoracic\nspine, for example in T3 and T12 (8: 70 and 72).\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Compared to prior study of ___, most of the lung nodules have grown,\nsuggestive of metastatic disease progression.\nStable sclerotic lesions throughout the thoracic spine and right diaphragmatic\nlymphadenopathy are likely stable metastatic disease.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 10:28 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThe patient is status post VATS and right upper lobectomy, with expected\npostoperative changes along the right hila.  A small to moderate loculated\nright pleural effusion is seen.  A focus of air immediately inferior to the\ncarina (02:47) is presumed postsurgical.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Status post recent VATS with right upper lobectomy and expected\npostoperative changes.\n3.  Small to moderate loculated right pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  No enlarged supraclavicular or axillary lymph nodes.\n\nUPPER ABDOMEN: The study is not optimized for the evaluation of\nsubdiaphragmatic structures.  Within this limitation, thickening of the left\nadrenal gland without discrete nodule is unchanged from ___.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  Coronary artery calcifications\nare severe and diffuse.  No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is a background of mild emphysema.  Postoperative\nchanges following right upper lobectomy are noted with pleural retraction near\nthe right apex (___).  No pulmonary nodule suspicious for malignancy. \nSeveral scattered calcified granulomas are present without evidence of active\ngranulomatous disease.\n2. AIRWAYS:  Airways are patent to the subsegmental level.  Right upper lobe\nbronchial stump appears intact.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  Thoracic aorta is normal in caliber with mild atherosclerotic\nplaque. While this study is not optimized for the evaluation of pulmonary\nvasculature, no central pulmonary embolism is detected\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesion or acute fracture.\nMultilevel thoracic vertebral body height loss is chronic.",
            "output": "Status post right upper lobectomy without evidence of local recurrence.\n\nStable thickening of the left adrenal gland without a discrete nodule."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. Mild atherosclerotic\ncalcifications of the thoracic aorta and of the coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild centrilobular\nparaseptal emphysema.  Mild diffuse bronchial wall thickening and\nirregularity.  Minimal apical scarring, left greater than right.\n\nClustered calcified punctate granulomas in the left lower lobe (6:196 and\n189).  Subpleural 2 mm nodule in the left lower lobe lateral segment (06:15\n8).  Left apicoposterior 2 mm pulmonary nodule (06:49) and right apical nodule\n(6:67).  No additional pulmonary nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is",
            "output": "Numerous micro nodules are statistically likely benign, however in the absence\nof prior imaging for comparison, follow-up CT thorax in 3 months time to\nensure stability is suggested.\n\nMild emphysema and chronic airways disease."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: The thyroid is grossly normal.  There is no\nsupraclavicular, axillary, mediastinal or hilar lymphadenopathy.  Left\nPort-A-Cath terminates in the upper right atrium.  The esophagus is grossly\nnormal.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta and\nproximal great vessels are well opacified and normal in caliber.  The main\npulmonary artery is normal in caliber.  There are subsegmental filling defects\nin the right lower lobe pulmonary arteries (5:172) compatible pulmonary\nemboli.  There is no sign a right heart strain.  There is minimal\natherosclerosis of the coronary arteries, namely the LAD (04:38).\n\nThe airways are patent to the subsegmental level.  There is no pleural\neffusion or pneumothorax.  There is a background of upper lobe mild to\nmoderate paraseptal emphysema.  Mild bronchial wall thickening unchanged. \nThere is no evidence of pulmonary infarct.\n\nThere are multiple tiny pulmonary nodules which are unchanged (5:60, 71, 78,\n89, 61, 76).  Punctate left lower lobe pleural nodule (5:97) is unchanged. \nThere is minimal apical scarring as before.\n\nOSSEOUS STRUCTURES: There is minimal anterior wedging of T5 which is unchanged\nfrom the prior study and overall appears chronic.  There is no worrisome\nblastic or lytic lesion.",
            "output": "1. New right lower lobe subsegmental pulmonary embolism.  There is no evidence\nof pulmonary infarct or right heart strain.\n2. No evidence of intrathoracic malignancy.  Multiple micronodules are\nunchanged.\n3. Please note CT of the abdomen and pelvis will be reported separately\n\nNOTIFICATION:  The findings were telephoned to ___ by ___\nat 16:00,  ___, 20 min after discovery."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  Borderline enlarged left axillary lymph node (3,\n23).  No right axillary adenopathy.  Left prepectoral Port-A-Cath in situ with\nthe catheter tip tip in situ in the proximal right atrium.\n\nUPPER ABDOMEN: Will be reported separately.  No hiatal hernia.\n\nMEDIASTINUM: Mediastinal lymph nodes (largest in the right lower paratracheal\narea measuring 9 mm in diameter) appearing similar compared to prior.\n\nHILA: Bilateral hilar lymph nodes measuring 11 mm in diameter appear slightly\nmore prominent in size compared to prior (10 mm previously) as well as\ndensity.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nMild left coronary artery calcifications.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA: Impacted bronchi with associated airspace nodules seen the\nposterior basal segment of the left lower lobe.  Mild generalized bronchial\nwall thickening.  New ground-glass nodule in the posterior aspect of the right\nupper lobe (5, 69) measuring 5 mm in diameter. Multiple pre-existing 2 mm\npulmonary the nodules (05: 35, 38, 39, 49, 50, 53, 56, 57, 84, 122, 133, 154)\nare unchanged.  Presumed atelectatic changes seen in the left lung base (5,\n229).  Centrilobular and paraseptal emphysematous changes and a is saber\nsheath trachea in keeping with COPD.\n-AIRWAYS: The airways are patent to the subsegmental level.\n-VESSELS: The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Dish and spondylotic changes of the cervicothoracic spine. \nSlightly expansile sclerotic lesion involving the right pedicle and pars\ninterarticularis appear similar compared to prior imaging.",
            "output": "No definite findings to suggest pulmonary metastatic disease.\n\nMild generalized bronchial wall thickening, left lower lobe small bronchiolar\nimpaction with associated airspace nodule suggests infection or subclinical\naspiration.\n\nIn the light of this finding, the newly detected ground-glass nodule in the\nright upper lobe (5, 69) with adjacent bronchial wall  thickening  is  most\nlikely infective/inflammatory in nature, but a neoplastic lesion cannot be\nexcluded with certainty and close attention should be paid to this nodule on\nthe next follow up study.\n\nMulti pre-existing pulmonary nodules are unchanged.\n\nMild interval increase in size and density of the bilateral hilar lymph nodes\nand again close attention should be paid to these on the next follow-up study.\n\nRECOMMENDATION(S):  Follow-up imaging should be determined in conjunction with\nthe extra thoracic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter. Multiple mediastinal\nlymph nodes are not pathologically enlarged and stable.  Heart size is normal.\nThere is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Bronchial wall\nthickening is diffuse.  Left lower lobe cluster of bronchial wall thickening,\nmore extensive than elsewhere with a adjacent ___ opacities is similar\nin appearance as compared to previous examination, but with slightly different\nairways being involved in slightly different pattern of the ___\nappearance, does consistent with fluctuating aspiration/ infection. No other\npulmonary nodules masses or consolidations demonstrated to suggest\nintrathoracic metastatic disease.  Centrilobular emphysema is mild to\nmoderate, unchanged.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of intrathoracic\nmetastatic disease.\n\nBronchial wall thickening, diffuse in conjunction with left lower lobe cluster\nof ___ nodules and endobronchial secretions is most likely\nrepresenting infectious etiology.\n\nMild centrilobular emphysema.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  Axillary lymph nodes are unchanged.  Left\nprepectoral Port-A-Cath in situ with the tip in the right atrium.  Mild\ngynecomastia.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Borderline mediastinal lymph nodes appear similar compared to\nprior.\n\nHILA: Right hilar lymph nodes are slightly decreased in size compared to\nprior.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo cardiomegaly.  No aortic valve calcification.  Mild coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular and paraseptal emphysematous changes.  No\nsuspicious pulmonary nodules or masses.  The peribronchial nodules in the left\nlower lobe is decreased compared to prior (infective/inflammatory etiology). \nPre-existing sub 4 mm nodules are unchanged.  No confluent airspace\nconsolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  Saber sheath\ndeformity of the intrathoracic trachea.  Mild, but diffuse bronchial wall\nthickening with associated mild impaction seen in the left lower lobe (4, 75).\nImpaction and peribronchial nodules in the left lower lobe is improved\ncompared to prior (4, 82)\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defect to\nsuggest pulmonary emboli.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "No findings to suggest intrathoracic metastatic disease.\n\nBorderline mediastinal and right hilar lymph nodes are similar to slightly\ndecreased in size compared to prior, and most likely secondary to bronchial\ninflammation.\n\nMild centrilobular and paraseptal emphysematous changes with an associated\nsaber sheath deformity of the intrathoracic trachea suggests COPD.  Mild, but\ndiffuse bronchial wall thickening, with mild bronchial impaction and\nperibronchial nodules in the left lower lobe (is slightly improved compared to\nprior) suggesting an infective/inflammatory etiology.  No bronchiectasis.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.  Bibasilar subsegmental atelectasis is noted.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is a minimally displaced right fifth rib fracture\n(03:50).  There is another possible not displaced left posterior first rib\nfracture There is no worrisome lytic or sclerotic lesion.  Multilevel\ndegenerative changes are absent.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\ncholecystectomy clips..",
            "output": "Minimally displaced right fifth rib and possibly left first rib fractures. \nOtherwise no acute sequelae of trauma."
        },
        {
            "input": "Thyroid gland enhances homogeneously.  There is no enlarged supraclavicular or\naxillary lymphadenopathy.  Again seen are multiple mediastinal and hilar lymph\nnodes, many of which are calcified.  Findings are overall similar compared to\nthe prior study in ___, and compatible with history of sarcoidosis.\n\nHeart is normal in size, without a pericardial effusion.  Thoracic aorta is\nnormal in caliber, without evidence of dissection.  The origins of the great\nvessels of the neck are unremarkable in appearance.  Main pulmonary artery is\nnormal in caliber.  Pulmonary arterial branches are opacified to the\nsubsegmental levels, without evidence of embolism.\n\nAirways are patent to the segmental bronchi bilaterally.  There is biapical\npleuroparenchymal scarring, right greater than left, which appears slightly\nincreased compared ___.  Again seen are innumerable parenchymal micronodules\nand perifissural micronodules, compatible with patient's known sarcoidosis.  A\nrepresentative example is seen on series 5, image 257, with multiple nodules\nseen along the right major fissure.  No suspicious nodules are identified. \nThere is no focal consolidation to suggest a superimposed infection.  No\npleural effusion or pneumothorax.\n\nLimited images of the upper abdomen are notable for intra- and extrahepatic\nbiliary dilatation, which were better assessed on the prior CT abdomen and\npelvis performed ___.  Left hepatic artery is replaced to the left\ngastric artery, a normal variant (5:323).\n\nNo suspicious lytic or sclerotic lesions are identified.  There is no acute\nfracture.  Soft tissues are unremarkable.",
            "output": "1. No new findings to suggest intrathoracic metastases.\n2. Innumerable parenchymal and perilymphatic micronodules along with multiple\ncalcified mediastinal lymph nodes are compatible with history of sarcoidosis.\n3. Intrahepatic and extrahepatic biliary dilatation, better assessed on the\nprior dedicated CT abdomen/pelvis."
        },
        {
            "input": "The patient has been extubated. Both of the right subclavian catheter and NG\ntube have been removed. Extensive bilateral perihilar consolidations with a\nlower lobe predominance have improved since most recent CT, particularly in\nthe upper lobes.  Aeration in the lower lobes has improved, but there\npersistent peribronchial opacities. There are still small bilateral\nnonhemorrhagic pleural effusions.\n\nThe thyroid gland is unremarkable.  There are prominent mediastinal and\naxillary lymph nodes, not enlarged by size criteria.  The esophagus is\nunremarkable.  The pulmonary arterial trunk is normal in caliber.  Small\npericardial effusion is slightly enlarged.\n\nThe tracheobronchial tree is patent to the subsegmental levels. The airways\nare normal in caliber.\n\nAlthough not tailored for subdiaphragmatic evaluation, the liver again\ndemonstrates diffuse low attenuation compatible with fatty deposition. Gastric\nlap band is in appropriate position. There is no blastic or lytic lesion\nsuspicious for malignancy.",
            "output": "1. Interval improvement of bilateral consolidations.  The marked improvement\ncompared to CT from 11 days prior favors an etiology such as eosinophilic\npneumonia over pulmonary edema or infection.\n2. Slight interval increase of pericardial effusion.\n3. Fatty liver."
        },
        {
            "input": "The examination is compared to ___.\nNo incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. All visible lymph nodes in these regions are normal\nin size. Mild dilatation of the ascending aorta, unchanged as compared to the\nprevious examination. No coronary calcifications, no valvular calcifications.\nMild cardiomegaly. No pericardial effusions. The posterior mediastinum is\nunremarkable. No osteolytic lesions at the level of the sternum, the ribs or\nthe vertebral bodies.\n\nMinimal apical thickening.  The pre-existing parenchymal opacities have\ncompletely resolved.  No remnant ground-glass opacities, no remnant\nparenchymal scars, no pleural thickening or pleural effusions.  Despite\nmoderate respiratory motion artifact 's at the bases of the lungs, there is\nevidence of airway wall thickening and airway wall irregularities, strongly\nsuggestive of chronic airways disease.  This could be further evaluated by a\npulmonary function tests. Several to 2 to 3 mm subpleural and perifissurral\nnodules (for example in the left lower lobe, series 4, image 199 and series 4,\nimage 210) non of which is suspicious for malignancy.  No signs of diffuse\nlung disease.  No areas of fibrosis.",
            "output": "As compared to ___, there is complete resolution of the\npre-existing bilateral pleural effusions and of the pre-existing parenchymal\nopacities.  Several non suspicious small subpleural pulmonary nodules persist.\nSigns of mild to moderate chronic airways disease that could be further\nevaluated by pulmonary function testing.  No lymphadenopathy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is enlarged with substantial right atrial\nenlargement, progressed since ___.  Trace pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Throughout lungs bilaterally, there are ground-glass opacities\nwith apical to basal and anterior posterior gradient, sparing the subpleural\nregion.  At the base, the ground-glass opacities are confluent.  In addition,\nthere is a 6 mm nodule in the left lower lobe (2:71), likely new since ___.  Pulmonary cyst in the right lower lobe measuring 7 mm is\nstable since ___.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  There is mild peribronchial wall thickening,\npresumably due to chronic airway disease.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  There is\nreflux of contrast into the IVC.  Gastric band is partially imaged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of acute pulmonary embolism.\n2. Extensive ground-glass opacities in apical basal and anterior posterior\ngradient sparing the subpleural region, consistent with given history of\ninterstitial lung disease.  Of note, these findings have not dramatically\nchanged since prior chest CT from ___.\n3. 5.5 mm nodule in the left lower lobe is new since ___.  Please\nrefer to the recommendation section for further follow-up.\n4. Interval progression of cardiomegaly, most notable of marked enlargement of\nthe right atrium with evidence of right heart strain with reflux of contrast\nin the IVC since remote prior exam.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged by CT criteria. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification. Hypodensity of the cardiac chambers compared to the myocardium\nsuggests anemia. There are large bilateral pleural effusions and a small\npericardial effusion .\nThere are extensive bilateral consolidations with perihilar and lower lobe\npredominance\nET tube is in standard position. Right central catheter tip is in the mid SVC.\nNG tube tip is in the stomach.  Lap band catheter projecting in the left upper\nquadrant of the abdomen.\nThis examination is not tailored for subdiaphragmatic evaluation there is\nfatty infiltration of the liver.\nThere are no bone findings of malignancy",
            "output": "Extensive bilateral consolidations with large bilateral pleural effusions\ndifferential diagnosis includes eosinophilic syndromes, multifocal pneumonia,\nsevere pulmonary edema\nAnemia\nFatty liver"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Subcentimeter hypodensity in the left hepatic lobe is too small\nto characterize, but most likely reflects a simple cyst.  Otherwise, the upper\nabdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There are extensive coronary\nartery calcifications as well as aortic annular calcifications.  A small\npericardial effusion is present, possibly physiologic.  A right-sided PICC\nterminates in the mid SVC (6:63).\nPLEURA: There are moderate bilateral pleural effusions, right greater than\nleft.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Peribronchovascular central ground-glass opacity greater in the\nupper lobes is likely reflective of mild pulmonary edema.  Compressive\natelectasis is present at the bilateral lung bases adjacent to the pleural\neffusions.  A 6 mm nodule is present in the right lower lobe (04:43).\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The main pulmonary artery is mildly dilated, measuring up to 3.2\ncm, which can be seen in pulmonary arterial hypertension.  The thoracic aorta\nis normal in caliber with mild atherosclerotic calcification.\nCHEST CAGE: There is a suspicious lytic or sclerotic osseous lesion or acute\nfracture.",
            "output": "1. Mild pulmonary edema appears improved comparison with the chest radiograph\n___.\n2. Moderate bilateral pleural effusions with adjacent compressive atelectasis.\n3. Extensive coronary artery and aortic annular calcification.\n4. 6 mm right lower lobe pulmonary nodule.  Follow-up chest CT in ___ months\nis recommended.\n5. Mildly dilated main pulmonary artery is suggestive of pulmonary arterial\nhypertension.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: A left-sided PICC line is\ndemonstrated with its tip at the cavoatrial junction.  Visualized thyroid is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separate report of CT performed the same day\nfor description of the intra-abdominal findings.\n\nMEDIASTINUM: Multiple prominent mediastinal lymph nodes are demonstrated.  For\nexample, there is a prevascular lymph node measuring 1.2 cm (02:12).  A right\nparaaortic lymph node measures 1.0 cm (02:20).\n\nHILA: Within the limitations of the unenhanced exam, no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is unremarkable with no pericardial effusion.\nPLEURA: Small bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  A 4 mm pulmonary nodule is noted in the right upper lobe\n(302:95).  Compressive atelectasis is noted at the lung bases.  Otherwise, no\nconsolidation or collapse.\n2. AIRWAYS:  Central airways are patent.\n3. VESSELS:  Minor atherosclerotic disease of the aortic arch.\nCHEST CAGE: Multilevel degenerative changes of the thoracic spine.  No\nsuspicious osseous lesion or acute fracture.",
            "output": "1. No evidence of a neoplastic process.\n2. Small bilateral pleural effusions.\n3. Prominent mediastinal lymph nodes are likely reactive.\n4. 4 mm pulmonary nodule in the right upper lobe.\n\nRECOMMENDATION(S):  The ___ Society guidelines for pulmonary nodule\nguidelines suggest for pulmonary nodules greater than 4 mm or less than 6mm,\n12 month follow-up in low-risk patients, and ___ month follow-up in high risk\npatients."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nDiffuse bilateral pulmonary emboli are seen in the truncus arteriosus, right\nintralobar artery, segmental arteries of the right middle and lower lobes, and\nleft upper lobar artery.  The main, right, and left pulmonary arteries are\nnormal caliber.  There is no evidence of right heart strain.\n\nPULMONARY PARENCHYMA: A 5 mm pulmonary nodule in the left upper lobe is more\nconspicuous than prior (4:46).  A 3 mm pulmonary nodule in the left upper lobe\nis unchanged (4:44). The 5 mm (4:99) and 3 mm (4:136) ground-glass nodules in\nthe left upper lobe are unchanged. There is mild centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Right chest wall Port-A-Cath\nterminates at the distal SVC.  The study is not optimized for evaluation of\nthe breast tissue.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen. \nHypoenhancing pancreatic lesion is best evaluated on MRI liver ___.  Please refer to separate report on same-day CT abdomen/pelvis for\ndescription of the abdominal findings.",
            "output": "1. Multiple, acute, bilateral lobar and segmental pulmonary emboli.  No\nevidence of right heart strain.\n2. Redemonstration of solid and ground glass nodules in the left upper lobe. \nThe need for followup imaging depends on staging and management considerations\nregarding the patient's extrathoracic malignancy.  Otherwise CT chest is\nrecommended for follow up in 6 months.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:58 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced with currently no evidence of\nfilling defect to suggest pulmonary embolism.  No lymphadenopathy\ndemonstrated.  No pericardial pleural effusion is seen.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is minimal.  Left upper lobe 1 mm nodule is stable.  Left upper lobe\n2 mm nodule is stable.  Left upper lobe ground-glass nodule, 4 mm is stable. \nLingular 4 mm nodule is stable.  No new nodules masses or consolidations\ndemonstrated.  The images corresponding to the nodules are as following:\nSeries 3 image 60, 22, 26, 69, 97.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease progression.\n\nPlease review CT abdomen and pelvis in corresponding report will be issued\nseparately."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  Heart size is\nnormal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nCoronary calcifications are moderate.\n\nAirways are patent to the subsegmental level bilaterally but endobronchial\nsecretions are present.  Centrilobular emphysema is minimal.  Left upper lobe\n1 mm nodule is stable, series 3, image 26.  At 2 mm left upper lobe nodule,\nseries 3, image 29 is stable.  Ground-glass opacity in left upper lobe, series\n3, image 76, 5 mm is stable.  Left lower lobe subpleural 3 mm mixed density\nnodule, series 3, image 163 is new but might represent small area of\natelectasis.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic progression of metastatic disease. \nSeveral stable pulmonary nodules are demonstrated with 1 questionable new\npulmonary nodules versus atelectasis in the left lower lobe, 3 mm that should\nbe reassessed in 3 months for documentation of stability.\n\nPlease review CT abdomen and pelvis in corresponding report will be issued\nseparately as part of the CT abdomen and pelvis."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  Heart size is\nnormal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is mild to moderate.  Several small scattered sub 3 mm pulmonary\nnodules are nonspecific, solid.  Ground-glass nodule in left upper lobe, 5 mm,\nis at series 4, image 91 industry mm ground-glass nodule is in the lingula,\nseries 4, image 127.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Nonspecific pulmonary nodules, most likely benign but reassessment in 3 months\nis required.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal intrapelvic findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a small anterior\nmediastinal hematoma resultant from the sternal fracture.\n\nPLEURAL SPACES: There is moderate left pneumothorax and extensive\npneumomediastinum tracking superiorly with extensive subcutaneous air along\nthe chest wall greater on the left.  Bilateral chest tubes are in place.\n\nLUNGS/AIRWAYS: There is bilateral large dense consolidations with air\nbronchograms consistent with bone contusions.  There is diffuse ground-glass\nopacification of the non-collapsed upper and middle lobes consistent with\npulmonary hemorrhage.  There are large bibasilar heterogeneous consolidations\nconsistent with bilateral lower lobe collapse.\n\nAn endotracheal tube terminates 2-3 cm from the carina.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There appears to be at least one laceration of the thyroid gland\n(2:8, 601:56).\n\nBONES: There is a displaced fracture of the distal left clavicle.  There is an\narea of contrast pooling posterior to the left clavicular fracture concerning\nfor active extravasation (02:14).  There are several segmental rib fractures,\npredominantly left-sided, some of which are displaced.  There is a comminuted\nsternal fracture with a small retrosternal/anterior mediastinal hematoma.\n\nSOFT TISSUES: There is diffuse, predominantly left-sided chest wall\nsubcutaneous emphysema.\n\nVASCULAR: There is a vessel arising from the right internal mammary\nvasculature likely representing the superior epigastric vasculature, and very\nunlikely to represent an area active bleeding) 02:42).  There is an area of\ncontrast pooling posterior to the left clavicular fracture concerning for\nactive extravasation (02:14).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a laceration of the medial left interpolar cortex.  There is\na surrounding small to moderate left perinephric hematoma.  However, the\nremaining kidneys appear to be enhancing normally.  In the the kidneys are of\nnormal and symmetric size with normal nephrogram.  There is no evidence of\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The abdomen is postsurgical within open anterior abdominal\nwall.  Hence, stomach anterior walls herniate through the open abdominal wall\ndefect.  There is mild pneumoperitoneum.  Surgical packing material is seen in\nthe anterior abdominal cavity.  A enteric tube is seen terminating in the\nstomach.  There is diffuse thickening and hyperenhancement of the small bowel\nwalls suggesting hypoperfusion.  The colon and rectum are decompressed.  The\nappendix is normal.  There is no evidence of mesenteric injury.\n\nThere is small volume hemoperitoneum, mainly involving extension from the left\nperinephric space into the left pericolic gutter.\n\nPELVIS:\n\nThe urinary bladder containing a Foley catheter is decompressed and therefore\nsuboptimally assessed.  Otherwise, the distal ureters are grossly\nunremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: A left femoral central venous catheter is visualized.  There is no\nabdominal aortic aneurysm or retroperitoneal hematoma.  Minimal\natherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Postsurgical abdomen with an open anterior abdominal wall. \nThere is subcutaneous emphysema, stranding and areas of subcutaneous hematoma\nalong the left hip soft tissues.",
            "output": "CHEST:\n\n1. Displaced left clavicular fracture with likely active extravasation\nposterior to the fracture, difficult to determine whether arterial or venous. \nShort interval repeat chest CT with contrast is recommended for further\nevaluation.\n2. Thyroid lacerations.\n3. Bilateral lower lobe collapse.  Bilateral pulmonary contusions and large\nvolume bibasilar pulmonary hemorrhage.\n4. Moderate left pneumothorax and extensive pneumomediastinum tracking\nsuperiorly with extensive subcutaneous air along the chest wall.  Bilateral\nchest tubes in place.\n5. Multiple rib fractures including ___ through ___ left ribs, several\ndisplaced.\n6. Sternal fracture with small retrosternal hematoma.\nABDOMEN/PELVIS:\n\n1. Grade 4 left kidney injury with perinephric hematoma.\n2. Small volume hemoperitoneum, predominant left retroperitoneal space.\n3. Postsurgical open abdomen status post splenectomy with mild\npneumoperitoneum and herniation of abdominal contents through the abdominal\nwall defect.\n4. Surgical sponge located in the left anterior abdominal cavity.\n5. Shock bowel.\n\nRECOMMENDATION(S):   Short-term interval repeat chest CT with contrast.\n\nNOTIFICATION:   Updated impression points 1, 2 and 3 discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 10:22 am, 5\nminutes after discovery of the findings.\n\nThe findings were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 11:50 pm, 2 minutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is not\nwell-visualized.  There is no supraclavicular or axillary lymphadenopathy. \nSurgical staples are partially visualized overlying the upper abdomen.\n\nUPPER ABDOMEN: Please see separate report for the same day CT abdomen for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is no pericardial\neffusion.\nPLEURA: A right pleural catheter is seen with the tip at the right lung apex. \nThere is a trace right pneumothorax.  There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Pulmonary lacerations are seen in the left upper and lower\nlobes near the displaced fractures of the fifth through seventh rib fractures.\nA left basilar consolidation with air bronchograms is concerning for pneumonia\nsuperimposed on atelectasis.  Right lower lobe atelectasis is noted.  There is\nmild residual ground-glass opacification in bilateral upper lobes consistent\nwith resolving pulmonary contusion.\n2. AIRWAYS:  An ET tube is seen terminating in the lower thoracic trachea.\n3. VESSELS:  The thoracic aorta, main, right, left pulmonary arteries are of\nnormal caliber.  The airways are patent to the subsegmental level bilaterally.\nCHEST CAGE: Again seen is a left distal clavicular fracture.  Re-demonstrated\nare left third through eleventh rib fractures, with fractures along the\nlateral and posterior portions of the ribs.  A comminuted sternal fracture is\nagain noted.",
            "output": "1. Findings concerning for left lower lobe pneumonia.\n2. Numerous left-sided rib fractures with underlying pulmonary lacerations and\na trace left pneumothorax with chest tube in place.\n3. Resolving bilateral upper lobe pulmonary contusions.\n4. Revisualization of a distal left clavicular fracture and comminuted sternal\nfracture."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary arteries are well opacified to the\nsubsegmental level.  There is no filling defect to suggest pulmonary embolism\nnoting that the distal segmental and subsegmental branches at the lung bases\nare obscured by respiratory motion.  The thoracic aorta is normal in caliber. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is heterogenous dense airspace opacification within the\nleft lower lobe, unchanged, and mild ground-glass opacification within the\nright upper lobe which may reflect infection/aspiration (series 4, image 45). \nThere is mild to moderate bibasal atelectasis.  Tracheostomy tube is in place.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The patient is status post tracheostomy tube placement without\nevidence fluid collections or stranding adjacent to tracheostomy tube.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube terminates within the\njejunal loops and in the left mid abdomen.  The small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.\nPELVIS:\n\nThe urinary bladder is decompressed and demonstrates a Foley catheter and\nmoderate intravesicular air.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Multiple healing left rib fractures which demonstrate\ninterval increased bridging callus when compared to prior CT chest performed\non ___.  C7 vertebral body height loss from prior fractures also\nnoted.  Additionally there has been interval increased bridging callus within\nthe displaced fracture of the midshaft of the left clavicle, bilateral first\nribs and sternum and surrounding the left sternoclavicular joint suggesting\nhealing.  There is no evidence of worrisome osseous lesions.  Hyperdense\nmaterial within the anterior abdominal wall likely reflects postsurgical\nchanges.",
            "output": "1. No pulmonary embolism noting that the distal segmental and subsegmental\nbranches at the lung bases are not assessed due to respiratory motion.\n2. The patient is status post tracheostomy tube placement without evidence of\nfluid collections around the tracheostomy site.\n3. Left basilar opacity most likely atelectasis, similar to prior.  Minimal\nright upper lobe ground-glass opacities, infection or inflammation are\npossible.\n4. No evidence of acute abdominopelvic pathology."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular or axillary lymphadenopathy.  The subcutaneous tissues\nof the chest wall are unremarkable.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows no significant\nabnormalities.  There is a moderate hiatal hernia.  There is no mediastinal\nlymphadenopathy.  The esophagus is patulous, with contrast material extending\nto the mid esophagus.  This may place the patient at risk for aspiration.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is top-normal in size.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  No focal consolidations or suspicious nodules are identified. \nThere is bibasilar atelectasis.\n2. AIRWAYS:  The airways are mildly, diffusely thickened, though patent\n3. VESSELS:  The main pulmonary artery is dilated to up to 4.7 cm, which may\nbe age related.\nCHEST CAGE: Multilevel degenerative changes in the thoracic spine are noted,\nincluding exaggerated kyphosis.  No suspicious focal lesions are identified",
            "output": "1.  No evidence of malignancy in the chest.\n2.  Patulous esophagus distended with oral contrast material places the\npatient at risk for aspiration."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No lymphadenopathy, masses, or suspicious pulmonary nodules."
        },
        {
            "input": "No size significant axillary, hilar, or mediastinal lymphadenopathy. \nIncreased number of subcentimeter mediastinal lymph nodes, likely reactive.\n\nRight internal jugular central line, left PICC line, left subclavian central\nline.\n\nThere is a stent within the superior vena cava.\n\nSmall bilateral pleural effusions are noted, slightly larger on the right.\n\nThere are multiple bilateral lung nodules seen, largest on the right is in the\nright upper lobe measuring 9 mm (03:26).  Second nodule within the right\nmiddle lobe measures 7 mm (03:28).\n\nOn the left, 2 nodules are seen in the left upper lobe measuring 3 mm (03:30)\nand 5 mm (03:29) respectively.\n\nBibasilar atelectatic change, without definite consolidation.\n\nMild-to-moderate diffuse subcutaneous edema is seen at the level of the\nthorax.  This is likely due to third spacing.\n\nNo suspicious bony lesions or fractures.",
            "output": "Multiple bilateral lung nodules as detailed above, largest measuring\napproximately 9 mm.  These are nonspecific .  Recommend short-term follow-up\n___ months) after the acute episode has resolved.  These  less likely\nrepresent an infectious/inflammatory process, although this could be\nreassessed at the time of the patient's recommended follow-up.\n\nRECOMMENDATION(S):  Follow-up CT scan of the chest in ___ months time after\nthe acute episode has resolved."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMild atherosclerotic calcifications are present in the arch of the aorta. \nOtherwise, the thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.\nThe main pulmonary artery primary left and right branches are mildly dilated,\nwhich may be seen in the setting of chronic pulmonary hypertension.\n\nThe heart is within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: A 1.1 cm upper right paratracheal node is\npresent (5:58).  Several prominent supraclavicular mediastinal nodes measuring\nup to 8 mm in the prevascular station are noted.  There is no hilar\nlymphadenopathy.\n\nLUNGS/PLEURA/AIRWAYS: Small volume right pleural effusion with associated\natelectasis.\nThe left hemidiaphragm is elevated and the left lung volume is reduced. \nSeveral confluent opacities are present in the left lower lobe, some\nassociated with central lucencies consistent with areas of cavitation\nassociated with patchy consolidations in the left lung.  Opacities also\ninclude ground glass and may in part reflect partly resolved atelectasis in\naddition to possible active inflammatory or infectious process.\n\nTwo lateral approach thoracostomy tubes are present, one terminating near the\napex, the other along the lateral midlung.\n\nThe left pleural space contains fluid, air, and hyperdense material compatible\nwith oral contrast.  The oral contrast can be traced from the distal esophagus\nat the level of the gastrojejunal anastomosis tracking superolaterally and\nposteriorly along the supradiaphragmatic space and left pleura\n(___).  The largest volume of concentrated contrast is noted in\nthe left subpulmonic space (5:190/07:33/08:58), but contrast can be seen on\nthe lateral and posterior-inferior pleura (5:213/07:42/8:60).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is mild central biliary ductal\ndilatation.  The patient is status post cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postoperative changes of Roux-en-Y gastric bypass are\npresent with distal gastrectomy.  An thin aerated tract from the anastomosis\nproceeds to the left and lateral and is blind-ending immediately below the\nleft hemidiaphgram.  There is also a tract to a cavity immediately above the\nleft hemidiaphgram, which is confirmed to be patent in the recent past by the\npresence of contrast in the left lower pleural space on both this study and\nthe prior one.  However, it is not possible to ascertain whether this contrast\nmay have extravasated from the gastrojejunal anastomotic site on this\nexamination specifically, or whether the contrast may be barium that is\nredistributed from the prior study.  On the prior examination there was a\npigtail drainage catheter within a large remaining air-fluid level.  This has\nsince been removed and replaced with a large-bore chest tube that terminates\nin the posterior pleural space, again with hyperdense material suggesting\ncontrast.  This is in addition to the second newly placed large-bore chest\ntube on the left.\n\nPostoperative small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThe appendix is not visualized.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS:\n\nA Foley catheter is in place and the urinary bladder is minimally distended. \nDistal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted in the abdomen and pelvis.\n\nBONES AND SOFT TISSUES: Multilevel degenerative changes in the spine with\ngrade 1 anterolisthesis of L4 over L5 where posterior fusion hardware is\npresent.  There is no evidence of worrisome osseous lesions or acute fracture.\n\nThere is diffuse anasarca. Subcutaneous emphysema is noted along the left\nposterolateral chest wall.",
            "output": "1.  Oral contrast tracking from the gastrojejunal anastomosis to the left\npleura along the supradiaphragmatic space may be compatible with leak, though\nthe visualized contrast could be residual from the previous study,\nparticularly if it was barium-based.  Accordingly this study is indeterminate\nas to whether there may be a persistent open communication with the left\npleural space.\n2.  Confluent opacities in the left lower lobe, compatible with pneumonia,\nsome associated with central lucencies suggesting cavitating components.  Part\n___ re-expansion of the left lung.\n3.  Two left thoracostomy drains with small volume fluid, air, and contrast in\nthe left pleura."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysm formation.  There is mild\natherosclerotic calcification involving the left subclavian are gin and the\narch of the aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary artery is borderline\nenlarged measuring 3 cm in diameter, the upper limits for normal.  This can be\nseen in pulmonary arterial hypertension.\n\nThere is no supraclavicular or axillary lymphadenopathy.  There are enlarged\nmediastinal nodes measuring up to 1.2 cm in short axis in the pre-vascular\nspace (02:39).  These are unchanged in appearance compared to the recent CT\nstudy and compared to the earlier study from ___.  Enlarged right hilar nodes\nmay have increased slightly in size (301:91).  The thyroid gland appears\nunremarkable.\n\nThe heart is moderately enlarged with predominately right-sided heart\nenlargement, there is reflux of contrast into the IVC.  Coronary artery\ncalcification noted.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion. \nCalcified pleural plaques seen superiorly, unchanged from prior studies.\n\nThere are extensive reticular opacities throughout both lungs with relative\nsparing of portions apices (601:34).  The overall extent of disease appears to\nhave increased when compared to the prior study from ___.  There is increased\nground-glass change, particularly in the dependent areas which may reflect\natelectasis versus acute on chronic inflammation.  Traction bronchiectasis\nagain noted.  The central airways are patent, however there is debris in the\nleft mainstem bronchus (02:48).\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Interstitial lung disease with traction bronchiectasis, ground-glass\nopacities and patchy areas of honeycombing.  The extent of involvement has\nincreased when compared to the prior CT study from ___.  The ground-glass\ncomponent has increased in extent when compared to more recent CT study in\n___ however this is predominately in the dependent position and may reflect\natelectasis versus superimposed acute infection or acute on chronic\ninflammation.\n2. No evidence an acute aortic syndrome or pulmonary embolus.\n3. Borderline enlargement of the main pulmonary artery and enlargement of the\nright atrium and right ventricle.\n4. Unchanged mediastinal lymphadenopathy.  Slight interval increase in size of\na right hilar lymph node.\n5. Small calcified pleural plaques."
        },
        {
            "input": "THORACIC INLET: An ET tube projects approximately 4 cm from the carina.  The\nNG tube projects below the left hemidiaphragm in the tip terminates in the\nstomach.  There is a right-sided PICC line with its tip in the proximal SVC. \nThyroid is unremarkable.  There are cysts no enlarged supraclavicular lymph\nnodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are multiple small bilateral mediastinal lymph nodes,\nunchanged since the prior study the largest measuring 12 mm in the left upper\nlobe.  There are no enlarged hilar lymph nodes.  There is moderate\ncardiomegaly.  There is moderate coronary artery calcification.  There is\natherosclerotic calcification involving the mitral annulus.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is moderate paraseptal emphysema.  Diffuse bilateral parenchymal\nabnormality comprising of diffuse ground-glass opacification bilaterally has\nimproved since the prior study and.  The residual parenchymal opacity most\nlikely represents patient's known interstitial lung disease.  There is\nevidence of prior wedge resection the right lower lobe.  There are new\nconfluent parenchymal opacities in both lower lobes left greater than right\n(301, 33) which could represent atelectasis however superimposed pneumonia\nspecially on the left lower lobe cannot be excluded.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with degenerative\nchanges involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Improving interstitial abnormality bilaterally the comprises of improved\npulmonary edema with residual opacification bilaterally most likely represents\npatient's known interstitial lung disease.  New confluent opacities in both\nlower lobes left greater than right could represent atelectasis however\nsuperimposed pneumonia in the left lower lobe cannot be excluded.\n\nStable small mediastinal lymph nodes are most likely reactive.\n\nSupport lines and tubes are in acceptable position.\n\nEvidence of prior wedge resection the right lower lobe.\n\nModerate cardiomegaly.  Coronary artery calcification.  Mitral annulus\ncalcification"
        },
        {
            "input": "There are no enlarged supraclavicular axillary lymph nodes. Specifically\nexcluding the breasts which require mammography for evaluation, elsewhere in\nthe chest wall there is no soft tissue abnormality concerning for malignancy. \nThis study is not designed for subdiaphragmatic diagnosis. But shows no\nadrenal mass. There are multiple nodules in the liver\n\nThyroid, which was most recently evaluated and biopsied in ___ and ___, is\ngreatly enlarged, moderately narrowing the adjacent trachea.  The thyroid is a\ngenerally heterogeneous, with the largest low density region, 20 mm across, in\nthe right lobe.  The isthmus is 42 x 48 mm, displacing the trachea\nposteriorly.\n\nAtherosclerotic calcification is not apparent head neck vessels and is only\nminimal in left anterior descending and right coronary arteries.  Aorta is\nnormal size.  Right pulmonary artery is mildly dilated, 27 mm. .  Evaluation\nof the heart, especially the dilated left atrium, would require dedicated\ncardiac imaging such as echocardiography.  There is no pericardial or pleural\nabnormality.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged.  There is\nno adenopathy in the diaphragmatic, pericaval or retrocrural stations.\n\nThere are no pulmonary nodules.  Dependent microatelectasis is mild.\nSubsegmental atelectasis in the adjacent superior and posterior basal segments\nof the left lower lobe is not due to bronchial obstruction, probably a\nfunction of the pulsatile tortuous aorta.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection and no compression or pathologic fractures.",
            "output": "No evidence of primary or metastatic intrathoracic malignancy.  Severe\nenlargement of the thyroid.  Most recent thyroid and evaluation was in ___\n___.  Consider follow-up ultrasound.\n\nLeft atrial enlargement."
        },
        {
            "input": "Compared with outside CT chest on ___, a right chest wall vascular\nlesion is increased in size, spanning approximately 7.1 x 2.6 cm, compared\nwith 3.5 x 1.6 cm previously, and is thickening and elevating the right chest\nwall skin.  The lesion is predominantly supplied from the right internal\nmammary artery which is intact.  There are multiple prominent venous\nperforators draining into the internal mammary vein.  There are few small\nvessels transversing the right pectoralis musculature (2: 30, 34, 43).  There\nis an apparent enlarged vein in the right axilla (2:33).  An additional more\nsuperficial soft tissue density with a fatty hilum is likely a lymph node\n(2:37).\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  There is thymic tissue in the\nanterior mediastinum.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality in the partially\nvisualized lungs. The airways are patent to the subsegmental level.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Interval increase in size of a right chest wall vascular lesion, which is\nthickening and elevating the overlying skin.  The lesion is predominantly\nsupplied by the right internal mammary artery, which is intact.  There are\nmultiple prominent venous perforators draining into the right internal mammary\nvein.  Multiple small vessels transverse the right pectoralis musculature, but\nthe subcutaneous vascular lesion and associated hemorrhage are separate from\nthe chest wall muscles."
        },
        {
            "input": "CTA:  No evidence of pulmonary embolism to the subsegmental level. The aorta\nis of normal caliber. No evidence of acute aortic pathology.\n\nLUNGS: Tracheobronchial tree is patent to the subsegmental level.  There are\nno worrisome opacities for infection or malignancy. No pleural effusion.\n\nMEDIASTINUM: No mediastinal, hilar or axillary lymphadenopathy.  Heart is of\nnormal size.  No pericardial effusion. Multiple hypodense nodules are seen in\nthe left lower pole of the thyroid, the largest measuring up to 1 cm (03:37).\n\nUPPER ABDOMEN: In segment VI of liver, there is an enhancing 5.8 x 4.2 cm\nlesion (2:124) which is only partially imaged.  An additional sub centimeter\nhypodensity noted in the posterior right lobe of the liver is unchanged since\nthe prior exam from ___.\n\nBONES: No suspicious lytic or sclerotic lesions.",
            "output": "1. No evidence of pulmonary embolism or other acute intrathoracic pathology.\n2. Incompletely visualized segment VI liver lesion measuring up to 5.8 cm. \nDifferential includes focal nodular hyperplasia or adenoma; further\ncharacterization with MRI with Eovist is recommended if not previously done at\nan outside institution.\n3. Multiple thyroid nodules as evaluated on the previous ultrasound."
        },
        {
            "input": "The patient's lung apices and lung bases are not included in the evaluation\ndue to patient's age.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. The patient's lung apices and lung bases are not included in the evaluation\ndue to patient's age.\n2. No evidence of pulmonary embolism or acute aortic abnormality.\n3. No evidence of pneumonia."
        },
        {
            "input": "CHEST CTA:  The thoracic aorta is normal caliber without evidence of aneurysm\nor dissection.  The main, lobar, segmental, and subsegmental pulmonary\narteries are well opacified without filling defect.  There is heavy\ncalcification of thoracic aorta.\n\nCHEST:  The thyroid is normal.  There are multiple enlarged mediastinal lymph\nnodes, measuring up to 1.3 cm (2a: 24).  Axillary, supraclavicular and hilar\nlymph nodes appear within normal size limits.  There is calcification of\ncoronary arteries.  Heart is mildly enlarged.  Prosthetic aortic and mitral\nvalves are noted.  The pericardium is intact without effusion.  Airways are\npatent to the subsegmental levels.\n\nNo pneumothorax or pneumomediastinum. Diffuse septal thickening, scattered\nground-glass opacities, as well as small right pleural effusion and trace left\npleural effusion are compatible with moderate pulmonary edema.  There is\nbibasilar atelectasis.  Scattered bilateral calcified pleural plaques are\nsuggestive of prior asbestos exposure, similar compared to ___.\n\nThe esophagus is unremarkable.\n\nAbdomen:  There is a 1.0 cm hypodensity the right lobe of the liver (2b:104). \nThe liver has congested appearance with uneven enhancement pattern.  \nHorseshoe kidney with multiple simple renal cysts, largest measuring 1.0 x 6.7\ncm on the left.  No evidence of hydronephrosis on the right.  There is left\ncongenital ureteropelvic junction obstruction likely due to a crossing vessel\nthough this is not clearly visualized.  The spleen, gallbladder, adrenal\nglands, and pancreas are unremarkable.  The stomach and duodenum are\nunremarkable. Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The abdominal aorta is focally aneurysmal measuring up to 2.5 cm\nin diameter at L3/4 level.  No abdominal lymphadenopathy, free air or free\nfluid is seen.  Left fat containing inguinal hernia is noted.\n\nPelvis: Bladder and prostate are unremarkable.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Sternotomy wires\nare intact.",
            "output": "1.  No pulmonary embolism.  Moderate pulmonary edema and small right pleural\neffusion.\n\n2.  Multiple intrathoracic lymphadenopathy could be reactive.  Please\ncorrelate clinically.  No lymphadenopathy is identified in the abdomen or\npelvis.\n\n3.  Congestive appearance of the liver, likely reflects heart failure.\n\n4.  Horseshoe kidney with congenital left ureteropelvic junction obstruction. \nMultiple simple renal cysts are noted measuring up to 6.7 cm.\n\nDOSE:  DLP 1547 mGy-cm."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Moderate atherosclerotic calcifications are noted in the\naorta and along the ostia of branch vessels.\n\nThe heart is mildly enlarged.  There is no pericardial effusion.  Postsurgical\nchanges related to CABG, aortic, mitral, and tricuspid valve replacements are\nnoted.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are no pathologically enlarged axillary\nor supraclavicular lymph nodes.  Multiple enlarged mediastinal lymph nodes are\ngrossly unchanged.  For example a subcarinal lymph node conglomerate measures\n17 x 32 mm, previously 16 x 35 mm (3:73), multiple right lower paratracheal\nlymph nodes measure up to 16 x 22 mm, previously 18 x 20 mm (03:23), and a\nprecarinal lymph node measures 14 x 23 mm, previously 17 x 25 mm (03:50). \nNumerous additional lymph nodes in the prevascular, aorticopulmonary window,\nand bilateral hilar stations are also grossly unchanged.\n\nPLEURAL SPACES:  A small right pleural effusion has slightly decreased in size\ncompared to the prior examination.  Scattered calcified pleural plaques are\nnoted.\n\n\nLUNGS/AIRWAYS:  Evaluation of lung parenchyma is limited by expiratory phase\nof imaging resulting in subsegmental atelectasis and areas of air trapping. \nIncreased ground-glass opacity within both lungs may reflect mild volume\noverload, however this is better assessed on the recent chest radiograph.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for small\nperihepatic ascites.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThe sternotomy wires are noted.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Mild cardiomegaly and postsurgical changes related to aortic, mitral, and\ntricuspid valve replacements and CABG.\n\n3.  Small right pleural effusion.\n\n4.  Unchanged mediastinal and hilar lymphadenopathy.\n\n5.  Small perihepatic ascites."
        },
        {
            "input": "No incidental thyroid findings.  Status post CABG and sternotomy.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  The moderate\nhilar and mediastinal lymphadenopathy (2, 18) is stable in appearance.  Severe\naortic arch calcifications.  Severe coronary calcifications.  Status post\naortic valvular replacement.  No pericardial effusion.  Global enlargement of\nthe heart.  No acute findings are noted in the upper abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nModerate degenerative vertebral disease.  No vertebral compression fractures. \nThe assessment of the lung parenchyma is limited by respiratory motion.  Mild\nto moderate fibrotic changes in the posterior portions of both lower lobes. \nGround-glass opacities at the bases of the middle lobe and the lingular,\nlikely reflecting infectious disease.  No pleural effusions.  No pleural\nthickening.  Signs of mild chronic airways disease.",
            "output": "Stable dorsal fibrosis.  Stable moderate cardiomegaly and status of the CABG. \nNo pleural effusions.  Ground-glass opacities in the middle lobe and the\nlingula could reflect infectious disease.  No suspicious lung nodules or\nmasses.  Pre-existing hilar and mediastinal lymphadenopathy is stable."
        },
        {
            "input": "The left jugular vein is widened, potentially by an exaggerated Valsalva\nmaneuver.  No supraclavicular, infraclavicular or axillary lymphadenopathy. \nNo enlarged lymph nodes in the mediastinum and at the hilar level. Mildly\ndilated pulmonary arteries might reflect pulmonary hypertension. The bronchial\narteries are not enlarged. The opacifications of the pulmonary arteries is\nsufficient to rule out the presence of pulmonary emboli in the central and\nsegmental vessels.  Borderline diameter of the heart.  No bulging of the\nseptum.  No pericardial effusion.  Moderate coronary calcifications, moderate\naortic wall calcifications.  Mild bilateral apical scarring.  Non\ncharacteristic scarring in the right lower lobe apex. Minimal anterior\nsubpleural fibrosis at the bases of the middle lobe.  No pleural effusions. No\npleural thickening.  Small right Bochdalek's hernia.  No suspicious lesions in\nthe lung parenchyma. .  The airways are patent.",
            "output": "No evidence of acute pulmonary embolism. No current vascular, parenchymal or\ncardiac changes attributable to pulmonary embolism."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild coronary calcifications.  Otherwise, the heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  Left PICC line terminates in the upper SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  There are\nmultiple small mediastinal and right hilar lymph nodes, which may be reactive\nin nature.  For example, a right upper paratracheal lymph node measures 7 mm\nin short axis (series 4, image 43).  There also multiple subcarinal lymph\nnodes.  No mediastinal mass.\n\nPLEURAL SPACES: There is a moderate-sized nonhemorrhagic left pleural effusion\nwith compressive atelectasis of the left lower lobe.  There is also a trace\nright pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Compressive atelectasis of the left lower lobe.  Ground-glass\nopacities within the upper lobes bilaterally, right greater than left.  There\nis also mild ground-glass opacification within the superior segment of the\nright lower lobe.  No other focal consolidations.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a large loculated fluid collection within the left upper\nabdomen with peritoneal thickening and enhancement.  There is also compression\nof the left hepatic lobe by this loculated collection.  There is also a\nsmaller loculated pocket of fluid within the gastrohepatic space, which\nappears contiguous with the larger left upper quadrant collection.  Fluid\nthere is a small amount of free fluid adjacent to the liver capsule on the\nright.  There is a large heterogeneous left adrenal nodule measuring 5.6 x 3.4\ncm (series 4, image 138), previously characterized as an adenoma.  There is\nalso a hypodensity arising from the upper pole of the left kidney,\ncharacterized as a cyst on the MR dated ___.\n\nBONES: Multiple chronic healed rib fractures are seen bilaterally.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Large loculated left upper peritoneal fluid collection with peritoneal\nthickening and enhancement, increased in size compared to the MR dated ___.  There is mass effect on the left lobe of the liver and left\nhemidiaphragm.  This fluid collection may explain the patient's shortness of\nbreath.\n3. Moderate left pleural effusion with associated compressive atelectasis. \nTrace right pleural effusion.\n4. Ground glass opacities within the upper lobes bilaterally, which should be\ncorrelated clinically for signs of infection.  Alternatively, this may reflect\nmosaic attenuation from hypoinflation.\n5. Unchanged large left adrenal adenoma."
        },
        {
            "input": "CHEST:  Mitral valvular, coronary arterial, and aortic atherosclerotic\ncalcifications are noted.  The heart and great vessels are otherwise\nunremarkable without evidence of acute injury.  There is no mediastinal\nhematoma.  There is no pericardial effusion.  There is no lymphadenopathy. \nThe imaged thyroid is normal.\n\nSmall bilateral pleural effusions with adjacent compressive atelectasis are\nnoted.  A 1.0 cm semi-solid pulmonary nodule in the right upper lobe is noted\n(2: 53).  Airways are patent to the subsegmental level.  There is no evidence\nof contusion or laceration.  There is no pneumothorax. A large uncomplicated\nparaesophageal hernia is noted.\n\nABDOMEN:  The liver is intact without signs of acute injury.  A 3.8 x 3.2 cm\nhypodense, peripherally nodular enhancing lesion in segment V represents a\nlarge hemangioma (2:94).  Additional smaller hypodensities in segment ___ and\n___ are too small to fully characterize and may represent simple cysts or\nbiliary hamartomas (2:  76, 77).  The spleen is intact and normal in size. \nFatty atrophy of the pancreas is noted.  The gallbladder and adrenals are\nunremarkable.  The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis.  Two small simple cysts are noted within the right\nkidney  There is no evidence of renal or collecting system injury.  The\nabdominal aorta is normal in course and caliber with widely patent major\nbranches.  No lymphadenopathy, free air, or free fluid.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  Diverticulosis is noted without\nevidence diverticulitis.  The appendix is normal.  The bladder is decompressed\nabout a Foley catheter.  There is no pelvic free fluid.\n\nBONES:  Significant kyphosis due to multiple vertebral compression fractures,\nmost severe at T9, without significant retropulsion to compromise the spinal\ncanal.  No rib fractures are identified.  No focal suspicious osseous\nabnormality.  Diffuse demineralization is noted as is a left hip\nhemiarthroplasty\n\nVASCULATURE:  A nonocclusive thrombus is seen within the right common femoral\nvein (2:178).  Extensive calcification of the abdominal aorta and iliac\narteries noted.",
            "output": "1. No evidence of rib fractures or acute intra-abdominal injury.\n2. Nonocclusive thrombus within the right common femoral vein.\n3. Multilevel vertebral compression fractures most severe at T9 without\nretropulsion.\n4. Large uncomplicated paraesophageal hernia.\n5. 1 cm subsolid pulmonary nodule the right upper lobe for which 3 month\nfollowup chest CT is recommended.\n6. Small bilateral pleural effusions.\n7. Extensive atherosclerotic calcifications.\n\nRECOMMENDATION(S):  3 month followup chest CT is recommended for 1 cm sub\nsolid pulmonary nodule.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. \n___ on the telephone on ___ at 11:47 ___, 25 minutes after the\ndiscovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Very patulous esophagus with slightly thickened\nwall.  No hilar or mediastinal lymphadenopathy.  No abnormalities at the level\nof the large mediastinal vessels.  No incidental pulmonary embolism.  Mild\nenlargement of the right heart.  Moderate hiatal hernia.  Severely cirrhotic\nliver and splenic enlargement.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Mild bilateral apical scarring.\nMild thickening any irregularities of the airway walls.  Multiple pulmonary\nmicro nodules, non of which is suspicious for malignant disease.  No pleural\neffusions.  No pleural thickening.  The airways are patent.  No diffuse lung\ndisease.",
            "output": "Severely cirrhotic liver.  Splenomegaly.  Patulous esophagus with a slightly\nthickened wall, combines to a moderate hiatal hernia.  Several pulmonary\nmicronodules.  There is no CT correlate of the 5 mm nodule seen on a previous\nchest x-ray examination."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  There is moderate atherosclerotic calcification of\nthe aorta and the heart, pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.  Moderate coronary artery\ncalcifications are seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Moderate to severe upper lobe predominant paraseptal and\ncentrilobular emphysema is noted.  There is a 4 mm right middle lobe\nsubpleural nodule along the minor fissure, similar to prior (2:82) and likely\nbenign.  There is no focal consolidation.  There is mild bronchial wall\nthickening bilaterally suggestive of mild airways inflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation throughout suggestive of\nhepatic steatosis.  There is no evidence of focal lesion or laceration.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: There are scattered calcifications throughout the pancreas with\npancreatic parenchymal atrophy and pancreatic ductal dilatation up to 1.4 cm\nwith intraductal calculi, similar to prior consistent with chronic\npancreatitis.  There is no peripancreatic fatty stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is cortical scarring in the left upper pole.  There is a\nsubcentimeter hypodense lesion in the left upper pole, too small to\ncharacterize but likely represents a cyst, similar to prior (2:150). \nOtherwise, the kidneys are of normal and symmetric size with normal\nnephrogram.  There is no evidence of solid renal masses or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.  In the perianal region, there is linear\nenhancement in the subcutaneous soft tissues bilaterally with possible tracts\nfrom the anus suspicious for perianal fistulous disease (2; 265).\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: Evaluation is limited due to streak artifact from the hardware in\nbilateral hips.\n\nThe urinary bladder is extremely distended.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nChronic fracture deformity of the right clavicle and right scapula is noted. \nChronic fracture deformities of the right fourth through seventh ribs and left\nthird through seventh ribs are seen with chronic nonunion of the left fifth\nthrough seventh rib fractures.  Patient is status post left hip\nhemiarthroplasty and status post right proximal femoral fixation without gross\nhardware complication.\n\nSOFT TISSUES: In the subcutaneous tissues of the right forearm, there is a\npartially visualized high density region in the subcutaneous soft tissues\nconcerning for contrast extravasation.",
            "output": "1. No acute traumatic abnormality.\n2. Enhancing tracts in the perianal soft tissues bilaterally concerning for\nperianal fistulous disease.  Correlate clinically with physical exam and\nfurther evaluation can be performed with nonurgent MR pelvis.\n3. High density material in the subcutaneous soft tissues of the right forearm\ncompatible with contrast extravasation (and confirmed on subsequent\nradiograph).  Please see note in the patient's OMR for further details.\n4. Likely hepatic steatosis.\n5. Unchanged 4 mm right middle lobe pulmonary nodule.\n6. Chronic pancreatitis similar to prior.\n\nRECOMMENDATION(S):\n1. Nonurgent MRI pelvis with contrast to assess perianal fistulous disease.\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by ___, M.D.\non the telephone on ___ at 11:00 pm, 5 minutes after discovery of the\nfindings.\n The updated findings were discussed with Dr. ___. by ___, M.D. on\nthe telephone on ___ at 11:25 pm, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There are\nsevere coronary artery atherosclerotic calcifications and moderate\natherosclerotic calcifications of the aortic arch and its main branches.  The\nheart, pericardium, and great vessels are otherwise within normal limits based\non an unenhanced scan. No pericardial effusion is seen.  Low attenuation of\nthe blood pool with respect to the myocardium suggests anemia.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes, the\nlargest of which is pretracheal node measures 9 mm may be reactive.  No\naxillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: There is a trace left pleural effusion.  No right pleural\neffusion or pericardial effusion.\n\nLUNGS/AIRWAYS: Severe bilateral centrilobular and paraseptal emphysema is\nagain seen.  Bilateral scattered ground-glass opacities involving the lingula,\nposterior right middle lobe, posterior right upper lobe, and bibasilar\nconsolidative opacities are new since ___ and may reflect aspiration or\ninfection.  Bronchial wall thickening has increased compared to prior.\n\nBASE OF NECK: The imaged portions of the base of the neck show no abnormality.\n\nABDOMEN:\nThe pancreatic parenchyma is severely atrophic with multiple coarse\ncalcifications and dilation of the main pancreatic duct to approximately 12\nmm, similar to prior, consistent with chronic pancreatitis.  Intraductal stone\nis unchanged in position.  No peripancreatic stranding to suggest acute\ninflammation.  The spleen and imaged portion of liver and kidneys are\nunremarkable.  The small hiatal hernia is redemonstrated.  Hyperdense likely\nhemorrhagic cyst noted within the left kidney anteriorly.\n\nBONES: No concerning lesions are identified.  Multiple chronic fracture\ndeformities of the bilateral lateral ribs are again seen.  Slight interval\ndisplacement and bone callus formation of previously seen left lateral fourth\nrib fracture.  Small amount of adjacent hematoma is seen abutting the pleura. \nNo interval new fractures are identified.  Bilateral gynecomastia is noted.",
            "output": "1.  No acute fracture or traumatic injury within limits of unenhanced scan. \nSlight interval displacement of a left lateral fourth rib fracture seen on\nprior with adjacent small hematoma.\n2.  Scattered ground-glass opacities and bibasilar consolidative opacities are\nnew since ___ and may reflect aspiration or infection.\n3.  Evidence of chronic pancreatitis and pancreatic ductal dilation secondary\nto intraductal stone are unchanged.  No evidence of acute inflammation.\n4.  Severe coronary artery atherosclerosis"
        },
        {
            "input": "CHEST: The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is normal in course and caliber with mild\natherosclerotic calcifications.  There is dense coronary artery calcification.\nThe heart is not enlarged and there is no pericardial effusions seen.  The\nmain pulmonary artery is at the upper limits of normal at 3 cm in diameter. \nNo lymphadenopathy.  The esophagus is decompressed.  The airways centrally\npatent.  No pleural effusion or pneumothorax.  Severe emphysema is noted. \nThere is mild diffuse bronchial wall thickening likely reflecting chronic\nairways inflammation.  No worrisome nodule, mass, or consolidation.  No signs\nof acute lung injury.\n\nABDOMEN: Diffuse hypoattenuation of the hepatic parenchyma is consistent with\nsteatosis.  No discrete liver lesion on this unenhanced exam.  The gallbladder\nappears normal.  Diffuse pancreatic ductal dilation with pancreatic\ncalcifications appear similar to prior and likely reflect the sequelae of\nchronic pancreatitis.  Previously described intraductal pancreatic stone is\nagain seen on series 2, image 140.  No signs of pancreatitis.  The spleen is\nnormal in size.  The adrenal glands are normal bilaterally.  The kidneys\nappear unchanged with a small hyperdense cortical lesion arising from the\nmidpole left kidney measuring approximately 10 x 8 mm, possibly a hemorrhagic\ncyst.  This lesion measures approximately 94 Hounsfield units centrally.  No\nadditional renal lesions or hydronephrosis.  The abdominal aorta is densely\ncalcified and normal in caliber.  No retroperitoneal hematoma or adenopathy. \nNo free air or free fluid.  The stomach and duodenum appear grossly\nunremarkable.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is not definitively visualized though there are no secondary signs of\nappendicitis.  The colon contains a mild fecal load.  No pelvic free fluid. \nStreak artifact through the pelvis from bilateral hip hardware limits\nevaluation.  The urinary bladder is well distended and appears intact.  No\npelvic sidewall or inguinal adenopathy.\n\nBONES: Acute fractures involving T10 and T11 without significant fracture\ndisplacement, retropulsion, or alignment abnormality.  Findings are best seen\ninvolving the inferior endplate of T10 on series 604, image 78 as well as\nseries 602, image 80.  A subtle fracture line is also seen involving the T10\nvertebral body on series 602, image 86.  There is minimal surrounding\nperivertebral hematoma.  No additional acute fracture seen.  Multiple subacute\nand chronic rib deformities are seen.  Incompletely healed fractures on the\nleft involves the fourth lateral arch, series 3, image 42, as well as the left\nseventh through ninth ribs along the lateral arch.  Subacute fractures are\nseen involving the right third anterior arch and the right tenth lateral arch.\nMultiple chronic rib deformities are also seen.",
            "output": "1.  Acute compression fractures involving T10 and T11 without significant\ndisplacement, retropulsion, or alignment abnormality.  Mild perivertebral\nhematoma noted.\n2.  Multiple subacute rib fractures as above.\n3.  Nonemergent findings include severe emphysema, hepatic steatosis,\nhyperdense left renal cyst likely a hemorrhagic cyst."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSubcentimeter left supraclavicular lymph node, 2:17, unchanged since ___.  2 subcentimeter sub muscular soft tissue nodules in the left lateral\nchest wall, 2:38-43  are new as is generalized edema on that side, suggesting\nprolonged left cubitus positioning.  Similar size subcutaneous soft tissue\nnodules on the right, 2:59, are unchanged.  There is no drainable fluid\ncollection.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, but shows no\nadrenal mass or subphrenic fluid collection and severe dystrophic\ncalcification in the pancreas as well as severe atherosclerotic calcification\nin the incompletely imaged mid abdominal aorta.\n\nCARDIO-MEDIASTINUM: Esophagus is cannulated by a drainage tube ending in the\nmidportion of a fluid-filled stomach.  Atherosclerotic calcification is heavy\nin the brachiocephalic all major coronary arteries.  Aorta and pulmonary\narteries are normal size.  Hypoattenuation of cardiac contents suggests\nanemia.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Changes as follows:\n\n13 mm right lower paratracheal mediastinum, previously 9 mm, and subcentimeter\nnodes in the right lower paratracheal and posterior paraesophageal stations\nare also larger than before.  Substantial adenopathy at the lower pole of the\nright hilus on this noncontrast study would be indistinguishable from severe\nadjacent consolidation.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is extremely severe in the right upper lobe\nwith air giant bullae, moderate in the left upper lobe and milder elsewhere. \nSevere peribronchial infiltration has developed in the right upper lobe since\n___, most likely acute pneumonia.  Coarse reticular abnormality in\nthe left upper lobe could be an earlier stage of the same infection or a\ndifferent pathogen.  In order to suggest an alternative diagnosis of post ARDS\norganizing fibrosis, would require intervening imaging showing the expected\nprogression.\n\nRight lower lobe is entirely consolidated.  It is homogeneous, but in the\nabsence of intravenous contrast agent I cannot tell whether it is due to\ncollapse or severe infection.  There is no obstructing mass although there is\na moderate amount of retained secretions, more superiorly in the right main\nbronchus at the origin of the upper lobe.\n\nSubpleural consolidation left lower lobe is also either atelectasis or\npneumonia.  Small left pleural effusion is not material.\n\nCHEST CAGE: Moderate compression T11 vertebral body unchanged since ___\nis new since ___, does not look pathologic.  Numerous bilateral rib\nfractures in various stages of healing are more numerous on the left side\ntoday than they were in ___.  Many other healing fractures are non\nfused..",
            "output": "New severe pneumonia, right upper lobe definitely, right lower lobe probably\n(although conceivably collapsed rather than infected), left upper lobe\nprobably.  In the absence of a series of very convincing intervening chest\nradiographs since ___, this does not look like diffuse alveolar\ndamage.  Mild reactive central adenopathy.\n\nSevere atherosclerotic calcification, all coronary and brachiocephalic artery.\n\nMultiple new, predominantly left rib fractures, an"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: There is a borderline enlarged right lower paratracheal lymph\nnode measuring 10 mm.  There is mild concentric thickening of the esophagus,\nwhich most likely represents esophagitis.\n\nHILA: There is an enlarged right hilar lymph node measuring 14 mm and a\nborderline enlarged left hilar lymph node measuring 10 mm.\n\nHEART AND VESSELS: The heart is normal in size.  There are extensive coronary\nartery atherosclerotic calcifications.  No pericardial effusion is identified.\n\nPLEURA: There is a small left pleural effusion without internal complexity.  A\ntrace right pleural effusion is also noted.  There is a small fat containing\nright Bochdalek hernia.\n\nAIRWAYS/LUNG: There is mucus/debris within the right mainstem bronchus. \nBronchial wall thickening likely represents chronic bronchitis.  There are\nsevere emphysematous changes.  There has been significant improvement in the\nmultiple areas of consolidation in the bilateral upper lobes and bilateral\nlower lobes, which are consistent with resolving multifocal pneumonia.\n\nBONES: There is redemonstration of the comminuted fracture through the\nsurgical neck of the left humerus with extension into the humeral head and\ninvolvement of the lesser and greater tuberosities.  Acute mildly displaced\nfracture through the lateral aspect of the left 4th rib and nondisplaced\nfractures through the anterior aspects of the left ___ through 6th ribs, and\nthe posterolateral aspect of the left 5th rib are unchanged.  There are\nadditional subacute and chronic bilateral rib fractures in various stages of\nhealing.  The subacute anterior wedge compression deformity of T11 and\nsubacute fracture through the manubrium are unchanged.\n\nSOFT TISSUES: Mild bilateral gynecomastia is noted.\n\nUPPER ABDOMEN: The study was not tailored for evaluation of the\nsubdiaphragmatic structures.  Partially visualized calcifications in the\npancreatic parenchyma are consistent with sequela from chronic pancreatitis. \nThere are multiple calcified lymph nodes in the upper abdomen.",
            "output": "1.  Interval improvement in the multifocal pneumonia.\n2.  Mucus/debris within the right mainstem bronchus.\n3.  Small left and trace right pleural effusions.\n4.  Multiple acute, subacute and chronic fractures, as detailed above."
        },
        {
            "input": "CHEST:  Imaged thyroid gland appears normal.\n\nNo axillary or supraclavicular lymphadenopathy.  Scattered mediastinal lymph\nnodes are not pathologically enlarged, measuring up to 4 mm in the right lower\nparatracheal station.  No hilar lymphadenopathy.\n\nHeart size is normal, without a pericardial effusion.  Coronary artery\ncalcifications are noted.  Thoracic aorta is normal in course and caliber,\ncontaining mild atherosclerotic calcifications throughout.  Main pulmonary\ntrunk is normal in caliber.\n\nAirways are patent to the segmental bronchi bilaterally.  There is severe\nupper lobe predominant paraseptal and centrilobular emphysema.  No pulmonary\ncontusion, laceration or pneumothorax.  There is no pleural effusion. \nScattered ground-glass opacities at the lung bases bilaterally may represent\naspiration or infection.\n\nBilateral gynecomastia.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is homogeneously hypoattenuating relative to the spleen,\nconsistent with hepatic steatosis.  There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS:  The pancreas is diffusely atrophic, with diffuse ductal dilation\nmeasuring up to 1.2 cm (2:69), unchanged from ___.  Additional\nfinding of scattered parenchymal calcifications, consistent with chronic\npancreatitis.  No peripancreatic fat stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Right kidney is normal in size with homogeneous enhancement\nthroughout.  There is a cortical defect along the upper pole of the left\nkidney, likely a sequela of prior insult.  Left kidney otherwise enhances\nhomogeneously.  There is a 1.0 by 0.9 cm simple cyst arising from the\ninterpolar region of the left kidney.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Large bowel loops\ndemonstrate normal caliber and wall enhancement throughout.  There is\nsuggestion of wall thickening involving the ascending colon and rectum,\nalthough evaluation is slightly limited by luminal underdistension.  It is\nunclear whether this represents wall edema or prominent intramural fat in the\nsetting of chronic inflammation.  There is moderate fecal loading throughout\nthe colon and rectum.  Appendix is not identified, but there are no secondary\nsigns of acute appendicitis.  No ascites.  No pneumoperitoneum.\n\nPELVIS:  Evaluation of the pelvic structures is slightly limited by extensive\nstreak artifact.  Urinary bladder is grossly unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is grossly unremarkable in appearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES:  There is a nondisplaced fracture of the distal right clavicle (2:1). \nFractures of the right fourth and fifth ribs may be acute to subacute.  Remote\nfractures of the posterior right eighth, ninth and tenth ribs.  Lateral left\nfourth rib fracture appears subacute to chronic.  Right femoral neck screw is\nintact, without hardware loosening.  Patient is post left hip\nhemiarthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right lateral ___ and 5th rib fractures appear acute to subacute.  Left\nlateral 4th rib fracture is subacute to chronic.\n2. Nondisplaced right distal clavicular fracture.\n3. No other sequela of trauma within the chest, abdomen or pelvis.\n4. Equivocal wall thickening in the ascending colon and rectum, which is\nnonspecific and may represent either chronic inflammation or wall edema in the\nsetting of colitis.  Clinical correlation is recommended.\n5. Hepatic steatosis.\n6. Pancreatic parenchymal atrophy, diffuse ductal dilation and scattered\ncalcifications, consistent with chronic pancreatitis.\n7. Scattered bibasilar ground-glass opacities, suspicious for aspiration or\ninfection.\n8. Severe upper lobe predominant paraseptal and centrilobular emphysema.\n9. Diffuse coronary artery calcifications.\n\nNOTIFICATION:  Updated findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:58 ___, 30 minutes after\nattending discussion."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is mild\natherosclerosis of the aortic arch with no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere are mildly enlarged mediastinal and hilar lymph nodes.  A right\nparatracheal node measures 1.1 cm short axis diameter, and a right hilar lymph\nnode measures 1 cm.  The thyroid gland appears unremarkable.  A right-sided\nPICC line terminates near the atrial caval junction.  There is no significant\npericardial effusion.\n\nThere are large bilateral pleural effusions with associated subsegmental\natelectasis. There are bilateral diffuse ground-glass opacities involving all\nlobes, with patchy areas of consolidation in the dependent aspects\nbilaterally, and in the left upper lobe near the apex.  There is background of\nsevere paraseptal and centrilobular emphysema, predominantly in the upper\nlobes.  No evidence of pneumothorax. A small amount of debris is seen in the\ntrachea.  Peribronchial thickening is noted.\n\nLimited images of the upper abdomen demonstrates free fluid..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere are old bilateral rib fractures.",
            "output": "1.  No evidence of pulm4onary embolism.\n2.  Diffuse bilateral ground-glass opacity with patchy areas of consolidation\nconsistent with the patient's known history of aspiration pneumonia.\n3.  Large bilateral pleural effusions with associated subsegmental\natelectasis."
        },
        {
            "input": "The imaged thyroid gland is unremarkable. There is no supraclavicular or\naxillary adenopathy identified. A previously 18 x 11 mm right lower\nparatracheal node currently measures 14 x 9 mm (2:25), decreased in size.\nThere is no hilar adenopathy. Esophagus is without a focal abnormality. The\nheart is mildly enlarged. There is no pericardial effusion. The aorta and\npulmonary arteries are normal in caliber.  Airways are patent to the\nsubsegmental level.\n\nPatient is status post right thoracotomy, trachobronchoplasty with mesh, and\nright middle lobectomy. Biapical scarring is noted. Patient is additionally\nstatus post left upper lobe wedge resection.  Several calcified nodules are\nidentified bilaterally (6:51, 48, 59). Several sub 4 mm nodules are noted\nwithin the right upper lobe (6:70, 83, 85), all of which are stable. The\nlargest pulmonary nodule within the right upper lobe currently measures 5 mm,\n(6:147) additionally stable.  Within the right lower lobe, a 5 mm nodule\n(6:123) is unchanged.  Within the healed basal segment of the right lower\nlobe, there is a 5 mm nodule (6:265) which appears more conspicuous on current\nexamination.\n\nWithin the left upper lobe, several sub 4 mm nodules are again seen (6:50,\n54), unchanged.  Within the left lower lobe, a previously 4mm nodule is\ndecreased in size measuring 3mm (6:226).  Just inferiorly, a similar appearing\nnodule is seen (6:231) measuring 3mm, previously 5mm.  Pleural thickening\nalong the lateral aspect of the left upper lobe wedge resection is noted the\nsignificantly unchanged from prior study. Prior anterior lingular rounded\nconsolidation is no longer present.  A small left pleural effusion is noted,\ndecreased since ___.\n\nStudy is not tailored for subdiaphragmatic evaluation. Allowing for this, no\nacute abdominal abnormality is detected.\n\nOsseous structures demonstrates no suspicious lytic or blastic lesion. Chronic\nappearing fractures through the fourth and fifth right posterolateral ribs is\nseen.",
            "output": "1.  Multiple pulmonary nodules which appear stable since most recent\nexamination dated ___.  The largest 5mm nodule within the right\nupper lobe appears stable dating back to at least ___.\n\n2.  Resolution of prior round lingular consolidation or abscess.  No new\nconsolidation is seen.\n\n3.  Small residual left nonhemorrhagic pleural effusion, decreased since prior\nexamination dated ___."
        },
        {
            "input": "Quality of the study is limited by absence of intravenous contrast. Allowing\nfor this limitation, unremarkable thyroid gland.\n\nNo supraclavicular, axillary, internal mammary, mediastinal, or hilar\nlymphadenopathy.\n\nMild cardiomegaly.  No pericardial fluid.  A right-sided single lead\npacemaker/ICD is in situ.  Tip projects over the apex of the right ventricle. \nHeavy coronary calcification.\n\nHyperdensity of the thoracic aortic wall may be related to underlying anemia. \nMild atheromatous calcification of the descending thoracic aorta.  Additional\ncalcification at the origins of the great arch vessels.  Allowing for motion\nartifact, the ascending aorta is ectatic at 3.9 cm in diameter.\n\nThe main pulmonary artery is mildly dilated (3.5 cm).  This may reflect\nunderlying pulmonary hypertension.\n\nCentral airways patent.\n\nMotion artifact related to breathing.  Allowing for this limitation, mild\ndependent atelectasis.  No consolidation in either lung.  No cavitating lung\nlesions.  Incidental azygos fissure on the right.\n\nNo pleural effusions or pneumothorax.\n\nLimited assessment of the upper abdomen.  Atrophic pancreas.  Incidental\naccessory spleen.  Bilateral renal cortical cysts.  No acute upper abdominal\npathology.\n\nNo acute or focal destructive osseous lesions.  Diffuse syndesmophyte\nossification.  This is typically seen in the context of ankylosing\nspondylitis.",
            "output": "Allowing for the limitations of the study, no evidence of pneumonia.  No\ncavitating lesions.\n\nNo acute intrathoracic pathology otherwise."
        },
        {
            "input": "The thyroid is normal.\n\nEnlarged supraclavicular lymph nodes measure up to 9 mm on the right side.\n\nMultiple enlarged mediastinal lymph nodes measure up to 13 mm in the right\nlower paratracheal station. In the right hilum lymph nodes measure up to 7 mm.\n\nAorta and pulmonary arteries are normal size.\nThere is mild to moderate cardiomegaly, there is no appreciable coronary\ncalcification.\nSmall interlobular septal thickening associated with ground-glass opacities\nsuggest interstitial pulmonary edema.\nThere is scarring in the right apex.  Diffuse mild bronchiectasis predominates\nin the lower lobes\nRight perifissural triangular nodule likely a intrapulmonary lymph node\n(6:163)\nLeft apical lung nodule measures 4 mm (6:  23).\nThere is no pericardial effusion.  Small bilateral pleural effusions are\nlarger on the right.\n\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nPort a cath tip is in the upper SVC\n\nThere are no bone findings of malignancy",
            "output": "Mild interstitial pulmonary edema\n4 mm left apical lung nodule attention in followup studies is recommended.\nMediastinal lymphadenopathy could be related to the pulmonary edema or\nmetastatic"
        },
        {
            "input": "The pulmonary arteries are well opacified to the segmental level.\nSevere respiratory motion artifacts limit the evaluation of the study and\nsubsegmental pulmonary emboli are suspected in the right lower lobe, series\n302:129 for example or in the left upper lobe series 301: 58, 42.\nNo  evidence of filling defect within the main, right, left, lobar pulmonary\narteries.\nThe main and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\nThere is no cardiomegaly and no pericardial effusion.\nLeft central line terminates in the right atrium.\nIn this non gated study the aorta and its major branch vessels are patent,\nwith no evidence of stenosis, occlusion, dissection, or aneurysmal formation. \nThere is no evidence of penetrating atherosclerotic ulcer or aortic arch\natheroma present.\n\nThe lung apices are not included in the study.\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nMajor airways are patent with minimal secretions in the lower trachea and\ncarina and scattered bronchial impactions in the lower lobes.\nEndotracheal tube in good position.\nSmall bilateral pleural effusions with secondary compressive atelectasis, left\ngreater than right.\nHeterogeneous ground-glass opacities involving both lungs is most probably\ninfections in origin.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "-Severe respiratory motion artifacts limit evaluation of the study,\nsubsegmental pulmonary emboli are suspected in the right lower lobe and left\nupper lobe.  No central pulmonary emboli or signs of right heart strain.\n-Small bilateral pleural effusion with adjacent compressive atelectasis, left\ngreater than right.\n-Bilateral heterogeneous ground-glass opacities are most probably infectious\nin origin.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:42 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber, without\nevidence of acute injury within limitations of a noncontrast study.  There are\nmild atherosclerotic calcifications of the thoracic aorta.  The main pulmonary\nartery is normal in caliber.  There are mild coronary calcifications.  Heart\nsize is normal.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no mediastinal or hilar\nlymphadenopathy.  There is no mediastinal hematoma.  There is no axillary\nlymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Subpleural reticulation throughout the bilateral lungs suggests\nmild interstitial fibrosis.  There is a 6 mm subpleural nodule in the medial\nright apex (2:25), possibly subpleural scarring.  There is no consolidation. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The left thyroid lobe is asymmetrically enlarged within\nunderlying 9 mm hypodense nodule (series 2, image 12).\n\nABDOMEN:  Included portion demonstrate a markedly nodular liver contour,\ncompatible with cirrhosis.  There is small volume perihepatic and perisplenic\nascites.  The gallbladder is distended and contains small stones.  There is no\ngallbladder wall thickening or surrounding inflammatory change.  There is\nhypodensity in the anterior cortex of the upper pole of the right kidney\nmeasuring 17 mm, compatible with cyst.  The right kidney is normal in size. \nThere is fullness of the right renal collecting system.  There is atrophy of\nthe left kidney.\n\nBONES: There is no acute fracture.  There is no soft tissue hematoma of the\nchest wall.",
            "output": "1. No evidence of traumatic injury in the thorax.\n2. Subpleural reticulation throughout the bilateral lungs suggests mild\ninterstitial fibrosis.\n3. 6 mm subpleural nodule in the right apex, possibly subpleural scarring.\nPlease refer to ___ guidelines below for detailed follow-up\nrecommendations.\n4. Cirrhotic liver with small volume ascites.\n5. Asymmetrically enlarged left thyroid lobe with an underlying 9 mm hypodense\nnodule.  Findings may be further assessed with thyroid ultrasound on a\nnonemergent basis.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is heavy in head neck\nvessels particularly left subclavian artery, and in major coronary arteries. \nAortic valvular case calcification is moderate.  Aorta and pulmonary arteries\nare normal size.  Central lymph nodes are not pathologically enlarged.  There\nis no pericardial or pleural effusion.\n\nMild emphysema is better appreciated on the earlier chest CT.  Upper lungs are\nclear aside from mild dependent edema micro atelectasis along the major\nfissures in the upper lobe.  Atelectasis at the lung bases, particularly right\nlower lobe and lingula is attributable to elevated hemidiaphragms.  There are\nno lung nodules and no consolidation.\n\nThere are no bone lesions in the chest cage suspicious for malignancy alert\nshould be noted that radionuclide bone and PET scanning are more sensitive in\ndetecting early metastasis than chest CT.",
            "output": "No evidence of intrathoracic or chest cage malignancy, primary or metastatic.\n\nSevere atherosclerosis, in head neck vessels particularly left subclavian\nartery and in major coronary arteries.  Sufficient aortic valvular\ncalcification to produce aortic stenosis, should be evaluated clinically.\n\nMild emphysema.  Basal atelectasis attributable to chronic diaphragm\nelevation, perhaps eventration.\n\nRECOMMENDATION(S):  Assess cardiac function, especially aortic valve."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.  Right hilar lymph node unchanged.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  No pericardial effusion.  Moderate\nmitral annular calcification.  Moderate to severe aortic valve calcification. \nModerate coronary artery calcification.  No aneurysmal dilatation of the\nascending aorta.  Moderate atherosclerotic changes of the intrathoracic aorta\nand supra-aortic vessels.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular emphysema appear similar compared to prior.\nSubsegmental atelectasis in the lower lung zones bilateral.  No new or\nenlarging pulmonary nodules or masses to suggest pulmonary metastatic disease.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  Mild, diffuse\nbronchial wall thickening..\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study to suggest pulmonary emboli.\nCHEST CAGE: Multiple sclerotic bony lesion involving the ribs bilateral: For\nexample right second and seventh ribs and left ninth rib, but appear\nrelatively similar compared to prior.  No pathological fractures.  Evidence of\nprevious previous cervical spinal fusion.  Spondylotic changes of the thoracic\nspine.",
            "output": "No new or enlarging pulmonary nodules or mediastinal lymph nodes to suggest\npulmonary or mediastinal metastatic disease.\n\nMultiple sclerotic bony lesions highly suggestive of bony metastatic disease. \nPlease refer to MR spine done on the same day.\n\nMild centrilobular emphysematous change with associated bronchial wall\nthickening suggest smoking related lung changes.\n\nModerate to severe aortic valve calcification.  Moderate coronary artery\ncalcification.\n\nFor abdominal CT findings and thoracic spine CT findings please refer to their\nrespective reports."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is an incompletely visualized thyroid nodule arising from the lower pole\nof the right thyroid lobe which measures at least 1.7 x 2.4 cm.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is minimal periosteophyte fibrosis in the medial right lower lobe. \nThere is a 3 mm left lower lobe pulmonary nodule (3:120).  There is otherwise\nno evidence of pulmonary parenchymal abnormality. The airways are patent to\nthe subsegmental level.\n\nLimited images of the upper abdomen are unremarkable, noting numerous surgical\nclips adjacent to the stomach..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere are mild degenerative changes of the thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. An incompletely visualized right thyroid lobe nodule measures at least 2.4\ncm.  Recommend nonurgent dedicated thyroid ultrasound.\n3. 3 mm left lower lobe solid pulmonary nodule.\n\nRECOMMENDATION(S):  If the patient is low risk, no specific follow-up is\nrecommended.  However, if the patient is high risk, dedicated chest CT in 12\nmonths is recommended per ___ Society guidelines.\n\nNOTIFICATION:  The new finding of a left lower lobe pulmonary nodule and\nrelated recommendations above were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:20 ___,  approximately 15\nminutes after discovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  A 3 mm nodule at the left lung base (2:67) is stable from prior\nexam.\n\nBASE OF NECK: Surgical clips are noted in the thyroid bed.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is slightly atrophic, but has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post gastric bypass procedure.  Small bowel\nanastomosis is noted in the left upper quadrant without evidence of\nobstruction.  No bowel wall thickening seen.  Appendix is not visualized. \nThere is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is a fracture of the anterior right seventh rib..  No focal\nsuspicious osseous abnormality.\n\nSOFT TISSUES: Fat containing right-sided ventral abdominal wall hernia is\nnoted.  Partially imaged fat containing ventral hernia to the left of midline\non the lowest most image.  Postoperative changes noted along the anterior\nabdominal wall.\n\nBONES: No suspicious osseous abnormality is seen.? There is a fracture of the\nanterior right seventh rib.",
            "output": "1. Acute right anterior seventh rib fracture.  No other acute intrathoracic\nprocess.\n2. No acute intra-abdominal process in the visualized portion of the abdomen.\n3. Stable 3 mm left lower lobe pulmonary nodule."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart is\nmildly enlarged.  The pericardium and great vessels are within normal limits\nbased on an unenhanced scan. No pericardial effusion is seen.  Leads from a\nAICD are partially imaged.\n\nAXILLA, HILA, AND MEDIASTINUM: Numerous bilateral axillary lymph nodes, some\nmeasuring up to 10 mm are present.  Several mediastinal nodes are also seen,\nthe largest in the right lower paratracheal station measuring up to 10 mm.  No\nmass or mediastinal hematoma.\n\nPLEURAL SPACES: A maxilla loculated medium size left pleural effusion is\nnoted, concordant with findings on radiograph obtained 4 hours prior.\n\nLUNGS/AIRWAYS: A loculated medium size left pleural effusion compressing the\nlung, concordant with findings on radiograph obtained 4 hours prior.\nThere is peribronchial thickening with distal mucous plugging most notable in\nthe lower lobes.  Irregular densities at the posterior right base may reflect\nsequela of aspiration or pneumonia.  Otherwise, the airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: There is a compression fracture of the T12 vertebral body of unknown\nchronicity.  No suspicious osseous abnormality is seen.?",
            "output": "1.  Loculated medium size left pleural effusion compressing the lung,\nconcordant with findings on radiograph obtained 4 hours prior.\n2.  Peribronchial thickening with distal mucous plugging most notable in the\nlower lobes.\n3.  Small irregular densities at the posterior right lung base could reflect\nsequela of aspiration or pneumonia.\n4.  Compression fracture of T12, unknown chronicity."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized lower neck appears\nnormal.  No axillary lymphadenopathy.  Cardiac device with wires entering the\nleft upper limb venous system and also coursing down the left lateral body\nwall to enter the pleural space and left lateral mediastinum.\n\nUPPER ABDOMEN: No abnormality in the visualized upper abdomen.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Coronary artery and valvular calcification.  No\npericardial effusion.\nPLEURA: Small left pleural effusion has decreased in size when compared to the\nprior study.  There has been interval insertion of the left-sided chest\ndrains.  No significant residual fluid surrounding the pigtail.   Several\nsmall pockets of gas within the pleural effusion.  The more inferior portion\nof the pleural effusion appears similar to prior and may be loculated.\nLUNG:\n\n-PARENCHYMA:  Mild bibasilar atelectasis.  Focal right lower lobe\nopacifications, possibly due to aspiration.  Mild bibasilar bronchiectasis.\n-AIRWAYS:  Airways appear patent.\n-VESSELS:  Not well assessed on this noncontrast study.  Marked arterial\ncalcification noted.\nCHEST CAGE: No suspicious osseous abnormalities.  T12 vertebral body\ncompression deformities likely longstanding.",
            "output": "1. Interval insertion of left sided pleural drain with decrease in the size of\nthe left-sided pleural effusion and some small pockets of gas within the\npleural fluid.\n2. The inferior portion of the left pleural effusion appears similar in size\nand configuration to the prior study and may be loculated.  Immediately\nsurrounding the pigtail, no significant residual fluid.\n3. Focal right lower lobe opacifications, likely related to aspiration."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nIncidental thyroids Findings.  Moderate to severe atherosclerosis in the head\nand neck arteries.  Left-sided dual lead pacemaker with leads terminating in\nthe right atrium, right ventricle and epicardium is redemonstrated. \nHypoattenuation of the chest wall subcutaneous tissue reflecting mild\nanasarca.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Small mediastinal lymph nodes are not enlarged by\nCT size criteria.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThere is moderate cardiomegaly.  Severe coronary artery calcification,\nspecially along the course of the LAD.  Aorta is top-normal 339 mm diameter. \nPulmonary arteries normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nEvaluation of the lung parenchyma is limited by respiratory motion. \nLeft-sided loculated pleural effusion with associated thickened pleural\nsurface and relaxation atelectasis appear mildly improved given by the\ndecreased volume.  Redemonstrated bilateral bronchial wall thickening.  Left\nchest tube remains in place.  New small right pleural effusion in the\ninterval, with associated relaxation atelectasis.  No evidence of focal\nconsolidation.  No pneumothorax.  The airways are patent to the subsegmental\nlevel.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No sclerotic or lytic bone\nlesions.\n\nUPPER ABDOMEN:\nExcluding the heavy calcification in the abdominal aorta, the limited sections\nof the upper abdomen show no significant abnormal findings.",
            "output": "1.  Loculated left pleural effusion which is slightly decreased compared to\nprior study.\n2.  New small right pleural effusion."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The main\npulmonary artery is top normal in size.  Moderate to severe calcification\naround the aortic arch and descending thoracic artery.  Severe tritruncal\ncoronary artery calcifications.  Moderate cardiomegaly.  The heart,\npericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen. Left chest wall dual lead pacer with leads\nterminating in the right atrium, right ventricle and epicardium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nA borderline enlarged right upper paratracheal lymph node measures 1 cm across\nthe short axis (302:74), unchanged from ___. No mediastinal mass.\nHilar lymph nodes are not well evaluated without intravenous contrast.\n\nPLEURAL SPACES: There is a small left-sided loculated pleural collection with\nassociated thickened pleura, which appears smaller compared to ___.  It now measures up to 4 cm in the maximal thickness, previously\nmeasuring 5.3 cm.  The collection now predominantly contains air, with pockets\nof dependent and nondependent loculated fluid (___).  A left posterior\napproach drainage catheter remains within the left lung base.  Small right\npleural effusion is unchanged.\n\nLUNGS/AIRWAYS: Evaluation of lung parenchyma is limited by patient motion. \nBibasilar atelectasis is unchanged.  No convincing evidence of focal\nconsolidation.  The central airways are patent with secretion noted within the\nmid trachea (302:41).\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? No acute fracture.  Mild\ndegenerative changes of the imaged spine.  Unchanged compression deformity of\nT12.\n\nABDOMEN:  Included portion of the upper abdomen is notable for moderate to\nsevere calcification in the abdominal aorta.",
            "output": "1. Mild interval decrease in size of the known left-sided loculated pleural\ncollection, now measuring up to 4 cm in the maximal thickness, previously\nmeasuring 5.3 cm.  The collection now predominantly contains air, with pockets\nof dependent and nondependent loculated fluids.  A left posterior approach\ndrainage catheter remains within the left lung base.\n2. Small right pleural effusion, unchanged.\n3. Unchanged borderline mediastinal lymphadenopathy is likely reactive.\n4. Chronic findings include severe coronary artery calcifications and moderate\nto severe aortic calcifications."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta measures up to 4.1 cm in the\nascending portion, unchanged and top-normal in size for patient's age. \nDescending thoracic aorta is normal caliber. There is heavy calcification of\nthe aortic arch and descending thoracic aorta. Left chest wall pacemaker\ndefibrillator device is noted which causes substantial streak artifact\nlimiting evaluation of the left hemithorax and mediastinum. Leads are noted\nterminating in the right atrium and coronary sinus.  Epicardial pacing wires\nare noted overlying the lateral wall of the left ventricle. Main pulmonary\nartery is enlarged measuring 3.4 cm in axial diameter. There are coronary\nartery calcifications. No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  Conspicuous\nmediastinal nodes measuring up to 10 mm are unchanged and likely reactive in\netiology (4:85).\n\nPLEURAL SPACES: There has been interval removal of a chest tube from a left\nhydropneumothorax. There has been interval reaccumulation of fluid in the left\nbasilar pleural space now a moderate to large amount.  Small amount of fluid\nis also loculated laterally, similar to prior.  The air component of this\nhydropneumothorax is likely similar from prior although the morphology makes\ncomparison difficult.  A small right pleural effusion is slightly larger from\nprior.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited by a substantial\nrespiratory motion artifact. Ground-glass opacification within the left\ngreater than right lung fields lung with smooth septal thickening is\nconsistent with asymmetric mild pulmonary edema.  Mild atelectasis is\ndemonstrated in the lower lobes.  Secretions are noted within the trachea. The\ncentral airways are otherwise patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nUnchanged compression deformity of T12 is partially visualized. There is a\nleast moderate body wall anasarca.",
            "output": "1. Interval removal of a chest tube from a left hydropneumothorax. In\ncomparison to prior there has been re-accumulation of fluid in this\nhydropneumothorax, now moderate in degree, with continued partial loculation\nof fluid laterally.  The air component is likely similar.\n2. A small right pleural effusion is slightly larger.\n3. Asymmetric mild pulmonary edema, more pronounced on the left.\n4. Minimal secretions are noted within the trachea but there is no evidence of\naspiration.\n5. Main pulmonary artery is enlarged which can be seen in setting of pulmonary\narterial hypertension.\n6. The thoracic aorta measures 4.1 cm, top normal for patient age, unchanged."
        },
        {
            "input": "Since the ___ examination there has been interval placement of a\nleft-sided chest tube, with near-resolution of a left pleural effusion. \nMild-to-moderate left lower and lingular edema, atelectasis, and tiny\nconsolidations have improved since ___ examination.\n\nThere has been interval near resolution of a small right pleural effusion, now\ntrace, with small peripheral consolidations/edema along the right lower lobe\n(series 302, image 159).\n\nThere is no pneumothorax or lobar consolidation.\n\nThe heart is mildly enlarged.  Pacer wires are unchanged in configuration. \nThere is no pericardial effusion.\n\nThe thoracic aorta measures up to 4.2 cm collection from prior.  Enlargement\nof the main pulmonary artery is again seen.\n\nThere are moderate atherosclerotic calcifications throughout the thoracic\naorta and coronary vasculature.\n\nThere are no osseous lesions concerning for malignancy or infection.",
            "output": "1. Interval placement of a left thoracostomy tube, with near-resolution of a\nleft pleural effusion.  Mild edema, atelectasis, and/or tiny consolidations\nalong the lingula and left lower lobe are similar in comparison to the ___ examination.\n2. Interval near-resolution of a right pleural effusion, now trace, with mild\nperipheral edema along the right lower lobe with tiny consolidations.\n3. No pneumothorax."
        },
        {
            "input": "Evaluation is limited due to technique.  The most inferior left costophrenic\nrecess is not within the field of view despite repeat imaging.\n\nHEART AND VASCULATURE: There is a left-sided pacemaker device with leads in\nthe right atrium and right ventricle.  The thoracic aorta is normal in\ncaliber.  There is triple-vessel atherosclerotic calcification of the coronary\narteries with stents in place.  Heart size is enlarged.  There is no\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There remains a left-sided chest tube at the base of the left\nhemithorax which is unchanged in position.  There is a recurrent small left\npleural effusion compared to CT from ___, with associated\npleural thickening.  A few tiny locules of gas are noted within the pleural\nspace.  There is trace right pleural effusion, minimally increased.\n\nLUNGS/AIRWAYS: There is moderate atelectasis and increased peribronchial\nconsolidations in the left lower lobe.  There is scattered linear atelectasis\nin the left upper lobe and lingula.  Small peribronchial consolidations in the\nright lower lobe are unchanged.  The patient was scanned in expiration,\nlimiting evaluation of the airways.  There trace secretions in the trachea.\n\nBASE OF NECK: Visualized portions of the base of the neck are unremarkable.\n\nABDOMEN:  Included portion of the visualized unenhanced upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Recurrent small left pleural effusion, with left basilar chest tube in\nplace.  Trace right pleural effusion, minimally increased.\n2.  Moderate atelectasis and increased peribronchial consolidations in the\nleft lower lobe.  Scattered linear atelectasis in the left upper lobe and\nlingula.  Small peribronchial consolidations in the right lower lobe are\nunchanged."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There is a right-sided PICC line\nwith its tip in the right atrium.  There is a left-sided pacemaker.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes which are most\nlikely reactive.  There is atherosclerotic calcification involving the\ndescending thoracic aorta.  There is severe coronary artery calcification. \nThe aorta and pulmonary arteries are normal in caliber.  There is no\npericardial effusion\n\n\nPLEURA: There is a moderate loculated left pleural effusion with associated\npleural thickening, slightly more prominent than on the prior study.  There is\nno right-sided pleural effusion.  Left-sided pacer leads project to the\npleura.\n\nLUNG: Stable subsegmental atelectasis in the right lung base.  There is stable\nsubsegmental atelectasis in the left lung base.  Consolidative opacity in the\nleft lower lobe could represent round atelectasis.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Small loculated left pleural effusion has slightly increased in volume since\nthe prior study.  Adjacent atelectasis is unchanged.\n\nModerate cardiomegaly.  Left-sided pacemaker."
        },
        {
            "input": "Stable appearance of the vascular and cardiac structures in the mediastinum. \nThe pre-existing pleural effusions have substantially decreased. The effusion\non the right is barely visible.  On the left, the effusion is minimal.  Also\nsubstantially decreased are the bilateral parenchymal consolidations, likely\nreflecting a combination of infection and atelectasis.  The decrease in extent\nand severity of these parenchymal changes is more obvious on the right than on\nthe left.  There is no evidence of new parenchymal abnormalities.  A drainage\ndevice is visualized in the left pleural space (5, 217).  No evidence of\npneumothorax.",
            "output": "Substantial improvement since ___, with substantial decrease in\nextent of the pre-existing pleural effusions and a decrease of the adjacent\nparenchymal abnormalities.  Improvement is more obvious on the right than on\nthe left.  Left pleural drainage system in situ."
        },
        {
            "input": "There are no enlarged axillary, mediastinal, or hilar lymph nodes.  Thymic\ntissue interspersed with fat in the prevascular space is likely due to\nresidual thymus gland;  thymic hyperplasia may have a similar appearance. \nHeart size is normal, and there is no pericardial or pleural effusion.  Small\nhiatal hernia is noted as well as mild distension of the intrathoracic\nesophagus, opacified with oral contrast.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nof the spine and several healed right rib fractures.\n\nWithin the lungs, note is made of minimal nonspecific biapical scarring.  3 mm\nbilateral lower lobe noncalcified nodules (137 and 132, 4) are noted as well\nas a 3 mm right middle lobe nodule (136, 4) and right upper lobe (98, 4.",
            "output": "1.  No CT evidence of primary thoracic malignancy.\n\n2.  Several incidentally detected 3 mm noncalcified lung nodules which are\nstatistically most likely benign in the absence of a known primary neoplasm.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings.\n\nRECOMMENDATION:\n\nIf the patient is found to have an extrathoracic primary neoplasm, followup CT\nwould be recommended in 3 months to ensure stability of the small nodules.  In\nthe absence of a known extrathoracic malignancy, no further imaging followup\nis necessary unless the patient has strong risk factors for primary lung\ncancer in which case a followup CT would be suggested in ___ year."
        },
        {
            "input": "There is no evidence of mediastinal, hilar or axillary lymph node enlargement.\nHeart is mildly enlarged and diffuse coronary artery calcifications are\npresent.  There is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate interval increase in number of\nsmall sclerotic foci in the thoracic spine and other imaged thoracic skeletal\nstructures.\nSeveral pre-existing sclerotic lesions have increased in size and density in\nthe interval, most notably in the manubrium and thoracic spine.\n\n\nAssessment of the lungs is somewhat limited by inadvertent expiratory phase of\nrespiration, reducing the sensitivity for detecting small pulmonary nodules\nand subtle interstitial abnormalities.  With these limitations in mind, no new\nor growing nodules are detected.\n\nBilateral gynecomastia is noted.",
            "output": "1. Interval increase an size and number of sclerotic bone metastases.  Please\ncorrelate with report of bone scan from the same date, dictated separately.\n\n2.  No CT evidence of pulmonary metastases.\n\n3.  Diffuse coronary artery calcifications."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is moderate coronary arterial calcification.  The\nheart, pericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Bibasilar consolidation with volume loss is new from the prior\nstudy.  A focus of parenchymal opacity in the right middle lobe likely\nrepresents mucous plugging or additional focus of infection (6:172) The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Included portion of the upper abdomen is unremarkable.\n\nBONES:  Numerous sclerotic foci compatible with prostate cancer metastases are\nslightly increased in size compared with the prior study.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. New consolidations with associated volume loss is concerning for pneumonia\nor aspiration.\n3. Additional parenchymal opacity within the right middle lobe may represent\ndeveloping pneumonia or mucous plugging.\n4. Slight interval increase in size of numerous sclerotic foci within the\nvisualized skeleton compatible with prostate cancer metastases."
        },
        {
            "input": "The thyroid is normal. Supraclavicular lymph nodes are not enlarged.  Right\naxillary lymph nodes have increased in size and number now measuring up to 12\nmm.  There has been interval increase in size and number of multiple\nmediastinal and hilar lymph nodes in the prevascular station measuring up to 7\nmm, in the right upper paratracheal station 10 mm, left lower paratracheal\nstation 6 mm, subcarinal station 15 mm.  In the left hilum up to 5 mm.\nIn the paramediastinal regions anterior and posterior right greater than left\nlung, peribronchial opacities and mild bronchiectasis are new, please\ncorrelate with radiotherapy treatment.\nPacer leads in standard position\nMild cardiomegaly and coronary calcifications again noted.\nAorta and pulmonary arteries are normal size.  There is no pleural or\npericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nDiffuse bony metastasis have progressed from ___",
            "output": "Interval increase in size in number of lymph nodes as described above in the\nmediastinum hilum and right axilla.\nProgression of diffuse osseous metastatic disease"
        },
        {
            "input": "Left thyroid nodule 17 x 15 mm is unchanged.  Aorta and pulmonary arteries are\nnormal in diameter.  No pathologically enlarged mediastinal hilar or axillary\nlymphadenopathy is present.  Heart size is normal.  Central venous line\nterminates in the right atrium.  There is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Postradiation\nchanges in the right apex are similar to previous examination.  Previously\nseen pulmonary nodules all stable with no new nodules masses or consolidations\ndemonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nThe patient is after right mastectomy and reconstruction surgery.\n\n Anterior mediastinal predominantly sclerotic vertebral lesions are noted\nconsistent with metastatic disease as well as the anterior lesion of the right\nrib at the level of the sternum, series 5, image 26.  Please correlate with\nthe results of the nuclear bone scan obtained the same day.",
            "output": "Stable appearance of the chest\n\nPlease review CT abdomen and pelvis and bone scan in the corresponding report\nthat will be issued separately."
        },
        {
            "input": "The examination is compared to ___. Known predominantly hypodense\nthyroid nodules that are all unchanged. There is no evidence of\nsupraclavicular, infraclavicular or axillary lymphadenopathy. Status post flap\nreconstruction of the right breast with expected postoperative changes. The\nposition of the clips is unremarkable, the soft tissues are showing normal\npostoperative appearance. No hilar or mediastinal adenopathy. No pericardial\neffusion. Normal appearance of the heart. Normal appearance of the posterior\nmediastinum.  Normal appearance of the large mediastinal vessels.  No\nincidental pulmonary embolism.  In the lung parenchyma, the fibrotic area in\nthe right upper lobe is unchanged. Again detected are several sub cm\nperifascial and subpleural nodules, all of which are unchanged as compared to\nthe previous examination.  The only new change is a very fissure lingular 1.5\ncm consolidation (6, 190) that is likely infectious or post infectious in\norigin. Similar but more extensive consolidations are seen.  At the bases of\nthe left lower lobe (6, 229) which increases the likely would that these\nlesions represent sequelae of infection or aspiration.  The pleural surfaces\nare even , there is no pleural effusion. The airways are patent.\nUpper abdominal findings are described in a dedicated abdominal CT report. \nThe sclerotic lesion at the level of T11 has again slightly increased in size.\nNo other bony lesions are detected.",
            "output": "All pre-existing lung nodules are stable.  New parenchymal opacities, likely\nsequelae of infection or aspiration are seen in the lingular in in the left\nlower lobe.  No pleural effusions. Unchanged postradiation fibrosis in the\nright lung apex.  Mild interval increase of a sclerotic lesion at the level of\nT11."
        },
        {
            "input": "The thyroid again demonstrates numerous small, subcentimeter hypodensities. \nMediastinal lymphadenopathy is noted, measuring up to 1.2 cm in short axis at\nthe subcarinal station (5:156), which appears minimally changed from the prior\nexamination dated ___.  There are no pathologically enlarged\nsupraclavicular, axillary, or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  No incidental pulmonary\nembolism.  A left-sided Port-A-Cath terminates within the right atrium.  The\nheart is normal in size and demonstrates no appreciable coronary artery\ncalcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Lung windows again demonstrate bandlike fibrosis at\nthe right lung apex, grossly unchanged from prior examination.  Multiple\nbilateral pulmonary nodules appear stable (5: 118, 116, 191, 207, 252).  There\nis no new, suspicious pulmonary nodule or mass.\n\nExtensive sclerotic osseous metastatic lesions are seen throughout the\nvisualized spine and right scapula.  Additional sclerotic foci are also noted\nwithin the left humeral head, left acromion, and lateral left ninth rib.\n\nFor description of the intra-abdominal contents, please see the separate CT\nabdomen and pelvis examination performed on the same day.",
            "output": "1.  Multiple, stable, small bilateral pulmonary nodules.  No new, suspicious\nnodules or masses are identified.\n2.  Diffuse osseous metastatic disease which appears minimally changed from\nthe prior examination.  No evidence for superimposed pathologic fracture.\n3.  Essentially stable, mild mediastinal lymphadenopathy.\n4.  For description of the intra-abdominal contents, please see the separate\nCT abdomen and pelvis examination performed on the same day."
        },
        {
            "input": "A 7 mm left thyroid hypodense nodule is stable (series 5, image 3). Smaller\nnodules are seen more inferiorly in the thyroid gland.  The esophagus is\nunremarkable.  There is no hiatus hernia.  The aorta and pulmonary artery\nnormal in caliber.  Major aortic arch branches are patent.  There is no\nsignificant thoracic aortic or coronary artery atherosclerotic calcification. \nThe heart and pericardium are unremarkable.  There is no pericardial effusion.\nA previously 12 mm subcarinal node is now 10 mm (series 6, image 114). \nScatter low paratracheal nodes are mildly increased in number but not\npathologically enlarged.  Additional anterior mediastinal/prevascular nodes\nare also increased in number, but not pathologically enlarged.  There is no\nhilar, axillary, or visible supraclavicular lymphadenopathy.\n\nLinear fibrotic change and minimal anterior right upper lobe subpleural\ninterstitial prominence at the right lung apex is unchanged from multiple\nprior examinations.  A 4 mm left upper lobe nodule is stable (6, 74).  A 3 mm\nright middle lobe nodule (6, 150) is stable.  A subpleural 2 mm left upper\nlobe nodule is unchanged (6, 70).  A 4 mm lingular nodule is stable (6, 165). \nA punctate lingular nodule is unchanged (6, 137).  A punctate left lung base\nnodule is also unchanged (6, 212).  There is no pleural effusion or\npneumothorax.\n\nThere is soft tissue thickening inseparable from the adjacent pleura and chest\nwall along the right internal mammary chain, currently measuring 2.0 cm in\nthickness (series 6, image 110), larger since ___ (at that time,\nmeasuring 1.6 cm in thickness).  A left chest subcutaneous port ends in the\nright atrium.  Stable postsurgical changes along the right anterior chest wall\nrelate to prior mastectomy and reconstruction.  Otherwise, the partially\nimaged subcutaneous soft tissues of the chest wall are within normal limits. \nNumerous osseous sclerotic lesions in multiple vertebral bodies, the largest\nof which in the T10 and T11 vertebral bodies measure up to 2 cm (for example\nsee series 5, image 38 and series 9, image 37), are unchanged.  Other similar\nlesions, for example involving the left scapula (series 5, image 4), are also\nstable.  There are no new focal osseous lesions, nor evidence of pathologic\nfracture.",
            "output": "1. Progressive soft tissue thickening along the right internal mammary chain\nis worrisome for recurrence.  Specific attention to this area on follow-up. \nFDG PET-CT may be of utility in further evaluation.\n2. Bilateral solid pulmonary nodules measuring up to 4 mm are stable since at\nleast ___, suggestive of benignity.  No new or growing nodules.\n3. Stable CT appearance of diffuse sclerotic osseous metastases.\n4. Previously borderline mediastinal lymphadenopathy has improved, now within\nnormal limits.\n5. Stable right upper lobe fibrotic change.\n6. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis.\n\nRECOMMENDATION(S):  Consider FDG PET-CT further evaluation progressive right\ninternal mammary chain soft tissue thickening."
        },
        {
            "input": "Central venous line terminates in the right atrium.  Substantial network of\nvenous collaterals is related to left brachial cephalic narrowing.  Aorta and\npulmonary arteries are normal in diameter.  No mediastinal, hilar or axillary\nlymphadenopathy is present.  The appearance of the right breast reconstruction\nis unremarkable.  Image portion of the upper abdomen will be reviewed\nseparately in corresponding report will be issued.\n\nSclerotic bone lesions scattered throughout the spine are similar to previous\nexamination.  For pre size details please review bone scan obtained the same\nthe as the current chest CT.\n\nPleural thickening along the right internal mammary artery, series 6, image\n112 is 17 x 33 mm, unchanged.  Right upper lobe fibrotic changes are stable.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules all stable with no new nodules masses or consolidations\nseen.",
            "output": "Overall stable appearance of the chest including sclerotic metastatic disease,\nsoft tissue thickening along the right internal  mammary chain, and right\nupper lobe fibrotic changes.\n\nPlease review bone scan and CT abdomen and pelvis obtained the same day and\nthe corresponding report."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is heterogeneous and\ncontains multiple small nodules, unchanged.  Supraclavicular and axillary\nlymph nodes are not enlarged.\n\nMEDIASTINUM:  Numerous enlarged mediastinal lymph nodes are unchanged from\nprior studies.  There is no new or enlarging lymph node.\n\nHILA:  Hilar lymph nodes are minimally prominent without meeting CT criteria\nfor pathologic enlargement, similar to prior studies.\n\nHEART:  The heart is moderately enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  An accessed\nleft pectoral Port-A-Cath catheter tip terminates in the right atrium.\n\nPULMONARY PARENCHYMA:  Areas of radiation fibrosis in the right lung apex and\nthe subpleural right middle lobe are unchanged (06:49, 198).  Soft tissue\nthickening in the right internal mammary chain is also in stable in size with\nprogressive interval increase in curvilinear internal densities, representing\neither calcification or vascularity (6:122).  Multiple small pulmonary nodules\nare unchanged from ___ (e.g.  6:75, 79, 80, 104, 157, 183).  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  Numerous sclerotic lesions throughout the visualized\nspine and ribs are unchanged in size and distribution from ___ but\nappear increased in density, most likely due to treatment effect.  Multilevel\ndegenerative changes are mild.  A subpectoral lymph node in the left chest\nwall measures 10 x 6 mm (6:71), previously measuring 7 x 3 mm in ___\n(6:66) and 5 x 3 mm in ___ (6:60).  A mildly enhancing subcutaneous\nnodule along the right chest wall is unchanged from ___ measuring up\nto 6 x 4 mm (6:228).  Patient is status post right mastectomy with\nreconstruction and right axillary lymph node dissection with stable\npostsurgical changes.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Interval increase in size of suspicious small left subpectoral lymph node\nfor which attention on follow-up imaging is recommended.\n2. Otherwise stable appearance of the chest including small pulmonary nodules,\nradiation fibrosis changes, and enlarged mediastinal and internal mammary\nchain lymph nodes.  Numerous sclerotic osseous lesions are unchanged in size\nand extent compared to ___ but appear more dense, likely reflecting\ntreatment effect.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no calcification of the\nhead and neck vessels.  The thyroid gland is homogeneous without discrete\nnodule.  Left axillary lymph nodes have increased in size and number\n(___).  There is no supraclavicular, infraclavicular or axillary\nlymphadenopathy.  Left pectoral lymph node measures 6 x 6 mm, previously 10 x\n6 mm (05:15).  A right subcutaneous nodule within the soft tissues of the\nright chest wall measures 7 x 5 mm, previously 6 x 4 mm (05:44).  Patient is\nstatus post right mastectomy with surgical reconstruction and right axillary\nlymph node dissection and stable postsurgical changes.\n\nUPPER ABDOMEN: Please see separate, same-day CT abdomen and pelvis report for\ndescription of subdiaphragmatic findings.\n\nMEDIASTINUM: Multiple prominent mediastinal lymph nodes are not pathologically\nenlarged by CT size criteria, similar to prior studies.\n\nHILA: Multiple prominent hilar lymph nodes bilaterally without pathologic\nenlargement.\n\nHEART and PERICARDIUM: Moderate cardiomegaly is unchanged.  There is no\ncoronary artery calcification.  There is no aortic or mitral valvular\ncalcification.  Left Port-A-Cath terminates in the right atrium.  There is no\npericardial effusion, displacement of epicardial fat or pericardial\ncalcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Areas of radiation fibrosis at the right lung apex in the\nsubpleural portion of the right middle lobe are unchanged.  Soft tissue\nthickening within the right internal mammary chain measures approximately 31 x\n12 mm with overall stable appearance of curvilinear internal densities, which\nlikely represent either calcification or vascularity (6:113), is either stable\nor slightly decreased and likely represents malignant involvement of right\ninternal mammary chain.  Multiple small pulmonary nodules are unchanged in\nsize since ___ (6:67, 73, 80, 93, 99, 131, 144).  Ground-glass nodule\nin the right middle lobe (6:140) is unchanged.  No new or growing pulmonary\nnodules.  No confluent airspace consolidation.  No pneumothorax.  No diffuse\nlung disease.\n-AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n-VESSELS:  Aorta and pulmonary arteries are normal in size.\nBONES: Numerous lesions throughout the visualized chest cage and spine are\noverall unchanged in size and distribution since ___ and demonstrate\nunchanged density overall.  Mild, multilevel degenerative changes.  No\nfracture identified.  No new lytic or blastic lesions.",
            "output": "1. Worsening left axillary lymphadenopathy.  Stable only mediastinal and hilar\nlymph nodes.\n2. Stable appearance of soft tissue lesion within the right internal mammary\nchain, most consistent with malignant nodal conglomerate.\n3. Stable appearance of multiple small pulmonary nodules and radiation\nfibrosis changes.\n4. Numerous sclerotic osseous lesions in the chest cage and spine, unchanged\nin size and overall extent compared to ___, but overall more\nhyperdense, suggestive of treatment response.\n5. Please see separate CT abdomen and pelvis report for description of\nsubdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unchanged enlarged and\nheterogeneous left hemi thyroid. The left chest port catheter terminates in\nthe upper right atrium.  Interval decrease in a left supraclavicular lymph\nnode, measuring 0.3 cm in short axis, previously 0.6 cm (___).  Interval\ndecrease in size of a left axillary lymph node, measuring 0.5 x 0.4 cm (___),\npreviously 1.0 x 0.8 cm.  No left axillary lymphadenopathy.  The patient is\nstatus post right mastectomy with surgical reconstruction and right axillary\nlymph node dissection.  Unchanged 0.8 x 0.5 cm right lateral chest wall\nsubcutaneous nodule (___).  Multiple prevascular collaterals are likely\nsecondary to narrowed left brachiocephalic and subclavian veins.\n\nUPPER ABDOMEN: Please see same-day separately dictated CT abdomen and pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: Interval increase in a left paraesophageal lymph node, measuring\n2.1 x 1.2 cm (___), previously 1.8 x 0.9 cm, which narrows the esophagus. \nUnchanged right paraesophageal lymph node, measuring 0.9 cm in short axis\n(___).\n\nHILA: Unchanged right hilar lymph node, measuring 1.6 x 1.6 cm (___),\npreviously 1.5 x 1.5 cm.  Unchanged left hilar lymph node, measuring 1.4 x 1.1\ncm (___), previously 1.5 x 1.1 cm.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  No pericardial effusion.  No\ncoronary artery or valvular calcifications.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\nPARENCHYMA:  Unchanged radiation fibrosis involving the right lung apex and\nanterior subpleural portion of the right middle lobe.  Unchanged soft tissue\nthickening within the right internal mammary chain, measuring 3.0 x 1.6 cm\n(___) with hyperdense foci, likely representing dystrophic calcifications,,\nconcerning for malignant involvement.  The soft tissue protrudes into the\nsubcostal space.  No new or growing nodules.  Multiple unchanged pulmonary\nnodules:\n- left upper lobe, 0.3 cm ___\n- left upper lobe, 0.4 cm (___)\n- multiple 0.2 cm nodules in the right upper lobe (___)\n- right upper lobe, 0.2 cm (___)\n- 0.4 cm ground-glass nodule in the right middle lobe (___)\n\nAIRWAYS:  Patent to the subsegmental levels bilaterally.\n\nVESSELS:  The pulmonary arteries are not enlarged.  No evidence of pulmonary\nembolism on this non PE protocol study.\n\nCHEST CAGE: Multiple sclerotic osseous lesions are unchanged, including the C7\nspinous process (___), posterior aspect of the T3 vertebral body, anterior\naspect of the T4 vertebral body, right aspect of the T7 vertebral body, near\ncomplete involvement of the T10, left aspect of the T11 vertebral bodies,\nsuperior aspect of the T12 vertebral body, left aspect of the L1 vertebral\nbody, superior and inferior aspects of the left scapula and the left humeral\nhead.  No compression or other fractures.  No evidence of posterior cortical\nbreach.  Multilevel degenerative change of the imaged spine.",
            "output": "1. Compare to ___, interval decrease in left axillary\nlymphadenopathy.\n2. Unchanged bilateral hilar lymphadenopathy.\n3. Interval increase in a left paraesophageal lymph node.\n4. No new or growing pulmonary nodules.  Multiple unchanged pulmonary nodules,\nmeasuring up to 0.4 cm.\n5. Unchanged soft tissue thickening within the right internal mammary chain,\nwhich may represent malignant involvement.\n6. No new osseous lesions, compression fractures or destructive lesions. \nUnchanged multiple sclerotic osseous lesions, likely treated metastases.\n7. Unchanged enlarged and heterogeneous left hemi thyroid.  If clinically\nindicated, consider thyroid ultrasound for further evaluation.\n\nRECOMMENDATION(S):  Consider thyroid ultrasound for further evaluation of an\nunchanged enlarged and heterogeneous left hemi thyroid.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:05 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThe heart is mildly enlarged.   There is no evidence of pericardial effusion. \nThere is no pleural effusion.\n\nThere is unchanged appearance of radiation fibrosis involving the right lung\napex and anterior subpleural portion of the right middle lobe.  Soft tissue\nthickening within the right internal mammary chain contains curvilinear\ninternal densities, likely representing calcifications or vascularity measure\ngrossly similar, previously 3.1 x 1.2 cm, now 3.1 x 1.6 cm.  Again seen are\nmultiple 1-4 mm pulmonary nodules in bilateral lung (5:65, 76, 93, 126, 135,\n136, 137, 142, 147, 166), not significantly changed compared to ___. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate multiple enlarged lymph nodes\nalong the celiac axis.  Previously demonstrated hepatic hypodensities are not\nwell seen on this exam.\n\nThe left thyroid lobe is heterogeneous and enlarged, unchanged from prior\nexam.  Left chest port catheter terminates in the right atrium, unchanged from\nprior.  There is no supraclavicular or left axillary lymphadenopathy.  Patient\nis status post lymph node dissection on the right with multiple clips in\nplace.\n\nMultiple mildly enlarged lymph nodes in the mediastinum are overall unchanged\nfrom prior exam.  There is no pathologic lymphadenopathy.  There is persistent\nsoft tissue density/lymph nodes in the subcarinal station.  Right hilar lymph\nnode measures up to 1.5 x 1.2 cm, previously 1.6 x 1.6 cm (05:10 7), left\nhilar lymph node measures up to 7 mm, previously 1.4 x 1.1 cm (5:128).\n\nThere are multiple sclerotic osseous lesions throughout the multiple vertebral\nbodies, ribs and scapula, better evaluated on the MR spine dated ___ and appear unchanged from prior exam.  There is no evidence of spinal\ncord compression.",
            "output": "1. No evidence of acute pulmonary embolism or aortic abnormality.\n2. Overall stable size of multiple lung nodules.\n3. Stable appearance of metastatic osseus lesions, better evaluated on prior\nMRI.  No acute fracture or evidence of cord compression.\n4. Status post right mastectomy and right lymph node dissection.  Stable post\nsurgical changes and right anterior wall soft tissue."
        },
        {
            "input": "Stable left thyroid nodule (4, 11).  Stable position of the left Port-A-Cath. \nNo supraclavicular, infraclavicular or axillary lymphadenopathy. Postoperative\nmorphology in the right axilla.  The pulmonary arteries continue to show\ndiameter suggestive of pulmonary hypertension.  No enlarged lymph nodes in the\nmoderate coronary calcifications, no pericardial effusion.  No evidence of\nincidental pulmonary embolism.  Upper abdominal organs are described in detail\nin the dedicated abdominal CT report.  No vertebral compression fractures, but\nextensive predominantly sclerotic metastatic vertebral body lesions are again\ndemonstrated.  Several sclerotic foci are also noted in the ribs. \nPostradiation fibrosis in the right upper lobe.  No pleural effusions.  No\npleural thickening.  All pre-existing millimetric pulmonary nodules are stable\nin size.  No new or growing nodules.  No diffuse lung disease.",
            "output": "No evidence of metastatic disease to the thorax.  Signs of pulmonary\nhypertension.  Known stable sclerotic bony metastasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcifications are mild.  There is no\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Scattered mediastinal lymph nodes are not\npathologically enlarged by CT size criteria.  No axillary or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is near complete collapse of the left lower lobe and\npartial collapse of the right lower lobe.  Otherwise, the lungs demonstrate no\nevidence of masses or areas of abnormal parenchymal opacification.  There is\nsmall volume secretions in the upper thoracic trachea (03:41), otherwise the\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show small\ncalcifications within the left thyroid lobe.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Near complete collapse of the left lower lobe and moderate atelectasis of\nthe right lower lobe."
        },
        {
            "input": "CTA CHEST WITH CONTRAST: There is no axillary lymphadenopathy.  The\nsupraclavicular spaces are incompletely imaged. There is no mediastinal\nlymphadenopathy. Right hilar lymph nodes are noted measuring 7 mm (03:51) and\n6 mm (3:71) in short axis best appreciated on the sagittal view. The esophagus\nis grossly normal.\n\nHeart size is normal without pericardial effusion. Aorta and main thoracic\nvessels are normal in caliber. The main pulmonary arteries are normal in\ncaliber and patent to the subsegmental level without evidence of pulmonary\nembolism.\n\nThere is no pleural effusion, pneumothorax or focal airspace opacity to\nsuggest pneumonia. The tracheobronchial tree is patent to the subsegmental\nlevel.\n\nOSSEOUS STRUCTURES: There are no worrisome blastic lytic lesions.\n\nUPPER ABDOMEN: This study is not designed for evaluation of the\nsubdiaphragmatic structures however the partially visualized solid organs and\nstomach are grossly normal.",
            "output": "1. Prominent though not pathologically enlarged right hilar lymph nodes are\nlikely reactive. No PE or pneumonia or other findings to account for chest\npain and leukocytosis.\n2. Mild bilateral gynecomastia."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: The mediastinum and hila are not well assessed\nin the absence of intravenous contrast.  Numerous paratracheal and mediastinal\nlymph nodes are prominent, but subcentimeter in size.  Prominent axillary\nlymph nodes are also subcentimeter in size.  Ingested food material fills the\nesophagus.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a dense left lower lobe consolidation with internal\nbronchiectasis, overall increased in size since ___.  There are\ndiffuse ___ and ground-glass, predominantly nodular opacities most\ndominant in the bilateral lower lobes right middle lobe, and lateral lingula. \nMore confluent, solid appearing opacities with internal air spaces, some of\nwhich reflects bronchiectasis are present in the left upper lobe, increased\nsince ___ (series 4, image 47) right upper lobe (series 4, image 45)\nright upper lobe (series 4, image 65), right middle lobe (series 4, image\n128).  A distinct nodule measuring 1.6 x 1.5 cm in the left lower lobe is new\nsince ___ (series 4, image 162).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Dense, extensive, paramediastinal left lower lobe consolidation increased\nsince ___.  In the absence of intravenous contrast or more recent\nimaging, it is difficult to determine extent of primary malignancy versus\natelectasis or superimposed infection.\n2. Diffuse, predominantly lower lobe, right middle lobe, and lingular\n___ and ground-glass opacities are concerning for atypical infection.\n3. A discrete, solid, 1.6 cm left lower lobe pulmonary nodule is concerning\nfor metastatic progression since ___.  As above, additional findings\nmay reflect additional foci of progression.  Recommend correlation with more\nrecent outside hospital imaging.\n4. Probable gastroesophageal reflux and/or dysmotility.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:44 pm, approximately\n30 minutes after discovery of the findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\nThere is a small left pleural and pericardial effusions.\nLarge area of peribronchial consolidation in the left lower lobe is likely due\nto pneumonia rather than postradiation pneumonitis given the clinical\nsymptoms. Previously visualized central nodule and an elongated more\nperipheral opacity in the left lower lobe are not clearly identified, obscured\nby the new opacities. Peribronchial opacities with distortion of the\narchitecture, bronchiectasis and fibrosis in the anterior left upper lobe,\nmedial right upper and right lower lobes have minimally progressed consistent\nwith postradiation changes.\nMild centrilobular emphysema upper lobe predominant, paraseptal emphysema seen\nin the upper lobes and scattered cysts are grossly unchanged from prior.\nThis examination is not tailored for subdiaphragmatic evaluation, the upper\nabdomen is unremarkable\nThere are no bone findings of malignancy",
            "output": "1. Peribronchial consolidations in the left lower lobe are most likely due to\npneumonia rather than postradiation pneumonitis given the clinical symptoms,\nfollow up is recommended\n2. Emphysema\n3. Post radiation changes as described above in the upper lobes and right\nlower lobe\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 2:30PM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thoracic aorta is normal in caliber with no significant atherosclerotic\ncalcifications along its course. Incidentally noted is a two vessel takeoff\nfrom the aortic arch with common origin of the brachiocephalic and left common\ncarotid arteries, normal variant.\n\nEvaluation of the subsegmental pulmonary arteries in the bilateral lower lobes\nis limited due to pulmonary opacities and respiratory motion at the lung\nbases. There is no filling defect within the main, right, left, lobar,\nsegmental or visualized subsegmental pulmonary arteries to suggest pulmonary\nembolism. The main and right pulmonary arteries are normal in caliber, and\nthere is no evidence of right heart strain.\n\nSupraclavicular, axillary, mediastinal, and hilar lymph nodes are not enlarged\nby CT size criteria.\n\nThere are no significant coronary artery calcifications. Trace pericardial\nfluid is within the physiologic range.\n\nNo nodule is seen in the imaged thyroid gland.\n\nEvaluation of the lung bases is somewhat limited by respiratory motion.\nCentrilobular and paraseptal emphysema with upper lobe predominance is similar\nto ___. Peribronchial consolidation in the left lower lobe is\nminimally improved compared to ___.  Peribronchial opacities with\narchitectural distortion, bronchiectasis and fibrosis in the anterior left\nupper lobe, at the right apex, and medial aspect of the right lower lobe are\nunchanged, likely related to prior radiation.  No new opacity is seen.  Trace\nleft pleural effusion is improved from ___.  No right pleural\neffusion.\n\nThe imaged upper abdomen appears unremarkable.\n\nNo bone finding suspicious for infection or malignancy is identified.",
            "output": "1.  No acute aortic pathology or pulmonary embolism.  Limited evaluation of\nthe bilateral lower lobe subsegmental arteries due to left lower lobe opacity\nand respiratory motion.\n\n2. Left lower lobe peribronchial consolidation may represent pneumonia,\nradiation pneumonitis or a combination, minimally improved since ___.  Otherwise, no change from ___ with stable emphysema in the\nbilateral upper lobes and radiation changes bilaterally as above. No new\npulmonary abnormality."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There is no axillary\nlymphadenopathy.  There are several borderline enlarged mediastinal lymph\nnodes, measuring up to 8 mm (2, 19). These are not significantly changed from\nthe prior exam from ___, and are presumably reactive. No definite\nhilar lymphadenopathy is identified on this noncontrast exam.\n\nThe heart is mildly enlarged. There is a tiny pericardial effusion. The\nthoracic aorta is normal in caliber without significant atherosclerotic\ncalcifications. The main pulmonary artery trunks are normal in diameter.\n\nThere is a dense consolidation with air bronchograms in the left lower lobe.\nIt extends to and causes mild bulging of the fissure with minimal extension to\nthe left upper lobe (5, 117). Overall, in comparison to the prior exam from ___, the opacity has increased in size and density. There is\nassociated mucus plugging in the segmental and subsegmental bronchi in the\nleft lower lobe. There is a tiny left pleural effusion.\n\nScarring in the upper lobes, including a 15 x 7 mm nodular focus of scarring\nin the left apex (5, 36) and a 20 x 5 mm stellate focus of scarring in the\nright upper lobe are not significantly changed from the prior exam. These may\nbe from prior radiation treatment. No new or worrisome discrete nodules\nidentified. There is mixed emphysema, which is predominantly paraseptal.  A\nfew scattered pulmonary cysts are unchanged.  There is no pulmonary edema,\nright pleural effusion, or pneumothorax.\n\nThis exam is not tailored to evaluate the subdiaphragmatic structures. There\nis an ill-defined linear hypodensity along the falciform ligament in the\ninferior aspect of the liver (2, 58) measuring approximately 21 x 14 mm. This\nwas not definitely present on prior exams. It is of unclear etiology. The\nimaged portions of the spleen, pancreas, adrenal glands, and kidneys are\nnormal.\n\nThere are no concerning lytic or sclerotic osseous lesions. No fracture is\nidentified. There are no significant degenerative changes.",
            "output": "1.  Interval increase in size and density of a left lower lobe opacity. This\nhas the morphology of a pneumonia. Given the patient's low CD4 count, this may\nbe an atypical or fungal. The opacity does not have the usual appearance for\nmalignancy or lymphoma, though these cannot be completely excluded. Followup\nto resolution is recommended.\n2. Stable appearance of the radiation changes in the upper lobes.\n3. New partially imaged hypodensity in the left lobe of the liver. An\nultrasound is recommended for further characterization."
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is no mediastinal\nhematoma.  There is no pericardial effusion.  There is no lymphadenopathy. \nThe imaged thyroid is normal.\n\nA 4 mm nodule is seen in the right lower lobe.  There is mild bibasilar\natelectasis.  Possible pleural calcifications are seen in the right lower and\nleft upper lobes (02:51) there is no evidence of pulmonary contusion or\nlaceration.  Airways are patent to the subsegmental level.  There is no\npneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  Numerous gallstones are seen within\na collapsed gallbladder.  The common bile duct is somewhat prominent.  The\npancreas and adrenals are unremarkable.  The kidneys enhance symmetrically and\nexcrete contrast promptly without hydronephrosis.  A hypodense lesion in the\nupper pole of the left kidney likely represents a small cyst.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is normal\nin course and caliber, and is severely calcified.  No lymphadenopathy, free\nair, or free fluid.\n\nThe stomach and small bowel are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is normal.  The bladder is unremarkable.  There is no pelvic free\nfluid.\n\nBONES:  A mid sternal step-off irregularity is noted without surrounding\nhematoma.  This likely represents the sequela of remote trauma, giventhe lack\nof soft tissue abnormalities.  No definite rib fracture is identified.  There\nis no vertebral body height loss.  No definite thoracic or lumbar fracture is\nidentified.",
            "output": "1.  No definite acute sequelae of trauma.\n2.  Sternal irregularity without significant soft tissue hematoma is possibly\nthe sequela of remote injury, in the absence of symptoms.\n3.  4 mm lung nodule in the right lower lobe.  If the patient is high risk a\nfollow-up CT can be obtained in ___ year."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary or supraclavicular\nadenopathy.  There are mildly enlarged mediastinal lymph nodes measuring up to\n12 mm in the right lower paratracheal station.  Mildly prominent hilar lymph\nnodes, largest measures 0.8 cm.  Enlarged AP window lymph node measuring 1.2\ncm.\n\nHeart size is borderline.  There is no pericardial effusion.  Coronary artery\ncalcifications and aortic valvular calcifications are severe.  The thoracic\naorta is top-normal measuring 3.8 cm.  There are dense calcifications at the\naortic arch.  The main pulmonary trunk is also dilated measuring 3.3 cm.\n\nThe airways are patent to the segmental level bilaterally.  There are low lung\nvolumes.  There is mild bronchial wall thickening at the lung bases.  There is\nhoneycombing involving the periphery of the lungs bilaterally, but most\npronounced in the lower lobes.  There is also increased peripheral reticular\nopacities.  Areas of traction bronchiectasis, parenchymal distortion.  There\nis no focal consolidation.  There is no overt pulmonary edema.  There is no\npleural effusion or pneumothorax.  No significant micro nodules, ground-glass\nopacities, or air trapping.\n\nThere is a 1.2 x 1.3 cm irregular nodular opacity adjacent to the major\nfissure (series 302, image 140).  Additionally, there is 0.8 cm nodular\nopacification adjacent interstitial lung disease and cystic changes are seen,\nimage 95.\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\ndemonstrate post cholecystectomy changes.\n\nOSSEOUS STRUCTURES: There are no suspicious bony lesions.",
            "output": "1. Interstitial lung disease, with lower lung zone predominance, areas of\nhoneycombing, most consistent with UIP pattern.  No evidence of acute process.\n2. 1.2 cm irregular nodular opacity adjacent to the major fissure in the right\nlower lobe,, additional 0.8 cm nodule in the right upper lobe, a short-term\nfollowup CT (3 month) is recommended to evaluate for stability.\n3. Enlarged mediastinal lymph nodes, likely reactive.\n4. Enlarged main pulmonary trunk, suggestive of pulmonary hypertension.\n5. Severe coronary artery and aortic valvular calcifications.\n\nRECOMMENDATION(S):  Three month follow-up CT."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not\npathologically enlarged and there is no soft tissue abnormality in the imaged\nchest wall concerning for malignancy.  This study is not appropriate for\nsubdiaphragmatic diagnosis, especially regarding the liver, but shows no\nunfavorable finding regarding and renal glands.  Patient has had\ncholecystectomy.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable, undisturbed by adjacent\nadenopathy.  There are no thyroid findings warranting further imaging\nevaluation.  Atherosclerotic calcification is mild in head and neck vessels\ngenerally, but moderate at their origins, also found throughout the coronary\narteries, particular left anterior descending.  Aortic valvular calcification\nis moderate to heavy, but substantial enough to be hemodynamically\nsignificant.  Echocardiography is advised if not recently performed.  Aorta is\nnormal size.  Pulmonary arteries are mildly enlarged, main 33 mm, right 29 mm,\npreviously 32 mm and 29 mm.  Cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\n\n\nTHORACIC LYMPH NODES: Mild central adenopathy is present in several\nmediastinal stations, but it is essentially stable stable, including\n\nRight upper paratracheal, 10 mm,\n\nRight lower paratracheal, 13 mm;\n\nRight posterior paraesophageal, 19 mm, previously 17 mm.\n\nHilar contours suggest equivalent lymph node enlargement.  There is no\ncompromise of the bronchi.\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Extensive, severe infiltrative/interstitial pulmonary\nabnormality is unchanged.  It consists of very coarse, predominantly\nperipheral septal and interlobular linear reticulation, most pronounced in the\nlung periphery increasing from apex to base, where there is appreciable\nperipheral bronchiolectasis and traction bronchiectasis.  The level of most\ndefinitive honeycombing however is in the anterior right upper lobe,\n13:80-100, and the lingula, all unchanged.  There is no clear ground-glass\nopacification, also a stable feature.\n\nExpiratory views show mild air trapping at the lung bases.\n\nThere are no lung nodules concerning for malignancy.\n\nCHEST CAGE: Unremarkable",
            "output": "Severe fibrosing interstitial lung disease, UIP pattern, stable since at least\n___.  Stable reactive central adenopathy.  No appreciable ground-glass\npulmonary opacity.\n\nNo lung lesions concerning for malignancy.\n\nNo change mild pulmonary artery enlargement.\n\nSufficient aortic valvular calcification to be hemodynamically significant.\n\nRECOMMENDATION(S):  Consider echocardiography, if not recently performed."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable. \nThere is no supraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: Small hemangioma in T7 vertebral body.  No evidence of osteo\ndestructive lesions.\n\nUPPER ABDOMEN: Included unenhanced upper abdominal organs are unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: No gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Patient is status post sternotomy.  Heart is normal in\nsize.  Complex cardiac malformation is not well-evaluated in this nondedicated\nstudy.  Ascending aorta measures up to 5 cm.  There is no pericardial\neffusion.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  No evidence\nof consolidations or any other evidence of infection.  Respiratory motion\nartifacts limit evaluation of fine details.  No lung nodules identified.",
            "output": "No evidence of pneumonia.\nComplex cardiac malformation is not well evaluated in this non-dedicated\nstudy. Fusiform aneurysm of the ascending aorta up to 5 cm."
        },
        {
            "input": "No incidental thyroid findings.  Borderline sized lymph nodes are seen in the\nleft axilla (3, 10), requiring attention on future follow-up.  In the\nmediastinum and at the level of the hilar structures, normal sized lymph nodes\nare visualized (3, 22).  Mild coronary calcifications.  Mild aortic valve\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Punctate sclerotic costal bone island (8,\n23).  Similar lesion in a single vertebral body (8, 68).  No vertebral\ncompression fractures.\n\nModerate bilateral scarring with nodular components (5, 29).  Mild\ncentrilobular pulmonary emphysema, predominating in the upper lobes.  The\nairways show moderate thickening and irregularities of the airway walls.  No\nsubstantial mucous plugging.\n\n\n-3 mm solid left lower lobe nodule (5, 167).\n-4 mm solid left lower lobe nodule (5, 173).\n-2 mm solid right lower lobe nodule (5, 214).\n-3 mm left lower lobe pleural nodule (5, 265).\n\nNo pleural thickening, no pleural effusions.  No diffuse lung disease.",
            "output": "Several pulmonary nodules, as described above.  Given the lack of comparison\nscans and the nature of the underlying disease, CT follow-up in 3 months is\nrequired."
        },
        {
            "input": "No incidental thyroid findings.  Stable normal to borderline sized axillary\nlymph nodes (2, 12).  No hilar or mediastinal lymphadenopathy.  Mild coronary\ncalcifications.  Mild aortic valve calcifications.  No pericardial effusion. \nThe posterior mediastinum is unremarkable.  Upper abdominal findings described\nin detail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Stable partial\nwedge-shaped deformity of T12.  Stable bilateral apical scarring with nodular\ncomponents.  Stable mild upper lobe predominant centrilobular pulmonary\nemphysema and stable signs of mild chronic airways disease.\nStable fissural left upper lobe nodule (3, 127).\nStable 3 mm left lower lobe nodule (3, 146).\nStable 2 mm right lower lobe nodule (3, 170).\nStable 3 mm left lower lobe nodule (3, 200).\nNo pleural abnormalities.  No diffuse lung disease.",
            "output": "Stable pulmonary nodules.  No new or growing nodules.  No pleural\nabnormalities.  Stable mild centrilobular pulmonary emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Stable peripherally calcified\nhypodense left thyroid nodule measuring 12 mm (4:15).  Otherwise normal\nthyroid gland.  Compared with the prior PET-CT, there is bilateral axillary\nlymphadenopathy, reduced in size, for example the largest right hilar lymph\nnode measures 1.6 cm (4:28), previously measuring 2.8 cm.  The largest left\naxillary node measures 1.5 cm (4:26), previously measuring 2.6 cm.  No\nenlarged or growing supraclavicular lymph nodes.  No soft tissue chest wall\nabnormality.  Right central venous catheter in place, with the tip in the\ndistal SVC.  Mild atherosclerotic calcification of the imaged neck arteries.\n\nUPPER ABDOMEN: Please see the CT abdomen and pelvis report dated the same day\nfor evaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Mildly enlarged mediastinal nodes are reduced in size, for\nexample 1.2 cm right lower paratracheal (4: 39), previously measuring 2.1 cm,\na 10 mm right upper paratracheal node (4:31), previously measured 14 mm.  The\nesophagus is diffusely thick-walled, most marked distally, where it is severe,\nand there is surrounding edema in the mediastinal fat, in keeping with\nesophagitis.  This may be post treatment in nature.  The thoracic aorta and\npulmonary arteries are normal in caliber.  Mild atherosclerotic calcification\nof the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size. Mild coronary artery calcification. \nMild aortic valve calcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax.  Moderate biapical\npleuroparenchymal scarring, stable.\n\nLUNG: Allowing for the mild lower lobe respiratory motion artifact;\n\n1. PARENCHYMA: 4 mm right upper lobe nodule (5:201), stable.  4 mm left lower\nlobe nodule (5:213), reduced in size, previously measuring 6 mm.  4 mm left\nlower lobe nodule (5:170), reduced in size, previously measuring 6 mm.  5 mm\nleft lower lobe nodule (5:223), reduced in size, previously measuring 6 mm.  4\nmm right upper lobe ground-glass nodule (5:67), reduced in size, previously\nmeasuring 6 mm.  3 mm middle lobe nodule (5:211), stable.  No new or enlarging\nlung nodule or mass.  No consolidation.  Mild upper lobe predominant\nparaseptal and centrilobular emphysema, stable.  Mildly heterogenous lung\nattenuation, most marked in the lung bases, likely representing multifocal air\ntrapping, likely secondary to small airways disease.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nNo bronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.No fracture.",
            "output": "-The esophagus is diffusely thick-walled, most marked distally, where it is\nsevere, and there is surrounding edema in the mediastinal fat, in keeping with\nesophagitis. This may be post treatment in nature.\n-Bilateral axillary and mediasti"
        },
        {
            "input": "Right thyroid it enlargement is stable.  Mediastinal lymphadenopathy is\nsymmetric and unchanged in might be in consistency was provided history of\nsarcoidosis giving the asymmetric appearance and stability.  A left\nventricular enlargement is extensive. Scarring of the apex is present.\nPacemaker leads terminate in the expected location within the right atrium and\nright ventricle.  No pericardial pleural effusion is demonstrated. Image\nportion of the upper abdomen will be reviewed separately in corresponding\nreport will be issued\n\n___ cyst in the left upper back is demonstrated.  Airways are patent to\nthe subsegmental level bilaterally although narrowing of the lower lobes\nbronchi noted bilaterally most likely due to lymphadenopathy with compression\nof the adjacent airways.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Bilateral extensive gynecomastia is symmetric.  Right upper\nlobe nodule, series 6, image 79 has increased from 2-5 mm, additional right\nupper lobe nodule, series 6, image 85 has increased films 382 3.5 mm, minimal.\nLarge air right upper lobe nodule, series 6, image 89 is currently 7 mm,\nunchanged as well as additional right upper lobe nodules. On the other hand\nthere is a new nodule, series 6, image 93, 4.4 mm in diameter.  A right upper\nlobe nodule, series 6, image 100 in 2 least 5 mm, increased as compared to 4\nmm on previous examination.  Additional right upper lobe nodule, series 6,\nimage 109 has increased as well from 3-4.4 mm.  Multiple additional pulmonary\nnodules in the right upper lobe are overall stable.  There is interval\nincrease in the right middle lobe nodule, from 3.8-5.5 mm, series 6, image\n201.  Additional right middle lobe nodules are noted with 1 of them increased\nin size as well, series 6, image 229, from 4 to 5.2 mm.  Part fissure left\nlower lobe nodules, series 6, image 150 have minimally increased in size by 1\nmm each still sub 4 mm in diameter.",
            "output": "Bilateral hilar as well as mediastinal lymphadenopathy similar to prior study\nand might potentially represent sarcoidosis.\n\nMultiple pulmonary nodules, some of them increased in size in the interim,\nconcerning for metastatic disease. Others are stable.\n\nEvidence of most likely present prior apical left ventricular infarction.\n\nFor assessment of the upper abdomen please review CT abdomen and corresponding\nreport"
        },
        {
            "input": "Right pectoral pacemaker.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the upper mediastinum. The\nnumerical increased and borderline to slightly enlarged lymph nodes in the\nmediastinum are unchanged.  Mild cardiomegaly.  No pericardial effusion. \nSeveral dorsal chest wall fibromas.  The abdominal findings are described in\ndetail in the abdominal CT report.  No evidence of osteolytic lesions at the\nlevel of the ribs, the sternum and the vertebral bodies.\n\nThere is unchanged evidence of diffuse bilateral solid and well-defined\nnodules.  These nodules are stable in size and morphology. The have not grown\nand no new nodules are visualized.  There is no pleural thickening and no\nevidence of pleural effusions.  The airways are patent, the airway walls are\nnormal.  No evidence of diffuse lung parenchymal disease.",
            "output": "As compared to ___, the size of the known and pre-existing\nmediastinal lymph nodes is constant. No growth of lymph nodes. The\npre-existing diffuse parenchymal soft tissue nodules is also constant. No new\nor growing nodules."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. There is no pleural\neffusion. The airways are patent to the subsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland is not visualized.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  Clear lungs."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged axillary,\nsupraclavicular, mediastinal, or hilar lymph nodes. Heart is normal in size\nand configuration. The heart thoracic aorta and pulmonary artery are normal in\ncaliber. There is no pericardial effusion.\n\nThe airways are patent to subsegmental level. A 3 mm nodule at the left apex\nis stable. No new nodules concerning for malignancy are identified. An area of\nparenchymal distortion along the inferolateral right middle lobe is unchanged\nand likely represents nonspecific scarring. There is no focal consolidation,\npleural effusion, or pneumothorax.\n\nA sclerotic focus in the right humeral head remains stable. No lytic or\nsclerotic osseous lesion concerning for malignancy identified.\n\nSubdiaphragmatic findings will be reported separately.",
            "output": "1. No evidence of metastatic disease in the chest.\n\n2. Please refer to separately dictated CT abdomen and pelvis report from the\nsame day for full description of subdiaphragmatic findings."
        },
        {
            "input": "The study is markedly degraded by motion artifact and delayed contrast bolus\ntiming.  This limits detection of segmental and subsegmental pulmonary emboli.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified in the central\npulmonary vasculature without filling defect to indicate a pulmonary embolus. \nEvaluation of the segmental and subsegmental vasculature is limited secondary\nto motion artifact and contrast bolus timing.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  There is mild\ncalcification within the thoracic aorta.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar dependent atelectasis.  Lungs are clear\nwithout masses or areas of parenchymal opacification.  Motion artifact limits\ndetection of small pulmonary nodules and fine interstitial changes.  ETT in\nsitu.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe thyroid is normal.\n\nABDOMEN: An enteric tube is seen within the body of the stomach.  The liver is\nhomogeneous in attenuation.  The spleen is unremarkable.  Limited view of the\npancreas is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThoracic spinal dextroscoliosis.",
            "output": "The study is severely limited by motion artifact and slightly delayed contrast\nbolus timing.\nWithin these limitations, the central pulmonary vasculature is well opacified\nwithout filling defect to indicate a pulmonary embolus.  Evaluation of the\nsegmental and subsegmental vasculature is limited.\n\nNo confluent airspace consolidation/pneumonia."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  There is moderate atherosclerotic disease along the aortic\narch.  Dense mitral annular calcifications are noted.  No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear atelectasis is seen in the left lower lobe, otherwise\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST PERIMETER: 15 mm wide low-attenuation region, left thyroid lobe warrants\nultrasound evaluation.  No supraclavicular or axillary adenopathy.  Breast\nevaluation is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.  Findings below the diaphragm will\nbe reported separately.\n\nCARDIO-MEDIASTINUM:Upper esophagus is moderately distended.  Mid and lower\nesophagus are normal caliber above a small to moderate hiatus hernia.  No good\nevidence for mass or obstruction.\n\nAtherosclerotic calcification is heavy in the head neck vessels, including\nright common carotid, bifurcating brachiocephalic, and proximal left\nsubclavian arteries.  Coronary calcification is extremely heavy.  The extent\nto which heavy aortic annulus calcification may extend into the aortic valve\nis obscured by pulsatile motion.  Pericardial effusion is small and there is\nno evidence currently of tamponade physiology.  No pericardial or mediastinal\nblood or catheter fragment following removal of the pericardial drain.\n\n\n\n\nTHORACIC LYMPH NODES: None pathologically enlarged.  Moderate right basal\nrelaxation atelectasis.  Right lung otherwise clear.\n\n\n\nLUNGS, AIRWAYS, PLEURAE:\nVolume loss in the left lower lobe is more severe, primarily due to greater\nbasal relaxation atelectasis. No good evidence for pneumonia or pulmonary\nedema.  Small generally nonhemorrhagic bilateral pleural effusions layer\nposteriorly. However posteriorly layering high attenuation material, 35-51 ___\nposterior left lower pleural space could be a small amount of hemorrhage,\n3:174-183.  On this noncontrast study it is difficult to separate from\nadjacent basal segmental atelectasis.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nCHEST CAGE: Unremarkable",
            "output": "Very small, probable left hemothorax;, otherwise, primarily nonhemorrhagic\nsmall bilateral layering pleural effusions.\n\nBibasilar relaxation atelectasis, moderate on the right, severe on the left.\n\nSmall residual pericardial effusion.  No pericardial or mediastinal bleeding.\n\nSevere atherosclerotic coronary and head and neck calcification.\n\nIncidentally discovered left thyroid nodule best evaluated with ultrasound.\n\nRECOMMENDATION(S):  Continue to monitor volume of pleural effusions,\nespecially partially hemorrhagic one on the left with conventional chest\nradiographs.\n\nNOTIFICATION:  The findings, including changes from the preliminary report,\nwere discussed with ___, M.D. by ___, M.D. on the telephone on\n___ at 7:42 am, 2 minutes after discovery of the findings."
        },
        {
            "input": "There are no enlarged mediastinal or axillary lymph nodes. Hila are\nsuboptimally assessed in the absence of intravenous contrast, but there is no\nbulky adenopathy present. Severe diffuse coronary artery calcifications are\npresent.  Heart size is normal. There is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of a biliary stent as well as a presence of pneumo be ilia.  Known\npancreatic head mass is incompletely imaged.  Diffuse vascular calcifications\nare present in the abdominal and thoracic aorta and branch vessels. Sludge is\npresent within the gallbladder.\n\nThere are no suspicious lytic or blastic skeletal lesions within the thorax.\n\nWithin the lungs, no suspicious nodules or masses root are detected.",
            "output": "1.  No CT evidence of pulmonary metastases.\n\n2.  Severe diffuse coronary artery calcification.\n\n3. Incompletely imaged pancreatic head mass. Correlation with results of\noutside cross-sectional imaging studies is suggested for more complete\nevaluation of the upper abdomen."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue lesions in the imaged chest wall suspicious for\nmalignancy. Evaluation of the breasts requires mammography.\n\nFindings below the diaphragm will be reported separately.\n\nThyroid is heterogeneous, not enlarged, and there are no possible nodules of\nsufficient size to warrant further imaging.\n\nAtherosclerotic calcification is not evident in head and neck vessels mild in\nthe right subclavian artery, moderate in the left and bifurcation of the\nbrachiocephalic arteries, and in the left main, anterior descending and\ncircumflex coronary arteries. Aorta and pulmonary arteries are normal size,\nbut there is heavy intimal calcification of the proximal ascending thoracic\naorta and more 's heavy calcification and atheroma and/or mural thrombus in\nthe arch and throughout the normal caliber, descending thoracic aorta. .\n\nPericardium is physiologic and there is no pleural abnormality.\n\nLymph nodes in the mediastinum, internal mammary, hilar, and retrocrural\nstations are not enlarged.\n\nThere are no lung lesions suspicious for malignancy. A small number of\npunctate nodules in the upper lungs are barely visible. A 7 mm ground-glass\nlesion in the right upper lobe, 6:74, is new, inflammatory, not malignant.\n\nTracheobronchial tree is normal to subsegmental levels.",
            "output": "No evidence of primary or metastatic intrathoracic malignancy.\n\nSubstantial large vessel, atherosclerotic calcification, including coronaries."
        },
        {
            "input": "There are again several subcentimeter hypodensities in the right lobe of the\nthyroid gland, unchanged.  There is no supraclavicular, axillary, or hilar\nlymphadenopathy.  Mediastinal lymph nodes remain prominent without pathologic\nenlargement.  The heart is normal in size and configuration, with moderate to\nheavy calcification of coronary arteries and the aortic valve.  The great\nvessels are normal in caliber.  There is no pericardial effusion.  A left\nchest wall port is noted, with the catheter terminating in the low SVC.  Oral\ncontrast layers within the esophagus, predisposing the patient to aspiration.\n\nThe airways are patent.  There has been interval resolution of the right upper\nlobe inflammatory ground-glass opacity.  There is dependent atelectasis\nbilaterally, without mass, nodule, or focal consolidation.  No pleural\neffusion or pneumothorax is present.\n\nNo focal osseous lesion concerning for infection or neoplasm is identified.\n\nPlease see the dedicated CT abdomen/pelvis report from the same day for\ndetailed evaluation of infra diaphragmatic structures.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Oral contrast layering within the esophagus predisposes the patient\naspiration."
        },
        {
            "input": "MEDIASTINUM/HEART:  Several subcentimeter hypodensities in the right thyroid\nlobe are unchanged. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged by CT size criteria. Aorta and pulmonary arteries are\nnormal in size.  Moderate atherosclerotic calcifications of the aortic arch\nand origins of the major branch vessels are identified. Heart size is normal\nwith moderate coronary calcification, most pronounced in the proximal LAD and\nright coronary artery. No pericardial effusion.\n\nLeft-sided Port-A-Cath terminates in the distal SVC, unchanged.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Except for\ndependent atelectasis bilaterally, the lungs are clear without focal\nconsolidation or pleural effusion. No pulmonary nodules detected.\n\nUPPER ABDOMEN:  Please refer to the dedicated CT abdomen pelvis report from\nthe current date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Multilevel mild degenerative changes of the thoracic spine are\npresent.",
            "output": "1.  No evidence of intrathoracic malignancy or metastatic disease.\n\n2.  Please refer to the dedicated CT abdomen and pelvis report of the same\ndate for the subdiaphragmatic findings."
        },
        {
            "input": "Sub cm hypodense nodule in the right lobe of the thyroid is unchanged.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nMediastinal lymph nodes are increase in number stable in size measuring up to\n8 mm.  Aorta and pulmonary arteries are normal size. Cardiac configuration is\nnormal and there is mild calcification in all coronary arteries.  The lungs\nare clear.  There is no pleural or pericardial effusion.  There is a small\nhiatal hernia\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "Several thyroid nodules are unchanged all sub 5 mm.  Mediastinal lymph nodes\nare not pathologically enlarged.  Aorta and pulmonary arteries are\nunremarkable.  Heart size is normal.  There is no pericardial pleural\neffusion.  Small hiatal hernia is present.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear. \nNo pulmonary nodules masses are consolidations present.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest was no evidence of active intrathoracic\ninfection or malignancy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodense right lobe of thyroid\nlesion unchanged.  No supraclavicular adenopathy.  Axillary lymph nodes\nunchanged.\n\nUPPER ABDOMEN: Will be reported separately.  Small hiatal hernia.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes unchanged.\n\nHILA: No axillary adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nLeft prepectoral Port-A-Cath in situ with the tip in the mid SVC.  Moderate\ncalcification of the aortic annulus.  Mild calcification of the aortic valve. \nModerate calcification of the LAD and right coronary artery.  Severe\ncalcification of the left circumflex coronary artery.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Retrospectively identified pulmonary nodule in the left upper\nlobe (5, 82) measuring 7 x 4 mm shows interval increase in size (4 x 4 mm on\nthe previous study done ___.  No new pulmonary nodules.  No confluent\nairspace consolidation.  No diffuse lung disease.  No bronchiectasis.  Bibasal\nsubpleural ground-glass in keeping with passive atelectasis.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary truncus is not dilated.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Growing left upper lobe nodule is highly suspicious for a metastatic focus.\n\nFor abdominal findings please see abdominal CT report."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, elsewhere in\nthe chest there are no soft tissue abnormalities suspicious for malignancy or\ninfection.  The subcutaneous infusion port is unremarkable and the central\ninfusion catheter terminates in the mid SVC with no evidence of thrombosis.\n\nMeasurable, top-normal Sign central lymph nodes are numerous, range in size up\nto 10 x 13 mm in the left lower paratracheal station, 5:100, previously 9 x 13\nmm.  9 mm right hilar node, 5:129 was 8 mm in ___.  Diaphragmatic,\nretrocrural, and posterior mediastinal nodes are not enlarged.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\nThyroid is unremarkable.  Atherosclerotic calcification is mild to moderate in\nhead neck vessels, and severe in coronary artery branches.  Aorta and\npulmonary arteries are normal size.  Pericardium is physiologic and there is\nno pleural effusion.  Aside from dependent microatelectasis, right lung is\nclear.\n\n6 x 8 mm left upper lobe nodules within the range of measurement area compared\nto 5 x 7 mm in ___.  Left lung is otherwise clear.",
            "output": "Minimal growth over 7 weeks of the previously questioned solitary pulmonary\nmetastasis, left upper lobe, is not necessarily significant.  There are no new\nor growing lung nodules or lymph nodes.\n\nStable borderline central lymph node enlargement.\n\nCoronary atherosclerosis."
        },
        {
            "input": "Heterogeneous right thyroid lobe is not appreciably changed, a nodule which\nmeasures 10 mm (3:9).  A left chest port terminates in the distal superior\nvena cava.  Scattered axillary nodes are not pathologically enlarged and\nnormal in morphology, present previously and stable.  A left supraclavicular\nnode is unchanged measuring 4 mm in diameter (3:9).  Scattered mediastinal\nnodes are present, none of which are pathologically enlarged, all of which are\nunchanged including a right lower paratracheal station node measuring 6 mm\n(03:37), an aortopulmonary window node measuring 8 mm (03:33), and a\nsubcarinal node which measures 8 mm (03:43).\n\nContiguous left hilar and mediastinal adenopathy have both enlarged.  Previous\n1.5 x 0.7 cm mediastinal component anterior to the left mainstem bronchus is\nnow 2.0 x 1.1 cm (5:81).  Previous 0.7 x 0.4 cm hilar component along the left\npulmonary artery is now 1.3 x 1.8 cm.\n\nAt the level of the diaphragmatic hiatus is a 1.7 x 0.8 cm node (3:76),\npreviously 0.9 x 0.5 cm.\n\nThe ascending aorta is non aneurysmal and the main pulmonary artery is within\nnormal limits in caliber.  There is no pericardial effusion.  Heart size is\nnormal.  Severe atherosclerotic calcifications involve the coronary arteries\ndiffusely.  Moderate noncalcified and calcified atherosclerotic disease\ninvolves the aortic arch and descending thoracic aorta.  Moderate\ncalcifications involve the proximal right brachiocephalic artery and to a\nlesser degree the proximal left subclavian artery.\n\nA 1.0 x 0.8 cm left upper lobe nodule continues to marginally grow since\n___.  The lungs are otherwise clear with mild dependent subpleural\natelectasis.  There is no pleural effusion or abnormality.\n\nThere are no worrisome osseous lesions in the chest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "1.  Growing left upper lobe nodule with enlarging left hilar and peribronchial\nmediastinal adenopathy is worrisome for metastatic disease.\n\n2.  Paraesophageal node at the level of the diaphragmatic hiatus is enlarging,\nadditionally worrisome for disease progression, particularly subdiaphragmatic.\n\n3. Coronary atherosclerosis.\n\n4. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed concurrently, clip number ___."
        },
        {
            "input": "Stable heterogeneous right-sided thyroid nodule (4, 3).  The bilateral\nparatracheal lymph nodes (4, 9) are stable in size and morphology.  The\npre-existing lymph node ventral to the left pulmonary artery (4, 16) is\nminimally increased in size.  The pre-existing subcarinal lymph node (4, 21)\nis stable in size.  A pre-existing paraesophageal lymph node (4, 35) has\nminimally decreased in size.  Stable morphology of the vascular mediastinal\nstructures and of the heart.  Upper abdominal findings are described in detail\nin the dedicated abdominal CT report.  Mild degenerative vertebral disease. \nNo vertebral compression fractures.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.\nThe known left upper lobe pulmonary nodule (6, 80) has not changed in size and\nmorphology.  The diameter on today's examination is 8 x 7 mm.  The lower\nportions of the nodule (6, 82) could have minimally grown, but this growth, if\nany, is in sub-millimetric ___.  Stable appearance of a 2-3 mm middle\nlobe nodule (6, 134).  Stable 3 mm left lower lobe nodule (6, 175).  No new\npulmonary nodules.  Respiratory motion at the lung bases.  The airways are\npatent.",
            "output": "No substantial dimensional changes with regard to a pre-existing left upper\nlobe nodule.  All other pre-existing pulmonary nodules are also stable.  No\nnew pulmonary nodules.  No substantial dimensional changes with regard to the\nknown mildly enlarged mediastinal lymph nodes."
        },
        {
            "input": "Aortopulmonic window lymph node is 16 mm, similar or minimally increased since\nthe prior study.  No additional mediastinal, hilar or axillary lymph nodes\ndemonstrated.  Heart size is normal.  There is no pericardial pleural\neffusion.  Right paracardiac lymph node, series 4, image 38, 11 mm is\nunchanged\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe not\npre-existing nodule is no cavitated, series 5, image 96 although its overall\nsize does not exceed 9 mm as previously.  No additional nodules\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm have been\ndemonstrated.",
            "output": "Pre-existing left upper lobe is now cavitated without interval increase in\nsize.\n\nNo new nodules masses or consolidations\n\nNo substantial evidence of progression of metastatic disease except for\nminimal increase in size in the aortopulmonic window lymph node from 14-16 mm."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Pre-existing\naortopulmonic lymph node has decreased in size from 19-13 mm.  No new\nmediastinal lymph nodes of hilar or axillary lymph nodes demonstrated.  No\nsupraclavicular lymph nodes present.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\ncavitary nodule in the left upper lobe has decreased in size from 11-6 mm,\nseries 6, image 88.  Lingular small nodular atelectasis, series 6, image 175\nis unchanged.  Nodular opacity in the left lower lobe is unchanged, series 6,\nimage ___, 6 mm in diameter.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval decrease in size in the cavitary nodule in the left upper lobe\n\nNo new nodules masses or consolidations with unchanged lingular all and left\nlower lobe nodules\n\nInterval substantial decrease in size in the aortopulmonic window lymph node\npotentially being reactive to the left upper lobe cavitary nodule process that\npotentially might represent infectious etiology.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal pathology."
        },
        {
            "input": "Thyroid is multiple small hypodense areas within both lobes of thyroid are\nunchanged.  There are no enlarged supraclavicular, axillary lymph nodes. \nSmall mediastinal nodes are stable.  An AP window lymph node measures 11 mm\nand is unchanged.  Small bilateral hilar lymph nodes are stable.  There is\nmoderate cardiomegaly.  There is coronary artery calcification.  Right\npericardial lymph node measures 8 mm and is unchanged.  Small periesophageal\nlymph nodes are stable.\n\nThere is no pleural or pericardial effusion.  There is coronary artery\ncalcification.  There is atherosclerotic calcification involving the\ndescending thoracic aorta.\n\nThere is bibasilar atelectasis.  The cavitary lesion in the left upper lobe\nmeasuring 6 mm with eccentric wall thickening (91, 6) is unchanged.  No new \nnodules are seen.\n\nReview of bones is unremarkable.\n\nLeft-sided Port-A-Cath tip projects to the SVC.\n\nLimited sections through the upper abdomen shows evidence of pneumobilia. \nPlease refer to a dedicated report on abdomen which has been dictated\nseparately.",
            "output": "Stable small mediastinal lymph nodes.\n\nStable cavitary lesion in the left upper lobe with eccentric wall thickening. \nNo new pulmonary nodules.  Continued follow-up in view of history of\nmalignancy is recommended.\n\nPneumobilia.  Please refer to dedicated report on abdomen which has been\ndictated separately."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  Mildly enlarged mediastinal lymph nodes measuring up to 1 cm\nare unchanged compared to the prior exam.  A enlarged left hilar lymph node\nmeasuring up to 1.3 cm, series 6, image 91 is also unchanged compared to the\nprior exam.  Mildly prominent subcarinal lymph nodes are stable.  Heart size\nis normal.  Pericardium is intact without evidence of an effusion.  The\nesophagus is normal without evidence of wall thickening or a hiatal hernia.\n\nThere has been no interval change in the 7 mm left upper lobe cavitary lesion\nwith 6 mm eccentric wall thickening, series 6, image 78.  There is no pleural\neffusion or pneumothorax.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "Stable cavitary lesion in the left upper lobe with eccentric soft tissue wall\nthickening measuring up to 7 mm, without evidence of concerning new or growing\npulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is heterogeneous as before,\nwith no focal findings to warrant further imaging.  There is no pathologic\nenlargement of lymph nodes in the supraclavicular or axillary stations.  Left\npectoral Port-A-Cath terminates in lower SVC.\n\nCHEST CAGE: There is no evidence of osteo destructive lesions, lytic or\nsclerotic at the level of the ribs, sternum or vertebral body.  Moderate\ndegenerative changes are predominantly of the lumbar spine.\n\nUPPER ABDOMEN: A geographic enhancement of the liver is largely unchanged,\nstent in the CBD extending into the left lobe.  Small quantity of pneumobilia\nis unchanged.  Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: Borderline 1 x 1.5 cm prevascular space lymph node (302:65) and\n1.1 cm left hilar lymph node (302:83) are unchanged.  Small hiatal hernia with\nsubcentimeter anterior lower paraesophageal lymph node (302:152).\n\nHEART and PERICARDIUM: Heart is normal in size.  Pericardium is physiologic. \nExtensive dense calcifications involve all coronaries.  Faint calcifications\nin aortic valve leaflets.  Thoracic aorta is extensively calcified, normal in\ndiameter.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  Bibasilar\ndependent microatelectasis.\n\nThe known, cavitated left upper lobe anterior segment nodule  (302:68), has\nnot changed in size and morphology in its upper portion (302:68) but its lower\nportion is larger, measuring 1.5 x 0.6 cm in total (302:72), on ___ 1.2 x 0.4 cm (6:81 in prior).\nThe nodule is clearly larger in comparison to ___ when it measured\n0.6 cm, and new since ___.  Since the nodule was solid and grew\nbetween ___ and ___ and subsequently cavitated, and the\nwall became thinner wall even though the overall lesion increased,  infection\nis much more likely than malignancy, unless of course patient has shown\nparallel fluctuations in the growth of other metastatic foci of pancreatic\ncarcinoma in response to chemotherapy.\n\nMicronodule in the lingula (302:106) and 0.3 cm nodule in the left lung base\n(144), stable since ___.  There are no new lung nodules.",
            "output": "Cavitated left upper lobe nodule is an active process, much less likely\nmalignancy than infection including all mycobacteria (although m.Tuberculosis\nusually progresses more quickly) and indolent fungal pathogens.\n\nRECOMMENDATION(S):  Percutaneous or bronchoscopic sampling, left upper lobe\nlesion"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  Left\nsupraclavicular lymph nodes are slightly prominent.  Axillary lymph nodes are\nnot enlarged.\n\nMEDIASTINUM: There are several enlarged prominent mediastinal lymph nodes. \nThe largest lymph node at the AP window level is stable compared to prior\nmeasuring 1.4 cm (6:76).    A right epiphrenic lymph node slightly larger\ncompared to prior, currently measuring 1.1 x 1.3 cm, previously measuring 0.7\nx 0.9 cm (6:175).  Several additional lymph nodes are grossly stable compared\nto prior including a left supraclavicular node (06:12), bilateral upper\ntracheal nodes (06:36), left lower paratracheal node (6:66), and a left\nparaesophageal node (06:23).\n\nHILA: A left hilar lymph node is slightly larger compared to prior currently\nmeasuring up to 2.3 x 1.5 cm, previously measuring 1.7 x 1.1 cm.  Right hilar\nlymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThere is moderate to extensive calcification of the thoracic aorta.  The main,\nright, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There is interval enlargement of a left upper lobe\nirregular opacity measuring approximately 2.7 cm, previously measuring 1.5 cm\nwith increased peribronchial infiltration/involvement.  The morphology\nsuggests infectious etiology however the pattern of growth in concordance with\nenlarging left hilar lymph node suggests a aggressive metastasis.  There is\nbilateral dependent atelectasis.  There is new increased atelectasis of the\nanteromedial left upper lobe (6:108).  There is no emphysema.\n\nAIRWAYS:  There is increased obstruction of the lateral branch of the left\nsuperior bronchus (6:85).\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: There is a new round 0.9 cm sclerotic lesion in the T5\nvertebral body which likely represents metastasis (09:36).  Multilevel\ndegenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen. \nPlease see separately submitted report of CT Abdomen and Pelvis from the same\ndate for description of subdiaphragmatic findings.",
            "output": "1. Enlarging left upper lobe opacity with increased peribronchial infiltration\nand in conjunction with enlarging left hilar lymph node is suggestive of\naggressive malignancy.\n2. Enlarging left hilar and right epiphrenic lymphadenopathy.  Otherwise, the\nremaining prominent mediastinal lymph nodes are stable.\n3. Obstructed left superior bronchus.\n4. New 0.9 cm T5 sclerotic lesion likely represents metastasis.\n5. Extensive coronary artery and atherosclerotic disease.\n6. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings."
        },
        {
            "input": "Left chest wall Port-A-Cath is noted, with catheter extending into the SVC. \nSeveral small thyroid nodules appear unchanged.\n\nThoracic aorta is moderately calcified and normal in course and caliber.  The\nmain pulmonary artery is normal in size.  A small filling defect is noted\nwithin a right upper lobe pulmonary arterial branch, best seen on series 6,\nimage 110.  No additional pulmonary embolism is seen.\n\nThere is interval increase in size of a left upper lobe mass concerning for\ntumor progression with this lesion measuring approximately 3.4 x 5.0 x 2.5 cm.\nThere is increased irregular soft tissue density within the mediastinum\nlocated within the AP window and prevascular space concerning for confluency\nadenopathy.  There is soft tissue encasement of the left upper lobe pulmonary\nartery and bronchus, increased from prior.  A satellite nodule within the left\nupper lobe is seen on series 6, image 96 measuring approximately 7 mm, new\nfrom prior.  A small left pleural effusion is new from prior and is associated\nwith compressive atelectasis in the left lower lobe and mild inferior lingular\natelectasis is also noted.  Evaluation is limited due to motion.  The right\nlung is clear.\n\nA left paratracheal lymph node best seen on series 6, image 45 appears\nslightly increased in overall prominence measuring 8 x 15 mm, previously 8 x\n12 mm.  A lymph node in the cardiophrenic recess appears unchanged measuring 8\nmm in short axis.\n\nPlease refer to separately dictated concurrently performed CT abdomen pelvis\nfor findings below the diaphragm.\n\nBones: Sclerotic osseous metastatic lesions noted at T8, T7, T5 as well as at\nthe upper body of the sternum near the sternomanubrial joint.  Findings appear\nprogressed.  No evidence of a pathologic fracture.  A sclerotic lesion\ninvolving the right posterior fourth rib is also concerning for a site of\nosseous metastatic disease.  Significant degenerative disease at bilateral\nshoulders is partially imaged.  No acute fracture.",
            "output": "1. Small pulmonary embolism, acute appearing, within a branch of the right\nupper lobe, anterior segment.\n2. Interval progression disease with increased size of a left upper lobe\nirregular mass and increasing soft tissue infiltration of the mediastinum.\n3. New satellite lesion in the left upper lobe measuring 7 mm.\n4. New small left pleural effusion.\n5. Worsening osseous metastatic disease.\n\nNOTIFICATION:  An e-mail was sent to the referring physician at the time of\nthis dictation conveying the above findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar or segmental\npulmonary arteries.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nFew top-normal mediastinal lymph nodes are noted, largest measuring 1 cm in\nthe lower paratracheal region (02:55).  There is no supraclavicular, axillary,\nor hilar lymphadenopathy.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Trace right pleural effusion. \nNo left pleural effusion.  A right-sided chest tube courses within the right\nupper pleural space and subsequently exits the pleural space with tip\nmalpositioned within the right anterolateral subcutaneous tissues.  Extensive\nadjacent subcutaneous emphysema noted. (02:59). There is a persistent small\nright hydropneumothorax.  No left pneumothorax.\n\nRight upper lobe chain sutures from prior wedge resection. Bibasilar, right\ngreater than left atelectasis is noted.  There is mild interlobular septal\nthickening with an apical predominance on a background of severe centrilobular\nand paraseptal emphysema.  The airways are patent to the subsegmental level. \nNo bronchiectasis or mucus plugging.\n\nLimited images of the upper abdomen are notable for bilateral simple renal\ncysts, largest measuring 3.4 cm right upper pole.  Additional subcentimeter\nrenal hypodensities are too small to characterize.  Additional partially\nvisualized intra-abdominal organs are unremarkable.\n\nChronic posterior left tenth rib fracture noted.  No acute fracture.  No lytic\nor blastic osseous lesion suspicious for malignancy is identified.  Soft\ntissues are notable for a 1.5 x 1.4 cm lobulated lesion within the slightly\nupper outer left breast at mid depth level (2:66).",
            "output": "1.  Malpositioned right chest tube with tip within the right anterolateral\nsubcutaneous tissues and extensive subcutaneous emphysema.\n2.  No evidence of pulmonary embolism or aortic abnormality.\n3.  1.5 cm left breast lesion for which nonurgent dedicated evaluation with\nbreast imaging is recommended if not previously performed.\n4.  Bibasilar atelectasis.\n5.  Severe centrilobular and paraseptal emphysema.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 1:25 pm, 15 minutes after discovery of\nthe findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  In the left upper\nabdominal wall, subcutaneous tissue, a 4 x 16 mm opacity continues to\ninvolute, 05:52 and there are no new soft tissue lesions in the chest wall\nsuspicious for malignancy.  A heterogeneous subcentimeter hypodensity in the\nleft thyroid lobe is unchanged since at least ___ and too small to\nwarrant further imaging evaluation for possible malignancy.\n\nAtherosclerotic calcification is not apparent in head neck vessels or coronary\narteries.  Aortic valve is not enlarged.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  Pericardium is physiologic.  A tiny\nresidual layering left pleural effusion, decreased since ___, is\nnonhemorrhagic and there is no pleural thickening, nodular or otherwise. \nLymph nodes in the mediastinum, hila, internal mammary, diaphragmatic, and\nretrocrural stations are not enlarged\n\nThe post treatment residual of treated tumor and atelectasis in the left lower\nlobe close to the inferior pulmonary vein at the lower pole of the left hilus\nis unchanged since ___, less masslike today than in ___ even though\n___ have not changed over the past 3\nMonths.  It is still narrows the proximal portions of the basal segmental\nbronchi.\n\nSince ___ the previously 10 x 19 mm soft tissue mass at the periphery of\nthe right upper lobe, either pulmonary or pleural, 6:75, has continued to\ninvolute, 6 x 16 mm today and partially replaced by fat.\n\n2 mm subpleural left upper lobe nodule, 6:77, is new.\n\nThere are no other new lung lesions.\n\nA small blastic lesion in the left seventh rib has not changed since ___, probably benign.\n\nA well-circumscribed 6 mm wide lucency in the third thoracic vertebral body,\n9:45, 6:83, is unchanged since at least ___, also benign.",
            "output": "Continued involution of a right peripheral upper chest wall mass, left\nanterior abdominal wall mass, stable left juxta hilar mass.  The only\nindication of possible active or new metastasis is a solitary new retained 2\nmm left upper lobe lung nodule, significance indeterminate."
        },
        {
            "input": "Right pectoral Port-A-Cath.  Stable 3 mm left thyroid nodule (5, 9).  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No evidence of\nhilar or mediastinal lymphadenopathy.  A small soft tissue structure in the\nleft frontal abdominal wall (5, 47) is stable.  No enlarged lymph nodes in the\nposterior mediastinum.  The upper abdomen is described in detail in the\ndedicated abdominal CT report.  There are no new blastic or lytic lesions at\nthe level of the ribs or the thoracic spine.  A small sclerotic lesion in the\nseventh left rib (9, 76) is stable.  Calcified right upper lobe pulmonary\nnodule.  No suspicious pulmonary nodules or masses.  The post treatment lesion\nin the left lower lobe (6, 183) continues to narrow the local segmental\nbronchi but continues to minimally decreased in size.  The lesion also\ncontinues to maintain contact to the pleura but the pleural thickening has\ndecreased in severity since the previous examination (6, 205).  No new\nparenchymal abnormalities.  No evidence of right pleural thickening.",
            "output": "Continued involution of the left lower lobe mass, decrease in severity of the\nadjacent pleural thickening.  Known calcified right upper lobe granuloma. \nKnown sclerotic rib lesion."
        },
        {
            "input": "The thyroid gland is notable for a 1.4 cm partially calcified nodule in the\nleft lobe, unchanged since the prior study.  Supraclavicular, axillary,\nmediastinal, and hilar lymph nodes are not enlarged.  The aorta and main\npulmonary artery are normal in caliber.  Minimal atherosclerotic\ncalcifications are present at the aortic arch.  The heart is normal in size. \nThere is no pericardial effusion.\n\nThe central airways are patent.  Scattered calcified granulomas are unchanged.\nAgain seen is a consolidation at the level of the left lower lobe bronchus\nwith fiducial seed centrally.  There is unchanged narrowing of the segmental\nbronchi with tethering to the pleura.  No new parenchymal abnormality is\nidentified.  There is no pleural effusion or pneumothorax.\n\nPlease refer to separate report on CT abdomen and pelvis performed on the same\nday for discussion of sub- diaphragmatic findings.\n\nNo suspicious lytic or sclerotic osseous lesion is identified. \nWell-circumscribed sclerotic lesion is unchanged at the left seventh rib\n(04:35).  A right chest Port-A-Cath terminates in the proximal right atrium.",
            "output": "Unchanged appearance of the left lower lobe mass with narrowing of the\nsegmental bronchi.  No evidence of new or worsening metastatic disease."
        },
        {
            "input": "Thyroid nodules are multiple, some of them calcified.  No mediastinal,\naxillary or right hilar lymphadenopathy is present.  Left hilar mass is\nsimilar to previous examination with no definitive evidence of interval grows.\n\nHeart size is normal.  There is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally except for rounded\natelectasis in the left lower lobe, unchanged.  no new pulmonary nodules\nmasses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued",
            "output": "No evidence of progression of intrathoracic metastatic disease with unchanged\nappearance of the left lower lobe mass with narrowing of the segmental\nbronchi."
        },
        {
            "input": "Multiple thyroid nodules measuring up to 1.0 cm, some partially calcified, are\nnot significantly changed.  There are no pathologically enlarged\nsupraclavicular, axillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.  A right-sided Port-A-Cath terminates in the right\natrium.\n\nNo pneumothorax or pleural effusion is identified.  The residual of a treated\nleft perihilar mass containing a fiducial with adjacent atelectasis and\nbronchiectasis in the lower lobe is not significantly changed.  There are\nscattered tiny calcified granulomas.  No new pulmonary nodules.\n\nA tiny rounded sclerotic lesion in the left seventh rib is unchanged.  No\nosseous lesions suspicious for infection or malignancy are identified.\n\n Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "-Stable appearance of treated left perihilar mass with adjacent atelectasis. \nNo evidence of new or recurrent intrathoracic metastatic disease.\n-Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "There are stable punctate calcifications within both lobes of thyroid.  Small\nhypodense lesions within the left lobe of thyroid are also unchanged.  There\nare no enlarged supraclavicular lymph nodes.  There are no enlarged axillary\nlymph nodes.\n\nRight-sided Port-A-Cath projects with its tip to the SVC.  Heart size is\nnormal.  There is no pericardial effusion.  There is no pleural effusion.\n\nThere are stable post radiation changes to the left lower lobe mass with\nevidence of bronchiectasis scarring and a radiopaque marker adjacent to it. \nThere is stable volume loss in the left lower lobe.  A 2 mm nodule in the\nright lower lobe image 32; series 5 is unchanged.  No new pulmonary nodules.\n\nReview of bones shows stable focal sclerosis in the seventh rib on the left.\n\nLimited sections through the upper abdomen shows left renal cyst.  The liver\nis mildly fatty infiltrated.  Please refer to dedicated report on abdomen\nwhich has been dictated separately.",
            "output": "Stable post treatment appearance of the left perihilar opacity with adjacent\nfiducial marker.  This most likely represents a metastasis treated with SBRT. \nStable tiny right lower lobe pulmonary nodule.  No new pulmonary nodules.\n\nRight-sided Port-A-Cath with its tip in the SVC.\n\nPlease refer to dedicated report on abdomen and pelvis performed on the same\nday for further details"
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is top-normal.  No pericardial effusion. \nThe thoracic aorta is normal in caliber.  Incidental note is made of a common\norigin of left common carotid and innominate arteries.  The main pulmonary\nartery is normal in caliber.  No central pulmonary embolus.  A right IJ\nPort-A-Cath tip is located in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Left lower lobe postradiation changes and chronic atelectasis\nare unchanged.  A 6 mm right upper lobe apical segment nodule is unchanged\nsince ___, substantially decreased in size since ___.  No\nnew pulmonary nodules or consolidations.  Scattered calcified granulomas are\nagain noted.\n\nBASE OF NECK: Subcentimeter thyroid nodules are unchanged.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: Focal lucency in the T3 vertebral body is unchanged since at least\n___.  Tiny lesions in posterolateral left fourth rib, anterior left\nfifth rib, and anterolateral left seventh rib are unchanged since at least\n___.  There is no acute fracture.  Mild bilateral glenohumeral\nosteoarthritis with joint space narrowing and subchondral cystic change.",
            "output": "Stable left lower lobe radiation changes and chronic atelectasis. No new or\nenlarging pulmonary nodules."
        },
        {
            "input": "Right pectoral infusion port terminates in the right atrium.  0.8 cm hypodense\nnodule with punctate calcification in the left thyroid lobe is unchanged. \nFocus coarse calcification in the left thyroid lobe is also unchanged. \nSupraclavicular, axillary, mediastinal, and hilar lymph nodes are not\npathologically enlarged.  Thoracic aorta and main pulmonary artery are normal\nsize.  There is no pericardial effusion.\n\nThere is no pleural effusion.  Posttreatment changes are again demonstrated in\nthe left lower lobe with focal segmental airway obstruction and parenchymal\nconsolidation.  Otherwise, airways are patent to subsegmental levels\nelsewhere.  Multiple millimetric calcified granulomas are noted in the right\nupper and lower lobes.  1.2 cm subpleural scarring or nodule at the right lung\napex (___) is unchanged.\n\nNo concerning bone or soft tissue lesion is identified.\n\nPlease refer to separate report for CT abdomen and pelvis for abdominal\nfindings.",
            "output": "1. No evidence of malignancy is identified in the chest.  Stable posttreatment\nchanges are noted at the left lower lobe."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Heterogeneous thyroid with\nhypodense left lobe nodule and coarse calcifications, unchanged since ___.\n No lymphadenopathy in the thoracic inlet.  Right anterior Port-A-Cath ends in\nright atrium.\n Minimal atherosclerosis in head and neck vessels.  Common origin of left\ncommon carotid artery and brachiocephalic artery (normal variant).\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Small hiatal hernia.  Esophagus is otherwise unremarkable.\nStable small mediastinal lymph nodes measuring up to 8 mm.  No hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM:\nHeart is normal in size. No pericardial effusions.\nMild atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Stable left lower lobe consolidation surrounding fiducial\nmarker, likely post radiation scarring.\nScattered calcified granulomas in both lungs.  Subpleural low-attenuation\nnodule right lung apex is stable and measures 1.2 cm.\n2. AIRWAYS:  Remaining airways are patent to subsegmental level.\n3. VESSELS:  Pulmonary artery is not enlarged.\nCHEST CAGE: No acute fractures.  Mild dorsal spondylosis in lower thoracic\nspine.  No lytic or sclerotic lesions suspicious for metastases.",
            "output": "Stable post treatment appearance of previous left lower lobe metastases.\nNo other suspicious lesions for intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLA, CHEST WALL: A 6 mm hypodense left thyroid nodule\nhas been stable since ___.  No enlarged or growing lymph nodes.  A\nright-sided Port-A-Cath ends in the cavoatrial junction.  There is a common\norigin of the left common carotid artery and brachiocephalic artery which is a\nnormal variant.\n\nMEDIASTINUM: There is a small hiatal hernia.  Lymph nodes are stable and\nmeasure up to 8 mm and are not pathologically enlarged by imaging criteria.\n\nHEART AND PERICARDIUM: The heart is not enlarged.  There are mild\ncalcifications in the thoracic aorta and coronary arteries.  There is no\npericardial effusion.\n\nPLEURA: No pericardial effusions.  There is no pneumothorax.\n\nLUNGS: Stable left pleural consolidation with fiducial marker, representing\npost radiation changes.  There are numerous scattered calcified granulomas in\nboth lungs that are stable with the largest measuring 5 mm in the right upper\nlobe (4; 55).\n\nBONES: No lytic or sclerotic lesions that are suspicious for metastasis.\n\nUPPER ABDOMEN: There is a left renal cyst.  Patient is status post right\nnephrectomy.  Please refer to same day abdominal CT report for remaining\nsubdiaphragmatic findings.",
            "output": "1.  No evidence of new or recurrent intrathoracic metastasis.\n2.  Stable post radiation changes in the left lower lobe.\n3.  Right-sided Port-A-Cath ends in the cavoatrial junction."
        },
        {
            "input": "THORACIC INLET: There stable multiple hypodense lesions within the left lobe\nof thyroid.  There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.  Multiple small\nnonenlarged axillary lymph nodes are unchanged.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  Right-sided Port-A-Cath projects to the SVC.  There is no pleural\neffusion.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The consolidative opacity in the left lower lobe with evidence of a\nfiducial within the left lower lobe bronchus most likely represents post\nradiation changes.  Numerous scattered bilateral calcified granulomas are\nagain seen.  No new or growing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of liver.  Patient status post right nephrectomy.  Please refer\nto dedicated report on abdomen which has been dictated separately",
            "output": "Stable post radiation changes involving the left lower lobe corresponds in 2\ntreated tumor with evidence of a fiducial marker in the left lower lobe\nbronchus.  No new or growing pulmonary nodules.\n\nMultiple scattered calcified 1-2 mm pulmonary nodules"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are at least 2\nwell-circumscribed hypoattenuating lesions throughout the left thyroid lobe a\nmeasure up to 6 mm, (series 3, image 6), unchanged.  There are multiple small\naxillary lymph nodes measure up to 10 mm in short axis, (series 3 image).  No\ninfraclavicular or supraclavicular lymphadenopathy.  A right-sided indwelling\nPort-A-Cath terminates at the right atrium, unchanged.\n\nUPPER ABDOMEN: Please refer to same-day CT abdomen and pelvis for detailed\nreport of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion.  No\ncalcified atherosclerosis involving the coronary arteries.  The vascular\ncaliber of the ascending aorta, main pulmonary artery and descending aorta are\nwithin normal limits.  No incidental pulmonary embolism is demonstrated.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  An opacity at the left lower lobe with evidence of a fiducial\nwithin left lower lobe bronchus most likely represents post radiation changes.\nMultiple subcentimeter calcified granulomas are unchanged in size and\nmorphology when compared to prior dated ___.  For example a 5 mm\ncalcified granuloma at the right upper lobe is unchanged, (series 4, image\n54).\nA 2 mm pulmonary nodule at the right upper lobe is unchanged, (series 4, image\n150).\n2. AIRWAYS:  Except for the left lower lobe bronchus, the airways are patent\nto the subsegmental level without bronchial wall thickening, bronchiectasis or\nmucus plugging.\nCHEST CAGE: No acute fracture.  Tiny focal lucency at T3 vertebral body is\nunchanged since ___.  Tiny lesions at the posterolateral left fourth\nrib, anterior left fifth rib and anterolateral left sixth rib are unchanged\nsince ___.  No new sclerotic or lytic osseous lesions.",
            "output": "1. Stable postradiation changes involving the left lower lobe with stable\nposition of  fiducial marker at the left lower lobe bronchus.\n2. Multiple calcified granulomas and pulmonary nodules measuring up to 5 mm\nunchanged when compared to CT chest dated ___.\n3. No new or growing pulmonary nodules."
        },
        {
            "input": "Two left thyroid hypodense nodules measuring up to 13 mm are stable.\n\nThe right upper lobe nodule has minimally increased in size measuring 10 x 8\nmm compared to 8 x 6 mm on next preceding study (___) and 5 mm in\n___. The dominant left lower lobe hyperenhancing mass, apposed to the\nleft inferior pulmonary vein, has increased in size measuring 4.40 x 4.5 cm\ncompared to 3.6 x 4.0. In addition, there is new contiguous extension of the\nhyper enhancing mass into the adjacent left lower lobe bronchus, just distal\nto the take-off of the superior segment bronchus(4:116, 601:57) with patency\nre-established in the anteromedial segment but becoming obstructed again more\ndistally. Findings are concerning for direct endobronchial extension of\nmetastasis. Stable impaction of the more distal posterior and lateral\nsegmental bronchi is hypodense relative to the more proximal enhancing mass\nand likely represent mucous plugging. No pleural effusion present.\n\nWithin the pericardium adjacent to the left lower lobe mass, there is a 6 mm\nenhancing ovoid soft tissue nodule likely representing a lymph node.  Multiple\nleft hilar lymph nodes measuring up to 6 mm are prominent by number, but not\npathologically enlarged by CT standards. No supraclavicular or axillary\nlymphadenopathy identified. The central vessels are unremarkable. Heart size\nis normal and without pericardial effusion;.\n\nLimited assessment of the upper abdomen demonstrates hepatic steatosis.\n\nNo suspicious lytic or blastic lesions identified. No superficial soft tissue\nmass is identified.",
            "output": "1.  Interval increased size of the right upper lobe nodule as well as the\ndominant left lower lobe mass.  The latter is associated with a contiguous\nendobronchial left lower lobe lesion concerning for direct tumor extension. \nIf clinically warranted, this could be further assessed with bronchoscopy.\n\n2.  Stable thyroid nodules measuring up to 13 mm."
        },
        {
            "input": "Multiple bilateral hypodense thyroid nodules are measuring up to 8 mm on the\nleft are unchanged. There is no supraclavicular, mediastinal, hilar or\naxillary lymphadenopathy.\n\nThere is a normal heart size with minimal coronary artery calcification and no\npericardial effusion. The main pulmonary artery and thoracic aorta are normal\nin caliber.\n\nEvaluation of the lungs demonstrates no significant change in the dominant\nleft lower lobe mass since ___. On today's exam, the mass measures 5.3\nx 4.4 cm as compared to 5.5 x 4.9 cm previously (4, 143). There is a stable\ndegree of endobronchial extension, as well as encasement and narrowing of\nseveral left lower lobe segmental pulmonary arteries. In addition, a right\nupper lobe subpleural nodule is minimally decreased in size measuring 9 x 6\nmm, previously 10 x 8 mm (4, 52). A punctate 2 mm right upper lobe nodule is\nalso stable (4, 56). Additional calcified nodules are incidentally noted in\nthe right upper and right lower lobes. No new pulmonary nodules are\nidentified. There is pleural effusion.\n\nNo destructive osseous lesions are identified.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Stable pulmonary metastases with no significant interval change since ___ in the dominant left lower lobe mass with endobronchial extension and\nencasement of several left lower lobe segmental pulmonary arteries."
        },
        {
            "input": "10 mm left peripectoral axillary lymph node, 07 : 44, was 11 mm on ___. There is no other axillary or supraclavicular adenopathy. And no soft\ntissue abnormality in the left chest wall suspicious for malignancy. Findings\nbelow the diaphragm will be reported separately.\n\nThe largest of several possible nodules in the left thyroid lobe is 9 mm, 06 :\n11, previously 12 mm and now too small to warrant further evaluation.\nAtherosclerotic calcification is not apparent. Aorta and pulmonary arteries\nare normal size. Mediastinum is free of adenopathy.\n\nThe long - standing, large left hilar mass, 50 x 43 mm at the level of its\ngreatest cross-sectional area, 06 : 38, invading the left inferior pulmonary\nvein was 53 x 46 mm measured at the same level in ___. The left\ndescending pulmonary artery and segmental branches are severely displaced but\nprobably not occluded. There is mild bronchial occlusion i n the posterior\nbasal segment, but no postobstructive pneumonia or atelectasis.\n\nThere is no pleural or pericardial abnormality. A pair of right upper lobe\nlung nodules, 7 and 3 mm wide, adjacent to a calcified granuloma, has been\npresent without any appreciable change since at least ___ and\nthere are no new lung nodules, nor is there any evidence of granulomatous\ninfection.\n\nA well-circumscribed 6 mm wide lucency in an upper thoracic vertebral body is\nbeen present without appreciable change since at least ___. There are\nno bone lesions suspicious for malignancy or infection in the chest cage.",
            "output": "Large left hilar or perihilar mass slightly smaller today than in ___ invades the left inferior pulmonary vein as before, produces mild\nbronchial obstruction, but no appreciable atelectasis or postobstructive\npneumonia.\n\nNo other evidence of active malignancy in the chest."
        },
        {
            "input": "Left thyroid lobe nodule is demonstrated, 10 mm in diameter, unchanged.\nAdditional left thyroid lobe nodule, series 5, image 12 is 7 mm in diameter.\nNo mediastinal lymphadenopathy is seen.  Left hilar mass that is in casing in\nattenuating left inferior pulmonary vein has minimally changed in the interim,\ncurrently measuring 38 by 34 mm as compared to 38 x 37 mm previously. The\nfiducial marker is in mid portion of the lesion, has been placed in the\ninterim.\n\nAorta and pulmonary arteries are unchanged in appearance.  The left hilar mass\nappears to be in casing and insinuating the left lower lobe bronchi with\nassociated air trapping and more distal areas of atelectasis.  Right upper\nlobe nodule is stable no new nodules masses are consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No substantial change in the left perihilar mass with left lower lobe\nsegmental bronchi obstruction.\n\nStable right upper lobe nodule\n\nLeft thyroid nodules, unchanged but should be at some point characterized with\nthyroid ultrasound"
        },
        {
            "input": "Soft tissues:The thyroid is heterogeneous with 2 nodules in the left lobe, the\nmore inferior nodule with peripheral calcification in the more superior nodule\nmeasuring 6 mm, unchanged from the prior CT.  No pathologically enlarged\naxillary, mediastinal, or hilar lymph nodes. The heart is normal in size and\nthere is no pericardial effusion. No significant coronary artery or valve\ncalcification.  The aorta and main pulmonary artery are normal in caliber. The\nesophagus follows a normal course and is normal in caliber.  Limited images of\nthe upper abdomen demonstrate surgical material from a right nephrectomy and a\nsimple cyst at the upper pole of the left kidney.  Evaluation of the soft\ntissues demonstrate a 10 mm nodule in the left anterior chest wall (02:46),\nlarger than on the prior study where measure 7 mm.  Additionally, there is a\nsecond nodule in the anterior abdominal wall in the midline (02:58), measuring\n6 mm.  At this same level, there is a nodule in the back measuring 6 mm\n(02:57).\n\nLungs: The airways are patent to the subsegmental level bilaterally. The\ndominant left lower lobe mass measures 29 x 27 mm, previously 38 x 34 mm. \nAround the mass is a new area of consolidation, pleural thickening, and\nbronchiectasis in keeping with the radiation pneumonitis.  Scattered calcified\ngranulomas in the right upper and lower lobes are again seen.  The subpleural\nright upper lobe mass (05:54) measures 7 x 12 mm, previously 8 x 5 mm.  No\npleural effusion or pneumothorax.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Interval decrease in size of the dominant left lower lobe lesion.\n2.  Interval increase in size of the subpleural right upper lobe lesion.\n3.  New/ larger soft tissue nodules in the anterior and posterior \nthoracic/abdominal walls as noted above.\n4.  New area of consolidation, pleural thickening, and bronchiectasis around\nthe left lower lobe mass in keeping with radiation pneumonitis."
        },
        {
            "input": "MEDIASTINUM/HEART:  Heterogeneous thyroid with two unchanged left thyroid\nnodules containing peripheral calcific are again seen (6:40, 52).\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged\nby CT size criteria. Aorta and pulmonary arteries are normal in size. Heart\nsize is normal with scattered unchanged coronary artery and aortic arch\ncalcifications. No pericardial effusion.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. The dominant\nleft lower lobe mass is difficult to measure due to geometric shape, however\nit appears enlarged and now measures 3.6 x 3.2 cm compared with 2.9 x 2.7 cm\npreviously (6:179).  It appears to invade into the surrounding area, causing\npostobstructive bronchial fluid.  There is continued adjacent consolidation,\npleural thickening/effusion, and bronchiectasis, in keeping with known\nradiation pneumonitis.  In the right upper lobe, the subpleural nodule has\nenlarged, now measuring 1.6 x 1.1 cm compared with 1.2 x 0.7 cm previously\n(6:61).  Multiple scattered calcified granulomas are unchanged.\n\nUPPER ABDOMEN:  Please see the dedicated CT abdomen and pelvis report from the\ncurrent date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: A lucent focus in the T3 vertebral body (9:44) is\nunchanged since the prior study and was also present in ___. \nMultilevel mild degenerative changes of the thoracic spine are present.\n\nPreviously described left anterior chest wall nodule has enlarged, now\nmeasuring 1.5 x 1.3 cm from 1.0 cm previously (6:232).  Midline anterior\nabdominal wall nodule has also enlarged, now measuring 1.2 x 0.8 cm compared\nwith 0.6 cm previously (6:291).",
            "output": "1.  Compared with the prior CT in ___, there has been progression of\ndisease.  The left lower lobe mass has increased in size, now measures 3.6 cm,\nand appears to invade into the adjacent area causing postobstructive bronchial\nfluid.\n\n2.  A right upper lobe subpleural nodule has also enlarged, measuring 1.6 cm. \nMultiple chest wall and posterior soft tissue lesions have also increased in\nsize as described above."
        },
        {
            "input": "MEDIASTINUM/HEART:  Heterogeneous thyroid with two unchanged left thyroid\nnodules containing peripheral calcific are again seen.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged\nby CT size criteria. Aorta and pulmonary arteries are normal in size. Heart\nsize is normal with scattered unchanged coronary artery and aortic arch\ncalcifications.  New moderate to large pericardial effusion.  No definite\nevidence of cardiac tamponade.  No pericardial nodularity or enhancement.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level.  Necrotic\nmass in the left lower lobe although difficult to measure has increased in\nsize, with the solid component of the mass extending more medially to the\nparaspinal location, and roughly 4 x 3.7 cm, previously 3.6 x 3.2 cm at a\ncomparable level (4:180) There is increasing adjacent left-sided pleural\neffusion.\n\nIn the right upper lobe, the subpleural nodule has enlarged, now measuring 1.6\nx 1.4 cm previously 1.6 x 1 cm (4:75).  Subpleural nodular opacities in the\nposterior segment of the right upper lobe (04:12 7) and superior segment of\nthe right lower lobe (04:14 1) measuring 5 mm are new and may represent\nnodular atelectasis but should have attention on follow up.\n\nMultiple scattered calcified granulomas are unchanged.\n\nUPPER ABDOMEN:  Please see the dedicated CT abdomen and pelvis report from the\ncurrent date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: A lucent focus in the T3 vertebral body (9:44) is\nunchanged since the prior study and was also present in ___.\nMultilevel mild degenerative changes of the thoracic spine are present.\n\nPreviously described soft tissue nodule in the left anterior chest wall also\nlikely metastatic has increased in size measuring 1.9 x 1.8 cm, previously 1.5\nx 1.3 cm.  Midline anterior abdominal wall nodule measuring 1.3 x 1.2 cm has\nalso increased previously measuring 1.2 x 0.8 cm.",
            "output": "Interval increase in size of left lower lobe mass, right upper lobe subpleural\nnodule, chest wall nodules and new moderate to large pericardial effusion.  No\nCT signs of cardiac tamponade at this time.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 2:56 ___, 30 minutes after discovery of\nthe findings."
        },
        {
            "input": "There is a 1.1 x 0.7 cm peripherally calcified and centrally hypodense nodule\nin the left thyroid lobe (2:7).  Visualized portion of the right thyroid lobe\nis homogeneous in appearance.\n\nNo axillary, supraclavicular, mediastinal or hilar lymphadenopathy by CT size\ncriteria.  Heart size is mildly enlarged.  Small to moderate non-hemorrhagic\npericardial effusion has substantially decreased compared to ___.  The\npericardial drain terminates adjacent to the apex.  Pneumopericardium would be\nin keeping with recent instrumentation (3:119).  Thoracic aorta contains\nminimal atherosclerotic calcifications, but is normal in course and caliber.\n\nMain pulmonary artery is normal in caliber.  No evidence of pulmonary embolism\nto the subsegmental levels on the right.  Within the left upper lobe branches,\nthere is no evidence of pulmonary emboli to the segmental levels, as\nevaluation of the subsegmental levels is limited by respiratory motion. \nEvaluation of the subsegmental branches of the left lower lobe pulmonary\nartery are obscured by adjacent consolidation and tumor.\n\nThere is a 1.8 x 1.3 cm nodule in the right upper lobe (02:17), not\nsignificantly changed from the prior study where it was 1.7 x 1.2 cm. \nImmediately inferior and posterior to this nodule, there is a 5 mm calcified\ngranuloma (02:18).  Streaky atelectasis is present in the right lower lobe. \nThe previously noted necrotic left lower lobe parenchymal mass is not clearly\ndelineated as it is largely surrounded by collapsed lung parenchyma, which is\nnew.  Previously noted subpleural nodular opacities in the posterior segment\nof the right upper lobe and superior segment of the right lower lobe are not\nwell visualized, and may be obscured by adjacent compressive atelectasis. \nSmall volume left pleural effusion is non-hemorrhagic in nature.  No\npneumothorax.\n\nThere is a 2.2 x 1.6 cm subcutaneous soft tissue nodule in the left anterior\nchest wall (2:86) that has progressively increased in size over several prior\nstudies, most recently measuring 1.9 x 1.5 cm on ___.  Of note,\nthis is located immediately adjacent to the recently placed pericardial drain.\nAdjacent fat stranding and subcutaneous emphysema is expected post pericardial\nwindow.\n\nAvailable images of the upper abdomen demonstrate no gross abnormalities.\n\nEvaluation of the osseous structures demonstrates a 1.5 x 0.9 cm lucent lesion\nin the right transverse process at T6 (02:42).  This dates back to the\nearliest available study performed in ___.  There are also\nsclerotic foci measuring 0.9 cm in the right lateral fifth rib (602b:64), and\n0.8 cm in the right lateral seventh rib (602b:68) that have also remained\nstable since ___, and are suggestive of a non-aggressive lesions\nsuch as fibrous dysplasia.  No other suspicious lytic or sclerotic lesions are\nidentified.  No acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Interval decrease in size currently small/moderate pericardial effusion\nsince recent pericardial window.  Pneumopericardium and other post-surgical\nchanges after recent pericardial window.\n3. Extensive left lower lobe opacification is due to a combination of known\nnecrotic lung mass, which is now surrounded by newly collapsed lung\nparenchyma.  Adjacent pleural effusion has increased.\n4. Little change in a 1.8 x 1.3 cm right upper lobe nodular opacity.\n5. Continued growth of a currently 2.2 x 1.6 cm left anterior chest wall\nsubcutaneous soft tissue nodule, presumably metastatic.\n6. A 1.1 cm peripherally calcified left thyroid nodule.\n7. Right T6 transverse process lucent lesion and sclerotic foci in the right\n___ and 7th ribs are stable from ___.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 3:30AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "Thyroid lesions are unchanged.  Aorta and pulmonary arteries are unremarkable.\nHeart size is top-normal.  No pericardial effusion is currently seen.  Left\npleural effusion is small substantially decreased since the prior study. \nThere is interval decrease in the left lower lobe mass, currently approaching\n4.5 x 2.7 cm.  The airways up partially patent centrally with distal airways\nbeing either occluded O compressed.\n\nNo interval increase in mediastinal, hilar or axillary lymphadenopathy is\npresent.  For pre size assessment of the CT abdomen please review the CT\nabdomen and the corresponding report that will be provided separately.\nRight upper lobe subpleural nodule has substantially decreased in size from 18\nx 13 mm to 11.5 x 7 mm, series 4, image 50 no new O lesions demonstrated.\nAirways are patent to the subsegmental level bilaterally elsewhere except for\nleft lower lobe.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nPreviously seen left anterior soft tissue lesion currently is not seen and\ninstead there is a linear 16 x 6 mm area that might represent res easier of\nthe previous nodule.",
            "output": "Substantial interval improvement in the right upper lobe lesion, left lower\nlobe mass, left anterior chest wall lesion as well as interval resolution of\nwill pericardial effusion and substantial decrease in left pleural effusion.\n\nFor assessment of the upper abdomen please review CT abdomen and the\ncorresponding report"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. Mild atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nStatus post midline sternotomy with coronary artery bypass grafting and aortic\nvalve replacement.  The heart is normal in size and shape. No pericardial\neffusion.  Mild atherosclerotic calcifications in the coronary arteries and\naorta.  The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nSmall right pleural effusion.  Mild bilateral apical scarring.\n\nLUNGS:\nthe airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging. No suspicious lung nodules or\nmasses. No consolidations.  Mild atelectasis is seen in the lung bases\nbilaterally.\n\nCHEST CAGE:\nSternotomy wires appear intact and properly alignment.  No evidence of sternal\ndehiscence.  No fluid collection overlying the sternum or in the retrosternal\nspace.  Subcutaneous fat stranding is seen overlying the entire sternum,\ngreater at the inferior margin, but likely compatible with recent sternotomy. \nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "No evidence of sternal dehiscence.  No drainable fluid collections or evidence\nof sternal osteomyelitis.  Stranding of the subcutaneous fat overlying the\nsternum is likely attributable to recent midline sternotomy, however recommend\ncorrelation with physical exam for any signs of cellulitis/infection."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans. Small hiatal hernia.  No adrenal lesions.  2 small hypodense hepatic\nlesions in segment 2 of the liver unchanged.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Small pericardial\neffusion measuring 8 mm diameter.  Mild aortic annular calcification.  Mild\nLAD calcifications.  Moderate right coronary artery calcification.  Mild\ndilatation of the ascending aorta measuring 42 mm in diameter.  Moderate\ncalcification of the aortic arch.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  There is mild to moderate fibrotic lung disease in the form\ndiffuse ground-glass changes with an apicobasal gradient, and subpleural\ninterstitial thickening with bronchiolectasis.  Associated architectural\ndistortion as evidenced by straightening of the pulmonary vessels and\nbronchiectasis.\n-There are no large areas of confluent airspace consolidation or nodular\n___ to suggest active infection.\n-2 new areas of subpleural opacity present in the superior segment of the\nright lower lobe (4, 78) and in relation to the oblique fissure (4, 108) which\nare indeterminate and may represent focal atelectasis, confluent fibrosis or a\nneoplastic process.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Fibrosing interstitial lung disease with the radiographic appearance of\nfibrotic NSIP.  Mild interval progression compared to previous imaging done\n___.\n\nNo large focal airspace consolidation or ___ peribronchial nodules to\nsuggest active lower respiratory tract infection.\n\nIt is the opinion of reporting radiologist that the progression of the\ninterstitial lung disease is more likely responsible for the patient's\nshortness of breath then an infective process.\n\nIndeterminate subpleural opacities in the superior segment of the right lower\nlobe and in relation to the right oblique fissure as described above.\n\nRECOMMENDATION(S):  Six-month follow-up advised for the indeterminate\npulmonary opacities/nodules."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Small subcutaneous sebaceous cyst in\nthe left anterior chest wall (2, 33) is unchanged.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Possible small hiatal hernia.  No adrenal lesions.  Mild perirenal\nstranding.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes are unchanged.  Calcified\nAP window nodes unchanged.\n\nHILA: No new hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  The previously noted\nsmall pericardial effusion has resolved.  Mild aortic annular calcification. \nModerate right coronary artery calcification.  Punctate LAD calcification. \nMild fusiform aneurysmal dilatation of the ascending aorta measuring 44 mm in\ndiameter, which is unchanged compared to prior imaging.\nPLEURA: Small nonhemorrhagic right-sided pleural effusion.\nLUNG:\n\n-PARENCHYMA: There is increased consolidation in relation to the previously\nnoted areas of subpleural fibrosis as well as increase in ground-glass\nopacification of the non fibrotic lung.\n  No airspace consolidation involving the non fibrotic lung or ___\npattern to suggest superimposed infection.  The pre-existing pulmonary\nnodules/confluent fibrosis are unchanged.\n-AIRWAYS: Patent to the subsegmental level.\n-VESSELS: The pulmonary artery is enlarged measuring 32 mm diameter.\nCHEST CAGE: Spondylotic changes of the thoracic spine. No lytic/destructive\nbony lesions.",
            "output": "There is interval development of consolidation in respect to the subpleural\npulmonary fibrosis as well as increase in ground-glass opacification in the\nnon fibrotic lung suggesting an exacerbation of the existing interstitial lung\ndisease.\nInterval development of a small right-sided pleural effusion is nonspecific.\n\nThe CT findings are not characteristic of a lower respiratory tract infection,\nbut please note that this cannot be excluded with absolute certainty.\n\nThe previously noted pulmonary nodules/confluent fibrosis are unchanged."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Sebaceous cyst in the anterior chest\nwall (2, 33).  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes are unchanged.\n\nHILA: Calcified left hilar and AP window lymph nodes unchanged.\n\nHEART and PERICARDIUM: No cardiomegaly.  Trace pericardial effusion.  Moderate\naortic valve calcification.  Moderate right coronary artery calcification.\nMild LAD calcification.  Fusiform aneurysmal dilatation of the ascending aorta\nmeasuring 44 mm in diameter. Moderate calcification of the aortic arch.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA: The fibrotic lung disease with an apical basal gradient and\nsubpleural predominance appears relatively similar compared to prior imaging. \nFibrosis as evidenced by increased lung attenuation, subpleural microcystic\nhoneycomb changes, bronchiectasis and architectural distortion.  The\nassociated ground-glass changes are essentially unchanged.  Pulmonary nodules\n(4, 142, 156 and 172) are unchanged.\n-AIRWAYS: Patent to the subsegmental level.  Diffuse cylindrical\nbronchiectatic changes with a posterior basal predominance.\n-VESSELS: The pulmonary artery measures at the upper limits in the setting of\ninterstitial lung disease and pulmonary hypertension should be excluded.\nCHEST CAGE: Spondylotic changes of the thoracic spine. No lytic/ destructive\nbony lesions.",
            "output": "The fibrotic lung disease appears relatively similar compared to most recent\nprior imaging done ___, but demonstrates moderate progression\ncompared to previous imaging done ___.\n\nThe ground-glass changes are unchanged compared to prior and most likely\nrepresents intralobular fibrosis under the resolution of CT, and less likely\nactive inflammatory change.\n\nPulmonary hypertension should be excluded."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate aortic wall calcifications.  Several\nnormal sized lymph nodes are seen in the mediastinum. No dilatation of the\nmain pulmonary artery.  Multiple calcified hilar and mediastinal lymph nodes\n(2, 26).  Mild coronary calcifications, mild aortic valve calcifications.  No\npericardial effusion.  Moderate hiatal hernia.  No acute abnormalities are\nvisualized in the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.\nThe known fibrotic subpleural parenchymal changes, mainly consisting of\narchitectural distortion and interlobular septal thickening, combines to mild\noverlying ground-glass, is overall stable.  The distribution and pattern is\nhighly suggestive of a fibrotic NSIP.  Honeycombing is not a predominant\nfinding.  The findings have not substantially progressed in the interval,\nnotably not at the lung bases.  Stable appearance of the airways.",
            "output": "Stability of the pre-existing fibrotic lung disease, that displays many\ntypical features of fibrotic NSIP.  Honeycombing is no predominant pattern."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes have increased in size since the\nprior study.  A right paratracheal node measures 17 mm it previously measured\n16 mm.  The left paratracheal node measures 11 mm and it previously measured 8\nmm.  Small bilateral hilar lymph nodes have also increased in size since the\nprior study.  The subcarinal node measures 16 mm as compared to the prior\nmeasurement of 8 mm.  There is moderate cardiomegaly.  Trace pericardial\neffusion is seen.  The ascending aorta is ectatic and measures 4.3 cm.  The\npulmonary artery is normal in caliber.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a lingular nodule measuring 2.3 x 1.9 cm concerning for\nmalignancy (3, 32).\n\nThe peripheral interstitial abnormality comprising of peripheral fibrosis is\nunchanged.  Lung volumes are preserved.\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "New left upper lobe mass with mediastinal and hilar adenopathy concerning for\nprimary bronchogenic carcinoma.  Small cell carcinoma can have a similar\nappearance.\n\nThe stable interstitial abnormality concerning for IPF.\n\nRECOMMENDATION(S):  The findings over sent to Dr. ___ via email at the\ntime of dictation."
        },
        {
            "input": "HEART AND VASCULATURE: Intraluminal filling defects are seen in the right\nmiddle and lower lobe segmental branches and left upper lobe segmental branch\n(5:114, 115, ___, 146, 180) with subsegmental extension concerning\nfor acute pulmonary embolism.  No evidence of pulmonary infarction or right\nheart strain.  The ascending aorta is ectatic measuring 4.1 cm.  The main\npulmonary artery is normal in caliber.  There is no pericardial effusion.\n\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or supraclavicular lymphadenopathy.\nMultiple enlarged mediastinal lymph nodes appear unchanged in size compared to\n___.  For example a right paratracheal node measures 1.5 cm,\npreviously 1.7 cm (04:57).  A left paratracheal node measures 1.0 cm,\npreviously 1.1 cm (04:53).  Bilateral hilar lymph nodes are likely unchanged\nin size compared to prior and measure up to 1.7 cm (4:72).  A subcarinal lymph\nnode measures 1.7 cm, previously 1.6 cm (4:69).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Stable appearance of a biopsy proven lingular adenocarcinoma\ncurrently measuring 2.2 x 1.7 cm, previously 2.3 x 1.9 cm (5:145).  Diffuse\nperipheral interstitial fibrosis is unchanged compared to prior.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Degenerative changes of the upper thoracic spine is again demonstrated.\nNo suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Acute pulmonary embolism affecting the right middle and lower lobe\nsegmental branches and left upper lobe segmental branch without evidence of\npulmonary infarction or right heart strain.\n2. Stable appearance of a biopsy-proven lingular adenocarcinoma measuring up\nto 2.2 cm.\n3. Stable appearance of multiple enlarged mediastinal and hilar lymph nodes\ncompared to ___.\n4. Diffuse peripheral interstitial fibrosis, unchanged compared to prior.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:47 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nNumerous bilateral segmental and subsegmental pulmonary emboli seen on the\nprior exam are resolved.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  There are mild aortic valvular\nand aortic arch calcifications.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  Increased size of\nprominent prevascular lymph nodes measuring up to 11 mm, previously up to 8 mm\n(3:74).  A prominent paratracheal nodes are also increased in size measuring\nup to 1.6 cm (3:62), previously up to 11 mm.  Conglomerate subcarinal\nlymphadenopathy is also worsened from prior measuring approximately 5.1 x 2.0\ncm (3:115).  Left hilar nodes are also increased in size measuring up to 19\nmm, previously up to 17 mm (3:116).  Small right hilar nodes are grossly\nstable.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lingular mass measuring 2.3 x 1.8 cm (3:109) is not simply\nchanged compared to prior when measured in a similar manner and consistent\nwith biopsy proven adenocarcinoma.  Diffuse subpleural interstitial fibrotic\nchanges are not significantly changed which compared to prior.  There is new\nground-glass opacification of the lateral right upper lobe.  The airways are\npatent to the level of the segmental bronchi bilaterally.  Diffuse mild\nbronchiectasis similar to prior.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable only for a small\nhiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.  Previously seen\nbilateral segmental pulmonary emboli have resolved.\n2. New ground-glass opacification of the right upper lobe concerning for\npneumonia.\n3. Worsening mediastinal and bilateral hilar lymphadenopathy.  Grossly stable\nsize and appearance of biopsy proven lingular adenocarcinoma.\n4. Unchanged background of fibrotic lung disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular is real\nif adenopathy.  The thyroid gland is unremarkable.  A 1.8 x 1.2 cm soft tissue\ndensity lesion is again seen along the anterior abdominal wall, unchanged\ncompared to prior exam and likely benign (2; 33).\n\nUPPER ABDOMEN: Please see the separate report for the same day CT abdomen and\npelvis for subdiaphragmatic findings.\n\nMEDIASTINUM: Multiple enlarged mediastinal lymph nodes are seen which have\ndecreased in size compared to the most recent prior.  For example a right\nparatracheal node which measure up to 1.1 cm which previously measured 1.8 cm\n(3; 68), a left paratracheal node which measures 0.8 cm, previously 1 cm  (3;\n90), and a 0.9 cm prevascular lymph node previously measured 1.1 cm (3; 84).. \nA conglomerate of subcarinal lymph nodes previously measuring 5.1 x 2 cm, has\nalso decreased in size, now measuring 4.2 x 1.4 cm (3; 116).  Left hilar\nadenopathy has also 8 decreased in size, for example a 1.1 cm lymph node\npreviously measured 1.9 cm (3; 117).  There are no enlarged right hilar lymph\nnodes.\n\n\nHEART and PERICARDIUM: Heart size is normal.  There is trace pericardial\nfluid.  There are minimal coronary artery calcifications and mild aortic valve\ncalcifications.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA AND AIRWAYS: A lingular mass measures 2.2 x 1.7 cm (3; 117), and\nappears mildly decreased in size compared to prior. There has been interval\nimprovement in the right upper lobe ground-glass opacities, which may have\nrepresented a pneumonitis.  The airways are patent to the subsegmental level\nbilaterally.  Again seen is subpleural, lower lobe predominant, pulmonary\nfibrosis with traction bronchiectasis.  Small calcified granulomas are seen\nwhich are unchanged (for example 3; 104, 174).\n2. VESSELS:  The ascending thoracic aorta is mildly ectatic measuring 4.1 cm. \nThe main, left, and right pulmonary arteries are of normal caliber.  There are\nmild coronary atherosclerotic calcifications along the thoracic aorta.\nCHEST CAGE: There is no acute fracture or aggressive osseous lesion.",
            "output": "1. Mild decrease in size of a 2.2 cm lingular mass, biopsy proven to be\nadenocarcinoma with interval improvement in mediastinal and hilar\nlymphadenopathy.\n2. Improving ground-glass opacities in the right upper lobe, possibly\nrepresenting a pneumonitis, on a background of fibrotic lung disease."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging.  Supraclavicular\nand axillary lymph nodes are not enlarged.  No soft tissue abnormalities in\nthe imaged chest wall concerning for malignancy.  Findings below the diaphragm\nwill be reported separately.\n\nCARDIO-MEDIASTINUM:Small hiatus hernia unchanged.  Esophagus otherwise\nunremarkable.  Atherosclerotic calcification is not apparent in head and neck\nvessels or coronary arteries.  Aortic valvular calcification is minimal. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: As follows:\n\n13 mm right posterior paraesophageal lymph nodes was 16 mm previously. \nBorderline enlarged and subcentimeter right hilar and lower paratracheal\nmediastinal nodes are unchanged.\n\nLUNGS, AIRWAYS, PLEURAE: 21 x 12 mm nodule, anterior segment left upper lobe\ninseparable from the mediastinal pleura, 6:160 ___ was 21 x 16 mm in ___.\n\nSevere extensive predominantly cortical pulmonary fibrosis has considerably\nless associated ground-glass opacification today than in ___, but heavy\nreticulation, some honeycombing, and traction bronchiectasis are all\nunchanged.\n\nSolitary calcification, left upper mediastinal pleura, 05:26 is the only\npleural abnormality.  There is no effusion or nodulation.  There is no pleural\neffusion or pleural nodulation.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "Continued involution left upper lobe lung mass and central adenopathy.  No new\nlung nodules.\n\nSevere pulmonary fibrosis.  Continued involution of ground-glass opacification\nmay be in indication of clearing active inflammatory component of infiltrative\nlung disease."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nEnlarged mediastinal and bilateral hilar lymph nodes are relatively similar\ncompared to the prior exam.  There is no supraclavicular or axillary\nlymphadenopathy.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion. \nLeft mediastinal pleural calcification is unchanged.\n\nAgain re-demonstrated is severe pulmonary fibrosis with continued\nhoneycombing, reticulation, and traction bronchiectasis, but markedly\nincreased ground-glass opacification.  New consolidative opacification is seen\nin the left upper lobe, concerning for pneumonia.  Additionally, associated\nwith the ground-glass opacification, particularly in the right upper lobe, is\nmild smooth septal thickening.  A left upper lobe nodular opacity appears\nchanged in morphology, measuring up to 18 x 13 mm, not grossly changed in size\nfrom the prior exam.  The airways are patent to the subsegmental level.\n\nSubcentimeter hypodense within the left hepatic lobe is too small to\ncharacterize on CT but are statistically benign.  Small hiatal hernia is\npresent.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.  A\nsubcutaneous cystic lesion within the anterior chest wall measures up to 17 mm\nand may reflect a sebaceous cyst (3:128).",
            "output": "1. New consolidation in the left upper lobe concerning for pneumonia.\n2. Diffusely increased ground-glass opacification on a background of chronic\ninterstitial lung disease, findings which could reflect infection,\ninflammation, or acute worsening of chronic interstitial lung disease.\n3. Mild smooth septal thickening in the right upper lobe could suggest an\nelement of mild fluid overload.\n4. No evidence of pulmonary embolism or acute aortic abnormality.\n5. Grossly unchanged left upper lobe nodule and mediastinal and bilateral\nhilar lymphadenopathy.\n\nNOTIFICATION:  Updated findings discussed with Dr. ___ by Dr. ___ at\n10:11pm, ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, aorta and mild in the\naortic valve.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Several enlarged mediastinal lymph nodes, most\napparently unchanged compared to prior study, the largest in the anterior\nmediastinum measuring 1.5 cm in short axis diameter (6:107).  Nodal tissue\nthickening is also noted in the left hilum.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  Subpleural reticular opacities\nassociated to interlobular septal thickening with an apical basilar gradient,\nmore predominant in the lung bases associated to traction bronchiectasis,\ndistal bronchiolectasis and mild honeycombing.\nThe lung mass in the lingula (06:42) is larger than compared to prior study\nnow measuring 2.3 x 1.6 cm (previously 1.8 x 1.6 cm).  The previously\nsuperimposed ground-glass opacities and consolidation in the left lobe upper\nlobe have near entirely resolved.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Improvement of the left upper lobe consolidation and diffuse ground-glass\nopacities likely representing toxicity pneumonitis.\nSevere fibrotic interstitial lung disease appears relatively stable compared\nto the study of ___.  However, when compared to the first chest CT\nof ___, this disease has shown progression in an UIP pattern like manner.\nThe left upper lobe lung mass known to be a lung cancer is slightly larger\nwhen compared to prior study.  Several mediastinal enlarged lymph nodes have\nalso grown.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 17:03 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Stable 17 mm nodule in the anterior soft tissues of the chest\nwall (6: 150).  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries, aorta and aortic\nvalve.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Multiple enlarged mediastinal and hilar lymph\nnodes most of which are either larger or more necrotic compared to prior\nstudy, for example in the room right upper paratracheal station the\nconglomerate now measures 3.7 x 3.0 cm (6:71), previously 2.4 x 1.1 cm).\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental vessels.  No bronchial wall\nthickening or mucoid impaction.  Mild traction bronchiectasis associated to\nsubpleural reticular opacities and interlobular septal thickening.  There is\nmild superimposed ground-glass opacities, notably in both lung bases,\nunchanged.  Unchanged appearance of honeycombing in the posterior aspect of\nboth lung bases.  New 1.0 cm nodule in the left lower lobe (6:101) as well as\nseveral other smaller nodules in the left upper lobe (6: 68 and 77) for\nexample.  The lingular mass is larger compared to prior now measuring 3.3 x\n2.8 cm (6:123).\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show interval appearance of multiple\nsmall hypodense nodules diffusely in the liver.",
            "output": "Known malignant lung mass in the left upper lobe with several new small\nnodules noted in the left upper and lower lobes, increase in size of\nmediastinal lymphadenopathy as well as appearance of new small hypodense\nlesions in the liver.  These findings are either new or slightly larger when\ncompared to the PET-CT from ___.\n\nStable appearance of interstitial lung disease as compared to ___.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 14:54 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Compared with CT chest on ___, there\nis no significant change in mediastinal and bilateral hilar lymphadenopathy. \nFor reference, the largest mediastinal lymph node measures 3.8 x 2.4 cm in the\nright paratracheal station, not significantly changed.  No axillary\nlymphadenopathy is present.  No mediastinal mass.  A 19 mm subcutaneous soft\ntissue nodule in the anterior chest wall is stable.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 3.4 cm lingular mass is not significantly changed.  Multiple\nadditional bilateral pulmonary nodules are not significantly changed.  There\nis lower lobe predominant honeycombing, and subpleural reticular opacities\nwith mild traction bronchiectasis, as seen on prior.  Superimposed\nground-glass opacities and septal thickening appears slightly increased from\nprior, possibly representing superimposed pulmonary edema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Multiple small hypodensities in the liver are better evaluated on\nrecent CT abdomen and pelvis.  Included portion of the upper abdomen is\notherwise unremarkable.\n\nBONES: A subtle superior endplate compression deformity is noted at T12\nwithout significant loss of vertebral body height. (602:42; 601:41).  No\nassociated malalignment or bony retropulsion.  In retrospect, this fracture\nmay have been present on the prior CT dated ___, with subtle increase\nin compression compared with prior.  No definite underlying lesion is seen.",
            "output": "1. No significant change in overall extent of metastatic disease within the\nchest including multiple pulmonary nodules and adenopathy when compared with\nrecent prior exam.\n2. Interstitial lung disease with increased interstitial opacities suggesting\nsuperimposed pulmonary edema.\n3. No evidence of pulmonary embolism or aortic abnormality.\n4. T12 superior endplate compression deformity appears subacute with minimal\nloss of vertebral body height and no bony retropulsion or alignment\nabnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Borderline hilar and lymph nodes may be\nreactive. No axillary, mediastinal, or hilar lymphadenopathy is present.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 6 mm nodular opacity at the left lung base, of\ndoubtful clinical significance in this age group, possibly representing\nintrapulmonary lymph node.  No focal consolidation.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Previous fluid-filled thick walled cavity in the right upper chest wall lower\naxilla is now air-filled,substantially smaller, 29 x 60 mm, previously 75 x 19\nmm, still with a thick wall and infiltration or edema in the adjacent soft\ntissue, and may contain a short drainage catheter or wick, 4:90.  7 mm\nsubcutaneous nodule just inferior to the lesion, 02:31, is probably a lymph\nnode cluster, 4:121, and may have been slightly smaller on ___.  Aside from\nexpected edema in the lower axilla and upper chest wall, there is no\nindication of postoperative bleeding or other complication.\n\nFindings below the diaphragm will be reported separately.\n\n5 mm left supraclavicular lymph node, 04:12, was 3-4 mm previously.  There are\nno pathologically enlarged supraclavicular left axillary nodes.\n\nMediastinal and hilar nodes are not enlarged.  There are no thyroid lesions\nwarranting further evaluation.  Atherosclerotic calcification is mild in head\nneck vessels but present in all coronary arteries.  Aorta and central\npulmonary arteries are normal size and free of filling defects.  There is no\naortic valvular calcification.  Small pericardial effusion is unchanged. \nElevation of the right hemidiaphragm causing atelectasis in right middle and\nlower lobes is new long-standing, present since at least ___.\n\nEmphysema is mild.  Peripheral interstitial abnormality in the right upper\nlobe is mild.\n\nFocal lung lesions are as follows:\n\nSpiculated 7 mm wide solid nodule in the left upper lobe, 04:57, with a halo\nof ground-glass opacification is new since ___, most likely infectious\nbecause of the rapid development.\n\nPunctate subpleural nodule close to the major fissure in the left lower lobe,\n04:54 has been present since ___.\n\n\n\nA pair of adjacent lung nodules, the largest 6 mm, left lower lobe, 4:217, is\nunchanged since ___ also.\n\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Previous thick walled fluid filled right axillary subcutaneous chest wall\nlesion has been drained, but not excised.  It is now air-filled.  Spiculated\nthick wall remains, along with relatively mild adjacent edema and a sub cm\nnodal cluster.\n\nSpiculated sub cm left upper lobe nodule, new since ___ is more likely\ninfectious than malignant.  Diagnostic possibilities include fungal infection\nas well as septic emboli.\n\nWidespread atherosclerotic coronary calcification.\n\nChronic elevation right hemidiaphragm with substantial right middle and lower\nlobe atelectasis unchanged since ___.\n\n\nOther sub cm left lung nodules also unchanged since ___.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:23 AM, 6 minutes after the\ninitial page that was placed immediately upon discovery of the findings."
        },
        {
            "input": "Supraclavicular and left axillary lymph nodes are not enlarged.  What was a\ncavitated infiltrative mass or abscess in the right upper lateral chest wall\nin ___, open to the skin, is now fluid filled and smaller, both in overall\nsize, 34 x 42 mm, 6:86, previously 36 x 60 mm, but also error generally in\nwall thickness.  The lesion is inseparable from the adjacent chest wall\nmusculature which remains widely indurated, generally unchanged in extent,\nexcept for greater involvement anterior to the tip of the scapula, 6:216. \nThis could be reaction to radiation or local tumor recurrence.  There is no\nrib destruction.\n\nFindings below the diaphragm will be reported separately.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head and neck vessels, but present in\nmultiple coronary arteries, most substantial left anterior descending.\n\nAorta and central pulmonary arteries are normal size.  Very small pericardial\neffusion is stable.  There is no pleural effusion.\n\nEmphysema is mild in the upper lobes, minimal elsewhere.  Mild peripheral\nradiation fibrosis in the right upper lobe is unchanged.  Elevation of the\nright hemidiaphragm is chronic resulting in both atelectasis and mild central\nbronchiectasis in both the right lower lobe and lateral segment of the right\nmiddle lobe.\n\n8 mm wide subpleural left lower lobe lung nodule was 10 mm in ___.  A 7 mm\nspiculated left upper lobe nodule that was new in ___, has resolved. \nThere are no new nodules or other findings to suggest active infection or\nmetastasis.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Previously cavitated post treatment right upper chest wall mass is generally\nsmaller, but may be extending in the right chest wall musculature. \nAlternatively muscular thickening at the level of the tip of the scapula could\nbe radiation change.  There are no findings elsewhere to suggest malignant\nrecurrence or metastasis.\n\n\nSubcentimeter left lower lobe lung nodule is smaller today than in ___\nand what was a new 7 mm left upper lobe nodule has resolved since ___,\ndiagnostic of a small infection.\n\nCoronary atherosclerosis.\n\nMild emphysema.  Mild radiation fibrosis right upper lobe.\n\nChronic elevation right hemidiaphragm responsible for chronic atelectasis and\nmild central bronchiectasis right middle and lower lobes."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or left axillary adenopathy.  Centrally hypodense collection\nin the right axilla (4, 73) currently measures 28 x 27 mm (approximately 33 x\n29 mm previously).  Scarring and soft tissue stranding involving the right\nlateral chest wall inferior to this appears slightly improved compared to\nprior.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes appear similar compared to\nprior.\n\nHILA: Subcentimeter hilar lymph nodes appear similar compared to prior.\n\nHEART and PERICARDIUM: The heart measures at the upper limits of normal. \nTrace pericardial fluid.  No aortic valve calcification.  Mild aortic annular\ncalcification.  Moderate coronary artery calcification.  No aneurysmal\ndilatation of the ascending aorta.  Moderate calcific atherosclerotic changes\nof the aortic arch.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  4 mm nodule in the left upper lobe (4, 70) appear similar\ncompared to prior.  10 mm nodule in the left lower lobe (4, 213) Appear\nsimilar compared to prior.  Mild biapical pleural-parenchymal scarring.  Mild\ncentrilobular and paraseptal emphysematous changes.  Subpleural interstitial\nthickening in the lateral aspect of the right upper lobe most likely related\nto prior radiation.  Elevated right hemidiaphragm with platelike atelectasis\nin the right lung base.\n2. AIRWAYS:  Non physiological shape of the trachea, suggest\ntracheobronchomalacia in the correct clinical setting.  The airways are patent\nto the subsegmental level.\n3. VESSELS:  The pulmonary arteries not dilated.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "10 mm nodule in the left lower lobe and 4 mm nodule in the left upper lobe are\nunchanged.  No new or enlarging pulmonary nodules or masses to suggest disease\nrecurrence or progression.\n\nPresumed postsurgical changes in the right axillary area shows slight an\nlesion.\n\nNon physiological trachea suggests tracheobronchomalacia in the correct\nclinical setting."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Several small\nmediastinal lymph nodes are not pathologically enlarged.  Right axillary\npostsurgical changes are similar to previous examination.  No pericardial\npleural effusion.\n\nImage portion of the upper abdomen will be discussed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is moderate to severe.  Pre-existing pulmonary nodules in the left\nupper and 2 left lower lobe are series 5, image 73, 176, 251.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest including the changes in the right axilla and\nthe pre-existing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings in the\nthyroid.\nNo supraclavicular lymphadenopathy.\nPostsurgical changes in the right axilla are unchanged in comparison with ___ and there is no evidence of disease recurrence or pathologically\nenhancement.\n\nUPPER ABDOMEN: Will be reported separately in the same day CT of the abdomen\nand pelvis.\n\nMEDIASTINUM: There is no mediastinal or hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no cardiomegaly.\nTrace pericardial effusion is physiologic and unchanged.\nModerate atherosclerotic calcifications in the LAD LCX and probably RCA.\nMinimal calcifications along the thoracic aorta.\nMajor vessels are not dilated.\n\nLUNG and PLEURA: Major airways are patent.\nIncidental findings-lenticular shaped trachea.\nMild to severe centrilobular emphysema affecting predominantly the upper\nlobes.\nUnchanged elevation of the right hemidiaphragm with adjacent relaxation\natelectasis of the right lung base.\nLeft lower lobe 9 mm nodule is unchanged in comparison to ___ (6:262).\nAdjacent tiny subpleural calcified granuloma is also unchanged as well as\nright upper lobe perifissural micro nodule (6:103) and subpleural right upper\nlobe micro nodule (6:123).\nNo new lung nodules or masses.\nNo pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "Unchanged appearance of postsurgical changes of the right axilla and lung\nnodules."
        },
        {
            "input": "CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Multiple small right-sided pulmonary nodules are demonstrated,\nfor example a 3 mm right perifissural pulmonary nodule (02:49).  3 mm and 2 mm\nright middle lobe pulmonary nodules are also seen (02:56, 63).  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized, however\nthere are no secondary signs of appendicitis.  There is no evidence of\nmesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  Chronic appearing bilateral pars defects\nare demonstrated at L5-S1 with associated 5 mm of anterolisthesis of L5 on S1\n(602:87).  There are mild degenerative changes of the pubic symphysis.  No\nfocal suspicious osseous lesions are identified.\n\nSOFT TISSUES: Fat containing umbilical hernia.",
            "output": "1. No evidence of acute traumatic injury in the chest, abdomen, or pelvis.\n2. Multiple right-sided pulmonary nodules measure up to 3 mm.  Please refer to\n___ criteria below for follow-up recommendations.\n3. Chronic appearing bilateral pars defects at L5-S1.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to suggest pulmonary embolism the\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Allowing for differences in technique, there is\nslight interval increase in conglomerate left axillary lymphadenopathy\nmeasuring up to 5.9 x 4.4 cm (3:89), previously 4.6 x 4.7 cm.  There is\nadjacent stranding in the left axilla, as seen previously.  No mediastinal or\nhilar lymphadenopathy is present.  No mediastinal mass.  The esophagus is\npatulous and contains debris.\n\nPLEURAL SPACES: Nodular thickening of the left major fissure (02:46) appears\nsimilar to prior and is nonspecific, although malignant involvement cannot be\nexcluded.  No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUES: Known left deltoid mass is partially visualized, better\nevaluated on the reference MR shoulder ___.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Known partially visualized left deltoid mass, better evaluated on the\nreference MR shoulder of ___.\n3. Slight interval increase in left axillary lymphadenopathy.\n4. Nodular thickening of the left major fissure is nonspecific but appears\nsimilar to prior.  Metastatic spread cannot be excluded.\n5. Patulous esophagus containing debris and may reflect an underlying\nesophageal dysmotility disorder."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\n\nAXILLA, HILA, AND MEDIASTINUM: There is left axillary lymphadenopathy\nmeasuring up to 3.6 cm in short axis, with mild adjacent stranding.  There is\nno mediastinal, or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis.  Otherwise, lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple small mediastinal and retroperitoneal lymph\nnodes that do not meet CT criteria for lymphadenopathy.  There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Left axillary lymphadenopathy measuring up to 3.6 cm in short axis with\nmild adjacent stranding, worrisome for neoplasm.\n2. No evidence malignancy or lymphadenopathy in the abdomen and pelvis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular or axillary lymphadenopathy.  The soft tissues of the\nchest wall are unremarkable.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows scattered colonic\ndiverticula.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: The lack of intravenous contrast limits evaluation for hilar adenopathy;\nno definitively enlarged hilar lymph nodes are identified.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.  Dense coronary atherosclerotic calcifications are noted.  The\naortic valve is also heavily calcified.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar subpleural atelectasis is moderate.  A middle lobe\nnodule measures up to 8 mm (302:141), and is most compatible with an\nintraparenchymal lymph node..  No other definite focal nodules are identified.\n2. AIRWAYS:  The airways are diffusely, mildly thickened.\n3. VESSELS:  The main pulmonary artery is normal in caliber.  At the level the\nmain pulmonary artery, the ascending aorta measures up to 4.0 x 3.7 cm.  The\ndescending aorta, at the same level measures 3.0 x 2.8 cm.  Minimal scattered\ncalcifications are noted at the descending aorta.  Mild calcification of the\naortic arch is present.  Incidental note is make of a persistent left SVC\ndraining into the coronary sinus.\nCHEST CAGE: There are no suspicious osseous lesions or acute fractures",
            "output": "1.  Heavily calcified aortic valve.\n2.  Minimal descending thoracic aortic calcifications.  At the level of the\npulmonary trunk, the ascending aorta measures up to 4 cm and the descending\naorta measures up to 3 cm.\n3.  Incidentally noted 8 mm middle lobe nodule.\n\nFor incidentally detected single solid pulmonary nodule measuring 6 to 8 mm, a\nCT follow-up in 6 to 12 months is recommended in a low-risk patient,\noptionally followed by a CT in ___ months. In a high-risk patient, a CT\nfollow-up in 6 to 12 months, and a CT in ___ months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular axillary lymphadenopathy.\n\nUPPER ABDOMEN: The liver is shrunken and nodular consistent with cirrhosis. \nThere is a large volume of ascites.\n\nMEDIASTINUM: There are no pathologically enlarged mediastinal lymph nodes.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is mild cardiomegaly.  A right-sided PICC\nterminates in the right atrium.  There is no pericardial effusion.  Dense\ncoronary artery and mild aortic valve calcifications are noted.\nPLEURA: There is a trace right and small left pleural effusion.  No\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is moderate emphysema.  Septal thickening and areas of\nground-glass opacification are consistent with pulmonary edema.  A 2.2 x 1.9\ncm cavitary lesion with spiculated margins seen in the right middle lobe (302;\n140).  A focal area of ___ opacification in the left upper lobe is\nconcerning for pneumonia (302; 301).  Additional areas of more confluent\nopacification in the right middle lobe may represent additional sites of\ninfection (302; 338.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta is of normal size with mild atherosclerotic\ndisease along the aortic arch.  The main pulmonary artery is enlarged\nmeasuring 3.3 cm.\nCHEST CAGE: No aggressive osseous lesion or evidence of acute fracture.",
            "output": "1. A focus of ___ opacification in the left upper lobe with additional\nfocal consolidation in the right middle lobe are concerning for multifocal\npneumonia.\n2. A 2.2 cm cavitary lesion with spiculated margins in the right middle lobe\nmay represent part of the same infectious process but also raises the\npossibility of septic emboli or malignancy.  A follow up CT chest should be\nperformed after the completion of treatment to ensure resolution.\n3. Additional septal thickening and ground-glass opacification in a\npredominantly central and dependent distribution most likely represents\npulmonary edema.\n4. Trace right and small left pleural effusions.\n5. Enlarged main pulmonary artery, which can be seen in pulmonary artery\nhypertension secondary to chronic emphysema.\n6. Cirrhotic liver with large volume ascites."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged. The elliptical 14 x\n38 mm soft tissue thickening of the skin of the left breast is presumably\nasymmetry in the nipple and areola. Clinical evaluation advised. There are no\nother soft tissue findings in the chest wall concerning for malignancy. Breast\nevaluation requires mammography.\n\nThyroid is unremarkable. Aorta and pulmonary arteries are normal size.\nAtherosclerotic calcification heavy in the left main anterior descending\ncircumflex coronary arteries. There may be a right Coronary stent. Aortic\nvalvular calcification is mild. There is no pleural or pericardial\nabnormality.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged.\n\nA well-circumscribed 5 mm nodule in the right middle lobe, 4:123, has soft\ntissue characteristics of solid tissue (37 ___. Lungs are otherwise clear and\nthe tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Isolated 5 mm solid both right middle lobe nodule could be a single\nmetastasis, bronchogenic carcinoma, or benign lesion. Followup chest CT in 3\nmonths recommended.\n\nAtherosclerotic calcification Coronary arteries, and dystrophic calcification\naortic valve, of on known hemodynamic significance. Clinical evaluation\nadvised."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged\nranging in diameter up to 7 mm in the left axilla, 3:8, unchanged since ___.\nThyroid is unremarkable. At since ___ patient has had median sternotomy.\nSternal wound in mediastinum have normal postoperative appearance is common\noccluding development small mediastinal lymph nodes. There is no fluid\ncollection. Mild relative hypoattenuation of cardiac contents sometimes\nindicates anemia.  There is no pleural or pericardial abnormality. Mild\nenlargement of the pulmonary arteries, main 36 mm, right 27 mm, has increased,\npreviously 34 mm and 26 mm respectively. This may indicate an increase in\npulmonary arterial pressure. Mild aortic valvular calcification is unchanged.\nNon calcified ascending thoracic aorta is normal caliber.\n\nThis study is not designed for subdiaphragmatic diagnosis but the but shows a\nheterogeneous well-circumscribed left adrenal mass, 42 x 24 mm, 5:272, was 44\nx 26 mm in ___. The report of the Abdomen MRI on ___ described this as a\nlikely hemangioma an adenoma.\n\nPunctate left upper lobe lung nodule, 05:34, is new or newly apparent.\nCalcified granuloma in the left lower lobe was obscured on the previous study\nby respiratory motion. 6 mm right middle lobe solid lung nodule, 5:169, is\nunchanged, in the only lesion large enough to raise concern for active\nmalignancy.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "6 mm right middle lobe nodule unchanged since one ___. Punctate left\nupper lobe nodule new or newly apparent.  Suggest followup chest CT in 6\nmonths.\n\nPossible increasing pulmonary arterial pressure. No evidence of congestive\nheart failure.\n\nPossible anemia.\n\nStable left adrenal mass.  See report of the abdomen MRI on one ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: There are no enlarged supraclavicular or\naxillary lymph nodes.  The thyroid gland is unremarkable.\n\nUPPER ABDOMEN: Please see separate dictation for same day CT abdomen and\npelvis for subdiaphragmatic findings.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.  The aorta is of\nnormal caliber.  There is a small hiatal hernia.\n\nHILA: There are no pathologically enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  There is no pericardial\neffusion.  There is mild coronary artery calcification.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is stable scarring at the left lung base.  Punctate\ngranulomas in the right upper and lower lobes are unchanged (6; 118, 247,\n257).  There is a stable 3 mm left lower lobe pulmonary nodule (6; 268) and a\npunctate 2 mm nodule in the left upper lobe (6; 81) which has been stable\nsince ___.\n2. AIRWAYS:  The airways are patent to a subsegmental level bilaterally.\n3. VESSELS:  The main, left, and right pulmonary arteries are normal in\ndiameter.\nCHEST WALL AND BONES: There are no lytic or sclerotic osseous lesions\nconcerning for malignancy or infection.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion. \nCalcified coronary atherosclerosis is mild. The thoracic aorta is normal in\ncaliber.  Aortic and great vessel origin atherosclerosis is minimal. No\npenetrating atherosclerotic ulcer or evidence of dissection.  The main\npulmonary artery is normal in caliber.  No central pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Left upper and lower lobe micro nodules are unchanged (series\n3, images 63 and 213).  Scattered calcified granulomas are unchanged.  No\nfocal consolidation or new pulmonary nodule.  The airways are patent to the\nsubsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of intrathoracic metastasis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Small left supraclavicular lymph nodes are\nunchanged in size.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Stable small mediastinal lymph nodes.  Heart size is normal. \nThere is no pericardial effusion.\nThe aorta and pulmonary artery are normal in caliber.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a 2 mm calcified granuloma in the right upper lobe.  There is\nminimal subsegmental atelectasis in the left lung base.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  There is decrease in disc intervertebral disc space at\nL1-L2 level.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nlesion in the left lobe of liver.  No adrenal masses are seen.  Please refer\nto dedicated report on abdomen which has been dictated separately.",
            "output": "No evidence of metastasis to the chest.\n\nPlease refer to dedicated report on abdomen which has been dictated separately\nfor further details."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging. No\nsupraclavicular or axillary lymph node enlargement.  No abnormalities in the\nchest wall concerning for malignancy. Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM:Hiatus hernia is small. Esophagus is mildly patulous. \nAtherosclerotic calcification is minimal in head and neck vessels and in at\nleast left anterior descending coronary artery.  Aorta and pulmonary arteries\nand cardiac chambers are normal size\n\nTHORACIC LYMPH NODES: Only one lymph node in the chest is enlarged:\n\nPrevascular mediastinum, 15 mm, 6:71, new since ___.\n\n\nLUNGS, AIRWAYS, PLEURAE: No measurable lung nodules or other focal findings of\nconsequence.\n\nLinear areas of scarring or atelectasis in calcified granuloma are unchanged. \nNo evidence of active infection.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.  Degeneration is responsible for\nintervertebral disc space narrowing and vacuum discs.",
            "output": "Solitary newly enlarged prevascular mediastinal lymph node since ___,\nsignificance indeterminate.  No other findings suggest malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART: The patient is status post CABG.  The heart is mildly enlarged.  There\nis extensive coronary arterial calcification of the native vessels.  There is\nno pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.  There is a small hiatal hernia.",
            "output": "1. No evidence of metastatic disease in the chest.\n2. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  The patient is after median\nsternotomy and CABG.  No pathologically enlarged supraclavicular, mediastinal\nor hilar lymph nodes demonstrated.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease\n\nStatus post CABG\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.  Right anterior port with tip in\nthe right atrium.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, none in the aorta or\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, the largest in the right lower\nparatracheal station measuring 1.0 cm in short axis diameter, stable.  The no\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No suspicious lung nodules or\nmasses.  No consolidations or atelectasis.\n\nCHEST CAGE:\nStatus post midline sternotomy.  No suspicious lytic or sclerotic lesions.  No\nacute fractures.  Mild dorsal spondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___.\nNo evidence of intrathoracic metastatic disease.\nNo suspicious lung nodules, lymphadenopathy or osseous lesions."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Prominent mediastinal lymph nodes measure up 0.9 cm in the right\nparatracheal station, unchanged compared to at least ___ (3:86).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART: Postsurgical changes related to CABG are noted.  There is extensive\ncoronary arterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  A right\nchest wall catheter terminates in the right atrium.\n\nPULMONARY PARENCHYMA: No suspicious pulmonary nodules or masses are\nidentified.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: Postsurgical changes related to median sternotomy are\nagain.  There is no worrisome lytic or sclerotic lesion.  Multilevel\ndegenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Please refer to separately reported CT abdomen and pelvis for description\nof the subdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: Right-sided Port-A-Cath tip projects to the right atrium,\nunchanged.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is evidence of prior cardiac surgery.  There is a small hiatus\nhernia.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  No new or growing\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nThere are degenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nsurgery in the upper abdomen.  Please refer to dedicated report on abdomen\nwhich has been dictated separately.",
            "output": "No evidence of metastasis to the chest.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  The patient is after median\nsternotomy and CABG.  No pathologically enlarged mediastinal, hilar or\naxillary lymph nodes demonstrated.  There is no pericardial or pleural\neffusion.  Coronary calcifications are extensive.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\nexcept for stable biapical pleuroparenchymal scarring.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid was incompletely\nimaged.  Right supraclavicular lymph node (2, 7) is unchanged.  No axillary\nadenopathy.  Left breast nodule (2, 20) is decreased in size compared to\nprior.  Moderate gynecomastia bilateral.  Mildly prominent subcutaneous\nvessels in the left anterior chest wall.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Exophytic right renal cortical cysts appear\nsimilar compared to prior.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  Left prepectoral dual lead\npacemaker in situ with the lead tips in the correct positions.  Mild to\nmoderate aortic valve calcification.  Severe calcification of the native\ncoronary arteries.  Evidence of previous CABG:  Free bypass graft from the\nanterior aspect of the ascending aorta to the LAD and LIMA to obtuse marginal.\nBorderline fusiform dilatation of the ascending aorta measuring 40 mm in\ndiameter.  Moderate calcification of the aortic arch, supra-aortic vessels and\ndescending thoracic aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA: The spiculated pulmonary nodule in the left upper lobe (series 4,\nimage 59) measuring 9 mm in diameter appear similar compared to prior\nscreening CT done ___.  Scar in the left lower lobe (4, 111)\nappear similar compared to prior imaging done in ___.  Paraseptal emphysema\nincludinh subpleural smoking related interstitial fibrosis in the right upper\nlobe (4, 58) appears similar compared to prior.  The pre-existing millimetric\nnodules (4, 67 and 80) are unchanged.  Mild bronchiectasis in the basal\naspects of the lower lobes.  No impaction to suggest superimposed infection.\n-AIRWAYS: Patent to the subsegmental level. No bronchiectasis.\n-VESSELS: The pulmonary artery measures at the upper limits of normal (32 mm\nin diameter).\nCHEST CAGE: Evidence of previous midline sternotomy with non ___ of both\nwell-corticated  sternal components. Sternal instability is reflected in\nfractured sternal wires, but there is no indication of infection.  Spondylotic\nchanges of the thoracic spine. No lytic/destructive bony lesions.",
            "output": "The spiculated nodule in the left upper lobe measuring 9 mm diameter is\nessentially unchanged compared to prior imaging.  Tissue sampling advised.\n\nThe scar in the left lower lobe is stable since ___.\n\nCardiac disease with post CABG changes as described above. The pulmonary\nartery measures at the upper limits of normal and pulmonary hypertension\nshould be excluded.\n\nRECOMMENDATION(S):  Tissue sampling of the left upper lobe pulmonary nodule\nadvised."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  Severe\ncoronary calcifications are again noted.  Mild cardiomegaly is stable.  Pacer\nleads are in standard position.  Patient is status post CABG.  There is no\npleural or pericardial effusion.\n13 x 8 mm nodule in the left upper lobe (5:67) was 13 x 9 mm.\nBibasilar ground-glass opacities worse in the left lower lobe are stable.\nMild paraseptal and centrilobular upper lobe emphysema is stable.\nCentrilobular ground-glass nodules in the upper lobes right greater than left\nare stable reflecting bronchiolitis.  Mild bibasilar bronchiectasis is stable.\nThere are no new or enlarging lung nodules.\nThis examination is not tailored for subdiaphragmatic evaluation hypodense\nrenal lesions likely cysts are again noted.  Patient is status post\ncholecystectomy.\nThere are no bone findings of malignancy",
            "output": "Stable left upper lobe lung nodule\nEmphysema, bronchiolitis and bronchiectasis are stable."
        },
        {
            "input": "Status post sternotomy and CABG. No incidental thyroid findings.  Small mucous\nretention cyst in the large airways.  Moderate aortic wall calcifications.\nSevere coronary calcifications. No relevant valvular calcifications.  An ICD\nis in situ.  Status post cholecystectomy. No other upper abdominal findings. \nModerate degenerative vertebral disease.  No vertebral compression fractures. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.\nThe irregular known left upper lobe nodule (5, 74) is minimally increased in\nsize.  The magnitude of these increase, however, is in the range of 1-2 mm\nand, thereby, within the variability of measurements.  No other concerning\npulmonary node nodules are visualized.  Areas of relatively extensive\nbilateral parenchymal scarring are again visualized.  No pleural\nabnormalities.",
            "output": "Minimal increase in size of the left upper lobe nodule might be due to\nmeasurement variability.  There is no obvious growth of the nodule.  No other\nchanges in the lung parenchyma, mediastinum or cardiac structures are noted. \nThe left lower lobe consolidations are also stable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged. \nMedian sternotomy wires are in place.\n\nUPPER ABDOMEN: Patient is status post cholecystectomy.  There is no evidence\nof acute abnormality within the remaining visualized upper abdomen.\n\nMEDIASTINUM: There is a mildly prominent paratracheal lymph node measuring 9.5\ncm (02:15).\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Patient is status post CABG.  Mild cardiomegaly is\nstable.  Severe atherosclerotic calcification of the coronary arteries.  No\npericardial effusion.  The thoracic aorta is normal in caliber. Moderate\ncalcification of the aortic arch and descending aorta.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: The irregular, spiculated left upper lobe nodule measures 1.3 x\n0.9 cm (04:47) which is similar to prior measurement.  However the nodule\ndemonstrates a notable change in morphology when compared to the CT exam from\n___, with increased spiculation and the development of a small\nperipheral component which was not seen on the prior studies (601:60).  The\nleft lower lobe consolidation appears slightly increased in density compared\nto prior studies, now measuring approximately 2.0 x 1.5 cm (4:104).  Bibasilar\nground-glass opacities reflect atelectasis, stable.  There is bibasilar\nbronchiectasis.  Mild upper lobe predominant paraseptal and centrilobular\nemphysema is unchanged. No evidence of new lung nodules or masses.\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  While this study is not optimized for the detection of pulmonary\nemboli, no central filling defect is seen.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion\nis detected.  There is moderate degenerative change of the thoracic spine,\nincluding anterior osteophytosis and mild scoliosis.  There is streak artifact\nemanating from a right shoulder arthroplasty.",
            "output": "1. The irregular, spiculated left upper lobe nodule demonstrates similar\nmeasurement, however a notable change in morphology compared to the CT exam\nfrom ___, with increased spiculation and the development of a small\nperipheral component which was not seen on prior studies.  These findings are\nconcerning for possible malignancy, for which image-guided biopsy should be\nconsidered.\n2. Left lower lobe consolidation measuring 2.0 x 1.5 cm appears slightly\nincreased in density and morphology.  Attention on follow-up imaging is\nrecommended in 3 months, however tissue sampling could also be considered."
        },
        {
            "input": "THORACIC INLET: Left-sided pacemaker is unchanged.  There are no enlarged\nsupraclavicular lymph nodes.  The thyroid is unremarkable\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes not enlarged by\nsize criteria.  There is evidence of prior cardiac surgery.  There is mild\ncardiomegaly.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The dominant left upper lobe irregular spiculated nodule has slightly\nincreased in size and now measures 1.4 x 1.3 cm, remains concerning for\nmalignancy.  The inferior more linear component has also increased in size and\nnow measures 16 mm as compared to the prior measurements of 10 mm.  The\nconsolidative opacity in the left lower lobe has improved and could represent\nresolving infection or inflammation.  No new or growing pulmonary nodules. \nThe airways are patent up to the subsegmental level.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Patient status post median sternotomy.  Sternal sutures\nare intact.  Evidence of internal replacement of the right humeral head.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows status post\ncholecystectomy.  No adrenal masses are seen.",
            "output": "Progressive increase in size of the left upper lobe mass which now measures\n1.4 x 1.3 by 2 cm, best seen on the sagittal projection, is concerning for\nmalignancy and could represent a primary bronchogenic carcinoma.\n\nLinear opacity in the left lower lobe appears slightly less dense than on the\nprior study and less prominent and could represent scarring or atelectasis. \nNo new or growing pulmonary nodules.\n\nStable small mediastinal lymph nodes.\n\nEvidence of prior cardiac surgery.\n\nLeft-sided pacemaker."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  The patient is after\nmedian sternotomy and CABG.  Sternal wires and sternum appear overall\nunremarkable.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Continues grows of\nleft upper lobe lesion is demonstrated with the solid component increasing\nfrom 13 x 14 mm to 15 x 25 mm, series 5, image 81 and interval development of\nlarge mixed density component in the superior aspect of the lesion, series 5,\nimage 73, 40 mm.  The craniocaudal dimension of the lesion is current ___ 33\nmm as compared to 20 mm.  Overall the increase in size is at least twice\ncompared to previous examination.\n\nCentrilobular and paraseptal emphysema is mild.  No additional nodules masses\nor consolidations demonstrated.  Linear opacity in the left lower lobe most\nlikely represent scarring or atelectasis.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.",
            "output": "Gradual continues progression of the left upper lobe lesion, currently  \nclassified as a lung mass, highly concerning for growing lung cancer. \nConsultation with thoracic surgery and decision on tissue biopsy is required\n\nUnderlying emphysema\n\nStatus post CABG"
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Extensive collaterals are seen in the left\nanterior chest wall most likely secondary to pressure injector.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmoderate cardiomegaly.  Moderate coronary artery calcification is seen.  There\nis a left-sided pacemaker with leads projecting to right atrium right\nventricle.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.  No pericardial effusion is seen.\n\nLUNG: Patient is status post CyberKnife treatment to the left upper lobe mass\nwith evolving post radiation changes.  The consolidative opacity in the left\nupper lobe has become more congruent, with evidence of air bronchograms and\ndecrease in size since the prior study, consistent with evolving post\nradiation changes.  The known left upper lobe mass is inseparable from the\nradiated area hence evaluation for viable tumor at this stage is limited.\n\nThere are new peripheral reticular/fibrotic changes bilaterally which extend\nalong the bronchovascular bundles in both lower lobes and also along the right\nmajor fissure, these could be related to organizing pneumonia.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: It sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen",
            "output": "Evolving post radiation changes to the left upper lobe.  Status post\nCyberKnife treatment to the left upper lobe mass with evidence of fiducial\nmarkers within it.\n\nNew peripheral bilateral reticular opacities which could represent organizing\npneumonia.\n\nLeft-sided pacemaker with leads projecting to the right atrium and right\nventricle.\n\nModerate cardiomegaly with coronary artery calcification\n\nNOTIFICATION:  The findings and recommendations were communicated to the\nreferring physician via email at 3:03 pm on ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple pulmonary nodules measure up to 5 mm in the right\nlower lobe (3:85) and 4 mm in the right middle lobe (3:107) as well as\nmultiple pleural based nodules which measure up to 7 mm in the left lower lobe\n(3:124, 129), all unchanged. There is a 4 mm pleural-based nodule in the right\nmiddle lobe (3:126), unchanged. A 2 mm pulmonary nodule in the left lower lobe\n(3:114) appears new since the prior CT from ___.  No focal\nconsolidations are seen within the lungs.  The airways demonstrate diffuse\nwall thickening bilaterally with scattered areas of mucous plugging, most\npronounced in the lower lobes and left upper lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Chronic bilateral rib fractures are noted.  Mild height loss of\nmultiple thoracic vertebral bodies including the T6, T7, T8, and T10 vertebral\nbodies appears unchanged.  No suspicious osseous abnormality is seen.? There\nis no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Diffuse bronchiolar wall thickening with scattered mucous plugging\ncompatible compatible with chronic bronchitis.\n3. Multiple pulmonary and pleural based nodules measure up to 7 mm, all of\nwhich appear unchanged from prior CT chest from ___ with the\nexception of a new 2 mm pulmonary nodule in the left lower lobe.  See\nrecommendations below.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThere is no axillary adenopathy.  There is extensive mediastinal adenopathy,\nas seen on prior PET-CT but increased in size.  For example, a prevascular\nnode has significantly increased, measuring 1.9 x 1.7 cm, previously 0.6 x 0.7\ncm. The largest mediastinal lymph node is located in the right subcarinal\nspace and measures at least 5.8 x 3.3 cm, this has increased in size compared\nto ___ (previously 5.1 x 2.9 cm).  This large node displaces and narrows\nthe right main pulmonary artery although the vessel is still patent.  Hilar\nadenopathy is also present with the largest right hilar node measuring 2.1 x\n2.7 cm, also mildly increased in size (previously 1.6 x 2.3 cm).\n\nHeart size is normal.  There is no pericardial effusion.\n\nAirways are narrowed by lymphadenopathy, particularly on the right middle lobe\nbronchi although airways do remain patent.  There are bilateral small pleural\neffusions, enlarged since prior, with associated atelectasis.  There is no\nfocal lung consolidation seen.  Right sided infrahilar mass re demonstrated\nmeasuring approximately 3.4 x 3.0 cm, increased from prior (previously 2.7 x\n2.4 cm).\n\nThere are numerous bilateral pulmonary nodules measuring up to 6 mm in the\nright upper lobe (03:10).  Other numerous nodules are identified, none of\nwhich were clearly identified on recent PET-CT scan.  While some may be too\nsmall to be visualized on prior given technique, the larger ones have likely\ngrown.\n\nThe thoracic esophagus is debris filled and mildly patulous.  Limited views of\nthe upper abdomen demonstrate multiple liver lesions, compatible with\nmetastatic disease.  Small volume ascites is present.\n\nOSSEOUS STRUCTURES:  Diffuse lytic lesions throughout the osseous structures,\ncompatible with osseous metastases.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Progression of metastatic disease in the chest with mild increase in size\nof a subcarinal and right infrahilar masses causing narrowing of a still\npatent right main pulmonary artery and right middle lobe bronchi.\n3. Small bilateral pleural effusions with associated atelectasis, increased\nfrom ___.\n4. Diffuse bony metastatic disease.\n5. Partially imaged metastatic lesions in the liver."
        },
        {
            "input": "A 3 mm hypodensity in the right lobe of the thyroid is unchanged from prior. \nA conglomeration of necrotic subcarinal lymph nodes are mildly increased in\nsize, measuring 4.4 cm x 2.3 cm (previously 4.1 x 2.1 cm).  A 7 mm right hilar\nlymph node (series 5, image 32) is not significantly changed from the prior\nexamination.  No supraclavicular or axillary lymphadenopathy is seen.  Aorta\nand pulmonary arteries are normal size.  There is no cardiomegaly and there is\nmild coronary artery calcifications which are unchanged from prior.  A 1.5 x\n1.3 cm necrotic lesion within the right middle lobe is grossly unchanged in\nsize from ___.  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation\nNumerous lytic lesions are seen throughout the thoracic and lumbar spine which\nare grossly unchanged from ___.  Compression deformity side of the\nendplates of the T7 and T8 vertebral bodies are unchanged in appearance. \nModerate degenerative changes are seen throughout the thoracic and lumbar\nspine.",
            "output": "1.  A necrotic nodule within the right middle lobe of the lung is stable in\nsize from ___.  No new nodules are seen.\n\n2.  The conglomeration of necrotic subcarinal lymph nodes are mildly increased\nin size from the prior examination.  7 mm right hilar lymph node is not\nsignificantly changed from prior examination.\n\n3.  Numerous lytic lesions are seen throughout the thoracic and lumbar spine\nwith re- demonstrated compression deformities of the T7 and T8 vertebral\nbodies."
        },
        {
            "input": "Aorta is heavily calcified, unchanged.  Pulmonary artery is normal in\ndiameter.  Paraesophageal lymph node has increased in size, currently 13 mm as\ncompared to 9 mm, series 2, image 32.  Sub-carinal lymph node is 16 mm as\ncompared to 7 mm.  No additional mediastinal, hilar or axillary\nlymphadenopathy is present.\n\nHeart size is enlarged.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen demonstrate calcified gallstones and\nbilateral perinephric stranding, similar to previous examination.\n\nAirways are patent to the subsegmental level bilaterally.  Dominant right\nlower lobe lesion has decreased in size, 3 x 3.7 cm as compared to 5 x 4.5 cm\npreviously, with no central cavity and with central calcifications no\nadditional nodules masses or consolidations demonstrated..\n\nThere are no lytic or sclerotic lesions that would be concerning for new\nmetastatic disease is.",
            "output": "Interval decrease in size in the dominant right lower lobe lesion as\ndescribed.\n\nInterval increase in size in the sub-carinal and paraesophageal lymph nodes as\ndescribed."
        },
        {
            "input": "Imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is moderately calcified and normal in\ncaliber.  The heart is within normal limits of size.  There is mild aortic\nvalvular calcification and moderate calcification along the LAD.  Main\npulmonary artery is enlarged measuring 3.5 cm, correlate for pulmonary\narterial hypertension.  There is no saddle PE.  Filling defects are however\nnoted within segmental and subsegmental branches of all pulmonary lobes.  No\nsigns of pulmonary infarction.  There is extensive lymphangitic thickening\nwith nodularity similar to what was seen on recent prior CT PET and highly\nconcerning for peritoneal carcinomatosis.  The mass in the right lower lobe is\nagain seen measuring approximately 3.7 x 2.7 cm.  Mediastinal lymph nodes are\nnot enlarged.\n\nWithin the imaged portion of the upper abdomen, cholelithiasis is noted.\n\nBones: No worrisome lytic or blastic osseous lesion.",
            "output": "1. Segmental and subsegmental PE noted within all pulmonary lobes.\n2. Right lower lobe mass with lymphangitic carcinomatosis.\n3. Bilateral pleural effusions right greater than left.\n4. Enlarged main pulmonary artery up to 3.5 cm could reflect pulmonary\narterial hypertension."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is a 3 mm left lower lobe pulmonary granuloma (3:166). \n9 x 8 mm well-circumscribed pulmonary nodule in the right lower lobe\ndemonstrates internal fat density, likely compatible with a pulmonary\nhamartoma (series 4, image 267, series 3, image 134).  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. 9 mm right lower lobe pulmonary nodule with internal fat density, likely\ncompatible with a pulmonary hamartoma."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion.  There is a stable small\namount of pneumomediastinum. The main pulmonary artery and thoracic aorta are\nnormal caliber. No incidental pulmonary embolus is identified.\n\nThere is a punctate 1 mm right upper lobe nodule does not warrant followup (5,\n100). No suspicious pulmonary nodule, mass or consolidation is identified. No\nendobronchial lesion or pleural abnormality is present.\n\nImages of abdomen are unremarkable.  The mid to lower esophageal wall is\nmildly thickened.\n\nThe bones are unremarkable.",
            "output": "Stable small amount of pneumomediastinum, which given the history of severe\nretching, is most likely due to Boerhaave syndrome."
        },
        {
            "input": "Hypodense left thyroid lobe nodule unchanged .\nTracheostomy in the trachea.\nThre are secretions in both lower lobes bronchi with consolidations and\nminimal left pleural effusion-bilateral lower lobe aspirations.\nThe left lower lobe consolidation is associated with partial loss of volume.\nMinimal bilateral upper lobe aspirations present at bilateral ___\nopacities.\n\nSeveral lymph nodes in the mediastinum are not pathologically enlarged and\ndecreased in size in comparisons to the previous study for example 8 mm right\nparatracheal lymph node measuring, previously measured 15 mm (302:55).\nNo axillary lymphadenopathy is present.\n\nMild to moderate cardiomegaly with trace pericardial effusion.\nThe contents the chambers is hypodense relative to the septum suggestive of\nanemia .\nMild atherosclerotic calcifications in aortic valve and coronaries.\nThe main pulmonary artery is 3.5 cm in diameter, unchanged-suggests for\npulmonary hypertension.\n\nIn the included upper abdomen moderate quantity of pneumoperitoneum is new in\ncomparisons to the previous study-pleural filtered echo cure and CT of the\nabdomen accession number ___.",
            "output": "Bilateral moderate lower lobe aspiration, left greater than right.\nModerate quantity of pneumoperitoneum."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal.  There is moderate calcification of the coronary\narteries and aortic valve.  There is no pleural or pericardial effusion. \nThere is a small amount of pericardial recess fluid.\n\nThe lungs are clear.  The airways are patent to the subsegmental level.  There\nis no concerning pulmonary nodule.\n\nLimited views of the upper abdomen are notable for a 2.5 cm cyst in the upper\npole the right kidney.  The stomach is quite distended.  No osseous lytic or\nsclerotic lesions are identified.  Mild anterior wedging of several mid\nthoracic vertebral bodies is unchanged dating back to ___.",
            "output": "No evidence of active intrathoracic infection or malignancy.  No cause for\nhemoptysis identified."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild to\nmoderate cardiomegaly, increased from ___.  The pericardium, and great\nvessels are within normal limits based on an unenhanced scan.  A small\npericardial effusion is seen.  Mild aortic valve and coronary calcifications\nare noted.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes are\nin noted, for example left paratracheal mediastinal lymph node measuring 0.9 x\n1.4 cm which does not meet CT size criteria for lymphadenopathy (4; 90).  No\naxillary lymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Trace bilateral pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is bibasilar atelectasis which is mild.  Interlobular\nseptal thickening is noted at the bases and is mild.  There is narrowing of\nthe trachea at the thoracic inlet as seen on prior.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: 7 mm hypodense left thyroid lobe nodule similar to prior.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates a 2.6\ncm hypodense lesion in the right upper pole, compatible with a simple cyst,\nunchanged from prior in ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nHeterotopic bone formation around the right coracoid process and from the\nright clavicle is similar to that seen in ___ (4; 20).",
            "output": "1. No focal consolidation.  Interlobular septal thickening suggesting mild\nedema.\n2. Cardiomegaly has increased since ___.  Small pericardial effusion.\n3. Trace bilateral pleural effusions.\n4. Focal narrowing of the trachea at the thoracic inlet as seen on prior\nwithout obvious cause of external compression."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The right-sided central line with the tip at the\ncavoatrial junction.  Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Minimal biapical scarring.  Moderate upper lobe predominant\ncentrilobular and paraseptal emphysema.  Small left and trace right pleural\neffusions.  There is an enhancing left lower lobe opacity with air\nbronchograms compatible with atelectasis however superimposed infection cannot\nbe excluded in the proper clinical context.  Minimal right lower lobe\natelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: There is extensive portal venous gas.  Again seen multiple\nhypodense lesions throughout the liver, likely represent cysts or biliary\nhamartomas.  A peripherally calcified lesion within the left hepatic lobe is\nstable. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The splenic parenchyma is hypoattenuating, consistent with infarct,\nunchanged.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Interval improvement of previously seen bilateral renal infarcts. \nThe kidneys are of normal and symmetric size with normal nephrogram.  No\nhydronephrosis.  There is no perinephric abnormality.  Bilateral renal cysts\nare present, largest of which measures 24 mm arising from the lower pole the\nright kidney.\n\nGASTROINTESTINAL: Enteric tube is present with the tip in the stomach.  The\nesophagus and stomach are fluid filled and dilated.  Extensive pneumatosis\nintestinalis involving the small bowel and colon with mild mural thickening\nand mesenteric fat stranding.  There is diffuse dilation of multiple loops of\nsmall bowel and colon.  Several loops of small bowel and the transverse colon\nlack wall enhancement.\n\nPELVIS: A Foley catheter is contained within a decompressed urinary bladder. \nThere is a moderate amount of free fluid in the lower pelvis and perihepatic\nascites.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The celiac trunk is not well opacified.  The splenic artery and\ncommon hepatic artery are not well visualized.  There is an accessory left\nhepatic artery and replaced right hepatic artery, both of which were seen on\nthe CTA of ___ however not definitively identified on the current\nstudy.  Patient is status post SMA stenting with unchanged narrowing of the\nproximal SMA but patency distally.  The ___ is not opacified.\n\nExtensive gas is noted within the mesenteric vessels\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Diffuse anasarca.  Multiple surgical staples overlie the\nanterior abdominal wall.",
            "output": "1.  Extensive pneumatosis intestinalis, heterogeneous bowel wall enhancement\npatterns, portal venous and mesenteric venous gas and free fluid in the lower\npelvis.  Given celiac trunk and ___ occlusion, constellation of findings are\ncompatible with acute mesenteric ischemia.\n2.  Post SMA stenting, with proximal narrowing but distal opacification of the\nSMA.\n3.  Left lower lobe consolidation, likely atelectasis but mild heterogeneity\nin the enhancement pattern suggests an element of pneumonia.  Small left\npleural effusion.\n4.  Mild upper lobe predominant emphysematous changes.\n5.  Stable splenic infarct.\n\nNOTIFICATION:   The findings and recommendations were communicated to Dr.\n___ via telephone,at 6:30pm on ___."
        },
        {
            "input": "There are no enlarged mediastinal, axillary, or hilar lymph nodes.  Heart size\nis normal, and diffuse coronary artery calcifications are present as well as\naortic valvular calcifications. There is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of marked gastric wall thickening with nodular and infiltrative\ncharacteristics, involving the gastric body, antrum, and likely extending into\nthe proximal duodenum. It is associated with concentric narrowing of the\ndistal stomach, likely accounting for market fluid-filled gastric distension\nproximally.  Tiny nonobstructing calculus is present in the right kidney.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nskeletal lesions.\n\nWithin the lungs, there are no suspicious nodules or masses.",
            "output": "1.  No CT evidence of intrathoracic metastatic disease.\n\n2. Severe gastric wall thickening with a nodular and infiltrative appearance,\nconsistent with malignancy. This results in high-grade narrowing of the distal\nstomach with marked proximal gastric distension.  Differential diagnosis\nincludes primary gastric adenocarcinoma, lymphoma, and metastatic disease.\nPlease correlate with results of outside MRI, EGD and biopsy results."
        },
        {
            "input": "The no incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  New 3.5 cm soft tissue lobulated anterior\nmediastinal mass (2, 27).  In addition, the presence of several borderline\nsized lymph nodes is noted (2, 27).  No abnormalities in the soft tissues of\nthe chest wall.  Moderate coronary calcifications, minimal valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  Lumbar vertebral fixation devices with asymmetry of the\nribcage.  Subsequent moderate degenerative vertebral disease.  No vertebral\ncompression fractures.\nSmall non characteristic right upper lobe ground-glass nodules.  No suspicious\npulmonary nodules or masses.  No pleural thickening, no pleural effusions. \nMild thickening and irregularities of the airway walls.  Moderate elevation of\nthe liver with scarring and areas of atelectasis at the right lung basis.  No\nevidence of diffuse lung disease.",
            "output": "New lobulated 3.5 cm anterior mediastinal soft tissue mass that requires\nfurther workup.  Small normal sized locoregional mediastinal lymph nodes. \nPostoperative spinal changes with elevation of the liver and subsequent areas\nof atelectasis at the right lung basis.  Stable moderate coronary\ncalcifications."
        },
        {
            "input": "Despite the short interval to the previous examination (___), the\nlobulated, homogeneous, non-calcified, anterior mediastinal lesion has\nslightly grown, from previously 32 x 32 mm to now 34 x 37 mm.  The\nlocoregional lymph nodes (2, 26) Continue to be normal in size.  Normal\nappearance of the large mediastinal vessels, with constant calcifications of\nthe aortic wall.  The pulmonary artery is of normal ___.  Stable mild\nto moderate coronary calcifications.  No valvular calcifications, no\npericardial effusion.  Normal appearance of the posterior mediastinum.  Stable\nperihepatic calcification (2, 40).  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Stable appearance of the\nvertebral fixation devices (602, 58).\nMinimal left apical scarring.  Stable small right upper lobe ground-glass\nnodule (302, 34).  Stable mild atelectasis at the right lung basis.  Normal\nappearance of the airways.  No suspicious pulmonary nodules or masses.  No\npleural thickening, no pleural effusions.",
            "output": "Mild interval growth of the lobulated homogeneous anterior mediastinal soft\ntissue lesion since the previous examination.  The lesion must be further\nworked up, a thoracic surgical consult is strongly recommended.  No\nlymphadenopathy.  No pleural abnormalities.  No suspicious pulmonary nodules\nor masses."
        },
        {
            "input": "CT Thorax:  The airways are patent to the subsegmental level.  There is no\nmediastinal, hilar, or axillary lymph node enlargement by CT size criteria. \nThe heart, pericardium and great vessels are within normal limits.  No\nesophageal abnormality is identified.\n\nLung windows do no demonstrate any focal opacity.  No pleural effusion or\npneumothorax is present.\n\nCTA Thorax:  The aorta and main thoracic vessels are well opacified.  The\naorta demonstrates normal caliber throughout the thorax without evidence of\ndissection or aneurysmal dilatation.  The pulmonary arteries are opacified to\nthe subsegmental level.  There is no filling defect to suggest pulmonary\nembolism.\n\nThough evaluation is suboptimal in assessment of subdiaphragmatic structures,\nno acute abnormalities detected within visualized portions of the liver\nstomach and spleen.\n\nOsseous structures:  No suspicious lytic or blastic lesions are identified.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "The aortic valve is heavily calcified, in keeping with history of severe\naortic stenosis.  Atheromatous calcifications are mild in the ascending aorta,\nmarked in the aortic arch, and moderate in the descending thoracic aorta.  The\nascending aorta is of normal caliber.  The descending thoracic aorta is\nectatic and mildly dilated at 4.1 cm in greatest diameter.\n\nThe heart is mildly enlarged with left ventricle and left atrial enlargement. \nSevere diffuse coronary artery calcifications are also noted.  Main pulmonary\nartery is enlarged suggesting pulmonary arterial hypertension.\n\nIntrathoracic lymph nodes are increased in number throughout the mediastinum\nbut no individual nodes measure greater than 1 cm short axis dimension.\n\nWithin the lungs, smoothly thickened septal lines are present bilaterally,\nsuggestive of hydrostatic edema.  A 5 mm diameter right lower lobe lung nodule\nadjacent to the major fissure is unchanged since ___ (image 124,\nseries 4).  A 2 mm right middle lobe nodule is also unchanged (116, 4).  Lungs\nare otherwise remarkable for unchanged linear scarring within the lingula and\nboth lung bases.   Note is made of a saber sheath configuration of the\ntrachea, frequently associated with COPD.\n\nSkeletal structures of the thorax are remarkable for multilevel degenerative\nchanges throughout the spine.  Note is also made of persistent fluid\nsurrounding the right shoulder, with distension of the bursa, small internal\nossicles, as well as marked degenerative changes at the glenohumeral joint. \nSimilar findings were present on the ___ CT scan.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of an incompletely imaged stent within the abdominal aorta.",
            "output": "1.  Heavily calcified aortic valve, in keeping with history of severe aortic\nstenosis.  Atheromatous calcifications of the thoracic aorta as described, as\nwell as unchanged mild dilation of descending thoracic aorta.  These images\nare available for review for preoperative planning.\n\n2. Diffuse coronary artery calcifications.  Left atrial and left ventricular\nenlargement.  Enlarged pulmonary artery suggestive of pulmonary term\nhypertension.  Mild hydrostatic edema.\n\n3.  Small pulmonary nodules are unchanged since ___ and are\nstatistically very likely benign given small size and lack of growth.\n\n4.  Chronic periarticular fluid collections surrounding the right shoulder\njoint suggestive of chronic bursitis or synovitis.  This could be more fully\nevaluated by right shoulder MRI if warranted clinically."
        },
        {
            "input": "Patient is status post pacemaker placement and aortic valve replacement.  The\npatient's pacemaker is partially imaged, with the superior most aspect out of\nthe field of view.  There is no evidence for abscess at the pacemaker\ninsertion site, or otherwise.\n\nNo axillary adenopathy.  The thyroid is normal.\n\nNo mediastinal or hilar lymphadenopathy by size criteria.\n\nDescending thoracic aorta measures at the upper limits of normal, 3.3 cm. \nThere is a moderate atherosclerotic disease burden.\n\nThe central tracheobronchial tree is patent.  Pulmonary vasculature is within\nnormal limits.\n\nNo pneumonia, effusion, or pneumothorax.  There is a 5 mm right lower lobe\npulmonary nodule seen on image 30 of series 2, unchanged since ___.\n\nEvaluation of the upper abdomen is unremarkable.\n\nNo concerning osseous lesions, noting multilevel degenerative changes of the\nthoracic spine.",
            "output": "No evidence for abscess post pacemaker placement."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The imaged lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in caliber without evidence of focal\ninjury, dissection, or aneurysm. There is no mediastinal hematoma or\npericardial effusion. The heart is normal in size. Aortic valve and coronary\ncalcifications are noted.  A small focus of inspissated secretions is noted in\nthe mid trachea; otherwise, the large central airways are patent. The\npulmonary artery and major central branches are patent.\n\nThere is a small amount of layering left pleural fluid which is mixed\nattenuation, possibly containing blood products from adjacent multilevel acute\nleft rib fractures. There is no pneumothorax. There is bibasilar dependent\natelectasis. Otherwise, the lungs are clear without focal contusion or\nlaceration. There is no evidence of worrisome nodule, mass, or consolidation.\n\nABDOMEN:  The liver is diffusely hypoattenuating, consistent with hepatic\nsteatosis. There is no evidence of focal splenic or liver injury.  The\ngallbladder, pancreas, adrenal glands appear normal.  The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis or focal\nlesion of concern. Mild to moderate atherosclerotic calcifications are most\nprominent in the infrarenal abdominal aorta. The abdominal aorta is normal in\ncourse and caliber with widely patent major branches. There is no\nretroperitoneal hematoma or lymphadenopathy. No free air or free fluid is\nseen.\n\nThe stomach and duodenum are normal.  Loops of small and large bowel are\nnormal in course and caliber without evidence of obstruction.  There is no\nevidence of mesenteric injury.\n\nPELVIS:  In the proximal right superficial femoral vein, a filling defect\nexpands the vessel lumen, consistent with a deep venous thrombus. Otherwise,\nthe imaged intrapelvic organs are unremarkable. There is no inguinal or pelvic\nlymphadenopathy. There is no free pelvic fluid.\n\nBONES: There are acute nondisplaced fractures of the seventh through tenth\nleft posterolateral ribs. There are chronic/old right lateral sixth and\nseventh rib fractures. The patient is status post total right hip\narthroplasty. Otherwise, there are moderate degenerative changes of the imaged\nthoracolumbar spine with multilevel bridging anterior osteophytes and\nintervertebral vacuum disc phenomenon. Grade 1 L1-L2 retrolisthesis is likely\ndegenerative in nature. Otherwise, alignment is normal.  Mild posterior disk\nbulges are noted at L4-5 and L5-S1.  Minimal loss of height anteriorly of the\nT6 vertebral body is likely chronic.",
            "output": "1. Right superficial femoral vein deep venous thrombosis.\n2. Left nondisplaced ___ acute rib fractures. A small amount of adjacent\nlayering left pleural fluid is mixed density, likely hemothorax. Otherwise, no\nadditional sequelae of trauma.\n3. Hepatic steatosis.\n4. Thoracolumbar spine degenerative changes, as above."
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.  Extensive coronary artery calcifications are noted.\n\nCHEST:\nThe thyroid is normal. There are numerous enlarged upper and lower\nparatracheal lymph nodes, as well as innumerable pulmonary soft tissue masses,\nin keeping with known history of metastatic urothelial carcinoma. There is no\neffusion or pneumothorax. The trachea and large airways appear patent.\n\nThe esophagus follows a normal course and is normal in caliber. Limited\nevaluation of the upper abdomen demonstrates an ill-defined hypodensity in the\nanterior aspect of the left lobe of the liver, not fully characterized.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism.\n2. Innumerable pulmonary metastases and numerous enlarged upper and lower\nparatracheal lymph nodes, in keeping with diffuse thoracic metastatic disease.\nFocal hypoattenuating lesion in the liver incompletely characterized,\npotentially addition metastatic disease."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere are extensive filling defects in the segmental pulmonary arterial\nbranches in the right anterior segment (03:39), right posterior segment\n03:38), right superior segment (03:56), right lateral basal (3:92) and right\nanterior basal (3:69), left anteromedial basal and left lateral basal segments\n(7: 73, 97), left superior and inferior lingular (3:93, 76).  The main and\nright pulmonary arteries are normal in caliber.  There is mild straightening\nof the intraventricular septum.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild bibasilar atelectasis in mosaic attenuation of the lower lobes,\nlikely related to respiratory phase.  There is no focal consolidation or\nevidence of pulmonary infarct.  The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "-Extensive, bilateral segmental pulmonary embolism, sparing the right middle\nlobe and left apical posterior segments.\n-Mild straightening of the intraventricular septum.  No reflux of contrast\ninto the IVC.  Evaluation with echocardiogram would be helpful for assessment\nof right heart strain.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 3:40 am, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "HEART AND VASCULATURE: Previously seen extensive bilateral segmental and\nsubsegmental pulmonary emboli are no longer present with the exception of a\nsmall clot within a subsegmental branch of the left pulmonary artery supplying\nthe left lower lobe (2:67).  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Previously seen extensive bilateral segmental and subsegmental pulmonary\nemboli are no longer present with the exception of a small clot within a\nsubsegmental branch of the left pulmonary artery supplying the left lower\nlobe.\n\nNOTIFICATION:   The findings were emailed to  ED QA nurses, M.D. by ___\n___, M.D.  on ___ at 9:17 am, 20 minutes after discovery of the\nfindings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Note is made of an aberrant right subclavian artery. \nThe heart, pericardium, and great vessels are otherwise within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is an unchanged 10 mm right axillary\nlymph node with coarse internal calcification (2:65). No mediastinal or hilar\nlymphadenopathy. No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Dependent atelectasis is noted bilaterally most prominent in\nthe lower lobes. No evidence of pulmonary mass or area of parenchymal\nopacification. The large airways are patent. Two endobronchial opacities are\nnoted in a branch supplying the medial segment of the right middle lobe\n(2:65).  A similar endobronchial opacity is noted in branch supplying the\nlateral segment of the right middle lobe (301:149).  Scattered peribronchial\nthickening is noted predominantly in the lower lobes. Scattered calcified\ngranulomas are noted, for example a 2 mm granuloma in the right upper lobe\n(301:75). An unchanged 3 mm pulmonary nodule is noted in the right middle lobe\n(301:59). An unchanged 4 mm perifissural nodular opacity in the lingula may\nreflect a perifissural lymph node (301:50).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Note is made\nof a simple cyst in the right hepatic lobe.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Scattered intrabronchial opacities involving the right middle lobe likely\nreflect mucous plugging. In addition, there is lower lobe dependent\nperibronchial thickening. This constellation of findings is suggests chronic\nbronchitis.\n3. Stable pulmonary nodules as described above."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  Aorta and pulmonary arteries\nare normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a 2 mm calcified granuloma in the right upper lobe (302, 83). \nNo other lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "2 mm calcified granuloma in the right upper lobe.  No other lung nodules.  No\nevidence of metastasis to the chest."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.  The\ntip of a right PICC line extends to the distal SVC.\n\nUPPER ABDOMEN: The visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: A subcarinal lymph node measures 1 cm in short axis.  An AP\nwindow lymph node measures 0.9 cm.  A conglomerate of small lymph nodes is\nnoted around the right mainstem bronchus.\n\nHILA: Limited evaluation for hilar lymphadenopathy given the lack of IV\ncontrast.  Probable calcified hilar lymph nodes bilaterally.\n\nHEART and PERICARDIUM: The heart is not enlarged.  Calcification of the aortic\nvalve and coronary arteries are noted.  Coronary stents are present.\nPLEURA: There is a trace right pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Scattered small consolidations are present within all\npulmonary lobes.  There is no particular apical basal gradient or central\nversus peripheral distribution.\n2. AIRWAYS:  Airways are patent through the subsegmental level.  Mild\nbronchial wall thickening is noted.\n3. VESSELS:  The main pulmonary artery is not enlarged.  Calcification of the\nthoracic aorta is present.\nCHEST CAGE: No acute osseous abnormality.",
            "output": "Diffuse, somewhat geographic airspace opacities bilaterally as well as a small\nright pleural effusion are most likely compatible with pulmonary edema. \nSuperimposed aspiration/pneumonia would be hard to exclude.\n\nNo evidence of interstitial lung disease."
        },
        {
            "input": "The thyroid gland appears enlarged and heterogeneous with day hypodense lesion\nseen involving the left thyroid gland measuring 1.8 cm x 1.7 cm.  A 1.3 cm\nhypodense lesion is seen within the right thyroid gland.  There is no\naxillary, hilar, or mediastinal lymphadenopathy.  Extensive aortic annular and\ncoronary calcifications are seen.  Heart is moderately enlarged.  The\nesophagus is normal without evidence of wall thickening.  A small hiatal\nhernia is noted.\n\nThe airways are patent to the segmental levels.  Diffuse bilateral airway wall\nthickening, particularly in the lower lobe bronchi, suggests airway\ninflammation.  Septal thickening predominantly at the lung bases, and diffuse\nground-glass opacities suggest mild pulmonary edema.  A conglomerate of small\nnodules is seen within the right upper lobe, series 4, image 103, which may be\nrelated to small airways disease and inflammatory or infectious in etiology. \nWithin the right upper lobe, a pleural-based lesion measures 1.9 cm x 1.1 cm\nwith peripheral calcifications, series 4, image 52.  There is mild left\nbasilar atelectasis and a small left pleural effusion.   There is no evidence\nof a pneumothorax.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however no gross abnormalities are detected.\n\nOsseous structures:  Acute rib fractures are seen involving the posterior left\nseventh, eighth, ninth, and tenth ribs.  Marked degenerative changes are seen\nwithin the shoulders bilaterally.  No clavicular fractures are seen.",
            "output": "1.  Acute rib fractures are seen involving the posterior left seventh, eighth,\nninth and tenth ribs.  No pneumothorax.\n\n2.  Mild pulmonary edema and small left pleural effusion.\n\n3.  1.9 cm pleural-based lesion with calcifications in the right upper lobe\nfor which a 6 month followup chest CT is recommended for further evaluation.\n\n4.    Diffuse airway wall thickening and conglomerate of small nodules within\nthe right upper lobe likely reflects small airways disease, either\ninflammatory or infectious in etiology.\n\n5.  Heterogeneous and nodular thyroid gland with a dominant 1.8 cm left\nthyroid lobe nodule.  Consider thyroid ultrasound for further assessment if\nnot done previously.\n\nRECOMMENDATION(S):  1.  Six-month follow-up chest CT.\n2.  Consider thyroid ultrasound for further assessment of the thyroid nodules\nif not done previously."
        },
        {
            "input": "LUNGS: In the left lower lobe, there is a focal area of peribronchial nodular\nconsolidations along with ___ opacities compatible with pneumonia. \nAdditional areas of ___ opacities are also noted in the lingula\n(03:38).  No pleural effusion.  No worrisome opacities for malignancy.\n\nMEDIASTINUM: Thyroid gland is within normal limits.  No mediastinal\nlymphadenopathy by CT criteria.  Atherosclerotic calcifications of the\ncoronary arteries are noted.  Cardiac size is normal.  No pericardial\neffusion.\n\nUPPER ABDOMEN: The imaged portion the abdomen, multiple cysts are noted in the\nkidney the largest which are compatible with either simple cyst or hemorrhagic\ncysts.  Also noted is an isodense 2.6 cm lesion extending off of the midpole\nof the left kidney (02:55) which does not meet cystic criteria.\n\nBONES: No suspicious lytic or sclerotic lesions.  Minimal compression\ndeformities of the T10 vertebral body anteriorly noted.",
            "output": "1. Findings concerning for left lower lobe pneumonia.\n2. Incidentally noted 2.7 cm isodense lesion off of the left kidney not\ncystic. Unfortunately prior imaging from PACs could not be retrieved at the\ntime of this dictation. When prior images become available, a radiologist\nshould be able to review these to determine if further imaging is necessary.\nOtherwise, would recommend a kidney ultrasound to start th per the report e\nevaluation.\nFinding 1 was posted on the ED dashboard. Finding 2 was conveyed to ___\n___ at 5:45 AM via telephone"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The paratracheal mass at the level\nof the thoracic inlet (5, 45) is decreased in size to previous neck CT done ___.  Evidence of previous tracheostomy.  No new or enlarging\nparatracheal lymph nodes.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Hypodense hepatic lesion appear similar compared\nto previous PET-CT.  Para-aortic and ___ lymph nodes and stranding appear\nsimilar compared to previous PET-CT.  Small calcified gallstone.  No features\nof cholecystitis.\n\nMEDIASTINUM: No new or enlarging mediastinal lymph nodes.  Prevascular soft\ntissue (5, 68) is decreased in size compared to prior CT neck.  Right lower\nparatracheal lymph node (3, 23) is unchanged.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nModerate aortic valve calcification.  Moderate left and right coronary artery\ncalcification.  Mild calcification of the mitral annulus.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Motion artifact degrades the diagnostic quality of the lung\nimages.  Right middle lobe airspace consolidation (5, 188) is new and measures\n27 x 28 mm.  Multiple peribronchial pulmonary nodules (5, 58, 99, 104, 114,\n117, 125, 126, 133, 136, 137, 144, 151, 154, 156, 167, 168,, 170, 171, 181,\n185, 206) with some of these nodules demonstrating cavitation.  Bronchial wall\nthickening with peribronchiolar nodules in the left lower lobe with associated\nsubsegmental atelectasis suggesting small airways disease.\n-AIRWAYS:  The tracheal stent is patent.  Narrowing of the supraglottic airway\n(3, 3).\n-VESSELS:  The pulmonary arteries not enlarged.  No pulmonary emboli.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.  Multiple chronic rib fractures involving the left lateral chest\nwall.",
            "output": "Multiple new pulmonary nodules (some of these demonstrating cavitation) with\nthe largest measuring 27 x 28 mm in the right middle lobe suggests multifocal\ninfection.  Diagnostic considerations include bacterial (including septic\nemboli), fungal and mycobacterial organisms."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL:\n\nPost treatment changes, including thickening in aryepiglottic fold, stranding\nin the paraglottic fat and piriform sinuses, are seen.\n\nPreviously seen soft tissue mass posterior to the trachea is no longer well\nvisualized.  A tracheal stent is in place, extending from the level of the\ncricoid cartilage to approximately 4 cm above the carina.  The stent is\npatent, though, in comparison to the most recent examination, soft tissue is\nseen along the left lateral and, to a lesser extent, anterior and posterior\nmargins (for example, 602b:65, 2: 32).\n\nThere is significant narrowing of the airway just above the vocal cords.  This\nappears more significant than on prior examinations, but may be related to\ntechnique.\n\nAt the thoracic inlet, there is subcutaneous gas.  This was not seen on prior\nexaminations.  Correlation with recent procedure or symptoms of infection is\nrecommended.\n\nUPPER ABDOMEN:  Limited evaluation of the upper abdomen demonstrates dependent\ngallstones.  A small hiatal hernia is present.  There is significant\nmesenteric standing and lymph nodes, incompletely assessed, similar to prior\nexaminations.  A hypodense lesion in the right hepatic lobe is again noted,\nand stable since prior examinations.\n\nMEDIASTINUM: Prominent mediastinal lymph nodes are noted, though evaluation is\nlimited due the lack of intravenous contrast.  A left paratracheal lymph node\nmeasures up to 1.2 cm in short axis (02:44).  A prominent subcarinal lymph\nnode measures up to 1.6 cm in short axis (2:45).\n\nHILA: There is no definite hilar lymphadenopathy, though evaluation is\nsomewhat limited due to the lack of intravenous contrast.\n\nHEART and PERICARDIUM: The heart is normal in size.  There are extensive\natherosclerotic calcifications of the coronary arteries.  Aortic annular and\nvalvular calcifications are noted.\n\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  Evaluation for small nodules is somewhat limited due to\nrespiratory motion.  A middle lobe nodule, measuring up to 7 mm is noted\n(4:234).  This was seen on prior examination, and is slightly smaller than\npreviously.  Other previously seen nodules are not appreciated on the current\nexamination.  There is suggestion minimal ground-glass opacity in the right\nupper lobe (4:196), which may be related to an infection in the appropriate\nclinical context.  There is middle lobe atelectasis.  Bibasilar atelectasis is\nalso noted.\n-AIRWAYS:  The airways are mildly, diffusely thickened.\n-VESSELS:  The aorta is normal in caliber.  The main pulmonary artery measures\n3.8 cm, which is enlarged.\nCHEST CAGE:  Multiple chronic bilateral rib fractures are identified.",
            "output": "1.  Apparent narrowing of the airway just above the vocal cords is more\nsignificant on the current examination than on priors, which may be due to\ntechnique, though, given history of stridor, may be clinically significant.\n2.  Subcutaneous air seen at the thoracic inlet.  Correlation with recent\nprocedure or signs of infection is recommended.\n3.  Tracheal stent is in stable position since the prior examinations.  Small\nsoft tissue at the proximal aspect of the stent is new since the prior\nexamination.\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 9:39 ___, 25 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Patient is status post tracheostomy, terminating approximately 4 cm above the\ncarina.\n\nThe thyroid is normal.  Prevascular soft tissue is not significantly changed\ncompared with ___ (3:12).  A 8 mm right lower paratracheal node is\nnot significantly changed.  No new mediastinal lymphadenopathy.  There are no\npathologically enlarged supraclavicular, axillary, or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize.  There are diffuse coronary artery calcifications and probable coronary\nstents.  There is no pericardial effusion.  A right-sided central venous\ncatheter terminates in the distal SVC.\n\nThere is a small right and trace left pleural effusions, new compared with\nprior, with dense consolidations at the bilateral lung bases.  Compared with\n___, a right middle lobe consolidation is decreased in size,\ncurrently measuring 1.2 x 1.1 cm, compared with 2.7 x 2.8 cm previously. \nThere are multiple new bilateral nodules.  For example, a 1.2 x 0.8 cm nodule\nin the left upper lobe and a 1.3 x 1.0 cm nodule in a right upper lobe are new\n(5:127,161).  There are diffuse ___ opacities in the right lung.  No\npneumothorax.  There are mucosal secretions in the left mainstem bronchus,\nhowever the airways are patent to the subsegmental level.\n\nMultiple old healed left rib fractures are noted.  No osseous lesions\nsuspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, there is cholelithiasis, with no evidence\nof acute cholecystitis.  The included portions of the upper abdomen are\notherwise grossly unremarkable.",
            "output": "1. Multiple new pulmonary nodules, and ___ opacities in the right\nlung, most consistent with multifocal infection with interval improvement in a\nright middle lobe consolidation compared with ___.\n2. Dense consolidations in both lung bases may represent atelectasis or\npneumonia.\n3. Small right and trace left pleural effusions.\n4. A tracheostomy tube terminates approximately 4 cm above the carina."
        },
        {
            "input": "The patient carries a tracheostomy tube.  The soft tissues around the 2 (2,\n10) are massively swollen.  At the anterior portions surrounding the tube (2,\n12) small air bubbles as well as a metallic punctate particle (2, 14) is\nvisualized.  The wall of the upper trachea appears moderately thickened and\nirregular (2, 17).  At the level of the aortic arch (2, 17) the paraesophageal\nsoft tissues also appear swollen.  Along the course of the esophagus (2, 29)\nthe esophageal wall is difficult to delineate.  The esophageal wall continues\nto be thickened down to the gastroesophageal junction (2, 43).  Also thickened\nis the gastric wall (2, 54).  The patient has moderate bilateral pleural\neffusions with basal areas of atelectasis.  In addition, scattered\nconsolidations and ground-glass opacities are visualized, 302, 102, and 156). \nThese areas could be caused by aspiration.  Moderate cardiomegaly with severe\ncoronary and aortic valve calcifications.  Minimal pleural effusion. \nRespiratory motion limits the assessment of the lung parenchyma.  Borderline\nsized mediastinal lymph nodes (2, 21) Are visualized.",
            "output": "Massive soft tissue swelling around the tracheostomy tube, with small ventral\nair inclusions in the soft tissues as well as a punctate metallic particle. \nModerate swelling of the tracheal wall, notably along the upper parts of the\ntrachea.  Moderate to severe thickening of the esophageal wall along its\nentire course, the out the perimeter of the esophagus and the esophageal lumen\ncannot be clearly delineated.  Moderate bilateral pleural effusions with\nadjacent atelectasis.  Mild mediastinal lymphadenopathy.  Mild bilateral\nparenchymal opacities potentially caused by aspiration."
        },
        {
            "input": "HEART AND VASCULATURE:  There is large focal outpouching of the descending\nthoracic aorta measuring up to 5.3 cm in CC dimension, extending from the\nlevel of the isthmus to the mid descending thoracic aorta.  This abnormality\nis thought to represent a large pseudoaneurysm and is best seen on series\n602b, image 44.  This pseudoaneurysm measures up to 6.4 cm in AP dimension. \nAt the proximal and distal margin a linear density extends partially into the\nlumen of the aorta, which could represent disrupted intima. No mediastinal\nhematoma.  The ascending thoracic aorta is unremarkable.  Pulmonary\nvasculature is well opacified to the segmental level without filling defect to\nindicate a pulmonary embolus.  Heart size is mildly enlarged.  There is\nhypertrophy of the left ventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the subsegmental level with\nbibasilar bronchial wall thickening, likely related to chronic inflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Large focal outpouching of the descending thoracic aorta beginning at the\nlevel of the isthmus concerning for a chronic pseudoaneurysm. No signs of\nrupture."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. The\nheart is moderately enlarged and demonstrates coronary artery calcifications.\nAtherosclerotic calcifications are also noted within the aorta.  The mitral\nvalve is calcified.\n\nAlthough better seen on the prior abdominal CT that covered part of the right\ninfrahilar region, there is a suspected mass occluding right lower lobe\nairways as well as the right inferior pulmonary vein.  Proximal right lower\nlobe pulmonary arteries are encased and mildly narrowed.  The suspected mass\nis difficult to distinguish from surrounding collapse of basilar segments, but\nmeasures probably about 5-6 cm in diameter, possibly more.\n\n\nThere is a filling defect noted along the right posterior pulmonary vein,\noccluding its inflow into the left atrium (2:30).   Although there may be\nbland associated thrombus, direct tumor invasion likely accounts for much of\nthis appearance.\n\nThe subsequently affected portion of the left lower lobe appears hypoperfused,\nand demonstrates diffuse consolidation. Additional airspace consolidations are\nnoted within the posterior right middle lobe.  A prior resection site is noted\nin the right upper lobe.\n\nA right pleural effusion is moderate in size.  There is a small left pleural\neffusion.  Left pleural effusions with adjacent atelectasis are present.\n\nUpper lobe predominant, moderate centrilobular and paraseptal emphysematous\nchanges are severe.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents. Within this limitation, left-sided renal cysts are noted.  Bilateral\nenhancement defects are partly demonstrated and probably unchanged although\nnot as well delineated with this technique or fully reimaged.\n\nThere are no suspicious bone lesions.",
            "output": "1.  Findings suggest a right perhilar mass occluding most of the right lower\nlobe airways with some sparing on the superior segment bronchus.  The mass\nencases the right lower lobe pulmonary arteries and obliterates the right\ninferior pulmonary vein including suspected direct invasion into the left\natrium.  Although it is not possible distinguish bland thrombus on this study\nfrom tumor thrombus, it possible that the left atrial abnormality may include\nbland thrombus to some extent.\n2.  Collapsed and consolidated right lower lobe with additional foci of\nconsolidation in the posterior right middle lobe; in the appropriate setting,\npost-obstructive pneumonia is possible.\n3. Moderate right and small left pleural effusions with adjacent atelectasis.\n4. Moderate, upper lobe-predominant, centrilobular and paraseptal emphysema.\n5. Moderate cardiomegaly.\n6 Bilateral cortical areas of relative decreased renal enhancement, probably\nunchanged allowing for differences in technique, suggesting pyelonephritis or\nareas of ischemia/incipient infarct.\n\nFinal report discussed with Dr. ___ at 1:20 pm on ___ at the\ntime of final interpretation."
        },
        {
            "input": "The thyroid gland is unremarkable. A few mildly prominent mediastinal lymph\nnodes measure up to 9 mm in short axis in the subcarinal location. There are\nno pathologically enlarged supraclavicular, axillary, or hilar lymph nodes.\n\nFusiform aneurysmal dilatation of the ascending thoracic aorta to 4.4 cm at\nthe level of the main pulmonary artery extends to the level of the left common\ncarotid artery. The ascending thoracic aorta measures 4.7 cm in mid diastole,\nand 4.4 cm in mid systole. Please see detailed valvular measurements below. A\nnormal variant common origin of the brachiocephalic and left common carotid\nartery is consistent with a 'bovine' aortic arch. This common trunk is\nslightly aneurysmal measuring 2.5 cm in greatest diameter.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nis top-normal caliber measuring 3.1 cm. No central pulmonary embolus is\nidentified. No intracardiac filling defects are present, including within the\nleft atrial appendage.  There is conventional anatomy of the coronary\narteries. The aortic valve is trileaflet without evidence of calcification.\n\nNumerous bronchiolar nodules and peribronchial ground-glass opacities in the\nright lower lobe, and to a lesser extent right upper lobe (7R, 86), are likely\ndue to infection. A 7 mm right lower lobe solid nodule is indeterminate (7R,\n126). There is mild upper lobe predominant centrilobular emphysema. Central\nairways are patent. There is no pleural effusion.\n\nImages of the upper abdomen are unremarkable.\n\nSmall sclerotic lesions involving to adjacent right lateral ribs may be small\nbone islands.\n\nMEASUREMENTS 3D IMAGING LAB:\n\n1. Aortic annulus: 27.7 x 35.4 mm\n\n2. Sinus of Valsalva: 33.8 x 42.6 mm\n\n3. Sinotubular junction: 32.5 x 33.7 mm\n\n4. Mid ascending aorta: 42.3 x 44.4 mm\n\n5. Distal ascending aorta: 37.8 x 41.6 mm\n\n6. Mid aortic arch: 26.8 x 30.5 mm\n\n7. Proximal descending aorta: 23.2 x 24.8 mm\n\n8. Mid descending aorta: 21.2 x 22.6 mm\n\n9. Distal descending aorta: 21.4 x 23.9 mm\n\n10. Main pulmonary artery: 26.3 x 35.4 mm",
            "output": "Fusiform aneurysmal dilatation of the ascending thoracic aorta to 4.7 cm in\nmid diastole which extends to the level of the left common carotid artery.\n\nTricuspid aortic valve without evidence of calcification.\n\nRight lower lobe infectious or inflammatory bronchiolitis.\n\nIndeterminate 7 mm right lower lobe solid nodule may be related to the\ninfectious process, however this warrants a 6 month followup chest CT\nfollowing appropriate antibiotic treatment.\n\nMild upper lobe predominant centrilobular emphysema.\n\nRECOMMENDATION(S):  As above.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on ___\nat 12:47 into the Department of Radiology critical communications system for\ndirect communication to the referring provider."
        },
        {
            "input": "The thoracic aorta is normal in caliber.  There is an aberrant right\nsubclavian artery.  The main pulmonary artery is normal in caliber.  No\ncentral filling defect within the main, left, right pulmonary artery to\nsuggest the presence of an acute large central pulmonary embolus.  The heart\nis top-normal in size.  No evidence of a pericardial effusion.\n\nThere is extensive diffuse mediastinal and bilateral hilar lymphadenopathy. \nThere is mild compressive affect on the azygos vein.  Multiple collaterals are\nseen; left subclavian vein not clearly seen and is suboptimally evaluated.  No\naxillary lymphadenopathy.\n\nNo concerning pulmonary lesions.  Small amount of atelectasis in the right\nmiddle lobe anteriorly.  Fibrotic changes from degenerative changes in the\nright lung noted.  The airways are patent to at least the subsegmental level. \nNo pleural effusion or pneumothorax.\n\nThe thyroid gland is unremarkable.\n\nThis exam is not dedicated for imaging of the upper abdomen.  A hiatal hernia\nis small.  A subcentimeter hypodensity in the right kidney mid pole is too\nsmall to accurately characterize on CT.  No obvious lymphadenopathy in the\npartially imaged upper abdomen.  Small bowel loops are decompressed.  Colonic\ndiverticulosis in the imaged upper abdomen is mild.\n\nNo suspicious lytic or sclerotic osseous lesion.  No acute fractures. \nBilateral mild nipple inversion is noted, but no obvious retroareolar masses\nidentified on this nondedicated exam.",
            "output": "1.  Extensive mediastinal and bilateral hilar lymphadenopathy.\n2.  Left subclavian vein not well evaluated and could be stenosed given\nmultiple collaterals.\n3.  Aberrant right subclavian artery.\n4.  Bilateral breast nipple inversion without obvious retroareolar mass. This\ncould be longstanding; correlate with clinical history and considered\ndedicated mammography if not already performed to further evaluate.\n6.  Colonic diverticulosis.\n7.  Small hiatal hernia."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.\n\nFor evaluation of the abdomen, please refer to dedicated CT of the abdomen\nperformed on the same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\n3 mm left perifissural nodule is unchanged compared to prior exam.  No\nconcerning new or growing pulmonary nodules identified.  3 mm left upper lobe\nnodule, series 3 image 48 is unchanged compared to the prior exam.",
            "output": "Stable millimetric left lung nodule.  No evidence of concerning new or growing\npulmonary nodules compared to the exam from ___."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  There are no lytic\nor sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.\n\nLungs are essentially clear with no evidence of disease recurrence.\n\nThe mm trick left lung nodule is stable, series 3 image 46.  No new nodules\nmasses or consolidations demonstrated.",
            "output": "No evidence of primary metastatic disease in the chest currently seen\n\nStable left upper lobe nodule\n\nThe study was done at the expiration reflecting mosaic attenuation especially\nin the mid and lower lungs."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  Mildly prominent bilateral hilar lymph nodes measuring\nup to 7 mm is unchanged compared to the prior exam.  Heart size is normal. \nThere is no pericardial effusion.  The esophagus is normal without evidence of\nwall thickening however note is made of a small hiatal hernia.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on the same day.\n\n4 mm left upper lobe nodule (3; 52) is unchanged compared to the prior exam. \nNew ill-defined consolidation is seen within the medial aspect of the right\nlower lobe (3; 118).  Additional ground-glass changes are seen within the left\nlower lobe.  There is no pleural effusion or pneumothorax.\n-3 mm right lower lobe nodule (3; 149) appears new compared to the prior exam.\n-a subpleural 4 mm left upper lobe nodule (3; 17) appears new compared to the\nprior exam.",
            "output": "-New bilateral nodules measuring up to 4 mm.\n-New consolidative process within the medial aspect of the right lower lobe as\nwell as ground-glass changes within the left lower lobe may be\ninfectious/inflammatory in etiology.\n-Mildly prominent bilateral hilar nodes are nonspecific, and may be reactive\nin etiology.\n\nRecommendations:\n\nSix-month follow-up with chest CT is recommended."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes and bilateral hilar lymph nodes are\nunchanged since the prior study.  The aorta and pulmonary arteries are normal\nin caliber.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized 4 mm left upper lobe pulmonary nodule is no longer\nseen.  The 4 mm left upper lobe nodule (302, 60) is unchanged.  A 3 mm right\nlower lobe pulmonary nodule is also no longer seen.  Previously visualized\npatchy parenchymal opacities in both lower lobes have improved.  The perihilar\nopacities in the right lower lobe and left lower lobe (302, 109 have also\nimproved.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Previously visualized consolidative opacities in both lower lobes have\nsignificantly improved.  The left upper and right lower lobe pulmonary nodules\nare no longer seen.  Some of the previously visualized nodules are unchanged\nin size.  No new pulmonary nodules.\n\nNo new sites of disease."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  There are no\nenlarged hilar lymph nodes.  Heart size is normal.  There is no pericardial\neffusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: A previously visualized 4 mm left upper lobe pulmonary nodule is no\nlonger seen.  A 3 mm nodule seen on the prior study in the left upper lobe (3,\n55) is unchanged.  Previously visualized patchy parenchymal opacities in both\nlower lobes are unchanged but improved since ___.  No new\nconsolidations or nodules.  There is a new area of focal pleural thickening\nseen posteriorly in the left lower chest (3, 94), new since the prior study\nand bears watching.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "New focal pleural thickening along the mediastinal surface of the pleura on\nthe left (601, 97), bears watching.\n\nAll the other previously visualized pulmonary nodules are unchanged.  No new\npulmonary nodules.  Stable scar-like opacities in both lower lobes.\n\nStable small mediastinal lymph nodes."
        },
        {
            "input": "HEART AND VASCULATURE: Of note, there is significant motion artifact which\nlimits evaluation of the pulmonary vasculature.  However, within these\nlimitations, there are large filling defects in the bilateral pulmonary\narteries, right greater than left, compatible with extensive pulmonary emboli.\nThe filling defects extend predominantly into the right and left lower lobes. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The cardiac size is mildly enlarged.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple mediastinal lymph nodes appear\nenlarged, measuring up to 11 mm (series 3: Image 233).  Additionally, there is\nincreased prominence of multiple infraclavicular lymph nodes, the largest\nmeasuring up to 8 mm on the right (series 3: Image 6).  There is no axillary\nor hilar lymphadenopathy.\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is interval increase in size of a right lower lobe\npulmonary nodule, measuring 11 x 9 mm, previously measuring up to 7 mm in\n___.  Atelectasis is noted dependently and in the lung bases.  No focal\nconsolidations identified.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for several\nprominent para-aortic lymph nodes seen at the level of the distal esophagus\n(series 3: Image 150), measuring up to 8 mm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes are seen in the thoracic spine.",
            "output": "1. Bilateral pulmonary emboli, predominantly extending into the right and left\nlower lobes.  No definite evidence of right heart strain.\n2. Interval increase in the size of a right lower lobe pulmonary nodule\nmeasuring up to 11 mm, previously 7 mm in ___.\n3. Enlargement of multiple mediastinal lymph nodes, measuring up to 11 mm.\n4. Increased prominence of bilateral and infraclavicular and para-aortic lymph\nnodes, possibly reactive.\n\nRECOMMENDATION(S):  A PET CT could be obtained for further evaluation\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 3:41 am, 1 minutes after discovery of the\nfindings."
        },
        {
            "input": "LYMPH NODES: The extensive supraclavicular and mediastinal lymphadenopathy\ndemonstrated on ___ and on the following ___ PET-CT has\nalmost completely resolved.\nThe only borderline enlarged mediastinal node, 0.8 x 2.1 cm lymph node in the\nAP window (6:82) has not changed, probably not malignant.\nThere is no supraclavicular, axillary, hila lymphadenopathy.\nMillimetric lymph nodes in the retrocrural, are significantly decreased in\nsize in comparison the prior and are not pathologic per CT size criteria.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nNo appreciable atherosclerotic calcifications in the coronaries or in the\nnormal caliber major vessels.\nNo evidence of incidental central pulmonary emboli and there is no evidence of\nthe bilateral prior pulmonary embolism.\n\nLUNG and PLEURA: Major airways are patent.\nLeft upper lobe micro nodule (6:75) not clearly demonstrated on previous\nexpiratory CTA study.\nleft perifissural micro nodule (6:110) unchanged.\nPreviously demonstrated right lower lobe medial subpleural 1.3 cm nodule\nalmost completely resolved, remaining only mild smaller stellate opacity which\ncould be scar (6:204).\nThere are no new lung nodules or masses.\nThere is no pleural effusion.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the abdomen pelvis.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "Almost complete resolution of previously demonstrated extensive\nsupraclavicular and intrathoracic lymphadenopathy as well as of the right lung\nnodule.  No new lung nodules or masses."
        },
        {
            "input": "THORACIC INLET: There is stable very small left supraclavicular lymph nodes. \nThe thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is a\nstable small AP window lymph node\n\nNODES: There are no enlarged hilar lymph nodes\n\nHEART, VESSELS and PERICARDIUM: There is no cardiomegaly.  No pericardial\neffusion is seen.  No appreciable atherosclerotic calcification in the\ncoronaries or in the major vessels.  The aorta and pulmonary arteries are\nnormal in caliber.\n\nPLEURA: There is no pleural effusion\n\nLUNG:\nPARENCHYMA:  Previously visualized tiny micro nodule in the left upper lobe is\nno longer seen.  The left perifissural nodule is unchanged (6, 113) no new\npulmonary nodule\nAIRWAYS:  The airways are patent up to the subsegmental level.\n\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.",
            "output": "Near complete resolution of the adenopathy seen on the prior CT chest done on\n___.  Previously visualized pulmonary emboli are also no longer seen.\n\nNo new lung nodules."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable with no evidence of pulmonary\nembolism.  Main pulmonary artery is dilated up to 3.2 cm, within normal\nlimits.  No mediastinal, hilar or axillary pathologically enlarged lymph nodes\ndemonstrated.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  New right lower\nlobe ground-glass nodular opacity is 17 x 12 mm, not seen on the previous\nexamination.  The finding might reflect focus of infection, most likely, and\nless likely to represent recurrence.  Left lower lobe nodule, series 6, image\n111 is stable.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "No definitive evidence of intrathoracic recurrence.  New ground-glass opacity\nin the right lower lobe most likely represent focus of infection but should be\nshortly followed up in ___ weeks for documentation of resolution."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet no abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size unchanged.  No pericardial effusion.  No\natherosclerotic calcifications in the aorta, coronary arteries or cardiac\nvalves.  The entire aorta and pulmonary arteries are normal in caliber.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.\nSmall lung nodules scattered throughout the lungs, ranging between 2 and 3 mm\nin size, unchanged compared to prior study.  No consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___.  The patient's\nprimary cancer was first identified is several enlarged lymph nodes. No new or\ngrowing lymph nodes were identified in the current study.  No new or growing\npulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Normal thyroid gland.  No axillary\nor thoracic inlet lymphadenopathy.\n\nUPPER ABDOMEN: Dictated separately.\n\nMEDIASTINUM: No lymphadenopathy.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Normal in size.  No pericardial effusion.\nPLEURA: No pleural effusion.  Millimetric subpleural nodules in the dependent\nlungs most likely represent subsegmental atelectasis (6:140; 6:156; and\n6:143).\nLUNG:\n\n1. PARENCHYMA: Stable micronodules. For example, a 3 mm left lower lobe\nperifissural nodule (6:115).  No new or growing suspicious pulmonary nodules.\n2. AIRWAYS:  Patent the subsegmental level bilaterally.\n3. VESSELS:  No significant coronary artery calcifications.  No incidental\npulmonary embolus.  Thoracic aorta and main pulmonary trunk are normal in\ncaliber.\nCHEST CAGE: No suspicious osseous lesions or acute fracture.  Degenerative\nchanges in the thoracic spine.",
            "output": "1. No evidence of recurrence in the chest.\n2. No new or growing suspicious pulmonary nodules.\n3. Millimetric subpleural nodules in the dependent lungs most likely represent\nsubsegmental atelectasis.\n4. CT of the abdomen and pelvis dictated separately."
        },
        {
            "input": "There is extensive pulmonary metastatic disease, predominantly sub pleural. \nRepresentative lesions are seen in the left upper lobe measuring 14 x 10 mm\n(6:96) and right upper lobe measuring 13 x 11 mm (6:112).  There is no pleural\neffusion. Right hilar lymphadenopathy ranges up to 14 mm (6:118). A 10 mm left\nparatracheal node was 6 mm in ___ (6:108). Retrocrural nodes range up to 13\nmm (3:61).\n\nThe airways are patent. Bronchial wall thickening and irregularity is\nconsistent with chronic bronchitis. No pleural effusion or pneumothorax.  The\nheart is mildly enlarged. There is no pericardial effusion. Coronary artery\ncalcifications are severe. Moderate calcifications involve a normal caliber\naorta and mitral valve. The main pulmonary artery is dilated to 3.6 cm.\n\nThe included thyroid is unremarkable. There is a small hiatal hernia. Findings\nbelow the diaphragm are better evaluated on the recent abdominal MRI and\ninclude a large pancreatic tail mass with surrounding stranding and multiple\nhepatic lesions. There is cholelithiasis without cholecystitis. A wide-mouth\nventral hernia contains fat and loops of bowel. Left-sided rib deformities\nfrom prior trauma are noted. There are no lytic or blastic osseous lesions\nwithin the chest.",
            "output": "1.  Extensive pulmonary metastatic disease with central lymphadenopathy. 2.\nSuspected pulmonary arterial hypertension.  3. Severe coronary artery disease.\n4. Abdominal findings are better evaluated on the recent abdominal MRI."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection.  There is moderate atherosclerotic calcification. Evaluation for\npulmonary embolism is limited by significant respiratory motion artifact.\nHowever, there are filling defects in the lobar branches of the right\npulmonary artery, and some segmental branches of the left lower lobe pulmonary\nartery, consistent with pulmonary thromboembolism (3:128, 145, 162). There is\nno evidence of right heart strain. There is dilation of the pulmonary artery,\nup to 3.5 cm, suggestive of pulmonary hypertension.\n\nCT CHEST WITH CONTRAST:\n\nThe imaged thyroid is normal. There is bilateral hilar and mediastinal\nlymphadenopathy, along with multiple pulmonary metastases, unchanged from ___.  There is no airspace consolidation, nor evidence of pulmonary\nedema. The heart is structurally normal, without pericardial effusion. There\nis extensive coronary arterial calcification. There is no pneumothorax. There\nis a trace left pleural effusion.\n\nThere is a 1.7 cm hypodensity in the liver, which was characterized of a\npossible metastasis on the prior MRI (2:109).\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  There are multiple healed left rib fractures.",
            "output": "1. Acute pulmonary thromboemboli without evidence of right heart strain.\n2. Unchanged metastatic disease.\n\nNOTIFICATION:  Preliminary findings were communicated to Dr. ___ by Dr.\n___ phone on ___ at 5:56 AM, 10 minute(s) after discovery."
        },
        {
            "input": "CTA CHEST WITH CONTRAST: The partially visualized thyroid is markedly enlarged\nnew since the study of ___. There is no supraclavicular, axillary, hilar or\nmediastinal lymphadenopathy.\n\nEvaluation of the lungs is slightly limited by motion artifact. There is faint\nnonspecific ground-glass opacity in the left upper lobe measuring\napproximately 9 mm (3:78) unchanged since ___.  There is no pleural effusion\nor pneumothorax.\n\nThe and pulmonary arteries are mildly enlarged suggesting component of\npulmonary hypertension. There are right upper, middle and lower lobe segmental\npulmonary emboli extending into subsegmental branches.\n\nOSSEOUS STRUCTURES: There are healed bilateral rib fractures. There is no\nworrisome blastic or lytic lesions.\n\nUPPER ABDOMEN: 2.2 x 1.6 cm lobulated cyst in segment 6 of the liver. There is\na nonspecific 4.2 x 1 cm subcapsular collection in the right lobe of the liver\n(3:205), possibly small focus of hemorrhage or complex cyst. This can be\nre-evaluated non urgently with right upper quadrant ultrasound in ___ weeks.",
            "output": "1. Multiple segmental pulmonary emboli in the right upper, middle and lower\nlobes extending into subsegmental branches.\n2.  4.2 x 1 cm subcapsular collection in the right lobe of the liver is\nnonspecific but may reflect small focus of hemorrhage or complex cyst. This\ncan be re-evaluated non urgently with right upper quadrant ultrasound for 6\nweeks.\n3. Interval development of diffusely enlarged multi nodular thyroid since\n___.\n\nNOTIFICATION:  Addition of impression 3 was discussed with Dr. ___ at 16:00 by\nDr. ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are mildly enlarged, suggestive of pulmonary\nhypertension. There is probable right heart strain with associated\nstraightening of the interventricular septum without paradoxical bowing. There\nis interval worsening of right-sided pulmonary emboli, now with increased\nright upper, middle, and lower lobe segmental pulmonary emboli with extension\ninto the subsegmental branches. There is remnant of a prior, old right-sided\npulmonary embolus in the hilum.  There is no evidence of left-sided pulmonary\nembolus. The left pulmonary arteries are well opacified to the subsegmental\nlevel, with no evidence of filling defect within the corresponding lobar,\nsegmental, or subsegmental pulmonary arteries.\n\nThere is no evidence of pericardial effusion.\n\nThere is a 9-mm lung nodule in the left upper lobe that is unchanged since\n___ (series 2, image 36). Calcified pulmonary nodule is noted in the lingula\n(series 2, image 56). There is no pleural effusion or pneumothorax.\n\nThe visualized lower lobes of the thyroid gland appears diffusely enlarged and\nheterogeneous. There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.\n\nThere are two hypodensities in the right lobe of the liver, measuring 2.1 x\n1.4 cm in the segment 7 of the liver (series 2, image 104) and 6 mm lesion in\nsegment 7 at the dome of the liver (series 2, image 84). Limited images of the\nupper abdomen are otherwise unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere are healed bilateral rib fractures and multi-level degenerative changes\nin the thoracic spine.\n\nThe patient has had a left mastectomy.",
            "output": "1.  Interval progression of right-sided segmental pulmonary emboli involving\nthe right upper, middle, and lower lobes.  Probable right heart strain.\n\n2.  Incidental small hypodensities in the right lobe of the liver, which are\nincompletely evaluated on this chest CTA exam.  Recommend follow-up imaging\nwith CT or MRI to further assess these lesions in a patient with a history of\nbreast cancer.\n\n3.  9 mm Left upper lobe lung nodule, stable since ___.  Additional calcified\npulmonary nodule in the lingula.\n\n4.  Diffuse thyromegaly. Further evaluation should be based on the clinical\nassessment.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with ___ from\nthe referring team, on the telephone on ___ at 2:44 ___, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Multiple bilateral hypodense thyroid nodules measure up to 11 x 16 mm on the\nright.  There is no supraclavicular, mediastinal, hilar or axillary\nlymphadenopathy. Coarsely calcified AP window lymph nodes are incidentally\nnoted.\n\nThere is mild cardiomegaly with predominantly left atrial enlargement. There\nis no pericardial effusion. Severe aortic valvular and moderate coronary\nartery calcifications are present.  The main pulmonary artery and thoracic\naorta are normal caliber. No incidental central pulmonary emboli are\nidentified.\n\nThere is minimal centrilobular emphysema. Two small pulmonary nodules measure\nup to 2 mm in the right lower lobe (7: 125 and 160). A few calcified\ngranulomas are incidentally noted bilaterally (7: 83, 93, 124). There is no\nendobronchial lesion or pleural abnormality.\n\nMild bilateral gynecomastia is incidentally noted.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nMultilevel spinal degenerative changes are present.",
            "output": "No evidence of primary intrathoracic malignancy.\n\nTwo pulmonary micronodules measuring up to 2 mm in the right lower lobe have a\nlow index of suspicion for malignancy.\n\nMinimal centrilobular emphysema"
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is demonstrated.  Dilated esophagus is unchanged\nsince the prior study.  The patient is after mitral valve replacement. \nCoronary calcifications are extensive.  There is no pericardial or pleural\neffusion.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Previously seen\nleft lower lobe nodule, series 3, image 220 on the prior study from ___ has not present on the current study.  Additional pulmonary nodules are\nstable:  Series 4, images 134, 166, 184.  No new nodules masses or\nconsolidations demonstrated.\n\nImage portion of the upper abdomen demonstrate liver hypodensity, unchanged.",
            "output": "Stability of pre-existing pulmonary rows with resolution of 1 of the\npreviously seen nodules (the largest 1) in the left lower lobe.\n\nInterval resolution of pleural effusion.\n\nGiving the stability of pulmonary nodules and the size no further followup\nindicated\n\nBasal atelectasis most likely sequela of previous pleural effusion and or\ninfection."
        },
        {
            "input": "The imaged thyroid is without focal nodularity.  There is no axillary or\nsupraclavicular adenopathy.  Central nodes are not pathologically enlarged. \nResidual thymic tissue is present in the anterior mediastinum.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  There is no pericardial effusion.  Heart size is\nnormal.  There are no appreciable coronary artery calcifications.\n\nBreast parenchyma is best assessed by dedicated imaging, recently performed by\nMR dated ___.\n\nThe tracheobronchial tree is patent to the subsegmental level.  Apical\nscarring is bilateral and symmetric.  A 3 mm nodule within the right middle\nlobe is noted (103:149) as is a 2 mm nodule within the left upper lobe\n(103:90). There is no consolidation or mass.  There is no pleural effusion or\npleural abnormality.\n\nThere is no worrisome lytic or sclerotic osseous lesion within the chest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "Two pulmonary nodules measure up to 3 mm, which although statistically most\nlikely benign, follow up examination in 3 to 6 months time is advised.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.\n\nRECOMMENDATION(S):  Follow up Chest CT in 3 to 6 months time to stability of\naforementioned nodules."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.  2\nmm nodule in the right middle and left upper lobes are stable (302a:112, 66). \nOtherwise the lungs are clear.  There are no new or enlarging lung nodules\nthere is no pleural or pericardial effusion.\nPatient is status post left mastectomy\nThis examination is not tailored for subdiaphragmatic evaluation there is\nfatty liver\nPort a cath tip is at the cavoatrial junction.\nThere are no bone findings of malignancy",
            "output": "Stable micro nodules, unlikely malignant.  No new or enlarging lung nodules\nidentified"
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. Mild-to-moderate atherosclerotic\ncalcifications of the thoracic aorta and moderate of the coronary arteries. \nMild calcifications of the aortic valve.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild paraseptal\nemphysema.  Calcified granuloma in the right lower lobe.  Mild air trapping on\nthis mildly expiratory scan, suggestive of air trapping.\n\nPulmonary nodules as follows:\n6 x 6 subpleural solid nodule in the left lower lobe (301 image 149)\nSubpleural 7 x 4 mm nodule in the left lower lobe (301 image 178)\nA 2 x 2 mm nodule in the right lower lobe (301 image 147).\nPerifissural nodule in the left lower lobe (series 301 image 140) measuring 6\nx 7 mm\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "Multiple subpleural nodules nodules in the lower lobes bilaterally, in the\nabsence of prior imaging or history of known malignancy could represent\nlymphoid aggregates given their location rather than metastatic.  A follow-up\nCT thorax in ___ months is suggested to ensure stability."
        },
        {
            "input": "The thyroid is normal.  The supraclavicular and axillary lymph nodes are not\nenlarged. There are multiple subcentimeter mediastinal and bilateral hilar\nlymph nodes which are nonenlarged by size criteria.\n\nAorta and pulmonary arteries are normal size.  There is severe calcification\nof the aortic valve and mitral valve annulus. The heart is enlarged with\nprominence of the left atrium and left ventricle. No pericardial effusion is\nseen.\n\nThe trachea and central bronchi are patent. There is a small right pleural\neffusion and a trace left pleural effusion with associated compressive\natelectasis at the lung bases. There are asymmetric peripheral\nperibronchovascular nodular opacities within both lungs, most pronounced in\nthe right upper and middle lobes. No focal consolidation is seen. There is\nincreased anteroposterior diameter of the thorax with flattening of the\nhemidiaphragms consistent with chronic obstructive pulmonary disease.\n\nLimited images through the upper abdomen demonstrate thickening of the left\nadrenal gland with a 1.4 cm left adrenal nodule measuring 2.0 Hounsfield units\nand consistent with a benign adrenal adenoma versus adenomatous hyperplasia by\nattenuation characteristics. There is no right adrenal nodule. High density\nmaterial is noted layering within the gallbladder consistent with sludge.\n\nSevere degenerative changes are noted throughout the visualized portions of\nthe spine.",
            "output": "1. Peripheral peribronchovascular nodular opacities most pronounced within the\nright upper and middle lobes with the primary consideration of atypical small\nairway infection given the degree of asymmetry.\n\n2. Small bilateral pleural effusions, greater on the right, with associated\ncompressive atelectasis at the lung bases.\n\n3. Cardiomegaly with left chamber enlargement and marked calcification of the\naortic valve and mitral valve annulus."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  There is\na thin linear filling defect in a right lower lobe segmental branch at the\nsite of pulmonary embolism on outside hospital CT from ___.  A\nsimilar thin linear filling defect in the left lower lobe subsegmental branch\nis also seen and also contain thrombus on prior CT chest.  There is no other\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is a peripheral 8 mm nodule in the left lower lobe, decreased in size\nfrom up to 2.2 cm on prior exam.  An additional peripheral 7 mm nodule\nsuperior to this on prior exam is no longer appreciated.  There are small\ncalcified granulomas seen in bilateral lungs.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen show calcifications of the gallbladder\nwall and thickening along the fundus that is stable from prior exams.  Misty\nmesentery in the mid upper abdomen is also stable from prior exam.  There is\nno lymphadenopathy.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Thin linear filling defects in a right lower lobe segmental branch and in a\nleft lower lobe subsegmental branch which previously contained thrombus\nconsistent with chronic or resolving pulmonary emboli.\n2. Interval decrease in size of two left lower lobe pulmonary nodules\nconsistent with benign process.\n3. Stable calcifications within the gallbladder wall."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue lesions in the chest wall suspicious for malignancy.\nThis study is not designed for subdiaphragmatic diagnosis but shows hepatic\nsteatosis, normal-size adrenal glands, and a new second punctate papillary\ncalcification in the upper pole of the left kidney.\n\nAtherosclerotic calcification in head and neck vessels is mild, but\nconsiderably more extensive in all the major coronary segments. Thyroid is\nunremarkable. Aorta and pulmonary arteries are normal size. Pericardium is\nphysiologic. There is no pleural abnormality.\n\nMediastinal lymph nodes are not pathologically enlarged, but 7 mm right upper\nparatracheal node, 02:13, was only 4 mm in ___. Other normal size lymph\nnodes contain chronic granulomatous calcifications.\n\nEmphysema is mild.\n\nFocal lung lesions are as follows:\n\n9 x 15 mm largely ground-glass spiculated right upper lobe nodule, 04:54, was\nno more than 7 by 9 mm in ___, essentially stable at that time since ___. The 5 mm soft tissue nodule at its inferomedial margin, 04:56, was\nbarely measurable in ___.\n\n3 mm juxta fissural right upper lobe nodule, 4:94 may have been less than 3 mm\nin ___.\n\nPrevious right middle lobe ground-glass nodule, 5:126 on ___ ,has\nresolved.\n\nThere are no other lung lesions of concern for active pathology.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Interval growth since ___ of both ground-glass and nodular components\nof a previously stable mixed density right upper lobe nodule is concerning for\ntransformation to an early phase lung adenocarcinoma.  Interval growth of\nipsilateral upper paratracheal lymph node from 4mm to 7 mm is not necessarily\nrelated but should be kept in mind.\n\nNo other lung lesions are of concern for malignancy.\n\nSevere coronary atherosclerosis.\n\nMild emphysema.\n\nSecond tiny papillary stone, left upper renal pole."
        },
        {
            "input": "A mixed attenuation nodule within the right upper lobe posteriorly demonstrate\nsubstantial growth of the solid component from 5 mm on ___ to 8 mm\non today's study.  The ground-glass component of the nodule has also increased\nin size, previously measuring 4 mm in now measuring approximately 7 mm (54,\n5).  A 2 mm solid right upper lobe nodule at the same level is unchanged (54,\n5).  A ground-glass 2 mm right upper lobe nodule (69, 5) and a 3 mm right\nupper lobe ground-glass nodule (104, 5) are also unchanged, as well as a 3 mm\nground-glass nodule adjacent to the minor fissure (96, 5).  Incidental\ncalcified granulomas present a right upper lobe.  Lungs are otherwise\nremarkable for mild emphysema and nonspecific subpleural and basilar\npredominant interstitial lung abnormalities\n\nSubcentimeter mediastinal lymph nodes are unchanged as well as calcified lymph\nnodes consistent previous granulomatous exposure.  Heart size is normal, and\nsevere diffuse coronary artery calcifications are present.  Small hiatal\nhernia is incidentally noted.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of vascular calcifications in the abdominal aorta and its branches as\nwell as tiny splenic calcified granuloma.  Hip\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.  .",
            "output": "1.  Substantial growth of mixed attenuation right upper lobe lung nodule, most\nconsistent with lung adenocarcinoma.  Absence of substantial FDG avidity on\nthe prior PET-CT likely reflected the small size of the solid component at\nthat time and should not preclude further invasive evaluation with either\nbiopsy or surgical resection.\n\n2. Otherwise stable CT appearance of the chest compared to ___."
        },
        {
            "input": "The study is slightly limited by motion.\n\nImaged portion of the thyroid gland is unremarkable in appearance.\n\nNo supraclavicular or axillary lymphadenopathy by size criteria.  Numerous\nmediastinal lymph nodes, most of which are sub-cm in size.  The largest is a\nright lower paratracheal node that measures up to 1.3 cm (02:35), but contains\na normal fatty hilum.  Evaluation for hilar lymphadenopathy is slightly\nlimited in the absence of intravenous contrast.\n\nHeart size is normal, without a pericardial effusion.  Coronary artery\ncalcifications are diffuse.  There appears to be a stent in the location of\nthe left anterior descending artery.  Thoracic aorta is normal in caliber,\ncontaining mild atherosclerotic calcifications along its arch.  Main pulmonary\ntrunk is prominent, measuring up to 3.5 cm in diameter (02:42), which can be\nseen in the setting of pulmonary arterial hypertension.\n\nAirways are patent to the segmental bronchi bilaterally.  There is no\nconsolidation.  Mild bibasilar dependent atelectasis.  There is a 2 mm\npulmonary nodule in the anterior/lateral basal segment of the right lower lobe\n(4:79, 503:65).  No pleural effusion or pneumothorax.\n\nCholelithiasis.  A proximal celiac stent is incidentally noted (series 2,\nimage 105).\n\nNo acute osseous abnormality identified.  No lytic or sclerotic lesion seen. \nNonspecific soft tissue stranding/density is seen in the left anterior chest\nwall measuring 2.0 x 1.3 cm (4:98).",
            "output": "1. 2.0 x 1.3 cm subcutaneous soft tissue density/stranding along the left\nanterior chest wall is nonspecific.  Correlate with any recent history of\ntrauma.\n2. 2 mm right lower lobe pulmonary nodule.  Given the history of suspected\nmalignancy, a follow up chest CT is recommended in 6 months.\n3. Single prominent mediastinal lymph node, just under strict cross-sectional\ncriteria for adenopathy.\n4. Diffuse coronary artery calcifications.\n5. Mild prominence of the main pulmonary arteries may reflect underlying\nchronic pulmonary arterial hypertension.\n6. Cholelithiasis.\n\nRECOMMENDATION(S):  Chest CT in 6 months."
        },
        {
            "input": "Images are limited by respiratory motion artifact, as the patient was unable\nto tolerate lying flat for a prolonged period of time.\n\nNECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: The previous 1.2 cm right lower paratracheal lymph node\ndemonstrates a normal fatty hilum and is unchanged since ___ (3:32). \nMultiple other prominent mediastinal lymph nodes do not meet CT size criteria\nfor pathologic enlargement.\n\nHILA: Hilar lymph nodes are not pathologically enlarged, within the limitation\nof an unenhanced scan.\n\nHEART and PERICARDIUM: The main pulmonary artery is prominent, measuring 3.9\ncm, as can be seen in pulmonary arterial hypertension.  This is similar to the\nprior study.  Heart size is normal with diffuse coronary artery\ncalcifications.  Re- demonstration an LAD stent (series 4, image 42).  There\nis no pericardial effusion.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level.  Mild mosaic\npattern of the bilateral lung parenchyma suggests the patient was\ninadvertently in partial expiration. Dependent bibasilar atelectasis is mild. \nThere is no focal consolidation.  The previous 2 mm nodule in the lateral\nbasal segment of the right lower lobe (5:231) is unchanged since ___.\nAnother 2 mm nodule at the base of the left lower lobe was not definitively\nseen on the prior study (5:303). No new suspicious pulmonary nodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, previously detected cholelithiasis is not\nimaged on the current study.  The previously described proximal celiac stent\nis incidentally noted (3:75).\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Within the limitation of this scan, the visualized bilateral\nglenohumeral and acromioclavicular joints are unremarkable, except for\ndegenerative changes.  Degenerative changes of the thoracic spine are moderate\nand unchanged.",
            "output": "1.  Evaluation was limited due to respiratory motion artifact and inadvertent\nexpiratory phase.  The patient was unable to tolerate lying flat for a\nprolonged period of time.  Within these limitations, no focal consolidation,\npleural effusion, or pneumothorax.  Mild right lower lobe atelectasis.\n\n2.  Two 2 mm pulmonary nodules in the right and left lower lobe.  As discussed\non the prior chest CT of ___, follow-up chest CT in 6 months is\nrecommended, given the patient's history of suspected malignancy.  This\nrecommendation has not changed, and the patient should have a follow-up chest\nCT in late ___.\n\n3.  Prominent main pulmonary artery likely reflects underlying pulmonary\narterial hypertension.\n\n4.  The imaged bilateral glenohumeral and acromioclavicular joints are\nunremarkable, except for degenerative changes.\n\nRECOMMENDATION(S):  Follow-up chest CT is due in late ___ to\ndocument stability or growth of bilateral lobe pulmonary nodules.  This\nrecommendation has not changed since the chest CT of ___."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation is slightly limited secondary to respiratory\nmotion artifact. Within this limitation the pulmonary vasculature is well\nopacified to the segmental level without evidence of filling defect to\nindicate pulmonary embolism. The thoracic aorta is normal in caliber within\nlimitation of a nongated study. The heart size is mildly enlarged.  No\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No hilar, mediastinal or axillary\nlymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax.  Trace bilateral pleural effusions.\n\nLUNGS/AIRWAYS: The lung volumes are low. Evaluation of the pulmonary\nparenchyma is limited due to respiratory motion artifact. There is bibasilar\nand right paramediastinal atelectasis. A linear opacity at the right lung apex\nis favored to represent atelectasis.  No focal consolidation to suggest\npneumonia. There is mild bronchovascular crowding at the lung bases as well as\nscattered bronchial wall thickening.  A very small nodule (5:52) in the right\nmiddle lobe measures 4 mm.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia and fatty liver.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Evaluation is limited secondary to respiratory motion artifact,\nparticularly at the lung bases.  Within this limitation there is no evidence\nof pulmonary embolism.\n2. Markedly low lung volumes with bibasilar atelectasis with bronchovascular\ncrowding and scattered bronchial wall thickening.\n3. Cardiomegaly.\n4. Fatty liver.\n5. Very small right middle lobe nodule measuring 4 mm.  If there are risk\nfactors such as smoking, occupational exposure, or strong family history of\npulmonary malignancy, then follow-up CT could be considered, however."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality.\n\nBreast, chest wall and bones:\nRight suprascapular intramuscular lipoma (2, 18).\n\nMediastinum:\nNo abnormalities.\n\nHila:\nNo abnormalities.\n\nHeart:\nModerate coronary calcifications.\n\nUpper Abdomen:\nNo abnormalities.\n\nLung:\n\nNodules:\n\nDominant nodule:\n5 mm irregular right upper lobe nodule, stable in size as compared to the\nprevious examination.  On today's examination the nodule appears partly\ncalcified.\n\nOther nodules:\nStable solid 4 mm right upper lobe nodule (5, 43).\n\nParenchyma:\nExtensive bilateral apical scarring.\nModerate centrilobular pulmonary emphysema.\n\nPleura and airways:\nExtensive mucous retention in the large airways (5, 73).\nModerate thickening and irregularities of the airway walls.",
            "output": "No change in size of the right-sided pulmonary nodules.  One of the nodules\nappears partly calcified on today's examination.\n\nLUNG-RADS CATEGORY AND RECOMMENDATION:  Lung-RADS category: Lung-RADS 2: We\nrecommend continuing CT lung cancer screening in 12 months.\n\n\n\nINCIDENTAL FINDINGS AND RECOMMENDATIONS:  None.\n\nManagement recommendations for incidental findings within the LungHealth\u00ae\nprogram are based on a multidisciplinary consensus document of our institution\nspecifically designed for this program.\n\nLUNG-RADS CATEGORIES, DESCRIPTION:  Lung-RADS 0: This category designates an\nincomplete or diagnostically insufficient CT examination.\nLung-RADS 1: This category designates the absence of nodules, or the presence\nof definitely benign nodules.\nLung-RADS 2: This category designates the presence of nodules with a very low\nlikelihood of becoming a clinically active cancer due to size or lack of\ngrowth.\nLung-RADS 3: This category designates probably benign nodules with a low\nlikelihood of becoming a clinically active cancer but with features that\nrequire confirmatory imaging follow-up.\nLung-RADS 4A: This category designates nodules that require additional\ndiagnostic imaging.\nLung-RADS 4B and 4X: This category designates nodules that require additional\ndiagnostic testing and/or tissue sampling. Nodules in this category are\npresented at the weekly multidisciplinary thoracic oncology conference of our\nprogram.\nS (with any category): This qualifier designates the presence of a relevant\nincidental (= distinct from lung cancer) finding, for which a specific\nmanagement recommendation is made.\nC (with any category): Prior diagnosis of lung cancer."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Multiple prominent mediastinal lymph nodes are\nnoted.  A pretracheal node on series 2, ___ 33 is enlarged 1.3 cm peer there\nis a large hiatal hernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is slightly limited due to\nrespiratory motion.  Within this limitation, there are diffuse ground-glass\nopacities bilaterally, right greater than left, and septal thickening,\nconsistent with pulmonary edema.  Slightly more consolidative opacity is noted\nin the right lower lobe.  There is right lower lobe atelectasis.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Diffuse bilateral ground-glass opacities, right greater than left, with\nseptal thickening, is most consistent with pulmonary edema, however,\nsuperimposed developing pneumonia in the right lower lobe cannot be excluded.\n3. There is a large hiatal hernia.\n4. Pretracheal lymphadenopathy could be due to CHF or infectious process"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  There are increased number of bilateral axillary\nlymph nodes.  Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\nThere is biapical scarring. A right greater than left. There is no pleural or\npericardial effusion.  Minimal bibasilar bronchiectasis most likely age\nrelated\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere is dilatation of the esophagus, the esophagus is patulous\nThere are no bone findings of malignancy.  There is a wedge compression\nfracture of a mid thoracic vertebral body (T6)",
            "output": "No evidence of active intrathoracic infection or malignancy.\nPatulous esophagus"
        },
        {
            "input": "Time from onset of symptoms: ___ days days\n\nLUNGS:\n\nImage quality is markedly degraded by motion artifact.\n\nGround glass opacities:\n  Bilateral, predominantly in the left lower lobe, and scattered smaller areas\nwithin the left upper and right middle lobes.\n  Multifocal\n  New\n\nConsolidations:\n  Right\n  Focal, dependent along the right oblique fissure in right upper lobe (4:92),\nwith mild associated peripheral ground-glass opacities.  This may relate to a\ndegree dependent atelectasis.  Subtle centrilobular opacities in the left\nupper lobe are noted (for example images 100 to 125 on series 4), somewhat\ndistorted by motion artifact\n\nCrazy paving pattern:\n  None\n  N/A\n\"Atoll\" sign or patterns of organizing pneumonia:\n  No\n  N/A\nDiscrete pulmonary nodules:\n  No\nARDS:\n  No\n\nAIRWAYS: Clear to at least the segmental branches.\n\nVESSELS: A right chest wall Port-A-Cath is present terminating at the atrial\ncaval junction.  The thoracic aorta is normal in caliber.  Abrupt change in\ncaliber of vessels/pruning is noted, suggestive of pulmonary arterial\nhypertension.  The main pulmonary artery does not appear dilated.\n\nPLEURA:\n\nPleural effusion:\n  Right:  None\n  Left:  None\n  Change: N/A\n\nMEDIASTINUM:\n\nLymphadenopathy: No\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Again noted are bilateral thyroid\nnodules, appearing to have increased in size in the right lobe now measuring\napproximately 2.0 x 1.5 cm, compared to 1.0 cm in ___.  There is no axillary\nlymphadenopathy.  Mild diffuse chest wall fat stranding may relate to mild\nbody wall edema.\n\nHILA: No gross hilar mass or lymphadenopathy is identified within limitations\nof a noncontrast examination.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  Trace pericardial\neffusion is likely present.\n\nCHEST CAGE: No suspicious osseous lesion is identified.  Moderate to severe\ndegenerative changes are noted in the mid and lower thoracic spine with\nmultilevel anterior bridging osteophytes.  No evidence of acute fracture.\n\nUPPER ABDOMEN: Few prominent nonenlarged gastrohepatic lymph nodes are\nidentified, nonspecific.  Otherwise no gross abnormality in the included\nabdomen is noted.",
            "output": "1. Findings which include currently described features of COVID-19. These may\nbe consistent with viral infection including COVID-19; other viral pneumonias\ncan have a similar radiological appearance.\n2. Mild cardiomegaly and likely underlying mild pulmonary congestion.  No\npleural effusions.  Suggestion of pulmonary arterial hypertension.\n3. Bilateral thyroid nodules, largest measuring up to 2 cm in the right lobe.\nFurther evaluation is recommended with thyroid ultrasound as an outpatient.\n\nRECOMMENDATION(S):  Outpatient thyroid ultrasound for evaluation of the\nbilateral thyroid nodules."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  No\nincidentally detected pulmonary embolism.  The heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a 8.1 x 4.0 cm subcarinal\nconglomeration of lymph nodes (___) that encases the left mainstem bronchus\nand right lower lobe bronchus as well as the right lower lobe pulmonary\narteries and right inferior pulmonary vein, without causing significant\nnarrowing of any of the structures.  No axillary lymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple small pulmonary nodules in all 5 lobes.  Index nodes:\n-right lung apex, measuring 0.3 cm (___)\n-right lung apex, measuring 0.4 cm (___)\n-left lung apex, measuring 0.4 cm (___)\n\nThere is a 2.3 x 1.6 cm nodule in the left lower lobe adjacent to the left\nmajor fissure (___) with adjacent nodular interlobular septal thickening,\nconcerning lymphangitic carcinomatosis.  There are a few foci of ground-glass\nopacity and consolidation in the right upper lobe, concerning for infection in\nthe correct clinical setting.\n\n The airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates a\nsmall hiatal hernia.  Otherwise, please refer to ___ from ___\nfor further details of subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. 8.1 x 4.0 cm subcarinal conglomeration of lymph nodes, concerning for\nmetastases, that encases the left mainstem bronchus, right lower lobe\nbronchus, right lower lobe pulmonary arteries and right inferior pulmonary\nvein, without causing significant narrowing.\n2. 2.3 x 1.6 cm nodule in the left lower lobe adjacent to the left major\nfissure with adjacent nodular interlobular septal thickening in the left lower\nlobe, concerning for lymphangitic carcinomatosis.\n3. Multiple small pulmonary nodules in all 5 lobes, measuring up to 0.4 cm,\nare indeterminate, but concerning for metastases.\n4. Few foci of ground-glass opacity and consolidation in the right upper lobe,\nconcerning for infection in the correct clinical setting."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Small left supraclavicular lymph\nnodes are unchanged.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The subcarinal nodal mass has decreased in size since the prior\nstudy and now measures 3.7 cm as compared to the prior measurements of 4.7 cm.\nThe soft tissue mass in the subcarinal region extends along the left mainstem\nbronchus with encasement of the left main stem bronchus extending along the\nleft lower lobe bronchus.  The overall size soft tissue in this region has\ndecreased in volume since the prior study.  No other enlarged mediastinal\nlymph nodes.  Heart size is normal.  The aorta and pulmonary arteries are\nnormal in caliber.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Multiple tiny pulmonary nodules ranging in size from 3-4 mm in the left\nlower lobe are again seen.  The soft tissue mass along the fissure in the left\nlower lobe has decreased in size measures 17 x 20 mm it previously measured 28\nx 21 mm.  There is minimal subsegmental atelectasis in the left lung base. \nThere is a small hiatus hernia, unchanged.  The septal thickening and\nnodularity in the left lower lobe has also slightly improved.  No new sites of\ndisease.  Few scattered ground-glass opacities in the right upper lobe seen on\nthe prior study have resolved and were most likely inflammatory.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hiatus\nhernia",
            "output": "Mild improvement in the size of the soft tissue in the subcarinal region as\ndescribed above in decrease in size of the soft tissue along the pleura and\nthe left lower lobe.  Tiny nodules in the left lower lobe along with septal\nthickening are slightly less apparent.\n\nComplete resolution of the inflammatory opacities in the right upper lobe.\n\nNo new sites of disease.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Subcarinal conglomerate of\nlymphatic tissue is current ___ approximately 2.4 x 5.6 cm as compared to 6 x\n3 cm, thus  decreased in size.  Small hiatal hernia is demonstrated.  Image\nportion of the upper abdomen will be reviewed separately in corresponding\nreport will be issued.\n\nAirways are patent till the subsegmental level bilaterally.  Right lung is\nclear.  Left lower lobe subpleural opacity is 17 by 16 mm as compared to 20 x\n17 mm, minimally decreased, series 6, image 178.  There is interval resolution\nof left lower lobe atelectasis.  No new consolidations demonstrated. \nPeribronchial thickening due to the lymphatic tissue in the left lower lobe\nappears to be similar to previous examination.",
            "output": "Minimal interval decrease in the sub-carinal mass as well as minimal decrease\nin the left lower lobe subpleural nodule.\n\nInterval resolution of left lower lobe atelectasis\n\nNo new pulmonary nodules seen.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All mediastinal lymph nodes are normal in size (4,\n23), with the exception of the known large subcarinal mass (4, 33) that is\noverall stable in size and morphology.  Stable appearance of the known hiatal\nhernia.  Stable large liver lesion (4, 59).  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  The left lower lobe\npulmonary nodule, adjacent to the major fissure (5, 189) is stable in\ndiameter, with an average diameter of approximately 17 mm.  No new nodules\nhave occurred.  The airways are patent.  No pleural effusions or pleural\nthickening.  No diffuse lung disease.",
            "output": "Stability in size and morphology of the pre-existing left lower lobe nodule\nand of the subcarinal soft tissue mass.  No new nodules or masses. The airways\nare patent.  No diffuse lung disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nModerate hiatal hernia.  The esophagus is otherwise unremarkable.  Stable\nlymphadenopathy in the subcarinal station.  No other pathologically enlarged\nmediastinal or hilar lymph nodes.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Unchanged appearance of a\nnodular like consolidation in the left lower lobe measuring 1.6 x 1.2 cm\n(3:148).  No new nodules.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study ___.  Stable subcarinal\nlymphadenopathy and nodular like lesion in the left lower lobe."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: 9 mm hypodense nodule in the right\nlobe thyroid, 7 mm hypodense nodule in the left lobe of thyroid.  Correlation\nwith thyroid ultrasound is advised.  No supraclavicular or axillary\nadenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve or coronary artery calcification. \nRight subclavian central line in situ with the tip in the proximal right\natrium.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Scarring in the\nright upper lobe (5, 72).  2 mm nodule in the right middle lobe (5, 156).  No\nconfluent airspace consolidation.  No diffuse lung disease.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Scarring in right upper lobe is most likely post infective in nature.\n\n2 mm nodule in the right middle lobe does not warrant further follow-up in\nthis patient.\n\nNo mediastinal adenopathy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Postsurgical changes in the superior and anterior mediastinum. \nAnterior mediastinal collection measures 19 ___ in density and 57 x 33 mm in\nthe axial plane (2, 19).  Reactive subcentimeter lymph nodes.  Left central\ncatheter in situ with the tip at the left brachiocephalic/SVC junction.\n\nHILA: Difficult to assess for hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: The aorta is suboptimally assessed on this noncontrast\nstudy.  Small pericardial effusion measuring 10 mm anterior to the right\nventricle.  Relative hypodensity of the blood pool suggesting anemia. \nCardiomegaly.  No coronary artery calcification.\nPLEURA: Small left-sided pleural effusion measuring 17 ___ in density.  Small\nright-sided effusion/hemothorax.\nLUNG:\n\n-PARENCHYMA:  The chest CT was performed during suboptimal inspiration.  There\nis complete atelectasis of the lingula and left lower lobe.  The rest of the\nleft upper lobe is essentially clear.  There is minor subpleural atelectasis\nin the right lower lobe and minor airspace opacification that right lung base\nmost likely representing retained secretions pneumonia.  The subpleural\nopacification in relation to the right lateral chest wall is indeterminate but\nis thought to be related to prior surgery.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is slightly dilated measuring 33 mm diameter.\nCHEST CAGE: Evidence of prior median sternotomy.  No lytic/ destructive bony\nlesions.  Bifid appearance of the anterior aspect of the right eleventh rib.",
            "output": "The surgical repair of the aorta is suboptimally assessed on this\nnoncontrasted study.\n\nNo conclusive findings of pneumonia.\n\nAnterior mediastinal fluid collection is most likely postsurgical in nature,\nbut in the absence of contrast agent infection is not excluded.\n\nComplete atelectasis of the lingula and left lower lobe.  Moderate size\nleft-sided pleural effusion.\n\nMinor subpleural atelectasis and minimal basal airspace consolidation in the\nright lower lobe is most likely due to retained secretions/atelectasis.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions. No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Necrotic soft tissue mass in the central upper abdomen immediately\nsuperior to the celiac artery and abutting the left gastric artery (3, 53)\nmeasuring 53 x 35 mm in the axial plane.\n\nMEDIASTINUM: Borderline subcarinal lymph node measuring 10 mm diameter (5,\n110)\n\nHILA: Multiple pathologically enlarged right hilar lymph nodes the largest\nmeasuring 31 mm in diameter (5, 134), appearing centrally necrotic.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  No coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Lobulated pulmonary\nnodule in the posterior basal aspect of the right lower lobe (5, 226)\nmeasuring 26 x 20 mm.  A few indeterminate sub 4 mm pulmonary nodules (5, 21,\n29, 33 and 161).  Mild, but diffuse bronchial wall thickening no interstitial\nlung disease.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects.\nCHEST CAGE: No lytic/ destructive bony lesions.  Benign-appearing sclerotic\nlesion in the L1 vertebral body (8, 65).",
            "output": "Lobulated pulmonary nodule in the right lower lobe is highly suspicious for\nmalignancy. Necrotic right hilar lymph nodes, borderline subcarinal lymph\nnode, and necrotic upper abdominal soft tissue mass.\n\nDifferential diagnosis includes primary lung cancer or atypical carcinoid with\nmetastatic disease to right hilum and upper abdomen, as well as pulmonary\nmetastatic disease from an extrathoracic primary.\n\nThe lobulated lesion in the posterior basal segment of the right lower lobe\nwould be amenable to image guided percutaneous biopsy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Known seroma at the level of the right breast is\nminimally smaller than on the previous examination.  Normal appearance of the\ncardiac structures.  No coronary calcifications, no pleural effusions.  No\nabnormalities in the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum or the vertebral bodies.\nMild bilateral apical scarring.  Small apical subpleural nodules are unchanged\nas compared to the previous examination.  The left upper lobe cluster of\nperibronchial nodules is substantially smaller and less dense than on the\nprevious examination (5, 101).  A second cluster of nodules in the right upper\nlobe has almost completely resolved.  No new or growing nodules.  No evidence\nof pleural effusions.  No pleural thickening.  The airways are patent.",
            "output": "Knee complete resolution of the pre-existing right upper lobe nodules,\ndecrease in size of the pre-existing left upper lobe nodules.  No new or\ngrowing nodules.  Seroma of the right breast has minimally decreased in size."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar, internal mammary, or axillary lymph\nnodes.  The patient has had prior right axillary lymph node dissection.\n\nHeart size is normal with no pericardial effusion.  The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolus is\nidentified.\n\nA few of the previously seen pulmonary micronodules have resolved.  However,\nthere are new clustered micronodules in the bilateral upper lobes, which are\nlikely infectious or inflammatory (5: 75, 92, 100, 112).  Previous diffuse\nground-glass opacities have resolved.  Mild diffuse bronchial wall thickening\nis stable.  A few of the more discrete solid nodules measuring up to 6 mm in\nthe left lower lobe are stable since ___ (05: 42, 81, 131, 161, 178). \nA 3 mm right upper lobe nodule is new, but is likely part of the infectious or\ninflammatory process (5, 124).  There is no endobronchial lesion or pleural\neffusion.  There are a few tiny calcified nodules in the subpleural right\nlower lobe.\n\nImages of the upper abdomen are unremarkable.\n\nA hypodense cystic lesion at the posterior aspect of the central right breast\nwith adjacent metallic clip is smaller measuring 1.1 x 2.3 cm, previously 1.8\nx 2.6 cm.  Surveillance of the breast requires mammography.",
            "output": "Interval resolution of previous bronchiolitis with new clustered micronodules\nin the upper lobes, which are also most likely infectious or inflammatory. \nHandful of more discrete solid nodules measuring up to 6 mm in the left lower\nlobe are stable.  A 6 month followup chest CT is recommended.\n\nDecreased central posterior right breast cystic lesion is most likely a small\nseroma.  Continued mammographic surveillance is advised.\n\nRECOMMENDATION(S):  6 month followup chest CT."
        },
        {
            "input": "CHEST:\nThe heart is normal in size without pericardial effusion. The aorta and its\nmajor branches are normal in caliber in contour without significant\natherosclerotic disease.\n\nThere is no pleural effusion or significant airspace opacity.\n\nMultifocal lymphadenopathy is seen throughout the chest. This includes\nnumerous bilateral axillary nodes.  Many of the larger nodes demonstrate a\nnormal fatty hilum, while several smaller nodes lack the fatty hilum. For\nexample a right axillary node has ___ of 14 x 12 mm without a normal\nfatty hilum (05:11). Additional lymph nodes are noted in the cardiophrenic\nspace (05:41), and throughout the mediastinum including prevascular (05:18),\nparatracheal (5:8) posterior mediastinal (5:45), and hilar (05:21).\n\nABDOMEN: The liver is normal in size and contour without focal lesion\nidentified on the single phase examination. Gallbladder is normal in\nappearance. There is no intra or extrahepatic bile duct dilation\n\nThe pancreatic parenchyma is normal in bulk and enhancement pattern. There is\nno focal lesion or ductal abnormality.\n\nThe patient is status post splenectomy.  A single 1 cm nodule remains within\nthe splenectomy bed and likely represents residual accessory splenic tissue.\n\nThe adrenal glands and kidneys are normal bilaterally.\n\nThere is extensive retroperitoneal and minimal mesenteric lymphadenopathy. The\nretroperitoneal, periaortic nodes are similar in distribution compared to\n___, however are significantly increased in size. For comparison\npurposes 8 previously 13 x 15 mm aortocaval node now has ___ of 18 x 23\nmm (5:64). A node just posterior to the pancreatic head has increased from 11\nx 10 the mm to 18 x 16 mm (05:59).  A gastrohepatic node has increased from 11\nx 14 to 13 x 28 mm (5:48). Aside from discrete lymph nodes, there is also\nincreased haziness and stranding within the retroperitoneum.\n\nThere are scattered diverticula associated with the sigmoid colon. No\nassociated inflammatory changes noted.\n\nAside from the splenic vein and venous structures of the abdomen remain\npatent. Arterial vascular anatomy is conventional.\n\nThere is no discrete ascites or fluid collection.\n\nPostsurgical change along linea ___ is noted, with a single tiny fat\ncontaining hernia (8b:47).\n\nPELVIS:\n\nSmall bilateral pelvic wall and external iliac chain nodes are present. None\nare pathologically enlarged by size criteria. Numerous inguinal nodes are also\npresent, the majority with a preserved fatty hilum.\n\nCurvilinear sclerotic changes noted within the anterior aspect of the left\nfemoral head. The location is atypical for avascular necrosis. No aggressive\nfeatures are appreciated and the appearance is unchanged from ___. Bones are\notherwise unremarkable without concerning lytic or sclerotic lesion.",
            "output": "IMPRESSION: \n\nProgressive lymphadenopathy throughout the chest abdomen and pelvis. While\nthis could be reactive in the setting of a systemic infection, no imaging\nevidence of infection is identified. As such, a lymphoproliferative disorder\nis highest on the differential diagnosis."
        },
        {
            "input": "CHEST:\nThe heart is normal in size without pericardial effusion. The aorta and its\nmajor branches are normal in caliber in contour without significant\natherosclerotic disease.\n\nThere is no pleural effusion or significant airspace opacity.\n\nMultifocal lymphadenopathy is seen throughout the chest. This includes\nnumerous bilateral axillary nodes. Merit many of the larger nodes demonstrate\na normal fatty hilum, while several smaller nodes lack the fatty hilum. For\nexample a right axillary node has ___ of 14 x 12 mm without a normal\nfatty hilum (05:11). Additional lymph nodes are noted in the cardiophrenic\nspace (05:41), and throughout the mediastinum including prevascular (05:18),\nparatracheal (5:8) posterior mediastinal (5:45), and hilar (05:21).\n\nABDOMEN:  The liver is normal in size and contour without focal lesion\nidentified on the single phase examination. Gallbladder is normal in\nappearance. There is no intra or extrahepatic bile duct dilation\n\nThe pancreatic parenchyma is normal in bulk and enhancement pattern. There is\nno focal lesion or ductal abnormality.\n\nThe patient is status post splenectomy. A single 1 cm nodule remains within\nthe splenectomy bed and likely represents residual accessory splenic tissue.\n\nThe adrenal glands and kidneys are normal bilaterally.\n\nThere is extensive retroperitoneal and minimal mesenteric lymphadenopathy. The\nretroperitoneal, periaortic nodes are similar in distribution compared to\n___, however are significantly increased in size. For comparison\npurposes 8 previously 13 x 15 mm aortocaval node now has ___ of 18 x 23\nmm (5:64). A node just posterior to the pancreatic head has increased from 11\nx 10 the mm to 18 x 16 mm (05:59). A gastrohepatic node has increased from 11\nx 14 to 13 x 28 mm (5:48).  Aside from discrete lymph nodes, there is also\nincreased haziness and stranding within the retroperitoneum.\n\nThere are scattered diverticula associated with the sigmoid colon. No\nassociated inflammatory changes noted.\n\nAside from the splenic vein and venous structures of the abdomen remain\npatent. Arterial vascular anatomy is conventional.\n\nThere is no discrete ascites or fluid collection.\n\nPostsurgical change along linea ___ is noted, with a single tiny fat\ncontaining hernia (8b:47).\n\nPELVIS:\n\nSmall bilateral pelvic wall and external iliac chain nodes are present. None\nare pathologically enlarged by size criteria. Numerous inguinal nodes are also\npresent, the majority with a preserved fatty hilum.\n\nCurvilinear sclerotic changes noted within the anterior aspect of the left\nfemoral head.  The location is atypical for avascular necrosis.  No aggressive\nfeatures are appreciated and the appearance is unchanged from ___.   Bones\nare otherwise unremarkable without concerning lytic or sclerotic lesion.",
            "output": "Progressive lymphadenopathy throughout the chest abdomen pelvis. While this\ncould be reactive in the setting of a systemic infection, no imaging evidence\nof infection is identified. As such, a lymphoproliferative disorder is highest\non the differential diagnosis."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is mild appreciable coronary calcification.\nThere is no pleural or pericardial effusion.\n\nThere is a moderate amount of atelectasis at the right lung base.\n\nEvaluation for tiny pulmonary nodules is limited by patient motion and body\nhabitus.\n\nGranulomas are incidentally noted in the right lung apex and the left lower\nlobe.\n\nA 2 mm subpleural nodule (series 4, image 37) was not definitively seen in\n___.  A 6 mm nodule in the right lower lobe (series 4, image 113) was not\nseen in ___.\n\nThere is a moderate amount of scarring at the right lung base.\n\nThere are no bone findings of malignancy.  Sclerotic foci in the inferior\nendplates of the T7 and T9 vertebral bodies likely represents degenerative\nchange.\n\nEvaluation of the abdomen is limited by patient body habitus, however the\nvisualized abdomen is unremarkable.",
            "output": "Evaluation for tiny pulmonary nodules is limited by patient motion and body\nhabitus.  At least two nodules measuring up to 6 mm were not seen in ___. \nThe 6 mm nodule allowing for technical differences is unchanged from ___.\n\nRECOMMENDATION:  If the patient is at high risk for malignancy, short term\ninterval followup in 6 months is recommended to assess stability."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities elsewhere in the imaged unenhanced chest wall\nsuspicious for malignancy.\n\nThyroid is heterogeneous but there are no lesions large enough to warrant\nfurther imaging evaluation.  Atherosclerotic calcification is mild in head\nneck vessels and present in at least the left anterior descending and right\ncoronary arteries.  Aorta, pulmonary arteries and cardiac chambers are normal\nsize.  Pericardium is physiologic.  There is no pleural abnormality.\n\nMediastinal and hilar lymph nodes are not enlarged.  A 6 mm right juxta\ncardiac diaphragmatic lymph node is unchanged since ___.  There is no\nenlargement of retrocrural nodes.\n\nFocal pulmonary abnormalities are as follows:\n\nPrevious 2 mm right upper lobe subpleural nodule is no longer present.\n\n6 mm solid right lower lobe nodule, 105:127, unchanged since ___.\n\nRight lung is otherwise clear.\n\nLeft lung is clear and the tracheobronchial tree is normal to subsegmental\nlevels.  There are no new lung lesions.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.\n\n\n\n.",
            "output": "Solitary 6 mm right lower lobe lung nodule confirmed, unchanged since ___, significance uncertain.  No other lung nodules.\n\nCoronary atherosclerosis.\n\n\nRECOMMENDATION(S):  Repeat chest CT in one year.\n\n The ___ pulmonary nodule recommendations are intended as\nguidelines for follow-up and management of newly incidentally detected\npulmonary nodules smaller than 8 mm, in patients ___ years of age or older. Low\nrisk patients have minimal or absent history of smoking or other known risk\nfactors for primary lung neoplasm. High risk patients have a history of\nsmoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed.\n\nIn the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12\nmonths and if no change, no further imaging needed. For high risk patients,\ninitial follow-up CT at ___ months and then at ___ months if no change.\n\nIn the case of nodule size >6 - 8 mm: For low risk patients, initial follow-up\nCT at ___ months and then at ___ months if no change. For high risk\npatients - initial follow-up CT at ___ months and then at ___ and 24 months\nif no change.\n\nIn the case of nodule size > 8 mm: Follow-up CTs at around 3, 9, and 24 months\nor consider dynamic contrast enhanced CT, PET, and / or biopsy."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, axillary, and mediastinal lymph\nnodes are not enlarged.  Ascending aorta and main pulmonary arteries are\nnormal size.  Coronary artery calcification is moderate to heavy. There is no\npericardial effusion.\n\nAirways are patent to subsegmental levels.  There is no consolidation or\npulmonary edema.  A 6 mm in nodule is again noted in the right lower lobe\n(02:36).  There is no pleural effusion.\n\nLimited evaluation of upper abdominal organs is notable for 80 partially\nimaged intermediate density renal lesion in the right kidney.  This lesion\nmeasures 6.0 cm, stable compared to ___.  There is new small\nradiodense material in the lesion.  Focal calcification at the pancreatic body\nis unchanged.\n\nNondisplaced fractures are identified at anterior left eighth and ninth ribs.\nThere is a subtle cortical step-off at the anterior left fourth rib which is\nequivocal for a nondisplaced rib fracture.  Linear lucency at the posterior\nright fifth rib is likely a nutrient canal.",
            "output": "1. Nondisplaced fractures are identified at the anterior left eighth and ninth\nribs.\n2. A 6 mm nodule is again noted in the right lower lobe, for which ___ year\nfollow-up CT was recommended previously on ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  The esophagus is patulous.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a consolidated focal opacity measuring 1.3 x 4.1 cm in\nthe left lung base (301:130), concerning for acute pneumonia.  There is a\nbibasilar subsegmental atelectasis.  In addition, there is a 2 x 5 mm nodule\nin the right middle lobe, which may be inflammatory.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe thyroid is not visualized.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is mild degenerative change of the thoracic spine with near complete\nintervertebral disc space height loss at T4-T5.",
            "output": "1. Focal left lower lobe consolidation is concerning for acute pneumonia or\naspiration.  Recommend PA and, importantly, lateral radiographs at this time\nto establish a baseline as well as in ___ weeks to document resolution.\n2. No pulmonary embolism in the main pulmonary arteries or segmental branches.\nThe subsegmental branches are not well visualized.\n3. 5 mm right upper lobe nodule in the right middle lobe is likely\ninflammatory.  See below for recommendations.\n4. Patulous esophagus may increase risk for aspiration.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "No incidental thyroid findings.  Approximately 18 x 19 mm non bulging soft\ntissue homogeneous lesion in the anterior mediastinum (2, 15).  The lesion\nextends down was to the level of the aortic arch (2, 16).  Otherwise the\nmediastinum and the heart are unremarkable.  No pericardial effusion no\nlymphadenopathy.  No abnormalities in the upper abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum or the vertebral bodies.\nSmall tracheal diverticulum (4, 25).  No pulmonary nodules or masses.  No\ndiffuse lung disease.  No pleural thickening or pleural effusions.  The\nairways are patent.",
            "output": "Soft tissue density structure in the anterior mediastinum, likely representing\na thymoma.  Small tracheal diverticulum, no other abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE: Respiratory motion artifact slightly limits assessment\nof subsegmental pulmonary arteries in the bilateral lung bases.  Pulmonary\nvasculature is well opacified to the subsegmental level without filling defect\nto indicate a pulmonary embolus.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  There is moderate\nenlargement of the right atrium and right ventricle.  No pericardial effusion.\nEnlargement of the main pulmonary artery is also noted to 3.7 cm, and\nconstellation of findings suggest pulmonary arterial hypertension.\n\nAXILLA, HILA, AND MEDIASTINUM: Mildly prominent mediastinal lymph nodes may be\nreactive with the largest being a right upper paratracheal lymph node\nmeasuring up to 9 mm.  No axillary or hilar lymphadenopathy is present.  Note\nis made of thymic tissue within the anterior mediastinum, likely reflective of\nthymic hyperplasia in this age group.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a 3.2 x 2.6 cm rim calcified left thyroid nodule.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Enlarged right atrium, right ventricle, and main pulmonary artery suggests\npulmonary arterial hypertension.\n3. 3.2 cm rim calcified left thyroid nodule.  Recommend further evaluation\nwith nonurgent thyroid ultrasound, if this has not already been performed.\n\nRECOMMENDATION(S):   Recommend further evaluation with nonurgent thyroid\nultrasound, if this has not already been performed."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\nNo lymphadenopathy in the thoracic inlet.\nDiffuse wall edema in the upper abdomen.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Esophageal feeding tube ending in the stomach fundus.  Esophagus\notherwise unremarkable.  Mediastinal and hilar enlarged lymph nodes the\nlargest lower paratracheal measuring 1.1 cm.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  No pericardial effusion.  Mild\natherosclerotic calcifications in thoracic aorta and coronary arteries. \nSevere calcifications in mitral annulus and moderate in aortic valve.\nPLEURA: New small bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Moderate centrilobular and paraseptal emphysema.\n5 mm solid nodule in the left apex (___).\nBilateral atelectasis with hypodense bronchial secretions in both lower lobes.\n2. AIRWAYS:  Remaining airways are patent to subsegmental levels.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: Severe compression fracture of T12, stable since ___. \nNo suspicious lytic or sclerotic lesions.",
            "output": "The bilateral lower lobe atelectasis with bronchial secretions and small\npleural effusions can be associated with pneumonia or aspiration.\n\nMildly enlarged mediastinal hilar lymph nodes, likely reactive.\n\nSevere mitral annulus calcification.  Moderate calcifications in the aortic\nvalve.\n\nAppropriately placed esophageal feeding tube.\n\nWall edema in the upper abdomen."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the imaged thyroid warranting any further\nimaging.  Supraclavicular and axillary lymph nodes are not enlarged.  No soft\ntissue abnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable. Atherosclerotic calcification is\nnot apparent in head and neck vessels or the coronary arteries. Aorta and\npulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: As follows:\n\nThoracic outlet, 9 mm, 05:31.\n\nLeft hilum, 11 mm, 5:145.\n\nLUNGS, AIRWAYS, PLEURAE: New consolidation posterior basal segment left lower\nlobe, either pneumonia or atelectasis.  No bronchial obstruction.  No lung\nnodule is visible elsewhere in the left lung.\n\n11 x 13 mm mixed density partially enhancing peribronchial nodule, posterior\nbasal segment right lower lobe, 4:62, present since ___.  Goes of\ndifferences in radiographic technique on prior abdominal CT scans, subtle\nchanges in size would not be appreciated, but the lesion has definitely not\ninvoluted.\n\nTracheobronchial tree is normal to subsegmental levels.  Very small left\npleural effusion is new.\n\nCHEST CAGE: Unremarkable",
            "output": "Enhancing right lower lobe lung nodule may be stable or slightly larger today\nthan on prior abdominal CT scans, may through ___.  Diagnostic\npossibilities include malignancy and hamartoma.\n\nNew left lower lobe pneumonia or atelectasis.  Mildly enlarged left hilarlymph\nnode, not previously imaged, is presumably reactive.\n\nRECOMMENDATION(S):  Any prior chest or abdomen or thoracolumbar spine CT\nshould be obtained to establish the radiographic history of the right lower\nlobe nodule.  If none is available, PET CT scanning might be helpful in\nestablishing the nature of the lesion, or determining whether it is advisable\nto remove or follow the lesion.\n\nIf immediate sampling is preferred, the interventional radiology and\ninterventional pulmonary services should be consulted for their opinions about\naccess."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMild atherosclerotic calcifications at the aortic arch and origin of the head\nand neck vessels.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Mild paraseptal emphysematous change. Dependent atelectasis\nbilaterally.  No focal consolidations.  No suspicious lung nodules.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK:  There is a hypodense septated nodule within the left lobe of\nthe thyroid measuring 2.0 x 1.8 cm (series 2, image 1).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Left thyroid nodule measuring up to 2.0 cm, which should be followed up\nwith a thyroid ultrasound.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber.\n\nCoronary artery calcifications are severe.  Trace pericardial fluid is likely\nphysiologic.\n\nAXILLA, HILA, AND MEDIASTINUM: No enlarged axillary, mediastinal, or hilar\nlymph nodes.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Respiratory motion limits detailed evaluation.  There are\npatchy ground-glass opacities in the right middle and lower lobes (3:108).  No\nfocal consolidations or large masses.  The central airways are patent.\n\nABDOMEN: Irregularity and thickening of the gastric wall (3:165) is likely\nsecondary to patient's known malignancy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to segmental level.\n2. Patchy ground-glass opacities in the right middle and lower lobes are\nlikely infectious or inflammatory in etiology.\n3. Irregularity and thickening of the gastric wall is likely secondary to\npatient's known gastric malignancy.\n\nNOTIFICATION:  The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:36 am, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CT Chest:  The incompletely visualized thyroid gland is unremarkable. No\naxillary, mediastinal or hilar lymphadenopathy present. The airways are normal\nand patent to the subsegmental levels. Minimal atelectatic changes are noted\nsurrounding the descending thoracic aorta. Lungs are otherwise clear.  No\npleural effusion.\n\nIncidental note is made of a right latissimus dorsi lipoma.\n\nSternotomy sutures are intact and without evidence of dehiscence.  No\nsuspicious lytic or blastic lesions identified.\n\nCTA chest: Heart size is demonstrates stable enlargement.  No pericardial\neffusion identified. Dense atherosclerotic calcification noted within the\ncoronary arteries as well as to a lesser degree the aortic arch with minimal\ndisease at the three vessel takeoff. There is re- demonstration of the known\ntype A dissection with dissection flap extending from the takeoff of the\ninnominate artery (02:30) extending through the arch and the descending\nthoracic aorta and visible abdominal aorta. The dissection is stable with the\nfalse lumen compressing the true lumen but to the same degree as on prior. The\ntrue lumen feeds the aortic arch vessels as well as celiac and superior\nmesenteric artery takeoffs, all of which are stable in size and patent.  The\nascending aorta arch is stable in size measuring 3.5 cm.  The descending\nthoracic aorta is also stable measuring 3.9 cm.",
            "output": "1. Stable Type A aortic dissection with no change in caliber of the true or\nfalse lumen.  The aortic arch vessels as well as celiac and superior\nmesenteric artery takeoffs are supplied by the true lumen and remain widely\npatent."
        },
        {
            "input": "Anterior mediastinal soft tissue nodular opacity is 12 x 12 mm in diameter.\n\nMain pulmonary arteries substantially dilated up to 4 cm concerning for\npulmonary hypertension.  Heart size is normal.  There is no pericardial or\npleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Assessment of the\nlung parenchyma demonstrate left upper lobe 2 mm nodule, series 4, image 51,\nleft lower lobe nodule, series 4, image 116, are left lower lobe 7 mm nodule,\nseries 4, image 119, left lower lobe nodule, series 4, image 123 as well as\nthere is a pleural lipoma, series 4, image 133, 8 x 35 mm.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\n Image portion of the upper abdomen demonstrate extensive hypodensity of the\nliver consistent with fatty infiltration.",
            "output": "Severe dilatation of main pulmonary artery concerning for pulmonary\nhypertension.  No evidence of abnormalities that might explain pulmonary\nhypertension demonstrated on this noncontrast enhanced chest CT\n\nAnterior mediastinal 12 mm nodule that might represent thymic lesion in should\nbe further assessed with MRI or alternatively followed up with chest CT in 3\nmonths.\n\nFatty infiltration of the liver."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified through the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nmain pulmonary artery is dilated up to 4.1 cm concerning for pulmonary\nhypertension, not substantially changed from prior.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart and pericardium within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is re-demonstration of an anterior\nmediastinal soft tissue nodule measures 1.2 x 0.9 cm (03:50), unchanged\ncompared to prior CT of the chest from ___.  There is no\nmediastinal, hilar or axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple pulmonary nodules are re-demonstrated.  For example a\nleft upper lobe nodule measures 3 mm (03:36), an inferior left upper lobe\nsubpleural nodule measures 2 mm (3:76), and a peripheral left lower lobe\nnodule measures 7 mm (3:78).  Additionally there is a redemonstration of a\npleural lipoma that measures up to 3.2 x 0.8 cm (3:81).  No airspace\nconsolidations are identified to suggest presence of infectious process.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism through the segmental level.\n2. Unchanged severe dilation of the main pulmonary artery concerning for\npulmonary hypertension.\n3. Redemonstration of a 12 mm anterior mediastinal nodule, which should be\nfurther assessed with MR ___ CT ___ in 3 months to document stability\nand/or resolution.\n4. Multiple incidentally detected pulmonary nodules measuring up to 7 mm, as\ndescribed above.  See below for recommendations.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT ___ in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT ___ in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are notable for small bilateral adrenal adenomas,\nunchanged dating back to ___.\n\nCT chest: Streak artifact related to a contrast bolus in the left\nsupraclavicular region limits evaluation of the thyroid; however, the isthmus\nappears larger today than it was previously; although, no nodule is\nidentified. There is no supraclavicular lymph node enlargement. The airways\nare patent to the subsegmental level. Small upper paratracheal lymph nodes do\nnot meet strict CT size criteria for pathologic enlargement and are stable\ndating back to at least ___. There is no mediastinal, hilar or axillary lymph\nnode enlargement by CT size criteria. Normal heart size. A small pericardial\neffusion or pericardial thickening is unchanged over multiple prior studies.\nStable appearance of a pericardial cyst. Moderate coronary artery\ncalcifications are stable. No hiatal hernia is present.\n\nThere is stable appearance of leftward upper mediastinal shift and left apical\nconsolidation of combined bronchiectasis and fibrosis. No new pulmonary\nnodules are identified.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "Stable appearance of the chest with no evidence of tumor recurrence and no new\nconcerning pulmonary nodules."
        },
        {
            "input": "Left mediastinal shift is unchanged.  Aorta and pulmonary arteries are\nunremarkable.  Heart size is normal.  Minimal amount of left pericardial\neffusion is unchanged.  Fluid loculation a adjacent to the right atrium is\nstable, potentially representing loculated pleural effusion or cystic\nstructure within the mediastinum.  No evidence of pleural effusion is seen\notherwise.\n\nNo mediastinal, hilar or axillary lymphadenopathy is currently noted.  Soft\ntissue within the left hilus, series 2, image 19, potentially representing\nprevious lymphadenopathy area is 25 by 13 mm, not substantially different from\nprevious examination.  Extensive postradiation changes in the left upper lobe\nand traction bronchiectasis are stable.\n\nAirways are patent otherwise to the subsegmental level bilaterally.  Lungs are\nclear with no new nodules masses or consolidations.\n\n Extensive postradiation changes in the left ribs, are noted but there are no\nlytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of tumor recurrence\nand no new concerning pulmonary nodules."
        },
        {
            "input": "The leftward mediastinal shift is stable since the previous examination.  The\nlarge mediastinal vessels appear unchanged.  There is no evidence of\nleft-sided perihilar or very mediastinal soft tissue structures suspicious for\na recurrence.  The posterior mediastinum along the aorta is unremarkable.  The\ncardiac structures are unchanged.  There is no evidence of a pericardial\neffusion.  The right mediastinal structures are also unremarkable.  In the\nupper abdomen no relevant abnormalities are seen.  In particular there is no\nevidence of adrenal lesions.\n\nModerate respiratory motion are defects.  Stable fibrotic consolidation of the\nleft lung apex, way surrounding ground-glass opacities and pleural thickening\n(5, 109).  The severity in extent of the changes is stable since the previous\nexamination.  The left lower lobe is well ventilated.  The lung parenchyma at\nthe left bases and on the right show no evidence of abnormalities, notably no\nsuspicious pulmonary nodules or masses.  No pleural effusions.  The airways\nare patent.  No diffuse lung disease.",
            "output": "Stable since ___.  No evidence of recurrence.  The postradiation\ntherapy changes on the left are unchanged."
        },
        {
            "input": "HEART AND VASCULATURE: Coronary, aortic arch, great vessel origin\ncalcifications are mild. The thoracic aorta and main pulmonary artery are\nnormal in diameter.  Heart size is normal.  A small pericardial effusion is\nunchanged.\n\nAXILLA, HILA, AND MEDIASTINUM: Small mediastinal lymph nodes are unchanged. \nNo hilar or axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Left upper lobe atelectasis and bronchial irregularity is\nunchanged compared to multiple prior examinations dating back to at least\n___.  A right upper lobe micronodule is unchanged (series 5, image\n127).  No new or enlarging pulmonary nodules.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A 1.4 x 1.2 cm left adrenal adenoma is unchanged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Left upper lobe posttreatment changes are stable.  No evidence of\nrecurrence or metastasis.\n2. Unchanged left adrenal adenoma."
        },
        {
            "input": "THORACIC INLET: The thyroid has a heterogeneous appearance, unchanged.  There\nare no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is stable small mediastinal nodes not enlarged by size\ncriteria.  Small pericardial effusion is unchanged.  There is mild\ncardiomegaly.  There is moderate coronary artery calcification.  There is a\nstable hypodense lesion adjacent to the right ventricle (2, 38) With average\nattenuation values of 35, could represent a pericardial cyst or diverticulum,\nis unchanged.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The consolidative opacity in the left upper lobe is unchanged and\nrepresents evolving post radiation therapy changes.  There is stable volume\nloss in the left hemithorax with stable shift of mediastinum to the left.  A 2\nmm right upper lobe pulmonary nodule (5, 127) Is unchanged.  No new pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows stable left\nadrenal thickening and nodularity which most likely represents an adenoma",
            "output": "Stable post radiation should changes to the left upper lobe with stable\nconsolidative opacity.  2 mm right upper lobe pulmonary nodule is unchanged. \nNo new pulmonary nodules.\n\nStable left adrenal thickening and nodularity which most likely represents an\nadenoma.\n\nStable appearance of the pericardial cyst/diverticulum."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged portion of the lower thyroid need\nany further imaging evaluation.  Supraclavicular and axillary lymph nodes are\nnot enlarged.  No soft tissue abnormalities in the chest wall. This study is\nnot appropriate for subdiaphragmatic diagnosis.  Nodulation lateral limb of\nthe left adrenal, partially imaged, is unchanged.  8 mm wide nodule in the\nright limb, 4:237, also stable.\n\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis moderately heavy in head and neck vessels and severe in the coronary\narteries, as before.  Aortic valvular calcification is mild.  Aorta and\npulmonary arteries are normal size.  Small pericardial effusion and probable\nsmall pericardial diverticulum, alongside the right heart, is unchanged.\n\nTHORACIC LYMPH NODES: No measurable lymph nodes in the chest are\npathologically enlarged or growing.  Upper pole of the left hilum is subsumes\nin radiation fibrosis and atelectasis, but has not changed in contour to\nsuggest any lymphadenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: Radiation fibrosis and atelectasis, left upper lung,\nand adjacent pleural thickening unchanged since at least ___.  Left lung\notherwise clear.\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy or active infection.\n\nAtherosclerotic calcification, severe in all coronaries, moderate in head and\nneck vessels."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The partially visualized thyroid is\nsomewhat heterogeneous but without discrete nodule.  No enlarged or growing\nsupraclavicular or axillary lymph nodes.  No suspicious chest wall masses.\n\nUPPER ABDOMEN: 1.5 cm nodule within the lateral limb of the left adrenal gland\n(2:123) is stable since at least ___ when it measured 1.5 cm.  1.2 cm\nnodule within the lateral limb of the right adrenal gland (2:115) is stable\nsince ___ as well when it measured 1.1 cm.\n\nMEDIASTINUM: The esophagus is unremarkable.  Multiple prominent subcentimeter\nmediastinal lymph nodes do not meet CT size criteria for pathologic\nenlargement and are stable since ___.  No new or growing mediastinal\nlymph nodes.\n\nHILA: The left upper hilum is obscured by radiation fibrosis and atelectasis,\nbut is unchanged in contour.  Elsewhere, no enlarged or growing hilar lymph\nnodes are seen.\n\nHEART and PERICARDIUM: Heart size is normal.  Small pericardial effusion is\nstable.  An ovoid fluid density along the right heart border was stable\nbetween ___ and ___ but has increased in size as compared to ___,\nmeasuring than 30 x 17 mm 235 x 25 mm on the current study, series 2, image\n75.  No solid component based on the measurements identified.  The finding is\nmost likely to reflect pericardial cyst.\n\nPLEURA: Pleural thickening within the left upper lung is unchanged since at\nleast ___.\n\nLUNG:\n\n1. PARENCHYMA:  Radiation fibrosis and atelectasis within the left upper lung\nappears similar dating back to ___.  2 mm right upper lobe nodule (4:66)\nand 1 mm nodule within the right lower lobe (4:170) are stable since ___.  No new or growing lung nodules.  Punctate granulomas in the right upper\nand right lower lobes are again seen.\n2. AIRWAYS:  Narrowing of the left upper lobe are bronchus in the region of\nradiation fibrosis and atelectasis is stable since at least ___. \nOtherwise, they airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta is normal in caliber and course.  The main\npulmonary artery is normal in diameter.\n\nCHEST CAGE: Cortical irregularity along the left third through fifth ribs is\nstable since ___, likely post treatment changes.  No suspicious lytic or\nsclerotic osseous lesions.  No acute fractures.",
            "output": "1. Stable post treatment changes within the left upper lung.  No evidence of\nintrathoracic malignancy.\n2. Interval increase of most likely pericardial cyst, attention on the\nsubsequent studies recommended.\n3. At least ___ year stability of nodules within the bilateral adrenal glands."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST\n\nThere is significant respiratory motion artifact which limits this\nexamination. The heart and great vessels are normal in caliber. There are no\nenlarged mediastinal or axillary lymph nodes. The central airways are clear.\nThere are small bilateral pleural effusions with associated atelectasis. No\ndefinite parenchymal nodules are identified.\n\nPlease see the same day abdomen/pelvis CT for subdiaphragmatic details.\n\nOsseous structures demonstrate no suspicious lytic or sclerotic lesions.",
            "output": "1.  The examination is limited by significant respiratory motion artifact.\n\n2.  Small bilateral pleural effusions and associated atelectasis which is new.\n\n3. Please see report of outside hospital study for comment on right hilar\nlymphadenopathy and subpleural right middle lobe nodule better assessed on\nthat CT."
        },
        {
            "input": "Endotracheal tip is in appropriate position 4 cm above the level of the\ncarina. An enteric feeding tube is seen coursing through the esophagus with\ntip coiled in the stomach. A 1.3 x 2 cm (02:24) station 7 lymph node is likely\nreactive. No additional supraclavicular, axillary, mediastinal, or hilar lymph\nnode enlargement by CT size criteria.The thyroid gland is unremarkable.\n\nThe heart is mildly enlarged without pericardial effusion. Atherosclerotic\ncalcifications are seen within the thoracic aorta and coronary arteries. The\ngreat vessels are normal caliber.\n\nNo pleural effusion.No pneumothorax.  Persistent diffuse bilateral\nbronchiectasis predominately at the lung bases with associated bronchial wall\nthickening, intermittent areas of mucoid impaction, adjacent ground-glass,\nnodular peribronchial opacities, with areas of slightly more confluent\nconsolidation within the left lower lobe and superior segment of right lower\nlobe. Findings are consistent with multifocal bronchopneumonia. Left lower\nlobe opacity has minimally increased since previous examination. Additional\nareas of mild bronchiectasis, ground-glass opacities, and areas of\nconsolidation are seen within the right and left upper lobes. Limited\nassessment of pulmonary nodules due to underlying parenchymal abnormality.\n\nOSSEOUS STRUCTURES:  Old healed left eighth lateral rib fracture. No lytic or\nblastic osseous lesions concerning for malignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is notable for dense calcification at the\nceliac axis.",
            "output": "1.  Diffuse bilateral bronchiectasis predominantly at the lung bases with\nbronchial wall thickening, intermittent areas of mucoid impaction, adjacent\nground-glass/nodular opacities with slightly more confluent consolidation is\nconsistent with multifocal bronchopneumonia with minimal increase in left\nlower lobe opacity.\n2.  No pleural effusion.\n3. 2 cm station 7 lymph node is most likely reactive.\n4.  Dense calcification of celiac axis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe unenhanced thyroid gland is unremarkable.  No enlarged lymph nodes in\neither axilla or thoracic inlet.  Excluding the breast tissue which requires\nmammography for evaluation,there are no abnormalities on the chest wall. No\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Mild coronary\nartery and aortic arch calcifications.  The main pulmonary artery is dilated\nto 3.8 cm, which could reflect pulmonary hypertension.  The aorta is normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nThe lower esophagus is unremarkable.  There is a 3.9 x 2.4 cm area to the left\nof the visualized cervical esophagus which contains an internal air-fluid\nlevel, possibly representing a Zenker's diverticulum, though incompletely\nimaged.  Several enlarged mediastinal lymph nodes are present including a 1.4\ncm short axis right lower paratracheal lymph node (series 302:84).  No\ndefinite hilar lymphadenopathy within limitations of a unenhanced study.\n\nPLEURA:\nNo pleural effusions.\n\nLUNGS:\nThere is a background of severe fibrotic and cystic change affecting the upper\nanterior lobes and lower lobes, with relative sparing of the mid lung field. \nAdditionally, there is ground-glass opacification particularly at the lung\nbases bilaterally, concerning for superimposed infection.  There is associated\nbronchiectasis in these areas.No evidence of mucous plugging.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show colonic diverticulosis, but no\nother significant abnormal finding.",
            "output": "1. Severe fibrotic change at the lung bases and anterior upper lobes, with\nrelative sparing of the midlung.  Ground-glass opacities at the bilateral lung\nbases is concerning for superimposed infection on a background of severe\nchronic lung disease.  This appearance is nonspecific but could represent\nviral infection, or pneumocystis pneumonia in the appropriate clinical\nsetting.  Associated mediastinal lymphadenopathy is nonspecific but probably\nreactive.\n2. 3.9 cm structure adjacent to the cervical esophagus with an air-fluid level\nis suggestive of a Zenker's diverticulum, incompletely imaged.  This can be\nfurther evaluated with barium esophagram.\n3. The main pulmonary artery is dilated to 3.8 cm, which could reflect\npulmonary hypertension.\n\nRECOMMENDATION(S):  Barium esophagram to further evaluate suggested Zenker's\ndiverticulum.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:55 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "BASE OF NECK: The thyroid gland is unremarkable.  A similar-appearing 3.2 x\n2.0 cm focal outpouching on the left of the cervical esophagus contains an\ninternal air-fluid level, likely reflective of a Zenker's diverticulum (3:6).\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Mild aortic\narch calcifications.  The main pulmonary artery is dilated, measuring up to\n3.9 cm, and may represent pulmonary arterial hypertension.  The heart and\npericardium are normal. No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nMultiple enlarged mediastinal lymph nodes, with the largest measuring up to\n1.4 cm in the right lower paratracheal station (3:26). No mediastinal mass.\nHilar lymph nodes are not well evaluated without intravenous contrast, but the\nhilar contour appears unremarkable.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Redemonstration extensive fibrotic and cystic changes,\npredominantly within the anterior upper lobes and posterior lower lobes, with\nassociated bronchiectasis.  The mid lungs are relatively spared. The overall\nappearance of the interstitial disease is unchanged.  Previously noted\nbibasilar ground-glass opacities are not seen.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? No acute fracture.\n\nABDOMEN: Limited evaluation of the imaged upper abdomen demonstrates mild\ncolonic diverticulosis.",
            "output": "1. Severe fibrotic and cystic changes of the bilateral lungs, not\nsignificantly changed from prior exam.\n2. Previously noted bibasilar ground-glass opacities have resolved.\n3. Redemonstration of a focal outpouching on the cervical esophagus, likely a\nZenker's diverticulum.\n\nRECOMMENDATION(S):  Further evaluation with barium esophagram may be\nconsidered if clinically warranted."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Unchanged\ndilatation of the pulmonary artery measuring 3.9 cm.  The heart and\npericardium are within normal limits based on an unenhanced scan. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  Several prominent\nmediastinal lymph nodes measuring up to 17 mm in the subcarinal region,\nslightly increased from prior.  Prominent bilateral hilar lymph nodes.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multifocal areas of honeycombing in the lungs bilaterally in a\nsimilar distribution to prior and consistent with interstitial lung disease. \nRight lung stable and consistent with prior surgery.  No new focal areas of\nparenchymal opacification to suggest superimposed pneumonia.  Very small new 3\nmm ground-glass nodule in the left upper lobe (4:63 close) is probably\ninflammatory and not likely of significance.\n\nBASE OF NECK: Partially visualized left lateral outpouching from the esophagus\ncontaining gas and fluid is similar to prior.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "-Unchanged appearance of the lungs consistent with pulmonary fibrosis\n-No evidence of superimposed infection on the current study.\n-Partially imaged upper esophageal/pharyngeal diverticulum appears similar to\nprior, incompletely imaged and characterized with this technique."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Bilateral breast prosthesis.  Swan-Ganz catheter with tip in\nthe right main pulmonary artery.  An Impella device is insert to the inferior\nvena cava ending in the main pulmonary artery.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is mildly enlarged.  No pericardial effusion.  Mild atherosclerotic\ncalcifications in the coronary arteries in aorta.  The pulmonary arteries and\naorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nAn esophageal feeding tube is seen in the esophagus, which is otherwise\nunremarkable.  No enlarged mediastinal lymph nodes by CT size criteria.  No\nhilar lymphadenopathy.\n\nPLEURA:\nSmall bilateral pleural effusions, right greater the left.  No apical\nscarring.\n\nLUNGS:\nThe patient is intubated.  The airways are patent to subsegmental levels.\nNew bilateral low-attenuation consolidations are seen in the posterior\ndependent areas of both lower lobes, greater to the right and more\nheterogeneous than to the left.\nCalcified granuloma in the middle lobe (02:41).\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "New bilateral lower lobe consolidations associated to small pleural effusions,\nright greater than left, suggestive of aspiration related pneumonia.\n\nStable position of the monitoring devices.  The esophageal feeding tube tip\nhas barely the GE junction and should be advanced further in order for all\nports to be inside the stomach.\n\nNOTIFICATION:  The findings were discussed with Dr ___, M.D. by\n___, M.D. on the telephone on ___ at 9:03 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CT CHEST WITHOUT CONTRAST: The thyroid is partially obscured by streak\nartifact but grossly normal. There is no supraclavicular or axillary\nlymphadenopathy.  The esophagus is grossly normal without hiatal hernia.\n\nA 12.5 x 8.1 x 10.3 cm anterior mediastinal mass is hypoattenuating centrally\ncompatible with necrosis. The mass is inseparable from the aortic arch, main,\nand left pulmonary artery. Anteriorly the mass abuts the pleural surface. \nCompared to the prior examination, the mass is little changed.2\n\nSmall left pleural effusion is decreased since the study of ___. There is\nmild adjacent atelectasis. A subpleural nodule in the left lower lobe was also\nseen on the interventional CT of ___ (4:187), not appreciably\nchanged.\n\nThe heart is not enlarged. There is a small to moderate nonhemorrhagic\npericardial effusion.  The tracheobronchial tree is patent to the subsegmental\nlevel. There is no pleural effusion or pneumothorax.\n\nThere is a 2.6 x 1.7 cm nodular focus of soft tissue in the left breast and\nadjacent 2.4 x 2.2 cm soft tissue focus (3:32 and 28).\n\nOSSEOUS STRUCTURES: No worrisome blastic or lytic lesion is detected.",
            "output": "1. Necrotic anterior mediastinal mass is incompletely evaluated without IV\ncontrast. As detailed above the mass is inseparable from the aortic arch and\nmain pulmonary artery.\n2. Small pericardial effusion is unchanged.\n3. Posterior subpleural nodule worrisome for pleural metastasis with\nassociated small left pleural effusion smaller since the prior study.\n4. Asymmetric left breast tissue recommend correlation with diagnostic\nmammogram.\n5. Please note CT of the abdomen pelvis will be reported separately"
        },
        {
            "input": "Detailed evaluation of the soft tissues, vessels, and solid organs is markedly\nlimited without the use of intravenous contrast.\n\nOverall, there is no significant interval change in appearance of lungs and\nmediastinum compared to the PET-CT on ___.\n\nThe thoracic aorta is non-aneurysmal with mild atherosclerotic calcifications.\nThe main pulmonary artery remains mildly dilated, measuring up to 30 cm,\ngrossly unchanged and can reflect sequelae of chronic pulmonary hypertension. \nA right Port-A-Cath tip ends in the distal SVC.  The heart is normal in size. \nA mild hypoattenuation of the cardiac blood pool suggests anemia.  A\npericardial effusion is small, overall unchanged.\n\nNo axillary or supraclavicular lymphadenopathy by CT size criteria.  The\nlarge, lobulated anterior mediastinal mass, corresponding to known malignancy\nis overall unchanged in size, measuring up to 5.4 x 4 cm on the axial images\nand 7.1 x 3.7 cm on sagittal images (series 2, image 23; series 602b, image\n88).  Prominence of the left hila suggests likely hilar lymphadenopathy, also\ngrossly unchanged.  No obvious right hilar lymphadenopathy on this non\ncontrast exam.  Subcarinal enlarged lymph nodes also unchanged.\n\nA left pleural effusion is large to moderate in size, nonhemorrhagic and\noverall unchanged.  Adjacent moderate left lower lobe parenchymal opacity with\nair bronchograms is also overall unchanged as well as left upper lobe\nposterior segment parenchymal opacity.  These may reflect chronic volume loss;\nalthough underlying infectious etiology and/or malignancy is possible. \nSignificant volume loss however is supported by marked elevation of the left\nhemidiaphragm in the setting of an otherwise large pleural effusion. \nNodularity of the medial pleural surfaces of the left lung along the\nmediastinum are also overall unchanged and compatible with known malignancy. \nSoft tissue density deposits along the left perihilar region narrows the left\nupper lobe and lower lobe bronchi and may contribute to some of the volume\nloss.  It is unclear if these masses are within the days themselves.  The\nright airways are patent.  Ground-glass opacities in the right lower lobe are\nunchanged and could reflect chronic aspiration.\n\nNo pneumothorax.\n\nThe thyroid is grossly unremarkable.  This exam is not dedicated for imaging\nof the chest wall and breasts; however it is grossly unremarkable in similar\nto the prior exam including nodular density in the left breast.\n\nProminent mottled and sclerotic appearance of an upper lumbar vertebral body\ncorresponds to FDG avid lesion on the recent PET-CT, unchanged (series 602 B,\nimage 69).  No evidence of pathologic fracture.  Otherwise multi-level\ndegenerative changes are noted in the visualized thoracic and upper lumbar\nspine.\n\nThis exam is not dedicated for imaging of the upper abdomen.  Mild anti\ndependent left pneumobilia is new since ___ and may reflect prior\ncholecystectomy and/or sphincterotomy.  A left lower renal pole cortical\nhypodensity is most likely a cyst, unchanged.",
            "output": "1.  No significant interval change since ___.\n2.  Persistent dominant anterior mediastinal mass and surrounding left\nparenchymal pleural nodular masses, unchanged.\n3.  Persistent large moderate nonhemorrhagic left pleural effusion with left\nlower lobe and left upper lobe parenchymal opacities which are also unchanged.\nParenchymal opacities may reflect chronic volume loss; concurrent infection\nand/or tumor is also likely.  Some soft tissue mass results in narrowing of\nthe left upper and lower lobe bronchi but not complete collapse.\n4.  Unchanged right lower lobe ground-glass opacities may reflect chronic\naspiration.  No evidence of substantial right lung volume loss.\n5.  Mild prominence of the pulmonary arteries is unchanged and may reflect\nsequelae of chronic pulmonary hypertension.\n6.  Persistent small pericardial effusion, unchanged.\n7.  Unchanged L1 vertebral body metastasis without evidence of pathologic\nfracture.\n8.  Mild pneumobilia likely reflects prior history of sphincterotomy.  No bile\nduct dilation.\n\nNOTIFICATION:  The findings, images, and impression were discussed with Dr.\n___. by ___, M.D. in person on ___ at 10:50 ___, 1\nminutes after discovery of the findings."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged. \nBreast evaluation is reserve for mammography, particular in light of marked\nasymmetry in soft tissue bulk, left greater than right, 02:31.  10 mm\nsubcutaneous nodule in the right upper back has low attenuation, associated\nwith sebaceous cysts.  It was present but slightly smaller in ___.  There\nare no findings in the chest wall concerning for malignancy.  This study is\nnot appropriate for subdiaphragmatic diagnosis, especially regarding the\nliver, but there is no adrenal mass.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.\n\nAtherosclerotic calcification is minimal in head and neck vessels but not\napparent in coronary arteries.\n\nAorta is normal size.  Main pulmonary arteries inseparable from a large\nprevascular mediastinal mass also contiguous with the pericardium..  Small\npericardial effusion is slightly larger today than in ___\n\nTHORACIC LYMPH NODES: Large soft tissue mass in the prevascular mediastinum is\ninseparable from mediastinal pleura, pericardium, main and left pulmonary\narteries and the upper pole of the left hilus.  Maximum diameter today, 48 x\n74 mm, compared to ___ by 75 mm in ___.  There is no clear\nenlargement of lymph nodes elsewhere in the mediastinum and hilar contours\nhave not changed to suggest adenopathy.  11 x 16 mm left diaphragmatic node,\n302:145, was slightly smaller in ___.\n\nLUNGS, AIRWAYS, PLEURAE: Region of peribronchial infiltration at the base of\nthe right lung, 302:170, in the posterior basal segment is new since ___ while similar appearing abnormality present earlier in the lateral basal\nsegment is cleared.  These lesions are most likely pneumonia, perhaps due to\naspiration.\n\nLarge area of confluent atelectasis with severe bronchiectasis in the\nparamediastinal and perihilar left lower lobe is presumably radiation\nfibrosis, not changed appreciably since ___.  Remainder of the left upper and\nlower lobes unremarkable.  There are no ground-glass abnormalities suspicious\nfor malignancy.\n\nModerate, nonhemorrhagic, posteriorly layering left pleural effusion is\nsmaller today than in ___, not changed since ___.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Probable recurrence aspiration pneumonia, right lower lobe.  Small volume of\ncurrent consolidation could be active pneumonia or organized post infectious\npneumonia.\n\nLarge prevascular mediastinal mass, slightly larger today than in ___, with\nno evidence of progression in involvement of adjacent structures, mainly left\nand main pulmonary artery and pericardium.\n\nModerate left pleural effusion stable since ___, improved since ___. \nRelatively stable region of radiation fibrosis in the left lung."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging.  Supraclavicular\nand axillary lymph nodes are not enlarged.  Evaluation of the breasts is\nreserved for mammographies E particularly in light of marked soft tissue\nasymmetry, left greater than right.  Elsewhere in the imaged chest wall there\nare no findings concerning for malignancy.  This study is not appropriate for\nsubdiaphragmatic diagnosis, particularly with respect to the liver.  There is\nno adrenal mass.\n\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels or in the coronary arteries.  Small\npericardial effusion is smaller today.  There are no findings of cardiac\ntamponade.  Aorta and pulmonary arteries are normal size.\n\nLarge prevascular soft tissue mass in the mediastinum is no larger, long\ndiameters still ranging from 54 to 63 mm, unchanged.  As before there is a\nlong border of continuity with the main and left pulmonary arteries and\npericardium and the mass extends to the upper pole of the left hilum, but\nthere is no compromise of left bronchial tree.  To assess vascular\ninvolvement, would require contrast infusion.\n\n\n\nTHORACIC LYMPH NODES: The prevascular mass the infiltrates the fat of the\nretrosternal mediastinum which probably contains numerous small lymph nodes,\nnone larger today than before.  At the only definite enlarged lymph nodes\nremote from the primary tumor and is a cluster of left epiphrenic\ndiaphragmatic nodes, ranging in diameter up to 12 mm, 4:146, previously 11 mm.\nLUNGS, AIRWAYS, PLEURAE: Previous peribronchial infiltration right lower lobe\nhas nearly resolved.  Right lung is essentially clear.\n\nArch region of radiation fibrosis in the left upper and superior segments left\nlower lobes unchanged.  Remainder of the left lung is free of findings of\neither infection or remote metastatic spread.\n\nCHEST CAGE: Chronic, moderate posterior and inferior left pleural effusion is\nnonhemorrhagic, slightly larger today than previously.",
            "output": "Previous right lower lobe infection has nearly resolved since ___.\n\nNo appreciable interval change large prevascular mediastinal mass, associated\nradiation fibrosis.  Persistent moderate size left pleural effusion may be\nslightly larger."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits.  Of note, the left\nupper lobe mass abuts the pulmonary artery with lack of fat plane between the\ntwo.  There is a small pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a 7.4 x 5.3 cm left anterior\nmediastinal mass, previously 6.4 x 4.7 cm in ___.  There is no soft\ntissue plane between it and the main and left pulmonary artery.  Additional\nepicardial soft tissue nodule (2:36 measures 2.9 x 1.9 cm, previously 2.2 x\n1.6 cm.  There is secondary leftward shift of mediastinal structures similar\nto prior. No axillary lymphadenopathy is present.\n\nPLEURAL SPACES: There is a small left apical pneumothorax which is slightly\nlarger compared to PET-CT from ___.  There is small volume partially\nloculated left pleural effusion though it is decreased in size since ___. \nNo right pleural effusion.\n\nLUNGS/AIRWAYS: Within paramediastinal region of the left lower lobe are areas\nof soft tissue density and bronchiectasis which in the setting of cancer may\nreflect post treatment changes, similar to prior.  Right lung is grossly clear\nbesides a 3 mm right basilar nodule (2:42).  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA well-circumscribed hypoattenuating lesion is demonstrated within the\ninferior pole of the left kidney and likely represents a simple renal cyst.\nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  The colon and rectum are within normal limits.  The appendix\nis not seen.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is a sclerotic lesion within the L1 vertebral body which is\nconsistent with metastatic disease better demonstrated on prior FDG PET\nperformed done ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Small persistent left apical pneumothorax, slightly increased since ___.\n2. Interval enlargement of the left anterior mediastinal mass.\n3. Increased soft tissue density within the paramediastinal region of the left\nlower lobe with areas of traction bronchiectasis is nonspecific but may\nrepresent post treatment changes.\n4. Enlarged cardiophrenic lymph nodes are also slightly increased in size.\n5. Small loculated left pleural effusion, decreased in size when compared to\nmost recent FDG PET."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is a new 8 mm left axillary lymph node.  However no\naxillary lymphadenopathy by CT size criteria.\n\nMEDIASTINUM: There is a 4.4 x 6.9 x 9.3 cm left anterior mediastinal mass,\nsimilar to prior study, but increased in size from ___.  There is a\nnecrotic center measuring approximately 2.8 by 2.3 cm.  There are multiple\nepicardial nodules measuring up to 1.9 cm and 1.4 cm (3:42, 43), again similar\nto prior study but increased in size from ___.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  Small pericardial\neffusion is stable in size from prior exam.\n\nPLEURA: Right-sided pleural nodules are noted (5:139, 205) which appear new\nfrom the prior exam.  Previously seen small left apical pneumothorax has\nresolved.  Again seen is a left loculated pleural effusion.\n\nLUNG: There is redemonstration left lower lobe soft tissue opacities with\nbronchiectasis likely reflecting post radiation changes.  There is stable,\nnear complete loss of the left lower lobe with expansion of the left upper\nlobe.\n\nDiffuse ground-glass opacities in the right lung.\n\nAirways are patent to the segmental level.\n\nCHEST CAGE: There is redemonstration of a sclerotic lesion in the L1 vertebral\nbody, consistent with known metastatic disease, and stable in size since ___.\n\nUPPER ABDOMEN: The study was not tailored for evaluation of the\nsubdiaphragmatic structures. Within this limitation, there are no gross\nabnormalities.",
            "output": "1. Left anterior mediastinal mass measuring approximately 4.4 x 6.9 x 9.3 cm\n(AP x TV x CC) with central necrosis, similar in size to CT from ___,\nbut increased in size from ___.\n2. Epicardial soft tissue nodules, again similar to prior CT, but increased in\nsize from ___.\n3. Multiple left sided pleural deposits are new from the prior studies and may\nrepresent additional metastatic disease versus pleurodesis.\n4. Metastatic, sclerotic lesion in the L1 vertebral body is stable since ___.\n5. Previously seen small left apical pneumothorax is resolved.\n6. Diffuse ground-glass opacities in the right lung is nonspecific, but may\nrepresent pneumonitis versus infection."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nleft upper lobe pulmonary arteries are not opacified, likely due to mass\neffect from mediastinal mass.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits.  There is a small to moderate\npericardial effusion, grossly stable.\n\nAXILLA, HILA, AND MEDIASTINUM: Again seen is a large, heterogeneously\nenhancing mediastinal mass measuring approximately 5.0 x 7.4 x 9.3 cm (TV x AP\nx CC).  There is an ill-defined central area of hypodensity likely\nrepresenting necrosis.\n\nEpicardial soft tissue nodules are again seen measuring up to 2.0 and 1.1 cm\nin the short axis, similar to the prior study.\n\nMultiple left axillary lymph nodes are seen measuring up to 8 mm, also seen on\nprior exam.\n\nPLEURAL SPACES:Again seen is a left loculated pleural effusion, similar to\nmildly increased in size from the prior exam.  Again seen are subcentimeter\nleft-sided pleural nodules, grossly stable.\n\nLUNGS/AIRWAYS:There is redemonstration of left lower lobe soft tissue\nopacities with bronchiectasis likely reflecting post radiation changes. \nWithin this area, there is increased ground-glass opacities concerning for\ninfection.  There is stable near complete loss of the left lower lobe with\nexpansion of the left upper lobe.  Airways are patent to the segmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nCHEST WALL: There is redemonstration of soft tissue nodules in the left\nanterior chest wall, chest wall measuring up to 3.2 x 2.1 cm. There is a right\nchest wall Port-A-Cath with tip in the distal SVC.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. The left upper lobe pulmonary artery is not patent, likely due to mass\neffect from known mediastinal mass.\n3. Redemonstration of left lower lobe soft tissue opacities with\nbronchiectasis likely reflecting postradiation changes.  Increased\nground-glass opacities in this region is concerning for pneumonia.\n4. Redemonstration of a large, heterogeneously enhancing mediastinal mass\nmeasuring approximately 5.0 x 7.4 x 9.3 cm with an ill-defined central area of\nnecrosis.  When compared to the prior exam, this mass appears slightly larger\nhowever this may be due to contrast enhanced technique.\n5. Small pericardial effusion, grossly stable.\n6. Grossly stable epicardial and pleural soft tissue nodules.  Grossly stable\nleft axillary lymph nodes.\n7. Left loculated pleural effusion, similar to mildly increased in size from\nthe prior exam.\n8. Left anterior chest wall soft tissue nodules, grossly stable.\n\nNOTIFICATION:  Updated findings were communicated with ___, MD by\n___, MD via telephone on ___ at 11:14 a.m."
        },
        {
            "input": "The imaged base of neck is unremarkable.  A right IJ access Port-A-Cath\nterminates in the lower SVC.  Thoracic aorta is normal in course and caliber\nwith mild atherosclerotic calcifications.  Left axillary lymphadenopathy is\nagain noted measuring up to 13 mm in short axis, series 4, image 73 through\n89.  The heart is within normal limits of size with trace pericardial\neffusion.  There is a large anterior mediastinal mass which is somewhat\nlimited in assessment due to lack of IV contrast though appears d to measure\napproximately 10.2 x 6.3 x 7.2 cm, previously 9.9 x 6.1 x 7.3 cm.  Previously\nnoted ground-glass opacity in the left lower lobe has resolved suggesting\nimprovement in pneumonia.  There is persistent bronchiectasis and scarring in\nthe left lower lobe.  Loculated left pleural effusion persists.  There is\npersistent mass effect on the heart due to an eventration of the right\nhemidiaphragm, as well as loculated left pleural fluid.  A small subpleural\nnodule in the lingula is noted on series 4, image 140 measuring up to 9 mm,\nunchanged.  No new or growing pulmonary nodule.  Motion limited exam.\n\nPlease refer to separately dictated CT abdomen pelvis for findings below the\ndiaphragm.\n\nBones: No worrisome lytic or blastic osseous lesion.\n\nSoft tissues: Nodularity within the left breast is again seen for which can be\ncorrelated with physical exam.",
            "output": "1. Intervally resolved left lower lobe pneumonia.\n2. Similar size of known anterior mediastinal mass.\n3. Persistent loculated left pleural effusion with chronic atelectasis and\nscarring in the left lower lobe.\n4. Persistent rightward shift of the cardiac silhouette due to loculated left\npleural effusion, mass, and eventration of the left hemidiaphragm.\n\nPlease note evaluation is somewhat limited due to absence of IV contrast."
        },
        {
            "input": "HEART AND VASCULATURE: The heart is normal in size.  There is small\npericardial effusion grossly unchanged from previous study.  There is a\nright-sided Port-A-Cath with tip terminating at the upper SVC.  There is mild\natherosclerotic calcification involving the thoracic aorta.\n\nAXILLA, HILA, AND MEDIASTINUM: There is redemonstration of a left anterior\nmediastinum mass measuring 6.8 x 5.6 x 8.0 cm grossly unchanged from previous\nstudy (previously measuring 6.6 x 5.1 x 8.1 cm in ___.  The mass is\nheterogeneous in its most likely consistent with areas of necrosis, series 2,\nimage 45.  There are additional soft tissue mass in the left cardiophrenic\nregion likely representing malignant lymphadenopathy.  There is mass effect\ncompressing the mediastinum with deviation to the right.\n\nPLEURAL SPACES: There is a stable small left loculated pleural effusion with\nassociated atelectasis.\n\nLUNGS/AIRWAYS: The central airways are patent.  There is redemonstration of a\nleft lower lobe consolidation likely secondary to atelectasis.  There also\nscattered right lung base atelectasis.  There is a left lower lobe 5 mm\ncalcified granuloma.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer CT abdomen and pelvis performed at the same day for\nfurther details.\n\nBONES: They are mild multilevel degenerative changes of the thoracolumbar\nspine.  There is sclerotic change of the L1 vertebral body consistent with an\nosseous metastasis.",
            "output": "1. Grossly unchanged, most likely necrotic anterior mediastinal mass with left\ncardiophrenic lymphadenopathy.\n2. Stable left loculated pleural effusion with associated atelectasis.\n3. L1 vertebral body osseous metastasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Prominent right internal jugular\nvein is again seen.  The thyroid is atrophic but otherwise unremarkable.  Few\nmeasurable supraclavicular lymph nodes measuring up to 0.5 cm on the left, are\nstable.  No pathologically enlarged or growing supraclavicular lymph nodes. \nSlight interval increase in size of few left axillary lymph nodes measuring up\nto 1.4 cm in short axis diameter (4:35), previously up to 1.1 cm. \nRedemonstration of soft tissues in the left anterior chest wall in the\nretroareolar region which measure up to 2.8 x 1.7 cm (4:73), some of which may\nrepresent fibroglandular tissue, unchanged since at least ___.\n\nUPPER ABDOMEN: Please refer to the separate same day report of the abdomen and\npelvis for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Allowing for differences in technique and patient positioning,\nthe known left anterior mediastinal mass, which is in close relation to the\naortic arch, is slightly increased in size.  For example, the largest axial\ncomponent superiorly measures 9.4 x 6.5 x 9.0 cm (4:39, 7:24), previously 8.4\nx 5.6 x 8.9 cm.  Although evaluation is limited without intravenous contrast,\nheterogeneity with multiple hypoattenuating areas appears similar.  Additional\nsoft tissue masses in the left cardiophrenic region, likely conglomerate nodal\nmasses, appear similar to slightly increased in size.  For example the\ndominant soft tissue mass measures 2.9 x 2.3 cm (4:71), previously 2.7 x 2.4\ncm.  There is persistent, similar mass effect and rightward mediastinal\ndeviation, grossly similar to prior.  The superior esophagus is slightly more\npatulous.\n\nHILA: The left hilum is obscured by mass.  No enlarged or growing right hilar\nlymph nodes within the limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart size is normal.  Small nonhemorrhagic pericardial\neffusion appears similar to prior.  Mild left-sided coronary artery and aortic\nvalvular calcifications appears similar.\n\nPLEURA: Small left loculated and nonhemorrhagic pleural effusion with\ncircumferential pleural thickening appears similar.  No right pleural\neffusion.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Redemonstration of moderate left lower lobe atelectasis,\nsimilar to prior.  Subpleural opacities measuring up to 1.8 cm in the left\nlung (5:168, 179, 191), all likely atelectasis/scarring, appear similar.  No\nnew or growing pulmonary nodules.  There is new mosaic attenuation throughout\nthe right middle and lower lobes suggesting small airway obstruction.\n2. AIRWAYS: The airways within the right lung are patent to the subsegmental\nlevel.  There is similar mild narrowing of the left main bronchus and severe\nnarrowing throughout multiple segmental and subsegmental bronchi throughout\nthe left lung.\n3. VESSELS:  Tip of right chest Port-A-Cath terminates in the lower SVC,\nunchanged.\n\nCHEST CAGE: Sclerosis of the L1 vertebral body, consistent with metastasis,\nappears similar to prior.  No new lytic or sclerotic osseous lesions.  No\nacute fracture.",
            "output": "1. Slight enlargement of necrotic anterior mediastinal mass and left axillary\nlymphadenopathy.  By virtue of the location of the tumor, there is probable\nrecurrent left laryngeal nerve pal"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary artery is top-normal in\nsize.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is a ___ year stable) 6 mm, solid nodule at the left apex (3, 37).  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of aortic dissection or pulmonary embolism."
        },
        {
            "input": "Chest:\n\nThe heart is borderline in size.  Mild atherosclerotic calcification is noted\nalong the aortic arch.  The thoracic aorta is normal in caliber.  No evidence\nof acute vascular injury.\n\nThyroid is mildly enlarged, unchanged.\n\nThere is no pleural or pericardial effusion.  No pneumothorax.  No enlarged\nlymph nodes are found in the chest.\n\nA triangular 6 mm nodule in the left upper lobe (2:16) is a stable finding.  A\n3 mm subpleural nodular focus in the right upper lobe (2:62) is new but likely\nminor atelectasis.  Minimal atelectasis or scarring at each lung base.\n\nAbdomen:\n\nThere is no biliary dilatation.  The gallbladder appears normal.  Unchanged\nsmall hemangioma in the right lobe of the liver (2:104).  The spleen is normal\nin size and appearance.  Pancreas appears normal.  Adrenals are unremarkable. \nSubcentimeter hypodense focus in the mid to lower left kidney is too small to\ncharacterize but doubtful in significance, probably a cyst.  Minimal scar\nalong the upper pole.\n\nThe stomach and small bowel appear normal.  Mild colonic diverticulosis, as\nseen previously.  Appendix appears normal.\n\nSmall fat containing umbilical hernia with a wide neck.\n\nPelvis:\n\nBladder is empty.  No discretely visible uterus.  There is no adnexal mass. \nAthero sclerotic changes are mild.  There is no free fluid or free air.  No\nlymphadenopathy.  Major vascular structures are widely patent.\n\nBones:\n\nNo displaced fracture is found.  Moderate degenerative changes affect L4-L5\nand L5-S1 facet joints. Mild reverse S shaped curvature to the visualized or\nthoracolumbar spine.",
            "output": "1.  No evidence of acute injury involving the chest, abdomen or pelvis.\n\n2.  Enlarged thyroid, not necessarily significant clinically although it may\nbe appropriate to correlate with any relevant history and with consideration\nof thyroid function testing."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  However,\nthere are moderate atherosclerotic calcifications in the thoracic aorta. \nAdditionally, there are moderate coronary artery and aortic valve\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits based on an unenhanced scan. No pericardial effusion is\nseen.  The tip of the right PICC terminates in the low SVC.\n\nPulmonary artery trunk is borderline dilated, measuring up to 3 cm, which may\nbe seen in the the presence of pulmonary hypertension.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  However, there is incidental note of a 6 mm left upper lobe\npulmonary nodule (series 3, image 33), 3 mm right upper lobe pulmonary nodule\n(series 5, image 138), and a 4 mm right upper lobe pulmonary nodule (series 5,\nimage 63), all of which are not significantly changed compared to prior exam\ndated ___.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nThe gallbladder is noted to be distended.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUE: There are scattered calcifications in the left breast, similar to\nprior.",
            "output": "1. No acute findings seen to explain the patient's symptoms.  Specifically,\nthe lungs appear clear without large areas of parenchymal opacification.\n2. Incidental note of multiple pulmonary nodules, all of which are unchanged\ncompared to prior exam."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Endotracheal tube\nterminates approximately 1.5 cm above the carina.  Right PICC line terminates\nnear the cavoatrial junction.  Left IJ line terminates in the lower SVC.\n\nPLEURAL SPACES: There are small bilateral pleural effusions, worse on the\nleft. There is no pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral pulmonary nodules measuring up to 6 mm in the left\nupper lobe (series 6, image 101) appear grossly unchanged.  There is\nrelaxation atelectasis of bilateral lung bases. There are no consolidations. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nLeft internal jugular line terminates in the distal SVC as mentioned above.\n\nABDOMEN: Enteric tube terminates in the stomach. There is hyperdense material\nlayering long the posterior antrum which appears isodense to intravenous\ncontrast, may represent ingested contrast or other ingested hyperdense\nmaterial, with gastric hemorrhage not excluded.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small bilateral pleural effusions, worse on the left.\n3. Endotracheal tube terminates approximately 1.5 cm above the carina,\nconsider retracting.\n4. Hyperdense material layering along the posterior wall in the antrum of the\nstomach may represent ingested contrast or other hyperdense material, however\ngastric hemorrhage is not excluded.  Please correlate clinically.\n5. Multiple bilateral pulmonary nodules, grossly unchanged compared to prior\nand measuring up to 6 mm in the left upper lobe."
        },
        {
            "input": "The thyroid gland is unremarkable.  There is no supraclavicular, mediastinal,\nhilar or axillary lymphadenopathy.\n\nHeart size is top normal with dense mitral annular calcifications, and less\nextensive aortic valve/root and coronary artery calcification. Of note, the\nascending aorta is not dilated. There is no pericardial effusion. The main\npulmonary artery and thoracic aorta are normal caliber.\n\nA punctate 2 mm left upper lobe nodule is stable since ___ (4, 114). Two\nadditional calcified granulomas are identified in the right lung (4, 118 and\n157). There are no new or worrisome lung nodules. There is no endobronchial\nlesion or pleural effusion.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Stable exam with no evidence of intrathoracic malignancy.\n\nPunctate 2 mm left upper lobe nodule is stable since at least ___ does\nnot warrant further evaluation.  No new or worrisome pulmonary nodules\nidentified."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal. There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy. The aorta and pulmonary arteries are\nnormal in size. Dense calcifications are again noted in the mitral annulus and\naortic valve, as well as mild coronary arterial calcifications. The heart size\nis normal and there is no pericardial effusion.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS: The airways are patent. There is no airspace consolidation. There is no\ndiffuse interstitial abnormality. Multiple punctate bilateral pulmonary\nnodules are unchanged (4:78, 134, 141, 181), some of which appear to be\ncalcified granulomas. There are no new or concerning pulmonary nodules.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN: Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial,\nmitral annular and aortic annular calcification.  There is no pericardial\neffusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  The study is somewhat limited by motion.  Multiple\npulmonary nodules, some of which appear to be calcified granulomas, measuring\nup to 2 mm (series 4, image 119, 163, 116) are unchanged.  There is no\nemphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No new or enlarging pulmonary nodules.  No evidence of lymphadenopathy.\n2. Coronary, mitral annular and aortic valvular calcifications are dense."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is increased conspicuity of a\nright supraclavicular lymph node measuring up to 11 mm (3:6), not seen on the\nprior study from ___.  Similarly, there is a prominent right axillary lymph\nnode measuring up to 9 mm (3:69), also new since ___.  No definite\nlymphadenopathy is seen.  The thyroid gland is unremarkable.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen and pelvis exam for\nfull description of subdiaphragmatic findings, including new right\nhydronephrosis.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: No hilar lymphadenopathy is appreciated.\n\nHEART and PERICARDIUM: The cardiac size is not enlarged.  There is again\nextensive coronary artery, mitral annular, and aortic valvular calcifications.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  No focal consolidation is appreciated.  There is stable\nappearance of 2 mm nodules, some of which appear to be calcified granulomas\n(3: 84, 90, 102) since ___.  No new or enlarging pulmonary nodules are seen.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  There is no enlargement of thoracic aorta.  Main pulmonary artery\nis normal in caliber.\nCHEST CAGE: Degenerative changes are again seen along the thoracic spine. \nThere is no sclerotic or lytic osseous lesion.",
            "output": "1. Increased prominence of a right supraclavicular and right axillary lymph\nnode, without meeting size criteria for lymphadenopathy, likely reactive.\n2. Stable appearance of micro-nodules since ___.  No new or enlarging\npulmonary nodules.\n3. Please refer to the dedicated CT abdomen and pelvis exam for full\ndescription of subdiaphragmatic findings, including new right hydronephrosis."
        },
        {
            "input": "HEART AND VASCULATURE: Moderate atherosclerotic calcifications of the thoracic\naorta.  There are moderate aortic valvular and coronary calcifications.  Heavy\nmitral annular calcifications.  The thoracic aorta is normal in caliber.  The\nmain pulmonary artery is mildly enlarged measuring 3.3 cm, suggesting\npulmonary arterial hypertension.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent right axillary lymph node is\nunchanged measuring 9 mm in short axis (series 3, image 70).  No new axillary\nlymphadenopathy.  Right supraclavicular lymph node is also unchanged measuring\n10 mm in short axis (series 3, image 9).  There is no mediastinal\nlymphadenopathy.  The previously visualized precarinal lymph node has\ndecreased in size, likely reactive.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A few punctate nodules are stable (series 3, image 117, 169). \nNo new or growing lung nodules.  Otherwise, the lungs are clear without masses\nor areas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  Coarse calcifications within the left breast.",
            "output": "1. Unchanged right axillary and right supraclavicular lymph nodes measuring up\nto 10 mm in short axis.  No new lymphadenopathy.\n2. Few unchanged micronodules within the lungs bilaterally.  No new or growing\npulmonary nodules.\n3. Please refer to the abdominal CT with the same date for evaluation of the\nintra-abdominal structures."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A right supraclavicular lymph node\nmeasures 6 mm, previously measuring up to 10 mm (4:2).  No other\nsupraclavicular lymphadenopathy.  Imaged portion of thyroid gland is\nunremarkable.  Prominent right axillary lymph node measures up to a 9 mm,\nunchanged from prior exam.  No other axillary lymphadenopathy seen. \nCalcifications within the left breast again noted and similar to prior.\n\nUPPER ABDOMEN: Please refer per concurrent CT abdomen pelvis for description\nof findings below the diaphragm.\n\nMEDIASTINUM: Multiple small paratracheal and subcarinal nodes are not\npathologically enlarged and overall decreased in number compared to prior\nexam.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is of normal size.  There is no pericardial\neffusion.  There are moderate coronary artery calcifications.  There are\nmoderate calcifications of the aortic valve.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Lungs are clear.  The sub 3 mm nodules in the lingula (5:129)\nand right lower lobe (5:198) are stable from prior exams.  The right lower\nlobe nodule appears calcified and likely represents a granuloma.  A left upper\nlobe nodule measures 4 mm, previously 2 mm (5:78).\n2. AIRWAYS:  The airways are patent to subsegmental levels bilaterally.\n3. VESSELS:  There is normal caliber of the thoracic aorta and main pulmonary\nartery.  There is no large central pulmonary embolus.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "1. Interval decrease in the size of the a prominent right supraclavicular\nlymph node.  Unchanged right axillary lymph node measuring up to 9 mm.  No new\nlymphadenopathy.\n2. Increased size of a 4 mm left upper lobe nodule, which may represent a\nnoncalcified granuloma, would be an extremely unusual presentation for\nrecurrence of lymphoma.  Recommend attention on follow-up in 6 months.  No\nother new or growing nodules.\n3. Please refer to report of concurrent CT abdomen pelvis for description of\nfindings below the diaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable. Left breast calcifications.\n\nUPPER ABDOMEN: Please refer to the separate report of the CT abdomen and\npelvis performed on the same day for subdiaphragmatic characterization.\n\nMEDIASTINUM: Several lower paratracheal and subcarinal nodes are measurable,\nbut not pathologically enlarged by CT size criteria.  There is no mediastinal\nmass.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.  Moderate aortic valvular\ncalcifications.  Mild coronary artery calcifications.  Severe mitral annulus\ncalcifications.  Mild atherosclerotic calcifications of the aortic arch and\nthoracic aorta.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: A left upper lobe pulmonary nodule measures 5 mm (301:76),\nslightly increased in density and size from 4 mm previously.  Stable sub 3 mm\nnodules within the lingula (301:119) and right middle lobe (301:131).  A\npreviously seen right lower lobe nodule is not as apparent on the study.  No\nnew pulmonary nodules identified.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. Slight interval increase in size and density of a 5 mm left upper lobe\npulmonary nodule.  No other new or growing nodules.\n2. No supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n3. Stable, severe mitral annulus calcifications.\n4. Please refer to the separate report of the CT abdomen and pelvis performed\non the same day for subdiaphragmatic characterization.\n\nRECOMMENDATION(S):  A follow-up chest CT in 6 months is recommended for\nfurther evaluation of a left upper lobe pulmonary nodule."
        },
        {
            "input": "No incidental thyroid nodule.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  All visible axillary lymph nodes (2, 15) are normal in size.\nModerate aortic wall calcifications.  Mild coronary calcifications, known\nsevere mitral annulus calcifications and aortic valve calcifications.  No\npericardial effusion.  The posterior mediastinum is unremarkable.  No adrenal\nabnormalities.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No no osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  On today's examination, there is a new 8 mm\nnodule in the right upper lobe (3, 39).  The previous 4 mm pulmonary nodule is\nnow spiculated and 19 mm in diameter.  There is a new 6 mm nodule in the right\nupper lobe (3, 71).  No other pulmonary nodules are noted.  No diffuse lung\ndisease.  The airways are patent.  No pleural thickening, no pleural\neffusions.",
            "output": "Massive increase in size of a pre-existing left upper lobe pulmonary nodule. \n2 new right upper lobe pulmonary nodules.  The morphology and growth of these\nnodules is highly suspicious for disease progression."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The great vessels are normal in caliber with moderate\ndescending thoracic aorta and aortic arch calcifications.  There are mitral\nand aortic annular calcifications.  There are mild coronary artery\ncalcifications.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No focal consolidation.  Right upper lobe 0.7 x 0.4 cm nodule\nhas decreased in size.  Another previously seen right upper lobe nodule more\ninferiorly is no longer visualized.  The previously seen left upper lobe\npulmonary nodule has substantially decreased in size measuring 1.0 x 0.7 cm\nwith per nodule atelectasis.  A 3 mm right middle lobe subpleural pulmonary\nnodule is unchanged.  No new or growing pulmonary nodules.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is moderately atrophic.  No focal lesion or pancreatic\nductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral kidneys are atrophic, particularly on the right,\nunchanged.  No hydronephrosis.  No focal renal lesion given limitation of a\nnoncontrast study.  Mild perinephric stranding bilaterally is unchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Infrarenal abdominal aortic aneurysm is unchanged measuring 3.8 x\n3.2 cm (series 2, image 68).  Right para-aortic soft tissue at the level just\ninferior to the right kidney is unchanged.  Extensive atherosclerotic disease\nis noted.  Again seen is chronic occlusion of the infrarenal IVC with\ncollaterals draining into the suprarenal IVC via the left gonadal vein and\nleft renal vein, unchanged.\n\nBONES AND SOFT TISSUES: Again seen is ill-defined mixed sclerotic lytic lesion\nin the right iliac bone measuring approximately 3.5 x 1.4 cm which is FDG avid\non prior PET-CT from ___, unchanged in size.  No acute fracture no\nnew suspicious osseous lesions.  There is left lumbosacral transitional\nanatomy.  There are multilevel degenerative changes of the thoracic and lumbar\nspine, moderate as before.  Scattered subcutaneous nodule in the right lower\nabdomen are likely injection sites.",
            "output": "1.  No acute process within the chest, abdomen, or pelvis.\n2.  No lymphadenopathy.\n3.  Unchanged right periaortic soft tissue and chronic occlusion of the\ninfrarenal IVC.\n4.  Interval decrease in size and number of the pulmonary nodules as described\nin the body of the report."
        },
        {
            "input": "The thyroid gland is unremarkable.  Multiple mildly prominent bilateral\naxillary lymph nodes are not pathologically enlarged, measuring no more than 5\nmm in short axis.  Several small mediastinal lymph nodes also do not meet\ncriteria for pathologic enlargement.  A paraesophageal lymph node is stable\nmeasuring 7 mm in short axis (3, 27).  There is no supraclavicular or hilar\nlymphadenopathy.\n\nHeart size is normal with no pericardial effusion.  The main pulmonary artery\nand thoracic aorta are normal caliber. Moderate coronary calcifications\npredominantly involve the left anterior descending and circumflex coronary\narteries. Low attenuation of the blood within the heart suggests anemia.\n\nThere are new upper lobe and peripheral predominant ground-glass opacities\nwith interlobular septal thickening. Mild diffuse bronchial wall thickening\nhas slightly increased.  A right upper lobe opacity with irregular borders is\nnew (5, 117). Small solid nodules measuring up to 4 mm in the subpleural left\nlower lobe are stable since ___ (5: 131, 167, 186). A punctate left\nlower lobe nodule is new (5, 168). There is no pleural abnormality.\n\nImages of the upper abdomen show several hypodense hepatic lesions which have\nbeen previously characterized by MRI as being cavernous hemangiomas (03: 52,\n54, 62).\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "New upper lobe and peripheral predominant ground-glass opacities may be due to\ninfection (e.g. atypical bacterial or viral), or cryptogenic organizing\npneumonia in the setting of graft versus host disease.\n\nStable hepatic cavernous hemangiomas.\n\nMild anemia.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 10:39 AM, 60 minutes after discovery of the\nfindings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  A two vessel aortic\narch is noted.  There is no evidence of penetrating atherosclerotic ulcer or\naortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nSevere centrilobular and paraseptal emphysema are noted.  There is bibasilar\natelectasis identified.  A calcified granuloma is identified within the left\nupper lobe.  Several tiny, millimetric pulmonary nodules are unchanged.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Severe emphysema."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  Incidental note is made of a common origin of the left common\ncarotid and right innominate arteries.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent mediastinal lymph nodes measure up to\n1 cm in short axis in the left precarinal station (series 2, image 46). \nProminent hilar lymph nodes measure up to 1 cm in the right hilus (series 2,\nimage 66). No axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a poorly defined region of ground-glass nodular\nopacities in the lateral right lower lobe with opacification of the associated\nsubsegmental bronchus and generalized asymmetric bronchial wall thickening in\nthe right lower lobe.  There is severe centrilobular emphysema.  There are\nscattered punctate calcified granulomas involving both lungs.  A 4 mm\npulmonary nodule in the right middle lobe abutting the minor fissure is\nunchanged (series 3, image 133).  A 5 mm pulmonary nodule in the right lower\nlobe abutting the major fissure is unchanged (series 3, image 141).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Right lower lobe ground-glass nodular opacities with associated bronchial\nwall thickening and mucus plugging are suspicious for small airways infection\nand/or aspiration.  Prominent mediastinal and right hilar lymph nodes may be\nreactive.\n3. Pulmonary nodules measuring up to 4 mm are unchanged since ___ and require\nno specific follow-up."
        },
        {
            "input": "HEART AND VASCULATURE: The ascending aorta at the level of the main and right\npulmonary artery measures 5.4 cm (series 3: Image 137), previously 5.1 cm on\nMRA from ___.  The descending aorta at the same level now measures 5.2 cm,\npreviously 4.3 cm.  The maximum caliber of the upper abdominal aorta is 5.7\ncm, at the level of the diaphragm, previously measured 4.1 cm on CT scan from\n___.  Of note, this area was not included on the MRA from ___.  There is no\nmediastinal hematoma.  Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are bilateral pleural effusions, left greater than right\nand interlobular septal thickening.  No pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Interlobular septal thickening is demonstrated.  In addition,\nthere is bronchial wall thickening which may be secondary to volume overload\nor chronic inflammation.  Scattered 4 mm pulmonary nodules are demonstrated in\nthe left upper lobe (series 3: Image 61).  There is approximately 6 mm\nnodule/ground-glass opacity in the right upper lobe (series 3: Image 31). \nThere is bilateral dependent atelectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolism.\n2. Interval growth ascending and descending portions of known thoracic aortic\naneurysm.  The most notable enlargement is at the level of the hiatus which\nnow measures 5.7 cm, previously 4.1 cm on CT from ___.  Of note, this level\nwas not included on MRA from ___.\n3. No mediastinal hematoma.\n4. Small bilateral pleural effusions and other signs of fluid overload\nincluding interlobular septal thickening.\n5. Bilateral pulmonary nodules measuring up to 6 mm on the right and 4 mm on\nthe left.  Please see recommendation below.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Moderate coronary\nartery calcifications are seen.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere are multiple mildly-enlarged mediastinal and bilateral hilar lymph\nnodes.  Examples include a 1.9 x 1.3 cm left hilar node (2:60) and a 2.2 x 1.5\ncm subcarinal node (02:59).  There is a 1.0 cm hypodense nodule in the left\nthyroid lobe.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is upper-lobe-predominant paraseptal emphysema. Note is made of\nbronchial wall thickening throughout the lungs with some areas of mild\nbronchiectasis, associated with multiple centrilobular and ___ nodules\nsuggesting acute respiratory bronchiolitis.  Note is made secretions within\nthe lower lobe bronchi associated with focal area of consolidation in the\nright lower lobe suggesting superimposed aspiration.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.   No pulmonary embolus or acute aortic abnormality.\n2.  Diffuse bronchial wall thickening associated with ___ nodules\nthroughout the lungs are compatible with respiratory bronchiolitis. \nSecretions within the bilateral lower lobe bronchi along with a focal area of\nconsolidation in the right lower lobe are likely due to superimposed\naspiration.\n3.  Multiple enlarged mediastinal and hilar lymph nodes are likely reactive,\nhowever these should be reassessed after resolution of the infectious process.\n3.  Moderate paraseptal emphysema.\n\nRECOMMENDATION(S):  Follow-up to complete resolution."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is mild prominence of axillary lymph nodes which are not\npathologically enlarged by CT size criteria.  There is no supraclavicular\nlymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: A precarinal lymph node measures 13 mm, moderately decreased from\n___.  An 11 mm subcarinal lymph node (series 5, image 31) is\nmoderately decreased in size.\n\nHILA: Prominent right hilar lymph nodes not meet CT size criteria for\nlymphadenopathy.  A left hilar lymph node measures up to 10 mm in short axis\n(series 5, image 33).\n\nHEART and PERICARDIUM: There is no pericardial effusion.  Coronary artery\ncalcifications are moderate.  There is no right heart strain.\nPLEURA: There is no pleural effusion or pleural abnormality.\nLUNG:\n\n-AIRWAYS:  There is moderate bronchial wall thickening, bronchiectasis and\nmucous impaction worse at the lung bases, bilaterally with re- demonstrated\nsubtle ___ opacities most conspicuous at the left lung base.  These\nfindings are significantly improved in comparison to the prior examination.\n-VESSELS:  There is an acute appearing pulmonary embolus at the bifurcation of\nthe superior and inferior lingular segmental pulmonary arteries with extension\ninto the proximal left anterior subsegmental pulmonary artery of the left\nlower lobe.  Within the limitations of this non optimized studies there is no\nadditional pulmonary embolus.  There is moderate centrilobular emphysema worse\nat the lung apices, bilaterally.  A granuloma in the periphery right upper\nlobe (series 6, image 150) is incidentally noted.  There is a questioned\nfilling there is a questioned filling defect in the right subclavian vein\n(series 6, image 48).\nCHEST CAGE: There is no evidence of osseous malignancy or infection.",
            "output": "1.  Left-sided segmental and subsegmental pulmonary embolus.  No evidence of\npulmonary infarction or right heart strain.\n2.  There is a questioned filling defect in the right subclavian vein.  This\nlikely represents flow artifact, however clinical correlation is recommended\nand if there is clinical concern an ultrasound may be useful for further\nevaluation.\n3.  Mild to moderate bronchiolitis and associated ___ opacities are\ndramatically improved in comparison to the prior study.  Mediastinal\nlymphadenopathy is significantly improved and likely reactive.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:02 ___, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CTA CHEST:\n\nA type B aortic dissection is again noted extending from the level of the left\nsubclavian artery, with caudal extension into the visualized upper abdomen. \nThe overall thoracic extent of the dissection is unchanged as compared to the\nprior examination, without evidence of cranial/proximal extension, or\ninvolvement of the bilateral common carotid/right subclavian arteries.  There\nis no incidental pulmonary embolus is identified.\n\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  The heart and mediastinum are normal.\nThe pericardium is intact without effusion.  Airways are patent to the\nsubsegmental levels.\n\nDependent bibasilar atelectasis is noted, similar to the prior examination. \nThe lungs are otherwise essentially clear and without focal abnormality. \nThere is no evidence of pleural effusion or pneumothorax.\n\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "Stable appearance of a type B thoracic aortic dissection without evidence of\ninterval cranial/proximal extension.  There is no evidence of dissection\ninvolvement of the right axillary or bilateral common carotid arteries."
        },
        {
            "input": "CTA TORSO:\nPatient is status post type B aortic dissection repair with endovascular graft\nextending from just proximal to the left subclavian artery to the distal\nthoracic aorta.  The left subclavian artery is excluded and not opacified\nproximally but reconstitutes approximately 3 cm distal with the remainder of\nthe subclavian artery appearing opacified.\n\nBeyond the stent the dissection flap remains visible with grossly stable size\nof the false and true lumens.  The celiac trunk, right and left renal arteries\noriginating from the true lumen and are patent.  There has been interval\nplacement of a left proximal renal artery stent which appears patent (2:161). \nThe patent ___ from the true lumen.  The dissection flap ends\napproximately 8 cm from the aortic bifurcation.\n\nTiny amount of thrombus adherent to the wall of the right jugular and\nbrachiocephalic vein is noted not extending to the SVC (02:39).\n\nCT CHEST WITH CONTRAST:\nThyroid is unremarkable.  No lymphadenopathy.  Scattered mediastinal lymph\nnodes are similar to prior not pathologically enlarged by CT size criteria. \nHeart size is normal without pericardial effusion.  The main pulmonary\narteries are enlarged up to 4.3 cm as before.  There is atherosclerotic\ncalcification of the coronary arteries most notably the LAD.\n\nThe tracheobronchial tree is patent to the subsegmental level.  There is no\nbronchial wall thickening.  Lungs are clear without pleural effusion or\npneumothorax.  There is no worrisome pulmonary nodule or opacity.\n\nCT ABDOMEN WITH CONTRAST:\nThe liver enhances normally without focal lesions.  The gallbladder, spleen\nand pancreas are unremarkable.  1.2 cm hypodense nodule in the right adrenal\ngland is incompletely characterize but is statistically most likely a benign\nadrenal adenoma, unchanged since the prior study.\n\nThe stomach, small and large bowel are normal in caliber without obstruction. \nThere is no mesenteric retroperitoneal lymphadenopathy.  There is no free air\nor free fluid.  There is a small fat containing paraumbilical hernia.\n\nCT PELVIS WITH CONTRAST:\nSmall fat containing bilateral inguinal hernias.  The urinary bladder, seminal\nvesicles and prostate are unremarkable.  There is no pelvic wall or inguinal\nlymphadenopathy.\n\nOSSEOUS STRUCTURES: No worrisome blastic or lytic lesions.",
            "output": "1. Expected postoperative appearance following repair of type B aortic\ndissection.\n2. The proximal neck vessels appear normal without evidence of dissection. \nThe excluded left subclavian artery is occluded proximally but reconstitutes\nafter approximately 3 cm.\n3. The main arterial structures of the abdomen and pelvis are patent. \nNotably, the left renal stent is patent and both kidneys enhance\nsymmetrically.\n4. Tiny amount of thrombus adherent to the wall of the right brachiocephalic\nand jugular veins is noted (02:39) but does not extend to the SVC possibly\nsecondary to previous central venous catheter.\n5. Stable enlargement of the main pulmonary artery suggesting component of\npulmonary hypertension.\n6. 1.2 cm hypodense nodule in the right adrenal gland is incompletely\ncharacterized but is statistically most likely an  adrenal adenoma.  Attention\ncan be paid on follow up imaging."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  There is moderate coronary atherosclerotic disease.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  A 12 x 11 mm pulmonary nodule at the left lower lobe has a\nsomewhat spiculated appearance.  There is a 9 x 9 mm pulmonary nodule in the\nleft lower lobe (series 4, image 122).\n\nAdditional scattered pulmonary nodules measure up to 9 mm (series 4, image 41,\n40, 94, 100, 143, 132, 70, 100, 101, 108, 112, 114, 122).\n\nBASE OF NECK:  There is a 19 x 14 mm hypoattenuating lesion in the right lobe\nof the thyroid and 11 mm lesion in the left lobe of the thyroid with a small\nrim calcification.\n\nABDOMEN:  For assessment of the abdomen please see the CT abdomen and pelvis\nfrom the same date.\n\nBONES: A 31 x 16 mm lytic lesion is noted through the midshaft of the right\nhumerus (series 2, image 9).  No additional osseous lesions are seen.\n\nSOFT TISSUES:  A hyperenhancing lesion measuring 13 x 14 mm is noted within\nthe right paraspinal musculature at the level of the thoracic inlet, series 2,\nimage 1.",
            "output": "1. Multiple pulmonary nodules measuring up to 12 mm concerning for metastatic\ndisease.  Paraspinal intramuscular lesion measuring 14 mm at the thoracic\ninlet concerning for metastatic disease.  Known right humeral lytic lesion\nrepresents bony metastasis.\n2. 19 x 14 mm thyroid nodule.  Ultrasound may be performed on a nonemergent\nbasis to further assess."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous in\nattenuation without focal nodularity.  There is no pathologic supraclavicular\nor axillary lymphadenopathy.  The chest wall is unremarkable, aside from mild,\nsymmetric gynecomastia.  Severe narrowing of the left subclavian artery is\nnoted due to heavy calcification.\n\nUPPER ABDOMEN: 4.9 cm and 2.9 cm hypodensities in the right lobe of the liver\nare unchanged from ___.\n\nMEDIASTINUM: Scattered lymph nodes are not pathologically enlarged.\n\nHILA: Evaluation of the hilar lymphadenopathy is limited on this noncontrast\nexam.  However, no definite hilar masses identified.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is trace\npericardial effusion.  Mild calcifications are noted along the coronary\narteries, with a stent along the LAD.  Aortic valvular calcifications are\nminimal.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Pleuroparenchymal scarring is minimal at the apices.  6 mm\nsubpleural nodule at the right apex is likely a continuation of\npleuroparenchymal scarring (05:42).  4 mm nodule with surrounding ground-glass\nopacity in the right lower lobe is superior to the elongated, somewhat\n___ nodules adjacent to the posterior pleural surface (5:165, 168). \nThere is a thick walled cyst in the left upper lobe (5:130), which may be a\nbronchiectatic terminal bronchus with a thick wall.  In the distribution of\nthe bronchi with mucous impaction, there are scattered areas of consolidation\nsurrounding ground-glass opacities (5:168, 176).  12 mm nodule in the left\nlower lobe is likely a part of the consolidation/mucous impaction (5:212). \nThere is a 5 mm elongated nodule with surrounding ground-glass opacity (5:234)\nin the middle of the left lower lobe.  Calcified granuloma is noted in the\nleft lower lobe.\n2. AIRWAYS:  Trace amount of secretions are noted in the left mainstem\nbronchus (5:146), and left lower lobe segmental bronchi extending into the\nconsolidation in the left lower lobe (5:199, 187).  More solid-appearing\nlow-density lesion within the left mainstem bronchus near the bifurcation is\npresumably secretions in the setting of recent bronchoscopy (05:27). \nOtherwise, airways are patent to the subsegmental levels.  Mild bronchiectasis\nis noted bilaterally, left greater than right.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is not dilated.  Hyperdense appearance of the vascular\nwall is likely related to patient's anemic state.\nCHEST CAGE: No suspicious osseous lesion concerning for malignancy or\nmetastatic disease is identified.",
            "output": "1. Consolidation and ground-glass opacities in the left lower lobe in the\nsetting of retained secretions and mucous impaction is most consistent with\npneumonia.  No evidence of abscess.  Focal areas of solid and ground-glass\nnodules in the right lower lobe may be a smaller focus of pneumonia. \nAforementioned left lower lobe pneumonia is likely worse when compared to\nchest radiograph from ___ and the pneumonia may be followed using\nconventional radiograph.  Follow-up with chest CT in 6 weeks is recommended to\ndocument resolution.  At that time, 12 mm left lower lobe nodular\nconsolidation should be re-evaluated to see if longer term follow-up is\nindicated.\n2. No pleural effusion.\n\nRECOMMENDATION(S):  CT chest in 6 weeks"
        },
        {
            "input": "THORACIC INLET:Visualized portions of the base of the neck show no\nabnormality.   The visualized thyroid is normal.  Supraclavicular lymph nodes\nare not enlarged.\n\nTHORACIC LYMPH NODES:  No axillary, mediastinal, or hilar lymphadenopathy is\npresent.\n\nHEART, VESSELS and PERICARDIUM: The thoracic aorta is normal in caliber. \nThere are severe coronary artery calcifications.  Moderate calcific\natherosclerotic disease is seen involving the aortic arch and extending into\nthe visualized head and neck vasculature.  No cardiomegaly.  Small pericardial\neffusion is unchanged.\n\nPLEURA:  No pleural effusion or pneumothorax.\n\nLUNG: Minimal biapical pleuroparenchymal scarring is noted.  As compared to\nthe prior exam there has been interval improvement in consolidative and\nground-glass opacities in the left lower lobe, compatible with resolving\npneumonia. 5 mm left lower lobe nodular consolidation is decreased in size,\npreviously measuring 12 mm (6:237).  Increased consolidative and ground-glass\nopacities at the extreme left lung base are new compared to prior exam (6:298)\nalthough opacities have more generally improved substantially.  Tiny nodular\nopacity in the right lower lobe is decreased in size currently measuring 2 mm,\npreviously 4 mm (6:181).  Scattered pulmonary granulomas are identified\n(6:111, 267).  Airways are patent to the level of the segmental bronchi\nbilaterally.  Again noted is mild diffuse dilatation of airways.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nmultiple hepatic hypodensities measuring up to 4.6 x 3.7 cm (6:304), likely a\nsimple hepatic cyst..",
            "output": "1. Overall much improved left lower lobe pneumonia.  Small portion is new\nsince the prior study.  This does not prove that this is a new or worsening\ninfection although persistent or worsening infectyion at the left lung base is\nnot excluded.\n2. Interval improvement in a tiny nodular opacity in the right lower lobe,\nlikely resolving pneumonia.\n3.  Similar diffuse mild bronchiectasis.\n4. Stable small pericardial effusion.\n5. Extensive coronary artery calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland enhances\nhomogeneously.  No axillary lymphadenopathy.  The soft tissues are\nunremarkable with the exception of bilateral gynecomastia.\n\nUPPER ABDOMEN: Subdiaphragmatic findings are dictated separately under the\nreport for the CT abdomen/pelvis examination, which was performed\nconcurrently.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size, without a pericardial\neffusion.  Heavy multifocal coronary calcifications are noted.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the lung parenchyma is notable for partially\ncalcified scarring in the lung apices bilaterally.  Patchy consolidation in\nthe left lower lobe has slightly increased compared to the prior CT performed\non ___, and is concerning for worsening aspiration or pneumonia.\n2. AIRWAYS:  The trachea is patent.  When compared to the prior CT, there is\nnew mucous plugging within segmental bronchi of the left lower lobe (6:198,\n6:200).\n3. VESSELS:  Thoracic aorta is normal in caliber, with moderate\natherosclerotic calcifications throughout.\nCHEST CAGE: No concerning osseous lesions are identified.",
            "output": "1. Slightly increased patchy left lower lobe consolidation suggestive of\nworsening pneumonia, although there may be a small component of atelectasis\ngiven new areas of mucous plugging in segmental left lower lobe bronchi.\n2. No intrathoracic lymphadenopathy."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  The aorta is\nunfolded and tortuous.  There is atherosclerotic calcification involving the\ndescending thoracic aorta and arch of aorta.  There is mild cardiomegaly. \nThere is moderate coronary artery calcification.  There is no pericardial\neffusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Previously visualized parenchymal opacity in the left lower lobe has\nsignificantly improved and most likely represents a resolving pneumonia. \nMinimal bronchiectasis in the left lower lobe, unchanged.  No new\nconsolidations concerning for pneumonia.  None there is stable biapical\npleuroparenchymal scarring.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions which most likely represent hemangiomas.",
            "output": "Near complete resolution of the left lower lobe parenchymal opacity which most\nlikely represents pneumonia.\n\nStable multiple hypodense liver lesions which could represent hemangiomas.\n\nFocal bronchiectasis in the left lower lobe is unchanged.\n\nMild cardiomegaly.\n\nModerate coronary artery calcification.\n\nAtherosclerotic calcification involving the descending thoracic aorta."
        },
        {
            "input": "The main  pulmonary arteries are well opacified without evidence of perfusion\ndefects to suggest pulmonary embolus. Evaluation for small subsegmental PE is\nlimited due to patient motion.  The main pulmonary artery is normal in size\nmeasuring 2.9 cm. Intra thoracic aorta is normal in caliber without evidence\nof acute aortic syndrome.  The great vessels are normal in appearance.  The\nheart is top normal in size without pericardial effusion.  The\ntracheobronchial tree is patent subsegmental levels.  Moderate bilateral\nnonhemorrhagic pleural effusions are noted. Bibasilar consolidations are most\nconsistent with atelectasis.  Sternotomy wires are in place.\n\nThe study is not tailored for subdiaphragmatic evaluation, intra-abdominal\nascites is partially imaged.\n\nOsseous structures: No suspicious lytic or sclerotic bony lesion seen.",
            "output": "1.  No evidence of pulmonary embolus or acute aortic syndrome.  However, given\npatient motion leading to suboptimal quality of the exam, evaluation for\nsubsegmenal PE is limited.\n2.  Moderate bilateral nonhemorrhagic pleural effusions.\n3.  Bibasilar consolidations, most compatible with atelectasis.\n4.  Ascites.\n\nNOTIFICATION:  Findings discussed with Dr. ___ in person at 3pm ___,\nimmediately following completion of the exam."
        },
        {
            "input": "HEART AND VASCULATURE: The there is extensive calcification of the thoracic\naorta a.  However, the thoracic aorta is normal in caliber.  There are\nextensive coronary artery calcifications.  There are moderate aortic valve\ncalcifications.  The heart, pericardium, and great vessels are within normal\nlimits based on an unenhanced scan.  There is a small pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent. No mediastinal mass or hematoma. PLEURAL SPACES: No pleural effusion\nor pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse moderate to severe, predominantly upper lobe,\ncentrilobular emphysema.  There is complete right middle lobe collapse with a\npossible 1.7 cm nodular obstructing lesion along the right middle lobe hilum\n(5:188).\n\nOtherwise, lungs are without additional masses or areas of parenchymal\nopacification.\n\nThere is focal mild right middle lobe bronchiectasis.  Otherwise, the\nremaining airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please see separately submitted report of CT Abdomen and Pelvis from\nthe same date for description of subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Complete right middle lobe collapse with a possible 1.7 cm obstructing\nlesion. CT chest with contrast and/or bronchoscopy is recommended for further\nevaluation.\n2. Moderate to severe emphysema.\n3. Focal right middle lobe bronchiectasis.\n4. Small pericardial effusion, likely within physiologic range.\n5. Extensive atherosclerotic disease.  Extensive coronary artery\ncalcifications.  Moderate aortic valve calcifications.\n6.  Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  CT chest with contrast and/or bronchoscopy is recommended."
        },
        {
            "input": "Thrombosed right internal jugular vein is partially imaged, series 2, image 1,\nwith the central venous line passing through the thrombosis.  No evidence of\nthrombosis is demonstrated beyond the junction with the right subclavian vein.\n\nAorta is affected by atherosclerotic disease, with ascending aorta measuring\nup to 3.8 cm.  Pulmonary arteries are normal in diameter.\n\nNo pathologically enlarged supraclavicular, mediastinal, hilar or axillary\nlymph nodes demonstrated.\n\nHeart size is normal.  Coronary calcifications are moderate.  There is no\npleural effusion.  There is small pericardial effusion, minimally increased\nsince previous examination.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Extensive\nsecretions are noted within the airways.  No discrete nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Right internal jugular vein thrombosis, chronicity undetermined.  .\n\nPericardial effusion, small, but increased since previous examination.\n\nEmphysema, moderate, chronic bronchitis\n\nExtensive atherosclerotic disease\n\nNo evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis and the corresponding report that will be\nissued separately.\n\nInterval resolution of the right middle lobe collapse.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:48 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THORACIC INLET: Right-sided Port-A-Cath tip projects to the SVC.  There are no\nenlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Small bilateral\nhilar lymph nodes are unchanged.  Stable small pericardial effusion.  The\naorta and pulmonary arteries are normal in caliber.  There is moderate\ncoronary artery calcification.  Extensive atherosclerotic changes involving\nthe aorta are again noted.\n\nPLEURA: There is a trace right pleural effusion.\n\nLUNG: There is moderate to severe diffuse centrilobular emphysema.  No new or\ngrowing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  Osteophytes is seen at the lumbar level.\n\nUPPER ABDOMEN: Please refer to dedicated report on abdomen which has been\ndictated separately",
            "output": "Previously visualized right internal jugular vein thrombus is no longer seen.\n\nRight-sided Port-A-Cath with its tip in the SVC.\n\nModerate to severe emphysema.\n\nNo new or growing pulmonary metastasis.\n\nExtensive atherosclerotic disease involving the aorta\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No discrete soft\ntissue abnormality in the newly severely fat depleted chest wall.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels but substantial in at least left anterior\ndescending coronary artery.  Aortic valvular calcification is mild to\nmoderate.  Aorta and pulmonary arteries are normal size.  Pericardial effusion\nis small, unchanged since ___.\n\nTHORACIC LYMPH NODES: Numerous cm size mediastinal lymph nodes, paratracheal\nstations are slightly larger, as are a 16 x 26 mm wide conglomerate of nodes\nin the right hilum and 13 mm right posterior paraesophageal lymph node that\nwas 9 mm in ___.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.  Right bronchial wall thickening\nin the lower lobes has increased and there is more middle lobe collapse\nsurround ectatic bronchi developed between ___ and ___ and has not\nresolved.  Bronchial wall thickening in the lower lobes has increased in their\nare more secretions retained in the trachea.  There are no pleural\nabnormalities.  Very small regions of peribronchial infiltration in the right\nupper lobe at the base of the left lung, 6:, 6:174, 226, 278 is probably\ninflammatory.  There are no lung lesions that look like metastasis or acute\npneumonia.\n\nCHEST CAGE: No pathological compression fractures or destructive bone lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "New cachexia..\n\nMild diffuse central lymph node enlargement probably reactive, perhaps in\nresponse to chemotherapy.\n\nNo good evidence for pulmonary metastasis.\n\nIncreased moderate bronchial inflammation at the lung bases and small areas of\ndiscrete inflammation could be due to endobronchial infection or aspiration.\n\nSevere emphysema.  Nonobstructed right middle lobe collapse persists."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  Mild mediastinal and bilateral hilar lymphadenopathy is\nunchanged compared to the prior exam.  Mild cardiomegaly is seen.  Small\npleural effusion is unchanged compared to the prior exam.  The main pulmonary\nartery is grossly unremarkable.  The esophagus is normal.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nSevere emphysema is seen.  Right middle lobe collapse surrounding ectatic\nbronchi, is unchanged compared to the prior exam.  The bronchial wall\nthickening within the right lower lobe has slightly improved compared to the\nprior exam.\n\nCurvilinear nodular density measuring 7 mm within the right upper lobe (5;\n131), is unchanged compared to the prior exam.  No definite new or concerning\npulmonary nodules are identified.  There is no pleural effusion or\npneumothorax.",
            "output": "-Stable 7 mm curvilinear nodular density within the right upper lobe without\nevidence of concerning new or growing pulmonary nodules (5; 131).\n-Stable mild hilar and mediastinal lymphadenopathy.\n-Severe emphysema.  Unchanged right middle lobe collapse surrounding ectatic\nbronchi.\n-Interval improvement of right lower lobe bronchial inflammation."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue mass or\nfluid collection in the fat depleted chest wall.  Findings below the diaphragm\nwill be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable, despite subcarinal mediastinal\nadenopathy.  Atherosclerotic calcification is moderately heavy in head and\nneck vessels and severe in 3 coronary arteries.  Aortic valvular calcification\nis mild to moderate.  Heavily calcified ascending thoracic aorta is normal\ncaliber.  Pulmonary arteries not enlarged.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Mediastinum:\n\nLeft lower paratracheal station, 15 mm, 17:124, unchanged since ___.\n\nSubcarinal, 12 mm, unchanged.  Left posterior paraesophageal, 13 mm,\nunchanged.\n\nRight hilus upper pole, 15 x 28 mm, unchanged.  Right hilus, 13 mm, severely\nnarrowing medial segmental middle lobe bronchus.  Unchanged.\n\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.\n\nNodules: None concerning for malignancy.\n\nTracheobronchial tree is heavily filled with retained secretions, no clear\nsolid impactions.\n\nRight middle lobe is chronically collapsed, traversed by moderately dilated\ncentral bronchi, cause uncertain.  At one time it appeared to contain a 2 cm\nwide mass, but that appearance is uncertain.\n\nNo pleural abnormalities.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No change, mild to moderate central lymph node enlargement.\n\nNo lung lesions particularly suspicious for metastasis.\n\nSevere emphysema."
        },
        {
            "input": "CTA THORAX:  The aorta and main thoracic vessels are well opacified.  The\naorta demonstrates normal caliber throughout the chest without evidence of\nintramural hematoma or dissection.  The pulmonary artery is well opacified to\nsubsegmental levels without filling defect to suggest pulmonary embolism.\n\n\nCT OF THE THORAX:  The included thyroid enhances homogeneously.  The esophagus\nis unremarkable without evidence of hiatus hernia.  There are multiple\nenlarged mediastinal lymph nodes.  For example, a right paratracheal lymph\nnode measures 19 mm; an AP window lymph node measures 17 mm.  These are mildly\nmore prominent comparison to chest the from ___.  There is severe\nglobal cardiomegaly.  There is no evidence of axillary, supraclavicular, or\nhilar lymphadenopathy.  The airways are patent to subsegmental levels.\n\nLung windows demonstrate interlobular septal thickening and ground-glass\nopacities most prominent at the lung apices, compatible with congestion and/or\nvolume overload.  Moderate bilateral layering pleural effusions are seen with\nadjacent relaxation atelectasis in the lower lungs.  There is no evidence of\nmass or nodule.\n\nThe partially imaged solid and hollow viscous organs of the upper abdomen are\nunremarkable.\n\nOSSEOUS STRUCTURES: The imaged thoracic spine is unremarkable.  Alignment is\nnormal.  There is no evidence of focal lytic or sclerotic osseous lesion. \nMultiple old bilateral rib fractures are identified.",
            "output": "1. No evidence of aortic dissection or pulmonary embolism.\n2. Diffuse interlobular septal thickening with ground-glass opacities, most\nprominent the lung apices, compatible with congestion and/or volume overload\nand possibly early pulmonary edema.\n3. Severe global cardiomegaly.\n4. Moderate bilateral layering pleural effusions with adjacent lower lung\nrelaxation atelectasis.\n5. Multiple pathologically enlarged mediastinal lymph nodes, mildly more\nprominent than on CT from ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable.  No axillary\nadenopathy.\n\nUPPER ABDOMEN: Within the limitations of this unenhanced scan the visualized\nstructures of the upper abdomen are unremarkable.  There is a small hiatal\nhernia.\n\nMEDIASTINUM: No abnormal mediastinal masses or pathologically enlarged\nmediastinal lymph node.\n\nHILA: No abnormal hilar masses or pathologically enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Cardiomegaly.  Aortic valve replacement is noted in\nsitu.  No pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Minimal atelectasis of the dependent lung bases bilaterally. \nNo suspicious pulmonary nodules or consolidation.\n2. AIRWAYS:  Patent to subsegmental level.\n3. VESSELS:  Coronary artery vascular calcifications and aortic root\ncalcifications are noted.\nCHEST CAGE: There is thickening and stranding of the presternal anterior\nmidline soft tissues (extending from the manubrium to the distal xiphoid\nprocess), particularly at the level of the manubrium around the first and\nsecond sutures, in keeping with recent prior thoracotomy performed 3 months\nago (602:72).  Although the median sternotomy wires remain aligned and intact,\nthere is nonunion of the apposition sternal and manubrial halves which\ndemonstrate reason option of the apposition ends.  A short linear sinus tract\n___: 74) extends from the manubrium at the level of the first and second\nsternal wire anteriorly to the skin.  There is no organized drainable fluid\ncollection, soft tissue gas or abnormal erosion of the remainder of the\nsternum and manubrium.  Bilateral gynecomastia is incidentally noted.",
            "output": "1. 3 months status post aortic valve replacement, although the above described\nsinus tract, nonunion of the appositioned sternum and stranding of the midline\npresternal soft tissues could represent evolving postsurgical changes,\nosteomyelitis cannot be excluded particularly at the proximal manubrium at the\nlevel of the first and second sternal wire.\n2. No organized drainable fluid collection, abnormal soft tissue gas or\nosseous erosion."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries or cardiac valves,\nmild in the aorta.  The pulmonary arteries and aorta are normal in caliber\nthroughout.  No filling defect in the main pulmonary artery throughout and\nsubsegmental branches bilaterally.  No aortic dissection, aneurysmal dilation\nor penetrating atherosclerotic ulcers.  No evidence of right heart strain.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Prior surgery to the right breast.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is mildly patulous but otherwise unremarkable.  Small\nmediastinal lymph nodes, not pathologically enlarged by CT size criteria.  No\nhilar lymphadenopathy.\n\nPLEURA:\nModerate bilateral pleural effusions, right greater than left.  No apical\nscarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  Respiratory motion artifacts impair optimal\nparenchymal evaluation.  Small air pockets in the anterior right hemithorax\n(301:68).  Partial compressive atelectasis in both lower lobes.\n\nCHEST CAGE:\nRecent rib fractures in the right anterior third through fifth and left\nanterior second and third ribs with slight displacement.  Healing fractures in\nthe left anterior third through fifth ribs.  Moderate dorsal spondylosis.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nRecent bilateral rib fractures showing some displacement with an associated\nsmall pneumothorax.  There are no associated lung contusions or lacerations."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Notable skin thickening of the left breast (302:156).  No\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries and cardiac valves,\nmild in the aorta.  The pulmonary arteries and aorta are normal in caliber\nthroughout.  Incidental filling defect in segmental branches of the right\ninferior pulmonary arteries (302:134).  No evidence of right heart strain.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nModerate bilateral pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the to subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No suspicious lung nodules or\nmasses.  Partial compressive atelectasis noted in both lower lobes.\n\nCHEST CAGE:\nRecent rib fractures in the right anterior third through fifth and right\nanterior ninth, the left anterior third through second through fifth ribs. \nMild dorsal spondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Incidental pulmonary emboli noted in the segmental branches of the right\nanterior pulmonary artery.\nRelatively unchanged bilateral moderate pleural effusions.\nMultiple bilateral rib fractures.\nInterval thickening of the left breast skin, possibly representing a\ncontusion.\n\nNOTIFICATION:  The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 3:41 pm."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries or cardiac valves,\nmild in the aorta.  The pulmonary arteries and aorta are normal in caliber\nthroughout.  No evidence of aortic dissection, penetrating atherosclerotic\nalso or aneurysmal dilations.  Redemonstration of filling defects the\nsegmental branches of the right inferior pulmonary artery (301:134), no other\nfilling defects are noted.  No evidence of right heart strain.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Demonstration of skin thickening and asymmetric breast tissue\nto the left, possibly related to a contusion in the setting of trauma. \nSurgical clip is noted in the right breast.  No atherosclerotic calcifications\nin the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nSmall bilateral pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation.  The\nairways are patent to the subsegmental levels.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  Partial compressive atelectasis in both\nlower lobes.  Small scattered calcified granulomas for example in the left\nlower lobe (301:104).  No suspicious lung nodules or masses.\n\nCHEST CAGE:\nRedemonstration of multiple bilateral rib fractures.  No suspicious lytic or\nsclerotic lesions.  Mild dorsal spondylosis.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "As previously noted in the chest CT from ___, there are segmental\npulmonary emboli in the right inferior pulmonary artery.\nRedemonstration of a left breast hematoma or infectious phlegmon.  The\ndevelopment of this 10 days after trauma raises concern for developing\nmastitis, for which clinical correlation is recommended.  Consider breast\nultrasound for better evaluation as well."
        },
        {
            "input": "HEART AND VASCULATURE: Of note, this is a suboptimal study due to bolus\ntiming.  However, there are bilateral filling defects seen in the right and\nleft main pulmonary arteries extending into the subsegmental branches of\nmultiple lobes including the right lower lobe, left lower lobe, left upper\nlobes.  The interventricular septum is mildly straightened with mild\nprominence of the main pulmonary artery, worrisome for right ventricular\nstrain.   The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Of note, this is a suboptimal study due to bolus timing.  However, there\nare extensive bilateral filling defects seen within the right and left main\npulmonary arteries extending into the subsegmental branches involving multiple\nlobes including the right lower lobe, left lower lobe and left upper lobe.\n2.  The interventricular septum is mildly straightened with mild prominence of\nthe main pulmonary artery, worrisome for right ventricular strain.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 5:18 am, 1 minutes after discovery of\nthe findings.\n\n The findings were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 9:23 am, 1 minutes after discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited images of the upper abdomen are notable for postoperative\nchanges of prior gastric bypass.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nThere is an oblong soft tissue density at the upper portion of the right\nbreast measuring 1.4 x 2.5 cm (03:23).",
            "output": "1. No pulmonary embolism or acute aortic syndrome on the current exam.\nPreviously seen pulmonary emboli are no longer visualized.\n2. Oblong soft tissue density at the upper aspect of the right breast for\nwhich mammographic imaging is suggested unless performed elsewhere.\n\nRECOMMENDATION(S):  Outpatient mammographic workup unless performed recently."
        },
        {
            "input": "There are no pathologically enlarged mediastinal hilar or axillary lymph\nnodes. No abnormality corresponding to the should suspected widening of the\nmediastinum on the chest radiograph demonstrated. Several mediastinal lymph\nnodes are sub 10 mm with the largest 1 in the aortopulmonic window being 8.8\nmm, series 3, image 23.  Aorta and pulmonary arteries are normal in diameter.\nNo hilar or axillary lymphadenopathy seen. The patient is after left breast\nand axillary surgery. No pericardial pleural effusion is present. Heart size\nis normal.\n\nImage portion of the upper abdomen demonstrate several liver and spleen\nhypodensities it needs to be further characterized. In addition there are\nmultiple hypodensities within the pancreas, with the largest 1 in the body of\nthe pancreas approaching 22 x 16.5 mm, as well as additional abnormality\nwithin the pancreatic head hypodense but solid approaching 19.8 x 16.4 mm.\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no pulmonary nodules worrisome for metastatic disease demonstrated.",
            "output": "No definitive evidence of intrathoracic metastatic spread. Status post left\nbreast and axillary surgery\n\nMultiple intra-abdominal abnormalities including pancreas, liver and spleen\nthat should be further characterized by dedicated abdominal imaging preferably\nMRI of the pancreas as well has liver and spleen."
        },
        {
            "input": "The thyroid gland is somewhat heterogeneous with no discrete nodules\nidentified. No mediastinal or hilar lymphadenopathy is detected. Numerous\nsmall axillary lymph nodes are stable and not enlarged. The esophagus is\nunremarkable. The thoracic aorta is normal in caliber with a typical 3 vessel\ntakeoff from the arch. The pulmonary arterial trunk is normal in caliber. The\nheart is normal in size without pericardial effusion. There is redemonstration\nof skin thickening surrounding the right breast, consistent with prior history\nof breast reduction and lifting.\n\nThe tracheobronchial tree is normal to the subsegmental levels. The airways\nare normal in caliber. Within the pulmonary parenchyma, there is no\ninterstitial abnormality. There is no pleural effusion or pneumothorax.  Left\nlower lobe nodule is stable, measuring 5 x 4 mm (series 4, image 156). There\nis redemonstration of tiny nodules adjacent to the pleura in the right lower\nlobe (series 4 image 172) and left upper lobe (series 4, image 103). Tiny\ncalcified granuloma is seen in the right lung.  No new nodules identified.\n\nFocus of sclerosis in the T4 vertebral body is stable (series 4, image 75). No\nnew blastic or lytic lesion suspicious for malignancy is present.\n\nAlthough this study is not designed for evaluation of subdiaphragmatic\nstructures, note is made of surgical clips in the right upper quadrant, likely\nrelated to prior cholecystectomy. Otherwise, visualized upper abdominal organs\nare normal.",
            "output": "1. Stable pulmonary nodules. No new pulmonary nodules identified.\n\n2. Unchanged 4 mm sclerotic lesion in the T4 vertebral body. No new focal\nosseous lesions identified."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy\nor infection.\n\nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is mild in the head\nand neck vessels, but moderate to severe distributed throughout the coronary\narteries.  Aorta is normal size, but pulmonary arteries are dilated, main 33\nmm, right 30 mm.  Pericardial effusion is small.\n\nModerate nonhemorrhagic bilateral pleural effusions layer posteriorly,\nprobably contributing to collapse of nearly all the basal segments of both\nlower lobes.  Configuration of the trachea at suggests a propensity to malacia\nwhich is probably responsible for narrowing of the bronchus intermedius and\nthe basal trunk bronchi in both lower lobes, another factor in basal\natelectasis.  There is no central mass or adenopathy.  Respiratory motion\nobscures fine detail in the upper lungs, but there is no pneumonia.  There is\nperhaps mild edema.  The small focus of atelectasis in the right middle lobe\nalong the heart border should not be mistaken for a nodule.\n\nSevere disc degeneration is responsible for osteophytes, disc space narrowing\nand vacuum discs in the mid and lower thoracic spine.  Fusion of 3 mid\nthoracic for vertebrae could be congenital or post inflammatory, but there is\nno evidence of infection currently.",
            "output": "No pneumonia, empyema, or evidence of intrathoracic infection or malignancy.\n\nBronchomalacia and moderate nonhemorrhagic layering bilateral pleural\neffusions contribute to severe bibasilar atelectasis.\n\nPossible pulmonary arterial hypertension."
        },
        {
            "input": "Th images are severely limited due to motion and overlying soft tissue.\n\nHEART AND VASCULATURE: Pulmonary vasculature is not well opacified beyond the\nlobar level although no filling defect to indicate a pulmonary embolus is\nseen.  The segmental and subsegmental pulmonary arteries are poorly assessed. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are essentially clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Limited assessment. No central or lobar pulmonary embolus.\n2. No evidence of acute aortic abnormality."
        },
        {
            "input": "There are no supraclavicular or axillary lymph nodes or soft tissue lesions in\nthe imaged chest wall suspicious for malignancy.  Thyroid and esophagus are\nunremarkable.  Atherosclerotic calcification is not evident. There is no\npleural or pericardial abnormality. Aorta, pulmonary arteries, and cardiac\nchambers are normal size.\n\nAside from minimal subpleural atelectasis, which in the lower lungs has a\nmildly nodular appearance, lungs are clear. Tracheobronchial tree is normal to\nsubsegmental levels. Bilateral posterior diaphragmatic (Bochdalek) hernias\ntransmitted only sub phrenic fat.",
            "output": "Normal chest CT. Although I do not see any lung nodules, the referenced\nprevious chest CTA should be obtained so that I can review it."
        },
        {
            "input": "THORACIC INLET: The thyroid has a heterogeneous appearance with a small nodule\nin the right lobe of thyroid.  There are no enlarged supraclavicular lymph\nnodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal nodes not enlarged by size criteria. \nThere is moderate cardiomegaly.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Patient is status post right upper lobectomy with acceptable\npostsurgical and post radiation changes to the right hemithorax.  There is\nevidence of parenchymal distortion and distortion of the right hilum which is\nmost likely related to combination of radiation therapy changes.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows wedge-shaped\nhyperenhancing lesion in the right lobe of liver (2, 29.  No adrenal masses\nare seen.",
            "output": "Status post right upper lobectomy with acceptable postsurgical and post\nradiation changes to the right hemithorax.  No evidence of local recurrence.\n\nNo evidence of metastasis to the chest.\n\nModerate to severe cardiomegaly.\n\nWedge-shaped enhancing focus in the right lobe of liver."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there is no soft\ntissue abnormality in the imaged chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis particularly in light of\nmultiple hypodensities in the liver which require dedicated abdominal imaging\nfor evaluation.\n\nMildly and symmetrically enlarged, free of filling defects, and does not\nnarrow the trachea.  Atherosclerotic calcification is not apparent in the head\nand neck vessels or in the coronaries.  Aorta and central pulmonary arteries\nare free of filling defects.  Heart is not overall enlarged.\n\nThere is no pleural or pericardial abnormality.\n\nA right lower paratracheal lymph node is 11 x 20 mm, but largely fat replaced.\nOther Mediastinal and hilar lymph nodes are not enlarged and there is no\nadenopathy in the retrocrural or diaphragmatic stations.\n\nEmphysema is mild.  Lungs are otherwise clear.  There are no bone lesions in\nthe chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  There is a small 5 mm hypodensity in the left\nlobe of the thyroid gland, an incidental finding.  Otherwise, the thyroid is\nhomogeneous.  Supraclavicular and axillary lymph nodes are not enlarged. \nThere is no calcification of the head and neck vessels.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  Heart size is normal.  There is no coronary arterial or cardiac\nvalvular calcification.  There is no pericardial effusion.\n\nVESSELS:  Thoracic aorta and main pulmonary artery are normal in size.  The\nright PICC line terminates in the right ventricle.\n\nPULMONARY PARENCHYMA:  There is mild dependent bibasilar atelectasis.  There\nis some scarring atelectasis in right upper lobe.  Distorted architecture with\nradiolucencies in the left lower lobe likely reflect scarring from old\ninfection (3:30).   There is no evidence of infection or malignancy.  There is\nno emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no soft tissue abnormality within the chest\nwall.  There are no lytic or sclerotic lesions suspicious for metastasis in\nthe chest cage or thoracic spine.\n\nUPPER ABDOMEN:  The study is not tailored for evaluation of subdiaphragmatic\nstructures.  Please see separate, same-day CT abdomen and pelvis report for\ndescription of subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Distorted architecture with radiolucencies in the left upper lobe likely\nreflects scarring in the left upper lobe.\n3. Scarring atelectasis in the right upper lobe.\n4. Please see separate, same-day CT abdomen and pelvis report for description\nof subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneous.  No\nlymphadenopathy.  The left breast contains a metallic clip (___).\n\nUPPER ABDOMEN: Multiple hypodense lesions throughout the liver, likely\nrepresenting cysts or biliary hamartomas.  Partially imaged simple cyst in the\nupper pole of the right kidney.\n\nMEDIASTINUM: No lymphadenopathy or mass.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is mildly enlarged.  Mild circumflex artery\ncalcification. The aortic valve and mitral annulus contain calcifications.  No\npericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is bibasilar atelectasis.  No pulmonary nodules.There is\nsubpleural fibrosis or dense atelectasis in the anterior left upper lobe, in a\npattern often seen in patients who have undergone prior breast radiation.\n2. AIRWAYS:  Patent to the subsegmental levels.\n3. VESSELS:  No evidence of pulmonary embolism on this non PE protocol study.\nCHEST CAGE:  There is grade 1 retrolisthesis of T12 on L1. Age indeterminate\ncompression deformity of the T12 vertebral body with approximately 70% height\nloss (602 B/70) and moderate retropulsion into the bony spinal canal.  There\nare degenerative changes the bilateral glenohumeral joints.  Extensive\ndegenerative changes of the visualized spine.",
            "output": "1. No pulmonary nodules, as clinically questioned.\n2. Age indeterminate T12 vertebral body compression deformity with\napproximately 70% height loss and moderate retropulsion into the bony spinal\ncanal."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is limited assessment of the right upper subsegmental pulmonary arteries\ndue to motion. There is no evidence of filling defect within the main, right,\nleft, lobar, segmental pulmonary arteries.  The main and right pulmonary\narteries are normal in caliber, and there is no evidence of right heart\nstrain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMotion artifact limits evaluation of the lung parenchyma.  Right upper lobe\natelectasis is mild.  There are bibasilar patchy consolidations with a few air\nbronchograms, which can be seen in the setting of pneumonia.  Patchy and\nconfluent opacity in the right middle lobe and lingula likely represent\ninfection. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrates diffuse hypoattenuation of\nthe liver suggestive of hepatic steatosis.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMultilevel degenerative changes of the visualized spine.",
            "output": "1. No pulmonary embolus detected to the segmental levels.  No acute aortic\nabnormality.\n2. Multifocal pneumonia.\n3. Suggestion of hepatic steatosis.  Correlation with LFTs is recommended."
        },
        {
            "input": "11 mm hypodense left thyroid nodule is unchanged since ___ and was\npreviously evaluated by ultrasound. There is no residual thymic tissue or\nenhancing mass in the anterior mediastinum.\n\nHeart size is normal with note made of dense coronary artery calcifications.\nThere is no significant pericardial fluid. The aortic arch and main pulmonary\nartery are normal in caliber. Note is made of a thrombosed aberrant left\nsubclavian artery with a grossly patent left subclavian stent graft in place.\nThere is no central pulmonary embolus. There is no supraclavicular, axillary,\nhilar or mediastinal lymphadenopathy by CT size criterion.\n\nThough this study is not tailored for subdiaphragmatic evaluation, the imaged\nupper abdomen is grossly unremarkable. Bilateral breast implants are in place.\n\nThe airways are patent to the subsegmental level. Biapical scarring is\nminimal. 2 5 mm areas of ground-glass in the right upper lobe (5:70, 77) are\nnonspecific. There is an additional 1 cm area of ground-glass density in the\nright lower lobe. 4 mm ground-glass nodule is noted in the left lower lobe\n(5:119). Additional 5 mm ground-glass nodule is located in the periphery of\nthe apical posterior segment of the left upper lobe (05:53). Linear\natelectasis is noted in the lingula. Pleural surfaces are clear without\neffusion or pneumothorax.\n\nOsseous structures: There are diffuse degenerative changes of the thoracic\nspine. Median sternotomy wires are intact. There is prominent chronic\ndeformity of the left humeral head from old fracture. There is no suspicious\nfocal osseous lesion.",
            "output": "1. No anterior mediastinal mass to suggest thymoma.\n2. Scattered areas of ground-glass nodularity in multiple lobes measuring up\nto 1 cm in the right lower lobe. The etiology is non-specific but may\nrepresent infection or inflammation.\n3. 11 mm left thyroid nodule stable since ___ and previously\nevaluated by ultrasound."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes. Right chest wall port catheter terminates\nat the cavoatrial junction. Heart size is normal and there is no pericardial\neffusion. Coronary artery and aortic valve calcifications are mild.  The aorta\nand main pulmonary artery are normal in caliber.  The distal esophagus is\nnormal and the subdiaphragmatic findings will be dictated in a separate report\nno significant abnormality within the chest wall.\n\nLungs:The airways are patent to the subsegmental level bilaterally. The lungs\nare clear with no concerning nodules, opacities, or pleural effusion. There is\nno pneumothorax.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "CHEST:\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged by CT criteria. The aorta and pulmonary arteries are\nnormal in size. The heart is not enlarged. No appreciable coronary\ncalcification. No pericardial effusion. No hiatal hernia.\n\nThe lungs are clear. The tracheobronchial tree is patent to the subsegmental\nlevel bilaterally. No suspicious nodules or masses. No pleural effusion or\npneumothorax.\n\nThe right-sided Port-A-Cath appears intact and unchanged in position. No\nsuspicious lytic or sclerotic bony lesions within the thoracic cage.\n\nABDOMEN/PELVIS:\nA description of the sub-diaphragmatic findings can be found in the dedicated\nreport for the CT abdomen and pelvis exam performed on the same day.",
            "output": "No evidence of active intrathoracic infection or malignancy. Please refer to\nthe dedicated report for the CT abdomen and pelvis exam performed on the same\nday."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes. Heart size\nis normal, and there is no pericardial or pleural effusion.\n\nSkeletal structures demonstrate no new suspicious lytic or blastic lesions in\nthe thorax.\n\nWithin the lungs, no new or growing pulmonary nodules are detected. Focal\natelectasis is noted in the right lung base. A dependent 7 mil low-density\nopacity in the proximal trachea posteriorly at the level of the thoracic inlet\nlikely reflects retained secretions (image 39, series 4)",
            "output": "1. No definite CT evidence of intrathoracic metastatic disease.  7 mm\ndependent opacity in proximal trachea is very likely due to retained\nsecretions. Attention to this region on next scheduled surveillance CT is\nrecommended. Alternatively, the patient could return sooner for limited prone\nimages through this region to assess for clearance.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings"
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.   The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  The previously described dependent low-density\nopacity in the proximal trachea is not visualized on this study, and likely\nrepresented retained secretions.  There is no airspace consolidation.  There\nare minimal changes associated with centrilobular emphysema.  There are no\nconcerning pulmonary nodules.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1.   No evidence of intrathoracic metastatic disease.\n\n2.  Minimal centrilobular emphysema.\n\n3.  Findings within the abdomen and pelvis will be reported separately by the\nAbdominal Radiology division."
        },
        {
            "input": "Within the lungs, minimal centrilobular and paraseptal emphysema are present\nas well as mild dependent atelectasis of the lung bases.  A 2 mm diameter\nsubpleural right apical nodule (47, 5) is unchanged since ___ and\nunlikely to represent a metastatic focus.  No new or growing nodules are\ndetected.\n\nNo enlarged intrathoracic lymph nodes are present.  Heart size is normal, and\nno pericardial or pleural effusion is evident.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1. No CT evidence of pulmonary metastases.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum and at the level of the hilar structures.  Mild\nor aortic wall calcifications.  Mild coronary calcifications, no pericardial\neffusion.  Normal appearance of the posterior mediastinum.  Upper abdominal\nfindings are described in detail in the dedicated abdominal CT report from ___.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nMillimetric left apical subpleural granuloma (5, 41).  No pleural effusions. \nNo diffuse lung disease.  The airways are patent.  No suspicious pulmonary\nnodules or masses.",
            "output": "No evidence of metastatic disease to the thorax.  No pleural effusions.  No\nadenopathy."
        },
        {
            "input": "The sternum is intact and there is no retrosternal hemorrhage. The overlying\nsoft tissues are unremarkable.\n\nThe thyroid gland is normal.  There are no pathologically enlarged axillary or\nmediastinal lymph nodes. The hilar contours are normal.  The thoracic aorta is\nnormal in caliber with a typical three vessel takeoff from the arch.  The\npulmonary arterial trunk is normal in caliber.  The heart is normal in size\nwithout pericardial effusion.\n\nThe tracheobronchial tree is normal to the subsegmental levels. The airways\nare normal in caliber.  The lungs are fully expanded and clear.  2 mm\nsubpleural nodule in the left lower lobe has the typical appearance of the\nlymphoid aggregate (5:186). There is no pleural abnormality.\n\nThis exam is not tailored for subdiaphragmatic evaluation. The imaged portions\nof the upper abdomen are normal. There is no blastic or lytic lesion\nsuspicious for malignancy.",
            "output": "No fracture."
        },
        {
            "input": "Thyroid is unremarkable.  There is no axillary or supraclavicular adenopathy. \nThere are scattered mediastinal lymph nodes measuring up to 8 mm, but none\nthat are pathologically enlarged.  Heart is moderately enlarged.  Coronary\nartery and aortic valvular calcifications are severe.  Post surgical changes\nfrom prior CABG are present.  The main pulmonary trunk is not dilated.\nThoracic aorta is normal in caliber with mild atherosclerotic disease.\n\nThe airways are patent to the segmental level bilaterally.  Right lung is\nnotable for mild basilar atelectasis.  There is a rounded consolidation at the\nleft lung apex, with nodular opacity, ___, and ground-glass opacity\nextending inferiorly.  There is no associated cavitation.  Suture line as well\nas scarring is noted in the lingula.  There is a 2 mm right lower lobe\npulmonary nodule (series 4, image 132).  There is a calcified granuloma at the\nright lung base.  There is no pleural effusion or pneumothorax.  There are no\nsuspicious pulmonary nodules.\n\nThe thoracic esophagus is unremarkable.  Relative low density of the blood\npool likely reflects underlying anemia.  Limited views of the upper abdomen\nare notable for bilateral adrenal thickening.  There is trace intra-abdominal\nascites.  The liver is dense in attenuation, which could relate to\nchemotherapeutic agents.  There is a fluid containing small ventral abdominal\nwall hernia.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: There are no suspicious bony lesions.  Median\nsternotomy wires are intact.",
            "output": "Rounded consolidation in the right lung apex with areas of ground-glass and\n___ opacity, consistent with pneumonia, most likely bacterial.  While\nthere are no specific findings to suggest fungal infection, in the setting of\nthe patient's immunocompromised status mucormycosis would also need to be\nconsidered.\n\nRECOMMENDATION(S):  Short-term followup chest radiograph (tomorrow) to ensure\nthat there is no rapid progression of disease.  Additionally, follow-up chest\nradiograph is recommended after treatment to demonstrate resolution."
        },
        {
            "input": "CT CHEST WITHOUT CONTRAST: The thyroid is unremarkable.  There is no axillary\nsupraclavicular lymphadenopathy.  Small scattered mediastinal lymph nodes are\nunchanged.\n\nThe heart is moderately enlarged as before.  Again there are severe coronary\nartery and aortic valvular calcifications.  There are postsurgical changes\nfrom prior CABG.  The main pulmonary artery is not dilated.  The thoracic\naorta is normal in caliber with mild atherosclerotic disease.  Suggestion of\nanemia.\n\nThe airways are patent to the subsegmental level bilaterally.  There is no\npleural effusion or pneumothorax.\n\nConsolidation in the left upper lobe has mildly decreased since prior. \nSurrounding ground-glass opacities and small solid nodules have significantly\nimproved.  A small opacity in the left lower lobe series 4, image 179 has\ndeveloped, possibly represents mucous plugging, or spread of infection again\nthere is a suture line and scarring in the lingula.  Minimal atelectasis in\nthe left lower lobe is worse.  There is mild bronchial wall thickening in the\nlower lobes.\n\n2 mm right lower lobe nodule (4:146) is unchanged.  Further inferiorly a\npunctate 1-2 mm nodule (4:155) was not definitely seen on the prior study and\nis likely inflammatory.  Stable small nodule in the right middle lobe.\n\nOSSEOUS STRUCTURES: There is no suspicious osseous lesion.  Median sternotomy\nwires are intact.  There is severe degenerative change right shoulder. \nPartially imaged degenerative change in the lower cervical spine with\nanterolisthesis of C7 on T1.\n\nUPPER ABDOMEN: As before there is mild bilateral adrenal thickening which may\nreflect hyperplasia in the setting of chronic disease.  There is a small\namount of intra-abdominal ascites.  Diffuse mild hyper attenuation of the\nliver parenchyma, can be seen with iron deposition, liver storage diseases,\nwith some medication use, including amiodarone.  There is a small fluid\ncontaining ventral abdominal wall hernia as before.",
            "output": "Mild interval decrease of left upper lobe consolidation, surrounding nodules,\nground-glass opacities.\nNew small opacity in the left lower ___ represent mucous plugging or\ninfection.\nRemainder as above"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery and aortic valve calcifications are\nmild.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar dependent atelectasis.  Multiple small\nbilateral pulmonary nodules are identified measuring up to 2 mm:\n\n-2 mm right lung apex pulmonary nodule (03:28).\n-2 mm right lower lobe pulmonary nodule (2:90).\n-2 mm left upper lobe pulmonary nodule (3:105).\nNo areas of abnormal parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck are notable for an\nincompletely evaluated 4 mm left thyroid hypodensity (3:1).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES/SOFT TISSUES: A 0.8 x 0.6 x 0.9 cm ossific density seen along the left\nlateral aspect spinal canal at the level of the T4-T5 vertebral bodies is not\nwell evaluated on current exam and results in mild-to-moderate spinal canal\nstenosis (3:50, 602:32).  No additional aggressive osseous lesions are\nidentified.  There is no acute fracture.  Post procedural changes in the right\nbreast are in keeping with provided history of breast cancer.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multiple bilateral pulmonary nodules measure up to 2 mm.  In the setting of\nno prior CT chest examinations for comparison and reported history of breast\ncancer a repeat noncontrast CT chest in the next ___ months is recommended to\nassess stability.\n3. 0.9 cm ossific density within the left lateral spinal canal at T4-T5 is\nincompletely evaluated on current exam with differential considerations\nincluding spinal meningioma.  This may be clarified with dedicated nonurgent\nMR imaging if clinically necessary."
        },
        {
            "input": "Intraluminal filling defect is present in the distal left pulmonary artery at\nits bifurcation site, extending distally into the descending/interlobar branch\nand lingular artery with associated mild vascular distension.  There are no\nenlarged intrathoracic lymph nodes.  Heart size is upper limits of normal and\ndiffuse coronary artery calcifications are present. No pericardial or pleural\neffusion is seen.\n\nWithin the lungs, a part solid nodule is present in the left upper lobe with\nthe ground-glass component measuring up to 2.5 cm and solid component\nmeasuring up to 1 cm, apparently new from ___.  Adjacent area\nperibronchiolar infiltration is present more centrally in the left upper lobe\n(76, 6), also demonstrating a spherical configuration on coronal reformations\nimages.  Additional focal peribronchiolar infiltration in the right upper lobe\n(134,6).\n\nDependent opacities in both lower lobes probably reflect dependent atelectasis\non this exam is limited by submaximal inspiratory level.  Lungs are otherwise\nremarkable for focal scarring in the lingula and both lung bases as well as\nchronic collapse of the right middle lobe without evidence of a centrally\nobstructing lesion.  Bilateral subpleural reticular opacities are also noted. \nIncidental calcified granulomas present in the right lung apex.\n\nRight hemidiaphragm remains mildly elevated.\n\nNo acute suspicious lytic or blastic lesions are detected within the skeletal\nstructures of the thorax.",
            "output": "1. Pulmonary embolism extending from the the bifurcation of the distal left\npulmonary artery into the descending branch and lingular artery.\n\n2.  New 2.5 cm part solid left upper lobe lung nodule and adjacent\nsubcentimeter nodule, as well as a focal peribronchiolar infiltration in the\nright upper lobe.  Considering rapid development since ___, this is most\nconsistent with an acute infectious or inflammatory process, and much less\nlikely lymphomatous involvement.  Differential diagnosis includes pulmonary\ninfection, including Nocardia and fungal organisms, as well as organizing\npneumonia.  Apperance is not typical of pulmonary infarction.\n\nNOTIFICATION:   The findings were discussed with ___ by ___\n___, M.D. on the telephone on ___ at 11:15 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is normal.  No\nsupraclavicular adenopathy.  No hilar adenopathy.\n\nUPPER ABDOMEN: Will be reported separately.  Possible small hiatal hernia.\n\nMEDIASTINUM: No esophageal masses.  No mediastinal adenopathy.\n\nHILA: No hilar adenopathy\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nRight-sided pectoral Port-A-Cath in situ with the lead tip seen in the right\natrium.  No vascular filling defects.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  The previously noted part solid nodules in the left upper lobe\nas well as central left upper lobe peribronchial infiltration has resolved. \nMultiple millimetric 2 mm nodules which are unchanged compared to prior\nimaging.  The right middle lobe collapse with no central endobronchial lesions\nare unchanged.  Mild scarring in the left lingula unchanged.\n-AIRWAYS:  The major airways are patent.  Mild asymmetry of the vocal cords\nwith the left being in a more medial position than the right.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  Mild spinal asymmetry.\nNo lytic/destructive bony lesions.  Mild pectus excavatum deformity.",
            "output": "No new or enlarging pulmonary nodules or masses.  No lymphadenopathy. The\npreviously noted part solid nodules in the left upper lobe has resolved.  The\npreviously noted pulmonary embolus has resolved.  No findings to suggest\nintrathoracic malignancy."
        },
        {
            "input": "A right chest wall Port-A-Cath is again noted with right IJ access and tip at\nthe cavoatrial junction.  The heart is within normal limits of size without\npericardial effusion.  Thoracic aorta is minimally calcified and normal in\ncourse and caliber.  There is left-sided coronary artery calcification.  The\nmain pulmonary artery is normal in size.  The pulmonary arterial tree appears\npatent without filling defect to suggest the presence of a pulmonary embolism.\nThere is no mediastinal, axillary or hilar lymphadenopathy.  There is no\npleural effusion or pneumothorax.  The central airways are patent.  There is\nmucoid impaction of right middle and right lower lobe bronchi with associated\natelectasis, appearing slightly progressed from prior.  There is also mild\ndiffuse bronchial wall thickening which could reflect the sequelae of airways\ninflammation.  No discrete nodule of concern.  A right upper lobe calcified\ngranuloma is noted on series 6, image 58.\n\nIn the imaged portion of the upper abdomen, no discrete abnormality is seen.\n\nBones:  Unremarkable.  No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Increase mucoid impaction within right middle and lower lobe bronchi with\nincreased associated atelectasis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\nregions.  All visible axillary lymph nodes (2, 13) Are normal in size.  Normal\nappearance of the large mediastinal vessels.  No evidence of pulmonary\nembolism.  Normal appearance of the cardiac structures.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  The upper abdomen is\nreported in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Normal\nappearance of the lung parenchyma.  No suspicious lung nodules or masses.  No\npleural effusions.  No abnormalities of the airways.",
            "output": "No adenopathy.  No pleural abnormalities.  The airways are patent.  No\nabnormalities in the lung parenchyma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  There is no supraclavicular lymphadenopathy.  There is no\naxillary lymphadenopathy.\n\nUPPER ABDOMEN: Visualized portion of the upper abdomen demonstrates a\npartially visualized endovascular stent graft in the visualized upper\nintra-abdominal aorta extending from the level of the esophageal hiatus. \nStents are also seen in bilateral renal artery origins, in the origin of the\nceliac axis and origin of the SMA.  There is a nonobstructing 5 mm right\ninterpolar region renal stone.  There is a partially visualized infrarenal\nabdominal aortic aneurysm sac outside of the stent graft measuring up to 5.6\ncm, similar to prior.\n\nMEDIASTINUM: There is prominent subcarinal lymphadenopathy measuring up to 1.1\ncm in short axis (302; 113).\n\nHILA: There is no hilar lymphadenopathy within limitations of this noncontrast\nscan.\n\nHEART and PERICARDIUM: Postsurgical changes are seen status post CABG.  There\nis a moderate to large hyperdense pericardial effusion measuring ___ of 45\nconcerning for hemorrhagic pericardial effusion.  Differential fluid-fluid\ndensities are seen in the right anterior pericardial recess which may suggest\norigin of hemorrhage or more acute bleeding.  Surgical clips are seen in the\nright anterior pericardial recess. There is severe coronary artery\ncalcification and aortic annulus calcification.  The heart is mildly enlarged.\n\nPLEURA: There are moderate right greater than left pleural effusions measuring\n___ of 21 on the right and ___ of 11 on the left.\n\nLUNG:\n\n1. PARENCHYMA:  There is bilateral lower lobe atelectasis and mild lingular\natelectasis.\n2. AIRWAYS: The airways are patent to the segmental level bilaterally.\n3. VESSELS: There is a bovine arch.  There is aneurysmal dilatation of the\nascending aorta measuring up to 4.1 cm (302; 100), similar to prior.  The main\npulmonary artery measures 3.3 cm, similar to prior.\n\nCHEST CAGE: Chronic fracture deformities are seen in the left posterior eighth\nthrough twelfth ribs.  There is no evidence of acute fracture or suspicious\nlytic or sclerotic osseous lesion.  Patient is status post median sternotomy. \nModerate to severe multilevel degenerative changes are seen in the visualized\nthoracic spine.",
            "output": "1. Moderate hemorrhagic pericardial effusion with differential fluid-fluid\ndensities in the right anterior pericardial recess suggestive of area of more\nacute hemorrhage.\n2. Stable aneurysmal dilatation of the ascending aorta measuring 4.1 cm.\n3. Moderate right greater than left pleural effusions with the right pleural\neffusion measuring slightly more complex than the left.\n4. Stable nonobstructing 5 mm right renal stone.\n5. Redemonstration of partially visualized endovascular stent graft in the\nvisualized intraabdominal aorta with aneurysmal sac of the infrarenal aorta\nmeasuring up to 5.6 cm similar to prior."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without evidence of\nfocal injury, dissection, or aneurysm.  There is no mediastinal hematoma.  The\nairways centrally patent.  The main pulmonary artery and central branches\nappear patent.  The heart is normal in size and shape.  No pleural or\npericardial effusion is seen.\n\nLungs are clear bilaterally without focal contusion, laceration or\npneumothorax.  No worrisome nodule, mass, or consolidation.   Mild basilar\ndependent atelectasis is noted.\n\nABDOMEN:  The liver and spleen appear intact without focal abnormality.  The\nspleen is mildly enlarged measuring up to 15.6 cm. Please correlate\nclinically.  The gallbladder, pancreas, adrenal glands appear normal.  The\nkidneys enhance symmetrically and excrete contrast promptly without\nhydronephrosis or focal lesion of concern.  Tiny hypodensity in the interpolar\nleft kidney is likely a cyst. The abdominal aorta is normal in course and\ncaliber with widely patent major branches. There is no retroperitoneal\nhematoma or lymphadenopathy. No free air or free fluid is seen.\n\nThe stomach and duodenum are normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal.  Large fecal load is seen within the colon. No free pelvic fluid.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "1. No acute sequelae of trauma.\n2. Splenomegaly incidentally noted for which clinical correlation is advised."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is top normal with no pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal caliber. No incidental pulmonary embolus\nis identified.\n\nAsymmetric soft tissue in the left lateral breast requires mammography for\ndefinitive evaluation (3, ___).\n\nRight middle lobe bronchiolectasis, mucoid impaction and linear atelectasis is\nlikely postinfectious in etiology (5, 94). A few pulmonary nodules measuring\nup to 4 mm in the left lower lobe are identified (5: 145, 177, 197). No\nendobronchial lesion or pleural abnormality is identified.\n\nMild multilevel spinal degenerative changes are present.  A sclerotic focus\ninvolving the posterior right rib is most likely a bone island (5, 139).\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "No evidence of primary intrathoracic malignancy.\n\nA few indeterminate pulmonary nodules measuring up to 4 mm in the left lower\nlobe are statistically most likely benign. A ___ month followup chest CT is\nrecommended to ensure stability.\n\nAsymmetric soft tissue in the left lateral breast for which mammography would\nbe recommended if not already performed recently."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is within\nnormal limits.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The study is not optimized for the evaluation of\nsubdiaphragmatic structures.  Within this limitation, the upper abdomen is\nunremarkable.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  Moderate coronary artery\ncalcifications are most severe in the left anterior descending and right\ncoronary arteries.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.  Right greater than left pleural\nscarring is demonstrated.\nLUNG:\n\n1. PARENCHYMA:  Suture line is demonstrated in the right lower lobe.  There is\nmild reticulation and centrilobular micro nodularity at both lung bases. \nNodules measuring up to 5 mm are demonstrated in the right upper and middle\nlobe (302:89, 603:27).\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The ascending aorta is minimally dilated, measuring up to 4.1 cm\nin the largest dimension (302:133).  The main, right and left pulmonary\narteries are normal in caliber.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion\nis demonstrated.  Mild degenerative changes of the thoracic spine are noted.",
            "output": "1. Mild fusiform dilatation of the ascending thoracic aorta measuring up to\n4.1 cm.  No significant aortic valvular calcification.\n2. Reticulation and micronodularity at the bilateral lung bases is\nnonspecific, but can be seen in inflammatory or infectious conditions, such as\nbronchiolitis.\n3. Several pulmonary nodules measuring up to 5 mm.  No CT follow-up is\nrecommended low risk patient, with an optional CT recommended in 12 months for\nhigh-risk patients.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "There is a moderate in size, layering right pleural effusion with adjacent\ncompressive atelectasis in the right lower lobe. There is heterogeneous\nconsolidation measuring approximately 8.2 x 4.4 x 7.1 cm (602b:26, 2:44)\nwithin the right middle lobe with areas of central hypodensity concerning for\nprimary malignancy. There may be adjacent areas of atelectasis or\npostobstructive pneumonia. Consolidation abuts the pericardium and while there\nis no frank pericardial nodularity though there is a moderate in size\npericardial effusion. Please correlate for tamponade physiology. The heart is\nnormal in size with left coronary artery calcification. The left lung is\nclear. No perceptible emphysema. No pneumothorax.\n\nThe thoracic aortic arch and main pulmonary artery are normal in caliber.\nThere is no central pulmonary embolus. There is no supraclavicular, axillary,\nhilar or mediastinal lymphadenopathy.\n\nThere is a sub cm right renal hypodensity. While this study is not tailored\nfor subdiaphragmatic diagnosis, the imaged upper abdomen is otherwise grossly\nunremarkable.\n\nThere is no suspicious focal osseous lesion. There are mild multilevel\ndegenerative changes of the thoracic spine.  There is a healing lateral right\nsixth rib fracture.",
            "output": "1. Right middle lobe mass concerning for primary lung malignancy. Moderate in\nsize right pleural effusion with compressive lower lobe atelectasis, cannot\nexclude a component of pneumonia. Would recommend biopsy of the right middle\nlobe mass or thoracentesis (with cytology) of the right pleural effusion for\ndefinitive diagnosis.\n2. Moderate pericardial effusion, could be reactive or malignant. Correlate\nfor tamponade physiology.\n3. Indeterminate right renal hypodensity incompletely evaluated. Recommend\nfurther evaluation with ultrasound."
        },
        {
            "input": "The thyroid gland is unremarkable.  Multiple mildly prominent mediastinal\nlymph nodes are stable in size and number, measuring up to 7 mm in short axis\nin the subcarinal location (2, 32).  There are no pathologically enlarged\nsupraclavicular, axillary, or left hilar lymph nodes. Difficult to delineate\nright hilar lymphadenopathy is probably not appreciably changed.\n\nHeart size is normal with a stable moderate low-attenuation pericardial\neffusion.  There is no evidence of tamponade physiology. However, there is new\nrightward deviation of the heart and mediastinum since ___ secondary\nto a right middle lobe volume loss. The main pulmonary artery and thoracic\naorta are normal caliber. Coronary artery calcifications are extensive.\n\nPrevious a moderate right pleural effusion with associated right lower lobe\npartial passive atelectasis has resolved. There is a new trace left pleural\neffusion. The known large right middle lobe mass-like consolidation has\nincreased, with new consolidation involving the right upper lobe. However,\nthere are new foci of air within the right middle lobe consolidation, which\nare likely due to cavitation (4, 188). There is no evidence of drainable lung\nabscess. Although there is a stable small parapneumonic pleural effusion,\nthere is no evidence of necessitation.\n\nA healing fracture of the right seventh anterior rib is not appreciably\nchanged. An old right rib fracture is unchanged. There are no bone lesions in\nthe thorax worrisome for infection or malignancy.\n\nA subcentimeter hypodense posterior right hepatic lobe lesion is too small to\ncharacterize but stable (2, 61). There is a layering gallstone in the\ngallbladder.",
            "output": "Interval worsening of right middle lobe organizing pneumonia with new\ninvolvement of the right upper lobe, and new right middle lobe cavitation with\nvolume loss. No drainable collection or evidence of necessitation. Stable\nsmall parapneumonic pleural effusion.\n\nInterval resolution of moderate layering right pleural effusion and associated\nright lower lobe partial passive atelectasis. New layering trace left pleural\neffusion.\n\nStable reactive mediastinal and right hilar lymphadenopathy.\n\nStable moderate pericardial effusion without evidence of tamponade physiology.\n\nExtensive coronary artery calcifications.\n\nCholelithiasis."
        },
        {
            "input": "The thyroid gland is unremarkable.  A right hilar lymph node has decreased\nmeasuring 8 x 21 mm, previously 15 x 27 mm (8, 123). There are no\npathologically enlarged supraclavicular, mediastinal, left hilar or axillary\nlymph nodes.\n\nHeart size is normal with a stable moderate nonhemorrhagic pleural effusion\npericardial effusion. Extensive coronary artery calcifications are present. \nThe main pulmonary artery and thoracic aorta are normal caliber.  No\nincidental central pulmonary embolus is identified.\n\nThe known anterior right upper and right middle lobe consolidation continues\nto involute.  Bronchial dilation and enlarging peribronchial cystic lucencies.\nSubstantial right middle lobe volume loss remains, although aeration of the\nlateral segment is slightly improved. There is no new consolidation evidence\nof lung abscess. The small anterior loculated pleural effusion has slightly\ndecreased. The previous left pleural effusion with associated left basilar\nsubsegmental atelectasis has resolved.\n\nImages of the upper abdomen is notable only for a stable small right renal\ncyst.\n\nMild spinal degenerative changes and old healed left rib fractures are\nunchanged. A small discrete calcific lesion closely related to the left\nscapula and left glenohumeral joint is most likely an intra-articular loose\nbody (3, 3). There are no bone lesions in the thorax worrisome for infection\nor malignancy.",
            "output": "Continued improvement of known anterior right upper and right middle lobe\npneumonia with substantial volume loss. Bronchial dilation may reflect post\ninfectious bronchiectasis although a reversible component of bronchial\ndilation is possible in the setting of recent infectious.\n\nSlightly decreased small parapneumonic pleural effusion, and resolved left\npleural effusion with associated left lower lobe partial passive atelectasis.\n\nStable moderate pericardial effusion.\n\nImproved reactive right hilar lymphadenopathy."
        },
        {
            "input": "The thyroid is normal.  Increase in number of axillary, mediastinal and left\nhilar lymph nodes are not enlarged and stable. Right hilar lymph node is\nstable measuring 27 x 15 mm. Aorta and pulmonary arteries are normal size.\nCardiac configuration is normal and there is moderate calcification in all\ncoronary arteries\n.\nSmall left layering non hemorrhagic effusion has increased, no evidence of\nabnormal pleural enhancement. Moderate pericardial effusion is grossly\nunchanged. Cardiac size is normal. dense calcifications in all coronary\narteries are again noted.\n\nMass-like consolidation in the right middle lobe has increased now extending\nthrough the fissure to the right lower lobe (5:167).  Right upper lobe\nconsolidation has also increased with increased in loss of volume, associated\nwith tiny cavitations (5:116, 129, 140)\nPleural effusion located anterior to the right middle and right upper lobe\nconsolidations is grossly unchanged\nLeft central catheter tip is in the mid SVC\n\nThis examination is not tailored for subdiaphragmatic evaluation , sub cm\nhypodense lesions in the right lobe of the liver are too small to be\ncharacterize\n\nThere are no bone findings of malignancy. Bilateral rib fractures and\ndegenerative changes in the thoracic spine are unchanged.",
            "output": "Interval worsening of right middle lobe and right upper lobe consolidations\nand loss of volume. There is no evidence of empyema\nStable reactive mediastinal right hilar lymphadenopathy\nmoderate pericardial effusion without evidence of tamponade physiology\nCoronary calcifications."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is moderate atherosclerotic calcification of the aortic arch and\ndescending thoracic aorta.\n\nThere are bilateral pulmonary arterial filling defects at the segmental and\nsubsegmental levels.  For example a left lower lobe segmental pulmonary artery\n(series 3, image 88), a right middle lobe segmental branch (series 3, image\n109), and right lower lobe subsegmental branches (series 3, image 132).  The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere are bilateral hypodense thyroid nodules, measuring 0.5 cm in the left\nlobe and 1.1 cm in the right lobe.\n\nThere is no evidence of pericardial effusion.  There are trace nonhemorrhagic\nbilateral pleural effusions.\n\nThere is bibasilar atelectasis. The airways are patent to the subsegmental\nlevel.  Respiratory motion limits evaluation for small pulmonary nodules.\n\nThere is a small hiatal hernia.  Otherwise, limited images of the upper\nabdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nChronic right ninth and tenth posterior rib fractures are noted.",
            "output": "1. Bilateral segmental and subsegmental pulmonary emboli.  No CT evidence of\nright heart strain.\n2. Trace nonhemorrhagic bilateral pleural effusions.\n3. 1.1 cm right and 0.5 cm left thyroid nodules do not require follow-up\nunless clinically indicated.\n\nRECOMMENDATION(S):  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:40 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\n\nThe left hemithorax has is diminutive and has extensive bronchiectasis and\nscarring, worse at the lung bases.  There is extensive calcification of the\nleft pleura and numerous left lung base calcifications.  Healed rib fractures\ndescribed under \"bones\", below.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypodensity along the anterior aspect of segment ___ likely\nrepresents focal fat. There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a large hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon and rectum are within normal limits.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A large calcified fibroid is noted in the posterior\naspect of the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There are subtle nondisplaced fracture of the anterior fourth fifth and\nsixth ribs on the right.  S-shaped scoliosis of the thoracolumbar spine is\nsevere.  Patient status post right hip arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Nondisplaced fractures of the anterior fourth, fifth and sixth ribs on the\nright are unchanged from ___.  No new fractures are identified.\n\n2.  Large hiatal hernia\n\n3.  Extensive scarring, bronchiectasis and pleural calcifications are noted in\nthe left lung, unchanged from ___.\n\n4.  Fibroid uterus."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  The aorta is normal in size.  The main pulmonary\nartery reaches a maximum of 3.7 cm, which is mildly enlarged.  Cardiac\nconfiguration is normal.  Extensive coronary atherosclerotic calcifications\nare noted.  Aortic annular calcifications are seen as well.  A moderate hiatal\nhernia is seen.\n\nThe left hemithorax is markedly abnormal with significant volume loss and\nperipheral bronchiectasis.  The pleura is calcified on the left.  There is\nwidespread calcification of the left pleura.  These findings may be the\nsequela of prior empyema or tuberculous infection.  Calcified nodules are\nscattered throughout the left hemithorax.  Areas of scarring are seen in both\nthe left upper and lower lobes are noted. Mild scarring is seen in the right\nupper lobe.   There is no focal consolidation.  No suspicious nodules are\nidentified.\n\nEvaluation of the bones shows market thoracic kyphosis with moderate\nmultilevel degenerative changes.  No significant vertebral body height loss is\nnoted.\n\nLimited evaluation of the upper abdomen shows no significant abnormalities.",
            "output": "1.  Marked abnormality of the left hemithorax with significant volume loss,\npleural calcifications, and bronchiectasis, may be the sequela of prior\nempyema or tuberculosis.  No focal consolidation or evidence of active disease\nis identified."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No significant pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Incidentally\nnoted is an accessory right hepatic artery arising from the SMA.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The thyroid gland is unremarkable. No pathologically enlarged supraclavicular,\nmediastinal, hilar or axillary lymph nodes are identified.\n\nThere is a normal heart size with no pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal in caliber.\n\nEvaluation of the lungs demonstrates no pulmonary mass or consolidation. \nThere is a stable 2 mm left lower lobe subpleural solid nodule (4, 200). No\nnew pulmonary nodules are identified. There is no endobronchial lesion or\npleural effusion.\n\nNo destructive osseous lesions are identified.\n\nImages of the upper abdomen are notable only for high-density material within\nthe right renal collecting system, presumably due residual contrast from the\ncontrast-enhanced MRI performed on the same day.",
            "output": "Stable 2 mm left lower lobe solid subpleural nodule, which may be followed up\nwith a chest CT in 12 months."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\nEvaluation of the breasts would require mammography. This study is not\ndesigned for subdiaphragmatic diagnosis.\n\nThyroid is normal size. Tiny hypodensities are too small to warrant further\nimaging evaluation. Atherosclerotic calcification is not present in the head\nand neck vessels, coronaries or aorta. Aorta and pulmonary arteries are normal\nsize. There is no pericardial or pleural abnormality.\n\nThymus is physiologic for age. Mediastinal lymph nodes are not enlarged and\nhilar contours do not suggest adenopathy.\n\nPunctate subpleural nodule left lower lobe, 4:196, is unchanged since both ___, 4:228, and ___, 4:200. It is benign.\n\nLungs are otherwise clear and the tracheobronchial tree is normal to\nsubsegmental levels.",
            "output": "No evidence of metastasis or other intrathoracic malignancy. From a\nradiographic standpoint, there are no findings warranting imaging followup.\n\nRECOMMENDATION(S):   From a radiographic standpoint, there are no findings\nwarranting imaging followup."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, are within normal limits. \nThoracic aorta measures up to 3.8 cm, enlarged since ___.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patient is status post right middle lobe wedge resection with\nsuture material in place.  Bibasilar ground-glass opacities are nonspecific. \nLungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mildly ectatic ascending aorta measures up to 3.8 cm, enlarged since\n___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is moderate stenosis of the proximal left common\ncarotid artery due to noncalcified plaque (03:56).  Heart size is normal. \nCoronary artery calcifications are moderate and diffuse.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is mediastinal lymphadenopathy, for\nexample a 1 cm right upper paratracheal node (03:56).  A left hilar lymph node\nmeasures 12 mm (3:117).  Axillary lymph nodes are not enlarged.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse bronchial wall thickening with secretions\nnoted an numerous subsegmental bronchi.  Ground-glass and nodular opacity in\nthe left lower lobe distal to secretions could reflect atelectasis, or\ndeveloping infection.  Dependent atelectasis is present at the right base.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatus hernia.  Otherwise, the imaged upper abdomen\nis unremarkable.  The left hepatic artery arises from the left gastric artery.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nSevere bilateral glenohumeral degenerative changes are noted.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Left lower lobe opacity distal to bronchial secretions could reflect a\ndeveloping infection, aspiration, or atelectasis.\n3. Diffuse bronchial wall thickening and multifocal bronchial secretions\nsuggests small airways inflammation.\n4. Mediastinal and left hilar lymphadenopathy may be reactive."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nEvaluation is limited by motion artifact; the pulmonary arteries are well\nopacified to the segmental level, with no evidence of filling defect within\nthe main, right, left, lobar, or segmental pulmonary arteries.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere are bilateral consolidations which may represent pneumonia.  There is\nright-sided atelectasis.\n\nThe airways are patent to the segmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere are there are healed right-sided rib fractures.",
            "output": "1. Evaluation is limited by motion artifact; no evidence of pulmonary embolism\nor aortic abnormality visualized.\n2. Bilateral consolidations may represent pneumonia."
        },
        {
            "input": "HEART AND VASCULATURE: Motion artifact mildly limits evaluation of the\nsubsegmental branches.  Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber with mild atherosclerotic\ncalcifications without evidence of dissection or intramural hematoma.  The\npericardium and great vessels are within normal limits.  There is mild\ncardiomegaly.  There are dense coronary artery calcifications.  Surgical clips\nare seen in the mediastinum.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  A calcified granuloma seen in the right lower lobe (3; 113). \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen show a subcentimeter\nhypodensity in the right hepatic lobe, too small to characterize, but stable\nsince at least ___ and likely a hepatic cyst or biliary hamartoma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPatient is status post median sternotomy.  Mild degenerative changes are seen\nin the thoracic spine.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Ill defined thyroid nodules are unchanged from prior study (2:4). There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy. The\nascending aorta is stably enlarged, measuring 4.3 cm in diameter. There are\natherosclerotic calcifications in the thoracic aorta and the coronary\narteries. Mild cardiomegaly is unchanged.  There is no pericardial effusion.\nCalcifications of the aortic valve are noted.\n\nThe airways are patent. There is no airspace consolidation. There is no\ndiffuse interstitial abnormality. There are a number of pulmonary nodules\nwhich are either new or grown significantly from the prior study. These are\nseen on the following images in series 4:\n\nA 13 x 7 mm peripheral nodule in the superior segment of the left lower lobe\nwas only 3 mm on the prior study (111), a new 19 x 16 mm nodule in the right\nazygos esophageal groove (131). There was only minimal peribronchial\nnodularity at this location on the prior study. A cluster of right apical\nnodules, the largest measuring 5 mm, are new from prior study (35). A 12 x 10\nmm right basilar nodule was 6 x 5 mm on the prior study (263). This nodule is\nsurrounded by focal atelectasis. The 4 mm nodule in the lateral segment of the\nright middle lobe is new from the prior study (200). A 4 mm nodule in the\nlateral basal segment of the right lower lobe is not seen on the prior study,\nbut could have been missed due to slice selection (151).\n\nSeveral other pulmonary nodules are stable and less likely to represent\nmetastatic disease. These are seen on the following images in series 4:  a 3\nmm amorphous subpleural nodule in the apical segment of the right upper lobe\n(51), a focus of perivascular nodularity in the posterior segment of the right\nupper lobe (84), a 3 mm nodule in the lateral basal segment of the right lower\nlobe (232), a 4 mm calcified subpleural nodule in the superior segment of the\nleft lower lobe (119), several 2-3 mm subpleural nodules in the left lower\nlobe (185), and a right lower lobe 5 mm perivascular nodule (176).\n\nThere is no pneumothorax. There is no pleural effusion. There are no\ndestructive focal osseous lesions concerning for malignancy within the imaged\nthoracic skeleton. Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "Multiple new or enlarging pulmonary nodules concerning for pulmonary\nmetastatic disease.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 16:08 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Lung Nodules: A 6mm left lower lobe nodule (5:216) has increased in size from\n4mm previously. Left lower lobe 10 mm nodule (5:159) smaller than previously\n(12mm).  A right lower lobe nodular area is smaller measuring 15mm x 6mm from\n21x 12 mm previously. 3mm left upper lobe nodule (5:46).  4mm left lower lobe\nnodule (5:172), unchanged. 6mm right lower lobe nodule (5:219), unchanged. A\ncluster at the inferior right middle lobe (5:236) with the largest at 5mm is\nunchanged. 3mm right upper lobe nodule (5:129) at 3mm, unchanged. A cluster of\nnodule at the right apex with the largest measuring 5mm (5:37). A 4mm nodule\nis seen (5:64) at the right upper lobe, unchanged. .\n The lungs have mild upper lobe predominant emphysema. There is no pleural\neffusion or pneumothorax.\n\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not pathologically enlarged (by CT criteria).  Aortic arch caliber\nis enlarged at 4.3cm. The pulmonary artery is not enlarged. Cardiac\nconfiguration is normal, however there is mild coronary calcification.\n\nThere is a right inferior pole kidney cyst that measures 2 x 2.7 cm (5:400)\nmeasuring simple fluid attenuation. At the left kidney, there is a 3.8 x 3.6\ncm simple fluid density exophytic cyst located at the posterior-lateral\ninferior pole. There is a 1.3 x 1.8 cm nodule on the medial left adrenal gland\nmeasuring <10 ___.  Post Whipple, there are surgical clips without obvious\nlocal recurrence and there is branching air within the central liver likely\nreflecting hepaticojejunostomy sequelae.\n\nThe bones and soft tissues are without worrisome lesions. There is moderate\ndegenerative changes at the thoracic and lumbar spine. Rotator cuff surgery\nsequelae seen.",
            "output": "1.  Since ___, many nodules are seen bilaterally, most unchanged in\nsize. Two nodules (noted above) are smaller and one nodular area is larger.\n2. Left adrenal medial limb adenoma, stable.\n3. Bilateral exophytic simple fluid attenuation lesions, statistically most\nlikely simple cysts."
        },
        {
            "input": "There postsurgical changes secondary to aortic valve replacement including\nmidline sternotomy wires. There is a small substernal anterior mediastinal\nfluid collection, nonspecific given recent surgery. There is a trace\npericardial effusion and small right pleural effusion. There are coronary\nartery calcifications.  There are unchanged, nonenlarged paratracheal lymph\nnodes. There are no enlarged axillary or hilar lymph nodes. Visualized\nportions of the thyroid gland are unremarkable.\n\nThere is no suspicious osseous lesion. There are degenerative changes of the\nlower thoracic spine.\n\nThere is no area of consolidation.\n\nThere are numerous bilateral pulmonary nodules. The largest nodule is again\nvisualized in the left lower lobe (4:122) and is unchanged measuring 12 mm by\n7 mm. A left lower lobe perivascular nodule (4:164) is slightly larger\nmeasuring 8 mm, previously 6 mm.\n\nThere is an unchanged 2 mm left upper lobe pulmonary nodule (04:39). There is\nan unchanged right upper lobe anterior nodule measuring 3 mm an unchanged 3 mm\nsubpleural nodule in the right upper lobe (04:49). There is no unchanged 1 mm\nright upper lobe peripheral nodule (4:67) with a similar appearing nodule\nanteriorly (4:70).\n\nThere is an unchanged 4 mm right upper lobe pulmonary nodule (4:72). There is\nan unchanged 2 mm subpleural right upper lobe pulmonary nodule (4:82). The\nthere is unchanged 2 mm left upper lobe pulmonary nodule (4:111). A 3mm right\nupper lobe nodule is seen in image (4:130), unchanged. There is a 4 mm left\nlower lobe calcified granuloma (4:131). There are unchanged 5 mm and 4 mm\nright lower lobe nodules (4:167 and 173). There is unchanged 3 mm left lower\nlobe nodule (4:196).\n\n This study is not designed for subdiaphragmatic diagnosis but shows no\nadrenal mass or abnormality in the imaged portions of the suboptimally\nenhanced or unenhanced solid organs in the upper abdomen. There are\npostsurgical changes in the upper abdomen. Enlarged left adrenal gland is\nsimilar in appearance and better characterized on same day MRI.",
            "output": "1. Growth of a left lower lobe pulmonary nodule currently measuring 8 mm in\nlength, previously 6 mm (4:164). Additional bilateral pulmonary nodules are\nunchanged in appearance.\n2. Small anterior mediastinal fluid collection of indeterminate significance\ngiven history of recent surgery. Postoperative infection cannot be excluded.\n3. Enlarged left adrenal gland better characterized on MRI ___."
        },
        {
            "input": "Soft tissues: The thyroid is homogeneous. Lower paratracheal lymph nodes are\nmore notable for number than for size.  Mechanical aortic valve is again\nappreciated.  Heart size is normal with no pericardial effusion.  Aorta and\nmain pulmonary artery are normal in size.  Esophagus is normal in course and\ncontour.  Sternal wires are intact.  Please refer to the MRI of the abdomen\nfor a detailed evaluation of the subdiaphragmatic structures.\n\nLungs: The airways are patent to the subsegmental level bilaterally. There is\nmild centrilobular emphysema.  Several nodules are stable since ___, for\nexample the nodularity at the right apex ___, 75), perifissural right\nmiddle lobe nodules (5:248), superior segment left lower lobe nodule (5:161)\nand adjacent millimetric nodule (5:165).  Spiculated left lower lobe nodule\n(5:212) measures 10 mm, previously 8mm.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Millimetric equivocal progression of spiculated left lower lobe nodule\nmeasuring 10 mm, previously 8 mm.  All other pulmonary nodules are stable\nsince at least ___.  No new mediastinal lymphadenopathy.\n2.  Please see the concurrent MRI of the abdomen discussing subdiaphragmatic\nfindings."
        },
        {
            "input": "Aorta approaching 4.2 cm at the level of the ascending aorta.  The patient is\nafter aortic valve replacement.  The findings are similar to previous\nexamination.  Pulmonary arteries are normal in diameter.  Heart size is mildly\nenlarged.  There is no pericardial pleural effusion.  Image portion of the\nupper abdomen will be reviewed separately in corresponding report will be\nissued.\n\nAirways are patent to the subsegmental level bilaterally.  Since the prior\nstudy there is a extensive progression of left lower lobe lesion currently 26\nx 16 mm as compared to 9 x 9.6 mm on the previous study, concerning for\nmalignancy.  Although potentially impaction of the airways with surrounding\n___ opacities is a possibility.  The alternative is that the tumor is\nimpacting the bronchi with subsequent will be impacted bronchi distension and\npostobstructive infection.  Additional pulmonary nodules are stable, series 4,\nimage 42, 45, 54, 60, 93, 126.  , 150, 196, 204, 205, 207, 209.  No new\nnodules demonstrated.\n\nPost sternotomy wires are unremarkable.  The patient is after right shoulder\nsurgery.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Substantial progression of the left lower lobe lesion as described versus a\ncombination of progression of the nodule with postobstructive bronchial\ndilatation and infectious process.  Followup with PET-CT is recommended or\nalternatively tissue diagnosis.  The findings are more likely to represent\nprimary lung lesion than metastatic disease.\n\nMultiple additional stable pulmonary nodules as described.\n\nNo evidence of mediastinal lymphadenopathy or off the areas of metastatic\ndisease progression.  ."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect. The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The heart and mediastinum are normal.\nThe pericardium is intact without effusion. Airways are patent to the\nsubsegmental levels.\n\nThe lungs are clear without focal or diffuse abnormality.  There is minimal\ndependent atelectasis. A 4 mm cavitary nodule in the right upper lobe is\nunchanged from ___ (3:74). The pleura is intact without effusion.\nNo pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "HEART AND VASCULATURE: The heart is normal size.  There is a small pericardial\neffusion measuring low-density.  The aortic root is not completely evaluated\nsecondary to heart motion however appears within normal limits without\nevidence of focal dissection.  There is moderate atherosclerotic calcification\nwith some eccentric plaque along the descending thoracic and upper abdominal\naorta however no dissection or intimal injury is demonstrated. The great\nvessels are within normal limits at their origins.  There is moderate\ncalcification of the aortic valve and coronary arteries.\n\nThe main pulmonary artery is normal caliber.  There is no large central\nfilling defect.  The pulmonary arterial branches are well opacified to the\nlevel of the subsegmental branches bilaterally.  An area of apparent non\nopacification within a right-sided apical segmental branch (series 301, image\n33) is thought to be streak artifact from overlying contrast bolus within the\nSVC.  Additional difficulties demonstrated visualizing the right superior and\napical segmental subsegmental branches which is likely secondary to\nrespiratory motion.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes measure up to 1.1 cm in\nthe short axis within the right paratracheal station, may be reactive.  No\nmediastinal masses.  No mediastinal hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate centrilobular emphysema.  No dense\nconsolidation.  There is moderate thickening of the distal airway bilaterally.\nThere is distal mucus plugging.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Cortical irregularities at the right lateral ninth rib, as well as the\nleft lateral third, fourth, fifth sixth and seventh ribs likely represent\nhealed fractures.  No acute osseous findings.  There is mild retrolisthesis of\nL1 or L2 which is almost certainly degenerative in nature.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Small, low-density pericardial effusion.\n3. Moderate atherosclerotic change most predominant at the descending thoracic\naorta and upper abdominal aorta.  Moderate calcification of the aortic valve\nand coronary arteries.\n4. Moderate centrilobular emphysema.  Moderate thickening of the distal\nairways and mucus plugging distally bilaterally is nonspecific but likely\nsequaelae of chronic bronchitis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  There is no evidence of pulmonary embolism.  The thoracic\naorta is normal in caliber, but noted to contain extensive calcified and\nnoncalcified plaque.  The heart is normal in size, but with extensive coronary\nartery calcifications.  There are also aortic valvular and annular\ncalcifications.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Axillary, mediastinal and hilar lymph nodes are\nnot enlarged.\n\nPleural spaces: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a background of severe centrilobular predominant\nemphysema.  The airways are patent to the subsegmental level.  There is\ndiffuse moderate bronchial wall thickening.  No significant mucous plug.  No\nworrisome nodule, mass, or consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There are calcifications again noted within the imaged portion of the\npancreas, likely related to chronic pancreatitis.  The imaged upper abdomen is\notherwise unremarkable.  Small hiatal hernia noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMultiple bilateral chronic rib fractures are noted.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Severe emphysema, and diffuse bronchial wall thickening consistent with\nsmall airways inflammation.\n3. Severe atherosclerotic disease involving the aorta, with calcified and\nnoncalcified plaque."
        },
        {
            "input": "Evaluation is somewhat limited by the lack of oral contrast, however there is\nno pneumomediastinum or mediastinal fluid collection to suggest esophageal\nperforation. Mild diffuse long segment esophageal wall thickening is in\nkeeping with the stated history of toxic ingestion. Wall thickening extends\ninto the imaged portions of the stomach, where there is irregularity and\nthickening of the rugal folds underdistention. Images of the upper abdomen\nalso demonstrate a small amount of perihepatic ascites, as well as mesenteric\nfat stranding and nodularity, raising concern for carcinomatosis. A\nrepresentative mesenteric soft tissue nodule measures 10 x 11 mm (4, 185).\nThere is also retroperitoneal lymphadenopathy with a representative right\npara-aortic lymph node measuring 1.8 x 1.2 cm (4, 212).\n\nMultiple mildly enlarged supraclavicular and mediastinal lymph nodes are\nnoted. A representative prevascular lymph node measures 1.9 x 1.0 cm (4, 68).\nA mildly prominent supraclavicular lymph node measures 1.2 x 1.2 cm (4, 52).\nThere are a few pathologically enlarged right axillary lymph nodes with\ncentral low attenuation and mild surrounding fat stranding, the largest of\nwhich measures 2.3 x 1.7 cm (4, 68). No left axillary lymphadenopathy is\nidentified. The thyroid gland is unremarkable.\n\nThere is a normal heart size with no pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal in caliber. There is no pericardial\neffusion.\n\nEvaluation of the lungs demonstrates numerous diffusely distributed\ncentrilobular nodules. There are also scattered branching tubular ___\nopacities\" in the right middle lobe (4, 113).  Several solid nodules are\nrandomly distributed throughout the lungs with representative measurements as\nfollows:\n\n6 mm right apical subpleural nodule (4, 53)\n3 mm right upper lobe nodule (4, 66)\n9 mm right upper lobe nodule (4, 65)\n3 mm right upper lobe nodule (4, 71)\n2 mm left upper lobe nodule (4, 136)\n6 mm right lower lobe nodule (4, 156)\n\nIn addition, there are small bilateral pleural effusions. Bilateral lower lobe\nground-glass opacities, focal consolidations and mild peribronchial thickening\nare likely due to aspiration. There is some component of bibasilar atelectasis\nas well. No destructive osseous lesions are identified.",
            "output": "No pneumomediastinum or mediastinal fluid collection to suggest an esophageal\nperforation. However, an esophagram may be performed for more sensitive\nevaluation.\n\nDiffuse esophageal and gastric wall thickening which is in keeping with the\nstated history of toxic ingestion.  However, a neoplastic process is not\nexcluded. Correlation with endoscopy is recommended.\n\nNumerous bilateral centrilobular pulmonary nodules and bibasilar\nconsolidations which are likely related to aspiration.\n\nSeveral solid nodules randomly distributed throughout the lungs, which are\nworrisome for metastatic disease.\n\nRight axillary, mediastinal and upper abdominal lymphadenopathy.  The right\naxillary lymph nodes are low in attenuation with surrounding fat stranding. \nThe appearance is nonspecific and may be due to neoplastic or infectious\netiologies. These right axillary nodes are amenable to percutaneous biopsy.\n\nSmall amount of upper abdominal ascites with findings that raise concern for\ncarcinomatosis. A dedicated contrast enhanced CT scan of the abdomen/pelvis is\nrecommended.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:27 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid gland is unremarkable. Right axillary, mediastinal, and to\ndifficult to delineate bilateral supraclavicular lymphadenopathy have not\nappreciably changed since ___.  A representative right axillary\nconglomerate measures 2.1 x 3.4 cm, previously 2.2 x 3.6 cm (2, 15). A\nprevascular lymph node is also stable measuring 0.9 x 1.6 cm, previously 1.0 x\n1.6 cm (4, 83).\n\nHeart size is top-normal with no appreciable pericardial effusion. There is\nstable mild dilatation of the main pulmonary artery at 3.1 cm.  No incidental\npulmonary embolus is identified. The thoracic aorta is normal caliber.\n\nThere has been interval placement of a left posterior approach pigtail\ncatheter which coils in the posterior pleural space. There has been\nsubstantial interval decrease in size of the posterior component of the left\npleural effusion, which is now small and contains small foci of\npost-procedural air.  However, a loculated anterior/medial component of the\npleural effusion adjacent to the left ventricle has slightly increased. There\nis improved aeration of the left lung, with only mild adjacent passive\natelectasis. Widespread centrilobular nodular and ___ opacities are\nimproved since ___. More discrete nodules measuring up to 5 mm in the\nright lower lobe are also unchanged (4, 152). A subcentimeter right upper lobe\ncystic lesion may be due to scarring from prior chest tube placement. Mild\ndiffuse bronchial wall thickening has slightly improved. Bilateral areas of\nlinear atelectasis or scarring are present.\n\nThe patient has had prior esophageal resection. Images of the upper abdomen\nshow stable infiltration of the mesenteric fat in the upper abdomen.\n\nThere are no destructive osseous lesions.",
            "output": "Interval placement of a left posterior approach pigtail catheter with\nsubstantial interval decrease in the adjacent portions of the known left\npleural effusion. However, a loculated anterior/medial component adjacent to\nthe left ventricle has increased since ___.\n\nImproved aeration in the left lung with only mild residual passive\natelectasis.\n\nInterval improvement in diffuse endobronchial spread of infection since ___.\n\nStable supraclavicular, mediastinal and bilateral axillary lymphadenopathy."
        },
        {
            "input": "The thyroid is normal.\n\nAxillary, supraclavicular, mediastinal, and hilar lymphadenopathy is not\nsignificantly changed from the most recent prior exam on ___.\n\nThe great vessels are normal caliber.\n\nThe heart size is normal. No pericardial effusion.\n\nA left posterior pigtail catheter has been removed from the prior examination.\nThere has been the moderate increase in size of a left posterior pneumothorax\ncompared to the prior examination with no evidence of shift to suggest\ntension. The left posterior pleural effusion containing small foci of air is\nnot significantly changed from the prior examination. Widespread centrilobular\nnodular and ___ opacities are similar in extent to ___.\nThere is a small right pleural effusion, similar in appearance to the prior\nstudy.\n\nThe patient is status post esophageal resection with surgical material seen\nunchanged in position.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Interval removal of a left posterior approach pigtail catheter with moderate\nincrease in the left posterior pneumothorax. Left pleural effusion with small\nfoci of gas is not significantly changed from the prior examination. A small\nright pleural effusion is unchanged.\n\nDiffuse parenchymal opacities are not significantly changed from the prior\nexamination. Stable lymphadenopathy.\n\nNOTIFICATION:  These findings were communicated to Dr. ___ telephone at\n11:00 on ___ by Dr. ___"
        },
        {
            "input": "Multiple low-attenuation the right axillary lymph nodes, ranging in diameter\nup to 26 mm, have grown substantially since ___, and a 13 mm left\nsupraclavicular lymph node, 2:7, is new.  Edema in the right axilla has\nincreased and extends inferiorly along the lateral chest wall. There is no\nsoft tissue collection an the ribs are intact. On the left, there is no fluid\ncollection or particular edema in the chest wall.  For punctate cortical\nlucencies in in the upper cortex of the left seventh and inferior cortex of\nthe eighth ribs laterally, adjacent to the upper abdominal surgical site have\ndeveloped since ___ and are more prominent since ___. This is not\nthe typical appearance of osteomyelitis ; instead, they could be defects from\nsurgical intervention. It is not clear if there were costal wires at this\nlevel. Most recent imaging of any costal wire, a chest radiograph on ___ showed one posteriorly surrounding the left eleventh rib. Followup is\nadvised if clinical findings persist.\n\nThyroid is unremarkable. Borderline enlargement of central lymph nodes, in the\nleft upper upper and right lower paratracheal station is unchanged. Previous\njuxta cardiac component of left pleural effusion has resolved, and only a\nsmall costal component remains. The previous pleural pocket has resolved, and\nleft lower lobe atelectasis has improved. There is no right pleural effusion.",
            "output": "Previous left pleural pocket and empyema have resolved.\n\nNo good evidence for osteomyelitis, but there are two pair of matching small\ncortical defects in the left ___ and 8th ribs laterally, possibly due to since\nremoved costal wires.  They should be monitored if clinical findings persist.\n\nSubstantial progression of large necrotic right axillary adenopathy and new\nsmall left supraclavicular node. This is presumably infectious at in either\nthis, but lymphoma should be considered."
        },
        {
            "input": "Low attenuation left cervical lymphadenopathy is stable with a representative\nnode measuring 13 mm in short axis, previously 13 mm (3, 2). However, chronic\nright axillary lymphadenopathy has progressed with the most dramatic increase\nseen in a 2.6 x 3.6 cm node which previously measured 0.9 x 1.3 cm (3, 13).\nThere are no pathologically enlarged mediastinal, hilar or left axillary lymph\nnodes. The thyroid gland is unremarkable.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber. No incidental pulmonary embolus is\nidentified.\n\nMultiple solid pulmonary nodules measuring up to 5 mm in the right upper lobe\nare not appreciably changed in size and number since ___ (5: 34, 61,\n71, 76, 78, 181). Upper lobe predominant centrilobular nodules and scattered\n___ opacities are unchanged. Mild diffuse bronchial wall thickening,\nand left upper and left lower lobe linear atelectasis or scarring are\nunchanged. Mild bilateral lower lobe cylindrical bronchiectasis is also\nunchanged. There are no new nodules or consolidations.\n\nHigh density material in the left pleural space is unchanged. Presumed\nsurgical defects in the left lateral seventh and eighth ribs are unchanged.\nThere is no new osteolysis or osteopenia to suggest interval development of\nosteomyelitis. No new chest wall or left pleural fluid collection is\nidentified.\n\nThe patient has had prior gastric surgery with stable distension of lower\nesophagus.",
            "output": "No evidence of new left chest wall fluid collection or interval development of\nosteomyelitis at the site of prior costal wire removal.\n\nProgressive necrotic right axillary lymphadenopathy may be due to TB, MAC or\nlymphoma.\n\nStable pulmonary nodules measuring up to 5 mm in the right upper lobe.\n\nStable mild diffuse infectious or inflammatory bronchial wall thickening with\nevidence of persistent mild endobronchial spread of infection.\n\nStable mild lower lobe cylindrical bronchiectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The thyroid is not visualized. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main pulmonary artery is within normal limits.  An accessory left hepatic\nartery arises from the left gastric artery.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.  Respiratory motion limits assessment for tiny pulmonary\nnodules.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "No evidence of pulmonary embolus or aortic injury."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary\nlymphadenopathy.  The chest wall is unremarkable in appearance.\n\nUPPER ABDOMEN: Evaluation of the upper abdomen is notable for a 2 mm stone in\nthe upper pole of the right kidney (2:62).\n\nMEDIASTINUM: There are multiple prominent mediastinal lymph nodes, measuring\nup to 8 mm in the left prevascular station and 14 mm in the right lower\nparatracheal station (302:63).\n\nHILA: Bilateral hilar nodes measure up to 10 mm on the right, and 11 mm on the\nleft.\n\nHEART and PERICARDIUM: Heart is normal in size, without a pericardial\neffusion.  Multifocal coronary calcifications are most pronounced in the left\nanterior descending artery.\nPLEURA: Pleural surfaces are smooth.  There is no pleural effusion or\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the lung parenchyma is notable for diffuse\nground-glass opacification, with areas of mosaic attenuation.  Some areas\nappear slightly nodular in the posterior segment right upper lobe (302:79). \nThe distribution is slightly upper lobe predominant, which would be atypical\nin the setting of pulmonary edema, particularly in the absence of associated\npleural effusions.  Several pulmonary nodules are present, measuring 5 mm in\nthe right upper lobe (302:57), 3 mm in the lateral segment right middle lobe\n(302:134).  A left lower lobe perifissural nodule measures up to 6 mm\n(302:107).\n2. AIRWAYS:  Airways are patent to the subsegmental bronchi bilaterally.\n3. VESSELS:  Thoracic aorta is normal in caliber.  Dilation of the main\npulmonary artery measuring up to 34 mm can be seen in the setting of pulmonary\narterial hypertension.\nCHEST CAGE: Evaluation of the osseous structures is notable for irregularity\nof the left lateral sixth and ninth ribs, which may represent remote fractures\n(02:29).  No suspicious lytic or sclerotic lesions are identified.",
            "output": "1. Diffuse upper lobe predominant ground-glass opacities, with an appearance\nsuspicious for hypersensitivity pneumonitis.  Infectious process may be\nconsidered in the appropriate clinical setting.  Pulmonary edema is felt to be\nless likely.  Findings may be reassessed with additional expiratory phase\nimaging, which can be performed at the time of surveillance imaging for\npulmonary nodules described below in impression #2, or sooner if earlier\nrepeat imaging is clinically warranted.\n2. Bilateral pulmonary nodules measuring up to 7 mm.\n3. Several prominent mediastinal and hilar nodes, may be reactive.\n4. Possible pulmonary arterial hypertension.\n5. Incidental 2 mm right upper pole renal stone.\n\nRECOMMENDATION(S):\n For incidentally detected multiple solid pulmonary nodules measuring 6 to\n8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk patient,\nwith an optional CT follow-up in 18 to 24 months. In a high-risk patient, both\na CT follow-up in 3 to 6 months and in 18 to 24 months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No hilar or mediastinal lymphadenopathy.  Visible\nmediastinal lymph nodes are normal to borderline in size (6, 21).  No coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nright kidney is not visualized.  1.5 cm liver cyst (6, 47).\n\nSubstantial scoliosis.  Vertebral fixation devices cause substantial local\nartifacts.  There is an asymmetry of the dorsal muscles and soft tissues (6,\n4).  In addition, there is right paravertebral soft tissue extending from the\nthoracic inlet down to the level of the main pulmonary artery.  No evidence of\nbony destruction, but extensive degenerative changes are present.\n\nThe lung parenchyma shows normal structure and attenuation.  There is no\nevidence of pulmonary nodules or masses.  No pleural thickening, no pleural\neffusions.  The airways are patent.  No diffuse lung disease.",
            "output": "Normal to borderline sized mediastinal lymph nodes.  No pleural abnormalities.\nNo suspicious pulmonary nodules or masses.  Severe scoliosis with\nstabilization devices, paravertebral soft tissue thickening and marked\nasymmetry of the dorsal musculature."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal and without\nnodules warranting further imaging evaluation.  Numerous not pathologically\nenlarged axillary nodes bilaterally.  Supraclavicular nodes are not\npathologically enlarged.\nRight paraspinal mass extending from the thoracic inlet to the right hilum is\noverall similar to the most recent study.\nRight paraspinal muscles are asymmetrically enlarged, irregular thickening of\nthe right intercostal muscles is again demonstrated.\n\nUPPER ABDOMEN: The imaged portion of the abdomen demonstrate ascites and\nomental nodules measuring up to 1.3 cm (5:245).  Additional upper abdominal\nfindings are described in detail on recent abdominopelvic CT dated ___.\n\nMEDIASTINUM: Irregular soft tissue nodularity is demonstrated at the\nsubcarinal station, without discrete nodes.\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal size. Coronary arteries are not\ncalcified. No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  New pulmonary nodule in the right upper lobe measures 1.2 x\n0.8 cm (5:142).  Otherwise, there is no consolidation.\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber. No central\npulmonary emboli.\nCHEST CAGE: Streak artifact from posterior fixation spinal rod limits\nevaluation of the adjacent tissues.  Within this limitation, multilevel\ndegenerative changes and severe S-shaped thoracic scoliosis appear unchanged. \nNo bone lesions or acute fracture are identified.",
            "output": "1. New 12 x 8 mm nodule in the right upper lobe (5:142).\n2. Redemonstrated right paraspinal soft tissue.\n3. Upper abdominal findings are more completely detailed on recent abdominal\nCT performed ___. Redemonstrated ascites and omental nodules in the left\nupper quadrant which are new since ___.\n\nRECOMMENDATION(S):  Follow up CT in 3 months."
        },
        {
            "input": "Corresponding to the region of abnormality on recent breast MRI is the\npresence of a lobulated,  heterogeneously enhancing lesion in the periphery of\nthe lateral segment of the right middle lobe measuring approximately 1.2 x 2.4\ncm with direct contact with the lateral pleural surface.  This finding is new\nsince an older chest CT of ___.  The at area of abnormality is it\ncorrectly contiguous superiorly with characteristic post radiation fibrosis\nwithin the right middle and right upper lobes with a subpleural reticulation\nand adjacent pleural thickening.  By report, the patient has received\nradiation therapy for a diagnosis of DCIS of the right breast.\n\nEvaluation of the remainder of the lungs is remarkable for moderately severe\ncentrilobular emphysema.  Bilateral juxta fissural elliptical opacities are\nlikely due to intrapulmonary lymph nodes.  As\n\nSoft tissue structures of the thorax remarkable for evidence of previous right\naxillary lymph node dissection and postoperative changes in the right breast\nwhich have been more fully assessed by a recent breast MRI.  Right breast skin\nthickening is consistent with history of radiation therapy.\n\nThere are no enlarged intrathoracic lymph nodes.  Heart size is normal, and\ncoronary artery calcifications are present.  No pericardial or or pleural\neffusion is evident.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of an incompletely imaged cystic lesion in the midpole portion of the\nleft kidney previously characterized as a simple cyst by abdominal ultrasound\nof ___.  Cirrhotic appearance of the liver and splenomegaly are\nknown findings more fully characterized on that prior ultrasound exam as well.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.  Healed right rib fractures are noted.  Note is also made of severe\ncompression deformities at T7 and L1.  The L1 compression deformity has been\nmore fully evaluated by MRI of ___ and the T7 deformity has been\npresent since an MRI of the spine of ___",
            "output": "1.  Enhancing, lobulated right middle lobe subpleural opacity is a nonspecific\nfinding but appears contiguous with characteristic post radiation changes more\nsuperiorly in the right lung.  It could potentially represent an atypical\nfocal response of the lung parenchyma to radiation therapy.  Followup CT is\nsuggested in ___ months to document stability or resolution.\n\n2.  Emphysema.\n\n3. Coronary artery calcifications.\n\n4.  Post treatment changes of the right breasts have been more fully evaluated\nby a recent breast MRI.\n\n5.  Cirrhosis and splenomegaly.\n\n6.  Severe compression deformities at T7 and L1.\n\nRECOMMENDATION(S):  Follow-up chest CT in ___ months."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Post therapeutic changes involving\nthe right breast (2, 30).\n\nUPPER ABDOMEN: The study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Left renal cortical cysts appear similar\ncompared to prior.  Cirrhotic and hypodense appearance of the liver. \nSplenomegaly and multiple portosystemic shunts in keeping with portal\nhypertension.  Small hiatal hernia.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.  Subcentimeter hilar lymph\nnodes appear similar compared to prior\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Mild to moderate coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.  Mild\natherosclerotic change of the aortic arch and supra-aortic vessels.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  The right middle lobe subpleural enhancing soft tissue (presumed\natelectasis) (4, 173) is decreased in size compared to prior currently\nmeasuring 11 x 11 mm (previously 15 x 12 mm).  Right upper lobe and right\nmiddle lobe anterior and anterolateral subpleural post radiation changes. \nModerate emphysematous changes.  No new or enlarging pulmonary nodules or\nmasses.  No confluent airspace consolidation.  No interstitial lung disease.\n-AIRWAYS:  The airways are patent to the subsegmental level.  Mild, diffuse\nbronchial wall thickening.  No bronchiectasis.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal.  No\nfilling defects on this nondedicated study\nCHEST CAGE: Spondylotic changes of the thoracic spine.  Old, healed\nright-sided rib fractures.  Severe wedge compression deformities of the T7 and\nL1 vertebral bodies appear similar compared to prior.",
            "output": "Interval decrease in size of the right middle lobe subpleural enhancing soft\ntissue favors a benign etiology such as atelectasis.\n\nSmoking related lung changes.\n\nMild to moderate coronary artery calcification.\n\nRECOMMENDATION(S):   No further follow-up imaging required."
        },
        {
            "input": "The study is not gated.  The aorta and its major branch vessels are patent,\nwith no evidence of stenosis, occlusion, dissection, or aneurysmal formation. \nModerate atherosclerotic calcifications along normal caliber thoracic aorta. \nThere is no evidence of penetrating atherosclerotic ulcer.\n\nThere is no cardiomegaly.  There is no evidence of right heart strain.  There\nis no pericardial effusion.  Severe calcifications of the coronary arteries\nare predominantly of the LAD.\nMain pulmonary artery measures 3.5 cm, suggestive of pulmonary hypertension. \nPulmonary arteries are well opacified to the segmental level, with no evidence\nof filling defect within the main, right, left, lobar, segmental pulmonary\narteries.\n\nMediastinal and hilar lymphadenopathy is new since ___.  Subcarinal\nlymph node measuring up to 1.5 x 2.6 cm (6:128), right lower paratracheal\nlymph node is borderline, 1 cm.\nLymphadenopathy in the hila measuring up to 1.8 x 2 cm (6:116) on the right\nand 1.6 x 1.4 cm in the left hilus.\n\nTracheobronchial tree is patent to the subsegmental level.  Centrilobular\nemphysema is severe, and apparently progressed since prior.  Extensive\nground-glass opacities and septal line thickening is new and involves both\nlungs, predominantly the upper lobes.\nMild subpleural nodularity in the right middle lobe is unchanged, likely\nscarring (5:60)\nTrace right pleural effusion.\n\nLimited images of the upper abdomen demonstrate worsened cirrhosis with liver\nappearing smaller, more nodular and severely heterogeneous in comparison to\n___.  New small to moderate ascites in the upper abdomen.\n1.4 cm lesion in the left adrenal is unchanged.\n\n\nSevere wedge compression deformity of T7 vertebral body is unchanged.  Old\nhealed fracture of mid sternum is.  There is no evidence of osteo destructive\nlesions.",
            "output": "-No evidence of pulmonary embolism.\n-Extensive ground-glass opacities and septal line thickening is new and\noverlies a background of likely progressed emphysema.  There is new\nmediastinal and hilar lymphadenopathy.  Infection, lymphangitic carcinomatosis\nand other etiologies should be considered.\n-Liver cirrhosis has progressed with increased nodularity, heterogeneity. \nThere is new moderate ascites."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The patient is intubated with\nendotracheal tube well above the carina.  A left upper extremity PICC line is\nnoted with tip in the proximal superior vena cava.  An enteric tube is seen\nextending into the stomach.  Its tip is beyond the lower limits of this study.\nMultiple surgical clips noted in the right axilla and right chest wall.  The\nthyroid gland is unremarkable.\n\nUPPER ABDOMEN: There is again ascites of the imaged upper abdomen.  Cirrhosis\nwith nodular liver contour and severely heterogeneous parenchyma with fatty\ninfiltration.  Left renal cyst is again partially imaged.  The left adrenal\nnodule is partially imaged, likely unchanged.\n\nMEDIASTINUM/hila: Mediastinal and hilar lymphadenopathy is improved from the\nprior study.  For example a subcarinal lymph node which previously measured\n2.4 x 1.9 cm now measures 1.8 x 1.0 cm.\n\nHEART and PERICARDIUM: Heart size normal.  No pericardial effusion.\nPLEURA: No pleural effusions\nLUNG:\n\n1. PARENCHYMA:  There is severe centrilobular emphysema that is not\nsignificantly changed from the most recent prior study.  The superimposed\nground-glass opacities and septal thickening that was previously upper lobe\npredominant has improved in the upper lobes and right middle lobe but has\nprogressed in the lower lobes.  Mild subpleural nodular scarring is not\nsignificantly changed.\n2. AIRWAYS:  Airways are patent to the subsegmental levels with mild traction\nbronchiectasis bilaterally.\n3. VESSELS:  The main pulmonary artery is dilated measuring up to 3.5 cm\ncompatible pulmonary hypertension.\nCHEST CAGE: Chronic compression deformity is noted of the T7 vertebral body. \nMultiple right-sided chronic rib fractures unchanged.",
            "output": "Severe centrilobular emphysema with superimposed ground-glass opacities and\nseptal thickening with an improved appearance in the upper lobes and worsened\nappearance in the lower lobes.  Given the waxing and waning appearance in a\nshort time frame, lymphangitic carcinomatosis and interstitial lung disease\nare considered unlikely.  This most likely represents pulmonary edema. \nInfection is also a consideration."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The thyroid gland is unremarkable.  No\nsupraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Evaluation of the upper abdominal structures is limited given\nlack of IV contrast enhancement.  Right renal stent, patency cannot be assess\non this exam.  Left nephrectomy.  Peripancreatic stranding is demonstrated,\nnew since the prior exam.  This is concerning for acute pancreatitis.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  The esophagus is unremarkable.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Cardiomegaly.  No pericardial effusion.\nPLEURA: Trace left pleural fluid.  Right pleural space is clear.\nLUNG:\n\n1. PARENCHYMA:  Limited evaluation of the lungs given respiratory motion. \nMosaic attenuation of the lungs with patchy areas of ground-glass opacity,\npredominantly within the left upper lobe, is favored to represent air trapping\nrather than pneumonia.  No obvious bronchial wall thickening.  No other\nevidence of edema. Atelectasis in the dependent portions of the lung bases.\n2. AIRWAYS:  Central airways are widely patent.\n3. VESSELS:  Mild vascular calcifications of the thoracic aorta and great\nvessels.\nCHEST CAGE: Degenerative changes of the shoulder joints bilaterally.  Flowing\nanterior osteophytes is consistent with diffuse idiopathic skeletal\nhyperostosis.",
            "output": "1. Trace left pleural effusion.\n2. No evidence of pneumonia.\n3. Pancreatic and peripancreatic inflammatory changes, consistent with acute\npancreatitis.\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 5:08 ___, 50 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THYROID:  Thyroid gland is homogeneous in attenuation throughout.\n\nLYMPH NODES:  No supraclavicular or axillary lymphadenopathy.  Mediastinal\nnodes are not enlarged by size criteria.  There is no evidence of hilar\nadenopathy.\n\nMEDIASTINUM:  No mediastinal hematoma.  Hyperdensity in the mid/distal\nesophageal lumen likely reflects ingested oral contrast (3:29).\n\nHEART AND GREAT VESSELS:  Mild cardiomegaly is stable.  No pericardial\neffusion.  Multifocal coronary artery calcification.  No appreciable aortic\nvalvular calcifications.  Normal caliber thoracic aorta with mild\natherosclerotic calcifications.  Pulmonary artery is top-normal in size,\nmeasuring 30 mm (4:101).  Right PICC terminates in the right atrium.\n\nAIRWAYS AND LUNGS:  There is suggestion of mucous plugging in the lower lobe\nairways, although evaluation is limited by respiratory motion.  Bilateral\npatchy ground-glass opacities may represent mild pulmonary edema or expiratory\nair trapping.  Small nonhemorrhagic pleural effusions, right greater than\nleft, are slightly increased from ___.  No pneumothorax.\n\nUPPER ABDOMEN:  Subdiaphragmatic findings dictated separately.\n\nBONES AND SOFT TISSUES:  No suspicious lytic or sclerotic lesions.  Chest wall\nis unremarkable.",
            "output": "1. No evidence of intrathoracic infection.\n2. Bilateral patchy ground-glass opacities may reflect mild pulmonary edema,\nalthough this is difficult to distinguish from air trapping as this study was\nperformed during relative expiration.\n3. Small bilateral nonhemorrhagic pleural effusions, right greater than left,\nminimally increased from ___.\n4. Probable mucous plugging in the small airways of both lower lobes."
        },
        {
            "input": "HEART AND VASCULATURE: Partial and near complete filling defects are seen\nbilaterally involving all multiple lobar, segmental and subsegmental levels,\ncompatible with bilateral pulmonary emboli.  No evidence for right heart\nstrain.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart is mild-to-moderately enlarged. \nPericardium is within normal limits. No significant pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM:  An irregular soft tissue density in the right\nhilum measuring 2.5 x 3.8 cm (02:47) likely reflects a conglomerate of lymph\nnodes.  Inferiorly, there is right hilar lymphadenopathy measuring up to 1.4\ncm.  Subcarinal enlarged lymph node measures up to 1.7 cm.  No axillary lymph\nnodes are seen.\n\nPLEURAL SPACES: Bilateral effusions, moderate on the right, small on the left.\n\nLUNGS/AIRWAYS: Patchy, irregular and somewhat geographic areas of ground-glass\nopacification are seen in the right upper lobe (3:153, 3:58, 85) and right\nlower lobe (3:134, 160), nonspecific.  Diffuse peribronchial airway wall\nthickening may be related to underlying pulmonary edema.  Node definite focal\nopacification to suggest infarct is seen.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for a small\nhiatal hernia and cholelithiasis.  Additionally, there is moderate narrowing\nof the proximal SMA due to noncalcified plaque.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Bilateral pulmonary emboli without evidence of right heart strain.\n2. 2.5 x 3.8 cm right hilar soft tissue mass concerning for malignancy. \nAdditional right hilar and mediastinal lymphadenopathy is demonstrated. \nSampling of the right hilar mass is suggested for further assessment.\n3. Nonspecific patchy areas of ground-glass opacification in the right upper\nand lower lobes.  Given the presence of the right hilar mass, neoplastic\ninvolvement is a concern, but differential considerations also include areas\nof inflammation or infection.\n4. Pulmonary edema with moderate right and small left pleural effusions.\n5. Moderate narrowing of the proximal SMA due to atherosclerotic mural plaque.\n6. Cholelithiasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Top normal heart size.  Mild coronary artery\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Mild thickening of the\ndistal esophagus could be related to reflux.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the pulmonary parenchyma is limited by\nrespiratory motion.  Given the limitation, no focal consolidation or\nsuspicious pulmonary nodule or mass.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatal hernia.  Otherwise, limited evaluation of the\nupper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes of the thoracic spines are mild.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  No acute process within the chest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is a ductus diverticulum, which is a normal\nvariant.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The bilateral lung apices and lung bases are excluded from the\nstudy.  Lungs are clear without masses or areas of parenchymal opacification. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nThere are bilateral breast implants.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes in the mediastinum and at\nthe level of the hilar structures. No abnormalities at the level of the large\nmediastinal vessels.  No pericardial effusion.  Moderate coronary\ncalcifications.  No aortic valve calcifications.  Fatty liver, the abdominal\nchanges are described in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum and the vertebral\nbodies.  Moderate thickening any irregularities of the bronchial walls. \nSeveral millimetric mostly subpleural nodules of benign appearance (for\nexample in the right lower lobe, series 5, image 181).  No suspicious or\nmalignant nodules or masses.  No pleural thickening.  No pleural effusions.",
            "output": "No metastatic disease to the thorax."
        },
        {
            "input": "HEART AND VASCULATURE: There is a filling defect in a basal segmental and\nsubsegmental branch of the right lower lobe (series 2; image 64), consistent\nwith acute pulmonary embolus.  There is no right heart strain. The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart is normal in size.  There is moderate to extensive\ncoronary artery calcification, most notable in the left anterior descending. \nPericardium and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is focal opacification at the right posterior lung base\nconcerning for pulmonary infarction.  Minimal left basal atelectasis is noted.\nOtherwise lungs are clear of focal consolidation or concerning nodularity. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Acute pulmonary embolism involving a basal segmental and subsegmental branch\nof the right lower lobe with associated pulmonary infarct. No evidence of\nright heart strain."
        },
        {
            "input": "HEART AND VASCULATURE: Re-demonstrated is a pulmonary embolism in a right\nlower lobe segmental and subsegmental branch, grossly similar to prior.  No\nnew pulmonary emboli are identified.  No CT findings to suggest right heart\nstrain.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart is normal in size.  Moderate\ncoronary artery calcifications, most notable in the left anterior descending\nartery, are again seen.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a new trace right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Increased still relatively small amount of nonenhancing\nperipheral consolidation and ground-glass opacification in the posterior right\nlower lobe is concerning for pulmonary infarction.  There is increased\natelectasis within the same region as well.  The lungs are otherwise clear\nelsewhere.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Right lower lobe segmental and subsegmental branch pulmonary embolism\nappears grossly similar.  No new pulmonary emboli.\n2. Increased peripheral consolidation and ground-glass opacification within\nthe affected right lower lobe is concerning for pulmonary infarct.\n3. New trace right pleural effusion."
        },
        {
            "input": "Within the lungs, numerous small noncalcified lung nodules are present in both\nlungs measuring up to 4 mm in diameter within the left lower lobe (image 209,\nseries 5).  Additional smaller, 2-3 mm diameter nodules are present throughout\nall lobes of both lungs, with representative examples on images 58, 63, 115,\n134, 143, 144, 150, 185, and 209, all on series 5.  Linear opacities in the\nleft upper lobe and lingula may reflect atelectasis or scarring.  Bilateral\ncalcified pleural plaques are present, suggesting prior asbestos exposure.\n\nCylindrical bronchial dilation with mid and lower lung predominance is a\nnonspecific finding and can potentially be age related in a patient of ___\nyears of age.\n\nThere are no enlarged mediastinal or hilar lymph nodes evident on this\nunenhanced chest CT.  The patient status post previous median sternotomy and\ncoronary bypass surgery, with calcification of the native coronary arteries. \nThe ascending aorta is ectatic, measuring up to approximately 4.3 cm in\ndiameter distally.  Heart size is normal, and no pericardial or pleural\neffusion is evident.\n\nExam was not tailored to evaluate the subdiaphragmatic region, which is been\nmore fully assessed by full abdominal and pelvic CT of ___.  Known\nbladder mass is outside of the field of view of this exam.\n\nSkeletal structures are remarkable for post sternotomy changes.  No suspicious\nlytic or blastic lesions are detected within the thorax.",
            "output": "1.  Numerous small noncalcified lung nodules measuring up to 4 mm in diameter.\nConsidering history of extrathoracic primary neoplasm, a followup CT is\nrecommended in ___ months to exclude the possibility of small pulmonary\nmetastases.\n\n2.  Ectatic and mildly dilated ascending aorta, which may also be assessed for\nstability at the time of followup CT.\n\n3.  Please see separately dictated abdominal and pelvic CT from ___ for\ncomplete description of subdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No suspicious adrenal lesions.  Punctate calcific density in relation\nto the lateral limb of the right adrenal.  A few scattered linear splenic\ncalcifications.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Evidence of previous CABG procedure.  Extensive\ncalcification of the native coronary arteries. No pericardial effusion.  Mild\nfusiform aneurysmal malformation the ascending aorta measuring 40 mm in\ndiameter (appearing similar compared to prior).  Moderate calcification the\naortic arch and supra-aortic vessels.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA: Multiple sub 4 mm pulmonary nodules are unchanged. No new or\nenlarging pulmonary nodules or masses.  Mild, but diffuse bronchial wall\nthickening suggests small airways disease. No confluent airspace\nconsolidation.\n-AIRWAYS: Patent to the subsegmental level.\n-VESSELS: The pulmonary arteries not dilated.\nCHEST CAGE: Spondylotic changes of the thoracic spine. No lytic/ destructive\nbony lesions.  Evidence of previous median sternotomy.",
            "output": "No conclusive findings to suggest intrathoracic metastatic disease.\n\nNumerous sub 4 mm pulmonary nodules are unchanged.\n\nNo new or enlarging pulmonary nodules or masses.\n\nMild fusiform aneurysmal dilatation of the ascending aorta is unchanged."
        },
        {
            "input": "CT Chest:\n\nThyroid: The thyroid is normal.\n\nLymph Nodes: There is no pathologic mediastinal lymphadenopathy.  Axillary\nlymph nodes are within normal limits.\n\nVessels: There is dense atherosclerosis of the thoracic aorta without\naneurysmal dilatation. There is no evidence of pulmonary embolism to the\nsegmental level.\n\nHeart and pericardium: There is coronary artery calcification. The heart and\npericardium are within normal limits.\n\nAirways: The airways are patent and appear within normal limits.\n\nLungs: There are trace bilateral pleural effusions and trace bibasilar\natelectasis.  There is no evidence of pneumothorax or focal consolidation.\n\n\nCT Abdomen:\n\nLiver, Gallbladder: There is a 1.3 x 0.8 cm hyperdense lesion in segment 6,\nwhich is incompletely characterized on this single phase CT.  The liver is\notherwise normal in size and attenuation.  The hepatic and portal veins appear\npatent.  There is no intra or extra hepatic biliary ductal dilatation.  The\ngallbladder is normal appearing with no evidence of cholecystitis.\n\nSpleen:The spleen is normal in size and enhancement.\n\nPancreas: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nKidneys, Adrenals: There is a 2.4 x 2.5 cm simple cyst arising off the lower\npole of the left kidney. There are multiple subcentimeter hypodensities seen\nthroughout both kidneys which are too small to characterize. The kidneys\ndisplay symmetric nephrograms and show no evidence of hydronephrosis.  The\nureters are normal in their course to the bladder.\n\nStomach, Bowel: The small bowel is normal appearing with no evidence of\nobstruction. The large bowel is filled with stool and is normal.\n\nVessels: There is dense atherosclerosis of the abdominal aorta however the\naorta is not pathologically enlarged.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\n\nCT Pelvis: There is extensive diverticulosis of the sigmoid colon with no\nevidence of diverticulitis.  The bladder is within normal limits. The rectum\nappears normal. There is no pelvic sidewall lymphadenopathy.\n\nOsseous Structures: There is extensive, severe degenerative change seen\nthroughout the thoracolumbar spine. There is evidence of prior kyphoplasty at\nT6 and T7.  No acute fractures of the spine are identified.  There are\ndeformities of the right third rib, fourth, and fifth ribs concerning for\nfracture. On the left, there is deformity of the seventh and eighth ribs also\nconcerning for possible fractures.",
            "output": "1. Multiple bilateral rib fractures as described above. No evidence of\npneumothorax.\n2. 1.3 x 0.8 cm hyperdense lesion in segment 6 of the liver which is\nincompletely characterized on this single phase exam, however likely\nrepresents a hemangioma.\n3. Diverticulosis of the sigmoid colon with no evidence of diverticulitis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.\nExcluding the breasts which must be evaluated by mammography the chest wall is\nunremarkable.\n\nUPPER ABDOMEN: Included upper abdominal organs with no gross findings.\nMinimal diffuse wall thickening of collapsed esophagus.\n\nMEDIASTINUM: There is no mediastinal, hila, internal mammary, any other\nintrathoracic lymphadenopathy.\n\nHEART and PERICARDIUM: S/p sternotomy and CABG.\nModerate cardiomegaly, no pericardial effusion. Pacemaker lead terminates in\nthe right ventricle.\nSevere and extensive calcifications of native coronaries, stent in the LAD.\nExtensive atherosclerotic calcifications of the normal caliber thoracic aorta.\nMain pulmonary artery 3.2 cm, suggesting pulmonary hypertension.\n\nPLEURA: No pleural effusion.\n\nLUNG: Minimal secretions in the trachea associated with mild diffuse airway\nwall thickening and minimal bibasilar bronchiectasis and minimal subpleural\ninterstitial line thickening.\n0.4 cm right upper lobe nodule (302:96).\nMicro nodule in the right lower lobe (302:109).\nTwo ground-glass micro nodules in the left upper lobe (302:72).\nMinimal bibasilar subsegmental platelike atelectasis.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "-No evidence of active intrathoracic malignancy.\n-Few pulmonary nodules for further follow-up.\n-Mild diffuse airway wall thickening suggestive of mild chronic airway\ndisease, chronic bronchitis.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, CT follow-up in 12 months is recommended in a high-risk\npatient."
        },
        {
            "input": "Patient has had left mastectomy.  Since ___ the previous left breast\nprosthesis has been removed.  At one level in the left paramedian anterior\nchest wall the subcutaneous fat planes are obliterated, 2: 127 -128.  The\nadjacent ribs are intact, but just superiorly there is anterior pleural\nthickening, 2: 112- 124. In the lower left hemi thorax pleural thickening is\nvery extensive, particularly along the descending thoracic aorta and spine,\nencasing a very small amount of pleural fluid, and along the diaphragmatic\nposterior and lateral costal surfaces and the left major fissure. In the\nadjacent lingula and left lower lobe are irregularly shaped nodular clusters,\n4:157, 209 and 215. The contrast-enhanced examination on ___ showed that\nin this area there was also atelectatic lung. Small foci of left pleural\nthickening are also found along the upper and lower pericardium, 4: 150 and\n167 and 187.\n\nMediastinal lymph nodes are not pathologically enlarged, but left\ndiaphragmatic juxta cardiac nodes adjacent to the cardiac apex, 6 and 7 mm in\ndiameter are rarely seen in normal patients. The hilar contours do not suggest\nadenopathy.\n\nEmphysema is mild. An irregularly shaped, but generally thin-walled cavity in\nthe superior segment of the right lower lobe, 9 x 15 mm today, 4:122, was 11 x\n13 mm on ___. Similar appearing lesions elsewhere are as follows: left\nupper lobe, 12 x 14 mm, 4:116, previously 9 x 12 mm; left lower lobe, 11 x 14\nmm, 4:152, previously 11 x 12 mm.  A much smaller lesion in the lingula, 5 x\n11 mm, with an eccentric cavity and relatively large soft tissue nodule\ncomprising more than half of the lesion. The lesion was entirely soft tissue,\nand 5 x 11 mm on ___. Another previous 7 x 8 mm cavity in the lingula on\n___ is 10 x 17 mm and entirely solid today.\n\nThe there are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Judging from the chest radiographs some of the left pleural abnormality and a\nsmall cavity in the left upper lobe present on ___. Pleural abnormality\nincreased by ___, but the lung volumes are difficult to see on that study.\n\nAll findings in the left lung could be due to atypical infection, particularly\nNocardia. Unfortunately it is possible that recurrence of aggressive\nmetastatic breast or other carcinoma could change with similar rapidity. The\nextensive pleural thickening and small left pleural effusion are similarly\nconsistent with empyema or malignant effusion, and the areas of pleural\nnodulation remote from the base of the lung are more likely malignant."
        },
        {
            "input": "CHEST:\n\nThe thyroid is normal.  Axillary, supraclavicular, mediastinal, and hilar\nlymph nodes are not pathologically enlarged by CT size criteria. The great\nvessels are unremarkable.  There are coronary artery calcifications. No\npericardial effusion. The pericardium is intact without effusion. The airways\nare patent to the subsegmental levels. The esophagus is unremarkable. The\nlungs are clear other than mild dependent atelectasis without focal or diffuse\nabnormality.  There is no evidence of pleural effusion or pneumothorax.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal abnormality.  The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder, pancreas, spleen, and bilateral adrenal\nglands are normal.  There are several renal cysts bilaterally.  No\nhydronephrosis. No suspicious renal masses.\n\nThe stomach is normal. The small and large bowel are unremarkable in\nappearance without dilation or wall thickening.  The appendix isnormal. There\nis no retroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum.  There are moderate atherosclerotic\ncalcifications of the aorta and its major branches.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES:  There is mild degenerative changes throughout the spine\nand thoracic kyphosis. There is a comminuted proximal right humeral fracture,\notherwise no fractures identified. A left total hip replacement is\nunremarkable. No focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "No intrathoracic or intra-abdominal injury.\n\nBilateral renal cysts.\n\nModerate atherosclerotic calcifications of the aorta and its major branches.\n\nCoronary artery calcifications.\n\nComminuted proximal right humeral fracture.  No other fractures identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: This study was not tailored for evaluation of subdiaphragmatic\nsections however it shows hypodense wedge-shaped hypodensity in the spleen.\n\nMEDIASTINUM: Esophagus is unremarkable.  Several enlarged mediastinal lymph\nnodes, the largest right paratracheal measuring 1.2 cm.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  No pericardial effusion.\nNo atherosclerosis in thoracic aorta or coronary arteries.\nPLEURA: Bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Respiratory motion artifacts impair parenchymal evaluation.\nConsolidations with air bronchograms in the left lower lobe, right lower and\nmiddle lobes.\nCoalescent centrilobular ground-glass nodules in the right upper lobe could be\nedema.\nTwo scattered calcified granulomas in the right lower lobe.\n2. AIRWAYS:  Remaining airways are patent to the subsegmental levels.\n3. VESSELS:  Pulmonary artery measures 3.2 cm today and is larger than\nyesterday.\nCHEST CAGE: Mild dorsal spondylosis.  No acute fractures.  No suspicious lytic\nor sclerotic lesions.",
            "output": "1.  Stable bilateral hilar and mediastinal enlarged lymph nodes, could be\nrelated to sarcoidosis or lymphoma.  The differential diagnosis could also\ninclude reactive lymph nodes.\n\n2.  Moderate bilateral pleural effusions have slightly decreased in volume,\nhowever consolidative opacities in both lower lobes have worsened since the\nprior study, these could represent atelectasis however superimposed pneumonia\ncannot be excluded.\n\n3.  Mild cardiomegaly, increase in size of the pulmonary artery since the\nprior study.  Waxing and waning pleural effusions along with cardiomegaly\ncould be related to congestive heart failure.\n\n4.  New hypodense lesion within the spleen could represent an infarct. \nEvaluation for DVT to exclude thromboembolic disease is recommended."
        },
        {
            "input": "Several small mediastinal lymph nodes are not pathologically enlarged.  Aorta\nand pulmonary arteries are within normal limits.  Coronary calcifications are\nnoted.  Aortic valve calcifications are present. Heart size is normal.  No\npericardial pleural effusion is seen.  Extensive amount of esophageal varices\nis demonstrated in particular in the mid and lower esophagus.\n\nImaged portion of the upper abdomen demonstrates stigmata of cirrhosis as well\nas liver lesion in will be discussed separately in details as part of the CT\nabdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right apical\nnodule, series 6, image 42 is 5 mm in diameter, with minimal central\ncavitation.  Within the anterior medial aspect of the right middle lobe the\nwas a cluster of ___ pulmonary nodules.  Rest of the lungs are\nunremarkable.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\nSevere gynecomastia is present.",
            "output": "A right apical nodule, chronicity undetermined.  Unlikely to represent\nmalignancy or infection such as mycobacterial but correlation with sputum\ncytology and short-term 3 months followup is required.\n\nRight middle lobe infectious process.\n\nSevere gynecomastia\n\nCoronary and aortic valve calcifications.\n\nStigmata of cirrhosis.  For pre size assessment of the upper abdomen please\nreview CT abdomen and corresponding report."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Minimal calcifications\nof the aorta are present as well as extensive calcifications of the Coronary\narteries.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and the corresponding report will be issued.\n\nSmall esophageal varices are partially imaged without contrast.  Small amount\nof right pleural effusion is present, new.  No left pleural effusion of\npericardial effusion is seen.  Heart size is normal.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nnodule, series 5, image 48, 4.6 x 5.3 mm is unchanged.  Right middle lobe\ncluster of nodules has slightly increased, in particular at the medial aspect,\nseries 5, image 242.  No new nodules masses or consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Stable right upper lobe nodule with internal small area of cavitation.\n\nInterval increase in right middle lobe cluster of nodules.\n\nBoth findings are most likely consistent with infectious process.\n\nCoronary calcifications and aortic valve calcifications, extensive, unchanged\n\nImage portion of the upper abdomen will be reviewed as part of the MRI of the\nabdomen obtained the same day."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Thyroid gland is\nunremarkable.  No pathologically enlarged mediastinal, hilar or axillary lymph\nnodes demonstrated.\n\nHeart size is normal.  Extensive Coronary calcifications present.\n\nSevere guiding, series bilateral and symmetric.  There is no pericardial\npleural effusion.  Esophageal varices are noted in the distal aspect of the\nesophagus.\n\nImaged portion of the upper abdomen demonstrate stigmata of cirrhosis,\nsplenosis, ascites and better appreciated on MRI of the liver obtained the\nsame day.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nnodule has slightly increased in size currently 5.7 mm as compared to 4.6 mm\non the previous study.  Extensive amount of centrilobular nodules in the right\nupper and left upper lobe is most likely consistent with respiratory\nbronchiolitis.  Right middle lobe paramediastinal linear opacity has\nsubstantially improved consistent with its atelectatic nature.  Left upper\nlobe calcified granuloma is stable.  No new nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Minimal interval increase in size in the right upper lobe nodule, potentially\nreflecting air of measurement, reassessment in 3 months is recommended.\n\nNo other abnormalities demonstrated.\n\nCentrilobular nodules, most likely consistent with respiratory bronchiolitis.\n\nExtensive Coronary artery calcifications."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive bilateral\nsymmetric gynecomastia is unchanged.  Coronary calcifications are extensive. \nHeart size is normal.  There is evidence of anemia.  There is no pericardial\nor pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nnodule, series 4, image 48 is 6 mm in diameter.  Right middle lobe nodularity,\nseries 4, image 208 is nonspecific similar to previous study from ___ except for 1 area where most solid component of 5 mm is present, series\n4, image 211.  Left upper lobe calcified nodule, series 4, image 74 represent\ncalcified granuloma.\n\nImage portion of the upper abdomen demonstrate evidence of previous liver\nsurgery and otherwise unremarkable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.  Nodule in the right middle\nlobe which is more pronounced compared to previous study might potentially\nrepresent infectious process but reassessment in 3 months is recommended\n\nSevere bilateral gynecomastia, symmetric\n\nExtensive coronary calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable thyroid.\nNo supraclavicular or axillary lymphadenopathy.\nExtensive symmetric gynecomastia, unchanged.\n\nUPPER ABDOMEN: Reported separately in the same day MRI of the abdomen.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion. \nModerate to severe coronary calcifications as well as aortic valve\ncalcifications.\nMajor vessels no dilated.\n\nLUNG and PLEURA: Major airways are patent.\nBiapical minimal pleural parenchymal fibrosis with specks of calcifications is\nunchanged.\nRight upper lobe 0.6 cm lung nodule is unchanged since ___ (5:48).\nRight lower lobe micro nodule is unchanged (5:148).\n\nRespiratory artifacts in the lingula containing few new micro nodules,\npossibly cluster of infectious foci.\nRight upper lobe micro nodule is new (5:204).\n\nLeft upper lobe micro nodule has decreased in size in comparison to ___ (5:113).\nMedial right middle lobe micro nodule has decreased in size (5:242).\n\nFew tiny calcified granulomas bilaterally.\nNo pleural effusion.\n\nCHEST CAGE: Degenerative changes in the spine.",
            "output": "No evidence of intrathoracic metastatic disease.\nFew of the previously demonstrated lung nodules has decreased in size, others\nunchanged, and a few are new - possibly representing cluster of infectious\nfoci."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Prominent right axillary lymph\nnodes have increased slightly in size.  The largest measures 1.6 x 1.0 cm.\n\nUPPER ABDOMEN: Status post liver transplant as demonstrated previously.\n\nMEDIASTINUM: There is widely scattered atherosclerotic calcification including\ncoronary artery calcification, as before.  Mediastinal structures are\notherwise unremarkable.\n\nPLEURA: There is no effusion.\n\nLUNG: A 6 mm right upper lobe nodule (series 4: Image 49) and 3 mm middle lobe\nnodule (4:165) are stable.  There are additional tiny right lung nodules\nmeasuring up to 2 mm which are unchanged as well.  Tiny calcified nodules\nconsistent with calcified granulomas are stable.\n\nCHEST CAGE: Degenerative changes are present in the spine.  There is no\nconcerning osteolytic or osteoblastic lesion.",
            "output": "Stable examination.  No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the imaged portion of the thyroid\nwarranting further imaging.  Supraclavicular and axillary lymph nodes are not\nenlarged.  Severe gynecomastia is symmetric, grossly unchanged since ___.  There are no soft tissue abnormalities elsewhere in the chest wall\nconcerning for malignancy.  This study is not appropriate for subdiaphragmatic\ndiagnosis which will be provided in the report an MRI of the liver performed\nconcurrently.  Bilateral posterior diaphragmatic hernias transmit only\nsubphrenic fat, clinically insignificant.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis mild to moderate in head and neck vessels, and heavy in coronary arteries. \nAortic valve calcification is moderately heavy, sufficient to be\nhemodynamically significant.\n\nAorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: As follows:\n\nNo thoracic lymph nodes are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions are as follows:\n\n7 mm solid nodule, right upper lobe, 04:34, connected to thickened pleura, 6\nmm in ___ and ___, pleura unchanged.\n\nLungs otherwise clear.  The bronchial tree is normal to subsegmental levels\nand there are no pleural abnormalities.\n\n\nCHEST CAGE: Unremarkable.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla lower\nthoracic inlet.  Large bilateral gynecomastia, symmetrical.  Mild\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, none in the aorta or\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Large collateral vessels are seen surrounding\nthe most distal esophagus (302:220).  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Small bilateral Bochdalek hernias.  No apical scarring\nbilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Unchanged 6 mm nodule in the\nright apex (___), connected to the adjacent pleura.  Small scattered\ncalcified granulomas, for example in the left upper lobe (302:73).  Please\nnote that the 3 mm nodule in the middle lobe mentioned in the chest CT from\n___ was an endobronchial nodule, representing a mucous secretion that\nhas cleared ever since.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___ with no\ndefinitive evidence of intrathoracic metastatic disease."
        },
        {
            "input": "CT CHEST:\n\nThe distal tip of the ___-Ganz catheter terminates in the right pulmonary\nartery.  An Impella device is noted. The distal tip of the endotracheal tube\nis 5 cm above the carina.  There has been previous median sternotomy.\n\nThe thyroid is unremarkable.\n\nThere is no size significant supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.\n\nNo atherosclerotic calcifications are seen.\n\nThe pulmonary artery is not enlarged.\n\nModerate right and small left pleural effusions are seen, with associated\nsubsegmental atelectasis.  There is no evidence of pericardial effusion.\n\nNo focal consolidation is seen within the lung parenchyma.  There is complete\ncollapse of the right lower lobe.  There is almost complete collapse of the\nright middle and left lower lobes.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nCT ABDOMEN AND PELVIS:\n\nLiver: The liver is homogeneous with a smooth contour.  No suspicious liver\nlesion.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder contains increased density material, which could represent\nvicarious excretion of previously administered contrast.  No gallbladder wall\nthickening.  No surrounding fat stranding.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: The urinary bladder contains a Foley catheter, with expected air.  The\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nGastrointestinal: The distal tip of the enteric tube is in the gastric body. \nThe bowel is within normal limits. There is no evidence of bowel dilatation or\nobstruction.\n\nVascular: There are mild atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: There is no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. Fat stranding is\nseen within the subcutaneous tissues of the left inguinal region, which could\nbe related to a recent procedure.",
            "output": "1. Worsening pleural effusions compared to ___.  No focal\nconsolidation within the lung parenchyma to suggest pneumonia/infection.\n\n2. No evidence of infection in the chest, abdomen or pelvis."
        },
        {
            "input": "CT CHEST:\n\nThe distal tip of the ___-Ganz catheter terminates in the right pulmonary\nartery.  An Impella device is noted. The distal tip of the endotracheal tube\nis 5 cm above the carina.  There has been previous median sternotomy.\n\nThe thyroid is unremarkable.\n\nThere is no size significant supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.\n\nNo atherosclerotic calcifications are seen.\n\nThe pulmonary artery is not enlarged.\n\nModerate right and small left pleural effusions are seen, with associated\nsubsegmental atelectasis.  There is no evidence of pericardial effusion.\n\nNo focal consolidation is seen within the lung parenchyma.  There is complete\ncollapse of the right lower lobe.  There is almost complete collapse of the\nright middle and left lower lobes.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nCT ABDOMEN AND PELVIS:\n\nLiver: The liver is homogeneous with a smooth contour.  No suspicious liver\nlesion.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder contains increased density material, which could represent\nvicarious excretion of previously administered contrast.  No gallbladder wall\nthickening.  No surrounding fat stranding.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: The urinary bladder contains a Foley catheter, with expected air.  The\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nGastrointestinal: The distal tip of the enteric tube is in the gastric body. \nThe bowel is within normal limits. There is no evidence of bowel dilatation or\nobstruction.\n\nVascular: There are mild atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: There is no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. Fat stranding is\nseen within the subcutaneous tissues of the left inguinal region, which could\nbe related to a recent procedure.",
            "output": "1. Worsening pleural effusions compared to ___.  No focal\nconsolidation within the lung parenchyma to suggest pneumonia/infection.\n\n2. No evidence of infection in the chest, abdomen or pelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The the left internal jugular line\nterminates in the left brachiocephalic vein at the junction with the SVC.  A\nSwan-Ganz catheter is in adequate position with the distal tip in the right\nmain pulmonary artery.  An Impella device is also located in the left\nventricle, unchanged from prior.\n\nStatus post sternotomy.  There is minimally increased step-off at the sternal\nosteotomy site measuring 4 mm, previously measuring 2 mm (series 602, image\n46), however the cerclage wires appear intact..  No mediastinal hematoma.  No\ndisruption of the sternal wires.\n\nUPPER ABDOMEN: Please refer to separate abdominal pelvis CT done the same day\nfor abdominal finding.\n\nMEDIASTINUM: Multiple motion artifacts.  No mediastinal collection.  No\nmediastinal adenopathy.\n\nHEART and PERICARDIUM: Unchanged mild to moderate cardiomegaly.  Small new\npericardial effusion measuring up to 17 mm in thickness.\nPLEURA: Interval decrease in size of left pleural effusion, now nearly\nresolved as well as interval decrease in size of a right pleural effusion\nremaining mild to moderate.\n\n\nLUNG:\n\n1. PARENCHYMA:  Consolidation of the right lower lobe is again noted although\nimproved, likely atelectasis although evaluation is limited on this\nnoncontrast study.  Left lower lobe linear atelectases is also improved.\n2. AIRWAYS:  The trachea and main bronchi are patent.",
            "output": "1. Multiple motion artifact limiting the evaluation.\n2. New small pericardial effusion.\n3. Interval improvement but persistent of a right pleural effusion with\nbilateral consolidation likely secondary atelectasis.\n4. Minimal increase in the step-off at the sternal osteotomy but with intact\nsternotomy wires.  No mediastinal collection seen."
        },
        {
            "input": "CT CHEST WITHOUT CONTRAST: Calcifications are heavy at the aortic valve,\ncoronary arteries, and mitral valve annulus.\n\nOSSEOUS STRUCTURES: Unremarkable.\n\nPULMONARY VEIN ANATOMY:  There are 4 pulmonary veins entering the left atrium.\n2 right pulmonary veins and 2 left pulmonary veins.\n\nThere is no evidence for pulmonary vein stenosis.\n\nBidirectional measurements of the pulmonary veins are as follows:\nRight superior: 16x22 mm, Area: 293 mm2\nRight inferior: 14x19 mm, Area: 223 mm2\nLeft superior: 21x26 mm, Area: 431 mm2\nLeft inferior: 12x16 mm, Area: 153 mm2\n\nRight saddle: 6mm\nLeft saddle: 5mm\n\nLEFT ATRIUM:  The left atrium isnormal in size and is normally opacified.  The\nleft atrial appendage is normally opacified. The calculated volume is 113cc\nwith the left atrial appendage and 97cc without.\n\nSVC anomalies are absent.  IVC anomalies are absent.",
            "output": "Normal pulmonary venous anatomy.\nNo evidence for pulmonary vein stenosis.\nNo left atrial or appendageal thrombus"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Unremarkable appearance of the upper abdomen on this\nnonenhanced study.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or hematoma.\n\nHILA: No hilar lymphadenopathy given noncontrast technique.\n\nHEART and PERICARDIUM: The heart is enlarged.  Coronary arterial\ncalcifications are again seen.  There is severe calcification of the mitral\nvalve.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is no focal consolidation or suspicious lesions.  There\nis a calcified granuloma in the right lower lobe (302:182)\n2. AIRWAYS:  The airways are patent through the subsegmental level.\n3. VESSELS:  The thoraco abdominal aorta is mildly aneurysmal.  This is\nhowever increased since prior.  The ascending aorta now measures up to 4.7 cm\n(601:38), previously measuring 4.2 cm (see series 601, image 20 on the prior\nscan).  The descending thoracic aorta measures up to 3.2 cm (02:20),\nunchanged.  The upper abdominal aorta at the level of the SMA measures 3.1 cm,\nalso unchanged.  There is extensive mural atherosclerotic calcified plaque\nthroughout the entire aorta.  No evidence of an intramural hematoma.\nCHEST CAGE: Cortical irregularity of the left fourth and seventh ribs are\nunchanged.  No new or suspicious osseous lesion.  Stable eventration of the\nleft hemidiaphragm and a small fat containing diaphragmatic hernia..",
            "output": "No evidence of pneumonia.\n\nMildly increased caliber of the aneurysmal ascending thoracic aorta, measuring\nup to 4.8 cm.  Extensive calcified and probable noncalcified atherosclerotic\nplaque throughout the visualized aorta."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid gland\nis unremarkable.  No supraclavicular or axillary lymphadenopathy.  Soft\ntissues of the chest are unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen show tiny\ncholelithiasis.  Partially image low-density round circumscribed lesion in the\nupper pole of the right kidney corresponds to a cyst.  Elevation of the left\nhemidiaphragm is unchanged, with a left Bochdalek hernia.\n\nMEDIASTINUM: Aneurysmal ascending aorta measures 4.7 cm.  Thoracic aorta is\nvery demonstrate heavy burden of calcified and noncalcified plaque and\nunchanged tortuous contours since ___.  A focal area of\ndissection in the retrocrural aorta at the level of the celiac axis is\nunchanged.  Esophagus is unremarkable.  Small hiatal hernia.  There are no\nmediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is an area of focal\nthinning in the left lateral wall which likely represents an area prior\ninfarction.  Heavy calcification in the mitral annulus.  No pericardial\neffusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Scattered small ground-glass opacities in the right lower lobe\nand left lower lobes.  Subsegmental atelectasis along the descending thoracic\naorta.\n2. AIRWAYS:  Airways are patent to subsegmental level.  There is mild\nbronchial wall thickening in both lower lobes, however greater on the left,\nwithout bronchiectasis mucous plugging.\n3. VESSELS:  Although is not the purpose of this study there is no central\nfilling defect in the pulmonary vasculature suggestive of pulmonary embolism.\nCHEST CAGE: No abnormal findings in the osseous structures of the chest\nredemonstration of hypoplastic fifth and seventh left ribs.",
            "output": "1. Scattered ground-glass opacities in the right lower and left lower lobes\ncould be secondary to aspiration and/or infection. Associated is mild\nbronchial wall thickening greater in the left lower lobe may represent sequela\nfrom prior infection.\n2. Aneurysmal ascending aorta measuring 4.7 cm is unchanged since ___.  Tortuous thoracic aorta with heavy calcified and noncalcified plaque is\nunchanged.  No new vascularity injury or central pulmonary embolism.\n3. Stable appearance of the elevated left diaphragm with left Bochdalek\nhernia."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nAgain demonstrated is aneurysmal dilatation of the ascending thoracic aorta\nmeasuring up to 4.7 cm, unchanged compared to the prior examination of ___.  There is a similar degree of severe calcific and noncalcific\nplaque throughout the thoracic aorta with unchanged appearance of a dissection\nin the retrocrural aorta at the level of the celiac axis (series 3, image\n223).  Heavy calcification of the mitral annulus is unchanged.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small to moderate right pleural effusion is new compared to ___.  No pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse interlobular septal thickening is suggestive of\npulmonary edema.  There is mild dependent and compressive atelectasis at the\nlung bases, right greater than left.  The airways are patent to the level of\nthe segmental bronchi bilaterally.  There is no focal consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for stable\nelevation of the left hemidiaphragm with small left Bochdalek's hernia,\nunchanged..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolus.\n2. Stable aneurysmal dilatation of the ascending thoracic aorta up to 4.7 cm\nas compared to ___.  No dissection.\n3. New small to moderate right pleural effusion and diffuse intra lobular\nseptal thickening is suggestive of pulmonary edema.  No focal consolidation."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged.\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Patulous esophagus contains a small volume of fluid. \nSmall hiatal hernia is noted.  There are no findings in the thyroid warranting\nfurther imaging evaluation.\nAtherosclerotic calcifications are noted in the aorta and coronary arteries. \nThe aorta, pulmonary arteries, and cardiac chambers are normal size.\nNo pericardial effusion.\n\nTHORACIC LYMPH NODES: Non pathologically enlarged, including internal mammary\nand diaphragmatic stations.\n\nLUNGS, AIRWAYS, PLEURAE:\nIrregular biapical pleuroparenchymal thickening, may represent scarring.\nScattered patchy and ___ opacities noted bilaterally, but more\nextensively involving the right upper lobe (series 5, image 117).  Also noted\nis a focus of ground-glass opacities in the left upper lobe (series 5, image\n75).\nMild lower lobes atelectasis associated with small pleural effusions, greater\non the left.\n7 mm nodule in the right upper lobe (series 6, image 115).\n\nConspicuous endobronchial secretions are seen within the right upper lobe\nbasilar subsegmental bronchi.  Otherwise, the tracheobronchial tree is patent\nand normal to the subsegmental levels.\n\nCHEST CAGE: No pathologic or acute compression fractures or destructive bone\nlesions.",
            "output": "1. Scattered patchy and ___ opacities predominantly involving the\nbasilar right upper lobe, associated with endobronchial secretions and a\npatulous esophagus, may be concerning for sequela of aspiration and/or\ndeveloping pneumonia.\n2.  Mild bibasilar atelectasis with small pleural effusions, greater on the\nleft."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: New extensive lingular (6:169) and left lower lobe (6:252)\nconsolidations and left lower lobe ___ opacities (6:240).  Right upper\nlobe tree in ___ opacities seen in the prior study have improved in the\ninterval.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nLingular and left lower lobe consolidations with associated left lower lobe\n___ opacities consistent with multifocal infection.  The ___\nopacities in the context of an immunosuppressed patient raise concern for\nmycobacterial infection in the appropriate clinical context."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Mild coronary\ncalcifications are noted.  There is evidence of high density of the myocardium\nconcerning for anemia.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.  There is no pericardial or pleural effusion.\n\nAortic valve calcifications are present and might be concerning for aortic\nvalve stenosis\n\nImage portion of the upper abdomen demonstrate liver hypodensity, series 4,\nimage 57, seen on the previous examination, and consistent with imaging ___.\n\nAirways are patent to the subsegmental level bilaterally.  Tracheal bronchus\nsupplying superior segment of right upper lobe is redemonstrated, series 4,\nimage 20.  ___ opacities in the right upper lobe, series 6, image 99,\n105 are similar to previous examination.  The largest area a is at series 6,\nimage 120.  Lingular cluster of pulmonary nodules with ___ appearance\nhas minimally improved since previous examination, series 6, image 154.  No\nnew clusters demonstrated.  Left lower lobe stent along nodule is stable,\nseries 6, image 221.  Cluster of left lower lobe nodules is present but\nsubstantially improved, series 6, image 239.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall substantial improvement in lingular and left lower lobe areas of\nclustered ___ nodules and consolidations with unchanged appearance of\nright upper lobe similar but less pronounced abnormalities.  Overall the\nfindings are potentially representing atypical mycobacterial infection.  Other\netiologies are possible but less likely.\n\nConcern for anemia\n\nAortic valve calcifications, please correlate with echocardiography to exclude\nthe possibility of clinically significant aortic valve stenosis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\ndissection, aneurysm, or penetrating atherosclerotic ulcer.  There are\nmoderate atherosclerotic calcifications of the thoracic aorta.\n\nThe pulmonary arteries are well opacified to the proximal segmental level,\nwith no evidence of filling defect to indicate pulmonary embolism.  Assessment\nof the distal segmental and subsegmental pulmonary arteries is limited by\nrespiratory motion artifact and attenuated vessels.  The main and right\npulmonary arteries are normal in caliber, and there is no evidence of right\nheart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere are tiny calcified nodules within the bilateral thyroid lobes.\n\nThe heart is normal in size.  There is no evidence of pericardial effusion. \nThere are moderate coronary calcifications involving the LAD.  Dual lead\npacemaker device in situ.\n\nThere is no pleural effusion or pneumothorax.\n\nSubsegmental atelectatic changes in the bilateral lower lobes and left upper\nlobe.  No consolidation suspicious for pneumonia.\n\nThe central airways are patent.\n\nLimited images of the upper abdomen are unremarkable.\n\nThere is no suspicious osseous lesion.  There are moderate degenerative\nchanges of the thoracic spine.",
            "output": "1.  No evidence of pulmonary embolism to the level of the proximal segmental\narteries.\n2.  No acute pulmonary parenchymal process."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the chest wall are\nnormal in size.  No hilar or mediastinal lymphadenopathy.  Normal appearance\nof the large mediastinal vessels.  No coronary calcifications, no valvular\ncalcifications, no abnormalities at the level of the pericardium. 3 cm left\nkidney cyst.  No abnormalities at the level of the ribs, the sternum, or the\nvertebral bodies.\nNo pleural effusions.  No abnormalities of the airways.  No pleural\nthickening.  Minimal paravertebral right lower lobe fibrosis (5, 161).  No\nfocal or diffuse lung abnormality.  No suspicious lung nodules or masses. \nSingle 2 mm intrapulmonary lymph node in the left lower lobe (5, 215).",
            "output": "Normal appearance of the lung parenchyma.  No pleural abnormalities.  No\nlymphadenopathy.  No bony changes likely to explain the clinical presentation\nof the patient."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  There is no pleural or pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No new or growing pulmonary nodules.  The abnormality\non the radiograph corresponds most likely to a vessel end on.  No lung\nnodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty liver. \nThere is a cyst in the upper pole of the left kidney.  It has not been\ncompletely imaged.",
            "output": "No lung nodules.\n\nFatty liver.\n\nLeft renal cyst."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.\n\nThere is severe centrilobular emphysema.  There is bibasilar atelectasis,\nsevere on the left, and a moderate left size pleural effusion and small\nright-sided pleural effusion.  A right-sided chest tube is in place.  There\nare areas of more confluent consolidation in the medial right lower lobe and\nright middle lobe as well as the upper lobes.  Infection is not excluded. \nThese changes are seen on a background of intersitial thickening with patchy\nground-glass opacities, in a central distribution with slight dependency, most\ncompatible with interstitial edema.  There is a small right apical\npneumothorax, expected postsurgically.   The airways are patent to the\nsubsegmental level.\n\nThe patient has undergone ___ esophagectomy with gastric pull-through. \nA gastric tube is in place.  A surgical drain is noted.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No acute pulmonary embolus or aortic abnormality.\n2.  More confluent consolidation in the right middle and lower lobes, which\ncould represent early infection.\n3.  Bilateral pleural effusions greater on the left than right with severe\nleft lower lobe atalectasis and moderate interstitial edema, superimposed on a\nbackground of severe centrilobular emphysema.\n4. Post ___ esophagectomy and gastric pull-through."
        },
        {
            "input": "CHEST:  The thyroid gland is homogeneous.  The aorta and main pulmonary artery\nare normal in caliber.  There is no significant atherosclerotic calcification\nof the descending thoracic aorta.  Heart size is normal and there is no\npericardial effusion.  No enlarged mediastinal lymph nodes are appreciated. \nThe patient is status post ___ esophagectomy with gastric pull-through.\nThe neo-esophagus contains oral contrast and there is no evidence of\nextravasation into the mediastinum.  There is no mediastinal hematoma.\n\nThe lungs demonstrate mild to moderate centrilobular and paraseptal emphysema\nand linear atelectasis in the left lower lobe and right middle lobe.  There is\nno focal consolidation to suggest pneumonia and no pleural effusion or\npneumothorax.\n\nABDOMEN:  The liver is normal in attenuation with no focal hepatic lesions or\nbiliary dilation.  The gallbladder is nondistended.  The pancreas is normal in\nattenuation with mild uniform prominence of the pancreatic duct.  There is a\nsmall wedge shaped hypodensity at the supermedial margin of the spleen, likely\nan infarct.  The adrenal glands are morphologically normal bilaterally.  The\nkidneys enhance and excrete contrast without hydronephrosis or perinephric\nabnormality.\n\nThe small bowel is normal in caliber without obstruction.  A direct jejunal\nfeeding tube is seen entering the right paramedian abdomen, terminating in the\nright mid abdomen within loops of nonopacified bowel.  The large bowel is\nnormal in caliber and there is a distal colocolonic anastomosis.  There is no\nfree fluid in the abdomen or pelvis.  No mesenteric or retroperitoneal\nlymphadenopathy.\n\nPELVIS:  Urinary bladder is well distended and thin-walled.  The uterus and\nadnexae are normal.  There is no free fluid the pelvis.  Noted is a small\namount of air in the vagina.\n\nBONES:  The patient is status post L5-S1 diskectomy and fusion with partial\nbony fusion across the vertebral bodies.  There is no thoracic or lumbar\ncompression fracture.  No focal suspicious osseous abnormality.",
            "output": "1.  Status post ___ esophagectomy with gastric pull-through, with no\nevidence of extravasation of contrast into the mediastinum.\n2.  Normal caliber small large bowel with the direct jejunal feeding tube seen\nin the right mid abdomen.\n3.  Mild to moderate centrilobular and paraseptal emphysema, but no evidence\nof acute pulmonary infection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There are prominent axillary lymph nodes without evidence of\nlymphadenopathy stable from previous study.\n\nUPPER ABDOMEN: Please refer CT abdomen pelvis performed at the same day for\nfurther detail.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is a right-sided Port-A-Cath with tip terminating\nat the cavoatrial junction.  The heart is normal in size.  No pericardial\neffusion is identified.  There is atherosclerotic calcification involving the\nthoracic aorta.  The ascending aorta is dilated measuring up to 4.2 cm.\n\nPLEURA: No pleural effusion is identified.\n\nLUNG: The central airways are patent.  There is mild centrilobular emphysema. \nThere is no focal consolidation.\n\nCHEST CAGE: No suspicious osseous lesions are identified.  There is mild\ndextroscoliosis of the thoracic spine.  Mild degenerative changes of the\nthoracic spine is noted.",
            "output": "1. No evidence of intrathoracic metastatic lesion.\n2. Dilated ascending aorta measuring up to 4.2 cm.  Follow-up with aorta\ncenter is recommended.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 15:18 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Dilatation of ascending aorta up to 4.2 cm is present, similar to previous\nexamination.  Pulmonary arteries are normal in diameter.  Coronary\ncalcifications are extensive.  Heart size is normal.  There is no pericardial\npleural effusion.\n\nNo supraclavicular, mediastinal, hilar or axillary lymphadenopathy is present\nwith multiple small mediastinal lymph nodes seen bilaterally.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal areas of\nlinear atelectasis are noted.  No discrete pulmonary nodules masses or\nconsolidations demonstrated.",
            "output": "No evidence of intrathoracic metastatic disease\n\nDilated ascending aorta, unchanged, annual follow-up is required.\n\nExtensive coronary calcifications\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: There are cholecystectomy clips and left renal cysts.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy. There is stranding\nextending to the anterior mediastinum, which could reflect mediastinitis\nrelated to osteomyelitis of the sternum (see below under \"Chest Cage.\"  No\nfocal fluid collection.\n\nHILA:  Evaluation is limited without IV contrast, but is grossly unremarkable.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  No pericardial effusion.  Severe\ntriple vessel coronary calcifications and post CABG changes.\n\nPLEURA: No pleural effusions.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is a 7 mm calcified granuloma in the right upper lobe\n(4:92).  There are 4 mm and 5 mm nodules in the right upper lobe (4: 106 and\n112) without calcification.  There mild-to-moderate subsegmental dependent\natelectasis bilaterally.  There is mild centrilobular emphysema.  No focal\nconsolidation.\n2. AIRWAYS:  The airways are patent to subsegmental levels.\n3. VESSELS:  The great vessels are normal caliber.\nCHEST CAGE: Patient is status post median sternotomy.  The subcutaneous\nsternotomy incision is open and appears packed with gauze.  There is air\nwithin the sternotomy defect and surrounding soft tissue swelling.  The\nmanubrium and upper body of the sternum have a moth-eaten appearance with\nirregularity of the margins and bone loss, highly concerning for\nosteomyelitis.  There is stranding extending to the anterior mediastinum,\nwhich could reflect mediastinitis.",
            "output": "1. Status post median sternotomy.  Air within the sternotomy defect and\nsurrounding soft tissue swelling.  Moth-eaten appearance with irregularity of\nthe margins and bone loss of the manubrium and upper body of the sternum,\nhighly concerning for osteomyelitis.\n2. Stranding extending to the anterior mediastinum, which could reflect\nmediastinitis. No focal fluid collection.\n3. Two solid nodules in the right upper lobe measuring up to 5 mm.  Optional\nCT in 12 months should be considered in this patient with background\nemphysema.  See below for recommendations.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The left\natrium and ventricle are enlarged.  There is high-density material within the\nleft atrial appendage and inferior aspect of the left atrium concerning for\nthrombus.  Mitral and tricuspid valve replacements noted.  No pericardial\neffusion is seen.  Cardiac device in situ in the left chest wall with mild\ninflammatory change and gas in the surrounding fat, presumed from recent\ninsertion.  Coronary artery calcification noted.  Mild asymmetry of the\npectoralis major muscles, likely due to small postoperative hematoma in the\nleft pectoralis major muscle.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild basilar atelectasis.  No evidence of pulmonary edema. \nLungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Mild enlargement of the low-density lesion in segment 8 lesion now\nmeasures approximately 14 mm and still likely represents cysts.  No other\nfocal liver lesions.  Small hiatal hernia.  Remaining visualized upper abdomen\nappears normal.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPrior sternotomy noted.  Multilevel thoracic spine degenerative change.",
            "output": "-High density material within the left atrial appendage and inferior aspect of\nthe left atrium is suspicious for thrombus.\n-Likely small postoperative left pectoralis major intramuscular hematoma.\n\nRECOMMENDATION(S):  Echocardiogram would likely further evaluate\n\nNOTIFICATION:  Discussed with Dr. ___, at 21:07 on ___."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nUpper Abdomen:\nNo abnormality\n\nChest Wall and bones:\nStatus post lumbar spine and right humeral surgery.  No lytic or sclerotic\nlesions worrisome for infection or neoplasm identified.\n\nMediastinum:\nMain pulmonary arteries dilated up to 3.5 cm, unchanged.\n\nOtherwise, no abnormality\n\nHila:\nNo abnormality\n\nHeart:\nCoronary calcifications.  Aortic arch calcifications, unchanged\n\nLung:\n\nNodules:\n\nDominant nodule:\n1 mm right upper lobe solid subpleural nodule is unchanged, series 4 image 51\n\nOther nodules:\n\n\nParenchyma:\nOpen lung biopsy in the right upper lobe and the lower lobe cysts postsurgical\nchanges are stable.  Paraseptal pulmonary emphysema is moderate, unchanged. \nDiffuse upper lobe predominant ground-glass opacities which also located in\nthe subpleural areas of the lower lobes are unchanged in combines to signed of\narchitectural distortion.\n\nPleura and airways:\nNo abnormality",
            "output": "Stable appearance of the chest including parenchymal changes, emphysema and 1\nmm right upper lobe solid pulmonary nodule\n\nNew findings are most likely reflecting smoking related interstitial lung\ndisease with predominant presence of NSIP and DIP\n\nSuspected pulmonary hypertension\n\nLung-RADS category: 2 very low likelihood of becoming clinically active lung\ncancer due to size and morphology as well as stability\n\nRECOMMENDATION(S):  Continued annual surveillance with low-dose chest CT in 12\nmonths\n\nIncidental findings**:\n\n\n\n\n___ Radiology is an ___ accredited CT lung cancer screening site.\n**All recommendations regarding incidental findings are based on ACR\nguidelines for the management of these findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal nodes are unchanged.  There is stable small hilar\nlymph nodes.  The main pulmonary artery is enlarged and measures 4 cm, most\nlikely related to secondary pulmonary hypertension.  Mild coronary artery\ncalcifications unchanged.  The aorta is normal in caliber.  The airways are\npatent to the subsegmental level.  There is no pericardial effusion.  There is\na small sized hiatus hernia, also unchanged.  Incidental note is made of a\nright-sided Bochdalek's hernia.\nd\nPLEURA: There is no pleural effusion\n\nLUNG: The interstitial abnormality comprising of of fibrosis along\nbronchovascular distribution in both upper lobes right greater than left is\nunchanged.  There is evidence of prior wedge resection in the right upper\nlobe.  Alveolar ground-glass opacification is also unchanged.  There is\nminimal bibasilar atelectasis.  The interstitial abnormality in both lower\nlobes is unchanged.  Both the alveolar component and the fibrotic components\nare stable.  Lung volumes are preserved.\n\nBONES AND CHEST WALL : Review of bones shows evidence of internal fixation of\nthe lumbar spine.  There are degenerative changes involving the thoracic\nspine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  Patient status post laminectomy.",
            "output": "Stable interstitial abnormality with preserved lung volumes.  The previous\nlung biopsy from the right upper lobe and right lower lobe showed nonspecific\ninterstitial fibrosis.  No new lung nodules.\n\nStable small mediastinal lymph nodes are most likely reactive.\n\nEvidence of pulmonary arterial hypertension."
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the subsegmental\nlevel without filling defect to suggest pulmonary embolism. Pulmonary arteries\nare normal in caliber.\n\nThere is no evidence of pulmonary parenchymal abnormality. There is no pleural\neffusion or pneumothorax. The airways are patent to the subsegmental level.\n\nHeart is unremarkable.  There is no pericardial effusion.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy. Included\nportion of the thyroid is unremarkable.\n\nThe liver is fatty.  Otherwise, the included portion of the upper abdomen is\nunremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere is no fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Fatty liver."
        },
        {
            "input": "There are no enlarged axillary, mediastinal, or hilar lymph nodes.  Heart is\nupper limits of normal in size and diffuse coronary artery calcifications are\npresent.  Permanent pacemaker is present with leads terminating in the right\natrium and right ventricle.  There is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nin the spine.\n\nAssessment of the lungs is limited by inadvertent expiratory phase of\nrespiration and respiratory motion, reducing sensitivity for detecting small\npulmonary nodules and subtle interstitial abnormalities.  With this limitation\nin mind, there are no suspicious nodules or masses to suggest the presence of\nprimary lung cancer as a potential cause of the patient's symptoms.",
            "output": "1.  Technically limited study demonstrating no evidence of primary lung\ncancer.\n\n2.  Diffuse coronary artery calcifications.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Unremarkable\n\nMEDIASTINUM: No lymphadenopathy in the mediastinum.  Calcifications involving\nthe thoracic aorta and the coronary arteries.  There is dilation of the main,\nright and left pulmonary arteries, suggestive of pulmonary arterial\nhypertension.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.  The heart is of normal size.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is atelectatic changes more prominent in both lung\nbases.\n2. AIRWAYS:  The airways are patent.\nBONY STRUCTURES: There is severe rightward scoliosis of the dorsal spine, as\nwell as degenerative dorsal changes.",
            "output": "1.  Enlargement of the pulmonary arteries suggestive of pulmonary arterial\nhypertension.\n2.  Some atelectatic changes involving both lungs, more prominent in the left\nlung base."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nThe heart size is normal and there is no pericardial effusion. Minimal\natherosclerotic calcifications of the thoracic aorta and mild focal of the LAD\ncoronary arteries.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent. The lungs are clear\nof interstitial or airspace opacity. No suspicious pulmonary nodules.  Minimal\nbands of atelectasis in the lower lobes and right middle lobe.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "Right lower lobe segment pole filling defect is demonstrated, series 4, image\n57, 67, consistent with segmental and subsegmental pulmonary emboli.  Lack of\ndilatation of the pulmonary arteries and mall linear nature of the filling\ndefect might represent sub out acute nature of the process.\n\nAirways are patent to the subsegmental level bilaterally.  No mediastinal,\nhilar or axillary lymphadenopathy is present.  There are no lytic or sclerotic\nlesions worrisome for infection or neoplasm.\n\nLeft apical nodule, series 5, image 74 is stable.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present",
            "output": "Subsegmental right lower lobe pulmonary embolism with no evidence of right\nheart strain.  Chronicity is undetermined but potentially it might represent\nsubacute process.\n\nNo evidence of intrathoracic metastatic spread.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:53 AM, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The thyroid is within normal limits. \nThere is no axillary or supraclavicular lymphadenopathy.  There is no\nmediastinal or hilar lymphadenopathy.\n\nHEART & VESSELS: The heart is normal in size.  The main pulmonary artery\nmeasures up to 31 mm.  The right main pulmonary artery measures up to 31 mm as\nwell The thoracic aorta is normal in caliber.  No large or central pulmonary\nembolism is identified.  A right-sided Port-A-Cath terminates in the proximal\nright atrium.\n\nLUNGS & AIRWAYS: The airways are patent to the subsegmental level. The lungs\nare clear without focal consolidation or pleural effusion.\n\nPulmonary nodules:\n3 mm, left upper lobe, 05:56\n\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nNo large or central pulmonary embolism is identified.\n\nEnlarged pulmonary arteries suggesting pulmonary hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nThere are no incidental chest wall findings.\n\nUPPER ABDOMEN: Reported separately on the same date CT of the abdomen and\npelvis.\n\nMEDIASTINUM: There is no mediastinal, hilar or retrocrural lymphadenopathy.\n\nHEART and PERICARDIUM: Right Port-A-Cath terminating in the cavoatrial\njunction.\nNo cardiomegaly and no pericardial effusion.\nMild enlargement of the left atrium up to 4.7 cm.\nMain pulmonary artery mildly dilated up to 3.3 cm, suggesting pulmonary\nhypertension, unchanged.\nMinimal calcifications in the LAD and LCX and aortic annulus.\nModerate calcifications along the thoracic aorta.\n\nLUNG and PLEURA: Minimal secretions in the trachea, otherwise major airways\nare patent.\nMinimal bibasilar dependent microatelectasis, otherwise the lungs are clear.\nThere are no lung masses.\nNo pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Right pectoral Port-A-Cath.  Stable appearance of\nthe large mediastinal vessels.  No adenopathy.  Moderate coronary\ncalcifications, no substantial valvular calcifications, no abnormalities in\nthe posterior mediastinum.  The upper abdomen, including the perianal hepatic\nand perisplenic ascites, are described in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nThe lung parenchyma is overall unremarkable, no evidence of suspicious lung\nnodules or masses.  The airways are patent.  No pleural thickening, no pleural\neffusions.  The only abnormality is a non characteristic scar at the bases of\nthe middle lobe (5, 172) as well as at the bases of the left lower lobe (5,\n180).  No diffuse lung disease.  No suspicious pulmonary nodules or masses.",
            "output": "Stable overall unremarkable appearance of the lung parenchyma.  No evidence of\nsuspicious pulmonary nodules or masses.  No pleural effusions.  No adenopathy."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  A single right hilar lymph node measures up to 1 cm in short axis,\nlikely reactive.  Hilar lymph nodes are otherwise not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.  There is severe aortic\nvalve leaflet thickening and calcification suggesting hemodynamically\nsignificant aortic stenosis.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is mildly\nenlarged, measuring 4.1 cm.  The main, right, and left pulmonary arteries are\nnormal caliber.\n\nPULMONARY PARENCHYMA:  There is no suspicious pulmonary nodule.  Subsegmental\natelectasis in the right greater than left lung base is similar to prior\ncardiac MRI and likely chronic.  Focal areas clustered nodularity in the right\nlung base may be inflammatory (4:  187, 190, 198).  There is severe\ncentrilobular emphysema, worst in the apices with large paramediastinal\nbullae.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  A chronic appearing fracture of the\nright posterior ninth rib is noted (02:45).\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nmultiple simple left renal cyst and a 2.0 x 1.9 cm left adrenal lesion\nmeasuring 1.6 ___, almost certainly a benign adrenal adenoma (2:63).  There is\na small hiatal hernia..",
            "output": "1. Single top-normal right hilar lymph node is likely reactive.  Otherwise no\nhilar or mediastinal lymphadenopathy.  No suspicious pulmonary lesion.\n2. Severe centrilobular bullous emphysema.\n3. Aortic valve leaflet thickening and calcification likely representing\nhemodynamically significant aortic stenosis.  Correlation with\nechocardiography, if not artery performed, is recommended.\n4. Minimally dilated ascending aorta measuring up to 4.1 cm.\n\nRECOMMENDATION(S):   If the patient is ___ years old, has a smoking history\nof greater than 30 pack-years and has smoked within the past ___ years, the\npatient meets criteria for annual lung cancer screening with low-dose chest\nCT, now available at this hospital."
        },
        {
            "input": "HEART AND VASCULATURE: The exam is markedly degraded by respiratory motion. \nWithin the limitation of the study there is no definite filling defect within\nthe pulmonary vascular tree to the segmental level.  An apparent defect\ninvolving a lingular branch is felt to represent volume averaging artifact\n(06:22).  There is calcification about the aortic valve.  Heart size is\nenlarged.  There is a trace pericardial effusion.  The patient is status post\naortic valve replacement (___).  The partially visualized great\nvessels within the neck are unremarkable.  The main pulmonary artery is normal\nin diameter.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy.  There is\nno definite and mediastinal lymphadenopathy although evaluation is limited\nsecondary to motion.  Fluid and mild stranding within the anterior mediastinum\nis nonspecific in favored to be postsurgical in etiology in the absence of\npatient's symptoms of sternal discomfort (6:79).\n\nPLEURAL SPACES: There is no pneumothorax.  Trace left pleural fluid.\n\nLUNGS/AIRWAYS: There is moderate centrilobular and paraseptal emphysema, most\nprominent in the upper lobes.  In addition, there are large bullae.  Bronchi\nare not well visualized entering the left lower lobe.  Central airways are\notherwise clear although evaluation is limited secondary to respiratory\nmotion.  There is complete collapse of the left lower lobe.  Prominent\natelectasis is noted at the right base.  There is no definite evidence of\npneumonia.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: While the exam is not tailored for its evaluation, included portions\nof the abdomen are unremarkable.\n\nBONES: The patient is status post median sternotomy.  Early postsurgical\nchanges are noted within the separated sternum.  A compression deformity\nmidthoracic vertebral bodies similar appearance to the prior exam.",
            "output": "1. Limited exam secondary to respiratory motion. No definite evidence of\npulmonary emboli.\n2. Complete collapse of the left lower lobe, possibly secondary to mucous\nplugging.\n3. Stranding and fluid in the anterior mediastinum, nonspecific and most\nlikely postsurgical.\n4. Moderate centrilobular and paraseptal emphysema.\n\nNOTIFICATION:  Findings communicated to the covering clinical service at the\ntime of dictation on ___ at 10:10 pm, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without focal consolidation or suspicious\nnodules.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for likely diffuse\nhepatic steatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Likely hepatic steatosis."
        },
        {
            "input": "Esophagus is patulous with substantial thickening of the wall starting at the\nlevel of proximal esophagus, that might potentially be related to large hiatal\nhernia but other etiologies cannot be excluded.  No mediastinal, hilar or\naxillary pathologically enlarged lymph nodes demonstrated.  Pulmonary artery\nis 3.5 cm in diameter, mildly dilated.  Heart size is mildly enlarged.  No\npericardial pleural effusion is demonstrated.\n\nImage portion of the upper abdomen reveals diverticulosis with no evidence of\ndiverticulitis.\n\nAirways are patent to the subsegmental level bilaterally. Pulmonary nodule\nseen on the prior CT in abdomen, series 5, image 195 is 5 mm in diameter in\nits stable. Several additional pulmonary nodules are demonstrated, calcified\ngranuloma series 5, image 42, noncalcified left upper lobe nodule, series 5,\nimage 65, right upper lobe nodule, series 5, image 71, lingular nodule, series\n5, image 125, right middle lobe nodule, series 5, image 154, 6 mm, left lower\nlobe subpleural nodule, series 5, image 157, 7.3 mm, series 5, image 179, 6\nmm, series 5, image 201, 6.5 mm.\n\nThere are no bone lesions worrisome for infection or neoplasm.  Extensive\ndegenerative changes are noted in the glenohumeral joint and along the image\nportion of the spine. Compression fracture of L1 is unchanged.",
            "output": "Several subpleural pulmonary nodules as described, 1 of them noted on the\nprior CT abdomen. Reassessment in 6 months with chest CT for documentation of\nstability is recommended\n\nAdditional pulmonary nodules that can be reassessed at the same time\n\nCompression fracture of L1.  .\n\nMild pulmonary artery dilatation that might represent hypertension."
        },
        {
            "input": "Thyroid is unremarkable.  Heavy calcification is seen at the mitral valve\nannulus and aortic valve.  Coronary artery calcification is minimal.  There is\nno pericardial effusion.  Main pulmonary artery is mildly dilated up to 36 mm\nin diameter, similar as before.\n\nAirways are patent to subsegmental levels.  Bronchiectasis in the right lower\nlobe is mild.  There is no pleural effusion.\nA 3 mm calcified granuloma in the left lung apex (5:67) is unchanged.\nMultiple pulmonary nodules are stable:\nA 2 mm subpleural nodule in the left upper lobe (5:89).\nA 5 mm subpleural nodule in the right upper lobe (5:101)\nA 3 mm subpleural nodule in the left upper lobe (5:157)\nA 4 mm subpleural nodule in the right upper lobe (5:162)\nA 5 mm subpleural nodule in the superior segment of left lower lobe (5:182)\nA 6 mm nodule in the right middle lobe (5:196)\nA 5 mm subpleural nodule in the superior segment of left lower lobe is is\n05:204)\nA 3 mm subpleural nodule in the superior segment of right lower lobe (05:208)\nA 3 mm nodule in the right lower lobe (5:216)\nA 4 mm nodule in the right lower lobe (5:222)\nA 6 mm subpleural nodule in the left lower lobe (5:225)\nA 3 mm subpleural nodule in the left lower lobe (5:226)\nA 2 mm nodule in the right lower lobe (5:224)\n\nLarge hiatal hernia is similar as before.\nThis study was not tailored for subdiaphragmatic evaluation.  Limited\nassessment of upper abdominal organs is notable for multiple foci of\ncalcification in the spleen similar as before.  Heavy calcification is noted\nat the origin of celiac trunk.  Few foci of radiodense material in the colon\nis possibly related to prior barium study.\n\nNo worrisome lesion is identified in the bones or soft tissue.  L1 vertebral\nbody compression deformity is stable.",
            "output": "1.  Multiple pulmonary nodules measuring up to 6 mm are stable compared to 6\nmonths prior.  Followup is recommended in ___ year.\n\n2.  Mild pulmonary artery dilation is stable and may represent pulmonary\nhypertension.\n\n3.  Heavy aortic valve and mitral annulus calcification.\n\nRECOMMENDATION(S):  ___ year followup."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild cardiomegaly.  No pericardial effusion is seen. \nMild coronary artery calcifications\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are areas of mosaic attenuation likely from chronic small\nvessel or small airway disease.  There is a 6 mm right upper lobe subpleural\nnodule (03:33).  Additional 6 mm right lower lobe subpleural nodule is also\nseen (3:135).  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Chronic anterolateral right seventh rib fracture is noted.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.  Right\nposterior chest wall lipoma seen just deep to the right trapezius.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. 6 mm right-sided subpleural nodules.  Please refer to ___ criteria\nfor follow-up recommendations.\n\nRECOMMENDATION(S):\nFor incidentally detected multiple solid pulmonary nodules measuring 6 to 8mm,\na CT follow-up in 3 to 6 months is recommended in a low-risk patient, with an\noptional CT follow-up in 18 to 24 months. In a high-risk patient, both a CT\nfollow-up in 3 to 6 months and in 18 to 24 months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable.\n\nUPPER ABDOMEN: Unremarkable.\n\nMEDIASTINUM: There are multiple prominent mediastinal nodes demonstrating\nnormal fatty hilum.  Similar appearing prominent bilateral axillary nodes with\nnormal fatty hilum are also noted.  These findings are unchanged from the ___ CTA chest.\n\nHILA: The study is not optimized for evaluation of the hilar structures given\nlack of IV contrast.\n\nHEART and PERICARDIUM: Cardiomegaly.  No pericardial effusion.\nPLEURA: New small (right greater than left) layering pleural effusions are\nnoted.\nLUNG:\n\n1. PARENCHYMA: Parenchymal opacification within the dependent aspects of the\nright and left lower lobes is consistent with compressive atelectasis in the\nsetting of the small bilateral pleural effusions.  However there are\nheterogeneous bilateral opacities in the upper and lower lung fields which\nreflect changes related to resolving pulmonary edema.\n2. AIRWAYS:  Patent to the segmental level bilaterally.\n3. VESSELS:  Evaluation of the vessels is limited in this noncontrast study.\nCHEST CAGE: Chronic right anterolateral seventh rib fracture and right\nposterior chest wall lipoma deep to the right trapezius are re-demonstrated.",
            "output": "1. When compared to the ___ chest x-ray, the previously seen\nbilateral pulmonary edema is improving.  Trace bilateral pleural effusions\nwith compressive dependent bibasilar atelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No abnormality\n\nUPPER ABDOMEN: Will be reviewed separately as part of the CT abdomen\n\nMEDIASTINUM: No abnormality\n\nHILA: No abnormality\n\nHEART and PERICARDIUM: No abnormality\nPLEURA: No abnormality\nLUNG:\n\n1. PARENCHYMA:  No abnormality\n2. AIRWAYS:  No abnormality\n3. VESSELS:  No abnormality\nCHEST CAGE: No abnormality",
            "output": "Normal chest CT\n\nPlease review CT abdomen pelvis in corresponding report will be issued\nseparately."
        },
        {
            "input": "The thyroid gland is unremarkable.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The heart is normal in size.\nAtherosclerotic calcifications are seen at the coronary arteries.  The caliber\nof the aorta as well as the pulmonary arteries are normal.  There is no\npericardial effusion.\n\nThe airways are patent to the subsegmental level.  There is atelectasis at the\nleft lung base.  Scattered calcified granulomas are identified.  No suspicious\nfocal lesion is seen.  There is no focal consolidation, pleural effusion, or\npneumothorax.\n\nNo suspicious lytic or sclerotic osseous lesion is seen.  Subdiaphragmatic\nfindings are reported separately.",
            "output": "No evidence of malignancy within of the chest."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The ascending aorta is dilated, measuring up to 4.1 cm\nin diameter (2:55).  There is no adjacent soft tissue stranding to suggest\nthat this is an acute process.  There is no evidence of acute thoracic aorta\ninjury.  Mild atherosclerotic calcifications are seen within the aortic arch. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is dependent atelectasis within the left lower lobe. \nOtherwise, the lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  An endotracheal tube is seen with tip projecting over the low\nthoracic trachea.\n\nBASE OF NECK: There is a 9 mm enhancing thyroid nodule within the right\nthyroid lobule (2:10) and a 4 mm hypodense nodule in the left thyroid lobe\n(2:12).  Otherwise, the visualized portions of the neck are normal.  There is\nno axillary or supraclavicular adenopathy.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is possibility of\npancreas divisum.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are several hypodense rounded structures within the bilateral kidneys\nthe largest measuring up to 1.6 cm in diameter on the right (2:113),\nsuboptimally characterized, but most likely representing renal cysts.  There\nis a nonobstructive 3 mm stone of the left kidney (2:131).  Otherwise, there\nis no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  Moderate stool burden is seen within the\nascending and transverse colon.  The appendix is not visualized.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.  Incidentally noted is an aberrant\norigin of the left gastric artery, arising directly from the aorta.\n\nBONES: There is an acute, nondisplaced, incomplete, transversely oriented\nfracture through the anterior aspect of the T5 vertebral body (602: 76). \nThere is no retropulsion.  Alignment is preserved.  There is also a chronic\nfracture of the middle third of the left clavicle (2:6).  Chronic appearing\nright lateral ninth and tenth rib fractures are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute, nondisplaced, transversely oriented fracture through the anterior\naspect of the T5 vertebral body.  Minimal height loss.  No evidence of\nretropulsion.  No additional acute fracture.\n2. No other findings to suggest acute injury in the chest, abdomen or pelvis.\n3. Dilated ascending aorta, measuring up to 4.1 cm in diameter, which appears\nchronic.\n4. Chronic fracture of the middle third of the left clavicle.\n5. 2 thyroid nodules are seen, largest of which measures up to 9 mm in the\nright thyroid lobule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "The aorta and its major branch vessels are patent.  Evaluation for pulmonary\nembolism is limited due to the timing of contrast.  Within these limits, no\nmain or segmental including pulmonary embolus demonstrated.  The main and\nright pulmonary arteries are normal in caliber.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThere is no pericardial or pleural effusion.\n\nThere are worsening ___ opacities, similar on the left, however\nmultiple new in the right lung base.  Additionally, there are scattered\nground-glass opacities at the right lung base.  These findings are likely\ninfectious/inflammatory.  There are new airspace nodules measuring up to 7 mm\non series 2, image 100, amenable to follow-up after treatment.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo aggressive osseous lesions demonstrated.",
            "output": "1. No evidence of acute central or segmental pulmonary embolism, as evaluation\nis limited due to the timing of contrast.\n2. Increase of ___ nodules at the lung bases and new 7 mm right lower\nlung nodule adjacent to the inflammation.  The findings may represent an\ninfectious or inflammatory bronchiolitis.  Consider obtaining follow-up chest\nCT in 3 months after treatment.\n\nRECOMMENDATION(S):  Consider obtaining follow-up chest CT in 3 months."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Mild aortic wall calcifications.  Small\nlymph nodes are visualized in the mediastinum.  Moderate coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable, with the exception of a small hiatal\nhernia.  No acute upper abdominal abnormalities.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Moderate\ndegenerative vertebral disease.  No vertebral compression fractures.  Stable\nmoderate bilateral apical scarring.  The airways are patent.  Minimal mucous\nretention in the trachea.  Mild thickening and irregularities of the airway\nwalls (4, 151).  Minimal scarring at the bases of the right lower lobe and the\nmiddle lobe.  The nodularity in the left lower lobe has slightly increased in\nseverity.  There is a new left pleural intrapulmonary lymph node (4, 217). \nThe previously seen nodule with a diameter of 4 mm (4, 220) Is stable in size.\nAlso new is a lingular perifissural nodule (4, 210).  No pleural effusions. \nNo diffuse lung disease..",
            "output": "Stable left lower lobe ___ nodularity.  2 new small lung nodules, 1 of\nwhich likely is an intrapulmonary lymph node.  Nonetheless, the nodules should\nbe followed in 6 month, to confirm the inflammatory nature.  No\nlymphadenopathy.  No pleural abnormalities."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis moderately heavy in head and neck vessels and the coronary arteries.  Aorta\nand pulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Biapical fibrocalcific scarring, including dystrophic\ncalcification, is symmetric and unchanged.\n\nMany foci of bronchial wall thickening some with surround ground-glass\nopacification, most pronounced in the left lower lobe are stable or improved. \nMild, inflammatory bronchiolar nodulation, most pronounced in the right upper\nlobe is stable also.  Previous new 5 mm left lower lobe nodule, 4:217 on ___ has resolved.  There are no focal lung lesions concerning for malignancy.\n\nCHEST CAGE: Unremarkable, aside from healed rib fracture deformities.",
            "output": "Persistent widespread bronchial inflammation, some of which could be smoking\nrelated, perhaps with indolent endo bronchial infection, generally improved\nsince ___.  A once new 5 mm left lower lobe nodule in ___ has resolved. \nThere are no focal lung lesions of concern for malignancy.\n\nAtherosclerotic calcification, moderately heavy in head and neck vessels and\npresent in all coronary arteries.\n\nRECOMMENDATION(S):  If the patient is ___ years old, has a smoking history\nof greater than 30 pack-years and has smoked within the past ___ years, the\npatient meets criteria for annual lung cancer screening with low-dose chest\nCT, now available at this hospital.  Study can be ordered as a CT, specified\nas CT LOW DOSE LUNG SCREENING (not a routine chest CT) on POE or OMR."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Atherosclerotic\ncalcifications are seen in the coronary arteries.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  A 9mm right thoracic outlet lymph node has grown\nsince ___ (05:22).  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is no focal parenchymal opacification.  Atelectasis is\nnoted in the dependent lung bases with mild left lower lobe scarring, possibly\nsequela of aspiration.  There are diffuse tiny centrilobular micronodules with\nmild diffuse bronchial wall thickening, likely reactive airways disease.  New\nhigh attenuation debris within the right main bronchus, possibly bloody\n(5:64).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for vicarious\nexcretion of contrast within the gallbladder.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes are mild-to-moderate along the visualized thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Likely aspiration, left lower lobe, and possible hemorrhagic debris in the\nright main bronchus.\n3. 0.9 cm thoracic outlet lymph node larger since ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is grossly\nunremarkable.  No axillary supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Limited assessment of the intrapelvic structures is grossly\nunremarkable.\n\nMEDIASTINUM: Prominent mediastinal lymph nodes measuring 9 mm (series 4, image\n125), are unchanged from prior examination not enlarged by CT size criteria.\n\nHILA: No definite hilar lymphadenopathy within limitations of this noncontrast\nCT.\n\nHEART and PERICARDIUM: Heart is not enlarged.  No pericardial effusion.\n\nPLEURA: No significant pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA:  Bilateral pleuroparenchymal scarring, is re-demonstrated. \nThere is increased peripheral consolidation at the posterior left lung base\n(series 4, image 268), concerning for pneumonia either due to aspiration or\ninfection.  Subtle right lung base ground-glass opacities, also appear\nunchanged (series 4, image 237).\n2. AIRWAYS:  Previously seen fluid in the right mainstem bronchus, is no\nlonger present.\n3. VESSELS:  Vascular calcifications are moderate.  Main pulmonary artery and\nascending aorta are normal in caliber.\nCHEST CAGE: No evidence of suspicious osseous lesion.  Moderate degenerative\nchange throughout the visualized thoracic and lumbar spine.",
            "output": "1.  Increased left lower lobe consolidation and unchanged mild right lower\nlobe ground-glass opacity, concerning for pneumonia either due to aspiration\nor infection.\n2.  Previously seen trace debris within the right mainstem bronchus is no\nlonger visualized."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Previously demonstrated focal consolidation in the left lower\nlobe has substantially improved in the interval.  However, lateral to this\npreviously noted area of consolidation in the left lower lobe there has been\ninterval development of ground-glass ill-defined nodular opacities in a\nperibronchial distribution which may represent infectious or inflammatory\nsmall airways disease. There are subtle ground-glass opacities of the right\nlower lobe which are unchanged. The airways are patent to the level of the\nsegmental bronchi bilaterally. However, there is mild bronchial wall\nthickening which indicates bronchitis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon and rectum are within normal limits.  The appendix is\nnot visualized.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is slightly enlarged measuring up to 4.5 cm with\ncoarse central calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolism or acute aortic pathology.\n2. Marked interval improvement in previously demonstrated pneumonia at the\nleft lower lobe.\n3. Interval development of ill-defined ground-glass nodular opacities in the\nleft lower lobe in a peribronchial distribution which may suggest inflammatory\nor infectious small airways disease, including aspiration.\n4. Mild bronchitis.\n5. No acute abdominopelvic pathology."
        },
        {
            "input": "Crescentic lack of enhancement is seen arising from the aortic root, and\nextending up to the distal ascending aorta, terminating 2.6 cm below the\norigin of the right brachiocephalic artery.  This is compatible with an acute\ntype A aortic dissection.  The dissection flap extends to the margin of the\nright coronary artery.  The dissection flap does not appear to affect the\norigin of the left main coronary artery.  There is no extension to the right\nbrachiocephalic or common carotid arteries.  There is hyperdense contrast\nmaterial seen within the false lumen, layering dependently.  I suspect this\nrepresents residual contrast from the patient's cardiac catheterization.\n\nFocal outpouching is noted at the apex of the left ventricle, with aperture\nmeasuring 2.9 cm, and the actual outpouching measuring 1.5 x 2.6 cm.  Given\nthe wide mouth nature of the finding, this likely represents a true left\nventricular aneurysm.  Dependent hypodensity in this region is incompletely\ncharacterized and may represent papillary musculature, however focal thrombus\nis not excluded.  Dedicated echocardiogram is recommended for further analysis\nof both these findings.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  Borderline size of the main pulmonary artery\nmeasuring 3.0 cm.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild bibasilar atelectatic change.  There are no suspicious pulmonary\nnodules or lesions identified. The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen demonstrate a partially imaged\nhypervascular mass arising from the medial aspect of the left kidney measuring\n5.1 x 0.9 cm, highly concerning for renal cell carcinoma.  Further evaluation\nwith dedicated MRI is recommended.  There are uncomplicated gallstones, as\nwell as colonic interposition.  There multiple clips noted at the level of the\ngastrohepatic ligament and in the hepatic hilum, as well as a\ngastrojejunostomy suggestive of prior Billroth procedure.  Please correlate\nwith exact surgical history.\n\nIn addition, there is a 2.3 x 2.7 cm cystic lesion arising from the body of\nthe pancreas.  Again, correlation with MRI is recommended..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Type A aortic dissection extending from the aortic root to approximately\n2.6 cm below the origin of the right brachiocephalic artery as detailed above.\nNo propagation to the brachiocephalic or common carotid arteries.  Small\namount of high density contrast seen within the false lumen likely represents\nresidual contrast from the patient's recent cardiac catheterization.\n2. Focal outpouching at the left ventricular apex as detailed above, with wide\nmouth 2.9 cm aperture.  This suggests a true ventricular aneurysm.  In\naddition, dependent hypodensity noted within the aneurysm is incompletely\ncharacterized, although focal thrombus is not excluded.  Dedicated\nechocardiogram is recommended for further analysis of both these findings.\n3. Partially imaged 5.1 x 4.9 cm hypervascular left renal mass is concerning\nfor renal cell carcinoma, and warrants further evaluation with dedicated MRI.\n4. 2.3 x 2.7 cm cystic lesion arising from the body of the pancreas is\nincompletely characterized on current study, but should be further\ncharacterized on the patient's above recommended dedicated MRI.\n\nRECOMMENDATION(S):  Abdominal MRI for further evaluation of the left renal\nmass and pancreatic cystic lesion detailed above.\n\nEchocardiogram for further evaluation of the suspected left ventricular true\naneurysm and possible thrombus.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:05 AM, 30 minutes\nafter discovery of the findings."
        },
        {
            "input": "Thyroid gland enhances homogeneously.\n\nThere is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy by\nsize criteria.  Heart size is mildly enlarged, without pericardial effusion. \nThere is a focal outpouching at the apex of the left ventricle as before which\nis unchanged likely reflecting a ventricular aneurysm.  Dependent hypodensity\nin this region is again seen and may reflect papillary musculature versus a\nthrombus.  Coronary artery calcifications are diffuse.\n\nAgain noted is an aortic dissection extending from the aortic root to the\nlevel of the arch, which is unchanged from ___.  No evidence of\nextension into the subclavian or common carotid arteries.  Main pulmonary\ntrunk is prominent measuring up to 3.2 cm in diameter (02:57), which can be\nseen in the setting of pulmonary arterial hypertension.  Please note that\nevaluation for pulmonary embolism is limited on this study due to contrast\nbolus timing.\n\nAirways are patent to the subsegmental levels.  Streaky bibasilar opacities\nmost likely represent atelectasis.  Trace bilateral nonhemorrhagic pleural\neffusions.  No pneumothorax.\n\nLimited evaluation of the upper abdomen demonstrates a similar 2.7 cystic\nlesion in the body of the pancreas.  Multiple surgical clips are again noted.\n\nNo lytic or sclerotic lesions concerning for malignancy.  Status post\nsternotomy.  No acute fracture.  Degenerative changes in the thoracic spine\nare mild.  Chest wall is unremarkable.",
            "output": "1. Type A dissection extending from the aortic root to the arch, unchanged\nfrom ___.  No evidence of extension into the common carotid or\nsubclavian arteries.  No hemopericardium.\n2. Diffuse coronary calcifications.\n3. Trace bilateral nonhemorrhagic pleural effusions with adjacent atelectasis.\n4. Unchanged focal outpouching at the left ventricular apex likely reflecting\nan aneurysm.  A dependent hypodensity within the aneurysm is again\nincompletely characterized and could be further assessed with echocardiogram.\n5. Unchanged cystic lesion in the body the pancreas."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  The thyroid gland is homogeneous. \nThere is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Although this exam is not tailored for the evaluation of the\nupper abdomen, there are multiple medial mesenteric surgical clips, possibly\nrelated to the patient's history of gastric cancer.  There is also an\nexophytic left upper pole lesion as noted on multiple recent chest CTA exams\n(series 3:image 66).  There are also gallstones, and there is an incompletely\nevaluated pancreatic body cystic lesion (series 3: Image 50).\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy, and a prevascular lymph\nnode is 6 mm in size.  There is a left internal mammary coronary bypass.\n\nHILA:  There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is top-normal in size, and there is a trace\npericardial effusion, likely physiologic.  There is extensive coronary artery\ncalcifications in the native coronary arteries along with multiple coronary\nartery stents.  There are mild aortic valvular calcifications and a moderate\namount of aortic arch and descending thoracic aortic calcifications.  The\nthoracic aorta is normal in caliber with the ascending aorta measuring 3.8 x\n3.9 cm or (series 3:image 27).  The previously noted type A aortic dissection\nis not well evaluated on this nonenhanced chest CT.\n\nPLEURA: There are small bilateral nonhemorrhagic pleural effusions.  There is\nno pneumothorax.\nLUNG:\n\n-PARENCHYMA:  The lungs are clear without focal consolidation.  There is no\nsuspicious pulmonary nodule.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is mildly enlarged measuring 3.2 cm in\ndiameter (series 3: Image 28).\nCHEST CAGE:  The patient is status post median sternotomy, and there is no\nconcerning osseous lesion.",
            "output": "1.  Ascending thoracic aorta is clear of calcification.  Moderate\natherosclerotic calcification along the aortic arch and descending thoracic\naorta.  Chronic type A dissection appreciated on this CT without intravenous\ncontrast.\n2.  Bilateral small layering non-hemorrhagic pleural effusions.\n3.  Mild enlargement of the main pulmonary artery may be from pulmonary\narterial hypertension."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary artery is mildly dilated\nto 3.3 cm, unchanged.  There is no evidence of right heart strain.  Heart size\nis mildly enlarged.  Diffuse coronary artery calcifications are present.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  There is a small hiatal hernia.\n\nThere is no evidence of pericardial effusion.  There is no evidence of\nhemothorax or pneumothorax.\n\nThere is no evidence of pulmonary contusion or laceration in the setting of\nrib fractures.  The bilateral mainstem bronchi, right middle lobe bronchus and\nbronchus intermedius are narrowed and again may reflect the sequela of\nbronchomalacia, unchanged when compared to most recent prior CT.  There is\nmoderate depended bibasilar atelectasis.\n\nLimited images of the upper abdomen are unremarkable.\n\nThe right humerus is anteriorly and inferiorly dislocated relative to the\nglenoid fossa with tiny adjacent osseous fragmentation suggestive of a small\nfracture fragment (02:32).  Acute fractures of the anterolateral right second\nand third ribs with adjacent extrapleural hematoma is demonstrated.  Mild\nmultilevel degenerative changes are demonstrated in the visualized thoracic\nspine.",
            "output": "1. Acute fractures of the right anterolateral second and third ribs with small\nadjacent extrapleural hematoma. No evidence of pulmonary contusion,\nlaceration, or pneumothorax in the setting of rib fractures.\n2. Redemonstration of right anterior glenohumeral dislocation.  Tiny ossific\ndensities adjacent to the dislocated right humeral head suggests small\nfracture fragments.\n3. No evidence of pulmonary embolism or aortic abnormality.\n4. Unchanged mild narrowing of the bilateral mainstem bronchi, right middle\nlobe bronchus and bronchus intermedius which again may represent\nbronchomalacia.\n5. Mild dilatation of the main pulmonary artery to 3.3 cm, unchanged, and\ncould reflect pulmonary arterial hypertension."
        },
        {
            "input": "The thyroid is normal. A tracheostomy tube is noted, and secretions are noted\nin the trachea. There is no supraclavicular lymph node enlargement.  A right\nparatracheal lymph node is borderline enlarged and likely reactive in nature,\nand there are no pathologically enlarged axillary or hilar lymph nodes (2:24).\nThe heart is normal size without pericardial effusion. The ascending and\ndescending thoracic aorta are of normal size. A left subclavian central venous\nline terminates within the upper SVC. There is no hiatal hernia or other\nesophageal abnormality. The patient is status post bilateral breast\naugmentation.\n\nThere is consolidation of nearly the entire right lower lobe with\nair-bronchograms compatible with pneumonia.  Dependent ___\nperibronchiolar opacities in the right upper and both lower lobes likely\nreflect infection or aspiration (4:78).  There are also bilateral small\npleural effusions, right larger than left. There is a 4 x 8 mm right middle\nlobe nodule and a 4 mm left apical nodule (4:59,164).\n\nBONES: There are no suspicious lytic or sclerotic osseous lesions to be\nconcerning for malignancy.\n\nAlthough this exam is not tailored for evaluation of subdiaphragmatic\nstructures, the visualized abdominal organs are normal.",
            "output": "1.  Consolidation of nearly the entire right lower lobe compatible with\npneumonia.\n2.  Multilobar dependent ___ opacities likely reflect infection versus\naspiration.\n3.  Bilateral small, right larger than left, pleural effusions.\n4.  Bilateral pulmonary nodules including a 8 mm right middle lobe nodule. \nRecommend imaging follow-up in ___ months to assess stability."
        },
        {
            "input": "The thyroid gland is unremarkable. Bilateral axillary lymphadenopathy has\nincreased since ___. The largest representative right axillary lymph\nnode has grown measuring 13 x 15 mm, previously 7 x 13 mm (2, 13). A\nborderline enlarged right lower paratracheal lymph node measures 10 mm in\nshort axis (2, 24). Hilar lymphadenopathy is difficult to exclude in the\nabsence of intravenous contrast.\n\nHeart size is normal with no pericardial effusion. Diffuse low attenuation of\nthe blood in the heart suggests anemia. The main pulmonary artery and thoracic\naorta are normal caliber. A right-sided PICC line terminates at the superior\ncavoatrial junction.\n\nA tracheostomy tube terminates in the upper trachea. Multiple images are\npartially degraded by respiratory motion artifact. Aeration of the right lower\nlobe has substantially improved since ___. A left lateral approach\nchest tube coils in the posterior pleural space. The previous moderate left\npleural effusion has resolved, and a small amount of air has been introduced\ninto the pleural space. Left lower lobe aeration has improved, but there is\nsubstantial residual atelectasis, consolidation, and new cylindrical\nbronchiectasis. Aeration of the right lower lobe has improved dramatically\nsince ___, but there is persistent significant posterior basal\nsegmental mucoid impaction with distal linear atelectasis or scarring.\n\nMultifocal bronchiolar nodules have improved since the prior exam. Focal\nanterior lingular subsegmental atelectasis is new (4, 101). There are layering\nsecretions in the lower trachea and bilateral mainstem bronchi. A 4 mm right\nlower lobe pleural nodule was previously obscured by pleural fluid and\natelectasis (4, 124). A 9 mm right middle lobe solid nodule is stable since\n___ (4, 156).\n\nThe patient has had bilateral breast implantation.\n\nImages of the upper abdomen show stable nodular thickening of the left adrenal\ngland to 1.0 cm.\n\nNo destructive bone lesion is identified.",
            "output": "Interval resolution of previous moderate left pleural effusion status post\ndrainage catheter placement.\n\nPartial re-expansion of the left lower lobe with residual left lower lobe\npneumonia and new transient cylindrical bronchiectasis. Persistent left lower\nlobe volume loss is likely a function of previous lobar collapse.\n\nPersistent right lower lobe mucoid impaction with distal linear atelectasis.\n\nImproved bronchiolitis.\n\nStable indeterminate 1 cm left adrenal nodule is better evaluated with\ndedicated abdominal imaging.\n\nAnemia.\n\nIncreased bilateral axillary adenopathy with edema, which may be reactive in\nnature."
        },
        {
            "input": "The thyroid is normal.  Small right axillary lymph nodes are decreased in size\ncompared to the prior study.  Mediastinal lymphadenopathy is similar.  To the\nprior study. For example, a prevascular lymph node measures 11 mm in short\naxis (series 2, image 22). A right lower paratracheal lymph node measures 9 mm\nin short axis (series 2, image 24).  A right hilar lymph node measures 12 mm\nin short axis (series 2, image 28).  Aorta and pulmonary arteries are normal\nsize.  The heart is mildly enlarged, and there is no appreciable coronary\ncalcification with minimal pericardial thickening is unchanged.\n\nAirways are patent subsegmental levels bilaterally.  Diffuse interlobular\nseptal thickening is noted, as well as bilateral relatively symmetric\nground-glass and solid opacities in the non dependent distribution, consistent\nwith multifocal pneumonia.  The previously noted left lower lobe consolidation\nis resolved, and there is no evidence of volume loss in the left lower lobe as\nthere was on the previous CT.  Bilateral pleural effusions are moderate on the\nright and small to moderate on the left, with adjacent compressive\natelectasis.\n\nPlease refer to concurrent CT abdomen pelvis for discussion of findings in the\nupper abdomen.  No suspicious lesion is seen in the visualized osseous\nstructures.  Soft tissue defect at the level of thyroid is consistent with\nprior tracheostomy.",
            "output": "1.  Multifocal pneumonia, most predominant in the upper lobes bilaterally.\n2.  Mild pulmonary edema, as evidenced by bilateral pleural effusions and\nsmooth interlobular septal thickening.\n3.  Resolution of previous left lower lobe consolidation.\n4.  Mediastinal and hilar lymphadenopathy, likely reactive and similar to\n___."
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is no mediastinal\nhematoma.  There is a small amount pericardial effusion.  There is no\nlymphadenopathy.  The imaged thyroid is normal.\n\nThe lungs are clear without mass or consolidation.  A 4 mm nodule in the right\nlower lobe is noted (02:56).  Airways are patent to the subsegmental level. \nThere is no evidence of contusion or laceration.  Left lower lobe atelectasis\nis likely related to the large hiatal hernia.  There is no pneumothorax or\npleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is normal\nin course and caliber with widely patent major branches.  No lymphadenopathy,\nfree air, or free fluid.\n\nThere is a large hiatal hernia.  Small bowel is normal in caliber without wall\nthickening or evidence of obstruction.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable. \nThere is mild wall thickening of the rectum, which is distended with stool,\ncompatible with impaction and mild proctitis.  A normal air-filled appendix is\nvisualized.  The bladder is unremarkable.  There is no pelvic free fluid.\n\nBONES:  There is a fracture of the distal left clavicle with an adjacent\nhematoma measuring 2.2 x 2.4 cm.  There is partially imaged asymmetric\nexpansion of the right vastus intermedius muscle of the right upper thigh a,\ncompatible with hematoma.  Chronic deformities of the pubic rami and multiple\nleft ribs are compatible with healed fractures.  No focal lytic or sclerotic\nosseous lesion is identified.",
            "output": "1. Distal left clavicle fracture with adjacent hematoma.\n2. Expansion of the vastus intermedius in the proximal right thigh, compatible\nwith hematoma, only partially imaged.\n3. 4 mm nodule in the right lower lobe.\n\nRECOMMENDATION(S):  According to ___ criteria, the 4 mm nodule in the\nright lower lobe can be followed up in ___ year would dedicated CT chest in a\nlow risk patient.  In a high risk patient, CT chest can be performed in 6\nmonths."
        },
        {
            "input": "BASE OF NECK: The visualized base of the neck is unremarkable.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged .\n\nCARDIO-MEDIASTINUM: The thoracic aorta is normal in caliber. The pulmonary\narteries are normal caliber.  The heart is not enlarged. There is no\npericardial effusion.  There is mild coronary artery calcification.\n\nLUNGS/AIRWAY: The airways are patent to the segmental level. Lungs are clear\nwithout masses or areas of parenchymal opacification.\n\nPLEURA: There is no pleural effusion.\n\nCHEST CAGE: Right chest wall Port-A-Cath.  Mild to moderate dorsal\nspondylosis.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning. Evaluation of breast is reserved exclusively\nfor mammography.\n\nUPPER ABDOMEN: Please refer to separate report on same-day CT abdomen/pelvis\nfor description of the abdominal findings.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are well\nenhanced.  No pathologically enlarged mediastinal, hilar, or axillary lymph\nnodes demonstrated.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued.",
            "output": "Normal chest CT.  No evidence of intrathoracic malignancy.\n\nPlease review CT abdomen and pelvis in the corresponding report will be issued\nseparately."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, hilar, or\nmediastinal lymphadenopathy.  The heart size is normal.  There is no\npericardial effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.  The aorta is normal in caliber.  The main\npulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nThere is a small right pleural effusion and adjacent atelectasis.  Anterior\nright upper lobe atelectasis is seen.  No concerning pulmonary nodules are\nidentified.",
            "output": "-No concerning pulmonary nodules identified.\n-Small right pleural effusion and adjacent atelectasis."
        },
        {
            "input": "The supraclavicular and axillary lymph nodes are not enlarged and there is no\nsoft tissue abnormality in the chest wall suspicious for malignancy or\ninfection. This study is not designed for subdiaphragmatic diagnosis but shows\nno mass in the unenhanced organs of the upper abdomen.\n\nThyroid is unremarkable. There is no atherosclerotic calcification in head and\nneck vessels or coronaries. Motion artifact obscures the ascending thoracic\naorta, but it is normal caliber as are the pulmonary arteries. Pleurae and\npericardium are normal.\n\nMediastinal lymph nodes are not pathologically enlarged and hilar contours do\nnot suggest lymph node enlargement.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere is one cm anterior displacement of the separated left ___ costo chondral\njunction. The the other costochondral junctions and the costo sternal\njunctions and the ribs are otherwise intact. There is no associated pleural or\nsoft tissue abnormality. The full distal extents of the tenth, eleventh, and\ntwelfth ribs are not included on the examination.\n\nMild scoliosis, concave left at the T6-7 and loss of height and a disc\nintrusion in the upper endplate of the T8 vertebral body could be post\ntraumatic. The chest cage is otherwise unremarkable.",
            "output": "Minimal separation left eighth costochondral junction.  No associated soft\ntissue or pleural abnormality.\n\nMild upper endplate compression, T8 vertebral body, conceivably post\ntraumatic. Minimal associated scoliosis, significance indeterminate."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis mild bilateral dependent atelectasis.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: The patient is status post bilateral mastectomy. \nPrepectoral expanders are in place.  There is no worrisome lytic or sclerotic\nlesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of metastatic disease in the chest.\n2. Refer to separate report of CT abdomen and pelvis performed same day for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal.  There is no axillary,\nmediastinal, or hilar lymphadenopathy.\n\nThe heart is normal in size.  There is no pericardial effusion.  Trace\ncalcifications are noted along the mitral annulus and mild calcifications are\nnoted in the coronary arteries.  The thoracic aorta is normal in caliber\nwithout evidence an aneurysm.  There is mild atherosclerotic plaque along the\narch.  The main pulmonary artery trunks are normal in diameter.\n\nThe airways are patent to the subsegmental levels.  There are multiple nodules\nin all the lobes of the lungs.  A few of the nodules are solid, such as 5 mm\nnodule in the right middle lobe (4, 112), though the majority of the nodules\nare sub solid.  They seen to have a peribronchiolar/perivascular distribution.\nThe lesions are less than a centimeter in size.  The largest is in the left\nupper lobe and measures 8 mm (4, 89).\n\nThere is a small amount of scarring and atelectasis in the left lower lobe. \nMultiple sub-5 mm calcified nodules are noted, and compatible with prior\ngranulomatous disease.\n\nThere is no pleural effusion or pneumothorax.\n\nThis exam is not tailored to evaluate the subdiaphragmatic structures.  Again,\nthere are several hypodensities in the liver, measuring up to 37 mm (4, 202). \nThe largest lesion demonstrates peripheral nodular enhancement, and is most\nlikely is a hemangioma.  There is minimal intrahepatic biliary duct dilation. \nThe known pancreatic mass is not included in the field of view on this exam. \nPlease see the upcoming abdominal MRI for complete subdiaphragmatic details.\n\nThere is a mild compression deformity in an upper thoracic vertebral body\n(602, 69).  The chronicity of this finding is unknown.  No definite underlying\nmass is identified.  There are no concerning osseous lesions.  The soft\ntissues are unremarkable.",
            "output": "Numerous sub solid pulmonary nodules, as described above, which given the\nappearance and distribution suggest an inflammatory or infectious process. \nThese do not have the typical appearance of metastases.  Close imaging\nfollow-up is recommended with a repeat CT of the chest in 3 months.\n\nRECOMMENDATION(S):  Chest CT in 3 months."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Right cardiophrenic lymph node is\nas increased measuring 7 mm in short axis previously 4mm.   No pathologically\nenlarged supraclavicular, axillary, or hilar lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size. \nNew central filling defect in the lateral segmental pulmonary artery of the\nright lower lobe.  Possible additional filling defects in the left lower lobe\nposterior segmental artery series 2, image 31.  The heart size is normal and\nthere is no pericardial effusion. Mild atherosclerotic calcifications of the\nthoracic aorta and of the coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Widespread\nground-glass and part solid pulmonary nodules some in a peribronchovascular\nand subpleural distribution have increased in size when compared to the prior\nexamination, particularly the ill-defined ground-glass component.  These\nnodules are without zonal predominance.  No lobar consolidation,\nbronchiectasis or bronchial wall thickening.\n\nBONES AND CHEST WALL:\nThere is a mild compression deformity of the T3 vertebral body\n(602b, 58).  The chronicity of this finding is unknown.  No definite\nunderlying\nmass is identified.  There are no concerning osseous lesions.  The soft\ntissues are unremarkable.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "1. Widespread ground-glass and part solid pulmonary nodules  have increased in\nsize since ___.  Metastatic disease with lepidic growth from\npancreatic adenocarcinoma is favored. However, infection (viral, fungal) or\norganizing pneumonia reaction from drug toxicity could also be considered in\nthe appropriate clinical setting.\n\n2.  Acute segmental pulmonary embolism in the right lower lobe and possibly in\nthe left lower lobe.  No signs of right heart strain.\n\nRECOMMENDATION(S):  Correlation with CA ___ could be considered.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:49 AM, 20 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The main pulmonary artery measures 3.5 cm, dilated and\nraises concern for underlying pulmonary arterial hypertension.  Pulmonary\nvasculature is well opacified to the subsegmental level without filling defect\nto indicate a pulmonary embolus.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are trace pleural effusions bilaterally.  No evidence of\npneumothorax.  There is moderate bilateral interstitial pulmonary edema.\n\nLUNGS/AIRWAYS: Scattered areas of subsegmental atelectasis noted.  No definite\nsigns of pneumonia.  There is interlobular septal thickening most conspicuous\nat the lung apices raising concern for interstitial pulmonary edema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  A 1.1 cm accessory spleen is incidentally noted.\n\nADRENALS:  The right adrenal gland is normal in size and shape.  A 1.3 cm\nhypodense nodule is seen in the medial limb of the left adrenal gland (05:27).\n\nURINARY:  There is a 9 mm obstructing stone in the left ureteropelvic junction\nwith moderate upstream hydronephrosis. There is mild hyperenhancement of the\nurothelium in the left renal pelvis, but without gross signs for\npyelonephritis. There is mild left perinephric stranding. The kidneys are\notherwise of normal and symmetric size with normal nephrogram.  There are\nmultiple bilateral hypodense lesions, too small to characterize but compatible\nwith simple cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:  A Foley catheter is seen within the decompressed bladder.  Otherwise,\nthe distal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is retroverted.  The endometrium appears\nmildly heterogeneous measuring up to 1.3 cm.  Bilateral adnexal cystic lesions\nare seen measuring 2.2 cm on the right and 2.5 cm on the left (607:34).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.  There\nis a chronic anterior wedge deformity of T12 vertebral body (608:42).",
            "output": "1. 9 mm obstructing stone in the left ureteropelvic junction with moderate\nupstream hydronephrosis.  While there is no definite evidence for\npyelonephritis, subtle hyperenhancement of the left pelvic urothelium could\nreflect highlights in the correct clinical setting.  Given report of sepsis,\nconsider percutaneous nephrostomy placement.\n2. Interstitial pulmonary edema with trace pleural effusions.\n3. No Pulmonary embolism.\n4. Left adrenal gland nodule measuring 1.3 cm, incompletely characterized. \nNon urgent dedicated adrenal CT or MRI should be considered.\n5. Bilateral adnexal cystic lesions measuring up to 2.5 cm with a dilated and\nheterogeneous endometrium.  If the patient is postmenopausal, nonurgent GYN\nfollow-up is recommended.\n\nNOTIFICATION:   The above impression was discussed with ___ MD on\n___ at 10:15 ___ by Dr. ___."
        },
        {
            "input": "No incidental thyroid findings.  Better visualized than on the previous\nexamination is a large right axillary mass (5, 11) that extends from the\nbreast through the entire axilla as well as in the soft tissues and along the\nmuscles of the right upper extremity.  No abnormalities in the anterior\nmediastinum.  The large mediastinal vessels are stable and normal in\nappearance.  Status post bilateral breast implantation.  Mild coronary\ncalcifications, mild cardiac enlargement.  No pericardial effusion.  The\nposterior mediastinum shows a small hiatal hernia and a normal para-aortic\nlymph node (5, 53).  The strongly progressive liver lesions and other\nabdominal findings are described in detail in the dedicated abdominal CT\nreport.  Stable moderately enlarged retrocrural lymph node (5, 61).  Massive\npredominantly sclerotic bone disease, involving virtually all ribs and all\nvertebral bodies has not substantially progressed.  Moderate bilateral apical\nscarring.  Postradiation fibrosis of the breast radiation on the right (6,\n123).  Several millimetric subpleural nodules but no nodules suspicious of\nmalignancy.  No pleural effusion.  The airways are patent.",
            "output": "Better visualization of an extensive right breast and right axillary mass,\nextending into the muscles of the right upper extremity.  No change in\nappearance of the lung parenchyma.  Diffuse predominantly sclerotic metastatic\nbone disease is not substantially progressive."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Heterogenous and edematous appearance\nof the the lateral aspect of the right pectoralis major and minor muscles (4,\n30) suggesting muscular metastatic disease (difficult to compare to prior\nimaging due to variable positions of the patient's right upper arm). \nSuspected intracapsular rupture of the right breast prosthesis.\n\nUPPER ABDOMEN: Will be reported separately.  Note is made of multiple hepatic\nmetastasis.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve calcification.  Minimal coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Subpleural fibrotic\nchanges in the anterior aspect of the right upper lobe in keeping with prior\nradiation.  Micronodules in the left lower lobe 6, 193 and 229) are unchanged.\n2 micronodules in the right lower lobe (6, 204) is new.  No new or enlarging\npulmonary nodules or masses.  No confluent airspace consolidation.  No diffuse\nlung process.\n-AIRWAYS:  Airways are patent to the subsegmental level.  No bronchiectasis.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Diffuse sclerotic bony lesions in keeping with known metastatic\nbony disease.  No pathological fractures visualized.",
            "output": "Heterogenous and edematous appearance of the lateral aspect of the right\npectoralis major and minor muscle suggesting muscular metastatic disease.\n\nExtensive bony metastatic disease.  No pathological fractures.\n\n2 indeterminate micro nodules in the right lower lobe (6, 204) is new and\ncould be re-evaluated at the next imaging follow-up study (3 months\nrecommended).\n\nSuspected intracapsular rupture of the right breast prosthesis.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous.  There are pathologically enlarged\naxillary, mediastinal, or hilar lymph nodes.  No abnormally enlarged internal\nmammary lymph nodes.  The heart size is normal and there is no pericardial\neffusion. Coronary artery calcifications are mild.  The ascending aorta and\nmain pulmonary artery are normal in caliber.  No incidental pulmonary embolism\nseen.  Bilateral breast implants are again noted.  No significant soft tissue\nabnormality.  The distal esophagus is normal and the findings within the\nabdomen and pelvis will be dictated in a separate report.\n\nLungs:The trachea is normal in size. The airways are patent to the\nsubsegmental level bilaterally.  Reticulation and scarring in the lateral\naspect of the right upper and middle lobes are unchanged, and consistent with\npost radiation changes.  Biapical scarring is again noted.  Left lower lobe\npulmonary nodule is unchanged (6:283). No new or enlarging nodules are\nidentified. There is no pleural effusion.\n\nBones: As seen on the prior study, diffuse vertebral and rib metastases are\nagain demonstrated without pathological fracture.",
            "output": "1. No new pulmonary lesions concerning for malignancy.\n\n2. Diffuse osseous metastases, as before."
        },
        {
            "input": "The thyroid gland is normal. There is no axillary, supraclavicular, hilar or\nmediastinal adenopathy. The esophagus is unremarkable. Heart size is normal.\nTrace pericardial fluid is physiologic. The aorta and pulmonary artery are\nwithin normal limits in caliber.\n\nThe tracheobronchial tree is patent to the subsegmental level. Minimal\nbilateral apical scarring is unchanged. A 3 mm left lower lobe solid pulmonary\nnodule is unchanged (5:197).  Triangular perifissural nodules along the right\nand left major fissures (5:185, 112, 97, 92, 88) demonstrate no suspicious\nfeatures and are unchanged. Subpleural reticulation anteriorly subjacent to\nthe right breast is most likely compatible with treatment changes (5:120).\nThere is no pleural abnormality or effusion.\n\nPatient is status post bilateral mastectomy and breast prostheses.\n\nMultiple sclerotic foci within the thoracic vertebral bodies, ribs and sternum\nare stable in appearance and in keeping with known metastatic disease.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___ clip number.",
            "output": "1.  No evidence of malignancy within the lung parenchyma.\n2.  Stable diffuse bony metastases without obvious progression.\n3.  For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed on the same date, ___ clip number."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy.\nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck vessels or the coronaries. Aorta and pulmonary arteries are\nnormal size. There is no pleural or pericardial abnormality.  There are no\npathologically enlarged lymph nodes in the mediastinum, hila, internal\nmammary, retrocrural, or diaphragmatic stations.\n\nBiapical pleural parenchymal scarring is chronic. Subpleural scarring in the\nright lung anteriorly is generally due to prior breast radiation. Lungs are\notherwise clear.\n\nBlastic metastases are present throughout the chest cage. Blastic\ntransformation is more pronounced in the T3 vertebral body, T11 and 12. Lesser\ninvolvement in other vertebral bodies and multiple ribs is unchanged. There is\nno pathologic fracture.",
            "output": "No evidence of metastasis in the lungs, mediastinum, or pleura.\n\nDespite increased blastic involvement of 3 thoracic vertebral bodies, among\nthe many bones in the chest cage with such lesions, there are no new lytic\nlesions, and no pathologic fractures."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.  3\nmm left perifissural nodule, likely correspond to an intrapulmonary lymph\nnode.  There is mild biapical pleural thickening.  Subpleural fibrosis in the\nright upper lobe/postradiation changes are stable.  There is no pleural or\npericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are bilateral breast implants.\nExtensive bone metastatic disease is unchanged",
            "output": "No lung nodules worrisome for metastatic disease.\nExtensive  bone metastatic disease is grossly unchanged."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\nModerate upper lobe predominant centrilobular emphysema is stable. Aside from\nminimal dependent bibasilar atelectasis, the lungs are clear.  There is no\npleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal finding.\nThere are no bone findings of malignancy",
            "output": "Emphysema. No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nNodular left breast soft tissue is stable, but definitive evaluation of the\nbreast requires mammography (6, 23).\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber. No incidental pulmonary embolus is\nidentified.\n\nA 2 mm left upper lobe nodule is stable since ___ (7, 39). There is no\nnew pulmonary nodule, mass or consolidation. Moderate upper lobe predominant\ncentrilobular emphysema is unchanged. A punctate calcified left lower lobe\ngranuloma is incidentally noted. Retained secretions are noted in the proximal\nright mainstem bronchus. There is no pleural abnormality.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThe bones are unremarkable.",
            "output": "No evidence of intrathoracic metastasis.\n\nStable moderate upper lobe predominant centrilobular emphysema."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThere is mild to moderate centrilobular emphysema.  2 subpleural 2 mm nodules\nare stable (7:54) in the left upper lobe, and in the right lower lobe (7:261).\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "Emphysema. No evidence of active intrathoracic infection or malignancy. \nPunctate lung nodules as described above are stable no new lung nodules"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Normal appearance of the soft tissues in\nthe chest wall.  Unremarkable appearance of the large mediastinal vessels. \nMinimal coronary calcifications, no valvular calcifications, no pericardial\neffusions.  Normal appearance of the posterior mediastinum.  The upper abdomen\nis reported separately in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.\nMild centrilobular pulmonary emphysema.  All of the pre-existing subpleural\npulmonary nodules (for example series 6, image 163 in the left lower lobe) are\nunchanged in size and morphology.  No evidence of new or growing pulmonary\nnodules.  No abnormalities at the level of the airways.  No pleural\nthickening, no pleural effusions.  No diffuse lung disease.",
            "output": "No relevant change as compared to ___.  No metastatic disease to the\nthorax.  Pre-existing millimetric pulmonary nodules are stable."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum and at\nthe level of the hilar structures are normal.  Normal ___ of the\npulmonary artery.  Moderate to severe aortic valve and coronary\ncalcifications.  Normal size of the heart.  No pericardial effusion.  The\nposterior mediastinum is unremarkable.  Calcifications in the right kidney,\npartly calcified left kidney cysts.  No osteolytic lesions at the level of the\nribs, the vertebral bodies, or the sternum.\n\nAt the level of the pulmonary artery, the ascending aorta has a diameter of 37\nx 37 mm.  At the same anatomical level, the descending aorta has a diameter of\n25 x 25 mm.  There is mild elongation of the descending aorta.\n\nMild bilateral apical scarring.  Mild to moderate centrilobular pulmonary\nemphysema.  Mild irregularities and thickening of the airway walls, consistent\nwith chronic airways disease.  Several millimetric subpleural granulomas (for\nexample in the left lower lobe, series 4, image 141).  No pleural thickening,\nno pleural effusions.  No suspicious lung nodules or masses.",
            "output": "Moderate to severe aortic valve and coronary calcifications.  Aortic\n___ are reported, as requested.  Mild to moderate centrilobular\npulmonary emphysema, associated to mild chronic airways disease."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThere is enlargement of the main, right main, and left main pulmonary\narteries, measuring 3.0, 3.0, and 2.9 cm, respectively.  These findings are\nsuggestive of underlying pulmonary arterial hypertension.  The thoracic aorta\nis normal in caliber with mild-to-moderate atherosclerotic disease without\nevidence of dissection.  Heart shows mild-to-moderate biatrial enlargement. \nAdditionally, there is reflux of contrast into the IVC and hepatic veins,\nconcerning for underlying heart failure.  Pericardium is within normal limits\nwithout pericardial effusion.  Great vessels appear otherwise unremarkable.\n\nAXILLA, HILA, AND MEDIASTINUM: There prominent supraclavicular lymph nodes,\nwhich do not meet CT size criteria for enlargement.  No axillary, mediastinal,\nor hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are trace bilateral pleural effusions, right greater\nthan left.\n\nLUNGS/AIRWAYS: There is adjacent compressive atelectasis, most notable at the\nright lung base without concerning focal consolidation. Patient has moderate\nto severe background centrilobular and paraseptal emphysema. There are\nmultiple pulmonary nodules, which measure up to 7 mm in the right lower lobe\n(series 4; and image 177). Additional, pleural based nodule in the right lower\nlobe measures 11 mm in size (series 4; image 71). No prior is available for\ncomparison.  Airways are patent to the subsegmental level bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Patient is status post distal pancreatectomy.  Remaining head and\nuncinate process are unremarkable.  There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is colonic\ndiverticulosis without surrounding inflammation to suggest diverticulitis. \nThe appendix is normal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is no large adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is minimal ectasia of the infrarenal aorta without evidence of\ndissection or aneurysm.  Moderate to extensive atherosclerotic disease is\nnoted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Moderate to extensive atherosclerotic disease with minimal ectasia of the\ninfrarenal abdominal aorta without evidence of aortic dissection in the chest,\nabdomen, or pelvis.  Patient is status post distal pancreatectomy and\nsplenectomy.\n2. No evidence of acute pulmonary embolus.\n3. Trace bilateral pleural effusions, right greater than left, with adjacent\ncompressive atelectasis.\n4. Multiple pulmonary nodules are noted on a background of moderate to severe\ncentrilobular and paraseptal emphysema, measuring up to 11 mm.  Recommend\nfollow-up CT chest in ___ months.  See full set of recommendations below.\n5. Enlargement of the main, right main, and left main pulmonary arteries\nsuggests underlying pulmonary arterial hypertension.\n6. Mild cardiomegaly, most specifically enlargement of both atria.\nAdditionally, there is mild reflux of contrast from the right heart into the\nIVC/hepatic veins. These findings are overall concerning for underlying heart\nfailure.\n\nRECOMMENDATION(S):    For incidentally detected multiple solid pulmonary\nnodules bigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "There is a 8 mm hypoenhancing lesion in the right lobe of the thyroid gland,\nunchanged the prior study and statistically likely a cyst.  A fat containing\nlesion in the right deltoid likely reflects lipoma, unchanged.  No enlarged\nsupraclavicular or axillary lymph nodes are seen.\n\nThere is unchanged moderate atherosclerotic calcification of the thoracic\naorta which demonstrates moderate unfolding but no frank dilatation. \nUnchanged mild enlargement of the main, right and left pulmonary arteries. \nMetallic artifact from the mitral clip somewhat limits evaluation of the\nheart, nonetheless there is enlargement of both the left and right atrium as\nseen previously.  No pericardial effusion seen.\n\nThe previously seen mediastinal lymph nodes are grossly unchanged.  A\nprevcarinal lymph node measures 1.2 cm in short axis (302:107).  Small right\nhilar nodes measure up to 1 cm in short axis (302:118).\n\nThere are small bilateral pleural effusions, slightly larger on the left.\n\nEvaluation of the lung bases is limited due to respiratory motion.  Paraseptal\nand centrilobular emphysema predominately the apices with scattered subpleural\nbullae seen also air.  Compressive atelectasis at the bilateral lung bases. \nPatchy areas of atelectasis along the left oblique fissure (302:127). \nNumerous scattered pulmonary nodules are unchanged compared to the prior\nstudy, a right upper lobe pulmonary nodule measures 4 mm (302:84).  Nodules at\nthe left lung base are less well seen due to atelectasis.  No consolidation\nseen.\n\nThis study is not tailored for evaluation of the intra-abdominal structures. \nVisualized portions of the abdomen are grossly unremarkable in appearance.  An\nextrarenal pelvis is again noted in the right kidney.\n\nThere are moderate degenerative changes throughout the thoracic spine.  No\nfracture seen.  No destructive lytic or sclerotic bone lesions seen.",
            "output": "1. Centrilobular and paraseptal emphysema, similar in appearance when compared\nto the prior study.\n2. Small bilateral pleural effusions, similar in appearance when compared to\nthe prior study.\n3. Prominent mediastinal and hilar lymph nodes measure just over 1 cm in short\naxis.\n4. Unchanged small pulmonary nodules.\n5. Mild enlargement of the central pulmonary arteries can be seen with\npulmonary arterial hypertension.\n6. Mild cardiomegaly.\n7. Moderate atherosclerotic calcification."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nenlargement.  Calcifications in the upper pole the right kidney could be\nvascular or non occluding stone.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head neck vessels, moderate in\nmultiple coronary arteries.\n\nProximal aorta is generally enlarged with no focal aneurysm, no appreciable\ncalcification, and no heterogeneity to suggest dissection or large thrombus. \nReaches a maximum diameter of 54 mm in the ascending portion at the level of\nthe intra pericardial right pulmonary artery, compared to 42 mm in ___.  D upper descending thoracic aorta is 51 mm across, previously 33 mm.\nThe distal thoracic aorta tapers gradually and the upper abdominal aorta 24 mm\nat the level of the superior mesenteric artery was 18 mm in ___.  There is no\nperiaortic abnormality to suggest any bleeding.  Aortic valve is not\nappreciably calcified.  Heart is normal size.  There is no pericardial or\npleural abnormality.\n\nEmphysema is moderately severe.  Right lung is clear aside from mild basal\natelectasis.  There are no lung lesions concerning for malignancy or active\ninfection.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.  No\nvertebral compression or pathologic fractures.",
            "output": "Thoracic aorta is greatly but diffusely enlarged, with no focal aneurysm and\nno indirect evidence of dissection on this noncontrast study.  Maximum\ndiameter ascending aorta, 54 mm compares to 42 mm in ___.\n\nModerate emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  There is diffuse dilatation\nof the intrathoracic aorta, increased slightly from the immediate prior study.\nThe ascending aorta measures up to 5.6 cm, previously 5.4 cm (4:122).  The\nproximal descending aorta measures up to 5.2 cm, previously 4.5 cm (4:75). \nThe mid descending aorta measures up to 4.8 cm, previously 4.5 cm (4:133). \nThere is no hyperdensity in the periphery of the vessel to suggest intramural\nhematoma.\n\nPULMONARY PARENCHYMA:  Apical predominant centrilobular emphysema is moderate\nto severe.  Biapical pleural and parenchymal scarring and bibasilar chronic\nappearing atelectasis with associated bronchiectasis is unchanged.  A 5 mm\nnodule in the right lower lobe was not seen previously 4:184), potentially\ninflammatory or related to atelectasis.  There is no evidence of active\ninfection.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Slight interval increase in diffuse dilatation of the intrathoracic aorta\nwith the ascending aorta now measuring up to 5.6 cm, previously 5.4 cm.  No\nevidence for intramural hematoma.\n2. Moderate to severe centrilobular emphysema.\n3. New 5 mm right lower lobe pulmonary nodule may represent atelectasis or\ninflammation.  Six-month follow-up chest CT is recommended to evaluate for\nstability.\n\nRECOMMENDATION(S):  Noncontrast chest CT in 6 months is recommended.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 13:36 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging. \nSubcentimeter left supraclavicular lymph nodes and right supraclavicular and\naxillary lymph nodes are neither enlarged nor growing.\n\nBreast evaluation is reserved for mammography.  No soft tissue abnormalities\nin the chest wall.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels, but is scattered in coronary\narteries.  Thoracic aorta is generally large, noncalcified in the ascending\nportion with maximum diameter of 61 mm at the level of the intra pericardial\nright pulmonary artery, previously 56 mm and maximum diameter,  descending\nthoracic aorta, 53 mm, previously 51 mm.  This study would not be sensitive in\ndetecting dissection or the extent of noncalcified thrombus, but than wk a\nheterogeneous calcification in the posterior descending thoracic aorta,\n___ be an indication of dissection or intramural bleeding.\n\nPericardium is physiologic.\n\nTHORACIC LYMPH NODES:  Thoracic lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: 4 x 6 mm stellate left apical nodule, grew slightly\nfrom ___ to ___, not subsequently.  This is presumably a\npleuroparenchymal scar.  A more irregular complex of soft tissue opacities the\nlateral pleural margin of the right apex is largely expanded subpleural fat\nindicative of a scar.\n\nLungs otherwise clear, tracheobronchial tree is normal to subsegmental levels\nand there is no pleural pathology.\n\nCHEST CAGE: No evidence of obstruction or infection.  No compression or\npathologic fractures.",
            "output": "Biapical lung scars stable since ___.  No lung lesions of\nconsequence or concern.\n\nGenerally aneurysmal thoracic aorta, continues to enlarge, maximum 61 mm\nascending, 53 mm descending.  Possible interval development of dissection or\nintramural hemorrhage, descending thoracic aorta.\n\nMild atherosclerotic coronary calcification.\n\nRECOMMENDATION(S):  Chest CTA.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___ on\n___ at 14:18 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Other than moderate cardiomegaly, the heart,\npericardium, and great vessels are within normal limits.  Moderate coronary\nartery calcification is noted.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  There is no pneumothorax.  Bilateral small simple pleural\neffusions are noted.\n\n\nLUNGS/AIRWAYS:  Ground-glass opacity and septal thickening are consistent with\nmild to moderate pulmonary edema.  There is diffuse bronchial wall thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  There is pericholecystic free fluid, which can be seen in the\nsetting of underlying liver disease or fluid overload.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild to moderate pulmonary edema and small bilateral pleural effusions.\n3. Pericholecystic free fluid, which can be seen in the setting of underlying\nliver disease or fluid overload."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.  Numerous\nsubcentimeter mediastinal lymph nodes, in the lower mediastinum as well as\nboth hila do not meet CT size criteria.  Distal esophagus is patulous with a\nsmall hiatal hernia.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. No substantial atherosclerotic\ncalcifications of the thoracic aorta and of the coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: Assessment of the lungs is somewhat limited\nby inadvertent expiratory phase of respiration and mild motion artifact,\nreducing sensitivity for very small pulmonary nodules and subtle interstitial\nlung abnormalities.  The airways are patent with mild bronchial wall\nthickening, suggestive of chronic airways disease.  Mild dependent\natelectasis.  The lungs are otherwise clear of interstitial or airspace\nopacity. No suspicious pulmonary nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "No interstitial lung disease.\n\nSmall hiatal hernia with patulous distal esophagus."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in caliber with mildly tortuous course\nand no significant atherosclerosis.  There is a moderate sized hiatal hernia. \nAlso noted is independent origin of the left vertebral artery from the aortic\narch.  An apparent left pulmonary artery courses posterior to the trachea. \nThe main pulmonary artery is normal in size and the central pulmonary arterial\nbranches appear patent.  There is no a lymphadenopathy or pneumomediastinum. \nThe air way is centrally patent.  The heart is normal in size and shape.\n\nLungs are clear bilaterally without focal contusion, laceration or\npneumothorax.  No worrisome nodule, mass, or consolidation.\n\nABDOMEN:  The liver and spleen appear intact without focal abnormality.  The\ngallbladder, pancreas, adrenal glands appear normal.  The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis or focal\nlesion of concern.  Simple renal cortical cysts are present, the largest of\nwhich arises from the lower pole right kidney measuring 4.1 x 4.1 x 4.3 cm. \nThe abdominal aorta is normal in course and caliber with widely patent major\nbranches. There is no retroperitoneal hematoma or lymphadenopathy. No free air\nor free fluid is seen. The stomach and duodenum are normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal. No free pelvic fluid.  Scattered colonic diverticulosis without\ndiverticulitis.  The urinary bladder is only partially distended though\nappears grossly intact.\n\nBONES:  There is a comminuted fracture involving the left acetabulum with\nassociated posterior and superior dislocation of the left femoral head.  The\nleft acetabular fracture involves the posterior column and posterior wall. \nThere is a fat fluid level within the left hip joint space.  The left femoral\nhead appears intact.  No vertebral body fracture or malalignment.\n\nLOWER EXTREMITIES:  There is subtle fragmentation along the inferior pole of\nthe left patella.  An accessory ossicle, fabella, is seen along the posterior\naspect of the left lateral femoral condyles.  There is gas within the soft\ntissues lateral and inferior to the left knee with a soft tissue defect along\nthe anterolateral upper shin.  A punctate hyperdensity along the soft tissue\ndefect in the upper shin on series 2, image 448 may represent a tiny foreign\nbody/debris.  No additional radiopaque foreign body is seen in soft tissue\ndefect.  There is no vascular injury or sizable hematoma.  Normal three-vessel\nrunoff is noted in the left lower leg.",
            "output": "1. Acute posterior fracture dislocation of the left hip with left acetabular\nfracture compromising the posterior wall and posterior column.\n2. Fracture along the inferior patella, correlate for integrity of the\npatellar tendon.\n3. Large soft tissue defect along the anterolateral aspect of the left calf\nwith single punctate debris/foreign body as detailed above.\n4. Moderate hiatal hernia.\n\nNOTIFICATION:  Findings discussed with trauma team at the time of initial\nreview."
        },
        {
            "input": "Supraclavicular lymph nodes are not enlarged.  Measurable lymph nodes are\npresent in both axillae, the largest on the left, 8 x 11 mm, 06:51, was 7 x 9\nmm in ___.  Excluding the breasts which require mammography for evaluation\nthere are no other soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nHeterogeneity in the thyroid, including calcifications in the left lobe do not\nwarrant further imaging evaluation for possible malignancy.  Atherosclerotic\ncalcification is not present in head and neck or coronary arteries.  Aorta and\npulmonary arteries are normal size.  There are no filling defects in the\ncentral pulmonary arteries.  There is no pericardial or pleural abnormality.\n\nLung lesions are as follows:\n\n3 mm perifissural nodule, right middle lobe, 6:111, smaller since ___ and\n___.\n\nPunctate nodule, right upper lobe, 6:95, unchanged.\n\nLungs are otherwise clear and the tracheobronchial tree is normal to\nsubsegmental levels.\n\nHeterogeneous demineralization in the thoracic spine is attributable to\nosteoporosis.  There is no appreciable vertebral compression.  Healed sternal\nfracture noted.  There are no bone lesions in the chest cage suspicious for\nmalignancy or infection.",
            "output": "No evidence of intrathoracic malignancy.  One lung nodule, too small to\nmeasure is stable since ___, the other is smaller.  Neither warrants\nfurther evaluation."
        },
        {
            "input": "Small bilateral axillary lymph nodes are stable and not pathologically\nenlarged.  No mediastinal or hilar lymphadenopathy is present.  Aorta and\npulmonary arteries are normal in diameter.  Heart size is normal.  No\npericardial pleural effusion is seen.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\nwith no new nodules masses or consolidations.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nMid sternum deformity is unchanged, series 302b, image 40",
            "output": "No intrathoracic spread of metastatic disease."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is normal, and no\npericardial or pleural effusion is identified.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.  Sternal deformity remains unchanged.\n\nWithin the lungs, no new or growing nodules are detected.  A 2 mm subpleural\nright upper lobe nodule is unchanged (108, 4).  A juxta fissural opacity along\nthe minor fissure is also unchanged (119, 4) and probably reflects an\nintrapulmonary lymph node.  Broad-based dependent opacity in superior segment\nright lower lobe is likely a focus of dependent nodular atelectasis.",
            "output": "Stable CT appearance of the chest with no findings to suggest pulmonary\nmetastases.\n\nPlease see separately dictated CT of the abdomen for complete description of\nsubdiaphragmatic findings."
        },
        {
            "input": "Multiple sub cm right supraclavicular and bilateral axillary nodes are\nunchanged.  7 x 10 mm left peripectoral node, 4:63, is also unchanged. \nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities elsewhere in the imaged chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThere are no thyroid abnormalities warranting further imaging evaluation,\nincluding dystrophic calcification in the left lobe.  Atherosclerotic\ncalcification is not apparent in the head neck vessels or coronary arteries. \n.  Aorta and pulmonary arteries and cardiac chambers are not enlarged.  There\nis no pleural or pericardial abnormality.\n\n Central lymph nodes are not pathologically enlarged in the mediastinal,\nhilar, internal mammary, diaphragmatic or retrocrural stations.  .\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThoracic spine is generally osteopenic, with mild loss of height at several\nlevels and multiple disc intrusions, but no findings concerning for\nmalignancy.  Sternal body is multi segmented and angulated suggesting healed\nremote fracture.  There are no bone lesions in the chest cage suspicious for\nmalignancy",
            "output": "No evidence of intrathoracic malignancy.\n\nLymph nodes are numerous, but not enlarged, and unchanged since at least ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.  Unchanged left\nsubpectoral lymph node measuring 1.0 x 0.6 cm.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is enlarged, new since in ___.  There is no coronary\narterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  No filling\ndefects within the pulmonary arteries.\n\nPULMONARY PARENCHYMA AND PLEURA:  Small bilateral pleural effusions with\noverlying atelectasis.  Posterior right upper lobe 4 mm nodule is likely\ninflammatory as on the coronal and sagittal images it appears linear.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nCHEST WALL AND BONES:  There is subcutaneous emphysema over the right neck and\nupper anterior chest wall.  A right internal jugular central venous catheter\nis present, the tip extending into the superior cavoatrial junction.\n\nThere is no worrisome lytic or sclerotic lesion.  Focal kyphotic deformity in\nthe mid thoracic spine is unchanged likely secondary to mild anterior\nmultilevel vertebral height loss.  The bones appear diffusely osteopenic. \nUnchanged chronic appearing deformity of the sternum.\n\nUPPER ABDOMEN:  Partially imaged surgical drain projects over the right upper\nquadrant.  The patient is status post liver transplant.  No ascites is\nvisualized in the upper abdomen.  Multiple splenules are noted.",
            "output": "1. No evidence of pulmonary embolism\n2. Subcutaneous emphysema within the right upper neck, likely associated with\nthe right internal jugular central venous catheter.\n3. Small bilateral pleural effusions with overlying atelectasis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Stable\nappearance of the large mediastinal vessels, including the minimal dilatation\nof the main pulmonary artery.  Minimal coronary calcifications, no pericardial\neffusion.  No incidental pulmonary embolism.  Posterior mediastinum is\nunremarkable.  The upper abdomen is described in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.\nMinimal bilateral apical scarring.  The airways are patent.  No suspicious\npulmonary nodules or masses.  No diffuse lung disease.  No pleural effusions.",
            "output": "No evidence of metastatic disease to the thorax.  No adenopathy, no pleural\nabnormalities."
        },
        {
            "input": "The imaged base of the neck including the partially visualized thyroid are\nunchanged with a partially calcified left thyroid nodule measuring up to 8 mm.\nThoracic aorta is normal in caliber and slightly tortuous in course, without\nappreciable atherosclerotic calcification.  The main pulmonary artery is\nwithin normal limits of size.  No filling defects are seen within the central\nbranches of the pulmonary arterial tree.  There is no mediastinal, axillary or\nhilar adenopathy.  The heart is normal in size and shape without pericardial\neffusion.  No pleural effusion is seen.  The esophagus is unremarkable.  The\nairways centrally patent.\n\nThe lungs are clear bilaterally without worrisome nodule, mass, or\nconsolidation.  Small posterior Bochdalek hernias are noted bilaterally.\n\nPlease refer to same-day CT abdomen pelvis for findings below the diaphragm.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.\n\nChest wall: Unremarkable.",
            "output": "No evidence of metastatic disease within the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Small right Bochdalek hernia.  No apical scarring\nbilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  6 mm nodule in the left lower\nlobe has grown compared to ___ (previously 2.5 mm-05:112).  Stable\npunctate subpleural nodule in the right upper lobe (5:132).  No new nodules.\n\nCHEST CAGE:\nOld healed fracture in the mid third of the sternum.  No acute fractures. \nMild dorsal spondylosis.  No suspicious lytic or sclerotic lesions.  Stable\nloss of height of T7 through T9.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show redemonstration of\nheterogeneous masses in the superior left, previously described as accessory\nspleens.",
            "output": "Compared to ___, there has been interval growth of a small lung\nnodule in the left lower lobe which is suspicious for developing metastatic\ndisease.  Recommend short-term CT follow-up in 3 months.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 08:58 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Small calcified left-sided thyroid nodule.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  Normal appearance of the large\nmediastinal vessels.  No incidental pulmonary embolism.  No substantial\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nStatus post liver transplantation.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  Stable mild bilateral apical\nscarring.\n\nThe pre-existing nodule in the left lower lobe apex has again increased in\nsize.  The nodule previously was 6 mm in diameter and is now 10 mm in\ndiameter.  The the nodule also shows a lobular contour.\n\nNo other pulmonary nodules are present.  Minimal areas of atelectasis in the\nposterior portions of the lungs.  No pleural thickening, no pleural effusions.\nNo diffuse lung disease.  The airways are patent.",
            "output": "Interval increase in size of a left lower lobe pulmonary nodule that now has a\nclearly lobulated contour.  Both shape and size increase make the nodule\nsuspicious for either a metastasis or a second primary neoplasm.  Further\nworkup is required.\n\nNo adenopathy, no pleural effusions, no diffuse lung disease."
        },
        {
            "input": "BASE OF NECK: Again seen is a small 3 mm calcified left-sided thyroid nodule.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged .\n\nCARDIO-MEDIASTINUM: The thoracic aortic is normal in caliber. The pulmonary\narteries are normal caliber. The heart is not enlarged. There is no\npericardial effusion.\n\nAIRWAY: The airways are patent to the segmental level.\n\nLUNGS: Patient is status post left lower lobe wedge resection.  Postsurgical\nchanges are seen in the left lower lobe.  Resected left lower lobe nodule is\ngone.   Trace bibasilar atelectasis is present.\nMultiple pulmonary nodules are scattered throughout the lung:\n-3 mm pulmonary nodule in the left upper lobe, unchanged compared to prior (5;\n23).\n-2 mm pulmonary nodule in the right upper lobe, unchanged compared to prior\n(5; 55).\n-3 mm pulmonary nodule in the fissure of the right lobe, unchanged compared to\nprior (6; 123), most likely represents a lymph node.\n\nPLEURA: There is no pleural effusion.  There is a 4 x 1.3 cm mass in the right\nlower lung zone with fat density, consistent with a Bochdalek hernia.\n\nCHEST CAGE: There is no worrisome lytic or sclerotic lesion.   Moderate\ndegenerative disease in the thoracolumbar spine.  There is an old fracture of\nthe sternum.\n\nUPPER ABDOMEN: Please refer to separate report on same-day CT abdomen/pelvis\nfor description of the abdominal findings.",
            "output": "1.  Stable bilateral pulmonary nodules.  No new pulmonary nodules identified.\n2.  No evidence of metastases in the chest.\n3.  Please refer to separate report on same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nRECOMMENDATION(S):  Thyroid ultrasound to further characterize calcified left\nthyroid lobe.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:06 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Aorta is well enhanced.  Main pulmonary artery is normal in diameter, well\nenhanced.  Heart size is normal.  There is no pericardial or pleural effusion.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe 3\nmm nodule, series 3, image 42 is stable.  Postsurgical changes in the left\nlower lobe do not appear different compared to previous examination with no\nevidence of local recurrence.\n\nImage portion of the upper abdomen will be reviewed separate part of the CT\nabdomen in and pelvis in corresponding report will be issued.\n\nRight anterior sixth rib focal area of sclerosis is demonstrated, less\nconspicuous than on the previous examination and minor might represent healing\nfracture unclear if pathologic or nonpathologic.  No new lytic or sclerotic\nlesions worrisome for infection or neoplasm demonstrated.",
            "output": "No substantial change since previous examination without evidence of interval\ndisease progression.\n\nSpecifically postsurgical changes in the left lower lobe, left upper lobe\nnodule and sclerotic changes in the right 6 rib anteriorly are similar to\nprevious study with decrease in the sclerosis in the rib as described.\n\nPlease review CT abdomen and pelvis in the corresponding report will be issued\nseparately."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  Breast evaluation\nreserved exclusively for breast imaging.  No soft tissue abnormality elsewhere\nin the chest wall.  Findings below the diaphragm will be reported separately.\nCARDIO-MEDIASTINUM:\nEsophagus unremarkable. Atherosclerotic calcification not apparent in either\nhead and neck vessels or coronary arteries. Aorta and pulmonary arteries and\ncardiac chambers normal size. Pericardium physiologic. Aortic valve not\ncalcified.\n\nTHORACIC LYMPH NODES: None pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nLeft upper lobe, 3-4 mm, 11:59, unchanged since at least ___, was\nsmaller than 2 mm in ___, 5:62.\n\nRight upper lobe, punctate nodule, 11:110, unchanged since at least ___.\n\n3-4 mm perifissural nodule right middle lobe, 11:135, unchanged since\n___.\n\nWedge resection site, right lower lobe, normal postoperative appearance.\n\nSmall region of atelectasis in the inferior subsegment of the lingula has a\nmore lobular appearance, but is unlikely to be a metastasis.\n\n\nCHEST CAGE: Tracheobronchial tree normal to subsegmental levels. No pleural\nabnormalities. No pathologic or compression fractures or destructive bone\nlesions in the chest cage.  Clinically significant anomaly, tripartite sternal\nbody.",
            "output": "No evidence of active intrathoracic malignancy.  2 small lung nodules are\nstable since ___ and the largest, 3-4 mm today is stable since\n___ and was 2 mm in ___."
        },
        {
            "input": "The aorta is not opacified with contrast but appears normal in caliber. The\npulmonary artery is of normal caliber. There is pulmonary embolus present\nwithin a left lower lobe segmental pulmonary artery (series 8, image 146).\nThere is no evidence of right heart strain or pulmonary infarction.\n\nThe thyroid gland is unremarkable. There are no enlarged supraclavicular\naxillary lymph nodes. Multiple enlarged mediastinal lymph nodes are noted. A\nlarge subcarinal lymph node measures 3.5 x 2.2 cm. A second enlarged\nsubcarinal lymph node measures 2.4 x 1.3 cm. Right hilar lymph nodes are\nprominent.  Enlarged pretracheal node measures 2.0 by 3.4 cm.\n\nThere is a 5.6 x 3.8 cm cavitary lesion in the right lower lobe compatible\nwith malignancy. There are innumerable pulmonary nodules throughout the lungs\ncompatible with metastatic disease. The largest is within the left lower lobe\nand measures 2.2 x 2.3 cm. There are small bilateral pleural effusions and\nbibasilar atelectasis. The airways are patent to the subsegmental levels.\n\nThere is a large hiatal hernia. Study is not tailored for evaluation of\nsubdiaphragmatic structures. Limited views demonstrate innumerable\nhypodensities within the liver likely representing metastatic disease but\nincompletely evaluated without contrast opacification. The liver contour is\nnodular. Intra-abdominal lymphadenopathy is significant including a large\ngastrohepatic lymph node measuring 3.0 x 3.0 cm. The spleen is top-normal in\nsize measuring 13.4 cm. Multiple perisplenic varices are noted. A 2.0 x 1.7 cm\nrounded structure in the perisplenic region also likely represents a lymph\nnode. There is a moderate amount of intra-abdominal ascites.\n\nThe bones are incompletely evaluated as no coronal and sagittal reformats were\nprovided. No suspicious osseous lesions are seen on the axial images.",
            "output": "1. Pulmonary embolus in a left lower lobe segmental pulmonary arterial branch.\n2. Large right lower lobe cavitary mass most compatible primary lung cancer\nwith innumerable pulmonary metastatic nodules and mediastinal and right hilar\nlymphadenopathy.\n3. Limited views of the abdomen demonstrate innumerable hypodensities within\nthe liver likely representing hepatic metastases, multiple enlarged\nintra-abdominal lymph nodes, splenomegaly with moderate ascites and\nperisplenic varices.\n4. Small bilateral pleural effusions.\n5. Large hiatal hernia\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 10:23 ___, 20 minutes after discovery of the findings."
        },
        {
            "input": "The thyroid gland is normal. There is no axillary, supraclavicular,\nmediastinal, or hilar adenopathy. The airways are patent to the subsegmental\nlevel. No esophageal abnormality is detected. The heart is normal in size. The\naorta and pulmonary arteries are normal in caliber. Very small pericardial\neffusion is physiologic.  Focal calcification is seen within the distal aspect\nof the anterior descending coronary artery. A small residual thymus is\npresent.\n\nThere is no consolidation or lung nodules suspicious for malignancy. Bibasilar\natelectasis is mild. Costal pleural thickening of at least the parietal\nsurface surrounds a very small right pleural effusion. Loculation is\nindeterminate.\n\nNote is made of a prior right clavicular fracture. No suspicious lytic or\nblastic lesion is identified.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date ___, clips number ___.",
            "output": "No focal consolidation or evidence of pneumonia.\n\nMild pleural thickening at the right lung base is associated with a small\nsubpulmonic pleural effusion, not definitely loculated.  While active\ninflammation cannot be excluded, pleural thickening could be due to recurrent\nor persistent pleural effusion seen on prior radiographs.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date ___, clips number ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Study is not optimally tailored for subdiaphragmatic findings,\nhowever within these limitations no acute abnormality is identified.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  There are mild coronary\natherosclerotic calcifications.  No pericardial effusion.  The thoracic aorta\nis normal in caliber.  There is minimal atherosclerotic calcification of the\naortic arch.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  The lungs are clear without focal consolidation, nodules, or\nmasses.  There is minimal bibasilar atelectasis.\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  While this study is not optimized for the detection of pulmonary\nemboli, no central filling defect is seen.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion\nis detected.  There is mild multilevel degenerative change of the thoracic\nspine, most notably including anterior osteophytosis at the lower thoracic\nspine.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "THORACIC INLET: Surgical clips are seen in the left lower neck, no evidence of\nlocal recurrence.  No evidence of lower neck adenopathy\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is moderate cardiomegaly.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are low volume with bibasilar atelectasis.  No new or growing\npulmonary nodules\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No evidence of metastasis to the chest.  Postsurgical changes in the left\nlower neck.\n\nPlease refer to dedicated report on neck for further details."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  Filling defects consistent with pulmonary emboli are seen\nextending across the right than left main pulmonary arteries consistent with a\nsaddle embolus.  Clot extends into the right upper lobe and bilateral lower\nlobe lobar, segmental, and subsegmental pulmonary arteries.  There is no\nevidence of pulmonary infarction.  The right ventricle is larger than the left\nwith interventricular septal flattening consistent with right heart strain. \nThe pulmonary arteries are normal in caliber.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Scattered granuloma suggest prior granulomatous disease.  There\nis mild biapical pleural and parenchymal scarring.  There is no suspicious\npulmonary nodule.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Acute saddle pulmonary embolism extending into the right upper lobe and\nbilateral lower lobe segmental and subsegmental pulmonary arteries with\nevidence of right heart strain.  No evidence of pulmonary infarction.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:20 ___, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is mildly dilated measuring 3.2 cm across maximal\ndiameter (series 5:74).  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen. \nRight central venous catheter is partially visualized.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a right lower paratracheal lymph node\nmeasuring 1.0 cm (series 5:60), borderline enlarged, possibly reactive. \nPericardial recesses are noted.  There is no axillary, supraclavicular, or\nhilar lymphadenopathy.\n\nPLEURAL SPACES: There are trace bilateral pleural effusions with associated\ncompressive atelectasis.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is dependent and subsegmental atelectasis in the\nbilateral left greater than right lower lobes.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.  Examination for subtle nodularity\nis limited by respiratory motion artifact.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Pneumobilia is noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Right lower paratracheal lymph node measuring 1.0 cm in short axis and\nborderline enlarged, nonspecific in etiology and could be reactive."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  No evidence of mediastinal\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Small focal ground-glass opacity in the medial right lower\nlobe dependently is likely atelectasis. Lungs are otherwise clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder is markedly distended with urine but appears\nintact.  The distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  No atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Mild multilevel degenerative changes with Schmorl's nodes are\ndemonstrated.  At L5-S4, there appears to be mild disc bulge posteriorly.  2\nsmall, well-circumscribed sclerotic osseous lesions in the left pelvis are\nlikely bone islands (series 602b, image 99).  The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1.  No CT evidence of acute solid organ or vascular injury in the torso.  No\ndisplaced fractures identified.\n2.  Mild degenerative changes in the spine at L5-S1 level."
        },
        {
            "input": "HEART AND VASCULATURE: There are multiple acute segmental and subsegmental\npulmonary emboli, predominantly within the right upper lobe (3:63), right\nlower lobe (3:80), and left upper lobe (03:55).  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  A 4 mm subpleural right middle lobe nodule (03:15) is stable\nsince ___.  The airways are patent to the level of the segmental\nbronchi bilaterally.  There is mild diffuse bronchial wall thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Other than a small hiatal hernia, included portion of the upper\nabdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multiple acute segmental and subsegmental partially occlusive pulmonary\nemboli within the bilateral lungs-noted in the right upper lobe, right lower\nlobe and left upper lobe respectively.  No pulmonary infarction or evidence of\nright heart strain.  The main pulmonary artery remains normal in caliber.\n2. No aortic abnormality.\n3. Mild diffuse bronchial airway inflammation.\n4. 4 mm right middle lobe nodule, stable since ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is an enlarged 1.9 cm right paratracheal node and an enlarged 1.2 cm\npretracheal node (3:42, 103).  There is no supraclavicular, axillary or hilar\nlymphadenopathy.  There is a 1.7 x 1.5 cm hypodense nodule with peripheral\ncalcification in the right thyroid lobe (3:11).\n\nHeart size is normal.  Coronary artery calcifications are present.  There is\nno evidence of pericardial effusion.  There is a trace right nonhemorrhagic\npleural effusion.\n\nThere is moderate centrilobular emphysema.  There is minimal bibasilar\natelectasis.  There is a 3 mm calcified pulmonary nodule in the right upper\nlobe (3:161) compatible with a granuloma. There is diffuse mild bronchial wall\nthickening, with secretions seen in the right mainstem bronchus (3:113) and\ntrachea.\n\nThe liver demonstrates diffuse hypoattenuation, consistent with hepatic\nsteatosis.  An ill-defined hyperdense lesion in the right lobe of the liver is\nincompletely characterized but likely represents a hemangioma (2:118).  A 2.5\nx 2.0 cm left adrenal hypodense nodule is incompletely characterized (2:127).\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Trace right pleural effusion and bibasilar atelectasis.  No left pleural\neffusion.\n3. Moderate emphysema with diffuse bronchial wall thickening suggestive of\nsmall airway disease and right mainstem endobronchial secretions.\n4. Mediastinal lymphadenopathy is nonspecific, however may be reactive to\nairway disease.\n5. 2.5 cm left adrenal nodule is incompletely characterized but statistically\nlikely an adenoma.  If there are signs of adrenal hyper function, consider\nbiochemical evaluation.  ___ year follow-up CT or MRI adrenal is recommended for\nfurther characterization and to assess for stability.\n6. 1.7 cm hypodense right thyroid nodule, for which outpatient thyroid\nultrasound is recommended for further evaluation.\n7. Hepatic steatosis and likely hepatic hemangioma.\n\nRECOMMENDATION(S):\n1. Recommend ___ year follow-up CT or MRI adrenal protocol.\n2. Recommend outpatient thyroid ultrasound."
        },
        {
            "input": "There is moderate centrilobular emphysema. There are extensive consolidations\nand ground-glass opacity in the right upper, middle, and lower lobes. There is\na small nonhemorrhagic right pleural effusion.\n\nScattered nodules in the left lung (02:35, 98) are also present.\n\nNon enlarged upper and lower mediastinal lymph nodes an shotty right hilar\nlymphadenopathy are likely reactive.\n\nThere is no evidence of acute aortic pathology or filling defect in the\npulmonary arteries. The heart is mildly enlarged. No pericardial effusion.\n\nLimited images of the upper abdomen demonstrate a hyperenhancing focus in\nhepatic segment VII measuring 1.8 x 1.4 cm (2:97), corresponding to the\nhemangioma previously characterized by MRI.  There is another, smaller focus\nof arterial enhancement just posterior to this region (02:101), not seen on\nthe ___ contrast enhanced MRI, likely a perfusion abnormality. While\nevaluation of liver density is limited in the absence of a precontrast scan,\nliver density appears diffusely low, suggesting fatty infiltration. There is\nmild periportal lymphadenopathy which is similar to ___, nonspecific\nbut possibly related to the underlying liver disease.  Spleen is top normal in\nsize, measuring 13 cm.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n2. Extensive consolidation in the right upper, middle, and lower lobes\ncompatible with pneumonia, with associated small to moderate nonhemorrhagic\nright pleural effusion.\n3. Small nodules in the left upper and lower lung may be related to infection,\nbut other etiologies not excluded, particularly in the setting of underlying\nemphysema.\n4. Probable fatty infiltration of the liver.\n5. Mild periportal lymphadenopathy, similar to ___ , which is\nnonspecific but may relate to underlying liver disease.\n6. In addition to the previously characterized hemangioma in hepatic segment\nVII, there is a smaller adjacent focus of arterial enhancement, not seen on\nthe ___ MRI. This may represent a perfusion anomaly, but other\netiologies are not excluded, given the suspected underlying liver disease.\n7. Borderline splenomegaly.\n\nRECOMMENDATION(S):\n1. Recommend follow up chest CT in ___ months for reassessment of the left\npulmonary nodules.\n2. Recommend correlation with liver function tests.\n3. Given the suspected underlying liver disease, repeated abdominal MRI is\nrecommended to assess the arterially enhancing focus which was not seen\npreviously, though it most likely represents a perfusion anomaly."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is top-normal in size.  The pericardium and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is residual scarring in the right lung fields consistent\nwith sequelae from prior infection.  There is diffuse mild bronchial wall\nthickening consistent with bronchiectasis.  There is diffuse background\ncentrilobular emphysema.  Lungs are without masses or areas of segmental\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a simple cyst in the upper pole of the bilateral kidneys. \nThere is a small hemangioma in the right hepatic lobe (2:88).  There is\nprominence of the common bile duct as expected post cholecystectomy. \nOtherwise, included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Right lung residual scarring sequelae of prior infection.  Diffuse\nbronchiectasis and emphysema."
        },
        {
            "input": "There is no axillary or supraclavicular lymphadenopathy.  A fat containing 13\nmm pretracheal lymph node is noted (02:24).  Additional, smaller central lymph\nnodes do not meet criteria for pathologic enlargement but are prominent. \nFinally, there is prominent peribronchovascular lymphoid tissue extending from\nthe left hilum (02:26). The heart is normal size and there is no pericardial\neffusion. A right coronary artery stent is noted.  Focal coronary artery\ncalcifications are moderate.  The main pulmonary artery is mildly enlarged,\nmeasuring 3.3 cm. The aorta is normal caliber.\n\nThere are severe changes of paraseptal and moderate changes of centrilobular\nemphysema, which predominate the lung apices. Innumerable, ground-glass\ncentrilobular nodules are seen within the upper lobes, and indicate\nbronchiolitis.  Subpleural reticular opacities predominate the mid to lower\nlung zones.  There is no focal airspace consolidation worrisome for infection.\nThere is no pulmonary edema. There is no evidence of honeycombing.  There are\nno lung masses of concern. A punctate granuloma is noted in the left lower\nlobe (4:162). There airways are patent through the subsegmental level.  There\nis minimal bronchial wall thickening without bronchiectasis.\n\nLimited views of the enhanced spleen, pancreas and adrenal glands are\nunremarkable.  Hypoattenuation of the liver is consistent with fatty\ninfiltration.  There is cholelithiasis without evidence of cholecystitis. \nThere are no lytic or blastic osseous lesions.  Old-appearing right-sided rib\nfractures are noted.",
            "output": "1. Severe changes of emphysema with subpleural mid to low lung reticular\nopacities, likely reflecting early Combined Pulmonary Fibrosis and Emphysema\n(CPFE). 2. Upper lobe centrilobular nodules indicating bronchiolitis, most\ncommonly from smoking.  3. Prominent central lymph nodes and\nperibronchovascular lymphoid tissue is likely reactive to these processes. 4.\nMild enlargement of the main pulmonary artery may indicate underlying\npulmonary hypertension. 5. Incidental findings include cholelithiasis and\nfatty liver."
        },
        {
            "input": "CTA:  The ascending aorta is mildly dilated measuring 4.1 x 3.9 cm. There is\nno evidence of aortic dissection.  The pulmonary arteries are well opacified\nto the subsegmental level bilaterally.  There is mild dilation of the right\nmain pulmonary artery measuring up to 2.4 cm.\n\nCHEST:  The thyroid is unremarkable.  There is no axillary or supraclavicular\nadenopathy.  There are scattered mediastinal and subcarinal lymph nodes\nmeasuring up to 8 mm in the prevascular space.  Heart is top-normal in size. \nThere is no pericardial effusion.  There are no significant Coronary artery or\naortic valvular calcifications.\n\nThe airways are patent to the subsegmental level bilaterally.  Note is made of\nan upper tracheal diverticulum (series 602b, image 29).  There is mild\nbiapical scarring.  The lungs are clear.  There is no suspicious pulmonary\nnodule.  There is no pneumothorax or pleural effusion.\n\nLimited views of the upper abdomen demonstrate a small hiatal hernia.\n\nNo suspicious bony lesions.",
            "output": "1. No evidence of pulmonary embolism.\n2. Ascending aorta aneurysm, measuring up to 4.1 cm.\n3. Small hiatal hernia.\n4. Numerous non-pathologically enlarged mediastinal lymph nodes, likely\nreactive."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary noncalcified lymph nodes.\nCalcified nodes in the left hilum and subcarinal region are consistent with\nprevious granulomatous exposure. Heart size is upper limits of normal, and\ndiffuse coronary artery calcifications are present.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nof the spine as well as several discrete lucent lesions in the spine. Examples\nin the mid thoracic spine are shown on images 40 and 41 of series 602b\n\nWithin the lungs, dependent foci of atelectasis are present at both lung\nbases. No suspicious pulmonary nodule or mass is detected to suggest primary\nor metastatic lung neoplasm.",
            "output": "1. No CT evidence of lung nodule or mass to suggest pulmonary neoplasm.\n\n2. Small lucent lesions in the thoracic spine, which are indeterminate.\nCorrelation with bone scan or MRI may be helpful.\n\n3. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "CTA:  The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is mild atherosclerotic calcification.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nCHEST:  The thyroid is unremarkable.  There is no axillary or supraclavicular\nlymphadenopathy.  Numerous prevascular mediastinal lymph nodes measuring up to\n7 mm are unchanged.\n\nHeart size is not enlarged.  There are no coronary artery calcifications.\n\nThe airways are patent to the subsegmental level bilaterally.  Again seen, is\nextensive lower lobe predominant ground-glass opacity which has mildly\nincreased when compared to ___.  There is no pleural effusion or\npneumothorax.\n\nThe esophagus is unremarkable.  There is small hiatal hernia.  Limited views\nof the upper abdomen are unremarkable.\n\nThere are no suspicious bony lesions.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Extensive bilateral ground-glass opacity, lower lobe predominant, mildly\nincreased in extent compared to ___, findings consistent with known PCP\n___.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:16 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nAortic arch calcifications are mild and unchanged.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no axillary supraclavicular lymphadenopathy.  Numerous prevascular\nmediastinal lymph nodes, measuring up to 6 mm, are unchanged.  The thyroid\ngland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThe airways are patent to the subsegmental level bilaterally.  Again seen are\nextensive bilateral lower lobe and perihilar predominant ground-glass\nopacities and septal thickening, consistent with provided history of PCP\n___.  Compared with the prior studies, this process appears more severe\nin the right upper lobe (5:48).  However, allowing for differences in\nrespiratory motion, these findings are otherwise not significantly changed\nsince ___.\n\nLimited images of the upper abdomen are notable for an unchanged small hiatal\nhernia..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMultilevel degenerative changes are again noted.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Extensive bilateral ground-glass opacities and septal thickening are\noverall similar in appearance since ___, and are slightly worse in the\nright upper lobe.  Again, these findings are consistent with provided history\nof known PCP ___."
        },
        {
            "input": "CT CHEST WITHOUT CONTRAST:  The partially imaged thyroid is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  Numerous scattered\nmediastinal lymph nodes are not pathologically enlarged by CT size criteria. \nFor example, there is a 9 x 4 mm paraaortic node (02:17).  The esophagus is\nunremarkable.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta and\nproximal great vessels are normal in caliber.  There is mild atherosclerosis\nof the aortic arch.  The main pulmonary artery is normal in caliber.\n\nThe airways are clear to the subsegmental level.  There is mild diffuse\nbronchiectasis.  There are extensive bilateral ground-glass opacities and\nseptal thickening with a predominantly perihilar and lower lobe predominant\ndistribution.  There is no cavitary lesion.  There is no pleural effusion or\npneumothorax.\n\nUPPER ABDOMEN: There is a small hiatal hernia.  The partially imaged solid\norgans and stomach are grossly normal.\n\nOSSEOUS STRUCTURES:  There is no worrisome blastic or lytic lesion.",
            "output": "1. Extensive bilateral ground-glass opacities and septal thickening worrisome\nfor atypical pneumonia, possibly PJP.  There is no cavitary lesion.\n2. Small hiatal hernia."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Moderate subcutaneous emphysema\nalong the anterior subcutaneous tissues with small amount air tracking along\nthe pectoralis major muscles bilaterally has decreased since ___ chest\nradiograph.  0.7 cm left thyroid nodule is noted.  Thyroid is otherwise\nunremarkable.  No supraclavicular or axillary lymph node enlargement.\n\nUPPER ABDOMEN:  Subcentimeter periportal lymph node is noted measuring up to\n1.1 cm in short axis (4:212), unchanged since ___ evaluation of\nthe solid organs are otherwise unremarkable.\n\nMEDIASTINUM: No mediastinal lymph node enlargement.  Mild rightward shift of\nmediastinum is expected post pneumonectomy.\n\nHILA: No left hilar lymph node enlargement.\n\nHEART and PERICARDIUM: Normal in size.  No pericardial effusion.  Moderate\ncoronary calcifications are noted.\n\nPLEURA: Trace left pleural effusion.  Patient is status post right\npneumonectomy with expected near complete opacification of the right\nhemithorax.  Single locule of air is noted (4:62).  Along the posterior aspect\nof the right upper hemithorax is a 0.5 cm linear radiopacity (02:16)\nconsistent with a surgical clip.\nLUNG:\n\n1. PARENCHYMA:  Moderate-sized left lower lobe opacity is noted with\nheterogenous enhancement suspicious for atelectasis with superimposed\ninfection.  Status post right pneumonectomy.\n2. AIRWAYS:  No bronchial wall thickening.  No mucous plug.  No\nbronchiectasis.\n3. VESSELS:  Thoracic aorta is normal in caliber without aneurysmal\ndilatation.  No dissection or intramural hematoma.  Main pulmonary artery is\nnormal in caliber.  No pulmonary embolism up to the lobar level.\nCHEST CAGE: Rib fractures from prior thoracotomy.  Specifically, mildly\ndisplaced two part fifth rib fracture with mildly displaced component\nposteriorly and nondisplaced component laterally (2: 19, 23).  Second mildly\ndisplaced posterolateral right sixth rib fracture is noted.  No additional\nfracture.  No lytic or blastic lesions worrisome for malignancy.",
            "output": "1.  Moderate left lower lobe airspace opacity with heterogenous enhancement,\nsuspicious for left lower lobe pneumonia.\n2.  Status post right pneumonectomy with expected near complete opacification\nof the right hemithorax containing single locule of gas.\n3.  Subcutaneous emphysema along anterior chest wall likely related to prior\nrecent chest tube removal, decreased since ___ radiograph.\n4.  Right chest wall thoracotomy changes.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:42 am, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is mildly\nheterogeneous with a 7 mm left thyroid nodule.  There is no supraclavicular or\naxillary lymphadenopathy by CT size criteria.  New since ___, there\nis new nonobstructive fluid layering between the right chest wall musculature,\ndistending the musculature and fascial layer laterally.  The fluid collection\nwithin the chest wall measures 8.8 x 3.9 cm (302:95).  In addition, there is\nincreased fat stranding around the right shoulder and chest wall musculature,\npossibly reactive to new fluid accumulating in the right chest wall.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.\n\nHILA: There is no left hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  No pericardial\neffusion is seen.  Moderate coronary calcifications are seen. \nEnhancement/hyperdense right mediastinal lining is likely postoperative\nappearance of surgical defect repair with mesh.\n\nPLEURA: Left small nonhemorrhagic pleural effusion is stable.  Patient is\nstatus post right pneumonectomy with expected complete opacification of the\nright hemithorax.  However, as described above, the pleural fluid appears to\nhave increased in size from prior exam and now bulging into the chest wall. \nPreviously seen single locule of air is no longer seen.  Surgical clips and\nfiducial is noted within the right pleural space.\n\nLUNG:\nPARENCHYMA:  Evaluation of the lungs are mildly limited due to respiratory\nmotion.  Moderate-size left lower lobe opacity with heterogeneous enhancement\nis persistent and may be related to superimposed infection.  5 mm nodule in\nthe left lower lobe is new since ___ and likely is infectious in\netiology (302:139).  In addition, there is ground-glass opacity with\nperipheral nodularity in the left upper lobe, new since ___, likely\nrepresenting infection or inflammation.\n\nAIRWAYS:  Patient is status post intubation with the endotracheal tube tip\nterminating approximately 2.2 cm from the carina.  As previously, there is\nair-fluid level within the distal trachea and carina with complete\nopacification of the right mainstem bronchus, unchanged from prior exam. \nThere is mild narrowing of the left lower lobe were bronchus supplying the\nbasal segment.\n\nVESSELS:  The ascending and descending aorta are normal in caliber.  The main\npulmonary artery remains prominent, measuring 3.1 cm.\n\nMUSCULOSKELETAL: Again seen are multiple rib fractures on the right, with\nanterior displacement of the posterior right fifth rib, unchanged.\nHyperdensity abutting the inner cortex of the displaced right sixth rib\npossibly represents periosteal reaction (302:104).\n\nUPPER ABDOMEN: New since ___, there is mild peripancreatic stranding\naround the tail of the pancreas (302:202).  There is associated mild\nthickening of the anterior Gerota's fascia (302:211).  There is no drainable\nfluid collection in the abdomen.  The enteric tube terminates in the stomach.",
            "output": "1. New ground-glass opacities with peripheral nodularity in the left upper\nlobe, new since ___ and persistent left lower lobe consolidation with\nheterogeneous enhancement, concerning for multifocal pneumonia.\n2. Increased fat stranding around the tail of the pancreas, concerning for\npancreatitis.  Please correlate with laboratory values.\n3. Postoperative appearance of the right hemithorax with evidence of enlarging\nright pleural effusion, now bulging into the right chest wall with likely\nreactive changes in the right chest wall, concerning for communication between\nthe pleural space and left chest wall.  Focus of hyperdensity in the inner\ncortex of the mildly displaced rib fracture possibly represents periosteal\nreaction. Consider evaluation of the pleural fluid for blood products and\nsigns of infection.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:39 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis, particularly\nevaluation of the liver, but shows no adrenal mass.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head and neck vessels, but is\nabundant in coronary arteries.  Aorta and pulmonary arteries are not enlarged.\nThere is no pericardial or pleural effusion.\n\nThoracic lymph nodes:\n\n10 mm right paraesophageal node, 02:26, was less than 7 mm in ___.  No other\nmediastinal lymph nodes are enlarged.  Left hilar lymph nodes are normal size.\n\nLungs and bronchial tree:\n\nCentral right middle and upper lobe mass, inseparable from right hilar\nadenopathy and distal atelectasis in the upper lobe is 8.5 x 7 cm in aggregate\ndiameters, 02:24, previously 5 x 8 cm.  Right upper lobe bronchus and\nposterior branch of the right upper lobe pulmonary artery are encased but not\nobstructed.  Branch of the right superior pulmonary vein and the anterior\nsegmental upper lobe bronchus are occluded, 2: 22, 25.  Tumor extends along\ncontiguous surfaces of the bronchus intermedius and middle lobe bronchus.\n\nMass or atelectasis now has a longer interface with the anterior costal pleura\nand the mediastinum.  Mediastinal invasion is likely, with new continuity\nalong the pericardium at the level of the right atrial appendage.  There is no\npericardial or remote pleural effusion.  Heterogeneous opacification at the\nbase of the right lung is probably atelectasis.  Mild linear and subsegmental\nlingular atelectasis is present in the left lung.  There are no left lung\nlesions concerning for malignancy.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Growing right lung mass involving upper lobe middle lobe, with possible\nextension into the mediastinum.  Interval growth of cm size paraesophageal\nmediastinal lymph nodes might be in indication of malignant involvement."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  Atherosclerotic calcifications are\nseen in the coronary arteries and aortic valve.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pneumothorax or evidence of dehiscence along the right\npneumectomy site.   Patient is status post right pneumonectomy.  Similar to\nthe prior study in ___, there is a nonhemorrhagic fluid collection within\nthe right chest wall, which is seen distending the musculature and fascial\nlayers laterally, concerning for communication between the pleura and right\nchest wall. There is again associated fat stranding seen along the right chest\nwall musculature, likely reactive to the accumulated fluid collection.  In\nparticular, there is interval increase in size of the fluid collection\nadjacent to the right scapula, measuring approximately 8.1 x 4.0 cm,\npreviously 5.1 x 4.2 cm in ___ (series 3: Image 22).\n\nLUNGS/AIRWAYS:   Interval increase in consolidations in the left lower lobe\nand left upper lobe since the prior study in ___ are concerning for\nworsening infection.  As before, there is near complete opacification of the\nright mainstem bronchus, unchanged.\n\nBASE OF NECK: Patient is status post tracheostomy with the tip terminating in\nthe distal trachea approximately 3.3 cm above the carina.  There has been\ninterval removal of an enteric tube.  Air-fluid levels are noted in the\nesophagus, concerning for risk of aspiration.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is grossly\nunremarkable.  The previously described peripancreatic stranding is not well\nvisualized on today's study.\n\nBONES: Multiple mildly displaced right posterior-lateral rib fractures are\nnoted involving the ___ ribs with the fifth rib appearing fractured in 2\nplaces.  Small amount of callus is indicative of healing.",
            "output": "1. Interval increasing consolidations in the left lower lobe and left upper\nlobe compared to the prior study in ___, concerning for worsening\nmultifocal pneumonia.\n2. Air fluid levels are noted in the esophagus, concerning for risk of\naspiration.\n3. Interval increase in the pre-existing nonhemorrhagic fluid collection\nwithin the right hemithorax extending into the right chest wall, particularly\ninvolving the fluid collection adjacent to the right scapula, measuring up to\n8.1 cm.\n4. Postsurgical changes seen following right pneumonectomy and right\ntracheostomy.\n5. Multiple subacute healing mildly displaced posterolateral right rib\nfractures are grossly unchanged.\n\nNOTIFICATION:   The findings were discussed with Thoracic surgery resident\n___, M.D. by ___, M.D. on the telephone on ___ at 4:27 pm, 1\nminutes after discovery of the findings."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nThe patient has median sternotomy with aortic valve replacement. Mild\ncardiomegaly with multichamber enlargement is stable. There is no pericardial\neffusion, and is not thickened or calcified.  There are extensive mitral\nannular calcifications. The main pulmonary artery and thoracic aorta are\nnormal caliber. The thoracic aorta measures 3.6 cm at the level of the main\npulmonary artery.\n\nCalcific atherosclerosis is mild, and minimally involves the anterior and\nmedial walls of the ascending thoracic aorta in a discontinuous fashion.\nDiscontinuous calcification of the aortic arch and descending thoracic aorta\nis also mild.\n\nThere are several pulmonary nodules measuring up to 5 mm, which were not\nincluded in the field of view of the prior CT abdomen/pelvis (6: 40, 46, 51,\n81, 98, 102, 114). A few calcified granulomas are also identified bilaterally.\nBilateral band-like opacities in the anterior right middle, left upper and\nboth lower lobes are likely due to atelectasis. Small subsegmental peripheral\nconsolidations involving the superior segment right lower lobe (6, 97),\nperipheral left upper lobe (6, 100) and the lateral segment right middle lobe\n(6, 140) may be due to infection or atelectasis. There is no endobronchial\nlesion or pleural abnormality.\n\nImages of the upper abdomen show cholelithiasis and colonic diverticulosis\nwithout evidence for diverticulitis.\n\nExtensive multilevel spinal degenerative changes are present.",
            "output": "Several solid pulmonary nodules measure up to 5 mm should be evaluated with \nfollowup chest CT in 6 months.\nMild atherosclerosis with aortic calcifications described above.\nSmall subsegmental peripheral consolidations involving the right middle, right\nlower and left upper lobes may be due to infection or atelectasis.\nCholelithiasis.\nColonic diverticulosis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland is heterogeneous with no focal nodule.\n\nThere is no pericardial or pleural effusion.\n\nThere is a consolidation in the left upper lobe with air bronchograms, which\nis concerning for pneumonia.  Apical subpleural scarring is present in the\nright upper lobe.  There is mild bronchial thickening, compatible with small\nairways disease.  The airways are patent to the subsegmental level.\n\nThere is a 1.3 cm lesion in the right upper renal pole, which measures fat\ndensity consistent with an angiomyolipoma.  Limited images of the upper\nabdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is marked dextroscoliosis of the thoracic spine with associated\ndegenerative changes.  There is pectus excavatum.",
            "output": "1. No pulmonary embolism.\n2. Left apical consolidation is concerning for pneumonia.\n3. No sequelae of trauma."
        },
        {
            "input": "HEART AND VASCULATURE: There is a filling defect in a left lower lobe\nsubsegmental pulmonary artery (3:162).  Pulmonary vasculature is otherwise\nwell opacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Biapical scarring, left greater than right, is stable compared\nwith ___.  No new focal consolidation.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is pectus excavatum and dextroscoliosis of the thoracic spine. \nNo suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Left lower lobe subsegmental pulmonary emboli.  No pulmonary infarct or CT\nevidence of right heart strain."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Opacity at the left apex is similar in appearance to prior\nstudy, likely representing scarring or fibrosis.  The scarring at the right\napex is also unchanged.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.4 cm cyst in the upper pole of the left kidney is unchanged.  There is no\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is a large\namount of stool within the colon.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder is distended.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus.  No adnexal abnormality is\nidentified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is dextroscoliosis of the thoracic spine and\nlevoscoliosis of the lumbar spine, with multi level degenerative changes.  The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolism or acute aortic abnormality.\n2. Paucity of intra-abdominal fat limits evaluation.  There is a large amount\nof colonic stool.  Otherwise, no acute intra-abdominal process to explain the\npatient's symptoms.\n3. Please note that CT is not adequate for the evaluation of breast tissues. \nIf there is clinical concern for breast pathology, dedicated breast imaging\nshould be performed."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Again seen is a similar appearing left apical ground-glass\nopacity, unchanged over multiple priors and most suggestive of scarring. \nMinimal scarring is noted at the right lung apex.  Upper lobe predominant\nemphysema noted.  Lungs are otherwise clear without worrisome nodule, mass, or\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is moderate dextroscoliosis of the midthoracic spine.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  No acute findings to account for acute chest pain.\n3.  Similar appearance of left apical ground-glass opacity which is thought to\nrepresent chronic scarring."
        },
        {
            "input": "HEART AND VASCULATURE: Focal nonocclusive segmental to subsegmental thrombus\nat a right medial basal pulmonary artery (series 3, image 124).  No pulmonary\narterial dilatation.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma..  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Apical pleuroparenchymal scarring as on prior.  Lungs are\notherwise clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No acute fractures.  Substantial rightward deviation of the spine is\nincompletely evaluated on these non standing views but appears similar to the\nprior study.",
            "output": "1. Focal nonocclusive right medial basal segmental to subsegmental pulmonary\nembolism (series 3, image 124).  No pulmonary arterial dilation.  No evidence\nof right heart strain although this is not a sensitive finding.  No signs of\npulmonary infarction.\n2. No acute aortic abnormality."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature demonstrates resolution of the\nprevious right lower lobe emboli, now with appropriate opacification to the\nsubsegmental level without filling defect to indicate an acute pulmonary\nembolus.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Previously noted biapical densities, particularly in the\nanterior right apex, appear more confluent, which which could represent\ninfectious process or pulmonary infarct.  (Series 4, image 20).  Upper lobe\ndominant centrilobular emphysematous changes are noted.  Airway is patent to\nthe subsegmental level bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: 1 cm cyst in the upper pole of the left kidney is largely unchanged. \nThe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nfree intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Several calcified uterine fibroids are largely unchanged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar\nspine with dextroconvex thoracic and levoconvex lumbar scoliosis, similar to\nthe prior study.  No acute fracture or suspicious lesions identified.  The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Previously demonstrated right basal pulmonary emboli have resolved. No new\npulmonary emboli noted.\n2.  Increased confluence of biapical densities, notably in the anterior right\napex, may be concerning for underlying infectious process versus pulmonary\ninfarct.\n3. No pleural effusion or pneumothorax."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Opacities at each lung apex are unchanged except for\nretraction and new cavitation of a right apical opacity.  This is most\nsuggestive of an evolving infarct associated with pulmonary embolism in early\n___.  No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally without bronchial wall thickening, mucous plugging or\nbronchiectasis\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is moderate dextroscoliosis of the thoracic spine.  Minimal\nmultilevel degenerative changes the thoracic spine redemonstrated.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Dense ground glass opacity at the right lung apex has retracted and\ncavitated since the prior study.  This suggests an evolving infarct, which in\nturn implies that there may have been an otherwise occult peripheral pulmonary\nembolism near the site when the patient previously presented with pulmonary\nembolim in early ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is redemonstration of focal ground-glass opacities in the\nbilateral lung apices, left greater than right, with interval resolution of\nthe previously seen right apical cavitating component.  This is likely due to\nscarring.  Otherwise, lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is dextroscoliosis of the thoracic spine.  Otherwise, there is no\nevidence of suspicious osseous lesions or acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Chronic biapical ground-glass opacities, grossly similar to prior study\nwith interval resolution of the previously seen cavitating component. \nFindings may be due to scarring potentially in the setting of prior radiation\nin the proper clinical setting."
        },
        {
            "input": "Aside from punctate calcifications in the right lobe, the thyroid gland is\nunremarkable.  There are no pathologically enlarged supraclavicular,\nmediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with moderate coronary artery calcification.  There is no\npericardial effusion.  The main pulmonary artery and thoracic aorta are normal\ncaliber.\n\nThe known apical posterior left upper lobe perihilar mass is not appreciably\nchanged when allowing for differences in technique measuring 1.9 x 2.5 cm\nsize, previously 1.8 x 2.3 cm (5, 124). As described in the recent PET-CT,\nthis mass abuts and buckles the left major fissure, but does not cross it. \nThe mass is just lateral and superior to the apical posterior division of the\nleft upper lobe bronchus adjacent to a small lateral branch (5, 124). The left\nmajor fissure is focally thickened lateral to this lesion (5, 126), but this\nmay be due to an adjacent band of atelectasis (5, 119). Despite the\nheterogeneous but overall low attenuation of this lesion ___ ranging from\n___, malignancy is still most likely given the high FDG avidity.\n\nAdditional smaller pulmonary nodules measuring up to 5 mm in the left lower\nlobe adjacent to the major fissure (5, 173) are stable since ___ (5:\n35, 92, 147, 173, 189, 193, 197, 213). A small area of focal bronchiolectasis\nassociated with band-like peripheral scarring is identified in the left lower\nlobe (5, 240). There is also mild diffuse bronchial wall thickening.\n\nImages of the upper abdomen are notable only for punctate calcifications\nclosely related to the pancreas, possibly due to chronic pancreatitis.\n\nThere are no bony lesions in the thorax worrisome for infection or malignancy.",
            "output": "No appreciable change in known 1.9 x 2.5 cm apical posterior left upper lobe\nperihilar mass since ___.\n\nAdditional smaller pulmonary nodules measuring up to 5 mm are stable since\n___. No new nodules identified."
        },
        {
            "input": "The examination is compared to ___.\nKnown an unchanged bilateral thyroid nodules.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  No enlarged lymph nodes in the\nmediastinum or at the level of the hilar structures. Mild coronary\ncalcifications.  No relevant valvular calcifications.  No pericardial\neffusion. Normal size of the heart.  Small hiatal hernia. Unremarkable\nposterior mediastinum.  In the upper abdomen, visibility is limited by\nmetallic are defects but no gross abnormalities are seen at the level of the\nadrenal glands.  No evidence of osteolytic lesions at the level of the ribs,\nthe vertebral bodies or the sternum.\n\nThe overall size of the known left upper lobe lesion (4, 72) as well as of the\nsmall lateral satellite lesion is unchanged.  Also unchanged are the\nspiculations of the lesions and the small very focal reaction, causing\ndeviation of the fissure. No metallic fiducial marker in the lesion is\ndetected.\nA second carries visual pulmonary nodule in the left lower lobe (4, 101) is\nalso unchanged an continues to measure 5 mm in diameter.  Unchanged subpleural\nmiddle lobe granuloma (4, 111).  Unchanged minimal left basal visual\nthickening (4, 123).  Unchanged on characteristic scarring at the bases of the\nleft lower lobe (4, 153).  No pleural thickening.  No pleural effusions. The\nairways are patent.",
            "output": "As compared to ___, the large left upper lobe mass and the 5 mm\nleft lower lobe pulmonary nodule are unchanged in size and morphology.  No new\npulmonary nodules have occurred.  No pleural effusions.  No lymphadenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid contains multiple\nhypoattenuating nodules measuring up to 1.4 cm (04:17).  A 1  Supraclavicular\nand axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Patient is status post left upper lobe CyberKnife for\nnon-small-cell lung cancer.  There is new partial left upper lobe collapse\n(04:51).  Central low attenuation within the collapsed parenchyma likely\nrepresents tumor necrosis (04:44).  Additional small subpleural nodules are\nstable from ___ (4:67, 115, 127).  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Moderate to severe left\nglenohumeral degenerative changes are noted (04:14).\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. New partial left upper lobe collapse status post CyberKnife therapy for\nsmall cell lung cancer with central low density suggesting tumor necrosis. \nResidual tumor or recurrence are difficult to exclude in this setting of\ncollapsed upper lobe parenchyma, and attention to this area on follow-up\nimaging is recommended.\n2. Otherwise, no change in small pulmonary nodules and no evidence of\nmetastatic disease within the chest."
        },
        {
            "input": "The thyroid contains multiple nodules with the largest in the left lobe\nmeasuring 1.4 cm, unchanged from prior.  There is no axillary, supraclavicular\nadenopathy.  There are no pathologically enlarged mediastinal lymph nodes. \nHeart size is normal.  There is no pericardial effusion.  Coronary artery\ncalcifications as well as aortic valvular calcifications are mild.  The\nthoracic aorta is normal in caliber with minimal atherosclerotic disease.  The\nmain pulmonary trunk is also normal in caliber.  Patient is status post left\nupper lobe CyberKnife for non-small cell lung cancer.\n\nThere is a partial left upper lobe collapse, as seen previously.  There is a\ncentral low-density region within the area of collapsed lung which is\nunchanged.  Pulmonary nodules are stable including the largest 8 mm nodule at\nthe left lung base in continuity with the left hemidiaphragm and 7 mm nodule\nat the left lung apex (series 4, image 157, 642).  There are other smaller\nperipheral nodules seen on (series 4, image 76, 127), that are unchanged\nsmaller compared to prior.  There is mild centrilobular emphysema.  There is\nno pleural effusion or pneumothorax.\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\ndemonstrate left adrenal gland thickening, stable from prior.  There is\ndiverticulosis of the colon.  There is moderate atherosclerotic disease.\n\nThe superficial soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES: There are no suspicious bony lesions.  There is partially\nimaged posterior lumbar spinal fusion hardware.",
            "output": "1. No interval change compared to ___, including partial left upper lobe\ncollapse with areas of low density centrally.  Residual tumor or tumor\nrecurrence in this location is difficult to exclude, and continued attention\non follow-up imaging is recommended.\n2. Seven month stability of left lower lobe and apical pulmonary nodules\nmeasuring up to 8 mm, possibly scarring, although attention to these areas on\nfollow-up imaging is also advised.\n3. Stable multinodular thyroid."
        },
        {
            "input": "The thyroid enhances homogeneously. A new prominent left axillary lymph node\nmeasures 9 x 11 mm (4:69). Mediastinal lymph nodes have increased in size, for\nexample a new right upper paratracheal node measures 15 x 9 mm (4:47), a\naround 9 mm AP window node previously measured 4 mm (4:71), right and left\nlower paratracheal nodes, 21 x 9 mm and 23 x 13 mm, previously measured 9 x 16\nand 11 x 7 mm respectively (4:84, 4:80). No pathologically enlarged right\nhilar node is appreciated.\n\nHeart is normal size. There is no pericardial effusion. The aorta and main\npulmonary artery are of normal caliber.\n\nThere is interval development of numerous pleural-based nodules in the left\nlung, some larger from prior for example a row of nodules abutting the\nposterior pleura measuring up to 8 mm (4:65), previously 2 mm, most are new\nand measuring up to 1.2 cm (4:76).  Multiple new parenchymal nodules are also\npresent in the left lung for example 8 mm nodule in the left mid lung (4:92).\nA calcified nodule in the posterior right lower lobe is unchanged (4:47). \nLeft perihilar radiation changes and postsurgical changes are noted. Bilateral\nscattered pleural calcifications unchanged and should be correlated with a\nhistory of asbestos exposure. There is no pleural effusion. No pneumothorax.\n\nThere is a study is not optimized for evaluation of subdiaphragmatic\nstructures however, a 1.5 cm cyst in the right lobe of the liver is unchanged.\n\nNo lytic or sclerotic osseous lesion concerning for malignancy identified.",
            "output": "1. Marked progression of pleural and parenchymal metastatic disease in the\nleft lung.\n\n2.  Increased mediastinal lymphadenopathy."
        },
        {
            "input": "Postradiation changes are again demonstrated in the left juxta hilar and\nparamediastinal regions.  Pleural thickening in the lower left hemi thorax\nappears similar to the previous study, with associated persistent trace left\npleural effusion, loculated medially in the lower left hemi thorax.  The\npleural thickening appears slightly nodular in keeping with metastatic\ndisease. The the extent of pleural thickening is similar to a ___\nbut improved compared to the earlier CT of ___. Nodular thickening of\nthe fissure all surfaces in the left lung also appears similar. Calcified\npleural plaques are incidentally noted.\n\n\nA 4 mm nodule lateral to the post radiation changes in the left upper lobe\nposteriorly (99, 4) is unchanged. Linear scarring at the site of apparent\nwedge resection and left lower lobe appear similar to the prior study.\nIncidental calcified granuloma in right lower lobe is unchanged. Left hilar\nnodal tissue contiguous with post radiation changes appears similar to the ___ chest CT, and subcentimeter mediastinal lymph nodes also appear\nunchanged since that time.\n\nThe exam was not tailored to evaluate the subdiaphragmatic region, but nodular\nthickening of the left adrenal gland is again demonstrated and appears\nunchanged. Hepatic cyst is also unchanged.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1.  Similar CT appearance of left pleural metastatic disease compared to ___ chest CT.\n\n2.  Stable CT appearance of mediastinal lymph nodes and post treatment changes\nin left juxta hilar region."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes. The heart is normal in size and there is no\npericardial effusion. The aorta and main pulmonary artery are normal in\ncaliber.Including views of the upper abdomen demonstrate stable nodularity of\nleft adrenal gland without focal lesion.  1.6 cm hypodensity in hepatic\nsegment ___ which is unchanged, but not optimally evaluated on this study.\n\nLungs: The central airways are patent.  There is increased nodularity of the\npleural surface of the left lower lobe posteriorly (6:87).  Left infrahilar\nconsolidation is compatible with post radiation changes.  Nodules in the\nlingula and left lower lobe (6:155), are increased minimally since the prior\nstudy.  Nodularity at the left lung base (06:204) is similar. Small left\npleural effusion on lung the medial aspect is unchanged. Calcified granuloma\nat the right lung base is unchanged (6:186).\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1. Stable nodularity of the left adrenal gland without a focal lesion.\n2. Stable left infrahilar postradiation changes.\n3. Increased nodularity along the pleural surfaces of the left lung and within\nthe lingula and left lower lobe, concerning for disease progression."
        },
        {
            "input": "7 x 12 mm left supraclavicular lymph node, 04:28, was 7 by 11 mm in ___.  There are no right supraclavicular or axillary nodes.  There are no\nsoft tissue lesions in the imaged chest wall suspicious for malignancy.\nEvaluation of the breasts requires mammography. This study is not designed for\nsubdiaphragmatic diagnosis, particularly with respect to the liver, but shows\nthere is no adrenal mass, and a 14 x 15 mm fluid attenuation lesion in the\nliver, 4:200, was 14 x 17 mm in ___.\n\nThere are no for abnormalities in the thyroid suspicious for a nodule large\nenough to warrant evaluation with ultrasound.\n\nAtherosclerotic calcification and is not apparent. Aorta and pulmonary\narteries are normal size. Overall cardiac silhouette is top-normal and\nunchanged since at least ___.\n\nThe overall bulk of the postoperative left hilus, following radiation,\nparamediastinal and juxta hilar radiation fibrosis is unchanged since ___. Indentation of the anterior aspect of the lingula bronchus is unchanged.\nAlso stable is the volume of tissue at the resection site in the left lower\nlobe, 02:31- 33. Combination of pleural thickening and subpleural atelectasis\nalong the paraspinal and posterior costal pleural surface is also stable,\nhowever the 9 x 13 mm nodule along the diaphragmatic surface, 02:37, may have\nbeen 7 x 11 mm in ___.\n\nRight lung is clear.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.\nPeriosteal sclerosis in the left ribcage is probably radiation induced.",
            "output": "The only lesion in the chest suspicious for active malignancy is a pleural\nnodule along the left diaphragmatic surface. The bulky left hilar and\nparamediastinal radiation fibrosis has been essentially stable since at least\n___."
        },
        {
            "input": "The thyroid gland is unremarkable. A 10 x 14 mm right lower paratracheal lymph\nnode is stable (2, 21).  No supraclavicular, hilar or axillary lymphadenopathy\nis identified.\n\nThere is mild cardiomegaly with predominantly left atrial enlargement. There\nis no pericardial effusion. The main pulmonary artery and thoracic aorta are\nnormal caliber. No incidental pulmonary embolus is identified.\n\nSeveral pre-existing pleural and fissural nodules, most concentrated at the\nupper posterior aspect of the left lung, are similar in size and number as\ncompared to ___. A left apical pleural nodule is minimally larger\nmeasuring 6 x 7 mm, previously 5 x 6 mm (4, 49). A bilobed pleural nodule more\ninferiorly is stable measuring 6 x 19 mm, previously 6 x 19 mm (4, 74). A 4 x\n8 mm left upper lobe nodule previously measured 5 x 7 mm (4, 117). The\npostoperative appearance of the left lung and bronchial tree following left\nlower lobe segmentectomy is stable. Paramediastinal radiation fibrosis is also\nstable. There is no evidence of local recurrence or new metastasis. Partially\ncalcified pleural plaques suggest prior asbestos exposure.\n\nImages of the upper abdomen show a stable 15 mm right hepatic lobe cyst. The\nadrenal glands are normal.  There is increased mild thickening of the mid\nesophageal wall (2, 27). In addition, there is increased mild circumferential\nthickening of the partially imaged distal stomach/proximal duodenum (2, 59).\n\nLeft rib cage postsurgical defects are unchanged. No lytic or sclerotic bone\nlesions are identified.",
            "output": "Stable exam with little to no appreciable change in multiple left pleural and\nfissural nodules since ___. No new adrenal metastases.\n\nStable paramediastinal radiation fibrosis.\n\nPleural plaques suggest prior asbestos exposure.\n\nIncreased mid esophageal wall thickening suggests worsening esophagitis, which\nmay be due to radiation or infection.\n\nIncreased mild circumferential wall thickening of the partially imaged distal\nstomach/proximal duodenum may be inflammatory or infectious in etiology.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on ___\nat 12:36 into the Department of Radiology critical communications system for\ndirect communication to the referring provider."
        },
        {
            "input": "The thyroid is normal.\n\nA 6 mm subcarinal lymph node (series 3, image 25) is decreased from the prior\nexamination when it measured 9 mm.  There is no pathologic mediastinal, hilar\nor axillary lymphadenopathy by CT size criteria.  Multiple calcified hilar and\nmediastinal lymph nodes are stable.\n\nThe great vessels are normal caliber. The heart size is normal.  No\npericardial effusion.  There is moderate coronary artery calcification.\n\nMultiple left lung pleural and fissural nodules are similar in size and number\ncompared to ___.  A small left apical pleural nodule measures 6 x 5\nmm (previously 6 x 7 mm) (series 3, image 12).  The postoperative appearance\nof the left lung and bronchial tree following a left lower lobe segmentectomy\nis stable.  Paramediastinal radiation fibrosis is unchanged in appearance. \nThere is no evidence of local recurrence or metastasis.  Similar to the prior\nexam, partially calcified pleural plaques suggest prior asbestos for exposure.\nA 5 mm calcified granuloma in the right lower lobe is stable (series 3, image\n34.\n\nThough this examination is not designed for subdiaphragmatic evaluation.  A 16\nmm well-circumscribed hepatic cyst is stable from the prior exam.  Mildly\nincreased thickening of the midportion of the esophagus and the gastric antrum\nis decreased in extent from the prior examination.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Stable examination with no significant change in multiple left pleural and\nfissural nodules since ___.\n\nStable paramediastinal radiation fibrosis.\n\nMidesophageal wall thickening and gastric antral thickening is not\nsignificantly changed."
        },
        {
            "input": "Thyroid is unremarkable.  Thoracic aorta and main pulmonary artery are normal\nsize.  There is no coronary artery calcification.  Trace pericardial effusion\nis physiologic.  Few calcified lymph nodes are noted in the mediastinum and\nbilateral hila.  Supraclavicular, axillary, mediastinal, and hilar lymph nodes\nare not enlarged.  A 9 mm subcarinal node (02:27) is stable.\n\nAirway is patent to subsegmental levels.  There is no pleural effusion. Left\nperihilar post radiation changes are noted.\nA 16 x 12 mm solid pleural based nodule in the left lower lobe (5:155) is\nslightly larger (previously 16 x 11 mm).\nA 9 mm solid pleural based nodule in the superior segment of left lower lobe\n(5:118) is larger (previously 5 mm).\nA 9 mm left juxta hilar lesion (5:138) is larger (previously 7 mm).\nA 7 mm nodule in the left apex (5:72) is larger (previously 6 mm).\nA 4 mm solid nodule in the superior segment of left lower lobe (05: 92) is\nlarger (previously 3 mm).\nOther pulmonary and pleural based nodules in the left hemithorax are stable.\n(5:  64, 85, 105, 159, 163).  A calcified granuloma with surrounding solid\ncomponent in the right lower lobe is stable (5:195).\nMultiple calcified pleural plaques are noted.\n\nBONES/ SOFT TISSUE:  Left 9 rib has been partially resected.  Lower some\nlesion is identified.\n\nABDOMEN:  Study was not designed for subdiaphragmatic evaluation.  Limited\nassessment of upper abdominal organs is notable for a 60 mm hypodensity in the\nright lobe of the liver, stable.  Thickened distal esophageal wall is\nunchanged.  Bilateral adrenal glands are unremarkable.",
            "output": "Some of the multiple pulmonary and pleural-based nodules are larger while\nothers are stable.  There is 21% increase in the longest diameter of the three\nlargest lesions.  No new nodule is identified.\n\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 9:35 AM"
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  A prominent subcarinal lymph node\nmeasures 9 mm in short axis (03:26), and is unchanged.  Several partially\ncalcified lymph nodes are again seen within the mediastinum and right hilum.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Post radiation changes are again noted in the left\nhilum.  Partially calcified, pleural plaques or unchanged (for example,\n03:26).  Mild diffuse bronchial wall thickening likely reflects chronic\nairways disease.\n\nA subpleural left upper lobe nodule measures 6 mm (06:57), previously 6 mm.  A\nleft.  Ventral nodule measures 5 mm (6:83), previously 4 mm.  A left lower\nlobe subpleural nodule measures 1.1 cm (6:107), previously 0.9 cm.  A cluster\nof contiguous subpleural left lower lobe nodules measures 1.9 cm (6:94),\npreviously 1.7 cm.  A left juxta hilar lower lobe nodule measures 1.1 cm\n(6:128), previously 0.8 cm.  Multiple additional pulmonary nodules are\nidentified, all of which are stable or slightly increased in size as compared\nto the prior examination.  A calcified granuloma in the right lower lobe is\nunchanged.\n\nThere has been partial resection of the left ninth rib.  No suspicious osseous\nlesions are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrates a 1.8 cm right hepatic hypodensity (6:236), unchanged the prior\nexamination..",
            "output": "1.  Numerous pulmonary and pleural-based nodules have either remained stable\nor have slightly increased in size compared to the prior examination dated\n___.\n2.  Extensive left hilar post-radiation changes are essentially unchanged from\nprior examination."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter and unchanged.  Since the\nprior study there is interval increase in old pre-existing lesions, including\nleft upper lung part fissure all lesion, series 5, image 49, currently 7.8 x\n5.1 mm, series 5, image 53, 3.2 mm, series 5, image 57, 4 mm, series 5, image\n64, 5 x 3 mm, series 5, image 67, 8 x 6 mm, series 5, image 73, superior\nsegment of left lower lobe subpleural lesions, see re- is 5 image 73, 7.2 x\n4.4 mm, as well as larger conglomerate of lesions in the left lower lobe,\nseries 5, image 81.  Vast majority of these lesions most likely represent\npleural metastasis.\n\nLeft lower lobe lesion, series 5, image 141 is currently 11 x 8 mm, slightly\nincreased in size bile due to of 1 mm.  Supradiaphragmatic left lower lobe\nlesion, series 5, image 182 is 15 x 19 mm, enlarged.\n\nInterval increase in size is at the left axillary lesion, that is currently 17\nmm as compared to 9 mm.  The right lower paratracheal lymph node is calcified\nand unchanged.  Left lower lobe para-aortic conglomerate of soft tissue has\nnot substantially increased in size, 3 x 2.7 cm.\n\nImage portion of the upper abdomen demonstrate liver hypodensities, partially\nimaged, and appear to be unchanged in the prior study but dedicated\nexamination with targeting liver imaging is required by CT or at least\nultrasound.  Left adrenal thickening is unchanged.  Retroperitoneal lymph node\non the left, series 3, image 57 has increased in size, well from 7-9.6 mm.\n\nAirways are patent to the subsegmental level bilaterally.\n\nFissure all thickening and pleural calcifications are unchanged on the right.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval increase in size in pleural metastatic disease, axillary lymph node\non the left and pulmonary nodules as described.\n\nPlease see the body of the report for the measurements."
        },
        {
            "input": "The thoracic aorta is normal in caliber without evidence of dissection. \nFocal, scattered, noncalcified and calcified atherosclerosis is unchanged. \nThe main, left, and right pulmonary artery are normal in caliber without\nfilling defect to indicate a central pulmonary embolus.  The heart size is\nnormal.  No significant coronary artery are cardiac valve calcifications.  No\npericardial effusion.\n\nLeft axillary lymph nodes are pathologically enlarged with the largest node\nmeasuring up to 2.4 x 1.9 x 2.4 cm, increased from the prior exam (series\n601b, image 42; series 2, image 19).  Right axillary lymph nodes also remain\nenlarged but retain their normal fatty hila, unchanged.  Prominent left\nsupraclavicular lymph nodes are unchanged, measuring up to 6 mm (series 2,\nimage 80).  No right supraclavicular lymphadenopathy.  A 1.4 x 1-cm, partially\ncalcified right lower paratracheal node is overall unchanged (series 2, image\n25).  An 1.9 x 0.8-cm subcarinal node is also unchanged (series 2, image 29). \nPost-therapy appearance of the left hilum is overall unchanged.  Right hilar\nlymphadenopathy has increased (series 4, image 153).\n\n2-mm right upper and lower lobe micronodules are new (series 4, image 122,\n175).  Other right pulmonary nodules and micronodules are unchanged:  3-mm\nright upper lobe, 3.5-mm right upper lobe perivascular, 3-mm right lower lobe\nperifissural, 3-mm right upper lobe perifissural (series 4, image 108, 119,\n122).\n\nNodular pleural thickening in the left upper lobe has substantially increased\nsince ___ (e.g.  Series 4, image 68), consistent with biopsy-proven\nmetastatic involvement.  Similar, nodular pleural thickening in the left lower\nlobe persists and is overall unchanged.  Numerous left subpleural and central\npulmonary nodules persist, some of which have remained unchanged in size, and\nothers of which have increased in size: for example, a 4-mm and 7-mm left\nlower lobe nodule are unchanged (series 4, image 175, 133), a 2-mm left upper\nlobe micronodule and 4-mm left upper lobe nodules have grown (series 4, image\n82). Multiple left pulmonary micronodules are new, for example, a 3-mm\nmicronodule in the left upper lobe (series 4, image 94).\n\nThe thyroid gland is diffusely enlarged without evidence of a focal nodule,\nunchanged.  Mild, broad dextroconvex scoliosis of the thoracic spine is\nunchanged.  The lateral left seventh rib has been resected, unchanged.\nNo suspicious lytic or sclerotic osseous lesion.  Multilevel degenerative\nchanges in the visualized thoracic spine are unchanged.\n\nA 1.1 x 1 cm left para-aortic, a 0.8 x 0.7 cm left retrocrural, and an 1.3 x\n0.6 mm right retrocrural lymph node have all slightly increased in the interim\n(series 2, image 53, 54, 62).\n\nA 1.4 x 1.2 cm hypodensity in the right hepatic lobe is unchanged (series 2,\nimage 56).  Prominence of the extrahepatic duct is overall unchanged since ___ (series 601b, image 49).  Thickening of the left adrenal gland is overall\nunchanged (series 2, image 58; series 601b, image 60, 58).  The right adrenal\ngland is normal in configuration and size.",
            "output": "1.  Interval disease progression with increased pleural thickening in the left\nupper lobe, increase in size and number or left pulmonary nodules, increased\nleft axillary lymphadenopathy, right hilar lymphadenopathy, and retrocrural\nand retroperitoneal lymphadenopathy.\n\n2.  Stable mediastinal and left supraclavicular lymphadenopathy.\n\n3.  Stable appearance of the adrenal glands.\n\n4.  Unchanged right hepatic hypodensity."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, or infraclavicular\nadenopathy.  New moderately enlarged left axillary lymph node. Stable\nappearance of the large mediastinal vessels.  New small right pleural\neffusion.  Unchanged minimal left pleural effusion.  No adrenal abnormalities.\nStable cystic lesion in the liver.  The osteolytic lesion at the level of the\nleft lateral ribcage (2, 33) is stable.  The parenchymal consolidation in the\nleft lung has moderately decreased in size.  The left basal staple line (4,\n159 is better visualized than on the previous examination.  In particular the\nlower lobe is better ventilated than on the previous examination. Stable lymph\nnode calcifications on the right.  Right posterior calcified granuloma. \nSevere respiratory motion artifacts preclude analysis of more subtle details\nin the right lung.",
            "output": "Stable left lateral chest wall defect, decrease of the left perihilar and\nparamediastinal consolidation with improved ventilation of the left lung,\nnotably at the level of the lower lobe.  New right pleural effusion.  Massive\nrespiratory motion are defects.  No adrenal abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous. \nThere is no axillary or supraclavicular lymphadenopathy, and a previous 15 x\n10 mm left axillary lymph node now measures 13 x 6 mm (series 3: Image 15).\n\nUPPER ABDOMEN: There is a 15 mm hepatic cyst in the liver.  Otherwise, the\nvisualized upper abdomen is within normal limits.\n\nMEDIASTINUM: There is no pathologically enlarged mediastinal lymph node.  The\nesophagus is normal in caliber and course, and there is no hiatal hernia.\n\nHILA: There are surgical clips from prior left lower lobectomy.  The left\nhilum and paramedian left upper and lower lobe consolidation is unchanged in\nsize and morphology.  The left pleural thickening is also unchanged.\n\nHEART and PERICARDIUM: The heart is normal in size with a trace pericardial\neffusion, likely physiologic.  The thoracic aorta is normal in caliber and\ncourse with a mild amount of calcification along the ascending aorta and\ndescending thoracic aorta.  There is also\n\nPLEURA:  There is a trace right pleural effusion, decreased in size form ___. The left pleural thickening is stable in extent and size.\n\nLUNG:\n\n-PARENCHYMA:  The left upper lobe, lower lobe and hilar consolidation is\nunchanged in morphology and size.  There is a new 3 mm right upper lobe\npulmonary nodule (series 5:image 25).  Other previously seen pulmonary nodules\nare not well seen on this exam, and there are no enlarging pulmonary nodules.\n-AIRWAYS:  The airways are patent to the segmental level.\n-VESSELS:  The main pulmonary artery is normal in caliber at 2.5 cm, and there\nare no filling defects to suggest a pulmonary embolism\nCHEST CAGE:  The seventh posterior lateral left rib defect is stable, and\nthere is no adjacent nodularity to suggest disease recurrence (series 5:image\n125).  There are no new concerning osseous lesions.",
            "output": "1.  Stable appearance of the left paramediastinal and perihilar all post\ntreatment consolidation and left lateral chest wall defect.  No evidence of\nlocal tumor recurrence.\n2.  New 3 mm right upper lobe pulmonary nodule since ___.  No enlarging\npulmonary nodules or adenopathy.\n3.  Trace right pleural effusion."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland enhances\nhomogeneously.  Supraclavicular and axillary nodes are not pathologically\nenlarged by size criteria.\n\nUPPER ABDOMEN: A 15 mm hypodensity in segment 4A is likely a cyst (2:52).\n\nMEDIASTINUM: No new mediastinal lymphadenopathy.  Dominant right lower\nparatracheal node measures 9 mm, unchanged.\n\nHILA: No evidence of hilar adenopathy.  A majority of hilar nodes are\ncalcified.\n\nHEART and PERICARDIUM: Heart is normal in size, without a pericardial\neffusion.\nPLEURA: Trace right pleural effusion, new from ___.  No pleural\neffusion on the left.\nLUNG:\n\n1. PARENCHYMA:  Minimal biapical scarring is noted.  Posttreatment changes in\nthe left lower lobe are stable.  No new soft tissue nodularity to suggest\nrecurrence.  Multiple pulmonary nodules measuring up to 4mm are stable from\nthe prior study (series 4, images 48, 65, 76, 82, 107).  No new or growing\nnodules are identified.  Calcified granuloma incidentally noted in the right\nlower lobe.\n2. AIRWAYS:  Airways are patent.  Stable bronchial wall thickening, most\npronounced in the left lower lobe.\n3. VESSELS:  Thoracic aorta and pulmonary arteries are normal in caliber.\nCHEST CAGE:  No new suspicious lytic or sclerotic lesions are identified. \nStable post-surgical changes along the left ribcage.",
            "output": "1. Left lower lobe post-treatment changes, without evidence of recurrence.\n2. Stable pulmonary nodules, measuring up to 4mm.\n3. New right pleural effusion, trace."
        },
        {
            "input": "The thyroid gland enhances homogeneously.  Supraclavicular, axillary,\nmediastinal, and hilar lymph nodes are not enlarged.  Prominent 8 mm\npretracheal node containing calcification is stable (02:22).  Hilar lymph\nnodes are mostly calcified, compatible with prior granulomatous disease. \nSingle vascular clip at the left hilus reflect prior lymph node dissection. \nThe caliber of the aorta and main pulmonary vessels are normal. \nAtherosclerotic calcifications of the aortic arch are mild.  The heart is\nnormal in size.  There is no pericardial effusion.\n\nCentral airways are patent.  Of note, the trachea is mildly displaced to the\nleft by a tortuous innominate artery, a chronic finding.  Extensive post\nradiation consolidation in the left upper and lower lobes are again noted. \nHowever, there has been interval expansion of consolidation into the anterior\nand posterior segments of the left upper lobe (4:96).  No discrete mass is\nidentified.  Left lower lobe bronchiectasis and volume loss from prior wedge\nresection are unchanged.  The previously identified 4 mm nodule in the right\nupper lobe is more ground-glass in appearance on the current study.  3 mm\nnodule in the left upper lobe (4:124) is minimally increased.  Scattered other\nmillimetric pulmonary nodules are unchanged in size and appearance (04:54, 74,\n79, 100).  No new nodules.  Previous trace right pleural effusion has\nresolved.  Left pleural thickening is stable.\n\nThe study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate a 1.6 cm hypodense\nliver liver lesion, unchanged and likely a cyst.  The bilateral adrenal glands\nare unremarkable.  The esophagus appears patulous with wall thickening, a\nchronic finding and can could reflect post radiation changes.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  Degenerative\nchanges in the thoracic spine are mild.",
            "output": "New expansion of consolidation in the anterior and posterior segments of the\nleft upper lobe superimposed on extensive background post radiation changes. \nNo discrete mass is identified.  However, given that patient's last radiation\ntreatment was in ___, it would be unusual to have delayed onset of\norganized radiation pneumonia.  Therefore, these findings could represent\nacute pneumonia or progressive tumor infiltration.\n\nNOTIFICATION:  Findings entered into the critical results dashboard by Dr. ___\nat 13:00 on ___, to be communicated directly with the referring\nprovider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  The\nsupraclavicular and axillary lymph nodes are nonenlarged.  The trachea is\nagain noted to be displaced leftward by a tortuous innominate artery, a\nchronic finding.\n\nUPPER ABDOMEN:  1.6 x 1 cm segment 8 hepatic hypodensity is most consistent\nwith a cyst. The visualized solid organs are otherwise unremarkable. \nSpecifically, the adrenal glands are normal.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  No mediastinal mass.\n\nHILA: Single vascular clip at the left hilus reflects prior lymph node\ndissection without enlarged left hilar lymph nodes.  Calcified nonenlarged\nright hilar lymph nodes are unchanged dating back to ___ and\nconsistent with prior granulomatous disease.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion. \nThe aorta is normal in caliber.\n\nPLEURA:  Small to moderate non hemorrhagic right pleural effusion with\nassociated compressive atelectasis demonstrates a fluctuating appearance since\n___.  Trace left pleural effusion with chronic left pleural\nthickening is unchanged. No pleural calcifications.\n\nLUNG:\n\n-PARENCHYMA:  Slightly limited evaluation due to respiratory motion.  Status\npost left lower lobe wedge resection with associated volume loss,\nbronchiectasis, and chain sutures.  Again seen is extensive postradiation\nopacification with air bronchograms involving the left upper and lower lobes. \nIn comparison to prior examination there is subtle decreased opacification\nwith improved aeration involving the anterior segment of left upper lobe and\nsuperior segment of left lower lobe.  No discrete mass.  New 0.4 cm right\nupper lobe tubular opacity may represent distal mucoid impaction given\nimpacted bronchus proximal to opacity (04:103 - 107) Additional subcentimeter\npulmonary nodules are stable (4:  69, 90, 98, 112).  Right lower lobe\ncalcified granuloma is stable.\n-AIRWAYS:  Impacted distal right anterior segment bronchus (04:103).  The\nairways are otherwise patent to the subsegmental level.\n-VESSELS:  Pulmonary arteries are well opacified and patent to the\nsubsegmental level.  No filling defect to suggest pulmonary embolism.\nCHEST CAGE:  No focal lytic or blastic lesions worrisome for malignancy.  Mild\ndegenerative changes of the thoracolumbar spine with anterior osteophytes,\nendplate sclerosis and disc space narrowing.",
            "output": "1.  Partial improvement involving the anterior segment of left upper lobe and\nsuperior segment of left lower lobe opacity on a background of posttreatment\nchanges.  Findings are suggestive of partially resolved pneumonia in the\nappropriate clinical setting.  Continued CT surveillance recommended to ensure\nreturn to baseline appearance of ___\n2.  4 mm right upper lobe opacity may represent distal mucoid impaction given\nimpacted bronchus proximally.  Attention on follow-up is recommended.\n3.  Stable subcentimeter pulmonary nodules, unchanged from ___.\n4.  Small to moderate right pleural effusion demonstrates a fluctuating\nappearance without signs of edema.\n\nRECOMMENDATION(S):  Recommend 4 week follow-up chest CT to its assess for\nreturn of left upper lobe to its baseline appearance on the ___ CT\nchest.  If there is persistence of findings, a PET-CT should be considered to\nassess for malignancy arising within an area of postradiation change.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 12:12 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, but the adrenal\nglands are not enlarged.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is minimal in head neck vessels and not apparent\nin coronary arteries.  Aorta and pulmonary arteries are normal size.  Small\nloculated pericardial effusion above the left atrial appendage is unchanged. \nThere is no pericardial nodularity.  Small layering nonhemorrhagic right\npleural effusion is unchanged since at least ___.  There is no pleural\nnodularity.  Mild left posterior pleural thickening and adjacent radiation\nfibrosis, left lower lung are unchanged.\n\nMid and lower esophagus are patulous, distended with air, unchanged.\nPosttreatment infiltrative nodal tissue in the mediastinum at the carina and\nalong the right main bronchus is unchanged.  There are no discrete, enlarged\nlymph nodes.\n\n3 mm ground-glass right upper lobe nodule, 4:75 unchanged since ___\nis too small to warrant further imaging evaluation.  Bronchial wall thickening\nand micro nodularity in the right lung under small mucoid impaction in the\nmedial segment of the right middle lobe are manifestations of airway\ninflammation, present over the long term.\n\nDense consolidation, perihilar left upper lobe, superior segment left lower\nlobe are unchanged since at least ___.  Compared to ___,\nthere has been an increase in the bulk of this consolidation extending\nlaterally from the bifurcation of the superior division of the left upper lobe\nbronchus, 4:95.  Whether it is all radiation fibrosis and atelectasis or could\nalso ___ local tumor recurrence is best determined by FDG PET scanning. \nBronchial wall thickening, left lower lobe has improved since ___.  Site\nof wedge resection left lower lobe has a normal postoperative appearance. \nThere is no evidence of new malignancy or infection.\n\nThere are no compression or pathologic fractures and no destructive bone\nlesions in the chest cage.",
            "output": "Recent stability, severe radiation induced consolidation and atelectasis, left\nupper and lower lobes, follows an increase in the bulk of this consolidation\nbetween ___ and ___.\n\nGeneralized bronchiolar inflammation, right lung, stable.  Interval\nimprovement in inflammation chronic moderate bronchiectasis, left lower lobe,\nprobably radiation induced.\n\nRECOMMENDATION(S):  Consider FDG PET CT for detection of possible left\nperihilar tumor recurrence."
        },
        {
            "input": "There is mild paraseptal and centrilobular emphysema.  Bronchial wall\nthickening is again noted with peribronchiolar nodularity consistent with\nrespiratory bronchiolitis.  A right pleural effusion with adjacent atelectasis\nis increased compared to ___.  Postsurgical changes involving the\nleft lower lobe are similar in appearance.  There is again fibrosis in the\nperihilar left upper lobe and superior segment of the left lower lobe with\nbronchiectasis.  There is slight increased fullness of the consolidation at\nthe anterior margin at the level of the left pulmonary artery (5:104).  A\nsubpleural left lower lobe nodule is increased in size compared to ___, now measuring 9 x 11 mm (5:165, previously 6 x 7 mm).  A nodule along\nthe left pericardium is increased in size, now measuring 8 mm (5:136,\npreviously 6 mm).\n\nThe thyroid gland is unremarkable.  There is no axillary, supraclavicular,\nmediastinal, or hilar lymph node enlargement by CT size criteria.  Calcified\nhilar lymph nodes are noted bilaterally.  Heart is normal in size without\npericardial effusion or coronary artery calcification.  The great vessels are\nnormal in caliber and configuration.  There is unchanged mild thickening of\nthe mid-distal esophagus.\n\nThis exam is not optimized for evaluation of infra diaphragmatic structures. \nWithin these limitations, other than an unchanged hepatic hypodensity, the\nvisualized upper abdomen is unremarkable.  Of note, the adrenal glands are not\nimaged on this exam.\n\nThere is no focal lytic or sclerotic osseous lesion to suggest neoplasm or\ninfection.",
            "output": "Findings concerning for tumor progression as detailed above."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular lymphadenopathy.  A left axillary lymph node is enlarged\nmeasuring 14 mm and was non tightly imaged on the prior examination.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: An 8 mm partially calcified pretracheal lymph node is unchanged\nfrom prior examination.  The esophagus is patulous and contains retained\nsecretions.\n\nHEART and PERICARDIUM: The aorta is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is a small right low-density pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA:  The patient status post partial left lower lobe resection. \nLeft perihilar consolidation is unchanged in size and extent from most recent\nprior though when compared with a prior from ___ yr ago, is increased in bulk\nand given FDG avidity on recent PET CT, this consolidation is concerning for\nslow-growing tumor.  A left upper lobe pulmonary nodule (series 6, image 132)\nand is mildly increased in size (10 x 7 mm, previously 9 x 6 mm).  A 16 x 10\nmm subpleural left lower lobe pulmonary nodule (series 6, image 162) is mildly\nincreased in size (previously 13 x 7 mm).  Right perihilar and right lower\nlobe reticular and ground-glass opacity (series 6, image 123) is moderately\nincreased in comparison the prior examination.\n2. AIRWAYS:  There is diffuse mild bronchial thickening\n3. VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: No evidence of osseous malignancy.",
            "output": "1.  Left perihilar consolidation, increased in comparison to ___ year ago and\nenlarging pulmonary nodules are concerning for worsening disease.\n2.  New ground-glass opacity associated with bronchial wall thickening, most\nconspicuous at the right hilum, is likely infectious."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Mild aortic wall calcifications. Several normal\nsized calcified mediastinal lymph nodes are visualized.  Moderate right\nperihilar adenopathy.  A pre-existing right pleural effusion is unchanged in\nextent but is less homogeneous in appearance, suggesting the presence of\ncoagulated elements or solid implants.  The low-density left apical\nconsolidation is unchanged in size, several pre-existing nodules, for example\nin the left upper lobe (5, 126) are stable in size.  Mild scarring at the\nbases of the left lung has slightly increased, a pre-existing left lower lobe\nnodule has a stable diameter of 17 mm.  No change in appearance of the adrenal\nglands and bony structures.",
            "output": "Overall stable disease as compared to ___.  The pre-existing\npulmonary nodules are stable.  The perihilar left-sided consolidation is\nunchanged in size and morphology.  The moderate right pleural effusion is less\nhomogeneous than on the previous examination, raising the possibility of\npotential seeding.  Attention on further follow-up is recommended."
        },
        {
            "input": "Imaged portion of the thyroid gland enhances homogeneously.\n\nHeart size is normal, without a pericardial effusion.  Thoracic aorta is\nnormal in course and caliber without evidence for dissection or intramural\nhematoma.  Main pulmonary artery is normal in caliber.  Pulmonary arteries are\nwell opacified to the subsegmental levels, without evidence of pulmonary\nembolism.\n\nSurgical clips in the right axilla, consistent with prior lymph node\ndissection.  Axillary lymph nodes are not pathologically enlarged by CT size\ncriteria.  The largest on the right measures up to 7 mm.  Largest lymph node\non the left measures 1.1 cm (3:67), but contains normal a fatty hilum.  No\nmediastinal or hilar lymphadenopathy by CT size criteria.  Esophagus is\ngrossly unremarkable in appearance, largely collapsed along its course.\n\nAirways are patent to the subsegmental levels.  Background centrilobular\nemphysema is mild.  No concerning pulmonary nodules or other parenchymal\nopacity.  Streaky areas of atelectasis are noted at the lung bases and\nlingula. No pleural effusion or pneumothorax.\n\nImaged upper abdominal structures are unremarkable.\n\nEvaluation of the chest wall reveals a relative paucity of breast parenchymal\ntissue on the right compared to the left, suggestive of prior right\nmastectomy.  A 1.5 x 1.1 cm circumscribed fat containing lesion in the right\nupper chest wall superficial to the pectoralis major muscle (03:58) likely\nrepresents fat necrosis.\n\nNo acute fracture.  No lytic or sclerotic lesion concerning for malignancy is\nidentified.",
            "output": "1. No evidence of aortic dissection or pulmonary embolism.\n2. Mild centrilobular emphysema."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Common origin of\nthe left common carotid and brachiocephalic trunk is a normal aortic arch\nvariant.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy by size\ncriteria although several mediastinal lymph nodes are prominent and measurable\nup to 9 mm short axis.  The thyroid gland appears unremarkable.\n\nNo evidence of pericardial effusion.  No pleural effusion.\n\nBilateral linear atelectasis and/or scarring is mild.  Mucosal thickening of\nthe bronchi in the lower lobes is mild with focal mucous plugging.  No\nconcerning pulmonary lesions.  The airways are patent to the subsegmental\nlevel.\n\nThis exam is not dedicated for imaging of the upper abdomen.  Within this\nlimitation: Multiple subcentimeter hepatic hypodensities are incompletely\ncharacterized on this nondedicated exam.  A hiatal hernia is small.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Multiple hepatic hypodensities, incompletely evaluated, too small to\ncharacterize.\n3.  Small hiatal hernia.\n4.  Mild peribronchiolar wall thickening with some mucous plugging."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Please note the lung apices were not completely imaged on this\nexamination.  Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "There are no enlarged supraclavicular or axillary nodes.  Excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the imaged chest wall suspicious for malignancy.  This study\nis not appropriate for subdiaphragmatic diagnosis, particularly regarding the\nliver, but shows normal size adrenal glands.\n\n\nThyroid is unremarkable.  Atherosclerotic calcification is mild in head neck\narteries, present in at least left main, left anterior descending coronary\narteries.  Aorta is normal size.  Right pulmonary artery is enlarged, 31 mm. \nAlthough this study is not designed for assessment of the pulmonary\ncirculation, there are no central filling defects.  Left atrium is enlarged,\nbest evaluated by dedicated cardiac imaging.  There is no aortic valvular\ncalcification.\n\nThere is no central adenopathy.\n\nPericardium and pleura are normal.\n\nMulti focal bronchial wall thickening is mild.\n\nFocal pulmonary abnormalities are as follows:\n\nTiny focus of the peribronchial ground-glass opacification, periphery of the\nleft upper lobe, 5:78.\n\n2 mm subpleural nodule, left lower lobe, 5:187.\n\n2 punctate right apical nodules, 05:51.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic metastases.\n\nCoronary atherosclerosis.\n\nEnlarged right pulmonary artery and enlarged left atrium should be evaluated\nwith dedicated cardiac imaging.\n\nMild bronchial inflammation.\n\nRECOMMENDATION(S):  Echocardiography, unless cardiac status is known."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is top normal.\nAtherosclerotic calcifications are seen within the thoracic aorta and coronary\narteries.  There is no pericardial effusion.\n\nThere is no evidence of pleural effusion or pneumothorax. The airways are\npatent to subsegmental levels.\n\nWithin the lungs, there is a region of atelectasis and probable scarring\nwithin the lingula (6:139), similar in size and morphology as compared to\n___. Within the right upper lobe, there is a new, 1.2 x 1.0 cm\nsolid pulmonary nodule (6:91).\n\nOSSEOUS STRUCTURES:  There are no destructive focal osseous lesions concerning\nfor malignancy identified within the imaged thoracic skeleton.  There is\ndiffuse idiopathic skeletal hyperplasia seen within the anterior thoracic\nspine.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. For further details, please see the concomitant dedicated CT\nabdomen and pelvis.",
            "output": "Interval development of a 1.2 x 1.0 cm solid pulmonary nodule within the right\nupper lobe, concerning for metastatic disease.  Recommend PET-CT or CT-guide\nbiopsy for further evaluation."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy. The aorta and pulmonary\narteries are normal in size. There is atherosclerotic calcification of the\ncoronary arteries. The heart size is normal and there is no pericardial\neffusion. There is calcification of the inferior aspect of the mitral annulus.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS: The airways are patent. There is no airspace consolidation. There is no\ndiffuse interstitial abnormality.  There is persistent lingular atelectasis or\nscarring likely resulting from prior pulmonary or pleural insult. The 1.2 x\n1.0 cm pulmonary nodule in the right upper lobe seen on the prior study has\nnow enlarged to 2.4 x 2.2 cm (5:74). A 4 mm ground-glass nodule in the right\nupper lobe is unchanged from the baseline study (5:54).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN: This study is not tailored to evaluate the abdomen.  The spleen\nis unusual in morphology but top-normal in size, with homogeneous attenuation.\nStable cholelithiasis is noted.",
            "output": "1. The right upper lobe pulmonary nodule, new on the prior study, has markedly\nenlarged, which is highly concerning for malignancy. Given the rapidity of\nenlargement without other manifestations of thoracic metastatic disease, an\naggressive primary lung malignancy should be considered as well as a solitary\nmetastasis.\n2. Cholelithiasis.\n3. Unusual splenic morphology but no splenomegaly or focal abnormality within\non this limited evaluation."
        },
        {
            "input": "Substantial progression of the metastatic bulk in the chest is demonstrated as\ncompared to ___ with no substantial change as compared to ___.  Since ___ it has been as stent placement in the right main\nbronchus with partial opening of the right main bronchus and right lower lobe\nbronchus.  Right upper lobe bronchus remains entirely excluded as well as the\nright middle lobe.  In fact a right middle lobe appears to be more occluded\ncurrently than on the previous study.\n\n\nMultiple new large likely necrotic metastatic lymph nodes/metastases in the\nanterior mediastinum in the prevascular space and extending along the right\nheart border with mild adjacent mass effect on the right atrium, as well as\nexpanding the site of prior right upper lobectomy. Right hilar masses\nsignificantly narrow the distal right main pulmonary artery (series 5, image\n24). The largest single mass measures 6.0 x 5.1 cm in axial ___ (series\n5, image 13), however conglomerate masses more superiorly are larger in\nconcert.\n\nPreviously described nodularity along the posterior right pleural margin has\nprogressed to large likely necrotic paravertebral nodal metastasis/metastasis\n(series 5, image 37). Multiple adjacent right lower lobe posterior subpleural\nnodules are also new, measuring up to 9 mm (series 5 image 29).\nA peripheral subpleural left upper lobe soft tissue nodule measuring 6 mm is\nnew since ___ (series 5, image 17).\n\nAssessment of the image portion of the skeleton re- demonstrate comminuted\nfracture of the right humerus.  No definitive lytic lesions in the thoracic\nspine have been demonstrated.",
            "output": "Extensive progression of the metastatic disease as described.  Occlusion of\nthe right upper lobe bronchus despite the presence of the new right main stem\nbronchus stent that remains patent but with still occluded right middle lobe. \nExtensive pressure/ potentially invasion of the right atrium and attenuation\nof the right main pulmonary artery and right lower lobe in right upper lobe\npulmonary arteries.  Occlusion of the right superior pulmonary vein.\n\nPotential invasion of the anterior chest wall.\n\nImage portion of the upper abdomen will be discussed and reviewed separately."
        },
        {
            "input": "MEDIASTINUM/HEART:  The included thyroid is normal.  Please see below for\ndiscussion of mediastinal lymph nodes.  Aorta and pulmonary arteries are\nnormal in size.  Coronary artery calcifications are most pronounced in the RCA\nand LAD.  Without the administration of IV contrast, invasion of the\npericardium by the known multiple metastases is difficult to evaluate.  It is\nalso difficult to evaluate the degree of mass effect on the right atrium and\npulmonary arteries.\n\nLUNGS/AIRWAYS:  Compared to the prior study, the right main stem bronchus\nstent appears patent, and there is improved aeration of the upper right lung. \nMultiple large metastatic lymph nodes and metastases in the anterior\nmediastinum prevascular space extending along the right heart border appear\nsimilar in size.  Similarly, nodularity along the right posterior pleural\nmargin appear grossly unchanged.  Previously described new left apical\nsubpleural nodule has enlarged, now measuring 11 mm compared with 6 mm\npreviously (5:77).\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures.  Within these limitations, the visualized portions of the liver,\nspleen, pancreas, and right adrenal gland are unremarkable.  Right pleural\nlesions abutting the liver capsule are again seen.  Previously described left\nadrenal gland nodule measuring 1.5 x 1.2 cm is grossly unchanged in size, now\nmeasuring 1.4 x 1.2 cm (5:250).\n\nSOFT TISSUES/BONES: Multiple anterior thoracic spinal bridging osteophytes are\nunchanged.  No new lytic or blastic lesion identified.",
            "output": "1.  Compared with the CT of ___, the right main stem bronchus stent is \npatent, with improved aeration of the upper right lung.\n\n2.  No change in multiple large metastatic lymph nodes and metastases in the\nanterior mediastinum and along the right posterior pleura.\n\n3.  Left apical subpleural nodule has enlarged, now measuring 11 mm compared\nwith 6 mm previously.\n\n4.  Without the administration of IV contrast, it is difficult to evaluate the\ndegree of pericardial invasion and mass effect of the malignancy on the right\natrium and pulmonary arteries.\n\nNOTIFICATION:  The above findings were entered by Dr. ___ the\n___ Imaging Findings Dashboard for communication to the ordering\nclinician at 12:04 on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.\nTiny punctate calcification in the left lobe of the thyroid, unchanged.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Pneumobilia is new in comparison to ___ where\nsevere biliary duct dilatation was demonstrated.\nNo focal lesions demonstrated in the liver or partially imaged pancreas and\nremaining included upper abdominal organs.\nSmall sliding hiatal hernia.\n\nMEDIASTINUM: The esophagus is patulous, otherwise unremarkable.\nLeft hilus 1.7 x 0.9 cm lymph nodes is larger in comparison to ___.\nSeveral sub cm lymph nodes in the mediastinum, not pathologically enlarged,\nfor example 0.7 cm sub carinal lymph node.\n\nHEART and PERICARDIUM: There is no cardiomegaly.  No pleural effusion.\nSevere atherosclerotic calcifications in the coronaries and aortic arch\nextending into the origin of the great vessels.\nMain pulmonary artery is within normal size and there is no evidence of\ncentral pulmonary emboli.\n\nLUNG and PLEURA: Mild diffuse airway wall thickening and scattered areas of\nmucous plugging suggesting chronic airway disease is associated with moderate\nto severe centrilobular emphysema affecting predominantly the upper lobes.\n\nSmall right and minimal left pleural effusion with subsequent atelectasis of\nthe lower lobes is new in comparison to ___.\nPreviously reported left lower lobe consolidation has resolved.\nTriangular consolidation of the lingula is unchanged since ___ and\nrepresents subsegmental atelectasis or scar.\nRight perifissural triangular and right upper lobe micro nodules unchanged\n(5:193, 73).\nNo new worrisome nodules or masses.\n\nCHEST CAGE: no evidence of destructive lytic or sclerotic bone lesions.\nMultilevel degenerative changes with increased kyphosis.",
            "output": "-Left hilus 1.7 x 0.9 cm lymph node is larger in comparison to prior,\notherwise no evidence of active intrathoracic malignancy.\n-New bilateral small pleural effusions, right greater the left.\n-Chronic airway disease on a background of moderate to severe emphysema.\n\nRECOMMENDATION(S):  3 month follow-up is recommended."
        },
        {
            "input": "CHEST PERIMETER: Right thyroid lobe is slightly larger than left.  There are\nno thyroid findings warranting further imaging evaluation.  Supraclavicular\nand axillary lymph nodes are not enlarged.  Specifically excluding the breasts\nwhich require mammography for evaluation, there are no soft tissue\nabnormalities in the imaged chest wall concerning for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mild circumferential wall thickening of the lower esophagus\nabove a small hiatus hernia, and mild dilatation of the mid and upper\nesophagus are unchanged.  There is no associated mass or evidence for\nobstruction.\n\nAtherosclerotic calcification is mild to moderate in head and neck vessels,\nthroughout normal caliber thoracic aorta, and involving at least left anterior\ndescending, circumflex, and right coronary arteries.  Aortic valve is not\ncalcified.  Pulmonary arteries are normal caliber.  Cardiac assessment would\nrequire echocardiography.  Pericardium is physiologic.\n\n\n\nTHORACIC LYMPH NODES: Previous borderline enlargement, left hilar lymph node\nhas resolved.  No lymph nodes in the chest are pathologically enlarged\nincluding retrocrural and diaphragmatic and posterior mediastinal stations.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nEmphysema is severe.  Bronchial wall thickening and retention of secretions in\nthe right lower lung is more pronounced today but there is no consolidation or\natelectasis.\n\nThere are no lung nodules.  Pleural surfaces are normal.\n\n\n\nCHEST CAGE: Unremarkable",
            "output": "No evidence of intrathoracic malignancy previous left hilar adenopathy has\nresolved.\n\nSevere emphysema.  Progressive bronchial inflammation and retained secretion,\nright lower lobe.\n\nCoronary atherosclerosis."
        },
        {
            "input": "CHEST:\nAt the level of the right pulmonary artery, the ascending aorta measures 4.8\ncm and the descending aorta measures 4.2 cm. Cardiomegaly is moderate.  There\nis no mediastinal hematoma.  There is no pericardial effusion. Mediastinal\nadenopathy, measuring 1.6 cm in the aortopulmonary window and a 1.5 cm\nprecarinal node, are similar to prior.  The imaged thyroid is normal. \nCoronary artery calcifications are seen.\n\nDiffuse ground-glass opacity and interlobular septal thickening may represent\npulmonary edema.  The lungs are otherwise clear without worrisome nodule,\nmass, or consolidation.  Airways are patent to the subsegmental level.  There\nis no evidence of contusion or laceration.  There is no pneumothorax or\npleural effusion.\n\nABDOMEN:\nThe liver is intact without focal lesion.  Cholelithiasis is seen without\nevidence of cholecystitis.  The spleen is intact and normal in size.  The\npancreas and adrenals are unremarkable.  Right kidney is atrophic.  Left\nkidney hypodensity is incompletely characterized. Diverticulosis without\ndiverticulitis.\n\nAortic aneurysm measures 4.6 cm in the upper abdomen and 3.8 cm infrarenal. \nRight iliac artery measures 2.2 cm and the left iliac artery measures 2.1 cm.\nIVC filter is seen. Clips in the right groin, potentially from right lower\nextremity bypass. Small to moderate ascites is seen around the liver, spleen,\nand paracolic gutters into the pelvis. No lymphadenopathy or free air.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.    \nThe bladder is unremarkable.  There is no pelvic free fluid.\n\nBONES:  There is no acute fracture.  No focal suspicious osseous abnormality.\nDegenerative changes are seen in the spine.",
            "output": "1. Thoracoabdominal aortic aneurysm is not significantly changed since ___.\n2. Cardiomegaly and mild pulmonary edema.\n3. Ascites.\n4. Mediastinal adenopathy, unchanged from ___.\n5. Otherwise unremarkable noncontrast CT of the chest/abdomen/pelvis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.\n\nAtherosclerotic calcification in head and neck vessels is mottled, but\nextensive in the coronary arteries.  There is no pleural or pericardial\neffusion.  Isolated calcified right pleural plaque is the only pleural\nabnormality.  Aortic valve is not calcified.  Ascending aorta is top-normal\nsize.  Athero mild and atherosclerotic calcification is moderately heavy in\nthe aortic arch and increases in the descending thoracic aorta, with probable\nnew plaque ulceration, just above the diaphragm, 6:220, but no evidence of\npenetration or periaortic bleeding.  Mild fusiform dilatation of the\nincompletely imaged upper abdominal aorta is unchanged in size, 28 mm, 6:298,\nsince ___.\n\n13 x 20 mm mediastinal lymph node in the prevascular station at the level of\nthe aortopulmonic window was 10 x 19 mm previously.  No other lymph nodes are\npathologically enlarged in the mediastinum, hila, paraesophageal or\ndiaphragmatic stations.\n\nAside from 2 calcified granulomas, right lung is clear of focal abnormality. \nLeft lung is clear.  There are no bone lesions in the chest cage suspicious\nfor malignancy.",
            "output": "No good evidence for intrathoracic malignancy.  Slight interval growth in\nsolitary enlarged central lymph node is unlikely to be pathologic.\n\nSevere atherosclerosis, including coronary arteries, and heavy plaque\nformation particularly descending thoracic aorta with new ulceration.\n\nPossible asbestos related pleural plaque.\n\nMild enlargement incompletely imaged upper abdominal aorta.  Consider\nultrasound for evaluation and monitoring.\n\n\nRECOMMENDATION(S):\nConsider abdominal ultrasound for aortic evaluation and monitoring."
        },
        {
            "input": "NECK AND THORACIC INLET: The thyroid is normal.\n\nAXILLAE, CHEST WALL, AND BONES:  There is no axillary lymphadenopathy.  The\nsoft tissues of the chest wall and bones normal.\n\nMEDIASTINUM: There is a pathologically enlarged, 17x10 mm lymph node (series\n6, Image 107), seen in the aorto-pulmonic window, and which will need 3 month\nCT chest follow-up.  Otherwise, there are scattered non-pathologically\nenlarged lymph nodes seen throughout the mediastinum.\n\nHILA: The bilateral hila are normal.  There are no pathologically enlarged\nhilar lymph nodes.\n\nHEART: The heart is normal in size. There is no pericardial effusion.  There\nare coronary calcifications, most prominently involving the left main and LAD.\n\nThe ascending aorta is top normal in size. There is substantial\natherosclerotic disease of the thoracic aorta and aortic arch with multiple\nmixed plaques.  Most prominently, there is a plaque in the descending aorta\nwhich is substantial and has areas of ulceration (series 5, image 45).\n\nLUNG:\n\n-PARENCHYMA:  There are 2 circular calcified right lower lobe subpleural\nnodules likely representing calcified granulomatous, seen on series 6, image\n185 and series 6, image 198, respectively.  There is also a small calcified\nsubpleural nodule seen involving the minor fissure (series 6, image 137).\nThere is another small calcified nodule involving the right major fissure at\nthe level of the bifurcation of the main pulmonary artery (series 6, image\n130). These likely are old calcified granulomas. Otherwise the lungs are\nclear.\n-AIRWAYS:  The airways are patent to subsegmental levels.\n-VESSELS:  No evidence of pulmonary embolus or other vessel abnormality.\nPLEURA: There is a calcified pleural plaque overlying the anterior right upper\nlobe (series 6, image 141).  Otherwise there is no pleural abnormality and no\npleural effusions.",
            "output": "1.  Pathologically enlarged 17x10mm mediastinal lymph node.  Will require\n3-month repeat CT chest for followup.\n2.  Significant coronary calcifications, mainly involving the LAD and left\nmain.\n3.  Significant atherosclerotic disease of the thoracic aorta, including a\nlarge mixed plaque involving the descending thoracic aorta with areas of\nulceration.\n4.  Multiple small calcified nodules throughout the right and left lungs,\nlikely old calcified granulomas.\n\nRepeat CT chest in 3 months for follow-up of solitary mediastinal\nlymphadenopathy.\nRECOMMENDATION:  Repeat CT chest in 3 months for follow-up of solitary\nmediastinal lymphadenopathy."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows there is no\nadrenal mass.  Low attenuation of the liver is diagnostic of hepatic\nsteatosis.  Drainage catheter noted in the left renal pelvis.\n\nThyroid is unremarkable.  Atherosclerosis is not apparent in the head and neck\nvessels.  Aorta and central pulmonary arteries are normal size.  Heart is not\nenlarged.  There is no pericardial or pleural effusion.\n\nHilar and mediastinal lymph nodes are normal size.  There is no thymic\nenlargement or mass.  Lymph nodes in the internal mammary, diaphragmatic, or\nretro crural stations are not enlarged.  Lungs are clear and the\ntracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Normal chest CT.  No thymic abnormality.\n\nHepatic steatosis.  Left ureteropelvic drainage tube in place."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is top normal.  Pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:\n\nThere is diffuse bronchial wall thickening, most severe in the bilateral lower\nlobes.  There is evidence of mucous trapping in the bronchi in the right lower\nlobe.  There are areas of atelectasis in the right lower lobe.  There are 2\nsubpleural nodules in the right lower lobe measuring 6 and 7 mm (series 2: 78\nand 83) There are two  3 mm nodule in the right upper lobe (series 3:59 and\n92) .  A perifissural nodule along the left major fissure (3:130) likely\nrepresents intraparenchymal lymph node.  There is no consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The liver demonstrates low attenuation compatible with hepatic\nsteatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bronchial wall thickening with evidence of mucous impaction and atelectasis\nin the right lower lobe.  Given the reported clinical history, these findings\nmay be compatible with asthma exacerbation\n3. There are 2 subpleural nodules in the right lower lobe measuring 6 and 7 mm\nrespectively.  Given the absence of any prior comparison study, chest CT in 3\nmonths is recommended."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild bibasilar atelectasis.  Otherwise, lungs are clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low-attenuation attenuation\nthroughout compatible with hepatic steatosis, with focal areas of fat sparing\nsurrounding the porta hepatis.\nThere is no evidence of focal lesion or laceration.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  There is no evidence of mesenteric injury,\nor free air within the mesentery/peritoneal cavity.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The rep prostate and seminal vesicles appear normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: Comminuted left intertrochanteric fracture with moderately displaced\nfragments.  There is also a partially imaged oblique fracture of the proximal\nleft femur.  Nondisplaced fracture of the medial right acetabulum at the base\nof right superior pubic ramus (3:225).  There is also a minimally displaced\nfracture of the inferior right pubic ramus (3:244).\n\nSOFT TISSUES: A moderate sized hematoma is seen surrounding the left\nintertrochanteric fracture.",
            "output": "1.  Comminuted left intertrochanteric fracture with moderately displaced\nfragments.\n2.  Partially imaged oblique fracture of the proximal left femur.\n3.  Fractures at the superior and inferior right pubic rami, inferior mildly\ndisplaced.\n4.  No solid organ injury in the thorax, abdomen or pelvis; no large hematomas\nin the chest, abdomen or pelvis; moderate-sized hematoma surrounding the left\nfemoral fractures; no active extravasation-within limitations of the single\ncontrast-enhanced exam.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:00 am, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  In the aorta and pulmonary artery\nare of normal caliber.  The heart and pericardium are unremarkable and there\nis no pericardial effusion.  Minimal coronary artery calcifications are\npresent. Patient's known esophageal cancer is not clearly identified but there\nis mild thickening of the distal esophagus.  There is no paraesophageal\nlymphadenopathy.\n\nThere is no focal consolidation, pleural effusion or pneumothorax.  A 7 mm\nright apical nodule is present.  There is a calcified granuloma within the\nright upper lobe (series 7, image 41).  The airways are patent to the\nsubsegmental levels\n\nThis study is not tailored for evaluation of subdiaphragmatic structures\nplease see the dedicated abdomen CT report for further details regarding\nintra-abdominal findings.\n\nThere is a 6 mm sclerotic lesion in T8 vertebral body which may represent a\nbone island.  No  osseous lesions worrisome for malignancy are identified.",
            "output": "1. 7 mm nodule in the right apex.  Although this is in the location that there\nis typically scaring, it does appear to be a solitary nodule.  Given the\nhistory of newly diagnosed malignancy, recommend follow-up with chest CT in 3\nmonths.\n2. Mild thickening of the distal esophagus.\n3. 6 mm sclerotic lesion in T8 vertebral body likely represents a bone island."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen and\npelvis CT report dictated under clip ___\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nHeart, pericardium and great vessels are within normal limits. No hiatal\nhernia is present.\n\nThere is linear atelectasis in left lower lobe and lingula. There is a 2 mm\nright upper lobe perifissural nodule (301:121) and an 8 mm ground-glass\nopacity in the left upper lobe (301:71). No pleural effusion or pneumothorax\nis present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.  Postsurgical changes related to recent upper thoracic laminectomies\ndecompression and resection are noted. Minimal anterior compression deformity\nof T6 is noted, unchanged from recent MRI.",
            "output": "1. No definite evidence of metastatic disease to the chest.\n2. Small nodules as described above are nonspecific and have a low likelihood\nof malignancy. If the lesion in the spine is not malignant, no followup is\nrequired.  If patient has malignancy recommend followup in 6 months.\n3. Postsurgical changes of the upper thoracic spine."
        },
        {
            "input": "CHEST PERIMETER: No thyroid lesions warrant further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged there are no soft\ntissue abnormalities in the imaged chest wall concerning for malignancy. \nFindings below the diaphragm will be reported separately.  Right posterior\ndiaphragmatic hernia, transmits only subphrenic fat.\n\nCARDIO-MEDIASTINUM:Small hiatus hernia is unchanged.  Also stable are several\nareas where the esophagus is patulous in distended with air but there is no\nassociated mass or good evidence for obstruction.\n\nAtherosclerotic calcification is not apparent in head and neck vessels and is\nmild in at least left anterior descending coronary artery.  Aortic valvular\ncalcification is minimal.  Aorta and pulmonary arteries and cardiac chambers\nare normal size.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Minimal nodular thickening left major fissure, 3:100,\nshould not be mistaken for a lung nodule.\n\n2-3 mm nodule, right middle lobe, 3:141 was present in ___.\n\n3 mm triangular nodule, left upper lobe, 3:115, also stable.\n\n3 x 4 mm perifissural nodule, right upper lobe, 3:116, also stable.\n\nTracheobronchial tree is normal to subsegmental levels.  There is no pleural\nabnormality.\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Handful of indeterminate tiny lung nodules stable since ___.  No new\nor growing lung nodules.  No evidence in other respects of active\nintrathoracic malignancy.\n\nRECOMMENDATION(S):  The need for followup imaging depends on staging and\nmanagement considerations regarding the patient's extrathoracic malignancy. \nOtherwise ___ guidelines for detection of pulmonary nodules would\napply.  See Recommendations below.\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland enhances\nhomogeneously.  There is no supraclavicular or axillary adenopathy.  Chest\nwall is unremarkable.\n\nUPPER ABDOMEN: Please refer to the separate dictation under clip ___ for\ndetails on subdiaphragmatic findings.  Small hiatal hernia is present.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged by size criteria.  Mild\ndiffuse esophageal wall thickening is most pronounced in the mid and distal\nesophagus.\n\nHILA: Bilateral hilar nodes, 9 mm on the right, and 5 mm on the left, are\nstable.\n\nHEART and PERICARDIUM: Heart size is normal, without a pericardial effusion.\nPLEURA: Pleural surfaces are smooth.  There is no effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the parenchyma is notable for mild biapical\npleuroparenchymal scarring.  Several bilateral nodules measuring 3 mm in the\nright apex (6:61), 4 mm right upper lobe perifissural nodule (6:143), 3 mm in\nthe middle lobe (6:175), 3 mm in the left upper lobe (6:138) are all stable\nfrom the earliest available study performed on ___.  No new or\ngrowing nodules are identified.\n2. AIRWAYS:  Airways are patent to the subsegmental bronchi.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are normal in caliber.\nCHEST CAGE: No suspicious lytic or sclerotic lesions are identified.",
            "output": "1. Four nodules measuring 3-4 mm each, all stable from ___.  No new\nor growing nodules.\n2. Stable esophageal wall thickening, which can be seen in the setting of\nreflux/esophagitis.  Clinical correlation is recommended."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  A small left\naxillary lymph nodes is unchanged\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is mild coronary artery\ncalcification.  There is a small hiatus hernia.  The aorta and pulmonary\narteries are normal in caliber the\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Stable 2 mm right upper lobe pulmonary nodule (5, 85).  Stable 3 mm left\nupper lobe pulmonary nodule (5, 158).  Stable 2 mm perifissural nodule (5,\n162) in the right middle lobe .\n\nStable 2 mm right middle lobe pulmonary nodule (5, 202).  No nodules or\nconsolidations are seen\n\nBONES AND CHEST WALL : Review of bones is unremarkable.  There are\ndegenerative changes involving the thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "Stable tiny 2-3 mm pulmonary nodules.  No new pulmonary nodules.\n\nContinued follow-up in view of history of malignancy is recommended."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal.  There\nis no pericardial or pleural effusion.\n\nLeft axillary lymph nodes are stable, series 2, image 26, 22.  No mediastinal,\nhilar, supraclavicular or axillary lymphadenopathy is present.  There is no\nchange in the small hiatal hernia.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules are stable, sub 6 mm, series 3, image 115, 35.  No new\nnodules masses or consolidations demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic disease\nprogression."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion. \nMinimal coronary calcification.  Thoracic aorta is normal in caliber.  Mild\naortic atherosclerotic calcification.  The main pulmonary artery is normal in\ncaliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Scattered areas of subtle ground-glass opacity correspond to\nareas of previously seen pulmonary nodules related to known vasculitis, likely\nresidual scarring.  A tiny left upper lobe micronodule is unchanged since ___.  A punctate left lower lobe micro nodules unchanged since ___.  No\nnew or enlarging pulmonary nodules.  Mild bronchial wall thickening with a\nfocus of subsegmental mucous impaction in the right lower lobe (series 4,\nimage 174), reflecting bronchial inflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild thoracic spine osteoarthritis.",
            "output": "1. No new or enlarging pulmonary nodules.  Subtle ground-glass opacities\ncorrespond to residual scarring from vasculitic nodules seen on the ___\nCT.\n2. Small airway inflammation."
        },
        {
            "input": "The pre described heterogeneous left-sided thyroid nodule (2, 7) is stable. \nNo supraclavicular, infraclavicular or axillary lymphadenopathy.  All visible\nlymph nodes in the mediastinum (2, 18 and 25) are stable.  A pre-existing\nright hilar lymph node is unchanged borderline in size and has not grown.  No\ncardiac abnormalities.  Normal appearance of the posterior mediastinum.  The\nupper abdomen is reported in detail in the dedicated abdominal CT report,\nincluding a left kidney cyst.  No osteolytic lesions at the level of the ribs,\nthe sternum, and the vertebral bodies.  Mild degenerative vertebral disease. \nNo vertebral compression fractures.  Moderate panlobular pulmonary emphysema. \nMild chronic airways disease.  No pleural thickening, no pleural effusions. \nNo suspicious lung nodules or masses.",
            "output": "Stable left thyroid nodule.  Stable borderline sized right hilar lymph node. \nNo suspicious pulmonary nodules or masses.  No pleural abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  The thoracic aorta and main\npulmonary artery are normal in caliber.  No appreciable coronary or aortic\nvalve calcifications.  Aortic arch calcifications are minimal.  No pericardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes are not pathologically\nenlarged.  No hilar or axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild right apical scarring.  Moderate centrilobular emphysema. \nNo pulmonary opacities or suspicious nodules.\n\nBASE OF NECK: A 1.6 x 1.1 cm heterogeneously enhancing left thyroid nodule is\nunchanged.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of intrathoracic metastasis.\n2. A 1.6 cm left thyroid nodule is unchanged.  Per ACR guidelines on\nincidentally discovered thyroid nodules, recommend dedicated thyroid\nultrasound for further evaluation on the basis of size."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unchanged left 1.7 cm thyroid\nnodule.\nNo supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the abdomen and\npelvis.\n\nMEDIASTINUM: No lymphadenopathy in the mediastinum.\nFew measurable lymph nodes are unchanged for example right upper paratracheal\n0.6 cm lymph node (series 4, image 68) and 1 cm sub carinal (4:119)\n\nHEART and PERICARDIUM: No cardiomegaly and no pericardial effusion.\nSpecks of calcifications in the LAD.\nMajor vessels not dilated.\n\nLUNG and PLEURA: Major airways are patent with diffuse unchanged airway\nthickening.\nModerate to severe centrilobular emphysema affecting predominantly the upper\nlobes.\nMicro nodule in the right upper lobe and left lower lobe, unchanged (4:62,\n140).\nNo new lung nodules or masses.\nNo pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum (7, 18)\nAre normal in size.  Normal appearance of the large mediastinal vessels.  No\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  The upper abdomen is reported in\ndetail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  Mild bilateral apical\nscarring.  Moderate pulmonary emphysema.  No suspicious pulmonary nodules or\nmasses.  The airways are patent.  Mild thickening any irregularities of the\nairway walls.  Bilateral areas of dependent atelectasis.  No fibrotic changes.\nNo pleural abnormalities.",
            "output": "Stable appearance of the thorax.  No evidence of metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE: No evidence pulmonary embolism.  The thoracic aorta is\npatent and normal in caliber.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No significant change in the prominent\nsubcarinal lymph node, currently measuring up to 1.0 cm (5:145).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate to severe centrilobular emphysema as well as\nmild biapical scarring.  No pleural effusion or focal consolidation.\n\nBASE OF NECK: Re-demonstrated is a partially calcified left thyroid nodule\nmeasuring up to 1.6 cm (4:6).\n\nABDOMEN: Partially imaged is left simple renal cyst.  Included portion of the\nupper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No pulmonary embolus demonstrated.\n2.  Moderate to severe centrilobular emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Heterogeneously hypoattenuated\nnodule measuring 1.7 cm in the left lobe of the thyroid (2:9) is unchanged in\nsize dating back to chest CT ___.  There is no axillary or hilar\nlymphadenopathy.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.\n\nMEDIASTINUM: Right lower paratracheal lymph node measuring 0.6 cm (02:27) and\nsubcarinal lymph node measuring 0.9 cm (02:34) are borderline enlarged and\nunchanged as compared to chest CT ___\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is moderate centrilobular emphysema.  There is no\nconsolidation or pulmonary nodule.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery is not enlarged.\nCHEST CAGE: There is no acute osseous abnormality.",
            "output": "1. Borderline mediastinal lymphadenopathy measuring up to 0.9 cm in the\nsubcarinal station is unchanged dating back to chest CT ___.  No\nevidence of intrathoracic malignancy or metastatic disease.\n2. Stable left thyroid nodule.\n3. Please refer to dedicated CT abdomen and pelvis report on same day for\nsubdiaphragmatic findings."
        },
        {
            "input": "A 15 mm left hypodense lesion is seen within the left thyroid lobe, series 6,\nimage 30.  The right thyroid lobe is unremarkable.  There is no axillary,\nmediastinal, or hilar lymphadenopathy.  The heart size is normal.  There is no\npericardial effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.  The aorta is normal in caliber.  The main\npulmonary artery is normal in caliber.\n\nFor evaluation of subdiaphragmatic structures, please refer to the dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nThere is diffuse paraseptal emphysema.  No concerning pulmonary nodules are\nidentified.  There is no large pleural effusion or pneumothorax.",
            "output": "No concerning pulmonary nodules identified."
        },
        {
            "input": "A left-sided hypodense thyroid nodule with peripheral calcifications measuring\nup to 13 mm is unchanged compared to the prior exam.  The right thyroid lobe\nis unremarkable.  There is no axillary, supraclavicular, mediastinal, or hilar\nlymphadenopathy.  The heart size is normal.  There is no pericardial effusion.\nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.  The aorta is normal in caliber.  The main pulmonary artery is normal\nin caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on the same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\n2 mm right lower lobe nodule, series 3, image 113 is more apparent on the\ncurrent exam likely given the decrease in the extent of atelectasis.  Moderate\ndiffuse paraseptal and centrilobular emphysema is seen.  There is no pleural\neffusion or pneumothorax.",
            "output": "More apparent 2 mm right lower lobe nodule on the current study may be\nsecondary to interval decrease in extent of atelectasis allowing for this\nnodule to be more discernible.  Otherwise, no concerning new or growing\npulmonary nodules identified."
        },
        {
            "input": "Left thyroid nodule is dense, 18 x 16 mm in diameter.  No mediastinal, hilar\nor axillary lymphadenopathy is present, except for top-normal right hilar\nlymph node, series 4, image 100, 10 x 11 mm.  Heart size is normal.  There is\nno pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is moderate.  None no pulmonary nodules masses or consolidations of\nconcern.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic metastatic disease.\n\nLarge left thyroid nodule that should be further assessed with thyroid\nultrasound.\n\nSubstantial emphysema.\n\nBorderline right hilar lymph node that should be reassessed in 3 months for\ndocumentation of stability."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  No coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  Small hiatal hernia.  No\nabnormalities at the level of the upper abdominal organs, which are described\nin detail in the dedicated abdominal CT report.  No no osteolytic lesions at\nthe level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Mild\n\nMild paraseptal pulmonary emphysema and severe centrilobular pulmonary\nemphysema.  Mild thickening and irregularities of the airway walls.  A\npre-existing 2 mm pulmonary nodule is still visualized but partly overlaid by\na platelike atelectasis (3, 118).  No new or growing nodules.  No pleural\nabnormalities.",
            "output": "Stable 2 mm right lower lobe nodule.  No new or growing nodules.  Severe\npulmonary emphysema and signs indicative of mild chronic airways disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is not visualized.  No\naxillary, supraclavicular or infraclavicular lymphadenopathy.  Minimal\ncalcified atherosclerosis involving the supra-aortic vasculature.\n\nUPPER ABDOMEN: Please refer to same-day CT abdomen and pelvis for detailed\nreport of subdiaphragmatic findings.  The esophagus is mildly patulous with\nminimal aerosolized secretions.\n\nMEDIASTINUM: There are multiple non pathologically enlarged mediastinal lymph\nnodes which measure up to 0.6 cm.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion.  No\ncalcified atherosclerosis involving the coronary arteries.  The vascular\ncalibers of the ascending aorta, main pulmonary artery and ascending aorta are\nwithin normal limits.  No evidence of pulmonary embolism.\nPLEURA: Mild biapical pleuroparenchymal scarring.\nLUNG:\n\n1. PARENCHYMA:  Moderate to severe centrilobular emphysema.\nA 2 mm subpleural pulmonary nodules demonstrated of the right lower lobe,\n(series 3, image 128), unchanged.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  However there\nis still mild bronchial wall thickening and irregularities of the airway\nwalls.\nCHEST CAGE: No acute fracture.  No lytic or sclerotic osseous lesions to\nsuggest infection or malignancy.",
            "output": "1. A 2 mm pulmonary nodule in the right lower lobe is unchanged.\n2. No new or growing pulmonary nodules\n3. Moderate to severe centrilobular emphysema.\n4. Findings suggestive of mild chronic airways disease, unchanged when\ncompared to CT chest dated ___."
        },
        {
            "input": "Ill-defined diffuse calcifications are seen throughout the left thyroid lobe. \nThere is no axillary, supraclavicular, mediastinal, or hilar lymphadenopathy. \nThe heart size is normal.  There is no pericardial effusion. The esophagus is\nnormal without evidence of wall thickening or a hiatal hernia.  The aorta is\nnormal in caliber.  The main pulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nA 2 mm right lower lobe nodule (6; 136) is unchanged compared to the prior\nexam.  No concerning new or growing pulmonary nodules are identified.  There\nis no pleural effusion or pneumothorax.  Extensive centrilobular emphysema is\nseen.",
            "output": "Stable millimetric right lower lobe nodule.  No concerning new or growing\npulmonary nodules identified."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Unchanged 2 mm right upper lobe and lower lobe nodules (series\n6, images 71 and 155).  No new or growing lung nodule.  Extensive\ncentrilobular emphysema is redemonstrated.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Redemonstrated calcification seen throughout the left thyroid\ngland.\n\nABDOMEN: Please refer to separately dictated report of the abdomen and pelvis\nperformed on the same day for the findings below the diaphragm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No concerning new or growing pulmonary nodules.\n2. Stable extensive centrilobular emphysema."
        },
        {
            "input": "There is a stable appearance of the large retrosternal goiter which causes\nmild leftward deviation and the anterior displacement of the upper trachea. No\npathologically enlarged supraclavicular, mediastinal, hilar or axillary lymph\nnodes are seen.\n\nThere is stable mild cardiomegaly with predominantly left-sided enlargement. \nDense coronary artery, aortic valve and mitral annular calcifications are also\npresent. There is no pericardial effusion. Diffuse low attenuation of the\nblood within the heart suggests mild anemia. The main pulmonary artery is\nnormal in caliber, however there is stable unilateral dilatation of the right\npulmonary artery which measures up to 3.6 cm in greatest transverse dimension.\nAtherosclerotic disease with discontinuous calcification diffusely involves\nthe thoracic aorta and its branches.\n\nThere is unchanged mild diffuse esophageal wall thickening and dilatation with\na 3.5 x 2.6 cm focal outpouching containing debris at the level of the aortic\narch just distal to the inferior aspect of the enlarged right thyroid lobe. \nImages of the upper abdomen also demonstrate a stable 1.7 x 1.6 cm left\nadrenal adenoma, and an unchanged 2.0 x 4.8 cm left subpleural lipoma\ncontaining a punctate calcification.\n\nEvaluation of the lungs demonstrates a coarse calcification along the right\nmajor fissure with an associated soft tissue component which is not\nsignificantly changed since ___ (4, 91).  Additional partially\ncalcified pleural plaques are noted bilaterally compatible with prior history\nof asbestos exposure. Branching tubular peribronchial nodular opacities have\nsignificantly improved with residual areas seen in the right upper lobe and,\nto a lesser extent, the lingula. Previously described anterior right upper\nlobe opacities have resolved. The largest 8 mm lobulated nodule in the left\nupper lobe is stable (4, 104).  Several additional smaller solid nodules are\nalso stable (4:  128, 134, 136, 141, 143, 163, 164, 171, 173, 174, 176, and\n197). There is unchanged posterior segment right upper lobe traction\nbronchiectasis, scarring and volume loss with postinflammatory pneumatocele\nformation. These findings are superimposed on mild centrilobular emphysema.\nMild diffuse bilateral peribronchial thickening is also unchanged. There is no\npleural effusion.\n\nEvaluation of the bones demonstrates multilevel lower thoracic and lumbar\nspinal degenerative changes.",
            "output": "Significantly improved but persistent infectious small airways disease in the\nright upper lobe and lingula as compared to ___.  Findings are likely\ndue to chronic aspiration.\n\nStable subcentimeter solid pulmonary nodules, which may be followed up with a\n12 month CT scan.\n\nStable retrosternal goiter causing leftward deviation, anterior displacement,\nand mild narrowing of the upper trachea.\n\nStable mild diffuse esophageal wall thickening with focal areas of outpouching\nand dilatation which are in keeping with the known history of surgically\nrepaired achalasia.\n\nStable mild dilatation of the right pulmonary artery,  pulmonary hypertension\nin the appropriate clinical setting.\n\nStable mild centrilobular emphysema.\n\nStable left adrenal adenoma."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged and\nthere is no soft tissue abnormality in the imaged chest wall suspicious for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal abnormality.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  There are no thyroid findings\nwarranting further imaging evaluation.  Atherosclerotic calcification is not\napparent head neck vessels or coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: None pathologically enlarged.  Granulomatous\ncalcifications are scattered in normal size central lymph nodes.  Thymus is\nphysiologic.\n\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are clear.  Tracheobronchial tree is normal to\nsubsegmental levels.  There is no pleural abnormality.\n\nCHEST CAGE: Unremarkable.",
            "output": "Normal chest CT."
        },
        {
            "input": "The main pulmonary artery, central and lobar branches appear patent. However\nin the left lower lobe basal segmental branches, filling defect is noted for\nexample on series 2, image 84.  Similar small filling defects can be seen in\nthe left lower lobe on series 2, image 70 and in the right lower lobe on\nseries 2, image 69. There is a small consolidation in the left lower lobe as\nseen on series 2, image 103 which could represent pneumonia versus infarction.\n\nThe thoracic aorta enhances normally without significant atherosclerosis,\naneurysm or dissection. The heart is top-normal in size without pericardial\neffusion. There is pulmonary edema with large right and small left pleural\neffusions.  Consolidation in the right lung base appears somewhat\nheterogeneous and may reflect a component of pulmonary infarction. Imaged\nthyroid gland appears normal. Mediastinal lymph nodes appear prominent likely\nreactive.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  The bones are diffusely demineralized.",
            "output": "1. Bilateral small pulmonary emboli, partially occlusive and possibly\nsubacute.  Areas of possible infarction in the right and left lung bases\nthough differential includes atelectasis/ pneumonia.\n2. Pleural effusions, large on the right and small on the left with pulmonary\nedema.\n\n3. Mild cardiomegaly."
        },
        {
            "input": "CHEST: The visualized thyroid is unremarkable.  There is no axillary or\nsupraclavicular lymphadenopathy.  Prominent upper paratracheal lymph nodes not\nmeet CT size criteria for lymphadenopathy.  There is no mediastinal or hilar\nlymphadenopathy.\n\nThe heart size within normal limits.  The aorta and main pulmonary artery are\nwithin normal size.\n\nThe airways are patent the subsegmental level.\n\nThere is no pulmonary embolus.  There is platelike atelectasis in the right\nlower lobe.  Ground-glass the dependent portion of the lungs is compatible\nwith atelectasis.  No worrisome pulmonary nodules.\n\nThe visualized upper abdomen is unremarkable.\n\nThe superficial soft tissues and bony structures are within normal limits.\n\nThe hepatic parenchyma is within normal limits.  The gallbladder is\nunremarkable.  There is no intra or extrahepatic biliary ductal dilatation. \nThere is fatty atrophy of the pancreas.  The adrenal glands are within normal\nlimits.\n\nThe spleen is not enlarged.  Subcentimeter renal hypodensities likely\nrepresent simple cysts.  There is no hydronephrosis.\n\nThe stomach is unremarkable.  Visualized loops of small bowel are within\nnormal limits.  There is mild colonic diverticulosis without evidence of\ndiverticulitis.\n\nThe uterus is surgically absent.  There is mild pelvic floor descent.\n\nThere is no abdominal aortic aneurysm.  Vascular calcifications are mild.\n\nThere is no retroperitoneal, mesenteric or pelvic lymphadenopathy.\n\nThe superficial soft tissues are unremarkable.\n\nNo worrisome osseous lesions.  There is mild anterolisthesis of L4 on L5.",
            "output": "No pulmonary embolus.  No evidence of pneumonia.  No acute intra-abdominal\nabnormality."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified and without filling defect. There is pulmonary arterial\ndilation, with the main pulmonary artery measuring 3.5 cm and the left\npulmonary artery measuring 2.8 cm. The remaining great vessels are normal in\nappearance.\n\nCT CHEST WITH CONTRAST:\n\nThere is a large mixed solid and cystic thyroid nodule in the left lobe,\nmeasuring 3.5 x 3.4 x 4.5 cm (TV x AP x CC) (5j:19, 8:77). There is a 14 mm\nright lower peritracheal lymph node (5j:44). Another 14 mm lymph node is seen\nof the left hilum (5j:59).  There is no axillary or supraclavicular\nlymphadenopathy. The heart is enlarged and there is dilation of the IVC,\nsuggestive of tricuspid regurgitation. Due to expiratory phase imaging, there\nis diffusely increased density of the airspaces, with patches of air trapping.\nThe airways are patent. There are no concerning pulmonary nodules. There is no\npneumothorax or pleural effusion.\n\nThere is a small hiatal hernia. The upper abdominal structures are otherwise\nunremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No pulmonary embolism.\n2. Dilation of the pulmonary artery consistent with pulmonary hypertension.\n3. Cardiomegaly with reflux into the IVC suggestive of tricuspid\nregurgitation. Correlate with echocardiography.\n4. 3.5 x 3.4 x 4.5 cm mixed solid and cystic thyroid nodule in the left lobe\nshould be further evaluated with ultrasound.\n5. Low-grade mediastinal and left hilar lymphadenopathy, likely reactive."
        },
        {
            "input": "HEART AND VASCULATURE: There are moderate atherosclerotic calcifications of\nthe aortic arch and at the origin of the head and neck vessels.  The thoracic\naorta is normal in caliber.  There are also moderate coronary calcifications.\nThe main pulmonary artery is enlarged measuring up to 4.3 cm, suggesting\npulmonary arterial hypertension (series 5, image 107).  Otherwise, the heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan.  Specifically, the right ventricle is not enlarged.  No pericardial\neffusion.  The IVC does appear enlarged measuring up to 4.1 cm.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a low left axillary lymph node\nmeasuring up to 10 mm in short axis (series 3, image 24), unchanged since\n___.  No new axillary or mediastinal lymphadenopathy is present.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a diffuse mosaic appearance of the lung parenchyma,\nlikely due to pulmonary hypertension or air trapping.  Linear opacity at the\nright base likely represent segmental atelectasis.  No other focal\nconsolidations.  Perifissural nodule within the left upper lobe likely\nrepresents an intrapulmonary lymph node (series 5, image 52).  There is an\nadditional subpleural nodule within the right middle lobe, also likely an\nintrapulmonary lymph node (series 5, image 130).  No suspicious lung nodules\nvisualized.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a large heterogeneous nodule within the left lobe of\nthe thyroid measuring 3.8 x 3.4 cm with tracheal deviation to the right,\nunchanged since ___ (series 3, image 9).\n\nABDOMEN: Subcentimeter hypodensity arising from the left kidney is too small\nto characterize, but likely represents a simple cyst (series 2, image 59). \nThere is a ventral hernia containing fat within the partially imaged upper\nabdomen.  No other abnormalities within the partially imaged upper abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Enlarged main pulmonary artery measuring up to 4.3 cm, suggesting pulmonary\narterial hypertension.  The right ventricle is not enlarged, however the IVC\nappears dilated measuring up to 4.1 cm.  ECHO should be considered for further\nevaluation.\n2. Mosaic attenuation of the lung parenchyma, either due to pulmonary\nhypertension or air-trapping.\n3. Large heterogeneous nodule within the left lobe of the thyroid measuring up\nto 3.8 cm with tracheal deviation to the right, unchanged since ___.\n4. Upper abdominal ventral hernia containing fat."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a 1 mm nodule in the right upper lobe (3, 18).\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\ncirrhosis.  There are gallstones.  There is a hypodense lesion within the\nright lobe of liver.  Please refer to dedicated report on MR of the abdomen\nfor further details",
            "output": "1 mm nodule in the right upper lobe.\n\nCirrhosis with a hypodense lesion within the right lobe of liver.  Gallstones.\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "CT chest with contrast: The thyroid is unremarkable in appearance. Heart size\nis normal without significant pericardial fluid. The main pulmonary artery and\nthoracic aortic arch are normal in caliber. Trace atherosclerotic\ncalcifications are noted in the thoracic aortic arch. There is no\nsupraclavicular, axillary, hilar or mediastinal lymphadenopathy by CT size\ncriterion.\n\nSuboptimal inspiratory effort results in hypoventilatory changes throughout\nboth lungs without discrete nodule, consolidation or mass lesion. There is\nmild bilateral dependent atelectasis. Pleural surfaces are clear without\neffusion or pneumothorax.  No traumatic findings are seen.\n\nCT abdomen with contrast: The liver enhances homogeneously without focal\nlesion, intra or extrahepatic biliary ductal dilatation. The portal vein is\npatent. The gallbladder is thin-walled and unremarkable.\n\nThe spleen, pancreas and adrenal glands are unremarkable in appearance. 9 mm\nleft interpolar renal hypodensity is incompletely characterized but likely\nrepresents a cyst. The kidneys present symmetric nephrograms and excretion of\ncontrast without focal solid lesion, hydronephrosis or perinephric\nabnormality.\n\nStomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction. The large bowel is thin-walled and unremarkable. The\nappendix is normal.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size region.\nThere is no ascites, pneumoperitoneum or hernia.\n\nCT pelvis with contrast: The bladder, ovaries, uterus and rectum are grossly\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria.\n\nOsseous structures: Nondisplaced right superior and inferior pubic ramus\nfractures are present. Right superior pubic ramus fracture is comminuted.\nThere is a small adjacent intramuscular hematoma best seen on series 601B,\nimage 34. Nondisplaced vertically oriented right sacral alar fracture. There\nare nondisplaced bilateral transverse process fractures of L5. There is a\nright nondisplaced transverse process fracture of L4. There is no suspicious\nfocal osseous lesion.",
            "output": "1. Nondisplaced comminuted right superior and inferior pubic ramus fractures. \nSmall adjacent intramuscular hematoma.\n2. Nondisplaced right sacral alar fracture.\n3. Bilateral transverse process fractures of L5 and right L4 transverse\nprocess fracture.\n4. No solid organ injury.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:45 ___, 2 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The full neck CT will be dictated\nseparately.  There is a 6 mm left thyroid nodule which does not appear\nsignificant changed from prior study.  No axillary enlarged lymph nodes are\ndemonstrated.  No lesions within the soft tissue of the chest wall.  No\nsupraclavicular lymphadenopathy is demonstrated.\n\nUPPER ABDOMEN: Please see dedicated report from same day CT abdomen and pelvis\nfor full description of intra-abdominal findings.\n\nMEDIASTINUM/HILA: No new or enlarging lymph nodes within the mediastinum or\nhila.  No mediastinal masses.\n\nHEART and PERICARDIUM: The heart is normal size.  There is moderate\natherosclerotic calcification of the coronary arteries.  No pericardial\neffusion.  The thoracic aorta is normal caliber.\nPLEURA: No pleural effusion.  No suspicious pleural thickening.\nLUNG:\n\n1. PARENCHYMA:  There are diffuse, subcentimeter bilateral pulmonary nodules,\nwhich are stable in size from the prior study.  No new pulmonary nodules.  A\nreference nodule in the left lingula measures 0.7 cm, unchanged from the prior\nstudy (series 3, image 98).  An additional reference lesion within the right\nlower lobe measures 0.7 cm (series 3, image 111), which is stable, with\nadditional smaller nodules anteriorly which are also stable (series 3, image\n114).  No dense consolidations.\n2. AIRWAYS:  The airways are patent to the level subsegmental bronchi\nbilaterally.\n3. VESSELS:  Top-normal main pulmonary artery.  No central filling defects.\nCHEST CAGE:\n\nThere is a new minimally displaced fracture of the posterior right ninth rib\n(series 3, image 144).\nA locally destructive lesion along the anterior aspect of the left second rib\n(series 3, image 65) now measures up to 0.8 cm in the short axis, previously\n0.4 cm.  There is increased sclerosis and apparent new pathologic fracture\nthrough the posterior aspect of the left fourth rib (series 3, image 57). \nThere is focal cortical thickening along the lateral aspect of the right\nseventh rib (series 3, image 133), at the site of a previously demonstrated\nlytic lesion.  There is additional mildly expansive lucency along the lateral\nright fourth rib (series 3 image 77), which is slightly increased in sclerosis\nbut unchanged in size, as well as a focal irregularity along the lateral ninth\nrib (series 3, image 185), which is new from prior.  There is an expansile and\nmildly destructive lesion along the posterior aspect of the left fourth rib\nmeasuring 1.3 cm (series 3, image 57), unchanged in size but increased in\nsclerosis from ___.\nThere is redemonstration of a soft tissue mass arising from the right pedicle\nat T7 vertebral body measuring 2.0 x 1.8 cm, previously 2.0 x 1.9 cm with\nresultant severe narrowing of the spinal canal, better assessed on the total\nspine MR from ___.  A sclerotic lesion within the body of T11 is\nunchanged (series 602, image 45).  Areas of sclerosis at the posterosuperior\nendplate of the C7 vertebral body (series 602 image 45) and a lucency at the\nposterior slightly rightward aspect of the T1 vertebral body (series 602,\nimage 43), are not well visualized and better characterized on the prior MR\nspine, however do not appear significantly increased in size.",
            "output": "1. New minimally displaced fractures of the right ninth and left fourth ribs\nposteriorly, which are likely pathologic and appear acute to subacute in\nchronicity.\n2. Redemonstration of multiple destructive osseous lesions throughout the\nbilateral ribs and thoracic spine as on prior which appear stable in size. \nThe dominant soft tissue lesion within the spinal canal at the level of T7 is\nalso stable, with unchanged severe spinal canal narrowing, however this better\nassessed on the prior MR total spine from ___.\n3. Diffuse bilateral subcentimeter bilateral pulmonary nodules are stable in\nsize from the prior study.  No new nodules.\n4. No enlarged lymph nodes or soft tissue masses within the right\nsupraclavicular region to correlate with the patient's symptoms.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___. \n___, M.D. on the telephone on ___ at 04:05 Pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal. \nCoronary calcifications are extensive.  There is no pericardial or pleural\neffusion.\n\nImaged portion of the upper abdomen demonstrate left adrenal hypodense lesion\nconsistent with angiomyolipoma, series 2, image 50, diffuse thickening of the\nadrenal glands and previous cholecystectomy and otherwise is unremarkable\nwithin the limitations of the study technique that was not designed for\nassessment of intra-abdominal pathology.  Liver hypodensities are only\npartially assessed.\n\nNo supraclavicular axillary or mediastinal pathologically enlarged lymph nodes\ndemonstrated.  Right hilar lymph node is top-normal, series 2, image 26, 14\nmm, increased compared to 12 mm previously.\n\nAirways are patent to the subsegmental level bilaterally.  Innumerable\npulmonary metastatic nodules are re-demonstrated.  Assessment of the most\nprominent nodules suggest interval grows, for example in left upper lobe from\n1.5 mm to 3.5 mm, in left upper lobe from 3-6 mm, series 4, image 71, in right\nlower lobe from 7 to 9 mm, series 4, image 106, in left lower lobe from 6 to\n9.5 mm, series 4, image 125.\n\nPreviously seen bone metastasis are re-demonstrated, series 2, image 12, 14,\n19, 23 (soft tissue lesion invading spinal canal, 20 x 21 mm, minimally\nincreased since previous examination, at the level of T7), 32, 34, 45.",
            "output": "Interval progression of multiple metastatic pulmonary nodules\n\nMultiple metastatic bone lesions as described.  The most concerning lesion is\npredominantly soft tissue lytic lesion at the level of T7 that is invading\nspinal canal.  Correlation with dedicated thoracic MRI is to be considered if\nclinically warranted.\n\nRight hilar lymph node, minimally enlarged most likely reflecting metastatic\ndisease as well."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  Stable small right\nhilar lymph nodes.  There are no enlarged hilar lymph nodes.  There is\nmoderate cardiomegaly.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nThe numerous bilateral pulmonary nodules and nodular opacities, predominantly\nwithin both upper lobes, unchanged since the prior study.  Several larger\nnodules also seen bilaterally.  There is no significant interval change in\nsize of multiple bilateral nodules.  The largest in the left lower lobe\nmeasures 8 mm and is unchanged (302, 126).  A right lower lobe pulmonary\nnodule measuring 8 mm open (302, 100) Is also unchanged.\n\nThere is minimal peripheral fibrosis in both lung bases, unchanged.\n\nBONES AND CHEST WALL : A soft tissue nodule in the left anterior chest wall is\nunchanged and could represent a sebaceous cyst (2, 16).  Review of bone shows\nmixed lytic and sclerotic lesions concerning for metastasis.  The osseous\nlesions are slightly more prominent than on the prior study, for example the\nstem lesion was barely perceptible on the prior study, shows increased\nsclerosis, this could represent treatment response rather than disease\nprogression.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  There is an angiomyolipoma in the left\nkidney.  These are followed to dedicated reported on MRI of the pelvis which\nis being dictated separately.",
            "output": "No significant interval change in the numerous bilateral pulmonary metastasis\nwhich range in size from 2-8 mm.\n\nStable small right hilar and mediastinal lymph nodes.\n\nOsseous metastasis slightly more prominent than on the prior study, which\ncould be related to increased sclerosis which could be secondary to treatment\nresponse rather than disease progression.\n\nPlease refer to the dedicated report MRI of the pelvis which has been dictated\nseparately for further details regarding the abdomen."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are stable small left\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The 9.7 mm subcarinal lymph nodes unchanged.  Heart size is\ntop-normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are numerous bilateral pulmonary nodules, ranging in size from 1\nmm to 5 mm the largest in the right lower lobe (7, 48).  The interstitium is\nalso prominent.\n\nThere is new consolidative opacity in the right lower lobe peripherally along\nthe pleura (7, 60) which could represent organizing pneumonia or could be\nrelated to radiation therapy.\n\nBONES AND CHEST WALL : Review of bones a stable soft tissue nodule in the left\nanterior chest wall (7, 14) Could represent a sebaceous cyst, is this is\nslightly decreased in size since the prior study.\n\nThere are mixed lytic and sclerotic lesions with several pathological\nfractures there are several bilateral rib fractures.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions.  Both adrenals are diffusely thickened.  Please refer\nto dedicated report on abdomen which has been dictated separately.",
            "output": "Multiple bilateral pulmonary metastasis ranging in size from 2-8 mm.  The\ninterstitium continues to be prominent.\n\nExtensive osseous metastasis.\n\nNew peripheral consolidative opacity in the right lower lobe could represent\norganizing pneumonia could be related to radiation therapy.  Correlation with\nhistory is recommended\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 1 cm hypodense left thyroid nodule\nis below ACR size threshold for imaging followup.  No supraclavicular or\naxillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: There is sludge or tiny gallstones in a nondistended,\nthin-walled gallbladder.  Approximately 2.4 cm fatty lesion in the posterior\nleft renal cortex is unchanged in size since ___ and likely a benign\nlesion such as angiomyolipoma.  2.3 x 1.6 cm right adrenal adenoma measured\n2.3 x 1.6 cm on ___.\n\nMEDIASTINUM:  No mediastinal mass or lymphadenopathy.\n\nHILA:  Evaluation is limited without IV contrast, but is grossly unremarkable.\n\nHEART and PERICARDIUM: Heart size is normal.  There is coronary artery\ncalcification.   No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There are numerous subpleural and centrilobular nodules,\nranging from ground glass to semisolid to solid in attenuation, predominantly\nin the upper lobes, the largest on the right measuring up to 4 mm (04:56). \nThere is a left upper lobe ground-glass nodule measuring up to 6 mm (04:43). \nNo focal consolidation.\n2. AIRWAYS:  There is mild central bronchial wall thickening.  The airways are\npatent to subsegmental levels.\n3. VESSELS:  The great vessels are normal caliber.\nCHEST CAGE: No concerning lytic or sclerotic lesion.  No acute fracture.",
            "output": "Multiple small nodules measuring up to 4 mm and a ground-glass nodule\nmeasuring up to 6 mm. Most likely these are smoking related, a combination of\nrespiratory bronchiolitis and/or Langerhans cell histiocytosis.\n\nRECOMMENDATION(S):  Followup chest CT for lung nodules in no more than six\nmonths, preferably after cessation of smoking"
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Severe calcifications of\ncoronary arteries are present.  No pathologically enlarged mediastinal, hilar\nor axillary lymph nodes are noted.  Multiple mediastinal lymph nodes are\nstable.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is demonstrated bilaterally.  Multiple centrilobular nodules\nare present in the upper lobes, with some more discrete nodules present for\nexample series 5 image 61 series 5, image 56, series 5, image 54, series 5,\nimage 50, all of them stable compared to previous examination.  Left upper\nlobe ground-glass nodule, series 5, image 53, 3 mm is stable as well.  No new\npulmonary nodules masses or consolidations demonstrated.\n\nImage portion of the upper abdomen only partially demonstrate previously seen\nfat density lesion in the left kidney and read demonstrate right adrenal\nhypodense lesion of 3 Hounsfield units in density consistent with benign\netiology.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Multiple pulmonary nodules, unchanged in part representing centrilobular\nnodules.\n\nNo new nodules demonstrated.\n\nUnchanged extensive coronary calcifications\n\nLeft kidney fat containing lesion, partially imaged\n\nRight adrenal adenoma\n\nOverall the findings might potentially represent smoking related lung disease,\nas previously suggested a combination of respiratory bronchiolitis and / or\nhistiocytosis"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nExtensive atherosclerotic disease is again seen within all 3 coronary\narteries.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion. \nNo pneumothorax.\n\nRedemonstration of centrilobular emphysema and several parenchymal blebs\nmeasuring up to 1.1 cm, not significant changed in size since prior exam.\n\nThere are multiple new and growing solid pulmonary nodules throughout the\nbilateral lungs, which, given history of malignancy, is concerning for\nmetastases.  There is also redemonstration of several previously seen tiny\npulmonary nodules measuring up to 3 mm, the majority of which are unchanged in\nsize.\n\nSeveral new and/or growing lung nodules are as listed below\nNew 4 mm nodule within the right upper lobe (series 3, image 43).\nNew 5 mm nodule within the left upper lobe (series 3, image 47).\nNew 5 mm nodule within the left upper lobe (series 3, image 78).\nNew 5 mm nodule within a left lower lobe (series 3, image 90).\nNew 7 mm nodule within the left upper lobe (series 3, image 98).\nNew 7 mm nodule within the right upper lobe (series 3, image 107).\nInterval enlargement of 7 mm nodule within the right lower lobe (series 3,\nimage 109), previously 3 mm.\n3 new clustered nodules within the right lower lobe (series 3, images 111,\n112, 114) measuring up to 5 mm.\nNew 6 mm right lower lobe peripheral nodule (series 3, image 140).\n\n The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen redemonstrate a 1.2 cm rounded\nhypoenhancing lesion within the body/tail, previously characterized as a side\nbranch intraductal papillary mucinous neoplasm, which is unchanged in size\nsince prior exam.\n\nThere are several lucent lesions within the bilateral ribs (specifically,\nposterior aspect of left second rib, posterior aspect of left fourth rib,\nlateral aspect of right fourth rib, posterior-lateral aspect of right seventh\nrib) as well as a sclerotic lesion within vertebral body of T11, concerning\nfor osseous metastatic disease.  Additionally, there is a subtle nondisplaced\npathologic rib fracture adjacent to the right 7th rib lucent lesion (series 2,\nimage 64).\n\nAn additional lucent lesion is seen in the right lateral aspect of the\nsternum, but this appears unchanged compared to ___ CT.  There also\nappears be a pathologic fracture along the posterior-lateral aspect of rib 7.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Nondisplaced pathologic fracture of the right seventh rib.\n\n3.  Multiple new and growing pulmonary nodules throughout the bilateral lungs\nin addition to several mixed lucent/sclerotic bony lesions within the ribs and\nthoracic vertebrae, concerning for metastatic disease.\n\n4.  1.2 cm rounded lesion within the pancreatic body/tail is unchanged from\nprior exam.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:04 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart is\nmoderately enlarged and there are moderate coronary artery calcifications. \nOtherwise, the heart, pericardium, and great vessels are within normal limits\nbased on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the pulmonary parenchyma is slightly limited by\nmotion.  No focal consolidation is seen.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nRight IJ tunneled HD traverses the expected course and terminates in the right\natrium.\n\nABDOMEN: Extensive noise artifact and lack of contrast somewhat limits\nevaluation of the abdomen.  There is mild ascites evident in ___'s pouch. \nDistal esophageal thickening was better evaluated on CT abdomen and pelvis ___.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  Superior endplate deformity of T6 is likely chronic and\nmay be a Schmorl's node.  Air within the soft tissues of the right arm appears\nintravenous and is likely secondary to IV access placement.",
            "output": "Extensive noise artifact in part from body habitus and patient's arms down at\nside, in conjunction with noncontrast enhanced study, makes assessment\nsuboptimal.\nModerate cardiomegaly and coronary calcifications.  No evidence to suggest\npulmonary infection.\n\nVery limited assessment of the partially imaged upper abdomen suggests small\namount of ascites.  Previously seen distal esophageal thickening was better\nevaluated on prior contrast enhanced CT.\n\nAir within the soft tissues of the right arm appears intravenous and is likely\nsecondary to IV access placement."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Right upper\nextremity pigtail catheter..  Redemonstrated moderate cardiomegaly. \nAtherosclerotic calcifications of the coronary arteries.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Scattered mildly prominent mediastinal lymph\nnodes, similar to prior, moderately reactive.  No axillary or mediastinal\nlymphadenopathy is present.\n\nPLEURAL SPACES: Trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Motion artifact limiting evaluation.  Bibasilar dependent\natelectasis.  No focal consolidation.  Trachea and mainstem bronchi are\npatent.\n\nBASE OF NECK: Visualized portions of the base of the neck are unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nPlease refer to same-day CT abdomen for abdominopelvic findings.",
            "output": "1. Motion artifact limiting evaluation.  No focal consolidation.\n2. Trace left pleural effusion, with bibasilar dependent atelectasis.\n3. Redemonstrated moderate cardiomegaly with atherosclerotic calcifications of\nthe coronary arteries.\n4. Please refer to same-day CT abdomen and pelvis for additional findings."
        },
        {
            "input": "The positioning of the arms limits evaluation of the study due to creation of\nartifact.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is markedly enlarged.  No pericardial\neffusion.  Pericardium, and great vessels are within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: The mediastinum contains innumerable small soft\ntissue nodules thought to represent lymph nodes though a component of\nhemorrhage is impossible to exclude.  These measure up to 1.2 cm for instance\nin the prevascular space.  Subcarinal adenopathy is difficult to measure.  No\npneumomediastinum.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are multilobar dense airspace opacities with subpleural\nsparing with consolidation most extensive in the mid and upper lungs.  The\nairways appear patent through the level of the segmental bronchi.  Mild left\nposterior basal atelectasis.\n\nBASE OF NECK: Please see separately reported CTA neck for further detail.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolism or acute aortic process.\n2. Multilobar airspace consolidation with subpleural sparing.  Differential\nconsiderations favor edema and/or hemorrhage though a component of infection\nis not excluded.  Multiple small mediastinal nodes, a component of hemorrhage\nis difficult to entirely exclude.  Biopsy may be considered.\n3. Marked cardiomegaly.  No pericardial effusion.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 6:30 pm, 10 minutes after discovery\nof the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: Tracheostomy tube in situ.  The visualized\nthyroid is normal.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  There are multiple prominent to enlarged mediastinal lymph\nnodes.  For example a cluster of aortopulmonary window nodes measure up to 0.8\ncm.  Multiple right paratracheal nodes measure up to 0.6 cm.  A pretracheal\nnode measures 0.8 cm.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is severely enlarged and there is extensive coronary\narterial calcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Again seen is bilateral ground-glass opacity with\nanterior to posterior gradient consistent with known diffuse alveolar\nhemorrhage, improved since ___.  No new focal consolidation.  There\nare bilateral dependent atelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is trace left pleural effusion.  No right pleural effusion.  No\npneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.  No\nsubstantial degenerative changes of the thoracic spine.\n\nUPPER ABDOMEN:  Limited evaluation of the upper abdomen is grossly\nunremarkable.",
            "output": "1. Interval improvement of diffuse bilateral ground-glass opacities, in\nkeeping with known diffuse alveolar hemorrhage.\n2. No new focal consolidation.\n3. Grossly unchanged likely reactive mediastinal lymph nodes.\n4. Severe cardiomegaly and extensive coronary artery calcifications."
        },
        {
            "input": "HEART AND VASCULATURE: Limited evaluation of the pulmonary vasculature is\nsecondary to respiratory motion and adjacent parenchymal opacities.  Pulmonary\nvasculature is well opacified to the segmental level without filling defect to\nindicate a pulmonary embolus.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  Stable severe cardiomegaly. \nSevere coronary artery calcification most pronounced in the LAD.  The\npericardium is physiologic.  No pericardial effusion.  Aortic and pulmonary\nvasculature is within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple borderline and prominent mediastinal\nlymph nodes do not meet CT criteria for lymphadenopathy and a likely reactive.\nFor example a 9 mm prevascular lymph node (series 305, image 40). \nAdditionally a 10 mm AP window lymph node (series 305, image 44).  No\naxillary, mediastinal, or hilar lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: Small left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Redemonstration of diffuse ground-glass opacities with anterior\nto posterior gradient with relative subpleural sparing consistent with known\ndiffuse alveolar hemorrhage.  This has mildly progressed in the left\nhemithorax but has improved along the right hemithorax.  No bleeding source is\nidentified.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Status post tracheostomy tube placement.  The rest of the base\nof the neck is within normal limits.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Redemonstration of diffuse, bilateral ground-glass opacities with anterior\nto posterior gradient consistent with known diffuse alveolar hemorrhage.  This\nhas mildly progressed in the left lung and moderately improved in the right\nlung.\n2. No bleeding source is identified.\n3. Grossly unchanged prominent mediastinal lymph nodes are likely reactive.\n4. Small left pleural effusion.\n5. No evidence of pulmonary embolism to the segmental level.  No acute aortic\nabnormality."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The mediastinal lymph nodes (3, 18) are borderline\nin size and unchanged as compared to the previous examination.  Also on going\nenlargement is seen at the level of the para-aortic and paratracheal lymph\nnodes (3, 25).  Finally, the sub- carinal lymph nodes also continue to be\nmarkedly enlarged.  There is no lymph node enlargement in the posterior\nmediastinum.  The upper abdomen shows a fatty liver and a small splenule (3,\n55).  Normal appearance of the cardiac structures.  No pericardial effusion. \nNo osteolytic lesions at the level of the ribs, the sternum and the vertebral\nbodies.  Moderate degenerative vertebral disease.  Predominantly interstitial\npulmonary nodules (for example series 5, image 46) are stable.  There is no\nevidence for a numeric increase in interstitial nodularity.  The largest\nnodule continues to be located in the right lower lobe (5, 180).  A\nperifissural noted in the left lower lobe (5, 220) is also unchanged.  No\npleural thickening, no pleural effusions.  The airways are patent.  No\npulmonary fibrosis.",
            "output": "No relevant change as compared to ___.  Scattered interstitial\npulmonary nodules.  No signs of nodular progression, no pulmonary fibrosis. \nNo airways disease.  Stability of multiple enlarged and borderline sized\npulmonary nodules."
        },
        {
            "input": "The ascending thoracic aorta is ectatic to 4.5 cm.  The main pulmonary artery\nis normal in caliber.  No enlarged supraclavicular, axillary, mediastinal\nlymph nodes are identified.  The left hilar contour cannot be evaluated, but\nthe right hilar contour is within normal limits.  Hypoattenuation of blood\npool relative to cardiac musculature is compatible with anemia.  Coronary\nartery calcifications in the LAD and right coronary artery are of unknown\nhemodynamic significance.  There is no pericardial effusion.\n\nThere is a large left nonhemorrhagic pleural effusion with adjacent\natelectasis resulting in the left lower lobe collapse and partial left upper\nlobe collapse.  A right pleural effusion is tiny with adjacent atelectasis. \nHeterogeneous ground-glass opacity in the right apex (___) is nonspecific\nbut may represent aspiration, infection or inflammation, unlikely to represent\na contusion given the location.  There is no pneumothorax or pulmonary\nlaceration.  Central airways are patent.\n\nA 1.3 cm hypodensity at the hepatic dome is likely a cyst.  The gallbladder is\ndistended and incompletely imaged.  No concerning abnormality is seen in the\nupper abdomen.\n\nFractures of the left posterolateral ninth, tenth, and eleventh ribs\ndemonstrate some callus formation, indicating they are subacute. \nAdditionally, there is deformity of the right fourth and sixth ribs suggesting\nnondisplaced fractures without subjacent abnormality.  There is mild loss of\nvertebral height of the T5 and T7 vertebral bodies.",
            "output": "1.  Large nonhemorrhagic left pleural effusion with volume loss in the left\nlung.  Trace right pleural effusion.\n2.  Heterogeneous ground-glass opacity in the right apex is nonspecific and\nmay be aspiration, infectious or inflammatory.\n3.  Subacute left rib fractures and nondisplaced right rib fractures, as\nabove.\n4.  Ectatic ascending thoracic aorta to 4.5 cm.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 3:00  ___, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Multiple metallic densities in the\nleft axilla are predominantly punctate except for an 11 mm linear density\nsuperior posterior to the left axillary artery (series 306, image 19).  A left\nsupraclavicular lymph node measures 9 mm in short axis (306:22).\n\nUPPER ABDOMEN: Please see separate report from CT of the abdomen pelvis\nperformed the same time for description of the subdiaphragmatic findings,\nwhich include massive splenomegaly and ascites.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  Mild coronary artery\ncalcifications.  Lower paraesophageal varices.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Normal cardiac size.  No pericardial effusion.\nPLEURA: Very large right and moderate left nonhemorrhagic pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Severe right lower lobe atelectasis.  Mild-to-moderate right\nmiddle and upper lobe atelectasis.  Subpleural ground-glass opacities in the\nright upper lobe (306:93).  More focal ground-glass opacity in the left upper\nlobe(306:42).  No suspicious pulmonary nodules identified.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  Right internal jugular approach central venous catheter\nterminates in the right atrium.  No central pulmonary embolus.\nCHEST CAGE: No suspicious osseous lesions or acute fracture.",
            "output": "1. Very large right and moderate left pleural effusions with severe right\nlower lobe atelectasis and moderate right upper and middle lobe atelectasis.\n2. Ground-glass opacities in both upper lobes are nonspecific and may\nrepresent focal pulmonary edema or atelectasis. Infectious process not\nexcluded.\n3. No suspicious pulmonary nodules or mediastinal lymphadenopathy.\n4. Borderline left supraclavicular lymph node is nonspecific, possibly\nreactive.\n5. Metallic densities in the left axilla of uncertain etiology, potential\nforeign bodies.\n6. Please see separate report from CT of the abdomen pelvis performed the same\ntime for description of the subdiaphragmatic findings, which include massive\nsplenomegaly and ascites."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.  Large-bore catheter with tip in\nthe right atrium.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nEnteric line passing through the esophagus with tip well into the stomach. \nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nRelatively unchanged large right pleural effusion.  Small left pleural\neffusion, also stable.  No apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging. No suspicious lung nodules or\nmasses.  Extensive compressive atelectasis in the right lower lobe and in the\nposterior segments of the right upper, middle and left lower lobes.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show redemonstration of cirrhosis\nwith splenomegaly and ascites.",
            "output": "1. No evidence of pneumonia or aspiration.\n2. Stable pleural effusions, large to the right and small to the left, with\nadjacent moderate compressive atelectasis of the right upper, middle and lower\nlobes."
        },
        {
            "input": "Large bilateral pleural effusions are present with interval increase,\nsubstantial in left pleural effusion and decrease in the right pleural\neffusion flow from large to moderate.  Right pigtail catheter is in place.\n\nImage portion of the upper abdomen demonstrates stigmata of cirrhosis,\npartially imaged with splenomegaly, ascites and nodular appearance of the\nliver.\n\nNG tube tip is in the stomach.  Central venous lines terminate in the right\natrium.\n\nCoronary calcifications are seen in LAD, highly concerning for atherosclerotic\ndisease giving the patient's age.  There is evidence of anemia.  Heart size is\nnormal.\n\nAirways are patent.  Left upper lobe 2 nodules are new, series 302, image 22\nhighly concerning for infectious process.  Bibasal consolidations are most\nlikely areas of atelectasis secondary to pleural effusions..",
            "output": "Improvement of the right pleural effusion but interval increase in left\npleural effusion.\n\n2 new left upper lobe nodules highly concerning for infectious process.\n\nCoronary calcifications concerning giving the patient is ___ severe\natherosclerotic disease.\n\nBibasal atelectasis secondary to pleural effusion\n\nPartially imaged stigmata of cirrhosis in the upper abdomen."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A central venous catheter\nterminates in the IVC.  No supraclavicular, infraclavicular or axillary\nadenopathy.  No calcification of the head and neck vasculature.  The thyroid\nis homogeneously attenuating without focal nodularity.\n\nUPPER ABDOMEN: The partially visualized upper abdomen demonstrates\nsplenomegaly measuring up to 18 cm.  Additionally, partially visualized\nhepatomegaly and small volume ascites are consistent with a history of known\ncirrhosis.\n\n\nMEDIASTINUM: Multiple, subcentimeter mediastinal lymph nodes measuring up to 7\nmm in short axis.\n\nHILA: No enlargement of the hila contours to suggest adenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No evidence of a pericardial\neffusion.  Mild calcification of the coronary arteries most pronounced in the\nLAD.  Additionally, mild circumferential calcification of the ascending and\ndescending aorta are consistent with premature atherosclerotic disease.  The\nvascular calibers of the ascending aorta, descending aorta and main pulmonary\nartery are within normal limits.\nPLEURA: Small, simple, bilateral pleural effusions with adjacent relaxation\natelectasis.\nLUNG:\n\n1. PARENCHYMA: There is confluent consolidation in the right lower lobe is\nconsistent with right lower lobe pneumonia.  The left hemithorax, right upper\nlobe and right middle lobes are clear.  A partial left major fissure is\ndemonstrated, (series 5, image 89).\n2. AIRWAYS:  The airways are patent to the segmental level.  No evidence of\nperibronchial thickening, mucous plugging or bronchiectasis\n\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesions to suggest\nmalignancy or infection.",
            "output": "1. Confluent consolidation in the right lower lobe is consistent with right\nlower lobe pneumonia.\n2. Small, simple, bilateral pleural effusions.\n3. Partially visualized hepatosplenomegaly and small volume ascites are\nconsistent with a history of known cirrhosis.\n4. Mild calcification of the coronary arteries, and mild circumferential\ncalcification of the ascending and descending aorta are consistent with\npremature atherosclerotic disease.\n\nRECOMMENDATION(S):  A follow-up chest radiograph ___ weeks after the\ncompletion of treatment is recommended to ensure resolution.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:58 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber has minimal\ncalcification.  The heart is normal in size with coronary artery\ncalcifications in the LAD which are prominent for patient's age.  No\npericardial effusion is seen.  A right IJ central venous catheter terminates\njust below the right atrium in the upper IVC, unchanged.  Diffuse\nhypoattenuation of the blood pool relative the myocardium is suggestive of\nanemia.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There may be minimal more pleural fluid in the right fissures\nthan on prior, however overall a small right pleural effusion is not\nsignificantly changed.  Small left pleural effusion is not significantly\nchanged.  No pneumothorax.\n\nLUNGS/AIRWAYS: Consolidation at the right lung base is not significantly\nchanged.  No new focal consolidation.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The spleen is partially visualized, however appears enlarged in the\naxial diameter, measuring 16 cm, stable.  There is trace ascites in the\nvisualized portion of the upper abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No significant change in a consolidation at the right lung base.  No new\nfocal consolidation.\n2. No significant change in small bilateral pleural effusions."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild\ncoronary calcifications.  Otherwise, the heart, pericardium, and great vessels\nare within normal limits based on an unenhanced scan. No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is a distal tracheal stent extending into the right and\nleft mainstem bronchi, which appears patent and in appropriate position. \nThere is a small amount of secretions laying dependently within the stent\n(series 2, image 20).  The distal airways are also patent.  Dependent\natelectasis bilaterally.  There is a 3 mm solid nodule within the right upper\nlobe (series 2 image 18), which is stable since ___.  Calcified\ngranuloma within the right lower lobe.  No new suspicious lung nodules. \nOtherwise, the lungs are clear without focal consolidations.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Chronic elevation of the left hemidiaphragm.  A 13 mm hypodensity\nwithin the posterior right lobe of the liver (series 2, image 55) likely\nrepresents a cyst or biliary hamartoma.  No other abnormalities within the\npartially visualized upper abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Distal tracheal stent extending to the right and left mainstem bronchi,\nwhich appears patent and in appropriate position.  There is a small amount of\nsecretions layering dependently within the stent.\n2. 3 mm solid nodule within the right upper lobe, stable since at least ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\n1.0 cm nodule in the left thyroid lobe.  No enlarged lymph nodes in either\naxilla or thoracic inlet.  No abnormalities on the chest wall.  Mild\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is moderately enlarged with dilation of both atria.  No pericardial\neffusion.  Mild atherosclerotic calcifications in the coronary arteries and\naorta, none in the cardiac valves.  The pulmonary arteries and aorta are\nnormal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  5 mm solid nodule in the left apex (___).\nScattered tiny calcified granulomas, for example in the left upper lobe\n(03:41).  Ill-defined ground-glass opacities in the left lower lobe, likely\ntransient inflammator/infectious findings.\n\nCHEST CAGE:\nLytic heterogeneous lesion in the left lateral fifth rib with cortical\ndestruction.  A smaller lytic lesion also destroying the cortices is noted in\nthe lateral left sixth rib.  A lytic lesion in the vertebral body of T7 is\nassociated to mild trabeculae and could represent a hemangioma.  No acute\nfractures.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Heterogeneous osseous lesions in left ribs, notably fin the lateral fifth rib.\nA bone scan is recommended to evaluate for the possibility of metastatic\ndisease.\nSmall solid nodule in the left apex, undetermined.\nIll-defined ground-glass opacities in the left lower could be attributed to\nincidental inflammatory/infectious process.\n\nRECOMMENDATION(S):  CT follow up in 6 months is recommended for further\nevaluation.\n\nBone scan is recommended given concern for metastatic involvement of the left\n5th rib.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 15:09 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nNo supraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: Imaged upper abdomen is notable for cirrhotic liver morphology,\nascites and splenomegaly.  An enteric tube courses through the proximal\nstomach, the distal tip of which is not imaged in this study.\n\nMEDIASTINUM: There are no abnormal mediastinal masses or mediastinal\nadenopathy.\n\nHILA: There are no suspicious hilar masses or lymphadenopathy within\nlimitations of this noncontrast enhanced scan.\n\nHEART and PERICARDIUM: Cardiomegaly.  No pericardial effusion.\nPLEURA: Trace left pleural effusion.  No pneumothorax\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the lung parenchyma, particularly the bilateral\nlower lobes, is limited by motion artifact.  Within limitations of the study\nthere is consolidating opacity within the dependent aspect of the left lower\nlobe which may represent left lower lobe pneumonia or atelectasis.  The\npreviously described 3 mm pleural based left lower lobe nodule and the 3 mm\nright upper lobe nodule are not well seen in this study, likely obscured by\nmotion artifact.\n2. AIRWAYS:  Within limitations of this motion degraded study, the central\nairways appear patent.\n3. VESSELS:  The central pulmonary vasculature appears prominent bilaterally\nsuggestive of volume overload.  The left PICC tip terminates within the distal\nSVC.  Coronary artery atherosclerotic calcifications and thoracic aortic\natherosclerotic calcifications are noted.\nCHEST CAGE: No aggressive osseous lesions or acute fractures.",
            "output": "1. Motion artifact limits evaluation of the lung parenchyma, particularly the\nlung bases.\n2. Within the limitations of this study, there is cardiomegaly and prominence\nof the bilateral central pulmonary tree suggestive of volume overload.\n3. There is consolidative opacity within the dependent aspect of the left\nlower lobe which may represent changes related to pulmonary edema, however\nleft lower lobe pneumonia or atelectasis are on the differential.\n4. Trace left pleural effusion.\n5. Cirrhosis, ascites and splenomegaly."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main pulmonary artery is dilated,\nmeasuring 3.6 cm..\n\nPULMONARY PARENCHYMA:  There is right greater than left lower lobe\natelectasis.  There is no emphysema.  There are scattered punctate granulomas.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of pneumonia.\n2. Dilated main pulmonary artery is similar to prior, which can be seen with\npulmonary arterial hypertension.\n3. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "CHEST: A left upper extremity access PICC line is seen terminating in the mid\nSVC.  Small thyroid nodules are noted.  Lymph nodes in the superior\nmediastinum appear mildly prominent measuring up to 1 cm in maximal dimension.\nThoracic aorta is mildly calcified and normal in caliber.  Coronary artery\ncalcification is moderate.  The heart is within normal limits of size without\npericardial effusion.  The main pulmonary artery is stably enlarged which\ncould reflect pulmonary arterial hypertension.  No central filling defects are\nseen within the pulmonary arterial tree.  There is a large simple appearing\nright pleural effusion which is new from the most recent PET-CT exam.  There\nis significant compressive atelectasis in the right lower lobe and right\nmiddle lobe.  There is trace left pleural effusion with mild subjacent\natelectasis.  No worrisome nodule, mass or consolidation is seen within the\nlungs.  No signs of acute traumatic injury.\n\nAbdomen: The liver appears nodular consistent with cirrhosis.  There is\npartially occlusive thrombus within the main portal vein which is seen\npartially extending into the left and right portal venous branches.  The\nacuity of this finding is unclear given no recent contrast enhanced priors and\nno recent abdominal ultrasound.  The gallbladder is normal.  Splenomegaly up\nto 16 cm in length.  Splenic vein appears patent.  The adrenal glands are\nnormal.  The kidneys are somewhat small though enhance symmetrically.  There\nis a stone within the right renal lower pole measuring approximately 5 mm in\nmaximal dimension.  An intermediate density lesion arises from the lower pole\nof the left kidney on series 2, image 154 measuring 11 x 17 mm, present on the\nprior exam as well.  With central attenuation approximately 73, possibly a\nhemorrhagic cyst though not fully characterized.  Several hypodense cortical\nlesions are seen within the kidneys which are too small to characterize. \nThere is a retroaortic left renal vein.  The aorta is moderately calcified\nthough normal in caliber.  There is no retroperitoneal lymphadenopathy.  No\nlymphadenopathy is seen within the upper abdomen or tracking along the small\nbowel mesentery.  The pancreas is normal.  The stomach is decompressed.  There\nis a small hiatal hernia.  The duodenum is normal aside from the presence of a\nsmall periampullary duodenal diverticulum.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  A\nperitoneal drain is seen terminating in the deep pelvis.  Despite the\nindwelling peritoneal drain, there is large volume ascites which appears\nsimple.  Haziness along the mesentery likely reflects portal hypertension.  No\ndefinite thrombus within the SMV.  The colon contains a mild fecal load. \nDiverticulosis is present.  There is no evidence of acute colitis or\ndiverticulitis.  At the level of the anal verge, there is prominence of the\nanus, with relative thickening and hyperemia, for which clinical correlation\nis advised for possible inflammation/infection and/or prolapse.  No adjacent\ncollection.  The urinary bladder is moderately distended with a thickened wall\nwhich could reflect cystitis.  Prostate is not enlarged.  There is no pelvic\nsidewall or inguinal adenopathy.\n\nBones: No acute fracture.",
            "output": "1.  No acute sequelae of trauma.\n2.  Large simple appearing right pleural effusion, new from prior with\ncompressive atelectasis in the right middle and lower lobes.  Trace left\npleural effusion.\n3.  Cirrhotic liver, large volume ascites with peritoneal drain in place,\nsplenomegaly.  Partially occlusive thrombus within the main portal vein\nextending into the right and left branches.\n4.  Hyperemia, thickening and possible prolapse of the anus for which clinical\ncorrelation is advised.\n5.  Thickened urinary bladder, correlate for cystitis.\n6.  Atrophic appearance of the kidneys, nonobstructing right kidney stone,\nindeterminate hyperdense left renal lesion, appears size stable, may represent\na hemorrhagic cyst though not fully characterized.\n6.  Additional nonemergent findings as above.\n\n\nNOTIFICATION:  Changes from the initial wet read were discussed over the phone\nwith Dr. ___ at 11:25 on ___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are increased in number and mildly\nincreased in size, likely reactive.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  There is a trace pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  Left\napproach PICC terminates at the cavoatrial junction.\n\nPULMONARY PARENCHYMA AND PLEURA: There has been interval placement of a right\nlung base pigtail catheter which terminates within the right lower pleural\nspace with interval decrease in size of the right pleural effusion, which\nremains moderate to large.  There is extensive associated atelectasis,\nparticularly of the right lower lobe.  Linear areas of parenchymal\nopacification in the lower right lung likely represent re-expansion pulmonary\nedema.  There is a small anterior pneumothorax (302:95), likely related to\npigtail catheter placement.  There has been interval increase in size of a\nsmall to moderate left pleural effusion with worsening left lower lobe\natelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for a\ncirrhotic liver with moderate ascites.",
            "output": "1. Interval placement of a right pleural drainage catheter with decreased size\nof the right pleural effusion, still moderate to large, with persistent\nassociated right-sided atelectasis and a new small right pneumothorax.\n2. Parenchymal opacification in the aerated portions of the right lung likely\nrepresents re-expansion pulmonary edema.\n3. Interval increase in small to moderate left pleural effusion with increased\nleft lower lobe atelectasis.\n4. Evaluation for superimposed consolidation is precluded by noncontrast\ntechnique."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is left greater than right axillary\nlymphadenopathy, with left axillary lymph nodes measuring up to 11 mm (03:40).\nRight hilar lymph nodes measure up to 13 mm (3:61) mediastinal lymph nodes are\nnot enlarged.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral lower lobe band like opacities most consistent with\natelectasis.  There are also multiple foci of peribronchovascular ___\nopacities throughout both lungs.  This, in combination with bronchial wall\nthickening is consistent with small airways inflammation.  A 7 mm nodular\nopacity in the left lower lobe is most likely inflammatory (3:69).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is diffuse hepatic steatosis.  The spleen is enlarged,\nmeasuring up to 15.5 cm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small airways inflammation, diffuse ___ opacities, and mucous\nplugging is suggestive of small airways inflammation.\n3. Nonspecific bilateral axillary lymphadenopathy.\n4. Hepatic steatosis and splenomegaly.\n5. 7 mm nodule in the left lower lobe is most likely infectious/inflammatory. \nHowever, imaging upon resolution of symptoms is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid appears unremarkable.  No\nsupraclavicular lymphadenopathy is identified.  There are bilateral axillary\nlymphadenopathy, left greater than right, measuring up to 1.2 cm in short axis\n(3; 14), similar to prior.\n\nUPPER ABDOMEN: Visualized portion of the upper abdomen demonstrates partially\nvisualized splenomegaly.\n\nMEDIASTINUM: Residual thymus noted in the anterior mediastinum.  No\nmediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  No substantial coronary\nartery calcifications are seen.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Interval resolution of previously seen left lower lobe\npulmonary nodule.  No new pulmonary nodule or focal consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels bilaterally.\n3. VESSELS:  The aorta appears normal in caliber.  The pulmonary arteries\nappear normal in caliber with no evidence of central pulmonary embolism.\nCHEST CAGE: No suspicious lytic or sclerotic lesions are identified.",
            "output": "Interval resolution of previously seen left lower lobe pulmonary nodule,\nlikely infectious or inflammatory in etiology.  No new pulmonary nodules.\n\nPersistent splenomegaly and axillary lymphadenopathy, unchanged from prior."
        },
        {
            "input": "Imaged thyroid gland is homogeneous in attenuation without focal nodularity. \nScattered axillary nodes do not meet CT size criteria for pathology,\nsymmetric.  There is no supraclavicular adenopathy.  Right hilar adenopathy\nmeasures approximately 1.5 x 2.0 cm (5:86).  There is no left hilar\nadenopathy.  Remaining mediastinal nodes are not enlarged.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Trace pericardial fluid is physiologic.  There are\nno significant coronary artery calcifications.  Heart size is within normal\nlimits.\n\nA nonhemorrhagic and layering right pleural effusion is moderate in volume,\nincreased since study performed ___.  There is associated\ncompressive atelectasis.  There is no left pleural effusion.\n\nAgain present are spiculated nodules within the right lung not appreciably\nchanged in size since prior examination (5:77, 78, 108).  The largest nodule\nwithin the right upper lobe measures up to 7 mm and abuts the mediastinum\n(5:77).  Atelectasis within the right lower lobe obscures visualization of\npreviously described 9 mm nodule.  Nodularity along the right major and minor\nfissures is again appreciated (5:76, 81, 90, 69) and is worrisome for pleural\nmetastatic disease.  A 4 mm opacity within the lingula abutting the\nmediastinum is not significantly changed (5:136).\n\nSclerotic focus within the left scapula (03:12) is unchanged, may reflect bony\nisland.  No worrisome osseous lesion is present within the chest cage. \nVertebral body heights appear preserved.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "1.  Spiculated nodules within the right upper lobe abut the mediastinum, not\nchanged in size or morphology.  Right compressive atelectasis obscures\npreviously described right base nodule.\n\n2.  Moderate right nonhemorrhagic and layering pleural effusion increased in\nsize relative to prior study.  No left pleural effusion.\n\n3.  Nodularity along the right major and minor fissures remains concerning for\npleural metastatic disease.\n\n4.  For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed concurrently, clip number ___."
        },
        {
            "input": "The pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left pulmonary arteries. \nThere is a filling defect in the segmental branch of the left lower lobe\npulmonary artery (6:149 -155) consistent with pulmonary embolism.  The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nSimilar appearance of mild pericardial thickening, associated with\nsubcentimeter nodularity abutting the anterior aspect of the pericardium,\nlikely representing metastatic deposits.  There has been near complete\nresolution of a right-sided pleural effusion status post thoracentesis, which\nis now trace.  There is a small right-sided anterobasal and apical\npneumothorax.  There is no left-sided pleural effusion.\n\nThere is an enhancing consolidative opacity in the right lower lobe, with more\ncentral hypodense area which could be related to aspiration, however\ndeveloping pneumonia cannot be excluded.  Patchy ground-glass opacities in the\nright lower lobe could be related to re-expansion edema, however these should\nbe reassessed on follow-up study, since early lymphangitic spread cannot be\nexcluded.\n\nThere has been no significant interval change in size in multiple bilateral\npulmonary nodules, highly concerning for metastatic disease, including a 1.1\ncm ill-defined right upper lobe nodule abutting the mediastinal pleural\n(05:52), a 7 mm right upper lobe nodule (05:48) and a 4 mm lingular nodule\n(5:78).   A 7 mm right lower lobe lung nodule (5:82) was not seen on prior\nstudy, however this was likely obscured by the pleural effusion.  Multiple\nsubcentimeter nodules are also noted along the right major fissure.\n\nLimited images of the upper abdomen shows multiple hypoenhancing liver lesions\nsuggestive of metastases.  Direct comparison with prior study is limited given\ndifferences in contrast timing, however this overall appear unchanged in size,\nsuch as a 7.8 x 7.7 cm mass involving segment 7 in 8 (5:87).\n\nLimited evaluation of the breasts shows an unchanged 1.6 cm nodule within the\nmedial aspect of the right breast (5:100).  Left port has its tip terminating\nat the cavoatrial junction.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  Subsegmental pulmonary embolus in the left lower lobe.  No evidence of\nheart strain.\n2.  Status post thoracentesis with near complete resolution of a right-sided\npleural effusion and interval development of small right apical and\nanterobasal pneumothoraces.\n3.  Patchy ground-glass opacities in the right lower lobe of the lung could\nrepresent re-expansion edema, however this should be reassessed on follow-up\nstudy since these could represent early lymphangitic carcinomatosis.\n4.  Consolidative opacity in the right lower lobe could represent a\ncombination of aspiration and atelectasis, however developing pneumonia cannot\nbe excluded.  Please correlate clinically.\n5.  Overall unchanged tumor burden as evidenced by similar pulmonary nodules,\nsoft tissue nodules abutting the pericardium and multiple partially imaged\nliver metastases.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:55 ___, 5\nminutes after discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Left pectoral Port-A-Cath terminates in the right\natrium.  The thoracic aorta is normal in caliber.  No large central pulmonary\nembolism.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Borderline right hilar lymph nodes are\nunchanged, and may be reactive in nature (series 6, image 110).  No new\naxillary, mediastinal, or hilar lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: Small nonhemorrhagic right pleural effusion with associated\natelectasis.  No pleural effusion on the left.  No pneumothorax.\n\nLUNGS/AIRWAYS: Multiple small subpleural and perifissural nodules are stable\nsince ___ (series 6, image 70, 89, 90, 96, 113, 123, 159, 169),\nindeterminate.  2 mm nodule within the right upper lobe is also stable (series\n6, image 65).  A previously visualized right basilar nodule is obscured by the\npleural fluid on today's examination.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multiple small subpleural and perifissural nodules are stable since ___, indeterminate.  2 mm right upper lobe nodule is also stable. \nPreviously visualized right basilar nodule is obscured by pleural fluid. \nBorderline right hilar lymphadenopathy.  No new lymphadenopathy.\n2. Small nonhemorrhagic right pleural effusion, decreased since ___.\n3. Please refer to the abdominal CT with the same date for evaluation of the\nintra-abdominal structures."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Right hilar lymph node\nis enlarged, series 4, image 37, minimally increased since the prior study\nfrom 15 x 14 mm to 16 x 18 mm.  No additional hilar or axillary\nlymphadenopathy is present.  No supraclavicular lymphadenopathy seen\n\nAorta and pulmonary arteries are unremarkable.  Right pleural effusion is\nsmall, unchanged.  Right lower lung atelectasis is unchanged.\n\nThere are no lytic or sclerotic new lesions demonstrated.  Pre-existing\nsclerotic nodule in the vertebral body of T1 and T2 and T3 are more\nconspicuous on the current examination and might reflect sequela of\nchemotherapy.  Sternal sclerotic lesion, series 7, image 7 has substantially\nmost sclerotic margins than on the previous examination and overall is 3 cm as\ncompared to 2 cm on the previous study.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules are similar with no new nodules or growing nodules\ndemonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.",
            "output": "Interval increase in the sclerotic component of the bone metastasis as\ndescribed for assessment of the intra-abdominal skeleton please review the CT\nabdomen and pelvis and the corresponding report\n\nUnchanged pulmonary nodules\n\nRight basal atelectasis and right pleural effusion, unchanged"
        },
        {
            "input": "The lungs are well expanded.  In the right lung are multiple nodules,\nincluding a spiculated nodule measuring 5 x 7 mm in the anterior right upper\nlobe abutting the mediastinum (4:94), 3 mm right upper lobe nodule (4:133,\n159), and right base nodule measuring 6 x 9 mm nodule (4:196).  Millimetric\nnodularity along the right major and minor fissures, in combination with a\nsmall right pleural effusion, is concerning for pleural metastatic disease.  A\ntriangular perifissural nodular opacity in the right upper lobe (4:82) is\ncompatible with an intrapulmonary lymph node.  No pneumothorax is appreciated.\n\nThe thyroid gland is unremarkable.  There is no axillary, supraclavicular, or\nmediastinal lymphadenopathy.  The heart is normal in size without pericardial\neffusion or coronary artery calcification.  The great vessels are normal in\ncaliber.\n\nNo focal lytic or sclerotic osseous lesion to suggest neoplasm or infection is\nidentified.\n\nThis exam is not tailored for evaluation of infra diaphragmatic structures. \nMultiple hepatic hypodensities and a hypodense pancreatic tail mass are better\nevaluated on prior contrast-enhanced CT abdomen/pelvis.",
            "output": "1. Multiple millimetric nodules along the right major and minor fissures\ncalming combination with a small right pleural effusion, is concerning for\npleural metastatic disease.\n2. Spiculated nodules in the right upper lobe and right base are atypical in\nconfiguration for metastatic disease, with morphology more consistent with a\nlung primary malignancy.\n\nRECOMMENDATION(S):  3 month followup CT chest to evaluate spiculated nodules\nin the right upper lobe and right base."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland enhances\nhomogeneously.  Supraclavicular and axillary nodes are not pathologically\nenlarged by size criteria.  Chest wall is unremarkable.\n\nUPPER ABDOMEN: Left adrenal nodule measures 22 x 13 mm (2:61).\n\nMEDIASTINUM: Multiple markedly enlarged mediastinal lymph nodes are noted. \nRight upper paratracheal station node measures 19 x 16 mm (4:94).  A left\nlower paratracheal station node measures 32 x 29 mm (4:108).  Most pronounced\nis confluent sub-carinal lymphadenopathy measuring 44 x 40 mm (4:149).\n\nHILA:  There are multiple soft tissue masses in the right hilus.  Soft tissue\nmass located superiorly measures 30 x 23 mm (4:149).  The largest is\ninfrahilar in location and measures up to 34 x 33 mm (4:175).  This could\nrepresent either extensive hilar lymphadenopathy, primary lung malignancy, or\na combination of both.  Of note, there is no hilar lymphadenopathy on the\nleft.\n\nHEART and PERICARDIUM: Heart is normal in size, without a pericardial\neffusion.\n\nPLEURA: Trace pleural effusion on the right.  No pleural effusion on the left.\nThere is no pneumothorax.\n\nLUNG:\n\nPARENCHYMA:  There is severe upper lobe predominant centrilobular and\nparaseptal emphysema.  There is pleural-parenchymal scarring at the lung\napices.  There is a lobulated subpleural opacity in the right lower lobe\n(4:220) which is nonspecific, and can be re-evaluated at the time of the next\nfollow-up.  Pulmonary nodules are as follows:\n- posterior segment of the right upper lobe nodule measuring 8 x 5 mm,\npreviously 7 x 4 mm (4:117).  Apparent differences in measurement may be\ntechnical\n- right middle lobe nodular opacity measuring 13 x 7 mm (4:216)\n- Anterior left upper lobe, 2 mm (4:78).\n- Left upper lobe subpleural nodule, 1 mm (4:98)\n\nAIRWAYS:  The right middle lobe bronchi, particularly the lateral segmental\nbranch, is narrowed as it courses through the hilar soft tissue mass (4:178),\nbut remains patent distally.  Diffuse bronchial wall thickening is\nnonspecific, and likely reflects chronic small airways inflammation.\n\nVESSELS:  Ascending thoracic aorta is top-normal in size, measuring up to 40\nmm (4:152), little changed from ___.  Main pulmonary trunk is normal in\ncaliber.  Right middle lobe pulmonary artery appears slightly attenuated by\nthe adjacent soft tissue (4:166), but remains patent.\n\nCHEST CAGE: No suspicious lytic or sclerotic lesions are identified.",
            "output": "1. Several large right parahilar soft tissue masses measuring up to 34 x 33\nmm, suspicious for primary lung malignancy with adjacent nodal metastases. \nLymphoma is felt to be less likely given the asymmetrical distribution of the\nparahilar masses and the presence of a new left adrenal nodule in this patient\nwith severe background emphysema.  Biopsy is recommended, with both parahilar\nand sub-carinal masses accessible by transbronchial approach.\n2. Trace right pleural effusion.\n3. Prominent ascending aorta, measuring 40 mm, unchanged from ___.\n\nRECOMMENDATION(S):  Transbronchial biopsy of the mediastinal and/or right\nparahilar soft tissue masses.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:51 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM: Lower esophagus mildly patulous.  No good evidence for\nobstruction or mass.  Atherosclerotic calcification not apparent in head and\nneck vessels or coronary arteries.  Aorta and pulmonary arteries are normal\nsize.  Pericardium physiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Sub 3 mm peripheral nodule left lower lobe, 7:169 is\nthe only focal pulmonary abnormality.  Tracheobronchial tree normal to\nsubsegmental levels.  No pleural abnormality.\n\nCHEST CAGE: Unremarkable",
            "output": "Solitary 2-3 mm left lower lobe lung nodule, indeterminate.  Otherwise normal\nchest CT.  The need for followup imaging depends on staging and management\nconsiderations regarding the patient's extrathoracic malignancy.  Otherwise\n___ guidelines for management of incidentally discovered pulmonary\nnodules would apply.  See recommendations below.\n\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  There are no abnormalities on the\nchest wall. No atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. Small pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\nascending or descending aorta.  Mild calcification in the aortic arch.  The\naorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is mildly patulous, which is new when compared to prior CT. \nSmall mediastinal lymph nodes, none pathologically enlarged by CT size\ncriteria. Multiple subcentimeter right hilar lymph nodes, that appear larger\nwhen compared to prior CT of the chest from ___ but do not reach\npathological criteria.  Cap\n\nPLEURA:\nNo pleural effusions. No pneumothorax.\n\nLUNGS:\nThe airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging.   No consolidations or\natelectasis.\n\nStable sub 3 mm peripheral nodule in the left lower lobe (series 6; image\n168).\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions. Although there\nare no bone lesions in the imaged chest cage suspicious for malignancy or\ninfection, it should be noted that radionuclide bone and FDG PET scanning are\nmore sensitive in detecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to separate report for CT abdomen and pelvis acquired on the same\nday for findings below the diaphragm.",
            "output": "1. Solitary, indeterminate 2-3 mm left lower lobe lung nodule.  The need for\nfollowup imaging depends on staging and management considerations regarding\nthe patient's extrathoracic malignancy.  Otherwise ___ guidelines for\nmanagement of incidentally discovered pulmonary nodules would apply.  See\nRECOMMENDATIONS below.\n2. Several subcentimeter right hilar lymph nodes are not pathologically\nenlarged but are slightly larger today  compared to CT of the chest from ___.  No immediate follow-up is recommended, however recommend\nmonitoring on any subsequent CT of the chest.\n3. New small pericardial effusion, not necessarily significant.\n4. Mildly patulous esophagus.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  Mild gynecomastia, otherwise there are no chest wall abnormalities. \nNo atherosclerotic calcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Stable small mediastinal lymph nodes ranging up to\n6 mm in the right lower paratracheal station.  No enlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Minimal\natherosclerotic calcifications in the coronary arteries, none in cardiac\nvalves or aorta.  Calcified ligamentum arteriosum.  Aorta and pulmonary\narteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  A left lower lobe 3 mm\nsubpleural nodule is stable (5:179).  No new or growing lung nodules.  No\nfocal consolidations.  No pleural effusions or thickening.\n\nCHEST CAGE:\nNo acute fractures.  Moderate dorsal spondylosis.  Stable mild height loss in\nthe T7-T9 vertebral bodies.  No lytic or sclerotic bone lesions worrisome for\nmalignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show stable hypodensities scattered\nthroughout the liver parenchyma ranging up to 8 mm.  No focal splenic lesions.\nAdrenals are unremarkable.",
            "output": "Stable left lower lobe 3 mm subpleural nodule.  No new or growing nodules.\n\nStable hypodense liver lesions ranging up to 8 mm."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormality in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in the head and neck or the coronary arteries, aortic valve is\nnot calcified, pulmonary arteries and aorta are normal size and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing measurable lung nodules: 3 mm\nsubpleural nodule left lower lobe, 5:132, unchanged since at least ___.  Punctate nodule, left upper lobe, 5:45, unchanged since at least ___ and probably the preceding ___.\n\nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities.\n\nCHEST CAGE: No compression or pathologic fracture or destructive bone lesion. \nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of active intrathoracic malignancy."
        },
        {
            "input": "HEART AND VASCULATURE: Right pectoral pacemaker with leads terminating in the\nright atrium and right ventricle.  Moderate atherosclerotic calcification\nthroughout the thoracic aorta and at the origin of the head and neck vessels. \nThe thoracic aorta is normal in caliber.  Severe coronary calcifications.  The\nheart is mildly enlarged.  Otherwise, the heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  Multiple small\nmediastinal lymph nodes, but none CT criteria for pathologic involvement.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No abnormalities within the left lower lobe to account for the\nabnormality seen on the recent chest radiograph.  There are no focal\nconsolidations.  Mild dependent atelectasis.  There is also subtle septal\nthickening at the lung bases bilaterally, likely reflecting mild fluid\noverload.  There is mild pleuroparenchymal scarring at the bilateral lung\napices.  A subpleural nodule within the right upper lobe with pleural\nextension likely represents an intrapulmonary lymph node (series 301, image\n91).  Additional small punctate nodule within the right lower lobe, which may\nbe partially calcified (series 301, image 127).  No suspicious lung nodules\nrequiring follow-up.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Simple cyst within the upper pole the right kidney.  There is\nadjacent high density, which may represent parenchymal calcification. \nAdditional subcentimeter hypodensities within the kidneys bilaterally are too\nsmall to characterize.  Severe atherosclerotic calcifications of the\nvisualized upper abdominal aorta.\n\nBONES: Spiculated sclerotic lesions in multiple ribs on the right and multiple\nvertebral bodies likely reflect bone islands.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "1. No abnormalities within the left lower lobe.  The abnormality seen on the\nrecent chest radiograph may represent a nipple shadow.\n2. Mild cardiomegaly and septal thickening at the lung bases, likely\nreflecting mild fluid overload.\n3. Severe coronary calcifications."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is mildly enlarged.  No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Calcified mediastinal and\nhilar lymph nodes may be sequelae of prior granulomatous disease.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lungs are clear with the exception of bibasilar\nsubsegmental dependent atelectasis.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable the exception\nof a small hiatus hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Calcified hilar and mediastinal lymph nodes may reflect prior granulomatous\ndisease."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is enlarged.  Small pericardial effusion.  Left chest Wall AICD with\nleads in the right atrium and right ventricle.  Atherosclerotic calcifications\nin the coronary arteries and aorta as well as calcification of the aortic\nvalve and mitral valve annulus.  The aorta and pulmonary arteries are normal\nin caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nSmall bilateral pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels with mild bronchial wall\nthickening and some areas of retained secretions, for example in the right\nmain bronchus.  Moderate centrilobular emphysema, upper lobe predominant.  No\nsuspicious lung nodules or masses.  Small subpleural ground-glass opacity in\nthe left upper lobe, which is new compared to prior study (302:89).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is not visualized and may be either decompressed\nor surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  A 3 mm left calcification in the renal pelvis most likely\nrepresents atherosclerotic disease.  (02:55).  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  The colon is within normal\nlimits, mostly decompressed.  The appendix is not definitively visualized. \nThere is a rectal prolapse.\n\nPELVIS: Foley catheter in the urinary bladder, which is decompressed. \nModerate diffuse ascites.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nSOFT TISSUES: Diffuse anasarca.\n\nOSSEOUS STRUCTURES:\n\nNo acute fractures.  Old healed fractures in the right anterior second through\nseventh and left anterior first through seventh ribs.  Old healed T5 spinous\nprocess fracture.  Compression deformities are noted throughout the\nthoracolumbar spine at T6, T8, T9, T11, L1 and L2.  Healed fractures of the\nright superior and inferior pubic rami.  Grade 2 anterolisthesis of L4 over L5\nsecondary to bilateral L4 pars interarticularis defects. Mild thoracolumbar\nspondylosis.  No suspicious lytic or sclerotic lesions.",
            "output": "1. Moderate ascites and anasarca.\n2. Moderate pulmonary emphysema. No current evidence of pneumonia or pulmonary\nedema.\n3. Small indeterminate ground-glass opacity in the left lower lobe, which may\nrepresent atelectasis or inflammatory changes. Recommend follow-up CT in 3\nmonths.\n4. Small bilateral pleural effusions.  Small pericardial effusion.\n5. Rectal prolapse."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: There are postradiation changes with volume loss and\nbronchiectasis in the right upper lung medially, similar to prior.  There are\nareas of peripheral mucus plugging in the right base, more prominent since\nprior.  There are no consolidations.  Stable mucous plugging in the lingula,\nleft lower lobe peripherally at the base.\nVessels: There are no pulmonary emboli.  Borderline size is mid ascending\naorta, 4.0 cm, stable since prior.\n\nMediastinum and Hila: No adenopathy in the mediastinum, hila, or along mammary\nchain.\n\nHeart and Pericardium: Normal heart size.  No effusion.\n\nPleura: No effusion\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: Postoperative change right breast.\n\nUpper Abdomen: Stable elevation of the right hemidiaphragm.\n\nChest Cage: Postradiation change in the upper right manubrium, right clavicle,\nanterior right ribs, stable since prior.",
            "output": "No pulmonary emboli.\nPostradiation changes.  No metastases, or adenopathy.\nAreas of mucous plugging are mildly more prominent.  No consolidations.\nProminent ascending aorta, 4.0 cm, stable."
        },
        {
            "input": "Thyroid gland is normal. Supraclavicular, axillary, mediastinal and hilar\nlymph nodes are not enlarged. Aorta is unremarkable without dissection or\naneurysm. Great vessels are unremarkable. Pulmonary arteries are normal in\ncaliber and well opacified to the subsegmental level without filling defect to\nsuggest pulmonary embolism.  The patient is status-post mitral valve\nreplacement with a severely enlarged left atrium.\n\nNo evidence of pulmonary parenchymal abnormality. Multiple pulmonary nodules\nare unchanged to slightly smaller in size (5:59, 173, 187, 205, 217, 231\ndegrees, 236, 250).  There is additionally 1 unchanged, calcified granuloma\n(5:182).  No pleural effusion or pneumothorax. Airways are patent to the\nsubsegmental level.\n\nVisualized liver, gallbladder, pancreas, spleen, adrenal glands, kidneys are\nunremarkable.  There is a single, non pathologically enlarged, but prominent\nportacaval lymph node, essentially unchanged since ___.\n\nThere is a severe compression fracture of L1, new since ___ and worse since\n___",
            "output": "1.  Numerous bilateral pulmonary nodules as described above, unchanged since\n___.  Given their stability, they do not require follow-up.\n2.  Severe compression fracture of L1, new since ___ and worse since ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nLinear opacities are visualized in the right lower lobe branches compatible\nwith webbing and may be attributable to prior treated pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild emphysematous changes are visualized in the bilateral\nlungs.  Lungs are clear without masses or areas of parenchymal opacification. \nThere is mild, lower lobe predominant, bronchial wall thickening and mucous\nplugging.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Mild, lower lobe predominant, bronchial wall thickening and mucous\nplugging."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation for pulmonary embolism is limited due to\nbolus timing.  Within these limits, central pulmonary vasculature is well\nopacified.  The evaluation of the ascending aorta is limited due to motion. \nNo dissection demonstrated in the remaining aorta.  No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited due to respiratory\nmotion.  Within these limits, lungs are clear.  There is mild peribronchial\nwall thickening of the lower lobes.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable aside from a\nhemangioma in the right lobe of the liver.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Mildly limited exam due to bolus timing.  No central pulmonary embolus."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent mediastinal lymph nodes including a\n1.4 cm subcarinal lymph node, likely reactive.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Consolidation in the left lower lung field is new compared to\nprior.  Additional consolidation involving the right lower lobe, middle and\nupper lobes, suspicious for infectious etiology.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Hyperdense lesion in the right lobe of liver is partially visualized,\nand previously described hemangioma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. New predominantly basilar consolidations, left greater than right, with\nadditional scattered regions consistent with infectious etiology, suggest\nmultifocal pneumonia.  Prominent mediastinal lymph nodes are likely reactive.\n\nNOTIFICATION:  Contrast extravasation communicated with ___, MD, at\nthe time of the event by ___, MD."
        },
        {
            "input": "Study is moderately degraded by motion, limiting evaluation of the\nsubsegmental pulmonary arteries.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  There focal filling defects within right upper lobe\nsubsegmental pulmonary arteries consistent with pulmonary emboli (303:60, 70).\nAdditional left lower lobe pulmonary embolus may be present, although\nevaluation is limited by substantial motion artifact (___).  The pulmonary\narteries are normal in caliber and there is no evidence of right heart strain.\nThere is no convincing evidence for pulmonary infarction.  The thoracic aorta\nis normal in caliber without evidence of dissection or intramural hematoma. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Nonhemorrhagic pleural effusions are moderate and partially\nloculated on the left and small on the right with substantial associated lower\nlobe atelectasis.\n\nLUNGS/AIRWAYS: Subsegmental atelectasis is noted in the dependent right upper\nlobe (303:65).  Similar appearing areas of linear parenchymal opacity in the\ndependent left upper lobe and lingula likely also represents atelectasis in\nthe setting of low lung volumes and relaxation from the moderate left pleural\neffusion, however superimposed early infectious process is difficult to\nexclude (303:87).  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please see separately submitted report of CT Abdomen and Pelvis from\nthe same date for description of subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Moderately motion degraded study.\n2. Right upper lobe subsegmental pulmonary emboli without evidence of right\nheart strain or pulmonary infarction.\n3. Increased moderate left and unchanged small right nonhemorrhagic pleural\neffusions with substantial associated lower lobe atelectasis.\n4. Irregular parenchymal opacification of the left midlung may represent\natelectasis related to low lung volumes and the moderate left effusion,\nhowever an early infectious process is difficult to exclude.\n5. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:35 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is notable for a 1.5 x 1 cm\nleft thyroid lobe nodule (06:30) as well as a 0.8 cm coarse calcification\nwithin the left thyroid lobe.  Axillary and supraclavicular lymph nodes are\nnot enlarged.  Left chest wall pacer device noted.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen/pelvis for details.\n\nMEDIASTINUM: Mediastinal lymph nodes are nonenlarged.  No anterior mediastinal\nmass.\n\nHILA: Hilar lymph nodes are nonenlarged.\n\nHEART and PERICARDIUM: Heart is mildly enlarged.  No pericardial effusion. \nPacer lead tips are in appropriate position.\nPLEURA: No pleural effusion or pneumothorax.  No pleural calcifications.\nLUNG:\n\n1. PARENCHYMA: Few subcentimeter bilateral calcified granulomas are noted. \nThere is no suspicious nodule.  No cavitary lesion.  No consolidation.\n2. AIRWAYS: Small amount of oropharyngeal secretions are noted within the\ntrachea (20:10).  There is minimal right lower lobe terminal bronchiectasis. \nThe airways are otherwise patent to the subsegmental level.  No bronchiectasis\nor bronchial wall thickening.\n3. VESSELS:  Thoracic aorta is normal in caliber measuring 3 cm.  Main\npulmonary artery is normal in caliber and well opacified to the lobar level\nwithout filling defect to suggest large pulmonary embolism.\nCHEST CAGE: There is asymmetric gynecomastia, left greater than right.  Soft\ntissues are otherwise unremarkable. No focal lytic or blastic lesions\nworrisome for malignancy. No acute fracture.\n\nTHORACIC SPINE: There are 12 rib-bearing thoracic type vertebral bodies. \nMillimetric anterolisthesis of T8 on T9 and T9 on T10 is likely degenerative. \nThere is multilevel intervertebral disc space narrowing, up to severe at the\nT8-T9 level with near complete loss of the disc space, endplate sclerosis,\nSchmorl's node formation, and endplate osteophyte formation.  Degenerative\ndisc space narrowing is to a lesser degree at other levels.  The thoracic\nvertebral body heights and alignment are otherwise preserved.\n\nSevere degenerative disc disease is also partially assessed at the C6-C7 and\nL3-L4 levels.  There is also multilevel overall mild facet degenerative\nchange.  Endplate osteophytes and small disc bulges are seen at multiple\nlevels, though there is no obvious high-grade spinal canal narrowing.  There\nis overall mild bony neural foraminal narrowing at multiple levels, though\nnone appears severe.  No fracture is identified",
            "output": "1. No evidence of malignancy within the chest.\n2. 1.5 cm left thyroid lobe nodule.\n3. Small amount of oropharyngeal secretions.\n4. Multilevel thoracic degenerative changes with up to severe degenerative\ndisc disease at T8-T9 as well as at C6-C7 and L3-L4.  No thoracic spine\nfracture.  Millimetric anterolisthesis of T8-T9 and T9-T10 is likely\ndegenerative.\n5. No suspicious focal bone lesion.\n\nRECOMMENDATION(S):  Recommend non urgent thyroid ultrasound if not previously\nperformed."
        },
        {
            "input": "Left pacemaker with tips terminating in the right atrium, right ventricle and\nthrough the coronary sinus in a left coronary vein.\nHeart is mildly enlarged, unchanged.\nMinimal pericardial effusion is new in comparison to prior.\n\nThe study is not gated.\nModerate atherosclerotic calcifications of the coronaries and aortic annulus,\nare noted also along the thoracic aorta and head and neck vessels.\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.\nThere is no evidence of penetrating atherosclerotic ulcer.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental\npulmonary arteries.\nThe main and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nSmall hypodense nodules with coarse calcification in the left lobe of the\nthyroid.\n\nEndotracheal tube in good position, terminating approximately 2.5 cm from the\ncarina.\nThe study was performed in partial inspiration, bibasilar dependent\natelectasis associated with subsegmental platelike atelectasis of the lingula.\nThere is no evidence of pneumonia.\nBilateral smooth septal thickening and minimal bilateral pleural effusions are\nnew in comparison to prior suggesting moderate pulmonary edema.\n\nABDOMEN:\nNasogastric tube terminates in the stomach.\nLiver is homogeneous, unremarkable with no intra or extrahepatic bile duct\ndilatation.\nGallbladder within normal limits.\n\nPancreas, spleen, adrenal glands are unremarkable.\n\nTiny cortical cysts in the lower pole of the right kidney.  No signs of\nhydronephrosis and there is no evidence of calculi.\nMinimal perirenal fat stranding and left trace of free fluid is nonspecific. \nThere is no free fluid in pelvis.\nNo intra-abdominal free air.\nUreters are collapsed.\nThe urinary bladder is empty with Foley catheter\n\nMild diverticulosis along the sigmoid and left colon with no signs of\ndiverticulitis.\nSmall bowel is unremarkable.\nAppendix within normal limits.\n\nExtensive atherosclerotic calcifications and soft plaques along abdominal\naorta and iliacs, no evidence of abdominal aneurysm.\n\nMinimal subcutaneous edema along the walls of the abdomen and pelvis.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nMultilevel degenerative changes of thoracic and lumbar spine.",
            "output": "-No evidence of pulmonary embolism or aortic abnormality.\n-Bibasilar dependent atelectasis, no evidence of pneumonia.\n-Moderate pulmonary edema associated with minimal bilateral pleural and\npericardial effusion, new in comparison to prior suggesting volume overload.\n-No acute abdominal pelvic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is heterogeneous with\nseveral hypodense nodules up to 1.4 cm in the left lobe, where coarse\ncalcifications in identified.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the abdomen and\npelvis.\n\nMEDIASTINUM: 0.7 cm right lower paraesophageal lymph node is unchanged in\ncomparison to prior (02:28), there is no new mediastinal or hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: Left pacemaker with electrodes terminating in the right\natrium and ventricle, and through coronary since in the left coronary vein.\nMild cardiomegaly, unchanged.\nThere is no pericardial effusion.\nMinimal tumoral atherosclerotic calcifications of the coronaries and normal\ncaliber thoracic aorta and head and neck vessels.\nMain pulmonary artery within normal limits.\n\nLUNG and PLEURA: Endotracheal tube terminates 0.7 cm from carina.\nSmall bilateral pleural effusions with subsequent passive and dependent\natelectasis of the lower lobes, no signs of pneumonia.  No signs of septic\nemboli.\nSmooth septal line thickening with heterogeneous ground-glass opacities\naffecting predominantly the upper lobes suggest vascular congestion and volume\noverload.\n\nCHEST CAGE: Multilevel degenerative changes of the spine with no evidence of\nlytic or sclerotic bone lesions suspicious for infection or malignancy.",
            "output": "-Endotracheal tube too deep, terminates 0.7 cm from carina, possibly\nresponsible for suboptimal ventilation.\n-No source of fever.\n-Volume overload with bilateral small pleural effusions, passive and dependent\natelectasis of the lower lobes, no signs of pneumonia.\n\nRECOMMENDATION(S):  Reposition of the trachea is recommended.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 5:08 pm, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: The bilateral lung apices and bases are excluded.  The\nvisualized pulmonary vasculature is well opacified to the subsegmental level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Atelectasis in right lung base.  Otherwise, lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes of the visualized thoracic spine are mild.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  No acute process within the chest."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere are multiple filling defects in the right sided pulmonary arteries\nconcerning for pulmonary emboli.  These are located in a lobar branch (03:57),\nand multiple segmental and subsegmental branches (3:  87, 109, 111, 119). \nSegmental and subsegmental left-sided pulmonary emboli are also identified\n(3:91, 111, 130).  A tiny wedge-shaped opacity extending to the pleura in the\nright lower lobe is suspicious for a pulmonary infarct ___, 2:82).\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nA 5 mm peripheral pulmonary nodule is incidentally noted in the right middle\nlobe (2:71).  Two smaller 4 mm nodules also present in the right lung (02:39,\n47).  Bibasilar atelectasis is also present.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  Bilateral pulmonary emboli are identified, affecting a right lobar and\nseveral bilateral segmental and subsegmental branches.\n\n2.  A wedge-shaped opacity extending to the pleura in the right lower lobe is\nsuspicious for a small pulmonary infarct.\n\n3.  Incidental note is made of a 5 mm right middle lobe pulmonary nodule and 2\nsmaller 4 mm pulmonary nodules.  By ___ society guidelines, if the\npatient is at low risk for malignancy, follow-up CT in 12 months is\nrecommended to evaluate stability.  If they are high risk, then follow-up CT\nmay be performed at 6 months.\n\nNOTIFICATION:   The above findings and recommendations were communicated via\ntelephone by Dr. ___ to Dr. ___ at 01:30, immediately after discovery."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber and moderately\ncalcified.  Moderate cardiomegaly.  S/p aortic valve replacement.  There is a\npacemaker with 2 endocavitary probes.  Extensive coronary calcifications are\nnoted.\n\nNo pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present.  There\nis a 13 mm right upper paratracheal lymph node, unchanged from prior exam.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a new small left pleural effusion. Trace pleural\neffusion on the right.\n\nLUNGS/AIRWAYS: There is a new small left pleural effusion with secondary\nlinear atelectasis. There is a linear atelectasis in the right lower lobe as\nwell as a small consolidation in the posterior segment of the right lower\nlobe.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Again noted is a 8 mm nodularity in the medial limb of the right\nadrenal, unchanged from prior of ___.  Uncomplicated cholelithiasis.\nFew tiny hemorrhagic/proteinaceous cysts are noted in the right upper pole of\nthe right kidney.\n\nBONES: Prior sternotomy for cardiac surgery.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.  There are consolidated\nfractures of the right ___ and 7th rib and ___ left rib.",
            "output": "1. Small Left pleural effusion and trace of right pleural effusion.\n2. Associated linear consolidations are likely secondary to atelectasis. \nSuperimposed infection is possible but thought to be less likely.\n3. Moderate cardiomegaly.\n4. Uncomplicated cholelithiasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid gland\nis within normal limits.  There is no supraclavicular or axillary\nlymphadenopathy.  There is no chest wall nodularity.\n\nUPPER ABDOMEN: Partially visualized upper abdomen shows a small to moderate\nhiatal hernia.  Otherwise, upper abdomen is unremarkable.\n\nMEDIASTINUM: Small mediastinal lymph nodes are noted, likely reactive.\n\nHILA: There are no hilar lymph nodes which meet CT size criteria for\nenlargement.\n\nHEART and PERICARDIUM: Heart is normal in size.  There are mild aortic valve\nas well as coronary artery calcifications.\nPLEURA: There is a small, complex pleural effusion with significant adjacent\npleural thickening (approximately 14 mm).  There is no left pleural effusion. \nThere is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  In the right lower lobe, there is an approximately 8.9 x 9.2 x\n7.1 cm hypodense collection with thick surrounding rind, which appears\nintraparenchymal consistent with lung abscess.  There is complete collapse of\nthe right middle lobe with fluid within the major and minor fissures.  There\nis minimal residual aeration within the lateral portion of the right lower\nlobe.  There is a ground-glass nodule, measuring approximately 6 mm, in the\nright upper lobe (series 5; image 129), which is likely inflammatory.  The\nleft lung appears clear.\n2. AIRWAYS:  There is compression of the right middle and lower bronchi. \nRemaining airways remain patent to the subsegmental level.\n3. VESSELS:  The main, right, and left pulmonary arteries appear normal in\nsize.\nCHEST CAGE: There are no concerning sclerotic or lytic lesions.  There are no\nacute compression deformities the thoracic spine.  There is moderate to severe\ndegenerative change of the lower thoracic spine.",
            "output": "Approximately 8.9 x 9.2 x 7.1 cm hypodense collection with thick surrounding\nrind, which appears intraparenchymal, consistent with lung abscess. \nCompression of the right middle and lower bronchi with complete collapse of\nthe right middle lobe and minimal residual aeration of the lateral portion of\nthe right lower lobe.  Small, complex right pleural effusion with pleural\nthickening."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  The aorta and pulmonary arteries are normal in caliber.  Stable trace\npericardial effusion\n\nPLEURA: Small loculated right pleural effusion associated with pleural\nthickening approximately (200 cc) is unchanged.\n\nLUNG: There is a large low-density lesion in the right lower lobe measuring\n8.9 x 9.2 x 7.1 cm with a thick rind and central low density consistent with\nknown lung abscess.  There is persistent complete atelectasis of the right\nlower lobe and the right middle lobe.  Secretions are seen within the right\nmiddle lobe and right lower lobe bronchi.  There is also mass effect on these\nbronchi from the abscess.\n\nBONES AND CHEST WALL : Review of bone shows degenerative changes involving the\nthoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "No significant interval change in the large right lower lobe abscess as\ndescribed above measuring 8.9 x 9.2 x 7.1 cm with surrounding thick carina and\ncausing compression of the right middle and right lower lobe bronchi. \nSecretions are seen within the right middle and right lower lobe bronchi with\nevidence of complete atelectasis of the right lower and right middle lobe.\n\nStable small volume right pleural effusion with associated pleural thickening,\napproximately (200 cc).  Series 502 and series 501 show the association of the\npleural effusion, the lung and the abscess."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are increased in number but not\nenlarged, similar to the priors.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is a slightly increased small pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Patient is status post placement of a right pleural\npigtail drainage catheter between the seventh and eighth lateral ribs, which\nterminates in the previously seen large loculated lower lobe abscess.  This is\nsubstantially decreased in size compared with the prior study with minimal\nremaining fluid.  There is trace gas within the abscess cavity (302: 135). \nThere is persistent complete atelectasis of the right middle lobe, although\nmass effect on the right middle lobe bronchus has improved slightly.  The\nbasilar subsegments of the right lower lobe are newly partially re-expanded\nwith persistent mild-to-moderate re-expansion edema and areas of subsegmental\natelectasis.  Opacity at the right lung base likely represents a combination\nof persistent atelectasis and subpulmonic effusion, difficult to the\ndistinguish without the use of IV contrast (302:167).  There is mild\nsubsegmental atelectasis of the left lung base.  The pulmonary parenchyma is\notherwise clear.  Apical interlobular septal thickening has increased slightly\nconsistent with mild volume overload.\n\nAIRWAYS:  The airways are newly patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is a lytic lesion with destruction of the upper\nsternum with a small soft tissue component cortical fragmentation (602:70).  A\nT11 vertebral body hemangioma is noted.  There is a severe compression\nfracture of L1 with 5 mm retropulsion into the spinal canal.  Multilevel\ndegenerative changes are otherwise moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Interval placement of a right-sided pleural drainage catheter with marked\nreduction in size of the previously seen right lower lobe abscess and\nassociated re-expansion of portions of the basilar segments of the right lower\nlobe.  Persistent opacification of the right lung base likely represents a\ncombination of atelectasis and residual fluid, difficult to delineate without\nIV contrast.  Unchanged complete collapse of right middle lobe with\nimprovement in right middle lobe bronchial compression.\n2. Slight interval increase in small pericardial effusion.\n3. Increased interlobular septal thickening in the apices suggesting mild\nvolume overload.\n4. Destructive lytic lesion in the upper sternum raises concern for metastatic\ndisease, with trauma and infection felt to be less likely.  Correlate with\nhistory of malignancy.\n5. Severe compression fracture of L1 with 5 mm retropulsion into the spinal\ncanal, unchanged from the immediate prior study."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is mildly calcified, mildly tortuous and\nnormal in caliber.  No mediastinal, axillary or definite signs of hilar\nadenopathy.  The heart is normal in size and shape without pericardial\neffusion.  Tracheobronchial tree calcifications are noted.\n\nRight lower lobe pigtail drain has been removed.  There is interval\nreaccumulation of a fluid collection within the right lower lobe measuring\napproximately 3.7 x 3.3 x 6.2 cm containing several locules of gas, concerning\nfor abscess.  There is adjacent consolidation in the right lower lobe,\nmarginally improved from the prior exam.  Chronic appearing atelectasis in the\nright middle lobe is also noted.  There is trace right pleural effusion.  No\nnew nodule, mass, or consolidation.\n\nWithin the imaged portion of the upper abdomen, cholelithiasis is noted. \nFecal load is moderate.\n\nBones: A lucent lesion is again seen involving the upper sternal body which is\nconcerning for malignancy.  Compression deformity at L1 is unchanged.  A\nvertebral body hemangioma is noted at T11.",
            "output": "1.  Interval removal of right lower lobe pigtail chest tube with\nreaccumulation of abscess in the right lower lobe measuring 3.7 x 3.3 x 6.2\ncm.  Adjacent right lower lobe atelectasis and likely trace right pleural\neffusion.\n2.  Destructive osseous lesion within the upper body of the sternum could\nreflect focal osteomyelitis, difficult to exclude metastatic disease.  This\nfinding appears unchanged from recent priors.\n\nNOTIFICATION:  Findings were discussed with Dr. ___ (Interventional\nPulm) at the time of this dictation."
        },
        {
            "input": "LOWER NECK: There is a subcentimeter hypodense left thyroid nodule which\nrequires no further evaluation.\n\nAIRWAYS/LUNGS:\nUpper airways are patent.  There is subsegmental atelectasis in the right\nlower lobe.\nThere has been interval re-insertion of a pigtail drainage catheter in the\nright lower lobe.  Previously seen right lower lobe collection has\nsignificantly decreased in size.  There is a 3 x 3 cm hypodensity surrounding\nthe pigtail tip which may represent some residual fluid.  Prominent adjacent\npleural thickening and enhancement is unchanged consistent with known abscess.\nRight middle lobe is collapsed.  Right upper lobe and left lung are clear. \nThere is no new airspace consolidation.\n\nPLEURA:  There is trace right pleural effusion.  There is no pneumothorax.\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.\n\nHEART and VASCULATURE: The heart is normal in size.  There is no pericardial\neffusion.\n\nCHEST WALL: Unremarkable\n\nBONES:  There is no destructive bone lesion.  Severe compression deformity at\nL1 is unchanged.  Degenerative changes are noted in the thoracic spine a lytic\nlesion measuring 18 mm in the proximal sternal body with associated pathologic\nfracture is unchanged.\n\nUPPER ABDOMEN: Limited assessment of the upper abdomen demonstrates gallstones\nwhich are partially included in the field of view.  Note is also made of\nbilateral renal cortical scarring/atrophy.  A small sliding hiatal hernia is\nnoted..",
            "output": "1. Significant interval decrease in size of the right lower lobe lung abscess.\n2. Persistent complete collapse of the right middle lobe.\n3. Stable 18 mm hypodense lesion of the proximal sternum with associated\npathologic fracture is unchanged, which could represent additional site of\ninfection or metastasis.\n4. Cholelithiasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: Redemonstrated 5 mm hypodense nodule in the\nleft lobe of the thyroid.  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main pulmonary artery is mildly\nenlarged, measuring 30 mm, suggestive of pulmonary arterial hypertension.\n\nPULMONARY PARENCHYMA/PLEURA: Multiple subpleural and perifissural nodules are\nunchanged.  A right posterior approach pigtail pleural drainage catheter\nterminates in the right lower lobe the site of prior abscess.  There is a\nsmall amount residual fluid with locules of air suggestive of necrosis, not\nsignificantly changed from most recent prior.  Right lower lobe atelectasis\nand right middle lobe collapse are unchanged.  There is a trace right pleural\neffusion.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nCHEST WALL AND BONES:  There is no new worrisome lytic or sclerotic lesion. \nLytic sternal lesion with associated pathologic fracture is re-demonstrated. \nCompression deformity of L1 is unchanged. Multilevel degenerative changes are\nmoderate to severe.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\ncholelithiasis and lobular atrophic kidneys.",
            "output": "1. Right posterior approach pleural drainage catheter terminates in the site\nof prior lung abscess, with minimal residual collection of fluid and air. \nLarge residual abscess is unchanged since ___, but smaller than ___\nand before.  No evidence of disseminated bronchial infection.\n2. Trace right pleural effusion.\n3. Right middle lobe collapse and right lower lobe atelectasis, unchanged.\n4. Unchanged pathologic sternal fracture with 18 mm lytic lesion.\n5. Unchanged compression deformity of the L1 vertebral body, probably not\ninfectious."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum. \nModerate dilatation of the main pulmonary artery.  Minimal coronary\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  The parenchymal opacity at the bases of the right lower lobe\nhas moderately decreased in extent and severity.  In the interval, the pigtail\ncatheter has been withdrawn from the known right lower lobe abscess.  The\nabscess itself appears to have decreased in size, from approximately 3 cm in\ndiameter to now approximately 1 to 2 cm in diameter, with a small gas\ninclusions.  The adjacent pleura is thickened and the extent of the adjacent\npleural effusion is stable.  The appearance of the left lung parenchyma is\nunchanged.",
            "output": "Removal of the right pigtail catheter from the right lower lobe abscess,\ndecrease in size and extent of the abscess, a small gas inclusion persists. \nThe adjacent parenchymal consolidation in the right lower lobe has decreased\nin extent but the extent of the adjacent pleural effusion is stable."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  There is moderate\ncalcification of the aortic arch and descending thoracic aorta.  The heart,\npericardium, and great vessels are within normal limits.  There are mild\ncoronary artery calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax.\n\nLUNGS/AIRWAYS: Further interval decrease in the extent of right lower lobe\nparenchymal opacity, compatible with resolution of right lower lobe abscess. \nThere is adjacent pleural thickening and small right pleural effusion, also\ndecreased.  Multiple subpleural and perifissural nodules are unchanged.  There\nis persistent atelectasis of the medial aspect of the right middle lobe. \nThere are few scattered left lower lobe and right upper lobe regions of\ncentrilobular ground-glass nodules.  The central airways are patent though\nthere are some areas of mucous plugging in the left lower lobe and distal\nareas of the right upper lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for\ncholelithiasis and atrophic kidneys.\n\nBONES: There is stable appearance of a compression deformity involving the L1\nvertebral body.  Lytic sternal lesion with associated pathologic fracture is\nunchanged in appearance.  T11 vertebral body hemangioma is again noted.",
            "output": "1. Interval decrease in the extent of right lower lobe parenchymal opacity,\ncompatible with resolution of previously seen right lower lobe abscess. \nAdjacent pleural thickening and small right pleural effusion, modestly\nimproved.\n2. Unchanged appearance of lytic sternal lesion with associated pathologic\nfracture.\n3. A few scattered regions of distal airway mucous plugging and centrilobular\nnodules, likely due to small airway inflammation."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and subcentimeter axillary lymph nodes are\nneither pathologically enlarged nor growing.  There are no soft tissue\nabnormalities elsewhere in the chest wall concerning for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Lower esophagus is moderately distended, unchanged. \nAtherosclerotic calcification is not apparent in head and neck vessels or in\nthe coronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and pericardium is physiologic.  Although this study is not\ndesigned for assessment of pulmonary circulation, there is no longer large\nfilling defect in the left descending pulmonary artery or any new defects in\nthe central pulmonary circulation.\n\n\n\nTHORACIC LYMPH NODES: Of previously enlarged lymph nodes are smaller:\n\nLeft upper paratracheal, 7 and 8 mm, 03:51-55, previously 11 and 13 mm.\n\nNo other thoracic lymph nodes are pathologically enlarged by size criteria, or\ngrowing.\n\nLUNGS, AIRWAYS, PLEURAE: Lung volumes have generally improved, perhaps a\nfunction of different breathing instructions for CTA and chest CT, but\nprevious bibasilar atelectasis has resolved.\n\nThere still more than a dozen pulmonary nodules in all lobes, and although no\nnew nodules are present, many have enlarged substantially, for example 17 mm\nleft lower lobe nodule, 3:214, previously 3 mm and 9 x 16 mm nodule right\nlower lobe, previously too small to measure.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Substantial growth since ___ of multiple pulmonary metastases. \nConcurrent involution of previously mildly enlarged upper mediastinal lymph\nnodes.  No new adenopathy.  No pleural abnormality.\n\nPrevious large thrombus, left lower lobe pulmonary artery has resolved. \nCentral pulmonary arteries are clear of filling defects, but the peripheral\ncirculation is not evaluated by this study."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 1.3 cm nodule in the right lobe of\nthe thyroid is stable.  Subcentimeter lymph nodes in both axilla are stable\nand not pathologically enlarged per size criteria.  No soft tissue\nabnormalities in chest wall to suggest metastatic deposits.\n\nCHEST CAGE: There is no evidence of osteo destructive lesions at the level of\nribs, sternum or thoracic vertebra.  No pathologic compression fractures.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: There are several subcentimeter lymph nodes in upper mediastinum\nand thoracic inlet measuring up to 0.8 cm (07:54), unchanged since ___.  0.8 cm enhancing lymph node in the right anterior supradiaphragmatic\nstation (7:236), slightly larger since prior.  Lower paraesophageal enhancing\nmillimetric lymph nodes are unchanged.\n\nHILA: Right perihilar necrotic metastatic mass measures 4.1 x 3.2 cm, in prior\nup to 2.2 cm.  Secretions or tumor invasion in the mildly compressed right\nmain bronchus.  The lesion exerts significant secondary mass effect on the\nbronchus intermedius, and there hyperdense secretions along the obstructed\nbronchus intermedius and lower lobe bronchi.  The contents of the bronchi\nrepresent most likely fluid bronchograms although bronchial invasion cannot be\nexcluded.\nThe right middle lobe is newly and completely atelectatic.  Multiple fluid\nbronchograms with associated subsegmental atelectasis in right lower lobe are\nnew as well.\n\nMultiple metastatic deposits in both lungs has significantly enlarged since ___, examples include right lower lobe dependent nodule now measures\n3.5 cm, in most recent prior 2.2 cm (7:105).  In the medial aspect of middle\nlobe, abutting the mediastinal fat 3.1 cm centrally necrotic nodule was in\nprior 1.6 cm (7:189).\n\nHEART and PERICARDIUM: Heart is normal in size.  Trace pericardial effusion is\nslightly increased since prior, no tamponade findings. Minimal calcifications\nin the coronaries.  Thoracic aorta is normal in caliber main pulmonary artery\nsub bronchial opacification reveals no filling defects.\n\nPLEURA: There is no pleural effusion, although many of the lesions probably\ninvolve th pleura.",
            "output": "Significant progression in multiple pulmonary metastatic nodules, the largest\nis right juxtahilar compressing and possibly invading the right main bronchus.\nThe bronchus intermedius is newly and completely compressed and there is\nsecondary complete atelectasis of the middle lobe.\nHyperdense fluid bronchograms in the bronchus intermedius, middle and right\nlower lobe.  Endobronchial neoplastic extension cannot be ruled out.\n\nRECOMMENDATION(S):  Bronchoscopy might be helpful in differentiating impaction\nof bronchi from tumor invasion."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged there are no chest\nwall lesions concerning for malignancy.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in the head and neck vessels or in the coronary arteries. \nAorta and pulmonary arteries and cardiac chambers are normal size.  Small\npericardial effusion has not enlarged despite growing adjacent pulmonary\nmetastasis.\n\nTHORACIC LYMPH NODES: As follows:\n\nMultiple subcentimeter lymph nodes at the thoracic inlet are stable.\n\n\n6 mm right hilar lymph node is new, 3:31, 4:151.\n\n8 x 14 mm left hilar lymph node, 4:167, was 9 x 8 mm in ___.\n\nThere is no pleural effusion or clear pleural tumor invasion despite multiple\ncontiguous lung nodules.\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Among more than a score of lung nodules, ranging in\nsize up to a stable 22 x 38 mm right upper lobe mass invading the anterior\ncostal and anterior mediastinal pleura, 4:174 the minority are also stable. \nMost areb smaller, such as:\n\n22 x 31 mm juxtahilar right lower lobe mass, 4:147 was previously 37 x 42 mm\nand invaded the bronchus intermedius, leading to impaction of the entire right\nbronchial tree below the upper lobe takeoff.  Bronchial tree is now patent and\nno tumor invasion is evident.  Previously collapsed right middle lobe has\nre-expanded.\n\n29 x 24 mm right lower lobe mass, 4:193, was 30 x 41 mm.\n\n11 x 7 mm left lower lobe nodule, 4:212, was 16 x 20 mm.\n\nHowever there is at least one new nodule,  9 x 16 mm, right lower lobe, 4:221.\n\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "There are dozens of pulmonary metastases ranging in size up to more than 4 cm\nacross.  The majority of these are clearly smaller than in ___.  Some\nare stable.  Only one new nodule is clearly identifiable.\n\nMost striking improvement has been remission of a right perihilar mass that\ninvaded and leg to obstruction of the right bronchial tree serving middle and\nlower lobes.  No bronchial invasion, or endobronchial tumor, is demonstrated\ntoday and previous atelectasis has resolved."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: A peripherally calcified nodule is\nseen in the right lobe of the thyroid, measuring up to 1.2 cm.  There is no\nsupraclavicular, lower cervical, or axillary lymphadenopathy.  Several\nprominent subpectoral lymph nodes are nonenlarged (for example 05:41).  The\nsubcutaneous tissues of the chest wall are unremarkable.\n\nUPPER ABDOMEN: Please see report from dedicated MRI of the abdomen for\ndetailed findings.  In short, there is an incompletely characterized, 2.9 x\n4.2 cm lesion in hepatic segment IV A/B (5:264).  A right renal mass is\nincompletely imaged.\n\nMEDIASTINUM: A prominent prevascular lymph node (5:94), measures up to 1.6 cm.\nAnother prevascular lymph node (05:50) measures up to 1.3 cm.\n\nHILA: No definite hilar lymphadenopathy is appreciated.\n\nHEART and PERICARDIUM: The heart is borderline enlarged.  There is no\npericardial effusion.\nPLEURA: Trace bilateral pleural effusions are likely present.\nLUNG:\n\n1. PARENCHYMA:  Multiple pulmonary nodules are possible pulmonary metastases. \nThe dominant nodules, in the right upper lobe (5:159), right lower lobe\n(5:169) and left upper lobe (5:77) measure 1.2 x 1.0 cm, 1.7 x 1.9 cm, and 1.2\nx 1.1 cm, other nodules are smaller than a centimeter across (5: 66, 107, 140,\n189, 187, 155, 154, 102, 94).  There is bibasilar atelectasis.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal in\ncaliber.  While this study is not tailored to evaluate for patency of the\npulmonary arteries, there is a filling defect involving the left lower lobar\npulmonary artery (for example 5:145), compatible with pulmonary embolism.\nCHEST CAGE: There are no suspicious osseous lesions or acute fractures.",
            "output": "1.  Multiple pulmonary nodules, measuring up to 1.9 cm, are concerning for\nthoracic metastases.  Prominent mediastinal lymph nodes are also concerning\nfor disease involvement.\n2.  Filling defect in the left lower lobar pulmonary artery is compatible with\na pulmonary embolus.\n3.  Please see report from MRI of the abdomen from the same date for\nsubdiaphragmatic findings.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ and Dr. ___ on the telephoneon ___ at 11:48 am,\n20 minutes after discovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Subcentimeter hypodense thyroid\nnodules.  No supraclavicular adenopathy.  No axillary adenopathy.  No gross\nbreast lesions.  Right prepectoral Port-A-Cath in situ with the tip in the mid\nright atrium.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.  Multiple partially calcified\nmediastinal and hilar lymph nodes in keeping with prior granulomatous\ninfection.\n\nHEART and PERICARDIUM: Normal cardiac configuration no pericardial effusion.\nNo aortic valve calcification.  No coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA: Mild biapical pleural-parenchymal scarring.  Left apical nodules\nappear relatively similar compared to prior (5, 25, 28 and 31).  Calcified\nnodules in the left upper lobe (5, 75), left lower lobe (5, 72 and 75) are\nunchanged.  Partially calcified nodules in the right middle lobe (5, 123 and\n142) and right lower lobe (5, 135) are unchanged.  No new or enlarging\npulmonary nodules or masses. No confluent airspace consolidation. No diffuse\nlung disease.\n-AIRWAYS: The airways are patent to the subsegmental level.\n-VESSELS: The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine. No lytic/ destructive\nbony lesions.",
            "output": "No findings to suggest intrathoracic metastatic disease.\nNo new or enlarging pulmonary nodules or masses. No mediastinal adenopathy. No\npleural effusion.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nA central catheter terminates in the low right atrium.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Moderate, right greater than\nleft nonhemorrhagic pleural effusions are new.\n\nAgain seen is mild biapical pleuroparenchymal scarring.  Again seen are left\napical nodules, though difficult to compare due to respiratory motion and\natelectasis.  However, the visualized left upper lobe nodules appear grossly\nsimilar (6:27, 29, 32, 35).  Calcified granuloma in the right middle lobe is\nseen (6:139).  There is mild bibasilar dependent compressive atelectasis.  The\nairways are patent to the subsegmental level.\n\nSmall focal locule of air in the anterior chest wall is likely post surgical\n(5:50).\n\nLimited images of the upper abdomen 2.1 x 1.9 cm area of hypodensity with\nnumerous small locules of air at the hepatic hilum (likely Surgicel) (06:203)\nin the caudate lobe, within the expected location of the previously seen\nhypoenhancing lesion.  Small volume pneumoperitoneum is likely due to recent\nsurgery.  A drain is partially imaged in the left upper quadrant.  There are 3\ncalcifications in the liver, likely related to prior granulomatous infection. \nThere is stable amount of hypodensities surrounding the hepatic vasculature at\nthe hilum, partially imaged.  Patient is status post intrathecal catheter\nplacement.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of acute pulmonary embolism.\n2. New moderate bilateral nonhemorrhagic large pleural effusions with minimal\ncompressive bibasilar atelectasis.\n3. Status post exploratory laparotomy with postsurgical changes and small\namount of pneumoperitoneum.\n4. Probable Surgicel abutting the caudate lobe of the liver.  Please correlate\nwith surgical history.\n5. Previously described lung nodules are suboptimally evaluated on this exam\ndue to atelectasis and motion.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 2:20 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.  Mildly prominent\nbilateral hilar lymph nodes measure up to 5 mm in short axis on the right.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolus is\nidentified.\n\nScattered bilateral subsegmental ground-glass opacities are present in\nmultiple lobes, particularly the lingula and left lower lobe. Mild diffuse\nbronchial wall thickening is also present. Two indeterminate punctate\npulmonary nodules measuring up to 1 mm in the right lower lobe are identified\n(7: 128, 139). A calcified left lower lobe granuloma is incidentally noted.\n\nImages of the upper abdomen show a small hiatal hernia and a partially imaged\nbiliary stent traversing the imaged portions of the common bile duct.  The\npancreatic duct is dilated however, no dominant mass is identified in the\nimage portions of the pancreas, and may be outside of the field of view.\n\nModerate bilateral gynecomastia is present.\n\nNo destructive osseous lesions are identified.",
            "output": "Bilateral subsegmental ground-glass opacities and small airways disease are\nmost likely due to atypical infection (e.g. viral or mycoplasma) or\naspiration.\n\nMildly prominent bilateral hilar lymph nodes may be reactive in nature, but a\nshort-term 3 month followup chest CT is recommended to exclude atypical\nmetastases or sarcoidosis.\n\nTwo indeterminate punctate pulmonary nodules measure up to 1 mm in the right\nlower lobe and may also be reassessed at the time of follow up CT.\n\nPartially imaged mildly dilated pancreatic duct. Known pancreatic mass is\nlikely outside of the field of view. Correlation with prior imaging of this\nregion for is advised.\n\nSmall hiatal hernia."
        },
        {
            "input": "The thyroid is normal.  Numerous measurable mediastinal lymph nodes ranging up\nto 9 mm in the right paratracheal station are not pathologically enlarged.\nThere is no supraclavicular, axillary, or hilar lymphadenopathy. Aorta and\npulmonary arteries are normal size. Cardiac configuration is normal and there\nis no appreciable coronary calcification.  There is no pericardial effusion.\n\nThe airways are patent to the subsegmental level. Previously noted bilateral\nsubsegmental ground-glass opacities have resolved.  Scattered ___\nand micronodules measuring up to 2 mm are unchanged since prior study (series\n9, images 111, 136, 140, 163, and 270) and are not suspicious for metastases.\nNo new nodule is identified. There is no pleural effusion or pneumothorax.\n\nNo lytic or sclerotic osseous lesions suspicious for malignancy is identified.\nA left chest Port-A-Cath terminates in the proximal right atrium.  Note is\nmade of bilateral gynecomastia. There is pneumobilia in the left lobe of the\nliver secondary to a CBD stent.",
            "output": "1.  Interval resolution of bilateral subsegmental ground-glass opacities.\n\n2.  Scattered ___ and micronodules, all unchanged in size since\n___ and are not suspicious for metastases.  No new nodules\nidentified.\n\n3.  Please refer to separate report on CT abdomen and pelvis performed on the\nsame date for discussion of subdiaphragmatic findings."
        },
        {
            "input": "Since ___, widespread bilateral pulmonary opacities are new, and\nare characterized predominantly by widespread ground-glass opacification and\nreticulation with slight nodularity.  Although diffusely involving all lobes\nof both lungs, the upper and mid lungs are affected to a greater degree than\nthe lower lungs.  The widespread new abnormalities reduce sensitivity for\ndetecting small pulmonary nodules, but pre-existing tiny nodule are likely\nunchanged allowing for this factor.\n\nSoft tissue structures of the thorax demonstrate interval increase in size of\nnumerous mediastinal A and bilateral hilar lymph nodes involving multiple\nnodal stations.  Heart size is normal, and there is no pericardial or pleural\neffusion.  Small hiatal hernia is present.\n\nSkeletal structures of the thorax demonstrate no suspicious new lytic or\nblastic lesions in the thorax.",
            "output": "1.  New widespread pulmonary opacities, concerning for pulmonary drug toxicity\nin the appropriate clinical setting.  Differential diagnosis includes atypical\nand opportunistic infections such as pneumocystis pneumonia and a\nhypersensitivity reaction.  An atypical manifestation of metastatic disease is\nmuch less likely considering rapid development since ___.\n\n2.  The acute pulmonary process limits sensitivity for detecting new pulmonary\nnodules, which could potentially be obscured.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 12:07 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Subcentimeter mediastinal lymph nodes have decreased in size and number\ncompared to prior CT.  There are no enlarged axillary or hilar lymph nodes. \nHeart size is normal, and there is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate subdiaphragmatic region, which is fully\nassessed by a separately dictated CTA of the abdomen performed the same date.\n\nSkeletal structures of the thorax demonstrate mild to moderate multilevel\ndegenerative changes in the spine but no new suspicious lytic or blastic\nskeletal lesions.\n\nWithin the lungs, previously present widespread pulmonary opacities have\nresolved.  No new or growing solid pulmonary nodules are detected to suggest\nthe presence of metastases.  Pre-existing nodules are similar to ___ chest CT, including a 2 mm superior segment right lower lobe nodule (120,\n4) a 2 mm right middle lobe nodule (137, 4) and an incidental punctate\ncalcified granuloma in the left lower lobe.",
            "output": "1.  ___ year stability of tiny pulmonary nodules.  No new or growing nodules to\nsuggest pulmonary metastases.\n\n2.  Please see separately dictated CTA of the abdomen from the same date for\ncomplete description of subdiaphragmatic findings."
        },
        {
            "input": "Left thyroid nodule is more conspicuous on the current study, less than 5 mm\nin diameter.  A right upper paratracheal lymph node is unchanged.  Several\nmediastinal lymph nodes are sub 6 mm and unchanged.  Aorta and pulmonary\narteries are unremarkable.  Small bilateral hilar lymph nodes are sub cm in\ndiameter except for largest in the right hilum, series 4, image 34, 10 x 14.5\nmm, stable since ___.  No pericardial or pleural effusion is seen.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\nsub 2 mm pulmonary nodules are stable, series 5, image 107, 121.  No new\nnodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest including top-normal right hilar lymph\nnode."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient is asymmetrically positioned within the\nscanner gantry.  Moderate aortic wall calcifications.  No incidental pulmonary\nembolism.  Status post aortic valve replacement.  Severe coronary\ncalcifications.  No pericardial effusion.  Status post gastric surgery. \nCystic liver lesions as well as other abdominal changes have been previously\nreported in an MR of the liver from ___.  No osteolytic lesions at\nthe level of the ribs, the sternum, or the vertebral bodies.  Moderate\ndegenerative vertebral disease.  No vertebral compression fractures.  Mild\nbilateral apical scarring.  Calcified millimetric left upper lobe granuloma\n(4, 45).  Stable 4 mm ground-glass nodule in the right upper lobe (4, 69). \nMild thickening and irregularities of the airway walls.  2 mm middle lobe\nintrapulmonary lymph node (4, 215.  2 mm subpleural lingular granuloma.  No\npleural thickening, no pleural effusions.",
            "output": "Small stable pulmonary nodules.  No new or growing nodules.  Status post\naortic valve replacement.  No pleural abnormalities.  No lymphadenopathy."
        },
        {
            "input": "Chest:\n\nHeart is borderline in size.  Coronary calcification is moderate.  Patient is\nstatus post endovascular aortic valve repair.\n\nSmall bilateral hilar and subcarinal calcified lymph nodes.  No enlarged lymph\nnodes by size criteria.  There is no pleural or pericardial effusion.\n\n___ opacities in the periphery of the left lower lobe are new and\nsuggest aspiration or pneumonia.\n\nIn the right upper lobe, dense ground-glass nodule of mixed attenuation has an\nirregular shape but measures about 13 x 10 mm in axial ___ (2:31).  In\n___ maximal dimension was only 6 mm and in ___ only 9 mm.  There is perhaps\nminimal early developing solid component measuring about 3 mm.\n\nAbdomen:\n\nLiver is cirrhotic.  A number of hepatic cysts appear unchanged since at least\n___.  Along the posterior margin of the liver, a mass including bulk fat is\nconsistent with a prior ablation site, not fully characterized with this\ntechnique, but with no indication of change allowing for differences in\nmodality.  There is no biliary dilatation.  Patient is status post\ncholecystectomy.  The pancreas appears normal.  Spleen is normal in size and\nappearance.  Adrenals are unremarkable.  Benign appearing cysts are found in\neach kidney, as seen previously.  No evidence for stones, solid masses or\nhydro nephrosis involving either kidney.\n\nPatient is status post hernia repair.  Small bowel appears normal.  Quantity\nof stool along the large bowel is mildly prominent.  Sigmoid diverticulosis is\nmoderate.\n\nSmall fat containing umbilical hernia, as seen previously.\n\nPelvis:\n\nThe prostate is markedly enlarged with central hypertrophy.  Seminal vesicles\nand bladder are unremarkable.  There is no lymphadenopathy or free fluid. \nAorta is tortuous and moderately calcified, but normal in caliber.  Patient is\nstatus post intact right inguinal hernia repair.\n\nBones:\n\nBones appear demineralized.  No displaced fractures are found.  There are no\nsuspicious bone lesions.",
            "output": "1.  Opacities in the left lower lobe suggesting sequela of aspiration\npneumonitis or bronchopneumonia.\n\n2.  Slowly growing predominant the ground-glass nodule at the right lung apex,\nnow measuring up to 13 mm, suggesting primary lung adenocarcinoma.\n\n3.  No evidence of acute injury involving the chest, abdomen or pelvis.\n\n\n\n\nNOTIFICATION:  Findings and recommendations were discussed with Dr. ___\n___ at 7:30 pm by telephone on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Normal thyroid gland. No enlarged\nor growing supraclavicular or axillary lymph nodes.  No soft tissue chest wall\nabnormality.  Mild atherosclerotic calcification of the imaged neck arteries.\n\nUPPER ABDOMEN: This examination is not tailored for subdiaphragmatic\nassessment.  Allowing for this; cirrhotic liver.  Multiple liver lesions\nappear stable and are better characterized on the recent MR liver dated ___.  Please see report for further details.  No splenomegaly. \nBilateral renal cysts.  Scattered atherosclerotic calcification of the imaged\nupper abdominal vasculature.\n\nMEDIASTINUM: Normal esophagus.  No enlarged or growing mediastinal lymph\nnodes.  A small calcified subcarinal lymph node may be secondary to prior\ngranulomatous disease.  No mediastinal mass.  The thoracic aorta and pulmonary\narteries are normal in caliber.  Moderate atherosclerotic calcification of the\nthoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size. Moderate coronary artery\ncalcification.  Status post endovascular aortic valve replacement.  Normal\npostprocedural appearances.  Small pericardial effusion, slightly increased in\nsize.\n\nPLEURA: No pleural effusion or pneumothorax.  Mild biapical pleuroparenchymal\nscarring, stable.\n\nLUNG:\n\n1. PARENCHYMA: Increase in the extent of the ___ nodularity, again\nnoted at the left base, but now involving the lingula inferiorly.  This may be\nsecondary to aspiration/infection.  Mixed density right upper lobe lesion\nmeasuring 13 mm x 12 mm (302:51), stable.  4 mm, 5 mm and 7 mm middle lobe\nnodules, stable (302: 108, 157, 158).  2 mm calcified granuloma left upper\nlobe (302:43), stable.  New 7 mm right lower lobe nodule (302:215).  No\nconsolidation.  Mild emphysema.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nNo bronchial wall thickening or bronchiectasis.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  No fracture.  Moderate spondylosis.  Moderate to severe bilateral\nglenohumeral joint arthropathy.  Moderate levoscoliosis of the lower thoracic\nand upper lumbar spine.  Mild dextroscoliosis of the midthoracic spine.",
            "output": "-Stable size and morphology of the right upper lobe mixed density lesion,\nremains concerning for adenocarcinoma spectrum lesion.\n- Increase in the extent of the ___ nodularity, again noted at the\nleft base, but now involving the lingula inferiorly.  This may be secondary to\naspiration/infection.  Stable multiple pulmonary nodules measuring up to 7 mm.\n-New 7 mm right lower lobe nodule.  Attention on follow-up imaging."
        },
        {
            "input": "HEART AND VASCULATURE: There is mixing of contrast seen in the right main\npulmonary artery (series 3, image 101), apparently from a right middle lobe\nsegmental branch.  Given that most of the right middle lobe is replaced with\ncystic bronchiectasis sing cavitation, this likely reflects altered perfusion.\nThe main pulmonary artery is normal caliber.  Otherwise, pulmonary vasculature\nis well opacified to the subsegmental level without filling defect to indicate\na pulmonary embolus.\n\nThe thoracic aorta is tortuous.  The aortic diameter is at the upper limits\nfor normal measuring 4 cm but without evidence of dissection or intramural\nhematoma.  There is a small amount of soft aortic plaque along the thoracic\ndescending aorta (series 3, image 57).  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is increased right hilar, paratracheal\nand subcarinal lymphadenopathy when compared to the prior study.  A\nconglomerate of lymph nodes in the right paratracheal region measures\napproximately 2.9 x 2 cm.\n\nLUNGS/AIRWAYS: There is a small amount of aerosolized secretions within the\nupper trachea (series 3, image 40).  There is a combination of bronchiectasis\nand cavitation seen in the right middle lobe with essentially no normal\nparenchyma seen.  The largest discrete cavity measures 4.8 x 2.5 cm (3: 108)\nand this contains a small amount of debris which could reflect an aspergilloma\nin the appropriate clinical circumstances (3:112).  Mild bronchiectasis and\nsubpleural scarring seen in the lingula.  New from the prior study there is\nincreased consolidation, bronchiectasis and cavitation in the right apex\n(___).  Mild apical pleural scarring seen on the left.\n\n\nPLEURA: There is a moderately large right-sided pleural effusion with a split\npleura sign and pleural hyper enhancement and mild thickening.  This is\nsimilar in appearance when compared to the prior study from ___ although\nthere were some locules of air that spine.  Nonetheless, the appearances\nremain concerning for either chronic empyema or the sequelae of prior\ninterventions.\n\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates multiple\nhypodense lesions within the right hepatic lobe measuring up to 5.4 cm, which\nappear unchanged from the study from ___, which may represent hepatic\ncysts or biliary hamartomas.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. New consolidation, fibrotic changes, traction bronchiectasis and cavitation\nin the right upper lobe suspicious for post primary TB given the patient's\nhistory..\n3. Progression of the cavitation and bronchiectasis in the right middle lobe. \nA large cavity in the right middle lobe contains a soft tissue nodule which\ncould reflect a tuberculoma or aspergilloma in the appropriate clinical\nconditions.\n4. Traction bronchiectasis and small areas of cavitation in the lingula, also\nsuspicious for involvement.\n5. Moderately large pleural effusion with a split pleura sign and hyper\nenhancement of the pleura suspicious for an empyema however this may also be\nseen in the setting of prior intervention and is not substantially changed\ncompared to the prior study from ___..\n6. Apparent contrast mixing in the right main pulmonary artery stemming from a\nright middle lobar artery, likely reflective altered perfusion secondary to\nthe collapsed and diseased right middle lobe."
        },
        {
            "input": "HEART AND VASCULATURE: Thoracic aorta is tortuous and at the upper limit of\nnormal in caliber measuring 4.0 cm.  Mild amount of atherosclerotic plaque is\nseen at the aortic arch.  While the current study is not optimized for such\ndetection there is no central pulmonary arterial filling defect.  The main\npulmonary artery is normal in caliber.  There is trace pericardial fluid. The\nheart is otherwise normal.  The great vessels are within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy.  As\nbefore, numerous conspicuous lymph nodes are seen within the mediastinum,\nparticularly in the right paratracheal and subcarinal lymph node stations,\nsimilar to prior.  There is right hilar lymphadenopathy.  No mediastinal mass\nor hematoma.\n\nPLEURAL SPACES:  There has been interval removal of a pigtail catheter from\nwhat is now a slightly larger lenticular rim enhancing posterior pleural\ncollection on the right which contains multiple air-fluid levels (4:171). \nThere is no left pleural effusion. There is no pneumothorax.\n\nLUNGS/AIRWAYS: Upper trachea appears somewhat patulous, unchanged from prior. \nCentral airways appear patent.  There is a combination of both bronchiectasis\nand cavitation in the right middle lobe where no normal parenchyma is\nidentified, similar to prior.  As before there is a large cavitary component\nin the right middle lobe which contains a focus of internal debris (04:21). \nBronchiectasis and subpleural scarring are again noted in the lingula.  There\nis bibasilar atelectasis as well as foci of round atelectasis in association\nwith the large right pleural collection.  Extensive consolidation is unchanged\nin the right lung apex.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There are numerous hypodense lesions within the right hepatic lobe\nmeasuring up to 5.5 cm, unchanged from prior.  Patient is status post\nRoux-en-Y gastric bypass.  Otherwise, the included portion of the unenhanced\nupper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Interval removal the pigtail catheter from a now slightly larger, rim\nenhancing posterior pleural collection on the right which contains multiple\nair-fluid levels.\n2. Extensive pulmonary abnormalities are similar to prior including severe\nbronchiectasis and cavitation in the right middle lobe including a large\ncavitary lesion with internal debris.\n3. Unchanged bronchiectasis and subpleural scarring in the lingula."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nEvaluation to the subsegmental level is limited.  The diameter of the\nascending aorta is again in the upper limit of normal, measuring up to 4.0 cm\nin diameter.  There is no evidence of dissection or intramural hematoma. \nOtherwise, the great vessels are within normal limits.  The heart is within\nnormal limits.  No substantial pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Several prominent but not pathologically\nenlarged paratracheal and subcarinal nodes are noted.  No axillary,\nmediastinal, or hilar lymphadenopathy is present.  No mediastinal mass is\nseen.\n\nPLEURAL SPACES: A posterior approach thoracostomy catheter is present within a\nmoderately-sized loculated pleural effusion, associated with pleural\nenhancement.  Several air locules are seen within the effusion.  A trace\neffusion is present on the left.\n\nLUNGS/AIRWAYS: Fibrosis with numerous destructive cavitations are again seen\ninvolving the right middle lobe.  Consolidations involving the right apex are\nsimilar allowing for differences in inspiratory effort.  Comparison with the\nprior study there are multifocal airspace and patchy consolidations primarily\ninvolving the lower lobes, but also seen in the left upper lobe, predominately\nwithin the dependent portions of the lungs.  The patulous trachea is patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen a prominent gallbladder and\nmultiple low attenuating liver lesions.\n\nBONES: Multilevel degenerative changes of the thoracic spine without\nsuspicious osseous abnormality.? There is no acute fracture.",
            "output": "1. Progressive bilateral multifocal consolidations in a background of\nsignificant fibrosis and destructive changes in the right middle lobe,\nsuggestive of multifocal pneumonia most notable in the lower lobes.  Given the\ndependent location of these changes, this may be secondary to aspiration.\n2. Persistent right loculated pleural effusion with catheter in place.\n3. No evidence of pulmonary embolism to the segmental level."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.  The remainder\nof the chest wall is unremarkable.\n\nUPPER ABDOMEN: Imaged portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM: Numerous borderline enlarged mediastinal lymph nodes are likely\nreactive, the largest measuring up to 10 mm in the prevascular station.\n\nHILA: Discrete hilar lymph nodes are not well seen due to the absence of\nintravenous contrast.  No hilar mass.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\n\nPLEURA: Small left pleural effusion.  No right pleural effusion.  No\npneumothorax.\n\nLUNG:\n\nThere is a dense consolidation with air bronchograms involving nearly the\nentire left lower lobe.  There is likely some mucous impaction of subsegmental\nleft lower lobe airways.  Airways are otherwise patent to the subsegmental\nlevel.  No other focal consolidations are seen.  There is atelectasis at the\nright lung base.  No gross mass.\n\nCHEST CAGE: No aggressive osseous lesions or acute fracture.",
            "output": "1. Consolidation involving nearly the entire left lower lobe is compatible\nwith pneumonia.  There is a small left parapneumonic effusion.\n2. Reactive mediastinal lymphadenopathy."
        },
        {
            "input": "CHEST:\n\nTechnically adequate study with no evidence of pulmonary embolism or acute\naortic syndrome.\n\nIncidental note is made of an aberrant right subclavian artery.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nThe thyroid gland is within normal limits.\n\nNo pleural or pericardial effusion.\n\nThe airways are patent.\n\nIll-defined ground-glass change noted in the posterior segment of the right\nupper lobe may represent foci of infection, especially given the clinical\ncontext.  This could be reassessed with CT scan in 3 months time to ensure\nresolution and to exclude the presence of an underlying lesion.  Otherwise, no\nsuspicious pulmonary nodules are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatus hernia.  Otherwise, the visualized\nsmall large bowel loops are unremarkable.  No intra-abdominal collection or\nabscess is identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An appropriately placed intrauterine device is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nare a few homogeneously enhancing lymph nodes within the left external iliac\nregion and left groin measuring up to 12 mm in short axis, likely reactive\n(series 10, image 73- 99).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Asymmetric appearance of the left anterior thigh musculature\nwith superimposed subcutaneous edema, which is incompletely evaluated.  This\nis concerning for underlying hematoma at this level.  The multiple lymph nodes\nseen in the left groin had along the left external iliac vein, likely\nreactive.",
            "output": "1. Technically adequate study without evidence of pulmonary embolism.\n2. Ill-defined ground-glass change noted at the posterior segment of the right\nupper lobe is suspicious for foci of infection, especially in the clinical\ncontext.  Reassessment with CT scan in 3 months is recommended to ensure\nresolution.\n3. Asymmetric appearance of the left anterior thigh musculature with\nsuperimposed subcutaneous edema and enhancing enlarged left groin lymph nodes.\nAlthough this may all be related to recent postoperative status, focal\nhematoma or cellulitis is not excluded and clinical correlation is\nrecommended.  No rim enhancing fluid collection in this region to suggest\npresence of an abscess.\n4. No intra-abdominal abscess or collection.\n\nRECOMMENDATION(S):   CT chest in 3 months time for reassessment of right upper\nlobe ground-glass changes as detailed above."
        },
        {
            "input": "The study is severely limited by respiratory artifact.  There is no central,\nmain, or segmental pulmonary embolism.  Beyond this, the study is\nnondiagnostic.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is scattered thyroid hypodensities in the left lobe measuring up to 1\ncm.\n\nThere is bibasilar atelectatic change.  Respiratory motion limits assessment\nof lung parenchyma, however no suspicious pulmonary lesion or nodule is\nidentified.\n\nNo suspicious bony lesion or fracture.\n\nModerate atherosclerotic change of the thoracic aorta.  Moderate coronary\nartery atherosclerosis.\n\nA 2.0 x 2.1 cm right adrenal nodule is incompletely characterized, but has\ndemonstrated increase in size since ___ when it measured 1.4 x 1.5\ncm.  Although a remains nonspecific, correlation with dedicated adrenal\nprotocol CT is recommended for further evaluation.\n\nThe left adrenal gland is mildly thickened without dominant nodule.\n\nEmphysematous change tracking throughout the posterior paraspinal musculature\nis likely postoperative in nature.  No drainable collection is identified.",
            "output": "1. Study limited due to significant motion artifact but, with no demonstrated\npulmonary embolism in the central, main, and segmental pulmonary arteries.\n2. Incompletely characterized 2.0 x 2.1 cm right adrenal nodule which has\ndemonstrated increased in size compared to prior from ___, when it\nmeasured 1.4 x 1.5 cm.  Recommend correlation with dedicated adrenal protocol\nCT for further evaluation.\n\nRECOMMENDATION(S):  Adrenal Protocol CT as above.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:16 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "At the imaged base of neck, the partially imaged thyroid is unremarkable.  The\nheart is moderately enlarged with significant left-sided coronary artery\ncalcification.  No pericardial effusion is seen.  The main pulmonary artery is\nenlarged measuring 3.4 cm, correlate for pulmonary arterial hypertension. \nThere is no definite signs for mediastinal or axillary adenopathy.  The aorta\nis mildly calcified and normal in caliber.  The airway is centrally patent.\nThere is a layering right pleural effusion which appears simple and at least\nmoderate in size.  There is associated compressive atelectasis in the right\nlower lobe and to a lesser extent right middle lobe.  There is no left-sided\npleural effusion.  No pneumothorax.\n\nDue to motion artifact evaluation is somewhat limited through the lungs. No\nworrisome pulmonary nodules.  Scattered calcified granulomas are present. \nThere is mild upper lobe predominant emphysema.\n\nWithin the imaged portion of the upper abdomen, a clip in the gallbladder\nfossa noted.  There is perihepatic and perisplenic ascites which is only\npartially visualized.  The spleen appears enlarged measuring at least 15 cm in\nlength.  A hypodensity arises from the right renal upper pole which could\nrepresent a cyst though not fully imaged.\n\nBones: Midline sternotomy wires are noted with sternal dehiscence.",
            "output": "1. Simple layering right pleural effusion, moderate in size with compressive\natelectasis in the right lower lobe and right middle lobe.\n2. Moderate cardiomegaly with coronary artery calcification.\n3. Enlarged main pulmonary artery, correlate for pulmonary arterial\nhypertension.\n4. Partially visualized upper abdominal ascites.\n5. Partially visualized splenomegaly."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.  A right PICC line\nterminates in the cavoatrial junction.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main pulmonary artery is normal caliber.\n\nPULMONARY PARENCHYMA: The study severely limited by respiratory motion.  There\nis a right lower lobe consolidation which appears more homogeneous with volume\nloss consistent with atelectasis and collapse of nearly the entire right lower\nlobe.  However, cannot exclude superimposed pneumonia.  Mild left lower lobe\natelectasis is noted.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is a large right pleural effusion and a small left pleural\neffusion.  No pneumothorax.\n\nCHEST WALL AND BONES: Patient is status post median sternotomy with nonunion\nand erosions and mild diastasis between the fourth and fifth sternotomy wires,\ncorrelate clinically.  No soft tissue edema or fluid collections were noted in\nthe subcutaneous soft tissues surrounding the median sternotomy.  0.5 cm\nsclerotic lesion in T5 likely a bone island (7; 132).\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates trace\nperihepatic and perisplenic ascites.  There is splenomegaly measuring 15.8 cm.",
            "output": "1. The study severely limited by respiratory motion.  There is a large right\npleural effusion and small left pleural effusion, similar in volume compared\nto CT abdomen pelvis from ___.  Right lower lobe atelectasis,\ninvolving nearly the entire lobe.  However superimposed infection cannot be\nexcluded.\n2. Status post median sternotomy with nonunion and erosions between the fourth\nand fifth sternotomy wires with mild diastasis, correlate clinically.  No\nfluid collections noted in the subcutaneous soft tissues.\n3. Limited visualization of the upper abdomen demonstrate small volume ascites\nand splenomegaly."
        },
        {
            "input": "Motion artifact limits the evaluation of the thorax.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is within normal limits. \nRight-sided PICC with tip in the SVC/right atrial junction.\n\nUPPER ABDOMEN: Please see the dedicated CT abdomen pelvis report for further\ndetails of the abdomen.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.  No mediastinal mass\n\nHILA: Evaluation of the hilar lymph nodes are limited due to lack of IV\ncontrast.\n\nHEART and PERICARDIUM: Cardiomegaly.  Marked coronary artery disease.  No\npericardial effusion.\nPLEURA: Large right pleural effusion is re-demonstrated.  Small left pleural\neffusion is slightly decreased in size.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Consolidation in the posterior right upper lobe consistent\nwith pneumonia.  There is a ring of consolidation in the lateral left apex\nwhich may represent a cavitation or slightly unusual shaped consolidation\nwhich likely represents additional area of pneumonia.  New focal consolidation\nin the right middle lobe.\n2. AIRWAYS:  Centrally clear.\n3. VESSELS:  Mild atherosclerotic calcifications of the thoracic aorta.\nCHEST CAGE: Sternotomy wires are noted.  The third, fourth, fifth, and sixth\nwires appear fractured, unchanged.  Mild degenerative changes of the spine. \nNo acute osseous process.",
            "output": "1. Multifocal pneumonia as described above.\n2. Large right pleural effusion is similar.  Small left pleural effusion has\nslightly decreased when compared to the prior study.\n3. Cardiomegaly.\n4. Additional findings as above"
        },
        {
            "input": "Although this study is not designed for assessment of intra-abdominal\nstructures, the visualized upper abdomen is unremarkable.\n\nCHEST:\n\nThe thyroid is unremarkable and there is no supraclavicular lymph node\nenlargement. The airways are patent to the subsegmental level. There is no\nmediastinal, hilar or axillary lymph node enlargement by CT size criteria. \nThe heart remains enlarged. The prosthetic aortic valve is in place. Dense\ncalcification of the mitral annulus noted. Moderate coronary artery\ncalcifications are present. There is a trace pericardial effusion. The\npulmonary arteries are mildly enlarged the main pulmonary artery measuring 3.3\ncm. No hiatal hernia is present.\n\nEvaluation of pulmonary parenchyma is somewhat limited by respiratory motion.\nThere is interstitial thickening and mild ground-glass opacity consistent with\nmild pulmonary edema. There is left greater than right small bilateral\nnonhemorrhagic pleural effusions with associated atelectasis.\n\nCTA CHEST:\n\nThe aorta and main thoracic vessels are well opacified. The aorta demonstrates\nnormal caliber throughout thorax without intramural hematoma or dissection.\nThe pulmonary arteries are opacified to the subsegmental level. There is no\nfilling defect in the main, right, left, lobar or segmental pulmonary\narteries.  Evaluation of the subsegmental pulmonary arteries is limited by\nrespiratory motion.\n\nOSSEOUS AND SOFT TISSUE STRUCTURES:\n\nNo lytic or sclerotic lesion concerning for malignancy is present.  Vertebra\nplana deformity of T9 has slightly progressed from ___ but is unchanged from\nchest radiographs dating back to at least ___. Compression deformity of T7\nalso unchanged from radiographs dating back ___. Changes related to prior\nmedian sternotomy are noted with intact sternotomy wires. Patient is status\npost right mastectomy with surgical clips seen in the right axilla.",
            "output": "1.  No evidence of pulmonary embolism to the segmental level. Evaluation of\nsubsegmental pulmonary arteries is limited by respiratory motion.\n\n2.  Cardiomegaly and mild pulmonary edema.\n\n3.  T7 and T9 vertebral compression fractures unchanged dating to at least\n___.\n\n4.  Small bilateral pleural effusions with associated atelectasis.\n\n5.  Mild dilatation of the pulmonary artery as can be seen in the setting of\npulmonary artery hypertension."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits besides atherosclerotic calcifications at the aortic arch and\norigin of the great vessels. No pericardial effusion is seen. A 1.9 x 1.5 cm\nfatty attenuation paramediastinal right lower focal density (series 3, image\n146) is compatible with a pericardial recess.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Evaluation is limited by respiratory motion.  There is\nsuspected centrilobular emphysema.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Limited by respiratory motion.  No evidence of pulmonary embolism to the\nsegmental level or aortic abnormality."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal. Scattered mediastinal lymph nodes ranging\nup to 13 x 4 mm in the precarinal region are not enlarged by CT size criteria.\nThere is no axillary or hilar lymphadenopathy. Aorta and pulmonary arteries\nare normal size. Cardiac configuration is normal. A speck of calcium is seen\nin the LAD. Small on-hemorrhagic pericardial effusion is present. There is no\nesophageal wall thickening of a hiatal hernia.\n\nLUNGS AND AIRWAYS: The airways are patent to the subsegmental level\nbilaterally. No intraluminal lesions are identified. There are no focal\nparenchymal opacities or nodules. No pleural effusion or pleural thickening is\npresent.\n\nOSSEOUS STRUCTURES: There are no lytic or blastic lesions concerning for\nmalignancy.\n\nAlthough this study is not tailored for the assessment of subdiaphragmatic\nstructures, limited examination of the imaged organs is unremarkable with the\nexception of 2 tiny calcified gallstones and probably enlarged spleen although\nnot completely imaged.",
            "output": "No evidence of active intrathoracic infection.  Cholelithiasis and probable\nsplenomegaly."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  The heart size is normal.  Pericardium is intact without\nevidence of an effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.\n\nThe study is limited for the evaluation of the subdiaphragmatic structures,\nhowever note is made of cholelithiasis.\n\n2 mm right upper lobe nodule, series 5, image 61 is unchanged compared to the\nprior exam.  A 2 mm left upper lobe nodule, series 5, image 97 is unchanged\ncompared to the prior exam.  A 3 mm left upper lobe nodule, series 5, image\n103 is unchanged compared to the prior exam.  A 3 mm right upper lobe nodule,\nseries 5, image 94 is unchanged.  A 1 mm right upper lobe nodule, series 5,\nimage 91 is stable.  A 1 mm medial right lower lobe nodule, series 5, image\n128 is unchanged.\n\nThere has been interval improvement of the previously noted ground-glass\nopacity in the left lower lobe with involvement of the lingula.  There is no\npleural effusion or pneumothorax.  Mild centrilobular emphysema is seen.  The\ntracheobronchial tree appears to be patent.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "1. Stable sub 5 mm pulmonary nodules compared to the prior exam.\n2. Interval improvement of the previously noted ground-glass opacity in the\nleft lower lobe with involvement of the lingula, which may have been\ninflammatory/infectious in etiology.\n3. Cholelithiasis.\n\nRECOMMENDATION(S):  Resume annual low-dose lung cancer screening-with the next\nstudy to be scheduled in 6 months."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized 2 mm right upper lobe pulmonary nodule is not well\nseen on the current study.  A 1 mm right upper lobe pulmonary nodule (9, 41)\nis unchanged.  The 2 mm left upper lobe pulmonary nodule (9, 57) is also\nunchanged.  The previously visualized ill-defined ground-glass opacification\nin the left lower lobe has resolved and was most likely inflammatory.  No new\npulmonary nodules\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows gallstones. \nNo adrenal masses are seen.\n1.8 cm lesion within segment ___ of the liver, it has been described in the CT\nabdomen done on the same day.",
            "output": "Stable tiny pulmonary nodules ranging in size from 1-2 mm.  No new pulmonary\nnodules.\n\nPreviously visualized ill-defined ground-glass opacity in the left lower lobe\nhas resolved and was most likely inflammatory.\n\n1.8 cm lesion within segment ___ of the liver, it has been described in the CT\nabdomen done on the same day."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  No\nsignificant calcified coronary atherosclerosis.  The thoracic aorta is normal\nin caliber.  Incidental note is made of an arch origin of left vertebral\nartery.  The main pulmonary artery is normal in caliber.  No pulmonary embolus\nto the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the subsegmental level.  There is\nmild paraseptal and centrilobular emphysema.  Scattered nonspecific nodules\nand micro nodules measuring up to 5 mm are unchanged since at least ___.\nNo new or enlarging pulmonary nodules.  No consolidations.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A 5.3 cm ablation cavity in segment II is incompletely assessed on\nCT- please refer to the recent abdominal MRI for further assessment.  The\nknown segment V lesion is not appreciated.  Cholelithiasis is noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of intrathoracic metastasis.  Although there are no bone lesions\nin the imaged chest cage suspicious for malignancy or infection, it should be\nnoted that radionuclide bone and FDG PET scanning are more sensitive in\ndetecting early osseous pathology than chest CT scanning."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  The airways are patent up to the subsegmental\nlevel\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nlesion within the left lobe of liver.  Please refer to dedicated report on MRI\nof the liver being performed on the same day.",
            "output": "No evidence of metastasis to the chest.\n\n5.3 cm hypodense lesion within the left lobe of liver.  Please refer to\ndedicated report on abdomen MR which has been done separately."
        },
        {
            "input": "NECK:  The visualized thyroid is normal.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not pathologically enlarged or growing.  Subcentimeter  paratracheal\nand subcarinal lymph nodes are decreased in size.  A 5 mm right diaphragmatic\nlymph node is minimally larger today.\n\nHEART AND VESSELS:  The heart is not enlarged and there is no coronary\narterial calcification.  There is no pericardial effusion.  Aortic caliber is\nnormal.  The main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis mild paraseptal and centrilobular emphysema most notably at the bilateral\napices.  There is a 3 mm calcified granuloma in the right upper lobe (5:97),\nunchanged from ___ there is no evidence of active infection or\nreactivation.  There is a 3 mm pulmonary nodule in the right upper lobe\n(5:97), unchanged from ___.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally. There\nis mild diffuse bronchial wall thickening in the lower lobes.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  There is there is minimal T3\nanterior vertebral body height loss, stable from at least ___.\n\nUPPER ABDOMEN:  This study is not tailored for subdiaphragmatic diagnosis. \nPlease see separate report for same day MRI liver.  There is cholelithiasis\nwithout evidence of cholecystitis.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMRI of the abdomen and corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules are stable, with no new nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of intrathoracic\nmetastatic disease."
        },
        {
            "input": "Significantly limited evaluation due to motion artifact.\n\nCHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart is normal in size.  There is no\npericardial effusion.  There is mild pulmonary artery dilation measuring up to\n3.0 cm.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: There is suboptimal assessment of the liver due to patient\nmotion.  The liver is with diffuse hypoattenuation consistent with steatosis. \nFocal 1.7 cm hypodensity on series 2, image 101 in the anterior segment 4 of\nthe liver is nonspecific and not well assessed on this study.  No perihepatic\nfluid is seen..  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder is distended and grossly unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nThere is grade 1 retrolisthesis of L5 on S1 without evidence of pars defect. \nThere is mild multilevel degenerative changes of the thoracolumbar spine. \nLikely Tarlov cyst seen in the distal sacrum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Suboptimal assessment due to patient motion.\n2. Suboptimal assessment of the upper abdomen, including the liver and\nsuboptimal assessment of some of the ribs due to patient motion.\n3. Hepatic steatosis.  1.7 cm hypodensity in the anterior segment 4 of the\nliver is not well assessed on this study.  The lack of apparent perihepatic\nfluid is reassuring in the setting of trauma.  Consider ultrasound or MRI for\nfurther assessment.\n4. No free fluid.\n5. Grade 1 retrolisthesis of L5 on S1 without evidence of pars defect, likely\ndegenerative.\n\nNOTIFICATION:  Udated liver findings discussed with Dr. ___ at 10:55\na.m. on ___ via telephone."
        },
        {
            "input": "The thyroid is normal.  7 mm left thoracic inlet lymph node (02:10) previously\nmeasured 10 mm and no longer enhances. Axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.\nCardiomegaly is increased compared to CT ___. There is no coronary\nartery calcification.\n\nCentral airways are patent to the subsegmental level. Previously described\ncavitary lesion in the right upper lobe measuring 6 mm in greatest dimension\nhas significantly decreased in size currently measuring 3 x 1 mm with\nresolution of surrounding wall thickening. Although detailed evaluation of\nlung parenchyma is limited by respiratory motion, previously seen areas of\nlinear and focal opacity scattered throughout the lungs have resolved.\nBibasilar ground-glass opacities are diffuse. There is no pleural effusion.\n\nThere is no osseous lytic or blastic lesion concerning for malignancy or\ninfection. There are mild degenerative changes of the thoracic spine including\nmultiple levels of Schmorl's nodes.\n\n 11 x 10 mm left adrenal nodule is similar to CT ___ but\nincompletely characterized. This study is not designed for subdiaphragmatic\ndiagnosis but shows no other abnormality in the imaged portions of the\nsuboptimally enhanced organs in the upper abdomen.",
            "output": "1. Effectively treated right upper lobe cavitary lesion and scattered\nopacities described on CT ___.\n2. Bibasilar ground-glass opacities in the setting of cardiomegaly suggest\npulmonary edema which may be followed with conventional chest radiographs.\n3. Small adrenal nodule is likely an adenoma, but this needs to confirmed with\nnon-contrast CT imaging on any subsequent Chest or Abd CT.\n\nRECOMMENDATION(S):  Small adrenal nodule is likely an adenoma, but this needs\nto confirmed with non-contrast CT imaging on any subsequent Chest or Abd CT."
        },
        {
            "input": "The thyroid is normal. Bilateral axillary lymph nodes, not pathologically\nenlarged, are noteworthy for their number. Scattered supraclavicular lymph\nnodes measure up to 4 mm and numerous mediastinal lymph nodes ranging up to 9\nmm in the left paratracheal station are also not pathologically enlarged.\nThere is no hilar lymphadenopathy. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification.\n\nThe airways are patent to the subsegmental level, though demonstrate very mild\ndiffuse bronchial wall thickening. A 6 mm cavity is present in the right upper\nlobe. Diffuse regional ground-glass opacities are present in the bilateral\nupper and lower lobes becoming more consolidative in the superior segments of\nthe bilateral lower lobes. There is no pleural effusion or pneumothorax.\n\nNo lytic or sclerotic osseous lesion suspicious for malignancy is identified.",
            "output": "Diffuse regional ground-glass opacities in the both upper and lower lobes with\nareas of more confluent consolidation in the superior segments of the lower\nlobes. In addition, a 6 mm cavitary lesion is present in the right upper lobe.\nGiven the various morphologies of the parenchymal abnormalities and clinical\nhistory of immunecompromise, multifactorial infection is the most likely\ndiagnosis. Wide spread multifocal bronchial sampling targeting areas of\ndiffering morphologies should be considered."
        },
        {
            "input": "CTA:  There are filling defects involving a single right lower lobe segmental\npulmonary artery at a branch point (series 7, image 79).  There is no CT\nevidence of right heart strain. Main pulmonary trunk is normal in caliber. The\nthoracic aorta is also normal in caliber with minimal atherosclerotic\ncalcifications.\n\nCT CHEST:  The thyroid is unremarkable.  There is axillary lymphadenopathy as\nwell as pre pectoral enhancing nodules with the largest measuring 18 x 15 mm\non the right (series 7, image 20).  There is extensive mediastinal adenopathy\nwith the largest conglomerate of necrotic lymph nodes in the sub carinal\nregion measuring up to 5.5 x 4.4 cm (series 7, image 57).  This lesion invades\nand obliteration mid esophagus, at least a 6 cm segment.  Proximal to this the\nesophagus is dilated and filled with debris including high density debris in\nthe upper third (series 3, image 13).  Large lymph node masses also causes\nnarrowing of the left greater than right mainstem bronchus without occlusion.\n\nA right chest wall Port-A-Cath ends in the right atrium.  There are small\nbilateral pleural effusions. Centrilobular emphysema is severe.  Heart size is\nnormal. There is no pericardial effusion. There are no significant Coronary\nartery calcifications.  There is biapical scarring.  Right lung is grossly\nclear.  There is a 6 mm nodule adjacent to the cardiac border (series 7, image\n82).  There is left lingular atelectasis.  There are nodular opacities in the\nleft lower lobe.\n\nViews of the upper abdomen demonstrate multiple rim enhancing liver lesions.\nIn addition, there is a 13 x 17 mm left adrenal lesion which is also\nconcerning for metastases.  There is dilation of the pancreatic duct within\nthe body and tail with a a probable lesion in the pancreatic tail (series 8,\nimage 274), incompletely image.  There is also a 14 mm hypodense lesion in the\nposterior aspect of the spleen. Subcentimeter renal hypodensities are too\nsmall to characterize.\n\nOSSEOUS STRUCTURES:  There is a destructive lesion of the T12 vertebral body\nwith 3 mm of bony retropulsion.  A smaller lytic lesion of the T10 vertebral\nbody is also seen.  Additional bony lesions include a destructive proximal\nright clavicular with a large soft tissue component and anterior right ___ and\nlateral right eighth rib, with a pathologic fracture of the right first rib. \nAs mentioned above, there are multiple enhancing soft tissue nodules seen in\nthe anterior and posterior soft tissues.",
            "output": "1. Large necrotic subcarinal mass obliterating the mid thoracic esophagus with\nproximal esophageal dilation and debris, possibly the source of hematemesis.\n2. Mediastinal mass causes narrowing of the bilateral mainstem bronchi without\ndefinite invasion, left greater than right.\n3. Pulmonary embolus involving a single right lower lobe segmental pulmonary\nartery. No evidence of right heart strain.\n4. Left lower lobe atelectasis and nodular opacities, concerning for\ninfection, possibly aspiration.\n5. Small bilateral pleural effusions.\n6. Multiple rim enhancing liver lesions, left adrenal lesion, splenic lesion,\nconcerning for metastatic disease.\n7. Pancreatic duct dilation with a probable incompletely imaged pancreatic\ntail lesion also concerning for metastatic disease.\n8. Multiple bony metastatic lesions including of the anterior right first rib\nwith a pathologic fracture and a destructive T12 lesion causing severe\nvertebral body compression with 3 mm of bony retropulsion.\n9. Axillary lymphadenopathy and multiple enhancing soft tissue nodules, also\nconsistent with metastatic disease.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 3:04 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.\n\nHILA: Hilar lymph nodes are incompletely evaluated in the absence of IV\ncontrast.  There is no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The known ascending aortic aneurysm measures 4.7 x 4.6\ncm (2:28).  Atherosclerotic calcifications in the aortic arch are minimal,\nhowever there are severe aortic valvular calcifications.  Heart size is normal\nwith mild coronary artery calcifications. Trace pericardial effusion is\nphysiologic.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is\ndiffuse bronchial wall thickening with mild centrilobular nodules, as can be\nseen in patients with smoking history and small airways disease.  There is no\nfocal consolidation. No pulmonary nodules detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, imaged portions of the liver, gallbladder,\nspleen, pancreas, and adrenal glands are unremarkable.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Multilevel degenerative changes of the thoracic spine are mild.",
            "output": "1.  Ascending aortic aneurysm measures 4.7 x 4.6 cm.  There are minimal\natherosclerotic calcifications in the aortic arch, with no appreciable\ncalcifications in the descending thoracic aorta.\n\n2.  Severe aortic valvular calcifications and mild coronary arterial\ncalcifications.\n\nRECOMMENDATION(S):  Correlation with echocardiogram to evaluate degree of\naortic stenosis is recommended."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  The\nlargest mediastinal lymph node is 10 mm in diameter (2, 19). The lymph node\nhas grown since the previous examination but is still within the accepted\nlimits of normality.  No hilar lymphadenopathy.  No coronary calcifications,\nno valvular calcifications.  Normal dimension of the cardiac structures.  No\npericardial effusion.  Small hiatal hernia.  Status post cholecystectomy,\nfatty liver.  No osteolytic lesions at the level of the ribs, the sternum or\nthe vertebral bodies.  Mild degenerative vertebral disease.\nMild respiratory motion are defects.  Several non characteristic millimetric\nsubpleural nodules (for example in the right upper lobe, series 4, image 88). \nMinimal thickening any irregularities of the airway wall, consistent with mild\nchronic bronchitis.  Non characteristic scarring at the bases of the lingular.\nMinimal ground-glass nodularity at the basal aspect of the left lower lobe,\nlikely reflecting minimal aspiration or infection.  No pleural thickening, no\npleural effusions.  Calcified left lower lobe granuloma (4, 185).",
            "output": "Minimal ground-glass opacities in the left lower lobe, likely reflecting\nminimal aspiration or infection.  No signs indicative of malignancy.  No\nlymphadenopathy.  No pleural effusions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  There are calcified left hilar and mediastinal\nlymph nodes.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple pulmonary nodules are demonstrated as detailed below:\n\nThere is a left upper lobe perifissural 8 mm lobulated nodule which distorts\nthe adjacent fissure, (series 3, image 74).\nLeft upper lobe 1.1 cm solid nodule which also demonstrates distorts the\nadjacent fissure, (series 3, image 89).\nA subpleural 4 mm solid pulmonary nodule is demonstrated within the right\nlower lobe, (series 3, image 109).\nThere is a 3 mm right middle lobe nodule (3:13).\n\nA 9 mm calcified granuloma demonstrated in the left lower lobe, (series 3,\nimage 90)\n\nThere is diffuse bronchiectasis most pronounced in the bilateral lower lobes. \nNo evidence of bronchial wall thickening and mucus plugging.\n\n\nBASE OF NECK: There is a 1.3 cm right thyroid nodule.\n\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: The visualized bones are diffusely demineralized.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Multiple pulmonary nodules are demonstrated throughout the bilateral lungs\nmeasuring up to 1.1 cm in the left upper lobe.\n3. No evidence of intrathoracic lymphadenopathy.\n4. A 1.3 cm right thyroid nodule.\n\nRECOMMENDATION(S):  Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\n For incidentally detected multiple solid pulmonary nodules bigger than 8mm, a\nCT follow-up in 3 to 6 months is recommended in a low-risk patient, with an\noptional CT follow-up in 18 to 24 months. In a high-risk patient, both a CT\nfollow-up in 3 to 6 months and in 18 to 24 months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  Small\nsubsegmental vessels at the left lung base are difficult to assess.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  A mildly prominent right hilar lymph node is seen measuring 8 mm,\nnot meeting CT size criteria for lymphadenopathy.  No mediastinal mass.  Soft\ntissue density in the anterior mediastinum is consistent with remnant thymic\ntissue.  Small amount of fluid is seen within a pericardial recess.\n\nPLEURAL SPACES: There is a trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is subsegmental atelectasis at bilateral lung bases. \nLungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No definite evidence of pulmonary embolism or acute aortic abnormality.\n2. Trace left pleural effusion."
        },
        {
            "input": "MEDIASTINUM: A large fat-attenuation mass within the pericardium posterior and\nlateral to the main and proximal right pulmonary arteries, and extending\nposteriorly to the pulmonary veins is overall similar in size since the prior\nstudy from ___, measuring 83 x 46 mm, previously 80 x 44 mm (2a:\n27). The mass appears to scallop the left pulmonary vein and left atrium (601\nB:66), without direct invasion. Minimal aortic and coronary artery\natherosclerotic calcifications are present. Calcified mediastinal and hilar\nlymph nodes are again noted, likely a sequelae of prior granulomatous\ninfection), with stable enlargement of central mediastinal lymph nodes up to\n16 x 10 mm (2a: 19). There is no supraclavicular or axillary lymphadenopathy.\nThere is no pericardial effusion. The esophagus is somewhat patulous, with\nmild wall thickening, as before, suggesting the possibility of esophageal\ndysmotility.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: Moderate background centrilobular emphysema is noted, with bilateral\nupper lobe predominance.  There is re- demonstration of stenosis of the right\nmiddle lobe bronchus by bronchioliths (4 a:106) with mild postobstructive\nvolume loss of the right middle lobe (4 a:104). No consolidation concerning\nfor pneumonia is identified. A 4 mm nodule along the oblique fissure in the\nleft upper lobe (4 a: 34) is stable.  A large calcified granuloma is present\nin the right lower lobe (4 a: 108).  A small area of atelectasis is present in\nthe lingula (4 a: 152). No concerning pulmonary nodules or masses are seen.\n\nBONES: A sclerotic focus in the T7 vertebral body (602B:72) is likely a bone\nisland. No osseous lesion concerning for malignancy or infection is identified\nin the chest cage.\n\nUPPER ABDOMEN:  Although this study is not designed 1 for evaluation of\nsubdiaphragmatic structures, the imaged upper abdomen is unremarkable.",
            "output": "1. Fat-attenuation mass in the pericardium is compatible with lipoma, and is\nsimilar in overall size since the prior study from ___, with no\nfocal soft tissue component or other specific findings to suggest liposarcoma.\n2. Unchanged mild bronchial stenosis of the lateral segment of the right\nmiddle lobe bronchus with distal broncholithiasis, possibly from local erosion\nof a calcified lymph node in the presence of prior granulomatous infection."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Few mildly prominent mediastinal lymph nodes are\nnot pathologically enlarged by CT size criteria.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Minimal bibasilar independent atelectasis is noted.  Lungs are\notherwise clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the very upper abdomen is grossly unremarkable,\nbut only very tiny portion was imaged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "Heavily calcified aortic valve is consistent with history of severe aortic\nstenosis and is accompanied by diffuse atheromatous calcification of the\nthoracic aorta and branch vessels. The calcification is moderate in the\nascending aorta, severe in the aortic arch and origin of great vessels, and\nmoderate in the descending thoracic aorta. Thoracic aorta is normal caliber\nwith ascending aorta measuring up to 3.4 cm and descending thoracic aorta\nmeasuring up to 2.4 cm in diameter. Heart size is normal, and there is no\npericardial or pleural effusion.  Within the upper retrosternal region, a\nbandlike area of calcification is present anterior to the ascending aorta and\nextending inferiorly to the level of the right atrial appendage, apparently\nonly a along the anterior pericardial surface.\n\nSkeletal structures of the thorax are remarkable for previous sternotomy and\nmultilevel degenerative changes throughout the spine.\n\nWithin the lungs, note is made of previous partial right upper lobes resection\nand apparent radiation therapy with geographically marginated paramediastinal\nfibrosis extending from the right apex to the right juxta hilar region.  There\nare no definite signs of local recurrence, but post operative site would be\nmore ideally evaluated with intravenous contrast and in comparison to prior CT\nscans which recurrent and available.\n\nThe lungs are otherwise remarkable for scattered foci of parenchymal scarring,\nparticularly at the lung bases.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of bilateral low-density renal lesions including a 3 cm left upper pole\nlesion and 2.1 cm right mid pole lesion. The left upper pole lesion is\ncompletely imaged appears to represent cysts were as the right lesion is\nincompletely imaged and cannot be fully characterized. Adrenal glands are\nnormal. Sub cm hypodensity in right lobe of liver posteriorly is most likely\ncysts but too small to characterize by CT.",
            "output": "1.  Evidence of previous sternotomy and apparent combined surgery and\nradiation therapy, which was reportedly performed to resect a paraganglioma.\nThe operative site is not optimally assessed without intravenous contrast, and\ndedicated contrast enhanced CT or along with comparison to previous\npostoperative scans would be more ideally ___ for this assessment.\n\n2.  Thick linear band of anterior pericardial calcification medially posterior\nto the sternotomy site.\n\n3. Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis. Normal caliber thoracic aorta with marked to severe atheromatous\ncalcifications as described. These images are available for preoperative\nreview for planning purposes\n\n4. Left upper pole renal cyst and incompletely characterized low-density right\nmid pole 2.1 cm lesion. If warranted clinically, this could be more fully\nevaluated by dedicated renal ultrasound exam.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 08:39 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider. These findings were also communicated by phone to nurse ___\n___ at 08:41 on ___"
        },
        {
            "input": "In the absence of intravenous contrast agent, given the relative absence of\nfatty tissue at the thoracic inlet, it is impossible to exclude right\nsupraclavicular adenopathy.  There is no lymph node enlargement in the left\nsupraclavicular station or the axilla, although sub cm lymph nodes are\nnumerous, particularly on the left.  It should also be noted that without\nintravenous contrast administration intramuscular metastases might remain\nundetectable.\n\nThyroid is not enlarged. Measurable lymph nodes are numerous in the\nmediastinum, ranging in diameter up to 12 mm in a cluster in the right lower\nparatracheal station and 16 mm in the right paraesophageal. Contour of the\nright hilus suggests adenopathy of comparable size. There is no bronchial\nnarrowing on the right, there is the suggestion of the indentation of the\nposterior wall of the origin of the left upper lobe by a left hilar\nadenopathy, 3:131, although occasionally the left descending pulmonary artery\nis entirely responsible.\n\nModerate nonhemorrhagic right pleural effusion layers posteriorly. Mild\ndependent edema or subpleural atelectasis is probably responsible for\nheterogeneous opacification at the base the right lung, mostly increase\nground-glass attenuation. Both the lungs are free of appreciable sized nodules\nor any consolidation.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.\nDegenerative changes with large osteophyte formation is most pronounced in the\nmid and upper thoracic spine.",
            "output": "No pulmonary metastases.  Small to moderate layering nonhemorrhagic right\npleural effusion new since ___, explanation unclear. .\n\nMild mediastinal and probable hilar lymph node enlargement, chronicity\nindeterminate."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta is normal in size. The main pulmonary artery is\nmildly enlarged. Heart size is normal. There is no pericardial effusion. There\nare no coronary artery calcifications.\n\nScattered calcified granulomas are seen throughout the lungs. There is no\npleural effusion. No pneumothorax. No focal consolidation. A 1 mm nodule in\nthe left upper lobe does not appear calcified but is stable (4, 78). Another 1\nmm nodule at the left lung apex is stable (4, 50).\n\nDegenerative changes are noted of the thoracic spine with there are no\nsuspicious bony lesions identified.\n\nIntra-abdominal findings are reported separately.",
            "output": "Two 1 mm pulmonary nodules in the left upper lobe are not definitely calcified\nhowever are unchanged, attention on follow up.\n\nNo lymphadenopathy.\n\nScattered calcified granulomas are seen throughout the lungs.\n\nPossible pulmonary hypertension."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The left vertebral artery arises as a direct branch of\nthe aorta, a normal variant.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are a few prominent bilateral axillary\nlymph nodes with fatty hilum.  No mediastinal or hilar lymphadenopathy is\npresent.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis as well as atelectasis in the\nright middle lobe (___).  Lungs are otherwise clear without masses or areas\nof parenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: There is a 1.6 cm hypodense lesion in the right thyroid lobe. \nThere are a few punctate calcifications in the inferior aspect of the right\nthyroid lobe.  Visualized portions of the base of the neck otherwise show no\nabnormality.\n\nUPPER ABDOMEN:\n\nThere are a few 0.9 cm and less hypodense lesions in the left lobe of the\nliver, too small to characterize.  Otherwise, visualized portions of the upper\nabdomen are unremarkable.\n\nBONES AND SOFT TISSUES: Slightly sclerotic lesion within the T11 vertebral\nbody measuring up to 1.1 cm is indeterminate.  The patient is status post\nbilateral breast implants.",
            "output": "1. No evidence of aortic dissection or pulmonary embolism.\n2. Apart from atelectasis, lungs are clear.\n3. There is a 1.6 cm hypodense lesion in the right thyroid lobe.  Consider\nthyroid ultrasound for further evaluation.\n4. Indeterminate 1.1 cm sclerotic lesion within the T11 vertebral body may\nreflect an atypical hemangioma or other osseous lesion.  Further evaluation\nwith a contrast enhanced MRI of the thoracic spine is recommended.\n\nRECOMMENDATION(S):   Consider thyroid ultrasound for further evaluation of a\n1.6 cm hypodense lesion in the right thyroid lobe.\n\nContrast enhanced MRI of the thoracic spine for further evaluation the\nvertebral body lesion.\n\nNOTIFICATION:    The findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 7:40 pm, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "Supraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no pericardial effusion.  There is a 0.6 x 1.5 x 1.1 cm\nradiopaque density in the left lower lobe bronchus, with subsequent partial\npostobstructive lobar collapse distal to it and associated consolidation which\nmay be due to postobstructive pneumonia. No other consolidation is identified.\nThere is no pleural effusion or pneumothorax.",
            "output": "1.5 cm foreign object in the left lower lobe bronchus, with partial\npostobstructive lobar collapse and possible postobstructive pneumonia."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare mild.  Heart size is normal.  There is no pericardial pleural effusion.\n\nBilateral breast prosthesis is in place.  The left breast prosthesis\npotentially rupture, please correlate with dedicated imaging.\n\nAirways are patent to the subsegmental level bilaterally.  Tracheal bronchus\nin the right upper lobe is noted.  Severe centrilobular emphysema is diffuse. \nNo pulmonary nodules masses or consolidations demonstrated.\n\nLeft humerus contains a well-defined lesion with a calcified chondroid matrix\nwith classic appearance of arcs and we rolls and has appearance of benign the,\nit consistent with benign enchondroma.  Since previous examination the finding\nhas minimally progressed.  Still appearance is consistent with benign\netiology.\n\nThere are no lytic or sclerotic lesions are otherwise demonstrated.",
            "output": "Severe emphysema\n\nTracheal bronchus, congenital variant\n\nNo evidence of abnormality that might explain weight loss\n\nPotential rupture of the left breast prosthesis, please correlate with\nclinical findings and dedicated imaging if needed"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  The main pulmonary artery is\nnormal caliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is severe centrilobular emphysema with a upper lobe\npredominance, affecting the left lung greater than right.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK AND CHEST WALL: Visualized portions of the base of the neck show\nno abnormality.  Bilateral breast implants are demonstrated.  The contour of\nthe left implant is irregular suggestive of implant rupture however the\nappearance is unchanged from prior.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of acute abnormality in the chest, specifically no evidence of\npulmonary embolism.\n2. Severe upper lobe predominant centrilobular emphysema is unchanged from\nprior, affecting the left lung greater than right.\n3. Suspected rupture of left breast implant, unchanged in appearance from\nprior."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nBreast, chest wall and bones:\nBilateral breast prostheses.  Potential rupture of the left prosthesis,\nunchanged in appearance compared to prior imaging\n\nMediastinum:\nNo abnormality\n\nHila:\nNo abnormality\n\nHeart:\nMild coronary calcifications\n\nUpper Abdomen:\nNo abnormality\n\nLung:\n\nNodules:\n\nDominant nodule:\nNone\n\nOther nodules:\nStable solid pulmonary nodules:\n\nRight upper lobe, 3 mm, series 4, image 15\n\nRight upper lobe, 4 mm, series 4, image 22\n\nRight upper lobe, 7 mm, series 4, image 46\n\nRight upper lobe, 1 mm, calcified, series 4, image 50\n\nRight lower lobe, 3 mm, series 4, image 114\n\nLeft upper lobe, 2 mm, series 4, image 43\n\nPreviously seen 4 mm right lower lobe pulmonary nodule, new at the previous\nexamination, has decreased in size on the current study to 2 mm, series 4,\nimage 106.\n\nParenchyma:\nSevere centrilobular and panlobular emphysema\n\nSevere left lower lobe air trapping\n\nPleura and airways:\nSevere diffuse bronchial wall thickness in bronchial wall irregularities.",
            "output": "Stable pulmonary nodules\n\nLUNG-RADS CATEGORY AND RECOMMENDATION:  Lung-RADS category: Lung-RADS 2S: We\nrecommend continuing CT lung cancer screening in 12 months.\n\n\nINCIDENTAL FINDINGS AND RECOMMENDATIONS:  Emphysema (centrilobular,\npanlobular, paraseptal, and combinations) occupying ? 30% of the lung\nparenchyma: We recommend clinical correlation by the referring physician.\n\n Airway wall thickening and/or irregularities: We recommend clinical\ncorrelation by the referring physician.\n\n *Mild coronary calcifications: We recommend clinical correlation by the\nreferring physician.\nManagement recommendations for incidental findings within the LungHealth\u00ae\nprogram are based on a multidisciplinary consensus document of our institution\nspecifically designed for this program.\n\nLUNG-RADS CATEGORIES, DESCRIPTION:  Lung-RADS 0: This category designates an\nincomplete or diagnostically insufficient CT examination.\nLung-RADS 1: This category designates the absence of nodules, or the presence\nof definitely benign nodules.\nLung-RADS 2: This category designates the presence of nodules with a very low\nlikelihood of becoming a clinically active cancer due to size or lack of\ngrowth.\nLung-RADS 3: This category designates probably benign nodules with a low\nlikelihood of becoming a clinically active cancer but with features that\nrequire confirmatory imaging follow-up.\nLung-RADS 4A: This category designates nodules that require additional\ndiagnostic imaging.\nLung-RADS 4B and 4X: This category designates nodules that require additional\ndiagnostic testing and/or tissue sampling. Nodules in this category are\npresented at the weekly multidisciplinary thoracic oncology conference of our\nprogram.\nS (with any category): This qualifier designates the presence of a relevant\nincidental (= distinct from lung cancer) finding, for which a specific\nmanagement recommendation is made.\nC (with any category): Prior diagnosis of lung cancer."
        },
        {
            "input": "There are minimal atherosclerotic calcifications of the aortic arch.  There is\nno thoracic aortic dissection or aneurysm.\n\nEvaluation is severely limited by respiratory motion. A filling defect in a\nleft upper lobe segmental pulmonary artery (series 2, image 40) is concerning\nfor pulmonary embolus with extension into the adjacent subsegmental branches\n(series 2 image 39).  No CT findings of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is an equivocal 8 mm hypodensity in the right lobe of the thyroid.\n\nThere is no evidence of pericardial effusion.  Trace left pleural effusion is\nnoted.\n\nPeripheral ground-glass opacities in the lung apices and anterior upper lobes,\nbilaterally could represent infection, inflammation, or infarcts.  Scarring\natelectasis is noted at the dependent portion of the lung bases, bilaterally. \nThe patient is post tracheostomy.  Surrounding skin thickening and edema\nwithin the superficial soft tissues of the anterior neck are likely related to\ntreatment changes.  Evaluation of the airways is limited by respiratory\nmotion.\n\nCholelithiasis without evidence of cholecystitis.  Enteric tube terminates in\nthe stomach.  Limited images of the upper abdomen are otherwise unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  Left upper lobe segmental pulmonary embolus.  Additional small pulmonary\nemboli are not excluded on this severely motion degraded study.  No right\nheart strain.\n2.  Peripheral ground-glass opacities in the lung apices and anterior upper\nlobes bilaterally, which could represent infection, inflammation, or infarcts.\n3.  Post tracheostomy.  Edema and skin thickening in the anterior neck at the\nlevel of the tracheostomy are likely due to treatment changes, but clinical\ncorrelation is needed for any evidence of infection or inflammation."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Densely calcified right lower paratracheal lymph\nnodes are noted (4:76).\n\nThere is fusiform dilation of the ascending thoracic aorta, measuring up to\n5.8 x 5.3 cm in the proximal ascending thoracic aorta (4:113), with\nnormalization of caliber at the level of the aortic arch.  The descending\nthoracic aorta is also normal in caliber, measuring approximately 3.1 x 3.1 cm\n(4:113).  There are dense aortic valvular calcifications, but essentially no\ncalcification in the ascending thoracic aorta and only mild calcifications in\nthe aortic arch.  The pulmonary arteries are normal size. Cardiac\nconfiguration is normal.  Moderate coronary arterial atherosclerosis is noted.\nThere is no pleural or pericardial effusion.\n\nThe airways are patent to the subsegmental level.  Multiple calcified\ngranulomas are noted bilaterally, including a 5 mm left apical granuloma\n(04:33), and punctate lingular (4:83) and right lower lobe granulomas (4:121).\nNo concerning pulmonary nodules or masses are identified.  Mild atelectasis is\nnoted in the bilateral lung bases.\n\nNo osseous lesion worrisome for malignancy or infection is identified. \nMultilevel thoracic vertebral degenerative changes are noted.",
            "output": "1. Ascending aortic aneurysm, measuring up to 5.8 cm.\n2. Dense aortic valvular calcifications, with no ascending aortic\ncalcification and mild aortic arch calcification.\n3. Calcified pulmonary nodules and mediastinal lymph nodes are likely related\nto prior granulomatous infection.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 13:23 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is moderate to severe calcifications in all\ncoronary arteries. There is no pleural or pericardial effusion .\nMinimal subpleural radiation changes in the left upper hemi thorax are stable.\nCalcified granuloma in the right lower lobe is unchanged. 4 mm nodule in the\nleft lower lobe (5, 176) and a 2 mm nodule in the right lower lobe (5, 145)\nare stable\n\nThis examination is not tailored for subdiaphragmatic evaluation, there\nappearance to be a small hiatal hernia. Patient is status post\ncholecystectomy. There is in surgical change in the stomach. There is\ndiverticulosis without evidence of acute diverticulitis. A nonobstructing\nstone in the left kidney measures 4 mm.\nThere are no bone findings of malignancy. Healed fractures in right ribs are\nagain noted",
            "output": "Stable lung nodules no new lung nodules identified.\nNo evidence of intrathoracic malignancy.\nExtensive coronary calcifications\nLeft renal stone\nDiverticulosis"
        },
        {
            "input": "HEART AND VASCULATURE: There is suboptimal contrast opacification of pulmonary\nvasculature.  Pulmonary vasculature is well opacified to the segmental level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma..  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is demonstrate scattered\ndiverticulosis..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "There is suboptimal contrast opacification of the pulmonary vasculature. \nWithin this limitation: There is no evidence of pulmonary embolism to the\nsegmental level."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal size. A tiny hypodensity along the posterolateral\nspleen focal fluid collection likely represents a splenic cleft. No focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an intrauterine pregnancy.  The placenta is\nheterogeneous.  There are multiple areas of relative ___\nposteriorly along the placenta (series 2, image 171).  The hypoenhancing areas\nextend posteriorly laterally and are interspersed along dilated uterine\nvessels.  There is no free fluid in the pelvis.  The amniotic fluid is\nlow-density.  The fetus is grossly within normal limits.\n\nThere are numerous heterogeneous fibroids throughout the uterus, which\nsomewhat limits evaluation.  The ovaries are not definitively visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo substantial atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nThere are bilateral os acetabuli along the anterior acetabuli (series 3 image\n212).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The placenta is diffusely heterogenous.  There are some hypoenhancing\nregions posteriorly along the placenta.  Some of the findings may represent\nplacental cotyledons/venous lakes, however an abruption could be present. \nFibroids are present diffusely throughout the uterus, which also limits\nevaluation of the uterine wall.  There is no free fluid in the pelvis.\n2. A tiny area of hypodensity along the posterolateral spleen without\noverlying focal fluid collection or adjacent fracture likely represents a\nsplenic cleft.\n3. No acute fractures.  No additional evidence of traumatic injury within the\nchest, abdomen or pelvis.\n\nNOTIFICATION:  The findings were discussed with Dr ___, M.D. by\n___, M.D. in person on ___ at the time of the exam. And\ndiscussed by Dr. ___ with Dr. ___ OB/GYN via telephone on\n___ after the completion of the study."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show densities in\nbilateral renal calyces which can represent gallstones or prior gadolinium\ninjected contrast from same day MRI.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  No mediastinal hilar enlarged lymph\nnodes by size criteria.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.\nMild atherosclerotic calcifications in thoracic aorta.  None in the\ncoronaries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Calcified granuloma in right lower lobe (302: 155).  4 mm\nnodule in the middle lobe (302:124).\n2. AIRWAYS:  Airways are patent to subsegmental levels.\n3. VESSELS:  The arteries are not enlarged.\nCHEST CAGE: Mild dorsal spondylosis.  No acute fractures.  No suspicious lytic\nor sclerotic lesions.",
            "output": "No evidence of thymic tissue in the anterior mediastinum.\nSmall pulmonary nodule in the middle lobe.  Follow-up is recommended below.\nDensities in renal calyces can be related to kidney stones.  If clinically\nwarranted, a renal ultrasound can be performed for better assessment.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.\n\nThere is no consolidation or ground-glass opacities to suggest acute\ninfection. Several pulmonary nodules measure up to 4 mm in the left lower lobe\nadjacent to the major fissure (04: 54, 86, 98, 104, 105, 170, 110, 133, 140,\n146, 148, 154). Several calcified granulomas are also identified bilaterally.\nThere is no endobronchial lesion or pleural abnormality.\n\nThe patient has had prior cholecystectomy.\n\nThe bones are unremarkable.",
            "output": "No evidence of acute intrathoracic infection.\n\nSeveral pulmonary nodules measure up to 4 mm in the left perifissural\nlocation.  Given the prior smoking history, a ___ month followup chest CT is\nrecommended to assess for stability."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  No pericardial\npleural effusion is seen.  Image portion of the upper abdomen reveals prior\ncholecystectomy.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are all stable, series 4, images 63, 72, 87, 91, 100, 112, 125, 138,\n132, 142, 148, 150, 152, 158.  No new nodules masses are consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nSclerotic focus and low thoracic vertebral body",
            "output": "Stable appearance of the chest with no new nodules demonstrated and multiple\npre-existing pulmonary nodules being stable.\n\nNo evidence of infection.\n\nFinal assessment in ___ with 15 is recommended for documentation of\n___ year stability."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nhomogeneous in attenuation without focal nodularity.  There is no\nsupraclavicular or axial lymphadenopathy by CT size criteria.  Aside from\nbilateral breast parenchyma, which is suboptimally evaluated on the current\nmodality, the imaged portion of the soft tissues are unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria. \nThere is nonspecific mild stranding of the anterior mediastinum, which may\nrepresent residual thymic tissue.\n\nHILA: Evaluation for hilar lymphadenopathy is limited on the current\nnoncontrast enhanced exam.  However no large hilar mass is identified.\n\nHEART and PERICARDIUM: Heart size is within normal limits.  There is no\npericardial effusion.  No significant coronary or valvular calcifications are\nnoted.\n\nPLEURA: There is no evidence of pleural effusion or pneumothorax.\n\nLUNG:\nPARENCHYMA:  There is no suspicious lung nodule requiring further follow-up. \nNo correlate for the pulmonary nodule seen on chest radiograph is identified. \nThere is trace ground glass opacity in the lingula.  Otherwise, there is no\nfocal consolidation.\n\nAIRWAYS:  The airways are patent to the subsegmental levels.\n\nVESSELS:  The ascending and descending aorta are normal in caliber.  The main\npulmonary artery is top-normal in caliber, measuring 3.0 cm.\n\nMUSCULOSKELETAL: There is no concerning osseous lesion suspicious for\nmetastatic disease.  Sclerotic appearance of the lateral left ninth rib is\nnonspecific and may represent fibrous dysplasia (8:127, 4:275).\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen demonstrate no acute\nabnormalities.  An accessory spleen measures 12 mm.",
            "output": "No CT correlate of pulmonary nodule seen on chest radiograph from ___, confirming that the opacity is likely a vessel on end."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Cardiomegaly.  There are coronary artery calcifications.\nThe heart, pericardium, and great vessels are otherwise within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is a 1.0 cm right pretracheal lymph node\n(___).  Otherwise, no axillary, mediastinal, or hilar lymphadenopathy is\npresent.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  The patient is status post right middle lobectomy with a\nstable postoperative appearance of the bronchial stump.  There is bilateral\nground-glass opacity in the lower lungs, likely representing atelectasis. \nThere is new fat density in the right upper lobe, likely representing\nherniation of fat into the extra-pleural space (___), measuring approximately\n8.3 x 1.4 cm.  There is an unchanged 0.7 cm nodule in the left upper lobe\n(___), stable since ___, presumed benign.  Again seen is a calcified\nleft upper lobe granuloma (___).  No new or enlarging nodules.  Lungs are\notherwise clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. There are ground-glass opacities throughout the lungs, which may represent\natelectasis with CT infectious process not excluded.\n3. Compared to ___, there is new fat density in the right upper\nlobe, likely herniation of fat into the extrapleural space.  No evidence of\nadjacent rib destruction."
        },
        {
            "input": "The thyroid gland is unremarkable. Multiple borderline enlarged lymph\nmediastinal lymph nodes are unchanged measuring up to 11mm in the right upper\nparatracheal station.  No pathologically enlarged supraclavicular,\nmediastinal, hilar or axillary lymph nodes are identified.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolus is\nidentified.\n\nThe patient is status post right middle lobectomy with a stable postoperative\nappearance of the bronchial stump and remaining right lung, except for a new\nregion of ground glass opacification in the posterior right upper lobe,\nprobably due to infection. Band-like soft tissue adjacent to the anterior\nsurgical suture is stable (5, 178).  A 5 mm left upper lobe nodule is stable\nsince ___, and presumed benign (5, 183). A calcified left upper lobe\ngranuloma is an indication of removed infection. There are no new pulmonary\nnodules, any endobronchial lesion or pleural abnormality. ___\nImages of the upper abdomen show gallstones.\n\nMild multilevel spinal degenerative changes are stable.",
            "output": "No evidence of intrathoracic malignancy.\n\nNew region right upper lobe ground-glass opacification is likely infectious in\netiology.\n\nCholelithiasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: As seen on reference neck CT\nperformed 1 day prior, there is a large mass partially visualized in the right\nsupraclavicular space just lateral to the right sternocleidomastoid muscle\nmeasuring approximately 5.4 x 3.1 x 3.8 cm best seen on series 8 image 28. \nThere is mild adjacent fat stranding.  Within the right axilla, there are 2\nenlarged nodes, series 5, image 19 measuring 18 x 15 mm and a second adjacent\nnode measuring 11 x 13 mm.  No left-sided axillary adenopathy.  A prominent\nlymph node is seen abutting the upper esophagus in the posterior mediastinum\non series 5, image 18 at the thoracic inlet measuring approximately 9 x 15 mm.\nThere are no chest wall abnormalities.\n\nUPPER ABDOMEN: Please refer to separately dictated CT abdomen pelvis for\nfindings below the diaphragm.\n\nMEDIASTINUM: Multiple enlarged mediastinal lymph nodes are seen, for example\nadjacent to the left mainstem bronchus on series 6, image 132 measuring 16 x\n20 mm.  Enlarged subcarinal lymph node is seen on series 6, image 164\nmeasuring 22 x 18 mm.  Several smaller rounded and concerning lymph nodes are\nalso seen adjacent to the trachea in the mediastinum on series 6 image 92 and\n103.\n\nHILA: No hilar mass or adenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size and shape without\npericardial effusion.  There is mild coronary artery calcification.\nPLEURA: No pleural effusion or pleural nodularity.\nLUNG:\n\n1. PARENCHYMA:  Severe emphysema is noted.  There is a spiculated nodule at\nthe right apex best seen on series 6, image 85 measuring 2.0 x 1.6 x 1.8 cm,\nconcerning for primary malignancy.  A second more rounded nodular lesion is\nseen within the right upper lobe on series 6, image 125 measuring 13 x 14 x 15\nmm.  This nodule closely approximates a right upper lobe bronchus, difficult\nto exclude invasion into the bronchus.  No additional nodules are seen within\neither lung.\n2. AIRWAYS:  There is diffuse bronchial wall thickening which likely reflects\nthe sequelae of chronic airways inflammation.  No significant mucous plugging.\n3. VESSELS:  Thoracic aorta contains mild atherosclerotic calcification and is\nnormal in course and caliber.  There is mild prominence of the main pulmonary\nartery which measures up to 3.1 cm.  There is no filling defect seen within\nthe central branches of the pulmonary arterial tree to suggest the presence of\na pulmonary embolism.\n\nCHEST CAGE: No worrisome bony lesion to suggest the presence of metastatic\ndisease.  No fracture.  Bones are slightly demineralized diffusely.",
            "output": "1.  Findings concerning for primary lung cancer with spiculated right upper\nlobe nodule.  Evidence of metastatic disease with right supraclavicular mass,\nright upper lobe presumed metastatic nodule, and nodal metastasis in the\nmediastinum and right axilla as detailed.\n2.  Severe emphysema with diffuse bronchial wall thickening likely reflecting\nchronic airways inflammation.\n\nPlease refer to separately 7 dictated CT of the abdomen pelvis for findings\nbelow the diaphragm."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular lymph nodes not enlarged.  13 x 21 mm right axillary node,\n2:15, was 15 x 18 mm in ___.  No new lymph node enlargement in the chest\nwall.\n\n\nCARDIO-MEDIASTINUM:\nSmall gastric hiatus hernia is stable.  Above that level esophagus is\nunremarkable despite adjacent adenopathy described below.\n\nAtherosclerotic calcification is moderate heavy in head and neck vessels and\nin at least left anterior descending, left circumflex and right coronary\nartery.  Pulmonary arteries are top-normal size and subject to the technical\nlimitations, free of filling defects.\n\nDescending thoracic aorta is mildly enlarged in a fusiform fashion, maximum\ndiameter 31 mm. There is been a slight increase in the caliber of mural\nthrombus or noncalcified plaque just above the aorta, 302:168, but no evidence\nof ulceration.\n\nPericardium is physiologic.\n\nTHORACIC LYMPH NODES:\n\nLeft lower paratracheal mediastinum, 14 x 23 mm, previously 17 x 23 mm.\n\nSubcarinal, 16 x 24 mm, previously 22 x 30 mm, and inseparable from the\nesophagus.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.  Spiculated mass, right upper\nlobed 13 x 17 mm, 302:50, previously 18 x 20 mm.\n\nRight suprahilar nodule, 12 x 13 mm, previously 14 x 15 mm.\n\nNo left lung nodules.\n\nNo pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "2 right upper lobe nodules and central adenopathy have all gotten somewhat\nsmaller since ___ details in the findings section.  Contiguous\nadenopathy is inseparable from the the subcarinal esophagus.  No direct\nevidence of obstruction.\n\nSevere emphysema.\n\nSevere atherosclerotic coronary, head and neck, and descending thoracic aortic\ncalcification."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes..  The right\naxillary lymph node has decreased in size and now measures 6 mm (5, 268\npreviously measured 13 x 21 mm.\n\nMEDIASTINUM: Mediastinal lymph nodes have decreased in size since the prior\nstudy.  The right paratracheal lymph node measures 8 mm it previously measured\n9 mm.  The left paratracheal lymph node measures 9 mm it previously measured\n12 mm.  The subcarinal lymph node is also is minimally decreased in size. \nSmall left hilar lymph node is unchanged.  The descending thoracic aorta is\nmildly enlarged and measures 31 mm there is, unchanged since the prior study. \nThere is evidence of atherosclerotic plaque.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The spiculated right upper lobe mass patient 15 mm and is decreased in\nsize since the prior study when it measured.  There is moderate to severe\nupper lobe predominant emphysema.  Minimal bibasilar atelectasis.  No new\npulmonary nodules.  Another right upper lobe pulmonary nodule seen on the\nprior study has also decreased in size now measures 8 mm it previously\nmeasured 12 mm (5, 34).\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "Decrease in size of the right upper lobe nodules and mediastinal adenopathy. \nNo new sites of disease.\n\nSevere upper lobe predominant emphysema.\n\nAtherosclerotic changes involving the aorta and coronary arteries."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL: The partially imaged thyroid is\nunremarkable.  No enlarged axillary, supraclavicular or cervical lymph\nnodes.Excluding the breast tissue which requires mammography for evaluation,\nthere are no soft tissue abnormalities in the chest wall. There is mild\natherosclerotic calcifications in the visualized head and neck arteries.\n\nHEART AND VASCULATURE: The heart is within normal limits of size and shape\nwithout pericardial effusion.  There is coronary artery calcification which is\nmoderate in overall extent.  There is aortic valve calcification also seen.\n\nMEDIASTINUM AND HILA: No hilar or mediastinal adenopathy.  The esophagus is\nunremarkable.\n\nPLEURA: No pleural effusions or pneumothorax. Mild bilateral apical scarring.\n\nLUNGS:Severe emphysema is again seen.  There is imaged unchanged appearance of\na spiculated nodule at the right apex best seen on series 6 image 66 measuring\napproximately 15 mm in maximal dimension which is unchanged.  No new or\ngrowing pulmonary nodule.  Airways appear patent throughout the mildly\nthickened likely reflecting chronic inflammation.  No significant mucous\nplugging.\n\nBONES: There is no acute fracture. No worrisome lytic or sclerotic lesions. \nMild spondylosis.  Mild dextroscoliosis of the lower thoracic spine.\n\nUPPER ABDOMEN: Please see the CT abdomen and pelvis report dated the same day\nfor further evaluation of the abdomen and pelvis.",
            "output": "1. Size stable spiculated right upper lobe nodule.  No new or enlarging lung\nnodules.\n2. Severe emphysema.\n3. Mild bronchial wall thickening likely reflecting chronic airways\ninflammation without significant mucous plugging.\n\nPlease refer to separately dictated CT abdomen pelvis for findings below the\ndiaphragm."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormality in the chest wall.  Breast evaluation reserved exclusively for\nmammography.  Findings in the abdomen will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus mildly patulous at several levels, distended\nonly with air, not an indication of obstruction.  Atherosclerotic\ncalcification is moderate in head and neck vessels and in all major coronary\narteries, most severe in the LAD.  Aortic valvular calcification is mild. \nPulmonary artery mildly enlarged, 33 mm, unchanged.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing ranging in diameter up to 10 mm in the left lower paratracheal\nstation.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nStellate right upper lobe lung nodule, 4 x 14 mm, 3:45, was 7 x 15 mm in ___,\nhad been 18 x 20 mm in ___.\n\n 3 mm solid and 5 mm sub solid left apical nodules unchanged since ___.\n\nEmphysema is severe. Mild generalized bronchial wall thickening unchanged.\n\nNo pleural abnormalities.\n\nCHEST CAGE: Generalized osteoporosis.  Mild loss of height due to upper\nendplate impression midthoracic vertebral body.  No new compression or any\npathologic or traumatic fracture or destructive bone lesion.  Although there\nare no bone lesions in the imaged chest cage suspicious for malignancy or\ninfection, it should be noted that radionuclide bone and FDG PET scanning are\nmore sensitive in detecting early osseous pathology than chest CT scanning.",
            "output": "Continued involution right upper lobe lung mass.  No new or recurrent\nmalignancy.\n\nTiny left apical lung nodule stable since ___ most likely benign can\nbe followed with routine surveillance chest CT.\n\nAtherosclerotic coronary calcification general, especially LAD.\n\nSevere emphysema, mild bronchial inflammation or both chronic.  Mild\nenlargement pulmonary artery"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  However, in the left\nupper lung zone, there is a 2.1 x 3.0 cm pleural based lesion (series 2, image\n26).  The lesion predominant demonstrates fluid density; however, along the\ninferior posterior aspect of the lesion, there is an area of soft tissue\ndensity.\n\nLUNGS/AIRWAYS: Mild biapical scarring.  Lungs are clear without masses or\nareas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is a subtle indentation of the anterior proximal sternal cortex\nwhich is equivocal for a possible nondisplaced sternal fracture.  No focal\nsuspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Indeterminate 3.0 cm left upper chest pleural based lesion which\ndemonstrates fluid density with some peripheral soft tissue density. \nRecommend chest MRI for further evaluation.\n2. Subtle indentation of the anterior proximal sternal cortex is equivocal for\na possible nondisplaced sternal fracture.\n3. No other acute fractures or evidence of injury to the soft tissue\nstructures within the torso.\n\nRECOMMENDATION(S):  Recommend chest MRI for further evaluation of the\nincompletely characterized left upper lung lesion.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:03 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  There are no abnormalities on the\nchest wall. No atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Moderate\ncoronary artery calcifications including the left main, left anterior\ndescending, circumflex, and right coronary artery.  The aorta and pulmonary\narteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy, the\nlargest being a 0.7 cm left hilar lymph node which is not significantly\nchanged.\n\nPLEURA:\nNo pleural effusions. Minimal bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging. A calcified granuloma in the\nright lower lobe is again noted (for example series 3:126).  No suspicious\nnodule or masses.  No consolidations.  There is micro atelectasis dependently.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. There are no bone findings in the\nchest cage suspicious for malignancy or infection but it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous metastases than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to separate report for CT abdomen and pelvis acquired on the same\nday for findings below the diaphragm.",
            "output": "1. No evidence of intrathoracic metastatic disease.  No significant interval\nchange compared to the prior study from\n2. Moderate and widespread coronary artery calcifications including the left\nmain, left anterior descending, circumflex, and right coronary artery. \nRecommend consideration of cardiology evaluation.\n3. Please refer to separate report for CT abdomen and pelvis acquired on the\nsame day for findings below the diaphragm.\n\nRECOMMENDATION(S):  Recommend consideration of cardiology evaluation given\nwidespread moderate coronary artery calcification."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is mild coronary artery calcification.  The aorta and\npulmonary arteries are normal in caliber.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately",
            "output": "No evidence of metastasis to the chest.  Please refer to dedicated report on\nabdomen which has been dictated separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, none in the aorta or\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Small scattered calcified\ngranulomas, for example the right lower lobe (3:122).  No suspicious lung\nnodules or masses.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___ with no evidence\nof intrathoracic metastatic disease."
        },
        {
            "input": "The thyroid is incompletely visualized.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe great vessels are normal caliber.  There is no evidence of pulmonary\nembolism to the subsegmental level\n\nThe heart is moderately enlarged.  There is no pericardial effusion.\n\nThe airways are patent to subsegmental levels.\n\nThere is mild bibasilar atelectasis.  There is no focal consolidation, pleural\neffusion or pneumothorax.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No evidence of pulmonary embolism to the subsegmental level.  No aortic\npathology is identified."
        },
        {
            "input": "HEART AND VASCULATURE: There is a right-sided PICC line with tip terminating\nat the cavoatrial junction.  The heart is mildly enlarged.  The thoracic aorta\nis normal in caliber.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes\nmeasure up to 1.5 cm, likely reactive.  Hilar lymphadenopathy is difficult to\nevaluate without contrast administration.\n\nPLEURAL SPACES: There is a moderate right hydropneumothorax with a pigtail\ncatheter at the right lung base.  There are possible loculated collections\nsuperiorly, in the right midlung field posteriorly, for which the pigtail\ncatheter is not draining.  There is a large left hydropneumothorax with a\nleft-sided chest tube terminating in the left lung base.  In the left midlung\nfield there is an additional loculated hydropneumothorax measuring up to 6.0\ncm (series 302, image 81).  There is loculated fluid along the left superior\nmediastinum without adequate drainage (series 302, image 44) and measuring up\nto 5.0 cm.  There is an additional loculated component along the left\nposterior apex measuring up to 4.0 cm (series 302, image 32) without adequate\ndrainage.\n\nThere is compressive atelectasis in the left lung with collapse of the left\nlower lobe.  Superimposed pneumonia is likely.  Scattered areas of\nconsolidative opacities in the right lung, particularly at the base, with more\nground-glass opacifications in the apex are concerning for multifocal\npneumonia.  There is smooth septal thickening in right lung which may\nrepresent fluid overload.\n\nAIRWAYS: There is a tracheostomy tube in place.  There are secretions and\ndebris in the lower trachea and extending into the left mainstem bronchi. \nThere is collapse of the left lower lobe.\n\nABDOMEN: Limited evaluation of the upper abdomen demonstrates pericholecystic\nfluid.\n\nBONES: Sclerotic focus in the right posterior seventh rib appears benign\n(series 302, image 80).",
            "output": "1. Fluid and debris in the left airways, including the left mainstem bronchus\nwith collapse of the left lower lobe.\n2. Large left hydropneumothorax with multiple loculated fluid collections as\ndescribed above, multiple not being drained by the chest tube in the lung\nbase.\n3. Moderate right hydropneumothorax with pigtail catheter in the right lung\nbase.  There are possible regions of loculated fluid in the midlung field.\n4. Evidence of multifocal pneumonia bilaterally.\n\nRECOMMENDATION(S):  Suction of airway secretions through bronchoscopy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Scattered mediastinal lymph nodes are not enlarged by CT\ncriteria.\n\nHILA:  A 0.8 cm calcified right hilar lymph node is noted (series 4, image\n133).  No hilar lymphadenopathy.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is biapical scarring.  The previously seen right\nupper lobe cavitary lesion has decreased in size measuring 1.7 x 1.1 cm and no\nlonger demonstrates central cavitation (series 4, image 75).  ___\nopacity surrounding the right upper lobe nodule has improved compared to the\nmost recent prior study.\n\nThe previously seen right lower lobe cavitary nodule is no longer visualized. \nAdditional right lower lobe subpleural nodular opacities appear similar in\nsize but decreased in density (series 4, image 166).\n\nA 0.6 cm left lower lobe nodule (series 4, image 154) has increased in size\nwith central cavitation.  No new suspicious nodule or mass.\n\nA 1.4 x 1.0 cm right lower lobe endobronchial lesion (series 4, image 144) has\nslightly increased in size ___.\n\nCalcifcation\n\nEndobronchial lesion increasing in size.  Metastatic, primary neoplastic,\ninfectious. Bronchus\n\n3 months follow up for llb\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  No acute fractures.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Interval decrease in size of the right upper lobe nodule with resolution of\ncentral cavitation improvement of being ___ opacities.  Interval\nresolution of the previously seen right lower lobe cavitary nodule. \nAdditional right lower lobe subpleural nodular opacities are similar in size\nbut decreased in density.\n2. Interval enlargement of a 0.6 cm left lower lobe nodule with central\ncavitation.  Follow-up in 3 months is recommended.\n3. 1.4 x 1.0 cm right lower lobe endobronchial lesion, slightly increased in\nsize compared to ___.  Differential diagnosis include metastatic,\nprimary neoplastic, or infectious.  Bronchoscopic evaluation is recommended.\n4. Please see separate report performed on the same day for detailed\nevaluation of the abdomen and pelvis.\n\nRECOMMENDATION(S):  1.  Chest CT in 3 months for further evaluation of\npulmonary nodules.\n2.  Bronchoscopic evaluation of the right lower lobe endobronchial lesion.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:23 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Right hilar calcified\nlymph node is present.  No pathologically enlarged mediastinal, hilar or\naxillary lymphadenopathy is present.  There is no pericardial or pleural\neffusion noted.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nnodular opacity consist of solid nodules approaching 1.6 cm with internal\ncavity, series 301, image 80 and a adjacent solid 10 mm nodules as well as\noverall surrounding area of ground-glass.  The overall extent of the\nabnormality approach is 7 by 3.5 cm.  More inferior ground-glass opacities,\nseries 301, image 106, 114, 118 can also be connected with the above described\nlesion.  Similar opacity in the right middle lobe with ___ nodules,\nseries 301, image 143 is present as well with no solid component as well as\nsmall opacities in the right lower lobe of also nodular and ___\ncomponent.  Additional nodular conglomerate is in the left lower lobe, 3\nseries 301, image 192 with nodules up to 1 cm\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Primarily right upper lobe consolidative process with nodular and ___\ncomponent with additional ___ opacities in the right lower lobe and  \nnodules in the left lower lobe.  The findings might represent diffuse\ninfectious process, atypical for example tuberculosis, especially giving the\nevidence of previous granulomatous exposure..  Alternatively vasculitis or\nneoplasm is a possibility.  Correlation with tissue biopsy is required in\nparticular of the right upper lobe lesion.  Transthoracic biopsy would be a\npossibility followed by the possibility of transbronchial biopsy.\n\nCoronary calcifications\n\nPlease review CT abdomen and pelvis and the corresponding report for the\nimaging findings of the upper abdomen."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  All\nvisible mediastinal lymph nodes are normal to borderline in size (2, 25). \nNormal diameter of the main pulmonary artery.  Moderate coronary\ncalcifications, minimal aortic valve calcifications, no pericardial effusion. \nSmall hiatal hernia.  No abnormalities in the upper abdomen, in particular no\nchanges at the level of the adrenal glands.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Minimal degenerative\nvertebral disease.  No vertebral compression fractures.\nMild bilateral apical scarring.  The cavitary pulmonary nodule in the right\nupper lobe (4, 89) shows an unchanged approximate diameter of 10 x 15 mm.  The\nsatellite nodules and the surrounding ___ opacities are also overall\nunchanged.  More widespread accompanying ___ nodularity in the lower\nparts of the right upper lobe are also stable.  Calcified lymphadenopathy at\nthe level of the hilar structures are unchanged.  The areas of mucous plugging\nand peribronchial ___ opacities in the lower lobes, notably on the\nright (4, 185) are overall stable.  No pleural effusions.",
            "output": "Overall stability of the pre-existing cavitary right upper lobe lesion, with\nsurrounding satellite nodules and surrounding ___ opacities.  The\nareas of mucous plugging and peribronchial nodularity in the lower lobes,\nright more than left, are also unchanged."
        },
        {
            "input": "The thyroid is normal.  Scattered subcentimeter mediastinal nodes are not\nsignificantly changed from prior.  Again seen is a partially calcified right\nhilar node, similar to prior.  There are no pathologically enlarged\nsupraclavicular, axillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates coronary artery calcifications in the LAD.  There is no\npericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  There is biapical scarring.  A cavitary nodule in the\nright upper lobe measures approximately 2.0 x 1.2 cm in greatest diameter, not\nsignificantly changed in overall size, however there is increased size of the\ncentral cavitation.  Surrounding satellite nodules and bronchiolar nodules in\nthe right upper and middle lobes are not significantly changed from prior. \nThere is a low-density lesion measuring 1.2 x 1.0 cm in the right lower lobe,\nincreased in size compared with prior, at which time it measured 0.3 x 0.3 cm\n(5:253), is probably a small, relatively indolent abscess.  Additional\n___ and nodular opacities in the lower lobes are not significantly\nchanged.\n\nA mixed sclerotic and lucent lesion along the inferior endplate of the T11\nvertebral body is unchanged.  Stability argues for chronic traumatic and/or\ndegeneration, and against infection.  There is new or pathologic fracture.\n\nA small hiatal hernia is stable.  This examination is not tailored for the\nevaluation of subdiaphragmatic contents.  Within this limitation, the included\nportions of the upper abdomen are grossly unremarkable.",
            "output": "A cavitary nodule in the right upper lobe is overall stable in size, however\nthere is increased size of the central cavitation and interval growth of a 1.2\ncm low-density nodule in the right lower lobe, previously 0.3 cm in ___. \nThese findings are consistent with active bronchogenic spread of infection,\nlikely mycobacterial including tuberculosis.\n\nNOTIFICATION:  Dr ___ spoke by telephone with Dr ___ the findings\nof progressive infection, likely mycobacterial, specifically including M.\ntuberculosis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild-to-moderate cardiomegaly is present.  There is\nthree-vessel coronary artery calcification and aortic valvular calcification. \nThe pericardium and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are few enlarged prevascular and\npretracheal lymph nodes, for example a pretracheal lymph node, measures 1.1 cm\nin short axis (2A/40).  These are likely reactive.  There are a few additional\nprominent, though nonenlarged, mediastinal lymph nodes.  No axillary or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  Large right simple pleural effusion.  Small left pleural\neffusion.  No pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is compressive atelectasis due to bilateral pleural\neffusions, more substantial in the right.  Patchy areas of bilateral\nground-glass opacity in the right upper lobe and left upper and lower lobes\nmay represent pulmonary edema with inflammation or infection considered less\nlikely.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY:  Diffuse hypoattenuation the liver relative to the spleen\nsuggests steatosis.  Nodular contour of liver is compatible with the history\nof cirrhosis.  There is no evidence of focal lesions.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY:  There is a 2.3 cm simple cyst in lower pole of the right kidney\n(2B/135).  The kidneys are of normal and symmetric size with normal\nnephrogram.  No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The bladder is decompressed due to Foley catheter.  The distal ureters\nare unremarkable.  There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an IUD device ___ loop) in the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  There are unchanged varices in the right upper quadrant\nwhich appear to communicate with the SMV and likely representing a right\nrenal-SMV shunt.  Main portal vein remains attenuated, as seen previously.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There are multilevel degenerative changes of the visualized\nspine.  Generalized body wall edema is noted.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n2. Bilateral patchy ground-glass opacity in the right upper lobe and left lung\nmay represent pulmonary edema with inflammation or infection considered less\nlikely.\n3. Generalized body wall edema with trace free fluid in the pelvis.\n4. No definite findings to explain patient's abdominal pain."
        },
        {
            "input": "CHEST CTA: Pulmonary arterial vasculature is well-visualized to the\nsubsegmental levels bilaterally.  No filling defects are identified to suggest\nthe presence of pulmonary embolism.  The aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The great vessels are\nunremarkable.\n\nCHEST: Minimal underlying emphysema is present.  The lungs are otherwise\nclear. There is no nodule, mass, or consolidation.  The airways are patent to\nthe subsegmental levels bilaterally.  No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes are identified.  There is no pleural\neffusion.  The heart and pericardium are within normal limits.\n\nThe study is not tailored for subdiaphragmatic evaluation, but the visualized\nintra-abdominal organs are unremarkable.\n\nBONE WINDOWS:  No focal lytic or sclerotic osseous lesion suspicious for\ninfection or malignancy is seen.",
            "output": "No evidence of pulmonary embolism. No acute findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nPulmonary emboli are seen involving the right middle lobe, right lower lobe,\nleft lower lobe, and left lingular branches with predominant clot burden\nwithin the right lower lobe pulmonary arteries.  The right lower lobar\npulmonary artery is near completely occluded after the takeoff of the superior\nsegmental branch.  Clot extends into the segmental and subsegmental branches. \nNonocclusive distal left lower lobar pulmonary artery as well as the segmental\nbranches demonstrate thrombosis.   The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nTrace physiologic pericardial effusion.  The heart is normal in size.  No\nevidence of right heart strain.  There is no pleural effusion.\n\nTwo  discrete ground -glass and slightly more confluent peripheral\nwedge-shaped right lower lobe opacities correspond to area of patient's clot\nburden and are worrisome for pulmonary infarcts.  The airways are patent to\nthe subsegmental level.\n\nLimited images of the upper abdomen are notable for a wedge-shaped hypodensity\nwithin the posterior spleen worrisome for infarct.  Arterially enhancing 0.9 x\n0.5 cm segment 8 hepatic lesion (2:88) is nonspecific and may represent a\nflash filling hemangioma.  Additional visualized solid organs are\nunremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  Acute bilateral pulmonary emboli with predominant clot burden in the right\nlower lobe.  No evidence of right heart strain.\n2. Two discrete right lower lobe wedge-shaped opacities are worrisome for\npulmonary infarcts.  Differential includes pneumonia in the appropriate\nclinical setting.\n3.  Findings worrisome for splenic infarct.\n4.  A 0.9 cm arterially enhancing segment 8 hepatic lesion is nonspecific and\nmay represent a flash filling hemangioma."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis.  No focal consolidations.  No\nsuspicious lung nodules.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: The thyroid is enlarged and heterogeneous in appearance.  No\nthyroid nodules requiring ultrasound follow-up.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  Incidental note is made of a Phrygian cap.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  Trace free fluid\nwithin the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is extremely enlarged and lobulated in\nappearance with multiple peripherally enhancing masses demonstrating central\nhypoenhancement, likely representing fibroids, some of which appear\ndegenerated.  Asymmetric enlargement of the right gonadal vein with prominent\nright-sided pelvic varices, findings which can be seen with pelvic congestion\nsyndrome.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Diastasis of the rectus abdominus with a shallow ventral hernia.\nOtherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of traumatic injury within the chest, abdomen, pelvis.\n2. Trace free fluid within the pelvis, likely physiologic.\n3. Numerous uterine fibroids, some of which appear degenerated.\n4. Asymmetric enlargement of the right gonadal vein and prominent right-sided\npelvic varices, findings which may represent pelvic congestion syndrome in the\ncorrect clinical setting."
        },
        {
            "input": "HEART AND VASCULATURE: There is no evidence of pulmonary embolism.  Thoracic\naorta is normal in appearance within limitation of a non-gated study. No\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal or hilar\nlymphadenopathy. No mediastinal mass lesion.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax. Right apical\npleuroparenchymal scarring.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis. No focal consolidation to\nsuggest pneumonia. There is bronchial wall thickening centrally and in the\nlower lobes. There are few scattered pulmonary micro nodules (3:99).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Included portion of the upper abdomen is notable for mild thickening\nof the distal esophagus, possibly due to under-distention.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No evidence of pneumonia.\n3. Bibasilar atelectasis with mild bronchial wall thickening centrally and in\nthe lower lobes, nonspecific.\n4. Mild thickening of the distal esophagus, possibly due to under-distention."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is.  Lymph either thoracic inlet chest wall atherosclerotic\ncalcifications head and\n\nMEDIASTINUM AND HILA:\nEsophagus is mildly patulous and thickened in its distal third with an\nassociated.  Enlarged mediastinal nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nIs in size and shape pericardial.  Atherosclerotic calcifications in the\narteries valves or aorta.  Aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No ground-glass opacities,\nbronchiectasis or honeycombing.  Expiratory acquisitions show no evidence of\nair trapping..  Mild subsegmental atelectasis in the lingula and left lower\nlobe.  No lung nodules or masses.  No focal consolidations.  No pleural\neffusions.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals are out of the field view.",
            "output": "No evidence of interstitial lung disease.\n\nMildly patulous and thickened distal esophagus with associated small hiatal\nhernia."
        },
        {
            "input": "The aortic valve is heavily calcified consistent with history of severe aortic\nstenosis.  Severe diffuse 3 vessel coronary artery calcifications are also\ndemonstrated.  The thoracic aorta is normal in caliber.  Atheromatous\ncalcifications are marked in the proximal ascending aorta, throughout the\naortic arch and in the descending thoracic and upper abdominal aorta and\nbranch vessels heart size is normal.  There is no pericardial or pleural\neffusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of intravenous contrast within the renal collecting systems, possibly\nrelated to recent catheterization or other contrast study outside of this\nexam.  1.6 cm low-density lesion in upper pole portion of right kidney is\nsuggestive of a cyst.  Remaining imaged upper abdomen is unremarkable on this\nvery limited assessment.\n\nWithin the lungs, minimal emphysema is present at the lung apices and\nincidental calcified granulomas are noted in the right upper lobe.  Scattered\nareas of linear scar or atelectasis are present in the mid and lower lungs as\nwell as mild bronchial dilation and bronchial wall thickening.  The trachea\nhas a lunate configuration and is enlarged at 2.6 cm in transverse dimension.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.",
            "output": "1. Heavily calcified aortic valve, consistent with history of aortic stenosis.\nSevere diffuse 3 vessel coronary artery disease.\n\n2.  Non dilated thoracic aorta with atheromatous calcifications as described\nabove.  These images are available for review for preoperative planning.\n\n3.  Tracheomegaly and lunate configuration of trachea, a combination of\nfindings that is frequently associated with a tracheomalacia.  The latter\nrequires additional dynamic expiratory imaging for diagnosis.  Such additional\nimaging may be considered the patient is experiencing recurrent respiratory\ninfections, cough and or dyspnea but is otherwise unexplained clinically."
        },
        {
            "input": "12 mm left peripectoral lymph node, 04:17, is new since ___.  Other\nsupraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require were choir mammography for evaluation,\nthere are no soft tissue abnormalities in the imaged portions of the chest\nwall.  This study is not appropriate for subdiaphragmatic diagnosis but shows\nno adrenal mass.  A right posterior diaphragmatic hernia transmits only\nsubphrenic fat.\n\nThyroid is generally enlarged, with a 16 mm hypodensity in the left lobe,\nunchanged since ___.\n\nAtherosclerotic calcification is mild in head neck vessels, at least mild in\nleft anterior descending and circumflex coronary arteries.  Aortic valve is\nnot appreciably calcified.  All cardiac chambers are enlarged.  Pulmonary\narteries are dilated, main 40 mm, right 28 mm, left 29 mm.  Echocardiography\nis recommended if not recently performed.  Pericardium is physiologic.  There\nis no pleural abnormality.\n\nEsophagus is unremarkable.\n\nLymph nodes:\n\nThoracic lymph nodes are not enlarged, including the hila.\n\nLungs:\n\nLungs are grossly clear and the tracheobronchial tree is normal to\nsubsegmental levels.\n\nChest cage:\n\nThere are no pathologic or compression fractures or destructive bone lesions.",
            "output": "Dilated pulmonary arteries are responsible for hilar enlargement. There is no\nadenopathy.  Global cardiomegaly is moderate.  Cardiac evaluation including\nechocardiography recommended for assessment."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Evaluation of the subsegmental pulmonary arterial\nvasculature is limited by motion.  Pulmonary vasculature is well opacified to\nthe segmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A right-sided chest port tip\nterminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, hilar, or mediastinal\nlymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.  A right middle lobe\n5 mm nodule is new (4:130).\n\nBASE OF NECK: A 17 x 18 mm area of confluent left supraclavicular lymph nodes\nappears increased in size from prior (previously approximately 14 x 18 mm) and\nsuspicious for malignancy.\n\nABDOMEN:\n\nHEPATOBILIARY: Centered at segment 4 is an ill-defined 7.6 x 8.3 cm\nheterogeneous hypodense mass with a lobulated contour, increased in size from\n___.  There are additional ill-defined hypodense hepatic lesions\nscattered throughout the remaining hepatic segments, some of which are new or\nincreased in size.  For example, 2 right hepatic lobe masses now measure up to\n19 and 14 mm in diameter, previously 11 and 7 mm (05:17).  There is mild\nintrahepatic biliary dilatation, unchanged.  Common bile duct is normal in\ncaliber.  The gallbladder is decompressed with an edematous wall likely\nrelated to third spacing, similar to prior.  New perihepatic ascites is seen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. \nSubcentimeter triangular hypodensity in the periphery of the spleen measures\nup to 6 mm, unchanged (05:24) and may reflect a tiny cyst or sequela of prior\ninfarct.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.3 cm hypodensity in the left kidney, unchanged.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is a small\namount of fluid in the pouch of ___.\n\nREPRODUCTIVE ORGANS: A 2.6 x 2.4 cm right adnexal cystic lesion is similar in\nsize and appearance to prior.  Uterus and left adnexa are unremarkable.\n\nLYMPH NODES: Again, there is extensive porta hepatis and retroperitoneal\nlymphadenopathy, increased in the size from the prior exam.  A left periaortic\nconfluent area lymphadenopathy measures up to 3.6 x 2.0 cm, previously 3.2 x\n1.7 cm.  Left common iliac node now measures 18 mm, previously 11 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  A small umbilical hernia containing fat is noted.",
            "output": "1. No evidence of pulmonary embolism within the segmental pulmonary\nvasculature.  Evaluation of the subsegmental pulmonary arteries is limited due\nto motion.\n2. Interval progression of disease with increased size and number of hepatic\nill-defined hypodense masses in the liver, and worsening extensive\nretroperitoneal, porta hepatis, and left supraclavicular lymphadenopathy.\n3. New 5 mm right middle lobe pulmonary nodule is concerning for metastasis.\n4. Unchanged mild intrahepatic biliary dilatation without common bile duct\ndilatation.\n5. New small volume ascites.\n6. 2.6 cm right adnexal cystic lesion, similar in size and appearance to\nprior.  Again this can be followed up on subsequent surveillance exams."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings.  Severe left supraclavicular\nadenopathy,, 21 mm conglomerate, 10:16, unchanged since ___.  Breast\nevaluation reserved exclusively for mammography.  No soft tissue abnormality\nelsewhere in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: No esophageal obstruction, despite lower paraesophageal\nmediastinal adenopathy.  Diverticulum in the right tracheoesophageal groove at\nthe thoracic inlet could originate in either esophagus or trachea, contains\nonly air.\n\nAtherosclerotic calcification not apparent in head and neck vessels or\ncoronary arteries.  Aorta and pulmonary arteries and cardiac chambers normal\nsize.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Multiple left hilar lymph nodes, 6-7 mm in diameter,\n11:160 have grown since ___.\nLower posterior paraesophageal lymph nodes ranging up to 12 mm, 11:208,\nunchanged since ___.\nLUNGS, AIRWAYS, PLEURAE: Nodules as follows:\n\n5 mm, right lower lobe, 11:148, new since ___.\n\n8 mm, right middle lobe, ___: 216, previously 5 mm.\n\n5 mm, left lower lobe, 11: 298, probably unchanged.\n\nBand of atelectasis or scarring, right lower lobe unchanged.  No pleural\neffusion.  No pleural nodulation.\n\nCHEST CAGE: Approximately 4 cm lung expansile lytic lesion lateral aspect left\nfifth rib, 14: 96-100, is roughly twice as long probably has a nondisplaced\npathologic fracture, 14:99.  No associated pleural abnormality.  Additional\nbone metastases are more sensitively detected by radionuclide bone or FDG PET\nscanning.",
            "output": "Progressive metastasis in the chest, including a handful of new or enlarging\nsmall lung nodules, growing subcentimeter left hilar lymph nodes, and\nexpanding lytic left fifth rib lesion with nondisplaced pathologic fracture.\n\nPre-existing left supraclavicular and lower paraesophageal mediastinal\nadenopathy are stable."
        },
        {
            "input": "CHEST PERIMETER: No findings in the thyroid warrant any further imaging. \nSubcentimeter and numerous small axillary lymph nodes are not pathologically\nenlarged.  Breast evaluation is reserved exclusively for mammography.  No soft\ntissue abnormalities elsewhere in the chest.  This study is not appropriate\nfor subdiaphragmatic diagnosis.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head neck or coronary arteries.  Aorta is normal caliber. \nAortic valvular calcification is minimal.  Pulmonary arteries and cardiac\nchambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged,\nhowever 7 mm wide para aortic lymph node close to the diaphragm is suspect for\nmalignancy by virtue of location.\n\nLUNGS, AIRWAYS, PLEURAE: No lung nodules or other focal lung lesions of\nconsequence.  Tracheobronchial tree is normal to subsegmental levels and there\nis no pleural abnormality\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.\n\nH shaped impressions of the endplates of several thoracic vertebrae raise\npossibility of hemoglobinopathy.",
            "output": "No pulmonary metastases.  The only finding as suggesting intrathoracic\nmalignaNcy is a subcentimeter posterior mediastinal or retrocrural lymph node.\n\nPossible hemoglobinopathy."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Seve\n\nOld rib fractures on the left.  Ral small mediastinal lymph nodes are not\npathologically enlarged.  Heart size is mildly enlarged.  There is no\npericardial pleural effusion.  Image portion of the upper abdomen reveals no\nappreciable abnormality.  No axillary lymphadenopathy seen.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\npulmonary nodule, series 4, image 84 and left lower lobe series 4, image 106\nwhere noted as well as cluster of the ___ nodules in the right middle\nlobe, series 4, image 137, 141.  Right lower lobe nodule, series 4, image 161\nis 8 x 3.6 mm in diameter.\n\nNo abnormality that would be equivalent O similar to the findings seen on the\nMRI demonstrated.  Old rib fractures are demonstrated anteriorly in the left\nribs, series 4, image 147.",
            "output": "No definitive abnormality in corresponding to the suspicious finding on the\nMRI demonstrated.  Correlation with bone scan is to be considered.\n\nSeveral pulmonary nodules that would require reassessment in 6 months."
        },
        {
            "input": "Anterior mediastinal triangular tissue is consistent with thymic residual. \nAorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.\n\nOf note is bilateral symmetric gynecomastia, moderate.\n\nThere is no pericardial pleural effusion.  Image portion of the upper abdomen\nwill be reviewed separately in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Normal chest CT."
        },
        {
            "input": "The esophagus is dilated and filled with oral contrast throughout.  The\nendotracheal tube terminates approximately 2.3 cm above the level of the\ncarina. There is enteric tube within the esophagus that terminates in the body\nof the stomach.\n\nNo pericardial effusion.  Extensive coronary artery calcifications are seen. \nThere is a central venous catheter that terminates at the cavoatrial junction.\nThere is a three vessel aortic arch.  The aorta is normal in course and\ncaliber with out definite aneurysmal dilatation, however, evaluation of the\nthoracic aorta is better made on prior CTA performed ___ where a\nlarge irregularly-shaped thrombus was seen extending from the aortic arch\nthrough the descending thoracic aorta, not as well evaluated on this\nexamination. Moderate vascular calcification of the aortic arch, descending\nthoracic aorta common origin of the great vessels.\n\nNo pneumothorax.  There are bilateral small to moderate pleural effusions\nright greater than left with associated compressive atelectasis in the lower\nlobes.  There is slightly more patchy consolidation within the superior left\nlower lobe and posterior left upper lobe which could reflect pneumonia. \nGround-glass opacities within the right lower and middle lobe are mild and\npossibly from edema or infection.  The central tracheobronchial tree is\npatent.\n\nLimited evaluation of the thyroid gland is grossly unremarkable. No definite\nmediastinal or axillary lymphadenopathy by CT size criteria.\nEvaluation for hilar lymphadenopathy is limited secondary to lack of\nintravenous contrast.\n\nNo suspicious osteolytic or osteoblastic bone lesions.  Multilevel\ndegenerative changes are seen throughout the thoracic and lumbar spine.  There\nis mild retrolisthesis of L1 respect to L2 and a grade 1 anterolisthesis of L4\nrespect L5.",
            "output": "1.   Bilateral small to moderate pleural effusions right greater the left with\nassociated compressive atelectasis.  More patchy areas of consolidation within\nthe left upper and lower lobes may represent pneumonia as may the mild\nground-glass opacities within the right lower and middle lobes, though these\nlatter opacities could be edema.\n\n2.  Previously-seen irregularly-shaped thrombus within the aortic arch and\ndescending thoracic aorta is not well evaluated on this examination."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe incompletely visualized thyroid gland appears unremarkable.  The right IJ\nport and median sternotomy wires are noted.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nEvaluation the pulmonary parenchyma is limited by substantial respiratory\nmotion artifact.  Within this limitation, no gross abnormalities are\nidentified. Incidental note is made of tiny perifissural nodules (6:131,\n6:174). There is a collection of mucus in the right mainstem bronchus. The\nairways are otherwise clear.\n\nLimited images of the upper abdomen are unremarkable.\n\nIncompletely visualized anterior cervical fusion hardware extending to the\nlevel of T1 is noted.  Sclerotic lesions in the vertebral bodies of T7 through\nT10 are unchanged.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Sclerotic lesions of T7 through T10 are unchanged."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis dense aortic arch and distal brachiocephalic artery calcification.\n\nCardiac configuration is normal. There is diffuse coronary artery\ncalcification.\n\nCentral airways are patent to the subsegmental level. The 2.4 x 2.5 cm left\nupper lobe lesion is re- identified. There are focal and linear opacities in\nthe right lung base. There are small, right greater than left, nonhemorrhagic\npleural effusions.\n\nThere is no osseous lesion concerning for malignancy or infection.",
            "output": "1.  Stranding right lower lobe opacities may be secondary to atelectasis,\nhowever pneumonia cannot be excluded.\n2.  2.4 x 2.5 cm left upper lobe nodule remains concerning for malignancy.\n3.  Coronary artery calcification.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:10 ___, 10 minutes after discovery of the findings."
        },
        {
            "input": "The thyroid is unremarkable.  Enlarged left supraclavicular lymph nodes are\nnoted, measuring up to 1.3 cm in short axis (3:4).  There has been interval\nenlargement of in a number of mediastinal lymph nodes including 2 AP window\nlymph nodes which now measures approximately 1.3 cm in short axis (03:22) and\na left paratracheal node (4L) which measures 1.7 cm in short axis and exerts\nmass effect on the esophagus (03:18).  Left hilar nodal tissue is contiguous\nwith the large left upper lobe mass.  The cardiac configuration is normal. \nExtensive coronary calcifications are identified.  The aorta is normal in\nsize.  Atherosclerotic calcifications are noted of the aortic arch.\n\nThe previously seen 2.5 x 2.5 cm left upper lobe mass has substantially\nincreased in size and now measures approximately 12.2 x 4.7 cm and (601:74). \nIt encases the left main pulmonary artery and directly contacts the distal\naortic arch and proximal descending thoracic aorta with loss of fat planes. \nIt is also associated with narrowing and abrupt termination of the distal left\nupper lobe bronchus.  Both the apicoposterior and anterior segmental bronchi\nare severely narrowed, but appear patent more distally. The mass also narrows\nthe lingular bronchus.  Separation of the mass from left hilar nodal tissue is\nnot feasible on this non contrast examination.   A 4 mm right lower lobe\nnodule which was not definitively seen on prior CT is noted. Additionally, new\nbilateral pleural thickening and nodularity is identified (for example ___:40,\n4:62). The right lower lobe consolidation seen on prior CT has resolved.  No\npleural effusion is present.\n\nEvaluation of the bones shows mild multilevel degenerative changes without\nsignificant vertebral body height loss.  No suspicious bony lesions are\nidentified.\n\nLimited evaluation of the upper abdomen shows two, possible, incompletely\nimaged hypodense lesions in the right hepatic lobe.  The right adrenal gland\nappears more nodular than on recent CT of the abdomen.  A prominent portacaval\nlymph node measures 1.1 cm in short axis, greater than seen on prior\nexamination (02:56).  A tiny, hyperdense focus in the gallbladder wall, at the\nfundus was seen previously as well.",
            "output": "Significant increase in size of left upper lobe mass accompanied by new\nintrathoracic and left supraclavicular nodal metastases, pleural metastases,\nand probable intra abdominal metastasis as detailed above.  The mass is\ncontiguous with bulky left hilar lymphadenopathy and results in the encasement\nand narrowing of bronchial structures as well as possible vascular invasion,\nthe latter difficult to assess in the absence of intravenous contrast.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:30 AM."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcifications are moderate.  No pleural\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild bibasilar dependent atelectasis.  Lungs are clear without\nmasses or areas of parenchymal opacification.  Multiple bilateral pulmonary\nnodules are stable compared to ___ with representative examples as\nfollows:\n\n-4 mm left upper lobe pulmonary nodule previously measured 5 mm (03:51).\n-2 mm right middle lobe pulmonary nodule is unchanged (3:103).\n-2 mm sub fissural right middle lobe pulmonary nodules unchanged (3:123).\n-3 mm left lower lobe pulmonary nodule is unchanged (3:127).\n-3 mm right middle lobe is unchanged (3:149).\nNo new or enlarging pulmonary nodules.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck small subcentimeter\nthyroid hypodensities measuring up to 8 mm in the Left thyroid lobe (series 3,\nimage 36).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multiple bilateral pulmonary nodules are stable since ___.\n3. Subcentimeter bilateral thyroid lobe nodules measure up to 8 mm in the\nright thyroid lobe.  These were previously characterized on ultrasound of ___.\n\nRECOMMENDATION(S):  Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Limited views of the upper abdomen show a enlarge left upper\npole of the kidney with central metallic object, likely related to recent\nembolization.  Otherwise upper abdomen is unremarkable.\n\nMEDIASTINUM: Small locule of air seat between the posterior aspect of the left\nmain bronchus and the esophagus, and appears extraluminal to both and most\nlikely is related to trauma.  Few scattered calcifications are noted in the\nright lower paratracheal nodal station.  No lymphadenopathy are seen.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is no pericardial effusion\nPLEURA: Small right pleural effusion appears simple.\nLUNG:\n\n1. PARENCHYMA:  Compressive subsegmental atelectasis of the left lower lobe. \nThere is increased ground-glass opacity surrounding the left lingular\nbronchus.  In addition, there are linear opacities and on follow the\nanatomical distribution as well as nodular opacities measuring up to 7 mm  in\nthe lingula and left upper lobe (5: 137-171).\n2. AIRWAYS:  Narrowing of the bronchial tree at the level of the left lower\nlobe, particularly the posteromedial segment.\n3. VESSELS:  Aorta and pulmonary arteries are normal in size and configuration\non nonenhanced CT.\nCHEST CAGE: There is displaced oblique fracture of the left mid to distal\nclavicle with a 6 mm fragmented bone displaced anteriorly in the deltoid\nmuscle.  Multiple rib fractures are noted throughout the right hemithorax, in\nparticular the right knee with posterior arch appears fractured and mildly\ndisplaced.",
            "output": "1. Linear and nodular as well as ground-glass opacities in the lingula and\nleft upper lobe could represent post trauma, contusion or re-expansion edema. \nThere is no pulmonary laceration or pneumothorax.  Small right pleural\neffusion appears simple.\n2. Multiple rib fractures through the right hemithorax and a displaced\nfracture through the mid to distal left clavicle.\n3. Enlarged upper pole of the left kidney with coil within it, in keeping with\nhistory of recent embolization."
        },
        {
            "input": "CHEST:  The patient is intubated with the endotracheal tube terminating\napproximately 3.5 cm above the carina.  An endogastric tube descends into the\nstomach.\n\nThe imaged portion of the thyroid gland appears normal.  The thoracic aorta\nopacifies normally demonstrating no evidence of acute injury.  The main\npulmonary artery is normal in caliber with patent central branches.  No\nmediastinal hematoma.  No mediastinal, hilar or axillary lymphadenopathy.  The\nheart is normal in size and shape without pericardial effusion.\n\nPosterior basal opacities most consistent with atelectasis, though exclude a\ncomponent of aspiration.  No pneumothorax, or evidence of contusion or\nlaceration.\n\nABDOMEN:  There is a small volume of abdominal ascites, simple appearing. \nHeterogeneous enhancement of the ectatic parenchyma likely reflect perfusional\nanomalies.  The main portal vein appears patent.  There is periportal edema\nand significant gallbladder wall edema which could reflect third spacing.  No\ndefinite focal liver lesion or evidence of contusion or laceration.  There is\nan edematous appearance of the proximal pancreas which could reflect shock\nphysiology.  Additionally, simple fluid is seen tracking along the root of\nmesenteric.  There is a partially calcified multiloculated hypodense lesion\nwithin the inferior pole of the spleen which could reflect a pseudocyst in the\nsetting of old injury.  Otherwise the spleen appears normal.  Adrenals are\nnormal.  Kidneys enhance symmetrically without signs of acute injury or\nworrisome lesion.\n\nThe abdominal aorta is mildly calcified and normal in course and caliber.  The\nmajor aortic branch vessels are widely patent.  No retroperitoneal hematoma or\nadenopathy.  An NG tube is seen coiled within the proximal stomach.  Stomach\nand duodenum appear normal.\n\nPELVIS:  Small bowel loops demonstrate no signs of ileus or obstruction.  No\nsigns of bowel or mesenteric injury.  The appendix is normal.  There is no\nfree air.  Trace free pelvic fluid is noted.  The urinary bladder is collapsed\non a Foley catheter.  There is no pelvic sidewall or inguinal adenopathy.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "1. ET and OG tubes positioned appropriately.\n2. Basal dependent opacities likely sequelae of atelectasis/aspiration.\n3. Small volume ascites, gallbladder wall edema, periportal edema likely\nreflects aggressive hydration.\n4. Edematous appearance of the proximal pancreas may reflect shock physiology."
        },
        {
            "input": "BASE OF NECK: Endotracheal tube terminates approximately 1.5 cm above the\ncarina.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  A right upper\nextremity PICC terminates within the superior cavoatrial junction.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple conspicuous axillary and thoracic\ninlet lymph nodes do not meet CT size criteria for lymphadenopathy.  No\nmediastinal or hilar lymphadenopathy.  A transesophageal enteric tube is\npartially imaged.\n\nPLEURAL SPACES: Trace bilateral nonhemorrhagic pleural effusions.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Patient motion and expiratory phase acquisition limit\nevaluation for subtle pulmonary parenchymal abnormalities. The airways are\npatent to the level of the segmental bronchi bilaterally.  Bibasilar\nhomogeneous consolidations without substantial volume loss likely represent\ninfectious/inflammatory changes instead of atelectasis.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? No acute fracture.\n\nABDOMEN:  Please refer to same day report on CT abdomen and pelvis for\ndescription of subdiaphragmatic findings.",
            "output": "1. Bibasilar homogeneous consolidations without substantial volume loss likely\nrepresent infectious/inflammatory changes instead of atelectasis.\n2. Endotracheal tube terminates approximately 1.5 cm above the carina.\n3. Please refer to same day report on CT abdomen and pelvis for description of\nsubdiaphragmatic findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere multiple prominent, though nonenlarged axillary, hilar and mediastinal\nlymph nodes.  The thyroid gland appears unremarkable.\n\nThere is trace pericardial fluid.  There is a small left pleural effusion, new\ncompared to ___ with overlying compressive atelectasis.\n\nAgain seen is at least 1 punctate pulmonary nodule in the right upper lobe,\n___.  Other previously seen nodules are not visualized on the study.  The\nlung parenchyma is otherwise clear. The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen demonstrate an unchanged hypodense\nsubcentimeter lesion in segment ___, too small to characterize (___).\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere are mild multilevel degenerative changes.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nCompared to ___, there is a new small left pleural effusion with\noverlying compressive atelectasis.\n\nUnchanged prominent, though nonenlarged, axillary, hilar and mediastinal lymph\nnodes."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the thyroid gland\nenhances homogeneously.  Supraclavicular and axillary nodes are not\npathologically enlarged by size criteria.  Chest wall is within normal limits.\nRight subclavian central line tip in the upper SVC.\n\nUPPER ABDOMEN: Punctate hypodensities in the right lobe of the liver measure\nup to 4 mm (3:68, 69), are too small to characterize, but may represent cysts\nor hamartomas.\n\nMEDIASTINUM: Mediastinal lymph nodes measure up to 11 mm in the right lower\nparatracheal station (5:145), unchanged from the prior study.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Trace pericardial effusion is\nlikely physiologic.  Mild coronary calcifications are noted predominantly in\nthe left anterior descending artery.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  No parenchymal opacities or consolidations suspicious for\npneumonia.  There is a calcified granuloma in the superior segment of the\nright lower lobe (5:181).  There are subpleural opacities, some reticular,\nwhile others are more nodular in appearance (series 5, images 70, 74, 98),\noverall similar in appearance compared to the prior chest CTA's dating back to\n___.  This is slightly more pronounced than normally seen with\napical pleural-parenchymal scarring.\n2. AIRWAYS:  Tracheobronchial tree is patent.\n3. VESSELS:  Thoracic aorta is normal in caliber, without appreciable coronary\ncalcifications.\nCHEST CAGE: There is no acute fracture.  No suspicious lytic or sclerotic\nlesion is identified.",
            "output": "1. No evidence of intrathoracic infection.\n2. Upper lobe small subpleural reticular and nodular opacities, likely\nrepresenting nonspecific pleural-parenchymal scarring."
        },
        {
            "input": "The aortic valve is heavily calcified, consistent with history of severe\naortic stenosis.  The thoracic aorta is non dilated and demonstrates\natheromatous calcifications which are mild in the ascending aorta, moderate at\nthe aortic arch level, and mild to moderate in the descending thoracic aorta.\n\nThe heart is mildly enlarged with biatrial prominence.  Diffuse coronary\nartery calcifications are also noted.  There is no pericardial effusion.  Main\npulmonary artery is mildly enlarged at 3.1 cm suggesting the possibility of\npulmonary arterial hypertension. There are no enlarged intrathoracic lymph\nnodes.\n\nWithin the lungs, nonspecific biapical scarring is present as well as diffuse\nheterogeneous lung attenuation with geographically marginated areas of\nrelatively low in attenuation interspersed with regions of higher attenuation.\nNote is also made of mild bronchial wall thickening.\n\nNumerous, scattered 2-3 mm noncalcified lung nodules are present bilaterally,\nwith representative examples in the right upper lobe on images 38, 59, 60, 94\nand 99; left upper lobe on image 52; lingula on image 116; left lower lobe on\nimages 152, and 89; and right lower lobe on images 146 and 154, all on series\n5.  Note is also made of an incidental calcified granuloma in the left lower\nlobe.  Lungs are otherwise remarkable for multifocal linear scarring,\npredominantly in the middle lobe and lingula.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of incompletely imaged cystic lesions in both kidneys.  Small hiatal\nhernia is incidentally noted.\n\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nwithin the spine as well as 2 adjacent compression deformities in the lower\nthoracic spine adjacent to the thoracolumbar junction with associated\nkyphosis.  Additional wedge compression deformities are seen in the upper and\nmid lumbar spine on the scout image.",
            "output": "1. Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis.  Mild to moderate atheromatous calcifications within a non dilated\nthoracic aorta as described above.  These images are available for review for\npreoperative planning.\n\n2.  Coronary artery calcifications and enlarged pulmonary artery suggestive of\npulmonary term hypertension.\n\n3.  Numerous 2-3 mm noncalcified pulmonary nodules are statistically very\nlikely benign in the absence of a history of primary extrathoracic malignancy.\nIf the patient has risk factors for primary lung cancer, followup CT would be\nsuggested in ___ year according to the ___ guidelines, if warranted\nclinically.\n\n4.  Heterogeneous lung attenuation potentially due to chronic small airways\ndisease or chronic vascular disease.\n\n5.  Wedge compression thoracic and lumbar spine fractures of indeterminate\nage.\n\n6.  Incompletely imaged cystic lesions within the kidneys, which could be more\nfully characterized by renal ultrasound if warranted clinically."
        },
        {
            "input": "Multiple thyroid nodules are unchanged as well as diffusely enlarged, right\nmore than left thyroid gland.  Aorta and pulmonary arteries are unremarkable. \nNo mediastinal, hilar or axillary lymphadenopathy is present.  The exception\nis the left mom artery in chain lymph node, series 5, image 41, 13 x 7 mm in\ndiameter, stable.  Image portion of the upper abdomen will be reviewed as part\nof the CT abdomen and pelvis in corresponding report will be issued.\n\nCoronary calcifications, aortic valve calcifications are mild, unchanged.\n\nAirways are patent to the subsegmental level bilaterally.  Elevated right\nhemidiaphragm is re- demonstrated higher than on the previous study that might\npotentially be related to the presence of localized ascites.  No pulmonary\nnodules masses or consolidations demonstrated.\n\nBibasal scarring is present.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive intrathoracic evidence of metastatic disease.  Bibasal scarring.\n\nStable left mom artery lymph node\n\nNew since ___ fluid surrounding the dome of the liver and\nelevated right hemidiaphragm.\n\nUnchanged multiple thyroid nodules.\n\nAortic valve calcification that should be correlated with echocardiography to\nexclude the possibility of hemodynamic significant aortic stenosis."
        },
        {
            "input": "A heterogeneous right thyroid lobe with hypodense 6 mm nodule appears stable\ndating through ___.  There is no axillary or supraclavicular\nadenopathy.  Scattered mediastinal nodes are not pathologically enlarged. \nThere is no hilar adenopathy.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Trace pericardial fluid is physiologic.  Aortic\nvalvular calcifications are of unknown hemodynamic significance.  Coronary\nartery calcifications are mild to moderate.  Mitral annular calcifications are\nmoderate.  Left atrial enlargement is unchanged.\n\nAirways are patent to the subsegmental level.  Respiratory motion is somewhat\nlimiting.  Subsegmental atelectasis within lower lungs is mild.  There is no\nmass, consolidation, or worrisome nodule.  A loculated pleural effusion\nmeasures 6.26 x 2.8 x 9.1 cm (anterior posterio x superior inferior x\ntransverse dimension).  This appears in close proximity to hepatic dome\nlesion, (5:60).\n\nThere is no worrisome lytic or sclerotic osseous lesion within the chest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___, clip number ___.",
            "output": "No evidence of active intrathoracic malignancy or infection.\n\nNew loculated right pleural effusion.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___, clip number ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The right lobe of thyroid gland is\nenlarged and contains a 6 mm hypodense nodule, not significantly changed when\ncompared to the prior study.  There is no supraclavicular axillary adenopathy.\n\nUPPER ABDOMEN: For a description of the subdiaphragmatic findings, please\nrefer to CT scan of the abdomen and pelvis from same date, ___ clips\nnumber ___.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph mph nodes.\n\nHILA: There are no enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  Mitral and aortic\nvalvular calcifications are again noted.  There is no pericardial effusion.\nPLEURA: There is stable loculated pleural effusion in the region of the dome\nof the liver; this measures approximately 3 by 8.5 by 3 cm in size.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the pulmonic parenchyma is compromised secondary\nto respiratory motion artifact.  Subsegmental atelectasis is evident in the\nlower lobes, not significantly changed.\n2. AIRWAYS:  St the trachea demonstrates normal morphology.  The airways are\npatent to the subsegmental level.\n\n3. VESSELS:  The aorta is atherosclerotic and demonstrates normal caliber.\nCHEST CAGE: Degenerative changes are evident in the spine.",
            "output": "Stable loculated right pleural effusion.\nMild cardiomegaly.\nStable subsegmental atelectasis lower lobes.\nFor a description of the subdiaphragmatic findings, please refer to CT scan of\nthe abdomen and pelvis from same date, ___ clips number ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Evaluation of the lungs is limited by respiratory\nmotion.  An 8 mm pulmonary nodule (6:165) in the posterior left lower lobe was\nseen on the prior study from ___, however new since ___. \nBibasilar atelectasis is noted.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  The loculated pleural effusion at the right lung base has\nsignificantly increased in size since ___.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\nperihepatic ascites, cirrhotic liver, and multiple hypodense lesions\ncompatible with known treated HCC.  An 8 mm right adrenal nodule is\nre-demonstrated and appears unchanged compared to the prior study. \nSplenomegaly is noted.  There is a small amount of ascites",
            "output": "1. No evidence of pulmonary embolus or acute aortic abnormality.\n2. 8 mm pulmonary nodule in the posterior left lower lobe, unchanged since ___. For incidentally detected single solid pulmonary nodule measuring 6\nto 8 mm, a CT follow-up in 6 to 12 months is recommended in a low-risk\npatient, optionally followed by a CT in ___ months. In a high-risk patient,\na CT follow-up in 6 to 12 months, and a CT in ___ months is recommended.\n3. Loculated pleural effusion at the right lung base has significant increase\nin size since the prior study.\n4. Cirrhotic liver with known HCC treated lesions and sequela of portal\nhypertension again noted.  Small amount of ascites.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:16 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Moderate enlargement of the right thyroid lobe, with a 1 cm right thyroid\nnodule.  No abnormalities in the chest wall.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  No enlarged lymph nodes in the\nmediastinum.  Stable borderline sized anterior mediastinal lymph node (2, 25).\nModerate coronary calcifications, moderate aortic valve and mitral valve\ncalcifications.  No pericardial effusion.  Moderate ascites and known\nextensive liver changes.  Moderate degenerative vertebral disease.  No\nvertebral compression fractures.  No osteolytic lesions at the level of the\nsternum or the ribs.  Mild respiratory motion.  The known diaphragmatic\neventration on the right (4, 120) Is stable.  The previously 8 mm left lower\nlobe nodule is substantially bigger than on the previous examination and now\nhas a diameter of 17 mm.  No other pulmonary nodules are noted.  Again noted\nis mild scarring in the posterior portions of both the left and the right\nlower lobe.",
            "output": "Substantial increase in size of a pre-existing 8 mm pulmonary nodule in the\nleft lower lobe that is now 17 mm in diameter.  Borderline sized lymph node in\nthe anterior mediastinum.  Mild non characteristic scarring at the lung bases."
        },
        {
            "input": "An endotracheal tube terminates at the level of the carina and should be\npulled back by approximately 2 cm for more optimal placement. There is no\naxillary lymphadenopathy. A mildly enlarged right lower paratracheal lymph\nnode measuring 12 mm is likely reactive (05:44).  There is no hilar\nlymphadenopathy.\n\nThere is a nearly occlusive pulmonary embolism in the right basal trunk,\nextending into the segmental and subsegmental branches (series 8, image 88). \nNo left-sided pulmonary embolism is seen through the level of the segmental\narteries.  The main, left, and right pulmonary arteries are well opacified. \nThe thoracic aorta is normal in caliber.  There is no evidence of aortic\ndissection.\n\nHeart size is normal.  There is no imaging evidence of right heart strain. \nThere is no pericardial effusion.  Mitral annulus calcifications and aortic\nvalvular calcifications are noted.\n\nThe central airways are patent.  Interval development of areas of\nheterogeneous consolidation and ground glass opacification throughout both\nlungs concerning for multifocal pneumonia.  There is also moderate dependent\natelectasis.  There are small bilateral pleural effusions with fluid also seen\nwithin the major fissures bilaterally.\n\nLimited images of the upper abdomen are notable for moderately large ascites\nand cirrhotic morphology of the liver with post treatment changes.  Known\nmultifocal hepatocellular carcinoma is better assessed on the recent MRI of ___.\n\nThere are acute, mildly displaced fractures of the left third through seventh\nribs and the right second through fourth ribs.\n\nA 1.1 cm hypodense right thyroid nodule is noted.",
            "output": "1. Nearly occlusive pulmonary embolism in the right basal trunk, extending\ninto the segmental and subsegmental branches.  No imaging evidence of right\nheart strain.\n2. Interval development of areas of heterogeneous consolidation and ground\nglass opacification throughout both lungs concerning for multifocal pneumonia,\nsuperimposed on moderate dependent atelectasis.\n3. Small bilateral pleural effusions.\n4. An endotracheal tube terminates at the level of the carina and should be\npulled back by approximately 2 cm for more optimal placement.\n5. Multiple acute bilateral mildly displaced rib fractures.\n6. Hepatic cirrhosis with multifocal HCC and superimposed post treatment\nchanges, not adequately assessed on the current study."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nThe heart size is normal and there is no pericardial effusion. No substantial\natherosclerotic calcifications of the thoracic aorta and of the coronary\narteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild biapical\nscarring right greater than left.  Mild diffuse bronchial wall thickening with\nmild bronchiectasis in the upper lobes bilaterally in a paramediastinal\nlocation.  Subpleural scarring in the anterior left upper lobe series 4, image\n39.  There is also mild linear opacities that are calcified and mild\nbronchiectasis in the right middle lobe and lingula.  Scattered calcified\ngranulomas throughout the lower lobes bilaterally.  In the left lower lobe\nnear the inferior pulmonary ligament there is linear and nodular opacity\nlikely scar or atelectasis series 4, image 102 and 602B, image 94.  The 4 x 4\nmm nodule in the left upper lobe series 4, image 72.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen demonstrates a subcentimeter hypodensity\nsegment 2 of the liver too small to characterize.  There is a small hiatal\nhernia.  Uncomplicated diverticulosis.",
            "output": "Mild bronchiectasis and areas of scarring in the upper lobes bilaterally seen\non recent CTA neck is likely the sequel of prior infection.\n\n 4 mm nodule on the left upper lobe, suggest follow-up CT thorax in ___ years\ntime to reassess.\n\nRECOMMENDATION(S):  Follow-up CT thorax in ___ years time to reassess left upper\nlobe nodule."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is normal.  There\nis no supraclavicular or axillary lymphadenopathy by size criteria.  No chest\nwall mass.  Left-sided PICC line with its distal tip in the distal SVC.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen demonstrates a large\nhiatal hernia.  There is slight thickening of the mid to distal esophagus\nlikely related to esophagitis, to be correlated clinically.  Left peripelvic\nand upper pole renal cysts.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  No mediastinal hematoma.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion. \nModerate coronary calcifications.\nPLEURA: Trace bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar atelectasis.  No focal consolidation.  No lung mass.\n2. AIRWAYS:  Though we very minimal diffuse bronchiectasis.  Airways are\notherwise patent to the subsegmental level.\n3. VESSELS:  Thoracic aorta and pulmonary artery are normal in caliber.  There\nis mild atherosclerotic disease within the aortic arch.\nCHEST CAGE: No osteolytic or osteoblastic bony lesions.  No acute fractures.",
            "output": "1.  Bibasilar atelectasis.  No focal consolidations to suggest pneumonia.\n2.  Large hiatal hernia with mild thickening of the mid to distal esophagus\nlikely related to esophagitis, to be correlated clinically."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Extensive calcifications at the level of the aorta\nand its branches.  Normal diameter of the main pulmonary artery.  Severe\ncoronary calcifications, no valvular calcifications, minimal pericardial\neffusion.  Stable moderate hiatal hernia.  Stable appearance of the upper\nabdomen.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.\nStable mild right upper lobe fibrosis (5, 34).  Moderate respiratory motion. \nSeveral stable micro nodules.  No larger consolidations.  Moderate atelectasis\nat the bases of the lingular, unchanged as compared to the previous\nexamination (5, 179).  Moderate thickening and irregularities of the airway\nwalls, reflecting chronic bronchitis.",
            "output": "Decrease in extent of the previous consolidation in the left lower lobe. \nOtherwise the lung parenchyma is comparable to the previous examination. \nModerate chronic bronchitis.  No new or growing parenchymal abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE:  The ascending thoracic aorta is mildly enlarged,\nmeasuring up to 4.2 cm (series 5: Image 142).  Atherosclerotic calcifications\nare seen along the coronary arteries and aortic arch.  A right Port-A-Cath tip\nterminates at the cavoatrial junction.  Otherwise, the heart is within normal\nlimits based on an unenhanced scan.  The main pulmonary artery is top normal\nin size, measuring 2.9 cm.  There is a small pericardial effusion, likely\nphysiologic.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild peribronchovascular opacities are seen in the left lower\nlobe, which can be seen in aspiration versus developing infection.  Linear\natelectasis is also seen in the left lower lobe.  There is mild diffuse\nbronchial wall thickening, likely reactive.  Small foci of ground-glass\nopacities are seen in the anterior right and left upper lobes, which are\nnonspecific.  There is a 3-4 mm solid pulmonary nodule in the right lower lobe\n(series 5: Image 201).  Additionally, there is a 3 mm pulmonary nodule in the\nleft lower lobe (series 5: Image 167).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is remarkable for a\nmoderate size hiatal hernia.  Atherosclerotic calcifications are seen along\nthe descending aorta.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Mild peribronchovascular opacities are seen in the left lower lobe, which\ncan be seen in aspiration versus developing infection.\n2. The ascending thoracic aorta is mildly enlarged, measuring up to 4.2 cm,\nbut unchanged since the prior study in ___.\n3. A couple scattered pulmonary nodules are noted, measuring up to 3-4 mm in\nthe right lower lobe.\n4. Moderate hiatal hernia."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy by CT size criteria.  Right Port-A-Cath tip\nterminates at the cavoatrial junction, unchanged from prior exam.  The imaged\nchest wall is unremarkable.\n\nUPPER ABDOMEN: 2.7 cm and 1.7 hypodensities in the interpolar region of the\nleft kidney are nonspecific, though statistically likely simple cysts.  Hiatal\nhernia is small.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.\n\nHILA: Evaluation for hilar lymphadenopathy is limited due to lack of\nintravenous contrast. However, the overall contour remains stable.\n\nHEART and PERICARDIUM: Three-vessel coronary calcifications are stable.  Trace\npericardial effusion is stable.\nPLEURA: There is no pleural effusion or pneumothorax.  The heart size is\nwithin normal limits.\nLUNG:\n\n1. PARENCHYMA:  5 mm left lower lobe pulmonary nodule has increased in size,\npreviously 2 mm (5:156).  7 mm left lower lobe nodule in the\nperibronchovascular distribution is also increased (5:175).  Moreover, the\ndominant 4 mm nodule in the right lower lobe has increased in size, now\nmeasuring 7 mm (5:204).  3 mm nodule in the right lower lobe may be new\n(5:255).  3 mm nodules in the right and left upper lobes are more conspicuous\non today's exam (5:135, 122).  3 mm para median nodule in the left lower lobe\nis more conspicuous (5:181).  2 mm nodule in the right upper lobe appears to\nbe new (05:13).  2 mm perifissural nodule and 2 mm parenchymal nodule in the\nright upper lobe are stable (5: 65, 93).  Bibasilar atelectasis, ground-glass\nopacities and linear opacities are grossly similar to ___.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.  Diffuse\nperibronchial wall thickening is suggestive of chronic bronchitis.\n3. VESSELS:  Mild dilation of the ascening thoracic aorta measuring up to 4.3\ncm is stable.  The descending aorta and the main pulmonary arteries are normal\nin caliber.\nCHEST CAGE: Mild degenerative changes of the thoracic spine with multiple\nSchmorl's node is stable.",
            "output": "1. Interval enlargement of bilateral pulmonary nodules, the largest measuring\n7 mm in the left lower lobe.\n2. Stable atelectasis and ground-glass opacities in the bilateral lower lobes\ncompared to ___.  No new focal consolidation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  The hiatal hernia is\nmoderate in size.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is severe coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber. \nAtherosclerotic calcifications in the thoracic aorta is mild.  The right\nPort-A-Cath terminates in the cavoatrial junction.\n\nPULMONARY PARENCHYMA: Evaluation of the pulmonary parenchyma is limited by\nrespiratory motion.  Given the limitation, no new or growing nodules.  5 mm\nright lower lobe pulmonary nodule (series 4, image 163) and 5 mm left lower\nlobe pulmonary nodule (series 4, image 134) have decreased in size. \nAdditional 3 mm right upper lobe pulmonary nodules (series 4, image 99 and\n117) are stable.  There is bibasilar atelectasis.  There is no emphysema.\n\nAIRWAYS:  Bronchial wall thickening is most severe in the bilateral lower\nlobes as on prior studies.  The airways are patent to the subsegmental level\nbilaterally.\n\nPLEURA:  No pleural effusion or pneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  No acute fractures.\n\nUPPER ABDOMEN:  Partially imaged upper abdomen is unremarkable.  Enteric tube\nextends into the stomach and out of view.",
            "output": "1. Limited exam due to respiratory motion.  Given the limitation, no new or\ngrowing pulmonary nodules.  Right lower and left lower lobe pulmonary nodules\nhave decreased in size.  Additional pulmonary nodules are stable in size\nmeasuring up to 3 mm.\n2. Unchanged bronchial wall thickening, worst in the lower lobes.\n3. Moderate hiatal hernia."
        },
        {
            "input": "HEART AND VASCULATURE: The study is limited by moderate motion artifact. \nGiven the limitation, no central, lobar, or segmental pulmonary embolism. \nAbnormalities in the subsegmental pulmonary arteries could easily be missed. \nHypodensity in the subsegmental pulmonary artery in the right upper lobe\n(series 6, image 104) is likely artifact.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  There are moderate coronary artery calcifications.  There\nis a right Port-A-Cath\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the pulmonary parenchyma is limited by motion\nartifacts.  Given the limitation, no focal consolidation to suggest pneumonia.\nPreviously seen tiny nodules are not evident on today's study, likely due to\nmotion degradation.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited evaluation of the abdomen pelvis demonstrated a small hiatal\nhernia and partially imaged enteric tube.  Otherwise the upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Limited study due to moderate motion artifacts.  Given the limitation, no\ncentral, lobar, or segmental pulmonary embolism.  Abnormalities could be\nmissed.  Hypodensity in the subsegmental pulmonary artery in the right upper\nlobe is likely artifact.\n2.  No additional acute process within the chest."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Substantial hiatal\nhernia is demonstrated.  NG tube tip is in the stomach.  Central venous line\ntip is in the proximal right atrium\n\nCoronary calcifications are extensive.  Heart size is normal.  There is no\npericardial or pleural effusion demonstrated.\n\nAirways are patent to the subsegmental level bilaterally but diffuse bronchial\nwall thickening is extensive.  As on the previous examinations substantial\nrespiratory/motion artifacts preclude pre size assessment of the lung\nparenchyma but within those limitations there is no new consolidations to\nsuggest interval progression of infectious process noted.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No substantial interval progression to suggest interval development of\ninfectious process.\n\nSevere respiratory motion precluding pre size assessment."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is stranding of the left\naxillary soft tissues containing multiple prominent but non pathologically\nenlarged left axillary nodes measuring up to 6 mm (02:12).  The endotracheal\ntube terminates at the mid trachea.  The enteric tube courses down the\nesophagus, the distal tip of which is not imaged in this study.  The right\ncentral venous access line terminates in the distal SVC.\n\nUPPER ABDOMEN: Unremarkable.\n\nMEDIASTINUM: Scattered prominent but non pathologically enlarged mediastinal\nnodes measuring up to 8 mm in the pretracheal region (02:16) are likely\nreactive.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Marked coronary artery vascular calcifications.  No\npericardial effusion.\nPLEURA: Moderate bilateral simple pleural effusions with near complete\ncollapse of the left lower lobe and compressive atelectasis of the dependent\nright lung base.\nLUNG:\n\n1. PARENCHYMA:  There is nonenhancing coalescing solid and ground-glass\nopacities within the dependent aspects of the right and left upper lobes and\nwithin the lingula which likely represent multifocal pneumonia.\n2. AIRWAYS:  There is mild peribronchial thickening of the bilateral upper and\nlower lobe small airways.\n3. VESSELS:  Mild atherosclerotic calcification of the aortic arch and origins\nof the left subclavian artery.\nCHEST CAGE: No aggressive osseous lesions.",
            "output": "1. Multifocal solid and ground-glass opacities predominantly in the dependent\naspect of the right and left upper lobe and scattered areas within the lingula\nare compatible with multifocal pneumonia.\n2. Near complete collapse of the left lower lobe and segmental atelectasis of\ndependent right lung base.\n3. Moderate bilateral pleural effusions.  No evidence of loculated effusion.\n4. Nonspecific stranding of the left axillary subcutaneous fat containing\nprominent but non pathologically enlarged left axillary lymph nodes."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART AND VESSELS: The heart is normal in size.  There are extensive coronary\nartery atherosclerotic calcifications.  No pericardial effusion is identified.\nThere is mild atherosclerotic disease of the thoracic aorta.\n\nPLEURA: There is a small right and trace left pleural effusion.\n\nAIRWAYS/LUNG: The central airways are patent.  There are mild paraseptal and\ncentrilobular emphysematous changes.  Biapical pleuroparenchymal scarring is\nnoted.  No focal consolidation is identified.  There is compressive\natelectasis in the bilateral lower lobes and subsegmental atelectasis in the\nright middle lobe and lingula.  No suspicious pulmonary lesions are\nidentified.\n\nBONES: There is redemonstration of the comminuted fracture through the left\nhumeral head and surgical neck.  There is contour deformity of the lateral\nright seventh rib, which most likely represents a healed fracture.  There is a\ncompression deformity of the T3 vertebral body, which appears unchanged\ncompared to prior CT cervical spine on ___.  Mild multilevel\ndegenerative changes are seen in the thoracic spine.\n\nSOFT TISSUES: No soft tissue abnormality.\n\nUPPER ABDOMEN: Please see separate report for concurrently performed CT\nAbdomen and Pelvis for findings below the diaphragm.",
            "output": "1.  No evidence of infection in the chest.\n2.  Small right and trace left pleural effusions.\n3.  Healing fracture through the left humeral head and surgical neck."
        },
        {
            "input": "Tracheostomy tube in correct position.  The thyroid is unremarkable. \nModerately patulous esophagus (2, 20).  No evidence of anterior mediastinal\nneoplasm.  No mediastinal lymphadenopathy.  No incidental pulmonary embolism. \nStable small right pleural effusion, new small left pleural effusion,\nrelatively extensive left lower lobe pneumonia.  Right basilar atelectasis. \nModerate cardiomegaly, coronary calcifications, no pericardial effusion. \nStable appearance of the liver and of the upper abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nModerate degenerative vertebral disease.  No vertebral compression fracture. \nRelatively stable appearance of the known humeral fracture (602, 124).  Mild\nbilateral apical scarring.  Abundant mucous retention (302, 78).",
            "output": "Relatively extensive left lower lobe pneumonia.  Moderate cardiomegaly with\nmoderate coronary calcifications.  No evidence of neoplasm.  New left pleural\neffusion.  Stable right pleural effusion.  No evidence of mediastinal\nneoplasm."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Mild\ncalcification within the thoracic aorta.  Moderate tritruncal coronary artery\ncalcifications.  Mild cardiomegaly.  The pericardium and great vessels are\nwithin normal limits. No pericardial effusion is seen. Distal tip of the right\nPICC line terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy. No mediastinal mass or hematoma. PLEURAL\nSPACES: No pneumothorax.  Small, nonhemorrhagic left pleural effusion.\n\nLUNGS/AIRWAYS: The distal tip of an endotracheal tube terminates approximately\n3 cm above the carina. Scatter nonobstructive endotracheal secretions are\nnoted.  Mild biapical scarring, unchanged.\n\nModerate atelectasis of the posterior right lower lobe.  Severe atelectasis of\nthe left lower lobe with notable volume loss.  No evidence of obstructive mass\nor pneumonia.  Ground-glass opacities in the right middle and lower lobes are\nnonspecific but may represent developing pneumonia.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: Compression deformity of the T3 vertebral body with 50% loss of\nvertebral height and no retropulsion is unchanged from ___.  There is no\nacute fracture.  Chronic appearing cortical irregularity of the left humeral\nhead, likely from prior injury.  Mild-to-moderate degenerative changes of the\nthoracic spine.\n\nABDOMEN: Please refer to same day report on CT abdomen and pelvis for\ndescription of subdiaphragmatic findings.",
            "output": "1. Severe atelectasis of the posterior left lower lobe and moderate\natelectasis of the posterior right lower lobe likely explain patient's\npresentation.\n2. Small, nonhemorrhagic left pleural effusion.\n3. Subtle ground-glass opacities in the right middle and lower lobes are\nnonspecific. It could represent developing pneumonia, but unlikely to explain\npatient's marked leukocytosis.\n4. No evidence of pulmonary embolism or aortic abnormality.\n5. Please refer to same day report on CT abdomen and pelvis for description of\nsubdiaphragmatic findings."
        },
        {
            "input": "THYROID: Unremarkable.\n\nLYMPH NODES: There is no supraclavicular, axillary, or mediastinal\nlymphadenopathy.\n\nHEART AND GREAT VESSELS: The heart is normal in size, without a pericardial\neffusion.  Severe multifocal coronary calcifications are noted.  There are\nalso mild to moderate aortic valve calcifications, and heavy mitral annular\ncalcifications.  Left pectoral pacer leads terminate in the right atrium and\nright ventricle.  Right-sided PICC terminates in the low SVC.\n\nAIRWAYS AND LUNGS: Mild thickening along the left posterolateral distal\ntrachea likely represents secretions (02:21).  Airways are otherwise patent to\nthe subsegmental levels bilaterally.\n\nDense consolidation at the right lung base likely represents atelectasis in\nthe setting of a small to moderate adjacent pleural effusion.  There is also\nmild atelectasis at the left lung base.  Scattered ___ opacities and\ncentrilobular micronodules are noted bilaterally, which are most pronounced in\nthe right upper lobe and at the lung bases.  This is a nonspecific finding,\nand may be infectious or inflammatory in etiology.\n\nUPPER ABDOMEN: An enteric tube extends to at least the body of the stomach.\n\nBONES AND SOFT TISSUES: No focal osseous lesions are identified.  There is no\nacute fracture.  Soft tissues are unremarkable.",
            "output": "1. Dense right lower lobe consolidation most likely represents compressive\natelectasis in the setting of a small/moderate right pleural effusion. \nFurther characterization is limited in the absence of intravenous contrast. \nMinimal left lung base atelectasis.\n2. Multifocal ___ opacities and centrilobular micronodules, compatible\nwith an active infectious or inflammatory process."
        },
        {
            "input": "Hypodense nodule in the right lobe of the thyroid is unchanged.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size.  Cardiomegaly is a stable. \nModerate calcifications in all coronary arteries are again noted. \nCalcification of the aortic valve is of unknown hemodynamic significance. \nLarge bilateral layering non hemorrhagic pleural effusions are larger on the\nleft side, associated with collapse of the left lower lobe, almost complete\ncollapse of the right lower lobe and large atelectasis of the lingula.  In the\naereated lungs there is diffuse ground-glass opacities associated with smooth\ninterlobular septal thickening.  Irregular consolidation in the right upper\nlobe seen in prior CT from ___ has resolved\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy\nCentral catheter tip is in the right atrium",
            "output": "Large bilateral pleural effusions are associated with collapse left lower lobe\nand large atelectasis in the right lower lobe and lingula\nGround-glass opacities in the upper lobes are due to pulmonary edema\nCoronary calcification"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Central venous\ncatheter ends in the upper right atrium, with no evidence of thrombosis,\napproaching from the left jugular vein.  ET tube in standard placement. \nNasogastric drainage tube ends in the stomach.\n\nThere are no soft tissue lesions in the chest wall suspicious for malignancy\nor infection.  Findings below the diaphragm will be reported separately.\n\n13 mm wide hypo density in the right thyroid lobe year is new or more apparent\ncompared to ___ and should be evaluated with ultrasound.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged.  There is\nno pericardial effusion.  Small nonhemorrhagic pleural effusions layer\nposteriorly, decreased on the left, stable on the right compared to ___. \nPulmonary artery enlargement, most severe on the right, 34 mm, is unchanged\nsince ___.  Atherosclerotic calcification is moderately severe in\nhead and neck vessels, more pronounced throughout the normal sized thoracic\naorta and in all major coronary arteries.  Heart size is best evaluated by\ndedicated cardiac imaging.\n\nEmphysema is moderately severe, with a large paraseptal component.  Basal\nsegments in the left lower lobe and posterior basal segment on the right are\nstill collapsed.  Smaller region of irregular consolidation in the posterior\nsegment of the left upper lobe has not changed appreciably since ___ when\nit was clearly atelectasis.  Currently it is more heterogeneous which could be\ndue to pneumonia, but is more likely incomplete re-expansion of the previous\natelectasis.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThe there are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\nNew",
            "output": "No evidence of intrathoracic infection.\n\nCompared to ___, there is bibasilar atelectasis, more severe on the left,\nand in the posterior segment of the left upper lobe, and small bilateral\npleural effusions, decreased on the left, stable on the right.\n\nProbable pulmonary arterial hypertension.\n\nModerately severe emphysema.\n\nThyroid nodule warranting ultrasound evaluation to exclude a nodule."
        },
        {
            "input": "Known 4 mm right thyroid nodule.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum are\nnormal in size.  Severe coronary calcifications, moderate aortic valve\ncalcifications.  Moderate aortic wall calcifications.  Minimal increase in\nextent of the right pleural effusion.  Stable left pleural effusion. \nAtelectasis at the bases of both the right and the left lower lobe. Moderate\ndegenerative vertebral disease.  No vertebral compression fractures. \nUnchanged paraseptal emphysema.  Unchanged mild generalized elevation of the\nlung attenuation, reflecting diffuse ground-glass opacities, likely based on\nmild pulmonary edema and insufficient inspiration.  No focal opacities\nsuspicious of pneumonia.  No suspicious lung nodules or masses.  No evidence\nof abscesses.",
            "output": "No relevant change as compared to the previous examination from ___. \nMinimal increase in extent of a pre-existing right pleural effusion. \nBilateral areas of atelectasis.  No evidence of pneumonia or abscess."
        },
        {
            "input": "MEDIASTINUM:  11 mm nodule in the right thyroid.  Numerous top normal\nmediastinal lymph nodes including right lower paratracheal (02:16) measuring 8\nmm in short axis and 10 mm sub carinal lymph node.\n\nHEART AND GREAT VESSELS:  The aorta is non aneurysmal.  Mild calcifications of\nthe aortic valve.  Severe coronary calcifications.  Mild to moderate\ncardiomegaly.  Mild mitral annular calcifications.  The right pulmonary artery\nis moderately enlarged, 2.9 cm.  No pericardial effusion.  Tunneled dialysis\ncatheter ends in the low SVC.\n\nPLEURA:  There is no pneumothorax.  Small left and moderate\nright-nonhemorrhagic pleural effusions layer posteriorly.  .\n\nLUNGS AND TRACHEOBRONCHIAL TREE:  The patient exhaled during the examination\ncausing breath motion artifact.  Significant collapse of the bronchial tree\nand shape of the trachea suggest tracheobronchomalacia.\n\nWidespread ground-glass opacification, some centrilobular, is  worse in the\nright lung than the left and there substantially more ground-glass\nopacification surrounding the 2.5 x 5.3 cm, subpleural, masslike consolidative\nabnormality in the right upper lobe  (4:99) first detected on chest\nradiographs ___.  Bibasilar atelectasis is moderate on the right, mild\non the left.\n\nCentrilobular and paraseptal emphysema is mild.\n\nBONES AND CHEST WALL:  There are no bone lesions in the chest cage or soft\ntissue lesions in the chest wall suspicious for malignancy or infection.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "Peripheral consolidation in the right upper lobe can be acute infection\nincluding bacterial or atypical organisms such as fungus.  Pulmonary infarct\nis considered less likely.\n\nAsymmetric ground-glass opacities worse on the right, in combination with\npleural effusions is likely asymmetric edema.  Aternative and/or concurrent\ndiagnoses include pulmonary hemorrhage and atypical infection.\n\nPossible pulmonary hypertension, etiology unclear.\n\nPossible tracheobronchomalacia."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, mediastinal, or hilar\nlymphadenopathy.  The heart size is normal.  The pericardium is intact without\nevidence of an effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.\n\nFor evaluation of the abdomen, please refer to the dedicated CT of the abdomen\nperformed on the same day.\n\nNo pulmonary nodules concerning for malignancy are identified.  There is no\npleural effusion or pneumothorax.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "No concerning pulmonary nodules identified."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Ascending aorta is 4.2 cm in\ndiameter, mildly dilated.  No pathologically enlarged mediastinal,\nsupraclavicular, hilar or axillary lymph nodes demonstrated.  Heart size is\nnormal.  Severe coronary calcifications are present.  There is no pericardial\nor pleural effusion.\n\nAirways are patent till the subsegmental level bilaterally.\nSpiculated nodule in right lower lobe, series 302, image 143 is 14 x 18 x 13\nmm with lobulated contour highly concerning for neoplasm.\nApical scarring is bilateral.  There is minimal centrilobular emphysema.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.",
            "output": "Right lower lobe spiculated lesion with lobulations, highly concerning for\nprimary lung cancer.  Thoracic surgery consultation is recommended.\n\nDilatation of ascending aorta that would require further assessment in\nfollow-up, please consider consultation with vascular surgeon."
        },
        {
            "input": "CHEST CTA:\nThe ascending aorta is mildly dilated measuring up to 4.3 cm without evidence\nof thoracic aortic dissection.  The main, lobar, segmental, and subsegmental\npulmonary arteries are well opacified without filling defect.  The remainder\nof the great vessels have a normal appearance.  There is no mediastinal\nhematoma.\n\nCHEST:\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  The heart is enlarged. There is no\npericardial effusion. There are no significant Coronary artery or aortic\nvalvular calcifications.\n\nThe airways are patent to the subsegmental level bilaterally, with mild\ndiffuse bronchial wall thickening. Lung volumes are low. There is\nmicroatelectasis at the lung bases bilaterally. There is no pleural effusion,\npneumothorax, or pneumomediastinum. There are no suspicious pulmonary nodules.\nThere is no focal consolidation.\n\nThere is a small hiatal hernia.  Additionally, there is a small fat containing\nBochdalek's hernia on the left. Limited views of the upper abdomen are\nunremarkable. The superficial soft tissues are normal.\n\nOSSEOUS STRUCTURES:\nNo focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Mildly dilated ascending aorta measuring up to 4.3 cm."
        },
        {
            "input": "This study is somewhat limited due to motion related to respiration.\n\nThere is obstruction and nonvisualization of the SVC and right subclavian vein\nwhich is likely secondary to compression from the large calcified mass at the\nbase of the right neck.  There are multiple collaterals noted in the\nsubcutaneous tissues and a distended appearance of the azygos vein.  The aorta\nand its major branch vessels are patent, with no evidence of stenosis,\nocclusion, dissection, or aneurysmal formation.  There is no evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, and segmental\nlevels.  There is a limited evaluation of the subsegmental pulmonary arteries\ndue to patient motion.  The main pulmonary artery is dilated measuring up to\n3.7 cm across maximal diameter (2:84).\n\nIn the base of the right neck posterior to the inferior margin of the right\nSCM muscle, there is a irregular calcified mass(2:52) which is grossly\nunchanged in size from PET-CT ___.  There is a calcified anterior\nmediastinal mass(2:80) which is unchanged.  There is a calcified mass in the\nlower left pectoralis muscle(2:65) which is unchanged.  A calcified right\naxillary lymph node (2:75) is unchanged.  There is a calcified left hilar\nlymph node measuring up to 0.9 cm across short axis (2:70) which is unchanged.\nThere is also right hilar and subcarinal lymphadenopathy.  There is confluent\nmediastinal and bilateral hilar soft density replacing the normal mediastinal\nand hilar fat concerning for confluent adenopathy.  Please note, there is soft\ntissue encasement without obstruction.\n\nThere are multiple nodules in the lung all of which are unchanged from ___.  They include the following: A 3 mm nodule in the right upper lobe\n(2:68), subpleural 6 mm nodule is noted in the right middle lobe 2:77), a 4 mm\nnodule in the right lower lobe (2:90), a 5 mm nodule in the superior aspect of\nthe left lower lobe (2:83), a 5 mm nodule in the subpleural region of the left\nlateral lower lobe (2:94),a 5 mm nodule in the left lower lobe (2:95) There is\nmild dependent atelectasis in the left greater than right lungs.   The airways\nare patent to the subsegmental level.\n\nThere is a catheter which courses along the an infrahepatic IVC and terminates\nin the intrahepatic IVC.\n\nBONES:  Lytic bone lesion in the left mandible measuring up to 1.4 cm (02:16)\nis unchanged.  Sclerotic foci in the T1 and T3 vertebral bodies are unchanged\nand could represent radiation change versus lesions secondary to multiple\nmyeloma.  There is some mottled appearance of the axial skeleton and ribs was\nis compatible with decreased bone mineralization as well as known multiple\nmyeloma.\n\nSOFT TISSUES:  There is a subcutaneous nodule measuring up to 1.4 cm in the\nregion of the left pectoralis muscle and a subcutaneous nodule measuring up to\n0.9 cm (2:63) superficial the left scapula.  Both of these nodules are\nunchanged.  Multiple collateral veins in the chest wall reflect SVC\nobstruction.",
            "output": "1. No central pulmonary embolism.\n2.  Multiple calcified masses including the base of the right neck, the left\npectoralis muscle, in the mid anterior mediastinum are unchanged in size from\nPET-CT ___.\n3. Multiple pulmonary nodules measuring up to 6 mm in the right middle lobe\nare unchanged.\n4.  Chronic appearing occlusion of the SVC and right subclavian vein likely\nsecondary to obstruction from mass at the base the right neck.  Extensive\ncollateral vessels in the subcutaneous tissues.\n5.  Mediastinal and hilar inflow and lymphadenopathy appears grossly unchanged\nfrom ___.\n6.  Stable appearance of the bones including a lytic lesion in the left\nmandible."
        },
        {
            "input": "Re- demonstration of obstruction and nonvisualization of the SVC and right\nsubclavian veins, likely due to compression from the large calcified mass at\nthe base of the right neck.  The azygos is distended, as before.  Multiple\ncollateral vessels again seen.  The aorta and its major branch vessels are\npatent, no evidence of stenosis, occlusion, dissection, or aneurysm formation.\nThere is no evidence of penetrating atherosclerotic ulcer or aortic arch\natheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main\npulmonary is dilated, up to 3.6 cm (3:70), unchanged.\n\nA calcified mass at the base of the right neck is unchanged in size, measuring\n5.9 x 2.9 cm.  Calcified anterior mediastinal mass is unchanged in size since\n___.  Hilar lymphadenopathy is grossly stable since the prior study. \nSubcarinal lymphadenopathy is also unchanged.  The thyroid gland appears\nunremarkable.\n\nThere is no evidence of pericardial effusion.  There is a small right pleural\neffusion.  Multiple pulmonary nodules are not significantly changed since\n___.  Bibasilar atelectasis is mild.  Airways are otherwise patent\nthe subsegmental level.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.  A catheter is seen in\nthe IVC.\n\nSclerotic lesions in T3 is unchanged (602b:34) previously described as\npostradiation change versus multiple myeloma.  Left breast soft tissue density\nis again seen and unchanged (3:128).  A left pectoral calcified lesion (2:24)\nis slightly larger compared to the prior study.  Another calcified lesion in\nthe right axilla (2:16) is unchanged in size.",
            "output": "1.  No evidence of pulmonary embolism.\n\n2.  Unchanged multiple pulmonary nodules since ___.  Slightly larger\nleft pectoral calcified lesion when compared with the prior study.\n\n3.  Chronic appearance of the known occlusion of the SVC and right subclavian\nvein and extensive collateral vessels in the subcutaneous tissues.\n\n4.  Calcified masses in the anterior mediastinum and right base of neck are\nunchanged."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Chronic obstruction of the superior vena cava and left\nbrachiocephalic vein are unchanged.  Prominent collateralization pathways\ninclude paraspinal veins and anterior chest wall veins, as well as a markedly\ndilated azygos vein.  Avid enhancement in the upper thoracic esophagus likely\nget reflects additional collaterals.  Coronary artery calcifications are\nnoted.  Heart size is top-normal.\n\nAXILLA, HILA, AND MEDIASTINUM: A calcified anterior mediastinal mass is\nunchanged, difficult to measure, but roughly 7.3 x 1.9 cm in the axial plane. \nAdditional scattered, calcified, mediastinal and hilar lesions/lymph nodes are\nunchanged.  Prominent right hilar lymphadenopathy is not grossly changed.  A\nnoncalcified left paratracheal lymph node measuring 1.3 cm unchanged (series\n2, image 11).\n\nPLEURAL SPACES: A trace right pleural effusion is unchanged.  Right\nposterolateral pleural thickening versus loculated fluid appears unchanged. \nNo pneumothorax.\n\nLUNGS/AIRWAYS: A new nodular density in the anterior right upper lobe\nmeasuring 1.3 x 0.8 cm with adjacent ground-glass opacities is new.  Focal\nnonspecific ground-glass opacities are also present in the anterior aspect of\nthe left upper lobe (series 3, image 60) as well as within the remainder of\nthe right upper lobe.  There is new left lower lobe atelectasis and mild right\nlower lobe atelectasis.\n\nBASE OF NECK: A calcified mass at the base of the right neck is difficult to\nmeasure, but likely unchanged, measuring at least 4.6 x 3.1 cm (series 2,\nimage 10).\n\nABDOMEN:  Included portion of the upper abdomen appears demonstrate minimal\nascites about the liver and spleen.\n\nBONES: Sclerotic lesions in the T1 vertebral body, right T1 pedicle, T2\nvertebral body abutting the right pedicle, and T3 vertebral body are not\nappreciably changed.  Mild T4 vertebral body height loss is unchanged.\n\nSOFT TISSUES: A calcified mass in the left pectoralis major is unchanged and\nmeasures 2.5 x 1.8 cm.  A calcified right axillary lesion has increased in\nsize and measures 2.0 x 1.7 cm, previously 1.5 x 1.3 cm (series 2, image 29). \nA subcutaneous nodule overlying the left scapula has increased in size and\nmeasures 1.5 x 1.1 cm, previously 1.3 x 0.8 cm (series 2, image 16).",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. New right upper lobe nodular density with right upper lobe ground-glass\nopacities are nonspecific findings, possibly reflecting infection,\ninflammation, or new malignant involvement.  An additional focus of relatively\nsimilar ground-glass opacity is located in the anterior left upper lobe, also\nnew.\n3. Slightly increased size of right axillary and posterior left back soft\ntissue masses concerning for disease progression.\n4. Additional scattered lymph nodes and masses are unchanged.\n5. Unchanged SVC and left brachiocephalic vein thrombosis with prominent\ncollateralization including the upper thoracic esophagus.\n6. Small volume ascites."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, and hilar lymph nodes are\nnot enlarged.  Mediastinal lymph nodes are borderline, increased in number\nmeasuring up to 8 mm in the right upper paratracheal station, 10 mm in the AP\nwindow and 7 mm right paraesophageal station Aorta and pulmonary arteries are\nnormal size.  There is mild cardiomegaly.  There are mild calcifications in\nall coronary arteries.  There is no pleural or pericardial effusion.\nInterstitial lung disease is characterized by diffuse subpleural reticular\nabnormalities associated with ground-glass opacities and bronchiolectasis\nThis examination is not tailored for subdiaphragmatic evaluation the upper\nabdomen is normal\nThere are no bone findings of malignancy",
            "output": "Interstitial lung disease most consistent with fibrotic NSIP"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic evaluation, especially\ninvolving the liver, but shows there are no adrenal abnormalities.\n\nAbove a small hiatus hernia, the esophagus is unremarkable.  There are no\nthyroid abnormalities warranting further imaging evaluation.  Atherosclerotic\ncalcification is mild to moderate in head and neck vessels and scattered in\nall coronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.  Pericardium is physiologic.  There is no pleural effusion.\n\nThoracic lymph nodes:\nSome previously mildly enlarged mediastinal lymph nodes are smaller, for\nexample a 15 mm wide aggregate in the right upper paratracheal station was 18\nmm in ___ other top-normal nodes are unchanged in size.\n\n\nLungs and airways the extensive, moderately severe predominantly peripheral\ninterstitial pulmonary abnormality is unchanged.  The peripheral reticulation\nin many areas qualifies as honeycombing.  The abnormality combines features of\nUIP an NS IP.  Example the distribution does not have basal predominance, seen\nin UIP, nor does it have a strong peribronchovascular component more commonly\nseen in NS IP, although there is definitely some, in the posterior segment of\nthe right upper lobe, 302:69.  There is no appreciable ground-glass\nopacification.\n\nThere are no lung nodules or any consolidation.\n\nChest cage:\n\nThere are no bone lesions in the chest cage concerning for malignancy or\ninfection.",
            "output": "No radiographic change over the past 6 months in severity widespread,\nmoderately severe, fibrosing interstitial lung disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathies in the thoracic inlet.\n No abnormalities on chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: This study was not tailored for evaluation of subdiaphragmatic\nsections however it shows no adrenal lesions\n\nMEDIASTINUM: Multiple mediastinal top-size lymph nodes measuring up to 1.0 cm,\nall unchanged since ___.\n\nHILA: No hilar lymphadenopathies.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nMild atherosclerotic calcifications in thoracic aorta and both coronary\narteries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA: Moderately extensive peripheral fibrosing interstitial\npulmonary abnormality has progressed slightly since ___.  This\nconsists of reticulation and honeycombing without an apico-basal gradient.  No\nground-glass opacifications are seen.  Mild air trapping suggests an\nobstructive component.\n8 mm solid nodule in left lower lobe (7:149), unchanged since ___.\n2. AIRWAYS:  Patent to the subsegmental levels.\n3. VESSELS:  Pulmonary artery is not enlarged.\nCHEST CAGE: Moderate dorsal spondylosis in lower thoracic vertebrae.",
            "output": "Moderately severe fibrosing interstitial lung disease minimally worse since\n___.  This interstitial disease could be explained by a prior\nexposition to pulmonary toxic medications.\nPulmonary solid nodule unchanged since ___, probably benign.\nRelatively limited expiratory changes are consistent with small airway\ndisease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, the largest in the subcarinal\nstation measuring up to 1.0 cm (302:88), and in the prevascular station\nmeasuring 2.0 x 1.2 cm, slightly larger.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening.  No bronchiectasis or mucus plugging.  Interstitial findings of\nperipheral interlobular septal thickening and mild unchanged honeycombing,\nsymmetrical and with no apical basilar gradient throughout the lungs.  There\nare no ground-glass opacities.  There is minimal air-trapping during dynamic\nexpiration, suggesting small airway obstruction.  Mild centrilobular\nemphysema.  Unchanged 8 mm nodule in the left lower lobe (302:135).\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "No interval change compared to prior study of ___ in\n moderate, fibrosing interstitial lung disease that does not fit strict\nradiologic criteria for diagnosing UIP.  This could be fibrosing NSIP or\natypical UIP.  There is no evidence of active inflammatory component, but\nthere is air trapping."
        },
        {
            "input": "Atherosclerotic disease of the aorta is advanced including ulcerated plaques\nwithin the descending aorta.  Coronary calcifications are present.  No under\nis might take dilatation of the aorta is noted.  Pulmonary arteries are normal\nin diameter.  Heart size is top-normal.  No pericardial pleural effusion is\ndemonstrated.\n\nThere are no mediastinal, hilar or axillary pathologically enlarged lymph\nnodes present.\n\nAirways are patent to the subsegmental level bilaterally.  Bi apical opacities\nmost likely represent scarring, series 6, image 24 symmetric.  Centrilobular\nemphysema is new moderate, bilateral, symmetric.  Diffuse ground-glass opacity\nin the left lower lobe with some areas of centrilobular nodules is present,\nmost likely representing infection or aspiration.  Lingular nodularity, series\n6, image 296 with the largest nodule of 6 mm and a adjacent multiple nodules\nis noted.  No additional nodules or masses demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Advanced atherosclerotic disease as described\n\nBi apical opacities most likely representing scarring.\n\nNodules in the lingula, up to 6 mm.  Reassessment in 6 months with chest CT is\nrecommended."
        },
        {
            "input": "The thyroid gland appears homogeneous in attenuation and normal in size.  A\ncentral venous line ends in the low superior vena cava.  The vertical segment\nof the right brachiocephalic vein and the entirety of the superior vena cava\nare severely narrowed.  This apparent stricture is a new development since the\nPET-CT in ___ prior to insertion of the central venous line.  Surprisingly\nno collateral venous circulation is apparent.  No collaterals are identified. \nThe left brachiocephalic vein is patent and normal in caliber.\n\nLinear streak of soft tissue density within the soft tissues of the right\nanterolateral chest wall may be scar related to VATS.  There is no axillary or\nsupraclavicular adenopathy.  Scattered central nodes are not pathologically\nenlarged, ranging in diameter up to 1.2 x 0.9 cm (04:22) in the right lower\nparatracheal station, and left paraesophageal nodes, 0.7 x 0.9 cm (04:46), 0.5\ncm (04:47), minimally larger today than on the PET CT scan in ___.  There\nis no hilar adenopathy.\n\nThe heart, thoracic aorta, and main pulmonary arteries are normal size. \nSubject to the limitations of this study the great vessels are free of filling\ndefects.  Trace pericardial fluid is physiologic.  Coronary artery\ncalcifications are mild to moderate and most pronounced within the left\nanterior descending coronary artery.  The esophagus is unremarkable.\n\nSuture material in the right upper lobe consistent denotes wedge resection for\nmetastatic squamous cell carcinoma.  Pulmonary nodules are more numerous and\nlarger in size, involve all lobes, and measure up to 1.2 x 0.9 cm (6:117)\nwithin the right upper lobe anteriorly.\n\nMild impressions of the upper endplates of multiple thoracic vertebral bodies\nare no different relative to prior examinations, likely degenerative in\nnature.  No destructive osseous lesions worrisome for metastatic involvement\nis identified.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___, clip number ___.",
            "output": "1.  Numerous pulmonary nodules involve all lobes and are increased both in\nnumber and size consistent with metastases.\n2.  New severe narrowing of the vertical portion of the right brachiocephalic\nvein and all of the superior vena cava concerning for stricture, perhaps\ncatheter related.  No evidence of collateral venous circulation.\n3. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed on the same date, ___, clip number ___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\nThere are innumerable lung nodules which have either increased in size or are\nnew.  Largest in the right upper lobe measures 7 mm (303:112), largest in the\nright middle lobe measures 7 mm (300b:177) common largest in the right lower\nlobe measures 11 mm (303:196), largest in the left lower lobe measures 12 mm\n(303:  123):  Largest in the left upper lobe measures 5 mm (3 or 3:103).\nIrregular peribronchial ground-glass opacities in the right middle lobe have\nprogressed\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.  There is a small hiatal hernia\nPort a cath tip is in the lower SVC.\nThere are no bone findings of malignancy.  Left chest healed rib fractures are\nagain noted",
            "output": "Progression of metastatic disease with innumerable new or enlarging lung\nnodules"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: This examination is mildly limited due to respiratory\nmotion artifact, particularly at the lung bases.  Within these limitations,\nacute to subacute pulmonary emboli involving the left lower lobar, segmental,\nand subsegmental pulmonary arteries.  No other pulmonary artery filling\ndefects.  The main pulmonary artery is not enlarged and there is no evidence\nof right heart strain.  Mild atherosclerotic calcifications of the aortic\narch.  The thoracic aorta is normal in caliber without evidence of dissection\nor intramural hematoma.  Mild coronary calcifications.  Otherwise, the heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Peripheral opacities within the left lower lobe are compatible\nwith pulmonary infarction (series 4, image 171).  No other focal\nconsolidations.  Pleuroparenchymal scarring at the bilateral lung apices. \nLinear atelectasis within the right middle lobe, some of which appears\nnodular.  Paramediastinal atelectasis within the right lower lobe.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensities within the kidneys bilaterally are too\nsmall to characterize, but likely represents cyst.  Otherwise, the kidneys are\nof normal and symmetric size with normal nephrogram.  There is no evidence of\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a large hiatal hernia within the right hemithorax. \nLarge amount of ingested material within the stomach.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon and rectum are within normal limits.  The appendix is not visualized. \nThere is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium is thickened measuring up to 15 mm. \nIndeterminate endometrial calcification.  No adnexal masses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Completely occlusive thrombus within the IVC just prior to the\nbifurcation extending throughout the right common iliac, right external iliac,\nand right common femoral veins.  The left iliac veins are patent without\nevidence of thrombosis.  Marked tortuosity of the abdominal aorta.  There is\nno abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: Chronic appearing proximal left humerus fracture with\nimpaction.  Multiple chronic well healed left lateral rib fractures.  Anterior\nfixation hardware within the partially imaged lower cervical spine.  Severe\nrotary dextroconvex scoliosis of the lumbar spine.  There is no evidence of\nworrisome osseous lesions or acute fracture.  The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. Acute to subacute pulmonary emboli involving the left lower lobar,\nsegmental, and subsegmental pulmonary arteries.  Opacities within the\nperipheral left lower lobe, compatible with infarction.  No evidence of right\nheart strain.\n2. Completely occlusive thrombus throughout the distal IVC, right common\niliac, right external iliac, and right common femoral veins.\n3. Thickened endometrium with a coarse calcification, which should be further\nevaluated with a pelvic ultrasound on a nonurgent basis.\n4. A large hiatal hernia within the right hemithorax containing a large amount\nof ingested material.\n5. Chronic left humerus and lower left rib fractures.\n\nRECOMMENDATION(S):  Nonurgent pelvic ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild coronary artery calcification and minimal\natherosclerotic calcification of the thoracic aorta.  The heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is right hilar lymphadenopathy, \nmeasuring 1.2 cm (02:54).   there is no axillary or mediastinal\nlymphadenopathy no mediastinal mass.\n\nPLEURAL SPACES: There is a small to moderate volume right pleural effusion\nwith overlying passive atelectasis.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: There is a large focal consolidation predominantly involving\nthe right lower lobe with ground-glass opacification extending into the right\nupper lobe as well.  There is diffuse peribronchial thickening. Minimal\ndiffuse emphysematous changes are seen in the left upper lobe. There is left\nbasilar atelectasis. No additional focal consolidation is identified.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a 1.4 cm\nhypodensity in the left lobe which is incompletely characterized though\npotentially cyst.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is mild multilevel degenerative changes of the visualized thoracic spine\nwith extensive anterior osteophytosis.",
            "output": "1. Focal consolidative and ground-glass opacities involving the right lower\nand upper lobes is compatible with pneumonia.\n2. Small to moderate volume right pleural effusion.\n3. Right hilar lymphadenopathy, likely reactive.\n4. No evidence of pulmonary embolism or aortic abnormality.\n\nRECOMMENDATION(S):  Follow-up radiographs to ensure resolution in ___ weeks."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormality in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis, especially for hepatic evaluation, but shows no\nadrenal mass or subphrenic fluid collection.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in the head and neck vessels but present in at least right and\nespecially left anterior descending coronary arteries.  Aortic valvular\ncalcification is mild to moderate and could be hemodynamically significant. \nCardiac evaluation would require echocardiography.  Very small pericardial\neffusion is larger today than in ___.\n\n\nTHORACIC LYMPH NODES: Nodes enlarged or new as follows:\n\nMediastinum:\n\nThoracic outlet, 10 mm, larger.\n\nLeft lower paratracheal, 12 x 23 mm, previously 4 x 15 mm.\n\nSubcarinal, 18 mm, unchanged.\n\nHilar contours do not suggest appreciable lymph node enlargement.\n\nLUNGS, AIRWAYS, PLEURAE: Mild scarring or atelectasis remains from otherwise\nresolved right lower lobe pneumonia.  Small layering nonhemorrhagic pleural\neffusions, smaller on the right, new on the left.  Small bilateral pleural\ncalcifications could be due to asbestos exposure.\n\nCHEST CAGE: Generalized osteopenia is more severe but there is no new\ncompression or any pathologic fracture or destructive bone lesion.  Although\nthere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Although there is no pulmonary edema, moderate aortic valvular calcification\nand atherosclerotic coronary calcification may be clinically significant. \nEchocardiography recommended if not recently performed.\n\nBilateral pleural calcifications could be due to prior asbestos exposure.  No\nevidence of pulmonary asbestosis.\n\nSmall bilateral pleural effusions, smaller on the right, new on the left since\n___"
        },
        {
            "input": "CT THORAX: No supraclavicular, axillary, mediastinal, or hilar lymph node\nenlargement by CT size criteria. The heart is unremarkable without pericardial\neffusion. No pleural effusion. The airways are patent to the subsegmental\nlevel. No pulmonary parenchymal abnormality.  No cavitary lesion. No\npneumothorax. The thyroid gland is mildly prominent.  A small hiatal hernia is\npresent. No mediastinal hematoma.\n\nCTA:  The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. No evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present. The\npulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main pulmonary artery is normal in\ncaliber, without evidence of right heart strain.  No active extravasation.\n\nOSSEOUS STRUCTURES: No lytic or blastic osseous lesions concerning for\nmalignancy.  A lipoma is noted in the right chest wall musculature (3:59).\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen demonstrates an ectatic and focally\ndilated celiac axis to 12 mm, which appears to demonstrate a linear flap which\nis likely 2 vessel walls opposed together rather than a dissection flap.\n(2:112; 602b: 41).",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  No CT evidence to explain patient's symptoms.\n3.  Focally dilated and ectatic celiac axis."
        },
        {
            "input": "The thyroid is normal.\nSince ___ there has been interval improvement of peripheral and\ncentral lymphadenopathy. For example right axillary node (series 4: Image 23)\nis 2.7 x 4 cm was 3.5 x 4.4 cm; left axillary node(04:26) is 2.5 x 6.3 cm was\n4.6 x 6.9 cm; left supraclavicular node (4:3) is 1.5 x 1.3 cm was 1.4 x 2.2\ncm; right upper paratracheal lymph node (04:15) is 1.2 x 1.4 cm was 1.2 x 1.9\ncm; right lower paratracheal lymph node (04:21) is 2 x 2.3 cm was 2.7 x 2.3\ncm.\nAorta and pulmonary arteries are normal size.  Patient is status post median\nsternotomy for cardiac surgery.  Cardiac configuration is normal and there is\nsevere coronary calcification, involving mainly the left anterior descending\ncoronary artery (04:24). .\n\nThere is no pericardial effusion.  Non-hemorrhagic moderate left pleural is\nunchanged since ___.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  There are no lung\nnodules suspicious for malignancy or infection. 4 mm subpleural nodules in the\nposterior segment of the right upper lobe (5:73) is unchanged since ___ and not concerning for malignancy.\n\n\n\nUPPER ABDOMEN\nAbdominal findings are described in a report of concurrent CT abdomen pelvis\nclips ___. Stable small hiatal hernia.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. Since ___ there has been interval improvement of peripheral and\ncentral lymphadenopathy.\n2. There are no new lung nodules suspicious for malignancy or infection.\n3. Stable moderate non-hemorrhagic left plural effusion since ___."
        },
        {
            "input": "The largest right supraclavicular lymph node is 12 x 21 mm, left is 11 x 14\nmm, 5:4, 3 there has also been slight involution of the much bulkier bilateral\naxillary lymph nodes, and extending along both lateral chest walls. The\nlargest right axillary node is 36 x 42 mm, 05:12, previously 38 x 45 mm and\nthe left is 23 x 49 mm, 05:18, previously 27 x 51 mm. previously 13 x 21 mm\nand 14 x 15 mm, respectively.\n\nMediastinal adenopathy has consistently been considerably smaller and the\naxillary, involving the prevascular, right upper and both lower paratracheal\nand paraesophageal stations ranging in diameter up to 22 x 24 mm in the right\nlower paratracheal station, 05:21, previously 23 x 24 mm. Small left pleural\neffusion has nearly resolved. Mild right posterior costal pleural thickening\nis stable. There is no pericardial effusion. Patient has had median sternotomy\nand coronary bypass grafting, without obvious complication. Very small hiatus\nhernia is stable.\n\nAn elliptical high attenuation, 114 ___ soft tissue opacity in the lingula\nwhich developed between ___ and ___ is almost certainly\nrounded atelectasis. Lungs are otherwise clear.\n\nThere are no bone lesions suspicious for malignancy in the chest cage.\n.",
            "output": "Slight decrease in size of widespread adenopathy inside and outside the chest,\nstill greatest in the axillae, but also minimally improved at the thoracic\ninlet and in the lower paratracheal stations of the mediastinum.  There is no\nnew lymph node enlargement or pulmonary involvement to suggest progressive\nmalignancy.\n\nSmall left pleural effusion has substantially decreased.\n\nSmall focus of rounded atelectasis in the lingula should not be mistaken for a\nlung lesion."
        },
        {
            "input": "There is interval slight increase in the right supraclavicular conglomerate of\nlymphadenopathy, measuring 28 x 33 mm as compared to 19 x 30 mm.  Assessment\nof the axillary and subpectoral lymphadenopathy demonstrate for example a\nright subpectoral lymph node being 37 x 23 mm as compared to 34 x 23 mm, the\nas consistent with increase. Additional lymph node in the left subpectoral\nlocation is currently 32 x 33 mm as compared to 24 x 26 mm.  Large more.\nFemoral lymph nodes have increased in size substantially with the lymph nodes\napproaching 5 x 4.8 cm on the right, and 5.3 where 4.5 cm on the left, at\nleast doubling in size as compared to previous examination.  The overall bulk\nof the disease has increased most likely 3 times.\n\nAssessment of the mediastinum demonstrates interval doubling in size of\nmultiple mediastinal lymph nodes, including the paratracheal lymph nodes, for\nexample right lower paratracheal lymph node is currently 12.5 as compared to 5\nmm.  Right lower paratracheal and paraesophageal lymph nodes have increased\nfrom 8214 mm. Left hilar lymph node is currently 10 as compared to 7 mm\npreviously. Paraesophageal lymph node is 14 mm as compared to 6 mm. There is\nminimal unchanged left pleural effusion. There is no pericardial effusion.\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and corresponding report will be issued\n\nAirways side patent to the subsegmental level bilaterally.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated. He\n\nSmall hiatal hernia is present.\n\nCoronary calcifications are extensive in this patient after CABG.\n\nAssessment of the lung parenchyma demonstrates no interval development of new\nlesions. Lingular atelectasis is unchanged",
            "output": "Interval progression of the bowel of lymphadenopathy, in particular in the\narea axillary areas but also in the mediastinum and supraclavicular areas\n\nSmall hiatal hernia.\n\nUnchanged minimal left pleural fluid."
        },
        {
            "input": "Examination is compared to ___.  Slightly enlarged thyroid. Status\npost CABG.  Substantial decrease in size of the pre-existing axillary\nlymphadenopathy. However, the lymph nodes in the axillary regions are still\nsubstantially enlarged and have diameters of up to 3 cm (4, 15).  Decrease in\nsize of the mediastinal lymph nodes, likewise these lymph nodes are still\nslightly enlarged tube borderline in size (4, 22).  Unchanged appearance of\nthe cardiac vascular structures of the CABG.  No pericardial effusion. \nUnchanged esophageal dilatation at the level of the lower esophagus.  No hilar\nlymph node enlargement.  No incidental pulmonary embolism.  Moderate\ndegenerative vertebral disease. No osteolytic lesions at the level of the\nvertebral bodies, the sternum and the ribs.  Several millimetric micronodules\nin subpleural location, none of which appear suspicious for malignancy. \nUnchanged mild left lateral pleural thickening (5, 182). Unchanged 10 mm\nlingular nodule (5, 206).  No pleural effusion.  No evidence of airways\ndisease.  No focal or diffuse parenchymal opacities suggesting pneumonia.",
            "output": "Despite an overall decrease in size of the mediastinal and axillary lymph\nnodes, the lymph nodes in these regions are still borderline to moderately\nenlarged.  Status post CABG.  No evidence of parenchymal changes suggesting\npneumonia or another infectious disease.  No pleural effusions."
        },
        {
            "input": "The thyroid is normal.\nRight supraclavicular lymph nodes have increased from 8 to 9 mm (5:7) and from\n4 to 9 mm (05:10) right axillary lymph node measuring 22 x 18 mm was 17 x 15\nmm (05:23), second largest lymph node in the right axillary region measuring\n21 mm was 16 mm (05:19).  Left axillary lymph node measuring 35 mm was 25 mm\n(05:19) 15 mm right lower paratracheal station lymph node was 14 mm\nprevascular lymph node measuring 16 mm was 13 mm (05:22)\nCardiac size is normal.  There is no pericardial effusion.  small right\npleural effusion is new from ___.  There is a small hiatal hernia.  Dense\ncalcifications are present in all coronary arteries.  Left central catheter\ntip is in the right atrium.\nNew small area of peribronchial ground-glass opacities in the right lower lobe\n(6:183) could represent small area of atelectasis or aspiration.  There are\nnew small atelectasis in the right lower lobe adjacent to the pleural\neffusion.  Respiratory motion artifact limits the evaluation of the lingula\nand left lower lobe.  10 mm nodule in the lingula is unchanged.  There are\nsecretions in the lower esophagus\n\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are new healing several right rib fractures",
            "output": "Increase in size in extensive mediastinal and axillary and supraclavicular\nlymph nodes."
        },
        {
            "input": "HEART AND VASCULATURE: There are filling defects within an apical subsegmental\nbranch of the right upper lobe (301:54) and a posterior subsegmental branch of\nthe right upper lobe (301:66).  There are questionable filling defects within\nsegmental branches of the right middle lobe.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma. \nPneumomediastinum surrounds the heart.  The heart is normal in size.  No\npericardial effusion.  No apparent coronary artery or valvular calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is scattered air\nthroughout the mediastinum.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Extensive ground-glass opacification with peribronchovascular\nand peripheral opacities worst in the left lower lobe are consistent with\nfindings seen in covid pneumonia.  Tip of the endotracheal tube terminates\napproximately 3 cm above the carina.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is enlarged but without discrete nodule.\n\nABDOMEN: An enteric tube descends into the body of the stomach and out of\nview.  A temperature probe terminates in the mid esophagus.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  A coarse calcification is seen within the glandular tissue\nof the left breast (3:39) which is better evaluated with mammography.",
            "output": "1. Few subsegmental and questionable segmental pulmonary emboli in the right\nlung.  Given their small size and vascular distribution, a significant hypoxic\neffect seems unlikely.\n2. Extensive ground-glass, peribronchovascular, and peripheral opacities\nconsistent with known COVID-19 pneumonia.  No findings to suggest bacterial\nsuperinfection.\n3. Pneumomediastinum, presumably due to barotrauma.\n4. Appropriate positioning of endotracheal tube.\n\nRECOMMENDATION(S):  Mammography if not recently performed.\n\nNOTIFICATION:  Findings discussed with ___, MD by ___, MD via\ntelephone at 17:25 on ___, 5 minutes after discovery."
        },
        {
            "input": "Moderate symmetric enlargement of bilateral axillary lymph nodes, ranging in\ndiameter up to 11 x 17 mm on the right, 13 x 15 mm on the left. \nSupraclavicular lymph nodes are not enlarged. Lymph nodes elsewhere in the\nchest, mediastinum hila, diaphragmatic and retrocrural stations are not\nenlarged.\nThymus is mildly enlarged for patient of this age, but has a physiologic\nshape, not concerning for malignancy.\n\nThyroid gland mildly enlarged, left lobe greater than right, including two 11\nmm wide relative hypodensities which are better evaluated with thyroid\nultrasound.\n\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis\nwhich shows no adrenal enlargement.\n\nLungs are well expanded and clear.  Tracheobronchial tree is normal to\nsubsegmental levels.  There is no evidence of infiltrative or other lung\ndisease.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of diffuse lung disease.  Lungs clear.\n\nMild to moderate symmetric enlargement bilateral axillary lymph nodes.  No\nintrathoracic adenopathy.\n\nRECOMMENDATION(S):   As a general rule, mammography is recommended foreign a\npatient of this age, if not recently performed."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. Dense coronary artery\ncalcifications are stable. The main pulmonary artery and thoracic aorta are\nnormal caliber.\n\nThe patient is status post right upper lobe resection and left lung wedge\nresection. Several previously seen subsolid nodules and ground-glass opacities\ndemonstrate variable behavior since ___.  The following lesions have\nchanged:\n\nA 2 x 6mm endobronchial lesion on the posterior wall of the right main\nbronchus, 4:102 was one third the size in ___.  The patient has chronic\nretention of secretions, so it is not possible to say that this is a nodule.\n\n- A right lower lobe ground-glass nodule which comprises the superior most\naspect of the complex irregularly-shaped lesion has slightly grown measuring\n0.8 x 1.1 cm, previously 0.5 x 0.8 cm (4, 150).\n- More inferiorly in the right lower lobe, a purely ground-glass nodule has\nslightly increased in size measuring 0.9 x 1.9 cm, previously 0.9 x 1.5 cm (4,\n159).\n- Even more inferiorly in the right lower lobe, a subsolid nodule inseparable\nfrom the diaphragmatic pleura is more radiodense, grown to  1.1 cm, previously\n0.9 cm (4, 162).\n\n- A subsolid ground-glass opacity in the inferior right lower lobe appears\nslightly decreased in size measuring 2.1 x 3.1 cm, previously 2.3 x 3.5 cm (4,\n169). This may be due in part to differences in inspiratory effort.\n- Adjacent to the suture line in the left lower lobe, a subsolid ground-glass\nopacity has slightly increased in size measuring 1.7 x 3.8 cm, previously 1.4\nx 3.5 cm (4, 122).\n\n\nThe following lesions are stable:\n- A left upper lobe subsolid ground-glass opacity adjacent to the suture line\nis stable in size measuring 1.0 x 1.9 cm, previously 1.0 x 1.9 cm (remeasured:\n4, 102).\n- An irregularly-shaped predominantly ground-glass opacity in the right\ninfrahilar lower lobe has not grown in the axial plane measuring 2.2 x 2.5 cm,\npreviously 2.2 x 2.4 cm (4, 124), but appears larger in the craniocaudal\ndimension (4, 124).\n - A left lower lobe 4 mm purely ground-glass nodule is stable since ___\n(4, 183).\n\nSeveral small ground-glass opacities in the both lower lobes have resolved,\nprobably infectious.  No new pulmonary nodules or ground-glass opacities are\nidentified on today's exam. Mild right lower lobe subpleural reticulation and\nscarring is unchanged (4, 108).\nImages of the upper abdomen show colonic diverticulosis and cholelithiasis. A\nleft posterior rib surgical defect is stable. There are no bone lesions in the\nthorax worrisome for infection or malignancy.\n\nMild bilateral gynecomastia is incidentally noted.",
            "output": "Possible growing endobronchial nodule, right main bronchus.\n\nMultifocal adenocarcinoma with several subsolid nodules and opacities\ndemonstrating variable behavior since ___.  A few lesions have\nincreased in either size or attenuation (4: 122, 150, 159, 162), and are most\nlikely to be undergoing histologic transformation to minimally invasive\nadenocarcinoma. The most concerning lesion is in the right lower lobe\ninseparable from the diaphragm (4, 162).\n\nA few bilateral lower lobe ground-glass opacities have resolved, suggesting an\ninflammatory or infectious etiology.\n\nColonic diverticulosis.\n\nCholelithiasis."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. Dense coronary artery\ncalcifications are stable. The main pulmonary artery and thoracic aorta are\nnormal caliber.  Lipomatous hypertrophy of the interatrial septum is again\nnoted.\n\nThe patient is status post right upper lobe resection and left lung wedge\nresection. A previously seen 2 x 6 mm endobronchial lesion on the posterior\nwall of the right main bronchus has resolved.  A new 3 x 7 mm nodular soft\ntissue lesion along the lung non dependent aspect of the lower tracheal wall\nis likely due to retained secretions (4, 89).\n\nThe majority of previously seen sub-solid ground-glass opacities are stable\nsince ___. A previous 4 mm purely ground-glass left lower lobe\nnodule is not seen on today's exam. The only lesion that has appreciably\nchanged is a sub-solid ground-glass opacity adjacent to the left lower lobe\nsuture line which has increased in size and density measuring 1.7 x 4.4 cm,\npreviously 1.7 x 3.8 cm (4, 124). All remaining lesions are stable with\nmeasurements as follows:\n\nRight lung:\n\n- An irregularly-shaped predominantly ground-glass opacity in the right\ninfrahilar lower lobe measures 2.3 x 2.5 cm, previously 2.2 x 2.5 cm (4, 134)\n\n- A right lower lobe ground-glass nodule which comprises the superior most\naspect of the complex irregularly-shaped lesion measures 0.8 x 1.1 cm,\npreviously 0.8 x 1.1 cm (4, 160)\n\n- More inferiorly in the right lower lobe, a purely ground-glass nodule\nmeasures 1.0 x 1.8 cm, previously 0.9 x 1.9 cm (4, 172)\n\n- Even more inferiorly in the right lower lobe, a sub-solid nodule inseparable\nfrom the diaphragmatic pleura is not appreciably changed in size or morphology\nmeasuring 1.1 cm, previously 1.1 cm (4, 175)\n\nLeft lung:\n\n- A left upper lobe sub-solid ground-glass opacity adjacent to the suture line\nmeasures 1.2 x 2.0 cm, previously 1.0 x 2.0 cm (4, 106)\n\nNo new pulmonary nodules or ground-glass opacities are identified. Mild right\nlower lobe subpleural reticulation and scarring is unchanged (4, 108).\n\nImages of the upper abdomen show colonic diverticulosis and cholelithiasis.\n\nA left posterior rib surgical defect is stable.\n\nMild bilateral gynecomastia is incidentally noted.",
            "output": "Bilateral sub-solid ground-glass opacities consistent with multifocal lung\nadenocarcinoma are unchanged since ___ with the exception of\ninterval increase in size and density of a 1.7 x 1.4 cm lesion adjacent to the\nleft lower lobe suture line.\n\nColonic diverticulosis.\n\nCholelithiasis."
        },
        {
            "input": "The thoracic aorta and central pulmonary vessels are normal in caliber.  The\nheart size is normal.  Coronary artery calcifications are diffuse and\nextensive.  No pericardial effusion.\n\nNo pathologically enlarged axillary, supraclavicular, mediastinal, or hilar\nlymphadenopathy within the limitations of this non-contrast exam.  Several\nmediastinal lymph nodes are measurable, to 5 mm in the prevascular space,\nunchanged (series 2, image 14).\n\nThe patient is status-post right upper lobectomy and partial lingula\nresection.  Expected post-operative appearance of the bilateral hila and\nbronchial stumps are unchanged.  A small amount of mucus secretions are\ndemonstrated in the right mainstem bronchus (series 4, image 104); otherwise,\nthe remaining major airways are clear.  No pneumothorax.\n\nMultiple mixed ground-glass and solid lesions bilaterally persist and in\ngeneral are overall progressing, with increasing solid component, size, and/or\nmore evidence of adjacent parenchymal distortion and retraction.  For example:\nA mixed ground-glass and solid lesion in the basal segment of the right lower\nlobe, abutting the diaphragm is overall unchanged in shape, size, and\nattenuation, with the solid component measuring 15 x 10 mm (series 602b, image\n59; series 4, image 172). Another right lower lobe perihilar mixed\nground-glass and solid lesion with cystic components or bronchiectasis now\nmeasures 3.2 x 2.4 x 4 cm (series 4, image 28; series 602b, image 62),\nincreased (previously, 3.1 x 2.2 x 3.5 cm); the solid component measures up to\na 6 mm, unchanged.  The lesion posteriorly and superiorly measures 2.1 x 1.8\ncm in the axial plane, previously 2.1 x 1.5 cm (series 4, image 115), also\nincreased.  A 1.2 x 1.1 cm right lower lobe lesion is overall unchanged\n(series 4, image 157).\n\nA left upper lobe perifissural ground-glass opacity measures approximate 5.6 x\n1.1 cm in the axial plane and 2.3 x 1.1 cm in the sagittal plane (previously,\n4.9 x 0.9 cm in the axial plane, 2.7 x 1.2 cm in the sagittal plane), overall\nunchanged or minimally increased but shows more distortion of adjacent\nparenchyma consistent with disease progression. The area of involvement\nextends into the left hilum as well as superiorly, measuring 2.1 x 1.4 cm\n(previously 1.7 x 0.9 cm) (series 4, image 93). No definite new ground-glass\nopacities or nodules.\n\nRight and left hilus and bronchial stumps are normal postoperative appearance\nafter right upper lobectomy and lingual.\n\nSubpleural scarring and atelectasis along the posterolateral costal right\npleural surfaces are unchanged. No pleural effusion.\n\nThe thyroid is unremarkable.  No suspicious lytic or sclerotic osseous lesion\nin the thoracic cage. Multi-level degenerative changes of thoracic spine and\nupper lumbar spine are mild-to-moderate with mild anterior osteophytes and\nSchmorl's nodes, overall unchanged.  Mild superior endplate compression\ndeformity of a mid thoracic vertebral body is unchanged (series 602b, image\n74).\n\nA hiatal hernia is small.\n\nThis study is not dedicated for imaging of the abdomen. However, limited\nimages of the upper abdomen are remarkable for cholelithiasis without evidence\nof cholecystitis (series 2, image 61).",
            "output": "1. Multiple mixed ground-glass and solid lesions bilaterally persist and in\ngeneral are overall progressing, with increasing solid component, size, and/or\nmore evidence of adjacent parenchymal distortion and retraction.\n\n2. Cholelithiasis."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there are no soft\ntissue abnormalities in the imaged chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis, but shows small\ncalcified gallstones unchanged since at least ___, no evidence of\ncholecystitis, and normal adrenal glands.\n\nThyroid is unremarkable.  Atherosclerotic calcification is minimal in the head\nand neck vessels, but considerable in the coronaries involving at least left\nmain, anterior descending, and circumflex branches.  Heart is normal size and\nthere is no pericardial or pleural abnormality.\n\nRight hilus and bronchial stump and left hilus and bronchial stump have normal\npostoperative appearances following right upper lobectomy and lingul use a\nectomy.\n\nMediastinal lymph nodes are normal size.\n\nSubpleural scarring and atelectasis along the posterior and lateral costal\nright pleural surfaces are unchanged.  The large generally ground-glass lesion\nin the superior segment of the right lower lobe, 4:115- 154, is unchanged\nsince at least ___, but mildly larger than it was in ___.  A\nsmaller ground-glass and soft tissue lesion in the right lower lobe, has the\nlargest soft tissue component of all the mixed lesions, 10 by 15 mm, different\nin shape but unchanged in size since ___.\n\nIn the left upper lobe, a 8 x 17 mm lesion of peribronchial ground-glass,\nadjacent to suture, was 9 x 11 mm in ___, and unchanged in size but\nslightly more radiodense than it was in ___.  Another mixed density\nlesion in the left upper lobe, close to suture and the major fissure, 4:131,\nhas changed in shape, but probably not in size since ___ although it has\ngrown since ___.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  Disc intrusions in the upper endplates of a mid thoracic and upper\nlumbar vertebral body are degenerative.",
            "output": "Stable or continued, extremely slow progression of several large primarily\nground-glass lung lesions, with small soft tissue components consistent with\nlocally invasive adenocarcinoma.  No evidence of nodal or pleural metastasis.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, or axillary lymph nodes demonstrated.  There is no\npericardial pleural effusion.\n\nImage portion the upper abdomen demonstrate calcified gallstones and otherwise\nis unremarkable.  Fourth\n\nAirways are patent to the subsegmental level bilaterally.  The patient is\nafter right upper lobectomy and partial lobectomy in the lung.\n\nSince the previous study obtained and ___, there is interval\nincrease in the solid component of 2 of the ground-glass lesions, in the right\nlower lobe, series 5, image 205, from 15 x 9 mm to 15 x 11.4 mm, series 5,\nimage 205 and an additional lesion in the left lower lobe, from 11 x 6 mm to\n13 x 7 mm, series 5, image 217.  Multiple ground-glass bilateral opacities\ndemonstrate minimal increase in size by inferior to of 1 a 2 mm in age\ndimension, series 5, image 145, he 27 x 18 mm, series 5, image 150, 40 x 15\nmm, series 5, image 158, 27 x 23 mm, series 5, image 191, 12 x 12 mm, series\n5, image 205, 27 by 15 mm.  Left upper lobe lesion is relatively stable,\nseries 5, image 121, 18 x 14 mm, with the lower aspect of this lesion being 58\nx 11 mm, series 5, image 151 as compared to 56 x 10 mm, does demonstrating\nminimal interval grows.\n\nHeart size is normal.  Extensive calcifications of Coronary arteries are re-\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Gradual and continues increase in size in multiple makes ground-glass/solid\nlesion with definitive increase in solid component in to the lesion in the\nright lower lobe."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Mild gynecomastia.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Multiple small calcific gallstones seen\ndependently in the neck of the gallbladder.  No features cholecystitis. \nMultiple colonic diverticula.  No features of diverticulitis.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial\neffusions.  Severe left coronary artery calcifications.  Moderate right\ncoronary artery calcifications.  The ascending aorta is not dilated.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  The part solid nodules with associated bronchiolectasis\nconcerning for adenocarcinoma in the posterior aspect of the left upper lobe\n(5, 152), inferior to the right hilum (5, 157) and in the medial basal segment\nof the right lower lobe (5, 213) is unchanged compared to ___, with\nthe lesion in the posterior aspect of the left upper lobe showing mild\ninterval increase in size compared to imaging done ___.  .\n-AIRWAYS:  Post right upper lobe and left lingular lobectomy/segmentectomy\nbronchial stumps are stable.\n-VESSELS:  The pulmonary truncus is not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.  Postsurgical changes involving the chest wall is bilateral.",
            "output": "The three part-solid pulmonary nodules (concerning for adenocarcinoma) are\nunchanged compared to previous imaging done ___.\n\nCompared to previous imaging done ___ only the lesion in the\nposterior aspect of the left upper lobe is minimally increased in size.\n\nSevere coronary artery calcification as described above.\n\nRECOMMENDATION(S):  Annual follow-up CT advised."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  There is no axillary or supraclavicular adenopathy.  There is no\nappreciable mediastinal adenopathy.  Evaluation for hilar adenopathy is\nlimited in the absence of intravenous contrast.  Overall contour of the hilar\nregions appears similar relative to prior study.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Trace pericardial fluid is physiologic.  Heart size\nis normal.  Severe atherosclerotic calcifications involve the coronary\narteries, worst in the left anterior descending coronary artery.\n\nPostsurgical changes reflect right upper lobe and left lingular segmentectomy.\nBronchial stumps appear stable without abnormal soft tissue growth. \nSecretions are noted within the main trachea.\n\nSub solid nodules with associated bronchiolectasis the posterior aspect of the\nleft upper lobe appears stable (4:120) as does sub solid opacity in the medial\nbasal segment of the right lower lobe (4: 177).  Similarly sub solid opacity\nin the posterior left upper lobe (5:126) is not appreciably changed.  Post\ntreatment changes involving the posterior right lower lobe along the pleural\nsurface is stable.  There is no growing pulmonary nodule.  No consolidation. \nThere is no pleural effusion.\n\nRibcage deformities are longstanding.  No acute fracture.  There is no\nworrisome osseous lesion.\n\nAlthough examination is not tailored for subdiaphragmatic evaluation, images\nof the upper abdomen demonstrate cholelithiasis without evidence of\ncholecystitis.  Scattered diverticula are noted throughout the imaged colon. \nThere does not appear to be in an acute abnormality.",
            "output": "Pre-existing sub solid pulmonary nodules demonstrate stability relative to\nprior examination dated ___ remain concerning for minimally\ninvasive lung adenocarcinoma.  A right lower lobe lesion, for example, at\nleast 4.4 x 3.5 cm with ground glass opacity with gradual growing solid\ncomponent, in ___ purely ground glass 1.1 x 0.8 cm.  Decision regarding\nsurgical treatment or chemotherapy should be made with clinical\nconsiderations.\n\nCoronary atherosclerosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable.\n\nUPPER ABDOMEN: Multiple dependent gallstones are seen, without evidence of\ncholecystitis.  Multiple colonic diverticula are noted, without evidence of\ndiverticulitis.  The imaged upper abdomen is otherwise unremarkable.\n\nMEDIASTINUM: Several mediastinal lymph nodes measuring up to 6 mm in the\nsubcarinal station (5:154) are smaller, previously measuring up to 8 mm at\nthis location.\n\nHILA: Several bilateral hilar lymph nodes measuring up to 5 mm (5:164) are\nmildly decreased in size or similar to prior.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare severe.  The thoracic aorta is normal in caliber. Small pericardial fluid\nis likely physiologic.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Patient is status post right upper lobectomy and left\nlingulaectomy.  Previously noted nodular consolidation in the bilateral lung\nbases on the ___ study have essentially resolved, consistent with an\ninfectious etiology.  However, subsolid opacities involving the right lower\nlobe (5:215) and left upper lobe (5:154) persist, and appear similar to ___.  A 3 mm sub solid nodule in the middle lobe (5:88) is new. \nAdditional bilateral solid and ground-glass nodules measuring up to 6 mm in\nthe superior segment of the left lower lobe (5:86) are unchanged, with other\nnodules as follows (5: 55, 213, 75, 82).\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.  Chronic rib deformities with prior resections are unchanged.",
            "output": "1. Compared to ___, previously noted nodular opacities in the\nbilateral lung bases have essentially resolved, consistent with an infectious\netiology.\n2. Subsolid opacities in the right lower and left upper lobes persist, similar\nto that seen on multiple recent prior studies.  Given their long-term growth\ncompared to earlier studies going back to ___, they remain concerning\nfor minimally invasive lung adenocarcinoma.\n3. New 3 mm right middle lobe sub solid nodule.  Recommend follow-up chest CT\nin ___ months.\n\nRECOMMENDATION(S):  Follow-up chest CT in ___ months for impression point 3."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy by CT\nsize criteria.  Scattered mildly prominent lymph nodes are overall unchanged. \nAside from minimal gynecomastia, chest wall is unremarkable.\n\nUPPER ABDOMEN: The imaged upper abdomen demonstrate cholelithiasis without\ninflammatory changes.  The bilateral adrenal glands are unremarkable.  There\nis mild stranding around the celiac axis, unchanged from ___.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not pathologic by CT size\ncriteria.  Small amount of fluid within the pericardial recess is unchanged.\n\nHILA: Evaluation for hilar lymphadenopathy is limited on noncontrast exam. \nHowever, oral contour of the hilar regions appear grossly similar to the prior\nstudy.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  Physiologic\npericardial effusion is again noted.  Dense coronary calcifications in the LAD\nand left circumflex arteries are again noted.  Aortic valve calcifications are\nminimal.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Patient is status post surgical intervention in the right\nupper lobe.  There is evidence of interval progression of disease or acute\ninfection.  For example, right paramedian ground-glass opacities with 6 mm\nsolid component at the level of the main airway bifurcation now measures 10 mm\n(5:133).  9 mm nodularity slightly inferior to the above-mentioned solid\nnodule is new (5:144).  Sub solid nodules with associated bronchiectasis in\nthe posterior aspect of the left upper lobe demonstrate new nodules measuring\nup to 1.2 cm in segmental distribution (5:133).  There is a cavitary nodule\nversus thickening around bronchietasis in the posterior left lower lobe.  Sub\nsolid opacity in the medial basal segment of the right lower lobe is overall\nunchanged, measuring 3.3 x 3.8 cm (5:203) in full list extent.  Sub solid\nopacity in the posterior left upper lobe is also not appreciably changed\n(5:115).  6 mm ground-glass opacity in the left lower lobe is nonspecific\n(5:214).\n2. AIRWAYS:  The central airways are patent.  Again seen is postsurgical\nchanges in the left mediastinum status post segmentectomy.  As previously, the\nbronchial stump appears within normal limits without interval soft tissue\ngrowth.  Bronchiectasis is overall unchanged.\n3. VESSELS:  The ascending aorta is non aneurysmal.  The main pulmonary is\nwithin normal limits in caliber.\nCHEST CAGE: Ribcage deformities are long-standing with prior rib resections. \nNo suspicious lesions concerning for acute infection or malignancy is seen.",
            "output": "Interval development of scattered solid nodules in the region of pre-existing\nbronchiectasis in the medial segment of the right lower lobe and posterior\naspect of the left upper lobe.  Unclear whether this represents interval\nprogression of disease or acute infection/pneumonia.  Recommend clinical\ncorrelation and short-term follow-up after empiric treatment, also consider\ntissue sampling."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.  There is\nno discrete supraclavicular, axillary, or lower cervical lymphadenopathy\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen is notable for layering\ngallstones and scattered colonic diverticula.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  A small hiatal hernia\nis present.\n\nHILA: The lack of intravenous contrast limits evaluation for hilar\nlymphadenopathy.  No discrete hilar lymphadenopathy is appreciated\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.  Dense coronary atherosclerotic calcifications are present.\nPLEURA: There is no pleural effusion or pneumothorax\nLUNG:\n\n-PARENCHYMA:  The patient is status post right upper lobectomy and\nlingulectomy, with associated postoperative changes.  Soft tissue surrounding\nthe architectural distortion in both the left upper lobe and right lower lobe\nis more prominent on the current study than on priors (for example 8:65, 110),\nand is likely compatible with disease progression bronchiectasis in the\nposterior aspect of the left upper lobe and right lower lobe is unchanged\nsince prior examinations.  There are numerous sub solid nodules, many of which\nare new since the most recent examination, and others which have grown.  For\nexample, there are multiple new nodules in the left apex (for example 05:47,\n51, 54, 109).  Other pulmonary nodules have increased in size (for example a\nnodule in the left lower lobe (5:196) previously measured 3 mm, and now\nmeasures 6 mm.  Also, for example, a previously 4 mm nodule now measures 8 mm\n(03:45).  Bilateral nodules are as follows: 05:30, 43, 47, 52, 54, 60, 65, 70,\n108, 174, 195, 223, 232, 243, 150, 149, 107, 105, 102, 98, 94, 89, 79, 62, 61,\n55, 46, 32, 34, 45, 180) post treatment changes involving the posterior right\nlower lobe along the pleural surface is stable.\n-AIRWAYS:  Scattered airway secretions are noted.  The airways are minimally\nthickened, but patent to the subsegmental level.\n-VESSELS:  The thoracic aorta and main pulmonary artery are normal in caliber.\nCHEST CAGE: There are no definite suspicious osseous lesions.  No acute\nfractures are identified.",
            "output": "1.  Evidence of disease progression with numerous new and growing primarily\nsub solid nodules as detailed above."
        },
        {
            "input": "AXILLA, HILA, AND MEDIASTINUM: No axillary adenopathy. Marked mediastinal\nadenopathy including a subcarinal lymph node measuring 2.5 cm, a 1.4 cm\nprevascular and a 1.1 cm pretracheal lymph nodes, new since ___.  There is\nhilar adenopathy measuring up to 1.9 cm.  No enlarged right hilar.\n\nHEART AND VASCULATURE: No pericardial effusion.  Moderate coronary artery\ndisease is again seen.\n\nPLEURAL SPACES: No pneumothorax or pleural effusion\n\nLUNGS/AIRWAYS: Status post right upper lobe lobectomy and lingulectomy.  There\nis increased masslike consolidation in the posterior aspect of the left upper\nlobe.  At this level, the proximal left upper lobe is mildly attenuated as\nwell as the left upper lobe arterial branches and proximal aspect of the left\nsuperior pulmonary vein.  Calcifications are again seen in the posterior\naspect of the airspace disease.  Distally, there is patchy airspace disease as\nwell as nodular and smooth septal thickening in the periphery and lateral\naspect of the left upper lobe.\n\nSmall spiculated opacities in the right upper lobe are unchanged.  Numerous\nsub- 4 mm pulmonary nodules, worse in the upper lobes, are unchanged. \nBronchiectasis in the medial right lower lobe is similar.\n\nABDOMEN:  The visualized upper abdomen is notable for cholelithiasis in the\nright omental calcification, as on prior\n\nBONES: No worrisome osseous lesions.  Post thoracotomy changes are seen\nbilaterally.",
            "output": "1. Post right upper and lingular resections with new masslike consolidation\nand patchy airspace disease, the latter concerning for postobstructive\npneumonia in the left upper lobe.  This is highly concerning for recurrent\ndisease, however difficult to measure given the postobstructive pneumonia.\n2. New mediastinal and hilar adenopathy.\n3. Numerous stable pulmonary nodules.\n4. Cholelithiasis."
        },
        {
            "input": "Aorta and great vessels are unremarkable without dissection or aneurysm.  The\nmain, left, and right pulmonary arteries are well opacified without filling\ndefect to suggest pulmonary embolism, beyond this level evaluation of the\nvessels is limited by motion artifact, and in the left upper lobe by\nattenuation of the vessels.  The pulmonary arteries are normal in caliber.\n\nHeart size is normal. There is no pericardial effusion.\n\n There is increased heterogeneous masslike consolidation in the left upper\nlobe, which likely represents worsening postobstructive pneumonia.  Throughout\nthe left lung there is increased septal thickening and increased ground-glass\nairspace disease, which may be secondary to worsening pneumonia or represent\nlymphangitic spread.  There is a moderate partially loculated left pleural\neffusion.  There is no pneumothorax.  The airways are patent to the\nsubsegmental level.\n\nThere is no supraclavicular or axillary lymphadenopathy.  There are multiple\nenlarged mediastinal and hilar lymph nodes which appear increased in size\ncompared to prior for example a right prevascular node 2.2 cm, previously 1.4\n(301; 73).  A conglomerate of subcarinal lymph nodes previously measured 2.8 x\n3.8 cm and now measure 2.9 x 4.7 cm (301; 111).  Right hilar lymph nodes now\nmeasure up to 1.3 cm, previously nonenlarged (301; 99).  The included thyroid\ngland appears unremarkable.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo suspicious osseous lesions identified.  There is no acute fracture.  Post\nthoracotomy changes are noted.",
            "output": "1. No pulmonary embolism in the main, left, right pulmonary arteries. \nEvaluation of the branches beyond this is limited by artifact and attenuation\nof the vessels by surrounding mass.\n2. Worsening postobstructive pneumonia in the left upper lobe.  Increased\nground-glass opacities throughout the left lung with septal thickening may\nrepresent a sequela of worsening pneumonia or lymphangitic spread.\n3. Disease progression with increasing size of mediastinal and hilar\nlymphadenopathy and possibly worsening lymphangitic spread in the left lung.\n4. Partially loculated left pleural effusion."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Stable 3 mm left lower lobe pulmonary nodule (series 2, 70).  Another 1\nmm left lower lobe pulmonary nodule (2, 75) is also unchanged.\n\nThere is a new focal ground-glass opacity in the right lower lobe (2, 64) most\nlikely inflammatory.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.",
            "output": "Stable 3 mm left lower lobe pulmonary nodule.  1 mm left lower lobe pulmonary\nnodule is also unchanged.\n\nNew focal ground-glass opacity in the right lower lobe.  This is most likely\ninflammatory.  Three-month follow-up is recommended."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of acute dissection. \nAtherosclerotic calcifications are seen along the aorta.  There are coronary\nartery calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  No focal consolidation is seen.  Right middle lobe linear\natelectasis/ scarring is a minor.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  There is minimal peribronchial wall thickening\nin the right middle lobe and the bilateral lower lobes.\n\nBilateral breast implants are seen, with the left partially imaged.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates partially imaged\ngastric bypass changes and a small hiatal hernia.  Partially imaged intra- and\nextrahepatic biliary ductal dilatation status post cholecystectomy, not well\nassessed on this study, but seen previously (CT abdomen/pelvis from ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "No mediastinal, hilar or axillary lymphadenopathy is present. Aorta and\npulmonary arteries are normal in diameter. Coronary calcifications are noted.\nThere is no pericardial pleural effusion. Image portion of the upper abdomen\nwill be reviewed separately spot is a CT abdomen corresponding report will be\nissued\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nMild paraseptal emphysema. Hazy bilateral predominantly in the apices.  There\nare no nodules masses are consolidations demonstrated",
            "output": "No evidence of intrathoracic metastatic disease.\n\nMild paraseptal emphysema in the apices."
        },
        {
            "input": "The aorta and its major branch vessels are patent, without dissection,\naneurysm or appreciable atherosclerosis.  The pulmonary arteries are well\nopacified to the subsegmental level, with no filling defect to suggest the\npresence of a pulmonary embolism.  There is no evidence of right heart strain.\nMain pulmonary artery is normal in caliber.  The heart is mildly enlarged with\nbi-atrial chamber enlargement.  No pericardial effusion.\n\nThere is no supraclavicular or axillary lymphadenopathy.  There are multiple\nmildly prominent lymph nodes in the mediastinum in bilateral hilum likely\nreactive.  The thyroid gland appears unremarkable.\n\nPulmonary interstitial edema is noted with interlobular septal thickening as\nwell as peribronchovascular interstitial engorgement with scattered areas of\nground-glass opacity, likely reflective of pulmonary edema.  No convincing\nnodule or evidence for pneumonia.  Trace pleural fluid noted bilaterally.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.  An accessory spleen\nmeasures up to 9 mm.  Small volume ascites is present.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No pulmonary embolism or aortic abnormality.\n2. Mild cardiomegaly with mild to moderate pulmonary edema."
        },
        {
            "input": "THORACIC INLET: Visualized portions of the base of the neck show no\nabnormality.   The visualized thyroid is normal.  Supraclavicular lymph nodes\nare not enlarged.\n\nTHORACIC LYMPH NODES:  No axillary, mediastinal, or hilar lymphadenopathy is\npresent.\n\nHEART, VESSELS and PERICARDIUM: The thoracic aorta is normal in caliber. \nThere are severe coronary artery calcifications.  Atherosclerotic\ncalcifications of the aortic arch, descending aorta, and head neck vessels are\nmild.  Otherwise, the heart, pericardium, and great vessels appear within\nnormal limits.  No pericardial effusion is seen.\n\nPLEURA:  No pleural effusion or pneumothorax.\n\nLUNG:\n\nPARENCHYMA: There is mild biapical pleuroparenchymal scarring.  Moderate\ndiffuse centrilobular emphysema.\nMild bronchial wall thickening and bronchiectasis is most severe at the lung\nbases.  These findings are most suggestive of a bronchitis.\n\nAIRWAYS:  Airways are patent to the level of the segmental bronchi\nbilaterally.\n\nNODULES:  Multiple pulmonary nodules are identified as follows:\n\n-2 mm left upper lobe pulmonary nodule (05:56).\n-2 mm left upper lobe ground-glass nodule (5:74).\n-2 mm left upper lobe pulmonary nodule (5:77).\n-2 mm left upper lobe pulmonary nodule (5:80).\n-3 mm left upper lobe pulmonary nodule (5:128).\n-3 mm solid appearing left lower lobe pulmonary nodule (5:157).\n-5 mm solid appearing left lower lobe pulmonary nodule (05:59).\n-11 x 4 mm right upper lobe pulmonary nodule does not appear substantially\nchanged compared to exam performed ___ (05:36).\n-2 mm right upper lobe pulmonary nodule (5:152).\n-3 mm right upper lobe pulmonary nodule (5:167).\n-A 2 mm right perifissural nodule (5:170).\n\nCHEST WALL AND BONES: There is mild to moderate degenerative changes of the\nright glenohumeral joint.  Mild to moderate diffuse degenerative changes of\nthe thoracic spine is also noted.  There is no worrisome lytic or sclerotic\nlesion.\n\nUPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Unchanged appearance of a 11 x 4 mm right upper lobe pulmonary nodule\ncompared exam performed ___. ___ guidelines are provided\nbelow.  Given the provided smoking history, patient should be considered for\ndedicated lung cancer screening.\n2. Multiple bilateral pulmonary nodules range in size from 2-3 mm, as\ndescribed above.\n3. Mild, predominately lower lobe, bronchial wall thickening is consistent\nwith bronchitis.\n4. Severe coronary artery calcifications.\n\nRECOMMENDATION(S):\n For incidentally detected multiple solid pulmonary nodules bigger than 8mm, a\nCT follow-up in 3 to 6 months is recommended in a low-risk patient, with an\noptional CT follow-up in 18 to 24 months. In a high-risk patient, both a CT\nfollow-up in 3 to 6 months and in 18 to 24 months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A tracheostomy tube is in place in terminates in the mid\ntrachea.  Previously seen tracheal and intermedius bronchus stents have been\nremoved since ___.  Tracheomalacia configuration with patent trachea.\nIn the posterior wall of the distal trachea, just above the carina, there is a\n1.1 x 0.7 cm outpouching filled with air, which is newly seen since from prior\nCTs likely obscured on the priors due to the presence of a stent.  The\nbronchus intermedius appears narrowed, yet patent.  Remainder of lobar and\nsegmental bronchial branches are patent.  The previously seen concentric soft\ntissue in the distal trachea and proximal to the bronchial stent are not\nappreciated on current study.\n\nSevere and extensive centrilobular emphysema is again seen, upper lobe\npredominant.  There has been improvement of the multiple peripheral opacities\nin the basal aspects of the right middle lobe and right lower lobes with some\nremaining in the right lower lobe.  New small ground-glass opacities in the\nleft lower lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Redemonstrated tracheobronchomalacia with removal of a tracheal and\nbronchus intermedius stents since ___.  Narrowing of the right\nintermedius bronchus, however with patency of the bronchus.\nNewly seen air-filled outpouching arising from the posterior wall of the\ndistal trachea.\n2. Improvement of multifocal infectious process in the right lower lobe and\nright middle lobes, with residual infection and new/ongoing infection\ndemonstrated by new opacities in the left lower lobe.\n3. Previously seen soft tissue thickening in the distal trachea and proximal\nbronchus intermedius is not noted on current study."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular, axillary\nadenopathy.  Unenhanced appearance of the thyroid gland is unremarkable.  Soft\ntissues of the chest wall are within normal limits.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.\n\nMEDIASTINUM: No mediastinal masses or adenopathy.\n\nHILA: Within the limitations of a nonenhanced CT, the right hilum measures up\nto 1.3 cm, previously 1.5 cm.  Left hilum is normal.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Severe centrilobular emphysema is upper lobe predominant. \nMultiple ill-defined, predominantly peripheral opacities in the basal aspects\nof the right middle lobe and right lower lobes have improved from prior.\n2. AIRWAYS:  A patent tracheal stent extends from approximately 1.2 cm above\nthe aortic notch to immediately superior to the carina, similarly position to\nprior study.  A second stent is seen in the bronchus intermedius, and\nterminates immediately superior to the origin of the middle lobe and superior\nsegment of the new right lower lobe.  High attenuation soft tissue distal to\nthe tracheal stent is similar to ___.  Immediately proximal to the\nbronchial stent there is a concentric narrowing of the airway by soft tissue,\nmost prominent in the posterior wall, resulting in narrowing of the airway by\napproximately 75% (401:91), improved from prior CT.  There is mild bronchial\nwall thickening, worse in the right middle lobe and subsegmental bronchial\nmucous impaction worse in the posterior basal segment of the right lower lobe\n(4:85, 90).\n3. VESSELS:  Pulmonary artery is normal in size and caliber.  Thoracic aorta\nis normal in size and is moderately calcified at the arch.\nCHEST CAGE: No evidence of acute fractures or suspicious bone lesions.",
            "output": "1. Status post stent placement in the distal trachea and bronchus intermedius,\nin similar positions to ___.\n2. High attenuation soft tissue noted distally to the tracheal stent and\nproximally to the bronchial stent could represent granulation tissue.  Will\ncompare to a new CT with tracheal protocol scheduled for ___.\n3. Secretions are seen in the trachea and occluding the bronchus to the\nposterior basal segment of the right lower lobe.\n4. Mild bronchial inflammation, worse in the right middle lobe and mucous\nimpaction, worse in the right lower lobe.\n5. Improving multifocal infectious process, particularly in the right lower\nlobe."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\n6 mm ground-glass opacity in the right upper lobe (6:97) is stable\n\nA 19 x 16 mm nodule in the superior segment of the right lower lobe (6:96), is\nless dense than before. There are no new lung nodules.\n\nThere is no pleural or pericardial effusion\n\nThis examination was not tailored for subdiaphragmatic evaluation in the upper\nabdomen is unremarkable.\n\nChronic fractures of T3 and T11 are stable. there is progression of L1\nvertebral body fracture",
            "output": "Two lung nodules as described above, largest in the right lower lobe has\nchanged in size and density, still is worrisome for malignancy PET-CT can be\nperformed for further evaluation."
        },
        {
            "input": "The patient is of the wedge resection and segmentectomy of the superior right\nlower lobe segment as well as of the mediastinal lymph node dissection.\n\nMinimal enlargement of the thyroid is unchanged.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy. No current evidence for enlarged\nlymph nodes in the mediastinum. The postoperative clip is seen adjacent to the\nmedioposterior aspects of the bronchus intermedius.  Mild coronary\ncalcifications.  No pleural effusions.  No pericardial effusions. Small hiatal\nhernia.  Mild aortic wall calcifications.  No abnormalities at the level of\nthe abdomen, in particular no adrenal lesions.\nThere are known vertebral compression fractures, not substantially changed\nsince ___.\nUnchanged minimal bilateral apical scarring.  5 mm part solid nodule in the\nright upper lobe (4, 122).  Both pre-existing nodules have been resected, the\nlargest extent of the post resection changes is at the right lung basis (4,\n160) it consists of a triangular area of consolidated lung parenchyma, partly\nencompassing the post surgical staples and having a maximum diameter of 4-5\ncm.  There are minimal areas of postsurgical atelectasis and minimal pleural\nthickening.  No abnormalities noted in the left lung.  Signs of mild chronic\nairways disease are unchanged.",
            "output": "Postoperative consolidation of right basal lung parenchyma after wedge\nresection and segmentectomy.  Minimal postoperative atelectasis and pleural\nirregularities.  New part-solid nodule in the right upper lobe (4, 122) that\nrequires CT followup within ___ month.  Unremarkable left lung."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive coronary\ncalcifications are present.  No pathologically enlarged mediastinal, hilar or\naxillary lymph nodes are present.  Heart size is normal.  There is no\npericardial or appreciable pleural effusion demonstrated.\n\nImage portion of the upper abdomen demonstrates severe right hydronephrosis\nand partially imaged mass, but note is made that the imaging was not designed\nfor assessment of intra-abdominal pathology.  It might potentially in the\ninferior vena cava and its associated with severe hydronephrosis.\n\nMultiple liver hypodensities are too small to characterize but potentially\nconcerning for metastatic spread.\n\nAirways are patent to the subsegmental level bilaterally.  Ground-glass nodule\nin the right upper lobe, series 302, image 78 is 6.5 mm.  Left upper lobe\nnodule, series 302, image 93 is 7 mm.  Emphysema moderate to severe,\ncentrilobular.\n\nNo lytic or sclerotic lesion worrisome for infection or neoplasm demonstrated.",
            "output": "No definitive evidence of intrathoracic metastatic disease with 2 pulmonary\nnodules that would require short-term followup in 3 months\n\nSevere emphysema\n\nSevere coronary calcifications.\n\nPartially imaged severe hydronephrosis of the right kidney with mass which\npotentially invades IVC, dedicated abdominal imaging is required."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is top-normal\nin size and demonstrates severe coronary artery calcifications. There is no\npericardial effusion.\n\nNo pneumothorax or pleural effusion is identified.  Within the inferior left\nupper lobe, there is again seen a lobulated soft tissue mass with incomplete\nperipheral calcifications (5:163).  The largest axial diameter of the mass\nmeasures approximately 2.7 x 1.9 cm, essentially unchanged from ___.\nThe lesion appears to arise from the adjacent bronchus (5:160), with distal\n___ airspace opacities (for example, 5:176), which likely represents\nand endobronchial and/or mucous plugging.  Several adjacent smaller soft\ntissue nodules (for example, 5:163), are stable.  The remainder of the airways\nare patent to the subsegmental level.\n\nNo suspicious osseous lesions are identified.  Mild chronic compression\ndeformities involving the T11 and L1 vertebral bodies are unchanged in\nappearance.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrate extensive bilateral renal and hepatic cysts, compatible with\npolycystic kidney disease.",
            "output": "1.  Essentially stable, lobulated, partially calcified left upper lobe soft\ntissue mass which appears to arise from the bronchus and causes distal\nendobronchial impaction.  This lesion is essentially unchanged in size from ___, and demonstrated low FDG avidity by PET-CT on ___. \nFindings are concerning for pulmonary carcinoid tumor, and tissue sampling is\nrecommended for further characterization.\n2.  No additional suspicious pulmonary nodules or masses.  No pathologic\nintrathoracic or extrathoracic lymphadenopathy.\n3.  Extensive bilateral renal and hepatic cysts, compatible with known PCKD.\n\nRECOMMENDATION(S):  tissue sampling is recommended for further\ncharacterization of lung nodule.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:23 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest wall suspicious for malignancy.  This study\nis not appropriate for subdiaphragmatic diagnosis, particular in light of\nsevere cystic renal disease and multiple hepatic cysts and large areas of\nrelative hypoattenuation in the right hepatic lobe, which require dedicated\nabdominal imaging for evaluation.\n\nAtherosclerotic calcification is not apparent in the head and neck vessels,\nbut is found in at least the left anterior descending and circumflex coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nSmall nonhemorrhagic pericardial effusion is unchanged since ___. \nThere is no pericardial calcification and no pleural abnormality.\n\nThyroid is unremarkable.  Central lymph nodes are not enlarged.  A small\npericardial recesses should not be mistaken for right lower paratracheal lymph\nnode enlargement.\n\nLower esophagus is mildly distended with air above a small hiatus hernia. \nNevertheless, the integrity of the gastroesophageal junction, specifically the\nabsence of stricture or small mass, can only be assessed by a contrast\nswallow.\n\nMinimal bronchial wall thickening is more pronounced in the upper lungs but\nthere is no bronchiolitis.\n\n\nThe partially calcified mass in developing the lingular bronchus and its sub\nsegmental divisions has enlarged slightly since ___, particularly\nthe bulbous soft tissue component inferior to the partial calcification, now\n16 x 17 mm, previously 16 x 15 mm and higher attenuation, 47 ___, previously 17\n___.  A small satellite component anterior to the lesion at the level of the\ncalcification is 8 mm in greatest diameter today, 4:177, previously 6 mm. \nThere is also a new area of extrinsic bronchial narrowing just proximal to the\nbulk of the lesion, 4:171.  Distal to the lesion in the inferior subsegment of\nthe lingula is a constellation of mild bronchiectasis, bronchiolectasis and\nperibronchial ground-glass opacification all reflecting bronchial obstruction.\nThere are no lesions elsewhere in the lungs are more proximally and the\nbronchial tree.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.  Mild\nto moderate upper endplate impression into lower thoracic vertebral bodies is\nunchanged since at least ___.",
            "output": "Continued slow growth of endobronchial or peribronchial mass in the lingula,\ndifferential diagnosis includes carcinoid tumor, hamartoma, amyloidosis and\npost infectious or indolent infectious lesion, such as coccidioidomycosis or\nother fungal pathogen.  Increase in attenuation of the lesion suggests\npossible hemorrhage.\n\nCoronary atherosclerosis.\n\nDilated lower Esophagus should be evaluated with barium swallow."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild\ncoronary arterial calcifications are noted, along with mild calcifications\nwithin the aortic arch.  Otherwise, the heart, pericardium, and great vessels\nare within normal limits based on an unenhanced scan.  A small amount of\npericardial fluid is again seen anteriorly, not significantly changed since\nthe prior study.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  There is a trace left pleural effusion posteriorly.\n\n\nLUNGS/AIRWAYS:  The previously described partially calcified lingular mass\nextending into branches of the lingular bronchus has been biopsied since the\nrecent prior study, with post biopsy changes including a small amount of\nground-glass about the mass compatible with pulmonary hemorrhage, and\nwedge-shaped atelectasis within the lingula distal to the mass.  The right\nlung is clear without masses or areas of parenchymal opacification.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  There is a small hiatal hernia.  Innumerable hepatic and renal cysts\nare partially imaged, but do not appear significantly changed since the prior\nCT.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Post-biopsy changes of partially calcified lingular mass include minimal\nsurrounding ground-glass compatible with hemorrhage, and subsegmental\natelectasis distal to the lesion.\n2. No pneumothorax.\n3. Trace left pleural effusion.\n4. Innumerable hepatic and renal cysts are partially imaged."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there are moderate calcifications in the LAD, and\ncircumflex coronary arteries.  There is trace pericardial effusion.  .  There\nis no pleural effusion.  Patient is status post lingular segmentectomy, no\nevidence of abnormal soft tissue adjacent to the suture lines.  There are\nminimal secretions in the left main bronchus .  There are no lung nodules\nThis examination is not tailored for subdiaphragmatic evaluation there is a\nsmall hiatal hernia.  Multiple liver cysts and polycystic kidneys are\npartially evaluated but appear unchanged.\nThere are no bone findings of malignancy",
            "output": "No evidence of recurrence.  Status post lingular segmentectomy.\nliver cysts and polycystic kidneys partially evaluated."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Mild aortic wall calcifications.  Moderate\ncoronary calcifications, small pericardial effusion. The posterior mediastinum\nis unremarkable, with the exception of a small hiatal hernia.  Known multi\ncystic kidney and liver disease.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.\nStatus post lingular wedge resection.  The resection site is stable and\nunremarkable.  No evidence of recurrence.  The airways are patent.  There is a\nstable right basal focus of pleural thickening (4, 169), completely unchanged\nas compared to the previous examination.  No pleural effusions.  No pulmonary\nfibrosis.",
            "output": "Stable appearance after lingular wedge resection.  No evidence of recurrence. \nNo adenopathy.  No pleural abnormalities, except for a stable focus of right\nbasal pleural thickening."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenectomy.  Patient is status post left mastectomy with surgical clips\nnoted in the left axilla.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.\n\nMEDIASTINUM: Few calcified lymph nodes in the mediastinum may be sequela from\ntreated Hodgkin's lymphoma or exposure to granulomatous disease.  No\nadenopathy.\n\nHILA: Within the limitations of unenhanced CT, the hilar contours appear\nnormal.\n\nHEART and PERICARDIUM: Heart is normal in size.  Severe coronary\ncalcifications involving the RCA, LAD and circumflex.  Severe calcification of\nthe aortic valve and mitral annulus.  The provided history of bicuspid aortic\nvalve cannot be assessed on current study given the lack of contrast and\nnon-gated technique.  Low-density of the blood pool suggests anemia.  Mildly\nthickening of the pericardium could be related to radiation.  Thoracic aorta\nis mildly calcified, measures up to 3.3 cm.  Pulmonary artery is normal in\nsize.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Ground-glass opacities in bilateral paramediastinal upper\nlobes and in the subpleural lingula are likely post radiation changes.  No\npulmonary nodules.\n2. AIRWAYS:  Airways are patent to subsegmental level bilaterally.\nCHEST CAGE: No suspicious bony lesions or acute fractures.  Diffuse bone\ndemineralization.",
            "output": "1. Severe aortic valve calcification and coronary calcifications.\n2. Severe coronary artery disease involving RCA, LAD and circumflex.\n3. Normal diameter of the thoracic aorta.\n4. Post radiation changes as noted above."
        },
        {
            "input": "The thyroid is normal.\n\nThere is no enlarged axillary or supraclavicular lymphadenopathy. There are\nmultiple scattered mediastinal nodes are not pathologically enlarged.  Of\nnote, there is a borderline lymph node in the left paraaortic region measuring\n8 mm which has not significantly changed (series 6, image 36).\n\nThe great vessels are normal caliber.\n\nThe heart size is normal.  No pericardial effusion.  Minimal coronary artery\ncalcifications are stable.\n\nThe airways are patent to subsegmental levels.\n\nThe lungs are clear.  Right perifissural middle lobe nodule is unchanged\n(series 6, 161). No focal consolidation, pleural effusion, or pneumothorax.\n\nThe esophagus is unremarkable.\n\nThe superficial soft tissues are normal.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nPlease see separate dictation for results of same day abdominal and pelvic CT.",
            "output": "No evidence of intra thoracic metastatic disease."
        },
        {
            "input": "The thyroid is unremarkable.  Stable, borderline enlargement of a right\naxillary lymph node, which measures 10 mm along the short axis and\ndemonstrates normal morphology including a prominent fatty hilum.  Stable,\nscattered subcentimeter mediastinal lymph nodes.  Stable subcentimeter right\nhilar lymph nodes.  No supraclavicular adenopathy.\n\nAorta and pulmonary arteries are normal in size.  There are no filling defects\nwithin the pulmonary arteries to suggest pulmonary embolism.  Heart is normal\nin size and there is no evidence of pericardial effusion.  There is no aortic\ncalcification.  There is minimal coronary artery calcification.  The esophagus\nis unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Stable, solid, 5 mm\nperifissural nodule in the right middle lobe (6, 137).  Stable, minimal\npleural thickening of the right minor fissure (6, 127).  There are no new\npulmonary nodules.  There is no pleural effusion.  There is stable, mild,\ndiffuse bronchial wall thickening without intraluminal secretions.\n\nModerate degenerative changes throughout the spine without evidence of\nsuspicious osseous lesions in the spine or thoracic cage.\n\nThis study is not designed for subdiaphragmatic evaluation.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter and well enhanced.  Heart\nsize is normal.  There is no pericardial pleural effusion.  Extensive coronary\ncalcifications are present.\nCentral venous line tip is in the cavoatrial junction.\n\nRight paracardiac lymph node, 9 mm, series 6, image 61 has mildly increased\ncompared to 5 mm previously.  Right paraesophageal lymph node is 9 mm,\nincreased compared to 5 mm, series 6, image 50.  Aortopulmonic lymph nodes are\nmultiple but small, sub 5 mm but still enlarged since previous examination. \nRight hilar lymph node has increased in size from 13 x 10 mm to 16 x 13 mm,\nseries 7, image 158.  No left hilar lymphadenopathy demonstrated.\n\n\nAirways are patent to the subsegmental level bilaterally.  2 potentially new\nnodules versus not seen on the previous examination due to motion artifact a\ndemonstrated in the left upper lobe, series 7, image 113, 2 and 1 mm each. \nAdditional pulmonary nodules are stable, series 7, image 143, 167.  There are\nno lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval increase in mediastinal and right hilar lymphadenopathy as described\n\nSeveral stable pulmonary nodules and 2 questionable new nodules in the left\nupper lobe, 2 mm.  Follow-up in ___ weeks with chest CT is recommended for\ndocumentation of stability."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  There is mild\ngynecomastia.  Otherwise, there are no suspicious chest wall lesions.\n\nUPPER ABDOMEN: The partially imaged upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  There is no mediastinal\nmass.  The esophagus is mildly patulous, but otherwise unremarkable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is enlarged.  There are moderate coronary\nartery atherosclerotic calcifications.  There is no pericardial effusion.  The\nascending thoracic aorta measures 3.7 cm.  There is aneurysmal dilatation of\nthe aortic arch measuring up to 5.2 cm (8:85).  There are extensive calcified\nand noncalcified atherosclerotic calcifications of the thoracic aorta.  Of\nnote, there are multiple noncalcified atherosclerotic plaques involving the\naortic arch (6:86, 89, 92).  Incidental note is made of an aberrant\nretroesophageal right subclavian artery, which is dilated measuring 2 cm.\nPLEURA: There is mild interval enlargement of a moderate loculated left\npleural effusion along the dependent portions of the left hemithorax with\nextension laterally and superiorly towards the lung apex.  There is interval\ndecrease in size of a nonhemorrhagic small right pleural effusion.  There is\nno pneumothorax.\nLUNG:\n\n1. PARENCHYMA: There is compressive atelectasis of the bilateral lower lobes,\nleft greater than right, overall similar to prior study.  There is no new\nfocal consolidation to suggest pneumonia.  Evaluation of the lung parenchyma\nfor pulmonary nodules is limited by extensive respiratory motion artifact. \nHowever, no large pulmonary masses or suspicious nodules are identified.\n2. AIRWAYS:  With exception of the bilateral lower lobe atelectasis, the\nremaining airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The pulmonary vasculature is unremarkable.\n\nCHEST CAGE: There is nonspecific sclerosis of the left posterior ninth rib\ndirectly adjacent to the vertebral body and a prominent vertebral body\nosteophyte (8:183 and 6:68).  There are no suspicious lytic or sclerotic\nosseous lesions.  There is no acute fracture.  There are multilevel\ndegenerative changes of the thoracic spine with bridging anterior vertebral\nbody osteophytes, unchanged.",
            "output": "1. Interval increase and loculation of the moderate left pleural effusion\ncompared to study dated ___, and interval decrease in size of the\nsmall right pleural effusion.  Associated compressive atelectasis is overall\nsimilar on the left and decreased on the right.  No new focal consolidation to\nsuggest pneumonia.\n2. Aneurysmal dilatation of the aortic arch measuring up to 5.2 cm. \nAdditionally, incidental there is an aberrant right retroesophageal subclavian\nartery, which is dilated measuring 2 cm.  Follow-up with the aortic center is\nrecommended.\n3. Extensive calcified and noncalcified atherosclerotic calcifications of the\nthoracic aorta.  Of note, there are multiple noncalcified atherosclerotic\nplaques along the aortic arch.\n4. Cardiomegaly with severe ___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery appears dilated measuring up to 3.7 cm.\nStable aneurysmal aberrant right subclavian artery measuring up to 2.6 cm. \nThe aortic arch measures up to 3.6 cm (301:39).  Extensive atherosclerotic\ndisease throughout, without dissection or intramural hematoma.  The heart is\nenlarged, but unchanged from prior.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, or hilar lymphadenopathy is\npresent.  Few prominent lymph nodes in the mesentery are noted.  No\nmediastinal mass.\n\nPLEURAL SPACES: Bilateral moderate nonhemorrhagic pleural effusions, have\nslightly increased on the right and decreased on the left.  Small amount of\nair in the left pleural space is likely secondary to pleural tapping.  No\npleural masses.\n\nLUNGS/AIRWAYS: Segmental bilateral lower lobe atelectasis.  No pulmonary\nnodules or opacities.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Unchanged bilateral subsegmental lower lobe atelectasis.  No evidence of\nconsolidation within the lung parenchyma.\n3. Bilateral moderate nonhemorrhagic pleural effusions, increased on the right\nand decreased on the left, relative to the volume prior to thoracentesis.\n4. Enlarged pulmonary artery up to 3.5 cm and aneurysmal aberrant right\nsubclavian artery.  Referral to aortic center is recommended.\n\nRECOMMENDATION(S):  Enlarged pulmonary artery up to 3.5 cm and aneurysmal\naberrant right subclavian artery. Referral to aortic center is recommended."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Prominent bilateral axillary lymph nodes\nexhibit normal morphology, and are nonspecific, but appear benign. There is no\nsupraclavicular, mediastinal, or hilar lymphadenopathy.   No mediastinal, or\nhilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is bilateral dependent atelectasis.  There are no masses\nor areas of focal consolidation.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Patient is\nstatus post cholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Status post cholecystectomy."
        },
        {
            "input": "Right lobe of the thyroid is homogeneous but greatly enlarged, diameter 38 by\n35 mm, left 16 x 24 mm.  Ultrasound evaluation is appropriate.\n\nSupraclavicular and axillary lymph nodes are not pathologically enlarged. \nExcluding the breasts which must be evaluated with mammography, there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis, recently\nperformed with an abdomen CT on ___.\n\nAtherosclerotic calcification is not apparent in head and neck vessels, but is\nheavy in the coronary arteries.  Evaluation of cardiomegaly would require\nechocardiography or other dedicated cardiac imaging, but the aorta appears\nnormal size and the pulmonary arteries are substantially enlarged, right 28\nmm, left 33 mm.\n\nCentral lymph nodes are not pathologically enlarged.  Pericardium is\nphysiologic.  Small pleural effusions are minimal.\n\nHeterogeneity in pulmonary background is due to pulmonary hypertension or\nalternatively small airway obstruction.\n\nSolitary lung lesion is a Spherical solid nodule, 9 mm, right lower lobe,\n7:154.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.  Disc\ndegeneration is severe at multiple levels in the thoracic spine with\nobliterated disc spaces enlarged or osteophytes.  There is no pathologic or\ncompression fracture.",
            "output": "Solitary sub cm right lower lobe lung nodule could be an isolated metastasis. \nLesion might be accessible to transthoracic needle aspiration biopsy\n\nSevere pulmonary hypertension is likely and should be evaluated.\n\nCardiomegaly, severe coronary atherosclerosis.\n\nLarge right goiter.  Thyroid ultrasound recommended.\n\nRECOMMENDATION(S):  Cardiac evaluation.\n\nThyroid ultrasound.\n\nConsult interventional radiography if transthoracic needle aspiration of right\nlower lobe lung nodule is contemplated."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The right lobe of the thyroid is\nenlarged, heterogeneous and contains a coarse calcification.  The left lobe of\nthe thyroid is normal.  There is no axillary or supraclavicular\nlymphadenopathy.  There is no mediastinal or hilar lymphadenopathy.\n\nHEART & VESSELS: The heart is enlarged but stable in size from the prior\nexamination in ___.  The main pulmonary artery measures up to 34 mm and is\nenlarged.  The thoracic aorta is normal in caliber. There is no pericardial\neffusion.\n\nLUNGS & AIRWAYS: The patient is status post recent thoracentesis on ___.  There are moderate bilateral effusions and compressive atelectasis\ninvolving the bilateral lower lobes, right greater than left.  The effusions\nand atelectasis have increased since the prior exam.  There are scattered\nareas of mucous plugging throughout multiple subsegmental bronchi.  Nodular\nopacities at the base of the left lung are likely related to atelectasis.\n\nPulmonary nodules:\n6 mm, right lower lobe, 4:164, stable\n\nNo new pulmonary nodules identified.  Motion artifact somewhat limits\nevaluation for small pulmonary nodules, particularly at the bases.\n\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions.",
            "output": "Small to moderate bilateral effusions are increased from ___.\n\nNo could evidence of active, intrathoracic metastatic disease.  6 mm Right\nlower lobe pulmonary nodule  stable since ___ is indeterminate.  No new\npulmonary nodules or masses are identified however the study is somewhat\nlimited due to the motion artifact.\n\nRight lobe of the thyroid is enlarged and heterogeneous.  Consider evaluation\nwith ultrasound if and when clinically appropriate."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts there are no soft tissue abnormalities in the imaged\nchest wall suspicious for malignancy.  Findings below the diaphragm will be\nreported separately.\n\nCardio mediastinum:\n\n Thyroid is chronically severely enlarged, mildly narrowing the subglottic\ntrachea.  It contains large heterogeneous segments, including a 20 mm wide\nhypodensity in the incompletely imaged upper pole of the right lobe.  Last\nimaged with ultrasound in ___, it should be kept under surveillance, as\nadvised in report of that study.\n\nEsophagus is unremarkable. Atherosclerotic calcification is not apparent head\nneck vessels or and is only mild in coronary arteries.\n\nPulmonary arteries are enlarged, main 38 mm, right 33 mm, previously 35 mm and\n27 mm respectively, indicating progressive pulmonary arterial hypertension, in\nthe setting of worsening cardiomegaly, best evaluated with echocardiography. \nA filling defect in the left upper lobe segmental pulmonary arterial branch,\n6:86 is a new pulmonary embolus.  Larger filling defects in the intra\npericardial right pulmonary artery and descending branches are equivocal but\nthose pulmonary emboli could be substantial.  Dedicated PE CTA is recommended\nif feasible.  There is no pericardial effusion.\n\nThoracic lymph nodes:\n\nNo adenopathy, by size criteria.\n\nLungs, airways, and pleura:\n\nThere are no lung nodules or consolidation.\n\nTracheobronchial tree is patent to subsegmental levels.  Previous pleural\neffusions have resolved.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning, compromised by technical limitations given patient's body habitus.",
            "output": "Acute pulmonary embolism involving at least segmental left upper lobe branch,\nconceivably more extensive.  Dedicated chest CTA would be needed for more\ndefinitive assessment.\n\nProbable pulmonary arterial hypertension, global cardiomegaly.\n\nNo good evidence for metastatic colon cancer in the chest.\n\nLarge goiter should be re-evaluated with thyroid ultrasound.\n\nRECOMMENDATION(S):  Consider chest PE CTA.\n\nThyroid ultrasound.\n\nConsider echocardiography.\n\nNOTIFICATION:  The findings were discussed with ___. , M.D.\nby ___, M.D. on the telephone on ___ at 12:06 pm, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is enlarged, 3.8 x 3.4 cm,\nparticularly the right lobe right lobe containing 1.6 cm hypodense nodule and\ncoarse calcification, mild narrowing of the subglottic trachea is unchanged.\n\nThere is no supraclavicular or axillary lymphadenopathy.\nThe included the chest wall is unremarkable.\n\nUPPER ABDOMEN: Nasogastric tube extending into the stomach, tip not imaged,\nremaining included upper abdominal organs are unremarkable.\n\nMEDIASTINUM: There is no mediastinal or gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Moderate cardiomegaly.  No pericardial effusion.\nA moderate atherosclerotic calcifications of the coronaries.\nMain pulmonary artery 3.7 cm, unchanged, suggesting pulmonary hypertension.\nThoracic aorta within normal size.\n\nLUNG and PLEURA : Study was performed in partial inspiration, severe\nrespiratory motion artifacts limit evaluation of fine detail.\nMajor airways are patent.\nLeft lower lobe lucency suggesting air trapping, unchanged since ___.\nIn the right lower lobe 0.6 cm nodule is unchanged since ___.\nThe there are no lung consolidations to suggest pneumonia.\nNo evidence of pulmonary edema.\nBilateral dependent microatelectasis.\nThere is no pleural effusion or thickening.\n\nCHEST CAGE: Extensive degenerative changes of the spine with diffuse\nosteoporosis.  Severe degenerative changes of the head of right  humerus.",
            "output": "No acute cardiopulmonary findings, no pleural effusion.\nLarge goiter with mild narrowing of the trachea is unchanged since ___."
        },
        {
            "input": "THORACIC INLET: The thyroid is diffusely enlarged with multiple hypodense\nareas within it and dystrophic calcification within the right lobe of the\nthyroid.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged supraclavicular lymph nodes.  There are no\nenlarged mediastinal hilar lymph nodes.  There is moderate cardiomegaly. \nThere is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nNo obvious nodules or consolidations are seen.  There is stable scarring in\nthe left lower lobe.\n\nBONES AND CHEST WALL : Review of bones stable complete resorption of the left\nhumeral head, unchanged since the prior study.  There are extensive\ndegenerative changes involving the right shoulder joint.  No obvious fractures\nor dislocations are seen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no obvious\nliver lesions.  There are extensive degenerative changes involving the\nvertebral bodies",
            "output": "Study limited due to respiratory motion however no obvious nodules or\nconsolidations.  Extensive degenerative changes involving the left shoulder\njoint with complete resorption of the left humeral head and extensive\ndegenerative changes involving the right shoulder joint.\n\nDiffusely enlarged thyroid, unchanged.\n\nModerate cardiomegaly."
        },
        {
            "input": "Exam is limited due to motion artifact the lung bases.  However, within these\nlimitations:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is enlarged but otherwise the pericardium and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a trace left pleural effusion which appears slightly\nloculated (3:201).  No right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is scattered subsegmental/linear atelectasis.  Otherwise,\nthe remaining lungs are clear without masses or areas of parenchymal\nopacification.  There is diffuse mild to moderate bronchial wall thickening. \nThere is mild-to-moderate centrilobular emphysema.  Otherwise, airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Diffuse bronchial wall thickening may represent chronic bronchitis."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The pulmonary\narterial vasculature is well opacified to the lobar level with no filling\ndefect to suggest pulmonary embolism.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild bibasilar atelectasis.  Multiple pulmonary nodules are\nseen.  For example, a 4 mm left upper lobe nodule (3:100), a right upper lobe\n3 mm nodule (3:105), a 2 mm right midlung nodule (3:126).  A millimetric\nperifissural polygonal opacity in the right lung is likely a lymph node\n(3:89).  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: Redemonstration of a T5 compression deformity without CT evidence of\nretropulsion (602:44).  Allowing for differences in techniques, the 38% loss\nof vertebral body height appears progressed from thoracic spine radiograph\ndated ___.\n\nABDOMEN:  Please refer to same day report on CT abdomen and pelvis for\ndescription of subdiaphragmatic findings.",
            "output": "1. Multiple pulmonary nodules, largest measuring up to 4 mm in the left upper\nlobe, are indeterminate.\n2. T5 compression deformity with 38% loss of vertebral body height appears\nprogressed from ___, allowing for differences in techniques.  No CT\nevidence of retropulsion.\n3.  Please refer to same day report on CT abdomen and pelvis for description\nof subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months."
        },
        {
            "input": "HEART AND VASCULATURE: Filling defects are demonstrated in the segmental and\nsubsegmental branches of the right lower lobe artery in the lateral basal\ndivision (for example series 5, image 119).  There is no evidence of right\nheart strain or pulmonary infarction.  The main pulmonary artery is normal in\ncaliber.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  A 1.0 cm nodular focus adjacent to the\nleft lateral wall of the descending thoracic aorta is of unclear etiology,\nhowever appears unchanged compared to multiple prior exams (5:166).  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  A right-sided central venous catheter terminates in the\nright atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace bilateral pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: Multiple bilateral pulmonary nodules are again demonstrated the\nlargest appearing slightly spiculated measuring up to 7 mm in the left lower\nlobe (5:141).  Mild compressive atelectasis overlying the trace bilateral\npleural effusions.  No consolidation.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to separately reported CT abdomen pelvis for description\nof the subdiaphragmatic findings.\n\nCHEST WALL: Status post tumor decompression and bilateral posterior fixation\nof T3-T7.  The inter pedicular screws on the left of T3-T4, and T6-T7 abut\ninto the vertebral canal, and likely extends into the epidural space.  This is\nunchanged compared to multiple prior exams.  Hyperdense embolization material\nis noted in the T4, T6, T7 vertebral bodies as well as along the epidural\nspace.  There is no acute fracture.",
            "output": "1. Segmental and subsegmental pulmonary emboli within the right lateral basal\npulmonary arteries without evidence of right heart strain or pulmonary\ninfarction.\n2. Scattered pulmonary nodules are unchanged in configuration compared to\nprior exam performed ___.  Continued attention on follow-up imaging\nis recommended.\n3. 1.0 cm nodular focus adjacent to left lateral wall of the descending\nthoracic aorta is of unclear etiology, however appears unchanged compared to\nmultiple prior exams dating back to ___.  Continued attention on\nfollow-up imaging is recommended.\n4. Trace bilateral pleural effusions.\n5. Redemonstration of postsurgical changes related to tumor decompression and\nposterior fixation of T3-T7, essentially unchanged in configuration compared\nto prior exam.\n6. Please refer to separately dictated CT abdomen pelvis for description of\nthe subdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Subcentimeter hypodense lesion in\nthe right lobe of thyroid.  No supraclavicular or axillary adenopathy.  Coarse\ncalcifications in the breasts.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  The gallbladder is packed with cholesterol gallstones.  No features\nof cholecystitis.  No adrenal lesions.  Nonspecific subcentimeter hypodense\nsplenic lesions (2, 56).\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  Trace\npericardial fluid.  Severe calcification of the aortic valve and annulus. \nModerate calcification of the mitral annulus.  Mild to moderate calcification\nof the coronary arteries.  The coronary arteries have normal origins.  Mild\nincrease in density of the ascending aorta wall but no frank calcification. \nThe ascending aorta measures 35 x 36 mm and the descending aorta at a\ncorresponding level measures 23 x 22 mm.  There is moderate calcification of\nthe aortic arch starting at the level of the origin of the brachiocephalic\nartery approximately 67 mm distal to the sino-tubular junction.  Moderate\ncalcification of the descending aorta.  Severe calcification of the wall of\nthe abdominal aorta with a small aortic diameter measuring 15 x 14 mm\n(immediately infrarenal).\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  A few indeterminate\nsub 4 mm pulmonary nodules.   Mild, but diffuse bronchial wall thickening. \nMild mosaicism of the pulmonary parenchyma. No confluent airspace\nconsolidation.  No diffuse lung disease.\n-AIRWAYS:  Small mucosal polypoid nodules in the trachea (4, 57, 65, 71) the\nlargest measuring 4 x 4 mm.  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is dilated measuring 39 mm in diameter\nsuggesting pulmonary arterial hypertension.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Severe calcification of the aortic valve and annulus.\nNormal origin of the coronary arteries.\nNo frank calcification of ascending aorta.\nModerate calcification of the aortic arch starting at the level of the\nbrachiocephalic artery.\n\nDilated pulmonary artery suggesting pulmonary arterial hypertension.\n\nMultiple small mucosal polypoid nodules in the trachea could be followed up\nwith CT or could be better evaluated with bronchoscopy."
        },
        {
            "input": "EXTRACARDIAC FINDINGS:\n\nCT CHEST WITH CONTRAST: The thyroid gland is normal.  The esophagus is within\nnormal limits.  There is no hiatus hernia.  There are no pathologically\nenlarged mediastinal, hilar, or axillary lymph nodes.  There is no visible\nsupraclavicular lymphadenopathy.  Major airways are patent to subsegmental\nlevels bilaterally.  A 2-3 mm right upper lobe subpleural lung nodule is\nstable (10, 33).  A 1-2 mm nodule at the left lung base is unchanged (10,\n134).  A 3 mm lingular nodule is unchanged (10, 72).  A 4 mm ground-glass\nnodule at the left lung base is unchanged (10, 139).  A 2 mm nodule at the\nleft lung base is unchanged (10, 126).  A 2 mm right middle lobe nodule is\nunchanged (10, 95).  There is no focal lung consolidation.  Minimal medial\nbasilar lower lobe subsegmental atelectasis is seen.  There is no pleural\neffusion or pneumothorax.\n\nCT ABDOMEN WITH CONTRAST: The liver enhances homogeneously without evidence of\nconcerning focal lesion. There is no intrahepatic biliary ductal dilation. The\nportal vein is patent.  Aside from gallstones, the gallbladder is\nunremarkable.  There is no extrahepatic biliary ductal dilation.  The pancreas\nenhances homogeneously. There is no peripancreatic stranding or ductal\ndilation.  There is no splenomegaly or focal splenic lesion.  The adrenal\nglands are normal.  The right kidney is malrotated.  Multiple small foci of\nrenal cortical thinning bilaterally may reflect sequelae from prior\ninflammation or infection.  Small bilateral renal cortical hypodensities are\ntoo small to characterize accurately by CT.  There is no concerning\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  There is\ndescending and rectosigmoid colonic diverticulosis.  The colon is otherwise\nunremarkable.  The appendix is normal.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nCT PELVIS WITH CONTRAST: There is mildly limited visualization of the\nintrapelvic structures due to streak artifact from left hip prosthetic\nhardware.  Within this limitation, the bladder and terminal ureters are\nunremarkable.  The uterus is not well seen.  There is no concerning focal\nadnexal abnormality.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nOSSEOUS STRUCTURES: Coarse calcifications in the right breast are unchanged. \nThere is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality.  The imaged thoracolumbar vertebral bodies are normally aligned.\nThere is moderate multilevel degenerative change. Vertebral body heights are\npreserved. No concerning focal lytic or sclerotic osseous lesions are seen.\n\nCTA:\n\nCARDIAC:  The right atrium is normal.  The right ventricle is normal.  The\nleft atrium is normal.  The left ventricle is hypertrophied.  The pericardium\nis normal and there is no pericardial effusion.  The aortic valve is is\ntricuspid with leaflet thickening and calcification.  Dominance of the\ncoronary artery system is right with normal origins and course.  Coronary\nartery calcification is moderate.\n\nPULMONARY ARTERIES:  The main, right and left pulmonary arteries are enlarged,\nand appears patent to the subsegmental level without filling defects.\n\nAORTA:  The thoracic and abdominal aorta is normal in caliber.  There are no\nascending thoracic aortic calcifications.  There is severe aortic arch,\ndescending thoracic aorta, and abdominal aortic calcification, worse in the\ninfrarenal abdominal aorta.  Major aortic arch branches and proximal\ntributaries of the abdominal aorta are patent.\n\nILIOFEMORAL ARTERIES:\nThe right side is patent at the common iliac, external iliac and common\nfemoral levels, calcifications are moderate in the common iliac and common\nfemoral and mild in the external, and tortuosity is mild.\n\nThe left side is patent at the common iliac, external iliac and common femoral\nlevels, calcifications are moderate in the common iliac and mild in the\nexternal iliac and common femoral, and tortuosity is mild.\n\nSUBCLAVIAN ARTERIES:  The right subclavian artery is patent. The left\nsubclavian artery is patent.  Calcifications are moderate to severe near the\norigin (10, 39) of the right subclavian artery and mild along its more distal\naspects.  Calcifications are also moderate about the proximal left subclavian,\nhowever minimal/mild along the remainder of its more distal course. \nTortuosity is mild.",
            "output": "1. Aortic valve stenosis without evidence of aortic aneurysm.\n2. Patent subclavian and common femoral arteries bilaterally.\n3. Bilateral solid pulmonary nodules measuring up to 3 mm are unchanged since\nrecent prior study of ___.\n4. Enlarged main pulmonary can be seen in the setting of pulmonary\nhypertension.\n5. Cholelithiasis.  Colonic diverticulosis.  Other incidental findings, as\nabove.\n6.  This report is provided without 3D and curved reformats measurements. \nWhen these images are available, an addendum will be generated and\nmeasurements provided."
        },
        {
            "input": "This exam is limited due to suboptimal bolus, particularly involving\nopacification of the pulmonary arteries, as well as respiratory and cardiac\nmotion artifact.  Within this limitation:\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nNo calcified atherosclerosis.\n\nEvaluation of pulmonary arteries is limited secondary to suboptimal bolus. \nHowever, the main, left common right pulmonary arteries are well opacified\nwithout evidence of a central pulmonary embolus. The main and right pulmonary\narteries are normal in caliber, and there is no evidence of right heart\nstrain.\n\nThere is no supraclavicular, axillary, or mediastinal lymphadenopathy.  A\nright lower paratracheal lymph node measures up to 8 mm in short axis but\nappears to have a fatty hila.  Coarse calcifications in the mediastinum are\nconsistent with prior exposure to granulomatous disease.  Mildly prominant\nright hilar lymph node is demonstrated.  The thyroid gland appears\nunremarkable.  There is a nonspecific 6 mm soft tissue lymph node in the right\nchest wall (series 3, image 96).  Nonspecific anterior mediastinal fat\nstranding has the appearance of residual or reactive sinus.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality other than\natelectasis. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable other than diffusely\ndecreased attenuation of the liver suggesting steatosis and mild colonic\ndiverticulosis.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No central pulmonary embolus in the main, left, and right pulmonary\narteries.\n2.  Non-specific mildly prominent right hilar lymph node."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is tortutous, but normal in caliber without evidence of\ndissection or intramural hematoma.  The heart is mildly enlarged.  The\npericardium and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are a few calcified left hilar lymph\nnodes as well as calcified granulomas in the left upper lobe, likely\nrepresenting sequela of prior granulomatous disease.  No axillary,\nmediastinal, or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for small hiatal\nhernia..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nA 7 mm soft tissue lymph node in the right chest wall (3:104) is unchanged.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. No\naxillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: 1.9 cm hepatic hypodensity (series 5, image 233) compatible\nwith a simple cyst.  Abdomen is otherwise unremarkable.\n\nMEDIASTINUM: Anterior mediastinal air, compatible with recent intervention. \nNo mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There are postsurgical changes from CABG and aortic\nvalve replacement.  Trace pericardial fluid and gas compatible with recent\nsurgery.  Coronary calcifications are moderate.\n\nPLEURA: Small bilateral pleural effusions with adjacent dependent atelectasis.\n\nLUNG:\n\n1. PARENCHYMA: There is a 1.8 x 1.0 x 2.0 cm perifissural left lower lobe,\nsuperior segment pulmonary nodule (series 5, image 108).  Additional, numerous\npulmonary nodules (series 5, image 152, 153, 115, 106, 65, 42) measure up to 6\nmm.  Bibasilar dependent consolidation, likely representing atelectasis. \nAssessment for underlying infection is limited without intravenous contrast.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Vascular calcifications are moderate.\nCHEST CAGE: Gas within superficial soft tissues and deep to the chest wall in\nthe lower chest (Series 5, image 246), compatible with recent sternotomy and\nsurgery.",
            "output": "1.  Indeterminate 1.8 x 1.0 x 2.0 cm left lower lobe pulmonary nodule. \nNumerous additional pulmonary nodules scattered throughout both lungs measure\nup to 6 mm.  Please see recommendations below.\n2.  Post sternotomy, CABG and aortic valvular replacement changes.\n\nRECOMMENDATION(S):  Further evaluation of the dominant left lower lobe\npulmonary nodule can be performed with PET-CT or alternatively a followup CT\nchest in 3 to 6 months.  Additional pulmonary nodules measuring up to 6 mm are\nto small to characterize on PET-CT but can also be reevaluated on followup CT\nchest."
        },
        {
            "input": "The heart is normal in size.  No filling defects are visualized among\npulmonary arteries.  There no pleural or pericardial effusions.  There is no\nlymphadenopathy.\n\nA consolidation involves much of the inferior part of the lateral segment of\nthe right middle lobe with more patchy opacity along its superior margin.\nElsewhere, the lungs remain clear.\n\nLimited views of the upper abdomen are unremarkable.\n\nThere are no suspicious lytic or blastic bone lesions.",
            "output": "Findings consistent with pneumonia in the right middle lobe. No evidence of\npulmonary embolism or other additional acute abnormality.\n\nFollow-up radiographs are recommended to show clearance in approximately six\nweeks."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is minimal atherosclerotic calcification.\n\nThe previously noted filling defects within the left lower lobe pulmonary\narterial branches have resolved since the prior study.  No new filling defect\nwithin the pulmonary arteries to the subsegmental levels.  The main and right\npulmonary arteries are normal in caliber, and there is no evidence of right\nheart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a small right pleural\neffusion with associated atelectasis, mildly increased from the prior study.\n\nApical scarring and/or atelectasis is noted on the right, unchanged from the\nprior study.  Patchy ground-glass opacities in the left lower lobe are likely\nrelated to atelectasis or pulmonary edema, unchanged.  The airways are patent\nto the subsegmental level.\n\nLimited images of the upper abdomen demonstrate cirrhotic morphology of the\nliver.  The previously seen infiltrative tumor of the right hepatic lobe is\nnot well visualized due to phase of contrast.  Mild perihepatic ascites.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "The previously seen filling defects in the left lower lobe pulmonary arterial\nbranches have resolved since the prior study.\n\nSmall right pleural effusion and associated atelectasis is mildly increased\nfrom the prior study.\n\nThe infiltrative tumor of the right hepatic lobe is not well evaluated on this\nstudy due to phase of contrast."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid demonstrates a 1.3 cm\nright thyroid lobe nodule is seen on prior study.  Supraclavicular and\naxillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple prominent mediastinal lymph nodes are noted.  For\nexample a right paratracheal node measures 0.7 cm (series 302, image 47) a\nright paratracheal node more inferiorly measures 0.8 cm (series 302, image\n86).  A subcarinal node measures 0.6 cm (series 302, image 114).  No\nmediastinal mass.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial and\naortic annular calcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is right lower lobe atelectasis. When compared to\n___, the left lower lobe has re-expanded with mild to moderate\nresidual atelectasis.  Otherwise, no additional foci of focal consolidation. \nNo evidence of septic emboli to the lungs.  No suspicious pulmonary nodule or\nmass.  There is no emphysema.\n\nAIRWAYS:  There is right basal posterior segmental bronchial wall thickening\nand mucus plugging (series 302, image 146).  Otherwise the remaining airways\nare patent to subsegmental level.  The endotracheal tube terminates\napproximately 4.0 cm above the carina.\n\nPLEURA:  There are bilateral small pleural effusions.  No pneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.  Again\nseen is T6 compression deformities without substantial interval changes.  No\nnew fracture identified.  Multilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Interval improved aeration of the left lower lobe with mild residual\natelectasis.  Right lower lobe atelectasis.\n2. No additional consolidation.  No evidence of septic emboli to the lungs.\n3. Right basal posterior segmental bronchial wall thickening and mucous\nplugging.\n4. Small bilateral pleural effusions.\n5. Unchanged T6 compression deformities.\n6. Please see separate report performed on the same day for detailed\nevaluation of the abdomen and pelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid contains a 1.3 cm right\nthyroid lobe nodule with calcifications.  Supraclavicular and axillary lymph\nnodes are not enlarged.\n\nMEDIASTINUM:  Scattered prominent mediastinal lymph nodes are again noted\nwithout substantial interval changes.  No mediastinal mass.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is aortic annular calcification.  There is a trace\npericardial effusion, minimally increased compared to ___.\n\nVESSELS: Aortic caliber is normal.  The main pulmonary artery is dilated\nmeasuring up to 3.6 cm.  The right and left pulmonary arteries are normal\ncaliber, making clinically significant pulmonary arterial hypertension\nunlikely.\n\nPULMONARY PARENCHYMA:  Bibasilar opacities and associated mucus plugging have\nworsened, consistent with worsening aspiration and atelectasis.  There are\nmultiple foci of new nodular opacities in the right lung apex (series 3, image\n45), posterior segment of right upper lobe (series 3, image 101), aerated\nright lower lobe (series 3, image 136), apical posterior segment of the left\nupper lobe and superior segment of the left lower lobe.  These most likely\nrepresent aspiration.  Underlying infection is possible.\n\nAIRWAYS:  Mucus plugging in the bilateral lower lobes as described above. \nOtherwise the remaining airways are patent to subsegmental level.  The patient\nis intubated with secretion in the upper airway (series 2, image 3). \nNarrowing of the lower trachea (series 2, image 17) has worsened, raising\nconcern for developing tracheomalacia.\n\nPLEURA:  No pleural effusion or pneumothorax.\n\nCHEST WALL AND BONES:  T6 compression deformities are unchanged.  No new\nfracture.  No suspicious osseous lesions.  Multilevel degenerative changes are\nmild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Worsening bibasilar opacities with persistent mucus plugging, consistent\nwith worsening aspiration and atelectasis.\n2. New foci of nodular opacities throughout the lungs, most likely\nrepresenting aspiration, alternatively viral infection.\n3. Unchanged T6 compression deformities.\n4. Please see separate report performed on the same day for detailed\nevaluation of the abdomen pelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  No thyroid nodules are identified.\n\nUPPER ABDOMEN: A 2 cm hepatic cyst is seen in the left hepatic lobe.  The\nspleen appears enlarged measuring at least 13.6 cm.  An 8 mm hypodensities is\nseen in the head of the pancreas (2; 66).  A 3.8 x 2.5 cm indeterminate right\nadrenal nodule seen, increased in size compared to prior (2; 60).  A 5.1 cm\ncyst is seen arising from the upper pole of the left kidney.  There is trace\nfluid adjacent to the left kidney, similar to prior.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  There is no evidence of\nmediastinal mass or hematoma.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: The heart is top-normal in size.  There is no\npericardial effusion.  Moderate coronary artery calcifications are noted. \nMitral annular and aortic valve calcifications.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  A 3 mm nodule in the right middle lobe is unchanged compared\nto ___ (5; 160).  There is no evidence of pulmonary mass or focal\nconsolidation.  Subsegmental atelectasis/scarring is seen in bilateral lower\nlobes.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nThere is mild bronchial wall thickening.\n3. VESSELS: The ascending thoracic aorta is ectatic measuring 3.8 cm.  There\nis moderate atherosclerotic disease along the thoracic aorta.  Incidental note\nis made of a common trunk for the right brachiocephalic and left carotid\nartery.  The main pulmonary artery is top-normal measuring 2.9 cm.\nCHEST CAGE: Mild degenerative changes are seen in the thoracic spine.",
            "output": "1. No acute intrathoracic abnormality.\n2. Interval increase in size of a 3.8 cm right adrenal nodule concerning for\nmetastatic disease.\n3. Stable splenomegaly.\n4. 8 mm hypodensity in the pancreatic head which is incompletely evaluated on\nthis exam, further evaluation with outpatient MRCP can be considered if\nclinically indicated."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal. \nMediastinal shift to the left is similar to previous examination and related\nto extensive volume loss in the left lung.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen demonstrate ascites, and otherwise is\nunremarkable within the limitations of the study technique that was not\ndesigned for assessment of intra-abdominal pathology.\n\nLeft epicardial lymph node is   7 mm, series 2, image 40.  Right epicardial\nlymph node is  , 6 mm, series 2, image 40.  Both have increased as compared to\n___ where the a sickness did not increase 2 mm.  Left supraclavicular\nlymph nodes are enlarged, series 4, image 34, approaching 15 x 11 mm,\nminimally increased since previous examination.\n\nNo mediastinal, hilar  lymph nodes demonstrated.  Bilateral hilar lymph nodes\nare not pathologically enlarged, stable\n\nTrachea and right main bronchus are overall unremarkable.  Severe left lung\nbronchiectasis with substantial volume loss are redemonstrated.  Right upper\nlobe bronchiectasis to substantially smaller extent are present as well. \nApical nodules, right upper lobe calcifications and left basal consolidations\nare stable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Mild interval increase in the left supraclavicular lymph nodes but substantial\nincrease in paracardiac lymph nodes.\n\nNo new pulmonary nodules\n\nSevere bronchiectasis with particularly substantial volume loss in the left\nlung as described with lung calcifications.\n\nAscites"
        },
        {
            "input": "HEART AND VASCULATURE: Extensive bilateral filling defects involving both\ndistal right and left pulmonary arteries with extension to the lobar,\nsegmental and subsegmental branches of old the lobes, worse on the right lower\nlobe.  There is straightening of the cardiac septum.  The pulmonary artery\ncaliber is normal.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  Pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No parenchymal abnormalities.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Extensive bilateral lobar, segmental and subsegmental pulmonary embolisms. \nStraightening of the cardiac septum concerning for right heart strain.  No\nparenchymal abnormalities.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:07 am, 10\nminutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is moderately enlarged and there is mild coronary arterial\ncalcification.  There is a tiny pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Ground-glass opacities in the bilateral lower lobes,\nleft greater than right, are nonspecific, possibly representing an\ninterstitial abnormality.  Linear scarring of the right middle lobe.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally with\nmild cylindrical bronchiectasis in the lower lobes.\n\nPLEURA:  There is no pleural effusion or pneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.  Acute\nnondisplaced anterior left sixth and seventh rib fractures.  Chronic anterior\nright sixth rib fracture.  Multilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, there is fatty atrophy of the pancreas and a small hiatal\nhernia.  Otherwise, the visualized portion of the abdomen is normal.",
            "output": "1. Nondisplaced acute fractures of the anterior left sixth and seventh rib. \nNo underlying pneumothorax.\n2. Bibasilar ground-glass opacities and bronchiectasis may be due to a chronic\ninterstitial lung disease."
        },
        {
            "input": "The thyroid is normal.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe great vessels are normal caliber.  There is no evidence of central\npulmonary embolism.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels.\n\nThe lungs are clear.  No focal consolidation, pleural effusion, or\npneumothorax.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No evidence of central pulmonary embolism.\n\nLimited assessment for PE due to poor opacification of the pulmonary arterial\ntree despite repeat attempts at scanning."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest wall suspicious for malignancy.  This study\nis not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nabnormality.\n\nThyroid is not imaged.  There is no atherosclerotic calcification in head neck\nor coronary arteries.  Numerous mediastinal lymph nodes are measurable but not\npathologically enlarged by size criteria.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  There is no pericardial or pleural\neffusion.\n\nBronchiolar nodulation is widespread, most severe in the right lower lobe. \nSeveral small areas of peribronchial ground-glass opacification are found, for\nexample, in the lingula, 4:118, left upper lobe, 4:95.  Several small\nirregular opacities Small nodular opacities, probably costal in areas of.  The\nhandful of small irregular opacities, for example left lower lobe, 4:111, 120,\nare probably the same process.\n\nThere are no bone lesions in the chest cage suspicious for malignancy",
            "output": "Multifocal broncho centric pulmonary abnormality, probably atypical infection,\nespecially virus, mycoplasma or psitticosis chlamydia.  Unless there is more\nthan one pathogen, this is unlikely to be bacterial, fungal, or pneumocystis\ninfection."
        },
        {
            "input": "Heart size is normal without significant pericardial fluid.  Thoracic aorta\nand main pulmonary artery are normal caliber.\n\nThere is no supraclavicular, axillary, or mediastinal lymphadenopathy.  There\nis no gross hilar lymphadenopathy given confines of a noncontrast examination.\n\nThe central airways are patent.  There are areas of peribronchial ___\nnodularity with surrounding ground-glass halos, most notable in the lingula\nand posterior segment of the left upper lobe along with less prominent areas\nin the right upper lobe, with additional mild areas in the left lower lobe,\nwith the affected areas appearing increased compared the prior examination,\nthough the areas of millimetric peribronchial nodularity in the right lower\nlobe was seen on the prior examination appear to have resolved.  No\ninterstitial scarring or prominence is seen.  Pleural surfaces are clear\nwithout effusion or pneumothorax.\n\nAlthough this study is not tailored for subdiaphragmatic analysis, the\nvisualized upper abdomen is notable for cholesterol stones within otherwise\nunremarkable gallbladder along with hyperdense sludge without surrounding\ninflammatory change or wall thickening.  The remainder of the visualized upper\nabdomen is grossly unremarkable.\n\nThoracic cage is intact without acute fracture or suspicious focal bone\nlesion.",
            "output": "1. Multifocal areas of peribronchial ___ nodularity with surrounding\nground-glass attenuation, most prominent in the left upper lobe, to a mild\ndegree in the right upper lobe and left lower lobe, with resolution of\nprevious involvement in the right lower lobe.  The findings are nonspecific,\nthough are most reflective of an atypical infectious or inflammatory process.\n2. Otherwise no evidence of interstitial lung disease.\n3. No thoracic lymphadenopathy.\n4. Cholelithiasis."
        },
        {
            "input": "CT CHEST WITHOUT IV CONTRAST: The thyroid is grossly normal.  There is no\nsupraclavicular, axillary, mediastinal or hilar lymphadenopathy.  There is a 7\nx 6 mm prevascular lymph node (5:65).  Within the limitations of a noncontrast\nenhanced study there is no mediastinal or hilar lymphadenopathy by CT size\ncriteria.\n\nHeart size is normal with small pericardial effusion.  There are\ncalcifications of aortic valve and at least moderate atherosclerosis of the\ncoronary arteries.  The thoracic aorta and proximal great vessels are normal\nin caliber.  The main pulmonary artery is normal in caliber.\n\nThe airways are patent to the subsegmental level.  There is no pleural\neffusion or pneumothorax.  Atelectasis in the lower lobes is mild.\n\nOSSEOUS STRUCTURES: There are moderate to severe degenerative changes in both\nglenohumeral joints with joint space narrowing, subchondral sclerosis and\nsubchondral cystic change in the humeral heads (2:4).  There are degenerative\nchanges at L1-L2 with significant disc height loss, disc vacuum phenomenon and\nendplate sclerosis.  No worrisome blastic or lytic lesion is detected.\n\nUPPER ABDOMEN: There is a stone in the gallbladder which is otherwise without\nwall thickening or pericholecystic fluid.  There is a small hiatal hernia. \nThe remaining partially visualized solid organs and stomach are grossly normal\nalthough incompletely evaluated on this study.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Moderate atherosclerosis of the coronary arteries.\n3. Small pericardial effusion.\n4. Cholelithiasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a single 5 mm micronodule at the right lower lobe\n(3:295).  Apart from minimal atelectasis in the dependent lower lobes, lungs\nare clear without focal consolidation.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatal hernia.  Included portion of the upper\nabdomen demonstrates mild intrahepatic biliary ductal dilatation, findings\nwhich may be secondary to prior cholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of aortic dissection or other acute abnormality in the chest.\n2. Small hiatal hernia.\n3. Single 5 mm micro nodule at the right lower lobe.  For incidentally\ndetected single solid pulmonary nodule smaller than 6 mm, no CT follow-up is\nrecommended in a low-risk patient, and an optional CT in 12 months is\nrecommend in a high-risk patient.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery\ncalcifications are extensive.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is upper lung predominant ground-glass opacity with\ninterlobular septal thickening in a more anti dependent portion of the lungs,\nconsistent with pulmonary edema.  There is bilateral dependent atelectasis. \nOtherwise no focal consolidation to suggest pneumonia.  3 mm and 4 mm right\nupper lobe nonspecific pulmonary nodules are noted.  There is mild lower lobe\npredominant bronchial wall thickening which could represent inflammation or\nrelated to pulmonary edema.  Otherwise, the airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrate scattered\nnonspecific hypodensities in the liver measuring up to 1.6 cm (series 3, image\n184).\n\nBONES: No suspicious osseous abnormality is seen.? There are nondisplaced\nright anterior ___ to 6th rib fractures.  There are nondisplaced left anterior\n___ to 5th rib fractures.  No additional fracture identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Upper lung predominant pulmonary edema with combination of dependent\natelectasis.\n3.  Right anterior ___ to ___ and left anterior ___ to ___ nondisplaced rib\nfractures.\n4.  Nonspecific 3 mm and 4 mm right upper lobe pulmonary nodules.\n\nRECOMMENDATION(S):  For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Mild-to-moderate\natherosclerotic calcifications are seen throughout the visualized aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nNumerous prominent mediastinal lymph nodes identified, none of which are\npathologically enlarged by CT size criteria.  Multiple calcified left hilar\nlymph nodes are again noted along with scattered calcified granulomas\nbilaterally.  There is no supraclavicular, axillary, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion. \nThe airways are patent to the subsegmental level, and demonstrate mild\nbronchial wall thickening within the lower lobes.\n\nSevere centrilobular emphysematous changes predominantly are seen within the\nupper lobes bilaterally.  Multiple bilateral pulmonary nodules are identified,\nall of which appear grossly stable as compared to the prior examination, the\nlargest within the right upper lobe measures up to 6 mm (9: 15, 42, 80, 82,\n83, 84).  Multiple bilateral calcified pulmonary nodules are also stable.\n\nLimited images of the upper abdomen demonstrate punctate calcifications within\nthe liver and spleen, in addition to a small axial hiatal hernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  Numerous, bilateral pulmonary nodules measuring up to 6 mm, grossly\nunchanged from prior examination.\n3.  Severe, predominately upper lobe centrilobular emphysema.\n4.  Mild, lower lobe bronchial wall thickening, suggestive of airway\ninflammation.\n5.  Evidence of prior exposure to granulomatous disease."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  No pericardial pleural effusion is seen.\nHeart size is normal.\n\nImage portion of the upper abdomen demonstrate liver and splenic\ncalcifications.\n\nDilated esophagus is containing air-fluid level, unchanged.\n\nAirways are patent to the subsegmental level bilaterally.  Severe\ncentrilobular and panlobular emphysema is unchanged.  Apical scarring right\nmore than left is nodular, unchanged..  5.5 subpleural nodule in the right\nupper lobe, series 5, image 107 is stable.  Adjacent to the nodule there is an\nimpacted bifurcating bronchus, series 5, image 115 not be mistaken for\npulmonary nodule.  Several pulmonary nodules are stable, series 5, image 107,\n167, 204, 212, 200 and 1, 215, all of them stable.\n\nMinimal cylindrical bronchiectasis are primarily seen in lower lobes.  No\nsubstantial bronchial wall thickening or endobronchial secretions\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Severe emphysema\n\nStable multiple pulmonary nodules\n\nEvidence of previous granulomatous exposure\n\nMinimal bronchiectasis"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nLimited images of the upper abdomen is remarkable for arterially enhancing 3.4\ncm lesion in the right hepatic lobe, incompletely characterized.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nIncidentally seen arterially enhancing 3.4 cm lesion in the right hepatic lobe\nis incompletely characterized, possibly hemangioma.\n\nRECOMMENDATION(S):  Recommend MRI for further evaluation of the liver lesion.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 10:17 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "A heterogeneously enlarged thyroid gland containing multiple hypodense\nnodules, a few which are calcified, is unchanged . There is no\nsupraclavicular, mediastinal, hilar or axillary lymphadenopathy.\n\nA left pectoral MediPort extends into the right atrium. Heart size is normal\nwith no pericardial effusion. Coronary artery and aortic annular\ncalcifications are stable.  No incidental pulmonary embolus is identified.\n\nPre-existing pulmonary nodules measuring up to 3 mm in the subpleural left\nlower lobe are stable (4: 109, 148). The previously seen lingular ground-glass\nnodule is no longer definitely seen, suggesting an infectious or inflammatory\netiology. There are no new nodules. No endobronchial lesion or pleural\nabnormality is identified.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nBones are unremarkable.",
            "output": "Stable exam with no appreciable interval change in pre-existing pulmonary\nnodules measuring up to 3 mm in the left lower lobe. No new nodules\nidentified.\n\nStable multinodular goiter."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta contains atherosclerotic\ncalcifications though is normal in caliber.  Mild coronary artery\ncalcifications are visualized otherwise the heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, hilar, or mediastinal\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 2-3 mm pulmonary nodule in the right lower lobe is unchanged\n(5:139) in addition to a calcified granuloma in the left lower lobe also 2-3\nmm (5:148).  No new nodules or focal consolidations are identified.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: A heterogeneous right thyroid lobe is demonstrated without focal\nnodularity identified.  No supraclavicular lymphadenopathy is identified\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for a\nmoderate sized hiatal hernia.  A 1.6 cm exophytic left upper pole renal lesion\ncould represent a renal cyst and is unchanged appearance from prior study.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No intrathoracic source of infection identified."
        },
        {
            "input": "A left PICC ends in the mid SVC.  The thyroid is normal.  There is no\naxillary, supraclavicular, a mole mediastinal or hilar adenopathy.  The heart\nsize is mildly enlarged and there is mild calcification of the coronary\narteries and the thoracic aorta.  The pulmonary arteries enlarged measuring 35\nmm in diameter, consistent pulmonary hypertension.  There is no pericardial\neffusion.  A trace left pleural effusion is significantly decreased in size.\n\nThere is scarring at the right lung apex, lingula and left lower lobe.  A\nground-glass opacity at the right lung apex (series 5, image 66) is unchanged.\n\nAn opacity in the right upper lobe along the right major fissure is\nsignificantly improved from ___ (series 5, image 86).  A left lower\nlobe consolidation (series 5 image 27) is dramatically improved from ___.\n\nAn opacity in the lingula is significantly improved as well (series 5, image\n141).\n\nA lipoma of the right chest wall is incidentally seen.  The partially\nvisualized superficial soft tissues of the chest wall are unremarkable.\n\nThe liver is homogeneous in attenuation without evidence of focal lesion.  The\nadrenal glands are within normal limits.  Spleen size is normal.  There is a\nmoderate hiatal hernia unchanged from ___.",
            "output": "1.  Residual, small bilateral opacities consistent with pneumonia are\nsignificantly improved from ___.\n\n2.  A trace left pleural effusion is significantly decreased in size."
        },
        {
            "input": "A PICC line is again noted, ending in the mid SVC, in stable position.\n\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  The cardiac silhouette is minimally enlarged and\nthere are mild coronary atherosclerotic calcifications.  The main pulmonary\nartery measures 3.5 cm in diameter, borderline enlarged.  The aorta is normal\nin size.  Calcifications are seen at the descending thoracic aorta.\n\nEvaluation of the lung parenchyma shows improved opacity in the right upper\nlobe in comparison to most recent examination.  However, there is persistent,\nand slightly more coalescent consolidation and atelectasis in the left lower\nlobe.  Again seen is scarring in the right apex, lingula, and left lower lobe.\nThere is a persistent, trace pleural effusion on the left\n\nAgain incidentally noted is a lipoma of the right chest wall.\n\nThe visualized portions of the upper abdomen show no significant abnormality\nother than a moderate hiatal hernia.",
            "output": "1.  Residual left lower lobe consolidation, consistent with persistent\npneumonia, and atelectasis.\n2.  Trace left pleural effusion is unchanged since most recent examination."
        },
        {
            "input": "MEDIASTINUM/HEART:  The patient appears to be post left hemithyroidectomy,\nunchanged. Supraclavicular, axillary, mediastinal and hilar lymph nodes are\nnot enlarged by CT size criteria. Aorta and pulmonary arteries are normal in\nsize.  Atherosclerotic calcifications of the aortic arch and descending\nthoracic aorta are unchanged. Heart size is mildly enlarged with mild,\nunchanged coronary artery calcification.\n\nThe left-sided central line terminates in the mid to lower SVC.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Compared\nwith the prior chest CT from 1 week earlier, the previously described small\nfocal consolidation in the medial right lung apex has significantly decreased\nin size.  There is mild scarring in the right apex, unchanged.  The previously\ndescribed more confluent consolidation in the left lower lobe has also\ndecreased in size and significantly improved (5:166).  No new areas of focal\nconsolidation are identified.  There is only a trace left pleural effusion,\nsmaller than on ___.\n\nUPPER ABDOMEN:  Visualized portions of the upper abdomen demonstrate an\nunchanged moderate-sized hiatal hernia containing most of the gastric fundus,\nas well as an unchanged exophytic simple renal cyst of the left kidney\n(5:257).\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Incidentally noted lipoma of the right chest wall is unchanged.",
            "output": "1.  Compared with the CT chest from 1 week earlier, the right upper lung and\nleft lower lung areas of consolidation have significantly improved.  No new\nfocal consolidation is identified.\n\n2.  Trace left pleural effusion is even smaller than 1 week prior.\n\n3.  Unchanged right upper lung scarring and moderate-sized hiatal hernia."
        },
        {
            "input": "As compared to ___, there are no new areas of lung consolidation\nor nodular opacification to suggest acute pulmonary infection.  Previously\npresent opacities at the right apex, lingula and left lower lobe show further\ninterval improvement with minimal residual opacities that are predominantly\nlinear in appearance.\n\nThere are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart size\nis normal, and focal coronary artery calcifications are present.  Moderate\nsized hiatal hernia is noted.\n\nExam was not tailored to evaluate subdiaphragmatic region, but no new\nconcerning abnormalities are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate mild degenerative changes of the\nspine.",
            "output": "No CT findings to suggest active pulmonary infection."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there are moderate coronary arterial\ncalcifications.  Subendocardial hypodensity at the cardiac apex suggests prior\nLAD infarction (4:152).  A triple-lumen right IJ central venous catheter\nterminates in the low SVC.\n\nThe airways are patent to the subsegmental level.  There is no focal\nconsolidation, bronchiectasis, or bronchial wall thickening.  Punctate subtle\ncentrilobular pulmonary nodules may represent response to bone marrow\ntransplant.  There is no pleural or pericardial effusion.\n\nThis study is not tailored for the evaluation of subdiaphragmatic structures. \nAllowing for this, a simple left renal cyst and a fat containing hiatal hernia\nare present.  A large right chest wall lipoma is noted measuring up to 8.3 by\n2.4 cm in axial ___ (4:152).",
            "output": "1. Subtle centrilobular nodules may represent response to bone marrow\ntransplant.  No evidence of infection.\n2. Subendocardial hypodensity suggesting prior LAD territory infarction.\n3. Large right chest wall lipoma measuring up to 8.3 cm.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. \n___ on the telephone on ___ at 1:23 ___, 3 minutes after the\ndiscovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nMild atherosclerotic plaques are seen throughout the aorta . Triple-lumen\nright IJ central venous catheter is again seen terminating in the low SVC. \nPreviously described subendocardial hypodensity at the cardiac apex is not\nwell visualized on today's exam.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Compared to exam\ntaken on the prior day, the patient is an expiratory phase.  Dependent\nground-glass opacities in bilateral lungs likely represent atelectasis.  The\nairways are patent to the subsegmental level.\n\nRight chest wall lipoma is again seen (4:86).\n\nLimited images of the upper abdomen demonstrate enlargement of the spleen,\nwhich is stable from prior exam.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Within the lungs, there are no new segmental or lobar areas of consolidation\nor new or growing pulmonary nodules to suggest active pulmonary infection. \nFocal linear atelectasis or scarring is again demonstrated within the lingula.\nA 2 mm diameter noncalcified nodule in the right lower lobe laterally is\nunchanged since ___ chest CT.\n\nSoft tissue and skeletal structures of the thorax are unchanged since the\nrecent CT of 6 days earlier.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but appearance\nis unchanged since prior abdominal CT.",
            "output": "No CT evidence of pulmonary infection."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is normal, and\nfocal coronary artery calcifications are again demonstrated as well as\nlipomatous hypertrophy of the interatrial septum.  Hiatal hernia is noted.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.\n\nWithin the lungs, no new focal areas of consolidation or nodules are present\nwithin the lungs to suggest the presence of pneumonia.  Although expiratory\nimages were not acquired, precluding assessment for expiratory air trapping,\nthere are no secondary/indirect signs of graft-versus-host disease.  Linear\nscar atelectasis is noted within the lingula.",
            "output": "No CT evidence of active pulmonary infection."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable.\n\nUPPER ABDOMEN: Partially visualized renal hypodensities likely represent\ncysts, better characterized on the prior MRI from ___.  No acute\nfindings in the upper abdomen.\n\nMEDIASTINUM: A large hiatal hernia noted.  Otherwise the esophagus appears\nnormal.  No mediastinal mass or adenopathy.\n\nHILA: No hilar abnormality on this unenhanced exam.\n\nHEART and PERICARDIUM: The heart appears normal in size and shape without\npericardial effusion.\nPLEURA: No pleural effusion arm thickening.\nLUNG:\n\n1. PARENCHYMA:  Lungs are clear without worrisome nodule, mass, or\nconsolidation.\n2. AIRWAYS:  Clear\n3. VESSELS:  Thoracic aorta is mildly calcified and normal in course and\ncaliber.  The main pulmonary artery is normal in size.  Faint Coronary artery\ncalcification noted.\nCHEST CAGE: Intact without worrisome lytic or blastic osseous lesion.  Minimal\nspurring along the endplates of the mid thoracic spine.",
            "output": "No findings in the chest to account for cough.  Large hiatal hernia noted\nwithout signs of aspiration."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Minimal calcification of the head\nand neck vessels.  8 x 3 mm hypodense nodule in the left lobe of the thyroid\ngland.  There is no supraclavicular, infraclavicular or axillary\nlymphadenopathy.  Excluding the breasts, for which dedicated mammographic\nassessment is required, soft tissues of the chest wall are grossly\nunremarkable.\n\nUPPER ABDOMEN: Although this exam is not optimized for evaluation of\nsubdiaphragmatic structures, multiple bilateral renal hypodensities, the\nlargest arising from the interpolar aspect of the left kidney measuring 1.6 x\n1.5 cm, are similar to prior exam and most consistent with simple renal cysts.\nLarge hiatal hernia.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac chambers are normal in size.  Minimal coronary\nartery calcification.  No appreciable valvular calcification.  There is no\npericardial effusion.\nPLEURA: No pleural effusion or nodularity.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA: 7 mm left upper lobe pulmonary nodule (05:44), indeterminate,\nis new since prior exam.  No confluent airspace consolidation.  No new or\ngrowing pulmonary nodules.  No diffuse lung disease.  Mild scarring and/or\natelectasis within the lingula.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level\nbilaterally.\n3. VESSELS:  The aorta and main pulmonary artery are normal in size. \nMild-to-moderate calcification of the aortic arch and descending thoracic\naorta.  On this nondedicated examination, there is no large central pulmonary\nembolus.\nCHEST CAGE: Mild spondylosis.  No lytic or destructive lesions within the\nchest cage or imaged thoracic spine.  No new pathologic or compression\nfractures.",
            "output": "New 7 mm left upper lobe pulmonary nodule is indeterminate, though may be\ninfectious or inflammatory origin.  Follow-up chest CT within ___ months to\nensure resolution is advised.\n\nRECOMMENDATION(S):  Follow-up chest CT in ___ months to ensure resolution of\nnew 7 mm left upper lobe pulmonary nodule, presumably of infectious or\ninflammatory origin."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Moderate to large sliding hiatal hernia.\nLeft kidney upper pole small cyst.\nRemaining included upper abdominal organs with no gross findings within the\nlimitation of study with no IV contrast.\n\nMEDIASTINUM: There is no mediastinal or gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Moderate cardiomegaly with no pericardial effusion.\nMinimal atherosclerotic calcifications in the LAD, aortic valve and along the\nthoracic aorta.\nMajor vessels within normal size.\n\nPLEURA: No pleural effusion or thickening.\n\nLUNG: Major airways are patent.\nNo evidence of consolidation to suggest pneumonia.\nTiny calcified granuloma in the left lower lobe is unchanged as well as micro\nnodule of the right lower lobe (4:118, 131).\nNo new lung nodules or masses.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "No source of fever."
        },
        {
            "input": "PULMONARY ARTERIES/AORTA: No pulmonary arterial filling defects.  Normal\ncaliber thoracic aorta with moderate calcifications at the arch.  Limited\nevaluation of the ascending aorta and root due to excessive motion.\n\nMEDIASTINUM: No mediastinal or hilar adenopathy.  Small pericardial effusion. \nMild coronary arterial calcifications.\n\nLUNGS/PLEURA: Ground-glass opacities in a perihilar distribution trace\nbilateral pleural effusions, compatible pulmonary edema.  There are multiple\npoorly defined centrilobular nodules in a central peribronchovascular\ndistribution most likely infectious/inflammatory.  There is segmental\nbibasilar atelectasis with calcified granulomas on the right.  Small left and\ntrace right pleural effusions.\n\nOSSEOUS/SOFT TISSUES: Osteopenia.  No aggressive osseous lesions.\n\nUPPER ABDOMEN: Subtle hepatic hypodensities in the visualized portions of the\nliver measuring up to 1.1 cm (Axial image 173 series 3).  These are\nindeterminate or too small to characterize.",
            "output": "1. No pulmonary embolus demonstrated. Multiple centrilobular nodules, likely\ninfectious/inflammatory such as seen with infections/inflammatory\nbronchiolitis or aspiration pneumonitis in a background of pulmonary edema. \nBilateral pleural and pericardial effusions\n2. Partially visualized hypodense hepatic lesions not characterized on this\nexamination.\n The findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 10:28 am, 30 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis mild cardiomegaly. There are mild calcifications in all coronary arteries\nand the aortic valve. There is a moderate calcification of the mitral annulus.\nThere are bilateral moderate layering non hemorrhagic pleural effusions\nThere is right apical scarring.\n2 mm subpleural right upper lobe lung nodule (5:91)\nSubpleural irregular small opacities in the left upper lobe (5:160, 147) and\nin the right middle lobe (5:202) are likely inflammatory in origin or\natelectasis\nThis examination is not tailored for subdiaphragmatic evaluation: There is\npneumobilia, dilatation of the intrahepatic bile biliary ducts, a biliary\nstent, surgical clips in the gallbladder fossa, and a right renal cyst\nThere are no bone findings of malignancy",
            "output": "Bilateral moderate pleural effusions\nPunctate lung nodule and probably inflammatory foci and small areas of\natelectasis as described above.  Followup as clinical protocol\nCoronary calcifications\nCalcification of the aortic valve is of unknown hemodynamic significance\ncardiomegaly"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Mild calcified\natherosclerotic plaques.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  Slight hypoattenuation of the posterior\nbasal segmental branch of the right lower lobe pulmonary artery is secondary\nto beam hardening artifact and should not be confused for embolus.  The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nLarge bilateral pleural effusions with associated moderate dependent\natelectasis of the right lower lobe, left upper and lower lobes.  Lungs are\notherwise clear.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a left percutaneous\ntranshepatic biliary drain and partial visualization of 1 on the right as well\nas a CBD stent.  Moderate biliary dilatation..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nSevere degenerative changes of the left glenohumeral joint with bone-on-bone\ncontact.",
            "output": "1. No evidence of pulmonary embolus or acute aortic abnormality.\n2. Large bilateral pleural effusions with associated moderate compressive\natelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is no evidence of a pulmonary arteriovenous malformation.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is consolidation and ground-glass opacities in the right\nlower lobe (3:171) subsegmental atelectasis is noted in the lingula.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Partially visualized thyroid is unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.  No evidence of\npulmonary arteriovenous malformation.\n2. Ground-glass opacity and consolidation right lower lobe could represent\npneumonia or aspiration."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Residual\nthymic tissue in the anterior mediastinum is again seen.  There is no\npericardial effusion.  The aorta and pulmonary arteries normal in caliber. \nThere is no pericardial effusion\n\nPLEURA: There is no pleural effusion\n\nLUNG: The focal parenchymal opacity in the posterior basal segment of the\nright lower lobe ((4, 41) is unchanged in size but has slightly decreased in\ndensity.  This lesion is new since ___.  No new consolidations.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of the liver.  No focal liver lesions are seen.  No adrenal\nmasses are seen",
            "output": "Slight decrease in density of the triangular opacity in the right lower lobe\nthe morphology in size of the opacities unchanged, this opacity is new since\n___ and could represent a resolving pneumonia.  Follow-up to\ncomplete resolution in ___ weeks is recommended."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nThere is no pericardial pleural effusion.\n\nImage portion of the upper abdomen demonstrate low liver density consistent\nwith fatty infiltration.\n\nAirways are patent to the subsegmental level bilaterally.  Several pulmonary\nnodules are stable, series 5, image 100, 3 mm, series 5, image 151, 3.5 mm. \nNo new nodules masses or consolidations demonstrated.\n\nPreviously seen right lower lobe ground-glass opacity has completely resolved.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval resolution of right lower lobe ground-glass opacity\n\n2 stable solid nodules, sub 4 mm.\n  For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMinimal atherosclerotic disease is noted.  Retroaortic left renal vein is\nincidentally noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No CT findings of acute trauma in the torso."
        },
        {
            "input": "CHEST:  The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is normal in course and caliber.  Main\npulmonary artery is normal in size with patent central branches.  No\nmediastinal mass, adenopathy or hematoma.  The heart is normal in size and\nshape without pericardial effusion.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  No\nsigns of traumatic lung injury.\n\nABDOMEN: The liver appears intact and is without focal concerning lesion. \nMain portal vein is patent.  No biliary ductal dilation.  The gallbladder is\nnormal.  The spleen is intact and normal in size.  The adrenal glands are\nnormal bilaterally.  The pancreas appears normal.  The kidneys enhance\nsymmetrically without concerning lesion or hydronephrosis.  No signs of renal\ninjury.  The abdominal aorta is normal in course and caliber.  No\nretroperitoneal adenopathy or hematoma.  The stomach and duodenum appear\nnormal.  Small bowel loops demonstrate no signs of ileus, obstruction or\ntraumatic injury.  The appendix is normal.  No mesenteric contusion.  No free\nair or free fluid.  The urinary bladder is well distended and appears intact. \nThe prostate and seminal vesicles appear normal.  No pelvic free fluid.  No\npelvic sidewall or inguinal adenopathy.\n\nThe stomach and duodenum are normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal. No free pelvic fluid.\n\nBONES:  A chronic deformity of the right distal clavicle is partially\nvisualized.  A subacute fracture involving the left posterior eleventh rib\narch with areas of callus formation.  No acute fracture is identified.",
            "output": "1.  No acute sequelae of trauma.\n2.  Subacute fracture involving the left eleventh posterior rib."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  Please see\nseparately submitted report of CT neck for details of the lower neck.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is a 1.3 x 0.9 cm right lower lobe pulmonary\nnodule (5:129).  Additional millimetric pulmonary nodules are noted in the\nleft upper lobe and lingula (5:134, 159).  There is bibasilar subsegmental\natelectasis.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Irregularity of the superior\nendplates of T3 and T4 most likely represent Schmorl's nodes without definite\nloss of height of the vertebral bodies at these levels.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. 1.3 cm right lower lobe pulmonary nodule with 2 additional millimetric\npulmonary nodules in the left lung, concerning for metastatic disease.\n2. Please see separately submitted report of CT neck for findings above the\nthoracic inlet."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nThere is a normal heart size with no pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal in caliber.\n\nThere are several stable pulmonary micronodules measuring up to 2 mm (5: 163,\n171, 212). A 2 mm perifissural nodule likely represents an intrapulmonary\nlymph node (5, 146). No new pulmonary nodules are identified. There are no\nendobronchial lesions or pleural effusions.\n\nNo destructive osseous lesions are identified.\n\nImages of the upper abdomen are unremarkable.",
            "output": "Several pulmonary micronodules which are stable dating back to ___\nand do not require further followup."
        },
        {
            "input": "CTA CHEST:  There is an equivocal filling defect in a single segmental branch\nof the lingular pulmonary artery (3:85). There are no other pulmonary arterial\nfilling defects. The main pulmonary artery is dilated, measuring 3.3 cm in\ndiameter. The thoracic aorta and arch vessels are normal. There is a central\nvenous catheter in the low SVC, terminating near the cavoatrial junction.\n\nCHEST:\n\nThere are bilateral ground-glass opacities and interlobular septal thickening\nconsistent with moderate pulmonary edema. There is bibasilar atelectasis\nand/or consolidation. There is no pneumothorax or pleural effusion.\n\nThere are prominent, but not pathologically enlarged mediastinal lymph nodes,\nlikely reactive. The airways are patent. There is minimal cardiomegaly. There\nis no pericardial effusion.\n\nThere are small foci of free intraperitoneal air in the upper abdomen, likely\nfrom recent gastrostomy placement. The upper abdominal structures are\notherwise unremarkable.\n\nMUSCULOSKELETAL:\n\nThere are no concerning focal osseous lesions.",
            "output": "1. Equivocal flow abnormality in a single segmental branches of the lingular\npulmonary artery, which may represent artifact, given that it is the only\nabnormality in the entire pulmonary arterial tree.\n2. Moderate pulmonary edema.\n3. Bibasilar atelectasis, but aspiration cannot be fully excluded.\n4. Dilation of the main pulmonary artery suggestive of pulmonary arterial\nhypertension.\n5. Small foci of intraperitoneal free air is secondary to recent gastrostomy\nplacement and no further imaging workup is required."
        },
        {
            "input": "CT Chest:  An NG tube courses inferiorly along the esophagus with its distal\ntip in the mid gastric body adjacent to the PEG tube. The endotracheal tube is\nseen terminating approximately 2 cm above the Carina. There is a normal course\nand caliber of the thoracic aorta with minimal atherosclerotic calcifications.\nThe main pulmonary artery and central branches appear patent. There is no\nmediastinal, hilar or axillary lymphadenopathy. The heart is overall normal in\nsize and shape. No pleural or pericardial effusion is seen. There is no\npneumothorax. The imaged portion of the thyroid gland appears normal.\n\nDense consolidation in the left lower lobe is consistent with complete\ncollapse of the left lower lobe. There is subsegmental mild right lower lobe\natelectasis. There is a 3 mm pulmonary nodule in the right middle lobe (series\n2, image 29). With a smaller adjacent nodule in the right middle lobe\nmeasuring 2mm.\n\nCT Abdomen:\n\nLiver, Gallbladder:  Hepatic parenchymal attenuation is slightly decreased\nwhich may reflect fatty deposition. The main portal vein appears patent. The\nhepatic veins appear patent. The gallbladder appears normal. No biliary ductal\ndilation.\n\nSpleen: The spleen is normal in size and enhancement.\n\nPancreas: The pancreas appears normal without focal lesion or pancreatic\nductal dilation. No evidence of pancreatitis.\n\nKidneys, Adrenals: The kidneys display symmetric nephrograms with no \nhydronephrosis or worrisome lesion in either kidney.  Hypodensities within the\nkidneys are noted, the larger of which in the interpolar left kidney\nrepresents a simple cyst measuring up to 4.5 cm in maximal dimension. Smaller\nlesions are too small to characterize.   The adrenal glands are unremarkable\nbilaterally.\n\nStomach, Bowel:  A PEG tube is noted in appropriate position. The tip of the\norogastric tube abuts the internal ring of the PEG tube. Loops of small bowel\ndemonstrate no signs of ileus or obstruction. No mesenteric lymphadenopathy.\nNo free air or free fluid is seen. Fluid distention of the colon is noted.\nThere is no evidence of appendicitis. No colonic wall thickening or evidence\nof obstruction. Diverticulosis is noted without diverticulitis.\n\nVessels: There is normal caliber of the abdominal aorta with widely patent\nmajor branches and no aneurysmal dilation. The aorta and its major branches\nare patent.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nCT Pelvis: A Foley catheter is seen within the bladder as well as few small\nfoci of air. There is no pelvic sidewall lymphadenopathy.\n\nThere is an abnormal appearance of the uterine cervix which appears distended\nand fluid filled best seen on series 602b, image 53 measuring 3.1 x 2.7 x 4.2\ncm.  The uterus contains a calcified fibroid near the fundus. The rectum is\nunremarkable. The sigmoid colon contains numerous diverticula without\ndiverticulitis.  There is no pelvic free fluid.\n\nOsseous Structures: There are no suspicious lytic or blastic lesions seen in\nthe visualized osseous structures.",
            "output": "1. Fluid distention of the colon likely reflects diarrhea. Diverticulosis with\nno evidence of diverticulitis.\n2. Cystic structure centered at the uterine cervix. Recommend nonemergent\nultrasound for further evaluation.\n3. Left lower lobe collapse, mild right basal atelectasis.\n4. Small (2-3mm) right middle lobe pulmonary nodules (Series 2, image 29). If\nthe patient is low risk, no followup is needed. The patient is high risk\nrecommend followup CT at 12 months and if unchanged at that time no further\nworkup is required.\n5. OG tube and ET tubes positioned as described. PEG tube in place.\n\nNOTIFICATION:  These findings were communicated in person to Dr. ___ at\n20:20 by Dr. ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal. Supraclavicular\nand axillary nodes are not enlarged by CT size criteria.\n\nUPPER ABDOMEN: The imaged portion of the abdomen is unremarkable. Findings\nbelow the diaphragm will be reported separately.\n\nMEDIASTINUM and HILUM: No mediastinal or hilar mass.  No mediastinal or hilar\nlymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: Heart is normal size.  Mild atherosclerotic\ncalcifications of the descending aorta.  Coronary arteries are mildly\ncalcified.  No pericardial effusion.\n\nPLEURA: No pleural effusions.\n\nLUNG:\n\n1. PARENCHYMA:  Mild bilateral dependent atelectasis.  Parenchymal lesions are\nas follows:\n\n3.5 mm pulmonary nodule in the left lower lobe (4:177)\n\n5 mm subpleural nodule in the left lower lobe (4:165)\n\n3 mm pulmonary nodule in the left lower lobe (4:154)\n\n3 mm nodule adjacent to the left major fissure (4:108)\n\n4 mm partially pleural based nodule in the right upper lobe (4:47)\n\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3.  VESSELS: The aorta and pulmonary artery are normal caliber.\n\n\nCHEST CAGE: No worrisome sclerotic or lytic lesions are identified.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "1. Multiple pulmonary nodules are identified, predominantly in the left lower\nlobe, with the largest measuring up to 5 mm.  Recommend follow-up CT in 3\nmonths to ensure stability.\n2. Mild bilateral dependent atelectasis.\n3. Please refer to the separate report of the CT abdomen/pelvis for further\nfindings below the diaphragm.\n\nRECOMMENDATION(S):  Recommend follow-up CT in 3 months to ensure stability of\nthe pulmonary nodules.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:37 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show no significant\nabnormal findings.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes..\n\nHEART and PERICARDIUM:\nHeart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: Small bilateral pleural effusions, left greater than right.  Mild\nbilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Subsegmental atelectasis in both lower lobes.  Tiny\ncentrilobular nodules notably in the right lower lobe.\n2. AIRWAYS:  Mild diffuse bronchial wall thickening.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: Mild superior endplate L1 compression fracture appears unchanged. \nNo suspicious lytic or sclerotic lesions.",
            "output": "Multiple small centrilobular nodules mainly in the right lower lobe suggestive\nof infectious process.\nSubsegmental atelectasis, as seen on prior chest radiograph, in both lower\nlobes and lingula.\nBilateral small pleural effusions, left greater than right.\nUnchanged L1 compression fracture."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nascending aorta is borderline dilated, measuring 3.7 cm in diameter.  The\ndescending thoracic aorta is normal in caliber without.  There is no  evidence\nof dissection or intramural hematoma.  There is a common origin of the\nbrachiocephalic artery and left common carotid, a normal anatomic variant.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Thre is a nonspecific enhancing prominent right\nhilar lymph node, measuring 0.9 cm in short axis.  No axillary or mediastinal\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No focal consolidation is seen..  There is a 3 mm solid nodule\nin the right upper lobe (2:28).  There are multiple perifissural lymph nodes\nidentified.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The patient is status post gastrojejunostomy.  The main pancreatic\nduct is prominent and contains a focus of gas, which may be related to prior\npancreatic duct reimplantation as was seen on CT dated ___.  There\nare several hypodense lesions scattered throughout the liver, incompletely\ncharacterized by CT but likely represent hepatic cysts and appear similar in\nsize and appearance compared to prior.  There is a flash filling hemangioma\nadjacent to the left hepatic vein (2:88).  The patient is status post\ncholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is a well corticated osseous fragment of the posterior right glenoid,\npossibly compatible with a chronic reverse Bankart fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Nonspecific hyperdense, enhancing 0.9 cm right hilar lymph node.\n3. Borderline mildly dilated ascending aorta, measuring 3.7 cm in short axis.\n4. 3 mm solid nodule in the right upper lobe.  For incidentally detected\nmultiple solid pulmonary nodules smaller than 6mm, no CT follow-up is\nrecommended in a low-risk patient, and an optional CT follow-up in 12 months\nis recommended in a high-risk patient.\n5. The main pancreatic duct is prominent and contains a focus of gas, which is\nlikely related to prior surgical reimplantation of the main pancreatic duct. \nPostsurgical changes status post gastrojejunostomy.\n\nRECOMMENDATION(S):  See the ___ ___ Society Guidelines for the\nManagement of Pulmonary Nodules Incidentally Detected on CT\" for comments and\nreference: ___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nhomogeneous in attenuation without focal nodularity.  There is no\nsupraclavicular or axillary lymphadenopathy by CT size criteria.  Aside from\nthe breast parenchyma, which is suboptimally evaluated on the current\nmodality, the chest wall is unremarkable.  Right upper extremity PICC\nterminates in the cavoatrial junction.\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: Evaluation for axillary lymphadenopathy is limited on this noncontrast\nexam.  However, no large hilar mass is seen\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\ncoronary or valvular calcifications.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild right greater than left basilar atelectasis. \nLinear opacity in the lingula likely represents scarring.  There are no\nsuspicious lung nodules requiring follow-up.\n2. AIRWAYS:  There is substantial narrowing of the trachea at the thoracic\ninlet, approximately 2.5 cm from the focal cords with diffuse soft tissue\nthickening.  The dimension at the narrowest portion measures up to 6 x 2 mm\n(302:76).  The length tracheal narrowing is approximately 2.7 cm (602:63). \nAside from this focal area of narrowing, there is nonocclusive low density\nwithin the right mainstem bronchus, likely representing secretions (302:121). \nThe airways are otherwise patent to the segmental levels.  Evaluation for\ntracheobronchomalacia is limited on this single phase exam.  2 mm nodule in\nthe right middle lobe does not require follow-up (301:301)\n3. VESSELS:  The main pulmonary artery is top normal in diameter, measuring up\nto 2.8 cm.  The ascending and descending aorta are normal in caliber.  No\nsignificant aortic arch calcifications are noted.\nCHEST CAGE: There are no osseous lesions concerning for infection or\nmalignancy.  Cortical irregularity of multiple anterior right ribs with\nperiosteal reaction likely represents healing rib fractures.",
            "output": "-Substantial focal stenosis of the cervical trachea with diffuse soft tissue\nthickening measuring approximately 2.5 cm below level of the vocal cord,\nextending approximately 2.7 cm, with the dimension at the narrowest portion\nmeasuring up to 6 x 2 mm.\n-Nonocclusive secretion within the right mainstem bronchus.\n-Due to patient's inability to perform breath holds, the dynamic exam was not\nperformed.  As such, evaluation for tracheobronchomalacia is limited."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologic dilatation of\naortopulmonary artery demonstrated.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nLeft breast prosthesis, with no evidence of rupture.  There are no lytic or\nsclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\nnodule is well demarcated, 5 mm in diameter, series 5, image 141.  There are\nno additional pulmonary nodules masses or consolidations.  Postsurgical\nappearance after right upper lobectomy is unremarkable.  Minimal thickening of\nthe fissure and atelectasis of the right middle lobe are noted.",
            "output": "Overall unremarkable appearance after right upper lobectomy with minimal\natelectasis of the right middle lobe\n\nRight lower lobe nodule, 5 mm with no concerning features but should be\nreassessed in ___ months for assessment of stability giving the lack of\nprevious imaging for comparison.\n\nUnremarkable appearance of the left breast prosthesis."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is moderate calcification in the LAD the and\ncircumflex coronary arteries. Detailed evaluation of the lungs is limited by\nrespiratory motion. There are multiple areas of atelectasis. There is no\npleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Limited evaluation of the lungs reveals multiple areas of atelectasis no large\nworrisome lung abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nhomogeneous in enhancement without focal nodularity.  Scattered\nsupraclavicular lymph nodes are not pathologic by CT size criteria.  Again\nseen are multiple markedly enlarged right axillary lymph nodes, which for\nmetabolically active on PET-CT from ___. Due to differences in\ntechnique and plane of imaging, direct comparison to prior is difficult,\nthough appears to stable in size.  The largest right axillary lymph node\nmeasures 14 mm, not significant changed from prior exam (4:80).  Known right\nshoulder subcutaneous nodule is excluded from the field of view and not\nevaluated on the current exam.  Postsurgical changes in the right breast is\nstable with similar appearance mild soft tissue stranding (02:47) and tenting\nof the tissue (02:36).\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not pathologically\nenlarged.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: The heart is mildly enlarged with moderate left atrial\nenlargement, unchanged from prior exam.  There is no pericardial effusion. \nModerate LAD and RCA calcifications, and mild valvular calcifications are\nagain seen.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\nPARENCHYMA:  Mild biapical scarring is stable.  New since ___, there is\na branching opacity in the right lower lobe with a calcific density associated\nwith the, possibly representing sequela of aspiration and mucous plugging\n(4:137).  No pathologic FDG uptake was seen in this region on ___. \nStable pleural calcifications are seen in the lower lobes.  5 mm right upper\nlobe nodule is stable (04:35).  No new suspicious nodule.\n\nAIRWAYS:  Airways are patent to the subsegmental levels.  There is mild\nperibronchial wall thickening especially in the lower lobes, not significant\nchanged from prior exam.\n\nVESSELS:  The ascending aorta is top normal in size.  The descending aorta and\nmain pulmonary artery are normal in caliber.\n\nMUSCULOSKELETAL: There is no suspicious osseous lesion concerning for acute\nfracture or metastatic disease.  Sclerotic focus in the left eleventh rib and\ncortical deformity in the lateral left twelfth rib are better seen on the\nsagittal projection (602:80, 79), unchanged from prior exam.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen pelvis report for\ndetails on subdiaphragmatic findings, including small hiatal hernia.",
            "output": "1. Stable size of metabolically active right axillary lymph nodes compared to\n___.\n2. No new lymphadenopathy or suspicious pulmonary nodule.  Stable pre-existing\n5 mm right upper lobe nodule.\n3. Please refer to the dedicated CT abdomen pelvis report for details on\nsubdiaphragmatic findings, including small hiatal hernia."
        },
        {
            "input": "Stable size and morphology of the metabolically active known right axillary\nlymph nodes (5, 18).  Several normal to borderline sized lymph nodes in the\nmediastinum are visualized (5, 21).  No abnormalities at the level of the\nlarge mediastinal vessels.  No incidental pulmonary embolism.  Moderate\nenlargement of the left ventricle, combined to moderate coronary\ncalcifications.  No pericardial effusion.  Stable moderate hiatal hernia.  The\nupper abdomen is reported in detail in the dedicated abdominal CT report. \nModerate degenerative vertebral disease.  No vertebral compression fractures. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.\nStable mild bilateral apical thickening.  New right upper lobe 3 mm subpleural\nnodule (6, 52).  Stable evidence of chronic airways disease.  The branching\nopacity in the right lower lobe, combined to a bronchiolith, is stable.  No\nother pulmonary nodules are noted.  No pleural thickening, no pleural\neffusions.  Minimal scarring with calcifications at the left lung basis (6,\n263).",
            "output": "New 3 mm right upper lobe nodule that requires CT follow-up in 3 months. \nOtherwise the findings are unchanged, including the stable branching bronchial\nopacity in the right lower lobe.  Stable metabolically active right axillary\nlymph nodes."
        },
        {
            "input": "The thyroid is unremarkable.  There is a lower cervical lymph node, partially\nimaged on the chest CT (image 1 series 4, please refer to dedicated report on\nneck for further details.\n\nThere are no enlarged supraclavicular lymph nodes.  There are multiple small\nright axillary lymph nodes the largest measuring 2.8 x 1.4 cm, unchanged since\nthe prior study.  Small mediastinal lymph nodes are stable in size.  There are\nno enlarged hilar lymph nodes.  There is no pericardial effusion.\n\nThere is no pleural effusion.  Moderate cardiomegaly.  Coronary artery\ncalcification.  The pulmonary artery and aorta are normal in caliber.  The\nairways are patent up to the subsegmental level.\n\nCalcified granuloma in the right lower lobe is unchanged.  3 mm subpleural\nright upper lobe pulmonary nodule (73, 5) is unchanged.  No new pulmonary\nnodules.\n\nReview of bones shows degenerative changes involving the thoracic spine.\n\nLimited sections through the upper abdomen shows left renal cyst.  No focal\nliver lesions are seen.",
            "output": "Stable 3 mm subpleural right upper lobe pulmonary nodule.  No new pulmonary\nnodules\n\nStable right axillary lymph nodes the largest measuring 2.8 x 1.4 cm.\n\nLower cervical lymph nodes, incompletely imaged.  Please refer to dedicated\nreport on abdomen and neck for further details."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Lower cervical lymph nodes are\nunchanged in size.  Bilateral small supraclavicular lymph nodes are also\nstable.\n\nBREAST AND AXILLA  : The right axillary lymph node measuring 2.9 by 1.8 cm (2,\n21) is unchanged in size.  Several other smaller right axillary nodes are also\nstable.\n\nMEDIASTINUM: The small mediastinal and bilateral hilar lymph nodes unchanged. \nThere is moderate cardiomegaly.  Coronary artery calcification is seen.  There\nis no pericardial effusion.  There is a moderate-sized hiatus hernia.  The\naorta and pulmonary arteries are normal in caliber.  There is no pericardial\neffusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are new bilateral ground-glass opacities with a broad-based to the\npleura with areas of solid component associated with it seen in the left upper\nlobe (2, 8) 2, 13 right lower lobe 2, 20 and left lower lobe 2, 34.  Several\nscattered subpleural nodular opacities are also seen in both lower lobes. \nThese are new since the prior study.  The 3 mm right upper lobe pulmonary\nnodule (303, 49) is unchanged.\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  Please refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "Multiple new bilateral nodules and nodular opacities is the largest in the\nright lower lobe with air bronchograms and ground-glass opacity associated\nfifth with.  These could represent cryptogenic organizing pneumonia.  The\ndifferential diagnosis would also include bacterial pneumonia.\n\nPreviously visualized 3 mm right upper lobe pulmonary nodule is stable.\n\nStable small bilateral supraclavicular,right axillary, mediastinal lymph\nnodes.\n\nNOTIFICATION:   The report was sent via e-mail to Dr. ___ at the time\nof dictation"
        },
        {
            "input": "MEDIASTINUM: No thyroid nodules identified.  Right axillary lymphadenopathy is\npartially imaged, with lymph nodes measuring up to at least 2.6 x 1.4 cm,\nsimilar to prior.  There are no pathologically enlarged left axillary or\nsupraclavicular lymph nodes.  Multiple prominent mediastinal lymph nodes do\nnot meet CT size criteria for pathologic enlargement, and appear stable to\nslightly decreased in size as compared to the prior study from ___. \nFor example, a precarinal lymph node now measures 0.9 cm in short axis,\npreviously 1.1 cm in ___.  Coronary artery calcifications are\npresent.  The heart is not enlarged.  The aorta and main pulmonary arteries\nare in size.  There is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.  Scattered\npleural based calcifications are seen at the left lung base.\n\nLUNGS: Airways are patent centrally.  Mild bronchial wall thickening,\nparticularly in the bilateral lower lobes, appears similar to prior.  There is\nmild biapical pleuroparenchymal scarring as well.  There has been significant\ninterval improvement in the degree of bilateral ground-glass opacities, with\nonly mild ground-glass and subpleural reticular opacities seen in the\nbilateral lower lobes, greater on the right.  Stable pulmonary nodules in the\nright upper lobe are again seen (5:85, 5:55).  No new suspicious nodules\nidentified.  Calcified granulomas in the right middle lobe are again noted.  A\nbranching opacity in the right lower lobe with associated calcific density is\nunchanged dating to at least ___, and may represent sequela of\naspiration and mucous plugging (5:179).  There is no new consolidation.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN: The study is not tailored for assessment of upper abdominal\nstructures.  Allowing for this limitation, there is a small to moderate size\nhiatal hernia.  The adrenal glands are unremarkable.",
            "output": "1. Significant interval improvement in the degree of bilateral ground-glass\nopacities, with only mild ground-glass and subpleural reticular opacities\nremaining in the bilateral lower lobes.\n2. No new pulmonary consolidation.\n3. Right axillary lymphadenopathy is partially imaged."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are enlarged right lower neck\nlymph nodes please refer to dedicated report on neck which has been dictated\nseparately\n\nBREAST AND AXILLA  : The right axillary lymph nodes are mildly enlarged the\nlargest measuring 12 mm, unchanged\n\nMEDIASTINUM: Small mediastinal nodes are unchanged in size.  The left lower\nparatracheal lymph node measures 9 mm.  The subcarinal node measures 11 mm. \nThere is moderate cardiomegaly.  There is moderate coronary artery\ncalcification.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are multiple new bilateral parenchymal opacities which are in a\nbronchovascular distribution, they are ground-glass in appearance for example\n(2, 14) in the right upper lobe right lower lobe (2, 31) and both lower lobes\n(2, 36).  More confluent parenchymal opacity in the left lower lobe (2, 43 is\nalso new and has a broad-based was the pleura.  There are several nodular\nopacities in a bronchus vascular distribution in the right lower lobe (2, 44).\nThese could represent multifocal pneumonia.  The differential diagnosis would\nalso include cryptogenic organizing pneumonia.  Few additional scattered\nground-glass opacities are also seen within the left upper lobe and lingula. \nThe subpleural right upper lobe pulmonary nodule measuring 4 mm (3, 53 is\nunchanged.  The tubular opacity in the right lower lobe (3, 134) is also\nunchanged.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  No lytic or sclerotic lesions concerning for metastasis\nare seen\n\nUPPER ABDOMEN: It sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "New multiple bilateral parenchymal opacities in a bronchovascular distribution\nwhich are mostly ground-glass in appearance, involving both lungs with more\nconfluent opacities seen in both lower lobes left greater than right these\ncould representcryptogenic organizing pneumonia and or pneumonitis in the\nsetting of a drug reaction however multifocal pneumonia can have a similar\nappearance.\n\nThe right upper lobe and right lower lobe pulmonary nodules are unchanged.\n\nStable small right high axillary lymph nodes.\n\nLower neck lymph nodes.  Please refer to dedicated report on abdomen and neck\nwhich is been dictated separately.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 11:56 am, 2 minutes after discovery of\nthe findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Left atrial and\nventricular enlargement is substantial, unchanged.  No pericardial pleural\neffusion is seen.  No pathologically enlarged mediastinal, hilar v lymph nodes\ndemonstrated with pre-existing lymph nodes within the mediastinum being\nstable.\n\nRight axillary lymphadenopathy, series 8, image 25 is substantial with the\nlargest lymph node approaching 3 cm, similar to previous examination, series\n8, image 24.  No left axillary lymphadenopathy is present.  No soft tissue\nabnormalities are otherwise demonstrated to suggest soft tissue metastatic\ndisease\n\nAirways are patent to the subsegmental level bilaterally.  Several pulmonary\nnodules are re-demonstrated, series 6, image 54, 155, most likely present on\nthe previous examination.  Ground-glass opacities in the lower lobes have been\npresent on the previous study but re-demonstrated on the current examination\nin slightly different location and does might represent recurrent aspiration\nor infectious process.  Organizing pneumonia is another possibility.\n\nPleural/subpleural calcifications in the left renal left lower lobe are\nunchanged.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nThere are no definitive lytic or sclerotic lesions worrisome for infection or\nneoplasm.  Severe degenerative disease is demonstrated within the spine",
            "output": "Right axillary lymphadenopathy, stable since previous examination\n\nBibasal ground-glass opacities that might represent aspiration, recurrent\ninfection or organizing pneumonia\n\nSeveral stable pulmonary nodules, difficult to pre size the compare them with\nslightly different previous technique\n\nSevere cardiomegaly.\n\nPlease review CT abdomen and pelvis in the corresponding report will be issued\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  Stable enlarged lymph nodes in the right axilla\nthe largest measuring 2.0 x 1.3 cm (6:83), none in the thoracic inlet or left\naxilla.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nMildly enlarged heart with a dilated left atrium.  No pericardial effusion. \nModerate atherosclerotic calcifications in the coronary arteries, mild in the\naorta and none in the cardiac valves.  The pulmonary arteries and aorta are\nnormal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Multiple small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria, all unchanged compared to prior\nstudy.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Peripheral pleural calcifications in the left lung\nbase, unchanged mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchiectasis, bronchial\nwall thickening or mucous plugging.  Waxing and waning appearance of the\nbronchocentric ground-glass opacities, improved in the left lower lobe and\nworse in the now in the right lower lobe.  Stable 4 mm nodule in the right\nupper lobe (6:63).\n\nCHEST CAGE:\nStable small sclerotic lesions in the anterior left third through seventh ribs\nand left posterior tenth rib, likely old healed fractures.  No acute\nfractures.  Moderate dorsal spondylosis.  No new suspicious lytic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Waxing and waning appearance of several ground-glass opacities in both lungs. \nImprovement in the left lower lobe is more likely related to resolving\norganizing pneumonia however worsening appearance in the right lower lobe\ncould reflect superimposed inflammatory/infectious process or even mild\nhemorrhage.\n\nStable lymphadenopathy in the right axilla.\n\nNo new or growing lung nodules, lymphadenopathy or osseous lesions.\nCardiomegaly with enlarged left atrium and moderate coronary atherosclerotic\ndisease."
        },
        {
            "input": "The thyroid gland is unremarkable. Enlarged right axillary lymph nodes remain\nunchanged, the largest measures 33 x 16 mm, not significantly changed since\nstudy from ___ (series 5, image 20). No significant mediastinal or\nhilar lymphadenopathy is detected.  There is a moderate sized hiatal hernia. \nThe thoracic aorta is normal in caliber with a typical 3 vessel takeoff from\nthe arch.  The pulmonary arterial trunk is normal in caliber.  The heart is\nenlarged. There is no pericardial effusion. Note is made of coronary artery\ncalcifications.\n\n4 mm nodule at the right lung apex is unchanged (series 6, image 50). There is\nredemonstration of a focal calcified nodule in the right lower lobe, with\ndistal mucoid impaction, similar in appearance to prior exam (series 6, image\n182). There is mild biapical scarring. No new pulmonary nodules identified.\nPleural calcifications are unchanged.\n\nNo blastic or lytic lesion suspicious for malignancy is present.\n\nPlease refer to the separate abdominal CT from the same day for a complete\nreport on the abdominal findings of this examination.",
            "output": "Stable 4 mm nodule in the posterior right lung apex."
        },
        {
            "input": "The thyroid gland is normal. Again seen is a prominent right axillary node\nunchanged in size (5:16). Several right axillary nodes are again identified,\nstable.  The largest measures 1.2 cm in short axis, similar in size and\nappearance(5:23). There is no left axillary, supraclavicular, mediastinal or\nhilar adenopathy. A moderate hiatal hernia is noted. Heart size is top-normal\nwith markedly enlarged left atrium. Trace pericardial fluid is physiologic.\nThe aorta and pulmonary artery are within normal limits in caliber. Coronary\nartery atherosclerotic calcifications are unchanged.\n\nThe tracheobronchial tree is patent to the subsegmental level. Biapical\nscarring is unchanged. Several punctate densely calcified nodules (6:195 and\n167) are most compatible with granulomas. A focal calcified nodule on the\nright lower lobe with distal mucoid impaction is again seen and similar in\nappearance (6:166). A 4 mm stable nodule in the posterior right lung apex is\nidentified. No new pulmonary nodule identified. Stable pleural calcifications\nare seen. There is no pleural effusion.\n\nNo suspicious osseous lytic or blastic lesion is identified. Multilevel\ndegenerative changes are identified.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, and ___ clip number ___.",
            "output": "1. Stable right apical 4 mm nodule. The no new pulmonary nodule is identified.\n2. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed on the same date, and ___ clip number ___."
        },
        {
            "input": "The thyroid is normal. Right axillary lymph nodes remain enlarged with the\nlargest measuring 3.1 x 1.5 cm, unchanged since ___. There is no\nleft axillary, supraclavicular, mediastinal, or hilar lymphadenopathy. Aorta\nand pulmonary arteries are normal in size. Atherosclerotic calcifications of\nthe LAD and aortic annulus are noted. There is no pericardial effusion. The\nheart size is top-normal with the marked enlargement of the left atrium.\nFilling defect in the left atrial appendage is concerning for possible\nthrombus.\n\nThe airways are patent to the subsegmental level. Biapical scarring is\nunchanged. Focal calcified nodule in the right lower lobe with distal mucoid\nimpaction is unchanged since ___. A 4 mm nodule in the right apex\nis also stable since ___ (series 4, image 35). A 5 mm subpleural\nnodule in the posterior right upper lobe appears more prominent since ___ (series 4, image 52). No additional pulmonary nodule is identified. There\nis no focal consolidation, pleural effusion, or pneumothorax.\n\nNo lytic or sclerotic osseous lesions suspicious for malignancy is identified.\nHemangioma is seen within the left T10 vertebral body. There is a moderate\nhiatal hernia.",
            "output": "1. 5 mm subpleural nodule in the posterior right lower lobe appears more\nprominent since ___. 3 month followup is recommended. Remaining\npulmonary nodules are unchanged since ___.\n\n2. Persistent right axillary lymphadenopathy.\n\n3. Filling defect within the left atrial appendage is concerning for possible\nthrombus. Correlation with echocardiogram is recommended.\n\n4. Please refer to separate from CT abdomen pelvis performed on the same date\nfor discussion of subdiaphragmatic findings.\n\nNOTIFICATION:  Finding #3 was discussed with ___ by ___ telephone at\n3:22pm on ___, 10 minutes following discovery."
        },
        {
            "input": "The thyroid gland is unremarkable. Right axillary lymphadenopathy is stable,\nwith a representative node measuring 15 x 33 mm, previously 15 x 31 mm (5,\n20).  There is no new pathologic supraclavicular, mediastinal, left axillary\nor hilar lymph node enlargement.\n\nMild cardiomegaly with predominantly left atrial enlargement is unchanged.\nMild coronary artery calcifications are again noted.  The main pulmonary\nartery and thoracic aorta are normal caliber. No incidental pulmonary embolus\nis identified. Persistent non-opacification of the left atrial appendage is\nunchanged, and is most likely due to mixing artifact. Echocardiographic\ncorrelation is again advised.\n\nPre-existing solid pulmonary nodules measuring up to 4 mm in the subpleural\nright upper lobe are stable (6: 47, 67). A calcified nodule or clip in the\nright lower lobe with associated focal bronchial impaction is unchanged (6,\n166). No new nodule is identified. No endobronchial lesion or pleural\nabnormality is present.\n\nThe patient has had right mastectomy. A moderate sized hiatal hernia is\nunchanged.\n\n For a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nA lower thoracic spine trabeculated lytic lesion is stable, and most likely\nrepresents a small hemangioma (5, 47). Extensive multilevel spinal\ndegenerative changes are stable.  There are no bone lesions in the thorax\nworrisome for infection or malignancy.",
            "output": "Stable examination with no interval change in pre-existing solid pulmonary\nnodules measuring up to 5 mm in the right upper lobe. No new nodules\nidentified.\n\nStable right axillary lymphadenopathy.\n\nModerate hiatal hernia.\n\nPersistent non-opacification of the left atrial appendage is most likely due\nto mixing artifact. Echocardiographic correlation is again advised.\n\nNOTIFICATION:  Persistent non-opacification of the left atrial appendage is\nmost likely due to mixing artifact. Echocardiographic correlation is again\nadvised."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. Enlarged right axillary lymph nodes\nare unchanged since ___, the largest measuring 3.3 x 1.4 cm (02:22).  There\nare no pathologically enlarged mediastinal or hilar lymph nodes.  Heart size\nis enlarged, including the AP diameter of the left atrium which measures 5 cm.\nCaliber of the great vessels is normal.  Coronary artery calcifications are\nmoderate.  No pericardial effusion.  Moderate hiatal hernia is again noted. No\nsoft tissue lesions are appreciated in the anterior or posterior chest wall. \nPlease see a separate report discussing the subdiaphragmatic findings.\n\nLungs: Right apical nodules (4:45, 58) are unchanged from the prior\nexamination.  Partially calcified pleural plaque at the left lung base is\nunchanged and indicative of asbestos exposure or prior granulomatous\ninfection.  There is no new or growing nodule.  No pleural effusion or focal\nconsolidation.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1. Stable pulmonary nodules measuring up to 5 mm at the right apex.  No new or\ngrowing nodules.\n2. Stable right axillary lymphadenopathy, with the largest measuring up to 3.3\ncm.\n3. Moderate hiatal hernia.\n4. Please see a separate report discussing findings within the abdomen and\npelvis."
        },
        {
            "input": "MEDIASTINUM/HEART:  The visualized thyroid is unremarkable. Enlarged right\naxillary lymph nodes measuring up to 3.2 x 1.4 cm (6:79) are unchanged.  No\nevidence of mediastinal, hilar, or supraclavicular lymphadenopathy by CT size\ncriteria. Aorta and pulmonary arteries are normal in size. No pulmonary artery\nfilling defect identified. Heart size, particularly the left atrium is\nenlarged, unchanged, with moderate coronary artery calcifications. No\npericardial effusion.\n\nThe moderate-sized hiatal hernia is unchanged.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. A 5 mm right\napical nodule is unchanged in size and morphology (6:37).  The other right\napical opacity is linear in configuration, and thinner, without worrisome\nfeatures (6:59).  Partially calcified pleural plaques in the bilateral lung\nbases are unchanged, indicative of prior asbestos exposure or granulomatous\ninfection.  Finally, a dilated fluid-filled airway in the superior segment of\nthe right lower lobe is unchanged (6:172). No new suspicious pulmonary nodule\ndetected.  No pleural effusion or focal consolidation identified.\n\nUPPER ABDOMEN:  Please refer to the dedicated CT abdomen and pelvis report of\nthe same date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy or infection. Multilevel moderate degenerative changes of the\nthoracic spine, including bridging osteophytes, are unchanged.",
            "output": "1.  No new suspicious nodule, mass, or lymphadenopathy concerning for\nintrathoracic malignancy or metastatic disease.\n\n2.  The previously described right upper lung nodules are unchanged to\nslightly smaller in size, without worrisome features.\n\n3.  Please refer to the dedicated CT abdomen and pelvis report of the same\ndate for the subdiaphragmatic findings."
        },
        {
            "input": "Right axillary lymph node is 3 x 1.6 cm, unchanged, series 2, image 23. \nAdditional smaller lymph nodes are min unchanged or slightly smaller, series\n2, image 25, 1.3 x 1 cm.  No left axillary lymphadenopathy seen.  No\nmediastinal or hilar lymphadenopathy is present.\n\nLeft atrium is enlarged substantially.  Coronary calcifications are extensive.\nHeart size is overall unchanged, unremarkable.  There is no pericardial\npleural effusion.  Small hiatal hernia is unchanged.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules are stable with no new nodules masses or consolidations. \nCalcifications in the left lower lobe and to lesser extent right lower lobe\nand most likely consistent with pulmonary ossifications and are unchanged.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nExtensive degenerative changes are present.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.",
            "output": "Overall stable appearance of the chest with no new pulmonary nodules masses or\nconsolidations.  In the chest including the right axilla with the bulky\nlymphadenopathy.\n\nSubstantial left atrial enlargement, hemodynamic significance is unclear."
        },
        {
            "input": "Right axillary lymph nodes, series 5, image 22 are 26 x 12 mm, 10.5 x 9.6 mm,\nand 11 x 6 mm, old decreased by view to of 3 mm in age dimension as compared\nto previous study.  No left axillary lymphadenopathy seen.  No interval\nincrease in non pathologically enlarged mediastinal or hilar lymph nodes\ndemonstrated.\n\nAorta and pulmonary arteries are normal in diameter.  Unchanged appearance of\nsubstantial left atrial enlargement, Coronary calcifications and left\nventricular enlargement is demonstrated.\n\nHiatal hernia is moderate, unchanged.  Image portion of the upper abdomen will\nbe reviewed separately in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is unchanged with no definitive evidence of active\ninflammation.  Right apical nodule, series 6, image 84 is 5 mm, as compared to\n2.5 mm, does increased in size.  Right lower lobe cluster of nodules, impacted\nairways in calcifications, series 6, image 190 is stable.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Interval decrease in size in the right axillary lymphadenopathy.\n\nInterval increase in size in the right apical nodule that should be reassessed\nin 3 months, since is highly concerning for metastatic disease.\n\nUnchanged right lower lobe cluster of impacted airways in calcifications\n\nUnchanged left atrial enlargement in Coronary calcifications.\n\nImage portion of the abdomen will be reviewed separately in corresponding\nreport will be issued"
        },
        {
            "input": "No incidental thyroid findings.  The pre-existing relatively extensive right\naxillary lymphadenopathy is not substantially changed (2, 28). No evidence of\nnew or growing lymph nodes.  No hilar or mediastinal lymphadenopathy.  Several\nnormal sized lymph nodes (2, 30) Are seen in the mediastinum.  Stable\nenlargement of the left atrium.  Moderate coronary calcifications.  Mild\ncardiomegaly.  No pericardial effusion.  Small hiatal hernia.  The upper\nabdomen is reported in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable massive degenerative vertebral disease.  Stable mild bilateral\napical scarring.  Stable 3-4 mm nodule in subpleural location in the right\nupper lobe.  There is no growth of this nodule.  No pleural thickening, no\npleural effusions.  No diffuse lung disease.  A partly calcified right lower\nlobe lesion (4, 156) is not substantially changed.  Several punctate\nsubpleural granulomas (4, 246) are stable.",
            "output": "Stable 3 mm right upper lobe nodule.  Stable moderate right axillary\nlymphadenopathy.  No new or growing pulmonary nodules.  No pleural effusions. \nNo diffuse lung disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery and aortic\nvalve calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: There prominent paraesophageal lymph node seen\nsuperiorly measuring up to 8 mm (3:79).  Distally, paraesophageal nodes\nmeasure up to 9 mm, previously 6 mm in ___.  The also appear more numerous\ncompared to prior exam.  Prevascular soft tissue may also represent lymph\nnodes measuring up to 8 mm in short axis, though it is elongated measuring 3.3\ncm AP.  No axillary or hilar lymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patient is status post right upper lobectomy.  Bronchiectasis\nis seen bilaterally most prominent at the base of the right lower lobe with\nsubpulmonic fibrotic changes and bibasilar scarring that is increased since\nprior imaging of ___.  Elsewhere, centrilobular emphysema is noted\nwith less extensive bronchiectasis elsewhere with seen throughout the lungs,\nparticularly the lingula\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: The imaged portion the spine demonstrates multilevel degenerative\nchanges without any suspicious osseous abnormalities seen.? There is no acute\nfracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral bronchiectasis most severe at the right lung base with interval\nincrease in subpulmonic fibrotic changes and bibasilar scarring when compared\nwith prior imaging.\n3. Mediastinal, paraesophageal lymph nodes though not pathologically enlarged\nby size have increased since ___.  These are nonspecific, potentially\nreactive though consider short interval follow-up is suggested unless exam\nperformed in the interval can prove stability."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  No soft tissue abnormalities in the\nimaged chest wall concerning for malignancy.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM:The lumen in the distal 2 cm of the esophagus is\nobliterated and new lobulation of the homogeneous soft tissue in the regions\nsuggests a new 17 mm posterior esophageal node, 02:38.  Upper esophagus is not\ndistended despite large subcarinal and posterior paraesophageal mediastinal\nlymph nodes.\n\nAtherosclerotic calcification is moderate in the head and neck vessels, hand\nprimarily in left circumflex coronary artery.  Aortic valvular calcification\nis mild.  Pulmonary arteries are borderline enlarged, main 32 mm, right 28 mm.\n\nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Adenopathy has increased substantially since ___ PET CT\non ___, primarily the subcarinal component now 27 x 37 mm, 02:23,\npreviously 23 x 30 mm, inseparable from and possibly invading the esophagus\nand extending inferiorly in to the posterior paraesophageal chain.  Also\ngrowing are 12 mm lower paratracheal nodes and subcentimeter prevascular nodes\nalong the aortic arch.  A new bulge in the contour of the descending right\npulmonary artery on this noncontrast study suggests adenopathy there as well. \nBronchial tree is not compromised.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.  Peribronchial ground-glass and\nbronchiectasis in the right lower lobe, stable since ___ suggests an\ninflammatory in fibrosing component, probably smoking related.  Smaller\nregions of fibrosing inflammation in the periphery of the left lung are also\nunchanged.\n\n16 mm soft tissue nodule base of the right lung, 4:170, was roughly 13 mm and\nFDG avid on the FDG PET CT in ___, barely visible on the one ___\nchest CT.\n\nCHEST CAGE: No compression or pathologic fracture or large destructive bone\nlesion.  Disc degeneration in the mid and lower thoracic spine is severe.",
            "output": "Compared to a FDG PET CT in ___, mediastinal adenopathy, predominantly\nsubcarinal, has grown substantially, and the presumed primary peripheral right\nlower lobe bronchogenic carcinoma has grown slightly.  Probable new right\nhilar and lower paraesophageal mediastinal adenopathy.\n\nSevere emphysema and areas of fibrosis, extensive in the right lower lobe\nright lower lobe and present in the left lung periphery are all unchanged\nsince ___.  Possible pulmonary arterial hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Peripherally hyperdense 0.6 cm\nlesion in the left hemi thyroid, of indeterminate clinical significance. \nModerate atherosclerotic calcification of the aortic arch and head and neck\nvessels.  Status post right mastectomy.  Incidentally noted anasarca.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from ___ for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: No lymphadenopathy.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion. \nMinimal atherosclerotic calcification of the coronary arteries and aortic\nannulus.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Diffuse upper lobe predominant centrilobular emphysema.  0.3\ncm nodule in the right upper lobe (___).  0.4 cm nodule in the right middle\nlobe (___).  Immediately adjacent 0.2 cm nodule in the right middle lobe\n(___).  0.4 cm nodule in the left lower lobe (___).  Radiation changes in\nthe right middle lobe.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.  There is mild, but\ndiffuse bronchial wall thickening, consistent with chronic airways disease.\n3. VESSELS:  The main pulmonary artery is mildly enlarged, measuring 3.2 cm\nand the left pulmonary artery measures 2.6 cm, at the upper limits of normal. \nThese findings can be seen in patients with pulmonary arterial hypertension.\nCHEST CAGE: Diffuse lytic and blastic bony lesions throughout the imaged\nskeleton.  No fractures.  Multiple vertebral lesions breech the posterior\ncortex without definite extension into the vertebral canal.",
            "output": "1. Four pulmonary nodules, measuring up to 0.4 cm, indeterminate, but\nconcerning for metastases in a patient with breast cancer.\n2. Diffuse metastatic disease throughout the imaged skeleton with multiple\nvertebral lesions that breech the posterior cortex without definite extension\ninto the vertebral canal.  If there is clinical concern for spinal cord\ncompromise, recommend MRI of the spine for further evaluation.\n3. The main pulmonary artery is in mildly enlarged, measuring 3.2 cm.  This\ncan be seen in patients with pulmonary arterial hypertension.\n\nRECOMMENDATION(S):  If there is clinical concern for spinal cord compromise,\nrecommend MRI of the spine for further evaluation.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 13:31 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "The visualized thyroid is unremarkable.\n\nHeart size is normal without significant pericardial effusion.  There are\nfocally moderate coronary artery calcifications.  Thoracic aorta is normal\ncaliber without significant atherosclerotic calcification.  The pulmonary\narteries are normal caliber and there is no filling defect to the subsegmental\nlevel to suggest a pulmonary embolus.\n\nThere is no supraclavicular, axillary, hilar, or mediastinal lymphadenopathy.\n\nThere is mild dependent atelectasis bilaterally.  There is no pleural effusion\nor pneumothorax.  There is mild centrilobular emphysema.  There is trace\nbiapical scarring.  No suspicious focal consolidation or nodule is seen.  The\ncentral airways are patent.\n\nAlthough this study is not tailored for subdiaphragmatic analysis, the\nvisualized upper abdomen is notable for morphologically cirrhotic appearance\nof the liver, incompletely characterized 9 mm hypodense lesion in the hepatic\ndome, as well as gallstones.\n\nThere is no suspicious focal bone lesion.  There are old bilateral healed rib\nfractures.  There is a well corticated linear defect in the lateral left\neighth rib, likely representing an un noted chronic fracture, or surgical\ndefect.  Otherwise no acute fractures are seen.",
            "output": "1. No pulmonary embolus or acute aortic syndrome.\n2. No acute findings in the chest.\n3. Morphologically cirrhotic liver.\n4. Cholelithiasis.\n5. Several chronic appearing bilateral rib fractures, one appearing ununited,\nthough sharply marginated suggesting chronicity on the left.\n6. Mild emphysema."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  Heart size is normal.  No pericardial pleural effusion is\nseen.  Minimal hiatal hernia is unchanged.\n\nImage portion of the upper abdomen demonstrate normal spleen, liver, kidneys\nexcept for left kidney cysts, series 3, image 64, unchanged since the prior\nstudy and measuring 15 Hounsfield units as well as left adrenal lesion,\nunchanged in since ___, does representing benign finding, most likely\nadenomas.\n\nAirways are patent to the subsegmental level bilaterally.  Bi apical fibrosis\nand right middle lobe fibrosis as well as pulmonary nodules are stable.  The\ncharacteristic scarring in the right middle lobe is unchanged.\n\nInterval resolution of the fluid collection in the right axilla is consistent\nwith its reactive etiology.  The right post mastectomy appearance of the chest\nis stable.  .",
            "output": "Stable appearance of the chest including fibrosis apical and right middle\nlobe, pulmonary nodules, Coronary calcifications, mild dilatation of ascending\naorta and abdominal findings including left adrenal adenoma and left kidney\ncyst."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  No mediastinal, hilar or axillary lymphadenopathy is present. \nSmall loculated pericardial fluid is similar to previous examination,\nunchanged early.  No pleural effusion is seen.  Image portion of the upper\nabdomen will be reviewed separately as part of the CT abdomen and pelvis in\ncorresponding report will be issued for the same the study\n\nAirways are patent to the subsegmental level bilaterally.  Postradiation\nchanges and biapical fibrosis are stable.  Pulmonary nodules seen on the\nprevious examination are all stable with no new nodules or increase in size on\nthe previously existing nodules demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease.  Unchanged fibrosis.\n\nPlease review CT abdomen and pelvis and the corresponding report that were\nobtained on the same day and will be dictated separately."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : Patient is status post bilateral mastectomies with\nbilateral tram flap reconstructions.  There is mild skin thickening overlying\nthe right breast, unchanged.  There are no enlarged axillary lymph nodes. \nThere are no enlarged internal mammary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.  There is moderate\ncardiomegaly.  Moderate coronary artery calcifications also seen.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a stable biapical pleuroparenchymal scarring (5, 53).  There is\na new part solid parenchymal opacity in the left lower lobe measuring\napproximately 2.3 x 2.8 cm with associated air bronchograms and bronchiectasis\nin a bronchus centric distribution, unchanged since ___ however is\nnew since ___.\n\nThere is stable post radiation changes to the anterior aspect of the right\nupper lobe and right middle lobe.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  No lytic or sclerotic lesions concerning for metastases\nare seen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows left renal\ncyst.  There is a stable left adrenal nodule measuring 2.8 cm.  This has\npreviously been characterized as an adenoma.  N.  No focal liver lesions are\nseen.",
            "output": "Status post bilateral mastectomies with bilateral tram flap reconstructions\nwith stable post radiation changes to the reconstructed right breast.\n\nStable biapical pleuroparenchymal scarring.\n\n2.3 x 2.8 cm part solid lesion in the left lower lobe with associated traction\nbronchiectasis is in a bronchial centric distribution, is new since ___ and unchanged since the PET-CT done on ___.  Given its\nmorphology and done appearance  it is most likely inflammatory and could\nrepresent organizing pneumonia.  The differential diagnosis includes an\npneumonia and metastasis however the latter is less likely given the\nmorphology.\n\nStable left adrenal adenoma and left renal cyst."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Status post bilateral mastectomy with flap\nreconstruction.  Clips are seen in the chest wall (2, 19).  Stable appearance\nof the large mediastinal vessels, with mild dilatation of the main pulmonary\nartery, calcifications of the coronary arteries and the aortic valve as well\nas of the aortic wall.  Mild global cardiomegaly.  No pericardial effusion. \nThe posterior mediastinum is unremarkable.  Stable appearance of the known\nleft adrenal enlargement (2, 52).  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  The areas of bilateral apical\nfibrosis are stable as compared to the previous examination.  There is no\nevidence of new pulmonary nodules or masses.  A known left lower lobe roughly\n3 cm parenchymal opacity (3, 82) is overall unchanged in size but has\nsubstantially decreased in attenuation.  Moreover, the solid parts of the\nlesion have completely resolved.  There is no evidence of pleural thickening\nor pleural effusion.  The airways are patent.  The parenchymal scars at the\nlateral aspect of the middle lobe (3, 135), causing mild pleural\nirregularities, are stable.",
            "output": "Substantial interval decrease in attenuation of the known left lower lobe\nlesion that remains unchanged in size.  Moreover, the solid components have\ncompletely resolved.  The timeline of the changes suggests a resolving\ninfectious process.  The fibrotic changes in the lung apices as well as the\nareas of subpleural middle lobe fibrosis are stable.  No new pulmonary nodules\nor masses.  No acute pleural abnormalities.  No lymphadenopathy."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged.\nEvaluation of the breast requires mammography.  There are no soft tissue\nabnormalities elsewhere in the chest wall suspicious for malignancy.\n\nRight lobe of the thyroid gland is normal size, although it still mildly\nindents the right side of the trachea. Atherosclerotic calcification is\nprominent at the origin of the left subclavian artery and in the left anterior\ndescending coronary artery. Relatively mild aortic valvular calcification has\nbeen noted previously, along with mild fusiform dilatation of the entire\nascending thoracic aorta to a maximum diameter of 43 mm, raising possibility\nof aortic stenosis. Remainder of the thoracic and image abdominal aorta is\nnormal size; substantial atherosclerotic plaque is found in both regions.\nModerate dilatation of the intra pericardial right pulmonary artery, 33.5 mm,\nis unchanged, could be due to pulmonary arterial hypertension. There is no\npleural or pericardial abnormality.\n\nRegion of coalescent peribronchial infiltration in the left apex has been\npresent with little change since at least ___. The distribution no\nsuggested may be related to prior radiation, but I have no information in that\nregard. A 6 mm wide irregularly shaped opacity in the right upper lobe, 4:80,\nnew since ___, more distinct today than it was on ___ but no larger,\nis probably inflammatory. Small scattered ground-glass opacities present in\n___ in the right upper lobe have cleared and in the right middle lobe and\nclose to the hilus in the lingula have improved, although there is a new\nregion of ground-glass opacity closer to the hilus, 04:105. This is also\ninflammatory and could be infectious or due to drug reaction or toxicity.\n\nThere are no lung nodules suspicious for malignancy.\n\nIntra thoracic lymph nodes including the mediastinal, hilar, internal mammary,\ndiaphragmatic and retrocrural stations contain no measurable lymph nodes. This\nstudy is not designed for subdiaphragmatic diagnosis but shows normal-size\nadrenal glands.\n\nAreas of sclerosis in multiple vertebral bodies are attributable to discogenic\nreaction, and areas of relative lucency, are stable since ___. As noted\npreviously the chest CT is less sensitive in detecting early metastasis than\nradionuclide bone or FDG PET scanning. .",
            "output": "Substantial interval improvement in less than a month of multi focal\nperibronchial alveolitis, which could be been infection or drug related. There\nis no good evidence for intrathoracic malignancy.\n\nPossible pulmonary hypertension.\n\nFusiform dilatation ascending thoracic aorta and possible calcific aortic\nstenosis. Clinical evaluation advised.\n\nCoronary atherosclerosis."
        },
        {
            "input": "BILOBED SINGLE OR 2 ADJACENT SMALL PULMONARY NODULES, LEFT UPPER LOBE, 6 MM IN\nAGGREGATE DIAMETER, 5:63 ARE UNCHANGED SINCE AT LEAST ___.\n\nSUPRACLAVICULAR AND AXILLARY LYMPH NODES ARE NOT PATHOLOGICALLY ENLARGED. .\nPATIENT HAS HAD RIGHT MASTECTOMY. THERE ARE NO CHEST WALL LESIONS SUSPICIOUS\nFOR MALIGNANCY, ALTHOUGH SHOULD BE NOTED THAT EVALUATION OF THE BREAST\nREQUIRES MAMMOGRAPHY.\n\nASYMMETRY IN THE THYROID LOBES IS STABLE AND THERE IS NO NODULATIONS. CENTRAL\nLYMPH NODES IN THE MEDIASTINUM ARE NOT ENLARGED AND THERE ARE NO CONTOUR\nABNORMALITIES IN THE HILA TO SUGGEST ADENOPATHY. THE INTERNAL MAMMARY\nDIAPHRAGMATIC AND RETROCRURAL STATIONS ___ NO ENLARGED LYMPH NODES.\nATHEROSCLEROTIC CALCIFICATION IS marked at THE ORIGIN OF THE LEFT SUBCLAVIAN\nARTERY, AND IN AT LEAST THE LAD. CALCIFICATION IN THE AORTIC VALVE IS HEAVY\nENOUGH, GIVEN THE PATIENT'S AGE TO WARRANT CLINICAL EVALUATION FOR POSSIBLE\nHEMODYNAMIC SIGNIFICANCE. ATHEROSCLEROTIC CALCIFICATION IS ALSO heavy IN THE\nDESCENDING THORACIC AORTA. ASCENDING THORACIC AORTA IS DILATED, BUT THE\nAPPARENT DIAMETER, 44 MM IS EXAGGERATED BY PULSATILE MOTION, COMPARED TO AN\nACCURATE ___ OF 42 MM IN ON ___. DESCENDING THORACIC THORACIC\nAORTA AND THE IMAGED UPPER ABDOMINAL DO SECTION ARE NORMAL CALIBER.\n\nHETEROGENEOUS CONSOLIDATION, anatomic DISTORTION AND MILD BRONCHIECTASIS AT\nTHE LEFT APEX, UNCHANGED SINCE ___ IS ATTRIBUTABLE TO PREVIOUS RADIATION,\nBUT THE only EARLIER IMAGES, FROM ___ SHOW less abnormality. IF\nTHERE IS CONCERN FOR ACTIVE INFECTION, CONVENTIONAL CHEST RADIOGRAPHS SHOULD\nBE OBTAINED.\n\nTHERE ARE multiple AREAS OF NEW PERIBRONCHIAL GROUND-GLASS INFILTRATION, FOR\nEXAMPLE E AXILLARY REGION OF THE RIGHT UPPER LOBE, 5:70- 78, POSTERIOR SEGMENT\nTHE RIGHT UPPER LOBE, 5: 95, LEFT LOWER LOBE ANTEROMEDIAL AND OTHER BASAL\nSEGMENTS, 05:104-117,  RIGHT MIDDLE LOBE, 5:154, RIGHT LOWER LOBE, 05:208 . IN\nMANY OF THESE AREAS and elsewhere in both lungs THERE IS NEW OR MORE\nPRONOUNCED BRONCHIAL WALL THICKENING. THERE IS NO MUCOID IMPACTION, OR ANY\nCONSOLIDATION.\n\nTHERE IS NO PLEURAL OR PERICARDIAL EFFUSION. THE MOTTLED TEXTURE OF OF\nMULTIPLE THORACIC VERTEBRAL BODIES could be due to osteoporosis however, but\nearly metastasis is not excluded, even though there is no appreciable change\nsince ___. Radionuclide ___ or FDG PET scanning is more sensitive in\ndistinguishing the between these 2 conditions.",
            "output": "Widespread moderately severe peribronchial alveolitis new since ___, most\ncommonly viral, is probably responsible for concurrent mild generalized\ninflammatory bronchial wall thickening\n\n2 tiny left upper lobe lung nodule stable since ___.\n\nMany small lucent areas in the thoracic spine unchanged since ___ could be\ndue to osteoporosis but early metastasis could be responsible for any of it. \nIf this is clinically undetermined, radionuclide scanning is recommended.\n\nDilated ascending thoracic aorta distal to calcified valve suggests there may\nbe aortic stenosis.\n\nCoronary atherosclerosis."
        },
        {
            "input": "There is no supraclavicular adenopathy. On the side of the prior mastectomy, a\nnew peripectoral lesion in the soft tissues of the right anterior chest wall\nat the anterior aspect of the right axilla has a geographic shape, internal\nattenuation of fluid, ___ ___, a uniform wall thickness of 2-3 mm, and\nconsiderable infiltration of the adjacent fat. At the level of its greatest\ncross-sectional area it is 14 x 20 mm, 5:95, but it has a vertical extent of\nat least 8 cm. Presuming the patient has not had a surgical procedure, this\nlesion is either malignant or infectious. Tiny lymph nodes in the left axilla\nare not of concern for malignancy.\n\nThyroid is unremarkable. Atherosclerotic calcification in the head and neck\nvessels is most pronounced at the origin of the left subclavian artery. It is\na quite severe in the coronaries at least in the left anterior descending and\ncircumflex branches. Fusiform dilatation of the ascending thoracic aorta to a\nmaximum diameter of 44 mm, 03:24, is unchanged since at least ___.\nConsiderable enlargement of the pulmonary arteries, right 33 mm, is also\nunchanged. The only pericardial effusion is in the superior pericardial\nrecess, unchanged. There is no pleural effusion. This study is not designed\nfor subdiaphragmatic diagnosis, but shows there is no change in the 20 x 30 mm\nleft adrenal mass since characterized as a likely adrenal adenoma by MR in\n___, and a bilobed nearly 4 cm wide cyst in the interpolar region of\nthe left kidney.\n\nAbnormalities in the lungs are as follows:\n\nIrregular scarring, consolidation, and peribronchial infiltration in the apex\nof the left lung has not changed appreciably since ___, presumably\ndue to prior radiation.\n\nA 3 mm nodule in the right upper lobe, 5:74 surrounded by a small ground-glass\nhalo, 7 mm wide in all is unchanged since ___, but new since ___ was\nprobably all ground-glass opacity in ___. It needs to be followed closely to\nexclude an early lung carcinoma, as opposed to a coalescent inflammatory\nlesion.\n\nMultiple foci of essentially peribronchial ground-glass opacification are new,\nmost marked in the right apex, 05:57 - 69,  anterior segment of the right\nupper lobe and contiguous middle lobe, 5:138- 190 are inflammatory, infectious\nor due to local radiation.\n\nThere are no lung lesions suspicious for metastatic breast carcinoma.\n\nGeneralized osteoporosis in the thoracic spine makes it difficult to determine\nwhether a subcortical lucency in the anterior T6 vertebral body, 8:81 and the\nheterogeneous demineralization of the sternum are malignant, but the sternal\nlesions are quite concerning for malignancy, either metastatic breast\ncarcinoma or multiple myeloma. There has been no change since at least ___ the and comparison with a ___ is difficult because of technical\nvariations.\n\n\n\n\n.",
            "output": "New right axillary metastatic malignancy or infection.\n\nMulti focal pulmonary abnormality in the right upper and middle lobes there\ncould be infectious. Alternatively if the patient has had right breast\nradiation, it could be a combination of radiation pneumonitis and cryptogenic\norganizing pneumonia.\n\nRight lung lesion, concerning for early lung carcinoma should be imaged again\nin no more than 6 months. There are no likely metastatic nodules in the lungs.\n\nIrregular demineralization thoracic spine and particularly the sternum is\nconcerning for malignancy, either metastatic breast carcinoma or multiple\nmyeloma. Radionuclide imaging, particularly PET scanning should be helpful.\n\nStable fusiform aneurysm ascending thoracic aorta.\n\nCoronary atherosclerosis.\n\nPossible pulmonary arterial hypertension."
        },
        {
            "input": "The examination is compared to a previous CT from ___.\n\nThe pre described right chest wall and axillary lesion (3, 21) is minimally\nsmaller than previously and has a diameter of 28 x 9 mm. The apicocranial\nextent of the lesion is not substantially changed. The stent of the lesion\ncontinues to be liquid.  Soft tissue stranding persists.  Despite the absence\nof growth of the lesion, suspicion for malignancy remains, and the lesion\nshould undergo short-term followup by imaging.  The size of the local lymph\nnodes remains normal.  No supraclavicular lymphadenopathy.\n\nNo incidental thyroid findings. Moderate calcification of the supraaortic\nbranches and the aortic arch. The fusiform dilatation of the ascending aorta\nis unchanged.  Unchanged severe coronary calcifications and mild aortic valve\ncalcifications. Moderate cardiomegaly persists.  No pericardial effusion.\nMinimal hiatal hernia and calcifications of the descending aorta. Otherwise\nunremarkable posterior mediastinum.  Small splenule.  Unchanged bilobed left\nkidney cyst.  The size of the known and predescribed enlarged left adrenal\ngland is constant.  The degree of heterogeneous bony demineralization is\nconstant, in particular at the level of the vertebral bodies and the sternum. \nA pre described subcortical rounded the mineralization at the level of T6 is\nnot substantially changed.\n\nIn the left lung apex, pre-existing spots of fibrosis are unchanged.  At the\nright lung apex, however, pre-existing ground-glass opacities have coalesced\nto larger areas of opacities showing reticulations and architectural\ndistortion, and reflecting fibrosis.  The pre described right upper lobe\nnodule with a diameter of approximately 7 mm (5, 64) is completely unchanged. \nNew 1 mm subpleural nodule in the right upper lobe (5, 90).  Areas of\nright-sided postradiation fibrosis are unchanged. Subtle middle lobe scarring\nis constant in extent and severity.  A part of the subpleural postradiation\nfibrosis, there is no evidence of pleural thickening or pleural effusions.  A\nleft subpleural 2-3 mm nodule (5, 190) is unchanged in size and morphology.\nTwo subpleural right lower lobe nodules (5, 172) are also unchanged.  No\nevidence of new pulmonary nodules.  The airways are patent.",
            "output": "Minimal decrease in size of a centrally liquid right axillary lesion.  Because\nthe lesion continues to show stranding, the suspicion for malignancy remains\nhigh and the lesion needs to be followed in close intervals.\nThe pre-existing right apical ground-glass opacities have progressed to\nmoderate fibrosis.  The pre-existing left apical fibrosis is unchanged.\nAll pulmonary nodules that pre existed are unchanged, in particular one 7 mm\nright upper lobe nodule.  No new nodules have appeared. There is no evidence\nof growing nodules.\nUnchanged on characteristic scarring at the level of the middle lobe.\nUnchanged fusiform dilatation of the ascending aorta.  No evidence of\nlymphadenopathy.  No pleural effusions.  The morphology of the bones is\nconstant, with known asymmetric demineralization, notably at the level of the\nvertebral bodies and the sternum."
        },
        {
            "input": "Mediastinal lymph nodes are not pathologically enlarged ranging up to 10 mm,\nalthough multiple.  Aorta and pulmonary arteries are normal in diameter. \nCoronary calcifications are mild.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally with secretions\ndemonstrated at the level of the main airways.\n\nPulmonary nodules seen on the previous CT abdomen, series 5, image 250, is 2.5\nx 4.5 mm in diameter with every diameter of 3.5 mm.  Calcified right lower\nlobe granuloma, series 5, image 104 is consistent with previous granulomatous\nexposure.\n\nBibasal ground-glass opacities insert test with emphysema most likely related\nto smoking provoked changes.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Emphysema, moderate\n\nStable right lower lobe pulmonary nodule.  Reassessment in 12 months with\nchest CT is recommended.  Please consider enrollment of the patient in the\nlung cancer screening program is qualified."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  No\npericardial pleural effusion is seen.\n\nHeart size is normal.  Subendocardial hypodensity in the anterior wall of the\nleft ventricle is concerning for old infarct, unchanged.\n\nImage portion of the upper abdomen the demonstrate high density of the liver,\nslightly more pronounced than on the previous examination.\n\nAirways are patent to the subsegmental level bilaterally.  Emphysema is mild\nto moderate, unchanged.  Right lower lobe nodule is stable as well as right\napical granuloma.  No new nodules masses or consolidations demonstrated.",
            "output": "Stable appearance of pulmonary nodules.\n\nUnchanged emphysema.\n\nAs previously suggested, enrollment in the lung cancer screening is to be\nconsidered if patient qualifies.\n\nEvidence of prior myocardial infarction based on the CT findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable.  No\nsupraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: This study is not optimized for subdiaphragmatic structures. \nWithin this limitation, a hypodense lesion in segment VI/VII measuring up to\n3.7 cm is better assessed on same-day MRI liver (302:225). There is a small\nhiatus hernia.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  Coronary artery calcifications\nare mild.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is a background of severe emphysema.  Residual fluid\ndensity at the left lung apex is most likely fluid in a previously seen bleb\nat the site of prior infection. Calcification and scarring is present at the\nright lung apex.  No pulmonary nodule suspicious for malignancy.\n2. AIRWAYS:  Airways are patent to the subsegmental level.  Peribronchial\nthickening is compatible with small airways inflammation.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  Although this study is not optimized for the evaluation of pulmonary\nvasculature, no central pulmonary embolism is detected.  The thoracic aorta is\nnormal in caliber with minimal calcified atherosclerotic plaque.\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesion or acute fracture.",
            "output": "No evidence of intrathoracic malignancy.\n\nFluid loculation in a bleb at the left lung apex is unchanged since ___.\n\nSevere emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. No\nevidence of clavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Detailed in the concurrent MRI of the liver.\n\nMEDIASTINUM: There is no mediastinal and no hilar lymphadenopathy with\nunchanged and not pathologically enlarged 0.7 cm right lower paratracheal\nlymph node.\n\nHEART and PERICARDIUM: Heart is normal size.  Minimal calcifications of the\ncoronaries.  Mild calcifications of the mitral valve.  Thoracic aorta and main\npulmonary artery are normal in diameter.  There is no pericardial effusion. \nReflux of contrast into the IVC can be secondary to phase of contrast or\ncardiac dysfunction.\n\nPLEURA: No pleural effusion.\n\nLUNG: Major airways are patent, mild bronchial wall thickening suggest chronic\nairway disease suggest chronic bronchitis.  No evidence of active infection. \nSevere centrilobular emphysema is widespread, predominantly of the upper\nlobes.\nStable residual fluid density at the level of left apex, measures 8 ___, is\nmost likely in a bleb demonstrated on ___ (4:80).\nCalcification scarring is present at the right lung apex.\nNo pulmonary nodules suspicious for malignancy identified.\n\nCHEST CAGE: There is no evidence of also destructive lesions in the vertebral\nbodies, sternum or ribs.  Demineralization is evident in the vertebral bodies.",
            "output": "No evidence of intrathoracic metastasis."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and subcentimeter axillary lymph nodes are\nneither pathologically enlarged nor growing since ___.  There are no\nsoft tissue abnormalities in the imaged chest wall concerning for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels but is seen in at least left anterior\ndescending coronary artery.  Aorta and pulmonary arteries are normal size and\npericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes, including diaphragmatic and\nposterior mediastinal lymph node stations, are not pathologically enlarged,\nranging in diameter up to 8 mm in the right posterior paraesophageal station,\npreviously 10 mm.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.  Biapical pleuroparenchymal\nscarring, partially calcified, is stable.  Subpleural atelectasis at the lung\nbases reflects a suboptimal inspiration.\n\nSubpleural 5 mm left lower lobe lung nodule, 4:186, is unchanged since\n___ and ___.  There is no consolidation, edema, or any\nother lung nodule.  Moderate bronchial wall thickening in the lower lungs is\nmore pronounced.\n\nThere is no pleural effusion.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy or active infection.\n\nSevere bullous emphysema.\n\nSince biapical pleuroparenchymal scarring is accompanied by calcification, is\ncould be due to prior tuberculosis but there is no evidence of reactivation\ninfection."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated except for\nslightly enlarged right hilar lymph node, 13 x 16 mm as compared to 14 x 11 mm\npreviously, series 5, image 193.\n\nAirways are patent to the subsegmental level bilaterally severe emphysema,\npanlobular and centrilobular is unchanged as well as biapical areas of nodular\npartially calcified scarring.  Diffuse bronchial wall thickening is extensive,\nsimilar to previous examination.  No nodules masses or consolidations are\notherwise demonstrated.  Heart size is normal.  There is no pericardial or\npleural effusion.\n\nImaged portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nMinimal increase in size in the right hilar lymph node, nonspecific, attention\non the subsequent studies is recommended.\n\nSevere emphysema\n\nBiapical pleuroparenchymal scarring with calcifications.\n\nPlease review MRI of the liver for assessment of the intra-abdominal findings."
        },
        {
            "input": "THYROID: Imaged part of the thyroid gland is unremarkable.\n\nLYMPH NODES: There is no supraclavicular, axillary mediastinal, or hilar\nadenopathy.  Posterior mediastinum is unremarkable.\n\nHEART AND GREAT VESSELS: The heart is normal in size, without a pericardial\neffusion.  Thoracic aorta is normal in caliber, with mild atherosclerotic\ncalcifications predominantly along the aortic arch.  There is no evidence of\npulmonary embolism to the subsegmental levels in the upper lobes.  In the\nlingular branches and bilateral lower lobes, there are no filling defects to\nthe level of the proximal segmental pulmonary arteries, with evaluation of the\ndistal branches is limited by respiratory motion.  Right central venous\ncatheter terminates in the low SVC.\n\nAIRWAYS AND LUNGS: There is a large enhancing consolidation in the right lower\nlobe with associated volume loss, compatible with atelectasis.  However, along\nthe anteromedial aspect of this atelectasis, there is consolidation that\ndemonstrates heterogeneous enhancement (2:69).  Findings are new compared to\nthe prior CT performed on ___, and may reflect pneumonia in the\nappropriate clinical setting.  Heterogeneous material within the right lower\nlobe bronchus may represent secretions (02:54).\n\nSevere centrilobular emphysema is again demonstrated.  There is biapical\npleuroparenchymal scarring, appearing nodular on the left, and partially\ncalcified on the right.  A rim calcified pleural based structure at the\nanterior aspect of the right middle lobe is stable from at least ___,\nand compatible with a benign process.  There is no pleural effusion or\npneumothorax.\n\nUPPER ABDOMEN: Included images of the upper abdomen are unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious lytic or sclerotic lesions are\nidentified.  There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism, within the limitations of this exam. \nEvaluation of the pulmonary arteries beyond the proximal segmental levels is\nlimited by respiratory motion in the lower lobes.\n2. Right lower lobe consolidation, the majority of which represent\natelectasis.  Heterogeneously enhancing component along the anteromedial\naspect of the right lung base may represent pneumonia in the appropriate\nclinical setting.  Recommend close interval follow-up with a repeat chest CT\nin 6 weeks to ensure resolution.\n\nRECOMMENDATION(S):  Chest CT in 6 weeks.\n\nNOTIFICATION:  The findings and recommendation were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 7:42 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal hilar lymph nodes.  There is\nmoderate cardiomegaly.  There is a stable small pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is stable scarring in both apices right greater than left.  A\nareas of calcification within both upper lobes are also unchanged and could be\nrelated to prior granulomatous disease.  There is severe diffuse emphysema. \nThere is minimal peripheral fibrosis right greater than left.  No new or\ngrowing pulmonary nodules.  Previously visualized parenchymal opacity in the\nright lower lobe has resolved and could have represented atelectasis.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows patient status\npost liver transplantation.  Please refer to dedicated report on MRI of the\nliver being done on the same day for further details",
            "output": "Severe diffuse emphysema.\n\nEvidence of prior calcification in both apices right greater than left.\n\nComplete resolution of the right lower lobe pneumonia in the interim.\n\nNo new pulmonary nodules.\n\nStatus post liver transplantation.  Please refer to dedicated report on MRI of\nthe liver being done on the same day."
        },
        {
            "input": "CHEST PERIMETER:\nNo thyroid findings need any further imaging.  Supraclavicular and axillary\nlymph nodes are not enlarged.  No soft tissue abnormalities in the chest wall.\nThis study is not appropriate for subdiaphragmatic diagnosis, will be\nevaluated by an MR of the liver scheduled today, reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification is\nmild in head and neck vessels and at least left anterior descending and right\ncoronary arteries.  Aorta and pulmonary arteries are normal size and a small\npericardial effusion is larger today.  There are no findings to suggest\ncardiac tamponade.\n\nThere is more semi-solid material in what is either a diverticulum of the mid\nesophagus, 5:155-181 or a complex of subpleural bullae.  In either case this\ncould represent a mycetoma.\n\n14 mm wide right paramedian calcified ring shadow in the internal mammary\nregion, 5:184, has been present without change since ___ and is\nprobably a benign cyst.\n\nTHORACIC LYMPH NODES: None pathologically enlarged or growing, ranging up to 8\nmm in multiple mediastinal stations.\n\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.  Biapical pleuroparenchymal\nscarring, partially calcified on the right, is unchanged and could be due to\nprior tuberculosis.\n\nBronchial wall thickening is extensive and as before there are small areas\nwhere retained secretions occlude the bronchial lumens in segmental and\nsubsegmental branches, for example right lower lobe, 5:216.\n\nThere are no discrete lung nodules or areas of focal consolidation.\n\nCHEST CAGE: Unremarkable",
            "output": "No evidence of active infection or malignancy.\n\nSevere emphysema and chronic bronchial wall thickening.  Stigmata prior\ntuberculosis.  No evidence of reactivation infection.\n\nPossible mycetoma, right lower lobe bullae."
        },
        {
            "input": "CHEST: There is no mediastinal hematoma.  Atherosclerotic calcifications seen\nthroughout the aorta and great vessels.  There is moderate cardiologic.  There\nis no pericardial effusion.  There is no lymphadenopathy.  The imaged thyroid\nis normal.\n\nCentrilobular and paraseptal emphysema is noted at the apices, right greater\nthan left.  The lungs are otherwise clear without worrisome nodule, mass, or\nconsolidation.  Airways are patent to the subsegmental level.  There is no\nevidence of contusion or laceration.  There is no pneumothorax or pleural\neffusion.\n\nABDOMEN:  There is a nodular contour to the surface of the liver suggesting\nchronic liver disease.  Punctate calcifications are noted likely from prior\ngranulomatous disease.  The liver is intact without focal lesion of signs of\nacute injury.  The spleen demonstrates multiple peripheral linear hypodense\nregions.  These areas are associated with retraction of the capsule most\nsuggestive of prior infarcts.  The gallbladder and adrenals are unremarkable. \nPancreas is fatty replaced.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  Multiple cysts\nidentified in the kidneys bilaterally, the largest on the left measuring 7.9 x\n6.9 cm.  There is no evidence of renal or collecting system injury.  The\nabdominal aorta is normal in course and caliber with widely patent major\nbranches.  Accessory bilateral renal arteries are noted.  No lymphadenopathy,\nfree air, or free fluid.\n\nThe stomach and small bowel are unremarkable.\n\nPELVIS:  Colonic diverticulosis is noted without diverticulitis.  There is no\nevidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is not visualized.  The bladder is unremarkable.  There is no pelvic\nfree fluid.\n\nBONES:  There acute nondisplaced right fourth, fifth, sixth, seventh and\neighth rib fractures.  Nondisplaced acute fractures through the right L1, L2\nand L3 transverse processes are also noted.\n\nDegenerative changes are noted in the spine and at the hips.  There is no\nsuspicious osseous lesion identified.  No focal suspicious osseous\nabnormality.",
            "output": "1. Acute nondisplaced right fourth through eighth rib fractures.  Nondisplaced\nright L1, L2 and L3 transverse process fractures.\n2. While splenic lacerations are not entirely excluded.  The appearance of the\nperipheral linear hypodensities in the spleen with retraction of the capsule\nis most suggestive of prior infarcts.  No other evidence of acute\nintrathoracic or intra-abdominal injury.\n3. Nodular contour of the liver suggesting chronic underlying liver disease.\n4. Emphysema."
        },
        {
            "input": "Detailed evaluation of the solid organs, soft tissues, and vessels is limited\nwithout the use of intravenous contrast. Within this limitation:\n\nThe thoracic aorta is normal in caliber.  The descending thoracic aorta is\ntortuous.  There is normal 3 vessel aortic arch anatomy.  The main, left, and\nright pulmonary arteries are dilated, with the main pulmonary artery measuring\nup to 36 mm.  The heart is enlarged, secondary to enlargement of both atria. \nA 3.2 x 2.9 x 1.7 cm relatively defined, ovoid mass-like hypodensity in the\nleft atrium that closely approximates the intra-atrial septum (Series 2, image\n31).  Aortic valve calcifications are minimal.  No pericardial effusion.\n\nNo axillary or supraclavicular lymphadenopathy.  Multiple diffuse mediastinal\nlymph nodes prominent, measuring up to 8 mm in short axis in the subcarinal\nstation.  No hilar lymphadenopathy.  The thyroid gland is enlarged; evaluation\nfor focal lesion is limited due to marked streak artifact from the left\nshoulder hemiprosthesis.  The enlarged thyroid displaces the brachiocephalic\ntrunk posteriorly and inferiorly.\n\nNo focal consolidation concerning for pneumonia.  Bilateral lower lobe\nmoderate peribronchiolar wall thickening can be seen with chronic small\nairways inflammation; some of the more distal subsegmental bronchi have small\nfocal secretions.  The central airways are widely patent. A 2 mm right lower\nlobe pulmonary micronodule is nonspecific (series 2, image 37).  Bibasilar\natelectasis is mild.  No pleural effusion or pneumothorax.\n\nMultilevel degenerative changes in the imaged spine are moderate.  Slight\nsuperior endplate compression deformity of the T10 vertebral body is age\nindeterminate but appears more chronic (series ___, image 52).  No\nconcerning lytic or sclerotic osseous lesions.\n\nThe upper abdomen is only partially imaged.  Multiple hepatic hypodensities\nare too small to accurately characterize on CT, statistically most likely\ncysts, hemangiomas, and/or biliary hamartomas.  Many of these lesions were\npresent on a prior CT abdomen and pelvis, incompletely imaged, but may appear\nmore conspicuous (e.g., series 2, image 56, 52, 51, 50, 46, 40, 34).  The\ngallbladder contains calcified gallstones/gravel (series 2, image 55).  A\nhiatal hernia is small.  An accessory spleen at the anterior splenic hilum is\nsmall (series 2, image 51).  A large exophytic cyst arising from the left\ninterpolar region measures up to 8.2 cm, slightly smaller.  A similar 5.3 cm\nexophytic cyst off the right upper renal pole is also slightly smaller.  A\nright peripelvic cyst measures up to 1.8 cm (series 2, image 59).  Multiple\nother bilateral renal cortical hypodensities are too small to accurately\ncharacterize on CT.",
            "output": "1.  3.2 x 2.9 x 1.7 cm mass-like hypodensity in a dilated left atrium, closely\napproximating the intra-atrial septum, corresponding to mass seen on recent\nechocardiogram.  Location is typical for an atrial myxoma, but thrombus is\nalso possible.  One could consider cardiac CTA or MRI if desired.\n2.  Dilated central pulmonary arteries can be seen as sequelae of chronic\npulmonary hypertension.\n3.  Moderate bilateral lower lobe peribronchiolar wall thickening with focal\ndistal airway secretions are consistent with small airways\ndisease/bronchiolitis.  No focal pneumonia.\n4.  Thyromegaly.\n5.  Cholelithiasis.\n6.  Small hiatal hernia.\n\nNOTIFICATION:  Findings were communicated to ___ via page on ___\nat 510 pm.  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:40 am, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "Mild cardiomegaly.  No evidence of calcified atherosclerosis in the coronary\narteries.  A central venous catheter terminates in the right atrium.  The\naorta and its major branch vessels are patent, with no evidence of stenosis,\nocclusion, dissection, or aneurysmal formation.  There is no evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion.  There are bilateral pleural\neffusion, moderate right and small left with adjacent subsegmental compressive\natelectasis.\n\nThere are multiple areas of patchy parenchymal opacification in the left upper\nand right upper lobes, concerning for multifocal pneumonia.  Central airways\nare patent\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multifocal pneumonia.\n3. Bilateral pleural effusion, moderate right and small left ,with adjacent\nsubsegmental atelectasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:40 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid looks unremarkable.  There are no enlarged lymph nodes in either\ndeep axilla or thoracic inlet.  There are no atherosclerotic calcifications in\nthe head and neck arteries.  There are no chest wall abnormalities.\n\nMEDIASTINUM AND HILA:\nThe esophagus looks unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  There is no hilar\nlymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  There is mild atherosclerotic\ncalcification in the coronary arteries.  None is seen in the cardiac valves. \nThe aorta and pulmonary artery are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nAirways are patent to the subsegmental level.  Lungs are well expanded and\nclear bilaterally, no bronchial wall thickening, bronchiectasis or mucus\nplugging.  Mild bilateral posterior dependent atelectasis.  A 13 mm\nthin-walled cyst air cyst in the right lower lobe is noted.  There is no\npleural effusion or thickening.  Mild apical scarring is seen bilaterally.\n\nCHEST CAGE:\nNo acute fractures.  Mild spondylotic changes.  Although there are no bone\nlesions in the imaged chest cage suspicious for malignancy or infection, it\nshould be noted that radionuclide bone and FDG PET scanning are more sensitive\nin detecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to same day report on abdominal CT dictated apart.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the imaged chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM: Vascular clips denote prior gastroesophageal surgery. \nEsophagus is unremarkable.  Atherosclerotic calcification not apparent in head\nand neck vessels is present in at least left anterior and posterior descending\ncoronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.\n\n23 mm wide filling defect at the tip of the right supraclavicular central\nvenous infusion catheter is probably thrombus and should be evaluated by\ninterventional radiology.\n\nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: 10 mm left lower paratracheal mediastinal lymph node was\n8 mm in ___.  Other subcentimeter mediastinal lymph nodes are stable.\n\nLUNGS, AIRWAYS, PLEURAE: No measurable lung nodules or other focal lung\nlesions of consequence.  Calcified granuloma left lower lobe.  No evidence of\nactive infection.  Tracheobronchial tree is normal to subsegmental levels.  No\npleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No good evidence for intrathoracic malignancy.\n\nCatheter related thrombus, right atrium should be evaluated by interventional\nradiology.\n\nRECOMMENDATION(S):  Catheter related thrombus, right atrium should be\nevaluated by interventional radiology.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___ on\n___ at 12:35 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "THORACIC INLET: There is a right-sided Port-A-Cath with its tip in the\ncavoatrial junction.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes are unchanged.  Heart size is normal.\nThere is moderate coronary artery calcification.  There is mitral annulus\ncalcification.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  There is minimal\nbibasilar atelectasis.  No new or growing pulmonary nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Vascular calcifications are seen within the arm.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "No evidence of metastasis to the chest.\n\nThe contrast face as compared with the prior study is different hence direct\ncomparison to exclude the previously visualized thrombus along the distal tip\nof the Port-A-Cath is limited.  Right-sided Port-A-Cath with its tip in the\ncavoatrial junction.\n\nModerate coronary artery calcification.  Moderate mitral annulus\ncalcification."
        },
        {
            "input": "HEART AND VASCULATURE: The patient is status post recent CABG with small\namount hematoma and stranding surrounding the sternotomy sites and in the\nanterior mediastinum.  Foci of skin defect overlying the sternotomy site are\nalso noted.  However no focal fluid collection is identified.  The heart is\nnot enlarged.  Severe coronary artery calcifications are noted.  The great\nvessels are normal in caliber.  Extensive aortic calcifications are noted.  No\npulmonary embolism identified.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes are\nnoted.  For example, a subaortic node measures 0.7 cm (series 4, image 103). \nA subcarinal node measures 1.0 cm (series 4, image 122).  A right paratracheal\nnode measures 0.8 cm (series 4, image 98).  These findings are most likely\nreactive.  No axillary or supraclavicular or hilar lymphadenopathy.\n\nPLEURAL SPACES: There are scattered foci of small loculated pleural effusions\non the left with the largest measuring 5.1 x 2.7 x 8.6 cm (TV by AP by CC). \nNo right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: No focal consolidation.  No pulmonary edema.  Extensive\ncentrilobular and paraseptal emphysema is noted with upper lobe predominance. \nAtelectasis is seen dependently in the left more than the right lower lobes\nand within the lingula which has a nodular appearance on the transverse images\nbut is more clearly atelectasis on the sagittal and coronal images.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited evaluation of the upper abdomen shows an apparent 1.3 cm\ncystic lesion within the tail of the pancreas.  There may be prior splenic\ninfarct.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes of the thoracic spine are moderate.",
            "output": "1.  Status post recent CABG with associated postoperative changes surrounding\nthe sternotomy sites and the anterior mediastinum.  Subcutaneous soft tissue\nstranding and skin defect overlying the sternotomy sites are noted and\nsuperinfection infection cannot be excluded, but there is no focal fluid\ncollection is identified.\n2.  Multiple foci of loculated pleural effusions on the left with the largest\nmeasuring 5.1 x 2.7 x 8.6 cm.\n3.  Severe emphysema.  Atelectatic region in the left lingula and dependently\nin the lungs, left greater than right.\n4.  1.3 cm apparent cystic lesion within the tip of the tail of the pancreas. \nNon-emergent MRCP in ___ months is recommended as an outpatient.\n\n\n\nRECOMMENDATION(S):  Non-emergent MRCP without with contrast in ___ months as\nan outpatient"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are increased in number but normal in\nsize and morphology, likely reactive.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.  Pacemaker wires are seen in\nexpected position.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are top normal in caliber.\n\nPULMONARY PARENCHYMA: Confluent consolidative opacities within the left lower\nlobe and lingula may represent acute infectious process or re-expansion\npulmonary edema, depending upon the clinical setting.  The aerated portions of\nthe right upper and right lower lobes are within normal limits.  There is no\nemphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nExcessive anterior bowing of the posterior wall of the trachea and mainstem\nbronchi suggestive of tracheobronchomalacia.\n\nPLEURA:  There is a large right pleural effusion with relaxation atelectasis\nof the majority of the right lower lobe.  Small volume residual left pleural\nfluid is present in the setting of a well placed pigtail catheter at the left\nlung base.  There is hyperdensity involving some of the fluid in the left lung\nbase consistent with small volume of blood products (5:259).\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  A small hyperdense focus in the\nleft anterior chest wall with a linear soft tissue density extension through\nthe anterior subcutaneous fat to the skin surface likely represents the\nsequelae of prior pericardial drain placement (5:274).  A left pectoral\npacemaker and its leads are noted in expected position.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Small volume residual left pleural fluid, including a small amount of blood\nproducts, status post placement of a pleural drainage catheter.\n2. Confluent consolidation of the lingula and left lower lobe may represent\npneumonia or re-expansion pulmonary edema.\n3. Large right pleural effusion with associated atelectasis of the majority of\nthe right lower lobe.\n4. Possible tracheobronchomalacia."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart is\nnormal in size with moderate coronary artery calcifications.  There are no\nsubstantial calcifications in the aorta.  No central or segmental pulmonary\nembolism.  A small amount of pericardial fluid is present.\n\nAXILLA, HILA, AND MEDIASTINUM:  Heterogeneous tissue in the anterior\nmediastinum likely represents residual thymus.  Scattered axillary,\nmediastinal, and hilar lymph nodes are not pathologically enlarged.  Surgical\nclips are noted in the left axilla.  A right hilar node measures 6 mm in short\naxis (6:120).  Two retrocrural lymph nodes measure 5 mm in short axis (6:210,\n6:214), unchanged from ___.\n\nPLEURAL SPACES:  A small right pleural effusion is nonhemorrhagic and new\nsince ___ without adjacent pleural thickening, nodularity, or\nenhancement.  No pneumothorax.\n\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally. Dependent atelectasis is mild.\n\nNew or growing nodules:\n- Right upper lobe abutting pleura measures 4 mm, slightly larger than in\n___ (6:72).\n- Right upper lobe nodules measure 6 mm, spiculated, and 3 mm, new since\n___ (6:100, 6:123, respectively).\n\nMultiple subcentimeter pulmonary nodules are stable since ___ (6:87,\n6:88, 6:112, 6:122, 6:141, 6:178).\n\nBASE OF NECK:  The thyroid is normal.  Visualized portions of the base of the\nneck show no abnormality.\n\nABDOMEN:  Please see report from same day CT of the abdomen and pelvis for\ndescription of the subdiaphragmatic findings..\n\nBONES:  Sclerotic focus in the right humeral head is consistent with a bone\nisland.  Right posterior rib lucency is unchanged, nonspecific, and may\nrepresent fibrous dysplasia (5:76).  Slight anterior wedge deformity of the\nT10 vertebral body is unchanged from ___ (605b:76).  There is no acute\nfracture.",
            "output": "1. Several new and growing pulmonary nodules.  Follow up chest CT is\nrecommended in 3 months.\n2. Small right pleural effusion, new since ___, may be reactive to\nabdominal process.  No concerning features to suggest malignant involvement.\n\nRECOMMENDATION(S):   Follow up chest CT is recommended in 3 months."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest wall suspicious for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nThere are no thyroid lesions large enough to warrant further imaging\nevaluation.  Atherosclerotic calcification is mild in head neck vessels, but\nnot apparent in the coronary arteries.  Aorta and pulmonary arteries are\nnormal size.  However there are several new, large but nonocclusive emboli  in\nthe right descending pulmonary artery and lower lobe segmental and\nsubsegmental branches.  The main and right and left pulmonary arteries are\nfree of filling defects. There is no pericardial or residual pleural effusion.\n\nSub cm mediastinal lymph nodes are numerous, for example in the left lower\nparatracheal and adjacent prevascular stations, but not pathologically\nenlarged and not changed since ___.  The same is true of the lymph node\ncluster the upper pole of the right hilus.\n\nLungs are clear.\n\nMultiple largely sclerotic metastases have developed in multiple thoracic\nvertebrae, the largest occupies more than half of T2, but there is no\npathologic fracture.",
            "output": "Acute pulmonary emboli, new since ___.  Referring physician notified\nimmediately.\n\nMultiple  largely sclerotic thoracic vertebral metastases new or larger since\n___ no compression or pathologic fractures.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:18 ___, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "CHEST:  In the right lobe of the thyroid gland, there is a 7 mm hypodense\nnodule (2, 7). The thyroid gland is otherwise normal. There is no axillary,\nmediastinal, or hilar lymphadenopathy. The heart is normal in size. There is\nno pericardial effusion. Moderate atherosclerotic calcifications are noted\nwithin the coronary arteries and mild atherosclerotic calcifications are noted\nalong the mitral annulus and aortic valve. The thoracic aorta is normal in\ncaliber with moderate calcifications along the arch and descending thoracic\naorta. There is no evidence of acute aortic pathology or stranding around the\naorta. There is no evidence of a mediastinal hematoma. The main pulmonary\narteries are normal in diameter.\n\nThe airways are patent to the subsegmental levels. There is volume loss in the\nright lower lobe, as well as a ground-glass opacity, consistent with\natelectasis.  There is minimal left basilar atelectasis. There is a small\nhemorrhagic right pleural effusion. There is no left pleural effusion. No\npneumothorax is identified.\n\nThere are multiple sub 4 mm pulmonary nodules (2; 9, 10, 16, 20, and 28).\nAdditionally, there is a dominant 7 mm nodule in the left lower lobe (2, 30).\n\nABDOMEN: The liver capsule is somewhat indented by a displaced rib fracture\nalong the right anterior margin (2, 20). The liver parenchyma itself appears\nnormal without evidence of a laceration or focal hepatic lesion. There is no\nperihepatic free fluid. The portal veins are patent. There is no intra or\nextrahepatic biliary duct dilation. The gallbladder is collapsed, though\nnormal in appearance. The spleen, pancreas, and adrenal glands are normal. In\nthe left kidney, there are two simple cysts, one which measures 46 mm, and one\nwhich measures 20 mm. There are no worrisome renal lesions. There is no\nevidence of a renal laceration. The kidneys enhance and excrete contrast\nsymmetrically. There is no pyelonephritis or hydronephrosis.\n\nThere is a small hiatal hernia. The stomach and small bowel are normal in\ncourse and caliber without focal inflammatory changes. There is no free air or\nfree fluid. The abdominal vasculature is normal in caliber without evidence of\nan aneurysm. There is no stranding around the abdominal aorta. There are\nmoderate atherosclerotic calcifications.  There is no retroperitoneal,\nperiportal, or mesenteric lymphadenopathy. There is no significant mesenteric\nstranding.\n\nPELVIS: The is a large amount of stool in the rectum. The remainder of the\nlarge bowel is mostly collapsed. Apparent wall thickening is likely due to\nunderdistention rather than inflammatory changes. There is no evidence of a\nfocal bowel injury. The appendix is not visualized, though there are no\nsecondary signs of appendicitis. The bladder is distended. The prostate is\nnormal in size with several coarse calcifications. There is no pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nOSSEOUS STRUCTURES:  There are segmental fractures of the right posterior and\nlateral seventh, eighth, and ninth ribs. There is a comminuted fracture of the\nright posterior tenth rib. No other fractures are identified. Moderate\nmultilevel degenerative changes are noted throughout the spine. There are no\nconcerning lytic or sclerotic osseous lesions. The soft tissues are\nunremarkable.",
            "output": "1. Seventh through tenth right rib fractures, as described above. There is an\nassociated small hemorrhagic right pleural effusion. No pneumothorax.\n2. Multiple pulmonary nodules, the largest measuring 7 mm. In the absence of\nspecific risk factors, a CT of the chest can be obtained in ___ months. If\nrisk factors, such as smoking or malignancy, exist, a CT of the chest can be\nobtained in ___ months.\n3. Moderate coronary artery calcifications.\n4. Large amount of stool in the rectum."
        },
        {
            "input": "There are emphysematous changes of the lungs. There are bilateral pulmonary\nnodules measuring less than 4 mm in the right middle lobe in series 4, image\n115, in the left upper lobe on image 54, and in the left upper lobe in image\n69. There is no area of consolidation.  Curvilinear opacity in the left apex\nlikely represent scar, however compared to prior exams may be considered to\nassess stability. Central airways are patent. There is a large right pleural\neffusion and moderate-to-large left pleural effusion. There are nonenlarged\nmediastinal lymph nodes.\n\nEvaluation of the abdomen is limited due to CT chest technique. There is mild\nnodular contour of the liver with small amount of perihepatic ascites.",
            "output": "1. Emphysematous lungs.\n2. Large right and moderate to large left pleural effusion with adjacent lower\nlobe atelectasis bilaterally.\n3. Bilateral pulmonary nodules measuring less than 4 mm. Followup in ___ year is\nrecommended.\n4. Area of curvilinear opacity in the left apex likely represents scarring,\nhowever comparison with outside films if available is recommended to assess\nstability.\n5. Mildly nodular hepatic contour suggestive of cirrhosis."
        },
        {
            "input": "Supraclavicularand axillary regions are unremarkable. Excluding the breasts\nwhich require mammography for evaluation, there are no soft tissue\nabnormalities in the imaged chest wall suspicious for trauma, malignancy, or\ninfection.\n\nRibcage, sternum, thoracic spine and shoulder girdles are intact.  Fracture\nthe upper shaft of the right humerus is healed.\n\nEndotracheal tube ends at the level of the aortic arch.  The cuff may slightly\nover distend the trachea.  Esophageal drainage tube passes into the upper\nstomach.  Right central venous catheter ends in the upper right atrium.\n\nAtherosclerotic calcification is not apparent in the head and neck vessels,\nbut is present in coronary arteries, at least the left main and anterior\ndescending branches.  Aortic valve is not calcified.  Aorta and pulmonary\narteries and cardiac chambers are normal size.  Small nonhemorrhagic\npericardial effusion is physiologic.  There is no appreciable pleural\neffusion.\n\nCentral lymph nodes are not enlarged.\n\nAside from mild dependent subpleural atelectasis in both lungs, lungs are\nclear.  Tracheobronchial tree is normal to subsegmental levels.",
            "output": "No evidence of thoracic trauma.  No pneumonia or indication of intrathoracic\nmalignancy.\n\nCoronary atherosclerosis.\n\nCuff of the properly positioned endotracheal tube may be mildly overinflated\nor the trachea may be mildly malacic."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The thyroid is within normal limits. \nThere is no axillary or supraclavicular lymphadenopathy.  There is no\nmediastinal or hilar lymphadenopathy.  Numerous small mediastinal lymph nodes\nare stable.\n\nHEART & VESSELS: The heart is normal in size. The great vessels are normal in\ncaliber. There is mild coronary artery calcified atherosclerosis.  There is a\ntrace, likely physiologic pleural effusion.\n\nLUNGS & AIRWAYS: The airways are patent to the subsegmental level. The lungs\nare clear without focal consolidation or pleural effusion.  There is minimal\natelectasis involving the bilateral lower lobes.  Apical scarring is overall\nunchanged.  Calcified granuloma in the right upper lobe is stable.\nPulmonary nodules:\n2 mm, right upper lobe, 3:73, stable\n6 mm, right upper lobe, 3:75, enlarged from ___ when it measured 3 mm\n6 mm, right lower lobe, 3:99, new\n3 mm, right lower lobe subpleural, 3:110, stable\n4 mm left lower lobe, 3:10 4, new\n5 mm, left lower lobe, 3:101, new\n2 mm, left lower lobe, 3:84, new\n4 mm, left upper lobe, 3:52, new\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions.",
            "output": "Multiple new and enlarging pulmonary nodules as described above consistent\nwith worsening metastatic disease.\n\nScattered, numerous small mediastinal lymph nodes are not pathologically\nenlarged and are stable from the prior examination."
        },
        {
            "input": "HEART AND VASCULATURE: Minimal atherosclerotic calcification of the thoracic\naorta.  There also mild calcifications of the coronary arteries.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple solid spiculated pulmonary nodules are visualized\nbilaterally, many of which have increased in size compared to ___.\nFor example, a solid spiculated nodule within the right lower lobe measures 6\nmm, previously measuring 2 mm (series 5, image 207).  An additional solid\nspiculated nodule within the right lower lobe measures 9 x 7 mm, previously\nmeasuring 6 x 6 mm (series 5, image 197).  There are multiple small nodules\nwithin the lower lobes bilaterally, some of which are new, and others which\ndemonstrate early cavitation (series 3, image 85, 98, 99).  The pleural\nparenchymal scarring seen at the lung apices bilaterally.  Mild dependent\natelectasis.  No focal consolidations.  There is a small tracheal diverticulum\nat the level of the carina (series 3, image 56).  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multiple solid spiculated pulmonary nodules bilaterally, increased in size\nand number compared to ___, some of which demonstrate early\ncavitation, consistent with progression of metastatic disease.\n2. Please refer to the CT abdomen and pelvis for description of the\nintra-abdominal findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Scattered axillary lymph nodes are\nnot enlarged.  Supraclavicular lymph nodes are not enlarged.  Thyroid is\nunremarkable.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not enlarged,stable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is not enlarged.  There is no coronary\natherosclerotic calcifications.\n\nPLEURA: No pleural effusion pneumothorax.\n\nLUNG PARENCHYMA AND AIRWAYS: There are multiple spiculated solid nodules, all\nof which have increased in size since ___.  For example, a\nsubpleural nodule in the left upper lobe measures 1.0 cm (7:136), previously\n0.7 cm.  A subpleural nodule in the superior segment of the left upper lobe\nmeasures 1.0 cm (7:211), previously 0.8 cm.  A subpleural nodule in the\nsuperior segment of the right upper lobe measures 0.9 cm (7:227), previously\n0.8 cm.  A subpleural nodule in the right middle lobe measures 0.8 cm (7:191)\npreviously 0.7 cm.  Some of these nodules are cavitating (7:203, 246),\nunchanged.\n\nThere is scarring in the bilateral lung apices, unchanged.  There is mild\ndependent atelectasis.  There is no consolidations.  A small tracheal\ndiverticulum at the level of the carina (7:146), is unchanged.  Airways are\npatent to the subsegmental levels.\n\nVESSELS:  Main and right pulmonary arteries are not enlarged.  Thoracic aorta\nis not enlarged.\n\nCHEST CAGE: There is no fracture or suspicious osseous abnormality.\n\nUPPER ABDOMEN: Please refer to CTA  abdomen pelvis report dated same day.",
            "output": "1. Multiple spiculated solid nodules, all of which have increased in size\nsince chest CT ___.  Some of these nodules are cavitating,\nunchanged.\n2. Please refer to CT abdomen pelvis for description of intra-abdominal\nfindings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Borderline sized lymph nodes are seen in the\nmediastinum.  Non calcified paratracheal lymph nodes (7, 38).  No abnormal\nvascular findings at the level of the large mediastinal vessels.  Moderate\ncoronary calcifications, mild aortic valve calcifications.  The posterior\nmediastinum shows an unchanged moderate hiatal hernia.  Stable moderate\nbilateral apical scarring.  The pre-existing pulmonary nodules have slightly\ndecreased in size, for example the pre-existing left upper lobe nodule has\ndecreased from 8 to 5 mm in diameter.  A previously 4 mm left upper lobe\nnodule (8, 135) Is now 2 mm in diameter.  Some of the previously spiculated\nand cavitated nodules (8, 119) Are also smaller.  The same pattern is seen in\nthe left lower lobe, here several of the previously cavitated nodules are\nsmaller.  Some of the pre-existing right lower lobe nodules are stable.  No\npleural effusion.  No pleural thickening.  The airways are patent.",
            "output": "As compared to in ___, some of the nodules show stability, some of\nthe nodules are smaller and some of the previously cavitated nodules are again\nsolid, with the cavitations having resolved.  A no growing nodules.  No\npleural effusions."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes at the level of the hilar\nor mediastinal stations.  Mild coronary calcifications, no valvular\ncalcifications.  No pericardial effusion.  Small hiatal hernia.  No\nabnormalities at the level of the large mediastinal vessels.  The abdominal\nfindings are described in detail in the dedicated abdominal CT report that was\ngenerated on ___.\nMild bilateral apical thickening.  Non characteristic scars in the left upper\nlobe (4, 83).  Minimal centrilobular pulmonary emphysema.  Mild irregularities\nand thickening of the airway walls, suggesting the presence of chronic\nbronchitis.  Bilateral basal areas of atelectasis.  Minimally increased\nperibronchial lymphoid tissue, focally in the right lower lobe (4, 251).  No\npleural thickening, no pleural effusions.",
            "output": "No evidence of metastatic disease to the thorax."
        },
        {
            "input": "Thyroid is unremarkable.  No supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  Stable, mild cardiomegaly.  Recommend dedicated cardiac\nimaging for further evaluation.  Minimal aortic arch and coronary artery\ncalcification.  Aorta and main pulmonary artery are normal in size.  New,\nsmall pericardial effusion.  There is a tiny hiatal hernia.\n\nAirways are patent to the subsegmental level bilaterally.  Stable, mild\nbiapical scarring with a calcified granuloma in the left apex.  Stable,\nminimal centrilobular emphysema.  There are two micronodules in the anterior\nright upper lobe (6, 187) and right middle lobe (6, 223).  Stable, 3 mm,\nsolid, subpleural nodule in the right middle lobe (6, 227).  Minimal,\nbibasilar, dependent atelectasis.  Stable, multiple calcified granulomas\nthroughout the right upper and left lower lobes.  No evidence of\nbronchopulmonary infection.  New, small, right pleural effusion.\n\nPlease refer to concurrent CT abdomen and pelvis examination for a complete\ndescription of the intra-abdominal findings.\n\nNo osseous lesions suspicious for malignancy.  No acute fracture.",
            "output": "1.  No evidence of acute intrathoracic infection.\n2.  No evidence of intrathoracic malignancy.\n3.  Stable, mild cardiomegaly.  Recommend dedicated cardiac imaging for\nfurther evaluation.\n\nRECOMMENDATION(S):  Dedicated cardiac imaging for further evaluation of mild\ncardiomegaly.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:55 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland enhances\nhomogeneously throughout.  Chest wall is within normal limits.  Axillary lymph\nnodes are not pathologically enlarged by CT size criteria.\n\nUPPER ABDOMEN: Please refer to the separate dictation under clip number\n___ for details on subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged by size\ncriteria.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal, without a pericardial effusion. \nCoronary artery calcifications are minimal.\n\nPLEURA: Trace pleural effusion on the right.  No pleural effusion on the left.\nThere is no pneumothorax.\n\nLUNG:\nPARENCHYMA:\nMinimal pleural-parenchymal scarring at the lung apices is similar to ___.  Upper lobe predominant centrilobular emphysema is mild.\nMild subpleural reticulation, particularly at the lung bases, are likely\nage-related.\n\nThere is a 3 mm nodule in the lateral segment of the right middle lobe\n(5:193), which is unchanged from the earliest available study of ___.  Slightly more superiorly also in the lateral segment of the right\nmiddle lobe, there is an additional 2 mm pulmonary nodule, also unchanged. \nScattered calcified granulomas are incidentally noted  (5: 45, 189, 202, 246).\nNo new nodules.\n\nAIRWAYS:  Airways are patent to the subsegmental levels.  Minimal bronchial\nirregularity and bronchial wall thickening may be related to bronchitis.\n\nVESSELS:  Thoracic aorta is normal in course and caliber, containing only\nminimal atherosclerotic calcifications.  Main pulmonary trunk is normal in\ncaliber.\n\nCHEST CAGE: No lytic or sclerotic lesions concerning for malignancy.",
            "output": "1. Two pulmonary nodules in the lateral segment right middle lobe measuring up\nto 3 mm, stable since ___.  These ___ be reassessed at the time of\nthe next surveillance CT.\n2. CT abdomen/pelvis dictated separately."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged there are no soft\ntissue abnormalities in the imaged chest wall suspicious for malignancy.  This\nstudy is not appropriate for subdiaphragmatic diagnosis, showing various\ndiscrete hypodensities in the liver, the largest of which are fluid\nattenuation and benign.  The smallest lesions are too small to characterize. \nThere is no adrenal enlargement.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head neck vessels but is\npresent in major coronary arteries.  Aorta and pulmonary arteries are normal\nsize.  There is no pericardial or left pleural abnormality.  Mild right\npleural thickening is attributable to recent surgery also responsible for\nelevation of the right hemidiaphragm.\n\n11 x 20 mm lymph node at the thoracic outlet, 04:31, is unchanged since ___\nPET-CT scan when no FDG avid lymph nodes in the chest were reported. \nElsewhere in the mediastinum and both hila there are no pathologically\nenlarged lymph nodes.  Right hilus and bronchial stump however normal\npostoperative appearance following right upper lobectomy.\n\nEmphysema with considerable subpleural inflammation end bronchial wall\nthickening, is extensive.  There are no lung nodules or pulmonary\nconsolidation.  Peripheral calcifications in the left lower hemithorax could\nbe pleural plaques, subpleural granulomata or osseous metaplastic nodules,\n4:186, 189, not clinically significant.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  Fracture lateral aspect right upper rib, 602b:18 is due probably\nsurgical, as yet incompletely healed.  Chest cage is otherwise intact.",
            "output": "No evidence of new or recurrent intrathoracic malignancy or complication of\nrecent right lower lobectomy.\n\nCoronary atherosclerosis.\n\nSevere emphysema with a strong inflammatory component."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  All mediastinal lymph nodes are normal in\nsize (3, 20).  Mild to moderate calcifications of the aortic wall.  Severe\ncoronary calcifications.  No incidental pulmonary embolism.  No pericardial\neffusion.  Small hiatal hernia.  Multiple cystic lesions in the liver.  No\nabnormalities at the level of the adrenal glands.  Postoperative rib changes\n(8, 21).  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.  The patient is of the right upper lobectomy.  There is\nrelatively extensive bilateral paraseptal pulmonary emphysema.  The resection\nstaples at the stump (5, 112) are unremarkable.  There is no evidence of local\nrecurrence.  The parenchyma of both the right and the left lung show areas of\nmulti segmental mucous airway plugging as well as bilateral subpleural\nfibrotic changes.  Calcified left granulomas, for example (5, 218) No evidence\nof suspicious lung nodules.  No pleural effusions.",
            "output": "No evidence of recurrence after right upper lobectomy.  No lymphadenopathy. \nNo pleural effusions.  Moderate chronic bronchitis with mucous plugging,\nparaseptal pulmonary emphysema.  Bilateral subpleural fibrotic parenchymal\nchanges, likely reflecting smoking-related interstitial lung disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. There is\nno supraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: Right second to fifth rib healed fracture. No evidence of\nosteo-destructive lesions at the level of ribs, vertebra or sternum.\n\nUPPER ABDOMEN: Few stable hypodense well-defined round lesions in the liver\nare likely cysts.  Small cortical cyst in the right kidney.  Remaining\nincluded upper abdominal organs are unremarkable.\n\nMEDIASTINUM: Thoracic inlet lymph node minimally enlarged but not\npathologically enlarged per size criteria (4:35).  Posterior mediastinum is\nunremarkable with the exception of small unchanged hiatal hernia. No hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Moderate calcifications of\nthe coronaries predominantly of the LAD and LCX.  Mild calcifications along\nthe normal caliber thoracic aorta and head and neck vessels.  Main pulmonary\nartery is normal in diameter.  Pericardium is physiologic.\n\nPLEURA: No pleural effusion.  Biapical mild pleuroparenchymal scarring is\nstable.\n\nLUNG: Patient is status post right upper lobectomy, remaining airways are\npatent to the subsegmental level.  Previous right lower lobe multisegmental\nmucus airways plugging has resolved.\nRight upper lobe stump is unchanged in appearance and there is no evidence of\nlocal recurrence.  Again noted bilateral paraseptal emphysema which is\nunchanged since ___.  Also unchanged is relatively extensive subpleural\ncoarse reticulation in the lower lobes.\nNo new lung nodules.\nFew scattered calcified granulomas (4:158).",
            "output": "-No evidence of intrathoracic recurrence or primary malignancy.\n-Unchanged bilateral subpleural fibrotic parenchymal changes, relatively more\nextensive and more severe than generally seen with smoking related\ninterstitial lung disease, raising concern for concurrent pulmonary fibrosis."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal.  No\npathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.  Pronounced bronchial arteries are present.  Coronary\ncalcifications are severe.\n\nImage portion of the upper abdomen demonstrate small hiatal hernia and liver\nhypodensities and otherwise is unremarkable.\n\nExtensive subpleural interstitial opacities and emphysema are demonstrated,\nsimilar to previous examination.  No new nodules masses or consolidations\nseen.\n\nThe patient is after right upper lobectomy with unremarkable appearance of the\nright upper lobectomy stump.",
            "output": "No evidence of local or remote recurrence.\n\nUnchanged bilateral subpleural fibrotic parenchymal changes"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the chest wall.  Stable\nappearance of the large mediastinal vessels.  Mild calcifications of the\naortic wall.  Stable appearance of the postsurgical clips at the level of the\nstump (3, 22), with abundant local vascular collaterals (3, 20).  Subcarinal\nclips are also unremarkable (3, 28).  No incidental pulmonary embolism.  No\nenlarged lymph nodes in the mediastinum.  Severe coronary calcifications\npersist.  No pericardial effusion.  Small hiatal hernia.  Multiple hypodense\nliver cysts.  No evidence of adrenal lesions.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  Stable mild bilateral\napical scarring.  Extensive bilateral subpleural fibrotic changes (302, 95). \nAccompanied by moderate to severe chronic airways disease.  Multiple bronchial\ndiverticular are noted (302, 119).  No suspicious pulmonary nodules or masses.\nNo pleural effusions.",
            "output": "Stable examination of the thorax.  Status post right upper lobectomy without\nevidence of recurrence.  Extensive fibrotic lung parenchymal changes,\nassociated to chronic airways disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla. \nBorderline enlarged lymph node in the thoracic inlet no abnormalities on the\nchest wall. No atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is enlarged with a dilated left atrium.  No pericardial effusion. \nSevere atherosclerotic calcifications in the coronary arteries, none in the\ncardiac valves or aorta. The aorta and pulmonary arteries are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is unremarkable. Small mediastinal lymph\nnodes, none pathologically enlarged by CT size criteria. No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nStatus post right upper lobectomy with unremarkable bronchus stump.  The\nremaining airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging.\n\nParaseptal emphysema is moderate to severe.  Associated pulmonary fibrosis\nresponsible for smaller diameter reticulations, also primarily peripheral has\nprogressed involving more lung, for example right lower lobe, 302:78 today\ncompared to 302:78 in ___ and right middle lobe, 302:134 today with\n302:133 in ___.\n\nSeveral scattered calcified granulomas, for example in the middle lobe\n(302:78).  No evidence of infection.  No suspicious lung nodules or masses. No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Status post right upper lobectomy with no evidence of recurrence or metastatic\ndisease.\n\nSlight interval worsening of the severe pulmonary fibrosis associated with\nparaseptal emphysema.\n\nSevere atherosclerotic coronary calcification."
        },
        {
            "input": "Aorta is top-normal, unchanged.  Pulmonary arteries are normal in diameter. \nCoronary calcifications are severe.  Heart size is enlarged.\n\nNo pericardial pleural effusion is seen.  Small hiatal hernia is present.\n\nImage portion of the upper abdomen demonstrate right kidney cyst, stable as\nwell as liver hypodensities, unchanged.\n\nAirways are patent to the subsegmental level bilaterally.  The patient is\nafter right upper lobectomy with no evidence of local recurrence.  Paraseptal\nemphysema and fibrosis are re-demonstrated, similar in severity but difficult\nto pre size the compared giving the suboptimal inspiratory effort.  Several\nmore nodular opacities are noted and might represent areas of parenchymal\nfibrosis but the nodular nature should be followed, series 302, image 95, 4\nmm, right lower lobe, series 302, image 95, 5 mm, left lower lobe.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of local recurrence\n\nSubstantial pulmonary fibrosis and emphysema\n\nPotentially 2 pulmonary nodules that should be reassessed in 3 months for\ndocumentation of stability.\n\nSevere Coronary calcifications."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging.  Adjacent lymph\nnodes, thoracic outlet have grown, 13 x 32 mm, 2:7, 7 x 20 mm in ___, and 13\nx 15 mm, 2:7, previously 10 x 13 mm.\n\nThere are no soft tissue abnormalities in the chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Moderate size gastric hiatus hernia unchanged.  Esophagus\nis unremarkable.  Atherosclerotic calcification is not apparent head neck\nvessels, but is substantial in coronary arteries, especially left main,\nanterior descending and circumflex.\n\nAorta is normal size.  Biatrial enlargement, should be evaluated by\nechocardiography if not recently performed.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES:\n\nRight upper paratracheal mediastinum, 13 mm, 302:37, previously 4 mm.\n\nLeft lower paratracheal mediastinum, numerous subcentimeter lymph nodes\nslightly larger generally.\n\nSubcarinal, 20 mm, newly enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Right hilum has a normal postoperative appearance\nfollowing upper lobectomy.\n\nNo lung nodules.\n\nExtensive subpleural cystic spaces in the lung periphery could be due in part\nto paraseptal emphysema with a fibrotic component, but generalized pulmonary\nfibrosis is likely.  There has been no progression since ___ when the patient\nwas in mild pulmonary edema.\n\nNo pleural abnormalities.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Progressive mediastinal adenopathy, detailed above, presumably recurrent\nmalignancy.  No compromise of vital structures.\n\nModerate to severe pulmonary fibrosis.\n\nExtensive atherosclerotic coronary calcification."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no axillary lymphadenopathy.\n\nMEDIASTINUM: Right upper paratracheal conglomerate of lymph nodes at the level\nof the thoracic inlet measures 3.4 x 1.2 cm (5:34), previously measuring 3.0 x\n1.4 cm.  A prevascular lymph node measures 1.4 cm (5:50), previously measuring\n1.0 cm.  Also seen is subcarinal heterogeneous density measuring approximately\n3.5 x 2.8 cm (5:136) which likely represents enlarging subcarinal\nlymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and VASCULAR: There is reflux of contrast into the hepatic veins and\nenlargement of the right heart concerning for right heart failure.  There is\nno pulmonary embolus to the level of the subsegmental arteries.  The thoracic\naorta is normal in caliber without evidence of dissection.  There is\nmulti-vessel coronary artery and aortic calcifications.  No pericardial\neffusion is identified.\n\nPLEURA: There is a small right pleural effusion.\n\nLUNG: Patient is status post right upper lobectomy.  Stable calcified\ngranulomas are seen bilaterally.  There is redemonstration of centrilobular\nemphysema.  There is redemonstration of extensive subpleural cysts, consistent\nwith fibrosis.\n\nCHEST CAGE: No suspicious osseous lesions are identified. Although there are\nno bone lesions in the imaged chest cage suspicious for malignancy or\ninfection, it should be noted that radionuclide bone and FDG PET scanning are\nmore sensitive in detecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN: The study was not tailored for evaluation of the\nsubdiaphragmatic structures.  Within these limitations: There is a hiatal\nhernia.  Multiple known hypodense hepatic lesions are redemonstrated,\npreviously described as hepatic cysts.  Small amount of abdominal ascites is\nseen.",
            "output": "1. No evidence of pulmonary embolus as clinically questioned.\n2. Interval progression of mediastinal lymphadenopathy described in detail\nabove, concerning for metastatic disease.\n3. New small right pleural effusion.\n4. New small of ascites.\n5. Redemonstration of pulmonary fibrosis.\n6. Findings consistent with right heart failure.  Correlation with\nechocardiography is recommended if not previously performed.\n\nNOTIFICATION:  As requested, preliminary findings were communicated with\n___, NP via telephone by ___, MD on ___\nat 14:30."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is top normal in caliber measuring up to 3.6 cm (06:58). \nHowever, there is no evidence of dissection or intramural hematoma.  The heart\nis mildly enlarged.  There are mild coronary artery atherosclerotic\ncalcifications.  The pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Area of increased lucency at the left lung apex medially,\npotentially due to air trapping.  Few clustered right apical pulmonary nodules\nare identified as well as biapical scarring.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Subcentimeter hypodensities at the hepatic dome are too small to\ncharacterize.  Otherwise, the included portion of the upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nChronic fracture deformity of the right lateral seventh and eighth ribs is\nseen.  Mild multilevel degenerative changes are seen throughout the thoracic\nspine including loss of intervertebral disc space height and anterior\nosteophyte formation.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary lymph nodes are not enlarged.\nThere has been interval increase in size of mediastinal lymph nodes for\ninstance a right upper paratracheal lymph node measuring 16 mm was 4 mm, 22 mm\nlymph node in the right lower paratracheal station was 4 mm.  Right hilar\nlymph node measuring 18 mm was 7, subcarinal lymph node measuring 12 mm was 7\nmm.  Other smaller lymph nodes in the right hilum are difficult to evaluate\nbut appears to be also increased\nSmall right pleural effusion is new\nInnumerable lung nodules chest large metastasis have increased in number and\nsize, largest in the right upper lobe measures 14 mm (03:27), largest in the\nright middle lobe measures 17 mm (03:31), largest in the right lower lobe\nmeasures 17 mm (03:34), largest in the left lower lobe measures 20 mm (03:39)\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there There are moderate calcifications in all coronary arteries.  . \nPacer lead is in standard position.  Hypodensity of the cardiac chambers\ncompared to the myocardium suggests anemia.\nIn the right axilla appears to be a peripheral line with tip in the axillary\nvein.\nPlease see concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are new lytic lesions in the vertebral bodies of T9 and T11",
            "output": "Progression of disease with interval increase in mediastinal and hilar\nlymphadenopathy, innumerable lung metastases and new lytic lesions in the\nvertebral bodies of T9 and T11\nNew small right pleural effusion\nNo evidence of pneumonia or pulmonary edema\n.\n\nNOTIFICATION:\n___ d/w Dr. ___ at 7:39PM, 10 mins after observation."
        },
        {
            "input": "VASCULATURE: No pulmonary embolus demonstrated.  No findings of right\nventricular strain.\n\nCHEST: There are small bilateral pleural effusions with associated compressive\natelectasis.  Aside from a calcified granuloma in left lower lobe (3:149), the\nremaining lungs are clear. There is no lymphadenopathy in the chest.\n\nABDOMEN AND PELVIS: There is nodular contour of the liver suggestive of\nadvanced cirrhosis.  Mild gallbladder wall edema can be secondary to\nhepatocellular disease. The spleen, pancreas, and kidneys are unremarkable.\n\nThere is no intestinal obstruction or ascites.  No abdominal or pelvic\nadenopathy.  A Foley catheter is noted.  The prostate is unremarkable.  There\nis no aggressive osseous lesion.  An IVC filter is noted.  There is diffuse\nsubcutaneous soft tissue edema which in the setting of retroperitoneal mild\nstranding and small bilateral pleural effusions could represent third spacing.",
            "output": "1. No pulmonary embolism.  Small bilateral pleural effusions.\n2. Findings suggestive of third spacing.\n3. Nodular contour of the liver concerning for advanced cirrhosis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the distal segmental level. \nThere is a partially occlusive filling defect within the distal branch of the\nanterior segment of the left upper lobe (series 301, image 79).  No other\nfilling defects identified.  There is no filling defect within the main,\nright, left or lobar pulmonary arteries.  Subsegmental branches are\nsuboptimally assessed.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nSubsegmental atelectasis are noted at the lung bases bilaterally.  There is no\nfocal airspace consolidation.  No evidence of interstitial pulmonary edema. \nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Partially occlusive filling defect within the distal anterior segmental branch\nof the left upper lobe consistent with segmental PE.\n\nRECOMMENDATION(S):  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:33 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no\nsoft tissue abnormality in the imaged chest wall concerning for malignancy.\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal abnormality.\n\nCardio mediastinum:\n\n Transesophageal tube ends in the distal stomach.  Esophagus is unremarkable.\nThere are no findings in the imaged thyroid concerning for malignancy.\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries. No aortic valvular calcification. Pericardium is physiologic.\n\nThoracic lymph nodes:\n\nNone enlarged.\n\nAirway, lungs, and pleura:\n\nPleural effusion is minimal if any, difficult to separate from improving\nminimal dependent atelectasis, nearly cleared since the previous 2\nexaminations.\n\nMicro nodularity in the upper lung zones is usually an indication of bronchial\ninflammation, most Common in smokers. Non physiologic shape of the mid trachea\nis sometimes an indication of tracheomalacia.  There is no bronchiectasis or\nretention of secretions. Lungs are otherwise clear. There is no pneumonia nor\nhas there been any evidence of pneumonia on the preceding 2 CTA scans.\n\nChest cage:\n\nUnremarkable.",
            "output": "No pneumonia.  Minimal residual dependent atelectasis.\n\nTracheal shape is sometimes associated with tracheomalacia.  Probable\ninflammatory bronchiolitis, usually seen in cigarette smokers."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no suspicious thyroid\nlesions.  There is no supraclavicular or axillary lymphadenopathy.  There are\nno suspicious chest wall lesions.\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen and pelvis\nperformed on the same day for description of the subdiaphragmatic findings.\n\nMEDIASTINUM: There are multiple subcentimeter mediastinal lymph nodes\nmeasuring up to 7 mm in the subcarinal station, not pathologically enlarged\nbased on CT size criteria.  There is no mediastinal mass.  The esophagus is\nunremarkable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The thoracic aorta is normal in caliber with minimal\natherosclerotic calcifications.  There are severe coronary artery\natherosclerotic calcifications.  Otherwise, the are and pericardium are within\nnormal limits.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is biapical pleuroparenchymal scarring.  There are\nmultiple foci of ground-glass opacities bilaterally in the right lower lobe\n(4:195, 4:228, 4:256, 4:285), right upper lobe (4:144), and left lower lobe\n(4:197, 4:243).  Several of these foci demonstrate more central consolidative\nand nodular components (4:195, 4:253, 4:183, 4:205 and 4:207), the largest in\nthe right lower lobe measuring 14 mm (4:184).  There is a solid pulmonary\nnodule in the left upper lobe measuring 2 mm (4:156).\n2. AIRWAYS:  The airways are patent to the subsegmental bronchi bilaterally.\n3. VESSELS:  The pulmonary vasculature is unremarkable.\n\nCHEST CAGE: There is a chronic deformity of the left lateral second rib\n(4:58).  Otherwise, there are no suspicious lytic or sclerotic osseous\nlesions.",
            "output": "1. Multiple bilateral foci of ground-glass opacities most likely represents\nmultifocal pneumonia.  Additional differential considerations include\nhemorrhage and vasculitis, which can give a similar appearance in the\nappropriate clinical context.  If there is a clinical concern for pneumonia,\nantibiotics and follow up to resolution is recommended.\n2. Indeterminate solid pulmonary nodule in the left upper lobe measuring 2 mm.\nSevere coronary artery atherosclerotic calcifications, which may be\nhemodynamically significant.\n3. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for description of the subdiaphragmatic findings.\n\nNOTIFICATION:  Dr ___ findings with Dr ___, by telephone, 2PM on\n___."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  There are severe coronary artery atherosclerotic\ncalcifications and mild atherosclerotic calcifications in the thoracic aorta. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  There is unchanged\nbiapical pleuroparenchymal scarring.\n\nLUNGS/AIRWAYS: There has been interval resolution of the bilateral\nground-glass opacities, which were likely infectious or inflammatory.  Lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nOTHER: The thyroid is normal.  There is a chronic deformity of the left\nlateral second rib (5; 31).  There are no other sclerotic or lytic osseous\nlesions.\n\nPlease refer to separate report of CT abdomen and pelvis performed on the same\nday for description of the subdiaphragmatic findings.",
            "output": "1. No radiographic evidence of intrathoracic metastases.\n2. Interval resolution of bilateral ground-glass opacities, which were likely\ninfectious or inflammatory.  Unchanged biapical pleuroparenchymal scarring.\n3. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for description of the subdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  Note is again made of chronic\ndeformity involving the lateral aspect of the second rib on the left.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There stable small mediastinal lymph nodes.  No enlarged hilar\nlymph nodes.  There is moderate coronary artery calcification.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  Tiny 2-3 mm nodules in\nboth apices are unchanged.  No new or growing pulmonary nodules.  Subpleural\nnodularity in both upper lobes posteriorly is unchanged.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable biapical pleuroparenchymal scarring and subpleural nodularity in both\nupper lobes.  No new or growing pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue lesions in the wall of the chest or imaged upper\nabdomen or bone abnormalities in the chest cage suspicious for malignancy or\ninfection.\n\nLymph nodes in the mediastinal stations, including internal mammary,\ndiaphragmatic, and retrocrural locations are not pathologically enlarged.\nHilar contours do not suggest lymph node enlargement in the the and\nnonenhanced hila, despite chronic granulomatous calcifications in the left\nhilum.  Atherosclerotic calcification is heavy in the coronary arteries which\nmay be stented. Heart is not enlarged.  Tiny pericardial effusion is\nphysiologic. There is no pleural effusion. Pulmonary arteries and aorta are\nnormal caliber.\n\nThere several different areas of pulmonary abnormality, all relatively mild,\nsome chronic. Subpleural reticulation in the posterior and lateral basal\nsegments of the right lower lobe, 5:231-251, and in the superior and posterior\nbasal segments of the left lower lobe, 5:154- 232, allowing for differences in\nradiographic collimation, is probably unchanged since ___ in ___. There is\nnew mild peribronchial ground-glass opacity in the left lower lobe, that\nincludes 2 new small nodules, 5:203-207. Also new is minimal subpleural\ninterstitial reticulation in the anterior segments of the upper lobes, 5:77,\nreminiscent of the more chronic lower lobe changes.\n\nAppearance of lung abnormalities on the chest CT is less extensive than I\nwould have expected given the appearance of the lungs on ___ chest\nradiographs. I suspect that an acute atypical pneumonia has nearly resolved.",
            "output": "Multifocal but very mild interstitial pulmonary abnormality, largely chronic\nsince ___ and ___ looks like minimal nonspecific interstitial pneumonitis.\n\nNew, also mild peribronchial ground-glass infiltration and 2 tiny nodules in\nthe left lower lobe, chronicity indeterminate, since these are not the\nabnormalities present and questioned on the most recent chest radiographs, ___, which have largely resolved.  I would obtain baseline chest\nradiographs now, including oblique views to see which of these findings can be\nseen and subsequently monitored with conventional radiography rather than CT\nscanning."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. There are no pathologically enlarged\nmediastinal, axillary, hilar lymph nodes.  As noted before, there are a few\nscattered left hilar and right upper paratracheal lymph nodes as well as\ncalcified granulomas in the left lung, indicative of prior granulomatous\ninfection.  The heart is normal in size and there is no pericardial\neffusion.Diffuse coronary artery calcification and coronary stents are again\nnoted.  The aorta and main pulmonary artery are normal in caliber. Limited\nevaluation of the upper abdomen demonstrates sutures from the liver transplant\nand expected pneumobilia in the nondependent aspect of the left lobe of the\nliver.\n\nLungs: The airways are patent to the subsegmental level bilaterally. No large\nconsolidation, mass, or pneumothorax.  Mild centrilobular and paraseptal\nemphysema.  Undulation in the contour of scattered bronchi is indicative of\nvaricose bronchiectasis.  There is also mild increase in caliber of a few\nsmall airways.  Previously seen interstitial opacities have resolved, as have\nthe pulmonary nodules, which were likely infectious.  No new or concerning\nnodules are identified.  There is redemonstration of subpleural thickening and\nreticulation particularly of the lower lobes bilaterally, indicative of\ninterstitial lung disease.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Interval resolution of previously seen interstitial opacities indicative\nof atypical infection, and resolution of infectious nodules, with no\nconcerning pulmonary nodules.\n2.  Redemonstration of intersitial lung disease, not progressed since the\nprior study.\n3.  Varicose bronchiectasis, which may related to chronic aspiration, however\nno other sign of aspiration are seen.\n\nRECOMMENDATION(S):  No pulmonary nodules. Continued screening is recommended\nper patient's risk factor for lung cancer."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal lesion.  Patient has had liver\ntransplant.  Pneumobilia is unchanged.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels but extensive in the coronary arteries. \nAorta and pulmonary arteries are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.  Granulomatous calcifications left hilar nodes are unchanged and\ndo not compromise the bronchial tree.\n\nLUNGS, AIRWAYS, PLEURAE: Subpleural reticulation, minimal in the anterior\nupper lobes, moderate at the right lung base, less pronounced on the left is\nall unchanged.  The right lower lobe component has mild traction\nbronchiectasis, but there is no honeycombing or peribronchial ground-glass\nopacification.\n\nNo lung nodules.  No definite pleural thickening or pleural effusion.\n\nMild to moderate air trapping in the lower lobes indicates a component of\nsmall airway obstruction.\n\nCHEST CAGE:",
            "output": "Stable fibrosing lung disease, has not progressed from relatively restricted\ninvolvement, moderate right lower lobe, mild left lower lobe.  No evidence of\nactive alveolitis.\n\nMild bibasilar air trapping could could could be due to transplant related\nbronchiolitis obliterans."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The coronary arteries demonstrate extensive calcifications.  The\nesophagus is normal without evidence of wall thickening or a hiatal hernia. \nThe aorta is normal in caliber.  The main pulmonary artery is normal in\ncaliber.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nSubpleural reticulation, moderate at the lung bases bilaterally, right greater\nthan left with mild traction bronchiectasis appears slightly progressed\ncompared to the prior exam.  There is no honeycombing or peribronchial\nground-glass opacification.  Additionally, subtle increased consolidation is\nseen at the right base.  No new lung nodules are seen.  There is no large\npleural effusion or pneumothorax.  Left perifissural lung nodule with central\ncalcification measuring 7 mm appears grossly unchanged compared to the prior\nexam.",
            "output": "-Slight interval increase in the extent of fibrosing lung disease compared to\nthe exam from ___. Additionally, subtle interval increase in\nopacities at the right lung base could be secondary to aspiration/infection.\n-Stable 7 mm left perifissural lung nodule with central calcification compared\nto the prior exam.  No concerning new or growing pulmonary nodules identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable.  No\naxillary adenopathy.\n\nUPPER ABDOMEN: Cholecystectomy surgical clips are noted in the gallbladder\nfossa.  There is a nonobstructed 4 mm calculus within right kidney.  Two 2.0\ncm and 1.7 cm left renal cortical cysts and an exophytic 1.6 cm renal cysts\nare partially visualized and were better assessed in the ___ CT\nurogram.\n\nMEDIASTINUM:No abnormal mediastinal masses or adenopathy.\n\nHILA: Small calcified hilar lymph nodes are seen.  No abnormal hilar masses or\nadenopathy within the limitations of this noncontrast enhanced scan.\n\nHEART and PERICARDIUM: There is extensive coronary vascular atherosclerotic\ncalcifications and aortic root calcifications.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Bilateral peripheral subpleural ___ opacities most\nnotable in the middle lobe, lingula and bilateral lower lobes suggest\ninfectious process.  Additionally, there is a subpleural 5 mm nodule in the\nleft lower lobe (5:184), which is unchanged since ___ CTA chest, and\na cluster of sub-4 mm nodules in the peripheral right upper lobe and middle\nlobe (5:162, 197, 209) all of which are unchanged since ___ CTA\nchest.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally\n3. VESSELS:  Mild calcified plaque within the thoracic aorta.  Extensive\ncoronary vascular atherosclerotic calcification and aortic root calcification\nas mentioned above.\nCHEST CAGE: Mild multilevel degenerative disc disease of the thoracic spine. \nIs of osseous lesions.",
            "output": "1. Bilateral peripheral ___ opacities predominant in the lower lung\nfields likely reflect an infectious process.\n2. Scattered bilateral subcentimeter pulmonary nodules, some of which were\nidentified in the recent ___ CTU, are stable dating back to ___ CTA chest.  No suspicious pulmonary nodules or masses."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Multiple left renal cysts are redemonstrated.  Status post\ncholecystectomy.  The imaged upper abdomen is otherwise unremarkable.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: No hilar mass.\n\nHEART and PERICARDIUM: Heart size is normal.  There are extensive coronary\nartery calcifications.  Dense aortic valvular calcifications are present.  No\npericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Left upper lobe.  Scarring, unchanged.  Ground-glass opacity\nin the anterior right upper lobe is new (4:90).  Numerous predominantly\nsubpleural nodules are redemonstrated: 4 mm right upper lobe (4:13), 4 mm\nright upper lobe (4:20), 4 mm right middle lobe (4:157), a 4 mm left lower\nlobe subpleural (4:76).  The right lower lobe 12 mm sub solid nodule seen on\nabdominal CT now has a more ground-glass appearance (4:153).  There is\nworsening subpleural reticulation and new ground-glass opacities in both lower\nlobes, and anteriorly along the right middle lobe.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Main pulmonary artery is normal in caliber.  Thoracic aorta is\nnormal in caliber with mild calcified atherosclerotic plaque.\n\nCHEST CAGE: No aggressive osseous lesion or acute fracture.",
            "output": "1. Worsening subpleural reticulation and ground-glass opacities, suspicious\nfor interstitial lung disease.  6 month follow-up chest CT is recommended.\n2. Numerous stable predominantly subpleural pulmonary nodules.\n\nRECOMMENDATION(S):  6 month follow-up chest CT."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmoderate coronary artery calcification.  There is mild calcification involving\nthe mitral annulus and aortic annulus.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The interstitial abnormality with a craniocaudal gradient comprising of\nperipheral reticular opacities in both lung bases associated with mild\nground-glass opacification is unchanged.  The lung volumes are preserved.\n\nThere is no evidence of honeycombing.\n\nThe previously visualized ground-glass opacity in the right upper lobe has\nresolved and was most likely inflammatory.  The subpleural 3 mm right middle\nlobe pulmonary nodule (6, 123 and a subpleural left lower lobe 3 mm pulmonary\nnodule (6, 143 are unchanged.  No new pulmonary nodules.  Minimal bibasilar\natelectasis.  A subpleural left lower lobe pulmonary nodule measuring 4 mm has\nalso resolved and most likely represented atelectasis.  Stable subpleural\nnodularity.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Stable interstitial abnormality comprising of a subpleural reticulation and\nground-glass opacities in both lung bases, most likely represents fibrotic\nNSIP.\n\nThe right upper lobe ground-glass opacity in the left lower lobe subpleural\nnodules have resolved in the interim and were most likely inflammatory.  New\npulmonary nodules.\n\nThe other 2 pulmonary nodules measuring 4 mm are unchanged.  No new pulmonary\nnodules.\n\nRECOMMENDATION(S):  ___ year follow-up is recommended."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate aortic wall calcifications, mild to\nmoderate coronary calcifications.  No pericardial effusion.  Small hiatal\nhernia.  Status post gastric surgery.  No abnormalities are noted in the upper\nabdomen.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nThe shape of the trachea (5, 71) is highly suggestive of\ntracheobronchomalacia, which could explain the clinical presentation of the\npatient.  The diameter of the right and left main bronchus.  Is also decreased\n(5, 105).  There is no evidence of interstitial lung disease but areas of\nrelatively extensive atelectasis in the right lung basis are seen, following a\nelevation of the right hemidiaphragm.  Non characteristic scarring at the lung\nbases.  No pleural effusions.  No pleural thickening.  No suspicious lung\nnodules or masses.  The airways are patent.",
            "output": "Moderate to severe coronary calcifications.  The shape of the trachea is\nhighly suggestive of tracheobronchomalacia.  This suspicion could be\nsubstantiated with an expiratory CT.  No suspicious pulmonary findings.  Non\ncharacteristic areas of scarring and atelectasis, notably at the right lung\nbasis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Heart size is top-normal.  There is moderate calcified\ncoronary atherosclerosis.  The thoracic aorta is normal in caliber. \nIncidental note is made of a common origin of the left common carotid and\ninnominate arteries.  The right pulmonary artery is enlarged with a diameter\nof 2.9 cm.  No evidence of pulmonary embolus to the segmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the subsegmental level.  There is\nmild dependent atelectasis.  No significant consolidations or pulmonary\nnodules.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is trace\nintrahepatic biliary ductal dilation with no obstructing process identified. \nThe gallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of laceration.  Hypoattenuating renal lesions are too small to\ncompletely characterize, but statistically likely reflect simple cysts.  No\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is apparent\nwall thickening and mucosal hyper enhancement of the descending and sigmoid\ncolon.  The appendix is normal.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nExtensive atherosclerotic disease is noted.  There is partially thrombosed\nfusiform aneurysmal dilation of the left internal iliac artery measuring 1.5\ncm in diameter.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nStatus-post right hip arthroplasty.  Mild lumbar spine degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is unremarkable.",
            "output": "1. No evidence of an acute traumatic abnormality in the chest, abdomen, or\npelvis.\n2. Possible descending and sigmoid colitis.\n3. Partially thrombosed fusiform aneurysm of the left internal iliac artery\nmeasuring 1.5 cm in diameter.\n4. Enlarged right pulmonary artery raising the possibility of pulmonary\nhypertension."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, mediastinal, axillary, and hilar\nlymph nodes are not pathologically enlarged.  Thoracic aorta and main\npulmonary artery are normal size.  There is no pericardial effusion.\n\nAirways are patent to subsegmental levels.  Bibasilar atelectasis is mild. \nThere is no pleural effusion.\n\nHiatal hernia is small.  Multiple hypodense lesions in the liver are\nidentified.  Larger lesions are compatible with simple cyst, however most of\nthem are too small to be fully characterized.  2.0 cm left adrenal nodule is\nconsistent with an adenoma.  Visualized upper abdomen is otherwise\nunremarkable.\n\nOld fractures in left scapula, left ___ ribs and right 7 ribs are new from\n___ but morphologically appear chronic.\n\nMild compression fracture of T4, T6, T10 vertebral bodies and severe T12\nvertebral body compression fracture are similar to ___. Mild compression\nfracture of T5 and T7 vertebral bodies are new since ___ but otherwise\nindeterminate age.",
            "output": "1. Mild compression deformities of the T5 and T7 vertebral bodies are new\nsince ___ but otherwise indeterminate chronicity.\n2. Multiple old fractures are identified in multiple thoracic vertebral\nbodies, bilateral ribs, and left scapula.\n3. Left adrenal adenoma."
        },
        {
            "input": "THORACIC INLET: Thyroid gland appears relatively atrophic.  No supraclavicular\nlymphadenopathy is seen.\n\nBREAST AND AXILLA  : No axillary lymphadenopathy VP shunt is seen in the\nsubcutaneous tissue of the anterior right chest.\n\nMEDIASTINUM: No mediastinal or hilar lymphadenopathy is seen.\n\nHEART, VESSELS and PERICARDIUM: There are mild atherosclerotic calcifications\nalong the aorta. Coronary artery and aortic valve calcifications are seen.  No\npericardial effusion is seen.\n\nPLEURA: No pleural effusion or pneumothorax is seen.\n\nLUNG: There is mild bilateral lower lobe atelectasis.  No focal consolidation\nis seen.\n\nBONES : There is a subtle nondisplaced fracture of the posterior right eighth\nrib (series 3, image 63).\n\nUPPER ABDOMEN: Although study is not dedicated for subdiaphragmatic\nevaluation, the patient is status post cholecystectomy.  VP shunt is seen\ncoursing and coiling into the upper abdomen.  There are moderate\natherosclerotic changes/calcifications along the imaged aorta.",
            "output": "Subtle nondisplaced fracture of the posterior right eighth rib.  No pleural\neffusion or pneumothorax."
        },
        {
            "input": "HEART AND VASCULATURE: There is a filling defect within the distal left main\npulmonary artery at the bifurcation of the left upper and lower lobar\npulmonary arteries consistent with pulmonary embolism (2; 55).  There are\nfilling defects in the right interlobar pulmonary artery consistent with\npulmonary embolism (2; 61) as well as a filling defect in a segmental branch\nof the right lower lobar pulmonary artery (2; 79).  There is no CT evidence of\nright heart strain.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  Mild coronary artery calcifications are\nseen.  Mild atherosclerotic calcifications are seen in the descending thoracic\naorta.  The heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Peripheral wedge-shaped opacities in the right lower lobe are\nconcerning for pulmonary infarcts likely combined with atelectasis.  Also\nnoted is atelectasis in the left lung base.  Emphysema is noted.  No worrisome\nnodule or mass.  Central airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck again demonstrates a\n1.3 cm hypodense right thyroid nodule (2; 14).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nChronic healing fractures are seen in the right lateral fifth through seventh\nribs.  There is a deformity at the left inferior scapula likely related to\nprior injury, with incomplete healing.",
            "output": "1.  Bilateral lobar and segmental pulmonary embolism without CT evidence of\nright heart strain.  Right lower lobe linear and wedge-shaped opacities raise\nconcern for pulmonary infarction.  Background emphysema noted.\n2.  Deformity at the inferior left scapula, appears subacute, please correlate\nfor focal pain.\n\nNOTIFICATION:   The findings were discussed with ___, Medical\nStudent by ___, M.D. on the telephone on ___ at 7:42 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "Evaluation of the lung parenchyma is somewhat limited by respiratory motion.\nHowever there is a 3.8 x 3.4 cm lobulated hypoenhancing mass in the left upper\nlobe (3:22). There are numerous other pulmonary nodules with irregular\nmargins. For example there is a 2.0 x 1.4 cm nodule in the left upper lobe.\nThere is a 1.1 x 1.0 cm peripheral nodule in a right lower lobe. There are\nalso ground-glass nodules such as a 1.5 x 1.3 cm lesion in the right middle\nlobe (5:129). The airways are patent to the subsegmental level. There is no\npleural effusion.\n\nThere is a 4 mm hypodensity in the left lobe of the thyroid. There are no\npathologically enlarged axillary, mediastinal, or hilar lymph nodes by size\ncriteria. However there is a left axillary lymph node with abnormal appearing\nmorphology (5:62). The thoracic aorta is normal in caliber with a typical\nthree vessel takeoff from the arch.  The pulmonary arterial trunk is normal in\ncaliber.  The heart is normal in size without pericardial effusion. Coronary\ncalcifications are noted.\n\nSubdiaphragmatic structures are described in a separate report. There are two\nosseous lytic lesions in the T5 and T7 vertebral bodies, measuring up to 0.9\ncm (5:91,121).",
            "output": "1. Numerous pulmonary metastases including a 3.8 cm mass in the left upper\nlobe.\n2. Two small lytic lesions in the thoracic spine as described above,\nsuspicious for osseous metastasis.\n3. Indeterminate left axillary lymph node, not enlarged by size criteria but\nwith abnormal morphology.\n4. Please see separate CT abdomen/pelvis report regarding subdiaphragmatic\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal. Supraclavicular\nand axillary nodes are not enlarged.\nThere are no soft tissue abnormalities in the chest wall concerning for\nmalignancy.\n\nUPPER ABDOMEN: The imaged portion of the abdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.\n\nHILA: A perihilar right upper lobe mass extends to the mediastinum and appears\ncontinuous with the subcarinal nodal conglomerate measuring up to 11 mm\n(02:27).  A lower left paratracheal node measures up to 13 mm in short axis\n(02:29).\n\nHEART and PERICARDIUM: Heart is normal size. Coronary arteries are not\ncalcified.  Trace pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG: A dominant perihilar and right upper lobe mass measures 5.5 x 4.3 x 5.2\ncm (4:121/5:73).  The mass encases the lobar and proximal segmental pulmonary\narterial branches in the right upper and middle lobes.  It directly encases\nthe distal right main pulmonary artery and very likely involves the right\nmainstem bronchus.  There is marked narrowing of the bronchus intermedius\nwhich remains patent.  Tumor involves the right upper lobe bronchus and\nproximal segmental airways of the right upper lobe.  Right middle lobe\nbronchus and proximal segmental airways appear occluded with invasion by\ntumor.  Tumor occludes the right upper lobe pulmonary vein.\n\nAlso noted is a pulmonary nodule in the right upper lobe measuring 1.4 x 1.2\ncm (4:105).  A subpleural right lower lobe nodule measures 10 mm (4:130). \nAdditional subcentimeter pulmonary nodules are present (4: 95, 109, 143, 163,\n182).  There is upper lobe dominant primarily paraseptal emphysema with\nsubpleural fibrosis most notable in the posterior left lower lobe. \n___ opacities are seen in the right upper and middle lobes,\naccompanied by mucous plugging.  This latter appearance suggests\npostobstructive bronchial inflammation.\n\nThere is no pleural effusion pneumothorax.\n\nThe aorta and pulmonary artery are normal caliber.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.",
            "output": "1.  Parihilar right upper lobe mass measuring up to 5.5 cm which is locally\ninvasive including extensive central airway in vascular involvement.\n2.  Mediastinal lymphadenopathy with subcarinal nodes appearing probably in\ncontinuity with the dominant right upper lobe mass."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcifications of normal caliber\nthoracic aorta mild atherosclerotic calcifications at the origins of the great\nvessels.  The heart, pericardium, and great vessels are within normal limits\notherwise based on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent given limitations of unenhanced scan.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: Moderate to large right pleural effusion.  No left pleural\neffusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: S/p debulking and restenting of the right mainstem bronchus,\nwith interval collapse of the right lung.  Near complete opacification of the\nright mainstem bronchus, slightly patent proximally.  Left upper lobe\npredominant centrilobular and paraseptal emphysema.  Pulmonary nodule\nmeasuring 4-5 cm along the superior aspect of the left lower lobe, previously\nmeasuring 3-4 mm.  Redemonstrated nodularity along the superior aspect of the\nleft lower lobe (image 18 series 301), this may reflect metastatic disease\nversus infectious/inflammatory process.  New area of subpleural nodularity\nalong the posterolateral left lower lobe (image 42, series 301), this may\nreflect a superimposed infectious/inflammatory process, metastatic/neoplastic\nprocess less likely but can't be completely excluded.\n\nBASE OF NECK: Scattered infraclavicular mildly prominent lymph nodes, more\nnoted on the right.  Thyroid is unremarkable.\n\nABDOMEN: Motion artifact limiting evaluation.  Scattered mildly prominent\nretroperitoneal lymph nodes., similar to PET-CT from ___..\n\nBONES: Interval development of mildly displaced left seventh lateral rib\nfracture, with associated soft tissue component that, and probable pleural\ninvolvement (image 157, series 301), correlate for mechanism of injury.",
            "output": "1. Status post debulking and right mainstem bronchus restenting, with interval\npostobstructive collapse of the right lung, and near complete opacification\nand probably fluid level within the right mainstem bronchus, with minimal\nresidual bronchus patency noted proximally.\n2. Moderate to large right pleural effusion.\n3. Redemonstrated scattered areas of ___ nodularity along the superior\naspect of the left lower lobe, with new areas of nodularity in the left lower\nlobe, this may reflect an infectious/inflammatory process, however\nmetastatic/neoplastic process cannot be completely excluded.\n4. Left seventh lateral rib fracture with adjacent soft tissue component and\nprobable adjacent pleural involvement.  Correlate with mechanism of injury, as\nthere was no focal abnormality in this region in ___.  Possibility of\nmetastatic disease with associated pathologic fracture should be considered."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild atherosclerotic calcification of the\nthoracic aorta and its branches.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a moderate size right pleural effusion which is\ndecreased in size from ___.  There is a small left pleural\neffusion..\n\nLUNGS/AIRWAYS: There are post treatment changes from debulking and restenting\nof the right mainstem bronchus.  There is now a 5.6 x 4.7 cm hypoattenuating\nmass involving the right mainstem bronchus (series 6, image 134).  The mass\nextends in the mediastinum.  The right bronchial stent now appears patent.\nThere is mild re-expansion of the right lower lobe.\nThere are bibasilar nodular and ground-glass opacities involving the right\nlower lobe, left upper lobe and left lower lobe which are much more extensive\nthan seen on ___.  These may represent an infectious/inflammatory\nprocess versus metastatic disease..\nAgain seen is centrilobular and paraseptal emphysema at the left upper lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Evaluation of the upper abdomen is limited due to low dose and lack\nof contrast.\n\nBONES: There is an expansile lesion involving the left seventh rib measuring\n3.8 cm in diameter (series 5, image 96).  This is markedly increased in size\nfrom ___ and is concerning for malignancy.  There is a lytic lesion\ninvolving the anterior T3 vertebral body, increased in size from ___, which is also concerning for malignancy.  There is an expansile lytic\nlesion involving the manubrium which is increased in size, now measuring\napproximately 2.9 cm in diameter.  There is an expansile lesion in the T4\nspinous process measuring up to 2.1 cm, which is new.",
            "output": "1.  Hypoattenuating mass involving the right mainstem bronchus consistent with\nknown malignancy.\n2.  The right bronchial stent is now patent and the right pleural effusion has\nslightly decreased in size, with re-expansion of the right lower lobe.\n3.  Multiple new or enlarged expansile lytic metastases within the axial\nskeleton.  This includes lesions in the left seventh rib, the manubrium, the\nT3 vertebral body and the T4 spinous process.\n4.  Increased bibasilar ground-glass and consolidative opacities, which could\nrepresent atelectasis or an infectious/inflammatory process.\n5.  Small left pleural effusion with associated atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  Coronary artery calcifications are\npresent.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nUnchanged scattered subcentimeter mediastinal lymph nodes do not meet CT size\ncriteria for enlargement.  Stable 1.8 x 0.9 cm epipericardial lymph node is\nenlarged however demonstrates a central fatty hilum (02:41).  No mediastinal\nmass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Again seen is centrilobular emphysema with mild bilateral\nlower lobe bronchiectasis and peribronchial wall thickening.  Previously noted\nleft upper lobe scarring and bronchiectasis is again seen (601b:57).  No\npulmonary nodule.  There is new interlobular septal thickening primarily\ninvolving the left upper lobe and lung bases.  No focal opacity.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for\nsmall hiatal hernia.  The gallbladder is surgically absent with clips in the\ngallbladder fossa.  Again seen are subcentimeter periportal lymph nodes\n(02:54), unchanged since prior examination.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  New bilateral peribronchial wall thickening with interlobular septal\nthickening is consistent with vascular congestion.  No pleural effusion.\n2.  Perihilar opacity noted on chest radiograph likely represents asymmetric\ncongestion in a focal area of scarring however superimposed infection cannot\nbe excluded.\n3.  Unchanged centrilobular emphysema with mild bilateral lower lobe\nbronchiectasis.\n4.  Stable subcentimeter periportal, and epipericardial lymph nodes."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes in the hilar or mediastinal\ncompartments. All visible mediastinal lymph nodes (2, 24) Are normal in size. \nModerate coronary calcifications.  No valvular calcifications, no pericardial\neffusion.  The posterior mediastinum is unremarkable.  The upper abdomen shows\nknown liver changes.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Moderate degenerative vertebral disease.\nSevere upper lobe predominant pulmonary emphysema.  Mild thickening any\nirregularities of the airway walls.  No suspicious pulmonary nodules or\nmasses.  Minimal aspiration related peribronchial micro nodularity in the\nright lower lobe (302, 198).  Small right Bochdalek hernia.  No pleural\nthickening, no pleural effusions.",
            "output": "Severe upper lobe predominant pulmonary emphysema.  Signs of moderate mild\nchronic airways disease.  No evidence of metastatic disease to the thorax."
        },
        {
            "input": "The thyroid gland is unremarkable. The thoracic aorta is normal in caliber.\nScattered aortic and head and neck vessel calcifications are noted. There are\ndense coronary artery calcifications. The central pulmonary arteries are\ndilated to 3.5 cm, 3.5 cm, and 2.9 cm within the main, right, and left\npulmonary arteries, respectively. The heart size is normal. There is a\nleft-sided pacemaker with associated right atrial, right ventricular, and\ncoronary sinus leads. There is no pericardial effusion. Small mediastinal\nlymph nodes measure up to 6 mm in the upper right paratracheal station\n(03:13). There is no hilar or axillary lymphadenopathy.\n\nPlease see the accompanying abdomen/pelvis CT report dated ___ for\ndetails regarding the subdiaphragmatic structures.\n\nMinimal retained secretions are seen within the trachea. The tracheobronchial\ntree is patent to the segmental level bilaterally. There is mild bilateral\nlower lobe bronchiectasis. Subsegmental atelectasis is seen within the\ndependent aspects of the upper and lower lobes. There is also mild right\nmiddle lobe and lingular atelectasis. Scattered sub 4 mm pulmonary nodules are\nseen throughout both lungs (5:  81, 88, 148, 201). A tiny calcified granuloma\nis seen within the left upper lobe (05:44). There are no pleural effusions.\n\nThere is diffuse demineralization of the imaged osseous structures. There is a\nnew 1.8 x 0.8 cm sclerotic lesion within the lateral aspect of the left fourth\nrib. Within the superoposterior aspect of the T6 vertebral body, there is a\npoorly defined 7 mm sclerotic lesion (___:23). There is also a 2.9 x 1.4 cm\nlesion within the right posterolateral aspect of the L1 vertebral body,\nextending into the right pedicle. Midline sternotomy wires are noted.",
            "output": "1. Scattered sub 4 mm pulmonary nodules. A followup CT in ___ year is\nrecommended given this patient's history malignancy.\n2. Sclerotic lesions within the left fourth rib, T6 vertebral body, and L1\nvertebral body.\n3. Dilated central pulmonary arteries can be seen in setting of pulmonary\narterial hypertension.\n4. Dense coronary artery calcifications."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: No abnormality visualized within the aorta or the\npulmonary artery.  The heart is normal.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis is noted.  Otherwise, lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There is a multilobulated mostly hypodense lesion in the right\nthyroid measuring up to 1.6 cm.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nBilobed cyst in the right lobe of the liver overall measures up to 5.3 x 2.5\ncm.  Additional scattered hypodensities in the liver may reflect biliary\nhamartomas.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is a large\nstool burden within the rectum and throughout the colon.  There is mild fat\nstranding around the rectum without wall thickening.  The appendix is not\nidentified.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Acute sternal fracture (series 602, image 38) with\nmild adjacent soft tissue stranding.  Sacral Tarlov cysts are noted.",
            "output": "1. Acute, minimally displaced sternal fracture.\n2. Large stool burden throughout the colon and rectum with mild stranding\naround the rectum, may be suggestive of stercoral proctitis.  Disimpaction is\nrecommended.\n3. 1.6 cm right thyroid nodule.  See recommendations below.\n\nRECOMMENDATION(S):  Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "Examination is degraded by motion particularly at the mid aspect of the chest.\n\nCHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is severe motion artifact which somewhat limits\nevaluation the lung parenchyma. There are scattered bilateral ground-glass\nopacities with a posterior and inferior predominance compatible with acute\npulmonary infection including viral etiology. There is moderate biapical\nscarring. The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a 2 cm hypodense thyroid nodule in the right lobe\nthyroid which is incompletely characterized.\n\nTHORACIC CAGE: No suspicious bone abnormality is seen.? Motion artifact\nevaluation for acute fractures, however within this limitation, no acute\nfracture is identified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There are three nonobstructive\nrenal stones in the left kidney measuring up to 3 mm.  There is a single\nnonobstructive 2 mm renal stone in upper pole of right kidney.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed.  Small bowel loops are not\ndilated.  The colon and rectum are within normal limits.  There is a moderate\nstool burden.  The appendix is not visualized.  There is no evidence of\nmesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder is unremarkable.  The ureters are not well\nvisualized.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  There is no adnexal mass. \nMultiple phleboliths are identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is a cortical irregularity of the right sacral ala with\ndeveloping callus, likely a healing fracture, new since ___.  There\nis no acute fracture. No focal suspicious osseous abnormality.  There is\nmultilevel degenerative disease of the lumbar spine most pronounced at L5-S1. \n___ cysts again noted at the sacrum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Motion artifact and lack of intravenous contrast moderately limits exam.\nWithin"
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes. Heart size\nis normal, and there is no pericardial or pleural effusion. Coronary artery\ncalcifications are demonstrate\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of apparent fatty infiltration of the liver.\n\nNo new suspicious lytic or blastic skeletal lesions are detected in the\nthorax.\n\nNo new or growing lung nodules are detected. 3 mm right lower lobe anterior\nsegment right lower lobe lung nodule (118, 4) is unchanged since ___.",
            "output": "No new or growing nodules to suggest presence of pulmonary metastases."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Minimal\ncoronary artery calcifications.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple calcified lymph nodes at the right\nparatracheal, precarinal, hilar stations which may represent prior granulomas\nexposure.  Otherwise, multiple conspicuous lymph nodes may represent prior\ngranulomatous disease or be reactive in nature.  No axillary or thoracic inlet\nlymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: Tiny subcentimeter right apical pneumothorax (05:34).  A right\nposterior approach pigtail drainage catheter is seen within the right lung\nbase.  In comparison to ___, there is interval decrease in size of\nthe right-sided partially loculated empyema.  It previously measured up to 3.9\ncm in the AP dimension, and now approximately 1 cm, but likely in part due to\nredistribution. Small locules of gas are now seen within. A 3.6 x 1.6 cm\nloculated perifissural fluid collection is seen right major fissure (5:171). \nTrace left nonhemorrhagic pleural effusion.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally. There is expected mild atelectasis of the right middle and lower\nlobes.  Mild atelectasis is also noted at the left lung base.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.  Mild\ndegenerative changes of the thoracolumbar spine.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.",
            "output": "1. Interval decrease in size of the right-sided partially loculated empyema. \nA right posterior approach pigtail drainage catheter remains within.\n2. Obscuration of the right heart border seen radiographically likely reflects\natelectasis.\n3. Multiple conspicuous mediastinal lymph nodes are likely reactive in\nnature.Multiple calcified mediastinal and hilar lymph nodes also reflect prior\ngranulomatous exposure."
        },
        {
            "input": "Evaluation for small pulmonary emboli is partially obscured by respiratory\nmotion artifact.  The main, lobar, and segmental pulmonary arteries enhance\nhomogeneously without evidence of filling defect.  The ascending and\ndescending thoracic aorta are normal in caliber with no penetrating\natherosclerotic ulcer or intramural hematoma.  Heart size is moderately\nenlarged with a prosthetic aortic valve and diffuse coronary artery\ncalcification.  There is no pericardial effusion.\n\nThere are nonhemorrhagic bilateral pleural effusions, left greater than right,\nwith adjacent compressive atelectasis.  The lung parenchyma demonstrates\nmoderate centrilobular emphysema and multiple solid lesions compatible with\nmetastatic disease.  Since the chest CT from ___, the dominant lesion\nin the right lower lobe has increased in size, measuring 17 x 14 mm,\npreviously 12 x 11 mm (5:176).  A 6 mm right upper lobe lesion (5:147), is\nstable, as is a right apical lesion (05:58).  The previously smaller right\napical lesion has increased in size (5:60), now measuring 9 x 5 mm.  A 14 x 12\nmm right lower lobe nodule has enlarged from 7 x 7 mm (series 5, image 201). \nA 6 mm right lower lobe nodules unchanged (series 5 image 196).  A 5 mm right\nupper lobe subpleural nodule appears more distinct (series 5, image 142).\n\nNo concerning osseous lesions or fractures.",
            "output": "1. Slightly limited examination secondary to respiratory motion artifact,\nhowever no large central, lobar, or segmental pulmonary embolism.  No acute\naortic process.\n2. Bilateral pleural effusions, small to moderate on the right and moderate to\nlarge on the left.\n3. In comparison to the chest CT from ___, progression of\nmetastatic disease in the right upper and lower lobes."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThere no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is moderate in head and neck vessels,\nparticularly the origin of the left subclavian artery however but considerable\nin the native coronary arteries and in a saphenous to left coronary bypass\ngraft.  Patient has had TAVR.  Graft is normal caliber but this study is not\nsufficient for graft evaluation.  Right pulmonary artery is mildly enlarged,\n30 mm, previously 32 mm, and subject to the limitations of this study, free of\ncentral filling defects.  Moderate cardiomegaly predominantly left ventricular\nis better evaluated with dedicated cardiac imaging.  There is no pericardial\neffusion.  Moderate, layering, nonhemorrhagic left pleural effusion is\nslightly larger today.  Previous right pleural effusion has resolved.  There\nis no pleural mass or appreciable pleural thickening.\n\nAmong and nearly a dozen pulmonary metastases, the smaller lesions are little\nchanged, but several of the larger are smaller today, for example 7 x 7 mm\nright upper lobe nodule, 04:41, was 7 x 11 mm in ___, and a 7 x 13 mm\nright lower lobe nodule, 4:131, was 14 x 17 mm.\n\nThere no rib lesions in the chest cage suspicious for malignancy.\n\n\n\n\n\n\n\n.",
            "output": "No evidence of new metastasis.  Several of the larger pulmonary metastases\nhave decreased in size since ___, but the cardial unchanged.\n\nPrevious right pleural effusion has resolved.  Moderate layering\nnonhemorrhagic left pleural effusion is slightly larger and since there are no\nfindings to suggest malignancy, is probably related to ascites.\n\nAtherosclerotic calcification in the native coronary arteries and left\ncoronary saphenous graft.  Moderate cardiomegaly, predominantly left\nventricular.  Possible pulmonary arterial hypertension.  TAVR grossly intact."
        },
        {
            "input": "The thyroid gland is normal. There is no axillary, supraclavicular, hilar or\nmediastinal adenopathy. A small hiatal hernia is present. The heart is within\nupper limits of normal in size. Patient is status post median sternotomy and\nCABG. Extensive coronary artery calcifications is stable. Additional note is\nmade of extensive calcification of the aortic valve.  There is no pericardial\neffusion. The aorta and pulmonary arteries are normal in caliber.\n\nModerate centrilobular emphysema more pronounced in the upper lobes\nbilaterally is unchanged since study dated ___. A 3 mm heavily\ncalcified nodule within the right upper lobe is most compatible with a\ngranuloma (5:99).  Subpleural bibasilar ground-glass opacities most likely\nreflects dependent atelectasis. There is no pleural abnormality or effusion.\nLungs are otherwise clear. The tracheobronchial tree is patent to the\nsubsegmental level. Mild bronchial wall thickening and bronchiectasis most\npronounced within bilateral lobes is noted which may be age related.\n\nOsseous structures demonstrates no suspicious lytic or blastic lesions.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___, clip number ___.",
            "output": "1.  No evidence of pulmonary metastases.\n2.  For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed on the same date, ___, clip number ___."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy. The aorta and pulmonary\narteries are normal in size.  Moderate cardiomegaly persists and particular\nenlargement of the left ventricle may have  progressed from prior studies,\nalthough this non EKG-gated examination is not tailored to evaluate heart\nchamber size. There is no pericardial effusion.  The patient is status post\nmedian sternotomy and CABG. Extensive coronary arterial calcifications are\nstable.  Again noted is extensive aortic valvular calcification. The esophagus\nis diffusely patulous.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS: The airways are patent. There is no airspace consolidation.  There is\nminimal dependent bibasilar atelectasis. Upper lobe predominant moderate\ncentrilobular emphysema is unchanged as far back as ___. There are no\nconcerning pulmonary nodules.  There is a calcified granuloma in the right\nmiddle lobe (6:133).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN: Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Possible interval enlargement of the left ventricle on this non EKG-gated\nstudy which is limited in accurately evaluating heart chamber size.\nCorrelation with echocardiography is recommended.\n3. Diffusely patulous esophagus suggestive of esophageal dysmotility.\nCorrelate with clinical symptoms."
        },
        {
            "input": "The thyroid gland is normal. There is no axillary, mediastinal, or hilar\nlymphadenopathy.  The heart is normal in size. There is no pericardial\neffusion. The patient is status post a CABG. There are severe calcifications\nalong the coronary arteries and aortic valve, similar to prior exams. The\nthoracic aorta is normal in caliber with moderate to severe atherosclerotic\ncalcifications along the arch and descending thoracic aorta.  The main\npulmonary artery trunk is normal in diameter.\n\nThe airways are patent to the subsegmental levels. There are moderate\nemphysematous changes, most pronounced at the apices. There are two foci of\nmild fibrosis in the right middle lobe, as well as in the left upper lobe (4,\n170 and 57). These are similar to the prior exam from ___.  A calcified\ngranuloma in the right middle lobe is unchanged. There are no concerning\nnodules.\n\nThere is no pulmonary edema, pleural effusion, or pneumothorax.\n\nThere are no concerning lytic or sclerotic osseous lesions. No fracture is\nidentified. Mild degenerative changes are noted in the thoracic spine.\n\nPlease see the abdominal CT report for subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Unchanged emphysema and small foci of mild fibrosis in the right middle\nlobe and left upper lobe."
        },
        {
            "input": "Since the prior study there is substantial interval enlargement in multiple\nmediastinal lymph nodes, series 6, image 30, 43, 48, 58, that are currently\nabout 10 mm in diameter as compared to sub 5 mm on the previous study.\nBilateral pleural effusions, moderate to large on the left and small to\nmoderate on the right a new. No pericardial effusion is seen.\n\nAorta and pulmonary arteries are unremarkable. Extensive calcifications of the\naortic valve as well as calcifications of the native Coronary arteries and\nevidence of previous bypass are re- demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Substantial\ncentrilobular emphysema is demonstrated bilaterally. Since the prior study\nthere is interval development of new right upper lobe opacities, ground-glass\nand frank consolidations, concerning for right upper lobe pneumonia.  To a\nlesser extent. Similar findings are demonstrated in the lower lobes. No new\ndiscrete pulmonary nodules masses or consolidations demonstrated to suggest\nmetastatic spread",
            "output": "Primarily right upper lobe consolidation concerning for pneumonia.\n\nBilateral new pleural effusions, substantial\n\nInterval increase in mediastinal lymph nodes, might be reactive to the right\nupper lobe and to a lesser extent lower lobes process\n\nSubstantial calcifications of the aortic valve, concerning for aortic valve\nstenosis.  Status post prior CABG with extensive calcifications of native\nCoronary arteries."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal.  Prominent mediastinal lymph nodes appear grossly\nstable from ___ (series 2, image 19; series 2, image 33; series 2,\nimage 39). Moderate calcifications are noted involving the aorta and native\ncoronary arteries. Patient is status post CABG. The pericardium is intact\nwithout effusion.  Airways are patent to the subsegmental levels.\n\nInterval increase in consolidation and ground-glass opacities, worse in the\nright lung is consistent with worsening pneumonia. Mild septal thickening\nraises concern for mild underlying pulmonary edema. Moderate to large\nbilateral pleural effusions are mildly increased from ___.  No\npneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nABDOMEN: Numerous, hepatic hypodensities are stable from ___ and\nlikely represent hepatic cysts. Expected pneumobilia is stable. Postsurgical\nchanges are noted in the pancreatic bed. The gallbladder is surgical absent.",
            "output": "1. Emphysema with superimposed pneumonia appears progressed compared with\nprior exam. Mild superimposed interstitial edema. Increase bilateral pleural\neffusions, moderate in size.\n2. No evidence of pulmonary embolism."
        },
        {
            "input": "As compared to ___ chest CT, moderate bilateral pleural effusions have\nincreased in size but remain dependent in location with simple fluid\ncharacteristics.  Numerous subcentimeter mediastinal lymph nodes are present\nand oral largely unchanged from the prior the recent study.  There is no\nevidence of axillary or hilar lymph node enlargement.  Heart size is mildly\nenlarged, and note is made of aortic valvular calcifications and calcification\nof the native coronary arteries in this patient status post coronary artery\nbypass surgery.\n\nWithin the lungs, smoothly thickened interlobular septal lines are present as\nwell as mild diffuse ground-glass opacification superimposed upon moderately\nsevere upper lobe predominant emphysema.  Dependent atelectasis is present\nadjacent to the pleural effusions, and these findings limits sensitivity for\ndetecting small lung nodules in the lower lobes.  With this limitation in\nmind, note is made of scattered calcified granulomas but no suspicious new or\ngrowing noncalcified pulmonary nodule is.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic skeletal lesions in.  Note is made of previous sternotomy and\nmultilevel degenerative changes within the spine.",
            "output": "1.  Moderate bilateral pleural effusions have increased in size since ___.  The presence of effusions and adjacent basilar atelectasis reduces\nsensitivity for detecting small basilar pulmonary nodules.  With this\nlimitation in mind, there are no new or growing noncalcified pulmonary nodules\nto suggest metastatic disease in the thorax.\n\n2.  Septal thickening and ground-glass opacities are most likely due to\nhydrostatic edema in the setting of a history of cardiac disease.  Attention\nto these findings on all next surveillance CT would be helpful to assess for\nresolution and to exclude other causes of interstitial lung abnormalities.\n\n3.  Aortic valvular calcifications in keeping with history of aortic stenosis.\n\n4.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Neck/cardiomediastinum:  The thyroid is unremarkable.  There is no axillary or\nsupraclavicular lymphadenopathy.  A 7 mm peritracheal lymph node (04:54) is\nstable.  An AP window lymph node measures 9 mm (4:81), stable since prior. \nHeart size is mildly enlarged.  The ascending aorta and main pulmonary artery\nare normal in caliber.  There are no pathologically enlarged hilar lymph\nnodes.  There is no pericardial effusion.  There is mild to moderate\ncardiomegaly.  An aortic stent is re-demonstrated. The aorta and main\npulmonary artery are normal in caliber.\n\nLung/airways:  The tracheobronchial tree is patent to the subsegmental level. \nThere is moderate upper lobe predominant centrilobular emphysema.  The\nbilateral pleural effusions have decreased in size, left greater than right. \nA 3mm right upper lobe lung nodule has increased in size (4:111) from 2mm\npreviously (6:166).\n\nAbdomen:  This exam is not tailored for the evaluation of infra diaphragmatic\nstructures.  Please see same-day abdomen/pelvic CT for infra diaphragmatic\ndetails.\n\nBones/soft tissues:  There are no lesions suspicious for malignancy.",
            "output": "1. 3 mm right upper lobe nodule.  Attention on followup.\n2. See abdomen/pelvic CT report for infra diaphragmatic details.\n3. Decreased bilateral pleural effusions, right greater than left."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there are no soft\ntissue abnormalities in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThyroid is heterogeneous but there are no lesions large enough to warrant\nfurther imaging.  Patient has had median sternotomy and coronary bypass\ngrafting and T AVR.  There is no evidence of surgical complications.\n\nAtherosclerotic calcification in head and neck vessels is moderate, most\npronounced the proximal left subclavian artery, present also in eighth\ncoronary arteries.  Cardiomegaly is moderate, most pronounced in the left\natrium, grossly unchanged since ___.  Pulmonary arteries, particularly the\nright, are moderately enlarged, unchanged.  Small pericardial effusion, small\nlayering nonhemorrhagic bilateral pleural effusion, left greater than right\nare all unchanged.  There is no pleural thickening or nodulation.\n\nBullous emphysema is severe in the upper lungs, milder elsewhere.\n\nOne right lung lesion is almost certainly a metastasis:\n\n6 mm wide right middle lobe nodule, 6:163, was 3 mm in ___.\n\nTwo others are suspicious for malignancy:\n\nAn 11 x 14 mm irregularly shaped spiculated soft tissue lesion in the right\napex, 6:83, may have originated in and a 4 mm wide lesion on ___.\n\nIrregular, spiculated, 11 x 12 mm wide right lower lobe nodule, 6:212, was 3\nmm in ___.\n\nAnd one lesion is more likely inflammatory:\n\nA 7 mm wide region of peribronchial thickening in the posterior segment of the\nright upper lobe, 6:119, is new.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "3 lung nodules have grown since ___, one almost certainly a metastasis\ncommon the right middle lobe (not upper lobe as described previously), one in\nthe right upper lobe and one in the right lower lobe.  A new right upper lobe\nlesion is more likely inflammatory.\n\nStable small to moderate left pleural effusion, small right pleural effusion,\ntiny pericardial effusion, with no evidence to suggest that they are\nmalignant.\n\nSevere emphysema.\n\nProbable pulmonary hypertension.  Persisting cardiomegaly, particularly left\natrial enlargement."
        },
        {
            "input": "No filling defects are seen among pulmonary arteries.\n\nThere is no lymphadenopathy.  There are no pleural or pericardial effusions. \nThe heart is mildly enlarged although this can be seen normally with\npregnancy.  Anterior thymic tissue is probably within normal limits for age.\n\nThe lungs appear clear.\n\nLimited views of the upper abdomen were are unremarkable.\n\nBony structures appear normal.",
            "output": "No evidence of pulmonary embolism or other acute thoracic disease."
        },
        {
            "input": "Bilateral axillary lymph nodes are prominent but not pathologically enlarged\nand unchanged.  No pathologically enlarged mediastinal, hilar lymph nodes\npresent.  Aorta and pulmonary arteries are stable in appearance and normally\nenhance.  Heart size is normal.  There is no pericardial pleural effusion. \nRight heart enlargement is a possibility.\n\nImage portion of the upper abdomen will be reviewed separately and\ncorresponding report will be issued\n\nSecretions in the trachea are extensive but overall the airways are patent to\nthe subsegmental level bilaterally.  Apical scarring is extensive, bilateral,\nand similar to previous examination, series 6, image 76.  Focal areas of\npotential cavities, versus traction bronchiectasis, series 6, image 76 are\nstable.  No interval progression of pulmonary nodules or masses demonstrated. \nPreviously demonstrated right middle lobe nodule has resolved and there is\nalso substantial decrease in previously seen multiple endobronchial secretions\nand nodules in the entire right middle lobe.  No additional nodules masses or\nconsolidations are seen.  Severe emphysema is bilateral.\n\nDiffuse degenerative changes are noted but there are no lytic or sclerotic\nlesions worrisome for infection or neoplasm.",
            "output": "No substantial change in the biapical scarring.\n\nSubstantial improvement in the mucus plugging in the right middle lobe and\nnodularity.\n\nNo new pulmonary nodules to suggest intrathoracic metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The\ncalcifications are present coronary arteries.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Prominent biapical scarring, traction bronchiectasis, and volume\nloss at the lung apices are unchanged from ___.\n\nThe right upper lobe infection has cleared since ___ with residual scarring\nand small nodular opacities which are unchanged from ___ (06:50, 6:72). \nNodular opacities at the left apex are more prominent and in different\nconfiguration than in ___ (6:61, 6:65, 08:26).  No new or growing pulmonary\nnodules concerning for malignancy.\n\nCentrilobular and paraseptal emphysema is severe. Linear opacities at the lung\nbases are consistent with atelectasis.\n\nBASE OF NECK:  The thyroid is normal.  Visualized portions of the base of the\nneck show no abnormality.\n\nABDOMEN:  Please see report from same day CT of the abdomen and pelvis for\ndescription is subdiaphragmatic findings.\n\nBONES:  Compression deformities of T11, T12, and L1 are new since ___ (9:37),\nand incompletely visualized on lumbar spine imaging in ___.  No osseous\nabnormality concerning for malignancy.? no acute fracture.",
            "output": "1. Nodular opacities at the left apex are more prominent and in different\nconfiguration than in ___ suggestive of new infection, much less likely\nneoplasic involvement.\n2. Compression deformities of T11, T12, and L1 are new since ___ and\nincompletely visualized on lumbar spine imaging in ___. Severe emphysema.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:25 ___, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber. Calcifications\nare present coronary arteries. No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally. Prominent biapical scarring, traction bronchiectasis, and volume\nloss at the lung apices are unchanged.  There is\n\nThere is scarring and small nodular opacities which are unchanged in both lung\napices. No new or growing pulmonary nodules concerning for malignancy.\n\nCentrilobular and paraseptal emphysema is severe. Linear opacities at the lung\nbases are consistent with atelectasis.\n\nBASE OF NECK: The thyroid is normal. Visualized portions of the base of the\nneck show no abnormality.\n\nABDOMEN:  Limited images through the abdomen demonstrate no abnormalities.\n\nBONES:  There are stable compression fracture deformities of T9 and L2.  No\nsuspicious lytic or blastic osseous lesions are seen. The bones are diffusely\ndemineralized.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nNo focal consolidation to suggest pneumonia.\nSevere centrilobular and paraseptal emphysema with stable scarring,\nbronchiectasis, volume loss, small nodular opacities in both lung apices."
        },
        {
            "input": "HEART AND VASCULATURE:  Of note, the study is suboptimal due to poor\nopacification of the vasculature from contrast bolus timing.  Given these\nlimitations, the pulmonary vasculature appears opacified to the segmental\nlevel without filling defect to indicate a pulmonary embolus.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is scarring and small nodular opacities which are\nunchanged in the bilateral lung apices, similar to prior exam in ___.  There are 2 new 3 mm left lower lobe pulmonary nodules (3:154 and 164).\nUnchanged 3 mm right lower lobe pulmonary nodule (3:160) when dating back to\n___.  A new 3 mm right lower lobe pulmonary nodule (3:231) is noted. \nAn additional 3 mm nodule more laterally in the lower lobe is unchanged back\nto ___.  Extensive centrilobular and paraseptal emphysema is again seen. \nAtelectatic changes are seen at the bilateral lung bases.  The airways are\npatent to the level of the segmental bronchi bilaterally.  Dependent\nendoluminal debris is noted in the distal trachea and right mainstem bronchus.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? Compression deformities of\nthe T11, T12 and L1 vertebral bodies are unchanged from prior CT.  There is no\nacute fracture.  Bones are diffusely demineralized.",
            "output": "1.  Saw the optional exam due to poor opacification of vasculature from\ncontrast bolus timing.  Given these limitations, there is no evidence of\npulmonary embolism to the segmental level.  No acute aortic abnormality.\n2.  No focal consolidation to suggest pneumonia.\n3.  Stable appearance of severe emphysema, scarring, and small nodular\nopacities in the bilateral lung apices since ___.\n4.  Several bibasilar 3 mm pulmonary nodules new since most recent exam.\n\nRECOMMENDATION(S):  Given background of emphysema, ___ year followup for new\npulmonary nodules is suggested."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  Left\nsupraclavicular lymph nodes (7, 17) is unchanged.  Subcentimeter axillary\nlymph nodes are unchanged.  Bilateral gynecomastia.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.  No aortic\nvalve calcification.  The aortic root is dilated measuring 44 mm in diameter\n(7, 215).\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Scarring in the bilateral upper lobes are stable.  Background\nsevere centrilobular, paraseptal and panacinar emphysematous changes are\nstable.  No new areas of airspace consolidation.  A few sub 4 mm pulmonary\nnodules are new/ slightly enlarged since ___ (7, 139, 145, 195, 204).\n-AIRWAYS:  The airways are patent to the subsegmental level.  Retained\nsecretions present in the distal trachea/carina and left lower lobe segmental\nbronchi (7, 222).  No bronchiectasis.  No bronchocentric nodules.\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Superior endplate insufficiency type fractures involving T11, T12,\nL1, L4 on L5 appears similar compared to ___, but is new since ___.\nNo lytic/destructive bony lesions.",
            "output": "No significant interval change compared to most recent prior imaging done ___.\n\nThere are a few new/enlarged sub 4 mm pulmonary nodules which are new since ___ and are concerning for metastatic disease and should be reassessed\nin 3 months.\n\nRECOMMENDATION(S):  3 month follow-up chest CT advised."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The thyroid is within normal limits. \nThere is no mediastinal, hilar or supraclavicular lymphadenopathy.  There is\nno axillary lymphadenopathy.\n\nHEART & VESSELS: The heart is normal in size. The great vessels are normal in\ncaliber.There is no pericardial effusion.\n\nLUNGS & AIRWAYS: There is severe centrilobular and paraseptal emphysema\nthroughout both lungs, similar in extent to the prior examination.  Apical\nscarring is unchanged in appearance.  There is no focal consolidation, pleural\neffusion or pneumothorax.\n\nPulmonary nodules:\nLeft upper lobe, 3 mm, 6:146, stable\nLeft upper lobe, 2 mm, 6:175, stable\nLeft lower lobe, 3 mm, 6:200, stable\nRight lower lobe, cluster of ___ nodules measuring up to 5 mm, 6:280,\nincreased in size and number from the prior exam\nRight lower lobe, 3 mm, 6:271, stable\nRight lower lobe, 4 mm, 06:308, stable\nRight middle lobe, 3 mm, 6:233, stable\nRight upper lobe, 3 mm, 6:176, stable\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions are\ndemonstrated.  Degenerative changes throughout the thoracolumbar spine and are\nstable.",
            "output": "1. Cluster of nodules involving the posterior right lower lobe are new from\nthe prior examination and likely reflect the sequela of aspiration or\ninfection given their morphology.  Recommend three-month follow-up CT for\ncontinued evaluation as these nodules are new from the prior study.\n2. Multiple additional pulmonary nodules are stable from the prior examination\nas noted above.\n3. Severe emphysema is unchanged.\n\nRECOMMENDATION(S):   CT chest in 3 months."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  In hands meant is\nunremarkable.  No mediastinal, hilar or axillary lymphadenopathy is present. \nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Severe\ncentrilobular emphysema is unchanged.  Extensive biapical scarring might\nrepresent sequela of previous disease such as granulomatous exposure or\nsarcoidosis.  Right upper lobe nodule, series 6, image 124 a has substantially\nincreased in size, currently 8 x 6 mm as compared to 3.5 x 3.5 mm.  Left lower\nlobe 10 cm pneumatoceles may be sequela of previous infection.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Compression fracture in the lower thoracic and lower lumbar\nspine are re-demonstrated.",
            "output": "Growing nodule in the right upper lobe.  Giving its current size of 8 x 6 mm\nit can be either reassessed in 3 months with chest CT or assessed with PET-CT.\n\nSevere emphysema and scarring in the upper lobes with volume loss\n\nLeft lower lobe pneumatoceles\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings in the\nthyroid.\nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Upper abdomen findings will be reported in the concurrent\nabdomen CT Accession number ___.\n\nMEDIASTINUM: There is no lymphadenopathy in the mediastinum or hila\nbilaterally.\n\nHEART and PERICARDIUM: There is no cardiomegaly and there is no pericardial\neffusion\nSpeck of calcification in the LAD.\nThe root of the aorta measures 5 cm, unchanged\n\nLUNG: Major airways are patent.\nSevere emphysema throughout the lungs, including particularly large bullae in\nthe left lung base.\nBiapical coalescent scarring with volume loss and traction of the main\nbronchi, unchanged, due to previous sarcoidosis or bilateral granulomatous\ninfection.\n\nRight lower lobe peripheral 0.3 cm lung nodule unchanged (5:59).\nRight upper lobe nodule has decreased in size now measures 0.5 cm, in the\nprior measured 0.9 cm (6:122).\nThere is no evidence of new or enlarging lung nodules.  No lung masses.\nThere is no pleural effusion.\n\nCHEST CAGE: No evidence of osteoblastic or osteolytic lesions.\nOld compression fractures of T11-T12 with mild increase kyphosis is unchanged.",
            "output": "Previous right upper lobe lung nodule has decreased in size from 9 mm to 5 mm\nsince ___.\n\n\nNo new or enlarging lung nodules-no other evidence of metastatic disease in\nthe chest."
        },
        {
            "input": "THORACIC INLET: The thyroid has a heterogeneous appearance, unchanged.  There\nare no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The mediastinal lymph nodes are unchanged since the prior study. \nUpper mediastinal lymph node measures 9 mm.  The small subcarinal lymph node\nis also unchanged.  There is moderate cardiomegaly.  Small right hilar nodes\nare stable.  There is moderate coronary artery calcification.  There is no\npericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Patient is status post CyberKnife treatment to the right middle lobe\nnodule.  The right middle lobe nodule has significantly decreased in size\nsince ___, now measures 2 x 1 cm as compared to the prior\nmeasurements of 2.4 x 1.8 cm.  The surrounding ground-glass opacification\nwithin the right middle lobe has significantly improved and most likely\nrepresents resolving post radiation changes.  High peripheral consolidation in\nthe right middle lobe is still present and could represent evolving post\nradiation changes.  The consolidative opacity in the right lower lobe abutting\nthe fissure (4, 121) Also most likely represents evolving post radiation\nchanges.\n\nThere are 2 new nodules in the right lower lobe measuring 15 mm (4, 161) and\n11 mm (4, 154).  These are concerning for metastasis.\nBONES AND CHEST WALL : Review of bones shows osteopenia and degenerative\nchanges involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\ncirrhosis and portal hypertension.  Lack of intravenous contrast limits\nevaluation of the liver.  Bilateral adrenal nodules are unchanged.",
            "output": "Status post CyberKnife treatment to the right middle lobe nodule with decrease\nin size of the right middle lobe nodule since the baseline scan. Evolving post\nradiation changes to the right middle lobe.  The consolidative opacities in\nthe right middle lobe have improved since the prior study.\n\n 2 new nodules in the right lower lobe concerning for metastasis.\n\nCirrhosis with evidence of portal hypertension.\n\nBilateral adrenal nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  No chest wall abnormalities.  Moderate calcifications at the proximal\nleft subclavian and distal brachiocephalic trunk arteries.\n\nMEDIASTINUM AND HILA:\nSmall sliding hiatal hernia is stable.  Serpiginous varicose vessels\nsurrounding the distal esophagus and extending to the porta hepatis. \nEsophagus is mildly patulous along its tract, most likely secondary to\ndysmotility disorder rather than to distal obstruction.\nRight posterior paraesophageal 17 x 9 mm lymph node is increased in size,\npreviously was 13 x 6 mm (3:41).  Remaining small 2-9 mm central mediastinal\nlymph nodes are unchanged.  Hilar contour suggest no evidence of enlarged\nlymph nodes within the limitations of a noncontrast study.\n\nHEART, PERICARDIUM AND VASCULATURE:\nModerate cardiomegaly.  Moderate to severe atherosclerotic calcifications in\nthe coronary arteries, mild in the aortic valves and moderate in the aortic\narch.  Aorta and pulmonary artery normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nRight lower lobe nodules with internal lucencies are progressively enlarging\nfrom previous examinations, the largest now measuring 18 x 18 mm, was 15 x 10\nmm (5:216), and the nearby smaller 11 x 16 mm now was 5 x 11 mm in the\nimmediate prior study (5: 210).\n\nRight middle lobe CyberKnife treatment changes, with decreased 11 x 5 mm soft\ntissue nodularity adjacent to the fiducial marker, previously was 21 x 10 mm\n(5:140).  The previously surrounding ground-glass opacification and\nconsolidation is now decreased in extension but increased in density\nreflecting evolving post radiation changes (5:131).  The nearby right lower\nlobe perifissural consolidation is also decreased in size and is most likely\nscarring tissue from post radiation therapy as well (4:158).\n\nThe airways are patent to the subsegmental levels bilaterally.  No bronchial\nwall thickening, bronchiectasis or mucus plugging.  No pleural effusions or\nthickening.  Mild biapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nNo acute fractures.  Moderate dorsal spondylosis.  Diffuse generalized\nosteopenia with no compression fractures.  Although there are no bone lesions\nin the imaged chest cage suspicious for malignancy or infection, it should be\nnoted that radionuclide bone and FDG PET scanning are more sensitive in\ndetecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show a cirrhotic morphology of the\nliver with enlarged caudate lobe and evidence of portal hypertension. \nUnchanged appearance of the bilateral adrenal nodules.  For further evaluation\nof subdiaphragmatic findings and abdominal and pelvic CT is recommended.",
            "output": "Unusual rapid progressive enlarging of the 18 and 16 mm right lower lobe\nnodules with internal lucencies could due to organizing pneumonia, other\nassociated post radiation changes or less likely metastatic disease.  Further\nassessment with PET/CT or CT-guided biopsy is recommended.\n\nCyberKnife reaction in the right lung is smaller in volume but increased in\nradiodensity probably scarring.\n\nCirrhosis with evidence of portal hypertension.\n\nStable bilateral adrenal nodules, for further characterization dedicated\nimaging is recommended.\n\nRECOMMENDATION(S):  Definitive diagnosis of the growing right lower lobe\nnodules would require needle aspiration biopsy"
        },
        {
            "input": "The thyroid is normal.  Multiple prominent mediastinal and hilar lymph nodes\nare identified, none of which are pathologically enlarged.  There are no\npathologically enlarged supraclavicular or axillary lymph nodes.  Aorta and\npulmonary arteries are normal size. Cardiac configuration is normal and there\nis no appreciable coronary calcification.  No incidental central pulmonary\nembolus is identified.\n\nThe airways are patent to the subsegmental levels.  There is no large pleural\neffusion or pneumothorax identified.  Multiple nodular and patchy parenchymal\nopacities with surrounding ground-glass are appreciated in the lungs.  These\nare most pronounced in the lower lobes and are peripherally base.  A\nrepresentative parenchymal opacity with surrounding ground-glass is noted in\nthe superior segment of the left lower lobe (06:25) and measures 2.4 x 2.4 cm.\n.\n\nFor description of the intra-abdominal findings, please see the separate CT\nabdomen and pelvis report.",
            "output": "Multiple nodular and parenchymal opacities with surrounding ground-glass and\nmild mediastinal/hilar lymphadenopathy.  Given the patient's presentation and\nimmunocompromised state, a primary pulmonary infection, including atypical and\nfungal etiologies, is felt most likely.  Additional diagnostic considerations\ninclude pulmonary lymphoma, and less likely septic emboli.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___ at 17:36 on\n___."
        },
        {
            "input": "The thyroid is normal.  Multiple prominent mediastinal and hilar lymph nodes\nare not pathologically enlarged by CT size criteria.  Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.\n\nThe airways are patent to the subsegmental levels. Redemonstrated are numerous\nbilateral nodular and patchy parenchymal airspace opacities, largely unchanged\ncompared to the prior examination.  There is no appreciable lesion cavitation\nidentified on this non-contrast examination.  Again, the lesions are\npredominantly peripheral and location, although not exclusively.  No discrete,\nnew lesions are identified.  There is no appreciable pleural effusion or\npneumothorax.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents. Within this limitation, multiple prominent retroperitoneal\nmesenteric lymph nodes are again noted, similar to the prior examination.",
            "output": "No significant interval change in the appearance of multiple, bilateral\nnodular and parenchymal airspace opacities.  A primary atypical pulmonary\ninfection remains the most likely etiology, with additional diagnostic\nconsiderations including pulmonary lymphoma and septic emboli."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Numerous bilateral hypoattenuating\nthyroid nodules measure up to 1.6 cm in the right lobe (6: 36).  There is no\nsupraclavicular or axillary lymphadenopathy.  The esophagus is unremarkable.\nThere is discontinuous enhancement of the left subclavian vein (06:32),\nassociated with numerous adjacent venous collaterals.  This could represent\nstenosis relating to prior central venous catheter use or an anatomical\nvariant.\n\nUPPER ABDOMEN: Please refer to separate report for same day CT abdomen pelvis\nstudy for discussion of findings below the diaphragm.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare moderate.  The thoracic aorta is normal in caliber. There is no\npericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  A few small solid nodules in the right upper lobe measure up\nto 4 mm (6:131, 145, 104).  No focal consolidations or diffuse lung disease.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits. No\ncentral pulmonary embolism.\nCHEST CAGE: Hemangiomas are noted in the T10 and T11 vertebral bodies.  No\nsuspicious osseous lesions are identified. There is no acute fracture.",
            "output": "1. A few solid pulmonary nodules in the right upper lobe measure up to 4 mm. \nRecommend follow-up chest CT in 3 months.\n2. Numerous bilateral thyroid nodules measure up to 1.6 cm in the right lobe. \nIf not previously evaluated, recommend nonemergent dedicated thyroid\nultrasound.\n3. Discontinuous enhancement of the left subclavian vein, with numerous\nadjacent venous collaterals, may represent focal stenosis relating to prior\ncentral venous catheter use or an anatomical variant.\n4. Please refer to separate report for same day CT abdomen pelvis study for\ndiscussion of findings below the diaphragm.\n\nRECOMMENDATION(S):\n1. Chest CT in 3 months.\n2. If not previously evaluated, dedicated thyroid ultrasound for multiple\nbilateral thyroid nodules."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced with no abnormalities.  Right\nthyroid nodule lesion is unchanged approaching 2 cm.\n\nMediastinal lymph nodes are multiple, minimally enlarged, and left hilar lymph\nnode is present, unchanged, enlarged, 13 mm.  There is no pericardial\neffusion.\n\nSince previous examination there is interval development of large right\npleural effusion and small left pleural effusion.  Right basal opacity is\nconsistent with atelectasis.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules R sub 5 mm and stable, series 3, image 44.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval development of large right and small left pleural effusion with\nassociated right lower lobe atelectasis\n\nOtherwise no evidence of intrathoracic disease progression\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra abdominal pathology."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nHeterogeneous thyroid with redemonstration of large hypodense nodules in the\nright lobe, stable.  No enlarged lymph nodes in either axilla or thoracic\ninlet.  No abnormalities on the chest wall.  Right anterior port with tip in\nthe right atrium.  Mild atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  Mild pericardial effusion, likely\nphysiologic.  Mild atherosclerotic calcifications in the coronary arteries and\naorta, none in the cardiac valves.  The pulmonary arteries and aorta are\nnormal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nSmall right pleural effusion, much smaller than the prior study.  No current\nleft pleural effusion.  Mild bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation. The\nairways are patent to the subsegmental levels.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  New 1.0 cm ground-glass nodule in the left\nupper lobe (03:47).  Stable 3 mm perifissural nodule in the middle lobe\n(3:109).\n\nCHEST CAGE:\nSevere dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "New ground-glass nodule in the left upper lobe suspicious for developing\nmetastatic disease.  Short-term CT follow-up in 3 months is recommended.\nThe bilateral pleural effusions are much smaller compared to prior study,\nresolved to the left and now small to the right.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 14:26 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: 16 mm low-density lesion is the largest abnormality in the\nthyroid, grossly unchanged since ___.  For evaluation, please\nconsult thyroid ultrasound, performed in ___.\n\nSubcentimeter left supraclavicular lymph nodes are slightly larger today than\nin ___.  Axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.\n\nFindings below the diaphragm will be reported separately.\n\n\nCARDIO-MEDIASTINUM:\nEsophagus is unremarkable.\n\nAtherosclerotic calcification is minimal in head and neck vessels, not\napparent coronary arteries. Aorta and pulmonary arteries and cardiac chambers\nare normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: As follows:\n\nThoracic outlet, 7 mm, unchanged.\n\nNo lymph nodes in the chest are pathologically enlarged or growing.\n\n\nLUNGS, AIRWAYS, PLEURAE: Mild edema in the lower lungs has improved and\nprevious small right pleural effusion is resolved.\n\nPrevious ground-glass lesion, posterior segment left upper lobe, has resolved.\nSimilar appearing, 9 mm wide ground-glass lesion in the right middle lobe,\n5:161, is new.  Both lesions are probably inflammatory.\n\nSolid 4 mm right middle lobe nodule unchanged.\n\nCHEST CAGE: Heterogeneous demineralization in lower thoracic vertebral body,\n08:57-65, unchanged since ___ is probably benign hemangioma.  Although\nthere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting early osseous pathology than chest CT\nscanning..",
            "output": "No strong evidence of intrathoracic metastasis.  The previous left upper lobe\nground-glass lesion has resolved since ___ and a new lesion in the right\nmiddle lobe are both probably inflammatory.\n\nPulmonary edema nearly resolved.\n\nSlight interval increase in size of subcentimeter left supraclavicular lymph\nnodes, significance uncertain."
        },
        {
            "input": "Right thyroid nodule, 15 mm is unchanged.  Several right upper paratracheal\nand right lower paratracheal areas are stable, not pathologically enlarged. \nLeft hilar lymph node is stable, 9 mm, series 3, image 49.  There is no\npericardial or pleural effusion.\n\nHeart size is normal.  Aorta and pulmonary arteries are well enhanced.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe 1\nmm nodule is stable, series 4, image 119 right middle lobe 4 mm nodule is\nstable, series 4, image 157 right lower lobe calcified nodule is stable,\nseries 9, image 33.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of new intrathoracic\nnodules of findings concerning for metastatic disease\n\nRight thyroid nodule that should be further assessed with thyroid ultrasound\nif clinically indicated."
        },
        {
            "input": "THORACIC INLET: There is a stable hypodense lesion within the right lobe of\nthyroid.  There is a right-sided Port-A-Cath with its tip in the right atrium.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is moderate upper lobe predominant emphysema.  No new or growing\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions.  The left adrenal is diffusely thickened.",
            "output": "No evidence of metastasis to the chest\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid gland shows mild diffuse enlargement with multiple hypodense lesions,\nthe largest  in the right thyroid lobe measuring 14 mm, an adjacent 8 mm lymph\nnode is stable (4:18).  No atherosclerotic calcifications in the head and neck\narteries.  Mild gynecomastia, otherwise there are no chest wall abnormalities.\nNo enlarged axillary lymph nodes.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Stable multiple central mediastinal lymph nodes,\nranging from 2-9 mm, with the largest in the right lower paratracheal station\nmeasuring 9 mm (5:124).  No enlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nMild cardiomegaly.  No pericardial effusion.  Mild to moderate atherosclerotic\ncalcifications in the coronary arteries, specially in the LAD, mild in the\naortic annulus, none in the aortic arch.  Aorta and pulmonary arteries are\nnormal in caliber throughout.  Right Port-A-Cath terminating in the right\natrium.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Scattered bilateral 2-5 mm\nnodules are stable since the ___ examination (5: 119, 145, 157,\n73).  No new or growing nodules.  No focal consolidations.  Interval\ndevelopment of bibasal interlobular septal thickening and associated bilateral\nsmall right greater than left nonhemorrhagic pleural effusions with associated\natelectasis.\n\nCHEST CAGE:\nNo acute fractures.  Unchanged appearance of the mixed density lesion in the\nvertebral body of T11, is most likely a hemangioma. No lytic or sclerotic bone\nlesions worrisome for malignancy.  Moderate dorsal spondylosis.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Scattered bilateral 2-5 mm nodules, stable since at least ___.  No\nnew or growing nodules.\n\nInterval development bibasal interlobular septal thickening with associated\nbilateral small right greater than left nonhemorrhagic pleural effusions,\nconsistent with mild pulmonary edema.\n\nMild diffuse thyroid gland enlargement with multiple hypodense lesions, the\nlargest in the right thyroid lobe measuring 14 mm, needle biopsy was\nrecommended on thyroid ultrasound from ___, however, no results\nfound in the hospital records.\n\nRight Port-A-Cath terminating in the right atrium.\n\nRECOMMENDATION(S):  Clinical consideration of recommendations for thyroid\nbiopsy in the report of prior thyroid ultrasound."
        },
        {
            "input": "THORACIC INLET: There is redemonstration of mild diffuse enlargement of the\nthyroid gland with multiple hypodense lesions in the right thyroid lobe, the\nlargest measuring 1.4 x 0.8 cm, which is stable compared to most recent study.\nRight-sided Port-A-Cath with its tip in the right atrium.\n\nBREAST AND AXILLA: No enlarged axillary lymph nodes.  Mild gynecomastia\n\nMEDIASTINUM AND HILA: Borderline enlarged mediastinal and hilar lymph nodes,\nthat appear stable compared to priors.  There is mild cardiomegaly, without\npericardial effusion. The aorta and pulmonary arteries are normal in caliber. \nMild to moderate calcification of the coronary arteries and mild at the aortic\nannulus.\n\nPLEURA: There is interval worsening of the right pleural effusion, still small\nin size, and stable small left pleural effusion, with associated atelectasis.\n\nLUNG: Airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No focal consolidation. \nScattered bilateral pulmonary nodules ranging from 2-5 mm, stable since ___ (3:114, 133, 142).  No evidence of new or growing pulmonary\nnodules.\n\nBONES AND CHEST WALL: The mixed density lesion in T11 vertebral body is\nunchanged in appearance, most likely a hemangioma.  No other suspicious\nosseous lesions.\n\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen performed the\nsame day.",
            "output": "1. Stable scattered bilateral lung nodules without new or growing nodules\nappreciated.\n2. Mild increase in size of right-sided pleural effusion.\n3. Stable mildly diffuse thyroid enlargement with unchanged hypodense lesions."
        },
        {
            "input": "The thyroid gland is symmetric and normal in appearance. There is no\nsignificant axillary or hilar lymphadenopathy. There are prominent, partially\ncalcified mediastinal lymph nodes measuring up to 1.5 cm in the right\nparatracheal station.  There is and incompletely imaged probable left\nsupraclavicular lymph node measuring 1.4 cm (series 2, image 1).\n\nThe heart is normal in size. There is no pericardial effusion.\n\nThe thoracic aorta is normal in caliber and contains mild atherosclerotic\ncalcification at the arch. The central pulmonary arteries are normal in\ncaliber.\n\nThere is no pleural effusion. Consolidative opacity with volume loss is noted\nadjacent to the minor fissure within the anterior segment of the right upper\nlobe (series 4, image 83) likely reflecting atelectasis. Soft tissue density\nmore proximally within the feeding bronchus may correspond to secretions\nversus a mass (series 2, image 21). Streaky linear opacity within the lingula\nlikely represent subsegmental atelectasis. There are bibasilar atelectatic\nchanges. There is a 9 mm subpleural semi-solid nodule within the posterior\nmedial right lower lobe (series 4, image 117) which is increased in size from\nthe prior exam when it measured approximately 5 mm. A tiny calcified granuloma\nis noted within the right lower lobe. No additional nodules are seen.\n\nPlease see the concurrent CT abdomen and pelvis report for further\ncharacterization of the upper abdomen.\n\nThe visualized osseous structures demonstrate mild degenerative changes of the\nthoracic spine.  There is bilateral rotator cuff muscle atrophy.",
            "output": "1. Right upper lobe anterior segment atelectasis with underlying soft tissue\ndensity within the feeding bronchus which may correspond to inspissated mucus\nversus mass. Bronchoscopy may be considered for further evaluation.\n\n2. Interval increase in size of a semi solid right lower lobe subpleural\nnodule now measuring 9 mm for which followup is recommended as this could be a\ndeveloping metastasis.\n\n3. Mediastinal and left supraclavicular lymphadenopathy, likely reflecting\nmetastases."
        },
        {
            "input": "VASCULATURE: :\n\nThe thoracic and abdominal aorta are normal in caliber and without evidence of\naneurysm or dissection.The celiac axis, SMA, bilateral renal arteries, and ___\nare grossly patent. Atherosclerotic mural calcifications are seen throughout\nthe aorta and its major branches.\n\nCHEST:\n\nThe thyroid is normal.  Again seen is a 1.5 x 1.1cm (2a: 4) (previously 1.8 x\n1.5 cm) left supraclavicular lymph node as well as prominent partially\ncalcified mediastinal lymph nodes, the largest measuring 2.2 x 1.6 cm\n(previously 2.2 x 1.5 cm) within the right paratracheal station. No additional\naxillary, mediastinal, or hilar lymph node enlargement. The heart and\nmediastinum are normal.  No pericardial effusion. A left subclavian central\nvenous line is seen with its tip at the cavoatrial junction.  Mild\ncentrilobular emphysema is noted.\n\nAgain seen is right upper lobe atelectasis secondary to mucous impaction,\nsimilar in appearance to previous examination. Lingular as well as right lower\nlobe atelectasis again noted. (2a:  45).  No pleural effusion or pneumothorax.\n1.1 x 0.9 cm (2a: 64) (previously 1.1 x 1.0 cm) subpleural nodule is again\nseen within the posterior medial right lower lobe and is essentially unchanged\nsince previous examination. A subcentimeter calcified granuloma is present\nwithin the right lower lobe.\n\nABDOMEN:\n\nThe liver is diffusely enlarged and nodular in contour, similar to previous\nexamination. Again seen are numerous heterogeneous rounded opacities. 2\nsurgical clips are again seen within the right hepatic dome. No intra or\nextrahepatic biliary duct dilatation.The portal vein, SMA, and splenic vein\nare patent. The gallbladder, pancreas, spleen, and bilateral adrenal glands\nare normal.The kidneys enhance symmetrically and are without suspicious solid\nmass.\n\nSmall hiatal hernia is present. The stomach is mildly enlarged and fluid\nfilled with small amount of fluid in the esophagus.The small and large bowel\nare normal in caliber and without evidence of wall thickening. The appendix is\nnormal without evidence of acute appendicitis. Colonic diverticulosis is\npresent without evidence of diverticulitis. No retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.No free abdominal fluid, or\npneumoperitoneum.Anterior abdominal wall subcutaneous tissue fat stranding and\nskin thickening is noted.  Small fat containing umbilical hernia is\ndemonstrated.\n\nPELVIS:\n\nThe bladder is unremarkable. No pelvic side-wall or inguinal lymph node\nenlargement.No free pelvic fluid is identified.  Prostate is mildly enlarged.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Stable heterogeneous lesions throughout the liver concerning for\nmetastatic disease.\n2.  Enlarged prostate.\n3.  No evidence of pulmonary embolism or aortic dissection.\n4.  Stable left supraclavicular and mediastinal lymphadenopathy worrisome for\nmetastasis.\n5.  Persistent right upper lobe atelectasis with mucous impaction.\n6.  No significant change in a right lower lobe subpleural nodule measuring\n1.1 cm which was FDG avid on recent PET-CT.\n7.  Anterior abdominal wall subcutaneous tissue fat stranding with skin\nthickening.  Clinical correlation to assess for cellulitis is recommended."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is dilated, measuring up to 4.4 cm.\nThe heart, pericardium, and great vessels are within normal limits based on an\nunenhanced scan.  There are extensive coronary artery calcifications.  Trace\npericardial effusion is likely within physiologic range.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  Calcified subcarinal lymph nodes\nlikely represent sequela from prior granulomatous disease.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: ___ opacity in the right upper lobe is likely\ninflammatory in etiology (04:54).  There is biapical pleural scarring.  The\ncentral airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for a\nsmall hiatal hernia.  Multiple hypodense liver lesions are incompletely\nevaluated, unchanged from prior.\n\nBONES: There is a comminuted and mildly displaced fracture of the posterior\nright tenth rib and a nondisplaced fracture of the posterior right eleventh\nrib, with pleural thickening noted along the tenth rib.  Multiple chronic\nbilateral rib fractures are also seen.  Unchanged compression deformity of\nT11.",
            "output": "1. There is a comminuted and mildly displaced fracture of the posterior right\ntenth rib and a nondisplaced fracture of the posterior right eleventh rib,\nwith pleural thickening along the eleventh rib.\n2. The thoracic aorta is dilated, measuring up to 4.4 cm.\n3.  Mild inflammatory change in the right upper lobe."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: The partially imaged thyroid is unremarkable. \nThere is no supraclavicular, or axillary lymphadenopathy.  There is a\nnonspecific 2.5 x 1.6 cm right lower paratracheal lymph node with a preserved\ncentral fatty hilum measuring.  There is no hilar lymphadenopathy.  Small\nepicardial lymph nodes measure up to 1.1 x 0.8 cm (3:80).  There is notable\nbilateral gynecomastia.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta and\nproximal great vessels are normal in caliber.  The proximal aorta is difficult\nto evaluate due to motion artifact.  There are at least moderate\natherosclerotic calcifications of the coronary arteries most notably the left\nanterior descending.\n\nThere is a very large nonhemorrhagic right pleural effusion.  There is\nmoderate atelectasis of the right middle lobe, severe atelectasis of the right\nupper lobe and complete collapse of the right lower lobe.  Atelectatic lung\nenhances normally and homogeneously.  There is no evidence of pneumonia.\n\nOSSEOUS STRUCTURES:  There is no worrisome bony lesion.",
            "output": "1. Large nonhemorrhagic right pleural effusion with complete collapse of the\nright lower lobe, severe atelectasis of the right upper lobe, and moderate\natelectasis of the right middle lobe.\n2. Homogeneous enhancement of atelectatic lung argues against underlying\npneumonia.\n3. Bilateral gynecomastia."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nAtherosclerotic calcification is not apparent in head neck vessels but is\nfound in at least the left anterior descending coronary artery .  There are no\nthyroid abnormalities warranting further imaging evaluation.  Aorta and\npulmonary arteries are normal size.  Pericardium is physiologic.  There is no\nlonger any appreciable pleural effusion.  Mild right pleural thickening and\npleural calcification are the residual of previous large pleural effusion. \nHilar and mediastinal lymph nodes are not pathologically enlarged.\n\nLungs are clear and tracheobronchial tree is normal to subsegmental levels.\n\n There are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, but it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild coronary atherosclerosis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary embolism is seen extending from near right\nmain pulmonary artery to segmental level in right middle lobe and subsegmental\nlevel in right lower lobe.  There is also pulmonary emboli in the left upper\nand lower lobe lobar to subsegmental arteries.  There is no evidence of right\nheart strain.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  There is mild atherosclerotic\ncalcification in the aorta.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited by motion.  Given\nthe limitation, lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for a right\nhepatic artery arising from the celiac trunk.  Wise the upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere are multilevel degenerative changes of the thoracic spine.",
            "output": "Extensive pulmonary emboli extending from near right main pulmonary artery to\nsegmental level in the right middle lobe and 2 subsegmental level in the right\nlower lobe and from lobar to subsegmental level in left upper and lower lobes.\nNo evidence of right heart strain.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:22 pm, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  Subsegmental pulmonary emboli are seen in the bilateral\nlung bases.  There is no evidence of associated pulmonary infarction or right\nheart strain.  The main pulmonary artery is dilated to 4.3 cm, suggestive of\npulmonary arterial hypertension.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  Coronary artery\ncalcifications are noted.  Dual lead left chest wall pacing device is noted. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a lap band around\nthe proximal stomach.  There is a small hiatal hernia.  The visualized organs\nof the upper abdomen are otherwise unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes seen throughout the spine.",
            "output": "1.  Subsegmental pulmonary emboli in the bilateral lung bases.  No evidence of\nassociated pulmonary infarction or right heart strain.\n\n2.  Dilated main pulmonary artery, suggestive of pulmonary arterial\nhypertension.\n\n3.  Small hiatal hernia.\n\n4.  Lap band around the proximal stomach."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nEnlargement of the main pulmonary artery measuring up to 4.4 cm suggests\nunderlying pulmonary arterial hypertension.  Left chest Port-A-Cath with leads\nterminating within the right atrium and right ventricle.  Mild atherosclerotic\ncalcifications at the aortic arch.  There are also mild coronary\ncalcifications.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits.  Trace pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Small mediastinal lymph nodes measuring up to 9\nmm in short axis at the prevascular station (series 2, image 32).  No\npathologically enlarged axillary, supraclavicular, mediastinal, or hilar lymph\nnodes.  No mediastinal masses.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Subtle ground-glass and nodular opacification within the left\nupper lobe and superior segment of the left lower lobe likely represent\nunderlying infection or inflammation (series 3, image 75, 87, 130 and series\n602, image 63). 2 mm nodule within the right lower lobe (series 3, image 144),\nwhich does not require follow-up.  Airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small hiatal hernia.  A lap band is in appropriate position.  No\nother abnormalities within the partially visualized upper abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild degenerative changes in the thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Ground-glass and nodular opacification within the left upper lobe and\nsuperior segment of the left lower lobe likely represent infection or\ninflammation.\n3. Enlargement of the main pulmonary arteries suggests pulmonary arterial\nhypertension.\n4. Trace pericardial effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.  The thyroid is unremarkable.\n\nMEDIASTINUM: Mediastinal lymph nodes measuring up to 0.6 cm (03:18) in the\nright lower paratracheal station are not pathologically enlarged by CT size\ncriteria and are unchanged from CT chest ___\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Left chest wall single lead pacemaker terminates within\nthe right atrium.  There is a small pericardial effusion, minimally increased\nin size from ___.\n\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA: There is no consolidation or concerning pulmonary nodule. \nThere is no consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The main and right pulmonary arteries are enlarged measuring 4.7\nand 3.2 cm, respectively (03:24), grossly unchanged from ___.\nCHEST CAGE: There is no suspicious osseous abnormality.\n\nUPPER ABDOMEN: A lap band is in appropriate position.  There is a small hiatal\nhernia.",
            "output": "1. No acute abnormality in the thorax to explain patient's shortness of\nbreath.\n2. Small pericardial effusion is minimally increased in size from CT chest ___.\n3. Dilated main and right pulmonary arteries measuring up to 4.7 and 3.2 cm,\nrespectively, unchanged from ___ are a strong indication\nofpersistent pulmonary arterial hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in both axilla or\nthoracic inlet.  Left anterior ICD with leads ending in right atrium, right\nventricle and coronary sinus.  No atherosclerotic calcifications in the head\nand neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is top-normal in size.  Mild pericardial effusion, slightly larger\nthan in prior study.  The aorta is normal in caliber throughout.  Mild\natherosclerotic calcifications are noted in the aortic arch and coronary\narteries.  The main pulmonary artery is stably enlarged measuring 4.8 cm.\n\nMEDIASTINUM AND HILA:\nA gastric band is noted surrounding the cardia, unchanged in position.  A\nmoderate sliding hiatal hernia is seen in the entire esophagus is mildly\ndistended, with significant amount of residual food bolus.  Small mediastinal\nlymph nodes, none pathologically enlarged by CT size criteria.  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusion.  No apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No interstitial septal\nthickening is noted.  No consolidations or lung nodules.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis in the lower thoracic spine.  No\nsuspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no other significant abnormal\nfindings.",
            "output": "No pulmonary findings are noted to suggest amiodarone lung toxicity.  The\nlungs are clear with no ground-glass opacities or interstitial thickening.\n\nStable enlargement of the pulmonary arteries suggestive of pulmonary\nhypertension for which correlation with an echocardiogram is recommended, if\nnot already performed."
        },
        {
            "input": "Study is limited by motion.\n\nCHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart is normal in size.  The pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild emphysema is seen at the bilateral lung apices. There is\nbibasilar atelectasis, right greater than left.  Otherwise, lungs are clear\nwithout worrisome nodule, mass or consolidation.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular, consistent with history of\ncirrhosis.  Several tiny hypoattenuating lesions at the dome of the liver, not\nfully characterized, appear unchanged.  No suspicious lesions.  There is no\nintrahepatic or extrahepatic biliary dilatation.  Cholelithiasis without\nevidence of cholecystitis.  There is adenomyomatosis at the gallbladder\nfundus.  A TIPS stent is seen between the right portal vein in the right\nhepatic vein.  The stent appears grossly patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: There is splenomegaly (15.2 cm in craniocaudal dimension), previously\n14.3 cm.  The spleen is normal in attenuation without focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple subcentimeter hypoattenuating cystic lesions that are too\nsmall to characterize but likely represent benign renal cysts.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  There is a large stool ball in the rectum. \nLarge stool burden throughout the colon.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.  Coarse\ncalcification in the prostate gland, similar prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Multiple prominent periportal and\nperipancreatic lymph nodes, likely secondary to portal hypertension and are\nnot pathologically enlarged by CT size criteria.\n\nVASCULAR: Coil embolization material is seen in multiple perigastric varices. \nMultiple small gastric and esophageal varices are present.  There is sequela\nof portal hypertension including a splenorenal shunt.  No atherosclerotic\ndisease is noted.  No abdominal aortic aneurysm.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nMild degenerative changes in the lumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\nevidence of gynecomastia.",
            "output": "1. No acute findings.\n2. Shrunken nodular liver consistent with cirrhosis.  Splenomegaly and\nportosystemic varices reflect portal hypertension.\n3. Cholelithiasis without evidence of cholecystitis.\n4. Large stool ball in the rectum and large stool burden throughout the colon.\n5. Stable positioning of the TIPS stent, which appears grossly patent."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury. Within the limitations of a non-gated study, the\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Several rounded but not enlarged axillary lymph\nnodes are noted, nonspecific. No mediastinal or hilar adenopathy by CT size\ncriteria.  No evidence of mediastinal hematoma.\n\nPLEURAL SPACES: There is a moderately sized right pneumothorax with a small\namount of air extending into the mediastinum posteriorly and superiorly (2:\n12,68). No evidence of tension at this time. There is a small right pleural\neffusion which contains air.\n\nLUNGS/AIRWAYS: Parenchymal opacities in the superior right lung are consistent\nwith contusion (02:21). The central airways are patent.\n\nBASE OF NECK: Multiple thyroid nodules are noted. Largest of these measures 14\nmm extending exophytically from the right thyroid lobe, similar from prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There are acute displaced fractures involving the right anterior first\nthrough seventh ribs. Subtle height loss of the superior endplate of the T4\nvertebral body is indeterminate clinical correlation is advised (605:70).\nMultiple Schmorl's nodes are noted in the L3 vertebral body.\n\nSOFT TISSUES: A small amount of subcutaneous air is seen in the posterior\nchest wall (02:18). There is a small fat containing umbilical hernia.",
            "output": "1. Moderately sized right pneumothorax without evidence of tension. Trace\namount of gas is seen within the mediastinum.\n2. Acute displaced fractures involving the right anterolateral first through\nseventh ribs with an associated pleural effusion and lung parenchymal\ncontusion in the right upper lobe.\n3. Subtle height loss of the superior endplate of the T4 vertebral body is age\nindeterminate. Clinical correlation is advised.\n4. Multiple thyroid nodules. The largest of these measures 14 mm extending\nexophytically from the right thyroid lobe, similar from prior.\n5. Sigmoid diverticulosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:45 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Mild atherosclerotic calcifications of the thoracic\naorta and at the origin of the head and neck vessels.  The thoracic aorta is\nnormal in caliber without evidence of acute injury.  Moderate coronary\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis.  No focal consolidations.  Punctate\nsubpleural nodule within the right lower lobe (series 2, image 71).  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously hypodense, likely representing\nsteatosis.  No focal lesions or lacerations.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia, predominantly containing fat.  The\nstomach is unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The colon and rectum are within normal\nlimits.  The appendix is normal.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.5 x 4.1 cm with\nprotrusion of the median lobe into the bladder base.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There are acute fractures of the right lateral seventh and eighth rib. \nMultiple additional chronic rib fractures are seen on the right.  There are\nsevere compression deformities of the T9 and T11 vertebral bodies with mild\nretropulsion, which are indeterminate in age, but new since ___.  No focal\nsuspicious osseous abnormality.\n\nSOFT TISSUES: Small amount of fat stranding over the right lower back is\nlikely posttraumatic (series 3, image 151).  Otherwise, the abdominal and\npelvic wall is within normal limits.",
            "output": "1. Acute fractures of the right lateral seventh and eighth ribs.  Severe\ncompression deformities of T9 and T11 vertebral bodies with mild retropulsion,\nindeterminate in age, but new since ___.  Multiple additional chronic rib\nfractures are seen on the right.\n2. No other acute traumatic injuries within the chest, abdomen, or pelvis.\n3. Punctate subpleural nodule within the right lower lobe, for which no\nfollow-up is recommended in a low risk patient.\n4. Other incidental findings include hepatic steatosis, cholelithiasis, a\nmoderate hiatal hernia, and prostatomegaly.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Right-sided Port-A-Cath tip projects to the SVC\n\n AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM:\n\nNODES: There are no enlarged mediastinal hilar lymph nodes.\n\nHEART, VESSELS and PERICARDIUM: Heart size is normal.  There is no pericardial\neffusion.  The aorta and pulmonary artery normal in caliber.\n\nPLEURA: There is no pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA:  There is minimal bibasilar atelectasis\n2. AIRWAYS:  The airways are patent to the subsegmental level\n3. Nodules: : 3 mm left lower lobe pulmonary nodule (46, 2) is unchanged.  No\nnew pulmonary nodules\nBONES : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "3 mm left lower lobe pulmonary nodules unchanged.  No new pulmonary nodules\n\nRight-sided Port-A-Cath with its tip in the SVC.\n\nPlease refer to dedicated report on abdomen which has been dictated separate"
        },
        {
            "input": "Right chest wall Port-A-Cath is seen with catheter tip extending into the\ncavoatrial junction.  The imaged portion of the thyroid is unremarkable. \nThoracic aorta is normal in course and caliber without appreciable\natherosclerosis.  The heart is normal in size and shape without pericardial\neffusion.  The main pulmonary artery is normal in size with patent central\nbranches.  There is no mediastinal, axillary, or hilar lymphadenopathy.  No\npleural effusion or pneumothorax.\n\nThe previously described nodule in the left lower lobe appears stable from ___, allowing for differences in technique, best seen on series 7,\nimage 191 measuring 6 mm.  Please note, discrepancy in reported size comparing\nprior with current exam likely reflects difference in slice thickness with 1\nmm thick axial slices available on current exam allowing for more accurate\nsizing of nodule.  No convincing evidence for new or growing nodule is seen\nwithin the lungs.\n\nPlease refer to same-day CT abdomen pelvis for findings below the diaphragm.\n\nBONES:  No worrisome lytic or blastic osseous lesion.  No fracture.",
            "output": "Size stable nodule in the left lower lobe, measuring up to 6 mm. No new or\ngrowing pulmonary nodule.  No convincing evidence for metastatic disease\nwithin the chest.  Port-A-Cath appears well positioned.  Please refer to\nsame-day CT abdomen pelvis for findings below the diaphragm."
        },
        {
            "input": "Right pectoral Port-A-Cath.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No incidental thyroid findings.  No enlarged lymph nodes in\nthe mediastinum.  Minimal thymic tissue in the anterior mediastinum, mildly\nincreased in size since the previous examination.  No abnormalities at the\nlevel of the large mediastinal vessels.  No substantial coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable, with the exception of a small hiatal\nhernia.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  No pleural effusions.  No pleural thickening.  No\ndiffuse lung disease.  The airways are patent.  A single nodule in the left\nlower lobe (302, 154) has a stable size of 6 mm and the morphology likely\nreflective of an intrapulmonary lymph node.  No evidence of suspicious\npulmonary nodules.",
            "output": "Stable size of a 6 mm left lower lobe nodule that likely reflect an\nintrapulmonary lymph node.  No suspicious pulmonary nodules.  No pleural\nabnormalities.  No lymphadenopathy."
        },
        {
            "input": "THORACIC INLET: There is a stable hypodense lesion within the right lobe of\nthyroid.  Right-sided PICC line projects to the cavoatrial junction.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The previously visualized 6 mm left lower lobe pulmonary nodule is\nunchanged (4, 180).  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.",
            "output": "Stable 6 mm left lower lobe pulmonary nodule.  No new pulmonary nodules. \nContinued follow-up in view of history of malignancy is recommended"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable\n\nUPPER ABDOMEN: Please refer to the abdominal CT done the same day.\n\nMEDIASTINUM: No mediastinal adenopathy.  Simple fluid in the superior\npericardial recess which is within normal limits.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.\nPLEURA: No pleural effusion\nLUNG:\n\n-PARENCHYMA:  Nodular ground-glass opacities with a peribronchovascular\ndistribution predominantly in the lingula and left lower lobe with a\nconsolidation in the lateral segment of the left lower lobe concerning for\npneumonia.\n-AIRWAYS:  Patent\n-VESSELS:  Unremarkable\nCHEST CAGE: No worrisome bone lesion.",
            "output": "-No concerning lesion for malignancy.\n-Multifocal left lung opacity predominantly in the lingula and the left lower\nlobe with consolidation concerning for pneumonitis. follow-up with imaging\npost treatment is recommended."
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the subsegmental\nlevel without filling defect to suggest pulmonary embolism. Pulmonary arteries\nare normal in caliber.\n\nThere is no evidence of pulmonary parenchymal abnormality. There is no pleural\neffusion or pneumothorax. The airways are patent to the subsegmental level.\n\nHeart is unremarkable.  There is no pericardial effusion.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy. Included\nportion of the thyroid is unremarkable.\n\nIncluded portion of the upper abdomen is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere is no fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild aortic\nannulus, aorta, and bilateral subclavian artery atherosclerotic calcifications\nare noted.  The heart, pericardium, and great vessels are otherwise within\nnormal limits based on this unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is a 5 mm pulmonary nodule in the lateral right middle\nlobe.  Lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates marked\nhepatic steatosis and diverticulosis.  Patient status post cholecystectomy..\n\nBONES:  There is a mildly posterolateral right tenth rib fracture.  No\nadditional fractures are identified, though the tenth and eleventh ribs are\nincompletely evaluated. No suspicious osseous abnormality is seen.?",
            "output": "1. Posterior lateral right tenth rib fracture.  No additional fractures\nidentified, though the eleventh and twelfth ribs are incompletely evaluated.\n2. 5 mm pulmonary nodule in the right middle lobe.  Per the ___\nrecommendations, if the patient is high risk for lung malignancy, recommend\nfollow-up CT in 6 months for further evaluation.  If the patient is low risk,\nrecommend follow-up CT in 12 months for further evaluation.\n3. Hepatic steatosis.\n\nRECOMMENDATION(S):  5 mm pulmonary nodule in the right middle lobe. Per the\n___ recommendations, if the patient is high risk for lung\nmalignancy, recommend follow-up CT in 6 months for further evaluation.  If the\npatient is low risk, recommend follow-up CT in 12 months for further\nevaluation."
        },
        {
            "input": "NECK AND THORACIC INLET: No incidental thyroid findings.\n\nAXILLAE, CHEST WALL, AND BONES: No enlarged lymph nodes in the axilla and at\nthe level of the chest wall.  Calcification in the right breast. . \nDegenerative vertebral body changes.\n\nMEDIASTINUM: Several borderline sized mediastinal lymph nodes.\n\nHILA: Several borderline sized hilar lymph nodes.\n\nHEART: Moderate cardiomegaly, coronary and mild valvular calcifications. Small\npericardial effusion.\n\nLUNG:\n\n-PARENCHYMA:  Signs of pulmonary edema. Additional upper lobe predominant,\nright more than left parenchymal opacities suggestive of multifocal pneumonia.\n-AIRWAYS:  Limited visualization of the airways given respiratory motion are\ndefects.\n-VESSELS:  Signs of moderate pulmonary venous congestion.\nPLEURA: Moderate bilateral pleural effusions.\n\nUPPER ABDOMEN: No acute findings in the upper abdomen.",
            "output": "Bilateral pleural effusions. Moderate pulmonary edema. Multifocal pneumonia,\nwith maximum extent in the right upper lobe.\n\nRECOMMENDATION:  No specific followup recommendations."
        },
        {
            "input": "HEART, PERICARDIUM AND VASCULATURE:\nNo evidence of calcifications or dilatation of the ascending aorta above the\naortic annulus.  Mild aortic annulus calcifications.  Severely calcified\naortic arch with elevation and duplication of intimal calcifications (302: 60\n79) and mild bulging of the proximal aortic arch (302:71).  Dilated 36 mm main\npulmonary artery, 33 mm right and 34 mm left pulmonary arteries.\n\nExtensive atherosclerotic calcifications of the coronary arteries, mild in the\naortic valve leaflets.  Marked right atrial and moderate left atrial\nenlargement.  Moderate pericardial effusion without evidence of tamponade. \nLow blood pool density suggests underlying anemia.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nPartially imaged thyroid gland is unremarkable.  No enlarged lymph nodes in\neither the axilla or thoracic inlet.  There are no chest wall abnormalities. \nModerate size calcified plaque in the proximal right common carotid artery.\n\nMEDIASTINUM AND HILA:\nModerate hiatal hernia.  Esophagus is mildly patulous without evidence of\ndistal obstruction.  Multiple central mediastinal lymph nodes and\nconglomerates, none enlarged by CT size criteria. No evidence of enlarged\nhilar lymph nodes within the limitations of a noncontrast study.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  Mild bronchial wall\nthickening, no bronchiectasis or mucus plugging.  Right upper lobe 3 mm\nsolitary nodule (302:31).  Diffuse bilateral lower lobe predominant\ninterlobular septal thickening and associated background gland gas opacities\nreflect mild pulmonary edema.  No focal consolidations.  Bibasilar\nsubsegmental atelectasis.  No pleural effusions.\n\nCHEST CAGE:\nNo acute fractures.  Severe dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals are unremarkable.  This study is not tailored for\nsubdiaphragmatic assessment, but within this limitations there is elevation of\nthe intimal calcifications similar to the aortic arch and associated\naneurysmal dilatation of the right renal artery origin in association with and\natrophic left kidney.",
            "output": "No evidence of calcifications in the ascending aorta.  The intimal elevation\nof the aortic arch and abdominal aorta atherosclerotic calcifications, mild\nbulging of the proximal aortic arch and aneurysmal dilatation at the origin of\nthe left renal artery raise concern for underlying aortic pathology, thus\nfurther assessment with CT angiography is recommended to rule out this\npossibility.\n\nSevere right atrial enlargement and moderate left atrial enlargement, further\nassessment with echocardiography is recommended.\n\nEnlarged main, right and left pulmonary arteries in keeping with pulmonary\nhypertension.\n\nSevere coronary artery atherosclerotic disease.\n\nMild pulmonary edema.\n\nIncidental right upper lobe 3 mm solitary nodule.  See recommendations below.\n\nRECOMMENDATION(S):  Torso CTA for proper characterization of possible aortic\npathology.\n\nEchocardiogram for further assessment of the biatrial enlargement.\n\nFor incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:13 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging. No suspicious lung nodules or\nmasses. No consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is diffusely enlarged with craniocaudal extension of 17.8\ncm.  No focal lesions are identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Mild fat stranding surrounding\nthe second through fourth portions of the duodenum (6:63).  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume abdominopelvic fluid noted in the paracolic gutters, mesentery\nand pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexal regions are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nWell-defined round sclerotic lesion in sacrum (6:88), likely a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild fat stranding surrounding the duodenum, possibly reflective of\nduodenitis.  Small volume abdominopelvic fluid.\n2. Homogeneous splenomegaly.\n3. Unremarkable examination of the liver with no clear evidence of prior\nsurgical resection or embolization.\n4. No definite evidence of metastatic disease within the chest, abdomen or\npelvis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:24 pm."
        },
        {
            "input": "The patient is status post transcatheter aortic valve repair.  There is\ncardiomegaly, with prominent right atrial enlargement.  The main pulmonary\nartery is normal caliber. There is no filling defect demonstrated within the\nmain pulmonary arteries or segmental branches. There is no mediastinal or\nhilar lymphadenopathy.  There is atheromatous calcification involving the\nthoracic aorta. The left subclavian and common carotid arteries are tortuous\nin appearance.\n\nThe pleural spaces are clear.  There is heterogeneous air trapping throughout\nboth lungs with subpleural reticulation also demonstrated similar in\nappearance to the prior examination.\n\nScattered sub 5 mm lung nodules are unchanged from the prior examination. 9 mm\nlesion arising from the upper pole of the left kidney likely represents a\ncortical cyst.\n\nMultilevel degenerative disc changes are noted involving the mid thoracic\nspine. There is no osseous lesion demonstrated.",
            "output": "1. No pulmonary embolus.\n2. Subpleural reticulation again seen throughout both lungs. The appearance is\nmost in keeping with nonspecific interstitial pneumonia (NSIP).  In addition\nthere are scattered areas of air trapping noted.\n3. Cardiomegaly with prominent right atrial enlargement."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta contains atherosclerotic\ncalcifications though is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.  A right pectoral Port-A-Cath is visualized catheter tip\nterminating in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple nonenlarged mediastinal lymph nodes\nare visualized.  No axillary or hilar lymphadenopathy is identified.  Surgical\nclips are re-demonstrated in the left axilla.\n\nPLEURAL SPACES: There is a trace left pleural effusion.\n\nLUNGS/AIRWAYS: Motion artifact limits evaluation though multifocal\nground-glass opacities with associated interlobular septal thickening is\nconsistent with pulmonary edema.  There is a small pleural effusion.  A left\nlower lobe 4 mm pulmonary nodule (4:97) and 6 mm right lower lobe pulmonary\nnodule (4:136) are unchanged.  Multiple punctate right lung calcified\ngranulomas are unchanged.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: The visualized thyroid is unremarkable.  No supraclavicular\nlymphadenopathy is identified.\n\nABDOMEN: The liver is heterogeneous in appearance with multiple ill-defined\nhypodense lesions compatible with previous findings concerning for metastatic\ndisease characterized on study of ___.  A large 4.7 left hepatic\nlobe hypodensity likely representing a patent cyst versus biliary hamartoma is\nunchanged.  A 4.5 cm right adrenal myelolipoma is not substantially changed\nfrom prior.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multifocal ground-glass opacities with associated interlobular septal\nthickening consistent with pulmonary edema.\n2. Stable bilateral lower lobe pulmonary nodules.\n3. Trace left pleural effusion.\n4. Chronic findings including right adrenal myelolipoma, left hepatic lobe\ncyst versus biliary hamartoma, and hepatic metastatic disease are all grossly\nunchanged from prior and better characterized on CT torso from ___."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber and tortuous. \nMild atherosclerotic calcifications of the thoracic aorta.  The heart is\nnormal size.  Trace pericardial effusion is similar.  Moderate coronary artery\ndisease.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present.  Mildly\nprominent mediastinal lymph nodes with the largest being a subcarinal lymph\nnode measuring 1 cm which is unchanged since ___.  Few subcentimeter\nright hilar lymph nodes.  No mediastinal mass or hematoma.  Re-demonstrated\nstatus post esophagogastrectomy with unchanged postoperative changes.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Re-demonstrated are\nlarge bilateral right greater than left pleural plaques appear similar to\n___.  There is a large left posterior diaphragmatic defect containing\nunobstructed loops of small and large bowel which appears to extend slightly\nmore cranially than on the prior study.\n\nLUNGS/AIRWAYS: Mild paraseptal emphysema noted in the right lung.  Apical\nscarring in the right greater than left lungs.  ___ nodularity in the\nright lower lobe and to lesser extent in the posterior right upper lobe\nsuggests infectious or inflammatory bronchiolitis.  Bibasilar right greater\nthan left lower lobe bronchiectasis is slightly more prominent.  Mild\ndependent atelectasis. The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: See the dedicated CT abdomen pelvis for full details of the abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThoracic kyphosis.  Mild degenerative changes of the spine.",
            "output": "1. Re-demonstrated unchanged postsurgical changes from esophagogastrectomy.\n2. ___ nodularity in the right lower lobe and to lesser extent in the\nposterior right upper lobe suggests infectious or inflammatory bronchiolitis.\n3. Similar bilateral right greater left pleural plaques.\n4. Large left diaphragmatic defect is re-demonstrated containing nonobstructed\nloops of small large bowel.\n5. Additional findings as above."
        },
        {
            "input": "NECK, THORACIC INLET, LYMPH NODES, CHEST WALL: Right supraclavicular 1.1 cm\nlymph node was not imaged in prior study (3:112).\nNo axillary lymphadenopathy is present.\n\nFew mediastinal and hilar lymph nodes have enlarged-subcarinal lymph node 1.8\nx 1.1 cm minimally larger since the prior 1.6 x 1 cm (302:75).  Right lower\nparatracheal 0.9 cm lymph node, in prior 0.5.\nRight hilum 2.7 x 3.7 cm, in prior 1.5 x 2.5 cm (302:75).  Left hilum lymph\nnode 1.4 cm, in prior 0.8 (302:81).\nNo mediastinal mass or hematoma.\n\nRe-demonstrated status post esophagogastrectomy with unchanged postoperative\nchanges.  Nasogastric tube terminates in neo esophagus.  Large quantity of\noral contrast filling the neo esophagus extending cranially filling the or\noropharynx (03:34), findings are concerning for possible aspirations.\n\nDiffuse subcutaneous edema of the chest wall is worse since prior.\n\nUPPER ABDOMEN: Liver is heterogeneous in appearance, will be described\nseparately in the same day CT of the abdomen and pelvis.\n\nHEART and PERICARDIUM: Minimal calcifications of aortic valve leaflets with\ndense calcifications of the coronaries.  The thoracic aorta is normal in\ncaliber and tortuous with mild atherosclerotic calcifications.  The heart is\nnormal size.  Trace pericardial effusion is unchanged.\n\nPLEURA: New bilateral pleural effusions, left moderate right small.  A left\npleural effusion is partially loculated, dense- exudate (20 ___ with septa and\nthickening of the pleura.  Small bubble of air is identified (302:73).\n\nRe-demonstrated are large bilateral right greater than left pleural plaques\nappear similar to ___.\n\nLUNG: Endotracheal tube terminates in good position.\nBibasilar consolidations adjacent to the new pleural effusions are concerning\nfor aspiration pneumonia.  New scattered consolidations and ___\nopacity involving right in the upper lobes are concerning for new multifocal\npneumonia.\nNo clear nodules suspicious for metastasis identified.\n\nMild paraseptal emphysema noted in the right lung.  Apical scarring in the\nright greater than left lungs.\n\nCHEST CAGE: No evidence of lytic or sclerotic bony destructive lesions.",
            "output": "-New bilateral pleural effusions, right is small.  Left is moderate and\npartially loculated with thickening of the pleura, containing bubble of gas\nconcerning empyema.\n-Multifocal heterogeneous new consolidations are likely multifocal pneumonia. \nBibasilar consolidations, probably aspiration pneumonia.\n-Mediastinal lymph nodes mildly enlarged and possibly reactive, attention on\nfollow-up."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  There are bilateral\ncalcified pleural plaques, some of which have a nodular configuration.\n\n\nLUNGS/AIRWAYS:  The central airways are patent.  There is mild bronchiectasis\nin the right lower lobe.  Linear and more nodular airspace opacity in both\nlung bases is favored to represent atelectasis.  No other areas of focal\nconsolidation are seen.  There is apical pleural parenchymal scarring on the\nright.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nESOPHAGUS:  The patient is status post esophagogastrectomy.  No mediastinal\nair or fluid is seen to suggest perforation.  Fluid is seen within the gastric\npull up.  No clear evidence of obstruction is seen.\n\nUPPER ABDOMEN:  There is a large left diaphragmatic hernia extending into the\nposterior left hemi thorax containing small and large bowel.  The left kidney\nis not visualized.  Along the anterior aspect of the liver there is a\nsuspected ill-defined hypodense nodule measuring approximately 1.9 cm (02:54).\n\nOSSEOUS STRUCTURES:  Degenerative changes are seen in the spine.",
            "output": "Status post esophagogastrectomy.  No evidence of perforation or obstruction.\nLarge left diaphragmatic hernia.\nSuspected ill-defined 1.9 cm hypodense lesion along the anterior aspect of the\nliver for which further evaluation with ultrasound is recommended.\n\nRECOMMENDATION(S):  Suspected ill-defined 1.9 cm hypodense lesion along the\nanterior aspect of the liver for which further evaluation with ultrasound is\nrecommended.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 14:55 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nEvaluation of the pulmonary arteries is markedly limited by body habitus.  No\nevidence of filling defect in the main, right, or left pulmonary arteries to\nindicate a large acute central pulmonary embolus.  The remaining pulmonary\narteries more distally are not well evaluated.  The main, right, and left\npulmonary arteries are normal in caliber, similar to the prior exam.  No\nevidence of right heart strain.\n\nA right paratracheal lymph node with normal fatty hilum measures up to 1.3 cm,\nunchanged.  Otherwise, no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  The visualized portions of the thyroid gland appear\nunremarkable.\n\nA fluid-attenuation pericardial effusion is small, decreased in size and\nattenuation since ___.  The overall size and configuration of the heart\nis similar to the prior exam.\n\nA right pleural effusion is moderate to large, increased in size since\n___.  A left pleural effusion is small, decreased compared to the prior\nexam.  A small amount of airspace opacity adjacent to the right pleural\neffusion in the right lower lobe that is most likely relax a shin atelectasis.\nThere is minimal atelectasis associated with the left pleural effusion.\n\nDetailed evaluation of the remaining aerated portions of the left lung is\nlimited from respiratory motion matter defect and body habitus.  However, no\nobvious pulmonary mass is identified.  No significant paraseptal thickening to\nsuggest significant edema.\n\nThe airways are patent to at least the subsegmental level.  No pneumothorax.\n\nA hiatal hernia is large, unchanged.  Decreased uniform attenuation of the\nliver suggests steatosis, similar the prior exam.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  Very limited exam to assess for pulmonary embolus secondary to patient\nbody habitus.  No evidence of a large acute central pulmonary embolus in the\nmain, right, or left pulmonary arteries.\n\n2.  Small, fluid-attenuation pericardial effusion, decreased in size and\nattenuation since the prior exam.  Unchanged size and configuration of the\nheart.\n\n3.  Moderate to large right pleural effusion with passive atelectasis and\nsmall the left pleural effusion with minimal associated atelectasis.\n\n4.  Large hiatal hernia.\n\nNOTIFICATION:  The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 3:10 AM, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "There is no calcification of the head and neck vessels.  The aorta and its\nmajor branch vessels are patent, with no evidence of stenosis, occlusion,\ndissection, or aneurysmal formation.  There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.  Heart is mildly\nenlarged.  Previously seen pericardial effusion has resolved.\n\nLimited evaluation due to patient body habitus.  Within this limitation, there\nis no large filling defect in the main, right or left pulmonary arteries,\nlobar and segmental arteries to suggest pulmonary embolus.  The subsegmental\narteries are not well evaluated.  The main, right and left pulmonary arteries\nare normal in caliber and there is no evidence of right heart strain.\n\nA 1.3 cm right paratracheal lymph node with a normal-appearing fatty hilum is\nsimilar to prior exam.  Otherwise, there is no supraclavicular,\ninfraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The thyroid\ngland appears unremarkable without discrete nodule.\n\nTrace pericardial effusion, which has significantly improved over the interval\nsince ___.  Previously identified bilateral pleural effusions have\nresolved.  There is minimal paraseptal emphysema.  Minimal bibasilar dependent\natelectasis.\n\n3 mm pulmonary nodule in the right upper lobe is unchanged since at least\n___.  No confluent airspace consolidation.  No diffuse lung disease.\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate informed hypoattenuation of\nthe liver, suggestive of hepatic steatosis, and a large hiatal hernia,\nunchanged.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Limited evaluation due to patient body habitus.  No pulmonary embolus to\nthe segmental level.  No acute aortic process.\n2. Stable 3 mm right upper lobe nodule, unchanged since at least ___.\n3. Trace pericardial effusion, significantly improved since prior exam.\n4. Resolved bilateral pleural effusions.\n5. Stable large hiatal hernia."
        },
        {
            "input": "Limited evaluation due to overlying soft tissue, bolus timing, and motion.\n\nHEART AND VASCULATURE: There is no central or segmental pulmonary embolus. \nApparent filling defect in the left segmental upper lobe pulmonary\nsubsegmental artery does not persist on other projections and most likely\nrepresent artifact due to motion volume averaging (301:83, 301:82).  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is top normal in size. The pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  There is no focal consolidation or pulmonary edema.  A 3 mm\nright upper lobe pulmonary nodule stable from ___ and does not require\ndedicated follow-up.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The large hiatal hernia is redemonstrated.  Included portion of the\nupper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Limited evaluation due to overlying soft tissue, bolus timing, and motion.\nNo central or segmental pulmonary embolism.\n2. No acute aortic abnormality.\n3. Moderate to large hiatal hernia."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are unremarkable.\n\nCT chest:  The thyroid is unremarkable.  The cervical vasculature is patent\nwith contrast pooling in the left supraclavicular region possibly in\ncollateral vessels.  A 2.4 x 2.4 cm left supraclavicular lymph node with areas\nof hypodensity may be partially necrotic. Prominent left axillary lymph nodes\nare more notable for their number than size measuring up to only 9 mm.  Bulky\ninfiltrative mediastinal lymphadenopathy appears similar to 2 days ago with\npersistent severe narrowing of both brachiocephalic veins with a lumen of 3 mm\non the right just above the level of the brachiocephalic confluence and 4 mm\non the left.  The brachiocephalic veins are narrowly patent; the superior vena\ncava is closer to normal patency. Lymphadenopathy encases the trachea and\nmainstem bronchi without substantial narrowing. The airways are patent to the\nsubsegmental level.\n\nCompared to the study 2 days ago there is a new pericardial drain extending\nalong the inferior aspect of the pericardium with the tip posterior to the\nleft atrium with resultant decrease in size of the pericardial effusion, now\nsmall. Heart size is normal.  A right pigtail pleural drainage catheter has\nalso been placed with the pigtail in the major fissure, but the right pleural\neffusion remains large with complete collapse of the right lower lobe and\nright middle lobe. A small left pleural effusion with associated relaxation\natelectasis in the left lower lobe appear similar to prior. 4 mm pulmonary\nnodule in the superior segment of the left lower lobe (3:67) unchanged from 2\ndays ago.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "1. Bulky mediastinal lymphadenopathy similar in appearance to recent prior\nstudy causes more severe narrowing of both brachiocephalic veins, both\nnarrowly patent, SVC more mildly narrowed.\n2. 2.4 cm left supraclavicular lymph node\n3. Interval placement of pericardial drain with resultant decrease in\npericardial effusion, now small\n4. Interval placement of right pleural drainage catheter terminating in the\nmajor fissure with persistent large right pleural effusion with associated\ncollapse of the right lower and middle lobes\n5. Unchanged small left pleural effusion with associated relaxation\natelectasis of the left lower lobe\n6. 4 mm have left lower lobe pulmonary nodule. Recommend attention on\nfollowup."
        },
        {
            "input": "MEDIASTINUM:  The thyroid is incompletely visualized.  A hypodensity is\npresent in the right upper thyroid lobe (Series 5, Image 8).  A left hilar\nlymph node is prominent but not pathologically enlarged (Series 5, Image 27). \nA retrosternal lymph node is also visualized but not pathologically enlarged\n(Series 5, Image 39).  No supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy by CT size criteria.  The aorta and pulmonary arteries are\nnormal in size.   The heart size is normal.  No pericardial effusion.\n\nLUNGS AND PLEURA:  Small-to-moderate bilateral, low-attenuation, pleural\neffusions with adjacent compressive atelectasis are present.  Parenchymal\nscarring in the right lung including apex is likely post-radiation change. \nThe airways are patent.  No nodules are identified.  No pneumothorax.\n\nSOFT TISSUE:  The patient is status-post right mastectomy.\n\nBONES:  Multi-level degenerative changes are noted.  Slightly sclerotic\nlesions in the thoracic vertebrae are likely also degenerative, but close\nattention to follow-up is advised.\n\nUPPER ABDOMEN:  Please refer to the dedicated report from the CT abdomen and\npelvis exam performed on the same day for a description of the\nsubdiaphragmatic findings.",
            "output": "1.  No definite evidence of metastatic disease in the thorax.\n\n2.  Small-to-moderate bilateral pleural effusions and atelectasis.  \nRight-sided probable post-radiation changes.\n\n3.  Prominent left hilar and retrosternal lymph nodes but not pathologically\nenlarged.  Close attention to follow-up.\n\n4.  Probable degenerative changes in bony thorax - close attention to\nfollow-up.\n\n5.  Please refer to the dedicated report from the CT abdomen and pelvis exam\nperformed on the same day for a description of the subdiaphragmatic findings.\n\nRECOMMENDATION(S):  1.  3-month follow-up CT chest.\n\n2.  Please refer to the dedicated report from the CT abdomen and pelvis exam\nperformed on the same day for a description of the subdiaphragmatic findings.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:48 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The imaged thyroid gland appears homogeneous.  Patient is status post right\nmastectomy.  There is no right axillary or left axillary adenopathy.  There is\nno supraclavicular, mediastinal, or hilar adenopathy.\n\nThe heart is within normal limits in size.  The ascending aorta is non\naneurysmal within the main pulmonary artery within normal limits in caliber. \nNo appreciable coronary artery calcifications are identified.  A small\npericardial effusion is indeterminate.  The esophagus is unremarkable.\n\nThe airways are patent to the subsegmental level.  Right upper lobe peripheral\nfibrotic changes are most consistent with post treatment changes, stable. \nBibasilar atelectasis is mild and symmetric.  A 0.2 cm nodule within the left\nlower lobe peripherally (4:135) is noted.  No consolidation or mass is\nidentified.  There is no pleural effusion or abnormality.\n\nRelative to prior examination performed ___, sclerotic lesions within\nthe thoracic and lumbar vertebral bodies appears to have progressed.  The\nlargest lesion within the L1 vertebral body appears enlarged, previously\napproximately 0.6 cm and currently measuring approximately 1.2 cm (602b:34). \nA sclerotic lesion within the T10 vertebral body appears more conspicuous and\na T6 sclerotic focus anteriorly appears new.  Sclerosis involving the T6\nvertebral body posteriorly to the left is more conspicuous (602b:34, 02:29).\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on ___, clip number ___.",
            "output": "1.  Progressed osseous metastatic disease involving the vertebral bodies\nwithout evidence of pathologic fracture.\n2. No evidence of intrathoracic metastatic disease.\n3. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed on ___, clip number ___."
        },
        {
            "input": "Status post right mastectomy.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Stable\nappearance of the heart.  No pericardial effusion.  Massive cystic changes in\nthe liver.  The heterogeneous partly lytic and partly sclerotic bony changes,\nnotably in the vertebral bodies, have minimally progressed.  No vertebral\ncompression fractures.  Mild bilateral apical thickening, unchanged in extent\nand distribution.  No pleural effusions.  No pleural thickening.  Not\ncharacteristic bilateral dependent areas of atelectasis (4, 123).  No pleural\neffusions.  No suspicious pulmonary nodules or masses.  No diffuse lung\ndisease.",
            "output": "As compared to ___, there is mild progression of the known\nmetastatic bone disease.  No pulmonary metastasis.  No pleural effusions.  No\nlymphadenopathy."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Patient has had\nright mastectomy.  Excluding the left breast evaluated with mammography, there\nare no soft tissue abnormalities in the chest wall suspicious for malignancy.\n\nThere are no thyroid lesions warranting further imaging evaluation.  Central\nlymph nodes are not pathologically enlarged, by size criteria.\n\nAtherosclerotic calcification is extremely heavy in the innominate artery, not\napparent in the coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size and there is no pericardial effusion.\n\nBiapical fibrosis and mild subpleural fibrosis in the right middle lobe are\nexplained by breast and axillary radiation.\n\nThere are no lung nodules concerning for metastasis.\n\nHeterogeneity at multiple levels in the thoracic spine shows a slight increase\nin some areas of treatment sclerosis, but little changed since at least ___.  There are no compression or pathologic fractures in the chest cage.",
            "output": "No evidence of intrathoracic malignancy or local recurrence of breast cancer\nafter right mastectomy.\n\nSlight increase in treatment effect in widespread chest cage metastases.  No\npathologic or compression fractures."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary   lymph nodes are not\nenlarged.  Left hilar lymph node measuring 11 mm was 8 mm (6:124).  Sub\ncarinal lymph node measuring 9 mm was 5 mm. Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal and there is no appreciable\ncoronary calcification.  Biapical fibrosis is right greater than left.  . \nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nMultiple sclerotic lesions in the vertebral bodies and  right clavicle are\nagain noted.\nPatient is status post right mastectomy",
            "output": "Increase in size of mediastinal and hilar lymph nodes attention in followup\nstudies is recommended\nMultiple lesions throughout the vertebral bodies and right clavicle are stable"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the left breast which requires mammography for evaluation, there are\nno soft tissue abnormalities that elsewhere in the chest wall suspicious for\nmalignancy.  Patient has had right mastectomy and all the subcutaneous fat in\nthe right upper chest wall has been removed ; the distorted a soft tissue due\nto the anterior muscular insertions looks unchanged and there is no abnormal\nsoft tissue in the right axilla.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification in head neck vessels is moderate to severe,\nparticularly the origin of the right subclavian artery, 06:37, where the lumen\nis obliterated by intimal calcification.  There is no appreciable\natherosclerotic coronary calcification.  Aorta and pulmonary arteries are\nnormal size.  Pericardium is physiologic.  5 x 9 mm prevascular mediastinal\nlymph node was 3 x 9 mm in ___.\n\nSubcentimeter lymph nodes in the lower paratracheal stations of the\nmediastinum and the lower pole of the right hilus are stable.  14 x 14 mm left\nhilar node was 11 x 14 mm.  11 x 31 mm right paraesophageal lymph node, 6:126,\nwas 9 x 24 mm in ___.  Retrocrural extension of subdiaphragmatic\nadenopathy is best evaluated in concert with other abdominal findings.\n\nRight apical radiation fibrosis is more mature.  there are no lung findings\nconcerning for metastasis.\n\nThere are no compression or pathologic fractures, but there has been\nprogression of sclerotic transformation in upper thoracic vertebra and\nmultiple rib metastases.\n\n\n\n\n.",
            "output": "Interval progression of mildly enlarged lymph nodes in the left hilus and\nright paraesophageal mediastinum.  Retrocrural tumor extension is more\npronounced, but best understood in light of other subdiaphragmatic findings to\nbe reported separately.\n\nIncrease in the volume of osteoblastic regions in the thoracic spine an in\nmultiple rib metastases.  No compression or pathologic fractures and no new\ndestructive bone lesions.\n\nSevere atherosclerosis, head and neck arteries, particularly the right\nsubclavian which may be occluded."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcification of the thoracic\naorta.  Dense atherosclerotic calcification of the proximal right subclavian\nartery.  Mild calcifications of the aortic annulus.  The thoracic aorta is\nnormal in caliber.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Previously visualized lower paratracheal\nlymphadenopathy has significantly decreased in size, now within normal limits.\nStable 4 mm prevascular lymph node (series 4, image 42).  No new mediastinal\nlymphadenopathy.  A left hilar lymph node has also decreased in size measuring\n10 x 10 mm, previously measuring 14 x 14 mm (series 5, image 118).  No new\nhilar adenopathy.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lower lung fields is limited due to motion\nartifact.  Within these limitations: Stable pleural parenchymal scarring at\nthe lung apices bilaterally, right greater than left, likely due to radiation.\n2 mm solid pulmonary nodules bilaterally (series 5, image 80, 129, 148), all\nof which are stable.  No focal consolidations.  No new suspicious lung\nnodules.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES AND SOFT TISSUES: The patient is status post right mastectomy. \nDiffusely heterogeneous sclerosis throughout the thoracic skeleton including\nall of the vertebral bodies, numerous ribs bilaterally, in the right clavicle\nis unchanged.  No new destructive lesions.  ? There is no acute fracture.",
            "output": "1. Evaluation of the lower lung fields is limited due to motion artifact. \nWithin these limitations, stable bilateral pulmonary nodules measuring up to 2\nmm.  No new suspicious nodules.  Stable radiation fibrosis of the lung apices\nbilaterally.\n2. Mediastinal and left hilar lymphadenopathy has decreased significantly.\n3. Stable diffuse heterogeneous sclerosis throughout the thoracic skeleton\nwithout evidence of destructive lesions or acute fracture.\n4. Please refer to the CT abdomen and pelvis with the same date for evaluation\nof the intra-abdominal structures."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous in\nenhancement without focal nodularity.  There is no supraclavicular or axillary\nlymphadenopathy by CT size criteria.  There is stable postsurgical changes\nfrom right mastectomy.  Remaining left breast parenchyma is suboptimally\nevaluated on the current modality.  Otherwise, the chest wall is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.\n\nHILA: There has been interval increase in the size of interlobar hilar\npulmonary lymph nodes.  For example, the left lobar lymph node posterior to\nthe takeoff of the lower lobar bronchus measures 9 mm, previously 6 (7:142). \nThe right lobar lymph node at the level of the right middle lobe bronchus take\nmeasures 9 mm, previously 6 (7:148).  The left hilar lymph node near the left\nmainstem bronchus stably measures at 9 mm (07:24).\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\npericardial effusion.  No significant coronary or valvular calcifications are\nnoted.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\nPARENCHYMA:  Moderate right and mild left pleuroparenchymal scarring at the\napices are stable.  There are multiple millimetric nodules in the apices\n(7:42, 43, 47, 51).  Since ___, focal nodular thickening along\nthe left major fissure has significantly progressed, which was previously\nbarely perceptible, now measuring 7 mm (2:143).  Nodularity along the minor\nfissure is stable (07:19).  Ground-glass opacity in the right middle lobe\nextending to the anterior pleural surface is stable from prior exam on ___ (7:140), likely postradiation changes.  Millimetric nodule in\nthe left lower lobe stable since ___ (7:207).\n\nAIRWAYS:  Airways are patent to the subsegmental levels.  There is stable,\nmild peribronchial wall thickening in the lower lobes.\n\nVESSELS:  The ascending and descending aorta and the main pulmonary arteries\nare normal in caliber.\n\nMUSCULOSKELETAL: Heterogeneous sclerotic appearance of multiple ribs and the\nvertebral bodies are grossly unchanged from prior exam on ___. \nThere is no acute fracture.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen pelvis report from the\nsame day for details on subdiaphragmatic findings, including multiple\nhypodensities throughout the liver.",
            "output": "1. Interval worsening hilar lymphadenopathy as described above.\n2. Progression of left major fissure focal thickening since ___,\nnow measuring 7 mm, previously barely perceptible.\n3. Diffuse sclerotic osseous metastatic disease, unchanged from prior exam. \nNo new fracture."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.\nStatus post right mastectomy, left breast parenchyma is suboptimally evaluated\non the current modality, better evaluated with mammography.  Otherwise the\nchest wall is unremarkable.\n\nUPPER ABDOMEN: Numerous to 6 lesions replace much of the hepatic parenchyma,\nunchanged appearance in comparison to prior, detailed report issued separately\nin the same day CT of the abdomen and pelvis.\n\nMEDIASTINUM and HILA: Right hilar 1.1 x 1.2 cm lymph node in the level of the\nright middle lobe bronchus, in prior 0.8 cm, enlarged (4:121).\nLeft hilar 1.3 x 1 cm lymph node near the left mainstem bronchus, in prior 0.9\ncm also enlarged (4:109).\n0.9 cm lymph node near the left mainstem bronchus is unchanged (4:94).\nThere is no new mediastinal lymphadenopathy.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nMinimal atherosclerosis of aortic valve annulus and along the normal caliber\nthoracic aorta with no appreciable atherosclerotic calcifications of the\ncoronaries.\n\nPLEURA: There is no pleural effusion or nodularity.\n\nLUNG: Major airways are patent to the subsegmental level bilaterally.\nPostradiation changes in the right apex and right upper lobe anterior\nsubpleural are unchanged.\nLeft perifissural nodule is mildly fuller in comparison to prior, 0.8 x 0.6\ncm, in prior 0.7 x 0.6 cm.  (4:105), barely perceptible in ___.\nLeft lower lobe micro nodule is unchanged (4:147).\nNo new lung nodules or masses are identified.\n\nCHEST CAGE: Heterogeneous sclerotic- lytic appearance of multiple ribs and\nvertebral bodies are grossly unchanged from prior.  No pathological fractures\nare identified.",
            "output": "Additional mild enlargement of bilateral hilar lymph nodes and left\n___ nodule suspected for progression of disease."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, or dissection. The ascending aorta is ectatic measuring\nup to 3.7 cm.  Otherwise aortic caliber is within normal limits.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThe heart size is top normal.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary artery is enlarged,\nmeasuring up to 3.5 cm (series 2:  Image 44), which can be seen in pulmonary\nhypertension.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThe left shoulder has been replaced.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Enlarged main pulmonary artery, measuring up to 3.5 cm, which can be seen\nin pulmonary hypertension.\n3. Ectasia of the ascending aorta, measuring up to 3.7 cm."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS:  The ascending aorta is ectatic measuring 4.2 cm.  No\ncalcifications of the ascending aorta.  Mild aortic valvular and moderate\nannular calcifications.  Severe coronary calcifications with coronary stents. \nNo pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  5 mm perifissural\nnodule along the minor fissure (04:11 6).  Circumscribed soft tissue nodule in\nthe right middle lobe with multifocal punctate calcifications measuring 19 x\n17 mm has no internal fat attenuation.  The nodule abuts but does not tether\nor involve the right major fissure.  Calcified granuloma in the right upper\nlobe.  Punctate 2 mm nodule in the left lower lobe (04:164).    No additional\npulmonary nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Although this study is not designed for the evaluation of\nsubdiaphragmatic structures, there is uncomplicated cholelithiasis and right\nrenal cyst measuring 3.5 cm.  The remaining visualized upper abdomen is\nunremarkable.",
            "output": "Circumscribed 2 cm nodule with punctate calcifications in the right middle\nlobe.  There are some benign features of this nodule including circumscribed\nborders and lack of local aggressive features, however size and eccentric\ncalcifications are not benign characteristics.  As such, the differential\nincludes benign nodules such as hamartoma or granuloma, and malignancy such as\ncarcinoid.\n\nThe nodule is easily identified on chest radiograph and prior chest imaging if\navailable should be reviewed to ensure stability.  Otherwise, if imaging is\nnot available a PET-CT should be considered."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  The\npatient is post CABG.  Moderate to severe coronary calcifications and mild\naortic valve calcifications.  Mild cardiomegaly.  No pericardial effusion. \nNormal appearance of the posterior mediastinum.  Status post cholecystectomy. \nModerate degenerative vertebral disease.\nMild irregularities and thickening of the airway walls.  Several non\ncharacteristic small and non suspicious pulmonary nodules, for example in\nperifissural location on the right (4, 139).  Minimal scarring in the anterior\naspect of the middle lobe (4, 175).  In the middle lobe, the pre-existing\npulmonary nodule is again visualized.  The nodule continues to have a diameter\nof 15 x 19 mm.  The nodule is relatively homogeneous, with the exception of\nsmaller calcific spots that are all unchanged in appearance.  The nodule is\nnot lobulated.  No other nodules are visualized.  No pleural effusions.  No\npleural thickening.  No diffuse lung disease.",
            "output": "Stable appearance of the middle lobe nodule with punctate calcifications.  No\nnodule growth.  No new pulmonary nodules.  No adenopathy, no pleural\nabnormalities."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nabnormalities elsewhere in the soft tissues of the chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.\n\nCardio mediastinum:\n\nLower esophagus is mildly patulous.  There is no obstruction or mass.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is mild to moderate in head and neck vessels and\nin left coronary artery and its branches.  Right coronary artery is calcified\nand stented.  Patient has had median sternotomy.  Sternal fragments are\nincompletely fused but otherwise there are no findings to suggest wound\ncomplications.\n\nAorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\nThoracic lymph nodes:\n\nNo adenopathy in the chest by size criteria.\n\nLungs, airways, pleura:\n\n6 mm perifissural right middle lobe nodule, 5:136, unchanged can be considered\nbenign.\n\nWell-circumscribed soft tissue nodule right middle lobe with small specks of\ncalcium, 20 x 18 mm, 5:170, maximum diameter on sagittal view 24 mm,\nre-measured at a comparable level, also 20 x 18 mm in ___, maximum\ndiameter on sagittal projection, 24 mm, and 19 x 19 mm ___,\nessentially no change over 21 months.  There are no other lung findings of\nconsequence.\n\nChest cage:\n\nUnremarkable.",
            "output": "Partially calcified solid right middle lobe lung nodule stable for 21 months\nis almost certainly benign.  Accepted criteria for monitoring lung nodules of\nthis size require 24 months of observed stability.  If additional CT scanning\nis elected, I would recommend waiting one more year for the final scan."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nstable coronary artery calcification.  There is evidence of prior CABG\nsurgery.  There is no pericardial effusion.  The aorta and pulmonary artery\nare normal in caliber\n\nPLEURA: There is no pleural effusion\n\nLUNG: The right lower lobe nodule with fat and calcification measures 2.0 cm\nand is unchanged.  The 6 mm perifissural right middle lobe pulmonary nodule is\nalso unchanged.  No new or growing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows status post\ncholecystectomy.  No adrenal masses are seen",
            "output": "Stable 2 cm right lower lobe pulmonary nodule, unchanged in size density and\nmorphology, the differential diagnosis includes carcinoid and hamartoma. \nTissue diagnosis for confirmation may be helpful\n\nStable 6 mm perifissural nodule.  No new or growing pulmonary nodules"
        },
        {
            "input": "AXILLA, HILA, AND MEDIASTINUM: There is no adenopathy in the chest.\n\nHEART AND VASCULATURE:  No pericardial effusion.  Mild atherosclerotic\ncalcifications of the thoracic aorta.\n\nPLEURAL SPACES: No pneumothorax or pleural effusion.\n\nLUNGS/AIRWAYS: Mild paraseptal and centrilobular emphysema.  Mild dependent\natelectasis.  No pulmonary mass demonstrated.\n\nABDOMEN:  Please see dedicated report regarding the abdomen for further\ndetails.\n\nBONES: No acute osseous process.",
            "output": "Mild emphysema.  No primary or metastatic disease demonstrated in the chest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level with presence of multiple bilateral pulmonary emboli,\ninvolving the distal main pulmonary artery, the right main pulmonary artery on\nits whole length, the inter lobar artery on the right with the extensive\nextension into segmental arteries of the ___ but as of postero basal and\nmedial basal segments, the main middle lobe artery extending into segmental\narteries of the middle lobe, superior lobar artery extending into segmental\narteries as well.  Pulmonary emboli are seen on the left involving the main\nleft upper lobe artery and left inter lobar artery extending into all\nsegmental arteries of the left lower lobe.  Basically all lobar arteries are\ninvolved.  There is right heart strain with dilation of the right ventricle\nmeasuring up to 46 mm and a top-normal main pulmonary artery.  Otherwise, the\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen. The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar linear atelectasis, but there is no evidence\nof pulmonary infarct or consolidation or infiltrate.  There is no suspicious\npulmonary nodule, a small calcified granuloma is noted in the right lower\nlobe..  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMultilevel degenerative disc disease.",
            "output": "Massive pulmonary emboli bilaterally seen in the distal main pulmonary artery,\nthe right and left main pulmonary arteries, and every lobar artery including\nthe bilateral interlobar arteries.  There is evidence of right heart strain\nwith the main pulmonary artery being top-normal in size.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:11 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THORACIC INLET, AXILLAE, CHEST WALL: No pathologic enlargement of lymph nodes\nin the supraclavicular or axillary stations.  Right PICC and right internal\njugular vein catheter terminates at the level of the cavoatrial junction.\n\nCHEST CAGE: There is no evidence of lytic or sclerotic osteo destructive\nlesion at the level of chest cage or vertebra suspicious for infection.  There\nare minimal degenerative changes of the mid-lower thoracic vertebra\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: Scattered lymph nodes in the mediastinum measure up to 0.7 cm in\nthe pre-vascular space, not pathologically enlarged and likely reactive. \nHilar contours suggest no gross lymphadenopathy.  Posterior mediastinum is\nwithin normal limits.\n\nHEART and PERICARDIUM: Heart is normal in size with mild signs of anemia. \nThere are no appreciable atherosclerotic calcifications.  Thoracic aorta and\nmain pulmonary artery are normal in caliber.  There are no pericardial\nabnormalities.\n\nPLEURA and LUNG: Left chest tube through ___ intercostal space terminates in\nthe apex. There is small left pneumothorax.\nThere are bilateral layering pleural effusion, left trace and right small with\nlikely adjacent relaxation atelectasis.\n\nEndotracheal tube terminates in good position, approximately 2.5 cm from\ncarina. The study was performed in expiration as demonstrated by the elevation\nof the diaphragms.\n\nLeft upper lobe dependent consolidation and patchy opacities suggest\nbronchopneumonia (302:65).  In the right upper lobe faint branching opacities\n(302:59) suggest mild bronchiolitis.",
            "output": "-Left upper lobe bronchopneumonia.\n-Left chest tube in place and there is small left pneumothorax.\n-There are bilateral layering pleural effusions, left trace, right small with\nlikely adjacent relaxation atelectasis."
        },
        {
            "input": "The visualized thyroid is unremarkable.\n\nHeart size is normal with trace pericardial fluid, likely physiologic. \nBorderline prominent anterior epicardial lymph node measuring 10 mm is\nunchanged, though demonstrates a normal fatty hilum, and may be reactive.  A\nright IJ central venous catheter is seen terminating in the low right atrium. \nOther scattered mediastinal lymph nodes are not enlarged by size criteria. \nThere is no supraclavicular or axillary lymphadenopathy.  There is no gross\nhilar lymphadenopathy given confines of a noncontrast examination.\n\nThe central airways are patent.  There is mild dependent atelectasis\nbilaterally.  Lungs are otherwise clear without suspicious focal consolidation\nor nodule.  There is no effusion or pneumothorax.\n\nA Dobhoff tube is seen with tip terminating at the level of the pylorus,\nsatisfactory.  Although this study is not tailored for subdiaphragmatic\nanalysis, the visualized upper abdomen is notable for a percutaneous\ncholecystostomy tube within the gallbladder lumen containing several stones. \nThere is persistent wall thickening and trace surrounding fat stranding of the\ngallbladder.  Previously seen ascites has essentially resolved.  No other\ngross acute findings are seen in the visualized upper abdomen.\n\nThe thoracic cage is intact without acute fracture or suspicious focal bone\nlesion.",
            "output": "1. No acute thoracic findings.  No suspicious focal consolidation or pulmonary\nnodule.\n2. Interval resolution of ascites.\n3. Percutaneous cholecystostomy catheter in place with similar degree of\ngallbladder wall thickening and trace surrounding inflammatory fat stranding."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere are multiple filling defects within the right lower lobe segmental\npulmonary artery and its distal branches, compatible with pulmonary emboli. \nThe main and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  The tip of a right central venous\ncatheter extends to the IVC and should be retracted.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a percutaneous cholecystostomy\ntube within the gallbladder.  An NG tube is present, with the tip in the\nstomach.  No acute abnormalities identified in the upper abdomen..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Segmental pulmonary emboli in the right lower lobe branches.  No evidence of\ninfarcted lung or right heart strain.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:22 pm, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "The thyroid gland is homogeneous in appearance.  No axillary, supraclavicular,\nmediastinal and hilar lymphadenopathy is noted.\n\nThere is flattening of the distal trachea (03:19), which is a nonspecific\nfinding, but can be seen in the setting of tracheobronchomalacia.  There is\nbibasilar dependent atelectasis.  Additional note is made of scattered areas\nof mosaic ground-glass attenuation; in the absence of pleural effusion and\ninterlobular septal thickening, this may reflect expiratory air trapping or\nsmall airways disease.  No evidence of pulmonary contusion, laceration or\npneumothorax.\n\nHeart size is moderately enlarged, and contains coronary and aortic valvular\ncalcifications.  The thoracic aorta contains mild atherosclerotic\ncalcifications, but is normal in caliber.  Main pulmonary artery is enlarged\nmeasuring up to 3.2 cm (02:39), which can be seen in the setting of pulmonary\narterial hypertension.\n\nThere are old healing fractures of the left third, left fourth and right fifth\nribs.  Additional right lateral eighth rib (605b:10) is age indeterminate. \nThere is greater than 50% loss of height at the T4 vertebral body with 2-3 mm\nretropulsion (605b:56), also age indeterminate.  No surrounding stranding or\nparavertebral hematoma.  No other fractures are identified.\n\nPlease refer to the separately dictated CT abdomen/pelvis report for details\non subdiaphragmatic findings.",
            "output": "1. Old bilateral healing rib fractures with an additional right lateral ___\nrib fracture that is age indeterminate.\n2. T4 compression deformity with 2-3 mm retropulsion, age indeterminate.\n3. Dilated main pulmonary artery measuring 3.2 cm, which can be seen in the\nsetting of pulmonary arterial hypertension.\n4. Mosaic areas of ground-glass attenuation most likely due to expiratory air\ntrapping or small airways disease.  No pleural effusion.\n5. Nonspecific flattening of the distal trachea, which can be seen in setting\nof tracheobronchomalacia.  If there is clinical concern for this entity,\nnon-urgent follow-up CT with dynamic maneuvers could be obtained.\n6. CT abdomen/pelvis dictated separately.\n\nRECOMMENDATION(S):  Consider non-urgent follow-up CT with dynamic maneuvers if\nthere is clinical concern for tracheobronchomalacia.\n\nNOTIFICATION:  Updated findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 9:59 AM, 60 minutes after discovery of\nthe findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive Coronary\ncalcifications are unchanged.  Cardiomegaly is unchanged.  No pericardial\neffusion is seen.\n\nLeft pleural effusion is moderate, new as compared to ___.  No\nright pleural effusion is demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nNo pathologically enlarged mediastinal lymph nodes demonstrated except for\nminimally increased prevascular lymph node, series 3, image 19 from 5.6-6.8\nmm.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Compression fracture of the superior thoracic vertebral body is\nunchanged.  Healed rib fractures are re- demonstrated.\n\nLunate shape of the trachea can explain tracheomalacia demonstrated on the\nprevious study.  Airways are patent to the subsegmental level.  No pulmonary\nnodules masses or consolidations demonstrated.  Bibasal left substantially\nmore than right areas of atelectasis are noted with a left lung atelectasis\nbeing rounded most likely increased as compared to previous study.",
            "output": "No definitive evidence of intrathoracic metastatic disease.  Interval increase\nin left pleural effusion, reason unclear.  The fusion is simple and\nnonhemorrhagic.\n\nCardiomegaly.\n\nMinimal interval increase in 1 mediastinal lymph nodes.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nCompression fracture of the superior thoracic vertebral body."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows normal left\nadrenal gland.  The right adrenal is below the level of imaging.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck vessels, but is very extensive in the coronaries.  Aorta and\npulmonary arteries are normal size.  Aortic valve is not calcified. \nPericardium is physiologic.  There is no pleural abnormality.  Esophagus is\nunremarkable.\n\nFocal lung lesions are as follows:\n\n3 punctate lung nodules, left upper lobe, 04:50, right upper lobe, 4:129,\nright middle lobe, 4:149, are too small to warrant further evaluation.\n\nAside from these nodules and a calcified right lung granuloma, lungs are\nclear.  Tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "There are no non calcified lung nodules large enough to raise concern for\nmalignancy or warrant further imaging.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen and pelvis report\nfrom the same date for description of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  Coronary artery calcifications\nare mild and diffuse.  Mild aortic annular calcifications are also\ndemonstrated.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  The lungs are clear without focal consolidation or mass.  A 4\nmm nodule is demonstrated in the left upper lobe (302:109).  A 3 mm\npleural-based nodule is demonstrated in the left upper lobe (302:88).  A 2 mm\nnodule is present in the right lower lobe (302:140).  There is a calcified\ngranuloma in the right upper lobe.  There are areas of scarring in the left\nand right upper lobes.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery is top normal in diameter, measuring up\nto 3 cm.  The thoracic aorta is normal in caliber.  There is moderate\ncalcified and noncalcified plaque within area of focal plaque ulceration along\nthe aortic arch (302:72).\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesions or acute\nfracture.",
            "output": "1. Multiple nodules measuring up to 4 mm are demonstrated, which are\nnonspecific but should be followed in the setting of malignancy.  Follow-up\nchest CT in 3 months is recommended.\n2. Multiple calcified granulomas.\n3. Focal plaque ulceration along the aortic arch.\n4. Please see the separately dictated CT abdomen and pelvis report from the\nsame date for a description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months to evaluate for nodule\nstability."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland appears homogeneous.\n\nUPPER ABDOMEN: Limited views of the upper abdomen are remarkable for\nthickening of the right adrenal gland, unchanged since the CT abdomen and\npelvis from ___.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy\n\nHILA: No evidence of hilar lymphadenopathy\n\nHEART and PERICARDIUM: Cardiac size is normal.  There is no pericardial\neffusion.  Atherosclerotic calcifications are seen along the coronary\narteries.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Multifocal nodules are seen in the chest, which are new or\nincreased since the prior study in ___.  For example, the largest\nnodule appears to measure 14 mm and demonstrates an area of cavitation (5:189)\nin the right lower lobe.  An 11 mm nodule is seen in the right lower lobe\n(5:177) and an irregular 10 mm nodule is seen in the right middle lobe\n(5:228).  A couple subpleural left upper lobe nodules measure 8 mm (5:111) and\n9 mm (5:84) respectively.  There is a focal region of ground-glass opacities\nin the left upper lobe (5:100), which is nonspecific but likely of\ninflammatory etiology.  No focal parenchymal opacification is seen.\n2. AIRWAYS:  The airways appear patent to the subsegmental level.\n3. VESSELS:  Again seen is moderate calcified and noncalcified plaque along\nthe aortic arch with area of focal plaque ulceration which appears similar to\nthe prior study (5:110).  The tip of a right Port-A-Cath is seen at the\ncavoatrial junction.\nCHEST CAGE: There is no osseous abnormality.",
            "output": "1. Multiple new or enlarging pulmonary nodules, some of which demonstrate\nareas of cavitation, are compatible with worsening metastatic disease since\n___.  No pneumothorax.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:01 pm, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular lymphadenopathy.\nNo axillary lymphadenopathy.  Imaged thyroid appears normal. A right internal\njugular catheter terminates at the cavoatrial atrial junction.  A right-sided\nPort-A-Cath reservoir is seen on the right chest wall.  Right subcutaneous\nemphysema in relation to a right hemithorax chest tube.\n\nUPPER ABDOMEN: Included portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM: There are no mediastinal lymphadenopathy.\n\nHILA: Bilateral hilar adenopathy are seen.\n\nHEART and PERICARDIUM: The heart is of normal size.  There is no pericardial\neffusion.  Mild coronary calcifications.\nPLEURA: Persistent hydropneumothorax bilaterally, moderate on the left and\nsmall on the right.\n\nLUNG:\n\n1. PARENCHYMA:  Known lung metastasis have increased in size and number.  Some\nof them are solid some of them are cavitated.  The largest measures up to 2.7\nx 3.2 centimeters in the left upper lobe.  Multiple areas of ground-glass\nopacities in the right upper lobe and right lower lobe, correspond to\nhemorrhage.  Subsegmental atelectasis at the bases.\n2. AIRWAYS:  The trachea and airways are patent to subsegmental levels\nbilaterally.\n3. VESSELS: Mild increase of the ascending aorta diameter.  Soft and hard\nplaques are seen along the aortic arch, with small ulceration (series 302:63).\nCHEST CAGE: There are no worrisome osseous lesions.",
            "output": "1.  Bilateral hydropneumothoraces, moderate on the left and small on the\nright.\n2.  Increase in size and number of the known lung metastasis.\n3.  A right upper and right lower lobes hemorrhage."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.  No\nlymphadenopathy in the supraclavicular or axillary stations.\nExcluding the breasts which must be evaluated by mammography there are no\nconcerning soft tissues abnormalities in the chest wall.\n\nCHEST CAGE: Minimal degenerative change of the spine with no evidence of osteo\ndestructive lesions in the ribcage.\n\nUPPER ABDOMEN: Included upper abdominal organs are unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Posterior mediastinum\nis unremarkable.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  No appreciable\natherosclerotic calcifications in the coronaries or normal caliber thoracic\naorta.  Main pulmonary artery is normal in diameter.\n\nPLEURA: Nodular biapical pleuroparenchymal scarring is minimal.\n\nLUNG: Airways are patent to the subsegmental level.\n0.9 x 0.7 x 0.9 cm nodular opacity in the right apex with few pleural tags is\nindeterminate (302:44; 601:49).\n\n0.3 cm nodules and micronodule in the right lower lobe (302:134, 153).  0.4 cm\nnodule in the same lobe (302:101). 0.5 cm nodule in the left lower lobe\n(302:154).",
            "output": "0.9 cm opacity in the right apex is the opacity demonstrated on plain\nradiograph, indeterminate particularly in the absence of prior studies, for\n___ month follow up.\nFew pulmonary nodules to 0.5 cm nodule.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nbigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk\npatient, with an optional CT follow-up in 18 to 24 months. In a high-risk\npatient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.  No\npathologic enlargement of lymph nodes in the supraclavicular or axillary\nstations.\n\nCHEST CAGE: There are right anterior healed rib fractures (02:36).  There are\nno lytic or sclerotic osseous destructive lesions at the level of ribs,\nsternum or vertebra.\n\nUPPER ABDOMEN: Included unenhanced upper abdominal organs are with no gross\nfindings.\n\nMEDIASTINUM: Scattered lymph nodes in the mediastinum measure up to 0.4 cm in\nthe prevascular space and are stable (4:82). There is no gross hilar\nlymphadenopathy.  Posterior mediastinum is within normal limits.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  There are no appreciable atherosclerotic calcifications of the\ncoronaries or along the normal caliber thoracic aorta.  Main pulmonary artery\nis normal in caliber.\n\nPLEURA and LUNG: There is nodule course biapical pleuroparenchymal thickening,\nessentially unchanged in comparison to ___.\n\nRight apex 0.9 x 0.9 cm nodular opacity with delicate pleural tags is stable\n(04:42).  Remaining pre-existing pulmonary nodules are stable as well,\nincluding 0.4 cm and micronodule in the right lower lobe (4:101, 142) and\nright upper lobe micronodule (4:83).  There are no new pulmonary nodules.",
            "output": "Pre-existing pulmonary nodules measuring up to 0.9 cm are stable since ___.  There are no new pulmonary nodules.\n\nRECOMMENDATION(S):  Chest CT in 6 months."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  Heart size is normal.  There is no pericardial pleural\neffusion.  Image portion of the upper abdomen will be reviewed separately as\npart of the CT abdomen and corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules masses or consolidations them the only nodule is seen is in the left\nlower lobe, series 4, image 228, triangular, 4 mm in diameter.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  No abnormality\nthat might explain supraclavicular swelling noted.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No abnormality that can explain the swelling over the left supraclavicular\narea.\n\nNo lymphadenopathy.\n\nLeft lower lobe pulmonary nodule that should be reassessed in ___ year with\nchest CT in the absence of history of known malignancy or smoking.  Otherwise\nassessment in 6 months would be beneficial.\n\nGallstones\n\nA trophic left kidney.  The entire discussion regarding the abdominal findings\nwill be issued separately as part of the CT abdomen and corresponding report\nwill be provided."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Endotracheal tube terminates 1 cm\nabove the carina.  Multiple thyroid nodules measure up to 1.6 cm.  The left\nlobe of thyroid contains large dystrophic calcification.\n\nThere is a 4.8 x 2.3 x 4.8 cm gas-containing fluid collection in the left\nprepectoral soft tissues (series 2, image 6) at the site of the prior\nAICD.There is no axillary or supraclavicular lymphadenopathy.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged by CT size criteria.\n\nHILA: Within the limitations of this non-contrast study, there is no hilar\nlymphadenopathy.\n\nHEART AND VESSELS: Coronary vascular calcifications are severe.  Thoracic\naorta is normal in caliber with heavy atherosclerosis.  There is borderline\nenlargement of the main pulmonary artery measures up to 3.1 cm.\n\nPLEURA: Pleural effusions are moderate on the left and small on the right.\n\nLUNG: There is extensive compressive atelectasis of nearly the entire left\nlung, limiting assessment. However at the left lung apex in left mid lung\nthere are some irregular appearing opacities, which appear less like\natelectasis and may represent pneumonia. Assessment is limited without\nintravenous contrast. Endotracheal tube and 1 cm above the carina.  Assessment\nis limited by extensive respiratory motion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is moderately atrophic.  There is no main pancreatic\nductal dilatation or suspicious lesion.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.7 cm\nsimple cyst arising from the lateral aspect of the left kidney.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder contains a Foley catheter is partially\ndecompressed, limiting assessment.  Moderate presacral edema is likely from\nthird-spacing.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Heavy atherosclerotic\ndisease is noted.\n\nBONES: The L2 vertebral body contains a hemangioma.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A 3.9 x 3.1 cm fatty lesion along the posterior, midline\nabdominal wall at the site of the patient's prior incision likely represents\nfat necrosis.  There is extensive body wall edema.\n\nA 2.3 x 1.8 cm soft tissue lesion in the left lower back likely represents\nsequela of prior injection (series 2, image 77).",
            "output": "1.  Moderate right and small left pleural effusions.  Assessment is limited by\na lack of intravenous contrast and near complete atelectasis of the left lung,\nhowever opacities in the left midlung and left lung apex are concerning for\npneumonia.\n2.  The endotracheal tube terminates 1 cm above the carina and should be\npulled back for more standard positioning.\n3.  4.8 cm left prepectoral chest wall subcutaneous gas-containing fluid\ncollection at the site of the prior AICD.  Correlate for infection.\n4.  Multiple thyroid nodules measuring up to 1.6 cm.  Non-urgent ultrasound is\nrecommended if not previously performed.\n5.  Severe coronary artery and vascular calcifications.\n6.  No evidence of infection within the abdomen and pelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Endotracheal tube terminates 1 cm\nabove the carina.  Multiple thyroid nodules measure up to 1.6 cm.  The left\nlobe of thyroid contains large dystrophic calcification.\n\nThere is a 4.8 x 2.3 x 4.8 cm gas-containing fluid collection in the left\nprepectoral soft tissues (series 2, image 6) at the site of the prior\nAICD.There is no axillary or supraclavicular lymphadenopathy.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged by CT size criteria.\n\nHILA: Within the limitations of this non-contrast study, there is no hilar\nlymphadenopathy.\n\nHEART AND VESSELS: Coronary vascular calcifications are severe.  Thoracic\naorta is normal in caliber with heavy atherosclerosis.  There is borderline\nenlargement of the main pulmonary artery measures up to 3.1 cm.\n\nPLEURA: Pleural effusions are moderate on the left and small on the right.\n\nLUNG: There is extensive compressive atelectasis of nearly the entire left\nlung, limiting assessment. However at the left lung apex in left mid lung\nthere are some irregular appearing opacities, which appear less like\natelectasis and may represent pneumonia. Assessment is limited without\nintravenous contrast. Endotracheal tube and 1 cm above the carina.  Assessment\nis limited by extensive respiratory motion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is moderately atrophic.  There is no main pancreatic\nductal dilatation or suspicious lesion.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.7 cm\nsimple cyst arising from the lateral aspect of the left kidney.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder contains a Foley catheter is partially\ndecompressed, limiting assessment.  Moderate presacral edema is likely from\nthird-spacing.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Heavy atherosclerotic\ndisease is noted.\n\nBONES: The L2 vertebral body contains a hemangioma.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A 3.9 x 3.1 cm fatty lesion along the posterior, midline\nabdominal wall at the site of the patient's prior incision likely represents\nfat necrosis.  There is extensive body wall edema.\n\nA 2.3 x 1.8 cm soft tissue lesion in the left lower back likely represents\nsequela of prior injection (series 2, image 77).",
            "output": "1.  Moderate right and small left pleural effusions.  Assessment is limited by\na lack of intravenous contrast and near complete atelectasis of the left lung,\nhowever opacities in the left midlung and left lung apex are concerning for\npneumonia.\n2.  The endotracheal tube terminates 1 cm above the carina and should be\npulled back for more standard positioning.\n3.  4.8 cm left prepectoral chest wall subcutaneous gas-containing fluid\ncollection at the site of the prior AICD.  Correlate for infection.\n4.  Multiple thyroid nodules measuring up to 1.6 cm.  Non-urgent ultrasound is\nrecommended if not previously performed.\n5.  Severe coronary artery and vascular calcifications.\n6.  No evidence of infection within the abdomen and pelvis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is mild fusiform dilation of the ascending thoracic aorta measuring up\nto 4.2 cm stable from previous exams.  There is mild atherosclerotic\ncalcification involving the thoracic aorta and coronary arteries.  There is no\nevidence of dissection or intramural hematoma.  The heart is mildly enlarged\nin size.  There is small pericardial effusion, slightly increased from\nprevious study.  There is right subclavian vein stenosis (series 3, image 27)\nwith multiple collateral vessels visualized in the right lateral and posterior\nchest wall.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  There is mild to moderate centrilobular emphysema.  There is a\nleft 3 mm perifissural nodule (series 3, image 127) likely a lymph node\nunchanged from previous study in ___.  There is also a right lower lobe 4 mm\nnodule (series 3, image 168), as seen on prior chest CT from ___. \nThere are bibasilar atelectasis/scarring.\n\nBASE OF NECK: Bilateral thyroid lobes are absent with surgical clips at the\nthyroid foci likely from previous thyroidectomy.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is chronic deformity of the right anterolateral sixth rib.  There\nis chronic compression deformity of the T12 vertebral body unchanged from\n___.  There is mild multilevel degenerative changes of the thoracic spine.",
            "output": "1. Unchanged fusiform dilatation of the ascending aorta to 4.2 cm.  No acute\naortic pathology or pulmonary embolism.\n2. Mild to moderate centrilobular emphysema.\n3. Chronic compression deformity of T12 vertebral body.  Chronic right lateral\nsixth rib deformity.\n4. Right lower lobe 4 mm nodule, present on prior chest CT from ___. \nAttention to this on follow-up screening chest CT is recommended.\n5. Slightly increased small pericardial effusion."
        },
        {
            "input": "There is a 2.4 cm hypodense nodule in the left lobe of the thyroid. No\nsupraclavicular, axillary mediastinal or hilar lymphadenopathy by CT size\ncriteria.  The heart is normal in size.  There is a small pericardial\neffusion.  Dense coronary artery calcifications are noted.  Mild dilatation of\nthe ascending aorta measuring up to 4.3 cm appears stable from prior studies. \nNo pleural effusion.\n\nThe airways are patent to the subsegmental level.  There is minimal subpleural\nand fissural nodularity without suspicious pulmonary nodule or focal\nconsolidation.\n\nThere is a new compression deformity of T12 with approximately 5 mm of\nretropulsion.  No lytic or sclerotic lesions suspicious for malignancy is\npresent.\n\nFor details regarding the abdomen and pelvis please see dedicated abdomen\npelvis CT report.",
            "output": "1. Small pericardial effusion.\n2. 2.4 cm thyroid nodule.\n3. Compression fracture of T12 with approximately 5 mm of retropulsion, new\nfrom ___ above of uncertain chronicity.\n4. None of these findings likely to explain the patient's weight loss and\nthere is no definite evidence of malignancy in the chest.\n5. For details regarding the abdomen and pelvis please see dedicated abdomen\npelvis CT report.\n\nRECOMMENDATION(S):  If not previously evaluated elsewhere, recommend further\nevaluation of the thyroid nodule with dedicated thyroid ultrasound.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 17:00 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart size\nis normal, and a coronary stent is present in the left anterior descending\nartery.  There is no pericardial or pleural effusion.\n\nNo suspicious lytic or blastic skeletal lesions are detected in the thorax.\n\nWithin the lungs, a 3 mm right lower lobe subpleural nodule is present in the\nposterior basilar segment (180, 301).  Lungs are otherwise remarkable for\nminimal apical emphysema and mild dependent atelectasis in the lower lobes. \nDiffuse, mild bronchial wall thickening is also evident.",
            "output": "1. 3 mm right lower lobe lung nodule is statistically most likely benign. If\nthe patient has a primary extra the malignancy with high propensity to\nmetastasize to the lungs, a ___ month followup CT would be recommended.\nOtherwise a ___ year followup CT would be recommended.\n\n2. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "New supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal mass.\n\nRight thyroid lobe has been resected.  Small hypodensities in the\npostoperative left lobe do not warrant further imaging evaluation. \nAtherosclerotic calcification is not apparent in head neck vessels, and is\nscattered in the coronary arteries.  Transvenous right atrial and right\nventricular pacer leads follow their expected courses.\n\nMediastinal and hilar lymph nodes are not enlarged.  Upper esophagus is\nparticularly distended with air.  Mid and lower esophagus are collapsed.  The\ndistal esophagus is circumferentially thick walled.  This could be due to\nesophagitis.\n\nLungs:\n\n1 x 2 mm nodule, left upper lobe, 04:40.\n\nPunctate nodule right upper lobe, 4:100.\n\nThere are no bone lesions in the chest cage concerning for malignancy or\ninfection.",
            "output": "Circumferential wall thickening, lower esophagus, unusual for achalasia. \nDirect evaluation by bronchoscopy recommended, if not recently performed. \nUpper esophageal dilatation is moderate.\n\nNo evidence elsewhere of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries, moderate in the aorta\nand none in the cardiac valves.  The pulmonary arteries are normal in caliber\nthroughout.  Circumferential thickening of the aorta and head and neck vessels\nwith two small penetrating atherosclerotic ulcers noted in the ascending aorta\n(302:103, 108).\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  High attenuation tissue, 53 ___, surrounding\nthe mid trachea and tracheal bifurcation is most likely infiltrative\nadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening with noted secretions in the right main bronchus extending into the\nright lower lobe where mucoid impaction is noted (302:162).  No\nbronchiectasis.  Moderate centrilobular emphysema, diffuse.  Unchanged pleural\nthickening in the left major fissure (302:116).  No suspicious lung nodules or\nmasses.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Diffuse wall thickening, thoracic aorta and adjacent infiltrative mediastinal\nadenopathy suggest aortitis, either infectious or otherwise inflammatory.  Two\nsmall penetrating atherosclerotic ulcers in the ascending thoracic aorta may\nbe related to the aortitis or to pre-existing atherosclerosis.\n\nBronchial secretions and mucoid impaction noted in the right lower lobe.\n\nRECOMMENDATION(S):  Annual surveillance with ECG gated chest CT of the\npenetrating atherosclerotic ulcers in the ascending aorta.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 10:19 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection. The right upper lobe pulmonary artery and segmental branches are\npatent narrowed, suggestive of chronic or subacute pulmonary embolism. There\nare no central filling defects suggestive of acute pulmonary embolism. The\nmain pulmonary arteries are patent. No filling defect is identified in the\nleft lobar, segmental, or subsegmental pulmonary arteries.\n\n\nCHEST:\n\nThe heart size is normal without evidence of right heart strain. The thyroid\nis normal. Axillary, supraclavicular, mediastinal, and hilar lymph nodes are\nnot pathologically enlarged. The pericardium is intact without effusion.\nAirways are patent to the subsegmental levels.\n\nThe lungs are clear without focal or diffuse abnormality. The pleura is intact\nwithout effusion. No pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Findings most consistent with  sequellae of chronic   pulmonary embolus in the\nright upper lobe pulmonary artery and segmental branches.\n\nNOTIFICATION:  The study results were discussed by telephone with Dr. ___\n___ by Dr. ___ at approximately 13:00 hours ___.\nThe decision was made to send the patient to the emergency department given\nher symptoms of increased shortness of breath in the past 3 days."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is a somewhat eccentric small filling defect in a right lower lobe\nsegmental pulmonary artery, best appreciated on the MIP images, suspicious for\nsubacute to chronic pulmonary embolism (9:14).  The main and right pulmonary\narteries are normal in caliber, and there is no evidence of right heart\nstrain.\n\nThere is a small amount of residual thymic tissue.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The thyroid\ngland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Right lower lobe segmental filling defect is suspicious for a subacute to\nchronic pulmonary embolism.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 3:48 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: A small volume of pneumo mediastinum is seen,\nseries 3, image 43, of unclear etiology.  Small amount of residual thymic\ntissue is present.  No axillary, mediastinal, or hilar lymphadenopathy is\npresent.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Although this exam is not optimized for evaluation of\nsubdiaphragmatic structures, included portions of the upper abdomen are\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "-No evidence of pulmonary embolism or aortic abnormality.\n-Small volume pneumomediastinum, of unclear etiology.  Please correlate\nclinically.\n\nNOTIFICATION:  Findings relating to pneumomediastinum were conveyed via ___ QA\nnurses at 15:30 on ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous. \nThere is no supraclavicular or axillary lymphadenopathy.  There are no soft\ntissues within the chest wall suspicious for malignancy.  There is no\ncalcification of the head and neck vessels.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Cardiac chambers are normal size.  There is mild\ncoronary arterial calcification.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Left apical bronchiectasis and mild diffuse bronchial wall\nthickening (5:78, 91, 96 and 99) suggest bronchial inflammation.  Multiple sub\n4mm, right apical nodules (05:53, 54, 58, 59 and 82) are indeterminate but, by\nvirtue of location, more likely inflammatory than metastatic.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level\nbilaterally.\n3. VESSELS: The aorta and main pulmonary artery are normal size.  There is\nmild calcification of the descending thoracic aorta. There is a large,\nnon-calcified plaque in descending aorta(3:17).\nCHEST CAGE: There is no lytic or sclerotic lesion in the chest cage or\nthoracic spine suspicious for malignancy.\n\nUPPER ABDOMEN: This study is not appropriate for evaluation of\nsubdiaphragmatic structures. Within this limitation, there is no adrenal\nlesion.  Moderate hiatus hernia.",
            "output": "1. Multiple right apical nodules are more likely inflammatory than metastatic.\nIndependent of the history of cholangiocarcinoma, these nodules would warrant\nfollowup chest CT in one year.\n2. Mild active bronchial inflammation and bronchiectasis in the left upper\nlobe.\n3. Large non-calcified descending aortic plaque.\n4. Mild coronary atherosclerotic disease.\n\nRECOMMENDATION(S):  See Impresison, above."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, axillary, and mediastinal lymph\nnodes are not enlarged.  Thoracic aorta and main pulmonary artery are normal\nsize.  Moderate calcification is again noted in the aortic valve and coronary\narteries.  Heavy calcification is noted in the thoracic aorta, most notably at\nthe aortic arch.  There is no pericardial effusion.\n\nThere is diffuse bronchial wall thickening with impaction of subsegmental\ndistal airways.  Focal areas of mild bronchiectasis and pleural parenchymal\nscarring in the left upper lobe (5:78, 147) are unchanged.  There is no\npleural effusion.  A 4 mm round solid nodule in the right upper lobe (05:57)\nis larger than before (previously 3 mm).  Multiple other smaller pulmonary\nnodules in upper lung distribution are stable from before.  There are\nextensive ___ opacities with basilar predominance which are new. \nSmall subpleural areas of consolidation are identified in the left lingula\n(5:188) and left lateral lower lobe (5:255), which are also new.\n\nHiatal hernia is small. Limited evaluation of included upper abdomen is\nnotable for cholelithiasis.  Known liver and pancreatic lesions are not well\ndemonstrated on this exam.  No suspicious bone lesion is identified.  Mild\ncompressive deformities of the thoracic vertebral body are unchanged.",
            "output": "1. New bronchial infection or inflammation, as evidenced by new or increased\nareas of consolidation, new bibasilar bronchiolar opacities, and diffuse\nbronchial wall thickening.  Possible etiologies include mycobacterium avium\ninfection or aspiration.\n2. A 4 mm nodule in the right upper lobe is larger compared to ___. \nIncreased size may be explained by concurrent infection, however attention is\nadvised on follow-up exam.\n3. Other smaller nodular opacities with upper lobe predominance appear similar\nto before and may reflect granuloma or other inflammatory change."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates moderate coronary artery and aortic valve\ncalcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified.  Biapical scarring and\nvolume loss and scarring in the left upper lobe are stable (4:62, 122).  There\nis background mild centrilobular emphysema.  Compared with ___, there\nhas been interval near complete resolution of bibasilar ___ opacities\nand subpleural areas of consolidation in the lingula and left lower lobe. \nThere is mild residual bronchial wall thickening and mucosal secretions, worse\nin the lower lobes (4: 73, 166, 152).  A 5 mm right upper lobe pulmonary\nnodule is stable since ___ (4:52).  Multiple additional subcentimeter\nnodules with an upper lobe predominance are stable (4:53, 55, 58, 59, 64, 72,\n75).  No new pulmonary nodules.  There are scattered punctate calcified\ngranulomas.\n\nThere are multilevel degenerative changes in the thoracic spine.  No osseous\nlesions suspicious for infection or malignancy are identified.\n\nThere is a small hiatal hernia.  This examination is not tailored for the\nevaluation of subdiaphragmatic contents.  Within this limitation, there is\ncholelithiasis, with no evidence of acute cholecystitis.  Patient's known\nsegment V mass is not well evaluated on this noncontrast scan (2:69).  The\nincluded portions of the upper abdomen are otherwise grossly unremarkable.",
            "output": "1. Interval near complete resolution of bibasilar ___ opacities and\nsubpleural areas of consolidation in the left lung consistent with resolving\ninfection.\n2. Mild residual lower lobe predominant bronchial wall thickening and mucosal\nsecretions may reflect recurrent/chronic aspiration\n3. Multiple pulmonary nodules including a 5 mm right upper lobe nodule are\nstable since ___.  No new pulmonary nodules.\n4. Cholelithiasis, with no evidence of acute cholecystitis."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The visualized thyroid is unremarkable. \nThere is no axillary or supraclavicular lymphadenopathy.  There is no hilar\nlymphadenopathy.  A 9 mm epicardial lymph node is increased in size from the\nprior examination when it measured 6 mm (5:215).  Additional small epicardial\nlymph nodes are also increased in size.\n\nHEART & VESSELS: The heart is normal in size. The great vessels are normal in\ncaliber. There is mild coronary artery atherosclerosis.  There is no\npericardial effusion.\n\nLUNGS & AIRWAYS: There is no focal consolidation, pleural effusion or\npneumothorax.  Scarring at the lung apices is similar to the prior\nexamination.  There is extensive bronchial wall thickening and secretions\nnoted throughout the airways.\n\nPulmonary nodules:\nLeft upper lobe, 3 mm, 05:52, stable\nRight upper lobe, 5 mm, 05:53, new\nLeft upper lobe, 5 mm, 5:138, stable\nLeft upper lobe, 3 mm, 5:143, new\nLeft lower lobe, perifissural, 5 mm, 5:135, new\nRight lower lobe, 3 mm, 5:166, new\nRight upper lobe, perifissural, 4 mm, 5:186, new\nRight middle lobe, 3 mm, 5:221, new\nRight lower lobe, 3 mm, 5:223, new\nRight lower lobe, 4 mm, 5:225, new\nLeft lower lobe, 5 mm, 5:231, new\nRight lower lobe, 7 mm, 5:253, new\n\n\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nMRI abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions. \nDegenerative change throughout the thoracic spine is stable.",
            "output": "Multiple new pulmonary nodules as described above concerning for pulmonary\nmetastases.  Enlarged epicardial lymph nodes are also concerning for foci of\nmetastatic disease.\n\nExtensive bronchial wall thickening and secretions throughout multiple\nsubsegmental branches of the bronchi."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nAtrophic thyroid gland.  Stable small axillary and thoracic inlet lymph nodes.\nNo chest wall abnormalities.  Mild atherosclerotic calcifications in the\nproximal left subclavian artery.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  No enlarged mediastinal or hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the left circumflex artery, mild in the\naortic arch and aortic valve leaflets.  Aorta and pulmonary arteries are\nnormal in caliber throughout.  Poor opacification of pulmonary arteries limits\nassessment of filling defects in the distal segmental branches, however there\nis no evidence of central emboli.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  The 2 right lower lobe pleural\nbased low-density nodules, measuring 22 x 19 mm and 29 x 24 mm are mildly\nincreased in size when compared to the immediate prior study when the\n___ were 19 x 15 mm and 24 x 25 mm respectively (302:175).  The left\nlower lobe similar lesion is grossly unchanged measuring 12 x 8 mm.  No\npleural effusion or thickening.  Stable mild biapical pleuroparenchymal\nscarring.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.  Stable 2 mm sclerotic lesion in the left\nscapula likely representing a bone island in stable.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Mild enlargement of the two right lower lobe 22 x 19 and 29 x 24 mm\nlow-density nodules.  Stable left lower lobe similar lesion measuring 12 x 8\nmm.  No new nodules.\n\nPoor opacification of pulmonary arteries limits assessment of filling defects\nin the distal segmental branches, however there is no evidence of central\nemboli.\n\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: There is evidence of thrombus with vessel expansion\nwithin the entire left lower lobe pulmonary artery (series 2; image 54)\nconsistent with pulmonary embolus extending into the segmental and\nsubsegmental branches.  No evidence of right heart strain.  The thoracic aorta\nis normal in caliber without evidence of dissection or intramural hematoma. \nThe remaining heart, pericardium, and great vessels are within normal limits. \nThere is evidence of bovine origin of the arch vessels.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are trace bilateral pleural effusions, left greater than\nright.  No pneumothorax.\n\nLUNGS/AIRWAYS: Left lower lobe atelectasis is demonstrated.  There are 2\nsubpleural and areas of soft tissue density in the right lower lobe (series 2;\nimage 81), measuring 4.7 x 3.4 cm and in the left lower lobe (series 2; image\n83), measuring 3.2 x 1.8 cm, concerning for lung metastases.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple subcentimeter hypodensities in the liver are too small to\ncharacterize but unchanged.  Mild periportal edema is noted.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is severe right-sided hydronephrosis and hydroureter with\nmarked thinning of the right renal cortex.  Normal appearance of the left\nkidney.  There is marked perinephric stranding on the right with no\nperinephric stranding on the left.  Subcentimeter hypodensities in the left\nkidney are too small to fully characterize, but may reflect cysts.\n\nGASTROINTESTINAL: Again seen is a soft tissue mass within the anterior\nperitoneum measuring 4.1 x 2.6 cm (series 2; image 162), previously measured\n3.7 x 2.3 cm with a metastasis.  The stomach is unremarkable.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is moderate\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Again seen is mixed solid and cystic heterogeneous soft\ntissue mass within the right hemipelvis at the site of known recurrent tumor\nmeasuring 4.5 x 5.8 cm (previously 4.5 x 5.7 cm on MRI from ___ findings are better assessed on recent MRI from ___.  \nPatient is status post hysterectomy.  No left adnexal masses detected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Again seen is expansion and heterogeneous filling defects in the\nbilateral common iliac veins, the right internal and external iliac veins, as\nwell as in the IVC extending superiorly beyond the level of the IVC filter and\ninvolving the intrahepatic IVC, compatible with tumor thrombus.  Collateral\nveins are also re-demonstrated in the pelvis.  The portal vein, SMV, and IMV\nappear patent.  Splenic vein is patent.  There is no abdominal aortic\naneurysm.  Mild atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: Grade 1 L4 on L5 anterolisthesis is present with mild\ndegenerative changes.  Schmorl's node is seen involving the L2 vertebral body.\nThere is no evidence of worrisome osseous lesions or acute fracture.",
            "output": "1. Left lower lobe pulmonary embolus extending to the segmental and\nsubsegmental branches.  Tumor thrombus cannot be excluded.  No evidence of\nright heart strain.\n2. Extensive tumor thrombus involving the bilateral common iliac veins, right\ninternal and external iliac veins, and IVC including the intrahepatic IVC\nsuperior to the IVC filter.\n3. Relatively unchanged solid and cystic soft tissue mass in the right\nhemipelvis compatible with known recurrent tumor, measuring 4.5 x 5.8 cm. \nModerate free fluid within the pelvis.\n4. Slightly increased size of peritoneal metastatic disease measuring 4.1 x\n2.6 cm (previously 3.7 x 2.3 cm).\n5. Severe right-sided hydronephrosis and hydroureter with atrophy of the right\nrenal cortex.\n6. Subpleural masses in both lower lobes measuring up to 4.7 cm in the left\nlower lobe, compatible with metastatic disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular and no\naxillary lymphadenopathy.  Excluding the breasts which must be evaluated by\nmammography there are no soft tissue abnormalities in the chest wall.\n\nUPPER ABDOMEN: Reported separately in the concurrent CT of the abdomen and\npelvis.\n\nMEDIASTINUM: There is no mediastinal and no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Mild cardiomegaly with no evidence of pericardial\neffusion.  Specks of calcifications of the coronaries and of normal caliber\nthoracic aorta.\n\nMain pulmonary artery is not dilated.  In this nondedicated study with\nsuboptimal pulmonary vasculature opacification the pre-existing, large,\nembolus distending the left descending pulmonary artery and extending into\nsegmental branches is unchanged since ___, (5:143).\n\nPLEURA: Biapical partially calcified pleural scarring is unchanged.  There is\nno pleural effusion, no pneumothorax.\n\nLUNG: The posterior right lower lobe two metastatic lesions are unchanged in\nsize since ___ remeasured as conglomerate 3.4 x 5 cm (5:218).\nThe left lower lobe subpleural metastatic lesion is mildly smaller 2.6 x 1.4\ncm cm, in prior 2.8 x 1.6 cm  (5:222), with unchanged intercostal space\ninvasion.  No clear adjacent rib destruction.\nAdditional bilateral lower lobes nodularity is unchanged with the largest\nnodule 1 x 0.4 cm (5:154, 189).\n\nCHEST CAGE: Multilevel degenerative changes of the spine with no evidence of\nlytic or sclerotic bony destructive lesions.",
            "output": "-The study is not dedicated for the evaluation of pulmonary vasculature but\nleft lower lobe pulmonary embolism is unchanged since ___ whether\nit is thrombotic or tumor embolus is radiographically indeterminate.\n-Left lower lobe subpleural metastatic lesion with chest wall invasion is\nmildly smaller while the right lower lobe lesions changed."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is no coronary artery\ncalcification.  This study is not designed to evaluate for pulmonary embolism.\nThere is filling defect in the left lower lobe pulmonary artery extending into\nthe subsegmental branches of the left lower lobe (6, 143 through 160),\nconcerning for pulmonary embolism.\n\nPLEURA: There is no pleural effusion\n\nLUNG: Multiple bilateral pulmonary metastasis have slightly increased in size\nsince the prior study.  The largest in the right lower lobe now measures 3.7\ncm as compared to the prior measurements of 3.4 cm.  The largest in the left\nlower lobe measures 2.7 cm it previously measured 2.6 cm.  Similarly the\nlingular lesion measuring 9 mm (5, 42) is new since the prior study.  A\nsubpleural right lower lobe nodule (5, 41) Is slightly more apparent than on\nthe prior study.There is stable biapical parenchymal scarring.\n\nBONES AND CHEST WALL :\nReview of bones shows degenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows an IVC filter\nin place.",
            "output": "Mild progression of pulmonary metastasis as described above.  At least 1 new\nlesion in the lingula measuring 9 mm.\n\nEccentric filling defect in the left lower lobe pulmonary artery extending to\nthe subsegmental branches concerning for subacute/chronic pulmonary embolism. \nThe pulmonary embolism appears similar to that seen on the CTA done on ___"
        },
        {
            "input": "BASE OF NECK: The thyroid is unremarkable.  No supraclavicular lymphadenopathy\nis identified\n\nHEART AND VASCULATURE: Though the study is not tailored for evaluation of\npulmonary embolism there is re-demonstrated filling defect in the left lower\nlobe pulmonary artery extending into the subsegmental branches left lower lobe\n(series 6, images 109 through 134).  The thoracic aorta is normal in caliber. \nThe heart, pericardium, and great vessels are within normal limits based on an\nunenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No mediastinal, axillary, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is re-demonstration of multiple bilateral pulmonary\nmetastases the largest in the right lower lobe measures 3.7 cm (302:178), the\nlargest in the left lower lobe measures 2.2 cm (302:172), and a lingular\nlesion measures 8 mm (302:180).  The left lower lobe lesion appears intervally\nsmaller though findings are likely secondary to improvement of associated\natelectasis.  Biapical scarring is re-demonstrated unchanged.  Lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: Multilevel degenerative changes are visualized throughout the imaged\nportion of thoracic spine without suspicious osseous abnormality\ndemonstrated.? There is no acute fracture.",
            "output": "1. Multiple pulmonary metastases, stable in size from prior with left lower\nlobe metastasis with improved associated atelectasis, as described above.  No\nnew pulmonary metastases identified.\n2. Unchanged filling defect in the left lower lobe pulmonary artery extending\nto the subsegmental branches suggestive of chronic pulmonary embolism.\n3. Please see same day CT abdomen pelvis for characterization of\nsubdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Status post total thyroidectomy.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Esophagus is mildly patulous in its mid third.  Stable enlarged\nazygos vein measuring 1.5 cm in diameter.  No enlarged mediastinal or hilar\nlymph nodes by CT size criteria.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nMild atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.  Mild bilateral apical scarring, associated to\narchitectural distortion and calcified granulomas in both apices, likely\nsequela from prior granulomatous disease.\nLUNG:\n\n1. PARENCHYMA:  Posterior dependent atelectasis.  No consolidations or lung\nnodules.\nUnchanged pre-existing pulmonary nodules, the largest in the right lower lobe\n(6:225 and 20) measuring up to 3.4 cm.  A left lower lobe subpleural nodule\n(6:214) measures 2.0 cm and causes round atelectasis in this lobe.\n2. AIRWAYS:  Airways are patent to subsegmental levels.\n3. VESSELS:  Pulmonary arteries are not enlarged.  Chronic filling defect of\nleft lower lobe pulmonary artery extending into the subsegmental branches\n(series 6, images 135 and 145).\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "Unchanged appearance of pre-existing pulmonary nodules suggestive of\nmetastatic disease.\nStable pulmonary emboli in the left lower lobe subsegmental arteries."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is stable biapical pleuroparenchymal scarring.  The right lower\nlobe mass measures 4.2 x 2.5 cm and is slightly increased in size it\npreviously measured 4.1 x 2.1 cm.  The subpleural left lower lobe nodule (3,\n162) is also slightly more prominent.  The filling defect in the left lower\nlobe pulmonary artery and segmental and subsegmental branches are again seen. \nThere is evidence of azygos and hemi azygous enlargement, unchanged.  All the\nother previously visualized pulmonary nodules are unchanged in size.  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.  There are\ndegenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: An IVC filter is seen.  Please refer to dedicated report on\nabdomen which has been dictated separately.  The right kidney is atrophic.",
            "output": "Slight increase in size of the right lower lobe mass.\n\nAll the other previously visualized pulmonary nodules are unchanged in size. \nNo new pulmonary nodules.\n\nPersistent filling defect within the left lower lobe pulmonary artery\nconsistent with known chronic thrombus.  No other obvious thrombus by seen\nwithin the pulmonary arteries.  Although the study is not designed to evaluate\nfor pulmonary embolism.\n\nThe azygos and hemiazygous systems are dilated, secondary to obstruction of\nthe IVC in the abdomen.\n\nPlease refer to dedicated report on abdomen which has been dictated separately\nfor further details."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Note is\nagain made of a distended azygos and hemi azygous system, most likely\nsecondary to distal obstruction of the IVC.  There is no pericardial effusion.\nHeart size is top-normal.  There is moderate coronary artery calcification.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The right lower lobe mass measures 4.2 x 2.7 cm and is slightly\nincreased in size since the prior study when it measured 4.2 x 2.5 cm.  The\nsubpleural left lower lobe pulmonary nodule has also slightly increased in\nsize since the prior study.  The chronic thrombus within the left lower lobe\npulmonary artery and segmental subsegmental branches is unchanged and again\nseen.  All the other previously visualized pulmonary nodules are unchanged. \nNo new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of an\nIVC filter with extensive clot distal to the filter.  Please refer to\ndedicated report on abdomen which has been dictated separately",
            "output": "Slight increase in size of the right lower lobe mass since the prior study. \nThe left lower lobe pulmonary nodule has also slightly increased in size.  No\nnew pulmonary nodules.\n\nAll the previously visualized tiny pulmonary nodules unchanged.\n\nNote is again made of the dilated azygos and hemi azygous system secondary to\nobstruction with IVC in the abdomen.\n\nIVC filter with the distal clot.  Please refer to dedicated report on abdomen\nwhich has been dictated separately."
        },
        {
            "input": "CHEST PERIMETER: No detectable thyroid a thyroid abnormality.  No enlargement\nof supraclavicular or axillary lymph nodes.  Breast evaluation is reserved\nexclusively for mammography.  Aside from slight increase in the caliber of\ncollateral venous drainage in the anterior thoraco abdominal wall, there are\nno soft tissue abnormalities of consequence in the chest wall.  Findings below\nthe diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels, and only minimal in coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\nThis study is not designed for mid the most sensitive assessment of the\npulmonary circulation, but it does show a new, but tiny, non occluding\nthrombus in the left descending pulmonary artery, 3:96, just proximal to a\nchronic web/organized thrombus more distally, that extends from the basal\ntrunk artery to the are gin of segmental branches, ___.  There are no\nlarge filling defects more centrally.\n\nDilatation of the posterior, azygos venous circulation, has increased\nreflecting obstruction of the systemic drainage in the abdomen.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing, including lower posterior mediastinal and diaphragmatic chains.\n\nLUNGS, AIRWAYS, PLEURAE: Biapical, partially calcified pleuroparenchymal\nscarring is stable.  There is no evidence of active infection.\n\n3 measurable lung nodules are unchanged:\n\nRight lower lobe, 22 x 16 mm and 30 by 25 mm, previously 22 x 18 mm and 30 x\n26 mm; left lower lobe, 14 x 10 mm, previously 15 x 8 mm.  All of these\nnodules are contiguous with adjacent pleural surfaces, but there is no pleural\nthickening either locally or remotely and no pleural effusion.\n\nNo new or other measurable lung nodules.  Several calcified granulomata noted.\nNo evidence of active infection.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "3 large lower lobe lung nodules, stable as described.  No evidence of new\nmetastasis.\n\nTiny embolus or in situ thrombosis left descending pulmonary artery is new,\nbut nonocclusive, proximal to chronic recannulized left lower lobe pulmonary\nartery thrombi.  No new central pulmonary artery filling defects.\n\nIncreased collateral venous drainage, chest wall and azygos system.\n\nNOTIFICATION:  Findings were discussed by telephone with the referring\nphysician Dr ___, at 09:00."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is not demonstrated. \nNo supraclavicular, infraclavicular or axillary lymphadenopathy.  Mild\ncalcified atherosclerosis involving the proximal left common carotid artery. \nBreast tissue is best evaluated by mammography.\n\nUPPER ABDOMEN: Please refer to same day CT abdomen and pelvis for detailed\nreport of subdiaphragmatic finding.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion.  The\nflecks of calcification at the circumflex coronary artery.  The avascular\ncaliber soft the ascending main pulmonary artery and descending aorta are\nwithin normal limits.  There are eccentric thrombus at the left lower lobe\nsegmental pulmonary artery and central thrombus at the left lower lobe\nsubsegmental pulmonary artery which is unchanged since ___.  There are\nconspicuous collateral venous drainage at the azygous and subcutaneous chest\nwall.\nPLEURA: Mild pleuroparenchymal scarring. No  pleural effusion or pneumothorax.\nLUNG:.\n\n1. PARENCHYMA:  The 2 pulmonary lesions at the right lower lobe measure 2.4 x\n2.5 cm, (series 3, image 178), 1.5 x 1.9 cm (series 3, image 175), previously\n3.0 x 2.5 cm and 1.6 x 2.2 cm.  The pulmonary lesion at the left lower lobe\nmeasures 1.1 x 0.7 cm, previously 1.4 x 1.0 cm.  The aforementioned pulmonary\nlesions are contiguous with the adjacent pleural surfaces.  There is no\npleural thickening locally or remotely.\nA 4 mm subpleural for pulmonary nodule is unchanged since ___.  No new\nor growing pulmonary nodules.  Linear hyperdensities at the left lower lobe\nand likely atelectasis/scarring.  Ground-glass opacities at the right lower\nlobe is most consistent with atelectasis.\n\n2. AIRWAYS:  The airways are patent to the subsegmental level without\nbronchial wall thickening, mucous plugging or bronchiectasis.\n3.\nCHEST CAGE: No wedge compression or pathologic fracture.  Mild\ndextroscoliosis, unchanged.  No suspicious lytic or sclerotic osseous lesions.\nA 5 mm sclerotic lesion is demonstrated at the proximal scapula which most\nlikely represent a bone island.",
            "output": "1. Eccentric thrombus at the segmental and subsegmental lower lobe pulmonary\narteries are chronic. Interval resolution of tiny embolus at the left\ndescending pulmonary artery. No new central pulmonary embolism.\n2. 3 large lower lobe lung nodules decreased in size described above.  No new\nor growing pulmonary nodules.\n3. Please refer to same-day CT abdomen and pelvis for detailed report of\nsubdiaphragmatic findings"
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There are small right\npericardial lymph nodes the largest measuring 6 mm (2, 39).  The aorta and\npulmonary artery normal in caliber\n\n\nPLEURA: There are small bilateral pleural effusions with bibasilar\natelectasis.\n\nLUNG: Lungs are well expanded with minimal peripheral fibrosis which could be\nage related.  No lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Sections through the upper abdomen shows evidence of peritoneal\ncarcinomatosis.  The liver is diffusely fatty infiltrated.  There is evidence\nof ascites",
            "output": "Small bilateral pleural effusions with bibasilar atelectasis right greater\nthan left.\n\nSmall right pericardial lymph nodes.\n\nAscites and peritoneal carcinomatosis.\n\nMinimal peripheral reticular opacities bilaterally could be related to age\nrelated fibrosis"
        },
        {
            "input": "MEDIASTINUM/HEART:  The imaged thyroid is unremarkable.  There are enlarged\nbilateral submental and submandibular lymph nodes.  Enlarged bilateral\naxillary lymph nodes noted.  Evaluation for mediastinal and hilar\nlymphadenopathy is limited on this study.  The aorta and main pulmonary artery\nare normal in size.  Heart size is normal with moderate coronary artery and\naortic valvular calcifications.\n\nLUNGS/AIRWAYS:  There are large bilateral nonhemorrhagic pleural effusions,\nwith adjacent compressive atelectasis.  Areas of peribronchial consolidation\nand ground-glass opacity involve the right middle lobe, lingula, and superior\nsegment of the left lower lobe.  Evaluation for underlying pulmonary nodules\nis severely limited, due to respiratory motion artifact, even on repeat scan.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, no acute upper abdominal abnormalities\ndetected.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic osseous lesion.  Multilevel\ndegenerative changes of the thoracic spine are moderate in severity.",
            "output": "1.  Large nonhemorrhagic bilateral pleural effusions.  Adjacent bilateral\nlower lobe compressive atelectasis.\n2.  Areas of peribronchial consolidation and ground-glass opacity involving\nthe right middle lobe, lingula, and superior segment of the left lower lobe\nare concerning for underlying infection and/or aspiration, given the clinical\nhistory.\n3.  Enlarged bilateral submandibular and submental as well as axillary lymph\nnodes.  Limited evaluation for mediastinal and hilar lymphadenopathy on this\nnon contrast enhanced exam."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Mild aortic arch\ncalcifications are identified.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  On series 2,\nimage 42, a nonspecific area of hypodensity in a segmental right pulmonary\nartery is thought to be due to a combination of streak artifact from the\nadjacent SVC and motion. No correlate is clearly seen on the other planes. \nThe vessel in this region is not expanded.  The main and right pulmonary\narteries are normal in caliber, and there is no evidence of right heart\nstrain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is a 9 mm oval-shaped hypodensity in the region of the right thyroid,\nwhich could be a thyroid nodule or necrotic lymph node (2:3).\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nExcept for mild dependent bibasilar atelectasis, there is no evidence of\npulmonary parenchymal abnormality. The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen demonstrate a small hiatal hernia, and\nunchanged dystrophic calcification in the left hepatic lobe, and multiple\nhyperdense gallstones.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  An area of hypodensity in a right upper lobe segmental right pulmonary\nartery is thought to be due to a combination of streak artifact from the\nadjacent SVC and motion.  No correlate is seen on the other planes, and the\nvessel is not expanded in this region.  No other evidence of pulmonary\nembolism.\n\n2.  9 mm exophytic thyroid nodule vs necrotic lymph node, for which thyroid\nultrasound is recommended.  Parathyroid adenoma is a less likely possibility.\n\n3.  Incidental note of multiple gallstones, as seen on the prior abdomen CT.\n\nRECOMMENDATION(S):  Ultrasound thyroid for better characterization of the\npartly visualized right sided exophytic thyroid nodule versus necrotic lymph\nnode\n\nNOTIFICATION:  Updated wet read with recommendation for thyroid ultrasound\ncommunicated to Dr. ___ at 8:52 on ___."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy. Evaluation of the breast requires mammography. This study is not\ndesigned for subdiaphragmatic diagnosis, but shows there is no adrenal mass. \nNearly all the stomach has passed through a hiatus hernia to the lower\nmediastinum.  The esophagus above that level is not dilated.\n\nThyroid is unremarkable. Atherosclerotic calcification is scattered in head\nand neck vessels, including normal caliber retroesophageal aberrant right\nsubclavian artery, considerable in all major coronary segments, and heavy in\nthe normal caliber arch, descending thoracic, and upper abdominal aorta, and\nextending into both renal arteries and branches of the celiac artery.\n\nAtherosclerosis in the ascending thoracic aorta is is limited to heavy plaque\nat the origin of both right and left coronaries, but superior to that level\nthere is no appreciable intimal calcification, and the maximum caliber of the\nascending thoracic aorta is 30 mm. Aortic valvular calcification is heavy.\nPulmonary arteries are normal size. There is no pericardial or pleural\nabnormality.\n\nCentral lymph nodes are not pathologically enlarged.\n\nFocal lung lesions are as follows:\n\nParticularly nodular biapical pleural parenchymal scarring is generally\nsymmetric.\n\nA diamond-shaped 6 mm subpleural nodule, 04:33, in the right apex could be a\ncomponent of pleural parenchymal scarring, but is morphologically distinct.\n\n6 mm sub solid nodule, right upper lobe, 04:58.\n\nThere are several areas of indistinct ground-glass opacification. In one of\nthem, in the superior segment of the left lower lobe, there are also small\nbronchiolar nodules and bronchial wall thickening, 4:138. This is probably due\nto chronic aspiration.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No atherosclerotic calcification, normal caliber ascending thoracic aorta\nabove heavy calcification at both coronary ostia. Heavy aortic valvular\ncalcification. Right subclavian artery is retroesophageal.\n\nTwo 6 mm right upper lobe nodule should be re-evaluated with chest CT in ___\nmonths.\n\nVery large gastroesophageal hiatus hernia, probably contributes to mild\naspiration changes, left lower lobe."
        },
        {
            "input": "Aorta and pulmonary arteries are distended.  Aorta is 4.5 cm.  Pulmonary\nartery is 4.4 cm.  No pathologically enlarged mediastinal, hilar or axillary\nlymph nodes demonstrated.  There is no pericardial pleural effusion except for\nminimal pleural thickening in the left basal pleura.\n\nImage portion of the upper abdomen demonstrate no left adrenal mass as well as\ndiaphragmatic mass, better characterized on recent CT abdomen.\n\nCentral venous line tip is at the level of lower SVC.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal areas of\natelectasis are present with minimal to cylindrical bronchiectasis.  No\nnodules masses or consolidations are otherwise noted\n\nThere are no definitive lytic or sclerotic lesions worrisome for infection or\nneoplasm.",
            "output": "No evidence of pulmonary neoplasm to suggest metastatic nature of the left\nadrenal mass\n\nMinimal bibasal bronchiectasis and atelectasis."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nNo pericardial pleural effusion is demonstrated.  Image portion of the upper\nabdomen reveals no appreciable abnormality.\n\nThere is no mediastinal, hilar or axillary lymphadenopathy.\n\nAirways are patent to the subsegmental level bilaterally.  There is interval\nincrease in 2 lesions colon right lower lobe superior lesion, series 4, image\n167, currently 8.8 mm as compared to 5 mm and the inferior component, series\n4, image 171, currently 19 x 9.2 mm, better ___ existing on the previous\nexamination.  There is new right apical nodule, series 4, image 77, 5.6 mm. \nRight middle lobe nodule, series 4, image 156 is unchanged.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nExtensive degenerative changes aggravated by the presence of scoliosis are\nsimilar to previous examination.  Compression fracture of the lower thoracic\nvertebral body is unchanged.",
            "output": "Interval increase in the right lower lobe lesion and new O right upper lobe\nlesion.  The findings are mainly concerning for progression of neoplasm\nalthough infectious process is a possibility.  Giving the size of the right\nlower lobe lesion, correlation with PET-CT would be appropriate next step."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There is no axillary,\nmediastinal, or hilar lymphadenopathy.\n\nThe patient is status post a sternotomy. The wires are intact. There is no\nosseous bridging along the sternotomy site, which is not unexpected given the\ntime frame. There is no evidence of osseous destruction or lucency to suggest\nosteomyelitis.  No dehiscence is noted. There is minimal stranding in\nsubcutaneous fat overlying the mid chest, which is likely postsurgical. No\ndiscrete fluid collection is identified.\n\nThere is a moderate nonhemorrhagic pericardial effusion. The contours of the\neffusion are somewhat lobulated, suggesting there may be internal adhesions. \nNo calcifications are noted within the effusion.  There is no infiltration of\nthe epicardial fat. Immediately posterior to the sternum in the prevascular /\nanterior mediastinal space, there is a moderate amount of fluid which is\nslightly more dense than that of the pericardial effusion.  The density is\nstill of that of simple fluid.  It is unclear if this fluid directly\ncommunicates with the pericardium, though it appears mostly separate.  There\nis no significant mass effect on the heart from this collection.  No CT\nevidence of tamponade is appreciated.\n\nThe heart itself is normal in size. There are severe calcifications along the\ncoronary arteries and surgical clips from a recent CABG around the heart and\nleft internal mammary artery. There are moderate calcifications on the aortic\nvalve. The thoracic aorta is normal in caliber with mild atherosclerotic\ncalcifications.  The pulmonary arteries are mildly enlarged, possibly\nrepresenting mild pulmonary artery hypertension.\n\nThe airways are patent to the subsegmental levels. Minimal bibasilar and\nlingular atelectasis is noted. There is no focal airspace opacity, pulmonary\nedema, or discrete nodule. Evaluation for tiny nodules is somewhat limited by\nrespiratory motion. There is no pleural effusion or pneumothorax.\n\nThis exam is not tailored to evaluate the subdiaphragmatic structures. Within\nthe limitations, the imaged portions of the liver, gallbladder, spleen,\npancreas, and right adrenal gland are normal. A 19 mm hypodense lesion in the\nmedial limb of the left adrenal gland has the density of fat, and is\nconsistent with an adenoma. A partially imaged 41 mm hypodensity in the right\nkidney is not fully characterize, though is likely a cyst. The imaged portions\nof the kidneys are otherwise normal. A coarse calcification along the inferior\nsurface of the origin of the celiac artery is present. Evaluation for\nsignificant narrowing is limited on this noncontrast exam.\n\nThere are no concerning lytic or sclerotic osseous lesions. No traumatic\nfracture is identified. There are moderate degenerative changes in the\nthoracic spine, flowing anterior osteophytes, suggestive of DISH.",
            "output": "1. Moderate nonhemorrhagic pericardial effusion, as described above. \nAdditionally, a moderate amount of nonhemorrhagic fluid is present directly\nposterior to the sternum, and presumably post-operative.  It is unclear if\nthis fluid and the pericardial fluid are in direct communication.  No CT\nevidence of tamponade.\n2.  No pleural effusion, pneumothorax, or evidence of active infection.\n3.  Left adrenal adenoma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no axillary lymphadenopathy.  The superficial soft\ntissues of the visualized lower neck and chest wall are otherwise grossly\nunremarkable.\n\nUPPER ABDOMEN: Although this study is not tailored for subdiaphragmatic\nanalysis, the visualized upper abdomen is notable for nodular contour of the\nliver with partially visualized splenomegaly.  There is a punctate calcified\ngranuloma in the right hepatic lobe.  There is an incompletely characterized\nleft adrenal mass measuring 25 x 24 mm (302:228).  There is also a partially\ncalcified right adrenal nodule measuring 7 mm.  There is also what appears to\nbe a left adrenal myelolipoma measuring 42 mm.  Few scattered celiac axis\nlymph nodes are borderline enlarged measuring 10 mm, and rounded, suspicious. \nFew gallstones are noted.  There is also a small right upper pole renal cyst.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal without significant pericardial\neffusion.  There are severe coronary artery calcifications.\nPLEURA: Pleural surfaces are clear without effusion pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  As seen on the same-day chest radiograph, there is a\nspiculated right upper lobe mass measuring 45 x 35 mm (302:64).  No other\nfocal consolidation is seen.  There is an additional 5 mm nodule in the left\nlower lobe (302:169).  There is an additional 4 mm subpleural left lower lobe\nnodule (302:185).  Additional 2 mm right lower lobe nodule (302:141). \nAdditional 3 mm subpleural right lower lobe nodule (302:120).  There is a\nbackground of moderate biapical predominant centrilobular emphysema.\n2. AIRWAYS:  The central airways are patent.  There is mild diffuse bronchial\nwall thickening.\n3. VESSELS:  There are moderate atherosclerotic calcifications along a normal\ncaliber thoracic aorta.  The pulmonary arteries are normal caliber and there\nis no central filling defect.\nCHEST CAGE: Thoracic cage is intact without acute fracture or suspicious focal\nbone lesion.",
            "output": "1. 45 x 35 mm spiculated right upper lobe lung mass as seen on the earlier\nsame day chest radiograph, concerning for primary malignancy.\n2. Additional 4 and 5 mm left lower lobe and 2 and 3 mm right lower lobe\npulmonary nodules.\n3. No thoracic lymphadenopathy.\n4. Incompletely characterized 25 mm left and 7 mm right adrenal nodules,\nconcerning given the presumed primary lung malignancy.\n5. Morphologically cirrhotic liver and partially imaged splenomegaly.\n6. Borderline enlarged mesenteric lymph node measuring 10 mm with round\nmorphology, concerning.\n7. Cholelithiasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Incidental note is made of a bovine arch.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple small rounded, prominent axillary\nnodes bilaterally are not pathologically enlarged.  No supraclavicular\nlymphadenopathy.  There are numerous small mediastinal nodes which are not\npathologically enlarged.  The largest is a prominent right paratracheal node\nmeasures up to 8 mm (05:33).  A prominent right hilar node measures up to 8 mm\n(05:54).  No left hilar adenopathy.  Small pre cardiac and numerous epiphrenic\nlymph nodes are also noted.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Area of consolidation is noted in the medial right lower lobe. \nNumerous cysts are seen throughout the lungs fields.  The airways are patent\nto the level of the segmental bronchi bilaterally.  Mild diffuse bronchial\nwall thickening is noted.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for numerous small\nretroperitoneal nodes and an enlarged aortocaval node that measures up to 1.8\ncm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Consolidation in the medial right lower lobe is likely reflective of\naspiration/pneumonia.\n3. Mild diffuse bronchial wall thickening suggestive of small airway disease.\n4. Numerous small rounded bilateral axillary lymph nodes and numerous small\nmediastinal lymph nodes are not pathologically enlarged.  Known\nretroperitoneal lymphadenopathy is partially visualized."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber.  Coronary artery calcification is moderate, especially\nalong the LAD.  Heart size is borderline enlarged.  Small amount of fluid is\nseen in the superior pericardial recess.\n\nThere is no supraclavicular or axillary lymphadenopathy by CT size criteria. \nHowever, there are new subcentimeter mediastinal lymph nodes that are\nincreased in size, but not pathologically enlarged by size criteria.  In\naddition, a right hilar lymph node is newly enlarged measuring 2.4 x 1.6 cm. \nThe thyroid gland appears unremarkable.\n\nThere is trace amount of pericardial effusion.  There is no pleural effusion.\n\nDiffuse ground-glass opacities in the dependent portion likely represents\natelectasis.  New since ___ is a 10 mm round ground-glass nodule with\nprobable punctate calcification in the periphery right lower lobe (3:151). \nDiffuse peribronchial wall thickening, especially in the lower lobes are\nsuggestive of chronic bronchitis.\n\nLimited images of the upper abdomen is notable for splenomegaly measuring 16.8\ncm in the AP dimension, not substantially changed since ___, possibly related\nto patient's known CLL.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of acute pulmonary embolism or aortic dissection.\n2. New right lower lobe ground-glass nodule measuring 10 mm.  See\nrecommendations below for need for follow-up.\n3. New right hilar lymphadenopathy and increased number of lymph nodes in the\nmediastinum in the setting of chronic bronchitis, possibly reactive or\npatient's known CLL diagnosis.  Attention on follow-up imaging is recommended.\n4. Stable splenomegaly.\n\nRECOMMENDATION(S):  For an incidentally detected single ground-glass nodule\nbigger than 6mm, CT follow-up in 6 to 12 months is recommended to confirm\npersistence. If persistent, CT follow-up every ___ years until ___ years after\ninitial detection are recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrate a moderate size\nhiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is a subpectoral right breast implant.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate-sized hiatal hernia."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is unremarkable.  Supraclavicular and axillary lymph\nnodes are not enlarged.  Breasts require mammography for evaluation.  Chest\nwall is not fully imaged.  Study is not appropriate for subdiaphragmatic\ndiagnosis but shows no adrenal mass.  Low-attenuation of the liver even\nfollowing contrast administration indicates steatosis.\n\nCARDIO-MEDIASTINUM:Above a small paraesophageal hiatus hernia, esophagus is\nnormal.  Atherosclerotic calcification is not apparent head and neck vessels\nor in the coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No thoracic lymph nodes are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Pair of 2 mm subpleural nodules, left upper lobe,\n5:90, 93, are indeterminate in nature, but not large enough generally to\nwarrant further imaging.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No good evidence for intrathoracic malignancy.  Two tiny upper lobe subpleural\nnodules are indeterminate, but would not warrant further imaging evaluation in\nthe absence of an extrathoracic malignancy."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is normal, and\ndiffuse coronary artery calcifications are present.  No pericardial pleural or\npleural effusion is evident.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nin the spine.\n\nWithin the lungs, moderate centrilobular emphysema is present with upper lung\npredominance.   Saber sheath configuration of the trachea is frequently\nassociated with COPD.\n\nSeveral approximately 2-3 mm diameter noncalcified nodules are present,\nlocated in the left lower lobe (136 and 137), right middle lobe (187), and\nright lower lobe (228), all on series 4.  A 3 mm right upper lobe calcified\ngranuloma is incidentally noted.  Nonspecific bibasilar linear scarring is\npresent with adjacent mild bronchiectasis.  Within the right lung base\nanteriorly adjacent to the diaphragm is a small cluster of bronchiolar nodules\neach measuring up to approximately 4 mm in diameter (236, 4).",
            "output": "1.  Several 2-3 mm lung nodules are a nonspecific finding.  In the setting of\na history of a bladder mass, a 3 to 6 month followup CT is recommended to\nassess for stability.\n\n2.  Emphysema.\n\n3.  Coronary artery calcifications.\n\n4.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Airways are patent to the subsegmental levels.  A single\nlocule of air is noted along the right posterolateral tracheal border near the\nthoracic inlet (3:12).  While direct communication with the tracheal lumen is\nnot visualized, this location is typical for a tracheal diverticulum.  There\nis bibasilar dependent atelectasis.  No evidence of pulmonary laceration or\ncontusion.  Several pulmonary nodules are incidentally noted:\n- 2 mm right perifissural nodule (2:48).\n- 4 mm nodule in the left upper lobe (2:35).\n- 5 mm posterior left upper lobe nodule (2:52)\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  Portal venous system is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  Normal appendix.  There is no evidence of\nmesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland and seminal vesicles are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nThere is grade 1 anterolisthesis of L5 over S1 (series 602b, image 83).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No sequela of acute traumatic injury within the chest, abdomen or pelvis.\n2. Several incidentally noted pulmonary nodules measuring up to 5 mm.   For\nlow risk patients, follow-up at 12 months and if no change, no further imaging\nneeded.\n3. Single locule of air along the right posterolateral border of the upper\ntrachea, in the location suggestive of a tracheal diverticulum.\n\nRECOMMENDATION(S):  In the case of nodule size >4 - 6 mm: For low risk\npatients, follow-up at 12 months and if no change, no further imaging needed.\nFor high risk patients, initial follow-up CT at ___ months and then at ___\nmonths if no change."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is top normal in diameter.  There are moderate\ncoronary calcifications predominantly throughout the left-sided distributions.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: In the superior segment of the right lower lobe, there is a 4.8\nx 2.6 x 3.0 cm tubular, branching, nonenhancing opacity measuring fluid\ndensity which extends tube but does not definitively abut the right hilum. \nAlthough there is no clear continuity with segmental bronchi in the region,\nthere is mild bronchial wall thickening of adjacent bronchi and small areas of\nassociated air trapping or focal bronchiectasis.  There are no definite\nassociated ___ opacities.  The opacity appears separate from the\narterial and venous system.  There is mild associated atelectasis as well as\nleft basilar atelectasis.  The lungs elsewhere are clear.\n\nBASE OF NECK: The partially visualized thyroid is unremarkable.  Visualized\nportions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. 4.8 cm tubular, branching opacity in the superior segment of the right\nlower lobe measures fluid density suggestive of mucoid impaction.  No definite\nendobronchial lesion identified.  Despite not having images for comparison, a\nsimilar finding consistent with mucoid impaction was described in the medical\nrecord through Atrius Health in ___ and ___ for which workup was already\nperformed and was found to represent mucoid impaction.  Differential causes\ninclude infected airway, including allergic bronchopulmonary aspergillosis,\nsegmental bronchial atresia, or less likely neoplasm.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:10 pm, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "Soft tissues:The thyroid is normal in size and contains multiple small\nhypodense nodules in both lobes.  There is no pathologically enlarged\naxillary, mediastinal, hilar lymphadenopathy. The heart size is normal and\nthere is no pericardial effusion. Coronary artery calcifications are moderate\nin severity. The aorta and main pulmonary artery are normal in caliber.  There\nis no significant chest wall abnormality and the subdiaphragmatic findings\nwill be dictated in a separate report.\n\nLungs:Biapical pleural/parenchymal scarring is again noted.  The airways are\npatent to the subsegmental level bilaterally, apart from a lingular and right\nmiddle lobe bronchi displaying mucous impaction (6:174, 205).  Many of the\nright lower lobe subpleural nodules seen on the prior CTA of the chest are no\nlonger procedure 2. Small nodules in the lingula (6:206, 213) may represent\nmucus within small airways, and are unchanged since ___. No evidence\nof pneumonia, pleural effusion, or new or enlarging nodules.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Stable lingular nodules. Disappearance of previously noted right lower\nlobe nodules. No evidence of metastatic disease within the thorax.\n\n2.  Please see a separate report discussing findings within the abdomen and\npelvis."
        },
        {
            "input": "Small nodule in the right lobe of the thyroid does not require further\nimaging.\nSingle right hilar lymph node measuring 6 mm is not pathologically enlarged\n(302:103).\nThere is no mediastinal, hilar or axillary lymphadenopathy.\n\nThere is mild cardiomegaly .\nNo pericardial effusion .\nBovine-variant aortic arch with common origin of the brachiocephalic and left\ncommon carotid artery.  The major vessels are otherwise normal.\n\nSecretions in the left main bronchi and both lower lobes airways with\nassociated left lower lobe small consolidation containing air bronchograms and\nright lower lobe subsegmental atelectasis.\nMinimal secretions in the left upper lobe airways with subsegmental\natelectasis.\n\nFine anatomic detail is compromised by respiratory motion but no significant\nfindings will be undiagnosed.\nLeft apex 6 mm nodule (302:36).\n\nThere is no pleural effusion.\n\nUpper abdomen findings will be reported in the concurrent abdomen CT accession\nnumber ___.\nNo evidence of bony destructive lesion .",
            "output": "Aspiration to both lung bases includes left lower lobe pneumonia.\n6 mm left apical nodule warrants follow up Chest CT in 3 to 6 months.\nNo findings related directly to recurrent esophageal carcinoma.\n\nRECOMMENDATION(S):  ChestCT in 3 to 6 months."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level, motion artifact limits evaluation of the subsegmental level. \nFilling defects are seen at the bifurcation of the left lower lobar artery,\nextending to segmental levels (for example 3; 101).  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma. \nIncidental note is made of a 2 vessel arch.  The heart, pericardium, and great\nvessels are within normal limits.  There is trace pericardial fluid, likely\nwithin physiologic range.  There is no evidence of right heart strain.\n\nAXILLA, HILA, AND MEDIASTINUM: A prominent right hilar lymph node measures 9\nmm, and does not meet CT size criteria for lymphadenopathy.  No axillary or\nmediastinal lymphadenopathy is present.  No mediastinal mass.  There is a\nsmall hiatal hernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Atelectasis is seen at bilateral lung bases, more significant\non the left.  A 6 mm nodule seen in the left apex, unchanged compared to prior\n(3; 54).  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show a partially\ncalcified 8 mm nodule, stable compared to prior.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild degenerative changes are seen throughout the thoracic spine.",
            "output": "1. Left lower lobar and segmental pulmonary emboli.  No evidence of right\nheart strain.\n2. Stable 6 mm left lung nodule, unchanged from prior."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  No enlarged lymph nodes in either the axilla or\nthoracic inlet.  Mild atherosclerotic calcifications in the subclavian\narteries.  No chest wall abnormalities\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable, and Dobhoff tube is coursing throughout ending at\nthe distal stomach.  Mediastinal lymph nodes are not enlarged by CT size\ncriteria.  No hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:, Consistent with known diagnosis of\nHeart size is enlarged, specially left ventricle and atrium.  No pericardial\neffusion.  Extensive atherosclerotic calcifications in the coronary arteries. \nEnlarged pulmonary artery diameter measuring 35 mm, reflecting pulmonary\nhypertension.  Aorta is normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nMultifocal confluent consolidations with air bronchogram and associated\n___ opacities are diffusely distributed throughout the lung parenchyma\nbilaterally.  Diffuse ground-glass opacities with thickened interlobular septa\nare noted adjacent to the consolidated portions reflecting edema.  Moderate\nbilateral pleural effusions.  The airways are patent to the subsegmental\nlevel, an endotracheal tube extends to 5 cm above the carina.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis lytic or sclerotic bone lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show a hypotrophic left kidney with\ncalcifications, consistent with known diagnosis of chronic kidney disease.",
            "output": "Diffuse confluent multifocal consolidations with associated edema and pleural\neffusion is concerning for multifocal pneumonia  ."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Transmural\nhypodensity in the thickened interventricular septum and intramural\nhypodensity in the apex are consistent with known acute myocardial infarct\n(___).  The papillary muscles are also hypodense in attenuation,\nconsistent with infarct (___). Severe coronary artery calcifications, most\nprominent at the LAD artery. Moderate cardiomegaly. Enlarged pulmonary artery,\nmeasuring up to 3.3 cm, likely reflects underlying pulmonary arterial\nhypertension. No evidence of pulmonary embolism to the segmental level.  The\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nBorderline enlargement of the right paratracheal lymph node is likely\nreactive.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Mild interval decrease of now small bilateral nonhemorrhagic\npleural effusions, likely cardiogenic.  No evidence of empyema.  No\npneumothorax.\n\nLUNGS/AIRWAYS: The distal tip of the endotracheal tube terminate approximately\n3 cm above the carina. The airways are patent to the level of the segmental\nbronchi bilaterally.  Again visualized are multifocal confluent predominantly\nperibronchial consolidations with air bronchograms, reflecting known\nmultifocal pneumonia.  Subtle decrease in consolidation in the left upper and\nposterior right middle lobes reflect mild interval improvement.  However, mild\ninterval increase in interlobular septal thickening and diffuse ground-glass\nopacities suggest progressive concomitant pulmonary edema.  No evidence of\nintraparenchymal abscess.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.  Mild\ndegenerative changes of the thoracic spine.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.",
            "output": "1. Mild interval decrease of consolidation within the left upper and posterior\nright middle lobes reflects subtle improvement of the multifocal pneumonia.\n2. Mild interval increase in interlobular septal thickening and ground-glass\nopacities, concerning for progressive pulmonary edema, likely cardiogenic.\n3. Mild interval decrease of now small bilateral nonhemorrhagic pleural\neffusions. No evidence of empyema.\n4. Marked hypodensity within the interventricular septum, cardiac apex, and\npapillary muscle is consistent with history of acute multivessel infarct. \nPatient is at high risk for interventricular septal rupture and acute mitral\nvalve regurgitation.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:49 pm, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum and at\nthe level of the hilar structures. Mild dilatation of the pulmonary artery. \nMinimal coronary calcifications.  No pericardial effusion.  Normal appearance\nof the large mediastinal vessels, with the exception of aortic wall\ncalcifications.  No pericardial effusion.  Mild hiatal hernia.  The upper\nabdomen is reported separately in a dedicated abdominal CT report.\nNo osteolytic lesions at the level of the ribs, the sternum, and the vertebral\nbodies. No abnormalities at the level of the shins soft tissues of the chest\nwall. The pleural surfaces are even.  No pleural thickening, no pleural\neffusions. No diffuse lung disease.  The airways are patent. No suspicious\npulmonary nodules or masses.",
            "output": "No evidence of metastatic disease to the thorax. Mild coronary calcifications,\nmild dilatation of the pulmonary artery. Mild aortic wall calcifications."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Main pulmonary artery is 4\ncm, concerning for pulmonary hypertension, unchanged.  Heart size is normal. \nThere is no pericardial pleural effusion.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nImage portion of the upper abdomen demonstrate small hiatal hernia and\notherwise is unremarkable\n\nAirways are patent to the subsegmental level bilaterally.  There are no\npulmonary nodules masses or consolidations.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis and the corresponding report will be issued\n\nSmall hiatal hernia."
        },
        {
            "input": "Several tiny supraclavicular lymph nodes are unchanged in size since at least\n___ and not pathologically enlarged by size criteria.  There are no\nenlarged axillary nodes.  Specifically excluding the breasts which require\nmammography for evaluation, there are no soft tissue abnormalities in the\nimaged chest wall suspicious for malignancy.  This study is not designed for\nsubdiaphragmatic diagnosis but shows normal size adrenal glands.  Imaged\nportion of the suboptimally enhanced liver is homogeneous.  Patient has had\ncholecystectomy.  Hiatus hernia is small.\n\nAtherosclerotic calcification mild in head neck vessels restricted to the\norigins of the innominate and left subclavian arteries, but not apparent in\nthe coronary arteries.  Enlargement of the pulmonary arteries, main 39 mm,\nright 28 mm is unchanged.  Aorta is normal size.  Aortic valve is not\ncalcified.  Pericardium is physiologic.  There is no pleural abnormality.\n\nLymph nodes:\n\nMediastinal, hilar, and other thoracic lymph nodes are not pathologically\nenlarged.  Paraesophageal node contains granulomatous calcifications.  There\nis no mediastinal mass in the thymic bed or elsewhere.\n\nLungs:\n\nLungs are clear.  There are no bone lesions in the chest cage suspicious for\nmalignancy or infection.",
            "output": "Small hiatus hernia.  Atherosclerotic calcification restricted to proximal\ninnominate and left subclavian arteries.  Otherwise normal chest CT.  No\nevidence of intrathoracic malignancy.  No thymic remnant."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nEnlarged main pulmonary artery is again seen.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Intervertebral osteophytes cause mild compressive atelectasis\nin the right lower lobe.  The airways are patent to the level of the segmental\nbronchi bilaterally.  Scattered areas of mucous plugging seen in the\nsubsegmental bronchi of the lower lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen are notable for a small hiatal\nhernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMild pulmonary artery is dilated measuring up to 3.3 cm, unchanged.  The\nthoracic aorta no pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There multiple enlarged mediastinal and hilar\nlymph nodes, for example, on the left, measuring 1.2 and 1.3 cm (___).  A\nsubcarinal lymph node measures 2.8 x 1.4 cm (___).  No axillary\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  There are diffuse metastases throughout the bilateral lungs. \nThe largest mass measures 5.0 x 4.5 cm (2a/40) with central areas of\nhypodensity, suggesting necrosis.  Lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK:  There is a subcentimeter hypodense lesion in the left\nhemithyroid, of indeterminate clinical significance.  Visualized portions of\nthe base of the neck otherwise show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: There there are multiple (greater than 5) hypodense lesions\nthroughout the liver, highly concerning for metastases.  Index lesions:\n- 1.4 cm hypodense lesion in segment VIII (2B/105)\n- 4.3 x 3.8 cm hypodense lesion in segment 7 (2 B/ 118)\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is mildly distended without evidence of stones or sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are simple cysts in the bilateral kidneys.  There is a 1.4 cm\nhypodense lesion in the midpole of the right kidney (2B/ 135), which measures\nabove expected for a simple cyst and may represent a hemorrhagic cyst.  The\nkidneys are of normal and symmetric size with normal nephrogram.  No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a large right lower quadrant multifocal\nheterogeneous mass, measuring approximate 8.4 x 10.8 x 8.9 cm (607 B/24) in\nthe region of the right ovary.\n\nLYMPH NODES: There is a prominent 0.8 cm aortocaval lymph node (2 B/ 144). \nThere is a right common iliac lymph node, measuring 1.0 cm (2 B/ 152).  There\nis a 1.1 cm external iliac lymph node (2B/ 170).\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There are multiple subcutaneous soft tissue nodules. \nIn the anterior abdominal wall, a soft tissue mass measures 2.9 x 2.2 cm (2\nB/150).  There is a 2.3 cm soft tissue mass in the lower pelvis which abuts\nthe bladder (2 B/178).  There is a 4.3 x 3.5 cm heterogeneous mass in the left\nlower quadrant (2 B/158).  No evidence of bony metastases.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Multifocal heterogeneous mass, measuring 8.4 x 10.8 x 8.9 cm in the region\nof the right ovary, consistent with patient's history of ovarian cancer.\n3.  Extensive metastatic disease in the lungs, liver and mesentery, as\ndescribed above."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is interval development of new subsegmental pulmonary emboli within the\nlateral segment of the right middle lobe, the right lower lobe, and the left\nlower lobe.  The main and right pulmonary arteries are normal in caliber, and\nthere is no evidence of right heart strain.\n\nThere is re- demonstration of multiple enlarged mediastinal and hilar lymph\nnodes.  For example, left hilar lymph nodes measure up to 1.3 cm in short axis\ndiameter (04:47) unchanged compared to previous.  A subcarinal lymph node\nmeasures 3.0 x 1.5 cm, also not significantly changed.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nBilateral innumerable pulmonary metastases are again noted.   A right\nparamediastinal mass measures 5.2 x 3.6 cm compared to 5.0 x 4.5 cm\npreviously, not significantly changed given the difference in patient\norientation.  Other masses are slightly decreased in size compared to\nprevious.  For example, a left lower lower mass measures 3.4 x 3.0 cm (4:90)\ncompared to 3.9 x 3.5 cm previously (2a:  79). A right lower lobe lesion in\nnear the major fissure measures 1.6 x 1.2 cm (8:193) compared to 2.2 x 2.0 cm\n(2a: 65) previously.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen again demonstrates multiple hepatic\nmetastases.  The largest is in segment ___ (4:  109) and measures 3.7 x 2.8\ncm, previously 4.3 x 3.8 cm.  There is an accessory left hepatic artery\narising from the left gastric.\n\nEvaluation of the spine is limited due to lack of sagittal reformats. No lytic\nor blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Subsegmental pulmonary emboli within the bilateral lower lobes and the\nlateral segment of the right middle lobe.\n2. Innumerable pulmonary and hepatic metastases, some which are slightly\ndecreased in size compared to previous CT from ___, but overall\nnot significantly changed."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  All visible\nlymph nodes in the chest (5, 16) Are normal in size.  Normal appearance of the\nlarge mediastinal vessels.  No incidental pulmonary embolism.  No substantial\ncoronary calcifications, no valvular calcifications.  Upper abdominal\nfindings, such as the hypodense liver lesions (5, 38) Are described in detail\nin the dedicated abdominal CT report.  There is no evidence of osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.\nThe lung parenchyma shows multiple metastatic pulmonary nodules.  The largest\nmetastasis is located in the left lower lobe and measures 17 x 17 mm in\ndiameter.  There is no evidence of pleural effusion.  No airways disease.  No\ndiffuse lung disease.",
            "output": "Multiple metastatic pulmonary nodules, the largest of which is located in the\nleft lower lobe and measures 17 x 17 mm in diameter.  No pleural effusions. \nNo diffuse lung disease.  No adenopathy."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No interval increase in\nmediastinal lymphadenopathy is present.  Substantial interval progression in\nmetastatic disease is demonstrated with the metastatic deposits increasing for\nexample from 7.4 mm in the right left upper lobe to ___ mm, from 10 mm in\nthe right upper lobe to 13 mm, from 14 mm to 17 x 17 mm in the right lower\nlobe.  The largest lesions are in the lingula, series 5, image 33, 25 x 22 mm\nand right lower lobe, series 5, image 33, 28.5 x 18 mm.  Bibasal areas of\natelectasis and small amount of pleural effusion is new.\n\nNo definitive lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated but sclerotic focus in the sternum is noted, its etiology is\nunclear\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.",
            "output": "Substantial interval progression of metastatic disease in the chest with\ncurrently multiple pulmonary enlarging nodules and masses, at least partially\nnecrotic, noted as described\n\nPlease review CT abdomen and pelvis and a separate report"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild cardiomegaly, increased from ___.  The\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: This study is not designed for subdiaphragmatic diagnoses.  The\nimaged upper abdominal organs are unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is no evidence of\nventricular wall thinning, ventricular aneurysm or pericardial effusion. \nPunctate calcifications in the LAD are unchanged.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Subsegmental atelectasis in the right middle and lower lobes is\nunchanged.  Mild left pleuroparenchymal scarring is stable.\n2. AIRWAYS: The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta, main, left, and right pulmonary arteries are\nof normal caliber.  Incidental note is made of a 2 vessel arch.\nCHEST CAGE: No acute fracture or aggressive osseous lesion.",
            "output": "No acute intrathoracic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  There is a punctate 2 mm\ncalcified granuloma in the right upper lobe (3:81).  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is possible mild hepatic steatosis.  Otherwise, included\nportion of the upper abdomen is unremarkable.\n\nBONES: There multilevel degenerative changes of the thoracic spine with\nextensive anterior vertebral body bridging osteophytes pattern with diffuse\nidiopathic skeletal hyperostosis.  Otherwise, no suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute thoracic aortic pathology.\n2. Possible hepatic steatosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\nBilateral gynecomastia.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: This study was not tailored for evaluation of subdiaphragmatic\nsections however it shows esophageal feeding tube with all ports within the\nstomach.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal lymph nodes.  Right hilar lymph node enlargement.\n\nHEART and PERICARDIUM: Moderate cardiomegaly.  No pericardial effusion. \nModerate atherosclerotic calcifications in thoracic aorta and coronary\narteries.  Enlarged ascending aorta, with root measurements up to 5.1 cm.\nPLEURA: Right posterior pleural thickening.  No pleural effusions.  Mild right\napical scarring.\nLUNG:\n\n1. PARENCHYMA: Geographic area of consolidation in the right lower lobe,\nextending from the pleural surface to the right hilum.\nGround-glass opacities in the right upper, middle and right lower lobes,\nlikely infectious.\nMosaic pattern throughout the lungs.\n2. AIRWAYS:  The well placed ETT.  Moderate bronchial wall thickening in the\nright lower lobe with some mucous plugging.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: Sternotomy wires are intact.  Old healed fracture in posterior\nright eighth rib.  Mild dorsal spondylosis.  No suspicious lytic or sclerotic\nlesions.",
            "output": "Ground-glass opacities superimposed to the mosaic pattern parenchyma are\nsuggestive of pneumonia.\nGeographic consolidation in right lower lobe could be inflammatory related. \nMalignancy cannot be excluded.  Conventional chest radiographs now and\nfollow-up in 6 weeks is advised.\nAscending aortic root aneurysmal dilatation.\n\nRECOMMENDATION(S):  Conventional chest radiographs should be obtained as soon\nas possible and repeated in 6 weeks."
        },
        {
            "input": "CHEST:HEART AND VASCULATURE: There is an endotracheal tube with the tip\napproximately 2 cm above the carina.  The thoracic aorta is normal in caliber\nwithout evidence of acute injury based on an unenhanced scan.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Small bilateral pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral patchy and confluent opacities in both lower lobes is\ncompatible with pneumonia.  Bibasilar atelectasis. There is compressive\natelectasis adjacent to the dilated esophagus.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nHeterogeneous appearance of the thyroid gland may be related to recent\nprocedure as this was unremarkable in appearance on the prior study from ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  2 mm vascular calcification in the\nupper pole of the right kidney.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: An OG-tube seen with the tip in the midesophagus. The\nesophagus is patulous and dilated containing oral contrast with interval\ndecrease in debris within the lower esophagus.  There is no contrast\nextravasation to suggest perforation.  Small bowel loops demonstrate normal\ncaliber.  There are prominent air-filled loops of large bowel without a\ndefinite transition point identified.  The appendix is not visualized.  There\nis no evidence of mesenteric injury.\n\nPELVIS: A Foley catheter is seen within a decompressed urinary bladder.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 2.6 cm adnexal lesion containing coarse calcifications,\nfor which further evaluation with pelvic ultrasound is recommended.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  A small left gastric lymph node is\npresent.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\na 2 cm nodule within the expected location of the right breast, which may\nrepresent dense fibroglandular tissue.  Correlation with mammography is\nrecommended.",
            "output": "1.  Patulous and dilated esophagus is compatible with achalasia.  No evidence\nof contrast extravasation to suggest esophageal perforation.\n2.  Bilateral lower lobe consolidation may reflect atelectasis or pneumonia in\nthe appropriate clinical setting.  Small bilateral pleural effusions.\n3.  A 2 cm nodule within the expected location of the right breast, which may\nrepresent dense fibroglandular tissue. Correlation with mammography is\nrecommended.\n4.  A 2.6 cm left adnexal lesion containing calcifications, for which\nnonemergent pelvic ultrasound is recommended for further evaluation.\n5.  Heterogenous appearance of the thyroid gland of uncertain clinical\nsignificance given the normal appearance on the prior CT.  Recommend\ncorrelation with thyroid function tests."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive Coronary\ncalcifications are unchanged.  There is no pericardial or pleural effusion.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.  There is no pericardial or pleural effusion noted.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nExtensive Coronary calcifications, unchanged."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. There is\nno supraclavicular and no axillary lymphadenopathy.  No concerning soft tissue\nabnormalities in chest wall to suggest metastasis.\n\nCHEST CAGE: Mild S shaped scoliosis.  Osteoporosis with mild increase kyphosis\nof the thoracic spine.  No evidence of osteo destructive lesions at the level\nof the ribs, sternum or vertebral bodies.\n\nUPPER ABDOMEN: Dictated separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: No mediastinal and no hilar lymphadenopathy.  Posterior\nmediastinum is unremarkable with the exception of small hiatal hernia and the\nesophagus is moderately patulous.\n\nHEART and PERICARDIUM: There is no cardiomegaly.  No pericardial effusion. \nSevere calcifications of the coronaries are particularly in the left main, LAD\nand LCX.  Mild calcifications along the normal caliber thoracic aorta.  Main\npulmonary artery is normal in diameter, no evidence of central filling defects\nin this nondedicated study.\n\nPLEURA: There is no pleural effusion.  Mild biapical pleuroparenchymal\nscarring.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  No nodules\nidentified, no lung masses.  Mild dependent bibasilar subsegmental\natelectasis.",
            "output": "No evidence of intrathoracic metastasis.\nSevere calcifications of the coronaries."
        },
        {
            "input": "HEART AND VASCULATURE: There are large bilateral pulmonary emboli at the level\nof the main pulmonary artery on the right and lobar pulmonary arteries on the\nleft with evidence of right heart strain including flattening of the\ninterventricular septum.  The ascending thoracic aorta is normal in caliber. \nNo evidence of penetrating atherosclerotic ulcer formation or dissection. \nCalcified coronary atherosclerosis is mild.  Aortic arch and great vessel\norigin atherosclerosis is mild.  Descending thoracic aorta atherosclerosis is\nmoderate with irregular ulcerating plaques.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is scattered pleural thickening and calcification.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacities most confluent in the paramediastinal\nleft upper lobe could reflect early pulmonary infarction.  Mild diffuse\nbronchial wall thickening and subsegmental mucous impaction.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Incidental anterolateral right fifth through eighth rib fractures with\nformation of some bridging callus.  Focal heterogeneity in the lateral right\nfifth rib is nonspecific.",
            "output": "1. Extensive pulmonary emboli beginning at the level of the main pulmonary\nartery on the right and the lobar pulmonary arteries on the left with evidence\nof right heart strain and possible early pulmonary infarction.\n2. Subacute anterolateral right fifth through eighth rib fractures with some\nevidence of healing.\n3. Nonspecific heterogeneity of the lateral right fifth rib. Recommend\ncorrelation with history of malignancy with an alternative common differential\nconsideration including fibrous dysplasia.\n4. Calcified pleural plaques suggest history of asbestos exposure.\n\nNOTIFICATION:  The findings related to the extensive pulmonary emboli were\ndiscussed with ___, M.D. by ___, M.D. on the telephone on\n___ at 2:26 pm, 1 minute after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental thyroid findings.\nNo supraclavicular or axillary adenopathy.\nNo incidental chest wall findings.\n\nUPPER ABDOMEN: The left adrenal round 4 cm mass is partially image, please of\nthe to the dedicated same day CT of the abdomen pelvis accession ___.\n\nMEDIASTINUM: The no mediastinal or hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nSevere to moderate calcifications of the mitral annulus.\nNo clear coronary calcifications.\nMajor vessels are within normal size\n\nLUNG: Airways are patent to the subsegmental level bilaterally.\nIncidental finding -  lenticular shaped trachea.\nThe study is not in complete inspirium with associated minimal mosaic pattern\nof attenuation over both lungs.\nNo evidence of lung masses to suggest aplasia.\nNo pulmonary opacifications to suggest pneumonia.\n\nCHEST CAGE: No evidence of bony destructive lesion.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Small left\nhilar nodes unchanged in size.  Heart size is normal.  The aorta and pulmonary\nartery normal in caliber.  There is a right-sided Port-A-Cath with tip in the\nright atrium.  The airways are patent up to the subsegmental level.\nModerate mitral annulus calcification is again seen.\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is bibasilar atelectasis.  No new lung nodules.\nBONES : Review of bones shows degenerative changes involving the thoracic\nspine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is a new approximately 4.1 x 3.2 cm left adrenal mass.  Please\nrefer to dedicated report on abdomen which has been dictated separately.",
            "output": "No evidence of metastasis to the chest.\n\nLeft adrenal mass.  Please refer to dedicated report on abdomen which has been\ndictated separately."
        },
        {
            "input": "Airways are patent to the subsegmental level bilaterally.\n\nName 3 mm right lower lobe pulmonary nodule, series 5, image 147 is stable. \nLeft upper lobe calcification is unchanged.  No new lymphadenopathy a\nsclerotic focus solid faces the but stated.\n\nAorta and pulmonary arteries are well enhanced.  Central venous line tip\nterminates in the right atrium/coronary sinus mitral annulus calcifications\nare extensive.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  There is no\npericardial or pleural effusion.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen re-demonstrate left adrenal lesion,\npartially imaged on the current study, better characterized on ___\nCT abdomen.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPartially imaged left indeterminate adrenal lesion better characterized on the\nCT abdomen from ___"
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  Right-sided Port-A-Cath tip projects\nto the right atrium.  There is dense calcification involving the mitral\nannulus.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  None pulmonary arteries are\nnormal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion\nhowever no new or growing pulmonary nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows small right\ndiaphragmatic lymph nodes.  Please refer to dedicated report on abdomen which\nhas been dictated separately.  There is a left adrenal nodule measuring 4.3 cm\nhas not been completely imaged",
            "output": "No evidence of metastasis to the chest.\n\n4.3 cm left adrenal nodule.\n\nSmall right diaphragmatic lymph nodes."
        },
        {
            "input": "The thyroid is normal.\n\nThere is no axillary or supraclavicular lymphadenopathy. Mediastinal\nlymphadenopathy persists with the largest precarinal lymph node measuring\napproximately 15 mm (series 2, image 21).\n\nThere has been interval increase in a small nonhemorrhagic pericardial\neffusion. The heart is not enlarged. There are severe coronary artery\ncalcifications. The great vessels are normal in caliber.\n\nThere is severe upper lobe predominant emphysema.\n\nPostsurgical changes from left upper lobectomy are present.\n\nThere is a small left and trace right nonhemorrhagic pleural effusion,\nimproved from ___ year prior. There is an azygos lobe, an incidental finding.\nRight apical scarring and calcification is unchanged. There are patchy\nground-glass and consolidative opacities most pronounced in the left lower\nlobe. Ground-glass and ___ opacities are seen to a much lesser extent\nin the right lower lobe. The airways are patent to the segmental level.\n\nThere is no pneumothorax or pneumomediastinum.\n\nThe esophagus is mildly thickened unchanged from one year ago. Views of the\nupper abdomen demonstrate no abnormality.\n\nThe superficial soft tissues are normal.\n\nOSSEOUS STRUCTURES:  Severe compression deformities of the T5 and 6 vertebral\nbodies with sclerosis are new from ___, but otherwise age indeterminate. \nNo soft tissue mass identified.  There is a healed sternal fracture, new from\n___. Thoracotomy changes involving the posterior left fourth and fifth\nribs are unchanged.",
            "output": "1. Multifocal consolidative and ground-glass opacities involving the left\ngreater than right lower lobes, most compatible with a multifocal infectious\nprocess.\n2. Small left and trace right nonhemorrhagic pleural effusions, improved from\n___.\n3. Moderate to severe compression deformities of the T5 and T6 vertebral\nbodies with sclerosis, new from ___, but otherwise age indeterminate."
        },
        {
            "input": "Examination is limited due to motion artifact.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized portions of the\nthyroid are unremarkable.  There is no cervical, supraclavicular, or axillary\nlymphadenopathy.  The endotrachial tube terminates one centimeter above the\ncarina.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows no significant\nabnormalities.  An enteric tube terminates in the stomach.\n\nMEDIASTINUM:  There is mediastinal shift to the left likely related to\nhyperexpansion of the right upper lobe.  Multiple enlarged mediastinal lymph\nnodes are noted.  A pre carinal lymph node measures 1.3 cm in short axis.  A\nsubcarinal lymph node measures up to 1.7 cm in short axis.\n\nHILA: Prominent hilar nodes are seen bilaterally, which are not definitively\nenlarged.\n\nHEART and PERICARDIUM: The heart is unremarkable aside from moderate\natherosclerotic calcifications of the coronary arteries.\n\nPLEURA: There are moderate bilateral pleural effusions, larger on the right\nthan on the left.\nLUNG:\n\n-PARENCHYMA:  Again noted is severe centrilobular emphysema.  Diffuse\nground-glass opacities are seen bilaterally.  Focal consolidation is noted in\nthe left lower lobe, similar to the prior examination.  2 nodular opacities,\nnew since the prior examination, are seen in the right middle lobe, measuring\napproximately 8 and 5 mm (03:48, 44).  There is bibasilar atelectasis.\n-AIRWAYS:  The airways are patent.\n-VESSELS:  Aside from significant atherosclerotic calcifications, the aorta is\nnormal in caliber.  The main pulmonary artery is normal in caliber as\nwell.There is focal dissection of the left subclavian artery, which is\nchronic, and appears to have progressed slightly since ___.  There is\nno extension into other vessels.\nCHEST CAGE:  There is distortion of the left upper ribs, which may be related\nto prior trauma. Severe multilevel degenerative changes are seen of thoracic\nspine, with severe vertebral body height loss of T5 and T6, unchanged since\nthe prior examination.",
            "output": "1. Multifocal consolidation, worst on the left with diffuse ground-glass\nopacity, concerning for a multifocal infectious process superimposed on a\nbackground of diffuse severe centrilobular emphysema.\n2.  Large right and moderate left pleural effusions, likely related to\ninfection, however sampling may be performed to determine exact etiology, as\nclinically relevant.\n3.  Asymmetric lung volumes as before with decrease in left hemithoracic\nvolume compared to the right side."
        },
        {
            "input": "The visualized portions of the thyroid are within normal limits. The heart\nsize is enlarged. There is no significant pericardial effusion. There is no\nevidence of thoracic aortic aneurysm. Atherosclerotic changes of the coronary\narteries and thoracic aorta are noted. There is no significant mediastinal,\nhilar, or axillary lymphadenopathy. The osseous structures are unremarkable.\nThe visualized upper abdominal structures are within normal limits.\n\nPostoperative changes from previous left upper lobectomy are again noted.\nThere is centrilobular emphysema. Since the previous exam there is interval\nimprovement in the right middle lobe and peripheral left lower lobe airspace\nopacities seen on the prior study. However, there is new bilateral lower lobe\nand posterior right upper lobe airspace disease. There are also bilateral,\nright greater than left, pleural effusions. There is no pneumothorax.",
            "output": "Multifocal new areas of airspace disease concerning for aspiration or\npneumonia. Right greater than left bilateral pleural effusions. Several of the\nareas of consolidation previouslyseen have however cleared or improved since\nthe last study and there is overall probably some improvement"
        },
        {
            "input": "The patient is status post CABG and median sternotomy wires are intact.  There\nis fat stranding and phlegmon with locules of air anterior to the sternum.\nAnterior to the sternum there is fat in a fluid collection measuring 1.2 cm in\ndepth tracking the length of the sternum. There is also a retrosternal soft\ntissue stranding extending into the mediastinum. A small 2.6 x 1.1 cm fluid\ncollection is seen posterior to the xiphoid process and anterior to the\npericardium (03:44).\n\nThe main pulmonary artery and thoracic aorta are normal in caliber There is\nmoderate atherosclerotic plaque of the aorta. The\nThe native coronary arteries are densely calcified.\n\nEvaluation of the lung parenchyma is slightly limited due to respiratory\nmotion.  There is a small to moderate-sized left-sided pleural effusion with\nassociated atelectasis. A trace amount of pleural fluid is noted on the right\nwith linear atelectasis.\n\nScattered mediastinal lymph nodes are not enlarged. The largest is located in\nthe right paratracheal station and measures 9 mm.\n\nAlthough this study is not designed to evaluate the upper abdomen other than\nhepatic steatosis there is no abnormality.\n\nOsseous structures: No concerning osteoblastic or osteolytic lesions are\nidentified.  No evidence of sternal osteomyelitis is appreciated.",
            "output": "Inflammatory changes surrounding the sternum and extending into the anterior\nmediastinal fat. Small locule of fluid posterior to the xiphoid process\nabutting the pericardium. Although these findings can be seen in the\npostoperative setting, given the nearly one month interval between surgery and\npresentation, the findings are concerning for mediastinitis.\n\nSmall to moderatesized left pleural effusion and compressive atelectasis.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 11:25 AM, 20 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  There are innumerable prominent lymph nodes in the mediastinum\nmeasuring up to 1.0 cm, worse compared to ___.  For example, 2\npretracheal nodes measure 1 cm (series 302, image 87 and 90).  Multiple left\nparatracheal node measure 2.8 cm (series 302, image 86).  Prominent\nprevascular nodes and subaortic nodes are seen on series 302, image 85 and 82\nrespectively.\n\nHILA:  Prominent bilateral hilar lymph nodes are also noted.  For example, a\n0.7 cm right hilar lymph node on series 302, image 105 and a 1.0 cm left lymph\nnode on series 302, image 115.\n\nHEART:  The heart is severely enlarged and there is extensive coronary\narterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  A right\ntunnel dialysis catheter terminates in the right atrium.\n\nPULMONARY PARENCHYMA:  Evaluation of the pulmonary parenchyma is limited by\nrespiratory motion.  Given the limitation, peripheral consolidation and\nsurrounding ground-glass opacities in the lateral segment of the right middle\nlobe could represent infection (series 302, image 126).  Another area of\nground-glass opacity in the right lower lobe (series 302, image 140) could\nrepresent another focus of infection.  Linear opacity in the left upper lobe\n(series 302, image 116) could represent subsegmental atelectasis, but\nsuperimposed infection is possible.  No suspicious pulmonary nodule or mass.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There are bilateral pleural effusions, small on the right and\nmoderate on the left.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  No acute fractures.  Midline\nsternotomy wires are intact.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Consolidation with surrounding ground-glass opacity in the right middle\nlobe and a small area of ground-glass opacity in the right lower lobe are\nconcerning for a typical or atypical infection.  Linear opacity in the left\nupper lobe could represent subsegmental atelectasis but superimposed infection\nis possible.\n2. Small right and moderate left pleural effusions.\n3. Mediastinal and bilateral hilar lymphadenopathy, likely reactive.\n4. Severe cardiomegaly with extensive coronary artery calcifications.\n5. Please see separate report performed on the same day for detailed\nevaluation of the abdomen and pelvis."
        },
        {
            "input": "Several thyroid small nodules are sub 3 mm, and appear to be unchanged since\nprevious CT neck dot largest nodule in the left thyroid lobe posteriorly is 6\nmm, unchanged.  Aorta and pulmonary arteries are well enhanced. \nAtherosclerotic disease of the aorta is present.\n\nAirways are patent to the subsegmental level bilaterally.  6 mm left lower\nlobe paramediastinal nodule versus small rounded atelectasis is similar\ncompared to ___ CT abdomen within the limitations of the comparison\nof to different study techniques.  No new nodules masses or consolidations\ndemonstrated.  Minimal bibasal bronchiectasis and bibasal subpleural\nnonspecific scarring are present.  Pacemaker leads terminate in right atrium\nand right ventricle.  There is no pericardial or pleural effusion.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nImage portion of the upper abdomen reveals no appreciable abnormality\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic metastatic disease.  Nonspecific left\nlower lobe 6 mm nodule might represent nodular atelectasis but should be\nreassessed in 3 months for documentation of stability.\n\nCoronary artery disease\n\nPacemaker leads in appropriate position\n\nBibasal minimal bronchiectasis\n\nSmall thyroid nodules, unchanged."
        },
        {
            "input": "Study is somewhat limited by late timing, respiratory motion artifact and low\nlung volumes.\n\nSubsegmental pulmonary emboli are visualized within the right upper and right\nlower lobes. No main pulmonary emboli are demonstrated.\n\nNo pericardial effusion. Mild polychamber cardiomegaly. Mild main PA\nenlargement, 3.5 cm, which may reflect pulmonary hypertension. Normal caliber\nthoracic aorta.\n\nThe patient is status post ___ fundoplication.  There is barium within the\nstomach resulting in streak artifact that limits assessment of adjacent\nstructures.  A large fluid collection with air-fluid levels is located within\nthe mediastinum surrounding the esophagus, originating at the carina and\nextending to the diaphragmatic crura, 14.7 x 9.4 x 11 cm, without layering\nhematocrit effect. This demonstrates mild mass effect upon the left atrium.\nPost Nissen fundoplication with suture line at the gastroesophageal junction. \nAn indeterminate heterogenous hyperdensity is noted inferior to the GE\njunction within the posterior abdomen (2, 95), oriented along the left\ndiagphragmatic crus, and might represent a portion of the wrap, although is\nonly partially imaged and indeterminate.\n\nNo endobronchial lesions. Passive atelectasis of bilateral lower lobes by the\nlarge mediastinal collection. Low lung volumes. Mild apical predominant\ncentrilobular and paraseptal emphysema. Scattered ground-glass densities\nwithin the bilateral apices and upper lobes are demonstrated.  No\npneumothorax.\n\nPost sternotomy.  Multiple prior left-sided rib fractures.  Degenerative\nchanges of glenohumeral joints.\n\n4.1 x 5.6 cm hypodense region within the visualized hepatic segment 3,\nincompletely characterized, appears geographic and is traversed by a vessel. \nThe appearance suggests retraction injury in postoperative patient.",
            "output": "-1.  Somewhat limited study secondary to delayed contrast timing, respiratory\nmotion and low lung volumes. Subsegmental pulmonary emboli within right upper\nand right lower lobes. No main pulmonary emboli.  Scattered ground-glass\ndensities within bilateral apices and upper lobes, possibly representing early\npulmonary infarcts or inflammatory/ infectious process. Large fluid collection\ndemonstrates mild mass effect upon the left atrium and passive atelectasis of\nboth lower lobes.\n-2.  Large periesophageal fluid collection, measuring 14.7 cm maximum\ndimension, with multiple air-fluid levels.   While this may represent a\npostoperative seroma, infection or anastomotic leak cannot be excluded,\nalthough none was noted on the fluoroscopic examination from one day prior. \nAn indeterminate heterogenous hyperdensity at the inferior aspect of this\ncollection in the upper abdomen may represent a portion of the wrap.\n-3.  Mild emphysematous changes.\n-4.  Geographic hypodensity of hepatic segment 3, incompletely characterized,\npossibly representing retraction injury."
        },
        {
            "input": "The patient is status post recent ___ fundoplication with no interval\nincrease in size in the bilobed paraesophageal fluid collection since ___ which measures 14.8 x 8.2 x 10.5 cm, previously 14.8 x 8.4 x 11.0 cm (4,\n151).  However, the fluid is now higher in attenuation with Hounsfield units\nranging from ___, and shows new peripheral enhancement. Foci of air within\nthis collection have significantly decreased in size and number.\n\nNo pathologically enlarged mediastinal, supraclavicular, hilar or axillary\nlymph nodes are identified. The thyroid gland is unremarkable.\n\nThere is mild cardiomegaly with multichamber enlargement and scattered\ncoronary artery calcifications. There is no pericardial effusion. There is\nstable mild dilatation of the main pulmonary artery which measures up to 3.6\ncm in greatest transverse dimension. The thoracic aorta is normal in caliber.\n\nEvaluation of the lungs demonstrates small subsegmental areas of ground-glass\nopacities and interlobular septal thickening which are overall not\nsignificantly changed since the study of 6 days ago. There is also a new\nconsolidation in the anterior right middle lobe. There are large bilateral\nintermediate attenuation ___ ranging from 15 -33) pleural effusions with new\nnear complete passive atelectasis of the bilateral lower lobes.\n\nImages of the upper abdomen show no significant interval change in the\ngeographic hypodense lateral left hepatic lobe region which likely corresponds\nto a contusion.\n\nThere are no lesions in the rib cage worrisome for infection or malignancy.",
            "output": "New hyperdensity and peripheral enhancement of the non-expanding\nparaesophageal fluid collection which suggests new infection of a seroma or\nearly abscess formation.\n\nNew large bilateral pleural effusions, which are no longer simple, and may be\nhemorrhagic and or infected.\n\nNew near-complete collapse of the bilateral lower lobes.\n\nBilateral ground-glass opacities and a new anterior right middle lobe\nconsolidation which may be due to confluent edema versus infection.\n\nStable mild dilatation of the main pulmonary artery, which suggests pulmonary\narterial hypertension in the appropriate clinical setting.\n\nUnchanged left hepatic lobe contusion.\n\nNOTIFICATION:\nThe findings were discussed by Dr. ___ with Dr. ___ on the telephone on\n___ at 7:06 ___, approximately 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen\npelvis CT report dictated under clip ___.\n\nCT chest: The thyroid is enlarged with multiple small nodules. There is no\nsupraclavicular lymph node enlargement. The airways are patent to the\nsubsegmental level. There is no mediastinal, hilar or axillary lymph node\nenlargement by CT size criteria. There is thickening of the left ventricle\nwhich could be related to systole; although, left ventricular hypertrophy is\npossible. The pericardium and great vessels are within normal limits.  There\nis mild coronary artery calcification.  There is a small hiatal hernia.\n\nAssessment of the lung parenchyma is extremely limited due to severe motion\nartifact. Several non characteristic 2-3 mm nodules are noted. No substantial\nfocal or diffuse lung disease. Atelectasis is seen as expected with the low\nlung volumes. Scarring is noted in the right middle lobe. There is a small\nleft pleural effusion. No pneumothorax.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "1.  No evidence of lymphadenopathy in the chest.\n\n2. Extremely limited assessment of the lung parenchyma due to severe motion\nartifact. No substantial focal or diffuse lung disease.\n\n3.  Multinodular thyroid, could be further evaluated with nonemergent thyroid\nultrasound as clinically indicated.\n\n4.  Thickening of the left ventricle could related to systole; although, left\nventricular hypertrophy is possible. Could be further evaluated with\nechocardiography if clinically indicated."
        },
        {
            "input": "AIRWAYS:\nEndotracheal tube is in place with the tip approximately 4 cm above the\ncarina.  Patient is status post right upper lobectomy.  Right upper lobe\nbronchial stump is unchanged.  Left-sided airways are patent to the level of\nthe subsegmental bronchi.\n\nLUNGS:\nThere are patchy and confluent airspace opacities in the left upper lobe\ndemonstrating peripheral ground-glass opacities.  Airspace consolidation is\nnoted in the right middle lobe and dependent portions of the right lower lobe,\nlingula and left lower lobe.  Note is made of high-density material within the\ncollapsed lung at the bases bilaterally.\n\nPLEURA:  There are bilateral pleural effusions, moderate on the right and\nsmall on the left.\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.  No evidence of mediastinal hematoma.\n\nHEART and VASCULATURE: The heart is mildly enlarged.  There are coronary\nartery calcifications. Single lead pacemaker is noted with the tip in the\nright ventricle.  Right-sided PICC line tip is in mid SVC.  No pericardial\neffusion.\n\nCHEST WALL: Unremarkable.\n\nBONES:  Subcentimeter sclerotic foci are noted in left T3 transverse process,\nleft posterior sixth rib, right anterolateral third rib and T11 vertebral body\nwhich are likely bone islands.  There are nondisplaced right second through\neighth anterolateral rib fractures.  Note is also made of left second through\nseventh rib fractures as well as a minimally displaced sternal fracture\n(602:44).\n\nUPPER ABDOMEN: Please refer to separate CT abdomen/pelvis report.",
            "output": "1. No evidence int chest wall hematoma.\n2. Nondisplaced bilateral rib fractures and sternal fracture as described.\n3. Patchy and confluent opacities with surrounding ground-glass in the left\nupper lobe are likely secondary to aspiration.  Less likely consideration\nwould include an infectious process or pulmonary hemorrhage.\n4. High density material within a collapsed lung at the bases bilaterally is\nlikely from prior aspiration of oral contrast.\n5. Moderate right and small left pleural effusions."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  A left chest wall pulse generator\ndevice with continuous lead terminating in the right ventricle is unchanged in\nposition or appearance since the prior study.  Persistent enlargement of the\nmain and right pulmonary arteries (03:32), suggests underlying pulmonary\narterial hypertension. The caliber of the intrathoracic aorta is normal.\nModerate aortic and coronary arterial atherosclerotic calcifications are again\nseen.   The heart size is normal and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The patient is status post right upper lobectomy. The right upper lobe\nbronchial stump is unremarkable. The overall appearance of the left lower lobe\nis stable compared to the prior study, with 2 small discrete consolidations\nsurrounding fiducial markers from prior CyberKnife treatment (5:166, 163), as\nwell as in the lingula (5:180).  No new or enlarging nodule or mass is\nidentified. Right lower lobe peripheral ___ opacities (5:234) is\nunchanged, as are innumerable punctate, representing microlithiasis. No\nairspace consolidations worrisome for infection are identified.\n\nBONES:  Since the prior study, there has been interval fracture of the\nproximal left humerus (05:10), with heterotopic bone formation indicating\nhealing. There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.  A well-circumscribed\nsclerotic focus in the right aspect of the T11 vertebral body likely\nrepresents a bone island (12:94). Multilevel degenerative changes are again\nnoted in the thoracic spine.\n\nUPPER ABDOMEN:  Although this study is not specifically tailored for\nevaluation of subdiaphragmatic structures, left hepatic lobe cyst, right\ninterpolar caliceal diverticulum with calcifications, atrophic left kidney,\nnodular left adrenal gland, and densely calcified splenic artery are\nunchanged.",
            "output": "1. Stable post-treatment changes following CyberKnife of left lower lobe and\nlingular nodules. No new nodules or masses are identified.\n2. Right lower lobe chronic ___ opacification with microlithiasis is\nunchanged, possibly from chronic aspiration or chronic inflammation in this\nlocation.\n3. Unremarkable appearance of right upper lobe bronchial stump, with no\nevidence of local disease recurrence.\n4. Proximal left humeral fracture, with interval healing and heterotopic\nossification.\n5. Unchanged pulmonary arterial enlargement, suggesting underlying pulmonary\narterial hypertension.\n6. Partially visualized upper abdominal findings are stable."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: Within the limitations of a study obtained without\nIV contrast there is no supraclavicular, axillary, hilar or mediastinal\nlymphadenopathy.  Left chest wall defibrillator has a single lead in the right\nventricle.  There is a small hiatal hernia.  Esophagus is otherwise\nunremarkable.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta and\ngreat vessels are normal in caliber with scattered atherosclerotic\ncalcification.  The main pulmonary artery is dilated to 3.3 cm, unchanged\nsuggesting pulmonary hypertension.  There are moderate to severe\ncalcifications of the coronary arteries.\n\nThe tracheobronchial tree is patent to the subsegmental level.  Right upper\nlobe bronchial stump appears unremarkable without sign of local recurrence. \nInnumerable bronchial opacities at the right base several with associated\nmicrocalcification (5:237) are essentially unchanged.\n\nPosttreatment changes following RFA in the left lower lobe appears unchanged\n(5:155).  There are subtle changes about the RFA site in the lingula.  Nodular\nsoft tissue in the lingula along the left heart border inferior to the\nfiducial marker shows a subtle increase in width and density (5:174). \nAdditionally, more proximally there is greater focal narrowing of the lingular\nbronchus (5:160).\n\n2 mm left upper lobe nodule (5:137) is unchanged.  Punctate left upper lobe\nnodule (5:136) is unchanged.  2 mm left upper lobe nodule (5:101), is\nunchanged.\n\nOSSEOUS STRUCTURES: There are incompletely imaged degenerative changes about\nthe left shoulder (3:1).  There are multiple sclerotic foci scattered\nthroughout the vertebral bodies likely reflecting bone islands the largest 7\nmm at approximately T11 (8:72).\n\nUPPER ABDOMEN: This study is not designed for evaluation of subdiaphragmatic\nstructures, however the following findings are noted.  Patient is status post\ncholecystectomy.  There is hyperintensity of the liver similar to prior\nstudies which may be secondary to a drug defect.\n\nThere is a unchanged calyceal diverticulum in the interpolar region of the\nright kidney containing 1.3 cm stone.  The partially imaged left kidney is\natrophic.",
            "output": "1. Subtle increase in nodular soft tissue in the lingula abutting the left\nheart border along the inferior aspect of the RFA ablation site and increased\nfocal narrowing of the lingular bronchus may potentially reflect local disease\nrecurrence/progression.  The bronchial narrowing site could be further\nevaluated with bronchoscopy.  Alternatively PET-CT may be considered to\nevaluate for increased FDG avidity at these sites.\n2. Unchanged appearance of left lower lobe RFA treatment site.  Stable postop\nappearance of right upper lobe bronchial stump.\n3. Persistent ___ opacities and microlithiasis in the right lower\nlobe.\n4. Stable enlargement of the main pulmonary artery suggesting pulmonary\nhypertension.\n5. Persistent hyperdensity of the liver may be secondary to amiodarone. \nRecommend correlation with medication history all."
        },
        {
            "input": "A pacemaker is seen in the left chest wall with single pacer lead extending\ninto the right ventricle.  The imaged portion of the thyroid gland appears\nnormal.  The remainder of the imaged base of the neck appears normal.  The\nthoracic aorta is mildly calcified and normal in caliber.  The main pulmonary\nartery is enlarged measuring 3.3 cm in diameter, which may reflect pulmonary\narterial hypertension.  There is no mediastinal or axillary lymphadenopathy. \nNo mediastinal or hilar masses seen.  The heart is top-normal in size without\npericardial effusion.  Three-vessel coronary artery calcification is again\nnoted most severe in the LAD distribution.  The esophagus appears normal.\n\nEmphysema again noted.  There is suture material in the right hilum reflecting\nprior write upper lobectomy.  The stump appears unremarkable without signs of\nrecurrent disease.\n\nPatient has undergone prior RFA for a left lower lobe lesion, series 4 image\n118.  When compared with the ___ CT exam, the extent of soft tissue component\nappears slightly increased along the margins for example on series 4, image\n120, the lesions surrounding the fiducial measures 2.9 cm in maximal\ndimension, previously 1.4 cm.  In the absence of IV contrast, evaluation is\nsomewhat limited though findings raise potential concern for tumor recurrence.\n\nA fiducial marks the previously treated lesion in the lingula, series 4, image\n129.  No new nodularity is seen at or around the region level of the fiducial\nmarker.  There is however persistent narrowing of the lingular bronchus,\nsimilar to prior. A tiny left upper lobe nodule measuring 3 mm on series 4,\nimage 78 is unchanged.  A 2 mm nodule in the left upper lobe on series 4,\nimage 104 is unchanged. Innumerable micronodular opacities in the write lung\nbase appear stable over many years with several tiny calcified nodules also\nseen within this distribution.\n\nWithin the imaged portion of the upper abdomen, a large calcification is again\nnoted within the right kidney.  Hyperdense appearance of the hepatic\nparenchyma may reflect amiodarone effect.  The kidneys appear relatively\natrophic though only partially imaged.  There are clips in the gallbladder\nfossa.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Chronic\ndeformity is noted involving the left proximal humerus.",
            "output": "1. Increase in nodular soft tissue abutting the fiducial in the left lower\nlobe superior segment concerning for local disease recurrence/progression. \nConsider PET-CT to further assess.  Other visualized nodules appear stable.\n2. Enlarged main pulmonary artery, suggestive of pulmonary arterial\nhypertension.\n3. Mild cardiomegaly with significant coronary artery disease.\n\nRECOMMENDATION(S):  PET-CT scan to further assess lesion in the left lower\nlobe."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There is no axillary\nlymphadenopathy. Several subcentimeter mediastinal lymph nodes are noted, and\nunchanged from the prior PET-CT. These were not FDG-avid. The largest measures\n7 mm (2, 22). There is no hilar lymphadenopathy.\n\nThe heart is normal in size. There is no pericardial effusion. Moderate to\nsevere calcifications are noted in the coronary arteries.  The thoracic aorta\nis normal in caliber without significant atherosclerotic calcifications. The\npulmonary artery trunks are normal in diameter.\n\nThe airways are patent to the subsegmental levels. The transverse dimension of\nthe lower trachea is greater than the anterior-posterior dimension, suggesting\na component of tracheomalacia. There is diffuse moderate bronchial wall\nthickening, consistent with chronic small airways disease. No endobronchial\nlesion is identified.\n\nIn the right upper lobe, there is a stellate lesion which measures 18 x 10 mm\n(4, 129). It is unchanged in size from the prior PET-CT. There is associated\ntethering of the adjacent minor fissure (4, 136).\n\nSuperior to this nodule, there are several smaller nodules of a similar\ndensity in the subpleural location, measuring up to 3 mm (4, 105). Some of\nthese nodules appear to be continuous with pleural-based scars. Additionally,\nthere are numerous milimetric subpleural nodules in the upper lobes, which\ndemonstrate benign morphology.\n\nThere is no focal airspace opacity, pulmonary edema, pleural effusion, or\npneumothorax.\n\nThis exam is not tailored to evaluate the subdiaphragmatic structures. Within\nthe limitations, the imaged portions of the liver, spleen, pancreas, adrenal\nglands, and kidneys are normal. Incidentally noted is a tiny 11 mm lipoma in\nthe left hemidiaphragm (2, 51).\n\nThere are no concerning lytic or sclerotic osseous lesions. No fracture is\nidentified. A deformity of the posterior aspect of the T11 vertebral body is\nlikely congenital (602B, 80), and unchanged from the prior exam.",
            "output": "1.  Unchanged stellate nodule in the right upper lobe.\n2. Sub-3-mm nodules in the bilateral upper lobes, which demonstrate no\nconcerning features.\n3. Moderate to severe coronary artery calcifications."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates severe coronary artery calcifications.  Mild dilation of\nthe left circumflex artery is noted proximal to the patient's stent.  Evidence\nof prior, chronic inferior wall infarction.  There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified.  The transverse diameter of\nthe trachea is large than the anterior of underlying tracheobronchomalacia. \nThe airways are patent to the subsegmental level.  Mild diffuse bronchial wall\nthickening is compatible with chronic airways disease.  Lung windows\ndemonstrate no parenchymal abnormality.\n\nA previously visualized right upper lobe stellate lesion has resolved. \nMultiple additional, sub-3 mm micronodules are again noted (04:23, 33, 35, 41,\n47), unchanged from prior examination.  No new suspicious pulmonary nodule or\nmass is identified.\n\nNo suspicious osseous lesions are identified.  A chronic deformity involving\nthe posterior aspect of the T11 vertebral body is unchanged and likely\ncongenital.  An 11 mm lipoma is noted within the left hemidiaphragm (02:54),\nunchanged.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "1.  Interval resolution of the prior stellate right upper lobe nodule.\n2.  Multiple stable, sub-3 mm nodules without evidence for new suspicious\npulmonary nodule or mass.  Recommend follow-up in ___ year.\n3.  Increased transverse diameter of the mid to distal trachea, which can be\nseen in tracheobronchomalacia.  Further evaluation by expiratory phase chest\nCT could performed, if clinically indicated."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All lymph nodes visible in the mediastinum (3, 24)\nare normal in size.  Moderate coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  No abnormalities in the posterior\nmediastinum or in the upper abdomen.  No osteolytic lesions at the level of\nthe ribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Mild thickening any\nirregularities of the airway walls suggests the presence of moderate chronic\nairways disease.  No evidence of mucous plugging.  Multiple pulmonary\nmicronodules are stable in size.  There is no evidence of new or growing\nnodules.  The only change since the previous examination is a small local\natelectasis at the posterior aspect of the lingula.  No pleural effusions.  No\ndiffuse lung disease.  The trachea shows a shape highly suggestive of\ntracheobronchomalacia.",
            "output": "Stability in size and morphology of all pre-existing pulmonary nodules.  No\nnew or growing nodules.  The nodules are small and do not have a size or\nmorphology suspicious for metastatic or malignant disease."
        },
        {
            "input": "Absence of IV contrast limits the evaluation.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No axillary lymphadenopathy is\nnoted.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows no abnormality.\n\nMEDIASTINUM: No enlarged mediastinal lymph node is seen.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  There is mild\ncardiomegaly.\nPLEURA: There are moderate bilateral pleural effusions, right greater than\nleft.\nLUNG:\n\n1. PARENCHYMA:  There is consolidative opacity in the bilateral lower lobes\nand lingula that could represent passive atelectasis, however superimposed\npneumonia cannot be excluded.  Upper lobe predominant interlobular septal\nthickening is likely due to interstitial pulmonary edema.\n2. AIRWAYS:  The airways are patent to the segmental level.\nCHEST CAGE: Mild degenerative changes are noted throughout the thoracic spine.",
            "output": "1.  Moderate bilateral pleural effusions, right greater than left, with\nconsolidative opacities in the bilateral lower lobes and lingula that could\nrepresent passive atelectasis, however superimposed pneumonia cannot be\nexcluded.  Please correlate clinically.  Follow up chest CT is recommended\nafter resolution of the pleural effusions for better evaluation of the lung\nparenchyma since there is concern for malignancy.\n2. Upper lobe predominant interlobular septal thickening likely represents\ninterstitial pulmonary edema.\n\nRECOMMENDATION(S):  Please see recommendations above."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcifications of the thoracic\naorta and coronary arteries.  The thoracic aorta is normal in caliber.  Mild\ncardiomegaly.  Otherwise, the heart, pericardium, and great vessels are within\nnormal limits based on an unenhanced scan.  Moderate dependent nonhemorrhagic\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Chest tubes within the pleural space of the lung bases\nbilaterally.  Bilateral hydropneumothorax, moderate on the right, small on the\nleft.  Thin septations are seen on the right.  Some of the air within the\nintrapleural space is likely due to chest tube insertion.\n\nLUNGS/AIRWAYS: Dense consolidations within the lower lobes bilaterally with\nair bronchograms, likely atelectasis, however pneumonia cannot be excluded,\nsimilar compared to prior.  Smooth septal thickening throughout the lungs\nbilaterally, likely reflecting interstitial edema.  No new focal\nconsolidations.  Scattered secretions within the distal airways (series 4,\nimage 61).  Otherwise, airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Triangular high-density attenuation within the right posterior\npararenal space likely represents retroperitoneal hemorrhage (series 2, image\n68).  There is also a small amount of intermediate density material within the\nleft pararenal space (series 2, image 73).  Small volume nonhemorrhagic\nperihepatic ascites.\n\nBONES: Heterogeneous appearance of the thoracic vertebral bodies may reflect\nosteopenia.  No suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "1. Bilateral chest tubes, which appear in appropriate position, however there\nis residual bilateral hydropneumothorax, moderate on the right, small on the\nleft, which suggests malfunction of the tubes.  Thin septations are seen on\nthe right.\n2. High-density attenuation within the posterior pararenal spaces bilaterally,\nright greater than left, concerning for retroperitoneal hemorrhage.\n3. Dense consolidations within the lower lobes bilaterally with air\nbronchograms, likely atelectasis, similar compared to prior, however pneumonia\ncannot be excluded.\n4. Unchanged smooth septal thickening throughout the lungs bilaterally, likely\ninterstitial edema.\n5. Moderate dependent nonhemorrhagic pericardial effusion, increased compared\nto prior.\n6. Small volume nonhemorrhagic perihepatic ascites.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:53 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Enlarged mediastinal hilar lymph nodes.  Heart size is normal. \nThere is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a 3 mm subpleural nodule in the left lower lobe (6, 46).  The\ninterstitium is prominent.  There is a cavitary lesion in the right middle\nlobe (6, 135).\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "Indeterminate cavitary lesion in the right middle lobe.  Differential\ndiagnosis would include a cyst and metastasis.  Attention to this on follow-up\nimaging is recommended.\n\nSubpleural left upper lobe 3 mm pulmonary nodule."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal.  No\npathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Cystic lesion in\nthe right middle lobe, 6 mm in diameter does not have identifiable borders or\nsoft tissue component, unchanged since previous examination.  No new nodules,\nmasses or consolidations demonstrated.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal pathology\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.  Cystic lesion in the right\nmiddle lobe is unchanged has no soft tissue component, unlikely to represent\nmetastatic disease.  Attention on the subsequent studies is recommended."
        },
        {
            "input": "Since ___ patient has had right upper lobectomy.\n\nNumerous bilateral axillary lymph nodes are unchanged since the preoperative\nstudy, ranging in the up to 8 mm on the right, 9 mm on the left, 2: 15, 10.\nSmaller subpectoral nodes are also unchanged. There is no supraclavicular\nadenopathy. Thyroid is unremarkable.\n\nRight hilus has a normal postoperative appearance following upper lobectomy.\nMediastinal and hilar nodes are not pathologically enlarged. A small volume of\nnonhemorrhagic right pleural fluid is present, some collected dependently, and\nsome possibly loculated along the upper mediastinum into the apex the right\nhemi thorax. There is no pericardial or left pleural effusion.\n\nAorta and pulmonary arteries are normal caliber.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows there is\nno adrenal mass and a 3.4 cm cyst in the left upper kidney is stable. Solid\norgans of the upper abdomen are not thoroughly imaged.\n\nElevation of the right hemidiaphragm is expected postoperatively. 6 mm\nsubpleural nodule in the right middle lobe, 4:132, is probably a portion of\natelectasis, but should be re-evaluated on subsequent surveillance imaging.\nRight middle and lower lobes are well expanded otherwise. Pleural parenchymal\nscarring at the apex of the left lung is unchanged. Emphysema is moderate to\nsevere in the left upper lobe, mild elsewhere. There are no other clinically\nsignificant abnormalities in the left lung.\n\nWell circumscribed sclerotic lesion in the T5 thoracic vertebral body, and\nsmaller sclerotic lesions in T6 and the right eighth rib are benign. There are\nno bone lesions in the chest cage suspicious for malignancy.",
            "output": "Unremarkable postoperative appearance following right upper lobectomy,\nincluding small to moderate residual right pleural effusion.  Nodule, right\nmiddle lobe, is probably atelectasis, should be followed.\n\nBorderline lymph node enlargement, both axillae, unchanged, probably not\nclinically active."
        },
        {
            "input": "Stable postoperative appearance of the chest following right upper lobe\nresection with no signs of local recurrence.  No new or enlarging mediastinal\nor hilar lymph nodes. Heart size remains normal, and there is no pericardial\nor pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but adrenal\nglands are well visualized and remain normal in appearance.  Incompletely\nimaged cystic lesion in the left kidney measures 3.6 cm.  This appears\nunchanged since ___ within its imaged portion.  Sub cm hypodensity\nin left lobe of the liver is unchanged since PET-CT of ___.\n\n Lungs are remarkable for persistent emphysema and nonspecific apical\nscarring. Nonspecific foci of scarring in middle lobe and lingula are also\nunchanged. Within the right lower lobe, and 11 mm x 7 mm wedge-shaped opacity\nhas developed in the lateral segment adjacent to the diaphragm (180, 4).\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1. No CT evidence of local recurrence following right upper lobe resection.\n\n2. New 11 mm wedge-shaped right lower lobe opacity, with morphology favoring\nfocal atelectasis or infarction. Neoplasm is considered unlikely, but\nattention to this region on 6 month followup CT may be helpful to ensure\nresolution."
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\nThe thyroid is normal. Mediastinal lymph nodes are not pathologically\nenlarged, and unchanged from ___. The heart and mediastinum are\nnormal. The pericardium is intact without effusion.\n\nThere has been prior right upper lobectomy with appropriate appearance of the\nsurgical margin and pleural fluid in the right hemi thorax. The airways are\npatent to the subsegmental level bilaterally. Centrilobular emphysema is worst\nin the left upper lobe, severe. Bibasilar atelectasis is worse at the left\nlung base.  No evidence of pleural effusion, pneumothorax, or focal\nconsolidation.\n\nLimited views of the upper abdomen demonstrate tiny hypodensities in liver,\ntoo small to characterize.\n\nOSSEOUS STRUCTURES:  Surgical clips and post thoracotomy changes in the right\nchest wall. No concerning osseous lesions.",
            "output": "1.  No pulmonary embolism.\n2.  Status post right upper lobectomy with no evidence of local recurrence.\n3.  Moderate centrilobular emphysema, particularly in the left upper lobe.\n4.  No evidence of pneumonia."
        },
        {
            "input": "The patient is status post right upper lobectomy.  There is centrilobular and\nparaseptal emphysema of the left upper lobe and medial right lower lobe. \nThere is mild scarring/atelectasis of the lateral right middle lobe, left\napex, and lingula.  No concerning pulmonary nodule or mass is identified. \nAirways are patent, with mild bronchial wall thickening.  There is no pleural\neffusion or pneumothorax.\n\nThe thyroid gland is unremarkable.  There is no axillary, supraclavicular,\nmediastinal, or hilar lymphadenopathy.  The heart is normal in size and great\nvessels are normal in caliber.  There is no pericardial effusion.\n\nWell-circumscribed sclerotic foci within the T4, T5, and T6 vertebral bodies\nare likely bone islands, and unchanged compared to multiple prior CTs.  There\nis no new focal lytic or sclerotic osseous lesion to suggest neoplasm or\ninfection.\n\nThis exam is not designed for the evaluation of infra diaphragmatic\nstructures.  Allowing for this, multiple subcentimeter hepatic hypodensities\nappear unchanged.  The remainder of the visualized upper abdomen is\nunremarkable.",
            "output": "No evidence of disease recurrence.  Unchanged emphysema, right middle lobe and\nlingular scarring, and postoperative changes after right upper lobectomy."
        },
        {
            "input": "Majority of the thyroid gland is not image.\n\nHeart size is normal without significant pericardial fluid. Three-vessel\ncoronary artery calcifications are severe. Aortic annular calcifications are\nsevere, there are only trace calcifications along the ascending aorta, roughly\n10-15 mm cranial to the right coronary ostia with more moderate calcifications\nat the takeoff points of the great vessels as well as the descending thoracic\naorta. Maximal ___ of the ascending aorta measures 38 (TV) by 39 (AP)\nmm at the approximate level of the main pulmonary artery, 25 mm cranial to the\nright coronary ostium.\n\nThere is no pathologic supraclavicular, axillary, hilar or mediastinal\nlymphadenopathy.\n\nAirways are patent to the subsegmental level. Right base atelectasis is mild.\nRight base 6 mm density (5:224) elongates on sagittal view and is consistent\nwith non-calcified pleural plaque. Lungs are otherwise clear without dense\nconsolidation. Several scattered calcified pleural plaques are small. There is\nno pleural effusion or pneumothorax.\n\nWhile the study is not tailored for subdiaphragmatic diagnosis, the imaged\nupper abdomen is noted for multiple millimetric calcified granulomas in the\nspleen as well as severe vascular calcifications, particularly at the origins\nof the celiac axis and SMA.\n\nBones and soft tissues: Thoracic cage is intact without focal lesion. Thoracic\ndegenerative changes are mild. Bilateral gynecomastia is mild.",
            "output": "1. Though three vessel coronary artery calcifications and aortic annular\ncalcifications are severe, the ascending aorta demonstrates only trace\natherosclerotic calcification roughly 10-15 mm cranial to the ostia. Maximal\ndiameter of the ascending aorta measures 38 (TV) by 39 (AP) mm, approximately\n25 mm cranial to the level of the right coronary ostium.\n2. Several scattered calcified and noncalcified asbestos related pleural\nplaques."
        },
        {
            "input": "The thyroid gland is incompletely imaged.  No significant axillary,\nmediastinal or hilar lymphadenopathy is detected.  The esophagus is\nunremarkable.  A left supraclavicular catheter terminates in the mid to lower\nSVC. The thoracic aorta is normal in caliber with a typical 3 vessel takeoff\nfrom the arch, which is mildly calcified.  The pulmonary arterial trunk is\nnormal in caliber.\n\nThe patient is status post mitral valve replacement and coronary artery bypass\ngrafting. The native coronary vessels are globally, densely calcified. The\nheart is moderately enlarged without pericardial effusion.\n\nAn endotracheal tube terminates at the level of the thoracic inlet. The\ntracheobronchial tree is normal to the subsegmental levels. The airways are\nnormal in caliber.  Within the pulmonary parenchyma, there is no interstitial\nabnormality.  There are small bilateral pleural effusions, left greater than\nthe right with associated compressive atelectasis. A small left pneumothorax\nis present.  There are no suspicious masses or pleural abnormalities.\n\nIntraabdominal findings are reported separately.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES:  No blastic or lytic lesion suspicious\nfor malignancy is present.\n\nThe patient is status post median sternotomy with intact wires. There is\ndiastasis of the sternum with fracture of the right sternal fragment causing\nleftward displacement of the second most caudal wire (2:28).  The most caudal\nwire surrounds only the right sternal fragment.  There is a vertically\noriented fluid collection extending between the sternal fragments and\nsubsternally, which has hyperdense contents that may represent Surgicel or\nhemorrhage (601b:22).  Overall, the fluid collection extends 23 cm\n(craniocaudal) x 3.0 cm (transverse) x 2.9 cm (anterior-posterior).\n\nTrace subcutaneous emphysema in the midline and left upper chest wall\nanteriorly reflect recent surgery.",
            "output": "1.  Sternal diastasis with intervening substernal fluid collection, as\ndetailed above, containing hyperdense contents, which may represent Surgicel\nor hemorrhage. Superimposed infection is not excluded.  Recommend clinical\ncorrelation.\n2.  Small left pneumothorax.\n3.  Small bilateral pleural effusions, left greater than right, with\nassociated atelectasis.\n4.  Intra-abdominal findings are reported separately.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 11:31 ___, 25 minutes after discovery of the findings."
        },
        {
            "input": "The lungs are fairly well aerated, with mild dependent atelectasis\nbilaterally.  Airways are patent.  Diffuse bilateral ground-glass opacities\nand consolidations, right greater than left and more focal in the superior\nsegment of the right lower lobe, are consistent with known multifocal\npneumonia.  There is also mild pulmonary edema.  No pleural effusion or\npneumothorax is seen.\n\nThe visualized thyroid gland is unremarkable.  There is no axillary,\nsupraclavicular, or mediastinal lymph node enlargement by CT size criteria,\nthough mediastinal lymph nodes are prominent.  The heart is normal in size\nwithout pericardial effusion.  Severe coronary artery calcifications are\nnoted.  There is a mitral valve prosthesis in place.  The aorta is normal in\ncaliber.  The main pulmonary artery is dilated, measuring 4.1 cm, suggestive\nbut not diagnostic of pulmonary artery hypertension.\n\nThe tip of the right internal jugular central venous catheter extends to the\nupper SVC and the left IJ catheter tip extends to the distal SVC.\n\nPlease see the dedicated CT abdomen/pelvis report from the same day for\ndetailed evaluation of infra diaphragmatic structures.\n\nThere is no focal lytic or sclerotic osseous lesion to suggest neoplasm or\ninfection.  Hardware overlying a median sternotomy is grossly intact, without\nsurrounding lucency or other evidence of hardware malfunction.",
            "output": "Right greater than left multifocal pneumonia in keeping with findings on chest\nradiograph from the same day, likely improving.  Mild pulmonary edema."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is mildly dilated to 4.0 cm.  There is no evidence of aortic\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits.  An aberrant right subclavian artery is noted.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  A prominent mediastinal lymph node is redemonstrated.  No\nmediastinal mass.\n\nPLEURAL SPACES:  There is trace pleural effusion on the left, new from prior\nexam.  There is no right pleural effusion.\n\n\nLUNGS/AIRWAYS:  Opacity in the right lung apex likely reflects post radiation\nchanges.  A nodule seen in the right lung base, new from prior exam and\nprobably representing atelectasis, although this could also reflect an early\ninfection in the right clinical setting.  There is a 4 mm nodule in the left\nlower lobe, unchanged from prior exam.  Lungs are clear without masses or\nareas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is is notable for nodular\nliver, consistent with known cirrhosis, and a left renal cysts.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  There is a new 11 x 2.4 cm fluid containing structure\nalong the anterior right chest wall, stable from prior exam and likely\nrelating to history of prior mastectomy and breast reconstruction.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Mildly dilated ascending aorta up to 4.0 cm.\n\n3.  Nodule in the right lung base, new from prior exam and probably reflecting\natelectasis, although this could also reflect an early infection in the right\nclinical setting.\n\n4.  Redemonstrated prominent mediastinal lymph node.  Comparison with more\nremote prior exams would be helpful for further evaluation.\n\n5. Trace left pleural effusion, new from prior exam.\n\n6.  4 mm nodule in the left lower lobe, unchanged from prior exam.  Recommend\nfollow-up as described on prior exam."
        },
        {
            "input": "Aorta and pulmonary arteries are stable in appearance.  Multiple mediastinal\nlymph nodes are not pathologically enlarged.  Heart size is normal.  There is\nno pericardial pleural effusion.\n\nImage portion of the upper abdomen demonstrate liver nodularity, multiple\nvarices, stigmata concerning for cirrhosis.  Renal cysts are most likely\ncortical, unchanged.\n\nPostsurgical appearance of the right breast is similar to previous. \nExamination except for tool nodularity is at its superior portion, series 2,\nimage 32, new, please correlate with the results of the mammography from ___.\n\nAirways are patent to the subsegmental level bilaterally.  Minimal impression\non the posterior wall of the trachea at its superior portion is due to right\naberrant subclavian artery.  Area of right apical scarring is similar to\nprevious examination.  Previously seen right basal nodular opacity has\nsubstantially decreased in size, currently 7 mm as compared to 15 mm on the\nprior study, most likely representing small focus of atelectasis.  Multiple\nnodules on the left upper lobe are sub 1 mm, all unchanged.  Left lower lobe\nnodule, series 4, image 107 is 4 mm, stable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval decrease in size in right lower lobe nodular opacity consist decrease\nin atelectasis.\n\nStable pulmonary nodules and mediastinal lymph nodes.\n\nSlightly different contour of the superior aspect of the right breast\nprostheses.  Please correlate with results of recent mammography from ___."
        },
        {
            "input": "FINDINGS:\n\nNo suspicious thyroid lesions.  No supraclavicular or axillary adenopathy.  No\ngross breast lesions.  This study was not tailored to evaluate the\nsubdiaphragmatic organs.  No adrenal lesions.  Mild perirenal stranding.  No\nhiatal hernia.  Normal cardiac configuration.  Mild cardiomegaly.  Trace\npericardial fluid is physiologic.  Calcification of left ventricular papillary\nmuscles.  No aneurysmal dilatation of the ascending aorta.  No aortic valve\ncalcification.  Moderate coronary artery calcification.  The pulmonary\narteries not dilated.  Multiple enlarged lymph nodes for example measuring 10\nmm in the para-aortic station (3, 18) measuring 11 mm in diameter in the left\nlower paratracheal station.  Difficult to comment on hilar adenopathy on this\nnoncontrast study.  Mildly patulous esophagus.  The airways are patent to the\nsubsegmental level.  No pleural effusions.  Extensive irregular peribronchial\nvascular nodules/airspace consolidation with air bronchograms.  The airspace\nopacification is fairly peripheral and basal.  No significant interstitial\nthickening to suggest pulmonary edema.\nMild spondylotic changes of the thoracic spine.  No lytic/destructive bony\nlesions.  Suspected hemangioma present in the T8 vertebral body.",
            "output": "Extensive peribronchovascular irregular pulmonary nodules/airspace\nconsolidation are most likely infective/post infective in nature.  In\ncomparison with prior chest radiograph done ___ the airspace\nopacification is most likely improved.  These findings may represent a\nresolving infective pneumonia (consider typical bronchopneumonia or\neosinophilic pneumonia) or a sequela of infection such as organizing pneumonia\n(inflammatory).  Follow-up chest radiograph may be performed to assess for\ncomplete resolution.\n\nNo interstitial edema or pleural effusions to suggest that there is underlying\ncardiac decompensation and pulmonary edema.\n\nThe findings are too acute to represent an interstitial lung disease (prior\nchest radiograph done ___ was normal).\n\nModerate coronary artery calcification"
        },
        {
            "input": "The thyroid gland is unremarkable.  Corresponding to an FDG avid abnormality\non the PET CT ___ is a 16 x 42 x 40mm left paratracheal soft\ntissue mass at the thoracic inlet, contiguous with the upper esophagus\ndisplacing the trachea to the right and narrowing it mildly. Thickening of the\ntracheal mucosa suggests possible invasion of the left posterolateral wall,\n5:11. The mass extends inferiorly in the prevascular plane subjacent to the\nmanubrium at the thoracic inlet, 05:15.\n\nAdjacent to the upper esophagus is a 15 x 10 mm left paratracheal node. A\nretotracheal node at the thoracic outlet (5:10) is notable only for location. \nAn 11 x 11 mm lower right paratracheal midline node corresponds to FDG avid\nabnormality on PET-CT dated ___.  There is no axillary or hilar\nadenopathy.\n\nThe airways are patent to the subsegmental level. The heart is mildly\nenlarged. The ascending aorta is fusiformly aneurysmal toe maximum diameter of\n5.1 cm. The pulmonary artery is normal in caliber.  Mild aortic valvular and\nmoderate mitral annular calcifications and coronary artery calcifications are\nunchanged.\n\nIn the right lower lobe is a cavitary 12 x 12 mm nodule (6:148) corresponding\nto a previously FDG avid solid pulmonary nodule on bulla PET-CT.  A left lower\nlobe subpleural nodule measures 4mm. Bilateral subpleural atelectasis\ninvolving the lower lobes as well as subsegmental atelectasis is identified.\nNo focal consolidation or additional new nodule is present.\n\nNo suspicious lytic or blastic osseous lesion is identified.  A right chest\nport is identified, its line terminating within the superior vena cava.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___, clip number ___.",
            "output": "1. Cervicothoracic soft tissue mass most compatible with adenopathy of\nmetastatic esophageal carcinoma, displaces, mildly narrows, and may invade the\nleft posterolateral wall of the trachea. Smaller lymph nodes at the thoracic\ninlet and in the right lower paratracheal station are concerning for\nmalignancy\n2.  5.1 cm fusiform aneurysm of the ascending thoracic aorta.\n3.  Subpleural left lower lobe 4 mm nodule ; short interval follow up is\nrecommended.\n4.  Previously solid right lower lung pulmonary nodule now cavitary measuring\nup to 1.2cm,  unchanged in size.\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed on the same date, ___, clip number ___."
        },
        {
            "input": "The thyroid is normal.\n\nThough this study is not designed for cardiac chamber evaluation, heart size\nis mildly enlarged. There is no significant pericardial fluid. Fusiform\nascending aortic aneurysm measuring up to 51 mm in diameter is unchanged.\nMildly ectatic main pulmonary artery measures up to 30 mm in diameter without\ncentral pulmonary embolus.\n\nExophytic soft tissue mass inseparable from the anterior esophageal wall in\nthe cervical esophagus abuts the cervical trachea and shifted to the right.\nOverall ___ of this mass measure roughly 47 x 23 mm (02:10), increased\nin size since ___ where it measured roughly 40 by an 18 mm.\nRoughly 5 cm segment of the adjacent esophagus demonstrates dense wall\nthickening. Adjacent prevascular left supraclavicular lymph node measures 13 x\n10 mm, similar to the prior study (2:9). Scattered nonenlarged axillary and\nmediastinal lymph nodes measure up to 8 mm. There is no pathologic axillary,\nhilar or mediastinal lymph node enlargement.\n\nAirways are patent to the subsegmental level. Biapical scarring is mild.\nBibasilar linear atelectasis is mild. 14 mm cyst in the posterior basal\nsegment of the right lower lobe (4:139) corresponds to cavitation at the site\nof a prior solid metastasis. There is no visible residual solid component. A\nfew scattered nodules measuring up to 4 mm in the posterior basal segment of\nthe left lower lobe are stable (4: 34, 154, 160). There is no new nodule.\nThere is no pleural effusion pneumothorax.\n\nWhile the study is not tailored for subdiaphragmatic diagnosis, the image\nupper abdomen is notable for gallstones, vascular calcifications,\ndiverticulosis and small hiatal hernia.\n\nBones and soft tissues: Thoracic cage is intact without suspicious focal\nlesion. Vertebral body hemangiomas are noted at multiple levels. Thoracic\ndegenerative changes are mild.",
            "output": "1. Interval increase in size of an exophytic soft tissue mass inseparable from\nthe anterior cervical esophageal wall with additional dense esophageal wall\nthickening involving a roughly 5 cm segment of the esophagus at the level of\nthe mass.  Lack of a clear fat plane with adjacent vascular structures is\nconcerning for invasion of peripheral vascular layers, whereas punctate\nmucosal thickening in the trachea adjacent to the mass suggest invasion.\n2. Stable adjacent enlarged left supraclavicular lymph node. No additional\npathologically enlarged lymph nodes.\n3. Cavitation in the posterior basal segment of the right lower lobe at site\nof a previously reported solid metastatic lesion. No residual solid component.\n4. Three nodules measuring up to 4 mm in the posterior basal segment of the\nleft lower lobe are stable. No new nodule.\n5. Stable 51 mm fusiform ascending aortic aneurysm.\n6. Cholelithiasis.\n7. Diverticulosis.\n8. Small hiatal hernia."
        },
        {
            "input": "A soft tissue conglomerate a ventral to the esophagus in the upper\nmediastinum, partially in contact with the trachea and the supraaortic\nbranches (5, 10) has slightly increased since the previous examination.  No\nsupraclavicular lymphadenopathy.  Other pre-existing mediastinal lymph nodes\nare unchanged in size (5, 25).  There is unchanged evidence of ectasia of the\nascending aorta as well as of massive coronary calcifications.  No pericardial\neffusion.  Normal appearance of the posterior mediastinum.  Several highly\nsuspicious hypodense liver lesions are noted.  A previous right kidney lesion\nis not visualized on today's examination.  Cholecystectomy.  No evidence of\nosteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.  A cystic lesion at the level of T11 was not avid on the PET CT.\nNon characteristic apical scarring.  A dorsal right upper lobe nodule has\ngrown, from approximately 2 to approximately 9 mm in diameter (6, 71).  A\nsubpleural nodule in the left lower lobe (6, 105) has newly appeared.  Also\nnewly appeared is a 5 mm right middle lobe nodule (6, 220).  The pre-existing\nFDG avid right lower lobe nodule has increased in size from approximately 15\nmm in diameter to 17 x 25 mm in diameter.  The lesion is now partly cavitated,\nlobulated and spiculated (6, 163).  No pleural effusions.  No pleural\nthickening.  No diffuse lung disease.",
            "output": "Progression of disease with growth of a mediastinal soft tissue conglomerate,\nto newly appeared pulmonary nodules, 1 growing right upper lobe nodule and 1\ngrowing right lower lobe nodule."
        },
        {
            "input": "There is a bilobed mass at the level of the superior mediastinum which is\ncompatible with known esophageal cancer.  This mass extends anteriorly from\nthe cervical esophagus to the left paratracheal region and measures 4.5 x 2.7\ncm (series 2, image 10) (previous 3.9 x 2.8 cm).  This mass causes near\ncomplete obstruction of the cervical esophagus at the level of the thoracic\ninlet with an impacted food bolus noted chest superior to the mass.  There is\nloss of fat plane with the adjacent trachea with soft tissue density noted\nalong the membranous portion of the trachea concerning for tracheal invasion. \nThere is resultant mild tracheal narrowing at this level.  There is also\napparent invasion of the left thyroid gland.  Left internal jugular vein\ntumoral invasion is a concern given apparent obstruction of the left internal\njugular vein at the level of the superior mediastinum.\n\nThere is no axillary adenopathy.  There is no mediastinal lymph nodes are\nseen.  Heart size is enlarged.  There is no pericardial effusion.  There are\ndense mitral annular and coronary artery calcifications.  The ascending\nthoracic aorta is dilated up to 4.6 cm, unchanged from prior.  There is\nmoderate atherosclerotic disease.  The main pulmonary trunk is not dilated. \nAlthough this study is not optimized for the evaluation of pulmonary emboli,\nno incidental central embolus is seen.\n\nThere is bibasilar atelectasis.  Again seen, are multiple right sided\npulmonary nodules.  The largest cavitary lesion in the right lower lobe has\nnot significantly changed in size measuring 2.5 x 2.2 cm (series 4, image\n142).  Smaller lesions in the right upper lobe have increased in size now\nmeasuring approximately 8 and 9 mm respectively (series 4, image 75; series 4,\nimage 169) (previously 6 mm and 7 mm).  An additional peripheral left upper\nlobe lung nodule now measures 5 mm (series 2, image 40) has also increased in\nsize.\n\nViews of the upper abdomen demonstrate multiple hypodense liver lesions,\ncompatible with metastatic disease.  There is increased in size of metastatic\nlesions within the were for example a a lesion in segment VII now measures 3.7\ncm, previously 2.8 cm.  There is cholelithiasis.  There is bilateral adrenal\nthickening which has also increased.\n\nOSSEOUS STRUCTURES:  The bones are diffusely demineralized.  There are no\nsuspicious bony lesions.",
            "output": "1. Interval increase in size of tumor involving the cervical esophagus with\nsignificant narrowing of the esophageal lumen and food bolus noted proximally.\n2. Findings detailed above concerning for tumoral invasion of the trachea,\nleft thyroid lobe and distal left internal jugular vein.\n3. Progression of hepatic metastases.\n4. Largest right lower lobe pulmonary nodule is stable however, the remainder\nof the pulmonary nodules have increased in size, also consistent with\nprogression of disease.\n5. Unchanged ascending thoracic aorta and aneurysm measuring 4.6 cm."
        },
        {
            "input": "MEDIASTINUM: A right thyroid lobe nodule is not significantly changed since\nthe prior CT, better characterized on dedicated thyroid ultrasound from ___ (05:12).  There is no supraclavicular, axillary, or hilar\nlymphadenopathy.  Measurable central and sub carinal mediastinal lymph nodes\nare not pathologically enlarged, and stable since the prior study.   The heart\nsize is normal and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: A paramediastinal mass abutting the descending thoracic aorta in the\nsuperior segment of the left lower lobe has increased in size since the prior\nstudy, now 21 x 14 mm, previously 15 x 10 mm (6:162).  A nearby left lower\nlobe pulmonary artery is attenuated by the mass, with no evidence of occlusion\nor identifiable pulmonary embolism, although subsegmental evaluation is\nsubptimal with this technique. Adjacent peribronchovascular consolidation and\nsmall nodules in the superior segment of left lower lobe have also increased\n(6:155, 166). A small amount of lingular atelectasis is again noted (06:206). \nOpacities adjacent to mid-thoracic right vertebral body osteophytes likely\nrepresent\n\nBONES AND SOFT TISSUES: There are no destructive focal osseous lesions\nconcerning for malignancy within the imaged thoracic skeleton.  Left breast\nprosthesis is unremarkable.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Interval growth of a paramediastinal mass in the superior segment of the\nleft lower lobe, with progression of adjacent peribronchovascular\nconsolidation and small nodules, compatible with disease progression.\n2. Right thyroid nodule is stable."
        },
        {
            "input": "Examination is compared to ___.\nA known small right thyroid nodule is unchanged.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  No enlarged lymph nodes in the\nhilar and mediastinal compartments.  No posterior mediastinal lymphadenopathy.\nThe large mediastinal vessels are unchanged.  Unchanged appearance of the\ncardiac structures.  No chest wall abnormalities, status post left breast\nimplant.  No pericardial effusion.  Unchanged mild coronary calcifications. \nNo osteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.\nUnchanged minimal bilateral apical thickening.  The central and para-aortic\ncomponents of the pre-existing mass in the left lower lobe have minimally\ndecreased in size.  This components now measure 19 x 14 mm.  The second\ncomponent of the mass, that protrudes into the lung parenchyma via the\nbronchovascular bundle (6, 127) and shows several small nodules along the its\ncourse is not substantially changed.  There is no evidence of new pulmonary\nnodules.  No pleural thickening, no pleural effusions.  Unchanged mild non\ncharacteristic scarring at the bases of the lingular (6, 177) the airways are\npatent.",
            "output": "As compared to ___, there is a mild decrease in size of the central\npara-aortic component of the pre described left lower lobe mass.  The more\nperipheral bronchovascular component is unchanged.  Unchanged size of the\nsurrounding pulmonary nodules.  Unchanged absence of lymphadenopathy and\npleural changes.  The small thyroid nodule that pre existed is constant."
        },
        {
            "input": "A previously described small hypodensity in the right lobe of the thyroid is\nnot significantly changed.\n\nThere is no supraclavicular or axillary lymphadenopathy.  A necrotic\npretracheal lymph node (series 5, image 21) measured 0.8 x 1.2 cm on the prior\nexamination and today measures 1.9 x 2.1 cm.  A subcarinal or paraesophageal\nlymph node measured 0.4 cm on the prior examination and today measures 1.0 cm\n(series 5, image 27).\n\nAorta and pulmonary arteries are normal size.  Mild cardiomegaly is stable and\nthere is no appreciable coronary artery vascular calcifications.\n\nA large left posterior perihilar mass is significantly increased in size from\n___.  The mass is centered along the lateral aspect of the descending\naorta and extends posteriorly along the posterior and medial left lower lobe\nsegmental bronchi with narrowing of these bronchi and associated atelectasis. \nThe lesion measures approximately 4.3 x 3.8 cm on today's examination\nsignificantly increased in size from prior.  Additional small pulmonary\nnodules within the left lower lobe are new or increased in size from ___, for example:\n\nA 6 mm subpleural nodule in the left lower lobe (series 6, image 155).\nA 4 mm nodule in the left lower lobe (series 6, image 147).\nA 3 mm subpleural nodule in the left lower lobe (series 6, image 148).\n\n\nScarring at the lingula (series 6, image 183) and right lung base are\nunchanged. There is no pleural or pericardial effusion.\nFor evaluation of the subdiaphragmatic structures, please see the CT abdomen\nand pelvis from the same date.\n\nThere are no bone findings of malignancy.  Moderate degenerative changes are\nnoted of the thoracic spine.\n\nA left breast implant and post surgical changes are unchanged.",
            "output": "1.  Significant increase in the patient's known left lower lobe mass in\ncomparison to ___.\n\n2.  Pretracheal and subcarinal or paraesophageal lymph nodes are significantly\nincreased in size from ___."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nPatient has had left mastectomy with breast prosthesis.  Excluding the right\nbreast which requires mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Abdominal findings\nwill be reported separately.  Previous central adenopathy has resolved.  For\nexample 84 mm right lower paratracheal node, 04:24, was 22 x 20 mm in\n___.  The Previous 34 x 30 mm left hilar mass is now too small to\nmeasure.  Previous nodular pleural thickening along the left lower lobe\nmedially has resolved and there is no pleural or pericardial effusion.\n\nAorta and central pulmonary arteries are normal size and subject to the\ntechnical limitations of this study, free of filling defects.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Complete involution of previous mediastinal and left hilar adenopathy since\n___.  No new lymph node enlargement, pulmonary metastases or evidence\nof pleural or chest wall malignancy.  It should be noted that radionuclide\nbone and PET scanning are more sensitive in the detection of early bone\nmetastasis and chest CT."
        },
        {
            "input": "MEDIASTINUM/HEART:  The thyroid is normal.  Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged by CT size criteria.  The\naorta and main pulmonary artery are normal in size. No pulmonary artery\nfilling defect identified. Heart size is normal with no appreciable coronary\nartery calcifications. No pericardial effusion.  Right-sided Port-A-Cath tip\nterminates in the right atrium.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level.  Bibasilar\ndependent atelectasis and linear lingular atelectasis is similar to the prior\nstudy.  No focal consolidation, pleural effusion, or pneumothorax.  No new or\ngrowing pulmonary nodules detected.\n\nUPPER ABDOMEN:  Please refer to the dedicated CT abdomen and pelvis report of\nthe current date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES:  Patient is post left mastectomy with breast prosthesis. \nThe right breast requires mammography for evaluation, but a 3 mm calcification\nin the central right breast is new (4:139).  No focal lytic or sclerotic\nlesion concerning for malignancy.  Mild to moderate multilevel degenerative\nchanges of the thoracic spine are unchanged.",
            "output": "1.  Excluding the right breast, which requires mammography for evaluation (for\nexample the new central right breast calcification), no new abnormalities in\nthe chest wall suspicious for malignancy.\n\n2.  No new or growing pulmonary nodules detected.\n\n3.  Please refer to the dedicated CT abdomen and pelvis report of the current\ndate for the subdiaphragmatic findings."
        },
        {
            "input": "Supraclavicular and axilla RN lymph nodes are not enlarged.  Patient has had\nleft mastectomy and breast prosthesis.  16 mm wide, the spherical subcutaneous\nlesion has developed at the site of since removed infusion port, 05:12.  The\nabsence of adjacent edema makes infection less likely than seroma.  Right\nbreast requires mammography for evaluation.\n\nFindings below the diaphragm will be reported separately.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nLeft subclavian central venous catheter ends at the superior cavoatrial\njunction with no associated thrombus.  Atherosclerotic calcification is not\napparent head neck vessels or coronary arteries.  Aorta and pulmonary arteries\nare normal size.  There is no pleural or pericardial abnormality.\n\nCentral lymph nodes in the mediastinum, hila, and lymph nodes in the\nretrocrural, diaphragmatic, and internal mammary stations are not enlarged.\n\nAside from subpleural atelectasis, right lung is clear.  Small region of\nsubsegmental atelectasis in the lingula is unchanged.  There are no bone\nlesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nNew fluid collection at the site of the since removed a central venous\ninfusion port reservoir, right upper subcutaneous chest wall.  Suggests an\nevaluation for possibility of infection."
        },
        {
            "input": "1.6 cm enhancing nodule in the right lobe of the thyroid gland is unchanged,\npreviously evaluated with ultrasound in ___.  Axillary,\nsupraclavicular, mediastinal, and hilar lymph nodes are not enlarged.  The\naorta and major pulmonary vessels are normal in caliber.  No significant\natherosclerotic calcifications.  The heart is normal in size.  There is no\npericardial effusion.\n\nThe airways are patent to the subsegmental level.  Scattered areas of\natelectasis in the lingula as well as subpleural atelectasis in the right lung\nare stable.  2 mm ground-glass nodule in the left upper lobe (07:55) is\nunchanged.  No new or growing nodule is identified.  There is no focal\nconsolidation, pleural effusion, or pneumothorax.\n\nPlease refer to separate report on CT abdomen and pelvis performed on the same\nday for discussion of sub- diaphragmatic structures.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  Degenerative\nchanges in the lower thoracic spine are mild.  A left breast implant appears\nintact.  Previously identified subcutaneous fluid collection at the right\nchest wall has resolved.",
            "output": "No evidence of active malignancy in the chest."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Patient has had\nleft mastectomy and implant.  Excluding the breasts which require mammography\nfor evaluation, there are no soft tissue abnormalities elsewhere in the imaged\nchest wall suspicious for malignancy.  Findings below the diaphragm will be\nreported separately.\n\nThyroid is heterogeneous in the right lobe is mildly enlarged but there are no\nfocal findings warranting imaging evaluation and the trachea is not\ncompromised.\n\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are normal size.  Pericardium is\nphysiologic.  There is no right pleural effusion.  Pleural thickening it joins\nregion of consolidation in the superior segment of the left lower lobe.\n\nThe only central lymph node enlargement is in the left hilus, 15 x 20 mm,\n5:117, previously 5 x 10 mm\n\nLungs:\n\nAside from scarring adjacent to large lower thoracic osteophytes, right lung\nis clear.\n\nLarge region of new, dense consolidation in the left lower lobe involves the\nsuperior and posterior basal segments. Serving bronchi are not occluded by\nipsilateral hilar adenopathy although the basal trunk is mildly narrowed.\n\nMild scarring in the lingula is unchanged.\n\n There are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, but it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "Left lower lobe pneumonia with reactive left hilar adenopathy.  No good\nevidence for intrathoracic malignancy.\n\nNOTIFICATION:  The findings were discussed with ___ by ___,\nM.D. on the telephone on ___ at 12:23 pm, 2 minutes after discovery of\nthe findings."
        },
        {
            "input": "The thyroid is heterogeneous as before.  Supraclavicular, axillary, lymph\nnodes are not enlarged.  Mediastinal lymph nodes have increased in the right\nupper esophageal station measuring 15 mm was 6 mm.  In the right hilum 9 mm\nwas 8 mm.  In the left the hilum 25 x 14 mm lymph node was 17 x 9 mm.  Aorta\nand pulmonary arteries are normal size.  Mild cardiomegaly is stable.  There\nis no appreciable coronary calcification.  There has been interval worsening\nof consolidation in the left lower lobe, increase in the attenuation of the\nvessels within the lesion and narrowing of the bronchi to the segment basal\nbronchi medially and posteriorly.  There is loss of fat plane between the\nlesion and the aorta (5:132), increased from prior.  There is no obvious\ninvasion in the posterior chest wall..  There is no pleural or pericardial\neffusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy.\nLeft breast implant is in place.",
            "output": "Given the progression of consolidation in the left lower lobe associated with\nworsening mediastinal and hilar lymphadenopathy this is worrisome for\nmalignancy.\n\nRECOMMENDATION(S):  Tissue sample is suggested.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 14:37 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CT CHEST WITH CONTRAST: The thyroid contains a 1 cm hypodensity in the right\nlobe unchanged since the prior study. There is left breast prosthesis. There\nis no supraclavicular, axillary, hilar or mediastinal lymphadenopathy. The\nheart is not enlarged. There is no pericardial effusion. There aorta and\npulmonary arteries are normal in caliber. There are no appreciable coronary\nartery calcification. The esophagus is grossly unremarkable without hiatal\nhernia.\n\nThere is no pneumothorax or pleural effusion. The airways are patent to the\nsubsegmental level without bronchiectasis or bronchial wall thickening.\nAtelectasis in the lingula and left base is unchanged. Fibrosis or atelectasis\nin the right lower lobe particularly in the paraspinal region (6:222) is also\nunchanged. 5 mm left lower lobe nodule (6:125) is unchanged.\n\nOSSEOUS STRUCTURES: There is no worrisome blastic or lytic lesion.",
            "output": "1. No evidence of new or recurrent disease in the chest.  Stable 5 mm left\nlower lobe nodule.\n2. Please note the abdomen and pelvis will be reported separately."
        },
        {
            "input": "The thyroid gland is unremarkable. There is new mediastinal lymphadenopathy,\nincluding a newly enlarged right lower paratracheal lymph node which measures\n9 x 16 mm, previously 5 x 9 (4, 22).  A newly enlarged subcarinal lymph node\nmeasures 12 x 20 mm (4, 27). There is no axillary, internal mammary,\nsupraclavicular, or hilar lymphadenopathy.\n\nHeart size is top-normal with no pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal caliber.  No incidental pulmonary embolus\nis identified.\n\nAn enhancing 1.6 x 2.5 cm left lower lobe paramediastinal soft tissue mass\nwhich is inseparable from the descending thoracic aorta at the level of the\nleft atrium is new since ___ (5, 137).  This is in the region of\npreviously documented metastasis. Subpleural reticulation and scarring in the\nmedial right lower lobe adjacent to spinal osteophytes is likely due to\nfibrosis. Lingular linear atelectasis or scarring is unchanged (5, 180). There\nis no pleural effusion.\n\nThe patient is status post left mastectomy with reconstruction.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "Recurrent left lower lobe paramediastinal metastasis which is inseparable from\nthe descending thoracic aorta at the level of the left atrium.\n\nNew mediastinal lymphadenopathy is most likely due to metastasis."
        },
        {
            "input": "MEDIASTINUM: There is a well-circumscribed thyroid nodule in the right lobe\nwhich is 11 mm in craniocaudal dimension and was present as far back as ___ (8:19). The previously enlarged 16 x 9 mm precarinal lymph node\nnow measures only 11 x 7 mm and has a more benign morphology consisting of a\nfatty hilum (04:20).  Several other adjacent lymph nodes have also decreased\nin size. Similarly, the 20 x 12 mm subcarinal lymph node now measures 19 x 10\nmm (04:24).  This lymph node was barely visible on the ___ study. \nThere is no supraclavicular, axillary, or hilar lymphadenopathy.  The aorta\nand pulmonary arteries are normal in size.   The heart size is normal and\nthere is no pericardial effusion.\n\nCHEST WALL:  The patient is status post left mastectomy and subpectoral\nimplant reconstruction. There are no findings concerning for malignancy in the\nchest wall, however evaluation of the breasts requires mammography.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  The mass-like para-aortic soft tissue which\nwas new on the prior examination has significantly decreased in size from 2.5\nx 1.6 cm to 1.6 x 1.5 cm (5:131). There are small patent airway now visible\nwithin it (5:129). Lingular and left basilar atelectasis or scarring is\nunchanged.  There is no diffuse interstitial abnormality.  There are no\nconcerning pulmonary nodules.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Significant interval improvement in mediastinal lymphadenopathy and the\npara-aortic lung lesion.\n2. An 11 mm thyroid nodule has been present since ___ but no ultrasound\nevaluation has been performed at ___.  If not previously performed at\nanother facility, evaluation with ultrasound is suggested as clinically\nindicated."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  The esophagus is\npatulous and dilated.  The aorta is normal in caliber.  The main pulmonary\nartery measures 3.1 cm.  There is moderate cardiomegaly.  There is no\npericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is biapical pleuroparenchymal scarring.  Evaluation of lung\nparenchyma is somewhat limited.  There is focal bronchiectasis within the\nright lower lobe (301, 138, could be related to prior infection.\n\nBONES AND CHEST WALL : No lung nodules are seen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nenhancing lesions within the left lobe of liver and also the right lobe of\nliver.  Please refer to dedicated report on abdomen which has been dictated\nseparately for further details",
            "output": "Small mediastinal lymph nodes.\n\nNo lung nodules.\n\nFocal bronchiectasis within the right lower lobe could be related to prior\ninfection or could be congenital.\n\nNodular configuration of the liver with multiple enhancing liver lesions\nconsistent with known tumor.  Please refer to dedicated report on abdomen\nwhich has been dictated separately."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMain pulmonary artery is mildly dilated to 3.1 cm which may relate to\ncomponent of underlying pulmonary hypertension.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 4 mm subpleural nodule in the lingula is new (3:93).  A 5 mm\nnodule at the lateral left lung base is unchanged (3:139).  Redemonstration of\nchronic pleuroparenchymal scarring at the lung apices and bronchiectasis in\nthe medial right lower lobe.  The airways are patent to the segmental level\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Redemonstration of a patulous and thickened esophagus, similar to\nprior.  A large mass centered about the caudate lobe of the liver is markedly\nbigger.  Innumerable satellite lesions are increased in number and size. \nThese were previously characterized as multifocal HCC.  Left upper quadrant\nembolization coils are noted.  Moderate volume ascites is partly imaged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Progression of multifocal HCC in the liver.\n3. New 4 mm nodule in the lingula is equivocal for metastatic disease.  Close\nattention on follow-up imaging recommended.\n4. Partially imaged, moderate volume abdominal ascites."
        },
        {
            "input": "The thyroid gland is unremarkable.  Small mediastinal lymph nodes measuring up\nto 11 x 21 mm in the right lower paratracheal location are stable in size and\nnumber as compared to ___ (3, 27).  There is no new pathologic lymph\nnode enlargement in the thorax.\n\nThe patient has had previous median sternotomy with aortic valve replacement. \nThe unenhanced appearance of the ascending aorta following graft repair is\nstable (3, 31).  Following contrast administration, the extent of the\nfenestrated dissection flap, which originates in the proximal aortic arch and\nextends through the descending aorta beyond the level of the SMA is stable. \nThe distal most aspect of the dissection flap is not imaged.  The celiac\nartery and SMA arise from the true lumen.  There is no evidence of contrast\nextravasation, intramural hematoma, or new aneurysm formation.  The appearance\nof the reimplanted right brachiocephalic and left common carotid arteries is\nunchanged.  The main pulmonary artery is normal caliber.  There is no evidence\nof large central pulmonary embolus.\n\nConventional coronary artery anatomy is noted.  Mild cardiomegaly with\npredominantly left-sided enlargement is unchanged.  Thinning with mild bulging\nof the left ventricular apex is compatible with a true aneurysm (10, 37). \nThere is no filling defect in the left apical aneurysm or left atrial\nappendage.  There is no pericardial effusion.  Coronary artery and mitral\nannular calcifications are extensive, involving all 3 vascular territories.\n\nAirways are patent to the subsegmental level.  Subpleural scarring and\nreticulation adjacent to the ectatic descending thoracic aorta are due to mild\nnon-characteristic fibrosis and are unchanged.  There is no pleural effusion. \nThere is no pulmonary nodule, mass or consolidation.\n\nLimited images of the upper abdomen are notable only for a small hiatal\nhernia.\n\nLower thoracic spine degenerative changes are stable.",
            "output": "Stable appearance of known type A dissection following ascending aortic graft\nrepair as compared to ___.\n\nStable left ventricular aneurysm.\n\nExtensive coronary artery and mitral annular calcifications.\n\nSmall hiatal hernia.\n\nAn addendum with 3D measurements of the aorta will be issued subsequently."
        },
        {
            "input": "There are numerous measurable lymph nodes in the supraclavicular stations, up\nto 6 mm, and in the axilla, 7 mm on the left, 9 mm on the right.  Punctate\nmediastinal nodes are numerous, measurable nodes range in diameter up to 8 mm\nin the left lower paratracheal and prevascular stations, and although hilar\ncontours do not suggest substantial adenopathy, there is at least one 9 mm\nleft hilar node, 5:139.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows normal\nadrenal glands.  There are no soft tissue lesions in the chest wall suspicious\nfor malignancy or infection.\n\nAtherosclerotic coronary calcification is mild in head and neck vessels, and\npresent in the coronaries in at least the left anterior descending branch. \nSmall pericardial effusion is physiologic.  There is no pleural effusion.\n\nThyroid is unremarkable.  Aorta and pulmonary arteries are normal caliber and\ncardiac chambers are not enlarged.\n\nThere are no lung lesions and the tracheobronchial tree is normal to\nsubsegmental levels.",
            "output": "No evidence of intrathoracic malignancy or infection.  No lung nodules\nwarranting further evaluation.\n\nMultiple lymph nodes in all stations, none pathologically enlarged, handful\nranging from 6-9 mm, most smaller, clinical significance indeterminate.\n\nMild coronary atherosclerotic calcification."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid status post right\nhemithyroidectomy.  supraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  A 5\nmm pulmonary nodule is seen in the right lower lobe, unchanged from ___\n(4:135).  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Moderate to severe degenerative\nchanges of the glenohumeral joints are noted bilaterally.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for fatty\natrophy of the pancreatic head with a large juxta papillary duodenal\ndiverticulum.",
            "output": "1. No fracture.\n2. No evidence of acute process in the chest."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nBreast, chest wall and bones:\nNo abnormality\n\nMediastinum:\nNo abnormality\n\nHila:\nNo abnormality\n\nHeart:\nCoronary artery calcification\n\nUpper Abdomen:\nStatus post cholecystectomy\n\nLung:\n\nNodules:\n\nDominant nodule:\nStable 4 mm solid right upper lobe pulmonary nodule (4, 117)\n\nOther nodules:\nStable 7 mm nodular opacity in the right middle lobe (4, 151) and (8, 65),\nappears more linear and most likely represents subsegmental atelectasis.  No\nnew or growing pulmonary nodules.\n\nStable solid 3 mm lingular nodule (4, 165).\n\nParenchyma:\nNo abnormality\n\nPleura and airways:\nMinimal diffuse airway thickening.",
            "output": "Stable 7 mm nodular opacity in the right middle lobe which most likely\nrepresents subsegmental atelectasis, appears more linear on the coronal and\nsagittal images.\n\nStable tiny pulmonary nodules ranging in size from 3-4 mm.  No new or growing\nnodules.\n\nLung-RADS category: 2\n\nRECOMMENDATION(S):  Continue low-dose lung cancer screening CT in 12 months.\n\nIncidental findings**:\nNone\n\n\n\n___ Radiology is an ___ accredited CT lung cancer screening site.\n**All recommendations regarding incidental findings are based on ACR\nguidelines for the management of these findings."
        },
        {
            "input": "Aorta and pulmonary arteries are overall normal in diameter except for mild\ndilatation of the ascending aorta up to 3.9 cm.  Heart size is slightly\nenlarged.  No pericardial pleural effusion is seen.  No mediastinal, hilar or\naxillary lymphadenopathy is present.\n\nImage portion of the upper abdomen demonstrate multiple soft tissue densities\nthroughout the omentum, similar in extent to ___ and ___.  Please review those studies for reports and pre size description.\n\nAirways are patent to the subsegmental level bilaterally.  Minimal bibasal\natelectasis present.  Left lower lobe subpleural nodule, series 4, image 141\nis 4 mm.  A right lower lobe subpleural nodule, series 4, image 86 is 1 mm. \nAdditional subpleural nodule in the right middle lobe, series 4, image 92 is\n6.6 mm.  Right lower lobe subpleural nodule series 4, image 116 is 1.6 mm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Several pulmonary nodules as described.  There nonspecific and might\npotentially represent B 9 findings versus metastatic nodules.  Does assessment\nin 3 months is required.\n\nMinimal bibasal atelectasis.\n\nAbnormal appearance of the upper abdomen, please review CT abdomen from ___ for the corresponding report describing it in details."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  This study is not designed for subdiaphragmatic diagnosis, last\nevaluated by MRI of the abdomen and pelvis on ___.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nRight subclavian infusion port catheter ends in the low SVC.  Atherosclerotic\ncalcification is not apparent head neck vessels or coronary arteries.  Aortic\nvalvular calcification is minimal.  Aorta and pulmonary arteries and cardiac\nchambers are normal size.  Very small pericardial effusion is physiologic. \nThere is no pleural abnormality.\n\nThoracic lymph nodes.\n\nMediastinal, diaphragmatic, and retrocrural lymph nodes are not enlarged and\nhilar contours do not suggest adenopathy on this noncontrast study.\n\nLungs:\n\nStable, 3-4 mm subpleural nodule nodules in the lower lobes have the\nmorphology of benign lymphoid aggregates 5:142, 200, 229,.  There are no other\nfocal pulmonary abnormalities or findings suggesting metastasis.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning...",
            "output": "Handful of tiny subpleural lung nodule stable since ___ are benign. \nNo new or growing lung nodules or other evidence of intrathoracic malignancy."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMRI of the abdomen corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  New areas of\n___ opacities in the superior segment of left lower lobe in the\nposterior aspect of right upper lobe are most likely consistent with acute\ninfection.  Similar area in the right middle lobe and in the right lower lobe\nposteriorly are from same etiology.  Left lower lobe subpleural pulmonary\nnodule is 4.5 mm, series 5, image 225.  It appears to be increased as compared\nto 2.5 mm on the previous examination.  Similar minimal gross is demonstrated\nin the right lower lobe subpleural nodule, series 5, image 170, 3.5 mm as\ncompared to 2 mm, in right lower lobe subpleural nodule, series 5, image 189,\n4 mm as compared to 3 mm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Several small areas of infection as described.\n\nMinimal interval increase in pulmonary nodules as described that might\npotentially represent progression of metastatic disease but reassessment in\nshort period of time such is 3 months would be required."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  A right-sided central venous catheter\nterminates in the lower SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  The esophagus is fluid filled\nthroughout nearly its entirety.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Motion artifact mildly limits evaluation of the lung parenchyma\nhowever there are bilateral nodular consolidations with interseptal thickening\nand areas of adjacent ground-glass opacification, left greater than right\ncompatible with pneumonia.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Fluid distension of the stomach and visualized proximal duodenum. \nThe patient is status post distal pancreatectomy and splenectomy..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Bilateral nodular consolidations and areas of adjacent ground-glass\nopacification most likely reflective of pneumonia including typical and\natypical organisms.  Aspiration pneumonia should also be considered given the\npresence of a fluid-filled esophagus.  Pulmonary hemorrhage is also a\ndifferential consideration."
        },
        {
            "input": "THORACIC INLET: The thyroid has a heterogeneous appearance with evidence of\nenlargement of the right lobe of thyroid with mild indentation on the proximal\ntrachea.  The trachea is patent..  There are no enlarged supraclavicular lymph\nnodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  There is a\nleft-sided pacemaker with leads projecting to the right atrium and right\nventricle\n\nMEDIASTINUM: There are small mediastinal lymph nodes which are most likely\nreactive.  There is a 6 mm right paratracheal lymph node.  There is moderate\ncardiomegaly.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Evaluation of lung parenchyma is somewhat limited, due to respiratory\nmotion.  There are several indeterminate pulmonary nodules.  There is a right\nupper lobe pulmonary nodule measuring 5 mm (302, 52).  There is a 4 mm right\nupper lobe pulmonary nodule (302, 70).  Another nodule is seen in the right\nupper lobe measures 2 mm (302, 76).  There is a 6 mm nodule in the right upper\nlobe (302, 110).  There is bibasilar atelectasis.  There is mild peribronchial\nthickening bilaterally.  There is evidence of mosaic attenuation in both lower\nlobes and also the right upper lobe which could be related to small airway\ndisease.  The there is no evidence of tracheobronchomalacia\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nSternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows status post\ncholecystectomy.  No adrenal masses are seen.  No focal liver lesions are\nseen.  The liver has a slight nodular appearance, could be related to cardiac\ncirrhosis.",
            "output": "Multiple right-sided pulmonary nodules ranging in size from 2-5 mm are\nindeterminate.  Three-month follow-up is recommended.\n\nModerate cardiomegaly.  Left-sided pacemaker.\n\nNo evidence of tracheobronchomalacia.\n\nEvidence of small airway disease."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Left prepectoral pacemaker in situ\nwith the lead tips present in the right atrium and right ventricle. \nRight-sided central venous line in situ with the tip terminating in the right\natrium.  No suspicious thyroid lesions.  No axillary adenopathy.  No gross\nbreast lesions.  Subcutaneous edema in keeping with third-spacing of fluid.\n\nUPPER ABDOMEN: Please refer to separately dictated CT abdomen report\n\nMEDIASTINUM: Expected postsurgical mediastinal changes.\n\nHEART and PERICARDIUM: Left ventricular assist device in situ.  The device\nresults in a large amount of beam hardening artifact.  The noncontrast nature\nof the study limits the ability to assess for extravasation.  Cardiomegaly. \nEvidence of prior CABG.  Pneumo hemo pericardium measuring 5 mm in diameter. \nAnterior and posterior pericardial drains in situ.\nPLEURA: Left-sided chest drain in situ.  Small residual left pneumothorax. \nSmall right and trace left-sided pleural effusion.\nLUNG:\n\n1. PARENCHYMA:   Bibasal airspace opacification (left more than right) most\nlikely represents atelectasis. Linear atelectasis in the left lung apex.  A\ncouple of millimetric right pulmonary nodules ranging up to 4 mm (series 302,\nimage 103) are indeterminate and appear fairly similar compared to prior CT\nchest report dated ___.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary artery appears prominent and pulmonary hypertension\nshould be excluded.\nCHEST CAGE: Evidence of prior sternotomy.  No lytic/destructive bony lesions.",
            "output": "Expected postoperative LVAD changes.\n\nSmall residual hemo pneumopericardium with pericardial drains in situ.  Small\nresidual left pneumothorax with a chest draining in situ appear\n\nAirspace opacification in the lung bases bilateral (left more than right) is\nfavored to represent atelectasis over pneumonia.  Small right-sided pleural\neffusion.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There are no\npathologically enlarged axillary, mediastinal, or hilar lymph nodes by size\ncriteria. The thoracic aorta is normal in caliber with the left vertebral\nartery originating from the aortic arch.  The pulmonary arterial trunk is\nnormal in caliber.  The heart is normal in size without pericardial effusion\nbut there are calcifications of the LAD (2:27).  The esophagus is\nunremarkable.\n\nThe tracheobronchial tree is normal to the subsegmental level.  Aside from\nmild dependent atelectasis, the lungs are clear. There is no pulmonary nodule.\nThere is no pleural effusion abnormality.\n\nAlthough not tailored for subdiaphragmatic evaluation, the included portions\nof the upper abdomen are normal. There is no blastic or lytic lesion\nsuspicious for malignancy.",
            "output": "1. No CT evidence of sarcoidosis.\n2.  Coronary artery calcifications are noteworthy in a patient of this age."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent.\n\nIn head and neck vessels or coronary arteries.  Aorta and pulmonary arteries\nare normal size.  Heart is enlarged a.m. would require echocardiography for\nevaluation.  There is no pleural or pericardial effusion.\n\nThoracic lymph nodes are not enlarged.\n\n\n\nLungs:\n\nFine anatomic detail is partially obscured by respiratory motion, but no\nsignificant lesions would be overlooked.  Aside from a calcified left upper\nlobe granuloma, there are no lung nodules.  Lungs are otherwise clear.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "Nodularity within the thyroid gland remains unchanged.  A right chest port\nterminates within the low superior vena cava.  There is no axillary,\nsupraclavicular, mediastinal, or hilar adenopathy.  There is a small hiatal\nhernia.\n\nThe ascending aorta is non aneurysmal and the main pulmonary artery within\nnormal limits in caliber.  Trace pericardial fluid is physiologic.  Heart size\nis borderline in size.  There are no appreciable coronary artery\ncalcifications.\n\nBiapical scarring is mild.  Subpleural 3 mm nodule within the right upper lobe\n(06:105), a 3 mm nodule within the right upper lobe just inferiorly (6:119),\nperifissural 4 mm nodule within the right lower lobe (6:137) diaphragmatic 5\nmm nodule within the right lower lobe (6:218). Calcified granuloma within the\nright lower lobe medially (6:198), calcified granuloma within the left upper\nlobe (06:10 9) and a subpleural 3 mm nodule in the left lower lobe (6:216) are\nstable since ___.  There is no pleural effusion or pleural\nabnormality.\n\nThere are no worrisome osseous lesions in the chest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "No new or growing pulmonary nodules.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular\nlymphadenopathy.  Included views of thyroid are within normal limits.  No\nenlarged axillary lymph nodes are seen.  A right Port-A-Cath terminates within\nthe right atrium (series 5 image 38).  At least 4 breast nodules are present. \nThese measure 0.9 x 0.9 cm along the medial right breast (series 5, image 36),\n1.1 x 1.1 cm along the lateral aspect of the mid left breast (series 5, image\n36), 0.5 cm along the lateral lower left breast (series 5, image 40), and 4 mm\nalong the medial aspect of the right mid breast (series 5, image 32).  These\nare unchanged comparison to the chest CT examinations from ___. \nPrior comparisons CTs did not include these regions within their field of\nview.\n\nUPPER ABDOMEN: Please refer to the separate abdominal CT dictation regarding\nabdominopelvic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  The thoracic aorta is\npatent and normal in caliber, without dissection.  There is a common trunk of\nthe left carotid and innominate arteries (series 5 image 18).  The main\npulmonary arteries are patent and normal in caliber.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is top-normal.  There is no pericardial\neffusion.\nPLEURA: There is no pneumothorax or pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is minimal dependent atelectasis, without focal\nconsolidation.  No pulmonary nodule or mass is detected.\n2. AIRWAYS:  The airways appear patent to the subsegmental levels.\n3. VESSELS:  The pulmonary arteries are patent and normal in caliber.  No\npulmonary embolus is detected to the proximal segmental levels.\nCHEST CAGE: There are no osseous lesions concerning for malignancy or\ninfection.",
            "output": "1. Four breast nodules, detailed above, are unchanged since the chest CT\nexamination from ___.  These were excluded from the field-of-view\non prior studies.  Please correlate with any available outside hospital\nimaging or prior mammograms.  No comparisons are available.  Continued\nattention to this region is warranted on follow-up chest CTs, or breast\nultrasound could be considered for further evaluation.\n2. No intrathoracic lymphadenopathy.  No concerning pulmonary nodule.\n3. Please refer to the separate abdominal CT dictation regarding\nabdominopelvic findings."
        },
        {
            "input": "There are hypoattenuating nodules involving the thyroid gland measuring up to\n7 mm, better appreciated on prior CT neck dated ___, but not\nrequiring follow-up based on current ACR guidelines.\n\nThere are scattered unenlarged mediastinal and axillary lymph nodes without\npathologically enlarged adenopathy.  There is bilateral asymmetric\ngynecomastia, left greater right.  The heart is mildly enlarged.  There is a\nleft chest wall cardiac pacing device with a single lead terminating in the\nregions of the right ventricle. There are coronary artery calcifications. \nThere is no pericardial effusion.  The thoracic aorta demonstrates\natherosclerotic calcifications.  Ascending thoracic aorta is mildly ectatic\nwithout aneurysm dilation.\n\nTracheobronchial tree is grossly patent.  There is a small right and trace\nleft pleural effusion with adjacent atelectasis.  Evaluation for subtle\npulmonary nodules is suboptimal secondary to respiratory motion artifact.  No\ndiscrete pulmonary mass is noted.  There is interlobular septal thickening. \nThere is no focal airspace consolidation.\n\nThere are multilevel degenerative changes of the thoracic spine.  Healed\nbilateral rib fractures are noted.\n\nFor intra-abdominal findings, please refer to the dedicated CT abdominal\nreport.",
            "output": "1.  Small right and trace left pleural effusion with adjacent compressive\natelectasis.\n2.  No evidence of acute injury or hematoma."
        },
        {
            "input": "The thyroid is normal.  Several non pathologically enlarged prevascular lymph\nnodes are not significantly changed compared with CT chest on ___.  A\n0.9 cm left hilar node is slightly decreased in size compared with CT chest on\n___ (2:30).  A 0.9 cm right hilar soft tissue density may represent a\nlymph node or central atelectasis, but is also not significantly changed since\nCT chest on ___ (2:34).     There is a small hiatal hernia.\n\nThe aorta and pulmonary arteries are normal in size.  There is moderate\ncardiomegaly, with enlargement of the left atrium up to 5.7 cm, similar to\nprior.  Coronary artery calcifications are similar to prior. Again seen is a\nsmall nonhemorrhagic pericardial effusion, not significantly changed since CT\nchest on ___.  A small amount of air in the brachiocephalic vein is\nlikely iatrogenic (4:65).\n\nTracheostomy is in place.  Severe tracheobronchomalacia distal to tracheostomy\nis similar to prior.  There is no fixed narrowing of the bronchi.  Compared\nwith CT neck on ___, again seen are bilateral layering\nnonhemorrhagic pleural effusions, right greater than left, with adjacent\nbibasilar atelectasis.  Compared with CT neck on ___, there is new\nright perihilar infiltrate, in the right upper lobe more than the right middle\nlobe and right lower lobe.  No pneumothorax  is identified.\n\nNo osseous lesions suspicious for infection or malignancy are identified. \nAgain seen is a old healed left clavicular fracture.  Multilevel degenerative\nchanges in the thoracic spine are similar to priors.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Please see separate dictation for CT abdomen and pelvis performed\non same day for description of subdiaphragmatic findings.",
            "output": "1. New right perihilar infiltrate, may represent pneumonia or pulmonary\nhemorrhage.\n2. Bilateral chronic layering non-hemorrhagic pleural effusions, right greater\nthan left, and adjacent bibasilar atelectasis.\n3. Chronic small non-hemorrhagic pericardial effusion is unchanged.\n4. Cardiomegaly and severe tracheobronchomalacia are similar to prior.\n5. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 11:22 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "CHEST:\n\nMEDIASTINUM/HEART:  A heterogeneously enhancing nodule is identified within an\nenlarged right thyroid lobe (4:20). Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged by CT size criteria. Aorta and pulmonary\narteries are normal in size.  There is no pulmonary embolism or aortic\ndissection. Heart size is normal with mild coronary artery calcifications. No\npericardial effusion.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Lungs are\nclear without focal consolidation or pleural effusion. No pulmonary nodules\ndetected.\n\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Multilevel degenerative changes of the thoracic spine are present.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: A lobulated 2.0 cm mass in the body/tail of the pancreas\ndemonstrates internal attenuation of - 80 ___, consistent with a lipoma\n(3b:128).  There is also an well-demarcated 3.4 x 2.4 cm hypodense area in the\nanterior pancreatic head with sparing the posterior aspect, which could be due\nto focal fatty infiltration (3b:135), as there is no pancreatic ductal\ndilatation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Two small accessory spleens are identified\n(3b:127).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions, or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR:  There is mild calcium burden in the abdominal aorta and great\nabdominal arteries.  No evidence of abdominal aortic aneurysm or dissection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.  The seminal vesicles are\nnormal.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.  Multilevel\ndegenerative changes, particularly of the lower thoracic spine, with anterior\nosteophyte formation, height loss, and disc space narrowing, is identified.\nUmbilical hernia containing fat is noted.",
            "output": "1. No evidence of aortic dissection.  No acute pathology identified within the\ntorso.\n2. Heterogeneously enhancing nodule in the lower right thyroid.  Consider\nthyroid ultrasound for further workup.\n3. A 3.4 cm well-demarcated hypodensity in the pancreatic head may be due to\nfocal fatty infiltration, as there is no pancreatic ductal dilatation or\nperipancreatic stranding.  This can be confirmed with MRI.\n\nRECOMMENDATION(S):  1.  Consider thyroid ultrasound for further workup of a\nright-sided heterogeneously enhancing nodule.\n\n2.  Consider MRI for further characterization of the pancreatic head\nhypodensity.\n\nNOTIFICATION:  The above findings and recommendations were communicated via\ntelephone by Dr. ___ to Dr. ___ at 12:24 on ___, 5 min\nafter discovery."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum are\nnormal to borderline in size (2, 18).  Normal appearance of the large\nmediastinal vessels.  No substantial coronary calcifications.  No valvular\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable, with the exception of a small hiatal hernia.  No abnormalities\nin the upper abdomen, with the exception of a punctate calcification of the\nliver that is unchanged as compared to the previous scan. No osteolytic\nlesions at the level of the ribs, the sternum or the vertebral bodies.\n\nMild paraseptal emphysema.  Several, partly confluent areas of subpleural\nground-glass opacities, with a slight nodular component, most likely\nsuggestive of respiratory bronchiolitis.  No definite fibrotic changes are\nnoted.  A pre-existing left pleural effusion has completely resolved.  There\nis unchanged evidence of non characteristic scarring at the bases of the right\nlower lobe, the middle lobe and the lingular.  No evidence of chronic airways\ndisease.  Stable appearance of a left upper lobe intrapulmonary lymph node (4,\n101).  The to subpleural 2-3 mm.  Nodules in the left upper lobe are also\nunchanged (4, 82).  No new pulmonary nodules.  No growing pulmonary nodules. \nNo evidence of diffuse lung disease.",
            "output": "The pre-existing pulmonary nodules are all unchanged in size and morphology. \n1 of these pulmonary nodules in the left upper lobe is an intrapulmonary lymph\nnode.  The pre-existing left pleural effusion has completely resolved. \nEvidence of upper lobe predominant paraseptal emphysema, combines to mild\nrespiratory bronchiolitis."
        },
        {
            "input": "There is no thoracic aortic dissection or aneurysm.  There is mild scattered\nnoncalcified atherosclerotic plaque throughout the thoracic aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect to indicate the presence of pulmonary embolism. \nThe main and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.  Heart size is normal.  There is no\npericardial effusion.\n\nThe visualized inferior aspect of the thyroid gland appears unremarkable.\n\nThere is no supraclavicular or axillary lymphadenopathy.  Borderline right\nparatracheal lymph nodes measuring up to 10 mm in short axis are stable. \nThere is no hilar lymphadenopathy.\n\nThere is no pleural effusion.\n\nThere is mild paraseptal emphysema, most pronounced in the bilateral upper\nlobes.  A 4 mm left fissural nodule likely represents a lymph node (series\n301, image 94).  A 6 mm paramediastinal nodular density in the left upper lobe\n(series 2, image 37) is also stable.  There is mild diffuse peripheral\nreticulation.  There is no consolidation.  There is mild linear subsegmental\natelectasis and/or scarring in the bilateral lung bases.  The airways are\npatent to the subsegmental level.\n\nThis study is not tailored for subdiaphragmatic evaluation.  Visualized upper\nabdominal structures are unremarkable.  There is a small hiatal hernia.\n\nThere is no suspicious osseous lesion.  There are mild multilevel endplate\ndegenerative changes of the thoracic spine.",
            "output": "1.  No evidence of pulmonary embolism or acute pulmonary parenchymal process."
        },
        {
            "input": "HEART AND VASCULATURE: Motion artifact limits evaluation of segmental and\nsubsegmental pulmonary arteries; there is no evidence of a central pulmonary\nembolus.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild paraseptal emphysema.  There are subpleural reticulations\nand dependent atelectasis.  Nodules include:\n\n-5 mm left upper lobe, unchanged (301:34)\n-6 mm left upper lobe, unchanged (301:44)\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small hiatal hernia.  Punctate right hepatic lobe calcification. \nMild calcified and noncalcified atherosclerotic plaque.\n\nBONES: No suspicious osseous abnormality is seen.? There is mild dorsal\nspondylosis.  There is no acute fracture.",
            "output": "1. Motion artifact limits evaluation of segmental and subsegmental pulmonary\narteries; there is no evidence of a central pulmonary embolism or acute aortic\nabnormality.\n2. The subclavian vessels are patent, without filling defects identified.  No\nPancoast tumor.  No CT evidence of thoracic outlet syndrome.\n3. Subpleural reticulations, increased from the prior study, are consistent\nwith smoking related interstitial lung disease.  Mild paraseptal emphysema.\n4. Stable left upper lobe 5 mm and 6 mm pulmonary nodules.\n5. Small hiatal hernia."
        },
        {
            "input": "HEART AND VASCULATURE:  Evaluation of pulmonary vasculature is limited due to\npoor bolus timing.  A line for limitations, pulmonary vasculature is opacified\nto the segmental level without filling defect to indicate a pulmonary embolus.\nMain pulmonary artery is top normal size with diameter of 3.2 cm.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Several mediastinal and bilateral hilar lymph\nnodes are mildly enlarged.  A left AP window lymph node measures 1.1 cm\n(02:39).  A left hilar lymph node measures 1.2 cm (02:43).  A right hilar\nlymph node measures 0.9 cm (02:46) No mediastinal mass.\n\nPLEURAL SPACES:  Bilateral pleural effusions are small.\n\n\nLUNGS/AIRWAYS:  Airspace opacity in the posterior right lung enhances\nhomogeneously and is consistent with mild atelectasis.  Posterior left lower\nlobe opacity demonstrates reduced enhancement and adjacent ground-glass\nopacity, suspicious for pneumonia.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Mild emphysema is noted.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nA 0.3 cm nodule in the left lobe of the thyroid does not require follow-up per\nACR guidelines.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Study limited due to poor bolus timing.  Allowing for limitations, there is\nno evidence of obvious pulmonary embolism to segmental levels.\n2. Hypoenhancing consolidation of left posterior lower lobe is suspicious for\npneumonia.\n3. Small bilateral pleural effusions.\n4. Mild mediastinal and hilar lymphadenopathy is likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneous.  No\npathologically enlarged axillary or supraclavicular lymph nodes.  Mild\natherosclerotic calcification of aortic arch and head and neck vessels.\n\nUPPER ABDOMEN:  There is increased attenuation of the mid abdominal fat (misty\nmesentery\" pattern) and a few adjacent soft tissue nodules, measuring up to\n1.4 x 1.3 cm (___).  Punctate calcific density in the right kidney, which\ncould represent a nonobstructive nephrolith or renal artery calcification. \nImaged portions of the upper abdomen are otherwise unremarkable on this\nnoncontrast study.\n\nMEDIASTINUM: No pathologically enlarged lymph nodes.\n\nHILA: No pathologically enlarged lymph nodes.\n\nHEART and PERICARDIUM:  The ascending aorta is enlarged, measuring 4.3 cm,\nunchanged from ___.  Heart size is normal.  No pericardial\neffusion.  Trace LAD and aortic annular calcification.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Compared to ___, interval resolution of previously\nseen pneumonia.  Multiple calcified granulomas ___, 166).  No evidence of\nactive or reactive infection.\n2. AIRWAYS:  Patent to the subsegmental levels bilaterally.  Mild, but diffuse\nbronchial wall thickening, likely representing chronic airways disease.\n3. VESSELS:  The pulmonary arteries are not enlarged.  No evidence of\npulmonary embolism on this noncontrast study.\nCHEST CAGE: No fractures or suspect osseous lesions.  Mild multilevel\ndegenerative changes of the imaged spine.",
            "output": "1. Unchanged dilatation of the ascending aorta, measuring 4.3 cm.\n2. Interval resolution of previously seen pneumonia.  No evidence of\nmalignancy in the chest.\n3. Incidentally noted increased attenuation of the mesenteric fat in the upper\nmid abdomen and a few adjacent soft tissue nodules, presumably lymph nodes. \nEtiology may be idiopathic with inflammatory and/or neoplastic causes not\nexcluded.  Recommend follow-up CT abdomen and pelvis with contrast in 6\nmonths.\n\nRECOMMENDATION(S):  Recommend follow-up CT abdomen and pelvis with contrast in\n6 months for further evaluation of the increased attenuation of the mid\nabdominal mesenteric fat.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:40 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Subcentimeter short axis\nnodes do not meet strict criteria for enlargement and are not appreciably\nchanged in size or number from the prior CT of ___.  Heart size\nis normal, and diffuse coronary artery calcifications are present.  A small\namount of pericardial fluid is unchanged and likely physiologic.  A very small\nhiatal hernia is incidentally noted.  A sub cm lower paraesophageal lymph node\nis unchanged.\n\nSkeletal structures of the thorax demonstrate no suspicious new lytic or\nblastic lesions.\n\nWithin the lungs, bibasilar subsegmental atelectasis is present.  2 mm solid\nleft upper lobe nodule (image 69, series 5) and 6 mm ground-glass nodule in\nthe right apex (image 57, series 5) are unchanged.  Minimal centrilobular\nemphysema is also demonstrated as well as mild, diffuse bronchial wall\nthickening and.",
            "output": "1.  2 mm solid left upper lobe nodule and 6 mm ground-glass right apical\nnodule are unchanged since ___ and unlikely to represent\npulmonary metastasis.  Continued CT surveillance may be helpful with followup\nCT in ___ to document ___ year stability.\n\n2.  Diffuse coronary artery calcifications.\n\n3. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings.  1"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular adenopathy.  The neck base is unremarkable.  No suspicious\nlytic or blastic osseous lesions are seen.\n\nUPPER ABDOMEN: Please see the separately dictated report for the CT of the\nabdomen and pelvis performed on the same day.\n\nMEDIASTINUM: There is no mediastinal adenopathy.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: The heart and pericardium are within normal limits\naside from mild coronary artery calcifications at the left and right main\narteries.  There is trace pericardial fluid.\n\nPLEURA: There is no pleural effusion.\n\nLUNG:\nPARENCHYMA:  Linear bibasilar atelectasis is seen.  All there is a stable 6 mm\nground-glass nodule in the right upper lobe on 05:51.  There is a stable 2 mm\nnodule in the left upper lobe on 05:45.  No new nodules are seen.\nAIRWAYS:  The central airways are patent.\nVESSELS:  There is no evidence of aortic abnormality or pulmonary embolism. \nThere is no evidence of penetrating atherosclerotic plaque, dissection, or\naneurysm.  The great vessels are normal in caliber.\n\nCHEST CAGE: No suspicious lytic or blastic osseous lesions are seen.",
            "output": "Stable appearance of the chest.  Stable 6 mm ground-glass nodule in the right\nupper lobe and stable 2 mm nodule in the left upper lobe.  No new nodules are\nseen.  There is no adenopathy."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  Small nonhemorrhagic pericardial effusion is stable.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Mild bibasilar and right middle lobe atelectasis is noted.  No\nmasses or worrisome areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.  Three adjacent 0.2\ncm left upper lobe pulmonary nodules are stable since ___ (03:55,\n50).  Two additional 0.3 cm left upper lobe ground-glass nodules (03:42,33)\nand 0.3 cm right upper lobe (3:93) pulmonary nodule are stable.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  External and internal biliary drains\nare unchanged since prior examination. Pneumobilia is predominately within the\nleft hepatic lobe with mild increase in right hepatic lobe intrahepatic\nbiliary duct dilatation.  Again seen are 2 metallic stents within the common\nhepatic duct traversing into the jejunostomy.  The gallbladder is resected.\n\nPANCREAS: Again seen is the soft tissue mass in the region of fiducial markers\nadjacent on series 2b, image 150 which measures 2.8 x 2.5 cm and demonstrates\npersistent contact with the SMA (previously 2.8 x 2.6 cm) (2b:151).  There is\na tubular fluid-filled structure in the region of the porta hepatis just above\nthe pancreatic lesion, representing a dilated pancreaticojejunostomy limb. \nDilation of this limit is new from prior and may be secondary to malignant\nobstruction given the proximity of this loop with the adjacent pancreatic mass\n(60___:28).  There is loss of fat plane between the mass and the dilated\npancreaticojejunostomy limb.  Adjacent fat stranding with small amount of\nmesenteric free fluid is mild.\n\nPatient is status post Whipple procedure.  The residual pancreas is atrophic\nwith dilatation of the main pancreatic duct to 0.4 cm which is unchanged since\nprior examination. Subtle increase in mild peripancreatic fat stranding\n(2b:147).\n\nSPLEEN: 1.4 x 1.3 cm and 0.8 x 0.5 cm accessory spleens are stable.  The\nspleen otherwise shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia.  The pylorus preserving gastrojejunostomy\nis unremarkable with intact suture material along the anterior abdomen.  Small\nbowel loops otherwise demonstrate normal caliber, wall thickness, and\nenhancement throughout.  The colon and rectum are within normal limits.  The\nappendix is normal.  No intraperitoneal free air.  There is mild thickening of\nthe right lateroconal fascia with small amount of adjacent free fluid and\nsubtle fat stranding which appears to tracks inferiorly from the\npancreaticojejunostomy and mesenteric root (2b:171)\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Stable mild prostatomegaly.  The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: Scattered retroperitoneal lymph nodes are unchanged since prior\nexamination with largest preaortic lymph nodes measuring 0.9 cm (2b:153)\n(previously 1 cm) and 1.2 cm (2b:151) (previously 1.2 cm).  There are no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  Celiac axis, SMA, and ___ are patent.  Main portal vein is\npatent.  There is new focal severe narrowing at the portal splenic confluence\nwith new focal SMV occlusion.  Mild dilatation of the distal SMV is unchanged\nand related to upstream occlusion most possible drainage via collateral flow.\n\nBONES AND SOFT TISSUES: Chronic left posterior rib fractures are again noted. \nThere is no evidence of worrisome osseous lesions or acute fracture.  Small\nfat containing umbilical hernia again noted.  The abdominal and pelvic wall is\notherwise within normal limits.",
            "output": "1. No pulmonary embolism or acute aortic abnormality.\n2. Dilation of the pancreatico-jejunostomy limb abutting the pancreatic mass\nlikely reflects a malignant obstruction.  Also noted, is occlusion of the SMV\njust proximal to the portal confluence.  Mild resultant edema along the root\nof mesentery.\n3. Stable bilateral pulmonary nodules largest measuring 0.3 cm, unchanged\nsince ___.\n4. Expected left pneumobilia with mild increase in right intrahepatic biliary\nduct dilatation with 2 metallic stents in the common bile duct.  Correlation\nwith laboratory data and clinical history is recommended.\n\nNOTIFICATION:   The findings were discussed with Dr. ___ by ___,\nM.D. on the telephone on ___ at 1:03 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy by CT\nsize criteria.  Left chest wall infusion port tip terminates in the right\natrium.  The imaged chest wall is unremarkable.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen pelvis report for\ndetails on subdiaphragmatic findings including dilated pancreaticojejunostomy\nlimb.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not pathologic by CT size\ncriteria in measure up to 5 mm.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: Moderate coronary artery calcifications are again\nnoted.  Small pericardial effusion is stable since ___.  The heart\nsize is within normal limits.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Pre-existing ground-glass nodules in the left upper lobe and\nright upper lobe (05:43, 69) and multiple scattered micro nodules measuring\nless than 6 mm with the representative in the left upper lobe and right upper\nlobe are stable since ___ (05:39, 59, 61, 64).  There are no new\nconcerning nodules.  There is no focal consolidation or pneumothorax.  There\nis mild bronchiectasis in the left upper lobe, similar\n2. AIRWAYS:  Airways are patent to the subsegmental levels.\n3. VESSELS:  While this exam is not tailored for evaluation of pulmonary\nembolism, no central filling defects are seen in the pulmonary arteries.\nCHEST CAGE: There is no worrisome osseous lesions concerning for metastatic\ndisease or acute fracture.",
            "output": "-No acute intra thoracic abnormalities.\n-Stable pre-existing ground-glass and micro nodules measuring less than 6 mm. \nNodules have predominantly centrilobular distribution and are likely\ninflammatory, less likely infectious given stability.  No new nodules.\n-No focal consolidation."
        },
        {
            "input": "CTA chest:  The aorta is unremarkable without dissection or aneurysm. Great\nvessels are unremarkable. The pulmonary arteries are well opacified to the\nsubsegmental level without filling defect to suggest pulmonary embolism.\nPulmonary arteries are normal in caliber.\n\nBibasilar, left greater than right, atelectasis is noted.  Pulmonary nodules\ninclude a stable 3 mm left upper lobe pulmonary nodule (03:33), stable 2 mm\nright upper lobe pulmonary nodule (3:97) and stable 4 mm ground-glass left\nupper lobe nodule (03:36).  There is no pleural effusion or pneumothorax. The\nairways are patent to the subsegmental level.\n\nHeart is unremarkable.  There is no pericardial effusion.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy. Included\nportion of the thyroid is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  The hepaticojejunostomy is\nunremarkable.  Pneumobilia has mildly increased in comparison to ___. \nIn comparison to ___ MRCP there is mild improvement in moderate\ndilatation of the right sided intrahepatic biliary system (2b:119).  There is\nan external biliary drain which courses through the hepatic parenchyma with\ntip coiled in the third portion the duodenum as well as an internal biliary\ndrain.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure.  The\npancreaticojejunostomy is unremarkable.  The atrophic remnant pancreatic\nparenchyma is within normal limits.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The gastrojejunostomy is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding.  The appendix is\nnormal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is interval increase in a soft tissue lesion now measuring\n2.1 x 2 cm (2b:129) (previously 1.9 x 1.1 cm) along a branch of the SMV with\nnew compression of this vein from the soft tissue.  The proximal and distal\nSMV are patent with collateral flow.  Additional residual soft tissue\nsurrounding the mesenteric root is stable. No portal vein thrombosis.  There\nis no additional retroperitoneal or mesenteric lymphadenopathy.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES:  There are multiple healed left posterior lateral rib\nfractures without evidence of acute fracture.  No evidence of worrisome\nosseous lesions.  The abdominal and pelvic wall are within normal limits.",
            "output": "1. Right-sided biliary system dilatation has mildly improved since ___ MR in ___ patient who is status post external and internal biliary drains.\n2. No pulmonary embolism or acute aortic abnormality.\n3. Interval increase in 2.1 cm soft tissue lesion around a branch of the SMV\nwith new compression of the vein with proximal and distal patency via\ncollateral flow.  No portal vein thrombosis.  Recommend FDG PET for further\nevaluation as this could represent recurrent tumor.\n\nRECOMMENDATION(S):  Recommend FDG PET for further evaluation of soft tissue\nlesion around a branch of the SMV.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 12:00 AM."
        },
        {
            "input": "No supraclavicular, axillary, mediastinal, or hilar lymph node enlargement by\nCT size criteria. The heart is unremarkable without pericardial effusion. No\npleural effusion. The airways are patent to the subsegmental level. No\nparenchymal nodule or mass. Lower lobe atelectasis noted bilaterally. No\nadditional pulmonary parenchymal abnormality. No pneumothorax. The thyroid\ngland is unremarkable. A right subclavian line tip is seen at the cavoatrial\njunction.\n\nThe aorta is patent without intramural hematoma, aneurysmal dilatation, or\nevidence of dissection. No evidence of penetrating atherosclerotic ulcer or\naortic arch atheroma present. The pulmonary arteries are well opacified to the\nlobar level with evidence of central or lobar pulmonary embolism. The main\npulmonary artery is normal in caliber, without evidence of right heart strain.\n\nOSSEOUS STRUCTURES: No lytic or blastic osseous lesions concerning for\nmalignancy.\n\nPlease refer to separate CT abdomen/ pelvis for additional findings.",
            "output": "1. No evidence of pneumonia.\n2. Mild bibasilar atelectasis."
        },
        {
            "input": "MEDIASTINUM/HEART:  The thyroid is normal. Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged by CT size criteria. Aorta\nand pulmonary arteries are normal in size. Heart size is normal with no\nappreciable coronary calcification. No pericardial effusion.\n\nRight-sided Port-A-Cath terminates at the cavoatrial junction.  Left-sided\nPICC line terminates in the distal SVC.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level.  A 5 mm\nopacity in the right upper lobe (3:17) is unchanged from the prior PET-CT, and\nwas not FDG avid at that time.  Lungs are clear without focal consolidation or\npleural effusion. No new pulmonary nodules detected.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures.  Within these limitations, the visualized portions of the liver,\nspleen, pancreas, and bilateral adrenal glands are unremarkable. Surgical\nclips in the gallbladder fossa denote prior cholecystectomy.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Mild multilevel degenerative changes of the thoracic spine, with\nanterior osteophytosis and disc space narrowing, are present.",
            "output": "A 5 mm opacity in the right upper lobe is unchanged since the PET-CT from ___, and was not FDG avid at that time.  It is not thought to be\ninfectious.  Chest CT in early ___ is recommended to demonstrate\nstability or resolution.\n\nRECOMMENDATION(S):  A 5 mm opacity in the right upper lobe is unchanged since\nthe PET-CT from ___, and was not FDG avid at that time.  It is not\nthought to be infectious.  Chest CT in early ___ is recommended to\ndemonstrate stability or resolution.\n\nNOTIFICATION:  The above findings were entered by Dr. ___ the\n___ Imaging Findings Dashboard for communication to the ordering\nclinician at 17:21 on ___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, mediastinal lymph nodes are not\nenlarged.  5 mm right hilar lymph node was 4 mm (5:132), left axillary lymph\nnode measuring 10 mm was 2 mm (5:61).  Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification.  Subpleural irregular nodular opacity with pleural tags in the\nright upper lobe measuring 4 mm is grossly unchanged from ___, was\nnot present in ___ study.  6 mm nodule in the left lower lobe\n(5:181) was 5 mm in ___, was not present ___. There is\nno pleural effusion.  Trace pericardial effusion is physiologic\nEsophageal wall is slightly thickened, further evaluation with endoscopic is\nrecommended\nRight and left central catheters tips terminate in the lower SVC\nThis examination is not tailored for subdiaphragmatic evaluation, patient is\nstatus post cholecystectomy.\nThere are no bone findings of malignancy",
            "output": "Enlarging left axillary lymph nodes, right hilar lymph node and left lower\nlobe lung nodule of unknown etiology, could represent recurrence of lymphoma.\n\nStable subpleural nodular opacity in the right upper lobe attention in\nfollowup studies is recommended\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 8:55 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nBilateral axillary lymph nodes measure up to 1.3 cm in short axis but appear\nmorphologically normal, could be reactive.  There is no supraclavicular,\nmediastinal, or hilar lymphadenopathy.  The thyroid gland appears\nunremarkable.  There is residual/reactive thymus in the anterior mediastinum.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Prominent but morphologically normal appearing bilateral axillary lymph\nnodes."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar, or segmental\npulmonary arteries.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThe lung apices and a portion of the lung bases are not captured on the\ncurrent study, which was performed per PE protocol.  There is no evidence of\npulmonary parenchymal abnormality in the imaged portion of the lung.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism to the segmental pulmonary arteries."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild cardiomegaly, likely secondary to\npregnancy state.  The pericardium and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lung apices are partially imaged.  However within these\nlimitations: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism to the segmental levels or aortic\nabnormality."
        },
        {
            "input": "The lung apices and lung bases are not included in the examination given\npatient's age.  Extremely limited evaluation of the upper abdomen.\n\nThe study is limited by HEART AND VASCULATURE: Pulmonary vasculature is well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber.  There is mixing\nartifact within the brachiocephalic vein and superior vena cava.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. The lung apices and lung bases are not included in the examination given\npatient's age."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There are moderate atherosclerotic calcifications of the\nthoracic aorta.  The heart is normal in size.  There are moderate to severe\ncoronary artery calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is right hilar lymphadenopathy measuring\nup to 1.3 cm in short axis (series 601:26).  There is mild confluent\nmediastinal lymphadenopathy, most notable in the left paratracheal and\nsubcarinal stations.  There is no axillary lymphadenopathy.\n\nPLEURAL SPACES: There is a trace left pleural effusion.  There is no right\npleural effusion.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate background centrilobular and paraseptal\nemphysema.  There is interlobular septal thickening, most pronounced in the\nbilateral lower lobes, and scattered ground-glass opacities, compatible with\ninterstitial edema.  There is no large consolidation.  Underlying chronic\ninterstitial changes are difficult to exclude.\n\nBASE OF NECK: There are multiple hypodense nodules in the thyroid measuring up\nto 3 mm in the right lobe.\n\nABDOMEN: There is a large hiatal hernia.\n\nBONES: No suspicious osseous lesion.  There is no acute fracture.",
            "output": "1. No pulmonary embolism to the subsegmental level.\n2. Interlobular septal thickening, most pronounced in the bilateral lower\nlobes, and scattered ground-glass opacities, compatible with interstitial\nedema.  Trace left pleural effusion.\n3. Mild mediastinal and right hilar lymphadenopathy is nonspecific and could\nbe reactive in etiology.  Contrast enhanced CT of the chest in 3 months is\nrecommended to assess for stability or resolution.\n4. Moderate background centrilobular and paraseptal emphysema.  Underlying\nchronic interstitial changes are difficult exclude.  Attention on follow-up is\nrecommended.\n5. Large hiatal hernia.\n\nRECOMMENDATION(S):  Contrast-enhanced CT of the chest in 3 months\n\nNOTIFICATION:  The updated findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 9:40 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Right renal hydronephrosis with delayed excretion of contrast\ncompared to the left.  Hypodense lesion in the medial aspect of the right\ninterpolar region of the left kidney measuring 25 x 24 mm and 16 Hounsfield\nunits is most likely a cortical cyst.  No adrenal lesions.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.  Moderate\ncoronary artery calcifications.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace opacification.  Minor paraseptal and centrilobular emphysematous\nchanges.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal.\nCHEST CAGE: Benign bony projections originating from the posteromedial aspects\nof the right eighth and ninth ribs forming a pseudoarthrosis.  Enostosis seen\nin the head of the left sixth rib.  No sclerotic/metastatic bony lesions.",
            "output": "No pulmonary metastasis.\n\nNo bony metastasis.\n\nRight renal hydronephrosis with delayed excretion of contrast compared to\nleft.  Likely left cortical hemorrhagic renal cyst.\n\nRECOMMENDATION(S):  Further workup of the right renal hydronephrosis and\nprobable left renal cyst, if not already performed."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  Heart size is normal.  There is no pericardial pleural\neffusion.\n\nSeveral small mediastinal lymph nodes are not pathologically enlarged and\nstable.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal cylindrical\nbronchiectasis to not she demonstrate evidence of infection.\n\nRight lower lobe nodule, series 5, image 223 appears to be slightly enlarged,\ncurrently 3.5 mm as compared to 2.8 mm on the previous study.  This may be\nrelated to its position and sample error.  Additional nodules in the left\nupper lobe, series 5, image 115, 2 mm and in the left lower lobe, series 5,\nimage 148, 2.4 mm are stable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nA left rib sclerotic focus, series 3, image 23 is unchanged dating back to ___.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\ndedicated imaging of abdomen and pelvis.",
            "output": "Questionable minimal interval increase in right lower lobe pulmonary nodule\nwhich potentially might represent difficulty in measuring giving its\nsupradiaphragmatic position.  2 additional stable pulmonary nodules. \nShort-term followup in 3 months would be suggested.  Overall no definitive\nevidence of intrathoracic malignancy present.\n\nMinimal cylindrical bronchiectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland appears normal. \nThere is no supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Subdiaphragmatic findings will be discussed separately on the\nsame-day CT abdomen and pelvis report.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mediastinal mass.  No\nmediastinal hematoma.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is nonenlarged.  There are extensive coronary\natherosclerotic calcifications.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  Again seen are multiple pulmonary nodules.  For example, there\nare multiple pulmonary nodules seen in the right lower lobe (series 4:  Image\n131, 189, 199) new.  The largest right lower lobe pulmonary nodule currently\nmeasures approximately 6 mm (series 4: Image 204), previously 4 mm.  Most of\nthese nodules appear enlarged compared to the prior study in ___ and\n.  Multiple pulmonary nodules are also seen in the left lung (series 4:  Image\n121, 142, 151, 158, 165) with the largest measuring up to approximately 4-5 mm\nand also mildly enlarged compared to the prior study in ___, some of\nwhich are new since ___.  No focal consolidation is identified.\n\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  There is no evidence of aortic aneurysm or dissection.  The main\npulmonary artery does not appear enlarged.\nCHEST CAGE: There is no concerning osseous lesion.",
            "output": "Multiple bilateral pulmonary nodules appear increased since the prior exam in\n___.\n\nRECOMMENDATION(S):  Short-term followup in 3 months is suggested."
        },
        {
            "input": "The imaged base of the neck including the thyroid gland appears normal.  There\nis no mediastinal or axillary lymphadenopathy.  The thoracic aorta is normal\nin course and caliber without appreciable atherosclerotic calcification.  The\nmain pulmonary artery is normal in size.  The heart is normal in size and\nshape with a small amount of coronary artery calcification noted along the\nLAD.  The esophagus is decompressed throughout.  The airway is centrally\npatent.\n\nMultiple pulmonary nodules appear to be increasing in size.  Most of the\nnodules appear to localized to the lower lungs.  For example a nodule in the\nlingula measures 2 measures 7 mm, previously 4 mm, seen on series 4, image\n137.  Right lower lobe seen on series 4, image 175, currently measures up to 6\nmm, previously 5 mm.  Nodule in the right lower lobe seen on series 4, image\n168 measures 4 mm, new from prior.  A nodule in the left lower lobe measures 6\nmm, series 4, image 161, previously 5 mm.  Another nodule in the left lower\nlobe measures 7 mm, series 4, image 152, previously 5 mm.  A right lower lobe\nnodule measuring 4 mm on series 4, image 143 was previously no greater than 3\nmm.  Background emphysema is moderate.\n\nPlease refer to same-day CT abdomen pelvis for findings below the diaphragm.\n\nChronic ribcage deformity involving the right ninth posterior rib arch.  No\nworrisome bony lesion.",
            "output": "Moderate emphysema with growing pulmonary nodules concerning for tumor\nprogression."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nNo supraclavicular, mediastinal, or axillary lymphadenopathy.  No mediastinal\nmasses.  The rest of the imaged base of the neck is otherwise unremarkable.\n\nUPPER ABDOMEN: Subdiaphragmatic findings will be reported separately on\ntoday's abdominal study.\n\nHEART and PERICARDIUM: Heart is normal in size.  Moderate atherosclerotic\ncoronary calcifications in the distal LAD and RCA.  No pericardial effusions. \nMild ectasia of the ascending aorta measures 4 cm and appears similar to the\nprior study.\n\nPLEURA: No pleural effusions or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  The previous nodule in the left upper lobe is stable measuring\n3 mm (4, 197), while another in the left upper lobe previously measuring 3 mm\nnow measures 5 mm (of 4, 256).  The nodule in the lingula is stable, measuring\n4 mm (4, 228).  Suture and consolidation/scarring are seen in the area of the\nright lower lobe wedge resection and are likely postsurgical in etiology.  The\nnodule in this region has been resected.  There is a likely new right lower\nlobe nodule adjacent to the area of resection measuring 4 mm (4, 265),\nalthough comparison to prior studies is difficult due to altered postsurgical\nanatomy.  A new right lower lobe nodule measures 3 mm (4, 198), while another\nlung nodule in the right lung base previously measuring 4 mm now measures 7 mm\n(4, 254).  The nodule in the left lower lobe previously measuring 6 mm now\nmeasures 8 mm (4, 258).  Another nodule in the left lower lobe appears stable,\nmeasuring 7 mm (4, 249).  A nodule in the right upper lobe previously\nmeasuring 4 mm now measures 7 mm (4, 206).  Mild nodularity in the right\nmiddle lobe may be secondary to atelectasis (4, 285).  Background emphysema is\nmoderate.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Diameter of the main pulmonary artery is within normal limits.\nCHEST CAGE: No worrisome lytic or sclerotic bony lesions.  Chronic ribcage\ndeformity involving the right ninth posterior rib arch is unchanged.  No acute\nfractures.",
            "output": "1.  Status post right lower lobe wedge resection with removal of\npathology-proven malignant solitary fibrous tumor.  Expected postsurgical\nchanges.\n2.  Interval increase in size of multiple pre-existing pulmonary nodules as\nwell as development of new nodules is suggestive of tumor progression.\n3.  Moderate emphysema."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged and\nthere are no soft tissue abnormalities in the imaged chest wall concerning for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mid esophagus is mildly patulous but there is no associated\nmass or evidence of obstruction.\n\nAtherosclerotic calcification is not apparent in head neck vessels but is\nscattered in at least left anterior descending and right coronary arteries. \nAorta and pulmonary arteries and cardiac chambers are normal size.  Small\npericardial effusion is physiologic.\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Scores of pulmonary nodules are more numerous and\nlarger, ranging in diameter up to 12 x 15 mm, right lower lobe, 03:18,\npreviously too small to measure, and 10 x 15 mm, right lower lobe, 3:143,\npreviously 6 x 7 mm.  Most of\n\nThere is no appreciable pleural mass or effusion.  Tracheobronchial tree is\nnormal to subsegmental levels.\n\nCHEST CAGE:\nThere are no compression or pathologic fractures or large destructive bone\nlesions. Radionuclide bone and FDG PET scanning would be more sensitive in\ndetecting early osseous metastases.",
            "output": "Scores of pulmonary nodules are generally larger or new since ___.\n\nNo adenopathy or pleural effusion.\n\nMild coronary atherosclerotic calcification."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.  The thyroid is unremarkable.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: Within the limitations of a noncontrast enhanced study, there is no\nhilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There are mild\ncalcifications of the coronary arteries.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There are multiple lung nodules, almost all of which are\nunchanged in size from chest CT ___.  However, there are two\nnodules which are increased in size.  A 8 mm nodule in the left lower lobe\npreviously measured 5 mm (3:160) and a 9 mm subpleural nodule in the right\nupper lobe previously was 5 mm (3:92).\n2. AIRWAYS:  There is a patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery is not enlarged.\nCHEST CAGE: There is no acute osseous abnormality.",
            "output": "The majority of the lung nodules are stable as compared to chest CT ___.  However, two nodules demonstrate interval increase in size.  A 8 mm\nleft lower lobe nodule was 5 mm and a 9 mm right upper lobe subpleural nodule\npreviously was 5 mm."
        },
        {
            "input": "CT CHEST WITH CONTRAST:  The thyroid is normal. Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged. Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.\n\nThe airways are patent to the subsegmental level. There is no pleural effusion\nor pneumothorax. Multiple subcentimeter peripheral pulmonary nodules abutting\nthe pleura are unchanged. For example, on the left images 6:43, 82, 195, 236.\nOn the right 6:47, and 6:229. The largest nodule in the apical segment of the\nright lower lobe measures 6 x 3 mm (6:120) previously 7 x 4 mm.\n\nBreast parenchyma appears asymmetric, left greater than right.\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions.",
            "output": "The dominant pulmonary nodule in the right lower lobe is smaller and other\nsubcentimeter pulmonary nodules are unchanged.  Followup recommendations\ndepend on whether decrease is spontaneous or secondary to chemotherapy.\n\nOther than the lung nodules, there are no findings to suggest intrathoracic\nmetastasis."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen and\npelvis CT report dictated under clip number ___\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nHeart, pericardium and great vessels are within normal limits. No hiatal\nhernia is present.\n\nA triangular shaped subpleural 6 mm nodule in the right lower lobe (4:95), 3\nmm left lower lobe nodule (4:157) and 3 mm pleural-based nodule in the left\nlower lobe (4:155) are unchanged. New clustered peribronchiolar nodules in the\nright upper lobe adjacent to an area of stable scarring are likely infectious\nor inflammatory in etiology.  No pleural effusion or pneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.  Mild degenerative changes of the thoracic spine with anterior\nosteophytes are unchanged.",
            "output": "1. Stable appearance of multiple previously reported pulmonary nodules as\ndescribed above.\n2. New clustered right upper lobe peribronchiolar nodules are likely\ninfectious or inflammatory in etiology and can be reassessed at next scheduled\nsurveillance CT."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are within normal\nlimits.  No mediastinal, hilar or axillary lymph nodes present.  Heart size is\nenlarged.  No pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Previously seen\npulmonary nodules are stable, series 6, image 127, 213, 252.  There is new\nlinear opacity in the right upper lobe, series 6, image 139, most likely\nrepresenting area of atelectasis and less likely infection as well as right\nmiddle lobe atelectasis, series 6, image 176.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest including pre-existing pulmonary nodules with\nonly new change being areas of atelectasis, most likely infection.  Followup\nof the patient in 3 months for documentation of the resolution is recommended."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the chest wall are\nnormal in size.  No hilar or mediastinal lymphadenopathy.  Mild coronary\ncalcifications, no valvular calcifications, unchanged borderline size of the\nheart.  Unremarkable posterior mediastinum.  The upper abdomen is reported in\ndetail in the dedicated abdominal CT report.  Normal appearance of the large\nmediastinal vessels.  No incidental pulmonary embolism.  No osteolytic lesions\nat the level of the ribs, the sternum or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.\n\nSeveral millimetric pre-existing pulmonary nodules, for example in the right\nlower lobe (6, 128) are stable in size and morphology.  No new or growing\nnodules.  Unchanged non characteristic scarring in the middle lobe (6, 169). \nThe airways are patent.  No diffuse lung disease.",
            "output": "No change in comparison to ___.  Pre-existing millimetric nodules are\nstable in size and morphology.  No new or growing pulmonary nodules.  No\nsuspicious lung parenchymal changes."
        },
        {
            "input": "Several sub 5 mm lung nodules are unchanged since ___. \nRepresentative examples are demonstrated on images 92, 131, 214, and 260 of\nseries 6.  No new or growing nodules are detected.  Scattered foci of\nparenchymal scarring are also unchanged.\n\nSubcentimeter intrathoracic lymph nodes are unchanged in size and number. \nHeart is mildly enlarged without evidence of pericardial effusion.  Coronary\nartery calcifications are noted.  There is no pleural effusion.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1. Stable CT appearance of the chest with no new or growing pulmonary nodules.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the chest wall (3, 16)\nAre normal in size.  Borderline sized but morphological E unremarkable\nmediastinal lymph nodes (3, 21).  No abnormalities at the level of the large\nmediastinal vessels.  Mild cardiomegaly.  No pericardial effusion.  The\nposterior mediastinum is unremarkable.  No abnormalities at the level of the\nupper abdomen.  Moderate degenerative vertebral disease.  No vertebral\ncompression fractures.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Moderate respiratory motion.  Subsequent\nattenuation heterogeneities in the lung parenchyma.  The presence of small\npulmonary nodules is again noted (for example 5, 87), the largest of which is\nlocated in the right lower lobe (5, 118).  The size and shape of the nodules\nis stable.  No new or growing nodules.  No pleural thickening, no pleural\neffusions.  The airways are patent.",
            "output": "Stable examination as compared to ___.  No new or growing nodules\nin the lung parenchyma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is grossly\nunremarkable, although streak artifact from contrast in the right subclavian\nvein obscures fine detail.  No enlarge supraclavicular or axillary lymph\nnodes.\n\nUPPER ABDOMEN: Please see the separately dictated MRI abdomen from the same\ndate for description of subdiaphragmatic findings.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is mildly enlarged. No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  No focal consolidation or mass.  Numerous nodules are again\nseen, measuring up to 6 mm in the right lower lobe (5:118).  No new or growing\nnodules are seen.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  While this study is not optimized for the evaluation of pulmonary\nvasculature, no central pulmonary embolism is detected.  The thoracic aorta is\nnormal in caliber.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion.",
            "output": "No evidence of intrathoracic malignancy.\n\nUnchanged nodules measuring up to 6 mm as compared to ___.  No new or\ngrowing lung nodules.\n\nMild cardiomegaly.  Echocardiography could be performed for more thorough\nassessment of cavity size and cardiac function.\n\nPlease see the separately dictated MRI abdomen from the same date for\ndescription of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Echocardiography if clinically appropriate."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular, lower cervical, or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see report from dedicated CT of the abdomen and pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is borderline enlarged, similar to the prior\nexaminations.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Millimetric nodules, primarily subpleural, are unchanged since\nat least ___.  No new or enlarging nodules are identified.  There is lingular\nand middle lobe atelectasis.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are normal in\ncaliber\nCHEST CAGE: No suspicious osseous lesions or acute fractures are identified.",
            "output": "No evidence of thoracic metastases."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\nThe left breast has a nodular appearance however this could represent\nasymmetric glandular tissue.  Correlation with mammography is recommended.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmild cardiomegaly.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  The airways are patent up to the subsegmental\nlevel.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is mild upper lobe predominant peribronchial thickening,\nunchanged.  There is minimal bibasilar atelectasis.  2 mm left upper lobe\npulmonary nodule is unchanged (302, 63).  Previously visualized 6 mm\nsubpleural right lower lobe opacity (302, 96) is also unchanged.  Stable 2 mm\nright lower lobe pulmonary nodule (302, 177).  Stable 3 mm left lower lobe\npulmonary nodule (302, 193).  No new or growing pulmonary nodules.  A 2 mm\nright lower lobe pulmonary nodule (302, 211) Is also unchanged.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nmesenteric soft tissue masses.  Please refer to dedicated report on abdomen\nwhich has been dictated separately",
            "output": "Stable pulmonary nodules ranging in size from 2 mm to 6 mm.  No new or growing\npulmonary nodules.\n\nStable mild cardiomegaly.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced and stable except for focal\ndilatation of left main pulmonary artery up to 2.8 cm, series 2, image 25,\nunchanged.  No pathologically enlarged mediastinal, hilar or axillary lymph\nnodes demonstrated.  No supraclavicular lymphadenopathy is present.\n\nHeart size is normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Minimal cylindrical\nbronchiectasis in the right middle lobe and right lower lobe associated with\nmild degree of bronchial wall thickening.  Same bronchial wall thickening can\nbe seen in the left bronchial tree.\n\nThere is interval development of diffuse ground-glass opacities and small\nseptal thickening especially in the lung bases, findings concerning for mild\ninterstitial pulmonary edema.  Interstitial pneumonitis is less likely\n\nSeveral stable pulmonary nodules are solid, series 302, images 49, 105, 65,\n154, 162.  No new nodules masses or consolidations demonstrated.\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable multiple solid pulmonary nodules\n\nInterval development of ground-glass opacities and septal thickening\nconcerning for interstitial pulmonary edema in conjunction with bronchial wall\nthickening, most likely secondary to that as well.  Pneumonitis is less\nlikely.  Please correlate clinically\n\nFocal unchanged dilatation of left main pulmonary artery.  Pulmonary stenosis\ncannot be excluded.  Correlation with echocardiography is recommended."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Note is\nmade of a prominent pericardial recess.  There is moderate cardiomegaly. \nThere is mild coronary artery calcification.  There is no pericardial\neffusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Previously visualized a subtle diffuse ground-glass opacification has\nresolved.  A 2 mm left upper lobe pulmonary nodule (302, 74) Is unchanged. \nThe 7 mm subpleural right lower lobe pulmonary nodule is unchanged (302, 106. \nThe 3 mm subpleural left lower lobe pulmonary nodule (302, 169) is also\nunchanged.  No new or growing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows\nlow-attenuation mass in the upper abdomen.  Please refer to dedicated report\non abdomen which has been dictated separately.",
            "output": "Stable pulmonary nodules measuring in size from 2-7 mm.  No new pulmonary\nnodules.\n\nPreviously visualized diffuse ground-glass opacification has resolved and was\nmost likely inflammatory.\n\nLow-density mass in the upper abdomen concerning for recurrent liposarcoma. \nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation.\n13 mm left axillary lymph node, unchanged since ___ and ___.  No lymph nodes in the supraclavicular or right axillary stations are\npathologically enlarged or growing.\n\nBreast evaluation is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.  Findings below the diaphragm will\nbe reported separately.\n13 mm left axillary lymph node, stable since at least ___.\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels or in the coronary arteries.  Central\nvenous infusion catheter ends in the right atrium with no associated thrombus.\n\nEvaluation of mild-to-moderate cardiomegaly would require echocardiography,\nbut the aortic valve is not calcified and the aorta and pulmonary arteries are\nnormal size and free of central filling defects.\n\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs clear.  Tracheobronchial tree is normal to\nsubsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of active intrathoracic malignancy."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is top-normal.  There is coronary artery calcification.  There is no\npericardial effusion.  There is moderate cardiomegaly.  Coronary artery\ncalcification is seen.  There is evidence of prior cardiac surgery.  ETT is in\nacceptable position.  NG tube projects below the left hemidiaphragm.\n\n\nPLEURA: There are small bilateral pleural effusions right greater than left.\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nThere are consolidative opacities in both lower lobes which could represent\natelectasis however superimposed pneumonia on the left cannot be excluded.\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nSternal sutures are intact.  No lytic or sclerotic lesions concerning for\nmetastasis are seen\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  There are gallstones.",
            "output": "Parenchymal opacities in both lower lobes most likely represent atelectasis\nhowever superimposed pneumonia on the left cannot be excluded.  Evaluation of\nlung parenchyma is limited by respiratory motion.\n\nETT and NG tube in acceptable position.\n\nMild upper lobe predominant emphysema.\n\nModerate cardiomegaly.  Evidence of prior cardiac surgery."
        },
        {
            "input": "The previously-seen left upper lobe pulmonary nodule has significantly\ndecreased in size compared to prior examination currently measuring\napproximately 4 mm and additionally appears less dense.  Numerous other\nnodules in the left lower lobe are not well seen on today's examination also\nlikely decreased compared to the prior.  No new nodules are visualized.\n\nScattered atherosclerotic disease is noted of the aorta.  Coronary artery\ncalcifications are seen.\n\nLimited evaluation of the upper abdomen is unremarkable.\n\nNo suspicious osseous lesions are visualized on this examination.",
            "output": "Previously seen pulmonary nodules have decreased in size or are no longer\nvisualized.  No target for biopsy.  Continued surveillance as clinically\nindicated.\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 9:47 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\n\nThe right breast is markedly abnormal with abnormal enhancement and skin\nthickening with retraction. A large mass measuring 8.7 x 4.8 x 7.5 cm appears\nto replace the majority of the breast although distinct margins are difficult\nto identify. There is loss of the fat plane with the pectoralis muscle which\nis enlarged and likely diffusely involved by the tumor. A second irregular\nenhancing mass within the lateral right breast near the axillary line is\npresent measuring 3.8 x 2.5 x 5.3 cm (series 8, image 38; series 11, image\n36). There is likely also a left breast mass which measures 5.3 x 2.7 x 3.9\ncm. A right chest wall mass to the right of the right breast and anterior to\nthe axillary region which involves the skin measures approximately 2.6 x 2.0\ncm on axial images.\n\nThere are no enlarged supraclavicular lymph nodes. Multiple prominent left\naxillary enhancing nodes are identified. For example a 11 x 14 mm left\naxillary node is abnormal in appearance. Smaller rounded nodes also appear\nabnormal. Multiple small lymph nodes are present in the anterior mediastinum\nwithin the prevascular space.\n\nThe thyroid gland is unremarkable. The heart and pericardium are unremarkable\nand there is no pericardial effusion. The aorta and pulmonary artery are of\nnormal caliber.  There is a large simple right pleural effusion with collapse\nof the right lower lobe. Mild atelectasis is present in the right upper lobe.\nThe left lung is clear except for mild basilar atelectasis. The airways are\npatent to the subsegmental levels.\n\nABDOMEN:\n\nThe liver enhances homogenously without any focal lesions or intra or\nextrahepatic biliary dilatation. The main portal vein is patent. The\ngallbladder, pancreas, spleen and adrenal glands are unremarkable. The kidneys\nenhance excrete contrast symmetrically without any hydronephrosis. Bilateral\nhypodensities are too small to characterize but are likely cysts. The stomach,\nsmall and intra-abdominal large bowel are unremarkable. There is no free\nfluid, free air lymphadenopathy within the abdomen. The aorta is of normal\ncaliber without evidence of aneurysm. There is mild calcified plaque.\n\nPELVIS:\n\nThe bladder is unremarkable. Uterus, rectum and sigmoid colon are\nunremarkable. There is no free fluid, free air lymphadenopathy within the\npelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is a lytic lesion involving the entire right first rib compatible with\nmetastatic disease. T5 vertebral body and L3 vertebral body are heterogeneous\nin appearance with mixed lytic and sclerotic lesions also worrisome for\nmetastases.  Transitional lumbosacral vertebral body anatomy is present.\nSeripinginous sclerosis in the right femoral head is noted and while may be\nmetastatic disease has the more typical appearance of avascular necrosis.\n\nGeneralized soft tissue anasarca is noted.  In assessing soft tissue\nabnormality extending along the right midaxillary line inferiorly to the soft\ntissues along the anterolateral right flank (series 8, image 60 ; series 11,\nimage 30) may be tumoral in nature given the significant enhancement in this\nregion.",
            "output": "1. Extensive right breast cancer with skin thickening, retraction and a mass\noccupying nearly the entire breast with loss of fat plane between the\npectoralis muscle which is enlarged and indistinct. A second enhancing\nirregular mass is present in the right lateral breast extending into the\nlateral chest wall, as well as extending into the right lateral subcutaneous\ntissues of the abdomen. There also is likely a large left breast mass;\nmorphology is similar to that on the right, and the degree of enhancement\nwould be unusual at this age for glandular tissues.\n\n2.  Multiple abnormal appearing left axillary lymph nodes and scattered small\nprevascular mediastinal lymph nodes.\n\n3.  Large right pleural effusion with atelectasis of the right lower lobe and\nsubsegmental atelectasis of the right upper lobe.\n\n4.  Bony metastases involving the right first rib, T5 and L3 vertebral bodies.\nSerepinginous sclerosis of The right femoral head may represent metastatic\nlesion however has the appearance of avascular necrosis. MRI can be obtained\nfor further evaluation, if clinically indicated.\n\n5.  No evidence of intraperitoneal/visceral metastatic disease within the\nabdomen or pelvis."
        },
        {
            "input": "MEDIASTINUM AND THORACIC SOFT TISSUES: The thyroid gland is normal. There is\nno significant interval change in markedly abnormal right breast with\nsignificant skin thickening and loss of fat plane between the right breast\nmass and the pectoralis muscles. A left breast mass with overlying skin\nthickening is also unchanged. Extensive bilateral thoracic wall and axillary\nlymphadenopathy is stable. Anasarca is identified.\n\nNumerous prevascular and internal mammary lymph nodes are not enlarged by CT\nsize criteria although concerning in a patient with breast cancer.  Right\nhilar adenopathy appears more conspicuous than on the previous exam although\nassessment is limited on this noncontrast study.  Calcified right hilar node\nis unchanged. The great vessels are  unremarkable. Minimal coronary artery\ncalcifications are present, otherwise the heart and pericardium are within\nnormal limits. Trace pericardial fluid is present. There is no esophageal wall\nthickening or hiatal hernia.\n\nLUNGS AND AIRWAYS:  The left lung is unremarkable with exception of some\nbasilar atelectasis.  New trace left-sided pleural effusion is present.\n\nCompared with the prior examination, there is improvement of aeration of the\nright middle and lower lobes. However, there are new large areas of\nground-glass opacification in the right upper and middle lobes with patchy\nconsolidation and associated air bronchograms. There is also mild interval\ndecrease in size of the large right-sided pleural effusion, which now appears\nmultiloculated. A right posterior approach chest tube ends adjacent to the\nanterior segment of the right upper lobe, in an area without any significant\nresidual fluid. Large locules of fluid along the right lower and middle lobes\nare still seen.\n\nOSSEOUS STRUCTURES:  Mild sclerosis and compression deformity of T5 is\nunchanged from ___.  There is also sclerosis and ___ compression\ndeformity of T2, also stable. Right first rib metastasis is unchanged.\n\nThis study is not tailored for evaluation of subdiaphragmatic structures but\nallowing for limitations there are no gross abnormalities seen in the imaged\nabdominal organs.",
            "output": "1.  Bilateral breast masses with extensive local invasion and metastatic\ndisease is not significantly changed from ___.\n\n2.  Extensive right lung ground-glass opacities with multiple of patchy areas\nof consolidation with air bronchograms are worrisome for pneumonia.\n\n3.  Although there has been mild interval decrease in size of the right\npleural effusion, this effusion is now multiloculated. The right-sided chest\ntube is seen ending anterior to the anterior segment of the right upper lobe,\nin a region without any significant residual pleural fluid.\n\n4.  Trace left pleural effusion.\n\n5..  Please note that assessment for empyema is limited without the\nadministration of intravenous contrast."
        },
        {
            "input": "Bilateral hypodense thyroid nodules measure up to 9 mm on the right.  Multiple\nsmall mediastinal lymph nodes are not appreciably changed in size and number\nsince the study of 2 days prior. Stable bilateral axillary lymphadenopathy is\nmost extensive on the right, with a representative node measuring 2.2 x 3.1 cm\n(2, 31).\n\nMinimal pericardial thickening is present (02: 22, 30, 36). The main pulmonary\nartery and thoracic aorta are normal caliber. No incidental central pulmonary\nembolus is identified. A left-sided PICC line terminates in the upper right\natrium.\n\nA newly-placed right posterior approach pigtail catheter coils in the\nposterior pleural space. A second posterior approach right chest tube is\nunchanged in position, traversing the posterior costophrenic sulcus and medial\npleural space to terminate in the right anteromedial pleural space. There has\nbeen substantial interval decrease in size of the loculated right pleural\neffusion since the study of 2 days prior. However, a few small loculations\nmeasuring up to 2.4 x 5.1 cm are unchanged (2, 35). The trace left pleural\neffusion is unchanged. Small foci of air in the right pleural space are likely\npostprocedural.\n\nEvaluation of the lung parenchyma is somewhat limited by respiratory motion\nartifact. There are several tiny pulmonary nodules some of which were present\npreviously, with others possibly obscured by prior collapse (04:21, 67, 74).\nAirways are patent to the subsegmental level.  There is interval decreased\nright pulmonary volume loss, with residual patchy infiltrate in the right\nlung, with prominent peribronchovascular soft tissue thickening. Mild left\nbasal and lingular atelectasis.\n\nA small ill-defined 1.3 x 2.4 cm hypodense lesion in the posterior right\nhepatic lobe is new since ___ and is indeterminate (2, 46). A small\nleft renal cyst is unchanged. Images of the upper abdomen are otherwise\nunremarkable. A small amount of retained layering debris is incidentally noted\nin the mildly patulous upper esophagus (4, 49).  Subcentimeter but prominent\nleft para-aortic lymph nodes are noted. Probable gallstones.\n\nExtensive skin thickening in right fourth and left breast, with associated\nright-sided breast masses, and possible left breast mass similar to recent CT\nexaminations. Moderate anasarca is also unchanged.\n\nDiffuse sclerosis and expansion of the right first rib is compatible with\nmetastasis.  The probable T5 vertebral body metastasis is stable, and shows no\nnew loss of height.",
            "output": "Substantial interval decrease in size of known loculated right empyema\nfollowing placement of a second pigtail catheter, which coils in the posterior\npleural space. Small loculations remain as described above.\n\nPartial re-expansion of the right lung.  Residual patchy infiltrates, with\nprominent peribronchovascular soft tissue thickening. The differential\ndiagnosis includes lymphangitic spread of metastasis or infection.\n\nSeveral pulmonary small nodules measuring up to 3 mm are worrisome for\nmetastases.\n\nNew ill-defined 1.3 x 2.4 cm hypodense lesion in the posterior right hepatic\nlobe is indeterminate.  Metastasis is not excluded.\n\nMinimal nonspecific thickening of the right pericardium.\n\nStable appearance of bilateral breast skin thickening and apparent masses.\n\nStable bilateral axillary lymphadenopathy (right or the left).\n\nStable anasarca.\n\nStable probable bone metastases involving the right first rib and T5.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___.\n___ on the telephone on ___ at 3:11 ___, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "Limited evaluation due to patient respiratory motion.\n\nCTA TORSO:\n\nThe pulmonary arteries are well opacified to the segmental level.  No obvious\nfilling defect to suggest pulmonary embolism.  Within the left lower lobe at\nthe subsegmental level there is a linear streaky hypodensity within a\npulmonary artery most consistent with artifact related to volume averaging and\nmotion (4:118).  The great vessels are normal in caliber.  The thoracic aorta\nis within normal limits without evidence of penetrating atheroma, intramural\nhematoma, or dissection.\n\nThe abdominal aorta are normal in caliber and without evidence of aneurysm or\ndissection.The celiac axis, SMA, bilateral renal arteries, and ___ are grossly\npatent. Atherosclerotic mural calcifications are seen throughout the aorta and\nits major branches. Assessment of the venous vasculature is limited by the\ntiming of contrast.\n\nCHEST:\n\nThe thyroid gland is heterogeneous.Again seen are multiple mediastinal lymph\nnodes which have slightly increased in size, largest measuring 1.2 x 1 cm (3a:\n28) (previously 1 x 0.9 cm) within the anterior paratracheal region. Interval\nincrease in multiple right axilla lymph nodes and metastatic deposits largest\nmeasuring 4 x 3 cm (3 a:  65) (previously 3.6  x 2.6 cm)with overlying skin\nthickening.\n\nMinimal pericardial thickening is again noted (3 a:  63, 53).  The heart is\notherwise unremarkable.  No pericardial effusion.The airways are patent to the\nsegmental levels however limited evaluation due to expiratory phase scanning.\n\nInterval removal of right-sided chest tube.  Interval increase in size of\nloculated right pleural effusion since ___ predominately along the\nposterior and medial pleural surfaces within the right upper hemi thorax\nmeasuring approximately 2.5 cm in maximal width (3 a:  25).  Interval increase\nin a 4.5 x 2.4 cm (3 a: 62) loculated collection within the right lower hemi\nthorax posteriorly in location of previous pigtail catheter.  Additional\nloculated collection along the lateral right hemi thorax has increased in size\nwith associated pleural thickening.  (3 a:  74) interval increase in moderate\nsized left pleural effusion.  No pneumothorax.\n\nEvaluation of the lung parenchyma is somewhat limited by respiratory motion\nartifact.  Previously identified lung nodules are not definitively visualized\non today's examination.\nAgain seen is significant right lower lobe collapse with prominent\nperibronchovascular soft tissue thickening thickening and adjacent areas of\nground-glass opacities with septal thickening (4:93).  Persistent right\nlingular and basal atelectasis is noted.\n\nExtensive skin thickening along bilateral breasts with associated an\nright-sided breast mass with extension to the right pectoralis muscle and\npossible left-sided breast mass which are similar to previous CT chest. \nModerate anasarca is noted.\n\nABDOMEN:\n\nAgain seen is a 1.3 x 1.1 cm (3B:  134) hypodensity within segment 7 of the\nliver, worrisome for metastatic lesion.  Additional lesion within segment 6 of\nthe liver measures 1.7 x 0.9 cm (3B:  151) and is worrisome for metastatic\nlesion.  The portal vein, SMA, and splenic vein are patent. Mild intrahepatic\nbiliary duct dilatation is noted.  The gallbladder is prominent with small\nlayering stones.  The pancreas, spleen, and bilateral adrenal glands are\nnormal.The kidneys enhance symmetrically.  A 1.4 x 0.9 cm (3B:  143) simple\nleft renal cyst is stable.  A 0.7 x 0.6 cm soft tissue lesion is seen anterior\nto the liver likely representing a metastatic focus (3B:  149).  Again seen is\nabnormal enhancement and thickening of the transversalis muscle on the right\nconsistent with metastatic disease and similar in appearance to previous\nexamination.  (3B:  143)\n\nA small hiatal hernia is present.  The stomach is grossly unremarkable in\nappearance.The small and large bowel are normal in caliber and without\nevidence of wall thickening. The appendix is not visualized however no\nevidence of acute appendicitis.  No retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.No free abdominal fluid, abdominal wall\nhernia, or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is unremarkable. No pelvic side-wall lymph node enlargement.No\nfree pelvic fluid is identified.  Again seen are multiple prominent inguinal\nlymph nodes largest measuring 1.6 x 1 cm (3B:  183) within the left groin\n(previously 1.5 x 1 cm).\n\nOSSEOUS STRUCTURES:  Diffuse sclerosis and expansion of the right first rib is\nconsistent with metastasis and similar in appearance to previous exam. \nProbable T5 vertebral body metastasis is stable without new loss of height. \nStable metastatic focus within T8 vertebral body is noted without loss of\nvertebral body height.  Heterogeneous appearance to L3 vertebral body with\nmixed lytic sclerotic lesions are worrisome for metastasis.  Transitional\nlumbosacral vertebral body anatomy is noted.  Serpiginous sclerosis in the\nright femoral head is stable in appearance and may be metastatic disease\nhowever has a more typical appearance for avascular necrosis.  Multilevel,\nmultifactorial degenerative changes are seen within the visualized\nthoracolumbar spine.",
            "output": "1.  No pulmonary embolism or aortic abnormality.\n2.  Evidence of disease progression with extensive metastatic disease as\ndescribed above predominately involving the anterior chest wall, right\npectoralis muscle, pericardium, right transversalis muscle, right axilla,\nbones, segment 6 and 7 of liver.  New likely metastatic focus along hepatic\ncapsule with mild increase in size of metastatic lesion within subcutaneous\ntissue is consistent with disease progression.\n3.  Interval increase in size of multiple loculated right pleural effusions. \nSuperinfection cannot be excluded.\n4.  Right lower lobe atelectasis with residual patchy infiltrates and\nprominent peribronchovascular soft tissue thickening.  Differential includes\nlymphangitic spread of metastasis or infection.\n5.  Diffuse anasarca.\n6.  Interval increase in size of moderate left pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are prominent but not enlarged.  The\ntip of a right PICC line extends to the distal SVC.\n\nMEDIASTINUM:  Innumerable centrally necrotic lymph nodes are present\nthroughout the mediastinum.  Reference lesions include a 2.2 x 1.8 cm lesion\nposterior to the junction of the left brachiocephalic vein and SVC.  A right\nparatracheal lymph node measures 3.1 x 2.2 cm (03:21).  A large subcarinal\nlymph node measures 3.3 x 4.1 cm.  There is a 1.0 x 0.9 cm right cardiophrenic\nangle lymph node.\n\nHILA:  The similarly there are multiple enlarged, centrally necrotic hilar\nlymph nodes bilaterally.  For example on the right is a conglomerate of lymph\nnodes measuring approximately 3.3 x 2.4 cm (03:26) a smaller lymph node more\ndistally measures 1.8 x 1.7 cm (03:35).  On the left is a mass/lymph node\nconglomerate measuring 3.6 x 2.3 cm (03:24.  This is narrowing and obstructing\nthe left upper lobe pulmonary artery and bronchus.  Inferiorly is a\nconglomerate of lymph nodes measuring 3.1 x 2.1 cm and encasing the left lower\nlobe segmental and subsegmental pulmonary arteries and bronchi.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is a small pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThis examination was not tailored for the assessment of pulmonary emboli\nhowever as mentioned above, given the extensive hilar lymphadenopathy\nbilaterally there is narrowing and effacement of several segmental pulmonary\narteries.  No central pulmonary embolism is identified.  The main pulmonary\nartery is not enlarged and there is no evidence of right heart strain.\n\nPULMONARY PARENCHYMA:  There is complete opacification of the left upper lobe\nlikely secondary to postobstructive collapse/pneumonia in the setting of\nunderlying hilar lymphadenopathy/masses.  There are multiple bilateral\npulmonary nodules.  For example in the right lower lobe is a 1.7 x 1.4 cm\nlesion (5:160).  Within the aerated left lower lobe is a 0.8 x 0.8 cm\nsubpleural nodule (5:112).  There is underlying moderate to severe\ncentrilobular and paraseptal emphysema.  Prominent interlobular septal\nthickening is unchanged from prior and wall it may reflect interstitial edema,\nunderlying lymphangitic spread is not excluded.\n\nAIRWAYS:  The right middle lobe segmental and subsegmental bronchi are\nnarrowed but patent.  There is narrowing and then complete occlusion of the\nleft upper lobe bronchus.  The left lower lobe segmental bronchus is also\nseverely narrowed but patent distally.\n\nPLEURA:  There are small bilateral pleural effusions, greater on the right and\nnot significantly changed from prior..\n\nCHEST WALL AND BONES:  Unchanged 1.6 cm lytic lesion within the T6 vertebral\nbody, likely a metastasis.  Multilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please refer to the report from the concurrent CT scan of the\nabdomen for abdominopelvic findings.",
            "output": "1. Extensive centrally necrotic mediastinal and hilar lymphadenopathy.\n2. Postobstructive collapse/pneumonia in the left upper lobe likely secondary\nto the hilar lymphadenopathy/mass.  The left hilar adenopathy is severely\nnarrowing and occluding the left upper lobe bronchus and pulmonary artery.\n3. Small bilateral pleural effusions.\n4. Scattered nodular opacities throughout both lungs as well as nodular\nthickening of the interlobular septa are concerning for metastatic lesions and\nlymphangitic spread bilaterally.\n5. Lytic lesion within the T6 vertebral body is suspicious for metastasis."
        },
        {
            "input": "CTA chest:  The aorta and its major branch vessels are patent, with no\nevidence of stenosis, occlusion, dissection, or aneurysmal formation. There is\nno evidence of penetrating atherosclerotic ulcer or aortic arch atheroma\npresent.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are top\nnormal in caliber, and there is no evidence of right heart strain.  Ingested\nmaterial is retained within the esophagus.\n\nThere is no evidence of pericardial effusion.  Heart size is enlarged.\n\nThere is moderate apical predominant centrilobular emphysema. There is\nmoderate bibasilar atelectasis. There is a trace right-sided pleural effusion.\nEvaluation is somewhat limited by respiratory motion artifact. Mosaic\nattenuation pattern of the parenchyma is likely secondary to submaximal\ninspiration. Lungs are otherwise clear.  The airways are patent to the\nsubsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe imaged thyroid gland appears unremarkable.\n\nCT abdomen with contrast: The liver enhances homogeneously without focal\nlesion, intra extrahepatic biliary ductal dilatation. The portal vein is\npatent. Gallbladder is not seen. Mild prominence of the CBD is expected in the\nsetting of cholecystectomy. There is a probable dropped stone in the right\nsubhepatic space. There is small ascites.\n\nMillimetric hypodensity in the spleen is too small to characterize, likely\nrepresenting cyst or hemangioma. The pancreas and adrenal glands are\nunremarkable. Bilateral subcentimeter renal hypodensities are too small to\nfully characterize but likely represent cysts. The kidneys. Symmetric\nnephrograms and excretion of contrast without focal solid lesion,\nhydronephrosis or perinephric abnormality.\n\nThere is a small hiatal hernia.  The stomach, duodenum and remaining small\nbowel is grossly unremarkable without evidence for obstruction. The large\nbowel is prominently dilated to a maximum of roughly 9 cm with mural\nthickening and submucosal hyper enhancement most prominent in the cecum.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriterion. There is no pneumoperitoneum or hernia.\n\nCT pelvis with contrast: Bladder is decompressed around the Foley catheter.\nUterus and ovaries are not seen.  Distension, wall thickening and submucosal\nhyper enhancement of the rectum appears similar to the remainder of the colon.\nThere is no inguinal or pelvic sidewall lymphadenopathy by CT size criterion.\n\nOsseous structures: There is no suspicious focal osseous lesion. Note of L2\nlimbus vertebral body.",
            "output": "1. Prominent colonic/rectal distension with wall thickening and submucosal\nhyperenhancement compatible with C. difficile colitis given history. Small\nascites.\n2. No evidence of pulmonary embolism or aortic abnormality.\n3. Moderate emphysema.\n4. Trace right-sided pleural effusion."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  The\nheart size is normal and there is no pericardial effusion. There is edema\nthroughout the subcutaneous tissues.\n\nThere are large bilateral pleural effusions with adjacent compressive\natelectasis.  No evidence of pneumonia.  No pneumothorax.\n\nIntra-abdominal findings are reported separately.\n\nNo suspicious bony lesions",
            "output": "Large bilateral nonhemorrhagic pleural effusions and adjacent compressive\natelectasis.  No evidence of pneumonia.\n\nDiffuse subcutaneous edema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No supraclavicular lymphadenopathy.  No axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Please refer to report from concurrent CT abdomen pelvis for\ndescription of findings below the diaphragm.\n\nMEDIASTINUM: Enlarged low right paratracheal node measures up to 1.2 cm\n(02:17).  No other mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is of normal size.  No pericardial effusion.  No\nsignificant coronary artery calcifications.\nPLEURA: Small nonhemorrhagic right greater than left-sided pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Smooth interlobular septal thickening at the apices\nbilaterally is suggestive of mild pulmonary edema.  There are scattered areas\nof ground-glass opacity particularly in the lingula and right middle lobe\nwhere there also more confluent areas of consolidation (e.g.  32:98 in the\nlingula and 302: 143 in the right middle lobe).  There are significant\nconsolidations of the lower lobes bilaterally with areas of heterogeneous\nhypoenhancement in the right lower lobe (302:176) and in the left lower lobe\n(302:174) concerning for superimposed infection.\n2. AIRWAYS:  Endotracheal tube terminates approximately 3.6 cm above the level\nof carina.  Airways are patent to subsegmental levels bilaterally.\n3. VESSELS:  There is normal caliber of the thoracic aorta.  Main pulmonary\nartery is mildly enlarged measuring up to 3.4 cm.\nCHEST CAGE: No concerning osseous lesions.",
            "output": "1. Multifocal pneumonia involving the bilateral lower lobes, right middle\nlobe, and lingula.  Areas of hypoenhancement in the lower lobes bilaterally\nare additionally concerning for necrosis.\n2. Small right greater than left pleural effusions.\n3. Mild pulmonary edema.\n4. Single enlarged mediastinal lymph node, likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Tiny hypodensity in the imaged left\nlobe of the thyroid new not warrant further imaging.  No pathologic\nenlargement of lymph nodes in the supraclavicular or axillary stations.\n\nCHEST CAGE: No evidence of lytic or sclerotic osteo destructive lesions at the\nlevel of the ribs, sternum or vertebra.\n\nUPPER ABDOMEN: NG tube extends into the stomach and out of view.  The liver\nwith hepatosteatosis.  Mild splenomegaly. Remaining included upper abdominal\norgans are unremarkable.\n\nMEDIASTINUM: Scattered lymph nodes in the mediastinum are subcentimeter,\nmeasure up to 0.8 cm in the right paratracheal station, none pathologically\nenlarged there is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Pericardium is with no\nabnormalities.  Main pulmonary artery suboptimal opacification reveals no\nembolus.\n\nPLEURA and LUNG:: Small to moderate right layering pleural effusion extends\ninto the lung apex, mildly larger since ___.  Left minimal layering\npleural effusion is stable.  The effusions measures 15 ___, simple fluid\ndensity.\n\nEndotracheal tube terminates in good position.  Right lower lobe bronchi are\nobstructed by secretions, the lobe is completely atelectatic and heterogeneous\nin density, reflecting combination of atelectasis and infection (302:132). \nThe dependent hypodensity in the lower lobes, greater in the right lower lobe\n(302:184), is more conspicuous in comparison to ___ and is concerning\nfor necrosis.\n\nRight middle lobe with heterogeneous consolidations, increased since prior,\nreflecting worse infection.\n\nLeft lower lobe consolidation adjacent to the minimal pleural effusion has\nenlarged, heterogeneity suggest combination of infection as well as\natelectasis.\nSmooth interlobular septal thickening is essentially unchanged, reflecting\nminimal pulmonary edema.",
            "output": "-Bilateral lower lobe pneumonia is worse in comparison to ___.  There\nis complete occlusion of the right lower lobe bronchi and worse pneumonia in\nthe middle lobe.  Increased right moderate pleural effusion.  Areas of\nhypoenhancement in the lower lobes are mildly more conspicuous consistent with\nevolving small area of peripheral necrosis.\n-Moderate right and small left pleural effusions of simple fluid density\nwithout definite evidence of empyema."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the proximal segmental levels,\nwithout evidence of pulmonary embolism.  However, evaluation of the distal\nsegmental and subsegmental levels is slightly limited by respiratory motion.\n\nSupraclavicular and axillary nodes are not enlarged by size criteria. \nScattered mediastinal lymph nodes are seen, the largest measuring up to 1 cm. \nThere is no hilar adenopathy.  Imaged part of the thyroid gland appears\nunremarkable.\n\nHeart is normal in size, without a pericardial effusion.  Left-sided central\nvenous catheter terminates in the region of the superior cavoatrial junction.\n\nThere is mild diffuse bronchial wall thickening, suggestive of small airways\ninflammation.  Evaluation of the lung parenchyma is notable for bibasilar\nconsolidations, significantly improved compared to ___.  There is no\nevidence of a pulmonary abscess.  There is no pleural effusion.\n\nAn enteric tube extends to at least the body of the stomach.  Limited images\nof the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism to the proximal segmental levels.\n2. Significant improvement in bibasilar pneumonia compared to ___.  No\nevidence of a lung abscess."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is normal.  There is no pericardial effusion.  The unenhanced aorta and\npulmonary artery are unremarkable\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  There is no\nevidence of pneumonia.\n\nBONES AND CHEST WALL : Review of bones are unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.",
            "output": "No evidence of pneumonia or lung nodules."
        },
        {
            "input": "There are bilateral subcentimeter thyroid nodules. Supraclavicular and hilar\nlymph nodes are not enlarged.  Mediastinal lymph nodes measure up to 13 mm in\nthe right lower paratracheal station.  Aorta and pulmonary arteries are normal\nsize. Cardiac size is top-normal.  There is mild calcification of the LAD. \nThere is a 1 mm perifissural nodule in the left upper lobe (05:38) and a 3 mm\nright perifissural nodules (5:92) most likely represent intrapulmonary lymph\nnodes.  There is evidence of air trapping.  There is no pleural or pericardial\neffusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy\nIrregular, lobulated, heterogeneous masses involving the right breast,\nmeasuring approximately 6.7 x 4.2 cm and 5.8 x 5.7 cm, associated with skin\nthickening compatible with known history of cancer. Adjacent right axillary\nlymph nodes appear to be affected, enlarged, and possibly necrotic (3:20). No\nleft-sided axillary lymphadenopathy",
            "output": "No evidence of lung metastases\nRight breast masses and overlying the skin thickening consistent with reported\nknown diagnosis of breast cancer\nAir trapping suggests small airways disease"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis moderate to severe cardiomegaly.  There are mild calcifications in the LAD\nfaint centrilobular ground-glass opacities in the upper lobes right greater\nand left represent infarction a or inflammatory changes.  There are no new\nlung nodules.  Atelectases are present throughout the bases of the lungs,\nlingula and right middle lobe.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy\nCentral catheter tip is in the mid SVC.  Pacer leads are in standard position",
            "output": "ground-glass opacities in the upper lobes, differential diagnosis is broad\ncould represent inflammatory changes, drug reaction, less likely infection,\naspiration.\nNo lung nodules identified"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is mildly dilated, and measures up to 3.7 cm.  The\nascending thoracic aorta is mildly dilated in a fusiform fashion, and measures\nup to 4.2 cm.  The descending thoracic aorta is normal in caliber.  Mild\natherosclerotic disease is seen of the thoracic aorta.  An aberrant right\nsubclavian artery is incidentally noted.  The heart is moderate enlarged. \nThere is no sizable pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are a number of calcified pulmonary nodules scattered\nthroughout both lungs, likely the sequela of prior granulomatous disease. \nBibasilar atelectasis/scarring is mild.  Focal area of left upper lobe\nbronchiectasis is noted, and may be related to prior infection (02:44).  Mild\nairway wall thickening is demonstrated, but the airways are patent to the\nsegmental bronchi.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrate a 19 mm\nheterogeneously hyperenhancing left thyroid nodule with calcifications.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates scattered\nhypodensities in the liver measuring up to 13 mm in the right lobe (301:166),\nlikely cysts.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Mild fusiform dilatation of the ascending aorta measuring up to 4.2 cm. \nNo evidence for aortic dissection.\n3.  Mildly dilated main pulmonary artery may be seen with pulmonary arterial\nhypertension.\n4.  19 mm heterogeneously enhancing left thyroid lobe nodule for which\ncorrelation with thyroid ultrasound is recommended.\n5.  Bilateral calcified pulmonary nodules are compatible with prior\ngranulomatous disease.\n6.  Focal area of bronchiectasis in the left upper lobe may be the sequela of\nprior infection.\n7.  19 mm left thyroid nodule.  Further evaluation with dedicated thyroid\nultrasound is recommended.\n\nRECOMMENDATION(S):  Thyroid ultrasound.\n\nNOTIFICATION:  Findings regarding the thyroid nodule was discussed with Dr. \n___, M.D. by ___, M.D. on the telephone on ___\nat 11:55 pm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Minimal calcification of the head\nand neck vessels.  2 mm hypodense nodule in the left lobe of the thyroid gland\n(5:12).  There is no supraclavicular, infraclavicular or axillary\nlymphadenopathy.  Soft tissues of the chest wall are grossly unremarkable.\n\nUPPER ABDOMEN: Although this exam is not optimized for evaluation of\nsubdiaphragmatic structures, punctate hypodensity at the liver dome is too\nsmall further characterize, though most consistent with a simple cyst.  Please\nrefer to separate, same-day CT abdomen report for further description of\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Multiple subcentimeter anterior mediastinal lymph nodes are not\npathologically enlarged.  No subcarinal or posterior mediastinal\nlymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac chambers are normal in size.  There is minimal\ncoronary artery calcification.  No appreciable valvular calcification.  There\nis no pericardial effusion.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Mild right apical pleural-parenchymal scarring.  No concerning\npulmonary nodules or masses.  No confluent airspace consolidation.  No diffuse\nlung disease.  There is mild dependent bibasilar atelectasis.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level\nbilaterally.\n3. VESSELS:  The aorta and main pulmonary artery are normal in size.  On this\nnondedicated examination, there is no central pulmonary embolus identified.\nBONES: Mild degenerative changes of the thoracic spine.  No focally\ndestructive lesions within the chest cage or imaged thoracic spine.  No\npathologic or compression fractures.",
            "output": "1. No intrathoracic lymphadenopathy. No concerning pulmonary nodules or\nmasses.\n2. Please refer to separate, same-day CT abdomen and pelvis report for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE:  Again seen are acute pulmonary emboli, involving the\nright middle and lower lobar pulmonary arteries.  Additional embolus in 2\nsubsegmental branches in the lingula, and in 2 segmental branches in the right\nupper lobe.  .  No evidence of right heart strain.  Main pulmonary artery is\nnormal size.  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  Moderate bilateral nonhemorrhagic pleural effusion.  No\npneumothorax.\n\n\nLUNGS/AIRWAYS:  There are multiple foci of peripheral ground glass opacity in\nthe right upper lobe, with subpleural distribution, suggestive of pulmonary\ninfarcts.  Given distribution, infection is less likely, cannot be excluded. \n.  Bibasilar atelectasis.  There is a 0.5 cm nodule in the left lung apex\n(___).  0.4 cm subpleural nodule left upper lobe image 33 series 5.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrate diffuse\nascites, similar compared with ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild multilevel degenerative changes of the imaged spine.",
            "output": "1. Acute pulmonary emboli.\n2. Peripheral ground-glass opacities in the right upper lobe laterally, may\nrepresent pulmonary infarcts, less likely pneumonia.\n3. 2 lung nodules, larger measures 0.5 cm.\n\nNOTIFICATION:  Findings discussed with MD ___ at 911 pm on ___ by MD ___, 10 min after discovery of the findings"
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: A 2.5 cm hypoattenuating nodule is\nagain seen in the posterior right lower thyroid lobe (06:45).  A subcentimeter\nnodule is also noted in the left thyroid lobe (06:32).  There is no\nsupraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. There are moderate coronary\nartery calcifications of the LAD.  The thoracic aorta is normal in caliber.\nThere is no pericardial effusion.\n\nPLEURA: There are small dependent bilateral pleural effusions, left greater\nthan right.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Moderate atelectasis in the bilateral lower lobes is worse. \nMultiple bilateral solid pulmonary nodules are not significantly changed in\nsize and measure up to 7 mm in the lateral left upper lobe (6:80).  Smaller\nnodules in the left upper lobe are also seen (6:50 84).  Right-sided nodules\nmeasure up to 5 mm in the anterior right upper lobe (6:103, ___, 131).\n2. AIRWAYS: An endotracheal tube terminates approximately 3.5 cm above the\ncarina.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits. No\ncentral pulmonary embolism.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA well-circumscribed subcentimeter hypoattenuating lesion in the left lower\npole (08:34) is too small to characterize, but likely represents a cyst. \nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: A transesophageal enteric tube terminates in the stomach. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon and rectum are within normal limits.  The appendix is\nnormal.\n\nPELVIS:\n\nThe urinary bladder is collapsed around a Foley balloon.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There are no pathologically enlarged abdominal or pelvic lymph\nnodes.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is an area of chondroid-appearing calcification\nin the medullary space of the left proximal humerus (6:65), which likely\nrepresents an enchondroma.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1. Several bilateral solid lung nodules measuring up to 7 mm in the left upper\nlobe are nonspecific and may represent granulomas.  Comparison with any old\nprior chest imaging would be helpful.  If there is no established history of\nmalignancy, recommend follow-up chest CT in ___ months and in ___ months, as\ndetailed below.\n2. No evidence for a primary malignancy.\n3. Moderate atelectasis in the bilateral lower lobes.\n4. Redemonstration of 2.5 cm nodule in the posterior right thyroid lobe.  If\nnot previously evaluated, recommend nonemergent thyroid ultrasound.\n5. Probable enchondroma in the left proximal humerus.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nLeft ventricular assist device hardware is seen, including a catheter\nterminating in the left ventricle adjacent to the aortic valve. Additional\ncatheters are identified within the aorta, right ventricle and inferior vena\ncava. Multiple mediastinal drains are also present. There is associated\npneumomediastinum. There is a small pericardial effusion. The aorta and its\nmajor branch vessels are patent, with no evidence of stenosis, occlusion,\ndissection, or aneurysmal formation. There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  A\nfilling defect is seen in the distal left pulmonary artery with extension of\nthe thrombus into the lingular segmental and subsegmental pulmonary arteries,\nas well as left lower lobe segmental pulmonary arteries (series 6, image 102\nthrough 107). No filling defects are seen on the right. The main and right\npulmonary arteries are normal in caliber, and there is no evidence of right\nheart strain.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: There are\nsmall right and trace left nonhemorrhagic pleural effusions.  There is\nassociated compressive atelectasis bilaterally.  There is a small pneumothorax\nseen at the left lung apex (series 5, image 18).\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification. The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Multiple drains are also seen at the base of the neck.  There is\na small 4 mm hypodense nodule in the right thyroid.  An endotracheal tube\nterminates approximately 5 cm above the carina.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a homogeneously enhancing lesion hepatic VII that measures 1.1 x 1.2\nx 1.0 cm (series 7, image 11) with surrounding  hypodensity.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains contrast and is otherwise normal.  There is a small amount of\nnonhemorrhagic perihepatic ascites that tracks inferiorly along the descending\ncolon.  There is also a small amount of retroperitoneal fluid tracking along\nthe right  psoas muscle.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Two accessory spleens are noted.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A nasogastric tube is curled in the gastric fundus.  The\nstomach is otherwise unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  Ascending colonic wall\ndemonstrates mild  fatty infiltration , which may be representative of chronic\ninflammation.  There is a small amount of stool throughout the colon, the\ncolon is mostly decompressed. The appendix is not visualized.  Small volume\nnonhemorrhagic ascites tracks along the liver and ascending colon. \nRetroperitoneal nonhemorrhagic fluid tracks along the right psoas muscle.\n\nPELVIS: A Foley catheter is present in a decompressed bladder with associated\nintravesicular air.  There is trace nonhemorrhagic pelvic free-fluid.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: A right femoral venous line extends through the IVC and into the\nright atrium.  There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: The patient is status post median sternotomy and the\nsternal wires appear intact.  There are no worrisome osseous lesions or\nevidence of acute fracture.\n\nThere is diffuse anasarca.  There are small bilateral fat-containing inguinal\nhernias.",
            "output": "1. Pulmonary emboli in the left main pulmonary artery with extension into left\nupper lobe and left lower lobe segmental branches.  No evidence of right heart\nstrain.  No right-sided pulmonary embolism.\n2. Small left apical pneumothorax.\n3. Small right and trace left nonhemorrhagic pleural effusions with associated\ncompressive bibasilar atelectasis.\n4. Status post LVAD placement with multiple mediastinal drains and associated\npneumomediastinum.  The left ventricular catheter terminates adjacent to the\naortic valve.\n5. A rounded 1 cm area of enhancement in hepatic segment VII may represent a\nhemangioma, hemorrhage, or ischemia. Follow-up non urgent liver imaging is\nrecommended to evaluate for stability and better characterization.\n6. An enteric tube is curled in the gastric fundus.\n7. Small volume non hemorrhagic ascites and retroperitoneal fluid.\n8. Diffuse anasarca.\n\nRECOMMENDATION(S):  Non urgent follow-up liver CT or MRI to re-evaluate the\nhepatic segment VII lesion.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:23 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "CHEST:\nThere is a Swan-Ganz catheter in place, the tip terminates within the right\nmain pulmonary artery.  There are multiple surgical clips in the mediastinum.\n\nThere are foci of air within the anterior chest wall subcutaneous tissue and\npectoralis musculature, new since prior..  There are sternotomy wires in\nplace.  Few air bubbles anterior and superior to the very upper margin of the\nmanubrium, adjacent mild stranding, may be reactive, may be postsurgical,\ndeveloping infection cannot be excluded, clinically correlate.  Underlying\nosseous structures are preserved, no destruction or erosion.  There is trace\nlower retrosternal fluid without air.\n\nAn endotracheal tube is in place and terminates 3-4 cm above the carina. \nThere is complete consolidation of the left lower lobe, similar to prior with\npredominantly open bronchial tree.  Right lower lobe atelectasis has\ndecreased.  There are patchy opacities in the right lower lobe laterally, may\nrepresent improvement from prior atelectasis, component of infection is\npossible.  Small area of atelectasis or infiltrate in the lingula.  Tiny\ncentrilobular nodules in seen in the posterior segment left upper lobe, left\nlung apex, right lung apex, mildly improved since prior, may represent mucoid\nimpaction, aspiration, infection.\n\nHeart size is normal.  There is no evidence of aortic aneurysm or enlarged\npulmonary artery.  There is similar pericardial opacification at the site\nprior LV assist device placement, and device has been removed in the interim.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent. No mediastinal mass.  There are several prominent mediastinal lymph\nnodes which may be reactive.\n\nPLEURAL SPACES: Small bilateral pleural effusions.  There is no pneumothorax.\n\n\nABDOMEN:\nThere is an enteric tube in place with tip terminating in the stomach.  There\nis a Dobbhoff tube in place with tip terminating within this first portion the\nduodenum.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSegment 7 lesion is not seen due to lack of contrast.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ncontrast.  There is no calcified gallstone.  There is minimal nonhemorrhagic\nperihepatic ascites which is decreased from prior.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nperipancreatic stranding.\n\nSPLEEN: There wedge-shaped zones of decreased attenuation throughout spleen,\nnew since prior, consistent with splenic infarcts\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber.  Large bowel\nand appendix are normal.  A rectal tube is in place.\n\nPELVIS: A Foley catheter is present in a decompressed bladder with associated\nintravesicular air.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: there is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: No soft tissue mass.  There are no worrisome osseous\nlesions or evidence of acute fracture.  Fat only containing bilateral inguinal\nhernias.  Epicardial pacer wires.\n\nThere is mild diffuse improved anasarca.",
            "output": "New splenic infarcts.\n\nSmall pleural effusions.  Bilateral lower lobe consolidations, largely from\natelectasis, component of pneumonia in the left lower lobe cannot be excluded,\nis probably unlikely given significant volume loss and predominant appearance\nof atelectasis.\n\nSmall areas of opacity in the right lower lobe, lingula, may represent\natelectasis or pneumonia.  Small centrilobular nodules in the upper, posterior\nlobes are less prominent, may represent mucoid impaction, aspiration,\npneumonia.\n\nSmall area with few air bubbles and trace fluid along the anterior, upper\nmargin of the manubrium, may represent postsurgical change from recent drain\nplacement, clinically correlate to exclude infection.  Adjacent osseous\nstructures are normal.  Anterior chest wall emphysema, likely postsurgical."
        },
        {
            "input": "CHEST:\nThere is a Swan-Ganz catheter in place, the tip terminates within the right\nmain pulmonary artery.  There are multiple surgical clips in the mediastinum.\n\nThere are foci of air within the anterior chest wall subcutaneous tissue and\npectoralis musculature, new since prior..  There are sternotomy wires in\nplace.  Few air bubbles anterior and superior to the very upper margin of the\nmanubrium, adjacent mild stranding, may be reactive, may be postsurgical,\ndeveloping infection cannot be excluded, clinically correlate.  Underlying\nosseous structures are preserved, no destruction or erosion.  There is trace\nlower retrosternal fluid without air.\n\nAn endotracheal tube is in place and terminates 3-4 cm above the carina. \nThere is complete consolidation of the left lower lobe, similar to prior with\npredominantly open bronchial tree.  Right lower lobe atelectasis has\ndecreased.  There are patchy opacities in the right lower lobe laterally, may\nrepresent improvement from prior atelectasis, component of infection is\npossible.  Small area of atelectasis or infiltrate in the lingula.  Tiny\ncentrilobular nodules in seen in the posterior segment left upper lobe, left\nlung apex, right lung apex, mildly improved since prior, may represent mucoid\nimpaction, aspiration, infection.\n\nHeart size is normal.  There is no evidence of aortic aneurysm or enlarged\npulmonary artery.  There is similar pericardial opacification at the site\nprior LV assist device placement, and device has been removed in the interim.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent. No mediastinal mass.  There are several prominent mediastinal lymph\nnodes which may be reactive.\n\nPLEURAL SPACES: Small bilateral pleural effusions.  There is no pneumothorax.\n\n\nABDOMEN:\nThere is an enteric tube in place with tip terminating in the stomach.  There\nis a Dobbhoff tube in place with tip terminating within this first portion the\nduodenum.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSegment 7 lesion is not seen due to lack of contrast.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ncontrast.  There is no calcified gallstone.  There is minimal nonhemorrhagic\nperihepatic ascites which is decreased from prior.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nperipancreatic stranding.\n\nSPLEEN: There wedge-shaped zones of decreased attenuation throughout spleen,\nnew since prior, consistent with splenic infarcts\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber.  Large bowel\nand appendix are normal.  A rectal tube is in place.\n\nPELVIS: A Foley catheter is present in a decompressed bladder with associated\nintravesicular air.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: there is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: No soft tissue mass.  There are no worrisome osseous\nlesions or evidence of acute fracture.  Fat only containing bilateral inguinal\nhernias.  Epicardial pacer wires.\n\nThere is mild diffuse improved anasarca.",
            "output": "New splenic infarcts.\n\nSmall pleural effusions.  Bilateral lower lobe consolidations, largely from\natelectasis, component of pneumonia in the left lower lobe cannot be excluded,\nis probably unlikely given significant volume loss and predominant appearance\nof atelectasis.\n\nSmall areas of opacity in the right lower lobe, lingula, may represent\natelectasis or pneumonia.  Small centrilobular nodules in the upper, posterior\nlobes are less prominent, may represent mucoid impaction, aspiration,\npneumonia.\n\nSmall area with few air bubbles and trace fluid along the anterior, upper\nmargin of the manubrium, may represent postsurgical change from recent drain\nplacement, clinically correlate to exclude infection.  Adjacent osseous\nstructures are normal.  Anterior chest wall emphysema, likely postsurgical."
        },
        {
            "input": "CHEST PERIMETER: 6 mm low-attenuation lesion in the left lobe of the thyroid\nis not large enough to warrant further imaging evaluation.  4 mm\nsupraclavicular lymph nodes are not pathologically enlarged.  Evaluation of\nthe breasts including the 3.5 cm wide high attenuation fluid or\nwell-circumscribed, low-attenuation solid lesion in the right breast,\nsurrounded by vascular clips is reserved for mammography.  There are no soft\ntissue abnormalities elsewhere in the chest wall concerning for malignancy.\n\n\nCARDIO-MEDIASTINUM:The eccentric lumen at the level of the gastroesophageal\njunction could be an epiphrenic diverticulum.  Above that level the mid\nesophagus is moderately patulous, otherwise unremarkable.\n\nAtherosclerotic calcification is not apparent head and neck vessels or\ncoronary arteries in the aortic valve is not calcified.  Aorta and pulmonary\narteries and cardiac chambers are normal size and small pericardial effusion\nis physiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged, ranging up to 12 mm at the upper pole of the right hilum.\n\nLUNGS, AIRWAYS, PLEURAE: Bilateral nonhemorrhagic pleural effusions layer\nposteriorly, moderate on the right, small on the left.  There is no pleural\nnodulation or thickening.\n\nA wedge-shaped area of heterogeneous, high attenuation consolidated lung in\nthe right middle lobe could be atelectasis.  However it lies just adjacent to\nthe right chest wall lesion, and it is important to correlate possible lung\ncomplication with a history of the chest wall lesion, not provided with this\nrequest.\n\nRelaxation atelectasis is severe in both lower lobes involving all the basal\nsegments and most of the superior segment on the right.  Lungs are otherwise\nclear.\n\n\n\nCHEST CAGE: No evidence of infection or malignancy.",
            "output": "Layering nonhemorrhagic pleural effusions, moderate on the right, small on the\nleft.  No other pleural abnormality.\n\nLarge region of atelectasis, infection, or hemorrhage, lateral segment right\nmiddle lobe.  Lesion is adjacent to a well-circumscribed fluid collection or\nlow-attenuation mass in a region of prior surgery in the right breast.\n\nRECOMMENDATION(S):  Mammographic evaluation and clinical correlation right\nbreast and lung lesions."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is within\nnormal limits.  There is no supraclavicular or axillary lymphadenopathy. \nPostsurgical changes within the right breast including presence of a\ncollection measuring approximately 3.8 x 2.5 cm in size surrounded by surgical\nclips noted.\n\nUPPER ABDOMEN: 5.6 cm subcapsular splenic fluid collection has improved\ncompared to prior (series 4; image 189), previously 8.7 cm.  Proximal aspect\nof a double-J stent is seen within the left renal pelvis\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is a new trace right and large left-sided pleural effusion,\nwhich appears serous in nature.\nLUNG:\n\n1. PARENCHYMA:  There is mild pleuroparenchymal scarring at the right lung\napex.  There is adjacent compressive atelectasis of the left lower lobe.  The\nsubsegmental atelectasis in the right lower lobe.  These findings are\nconcerning for underlying mass.\n2. AIRWAYS:  Airways remain patent to the subsegmental level.  There is no\ncentral, incidentally noted pulmonary embolus.\n3. VESSELS:  Main, right main, and left main pulmonary arteries are normal in\nsize.\nCHEST CAGE: No acute compression deformity is seen of the thoracic spine. \nThere are no concerning sclerotic or lytic lesions",
            "output": "1. Large left pleural effusion with resultant left lower lobe atelectasis. \nSmall right pleural effusion with right basilar subsegmental atelectasis.  No\nunderlying mass identified.\n2. Persistent but smaller subcapsular splenic fluid collection.\n3. Unchanged hypodense collection with adjacent clips in the lateral right\nbreast, likely postoperative."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  There is\nevidence of prior right axillary lymphadenectomy.  A small seroma seen in the\nright axillary region\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  There are no\nenlarged hilar lymph nodes.  Heart size is normal.  There is no pericardial\neffusion.  There is no coronary artery calcification\n\n\nPLEURA: There are small bilateral pleural effusions the left pleural effusion\nhas significantly decreased in volume since the prior study, status post\nplacement of a left-sided pigtail catheter.  Stable small right pleural\neffusion.  Small pneumothorax is seen on the left.\n\nLUNG: Consolidative opacity in the left lower lobe represents subsegmental\natelectasis.  There is subsegmental atelectasis in the right lung base.  There\nare scattered bands of atelectasis in the right middle lobe and both lower\nlobes.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows stable small\nsub skull capsular splenic fluid collection.",
            "output": "Status post placement of a left-sided pigtail catheter.  Left pleural effusion\nhas significantly improved.  Small left-sided pneumothorax and subsegmental\natelectasis in the left lower lobe.\n\nStable small right pleural effusion.\n\nFew scattered bilateral parenchymal opacities which are most likely\ninflammatory.\n\nStable subcapsular perisplenic fluid collection."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\nMinimal anterior mediastinal soft tissue density likely reflects thymic\nhyperplasia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Focal heterogeneous hypo dense consolidative opacity in the\nright lower lobe is concerning for an area of pneumonia.  3 mm left lower lobe\npulmonary nodule (3:126), and 2 mm right lower lobe pulmonary nodule (3:132)\nare noted.  There is mild airway wall thickening.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Focal area of hypoattenuation within the right lower lobe concerning for\npneumonia.\n3. Mild airway wall thickening suggestive of mild bronchitis.\n4. Bilateral lower lobe pulmonary nodules measuring up to 3 mm.  Please see\nrecommendations below.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass.  There are multiple hilar lymph nodes measuring\n18 x 15 mm (4:94) and 11 x 9 mm (4:117) on the right, and up to 15 x 12 mm on\nthe left (4:11).  Findings are likely in keeping with history of sarcoidosis.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Minimal bibasilar dependent atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a tiny hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Small bowel loops are dilated up to 3.2 cm with fecalization\nand a transition point in the right lower quadrant (700:49, 5:53).  Findings\nare compatible with a small bowel obstruction.  There is no bowel wall\nthickening, pneumatosis or abnormal enhancement to suggest ischemia. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding.  The appendix is normal.\n\nSmall amount of perihepatic, mesenteric, and pelvic free fluid.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.  No gross\nadnexal masses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is mild grade ___ mm anterolisthesis of L4 on L5. \nMild rectus diastasis is noted.  Otherwise the the abdominal and pelvic wall\nis within normal limits.",
            "output": "1. Small-bowel obstruction with a transition point in the right lower quadrant\n(700:49, 5:53).  Associated small amount"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is severe cardiomegaly with moderate to severe\ncoronary artery atherosclerotic calcifications.  Reflux of contrast is seen in\nthe hepatic veins.  Otherwise, the pericardium and great vessels are within\nnormal limits. No large pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is extensive mediastinal lymphadenopathy\nwith multiple enlarged lymph nodes measuring up to 1.4 cm in the right lower\nparatracheal station and 1.2 cm in the left prevascular station (2:35 and\n2:30).  Otherwise, there is no axillary or hilar lymphadenopathy is present. \nNo mediastinal mass.\n\nPLEURAL SPACES: There are moderate bilateral pleural effusions.  There is no\npneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse interstitial thickening and patchy\nground-glass opacities in the bilateral lungs, compatible with moderate\npulmonary edema.  Otherwise, there are no definite pulmonary masses.  There is\nmild peribronchial wall thickening and minimal atelectasis in the bilateral\nlower lobes.  Otherwise, the airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There are calcified granulomas in hepatic segment 7 (2:98) and the\nsplenic hilum (2:108).  There is focal narrowing at the origin of the celiac\nartery secondary to atherosclerotic calcifications, which appears patent\ndistally (2:103).  Otherwise, included portion of the upper abdomen is\nunremarkable.\n\nBONES/SOFT TISSUES: There is diffuse subcutaneous edema predominantly in the\nlateral and posterior chest wall.  There are age indeterminate endplate\nirregularities involving the inferior endplate of T6 and superior endplate of\nT7, likely representing a degenerative process (602:37).  There is no acute\nfracture.",
            "output": "1. Moderate pulmonary edema with moderate bilateral pleural effusions.\n2. No evidence of pulmonary embolism or acute thoracic aortic abnormality.\n3. Extensive mediastinal lymphadenopathy which may be reactive, however\nunderlying neoplastic process cannot be definitively excluded.  Short-term\ninterval follow-up with chest CT in ___ weeks is recommended after the\nresolution of the acute process.\n4. Severe cardiomegaly with moderate to severe coronary artery atherosclerotic\ncalcifications.\n5. Focal severe narrowing at the origin of the celiac artery, which otherwise\nappears patent distally.\n\nRECOMMENDATION(S):  Short-term interval follow-up with CT chest in ___ weeks\nafter the resolution of the acute process is recommended."
        },
        {
            "input": "The heart is mild-to-moderately enlarged.  Coronary artery calcification is\nmoderately extensive.\n\nAorta is mildly calcified and tortuous, but normal in caliber.  Central\npulmonary arteries are also normal in size.\n\nNew but trace pericardial effusion only.  Pleural effusions have resolved.\n\nLymphadenopathy in the chest has substantially decreased. For example a right\nlower paratracheal lymph node (2:20) now measures up to 22 x 12 mm in axial\n___, previously up to 25 x 18 mm.  A prevascular node, which previously\nmeasured 23 x 16 mm, now measures only up to 15 x 10 mm. Other nodes have also\ndecreased.\n\nThyroid is atrophic.  Signs of right vocal cord paralysis.\n\nSmall quantity of aerosolized debris in the upper trachea, but not even nearly\nocclusive.\n\nMild mosaic attenuation suggests vascular congestion, but more pulmonary edema\nhas resolved since the prior CT.  Mild patchy left posterior bronchovascular\nopacities suggest minor aspiration pneumonitis or perhaps bronchopneumonia. \nThese are less typical of atelectasis.  Mild background interstitial\nabnormalities in the upper lungs show no change.\n\nSmall capsular calcification again noted along the posterior margin of the\nliver.  Moderate vascular calcification.  Contrast is present in the partly\nvisualized large bowel.  Pancreas is atrophic calcifications consistent with\nchronic pancreatitis.\n\nThere are no suspicious bone lesions.  Narrowing and erosive change along the\nC6-C7 interspace appears unchanged, probably a fairly aggressive form of\ndegenerative change.",
            "output": "1.  Findings suggest very mild vascular congestion.  Substantial pulmonary\nedema has mostly resolved.  Minimal patchy of left posterior basilar opacities\nwhich could be seen with minor aspiration pneumonitis or bronchopneumonia. \nCorrelation with clinical circumstances is suggested.\n\n2.  Substantial decrease in lymphadenopathy.\n\n3.  Trace pericardial effusion, but not substantial.  Resolution of pleural\neffusions.\n\n4.  Small secretion/mucus in the upper trachea."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There is minimal dependent bibasilar atelectasis. \nOtherwise, there is no evidence of infection or malignancy.  There is no\nemphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: A comminuted completely displaced left midclavicular\nfracture with apex overriding is again visualized (3:8).  There is diffuse\nosteopenia.  There is no additional worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. No evidence of lung contusion or other pulmonary abnormality.\n2. Known displaced, comminuted left clavicular fracture again visualized."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Status post sternotomy.  Left pectoral pacemaker in\nsitu. Status post aortic valve replacement.  Moderate cardiomegaly and\ncalcification of the ascending aorta.  Moderate coronary calcifications.\nModerate cardiomegaly. Moderate nonhemorrhagic left-sided pleural effusion\nwith subsequent atelectasis of the left lower lobe.  Calcifications along the\nleft pericardium.  Mild hiatal hernia. No hilar lymphadenopathy. Several\nborderline to slightly enlarged lymph nodes in the mediastinum (2, 16).  No\nosteolytic lesions at the level of the ribs, the sternum and the vertebral\nbodies.  Mild bilateral apical thickening, symmetrical in distribution. The\nassessment of the lung parenchyma is limited by severe respiratory motion are\ndefects. Signs of mild chronic interstitial fluid overload. No suspicious\nmasses or nodules.  No evidence of diffuse lung disease.  The airways are\npatent.",
            "output": "Nonhemorrhagic left-sided pleural effusion with subsequent left lower lobe\natelectasis.  Mild mediastinal lymph node enlargement. Moderate cardiomegaly. \nModerate coronary calcifications.  Status post CABG and aortic valve\nreplacement."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart size\nis normal, and there is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nskeletal lesions.\n\nThe lungs are clear, and the airways are widely patent.",
            "output": "1.  No CT evidence of intrathoracic malignancy or active pulmonary infection.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is mild atelectasis or scaring in the upper lobe of the\nleft lung (2:50).  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is contains stones, without\nevidence of gallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix contains air, has normal caliber without evidence of fat stranding. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nright femoral rod is incompletely visualized.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute aortic abnormality or pulmonary embolism.  No\npneumothorax or pleural effusion.\n2. No free fluid in the abdomen or pelvis. No pneumoperitoneum.\n3. Cholelithiasis without evidence of acute cholecystitis.\n4. Normal appendix."
        },
        {
            "input": "HEART AND VASCULATURE: Thoracic aorta appears normal in course and caliber\nwith minimal atherosclerotic calcification noted.  The main pulmonary artery\nappears normal in caliber.  There is faint coronary artery calcification.  The\nheart is within normal limits of size.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary, mediastinal adenopathy. \nNo hilar mass or definite adenopathy seen.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lungs are clear without worrisome nodule, mass, or\nconsolidation seen.  No contusion or laceration.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe imaged portion of the thyroid is unremarkable.\n\nABDOMEN:  A small hiatal hernia is present.  Partially visualized mesenteric\nroot haziness with few scattered lymph nodes could suggest mesenteric\npanniculitis.  A tiny hypodensity within the right lobe, series 3, image 50 is\nnoted, not characterized.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDISH related changes of the T-spine noted.  Areas of calcification abutting\nthe humeral heads may reflect tendinopathy of the rotator cuff.",
            "output": "No rib fracture.  Incidental findings detailed above."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Several borderline sized lymph nodes in the left\nand right axillary region.  Severe calcifications of the aortic arch, moderate\ncalcifications of the ascending aorta and the descending aorta.  At the level\nof the main pulmonary artery, the ascending aorta has a diameter of 3.4 x 3.5\ncm.  At the same anatomical level, the descending aorta has a diameter of 2.1\nx 2.1 cm.  The diameter of the main pulmonary artery is at the upper range of\nnormal and averages 3 cm.  Severe aortic valve calcifications.  Severe\ncoronary calcifications.  Severe mitral valve calcifications.  No pericardial\neffusions.  The tortuosity of the descending aorta is moderate.  No hilar or\nmediastinal lymphadenopathy.  Small hiatal hernia.  No acute abnormalities in\nthe upper abdomen.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  No osteolytic lesions at the level of the ribs and the\nsternum.  Old healed right-sided rib fractures.\n\nMild to moderate to severe pulmonary emphysema.  Mild bilateral apical\nscarring.  Non characteristic scars at the bases of the left upper lobe, as\nwell as at the bases of the lingular.  Moderate to severe chronic airways\ndisease, as manifested by airway wall thickening and airway well\nirregularities, 12 has mild mucous plugging.  There is visualization of\nseveral mostly subpleural pulmonary nodules, for example in the right lower\nlobe (6, 157), all of which have benign appearance and do not exceed 4 mm in\ndiameter.  No pleural thickening, no pleural effusions.",
            "output": "Aortic ___ are reported above.  Moderate to severe aortic wall\ncalcifications.  Severe valvular and coronary calcifications.  Moderate to\nsevere pulmonary emphysema, associated with moderate to severe chronic airways\ndisease.  No acute lung parenchymal changes."
        },
        {
            "input": "The quality of the study is slightly decreased by motion artifact. Within this\nlimitation,\n\nCHEST:\n\nHEART AND VASCULATURE: Previously demonstrated bilateral segmental and\nsubsegmental pulmonary emboli are not clearly evident in today's study.  The\npulmonary vasculature appears well opacified at least to the segmental level\nwithout filling defect to indicate a pulmonary embolus at this level.  There\nis poor evaluation of the subsegmental pulmonary arterial branches in the\nright lower lobe due to motion.\n\nThe minimally calcified thoracic aorta is normal in caliber, without evidence\nof dissection or intramural hematoma.  The main pulmonary artery appears\nslightly dilated and measures approximately 3.4 cm, overall not substantially\nchanged from prior study.  Otherwise, the heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Bilateral trace pleural effusions, new since prior.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Surgical chain sutures seen along the left major fissure as on\nprior.  Upper lobe dominant emphysema with prominent bullae again noted. \nThere is mild bilateral dependent atelectasis, otherwise, lungs are without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Previously noted hypodense lesions throughout the liver have\nincreased in size and number.  For example, hypodense lesion in segment 7 now\nmeasures up to 5.2 cm, previously 1.8 cm (9:18).  A lesion in the left hepatic\nlobe previously measuring up to 1.8 cm now measures 3.5 cm (9:16).  Additional\nlesions are increased size and more conspicuous (9: 15, 18, 28, 28).  There is\nno intrahepatic biliary ductal dilatation.  Common bile duct measures up to 10\nmm, slightly increased from the prior study when it measured 7 mm.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Several bilateral cortical hypodensities are too small to\ncharacterize, but are largely unchanged from the prior study and may represent\ncysts.  Otherwise, the kidneys are of normal and symmetric size with normal\nnephrogram.  There is no evidence of focal renal lesions or hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  There is no free intraperitoneal fluid or\nfree air.  Appendix not visualized.\n\nPELVIS:\n\nThe urinary bladder is mildly distended.  The distal ureters are unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is a new compression fracture of the of the T8\nvertebral body with surrounding paraspinal soft tissue swelling.  Again\ndemonstrated are numerous primarily sclerotic lesions throughout the axial and\nimaged appendicular skeleton.  There is apparent increased soft tissue density\nwithin the canal anteriorly at the T10 level and likely affecting at T9 as\nwell.\n\nA 4.7 cm fatty lesion in the right posterior subcutaneous tissues, likely\nwithin the right trapezius muscle is compatible with a lipoma (5:6), largely\nunchanged from the prior study.\n\nThere is a small left fat containing inguinal hernia.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Near complete resolution of the previously demonstrated pulmonary emboli. \nOf note right lung base subsegmental branches are not well assessed due to\nmotion.\n2. Diffuse mixed lucent and sclerotic osseous metastases as seen previously\nwith pathologic fracture of the T8 vertebral body, new from prior study.\n3. Suggestion of soft tissue extension of metastatic vertebral body lesions\ninto the canal most notably at T9 and T10 though this would be best assessed\nby MRI.\n4. Progression of metastatic liver lesions.\n5. No signs of bowel obstruction or other acute intra-abdominal process."
        },
        {
            "input": "The imaged base of neck including the thyroid gland appears normal. The\nthoracic aorta is ectatic and tortuous with mild calcification.  Aortic\nvalvular calcification is also noted with top-normal heart size.  No\npericardial or pleural effusion is seen.  Main pulmonary artery is mildly\nenlarged at 3.2 cm in diameter.  There is no mediastinal mass or adenopathy. \nNo axillary or definite hilar adenopathy.  Diffuse bronchial wall thickening\nsuggestive of chronic airways inflammation.\n\nThere is severe paraseptal and centrilobular emphysema.  There is a left upper\nlobe nodule best seen on series 5 image 120 measuring 9 x 11 mm, previously 8\nx 7 mm.  Previously described nodularity in the inferior lingula appears less\nconspicuous on today's exam.  No new pulmonary nodule, mass, or consolidation.\n\nIn the imaged upper abdomen, no discrete abnormality is identified.\n\nBones/soft tissues:  Diffuse bony sclerosis is consistent with known diffuse\nmetastatic disease in the setting of prostate cancer.  No pathological\nfracture is identified.  A lipoma is noted deep to the right latissimus\nmuscle.",
            "output": "1. Severe emphysema with growing nodule, now measuring 9 x 11 mm, in the left\nupper lobe concerning for primary malignancy.\n2. Diffuse osseous metastatic disease in the setting of known metastatic\nprostate cancer.\n3. Prominence of the main pulmonary artery, likely reflect pulmonary arterial\nhypertension.\n4. Chronic airways disease."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, particularly\nevaluation of the liver and kidneys, but shows there is no adrenal mass.\n\nEsophagus is mildly patulous in the upper third, but there is no obstruction.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is minimal in head and neck vessels, but not\napparent in the coronary arteries.  The brachiocephalic artery is diffusely\nenlarged, 20 mm in maximum diameter, unchanged.  Aorta and pulmonary arteries\nare normal size.  Pericardium is physiologic.  There is no pleural effusion.\n\nThoracic lymph nodes:\n\nNo adenopathy, according to criteria of size and morphology.\n\nLungs and airways:\n\nEmphysema is severe.  There are no abnormalities in the right lung concerning\nfor infection or malignancy.\n\nThe site of wedge resection in the left upper lobe has a normal postoperative\nappearance.  Left lower lobe is unremarkable.\n\nChest cage:\n\nDespite widespread osseous metastasis, there is no compression or pathologic\nfracture or large destructive bone lesion.  Overall, compared to ___,\nmuch of the previous global blastic metastasis has grown less so, for example\nin the manubrium.",
            "output": "Normal postoperative appearance, following wedge resection, left lung cancer. \nNo evidence of local recurrence or complications.\n\nSevere emphysema.\n\n Unexplained reversion of blastic skeletal metastases from prostate carcinoma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland is homogeneous.\n\nUPPER ABDOMEN: Limited views of the upper abdomen are remarkable for a\nsubcentimeter hypodensity in the right hepatic lobe, which is unchanged since\nthe prior study in ___.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The cardiac size is mildly prominent but unchanged. \nThere is no pericardial effusion\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Postsurgical changes are seen in the left upper lobe following\nwedge resection.  No new suspicious pulmonary nodules identified.  Again seen\nis severe paraseptal and centrilobular emphysema with upper lobe predominance.\n2. AIRWAYS:  The airways are centrally patent.\n3. VESSELS:  There is no enlargement of the thoracic aorta.  The main\npulmonary artery is mildly enlarged, measuring 3.3 cm (4:112), which can be\nseen in pulmonary artery hypertension.  There is no central pulmonary embolus.\nCHEST CAGE: There is again reversion of previously sclerotic lesions in the\nthoracic spine, ribs, and sternum, likely from treatment of known prostate\ncancer metastasis.",
            "output": "1. Expected postsurgical changes again seen in the left upper lobe following\nwedge resection.  No new suspicious pulmonary nodules identified.\n2. Stable upper lobe predominant severe paraseptal and centrilobular\nemphysema.\n3. Reversion of blastic osseous metastasis is likely from treatment of known\nprostate cancer."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Dilatation of main pulmonary\nartery up to 3.5 cm is demonstrated that might be concerning for pulmonary\nhypertension.  Heart size is normal.  There is no pericardial or pleural\neffusion.\n\nImage portion of the upper abdomen demonstrate diffuse thickening of the left\nadrenal but otherwise is unremarkable.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is extensive and continues to the subsegmental level.  Severe\ncentrilobular and bullous emphysema is bilateral.  The patient is after wedge\nresection of the left upper lobe with stable appearance of the surgical\nchange.  No new pulmonary node solid a shins demonstrated.\n\nDiffuse decreased density of the bones with some more focal focal areas of\nhypodensity is demonstrated in the image portion of the spine, similar to\nprevious examination.  It also involves the sternum and ribs bilaterally to\nlesser extent.\n\nPosterior right upper back lipoma is 2.5 x 5 cm, series 3, image 7.",
            "output": "Overall stable appearance of the lungs including severe emphysema, post wedge\nresection in the left upper lobe and pulmonary artery dilatation consistent\nwith pulmonary hypertension.\n\nDiffuse osteopenia as described with some focal lytic lesions, concerning for\npotentially additional process on the top of osteopenia, correlation with bone\nscan and  laboratory workup is recommended\n\nRight upper back lipoma, 5 cm."
        },
        {
            "input": "HEART AND VASCULATURE: The ascending thoracic aorta is aneurysmal measuring\n4.1 cm, unchanged.  Mild calcified atherosclerotic plaque seen at the aortic\narch and descending thoracic aorta.  Main pulmonary artery remains enlarged\nmeasuring up to 3.3 cm, unchanged from prior.  There is no central pulmonary\nembolism.  Trace calcifications are noted at the aortic root.  There is no\npericardial effusion.  The heart, pericardium and great vessels are within\nnormal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary, mediastinal or hilar\nlymphadenopathy.  There is no mediastinal mass.\n\nPLEURAL SPACES: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patient is status post left upper lobe wedge resection with\nstable postsurgical changes and no evidence of local recurrence.  There is\nsevere centrilobular and bullous emphysema which is similar in comparison to\nthe prior exam.  There is a new 7 mm round pulmonary nodule in the right\nmiddle lobe (6:190).  Central airways are patent. There is mild bronchial wall\nthickening without evidence of dilation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please refer to the separately dictated CT abdomen/pelvis for full\ndescription of the subdiaphragmatic findings.\n\nBONES: There is a mottled appearance of the osseous spine and chest cage\nalthough no pathologic compression fracture or expanding osseous lesion is\nidentified.\n\nSOFT TISSUES: Posterior right upper back lipoma measures up to 5 cm,\nunchanged.",
            "output": "1. 7 mm right middle lobe nodule, new since ___, probable metastasis.\n2. Aneurysmal ascending thoracic aorta measuring 4.1 cm, unchanged.\n3. Stable enlarged main pulmonary artery which can be seen in the setting of\npulmonary arterial hypertension.\n4. Please refer to the separately dictated CT abdomen/pelvis for full\ndescription of the subdiaphragmatic findings.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 15:09 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Chest wall: There is extensive subcutaneous emphysema which is seen extending\ninto the neck, arms and abdominal wall.\n\nHEART AND VASCULATURE: The ascending thoracic aorta is ectatic, measuring up\nto 4.0 cm in diameter.  There is also mild prominence of the main pulmonary\ntrunk, measuring up to 3.1 cm.  Overall, appearance is unchanged in size\ncompared to prior chest CT.  No pericardial effusion or pneumopericardium.\n\nAXILLA, HILA, AND MEDIASTINUM: There is extensive pneumomediastinum.  No\naxillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion.  There is a mild to moderate sized right\npneumothorax without evidence of tension.\n\nLUNGS/AIRWAYS: Status post right middle lobe wedge resection with suture noted\nat the resection site.  Severe centrilobular and paraseptal emphysema is again\nseen.  Given presence of a right pneumothorax and history of recent right\nmiddle lobe wedge resection, findings are concerning for air leak at the\nresection site.\n\nNodular perifissural atelectasis at the inferior aspect of the left lower lobe\nis noted.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Better assessed on concurrently performed CT neck.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for\nextensive subcutaneous emphysema of the abdominal wall.\n\nBONES: Redemonstration of mottled appearance of the visualized bony\nstructures, including the vertebral bodies, ribs, and clavicles, which may\nrepresent osseous disease from patient's known metastatic prostate cancer. \nThere appears to be bony expansion of the right L1 transverse process causing\nmild focal canal narrowing (series 302, image 246), unchanged from prior. \nThere is no acute fracture.\n\nOTHER: Slight interval growth of right posterior chest wall lipoma, currently\n5.6 cm (series 2, image 15), previously 5.0 cm.",
            "output": "1. Extensive subcutaneous emphysema involving the body wall extending into the\narms and neck, with pneumomediastinum and moderate right pneumothorax (no\ntension).  Given history of recent wedge resection in the right middle lobe,\nfindings are most concerning for air leak at the resection site with gas\ntracking into the body wall through the VATS entry site.\n2. Slight interval growth of right posterior chest wall lipoma.\n3. Mottled appearance of visualized bony structures, likely secondary to\nosseous involvement by metastatic prostate cancer, with expansion of the right\nL1 transverse process.  No acute fractures.\n\nRECOMMENDATION(S):  Right chest tube.\n\nNOTIFICATION:  Findings were discussed in person with Dr. ___ time of\ninitial review."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal. Supraclavicular\nand axillary nodes are not enlarged.  Previous extensive subcutaneous air is\nnow resolved.\n\nMEDIASTINUM: Sub-centimeter left lower paratracheal lymph nodes (5:64, 5:111)\nare of uncertain chronicity due to extensive emphysema on prior study.  No\nmediastinal mass.  The ascending aorta is ectatic at 4 cm, without interval\ngrowth from ___.  The main pulmonary artery is of mildly enlarged at 3\ncm, also unchanged.  The esophagus is normal.  Previous pneumomediastinum has\nresolved.\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: The cardiac size is normal.  Moderate calcification of\nthe aortic annulus and coronary arteries, specifically the LAD. Small\npericardial effusion is physiologic.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  The right pneumothorax has resolved. Severe upper lobe\npredominant centrilobular and paraseptal emphysema is again demonstrated. \nStaple lines noted from prior right middle and left upper lobe wedge\nresections.  No pulmonary nodules.\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The pulmonary vasculature are normal caliber.\nCHEST CAGE: Diffuse mottled appearance of the ribs, vertebral bodies and\nclavicles are unchanged and most consistent known metastatic prostate cancer. \nAgain demonstrated is bony expansion of the right L1 transverse process\ncausing mild focal canal narrowing (5: 255), largely unchanged from ___.\n\nUPPER ABDOMEN: The imaged portion of the abdomen is unremarkable.\nFindings below the diaphragm will be reported separately.",
            "output": "Status post left upper and right middle lobe wedge resections with no evidence\nof local recurrence.  No new pulmonary nodules.  Stable bony metastases with\nunchanged mild vertebral canal narrowing at the level of L1.\n\nInterval resolution of significant subcutaneous air and pneumomediastinum."
        },
        {
            "input": "Chest CTA: Predominantly segmental and subsegmental filling defects are noted\nwithin the right lower lobe and within the right middle lobe.  There is\nenlargement of the main pulmonary artery which measures approximately 3.4 cm\nin diameter suggesting pulmonary arterial hypertension.  There is slight\nflattening of the interventricular septum which may also indicate acute right\nheart strain.  The heart is mildly enlarged.  The thoracic aorta is slightly\nunfolded with mild atherosclerosis.  No aortic aneurysm though aortic ectasias\na is present.  The airway is centrally patent.  No lymphadenopathy.  The heart\nis normal in size and shape without pericardial effusion.  No pleural effusion\nis seen.  Severe emphysema is noted with prominent bullae in the upper lungs. \nNo worrisome nodule, mass, or consolidation is seen.  Evidence of bronchial\nwall thickening likely reflects chronic airways inflammation though there is\nfocal area of mucous plugging in the left lower lobe on series 4 image 146. \nSuture in the right anterior lung base.\n\nCT abdomen: Within the liver, new hypodense lesions are present for example in\nsegment 6 on series 5, image 26 measuring 1.8 x 2.3 cm and inferiorly in\nsegment 6 on series 5 image 37 measuring 14 x 15 mm.  A lesion in the left\nhepatic lobe is best seen on series 5, image 18 measuring 14 x 18 mm.  The\nlesions are new from prior.  Main portal vein is patent.  No intrahepatic or\nextrahepatic biliary ductal dilation.  The gallbladder is normal.  The spleen\nis normal.  The adrenals are normal bilaterally.  The kidneys enhance\nsymmetrically and contain several tiny cortical hypodensities which are too\nsmall to characterize.  There is no retroperitoneal lymphadenopathy.  No free\nair or free fluid.  The stomach and duodenum appear grossly unremarkable.\n\nCT pelvis: Small bowel loops demonstrate no signs of ileus or obstruction. \nThe appendix is not clearly visualized though there are no secondary signs of\nappendicitis.  Colonic diverticulosis is noted without definite signs of\ndiverticulitis.  The abdominal aorta is mildly calcified and tortuous though\nwithout aneurysm.  The urinary bladder is partially distended and appears\nnormal.  The prostate is not enlarged.  There is no pelvic sidewall or\ninguinal adenopathy.\n\nBones: Multiple sclerotic osseous metastatic lesions are again seen.  No\ndefinite signs of a pathologic fracture.",
            "output": "1.  Segmental and subsegmental pulmonary emboli in the right middle and lower\nlobes.  Evidence of right heart strain and pulmonary arterial hypertension. \nSevere emphysema.\n2.  Bronchial wall thickening with mucous plugging in the left lower lobe.\n3.  New liver hypodensities concerning for new metastatic disease.\n4.  Extensive osseous metastatic disease again noted."
        },
        {
            "input": "No supraclavicular, axillary, mediastinal, or hilar lymph node enlargement by\nCT size criteria.Calcified left hilar lymph node noted.   The thyroid gland is\nunremarkable.\n\nThe heart size is normal without pericardial effusion. Atherosclerotic\ncalcifications are seen within the thoracic aorta and coronary arteries. The\ngreat vessels are normal caliber.\n\nNo pleural effusion.No pneumothorax.  The airways are patent to the\nsubsegmental level.\n\nMild bilateral lower lobe atelectasis is present.  0.7 cm left upper lobe\ncalcified granuloma (2:20).\n\nOSSEOUS STRUCTURES:  Nondisplaced fracture of anterior right 7th rib\ncartilage. Nondisplaced fractures of anterior 8 through 10 ribs. Minimally\ndisplaced right anterior 11th rib fracture. Evidence of healed the left\nantrolateral rib fractures through ___ ribs and 12th rib. No lytic or\nblastic osseous lesions concerning for malignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen are notable for 1.9 x 1.6 and 1.3 x 1.3\ncm (2: 68, 77) left and right lower pole renal cysts.Tiny splenic\ncalcifications consistent with granulomata consistent with prior granulomatous\ndisease.",
            "output": "1. Acute minimally displaced right anterior 1th rib fracture and nondisplaced\nanterior ___ through 10th rib fractures. Nondisplaced fracture of anterior ___\nrib cartilage.\n2.  Old healed left anterolateral rib fractures as described above.\n3.  Evidence of previous granulomatous diease with calcified left hilar lymph\nnode, left upper lobe granuloma, and splenic granuloma."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Moderate hiatal hernia.  No adrenal lesions.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Mild calcification of the LAD.\nPLEURA: Trace left pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Multifocal\nperibronchovascular ground-glass opacities in the left upper lobe (for example\n5, 100) and lingula.  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  No interstitial lung disease.  No bronchiectasis. \nLinear/bandlike atelectasis in the posterior basal aspects of the lungs\nbilateral.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbone lesions.  Sclerotic lesion in the lateral aspect of the tenth right rib\nhas a benign appearance (3, 54).",
            "output": "Multifocal peribronchovascular ground-glass opacities in the left upper lobe. \nIn the absence of prior CT chest is impossible to determine whether these are\ndeveloping or resolving.  In this clinical setting consider at the top of the\ndifferential diagnosis atypical/viral lower respiratory tract infection."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no axillary or supraclavicular lymphadenopathy.  The visualized superficial\nsoft tissues are normal.\n\nUPPER ABDOMEN: There is a small right Bochdalek's hernia and a moderate hiatal\nhernia.  The visualized abdomen is otherwise unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  The aorta is normal\nin size.  There is mild prominence of the main pulmonary artery measuring up\nto 27 mm.  There is no coronary or aortic valvular calcification.\nPLEURA: There is no pleural abnormality or pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Subtle ground-glass nodules in the right lung are new or\nincreased (series 4, 106, 112, 118, 126, 132, 144, 196, 211, 158).  Trace left\nupper lobe ground-glass nodules (series 4, image 115, 133, 144) are\nsignificantly improved in comparison ___.\n-AIRWAYS:  The airways are patent the subsegmental level.\n-VESSELS:  Mild prominence the main pulmonary artery measuring 27 mm.\nCHEST CAGE: There are threaded screws in the head of the right humerus.  A\ndeformity of the left lateral ninth rib is consistent with prior trauma and a\ntiny sclerotic focus in the left lateral ninth rib (series 2, 41) likely\nrepresents a bone island.  There is a benign lesion in the lateral aspect of\nthe right tenth rib (series 7, 16), unchanged.",
            "output": "1.  Numerous new peribronchovascular ground-glass opacities in the right lung\nwith significant improvement or resolution of previously seen ground-glass\nopacities on the left.  Findings are concerning pneumonia, infectious or\naspiration, particularly given the patient's moderate hiatal hernia."
        },
        {
            "input": "The imaged portion of the thyroid gland is unremarkable.  There is central\nlymphadenopathy, which is not significantly changed from the prior study. A\nlymph node in the aortopulmonary window measures 1.4 x 1.2 cm (previously 1.3\nx 1.3 cm). Multiple small axillary and subpectoral lymph nodes bilaterally are\nnotable for number but not pathologically enlarged by CT size criteria and\nunchanged from ___.  The esophagus is unremarkable.  The thoracic\naorta is normal in caliber with a typical 3 vessel takeoff from the arch.  The\npulmonary arterial trunk is normal in caliber, measuring 2.4 cm in diameter\n(previously 2.3 cm).  The heart is top normal in size with dilation of the\nright atrium. Hypoattenuation of the cardiac chambers relative to the\nmyocardium suggests underlying The SVC and IVC are dilated. There is no\npericardial effusion.  Calcification of the pericardium along the right and\ninferior heart borders is unchanged.\n\nThe tracheobronchial tree is normal to the subsegmental levels. A small area\nof ___ opacities is seen in the base of the right upper lobe (4:89).\nThere is a 4 mm pulmonary nodule in the right upper lobe (4:86) and a 4.5 mm\npulmonary nodule in the lingula (4:144), which are unchanged from ___.  There is a moderate to large right pleural effusion, which is increased\nin size from ___. Fluid extends into the right major fissure and\nanteriorly at the lung base, as before. A small to moderate left pleural\neffusion is unchanged from the prior study, which is predominantly\nsubpulmonic. Again seen is an area of consolidation and volume loss in the\nparamediastinal right upper lobe with traction bronchiectasis consistent with\npost radiation changes. A linear coarse calcification in the lingula with\nadjacent peripheral nodular opacities are unchanged from the prior CT. There\nis chronic rounded atelectasis in the left lower lobe adjacent to the left\npleural effusion.  There is no interstitial edema.\n\nNo blastic or lytic lesion suspicious for malignancy is present.  The patient\nis status post median sternotomy with intact wires.\n\nAlthough this study is not tailored for the evaluation of subdiaphragmatic\ncontents, the imaged upper abdomen demonstrates trace perihepatic ascites.",
            "output": "1. Increased size of moderate to large right pleural effusion compared to ___.  No interstitial pulmonary edema.\n2. Unchanged small to moderate left pleural effusion with associated chronic\nrounded atelectasis in the left lower lobe.\n3. New small area of ___ opacities in the base of the right upper lobe\nmay represent infection or inflammation.\n4.  Stable post radiation changes in the paramediastinal right upper lobe.\nUnchanged coarse linear calcification and peripheral nodular opacities in the\nlingula.\n5. Stable central adenopathy."
        },
        {
            "input": "THORACIC INLET:Visualized portions of the base of the neck show no\nabnormality.   The visualized thyroid is normal.  Supraclavicular lymph nodes\nare not enlarged.  The esophagus is markedly distended with intraluminal\ningested content seen extending to the level of the thoracic inlet, decreased\nin extent compared to recent outside hospital CT chest (302: 42).\n\nTHORACIC LYMPH NODES:  No axillary, mediastinal, or hilar lymphadenopathy is\npresent.\n\nHEART, VESSELS and PERICARDIUM: AICD device is again seen in similar position.\nThere is mild cardiomegaly.  Coronary artery calcifications are severe.  There\nis mild calcification of the mitral annulus and aortic valve.  No pericardial\neffusion is seen.\n\nPLEURA: Small bilateral pleural effusions have increased in size compared to\n___.\n\nLUNG: Bilateral lower lobe consolidative opacities are progressed compared to\nprior exam.  There are areas of nodular opacification in the right middle lobe\nand left lung base which are new compared to prior exam (302:126, 144).  There\nis a 3 mm right perifissural nodule, not definitely seen on prior exam\n(302:91).  There is moderate bronchial wall thickening with mucous plugging at\nthe lung bases, progressed compared to prior exam.  Airways are otherwise\npatent to the level of the segmental bronchi bilaterally.\n\nCHEST WALL AND BONES: Postsurgical changes related to a median sternotomy are\nnoted.  Exaggerated thoracic kyphosis.  There is no worrisome lytic or\nsclerotic lesion.\n\nUPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Persistent distension of the esophagus with intraluminal ingested content\nseen extending to the level of the thoracic inlet.\n2. New small bilateral pleural effusions.\n3. Bilateral lower lobe consolidative opacities appear progressed compared to\nprior exam and may reflect atelectasis, however superimposed pneumonia would\nbe difficult to exclude.  This is associated with areas of nodular\nopacification in the right middle lobe and left lung base, which may reflect a\ndeveloping pneumonia and/or aspiration.\n4. Moderate bronchial wall thickening and mucous plugging at the lung bases\nappears progressed compared to prior exam.\n5. 3 mm right perifissural nodule.  Please refer to ___ criteria below\nfor follow-up recommendations.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nPostsurgical changes in the right axilla are due to lymphadenectomy in patient\nwith history of right breast cancer (series 2:image 19). Left internal jugular\nPort-A-Cath has tip ending in the lower SVC (series 2: Image 17). The Aorta\nand pulmonary arteries are normal size. Cardiac configuration is normal and\nthere is no appreciable coronary calcification.\n\nThere is no pericardial or pleural effusion.\nRight breast skin thickening might be due to radiation therapy.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  There are no lung\nnodules suspicious for malignancy or infection. Inhomogeneous appearance of\nthe lung parenchyma is likely due to are air trapping for suboptimal\ninspiratory level.\n\n\n\nUPPER ABDOMEN\nAbdominal findings are described in report of concurrent CT abdomen and pelvis\nclip ___.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. No evidence of active intrathoracic infection or malignancy.\n2. Right breast skin thickening might be related to radiation therapy and\nright surgical changes are due right axilla lymphadenectomy\n3. There are no lung nodules suspicious for malignancy infection.\n4. There is no central or peripheral lymphadenopathy\n5. Inhomogeneous appearance of the lung parenchyma is probably due to\nair-trapping"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patient is status post left lower lobe resection.  Bilateral\nbronchial wall thickening and mucous impaction, left worse than right, appears\nunchanged and in a similar distribution compared to ___.  Multiple areas\nof ___ and ground-glass opacification in the right lower and middle\nlobes appear more prominent compared to ___ and may represent a\ncomponent of acute on chronic small airways infection/inflammation (3:61, 127,\n136).  Branching nodular hyperdensities seen in the anterior and posterior\nleft lung measure 9 mm and 8 mm respectively (3:113, 121) and appear increased\nin size compared to most recent prior, likely representing worsening mucoid\nimpaction.  No evidence of a large focal consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrates\nmillimetric bilateral thyroid hypodensities.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Again demonstrated is moderate dextroscoliosis.  A superior endplate\ndeformity of the T12 vertebral body (602:38) appears chronic and is similar to\nprior exam.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Multiple scattered areas of ground-glass opacity in the right lower and\nmiddle lobes appear slightly more prominent compared to prior exam and may be\nsecondary to acute on chronic small airways infection/inflammation.  Attention\nat followup.\n3. Branching nodular hyperdensities in the anterior and posterior left lung\nappear increased in size compared to most recent prior and may represent\nworsening mucoid impaction, however given patient's clinical history of\npulmonary carcinoid, recommend repeat CT chest in 3 months for re-evaluation. \nAdditional areas of mucous impaction, left greater than right, are similar to\nprior.\n4. Bilateral bronchial wall thickening and bronchiectasis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nPostsurgical changes from previous left lower lobe resection are present. \nThere is bronchial wall thickening and mucous impaction of essentially all of\nthe left lower lobe segmental bronchi (3:142).  Bronchial wall thickening in\nthe right lower lobe is more mild.  In the right lung, multiple scattered\nareas of peribronchiolar nodules and ground-glass opacity, some with a\n___ configuration, are compatible with an infectious process.  No\nlarge focal consolidation.\n\nLimited images of the upper abdomen are unremarkable.\n\nSuperior endplate compression deformity of a lower thoracic vertebral body\n(602b:33) is new since ___, but appears sclerotic, and therefore likely\nchronic.  No paravertebral swelling.  Exaggerated thoracic kyphosis again\nnoted.",
            "output": "1.  No pulmonary embolus or acute aortic abnormality.\n2.  Bilateral bronchial wall thickening and mucous impaction of essentially\nall the left lower lobe segmental bronchi.\n3.  Multiple scattered areas of peribronchiolar nodularity and ground-glass\nopacity, some in a ___ configuration, compatible with an infectious\nprocess.  No large focal consolidation."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\naxillary are mediastinal lymph nodes by size criteria. The hilar contours are\nnormal.  The esophagus is unremarkable.  The thoracic aorta is normal in\ncaliber with a typical three vessel takeoff from the arch.  The pulmonary\narterial trunk is normal in caliber.  The heart is normal in size without\npericardial effusion, though there are coronary artery calcifications.\n\nWidespread cystic bronchiectasis and surrounding inflammatory changes\nthroughout the tracheobronchial tree begin distal to the lobar bronchi.\nOverall, these findings are stable from ___ with the exception of several\nareas. In the superior segment of the left lower lobe, bronchial wall\nthickening and impaction has worsened with peripheral opacification and\nsurrounding inflammatory changes (5:139,150). Two areas in the basal segments\nof the same lobe show similar worsening, particular in the medial segment\n(5:284).  There is also a focus of worsening opacification in the posterior\nsegment of the right upper lobe (5:127). None of these areas show high\nattenuation compatible with blood. The trachea is notably large in diameter.\n\nThis exam is not tailored for subdiaphragmatic evaluation. Allowing for this,\nthe included portions of the upper abdomen are unremarkable. There is no\nblastic or lytic lesion suspicious for malignancy.",
            "output": "Widespread severe bronchiectasis and surrounding inflammation, worsened in\nseveral different areas described above. No findings worrisome for malignancy\nor pulmonary hemorrhage; endobronchial blood is rarely identifiable."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality.\n\nBreast, chest wall and bones:\nMild degenerative vertebral disease.\n\nMediastinum:\nNo abnormalities.\n\nHila:\nNo abnormalities.\n\nHeart:\nMild coronary calcifications.\n\nUpper Abdomen:\nNo abnormalities.\n\nLung:\n\nNodules:\n\nDominant nodule:\nNew nodular 10 mm consolidation in the left upper lobe (5, 41).\nClustered right upper lobe micro nodules.\n\nOther nodules:\nNone.\n\nParenchyma:\nThe previous left upper lobe consolidation has resolved.  There is a new\nperipheral consolidation in the left lower lobe.  Stable right upper lobe and\nmiddle lobe consolidations.\n\nPleura and airways:\nThe shape of the trachea is suggestive of tracheobronchomalacia.\nStable extensive bronchiectasis with mildly progressing mucous plugging.",
            "output": "Waxing and waning peribronchial opacities, likely reflecting chronic or\nrecurrent infectious disease.  In particular, there is 1 new left upper lobe\nconsolidation.  No evidence of suspicious pulmonary nodules or masses. \nExtensive bronchiectasis with mildly progressive mucous plugging.\n\nLUNG-RADS CATEGORY AND RECOMMENDATION:  Lung-RADS category: Lung-RADS\nLung-RADS 2: We recommend continuing CT lung cancer screening in 12 months.  :\nWe recommend continuing CT lung cancer screening in 12 months.\n\n\n\nINCIDENTAL FINDINGS AND RECOMMENDATIONS:\n\nManagement recommendations for incidental findings within the LungHealth\u00ae\nprogram are based on a multidisciplinary consensus document of our institution\nspecifically designed for this program.\n\nLUNG-RADS CATEGORIES, DESCRIPTION:  Lung-RADS 0: This category designates an\nincomplete or diagnostically insufficient CT examination.\nLung-RADS 1: This category designates the absence of nodules, or the presence\nof definitely benign nodules.\nLung-RADS 2: This category designates the presence of nodules with a very low\nlikelihood of becoming a clinically active cancer due to size or lack of\ngrowth.\nLung-RADS 3: This category designates probably benign nodules with a low\nlikelihood of becoming a clinically active cancer but with features that\nrequire confirmatory imaging follow-up.\nLung-RADS 4A: This category designates nodules that require additional\ndiagnostic imaging.\nLung-RADS 4B and 4X: This category designates nodules that require additional\ndiagnostic testing and/or tissue sampling. Nodules in this category are\npresented at the weekly multidisciplinary thoracic oncology conference of our\nprogram.\nS (with any category): This qualifier designates the presence of a relevant\nincidental (= distinct from lung cancer) finding, for which a specific\nmanagement recommendation is made.\nC (with any category): Prior diagnosis of lung cancer."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nTri-truncal atherosclerotic calcification is noted, as well as mitral annular\ncalcification.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nPlease note that the exam was protocoled as a CTA study for assessment of the\npulmonary arterial vasculature rather than high-resolution CT protocol,\ntherefore evaluation for subtle parenchymal changes is somewhat limited. \nThere are focal ___ nodules seen in the right upper lobe, likely\nrelated to viral infectious bronchiolitis.\n\nThere is also a bilobed nodule seen in the lingula, measuring up to 6 mm. A\n___ month follow-up is recommended for further evaluation of this finding\ndepending on the underlying risk factors. No other suspicious pulmonary\nparenchymal abnormalities identified. There is bibasilar atelectatic change.\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere are degenerative changes noted at the lower thoracic spine.\n\nA 1.2 cm nodule is seen abutting the skin, anterior to the sternum in the\nmidline. This is shown mild increase in size from previous where it measured\n0.8 cm. It may represent a small sebaceous cyst. It appears to contain a fluid\nfluid level. Recommend correlation with dedicated soft tissue ultrasound for\nfurther assessment of this finding.  A second soft tissue nodule is seen more\ninferiorly measuring 6 mm, this could also be assessed with soft tissue\nultrasound.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\n6 mm bilobed nodule in the left lingula as detailed above, recommend ___\nmonth follow-up depending on underlying risk factors.\n\n___ nodules seen in the right upper lobe, likely related to infectious\nbronchiolitis.\n\n2 soft tissue nodules seen abutting the skin at the anterior chest wall\nmeasuring 1.2 and 0.6 cm as detailed above. The larger nodule appears to\ncontain a fluid fluid level and may represent a sebaceous cyst. Further\nevaluation with ultrasound is recommended as they remain nonspecific and have\nincreased in size when compared to previous.\n\nRECOMMENDATION(S):  CT scan of the chest in ___ months time depending on\nunderlying risk factors for reassessment of the bilobed left lingular nodule\nas detailed above.\n\n2 subcutaneous soft tissue nodules measuring 1.2 cm and 0.6 cm as detailed\nabove, for further evaluation with dedicated soft tissue ultrasound.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 12:05 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Mild aortic wall calcifications, known soft tissue\nnodule in the anterior chest wall (3, 23).  Stable moderate to severe coronary\nand aortic valve calcifications.  Stable size of the heart. No pericardial\neffusion.  Sludge in the gallbladder.  Mild degenerative vertebral disease. \nNo vertebral compression fractures.  No osteolytic lesions.  Old healed rib\nfracture (8, 30).  Small bone island in the manubrium of the sternum (8, 87). \nModerate respiratory motion.  Small parenchymal scar in the right upper lobe\n(5, 78), unchanged to the previous examination.  The pre described bilobed\nnodule in the lingular is no longer visualized.  However, the lingular and the\nmiddle lobe, show areas of relatively extensive mucous plugging with\nsubsequent peripheral consolidation, likely atelectatic in origin.  Extensive\nairway wall thickening and mucous plugging is also seen in the lower lobes,\nnotably on the left.  Areas of punctate calcifications are again noted on the\nleft.  No pleural effusions.  No diffuse lung disease.",
            "output": "Resolution of a pre described bilobed nodule in the lingula.  However,\nlingular and middle lobe opacities are visualized in the periphery of areas of\nmucous plugging and moderate to severe airways disease.  Similar changes are\nnoted in both lower lobes.  Overall, the findings are highly suggestive of\nrecurrent airway foreign infection.  This is potentially associated to a\nslightly dilated esophagus (chronic aspiration? ).  Moderate to severe\ncoronary calcifications.  Moderate to severe aortic valve calcifications."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere are stable coronary artery and aortic valve calcifications.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is diffuse bronchial wall thickening, worst in the lower lobes, with\nmucus plugging and peripheral consolidation likely representing atelectasis\nand aspiration, slightly increased from prior (3:122).   Small amount of\nground-glass in the right middle lobe may represent a superimposed viral or\natypical pneumonia (3:122).  A small parenchymal scar in the right upper lobe\nis unchanged (2:14).\n\nLimited images of the upper abdomen are unremarkable.\n\nThere is an old healed right rib fracture (602b:17).  There are severe\ndegenerative changes in the bilateral shoulders.  Multilevel degenerative\nchanges in the thoracic spine are unchanged.  No lytic or blastic osseous\nlesion suspicious for malignancy is identified.\n\nA soft tissue nodule in the anterior chest wall, likely a sebaceous cyst, is\nunchanged (2:36).",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Diffuse bronchial wall thickening, worst in the lower lobes, with mucus\nplugging and peripheral consolidations, likely representing atelectasis and\naspiration, is slightly increased from prior.\n3. Peripheral ground-glass opacity in the right middle lobe may represent a\nsuperimposed viral or atypical pneumonia."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Diffuse coronary artery and aortic valvular\ncalcifications are present.  The heart, pericardium, and great vessels are\notherwise within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild centrilobular and paraseptal emphysema along the\nleft major fissure.  Mild atelectasis is noted in the lung bases without focal\nconsolidation.  2 mm left lower lobe pulmonary nodule (3:148) is unchanged. \nDiffuse mild bronchial wall thickening with mucous plugging predominantly in\nthe lower lobes is again noted, slightly improved in the interval.  Minimal\nsecretions are demonstrated within the trachea.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a small hiatal\nhernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMultilevel degenerative changes of the thoracic spine are again noted.\n\nSOFT TISSUES: Bilateral gynecomastia is noted.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Diffuse bronchial wall thickening with mucous plugging predominantly in the\nlower lobes, slightly improved in the interval, compatible with chronic\nbronchitis.\n3. No pneumonia."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Left-sided PICC line in situ with the\ntip in the proximal right atrium.  Sebaceous cyst in the anterior chest wall\n(2, 22).  A couple of smaller sebaceous cyst also noted.  Moderate bilateral\ngynecomastia.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.  Mildly patulous\nappearance of the esophagus.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.  Normal cardiac configuration.\nMild cardiomegaly.  Severe calcification of the aortic valve.  Suspected stent\nin the left circumflex coronary artery.  Moderate to severe coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.\nPLEURA: Very small bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Atelectasis in the posterior basal aspects of the lower lobes\nbilateral.  A few nonsuspicious pulmonary micro nodules.  Minimal aspirated\nbarium in the posterior basal lungs (302, 190) for example in the left lung\nbase.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.  Minimal secretions present in the distal trachea (302, 99).\n3. VESSELS:  The pulmonary artery measures at the upper limits of\nnormal/mildly dilated (33 mm).\nCHEST CAGE: Moderate spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "Findings most likely represent posterior basal subsegmental atelectasis. \nSmall associated pleural effusions.\n\nMinimal aspirated barium seen in the posterior basal lung segments.  Chronic\naspiration should be excluded.\n\nSevere aortic valve calcifications suggest aortic stenosis.\nModerate to severe coronary artery calcification.\n\nFor abdominal findings please refer to CT abdomen report\n\nRECOMMENDATION(S):  Cardiac evaluation, if not recently performed."
        },
        {
            "input": "Aorta and great vessels are unremarkable without dissection or aneurysm.  The\npulmonary arteries are well opacified to the subsegmental level without\nfilling defect to suggest pulmonary embolism. The pulmonary arteries are\nnormal in caliber.  Moderate coronary artery and aortic atherosclerotic\ncalcifications.\n\nHeart size is normal. There is no pericardial effusion.\n\nThere is no consolidation, pleural effusion or pneumothorax.  The airways are\npatent to the subsegmental level.  4 mm solid nodule seen in the left lower\nlobe (series 3, image 113).  Multiple calcified nodules seen in the right\nlung, likely represent calcified granulomas.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe included thyroid gland appears unremarkable.\n\n Limited images of the upper abdomen are suggestive of prominent celiac axis\nlymph nodes; however, these are not fully assessed on this exam.\n\nNo suspicious osseous lesions identified.  There is no acute fracture.",
            "output": "1.  No pulmonary embolism or acute aortic abnormality.\n2.  4 mm solid nodule seen in the left lower lobe.  Recommendation as below.\n3.   Limited images of the upper abdomen are suggestive of mildly prominent\nceliac axis lymph nodes; however, these are not fully assessed or fully imaged\non this exam.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is enlarged.  Both atria are enlarged, left\ngreater than right.  Coronary artery calcifications are present.  Other than\nmild atherosclerotic calcification, the great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Right pleural nodularity\ncalcifications appear stable from ___.\n\nLUNGS/AIRWAYS: There is paraspinal post radiation change in the right lung\napex and superior aspect of the right lower lobe. Previously described 12 mm\nground-glass nodule in the superior right lower lobe appears stable from ___\n(2:75).  No new concerning nodules or consolidations.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Streak artifact from extensive posterior cervical and thoracic\nvertebral hardware limits assessment of the surrounding structures. \nPreviously described paraspinal masses at T4 and T5 are not well appreciated\non today's examination given streak artifact retained hardware right\nparaspinal atelectasis.  Redemonstrated is a severe compression deformity of\nthe T5 vertebral body as seen on prior chest CT from ___.  Chronic\ndeformity of the sternal body is re-demonstrated, similar to prior.  No acute\nfracture is seen.?",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Enlarged heart and left atrium.\n3. Stable 12 mm ground-glass nodule in the right lower lobe."
        },
        {
            "input": "The imaged thyroid gland appears homogeneous in attenuation without a focal\nlesion identified.  Scattered axillary nodes appear symmetric in size and\nnormal in morphology, not pathologically enlarged.  There is no\nsupraclavicular adenopathy.  Several infraclavicular nodes are present as well\nas central nodes.  A right lower paratracheal station node measures\napproximately a mm in size.  A left lower paratracheal station node measures 9\nmm in short axis (02:17).  Evaluation for hilar adenopathy is limited in the\nabsence of intravenous contrast.  Right upper paratracheal station nodes are\nadditionally present as are prevascular space nodes.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is enlarged,\nsuggestive of though not diagnostic for pulmonary hypertension.  A pericardial\neffusion is small and nonhemorrhagic.  Calcifications involve the left\nanterior descending coronary artery, moderate.  Heart size is mildly enlarged.\nThere is a small hiatal hernia.\n\nA right chest pigtail catheter traverses the anterior fifth and sixth rib\ninterspace.  Focus of air surrounds the pigtail catheter at its tip.  There\npersist nonhemorrhagic pleural fluid in the space.  Posteriorly,\nnonhemorrhagic pleural fluid appears in part to be loculated.  Relative to\nexamination dated ___, the pleural fluid inferiorly and posteriorly\nappears minimally increased in volume.\n\nThe central airway appears patent.  Lung windows demonstrate moderate\npredominantly centrilobular emphysema which is upper lobe predominant. \nConsolidation and air bronchograms within the right lower lobe likely reflects\na component of atelectasis though superimposed infection is difficult to\nexclude.  The left lung is grossly clear with minimal atelectasis at its base.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, imaged abdomen\ndemonstrates nodular liver with numerous hypodensities, and completely\ncharacterized on this nonenhanced CT.  Splenomegaly and portosystemic\ncollaterals are most consistent with portal hypertension.\n\nNo osseous lesion worrisome for malignancy or infection is identified.",
            "output": "1.  Right chest pigtail catheter traverses the anterior fifth and sixth rib\ninterspace.  Focus of air surrounds the pigtail catheter tip with persistent\nsmall loculated nonhemorrhagic pleural fluid.  Posterior and inferior right\nprobably in part loculated nonhemorrhagic fluid is increased in volume\nrelative to examination dated ___.\n\n2.  Consolidated parenchyma and air bronchograms within the right lower lobe\nlikely reflects component of atelectasis though infectious process is\ndifficult to exclude.\n\n3.  Centrilobular emphysema is moderate and upper lobe predominant.\n\n4. Mediastinal adenopathy most likely reactive.\n\n5.  Findings concerning for liver cirrhosis with portal hypertension,\nsplenomegaly and ascites."
        },
        {
            "input": "The visualized portion of the thyroid is unremarkable.\n\nHeart size is mildly enlarged without significant pericardial fluid.  There is\nscattered mediastinal lymphadenopathy with lymph nodes measuring up to 10 mm\nin short axis.  Hilar lymphadenopathy is difficult to evaluate given lack of\nIV contrast, however there is mild nodular fullness of the right hilum.  There\nis no axillary or supraclavicular lymphadenopathy by CT size criteria.  Right\ninternal jugular approach central venous catheter terminates in the distal\nSVC.\n\nEndotracheal tube is in place.  Evaluation of the lung parenchyma is limited\nby motion.  There is dense consolidation of the right lower lobe and right\nmiddle lobe with air bronchograms, consistent with pneumonia.  A right base\npleural pigtail catheter is in place.  There is a trace of associated pleural\ngas.  There is no associated pneumothorax.  There is a small right-sided\neffusion.  Mild central ground-glass opacities are noted in the right upper\nlobe.  There is moderate centrilobular emphysema.  There is mild left base\natelectasis.  The left lung is otherwise clear.\n\nThoracic cage is intact without suspicious focal bone lesion.  Some endplate\nirregularity at the T1-T2 reticulation and correlates with history of discitis\nosteomyelitis on recent MRI.",
            "output": "1. Dense right lower lobe and right middle lobe consolidations with air\nbronchograms consistent with pneumonia.\n2. Probable reactive mediastinal lymphadenopathy.\n3. Right base chest tube in place with small residual pleural effusion. \nMinimal associated pleural gas.  No substantial pneumothorax.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 11:23 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid is normal. The heart is enlarged with no significant pericardial\nfluid.  Scattered mediastinal lymphadenopathy is better appreciated on prior\nchest CT examination.  There is no new concerning lymphadenopathy.\n\nEndotracheal tube terminates in the right mainstem bronchus.\n\nEvaluation of underlying lung parenchyma is somewhat limited due to secondary\nrespiratory motion artifact.  However, there is smooth interlobular septal\nthickening noted at the right upper lobe which could be secondary to pulmonary\nedema.\n\nDense consolidations and collapse in the right lower lobe and right middle\nlobe with air bronchograms are consistent with pneumonia as seen on prior\nchest CT.  There is a new/progressed loculated and moderate-large sized\nnonhemorrhagic pleural effusion along the lateral aspect of the right\nhemithorax.\n\nThere is atelectasis at the left lung base with an associated small left\npleural effusion.\n\nAlthough this study is not targeted for evaluation of subdiaphragmatic\nstructures, there is a moderate ascites, seen in conjunction with a nodular,\ncirrhotic liver and splenomegaly.  Degree of ascites has worsened since the\nabdominal CT from ___.  Low density lesions in the lesion are not\ncharacterized on this noncontrast thoracic examination of frequently\nrepresentative of cysts.\n\nNo blastic or lytic lesion concerning for malignancy.",
            "output": "1.  Endotracheal tube terminates in the right mainstem bronchus. Repositioning\nis advised.\n2. New/ increased large loculated nonhemorrhagic pleural effusion along the\nlateral right hemi thorax.\n3. New large nonhemorrhagic right effusion.\n4. Small left pleural effusion.\n5. Right lower lobe and right middle lobe consolidations consistent with\npneumonia and collapse.\n6.  Ascites, cirrhosis partially visualized has progressed compared to ___.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 7:39 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  A right chest port terminates within the low superior vena cava. \nThere is no axillary or supraclavicular adenopathy.  There is no mediastinal\nor hilar adenopathy.\n\nPatient is status post median sternotomy and CABG.  The ascending aorta is non\naneurysmal.  The main pulmonary artery is within normal limits in caliber. \nThere is no pericardial effusion.  Heart is upper limits of normal in size. \nThere is extensive calcification of the native coronary arteries.\n\nPatient is status post esophagectomy with gastric pull-through.  The\ntracheobronchial tree is patent.  There are bilateral nonhemorrhagic and\nlayering pleural effusions, left greater than right.  There is associated\ncompressive atelectasis.\n\nCentrilobular emphysema is mild and apical predominant.  There is no mass or\nfocal consolidation.  Subpleural reticulation is mild in the anterior left\nupper lobe.\n\nMultiple left-sided rib fractures are longstanding.  There are no worrisome\nosseous lesions.  Compression of the superior endplate of T11 vertebral body\nappears unchanged.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "Status post esophagectomy with gastric pullthrough without evidence of\nintrathoracic malignancy or active infection.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___."
        },
        {
            "input": "Heart is normal in size.  Possible left ventricular hypertrophy.  Mild\ncoronary artery calcification.\n\nPatient is intubated.  An orogastric tube courses across the esophagus.  Small\nquantity of air in a left hepatic vein is likely related to contrast injection\nvia a right iliac venous catheter.\n\nThere is moderate-sized occlusive pulmonary embolus beginning in the right\nupper lobe all pulmonary artery and extending into the right anterior\nsegmental artery.  Following a short segment of open right upper apical\nsegmental artery, more distal component of that segmental is occluded.  More\ngenerally, particularly at the lung bases, distal pulmonary arterial branches\nare somewhat difficult to assess but a subsegmental embolus is visible in the\nright lower lobe (303:136).\n\nFew patchy ground-glass and micronodular opacities in the right upper lobe,\nmostly in the posterior segment, as well as similar opacities which are found\nin the superior segment of the right upper lobe right lower lobe suggest mild\ninflammatory change in lower airways.  Mild bronchiectasis in the right middle\nlobe.  Flat nodule in the right upper lobe measures at most 3 mm, probably\nbenign.  These are not very suggestive of ischemia.  Prior wedge resection\nsite is visualized in the right lower lobe.  The left lung appears clear.\n\nThere is no pleural or pericardial effusion.  No enlarged lymph nodes.\n\nAbdomen is reported separately.\n\nThere are no suspicious bone lesions.  Remodeled appearance is to the right\nposterior fourth to several right upper posterior ribs are consistent with\nsequela of remote prior trauma.  Moderate degenerative changes of each\nsternoclavicular joint, but right worse than left, including hypertrophy of\nthe synovial hypertrophy.  No visible fluid.",
            "output": "Positive for pulmonary embolism, mostly involving segmental branches in the\nright upper lobe.  Opacities in the right lung suggesting inflammatory change\ninvolving distal airways.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:55 p.m., 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Calcified mediastinal lymph nodes are\ndemonstrated.  Aortopulmonic lymph nodes are not pathologically enlarged but\nmultiple.  Pre-vascular lymph node is 8 mm, unchanged, series 3, image 76.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Right lower lobe 6 mm nodule is new, series 3, image 131.  No\nconsolidations demonstrated.  Right upper lobe parenchymal scarring and\nassociated bronchiectasis are unchanged.  Right middle lobe bronchiectasis are\nextensive but with no evidence of inflammation and unchanged.\n\nLungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable except for\npartially imaged splenomegaly.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nNew right lower lobe 6 mm pulmonary nodule\n\nCalcified and noncalcified mediastinal lymph nodes, stable\n\nResolution of previously seen pulmonary embolism\n\nScarring and bronchiectasis in the right lung is described."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Mild\natherosclerotic calcification of the thoracic aorta is noted.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  There are\nmoderate coronary artery calcifications.\n\nThere are small mediastinal lymph nodes.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  There is a 1.0 cm hypodense\nnodule in the left lobe of the thyroid and an additional 5 mm nodule within\nits right lobe.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Mild\nbronchiectasis is noted in both lower lobes.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nThere are degenerative changes throughout the thoracic spine, notably in the\nlower thoracic  spine.",
            "output": "1.   No evidence of pulmonary embolism or aortic abnormality.\n2.  Mild lower lobe predominant bronchiectasis could be related to chronic\nairway disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Cardiac size is within normal limits.  No evidence of\npericardial effusion.  No evidence of calcified atherosclerotic.  The great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 5 mm perifissural pulmonary nodule in the superior\nsegment of the right lower lobe, (series 4, image 69).  Minimal bibasilar\natelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.  No evidence of bronchial wall thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates hypoattenuation\nof the liver and likely represents moderate diffuse steatosis.  Expected\npostsurgical changes following Roux-en-Y gastric bypass.  An indeterminate, 13\nmm lesion extending from the medial limb of the left adrenal is demonstrated.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild multilevel degenerative changes demonstrated in the upper thoracic spine.\n\n\nSoft tissues: Bilateral breast prosthesis are incidentally noted.  Breast\ntissue is preferentially evaluated by mammography.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. An indeterminate 13 mm left adrenal lesion is likely an adrenal adenoma.\n3. Moderate diffuse hepatic steatosis.\n4. A 5 mm pulmonary nodule in right lower lobe.\n\nRECOMMENDATION(S):  1.  For incidentally detected single solid pulmonary\nnodule smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT in 12 months is recommended in a high-risk\npatient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and refeRence:\n___\n\n\n2. Radiological evidence of fatty liver does not exclude cirrhosis or\nsignificant liver fibrosis which could be further evaluated by ___.\nThis can be requested via the ___ (FibroScan) or the Radiology\nDepartment with either MR ___ or US ___, in conjunction with\na GI/Hepatology consultation\" *\n\n* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver\ndisease: Practice guidance from the ___ Association for the Study of\nLiver Diseases.  Hepatology ___ 67(1):328-357"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Hazy ground-glass opacities with dependent predominance and\nlinear opacities in both lung bases are consistent with atelectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Included portion of the upper abdomen is unremarkable.\n\nBONES:  Moderate compression deformity of the T3 vertebral body is stable from\nradiograph performed on ___. A mild compression deformity of the T5\nvertebral body was not well-visualized on that study.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Scattered ground opacities may represent small airways disease or mild\nfluid overload."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The patient is status post\ntracheobronchial plasty.  An endotracheal tube is seen past the thoracic inlet\nand well above the carina.  Several mediastinal clips are noted.  A\nright-sided chest tube is noted with tip in the posterior aspect of the right\nupper lobe.\n\nThere is extensive subcutaneous edema predominantly in the anterior chest wall\nwith extension into the neck and several small foci are also noted in the\nposterior and right lateral chest wall.  This emphysema is seen tracking\nthrough the mediastinum into the visualized portion of the upper abdomen.\n\nUPPER ABDOMEN: There is an enteric tube with tip past the GE junction.  Its\ntip appears to be within the third portion of the duodenum. Decreased\nattenuation of the liver compatible with hepatic steatosis.\n\nMEDIASTINUM: There is extensive mediastinal air as discussed above.  No\nenlarged lymphadenopathy.\n\nHILA: Evaluation of hilar lymphadenopathy is limited without intravenous\ncontrast.\n\nHEART and PERICARDIUM: Normal heart size.  No pericardial effusion.\nPLEURA: Tiny right apical pneumothorax.\nLUNG:\n\n1. PARENCHYMA: High density suture material is noted in the right lung apex. \nThere is extensive ground-glass opacification of the posterior aspect of the\nright upper lobe adjacent the chest tube and surgical suture material likely\nrepresenting hemorrhage or infection.  A smaller, second focus of ground-glass\nopacification is noted in the anterior aspect the right lower lobe. \nAdditionally, patchy consolidation is noted in the basilar segments of both\nlower lobes, right greater than left.  Although nonspecific, this could\nrepresent aspiration.\n2. AIRWAYS: The lower lobe central airways demonstrate narrowing which may be\naccentuated by bronchomalacia but may have some wall thickening.\n3. VESSELS:  Evaluation of the vasculature is limited without intravenous\ncontrast.\nCHEST CAGE: There has been partial resection of the posterior right fifth rib.",
            "output": "1. Extensive ground-glass opacification in the posterior aspect of the right\nupper lobe.  Additional focus of ground-glass opacification in the right lower\nlobe.  Findings likely represent hemorrhage and/or infection.  Patchy\nconsolidation in basilar segments of both lower lobes likely represent\naspiration pneumonia.\n\n2. Extensive subcutaneous edema with extension through the mediastinum into\nthe upper abdomen.\n\n3. Right-sided chest tube with trace right apical pneumothorax."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is\nunremarkable.  Tracheostomy tube is in good position.  Left-sided PICC\nterminates at the cavoatrial junction.  Esophageal tube terminates within the\nstomach.  No supraclavicular adenopathy.\n\nUPPER ABDOMEN: Visualized structures are unremarkable.\n\nMEDIASTINUM: Resolution of mediastinal air and subcu emphysema.  Prominent\nmediastinal lymph nodes are again demonstrated, unchanged.\n\nHILA: Difficult to assess for hilar adenopathy given the lack of IV contrast. \nHowever, there is right greater than left hilar fullness.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.\nPLEURA: No pneumothorax.  No pleural effusion.  No pleural plaques.\nLUNG:\n\n1. PARENCHYMA:  Worsened scattered nodular and ground-glass opacities mainly\nbilateral lower lobes, concerning for infectious or aspiration pneumonia.  New\nleft upper lobe complete collapse.  Segmentectomy right upper lobe.\n2. AIRWAYS:  Interval placement of a left mainstem bronchus stent which\nappears to occlude the left upper lobe bronchi resulting in complete collapse\nof the left upper lobe.  Left lower lobe is well aerated.  There is mild\nnarrowing right lower lobe bronchus proximally, appears unchanged.\n3. VESSELS:  Normal caliber thoracic aorta and pulmonary arteries.  Lack of\ncontrast opacification limits assessment.\nCHEST CAGE: No acute osseous abnormality.",
            "output": "-New left upper lobe complete collapse likely secondary to occlusion of the\nleft upper lobe bronchus post left main bronchus stent placement.\n-New patchy airspace opacities concerning for infectious pneumonia or\naspiration pneumonia.\n\nDetails of findings above.\n\n The findings were discussed with Daily ___, From Thoracic Surgery by ___\n___, M.D. on the telephone on ___ at 9:53 pm, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Nasogastric tube terminating in the second portion of the\nduodenum.\nRemaining included upper abdominal organs with no gross findings within the\nlimitations of a study with no IV contrast infusion.  What appears to be a\npushed stent is seen in the duodenum.\n\nMEDIASTINUM: Few sub cm, not pathologically enlarged mediastinal lymph nodes\nare mildly smaller in comparison to prior for example right lower paratracheal\n0.5 cm lymph node (5:93).\nThere is no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no cardiomegaly.\nNo pericardial effusion.\nRight PICC line terminates in the lower SVC.\nThe no appreciable atherosclerotic calcifications in the coronaries or in\nnormal caliber major vessels.\n\nPLEURA: Previously demonstrated small left pleural effusion is resolved, right\nminimal pleural effusion remaining.\n\nLUNG: Significant respiratory motion artifacts in both lower lungs, it is\nunclear whether the study was performed in end inspiration.\n\nTracheostomy tube in a patent trachea.  S/p tracheobronchoplasty.\nCarina is partially collapsed, 0.5 cm in AP diameter, grossly unchanged in\ncomparison to prior studies (5:100).\n\nThere has been interval removal of the left main bronchus stent. The left\nupper lobe bronchus is unchanged in appearance in comparison to prior,\nremaining impacted with total collapse of the left upper lobe.\nMain bronchi almost completely collapsed with residual millimetric lumen.\n\nPreviously demonstrated bilateral patchy consolidations and branching\nbronchiolar opacities of the right upper and both lower lobes are markedly\nimprove with only minimal bilateral branching opacities remaining, right\ngreater the left.\nThe previously demonstrated right lower lobe medial consolidation containing\nair bronchograms is significantly smaller (5:158).\nS/p right upper lobe segmentectomy with surgical changes in the adjacent fifth\nrib.\n\nCHEST CAGE: Mild degenerative changes in the spine.",
            "output": "-Significant improvement of multilobar pneumonia.\n-Although the left main bronchus stent was removed there is unchanged\nimpaction of the left upper lobe bronchus and secondary left upper lobe\ncomplete collapse.\n-Significant narrowing of the carina and almost complete effacement of main\nbronchi which remain patent, though with millimetric lumen, severely effaced\non the right."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is grossly opacified without\nfilling defect to indicate a pulmonary embolus.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes are noted without\nmeeting CT size criteria for lymphadenopathy.  There is no axillary or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The tracheostomy tube is seen in the patent trachea. \nSecretions are again seen in the distal trachea.  There is interval\nimprovement in aeration of the lingula as compared to the prior exam in\n___.  A left PICC terminates in the mid to distal SVC.  Postsurgical\nchanges are again seen in the right upper lobe following segmentectomy. There\nis mild persistence of peribronchovascular opacities in the right upper lobe,\nalthough vastly improved since the prior study in ___. Mild\natelectasis is seen in the lung bases, left greater than right.  No new focal\nparenchymal opacification is identified.\n\nIncreased diffuse bronchial wall thickening is noted in the lower lobes,\nlikely reactive.  The airways are otherwise patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to the same-day CT abdomen and pelvis exam for full\ndescription of subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPostsurgical changes are seen along the right fifth posterolateral rib.",
            "output": "1. Interval improvement in aeration of the lingula as compared to the prior\nstudy in ___.\n2. There is persistence of peribronchovascular opacities in the right upper\nlobe, although significantly improved since the ___ CT exam.\n3. Tracheostomy tube is in place.  Mild secretions are noted in the distal\ntrachea.\n4. Please refer to the same-day CT abdomen and pelvis exam for full\ndescription of subdiaphragmatic findings"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Tracheostomy in place.\nThyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Upper abdominal organs are unremarkable.\nEsophagus is retracted toward a right surgical staples, unchanged.\n\nMEDIASTINUM: Several sub cm lymph nodes in the mediastinum are unchanged in\ncomparison to prior measuring up to 0.7 cm in the left paratracheal station,\nRight hilar borderline 0.9 cm lymph node also unchanged.\n\nHEART and PERICARDIUM: Left PICC terminates in the lower SVC.\nThere is no cardiomegaly.  Trace pericardial effusion is unchanged.\nNo appreciable atherosclerotic calcifications of the coronaries and normal\ncaliber thoracic aorta and head and neck vessels.\nMain pulmonary artery within normal size.\n\nPLEURA: Trace bilateral pleural effusions are unchanged.\nThere is no pneumothorax.\n\nLUNG: Tracheostomy tube seen in the patent trachea.\nMinimal secretions in the distal trachea and main bronchi.\nUnchanged distal trachea and main bronchi thickening with extensive\ncalcifications. Diffuse wall thickening also noted in the bronchus\nintermedius.\nSecondary severe narrowing of main bronchi and bronchus intermedius with\nremaining millimetric lumen are also unchanged in comparison to the prior\nstudy in ___ (302:88, 98).\nScattered bronchi impactions in the right lower lobe associated with increased\nbranching bronchial opacities in the right lower lobe, there are no new\nconsolidations.  Findings are consistent with bronchiolitis.\nPostsurgical changes are again seen in the right upper lobe abutting\nsegmentectomy.\nBibasilar dependent atelectasis unchanged.\n\nCHEST CAGE: No suspicious osseous abnormalities identified.",
            "output": "Mild secretions in the distal trachea and main bronchi with severe narrowing\nand remaining millimetric lumen of main bronchi and bronchus intermedius are\nunchanged since ___.\nNew right lower lobe scattered bronchial impactions with bronchiolitis. no\nfrank consolidative pneumonia."
        },
        {
            "input": "VASCULAR: Study is limited for evaluation of the distal segmental and\nsubsegmental branches due to motion artifact.  There is no large pulmonary\nembolism in the main, right, left, or proximal segmental pulmonary arteries.\n\nBASE OF NECK: Tracheostomy is in place and in appropriate position. \nVisualized thyroid is within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: There are several prominent mediastinal lymph\nnodes measuring up to 1 cm no hilar adenopathy.  No axillary adenopathy. \nPatulous esophagus.\n\nHEART AND VASCULATURE:  The heart is normal size.  No pericardial effusion.\n\nPLEURAL SPACES: No pneumothorax or pleural effusion.\n\nLUNGS/AIRWAYS: Segmental atelectasis at the lung bases.  Mild dependent\natelectasis.  Motion artifact limits evaluation for subtle nodules.  There is\nnarrowing of the right and left mainstem bronchi which may be related to\nsecretions.\n\nABDOMEN:  Small hiatal hernia.  Limited evaluation of the upper abdomen is\nwithin normal limits.\n\nBONES: Mild gynecomastia.  Within the posterior fourth rib, there is area of\nlikely congenital nonunion versus sequela of prior trauma.  These latter is\nmore likely given suggestion of osseous bridging.  No acute osseous process.",
            "output": "1. Study is limited for evaluation of the distal segmental and subsegmental\nbranches due to motion artifact. There is no large pulmonary embolism in the\nmain, right, left, or proximal segmental pulmonary arteries.\n2. Mildly prominent mediastinal lymph nodes measure up to 1 cm.\n3. Additional findings as above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:05 pm."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A right pectoral Port-A-Cath\ncatheter tip terminates in the low SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a multinodular thyroid gland the left-sided nodule that\nmeasures up to 1.6 cm (3:1).  Visualized portions of the base of the neck\notherwise show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nVertebral body hemangiomas are unchanged.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multinodular thyroid gland for which nonemergent thyroid ultrasound is\nrecommended, if not already performed elsewhere.\n\nRECOMMENDATION(S):  Nonemergent thyroid ultrasound is recommended, if not\nalready performed elsewhere."
        },
        {
            "input": "MEDIASTINUM/HEART:  The visualized thyroid is unremarkable. Supraclavicular,\naxillary, mediastinal and hilar lymph nodes are not enlarged by CT size\ncriteria.  Multiple mediastinal nodes are calcified. Aorta and pulmonary\narteries are normal in size.  A borderline right interlobar measures 10 mm in\nshort axis (4:103). No pulmonary artery filling defect identified. Heart size\nis normal with no appreciate coronary artery calcifications or pericardial\neffusion.\n\nIn the prevascular anterior mediastinum extending to the right, there is a 5.1\nx 2.4 x 5.7 cm soft tissue density oval mass with predominantly smooth, but\nfocally lobulated borders (4:121, 601b:33).  It demonstrates internal areas of\nhypodensity, likely internal cystic necrosis.  The fat plane with the a\nadjacent aorta is preserved.  No calcifications are identified.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. A 4 mm\ncalcified granuloma is identified in the right upper lung (4:62).  Multi lobar\ncylindrical bronchiectasis in the bilateral middle and lower lungs identified,\nwithout signs of active infection.  No focal consolidation, pleural effusions,\nor pneumothorax.  No pleural thickening.  No new suspicious pulmonary nodule\ndetected.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the visualized portions of the liver, pancreas,\nand bilateral adrenal glands are unremarkable. Multiple small calcified\ndensities in the spleen likely reflect prior granulomatous disease.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Superior endplate deformity of the T9 vertebral body is age\nindeterminate (602b:85).",
            "output": "1.  5.7 cm mass in the anterior mediastinum extending to the right of midline.\nGiven its large size, lobulated contour, and heterogeneous density, findings\nare concerning for a high-grade thymoma.\n\n2.  No evidence of lymphadenopathy, pleural thickening/nodularity, or vascular\ninvasion.\n\n3.  Multi-lobar cylindrical bronchiectasis without signs of active infection."
        },
        {
            "input": "MEDIASTINUM/HEART:  The thyroid is unremarkable. Supraclavicular,\naxillary, mediastinal and hilar lymph nodes are not enlarged by CT size\ncriteria.  Multiple mediastinal nodes are calcified. Aorta and pulmonary\narteries are normal in size.  A borderline right interlobar measures 10 mm in\nshort axis (4:103). No pulmonary artery filling defect identified. Heart size\nis normal with no appreciate coronary artery calcifications or pericardial\neffusion.\n\nIn the prevascular anterior mediastinum extending to the right, there is a 5.1\nx 2.4 x 5.0 cm soft tissue density oval mass with predominantly smooth, but\nfocally lobulated borders (7:31).  It demonstrates internal areas of\nhypodensity, likely internal cystic necrosis.  The fat plane with the a\nadjacent aorta is preserved.  No calcifications are identified.\n\nLUNGS/AIRWAYS:  Assessment of the lungs is somewhat limited by inadvertent\nexpiratory phase of respiration and mild motion artifact, reducing sensitivity\nfor very small pulmonary nodules and subtle interstitial lung abnormalities. \nThe airways are patent to the subsegmental level.\nA 4 mm\ncalcified granuloma is identified in the right upper lung (4:62).  Multi lobar\ncylindrical bronchiectasis in the bilateral middle and lower lungs identified,\nwithout signs of active infection.  Stable asymmetric elevation of the right\nhemidiaphragm.  No focal consolidation, pleural effusions,\nor pneumothorax.  No pleural thickening.  No new suspicious pulmonary nodule\ndetected.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the visualized portions of the liver, pancreas,\nand bilateral adrenal glands are unremarkable. Multiple small calcified\ndensities in the spleen likely reflect prior granulomatous disease.  Mildly\npatulous esophagus.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Superior endplate deformity of the T9 vertebral body is\nunchanged.",
            "output": "Stable appearance of the thorax.\n\n1.  Anterior mediastinal mass consistent with thymic epithelial tumor.\n\n2.  No evidence of lymphadenopathy, pleural thickening/nodularity, or vascular\ninvasion."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the chest wall suspicious for malignancy, infection, or\noperative complication.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal mass.\n\nThyroid is unremarkable.  There is no residual soft tissue, fluid, or\nhemorrhage at the operative site in the upper prevascular mediastinum.  There\nis no pleural nodularity or effusion.\n\nAtherosclerotic calcification is not apparent in head neck vessels or in\ncoronary arteries.  There is no pericardial abnormality.  Aorta and pulmonary\narteries and cardiac chambers are normal size.\n\n10 x 16 mm right hilar lymph node is not pathologically enlarged, unchanged\nsince ___.  No other central lymph nodes are pathologically\nenlarged.\n\nAside from a small band of atelectasis in the right middle lobe and a\ncalcified granuloma in the right upper lobe, lungs are clear.  Minimal\nbronchial wall thickening is unchanged and there is no bronchial dilatation or\nmucous retention.\n\nSchmorl's nodules at multiple levels in the thoracic spine, including a lower\nthoracic vertebral body with able mild impression of the upper endplate are\nunchanged since at least ___.  There are no bone lesions in the\nchest cage suspicious for malignancy or infection.",
            "output": "Normal postoperative appearance following resection of thymoma.  No evidence\nof intrathoracic malignancy.  No thyroid abnormality.\n\nSolitary calcified granuloma, right lung.  No evidence of granulomatous\ninfection.\n\nMinimal bronchial wall thickening unchanged."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is homogeneous.  No\naxillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Small hiatus hernia.  Slight increase in moderate-severe\ndilatation of the esophagus.  The spleen contains a a few punctate\ncalcifications, indicative of prior granulomatous exposure.  Diverticulosis\nwithout evidence of diverticulitis.  Otherwise, the imaged portion of the\nupper abdomen is unremarkable.\n\nMEDIASTINUM: No residual soft tissue at the operative site in the upper\nprevascular mediastinum.  No mediastinal mass.  A few calcified granulomatous\nlymph nodes are unchanged.\n\nHILA: No lymphadenopathy.  Interval decrease in size of a right hilar lymph\nnode, measuring 1.2 x 0.9 cm (___), previously 1.6 x 1.0 cm.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Unchanged calcified granuloma in the right upper lobe (___).\nNo evidence of active or reactive infection.  Unchanged band atelectasis/ scar\nin the right middle lobe and lingula.\n2. AIRWAYS:  Airways are patent to the subsegmental levels bilaterally.\n3. VESSELS:  No evidence of pulmonary embolism on this non PE protocol study.\nCHEST CAGE:  No fractures.  No suspicious osseous lesions.  Unchanged round\nsclerotic focus in the right posterior tenth rib (___), likely representing\na bone island.  Unchanged degenerative change, including multiple Schmorl's\nnodes in the thoracic spine.",
            "output": "1. Compared to ___, normal postoperative appearance following\nresection of a thymoma.  No evidence of intrathoracic malignancy.  No thyroid\nabnormality.\n2.  Slight increase in moderate-severe dilatation of the esophagus.  If\nclinically indicated, consider an esophagram for further evaluation.\n\nRECOMMENDATION(S):   Slight interval increase in moderate-severe dilatation of\nthe esophagus.  If clinically indicated, consider an esophagram for further\nevaluation.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 11:01 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  Multiple prominent mediastinal lymph nodes are identified,\nhowever none are enlarged by CT size criteria.  There is no hilar\nlymphadenopathy.  The heart size is normal.  There is no evidence of\npericardial effusion.  The esophagus is normal without evidence of wall\nthickening, or a hiatal hernia.\n\nThe aorta is unremarkable.  There is normal three-vessel arch.\n\nThe airways are patent to the subsegmental levels.\n\nAssessment of the lungs is limited, secondary to extensive respiratory motion.\nHowever, in the context of these limitations note is made of moderate\nparaseptal, emphysema.  A 3 mm nodule is seen in the superior segment of of\nthe right lower lobe, series 4, image 125.  A 3 mm nodule is seen in the right\nlower lobe, series 4, image 131.  A ground-glass 4 mm nodule is seen in the\nright lower lobe, series 4 image 148.  A granuloma is seen, series 4, image\n156 in the right lower lobe.  A 2 mm nodule is seen within the right middle\nlobe, series 4, image 190.  There is mild atelectasis within the lung bases\nbilaterally.\n\nA left lower lobe 5 mm nodule, is seen series 4, image 200.  Note is made of\nlingular atelectasis.\n\nWithin the left lung apex, a triangular pleural-based wedge-shaped soft tissue\nlesion is seen, measuring 1.8 cm x 2.1 cm, series 4, image 38.\n\nThe study is not optimal for the evaluation of the subdiaphragmatic\nstructures, however note is made of a cirrhotic liver as well as enlarged\nmesenteric and periportal lymph nodes.  Nodularity around the gallbladder with\nincreased fat is incompletely evaluated on this exam, however should be\nassessed with non-urgent MRI to evaluate for malignancy.\n\nOsseous structures:  No lytic or blastic lesions concerning for malignancy are\nidentified.",
            "output": "1.  2.1 cm subpleural wedge-shaped lesion within the left lung apex, could be\nsecondary to apical scarring or the sequela of recent infection, however given\nthe patient's extensive smoking history, a 3 month follow up with chest CT is\nrecommended for further evaluation.\n\n2.  Additional sub 5 mm ground-glass and solid nodules, are incompletely\nevaluated on this exam due to extensive motion artifact, however did the\nappearance is most suggestive of aspiration and small airways infection. \nConsideration for antibiotic therapy should be given.  Follow-up of these\nlesions can be the time of the CT in 3 months\n\n3.  Cirrhotic liver and enlarged mesenteric lymph nodes, incompletely\nevaluated on this exam.  A non-urgent MRI should be considered for further\nevaluation.\n\nRECOMMENDATION(S):  1.  3 month followup with chest CT.\n2.  Consideration of non-urgent MRI of the liver for cirrhosis.\n\nNOTIFICATION:  Findings were discussed with Dr. ___ by Dr. ___ at 21:00\non ___, 2 hr after discovery by phone."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis an aberrant right subclavian artery.  Cardiac configuration is normal and\nthere is no appreciable coronary calcification.  Thickening of the right major\nfissure and perifissural nodularity in the right lower lobe is stable (4:123)\nperifissural nodule on the right is also stable (4:150).  Subpleural dependent\natelectasis are larger on the right lower lobe.  Punctate nodules in the left\nlower lobe (4:202), in the right lower lobe (4:211) and a 3 mm nodule in the\nleft lower lobe (4:149) are all stable.  There are no new lung nodules. \nBiapical scarring is again noted.  .  There is no pleural or pericardial\neffusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nCentral catheter tip is in the lower SVC.\nSmall sclerotic focus in T9 is unchanged.",
            "output": "Stable lung nodules.  No evidence of new lung nodules."
        },
        {
            "input": "Aberrant right subclavian artery is re- demonstrated.  Aorta and pulmonary\narteries are unremarkable.  Heart size is normal.  No pericardial pleural\neffusion is seen.  No mediastinal, hilar or axillary lymphadenopathy is\npresent.\n\nImage portion of the upper abdomen will be reviewed separately and\ncorresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules are stable with no new nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest was no evidence of intrathoracic metastatic\ndisease."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  Mild coronary artery calcifications are noted.  The\nheart, pericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild centrilobular emphysema is seen. There is mild bibasilar\natelectasis.  Punctate granuloma is seen within the right upper lobe.  There\nis no evidence of pleural or pericardial effusion.  Secretions are noted\nwithin the carina and right mainstem bronchus.  The remainder of the airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.2 x 2.6 cm hypodense lesion with peripheral nodular enhancement,\nin segment 7 of the liver, compatible with a hemangioma.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are multiple bilateral renal hypodensities, too small to characterize,\nlikely representative renal cysts. There is no evidence of hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Surgical material is seen adjacent to the stomach and lower\nesophagus suggestive of prior surgery.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  Diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe appendix is not visualized. There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Extensive posterior hardware fixation of T5 through S1 and pelvis is\nseen with no evidence of hardware fracture or loosening though the posterior\npedicle screws of T5 and T6 that traverse into the intervertebral disc space\nof T4-T5 and T5-T6. There is osseous fusion of L2 through L5. There is a\nhorizontally oriented fracture of L1 with a sclerotic border and vertebral\nbody height loss likely chronic in nature given lack of hardware at this\nlevel. There is mild anterolisthesis of L5 on S1. There are old healed\nfractures of the right superior and inferior pubic rami. There are no acute\nfractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute traumatic abnormalities within the torso.\n2. No acute fractures or malalignment identified with a chronic fracture of L1\nseen.\n3. No acute hardware related complications of extensive posterior hardware\nfixation of T5 through S1, though the posterior pedicle screws of T5 and T6\ntraverse into the intervertebral disc space of T4-T5 and T5-T6 respectively.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ in ___ ___ at 9:45 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 7 mm and 8 mm hypodense thyroid\nnodules are noted inferiorly in the left thyroid lobe.  No enlarged\nsupraclavicular or axillary lymph nodes.  Breast assessment is reserved for\ndedicated breast imaging.  Excluding the breasts, no soft tissue chest wall\nabnormality.  Right-sided chest port in situ, with the tip at the cavoatrial\njunction.  Mild atherosclerotic calcification of the imaged neck arteries.\n\nUPPER ABDOMEN: Please see the CTA abdomen and pelvis report dated the same day\nfor evaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Mild hiatus hernia.  Normal esophagus.  Numerous prominent, not\nenlarged by size criteria, e.g: 9 mm aortopulmonary lymph node (305:68).  No\nmediastinal mass.  The thoracic aorta and pulmonary arteries are normal in\ncaliber.  Mild atherosclerotic calcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size. No coronary artery or cardiac valve\ncalcification.  No pericardial effusion.\n\nThinning and hypodensity in the anterior myocardial wall especially close to\nthe apex, series 303, image 75 in some endocardial distribution concerning for\nprevious myocardial infarct.\n\nPLEURA: No pleural effusion or pneumothorax.  Minimal biapical\npleuroparenchymal scarring.\n\nLUNG:\n\n1. PARENCHYMA: 6 mm right upper lobe nodule (305:79), 5 mm right upper lobe\nnodule with adjacent branching structures arising from (305:92), may represent\nmucous filled bronchioles or an irregular nodule.  2 mm and 3 mm middle lobe\nnodules (305:138, 110).  Several slight mixed density nodules with\nground-glass component are present, series 305, image 79, 92, 138, 99.  No\nconsolidation.  Mild bibasal linear atelectasis.  Minimal emphysema.\n2. AIRWAYS:  The tracheobronchial tree is patent to the segmental level.  No\nbronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.No fracture. Mild spondylosis.",
            "output": "Pulmonary nodules measuring up to 6 mm (right upper lobe).  Some of those\nnodules have ill-defined contours with ground-glass component.  Giving the\nprovided history of pancreatic cancer, this appearance of the nodules is\nconcerning for potential metastatic disease.  Short-term follow-up in 3 months\nis required with chest CT.\n\nNo lymphadenopathy.\n\nRECOMMENDATION(S):\nThyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper"
        },
        {
            "input": "Left thyroid nodule is 17 mm, stable.  Right thyroid lobe ___ is 9 mm,\nstable.\n\nAorta and pulmonary arteries are well enhanced.  Heart size is normal.  There\nis no pericardial or pleural effusion.\n\nNo pathologically enlarged supraclavicular, mediastinal, hilar or axillary\nlymph nodes demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple\npre-existing pulmonary nodules are sub 6 mm stable, solid, series 4 images 83,\n79, 87, 103, 125, 135, 138.  No new nodules.",
            "output": "Overall stable appearance of the chest including multiple pulmonary nodules\nwith no evidence of intrathoracic disease progression.\n\n2 abnormal thyroid nodules, left larger than right, consider correlation with\nthyroid ultrasound\n\nPlease review CT abdomen and pelvis in corresponding report will be issued\nseparately."
        },
        {
            "input": "The previously visualized high-density material within the azygos vein is no\nlonger identified on the initial noncontrast phase imaging, and is\nsubsequently reproduced on the delayed phase postcontrast imaging.  Otherwise,\npostcontrast images of the azygos vein and it adjacent structures are\nunremarkable.\n\nThere is no pathologically enlarged axillary, mediastinal, or hilar\nlymphadenopathy.  The heart is normal in size.  There is no pericardial\neffusion.  Residual thymic tissue is noted within the anterior mediastinum. \nThe main and right pulmonary arteries are normal in caliber and without\nevidence of incidental pulmonary embolism.\n\nLung windows demonstrate minimal linear atelectasis along the lateral aspect\nof the right lower lobe and along the anterior aspect of the right middle\nlobe.  Otherwise, there is no consolidation or suspicious nodule.  Airways are\npatent to the subsegmental levels.  No pleural effusion or pneumothorax\nidentified.\n\nThe included osseous structures are intact, without evidence of fracture.  No\nsuspicious bone lesion is seen.",
            "output": "1.  No evidence for acute intrathoracic process, within the imaged portion of\nthe chest cavity.\n2.  The previously visualized high-density material which been seen at the\nlevel of the azygos vein is no longer visualized on initial noncontrast\nimaging, but is subsequently replicated on delayed phase imaging following\ncontrast administration.  Findings likely represented pooling/puddling of\nintravenous contrast material."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Right lobe of thyroid nodule\nmeasuring 17 mm in length and correlation with thyroid ultrasound is advised. \nNo supraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.  Exophytic hypodense lesion\narising from the anterior aspect of the upper pole of the left kidney (3, 64)\nmost likely representing a simple renal cyst.  Hyperdense cystic lesion\narising from the lateral aspect of the midpole of the left kidney (3, 73)\nmeasuring 85 ___ most likely representing a hemorrhagic renal cyst.  Both these\ncystic lesions have a benign appearance, but please note that the hyperdense\ncyst was not imaged in its entirety, therefore correlation with ultrasound may\nbe performed.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  Trace\npericardial fluid is physiologic.  No aortic valve calcification.  No\naneurysmal dilatation of the ascending aorta.  Severe coronary artery\ncalcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Mild paraseptal\nand centrilobular pulmonary emphysematous changes with an upper lobe\npredominance.  Marked interval improvement in the previously noted\nperibronchovascular and peripheral ground-glass opacities.  9 mm pulmonary\nnodule in the right upper lobe (5, 191) Is unchanged compared to previous\nimaging done ___.  No other suspicious pulmonary nodules or masses.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  Mild, but\ndiffuse bronchiectasis may be reactive to organization or fibrosis, this could\nbe reassessed on follow-up imaging.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Marked interval improvement in the patient's organizing pneumonia.\n\n9 mm pulmonary nodule right upper lobe appear similar compared to prior\nimaging (done 2 months ago) and a six-month follow-up chest CT is advised to\nre-evaluate for stability.\n\nRight lobe of thyroid nodule measuring 17 mm in length and correlation with\nthyroid ultrasound is advised.\n\nBenign-appearing left renal cysts, but please note that the inferiorly\nsituated cyst was not imaged in its entirety and it could be better assessed\nwith ultrasound."
        },
        {
            "input": "Compared to the prior exam from ___, there has been interval\nprogression of the predominantly peripheral peribronchovascular ground-glass\nopacities within apical basal distribution.  There has been no significant\ninterval change in the 9 mm pulmonary nodule within the right upper lobe\ncompared to the prior exam.  No concerning new or growing pulmonary nodules\nare identified.\n\nModerate to severe centrilobular and apical predominant paraseptal emphysema\nis re-demonstrated.  The airways are patent to the subsegmental levels.\n\nA 6 mm hypodensity seen within the right thyroid lobe.  There is no axillary\nhilar, or mediastinal lymphadenopathy, however prominence of the hilar and\nmediastinal lymph nodes measuring up to 0.8 cm in short axis appears to have\nprogressed compared to the prior exam.  For example a right hilar lymph node\nmeasures 0.8 cm in short axis, series 4, image 124 progressed compared the\nprior exam which time this measured no more than 0.4 cm.  The heart size is\nnormal.  The pericardium is intact without evidence of effusion.  Moderate\ncoronary artery calcifications are seen.\n\nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures however Re demonstrated is a hyperdense lesion within the midpole\nof the left kidney measuring 1.9 cm x 1.6 cm, series 4, image 280, partially\nvisualized on this exam.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are seen.",
            "output": "1. Overall, compared to the prior exam from ___ there has been interval\nprogression of peripheral peribronchovascular ground-glass opacities in\napicobasal distribution, concerning for radiographic worsening of patient's\norganizing pneumonia.\n2. Stable 9 mm right upper lobe nodule compared to the prior exam.\n3. 1.9 cm hyperdense lesion within the midpole of the left kidney is\nincompletely evaluated on this exam however could be secondary to a\nhemorrhagic/proteinaceous cyst.  A renal ultrasound is recommended for further\nevaluation.\n\nRECOMMENDATION(S):  Renal ultrasound of left kidney hyperdense lesion."
        },
        {
            "input": "VASCULATURE: The left cephalic vein appears distended and nearly completely\nunopacified although a small amount of contrast is seen within the vessel as\nwell as the subclavian vein.  There is surrounding stranding, compatible with\nrecent ultrasound findings of cephalic vein thrombosis.  The patient has a\nleft internal jugular central venous line, the tip ending in the low right\natrium.  A thrombosed venous graft is seen extending from the left\nbrachiocephalic vein to the thrombosed left cephalic vein.  The left\nbrachiocephalic vein itself remains patent.  The left axillary and brachial\nveins are patent.  Patient has undergone brachiocephalic artery to\nbrachiocephalic vein loop graft, which appears patent.  Soft tissue stranding\nsurrounding the graft and single focus of air is compatible with recent\npostoperative status (3:73).  The right brachiocephalic and subclavian veins\nare patent.\n\nPulmonary vasculature is well opacified to the subsegmental level without\nfilling defect to indicate a pulmonary embolus.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.\n\nHEART: The heart and pericardium are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Airways are patent to the level of the subsegmental bronchi\nbilaterally.  Mild scarring is seen in the right lower lobe.  No concerning\npulmonary nodules are identified.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Near complete thrombosis of the venous graft extending from the left\nbrachiocephalic vein to the left cephalic vein.  The left cephalic vein is\ndistended and minimally opacified, with surrounding stranding, compatible with\nrecent ultrasound findings of cephalic vein thrombosis.\n2. The left brachycephalic vein itself remains patent.\n3. No additional areas of venous thrombosis are seen in the left upper\nextremity.  The right brachiocephalic and subclavian veins are patent.\n4. Status post recent brachiocephalic artery to brachiocephalic vein loop\ngraft, which appears patent.  Postoperative changes are seen surrounding the\nsurgical site."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Mildly enlarged mediastinal lymph nodes, the\nlargest in the right lower paratracheal station measuring 12 mm and in the AP\nwindow measuring 10 mm.  No hilar lymphadenopathy within the limitations of\nthis noncontrast study.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.  Small right Bochdalek\nhernia.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nwall thickening, no bronchiectasis or mucus plugging.  Numerous centrilobular\nnodules with ___ pattern, coalescing into peribronchial\nconsolidations, most notable in the right lungs.  No grossly large suspicious\nlung nodules.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show nonobstructive calculus in the\nleft kidney (02:51).  Measuring up to 3 mm. Small to moderate bilateral fat\ncontaining Bochdalek hernias are noted.",
            "output": "1.  Extensive diffuse centrilobular nodules with ___ pattern\ncoalescing into large peribronchial consolidations, in keeping with known\ndiagnosis of active tuberculosis.\n2.  Mildly enlarged mediastinal lymph nodes are likely reactive."
        },
        {
            "input": "Multiple small left supraclavicular and axillary lymph nodes are unchanged\nsince ___.\n\nThere are no soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis, but\nshows there is no adrenal mass.\n\nEsophagus is mildly patulous at several levels, with no evidence of an\nobstructing mass.  There are no thyroid findings warranting further imaging\nevaluation.\n\nAtherosclerotic calcification is mild in head and neck vessels and scattered\nin coronary arteries.  Aortic valvular calcification is mild to moderate,\nprobably unchanged since contrast examination is performed in ___. \nAorta is normal caliber.  Right and left pulmonary arteries are enlarged, 34\nand 36 mm respectively, previously 31 and 35 mm, suggesting pulmonary arterial\nhypertension.  The atrial enlargement has also progressed.  These findings are\nbest evaluated with echocardiography.  Pericardium is physiologic.  New small\npleural effusions layer posteriorly.\n\nThoracic lymph nodes:\n\nEnlargement of the right lower paratracheal mediastinal nodes, to 14 mm, is\nnew.  14 mm subcarinal node was previously 9 mm.  Hilar contours do not\nsuggest adenopathy.\n\nLungs and airways:\n\nDiffuse bronchial wall thickening in the lower lobes, moderate on the right,\nmild on the left is not accompanied by retained secretions or peribronchial\ninfiltration.  Could be due to either bronchial inflammation or mild\nperibronchial edema since septal thickening reflects Lymphovenous engorgement\nand there are new small pleural effusions.\n\nAside from a solitary calcified granuloma in left lung, and long-standing\nisolated bullae, lungs are clear of focal abnormalities.  There is no lung\nnodule of concern.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No lung nodule.\n\nMild cardiac decompensation reflected in Lymphovenous engorgement, small\npleural effusions, increased left atrial enlargement.  Coronary artery\ncalcification is relatively mild.  Aortic valvular calcification moderate. \nInterval increase in already enlarged pulmonary arteries could be a function\nof acute cardiac decompensation or progressive pulmonary arterial\nhypertension.\n\nRECOMMENDATION(S):  Cardiac assessment."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the lobar\nlevel without filling defect to indicate a pulmonary embolus.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  There is aortic valve calcification.  The heart is moderately\nenlarged.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple enlarged mediastinal lymph nodes are\nseen, for example: Right paratracheal node measuring 1.6 cm previously  1.2 cm\n(02:41), Left paratracheal lymph nodes measuring 1.5 cm (3:85), subcarinal\nnode measuring 1.8 cm, previously 1.1 cm (3:113).  Pre-vascular lymph node\nmeasuring 1.0 cm, not previously seen (02:21).  No axillary or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Motion artifact limits evaluation. Scattered diffuse granulomas\nare seen. There is mild nonspecific bronchial wall thickening most prominently\nat the lung bases.  There is mild bibasilar atelectasis.\n\nBASE OF NECK: Prominent supraclavicular lymph nodes.\n\nABDOMEN: There is mild atherosclerotic calcification.  There is moderate\ncalcification of the origin of the celiac axis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Motion artifact limits evaluation.  No central pulmonary embolism.\n2. Mild nonspecific bronchial wall thickening likely represents small airway\ndisease, either inflammatory or infectious.  No consolidation.\n3. Mediastinal adenopathy, increased from ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No supraclavicular lymphadenopathy.  No axillary\nlymphadenopathy.  Right-sided PICC terminates at the cavoatrial junction.\n\nUPPER ABDOMEN: Limited view of the upper abdomen is notable for cirrhotic\nliver morphology.  There is small volume ascites.  Spleen is enlarged\nmeasuring up to 20.0 cm.  Hyperdense material within the gallbladder may\nrepresent vicarious excretion of previously administered contrast. \nEmbolization coils are noted in the epigastric region.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy within limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart size is top-normal.  There are extensive coronary\nartery calcifications.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Multifocal areas of ground-glass opacity with perihilar\npredominance is consistent with pulmonary edema.\n2. AIRWAYS:  Airway is are patent to subsegmental levels bilaterally.\n3. VESSELS:  Thoracic aorta is of normal caliber.  Main pulmonary artery is\nmildly dilated measuring up to 3.5 cm.\nCHEST CAGE: No worrisome osseous lesions.",
            "output": "1. Moderate pulmonary edema.\n2. Cirrhosis with sequela of portal hypertension including small volume\nascites and splenomegaly noted in the visualized portion of the upper abdomen."
        },
        {
            "input": "CHEST: Small right pneumothorax is noted. There is no pleural or pericardial\neffusion.  The lungs are clear. Central airways are patent. There is moderate\ncardiomegaly. Dense atherosclerotic calcifications noted at the aorta, great\nvessels and coronary arteries. There is no mediastinal hematoma or\npneumomediastinum. There is no mediastinal or hilar lymphadenopathy.\n\nABDOMEN: There is a 2.5 cm laceration within segment V of the liver. The\nlaceration does not involve the capsule.  Multiple round hypodensities noted\nwithin the liver, the largest of which is compatible with a simple cyst.\nOthers are too small to fully characterize. There is no hemoperitoneum or free\nair. Portal vein is patent. The spleen, pancreas, and bilateral adrenal glands\nare normal.\n\nSeveral subcentimeter hypodensities in the right kidney are too small to\ncharacterize but are likely simple cysts. There are no radiodense stones. No\nhydronephrosis.\n\nThe stomach and bowel loops are nondistended and are without evidence of\nobstruction. Appendix is normal. There is diverticulosis without evidence of\ndiverticulitis.\n\nThe thoracic and abdominal aorta are normal in caliber and without evidence of\naneurysm or dissection.  There is no retroperitoneal, mesenteric, or pelvic\nsidewall lymphadenopathy.\n\nA pessary device is noted.  Uterus is not seen.\n\nThere are multiple right sided lateral rib fractures involving ribs ___.  In\naddition, there is acute fracture of the right T3 transverse process.  An old\nsternal fracture is also incidentally noted. The patient is status post right\nhip arthroplasty.",
            "output": "1.  Rib fractures involving right ___ through 10th ribs on the right.\n2.  Acute fracture of the T3 right transverse process.\n2.  Small right pneumothorax\n3.  Grade 2 liver laceration involving liver segment V. There is no\nhemoperitoneum."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Residual thymic tissue seen\nin the anterior mediastinum.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The liver is diffusely hypoattenuating in comparison to the spleen\nsuggestive of hepatic diffuse steatosis.  Patient is status post\ncholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is subcutaneous soft tissue swelling posteriorly at the L3-L4 level.",
            "output": "1. No acute traumatic injury identified within the chest.  No acute fracture.\n2. Probable hepatic steatosis."
        },
        {
            "input": "LOWER NECK: Lower neck is unremarkable.  An enteric catheter is in place. \nNote is made of a distended esophagus containing oral contrast which extends\nto the level of the thoracic inlet.\n\nAIRWAYS/LUNGS:\nThere is mucous plugging within the lobar and proximal segmental branches of\nthe lower lobes bilaterally.\nThere is minimal subsegmental atelectasis at the lung bases bilaterally. \nThere is no focal airspace consolidation.\n\nNote is made of severe background centrilobular and paraseptal emphysema. \nThere is a 7 mm spiculated nodule in the right lower lobe (series 302, image\n130), similar to most recent study but more prominent than ___.\n\nPLEURA:  There are small bilateral pleural effusions, new from prior.\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.\n\nHEART and VASCULATURE: The heart is not significantly enlarged.  Coronary\nartery calcifications are noted.  No pericardial effusion.\n\nCHEST WALL: Note is made of surgical clips in the left upper chest wall. \nSurgical clips are also present in the proximal left upper arm with some\nassociated subcutaneous emphysema presumably postprocedural in nature.\n\nBONES:  No aggressive bony lesions.\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen/pelvis obtained\nthe same day.",
            "output": "1. Oral contrast is noted within the thoracic esophagus extending to the level\nof the thoracic inlet.  This may pose increased risk for aspiration.\n2. Mucous plugging noted in the lower lobes bilaterally with minimal basilar\nsubsegmental atelectasis.\n3. 7 mm spiculated nodule in the right lower lobe is similar to most recent\nexam but more prominent than ___.  It is difficult to exclude a primary lung\nmalignancy.  Short-term follow-up CT thorax in 3 months is recommended for\nreassessment.\n4. Centrilobular and paraseptal emphysema.\n5. Apparent postsurgical changes along the left chest wall and left upper arm.\nSoft tissue gas in the left upper arm is presumed to be postprocedural in\nnature."
        },
        {
            "input": "The thyroid gland is grossly unremarkable.  Heart size is normal with small\npericardial effusion.  There are moderate aortic annular and coronary artery\ncalcifications.  There are severe atherosclerotic calcifications along a\nmildly ectatic thoracic aorta, with the descending thoracic aorta measuring up\nto 3.5 cm in maximal caliber, unchanged.  A tiny outpouching of the ascending\nthoracic aorta is unchanged, consistent with known pseudoaneurysm.  Abdominal\naortic stent graft along with branch vascular stents are partially visualized.\nMain pulmonary artery is top normal caliber. Small nonocclusive rounded\nfilling defect, with some a tear in portions are noted in the proximal\nanterior basal segmental pulmonary artery in the right lower lobe, as well as\nmore component in the posterior basal distal segmental branch, extending to\nsome of the subsegmental branches.  This appears unchanged compared to the\nrecent CT examination from ___.  Other at liver the minimal\ninvolvement in a right middle lobe subsegmental branch is also unchanged.  The\nremainder of the pulmonary arteries are well opacified to the subsegmental\nlevel without additional filling defect.  There remains flattening of the\ninterventricular septum suggesting a component of right heart strain.\n\nThere is no supraclavicular, axillary, or hilar lymphadenopathy.  Borderline\nprominent mediastinal nodes are unchanged, not enlarged by CT size criteria.\n\nModerate bilateral nonhemorrhagic pleural effusions appear increased in volume\ncompared the prior study.  There is no appreciable pneumothorax.  Background\nmoderate to severe centrilobular and paraseptal emphysema is again seen.  The\npreviously noted partially cavitary lesion in the right middle lobe appears\nmore confluently solid in the prior examination, though slightly decreased in\nsize measuring 7 mm, previously 10 mm.  There is moderate compressive\natelectasis in the bilateral lung bases.  Other previously noted cavitating\nareas in the medial right middle lobe previously measuring up to 18 mm have\nall also decreased in size, and now appear more solid, now 7 mm (7:189). \nThere are overall unchanged areas of scarring in the right lower lobe.  An\nadditional 5 mm nodule in the right lower lobe is unchanged (7:188).  Moderate\nbiapical pleuroparenchymal scarring is unchanged.  Areas of ground-glass and\nconsolidation in the left upper lobe are significantly improved compared the\nprior study, though subtle areas persist, though this area is not well\nevaluated due to respiratory motion artifact.  There is diffuse bronchial wall\nthickening with a mucous impaction of the bilateral lower lobe segmental and\nsubsegmental branches.\n\nAlthough this study is not tailored for subdiaphragmatic analysis, the\nvisualized upper abdomen is notable for the aforementioned aortic endograft. \nUpper enteric tube is partially visualized, reaching at least the proximal\nstomach.\n\nThe bones are diffusely demineralized.  There is an unchanged subacute\nangulated fracture of the mid sternal body.  There are old right-sided rib\nfractures.  No new fracture or suspicious focal bone lesion is seen.",
            "output": "1. Unchanged small areas of pulmonary emboli in the right right lower lobe\nsegmental and subsegmental branches and minimal involvement in a right middle\nlobe subsegmental branch.  No new pulmonary embolus noted.  There is\nflattening of the intraventricular septum suggesting component of right heart\nstrain, though there is only unchanged very small burden of pulmonary embolus.\n2. Unchanged small pseudoaneurysm of the aortic arch and partial visualization\nof an abdominal aortic aneurysm endograft.  No acute aortic abnormality.\n3. Previously noted 10 mm cavitary right middle lobe lung lesion and other 18\nmm medial lesion have both decreased in size, now both 7 mm, though now\nappearing more solid.  Additional 5 mm nodule in the right lower lobe is\nunchanged.  Given the rapid interval change, these may be infectious, though\nthese warrant follow-up surveillance.\n4. Diffuse bronchial wall thickening with slightly worsening mucous impaction\nof the bilateral lower lobe distal segmental and subsegmental airways with\nassociated atelectasis.\n5. Interval improvement of ground-glass and consolidative opacities in the\nleft upper lobe consistent with improving pneumonia, though small areas of\ninvolvement persist.\n6. Background moderate to severe emphysema.\n7. Increasing volume of moderate bilateral nonhemorrhagic pleural effusions.\n8. Unchanged now subacute angulated fracture of the mid sternal body.\n\nRECOMMENDATION(S):  Three-month interval chest CT follow-up is recommended in\norder to confirm stability or continued decrease in size of the above\nspiculated nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is moderate four-chamber cardiac enlargement. \nThere is mitral annular calcification.  Mild calcification of the coronary\narteries most pronounced in the LAD.  No pericardial effusion.  Main pulmonary\nartery measures up to 3.6 cm which may reflect pulmonary artery hypertension. \nThoracic aorta is tortuous, but normal in caliber containing mild-to-moderate\natherosclerotic calcification.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate bilateral pleural effusions.\n\nLUNGS/AIRWAYS: Significant compressive atelectasis is noted in the bilateral\nlower lobes.  Atelectasis in the right middle lobe is also present with subtle\nadjacent ground-glass opacity which could reflect a component of pulmonary\nedema.  No worrisome nodule or mass.  No convincing evidence for pneumonia.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: The patient is status post median sternotomy with sternal wires intact.\nNo suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Moderate bilateral pleural effusions with adjacent compressive atelectasis.\nModerate cardiomegaly, probable mild pulmonary edema.\n3. Enlarged main pulmonary artery measuring 3.6 cm may reflect pulmonary\narterial hypertension."
        },
        {
            "input": "LUNGS: There is a partially ground-glass consolidation in the superior segment\nof the left upper lobe (04:14) spanning a similar territory to the ___ study. In addition, there are now bilateral pleural effusions as well as\nbibasal atelectasis.  A trach tube is in place. The tracheobronchial tree is\npatent.\n\nMEDIASTINUM: Trace pericardial effusion. Heart size is normal. Aorta is of\nnormal caliber. A right-sided PICC line terminates at the cavoatrial junction.\nNo mediastinal hilar or axillary lymphadenopathy by CT criteria.\n\nUPPER ABDOMEN: Imaged portion the upper abdomen demonstrates a simple renal\ncyst on the left, but otherwise no gross abnormal pathology.\n\nBONES: No suspicious lytic or sclerotic lesions of the bone identified.\nDegenerative changes as well as a T5 vertebral body partial compression\nfracture with approximately 50% height loss are noted.",
            "output": "1. Left upper lobe ground-glass infiltrate worrisome for pneumonia, similar to\n___ study\n2. New small bilateral pleural effusions and adjacent atelectasis"
        },
        {
            "input": "A calcified nodule is seen in the left lobe of the thyroid.  Supraclavicular,\naxillary, and hilar lymph nodes are not enlarged.  A pretracheal lymph node\nmeasures approximately 1 cm in short axis (8:103) .  Aorta and pulmonary\narteries are normal size.  Atherosclerotic calcifications of the aorta are\nnoted. Midline sternal wires are well aligned and intact.  Cardiac\nconfiguration is normal.  There is biatrial enlargement, greater on the left\nthan on the right.  There has been prior mitral and aortic valve replacement. \nTricuspid annuloplasty is also noted.\n\nEvaluation of the lungs bases is limited by respiratory motion artifact. \nRight middle lobe and lingular atelectasis is noted.  No suspicious nodules\nare identified.\n\nFor infradiaphragmatic findings, please see CT of the abdomen and pelvis from\nsame date.\n\nEvaluation of the bones shows age indeterminate compression deformity of the\nT10 vertebral body.  This is was not definitively present on comparison chest\nxray.",
            "output": "1.  No CT evidence of metastatic disease in the chest."
        },
        {
            "input": "The aortic valve is heavily calcified, consistent with history of severe\naortic stenosis. The thoracic aorta is normal in caliber. Atherosclerotic\ncalcifications are mild in the ascending aorta, moderate in the aortic arch,\nand moderate to markedly in the descending thoracic aorta. Vascular\ncalcifications are also present in the origin of the great vessels most marked\nat in the left subclavian artery. Diffuse coronary artery calcifications are\npresent as well as coronary artery stents. Heart is mildly enlarged. There is\nno pericardial or pleural effusion. Small hiatal hernia is incidentally noted\n\nAnd increased number of lymph nodes is present throughout the mediastinum,\nmost of which are below 1 cm in short axis dimension. An exception is a 2.7 cm\nx 1.6 cm diameter lymph node in the azygos esophageal recess. And increased\nnumber of subcentimeter nodes are also seen within the lower paraesophageal\nregion.\n\nWithin the lungs, basilar predominant septal thickening and irregular\nreticular opacities are present bilaterally, as well as minimal paraseptal\nemphysema. A few 2-3 mm diameter noncalcified upper lung nodules are present\nbilaterally in the apices (images 30, 35, 27, series 4).\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of dependent calcified gallstones within the gallbladder. Diffuse\nvascular calcifications are present in the abdominal aorta and its branches\nincluding the proximal renal arteries bilaterally. Small, subcentimeter upper\nabdominal lymph nodes are of uncertain clinical significance.",
            "output": "1 Diffuse vascular calcifications in the thoracic aorta as described above,\nextending into branch vessels including the left subclavian artery. These\nimages are available for pre operative for review.\n\n2 Increased number of mediastinal and upper abdominal lymph nodes, with a\ndominant enlarged lymph node in azygos esophageal recess measuring 1.6 cm in\nshort axis dimension. As incidental findings, these lymph nodes are of\nuncertain clinical significance. Enlarged mediastinal lymph nodes can be seen\nin the setting of acute and chronic congestive heart failure, but malignancy\nsuch as lymphoma is also possible. Further evaluation could be performed by\nshort-term followup CT in ___ months. If the patient has a known primary\nmalignancy or systemic symptoms, consider more immediate further evaluation\nwith PET-CT exam.\n\n3. Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis. Diffuse coronary artery calcifications and previous coronary stent\nplacement\n\n4.  Basal predominant interstitial lung disease, which may represent a\ncombination of acute and chronic changes from congestive heart failure,\nalthough underlying fibrotic lung disease is also possible. These findings may\nbe reassessed if short-term followup CT is performed for assessment of\nmediastinal lymph nodes.\n\n5. Cholelithiasis"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  Main\npulmonary artery diameter is normal.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart appears\nslightly enlarged in the interval. There is new indentation upon the right\natrium and ventricle from the fragmented end of the left anterior fifth rib\n(3:149).  There is a no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is moderate volume left hemopneumothorax, with more\nisolated collections seen at the anterior upper chest (3:46) and at the right\nlung apex (3:7).  There is a small right pneumothorax.  These are likely\nrelated to recent surgery.\n\nLUNGS/AIRWAYS: Hypoenhancing consolidation in the right lower lobe (3:101) is\nsuspicious for pneumonia.  There is mild subsegmental atelectasis elsewhere in\nthe right lower lobe.  There is near complete collapse of the left lower lobe.\nThe central airways are patent.\n\nBASE OF NECK: The thyroid is unremarkable.\n\nABDOMEN: No concerning abnormalities.\n\nBONES AND CHEST WALL: No suspicious osseous abnormality is seen.? There are\nexpected postsurgical changes in the chest wall from recent chest wall\nreconstruction, including moderate volume subcutaneous air.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Hypoenhancing consolidation the right lower lobe is concerning for\npneumonia.\n3. Near complete collapse of the left lower lobe.\n4. Moderate indentation upon the right atrium and ventricle from the left\nanterior fifth rib, of uncertain clinical significance.  New mild cardiac\nenlargement.  Consider correlation with echocardiography, as clinically\nwarranted.\n5. Partially loculated left pleural effusion appears slightly hyperdense, and\nmay contain blood products.  Small left pneumothorax and small right\npneumothorax."
        },
        {
            "input": "LINES AND TUBES:\n\nSince the CTA performed ___, patient has been intubated.  The tip\nof the endotracheal tube is located approximately 5.1 cm above the carina.\n\nThere has been placement of a gastric feeding tube, which is seen curling in\nthe mid to lower esophagus.\n\nThere are two newly placed large bore pleural drains.  The more anterior drain\ncourses along the anterior pleura and terminates within the posterior left\nlung apex.  There is a more lateral large-bore pleural drain, placed\napproximately at the same level, seen coursing in the left anterolateral\npleural space.  In the lower left lateral pleural space, this drain\ndemonstrates a sharp kink and courses superiorly, terminating approximately at\nthe T7-T8 disc level.\n\nInterval placement of small caliber epidural catheter.\n\nCHEST:\n\nPatient is status-post redo pectus-excavatum repair.  There is a malleable\nplate and screw construct along the anterior sternum.  As on the recent prior\nstudy many of the screws in the mid to lower portions of the fusion plates do\nnot protrude into bone.  Stable acute osseous defect along the lower margin of\nthe sternum, likely postsurgical in nature.  Stable acute osteotomies through\nthe anterior ribs.\n\nStable position of the heart in the left hemithorax, related to known pectus\ndeformity.  Again redemonstrated is a slight contour deformity within the\nright atrium, related to osteotomy of the left anterior rib (series 2, image\n41).  This is unchanged from prior.  Surrounding the rib in question is\nmoderate amount of fluid, centered on the anterior chest wall, likely\npostsurgical in nature, demonstrating no adverse interval change.  There is\nsmall volume pericardial fluid, slightly increased from the prior study, but\nwithin physiologic limits.  No perceptible filling defects within the cardiac\nchambers.\n\nNo evidence of large central filling defect within the pulmonary arterial\nvasculature on this non-dedicated study.\n\nThoracic aorta is non-aneurysmal.\n\nSince the placement of the pleural drains, there has been at least moderate\nimprovement in the volume of the left-sided pleural fluid.  Specifically, the\nloculated component localized to the anterior left lung apex demonstrates\ncomplete resolution.  A small volume of non-loculated pleural fluid remains on\nthe left, improved from prior.  There is a small right-sided pleural effusion,\ncircumferential, and again slightly improved from prior.\n\nThe small to moderately large right-sided pneumothorax noted on the prior\nstudy has resolved.  There is no perceptible left-sided pneumothorax.\n\nCentral airways are patent.\n\nDense atelectasis involving the right upper lobe has improved from the prior\nstudy.  There remain atelectatic changes at the right and left lung bases. \nThere is no evidence of new consolidation in either lung.\n\nScattered small supraclavicular and mediastinal lymph nodes are reactive in\nnature.  No pathologically enlarged lymph nodes.\n\nLimited assessment of the upper abdomen.  No acute upper abdominal pathology\nis identified.\n\nThere is a new skin defect along the anterior chest wall, spanning the length\nof the sternotomy (series 2, image 22).  This skin defect is superficial and\ndoes not extend to the level of the surgical plate described above. \nPreviously seen pocket of subcutaneous emphysema along the superior sternotomy\nbed is no longer visualized.\n\nThere is a small volume of new air within the spinal canal, likely epidural,\nand likely related to placement of epidural catheter.",
            "output": "1.  Interval intubation.  The position of the endotracheal tube is slightly\nhigh at 5.1 cm.\n\n2.  Interval placement of gastric feeding tube.  This tube is seen curling in\nthe mid to lower esophagus.  The tube should be pulled back and re-advanced\nbelow the diaphragm.\n\n3.  Interval placement of two left sided pleural drains.  The more lateral\ndrain courses inferiorly but kinks in a sharp manner at the level of the lower\nlateral pleura, then coursing superiorly.\n\n4.  Interval improvement of loculated pleural fluid in the left hemithorax,\nwith residual non loculated fluid, as above.  Similarly, interval decrease in\nthe volume of the right-sided pleural fluid.\n\n5.  Interval resolution of right-sided pneumothorax.\n\n6.  No new consolidation in either lung.\n\n7.  Stable indentation of the right atrium related to an apparent osteotomy of\na left anterior rib.  Small volume pericardial effusion, slightly increased\nfrom the prior study, but remaining physiologic in volume.\n\n8.  New superficial skin defect along the length of the sternotomy. \nImprovement of post-surgical subcutaneous emphysema along the anterior chest\nwall associated with interval surgery.\n\n9.  New small volume epidural air, likely related to placement of small\nepidural catheter.\n\nNOTIFICATION:  Discussed with ___ from Thoracic Surgery at 17h24 on\n___"
        },
        {
            "input": "The aorta and its major branch vessels are normal in caliber.  No aortic\ndissection is seen.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nfilling defect within the main, right, left, lobar, segmental.  Subsegmental\narteries are not well evaluated due to motion.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland is heterogeneous.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nBilateral upper lobe predominant centrilobular emphysematous changes are\nsevere. There are several nodules in the lungs, including a 6 mm nodule in the\nright upper lobe (image 3:86), as well as 4 mm (image 3:29), 5 mm (image\n3:35), and 4 mm (3:44) nodules in the left upper lobe. There is a 4 mm (image\n3:78) in the left lower lobe. The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No pulmonary embolism or acute aortic abnormality.\n2.  Bilateral pulmonary nodules, largest is a 6 mm nodule in the right upper\nlobe.  Follow-up CT in ___ months is recommended for high risk patients.\n3.  Heterogenous thyroid not optimally assessed.  Consider correlation with\nTFTs/ultrasound if not already performed."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  No\nincidental pulmonary embolism. The large mediastinal vessels are unremarkable.\nMild to moderate coronary calcifications.  No pericardial effusion. The\ncardiac structures appear normal. The posterior mediastinum, including the\ndescending aorta is normal. The upper abdomen is reported separately. No\nosteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.\nMinimal bilateral apical scarring.  Several millimetric mostly subpleural\nmicronodules (for example series 6, image 117).  No lung nodules suspicious\nfor metastatic or malignant disease.  The airways are patent.  No pleural\neffusions.  No pleural thickening.  No evidence of diffuse lung disease.",
            "output": "No hilar or mediastinal adenopathy.  No pleural effusions.  No lung nodules\nsuspicious for malignant or metastatic disease."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes in the mediastinum and at\nthe level of the hilar structures. No incidental pulmonary embolism. No\ncoronary calcifications. No pericardial effusion. No abnormalities in the\nposterior mediastinum.  Upper abdominal changes are described in detail in the\nabdominal CT report.  No convincing evidence for the presence of chest wall\nlesions.  No osteolytic lesions at the level of the sternum, the ribs or the\nvertebral bodies.  Minimal bilateral apical scarring. No pleural effusions. No\npleural thickening.  The airways are patent.\n\nIn the right upper lobe, in anterior subpleural location, a 3 mm nodule is\nvisualized.  In retrospect, at the same location, a sub millimetric micro\nnodule was seen on the previous examination.  The location of the nodule is\nseries 6, image 119. Although the lesion is still too small to characterize,\nthe minimal interval grow makes it suspicious and either short-term followup\nor histologic sampling should be considered.\n\nNo other pulmonary nodules or masses.",
            "output": "Minimal growth of a now 3 mm right upper lobe subpleural nodule, seen in\nretrospect on the previous examination from ___ and than sub\nmillimetric in size.  Given the underlying disease and growth of the nodule,\nhistologic sampling should be considered.  The findings were posted to the\nradiology dashboard."
        },
        {
            "input": "CT chest with contrast:  Thyroid is unremarkable.\n\nModerate cardiomegaly with mainly biatrial enlargement.  Severe mitral\nannular, aortic valvular and 3 vessel coronary artery calcifications.  Severe\natherosclerotic calcifications along a normal caliber thoracic aortic arch. \nTortuosity of the thoracic aorta owing to moderate thoracic dextroscoliosis. \nRight pulmonary artery is dilated to 3.2 cm.  No central pulmonary embolus. \nNo supraclavicular, axillary, hilar or mediastinal lymphadenopathy by CT size\ncriteria.\n\nModerate apical predominant centrilobular emphysema.  Mild bibasilar\natelectasis.  Millimetric calcified granuloma in the left lung base.  Diffuse\nairway calcifications noted.  Airways are patent to the subsegmental level. \nNo pleural effusion or pneumothorax.\n\nCT abdomen with contrast:  Liver enhances homogeneously without focal lesion\nor biliary dilatation.  Portal vein is patent.  Gallbladder is unremarkable.\n\nIll-defined 6 mm hypodensity in the spleen, not fully characterized (02:37),\npotentially a hemangioma.  Spleen is normal size.  Pancreas is atrophied\nwithout gross lesion.  Adrenal glands are unremarkable.\n\nMillimetric hypodensity in the right interpolar kidney is too small to fully\ncharacterize, likely a cyst.  Kidneys otherwise present symmetric nephrograms\nand excretion of contrast without focal solid mass or hydronephrosis.\n\nStomach and duodenum are unremarkable.  Distal small bowel loops are normal\ncaliber without evidence of obstruction.  Large bowel is thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection.\n\nSevere atherosclerotic calcifications along a normal caliber abdominal aorta. \nProminent atherosclerotic calcifications along the branch vasculature.  Severe\nstenosis at the origin of the celiac axis.  At least mild stenosis at the\norigin of the left renal artery.  No mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria.  No ascites, pneumoperitoneum or ventral\nabdominal hernia.\n\nCT pelvis with contrast:  Bladder, uterus, adnexa and rectum are grossly\nunremarkable.  Severe atherosclerotic calcifications along the bilateral\nexternal and internal iliac arteries with at least moderate to severe stenosis\nat the origin of bilateral common femoral arteries.  No free pelvic fluid or\nair.  No inguinal or pelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues:  Healed left inferior pubic ramus fracture.  Two long\nfixation screws in the left iliac bone/ acetabulum without evidence of\nhardware failure.  Bones are diffusely demineralized.  Moderate thoracolumbar\ndextroscoliosis.  Severe degenerative changes of the left shoulder along with\nmild subluxation of the humeral heads bilaterally.  Sternotomy wires are\nintact.  No suspicious focal bone lesion.  Moderate compression deformity of\nthe T7 and T8 vertebral bodies.  Mild compression deformity of the T9, T10 and\nT11 vertebral bodies.  Moderate compression deformities of the T12 and L1\nvertebral bodies.  Mild compression deformity of the L4 vertebral body. \nModerate multilevel degenerative change of the spine.",
            "output": "1. Compression deformities of the T7 through L1 and L4 vertebral bodies, as\nabove, age indeterminate, but likely chronic.\n2. Otherwise no acute CT findings in the torso.\n3. Subtle 6 mm hypodensity in the spleen, not fully characterized, may\nrepresent hemangioma.\n4. Moderate emphysema.\n5. Severe atherosclerotic disease.\n6. Dilated right pulmonary artery has an association with pulmonary\nhypertension."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.\n\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small bilateral mediastinal and hilar lymph nodes which\nare most likely reactive.  There is moderate coronary artery calcification. \nThere is no pericardial effusion.\n\nPLEURA: There are small bilateral pleural effusions right greater than left.\n\nLUNG: Previously visualized consolidative opacities in both lower lobes have\nsignificantly improved and most likely represented aspiration.  Patchy\nopacities in the superior segment the left lower lobe (7, 81 looks slightly\nmore prominent and is most likely inflammatory.  Ground-glass opacities\nscattered within the left upper lobe are unchanged.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Suboptimal opacification of the pulmonary artery and its segmental and\nsubsegmental branches.  No evidence of central pulmonary embolism.\n\nSmall bilateral pleural effusions with bibasilar atelectasis.\n\nPreviously visualized parenchymal opacities in both lower lobes have\nsignificantly improved right greater than left and most likely represented\naspiration pneumonia.\n\nNonspecific parenchymal opacity in the superior segment of the left lower lobe\nand the left upper lobe are slightly more prominent than on the prior study\nand most likely inflammatory"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The there is mild cardiomegaly; the pericardium and\ngreat vessels are within normal limits.  Atherosclerotic calcifications are\nnoted in the coronary arteries.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are scattered prominent mediastinal and\nhilar lymph nodes, none of which are pathologically enlarged by CT size\ncriteria.  No axillary lymphadenopathy is present.  Triangular soft tissue\ndensity with interdigitating fat in the anterior mediastinum is unchanged\nsince ___, likely thymic hyperplasia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Dependent atelectasis is noted bilaterally.  There is mild\nairway wall thickening diffusely likely due to airway disease.    The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Thyroid gland is heterogeneous in appearance and there is a 9 mm\nhypodense left thyroid nodule.   The remainder of the visualized portions of\nthe base of the neck show no other abnormalities.\n\nABDOMEN: The partially visualized 2.5 cm left parapelvic hypodensity likely\nrepresents the large 7.3 cm simple renal cyst seen in the ___ CTA\nchest which has now significantly decreased in size.  There is a small hiatal\nhernia.  The remainder of the visualized part of the upper abdomen is\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Diffuse mild airway wall thickening suggestive of chronic airways disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There are atherosclerotic calcifications in the coronary\narteries, aorta and origin of the great vessels.  Mild cardiomegaly is\nunchanged.  Otherwise, the heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Triangular soft tissue density in the anterior\nmediastinum is unchanged and likely represents thymic hyperplasia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:Aside from mild bibasilar atelectasis, the lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A small hiatal hernia is again noted.  Subcentimeter hypodensity in\nthe left lobe of the liver is too small to characterize, but likely a cyst. \nIncluded portion of the upper abdomen is otherwise unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nModerate multilevel degenerative changes are seen, particularly in upper\nthoracic/lower cervical spine.  Chronic deformity is seen in the inferior\nportion of the sternum, potentially from prior trauma.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect identified to the level of the proximal segmental\npulmonary arteries.  Distal segmental and subsegmental branches are not well\nassessed due to timing of contrast bolus.  The main and right pulmonary\narteries are normal in caliber, and there is no evidence of right heart\nstrain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nBilateral lower lobe focal consolidations with air bronchograms and peripheral\nground-glass opacification are concerning for multifocal pneumonia\n(4:142-146).  The airways are patent to the subsegmental level.  A 3 mm nodule\nat the left lung apex is unchanged since ___ (4:26).\n\nLimited images of the upper abdomen are notable for a small hiatal hernia. \nSubcentimeter hypodensity in the right kidney is too small to characterize by\nCT, but unchanged since ___ and statistically likely a cyst.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nDegenerative changes in the thoracic spine are mild.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Bilateral lower lobe focal consolidations with air bronchograms and\nperipheral ground-glass opacification, right greater than left, concerning for\nmultifocal pneumonia."
        },
        {
            "input": "Aorta is calcified. Pulmonary arteries are normal in diameter.  Heart size is\nnormal. There is no pericardial pleural effusion. Image portion of the upper\nabdomen reveals no appreciable abnormality.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Assessment of the\nlung parenchyma demonstrates no evidence of interstitial lung disease,\ninfectious or other abnormalities. Right lower lobe pulmonary nodule, series\n5, image 218 is 2 mm in diameter. No new other pulmonary nodules most of the\nconsolidations demonstrated\n\nThere is mild narrowing in the AP dimension of the mid trachea, potentially\ndue to relatively large thyroid isthmic nodule.",
            "output": "Unremarkable examination with no evidence of findings to explain patient's\nsymptoms."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection. There is a filling defect in the right interlobar artery as well\nas a few small filling defects noted within some right lower lobe segmental\nbranches.  No filling defects are identified on the left. The remainder of the\ngreat vessels have a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. There is no significant mediastinal, hilar, or axillary\nlymphadenopathy. The heart is normal in size. There is no significant\npericardial effusion.\n\nThe central airways are patent. There are scattered areas of subsegmental\natelectasis bilaterally. There is no focal consolidation or pulmonary mass.\nThe pleural spaces are clear. There is no pneumothorax.\n\nMultiple surgical clips are noted along the posterior aspect of the liver\ndome. There also appears to be a myelolipoma arising from the right adrenal\ngland although this is not completely characterized.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Right-sided pulmonary emboli as described.\n\nNOTIFICATION:  These findings were communicated to ___ NP at 10:23\non ___ within 5 min of discovery."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\nPatient is status post left lower lobectomy. Surgical stump is unremarkable.\nThere is no pleural or pericardial effusion.  2 mm subpleural nodules are\nstable (6:101, 105, 118, 126, 147) faint ground-glass opacity in the left\nupper lobe difficult to measure was present in prior study (6:85) subpleural\natelectasis and a cluster of peribronchial tiny nodules in the right upper\nlobe is stable (6:92) there are no new lung nodules\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings. There is a hiatal hernia\nThere are no bone findings of malignancy",
            "output": ". No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.  The heart size mildly enlarged. There is no\npericardial effusion. Extensive coronary artery calcifications are seen. \nCalcifications are also seen involving the mitral and aortic annuli.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is diffuse interlobular septal\nthickening and ground-glass opacities, most consistent with pulmonary edema. \nMore nodular heterogeneous opacities at the bases may represent aspiration,\nhowever superimposed infection cannot be excluded.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen. \nCalcification of the right adrenal gland is seen.  Otherwise the imaged upper\nabdominal structures are grossly unremarkable.",
            "output": "1.  Pulmonary edema.\n2.  Subtle consolidation at the right lung base concerning for aspiration\nversus pneumonia.\n3.  Coronary artery calcifications."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary or supraclavicular\nadenopathy.  Scattered mediastinal lymph nodes are not pathologically\nenlarged.  Heart size is normal.  There is no pericardial effusion.  There is\nno thoracic aortic aneurysm.  There is moderate atherosclerotic disease. \nCoronary artery calcifications are severe.\n\nThe airways are patent to the subsegmental level bilaterally.  There is\nground-glass opacity, most pronounced in the right upper and lower lobes. \nThere is no overt pulmonary edema.  There is bibasilar atelectasis.  There is\nno pleural effusion.  There is no suspicious pulmonary nodule.  Right lower\nlobe calcified granuloma is noted.\n\nViews of the thoracic esophagus are unremarkable.  Limited views of the upper\nabdomen post cholecystectomy changes.  There is a abnormal wall herniation\nanteriorly.  Calcification of the right adrenal gland is unchanged.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: There is no superficial soft tissue\nabnormality.  There are no suspicious bony lesions.",
            "output": "1. Right lung ground-glass opacities, consistent with pneumonia, although\nfindings could represent bacterial infection, the appearance can also be seen\nin the setting of PCP.\n2. No pulmonary edema.\n3. Coronary artery calcifications."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable\n\nBREAST AND AXILLA  : The the dystrophic calcification is seen in the right\nbreast.  Is dystrophic calcification in the left breast.  There are no\nenlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The aorta\nis tortuous.  There is extensive atherosclerotic calcification involving the\ndescending thoracic aorta and the aortic annulus.  There is also evidence of a\nsevere calcification involving the coronary arteries and the mitral annulus. \nThere is moderate cardiomegaly.  Trace pericardial effusion is seen.\n\n\nPLEURA: The moderate right and small left pleural effusion.\n\nLUNG: Parenchymal opacity in the right apex with evidence of traction\nbronchiectasis could be related to prior radiation therapy.  Evaluation of\nlung parenchyma is limited by respiratory motion.  There is mild interstitial\nedema.  There is subsegmental atelectasis in the right upper lobe and right\nlower lobe.\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.  There is evidence of kyphoplasty involving an\nupper thoracic vertebral body (9, 36).\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows extensive\nvascular calcification",
            "output": "Moderate is right and small left pleural effusion with subsegmental\natelectasis in the right lung base.  Mild interstitial edema.\n\nTrace pericardial effusion, is most likely physiological.\n\nExtensive atherosclerotic calcification involving the aorta coronary arteries\nand vascular calcifications.\n\nDystrophic calcifications within the right breast, could be related to prior\nradiation therapy to the right breast."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nAortic arch calcifications are mild.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nCentrilobular emphysema is mild.  No focal consolidation detected.  Incidental\nnote is made of a millimetric calcification in the left upper lobe (2:26),\nprobably a granuloma.  Incidental note is also made of mild bronchial wall\nthickening and mosaic attenuation in the lower lobes, compatible with air\ntrapping and small airways disease.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable, noting a small accessory\nspleen..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or pneumothorax.\n2.  Mild centrilobular emphysema.  Small airways disease."
        },
        {
            "input": "Exam is mildly limited due to poor bolus timing and motion.\n\nLimited ascending of the ascending aorta due to excessive motion.  The\npulmonary arteries are well opacified to the segmental level.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no pericardial effusion.  There are trace bilateral pleural\neffusions.  There is adjacent compressive atelectasis.  Additional evaluation\nof the lung parenchyma is mildly limited due to motion.\n\nLimited images of the upper abdomen are unremarkable.  Partially seen left\nhepatic artery replaced to the left gastric.\n\nNo worrisome osseous lesions.  Again seen are mild degenerative changes at\nT6-7 with acquired fusion resulting in mild spinal canal stenosis, similar\ncompared to prior.  Healed fracture of the anterior right, 4th rib, unchanged.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Trace bilateral pleural effusions with adjacent compressive atelectasis."
        },
        {
            "input": "CHEST: Endotracheal tube is in appropriate position.  The thoracic aorta\nappears intact.  There is no mediastinal hematoma.  The heart is unremarkable.\nThere is no pericardial effusion.  There is no lymphadenopathy. The imaged\nthyroid is normal.\n\nThere is bibasilar dependent atelectasis. The lungs are otherwise clear\nwithout worrisome nodule, mass, or consolidation.  There is no pneumothorax or\npleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is normal\nin course and caliber with widely patent major branches. Minimal\natherosclerotic disease is identified.  No lymphadenopathy, free air, or free\nfluid.\n\nThe enteric tube terminates in the distal gastric antrum. The stomach and\nduodenum themselves are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable. The\nappendix is normal.  The bladder is collapsed around a Foley catheter.  There\nis no pelvic free fluid. A rectal probe is in place.\n\nBONES:  Multilevel degenerative changes of the thoracolumbar spine are\nidentified. Multiple acute bilateral anterior rib fractures are identified,\nconsistent with sequela from recent chest compressions (2:33, 35, 41).",
            "output": "1. Multiple acute bilateral anterior rib fractures consistent with sequela\nfrom recent chest compressions.\n\n2. Otherwise, no other sequela of acute trauma.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr. ___\nto Dr. ___ at the time of his call."
        },
        {
            "input": "Compared to the prior chest CT of ___ there is a new large right\npleural effusion, complete right lower lobe and partial right middle lobe\ncollapse.  Leftward shift of the mediastinum is also new.\n\nPatchy ground-glass opacities and smooth septal thickening is most predominant\nin the left upper lobe and superior segment of the left lower lobe, consistent\nwith 'crazy paving' has increased in extent since ___.  There is only\nminimal ground glass opacity in the right upper lobe. There is no\npneumothorax. The airways are clear to the segmental level, however, the right\nlower lobe bronchus is compressed due to mass effect from the large right\npleural effusion.\n\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  For example a precarinal lymph node measures 7 mm in\nshort axis (series 2, image 25). Aorta and pulmonary arteries are normal size.\nThe aorta is calcified.  Cardiac configuration is normal and there are\ncoronary calcifications.  Low density of blood is concerning for anemia.\n\nOsseous structures and soft tissues: No concerning osteoblastic or osteolytic\nlesions are identified.\n\nThis study is not designed to evaluate the upper abdominal structures. The\nTIPS stent is seen within the liver. Sludge within the gallbladder is better\ndelineated on the prior ultrasound ___.  The liver is cirrhotic, the\nspleen is enlarged and there are varices.",
            "output": "1.  'Crazy paving' opacities increased in extent since ___.  The\ndifferential diagnosis includes infection or hemorrhage.\n\n2.  Large right pleural effusion has markedly increased since ___.  The\neffusion causes complete collapse of the right lower lobe, partial collapse of\nthe right middle lobe and shift of the mediastinum to the left.\n\n3.  Hypodensity of the blood is concerning for anemia."
        },
        {
            "input": "The thyroid gland is unremarkable.\n\nNo supraclavicular, axillary, or hilar lymphadenopathy identified. \nMultiplanar mediastinal lymph nodes measure up to 8 mm. Dense atherosclerotic\ncalcifications are evident within the coronary vessels and to a lesser degree\nthe aortic arch. Heart size is normal and without pericardial effusion. \nHypodense intracardiac blood volume relative to the surrounding myocardium\nsuggests underlying anemia.\n\nAirways are normal and patent to the subsegmental levels.  There has been\ninterval development of extensive ground-glass and reticular opacifications\nwith well demarcated areas of geographic sparing and associated smooth septal\nthickening involving the entire left lung and predominantly in the right lower\nlung. There is a slight suggestion of subpleural sparing however this is not a\nmarked feature.  There is no gravitational dependence are other evidence of to\nsuggest this is ARDS or hydrostatic pulmonary edema. Upon review of prior\nradiographs, appearance is waxing and waning and with a different distribution\nin the right lung compared to the ___ CT, leading to differential\nconsiderations of atypical infection, hemorrhage in setting of patient with\nliver disease induced coagulopathy or possibly TRALI (transfusion related\nacute lung injury) given multiple transfusions.\n\nLimited assessment of the upper abdomen demonstrates a cirrhotic liver with\nsequela of portal hypertension including massive splenomegaly and\nintra-abdominal varices and new TIPS placement. Poorly evaluated reniforms\nsoft tissue densities within the paraesophageal space likely represent a\ncombination of lymph nodes and possibly varices which appear new, though this\narea was previously obscured by a large right layering pleural effusion which\nis now small in size. There is a new small left layering pleural effusion.\n\nNo suspicious lytic or blastic lesions identified. No superficial soft tissue\nmass is identified.",
            "output": "1.  Ground-glass and reticular opacifications and smooth septal thickening\nwithout gravitational dependence and with waxing and waning pattern of\npresentation suggest atypical infection, possibly hemorrhage, or possibly\nTRALI.  Please correlate clinical symptoms of worsening dyspnea with\ntransfusion and/or aggressive diuresis (which can worsen TRALI).\n\n2. Near complete resolution of right pleural effusion, now small in size. New\nsmall left pleural effusion.\n\n3. New soft tissue density surrounding the lower esophagus may represent lymph\nnodes versus varices, the latter would be an unexpected finding following\nTIPS. Given recent Doppler ultrasound demonstrating angle corrected mid stent\nvelocities of 255 cm/sec, findings concerned for TIPS stenosis. Finding could\nbe further assessed with repeat ultrasound.\n\nNOTIFICATION:  ___ discussed findings with Dr. ___, ___\nvia telephone ___ minutes after interpretation."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland appears within\nnormal limits.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see separately dictated CT abdomen and pelvis from the\nsame date.\n\nMEDIASTINUM: Small mediastinal lymph nodes are not enlarged by size criteria.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild atelectasis at the lung bases.  No lung mass.\n2. AIRWAYS:  The airways are patent to the segmental level.\n3. VESSELS:  Patent.\nCHEST CAGE: No suspicious osseous lesion.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "Repeat examination was performed given suboptimal contrast bolus.  Images are\nsomewhat degraded due to motion.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  Scattered mediastinal lymph nodes are noted, measuring less than 1\ncm in short axis.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  The lungs are clear aside from bibasilar atelectasis.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for a\nhomogeneously hypodense liver, consistent with fatty liver.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Hepatic steatosis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  An amorphous calcification within the\nanterosuperior mediastinum may represent calcified mediastinal lymph nodes\nreflecting treated lymphoma.  Simple fluid is seen within multiple pericardial\nrecesses within the mediastinum.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral paramediastinal, left greater than right, pleural\nthickening with traction bronchiectasis and distortion of the left hilum\nlikely reflects the sequelae of prior radiation.  There is bilateral dependent\natelectasis.  There is no pulmonary mass or focal consolidation.  A 3 mm\nnodule seen in the right upper lobe (2:24).  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck shows multiple\nthyroid nodules in the right thyroid lobe measuring up to 1.1 cm.  The left\nthyroid lobe is surgically absent.\n\nThe patient is status post left mastectomy.\n\nABDOMEN:  Included portion of the upper abdomen shows a focus of\nhyperenhancement in hepatic segment 7 which may represent a hemangioma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. 3 mm right upper lobe pulmonary nodule.  Follow-up is recommended per the\n___ criteria as detailed below.\n3. Findings suggestive of prior mediastinal radiation.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CTA thorax:The aorta and main thoracic vessels are well opacified.  The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection.A filling defect consistent with acute thrombus distends the\nleft anterior basal segmental artery at its branch point into subsegmental\narteries.\n\nCT thorax: The airways are patent to the subsegmental level.There is no\nmediastinal, hilar, or axillary lymph node enlargement by CT size criteria.The\nheart, pericardium, and great vessels are within normal limits.No hiatal\nhernia or other esophageal abnormality is present.Consolidation in the left\nlower lobe involves both the posterior and anterior basal segments likely\nrepresents pneumonia, although superimposed infarct cannot be excluded.\n\nOsseous structures: No focal osseous lesion concerning for malignancy is\npresent.\n\nAlthough this study is not designed for the assessment of intra-abdominal\nstructures, the visualized solid organs and stomach are unremarkable.",
            "output": "1. Acute pulmonary embolism within the left anterior basal segmental artery.\n2. Consolidation in the left lower lobe involves both the posterior and\nanterior basal segments, which could represent infarct and/or pneumonia.\n\nNOTIFICATION:   These findings were communicated via telephone by Dr.\n___ to Dr. ___ at 17:24 on ___, immediately upon\ndiscovery."
        },
        {
            "input": "CTA: The thoracic aorta is normal in course and caliber without dissection,\naneurysm, atheromatous ulcer, or significant atherosclerosis.  The major\nbranches of the thoracic and abdominal aorta appear widely patent and with a\nnormal branching pattern.  There is an accessory left renal vein.  The site of\nabnormality on outside hospital ultrasound, there is a retroaortic left renal\nvein which is a normal anatomical variant.  The main pulmonary artery is\nnormal in size with patent central branches.\n\nCHEST: Residual thymic tissue is noted in the anterior mediastinal space.  No\nadenopathy.  The heart is normal in size and shape.  No pleural or pericardial\neffusion.  The lungs are clear.\n\nABDOMEN: Evaluation of the solid organs is somewhat limited given arterial\nphase enhancement though allowing for this, the liver, gallbladder, pancreas,\nspleen, adrenals appear normal.  The kidneys enhance symmetrically.  No\nadenopathy, free air or free fluid.  The stomach and duodenum appear normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction.  The appendix is not clearly visualized though there are no\nsecondary signs of appendicitis.  Fecal loading of the colon is moderate.  No\nfree pelvic fluid.  The uterus and adnexal regions are unremarkable.  The\nurinary bladder is moderately distended and appears normal.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "1.  No aortic dissection, aneurysm or penetrating atheromatous ulcer.  The\nreported abnormality on outside hospital ultrasound represents a retroaortic\nleft renal vein.\n2.  No findings to account for reported symptoms of pain."
        },
        {
            "input": "CHEST PERIMETER: Subcentimeter low-density region in the left thyroid lobe is\ntoo small to require further imaging evaluation.  Supraclavicular and left\naxillary lymph nodes are not enlarged.  11 x 15 mm right hilar node is newly\nenlarged since ___, 02:15.\n\nBreast evaluation is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.\n\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification\nmild in head and neck vessels, not apparent in coronary arteries.  Aorta and\npulmonary arteries are normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nby size criteria.  Partially fat replaced right lower paratracheal node, 8 x\n19 mm today, 302:67 was 4 x 17 mm in ___, has a benign morphology.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\nPunctate nodule, right upper lobe, 302:13, unchanged.\n\nAside from mild basal subsegmental atelectasis, lungs are clear.\n\nTracheobronchial tree is normal to subsegmental levels and pleural surfaces\nare normal.\n\nCHEST CAGE: No bone abnormalities.",
            "output": "Isolated mild enlargement right axillary lymph node is not good evidence for\nlymphoma.  No findings of intrathoracic malignancy or active infection."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, mediastinal, or hilar\nlymphadenopathy.  The mediastinum and heart are deviated to the left.  The\nheart size is normal.  There is a small pericardial effusion.  The esophagus\nis unremarkable.  The aorta is normal in caliber.  The main pulmonary artery\nis normal in size.  Small bilateral pleural effusions are seen.\n\nFor evaluation of the abdominal structures, please refer to dedicated CT of\nthe abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nThere is left lower lobe and lingular atelectasis with shift of the\nmediastinum to the left.  Heterogeneous enhancement is seen involving the left\nlung base consolidation.  Additional diffuse ground-glass opacities are seen\nwithin the right upper and right lower lobes.  Mild right lower lobe\natelectasis is seen.  There is no evidence of pneumothorax.",
            "output": "1. Left lower lobe and lingular atelectasis with leftward shift of the\nmediastinum.  Heterogeneous enhancement involving the left lung base\nconsolidation raises concern for superimposed infection.\n2. Additional diffuse ground-glass opacities within the right upper and lower\nlobes may be sequelae of infectious/inflammatory process.\n3. Small bilateral pleural effusions."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the chest cage suspicious malignancy. Evaluation of the\nbreasts requires mammography.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows\nnormal-size adrenal glands. There are no abnormalities in the thyroid\nsuspicious for a nodule large enough to warrant ultrasound evaluation.\nAtherosclerotic calcification is relatively mild in the coronary arteries.\n\nTransvenous right ventricular pacer lead is continuous from the left pectoral\ngenerator. Small, nonhemorrhagic pericardial effusion is slightly larger today\nthan in ___. Aorta, pulmonary arteries, and cardiac chambers are normal size.\nThere is no pleural abnormality.\n\nEmphysema is mild.  Right lung is clear. Left lower lobe basal segmental\nbronchi are impacted at their origins, 45:178 -185 Mild bronchiectasis in the\nleft lower lobe distally is responsible for atelectasis primarily in the\nanteromedial basal segment.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.\n\n\n\n\n\n.",
            "output": "Mild to moderate emphysema.\n\nBronchial inflammation probably responsible for impaction of left lower lobe\nbasal segmental bronchi, distal bronchiectasis and atelectasis predominantly\nin the anteromedial basal segment.  This might be due to reflux and chronic\naspiration\n\nMild to moderate emphysema.\n\nMild coronary atherosclerosis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary emboli are seen in the bilateral central\npulmonary arteries, bilateral lower lobe segmental and subsegmental arteries,\nright upper lobe segmental pulmonary artery.  No evidence right heart strain. \nThere is aneurysmal dilatation of the distal thoracic aorta measuring 4.6 x\n3.6 cm.  The heart, pericardium, and great vessels are within normal limits. \nTrace pericardial effusion is noted, likely physiologic.  There is paucity of\ncontrast in the proximal left subclavian artery (series 6, image 65), likely\nrepresenting noncalcified plaque.  The left subclavian artery distally is\npatent.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy. \nScattered mediastinal lymph nodes are noted measuring up to 1.1 cm in the\npretracheal station.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No focal consolidation to suggest pneumonia.  Scattered nodular\nopacities in the left upper and lower lobe (series 6, image 116, 138, 174, and\n216).  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is diffuse airway thickening on the left.  Otherwise, the\nairway are patent to subsegmental level bilaterally.  There is severe\nbackground emphysema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please see separate report from earlier on the same day for detailed\nevaluation of the abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nPatient is status post bilateral mammoplasties.",
            "output": "1.  Pulmonary emboli in the bilateral main, right lower lobe segmental to\nsubsegmental, and right upper lobe segmental pulmonary arteries.  No evidence\nof right heart strain.\n2.  Nodular opacities in the right upper and lower lobes with diffuse airway\nthickening, which could represent bronchiolitis/subtle infection.\n3.  4.6 x 3.6 cm focal aneurysmal dilatation of the distal descending thoracic\naorta.\n4.  Please see separate report performed earlier on the same day for detailed\nevaluation of the abdomen.\n5.  A single enlarged pretracheal mediastinal lymph node, nonspecific, likely\nreactive.\n6.  Severe background emphysema.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:19 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Esophagus is patulous at several levels.  Mediastinal\nlymphadenopathy, larger than in ___, the largest left lower\nparatracheal measuring 1.4 cm.  A new enhancing soft tissue mass is noted in\nthe aortopulmonary window, with 1.4 cm.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Moderate cardiomegaly with mitral valve replacement. \nNo pericardial effusion.  No atherosclerotic calcifications in thoracic aorta\nor coronary arteries.\nPLEURA: No pleural effusions.  Mild bilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular emphysema.\n2 new solid nodules, a perifissural in the middle lobe measuring 2.5 mm\n(3:134) and a 3 mm nodule in the right lower lobe (3:102).\nDependent posterior atelectasis.\n2. AIRWAYS:  Patent to subsegmental levels.\n3. VESSELS:  Prominent pulmonary vessels.\nCHEST CAGE: Intact sternotomy wires.  No acute fractures.  No suspicious lytic\nor sclerotic lesions.",
            "output": "New small pulmonary solid nodules since ___ could be new metastases. \nFollow-up CT in 3 months is advised.\n\nMediastinal lymphadenopathy larger than in ___, with new enhancing\npre-vascular soft tissue concerning for disease progression.\n\nRECOMMENDATION(S):  Chest CT in 3 months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  A 1.3 cm left lower paratracheal lymph node is unchanged.  A 9\nmm enhancing soft tissue structure in the aortopulmonary window is decreased\nfrom prior (3:68), previously 1.4 cm.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is moderately enlarged and there is no coronary arterial\ncalcification.  A prosthetic mitral valve is again seen.  There is no\npericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There are numerous pulmonary nodules throughout the\nlungs, with representative nodules as follows:\nA 1.3 x 2.3 cm nodule in the left lower lobe (3:127), new from prior.\nA 1.1 cm perifissural nodule in the right middle lobe (3:134), previously 2-3\nmm.\nA 1.5 cm nodule in the right lower lobe (3:145).\nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.  The\npatient is status post median sternotomy, with intact sternal wires, and no\nevidence of dehiscence.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Numerous new or enlarged pulmonary nodules throughout the lungs, consistent\nwith metastatic disease.\n2. Unchanged mildly enlarged left lower paratracheal lymph node.\n3. Decreased size of previously seen enhancing soft tissue structure in the\naortopulmonary window, which likely represents a lymph node.\n4. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No abnormalities on the chest wall.  No enlarged\nlymph nodes in either axilla or thoracic inlet.  No atherosclerotic\ncalcifications in the head and neck arteries.  Right anterior port with tip in\nthe right atrium.\n\nHEART AND VASCULATURE:\nThe heart is enlarged.  No pericardial effusion.  No atherosclerotic\ncalcifications in the coronary arteries, aorta or cardiac valves.  Status post\nmitral valve replacement.  The aorta and pulmonary arteries are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Small\nmediastinal lymph nodes, the largest in the right lower paratracheal station\nmeasuring 1.0 cm (8:104), stable.  Enlarged right hilar lymph node with a\nnecrotic center (8:102) measuring 1.6 cm.  No left hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Numerous bilateral lung nodules\nand masses slightly larger compared to prior study, for example in the middle\nlobe measuring 1.0 cm, previously 7 mm) 8:164) and in the right lower lobe\nmeasuring 1.8 cm, previously 1.5 cm (3:182).\n\nCHEST CAGE:\nStatus post midline sternotomy, unremarkable.  No acute fractures.  No\nsuspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Interval growth of the metastatic lung nodules and right hilar lymphadenopathy\nsuggestive of metastatic disease progression.\nStable postoperative appearance of mitral valve replacement.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 14:54 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmoderate cardiomegaly.  There is evidence of prior cardiac surgery.  A\nprosthetic mitral valve is in place.  There is no pericardial effusion.  The\naorta and pulmonary artery are normal in caliber.  The airways are patent up\nto the subsegmental level\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  There is\nminimal subsegmental atelectasis in the left lung base.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Stable sternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions.  Please refer to dedicated report on abdomen which\nhas been dictated separately",
            "output": "No evidence of metastasis to the chest.  Please refer to dedicated report on\nabdomen which has been dictated separately"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Main pulmonary artery trunk is prominent measuring 3.1\ncm.  The heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Dependent atelectasis in the lung bases.  The airways are\npatent to the level of the segmental bronchi bilaterally.  Bronchial wall\nthickening in the lung bases may suggest small airways disease.  There is\nminimal scarring in the lung apices.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small airways disease."
        },
        {
            "input": "Thyroid is unremarkable.  Thoracic aorta and main pulmonary artery are normal\nsize.  Coronary artery calcification is moderate.  Pericardial effusion is\nsmall.  Supraclavicular, axillary, and mediastinal lymph nodes are not\nenlarged.  A prominent 6 mm diaphragmatic node  (03:39) is stable.  A\nretrocrural lymph node (03:41) measures 5 mm.  The esophagus is distended with\nair.\n\nAirways are patent to the subsegmental levels.  Left pleural effusion is\nsmall.  Most of multiple pulmonary nodules measuring 4 mm or less appear\nstable (06:39, 45, 47, 49, 54, 56, 83, 106, 110, 109, 119, ___, 146. \nA 3 mm nodule in the left apex could not be appreciated in the prior exam\n(6:41) which could be due to technical differences between the studies.\n\nBONES/ SOFT TISSUE:   No worrisome lesion is identified. Bones are diffusely\ndemineralized.\n\nABDOMEN: This study was not designed for subdiaphragmatic evaluation. Limited\nassessment of upper abdominal organs is notable for new development of\nenhancing thickened and nodular peritoneum along the right abdominal wall and\nthe inferior surface of right hemidiaphragm.  Large ascites is new.  Hiatal\nhernia is small.",
            "output": "1.  No evidence of intrathoracic malignancy.\n\n2.  A prominent diaphragmatic node and multiple pulmonary nodules 4 mm or less\nare stable.\n\n3.  Small left pleural effusion.\n\n4.  Thickened, nodular, and enhancing peritoneum is consistent with history of\nperitoneal metastasis.  Large ascites."
        },
        {
            "input": "Please note that this study is somewhat degraded by a respiratory motion\nartifact.\n\nMEDIASTINUM: The imaged thyroid is normal.  No supraclavicular, axillary, or\nhilar lymphadenopathy.  Multiple prominent, although not technically enlarged\nlymph nodes in the mediastinum.  The aorta and pulmonary arteries are normal\nin size.   The heart size is normal and there is no pericardial effusion.\nModerate coronary artery calcifications are seen diffusely.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent, although demonstrate minimal persistent\nirregularity.  There is no airspace consolidation.  There are no findings of\ndiffuse lung disease.  Minimal bilateral symmetrical apical scarring is again\nseen.  Re- demonstrated is an unchanged 5 mm solid pulmonary nodule in the\nright upper lobe (4:101), as well as a subpleural 4 mm lateral solid pulmonary\nnodule (4:150).  A 3 mm nodule in the left upper lobe (4:100) is new over the\ninterval.  Several small calcified granulomas are also seen in the left lower\nlobe.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen. Within\nthese limitations no gross abnormality is seen.",
            "output": "Please note that this study is somewhat degraded by a respiratory motion\nartifact.\n\n1.  Stable solid 5 mm right upper lobe nodule and subpleural 4 mm left lower\nlobe nodule.\n\n2.  Interval development of a punctate left upper lobe nodule.\n\n3.  Mild chronic airways disease.\n\n\nRECOMMENDATION(S):  Followup CT in 12 months is recommended to evaluate\nstability of bilateral pulmonary nodules."
        },
        {
            "input": "Thyroid gland is homogeneous.  There is no axillary, supraclavicular,\nmediastinal, or hilar lymphadenopathy.  Thymus is physiologic.  Heart size is\nnormal.  No pericardial effusion. No coronary or valvular calcifications. \nThoracic aorta and central pulmonary arteries are normal in caliber.\n\nThe airways are normal.  There is no suspicious pulmonary nodule,\nconsolidation, or pleural effusion.\n\nLimited view of the upper abdomen is unremarkable.  No lytic or sclerotic\nosseous lesion is identified",
            "output": "No abnormality detected."
        },
        {
            "input": "Heart is normal in size.  Mitral annulus is calcified.  Possible left\nventricular hypertrophy.\n\nAortic annulus is also calcified.  Ascending aorta is again mildly ectatic,\nmeasuring up to 46 mm in diameter, stable since the remote prior chest CT. \nMixed type atherosclerotic changes are moderate along the aorta more\ngenerally.  Central pulmonary arteries appear normal.\n\nThere are trace barely perceptible bilateral pleural effusions.  No\npericardial effusion.  No lymphadenopathy is found in the chest.\n\nEmphysema is moderate in severity. Chest appears hyperinflated.  A few small\ncalcified granulomas.  Mild dependent atelectasis in each posterior basilar\nlower lobe.  Minimal dependent atelectasis in the left upper lobe.  Mild\ncentral airway thickening is probably inflammatory.  Major airways appear\npatent.\n\nInfiltrative tumor in the left lobe of the liver was better characterized on\nrecent imaging.  Persistent partly imaged ascites in the upper abdomen, at\nleast moderate and volume.  Left adrenal mass is unchanged.\n\nThere are no suspicious bone lesions.  The T6 and T7 vertebral bodies show\nmild probably chronic anterior wedging with slightly exaggerated kyphosis. \nSeveral mid thoracic interspaces are moderately narrowed.  Bones appear\ndemineralized.",
            "output": "No evidence of metastatic disease in the chest.  Moderate emphysema.  Mild\natelectasis.  Coronary calcification and possible left ventricular\nhypertrophy.  No definite short-term change in upper abdominal findings\nallowing for differences in modality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  No pseudoaneurysm is\nidentified.  The outpouching seen in the proximal descending thoracic aorta at\nthe its miss is consistent with a ductus bump.  Aortic caliber is normal.  The\nmain, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Peripheral ground-glass opacities within the right lung\nlikely reflect evolving contusions.  There is dependent atelectasis\nbilaterally.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  The lung apices are not included\nhowever there is no large pneumothorax identified.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. No evidence of pseudoaneurysm is clinically question.  The a patching seen\non the prior study reflects a normal variant ductus diverticulum.\n2. Evolving parenchymal contusions."
        },
        {
            "input": "Calcified bilateral thyroid nodules appears similar to prior examination.\n\nPulmonary vasculature is well opacified to the subsegmental level without\nfilling defect to indicate a pulmonary embolus.  The main pulmonary trunk is\nmildly prominent measuring up to 3.1 cm in greatest diameter.  The thoracic\naorta demonstrates atherosclerotic calcification but is normal in caliber\nwithout evidence of dissection or aneurysm dilation.  There is mild stenosis\nof the left common carotid artery.  The heart is enlarged.  No pericardial\neffusion is seen.  There are coronary artery calcifications.\n\nThere is a large right and small to moderate left pleural effusion with\nadjacent compressive atelectasis which has increased in size from the prior\nstudy.  There has been interval development of ground-glass changes of the\nleft upper lobe.\nNo obvious large pulmonary mass is identified.  Scattered tiny pulmonary\nnodules are obscured by atelectasis and better appreciated on the previous\nstudy.\n\nThere is no pathologically enlarged hilar, mediastinal, or axillary\nlymphadenopathy.  The tracheobronchial tree is grossly patent.\n\nNo acute fracture or suspicious osseous lesions are identified.\n\nPlease see separate report for concurrently performed CT Abdomen and Pelvis\nfor findings below the diaphragm.",
            "output": "1.  No CTA evidence to suggest an acute pulmonary embolism.\n2.  Interval development of left upper lobe pulmonary ground-glass, which may\nrepresent infection or aspiration related changes.\n3.  Increasing large right and small to moderate left pleural effusion with\nadjacent compressive atelectasis.\n4.  Mildly prominent main pulmonary arterial trunk which may reflect pulmonary\narterial hypertension in the appropriate clinical setting."
        },
        {
            "input": "HEART AND VASCULATURE: Right atrium is enlarged.  Aortic, mitral and coronary\nartery calcification noted.  Enlargement of the veins from the left upper\nlimb, presumed secondary to a left upper limb fistula.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  Mild\nto moderate thoracic aorta calcification.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Bilateral pleural effusions, moderate sized on the right and\nsmall on the left.  Collapse of the right lower lobe and compressive\natelectasis of the left lower lobe.\n\nLUNGS/AIRWAYS: The central airways are patent.  There are unchanged\nmillimetric nodules and calcified granulomas in the right upper lobe.\n\nBASE OF NECK: Small calcified bilateral thyroid nodules, similar to prior.\n\nABDOMEN:  See report of contemporaneously acquired CT abdomen and pelvis..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Bilateral pleural effusions, moderate size on the right and small on the\nleft with right lower lobe collapse.\n2. Cardiomegaly with marked right atrial enlargement, which is progressed\ncompared to prior CT on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.\nSubcutaneous edema predominant in the lower and dependent chest wall.\n\nUPPER ABDOMEN: Reported separately in the same day of the abdomen and pelvis.\n\nMEDIASTINUM: There is no mediastinal or gross hilar lymphadenopathy.\nEsophagus is collapsed and unremarkable.\n\nHEART and PERICARDIUM: Hypodensity of blood pool active to the septum suggests\nanemia.\nNo appreciable atherosclerotic calcifications in the coronaries or normal\ndiameter major vessels.\nThere is no pericardial effusion.\n\nPLEURA: Small left pleural effusion with trace of right pleural effusion.\n\nLUNG: Airways are patent to the subsegmental level.\nLeft lower lobe subsegmental platelike atelectasis.\nFew scattered foci of ground-glass opacities are possibly inflammatory in\norigin, for example in the right lower lobe series 4:219.\nNo concerning lung nodules identified, no lung masses.\n\nCHEST CAGE: No evidence of bony lytic or sclerotic destructive lesions.",
            "output": "No evidence of intrathoracic malignancy.\nSmall left, trace right pleural effusions.\nFew scattered foci of ground-glass opacities are nonspecific, could be\ninflammatory in origin."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Patient is intubated with\nendotracheal tube in expected position however the diameter of the\nendotracheal tube is lesser than a third of the diameter of the trachea. No\nsupraclavicular or axillary lymphadenopathy.  Visualized portions of the\nthyroid are unremarkable.\n\nUPPER ABDOMEN: NG tube terminates in the stomach.  Mildly atrophic pancreas\nwith mild surrounding mesenteric fat stranding.  The remaining of the\nvisualized structures are unremarkable.\n\nMEDIASTINUM: Few subcentimeter lymph nodes are noted in the mediastinum, none\nof them enlarged.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Moderate cardiomegaly.  There is no pericardial\neffusion.  Mildly ectatic ascending aorta measuring up to 4.1 cm.  The main\npulmonary artery is enlarged measuring up to 4.9 cm.  Coronary and aortic\nvalvular calcifications are noted.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  A 3.4 x 2.7 x 2.1 cm well-circumscribed mass containing fat\nand central coarse calcification is seen in the right upper lobe. The mass\ncauses obliteration of the bronchus (302:72). Partial right lower lobe\ncollapse likely secondary to dependent low-density material within the right\nmainstem bronchus and posterior branch of the right lower lobe bronchus, which\nis completely occluded (302:117), and likely represent mucus or secretions. \nLinear atelectasis is seen in the left base.\n2. AIRWAYS:  4 mm nodule is seen the posterior wall of the trachea (302:39),\nat the level of the distal endotracheal tube.  As mentioned above, depending\nlow-density material occluding the posterior branch of the right lower lobe\nbronchus.  The remaining of the airways are patent.\n3. VESSELS: Prominence of pulmonary vasculature in the context of cardiomegaly\nand enlargement of the main pulmonary artery.\nCHEST CAGE: Degenerative changes seen throughout the thoracic spine. \nDextrocurvature of the midthoracic spine.  No fractures suspicious bone\nlesion.",
            "output": "1. 3.4 cm mass in the right upper lobe.  Given morphology and content\ncharacteristics it is most likely a benign hamartoma, or post infectious\ngranulomatous lesion.\n2. Obstructive right lower lobe partial collapse secondary to retained\nbronchial secretions.\n3. Endotracheal tube size lesser than ___ of the tracheal diameter. \nRe-evaluation of the appropriate size of the tube is recommended.\n4. Cardiomegaly, pulmonary vascular congestion and pulmonary hypertension\nwithout pulmonary edema."
        },
        {
            "input": "HEART AND VASCULATURE: Stable enlargement the pulmonary artery trunk measuring\n4.5 cm suggesting pulmonary artery hypertension.  No central filling defect to\nsuggest emboli.  Evaluation of lobar, segmental, and subsegmental branches is\nlimited due to phase of contrast and respiratory motion however there do\nappear to be some filling defects noted within the left lower lobe segmental\nbranches (series 10 images 203, 208, and 214) raising suspicion for emboli.\n\nStable mild aneurysmal dilatation of the ascending thoracic aorta measuring\napproximately 4.1 cm.  No acute aortic injury.  Stable multichamber\ncardiomegaly in the setting of coronary artery and aortic valvular\ncalcifications.  No significant pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  A small amount of fluid is\nseen refluxing into the mid to proximal esophagus similar to prior CT.  The\nnasogastric tube is been removed.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Stable 3.4 cm right upper lobe mass containing calcification\nand fat density compatible with a benign biliary hamartoma.  There has been\nsignificant interval improvement in previously identified right lower lobe\nairspace disease/atelectasis with some minimal residual subsegmental\natelectasis/scarring.  The lungs are otherwise clear without new airspace\nopacities or suspicious lung nodules.  The airways are now widely patent with\ntracheostomy tube in place.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please see separate CT abdomen report.\n\nBONES: Stable degenerative change without fracture or suspicious osseous\nlesion.",
            "output": "1.  Significant interval improvement of right lower lobe\nconsolidation/atelectasis without new significant airspace disease identified.\n2.  Stable enlargement pulmonary artery trunk compatible with pulmonary artery\nupper tension.  Filling defects are noted within segmental branches of the\nleft lower lobe distribution which could be artifactual due to respiratory\nmotion and incomplete opacification however remain concerning for emboli. \nDedicated CTA of the chest is recommended for confirmation if it will affect\nthe overall clinical management of the patient.\n3.  3.4 cm calcium and fat containing mass right upper lobe compatible with a\nbenign hamartoma.\n4.  Additional chronic changes as detailed above."
        },
        {
            "input": "Study is limited by respiratory motion.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  There is\na filling defect in the lateral subsegmental pulmonary artery of the left\nlower lobe (series 301, image 139).\n\nThe main pulmonary arteries is dilated measuring 4.8 cm which could represent\npulmonary arterial hypertension.  The ascending aorta is slightly enlarged\nmeasuring 4.4 cm.  Unchanged four-chamber cardiomegaly.\n\nNo mediastinal or cervicothoracic lymphadenopathy.  Portion visualized of the\nthyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Trace of right pleural\neffusion.\n\nStable 3.4 cm right upper lobe mass containing calcification and fat density\ncompatible with a benign hamartoma.  Minimal residual subsegmental\natelectasis/scarring is again noted.  The lungs are otherwise clear without\nnew consolidation.  Tracheostomy tube in place.\n\nLimited images of the upper abdomen are unremarkable.  Again seen is a right\nventricular peritoneal catheter in the right upper quadrant.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Left lower lobe subsegmental pulmonary embolism, which appears unchanged\nfrom ___.\n2. Four-chamber cardiomegaly.\n3. Subsegmental bilateral lower lobe atelectasis are unchanged.\n4. Stable 3.4 cm right upper lobe pulmonary hamartoma.\n5. Dilatation of the main pulmonary trunk, which can be seen in the setting\npulmonary artery hypertension.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:09 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "MEDIASTINUM/HEART:  The thyroid is normal.  Patient is status post median\nsternotomy and resection of a thymic lesion.  Compared to the prior CT in ___, there is been interval reduction in the soft tissue stranding of the\noperative bed.  The previously described fluid anterior to the ascending aorta\nand main pulmonary artery has decreased.  No evidence of recurrent mass in the\noperative bed.\n\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged\nby CT size criteria. The aorta is normal in size. The main pulmonary artery is\nenlarged, measuring 4.0 cm and suggesting pulmonary arterial hypertension\n(02:29). Heart size is normal with unchanged diffuse coronary calcification.\nNo pericardial effusion.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Mild, upper\nlobe predominant paraseptal and centrilobular emphysema is unchanged.\n\nSubpleural and basilar predominant reticular interstitial opacities are\nsimilar to the prior CT chest. Multiple scattered punctate nodules are\nunchanged since the prior study.  The largest of these measures 5 mm and is\n___ about the right major fissure in the right lower lobe (5:226).\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures.  Within these limitations, the visualized portions of the liver,\nspleen, and pancreas are unremarkable. A 1.2 cm nodule of the left adrenal\ngland has not changed (2:64).\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Multilevel degenerative changes of the thoracic spine are present.\nExpected postoperative changes at the sternotomy site are stable.",
            "output": "1.  No CT evidence of local recurrence following thymic mass resection.\n\n2. Unchanged punctate lung nodules. The largest nodule measures 5 mm in the\nright lower lobe and is stable since the CT chest from ___.\n\n3. Enlarged main pulmonary artery suggests pulmonary arterial hypertension.\n\n4. Stable left adrenal nodule."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged.  Moderate gynecomastia is\nsymmetric and chronic.  There are no soft tissue abnormalities in the chest\nwall suspicious for malignancy or infection.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass.  Dystrophic\ncalcifications at the gastroesophageal junction, could be postinflammatory or\npostsurgical, are unchanged since at least ___.\n\nThyroid is unremarkable.  Atherosclerotic calcification is heavy in head and\nneck vessels, starting at the aortic arch and in the native coronaries.  Aorta\nis normal size.  Enlargement of the pulmonary arteries, main 43 mm, right 28\nmm, has been present since at least ___ consistent with pulmonary\narterial hypertension.  Cardiac chambers are normal size.\n\nThe surgical bed in the prevascular mediastinum has a normal postoperative\nappearance and is unchanged since ___.  There is no lymph node\nenlargement in the prevascular station or elsewhere in the mediastinum, or any\npericardial or pleural fluid or nodulation.  A 15 x 26 mm wide cluster of\nright hilar lymph nodes, 02:28, is unchanged since ___ in ___ it\nwas 20 x 36 mm.  Fat deposition in the mediastinum and extra pleural explained\nis benign.\n\nMild subpleural reticulation in the upper lungs anteriorly is generally\nstable, but slightly more advanced in the anterior segment of the right upper\nlobe, 02:20, are where it has been progressing since ___.  On the\nother hand, the region of interstitial abnormality including mild traction\nbronchiectasis indicative of fibrosis is most marked in the lateral segment of\nthe right middle lobe, 4:161- 184, but in that location it is been stable\nsince this since at least ___.\n\nThere are no lung nodules or any regions of consolidation.\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of recurrent thymic carcinoma or other intrathoracic malignancy.\n\nMinimally progressive interstitial lung disease, probably fibrosing NSIP and\nonly a small region of disease otherwise stable since ___.\n\nProbable chronic pulmonary arterial hypertension.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "The partially imaged thyroid is unremarkable.  Resection bed postsurgical\nchanges including a small amount of stranding and mediastinal surgical clips\nare unchanged in appearance since prior exam.  Trace fluid is seen within the\nmid esophagus, which is otherwise unremarkable.  There is no hiatus hernia. \nThe aorta is normal in caliber.  There is a severely dilated main pulmonary\nartery measuring 4.3 cm in diameter (series 3, image 25).  There is moderate\nto severe thoracic aortic and great thoracic vessel atherosclerotic\ncalcification.  Major aortic branch vessels are calcified, but otherwise\ngrossly patent.  There is severe coronary artery calcification.  The heart and\npericardium are otherwise unremarkable.  There is no pericardial effusion.  A\nsubcarinal lymph node measures up to 9 mm in short axis.  Additional scattered\nparatracheal, epicardial, and prevascular lymph nodes are not pathologically\nenlarged.  A cluster of right hilar lymph nodes measuring 2.1 x 1.0 cm (series\n5, image 134) is unchanged.\n\nMajor airways are patent to subsegmental levels.  A 4-5 mm right major\nperifissural nodules unchanged (series 5, image 210).  A 2 mm right middle\nlobe nodule is stable (series 5, image 191).  A 4 mm nodule at the left lung\nbase is unchanged (series 5, image 251).  Subpleural and basilar-predominant\nreticular interstitial opacities, aside from small area in the inferior aspect\nof the right upper lobe (series 7, image 101), are relatively unchanged, worst\nin the lateral right middle lobe.  Mild to moderate upper lobe predominant\nparaseptal and centrilobular emphysema is stable since prior.  There is no\npleural effusion or pneumothorax.\n\nRe-identified are multiple median sternotomy wires.  A compression deformity\nof the superior endplate of the L1 vertebral body with probably less than 50%\nloss of height (series 8, image 70) is age indeterminate, but at least new\nsince ___.  There is stable moderate to severe multilevel thoracic\nspine degenerative change, with large anterior intervertebral osteophytosis. \nAlignment is normal.  Vertebral body heights are preserved.  No concerning or\nsuspicious focal lytic or sclerotic osseous lesions are seen.  The partially\nimaged solid and hollow viscous organs of the upper abdomen are unremarkable\naside from a cluster of calcified retrocrural lymph nodes and a 1 cm left\nadrenal nodule (series 3, image 64), both unchanged from prior.  Severe\nabdominal aortic atherosclerotic calcification is noted.",
            "output": "1. No evidence of recurrent thymic carcinoma.\n2. Focal linear opacity near the right major fissure in the right upper lobe\nmay represent focal atelectasis versus focal progression of fibrotic lung\ndisease.  Otherwise, stable mild interstitial lung disease.\n3. Age-indeterminate compression deformity of the superior endplate of L1 is\nnew since ___.  Consider MRI for further assessment if warranted\nclinically.\n4. Stable 2.1 x 1.0 cm cluster of right hilar nodes.\n5. Stable markedly dilated pulmonary artery, suggestive of pulmonary\nhypertension.\n6. Stable upper lobe predominant centrilobular and paraseptal emphysema.\n7. Severe coronary artery calcification."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.\nUPPER ABDOMEN: Left adrenal nodule involving the medial limb measuring 15 mm\nin diameter appear similar in size compared to imaging done in ___.  Evidence\nof previous anti reflux procedure.  Exophytic right renal cortical cyst. \nSubcentimeter lymph node in the left upper abdomen (3, 55).\n\nMEDIASTINUM:  Post therapeutic changes noted in the superior and anterior\nmediastinum which is unchanged.  No new or enlarging soft tissue masses.  All\nthe previously noted mediastinal lymph nodes demonstrate interval decrease in\nsize for example station 4A measures 7 mm in diameters (3, 23) previously\nmeasuring 12 mm in diameter and subcarinal currently measuring 8 mm in\ndiameter (3, 28) (previously measuring 14 mm in diameter).\n\nHILA: Previously noted bilateral hilar lymph nodes also demonstrate interval\ndecrease in size.\n\nHEART and PERICARDIUM: No pericardial effusion.  Severe coronary artery\ncalcifications.  Moderate calcification of the aortic arch and supra-aortic\nvessels.\nPLEURA: Interval resolution of the bilateral pleural effusions.\nLUNG:\n\n-PARENCHYMA:  Background centrilobular and paraseptal emphysematous changes\nwith with an upper lobe predominance.  Postradiation fibrosis in the medial\naspect of the right upper lobe.  New cavitating pulmonary nodule measuring 6\nmm in diameter present in the right upper lobe (5, 138) which was not present\non previous imaging.  Cavitary nodule in the right middle lobe (5, 154)\nappears similar compared to previous imaging measuring 5 mm in diameter. \nThere are a few millimetric nodules in the anterior aspect of the right upper\nlobe with associated subpleural interstitial thickening which appear similar\ncompared to previous imaging.  Small 4 mm nodule in the basal aspect of the\nright lower lobe (5, 263) appearing similar compared to previous imaging done\n___.  Multiple millimetric small nodules in relation to the right\noblique transverse fissure show interval decrease in size.  5 mm nodule in the\nposterior basal aspect of the left lung (5, 245) appearing similar compared to\nprevious imaging done ___.  A few millimetric pleural-based calcified\ngranulomas.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary trunk is markedly enlarged measuring 42 mm diameter\nand pulmonary arterial hypertension should be excluded.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  Old fracture of the\nposterior aspect of the left first rib.  Post sternotomy changes.",
            "output": "Postsurgical changes in the superior and anterior mediastinum with no new or\nenlarging soft tissue masses to suggest local recurrence.  Interval decrease\nin size of the mediastinal and hilar lymph nodes.  Interval resolution of the\nbilateral pleural effusions.  The pleural based nodules in relation to the\nright oblique and transverse fissures appear slightly decreased in size.\n\nNew cavitating nodule seen in the right upper lobe measuring 6 mm in diameter.\nThis lesion is nonspecific and may represent a cavitary metastatic lesion or\nLCH and short interval (8 weeks) follow up is suggested to evaluate for\ninterval change.\n\nMultiple pre-existing cavitary and non cavitary nodules unchanged in size.\n\nEmphysematous changes with enlargement of the pulmonary arteries suggesting\npulmonary arterial hypertension.\n\nSevere coronary artery calcifications.\n\nRECOMMENDATION(S):  8 week follow-up CT chest."
        },
        {
            "input": "Status post sternotomy.  Sternal wires in situ.  Clips after robotic\nthymectomy are visualized.  The mediastinum shows a normal postoperative\nappearance, no evidence of fluid retention.  Probably minimally increased area\nof soft tissue density (3, 19) has decreased in size.  Stable appearance of\nthe large mediastinal vessels, with aortic wall calcifications and substantial\ndilatation of the main pulmonary artery.  Stable appearance of the cardiac\nstructures, with severe coronary and moderate aortic valve calcifications.  No\npericardial effusion.  The posterior mediastinum and the upper abdomen appear\nstable, including the stable calcification at the gastroesophageal junction\n(3, 55).  Stable moderate pulmonary emphysema.  Stable areas of postradiation\nfibrosis.  The pre described right upper lobe partly cavitary nodule (5, 151)\nhas decreased in size and now measures 5 mm in diameter.  A slightly dilated\nmiddle lobe bronchus (5, 165) is stable.  Other small pre-existing pulmonary\nnodules, for example in the middle lobe (5, 195) and in the right lower lobe\n(5, 220) are also stable.  No new or growing nodules.  No pleural thickening\nor pleural effusions.  Stable areas of non characteristic fibrosis in\nsubpleural lung areas, in particular on the right (5, 212).",
            "output": "1 of the pre described pulmonary nodules has decreased in size.  The second\npre described pulmonary nodule is a dilated bronchus.  Stable small pulmonary\nnodules.  Stable postsurgical findings in the mediastinum, stable non\ncharacteristic scarring in the lung parenchyma."
        },
        {
            "input": "Status post robotic thymectomy and median sternotomy for thymic carcinoma. \nStatus post radiotherapy.  Sternotomy wires are in stable unchanged position. \nPostsurgical sequela are seen in the anterior mediastinum (2, 12).  The\nmediastinal and combined parenchymal scars with calcifications (2, 19) are\nunchanged.  There are several slightly enlarged mediastinal and hilar lymph\nnodes (2, 20 second) that deserve attention.  There also is stable dilatation\nof the main pulmonary artery as well as a new mild left and minimal right\npleural effusion.  Given the fact that the patient has received contrast\nmaterial, an area of sub-carinal and left hilar lymphadenopathy (2, 31) is\nvisually more apparent than on the previous examination.  Stable appearance of\nthe heart, including severe valvular and coronary calcifications.  No\npericardial effusion.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  Stable bilateral apical scarring.  New\ncalcified right upper lobe granuloma (4, 58).  Areas of scarring in the right\nparamediastinal lung are stable.  A previously 7 mm right upper lobe cavitated\nnodule has markedly decreased and is now 3 mm in diameter.  A small 3 mm\ncavitated at the bases of the right upper lobe (4, 121) Is stable.  Also\nstable are areas of mild right pleural thickening (4, 122).  Stable 3 mm solid\nnodule in the middle lobe (4, 144).  Stable areas of scarring in the lateral\naspect of the middle lobe as well as in both lower lobes.",
            "output": "No change in appearance of the postoperative mediastinum.  Decrease in size of\na cavitated right upper lobe nodule.  All other pulmonary nodules are stable. \nNo new or growing nodules.  Areas of scarring in the lung parenchyma are\nstable.  However, there is a minimal increase in lymph node size at the level\nof the mediastinum and the left hilus, as well as a new moderate left pleural\neffusion and a minimal right pleural effusion."
        },
        {
            "input": "Stable appearance of the thyroid.  Stable sternotomy.  No evidence of\nmediastinal fat stranding.  Stable dilatation of the main pulmonary artery. \nStable severe coronary calcifications.  stable mild aortic valve\ncalcifications.  Normal appearance of the posterior mediastinum.  Stable post\ninterventional appearance of the gastroesophageal junction (16, 50).  No\nosteolytic lesions at the level of the ribs, the sternum, and the vertebral\nbodies.  Mo calcified granulomas.  Derate degenerative vertebral disease.  No\nvertebral compression fractures.  Moderate respiratory motion are defects. \nMinimal bilateral pleural effusions.  Mild to moderate pulmonary emphysema and\nchronic airways disease.  Minimal non characteristic lower lobe nodularity and\nscarring but no evidence of acute infectious disease.  No masses.  Several",
            "output": "No evidence of acute changes in the thorax, notably in the mediastinum.  No\nevidence of compression of the vena cava."
        },
        {
            "input": "HEART AND VASCULATURE: Moderate cardiomegaly.  Trace pericardial fluid within\nphysiologic limits.  Severe coronary atherosclerosis with evidence of CABG\nincluding mediastinal clips and median sternotomy wires.  The thoracic aorta\nis normal in caliber.  Aortic and great vessel origin calcifications are\nmoderate.  The main pulmonary artery is severely enlarged with a diameter of\n4.6 cm.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Small left and trace right pleural effusions.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Patient is intubated with the endotracheal tube tip located in\nthe mid thoracic trachea.  Mild biapical scarring.  Diffuse interlobular\nseptal thickening and basilar predominant ground-glass opacities.  Significant\nbibasilar atelectasis.  Mild diffuse bronchial wall thickening, though the\nairways are patent to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: An enteric catheter courses below the diaphragm and terminates within\nthe gastric body.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nAn L2 compression deformity is unchanged.\n\nSOFT TISSUES: Diffuse subcutaneous edema consistent with severe anasarca. \nBilateral gynecomastia.",
            "output": "1. Moderate pulmonary edema with bibasilar atelectasis and severe anasarca. \nDifficult to exclude superimposed infection.\n2. Severe enlargement of the main pulmonary artery is suggestive of a\npulmonary hypertension."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there are no soft\ntissue abnormalities in the chest wall suspicious for malignancy or infection.\nThis study is not appropriate for subdiaphragmatic diagnosis but shows\nnormal-size adrenal glands, no abnormality in the imaged portion of the\nunenhanced liver and normal size abdominal aorta with moderate calcification\ncomparable to the thoracic appearance.\n\nThere are no lesions in the thyroid warranting further imaging evaluation.\n\nAtherosclerotic calcification is moderately heavy in head and neck vessels and\ncoronary arteries, particularly the LAD and left circumflex branches.  Aortic\nvalve has sufficient calcification to warrant clinical evaluation of function.\nAscending arch and descending thoracic aorta normal caliber and moderately\nheavily calcified.  Main and right pulmonary arteries are dilated, 35 mm and\n31 mm respectively.  Wall cardiac chambers are not dilated, particularly left\natrium and ventricle.\n\nMediastinal lymph nodes are borderline enlarged in several stations, right\nupper paratracheal, 14 mm, 4:69 ; right lower paratracheal, 14 mm, 4:77 ;\nsubcarinal, 17 mm, 4:94.  Relative low attenuation of these lymph nodes\nsuggests they are due to heart failure.  Hilar lymph node enlargement, if any,\nis less pronounced.  There is no compromise of vital structures.\n\nPericardial effusion is minimal.  Small nonhemorrhagic pleural effusions,\nright greater than left, layer posteriorly.  There is no pleural thickening or\nnodularity.\n\nRespiratory motion obscures fine detail in the lungs.  There are no findings\nto suggest pulmonary fibrosis or widespread bronchial abnormality, but there\nis heterogeneity in background density of the lungs which could be due to\nsmall airway obstruction, perhaps cardiogenic asthma, or alternatively the\nresidual edema or vascular disparity due to pulmonary arterial hypertension. \nI doubt intrinsic pulmonary disease.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Severe cardiomegaly, predominantly left atrial and left ventricular. \nAtherosclerotic coronary calcification, aortic valvular calcification, and\npulmonary arterial enlargement are all sufficient to warrant clinical\nevaluation for hemodynamic significance.\n\nThe only evidence of possible pulmonary abnormality are findings that are also\nconsistent with either small airway obstruction (perhaps cardiac  asthma) or\nresidual edema or vascular deficiency due to pulmonary arterial hypertension.\n\nModerate central low density lymph node enlargement usually caused by heart\nfailure."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Moderate\ncardiomegaly.  Mild coronary artery calcifications.  Mild calcifications of\nthe aortic annulus and aortic valves.  Pericardium, and great vessels are\nwithin normal limits based on an unenhanced scan. No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Bilateral trace pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: The subpleural opacifications within the bilateral lower lobes\nmay represent aspiration/aspiration pneumonia.  Atelectasis is in the\ndifferential diagnosis.  There is air trapping throughout the lungs which is\nsecondary to either small airway disease or to the expiratory phase of the\nscan.\n\nThe airways are patent to the level of the segmental bronchi bilaterally. \nDiffuse bronchial wall thickening suggest inflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: The visualized osseous structures are diffusely demineralized.  Acute\nto subacute nondisplaced left 6 and 8 rib fractures.  No surrounding hematoma.\nSubacute to chronic right posterior third rib fracture.  Chronic, healed lower\nrib fractures are noted bilateral.  No suspicious osseous abnormality is\nseen.? flowing vertebral body osteophytes may represent DISH",
            "output": "1. Acute to subacute nondisplaced left 6 an 8 rib fractures.  No pneumothorax.\n2. Dense opacifications at the bilateral lower lobes may represent infection\nversus atelectasis.\n3. Trace bilateral pleural effusions.\n4. Subacute to chronic posterior right third rib fracture and multiple\nbilateral healed lower rib fractures are demonstrated.\n5. There is air trapping in the lungs which may be secondary to small airway\ndisease or expiratory phase of the scan.\n6. Bronchial wall thickening suggest bronchial inflammation\n7. The main pulmonary artery is enlarged to 3.5 cm which may suggest pulmonary\nartery hypertension.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 12:43 pm, 10 minutes after discovery\nof the findings."
        },
        {
            "input": "Ascending aorta is stable including the postoperative appearance.  Extensive\nCoronary calcifications are present.  The patient is after median sternotomy\nand CABG.  Heart size is top-normal, unchanged.  There is no pericardial or\npleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nTop-normal mediastinal lymph nodes are stable.  Airways are patent to the\nsubsegmental level bilaterally.  No discrete pulmonary nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic metastatic disease\n\nStable appearance of postsurgical aorta\n\nExtensive Coronary calcifications."
        },
        {
            "input": "Severe calcifications of the aorta and tortuosity of the aorta are unchanged. \nAscending aorta is at least 4 cm in diameter with the aortic sinuses\napproaching 4.2 cm.  Coronary calcifications are extensive.\n\nSeveral mediastinal lymph nodes are enlarged with the largest 1 being in the\nright lower paratracheal area, increased since previous examination, currently\n1.8 x 3.4 cm as compared to 1.2 x 1.9 cm, series 3, image 22.  No pericardial\nor appreciable pleural effusion demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules are present.\n\nMetastatic involvement of the skeleton is diffuse, with the following\nexamples:\n\nNew lytic lesion, series 3, image 34 in T8, 3.2 x 2.5 cm,\nLytic lesion in the right transverse process of T4, progressed since previous\nexamination Sclerotic lesion in T12, series 3, image 55, 1.6 cm.\nDiffuse lytic and sclerotic involvement of the sternum, more pronounced since\nprevious examination.\nSeveral mid/lower vertebral compression fractures are all new\n\nNo definitive invasion of the spinal canal is present but it cannot be\nexcluded..  Nodular pleural thickening, in the right upper posterior\nparaspinal pleura, series 3, image 12 is 7 x 22 mm, not clearly present on the\nprevious examination.\n\nBilateral gynecomastia is severe, extensive.",
            "output": "Progression of metastatic disease within the skeleton as described in details\n\nConsider assessment with are thoracic and lumbar MRI to exclude invasion into\nthe spinal canal\n\nInterval progression of right lower paratracheal lymph node as described\n\nDilated ascending aorta, status post CABG, extensive calcifications of the\nnative coronary arteries."
        },
        {
            "input": "HEART AND VASCULATURE: There is filling defect in the posterior basal\nsegmental pulmonary arteries of the left lower lobe (3:130, 140).  The main\npulmonary artery is top normal in caliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  Minimal paraseptal\nemphysema is noted at the right apex.  There is a 2-3 mm nodule the right\nupper lobe (03:53).  There is a granuloma in the right upper lobe (3:99). \nPeribronchial wall thickening is moderate in the lower lobes, suggestive of\nchronic bronchitis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a 5.2 x 3.9 cm\nsplenic cyst.  2.6 cm hypodensity arising from upper pole of the right kidney\nis likely a cyst.  There is a small hiatal hernia.  Patient is status post\ngastric sleeve.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPartially imaged 2.0 cm soft tissue nodule in the posterior upper soft\ncutaneous tissue is nonspecific, though likely a sebaceous cyst (3:1).",
            "output": "1. Acute pulmonary embolism of the posterior basal segmental pulmonary\narteries of the left lower lobe.\n2. Moderate peribronchial thickening of the lower lobar bronchi, suggestive of\nbronchitis.\n3. 2-3 mm nodule in the right upper lobe.  Please refer to the recommendation\nsection for follow-up.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart size\nis normal, and there is no pericardial or pleural effusion.\n\nLungs are clear except for dependent bibasilar atelectasis. Airways are widely\npatent.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute\nconcerning findings are evident in this region on this limited assessment.\n\nThere are no suspicious lytic or blastic skeletal lesions.",
            "output": "No CT findings to account for hemoptysis.  If this symptom persists, consider\nbronchoscopy to exclude an occult endobronchial abnormality as a cause of the\nsymptom."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are in not pathologically enlarged\nranging in diameter up to 7 mm left peripectoral nodes, 4:  15.  With the\nexception of the breasts which require mammography for evaluation, soft\ntissues of the chest wall are unremarkable.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass or heterogeneity in the\nliver.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in the\nhead and neck vessels or in the coronaries.  Aorta and pulmonary arteries are\nnormal size.\n\nThere is more residual thymic tissue in this patient than in most patients of\nher age, but the the tissue is not masslike.\n\nPericardium is physiologic.  There is no pleural abnormality.\n\nMediastinal lymph nodes are not pathologically enlarged and hilar contours do\nnot suggest adenopathy.\n\nHiatus hernia is small.  Above that the esophagus is unremarkable.\n\nLung findings are as follows:\n\nApical pleural parenchymal scarring is greater on the right, but not\nsuggestive of an active process.\n\nLungs are clear of any focal or generalized abnormality.  The punctate right\nmiddle lobe nodules present a CTA, on ___ when the patient had\nextremely severe pulmonary emboli, have resolved.\n\nOn expiration, air trapping is mild.\n\nTracheobronchial tree is normal to subsegmental levels.",
            "output": "No radiographic explanation for restrictive lung disease.  Of note this\nexamination does not assessed chest wall mechanical factors in ventilation.\n\nNo lung nodules.\n\nNo evidence of pulmonary arterial hypertension.\n\nThis study does not evaluate pulmonary emboli."
        },
        {
            "input": "Several up to 1 cm large thyroid nodules that could be further worked up by\nultrasound.  No supraclavicular, infraclavicular or axillary lymphadenopathy. \nMild dilatation of the ascending aorta.  Mild coronary calcifications.\nGeneralized cardiac enlargement.  No pericardial effusion. Elongation of the\ndescending aorta.  Small hiatal hernia. The posterior mediastinum is otherwise\nunremarkable.  No incidental pulmonary embolism.\nThe abdominal findings are reported in detail in the dedicated abdominal CT\nreport.\nModerate degenerative vertebral disease.  No vertebral compression fractures.\nSevere respiratory motion artifact limits the interpretation of the\nexamination.  No pleural effusions.  No pleural thickening.  No visible airway\nabnormalities. Non characteristic minimal scarring at the left and right lung\nbases.  The only other abnormality in the lung parenchyma are to left upper\nlobe ground-glass nodules with diameters between 3 and 6 mm (6, 72).  Several\nmillimetric subpleural granulomas, for example in the right upper lobe (6,\n39).",
            "output": "No convincing evidence of infection or neoplastic disease, or of other lung\ndisease potentially explaining the clinical presentation, on the basis of a CT\nexamination limited by respiratory motion artifacts.  No pleural effusions."
        },
        {
            "input": "CTA:\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nIn a single subsegmental branch of a right lower lobe pulmonary artery there\nis an eccentric filling defect (series 3, image 137). The remainder of the\npulmonary artery branches are normal without filling defects.  There is no\nevidence of right heart strain.  No evidence of pulmonary infarction. There is\nno mediastinal hematoma.\n\nCHEST:\n\nRight chest wall Port-A-Cath ends in the right atrium.\n\nThere are no enlarged axillary or supraclavicular lymph nodes. Scattered\nmediastinal lymph nodes have not significantly changed from ___,\nmeasuring up to 8 mm in the right upper paratracheal station (series 3, image\n79).\n\nThe heart size is normal. There is no pericardial effusion. There no\nsignificant coronary artery calcifications.\n\nThe airways are patent to the subsegmental level bilaterally. There is no\nfocal lung consolidation. A 5 mm right lower lobe pulmonary nodule is\nunchanged from ___ (series 6, image 122). There is no pleural effusion.\n\nThe thyroid is enlarged and heterogeneous, unchanged. The thoracic esophagus\nis unremarkable.\n\nMultiple hepatic cysts in the left lobe of the measuring 14 mm, stable. A\npartially imaged exophytic right renal cyst is present.\n\nOSSEOUS STRUCTURES:  No lytic or blastic osseous lesion suspicious for\nmalignancy is identified. Multilevel degenerative changes are not\nsignificantly changed.",
            "output": "Single eccentric filling defect in a right lower lobe subsegmental pulmonary\nartery, compatible with a pulmonary embolus. No evidence of pulmonary\ninfarction.\n\nRECOMMENDATION(S):  Consider lower extremity DVT study.  If negative, the\nslightly excentric PE may be chronic.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with ___\n___, NP on the telephone on ___ at 2:15 ___, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet by CT size criteria, however note is\nmade of a 0.9 cm left axillary lymph node.  Overlying the left posterolateral\n___ ribs, there is stranding of the subcutaneous fat and skin thickening,\nwithout organized fluid collection.  There are no other abnormalities on the\nchest wall. Mild atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Mild\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. No bilateral apical scarring.\n\nLUNGS:\nMild centrilobular emphysema is overall similar to prior chest CT from\n___ airways are patent to the subsegmental levels. No bronchial wall\nthickening, bronchiectasis or mucus plugging. No suspicious lung nodules or\nmasses. Subsegmental atelectasis of the lung bases, right greater than left.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show similar appearance of enlarged\nand multi cystic native kidneys.",
            "output": "Cellulitis of the left back overlying the left posterolateral ___ ribs. \nNo drainable fluid collection."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis mild bibasilar atelectasis.  There is mild centrilobular emphysema versus\npulmonary cysts, similar to prior.\n\nAIRWAYS: The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild periportal edema.   There\nis mild central intrahepatic biliary ductal dilatation, similar to prior, as\nwell as similar mild dilation of the common bile duct, measuring up to 1.1 cm.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Diffuse prominence of the main pancreatic duct is similar to\nprior, measuring up to 4 mm.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are enlarged, with innumerable cysts, some of\nwhich are calcified and some which are hyperdense, similar to prior,\nconsistent with polycystic kidney disease.  Surgical clips are visualized in\nthe right kidney.  A right lower quadrant transplant kidney is diffusely\nhypoenhancing and appears edematous.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post left hemicolectomy.  There is a large amount of stool throughout\nthe colon, particularly at the anastomosis in the mid abdomen.  The appendix\nis normal.\n\nPELVIS: The urinary bladder is decompressed.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDiffuse osseous sclerosis is similar to prior, likely related to renal\nosteodystrophy.\n\nSOFT TISSUES: There is a midline anterior abdominal wall surgical scar.  The\nabdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. Status post left hemicolectomy, with likely impacted fecal material\nproximal to the colonic anastomosis in the mid abdomen, as well as a large\namount of stool throughout the remaining colon.  No evidence of wall\nthickening or pericolonic stranding to suggest stercoral colitis.\n2. No evidence of pneumonia.\n3. Similar appearance o"
        },
        {
            "input": "The patient is asymmetrically positioned in the scanner.  No incidental\nthyroid findings.  Moderate aortic wall calcifications.  Mild dilatation of\nthe main pulmonary artery.  Mild coronary calcifications.  No valvular\ncalcifications.  No pericardial effusion.  Moderate cardiomegaly.  Moderate\nleft and small right pleural effusion, the upper abdominal findings are\ndescribed in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures. \nEvaluation of the lung parenchyma is limited by severe respiratory motion. \nMild centrilobular pulmonary emphysema.  Extensive bilateral areas of\natelectasis adjacent to the pleural effusions.  The enhancement pattern of\nthese changes is not suggestive of pneumonia.  No other larger focal\nparenchymal abnormalities.  No suspicious lung nodules or masses.",
            "output": "Lateral pleural effusions with adjacent areas of atelectasis.  No evidence of\npneumonia.  No lymphadenopathy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes at the level of the hilar or\nmediastinal structures.  No substantial coronary calcifications, mild aortic\nvalve calcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  In the upper abdomen, no evidence of abnormalities is present. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  Status post right middle lobe wedge resection and mechanical\npleurodesis.  There is a staple line in the right lung apex.  Ventral to the\nstaple line the relatively substantial amount of free pleural air is\nvisualized.  Pleural air is also present in fissural location (5, 77) creating\nan air-fluid level with a pre-existing pleural effusion.  Only, there is a\nsmall pocket of pleural air in para cardial location.  Moderate right basal\npleural effusion, combines to a basal pneumothorax (5, 184).  No air leak can\nbe identified.  Overall normal appearance of the left lung, with the exception\nof a small fissural air collection (5, 175).",
            "output": "Relatively extensive postoperative fluidopneumothorax on the right, the right\napical staple line appears normal.  A small pleural air collection is also\nseen on the left.  No adenopathy.  Mild aortic valve calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Please refer to the separately dictated CT abdomen and pelvis\nreport for the same date for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  Soft tissue in the\nanterior mediastinum, consistent with thymic tissue.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\nPLEURA: No pleural effusion.  Previously seen right pneumothorax and pleural\neffusion have resolved.  There are changes following talc pleurodesis.\nLUNG:\n\n1. PARENCHYMA:  Numerous thin-walled parenchymal cysts throughout both lungs\nare overall similar, consistent with the history of ___.  No focal\nconsolidation.  There is scarring at the right lung apex, there is scarring at\nthe right lung apex and right middle lobe, consistent with prior surgical\nchanges.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  While this study is not optimized for the evaluation of pulmonary\nvasculature, no central filling defect is seen.  The thoracic aorta is normal\nin caliber.\n\nCHEST CAGE: No aggressive osseous lesion or acute fracture.",
            "output": "1. Resolved right hydropneumothorax following talc pleurodesis.\n2. Similar scattered thin wall parenchymal cysts, consistent with ___."
        },
        {
            "input": "CT THORAX: No supraclavicular, axillary, mediastinal, or hilar lymph node\nenlargement by CT size criteria. The heart is unremarkable without pericardial\neffusion. No pleural effusion.  Coronary artery calcifications are present.\nThe airways are patent to the subsegmental level. Diffuse mild bilateral\nground-glass opacities is due to poor inspiratory effort.  Bilateral lower\nlobe atelectasis with slightly more confluent opacity in the right lower lobe\nis most consistent with atelectasis.  No pneumothorax. The thyroid gland is\nunremarkable.  A 4 mm (2:46) right middle lobe pulmonary lung nodule.\n\nCTA:  The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. No evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present. The\npulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main pulmonary artery is normal in\ncaliber, without evidence of right heart strain.\n\nOSSEOUS STRUCTURES:  Thoracic kyphosis is present. No lytic or blastic osseous\nlesions concerning for malignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is notable for an enhancing 0.9 x 0.9 cm\n(02:10 2) segment 4B lesion.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2.  0.9 cm enhancing segment 4B hepatic lesion is incompletely evaluated is\nlikely represents a flash filling hemangioma. Recommend dedicated ultrasound\nfor further evaluation.\n3.  4 mm right middle lobe pulmonary nodule. In the case of nodule size <= 4\nmm: No follow-up needed in low-risk patients. For high risk patients,\nrecommend follow-up at 12 months and if no change, no further imaging needed.\n\nNOTIFICATION:  Impression #3 was discussed by Dr. ___ with ___ QA\nNurses via email  on ___ at 8:54 AM, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nHeterogeneous thyroid with a 1.0 cm hypodense nodule in the left lobe (04:48).\nNo enlarged lymph nodes in either axilla or thoracic inlet.  No abnormalities\non the chest wall.  Moderate atherosclerotic calcifications in the head and\nneck arteries, notably in the left subclavian artery.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  There is herniation of mild amount of\nmesenteric fat through the diaphragmatic hiatus.  Small mediastinal lymph\nnodes, none pathologically enlarged by CT size criteria.  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusion. Mild bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation. Non\nphysiologic shape of the trachea suggestive of tracheomalacia.  The airways\nare however patent to the subsegmental levels.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  No suspicious lung nodules or masses. \nThere is a calcified granuloma in the right upper lobe.  No consolidations or\natelectasis.\n\nCHEST CAGE:\nThere is diffuse idiopathic skeletal hyperostosis of the thoracic spine with\nincreased thoracic kyphosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThere is redemonstration of the pancreatic mass, which is further\ncharacterized on prior CT abdomen and pelvis.  A calcified splenic artery\naneurysm is unchanged.  Large gallstones are seen within the decompressed\ngallbladder.  A small hiatal hernia is noted.  The adrenal glands are mildly\nthickened.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid gland\nshows a 0.6 cm hypodense nodule in the right lobe of the thyroid gland for\nwhich no specific follow up is recommended.\n\nUPPER ABDOMEN: Partially visualized upper abdomen shows prior cholecystectomy.\nOtherwise, upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There are extensive coronary\nartery calcifications most notable in the LAD and left circumflex.  There are\nmild-to-moderate mitral annulus calcifications.  There is no pericardial\neffusion.\nPLEURA: There are trace bilateral pleural effusions, left greater than right.\nLUNG:\n\n1. PARENCHYMA:  There is a 1.4 cm calcified granuloma in the left lower lobe,\nwhich correlates with round opacity seen prior chest radiograph.  There is\nmoderate background pan-loblar and centrilobular emphysema.  Further, there\nare subpleural interstitial changes, which are nonspecific.  No evidence of\nfibrosis.  There is minimal left apical scarring.  There is bibasilar\natelectasis without focal consolidation.  7.3 mm nodule is seen in the right\nlower lobe with indistinct borders.  Multiple additional micronodules are seen\nthroughout the lungs (for example series 5; images 163, 233, and 237).\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Main, left, and right pulmonary arteries are normal in size.\nCHEST CAGE: There is no concerning sclerotic or lytic lesion.  There is no\nacute compression deformity of the thoracic spine.",
            "output": "1. 1.4 cm calcified granuloma in the left lower lobe correlates with round\nopacity seen on prior chest radiograph, likely sequela of prior granulomatous\ndisease.\n2. 7.3 mm nodule seen in the right lower lobe with indistinct borders. \nRecommend six-month follow-up of this nodule.  Multiple additional micro\nnodules are seen throughout the lungs, which can be monitored on follow-up\nexamination.  Please consider enrollment in lung cancer screening program if\npatient qualifies.\n3. Moderate background centrilobular emphysema with minimal apical scarring on\nthe left and bibasilar atelectasis without focal consolidation.  Subpleural\ninterstitial changes are seen, which are nonspecific, without fibrosis.\n4. Extensive coronary artery calcifications.\n\nRECOMMENDATION(S):  Recommend six-month follow-up of 7.3 mm nodule in the\nright lower lobe."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  There is interval decrease in\nsize in prevascular lymph node, series 2, image 18, from 10-7.5 mm.  Sub-\ncarinal and paraesophageal lymph nodes have decreased from 13-12 mm. Hilar\nlymph nodes and perihilar lymphatic tissue have decreased from 5 mm in\nthickness to less than 2 mm.  There is no pericardial pleural effusion.  There\nis no axillary lymphadenopathy.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Predominantly upper\nlobe process presented as very bronchovascular areas of fibrosis, nodularity\nspoon and ground-glass opacities is substantial but markedly the improved as\ncompared to previous examination, for example at the level of the carina in\nimmediately sub- carinal area, series 4, image 76.  The volume loss is\npredominantly in the upper lobes and unchanged but there is substantial\nimprovement in the centrilobular extensive opacities within the lower lobes,\nespecially at the level of the superior segments of the lower lobes, series 4,\nimage 97.  No new nodules masses are consolidations have been demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\nLung volumes remain relatively low but unchanged since previous examination.",
            "output": "Substantial interval improvement in extensive involvement of the lungs by\nsarcoidosis seen as decrease in the lymphadenopathy, but primarily decrease in\nthe peribronchovascular all tissue and extensive ground-glass and\nperibronchovascular nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Compared to the chest radiograph dated ___, the right subclavian catheter tip has changed orientation, now\nterminating within the left innominate vein.  The thoracic aorta is normal in\ncaliber.  The heart, pericardium, and great vessels are within normal limits\nbased on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear atelectasis within the right middle lobe.  No focal\nconsolidations to suggest pneumonia.  Calcified granuloma within the lingula. \nPunctate perifissural nodular along the right major fissure, likely an\nintrapulmonary lymph node (series 4, image 140).  There is also a subpleural\nnodule within the right lower lobe, also likely an intrapulmonary lymph node\n(series 4, image 199).  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES AND SOFT TISSUES: Mottled appearance of all of the thoracic vertebral\nbodies, compatible with diffuse m myelomatous involvement.  In addition, there\nis mild loss of height involving multiple thoracic and upper lumbar vertebral\nbodies (T7 through T11 and L1).  Moderate to severe loss of height at T12,\nsimilar compared to the skeletal survey dated ___.  No acute\nfractures.  Note is made of bilateral gynecomastia.",
            "output": "1. Right subclavian catheter tip has changed orientation, now terminating\nwithin the left innominate vein.\n2. No focal consolidations to suggest pneumonia.\n3. Mottled appearance and mild loss of height involving multiple thoracic and\nupper lumbar vertebral bodies, compatible with myelomatous involvement. \nModerate to severe loss of height at T12 is also unchanged.\n\nNOTIFICATION:  The findings were discussed with ___, NP by\n___, M.D. on the telephone on ___ at 1:50 pm, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST CTA:  Pulmonary arterial vasculature is well-visualized to the\nsubsegmental levels bilaterally.  No filling defects are identified to suggest\nthe presence of pulmonary embolism.  The aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The great vessels are\nunremarkable.\n\nCHEST:  There is atelectasis in the bilateral lungs, left greater than right.\nThe lungs are otherwise clear. There is no nodule, mass, or consolidation. \nThe airways are patent to the subsegmental levels bilaterally.  No\npathologically enlarged axillary, mediastinal, or hilar lymph nodes are\nidentified.  There is no pleural effusion.  The heart and pericardium are\nwithin normal limits.\n\nThe study is not tailored for subdiaphragmatic evaluation, but the visualized\nintra-abdominal organs are unremarkable.\n\nBONE WINDOWS:  No focal lytic or sclerotic osseous lesion suspicious for\ninfection or malignancy is seen.",
            "output": "No evidence of pulmonary embolism.  Bilateral atelectasis, left greater than\nright. No acute findings.\n\nNOTIFICATION:  Findings were communicated to Dr. ___ at 10:56 p.m. on ___ by phone."
        },
        {
            "input": "HEART AND VASCULATURE: The heart is within normal limits of size.  No\npericardial effusion.  Thoracic aorta is normal in course and caliber without\nappreciable atherosclerotic calcification.  The main pulmonary artery is\nnormal in size.  The central branches of the pulmonary arterial tree appear\npatent without filling defect to suggest the presence of a pulmonary embolism.\nPulmonary vasculature is well opacified to the subsegmental level without\nfilling defect to indicate a pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation through the lower lungs is limited given motion\nartifact.  No worrisome nodule, mass, or consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nPartially imaged thyroid is unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No pulmonary embolism or acute aortic process.  Slightly limited assessment\ngiven motion artifact in the lower lungs."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged by CT size criteria. Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal.  Extensive coronary artery\ncalcifications are noted.  No pericardial effusion.  Atherosclerotic\ncalcifications of the aorta are extensive.\n\nThe airways are patent to at least the subsegmental level.  No focal\nconsolidation.  Mild basilar atelectasis is noted bilaterally.  Several\nbilateral pulmonary nodules are identified.  There is a 5 mm nodule in the\nright upper lobe (series 2, image 14).  There is a calcified granuloma in the\nright middle lobe (series 2, image 26) and right upper lobe (series 2, image\n8).  There is a 2-mm nodule in the right lower lobe (series 2, image 37). \nThere is an 8 mm nodule in the left upper lobe (series 2, image 19).  There is\na calcified granuloma in the left lower lobe (series 2, image 45).  No pleural\neffusion.\n\nMulti-level degenerative changes of the visualized spine are noted.  The\nincompletely visualized cervical spine shows anterior spinal fixation\nhardware.",
            "output": "1.  5-mm right upper lobe, 2-mm right lower lobe, and 8-mm left upper lobe\npulmonary nodules could represent a metastatic focus in the absence of\ncomparison exams.\n2.  Several calcified granulomas reflecting prior granulomatous disease.\n3.  Please refer to the dedicated CT Abdomen and Pelvis exam from the same day\nfor findings below the diaphragm."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes present.  Minimal\npericardial effusion is seen.  Vascular calcifications including Coronary\narteries and aorta are present, extensive.  Heart size is top-normal in\nparticular left ventricle.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Secretions are\npresent in the bronchus intermedius.  Centrilobular emphysema is moderate\nmultiple pulmonary nodules are present, series 4, images 70, 76, 79, 92, 105,\n134, 108, 181.  Left upper lobe, series 4 in image 116 and right middle lobe,\nseries 4, image 146 subpleural opacities are present.  The nodules are ranging\nup to 7 mm.  Some of them are clustered ans some  might represent\nendobronchial secretions.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Multiple pulmonary nodules, ranging up to 7 mm in diameter.  Although some of\nthem a cluster at and might potentially represent infectious process, others\nmight be solid and of different etiology.  Reassessment in 6 months for\ndocumentation of stability is recommended."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The visualized thyroid is within normal\nlimits.  There is no axillary or supraclavicular lymphadenopathy.  There is no\nmediastinal or hilar lymphadenopathy.\n\nHEART & VESSELS: The heart is normal in size.  There is a trace, likely\nphysiologic pericardial effusion.  There is heavy calcified atherosclerosis of\nthe coronary arteries.  There is significant mitral annular calcification. \nThere is moderate calcified atherosclerosis of the aortic arch and descending\nthoracic aorta.\n\nLUNGS & AIRWAYS: There is mild centrilobular emphysema.  There is no focal\nconsolidation or pleural effusion.  There is no pneumothorax.\nPulmonary nodules:\n4 mm, sub solid, right upper lobe, 05:39, stable\n3 mm, right upper lobe, 05:45, stable\n3 mm, right upper lobe, 05:55, new\n7 mm, right upper lobe cluster, 05:59, stable\n2 mm, right upper lobe, 5:93, stable\n8 mm, left lower lobe, 5:117, stable\n\nSmall clustered nodules that were previously seen in the right lower lobe are\nno longer present on the current examination.\n\n\nUPPER ABDOMEN: Limited views of the upper abdomen are within normal limits.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions are seen.",
            "output": "Multiple pulmonary nodules ranging up to 8 mm are demonstrated.  Compare to\nthe prior examination few nodules have resolved, while others are new\nsuggesting a potentially infectious or inflammatory process.  The largest\nnodule in the left lower lobe measures up to 8 mm and is stable from the prior\nexamination in ___.  Recommend follow-up with CT in ___ year for\ncontinued evaluation."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged. \nSpecifically excluding the breasts which must be evaluated by\nechocardiography, there are no soft tissue abnormalities in the incompletely\nimaged chest wall concerning for is malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows a\nslight decrease in size of the low-attenuation 30 x 19 mm benign adenoma in\nthe left adrenal compared to ___ right adrenal is unremarkable.\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable. There are no findings in the\nthyroid warranting further imaging evaluation. Atherosclerotic calcification\nis moderate in head and neck vessels and severe in at least left anterior\ndescending and circumflex coronary arteries. Aortic valvular calcification is\nmild. Mitral annulus calcification is moderately heavy. Small pericardial\neffusion is unchanged, probably physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\nMeasurable thoracic lymph nodes are numerous in the lower paratracheal\nstations of the mediastinum but not pathologically enlarged or growing since\n___.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is mild to moderate in the upper lungs,\nmilder elsewhere.  Mild bronchiolar nodulation in combination with mild\ngeneralized bronchial wall thickening bronchial wall thickening, unchanged,\nare most commonly seen in cigarette smokers.\n\n2-3 mm solid right upper lobe lung nodule, 05:36, is more radiodense today\nthan it was in ___.\n\nPrevious, similar size solid right apical nodules, 05:50, 54, 55, have\nresolved.\n\n2-3 mm solid nodule, right upper lobe, 5:74, more conspicuous but unchanged in\nsize.\n\n7 x 8 mm cluster of nodules, superior segment left lower lobe, 5:112,\nunchanged since since ___, was 7 by 9 mm in ___..\n\nPleural surfaces are normal.\n\n4 mm subpleural nodule, right middle lobe, 5:166, unchanged since ___.\n\nMild bronchial wall thickening is generalized.  There is no bronchiectasis. \nPleural surfaces are normal.\n\nCHEST CAGE: There are no pathologic or compression fractures or destructive\nbone lesions.",
            "output": "No new or growing lung nodules.  Some of the previous tiny lung nodules have\nresolved.  Bronchiolar nodulation is slightly less pronounced, but combination\nof bronchial wall thickening, bronchiolar nodulation and emphysema suggests\ncigarette smoking may be continuing. Clinical assessment advised.\n\nSevere atherosclerotic coronary calcification.  Moderately severe mitral\nannulus calcification can contribute to mitral regurgitation.  No pulmonary\nedema currently."
        },
        {
            "input": "Under is might take lead dilated aortic arch similar to previous examination,\nseries 2, image 25 with appearance most likely consistent with pseudoaneurysm\nof focal dissection.  Pulmonary arteries normal in diameter.  Heart size is\nenlarged.  There is minimal pericardial effusion that appears to be similar to\nprevious examination.\n\nNo discrete mediastinal hilar or axillary pathologically enlarged lymph nodes\ndemonstrated.  Sebaceous cyst at the posterior midline is unchanged, series 2,\nimage 9.\n\nCentral airways are patent to the subsegmental level bilaterally.  Right upper\nlobe lesion reflecting also changes after radiofrequency ablation is stable, 4\nx 2.3 cm.  Postsurgical changes in the left lung are stable.\n\nDiffuse degenerative disease affecting the spine but no new lytic or sclerotic\nlesions that would be worrisome for infection or neoplasm demonstrated.\n\nImage portion of the upper abdomen demonstrate calcified gallstone, liver\nhypodensity only partially characterized on this nonenhanced study and\nmultiple renal cysts also partially assessed.",
            "output": "Overall stable appearance of the chest with no evidence of interval disease\nprogression"
        },
        {
            "input": "The thyroid is unremarkable.  There are no enlarged supraclavicular, axillary\nlymph nodes.  A hypodense lesion in the upper posterior back measuring 1.7 x\n2.2 cm most likely represents a sebaceous cyst.\n\nSmall mediastinal lymph nodes are stable.  Heart size is normal.  There is\natherosclerotic calcification involving the aorta.  There is a focal\noutpouching of the aorta at the level of the aortic arch (21 series 2), most\nlikely represents an atherosclerotic ulcer or of focal aneurysm.  Lack of\nintravenous contrast limits evaluation.\n\nThere is mild atherosclerotic calcification involving the aortic annulus in\nthe LAD.\n\nThere is a small pericardial effusion.  There is no pleural effusion\n\nThere are stable postsurgical changes following wedge resection in the left\nupper lobe and left lower lobe.  There is no evidence of local recurrence. \nThe right upper lobe nodule has changed in morphology and appears to have a\nconsolidative elongated appearance and measures approximately 3.3 x 2.3 cm. \nThis lesion has been ablated by radiofrequency ablation in the interim, this\nmost likely represents evolving post ablation changes.  Evaluation for\nresidual disease is limited.  Continued follow-up is recommended.\n\nNo new pulmonary nodules.\n\nReview of bones shows evidence of osteopenia.  There is a lytic lesion\ninvolving the pedicle of L2 vertebral body.  No  new lytic or sclerotic\nlesions concerning for metastasis are seen.\n\nLimited sections through the upper abdomen shows a large exophytic right renal\ncyst.  There are multiple hypodense liver lesions which could represent cysts\nor hemangiomas.  There are gallstones.  Please refer to dedicated report on\nabdomen which has been dictated separately.",
            "output": "Status post radiofrequency ablation of the right upper lobe nodule in the\ninterim with evolving post ablation changes.  No new pulmonary nodules. \nStable postsurgical changes in the left upper lobe and left lower lobe\nfollowing wedge resections.\n\nStable outpouching of the arch of aorta with dystrophic calcification, could\nrepresent an atherosclerotic ulcer or focal aneurysm.\n\nLytic lesion involving L2 right lateral pedicle, best seen on the sagittal\nreconstruction.\n\nMultiple liver lesions and right renal cyst.  Please refer to dedicated report\non abdomen which has been dictated separately."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The esophagus is normal without evidence of wall thickening or a\nhiatal hernia.  Pneumoperitoneum and subcutaneous gas may be postsurgical in\netiology.\n\nCTA: The aorta is normal in caliber.  The main, and lobar branches are\nunremarkable.  Within the subsegmental branch of the left upper lobe pulmonary\nartery, a filling defect is seen concerning for a pulmonary embolus.  No\nevidence of right heart strain.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nConsolidation is seen within the posterior segment of the right upper lobe. \nMild diffuse emphysema is seen.  Consolidations with heterogeneous enhancement\nare seen within the lung bases bilaterally.  There is a moderate left pleural\neffusion.  Small left pneumothorax is seen.",
            "output": "-Pulmonary embolus is seen within the subsegmental branch of the left upper\nlobe.\n-Bibasilar consolidations with heterogeneous enhancement as well as\nconsolidation within the right upper lobe, concerning for infectious process.\n-Small left pneumothorax, pneumoperitoneum, subcutaneous gas-consistent with\nrecent postoperative changes.\n-Moderate left pleural effusion."
        },
        {
            "input": "The patient is intubated.  No incidental thyroid findings.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Stable\nborderline sized lymph nodes in the mediastinum.  Stable appearance of the\nlarge mediastinal vessels.  The pre described potential embolus is not\nvisualized.  The extent of the left more than right pleural effusion as well\nas the extent of the adjacent areas of atelectasis are stable.  Upper\nabdominal findings, including small liver cyst, are described in detail in the\ndedicated abdominal CT report.  Mild degenerative vertebral disease.  No\nvertebral compression fracture.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Extensive respiratory motion. \nIncrease in extent and severity of a pre-existing right upper lobe peripheral\nopacity and consolidation that is likely infectious in origin.  No other\nparenchymal changes are noted.",
            "output": "Stability of bilateral pleural effusions with adjacent areas of atelectasis. \nMild increase in extent and severity of a likely infectious right upper lobe\nprocess.  Stable appearance of the cardiac and mediastinal structures."
        },
        {
            "input": "HEART AND VASCULATURE: Extensive calcifications of the thoracic aorta, at the\norigin of the head and neck vessels, and of the coronary arteries.  There are\nalso moderate aortic valvular calcifications.  Mild dilatation of the\nascending aorta measuring up to 4.4 cm.  Otherwise, the heart, pericardium,\nand great vessels are within normal limits based on an unenhanced scan. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the bilateral lung bases are limited due to\nmotion artifact.  Within these limitations, dependent atelectasis, but no\nfocal consolidations.  2 millimetric nodules within the left upper lobe are\nunchanged since at least ___ (series 4 image 99, 106).  No new or growing\nnodules are visualized.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is new intra and extrahepatic biliary dilatation, although\nincompletely evaluated on this examination.  No other abnormalities within the\npartially imaged upper abdomen.\n\nBONES: There is a moderate compression deformity of the T11 vertebral body\nwith mild retropulsion, indeterminate in age, but new since ___. Also, there\nappears to be a linear lucency traversing the superior and inferior endplates\n(series 602, image 75), likely acute/subacute.  No suspicious osseous\nabnormality is seen.?",
            "output": "1. 2 unchanged millimetric nodules within the left upper lobe.  No new or\ngrowing nodules.  No lymphadenopathy.\n2. Moderate compression deformity of the T11 vertebral body with mild\nretropulsion, new since ___, with a linear lucency traversing the superior\nand inferior endplates, indeterminate, but likely acute/subacute.\n3. New intra and extrahepatic biliary dilatation.  Dedicated abdominal CT or\nMRCP is recommended.\n4. Mild dilatation of the ascending aorta measuring up to 4.4 cm.\n\nRECOMMENDATION(S):  Dedicated CT or MRCP is recommended to evaluate the\nbiliary dilatation.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:26 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "THORACIC INLET: Tracheostomy tube is in place.  There are secretions within\nthe proximal trachea.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There are\nsmall right paratracheal lymph nodes not enlarged by size criteria.  Heart\nsize is normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Consolidative opacities in both lower lobes enhance uniformly and could\nrepresent subsegmental atelectasis.  Evaluation of lung parenchyma is some\nwhat limited by respiratory motion however no obvious nodules or\nconsolidations are seen.  There is an emphysematous cyst in the right upper\nlobe.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe lumbar spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions",
            "output": "Consolidative opacities in both lower lobes most likely represent atelectasis.\n\nTracheostomy tube in place.\n\nNo evidence of pneumonia."
        },
        {
            "input": "CHEST: The endotracheal tube terminates approximately 5 cm above the carina. \nThe OG tube terminates at the GE junction and should be advanced for more\noptimal positioning.  The imaged base of neck including the partially\nvisualized thyroid is unremarkable.  The ascending thoracic aorta is slightly\nectatic measuring 3.9 cm in diameter.  No significant atherosclerotic\ncalcification is seen.  The heart is within normal limits of size without\npericardial effusion.  The main pulmonary artery is normal in caliber with\npatent central branches.  No mediastinal mass or adenopathy.  No\npneumomediastinum.  A small amount of debris is seen within the trachea and\nwithin the right mainstem bronchus likely reflecting aspiration.\n\nPosterior bibasilar consolidations likely reflect the sequelae of aspiration. \nThere is otherwise no abnormality and no evidence of traumatic injury in the\nchest.\n\nABDOMEN: The liver enhances normally without signs of injury or focal\nabnormality.  The main portal vein is patent.  No biliary ductal dilation. \nFocal nodularity at the gallbladder fundus may represent a small polyp, series\n2, image 137, measuring approximately 9 mm in maximal dimension.  The spleen\nappears normal and without signs of injury.  Adrenals are normal.  The\npancreas enhances normally.  The kidneys enhance symmetrically.  No signs of\nrenal injury or hydronephrosis.  The abdominal aorta is normal in course and\ncaliber with mild atherosclerotic calcification.  No retroperitoneal hematoma\nor adenopathy is seen.  No free air or free fluid.\n\nThe stomach and duodenum appear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction.  No\nsigns of bowel or mesenteric injury.  The appendix is normal.  The colon\ncontains a mild fecal load.  No pelvic free fluid.  No pelvic sidewall or\ninguinal adenopathy.  A Foley catheter is seen within the decompressed urinary\nbladder.  The prostate appears normal.\n\nBONES:  No fracture or worrisome bony lesion.  Degenerative disc disease is\nnotable at L4-5 and L5-S1.",
            "output": "1. Slightly high-riding endotracheal tube.  Consider advancement by 1-2 cm for\nmore optimal positioning.\n2. OG tube terminates at the GE junction.  Recommend advancement for more\noptimal positioning.\n3. Bilateral posterior basal consolidations likely reflect the sequelae of\naspiration.  Small volume tracheal and right mainstem bronchial aspirate\nnoted.\n4. 9 mm nodular lesion at the gallbladder fundus may represent a polyp.  A\nnonemergent ultrasound may be performed to further assess.\n\nNOTIFICATION:  Findings were discussed with Dr. ___ at the time of\ninitial review."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is moderately enlarged and there is moderate coronary\narterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Rounded areas of airspace opacity are noted in the\nposterior basal subsegment of the left lower lobe (5:230).  Centrilobular\nemphysema is mild.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate to severe, better evaluated on\nthe recent MRI total spine.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nnonspecific mildly prominent right perinephric stranding (5:273, 265).",
            "output": "1. Left lower lobe airspace opacities may represent atelectasis, early\npneumonia, aspiration, or, given the provided history, a septic embolus.  The\nremainder of the lung parenchyma is notable for mild centrilobular emphysema.\n2. Nonspecific right perinephric stranding may be a normal finding or suggest\nunderlying infectious process such as pyelonephritis, partially evaluated on\nthis noncontrast chest CT."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separate report of CT chest performed the same\nday for description of the abdominal and pelvic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Cardiomegaly.  Mild coronary artery calcification.  No\npericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild breathing motion artifact.  Lungs are clear with no\nevidence of pneumonia.  There is mild residual scarring in the posterior left\ncostophrenic angle compared to prior.\n2. AIRWAYS:  Central airways are widely patent.\n3. VESSELS:  The thoracic aorta is unremarkable.  The main pulmonary artery is\nnormal caliber.\nCHEST CAGE: No acute or aggressive osseous abnormality.  There are\ndegenerative changes involving bilateral shoulders, spine.",
            "output": "No evidence of infection in the thorax.\nNo adenopathy"
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The visualized thyroid is within normal\nlimits.  A left chest wall pacer and dual leads are in expected position. \nThere is no axillary lymphadenopathy.  Scattered, small mediastinal lymph\nnodes are demonstrated.\n\nHEART & VESSELS: The heart is severely enlarged and there is a small to\nmoderate pericardial effusion.  The patient is status post coronary artery\nstenting.  There is moderate calcification of the aortic valve.  The great\nvessels are normal in caliber and there is marked calcified atherosclerosis of\nthe aortic arch and descending thoracic aorta.\n\nLUNGS & AIRWAYS: There is a moderate to large right pleural effusion as well\nas trace left effusion.  There is extensive collapse of the right lower lobe,\nlikely related to compression from the adjacent pleural effusion.  There is\nminimal atelectasis involving the dependent left lower lobe.\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: There is prominent bilateral gynecomastia. \nNo suspicious osseous lesions identified.",
            "output": "Severe cardiomegaly with a moderate pericardial effusion.  Moderate to large\nright pleural effusion and collapse of the right lower lobe. Minimal\natelectasis and a trace left effusion.\n\nProminent bilateral gynecomastia.  Subdiaphragmatic structures will be\ndetailed on the concurrent CT abdomen and pelvis."
        },
        {
            "input": "The imaged base of the neck including the partially visualized thyroid is\nunremarkable.  There is a mildly prominent superior mediastinal lymph node\nwhich is best seen on series 3, image 38 measuring 11 mm in short axis,\nslightly increased from prior, likely reactive.  Additional lymph nodes at the\nmediastinal station appear normal in size.  No hilar or axillary\nlymphadenopathy.  The thoracic aorta is mildly calcified and normal in course\nand caliber.  The heart is normal in size and shape with trace pericardial\nfluid.  There is moderate LAD calcification.  The main pulmonary artery is\nnormal in size.  There is no filling defect within the branches of the\npulmonary arterial tree to suggest the presence of a pulmonary embolism. \nBilateral pleural effusions appear small in overall size, new from prior,\nslightly larger on the right than left, and are associated with compressive\natelectasis in the lower lobes.\n\nNo worrisome nodule, mass, or consolidation.\n\nThe imaged portion of the upper abdomen is unrevealing.\n\nBones: A chronic compression deformity is again seen at T5.",
            "output": "1.  No pulmonary embolism or acute aortic process.\n2.  Small pleural effusions with compressive lower lung atelectasis.\n3.  Coronary artery calcification most notable along the LAD.\n4.  Trace pericardial fluid."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Heart is mildly enlarged. \nCoronary artery calcifications.  There is no pleural effusion.\n\nThere is moderate right, mild left lower lobe mucous plugging.  There is\nmoderate volume loss and consolidation the left lower lobe from atelectasis,\nand mild atelectasis in the right lower lobe.  There is 0.4 cm nodule in the\nright lower lobe series 6, image 171.  0.3 cm nodule right middle lobe series\n6, image 131.  0.2 cm nodule right upper lobe image 87.\n\nEndotracheal tube is in place, the tip terminates 5 cm above the carina. \nEnteric tube is in place.  The tip is within the distal esophagus, as seen on\n___ 11:57 radiograph, recommend advancement.  Long segment distal\nesophageal wall thickening, consider esophagitis.  Visualized liver shows a\nheterogeneous enhancement pattern, this may be due to fatty infiltration or\nunderlying liver disease.  There is a small amount of perihepatic ascites.\n\nLeft PICC is in place, the tip terminates in the upper most SVC.\n\nThere are multiple nondisplaced subtle fractures of the anterior bilateral\nribs, of indeterminate age.  Benign mid vertebral body hemangioma.  There is\nmild T11 compression fracture, age indeterminate, possibly chronic there is no\nadjacent edema.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nEnteric tube is in place and terminates within the distal esophagus, recommend\nadvancement.  Long segment distal esophageal wall thickening, consider\nesophagitis.\n\nBibasilar moderate left lower lobe, mild right lower lobe atelectasis, with\nareas of bilateral lower lobe mucous plugging.\n\nLung nodules, largest measures 0.4 cm, benign and no further follow-up needed\nin the absence of history of smoking or malignancy.  If there is history of\nsmoking, follow-up CT chest without contrast in 12 months recommended.\n\nInhomogeneous attenuation of the liver, may be due to fatty infiltration or\nunderlying liver disease."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Extensive axillary, mediastinal,\nhilar and upper abdominal lymphadenopathy new since ___.  Index lymph\nnodes include left axillary measuring 11 x 10 mm (02:24), prevascular\nmeasuring 11 x 16 mm (02:24), left lower paratracheal (02:24) measuring 11 x\n12 mm and upper abdominal celiac axis (02:57) 15 x 16 mm.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nThe heart size is moderately and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  Small bilateral pleural effusions.\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Significant patient\nmotion limits anatomic detail.  Linear peribronchial opacities in the lower\nlobes bilaterally can be atelectasis.  Mild lower lobe symmetric\nbronchiectasis can be related to chronic aspiration.  Right lower lobe\npulmonary nodule measuring 6 x 5 mm is stable since ___, and likely a\nnoncalcified granuloma.  Calcified granuloma in the left lower lobe.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, extensive upper abdominal lymphadenopathy.  The spleen is enlarged\nmeasuring 15 cm.  Small hiatal hernia with a patulous esophagus which is fluid\nfilled.",
            "output": "Extensive, new lymphadenopathy involving multiple stations in the thorax and\nvisualized upper abdomen, described above, concerning for recurrent lymphoma.\n\nPatulous esophagus which is fluid filled and mild lower lobe bronchiectasis\nlikely related to chronic aspiration."
        },
        {
            "input": "Adenopathy has involuted substantially for example:  Axillary nodes which\nranged up to 14 x 21 mm on the left on ___, now 6 x 12 mm, 12:8 ; in\nthe right lower paraesophageal station of the mediastinum, previously 14 x 27\nmm, currently 6 x 15 mm or smaller.  There are no newly enlarged lymph nodes\nin the mediastinum, hila, internal mammary, diaphragmatic, or retrocrural\nstations.\n\nPrevious small pericardial effusion has resolved.  Small nonhemorrhagic,\ndependent, right pleural effusion is larger, and tiny dependent left pleural\neffusion is unchanged.\n\nRight central venous catheter ends in the upper right atrium, with no evidence\nof associated thrombus.  Aorta and central pulmonary arteries are normal size\nand subject to the limitations of this non gated study, free of filling\ndefects.\n\nDiffuse wall thickening of the esophagus however is more pronounced at\nmultiple levels from the thoracic inlet to the diaphragm.  There is no\nintramural emphysema or surrounding inflammation in the mediastinal tissues\nand no evidence of esophageal perforation.\n\n5 anatomic anatomic strongly enhancing region of consolidation at the base of\nthe right lung, 6:196 is probably atelectasis.  Left lung is essentially clear\naside from an even smaller region of dependent atelectasis.\n\nFindings below the diaphragm including changes in the spleen will be reported\nseparately.",
            "output": "Interval involution of the size central and axillary adenopathy since ___\none.\n\nNew generalized wall thickening of the esophagus, presumably inflammatory, not\nnecessarily infectious.  Small slightly larger nonhemorrhagic layering right\npleural effusion.  Stable tiny left pleural effusion.\n\nNo other evidence of intrathoracic infection or active malignancy.\n\nSee the report of the concurrent abdomen CT common especially for new findings\nin the spleen."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.  Thyroid is normal. \nAtherosclerotic calcification is minimal in head neck vessels, not appreciated\nin the coronary arteries.  Aorta pulmonary arteries and cardiac chambers are\nnormal size.   Right jugular central infusion catheter ends in the superior\ncavoatrial junction with no evidence thrombus.  Previous wall thickening of\nthe lower esophagus has resolved entirely.\n\nMediastinal and hilar lymph nodes are not enlarged.  Pleurae and pericardium a\nnormal.\n\nFocal lung lesions are as follows:\n\n4 mm right lower lobe lung nodule 6:172, is unchanged since at least ___.  Lungs are otherwise clear and the tracheobronchial tree is normal to\nsubsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy or specifically recurrent lymphoma. \nNo adenopathy or pleural effusion.\n\n5 mm right lower lobe nodule stable since ___ can be considered benign."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions. No\nsupraclavicular adenopathy.  Right prepectoral Port-A-Cath in situ with the\ntip at the cavoatrial junction.  No axillary adenopathy.\n\nUPPER ABDOMEN: Will be reported separately.  No hiatal hernia.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: Right hilar lymph nodes appear similar compared to prior.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial\neffusion.  Minimal calcification at the bifurcation of the left coronary\nartery.  No aortic valve calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Multiple 2 mm pulmonary nodules appearing similar compared to\nprevious imaging (4:  24, 51, 89, 96 and 201).  Calcified granuloma in the\nsuperior segment of the left lower lobe (4, 104) unchanged.  2 ground-glass\nnodules seen in the right lower lobe (4, 148) measuring 5.7 mm in diameter and\nin the right upper lobe measuring 2.8 mm in diameter (4, 138) appearing\nsimilar compared to ___ and ___\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\n\n-CHEST CAGE: No lytic/destructive lesions.  Spondylotic changes of the\nthoracic spine.",
            "output": "Stable appearance of the thorax.  No new or enlarging pulmonary nodules or\nmasses.  No lymphadenopathy or other evidence of lymphoma.\n\nPlease see the abdominal CT report for a description of the abdominal\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.  A right porta cath\ntip terminates in the low SVC.\n\nUPPER ABDOMEN: Please refer to separate CT abdomen/ pelvis report for details.\n\nMEDIASTINUM: No mediastinal mass or hematoma.  Mediastinal lymph nodes are not\nenlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: The heart is top-normal in size.  No pericardial\neffusion.  Mild atherosclerotic calcifications are present.  The ascending\naorta is normal in caliber without aneurysmal dilatation.\n\nPLEURA:  No pleural effusion, pleural thickening, or pleural calcifications. \nNo pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  No pulmonary mass or consolidation. Millimetric pulmonary\nnodules are stable since ___ (05:41, 66, 171, 183) with largest\nnodule measuring 0.5 cm in right lower lobe (5:183). Calcified granuloma in\nthe superior segment of the left lower lobe is unchanged.  No new or growing\npulmonary nodules.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  Main pulmonary artery is normal in caliber and opacified to the\nsegmental level without filling defect to suggest pulmonary embolism.\nCHEST CAGE: No focal lytic or blastic lesions worrisome for malignancy.  No\nacute fracture.  Mild multilevel degenerative changes of the thoracic spine\nwith anterior osteophytes, endplate sclerosis and disc space narrowing.",
            "output": "1.  Stable pulmonary nodules, largest measuring 0.5 cm in right lower lobe,\nunchanged since ___.  No new or growing pulmonary nodules.\n2.  No lymphadenopathy or evidence of lymphoma.\n3.  Please see dedicated CT abdomen/pelvis for additional details."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular axillary lymphadenopathy.\n\nUPPER ABDOMEN: No adrenal nodules or other acute abnormality.\n\nMEDIASTINUM: Small mediastinal lymph nodes measuring up to 6 mm and on the CT\nsize criteria for lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is trace pericardial\nfluid.\nPLEURA: There are trace bilateral nonhemorrhagic pleural effusions.  No\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is bibasilar dependent atelectasis.  There is no focal\nconsolidation.  There are multiple stable pulmonary nodules, the largest is a\n5 mm ground-glass nodule in the right lower lobe (5; 158).  A calcified\ngranuloma is seen in the left lower lobe nodule (3; 28).\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  A right chest wall port ends in the low SVC.  The thoracic aorta\nis of normal caliber with mild atherosclerotic calcifications noted along the\naorta aortic arch.  The main, left, and right pulmonary arteries are than\nnormal limits.\nCHEST CAGE: No acute fracture or aggressive osseous lesion.",
            "output": "1. Trace bilateral pleural effusions. Trace pericardial effusion.\n2. Stable pulmonary nodules measuring up to 0.5 cm in the right lower lobe.\n3. No focal consolidation to suggest pneumonia."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging.  Supraclavicular\nif and axillary lymph nodes are not enlarged.  There is no abnormality\nsurrounding the subcutaneous right central venous infusion port, specifically\nno fluid, edema, or subcutaneous gas.  There are no soft tissue abnormalities\nelsewhere in the chest wall concerning for infection or malignancy.  This\nstudy is not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nmass or subphrenic collection.\n\nCARDIO-MEDIASTINUM:Esophagus is moderately patulous in the midportion,\ndistended with air alone, but otherwise unremarkable.\n\nAtherosclerotic calcification is not apparent in head and neck vessels or in\nthe coronary arteries.  Aortic valve is not appreciably calcified.  Aorta and\npulmonary arteries and cardiac chambers are normal size and small pericardial\neffusion is probably physiologic.  Infusion port catheter ends at the superior\ncavoatrial junction with a possible sleeve thrombus at the tip approximately\n11 mm long: 5:166-176.\n\nTHORACIC LYMPH NODES:\n\nNo lymph nodes in the chest are pathologically enlarged, ranging in diameter\nup to 12 mm, upper pole right hilum, 5:134, previously 9 mm on ___.\n\nLUNGS, AIRWAYS, PLEURAE: New centrilobular bronchiolar nodulation, throughout\nthe lungs, but most pronounced in the right apex and superior segment of the\nright lower lobe, 5: 60-94, 172-177 is probably infectious, usually due to\nvirus.  There are no large enough lung nodules to suggest abscess or septic\nemboli and no consolidation to suggest bacterial infection.  Larger bronchi\nare normal.\n\nSmall nonhemorrhagic left pleural effusion developed between ___, subsequently unchanged.\n\n\n\nCHEST CAGE: Unremarkable",
            "output": "No abnormality associated with subcutaneous right pectoral reservoir.\n\nNew, cm size thrombus, tip of the infusion port catheter.\n\nNew bronchiolitis, probably viral infection.\n\nNOTIFICATION:  The findings were discussed with  ___. by\n___, M.D. on the telephone on ___ at 2:21 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "AIRWAYS: Unremarkable.\n\nLUNGS:\nPeripheral, nodular, round areas of consolidation noted in the right lower\nlobe and left lingula with surrounding ground-glass opacity (series 4 ; image\n139 and series 4; image 121, respectively).  Several additional areas of\nground-glass opacities are noted in predominantly the upper lobes.  Multiple\nbilateral lung nodules outlined below.  Multiple areas of atelectasis, most\nnotable at the left lingula.  Incidentally noted calcification in the left\nlower lobe consistent with granuloma.\n\nRight lung:  Multiple nodules are noted within the right lung, largest\nmeasuring 8 mm (series 4 ; image 105).  Additional nodules are noted in the\nright upper lobe measuring 3 mm (series 4; images 36, 61, 93, and 140) and 4\nmm (series 4; image 56).  An additional nodule is also noted in the right\nlower lobe measuring 4 mm (series 4; image 119).\n\nLeft lung:  Multiple nodules are noted within the left lung, largest measuring\n6 mm (series 4; image 183).  Additional nodules are noted in the left upper\nlobe measuring 2-3 mm (series 4; images 65, 116 and 172).  An additional\nnodule is noted in the left lower lobe measuring 2 mm (series 4; image 172).\n\nPLEURA: No effusion.\n\nLower neck: Unremarkable\n\nLYMPH NODES and MEDIASTINUM: Borderline enlarged right paratracheal lymph node\nmeasuring 1 cm.\n\nHEART and VASCULATURE:  Minimal coronary artery calcification. No pericardial\neffusion.\n\nCHEST WALL: unremarkable\n\nUPPER ABDOMEN:  Incidentally noted small hiatal hernia.\n\nBONES: No aggressive bony lesions.",
            "output": "Two peripheral, nodular, round areas of consolidation noted in the right lower\nlobe and left lingula with surrounding ground-glass opacity.  These may be\npotentially infectious in origin.  Follow-up necessary to exclude neoplasm\ngiven patient's history. At the time of follow-up, additional bilateral lung\nnodules and borderline right paratracheal lymph node can be reassessed."
        },
        {
            "input": "Given the engorgement of head neck vessels, it would be difficult to detect\nmild enlargement right supraclavicular lymph nodes on this noncontrast study. \nThere is no axillary adenopathy.  Specifically excluding the breasts which\nrequire mammography for evaluation, elsewhere in the chest wall there is no\nsoft tissue abnormality of concern for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, most recently\nbut shows no adrenal mass.  Lobulation to the upper pole the right kidney\ncould be due to renal scarring or atrophy.\n\nAtherosclerotic calcification is mild in head neck vessels, not apparent in\ncoronary arteries.  Aorta is normal size.  Pulmonary arteries are enlarged,\nmain 37 mm, unchanged since at least ___.  Hypoattenuation of cardiac\ncontents is consistent with anemia.  Moderate cardiomegaly would require\nechocardiography for evaluation.\n\nThyroid is diffusely enlarged but homogeneous.  It circumferentially narrows\nthe trachea reducing the lumen by about one/3.  Subcentimeter, reactive\nmediastinal lymph nodes are generally slightly larger today than on ___.\n\nThere is no pericardial or pleural effusion.\n\nMultifocal pneumonia, with heterogeneous areas of consolidation, bronchiolar\nand acinar nodules and ground-glass is new in contiguous locations in the\nright upper lobe, 7:99 -164, expanded in area of previous involvement in the\nright lung base, and may be starting in the lingula.  Diffuse bronchial wall\nthickening has worsened.\n\nThere are no bone findings in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Right lower lobe pneumonia has expanded since ___ in its original\nlocation and spread to a large area in the right upper lobe, and may be\nbeginning in the lingula.  Most likely pathogen is bacteria, but fungus and\neven mycobacterial species are possible.\n\nChronic pulmonary hypertension and moderate cardiomegaly.\n\nPossible abnormal right kidney.\n\nModerate size goiter mildly narrows the upper trachea.  No dominant thyroid\nmass.\n\nNOTIFICATION:   The findings were discussed on the telephone by Dr. ___\nwith ___  who responded 40 minute(s) after the initial page placed\nat 10:19 AM, ___ within one minute after initial discovery of the\nfindings."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: The airways are patent.  There few clusters of tiny\nnodules in the right lung series 4, image 55 260, image 67 to 87, 104- 121 in\nthe right upper lobe laterally in posteriorly, they are predominantly in the\nareas of previously seen lung nodules, and may be residua, or new\nabnormalities.\nFew new anterior right upper lobe nodules series 4, image 112.  There are no\nareas of consolidations.  There are no infiltrates or nodules in the left\nlung.  There is linear scarring or atelectasis in the lung bases, with mild\nbronchiectasis.\nVessels: Main pulmonary artery is enlarged measuring 3.6 cm, consistent with\npulmonary artery hypertension.  Normal aorta.\n\nMediastinum and Hila: There are few small mediastinal lymph nodes, largest\nmeasures 1.1 cm, similar to prior, may be reactive.  There is no hilar\nadenopathy.\n\nHeart and Pericardium: Borderline heart size.  No effusion.  Suggestion of\nCoronary artery calcifications\n\nPleura: No pleural effusion\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: Diffuse thyroid enlargement stable.\nThere is right IJ central line tip in the low SVC.  There is no mass, no\nadenopathy.\n\nUpper Abdomen: Suggestion 1.4 cm subcapsular low-attenuation lesion right\nhepatic lobe series 2, image 44, not definitely seen on prior, ultrasound exam\nrecommended further evaluation.\n\nChest Cage: Degenerative changes spine, shoulders there is chronic right rib\nfracture.",
            "output": "Clusters of small nodules in the right lung, largely in the areas of\npreviously seen lung nodules on ___, some may represent residua\nof previously treated, new infection cannot be excluded, particularly in the\narea of new nodularity.\nPulmonary artery hypertension.\nFew mildly prominent mediastinal lymph nodes, may be reactive.\nSuggestion of 1.4 cm hepatic lesion, indeterminate, ultrasound exam\nrecommended.\n\nRECOMMENDATION(S):  Hepatic ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE:  The study is not tailored for evaluation of the\npulmonary arteries, but there are no filling defects to suggest pulmonary\nemboli.  The main pulmonary artery is enlarged, measuring 3.6 cm in diameter. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  Multiple small mediastinal lymph nodes are again seen, measuring up\nto 8 mm in short axis diameter.  Prominent paraesophageal lymph nodes are\nseen, measuring up 9 mm in short axis diameter (5:210).  There are no\nmediastinal masses.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is re- demonstration of bibasilar subsegmental\natelectasis.  Scattered nodular opacities are noted, in the right upper lobe\nmeasuring 1.4 x 1.0 cm (5:117), in the right lower lobe (5:169) measuring 1.3\nx 0.9 cm, and in the right lower lobe measuring 6 mm (5:207), with mild\nsurrounding patchy ground-glass opacities.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK:  There is re- demonstration of subcutaneous soft tissue defect\nalong the right anterior chest wall, likely from prior port removal.\n\nABDOMEN:  Please see separate report for CT of the abdomen and pelvis for\ndetailed description of intra-abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Scattered nodules are noted in the right lung with mild surrounding patchy\nground-glass opacities.  These are nonspecific but may be of infectious or\ninflammatory etiology.\n2. Persistent dilated main pulmonary artery, measuring up to 3.6 cm,\nsuggestive of pulmonary arterial hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: Please refer to concurrent CT abdomen report.\n\nMEDIASTINUM:  No mediastinal mass or lymphadenopathy.\n\nHILA:  No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is top normal.  No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  No focal consolidation.  7 mm perifissural nodular opacity in\nthe right lower lobe (6:212) previously measured up to 1.3 cm.  There is mild\nground glass opacity at the location of the previously seen\nperibronchovascular nodular opacity in the right upper lobe.  The nodular\nopacity at the inferior right lower lobe is essentially resolved.  There is\nminimal haziness and ground glass opacity at the right base.\n2. AIRWAYS:  The airways are patent to subsegmental levels.\n3. VESSELS:  The main pulmonary artery measures up to 3.6 cm and the right\npulmonary artery measures up to 2.9 cm, similar to prior.  There is fair\ncontrast opacification of the pulmonary arteries and no filling defect to\nsuggest pulmonary embolism.\nCHEST CAGE: No suspicious lytic or sclerotic lesion.  No acute fracture. There\nis mild degenerative change in the left shoulder and spine.",
            "output": "1. Residual 7 mm perifissural nodule is smaller compared to prior.  Other\npreviously seen nodular opacities are improved or resolved.  No fluid\ncollection.\n2. Enlargement of the main pulmonary arteries is similar to prior, and raises\nthe possibility of pulmonary arterial hypertension."
        },
        {
            "input": "The imaged thyroid is grossly unremarkable.\n\nHeart size is normal without significant pericardial effusion.  There are mild\natherosclerotic calcifications along a normal caliber thoracic aorta.  Main\npulmonary artery is mildly dilated to a maximum caliber of 35 mm.\n\nThere is no supraclavicular, axillary, or mediastinal lymphadenopathy by CT\nsize criteria.  There is no gross hilar lymphadenopathy given confines of a\nnoncontrast examination.\n\nThe central airways are patent.  Small area of subpleural scarring in the\ninferior lingular segment appears slightly worsened compared to the prior\nstudy.  There are minimal areas of interlobular septal thickening and\nground-glass, with equivocal areas of millimetric peribronchial ___\nnodularity.  This appears most prominent in the lung bases.  There is minimal\natelectasis in the lung bases.  Otherwise no gross dense consolidation is\nseen.  There is a 2 mm nodule in the left upper lobe, not seen previously\n(5:77).  Few other scattered 1-3 mm pulmonary nodules are seen, though these\nare difficult to differentiate from the presumed inflammatory/infectious\nprocess.  There is a punctate calcified granuloma in the left lung base.\n\nThere is no effusion pneumothorax.\n\nAlthough this study is not tailored for subdiaphragmatic analysis, the\nvisualized upper abdomen demonstrates no gross acute abnormality.  There is a\nsmall hiatal hernia.\n\nThoracic cage is intact without acute fracture or suspicious focal bone\nlesion.",
            "output": "1. Subtle areas of scattered ground-glass and ___ nodularity, most\nnotable in the lung bases, nonspecific, suggesting inflammation or atypical\ninfection.  Few scattered 1-3 mm pulmonary nodules are seen, though these are\ndifficult to differentiate from the presumed inflammation/atypical infectious\nprocess.\n2. No gross evidence of active tuberculous involvement.\n3. Dilated main pulmonary artery suggesting pulmonary arterial hypertension.\n4. Tiny hiatal hernia.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "LOWER NECK: Unremarkable\n\nAIRWAYS/LUNGS:\nThe airways are patent to the subsegmental level.\n\nThere is mild interlobular septal thickening bilaterally, predominantly in the\nlung bases, suggestive of mild interstitial pulmonary edema.\nPatchy opacities in the lingula are unchanged and may represent areas of\nsubsegmental atelectasis.  Note is again made of scattered ground-glass\nopacities and centrilobular nodules in the right upper lobe and lower lobes\nbilaterally.  There is no focal airspace consolidation.\n2 mm calcified granuloma noted in the left lung base.\n\nPLEURA:  There is no pleural effusion.\n\nLYMPH NODES and MEDIASTINUM: There are no significantly enlarged lymph nodes. \nFew prominent mediastinal lymph nodes are noted.  For example, aortopulmonary\nnode (series 3, image 19) measuring 7 mm in short axis\n\nHEART and VASCULATURE: The heart is mildly enlarged.  There is no pericardial\neffusion.  There is normal caliber of the thoracic aorta.  Mild calcified\natherosclerotic disease is noted.  Redemonstration of dilated pulmonary trunk\nmeasuring up to 3.6 cm.\n\nBONES/ CHEST WALL:  There is no concerning focal bone lesion.  Degenerative\nchanges are noted in the thoracic spine.\n\nUPPER ABDOMEN: Small paraesophageal hernia again noted.",
            "output": "1. Mild interstitial pulmonary edema.\n2. Scattered ground-glass opacities and centrilobular nodules are seen in the\nright upper lobe and lower lobes bilaterally which are nonspecific and may be\ninfectious or inflammatory.  There is no focal airspace consolidation."
        },
        {
            "input": "No abnormalities at the level of the thoracic inlet.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy. No enlarged lymph nodes in hilar\nor mediastinal location.  The large mediastinal vessels are unremarkable. \nThere is no evidence of PE.  No evidence of right heart strain.  Normal\nmorphology of the cardiac structures.  No pericardial effusion.  The posterior\nmediastinum is unremarkable.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  No evidence of rib fractures.\nMild bilateral apical scarring.  No pneumothorax.  No pleural thickening or\npleural effusions.  Send the airways are patent.  No vascular abnormalities. \nNo other chest wall abnormalities.",
            "output": "No evidence of PE or other vascular disease.  No pneumonia, no pulmonary\nedema, no pneumothorax, no parenchymal or pleural lesions that could\npotentially explain the clinical presentation of the patient."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal nodes are stable.  Small bilateral hilar lymph\nnodes are also unchanged, not enlarged by size criteria.  Heart size is\nnormal.  The aorta ascending aorta is mildly ectatic but unchanged.  There is\ncoronary artery calcification.  The esophagus is mildly patulous but\nunchanged.\n\n\nPLEURA: There are calcified and noncalcified right-sided pleural plaques which\ncould be related to prior granulomatous disease.\nLUNG:\nBiapical pleuroparenchymal scarring is again seen.  There is moderate to\nsevere upper lobe predominant emphysema a focal area of bronchiectasis with\n___ nodularity in the posterior segment the right upper lobe (3, 17 is\nnew.  Left upper lobe pulmonary nodule measuring 11 mm also associated with\nfocal area of ___ nodularity and mild bronchiectasis in the left upper\nlobe (3, 23 is also new.  ___ nodularity is again seen in the\nposterior segment the right lower upper lobe (3, 29, new since the prior\nstudy.  A cluster of nodules in the right middle lobe (3, 34) with is the tiny\nsatellite nodules surrounding the larger nodule which measures 9 mm is also\nnew.\n\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.",
            "output": "Moderate upper lobe predominant centrilobular emphysema.\n\nMultifocal areas of ___ nodularity associated with mild bronchiectasis\nand cluster of nodules in the posterior segment the right upper lobe apical\nposterior segment of the left upper lobe and the right middle lobe, could be\nrelated to granulomatous disease such as ___ infection.\n\nCalcified right-sided pleural plaques could also be related to prior\ngranulomatous disease.\n\nA pulmonary consult would be helpful to assess the significance of the\nfindings."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE:  The thoracic aorta contains mild atherosclerotic\ncalcifications though is normal in caliber.  Substantial coronary artery\ncalcifications are visualized otherwise the heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Enlarged conglomerate of right hilar lymph\nnodes measures 1.9 x 1.4 cm.  No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  Esophagus is patulous\nPLEURAL SPACES: Calcific right fibrothorax is re-demonstrated with moderate\nrestriction of the right lower lobe with an associated area of rounded\natelectasis and scarring (4:140).  No pleural effusion or pneumothorax is\nidentified.\n\nLUNGS/AIRWAYS: Moderate to severe, upper lobe predominant, paraseptal\nemphysema is unchanged from prior.  Previously demonstrated ___\nnodularity in the right upper and right middle lobes has progressed with\nbronchiolar and acinar nodules measuring up to 9 mm in the lateral aspect of\nthe right upper lobe (4:105).  Bronchiolar and acinar nodule of the posterior\naspect of the left upper lobe measures 11 mm (4:82) and is unchanged from\nprior study.  Mass-like consolidation in the paramediastinal right upper lobe,\nmeasuring up to 1.9 cm (4:83) is likely another region of acinar and\nbronchiolar consolidation though other causes cannot be excluded.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: Multilevel degenerative changes are visualized throughout the imaged\nportion of the thoracic spine without suspicious osseous abnormality seen.?\nThere is no acute fracture.",
            "output": "1. Mild progression of inflammatory bronchiolar and acinar nodules and right\nhilar lymphadenopathy are probably due to infection with a non tuberculous\nmycobacteria pathogen the usual hallmarks of suppurative bronchiectasis due to\nthat organism are absent.\n2. New, paramediastinal right upper lobe consolidation could be due to the\nsame infection or even lung involvement by Crohn disease, but it should be\nscanned again after treatment to exclude unexpected malignancy.\n3. Calcific fibrothorax with moderate restriction of lower lobe with\nassociated area of rounded atelectasis and scarring.\n\nRECOMMENDATION(S):  Repeat Chest CT in three months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Low overall attenuation of the\nthyroid gland.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show no significant\nabnormal Findings.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nMild atherosclerotic calcifications in thoracic aorta and coronary arteries.\nDilatation of the entire thoracic aorta, stable.\nPLEURA: No pleural effusions.\nPleural thickening with calcified plaques to the right.\nLUNG:\n\n1. PARENCHYMA:  Unchanged appearance of centrilobular nodules in the right\nupper lobe.  Some nodules are also seen in the left upper lobe (4: 81 in 86.\nRounded atelectasis in the right lower lobe (4:142).\nStable moderate paraseptal emphysema, upper lobe predominant.\n2. AIRWAYS:  Traction bronchiectasis in the right lower lobe.  Mucous\nsecretions are seen along the trachea.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions. \nMild dorsal spondylosis.",
            "output": "Unchanged appearance of centrilobular nodules in the right and left upper\nlobes, sometimes with ___ pattern, but could be related to atypical\nmycobacterial infection.\nCalcified plaques, notably in the right lung base, causing restriction to the\nright lower lobe, rounded atelectasis in traction bronchiectasis can be\nattributed to prior asbestos exposure.\nStable ectasia of the entire thoracic aorta.  Yearly CTA follow-up is advised.\nUnchanged low-attenuation of the thyroid gland, compatible with\nhypothyroidism."
        },
        {
            "input": "CHEST PERIMETER: 10 mm low-density lesion left thyroid lobe, 302:54, has grown\nsince ___, warranting ultrasound evaluation for possible nodule. \nLow-attenuation, tubular, high right axillary lesion, 19 x 32 mm at the level\nof its greatest cross-sectional area, is new since ___ concerning\nfor recurrent breast carcinoma.\n\nSupraclavicular and left axillary nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities elsewhere in the imaged chest wall concerning for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis heavy at the origin of the left subclavian artery, not apparent elsewhere\nin head and neck vessels, present in left anterior descending, circumflex and\nright coronary arteries.  Aorta and pulmonary arteries and cardiac chambers\nare normal size.  Aortic valvular calcification is minimal.\n\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderate to severe in the upper lobes,\nmilder elsewhere.\n\nFocal lesions as follows:\n\n3 mm subpleural left upper lobe lung nodule, 302:74, is new or newly apparent\ndue to differences in radiographic technique, since ___.\n\nPunctate perifissural nodule, right lung, 302:132, is stable.\n\n\nCHEST CAGE:\n Tracheobronchial tree is normal to subsegmental levels. There is no pleural\nabnormality.  Multiple healed non pathologic fractures, lateral right mid and\nlower ribs. No compression or pathologic fractures or large destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "New right axillary lymphocele or large necrotic lymph node should be\naccessible to percutaneous ultrasound-guided aspiration.\n\nSolitary 3 mm subpleural left upper lobe lung nodule is unlikely to be a\nsingle metastasis.  Although its nature is indeterminate, lesions with this\nappearance are usually benign lymphoid aggregates.\n\nModerate emphysema.\n\nCoronary atherosclerosis.\n\nGrowing left thyroid lesion should be evaluated with ultrasound.\n\nRECOMMENDATION(S):  Ultrasound-guided, percutaneous needle aspiration, new\nright axillary lesion.\n\nThyroid ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: There is a filling defect within a subsegmental\npulmonary artery in the left lower lobe (series 2, image 67).  And a filling\ndefect is seen within a subsegmental pulmonary artery in the left upper lobe\n(series 2, image 27).\n\nThe thoracic aorta is mildly ectatic but within normal limits for the\npatient's age.  No evidence of dissection or intramural hematoma.  The\npulmonary trunk is mildly dilated however this is stable when comparisons is\nmade with scans dating back to ___.  The heart is mildly enlarged.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs show mild to moderate emphysema, worse at the apices and\nmostly centrilobular.  Stable 2 mm nodule along the minor fissure.  Minor\natelectasis is found in each basilar lower lobe as well as the right middle\nlobe and lingula.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nBones appear probably demineralized.",
            "output": "Filling defects are seen in subsegmental pulmonary arteries in the left lung\nin keeping with acute pulmonary emboli.  Emphysema.\n\nRECOMMENDATION(S):   The findings were discussed with Dr.  ___, M.D.\nby ___, M.D. on the telephone on ___ at 8:41 pm, 10\nminutes after discovery of the findings."
        },
        {
            "input": "Heterogeneously bulky right thyroid lobe.\n\nNo axillary, supraclavicular, mediastinal, and specifically paraesophageal\nlymphadenopathy is identified.  No hilar adenopathy.  The proximal to mid\nesophagus is distended with an air-fluid level, with abrupt narrowing\ninvolving the distal esophagus which demonstrates circumferential wall\nthickening up to 7 mm to the level of the GE junction, better seen on the\nrecently performed esophagram.  No extra luminal mass is identified to account\nfor this apparent esophageal narrowing.  Direct visualization with endoscopy\nremains recommended.\n\nThe heart size is normal in there is no evidence for a pericardial effusion.\n\nPleural spaces are clear bilaterally.\n\nTrachea and central airways are patent.  Lung parenchyma is normal in\nappearance.  6 mm ground-glass attenuating nodule is seen within the right\nupper lobe (series 2, image 22), nonspecific in etiology.  No pulmonary\nmasses.\n\nLimited evaluation of the upper abdomen due to phase of contrast and limited\nvisualization.  Marked fatty replacement of the pancreas.  Dense\ncalcifications are noted in the right upper quadrant.  Extensive\natherosclerotic disease involves the aortic arch, branch vessels and\ndescending thoracic aorta, with involvement of the celiac axis and superior\nmesenteric artery.  No aneurysmal dilatation.  Multiple simple renal cysts\nwithin an incompletely visualized left kidney.\n\nSubacute left lateral tenth rib fracture with some callus formation.  Chronic\nanterior endplate compression of the T11 vertebral body.  No acute or\naggressive osseous lesions are demonstrated.",
            "output": "1.  Best appreciated on the esophagram performed ___, is narrowing and\na circumferential wall thickening of the distal esophagus, as described above.\nNo extra luminal mass is identified on today's CT scan to account for this\nnarrowing and therefore direct visualization with endoscopy remains\nrecommended.  No paraesophageal lymphadenopathy.\n2.  Subacute left lateral tenth rib fracture.\n3.  6 mm ground-glass attenuating pulmonary nodule right upper lobe.  In a low\nrisk patient, a follow-up CT scan of the chest in 12 months time is\nrecommended.  In the high risk setting for lung cancer, a follow-up CT in 6\nmonths time is recommended.\n\nRECOMMENDATION(S):  Upper endoscopy.\n\nCT chest in ___ months time."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is diffusely\nheterogeneous and markedly enlarged on the left, consistent with known history\nof multinodular goiter.  Several nodules are calcified.  Supraclavicular and\naxillary lymph nodes are not pathologically enlarged by size criteria.\n\nUPPER ABDOMEN: There is cholelithiasis.\n\nMEDIASTINUM: There is a prominent right lower paratracheal node measuring 10\nmm (5:113) although this is unchanged from ___.  No new mediastinal\nadenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is moderate enlarged, with notable aortic\nvalvular calcifications.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\nPARENCHYMA:  There is pleural-parenchymal scarring at the lung apices, as well\nas in the right middle lobe.  2 new small patchy foci of opacity are present\nin the right upper lobe anteriorly and posteriorly comprised of ground-glass\nand solid components (images 96, 113 and 106, series 5).  .  No lobar or\nsegmental pneumonia.  The following pulmonary nodules are identified, and all\nstable from ___:\n- Two adjacent nodules in the right middle lobe, 5mm each (5:151)\n- Anterior left upper lobe nodule, 2mm (5:117)\n- medial left lower lobe nodule, 3 mm (5:151)\n\nSmooth interlobular septal thickening in the dependent portions the lungs\nbilaterally is consistent with hydrostatic pulmonary edema.\n\nAIRWAYS:  There are intraluminal secretions on the right lateral aspect of the\nmid thoracic trachea (5:69).\n\nVESSELS:  Thoracic aorta and main pulmonary arteries are normal in caliber.\n\nCHEST CAGE: A sclerotic lesion along the right lateral aspect of the T7\nvertebral body (16:51) is unchanged from ___, and may represent a bone\nisland.",
            "output": "1. No lobar or segmental pneumonia.  Localized opacities in the right upper\nlobe anteriorly and posteriorly may represent early or resolving infection or\ninflammation.\n2. Mild hydrostatic pulmonary edema.\n3. Moderate cardiomegaly; aortic valvular calcifications.\n4. Multinodular goiter.\n5. Cholelithiasis."
        },
        {
            "input": "Sternotomy wires are unremarkable.  Aorta and pulmonary arteries are within\nnormal limits size wise.  There is anterior mediastinal low-density\ncollection, series 2, image 22 measuring -8 Hounsfield units, most likely\nrepresenting post resection changes after resection of then T mediastinal\nlesion demonstrated back in ___.  No axillary hilar or\nmediastinal lymphadenopathy seen.\n\nHeart size is top-normal. There is no pericardial effusion. Large hiatal\nhernia is noted. Image portion of the upper abdomen will be reviewed\nseparately in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Appearance of the\nlungs is stable as compared to the previous study, including several pulmonary\nnodules and potentially postradiation changes in the paramediastinal location,\nseries 4, images 42, 46, 81, 123, 149. No new nodules masses are\nconsolidations have been demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest as described.\n\nLow density tissue in the anterior mediastinum, similar in the appearance to\nprevious examinations, most likely reflecting postsurgical changes but\nreassessment in ___ months is recommended giving slightly different appearance\nas compared to previous examination.\n\nOverall no findings to explain unintentional weight loss demonstrated in the\nchest."
        },
        {
            "input": "The patient is after median sternotomy.  The appearance of the sternotomy is\nunremarkable.  Anterior soft tissue appears to be decreased since the prior\nstudy, consistent with gradual decrease of postsurgical findings.  Large\nhiatal hernia is unchanged.  Heart size is normal.  There is no pericardial\npleural effusion.  Aorta and pulmonary arteries are normal in diameter.\n\nImage portion of the upper abdomen reveals no appreciable abnormality except\nfor prior cholecystectomy\n\nAirways are patent to the subsegmental level bilaterally\n\nBilateral brain stimulators have been inserted, with the L is rods continuing\nto warrant the neck.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nPreviously seen pulmonary nodules all stable including calcified and\nnoncalcified nodules.  No new nodules masses are consolidations demonstrated.",
            "output": "Stable appearance of the chest.  No evidence of mediastinal soft tissue\nprogression with the evidence of is decreased in size.\n\nLarge hiatal hernia."
        },
        {
            "input": "Soft tissues: The partially imaged thyroid gland is normal.  No pathologically\nenlarged axillary, mediastinal, or hilar lymph nodes.  Heart size is normal\nand there is no pericardial effusion.  Coronary artery calcifications are\nmild.  The study is not dedicated for subdiaphragmatic diagnosis and limited\nimages of the upper abdomen are unremarkable.\n\nLungs: There airways are patent to the subsegmental level bilaterally.  There\nis no focal consolidation or pleural effusion.  There are moderate\ninterstitial opacities in a subpleural location of the lower lobes bilaterally\nwhich may represent early interstitial lung disease.  No evidence of\nhoneycombing.  No concerning pulmonary nodules.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "Increased interstitial opacities in a subpleural location in the lower lobes\nbilaterally may represent early interstitial lung disease, possibly NSIP.  If\nthe symptoms persist, dedicated High-Resolution CT of the chest can be\nperformed in 6 months to evaluate for change in interstitial disease."
        },
        {
            "input": "Soft tissues: The partially imaged thyroid gland is normal.  No pathologically\nenlarged axillary, mediastinal, or hilar lymph nodes.  Heart size is normal\nand there is no pericardial effusion.  Coronary artery calcifications are\nmild.  The study is not dedicated for subdiaphragmatic diagnosis and limited\nimages of the upper abdomen are unremarkable.  11 mm nodule in the lateral\nleft lower breast series 4, image 25 is incompletely characterized and may\nreflect asymmetric breast tissue.\n\nLungs: The airways are patent to the subsegmental level bilaterally. Moderate\ninterstitial opacities in a subpleural location with minimal traction\nbronchiolectasis most predominant in the lower lobes bilaterally have not\nsubstantially progressed.  Although less pronounced they are verified on prone\nimaging.  No honeycombing.  No concerning pulmonary nodules.  No acute focal\ninterstitial or airspace opacity.  Minimal air trapping on the expiratory\nscan.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection. \nStable bone island in the T11 vertebral body.",
            "output": "Bibasilar predominant mild interstitial lung disease, likely NSIP pattern has\nnot substantially changed.\n\n11 mm nodule in the lateral left lower breast may reflect asymmetric breast\ntissue, however is incompletely characterized and should be correlated with\nmammography.\n\nRECOMMENDATION(S):  Mammography.\n\nFollow up Chest CT, as determined by clinical progression, can be with\nconventional CT (rather than CT for Diffuse Lung Disease)."
        },
        {
            "input": "Chest:\n\nThe tip of a right PICC line extends to the cavoatrial junction.  There is an\nincompletely evaluated soft tissue nodule projecting over the upper trachea\n(6:1).  There are new small mediastinal lymph nodes measuring up to 6 mm in\nshort axis along the right paratracheal region.  Additional smaller lymph\nnodes are present and while they are not size significant by CT criteria, the\nare increased in number.  There is no right hilar adenopathy however\nnodules/lymph nodes are seen around the left hilum.  There is no size\nsignificant supraclavicular lymphadenopathy.  A left axillary lymph node\n(06:56) measures 1.1 cm in short axis.\n\nThere is no pericardial effusion.  New pleural based nodules are seen along\nthe pericardium, and underlying pericardial metastases are suspected.\n\nThere is a small right pleural effusion.  Postsurgical changes are seen in the\nright lower lobe.  No pneumothorax.  New pleural thickening and a soft tissue\nnodularity is concerning for new pleural disease.\n\nMultiple diffuse bilateral pulmonary nodules are seen, increased in size and\nnumber.  The largest in the right upper lobe (6:75) measures 1.5 x 2.3 cm.  A\nnew nodule in the right middle lobe measures 1.1 x 0 0.9 cm (6:133).  A new\nnodule in the left upper lobe measures 1.0 x 1.0 cm (6:137).  And the largest\npartially necrotic mass in the left lower lobe now measures 7.9 x 6.3 cm,\nincreased in size since prior.  Additional smaller satellite nodules/lesions\nare present in the left lower lobe.\n\nThe heart is not enlarged.  No signs of right heart strain.  Please note that\nthis study is not diagnostic for the evaluation of pulmonary emboli.\n\nAbdomen:\n\nThe liver is unremarkable.  There is no intra or extrahepatic biliary ductal\ndilatation.  The gallbladder does not contain any radiodense stones.  A tiny\nnodule is seen at the gallbladder fundus, possibly reflecting a polyp.  No\nfocal splenic lesions.  The adrenal glands are unremarkable.  An exophytic\nsoft tissue lesion arising from the left midpole measures 1.9 x 1.6 cm,\nincreased in size since prior.  A new additional exophytic lesion arising from\nthe lower pole of the left kidney (05:44) is also noted.  There is no\nhydronephrosis or perinephric abnormality.\n\nThere is mesenteric lymphadenopathy.  For example on series 5, image 58 is a\n1.1 cm lymph node.  Additionally on series 5, image 43 is a 1.4 cm lymph node\nlocated posteriorly inferior to the transverse colon.  Additional smaller\nnodules are seen within the mesentery.  Adjacent to the right psoas is a 1 cm\nnodule (05:55).\n\nThe colon is unremarkable.  There are no abnormally dilated loops of small\nbowel.  A percutaneous gastrojejunostomy tube is present and unremarkable.\n\nThere is no free fluid.\n\nMultiple soft tissue nodules are seen within the subcutaneous tissues,\nincreased since prior.  For example along the left flank is a 2.0 x 1.6 cm\nlesion, increased in size.\n\nThere is a lucent lesion within the L2 vertebral body.  Additionally within\nthe left femoral intertrochanteric region is a 6 mm lucency.  No acute\nfracture.",
            "output": "Since ___, there has been progression of disease within the\nlungs, pleura, pericardium, left kidney, mesentery, subcutaneous tissues and\npossibly the bones.  If indicated, continued evaluation with PET-CT would be\nmore beneficial as it is a more sensitive examination for the detection of\nmelanoma lesions."
        },
        {
            "input": "Chest:\n\nThe tip of a right PICC line extends to the cavoatrial junction.  There is an\nincompletely evaluated soft tissue nodule projecting over the upper trachea\n(6:1).  There are new small mediastinal lymph nodes measuring up to 6 mm in\nshort axis along the right paratracheal region.  Additional smaller lymph\nnodes are present and while they are not size significant by CT criteria, the\nare increased in number.  There is no right hilar adenopathy however\nnodules/lymph nodes are seen around the left hilum.  There is no size\nsignificant supraclavicular lymphadenopathy.  A left axillary lymph node\n(06:56) measures 1.1 cm in short axis.\n\nThere is no pericardial effusion.  New pleural based nodules are seen along\nthe pericardium, and underlying pericardial metastases are suspected.\n\nThere is a small right pleural effusion.  Postsurgical changes are seen in the\nright lower lobe.  No pneumothorax.  New pleural thickening and a soft tissue\nnodularity is concerning for new pleural disease.\n\nMultiple diffuse bilateral pulmonary nodules are seen, increased in size and\nnumber.  The largest in the right upper lobe (6:75) measures 1.5 x 2.3 cm.  A\nnew nodule in the right middle lobe measures 1.1 x 0 0.9 cm (6:133).  A new\nnodule in the left upper lobe measures 1.0 x 1.0 cm (6:137).  And the largest\npartially necrotic mass in the left lower lobe now measures 7.9 x 6.3 cm,\nincreased in size since prior.  Additional smaller satellite nodules/lesions\nare present in the left lower lobe.\n\nThe heart is not enlarged.  No signs of right heart strain.  Please note that\nthis study is not diagnostic for the evaluation of pulmonary emboli.\n\nAbdomen:\n\nThe liver is unremarkable.  There is no intra or extrahepatic biliary ductal\ndilatation.  The gallbladder does not contain any radiodense stones.  A tiny\nnodule is seen at the gallbladder fundus, possibly reflecting a polyp.  No\nfocal splenic lesions.  The adrenal glands are unremarkable.  An exophytic\nsoft tissue lesion arising from the left midpole measures 1.9 x 1.6 cm,\nincreased in size since prior.  A new additional exophytic lesion arising from\nthe lower pole of the left kidney (05:44) is also noted.  There is no\nhydronephrosis or perinephric abnormality.\n\nThere is mesenteric lymphadenopathy.  For example on series 5, image 58 is a\n1.1 cm lymph node.  Additionally on series 5, image 43 is a 1.4 cm lymph node\nlocated posteriorly inferior to the transverse colon.  Additional smaller\nnodules are seen within the mesentery.  Adjacent to the right psoas is a 1 cm\nnodule (05:55).\n\nThe colon is unremarkable.  There are no abnormally dilated loops of small\nbowel.  A percutaneous gastrojejunostomy tube is present and unremarkable.\n\nThere is no free fluid.\n\nMultiple soft tissue nodules are seen within the subcutaneous tissues,\nincreased since prior.  For example along the left flank is a 2.0 x 1.6 cm\nlesion, increased in size.\n\nThere is a lucent lesion within the L2 vertebral body.  Additionally within\nthe left femoral intertrochanteric region is a 6 mm lucency.  No acute\nfracture.",
            "output": "Since ___, there has been progression of disease within the\nlungs, pleura, pericardium, left kidney, mesentery, subcutaneous tissues and\npossibly the bones.  If indicated, continued evaluation with PET-CT would be\nmore beneficial as it is a more sensitive examination for the detection of\nmelanoma lesions."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the anterior\nmediastinum.  The large mediastinal vessels appear unremarkable.  No\npathologic changes at the level of the heart.  No lesions in the posterior\nmediastinum.  Stable appearance of the PEG device.  In the interval, a lytic\nlesion in L2 has progressed to massive generalized sclerosis of the vertebral\nbody that starts to develop a wedge like shape.  No other evidence of bony\ndisease.  Many of the pre-existing pulmonary nodules have either completely\nresolved or substantially decreased in size.  For example, a reference lesion\nin the right upper lobe, formally 23 mm in maximum diameter now is 4 mm in\nmaximum diameter (3, 58).  The postsurgical changes in the right lower lobe\nare stable.  The large masslike lesions in both lower lobes (3, 142) are still\npresent but have substantially decreased in size.  Also decreased has the\nextent of right major fissural nodularity (3, 130).  The right and left lower\nlobe are substantially better ventilated than on the previous examination,\nthere is no evidence of a right pleural effusion.  The air in the right chest\nwall has completely resolved.",
            "output": "Substantial improvement with decrease in size or complete resolution of the\nsome of the pulmonary nodules, as well as a substantial decrease in size of\nthe pre-existing right and left lower lobe masses.  Resolution of the right\npleural effusion."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is normal in course and caliber.  The main\npulmonary artery is normal in size.  The heart is within normal limits of size\nwithout pericardial effusion.  New from prior is a large cluster of\ncommunicating soft tissue masses in the anterior mediastinal space best seen\non series 4 image 61 through 94.  These masses appeared contiguous with\noverall measurements approximating 4.2 x 8.5 x 3.4 cm.\n\nThere is a new small right pneumothorax without signs of tension.  There is\ngas-filled focal outpouching of the pleura seen on series 4, image 133 which\ncould reflect sequelae of prior trauma possibly reflecting site of prior chest\ntube.  Also noted is a small simple appearing right pleural effusion. \nMultiple pulmonary metastatic nodules are increased in number and size,\nseveral appearing pleural based.  Evidence of prior partial lung resection is\nagain seen in the right lower lobe.  Lobular mass at the left lung base with\nassociated central bronchiectasis appears slightly larger compared with prior.\n\nPlease refer to separately dictated CT abdomen pelvis for findings below the\ndiaphragm.\n\nBones: No worrisome lytic or blastic osseous lesion.\n\nBody wall: Several nodules in the chest wall are seen, for example on series 4\nimage 22 on the right, series 4, image 39, anterior midline, left low chest\nwall, series 4, image 159, all concerning for worsening metastatic disease.",
            "output": "1.  Small right pneumothorax with small right pleural effusion.  No signs of\ntension.\n2.  Progression of metastatic disease, with increased pleural/pulmonary\nlesions, new large anterior mediastinal mass, increased chest wall nodules.\n3.  Gas-filled outpouching of the pleura along the right lower anterolateral\nmargin likely related to site of prior chest tube insertion.\n\nPlease refer to separately dictated CT abdomen pelvis for findings below the\ndiaphragm."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: No central pulmonary arterial filling defects.  The\nmain pulmonary artery measures 2.6 cm.  There is an area of focal attenuation\nof the right apical lobar branch secondary to either compression or invasion\nby adjacent tumor (series 601, image 34).  No additional filling defects to\nindicate pulmonary embolism to the segmental level, however extensive\nparenchymal disease and respiratory motion limits evaluation of the\nsubsegmental pulmonary arteries.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nHILA AND MEDIASTINUM: There is a anterior mediastinal mass measuring\napproximately 9.6 x 5.2 cm, previously approximately 6.4 x 4.2 cm (series 302,\nimage 65).  Hilar masses are present, most predominantly on the right where\nthere is a hilar nodal conglomerate measuring up to 2.7 cm (series 301, image\n46).\n\nLUNGS/AIRWAYS: There is diffuse pulmonary parenchymal disease with innumerable\nround opacities throughout both lungs.  This represents a substantial increase\nin tumor burden and size compared to the prior study.  Reference lesions\ninclude a area of pleural-based nodularity measuring 4.1 x 2.6 cm along the\nright major/minor fissure (series 301, image 41), slightly superior to the\nlung resection site, which was previously nonmeasurable.  Additional confluent\nnodules in the anterior right middle lobe are worse.   A conglomerate of\nnodules in the left upper lobe measures 1.5 x 1.1 cm (series 301, image 25),\npreviously 0.6 x 0.4 cm.  There is focal bronchiectasis and opacity in the\nleft lower lobe along the major fissure, which appears similar to the prior\nstudy and may be postprocedural or represent round atelectasis (series 301,\nimage 62).  No persistent pneumothorax is demonstrated.\n\nThe airway is patent to the level of the segmental bronchi bilaterally, with\nvisualization of the subsegmental bronchi limited by respiratory motion.\n\nSmall right pleural effusion is; change in size, with pleural nodularity.  No\nlarge left pleural effusion.\n\nBASE OF NECK: Visualized portions of the base of the neck appear unremarkable.\n\nAXILLA/CHEST WALL: There are numerous axillary lymph nodes, measuring up to\n1.5 cm in the short axis within the left axilla, which previously demonstrate\nnormal morphology (series 301, image 10).  Numerous soft tissue masses are\nseen along the chest wall diffusely, a previously measured nodule along the\nleft manubrium previously measured up to 0.9 cm, now measuring 1.0 cm.  There\nare increased number of nodules seen, a right axillary node or mass measures\n1.7 cm, previously 1.1 cm (series 301, image 33).\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation.  Along the\ngallbladder fossa there is a 2.4 x 2.0 cm hypodensity previously measuring 1.9\nx 1.1 cm (series 304, image 22).  Numerous hypodensities are demonstrated\nwithin both hepatic lobes which are too small to characterize by CT.  A\nill-defined 1.3 cm hypodensity within the right hepatic dome segment 4(series\n304, image 10) was not definitively visualized on the prior study. \nAdditionally there is a hypodensity at the confluence of the hepatic vein now\nmeasuring 2.9 x 2.2 cm, previously 1.8 x 1.5 cm.  The intrahepatic vasculature\ndemonstrates normal enhancement definite occlusion.  The portal venous\nvasculature is patent.  No biliary dilatation.  The gallbladder is\nunremarkable.\n\nAlong the anterior inferior aspect of the liver, there is a focal area of soft\ntissue density measuring approximately 7.9 by 6.1 cm, previously 3.4 x 2.1 cm\nand maximum ___ (series 304, image 28), concerning for increase in\nmetastatic disease.  The lesion extends inferiorly along the omentum (series\n34, image 41).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal size.  There is soft tissue irregularity\nextending along the mesentery inferior to the spleen which is more prominent\nthan on the prior study (series 34, image 29).  There is trace perisplenic\nascites which is new from prior.  The splenic artery and vein are patent.\n\nADRENALS: There is a 2.0 cm slightly hypoenhancing right adrenal lesion which\nis new from the prior study (series 304, image 27).  The lesion abuts the\nposterior aspect of the inferior cava (series 34, image 27).  No definite\nintraluminal thrombus is demonstrated however findings are concerning for\ntumor thrombus.\nThe left adrenal gland demonstrates medial limb thickening which is new from\nthe prior study up to 1.2 cm (series 34, image 22).\n\nURINARY: Bilateral perinephric hematomas are increased in size from prior\nstudy, with areas of heterogeneous attenuation is most predominant in the\nright (series 34, image 36).  There is additional nodularity along soccer can\ndoes fascia bilaterally which is more prominent than the prior study (series\n304 image 33).  There is irregularity of the bilateral renal cortex with\notherwise symmetric enhancement.  Numerous hypodensities are seen throughout\nboth kidneys and appear to have increased in size and number compared to the\nprior study, concerning for intrarenal metastatic disease.  A reference lesion\ninclude a 1.4 cm hypodensity in the right interpolar region (series 304, image\n33).  No hydronephrosis.  Renal arteries appear patent.\n\nGASTROINTESTINAL: No evidence for bowel obstruction.  No gross areas of bowel\nwall thickening or pneumatosis.\n\nMESENTERY/LYMPH NODES: There is multifocal omental nodularity and stranding\nwhich appears worsened in extent compared to the prior study.  Numerous\nintraperitoneal nodules are increased in size and number from the prior CT\nabdomen and pelvis (series 304, image 30; series 34, image 56).  Numerous\nmesenteric lymph nodes are again demonstrated measuring up to 0.9 cm (series\n304, image 37).\n\nPELVIS:\n\nThere is an area of nodular opacity measuring 0.4 cm along the dome of the\nbladder (series 66, image 32).  3-4 mm hyperdense linear focus in the right\naspect of the bladder, not distended but not clearly located within the\nbladder wall, is unchanged, unclear whether a calcification or metal (series\n304 image 89).\n\nThere is no free fluid in the pelvis.  The previously demonstrated presacral\nhematoma has resolved.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES AND SOFT TISSUES: The known L2 vertebral body metastatic lesion with\nmild pathologic anterior height loss is unchanged.  Ill-defined sclerotic foci\nwithin the right greater than left proximal femurs and right superior\nacetabulum are again noted.\n\nNumerous soft tissue density lesions throughout the abdominal wall most\nprominently within the slightly right midline measuring 2.5 cm, previously 2.7\ncm.  A right flank nodule measures 1.1 cm, previously 0.8 cm (series 304,\nimage 57).  Additional subcutaneous nodules throughout the abdominopelvic wall\nare increased in size (series 304 image 44, 52, 59).",
            "output": "1. Progression of diffuse metastatic disease, including mediastinal,\ninnumerable bilateral pulmonary, right pleural, scattered hepatic, and\nmultiple probable renal metastases.  Increased peritoneal, mesenteric, and\nomental seeding.  Increased subcutaneous nodules in the chest and abdominal\nwall.\n2. Attenuation of the right apical lobar pulmonary arterial branch is\nsecondary to either compression or invasion by adjacent metastatic disease. \nOtherwise, no evidence for pulmonary embolism.\n3. Interval increase in size of large bilateral renal subcapsular hematomas,\nwith slight irregularity on the right which may represent metastatic\ninvolvement or subacute blood products.  No hydronephrosis.\n4. 2.9 cm hypodense hepatic lesion at the confluence of the hepatic veins is\ndemonstrated without clear intravascular involvement.  A new right adrenal\nlesion abuts the posterior inferior vena cava, with likely small amount of\ntumor thrombus.\n5. Unchanged appearance of a known L2 vertebral body metastatic lesion with\nmild pathologic anterior height loss."
        },
        {
            "input": "NECK, THORACIC INLET, CHEST WALL, AXILLA:Visualized portions of the base of\nthe neck show no abnormality.   The visualized thyroid is normal. \nSupraclavicular lymph nodes are not enlarged.\n\nMEDIASTINUM AND HILA: No hilar lymphadenopathy.  Small mediastinal lymph nodes\nare not enlarged.\n\nHEART, VESSELS and PERICARDIUM: The heart is not enlarged and there is no\ncoronary arterial calcification.  There is no pericardial effusion.   Aortic\ncaliber is normal.  The main, right, and left pulmonary arteries are normal\ncaliber.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG: There are numerous bilateral pulmonary nodules with largest in the left\nlower lobe measuring 6.5 x 6 x 5 cm with vascularity and heterogeneous\ncomponents including tiny calcifications (5; 178 in 7; 42).  Smaller adjacent\nlesion measuring 3.5 cm (5; 190).  Additional lesion in the right upper lobe\nmeasures 2.7 x 1.8 x 2.6 cm (5; 79 and 7; 33).  1.2 cm nodule in the left\nlower lobe (5; 206).  There is a 0.74  X 1.5 cm nodule in the right lower lobe\n(5; 220).  Additional right upper lobe nodule measures 0.5 cm (5; 158). \nAdditional tiny nodules are diffusely noted for example series 5; images 251,\n132, 131, 120, 122, and 121).\n\nBONES: There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN: Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "Numerous lung nodules, with the largest measuring 6.5 cm in the left lower\nlobe concerning for metastatic disease, possibly from melanoma, testicular\ncancer, or lymphoma.  Recommend biopsy of the largest lesion.  Given\nheterogeneity of the lesion, several samples should be obtained."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Several hypoattenuating nodules in\nthe lower thyroid lobes bilaterally measure up to 2.2 cm (4: 12), some of\nwhich contain calcifications.  There is no supraclavicular or axillary\nlymphadenopathy.  The esophagus is unremarkable.\n\nUPPER ABDOMEN: There is diffuse hepatic steatosis.  Postsurgical changes are\nnoted in the stomach.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare mild.  The thoracic aorta is normal in caliber.  There is common origin\nthe innominate and left common carotid arteries.  There is no pericardial\neffusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is mild bibasilar atelectasis.  No focal consolidations\nor worrisome masses.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is mildly dilated at 3.2 cm.  No\npulmonary embolism to the segmental level.\nCHEST CAGE: No suspicious osseous lesions.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Thyroid nodules measure up to 2.2 cm, some of which contain calcifications.\nIf not previously evaluated, nonemergent thyroid ultrasound is recommended.\n\nRECOMMENDATION(S):  Thyroid nodule.  Nonurgent ultrasound follow up\nrecommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All lymph nodes in the chest wall (5, 12) are\nnormal in size.  Normal size of the anterior and middle mediastinal lymph\nnodes (5, 22).  Severe aortic wall calcifications.  Severe aortic valve\ncalcifications.  Minimal coronary calcifications.  No pericardial effusion. \nThe posterior mediastinum is unremarkable.  The part the normal sized\npara-aortic lymph node (5, 47) no lymphadenopathy is noted.  Small hiatal\nhernia.  The upper abdomen is reported separately in a dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Moderate degenerative vertebral disease.  No vertebral\ncompression fractures.  Minimal bilateral apical scarring.  Mild thickening\nany irregularities of the airway walls, suggesting chronic airways disease. \nSeveral punctate subpleural micronodules, none of which is suspicious in size\nor morphology.  2 mm.  Right upper lobe pure ground-glass nodule (6, 151). \nMinimal scarring at the bases of the lingular (6, 166).  No pleural effusions.\nNo diffuse lung disease.",
            "output": "No lymphadenopathy.  No malignant or infectious changes in the lung\nparenchyma.  Signs of mild chronic bronchitis.  No diffuse lung disease."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  There is no axillary or supraclavicular adenopathy.  There is no\nhilar or mediastinal adenopathy.\n\nSevere aortic wall calcifications are longstanding.  There are superior or\naortic valvular calcifications, of unknown hemodynamic significance.  Coronary\nartery calcifications are minimal.  Heart size is normal.  Trace pericardial\nfluid is physiologic.  The ascending aorta is non aneurysmal.  The main\npulmonary artery is within normal limits in caliber.\n\nThe tracheobronchial tree is patent to the subsegmental level.  There is mild\nthickening and irregularity of the airways suggesting chronic airways disease,\nstable.  Minimal scarring involves the lingula.  A left lower lobe 3 mm nodule\nis unchanged (6:246).  There is no mass or consolidation.  There is no pleural\neffusion or pleural abnormality.\n\nThere are no osseous lesions worrisome for malignancy or infection in the\nchest cage.  Moderate degenerative changes within the spine are not\nappreciably changed.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "No adenopathy.  No malignant or infectious changes within the lung parenchyma.\n\nSevere aortic valvular calcifications are of unknown hemodynamic significance,\nbest evaluated by echocardiography.\n\nFindings to suggest mild chronic bronchitis, unchanged.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 2:34 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, CHEST WALL, UPPER ABDOMEN: No incidental findings in the\nthyroid.\nUpper abdomen findings will be reported in the concurrent abdomen CT accession\n___.\n\nMEDIASTINUM: No lymphadenopathy in the mediastinum, hila or axilla\nbilaterally.\n\nHEART and PERICARDIUM: There is no cardiomegaly or pericardial effusion.\nModerate to severe calcifications in the aortic valve.\nSpecks of calcifications in the LAD.\nMinimal atherosclerotic calcifications along the thoracic aorta.\n\nAIRWAYS:  Airways are patent to the subsegmental level.\nMild bronchial wall thickening is prominent in the upper lobes bilaterally.\nThere are no retained secretions or bronchiectasis.\nPARENCHYMA:  No lung nodules or masses are identified.\nThere is no pleural effusion.\n\nCHEST CAGE: There is no evidence of bony destructive lesions.\nDegenerative changes in the spine.",
            "output": "No evidence of intrathoracic malignancy.\n\nRECOMMENDATION(S):  Moderate to severe calcifications of the aortic valve-for\nfurther evaluation by echo."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable. \n0.8 cm right supraclavicular lymph node is stable (03:17).  There is no\naxillary lymphadenopathy.\n\nCHEST CAGE: Moderate degenerative changes of the vertebra with no\nosteo-destructive lesions.\n\nUPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: 0.7 cm right lower paratracheal lymph nodes are stable and not\npathologically enlarged (3:94).  Posterior mediastinum is unremarkable with\nthe exception of small hiatal hernia.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion. \nDense and severe calcifications of the aortic valve leaflets as well as of the\nannulus.  Moderate calcifications the coronaries.  Extensive calcifications\nalong the normal caliber thoracic aorta and major branches.  Main pulmonary\nartery is normal in diameter.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Mild diffuse bronchial wall thickening with no branching opacities or\nconfluent consolidations to suggest active infection.  No bronchiectasis.\nMinimal subpleural upper lobe interstitial line thickening is unchanged.\n0.5 perifissural left lower lobe nodule is stable since ___ (3:168),\nthere are no new lung nodules.",
            "output": "No evidence of intrathoracic lymphoma.\nSevere calcifications of the aortic valve leaflets."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The main pulmonary artery is top normal in size. \nModerate calcification along the origins of the great vessels.  Severe\ntritruncal coronary artery calcifications.  The heart size in is within normal\nlimits.  No evidence of right heart strain.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy.  No mediastinal mass.  No hilar\nlymphadenopathy.  The esophagus is patulous.  Small hiatal hernia.\n\nPLEURAL SPACES: Small to moderate left pleural effusion.  No right pleural\neffusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Homogeneous enhancement, at higher attenuation than background\nmuscle, within a collapsed left lower lobe likely represents atelectasis\n(2:48).  Similar platelike atelectasis of the lingula (2:48).  There is\ncorresponding elevation of the left hemidiaphragm.  No suspicious pulmonary\nnodules or mass.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? No acute fracture. \nMild-to-moderate degenerative changes of the imaged spine.  Midline sternotomy\nwires are intact and well approximated.\n\nABDOMEN: Extensive pneumobilia, predominantly within the left lobe of the\nliver is unchanged.",
            "output": "1. No evidence of pulmonary embolism.\n2. Severe left lower lobe atelectasis with surrounding small to moderate\npleural effusion.  Moderate atelectasis of the lingula.\n3. Severe tritruncal coronary artery calcifications."
        },
        {
            "input": "The thyroid gland is unremarkable.  The esophagus is within normal limits. \nThere is no hiatus hernia.  The aorta and pulmonary artery are normal in\ncaliber.  Major aortic arch branch vessels are patent along their proximal\nvisualized course.  There is mild mixed atherosclerotic disease involving the\ndescending thoracic aorta predominantly.  The main, right, left, and lobar\npulmonary arterial branches are without evidence of intraluminal filling\ndefect.  There is mild-to-moderate coronary artery calcification.  The heart\nand pericardium are otherwise unremarkable.  There is a right upper extremity\nPICC with distal tip in the low SVC.\n\nAn AP window lymph node measures up to 1.4 x 1.0 cm, unchanged from prior exam\n(5, 126).  Lymph node aggregate at the right hilum measures up to 1.1 cm in\nshort axis (5, 161).  An additional prominent right hilar node measures up to\n1.1 cm (series 5, image 208).  There is left hilar lymphadenopathy, with\nindividual lymph nodes measuring up to 1.4 cm in short axis, unchanged from\n___ (series 5, image 154).\n\nMajor airways are patent to subsegmental levels bilaterally.  Again seen in\nthe right lower lobe are nodular opacities which are nearly confluent near the\nmedial right lung base (see series 5, image 280) in a peribronchovascular\ndistribution, with areas of mucous plugging of the distal subsegmental right\nlower lobe bronchi (for example see series 5, image 244).  This is not\nappreciably changed in appearance in comparison to prior FDG PET-CT from ___.  Small focus of subcentimeter nodularity is seen in the inferior\nright upper lobe (series 5, image 199), likely infectious or inflammatory. \nThere is a 3 mm right upper lobe pulmonary nodule seen peripherally (series 5,\nimage 176), unchanged.   The spiculated, left upper lobe pulmonary nodule\nmeasures 7 mm in longest dimension (series 5, image 73), unchanged from prior\nexams.  There is diffuse, severe centrilobular emphysema worst at the lung\napices. There is no pleural effusion or pneumothorax.\n\nThe partially imaged solid and hollow viscous organs of the upper abdomen are\nwithout acute focal abnormality.",
            "output": "1. Peribronchovascular, confluent nodular opacities in the medial right lower\nlobe with adjacent areas of distal bronchial mucous plugging and bronchial\nwall thickening, unchanged in appearance since prior from ___. \nRecommend continued attention on follow-up imaging.\n2. Smaller cluster of subcentimeter nodular opacities in the inferior right\nlower lobe, likely infectious or inflammatory nature.\n3. Spiculated 7 mm left upper lobe lung is stable.\n4. Left hilar and AP window lymphadenopathy is re- demonstrated.  Prominent\nright hilar lymph nodes measure up to 1.1 cm, as on prior exam.\n5. Unchanged 7 mm left upper lobe solid pulmonary nodule.  Recommend continued\nattention on follow-up imaging.\n6. Severe centrilobular emphysema.\n7. Right arm PICC with tip in the distal SVC."
        },
        {
            "input": "The thyroid is normal.  An aortopulmonary window lymph node is not\nsignificantly changed, measuring 1.5 x 1.0 cm (6:142).  A right hilar node is\nstable, measuring 1.9 x 1.1 cm (6:177).  A left hilar node is not\nsignificantly changed, measuring 1.9 x 1.4 cm (6:167).  1.0 cm left\nparaesophageal is not significantly changed (6:155).  There are no\npathologically enlarged supraclavicular or axillary lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates moderate coronary artery calcifications. There is no\npericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Severe background emphysema is stable.  A spiculated\nnodule in the left upper lobe measuring 7 mm is not significantly changed. \n(6:82). A 3 mm right upper lobe nodule is stable (6:195).  No new pulmonary\nnodules.  Previously mildly FDG avid peribronchiolar infiltration at the\nmedial right lung base, with areas of bronchial thickening and mucous\nplugging, is not significantly changed (6:303).  A previously seen focus of\nmild inflammation in the right upper lobe is nearly completely resolved\n(6:225).\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\n Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "1. A 7 mm spiculated left upper lung nodule and mediastinal and hilar\nlymphadenopathy are not significantly changed.  No new pulmonary nodules.\n2. Peribronchiolar infiltration at the medial right lung base, with areas of\nbronchial wall thickening and mucous plugging, is not significantly changed,\nand is consistent with purulent bronchiectasis.\n3. Stable severe emphysema.\n4. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Continue imaging surveillance with repeat Chest CT in six\nmonths."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged there are no lesions\nin the chest wall suspicious for malignancy.  New subcutaneous fat is severely\ndepleted, new but has probably improved since ___.\n\nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels, but is found in all major coronary arteries.  Tiny pericardial\neffusion is physiologic, unchanged and there is no pleural effusion.\n\nPrevious previously enlarged left hilar lymph node was 13 x 18 mm in\n___, currently 10 x 10 mm, 4:134.\n\n15 x 27 mm cluster of right hilar lymph nodes, 4:145, was 13 x 28 mm as\nremeasured in ___ mm node at the lower pole of the right hilus was 7\nmm in ___.  Central lymph nodes elsewhere are not pathologically\nenlarged, although subcarinal and subcentimeter right paraesophageal nodes are\nquestionably more strongly enhancing today than in ___.\n\nEmphysema is severe.  Retention of secretions in widespread mildly dilated\nbronchiectasis, right lower lobe lateral and posterior basal segments is more\npronounced probably responsible for greater retention of secretions in the\nright main bronchus and lower trachea in consider a local peribronchial\ninfiltration.\n\n5 x 6 mm left upper lobe nodule, 4:68, was 6 x 7 mm in ___.\n\n There are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, but it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "Subcentimeter left upper lobe lung nodule is minimally smaller today than in\n___.  No detectable local radiation effect.\n\nPrevious left hilar adenopathy substantially smaller.  Minimal changes in\nbilateral subcentimeter lymph nodes in the mediastinum and borderline enlarged\nright hilar nodes are of unclear significance.\n\nNo new or growing lung nodules.\n\nSignificant progression of suppurative bronchiectasis, centered in the right\nlower lobe causing severe local inflammation, and responsible for retained\nsecretions generally.\n\nSevere emphysema."
        },
        {
            "input": "Mediastinal lymph nodes have slightly decreased in size and enhancement, in\nparticular in the sub-carinal location, series 2, image 36.  No hilar or\naxillary lymphadenopathy is present.\n\nAorta and pulmonary arteries are unremarkable.  Heart size is normal. \nCoronary calcifications are extensive.  There is no pericardial or pleural\neffusion.\n\nCentral airways patent.  Right lower lobe posteromedial area of impacted\nairways in bronchiectasis is similar/minimally improved compared to previous\nexamination, series 4, image 254.  Severe emphysema is centrilobular and\npanlobular, bilateral.  Left upper lobe nodule has additionally decreased in\nsize currently 3.5 mm as compared to 5.5 mm on previous examination, series 4,\nimage 73.  Postradiation changes in the left upper and left lower lobe in\nparamediastinal location are extensive no new areas of consolidations or\npulmonary nodules demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately and\ncorresponding report will be issued\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "All ___.\n\nF sub-operative bronchiectasis in the right lower lobe, extensive, minimally\nimproved since the prior study\n\nSevere emphysema.\n\n3 dear coronary calcifications\n\nPostradiation chain changes in the left upper and lower lobe in expected\nlocation.\n\nSlight interval decrease in enhancement of the mediastinal lymph nodes."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid incidental findings.\nThere is no supraclavicular or axillary lymphadenopathy.\nNumerous right chest wall collaterals.\n\nUPPER ABDOMEN: Findings of the upper abdomen will be reported in the\nconcurrent CT of the abdomen pelvis accession number ___.\n\nMEDIASTINUM: Few measurable not pathologically enlarged lymph nodes in the\nmediastinum for example precarinal 0.6 cm (4:107), 0.5 cm in the AP window\n(4:99).\nRight hilar lymph node 2.4 x 1.2 cm is unchanged (4:128).\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nExtensive coronary calcifications involve the coronary arteries.\nMajor vessels are within normal size.\n\nLUNG: Secretions in the carina and right lower lobe thickened wall bronchi\ncontaining air-fluid levels associated with right lower lobe posteromedial\nconsolidation - grossly unchanged in comparison with ___.\nRight lower lobe peribronchial nodule measuring 1.2 cm is unchanged (4:170).\nLeft upper lobe 5 mm nodule is grossly unchanged in comparisons prior (4:57).\nPostop radiation changes in the left upper and left lower lobe in\nparamediastinal location are unchanged.\nThere are no new lung nodules or masses.\nSevere centrilobular and panlobular emphysema prominent in the upper lobes.\nThere is no pleural effusion.\n\nCHEST CAGE: There is no evidence of bony destructive lesions.",
            "output": "Secretions in the carina and right lower lobe thickened wall bronchi\ncontaining air-fluid levels associated with right lower lobe posteromedial\nconsolidation - unchanged severe bronchitis and chronic aspiration in\ncomparison to ___.\nNo new or enlarging lung nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Scattered design a lymph nodes are not enlarged by CT criteria.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Patient is status post radiation therapy of the left\nupper lobe with an unchanged 5 mm solid nodule (series 3, image 72).  A 3 mm\nright upper lobe solid nodule (series 3, image 160) is unchanged.  No new or\ngrowing pulmonary nodules.  Again seen is bronchial impaction of the posterior\nand lateral basal segmental bronchi of the right lower lobe, unchanged since\n___.  Surrounding chronic consolidative opacity with bronchiectasis is also\nstable since ___. emphysema is severe.\n\nAIRWAYS:  Bronchial impaction within the posterior and lateral basal segments\nof the right lower lobe as described above.  Otherwise the remaining airways\nare patent to the subsegmental levels.  The\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  No acute fractures.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Status post radiation of the left upper lobe and mediastinum with unchanged\nleft upper lobe nodule.  No new or growing pulmonary nodules.\n2. Chronic consolidative opacity with bronchiectasis and bronchial impaction\nin the right lower lobe, unchanged since ___.\n3. Please see separate report performed on the same day for detailed\nevaluation of the abdomen and pelvis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum and at\nthe level of the hilar structures are normal in size.  No abnormalities along\nthe large mediastinal vessels.  Moderate coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum shows\nstable thickening of the esophageal wall.  The upper abdomen is reported in\ndetail in the dedicated abdominal CT report.  No evidence of adrenal masses. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.\nStable severe pulmonary emphysema.  Stable spiculated left upper lobe nodule\n(3, 55) and stable perihilar left-sided postradiation changes.  Unchanged\nevidence of moderate chronic airways disease.  The consolidation in the right\nlower lobe, pre-existing on the previous examination has slightly increased in\nextent and severity.  The consolidative component of the abnormality is bigger\nthan on the previous examination.  There is slightly more airway plugging than\non the previous scan.  No pleural effusions.  Mucoid retention in the large\nairways.",
            "output": "Stable spiculated left upper lobe nodule.  Mild increase in extent and size of\nthe consolidation in the right lower lobe, combines to mucous plugging of the\nairways and mucous retention in the larger airways."
        },
        {
            "input": "CHEST PERIMETER: NO THYROID FINDINGS WARRANT ANY FURTHER IMAGING. \nSupraclavicular and axillary lymph nodes are neither enlarged nor growing.  No\nsoft tissue abnormality in the imaged chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mid and lower esophagus are patulous, unchanged.  No\nretention of fluid or other indication of obstruction.  Atherosclerotic\ncalcification is mild in head and neck vessels and present in at least left\nanterior descending, left circumflex, right and posterior descending coronary\narteries, as before.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and pericardium is physiologic.\n\n\n\nTHORACIC LYMPH NODES:  No lymph nodes in the chest are pathologically enlarged\nor growing.  Two 9 mm right hilar nodes are unchanged.  Bronchi are not\ncompromised.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.\n\nMost severe region of bronchiectasis and retention of secretions in the right\nlung are the basal segments of the right lower lobe, where peripheral\nconsolidation is cleared only minimally.  Bronchial inflammation in the right\nmiddle lobe, without frank bronchiectasis has increased and there is new\nperipheral bronchiolar nodulation suggesting dissemination of infection.\n\nStellate scar-like lesion left upper lobe is slightly larger today, greatest\ndiameters, 6 x 11 mm, previously 4 x 7 mm.  Extension to the lateral costal\npleural surface and into the walls of local bullae is unchanged.\n\nRadiation induced bronchiectasis, left upper lobe contains more secretions,\n6:190, but there is no evidence of bronchogenic spread of infection elsewhere\nin the left lung.\n\nNo remote pleural abnormalities.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Slight interval growth treated left upper lobe lung cancer could be\nrecurrence.  Stable involvement surrounding lung and adjacent pleura.  No\nevidence of metastasis elsewhere in the chest\n\nContinued severe, chronic bronchiectasis and bronchogenic of infection,\npredominantly right lower lobe, with slight worsening in the right middle lobe\nand possible spread to a single radiation induced focus in the left upper\nlobe.\n\nAtherosclerotic coronary calcification."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous in\nattenuation without focal nodularity.  There is no supraclavicular or axial\nlymphadenopathy by CT size criteria.  The imaged chest wall is unremarkable,\naside from incidental collateral flow of the injected contrast along the right\nchest wall, likely related to chronic stricture of the right subclavian vein.\n\nUPPER ABDOMEN: Please refer to the dedicated abdomen and pelvis CT from ___ and MRCP from ___ for details on intra-abdominal\nfindings.  The known pancreatic head mass is partially imaged and not well\nevaluated on the current study.  The degree of pneumobilia is slightly\nincreased when compared to exam on ___ and predominantly in the\nleft lobe of the liver.  Hypervascular left hepatic mass measuring 4.2 x 4.2\ncm partially exophytic in the left lobe of the liver is better characterized\non the MRI from ___.\n\nMEDIASTINUM: Upper right paratracheal lymph node measures 6 mm, stable from\nprior exam (4:64).  Subcarinal lymph nodal conglomerate measuring 1.6 x 1.0 cm\nis stable since ___, though increased in size when compared to ___ (02:34).\n\nHILA: Right hilar lymph nodes measuring up to 14 mm are also stable since ___, new since ___.  No new hilar lymphadenopathy is seen\ncompared to ___.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.  Moderate coronary artery calcifications are seen along the LAD,\ncircumflex and RCA.\nPLEURA: There is no pneumothorax.  Tiny right lower lobe pleural\nLUNG:\n\n1. PARENCHYMA:  Again seen is severe centrilobular emphysema, worst in the\nupper lobes.  Pre-existing stellate scar like lesion in the left upper lobe\nmeasures 7 x 13 mm, including the component tethering to the pleura and to the\nwalls of the local bulla (4:73).  Chronic consolidation in the right lower\nlobe has increased from prior exam on ___, probably a flare of\nchronic infection.\n2. AIRWAYS:  Cylindrical bronchiectasis is most severe in the lower lobes. \nThere are focal mucous plugs in the right middle lobe and right lower lobe\n(4:220, 258), persistent since ___.  However, when compared to ___, the degree of mucous plugging of the right lower lobes is\nslightly improved.\n3. VESSELS:  Ascending and descending aorta are normal in caliber.  The main\npulmonary artery is not dilated.  Mild calcifications are noted at the aortic\narch and the head and neck vessels.\nCHEST CAGE: There is no suspicious osseous lesion concerning for metastatic\ndisease or infection.  There is no acute fracture.",
            "output": "1. Increased consolidation in the region of chronic inflammation or infection,\nright lower lobe\n2. Left upper lobe spiculated mass, stable since ___, though\nincreased in size since ___, concerning for malignant recurrence."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous. \nThere is no supraclavicular or axillary lymphadenopathy by CT size criteria. \nThe imaged chest wall is unremarkable.\n\nUPPER ABDOMEN: Redemonstration of pneumobilia.  The known pancreatic mass is\nnot well assessed on this unenhanced scan.\n\nMEDIASTINUM: There is no mediastinal adenopathy.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  There are coronary\ncalcifications.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Area of consolidations, alveolar infiltrates and ___\ninfiltrates in the right lower lobe, and in the right upper lobe.  There is\nsevere centrilobular emphysema.  Left upper lobe stellate nodule measuring 9\nmm, has enlarged since ___ where a previously measured 5 mm and\ndemonstrated overall less spiculation.  This is noted in area of previous lung\nneoplasia.\n2. AIRWAYS:  There is some mucous plugging in the right lower lobe.\n3. VESSELS:  The aorta is not dilated.\nCHEST CAGE: Bony structures are unremarkable.",
            "output": "Evidence of new infective changes in the right upper and lower lobes.  These\ncould be secondary to aspiration.\n\nLeft upper lobe nodule has enlarged since ___, which is concerning\nfor recurrence."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout. \nSmall filling defects in subsegmental artery in the right lower lobe (6:223),\nin subsegmental branches of the right lower lobe (6:207) and in subsegmental\nbranches of in the middle lobe (6:199).  There is a large right ventricle,\nunchanged from prior studies, however the interventricular septum is not\nrectified\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Mild subcutaneous emphysema after left central venous line\nplacement which shows tip in the lower SVC.  No atherosclerotic calcifications\nin the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Unchanged infiltrative mediastinal and hilar\nlymphadenopathy.\n\nPLEURA:\nTrace left pleural effusion.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening.  No bronchiectasis or mucus plugging.  Severe centrilobular\nemphysema is again noted.  There has been interval interlobular septal\nthickening.  Linear atelectasis in the left lobe upper lobe).  Bilateral\nconsolidations in both lower lobes.  In the right lower lobe this shows high\nattenuation suggestive of atelectasis, however in the left lower lobe a to\nsevere a genius lower attenuation suggestive of an infectious process.  No\nsuspicious large lung nodules or masses.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show diffuse ascites and known\nhepatic metastatic disease.",
            "output": "Small bilateral subsegmental pulmonary emboli, likely either chronic or\nsubacute in nature.\nLeft lower lobe consolidation associated to bronchial inflammation and\nsurrounding ground-glass opacities concerning for pneumonia, likely aspiration\nrelated.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:47 am."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum are\nnormal in size.  The large mediastinal vessels are unremarkable, minimal\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable, with the exception of a small\nhiatal hernia.  No abnormalities are seen in the upper abdomen.  Calcified\ngallstones.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  Minimal bilateral apical scarring, symmetrical in\ndistribution.  No diffuse lung disease.  Mild irregularities of the airway\nwalls.  No evidence of mucous plugging.  No pleural thickening, no pleural\neffusions.  Minimal scarring at the bases of the middle lobe.  3 mm subpleural\nleft lower lobe pulmonary nodule (5, 242).  No other pulmonary nodules or\nmasses.",
            "output": "Non concerning 3 mm subpleural left lower lobe pulmonary nodule.  Signs of\nmild chronic airways disease that could be worked up by pulmonary function\ntests.  No panlobular emphysema.  No pleural abnormalities."
        },
        {
            "input": "CTA CHEST:\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. The pulmonary\narteries are also well opacified to the segmental level, with no evidence of\nfilling defect.  Subsegmental arteries are not well assessed. The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nCHEST:\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.  The heart and mediastinum are normal. The\npericardium is intact without effusion.\n\nThe airways are patent to the subsegmental level.  There is mild bibasilar\natelectasis.  No focal consolidation is identified.  There is no evidence of\npleural effusion or pneumothorax.\n\nEvaluation of intra-abdominal soft tissues in organs is somewhat limited\nwithout the administration of IV contrast.\n\nABDOMEN:\n\nThe liver demonstrates homogeneous attenuation.  No focal liver lesion is\nidentified on this limited noncontrast enhanced study.  The gallbladder is\nsurgically absent.  There is no definite evidence of collection within the\ngallbladder fossa.  There is no intra or extrahepatic biliary ductal\ndilatation.  The pancreas, spleen, and bilateral adrenal glands are normal. \nThe kidneys are symmetric in size and shape.  There is no hydronephrosis or\nperinephric abnormalities.  No urolithiasis is identified.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening. The appendix is\nnot visualized but there are no secondary signs of appendicitis.  There is no\nretroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum.  The abdominal aorta is normal in caliber\nwithout aneurysmal dilatation.  There are post surgical changes in the soft\ntissues of the anterior abdomen with scattered foci of air.  There is no\nabnormal intra-abdominal fluid collection.  There are calcific densities\nmeasuring up to 8mm anterior to the right psoas muscle just lateral to the\nright ureter, unchanged since prior study.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.  The uterus and adnexa are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n\n2.  No urolithiasis.\n\n3.  Status post cholecystectomy without evidence of abnormal intra-abdominal\nfluid collection.\n\n4.  Unchanged small hyperdensities anterior to the right psoas muscle\nmeasuring up to 8 mm adjacent to the right mid ureter could represent dropped\nstones versus venous phleboliths."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  No soft tissue abnormalities in the\nchest wall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Upper esophagus is severely distended with air.  There is\neither an air-filled hiatus gastric hiatus hernia of moderate size or second\nregion where the esophagus is substantially dilated with air.  Contrast\nswallow is recommended for functional and anatomic assessment.\n\nAtherosclerotic calcification is not apparent in head and neck vessels or in\nthe coronary arteries.  Aortic valve is not calcified.  Aorta and pulmonary\narteries and cardiac chambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Multiple cm size as lymph nodes in the lower\nparatracheal and subcarinal stations are not pathologically enlarged by size\ncriteria.\n\n\nLUNGS, AIRWAYS, PLEURAE: No measurable lung nodules or focal lung lesions of\nconsequence.  Tracheobronchial tree is normal to subsegmental levels.  No\npleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nModerate distension upper esophagus may indicate functional abnormality. \nConsider contrast swallow for assessment."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  On series 3, image 161, there is an equivocal very focal\nnonocclusive filling defect in a posterior, inferior right lower lobe\nsubsegmental pulmonary artery branch versus artifact.  No pulmonary embolism\nis seen elsewhere..  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: A trace right pleural effusion is decreased in size from\nprior.  No pneumothorax.\n\nLUNGS/AIRWAYS: Again seen are postsurgical changes with scarring along the\nright lower lung, particularly in the middle lobe.  There is no focal\nconsolidation.  There are scattered punctate calcified granulomas.  Patient is\nstatus post tracheostomy.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is Re-demonstrates partially\nimaged intrahepatic biliary ductal prominence in this patient status post\ncholecystectomy..\n\nBONES: Multiple old healed rib fractures are seen bilaterally.  Patient is\nstatus post kyphoplasty of a lower thoracic vertebral body.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "Equivocal very focal nonocclusive filling defect in a posterior, inferior\nright lower lobe subsegmental pulmonary artery branch versus artifact, which\nis felt to unlikely to be clinically relevant currently.\n\nOtherwise, no evidence of pulmonary embolism elsewhere more centrally.\n\nRe-demonstrated postsurgical changes.\n\nNOTIFICATION:  Discussed with Dr. ___ 4:55 pm"
        },
        {
            "input": "The patient is intubated.  ET tube tip is in appropriate position.  Multiple\nmediastinal lymph nodes borderline, none of the specifically pathologically\nenlarged.  No definitive hilar lymphadenopathy seen within the limitations of\nthis noncontrast enhanced study.  No axillary lymphadenopathy present.\n\nAorta and pulmonary arteries are normal in diameter.  Heart size is\ntop-normal.  There is no pericardial effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Minimal bilateral\npleural effusions are noted but the vast majority of the lung bases is\noccupied by bilateral consolidations with air bronchogram, relatively\nsymmetric, concerning for bibasal pneumonia versus aspiration.  There are no\npulmonary nodules masses or consolidations.  There is no pulmonary edema\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nOld rib fractures noted on the left.",
            "output": "Bibasal consolidations most likely concerning for infectious process, left\nmore than right.  Aspiration is another possibility.\n\nNo pulmonary edema.\n\nMinimal pleural effusion.\n\nFor assessment of the sub- diaphragmatic findings please review CT abdomen and\npelvis and the corresponding report that would be issued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No axillary\nlymphadenopathy by CT size criteria.\n\nHEART AND VASCULATURE:\nThe heart is moderately enlarged. There are severe mitral annulus\ncalcifications. Mild coronary artery calcifications. Trace pericardial fluid.\nThe pulmonary artery is mildly dilated to 3.4 cm which can be seen in the\nsetting of pulmonary hypertension.\n\nMEDIASTINUM AND HILA:\nEvaluation of the mediastinal and hilar lymph nodes is somewhat limited due to\nnoncontrast technique, however mediastinal lymphadenopathy is present. For\nexample, there is a a 1.3 cm right lower paratracheal node (series 302:91).\nNodal tissue in the subcarinal station appears confluent measuring up to 2.0\ncm and probably extends along toward the right hilus. There is bulkiness of\nthe right hilus suggesting underlying hilar adenopathy. Mediastinal and nodal\ntissue appears somewhat hyperattenuating, of uncertain clinical significance.\n\nPLEURA:\nSmall bilateral nonhemorrhagic pleural effusions.\n\nLUNGS:\nThere is mild diffuse centrilobular emphysema.  A 1.7 cm consolidative opacity\nin the right upper lobe is new from prior CTA head neck on ___,\nconcerning for infection/aspiration. There is diffuse bilateral ground-glass\nopacification with septal thickening, most consistent with pulmonary edema.\nThere is apical scarring and mild paraseptal emphysema. There is moderate\ndiffuse bronchial wall thickening.  Desiccated secretions are seen in the left\nmainstem bronchus.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis.",
            "output": "Small bilateral pleural effusions with diffuse bilateral ground-glass\nopacification which most likely represents pulmonary edema.\n\nNew focal parenchymal opacity in the right upper lobe could represent an early\npneumonia.\n\nMediastinal and hilar lymph nodes are enlarged and some which are calcified,\ncould be related to prior granulomatous disease.\n\nMultiple scattered bilateral pulmonary nodules some which which are calcified\ncould also represent granulomatous disease.\n\nModerate cardiomegaly.  More moderate to severe mitral annulus calcification. \nModerate coronary artery calcification.  Evidence of pulmonary arterial\nhypertension."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Soft tissue within the\nanterior mediastinum may reflect residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: 7 mm pulmonary nodule of the right upper lobe (301:98). \nMultiple ground-glass opacities of the right upper lobe measure up to 5 mm\n(301:78).  Ground-glass opacities of the left upper lobe measure up to 6 mm\n(301:77).  Multiple nodular opacities are within the left lower lobe\n(301:106).  Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: A heterogeneous left thyroid nodule measures 2.7 x 2.1 cm. \nOtherwise, the visualized portions of the base of the neck show no\nabnormality.\n\nABDOMEN: Hepatic steatosis.  Otherwise, the included portion of the upper\nabdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Multiple nodular opacities within the left lower lobe, likely pneumonia. \nMultiple other bilateral pulmonary nodules, some ground-glass, measure up to 7\nmm, likely infectious or inflammatory.  A follow-up chest CT is recommended in\n3 months to ensure resolution.\n3. Approximately 2.7 cm heterogeneous left thyroid nodule.  A nonemergent\nthyroid ultrasound is recommended for further evaluation.\n4. Hepatic steatosis.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is mild dependent atelectasis.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nModerate degenerative changes of the thoracic spine are noted.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nNo pulmonary embolism or lobar consolidation."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber. There is\nmoderate calcified atherosclerotic plaque within the aortic arch and\ndescending thoracic aorta. The left and right pulmonary arteries are not\nenlarged. Mild calcified atherosclerotic plaque is seen within the right\nbrachiocephalic artery, as well as in the proximal and mid-portions of the\nleft subclavian artery.  Diffuse coronary artery calcification is seen within\nall the major coronary arteries. There is mild-to-moderate calcification of\nthe aortic valve. The heart size is within normal limits. There is no\npericardial effusion. The heart, pericardium, and partially visualized great\nvessels are otherwise within normal limits based on an unenhanced scan.\n\nAXILLA, HILA, AND MEDIASTINUM: Lymph nodes within the left axilla are at the\nupper limit of normal in size without suspicious morphologic features (05:45,\n5:74).  There is no evidence of mediastinal lymphadenopathy by CT size\ncriteria.  There is no evidence of mediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a trace right pleural effusion, there are no large\npleural effusions.  No evidence of pneumothorax.  No evidence of suspicious\npleural thickening.\n\nLUNGS/AIRWAYS: There is a 2-3 mm subpleural solid pulmonary nodule within the\nlateral basal segment of the right lower lobe (5:172). Scattered calcified\ngranulomas are seen bilaterally. Evaluation of the inferior portion of the\nleft lower lobe is somewhat limited secondary to respiratory motion.  Lungs\nare otherwise clear without evidence of masses or focal infiltrates.  Small\namount of free fluid is seen within the posterior aspect of the right major\nfissure.  The airways are patent to the level of the subsegmental bronchi\nbilaterally.  There are bibasilar dependent atelectatic changes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe visualized thyroid gland is unremarkable.\n\nABDOMEN: Please note that the current exam is not tailored for evaluation of\nthe partially visualized abdominal organs.  The patient's known pancreatic and\nhepatic lesions are better evaluated on the prior CTA of the abdomen dated ___.  In comparison to the prior study, there has been interval\nintroduction of a biliary stent as well as new development of expected\npneumobilia status post sphincterotomy.  Diffuse calcified atherosclerotic\nplaque is seen within the partially visualized abdominal aorta and great\nvessels.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is exaggerated kyphosis of the thoracic spine.  Mild degenerative\nchanges are noted about the thoracolumbar spine including anterior osteophyte\nformation in the proximal thoracic spine.\n\nSOFT TISSUES: Sub-centimeter rounded calcifications in the subcutaneous\ntissues of the posterior thorax may represent areas of fat necrosis or the\nsequelae of prior injections (5:167, 602:107).",
            "output": "1. There is a 2-3 mm subpleural solid pulmonary nodule within the right lower\nlobe of indeterminate etiology. The need for followup imaging depends on\nstaging and management considerations regarding the patient's extrathoracic\nmalignancy.  Otherwise ___ guidelines for detection of pulmonary\nnodules would apply.  See Recommendations below.\n2. No evidence of lymphadenopathy by CT size criteria within the chest.\n3. No evidence of infection.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.  Oral contrast is seen in the\nstomach which was most likely administered via the PEG tube.  Small sliding\nhiatal hernia.\n\nMEDIASTINUM: On prior chest radiograph done ___ there was an\nesophageal stent in situ, which has subsequently been removed.  There is a\nlinear metallic density in the mid esophagus measuring 17 mm in length and 1\nmm in diameter at the level of the carina (suspected foreign body).  The\nesophagus is severely distended above this level with air-fluid levels\nsuggesting stasis/obstruction.  Difficult to comment on esophageal anatomy on\nthis noncontrast study, but the walls appear severely thickened, and the\nsurrounding mediastinal fat is very indurated.  Mediastinal lymph nodes are\nsuboptimally characterized on this noncontrast study.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Small pericardial effusion measures 13 mm in diameter\nadjacent to the right ventricle.  Mild relative hypodensity of the blood pool\nsuggesting anemia.  Mild aortic valve calcification.  Mild coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.  Right IJV\nCVP in situ with the tip in the distal SVC.\nPLEURA: Trace left-sided pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is bronchus centric nodular airspace consolidation in\nthe dependent aspect of the right upper, left upper, middle and bilateral\nlower lobes (most severe in the lower lobes) concerning for aspiration\npneumonia.  More confluent consolidation in the left lower lobe most likely\nrepresents an element of associated atelectasis (atelectasis appears mildly\nimproved compared to prior radiograph done ___.  Mild paraseptal\nemphysematous changes in the lung apices.\n2. AIRWAYS:  Aspirate/retained secretions present in the distal trachea and\nmain bronchi (302, 81).Saccular bronchiectasis in the dependent aspect of the\nright upper lobe (302, 103).  Cylindrical bronchiectasis in the lung bases.\n3. VESSELS:  The pulmonary artery measures at the upper limits of normal, but\nthe right main pulmonary artery appears dilated and pulmonary hypertension\nshould be excluded.\nCHEST CAGE: No lytic/destructive bony lesions.  No left humeral fracture. \nSmall well corticated lytic lesion in the inferior aspect of the left sixth\nrib (302, 88).  No acute left rib fractures.",
            "output": "Marked esophageal distension, severe wall thickening, mediastinal induration\nand possible adenopathy.  Esophageal anatomy suboptimally evaluated on this\nstudy, better assessed with esophagoscopy and sampling of the process\ninfiltrating the wall - possible diagnoses are lymphoma, eosinophilic\nesophagitis, Crohn's disease, candidal or other fungal infection.  Metallic\nforeign object in the mid esophagus at the level of the carina should be\nremoved.\n\nMultifocal aspiration pneumonia involving dependent aspects of all lung lobes.\n\nNo acute left rib fractures or left humeral fracture.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodensities in the inferior\nbilateral thyroid lobes.  No supraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: Small sliding hiatal hernia.\n\nMEDIASTINUM: Similar appearance of a linear metallic foreign body in the\nmidesophagus measuring up 2.1 cm in length and up to 4 mm in diameter similar\ncompared to the prior study, with slightly different orientation on today's\nscan..  The entirety of the visualized esophagus demonstrates marked\ndilatation and distension with fluid with a few small pockets of air.  Again\nnoted is surrounding fat stranding.  Esophageal perforation and position of\nforeign body in relation to esophageal wall, given paraesophageal stranding\ninflammatory changes, is difficult to exclude without use of intravenous\ncontrast.\n\nMediastinal lymph nodes are suboptimally characterized on this noncontrast\nstudy.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART AND PERICARDIUM: Small pericardial effusion measures 12 mm in diameter\nadjacent to the right ventricle, unchanged.  Mild relative hypodensity of the\nblood pool suggesting anemia.  Mild aortic valve calcification.  Mild coronary\nartery calcification.  No aneurysmal dilatation of the ascending aorta.  Right\ncentral venous catheter terminates in the distal SVC.\n\nPLEURA: Trace left-sided pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA: There has been interval progression of nodular airspace and\nground-glass opacity throughout the lungs, particularly in the right and left\nlower lobes.  This is concerning for progression of aspiration pneumonia. \nMore confluent consolidation in the left lower lobe most likely represents\nsuperimposed atelectasis.  Mild paraseptal emphysematous changes in the lung\napices.\n2. AIRWAYS:  Aspirate/retained secretions present in the distal trachea and\nmain bronchi.  Saccular bronchiectasis in the dependent aspect of the right\nupper lobe is similar.  Cylindrical bronchiectasis in the lung bases.\n3. VESSELS:  The main pulmonary artery measures normal in caliber.  The right\nmain pulmonary artery is dilated which can be seen in the setting of pulmonary\narterial hypertension.\n\nCHEST CAGE: No suspicious lytic or blastic osseous lesions are seen.  No acute\nfractures.",
            "output": "1. Similar appearance of fluid-filled, dilated esophagus with esophageal wall\nthickening.  The metallic foreign body within the esophagus at the level of\nthe carina appears at same level.  Position of metallic foreign body in\nrelation to esophageal wall is difficult to assess without use of intravenous\ncontrast given esophageal wall thickening and paraesophageal stranding. \nTherefore perforation is difficult to exclude.  Contrast-enhanced scan is\nsuggested.\n2. Multifocal aspiration pneumonia has worsened.  There are tracheal\nsecretions.\n3. Trace left pleural effusion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The partially imaged lungs demonstrate a 4 mm pulmonary nodule\nin the right middle lobe (3:84).  There is no focal consolidation.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n4 mm right middle lobe pulmonary nodule.\n For incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nRECOMMENDATION(S):  See Fleischer criteria guidelines detailed above."
        },
        {
            "input": "HEART AND VASCULATURE: Central filling defects within the segmental and\nsubsegmental arteries of the right lower lobe compatible with acute pulmonary\nembolism.  No evidence of right heart strain.  Main pulmonary artery is normal\nin caliber.\n\nAdditionally, occlusive thrombus is seen involving the imaged left brachial,\nleft axillary, and left subclavian veins to the level of the costoclavicular\njunction where there appears to be a caliber change in the subclavian vein\n(04:27).  This may represent venous thoracic outlet obstruction or effort\ninduced thrombosis, also known as Paget-Schroetter syndrome.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Anterior mediastinal soft\ntissue density is compatible with residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification to suggest pulmonary infarct. The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Pulmonary emboli involving the segmental and subsegmental arteries of the\nright lower lobe.  No evidence of right heart strain or pulmonary infarct.\n2. Occlusive thrombus is seen within the visualized left brachial, axillary\nand subclavian veins extending to the level of the costoclavicular junction\nwhere the subclavian vein appears to be narrowed.  This may represent venous\nthoracic outlet obstruction or effort induced thrombosis, also known as\nPaget-Schroetter syndrome.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:00 pm.  Patient is already on a\nheparin drip."
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The heart and mediastinum are normal.\nThe pericardium is intact without effusion. Airways are patent to the\nsubsegmental levels.\n\nThe lungs are clear without focal or diffuse abnormality. There are small\nbilateral pleural effusions, right greater than left, with adjacent\ncompressive atelectasis. No pneumothorax or pneumomediastinum.\n\nABDOMEN:  The liver is homogeneous in attenuation with no focal lesions. \nHypodensity at the inferior aspect of the right lobe of the liver adjacent to\nthe right kidney is likely a contusion/retraction injury from recent surgery. \nPortal and hepatic veins are patent.  The gallbladder is within normal limits.\nThe pancreas and spleen are unremarkable.  The adrenal glands are normal\nbilaterally.  The left kidney enhances and excretes normally.  The right\nkidney is status post resection of an angiomyolipoma with small amount of\nhemorrhage in the resection bed and adjacent perinephric space compatible with\nrecent surgery.  There is mild contrast extravasation from the collecting\nsystem into the perinephric space, in the resection bed, which is expected\npost procedurally.  Mild hypoattenuation of the interpolar and lower pole of\nthe right kidney likely indicates renal injury not unexpected post surgery. \nNo hydronephrosis.\nThe distal esophagus, stomach, and small bowel are normal in caliber.  The\nappendix is not visualized.  The large bowel is moderately fecalized.  No\nevidence of colitis.  There is mild haziness in the right anterior abdominal\nwall and along the right retroperitoneum consistent with postsurgical changes.\nAir in the soft tissues of the anterior lower chest and abdominal wall\nbilaterally is also postsurgical.  No free fluid.\n\nPELVIS:  The uterus is enlarged and heterogeneous, compatible with fibroids. \nThe urinary bladder is normal.  No pelvic free fluid or lymphadenopathy. \nOvaries are normal.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n2. Small bilateral pleural effusions with adjacent atelectasis.\n3. Status post right partial nephrectomy for angiomyolipoma resection with\nexpected postoperative changes in the right kidney, right retroperitoneum and\nanterior abdominal wall.  Included in these postoperative changes is a small\namount of contrast extravasating from the right renal collecting system into\nthe perinephric space.\n4. Fibroid uterus."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient is asymmetrically positioned within the\nscanner.  Moderate aortic wall calcifications.  Postsurgical metallic\nstructures are seen in the right axilla.  No hilar or mediastinal\nlymphadenopathy.  All visible mediastinal lymph nodes (7, 41) Are normal in\nsize.  Minimal coronary calcifications, no valvular calcifications, no\npericardial effusion.  The posterior mediastinum is unremarkable, with the\nexception of a small hiatal hernia.  Upper abdominal findings are described in\ndetail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Moderate scoliosis\nand subsequent degenerative vertebral disease.  Relatively extensive bilateral\napical scarring, with a nodular component.  Mild thickening any irregularities\nof the airway walls.  Focal areas of non characteristic scarring in the lung\nparenchyma.  No suspicious pulmonary nodules or masses.  Relatively extensive\nlingular atelectasis (8, 219).  No pleural effusions.",
            "output": "Non characteristic areas of scarring and atelectasis but no evidence of\nmetastatic disease to the thorax.  No pleural effusions.  Signs of mild\nchronic airways disease."
        },
        {
            "input": "The patient is after median sternotomy and CABG. Aorta and pulmonary arteries\nare normal in diameter. Heavy calcifications of aortic valve a present but the\npatient is after aortic valve replacement. Heart size is mildly increased.\nThere is no pericardial pleural effusion. Pacemaker leads terminate in right\natrium and right ventricle with these right ventricular lead looping in the\nIVC.\n\nImage portion of the upper abdomen demonstrate bilateral renal non obstructing\nstones an right renal cyst.\n\nAirways are patent to the subsegmental level bilaterally. Bibasal still in the\nreconstruction atelectasis are noted. Subpleural interstitial opacities are\nreticular and honeycombing in nature that might be consistent with gradual\nmild progression of fibrotic for was and a site PE.  No discrete nodules mild\nassess O consolidations demonstrated. No discrete lesions of a suspicious for\nmalignancy demonstrated.\n\nNo lytic or sclerotic lesions are noted within the bones worrisome for\ninfection or neoplasm.",
            "output": "Interval additional progression of basilar predominant fibrotic lung disease\nmost likely fibrotic sub type and this AP\n\nNo new pulmonary nodules\n\nRenal cysts and nonobstructing stones."
        },
        {
            "input": "The thyroid gland is unremarkable.  Axillary, supraclavicular, mediastinal,\nand hilar lymph nodes are not enlarged.  Atherosclerotic calcifications of the\naortic arch and the coronary arteries are severe.  Patient is status post\naortic valve replacement.  A left chest pacemaker has leads terminating in the\nright atrium and right ventricle.  The aorta is normal in caliber.  The main\npulmonary trunk is enlarged measuring up to 4 cm, suggestive but not\ndiagnostic of chronic pulmonary arterial hypertension.  The heart is mildly\nenlarged.  There is no pericardial effusion.\n\nThe central airways are patent.  However, there has been interval progression\nof NSIP with diffuse lower lobe predominant peribronchovascular infiltration,\nsubpleural reticulations and ground-glass opacities.  These abnormalities now\nencompass bilateral upper lobes which were relatively spared.  Traction\nbronchiectasis is also more pronounced compared to the prior study and most\nprominent in the right lower lobe.  Some component of honeycombing is present\nin the right middle lobe.  No evidence of air trapping on expiratory images. \nTwo pulmonary nodules are unchanged including a 6 mm nodule in the left upper\nlobe (4:167) and a 6 mm nodule in the left lower lobe (04:124).  No pulmonary\nedema, large consolidation, pleural effusion, or pneumothorax.\n\nThe study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate bilateral renal\ncysts measuring up to 3.3 cm on the right.  Scattered non-obstructing right\nrenal calculi are identified with the largest measuring 1.4 x 1.0 cm in the\ninterpolar region (05:56).\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  A healed\nfracture of the left lateral sixth rib is noted.  There is also a healed\nfracture of the lower body of the sternum.  Median sternotomy wires are\nintact.  Degenerative changes are moderate throughout the thoracic spine.",
            "output": "1.   Significant interval progression of NSIP with fibrosing component with\nworsening disease in the lower lobes now extending into the bilateral upper\nlobes.\n\n2.  Dilated main pulmonary trunk to 4 cm, reflecting chronic pulmonary\narterial hypertension.\n\n3.  Non-obstructing right renal calculi measuring up to 1.4 cm in the\ninterpolar region."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nThe heart size is normal with no pericardial effusion.  The main pulmonary\nartery is normal in caliber. The ascending aorta is mildly ectatic measuring\nup to 3.6 cm in greatest dimension. The tip of a right-sided MediPort extends\ninto the distal SVC.\n\nThere are numerous new pulmonary nodules which are new metastases. The largest\nlingular nodule is stable in size measuring 5 mm (4, 220 and 6, 19). There is\nno endobronchial lesion or pleural effusion.\n\nThere are no bony lesions in the rib cage worrisome for infection or\nmalignancy.  Mild S-shape scoliosis of the thoracolumbar spine is unchanged.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Interval progression of disease since ___ with numerous new pulmonary\nnodules which most likely represent metastases."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Again demonstrated is heterogeneous attenuation of the liver, similar\nto prior study and compatible with regions of fatty infiltration. \nPostoperative changes of sleeve gastrectomy a partially imaged.  Also\npartially imaged are splenic cysts, better characterized on prior CT of the\nabdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nA VP shunt is partially imaged with the anterior subcutaneous tissues.",
            "output": "-No evidence of pulmonary embolism or acute aortic abnormality.\n-No focal consolidation."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Triangular soft tissue within the anterior\nmediastinum most likely represents remnant thymic tissue.  No axillary,\nmediastinal, or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Please note the lung apices are not included on this\nexamination.  Mild dependent atelectasis bilaterally.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  There is no axillary or supraclavicular adenopathy.  Central\nnodes are not pathologically enlarged.  A right upper paratracheal station\nnode measures 8 mm (02:14).  A prevascular station measures 6 mm (02:15).  A\npartially calcified subcarinal measures 8 mm (02:25).  Calcified right hilar\nnodes are not enlarged.  There is no retrocrural adenopathy.  Note is made of\na right diaphragmatic node which measures 8 mm (02:43).\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Heart size is normal.  There is no pericardial\neffusion.  Coronary artery calcifications are mild.  A 2 vessel aortic arch is\nnoted, the origins of the right brachiocephalic and left common carotid artery\nshared, a normal anatomic variant.\n\nMillimetric nodule in the right middle lobe in a subpleural location is noted\n(4:154).  A somewhat triangular nodule along the pleura in the left lower lobe\n(4:174) measures 4 mm, likely an intrapulmonary node.  Calcified granulomas\nwithin the right lower lobe are noted.  Tracheobronchial tree is patent. \nThere is no pleural effusion or pleural abnormality.\n\nThere are no osseous lesions worrisome for malignancy or infection in the\nchest cage.\n\nAlthough examination is not tailored for subdiaphragmatic evaluation, note is\nmade of cirrhotic liver MR the morphology and evidence of chemoembolization\nwithin the left hepatic lobe several stones are noted within the gallbladder\nlumen.  A left adrenal myelolipoma is stable.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is mild heterogeneity of the\nlower portion of the right lobe of the thyroid gland without dominant nodule. \nOtherwise, the visualized thyroid gland is within normal limits.  There is no\nsupraclavicular lymphadenopathy.  Axillary lymph nodes are mildly prominent,\nbut normal in morphology.\n\nUPPER ABDOMEN: Esophagus is patulous throughout its course which may be\nsuggestive of esophageal dysmotility.  There is a right-sided subdiaphragmatic\nnodule (series 4; image 177), which appears unchanged compared to prior exam\nin ___.\n\nMEDIASTINUM: There are multiple prominent mediastinal lymph nodes.  Subcarinal\nlymph node measures 0.9 cm in short axis (series 4; image 96), unchanged\ncompared to prior.  An additional left peribronchial mediastinal lymph node\nmeasures 1.0 cm in short axis (series 4; image 100), also unchanged compared\nto prior.  No new or enlarging lymph nodes in the mediastinum.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There are mild coronary\nartery calcifications.  There is no pericardial effusion\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG: There airways are patent to the subsegmental level.  Millimetric nodule\nin the right middle lobe in a subpleural location is unchanged (series 4;\nimage 128).  An additional nodule along the pleura of the left lower lobe\n(series 4; image 123) measures 4 mm, likely intrapulmonary node, and unchanged\ncompared to prior.  Calcified granuloma is within the right lower lobe are\nnoted.\n\nCHEST CAGE: There are no concerning osseous lytic or sclerotic lesions.  There\nis no acute compression deformity of the thoracic spine.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Fat stranding in the right lateral chest wall.  No\natherosclerotic calcifications in the head and neck arteries..\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria, the largest in the right superior\nparatracheal station measuring 9 mm (302:53).  No hilar lymphadenopathy.\n\nPLEURA:\nNew large right pleural effusion.  No left pleural effusion.  No apical\nscarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Respiratory motion artifacts\nimpair optimal parenchymal evaluation..  No suspicious lung nodules or masses.\nCompressive atelectasis of the right lower lobe.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show status post ablation of a\nhepatic segment 8 lesion.",
            "output": "New large right pleural, with intermediate attenuation values of ___ ___, not\nspecific for simple fluid or frank blood.  Correlation with thoracocentesis is\nrecommended.\nStatus post ablation of a segment 8 hepatic lesion."
        },
        {
            "input": "Large right pleural effusion.",
            "output": "Successful CT-guided placement of an ___ pigtail catheter into the right\npleural effusion.\n\nRECOMMENDATION(S):  Leave catheter to water seal."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Atherosclerotic disease along the thoracic aorta is\nmoderate.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are multiple bilateral lung nodules measuring up to 6mm\nin the right middle lobe (2:43). There is a very large hiatal hernia\ncontaining the entire stomach (which is flipped upside down) and some small\nbowel.  There is bibasilar atelectasis/scarring, with adjacent smooth pleural\nthickening at the medial lung bases.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a large hiatal\nhernia containing the entire stomach and several loops of small bowel. \nOtherwise, the upper abdomen is grossly unremarkable..\n\nBONES: Sclerotic lesions in the left posterior elements of the left tenth\nvertebral body (602:36), T4 vertebral body (602:34), and a lytic lesion in the\nT9 vertebral body (602:35) may be concerning for metastatic disease. \nCompression deformity of the T12 vertebral body appears chronic. Partially\nimaged are large, well-defined fluid-containing areas overlying the partially\nimaged bilateral shoulders.  Correlate with history of lymphedema or possible\nsevere bursitis.\n\nSOFT TISSUES: A 3.2 x 2.0 cm soft tissue density in the right breast may\nreflect the patient's known right breast cancer (2:89).",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Very large hiatal hernia including the entire stomach (which is flipped\nupside down) and proximal small bowel.\n3. Multiple pulmonary nodules measuring up to 6 mm in the right middle lobe.\n4. Well-defined, fluid-filled structures surround the partially-imaged\nbilateral humeri.  This is incompletely characterized on this study, but may\nreflect bursitis or lymphedema in the appropriate clinical setting.  Correlate\nwith prior imaging and clinical examination.\n5. Multiple sclerotic lesions and one lytic lesion in the thoracic spine are\nsuspicious for metastatic disease given the patient's history of breast\ncancer.\n6. Density in the right breast probably reflects the known breast cancer.\n7. Chronic compression deformity of the T12 vertebral body."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart is\nenlarged.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nDespite lack of intravenous contrast there is apparent mediastinal and\nbilateral hilar adenopathy.  This could be reactive or represent a malignancy.\n\nPLEURAL SPACES: No pleural effusion.\n\nLUNGS/AIRWAYS: Diffuse patchy parenchymal ground-glass opacities with\nconsolidations in the lower lobes consistent with severe inflammatory or\ninfectious etiology.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Moderate amount of ascites.  Gallstone in the gallbladder without\nevidence of acute cholecystitis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Diffuse patchy parenchymal opacities in both lungs with consolidations in\nthe lower lobes consistent with severe infectious or inflammatory process.\n2. Bilateral hilar and mediastinal lymphadenopathy may be reactive to the\nabove process or represent a malignancy, less likely.\n3. Moderate amount of ascites.\n4. Gallstone without evidence of acute cholecystitis."
        },
        {
            "input": "The thyroid is normal.  There is extensive mediastinal lymphadenopathy, not\nsignificantly changed.  Bilateral hilar lymphadenopathy is not significantly\nchanged.  No axillary lymphadenopathy.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is mildly\nenlarged, stable.  Hypoattenuation of the blood pool relative to the\nmyocardium is suggestive of anemia.  There is no pericardial effusion.  A\nleft-sided PICC line terminates at the junction of the left brachiocephalic\nvein with the SVC.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  There are ground-glass opacities throughout the\nbilateral lungs, most confluent in the bilateral lower lobes, as seen on\nrecent CT abdomen and pelvis, and slightly improved compared with ___\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, there is cirrhosis with splenomegaly and\ntrace perihepatic ascites, cholelithiasis, and prominent upper abdominal lymph\nnodes which are better evaluated on recent dedicated CT abdomen and pelvis. \nThe included portions of the upper abdomen are otherwise grossly unremarkable.",
            "output": "1. Ground-glass opacities throughout the bilateral lungs, most confluent in\nthe bilateral lower lobes, are slightly improved compared with ___, may be due to an infectious/inflammatory process or edema.\n2. No significant change in mediastinal and hilar lymphadenopathy.\n3. Cirrhosis with splenomegaly and trace ascites."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Patulous esophagus.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis.  The airways are patent to the level of\nthe segmental bronchi bilaterally.  Very mild bronchial wall thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  A left-sided\nMorgagni hernia is incidentally noted.\n\nBONES: Patient is status post posterior spinal fusion hardware spanning from\nT9 to at least L1.  Degenerative changes throughout the lumbar spine.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Patulous esophagus, bibasilar atelectasis and very mild bronchial wall\nthickening."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate an acute pulmonary\nembolus.  Web-like filling defect in the left lower lobe segmental branch\n(3:85) suggests prior resolved pulmonary embolism.  The thoracic aorta is\nmoderately calcified, however is normal in caliber without evidence of\ndissection or intramural hematoma.  There are coronary artery and aortic valve\ncalcifications.  The heart, pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is no\npneumomediastinum.  An 8 mm node anterior to the ascending aorta is unchanged\nsince ___.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  A 4 mm right upper lobe\npulmonary nodule is stable since at least ___, and does not require\nadditional follow-up (3:41).  No new pulmonary nodules.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatal hernia.  The spleen is enlarged, measuring 14\ncm, unchanged.  Included portion of the upper abdomen is otherwise\nunremarkable.\n\nBONES: There are degenerative changes in the thoracic spine.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No acute pulmonary embolism or aortic abnormality.\n2. No pneumomediastinum.\n3. Splenomegaly, stable.\n4. Small hiatal hernia."
        },
        {
            "input": "LYMPH NODES: Axillary, mediastinal, and hilar nodes are not enlarged by size\ncriteria.\n\nHEART AND GREAT VESSELS: Heart is mildly enlarged.  There is no pericardial\neffusion.  Heavy multifocal coronary calcifications are noted.  There are mild\naortic valve calcifications.  Heavy mitral annular calcifications are also\nnoted.  Thoracic aorta is normal in caliber, with mild atherosclerotic\ncalcifications throughout.\n\nAIRWAYS AND LUNGS: Since the prior CT performed on ___, there has\nbeen interval left upper lobectomy.  A small amount of residual pleural air at\nthe left apex persists.  However, when comparing prior radiographs performed\non ___ compared to ___, the amount of air appears to\nhave decreased.  Severe background centrilobular emphysema noted.  There is\npleuroparenchymal scarring at the right apex.  Small bilateral pleural\neffusions.  Bibasilar consolidations, more streaky in appearance on the left\nlung base, likely represent atelectasis.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows heavy\natherosclerotic disease in the upper abdominal aorta.\n\nBONES AND SOFT TISSUES: There is no acute fracture.  Several remote fractures\nare noted involving the left lateral third, fourth, fifth ribs.  No suspicious\nlytic or sclerotic lesions are identified.  The soft tissues are unremarkable.",
            "output": "1. Postsurgical changes after interval left upper lobectomy.  Small amount of\nleft apical pleural air may have minimally decreased between ___ and\n___, which is likely postsurgical.  A bronchopleural fistula is not\nexcluded, although felt to be less likely given the interval decrease in air\npocket within the left upper lobectomy surgical bed.\n2. Small bilateral pleural effusions.  Bibasilar opacities likely represent\natelectasis, although superimposed infection would be difficult to exclude.\n3. Severe background centrilobular emphysema."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging.  Supraclavicular\nand axillary lymph nodes are not enlarged.  Breast evaluation is reserved\nexclusively for mammography.  No soft tissue abnormalities elsewhere in the\nchest wall.  This study is not designed for subdiaphragmatic diagnosis but\nshows no adrenal mass or subphrenic collection.\n\nCARDIO-MEDIASTINUM:Esophagus is traversed by a drainage or feeding tube ending\nin the upper portion of a mildly dilated stomach, otherwise unremarkable. \nAtherosclerotic calcification is not apparent head and neck vessels, but is\nscattered in coronary arteries.  Multi chamber cardiomegaly and enlargement of\nthe pulmonary arteries is best evaluated by echocardiography.  Ascending\nthoracic aorta is unremarkable.  Descending thoracic aorta is generally\ntop-normal size.  Extensive atherosclerosis below the diaphragm involves\nnormal caliber aorta and major visceral arteries, including the right renal\nartery.  There is no pneumomediastinum or abnormal fluid collection in the\nmediastinum.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically enlarged\nor growing.\n\n\nLUNGS, AIRWAYS, PLEURAE:\n\nEmphysema is severe.  Right lung is clear of focal abnormalities.  Mild\nretention of secretions is present in the right lower lobe.\n\nLeft upper lobe bronchial stump has the anticipated postoperative appearance\nwhere there may be a tiny remnant of upper lobe bronchus or a tiny\ndiscontinuity permitting a small, gas containing diverticulum that extends\nonly 5 mm beyond the plane of the ligation, 302:95.  This tiny gas containing\ncomponent is smaller today than it was on ___, but on neither study is\nthere an associated fluid collection or any  gas in the adjacent pleural space\nor mediastinum to suggest dehiscence.  Today there is a much heavier volume of\nretained secretions in the left lower lobe bronchus and its segmental\ndivisions, accounting for an increase in moderately severe basal atelectasis.\n\nSmall nonhemorrhagic right pleural effusion has nearly resolved.  Small,\nlayering and dependent component nonhemorrhagic left pleural effusion is\nunchanged.  Loculated air and fluid collection in the persistent pleural space\nat the apex of the left hemithorax is unchanged in overall size and the air\ncollection, entirely at the extreme apex, is smaller, 29 x 25 mm today, 2:9,\n40 x 25 mm on ___.  There are no bubbles of gas in either the\nmediastinum or the persistent apical pleural space, which is slowly filling\nwith fluid.\n\n\nCHEST CAGE: Aside from healing fractures, anterolateral left upper ribs,\npresumably dating from surgery, chest cage is unremarkable.",
            "output": "No radiographic findings to suggest dehiscence, left upper lobe bronchial\nstump which has the expected postoperative appearance persistent left apical\npleural space is slowly filling with fluid.  No subcutaneous emphysema no\nextravasated gas in either the mediastinum or the pleural space.\n\nSmall, layering nonhemorrhagic dependent pleural effusions, left greater than\nright, both smaller today than on ___.\n\nHeavy retained secretions, left lower lobe bronchial tree explains persistent\nmoderately severe left lower lobe atelectasis.\n\nSevere cardiomegaly.\n\nSevere emphysema.\n\nHeavy atherosclerotic calcification abdominal aorta and major vessels."
        },
        {
            "input": "Heart size is enlarged especially left atrium, unchanged.  Main pulmonary\narteries substantially dilated up to 3.6 cm mitral annulus calcifications are\nextensive.  The patient is after mitral clip surgery.\n\nAirways are patent to the subsegmental level bilaterally.  Severe emphysema,\ncentrilobular is bilateral.  Right apical scarring is stable, series 4, image\n19.  Right lower lobe 5 mm nodule is stable, solid, series 4, image 193.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.",
            "output": "No evidence of local or remote recurrence.\nCardiomegaly, pulmonary hypertension.\nStatus post mitral clip surgery.\nSevere emphysema."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, lymph nodes are not\nenlarged.  Hilar lymphadenopathy is difficult to evaluate in a given the lack\nof IV contrast.  Prevascular lymph node measures 8 mm.  Right upper\nparatracheal station lymph node measures 11 mm.  The ascending aorta measures\n3.3 cm in maximum diameter.  The pulmonary artery is enlarged measures 3.2 cm.\nThere is speckle of calcification medially in the proximal ascending aorta. \nThere is mild calcification in the arch and mild to moderate calcification in\nthe descending thoracic aorta.  There is mild cardiomegaly.  There are dense\ncalcifications in all coronary arteries and in the mitral annulus.  There is\nmoderate calcification in the aortic valve.  There is no pleural or\npericardial effusion.\nGround-glass opacities predominating in the upper lobes are associated with\ninterlobular septal thickening likely represent edema.\nLung nodules are as follows:\n4 mm right upper lobe (04:59)\n2 mm subpleural right upper lobe (04:59)\n5 mm subpleural right lower lobe (4:144)\n7 mm right lower lobe (4:132)\n2 mm nodule in the right apex ___ ).\nModerate centrilobular emphysema is upper lobe predominant.\nSubpleural peribronchial opacities in the posterior segment of the right upper\nlobe could be asymmetric edema or infection\nThere are multiple impacted bronchi in the lower lobes\nThis examination is not tailored for subdiaphragmatic evaluation there is a\nsmall hiatal hernia.  Patient is status post cholecystectomy.  The left\nadrenal gland is slightly nodular\nThere are no bone findings of malignancy",
            "output": "Emphysema\nPulmonary edema\nOpacities in the posterior segment right upper lobe could be infection or\nasymmetric edema\nExtensive coronary calcifications and calcification in the aortic valve and\nmitral annulus.\nMediastinal lymphadenopathy is likely reactive\nEnlarged pulmonary artery could represent pulmonary edema\nSmall hiatal hernia\nLung nodules followup in ___ year is recommended"
        },
        {
            "input": "There is stable mild enlargement of the thyroid gland with presence of\nmultiple hypodense nodules measuring up to 7 mm on the right. There are no\npathologically enlarged supraclavicular, mediastinal, hilar or axillary lymph\nnodes.\n\nHeart size is normal with no pericardial effusion. Moderate aortic valvular\nand coronary artery calcifications are stable. The main pulmonary artery and\nthoracic aorta are normal caliber. No incidental central pulmonary embolus is\nidentified.\n\nThe patient has had prior right upper lobectomy with an unremarkable\npostoperative appearance of the bronchial stump and remaining right lung. A 5\nmm left upper lobe subpleural nodule is stable (series 301, image 145). No new\nnodules are identified. Mild to moderate centrilobular and paraseptal\nemphysema is stable. Punctate calcified granulomas are identified bilaterally\n(301, 117 and 168). There is no endobronchial lesion or pleural abnormality.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Stable exam with no interval growth of a pre-existing 5 mm left upper lobe\nsubpleural nodule, which is stable since ___, and is presumed benign.\nNo new nodules identified.\n\nStable mild to moderate emphysema."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: Heterogeneous thyroid with subcentimeter nodules is\nunchanged.  No supraclavicular, axillary, hilar or mediastinal\nlymphadenopathy.  The esophagus contains some retained enteric contrast but is\notherwise unremarkable.\n\nThe heart and pericardium are within normal limits.  The thoracic aorta and\ngreat vessels are normal in caliber with scattered atherosclerosis.  There is\nalso calcification of the aortic valve and coronary arteries.  The main\npulmonary arteries are normal in caliber and well opacified centrally.\n\nPatient is status post right upper lobectomy.  The bronchial stump appears\nintact.  There is no new abnormal soft tissue along the resection margin to\nsuggest local recurrence.  No pleural effusion or pneumothorax.\n\nScarring and architectural distortion in the right middle lobe is similar to\nprior.  There moderate bilateral centrilobular and paraseptal emphysema on a\nbackground of mild interstitial lung disease with subpleural fibrosis in the\nmid and lower lungs bilaterally, slightly progressed. A new peribronchial\ninfiltration in the right middle lobe measures 13 mm in aggregate diameter\n(6:109).\n\n6 mm left upper lobe subpleural nodule is unchanged (6:164).  5 mm right lower\nlobe nodule (6:133) is unchanged.\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions.",
            "output": "1. No definite evidence of recurrent malignancy in the thorax.\n2. New 13 mm nodular peribronchial infiltrates in the right middle lobe could\nbe inflammation or malignancy.  Follow-up CT in 3 months is recommended to\ndocument resolution.\n3. Stable left upper and right lower lobe pulmonary nodules since at least\n___.\n4. Centrilobular and paraseptal emphysema is moderate on a background of mild\nactive non-specific interstitial lung disease which has minimally progressed,\npossibly NSIP.\n\nRECOMMENDATION(S):  Follow-up CT in 3 months is recommended to document\nresolution of right middle lobe peribronchial infiltrates."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Heterogeneous thyroid with\nsubcentimeter nodules unchanged.  There is no supraclavicular or axillary\nlymphadenopathy.  There is no soft tissue abnormality within the chest wall\nsuspicious for malignancy. There is minimal calcification of the head and neck\nvessels.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is mild calcification of\nthe coronary arteries and mild calcification of the aortic valvular annulus. \nThere is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA: Patient status post right upper lobectomy.  Scarring and\narchitectural distortion in the right middle lobe is unchanged.  There is\nmoderate centrilobular and paraseptal emphysema.  There is mild subpleural\nfibrosis in the bilateral mid and lower lungs.   The bronchial stump appears\nintact and there is no abnormal soft tissue along the resection margin to\nsuggest local recurrence. 5 mm right lower lobe nodule (6:125) previously\nmeasured 4 mm.  6 mm left upper lobe subpleural nodule (6:149) previously\nmeasured 6 mm.\n2. AIRWAYS:  Tracheobronchial tree is patent to the subsegmental level\nbilaterally.\n3. VESSELS:  Aorta and main pulmonary artery are normal size.\nBONES: There is no lytic or sclerotic lesion in the chest cage or thoracic\nspine suspicious for malignancy.\n\nUPPER ABDOMEN: The study is not designed for evaluation of subdiaphragmatic\nstructures.  Please see separate, same-day CT abdomen and pelvis report for\ndescription of subdiaphragmatic findings.",
            "output": "1. No evidence of local recurrence or intrathoracic metastatic disease.\n2. Interstitial lung disease with mild subpleural fibrosis in the bilateral\nmid and lower lungs.\n3. Moderate centrilobular and paraseptal emphysema.\n4. Please see separate, same-day CT abdomen and pelvis report for description\nof subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unchanged 1.7 cm hypodense lesion\nin the left hemi thyroid and multiple subcentimeter hypodensities throughout\nthe thyroid.  No axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No lymphadenopathy.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion. \nModerate coronary artery and aortic valvular calcification.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Status post right upper lobectomy.  Unchanged scarring and\narchitectural distortion in the right middle lobe.  Unchanged moderate\ncentrilobular and paraseptal emphysema.  The bronchial stump is intact without\nabnormal soft tissue along the resection margin to suggest local recurrence. \nNo new or growing pulmonary nodules.  Unchanged 0.5 cm subpleural nodule in\nthe right lower lobe (___).  Unchanged 0.6 cm subpleural nodule in the left\nupper lobe (___).  Unchanged 0.2 cm nodule in the left upper lobe (___). \nA few punctate calcified granulomas are unchanged.  No evidence of active or\nreactive infection.  Unchanged emphysema - related interstitial lung disease.\n2. AIRWAYS:  The trachea has a saber sheath configuration, measuring 3.3 x 1.6\ncm, similar to prior.  Few inspissated secretions in the trachea, concerning\nfor aspiration (___).  Patent to the subsegmental levels bilaterally.\n3. VESSELS:  The main pulmonary artery is normal in size.  The right pulmonary\nartery is enlarged, measuring 2.9 cm.  No incidental pulmonary embolism.\nCHEST CAGE: No fractures or suspect osseous lesions.  Minimal multilevel\ndegenerative changes of the imaged spine.",
            "output": "1. The patient is status post right upper lobectomy.  Compared to ___,\nno new or growing pulmonary nodules.\n2. No lymphadenopathy.\n3. Unchanged 1.7 cm hypodense lesion in the left hemi thyroid.  If clinically\nindicated, consider thyroid ultrasound for further evaluation.\n4. Unchanged moderate centrilobular and paraseptal emphysema.  Unchanged\nemphysema related interstitial lung disease.\n\nRECOMMENDATION(S):  If clinically indicated, consider thyroid ultrasound for\nfurther evaluation of an unchanged 1.7 cm hypodense lesion in the right hemi\nthyroid.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 13:42 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Left thyroid nodule is stable..  Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal, there are severe calcifications in all\ncoronary arteries.  Moderate calcification in the aortic valve is of unknown\nhemodynamic significance.\nPatient is status post right upper lobectomy, the stump is unremarkable.  The\nesophagus is slightly patulous.  Scarring and architectural distortion in the\nright middle lobe is stable.  Moderate centrilobular and paraseptal emphysema\nand emphysema related interstitial lung disease are stable.  Pre-existing\nmicro nodules are stable none new or enlarging lung nodules identified\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Emphysema and emphysema related interstitial lung disease are stable.\nNo new or enlarging lung nodules"
        },
        {
            "input": "Aorta is normal in diameter.  Aortic valve calcifications are extensive and\nconcerning for potential aortic stenosis.  Coronary calcifications are\nmoderate.  Main pulmonary artery is dilated up to 3.4 cm..  Heart size is\nenlarged.  There is no pericardial or pleural effusion.\n\nRadiopaque object approximately 15 mm is demonstrated in the left lower lobe\npulmonary artery branch.  It can be seen on axial and coronal reconstructions,\nseries 7 image 59-50.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse\nground-glass opacity is demonstrated, involving all the lung parenchyma with\nfocal areas of lower lucency for example in left upper lobe, series 5, image\n57 or in superior segment of left lower lobe, series 5, image 115 or left\nupper lobe, series 5, image 115.  Minimal ___ opacities are\ndemonstrated in the lingula, series 5, image 163 and in right lower lobe,\nseries 5, image 201.\n\nRight upper lobe nodule is 7 mm, series 5, image 57, solid\n\nRight lower lobe nodule is 6 mm, series 5, image 201.  Left upper lobe nodule\nis 9 mm, mixed density, series 5, image 115.\n\nImage portion of the upper abdomen demonstrate no appreciable abnormality\nwithin the limitations of the study technique that is not designed for\nassessment of intra-abdominal pathology.",
            "output": "Dilated main pulmonary artery concerning for pulmonary hypertension\n\nFocal radiopaque density in the right lower lobe pulmonary artery that might\nrepresent segment of previously inserted intravascular device, please\ncorrelate with patient history.  Consultation with vascular surgery is\nrecommended.\n\nMosaic attenuation that might reflect the presence of pulmonary hypertension\n\nSeveral pulmonary nodules as described.  Giving the size of the largest\nnodule, short-term follow-up in 3 months is required.\n\nMinimal ___ opacity in the right middle lobe and right lower lobe\nmight represent current infection, please correlate clinically.\n\nCardiomegaly.  Aortic valve calcifications that might be concerning for aortic\nstenosis, echocardiography is recommended.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:56 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "HEART AND VASCULATURE: The heart is enlarged.  There is moderate\natherosclerotic calcification of the coronary arteries and aortic valve.  A\nlinear opacity is again demonstrated in inferior left hilum (series 5, image\n151).  No pericardial effusion.  The main pulmonary artery measures 3.1 cm in\ndiameter.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy. \nInterval increase in size of multiple mediastinal nodes, a right paratracheal\nnode measures 1.1 cm in the short axis (series 5, image 115), a left\nparatracheal node measures approximately 1.1 cm in the short axis.  Evaluation\nfor hilar lymphadenopathy is limited without contrast however both hila appear\nmore full compared to the prior study, however this may be due to differences\nin breath-holding and increased pulmonary venous pressure.\n\nLUNGS/AIRWAYS: There is diffuse bilateral ground-glass opacity with septal\nthickening most predominant within the right upper and lower lobes with a\npredominance for the posterior and peripheral lung.  Findings are\nsubstantially worsened compared to the prior study.  A periportal 6 mm nodules\nin the right lower lobe is grossly unchanged (series 5, image 210).  A right\napical nodule measures 0.5 cm and is unchanged compared to the prior study. \nThe airway is patent bilaterally.\n\nSmall bilateral pleural effusions, greater on the right, which are\nnonhemorrhagic.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A hypodensity within the right kidney is too small to characterize by\nCT but could represent simple cyst.  There is some perinephric stranding\nbilaterally.  There are prominent right periaortic nodes measure up to 1.2 cm\n(series 5, image 95).\n\nBONES: A 6 mm sclerotic focus within the T6 vertebral body is stable (series\n7, image 81).  There is no acute fracture.",
            "output": "1. Substantial interval worsening of now diffuse bilateral ground-glass\nopacities which include septal thickening most predominant in the posterior\nright upper and lower lobe.  Differential includes disseminated infectious\n(bacterial versus viral) process, chronic interstitial disease (less likely\ngiven interval change), hypersensitive pneumonitis, acute alveolar process\nsuch as edema or sarcoidosis.  Tuberculosis is not completely excluded given\nthe patient's clinical history, however would be atypical in appearance.\n2. Redemonstration of a linear density within the inferior left hilum,\nconcerning for retained catheter tip within a pulmonary artery, as\ndemonstrated previously.\n3. Bilateral small nonhemorrhagic pleural effusions, right greater than left.\n4. Cardiomegaly with moderate-severe calcification of cardiac structures."
        },
        {
            "input": "Milli metric right thyroid nodule (2, 1).  No supraclavicular, infraclavicular\nor axillary lymphadenopathy.  A borderline sized lymph node in the right part\nof the thoracic inlet (2, 8).  No enlarged hilar or mediastinal lymph nodes. \nBilateral gynecomastia.  No substantial coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  Mild enlargement of the left atrium\n(2, 33).  The degree of wall thickening of the lower esophagus, as well as the\nlocal venous collaterals and the abundant ascites in perihepatic and\nperisplenic location are not substantially changed as compared to the previous\nexamination.  Upper abdominal findings are described in detail in the\ndedicated abdominal CT report.  Moderate degenerative vertebral disease.  No\nvertebral compression fractures.  Stable mild bilateral apical scarring. \nStable mild paraseptal pulmonary emphysema.  Several pre-existing micro\nnodules are all unchanged in size and morphology.  Also unchanged is a 3-4 mm\nright fissural nodule.  Respiratory motion limits the assessment of the lung\nbases.  No pleural thickening, no pleural effusions.",
            "output": "Stable morphology of the upper abdomen and the gastroesophageal junction. \nStable pulmonary micro nodules in right perifissural nodule.  No new or\ngrowing nodules.  No pleural effusions.  Borderline sized right thoracic inlet\nlymph node."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular lymph nodes are not enlarged.  Numerous\nsubcentimeter lymph nodes are present in both axillae.  Gynecomastia is\nmoderate on the left, mild on the right.\n\nThis study is not designed for subdiaphragmatic diagnosis last evaluated by an\nMRI of the liver on ___.\n\nCARDIO-MEDIASTINUM:Hiatus hernia is small and surrounded by varices.  Above\nthat level the esophagus is normal.  Atherosclerotic calcification is not\napparent in head and neck vessels or in the coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions:\n\nPunctate perifissural nodule, right middle lobe, 5:137.\n\nLeft lung is clear.\n\nTracheobronchial tree is normal to subsegmental levels.  There is no pleural\nabnormality.\nCHEST CAGE:\nAside from endplate disc intrusion is and discogenic sclerosis, there are no\nfindings of note in the chest cage. Although there are no bone lesions in the\nimaged chest cage suspicious for malignancy or infection, it should be noted\nthat radionuclide bone and FDG PET scanning are more sensitive in detecting\nearly osseous pathology than chest CT scanning.",
            "output": "Solitary punctate lung nodules not good evidence for intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No abnormalities seen at the base\nof the neck.  The thyroid gland demonstrates a few subcentimeter scattered\nhypodensities in bilateral lobes.\n\nUPPER ABDOMEN: Please refer to the dedicated same day CT abdomen and pelvis\nfor full description of subdiaphragmatic findings including cirrhotic liver\nand multiple varices.  There is irregularity of the distal esophagus and\ngastroesophageal junction.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mediastinal mass.\n\nHILA: No evidence of hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The cardiac size is mildly prominent, but unchanged. \nThere is no pericardial effusion.\nPLEURA: No evidence of pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is again mild paraseptal emphysema in the upper lobes. \nIncidental note is made of a 4 mm perifissural nodule in the right major\nfissure (6:134), which was probably present in ___.  No focal consolidation\nis appreciated.\n2. AIRWAYS: The airways appear patent to the subsegmental level.\n3. VESSELS:  There is no evidence of thoracic aortic aneurysm.  The main\npulmonary artery is nonenlarged.  There is enlargement of the azygos, likely\nsecondary to portal hypertension.\nCHEST CAGE: There is no concerning osseous lesion identified.",
            "output": "1. 4 mm perifissural nodule in the right major fissure was probably present in\n___, accounting for differences in positioning and technique.  Otherwise, no\nnew concerning lesions are seen in the chest.\n2. Please refer to the dedicated same day CT abdomen and pelvis for full\ndescription of subdiaphragmatic findings including cirrhotic liver and\nmultiple varices."
        },
        {
            "input": "LINES/TUBES: Satisfactory placement of the right IJ venous catheter, and\nendotracheal tube the enteric tube courses into the stomach but terminate\noutside of the field of view.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland appears\nunremarkable.  There is no evidence of axillary or supraclavicular\nlymphadenopathy.\n\nUPPER ABDOMEN: See separate report from concurrently performed CT abdomen and\npelvis.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria. \nContrast seen refluxing into the esophagus.\n\nHILA: There is no evidence of hilar lymphadenopathy, although evaluation is\nlimited by the absence of intravenous contrast.\n\nHEART and PERICARDIUM: The heart is not enlarged.  Coronary atherosclerotic\ncalcifications are noted.  There is a trace amount of pericardial fluid.\nPLEURA: A small right and moderate left pleural effusion are new compared to\nprior CT.  No pneumothorax is identified.\nLUNG:\n\n1. PARENCHYMA:  There is moderate centrilobular and paraseptal emphysema. \nThere is complete collapse of the left lower lobe.  There is new patchy\nmultifocal airspace disease, which predominantly involves the right upper lobe\nand right lower lobe but is also seen in the right middle lobe, left upper\nlobe and lingula.\n2. AIRWAYS:  Endotracheal tube is proper positioned.  No endobronchial lesions\nidentified.  There is mucous plugging in the subsegmental airways of the\nbilateral upper lobes and right lower lobe.\nCHEST CAGE: Multiple old healed/healing rib fractures are noted.  No\nsuspicious osseous lesions.",
            "output": "1.  New mucous plugging in the subsegmental airways and patchy multifocal\nairspace disease, which may represent multifocal pneumonia or aspiration\npneumonitis.\n2.  New small right and moderate left effusions with complete collapse of the\nleft lower lobe.\n3.  Moderate emphysema.  No pneumothorax."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe main and proximal right and left pulmonary arteries are markedly dilated. \nThere is mild cardiomegaly.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma. No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM, neck base, axilla: There is 0.5 cm short axis\nright paratracheal thoracic inlet nodule, likely lymph node.  There is no\nadenopathy in the mediastinum, hila.  No axillary adenopathy.  There is\nenhancing 1.7 cm clavicular nodule, lateral to the common carotid artery and\ninternal jugular vein, worrisome for pathologic lymph node.  No mediastinal\nmass.\n\nPLEURAL SPACES: There are small right and trace left pleural effusions,\nnonhemorrhagic.  No pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is biapical subpleural scarring.  There is mild\ninterlobular septal thickening, best seen at the bases, consistent with mild\npulmonary edema.  There is minimal basilar atelectasis, adjacent to pleural\neffusions.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY:\nThere are few hyperattenuating areas within right renal collecting system, and\nproximal right ureter, consistent with by FRAX, correlate for hematuria.\nThere is a large, heterogeneously, avidly enhancing mass arising from the\nlower pole of the left kidney.  The dominant, avidly enhancing portion\nmeasures at least 9.7 x 8.8 x 7.3 cm (series 6, image 136; series 14, image\n15).  Superior to the measured portion described above, heterogeneity\nextending into the remaining renal parenchyma suggests substantial tumoral\ninfiltration, and tumor itself may measure up to 15 cm, series 9 image 29,\nsagittal images.\nThe right renal vein is heterogeneously opacified by enhancing tumor just\nproximal to its confluence with the inferior vena cava, probable small\ncomponent of bland thrombus.  There is extensive collateralization of venous\ndrainage from the right kidney which drains into the right gonadal vein. \nThere is linear thickening and enhancement of the right perianal soft tissues,\nmay be from tumor infiltration..  Prominent pararenal vasculature.  Dilated\nright upper pole collecting system of the right kidney.\n\nLeft kidney is normal in size and attenuation with multiple scattered\nhypoattenuating lesions which are too small to completely characterize, but\nstatistically likely simple cysts.  No hydronephrosis or left perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is not visualized.  There is no free intraperitoneal\nfluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is significant\npresacral edema and a small amount of pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is slightly retroflexed.\n\nLYMPH NODES: There is extensive retroperitoneal lymphadenopathy.  A right\npericaval lymph node measures 3.1 x 1.9 cm and abuts the right psoas muscle\n(series 6, image 136).  Another heterogeneous pericaval lymph node measures\n2.2 x 1.8 cm (series 6, image 118).  An aggregate of pericaval/aortocaval\nlymph nodes measures 4.3 x 2.5 cm and appears to anteriorly displace the\ninferior vena cava (series 6, image 105).  The largest left para-aortic lymph\nnode measures 1.9 x 1.2 cm (series 6, image 117).  No mesenteric, pelvic, or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is fat only containing left inguinal hernia. \nDegenerative changes spine, sacroiliac joints, hips, pubic symphysis.",
            "output": "1. A large right renal mass measuring up to 15 cm is most consistent with\nrenal cell carcinoma.  There is invasion of the right renal vein extending\njust proximal to its confluence with the inferior vena cava, with small\ncomponent of bland thrombus.  Extensive retroperitoneal lymphadenopathy is\nconsistent with metastasis.  Hypervascular medial left supraclavicular nodule,\nlikely represents metastatic lymph node.  Suggestion of right hematuria. \nObstructed right upper pole renal collecting system, delayed right nephrogram.\n2. Dilation of the pulmonary arteries suggests pulmonary hypertension.  No\nevidence of pulmonary emboli.\n3. Nonspecific small right and trace left pleural effusions.  There is mild\npulmonary edema, and cardiac enlargement."
        },
        {
            "input": "A 0.5 cm hypodense lesion is seen within the left thyroid lobe.  The thyroid\nis otherwise unremarkable.  There is no axillary lymphadenopathy.  A large\nleft supraclavicular mass, has increased in size compared to the prior exam,\nnow measuring 2.6 cm x 2 cm, previously measuring no more than 1.8 cm, series\n4, image 48 additional prominent left supraclavicular lymph nodes are seen\nmeasuring up to 0.6 cm, concerning for neoplastic involvement.  There has been\ninterval increase in mediastinal lymphadenopathy, for example a right\npretracheal lymph node, series 4, image 102 measures 1.2 cm, increased in size\ncompared to the prior exam.  Mild prominence of the right hilar lymph nodes\nmeasuring up to 0.7 cm in short axis is unchanged compared to the prior exam. \nA subcarinal lymph node measures up to 0.8 cm, unchanged compared to the prior\nexam.  An enlarged prevascular lymph node, series 4, image 88 measures 0.9 cm,\nslightly increased in size compared to the prior exam at which time this\nlesion measured no more than 0.6 cm.\n\nThe esophagus is patulous, otherwise unremarkable.\n\nMild cardiomegaly is unchanged compared to the prior exam.  The main and\nproximal right and left pulmonary arteries are markedly dilated, overall\nsimilar in appearance compared to the prior exam.  A pulmonary embolus is seen\nwithin a segmental branch of the left lower lobe pulmonary artery.  There is\nno definite evidence of right heart strain.  There is no evidence of\nassociated pulmonary infarction.  The thoracic aorta is normal in caliber. \nThere is no evidence of a pericardial effusion.  Mild-to-moderate coronary\ncalcifications are seen along the proximal coronary arteries.\n\nThe airways are patent to the subsegmental levels.  Note is made of biapical\nscarring.  No concerning pulmonary nodules are identified.  Bibasilar\nrelaxation atelectasis is seen.  There is no pleural effusion or pneumothorax.\n\nFor evaluation of the abdominal structures, please refer to the dedicated CT\nof the abdomen performed on the same day.\n\nOsseous structures: No focal lytic or sclerotic lesions are seen within the\nthoracic spine.",
            "output": "1. New pulmonary embolus is seen within the subsegmental left lower lobe\npulmonary artery, however there is no evidence of pulmonary infarction or\nright heart strain.\n2. Interval increase in size of a large left supraclavicular mass, now\nmeasuring up to 2.6 cm, previously measuring no more than 1.8 cm concerning\nfor worsening metastatic involvement.\n3. Slight interval increase in mediastinal lymphadenopathy, now measuring up\nto 1.2 cm, concerning for underlying neoplastic involvement.\n4. Stable dilatation of the pulmonary arteries, suggestive of pulmonary\nhypertension.\n5. No concerning pulmonary nodules identified.\n\nNOTIFICATION:  Communication of the pulmonary embolus was discussed with\n___, M.D.  By ___, M.D. on the telephone on ___ at 9:21\npm, 10 minutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Re-demonstrated is a 5 mm nodule in\nthe left lobe of the thyroid gland.  There a left supraclavicular mass\nmeasuring 2.4 by 2.4 x 2 .2 cm in size and previously measuring 2 x 2.0 x 1.8\ncm in size by my measurements.  There is compression with displacement of the\nadjacent left common carotid artery medially.\n\nUPPER ABDOMEN: Please refer to the report for the CT scan of the abdomen which\nwas performed on the same day.\n\nMEDIASTINUM/HILA: There is slight decrease in mediastinal adenopathy.  For\nexample, there is a pretracheal lymph node, series 5, image 131 which\npreviously measured 12 mm and today measures 10 mm in short axis.  Previously\nnoted 7 mm right hilar lymph node has decreased in size.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  There is no pericardial\neffusion.  The thoracic aorta maintains normal caliber.\nPLEURA: There are no pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Stable scarring is seen in the lung apices.  There is a stable\n2 mm nodule in the left lower lobe.  The airways are patent to the\nsubsegmental level.\nCHEST CAGE: The bones are diffusely osteopenic.  Degenerative changes are\nevident in the spine.",
            "output": "Enlarging left supraclavicular mass, likely metastatic nodal mass.\n\nDecrease in size of previously seen mediastinal and right hilar lymph nodes.\n\nStable 2 mm left lower lobe nodule."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.6 cm nodule in the left lower\nthyroid is unchanged, too small to warrant further imaging.  Left\nsupraclavicular 1.9 x 1.4 cm enhancing mass, mildly smaller in comparison to\n___ when it measured 2.6 x 2 cm (03:12).\n\nCHEST CAGE: Multilevel moderate degenerative changes of the vertebra with no\nevidence of lytic or sclerotic osseous destructive lesions the level of the\nribs, sternum or vertebra.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: Subcarinal lymph node measuring 0.7 cm, unchanged and\nnonpathologic enlarged (3:95).  0.8 cm right lower paratracheal enhancing\nlymph node are stable (3:81).  The posterior mediastinum is within normal\nlimits.  There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Marked dilatation of the main, proximal right and left\npulmonary arteries, measuring up to 4.3 cm (02:25, a 602:47), unchanged in\ncomparison to ___.\nSuboptimal opacification of pulmonary vasculature is no central filling\ndefects.\n\nThere are no appreciable atherosclerotic calcifications of the coronaries. \nMinimal calcifications along the left ventricular outflow tract, unchanged. \nThe thoracic aorta is minimal calcified and normal in diameter.  The heart is\ntop-normal in size, exaggerated by the mild pectus excavatum.  Pericardium is\nphysiologic.\n\nPLEURA: Biapical nodular pleuroparenchymal scarring and containing punctate of\ncalcifications extending posteriorly and laterally to the level of major\nfissure is stable.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  Left upper\nlobe 0.3 cm nodule is stable since ___.  No new pulmonary nodules.",
            "output": "Left supraclavicular metastatic lesion has mildly decreased in size in\ncomparison to ___.  Stable small mediastinal lymph nodes.\nNo new pulmonary nodules or other new site of disease.\nEnlarged stable main pulmonary artery."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  There is no evidence of right heart strain. \nAs on prior, the main pulmonary artery is prominent and the left pulmonary\nartery is enlarged up to 4.3 cm.\n\nA left supraclavicular confluence of lymph nodes measures up to 2.9 cm (03:13)\nand appears more conspicuous than on prior CT from ___.  A subcarinal\nlymph node measures 0.5 cm and is slightly less prominent than on prior\n(3:67).  No hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is biapical pleural thickening and scarring.  No focal consolidation or\nsuspicious pulmonary masses are identified.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nMultilevel degenerative changes of the thoracic spine.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.  Persistent\nenlargement of the left main pulmonary artery.\n\n2.  Interval increase in size of a confluence of left supraclavicular lymph\nnodes measuring up to 2.9 cm."
        },
        {
            "input": "THORACIC INLET: The thyroid is heterogeneous with a stable hypodense lesion in\nthe left lobe of thyroid.  The left supraclavicular nodal mass measures\napproximately 3.6 x 3.7 cm and has increased in size it previously measured\n3.4 x 3.2 cm.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal and left hilar lymph nodes are also unchanged\nin size.  The main pulmonary artery is enlarged and measures 4.1 cm.  There is\nmild cardiomegaly.  There is no coronary artery calcification.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is biapical pleuroparenchymal scarring.  There is bibasilar\natelectasis.  No new or growing pulmonary nodules\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with degenerative\nchanges involving the thoracic spine.  No lytic or sclerotic lesions\nconcerning for metastasis are seen\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows patient is\nstatus post right nephrectomy.  Please refer to dedicated report on abdomen\nwhich has been dictated separately.",
            "output": "Progressive increase in size of the condylar merit L left supraclavicular\nnodal mass.\n\nStable small mediastinal left hilar lymph nodes.\n\nNo new or growing pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated.  Patient\nstatus post right nephrectomy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  The left\nsupraclavicular nodal mass measures approximately 3.6 x 3.6 cm, unchanged from\npreviously measuring 3.6 x 3.7 cm.\n\nMEDIASTINUM AND HILUM:  There are multiple small mediastinal and hilar lymph\nnodes measuring up to 8 mm, unchanged from prior study.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main pulmonary artery and left pulmonary artery are enlarged and\nunchanged.\n\nPULMONARY PARENCHYMA:  There are no new or developing pulmonary nodules. \nThere is no emphysema.  There is unchanged biapical pleuroparenchymal\nscarring.  There is unchanged right middle lobe atelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen. \nPlease refer to the same day CT abdomen and pelvis report for further details\nof subdiaphragmatic findings.",
            "output": "1. Unchanged left supraclavicular nodal mass.\n2. No new or developing pulmonary nodules.\n3. Please refer to the same day CT abdomen and pelvis report for further\ndetails of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla. \nUnchanged size of a heterogeneous mass in the left cervical space measuring\n3.9 x 3.2 cm (03:17).  Other nodules the same appearances are noted in the\nipsilateral posterior cervical cyst space, larger than in prior study, for\nexample a nodule (3:8) measuring 2.0 x 1.5 cm, previously 0.8 x 0.7 cm.  No\natherosclerotic calcifications in the head and neck arteries.  No\nabnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries or cardiac valves,\nmild in the aorta.  The aorta is normal in caliber throughout.  Enlarged main\nand left pulmonary arteries, unchanged from prior.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Multiple small mediastinal lymph nodes, some\nof which are hyperdense, all unchanged and not pathologically enlarged by CT\nsize criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Moderate bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Stable 3 mm nodule in the left\nupper lobe (3:100).  No suspicious lung nodules or masses.  No consolidations\nor atelectasis.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Redemonstration of left cervical and supraclavicular lymphoid conglomerates\nsuggestive of metastatic disease.  Some of the nodules in the left cervical\nspace have grown compared to ___ suggestive of metastatic disease\nprogression.\n\nAsymmetric dilation of the main and left pulmonary arteries is suggestive of\npulmonary hypertension, possibly associated to either valvular or\nsupravalvular stenosis. Recommend further assessment with echocardiogram.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 14:48 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: Growing left supraclavicular nodal conglomerate, at least 30\nx 75 mm in aggregate diameters, previously 16 x 69 mm, more severely\ncompromises but does not occlude left subclavian vein.  New edema in the left\nupper anterior chest wall and breast is new.  Left peripectoral upper chest\nwall adenopathy ranging in diameter up to 19 mm, 02:25, is new.  Findings\nbelow the diaphragm will be reported separately.\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head neck vessels but is considerable in left circumflex\ncoronary artery.  Main pulmonary artery at the origin of the left pulmonary\nartery is severely dilated, 49 mm probably unchanged.  Right pulmonary artery\ntop-normal caliber.  Pattern suggests pulmonic stenosis.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Nodular biapical fibrocalcific scarring, right\ngreater than left is stable.\n\nNo lung nodules or focal lung lesions of consequence.  Tracheobronchial tree\nis normal to subsegmental levels.  No pleural effusion or nodulation.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Interval growth, large supraclavicular and low neck mass, more severely\ncompromises the left subclavian vein, responsible for new local edema.  New\nleft upper chest wall peripectoral adenopathy.\n\nConfiguration of chronically dilated main and left pulmonary artery suggests\npulmonic stenosis.  Echocardiography would be required for assessment."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  The left supraclavicular nodal conglomerate is incompletely\nvisualized, however there appears to be significant decrease in bulk of\nenhancing soft tissue consistent with known metastatic disease measuring\napproximately 1.2 x 5.0 cm where it measured 3.3 x 10.7 cm at a similar level\npreviously (3; 4).  There is no longer mass effect on the adjacent veins.  The\nleft internal jugular and subclavian veins appear patent. There is no right\nsupraclavicular lymphadenopathy.  There is no right axillary lymphadenopathy. \nHowever, there is interval increase size of a left axillary lymph node,\nmeasuring 2.0 x 1.5 x 3.5 cm, previously measuring 1.8 x 1.9 x 2.1 cm (2; 17).\nThere is interval decrease in edema of the left breast and anterior chest wall\nsoft tissue.\n\nUPPER ABDOMEN: Please see separate dictated report of CT abdomen pelvis for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: There are a few mediastinal lymph nodes which appear to be\nslightly decreased in size, for example a right paratracheal lymph node\nmeasuring 0.5 cm in short axis, previously 0.7 cm in short axis (2; 11).  A\nprecarinal lymph node measures 1.0 cm in short axis, previously 1.2 cm in\nshort axis (2; 23).\n\nHILA: A right hilar lymph node measuring 0.7 cm in short axis previously\nmeasured 0.9 cm in short axis (2; 26).  There is no left hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is no pericardial\neffusion.  Mild valvular calcifications are seen.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is stable moderate biapical pleural-parenchymal\nscarring, right greater than left.  Stable 2-3 mm pulmonary nodules are noted\nin the left upper lobe and left lower lobe (3; 116, 235).  There are no\nsuspicious pulmonary nodules.\n2. AIRWAYS:  There is mild bronchial wall thickening bilaterally.  The airways\nare patent to the subsegmental level bilaterally.\n3. VESSELS:  The intrathoracic aorta is normal in caliber.  There is\ndilatation of the left pulmonary artery at its origin measuring up to 4.9 cm,\nsimilar to prior (2; 24), again suggestive of pulmonic stenosis.\nCHEST CAGE: There is no acute fracture.  There is no suspicious lytic or\nsclerotic osseous lesions.  Mild multilevel degenerative changes are noted\nthoracic spine. Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "1. Incompletely imaged left supraclavicular nodal conglomerate has decreased\nin bulk compared to prior without mass effect on adjacent venous structures\nand with interval decrease in left anterior chest wall edema.\n2. Interval increase in size of left axillary lymphadenopathy.\n3. A few central prominent and subcentimeter central lymph nodes have\ndecreased in size.\n4. Chronically dilated left pulmonary artery at its origin suggests pulmonic\nstenosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. The left axillary\nlymphadenopathy is moderately increased in the interval, with 2 largest\nnodules measuring now 18 x 23 mm and 21 x 18 mm, previously 16 x 13 mm and 15\nx 14 mm respectively.  No right axillary lymphadenopathy.  A previously\ndescribed left supraclavicular lymphoid aggregate appears to be out of the\nfield of view in the present study.   Excluding the breast tissue which\nrequires mammography for evaluation, there are no abnormalities on the chest\nwall. Mild atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries.  Mild aortic annulus\ncalcification. The aorta is normal in caliber throughout.  Stable appearance\nof the enlarged main pulmonary artery measuring 49 mm.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Stable small mediastinal and hilar lymph nodes,\nnone enlarged by CT size criteria.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nStable left upper and lower lobe 2-3 mm pulmonary nodules (4:118, 221).The\nairways are patent to the subsegmental levels. Mild bronchial wall thickening\nis unchanged, no bronchiectasis or mucus plugging. No suspicious lung nodules\nor masses. No consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nPlease refer to separate report for CT abdomen and pelvis acquired on the same\nday for findings below the diaphragm.",
            "output": "Increased size of the left axillary lymphadenopathy.\n\nStable appearance of the mediastinal lymph nodes.\n\nUnchanged enlargement of the main pulmonary artery suggesting pulmonary\nhypertension.\n\nPreviously described left supraclavicular conglomerate is out of the field of\nview in the present study."
        },
        {
            "input": "THORACIC INLET: There is a stable hypodense lesion within the left lobe of\nthyroid.  There are no enlarged axillary lymph nodes\nBREAST AND AXILLA  : The left axillary lymph node has mildly increased in size\nand now measures 3.2 cm it previously measured 2.6 cm.\n\nMEDIASTINUM: The there are small mediastinal nodes.  A right paratracheal\nlymph node measures 10 mm, it was barely perceptible on the prior study.  The\nmain pulmonary artery is enlarged but unchanged since the prior study.  There\nare small bilateral hilar lymph nodes.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is minimal bibasilar atelectasis.  There is biapical\npleuroparenchymal scarring.  No lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Mild increase in size of the left axillary lymph node and the mediastinal\nlymph nodes.\n\nNo new pulmonary nodules.\n\nBiapical pleuroparenchymal scarring.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately.\n\nStable enlarged main pulmonary artery related to pulmonary arterial\nhypertension."
        },
        {
            "input": "No supraclavicular adenopathy.  No incidental thyroid findings.  The known\nbilobed enlarged left axillary lymph node is overall stable, with a diameter\nof approximately 3 cm (5, 21).  Mediastinal and hilar lymph nodes (5, 49) are\nalso stable.  The main pulmonary artery continues to be widened.  The heart is\nslightly enlarged.  Stable mitral annulus calcifications but no pericardial\neffusion.  The posterior mediastinum continues to show a small hiatal hernia\n(5, 85).  Upper abdominal findings are described in detail in the dedicated\nabdominal CT report.  Moderate degenerative vertebral disease.  No vertebral\ncompression fractures.  No evidence of osteolytic lesions.  Stable bilateral\napical scarring with calcifications and nodular components.  No pulmonary\nnodules.  No pleural thickening or pleural effusions.  The airways are patent.\nStable minimal scarring at the lingular basis (14, 246).",
            "output": "Stable 3 cm left axillary lymph node.  Stable normal hilar and mediastinal\nlymph nodes.  No pulmonary nodules.  No pleural abnormalities."
        },
        {
            "input": "A left axillary node is again seen measuring 2.2 x 2.8 x 3.7 cm, not\nsignificantly changed.  Adjacent mildly prominent lymph nodes are unchanged. \nNo mediastinal or hilar adenopathy.  The thoracic aorta is mildly calcified\nand normal in course and caliber.  Prominence of the main PA measuring up to\n3.5 cm should be correlated for symptoms of pulmonary arterial hypertension. \nThere is no filling defect seen within the central branches of the pulmonary\narterial tree.  The esophagus is unremarkable.  No pleural or pericardial\neffusion is seen.\n\nThere is biapical pleuroparenchymal scarring.  No worrisome nodule, mass, or\nconsolidation.\n\nPlease refer to separately dictated CT of the abdomen pelvis for findings\nbelow the diaphragm.\n\nBONY STRUCTURES: There are no worrisome lytic or blastic osseous lesions.",
            "output": "Enlarged left axillary lymph node appears unchanged.  No worrisome pulmonary\nnodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the thyroid gland\nis unremarkable.  Multiple small left supraclavicular lymph nodes measuring up\nto about 7 mm are similar (8:7).  Numerous enlarged left axillary lymph nodes,\nthe largest measuring 2 cm are unchanged (8:45).  Right axillary lymph nodes\nare not enlarged.  The imaged chest wall soft tissues are otherwise\nunremarkable.\n\nUPPER ABDOMEN: Please refer to the separately dictated CT abdomen and pelvis\nreport for the same date for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Numerous mediastinal lymph nodes are redemonstrated, the largest\nin the right low paratracheal station measures 1.1 cm (8:90).  This is\nunchanged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  No pericardial effusion.\nThe thoracic aorta is normal in caliber.\nPLEURA: No pleural effusion or pneumothorax.  Biapical pleural scarring is\nsimilar.\nLUNG:\n\n1. PARENCHYMA:  There is dependent atelectasis.  No focal consolidation.  No\nmass.  No suspicious pulmonary nodules.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Redemonstrated dilation of the main and left greater than right\npulmonary artery, not significantly changed.\n\nCHEST CAGE: No worrisome osseous lesions or acute fracture.",
            "output": "1. Unchanged enlarged left axillary lymph nodes, and mediastinal lymph nodes\nmeasuring up to 11 mm.  No new or increasing lymphadenopathy.  No suspicious\npulmonary nodules.\n2.  Please refer to the separately dictated CT abdomen and pelvis report for\nthe same date for description of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the thyroid gland\nis unremarkable.  No enlarged or growing supraclavicular adenopathy.  Left\naxillar adenopathy in levels 1 2 and 3 measure up to 2 cm, similar to prior\n(6:20).  Right axillary lymph nodes are not enlarged.  No abnormal findings in\nthe soft tissues of the chest wall.\n\nUPPER ABDOMEN: Please refer to separately reported same-day CT abdomen pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes measure up to 1 cm in the right lower\nparatracheal nodal station.  No new or growing lymph nodes within.  Small\nhiatal hernia.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  No pericardial effusion.\nThoracic aorta is normal in caliber with mild atherosclerotic disease.\nPLEURA: No pleural effusion.  Mild biapical scarring is similar.\nLUNG:\n\n1. PARENCHYMA:  Lingular atelectasis is unchanged.  Left upper lobe 2 mm\npulmonary nodule (15:99) is unchanged from ___.  No new pulmonary\nnodules.\n2. AIRWAYS:  Airways are patent to subsegmental level.\n3. VESSELS:  Stable dilation of the main and left greater than right pulmonary\nartery.\n\nCHEST CAGE: No suspicious osseous lesions or acute fractures.  There is\ndiffuse bone demineralization.",
            "output": "1. Stable left axillary adenopathy, biopsied in ___, which showed\nno metastatic carcinoma.  Refer to pathology report from ___.\n2. No suspicious pulmonary nodules.\n3.  Please refer to separately reported same-day CT abdomen pelvis for\nsubdiaphragmatic findings."
        },
        {
            "input": "There are few subcentimeter hypodense nodules in the thyroid. Supraclavicular,\naxillary, mediastinal and hilar lymph nodes are not enlarged. Aorta and\npulmonary arteries are normal size. Cardiac configuration is normal and there\nis mild calcification in the LAD.  There are bibasilar atelectasis.  There are\nmild bibasilar bronchiectasis likely age related.  There is no pleural or\npericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation, there is a\n13 mm hypodense lesion in the right lobe of the liver (02:58), stable from\nprior study.  A cyst in the right kidney is incompletely imaged.\nThere are no bone findings of malignancy\nThe left hemidiaphragm is elevated.\nThe esophagus is dilated",
            "output": "No evidence of active intrathoracic infection or malignancy.  No masses in the\nanterior mediastinum\nDilated esophagus, ?achalasia"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a small left-sided\npleural effusion.\n\nOpacification in the left lower lobe appears to enhance and is likely\nconsistent with airway obstruction due to secretions with severe atelectasis. \nOpacification in the right lower lobe with nodular peribronchovascular\nopacifications in the upper right lower lobe and right middle lobe appears to\nshow less enhancement relative to the left side and is concerning for\natelectasis with superimposed infection.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen show evidence of free air anteriorly\nconsistent with patient's recent surgery.  Perihepatic and perisplenic ascites\nis small to moderate in volume.  Upper abdomen is otherwise unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Right lower lobe opacification with right lower and middle lobe\nperibronchovascular nodular opacifications enhance less relative to left lower\nlobe opacification and are concerning for atelectasis with superimposed\ninfection.  Left lower lobe opacifications likely represent atelectasis.\n3. Upper abdomen shows free air anteriorly consistent with patient's recent\nsurgery.  Perihepatic and perisplenic ascites is small to moderate volume.\n4.  During this exam an intravenous extravasation occurred.  For details\nplease see note in electronic medical record/OMR. The patient has received\ninstruction on how to manage this event at home."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental thyroid findings. \nThere is no axillary adenopathy.\n\nUPPER ABDOMEN: For detailed description of the upper abdomen, please refer to\nthe separately reported CT of the abdomen and pelvis performed on the same\nday.\n\nMEDIASTINUM: There is no mediastinal masses or lymphadenopathy.\n\nHILA: There is no hilar masses or lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is of normal size and there is no pericardial\neffusion.  Coronary calcifications are seen and mild aortic valve\ncalcifications.  A papillary muscle is calcified on the left ventricle.  The\nheart chambers are hypoattenuating compared to the septum, suspicious for\nanemia.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is severe centrilobular and paraseptal emphysema with\nupper zone predominance.  Post resection changes are again seen in left upper\nlobe.  The linear opacity seen along the suture lines measures 12 mm in\nmaximal thickness the on series 4, image 106 and remains stable.  Calcified\npleural/parenchymal scarring is again seen at the right apex.  Dense\nreticulations are seen in the right posterior lung base, which could be due to\nearly infection or fluid.  Middle lobe nodule measuring 4 mm stable since\n___.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  There is diffuse atherosclerotic aortic calcifications.  There is\nan aberrant right subclavian artery.\nCHEST CAGE: There is acute fracture involving the fifth right rib, healing\nfracture of the sixth and eighth right ribs.",
            "output": "1. Stable left upper lobe scar with no evidence of intrathoracic recurrence.\n2. Acute nonpathologic, right fifth rib fracture, with healing fractures of\nsixth and eighth ribs.\n3. Hypoattenuating heart chamber suspicious for anemia.\n4. Severe atherosclerotic calcification, head and neck arteries, aorta,\ncoronary arteries.  Moderately heavy calcification, aortic valve and papillary\nmuscle.  Consider echocardiography if not recently performed."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nAside from a calcified granuloma in the left apex (___) and a 1 mm nodule in\nthe lingula (4:166) the lungs are clear .  There is no pleural or pericardial\neffusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "No findings to explain patient's symptoms.  Evidence of prior granulomatous\ninfection"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of dissection.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen. Coronary artery and mitral\nannulus calcification\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  There is bibasilar subsegmental atelectasis.  There are three\npulmonary nodules, these measure 5 mm in the right middle lobe with some\nadjacent ground glass opacity (06:152), 3 mm right lower lobe superior segment\n(06:168), and a 3 mm nodule in the lingula (6:170).  Airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nModerate right fat-containing Bochdalek hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is mild peripancreatic\nfat stranding at the head of the pancreas, recommend correlation with lipase.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Moderate\ndiverticulosis throughout the colon.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable noting air in\nbladder, correlate with history of catheterization.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nDegenerative or post traumatic changes of the shoulders.  Right convex\nthoracolumbar scoliosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. There are 3 pulmonary nodules.  The largest measures up to 5 mm.\nNoncontrast chest CT in ___ months is recommended to ensure stability.\n2. Mild peripancreatic fat stranding in the head of the pancreas, this may be\nseen in the setting of pancreatitis.  Recommend correlation with chemical\nassessment.\n3. Moderate diverticulosis throughout the colon most severe in the sigmoid and\ndescending colon.\n4. No mass to explain hypercoagulable state as clinically questioned.\n\nRECOMMENDATION(S):   Noncontrast chest CT in ___ months.  Correlation with\nserum lipase when possible\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 9:49 AM, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of dissection.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen. Coronary artery and mitral\nannulus calcification\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  There is bibasilar subsegmental atelectasis.  There are three\npulmonary nodules, these measure 5 mm in the right middle lobe with some\nadjacent ground glass opacity (06:152), 3 mm right lower lobe superior segment\n(06:168), and a 3 mm nodule in the lingula (6:170).  Airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nModerate right fat-containing Bochdalek hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is mild peripancreatic\nfat stranding at the head of the pancreas, recommend correlation with lipase.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Moderate\ndiverticulosis throughout the colon.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable noting air in\nbladder, correlate with history of catheterization.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nDegenerative or post traumatic changes of the shoulders.  Right convex\nthoracolumbar scoliosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. There are 3 pulmonary nodules.  The largest measures up to 5 mm.\nNoncontrast chest CT in ___ months is recommended to ensure stability.\n2. Mild peripancreatic fat stranding in the head of the pancreas, this may be\nseen in the setting of pancreatitis.  Recommend correlation with chemical\nassessment.\n3. Moderate diverticulosis throughout the colon most severe in the sigmoid and\ndescending colon.\n4. No mass to explain hypercoagulable state as clinically questioned.\n\nRECOMMENDATION(S):   Noncontrast chest CT in ___ months.  Correlation with\nserum lipase when possible\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 9:49 AM, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There are moderate\natherosclerotic calcifications throughout the thoracic aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere has been interval decrease in size in the multiple mediastinal lymph\nnodes, now subcentimeter in size, which are likely reactive.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The thyroid\ngland appears unremarkable.  The patient has been extubated.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere are diffuse bilateral ground-glass opacities with interval improvement\nin the consolidative opacities in both lower lobes, with mild interlobular\nseptal thickening likely representing improving pulmonary edema. The airways\nare patent to the subsegmental level.\n\nLimited images of the upper abdomen shows the tip of the enteric tube in the\ngastric body.  Debris is noted within the esophagus however, placing the\npatient at risk for aspiration.\n\nThere are mild degenerative changes throughout the thoracic spine.  There is\nsevere osteoarthritis of both shoulders.",
            "output": "1. No evidence of pulmonary embolism.\n2.  Interval improvement in pulmonary edema.\n3.  Interval decrease in size in now subcentimeter mediastinal lymph nodes\nwhich are likely reactive.\n4.  Debris/fluid within the esophagus, placing the patient at risk for\naspiration."
        },
        {
            "input": "CT CHEST WITH CONTRAST: There is no supraclavicular lymphadenopathy. A 1 cm\nleft axillary lymph node (5:63) is unchanged since at least ___.\nThere is no mediastinal lymphadenopathy. Small right hilar lymph nodes up to 8\nmm (5:149) are unchanged. Right Port-A-Cath terminates near the cavoatrial\njunction.\n\nThe heart is not enlarged. There is no pericardial effusion.  Moderate\natherosclerotic calcifications of the coronary arteries are not appreciably\nchanged. There is calcification of the aortic valves. The aorta and pulmonary\narteries are normal in caliber. There are prominent atherosclerotic\ncalcifications at the origins of the great vessels, the aortic arch and\ndescending thoracic aorta.\n\nThere is no pleural abnormality. A generally thin walled, elliptical ring\nshadow developed in a region of prior ground-glass opacification in the right\nupper lobe between ___ and ___. I think this is focal\nbronchiectasis, alternatively a small pneumatocele, but, in any case, it has\nnot changed since its initial appearance. Minimal bronchiolitis has been\nstable in the left upper lobe (5:102), and lingula (5:182), and inferior to\nthe ring shadow since at least ___. There is no new focal opacity or\nnodule detected. Emphysema is mild.\n\nOSSEOUS STRUCTURES: There are no bone findings suspicious for malignancy or\ninfection.  There are prominent bridging anterior-right lateral thoracic\nosteophytes possibly reflecting DISH.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Minimal bronchiolitis in both upper lobes and a solitary bronchiectatic\nsaccule in the right upper lobe stable since ___ if this is\natypical mycobacterial infection, it is extremely indolent.\n3. Please note CT of the abdomen and pelvis will be reported separately"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation.  No\nsupraclavicular and axillary lymph node enlargement.\n\nBreast evaluation is reserved exclusively for breast imaging.  No soft tissue\nabnormalities elsewhere in the partially imaged chest wall.\n\nCARDIO-MEDIASTINUM: Thickening of the posterior tracheal wall and adjacent\nsoft tissue induration, extending below the level of the carina is not\nunexpected after tracheal broncho plasty.  Mid esophagus is circumferentially\nthickened, inseparable from the surgical repair of the posterior tracheal\nwall.  There is insufficient esophageal distension to suggest any dysfunction.\nThere are no mediastinal fluid collections or mediastinal emphysema.\n\nAorta and cardiac chambers are normal size.  Pericardium is physiologic. \nHeart size has increased since preoperative chest CT in ___, would require\nechocardiography for functional assessment.\n\nPULMONARY ARTERIES:\n\nNormal caliber.  No pulmonary emboli.\n\nTHORACIC LYMPH NODES:\n\nRight hilum, 13 x 21 mm could be reactive following local surgery.\n\nNo lymph nodes elsewhere in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Small nonhemorrhagic right pleural effusion largely\ndependent, with a fissural component.\n\nAside from mild subpleural atelectasis, right lung is clear.\n\nGround-glass opacification of the base the left lung could be additional\natelectasis or an indication of aspiration, less likely pneumonia.\n\nCHEST CAGE: Unremarkable.  Healed lateral left mid rib fractures.",
            "output": "Expected postoperative appearance following recent tracheal repair, including\nthickening posterior tracheal wall adjacent esophagus, small right pleural\neffusion and subpleural atelectasis.\n\nIsolated right hilar lymph node enlargement could be reaction to recent\nsurgery.\n\nNo pulmonary embolism.\n\nPossible active inflammation left lower lobe, consider aspiration."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the soft tissues are\nnormal in size.  The mediastinum continues to show evidence of moderate\nlymphadenopathy.  There also are normal calcified lymph nodes (6, 19).  Stable\nnormal dimension of the main pulmonary artery.  Stable mild to moderate\ncoronary calcifications.  No valvular calcifications.  No pericardial\neffusion.  Mild dilatation of the lower esophagus.  Linea pleural\ncalcifications (6, 28).  Mild degenerative vertebral disease without\nsubstantial change.\nThe overall attenuation of the lung parenchyma has increased.  The fibrotic\nopacities and consolidations, predominating in the peripheral areas of the\nlungs, are increased in extent and severity, most notably in the middle and\nlower lung zones.  An appropriate anatomical level for direct comparison is\nseries 7, image 154, as compared to series 7, image 179 on the previous\nexamination.  Honeycombing is still no predominant feature.  No pleural\neffusions.  Stable mild dilatation of the lower esophagus.",
            "output": "Interval progression of the fibrotic changes, morphologically most consistent\nwith a form of fibrotic NSIP."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  Thoracic aorta appears normal in course and caliber without\nappreciable atherosclerotic calcification.  The heart is normal in size and\nshape without pericardial effusion.  The main pulmonary artery is normal in\ncaliber measuring 2.6 cm.  There is no filling defect seen within the\npulmonary arterial tree to suggest the presence of a pulmonary embolism. \nThere is no lymphadenopathy.  The airways centrally patent.  The esophagus is\ndecompressed.\n\nLungs are clear without worrisome nodule, mass, or consolidation.  Mild basal\natelectasis is noted.\n\nThe imaged portion of the upper abdomen notable for a 3.1 x 2.0 cm lesion in\nthe posterior right lobe, segment 7 with peripheral nodular discontinuous\nenhancement most likely a hemangioma.\n\nBones: Unremarkable.",
            "output": "-No pulmonary embolism or other acute process in the chest.\n-Hepatic hemangioma within segment 7.\n\nNOTIFICATION:  Findings discussed in person with ___. ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable.\n\nUPPER ABDOMEN: Re-demonstration of known hepatomegaly.\n\nMEDIASTINUM: There is no mediastinal mass.  A 7 mm left periaortic node\n(4:213) is indeterminate.  Scattered subcentimeter mediastinal lymph nodes are\nnot enlarged by CT size criteria.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. No significant coronary artery or\nvalvular calcifications.  The thoracic aorta is normal in caliber. There is no\npericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is minimal atelectasis in the bilateral lower lobes. \nThe lungs are otherwise clear.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits. No\ncentral pulmonary embolism.\nCHEST CAGE: No suspicious osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. No evidence metastatic breast cancer in the chest.\n2. A 7 mm left periaortic node is indeterminate.  Recommend close attention on\nfollow-up imaging given new diagnosis of lymphoma.\n3. Re-demonstration of known hepatomegaly."
        },
        {
            "input": "Heavily calcified aorta and pulmonary arteries are unchanged.  The patient is\nafter CABG.  Several mediastinal lymph nodes are not pathologically enlarged\nand similar to previous examination.\n\nAirways are patent to the subsegmental level bilaterally.  Emphysema and\nnodularity in the right upper lobe is similar.  Septal thickening is mild but\nnew and might represent mild degree of pulmonary edema.  Areas of rounded\natelectasis are similar to previous examination.  The basal septal thickening\nis extensive as well.  Heart size is enlarged.  There is evidence of anemia. \nThere is no pericardial effusion.  Left pleural effusion is moderate,\nunchanged.  Right pleural effusion is heavily loculated with extensive amount\nof trapped air within and non simple right pleural effusion, highly concerning\nfor infectious process giving its appearance even in the absence of IV\ncontrast.\n\nLeft pleural calcifications are unchanged as well as right pleural\ncalcifications.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nExtensive bilateral pleural calcifications are present.",
            "output": "Loculated right pleural effusion with PleurX catheter with pockets of air\nconcerning for superimposed infection\n\nLeft loculated pleural effusion, also partial loculated, both are minimally\ndecreased.\n\nMild interstitial pulmonary edema\n\nAsbestos exposure\n\nStatus post CABG in a patient with severe Coronary artery disease\n\nSeptal thickening, new that might be consistent for current arm mild pulmonary\nedema\n\nAlthough no definitive findings of sub consistent with malignancy demonstrated\nit cannot be entirely excluded.\n\nCorrelation with contrast enhanced imaging is to be considered if feasible."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Multiple cysts are again seen in both kidneys, similar to the\nCT abdomen and pelvis dated ___. There is sludge in the gall\nbladder.\n\nMEDIASTINUM: There are multiple small mediastinal lymph nodes, none of which\nmeet pathologic size criteria.  These are similar to the prior exam.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is enlarged, without pericardial effusion. \nSevere coronary artery calcifications are present.  This patient is status\npost CABG.\nPLEURA: Bilateral chest tubes remain in place. There are small bilateral\nresidual pneumothoraces, right greater than left.  The loculated right pleural\neffusion has decreased since ___.  The small left pleural effusion\nhas also decreased in size, but now demonstrates more loculation.  Pleural\ncalcifications consistent with asbestos exposure are again seen bilaterally.\nLUNG:\n\n1. PARENCHYMA:  There is mild upper lobe predominant centrilobular emphysema,\nright greater than left.  Multiple sub 6 mm nodules are again appreciated in\nthe right lung, the largest measuring 4 mm in the right upper lobe (302:57). \nAdditional smaller nodules are seen on series 302, images 125, 131 and 137,\nand are all similar to the prior exam.\n2. AIRWAYS:  The central airways are patent to the segmental level.\n3. VESSELS: Evaluation of the vasculature is limited due to lack of IV\ncontrast. There are severe atherosclerotic calcifications in the thoracic\naorta and its branches.\nCHEST CAGE: There are degenerative changes in the spine.  No acute osseous\nabnormality is identified.",
            "output": "1.  Bilateral chest tubes remain place with small bilateral residual\npneumothoraces, right greater than left.The loculated right pleural effusion\nhas decreased since ___. The small left pleural effusion has also\ndecreased in size, but now demonstrates more loculation.\n\n2.  Multiple bilateral pulmonary nodules, the largest measuring 4 mm in the\nright upper lobe.\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n3.  Status post CABG."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are increased in number but normal in\nsize, likely reactive.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is moderately enlarged and there is extensive coronary\narterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is mild centrilobular emphysema.  There is no\nconvincing evidence for infection or malignancy.  There is substantial\nright-sided atelectasis associated with a large right pleural collection.\n\nAIRWAYS:  A rounded soft tissue attenuation focus in the right mainstem\nbronchus that was not present on previous studies likely represents aspirated\ndebris (302:100).  The airways are otherwise patent to the subsegmental level\nbilaterally.\n\nPLEURA:  The right pleural collection has increased substantially compared\nwith the prior study, predominantly composed of heterogeneous high-density\nmaterial consistent with blood products with loculated foci of air and simple\nfluid.  2 pleural drainage catheters are in place in the right pleural space. \nThere is a small left pleural effusion with a pleural drainage catheter in\nplace, slightly decreased from the immediate prior study..  Small foci of air\nwithin the left pleural space are likely related to the catheter placement\n(302:215).  Scattered pleural calcifications may reflect prior asbestos\nexposure.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nbilateral renal cysts and incompletely imaged aneurysmal enlargement of the\ninfrarenal abdominal aorta measuring at least 4 cm, similar to the prior CT of\nthe abdomen and pelvis (302:294).",
            "output": "1. Interval increase in size of the complex right pleural effusion, which\ncontains a moderate to large amount of heterogeneous high-density blood\nproducts, as well as simple fluid, foci of air, and 2 pleural drainage\ncatheters.\n2. Small to moderate left pleural effusion with small foci of air and a\npleural drainage catheter.\n3. Unchanged partially imaged infrarenal abdominal aortic aneurysm measuring\nup to 4 cm.\n4. Mild centrilobular emphysema.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:27 pm, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection. The pulmonary arteries enhance symmetrically without evidence of\nfilling defect to suggest pulmonary embolism. The remainder of the great\nvessels have a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. There is no significant mediastinal, hilar, or axillary\nlymphadenopathy. The heart is normal in size. There is no significant\npericardial effusion.\n\nThe central airways are patent.  The lungs are clear without focal or diffuse\nabnormality. The pleural spaces are clear. There is no pneumothorax.\n\nThe visualized upper abdominal structures are within normal limits.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "Examination is severely degraded due to motion artifact and suboptimal\nopacification of the pulmonary arteries.\n\nHEART AND VASCULATURE:  Evaluation of the pulmonary arteries severely limited\ndue to motion artifact and suboptimal opacification.  Though no central\npulmonary embolism is identified.  Lobar and segmental pulmonary emboli are\nnot excluded given significant artifact.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart is\nmildly enlarged.  Coronary arterial calcifications are noted.  There is no\npericardial fluid.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is bibasilar atelectasis.  No definite consolidation is\nnoted.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nABDOMEN:  Colonic diverticulosis is noted.",
            "output": "Severely limited examination given motion artifact and opacification of the\npulmonary arteries.  Lobar, segmental, and subsegmental pulmonary emboli are\nnot excluded.  No definite central pulmonary embolism is noted, however of the\nright main pulmonary artery distorted due to streak artifact.  If there is\npersistent clinical concern for pulmonary embolism, nuclear medicine scan can\nbe considered."
        },
        {
            "input": "Please note that streak artifact from spinal hardware limits evaluation.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is homogeneous.  There\nare a few prominent, though nonenlarged, bilateral axillary lymph nodes.\n\nUPPER ABDOMEN: There is a 1.7 x 1.5 cm aortocaval lymph node (___).  Limited\nevaluation of the upper abdomen is otherwise unremarkable.\n\nMEDIASTINUM:  There are multiple bulky conglomerations of lymph nodes.  An AP\nwindow lymph node measures 2.8 x 1.4 cm (___).  A right subcarinal lymph node\nmeasures 2.0 x 1.9 cm (___).  A precarinal lymph node measures 2.5 x 1.5 cm. \nA subcarinal lymph node measures 2.4 x 2.4 cm (___).  Right hilar adenopathy\nis less pronounced, but does narrow arterial branches to the posterior segment\nof the right upper lobe and superior segment of the right lower.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Enlarged lymph nodes encase the right superior\npulmonary vein and deform the posterior wall of the upper left atrium (___). \nHeart size is otherwise normal.  No coronary artery valvular calcifications.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Right upper lobe ground-glass opacity (___), is likely\npostinflammatory.\n2. AIRWAYS:  Normal to subsegmental levels.\n3. VESSELS:  No evidence of pulmonary embolism on this non PE protocol study.\nRight hilar adenopathy narrows arterial branches to the posterior segment of\nthe right upper lobe and superior segment of the right lower.\nCHEST CAGE: Dextroscoliosis with ___ rod.  No fractures.",
            "output": "1. Please note that no comparison was available at the time of interpretation.\n2. Bulky cental lymph node conglomerations largest in the prevascular and\nperitracheal stations of the mediastinum, narrows arterial branches to the\nright upper lobe posterior segment right lower lobe superior segment, and\nencases the right superior pulmonary vein and upper left atrium.  Differential\nincludes lymphoma, reaction to viral or other infection, and metastases. \nSarcoidosis is considered less likely because adenopathy is mild in the hila\nand the lungs are essentially clear."
        },
        {
            "input": "LYMPH NODES & MEDIASTINUM: No mediastinal or axillary adenopathy.\n\nHEART & VESSELS: The heart is normal in size.  The great vessels are normal in\ncaliber.  There is no evidence of pulmonary embolism to the segmental level. \nSubsegmental branches are difficult to evaluate due to breathing motion and\nstreak artifact from spinal rods.\n\nLUNGS & AIRWAYS: Multifocal areas of consolidation throughout both lungs are\nconsistent with multifocal infection.  There is no pneumothorax or pleural\neffusion.\n\nUPPER ABDOMEN: Limited views of the upper abdomen are within normal limits.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: ___ rods are demonstrated.  No\naggressive osseous lesions are seen.",
            "output": "Multifocal areas of consolidation through both lungs consistent with\nmultifocal pneumonia.  No effusion or pneumothorax.\n\nNo evidence of pulmonary embolism to the segmental level.  No aortic\nabnormality."
        },
        {
            "input": "Stable appearance of the thyroid.  Stable vertebral fixation devices. \nMultiple borderline to moderately enlarged mediastinal lymph nodes are again\nvisualized (2, 14).  Stable appearance of the heart and the posterior\nmediastinum.  Stable appearance of the upper abdomen.  Stable mild bilateral\napical scarring.  Extensive diffusely distributed ground-glass opacities have\nslightly increased in extent and severity.  The pre-existing bilateral\nparenchymal consolidations in the lower lobes are not substantially changed in\nextent and severity.  On in the left lower lobe the consolidation might have\nminimally decreased (4, 151).  There are no pleural effusions.  No new\nparenchymal opacities are visualized.",
            "output": "Little overall change as compared to ___.  Only in the left lower lobe\nthe pre-existing consolidations are minimally decreased in extent and\nseverity.  The other consolidations and widespread ground-glass opacities are\nstable."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not appropriate for subdiaphragmatic diagnosis, however vascular\nclips denote prior upper retroperitoneal surgery, perhaps partial nephrectomy.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is moderate in head and neck vessels and\nscattered throughout coronary arteries.  Aorta and pulmonary arteries are\nnormal size.  Aortic valvular calcification is mild.  Pericardium is\nphysiologic.  There is no pleural effusion.\n\nMediastinal lymph nodes are not pathologically enlarged and hilar contours do\nnot suggest lymph node enlargement.\n\nLungs:\n\nEmphysema is moderately severe in the upper lobes, milder elsewhere.  Stellate\nopacity right upper lobe, 5:89, developed between ___ and ___ is\nslightly larger today, on its lateral aspect, 5:89.\n\nMild multifocal cylindrical bronchiectasis is generally stable.  Bronchial\nwall thickening is mild.  Previously widespread bronchiolar nodulation has\nimproved in all lobes.\n\nHandful of small but measurable lung nodules is stable or smaller.  There are\nno new or growing lung nodules or any lesions concerning for malignancy.\n\nGeneralized osteopenia is widespread but there are no thoracic vertebral\ncompression fractures.  A solitary well-circumscribed sclerotic lesion in the\nanterior aspect of an upper thoracic vertebral body, 8:68, is unchanged since\n___ and can be considered benign.  There are no bone lesions in the chest\ncage concerning for malignancy or infection.",
            "output": "Definite improvement since ___ in previous widespread bronchiolitis, now\nstill multifocal, but relatively mild.  Multifocal bronchiectasis is also mild\nand does not have features of active suppuration.\n\nSolitary scar-like lesion a right upper lobe minimally larger today than in\n___ is more likely inflammatory than malignant.  It would be prudent to\nrepeat a conventional chest CT in one year to detect any malignant features.\n\nModerate emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a 1.2 cm hypodense nodule\nin the right upper thyroid pole (4:9).  There is no supraclavicular or\naxillary lymphadenopathy.  The esophagus is unremarkable.\n\nUPPER ABDOMEN: A subcentimeter hypodensity in the inferior right hepatic lobe\nis too small to characterize, but likely represents a cyst or biliary\nhamartoma.  A coarse calcification of the pancreas head is noted.  Surgical\nclips are noted around the right kidney.  A subcentimeter hyperdense lesion in\nthe right lower renal pole (2:66) likely reflects a hemorrhagic cyst. \nPartially imaged colonic anastomosis sutures are noted in the right upper\nquadrant.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. There is focal severe\ncalcification in the proximal LAD.  The thoracic aorta is normal in caliber. \nThere is mild-to-moderate calcified atherosclerotic disease involving the\nascending and descending thoracic aorta and aortic arch.  There is no\npericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA/AIRWAYS: There is peribronchovascular nodularity and\nopacification involving the bilateral lower and upper lobes, associated with\nmucus plugging of the small airways.  Mild centrilobular and paraseptal\nemphysematous changes are noted in the bilateral upper lobes.\n2. VESSELS:  Main pulmonary artery diameter is within normal limits.\nCHEST CAGE: No suspicious osseous lesions or acute fracture.",
            "output": "1. Peribronchovascular nodularity and opacification involving the bilateral\nlower and upper, associated with mucus plugging of the small airways are most\ncompatible with multifocal infection.\n2. Focal severe calcification in the proximal LAD artery."
        },
        {
            "input": "Heart is normal in size.  Coronary calcification is mild.  Aorta is normal in\ncaliber with moderate agree of calcification.  Central pulmonary arteries are\nalso normal in size.\n\nThere are trace bilateral pleural effusions.  No pericardial effusion.  No\nenlarged lymph nodes are found in the chest by size criteria.\n\nEmphysema is moderately severe.\n\nOpacities in the posterior apical right upper lobe have mostly resolved\nleaving only mild residual scarring. A mall nodule in the anterior segment\nmeasuring up to 6 mm (5:163) is unchanged. Few new small ___ type\nopacities and minimal ground glass in the right middle lobe are new.  In the\nright lower lobe, patchy consolidative opacity has developed with airway\nthickening and mucous plugging, suggesting pneumonia. In the lingula, new\npatchy mixed attenuation opacities suggests pneumonia.  In the left lower lobe\npreviously noted opacities have cleared.  A nodule in the superior segment of\nthe left lower lobe (5:171) measures at most 5 mm, also stable, since at least\n___..\n\nGastrostomy tube terminates in the stomach.  In the upper pole of the left\nkidney, there is cortical focus of mild hyperattenuation measuring 13 mm\n(attenuation of 45 Hounsfield units), which appears unchanged.  Comparison is\nalso made to renal MR dated ___.  This was previously been shown\nto represent a nonenhancing cyst.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.",
            "output": "New opacities consistent with multifocal pneumonia.  Mostly resolved opacities\nwhich had suggested pneumonia from ___.  Emphysema."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are not pathologically enlarged or\ngrowing.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.\n\nCARDIO-MEDIASTINUM:Moderate circumferential wall thickening lower esophagus is\nunchanged.  Above that level esophagus is moderately patulous. \nAtherosclerotic calcification is minimal in head and neck vessels and not\napparent coronary arteries.  Aorta is normal size.  Pulmonary arteries are\ndilated, main 41 mm, right 35 mm, previously 37 mm and 35 mm.\n\nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Calcifications have the developed in 2 sets top-normal\nsize lymph nodes in the left hilum, 4:98 109.  No other lymph nodes in the\nchest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Right lung and left upper lobe are clear and the\nbronchial tree in those regions is clear.\n\nA large region of abnormality in the superior segment of the left lower lobe\nhas changed or little.  A dominant nodule, 19 mm across today, 4:106, is the\nsame size,; its attenuation, ___ ___ compares ___ ___ in ___.  As\nbefore there are dozens of nearly contiguous tiny nodules, some of which lie\nalong the major inferior pulmonary vein.  A a crescentic projection extends to\nand retracts the left major fissure, 4:104, it was 9 x 19 mm in ___, 10 x 17 mm in ___ and 9 x 23 mm today.  2 smaller projections\nextend to the costal pleural surface, one thicker today than it was in\n___, the other thinner.  The pleura itself is not thickened and\nthere is no pleural abnormality in either hemithorax.\n\nA small region of ground-glass opacification in the anteromedial basal segment\nof the left lower lobe, 4:142 may contain a new, 6-7 mm irregularly shaped\nsolid nodule, 4:142.\n\nCHEST CAGE: Small region of cortical dysplasia in lateral aspect of a mid a\nbony bridge connects to transverse processes left transverse processes of 2\nmidthoracic vertebral bodies. The chest cage is otherwise unremarkable.",
            "output": "Solitary, large region of contiguous lung nodules ranging up to nearly 2 cm\nwide has not grown or spread appreciable since ___.  Average\nattenuation values have increased from levels associated with fat and fluid to\ncurrent values at fluid-level attenuation.  Ipsilateral hilar lymph nodes have\ndeveloped dystrophic calcifications.  Overall findings point to an indolent\ninflammatory process, including histoplasmosis or other indolent fungal\ninfection, either exogenous or endogenous lipoid pneumonia, or limited\nsarcoidosis.  It is the only finding to which I can explore ascribe chronic\ncoughing.\n\nPossible pulmonary arterial hypertension.\n\nPossible esophageal dysfunction and/or esophagitis.\n\n\nRECOMMENDATION(S):  Consider workup for possible aspiration or mineral oil\nlaxative use, although either of these may have resolved since ___ years ago\nwhen the manifestations first developed radiographically."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged. \nRight chest wall Port-A-Cath with tip extending to the cavoatrial junction.\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen and pelvis report\nperformed concurrently for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  A small hiatus hernia\nis incidentally noted.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  The\nthoracic aorta is normal in caliber without atherosclerotic plaque.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Diffuse ___ opacities in the perihilar region of the\nright upper lobe, possibly infectious or inflammatory.  Mild dependent\nbibasilar atelectasis.  There is a 4 mm nodule in the left upper lobe (4:92).\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  While this study is not optimized for the detection of pulmonary\nemboli, no central filling defect is seen.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion\nis detected.  Bilateral gynecomastia is noted, left greater than right.",
            "output": "1. Diffuse ___ opacities in the perihilar region of the right upper\nlobe, possibly infectious or inflammatory.\n2. Solitary 4 mm pulmonary nodule in the left upper lobe.\n3. For complete description of subdiaphragmatic findings, please see dedicated\nreport of CT abdomen/pelvis performed concurrently the same day.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Thyroid is 412unremarkable.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  Heavy calcification or stent is noted\nat the left anterior descending coronary artery.  A right pectoral pacemaker\nleads terminate in the right atrium and right ventricle.  Thoracic aorta and\nmain pulmonary artery are normal size.\n\nCentral airways are widely patent.  1 mm right upper lobe subpleural nodule\n(06:18) is non specific.\nThere are no additional discrete pulmonary nodules.  Minimal bibasilar\ndependent atelectasis is present.\n\nPlease refer to separate report for CT abdomen and pelvis obtained at the same\ntime for abdominal findings.  Compression deformity is noted at the T6\nvertebral body, likely chronic.  No lytic or blastic bone lesions identified.",
            "output": "1. 1 mm right upper lobe subpleural nodule is non specific.\n2. No additional pulmonary nodules, mediastinal lymphadenopathy, pleural\neffusions identified.\n3. Please refer to dedicated CT of the abdomen performed on the same day for\nabdominal findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head neck vessels, but pronounced in\nat least the left anterior descending coronary artery.  Mild enlargement of\nthe main pulmonary artery, 33 mm, is unchanged, CT scan indication of elevated\nand artery pressure, but right and left main pulmonary are are normal size. \nCardiac evaluation would require dedicated imaging such as echocardiography. \nThere is no pericardial or pleural abnormality.\n\nLungs:\n\n2 x one mm subpleural right upper lobe nodule, 05:52, is stable, too small to\nfollow.  Lungs are otherwise clear and the tracheobronchial tree is normal to\nsubsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  Mild congenital anomaly, mid thoracic vertebral body, unchanged,\n601b:102.",
            "output": "No evidence of intrathoracic malignancy.\n\nPossible pulmonary arterial hypertension.\n\nSevere coronary atherosclerosis, LAD."
        },
        {
            "input": "Right pectoral ICD.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  All lymph nodes in the chest wall (3, 21) are normal in\nsize.  Compartments.  Severe coronary calcifications.  No incidental pulmonary\nembolism.  No pericardial effusions.  Dilatation of the lower esophagus. \nUpper abdominal findings, including the known pancreatic neoplasm, are\ndescribed in detail in the dedicated abdominal CT report.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  No osteolytic\nlesions.  Stable non characteristic left upper lobe predominant ground-glass\nopacities (5, 26).  The lesions are not substantially changed as compared to\nthe previous examination.  No pleural effusions.  No pleural thickening.  The\nairways are patent.  No solid pulmonary nodules suspicious for metastatic or\nmalignant disease.",
            "output": "Stable non characteristic left upper lobe predominant ground-glass opacities. \nNo solid nodules suspicious for metastatic disease.  No pleural effusions.  No\nadenopathy"
        },
        {
            "input": "Right pectoral Port-A-Cath.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  All visible axillary lymph nodes (2, 9) Are normal in size. \nNormal sized mediastinal lymph nodes (2, 17).  Severe coronary calcifications,\nno valvular calcifications, no pericardial effusion.  The posterior\nmediastinum is unremarkable.  Fatty infiltration of the liver.  The other\nabdominal findings have been described on the CT from ___.\nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  No pleural effusions.  No diffuse lung disease.  The airways are\npatent.  There currently is no evidence for the presence of suspicious\npulmonary nodules or masses.  Millimetric right perifissural nodule (4, 100).",
            "output": "No lymphadenopathy.  No pleural abnormalities.  No suspicious pulmonary\nnodules or masses."
        },
        {
            "input": "The thoracic aorta is normal in caliber with mild scattered atherosclerotic\ncalcifications and noncalcified plaque.  The central pulmonary arteries are\nnormal in caliber.  Coronary artery calcifications particularly in the left\nanterior descending artery are extensive.  A partially imaged right\nPort-A-Cath tip ends in the right atrium.  Cardiac pacer leads in place.\n\nNo mediastinal, supraclavicular axillary, or hilar lymphadenopathy.\n\nMultiple bilateral pulmonary nodules are new and/or more much more conspicuous\nfrom the prior exam, concerning for new metastases (series 7, image 68, 64,\n61, 57, 52, 43, 18, 47, 40, 76, 80, 26, 40, 13):\n-9 mm, largest left lower lobe nodule (series 7, image 68)\n-7 mm, largest right lower lobe nodule (series 7, image 61)\n\nA 3 mm and 4 mm right lower lobe nodules were previously less than 1 mm\n(series 7, image 57, 47). Perifissural nodule in the right lung is unchanged\n(series 7, image 58).\n\nSecretions in the right mainstem bronchus on the prior exam are no longer\npresent.  The airways are patent to at least the subsegmental level.  No focal\nparenchymal opacity concerning for focal pneumonia.  Bibasilar atelectasis is\nmild. No pleural effusion or pneumothorax.\n\nThe imaged thyroid is normal in size without evidence of a mass.\n\nAir within the left subclavian vein is related to intravenous injection.  No\nsuspicious soft tissue masses in the chest cage.  No osseous lesions\nconcerning for malignancy in the chest cage.  Deformity of the posterior T6\nvertebral body is unchanged. Bilateral gynecomastia is mild.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "Multiple bilateral new pulmonary nodules measuring up to 9 mm, suspicious for\nmetastasis."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging.  Left\nsupraclavicular station obscured by contrast artifact.  Right supraclavicular\nand axillary lymph nodes are not enlarged.  Breast evaluation is reserved\nexclusively for mammography.  No soft tissue abnormalities elsewhere in the\nchest wall.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.  Tiny hypodensities in the liver cannot be evaluated. \nHepatic evaluation would require dedicated cross-sectional imaging.\n\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels or in the coronary arteries.  Aorta\nand pulmonary arteries and cardiac chambers are normal size.  Change in\ndistribution of a persistent small pericardial effusion may be a function of\nmediastinal shift due to right upper lobectomy.  There is no infiltration of\nepicardial fat or nodulation to suggest malignant involvement.\n\nTHORACIC LYMPH NODES: 7 mm right posterior paraesophageal and 9 mm left lower\nparatracheal node are new, 05:36, 98.  Lymph node, 05:36, is new.\n\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is mild to moderate.  Right hilus and\nbronchial stump have a normal postoperative appearance following upper\nlobectomy.\n\nHigh attenuation tissue is atelectasis following a long row of suture in the\nneo fissure, presumably a site of resection.\n\nLeft lung is free of nodules or other focal pulmonary abnormality.  There is\nno pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..  Surgical rib fractures are healing.",
            "output": "Normal postoperative appearance following upper lobectomy.  Growing\nsubcentimeter mediastinal lymph node should be re-evaluated on surveillance\nimaging.\n\nMild to moderate emphysema."
        },
        {
            "input": "The pulmonary arteries are well opacified to the segmental levels throughout\nwithout filling defect to suggest pulmonary embolism. . The subsegmental level\nbranches of the upper lobes are clear as well with no filling defect.\nSubsegmental branches to the lower lobes are not well assessed due to motion.\n\nThe lungs are clear without suspicious pulmonary nodule, consolidation,\neffusion or pneumothorax. The central airways are patent. There is no\naxillary, mediastinal, or hilar adenopathy. There is moderate cardiomegaly\ninvolving all chambers of the heart including left atrium. Mitral annuloplasty\nchanges identified.\n\nThere is an incompletely characterized exophytic 1.9 cm cyst arising from the\nupper pole the left kidney which is not simple in attenuation. Additional\nincompletely characterized probable right renal cyst is not completely\nvisualized. Included upper abdominal structures are otherwise grossly\nunremarkable.\n\nNo suspicious osseous lesion or fracture identified. Median sternotomy wires\nare noted.",
            "output": "1. No evidence of pulmonary embolism noting the subsegmental branches of the\nlower lobes are not well assessed due to motion. No acute aortic syndrome.\n2.  Incompletely characterized hypodense renal lesions, not fully assessed and\non the left not simple in attenuation for which dedicated nonurgent renal\nultrasound is suggested."
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the segmental\nlevel without filling defect to suggest pulmonary embolism.  Evaluation of the\nsubsegmental pulmonary arteries is limited by respiratory motion.  The main\npulmonary artery is dilated measuring up to 3.1 cm with dilation of the right\npulmonary artery of to 3.4 cm suggestive of pulmonary artery hypertension.\n\nThere are moderate bilateral nonhemorrhagic pleural effusions with associated\natelectasis.  Scattered bilateral ground-glass opacities likely reflect\npulmonary edema.  The airways are patent to the subsegmental level.\n\nThe heart is enlarged.  Note is made of a prosthetic mitral valve.  There is\nno pericardial effusion.  There is a prominent right paratracheal lymph node\nmeasuring 1.2 x 2 cm (02:42) which may be reactive.  There is no\nsupraclavicular, axillary or hilar lymphadenopathy. Included portion of the\nthyroid is unremarkable.\n\nIncluded portion of the upper abdomen is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere is no fracture.  Post median sternotomy changes are noted with intact\nsternal wires",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Cardiomegaly with moderate bilateral pleural effusions and pulmonary edema\nlikely reflecting congestive heart failure.\n3. Dilation of the pulmonary artery suggesting pulmonary artery hypertension."
        },
        {
            "input": "CTA torso: The aorta is well opacified, demonstrating unchanged dilation of\nthe ascending aorta (4.6 cm).  A descending aorta graft extends from the\naortic arch through the thoracic aorta, terminating just above the diaphragm. \nThere is a 1.0 x 1.4 x 2.6 cm focus of contrast extravasation into the\naneurysm sac at the distal edge of the graft, consistent with a type 1B\nendoleak (leak at the distal graft attachment site).  The aneurysm sac\nmeasures 4.6 cm in greatest cross-sectional dimension (previously\napproximately 4.5 cm).  The abdominal aorta is normal in caliber, but\ntortuous.  There is moderate calcium burden of the abdominal aorta and its\nmajor branches.\n\nCT thorax: The airways are patent to the subsegmental level.  There is mild\ncentrilobular emphysema.  An 8 x 13 mm nodule in the right lower lobe (3:62)\nis unchanged dating back to ___.  Other punctate nodular opacities in\nthe right lung apex (___) and right middle lobe (3:71) are also\nunchanged.There is no supraclavicular, axillary, or hilar lymphadenopathy. \nRight paratracheal mediastinal lymph nodes are prominent, but not\npathologically enlarged by CT size criteria.The heart and pericardium are\nnormal in appearance, without pericardial effusion.A large hiatal hernia is\nunchanged.There is no pleural effusion or pneumothorax.\n\nCT ABDOMEN:\nLIVER: The liver enhances homogeneously, without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent.The gallbladder is within\nnormal limits, without wall thickening, stone, or pericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion or peripancreatic stranding or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys are symmetric and normal in size, demonstrating normal\nnephrograms.  There is no stone or hydronephrosis.  A 4.1 cm simple cyst\narising from the upper pole of the left kidney is unchanged.\n\nGI:  There is surgical material in the right lower quadrant, consistent with\nprior partial ileocolectomy.  The remaining small and large bowel is within\nnormal limits, without wall thickening or evidence of obstruction.  There is\ncolonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:Again seen is posterior fixation hardware from the L2\nthrough S1 levels, with resultant beam hardening artifact.  No focal lytic or\nsclerotic lesion to suggest neoplasm or infection is identified.",
            "output": "1. Status post TEVAR, with a type 1B endoleak as described above. Overall\nunchanged size of the aneurysm sac.\n2. Unchanged right lower lobe nodule dating back to ___.\n3. Unchanged large hiatal hernia and diverticulosis without evidence of acute\ndiverticulitis."
        },
        {
            "input": "CT CHEST WITH CONTRAST: No supraclavicular or axillary lymphadenopathy.  Soft\ntissues of the chest wall are unremarkable.  No mediastinal or hilar\nadenopathy.\nMosaic attenuation of the lungs is again seen.  Peripheral reticulation is\nmost pronounced at the bases of the lungs, and is slightly progressed since\n___.  Subsegmental atelectasis in the left lung base is again seen. 3 mm\nright apical nodule is unchanged from ___ (3:84).   A 1.5 x 0.7 cm oval\nopacity in the right lower lobe is not substantially changed since ___, may\nrepresent atelectasis. No new pulmonary nodules no pleural effusion or\npneumothorax.  Changes from Nissen fundoplication noted with patulous distal\nesophagus.\n\nCT ABDOMEN: limited sections through the upper abdomen are notable for a left\nupper pole simple cyst, although incompletely seen, is likely unchanged,\nmeasuring up to 5.7 cm in the provided images.  Colonic diverticulosis.\n\nOSSEOUS STRUCTURES: No acute fractures or suspicious bony lesions.  Stable\nmild compression deformity of T8 vertebral body.\n\nCTA:\n\nCARDIAC:  The right atrium is normal.  The right ventricle is normal.  The\nleft atrium is dilated.  The left ventricle is normal.  The pericardium is\nnormal and there is no pericardial effusion.  The aortic valve is is tricuspid\nwith calcifications.  Dominance of the coronary artery system is right with\nnormal origins and course.  Coronary artery calcification is moderate in the\nLAD.  There is substantial tortuosity of the right subclavian artery and vein\nand innominate artery.\n\nPULMONARY ARTERIES: The main pulmonary artery measures up to 37 mm, unchanged\nfrom prior.\n\nAORTA: There is dilation of the thoracic aorta measuring up to 5 cm, which is\nunchanged from ___.  The aortic graft in the descending aorta remains in\nsimilar position, spanning from approximately 2 cm distal to the left\nsubclavian artery origin to the diaphragm.  The partially thrombosed excluded\naneurysmal sac measures up to 5.3 cm currently and demonstrates slowly growth\nsince ___ (4.9 cm in ___ and 4.4 cm in ___.  Again seen is contrast\ntracking into the excluded aneurysmal sac between the wall of the graft and\nthe wall of the aorta both proximally and distally to the graft, which appears\nto be the result of a progressive dilation of the aorta beyond the edges of\nthe graft.\n\n MEASUREMENTS 3D IMAGING LAB (Dmin - Dmax):\n\n1. Aortic annulus: 23.6 x 27.7 mm\n2. Sinus of Valsalva: 29.4 x 39.4 mm\n3. Sinotubular junction: 39.7 x 45.3 mm\n4. Mid ascending aorta: 43.4 x 40.8 mm\n5. Distal ascending aorta: 46.5 x 14.5 mm\n6. Mid aortic arch: 42 x 45.8 mm\n7. Proximal descending aorta: 45.2 x 49.7 mm\n8. Mid descending aorta: 38 x 43.5 mm\n9. Distal descending aorta: 51 x 52 mm\n10. Main pulmonary artery: 37.8 x 47.3 mm",
            "output": "1. Slowly growing ascending aorta aneurysm proximally and distally to the\nTEVAR graft since ___.  Contrast in the excluded aneurysm proximally and\ndistally to the graft is the result of a progressive dilation of the aorta\nbeyond the edges of the graft.\n2. Stable since ___ dilation of the main pulmonary artery up to 37 mm,\nindicative of pulmonary hypertension.\n3. Subtle mosaic attenuation and subpleural reticular opacities, slowly\nprogressed since ___.\n4. Stable right apical nodule."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThe lungs are clear.  There is a 2 mm subpleural nodule in the left upper lobe\n(5, 74).There is no pleural or pericardial effusion.\nFrom T 4 to T10 there are bilateral hypodense para spinal lesions measuring up\nto 15 mm,  right lesions slightly larger than left.\nPlease refer to the concurrent CT abdomen for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "2 mm subpleural nodule in the left upper lobe is unlikely malignant\nParaspinal bilateral soft tissue lesions could represent schwannomas.  MRI is\nrecommended\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 09:41 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  There is no supraclavicular lymphadenopathy.  There is no\naxillary lymphadenopathy.\n\nUPPER ABDOMEN: Limited view of the upper abdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy within limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart is moderately enlarged.  There are extensive\ncoronary artery calcifications.  Single lead from left chest wall pacemaker\nterminates in the right ventricle.  There is no pericardial effusion. \nRelative hypodensity of the blood pool is suggestive of anemia.\nPLEURA: There are small nonhemorrhagic pleural effusions.  There are several\ncalcified pleural plaques throughout the lungs suggestive of prior asbestos\nexposure.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild smooth interlobular septal thickening at the\nlung apices and lung bases bilaterally suggesting mild pulmonary edema.  There\nis compressive atelectasis at the bases bilaterally, worse on the right side. \nFew micro nodules seen throughout the lungs (302:159, 60 there is a 5 mm left\nupper lobe nodule (302:11).  There is a 5 mm right lower lobe perifissural\nnodule (302:171).\n2. AIRWAYS:  Airways are patent to subsegmental levels bilaterally.  There is\nmild bronchiectasis at the lung bases bilaterally.\n3. VESSELS:  The thoracic aorta is of normal caliber.  There are mild\natherosclerotic calcifications of the aortic arch and descending thoracic\naorta.  The main pulmonary artery is dilated measuring up to 3.7 cm,\nsuggesting pulmonary hypertension.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "1. Mild pulmonary edema and small bilateral pleural effusions suggestive of\nfluid overload.\n2. Right greater than left-sided compressive basilar atelectasis for which\nunderlying pneumonia is difficult to exclude in the appropriate clinical\nsetting.\n3. No evidence of interstitial lung disease.\n4. Calcified pleural plaques suggestive of asbestos exposure.\n5. Sub 6 mm pulmonary nodules as above.  Recommend follow-up per ___\ncriteria.\n6. Extensive coronary atherosclerotic disease.  Hypodensity of the blood pool\nsuggestive of anemia.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is normal in\nappearance.  There is no axillary lymphadenopathy.  There is a 6 cm x 1.7 cm\nleft lateral chest wall lipoma.\n\nUPPER ABDOMEN: Please see separately dictated CT abdomen and pelvis from the\nsame date.\n\nMEDIASTINUM: There is no mediastinal adenopathy.  Mild atherosclerotic\ncalcification of the aortic arch is noted.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not grossly enlarged.  There is no\npericardial effusion.  There are coronary artery calcifications.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild atelectasis posterior right costophrenic angle.  There is\nmild mucous plugging peripheral bronchial branches left lower lobe.  Minimal\nmucous plugging in peripheral bronchial branches in the right lower lobe. \nMildly prominent interstitial thickening posterior right costophrenic angle,\nwith few centrilobular nodules and ___ opacities, may represent mucoid\nimpaction versus infection, possibly aspiration.  There is bronchial wall\nthickening in both lower lobes, may be inflammatory or infectious.  Mild\nscarring posterior left lower lobe.  No dominant lung nodules.\n-AIRWAYS:  Areas of mild mucous plugging lower lobes as described above.  .\nCHEST CAGE: Small focus of faint sclerosis anterior left fifth rib series 7,\nimage 190, of doubtful significance.  No other osseous abnormalities.  There\nare degenerative changes in the thoracic spine.  Thoracic kyphosis.  .",
            "output": "No metastases.\n\nMild mucous plugging bilateral lower lobes, with bronchial wall thickening,\ninflammatory or infectious.  Area of tiny centrilobular nodules right lower\nlobe, consider infection, aspiration, mucoid impaction."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  Coronary\ncalcifications are moderate.\nPLEURA: There is no pleural abnormality or pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Atelectasis is noted in the dependent portion of the lung bases,\nbilaterally.  No evidence of malignancy.\n-AIRWAYS:  The airways are patent subsegmental level.\n-VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: There is a left intercostal lipoma incidentally noted (series 5,\nimage 35).  The superficial soft tissues are otherwise unremarkable.  There is\nno evidence of osseous malignancy or infection.",
            "output": "1.  No evidence of malignancy within the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular lymph\nadenopathy.  Pre-existing left axillary lymph nodes have somewhat increased in\nsize since ___, though stable since ___.  For example, the\nlargest mid axillary lymph node measures 2.8 cm (2:60).  The level 2 and 3\nlymph nodes measure up to 1.5 cm (02:11).  Lower axillary lymph nodes measure\nup to 1.9 cm (02:24).  Metallic density in the lower axillary lymph node is\nnew since ___ and likely representing a biopsy marker.  Right chest\nwall infusion port tip terminates at the right atrium.\n\nUPPER ABDOMEN: The imaged upper abdomen is unremarkable.\n\nMEDIASTINUM: Compared to ___, pre-existing mediastinal\nlymphadenopathy is overall worsened.  For example, pre-existing pre-vascular\nupper mediastinal lymph node stably measures at 6 mm, previously 5 mm (02:14).\nThe largest mediastinal lymph node conglomerate at the mid pretracheal station\nmeasures 19 mm, possibly representing 2 enlarged lymph nodes (02:16),\npreviously 8 mm.  The lower pretracheal station lymph node at the carinal\nbifurcation measures 11 mm, previously 8 mm (02:18).  Sub carinal soft tissue\nmeasures 2.1 x 1.8 cm, previously 7 mm (02:24).\n\nHILA: Compared to prior exam on ___, the hilar structures appears\nslightly the more confluent.  However, due to lack of intravenous contrast\nevaluation of of individual lymph node is difficult.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\npericardial effusion.  Moderate three-vessel coronary calcifications are\nstable.\nPLEURA: New since ___ is a small amount of left pleural\nnonhemorrhagic effusion layering against the posterior basal pleural.  There\nis no evidence of loculated fluid.  There is likely trace amount of fluid\ntracking along the oblique fissure.  There is trace nonhemorrhagic layering\npleural effusion on the right.\nLUNG:\n\n1. PARENCHYMA:  New since ___ are opacities in lower lobe\npredominant peribronchovascular distribution and surrounding gland grass\nopacities.  In the right upper lung there are patchy areas of nodular\nopacities with adjacent ground-glass opacities (4:62, 74), also in\nperibronchovascular distribution.\n2. AIRWAYS:  Airways are patent to the subsegmental levels.  However, there is\ndiffuse peribronchial wall thickening, continuous with the pulmonary opacities\ndescribed above.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is unremarkable.\nCHEST CAGE: There are healing fractures at right fifth and sixth anterior\nribs, unchanged from ___.  Sclerotic focus at T9 is likely a bone\nisland (602:60).",
            "output": "1. Extensive multilobar peribronchovascular distribution, lower lobe\npredominant opacities with scattered areas of nodular opacities surrounded by\nground-glass opacities, likely representing multilobar pneumonia, possibly\nrelated to aspiration.\n2. Small non-hemorrhagic left pleural effusion. Trace nonhemorrhagic right\npleural effusion. Likely representing parapneumonic pleural effusions.\n3. Interval worsening of mediastinal lymphadenopathy and stable, though\npersistent left axillary lymphadenopathy.  This could be reactive changes\nsuperimposed on metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level, with significant the limited evaluation at the lung bases due\nto respiratory motion.  Within this limitation, there is no pulmonary\nembolism. The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  Chemotherapy port terminates in the right\natrium.  Coronary artery calcifications are moderate and diffuse.  No\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Enlarged left axillary lymph nodes are grossly\nunchanged from ___, measuring up to 2.6 cm in short axis (05:25). \nExtensive, bulky mediastinal and hilar lymphadenopathy is also grossly\nunchanged, for example a right low paratracheal lymph node measures 15 mm\nsimilar to prior (05:38) a prevascular node measures 11 mm, also unchanged\n(05:38).\n\nPLEURAL SPACES: There is bilateral pleural effusions have decreased.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Lower lobe predominant opacities are slightly improved from 4\ndays prior given extensive respiratory motion.  There are numerous pulmonary\nnodules in both lungs, which are essentially unchanged from 4 days prior. \nMany of these are new in comparison with ___, and it is unclear at\nthis time whether they reflect sequelae of infection or metastases.  For\nexample, a nodule in the left upper lobe measures 5 mm (06:57), and a nodular\nopacity in the right upper lobe is spans 16 mm (6:66).  There remains diffuse\nbronchial wall thickening primarily in the lower lobes.  Airways are patent to\nthe subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Several poorly defined foci of enhancement in the liver are\nincompletely assessed on this study, for example in hepatic segment II, VI and\nVIII (5:96, 98, 123, 241).\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Pulmonary vasculature can only be evaluated to the segmental level,\nparticularly in the lower lobes, due to extensive respiratory motion.\n2. Within this limitation, there is no evidence of pulmonary embolism or\naortic abnormality.\n3. Allowing for motion artifact, there has been interval improvement of lower\nlobe predominant peribronchial opacities.\n4. Bilateral pulmonary nodules could be related to infection, although\nmetastatic lesions cannot be excluded.  Recommend attention on follow-up\nimaging for resolution.\n5. No change to extensive left axillary, mediastinal, and hilar\nlymphadenopathy.\n6. Foci of enhancement in the liver are not well assessed on this study, and a\ndedicated abdominal MRI could be obtained for more complete assessment.\n\nRECOMMENDATION(S):  Dedicated abdominal MRI could be considered for more\ncomplete assessment of subtle enhancing foci in the liver as described above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus,\nhowever, there is significant respiratory motion which limits evaluation of\nthe lung bases.  Within this limitation, there is no pulmonary embolism.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There has been interval decrease in size in\nleft axillary lymphadenopathy, currently measuring up to 1.7 cm in short axis\npreviously 2.6 cm (03:47).  Mediastinal and hilar lymphadenopathy appears\nstable, if not decreased compared prior.  For example, a right low\nparatracheal lymph node (3:61) measures 1.2 cm in short axis, previously 1.5\ncm and a left prevascular node measures 1.1 cm in short axis (3:63),\nunchanged.\n\nPLEURAL SPACES: No significant pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is been continued interval improvement in peribronchial\nopacities.  The lungs demonstrate mosaic attenuation consistent with small\nvessel versus small airway disease.  There is mucous plugging at the bases\nbilaterally well as mild bronchial wall thickening.  Mild bibasilar\natelectasis also present.  Multiple pulmonary nodules are unchanged compared\nto prior.  For example, there is a 5 mm nodule in the left upper lobe (3:45)\nas well as a 5 mm nodule in the right upper lobe (3:55), unchanged.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nA right chest port catheter terminates in the right atrium, as before.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Interval improvement of lower lobe peribronchial opacities.\n3.  Interval decrease in size in left axillary adenopathy.  Stability or\ndecreased size of mediastinal and hilar lymphadenopathy.\n3.  Unchanged bilateral pulmonary nodules compared to ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is mildly enlarged.  Coronary artery\ncalcifications are moderate.  No pericardial effusion is seen.  A Port-A-Cath\nterminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: Left axillary lymph nodes are slightly smaller,\nmeasuring up to 13 mm in short axis, previously up to 17 mm (3:55). \nMediastinal lymphadenopathy is also slightly improved; for example a right low\nparatracheal node measures 11 mm in short axis, previously 14 mm (3:76). \nBilateral hilar lymphadenopathy is overall unchanged, with a left hilar lymph\nnode measuring up to 12 mm.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse bilateral ground-glass opacities are overall similar to\nprior, and may reflect air trapping.  ___ opacities in the lateral\nright upper lobe and left lower lobe suggest infectious bronchiolitis (3:87). \nA 5 mm left lower lobe nodule is unchanged (3:89).  A 5 mm left upper lobe\nnodule is also unchanged (03:58).  Mild diffuse bronchial wall thickening\nappears most prominent in the lower lobes.  Bibasilar atelectasis is\nunchanged.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Foci of arterial hyperenhancement in the liver are incompletely\nassessed on this study, for example a 7 mm focus on 3:150, a 10 mm focus on\n3:155, and a vague 12 mm focus on 3:197.  These are unchanged since ___, and were characterized as likely perfusional abnormality on MRI on ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is a stable bone\nisland in the T9 vertebral body (302:39). There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. New areas of ___ nodular opacities in the lateral right upper lobe\nand left lower lobe in combination with diffuse bronchial wall thickening are\nlikely due to infectious bronchiolitis and bronchitis.\n3. Interval improvement in left axillary and mediastinal lymphadenopathy. \nRelatively unchanged bilateral hilar lymphadenopathy.\n4. Other pre-existing pulmonary nodules are not changed in size in comparison\nwith ___ CT chest.\n5. Hyperenhancing foci in the liver were characterized as likely perfusion\nabnormality on MRI ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nSubsegmental branches, particularly at the lung bases are not well assessed\ndue to motion.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  There are moderate coronary artery\ncalcifications.  No pericardial effusion is seen.  A right Port-A-Cath\nterminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: Left axillary lymph nodes are not significantly\nchanged from prior, measuring up to 1.2 cm in short axis (02:21), previously\n1.3 cm.  Slight enlargement of prevascular lymph nodes, specifically in 0.8 mm\nshort axis node (03:51, previously 6 mm.  An additional prevascular lymph node\nmeasures 1.1 cm (3:69), previously 0.8 cm.  Additional mediastinal and hilar\nnodes have not changed.  For example, a right low paratracheal lymph node\nmeasures 1.1 cm in short axis (02:37), unchanged, and a left hilar lymph node\nmeasures 1.2 cm in short axis (02:51), also unchanged.  Subcarinal node\nmeasures 1.3 cm short axis, unchanged.\n\nPLEURAL SPACES: No right pleural effusion or pneumothorax.  Trace left pleural\neffusion is noted.\n\nLUNGS/AIRWAYS: There are diffuse ground-glass opacities bilaterally,, likely\nin part due to extra poorly phase of exam.  There is centrilobular emphysema. \nSeveral regions of consolidation are noted, more notable in the right lung. \nFor example, there is a 2.0 x 1.8 cm focus in the right upper lobe, with a 1.3\nx 0.9 cm solid component, which is centered at the airway.  Additional focal\nareas of nodularity include a 5 mm nodule in the right lower lobe, with\nsurrounding ground-glass opacity (3:123), and a 5 mm ground-glass nodule in\nthe left upper lobe (3:75).  Atelectasis is noted at the lower lobes.  Please\nnote that subtle nodules would be obscured secondary to respiratory motion. \nThe airways are patent to the level of the segmental bronchi bilaterally, with\nmild diffuse peribronchial thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for incompletely\nevaluated foci of arterial hyper enhancement, previously characterized on MR\nas likely perfusional abnormality (2:77, 76, 91, 99).\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  New focal ground-glass and solid opacities, the largest of which measures\n2.0 x 1.8 cm in the right upper lobe suggestive of bronchopneumonia.\n3.  A few prevascular lymph nodes appears slightly enlarged compared to prior.\nAdditional unchanged axillary, mediastinal and hilar lymphadenopathy."
        },
        {
            "input": "Multiple bilateral hypodense thyroid nodules measure up to 5 mm on the left. \nThere are no pathologically enlarged supraclavicular, mediastinal, hilar or\naxillary lymph nodes. Previously described cluster of right lower paratracheal\nlymph nodes is stable.\n\nThere is stable marked cardiomegaly with multichamber enlargement and stable\nleft ventricular hypertrophy. Extensive aortic valve, mitral annular, and\ncoronary artery calcifications are present. There is stable fusiform\naneurysmal dilatation of the ascending aorta which measures 5.2 cm in greatest\ntransverse dimension. Moderate atherosclerosis diffusely involves the imaged\nportions of the aorta and its branches. No incidental pulmonary embolism is\nidentified.\n\nThe patient is status post right upper lobe wedge resection and right lower\nlobectomy with stable mild centrilobular emphysema. In addition, several solid\npulmonary nodules are stable since ___ (5: 82, 96, 118, 122, 125,\n145, 151, 154). A 4 mm left lower lobe nodule is stable since ___ (5,\n171). The largest right middle lobe perifissural nodule is stable ___\nmeasuring 9 x 12 mm (remeasured: 5, 152). No new pulmonary nodules are\nidentified. Mild ground-glass opacities and interlobular septal thickening may\nrepresent mild pulmonary edema. A moderate nonhemorrhagic layering right\npleural effusion is stable.\n\nSmall left pleural and posterior right chest wall lipomas are incidentally\nnoted.\n\nModerate thoracic spine degenerative changes are noted. No destructive osseous\nlesions are identified.\n\nFor a detailed discussion of the upper abdomen, including a partially imaged\nright renal upper pole cyst and coarse right adrenal gland calcification,\nplease refer to the separate report from the CT abdomen/pelvis performed\nconcurrently.",
            "output": "Multiple pulmonary nodules which have not demonstrated interval growth since\n___.\n\nMild pulmonary edema.\n\nMild centrilobular emphysema.\n\nStable moderate right pleural effusion.\n\nStable fusiform aneurysmal dilatation of the ascending aorta with extensive\naortic valve calcifications, with suggests aortic stenosis"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the imaged chest wall suspicious for malignancy.\nFindings below the diaphragm will be reported separately.\n\nSub cm defects in both lobes of the thyroid are too small to warrant further\nimaging evaluation. Atherosclerotic calcification is mild to moderate in the\nproximal head and neck vessels, severe in the coronaries. This study is not\ndesigned for cardiac evaluation but suggests left ventricular enlargement.\nThere is no pericardial effusion.\n\nPleural fluid at the base of the right lung has slowly decreased in volume\nsince ___. The parietal pleural surface is smoothly thickened and\nminimally calcified. There are no nodular deposits in the pleura.\n\nA 5 mm nodular opacity on the mucosal surface of the junction of the right and\nposterior walls of the trachea at the thoracic inlet, 06:46 is concerning for\na possible soft tissue nodule because a slightly smaller abnormality was\npresent in the same location on one ___, 05:57 and perhaps on ___, 04:44. Trachea has a non physiologic configuration, which is\nassociated with greater propensity for tracheomalacia.\n\nA 26 x 9 mm conglomerate of right lower paratracheal lymph nodes, 05:24, was\n14 x 31 mm in ___. , at 12 x 33 mm in ___. Right hilus and\nbronchial stump have normal appearance is postoperatively following lower\nlobectomy.\n\nFusiform dilatation of the ascending thoracic aorta, to maximum diameter 54 mm\nat the level of the intra pericardial right pulmonary artery, 05:30, was 55 mm\nin ___. Aortic valvular calcification is moderate. Pulmonary arteries are\nnormal size. Aortic arch and descending thoracic aorta are not normal size\ndespite heavy burden of atheroma and/or mural thrombus.\n\nEmphysema is mildly to moderately severe in the upper lungs, less severe\nelsewhere. Focal lung lesions are as follows:\n\n6 mm cavity, right upper lobe with an eccentric wall, 6: 97, unchanged since\nat least ___.\n\n9 x 13 mm soft tissue nodule in or just inferior to the right minor fissure,\n10:14, 6:174, was 9 x 15 mm in ___. Of\n\n4 mm right middle lobe nodule, 6:177, unchanged since ___.\n\nSmall region of atelectasis, right lung base associated with small intercostal\npulmonary hernia, 6:209, improved since ___.\n\n\n3 mm left lower lobe nodule, 6:171, stable since ___.\n\nHeterogeneous, largely soft tissue 6 mm left lower lobe subpleural nodule,\n6:199, unchanged since ___, increased since ___.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Possible endotracheal nodule. Bronchoscopy recommended.\n\n6 mm left lower lobe nodule has grown since ___, could be clinically\nsignificant. Followup advised. Handful of other small lung and pleural\nlesions, detailed above, including a sub cm right upper lobe cavity are stable\nmore than a year and unlikely to be clinically active.\n\n\nPostoperative right pleural effusion, possibly loculated, continues to\nresolve. Normal postoperative appearance, right lower lobectomy.\n\nStable fusiform dilatation ascending thoracic aorta may be related to calcific\naortic stenosis.\n\nSevere atherosclerotic coronary calcification.  Possible left ventricular\nenlargement.\n\nMild to moderate emphysema."
        },
        {
            "input": "Thyroid is unremarkable.  Ascending aorta is dilated up to 54 mm, unchanged\nfrom before.  Main pulmonary artery is normal size.  There is heavy\ncalcification at the coronary arteries, mitral valve annulus, and aortic\nvalve.  Trace pericardial effusion is physiologic.  Left ventricle may be\nhypertrophic.  Supraclavicular, axillary, mediastinal, and hilar lymph nodes\nare not enlarged.  A lower paratracheal lymph node measures 9 mm in short axis\n(02:26), stable.\n\nPost operative changes from right lower lobectomy is stable.  Airway is patent\nto subsegmental levels.  Previously seen small nodule on the tracheal surface\nis no longer present.  A small right pleural effusion and smooth right pleural\nthickening is unchanged.  Mild emphysema is noted in bilateral apices.\nA 5 mm cystic lesion the right upper lobe (4:81) is unchanged.\n\nMultiple pulmonary nodules are stable:\nA 2 mm solid nodule in the right lung apex (___).\nA 13 mm solid nodule in between minor fissure (4:152).\nA 4 mm solid nodule in right middle lobe(04:155).\nA 5 mm ground glass and solid mixed density nodule in left lower lobe (4: 178)\n.\nA 5 mm solid nodule in left lower lobe (4:181).\n\nBONES/ SOFT TISSUE:  No worrisome lesion is identified.\n\nABDOMEN:  The study was not designed for subdiaphragmatic evaluation.  Limited\nassessment of upper abdominal organs is notable for simple cysts in bilateral\nkidneys.  A 15 mm partially calcified right adrenal nodule is unchanged.",
            "output": "1.  Postoperative changes from right lower lobectomy and small right pleural\neffusion are stable.\n\n2.  Multiple pulmonary nodules are stable.\n\n3.  Fusiform dilation of ascending aorta is stable.\n\n4.  Heavy calcification is noted at the coronary arteries, mitral valve\nannulus, and aortic valve."
        },
        {
            "input": "The patient is status post right lower lobe resection with stable\npostoperative appearance at the operative site.  Assessment of the lungs is\nremarkable for moderately severe upper lobe predominant emphysema and minimal\nnonspecific biapical scarring.  Small right pleural effusion with surrounding\nsmoothly marginated pleural thickening is unchanged, as well as a small amount\nof fluid within the major fissure.\n\nPreviously noted small nodules are unchanged including a fluid density 13 mm\nnodular opacity in the fissure which probably reflects loculated fluid ___,\n4) and several sub 5 mm nodules including a juxta fissural nodule on the right\n(150, 4), a right upper lobe nodule (80, 4), four left lower lobe nodules (82,\n171, 176 and 178, 4) and a left apical nodule (41, 4).  No new or growing\nnodules are detected.\n\nFusiform dilation of ascending aorta is again demonstrated, measuring up to\n5.1 cm in diameter.  Diffuse coronary artery calcifications are also noted as\nwell as aortic valvular calcifications.  There is no pericardial or left\npleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nagain made of a calcified right adrenal nodule and an incompletely imaged\nlesion in the midpole portion of the right kidney (66, 2), more fully\nevaluated by prior MRI of the abdomen of ___.  Small cyst in upper\npole portion of right kidney is incidentally noted.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nof the spine",
            "output": "1. Stable postoperative appearance following right lower lobe resection with\nno evidence of local recurrence the operative site.\n\n2.  Small right pleural effusion with surrounding smoothly marginated pleural\nthickening is unchanged.\n\n3.  Continued CT stability of small pulmonary nodules, with no new or growing\nlung nodules.\n\n4. Upper pole left kidney lesion is incompletely imaged and has previously\nbeen characterized as suspicious for clear cell renal cell carcinoma on MRI of\nthe abdomen of ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  No cervical tracheal masses.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  No adrenal lesions.  Partial calcification of the\nright adrenal unchanged.  Extensive atherosclerotic vascular changes involving\nthe abdominal vasculature.  Multiple calcifications extending to the renal\npapillae which may represent vascular or papillary calcifications\n(nonobstructing calculi).  Exophytic renal cortical cyst in relation to the\nupper pole of the right kidney is unchanged.\n\nMEDIASTINUM: Mediastinal lymph nodes (the largest in the right lower\nparatracheal station 03:27) is similar to slightly decreased in size compared\nto previous imaging.  These lymph nodes measure low-density and may be\ncongestive in nature.\n\nHILA: Right hilar lymph nodes appear similar compared to prior imaging.\n\nHEART and PERICARDIUM: Cardiomegaly with layering of contrast seen in the SVC\nand IVC as well as contrast reflux into the liver suggesting decreased cardiac\nfunction.  Severe aortic valve, right, LAD and circumflex artery\ncalcifications.  Moderate calcification of the mitral annulus.  Trace\npericardial fluid.  The left atrium is enlarged measuring 56 mm in the AP\nplane.  There is non opacification of the anterior tip of the left auricle (3,\n34) which is most likely phase related, but an atrial appendage thrombus can't\nbe excluded and this may be correlated with cardiac echo.  Fusiform aneurysmal\ndilatation of the ascending aorta measuring 52 mm in diameter appearing\nsimilar compared to prior imaging.\nPLEURA: Small nonhemorrhagic right pleural effusion is slightly smaller\ncompared to prior imaging done ___.\nLUNG:\n\n-PARENCHYMA:  All the pre-existing pulmonary nodules (5, 52, 91, 106, 111,\n123, 138, 150, 193, ___ and 233) are unchanged.  The peribronchiolar\nconsolidation in the posterior basal aspect of the right lung (right middle\nlobe) shows interval improvement as does the cluster of ___ nodules in\nthe lateral aspect of the right mid lung zone.  Marked centrilobular\nemphysematous changes in the upper lobes.\n-AIRWAYS:  Stable postsurgical tracheal changes.  Non physiologic appearance\nof the trachea suggesting tracheobronchomalacia.  Evidence of previous right\nlower lobectomy.\n-VESSELS:  The pulmonary artery is dilated measuring 40 mm in diameter\nsuggesting pulmonary arterial hypertension.  Circumferential filling defect in\nthe right descending pulmonary artery (5, 170) adjacent to the site of\nprevious right lower lobectomy.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.  Sclerotic lesion in the anterior aspect of left ninth rib is\nunchanged.",
            "output": "1.  No evidence of disease recurrence in the trachea.\n2.  Right pulmonary artery filling defect suggesting chronic/ muralized\nthrombus at the right lower lobe bronchial stump.  Although likely due to\nbland thrombus, tumor thrombus cannot be excluded.  Filling defect in the left\nauricle is nonspecific and may be phase related or represent thrombus.\n3. Resolution o it f the prior right lower lung zone (right middle lobe) lower\nrespiratory tract infection.\n4.  Fusiform aneurysmal dilatation of the ascending aorta again noted\n5.  All the pre-existing pulmonary nodules unchanged.\n\nRECOMMENDATION(S):  Filling defect in the left auricle which may be phase\nrelated or represent thrombus and this may be correlated with cardiac echo or\nalternatively may also be evaluated with MRA.\n\nFilling defect within right distal pulmonary artery could also be assessed\nwith MRA to differentiate  bland thrombus from tumor thrombus.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:14 ___, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland enhances\nhomogeneously.  Chest wall is within normal limits.\n\nUPPER ABDOMEN: Subdiaphragmatic findings are dictated separately under clip\n___.\n\nMEDIASTINUM: There are scattered mediastinal lymph nodes, measuring up to 1 cm\nin the right lower paratracheal station (6:131).  This has increased in size\ncompared to ___, where the same node measured up to 0.9 cm in short\naxis.\n\nHILA: There is no hilar lymphadenopathy by size criteria.\n\nHEART and PERICARDIUM: Heart size is mildly enlarged, without pericardial\neffusion.  There is suggestion of mild aneurysmal dilation at the left\nventricular apex (___).  Aortic valvular calcifications are overall\nunchanged.  Coronary calcifications are diffuse.\n\nPLEURA: There is no pneumothorax.  A moderately-sized non-hemorrhagic pleural\neffusion on the right has increased from ___.  No pleural effusion\non the left.\n\nLUNG:\n\nPARENCHYMA:  An azygos lobe is incidentally noted.  Right lower lobe has been\nresected for squamous cell carcinoma.  Moderate centrilobular emphysema\npredominantly affects the upper lobes.  Patchy nonenhancing opacities in the\nright middle lobe (6:194) have developed in the interim since ___\nand concerning for infection.  There is also background centrilobular nodules\nand ___ opacities.\n\nThe following nodules are noted and stable from at least ___:\n- 4 mm posterior right upper lobe (06:109).\n- 1.2 cm perifissural nodule measuring simple fluid attenuation (6:191),\npotentially representing fissural fluid.\n- 3 mm adjacent right middle lobe nodule (6:195).\n- 3 mm left apical nodule (06:51).\n- 4 mm nodule in the superior segment of left lower lobe (6:110).\n- 8 mm mixed attenuation nodule in the left lower lobe (6:218).\n\nA 5mm subpleural nodule in the right upper lobe is new (6:146).\n\nAIRWAYS:  Other than right lower lobe resection, other airways are patent to\nthe subsegmental levels.\n\nVESSELS:    The ascending thoracic aorta is aneurysmal, measuring up to 5.3 cm\nin diameter (05:36), unchanged from ___, but enlarged from ___\nwhere it measured 5 cm. Moderate atherosclerotic calcifications and calcified\nplaque are present throughout the thoracic aorta.  Main pulmonary artery is\nslightly prominent, measuring up to 3.1 cm in diameter (05:33).\n\nCHEST CAGE: No osseous lesions concerning for malignancy.  Anterior\nosteophytes in the thoracic spine are most pronounced from T3 through T10.",
            "output": "1. Right middle lobe patchy opacities, centrilobular nodules and ___\nopacities are new from ___ and concerning for infection.  A\nfollow-up chest CT should be performed in 3 months to document resolution.\n2. Increased right pleural effusion, now moderate, likely parapneumonic. \nSimilarly, prominent mediastinal lymph nodes are likely reactive.\n3. Otherwise no evidence of intrathoracic recurrence.\n4. Moderate upper lobe predominant centrilobular emphysema.\n5. New 5mm right upper lobe subpleural nodule.  Remainder of the pulmonary\nnodules described above are stable from ___.\n6. 5.3 cm ascending aortic aneurysm, increased from 5 cm in ___, for which\nannual surveillance is recommended if not already being evaluated on oncology\nfollow-up studies.\n7. CT abdomen/pelvis dictated separately.\n\nRECOMMENDATION(S):  Chest CT in 3 months to evaluate resolution of presumed\nright middle lobe infection.\n\nNOTIFICATION:  Finding #1 was discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:15 ___, 15 minutes after discovery\nof the findings."
        },
        {
            "input": "There are 6 mm hypodense right and left thyroid nodules requiring no specific\nfollowup.  There is no axillary, supraclavicular adenopathy.  There is a\nstable enlarged mediastinal lymph node measuring 1.4 cm in the lower right\npretracheal station.\n\nThe heart is mildly enlarged.  There is no pericardial effusion.  Coronary\nartery and aortic valvular calcifications are severe.  There also\ncalcifications at the takeoff of the great vessels.  The main pulmonary trunk\nis dilated up to 3.6 cm.  Dilation of the ascending thoracic aorta up to 4.9\ncm is stable.\n\nAirways are patent to the subsegmental level bilaterally with diffuse airway\nthickening.  There are postsurgical changes from right lower lobectomy. \nModerate biapical scarring, is unchanged.  There is severe centrilobular\nemphysema.  A moderate loculated right pleural effusion is unchanged. \nMultiple pre-existing pulmonary nodules are also unchanged including the\nlargest perifissural nodule which measures 1.2 x 0.8 cm in the right lower\nlobe (series 303, image 144).  Other pulmonary nodules are seen on (series\n303, image 85, 169).\n\nThe thoracic esophagus is unremarkable.  Please see same day abdominal and\npelvic CT for subdiaphragmatic details.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: There is no superficial soft tissue\nabnormality.  There are no suspicious bony lesions.",
            "output": "1. Stable appearance of the chest without evidence of disease recurrence.\n2. Pre-existing pulmonary nodules, detailed above, are stable.\n3. Unchanged ascending thoracic aortic aneurysm measuring 4.9 cm.\n4. Stable loculated right pleural effusion.\n5. Enlarged main pulmonary artery, suggests underlying pulmonary hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is mildly heterogeneous.\nThere is no supraclavicular or axillary lymphadenopathy.\nThe chest wall is with no soft tissue abnormalities.\n\nUPPER ABDOMEN: 1.3 cm partially calcified lesion in the right adrenal gland is\nunchanged and better characterized on the CT of the abdomen and pelvis ___.  Small cortical cyst in the upper pole of the right kidney.\nRemaining included upper abdominal organs are unremarkable within the\nlimitation of study non IV contrast\n\nMEDIASTINUM: In the lower right paratracheal station 1.4 x 3.8 cm is unchanged\nsince ___.  large number of sub cm lymph nodes predominantly in AP window\nalso unchanged.  There is no gross hilar lymphadenopathy.\nThe esophagus is patulous and unremarkable.\n\nHEART and PERICARDIUM: Heart is mildly enlarged.  There is no pericardial\neffusion.\nCoronary and aortic valve leaflets calcifications are dense and extensive.\nFusiform aneurysm of the ascending aorta up to 5.2 cm is unchanged.\nModerate to severe atherosclerotic calcifications of the thoracic aorta and\nhead and neck vessels.\n3.7 cm main pulmonary artery is grossly unchanged suggesting pulmonary\nhypertension.\nDense calcifications of the mitral valve.\n\nLUNG and PLEURAE: Severe emphysema affecting predominantly the right upper\nlobe with diffuse mild bronchial thickening.\nStatus post right lower lobectomy, with no evidence of soft tissue abnormality\nin the surgical bed to suggest local recurrence.\nThere has been interval development of bronchial impaction in the lower\nportion of the right bronchial trunk, but there are no new consolidations to\nsuggest focal pneumonia.\nIn the right upper lobe centrilobular nodules and peribronchial infiltrations\nare new since ___ and most probably additional foci of inflammation\n(4:98).\n\nIn the right base subsegmental atelectasis with moderate loculated right\npleural effusion are mildly smaller.\n1.1 cm nodule middle lobe (4:142) and adjacent 0.3 cm nodule are unchanged. \nThere are no new or enlarging lung nodules.\n\nCHEST CAGE: No evidence of lytic or sclerotic bony lesions.  Multilevel\ndegenerative change of the spine, DISH.",
            "output": "-retained secretions in the lower portion of the right bronchial trunk are new\nsince ___ with no focal consolidations.  Minimal peribronchial\ninfiltration in the right upper lobe is likely additional focus of\ninflammation.\n-Few pulmonary nodules are unchanged and there are no new or enlarging\nconcerning lung nodules.\n-Severe aortic valvular calcification could be at stenotic.  Fusiform aneurysm\nof the ascending aorta up to 5.2 cm, unchanged.\n\nRECOMMENDATION(S):  Echocardiography for aortic valve assessment."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  There is dilation of the ascending thoracic aorta which\nmeasures up to 5.4 cm in maximal diameter, previously 5.2 cm at a similar\nlevel.  Atherosclerosis is moderate in extent.  Main pulmonary artery is\ndilated measuring 3.8 cm in diameter.  There is no filling defect within the\npulmonary arterial tree to suggest the presence of a pulmonary embolism.  The\nheart remains stably enlarged with mitral annular and aortic valvular\ncalcifications noted.  There is biatrial chamber enlargement.  Coronary artery\ncalcification is also again noted.  There is no pericardial effusion.  Stable\nmild prominence of mediastinal lymph nodes with a large precarinal lymph node\nmeasuring 14 mm in short axis on series 2, image 42.  Additional mediastinal\nlymph nodes do not meet size criteria for pathological enlargement.  No\nenlarged hilar or axillary nodes.  There is an azygous lobe.  A right pleural\neffusion appears partially loculated and increased from prior.\n\nInterlobular septal thickening and mild ground-glass opacity is consistent\nwith edema.  Mild diffuse bronchial wall thickening likely reflects chronic\nairways inflammation.  No worrisome nodule, mass, or consolidation is seen\nwithin the lungs.  There is a left lower lobe pulmonary nodule seen on series\n2, image 36 measuring 6 mm, unchanged from ___.  Nodular opacity in\nthe right lower lung on series 2, image 66 likely represents loculated pleural\nfluid.  Background emphysema noted.\n\nIn the imaged portion of the upper abdomen, there is again noted to be a\ncalcified right adrenal nodule which is unchanged.  Bilateral renal cysts are\npartially visualized.  No discrete finding of concern in the upper abdomen.\n\nBones: No worrisome bony lesion.  No fractures.  Anterior bridging osteophytes\nnoted within the thoracic spine.",
            "output": "1. No pulmonary embolism.\n2. Mild pulmonary edema with loculated right pleural effusion, small in volume\nthough increased from prior.\n3. Aneurysm of the ascending thoracic aorta measuring 5.4 cm, previously 5.2\ncm.\n4. Cardiomegaly with biatrial chamber enlargement and mitral and aortic\nvalvular calcification.\n5. Enlarged main pulmonary artery suggestive of pulmonary arterial\nhypertension.\n6. Emphysema with greater than ___ years stability of a 6 mm left lower lobe\npulmonary nodule."
        },
        {
            "input": "CHEST PERIMETER: Subcentimeter low-attenuation regions in both thyroid lobes\nare too small to warrant further imaging.  Supraclavicular and axillary lymph\nnodes are not enlarged or growing and there are no soft tissue abnormalities\nelsewhere in the chest wall concerning for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis heavy in head and neck vessels, particularly left subclavian artery, in all\nthe major coronaries.  Aortic valvular calcification is heavy enough to be\nhemodynamically significant, reflected in fusiform dilatation of the ascending\nthoracic aorta to 53 mm, stable since at least ___.  Full cardiac\nevaluation of chamber size and function would require echocardiography. \nPulmonary arteries are not enlarged.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES:\n15 x 34 mm right lower paratracheal node and many smaller mediastinal lymph\nnodes are stable.  Hilar lymph nodes are not enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is mild to moderate, and there is\nsubstantial heterogeneity in background lung density is well as small impacted\nbronchi, such as left lower lobe, 4:162, suggesting small airway obstruction\n\nFocal lesions:\n\n6 mm left lower lobe solid nodule, 4:73, stable since ___ and ___.\n\n9 x 13 mm solid right basal nodule, 4:136, also unchanged, as remeasured since\n___ was 8 x 12 mm in ___..\n\nModerate size nonhemorrhagic loculated right pleural collection base of the\nright lung stable ___ and ___.\n\nRight hilus and bronchial stump have normal postoperative appearance following\nlower lobectomy.\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No new or growing lung lesions concerning for new or recurrent intrathoracic\nmalignancy.  Minimal interval growth, right basal lung nodule since ___,\nhas been present and nearly the same size since ___.  It was not FDG avid\nwhen last evaluated by a PET CT scan in ___.  Other smaller lung\nnodules are stable long-term as well.\n\nStable postoperative right pleural fluid loculation.\n\nIs severe atherosclerosis involving head and neck and coronary arteries.\n\nHeavily calcified aortic valve probably hemodynamically significant\ncontributing to stable, moderate poststenotic dilatation of the ascending\nthoracic aorta.\n\nMild emphysema.  Moderate small airway obstruction."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is heterogeneous but no hyper lucencies are large\nenough to require further imaging evaluation.  Supraclavicular and axillary\nlymph nodes are not pathologically enlarged.  No soft tissue abnormalities in\nthe imaged chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Esophagus is mildly patulous above the aortic arch.  There\nis no good evidence for obstruction.\n\nAtherosclerotic calcification is moderately heavy in head neck vessels which\nalso contain noncalcified plaque, severe in all major coronary arteries. \nAortic valve is heavily calcified and the mildly calcified ascending thoracic\naorta is dilated in a fusiform fashion to maximum diameter of 54 mm,\npreviously 57 mm.  Heart is generally enlarged.  Left ventricular hypertrophy\nis most pronounced in the anterior aortic outflow tract and septum.  Mitral\nannulus is heavily calcified, sometimes associated with mitral regurgitation. \nCardiac evaluation would require echocardiography.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: Enhancing soft tissue inseparable from the right lateral\nwall of the upper trachea, 10 x 12 mm, 04:34, is new since ___ was 6\nx 10 mm in ___, 04:37.\n\nMeasurable mediastinal lymph nodes are numerous, or ranging up to 15 x 32 mm\nin the right lower paratracheal station, unchanged since ___ 18.  Other\nlymph nodes are top-normal or barely enlarged, but all in the mediastinum and\nhila are stable size.\n\n\n\nLUNGS, AIRWAYS, PLEURAE:\nRight hilum and bronchial stump have a normal postoperative appearance\nfollowing lower lobectomy.  Moderate nonhemorrhagic right pleural effusion is\nslightly larger, collected and probably loculated at the right lung base\nposteriorly. Surrounding pleura is generally smooth.\n\nEmphysema is mild. 6 mm solid nodule, superior segment left lower lobe, 4:75,\nstable since ___.\n\nGeneralized septal thickening and variation in background attenuation is most\nlikely mild pulmonary edema. Component of air trapping would be difficult to\ndistinguish, especially since mild generalized bronchial wall thickening is\ndifficult to distinguish from peribronchial cuffing from edema.\n\n9 mm perifissural nodule, right middle lobe and a smaller adjacent nodule,\n4:138, 141, unchanged since ___.\n\nCHEST CAGE: Decreased radiodensity in upper thoracic vertebral bodies stable\nsince ___ is not malignant.  Well-circumscribed sclerotic lesion lateral\naspect left middle rib, 602:147, is also stable since ___.  There is\nno compression or pathologic fracture or clearly destructive bone lesion in\nthe chest cage.\n\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning..",
            "output": "No good evidence for active intrathoracic malignancy.  Numerous measurable and\na small number of enlarged lymph nodes, and a handful of tiny solid lung\nnodules are all stable since ___.\n\nPostoperative right pleural fluid loculation is chronic.\n\nSevere aortic valvular calcification, could be hemodynamically significant,\nlong with extremely heavily calcified mitral annulus.  Atherosclerotic\ncalcification is extremely heavy, including coronaries and head and neck\nvessels.\n\nFusiform aneurysmal dilatation ascending thoracic aorta has not progressed.\n\nAcute pulmonary edema is mild.  Mild emphysema is chronic."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  Mild atherosclerotic calcifications in the head and neck arteries. \nThere are no chest wall abnormalities.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Stable multiple enlarged central mediastinal lymph\nnodes, the largest in the right lower paratracheal station measuring 16 mm\n(4:99).  Hilar contours show no evidence enlarged lymph nodes within the\nlimitations of a noncontrast study.\n\nHEART, PERICARDIUM AND VASCULATURE:\nUnchanged appearance of the moderate cardiomegaly.  No pericardial effusion. \nStable severe atherosclerotic calcifications in the coronary arteries, aortic\nvalve leaflets, mitral annulus and moderate in the aortic arch and descending\naorta.  Ascending aorta aneurysm measuring 54 mm is unchanged prior study. \nPulmonary artery measuring 44 mm is unchanged as well.\n\nLUNGS, AIRWAYS, AND PLEURA:\nStable multiple bilateral nodules ranging from 4-14 mm (4:67, 80, 107, 148). \nNo new or growing nodules the airways are patent to the subsegmental levels\nwith associated mild bronchial wall thickening, no bronchiectasis or mucus\nplugging.  Moderate upper lobe predominant centrilobular emphysema is\nredemonstrated.  Unchanged appearance of right lower lobe lobectomy\npostsurgical changes.  Stable appearance of the longstanding organized right\npleural effusion and associated right base subsegmental atelectasis.\n\nCHEST CAGE:\nNo acute fractures.  Severe dorsal spondylosis.  A 7 mm sclerotic lesion in\nthe lateral aspect of the left ninth rib is stable since ___ and is\nmost likely a bone island.  No suspicious lytic or sclerotic bone lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show stable calcifications in the\nright adrenal gland.  Left adrenal gland is unremarkable.  No evidence of\nfocal lesions in the partially imaged liver and spleen.",
            "output": "Unchanged appearance of the multiple bilateral nodules ranging from 4-14 mm\nsince ___.  No new or growing nodules.\n\nUnchanged appearance of the multiple enlarged central mediastinal lymph nodes\nranging from 2-16 mm since ___ as well.\n\nStable 54 mm ascending aorta aneurysm and enlarged 44 mm pulmonary artery.\n\nUnchanged appearance of the right lower lobe lobectomy postsurgical changes\nincluding unremarkable bronchial stump as well as the longstanding organized\nright pleural effusion.\n\nSevere coronary artery atherosclerotic disease and aortic valve leaflets\ncalcifications are unchanged as well."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nSimilar narrowing of the branch to the right lower lobe due to right lower\nlobectomy.  The thoracic aorta is dilated measuring up to 5.4  Cm in the\nascending segment and 4.1 cm in the descending segment.  The thoracic aorta is\nmoderately calcified. Moderate Cardiomegaly is unchanged.  Coronary and aortic\nvalve calcifications are again seen.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.   Numerous\nmediastinal lymph nodes are not enlarged.  No mediastinal mass.  Prominent\nright hilar lymphoid tissue.  The right hilar stump has postoperative\nappearance.\n\nPLEURAL SPACES:  No pneumothorax. Decreased partly organized right pleural\neffusion.  No left pleural effusion.\n\nLUNGS/AIRWAYS: Bilateral mild bronchial wall thickening, not present in ___. \nStatus post right lower lobectomy.  Airways are patent with some subsegmental\nareas of mucous plugging. There is mild bronchial wall thickening in the right\nlower lobe.  Mild emphysema.\n\nStable multiple pulmonary nodules including a 6 mm left lower lobe nodule\n(301:80, 3 mm right upper lobe nodule (301:79), 1 cm right perifissural nodule\n(601:135), previously measuring 9 mm.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.  Degenerative changes\nincluding diffuse multilevel calcification of the anterior longitudinal\nligament and anterior bridging osteophytes suggests DISH.  There is no acute\nfracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Diffuse mild bronchial wall thickening and mild mucous plugging.  No\npulmonary edema.\n3. Stable multiple pulmonary nodules since at least ___.\n4. Moderate cardiomegaly.  Stable aneurysmatic thoracic aorta measures up to\n5.4 cm.  Follow up in the Aortic center recommended regarding the thoracic\naneurysm.\n5. Calcified aortic valve, with right atrium enlargement, suggests possibility\nof aortic stenosis.  If not artery performed echocardiogram should be\nconsidered.\n6. Enlargement of the pulmonary artery.\n7. Decreased partly organized small right pleural effusion.\n\nNOTIFICATION:  And emailed to the ED nurses was signed by ___,\nMD.  At 10:05 a.m. to ensure proper follow-up."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: reported separately.\n\nMEDIASTINUM: Multiple borderline enlarged paratracheal lymph nodes, the\nlargest in the right upper paratracheal area (2, 15) measuring 10 mm in\ndiameter.  Feeding tube in situ in the stomach.  Right and left pulmonary\narteries are dilated, suggesting pulmonary hypertension.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Cardiomegaly.  The left atrium is distended measuring\n63 mm in the AP plane.  Moderate aortic valve calcifications.  Severe LAD\ncalcifications.  Mild circumflex and right coronary artery calcifications. \nMild mitral valve calcification.\nPLEURA: Large right-sided nonhemorrhagic pleural effusion.  Moderate sized\nleft-sided pleural effusion.\nLUNG:\n\n-PARENCHYMA:  There is volume loss in both lungs likely secondary to\nbackground pleural effusions.  A atelectasis in the left lung is most marked\nat the lung base and lingula.  On the left, there are multiple micro nodules\nin a somewhat random centrilobular distribution.  On the right, there is\nthickening of the interlobular septae a throughout most marked at the right\nlung apex but is somewhat patchy distribution.  Mild background increased\nground-glass opacity is also seen in the right more than left lung.\n-AIRWAYS:  ET tube in situ with the tip 20 mm proximal to the carina.  The\nairways are patent to the subsegmental level.  There may be a minor degree of\nperipheral bronchiectasis in the right middle lobe (series 4, image 117).\n-VESSELS:  The pulmonary artery is enlarged measuring 32 mm diameter.  No\nfilling defects on this nondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "1. Mild ground-glass opacity and micro nodularity most marked the left lung. \nThese changes suggest atypical infection or aspiration.\n2. Interstitial changes on the right could reflect asymmetric interstitial\nedema however followup imaging follow up after resolution of acute phase is\nrecommended to exclude a fibrotic process.\n3. Large right-sided pleural effusion.  Smaller left-sided pleural effusion.\n4. Dilated right and left pulmonary arteries suggesting pulmonary\nhypertension."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Interval decrease in\nmediastinal lymphadenopathy is demonstrated, for example at the level of right\nlower paratracheal lymph node with a decreased from 12-8 mm is demonstrated,\nat the level of the right upper paratracheal lymph node with decreased from\n15-7 mm is demonstrated.  Prevascular lymph nodes are unchanged.  No hilar or\naxillary lymphadenopathy is seen.  Subcutaneous nodule in the left chest wall\nhas resolved.\n\nCoronary calcifications are extensive.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen demonstrate hypodense adrenal lesion and\nwill be discussed separately as part of the CT abdomen and pelvis.\n\nAirways are patent to the subsegmental level bilaterally.  Additional interval\ndecrease in multiple pulmonary nodules demonstrated, series 4, images 151, 51,\n161, 200 and 3, 200 and 5, with the largest nodule currently seen in left\nlower lobe measuring 6 x 7 mm as compared to 12 x 11 mm, series 4, image 162. \nNo new nodules masses or consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Additional interval decrease in pulmonary nodules as described.  No new\nnodules\n\nInterval decrease in mediastinal lymphadenopathy\n\nResolution of previously seen left chest wall soft tissue nodule."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged bilateral\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes\n\nMEDIASTINUM: Small mediastinal nodes are stable and measure 3-6 mm.  Moderate\ncoronary artery calcifications again seen.  There is no pericardial effusion. \nThe main pulmonary artery is mildly enlarged but unchanged.  The ascending\naorta is ectatic but unchanged measures 4.1 cm.  The airways are patent up to\nthe subsegmental level.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: All the previously visualized pulmonary nodules are unchanged in size\n(3, 59, 67, 87, 167, 203, 204).  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows bilateral\nadrenal thickening.  No focal liver lesions are seen.",
            "output": "Stable number size and distribution of multiple tiny pulmonary nodules.  No\nnew nodules.\n\nStable small mediastinal lymph nodes.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcifications of the thoracic\naorta.  There are severe coronary calcifications.  The thoracic aorta is\nnormal in caliber.  The main pulmonary artery is enlarged suggesting pulmonary\narterial hypertension.  Otherwise, the heart, pericardium, and great vessels\nare within normal limits based on an unenhanced scan. No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  There are\nmultiple small mediastinal lymph nodes measuring up to 8 mm at the right lower\nparatracheal station, unchanged compared to prior.  No mediastinal\nlymphadenopathy meeting CT criteria for pathologic involvement.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple punctate nodules within the lungs bilaterally, some of\nwhich are calcified, all of which are unchanged compared to the CT dated ___ (series 3, image 63, 92, 115, 190, 198, 220).  No new or growing\npulmonary nodules.  Mild linear atelectasis within the right lower lobe.  No\nfocal consolidations.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of metastatic disease within the chest.  Multiple punctate\nnodules within the lungs bilaterally, unchanged compared to ___. \nNo new or growing pulmonary nodules.\n2. Please refer to the abdominal CT with the same date for evaluation of the\nintra-abdominal structures."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging.  Supraclavicular\nand axillary lymph nodes are not enlarged and there are no soft tissue\nabnormalities in the imaged chest wall concerning for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mid and lower esophagus are moderately patulous.  No\nretention of fluids to suggest obstruction.  Atherosclerotic calcification is\nnot apparent in head and neck vessels but is present in at least left anterior\ndescending (most pronounced) left circumflex and right coronary arteries. \nAorta and pulmonary arteries are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions:\n\n2-3 mm right lower lobe nodule, 4:202, was too small to measure in ___ and\nnot present in ___, concerning for growing metastasis.\n\nPunctate nodule right upper lobe, 4:124, left lower lobe, 4:237, and right\nlower lobe, 4:215, unchanged since ___.\n\nLungs otherwise clear.  Tracheobronchial tree is normal to subsegmental levels\nand there is no pleural abnormality\n\n\n\nCHEST CAGE: No compression or pathologic fracture or destructive bone lesions.\n3 small sclerotic lesions and one small sclerotic ring shadow in right and\nleft middle ribs are unchanged since ___, 7:63, 62, 18, 14, can be\nconsidered benign.",
            "output": "3 mm right lower lobe lung nodule new since ___ has grown since ___, concerning for active metastasis.  There are no other lung lesions of\nconsequence.\n\nAtherosclerotic coronary calcification."
        },
        {
            "input": "Included views of thyroid are within normal limits.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.  Prominent\nmediastinal lymph nodes demonstrate normal for morphology, measuring up to 8\nmm (pretracheal, series 4, image 108).\n\nThe heart size is normal.  There is no pericardial effusion.  Extensive\ncoronary vascular calcifications are noted (series 4, image 165).\n\nThe great vessels are normal in caliber.\n\nA 5 mm right middle lobe pulmonary nodule has enlarged from 3 mm on the ___ examination (series 4, image 210).  A 3 mm right upper lobe\nsubpleural nodule has enlarged from 2 mm on the prior study (series 4 image\n136).\n\nA 4 mm central left upper lobe subpleural nodule is unchanged (series 4, image\n88).  A 2 mm left lower lobe subpleural nodule is unchanged (series 4, image\n245).  A 3 mm right lower lobe pulmonary nodule is unchanged (series 4, image\n221).  An adjacent 3 mm right lower lobe pulmonary nodule is also unchanged\n(series 4, image 214).  Trace ___ opacities with along the right lower\nlobe likely reflect mild inflammation (series 4, image 207).  A 2 mm right\nlower lobe nodule adjacent to the main fissure is unchanged (series 4, image\n183).\n\nNo new pulmonary nodule is detected.  There is no focal consolidation or\npleural effusion.\n\nThere are no osseous lesions concerning for malignancy or infection.\n\nPlease refer to the separate CT dictation regarding intra-abdominal findings.",
            "output": "1. Enlarging 5 mm right middle lobe pulmonary nodule is concerning for\nmetastasis.\n2. 3 mm right upper lobe subpleural nodule has slightly enlarged since ___, concerning for early metastasis.\n3. Other sub 5 mm pulmonary nodules are unchanged, warranting attention on\nsubsequent surveillance studies.\n4. Minimal inflammation along the right lower lobe likely reflects mild\naspiration.  No focal consolidation.\n5. Please refer to the separate CT dictation regarding intra-abdominal\nfindings.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 10:48 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM:Mid and lower esophagus are mildly patulous, unchanged.  No\nassociated mass or evidence of obstruction.  Atherosclerotic calcification is\nnot apparent head neck vessels, but is present in all major coronary segments.\nPulmonary artery is enlarged, main 35 mm, unchanged.  Aorta is normal size. \nAortic valve is not calcified.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE:\nNo new or growing lung nodules of consequence.\n\nPrevious 5 mm right middle lobe nodule, 3 mm right lower lobe nodule, has\nresolved since ___.  Handful of other punctate lung nodules\nunchanged.\n\nMinimal bronchial wall thickening and scattered mildly dilated peripheral\nbronchi, also unchanged.  No evidence of bronchial infection.  No pleural\nabnormalities.\n\nSolitary calcified pulmonary granuloma.  No evidence of active infection.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.  Previous measurable lung nodules\nhave resolved since ___ handful of punctate nodules unchanged, nature\nindeterminate.  No new or growing lung nodules.\n\nAtherosclerotic coronary calcification is extensive.\n\nPersistent enlargement main pulmonary artery may be in indication of pulmonary\narterial hypertension."
        },
        {
            "input": "There remain tiny, less than 3 mm, many subpleural and perifissural nodules\n(series 4), scattered in the right upper lobe (image 60), right lower lobe\n(image 145 and 148), left lower lobe (192, 237), overall less conspicuous, if\nnot unchanged.  The previous dominant nodule on the CT of ___ in\nthe right middle lobe, is no longer visualized, and there are no new nodules\nor masses.  There remains an atelectatic band within area of traction\nbronchiectasis and calcified granuloma in the right lower lobe.\n\nThere remains diffuse coronary arterial calcifications, and dilation of the\npulmonary arteries, in keeping with pulmonary arterial hypertension.  Remain a\nfew prominent paraaortic, AP window, and right lower paratracheal lymph nodes,\nthe latter measuring up to 9 mm in short axis, arguably slightly smaller, if\nnot unchanged compared to previous.\n\nPlease refer to separate CT abdomen report from the same day, for\nsub-diaphragmatic findings.\n\nNo suspicious bone lesion.",
            "output": "Multiple scattered tiny less than 3 mm nodules persist, overall unchanged if\nnot slightly less conspicuous, many benign-appearing.  No finding suspicious\nfor new, or progressed intrathoracic metastatic disease."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  A solitary precarinal lymph node (2, 20)\nis stable in size.  Moderate coronary calcifications, minimal aortic valve\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable, status post cholecystectomy.  No osteolytic lesions at the level\nof the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  Again noticed is the\npresence of millimetric pulmonary nodules, mostly in subpleural location, for\nexample in the right lower (4, 142 and 186) and left lower lobe (4, 190).\nThere is no evidence of new or growing nodules.  They small zone of fissural\ndeviation on the left (4, 160) is stable.  Airways are patent.  No pleural\nthickening, no pleural effusions, no diffuse lung disease.",
            "output": "Stable examination of the thorax.  Several stable small pulmonary nodules.  No\nnew or growing nodules.  No pleural abnormalities.  No adenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately\n\nMEDIASTINUM: Borderline right lower paratracheal lymph node measuring 10 mm\ndiameter (series 3, image 88) appear similar compared to prior imaging.  AP\nwindow lymph node measuring 7 mm diameter is stable.\n\nHILA: No obvious hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Mild aortic annular and\nmoderate severe coronary artery calcification is again noted.  Mild aneurysmal\ntransformation of the ascending aorta measuring 40 mm in diameter.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Again noted are multiple millimetric pulmonary nodules which\nare unchanged predominantly in subpleural locations (series 3, image 60, 93,\n150, 186, 75, 168).  No confluent airspace consolidation.  Linear atelectasis\nin the right lung base.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary truncus is mildly dilated measuring 35 mm diameter.\nCHEST CAGE: No new bone lesions.  A well-circumscribed lytic lesion in the\nsixth left rib (series 3, image 21) is similar compared to prior imaging. \nNone less well circumscribed lesion in the left fifth rib (series 3, image 98)\nappear similar compared to prior imaging.  A couple of sclerotic bony lesions\nare stable most likely representing bony islands (series 3, image 39, 34 and\n67).",
            "output": "No CT evidence of metastatic disease to the chest.\n\nMultiple millimetric pulmonary nodules predominantly in a subpleural location\nare stable compared to prior.  No new or enlarging nodules.\n\nMild aneurysmal dilatation of the ascending aorta measuring 40 mm in diameter.\nModerate severe coronary artery calcification again noted.\n\nA few lucent and sclerotic bony lesions are all stable.\n\nFor abdominal findings reference is made to CT abdomen report of the same day."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Normal sized lymph nodes continue to be present in\nthe mediastinum (3, 14).  Mild aortic wall calcifications.  No abnormalities\nat the level of the large mediastinal vessels.  Moderate coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable.  The upper abdomen, including a\nslightly plump left adrenal (3, 57) is reported in detail in the dedicated\nabdominal CT report.  Several partly hyperlucent and hypo lucent bony lesions\n(for example series 7, image 63) are visualized.\nPresence of stable micro nodules but no new or growing nodules are noted. \nMinimal non characteristic perifissural right lower lobe scarring (4, 207). \nNo pleural effusions.  No pleural thickening.  No diffuse lung disease.",
            "output": "Stable examination of the thorax as compared to ___.  Stable\npulmonary micro nodules.  Stable normal sized lymph nodes.  No new or growing\nnodules.  No pleural abnormalities.  Stable scattered bony lesions."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is normal.  No evidence\nof supraclavicular or axillary adenopathy.  Incidental note is made of mild\nsymmetric bilateral gynecomastia.\n\nUPPER ABDOMEN: Please refer to the separate report from the concurrent CT scan\nof the abdomen and pelvis for the abdominopelvic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  No calcified lymph nodes\nidentified to suggest prior granulomatous exposure.\n\nHILA: No evidence of hilar adenopathy.\n\nHEART, VESSELS and PERICARDIUM: The heart is not enlarged.  No pericardial\nfusion.  No significant coronary atherosclerotic disease.  The size of the\nthoracic aorta and main pulmonary artery are within normal limits.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Scattered millimetric nodules, measuring up to 3 mm (7:205) are\nnonspecific however should be followed up as per clinical protocol.  No focal\nconsolidation.  There is mild atelectasis noted in both lower lung zones.\n-AIRWAYS:  The airways are patent.\nCHEST CAGE: Since ___ there is new sclerosis along the anterior inferior\nendplate of T11 which is likely degenerative in nature given vacuum phenomenon\nof the adjacent disc.",
            "output": "1. Tiny nodules are noted throughout the lungs, measuring up to 3 mm and are\nnonspecific however continued follow-up as per clinical protocol is\nrecommended.\n2. No evidence of prior granulomatous disease exposure."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is atelectasis in the right middle lobe.  Small\nconsolidation is not entirely excluded.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2.  Right middle lobe atelectasis.  Consolidation is not entirely excluded in\nthe appropriate clinical context."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal.  There are no enlarged axillary lymph nodes.  Scattered\nmediastinal lymph nodes are present measuring up to 9 mm in the lower\nprevascular space, minimally increased from ___.  Heart is mild-to-moderately\nenlarged.  The main pulmonary artery is enlarged suggesting pulmonary artery\nhypertension.  There are no significant coronary artery or aortic valvular\ncalcifications.\n\nThe airway is are patent to the subsegmental level bilaterally.  There are\nsmall bilateral pleural effusions right greater than left with associated\natelectasis.  There is mild septal thickening.\n\nThere is a small hiatal hernia.  The thoracic esophagus is otherwise\nunremarkable.  Views of the upper abdomen demonstrate surgical changes from\nprior cholecystectomy.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Mild cardiomegaly, bilateral small pleural effusions, and septal\nthickening, compatible with mild volume overload.\n3. Enlarged pulmonary artery, suggestive of pulmonary artery hypertension."
        },
        {
            "input": "There is conventional 3 vessel aortic arch anatomy.  The aorta and its major\nbranch vessels are patent without aneurysmal dilatation.  Atherosclerotic\ncalcifications are noted throughout the thoracic aorta.  The heart size is\nnormal.  No pericardial effusion.\n\nThere is suboptimal opacification of the pulmonary vessels.  Within this\nlimitation, is no definite acute pulmonary embolus. The main is slightly\nectatic measuring 3.6 cm, suggesting pulmonary hypertension.  The right and\nleft pulmonary arteries are normal in caliber.  No evidence of right heart\nstrain.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nBilateral lower lung opacities may represent atelectasis or aspiration in the\nappropriate clinical setting.  The airways are patent to at least the\nsubsegmental level.  No pleural effusion.\n\nThere is a subtle hyperdense focus in the right hepatic lobe in the region of\nthe dome may represent a hemangioma or perfusion abnormality and is only\nclearly noted on the axial view (Series 2K, Image 54).  Otherwise, limited \nimages of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy.  There is\ndiffuse idiopathic skeletal hyperostosis.",
            "output": "1. Sub-optimal opacification of subsegmental pulmonary arterial branches. \nOtherwise, no definite acute PE.\n\n2.  Bilateral consolidations suggesting pneumonia/aspiration in appropriate\nclinical setting versus atelectasis.\n\n3.  Mildly ectatic main pulmonary artery suggesting pulmonary hypertension.\n\n4.  Right hepatic lobe hyperdensity (Se 2K, Im 54), possibly a hemangioma. \nOutpatient ultrasound recommended to further evaluate initially."
        },
        {
            "input": "The thyroid gland appears normal.  There is no mediastinal hematoma.  Thoracic\naorta is mildly calcified though normal in caliber the heart is top-normal in\nsize with dense mitral annular calcification as well as faint aortic valvular\ncalcification.  No pericardial effusion is seen.  No pleural effusion or\npneumothorax.  No definite signs of lymphadenopathy.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  There\nis mild bibasilar atelectasis.  No evidence of contusion.\n\nIn the imaged portion of the upper abdomen, no definite acute abnormalities\nare identified.\n\nBones:  Acute mildly displaced fractures involving the left ___ ribs noted\nalong the lateral arch.  No additional fractures are seen.  The thoracolumbar\nspine notable for degenerative changes and multiple levels with loss of disc\nspace and small anterior osteophytes though no compression fracture or\nmalalignment is seen.  The sternum is intact.  No lytic or blastic osseous\nlesion suspicious for malignancy is identified.",
            "output": "Left rib fractures along the lateral arch of ribs 3 - 7.  No pneumothorax or\nhemothorax.  Additional nonemergent findings as detailed above."
        },
        {
            "input": "There is a large confluent right hilar mass encasing the right hilar\nbronchovascular structures and causing encasement and significant narrowing of\nthe bronchus intermedius.  This lesion measures approximately 9.6 x 4.8 x 8.1\ncm with significant subcarinal extension and soft tissue encasement of the\ndistal trachea and carina.  There is tumoral encasement of the right pulmonary\narterial branches without secondary occlusion.  Severe emphysema is noted. \nAdditional nodules are seen within the right lower love for example on series\n2, image 70 measuring 10 x 12 mm and on series 2, image 81 measuring 1.8 x 2.0\ncm.\n\nThe imaged thyroid is unremarkable.  The thoracic aorta contains moderate\ncalcification and is normal in caliber throughout.  The main pulmonary artery\nis normal in size.  The pulmonary arterial tree is patent without filling\ndefect to suggest the presence of a pulmonary embolism.  As stated above,\nsignificant mass-effect from right hilar and mediastinal mass causes partial\neffacement of the right central pulmonary arterial tree.  The heart is normal\nin size and shape.  No pleural or pericardial effusion is seen.\n\nWithin the imaged portion of the upper abdomen, no overt abnormalities seen. \nThere is a small hiatal hernia.\n\nBones:  No worrisome lytic or blastic osseous lesion.  Chronic bilateral rib\ndeformities are noted.",
            "output": "1. Severe emphysema with large right hilar mass with mediastinal extension\nconcerning for primary lung cancer with 2 nodules in the right lower lobe. \nSignificant tumoral encasement of the bronchus intermedius with marked luminal\nnarrowing.\n2. No pulmonary embolism though the right hilar mass does encase and mildly\nattenuate the right central pulmonary arterial tree."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level on the left and subsegmental level on the right without\nfilling defect to indicate a pulmonary embolus.  Respiratory motion limits\nassessment of the subsegmental left lower lobe pulmonary arteries.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart is mildly enlarged.  Mild coronary artery\ncalcifications are demonstrated.  The pericardium and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is no axillary, left hilar, or\nsupraclavicular lymphadenopathy.  Confluent soft tissue mass within the right\nhilum extending into the mediastinum has substantially decreased in size\ncompared to the prior study.  Encasement and mild narrowing of the bronchus\nintermedius is mildly improved in comparison to the prior examination.  The\nmid and distal esophagus is mildly patulous and demonstrates mild wall\nthickening (series 2, image 98). There is a small hiatal hernia.\n\nPLEURAL SPACES:  There is no focal pleural abnormality or pleural effusion. \nThere is a small Bochdalek's hernia on the right.\n\n\nLUNGS/AIRWAYS:  There is moderate diffuse centrilobular emphysema.  There is\nmoderate scarring at the lung apices, bilaterally.  A 6 mm pulmonary nodule in\nthe right lower lobe has substantially decreased in size, (series 2, image 80)\npreviously measuring 18 x 18 mm.  A second previously seen smaller, adjacent\nnodule has resolved.  No new nodules are detected.  There is no focal\nconsolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  There is nodular thickening of the left adrenal gland, unchanged. \nOtherwise, the upper abdomen is unremarkable.\n\nBONES:  Bilateral chronic rib deformities are unchanged.  There is no acute\nfracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic aortic abnormality.\n2.  Confluent soft tissue mass in the right hilum and mediastinum compatible\nwith known small cell lung cancer has substantially decreased in size from the\nprior examination with mildly improved narrowing of the bronchus intermedius.\n3.  Moderate centrilobular emphysema.\n4.  Previously seen right lower lobe pulmonary nodules are markedly decreased\nin size or resolved."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  Main pulmonary artery is dilated to 3.5 cm.  Trace\ncoronary artery calcifications.  The heart, pericardium, and great vessels are\notherwise within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Trace right apical pneumothorax with appropriately positioned\nchest tube in the right lateral posterior pleural space.  No left\npneumothorax.  No hemothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacities are most prominent in the right greater\nthan left lung bases suggest atelectasis although slight aspiration or\ncontusion is possible.  Linear opacities in the anterior right lower lobe\nsuggests atelectasis.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis.  Both kidneys contain simple cysts. \nThere is mild perinephric edema.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: Numerous displaced and nondisplaced contiguous right-sided fractures\nare acute.  Posterior third and fourth rib fractures are nondisplaced. \nDisplaced comminuted right posterior fifth and nondisplaced lateral fifth\nfractures.  Displaced posterior comminuted ___ and mildly displaced\nanterolateral 6th rib fractures.  Displaced comminuted posterior ___ and\nequivocal nondisplaced right anterolateral 7th rib fractures.  Displaced\nposterior 8th rib fracture.  Displaced posterior ___ with nondisplaced lateral\n9th rib fracture.  Chronic appearing left anterior 6 rib fracture,\nnondisplaced.  Severe degenerative changes at the sacroiliac joints.  Right\ntotal hip arthroplasty with associated streak artifact limiting assessment of\nsurrounding structures.\n\nMild superior endplate compression deformity of the T3 vertebral body is age\nindeterminate (602:105) but appears chronic, no retropulsion.\nNo focal suspicious osseous abnormality.\n\nSOFT TISSUES: Subcutaneous gas in the right chest wall extending into the neck\nis compatible with chest tube placement.  A",
            "output": "1. Numerous displaced and nondisplaced acute right-sided contiguous rib\nfractures involving the third through ninth ribs. Trace right apical\npneumothorax with appropriately positioned chest tube.  No hemothorax.\n2. Ground-glass opacities in the right greater than left lung bases suggest\natelectasis although slight aspiration or contusion is possible.\n3. Mild superior endplate compression deformity of the T3 vertebral body is\nage indeterminate, but appears chronic, no retropulsion.\n4. Main pulmonary artery is dilated to 3.5 cm, may suggest pulmonary\nhypertension.\n5. No evidence of intra-abdominal traumatic injury.\n\nNOTIFICATION:  The findings were discussed with ___ of trauma surgery, M.D.\nby ___, M.D. on the telephone on ___ at 1:17 am, at the time of\ndiscovery of the findings."
        },
        {
            "input": "The thyroid is normal.  There are no enlarged supraclavicular, axillary,\nmediastinal or hilar lymph nodes. The heart and pericardium are unremarkable\nand there is no pericardial effusion. The aorta and pulmonary arteries are\nnormal size.  There is no focal consolidation, pleural effusion or\npneumothorax. A 4 mm ground-glass nodule in the right upper lobe (5:92) is\nunchanged since ___.  A 4 mm tubular nodule in the right lower lobe,\n3 mm right lower lobe nodule (5:164) and a 3 mm left lower lobe nodule are\nunchanged in size in morphology, and have the appearance of intrapulmonary\nlymph nodes.  These are unchanged since ___.\n\nThis study is not tailored for evaluation of subdiaphragmatic structures, but\nlimited views demonstrate a 2 mm nonobstructing right upper pole stone. There\nare no concerning bone lesions.",
            "output": "1. No acute intrathoracic process.\n2. 4 mm right upper lobe ground-glass nodule, for which followup is\nrecommended in ___ year. No significant change in other small solid nodules."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Evaluation of the bilateral lower subsegmental\npulmonary vasculature is limited due to suboptimal contrast timing and\nrespiratory motion.  Pulmonary vasculature is well opacified to the segmental\nlevel without filling defect to indicate a pulmonary embolus.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart is normal in size.  No substantial coronary artery or\nvalvular calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace bilateral pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral lower lobe atelectasis..  Lungs are otherwise clear\nwithout masses.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic steatosis.  The liver demonstrates homogenous\nattenuation throughout.  There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.  There is small volume perihepatic ascites, of\nindeterminate attenuation ___ 16).\n\nPANCREAS: Areas of the head, uncinate process, neck, and proximal body of the\npancreas are edematous and nonenhancing, consistent with necrotizing\npancreatitis.  The pancreatic duct is not dilated.  No definite pancreatic\nlesion is seen in the enhancing pancreatic parenchyma.  There is extensive\nintermediate density ___ 22) peripancreatic fluid in keeping with\nperipancreatic fat necrosis.  Fluid also extends along the bilateral anterior\nrenal fascia, along the bilateral lateral conal fascia and along the paracolic\ngutter into the pelvis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Mild dilatation of\nshort-segment loops of small bowel in the left lower quadrant are nonspecific.\nOtherwise, small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  The colon and rectum are within normal limits.  The\nappendix is normal.  There is no free intraperitoneal air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is moderate\npelvic ascites.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The splenic artery within the region of non enhancing pancreas is\nsomewhat obscured by fluid, but no gross pseudoaneurysm is seen.  The splenic\nvein as well as the portal vein and SMV are patent.  Celiac axis and its\nbranches are patent without aneurysm.  There is no abdominal aortic aneurysm. \nMild atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Necrotizing pancreatitis with surrounding acute peripancreatic necrotic\ncollections.  No gas locules noted within these collections.\n3. Approximately ___ involvement of the pancreatic parenchyma which lies\nalong the course of the pancreatic duct raises concern for future development\nof disconnected duct syndrome.  No evidence of vascular complications.\n4. Moderate bilateral lower lobe atelectasis.\n5. Trace bilateral pleural effusions."
        },
        {
            "input": "AIRWAYS: The tracheobronchial tree is patent.\n\nLUNGS: The lungs are clear with no significant interstitial or airspace\nopacities.  2 mm pulmonary nodule noted in the right lung apex.  There is a\nsmall calcified granuloma in the left lower lobe.\n\nPLEURA: No effusion.\n\nLower neck: Unremarkable\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.\n\nHEART and VASCULATURE: Heart is not enlarged.  No coronary artery\ncalcification appreciated on this non gated CT.  Trace fluid in the\naortopulmonary recess but no frank pericardial effusion.\n\nCHEST WALL: unremarkable\n\nUPPER ABDOMEN: Unremarkable.\n\nBONES: No aggressive bony lesions.",
            "output": "Normal study.  In particular, no evidence of active lung disease."
        },
        {
            "input": "The thyroid gland is unremarkable. No pathologically enlarged supraclavicular,\nmediastinal, hilar or axillary lymph nodes are identified.  Previously\ndescribed infra diaphragmatic lymph nodes have resolved.\n\nThe tip of a new right-sided MediPort extends into the right atrium. There is\na normal heart size with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal in caliber. No incidental central pulmonary\nembolism is identified.\n\nEvaluation of the lungs demonstrates several solid pulmonary nodules which are\nstable since ___ (4, 154, 198, and 225). The largest right middle\nlobe nodule is stable in size measuring 7 mm (4, 165). There is also a\npunctate new nodular opacity in the left upper lobe (4, 70). Mild anterior\nright middle lobe subsegmental atelectasis is unchanged. No endobronchial\nlesions or pleural effusions are present.\n\nNo destructive osseous lesions are identified.\n\nThere is a small broad-based right Bochdalek hernia. For a detailed discussion\nof the upper abdomen, please refer to the separate report from the CT\nabdomen/pelvis performed concurrently.",
            "output": "Several, subcentimeter, solid pulmonary nodules stable since ___. A\n12 month followup chest CT is recommended to look for change.\n\nPunctate new tiny nodular opacity in the left upper lobe which is nonspecific\nand may be infectious in etiology. Lesions of this size would generally not be\nfollowed, however given the history of malignancy, this area may be also be\nreassessed in 12 months."
        },
        {
            "input": "The thyroid is grossly normal. Axillary, supraclavicular, mediastinal, and\nhilar lymph nodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is normal.  No\npericardial effusion.\n\nThe lungs demonstrate a dominant solid pulmonary nodule within the right\nmiddle lobe, measuring 7 mm (4:159) and unchanged since ___.\nMultiple additional sub-3 mm solid pulmonary nodules are noted (4:147, 190,\n214), largely stable as compared to the prior exam. There are no new pulmonary\nnodules identified.  Biapical pleural scarring is similar as compared to the\nprior.  The airways are patent to subsegmental levels. There is no focal\nconsolidation, pleural effusion, or pneumothorax.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. For further details, please see the concomitant dedicated CT\nabdomen and pelvis.",
            "output": "Multiple, subcentimeter, solid pulmonary nodules which have remained stable\nsince ___. Recommend 12 month followup chest CT in to document\n___ stability."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.   The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  There are no concerning pulmonary\nnodules.  A dominant 7 mm subpleural right middle lobe nodule is unchanged\n(06:201), as are several other smaller nodules, several which have morphology\nto suggest they are intrapulmonary lymph nodes (series 6, images 76, 173, 191,\n241, and 273).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "No evidence of thoracic metastatic disease."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart size\nis normal, and there is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.\n\nWithin the lungs, several subcentimeter lung nodules measuring up to 7 mm in\nthe right middle lobe (image 44, series 5) appear unchanged. The remaining\nnodules are located on images 80, 179, 203, 239, 254, and 287 of series 6.  No\nnew or growing nodules are identified.\n\nNonspecific biapical scarring is also noted.",
            "output": "1.  Stable CT appearance of several subcentimeter pulmonary lung nodules, with\nno new or growing nodules detected.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "The right chest wall Port-A-Cath ends in the right atrium. The thyroid is\nnormal.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThere is a central filling defect within a segmental right lower lobe\npulmonary artery (series 5, image 46). The pulmonary arteries are not\nenlarged. The thoracic aorta is normal in caliber.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels.  The lungs are clear without\nfocal consolidation. There is no pneumothorax, pleural effusion, are\npneumomediastinum.\n\nThere is unchanged scarring at the bilateral lung apices. Several punctate\npulmonary nodules are all stable compared to prior seen on (series 6, image\n250, 50, 170, 235, and 265). No new pulmonary nodules are identified. A 7 mm\nright middle lobe intramammary lymph node is also unchanged.\n\nThe superficial soft tissues are normal.  The esophagus is unremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nPlease see separate dictation for details on same day abdominal and pelvic CT.",
            "output": "1. Acute emboli of a segmental right lower lobe pulmonary artery.\n2. No evidence of intrathoracic metastatic disease. Stable CT appearance of\nseveral subcentimeter pulmonary lung nodules as detailed above.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:30 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  The\npreviously seen filling defect in a right lower lobe pulmonary artery is no\nlonger definitely visualized, although this study is not optimized for\nassessment of pulmonary emboli.  A 1.0 cm right diaphragmatic lymph node is\ndouble in size compared the prior study (series 2, image 58).  Left periaortic\nlymphadenopathy is stable (series 2, image 58).  Cardiac configuration is\nnormal and there is no appreciable coronary calcification.  A right chest port\nis present with tip terminating in the proximal right atrium.\n\nAirways are patent to subsegmental levels bilaterally.  Biapical scarring is\nstable.  Multiple pulmonary nodules are again noted.  The largest nodule is in\nthe right middle lobe, measuring 7 mm, stable criteria consistent with\nintrapulmonary lymphoid tissue (series 4, image 173).  A 3 mm nodule in the\nright upper lobe has increased in size (series 4, image 113).  Multiple\nmillimetric additional nodules remain stable (series 4, image 55, 103, 161,\n168, 204).  Incidental note is made of a small calcified granuloma in the\nlingula (series 4, image 200).\n\nPlease refer to concurrent CT abdomen pelvis report for discussion of findings\nin the upper abdomen.  No suspicious lesion is seen in the visualized osseous\nstructures.",
            "output": "1. Increase in size of both a right diaphragmatic lymph node and a pulmonary\nnodule, consistent with worsening metastatic disease.\n2.  Multiple additional pulmonary nodules remain stable.\n3.  Please note that this exam is not specifically tailored for evaluation for\npulmonary emboli."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is\nunremarkable.  Supraclavicular and axillary lymph nodes are nonenlarged. \nChest wall is notable for bilateral gynecomastia.\n\nUPPER ABDOMEN: Limited evaluation of the abdomen is notable for trace\nperihepatic and perisplenic ascites and gastrosplenic varices.  Visualized\nintra-abdominal organs are otherwise unremarkable.\n\nMEDIASTINUM: No anterior mediastinal mass or hematoma.  Mediastinal lymph\nnodes are nonenlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.\n\nPLEURA: Trace right pleural effusion noted.  No pleural calcifications.  No\nleft pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA: In comparison to ___ there are new bilateral\nperihilar ground-glass opacities with peripheral sparing predominately\ninvolving the upper lobes and superior segments of the lower lobes.  No\ncavitary lesion or interlobular septal thickening.  When compared to ___ chest radiograph findings are similar in appearance given differences in\nmodality.  Previously noted left lower lobe opacity has resolved with residual\nlingular and bibasilar, right greater than left, atelectasis.\n2. AIRWAYS: The airways are patent to the segmental level.  No bronchiectasis,\nbronchial wall thickening, or mucous plugging.\n3. VESSELS:    No abdominal or thoracic aortic aneurysm.  No intramural\nhematoma.  No dissection.  No significant atherosclerotic calcifications are\nnoted.  Main pulmonary artery is mildly dilated measuring 3.8 cm suggestive of\npulmonary artery hypertension.  Suboptimal bolus timing to assess the\npulmonary vasculature however no lobar filling defect to suggest pulmonary\nembolism.\nCHEST CAGE: No focal lytic or blastic lesions worrisome for malignancy.  No\nacute fracture.",
            "output": "1.  Bilateral perihilar ground-glass opacities with peripheral sparing\ninvolving the upper lobes and superior segments of lower lobes.  Findings are\nworrisome for PCP pneumonia, multifocal pneumonia, early ARDS, and pulmonary\nhemorrhage, overall similar in appearance to ___ chest radiograph\ngiven differences in modality.\n2.  Near complete resolution of left lower lobe collapse.\n3.  Trace ascites with gastrosplenic varices may be related to underlying\ncirrhosis with sequelae of portal hypertension.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 6:18 pm, 2 minutes after discovery of\nthe findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla lower\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Numerous small subpleural\nnodules scattered throughout the lungs, for example in the left lower lobe\n(4:188 and 203) measuring up to 4 mm.  No consolidations or atelectasis.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Small subpleural lung nodules, indeterminate.  These nodules are not highly\nconcerning for metastatic disease however, given patient's known malignant\nhistory, attention on follow-up scans is recommended.\nNo other suspicious lymphadenopathy or osseous lesions to suggest definitive\nmetastatic disease."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized small 1-2 mm multiple bilateral subpleural\npulmonary nodules, (3, 54, 117, 166, 168, 179, 185).  No new or growing\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: The sections through the upper abdomen are also unremarkable",
            "output": "Stable multiple 1-2 mm bilateral pulmonary nodules.  In view of history of\nmalignancy continued surveillance is recommended.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized multiple tiny pulmonary nodules measuring 1-2 mm\nare unchanged since the prior study (5, 70, 139,).  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable tiny 1-2 mm bilateral pulmonary nodules.  No new pulmonary nodules. \nContinued follow-up in view.  Malignancy is recommended."
        },
        {
            "input": "There is no filling defect within the pulmonary arterial tree to suggest the\npresence of a pulmonary embolism. The thoracic aorta demonstrates atheromatous\ncalcification. The ascending aorta is enlarged measuring 3.3 cm in maximal\ndiameter, which is similar to previous in ___.  There are dense coronary\ncalcifications and global cardiomegaly with a 3 lead pacemaker in place. There\nis no lymphadenopathy. The airway is centrally patent. There are bilateral\npleural effusions, right greater than left with adjacent compressive\natelectasis. The imaged portion of the thyroid gland is unremarkable.\n\nThere are mild bilateral ground-glass opacities with associated septal\nthickening, right greater than left, that are nonspecific but may be related\nto congestive heart failure.\n\nThe imaged portion of the upper abdomen is unrevealing. The patient is status\npost sternotomy. There are no suspicious focal bone lesions.",
            "output": "1.  No pulmonary embolism.\n2.  Bilateral pleural effusions, cardiomegaly and ground-glass opacities in\nthe lungs likely related to congestive heart failure."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum (3, 25)\nare normal.  Stable mild to moderate coronary calcifications.  Mild aortic\nvalve calcifications.  In the interval, the patient has developed a moderate\nright and a small left pleural effusion.  Sections at the level of the liver\nshow perisplenic and perihepatic ascites.  Upper abdominal findings are\ndescribed in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nMassive respiratory motion artifacts.  Areas of platelike atelectasis are seen\nadjacent to the pleural effusions.  In addition, a rounded atelectasis is\nvisualized at the bases of the lingula (4, 202) and in the left lower lobe (4,\n217).  No other abnormalities are noted in the lung parenchyma.",
            "output": "Interval development of a moderate right and a small left pleural effusion,\nwith adjacent areas of atelectasis in both the left and the right lung. \nMassive respiratory motion.  No lymphadenopathy."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Interval resolution of\nbilateral pleural effusions since ___ with significant improvement\nin bilateral basilar linear and rounded atelectasis. The airways are patent to\nthe subsegmental level.\n\nLimited images of the upper abdomen demonstrate a 6.4 x 5.4 cm lesion in the\nright upper renal pole with ___ of 17 consistent with a cyst.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  Interval resolution\nof bilateral pleural effusions and improvement in bibasilar atelectasis."
        },
        {
            "input": "CHEST PERIMETER: Indistinctly marginated and incompletely imaged 17 mm\nlow-density region of the right thyroid lobe, 6:4, should be evaluated with\nthyroid ultrasound.  No supraclavicular or axillary lymph nodes are\npathologically enlarged.  Breast evaluation is reserved exclusively for breast\nimaging.  No soft tissue abnormalities in the chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Large axial hiatus hernia is larger today than previously.\nIt probably contains a large mass along the posterior wall, roughly 4 x 5 cm,\n5:58.  Above that level esophagus does not appear to be obstructed. \nAtherosclerotic calcification though heavy in the aortic arch is not apparent\nin head and neck vessels.  Native coronary arteries are heavily calcified. \nCoronary bypass grafting via median sternotomy, involved both saphenous and\nleft internal mammary grafts.  They are not evaluated by this examination. \nMediastinum and retrosternal soft tissue has a normal postoperative\nappearance.  The sternal fragments are closely apposed though not fully fused.\nNo evidence of wound complications.\n\nTHORACIC LYMPH NODES: Growing or pathologically enlarged lymph nodes as\nfollows:\n\nRight lower paratracheal station, 10 mm, 5:30, previously less than 4 mm. \nLeft hilum, 3 cm, and 2 cm, 5: 47 and 36, both new, narrowing the stump of the\ndivided left descending pulmonary artery, but not compromising the\npostoperative airway following lower lobectomy.\n\nLUNGS, AIRWAYS, PLEURAE: Right lung is clear.  Postoperative the left upper\nlobe following lower lobectomy also clear.  Left pleural tumor implants,\nposterior costal, 28 mm, 6:182 and para aortic, 23 mm, 6:157 are new.  There\nis no pleural effusion or transthoracic extension into the chest cage.\n\nCHEST CAGE: New destructive the lesion involving the anterior half of the\ntenth thoracic vertebral body is new.  It does not appear to extend foreign of\ninto the vertebral body to abut the vertebral canal at risk, but if assessment\nof the neural elements is needed, that would require MRI.",
            "output": "Extensive intrathoracic malignancy is new since ___:\n\nLarge gastric mass in the in the upper portion of a herniated stomach; large\nleft hilar and smaller mediastinal lymphadenopathy; large left pleural masses;\nlarge lytic metastasis T12 vertebral body."
        },
        {
            "input": "This examination is moderately limited due to respiratory motion artifact,\nparticularly at the lung bases.  Within these limitations:\n\nHEART AND VASCULATURE: The pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  Mild\natherosclerotic calcifications of the aortic arch and coronary arteries.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Borderline enlargement of the main pulmonary artery\nsuggests pulmonary arterial hypertension.  Note is made of bilateral SVCs. \nOtherwise, the heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent but subcentimeter\nmediastinal lymph nodes are likely reactive in nature.  No axillary or hilar\nlymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple foci of nodular appearing ground-glass opacification\nwithin the right upper, middle, and lower lobes likely represent infectious\nbronchiolitis.  Segmental atelectasis at the lung bases bilaterally, left\ngreater than right.  No focal consolidations.  Diffuse airway wall thickening\nwith areas of mucous plugging within the left lower lobe is demonstrated.\n\nBASE OF NECK: 5 mm hypodense nodule within the left lobe of the thyroid\n(series 3, image 18).  This does not require further imaging assessment per\nACR recommendations.\n\nABDOMEN: Subcentimeter hypodensity within the left lobe of the liver is too\nsmall to characterize, likely a cyst or biliary hamartoma (series 3, image\n165).  Additional subcentimeter hyperenhancing foci within the liver may\nrepresent small hemangiomas or may be perfusional in nature (series 3, image\n146).  Gastrostomy tube is seen within the stomach.\n\nBONES: Multiple chronic healed rib fractures are seen on the left.  Sclerotic\nlesion within the right posterolateral sixth rib is likely benign (series 3,\nimage 113).  No suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "1. This examination is moderately limited due to respiratory motion artifact,\nparticularly at the lung bases.  Within these limitations, no evidence of\npulmonary embolism.\n2. Foci of nodular appearing ground-glass opacification within the right\nupper, middle, and lower lobes, likely reflecting infectious bronchiolitis.\n3. Diffuse airway wall thickening with multiple areas of mucous plugging\nwithin the left lower lobe indicative of chronic airways disease."
        },
        {
            "input": "Several mediastinal lymph nodes are present, series 2, image 10, 7.5 mm, and\nparamediastinal location series 2, image 13, 11 mm, in prep vascular location,\nseries 2, image 17 up to 15 mm, in paratracheal location, series 2, image 18,\n14 mm, all slightly be clear as compared to a remote study from ___.  The largest lymph node is in the paraesophageal location, 3 x 2.8 cm. \nHilar lymph nodes are sub cm, left more than right.\n\nSubstantial dilatation of the pulmonary artery up to 4 cm is present,\nunchanged since prior examination.  Heart size is enlarged.  Aorta is normal\nin diameter and enhancement.  Axillary lymph nodes are multiple but not\nenlarged.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and corresponding report will be issued.  Bilateral pleural\neffusions are noted, small on the right and small to moderate on the left.\n\nAirways are patent to the subsegmental level bilaterally.  Septal thickening\nand minimal diffuse ground-glass opacities are present, and might be\nconsistent with resolving pulmonary edema.  Linear atelectasis in the lingula\nis present, series 4, image 99.  More extensive area of atelectasis is noted\ninferiorly, series 4, image 112.  Right lower lobe rounded atelectasis is\npresent, extensive, although appears to be improved as compared to ___.  The appearance is more consistent with an atelectasis and less\nconcerning for a new infectious process.  Left basal atelectasis is minimal. \nScattered sub 4 mm nodules are stable.  No new consolidation demonstrated. \nOverall there is no evidence of new infectious process.\n\nDiffuse sclerotic appearance of the bones might be consistent with age\nend-stage renal disease.  No focal lytic or sclerotic lesions demonstrated.",
            "output": "Bilateral pleural effusions, relatively small.\n\nExtensive lymphadenopathy, minimally progressed as compared to ___\n\nMinimal ground-glass opacities and septal thickening, findings that might be\nconsistent with resolving pulmonary edema.\n\nDiffuse sclerotic appearance of the bones, most likely consistent with\nend-stage renal disease related changes."
        },
        {
            "input": "Stable moderate enlargement of the thyroid, with a potential millimetric\nnodule in the right thyroid lobe (2, 3).  Borderline sized lymph nodes are\nseen in the axillary region.  The known and pre-existing mediastinal\nlymphadenopathy has slightly decreased in severity.  Also decreased in size\nare the sub-carinal lymph nodes.  The widening of the main pulmonary artery,\nindicative of pulmonary hypertension, persists in unchanged manner.  Also\nunchanged is the marked ___ a mass tear.  Mild coronary calcifications. \nModerate cardiomegaly.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  Bilaterally hypoplastic kidneys with several small cysts.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable diffuse sclerotic bone disease.  The parenchymal pulmonary\narteries show signs of pulmonary hypertension, reflecting the more central\nparts of the pulmonary arterial bed.  There is no evidence of pleural\neffusions.  In the right lower lobe, a rounded atelectasis of relatively\nsubstantial extend is visualized, combines to pleural thickening and volume\nloss (302, 146).  The lung parenchyma shows no other signs of consolidations,\nbut in the right upper lobe, several ground-glass nodules are noted (302, 74).\nIn addition, there are subtle but diffuse ground-glass opacities in the left\nlower lobe (302, 177).  Overall, these findings could reflect pneumonia.  The\nairways are patent.  No evidence of fibrosis.",
            "output": "No pleural effusions.  Relatively large right lower lobe rounded atelectasis\nwith calcifications and volume loss.  Ground-glass nodules and opacities in\nthe left upper and left lower lobe, consistent with infection.  Minimal\ndecrease of the pre-existing mediastinal lymphadenopathy."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.",
            "output": "No evidence of a nodules or adenopathy in the chest."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  In the absence of\nknown malignancy, a 6 mm subcutaneous nodule left anterior chest wall, 03:26,\nis not particularly concerning.\n\nThis study is not appropriate for subdiaphragmatic diagnosis except to note\nnormal adrenal glands, evidence of prior cholecystectomy, and fatty\nreplacement of the liver.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels and is minimal\nin coronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.  Pericardium is physiologic.  There is no pleural abnormality.\n\nThoracic lymph nodes:\n\nLymph nodes in the chest are not enlarged.\n\nLungs:\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nChest cage:\n\nMild impression upper endplates in severaL thoracic and lumbar vertebrae\naccount for mild loss of vertebral body height.\n\nThere are no bone findings concerning for malignancy or infection.",
            "output": "Normal chest CT.\n\nSevere fatty replacement of the liver."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nintramural hematoma.  The heart is moderately enlarged.  The pericardium and\ngreat vessels are within normal limits. No pericardial effusion is seen. \nCalcifications are noted in the aortic arch and coronary arteries.  A right\npectoral pacemaker seen with transvenous lead in the right ventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  There are bilateral small, dependent, nonhemorrhagic,\nlayering pleural effusions, right greater than left.  No pneumothorax.\n\nLUNGS/AIRWAYS:  Ill-defined nodular opacities in the left apex may be due to\nsmall airways disease.  There is mild bronchial wall thickening diffusely. \nLungs are without masses or areas of parenchymal consolidation.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of gross focal lesion.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\ngross focal lesions or pancreatic ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of gross focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Multiple hypodense\nlesions are noted in the bilateral kidneys with the largest measuring 4.0 x\n3.1 cm in the right upper renal pole and 3.6 x 3.9 cm in the left lower renal\npole, likely cysts.  There is no evidence of hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  A 3.3 cm right adnexal\nsimple appearing cyst is identified.  Left adnexa is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nThere is mild anterolisthesis of the L4-L5 vertebral level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute traumatic injury in the torso.\n2. A 3.3 cm adnexal simple appearing cyst, abnormal in a postmenopausal\nfemale.  Non urgent pelvic ultrasound should be considered if clinically\nindicated.\n3. Cholelithiasis without evidence of acute cholecystitis.\n4. Ill defined nodular opacities in the left upper lobe concerning for small\nairways disease, either infectious or inflammatory.\n5. Multiple bilateral renal cysts.\n6. Moderate cardiomegaly and small bilateral pleural effusions.\n\nRECOMMENDATION(S):  Recommend further evaluation of the 3.3 cm right adnexal\ncyst with a non-emergent pelvic ultrasound if clinically indicated."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThere is a small pericardial effusion.  Layering right pleural effusion is\nlarge associated with collapse of the right lower lobe .  Extensive\nground-glass opacities are present in the right upper lobe in lesser extent in\nthe left upper lobe.\nThis examination is not tailored for subdiaphragmatic evaluation the liver is\nshrunken and has noduler contours, is associated with splenomegaly this is\nworrisome for cirrhosis with portal hypertension.  There is ascites.  There\nappears to be that the umbilical vein is 8, incompletely evaluated\nThere are no bone findings of malignancy .\nCentral catheter tip is in the lower SVC.",
            "output": "Large right pleural effusion with associated collapse of the right lower lobe.\nGround-glass opacities could represent infection, less likely aspiration or\nnoncardiogenic pulmonary edema.\nCirrhosis with portal hypertension."
        },
        {
            "input": "THORACIC INLET: There are small left supraclavicular lymph nodes measuring up\nto 4 mm.  The thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are small left axillary lymph nodes measuring up to\n4 mm.  Not enlarged by size criteria\n\nMEDIASTINUM: The trachea is a saber sheath appearance.  There are small\nmediastinal lymph nodes.  There is a 4 mm right lower paratracheal lymph node.\nThe subcarinal lymph node measures 6 mm.  The descending thoracic aorta is\natherosclerotic with evidence of wall calcification.  There is no pericardial\neffusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is moderate upper lobe predominant emphysema.  There is a right\nupper lobe pulmonary nodule measuring 9 mm (302, 79).  There is another 4 mm\nnodule in the right right upper lobe (302, 103).  There is a subpleural 4 mm\nnodule in the left upper lobe (302, 101).\n\nThere is a dominant lobulated mass in the right middle lobe measuring\napproximately 4.5 x 4.2 cm with a pocket of air within it.  The mass has\npleural tags and spiculations, is highly concerning for primary bronchogenic\ncarcinoma.\n\nMinimal bibasilar atelectasis.\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a left renal\ncyst.  There is a tiny hypodense lesion within the left lobe of liver.  Please\nrefer to dedicated report on abdomen which has been dictated separately",
            "output": "4.5 x 4.2 cm mass in the right middle lobe concerning for primary bronchogenic\ncarcinoma.\n\nSeveral pulmonary nodules within the right upper lobe are indeterminate but\ncould represent metastasis.\n\nUpper lobe predominant emphysema.\n\nSaber sheath appearance of the trachea.\n\nSmall mediastinal lymph nodes.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  Previously seen pulmonary emboli are no longer present. The\nremainder of the great vessels have a normal appearance.\n\nCHEST:\n\nThe heart is unremarkable. The pericardium is intact without effusion. \nAirways are patent to the subsegmental levels.  Views of the lungs are limited\nby motion. Again seen are bilateral diffuse ground-glass opacities most\npronounced in the left upper lobe and lingula, with numerous centrilobular\nnodules in the right lower lobe and right upper lobe (3:77). The thyroid gland\nis bulky, but without discrete nodules.\nThe pleura is intact without effusion. No pneumothorax or pneumomediastinum.\n\nScattered mediastinal lymph nodes are identified within an enlarged subcarinal\nlymph node measuring 15 mm in short axis dimension. Additionally, posterior to\nthe carina, there is a 2.7 x 1.6 cm soft tissue density causing displacement\nof the esophagus to the left. This density was seen previously, but has\nprogressively increased in size since ___ (02:37). This density appears\nextraluminal.\n\nThere is elevation of the right hemidiaphragm with associated right basilar\natelectasis.  Upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Resolution of the previously demonstrated pulmonary emboli.  No new\npulmonary embolism identified.\n2. Limited assessment of the pulmonary parenchyma due to respiratory motion,\nhowever, scattered areas of ground-glass opacification with centrilobular\nnodules more pronounced in the left lung appear grossly unchanged from prior.\nSarcoidosis remains a differential consideration.\n3. Soft tissue density posterior to the carina and displacing the esophagus\nlaterally has progressively grown since ___, and may represent an enlarged\nlymph node given the presence of subcarinal lymphadenopathy.  These findings\nmay relate to sarcoidosis/diffuse lung disease, however, neoplasm is not\nexcluded, and recommend followup chest CT in ___ month with IV contrast for\nfurther evaluation.\n\nNOTIFICATION:  Changes to the wet read  impression #3 were emailed to the\nradiology QA nurses on ___ by Dr. ___."
        },
        {
            "input": "CHEST:\n\nParenchyma and Airways: There is mild cylindrical bronchiectasis in the lower\nlobes.  Bibasilar atelectasis without focal consolidation is present.  Upper\nlobe predominant paraseptal emphysema is noted.  There is calcified pleural\nscarring in the right apex (___).  Airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nVessels: No evidence of central pulmonary embolism.  The right pulmonary\nartery is prominent, measuring up to 2.8 cm (___).  The aorta is normal in\ncaliber without evidence for acute injury.  Great vessels are unremarkable.\n\nMediastinum and Hila: No evidence of axillary, mediastinal or hilar\nlymphadenopathy.\n\nHeart and Pericardium: There is mild cardiomegaly.  The pericardium is\nunremarkable.\n\nPleura: No pleural effusion or pneumothorax.\n\nChest Cage: No evidence of rib fracture, as clinically questioned.  No other\nfractures are identified.\n\nMiscellaneous:  Unremarkable thyroid.\n\nABDOMEN AND PELVIS:\n\nHepatobiliary: There is a 3.6 x 3.1 cm simple cyst in segment 5 (___). \nThere is an adjacent 2.2 x 2.5 cm simple cyst in segment 4B (___).  There\nare multiple sub cm hypodense lesions throughout the liver, likely\nrepresenting biliary hamartomas.  There is mild intrahepatic biliary\ndilatation without extrahepatic dilatation.  Common bile duct measures 7 mm. \nThe gallbladder is relatively contracted.  There are no radiopaque gallstones.\n\nSpleen: Normal in size without focal injury.\n\nAdrenals: The right adrenal is normal.  The left adrenal is mildly enlarged\nwithout definite nodule.\n\nKidneys, Bladder, Ureters: There is a 1.3 cm parapelvic cyst in the interpolar\naspect of the right kidney (___).  The left kidney is unremarkable.\n\nPancreas: The main pancreatic duct is diffusely dilated, measuring up to 7 mm\nwith multiple prominent side ducts throughout the pancreas, most commonly\nwithin the uncinate process and head.  No obstructing masses are visualized. \nThe pancreatic parenchyma is normal in bulk without evidence for acute\ninflammation.\n\nGastrointestinal: The stomach is underdistended, limiting evaluation.  The\nsmall bowel is unremarkable.  There is a moderate colonic stool burden.  There\nare multiple diverticula without evidence of diverticulitis.\n\nLymph Nodes: No mesenteric, retroperitoneal, pelvic or inguinal\nlymphadenopathy.\n\nReproductive Organs: The patient is status post hysterectomy.  Adnexal regions\nare unremarkable\n\nVascular: There is trace atherosclerotic disease.  No evidence of abdominal\naortic aneurysm.\n\nSoft Tissues: There is a tiny fat containing umbilical hernia.\n\nBones: No lytic or blastic bony lesions.  No acute fractures.  There\nmultilevel degenerative changes of the spine.  There is a tiny sclerotic focus\nin the left femoral head (___), likely representing a bone island.",
            "output": "1.  No acute injuries in the chest, abdomen or pelvis.\n\n2.  Main pancreatic duct is diffusely dilated, measuring up to 7 mm with\nmultiple prominent side ducts throughout the pancreas, but no definite\nobstructing mass seen on this exam.  Findings could relate to a pancreatic\nduct stricture, ampullary stenosis or ampullary lesion.  Recommend MRCP for\nfurther evaluation.\n\n3.  Mild intrahepatic biliary ductal dilatation without common bile duct\ndilatation.  Again, findings can be better assessed with MRCP.\n\nRECOMMENDATION(S):  MRCP."
        },
        {
            "input": "Coarse calcifications are seen within an enlarged left thyroid lobe. The\nremaining thyroid gland appears somewhat heterogeneous. No significant\naxillary, mediastinal or hilar lymphadenopathy is detected. The heart is\nenlarged. There is no pericardial effusion. Coronary artery calcifications and\ncalcifications at the head and neck vessels are noted.  The thoracic aorta is\nnormal in caliber. The main pulmonary artery is dilated to 37 mm and the right\nmain pulmonary artery is dilated to 29 mm.\n\nThe tracheobronchial tree is patent to the subsegmental levels. The airways\nare normal in caliber. There are small bilateral nonhemorrhagic pleural\neffusions, layering posteriorly, right greater than left and  larger as\ncompared to study from ___. Associated compressive atelectasis is\nmost significant at the left lung base. Within the pulmonary parenchyma, there\nis no interstitial abnormality. No focal consolidation or pneumothorax is\npresent. There are no suspicious opacities or masses.\n\nCompression deformity of the T6 vertebral body appears stable since at least\n___. No blastic or lytic lesion suspicious for malignancy is present.\n\n\nFor a full report of the abdominal component of this examination, please refer\nto clips number ___.",
            "output": "1. Small bilateral non hemorrhagic pleural effusions, right greater than left,\nincreased since ___, with associated compressive atelectasis, most\nsignificant at the left lung base.\n\n2. No suspicious opacities, masses or pneumonia.\n\n3. Ectatic main and right pulmonary arteries, concerning for pulmonary\nhypertension.\n\n4. Coarse calcifications within an enlarged left thyroid lobe. In not already\nperformed, further evaluation can be considered with thyroid ultrasound."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.  Questionable focus of decreased attenuation in a right lower\nlobe segmental artery is likely secondary to respiratory artifact and an\nadjacent airway (6:195).\n\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The the thyroid has a\nheterogeneous appearance, most likely represents a goiter with areas of low\ndensity and calcification.  The main pulmonary artery is mildly enlarged and\nmeasures 3.3 cm, could be secondary to pulmonary arterial hypertension.  There\nis moderate coronary artery calcification and moderate cardiomegaly.\n\n\nPLEURA: There is a small left pleural effusion.\n\nLUNG: Lungs are low volume with minimal bibasilar atelectasis.  There is no\nevidence of pneumonia pulmonary edema or interstitial abnormality.  There is\nsubsegmental atelectasis in the left lower lobe and left lung base.  Minimal\nsubsegmental atelectasis in the right lung base.  Evaluation of lung\nparenchyma is somewhat limited by respiratory motion.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality.  Questionable\nfocus of decreased attenuation in a right lower lobe segmental artery is\nlikely secondary to respiratory artifact and an adjacent airway (6:195).\nSmall left pleural effusion with associated basilar atelectasis.\nDilation of the main, left, and right pulmonary arteries, unchanged from prior\nstudy dated ___ and compatible with pulmonary hypertension.\nPartially imaged abdomen demonstrates intrahepatic biliary ductal dilatation\nand pneumobilia, compatible with known diagnosis of Caroli's disease."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Visible lymph nodes in the mediastinum (3, 49) Are\nnormal in size.  Normal appearance of the large mediastinal vessels.  No\nincidental pulmonary embolism.  Mild coronary calcifications.  No pericardial\neffusion.  Minimal circumferential thickening of the esophageal wall, in the\nlower third of the esophagus (3, 94).  Upper abdominal findings are described\nin detail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Moderate\ndegenerative vertebral disease.  Several peripheral sclerotic vertebral\nlesions (7, 60).\nMild bilateral apical scarring.  Moderate centrilobular pulmonary emphysema. \n2 mm calcified right upper lobe granuloma (4, 76).  Substantial mucous\nretention in the large airways (4, 118).  Mild thickening any irregularities\nof the airway walls.  1 mm solid right lower lobe nodule (4, 226).  4 mm right\nlower lobe intrapulmonary lymph node (4, 281).  Minimal scarring in the left\nand right lung bases (4, 299).",
            "output": "No lymphadenopathy.  No pleural thickening or pleural effusions.  Several\nmillimetric non suspicious pulmonary nodules.  Moderate pulmonary emphysema\nand mild chronic airways disease."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged.\nThere are no soft tissue abnormalities in the wall of the chest suspicious for\nmalignancy or infection.  Thyroid is unremarkable.  Atherosclerotic\ncalcification, scattered in normal caliber head and neck vessels, is\nconsiderably more extensive in the major coronary branches. Aorta and\npulmonary arteries are normal size.\n\nThere is no Pathologic enlargement of the central lymph nodes or nodes in the\ninternal mammary, diaphragmatic, or retrocrural stations, the latter ranging\nin diameter up to 6 mm, 3:60, unchanged since ___.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows there is\nno adrenal mass.  As before only the upper aspect of scratch the abdominal\naorta dilatation is imaged, 27 mm at the level of the renal arteries, compared\nto a diameter 20 mm at the origin of the superior mesenteric. Ultrasound\nmonitoring of the abdominal aorta is recommended, if not already performed.\n\nSmall triangular scar in the right lung apex, 05:41, unchanged since at least\n___, while a small region of pneumonia just inferior to it has resolved.\nA faint elliptical ground-glass opacity in the right middle lobe, 5 x 10 mm,\n5:157, is barely visible in retrospect on ___ in ___, probably smaller\nthen.\n\nTiny region of pleural thickening at the base the right lung medially, 5:263,\nis unchanged since ___, and should not be mistaken for a lung nodule.\n\nThe heterogeneous, subpleural indistinctly marginated lesion in the axillary\nregion of the left upper lobe that has been followed since ___ is no\nlarger than 13 x 23 mm, 5:111, compared to 13 x 22 mm in ___. The\nextent of soft tissue nodulation in the lesion has not clearly changed in 6\nmonths. Nevertheless, since it grew initially between ___ and ___\nand has not subsequently involuted, it remains suspicious for an early locally\ninvasive adenocarcinoma.\n\nNodular and linear scarring in the lingula has been unchanged since ___.\nA large bulla at the left base is also long-standing.\n\nThe Tiny pericardial effusion is physiologic. There is no pleural abnormality.\n\nThere are no bone lesions in the chest cage suspicious for malignancy. Multi\nlevel disc intrusion and osteophytes reflect degenerative disc disease, and\nthere are healed right lower rib fractures.",
            "output": "2 cm wide mixed soft tissue and ground-glass lesion in the left upper lobe not\nappreciably changed since ___ after prior growth could be an early\nadenocarcinoma. Followup CT suggested in 12 months. At that time a newly\ndiscovered ground-glass right lung lesion which has grown since ___ will\nbe re-evaluated\n\nSevere atherosclerotic coronary calcification. Imaging of the aspect of and\nthe abdominal aortic aneurysm is not adequate evaluation, which warrants\nultrasound, if not already performed."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Small calcified normal-sized mediastinal lymph node\n(2, 19).  Moderate aortic wall calcifications.  Moderate coronary and aortic\nvalve calcifications.  No pericardial effusion.  No enlarged hilar or\nmediastinal lymph nodes.  Small hiatal hernia.  No abnormalities in the upper\nabdomen.  No osteolytic lesions at the level of the ribs, the sternum or the\nvertebral bodies.  Moderate degenerative vertebral disease.  Diffuse pulmonary\nemphysema persists.  A subtle parenchymal opacity at the lateral and posterior\naspect of the left upper lobe (4, 95) is completely unchanged as compared to\nthe previous examination.  A pre-existing middle lobe ground-glass nodule (4,\n176) is unchanged as compared to the previous examination.  A nodular scar in\nthe lingula (4, 161) is surrounded by slightly more fibrotic tissue but is\nunchanged in size and morphology.  No areas of pleural thickening or pleural\neffusions.  No other lung nodules.  A bulla in the left lower lobe is\nunchanged in size and morphology.  Irregularities of the airway walls persist.\nNo diffuse areas of lung fibrosis.",
            "output": "No relevant change as compared to the previous examination, with respect of a\nnodular scar in the lingular, a lateral and posterior ground-glass opacity in\nthe left upper lobe as well as a middle lobe ground-glass nodule.  Because of\nthe presence of diffuse pulmonary emphysema and airways disease these lesions\nshould non the less be kept on the yearly CT monitoring."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there are severe calcifications in all coronary\narteries.  There is no pleural or pericardial effusion.\nThere is mild diffuse bronchial wall thickening.\nThere is mild upper lobe predominant centrilobular emphysema.\nPredominantly soft tissue subpleural nodule in the left upper lobe has\nincrease in density measures 13 x 10 mm (4:82) worrisome for malignancy in the\nadenocarcinoma spectrum given the appearance.  Atelectasis and/or scar in the\nlingula is stable.\nSeveral other micro nodules are stable (4:28, 40, 55, 78, 138)\nPeribronchial opacities in the right middle lobe and bronchiectasis are stable\n(4:154).\nThis examination is not tailored for subdiaphragmatic evaluation there is\nsmall hiatal hernia, hypodense subcentimeter lesion in segment 6 of the liver\nis stable (4:279.\nThere are no bone findings of malignancy",
            "output": "Increased density of  nodule in the left upper lobe worrisome malignancy in\nthe adenocarcinoma spectrum.\nEmphysema\nOther stable micro nodules\nCoronary calcifications\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:12 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is normal.  There is moderate coronary artery calcification.  There is a\nsmall pericardial effusion.\n\nPLEURA: There is no pleural effusion\n\nLUNG: The left upper lobe peripheral spiculated mass measuring approximately\n1.5 x 1.2 cm is unchanged in size density and morphology since the prior\nstudy.  The mass abuts the fissure.  There is subsegmental atelectasis in the\ninferior lingula.  There is a large emphysema is bleb in the left lower lobe. \nNo new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  There is by a lateral perinephric\nstranding.  There is atherosclerotic calcification involving the descending\nthoracic aorta.",
            "output": "Stable size density and morphology of the left upper lobe nodule. It remains\nconcerning for primary bronchogenic carcinoma.  No new pulmonary nodules.\n\nMild upper lobe predominant emphysema.\n\nScarring in the lingula.\n\nEmphysematous blebs in the left lower lobe."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormality in the chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis, especially involving the liver, but there is no\nadrenal abnormality or subphrenic collection.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.\n\nAtherosclerotic calcification is moderately heavy in head and neck vessels and\nsevere in all major coronaries.  Aortic valve is mildly calcified.  Aorta and\npulmonary arteries and cardiac chambers are normal size and small pericardial\neffusion is physiologic.  Intra cardiac left ventricular calcification\nsuggests prior infarction.\n\n\nTHORACIC LYMPH NODES:\nNo lymph nodes in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Centrilobular emphysema is moderate.  Non physiologic\nconfiguration of the trachea may be in indication of tracheomalacia.\n\nAtelectasis or linear scarring in the right middle lobe is stable.  Right lung\notherwise clear of focal abnormalities.\n\nSpiculated subpleural nodule, left upper lobe though stable in terms of\ndiameters, 10 x 14 mm, contains more confluent solid tissue, compare 4:84\ntoday with 4: 71 in ___ or 4:82 in ___, and sagittal image,\n602:120 today with 602:119 in ___..\n\nLesion remains contiguous with mildly costal thickened pleura, and abuts the\nmajor fissure.  There is no pleural abnormality elsewhere or any pleural\neffusion.\n\nRegion of linear scarring and atelectasis in the lingula is unchanged.  There\nis new subsegmental atelectasis in the left lower lobe.  Large bulla, base of\nthe left lower lobe is unchanged.\n\n\n\n\n\n\nCHEST CAGE: Unremarkable, for age.",
            "output": "New increase in soft tissue bulk of small left upper lobe mass could be\ndevelopment of atelectasis, but is concerning for malignancy.  Lesion is large\nenough to warrant repeat FDG PET scanning, or transthoracic image guided\nneedle aspiration.\n\nNo adenopathy.  Pleural thickening contiguous with the left upper lobe lesion\nis stable.  No pleural effusion.\n\nSevere atherosclerotic coronary calcification.  Mild aortic valvular\ncalcification.  Probable post infarction of left ventricular calcification."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged in appearance including aortic\ncalcifications and normal diameters.  Coronary calcifications are extensive. \nNo pericardial pleural effusion is seen.\n\nImage portion of the upper abdomen demonstrate abdominal aortic aneurysm,\npartially imaged, approaching 4 cm, series 2, image 77.\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe\nsubpleural lesion of mixed density is currently after ablation.  The overall\nsize of the lesion is 35 x 27 mm with the solid component being 15 mm in\ndiameter, series 601, image 77.  The ground-glass component giving its\nwell-circumscribed appearance most likely represent post ablation changes. \nThe solid component, 15 x 3 cm might at least in part represent postprocedure\nchanges as well.\n\nCentrilobular emphysema is mild.  No new nodules masses or consolidations\ndemonstrated.  Cystic left basal structure is unchanged, 6 x 9 cm.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymphadenopathy\npresent.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Post ablation changes in the known left upper lobe nodule as described. \nContinues follow-up with chest CT is recommended for documentation of\nresolution of the postprocedure changes in assessment of the volume of the\nnodule\n\nExtensive coronary calcifications\n\nMild emphysema.\n\nAbdominal aortic aneurysm, partially imaged, approaching at least 4 cm. \nDedicated imaging for follow-up and pre size assessment of the size is\nrecommended."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification\n\nPLEURA: There is no pleural effusion\n\nLUNG:\nPatient status post ablation of a left upper lobe nodule on ___.\nThe ablated area now measures 3.1 x 2.0 cm and appears more denser than on the\nprior study, could represent evolving post ablation changes. Attention to this\non follow-up imaging is recommended. There is a large bleb in the left lower\nlobe. There is severe lower lobe predominant emphysema. No new pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a partially\nvisualized abdominal aortic aneurysm.",
            "output": "Increase size and density of a triangular consolidative opacity in the left\nupper lobe which most likely represents evolving post ablation changes.  No\nnew pulmonary nodules.\n\nSevere emphysema.\n\nLarge bleb in the left lower lobe.\n\n\nRECOMMENDATION(S):  Continued follow-up is recommended."
        },
        {
            "input": "There is no supraclavicular or axillary lymph node enlargement, or any soft\ntissue abnormality in the imaged chest wall suspicious for malignancy.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows there is\nno adrenal mass.\n\nThyroid is unremarkable. Atherosclerotic calcification is scattered in head\nand neck vessels and coronary arteries. Aortic valvular calcification is\nmoderately severe. This study is not designed for cardiac evaluation but shows\nmoderate enlargement all chambers.  Pericardium is physiologic. There is no\npleural effusion. Vascular clips and suture at the gastroesophageal junction\ndenote prior surgery.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Normal lungs.\n\nMild generalized cardiomegaly. Aortic valvular calcification of indeterminate\nhemodynamic significance. No pulmonary edema or pleural effusion currently."
        },
        {
            "input": "___:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Incompletely visualized thyroid\ngland.  Multiple supraclavicular lymph nodes the largest measuring 10 mm in\ndiameter (2, 9).  Enlarged edematous appearance of the left serratus anterior\nmuscle suggesting intra muscular hematoma.  Edema of the surrounding\nsubcutaneous fatty tissue.\n\nUPPER ABDOMEN: Will be reported separately.  Surgical clips in relation to the\ngastroesophageal junction.  Oral contrast seen in the stomach and small bowel.\nNo contrast surrounding the distal esophagus or proximal stomach.\n\nMEDIASTINUM: Multiple borderline enlarged mediastinal lymph nodes the largest\nin the right paratracheal area measuring 14 mm (2, 13).\n\nHILA: Left hilar prominence suggestive of adenopathy, but it is difficult to\naccurately determine the extent due to the noncontrast nature of the study.\n\nHEART and PERICARDIUM: Small pericardial effusion measuring 8 mm in diameter\nadjacent to the left ventricle measuring 34 Hounsfield units in density.  No\naortic or coronary artery calcifications.  Relative hypodensity of the blood\npool suggesting anemia/ hemodilution.\nPLEURA: Small residual left-sided pleural effusion predominantly seen in the\nmedial basal aspect of the left hemithorax.  A few residual air locules in the\npleural space including subpulmonic (4:  94, 115 and 132).\nLUNG:\n\n-PARENCHYMA:  Airspace collapse/ consolidation seen in the medial basal aspect\nof the left lower lobe (4, 126).  Mild residual lymphatic engorgement\ninvolving the left lower lobe.  Subsegmental atelectasis in the lingula.  The\nright lung is clear.\n-AIRWAYS:  The airways are patent.\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: No lytic/ destructive bony lesions.",
            "output": "The left pleural effusion appears decreased in size compared to previous\nimaging with a few associated air locules.  Subsegmental collapse/\nconsolidation seen in the medial basal segment of the left lower lobe. \nSecondary infection/pneumonia should be excluded.\nSmall residual pericardial effusion.\n\nOral contrast seen in the stomach and small bowel, with no contrast seen\nextraluminally in the area of the distal esophagus and proximal stomach\nsuggesting no extravasation/leak.  There is no evidence of active staff\navailable fluoro lower esophagus mediastinal leak."
        },
        {
            "input": "CHEST:  Thoracic aorta is intact without signs of mediastinal hematoma.\nIncidental note is an aberrant origin of the right subclavian artery rising\ndirectly from the aorta and coursing posteriorly through this superior\nmediastinum. The main pulmonary artery and central branches appear patent. The\nheart is normal in size and shape. Fluid distended esophagus is noted. No\nlymphadenopathy. No pneumothorax or pneumomediastinum. The imaged portion of\nthe thyroid gland appears normal.\n\nNo worrisome nodule, mass, or consolidation is seen within the lungs. Mild\ndependent atelectasis is noted. No evidence of contusion or laceration.\n\nABDOMEN:  The liver appears intact. The gallbladder contains gallstones. There\nis mild intrahepatic and extrahepatic biliary ductal dilation. The gallbladder\nis noted to contain gallstones. No CT evidence for acute cholecystitis. The\npancreas, spleen, adrenal glands are intact. The kidneys enhance symmetrically\nand excrete contrast promptly without worrisome lesion or hydronephrosis. A\ntiny too small to characterize hypodensity is seen cyst in the upper pole of\nthe right kidney likely a cyst. The abdominal aorta is normal in caliber and\ntortuous along its distal course. No retroperitoneal hematoma. The stomach is\nmoderately distended with fluid. The duodenum is normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. The\ncolon is unremarkable. The urinary bladder is partially distended. No free\npelvic fluid. Colonic diverticulosis is noted. No pelvic sidewall\nlymphadenopathy.\n\nBones: Transverse process fracture involving L4 on the right and L5\nbilaterally noted. In addition there is a comminuted sacral fracture involving\nboth right and left sacral ale a with a vertical midline component. The left\nsacral fracture involves the left iliac bone adjacent to the SI joint were\nthere may be mild widening superiorly. Small presacral hematoma is noted\nwithout definitive evidence for bleeding. Displaced fractures of the left\nsuperior and inferior pubic rami noted. Areas of probable active bleeding\nnoted on series 2, image 118 and series 2, image 122 adjacent to the inferior\nramus fracture. Additionally, there is pooling of contrast adjacent to the\nleft proximal femur at the site of hematoma in the left upper thigh.",
            "output": "1.  Multiple pelvic fractures as described above with concern for active\nbleeding adjacent to the left inferior pubic ramus fracture. Small hematoma\nadjacent to the left proximal femur with active bleeding. L4 and L5 transverse\nprocess fractures.\n2.  No intrathoracic injury.\n3.  Mild intrahepatic and extrahepatic biliary ductal dilation with gallstones\nwithin the gallbladder. Please correlate clinically.\n4.  Fluid distended esophagus may predispose to aspiration.\n\nNOTIFICATION:  Findings were discussed by Dr. ___ Dr. ___ with\nthe trauma team in person at the time of initial review."
        },
        {
            "input": "Endotracheal tube in the trachea in correct position.\nExtensive bronchiolar and peribronchial infiltration, most prominent in the\nlower lobes and retained bronchial secretions bronchi have all increased\nsubstantially over half a day, indicating severe aspiration and developing\nbronchopneumonia.\n\nHigh attenuation (38-48HU) collection located posterior to, but not narrowing,\nthe upper trachea, inseparable from the esophagus, measuring 3.9 x 2.4 cm\n(2:19), slightly larger since the previous study is most likely a slowly\ngrowing hematoma.  Its vascular origin is not identified on this examination\nperformed without IV contrast infusion at the request of the ordering care\nteam.  There is no pneumomediastinum to suggest laceration of the trachea or\nesophagus.\n\nThere is no cardiomegaly.\nTrace pericardial effusion.\nCalcifications in the aortic valve, coronaries and along the thoracic aorta.\n\nUpper abdomen findings will be reported in the concurrent abdomen CT,\naccession number ___.\nNo fractures are identified.\nChronic degenerative changes in C7-D1 disc space.",
            "output": "Retrotracheal upper mediastinal hematoma enlarged over the past fourteen\nhours.  No hemothorax or hemopericardium.\nNo acute fractures are identified.\nWorsening aspiration and broncho pneumonia with minimal right pleural effusion\n\nRECOMMENDATION(S):  CTA of the chest with IV contrast infusion to evaluate the\norigin of the mediastinal hematoma should be considered.\n\nNOTIFICATION:  The findings were discussed with Dr.  ___, by ___, M.D.\non the telephone on ___ at 5:34 pm, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "Soft tissues:Left chest wall port catheter terminates at the cavoatrial\njunction.  The thyroid is homogeneous with no lesions.  There are no\npathologically enlarged supraclavicular, axillary, mediastinal, or hilar lymph\nnodes.  The heart is normal in size and there is no pericardial effusion.  The\naorta and main pulmonary artery are normal in caliber. The distal esophagus is\nnormal and the subdiaphragmatic findings will be dictated in a separate\nreport.  No significant abnormality in the soft tissues of the chest wall.\n\nLungs:Mild biapical scarring is again noted. The airways are patent to the\nsubsegmental level bilaterally.  No pulmonary consolidation, pleural effusion,\npneumothorax, or large mass.  Several pulmonary nodules are identified,\nranging in size from 2-5 mm, including:\n\nRight upper lobe (5:51, 107, 111)\n\nRight middle lobe (5:152)\n\nRight lower lobe (5:256)\n\nLeft lower lobe (5:133, 157, 173, 201, 220, 255)\n\nLingula (5:73).\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "No evidence of intrathoracic malignancy. Several pulmonary nodules as noted\nabove, ranging from 2-5 mm, stable since ___.\n\nPlease see a separate report discussing findings within the abdomen and\npelvis."
        },
        {
            "input": "There is no axillary, supraclavicular or central lymphadenopathy.  Normal size\nand there is no pericardial effusion.  The aorta and main pulmonary artery are\nnormal caliber. A left MediPort terminates in the low SVC.  Though not\ntailored for full evaluation, there are no findings to indicate a pulmonary\nembolus.\n\nA 3 mm nodule in the lingula has minimally increased in size from ___\n(6:193). Accounting for differences in technique, the remaining pulmonary\nnodules are unchanged from 3 months prior but increased in size and density\nfrom ___. For example, a 4 mm nodule in the middle lobe was 3 mm\n(6:177), a 4 mm nodule in the right upper lobe was 2 mm (6:137) and a 4 mm\nnodule in the lingula was 2 mm (6:199) when compared to ___. The remaining\nsub 4 mm nodules show a similar pattern of growth (6:130, 134, 137, 154, 155,\n167, 177, 189, 199, 201, 203, 254). There are no new nodules.\n\nThe airways are patent through the subsegmental level. There is no bronchial\nwall thickening or bronchiectasis. No pleural effusion, pneumothorax or\nevidence for active infection.\n\nThe esophagus is unremarkable. The abdominal findings are described\nindependently of this report. There are no lytic or blastic osseous lesions\nwithin the chest.",
            "output": "1. At least one pulmonary nodule has shown minimal interval growth from 3\nmonths prior.  2. With longer term followup and in retrospect, there has been\nan increase in size and density of the remaining numerous pulmonary nodules\nfrom ___ ; however, these have shown a 3 months stability.  Continued\nsurveillance is recommended as these remain concerning for metastatic disease."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes. The heart is normal in size and there is no\npericardial effusion. The aorta and main pulmonary artery are normal in\ncaliber.Please see a separate report discussing findings within the abdomen\nand pelvis.\n\nLungs:The airways are patent to the subsegmental level bilaterally. Several\nsolid pulmonary nodules with surrounding halo of ground-glass opacity are\nidentified bilaterally, for example, the right upper lobe (4:77, 79, 96) right\nlower lobe (4:153, 157, 178, 191, 192, 200). Right middle lobe (4:114, 133,\n135, 142, 166, 176), left upper lobe (4:102, 131, 133), left lower lobe\n(4:102, 120, 134, 154, 168, 184. There is no large consolidation, pleural\neffusion, or pneumothorax.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "Numerous pulmonary nodules, as described above, have overall increased in\nsize, with some individual nodules appearing stable since ___.\nFindings are overall concerning for progression of metastatic disease within\nthe chest."
        },
        {
            "input": "The thyroid gland is normal. There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy. The heart is normal in size. There is\nno pericardial effusion. The thoracic aorta is normal in caliber without\nsignificant atherosclerotic calcifications. The main pulmonary artery trunk is\nnormal in diameter. A left-sided Port-A-Cath is present with the tip in the\nlow SVC.\n\nThe airways are patent to the subsegmental levels. There is biapical scarring.\nAgain, there are numerous predominately solid nodules, some with small\nground-glass halos. They are not significantly changed from the prior exam.\nThey measure up to 6 mm (6; 53, 107, 109, 111, 129, 135, 153, 158, 172, 177,\n187, 198, 202, 208, 209, 213, 260, 231, 234). No new nodules are identified.\nThere is no focal airspace opacity, pulmonary edema, pleural effusion, or\npneumothorax.\n\nA 7 mm sclerotic focus in T1 (10, 27) is unchanged from multiple prior exams,\ndating to ___.  This is likely a bone island.\n\nPlease see the abdominal CT report for complete subdiaphragmatic details.",
            "output": "Numerous pulmonary nodules which have not significantly changed since the\nprior exam in ___. No new metastases."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal. Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal. There is no coronary calcific disease.\nNo pericardial effusion is present. There is no esophageal wall thickening of\na hiatal hernia.\n\nLUNGS AND AIRWAYS:  The airways are patent to the subsegmental level\nbilaterally. No intraluminal lesions are identified. No pleural effusion or\npleural thickening is present.  Scarring at the lung apices is unchanged from\n___. Calcified granuloma at the lung apex is unchanged from ___.\n\nNumerous stable lung nodules are unchanged from ___:\n\n6 mm right upper lobe pulmonary nodule (series 6, image 108)\n5 mm left lower lobe pulmonary nodule (series 6, image 125)\n6 mm left upper lobe pulmonary nodule (series 6, image 161)\n\nOSSEOUS STRUCTURES:  A sclerotic lesion in the T1 vertebral body is unchanged\nfrom ___. Otherwise, there is no evidence of infection or malignancy\nin the bony skeleton. Numerous soft tissue calcifications in the chest wall\nare stable from ___.\n\nAssessment of subdiaphragmatic structures is included in the CT abdomen and\npelvis report from the same date.",
            "output": "1. Numerous stable pulmonary nodules are unchanged from ___. No\nnew pulmonary nodules are identified.\n\n2. A sclerotic lesion in the T1 vertebral body is stable from CT chest ___.\n\n3. Scarring at the lung apices is grossly unchanged from CT chest ___."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  No pericardial pleural effusion is seen.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are re- demonstrated, series 7, images 42, 97, 124, 132, 141, 153,\n164, 167, 169, 191, 192, 196, 216, 217, 229, 233, 243.  Most of the nodules\nappear to be 1 a 1.5 mm less than on the previous examination.  No new nodules\ndemonstrated.  Apical scarring is unchanged, bilateral\n\nSclerotic lesion in T1, series 6, image 6 is unchanged.",
            "output": "Multiple pulmonary nodules, all stable or slightly decreased in size from the\nprior study.  They share similar morphology which is a central solid core and\nsurrounding ground-glass opacity.\n\nStable T1 sclerotic focus\nStable scarring in the lung apices."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Small mediastinal lymph nodes are not pathologically\nenlarged.  Aorta and pulmonary arteries are normal size. Cardiac configuration\nis normal and there is no appreciable coronary calcification.  There is no\npericardial effusion.  A right chest port is present with tip terminating at\nthe cavoatrial junction.\n\nAirways are patent to subsegmental levels bilaterally.  Mild apical scarring\nit is stable.  Multiple nodules, with a solid center and surrounding\nground-glass, mostly show continued decrease in size since the prior study. \nFor example, a lesion in the right upper lobe remains stable in overall size,\nbut the solid portion has decreased in size, from 5 mm on the prior study to 4\nmm on the current study (series 8, image 100).  Additional nodules show\nsimilar changes (series 8, image 95, 98, 139, 159, 168, 203, 213, 235, 212,\n189, 156, 113, 151).  One right upper lobe nodule appears stable since the\nmost recent prior study (series 8, image 118). There is no pleural effusion or\npneumothorax.\n\nPlease refer to concurrent CT abdomen pelvis for discussion of findings in the\nupper abdomen.  A large sclerotic focus in T1 is stable since ___. \nNo additional suspicious osseous lesion is present.",
            "output": "1. Continued decrease in size of multiple pulmonary nodules, consistent with\ndisease response.  No new or growing pulmonary metastases."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  Note is made of a bovine arch.  Moderate\ncalcifications of the aortic valve are noted.  There also moderate coronary\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nunremarkable.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.  There is a\nlarge hiatal hernia containing the majority of the stomach.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis bilaterally.  No focal\nconsolidations.  No suspicious lung nodules are visualized.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: The patient is status post right shoulder arthroplasty, which is\nunremarkable in appearance.  Acute appearing nondisplaced fractures are seen\nof the right anterior fifth, sixth, and eighth ribs.  There also multiple\nchronic healed right anterior rib fractures.  Severe compression deformities\nof T8 and T9 are unchanged compared to ___.  There is mild\nretropulsion at T8.  No focal suspicious osseous abnormality.\n\nUPPER ABDOMEN: Multiple gallstones are seen within the gallbladder.  There is\nno evidence of acute cholecystitis.  Subcentimeter hypodensity within segment\nVI of the liver is too small to characterize, but likely represents a cyst or\nbiliary hamartoma (series 4, image 101).  There are hypodense lesions within\nthe pancreatic head and neck measuring 12 mm and 9 mm (series 4, image 85,\n94), which may represent side branch IPMNs, but can be further evaluated with\nan MRCP.  Accessory spleen at the hilum.",
            "output": "1. Acute appearing nondisplaced fractures of the right anterior fifth, sixth,\nand eighth ribs.  No other acute traumatic injury within the chest.\n2. Additional chronic healed right anterolateral rib fractures.  Unchanged\nchronic compression deformities of T8 and T9 with mild retropulsion at T8.\n3. Hypodense lesions within the pancreatic head and neck measuring up to 12\nmm, which may represent side branch IPMNs.  MRCP can be considered for further\nevaluation.\n4. Cholelithiasis.\n5. Large hiatal hernia containing majority of the stomach.\n\nRECOMMENDATION(S):  MRCP can be considered."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\ncardiomegaly and aortic valve calcifications.  The pericardium and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is bibasilar atelectasis.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  There is a large hiatal hernia (601b:28).  There is cholelithiasis,\nwith no evidence of acute cholecystitis (2:53).  Included portion of the\nunenhanced upper abdomen otherwise are unremarkable.\n\nBONES:  There is a nondisplaced fracture of the right fifth rib (5:266). \nThere is a old healed fracture of the right sixth rib (5:320).  There are\nsevere compression deformities of T8 and T9, chronic appearing, with no CT\nevidence to acute compression fracture (602b:60).\n\nSOFT TISSUE:  There are suspected postsurgical changes in the bilateral\nbreasts (4:112; 123).",
            "output": "1. Nondisplaced fracture of the right fifth rib.  Old healed right sixth rib\nfracture.\n2. Chronic appearing compression deformities of T8 and T9, with no CT evidence\nto suggest acute compression fracture.\n3. Large hiatal hernia.\n4. Cholelithiasis, with no evidence of acute cholecystitis."
        },
        {
            "input": "Several mediastinal and thoracic inlet lymph nodes are present.  The\nmediastinal lymph nodes in the paraesophageal location approach 16 x 23 mm in\nthe sub-carinal location approach 27 x 25 mm and in the supraclavicular\nlocation approach 10 mm.  No axillary or hilar lymphadenopathy is present. \nHeart size is normal.  There is no pericardial pleural effusion.\n\nRetroperitoneal lymph nodes which are partially imaged approach 3 cm to the\nright of the aorta and a conglomerate of lymph nodes in the retroperitoneal\narea at the upper abdomen is 5 x 3.2 cm.\n\nAirways are patent to the subsegmental level bilaterally.  There are no\npulmonary nodules masses or consolidations demonstrated.\n\nExtensive calcifications in the right shoulder are present.  There are no\nlytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Final, retroperitoneal and supraclavicular pathologic lymphadenopathy as\ndescribed"
        },
        {
            "input": "THORACIC INLET: There is a left-sided Port-A-Cath with its tip in the\ncavoatrial junction.  There is a 1.4 cm right supraclavicular lymph node\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The mediastinal lymph nodes have significantly increased in size\nsince the prior study for example left paratracheal lymph node measures 3.9 cm\nit previously measured 1.8 cm.  Another left lower paratracheal node has\nenlarged in size and measures 2.8 cm it previously measured 1.4 cm.  The\nsubcarinal node has also enlarged in size and measures 25 mm it previously\nmeasured 22 mm.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is bibasilar atelectasis.  No lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows right renal\ncyst.  No focal liver lesions are seen.  The spleen is normal in size.  No\nadrenal masses are seen. Please refer to dedicated report on abdomen which has\nbeen dictated separately",
            "output": "Significant increase in size of the mediastinal adenopathy since ___, consistent with progressive lymphoma lymphoma.\n\nNo new sites of disease.\n\nLeft-sided Port-A-Cath with its tip in the SVC.\n\nMinimal bibasilar atelectasis."
        },
        {
            "input": "The thyroid is normal.  There is no axillary lymphadenopathy.  A left-sided\nPort-A-Cath has its tip in the cavoatrial junction.  An enlarged 1.4 cm right\nsupraclavicular lymph node is unchanged compared to the prior exam.\n\nOverall, there has been interval increase in size of the necrotic mediastinal\nlymphadenopathy compared to the exam from ___.  For example a left\nparatracheal necrotic mediastinal lymph node measures 4.7 cm x 4.8 cm,\npreviously measuring up to 4 cm, series 3, image 90.  A necrotic subcarinal\nlymph node measures 2.9 cm x 2.6 cm, slightly increased in size compared to\nthe prior exam at which time this measured 2.6 cm x 2.2 cm.  Again, the large\nmasses are in contact with the adjacent vascular structures and soft again is\nas well as causing mass effect on the airway overall similar in extent\ncompared to the prior exam.  There is no pericardial effusion.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nThere is no pleural effusion or pneumothorax.  No concerning new or growing\npulmonary nodules are identified.  Note is made of mild bibasilar atelectasis.",
            "output": "Overall, there has been mild interval increase in the size of the necrotic\nmediastinal lymphadenopathy compared to the exam from ___."
        },
        {
            "input": "THORACIC INLET: Left-sided Port-A-Cath projects to the cavoatrial junction. \nThere are stable small bilateral supraclavicular lymph nodes measuring up to 4\nmm.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The left paratracheal mass has significantly increased in size\nsince the prior study and now measures 6.3 x 5.1 cm as compared to the prior\nmeasurements of 3.5 x 2.5 cm.  The small right paratracheal lymph node is\nunchanged.  The subcarinal lymph node has also increased in size and measures\n3.7 cm it previously measured 2.6 cm.  There is a small pericardial effusion\nwhich is unchanged.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There are tiny parenchymal opacities in a bronchus centric distribution\nin the left lower lobe (5, 131 which are new since the prior study and most\nlikely inflammatory.  There is minimal bibasilar atelectasis.\n\nReview of bones shows degenerative changes involving the thoracic spine.\n\nLimited sections through the upper abdomen shows no evidence of liver lesions.\nThe spleen is normal in caliber.  No adrenal masses.  Please refer to\ndedicated report on abdomen which has been dictated separately",
            "output": "Increase in size of the mediastinal lymph nodes as described above concerning\nfor progression of disease.  No new sites of disease within the chest.\n\nPlease refer to dedicated report on abdomen and neck which has been dictated\nseparately."
        },
        {
            "input": "CHEST:\nTHORACIC INLET, AXILLAE, CHEST WALL: There is no pathologic enlargement of\nlymph nodes in the supraclavicular or axillary stations\n\nMEDIASTINUM: Large lobulated centrally necrotic mass centered in AP window is\nsignificantly larger in comparison to ___ and ___,\ncurrently 8.5 x 12 cm (302:99), on ___ remeasured 8.2 x 6.2 cm\n(4:124), on ___ 6.2 x 7.2 cm (5:117).\n\nThe mass displaces anteriorly and laterally the trachea and carina causing\nmild narrowing down to 0.9 cm of the mid trachea, left main bronchus lumen is\n0.9 cm.\nThe left upper and lower lobe bronchi are severely narrow, in the in left\nupper lobe segmental atelectasis has developed (302:116).\nBilateral hilar lymphadenopathy mildly progressed.\n\nThe subcarinal necrotic mass is larger as well, measuring 6.2 x 6.1 cm\n(302:134), in prior 4.1 x 3.8 cm.  The prior fat plane between the masses\neffaced and the masses are confluent.\n\nThere is no fat plane between ascending aorta, arch and proximal descending\naorta.  There is mild mass effect, increased since prior at the level of the\nposterior left atrium (302:152).\n\nThe mass is inseparable from the embedded esophagus, most likely involved. \nThe uppermost esophagus is dilated containing air-fluid level.\n\nHEART and PERICARDIUM: Heart is normal in size.  Left pectoral Port-A-Cath\nterminates in lower SVC.  SVC is compressed by the larger mediastinal mass but\npatent.  There is trace pericardial effusion, minimally increased since prior.\nTranscutaneous catheter extends from the sub xyphoid inferiorly to the heart\nterminating in the subcarina.\n\nThe mass splays and moderately narrow the main pulmonary arteries, the left\npulmonary artery severely narrowed (602:50).  Due to motion artifacts and\ntiming, evaluation of segmental and subsegmental pulmonary arteries is\nlimited.  There is no central, left or right main pulmonary arteries.\n\nPLEURA: The there is small to moderate bilateral layering pleural effusion,\nessentially new since ___ when trace left effusion was demonstrated. \nThere is a adjacent relaxation atelectasis of the lower lobes.\n\nLUNG: As mentioned in the mediastinal section, trachea is deviated to the\nright, minimally narrowed. The left upper and lower lobe bronchi are severely\nnarrow, in the in left upper lobe segmental atelectasis has developed\n(302:116).\nSmooth septal line thickening in the left upper lobe reflects new congestion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nBilateral renal cortical hypodensities are present, most consistent with\ncysts.  No evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.  Variant is left retroaortic renal\nvein.\n\nBONES: There is no evidence of worrisome osseous lesions.\nDegenerative changes in the right shoulder with multiple free calcified bodies\nand increased intracapsular fluid unchanged, likely synovial\nosteochondromatosis.\nStable degenerative changes, most pronounced at T1- T2, L5-S1, and L1-2.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "-The large mediastinal and subcarinal masses are significantly larger,\ncurrently confluent.  Secondary mass effect on the trachea and carina is mild,\nyet significant at the level of left central bronchi bifurcations and there is\nnew left lung central atelectasis.\n-Worse mass-effect with severe narrowing of the left main pulmonary artery. \nThere is no central, left or right main pulmonary arteries pulmonary embolus.\n-New bilateral small to moderate layering pleural effusions.\n-No evidence of disease within the abdomen and pelvis.\n\nNOTIFICATION:  The findings and impression were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 10:30 pm, 10\nminutes after discovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect.  There is continued moderate narrowing of the main\npulmonary artery with severe narrowing of the left main pulmonary artery\n(Series 9; image 50).\n\nThe thyroid gland is unremarkable.  Left chest wall port tip terminates at the\ncavoatrial junction, unchanged.\n\nThere is no supraclavicular or axillary lymphadenopathy.  Again seen is a\nlarge lobulated, centrally necrotic mass centered in the AP window, unchanged\ncompared to prior exam on ___ measuring 8.0 x 11.7 cm (series 5; image\n65) superiorly and 6.2 x 6.2 (series 5; image 90), previously 8.5 x 12 cm and\n6.2 x 7.2 cm, respectively.\n\nThis mass continues to displace the trachea anteriorly and to the right\ncausing mild narrowing without occlusion.  There is continued severe narrowing\nof the left upper and lower bronchi.  Resultant left upper lobe collapse\nappears more confluent compared to prior (series 5; image 72).  Additionally,\nthere is bibasilar atelectasis without focal parenchymal consolidation\nsuggestive of infection.  Patient is status post left pleural pigtail catheter\nplacement with tip terminating in an apically-oriented direction.  There is a\nsmall anteriorly and medially located pneumothorax the left.\n\nThere is trace pericardial effusion.  SVC remains compressed by mediastinal\nmass without occlusion.  There is been interval removal of subxiphoid\ncatheter.  There are small to moderate bilateral pleural effusions, decreased\ncompared to ___.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nSclerosis at the inferior endplate of T1 and superior endplate of T2 is likely\ndegenerative in nature.  Multiple calcific loose bodies are seen anterior to\nthe glenoid and lateral to the coracoid process, likely loose bodies etiology,\nunchanged.",
            "output": "1. No evidence of pulmonary embolism to the segmental level or acute aortic\nabnormality.  Continued moderate narrowing of the pulmonary artery with severe\nnarrowing of the left main pulmonary artery due to mediastinal mass.\n2. Interval placement of apically-oriented left pigtail catheter with interval\ndecrease in now small to moderately sized left pleural effusion.  There is a\nsmall, anterior left pneumothorax.  Small to moderate right pleural effusion\nis also decreased in size compared to prior.\n3. Bibasilar atelectasis alongside worsening collapse of the left upper lobe\ncompared to prior without focal consolidation suggesting infection.\n4. Unchanged large lobulated, centrally necrotic mediastinal mass centered in\nthe AP window, as above."
        },
        {
            "input": "BASE OF NECK: The visualized portion of the thyroid is unremarkable. \nSupraclavicular lymphadenopathy is identified\n\nHEART AND VASCULATURE:  The thoracic aorta contains atherosclerotic\ncalcifications though is otherwise normal in caliber.  The vessels appear\ndense throughout suggestive of an anemic state.  Otherwise the heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan.  A trace pericardial effusion is re-demonstrated.  A left pectoral\ninfusion catheter is visualized catheter tip terminating at the cavoatrial\njunction.\n\nAXILLA, HILA, AND MEDIASTINUM: A large lobulated mediastinal nodal\nconglomerate centered about the AP window demonstrates substantial interval\ndecrease in size measuring up to 10.1 in the craniocaudal axis (05:50),\npreviously measuring 13.2 on ___, with no definite changes in density,\npreviously visualized, within the limitations of an unenhanced scan. \nAdditionally mass effect on the left mainstem bronchus and bronchus\nintermedius has substantially decreased.\n\n\nPLEURAL SPACES: There is a small left pleural effusion.  No pneumothorax\nidentified.  Left-sided chest tube is re-demonstrated terminating near the\nleft lung apex with only a trace left pleural effusion remaining.\n\nLUNGS/AIRWAYS: Bibasilar and lingular atelectasis is visualized.  Otherwise\nthe lungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: Multilevel degenerative changes are re-demonstrated with no suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Substantial interval decrease in size of lobulated mediastinal nodal\nconglomerate centered about the AP window, as described above, with\ncorrelating interval decrease in mass effect, and no additional significant\nchanges, though evaluation is limited given lack of IV contrast enhancement.\n2. Persistent small right pleural effusion trace left pleural effusion status\npost placement of left sided apically oriented pigtail drainage catheter."
        },
        {
            "input": "The included thyroid is normal. There is no axillary, supraclavicular or\ncentral lymphadenopathy. The heart is normal size and there is a trace,\nphysiologic pericardial effusion. Focal coronary artery calcifications and\naortic valve calcifications are mild to moderate. The aorta and main pulmonary\nartery are normal caliber.\n\nThe trachea is normal caliber. The airways are patent through the subsegmental\nlevel. Slight irregularity of the airways is consistent with an extensive\nhistory of smoking and chronic airways disease. There are no lung masses. \nSeveral, non calcified, predominantly subpleural micronodules are present,\nnone of which have a morphology suspicious for malignancy (4:92, 163, 223).  \nA triangular shaped nodule along the minor fissure (4:165) and a 3 mm\nsubpleural nodule in the right lower lobe (4:182) are likely lymph nodes. \nCalcified granulomas are seen in the right upper lobe (4: 97, 116), one of\nwhich results in distal bronchial impaction. There is no pleural effusion or\npneumothorax.\n\nNumerous hypodensities throughout the liver are incompletely characterized but\nunchanged from the ___. The esophagus is unremarkable. Included views of\nthe unenhanced spleen, pancreas and adrenal glands are unremarkable. The\nkidneys show no hydronephrosis or nephrolithiasis. Simple renal cysts seen in\nthe right interpolar region (2:71) and left upper pole (2:65, 66) are\nunchanged.\n\nThere are no lytic or blastic osseous lesions within the thorax.  Moderate\ndegenerative changes of thoracic spine are evidenced by anterior osteophytes.",
            "output": "1.  Several, non-calcified, punctate and solid micronodules as above. None of\nthese have a morphology suspicious for malignancy.  2. Chronic airways\ndisease, likely from smoking."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nIrregularity within the main pulmonary artery does not appear to be acute. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  A small, subpleural nodule is noted in the right upper lobe\n(02:30).  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nABDOMEN: Limited evaluation of the upper abdomen shows a small hiatal hernia. \nThe gallbladder is surgically absent.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.  Evidence of previous\ncholecystectomy.  Mild stranding surrounding the left kidney.\n\nMEDIASTINUM: No mediastinal adenopathy.\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Dual lead pacemaker in situ with the lead tips present\nthe right atrium and right ventricle. Multiple coronary artery stents in situ.\nMild calcification of the mitral annulus.  No aortic valve calcification. The\naorta is not dilated.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild to moderate paraseptal emphysematous changes.  Sub 5 mm\nground-glass nodule in the left upper lobe (4, 183) is unchanged.  The\nmultiple spiculated nodules demonstrates variable interval change, with the\nmajority demonstrating interval decrease in size for example the nodule in the\nbase of the left lower lobe currently measures 18 x 13 mm (previously 19 x 16\nmm) this nodule is transversed by patent bronchi.  Some nodules are slightly\nincreased in size for example in the right lower lobe (4, 195) the lesion\ndemonstrates a new nodular component anterosuperiorly measuring 7 mm diameter\nand the nodule in the medial aspect of the right lobe (4, 190) currently\nmeasures 7 x 5 mm (5 x 4 mm previously).  A few small nodules are new (4, 184,\n129, 127) with the largest nodule measuring 4 mm in diameter.  No lobar\nairspace consolidation.  No fibrosis.\n-AIRWAYS:  Patent to the subsegmental level.  No bronchiectasis.\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Suspected DISH. No lytic/ destructive bony lesions.",
            "output": "Multiple spiculated/irregular pulmonary nodules, some with consolidative\nfeatures, predominantly demonstrate interval decrease in size, however a few\nare minimally larger, and a few small sub 4 mm nodules are new.\nThe discrepant change of nodules favors cryptogenic organizing pneumonia.\nIn the differential diagnosis consider vasculitis.\nThe fact that some of the nodules are decreased in size makes malignancy\nextremely unlikely."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinal and\nhilar compartments.  Borderline diameter of the main pulmonary artery.  Severe\ncoronary calcifications, mild aortic valve calcifications.  Cardiac pacemaker\nleads.  The posterior mediastinum is unremarkable.  No abnormalities are seen\nin the upper abdomen.  There is stable minimal fibrotic scarring along the\npleural surfaces.  Some of the parenchymal abnormalities that pre existed on\nthe preceding examination, for example a perifissural part solid and sub solid\nopacity in the upper lobe on the right (4, 164) are stable.  Other nodular\nopacities have resolved.  For example, a previous subpleural right lower lobe\nnodule (4, 184 on the previous examination) is no longer visualized.  The\nnodule aided spicular lesion in the lingular (4, 224) is stable.  There is no\nevidence of new parenchymal lesions.  Mild lower lobe predominant\nbronchiectasis.  The airways are patent.  No pleural effusions.",
            "output": "Several pre-existing pulmonary nodules have completely resolved.  Others\npersist in unchanged manner.  The interval changes suggest healing organizing\npneumonia as a primary diagnosis.  Mild stable subpleural fibrosis. Mild lower\nlobe predominant bronchiectasis.  Severe coronary calcifications."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmild cardiomegaly.  A prosthetic aortic valve is in place.  There is severe\ncoronary artery calcification.  There is a trace pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is biapical pleuroparenchymal scarring.  A calcified granuloma in\nthe right upper lobe (302, 65 is unchanged.  Previously visualized diffuse\nbilateral parenchymal opacification has resolved and most likely represented\npulmonary edema.  Previously visualized bilateral pleural effusions have also\nresolved.  No new consolidations\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  There is severe endplate changes involving the lower\nthoracic and upper lumbar spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\npneumobilia.  Patient status post cholecystectomy.  Lack of Intravenous\ncontrast limits evaluation of the liver.  There is mild intrahepatic biliary\nductal dilatation.  Patient status post liver transplantation.",
            "output": "Previously visualized bilateral pleural effusions and fused bilateral\nparenchymal opacification has resolved and most likely represented pulmonary\nedema.\n\nStable calcified granuloma in the right upper lobe.\n\nStatus post liver transplantation.  Mild intrahepatic biliary ductal\ndilatation with evidence of pneumobilia.\n\nLack of Intravenous contrast limits evaluation of the liver.\n\nExtensive degenerative changes involving the lower thoracic and upper lumbar\nspine."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Prostatic\naortic valve is again seen.  There are severe atherosclerotic calcifications\nof the coronary vessels and mild-to-moderate calcifications of the thoracic\nand partially visualized abdominal aorta..  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  The esophagus is mildly\npatulous.\n\nLUNGS/AIRWAYS: There is mild bibasilar subsegmental atelectasis.  There is\nunchanged mild biapical parenchymal scarring.  2 small calcified granulomas\nare seen in the posterior right upper lobe (0 5: 118, 123), unchanged. There\nare stable mild centrilobular emphysematous changes.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Again seen is mild central pneumobilia, biliary duct dilatation and\nstable postsurgical changes status post liver transplant.  There is\nsubstantial calcifications at the origins of the bilateral renal arteries and\nmoderate calcification of the origin of the superior mesenteric artery.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nRedemonstrated are extensive degenerative changes of the thoracic spine.",
            "output": "1. No acute cardiopulmonary abnormality.\n2. Stable mild emphysematous changes.\n3. Status post liver transplantation with stable mild intrahepatic biliary\nductal dilatation and central pneumobilia."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe main pulmonary artery is not dilated.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  Mild\natherosclerotic plaque in the aortic arch and descending thoracic aorta.  Mild\ncardiomegaly.  No pericardial effusion.  Coronary artery calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace pleural effusions..\n\nLUNGS/AIRWAYS: There is mild centrilobular emphysema with few subpleural blebs\nat the apices.  There is no fibrosis or honeycombing at the bases.  Mild\nbasilar atelectasis.  There is a 7 mm subpleural nodule in the right lung apex\n(series 301, image 17).  No focal consolidation.  No airways are patent to the\nlevel of the segmental bronchi bilaterally.  There is mild bronchial wall\nthickening, may be inflammatory.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Post TACE changes seen in hepatic segments VI and VII not\nsignificantly changed in size from prior.  The liver contour is nodular in\nkeeping with known liver cirrhosis.  No new worrisome hepatic mass lesions. \nNo intrahepatic or extrahepatic biliary duct dilatation.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is top-normal in size measuring 13 cm in maximal dimension. \nThere is no focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Esophagus is mildly\npatulous.  The remainder stomach is normal.  There are abdominal varices,\nincluding paraesophageal varices.  There is a small juxta papillary duodenal\ndiverticulum.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThere is moderate amount of ascites which has increased in size when compared\nto prior.  There is slight thickening of the peritoneal lining at the\ncul-de-sac (series 2b, image 153) which is new from prior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Few prominent retroperitoneal lymph nodes, not significantly\nchanged from prior and not pathological by size criteria.  No mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Slight ectasia of the infrarenal abdominal aorta measuring 2.4 cm,\nunchanged from prior.  Moderate atherosclerotic disease is noted.  Mild\natherosclerotic disease is noted.  The previously described small filling\ndefects within the right external iliac vein and right common iliac vein are\nnot visualized on today's study.\n\nBONES AND SOFT TISSUES: Minimal grade 1 anterolisthesis of L5 on S1 due to\nbilateral L5 pars defects..  The abdominal and pelvic wall is within normal\nlimits.  Suggestion of bilateral femoral head chronic AVN.  Degenerative\nchanges bilateral hips, no articular surface collapse.",
            "output": "1.  No pulmonary embolism.\n2.   liver cirrhosis.  Post TACE changes in the liver.  No new worrisome\nhepatic mass lesions.\n3.  Moderate ascites, worsened from prior.  There is slight thickening of the\nperitoneal lining at the cul-de-sac which is new from prior.  Differential\nincludes layering hemorrhage or debris, possibly from infection. \nAlternatively enhancing tumor is not completely excluded, is less likely given\nfindings are new from ___.."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  Patient status-post aortic valve\nreplacement.  Coronary atherosclerosis is severe. The thoracic aorta is normal\nin caliber.  Aortic arch and great vessel origin calcifications are mild.  The\nmain pulmonary artery is normal in caliber.  Trace pericardial fluid is within\nphysiologic limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Moderate biapical scarring and mild centrilobular emphysema.  A\n7 mm subpleural nodule at the right apex is unchanged, possibly focal\ncomponent of scarring (series 5, image 45).  Few punctate calcified\ngranulomas.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The partially imaged liver is better evaluated on recent liver MRI. \nDense hyper attenuation in the posterior aspect of hepatic segment VII\npresumably reflects sequela of trans arterial chemoembolization of patient's\nknown hepatocellular carcinoma.  No new hepatic lesions identified within\nlimitations of noncontrast CT.  Large volume abdominal ascites.\n\nBONES: Mild heterogeneity of the visualized osseous structures, though no\ndiscrete, suspicious lesions are seen.  Small bone islands in the right\nclavicular head are unchanged.  Mild thoracic spondylosis.  No acute fracture.\n\nSOFT TISSUES: Left gynecomastia.  Mild diffuse subcutaneous edema.",
            "output": "1. 7 mm nodular opacity in the right apex is unchanged for 3 months, possibly\nfocal scarring.  Recommend follow-up chest CT in ___ months to assess for\nstability.\n2. Mild centrilobular emphysema.\n3. Severe coronary atherosclerosis.\n4. Large volume abdominal ascites.\n\nRECOMMENDATION(S):  7 mm nodular opacity in the right apex is unchanged for 3\nmonths, possibly focal scarring. Recommend follow-up chest CT in ___ months\nto assess for stability."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings and thyroid.\nNo supraclavicular or axillary lymphadenopathy.\nUnchanged asymmetric left gynecomastia, 4.5 cm. measured 2.5 cm in ___ - enlarged, for further evaluation.\n\nUPPER ABDOMEN: Large quantity of ascites, grossly unchanged\nThe partially imaged liver is better evaluated on MRI dated ___.  Dense\nhyper attenuation in the posterior aspect of the right lobe reflect previous\nchemoembolization, No new gross findings in the liver within the limitation of\nstudy with no IV contrast infusion.\n\nMEDIASTINUM: No mediastinal or retrocrural lymphadenopathy.\nThe esophagus is patulous with suggested reflux, unchanged.\n\nHEART and PERICARDIUM: Status post TAVI.\nCoarse atherosclerotic calcifications of the coronaries especially LAD.\nModerate calcifications of the mitral valve.\nMajor vessels not dilated.\n\nLUNG and PLEURA: Major airways are patent.\nDiffuse airway wall thickening is associated with moderate centrilobular and\nparaseptal emphysema, affecting predominantly the upper lobes.\nRight upper lobe subpleural 0.5 cm nodule is unchanged since ___, most\nprobably scar tissue (4:44).\nTiny few calcified granulomas.\nNo new lung nodules or masses to suggest metastatic disease.\nNo pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "-No intrathoracic malignancy.\n-asymmetric left gynecomastia is increased - although it could be explained by\nthe severe cirrhosis further evaluation by clinical correlation and possibly\nUS or mammography should be considered."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. There is\nno supraclavicular or axillary lymphadenopathy.\nAsymmetric left greater than right gynecomastia is unchanged since prior, more\nprominent since ___.\n\nUPPER ABDOMEN: Moderate quantity of ascites is smaller since ___.  Spleen is larger 13 cm, in prior 10 cm.  Previous chemo embolization\ntreatment in the right lobe of the liver, remaining findings reported in\ndetail in the same day MRI of the liver.\nEsophagus is patulous with no evidence of masses or wall thickening.\n\nMEDIASTINUM: There is no mediastinal or gross hilar lymphadenopathy.\n0.6 cm juxtacardiac node is unchanged (02:42).\n\nHEART and PERICARDIUM: Heart is normal in size.  S/p TAVI.  Dense\ncalcifications of the coronaries with mild to moderate calcifications of the\nnormal caliber thoracic aorta.  Main pulmonary artery is normal in size.\nThere is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Airways are patent to the subsegmental level, mild diffuse bronchial\nwall thickening is unchanged.  Moderate centrilobular and paraseptal emphysema\nis unchanged, affecting predominantly the upper lobes.\nPre-existing right upper lobe subpleural 0.4 x 0.7 cm and 0.6 x 0.9 cm nodules\nunchanged since the ___ (302:31, 40).\nNo new or growing lung nodules.\nFew tiny scattered calcified granulomas in right lung.\n\nCHEST CAGE: Multilevel mild-moderate degenerative change of the spine with no\nevidence of osteo-destructive lesions.",
            "output": "No evidence of active intrathoracic metastasis.  Indeterminate, subcentimeter\nright upper lobe nodules stable since ___.\n\nPatulous esophagus suggests possible esophageal dysmotility."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. There is\nno pathologic enlargement of lymph nodes in the axilla or supraclavicular\nstations.  Asymmetric left greater than right gynecomastia is unchanged since\n___.\n\nCHEST CAGE: Multilevel mild-moderate degenerative change of the spine, no\nevidence of osteo-destructive lesions.\n\nUPPER ABDOMEN: Liver is shrunken with cirrhotic stigmata, previous\nchemoembolization in the right lobe of the liver.  Moderate quantity of\nascites is unchanged.\nEsophagus is patulous containing minimal air-fluid levels, unchanged, no\nevidence of masses or wall thickening.\n\nMEDIASTINUM: Scattered subcentimeter mediastinal lymph nodes are not\npathologically enlarged unchanged, juxta cardiac 0.6 cm lymph node is stable\n(5:201).  No gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  S/p TAVI.  Dense\ncalcifications of the coronaries are mild to moderate along the normal caliber\nthoracic aorta.  Main pulmonary artery is normal in size.  There is no\npericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Mild diffuse bronchial wall thickening is similar to prior, there are no\nmucoid impactions, no branching opacities to suggest active infection. \nFindings suggest chronic mild airway inflammation.\nMinimal centrilobular and paraseptal emphysema is unchanged, affecting\npredominantly the upper lobes.\nPre-existing right apex subpleural 0.4 x 0.7 cm unchanged since ___\n(302:31).  No new or growing lung nodules.  Few tiny scattered calcified\ngranulomas in right lung.",
            "output": "-No evidence of active intrathoracic metastasis.\n-Subcentimeter right apical nodule stable since ___.\n-Unchanged patulous esophagus suggests possible esophageal dysmotility."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Replaced aortic valve is\nre-demonstrated as well as coronary calcifications.  There is no pericardial\nor pleural effusion.  There is evidence of ascites, liver lesion that would be\nassessed in details as part of the MRI of the liver.\n\nGynecomastia is bilateral, very ice asymmetric, substantially larger on the\nleft compared to right, progressed as compared to ___, similar to ___.\n\nAirways are patent to the subsegmental level bilaterally.  Right apical nodule\nis stable, 5 mm, series 4, image 45.  Right upper lobe calcification is\nstable.  No new pulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest CT with no evidence of disease\nprogression.\n\nPlease review MRI of the liver for separate assessment of the upper abdomen\nfinding"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART: Prosthetic aortic valve the is again seen.  The heart is not enlarged. \nThere is extensive coronary arterial calcification and calcifications of the\nmitral valve.  There are mild calcifications of the head neck vessels and\naortic arch.  There is a small pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  A 5 mm nodule in the right apex is unchanged (05:30). \nScattered punctate calcified granulomas are unchanged.  A 2 mm nodule in the\nright upper lobe is new from prior (5:121), as well as a punctate nodule in\nthe left upper lobe (5:85).  There is mild centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nsurgical clips related to liver transplant and partially visualized bile duct\nstent.",
            "output": "1. A 5 mm right apical nodule is unchanged, likely representing parenchymal\nscar.  A 2 mm right upper lobe nodule and punctate left upper lobe nodule are\nnew from prior, of unclear significance.  Six-month follow-up chest CT is\nrecommended.\n2. A small pericardial effusion is new.  No findings to suggest malignant\ninvolvement.\n\nRECOMMENDATION(S):  Six-month follow-up chest CT."
        },
        {
            "input": "HEART AND VASCULATURE:  Patulous esophagus.  The thoracic aorta is normal in\ncaliber.  Redemonstration of prosthetic aortic valve and extensive coronary\nartery and mitral annulus atherosclerotic calcifications.  A right-sided\nperipheral approach central venous catheter is seen, with tip terminating in\nthe distal SVC.  Mild cardiomegaly.  Otherwise, the great vessels are within\nnormal limits based on an unenhanced scan.  A small pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM:   No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Interval development of moderate-large right-sided and\nmoderate left-sided pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: New smooth septal and bronchovascular thickening throughout the\nlungs along with regions of ground-glass opacities, most pronounced in the\nright perihilar and left upper lobes, compatible with moderate pulmonary\nedema.  There are additional more focal regions of airspace consolidation\nconcerning for superimposed multifocal pneumonia particularly within the right\nmiddle lobe and both lower lobes.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Mild centrilobular emphysema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for a\nsmall amount of pneumobilia, an expected postsurgical change.  Surgical clips\nare again seen in the region of the IVC compatible with liver transplantation.\n\nBONES: Multilevel degenerative changes are seen with several small Schmorl's\nnodes in the lower thoracic and upper lumbar spine, the largest of which\nmeasures up to 1.3 cm in diameter along the superior aspect of L1 (series 4,\nimage 230) and is unchanged compared to prior CT abdomen.  There is no acute\nfracture.\n\nCHEST WALL: Asymmetric left-sided gynecomastia.",
            "output": "1. New moderate pulmonary edema with moderate-large right-sided and moderate\nleft-sided pleural effusions.\n2. Additional more focal regions of airspace consolidation concerning for\nsuperimposed multifocal pneumonia.\n3. Small pericardial effusion.\n4. Patulous esophagus, which may suggest esophageal dysmotility.\n5. Redemonstration of extensive coronary and mitral annulus calcifications."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The patient is status post left\nthyroidectomy as before.  The right lobe of the thyroid is unremarkable. \nThere is no axillary or supraclavicular lymphadenopathy.  A  1.3 x 2.0 cm\nmediastinal lymph node at the level of the aortic arch is increased from the\nprior examination when it measured 1.1 x 0.7 cm (03:18).  No additional,\npathologically enlarged hilar or mediastinal lymph nodes are identified.  Few\nminimally prominent hilar nodes are overall unchanged in size from the prior\nexamination.\n\nHEART & VESSELS: The heart is normal in size. The great vessels are normal in\ncaliber.\n\nLUNGS & AIRWAYS: There is no large focal consolidation or pleural effusion. \nThere is no evidence of pneumothorax.  Multiple large pulmonary nodules are\nstable to minimally increased from the prior examination.\nPulmonary nodules:\n 9 x 9 mm, right upper lobe, 5:64, increased from 5 x 4 mm\n4 x 6 mm, left upper lobe, 5:63, stable\n10 x 8 mm, left lower lobe, 5:72, increased from 6 x 5 mm\n23 x 22 mm, left lower lobe, 05:104, increased from 18 x 20 mm\n25 x 24 mm, right lower lobe, 05:109, minimally increased from 25 x 22 mm\n34 x 24 mm, right lower lobe, 5:193, stable\nMultiple large nodules at the base of the left lung have coalesced and\nincreased in overall size from the prior examination.  (5:161).\n\nNumerous other subcentimeter pulmonary nodules are overall stable in size from\nthe prior examination.  No definite new pulmonary nodules are identified.\n\nUPPER ABDOMEN: Thickening of the left adrenal gland is stable.  The patient is\nstatus post cholecystectomy.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions are seen.",
            "output": "Multiple large pulmonary nodules throughout both lungs are minimally increased\nfrom the prior examination consistent with worsening disease.  Multiple\nadditional subcentimeter nodules are grossly stable.  No new pulmonary nodules\nare identified.\n\n1.3 cm enlarged AP window lymph node is increased from the prior examination. \nNo additional mediastinal lymphadenopathy is demonstrated.  Prominent hilar\nlymph nodes are overall unchanged."
        },
        {
            "input": "CHEST PERIMETER: 18 mm low-attenuation lesion in the enlarged right lobe of\nthe thyroid is been present without much change since ___. \nSupraclavicular and axillary lymph nodes are not enlarged despite growth of\ncentral adenopathy in other locations.  There are no soft tissue abnormalities\nin the imaged chest wall concerning for malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis, which would require dedicated\nabdominal imaging, but incompletely shows a low-attenuation lesion in the\nposterior cortex of the interpolar left kidney, not previously imaged.\n\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable above a small paraesophageal\nhernia.\n\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are normal size.  There is no\npericardial effusion.\n\n\nTHORACIC LYMPH NODES: Central adenopathy is present at the stations, and\ngrowing:\n\nThoracic outlet, 22 x 26 mm, previously 13 x 20 mm in ___, now\ndisplacing the trachea slightly to the left;\n\nPrevascular at the level of the aortopulmonic window, 18 x 24 mm, previously\n15 x 12 mm.\n\nCm size right hilar lymph node is larger as well.\n\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Dozens of pulmonary metastases ranging in diameter up\nto a 51 x 52 mm conglomerate in the left lower lobe, are little changed.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Small number of large mediastinal lymph nodes have grown since ___.\n\nNumerous pulmonary metastases, some quite large, are unchanged in the interim."
        },
        {
            "input": "THORACIC INLET: The right lobe of thyroid is enlarged with a heterogeneous\nappearance., status post left thyroidectomy.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : Small bilateral axillary lymph nodes not enlarged by size\ncriteria are unchanged.  The left axillary lesion has been resected in the\ninterim.\n\nMEDIASTINUM: The mediastinal lymph nodes are not significantly changed since\nthe prior study.  An upper right paratracheal node measures 2 cm in short\naxis.  The pre-vascular node measures 2.6 x 1.4 cm as compared to the prior\nmeasurements of 2.4 x 1.5 cm.  Another pre-vascular node measures 19 mm it\npreviously measured 18 mm.  The subcarinal node measures 16 mm and is\nunchanged.  Small bilateral hilar lymph nodes are also stable.  Slight\ndifferences in measurement could be related to slice selection.  Heart size is\ntop-normal.  There is no pericardial effusion.  There is mild coronary artery\ncalcification.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Multiple bilateral pulmonary metastasis are again seen, and are\nunchanged in size since the prior study.  The largest in the left lower lobe\nmeasures 5.3 x 4.5 cm.  The left upper lobe pulmonary nodule measures 14 mm\n(3, 15).  The right lower lobe pulmonary nodule measures 2.4 cm (3, 26). \nSimilarly all the other numerous bilateral pulmonary nodules are also\nunchanged.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no obvious lytic or sclerotic\nlesions concerning for metastasis.  Bones osteopenic.  Lucency within T8\nvertebral body could represent a hemangioma.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows left adrenal\nthickening.  The liver has a heterogeneous appearance.",
            "output": "Status post resection of the left axillary mass in the interim.  The left\naxilla has not been completely imaged on the cross-sectional images.\n\nNo significant interval change in the overall tumor burden within the chest\ncomprising of mediastinal and hilar adenopathy and multiple bilateral\npulmonary metastasis.  No new pulmonary nodules.  Continued follow-up is\nrecommended."
        },
        {
            "input": "BASE OF NECK: The right thyroid is enlarged and heterogeneous in appearance\nwithout dominant nodularity identified.  No supraclavicular lymphadenopathy is\nidentified.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild\ncoronary artery calcifications are re-demonstrated and unchanged otherwise the\nheart, pericardium, and great vessels are within normal limits.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple enlarged mediastinal nodes are\nre-demonstrated with a right paratracheal node measuring 1.1 cm (05:16),\npreviously measuring 2 cm.  A prevascular nodal conglomerate measures up to\n3.8 x 3.3 cm (05:37) previously measuring 3.4 x 4.1 cm.  A subcarinal node\nmeasures 2.1 cm (05:57), previously measuring 2.0 cm.  Small bilateral hilar\nlymph nodes re-demonstrated and unchanged.\n\nNo axillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple bilateral pulmonary lesions are re-demonstrated, not\nsubstantially changed in size from prior study with the largest in the left\nlower lobe measuring 5.3 x 4.3 cm (5:65), previously measuring 5.2 x 4.2 cm,\nand the largest in the right lower lobe measuring 3.1 x 2.5 cm (5:80),\npreviously measuring 3.1 x 2.37.  No new pulmonary nodules/masses are\nidentified.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for\nmultiple hypoenhancing lesions in the liver.  For further characterization of\nfindings below the diaphragm please see same day CT abdomen pelvis.\n\nBONES: A lucency within the T8 vertebral body likely represents a hemangioma.?\nThere is no acute fracture.",
            "output": "1. No substantial interval change in overall tumor burden within the chest\nwith interval decrease in size of right paratracheal node, though the\nremaining mediastinal and hilar lymphadenopathy, as well as bilateral\npulmonary metastases remain stable.\n2. Please see same day CT abdomen pelvis for characterization of\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST PERIMETER: Roughly 15 mm wide low density region in the over size right\nthyroid lobe, has not changed in size since at least ___.  Diminutive\nleft thyroid lobe suggest prior resection.  Further characterization would\nrequire thyroid ultrasound.  The 8 x 12 mm wide enlarged lymph node at the\nthoracic inlet in the right tracheoesophageal groove, 10:13, was 11 x 17 mm in\n___.  Supraclavicular and axillary nodes are not enlarged.  Findings below\nthe diaphragm will be reported separately.\nCARDIO-MEDIASTINUM:Small hiatus hernia is stable.  Moderate esophageal\ndistention above level is slightly more pronounced today, but there is no\nretention of fluid to suggest real obstruction.  Dysmotility may be\nexplanation.\n\nAtherosclerotic calcification is not apparent head and neck vessels or in the\ncoronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and pericardium is physiologic.  Central venous infusion catheter\nends at the superior cavoatrial junction with no associated thrombosis.\n\nTHORACIC LYMPH NODES: Adenopathy as follows:\n\nPrevascular, 42 x 34 mm, 11:93, previously 38 x 33 mm, with greater extension\ninto the aortopulmonic window.\n\nRight hilum, 19 x 22 mm, previously 15 x 24 mm, and 22 x 30 mm, previously 24\nx 30 mm.\n\n\nLUNGS, AIRWAYS, PLEURAE: Numerous lung masses, large and small,\ncharacteristically as follows:\n\nLeft upper lobe, 22 x 43 mm, 11:75 previously 14 x 30 mm, and 23 x 25 mm,\n11:103, previously 24 x 24 mm.\n\nRight lower lobe, 25 x 26 mm, 11:121, previously 25 x 26 mm.\n\nLeft lower lobe, 49 x 57 mm, 11:164, previously 43 x 53 mm, with a\nsubstantially larger extension to the diaphragmatic and posterior costal\npleural surface, invading the extrapleural fat, but absent pleural effusion.\n\nRight lower lobe, 29 x 35 mm, 11:198, previously 25 x 31 mm.\n\nTracheobronchial tree is normal to subsegmental levels.  No pleural effusion.\n\n\n\nCHEST CAGE: Well-circumscribed lucent lesion traversed by vertical trabeculae,\nmidthoracic vertebral body, unchanged since ___ is probably benign. \nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Since ___, pulmonary metastases have continued to grow, some\nsubstantially, and some lymph nodes are also larger, others slightly smaller,\nfollowing previous improvement generally between ___ and ___.\n\nRight thyroid lesion has been stable since ___.  If further\ncharacterization is desired, ultrasound should be performed."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is unchanged in\nappearance, with a small amount residual thyroid tissue, and a heterogeneous\nright thyroid lobe.  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nMEDIASTINUM: A 4.0 x 3.3 cm pre-vascular lymph node conglomerate with central\nhypodensity is not substantially changed from prior (6:85), previously 4.2 x\n3.4 cm.  An 8 mm right upper paratracheal node is unchanged (06:26).\n\nHILA:  Enlarged right hilar lymph nodes are not substantially changed, when\nmeasured with similar technique, measuring 1.6 x 2.9 cm (6:126) and 1.7 x 1.7\ncm (6:102).  A 0.9 x 1.0 cm left hilar lymph node is also unchanged (6:111).\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Numerous lesions are again seen throughout the lungs\nbilaterally, with representative lesions as follows:\nA left upper lobe mass measures 2.2 x 4.0 cm (6:71), previously 2.2 x 4.3 cm.\nA left upper lobe mass measures 2.4 x 2.5 cm (6:96), previously 2.3 x 2.5 cm.\nA right lower lobe mass measures 2.5 x 2.6 cm (6:115), previously 2.5 x 2.6\ncm.\nA right lower lobe mass measures 2.6 x 3.4 cm (6:193), previously 2.9 x 3.5\ncm.\nA left lower lobe mass measures 4.9 x 5.7 cm (6:158), previously 4.9 x 5.7 cm.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Extensive pulmonary metastases are re-demonstrated, unchanged compared to\nprior study.\n2. Unchanged mediastinal and hilar lymphadenopathy.\n3. Unchanged appearance of heterogeneous right thyroid.\n4. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nStatus post left hemithyroidectomy, unchanged.  No enlarged lymph nodes in\neither axilla or thoracic inlet.  Right anterior port with tip in the\ncavoatrial junction.  No atherosclerotic calcifications in the head and neck\narteries.  No abnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout. \nNo filling defects suggestive of pulmonary embolism.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Large mediastinal mass in the prevascular\nstation measuring 4.0 x 3.3 cm (2:70), slightly larger compared to ___.  Unchanged bilateral hilar lymphadenopathy, the largest to the right\nmeasuring 2.9 x 1.8 cm (2:105).\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nthickening, no bronchiectasis or mucus plugging.  The large central lung mass\nin the left lower lobe and associated obstructive atelectasis are slightly\nbulkier today., Relatively unchanged are many lung nodules elsewhere in both\nlungs, the largest in the left upper lobe measuring 2.5 x 2.4 cm (2:75) and in\nthe right lower lobe measuring 2.6 x 2.5 (2:93).\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show status post cholecystectomy. \nUnchanged lobulated appearance of the left adrenal gland.  Redemonstration of\na enlarged mass in the right hepatic lobe, of difficult comparison in this\narterial phase of enhancement.",
            "output": "No evidence of involution of any lesions representing extensive metastatic\nmalignancy.\n\nCombination of central mass in the left lower lobe and postobstructive\npneumonia is bulkier today than in ___.\n\nThe dominant prevascular mediastinal mass looks slightly larger than before,\nbut this could be due to a difference in patient positioning.\n\nMultiple lung nodules and  mediastinal and hilar lymphadenopathy are stable."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  The\nthoracic aorta is normal in caliber.  No evidence of dissection or penetrating\natherosclerotic ulcer formation.  The main pulmonary artery is normal in\ncaliber.  No evidence of pulmonary embolus to the segmental level.  A right IJ\nPort-A-Cath tip is located at the superior cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: Allowing for differences in measurement\ntechnique and imaging plane, mediastinal lymphadenopathy is unchanged.  A\nheterogeneously enhancing, partially necrotic lymph node in the aortopulmonary\nstation measures 4.6 x 3.1 cm.  A right subcarinal lymph node measures 3.0 x\n2.2 cm.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Innumerable pulmonary nodules and masses are not significantly\nchanged since the prior examination.  A representative nodule in the left\nlower lobe measures 2.6 x 2.4 cm.  A nodule in the right lower lobe measures\n2.6 x 2.6 cm.  A mass in the left lower lobe measures 5.7 x 5.0 cm.  No\ndefinite new or enlarging pulmonary nodules.  Mosaic attenuation of the\nbackground lung parenchyma is unchanged since the prior examination.\n\nBASE OF NECK: Multinodular thyroid gland, unchanged.  A dominant nodule\nmeasures 1.5 cm in the right thyroid lobe.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: There is and expansile lucent lesion in the manubrium measuring 1.8 x\n1.3 x 2.2 cm, unchanged in size, but more readily apparent on the prior\nexamination (series 303, image 39; series 604, image 95). Unchanged T8\nvertebral body hemangioma. No other definite osseous lesion identified.",
            "output": "1. No appreciable changed in innumerable pulmonary nodules and masses and\nmediastinal lymphadenopathy.\n2. A manubrial lesion is unchanged in size, but more readily apparent on the\nprior examination.\n3. Unchanged multinodular thyroid gland with a dominant nodule measuring 1.5\ncm."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThere are areas of distortion narrowing of the pulmonary arteries due to\nmetastatic disease detailed below.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  Right chest wall port is seen with catheter in the right\natrium.\n\nAXILLA, HILA, AND MEDIASTINUM: Enlarged bilateral hilar lymph nodes most\nnotably in the right infrahilar region measuring 3.3 x 3.2 cm, previously 3.0\nx 2.2 cm.  Prevascular lymph node conglomerate measures 5.2 x 3.6, previously\n5.3 by 3.0 cm.  Other discrete right paratracheal and left supraclavicular\nnodes are noted.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral parenchymal metastatic lesions are identified, the\nlargest lesion is located in the left lower lobe and measures 5.2 x 5.0 x 3.6\ncm, previously 5.6 x 4.7 x 3.9 cm.  Given differences in positioning, this is\nnot significantly changed.  Dominant right lower lobe mass measures 3.3 x 2.5\ncm, previously 3.4 x 2.6 cm.  Additional right lower lobe lesion in the\nsuperior segment measures 2.7 x 2.4 cm, previously 2.7 x 2.7 cm.  Dominant\nright upper lobe discrete lesion measures 2.6 x 2.5 cm, previously 2.6 x 2.4\ncm.  There are numerous additional smaller pulmonary nodules with conglomerate\nnodularity at the left lung apex.  Right inferior hilar lymph node\nconglomerate measures.  Central airways are patent.  Left lower lobe segmental\nbronchi are obliterating the segmental airways.  Diffuse mosaic attenuation is\nagain seen throughout the lungs.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality\nbesides left supraclavicular adenopathy.\n\nABDOMEN:\n\nHEPATOBILIARY liver is again notable for numerous parenchymal metastatic\nlesions.  The largest conglomerate mass centered in the right lobe is\ndifficult to accurately measure given adjacent altered enhancement but\nmeasures approximately 11.4 x 6.2 by 16.1 cm, previously 10.0 x 6.2 by 18.9\ncm.  Additional smaller lesions noted in the left lobe of the liver.  Areas of\naltered perfusion noted at the periphery of the lesions as well.  Surgical\nclips seen along the undersurface of the liver adjacent to the gallbladder\nfossa.  The gallbladder itself is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Apparent colonic\nwall thickening noted along the ascending colon as seen previously.  The cecum\nand proximal ascending colon do demonstrate submucosal fat suggesting prior\ninflammation.  There is no surrounding stranding currently.  Elsewhere, the\ncolon is unremarkable.  The appendix is not visualized.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterine calcification may be from fibroid.  No adnexal\nabnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Sclerotic focus in the right iliac bone (5:61) is\nunchanged dating back to ___.  Sclerotic focus in the left iliac bone\nabutting the SI joint (5: 60) is new from the remote study though unchanged in\nsize from more recent studies.  This is compatible with a metastatic lesion\ngiven increased uptake on prior gallium study.  T8 vertebral body hemangioma\nis noted.  Lucent lesion within the manubrium (602:33) is also unchanged this\nis also compatible with a metastatic lesion.",
            "output": "1. No pulmonary embolism or acute aortic syndrome.\n2. Findings compatible with metastatic disease with innumerable pulmonary\nnodules and masses.\n3. Metastatic burden in the liver has not drastically changed noting that the\nphase of contrast and regions of altered perfusion limit evaluation for subtle\ninterval differences.\n4. Metastatic osseous lesions as seen on priors with no new lesion identified.\n5. Colonic wall thickening of the ascending colon in part due to submucosal\nfat.  Underdistention or post treatment changes may also account for some of\nthis findings.  No change from prior nor surrounding stranding to further\nsuspect acute inflammation though clinical correlation is suggested regarding\npossibility of colitis.\n6. Otherwise, acute intra-abdominal process, no change since prior exam."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: Please refer to concurrent CT abdomen report.\n\nMEDIASTINUM:  Pre-vascular, bilateral lower paratracheal, subcarinal, and\nright paraesophageal lymphadenopathy are not significantly changed since 4\ndays prior.  The largest conglomerate of lymph nodes is located prevascular,\nmeasuring approximately 2.5 x 3.3 cm, similar to prior.\n\nHILA:  Bilateral hilar lymphadenopathy is not significantly changed since 4\ndays prior.\n\nHEART and PERICARDIUM: Cardiomegaly is mild, as on prior.  There is some\nstraightening and perhaps minimal bowing of the interventricular septum\ntowards the left ventricle (304:144).  No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  7 mm right upper lobe nodule (304:56) with mild surrounding\nground-glass is again seen.  There is a calcified granuloma in the right\nmiddle lobe.  Subpleural somewhat triangular-shaped irregular opacity in the\ninferior lateral right upper lobe (304:114) is new since prior.  A somewhat\ntriangular opacity in the right middle lobe (304:149), and irregular\nsubpleural opacities in the posterior left lower lobe appear similar to prior.\n2. AIRWAYS:  The airways are patent to subsegmental levels.\n3. VESSELS:  Bilateral lobar as well as more distal pulmonary embolism is\nsimilar to prior.  The main pulmonary artery measures up to 3.4 cm, compared\nto 3.6 cm on prior.  The right pulmonary artery measures up to 2.7 cm,\ncompared to 2.3 cm on prior.\nCHEST CAGE: No concerning lytic or sclerotic lesion.  No acute fracture.",
            "output": "1. Extensive bilateral pulmonary embolism and mediastinal lymphadenopathy are\nsimilar to 4 days prior. The adenopathy is unexplained on this chest CT and\ncould represent lymphoproliferative disease, extrathoracic primary, or less\nlikely an occult lung malignancy.\n2. Enlargement of the right pulmonary artery is sufficient to suggest\npulmonary hypertension and is slightly worse compared to prior.  Reversal of\nthe interventricular septal architecture suggests recurrence of secondary\nright ventricular dilatation.\n3. Opacity in the inferolateral right upper lobe is new since prior and may\nrepresent pulmonary infarction and/or infection.  Opacities in the right\nmiddle lobe and posterior left lower lobe are similar to prior and may\nrepresent pulmonary infarction and/or infection.\n4. 7 mm nodule in the right upper lobe.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  Critical results were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:50 am, 9 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  There are trace bilateral pleural effusions.  No pneumothorax\nis identified.\n\nLUNGS/AIRWAYS:  Again seen are patchy bilateral opacities involving the upper\nlobes, consistent with multifocal pneumonia.  These opacities are slightly\nprogressed since the prior examination.  There is bibasilar atelectasis, worse\non the right than on the left.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is heterogeneously hypodense with large areas of\nfatty change.  Differential enhancement is similar to the prior examination. \nAgain noted is atrophy of the left lobe and caudate hypertrophy, in keeping\nwith the patient's underlying cirrhosis.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThe umbilical vein is recanalized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is borderline enlarged, measuring up to 14 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Relatively dilated\ncontrast excretion is seen on the last, which may be obstructive in etiology\ngiven large fecal impaction.  There is no focal renal lesions.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is large\nfecal impaction causing mass effect on the adjacent uterus and bladder, likely\nresulting in obstruction of left ureter.\n\nSmall amount of free fluid is seen in the mid abdomen.\n\nPELVIS:  A Foley catheter is seen within the bladder, which is anteriorly\ndisplaced.\n\nREPRODUCTIVE ORGANS: The uterus is anteriorly displaced.  No definite adnexal\nmasses are identified.\n\nLYMPH NODES: Scattered prominent retroperitoneal and mesenteric lymph nodes\nare seen, not measuring more than 1 cm in short axis.  There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR:  No significant atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multifocal pneumonia, slightly worsened since the comparison examination.\n2. Hepatic steatosis and findings consistent with cirrhosis.\n3. Large fecal impaction."
        },
        {
            "input": "The partially imaged thyroid gland is heterogeneous in appearance.  The\nesophagus is within normal limits.  There is an enteric catheter within the\nlumen of the esophagus, partially visualized.  The aorta demonstrates normal\ncaliber throughout the chest.  There is no significant aortic arch\ncalcification.  The heart is probably normal in size, accentuated due to\nexpiratory phase of scanning.  The pulmonary artery is normal in caliber\nalthough somewhat obscured due to extensive cardiorespiratory motion.  There\nis no significant pericardial effusion.  The scattered mediastinal lymph nodes\nare somewhat prominent but not individually pathologically enlarged (for\nexample see series 4, image 76 for an 8 mm AP window lymph node), likely\nreactive in nature, unchanged from prior, less well seen in the absence of\ncontrast.  There is no axillary lymphadenopathy.  Left supraclavicular lymph\nnodes are mildly numerous but not enlarged.\n\nAn endotracheal tube terminates in the mid-to-distal trachea, in appropriate\nposition, new from prior exam.  Otherwise, the major airways are patent to\nsubsegmental levels bilaterally.  Multifocal bilateral lingular, right middle,\nand bilateral upper lobe mixed consolidative and ground-glass opacities are\nimproved since study from ___, with improved aeration of the upper\nlobes.  Focal opacities in the right upper (4, 53 and 69) and lateral lingula\n(4, 123) are new or worsening since prior, concerning for developing\ninfection.  There is collapse of the entire right lower and left lower lobes\nwhich is unchanged.  Trace layering left pleural effusion is unchanged.  There\nis no pneumothorax.  Mild interlobular septal thickening seen at the lung\napices (for example see series 4, image 36), likely due to mild pulmonary\ninterstitial edema.  There is no pneumothorax.  There is no worrisome lung\nnodule or mass identified.\n\nThere is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality.  The imaged thoracic vertebral bodies are normally aligned. No\nconcerning focal lytic or sclerotic osseous lesions are seen.\n\nRe-identified within the partially imaged upper abdomen is an\nenlarged-appearing, heterogeneous and markedly steatotic liver.  Oral contrast\nlayers dependently within the fundal gastric lumen.  Distal aspect of the\nenteric catheter is seen coiled within the gastric lumen, only partially\nvisualized, tip not seen.  No other focal abnormalities seen within the\npartially imaged upper abdominal solid and hollow viscous organs, on limited\nnon-contrast evaluation.",
            "output": "1. Considerable interval improvement in the largest right middle and bilateral\nupper lobe consolidations since the prior study from ___ given\npresence in the anti-dependent portions of the upper lungs, these may have\nrepresented pulmonary edema.\n2. New/worsening foci of mixed ground-glass and consolidative opacity in the\nright upper lobe and left lower lobe likely reflect developing infection.\n3. Unchanged lobar atelectasis of the right and left lower lobes.\n4. Mildly numerous nonenlarged axillary mediastinal lymph nodes are likely\nreactive, unchanged.\n5. Unchanged trace layering left pleural effusion.\n6. Minimal pulmonary interstitial edema.\n7. Partially visualized heterogeneous, enlarged, markedly steatotic liver."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Partial anomalous pulmonary\nvenous return with superior left pulmonary vein draining to the left\nbrachiocephalic vein, a congenital variant.\n\nAXILLA, HILA, AND MEDIASTINUM:  Mildly prominent subcentimeter bilateral\naxillary lymph nodes are noted.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear besides mild bibasilar atelectasis without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK:  Patient is status post thyroidectomy.\n\nABDOMEN:  An accessory left hepatic artery branch arises from the left gastric\nartery.  The remaining included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nIncreased sclerosis of the costovertebral junction of the ___ vertebral body\nlikely degenerative.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Incidental congenital variant of partial anomalous pulmonary venous return."
        },
        {
            "input": "No axillary, mediastinal, or hilar lymphadenopathy by CT size criteria.\n\nHeart size is normal, and there is no pericardial effusion.  Mild coronary\nartery calcifications are noted.  No aortic valvular calcifications.  Thoracic\naorta is normal in course and caliber, with mild atherosclerotic\ncalcifications throughout.  Main pulmonary trunk is prominent, measuring up to\n3.2 cm in diameter (3:92), which can be seen in the setting of pulmonary\narterial hypertension.  No evidence of pulmonary embolism to the segmental\nlevels.  Evaluation of the subsegmental levels is limited by respiratory\nmotion.  Incidental note is made of a prominent venous structure arising from\nthe left brachiocephalic vein (3:46), likely representing partial anomalous\npulmonary venous return.\n\nAirways are patent to the segmental bronchi bilaterally.  Mild upper lobe\npredominant centrilobular emphysema.  Mild bibasilar dependent atelectasis. \nNo pleural effusion or pneumothorax.\n\nNo concerning lytic or sclerotic lesions.  No acute fracture.  Chest wall is\nunremarkable.\n\nIncluded images of the upper abdomen are grossly unremarkable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild upper lobe predominant centrilobular emphysema.\n3. Coronary artery calcifications.\n4. Possible pulmonary arterial hypertension.\n5. Probable partial anomalous pulmonary venous return."
        },
        {
            "input": "Right pectoral Port-A-Cath.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the mediastinum or at the level\nof the hilus.  However, several borderline sized lymph node and calcified\nlymph nodes are visualized.  Mild coronary calcifications, no valvular\ncalcifications, small bilateral pleural effusions.  The posterior mediastinum\nis unremarkable.  No relevant findings in the upper abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures. \nCalcified right upper lobe granuloma, surrounded by an area of interstitial\nthickening and ground-glass opacities.  Similar ground-glass opacities are\nnoted in the left upper lobe.  Subpleural ground-glass opacities and linea\nconsolidations, likely reflecting atelectasis, are visualized in both lower\nlobes.  However, non dependent ground-glass opacities are visualized in the\nanterior portions of the right lower lobe and the posterior portions of the\nmiddle lobe.  No abnormalities at the level of the airways.",
            "output": "Small bilateral pleural effusions.  Bilateral ground-glass opacities with\ninterstitial thickening, right more than left, and predominating in the upper\nlobes.  In the appropriate clinical setting, the findings would be consistent\nwith pneumonia."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild dependent atelectasis in the bilateral lungs. The airways are\npatent to the subsegmental level.\n\nA hypoattenuated lesion in the right hepatic lobe measuring 1.3 x 1.0 cm\n(2:81) is unchanged from CT chest ___.  There is a calcified\nsplenic arterial aneurysm measuring 0.9 cm in maximal set diameter (2:84),\nincreased from chest CT ___.  There is a small hiatal hernia\n(series 2, image 75).\n\nCompression deformities involving the T5, T8, and T10 vertebral bodies are new\nsince chest CT ___.  Some of these deformities were noted on\nchest radiograph ___.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Compression deformities involving the T5, T8, T10 vertebral bodies which\nare age indeterminate.  Some of these deformities were noted on chest\nradiograph ___.\n3.  Small hiatal hernia.\n4.  8 mm splenic artery aneurysm has slightly enlarged since ___.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 4:51 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  Moderate coronary\nartery calcifications.  Heart size is normal.  No pericardial effusion is\nseen.  Moderate atherosclerotic calcifications of the thoracic aorta and great\nvessels.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There may be a trace right pleural effusion.  There is no left\npleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis in the right lower lobe. \nNo evidence of pulmonary mass or suspicious nodules.  Central airways are\npatent.\n\nBASE OF NECK: The thyroid is atrophic.  Otherwise, the visualized portions of\nthe base of the neck are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhypoattenuating lesion within the right hepatic lobe measures 1.1 cm, similar\nin appearance to the prior study from ___, but incompletely characterized on\nan unenhanced scan.There is no perihepatic free fluid.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is homogeneous in attenuation.  There is no main ductal\ndilatation.\n\nSPLEEN: The spleen is normal in size and homogeneous in attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is mild fullness\nof the right renal collecting system.  There is no hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber.  Scattered colonic diverticulosis, without evidence of acute\ndiverticulitis.  The appendix is normal.  There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS AND REPRODUCTIVE ORGANS:\n\nExtensive streak artifact from bilateral hip prostheses limit evaluation of\nthe pelvic structures.  There is at least small calcified uterine fibroid. \nBilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: A calcified splenic artery aneurysm measures 1.1 cm, not\nsubstantially changed (2:91).  There is no abdominal aortic aneurysm or\nretroperitoneal hematoma.  Moderate atherosclerotic disease is noted.\n\nBONES: The bones are diffusely demineralized.  Mildly displaced fractures of\nthe right anterolateral ___ through 9th ribs and lateral and posterior ___\nribs.  No left-sided rib fractures. Mild S-shaped scoliosis of the\nthoracolumbar spine. Severe, multilevel degenerative changes. \nMild-to-moderate compression deformities of the T5, T8, and T10 vertebral\nbodies appear similar to the prior CT chest from ___.  A mild\ncompression deformity of the L1 vertebral body, as well as height loss at the\nsuperior endplates of L2 and L3, are unchanged compared to outside MRI of the\nlumbar spine from ___.  The patient is status post bilateral total\nhip arthroplasty, with cerclage wires about the proximal left femur about a\nchronic, comminuted, ununited fracture of the greater trochanter.  No\nsuspicious osseous lesion.\n\nSOFT TISSUES: Bilateral, right greater than left, fat containing inguinal\nhernias.",
            "output": "1. Mildly displaced fractures of the right ___ through 10th ribs.  No\npneumothorax.  Mild dependent atelectasis in the right lower lobe.  There may\nbe a trace right pleural effusion.\n2. No substantial change in compression deformities/height loss of multiple\nthoracic and lumbar vertebral bodies.\n3. No evidence of traumatic organ injury in the chest or abdomen, within\nlimitations of a noncontrast study.  Evaluation of the pelvis is limited\nsecondary to extensive streak artifact from bilateral hip prostheses."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  Atherosclerotic calcifications noted in the\nthoracic aorta.  The heart, pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bronchial wall thickening and scattered mucous\nplugging in the bilateral lower lobes, which may be related to aspiration or\nbronchitis.  There is consolidation in the right lower lobe, which may\nrepresent sequela of aspiration or pneumonia.  Atelectasis noted in the\nbilateral lung bases.  No lung masses.\n\nBASE OF NECK: Heterogeneous thyroid gland noted, with a heterogeneous nodule\nin the right lobe measuring up to 1.2 cm, which does not require further\nevaluation based on current ACR guidelines.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is mild\nintrahepatic biliary duct dilation noted in the right lobe (2:100).  Also seen\nis mild extra hepatic biliary ductal dilation with the common hepatic duct\nmeasuring up to 8 mm.  The gallbladder appears mildly distended with multiple\nstones visualized in the gallbladder neck.\n\nPANCREAS: The pancreas has normal attenuation throughout without evidence of\nfocal lesions.  The pancreatic duct is prominent measuring up to 3 mm.  There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: There is a 1.4 cm right adrenal nodule and a 1.1 cm left adrenal\nnodule.\n\nURINARY: There is moderate bilateral hydroureteronephrosis.  Multiple cysts\nare visualized in the bilateral kidneys.  For reference, the largest measures\n2.3 cm on the right and 1.7 cm on the left.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia noted.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is a\nmoderate stool burden within the colon.  Diverticulosis of the colon is noted,\nwithout evidence of wall thickening and fat stranding.  There are anastomotic\nsutures at the rectosigmoid junction.  The appendix is not visualized.  There\nis no evidence of mesenteric injury.\n\nThere is no free air in the abdomen.\n\nPELVIS:\n\nThere is thickening of the bladder wall with numerous bladder diverticula. \nTrace free fluid noted in the pelvis (2:187)\n\nREPRODUCTIVE ORGANS: There is a 3.8 cm hypoenhancing lesion along the right\nside of the prostate gland which extends into the right seminal vesicle.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is a compression deformity of T12 with approximately 75% loss of\nthe vertebral body height, which appears chronic.  No focal suspicious osseous\nabnormality.  Multilevel degenerative changes of the thoracolumbar spine\nnoted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right lower lobe opacity, which is concerning for pneumonia and may be\naspiration related.\n2. A 1.4 cm right adrenal nodule and a 1.1 cm left adrenal nodule.\n3. Cholelithiasis with stones in the gallbladder neck.  No evidence of\ncholecystitis.\n4. Mild intrahepatic biliary ductal dilatation.\n5. Bladder wall thickening and numerous bladder diverticula, with moderate\nbilateral hydroureteronephrosis, which may be related to chronic urinary\nretention or outflow obstruction.  No evidence of an obstructing stone.\n6. Chronic compression deformity of T12 with approximately 75% loss of\nvertebral body height.\n\nRECOMMENDATION(S):  Incidentally discovered adrenal lesion without prior\nstudies for comparison measuring 1-2 cm. If there is no history of malignancy,\nthis is probably benign. Follow up dedicated adrenal CT in 12 months could be\nconsidered. If there is a history of malignancy, a dedicated adrenal CT is\nrecommended.\n\nRecommendations based on ___ ACR guidelines:\n___\n\nNOTIFICATION:  Updated findings discussed with ___, MD by ___\n___, MD via telephone ___ at 17:10."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No findings to explain patient's symptoms."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Lower cervical, axillary, and\nsupraclavicular lymph nodes are nonenlarged.  Thyroid is unremarkable.\n\nUPPER ABDOMEN: Although the study is not designed for the evaluation of the\nintra-abdominal organs, visualized solid organs are unremarkable.\n\nMEDIASTINUM: No anterior mediastinal soft tissue lesion or hematoma. \nSubcentimeter mediastinal lymph nodes do not meet criteria for enlargement. \nLargest measuring 0.6 cm in the lower paratracheal region (03:27).\n\nHILA: Hilar lymph nodes are nonenlarged.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.\n\nPLEURA: No left pleural effusion or pleural irregularity.  Interval increase\nin size of a small right pleural effusion when compared to ___ CT\nwhich is overall unchanged since radiographs dating back to ___. \nOverall, this fluid has decreased in density since ___ consistent\nwith expected evolution of a hemothorax.  A right-sided pigtail catheter is\nseen coursing along the right lateral chest wall entering the right pleural\nspace with tip terminating within the posterior mid pleural space, in\nappropriate position.  A small loculated component is noted at the right\ncardiophrenic angle.\nLUNG:\n\n1. PARENCHYMA: Left lung is clear.  There is mild progression of right middle\nlobe and right lower lobe atelectasis.\n2. AIRWAYS:  Mild right lower lobe and right middle lobe bronchial wall\nthickening is noted.  Airways are otherwise patent.  No mucous plugging or\nbronchiectasis.\n3. VESSELS:  Ascending aorta is top normal in caliber measuring 4 cm.  Main\npulmonary artery is normal in caliber.\nCHEST CAGE: Previously noted subcutaneous emphysema along the right lateral\nchest wall has resolved.  No chest wall hematoma.  Again noted are multiple\ndisplaced right-sided rib fractures with evidence of interval healing. \nRight-sided rib fractures as described: lateral fifth, displaced lateral\nsixth, displaced lateral seventh with a second component along the posterior\naspect, minimally displaced eighth rib with a second component along the\nposterior aspect, and lateral ninth rib fractures.  No new fractures.",
            "output": "1.  No significant change in a small right pleural effusion with expected\nevolution of blood products when compared to most recent chest radiographs\ndating back to ___.  Small loculated component at the right\ncardiophrenic angle.\n2.  Pigtail catheter in appropriate position.\n3.  Multiple rib fractures as above.\n4.  Right and middle lobe atelectasis with small airways disease."
        },
        {
            "input": "BASE OF NECK: A partially visualized thyroid is within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary adenopathy.  Subcarinal lymph node\nremains enlarged measuring 1.2 cm.  Additional subcentimeter mediastinal lymph\nnodes are additionally noted.  Right hilar lymph node is enlarged measuring\napproximately 1.1 cm.  No left hilar lymph nodes.  These are likely reactive.\n\nHEART AND VASCULATURE:  The heart is normal size.  No pericardial effusion.\n\nPLEURAL SPACES: No left pleural effusion or pneumothorax.  A new pigtail\ncatheter is in the right lower posterior pleural space with interval decreased\nsize of a right pleural effusion with a few foci of air which are likely\niatrogenic from pigtail placement.  Re-demonstrated chest tube in the right\nmid posterior pleural space which is unchanged in position.  Overall, there is\ninterval decreased size of right pleural effusion.\n\nLUNGS/AIRWAYS: The left lung is clear.  Interval improved aeration of the\nright lung with linear atelectasis predominantly in the right lower and right\nmiddle lobe.  The airways are centrally clear.\n\nABDOMEN:  The upper abdomen is unremarkable.\n\nBONES: Multiple nondisplaced to mildly displaced right rib fractures in\nvarious levels of healing are re-demonstrated.  No new acute osseous process",
            "output": "1. Interval placement of right lower pleural space pigtail catheter with\nmildly decreased right pleural effusion.  The upper chest right chest tube is\nin unchanged position.\n2. Multiple right rib fractures are re-demonstrated with various levels of\nhealing.\n3. Mildly improved aeration of the right lung."
        },
        {
            "input": "There is no pathologic enlargement of lymph nodes in the supraclavicular,\naxillary,, hilar, internal mammary, retrocrural, or diaphragmatic lymph node\nstations. Left lower paratracheal nodes ranging in diameter up to 9 x 19 mm\nare the only enlarged mediastinal nodes, including subcarinal nodes which are\nthe most at risk for intra thoracic nodal metastasis from retro peritoneal\nextension of tumor to the posterior mediastinum.\n\nThere is no pleural or pericardial abnormality. Aside from a calcified\ngranuloma in the right lower lobe, lungs are clear and the tracheobronchial\ntree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Mild enlarged left lower paratracheal mediastinal lymph nodes are the only\ncandidate for intrathoracic malignancy. It would be be very unusual for that\nto be the sole venue for metastatic colon carcinoma in the chest."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\ncompartments.  The borderline sized lymph nodes in the aortopulmonary window\n(5, 27) are all stable in size and morphology.  No abnormalities at the level\nof the large mediastinal vessels.  Moderate coronary calcifications, no\npericardial effusion.  No abnormalities in the posterior mediastinum.  Upper\nabdominal findings, including the large hypodense lesions in the liver, new\nsince the previous examination, are reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Moderate degenerative vertebral disease. \nNo vertebral compression fractures.  Stable bilateral apical scarring.  Stable\npost granulomatous changes in the right upper lobe (6, 120).  No pleural\nthickening, no pleural effusions.  No diffuse lung disease.  Stable calcified\nsubpleural granuloma in the right lower lobe (6, 198).  Stable non\ncharacteristic scarring at the bases of the middle lobe (6, 227).  No\nsuspicious or growing lung nodules.",
            "output": "Stable since ___.  Post granulomatous right upper lobe and right\nmiddle lobe changes.  No suspicious lung nodules or masses.  Stable moderate\ncoronary calcifications.  Newly appeared multiple large hypodense liver\nlesions."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Right prepectoral Port-A-Cath in situ\nwith the tip terminating in the distal right atrium.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Left lower paratracheal lymph nodes (6, 107) appear similar\ncompared to prior.  Subcentimeter left prevascular lymph node (6, 79) appear\nsimilar compared to prior.  Right paracardiac necrotic appearing lymph node\n(6, 230) is decreased in size currently measuring 21 x 7 mm (previously 26 x\n11 mm).\n\nHILA: No new or enlarging hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve or coronary artery calcification.  No aneurysmal malformation\nof the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Minimal biapical pleural-parenchymal scarring.  Multiple small\ncalcified granulomas with associated scarring and mild bronchiectasis in the\nposterior segment of the right upper lobe (6, 102) suggest prior infection. \nMild scarring also noted in the right middle lobe.  The patient has numerous\npulmonary nodules all of them being subcentimeter with some of these nodules\n(6, 127, 150, 157, 176, 187, 209) appearing marginally increased in size, but\nthis cannot be stated with certainty due to possible measurement error. \nMultiple pulmonary nodules are unchanged in size.  No confluent airspace\nconsolidation.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No lytic/\ndestructive bony lesions.",
            "output": "Interval decrease in size of the right pericardiac lymph node.  No new or\nenlarging mediastinal lymph nodes.\n\nNumerous pulmonary nodules, many of these are unchanged, some of them are\ncalcified (most likely related to prior infection), but some of them possibly\nbeing marginally increased in size (but this cannot be stated with with\ncertainty due to possible measurement error) and attention should be paid to\nthe specific nodules on follow-up imaging to exclude metastatic disease.\nPlease note that the prior CT study was 5 months ago (and in this interval the\nnodules demonstrate minimal interval change, if any), hence follow -up CT\nadvised in ___ months.\n\nFor abdominal findings please refer to CT abdomen report.\n\nRECOMMENDATION(S):  Follow-up CT advised in ___ months."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nThere is no pericardial or pleural effusion.  Image portion of the upper\nabdomen will be reviewed separately as part of the CT abdomen and pelvis in\ncorresponding report will be issued\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.  The right paracardiac lymph node has additionally decreased in\nsize, series 4, image 50, from 8.5-6.5 mm.  No new nodules demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are unchanged, series 6, image 76, 86, 100, 107, 145, 167, 172, 188,\n200 and 2, 207, 254.  There is 1 new nodule/atelectasis in the left upper\nlobe, series 6, image 82, 5 mm in diameter.  No new consolidations seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest including post granulomatous disease\nchanges, numerous pulmonary nodules that most likely represent metastatic\ndisease but not substantially different since the prior study and 1 new\nnodule/atelectasis in the left apex.  Reassessment in 3 months is required\nfocus is a shin of the left upper cul nodule.\n\nFor abdominal findings please refer to CT abdomen and pelvis and the\ncorresponding report.\n\nInterval additional decrease in size of the right pericardial lymph node."
        },
        {
            "input": "Right pectoral Port-A-Cath.  Mild enlargement of the thyroid.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum or at the level of the hilar structures.  No\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  The upper abdomen, including the\nknown hypodense liver and splenic lesions, is reported in detail in the\ndedicated abdominal CT report.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  There is mild interval growth\nof several of the pre-existing pulmonary nodules, for example in the left\nright upper lobe (4, 81 and 84).  Other nodules, for example in the right\nlower lobe (4, 120) are stable.  No new nodules.  Status post segmentectomy on\nthe right.  No lymphadenopathy.  No pleural effusions.",
            "output": "Interval growth of several of the pre-existing pulmonary nodules. Other\nnodules are stable.  No new nodules.  No pleural effusions.  Stable appearance\nof the segmentectomy site on the right."
        },
        {
            "input": "No incidental thyroid findings.  right pectoral Port-A-Cath.  No enlarged\nlymph nodes in the chest wall.  Normal appearance of the large mediastinal\nvessels.  No incidental pulmonary embolism.  No coronary calcifications, no\nvalvular calcifications, no pericardial effusion.  The posterior mediastinum\nis unremarkable.  Hypodense lesions in the liver and in the spleen are\ndiscussed in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Stable\nmild bilateral apical scarring.  Several of the pre-existing pulmonary\nnodules, for example in the left upper lobe (4, 37, 57, and 77) have slightly\nincreased in size.  A similar increase in size is also noted for several of\nthe larger nodules (4, 103).  The size increase is most obvious for a\nreference lesion in the middle lobe (4, 171).  Some of the millimetric\npulmonary nodules are stable but none of the nodules has decreased in size. \nNo pleural effusions.  No pleural thickening.",
            "output": "Further increase in size of the pre-existing multiple pulmonary nodules.  No\nlymphadenopathy.  No pleural abnormalities."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or supraclavicular\nlymphadenopathy.  A left paratracheal prominent lymph node measures\napproximately 0.8 cm, not significantly changed compared to the prior exam. \nNo new mediastinal lymphadenopathy is identified.\n\nThe heart size is normal.  The pericardium is intact without evidence of an\neffusion.\n\nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.\n\nCalcified punctate nodules within the posterior aspect of the right upper\nlobe, series 6, image 124 appear unchanged compared to the prior exam. \nOverall, there has been interval progression of disease.  For example:\n\n-a right lower lobe 0.6 cm nodule, series 6, image 157 is unchanged compared\nto the prior exam.\n\n-a 0.2 cm right lower lobe nodule, series 6, image 182 is unchanged compared\nto the prior exam.\n\n-a second 0.2 cm right lower lobe nodule, series 6, image 191 appears new\ncompared to the prior exam.\n\n-a 0.4 cm subpleural nodule within the right lower lobe, series 6, image 220\nis unchanged compared to the prior exam.\n\n-a 0.5 cm medial right lower lobe nodule, series 6, image 226, has increased\nin size compared to the prior exam.\n\n-a 0.2 cm nodule within the right lower lobe, series 6, image 250 appears new\ncompared to the prior exam.\n\n-a 0.4 cm nodule within the right lower lobe, series 6, image 284, which\nappears new compared to the prior exam.\n\nAdditional apparent new nodules within the right lung base are incompletely\nevaluated, given the increased motion artifact seen on the prior chest CT.\n\nAdditional nodules within the superior segment of the right lower lobe, have\nincreased in size compared to the prior exam.\n\n-a 0.7 cm nodule within the right upper lobe, has increased in size compared\nto the prior exam, series 6, image 181.\n\n-a left upper lobe nodule, series 6, image 106 has increased in size compared\nto the prior exam measuring 0.7 cm.\n\n-a 0.6 cm left lower lobe nodule, series 6, image 206 has slightly increased\nin size compared to the prior exam at which time this measured no more than\n0.4 cm.  Additional conglomerate of nodules within the left lower lobe have\nincreased in size.\n\nThere is no pleural effusion or pneumothorax.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are seen.",
            "output": "1. Overall, compared to the prior exam from ___, there has been\ninterval progression of metastatic disease with new nodules and increasing\nsize of the pre-existing nodules, as described in detail above."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or hilar lymphadenopathy. \nMildly prominent mediastinal lymph nodes measuring up to 0.8 cm is unchanged\ncompared to the prior exam.  The heart size is normal.  Pericardium is intact\nwithout evidence of an effusion.  The esophagus is normal without evidence of\nwall thickening or a hiatal hernia.\n\nCalcified punctate nodules within the posterior aspect of the right upper lobe\nappear grossly similar to the prior exam.  Overall, there has been no\nsignificant interval change in the burden of disease with the innumerable\nnodules involving both lungs compared to the prior exam.\n\n-a 5 mm x 5 mm nodule within the right lower lobe, series 3, image 111 is\nunchanged compared to the prior exam.\n\n-a 10 mm x 9 mm subpleural nodule within the right middle lobe is unchanged\ncompared to the prior exam, series 3, image 168.\n\n-a left upper lobe nodule, series 3, image 108 measuring 7 mm is unchanged\ncompared to the prior exam.\n\n-a left lower lobe 6 mm nodule, series 3, image 155 is unchanged compared to\nthe prior exam.\n\nRe-demonstrated is biapical scarring.  There is no pleural effusion or\npneumothorax.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "Overall, stable burden of metastatic disease within the lungs bilaterally\ncompared to the exam from ___."
        },
        {
            "input": "NECK, THORACIC INLET, CHEST WALL: The visualized base of the neck, including\nthe thyroid, is unremarkable. The tip of a right chest Port-A-Cath terminates\nin the proximal right atrium.\n\nMEDIASTINUM, HILA, AND AXILLAE: Mildly conspicuous mediastinal lymph nodes\nmeasuring up to 0.8 cm (6:111) at the left lower paratracheal stations do not\nmeet CT size criteria for pathologic enlargement and are unchanged.  No\naxillary or hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  Trace pericardial effusion is\nlikely within normal physiologic limits and is unchanged.  No substantial\ncoronary artery or valvular calcifications.  The thoracic aorta is normal in\ncaliber and course.\n\nPLEURA: Mild biapical pleuroparenchymal scarring is again seen.  No effusion\nor pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  Overall, there has been no significant interval change in the\nburden of disease compared to the prior study nor since ___ with\ninnumerable nodules measuring up to 1.1 cm grossly stable.  Calcified nodules\nwithin the posterior segment of the right upper lobe are grossly unchanged\nsince at least ___.   There are no new focal consolidations.\n\n-AIRWAYS:  The airways are patent to the level of the bilateral segmental\nbronchi.\n-VESSELS:  Although not optimized for the evaluation of pulmonary emboli, the\nvasculature is well opacified to the segmental level without filling defects.\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesions.  No acute\nfracture.\n\nUPPER ABDOMEN: Please refer to the dedicated same day report for findings\nwithin the abdomen and pelvis.",
            "output": "1. Stable overall burden of metastatic disease within the lungs since at least\n___.\n2. Please refer to the dedicated same day report for findings within the\nabdomen and pelvis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There is a right-sided\nPort-A-Cath with its tip in the SVC.  There are no enlarged supraclavicular\nlymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  There is a right-sided Port-A-Cath with its\ntip in the right atrium.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are multiple bilateral pulmonary nodules consistent with known\nmetastases ranging in size from 2 mm to 9 mm.  The largest in the right middle\nlobe (5, 153) measuring 9 mm is unchanged.  No new or growing pulmonary\nnodules.  All the other pulmonary nodules are also unchanged in size and\nmorphology.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhepatic metastasis.  There is a hypodense lesion within the spleen.  Please\nrefer to dedicated report on abdomen which has been dictated separately.",
            "output": "Multiple bilateral pulmonary metastasis unchanged number size and density\nsince the prior study.  No new pulmonary nodules.\n\nHepatic metastasis.\n\nRight-sided porta cath with its tip in the right atrium.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "Stable borderline size of the thyroid.  Stable position of the right pectoral\nPort-A-Cath.  No supraclavicular, infraclavicular or axillary lymphadenopathy.\nNo enlarged lymph nodes in the mediastinum or at the level of the hilar\nstructures.  Stable borderline sized lymph nodes in the aortopulmonary window\n(5, 21).  No evidence of incidental pulmonary embolism.  The appearance of the\nlarge mediastinal vessels is unremarkable.  There is increasing\nlymphadenopathy at the lower aspect of the left hilus (5, 28).  Mild coronary\ncalcifications, no valvular calcifications, no pericardial effusions.  The\nposterior mediastinum is unremarkable.  The known metastatic lesions in the\nliver and the spleen are described in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Moderate degenerative vertebral disease.  No vertebral\ncompression fractures.\nThere is virtually unchanged presence of multiple bilateral metastatic\npulmonary nodules, the size of most nodules is not substantially changed. \nSome of the nodules, notably in the lower lobes (6, 235) have minimally\nincreased in size.  Only 1 lesion located in the middle lobe has substantially\ngrown, from approximately 15 mm to now 25 mm in diameter.  The interface of\nthis lesion with a chest wall suggests invasion (6, 196).",
            "output": "Increase in size of some but not of all pre-existing metastatic pulmonary\nnodules.  No pleural effusions.  Mild progression of left hilar adenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No axillary or supraclavicular adenopathy.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen is notable for ascites,\nretroperitoneal soft tissue deposit, multiple liver masses and hypoattenuating\nsplenic lesion.  Please see same-day CT abdomen and pelvis for detailed\nabdominopelvic findings.\n\nMEDIASTINUM: Extend all lymphadenopathy has slightly progressed in the\ninterim.  A representative 1.1 cm left paratracheal node measured 9 mm in\n___.\n\nHILA: Conspicuous bilateral hilar lymph nodes have not significantly changed\nin the interim.  A representative left hilar node continues to measure 8 mm\n(05:29).\n\nHEART and PERICARDIUM: In size.  The right chest wall Port-A-Cath ends in the\nright atrium.  No pericardial effusion.\nPLEURA: Trace right pleural effusion is new from ___.\nLUNG:\n\n1. PARENCHYMA:  Numerous bilateral metastatic pulmonary nodules are\nre-demonstrated.  Grossly, many many of these nodules have grown in the\ninterim.  A representative 2.9 x 1.9 cm peripheral middle lobe nodule (6:190)\nmeasured 2.4 x 1.8 cm in ___.  A representative 1.1 cm left lower lobe\nnodule previously measured 9 mm in ___ (6:221).\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  The aorta main pulmonary artery are normal in caliber.\nCHEST CAGE: No aggressive osseous lesions or acute fractures.",
            "output": "1. Numerous bilateral pulmonary nodules in keeping with known pulmonary\nmetastatic disease, many of which have slightly grown since ___.\n2. Mediastinal adenopathy has slightly progressed since ___. The stable bilateral hilar prominent lymph nodes.\n4. New trace right pleural effusion.\n5. No thoracic osseous lesions.\n6. Ascites, retroperitoneal soft tissue deposits, multiple liver masses and a\nhypoattenuating splenic lesion are partially assessed.  Please see same-day CT\nabdomen and pelvis for detailed abdominopelvic findings.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:57 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Borderline size of the thyroid.  Stable right pectoral Port-A-Cath. Stable\nappearance of the large mediastinal vessels, no incidental pulmonary embolism.\nMild increase in size of the pre and paratracheal lymph nodes (2, 20).  The\namount of hilar lymphatic tissue is not substantially changed.  Stable\nappearance of the cardiac structures.  No pericardial effusion.  Upper\nabdominal findings, including the large hypodense liver lesion as well as the\nsplenomegaly and the ascites are described in detail in the dedicated\nabdominal CT report.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  The pre-existing pulmonary nodules have slightly\nincreased in size.  A reference lesion in the left upper lobe, previously 8\nmm, is now 9.5 mm.  Several miniscule peripheral nodules might be new.  The in\ncapsulated known right pleural effusion, combines to areas of pleural\nthickening, has slightly decreased, but individual pockets are bigger than on\nthe previous examination (4, 115).",
            "output": "Mild progression with increase in number and size of the pre-existing\npulmonary nodules.  Increase in mediastinal lymphadenopathy.  Hilar\nlymphadenopathy is stable.  Minimal decrease in extent of the loculated right\npleural effusion."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged. \nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities in the remainder of the imaged chest\nwall suspicious for malignancy.  Findings below the diaphragm will be reported\nseparately.\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Thyroid is heterogeneous but\nthere are no findings large enough to require further imaging evaluation. \nAtherosclerotic calcification is not apparent head and neck vessels or\ncoronary arteries.  Aorta, pulmonary arteries, and cardiac chambers are normal\nsize.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: Hilar contours do not suggest adenopathy.  Elsewhere\nthere are no enlarged lymph nodes in the chest planning size criteria.\n\n\nLUNGS, AIRWAYS, PLEURAE: Punctate nodule, left upper lobe, 4:113 isolated to a\nregion of saccular bronchiectasis, anteromedial basal segment left lower lobe,\nwith mild peripheral impaction, 4:194, are the only focal abnormalities in\nlungs or airways.\n\nNo pleural abnormality.\n\n\nCHEST CAGE: Unremarkable",
            "output": "No evidence of intrathoracic malignancy.\n\nSolitary region of tubular bronchiectasis, left lower lobe, activity\nindeterminate."
        },
        {
            "input": "Previous adenopathy has involuted in all stations, including the\nsupraclavicular and thoracic inlet, axillary, mediastinal, hilar, internal\nmammary, and retrocrural. Previous right pleural effusion has resolved. \nAsbestos related pleural plaques are largely calcified. All other pleural\nsurfaces are thin and smooth, except for moderate thickening of the anterior\nright diaphragmatic pleural surface, 10 mm at the thickest point, 09:28.\nPericardium is normal.\n\nThyroid is unremarkable. Elongation of the trachea, with mild side-to-side\nnarrowing is mild, unchanged, usually due to chronic lung disease. Aorta and\npulmonary arteries are normal caliber. Aortic valvular calcification is\nmoderate to severe. Atherosclerotic calcification is scattered in the main\ncoronary arteries. Heart size is normal.\n\nLungs are clear.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection. On",
            "output": "Complete involution of previously extensive peripheral and central adenopathy,\nsince ___.\n\nAlthough previous right pleural effusion is resolved, there is new thickening\nof the right diaphragmatic pleural surface, which should be followed.\n\nProbable calcific aortic stenosis. coronary atherosclerosis.\n\nLungs are clear.\n\nAsbestos related pleural plaques, some calcified. No evidence of asbestosis or\nbronchogenic carcinoma."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is top-normal with no pericardial effusion.  Extensive aortic\nvalvular calcifications are present.  There is stable dilatation of the main\npulmonary artery to 3.5 cm. No incidental central pulmonary embolus is\nidentified.  The thoracic aorta is normal caliber.\n\nBilateral partially calcified pleural plaques are consistent with prior\nasbestos exposure. Solid pulmonary nodules measuring up to 3 mm in the left\nupper lobe are stable since ___ (05: 36, 24). No new nodules are\nidentified. No endobronchial lesion is identified. Previously described\nright-sided pleural thickening is actually just variation in diaphragmatic\nthickness.\n\nThere is stable chronic mild circumferential wall thickening involving the mid\nto lower esophagus. For a detailed discussion of the upper abdomen, please\nrefer to the separate report from the CT abdomen/pelvis performed\nconcurrently.\n\nMild predominantly lower thoracic spine degenerative changes are stable.  No\nlytic or sclerotic bone lesions are identified.",
            "output": "No evidence of intrathoracic recurrence.\n\nSolid pulmonary micronodules are stable since ___. No new nodules\nidentified.\n\nStable dilatation of the main pulmonary artery suggests pulmonary arterial\nhypertension.\n\nModerate aortic valvular calcifications.\n\nBilateral pleural plaques suggest prior asbestos exposure.\n\nStable mild circumferential mid to lower esophageal wall thickening may be due\nto chronic infectious or inflammatory esophagitis. Endoscopic correlation is\nsuggested if clinically warranted.\n\nRECOMMENDATION(S):  Endoscopic evaluation of mild mid to lower esophageal\ncircumferential wall thickening if clinically warranted."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There is no soft\ntissue abnormality in the chest wall suspicious for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels or coronary arteries.  Aortic valvular calcification is moderate,\nsufficient to be hemodynamically significant.\n\nBorderline enlargement pulmonary arteries is unchanged.  Small pericardial\neffusion is unchanged.  There is no pleural effusion.  A small number of\nasbestos related pleural plaques, some calcified, are unchanged.\n\nCentral lymph nodes are not enlarged.  Diffuse wall thickening lower esophagus\nand mild distention of the esophagus above that level are unchanged.\n\nSeveral long-term tiny lung nodules are stable, the largest, 4 mm in the left\nlower lobe, 4:193.  There are no new or growing lung nodules or pulmonary\nfindings of concern.  Tracheobronchial tree is normal to subsegmental levels.\n\n,",
            "output": "Persistent diffuse esophageal wall thickening, presumably inflammatory.  No\nstricture.  Suggest clinical correlation with symptomatology to see if\nesophagoscopy is indicated for diagnosis.\n\nHeavy aortic valvular calcification.\n\nSmall number of tiny lung\n\nNodules, long-term stable.  No new lesions.  No followup indicated for these\nlesions.\n\nAsbestos related pleural plaques.\n\nRECOMMENDATION(S):  Assessment of possible aortic stenosis.\n\n If the patient is ___ years old, has a smoking history of greater than 30\npack-years and has smoked within the past ___ years, the patient meets criteria\nfor annual lung cancer screening with low-dose chest CT, now available at this\nhospital.  Study can be ordered on POE or OMR ."
        },
        {
            "input": "BASE OF NECK: The visualized portion of the thyroid is unremarkable.  No\nsupraclavicular lymphadenopathy is visualized.\n\nHEART AND VASCULATURE:  The thoracic aorta contains mild atherosclerotic\ncalcifications though is normal in caliber.  A left pectoral pacemaker is\nre-demonstrated with the leads terminating in the right atrium and right\nventricle.  Aortic valvular calcifications are re-demonstrated and unchanged. \nOtherwise the heart, pericardium, and great vessels are within normal limits\nbased on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  There is diffuse wall thickening\nof the lower esophagus, unchanged from prior.\n\nPLEURAL SPACES: Multiple bilateral pleural plaques are re-demonstrated, some\nof which are calcified, all of which remain unchanged.  No pleural effusion or\npneumothorax.\n\nLUNGS/AIRWAYS: Motion limits assessment of the lung apices.  Multiple micro\nnodules are re-demonstrated with a 4 mm left lower lobe pulmonary nodule\nvisualized measuring 4 mm (6:232), unchanged from prior.  No focal\nconsolidations are identified.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nFor characterization of findings below the diaphragm please see same day CT\nabdomen pelvis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of intrathoracic lymphoma identified.\n2. Stable left lower lobe pulmonary nodule dating back to at least ___.\n3. Unchanged pleural plaques.\n4. Stable appearance of diffuse lower esophageal wall thickening without focal\nmasses or strictures identified."
        },
        {
            "input": "CHEST PERIMETER: Upper limit of imaging is sternal notch, not including the\nthyroid and the full thoracic outlet; lower limit is spleen, excluding the\nleft lower posterior pleural sulcus.  No abnormalities in the chest wall. \nThis study is not appropriate for subdiaphragmatic diagnosis.\n\nCARDIO-MEDIASTINUM: Esophagus is un remarkable.  Aorta and are gin of the\ngreat vessels are normal.  Pericardium is physiologic.\n\nPULMONARY ARTERIES:\nRespiratory motion obscures vascular and other anatomic detail.  There are no\ncentral pulmonary emboli to the lobar level.  More distally, no definite\npulmonary emboli, but tiny filling defects could be obscured.\n\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the imaged chest are pathologically\nenlarged.\n\n\nLUNGS, AIRWAYS, PLEURAE: Heterogeneous opacification at the lung bases is\nprobably due to micro atelectasis from under inflation.  Tracheobronchial tree\nis normal to subsegmental levels.  There is no pleural abnormality.\n\nCHEST CAGE: Imaged chest cage is unremarkable",
            "output": "Technically compromised study.  No definite pulmonary emboli."
        },
        {
            "input": "The right thyroid lobe is either absent or small.  The left lobe is within\nnormal limits.  A prominent subcarinal lymph node measures 13 mm in short axis\n(02:23).  Several additional prominent diaphragmatic lymph nodes measure 8 mm\nand 11 mm in short axis, respectively (2:38, 43).  There are no pathologically\nenlarged supraclavicular, axillary, or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Lung windows demonstrate linear atelectasis at the\nleft lung base due to left hemidiaphragm elevation in the setting of\nsplenomegaly.\n\nNo suspicious osseous lesions are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrate a small hiatal hernia, massive splenomegaly, and probable\nmesenteric lymphadenopathy..",
            "output": "1.  No evidence for acute intrathoracic process.  Specifically, left basilar\natelectasis, likely due to left hemidiaphragm elevation in the setting of\nsplenomegaly. No evidence for pneumonia.\n2.  Prominent diaphragmatic, left internal mammary, and mediastinal lymph\nnodes, which may relate to the patient's provided diagnosis of underlying\nleukemia.\n3.  Splenomegaly, small hiatal hernia, and probable mesenteric lymphadenopathy\nwhich is incompletely visualized."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nNo incidental thyroid Findings.  No enlarged lymph nodes either in the axilla\nor thoracic inlet.  No atherosclerotic calcifications in the head and neck\narteries.  No chest wall abnormalities.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small lymph nodes, none enlarged by CT size\ncriteria.  No hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nSevere cardiomegaly.  Post double CABG surgery changes.  No cardiac valves or\naortic calcifications.  Aorta is normal in caliber throughout.  The main\npulmonary artery is top limits of normal.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to subsegmental level.  Lungs are well expanded and\nclear, however, the motion artifact limits parenchymal evaluation.  Right\nmoderate dependent pleural effusion.\n\nCHEST CAGE:\nExtensive fluid collection along the anterior sternum measuring 15 x 3 cm\n(6:115) with adjacent edema probably related to postprocedural inflammation. \nThere is no retrosternal collection.  No acute fractures.  Moderate dorsal\nspondylosis.  No lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormality.",
            "output": "Extensive 15 x 3 cm collection along the anterior surface of the sternum.  No\nretrosternal collection.\nStatus post double CABG.\nModerate right pleural effusion."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bilateral dependent atelectasis. No focal\nconsolidation to suggest pneumonia.  Left upper lobe scarring.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Again demonstrated are innumerable hypoattenuating lesions\nthroughout the liver with necrotic centers measuring up to 7.7 cm in the left\nlobe and 7.3 cm in the right lobe, overall similar to ___.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic without focal lesion or pancreatic ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The small and large bowel\nloops demonstrate no obstruction.  The colon and rectum are within normal\nlimits.  The appendix is not visualized.  There is no free intraperitoneal\nfluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.  The 3.5 cm presacral soft tissue mass is grossly stable\nin size compared to ___\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.  Again seen is\nreflux of contrast material into the left gonadal vein with prominent\nparauterine veins, unchanged compared to prior..\n\nLYMPH NODES: Upper abdominal lymphadenopathy measuring up to 1.4 cm current\nseries 2, image 123) is unchanged.  No mesenteric lymphadenopathy.  There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No pulmonary embolism or acute aortic abnormalities.\n2.  Unchanged innumerable hepatic metastatic disease and abdominal\nlymphadenopathy.  Grossly stable 3.5 cm presacral mass."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is top-normal.  Trace pericardial fluid is\nwithin physiologic limits.  No significant coronary calcification.  Thoracic\naorta is normal in caliber.  No significant aortic or great vessel origin\ncalcification.  The main pulmonary artery is normal in caliber.  No central\npulmonary embolus.  A right IJ Port-A-Cath tip is located at the superior\ncavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a prominent epipericardial lymph node\nmeasuring 9 mm in short axis near the midline, but with a fatty hilum\nsuggestive of benignity (series 4, image 39).  No axillary, mediastinal, or\nhilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Left apical scarring. Multiple punctate micro nodules, some a\nsubpleural and perifissural (series 5, images 46, 49, 57, 69, 124, 138, 163,\n172).  No suspicious pulmonary nodules.  No focal consolidation.  The airways\nare patent to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Multiple hepatic lesions and enlarged periportal/porta hepatic lymph\nnodes compatible with metastasis.  Please refer to separate report for\nsame-day CT abdomen/pelvis for description of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of intrathoracic metastasis.\n2. Hepatic and perihepatic metastases which will be further detailed in the\ndedicated abdomen/pelvis CT."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: Patent airways.  There is interlobular septal\nthickening bilateral lungs, consistent with component of mild interstitial\nedema.  There is rounded area of subpleural consolidation in the right lower\nlobe associated with volume loss, most consistent with rounded atelectasis. \nThere is atelectasis and moderate volume loss in the left lower lobe.  Mild\nbronchial wall thickening, likely from edema.\nVessels: Normal size main pulmonary artery, aorta.\n\nMediastinum and Hila: No adenopathy.\n\nHeart and Pericardium: Borderline heart size.  There is small pericardial\neffusion.  Minimal Coronary artery calcifications.\n\nPleura: There is single right chest tube, terminating in the right apex. \nThere 2 left pleural catheters, 1 terminates in the lateral mid chest, second\npigtail in the posterior, lower left chest.  There is moderate, predominant\nfree-flowing right pleural effusion.  There is partially loculated, left\npleural effusion, including fluid insinuating along major fissure.  There is\nmild volume of pleural air at the lower left chest.  There is mild pleural\nthickening bilaterally, more prominent on the left, may be reactive for of\npleural catheters there are in place, versus infection, inflammation.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: Right Port-A-Cath tip in the low\nSVC.  No mass, no adenopathy.  Normal thyroid gland.\n\nUpper Abdomen: There is small volume upper abdominal ascites.  Left internal\nureteral stent is in place.  There is benign simple cyst in the left kidney. \nIndeterminate 1.3 cm exophytic lesion arising from the lower pole left kidney,\nultrasound exam recommended.  Probable calcified lymph nodes in the upper\nabdomen.  Residual contrast in the colon.\n\nChest Cage: There are degenerative changes spine.  No worrisome lesions",
            "output": "There is moderate largely free-flowing right pleural effusion. There is\npartially loculated mild left pleural effusion containing air within the lower\nchest, likely related to pleural catheter use.  Mild pleural thickening\nbilaterally, may be reactive, consider infection.\nBibasilar atelectasis with volume loss in the lower lobes.\nMild pulmonary edema.\nIndeterminate 1.3 cm lesion left kidney, ultrasound recommended in further\nevaluation.\n\nRECOMMENDATION(S):  Renal ultrasound"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart and great vessels are within normal limits. \nRight internal jugular venous catheter terminates in right atrium. \nPericardial effusion is small.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.4\n\nPLEURAL SPACES:  Large bilateral pleural effusions, right larger than left\nappear mildly increased in size compared to ___.  Left pleural space\nappears loculated and contains more fluid and less air compared to before. \nBilateral chest tubes are present.  Mild pleural enhancement and thickening is\nagain noted, greater on the left.\n\n\nLUNGS/AIRWAYS:  Substantial atelectasis of bilateral lower lobes are similar\nto before.  There is interstitial septal thickening, predominantly in the\nupper lung zones.  There is increased ground-glass opacity involving the right\nupper lung and left upper lung lingula, likely increased pulmonary edema. \nThere is narrowing of the subsegmental airways in bilateral lower lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for small ascites. \nThere are calcified lymph nodes about the pancreas.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSmall amount of subcutaneous air is noted along the left lateral chest wall\nand axilla.  Axillary subcutaneous air is new but likely tracks along the left\nchest wall.  Subcutaneous tissue edema is noted along the right chest wall.  7\nmm left anterior chest wall subcutaneous cyst or nodule (2:32) is stable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild increase in size of bilateral pleural effusions.  The left pleural\neffusion demonstrates mild interval decrease in the amount of air and increase\nin the amount fluid present.  Mild bilateral pleural enhancement and\nthickening as before.  Bilateral chest tubes are present.\n3. Pulmonary edema is increased compared to ___."
        },
        {
            "input": "HEART AND VASCULATURE: There is a filling defect involving subsegmental\npulmonary arteries of the right lower lobe (series 3:162) and left lower lobe\n(series 3:183 and 176).  Possible filling defect in a subsegmental lingular\nartery (series 3:132) versus artifact.  No flattening of the interventricular\nseptum to suggest right heart strain.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a 2.4 x 1.6 cm low\nattenuating lesion in the posterior mediastinum the inferior border of the\nheart, possibly representing a pericardial cyst (series 3:191).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Mild biapical pleuroparenchymal scarring.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Bilateral subsegmental pulmonary emboli involving the lower lobes and\npossibly the lingula.  No CT evidence of right heart strain.\n2. 2.4 cm low attenuating lesion in the posterior mediastinum adjacent to the\ninferior heart border.  While this may represent a pericardial cyst, the\nlocation is somewhat atypical.  Follow-up with nonurgent MRI can be considered\nto further characterize."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nPreviously noted bilateral lower lobe and lingular subsegmental pulmonary\nemboli have resolved.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  There is redemonstration of a 1.9 x 1.5 cm\nhomogeneous hypodense lesion in the posterior mediastinum (series 301, image\n172), decreased in size and appearance compared to prior exam dated ___, possibly representing a small pericardial cyst.\n\nPLEURAL SPACES: Mild biapical pleural scarring.  No pleural effusion or\npneumothorax.\n\nLUNGS/AIRWAYS: There is a 5 mm triangular pulmonary nodule along the fissure\nin the left lower lobe (series 3, image 51), which is unchanged compared to\nprior.  Otherwise, the lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for hepatic\nsteatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute thoracic aortic abnormality.\n2. Redemonstration of a 1.9 x 1.5 cm posterior mediastinal hypodense lesion,\nwhich may represent a pericardial cyst, decreased in size compared to prior\nexam dated ___.\n3. Hepatic steatosis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis.  Otherwise, lungs are clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nMISCELLANEOUS: Again seen are surgical clips in the left breast and axilla,\ncompatible with postoperative changes.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. No findings to explain patient's symptoms."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart and pericardium are within normal limits.  The\npulmonary artery is mildly dilated measuring 3.3 cm, which may be seen in\nsetting of pulmonary arterial hypertension.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Surgical clips are seen in the left axilla from\nprior lymph node dissection.  There are multiple enlarged heterogeneous left\naxillary lymph nodes, largest measuring 2.1 cm (02:19, 02:23, 02:22).  No\nmediastinal or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a heterogeneous, ill-defined mass at the left neck base\nencasing the subclavian vessels measuring 4.8 x 2.8 x 2.0 cm (2:10 and 602:50)\ncausing focal narrowing of the left subclavian artery (02:13) and destruction\nof the left first rib (02:17).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is no acute fracture.\n\n\nCHEST WALL: Postsurgical changes are seen in the left breast. A 6 mm left\nintramammary lymph node is again seen, unchanged from prior study dated\n___.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Heterogeneous, ill-defined mass at the left neck base encasing the\nsubclavian vessels measuring up to 4.8 cm with destruction of the left first\nrib, concerning for malignancy/disease recurrence.\n3. Multiple pathologically enlarged left axillary lymph nodes measuring up to\n2.1 cm also highly concerning for disease recurrence.  Recommend direct tissue\nsampling for further assessment.\n4. Mild dilation of the pulmonary artery measuring 3.3 cm, which can be seen\nin the setting of pulmonary arterial hypertension."
        },
        {
            "input": "No incidental thyroid findings.  The masslike lesion in the left chest wall,\nat the level of the thoracic inlet (2, 10) has decreased in size, and is now\napproximately 30 mm in largest diameter, as opposed to 48 mm on the previous\nexamination.  The size of the previously enlarged axillary lymph nodes has\ndecreased, the largest axillary lymph node is now 11 mm in diameter (2, 15). \nClips are visualized in the left axilla and in the left breast.  There is no\nevidence of enlarged mediastinal lymph nodes.  The largest mediastinal lymph\nnode is borderline in size (302, 68).   The vascular structures are intact. \nNo coronary calcifications, no pericardial effusion.  Slight cardiomegaly. \nThe posterior mediastinum is unremarkable.  No abnormalities are seen at the\nlevel of the upper abdomen.  No osteolytic lesions at the level of the ribs,\nthe sternum, or the vertebral bodies.  Mild degenerative vertebral disease. \nNo vertebral compression fractures.  Stable mild bilateral apical thickening. \nModerate respiratory motion.  No suspicious pulmonary nodules or masses.  No\npleural effusions.  The airways are patent.",
            "output": "Decrease in size of the left thoracic inlet mass.  Decrease in size of the\nleft axillary lymph nodes.  No hilar or mediastinal lymphadenopathy.  No\nsuspicious pulmonary nodules or masses."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  The left anterior chest wall soft tissue mass is\nmoderately decreased in size in the interval measuring 21 x 14 mm (4:23),\npreviously was 27 x 15 mm (remeasured).  A previously described enlarged left\naxillary lymph node has resolved.  Stable appearance of left axillary\nlymphadenectomy and breast lumpectomy surgical clips.  Right Port-A-Cath\nterminates in the right atrium.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  New and enlarging central lymph nodes ranging up\nto 12 mm in the prevascular station and to 10 mm in the right lower\nparatracheal station (4:54, 70).  Stable right hilar 8 mm lymph node (4:91).\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  Aorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels without bronchial wall\nthickening, bronchiectasis or mucus plugging.  New areas of consolidation in\nthe left upper lobe (4: 58, 45).  The remaining lung parenchyma shows no\nnodules or masses.  Mild biapical pleuroparenchymal scarring.  No pleural\neffusion or thickening.\n\nCHEST CAGE:\nInvolvement of the first left rib by the aforementioned left upper chest wall\nsoft tissue lesion appears today more sclerotic and showing a new irregular\ntrace of fracture (4:36).  Minimal dorsal spondylosis.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show interval development of a 62 mm\nheterogeneously enhancing lesion in the hepatic segment VII concerning for\nmetastatic involvement (2:48).  No focal splenic lesions.  Adrenals are\nunremarkable.",
            "output": "Interval size decrease of the left upper chest wall soft tissue mass and\ncomplete resolution of the left axillary lymphadenopathy.  Involvement of the\nleft first rib appears today more sclerotic and with a new irregular trace of\nfracture.\n\nNew areas of consolidation in the left upper lobe most likely reflect\norganizing pneumonia secondary to radiation therapy.\n\nNew and enlarging central mediastinal lymph nodes up to 12 mm in the\nprevascular station.\n\nNew 62 mm heterogeneously enhancing mass in the hepatic segment VII is\nconcerning for metastatic disease.  Further assessment with dedicated imaging\nis recommended to confirm this possibility.\n\nRight Port-A-Cath ends in the right atrium"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Soft tissue\nstranding in the left axilla region of vascular clips and overlying skin\nthickening are stable.  Breast evaluation is reserved exclusively for breast\nimaging.  No soft tissue abnormalities elsewhere in the chest wall.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent head neck vessels or the coronary arteries.  Aorta and pulmonary\narteries normal size.  Pericardium is physiologic.  Central venous infusion\ncatheter ends low in the right atrium, with no associated thrombosis.\n\nTHORACIC LYMPH NODES:\n\nLeft upper paratracheal mediastinal, 13 x 20 mm, 5:10, previously 11 x 17 mm.\n\nRight upper paratracheal mediastinum, 10 mm, previously 8 mm.  No lymph nodes\nelsewhere in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Volume of multifocal post radiation pneumonitis, left\nupper lobe, has increased, 6:48-89.  Left lower lobe is\n\nRight lung and left lower lobe are clear.\n\nThere is new mild pleural thickening, adjacent to radiated left first rib, 6:\n35-46.  This could be reactive.  Pleural thickening adjacent to radiation\nfibrosis left upper lobe is stable.  No pleural effusion or other pleural\nabnormality.\n\nCHEST CAGE: Sclerosis and linear fracture left first rib not appreciably\nchanged.  Although there are no other bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Stable post treatment appearance pathologic fracture radiated left first rib. \nMinimal associated pleural thickening could be reactive.  No evidence for\nlocal progression of malignancy, including stable appearance of the left\naxilla free of obvious mass.\n\nSlight interval enlargement upper paratracheal mediastinal lymph nodes is the\nonly evidence of possible metastasis, but could be reactive.\n\nIncreasing post radiation organizing pneumonia, left upper lobe."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Right-sided Port-A-Cath tip\nprojects to the SVC.  The\nBREAST AND AXILLA  : There are postsurgical changes in the left breast.  There\nare no enlarged left axillary lymph nodes\n\nMEDIASTINUM: The mediastinal lymph nodes have slightly increased in size since\nthe prior study.  The right paratracheal lymph node measures 14 x 14 mm it\npreviously measured 10 x 10 mm.  The soft tissue in the left upper\nparatracheal region is also slightly more prominent than on the prior study. \nThere are no enlarged hilar lymph nodes.  Heart size is normal.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber.\nThere is a right-sided Port-A-Cath with its tip in the cavoatrial junction.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Parenchymal opacity peripherally in the left upper lobe is slightly more\nprominent and most likely represents post radiation therapy changes.  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a large\nhypodense mass in the dome of liver measuring approximately 7.6 x 8.5 cm.",
            "output": "Mild increase in size of the mediastinal lymph nodes.\n\nPost surgical and post radiation changes to the left breast.\n\nParenchymal opacity in the left upper lobe most likely represents post\nradiation therapy changes.\n\nLarge mass in the right lobe of liver.  Please refer to dedicated report on\nabdomen which has been dictated separately"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged ranging in diameter\nup to 6 mm in the right axilla.\n\nNo soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead neck or coronary arteries.  Aorta and central pulmonary arteries are\nnormal size, although the images are degraded by pulsatile motion, and free of\nlarge filling defects.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged ranging up\nto 8 mm in the left lower paratracheal station, 10:32, and a 5 mm prevascular\ndiaphragmatic node, 10:66.  There is no pleural or pericardial effusion.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Normal CT of the chest.  No evidence of intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized portion of the\nthyroid gland is without discrete nodule.  There is no axillary or\nsupraclavicular adenopathy.\n\nUPPER ABDOMEN: The liver demonstrates nodular contour with hypertrophy of the\nleft hepatic lobe consistent with cirrhotic morphology.  Perigastric varices\nare noted.  Small volume ascites.  Splenomegaly with the spleen measuring 16.1\ncm small hiatal hernia.\n\nMEDIASTINUM: No pathologically enlarged mediastinal lymph nodes.  The\nesophagus is patulous with an air-fluid level.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is evidence of prior left\nventricular infarct.  There is trace pericardial fluid.  Severe coronary\nartery calcifications are noted.  Hyper dense appearance of the\nintraventricular septum relative to the blood flow is suggestive of anemia.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild air trapping in the left lower lobe.  No\nevidence of interstitial lung disease.  In the left lower lobe there are small\nperibronchial nodules with surrounding ground-glass opacification concerning\nfor infection or aspiration.  Septal thickening at the lung bases, left\ngreater than right is suggestive of mild interstitial edema.\n2. AIRWAYS:  The central airways are patent.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are normal caliber.\n\nCHEST CAGE: Multilevel degenerative changes in the thoracic spine are noted\nwith bridging anterior osteophytes.",
            "output": "1. No interstitial lung disease.\n2. Peribronchial nodularity with surrounding ground-glass opacification in\nleft lower lobe concerning for infection or aspiration.\n3. Septal thickening at the lung bases, left greater than right, suggestive of\nmild interstitial edema.\n4. Cirrhotic liver with sequelae of portal hypertension including splenomegaly\nand small volume ascites."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality will be\nreviewed separately is part of the CT abdomen pelvis in corresponding report\nwill be issued\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules masses or consolidations to suggest malignant process demonstrated. \nMinimal bibasal atelectasis present.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nhomogeneous.  No axillary lymphadenopathy is seen.\n\nUPPER ABDOMEN: Please refer to dedicated the abdomen and pelvis CT performed\nconcurrently today.\n\nMediastinum/hila: No mediastinal or hilar adenopathy is seen.  Patient is\nstatus post esophagectomy and gastric pull-through with oral contrast seen in\nthe esophageal conduit to the level of the upper chest, which may have been\nrefluxed or recently swallowed/hung up.\n\nHEART and PERICARDIUM: Some coronary artery calcifications are seen.  There\nmay be very trace pericardial fluid.  No pleural effusion is seen.\nPLEURA: No pleural effusion or pneumothorax is seen.\nLUNG:\n\n1. Mild lingular, medial inferior right upper lobe, and right lower lobe\natelectasis is seen.  No focal consolidation or worrisome pulmonary nodules\nidentified.\nCHEST CAGE: No concerning osteoblastic or lytic lesion is seen.",
            "output": "Status post esophagectomy and gastric pull-through.  No evidence of metastatic\ndisease in the chest.\n\nPlease review CT abdomen and pelvis findings in the corresponding report will\nbe issued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  There is no supraclavicular lymphadenopathy.  No axillary\nlymphadenopathy.  Right chest wall Port-A-Cath device is noted\n\nUPPER ABDOMEN: Limited view of the upper abdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  Status post esophagectomy with\ngastric pull-through procedure.  There is an unchanged and unremarkable\nappearance of the gastric pull-through.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is of normal size.  There are mild coronary\nartery calcifications.  There are mild aortic valvular calcifications.  No\npericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild apical predominant centrilobular emphysema.  Few\ncalcified granulomas are noted.  3 mm right lower lobe nodule (5:161) is\nunchanged.  Left lower lobe micronodule is unchanged (5:133).  Perifissural\nleft upper lobe micronodule is also unchanged (5:87).  Right lower lobe\nmicronodule is unchanged (5:210).  No new or growing pulmonary nodules.\n2. AIRWAYS:  Airways are patent subsegmental levels bilaterally.\n3. VESSELS:  Thoracic aorta is of normal caliber.  There are minimal\natherosclerotic calcifications of the aortic arch.  Main pulmonary artery is\nof normal caliber.  No large central pulmonary embolism on this non tailored\nexam.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "Status post esophagectomy with gastric pull-through.  No evidence of\nintrathoracic metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild\natherosclerotic calcification along the aortic arch and descending thoracic\naorta.  The heart, pericardium, and great vessels are within normal limits\nbased on an unenhanced scan.  Mild coronary artery calcifications.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  Redemonstration of a cystic structure within the anterior\nmediastinum measuring 2.9 x 1.4 cm (02:33), similar in appearance to prior CTA\nchest from ___ and previously aspirated.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patient is status post right lower lobectomy and right middle\nlobe segmentectomy with stable appearance of postoperative changes.  Mild\ninterstitial thickening, most prominent at the lung apices and similar in\nappearance to prior study.  Few pulmonary nodules are stable, with the largest\nin the right lower lobe measuring 6 mm (4:129), unchanged since ___. \nThe airways are patent to the level of the segmental bronchi bilaterally. \nAirway thickening is compatible with small airway disease.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nModerate hiatal hernia is noted.  Mild thickening of the left adrenal gland. \nFew simple appearing bilateral renal cysts, with the largest in the right\ninterpolar region measuring 3.9 cm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nModerate to severe degenerative change of the thoracolumbar spine, including\nanterior osteophytosis and multilevel disc space narrowing.",
            "output": "1. No evidence of fracture or acute intrathoracic injury.\n2. Multiple stable chronic changes, including postsurgical changes in the\nright lower lung, mild interstitial thickening, and few pulmonary nodules with\nthe largest measuring 6 mm in the right lower lobe, unchanged since ___.\n3. Moderate hiatal hernia.\n4. Redemonstration of a previously aspirated cystic structure within the\nanterior mediastinum measuring 2.9 x 1.4 cm (02:33), similar in appearance to\nprior CTA chest from ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nAgain noted is the diffuse enlargement of the thyroid gland.  Minimal\ncalcifications both proximal subclavian arteries.  Small axillary and thoracic\ninlet nodules are stable in appearance.  Moderate gynecomastia is unchanged.\n\nMEDIASTINUM AND HILA:\nAgain noted is the patulous air-containing esophagus probably secondary to\ndysmotility disorder.  A right upper paratracheal enlarged lymph node is now\nmeasuring 11 mm, before was 16 mm (03:55).  A previously-seen prevascular\nenlarged lymph node has resolved.  The remaining small mediastinal lymph nodes\nare either stable or decreased in size as well.  No new or growing lymph node\nin the mediastinum or hila.  Right hilar enlarged lymph node is now measuring\n12 mm, previous was 15 mm (3:96).\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Again noted\nis the apical myocardial linear hypodensity reflecting old myocardial\ninfraction.  Moderate atherosclerotic calcifications in the arteries.  None in\nthe cardiac valves.  Aorta and pulmonary artery are normal in caliber\nthroughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to subsegmental level.  No pleural effusion.\nModerate overall improvement of the widespread metastatic disease given by the\ndecrease in size of many of the metastatic lesions, for example the 1 in the\nmiddle lobe and a perifissural location if now measuring 5 mm, previously was\n16 mm (3:152), another 1 in left upper lobe, also in perifissural location now\nmeasuring 11 mm was 24 mm on the previous study (3:69)\n\nCHEST CAGE:\nWidespread blastic chest cage metastatic disease are stable in appearance with\nno acute fractures.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "1.  The substantial improvement of the multiple parenchymal metastatic lesions\nsince ___.  No new or growing nodule.\n2.  moderate improvement of the mediastinal lymphadenopathy, no interim new or\nenlarging lymph nodes in the mediastinum or hila.\n3.  Redemonstration of the widespread blastic metastatic disease throughout\nthe chest cage.\n4.   Patulous air-containing esophagus concerning for dysmotility disorder.\n5.  apical myocardial linear hypodensity reflecting old myocardial infarct,\nunchanged"
        },
        {
            "input": "Severe diffuse enlargement of the thyroid, with multiple bilateral thyroid\nnodules (4, 7).  No enlarged lymph nodes in the chest wall.  Several\nmediastinal lymph nodes (4, 14) are moderately to severely enlarged.  There\nalso is hilar lymph node enlargement.  Substantial bilateral gynecomastia, new\nsince the previous examination.  Mild coronary calcifications, mild\ncardiomegaly.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  There is massive mixed sclerotic and lytic diffuse\nmetastatic bone disease.  Mild bilateral apical scarring.  Innumerable partly\nill-defined metastatic pulmonary nodules in all lobes.  The largest nodules\nmeasure up to 2 cm.  No evidence of pleural effusion.  The airways are patent.",
            "output": "Interval development of diffuse metastatic lung disease, associated to\nextensive lymphadenopathy and diffuse metastatic bone disease.  Diffusely\nenlarged multinodular thyroid."
        },
        {
            "input": "CHEST PERIMETER: Diffuse relatively symmetric enlargement of the thyroid gland\nhas increased slightly with mild coronal narrowing of the subglottic trachea,d\ndiameters 15 x 29 mm today, previously 20 x 26 mm in ___.  There is\nno supraclavicular or axillary adenopathy, however a 16 x 18 mm cluster of\nthoracic outlet lymph nodes, as well as other central nodes described below,\nare stable.\n\nModerate gynecomastia is symmetric slightly smaller today than in ___.\n\nNo other soft tissue abnormalities in the chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is moderately to severely patulous, containing\nair throughout.  This is more likely functional than obstructive.  Full\nesophagram should be considered to supplement swallowing study performed in\n___.\n\nAorta and main pulmonary artery are normal size.  Right pulmonary artery is\ndilated, 31 mm, previously 35 mm.  Cardiac chambers are normal size and\npericardium is physiologic.\n\nAtherosclerotic calcification is mild in the head and neck vessels, present in\nall major coronary segments.\n\nTHORACIC LYMPH NODES: As follows:\n\nRight upper paratracheal mediastinum, 16 mm, 5:83, unchanged.\n\nPrevascular mediastinum, 11 mm, previously 14 mm.\n\nUpper pole, right hilum, 15 mm, previously 20 mm.  No lymph nodes elsewhere\nare enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Most of the widespread hematogenous nodule and\nlymphangitic carcinomatosis scattered through the lungs is stable,, for\nexample 15 x 17 mm spiculated left upper lobe mass, 05:42, but some has\nprogressed, for example the perivascular infiltration in the superior segment\nright lower lobe, 5:137-148.\n\nTracheobronchial tree is normal to subsegmental levels.  Despite many\nlocations at which disseminated lung malignancies contiguous with pleural\nsurfaces there is no discrete pleural mass or effusion.\nCHEST CAGE: Widespread blastic metastases throughout the chest cage are more\nextensive, but there is no compression or pathologic fracture.",
            "output": "Metastatic progression since ___, primarily in severe involvement of\nthe chest cage, although there is no compression or pathologic fracture, and\nmild progression of already severe metastatic involvement of the lungs. \nRelatively mild adenopathy is unchanged or slightly diminished.\n\nGeneralized esophageal distension suggests dysmotility.  Consider esophagram\nin addition to recent swallowing study.\n\nAtherosclerotic calcification including all major coronary vessels."
        },
        {
            "input": "The thyroid is not visualized.  . Supraclavicular, axillary, mediastinal lymph\nnodes are not enlarged.  10 mm distal right hilar lymph node is stable,  more\nmedially a lymph node in the right hilum measuring 14 x 12 mm was 17 x 13 mm.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.  Millimetric lung nodules\nare stable (6:48, 50, 74, 97, 107, 121, 142, 186) there are no new lung\nnodules.  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation, thereis a\nsmall hiata\nThere are no bone findings of malignancy",
            "output": "Stable millimetric lung nodules.  No new lung nodules identified\n\nSmall hiatal hernia"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No pathologic enlargement of lymph\nnodes in the supraclavicular or axillary lymph nodes.\n\nCHEST CAGE: Mild lower thoracic vertebra spondylosis is mildly progressed. \nThere is no evidence of osteo destructive lesions at the level of the\nvertebra, ribs, sternum.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: There is no pathologic enlargement of lymph nodes in mediastinum.\nPosterior mediastinum is unremarkable with the exception of small hiatal\nhernia.  Right hilar 1.3 cm lymph node is stable, not pathologically enlarged.\n\nHEART and PERICARDIUM: Heart is normal in size.  No appreciable\natherosclerotic calcifications.  Mild calcifications of the mitral valve. \nThoracic aorta and main pulmonary artery are normal in caliber.  Pericardium\nis physiologic.\n\nPLEURA: No pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level. Bilateral\nnodules measuring less than 0.3 cm are stable.  No new nodules.  Reference\nnodules are - left lower lobe perifissural triangular nodule, likely\nintrapulmonary lymph node (6:204) and same lobe micronodule (6:134).\nMicronodule in the right lower lobe (06:158, 148).",
            "output": "Pulmonary nodules are stable since ___.  No new lung nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No axillary lymphadenopathy. \nNormal thoracic inlet. No chest wall lesions.\n\nUPPER ABDOMEN: Dictated separately.  Juxtacaval fat (pseudolipoma)\nredemonstrated, of unlikely clinical significance, normal variant (02:43;\n601:24; 602:41, 40).\n\nMEDIASTINUM: No lymphadenopathy.\n\nHILA: Stable right hilar node measure 14 mm in short axis.  No left\nlymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion. \nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA: Scattered pulmonary nodules are stable.  For example, the\nlargest nodules measure up to 5 mm are in the left upper lobe (3:73, 3:113)\nand the right middle lobe (3:98; 03:13).  No new or growing nodule.\n2. AIRWAYS: Patent to the subsegmental level bilaterally.\n3. VESSELS: Thoracic aorta and main pulmonary trunk are normal in caliber.  No\nincidental pulmonary embolus.  Unremarkable appearance of the great vessels. \nNo significant coronary artery calcification.\nCHEST CAGE: No suspicious osseous lesions in the chest.  Degenerative changes\nin the spine most prominent at T12-L1.",
            "output": "1. Stable pulmonary nodules measuring up to 5 mm.\n2. No new or growing pulmonary nodules."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nThere is stable mild cardiomegaly with multichamber enlargement and scattered\ncoronary artery calcifications. There is no pericardial effusion. The main\npulmonary artery and thoracic aorta are normal in caliber. No incidental\ncentral pulmonary embolus is identified.\n\nNo pulmonary nodule, mass or consolidation is identified. There is no\nendobronchial lesion.  A trace right pleural effusion is unchanged since ___.\n\nFor a detailed discussion of the upper abdomen, including cholelithiasis and\nhypodense hepatic lesions, please refer to the separate report from the CT\nabdomen/pelvis performed concurrently.\n\nNo lytic or sclerotic osseous lesions are identified.",
            "output": "No evidence of pulmonary metastases.\n\nCholelithiasis."
        },
        {
            "input": "There is no supraclavicular or axillary adenopathy, no soft tissue lesions in\nthe chest wall suspicious for malignancy.  This study is not designed for\nsubdiaphragmatic diagnosis. Most recent cross-sectional abdominal imaging was\na CT of the abdomen on ___.\n\nThyroid is unremarkable. Atherosclerotic calcification is scattered in the\ncoronaries. Aorta and pulmonary arteries are normal size. There is no pleural\nor pericardial abnormality.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nCoronary atherosclerosis."
        },
        {
            "input": "Stable prominent 0.9 in short axis paratracheal lymph node.  No additional \nsupraclavicular, axillary, mediastinal, or hilar lymph node enlargement by CT\nsize criteria.The thyroid gland is unremarkable.\n\nThe heart size is normal without pericardial effusion. Small amount of\natherosclerotic calcifications are seen within the thoracic aorta and coronary\narteries. The great vessels are normal caliber.\n\nNo pleural effusion.No pneumothorax.  An opacity filling a subsegmental branch\nof the left upper lobe bronchi is most consistent with a mucus plug, unchanged\nfrom ___ (5:75).  The airways are patent to the subsegmental\nlevel.\n\nBilateral lower lobe atelectasis is present. A stable 0.1 cm calcified\ngranuloma is seen within the right lower lobe (5: 172). Within the lungs, no\nadditional focal opacity, pulmonary nodule, or mass seen.\n\nOSSEOUS STRUCTURES: No lytic or blastic osseous lesions concerning for\nmalignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is notable for 1.3 x 0.1 cm (3:60)\ncalcified gallstone without gallbladder wall thickening or pericholecystic\nfluid to suggest acute cholecystitis. A 4.6 x 3.3 cm hypodensity within\nsegment 7 of the liver (03:52).   For further details, please see the MR\nabdomen performed on the same day.",
            "output": "1.  No findings worrisome for metastatic disease within the chest.\n2.  Stable mucous plug within a subsegmental branch of left upper lobe\nbronchus.\n\n3.  Cholelithiasis without evidence of acute cholecystitis.\n4.  4.6 cm segment 7 hepatic hypodensity. For further details please refer to\nMR abdomen performed on same day."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis mild cardiomegaly, there is minimal calcification in the LAD.  There is a\nsmall hiatal hernia. There is no pleural or pericardial effusion.\nThere are dependent bibasilar atelectasis\nNo suspicious lung nodules\n\nThis examination is not tailored for subdiaphragmatic evaluation abdominal\nfindings were better evaluated in MR ___. Patient has cholelithiasis,\nhypodense lesion in the liver consistent with ablation zone with necrosis,\ncirrhosis",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "Neck and cardio mediastinum:  The thyroid is unremarkable.  There are no\npathologically enlarged axillary or supraclavicular lymph nodes.  1.1 cm right\nlower paratracheal lymph node is benign appearing and stable.  Cluster of sub\n5 mm right upper paratracheal lymph nodes are stable.  5 mm pericardial lymph\nnodes are stable.  Para-aortic lymph nodes measuring up to 4 mm are stable. \nThe heart is top-normal.  The ascending aorta is normal in caliber.  The main\npulmonary artery is top-normal.  There is no ___ effusion.  3 mm\nparaesophageal lymph nodes are stable.\n\nLung/airways:  The tracheobronchial tree is patent to the subsegmental level. \nThe following lung nodules will be compared to chest CT dated ___. \nRight upper lobe subpleural 2 mm nodule (4:73) is stable.  Right middle lobe 2\nmm nodule (4:119) is stable.  Right middle lobe 2 mm subpleural (4:149) nodule\nis stable.  Left lower lobe subpleural nodule (4:151) is stable.  There are no\nnew lung nodules.  There is bibasilar atelectasis.\n\nAbdomen:  This exam is not tailored for the evaluation of infra diaphragmatic\nstructures.  There is a 1 cm calcified gallstone without evidence of\ncholecystitis.  Post ablated changes at the posterior right liver lobe are\nunchanged.\n\nBones and soft tissues:  There is no lesions suspicious for malignancy or\ninfection.",
            "output": "1. No evidence of intra-thoracic malignancy.\n2. Cholelithiasis without evidence of cholecystitis."
        },
        {
            "input": "Subcentimeter mediastinal lymph nodes are similar in size and number to ___ chest CT.  Heart size is normal, and focal coronary artery\ncalcifications are present.  A trace right pleural effusion is new since ___ study.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of interval liver transplantation since the prior study.  The\ntransplanted liver is not fully imaged on this exam which is also limited by\nabsence of intravenous contrast.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions in the thorax.\n\nWithin the lungs, a new peripheral nodular opacity has developed in the right\nupper lobe posteriorly measuring 1.7 cm by 1.1 cm in diameter with lobulated\nmargins and a small dilated air bronchogram inferiorly.  The opacity has a\nbroad-based contact with the adjacent posterior pleural surface.  Adjacent to\nand below this lesion are several clustered satellite nodules as well as areas\nof bronchiolar disease throughout the posterior segment of the right upper\nlobe to the level of the minor fissure.  Clustered centrilobular nodules are\nalso present dependently in the left upper lobe (104, 4) and lingula. \nNonspecific peribronchiolar opacities are also present at the extreme left\nlung base.  Linear atelectasis or scarring is present in in both lower lobes,\nright greater than left.  Dependent atelectasis is also present adjacent to\nthe trace right pleural effusion.  As",
            "output": "1.  New 1.7 cm x 1.1 cm right upper lobe lung nodule.  Although its morphology\nis concerning for a primary lung cancer, the presence of adjacent satellite\nnodules and multifocal peribronchiolar ground-glass opacities are more typical\nof a pulmonary infection, particularly in this immunosuppressed patient. \nDifferential diagnosis is broad and includes fungal, bacterial and\nmycobacterial organisms.  Considering the dependent distribution, multifocal\naspiration pneumonia also a consideration.\n\n2.  Status post liver transplant.  Transplanted liver is not optimally\nassessed on this dedicated unenhanced chest CT exam.\n\nRECOMMENDATION(S):  Followup CT is recommended in ___ weeks following\ntreatment for presumed infection.  If this nodule fails to substantially\ndecreased in size at follow-up, further management options would include\nPET-CT and biopsy.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 10:15 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Subcentimeter mediastinal lymph nodes are similar in size and number.  Heart\nsize is normal, and focal coronary artery\ncalcifications are present.  No pleural effusions.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of interval liver transplantation since the prior study.  The\ntransplanted liver is not fully imaged on this exam which is also limited by\nabsence of intravenous contrast.  Low attenuation of the cardiac blood pool\ncan be seen with anemia.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions in the thorax.\n\nPreviously seen peripheral nodular opacity in the right\nupper lobe posteriorly has substantially decreased with minimal residual\nLinear and ground-glass opacity series 5, image 87.  Previously-seen clustered\nground-glass opacities and peribronchial nodular opacities also decreased\nsince the prior.  Clustered centrilobular nodules in the left upper lobe and\nlingula also resolved, as well as ground-glass nodules in the left lower lobe.\nMild diffuse bronchial wall thickening.  Linear bands of atelectasis in the\nright lower lobe persist.  No new or growing pulmonary nodules.\n\nLinear atelectasis or scarring is present in in both lower lobes,\nright greater than left.  Dependent atelectasis is also present adjacent to\nthe trace right pleural effusion.",
            "output": "Substantial interval improvement and areas of resolution of the multifocal\nground-glass and nodular opacities, particularly the dominant nodule in the\nright upper lobe suggestive of resolving infection and/or inflammation."
        },
        {
            "input": "The thyroid gland is within normal limits.  The esophagus is unremarkable. \nThere is no hiatus hernia.  The thoracic aorta is mildly calcified at the\narch, but demonstrates normal caliber throughout the chest.  The pulmonary\nartery is normal in caliber.  The heart is mild-to-moderately enlarged,\nunchanged.  Trace pericardial effusion is likely physiologic and unchanged. \nThere is mild to moderate coronary artery calcification.  Scattered\nmediastinal lymph nodes are not pathologically enlarged.  There is no visible\nsupraclavicular, subpectoral, axillary, or discernible hilar lymphadenopathy.\n\nMajor airways are patent to the subsegmental level bilaterally.  There is mild\nbronchial wall thickening which appears unchanged, likely due to mild\ninflammation.  The clustered nodular focus seen in the posterior right upper\nlobe on prior exam from ___ has resolved in the interim.  A punctate\ncalcified granuloma is seen in the upper aspect of the right middle lobe. \nThere are no new or growing pulmonary nodules seen.  Right lower lobe linear\natelectasis is unchanged.  There is no focal lung consolidation.  There is no\nnew pleural effusion or pneumothorax.\n\nThere is mild dependent chest wall subcutaneous edema There is no concerning\nfocal subcutaneous or musculoskeletal soft tissue abnormality.  The imaged\nthoracic vertebral bodies are normally aligned. There is mild multilevel\ndegenerative change. Vertebral body heights are preserved. No concerning focal\nlytic or sclerotic osseous lesions are seen.\n\nSurgical clips are seen about the intrahepatic IVC, consistent with orthotopic\nliver transplantation.  The partially imaged solid and hollow viscous organs\nof the upper abdomen are without acute focal abnormality on limited\nnoncontrast evaluation.",
            "output": "1. No concerning solid pulmonary nodules or lung masses identified.  Interval\nresolution of previously demonstrated right upper lobe clustered nodules,\nwhich were likely infectious or inflammatory.\n2. Unchanged mild to moderate global cardiomegaly."
        },
        {
            "input": "Several small mediastinal lymph nodes are stable, top-normal.  Aorta and\npulmonary arteries are stable.  Heart size is normal.  There is no pericardial\npleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is extensive there is new left lower lobe subpleural opacity,\nmost likely representing atelectasis a small focus of infection and less\nlikely to represent metastatic disease, series 4, image 159.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nImage portion of the upper abdomen demonstrate evidence of previous liver\ntransplantation",
            "output": "Left lower lobe subpleural nodule, new most likely infectious and neoplastic\nbut reassessment in 3 months is required\n\nStatus post liver transplantation with stable appearance of the abdomen\n\nNo evidence of intrathoracic metastatic disease.\n\nCardiomegaly, unchanged"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Postsurgical liver transplant changes are noted in the upper\nabdomen.  Otherwise, unremarkable appearance of the upper abdomen.\n\nMEDIASTINUM: A pretracheal lymph node is mildly decreased in size (9 mm,\npreviously 11 mm).\n\nHILA: Within limitations of this noncontrast CT there is no hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: Coronary calcifications are moderate.  There is no\npericardial effusion.  The heart is within normal limits.\nPLEURA: There is no pleural effusion.  No pleural abnormality.\nLUNG:\n\n1. PARENCHYMA:  There is mild scarring at the right lung base, unchanged. \nAssessment is mildly limited by respiratory motion.  A 2 mm pulmonary nodule\nin the right middle lobe (series 4, image 125) is unchanged.  Interval\nresolution of the left lower lobe lesion in question on the prior examination.\n2. AIRWAYS:  There is mild diffuse bronchial thickening worse at the right\nlung base.\n3. VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: No evidence of osseous malignancy or infection.",
            "output": "1.  Interval resolution of the left lower lobe lesion in question.\n2.  Mild chronic bronchial wall inflammation, worse at the lung bases."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.  No\nsupraclavicular and no axillary lymphadenopathy.  Chest wall with no\nconcerning soft tissue abnormalities.\n\nCHEST CAGE: No evidence of osteo-destructive lesions in the ribcage.\n\nUPPER ABDOMEN: Postsurgical liver transplant changes are noted in the upper\nabdomen.  Unremarkable appearance of the unenhanced remaining upper abdominal\norgans.\n\nMEDIASTINUM: 0.8 cm right lower lobe paratracheal lymph node and 0.4 cm right\npericardial lymph node unchanged (5:227).\nPosterior mediastinum is unremarkable with the exception of small hiatal\nhernia,  the esophagus is unremarkable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Specks of calcifications in\nthe coronaries.  No appreciable atherosclerotic calcifications along the\nnormal caliber thoracic aorta and head neck vessels.  Main pulmonary artery is\nnormal in diameter.  No pericardial effusion.\n\nPLEURA: There is no pleural effusion, no nodularity.\n\nLUNG: Airways are patent to the subsegmental level.  Respiratory motion\nartifacts limiting evaluation of fine details in the lung bases.  Pre-existing\ntiny calcified granuloma in the right middle lobe is unchanged since ___.\nNo lung nodules identified.  Subsegmental platelike atelectasis or scarring in\nright lower lobe is stable.",
            "output": "No evidence of intrathoracic metastasis."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.\n\nThere is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen demonstrate previous liver transplantation\nchanges and otherwise is unremarkable within the limitations of the study\ntechnique that was not designed for assessment of intra-abdominal pathology.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\npulmonary nodule is stable, series 5, image 153.  Right lower lobe linear\nopacities consistent with atelectasis.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of intrathoracic\ninfection or concern for malignancy.\n\nNote is made that the assessment of the upper abdomen is extremely limited due\nto lack of IV contrast administration."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Mild coronary\nartery calcifications, unchanged.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nMultiple subcentimeter mediastinal lymph nodes do not meet CT size criteria\nfor lymphadenopathy.  Evaluation of hilar lymph nodes is limited in the\nabsence of intravenous contrast but there is no obvious hilar contour\nabnormality. No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild biapical scarring. Linear opacities in the right lower lobe\nare consistent with atelectasis, unchanged from ___. 2 mm calcified\ngranuloma in the right middle lobe (302:125) is unchanged since ___. \nLungs are clear without masses or areas of parenchymal opacification.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.  Mild\ndegenerative changes of the thoracic spine.\n\nABDOMEN: Patient is status post liver transplant. Please refer to same day\nreport on CT abdomen and pelvis for description of subdiaphragmatic findings.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic malignancy or\ninfection."
        },
        {
            "input": "Slightly hypodense 1 cm right thyroid nodule that should be further evaluated\nby ultrasound.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the hilar and mediastinal\ncompartments.  Normal appearance of the large mediastinal vessels.  No\nincidental pulmonary embolism.  No substantial coronary calcifications.  No\nvalvular calcifications.  Normal cardiac ___. Small hiatal hernia.\nOtherwise unremarkable posterior mediastinum. Several 1 cm loss smaller\nhypodense liver lesions, too small to evaluate on CT.  1.5 cm in homogeneous\nright kidney cyst.  Both the liver lesions and the kidneys cyst should be\nfurther worked up with ultrasound or MRI.  No osteolytic lesions at the level\nof the ribs, the sternum or the vertebral bodies.\n\nExcept for a minimal right middle lobe scarring, likely post infectious in\norigin, the lung parenchyma is completely normal.  There is no evidence of\nactive focal or diffuse disease.  No changes in lung attenuation.  The airways\nare patent.  The pleural surfaces are even, no pleural thickening, no pleural\neffusions.",
            "output": "Minimal non characteristic middle lobe scarring. Otherwise completely normal\nlung parenchyma, no suspicious lung nodules. No infectious or inflammatory\nchanges.\n\n1 cm right thyroid nodule, inhomogeneous 1.5 cm right kidney cyst, and several\nhypodense liver lesions should be further worked up with ultrasound or MRI."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The main pulmonary artery is dilated, measuring up\nto 3.2 cm, which may suggest underlying pulmonary arterial hypertension.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.PLEURAL SPACES:\nNo pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Multiple hypodense thyroid nodules, largest measuring up to 1.6\ncm in the left thyroid lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRedemonstration of a 8 mm simple renal cyst at the lower pole of the left\nkidney.  There is no evidence of focal renal lesions or hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nMild degenerative changes of the imaged spine.\n\nSOFT TISSUES: Redemonstration of a 2 cm injection granuloma in the right lower\nabdominal wall.  No evidence of abdominal wall hematoma.",
            "output": "1. No evidence of acute traumatic injury.\n2. Dilated main pulmonary artery may suggest underlying pulmonary arterial\nhypertension.\n3. Multiple hypodense thyroid nodules, largest measuring up to 1.6 cm in the\nleft thyroid lobe.\n\nRECOMMENDATION(S):  Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION:  The updated recommendations were emailed to ED QA staff by\n___, M.D. on the telephone on ___ at 10:11 am, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THORACIC INLET: Thyroid is heterogeneous in appearance, unchanged.  There are\nno enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : Enlarged axillary\n\nMEDIASTINUM: Residual thymic tissue in the anterior mediastinum is unchanged\ncould represent rebound thymic hyperplasia.  There are no enlarged mediastinal\nhilar lymph nodes.  Unenhanced aorta and pulmonary arteries are normal in\nsize.  Heart size is top-normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is moderate upper lobe predominant emphysema.  No new\nconsolidations are seen.\n\nBONES AND CHEST WALL : Review of bones shows evidence of osteopenia.  There\nare acute fractures involving the lateral aspect of the lower ribs on the left\n(301, 49 45,).\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of the liver.  No adrenal masses are seen",
            "output": "Moderate diffuse emphysema.\n\nMildly displaced acute fractures involving the lateral aspect of the lower\nribs on the left.\n\nOsteopenia with degenerative changes involving the spine.\n\nNo evidence of pneumonia."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Cardiac size\nis normal.  Mild coronary artery calcification.  Mild aortic valve\ncalcifications is unknown hemodynamic significance.  No pericardial effusion. \nThe aortic and pulmonary arteries are within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: Interval increase in size of multiple prominent\naxillary lymph nodes bilaterally which do not meet CT criteria for\nlymphadenopathy and may be reactive.  Remnant thymic tissue is again\nidentified in the anterior mediastinum.  Multiple subcentimeter mediastinal\nlymph nodes are again identified that do not meet CT criteria for\nlymphadenopathy. No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The central airways are patent. Mild emphysematous changes.\nMild bibasilar atelectasis. A 2 mm nodule in the right lower lobe (4:175) is\nunchanged and likely benign. A 3 mm calcified granuloma of the left lower lobe\nis again identified (series 4, image 163). No evidence of pneumonia. The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Heterogenous thyroid gland with largest hypoattenuating lesion\nmeasuring up to 1.7 cm in the left thyroid lobe (series 4, image 24), which\nwas previously evaluated on thyroid ultrasound.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates\nhyperdensity within the gastric body most consistent with ingested material. \nFatty infiltration of the liver is not as apparent on current study.\n\nBONES: Visualized osseous structures are diffusely demineralized.  Healed left\nrib fractures are identified.  Mild to moderate degenerative changes of the\nthoracic spine included intervertebral disc space narrowing, osteophytosis in\nplace sclerosis and vacuum phenomena.  There is no acute fracture.  No new\nsuspicious osseous lesions. Please note PET-CT is more sensitive for\nevaluation of myelomatous lesions.",
            "output": "1. No acute fracture or suspicious osseous lesions identified.  Please note\nPET-CT is more sensitive for evaluation of myelomatous lesions.\n2. No evidence of pneumonia or acute cardiopulmonary process."
        },
        {
            "input": "Large right thyroid approaching 3 x 2.5 cm with internal calcifications is\nsimilar to previous examination.  Aorta and main pulmonary artery are\nunchanged as well including   dilatation of the main pulmonary artery up to\n3.7 cm, concerning for pulmonary hypertension and dilatation of ascending\naorta up to 4.3 cm that appears to be more pronounced than on the previous\nchest CT.  Coronary calcifications are extensive.  Heart size is enlarged\npredominantly the left ventricle.\n\nSevere ascites in stigmata of cirrhosis are noted in the upper abdomen. \nBilateral pleural effusions are small to moderate, and potentially secondary\nto ascites.\n\nAirways are patent to the subsegmental level bilaterally.  Extensive\ninvolvement of the lung parenchyma by consolidations including solid central\ncomponent and surrounding ground-glass, series 302, images ___ are\ndemonstrated in concerning for multifocal process.  Similar areas but in\ndifferent distribution where present on CT chest from ___ but\npotentially reflected similar or different etiology but a separate episode.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Multifocal opacities concerning for either multifocal infection or non\ninfectious process such as cryptogenic organizing pneumonia (less likely\n\nSevere ascites\n\nBilateral pleural effusions\n\nExtensive coronary calcifications\n\nSuspected pulmonary hypertension\n\nMildly dilated ascending aorta that should be further followed on an annual\nbasis."
        },
        {
            "input": "Right thyroid lobe is enlarged, contains calcifications enlarged\nlow-attenuation areas which should be evaluated further with ultrasound, if\nnot yet performed.  Slightly enlarged left axillary node or nodal cluster, 9 x\n15 mm, 4:74, was 7 x 13 mm on ___.  Numerous central lymph nodes are\nstable or is slightly different in size, ranging from 7 mm in the right upper\nparatracheal station to 13 mm in the right lower, 4:73, previously 12 mm and\nright hilus, 17 x 23 mm, 4:87, previously 17 x 25 mm.  Lymph nodes do not\ncompromise vital structures.\n\nAlthough although atherosclerotic calcification is not apparent in head neck\nvessels, it is considerable in the coronaries, at least the left anterior\ndescending.  There is no pericardial or left pleural abnormality aorta and\ncentral pulmonary arteries are normal size and subject to the limitations of\nthis study free of filling defects.  .\n\nPrevious moderate right pleural effusion is smaller, following insertion of a\npigtail pleural drainage catheter posterolaterally.  The residual pleural\nfluid which is also posterolateral is nonhemorrhagic, contains small\ncollections of air has expected with pleural drainage, and relatively mild\nparietal pleural thickening and visceral pleural thickening inseparable from\nadjacent atelectasis in the lower lobe.  There is no fluid collection in the\nchest wall associated with the tube or elsewhere, or any extension of the\npleural abnormality into the chest wall or adjacent ribs.\n\nThe large, partially septated, smooth-walled, air containing space at the\nmedial aspect of the right lower lobe extending to the diaphragm has a slight\ndecrease in the small amount of low attenuation tissue on its posterior wall,\n4:132.  I suspect this is a pneumatocele, from previous, or even remote\ninfection, or communicating bronchogenic cyst, sequestration, or other\ncongenital abnormalities such as cystic adenomatoid malformation.  It may not\nbe related to the draining right exudate.  Because it is so large, it should\nbe visible on prior conventional chest radiographs which should be obtained to\nsee if it is changing.\n\nWhat was probably pneumonia in the right lower lobe superior segment on\n___ it has improved, but there is still severe atelectasis in both the\nsuperior and posterior basal segments, absent any bronchial obstruction. \nScattered areas of peribronchial ground-glass opacification in the left lung,\nmost pronounced in the upper lobe have changed in distribution, and are\nslightly more extensive today.  These findings, not detectable on conventional\nradiographs, could be recurrent atypical pneumonia or small areas of pulmonary\nhemorrhage, but new less likely aspiration because of its non dependent\ndistribution.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows a\nlow-attenuation right subdiaphragmatic collection and severe fatty change in\nthe liver.",
            "output": "Substantial decrease since ___ in the volume of now, probably\nloculated right pleural effusion, drained by new right pigtail catheter, with\nno evidence of complication.  Improvement in the likely responsible right\nlower lobe pneumonia.  Persistent substantial bisegmental atelectasis right\nlower lobe.\n\nLarge right lower lobe cystic space, either pneumatocele or communicating\ncongenital abnormality, not appreciably changed, not necessarily related to\nthe empyema.  Any prior chest imaging should be reviewed to monitor its\nprogress.\n\nMulti focal alveolar abnormality, predominantly left upper lobe, could be\natypical pneumonia or multifocal pulmonary hemorrhage.\n\nCoronary atherosclerosis.\n\nGoiter, predominantly right thyroid lobe.  Suggest ultrasound.\n\nRECOMMENDATION(S):  Search for prior chest radiographs and obtain subsequent\nones, in order to monitor of the right pleural effusion and establish a growth\nhistory of the right basal cystic space.\n\nThyroid ultrasound."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no incidental thyroid\nfindings.\nNo supraclavicular or axillary lymphadenopathy.\nThe chest wall is with no incidental findings.\n\nUPPER ABDOMEN: Will be reported separately in the concurrent same day CT of\nthe abdomen and pelvis.\n\nMEDIASTINUM: There is no mediastinal or hilar lymphadenopathy.\nThe esophagus is collapsed.\n\nHEART and PERICARDIUM AND GREAT VESSELS: The study is not tailored for the\nevaluation of pulmonary emboli however there are several segmental and\nsubsegmental pulmonary arteries which appear expanded and demonstrates central\nhypoattenuation, most notable in the left lower lobe (6:122 through 138 and in\nthe right lower lobe series 6, image 173).  There is mild cardiomegaly.\nNo pericardial effusion.\nCoronary calcifications, moderate in the LAD, minimal in the LCX and RCA and\nalong the thoracic aorta.\n\nLUNG: Major airways are patent.\nRespiratory motion artifacts limit evaluation of both lung bases.\nNo lung masses to suggest neoplasia.\nNo lung opacifications to suggest infection.\nSmall calcified granuloma in the left base.\nRight middle lobe 4 mm lung nodule (series 6, image 141).\nMinimal dependent subsegmental atelectasis in the right lower lung base.\nNo pleural effusion.\n\nCHEST CAGE: Degenerative changes in the spine.\nNo evidence of bony destructive lesions.",
            "output": "-No evidence of intrathoracic malignancy.\n-Although the study is not tailored for the evaluation of pulmonary emboli,\nsegmental and subsegmental pulmonary arterial filling defects are seen most\nnotably in both lower lobes.\n-Right middle lobe 4 mm lung nodule.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Respiratory motion markedly limits evaluation of the\npulmonary parenchyma, particular within the mid and lower lungs.  Allowing for\nthis, there is no evidence of infection or large pulmonary nodule.  There is\nbibasilar subsegmental atelectasis.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Limited examination due to respiratory motion.  Allowing for this, no\nevidence of intrathoracic malignancy.\n2. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "The thyroid gland is unremarkable. Patient is intubated and the endotracheal\ntube is approximately 2.5 cm above the carina. A nasogastric tube courses\nbelow the diaphragm into the stomach.  There are no enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  The heart and pericardium are\nunremarkable and there is no pericardial effusion. The airways are patent to\nthe subsegmental levels.  Evaluation of the lungs is somewhat limited due to\nthe severe motion artifact particularly at the lung bases.  There are\ninnumerable small pulmonary nodules bilaterally in all lobes that vary in size\nfrom 1-9 mm. Nodular thickening of the fissures, for example in the right\nmajor fissure (4:145) is noted. There is a large layering left pleural\neffusion with associated overlying atelectasis. A small right effusion is\npresent. There is no pneumothorax.\n\nPlease see the dedicated abdomen report for further details\n\nThere are no bony lesions concerning for malignancy.",
            "output": "1. Innumerable bilateral pulmonary nodules in all lobes with associated\nnodular thickening of the fissures. These findings are most consistent with\nwidespread pulmonary metastases.\n2. Large left and small right pleural effusions with associated atelectasis.\n3. Please see the dedicated abdomen report for further details.\n\nThese findings were discussed with Dr. ___ by Dr. ___\ntelephone at 3pm on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS AND PLEURA:\nThe airways are patent to the subsegmental levels. Lungs are well expanded and\nclear, with no bronchial wall thickening, bronchiectasis or mucus plugging. No\nsuspicious lung nodules or masses. No pleural effusions. Mild bilateral apical\nscarring.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "CTA:  The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary trunk is top-normal in\nsize measuring 2.9 cm.\n\nCT CHEST:  There is no axillary, supraclavicular, or mediastinal lymph nodes. \nThere is a single enlarged left paraesophageal lymph node measuring 11 mm in\nshort axis dimension (series 3, image 97).  Heart size is not enlarged.  There\nis no pericardial effusion.  There are no significant coronary artery\ncalcifications.\n\nThe airways are patent and normal to the subsegmental level bilaterally. \nThere is no focal consolidation, pneumothorax, pleural effusion, or\npneumomediastinum.  There is mild bibasilar atelectasis.  There is a calcified\ngranuloma in the right middle lobe (series 3, image 84).  There are no\nsuspicious pulmonary nodules.\n\nThe esophagus is unremarkable.  A small hiatal hernia is visualized.  Limited\nviews of the upper abdomen partially demonstrate surgical changes from recent\nsleeve gastrectomy.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.  The superficial\nsoft tissues are unremarkable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Single enlarged left paraesophageal lymph node which may be reactive in the\nsetting of recent surgery, and correlate for any evidence of esophageal\nsymptoms."
        },
        {
            "input": "The right thyroid lobe is mildly enlarged, extending posteriorly into the\ntracheoesophageal groove.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is top-normal with no pericardial effusion. Moderate coronary\nartery and aortic annular calcifications are present.  The main pulmonary\nartery is mildly dilated to 3.2 cm.  No incidental pulmonary embolus is\nidentified.  Mild calcific atherosclerosis diffusely involves the thoracic\naorta and its branches.  There is a common origin of the right common carotid\nand brachiocephalic arteries which is a normal anatomic variant (bovine arch).\n\nThe patient is status post right upper lobe wedge resection. Severe apical\npredominant centrilobular emphysema is present.  There is a 8 x 10 mm rounded\nperibronchial lesion adjacent to the right apical segmental bronchus (4, 82).\nA few pulmonary nodules measuring up to 9 mm in the left lower lobe are\npresent (4: 112, 117, 148, 149). A calcified left upper lobe granuloma is\nincidentally noted. There is mild left lower lobe subsegmental atelectasis.\n\nImages of the upper abdomen show multiple hypodense hepatic lesions, the\nlargest of which in the right hepatic lobe is a stable cyst. A few hypodense\nright renal lesions are too small to characterize, but there is a posterior\nmid pole cyst. Punctate splenic calcifications are likely due to old healed\ngranulomatous disease. A 2.2 x 1.2 cm indeterminate left adrenal nodule is\nunchanged since the study of 1 day prior (2, 57).\n\nA mixed lytic and sclerotic lesion involving the T12 vertebral body and\nposterior elements is unchanged in configuration (602 B, image 31).",
            "output": "8 x 10 mm necrotic right apical peribronchial lesion may represent local\nrecurrence or nodular scarring. Initial further evaluation should include\ncomparison with previous CT scans to assess for stability or interval growth.\n\nA few indeterminate solid pulmonary nodules measure up to 9 mm in the left\nlower lobe should also be compared to prior CT.If unavailable, consider\nPET-CT.\n\nSevere emphysema.\n\nUnchanged appearance of mixed lytic and sclerotic T12 vertebral body\nmetastasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid unremarkable. \nSupraclavicular lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  Esophagus is grossly\nunremarkable.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification in the right coronary, left anterior descending and left\ncircumflex arteries.  There is no pericardial effusion.  Extensive dense\nmitral annulus calcification.  Mild aortic valve calcification.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber measures 3.3\ncm (02:21).  The main pulmonary artery measures 3.1 cm (02:21).  There is mild\natherosclerotic calcification at the origin of the innominate and left\nsubclavian arteries (2:6).  Discontinuous atherosclerotic calcification\ninvolving the descending thoracic aorta is most pronounced at the\nposteromedial wall with relative sparing of lateral wall of the distal\nthoracic aorta (for example: 02:18, 02:26, 238: ___.\n\nPULMONARY PARENCHYMA: Bibasilar atelectasis.  A 4 mm left upper lobe pulmonary\nnodule is indeterminate(4:71).  A 2 mm right upper lobe calcification likely\nrepresents a calcified granuloma (04:35).\n\nAIRWAYS: The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\nextensive abdominal aorta atherosclerotic calcification, and is otherwise\nunremarkable.",
            "output": "1. Discontinuous atherosclerotic calcification involving the descending\nthoracic aorta is most pronounced at the posteromedial wall and is associated\nwith relative sparing of the lateral wall in the distal thoracic aorta.\n2. Extensive coronary artery and mitral annulus atherosclerotic\ncalcifications.\n3.  4 mm left upper lobe solid pulmonary nodule is indeterminate.\n4. Partially visualized upper abdomen demonstrates extensive atherosclerotic\ncalcifications of the abdominal aorta."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged portion of the thyroid need any\nfurther imaging.\n\nSupraclavicular and left axillary lymph nodes are not enlarged.  Evaluation of\nthe breasts and enlarged right axillary lymph nodes reserved for mammography. \nNo soft tissue abnormalities elsewhere in the chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels or the coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size and the pericardium is\nphysiologic.  Size and appearance of the thymus are also normal for age.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nincluding the internal mammary and diaphragmatic stations.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions:\n\n3 mm nodule, right upper lobe, 8:131.\n\n3 mm nodule, left upper lobe, 8:83.\n\nDilated peripheral vessels or possible pair of subcentimeter nodules, left\nlower lobe, 8:218.\n\nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities.\nCHEST CAGE: The need for followup imaging depends on staging and management\nconsiderations regarding the patient's extrathoracic malignancy.  Otherwise\n___ guidelines for management of incidentally discovered pulmonary\nnodules would apply.  See recommendations below.",
            "output": "There are 2 or 4 tiny lung nodules.  Although these are indeterminate, the\nsize in distribution argues against metastasis.  If there were no history of\nextrathoracic malignancy, follow-up recommendations would be as described\nbelow.\n\nPossible right axillary adenopathy.  Assessment should begin with review of\nserial breast imaging.\n\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is mild\natherosclerotic disease.  There is no mediastinal hematoma.  There is no\npericardial effusion.  There is no lymphadenopathy.  The imaged thyroid is\nnormal.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  Airways\nare patent to the subsegmental level.  There is no evidence of contusion or\nlaceration.  There is no pneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is normal\nin course and caliber with widely patent major branches.  No lymphadenopathy,\nfree air, or free fluid.  The stomach, small, and large bowel are\nunremarkable.  There is no evidence of mesenteric injury.\n\nPELVIS:  The bladder is distended with a Foley catheter.  There is small\namount of presacral stranding.  In addition, there is enlargement of the\npelvic musculature surrounding the fractures, consistent with intramuscular\nhematoma.\n\nBONES:  There is a moderate acute compression fracture of the L1 vertebral\nbody.  The posterior elements are not involved.  There is no significant bony\nretropulsion.  There is a left comminuted inferior pubic ramus fracture with a\nshafts width of displacement.  There is a mildly comminuted superior pubic\nramus fracture.  There is a v-shaped comminuted fracture through the roof of\nthe acetabulum involving both the anterior and posterior cortices and\nextending to the iliac bone.  There is a displaced fracture of the medial wall\nof the acetabulum (where the acetabulum joins the ischium) with 9 mm of medial\ndisplacement of the fracture fragment.  As described above there is associated\nmuscle hematoma.  There is a chronic right inferior pubic ramus fracture.",
            "output": "1. No solid organ injury in the chest, abdomen, and pelvis.\n2. Transverse fracture through the body of the L1 vertebra with approximately\n20% decrease in vertebral body height without retropulsion of bony fragments\ninto the adjacent spinal canal or a large associated hematoma.  Posterior\nelements of L1 are intact.\n3. Comminuted left inferior and superior pubic rami fractures.\n4. Complex left acetabular fracture with associated intramuscular hematoma and\nmild presacral stranding, as described above.\n5. Foley catheter within a distended bladder, correlate to ensure the catheter\nis draining properly.\n\nNOTIFICATION:  Impression # 5  discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 9:49 AM, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "Heavy calcifications of the aorta are not associated with abnormal aortic\ndilatation.  Pulmonary arteries normal in diameter.  The patient is after\nmedian sternotomy and CABG.  Multiple mediastinal lymph nodes are not\npathologically enlarged but the N number is exceeding the usual appearance the\nranging up to 7 mm.\n\nPacemaker leads terminate in right atrium and right ventricle.  Heart size is\nmildly enlarged.  There is evidence of anemia.  There is no pericardial\neffusion.  There is small bilateral effusion, right more than left.\n\nImage portion of the upper abdomen demonstrate right kidney cysts and\notherwise is unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is mild to moderate.  The study is done with suboptimal inspiratory\neffort does diffuse ground-glass opacities most likely represent expiratory\nnature of the study.  Alternatively mosaic attenuation would be an possibility\nwith the potential presence of small airway disease.  Subpleural areas of\ncoarse reticular linear opacities are present, and might represent either\nrecurrent aspiration or fibrosis.  The are symmetric, bibasal and involve\nposterior and lateral aspect of the lower lobes.  No discrete pulmonary\nnodules are demonstrated except for left upper lobe subpleural 2.5 mm nodule,\nseries 4, image 65, left upper lobe calcified granuloma.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic malignancy but borderline mediastinal\nlymph nodes might be reactive and still would need a follow-up in ___ months.\n\nSubpleural interstitial changes most likely representing nonspecific\ninterstitial pneumonia.\n\nMosaic attenuation, concerning for small airway disease with mild to moderate\ncentrilobular emphysema.\n\nStatus post CABG."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild calcification of the thoracic aorta and\nthe great vessels of the head and neck.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear with no parenchymal opacification.  There is\nminimal dependent atelectasis.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Mild airway wall thickening is seen diffusely.\nThere are multiple pulmonary nodules including a 4 mm nodule (4:88) in the\nright upper lobe and a 3 mm nodule (4:91) in the right upper pole lobe, a 1 mm\nnodule in the left lower lobe (4:141).  There are multiple 4 mm nodules in the\nright lower lobe (4: 130, 134, 159) and 5 mm nodule in the right middle lobe\n(4:159).\n\nBASE OF NECK: There is a large 5.6 x 4.7 cm (in axial ___\n(heterogeneous hypodense mass in the right thyroid lobe, incompletely\nvisualized, with local mass effect causing leftward deviation and narrowing of\nthe trachea.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hypodense lesions in the liver, including a\n2.5 cm lesion in hepatic segment ___ (5:9), a 1.4 cm lesion in hepatic\nsegment 2 (5:16) and a 1.1 cm lesion in hepatic segment 4A (5:14). These\nlesions are incompletely characterized but are favored to represent cysts. \nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon and rectum are within normal limits.  The appendix is\nnormal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is hypodense area in the endometrial canal, which\nmeasures 6 mm.  No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Enlarged, heterogeneous right thyroid mass, incompletely visualized,\nmeasuring up to 5.6 cm in axial ___ with local mass effect causing\nleftward deviation and narrowing of the trachea.  See recommendations below.\n2. Multiple pulmonary nodules.  See ___ recommendations below.\n3. Hypodensity in the endometrial canal, which measures 6 mm in thickness,\npotentially fluid or endometrial thickening.  See recommendations below.\n\nRECOMMENDATION(S):\n1. Please correlate with prior workup of right thyroid mass.\n2. For incidentally detected multiple solid pulmonary nodules smaller than\n6mm, no CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.  See the ___\n___ Guidelines for the Management of Pulmonary Nodules\nIncidentally Detected on CT\" for comments and reference:\n___\n3. Please correlate CT findings of the endometrium with non emergent,\noutpatient pelvic ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is some limitation due to respiratory motion of the lingular segmental\nand subsegmental branches.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Splenule identified adjacent to the pancreatic tail.  In addition,\nthere is a rounded adjacent 12 mm nodule which is indistinguishable from the\npancreatic tail.  This may also represent a splenule though it is less clearly\ndelineated from the pancreas.  Patient is status post cholecystectomy.  Common\nbile duct measures up to 1.5 cm potentially related to post cholecystectomy\nstate.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Rounded lesion in indistinguishable from the pancreatic tail which may\nrepresent a splenule however dedicated imaging which can be done by MRI\nsuggested to exclude underlying primary pancreatic lesion."
        },
        {
            "input": "THORACIC INLET: There are multiple hypodense areas within both lobes of\nthyroid.  There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Previously\nvisualized right breast mass has significantly regressed in size and now\nmeasures 5 mm.  The right axillary lymph nodes have also significantly\ndecreased in size.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  The esophagus is patulous and dilated.  There is a small size\nhiatus hernia.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is minimal bibasilar atelectasis.  No new pulmonary nodules are\nseen.\n\nBONES AND CHEST WALL : Review of bones shows a stable expansile sclerotic\nlesion involving the right posterior eleventh rib (2, 58),.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable. \nPlease refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "Significant decrease in size of the right breast mass and right axillary\nadenopathy.  The subpectoral lymph nodes have also regressed in size since the\nprior study.\n\nNo new or growing pulmonary nodules.\n\nStable sclerotic lesion involving the posterior aspect of the eleventh rib on\nthe right\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "THORACIC INLET: Redemonstrated partially imaged thyroid is heterogeneous, with\na 9 mm rounded hypodense nodule on the right and a 1.3 cm partially imaged\nheterogeneous nodule in the left lobe.\n\nBREAST AND AXILLA  : Soft tissue in the region of the previously seen right\nbreast mass has continued to decrease and is now only slightly visible (series\n3, image 102).  A couple other areas of right breast nodularity appear\nslightly smaller in size compared to the prior study, for example on series 3,\nimage 74 posterior right breast nodule measures 0.8 x 0.7 cm, previously\nmeasured 9 mm.\n\nSmall axillary lymph nodes are not pathologically enlarged.\n\nMEDIASTINUM: No mediastinal or hilar lymphadenopathy is seen.  There is a\npartially imaged small hiatal hernia.\n\nHEART, VESSELS and PERICARDIUM: No pericardial effusion is seen.\n\nPLEURA: No large pleural effusion or pneumothorax is seen.\n\nLUNG: Mild bibasilar atelectasis is seen.  There is also mild lingular\natelectasis.  Subtle diffuse areas of ground-glass opacity may relate to\nexpiration.  No worrisome pulmonary nodule is seen.\nBONES : Heterogeneous lucent and expansile irregularity of the posteromedial\nleft ninth rib, concerning for metastasis.  The lytic component now extends to\nthe left aspect of the T9 vertebral body left T9 transverse process and\npedicle.  This finding appears progressed compared to ___ PET CT.\n\nPreviously seen expansile lesion involving the posterior right eleventh rib\nwas not included on this chest study.\n\nUPPER ABDOMEN: Please refer to concurrent abdominopelvic CT for findings in\nthe abdomen and pelvis.",
            "output": "Continued decrease in soft tissue in the region of the previously seen right\nbreast mass.  A couple other areas of right breast nodularity also have\ndecreased in size.\n\nIncreased expansion and heterogeneity of the posteromedial left ninth rib with\nnew extension to the left aspect of the T9 vertebra, including the left\nvertebral body, pedicle, and left transverse process, most consistent with\nmetastasis."
        },
        {
            "input": "For subdiaphragmatic findings, please refer to separate abdominopelvic CT\nreport from same date.\n\nCHEST PERIMETER: Redemonstration of a heterogenous, partially imaged thyroid\nwith stable appearing 1.3 cm hypoattenuating nodule in the left and 9 mm\nnodule in the right.  There is no axillary or supraclavicular or\ninfraclavicular lymphadenopathy.  Right breast nodularity evaluation is\nexclusively reserved for breast imaging techniques.\n\nCARDIO-MEDIASTINUM: Moderate sized hiatus hernia with fluid-filled patulous\nesophagus, worse from previous.  This is at least an indication of substantial\ndysmotility.  Heart size is normal.  The caliber of the aorta and pulmonary\narteries is within normal limits.  There is no mediastinal lymphadenopathy.\n\nTHORACIC LYMPH NODES: No thoracic lymphadenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: Mild, bibasilar atelectasis, worse on the left. \nGround-glass nodule in the left upper lobe measures 4 mm (6:139), solid nodule\nin the left lower lobe measures 5 mm (6:132), largely unchanged from previous.\nA new, mildly spiculated nodule in the left upper lobe measures 8 mm (6:109). \nFaint area of ground-glass opacity in the left upper lobe is also new (6:\n110).  New 5 mm ground-glass opacity in the left upper lobe (6:103).  The\ntracheobronchial tree is patent to the subsegmental level.  The pleural\nsurfaces are normal and there is no focal consolidation.\n\nCHEST CAGE: Mildly increased left posterior ninth rib expansile lytic lesion,\nwhich extends into the pedicle of T9, the left lateral vertebral body margin,\nand transverse process, as well as some soft tissue extension into the left\nlateral vertebral canal and neural foramina (6:195).  Partially imaged\nexpansile lytic lesion in the left posterior twelfth rib is consistent with\nmetastasis, appears more conspicuous compared to previous scan.  Sclerotic\nfocus in the right inferior scapula is largely unchanged from prior CT (5:47).",
            "output": "Interval expansion of a left posterior ninth rib metastasis with apparent\nextension of the lesion into the vertebral canal with at least mild stenosis,\nright posterior twelfth rib lytic lesion are concerning for progression of\nmetastatic disease.  Recommend dedicated spinal imaging if clinically\nwarranted.\n\nModerate paraesophageal hiatus hernia with a fluid-filled esophagus, which may\nrepresent dysmotility and less likely obstruction.  Recommend esophagoscopy or\nesophagram for further evaluation.  New scattered nodules in the left lung in\nthis setting may represent aspiration or new metastatic disease.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:53 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "THORACIC INLET: There is a stable hypodense lesion within the left lobe of\nthyroid.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : The left axillary lymph nodes have increased in size\nsince the prior study.  Both breasts have not been completely included in the\nfield of view.\n\nMEDIASTINUM: The esophagus is patulous and dilated.  There is a moderate-sized\nhiatus hernia small mediastinal lymph nodes are unchanged.  A prevascular node\nmeasures 12 mm.  There is moderate cardiomegaly.  There is no pericardial\neffusion.\n\n\nPLEURA: The loculated left pleural effusion has slightly decreased in volume. \nA left-sided pigtail catheter has been placed in the interim.  The pockets of\nair within the posterior and lateral aspects of the pleural effusion are new. \nSmall right pleural effusion has slightly increased in volume.\n\nLUNG: The evaluation of lung parenchyma is limited by respiratory motion. \nBands of atelectasis are seen in the right lung base.  Consolidative opacity\nin the inferior lingula most likely represents re-expansion edema.\n\nBONES AND CHEST WALL : Review of bones shows an expansile lytic lesion\ninvolving the posterior aspect of the left ninth rib with involvement of the\nleft clavicle lamina and the vertebra at T9 vertebral body.  There is also\nevidence of bone destruction involving T8 vertebral body.  A pathological\nfracture involving T9 vertebral body is again seen.  There is a additional\nlytic lesions involving L1 vertebral body, eleventh right rib and the right\nscapula with a sclerotic lesion within it.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows bilateral\nadrenal thickening left greater than right.",
            "output": "Status post placement of a left-sided pigtail catheter with mild decrease in\nvolume of the left pleural effusion and presence of pockets of air within the\npleural fluid.  Residual moderate loculated left pleural effusion.\n\nSubsegmental atelectasis within the lingula.\n\nSmall right pleural effusion slightly increased in volume.\nThe left axial lymph nodes have mildly increased in size.\n\nStable hypodense lesion within the thyroid.\n\nOsseous metastasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  There is lack of opacification of the right posterior\nbasilar segmental pulmonary arterial branch compatible with pulmonary\nembolism.  However given small caliber of the vessel and presence of prior\nfilling defect in this region on prior, this is most likely a chronic finding.\nAdditionally, there is scarring in a similar distribution of the lung, further\nsupporting chronicity.  Branch of the right lower lobe pulmonary artery\nfilling defect with small caliber of the right posterior basilar segment of\nthe right lower lobe without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear opacity at the right lung base likely atelectasis versus\nscarring.  Lungs are clear without masses or areas of parenchymal\nopacification.  There is a 3 mm right upper lobe pulmonary nodule (04:37) was\nnot visualized in ___.  Central airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for pneumobilia. \nLow attenuation of the liver suggests steatosis.\n\nBONES: Healing right lateral ninth and tenth rib fractures are noted. \nPosterior right eleventh and twelfth rib fractures are also similar acuity. \nNo suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Filling defect with narrow caliber of a segmental branch of the right lower\nlobe which has the appearance of a chronic pulmonary embolism.  No definite\nacute pulmonary embolism.\n2. Healing fractures of the right ninth through twelfth rib fractures. \nPresence of callus formation suggests that these are not acute.\n3. Hepatic steatosis.\n\nRECOMMENDATION(S):  If patient has risk factors, optional one year followup\nchest CT is suggested.  Otherwise, no additional follow-up is necessary."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax.  New moderate-sized right pleural effusion\nwhich was not present on the study from ___.\n\nLUNGS/AIRWAYS: There is almost complete collapse of the right lower lobe. \nThere is atelectasis throughout the remaining right lung and the left lower\nlobe and lingula.  Patchy ground-glass opacification in the right lung. \nSignificant reduction in the AP diameter of the intrathoracic trachea with a\ncrescentic configuration consistent with tracheomalacia.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Incompletely imaged right IJV Port-A-Cath.  Visualized portions\nof the base of the neck show no abnormality.\n\nABDOMEN:  See report of contemporaneously acquired CT abdomen and pelvis..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "-Interval development of a large right pleural effusion with almost complete\ncollapse of the right lower lobe since the CT on ___.\n-No pulmonary embolus identified"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation.  No\nsupraclavicular or axillary lymph node enlargement.  No soft tissue\nabnormality in the chest wall.  Breast evaluation is reserved exclusively for\nmammography.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal abnormality or subphrenic fluid collection.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels, and scattered in at least left anterior\ndescending coronary artery.  Right supraclavicular transjugular central venous\ncatheter ends low in the right atrium.  Aorta is normal size.  Pericardium is\nphysiologic.\n\nPULMONARY ARTERIES:\n\nNormal size.\n\nNo pulmonary emboli.\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\n\nLUNGS, AIRWAYS, PLEURAE:\nModerate nonhemorrhagic right pleural effusion is slightly smaller today than\non ___.  No left pleural effusion.\n\nAtelectasis of the basal segments of the right lower lobe is severe but\nimproved.\n\nLeft upper lobe is clear. Well-defined peribronchial consolidation in the left\nlower lobe is well-perfused and there is no alveolar or bronchiolar\nopacification to suggest inflammation of either lung or airways. This is more\nlikely atelectasis than pneumonia.\n\nCHEST CAGE: Unremarkable",
            "output": "No pulmonary embolism.\n\nModerate right pleural effusion is smaller today than on ___, still\ncontributing to severe right lower lobe atelectasis.  Moderate subsegmental\natelectasis left lower lobe unchanged.  No good evidence for pneumonia."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Moderate atherosclerotic\ncalcifications in the coronary arteries.  Right Port-A-Cath terminates in the\nright atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Bibasal pleural effusions described in the prior examination\nare now completely resolved.  No pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Bibasal linear atelectasis are noted.  The airways are patent\nto the level of the segmental bronchi bilaterally.  Scattered calcified\ngranulomas are unchanged.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism.  No evidence of pulmonary infarction.\n\nInterval resolution of the bilateral pleural effusions."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum and at\nthe level of the hilar structures.  The large mediastinal vessels are\nunremarkable.  No incidental pulmonary embolism.  Moderate coronary\ncalcifications.  No substantial valvular calcifications.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  No evidence of enlarged\nlymph nodes.  Status post cholecystectomy.  No osteolytic lesions at the level\nof the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  No evidence of\ninfection.  No suspicious pulmonary nodules or masses.  Stable platelike scars\nin both lower lobes and at the bases of the middle lobe, (3, 125).  No pleural\neffusions.  The airways are patent.",
            "output": "No adenopathy.  No pleural effusions.  Platelike scars in both lower lobes. \nNo suspicious pulmonary nodules or masses.  No evidence of pulmonary\ninfection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is redemonstration of\nsubcentimeter partially calcified hypodense nodules in the right thyroid lobe.\nThere is no axillary lymphadenopathy.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion\nis identified.  Right upper extremity approach intravenous catheter terminates\nin the distal SVC.\n\nPLEURA: No pleural effusion or pneumothorax is identified.\n\nLUNG: There is redemonstration of linear scarring in the bilateral lung bases.\nThere are new linear opacities in the left lung base (6: 40, 44), likely\nrepresenting atelectasis, however superimposed pneumonia should be clinically\nruled out.\n\nThere is a 3 mm pulmonary nodule in the right upper lobe (7:147) that is\nunchanged since ___.\n\nThe airways are patent to the subsegmental level.\n\nCHEST CAGE: There are postsurgical changes of partial resection of the medial\nhead of the left clavicle and soft tissue debridement at the sternoclavicular\njoint, noting large defect in the mid to left anterior upper chest wall with a\nwound VAC.  There is fat stranding without evidence of focal fluid\ncollections.\n\nUPPER ABDOMEN: Please see separate dictation for CT abdomen/pelvis.",
            "output": "1. Redemonstration of linear scarring in the bilateral lung bases.  New linear\nopacities in the left lung base is suggestive of atelectasis, however\nsuperimposed pneumonia should be clinically excluded.\n2. Postsurgical changes of partial resection of the medial head of the left\nclavicle and soft tissue debridement at the left sternoclavicular joint. \nLarge defect in the mid to left anterior upper chest wall with a wound VAC,\nnoting fat stranding without evidence of drainable fluid collections.\n3. Right upper extremity PICC terminates in the distal SVC.\n4. 3 mm pulmonary nodule in the right upper lobe is unchanged since ___."
        },
        {
            "input": "LUNGS:\n\nGround glass opacities:\nThere is patchy ground-glass opacities scattered throughout the lungs,\npredominantly in the upper lobes, new since ___.\n\nConsolidations:\nThere is ground-glass shadowing in a perihilar distribution, new since ___.\nIncreased bibasilar opacities, likely combination of atelectasis and\nsuperimposed inflammation\n\nLower lobe linear opacities, similar compared to the prior exam.\n\nCrazy paving pattern:\nNot present.\n\n\"Atoll\" sign or patterns of organizing pneumonia:\nNot present.\n\nDiscrete pulmonary nodules:\nNot present\n\nARDS: Not present\n\nPLEURA:\n\nPleural effusion:\nNo pleural effusion\n\n\nMEDIASTINUM:\n\nLymphadenopathy: No enlarged mediastinal\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: : Visualized portions of the base\nof the neck show no abnormality. Status post debridement of left\nsternoclavicular joint (___).  There is extensive soft tissue\nthickening at the operation site which is slightly more prominent when\ncompared with the prior study..  There is a 9 x 3 x 11 cm fluid collection in\nthe upper half of the left breast which has developed since the previous scan.\nThere is a large skin defect in the mid upper anterior chest wall as\ndemonstrated on the previous scan.\n\nHILA: There are no enlarged hilar nodes.\n\nHEART and PERICARDIUM: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nUPPER ABDOMEN:  Included portion of the unenhanced upper abdomen is\nunremarkable.",
            "output": "1. Multiple peripheral ground-glass opacities throughout both lungs these, new\ncompared to ___, and increased bibasilar opacities, consistent with\nprogressing multifocal viral pneumonia in this COVID-19 positive patient\n2. New 9 x 11 cm fluid collection posterior to the left breast, along the left\nanterior ribcage, possibly an abscess; however, evaluation is evaluated in the\nabsence intravenous contrast.  Status post left sternoclavicular joint\ndebridement (___) with extensive soft tissue thickening at the operation\nsite, concerning for infection/inflammation.  Clinical correlation is\nrecommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, AND CHEST WALL: The visualized thyroid is\nnormal.  Supraclavicular and axillary lymph nodes are not enlarged. Patient is\nstatus post left sternoclavicular joint debridement with extensive soft tissue\nthickening at the joint similar to the prior study (5:31).  The previously\nseen fluid collection in the left upper chest has decreased in size measuring\n2.1 x 4.8 x 8.6 cm (5:65, 6:33) previous measuring 8.0 x 2.8 x 11.7 cm. \nPreviously seen large skin and subcutaneous soft tissue defect along the mid\nupper anterior chest wall is unchanged.\n\nMEDIASTINUM:  Multiple right upper and lower paratracheal lymph nodes are\nincreased in size measuring up to 1.1 cm (5:82).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  The right\nupper extremity PICC terminates in the superior vena cava.\n\nPULMONARY PARENCHYMA: There is predominantly peribronchial ground-glass\nopacity in the posterior upper lobes, right middle lobe and lingula and\ndiffusely within bilateral lower lobes which have become more confluent and\nsignificantly increased since the prior study.  Discrete pulmonary nodules and\natoll sign are not present.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion, however there is thickening of the\nright major fissure which is also increased since the prior study.\n\nBONES: Status post debridement of the left sternoclavicular joint as noted\nabove.  Diffuse osteopenia is noted.  There are mild multilevel degenerative\nchanges of the thoracic spine.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\nextensive splenic arterial calcification.",
            "output": "1. Ground-glass and consolidative opacities throughout both lungs have\nsignificantly increased in extent since the prior study from ___, and\nare consistent with progressive multifocal pneumonia.  There are no specific\nfeatures to indicate a particular infectious etiology given the extensive\ndegree of consolidation.\n2. Status post left sternoclavicular joint debridement with extensive soft\ntissue thickening, not significantly changed since the prior study.\n3. A fluid collection in the left upper anterior chest is decreased in size\nsince the prior study and may represent resolving soft tissue\ninfection/inflammation.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:00 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Focal calcifications within the\nright thyroid lobe (7:1).  Multiple left lower cervical, supraclavicular and\nsuperior mediastinal nodes measure up to 1.0 cm (for example, 7:4, 22, 45). \nThere is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to the separate report of the CT abdomen and\npelvis performed on the same day for subdiaphragmatic characterization.\n\nMEDIASTINUM: Multiple prominent mediastinal nodes are noted, the largest of\nwhich measures 1.4 cm in the prevascular station (7:79).  There is no\nmediastinal mass. The esophagus is unremarkable.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.  Mild to moderate coronary artery\ncalcifications.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Minimal bibasilar atelectasis.  Otherwise, the lungs are clear,\nwithout evidence of suspicious masses, nodules, or focal consolidations.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No suspicious osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. Left lower cervical, left supraclavicular and mediastinal lymphadenopathy.\n2. No evidence of a pulmonary mass.\n3. Please refer to the separate report of the CT abdomen and pelvis performed\non the same day for subdiaphragmatic characterization."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  Scattered\npredominately left-sided supraclavicular and pre-vascular lymph nodes are not\nsubstantially changed compared to ___ and measure up to 1.1 cm in\nshort axis (05: 12, 15, 33).  Left-sided axillary lymph nodes are not enlarged\nby CT size criteria and demonstrate mild adjacent fat stranding, similar in\nappearance compared to ___ (for example 05: 21, 55).  These\nfindings can be seen in the setting of infection, inflammation, malignancy or\nabnormal drainage.\n\nMEDIASTINUM:  Superior mediastinal lymph nodes are also enlarged up to 1.2 cm\n(5:69).  This does not appear appreciably changed compared to most recent\nprior exam.  No mediastinal mass is identified.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  A\nright-sided central venous catheter terminates in the lower SVC.\n\nPULMONARY PARENCHYMA:  1-2 mm right-sided pulmonary nodules are not\nsubstantially changed compared to ___ (5:114, 231).  No concerning\npulmonary nodules are identified.  No areas of abnormal parenchymal\nopacification.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Left supraclavicular mediastinal lymphadenopathy is not substantially\nchanged compared to ___.  No new or enlarging lymph nodes are\nidentified.\n2. Mild fat stranding in the left axilla adjacent to the nonenlarged axillary\nlymph nodes is not appreciably changed compared to ___ and may\nreflect infection, inflammation, malignancy, or abnormal lymph drainage.\n3. Millimetric 1-2 cm pulmonary nodules in the right upper and lower lobes are\nunchanged compared to ___ and are without concerning features.  No\nnew or growing pulmonary nodules are identified.\n4. Please refer to separate report of CT abdomen and pelvis performed\nconcurrently for description of the subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There has been marked interval improvement\nmediastinal lymph nodes, now all subcentimeter in size.  Left supraclavicular\nnodes have slightly improved, previously measuring up to 1.1 cm, now measuring\nup to 1.0 cm (15:8).  No hilar lymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: There are new trace bilateral pleural effusions, left greater\nright.  No pneumothorax.\n\nLUNGS/AIRWAYS: Linear enhancing opacities throughout the bilateral lower lobes\nlikely represent atelectasis.  Micronodule in the right upper lobe (15:116) is\nunchanged.  Right base consolidative opacities obscure the region of known\nmicronodule.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. New bilateral lower lobe consolidative opacities likely represent\natelectasis.  However, in the proper clinical setting, aspiration or pneumonia\ncannot be excluded.\n3. New trace bilateral pleural effusions, left greater right.\n4. Interval improvement in mediastinal lymphadenopathy suggests treatment\nresponse."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.\n\nCoronary calcifications are extensive.\n\nHeart size is normal.  There is no pericardial pleural effusion.  Airways are\npatent to the subsegmental level bilaterally. Right upper lobe 1 mm nodule,\nseries 11, image 18 is stable, 1 mm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen will be reviewed separately.",
            "output": "No evidence of intrathoracic disease recurrence.\n\nStable pulmonary nodule in the right upper lobe, 2 mm.\n\nPlease review CT abdomen and pelvis in the corresponding report will be issued\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid demonstrates a 1.1 cm\nhypodensity in the right lobe associated with coarse calcifications. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  A 1.4 cm soft tissue\nnodule in the medial right breast (4:129) and 1.1 cm soft tissue nodule in the\nsuperior left breast (4:76) are new since the prior study.  A right chest wall\nPort-A-Cath extends to the right atrium.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is mild linear atelectasis at the left lung base.\nRe-demonstrated is a 2 mm pulmonary nodule in the right upper lobe (4:123),\nunchanged since ___. There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\ncholecystectomy clips.  In addition, hypodense lesions in the liver measuring\nup to 2.7 cm compatible with diffuse large B-cell lymphoma are better\nevaluated on CT from ___.  An 8 mm portacaval lymph node (4:291) is\nagain noted, unchanged since the prior CT from ___.",
            "output": "1. No acute intrathoracic abnormality.\n2 mm right upper lobe pulmonary nodule, unchanged since ___.\n2. Soft tissue nodules in bilateral breasts no new since the prior study. \nFurther evaluation with diagnostic mammogram is recommended if not previously\nworked up.\n3. Partially imaged hypodense liver lesions compatible with diffuse large\nB-cell lymphoma better evaluated on CT from ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is mild calcific atherosclerotic plaque involving\nthe aortic arch and descending thoracic aorta.  Coronary artery calcifications\nare mild.  A right-sided chest wall port terminates in the right atrium.  No\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A mild bibasilar atelectasis.  3 mm pulmonary nodule in the\nright upper lobe is not changed compared to at least ___ (series\n5, image 114).  No new or enlarging pulmonary nodules are identified.  Airways\nare patent to the segmental level bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck is notable for a\npartially imaged 0.9 cm right thyroid lobe nodule with coarse calcification\nwhich is not appreciably changed (series 5, image 1).\n\nABDOMEN:  Included portion of the upper abdomen is notable for postsurgical\nchange related to prior cholecystectomy.  The spleen is enlarged up to 13.7 cm\nin maximum AP dimension (series 5, image 233).  Previously described hypodense\nliver lesions were better assessed on prior CT abdomen pelvis performed ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.\n2. No acute intrathoracic process.\n3. Unchanged 3 mm pulmonary nodule right upper lobe compared to at least ___.  No new or enlarging pulmonary nodules.\n4. Mild splenomegaly."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  There is diffuse\nsubcutaneous stranding of the chest wall consistent with anasarca.\n\nUPPER ABDOMEN: 1.8 and 1.3 cm hypodense lesions are partially visualized in\nthe right hepatic lobe (5: 327, 331), better assessed on CT of the\nabdomen/pelvis from ___.  The patient is status post\ncholecystectomy.  There is trace perihepatic and perisplenic ascites.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy, within limitations of a noncontrast\nstudy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is trace pericardial\nfluid, within physiologic limits.  Moderate coronary artery calcifications are\nnoted.  Hypoattenuation of the blood pool relative to the myocardium suggests\nanemia.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild dependent atelectasis at bilateral lung bases. \nThere are no parenchymal opacities concerning for infection.  A 2 mm nodule in\nthe right upper lobe (series 5, image 140, 2 mm nodule in the right lower lobe\n(series 5, image 241), and 1 mm nodule in the lingula (series 5, image 210)\nare stable dating back to CT of the chest from ___.  There are no\nnew or enlarging pulmonary nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta, as well as the main, left, and right\npulmonary arteries are normal in caliber.  A right chest wall port terminates\nin the right atrium.\n\nCHEST CAGE: No acute fracture or aggressive osseous lesion.",
            "output": "1. No acute pulmonary parenchymal findings.\n2. Partially imaged right hepatic lobe lesions are better assessed on CT of\nthe abdomen/pelvis from ___.  Trace perihepatic and perisplenic\nascites.\n3. Hypodensity of the blood pool relative to the myocardium suggests anemia.\n4. Tiny bilateral pulmonary nodules are stable dating back to CT of the chest\nfrom ___.  No new or enlarging pulmonary nodules."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: There is mild atherosclerotic disease in the aortic\narch and descending thoracic aorta.  The thoracic aorta is normal in caliber\nwithout evidence of acute injury.  There is moderate coronary artery\ncalcification.  A right chest port terminates in the right atrium.  Otherwise,\nthe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Punctate calcified granulomas in the right upper lobe (5:130)\nand right lower lobe (5:206) are unchanged.  A 2 mm nodule in the lingula\n(5:211) is also unchanged.  There is bilateral subsegmental atelectasis in the\nlung bases.  There are no new suspicious pulmonary nodules.  There is no focal\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Partially visualized is a partly calcified, 8 mm hypoattenuating\nnodule in the right thyroid gland (5:1).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nIll-defined hypoattenuating lesions in the right hepatic lobe measuring 1.6 x\n1.2 and 0.8 x 0.8 cm (4:62) are grossly unchanged compared to the most recent\nprior study and decreased when compared to ___.  Mild intrahepatic\nductal dilatation is unchanged, possibly due to previous cholecystectomy.  The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring up to 13.8 cm, similar to\nprior.  The spleen shows normal attenuation throughout, without evidence of\nfocal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter renal hypodensities bilaterally are too small to characterize,\nbut statistically likely represent simple cysts and are unchanged.  There is\nno evidence of suspicious focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: The previously described left para-aortic lymph node is no longer\npathologically enlarged by CT size criteria. Scattered retroperitoneal lymph\nnodes have also decreased in size.  No new or enlarging abdominopelvic\nlymphadenopathy is identified.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: There is a 1.7 cm coarse calcification in the right gluteus\nmedius muscle (4:102), which may represent sequela of prior trauma.  Small\nlocules of gas within the anterior abdominal wall likely related to previous\nsubcutaneous injections.  There is mild anasarca.",
            "output": "1. No acute pathology in the chest, abdomen or pelvis.\n2. Interval decrease in retroperitoneal lymphadenopathy.  No new\nlymphadenopathy is identified.\n3. Grossly stable hepatic hypodensities corresponding to biopsy-proven diffuse\nlarge B-cell lymphoma.\n4. Stable splenomegaly.\n5. Tiny bilateral pulmonary nodules are also stable.  No new or enlarging\npulmonary nodules are identified."
        },
        {
            "input": "Right chest tube terminates at the medial right base. There is persistent\nlarge pleural effusion with complete collapse of the right lung in addition to\nincreased density within the right pleural space and thickened, nodular\npleural rind, which may reflect hemorrhagic debris or metastatic involvement.\nSignificant irregularity of the pleural surfaces in is noted, most prominently\ninferiorly, suggesting metastasis. A pleural nodule measuring 4 x 2.7 cm in\nthe right anterior base is noted. Multiple bronchial stents.  This results in\nleftward shift of the mediastinum with mild mass effect upon the SVC. \nProminent right axillary adenopathy.\n\nPulmonary emboli within subsegmental left upper lobe branches, most\nprominently anterior segment, are demonstrated. No pulmonary emboli of the\nmain or lobar arteries. Limited evaluation of the collapsed right lung\narteries without definite emboli.\n\nSignificant mediastinal adenopathy is present.  Confluent soft tissue from the\nright lung extends to surround the distal trachea and esophagus, suspicious\nfor malignant invasion.  Multiple pulmonary nodules within the left chest are\ndemonstrated, largest 5 mm left upper lobe (3, 77), new since prior, highly\nsuspicious for metastases.\n\nmild atherosclerosis in normal caliber thoracic aorta.  Images of the upper\nabdomen demonstrate a 7.1 x 6 cm probable left adrenal mass in addition to\nnumerous enlarged upper abdominal nodes, presumed metastases.  Right adrenal\nnodule is also present, new since prior, likely metastasis. Ill-defined 2.3 x\n1.8 cm liver lesion, new since prior, probable metastasis.\n\nNo suspicious osseous lesions are identified.",
            "output": "-Subsegmental pulmonary emboli, most conspicuously involving the left upper\nlobe.\n-Advanced metastatic lung cancer. Probable metastases are demonstrated\nthroughout the right chest wall, visualized upper abdomen, right axillary\nnodes as detailed above.\n-Large complex pleural effusion within the right chest with indwelling chest\ntube terminating at right base. Thickened and nodular pleural rind is\ndemonstrated, suggestive of metastatic involvement.\n- Other findings as detailed above."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bilateral lower lung atelectasis.  There is right\nupper lobe pulmonary nodule that measures 6 mm and multiple left lower lung\nsubpleural nodules largest measures up to 6 mm.  All visualized lung nodules\nappear stable when compared with most recent CT chest demonstrating stability.\nInterlobular septal thickening is noted.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is enlarged and heterogeneous without dominant mass\nidentified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a large multilobulated cystic mass spanning the right and left\nhepatic lobes and measures 8.2 x 5.1 cm, previously measuring 5.0 x 3.7 cm. \nThere is altered perfusion on the arterial study surrounding the lesion and\nthe portal venous phase, with suspected peripheral enhancement and enhancement\nof the septations.  (.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is notable for small hiatal hernia.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits.  The appendix is normal.  There\nis no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is a small\namount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fluid is seen within the endometrial cavity versus\nendometrial thickening.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Degenerative changes noted in the spine.  Grade 1\nanterolisthesis of L5 on S1.  Small fat containing umbilical hernia.  The\nabdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. No evidence of pulmonary embolus.\n2. No evidence of acute intra-abdominal or pelvic findings.\n3. Interlobular septal thickening suggesting interstitial pulmonary edema.  In\ncombination with mild periportal edema and trace free fluid in the pelvis,\nfindings are suggestive of third-spacing.\n4. Multilobulated cystic liver mass, increased in size from prior study now\nmeasuring 8.2 cm which has subtle enhancement of the walls suspicious for\nbiliary cystadenoma.  Consider dedicated MRI of the liver for further\ncharacterization.\n5. Fluid within the endometrial cavity versus thickening of the endometrium\nfor which nonurgent pelvic ultrasound is suggested in this postmenopausal\nfemale."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nCoarse calcification in the right thyroid lobe.  No enlarged lymph nodes in\neither axilla or thoracic inlet.  No abnormalities on the chest wall.  Mild\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The aorta is normal in caliber throughout.  The main pulmonary\narteries mildly dilated measuring 3.2 cm.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nwall thickening.  Mild centrilobular and paraseptal emphysema.  Tiny punctate\ncentrilobular nodules scattered throughout both lungs, more prominent in the\nupper lobes.  Small nodules measuring up to 3 mm nodule in the right upper\nlobe (302:75 and 72) and in the left upper lobe (302:45).\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No evidence of intrathoracic primary malignancy.\nSmall lung nodules measuring up to 3 mm are indeterminate.  Attention on\nfollow-up studies.\nPulmonary emphysema, bronchial wall inflammation and respiratory bronchiolitis\nare smoking related findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged. The esophagus is\npatulous with an air-fluid level in the mid esophagus. There is a small hiatal\nhernia.\n\nHILA: There is right hilar adenopathy measuring 1.7 x 1.5 cm (02:25).\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.  Atherosclerotic\ncalcification along the aortic arch is noted.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  A 3.5 x 3.4 x 2.8 cm right upper lobe spiculated mass\nis noted.  A 9 mm ground-glass opacity in the right lung apex is noted (2:9). \nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates a\npunctate calcification at the hepatic dome. A 1.4 cm hypodensity in the right\nlobe of the liver is well-defined most consistent with a cyst.",
            "output": "There is a 3.5 cm spiculated mass in the right upper lobe suspicious for\nprimary lung malignancy.  Right hilar adenopathy is suspicious for malignant\nadenopathy.\n\n9 mm ground-glass opacity in the right lung apex.\n\nA 1.4 cm hypodensity in the right lobe of the liver is well-defined most\nconsistent with a cyst.\n\nSmall hiatal hernia.  Fluid in the esophagus could be from reflux or\ndysmotility."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary, or supraclavicular lymph\nnodes.  No pathologic mediastinal lymph nodes are identified.\n\nHeart size is normal.  There is trace pericardial fluid.  There is mild\natherosclerotic disease of the ascending aorta.  There is no thoracic\nascending aortic aneurysm.  The main pulmonary trunk is not dilated.  No\nincidental central embolus is identified.\n\nPostsurgical changes are noted from right upper lobectomy.  There is a\nmoderate right pleural effusion with mild associated atelectasis.  Trace left\npleural effusion is noted.  There is no pneumothorax.  Along the anterolateral\nright heart border is a rounded consolidative opacity measuring 4.1 x 2.8 cm\nwith vessels coursing through (series 2, image 26).  Both right middle lobe\nsegmental bronchi are pretty well seen, abnormalities unlikely to represent\ncollapsed lung segment.\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\ndemonstrate a 1.4 cm probable simple cyst in hepatic segment VII.  There is a\ncalcified granuloma in the dome of the liver.  The adrenal glands are\nunremarkable.  There is a small hiatal hernia.\n\nThere is no superficial soft tissue abnormality.  There are no suspicious bony\nlesions.",
            "output": "1. Postsurgical changes from recent right upper lobectomy.\n2. Indeterminate rounded 4 cm abnormality anteromedial right upper lung, may\nrepresent a mass.  Comparison to preoperative scan recommended.\n3. Moderate right pleural effusion."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is heterogeneous but there is no focal abnormality\nlarge enough to warrant further imaging evaluation.  Supraclavicular and\naxillary lymph nodes are not pathologically enlarged.  Specifically excluding\nthe breasts which require mammography for evaluation, there are no soft tissue\nabnormalities elsewhere in the chest wall concerning for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal abnormality.  Discrete, 11 mm wide, lucency in the right hepatic lobe\nhas attenuation characteristics of a cyst but liver evaluation would require\ndedicated abdominal imaging.\n\n\n\nCARDIO-MEDIASTINUM:Wall of the lower esophagus is mildly circumferentially\nthickened, unchanged.\n\nAtherosclerotic calcification is not apparent head and neck vessels or\ncoronary arteries.  Aorta and pulmonary arteries are normal size.  Small\npericardial effusion is physiologic.\n\nA previous right para mediastinal pleural or hilar hematoma  at the level of\nthe right superior pulmonary vein, questions a lung lesion, has resolved. \nThere is no evidence of active bleeding.\n\nTHORACIC LYMPH NODES: 7 mm wide lymph node at the thoracic inlet, 04:56, in\nthe left upper paratracheal station are unchanged.\n\nLUNGS, AIRWAYS, PLEURAE: Right hilus and bronchial stump have a normal\npostoperative appearance following upper lobectomy.  Middle and lower lobes\nare both well expanded.\n\nLeft lung is essentially clear.  Tracheobronchial tree has a normal\npostoperative appearance and there is no pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Normal postoperative appearance following right upper lobectomy.  No evidence\nof recurrence or new malignancy or complications.  Previous central hematoma\nhas resolved."
        },
        {
            "input": "CHEST PERIMETER: Both lobes of the thyroid and moderately enlarged, as before.\nHowever the 13 mm wide low-attenuation lesion in the right thyroid lobe is\nmore conspicuous today than on prior Chest CT scans, warranting ultrasound\nevaluation.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Evaluation of the\nbreasts is reserve for mammography.  This study is not appropriate for\nsubdiaphragmatic diagnosis.  It shows a well-circumscribed 14 mm wide\nhypodensity in the right lobe of the liver, 4:255 which was slightly smaller\nand lower in attenuation on prior studies.  It is probably benign lesion but\nshould be re-evaluated by ultrasound.\n\n\nCARDIO-MEDIASTINUM:\n\nHiatus hernia is small. Above that level the esophagus is mildly patulous.\nAtherosclerotic calcification is not apparent in head and neck vessels and is\nonly mild in the right coronary artery. Aorta and pulmonary arteries are\nnormal size and pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES:\n\n6 mm left upper paratracheal lymph node, was smaller than 5 mm across in\n___.  No other central lymph nodes are enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are clear, right hilus has a normal\npostoperative appearance following upper lobectomy, tracheobronchial tree is\nnormal to subsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE: Unremarkable",
            "output": "Normal postoperative appearance, following right upper lobectomy. No evidence\nof intrathoracic malignancy.\n\nSlight interval growth of both right thyroid and hepatic hypodensities should\nbe re-evaluated with directed ultrasound.\n\nRECOMMENDATION(S):  Thyroid ultrasound.\n\nHepatic ultrasound."
        },
        {
            "input": "CHEST PERIMETER: Enlarged heterogeneous thyroid is unchanged since ___, when\nthyroid ultrasound recommended yearly follow-up.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  Elsewhere in the chest wall there\nare no soft tissue abnormalities of consequence.  This study is not\nappropriate for subdiaphragmatic diagnosis but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM:Small hiatus hernia is unchanged.  Esophagus above that\nlevel is mildly patulous, essentially normal.  Atherosclerotic calcification\nis not apparent in head and neck vessels or the coronary arteries.  Aortic\nvalve is not calcified.  Small pericardial effusion unchanged is probably\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes are pathologically enlarged or growing,\nranging up to:\n\n9 mm thoracic outlet, 05:38, unchanged, and\n\n5 and 6 mm left upper paratracheal node, 05:56-62, unchanged.\n\nLUNGS, AIRWAYS, PLEURAE: Right hilum and bronchial stump have a normal\npostoperative appearance following upper lobectomy.  Lungs are clear,\ntracheobronchial tree is normal to subsegmental levels and there is no pleural\nabnormality.\n\nCHEST CAGE: Unremarkable.  Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.",
            "output": "Normal postoperative appearance after right upper lobectomy.  No evidence of\nnew or recurrent intrathoracic malignancy.\n\nPersistent thyromegaly.  Continued ultrasound follow-up has been recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nhomogeneous in attenuation without focal nodularity.  Previously noted 8 mm\nnodule posterior to the right thyroid lobe is also unchanged, unclear whether\nthis is contiguous with the right lobe or separate (04:38).  The imaged chest\nwall is unremarkable, aside from bilateral breast parenchyma, which is\nsuboptimally evaluated on the current modality.\n\nUPPER ABDOMEN: Calcified granuloma and 1.5 cm hypodensity in the right lobe of\nthe liver are unchanged from prior exam.  No acute intra-abdominal\nabnormalities are identified.  Mildly thickened appearance of the left adrenal\ngland is similar to prior exam.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not pathologically\nenlarged.  There are no growing lymph nodes in the mediastinum.\n\nHILA: There is no pathologically enlarged or growing hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is top normal.  Trace pericardial\neffusion is likely physiologic.  Mild coronary and aortic valvular\ncalcifications are seen.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Patient is status post right upper lobectomy with expansion of\nthe right middle lobe.  There is new undulation of the left posterior pleural\nsurface with tethered and focally thickened appearance of the pleura (4:113,\n156), likely dependent atelectasis.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.  Ligated upper\nlobar bronchus stump is unremarkable.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is not dilated.  While this exam is not tailored for\nevaluation of pulmonary embolism, no central filling defects are identified.\nCHEST CAGE: There is no suspicious osseous lesion concerning for acute\nfracture or metastatic disease is identified.",
            "output": "1. No evidence of new disease or recurrence.\n2. Stable postoperative appearance of right upper lobectomy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is enlarged measuring 3.3 cm across maximal diameter\n(series 3:2).  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is right hilar lymphadenopathy measuring\n1.7 cm (series 3:92).  There is no axillary, supraclavicular, or mediastinal\nlymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild biapical scarring.  There are ill-defined\nopacities in the superior segment of the left lower lobe which are nonspecific\nand could represent dependent atelectasis (series 3:85).  There are also band\nlike opacities in the dependent portions of left lower lobe favoring\nsubsegmental atelectasis.  These areas are associated with bronchiectasis. \nThere is a 4 mm left lung base pulmonary nodule (3:148).  There is significant\nbronchial wall thickening in the segmental bronchi to the right lower lobe\nmore so than the right middle lobe with associated mucous plugging.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bronchial wall thickening with mucous plugging in the right mainstem\nbronchus and the right middle and lower lobe airways with associated right\nhilar lymphadenopathy, likely reactive, and likely secondary to an infectious\nor inflammatory etiology.\n3. Ill-defined opacities in the superior segment of the left lower lobe which\nare nonspecific and could represent dependent atelectasis or aspiration.\n4. Dilated main pulmonary artery measuring 3.3 cm suggesting pulmonary\nhypertension.\n5. A 4 mm left lower lobe pulmonary nodule.\n For incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery\ncalcifications are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: Enlarged right hilar lymph node measures 1.5 x\n1.9 cm (02:47).  Other subcentimeter axillary, mediastinal left hilar lymph\nnodes are noted.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Dependent regions of consolidation noted bilaterally, more\nextensive on the right than on the left.  There is a 6 mm pulmonary nodule\nalong the minor fissure (3:109) and an adjacent 4 mm nodule in the right\nmiddle lobe on the same image.  A 3 mm left lower lobe pulmonary nodule is\nalso noted (3:146).  Diffuse ground-glass opacities are noted throughout the\nlungs, particularly the upper lungs.  No other area of consolidation\nidentified.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for geographic\nhypoattenuation in the liver, potentially due to geographic fat.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Dependent areas of consolidation involving the bilateral lower lobes, right\nworse than left, likely representing at least some component of atelectasis\nthough a component of pneumonia would certainly be possible, particularly at\nthe right lower lobe.\n3. Superimposed mild diffuse ground-glass opacities in the lungs elsewhere. \nThis is nonspecific and could be in part due to expiratory phase though\nadditional possible etiologies are broad and include atypical infection or\ninterstitial processes or hypersensitivity.  Pulmonary consultation is\nsuggested.\n4. Right hilar adenopathy, potentially reactive but attention on follow-up\nwill be necessary.\n5. Right middle lobe and perifissural pulmonary nodules.\n\nRECOMMENDATION(S):  Six-month follow-up chest CT is suggested in ___ months.\n\nNOTIFICATION:   The updated finding/s were discussed with Dr.  ___.\nby ___, M.D. on the telephone on ___ at 9:04 pm, 4 minutes\nafter discovery of the findings."
        },
        {
            "input": "No significant change in appearance or size of aorta since prior.  Proximal\ndescending aorta measures 3.8 cm.  Distal descending aorta measures 3.1 cm. \nAortic annulus measures 3.4 cm.  At sinuses of Valsalva aorta measures 4.5 cm.\nAt sino-tubular junction aorta measures 3.6 cm.  Mid ascending aorta measures\n4.8 cm measured on coronal plane image 33, stable since prior.  Aortic arch\nmeasures 3.6 cm.\n\nAorta and its major branch vessels are patent, with no evidence of stenosis,\nocclusion, or dissection.  There is no evidence of penetrating atherosclerotic\nulcer or aortic arch atheroma present.  Abdominal aortic branches, including\nrenal arteries are widely patent.  There is mild ectasia of the superior\nmesenteric artery at the origin of with second order mesenteric branch series\n3, image 288.  There are no other areas of ectasia in the visualized abdomen. \nMild atherosclerotic plaque is seen at the aortic arch.\n\nThere is single web in the right lower lobe subsegmental branch bifurcation to\nthe posterior basilar segment series 3, image 160, probably present on prior\nscan, consistent with sequela of chronic pulmonary embolus.  There are no\nacute pulmonary emboli.  Pulmonary arteries are otherwise patent.  Main\npulmonary artery is mildly dilated measuring 3.4 cm, consistent pulmonary\nartery hypertension, more prominent since prior.  There is no or right heart\nstrain.  There is mild left ventricular hypertrophy.  There are coronary\nartery calcifications.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a moderate right and\nsmall left pleural effusion.\n\nMild relaxation atelectasis is seen in the right lower lobe.  There is mild\nvolume loss and linear atelectasis with nodular component in the medial\nsegment of the right middle lobe, new since prior.  Areas of attenuation\ndifference in bilateral lungs, most prominent in the left lower lobe of the\nlung base, and lung apices common with anterior posterior gradient, likely\nrepresents edema.  Few small areas of air-trapping are seen.  There is mild\ninterlobular septal thickening, consistent with edema.  Previously noted lung\nnodules are poorly evaluated due to multifocal atelectasis. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate patent single renal arteries\nbilaterally.  A 1.2 cm fluid-attenuating lesion within the upper pole of the\nleft kidney represents an unchanged cyst.  Other subcentimeter cysts are noted\nwithin the left kidney is well.\n\nModerate diverticulosis is seen within the visualized along the hepatic and\nsplenic flexures.  No diverticulitis is identified.  There is benign simple\ncyst in the upper pole of the left kidney, stable.  Probable tiny cyst in the\nlower pole of the right kidney.  There is small esophageal hiatal hernia.\n\nOtherwise the visualized abdomen appears unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Stable 4.8 cm ascending aortic aneurysm.  No dissection.\n2. Patent single bilateral renal arteries.\n3. Moderate right and small left pleural effusions with mild pulmonary edema. \nLeft ventricular hypertrophy with mild cardiac enlargement.\n\n4. Sequela of chronic pulmonary embolus with single web in the right lower\nlobe subsegmental branch, probably present on prior.  Suggestion of pulmonary\nartery hypertension.  There is no acute pulmonary embolus.\n5. Multifocal atelectasis."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and subcentimeter axillary lymph nodes are\nnot pathologically enlarged.  There are no soft tissue abnormalities elsewhere\nin the chest wall concerning for malignancy or infection.  This study is not\nappropriate for subdiaphragmatic diagnosis but shows no adrenal mass.\n\n\nCARDIO-MEDIASTINUM:Esophagus is traversed by feeding or drainage tube,\notherwise unremarkable.\n\nAtherosclerotic calcification is mild in head and neck vessels, and present in\nat least left anterior descending coronary artery. Minimally calcified\nascending thoracic aorta is dilated in a fusiform fashion to maximum diameter\nof 51 mm could, unchanged since at least ___.\n\nAortic valve is not calcified.  Small pericardial effusion is new.  There is\nno pericardial calcification or evidence of tamponade physiology.\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged by\nsize criteria.\n\nLUNGS, AIRWAYS, PLEURAE: Large scale opacification in the left lower lobe,\nsuperior and posterior basal segments is  sharply marginated, more likely\natelectasis than pneumonia.  Atelectasis is also found in the right middle\nlobe.  In the right lower lobe, mild peribronchial ground-glass opacification\nand peribronchial infiltration in the  superior segment and lateral and\nposterior basal segments, 302:133-159, suggests that in addition to dependent\natelectasis there is either pneumonia or active aspiration.  That\ndifferentiation is more easily made with use of intravenous contrast agent\nshowing differential in profusion between atelectasis and pneumonia.\n\nThere are no lung nodules or cavities to suggest septic emboli.\n\nThere is no appreciable pleural effusion.  Tracheobronchial tree is remarkable\nonly for inflammatory mucosal thickening in the trachea distal to the\nindwelling endotracheal tube.\n\nCHEST CAGE: Unremarkable",
            "output": "No pleural effusion.  Opacification seen at the lung bases on conventional\nradiographs is predominantly atelectasis, and possible pneumonia in the right\nlower lobe.  There is no bronchial obstruction or pleural restriction.\n\nNew small pericardial effusion.\n\nModerate fusiform ectasia, noncalcified ascending thoracic aorta, stable since\n___."
        },
        {
            "input": "THYROID: Unremarkable.\n\nLYMPH NODES: There is no supraclavicular or axillary lymphadenopathy. \nMediastinal lymph nodes are not enlarged by size criteria.\n\nHEART AND GREAT VESSELS: There is a small to moderate pericardial effusion,\nwhich has increased from ___.  Some of the fluid along the anterior\npericardium is slightly hyperdense, and could represent blood products\n(03:36).  Ascending thoracic aorta is mildly enlarged, measuring up to 4.7 cm\n(03:28).  Intramural hematoma involving the aortic arch and descending\nthoracic aorta is slightly less conspicuous compared to the prior CT on ___.\n\nRight-sided hemodialysis catheter terminates in the proximal right atrium.\n\nAIRWAYS AND LUNGS: Evaluation of the lung parenchyma is slightly limited by\nrespiratory motion.  There are patchy areas of subsegmental atelectasis. \nBibasilar consolidations seen on the prior CT have largely resolved.  There is\na small left pleural effusion.  No pneumothorax.\n\nUPPER ABDOMEN: Cortical irregularity/defect along the upper pole of the right\nkidney may represent a sequela of prior infection or infarction (5:304).  A\nDobhoff tube terminates at the gastroesophageal junction.\n\nBONES AND SOFT TISSUES: No suspicious osseous lesions are identified.  Small\nlocule of air in the region of the right axilla is likely due to recent\nintravenous access (5:113).",
            "output": "1. Essentially resolved bibasilar consolidations, now with patchy areas of\nsubsegmental atelectasis.  Small left effusion.\n2. Interval increase in now small to moderate pericardial effusion, possibly\nwith a hemorrhagic component.\n3. Evolving intramural hematoma involving the aortic arch and descending\nthoracic aorta.\n4. Aneurysmal dilation of the ascending aorta measuring up to 4.7 cm.\n5. Dobhoff tube terminates at the gastroesophageal junction.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:12 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a prominent 10 mm right axillary lymph\nnode.  In addition, there are prominent borderline enlarged additional right\naxillary lymph nodes.  The left axilla is not well visualized however there\nalso appears to be enlarged 10 mm left axillary lymph node, partially imaged\n(6:69).  Otherwise, no mediastinal or hilar lymphadenopathy is present.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis.  Otherwise, lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates delayed\nenhancement of the right kidney with partially imaged moderate hydronephrosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Partially imaged delayed right renal enhancement with moderate\nhydronephrosis.  Recommend CT abdomen pelvis for further evaluation.\n3. Multiple prominent and enlarged right axillary lymph nodes.  Possible\nenlarged left axillary lymph nodes.  Correlation with screening mammography is\nrecommended.\n\nRECOMMENDATION(S):   CT abdomen pelvis for further evaluation of delayed right\nrenal enhancement and right hydronephrosis.\n\nCorrelation with screening mammography."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid unremarkable.  A cluster of\nmildly prominent left supraclavicular nodes appears unchanged.  Prominent\nright axillary lymph node measuring 8 mm in short axis, similar to prior, but\nnot enlarged by size criteria and unchanged.\n\nUPPER ABDOMEN: Please refer to CT abdomen and pelvis from the same day, for\nabdomen/pelvis findings.\n\nMEDIASTINUM: Small anterior mediastinal nodules are also stable.  Right IJ\ncentral catheter terminating at the cavoatrial junction.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  Mild coronary artery\ncalcification.  No pericardial effusion.\nPLEURA: There is a very small right-sided pleural effusion.  No pleural\neffusion on the left.\nLUNG:\n\n1. PARENCHYMA:  Posteromedial right lower lobe atelectasis, similar to prior. \nPleural-based pulmonary micronodule (less than 4 mm) along the superior left\nupper lobe (image 131, series 5), with an adjacent smaller micronodule (image\n127, series 5) both are not significantly changed compared to prior.  No focal\nconsolidation.\n2. AIRWAYS:  Trachea and mainstem bronchi are patent.\n3. VESSELS:  Normal caliber pulmonary arteries.\nCHEST CAGE: Degenerative changes of the thoracic spine.",
            "output": "No definite evidence of acute infectious process involving the chest.\n\nRedemonstrated prominent right axillary lymph nodes, largest measuring 8 mm\nintra axis, previously measured 10 mm in short axis.  Unchanged the group of\nmildly prominent subcentimeter left supraclavicular lymph nodes.  Unchanged\nthe small anterior mediastinal nodule/lymph nodes.\n\nFew small pulmonary nodules demonstrate no short-term change.  Attention in\nfollow-up imaging is recommended."
        },
        {
            "input": "LINES: There is a right-sided double lumen catheter with its tip at the\ncavoatrial junction.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is bibasilar dependent atelectasis.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to dedicated CT of the abdomen pelvis for further\ncharacterization.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No findings on CT chest to explain patient's neutropenic fevers."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Heart is\nborderline in size, unchanged.  No pericardial effusion is seen. \nRedemonstrated right-sided internal jugular central venous catheter with tip\nterminating at the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes are not enlarged by\nsize criteria.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild increased nodularity, new compared to prior suggesting\nminimal ___ opacities in the left lower lobe (series 4, image 19). \nAdditional tiny nodules identified (series 4, image 159, 137, 122, 121, 104,\nand 65) which are indeterminate but mostly new aside from a very small nodule\nat the right apex.  None of these measures over 3 mm.  Otherwise, the lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Very minor focus involving the left lower lobe may suggest aspiration or\ninfectious etiology, in addition to several new scattered bilateral pulmonary\nmicro nodules, clinical significance being uncertain."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  There is a right-sided central line with its tip\nin the SVC.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes have slightly increased in volume\nsince the prior study.  For example a prevascular node measures it previously\nmeasured 6 mm (5, 17).  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a new 4 mm subpleural nodule in the left upper lobe (6, 76). \nThe cluster of tiny nodules in the left lower lobe have resolved.  A 2 mm\nsubpleural left lower lobe pulmonary nodule (6, 143) Is unchanged.  Subtle\nsubpleural nodularity posteriorly in the left lower lobe (6, 169) Is also\nunchanged\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Previously visualized cluster of tiny nodules in the left lower lobe have\nresolved.  These are most likely inflammatory.\n\n4 mm subpleural nodule in the left upper lobe is new and could represent an\nintraparenchymal lymph node.  The 3 mm left lower lobe pulmonary nodule and\nsubpleural nodularity in the left lower lobe is unchanged.\n\nNo new consolidations.\n\nThe mediastinal lymph nodes have slightly increased in size since the prior\nstudy and are most likely reactive.\n\nRight-sided Port-A-Cath with its tip in the SVC."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nPartially imaged thyroid gland is unremarkable.  Mild interval enlargement of\na right axillary 10 mm lymph node, previously was 7 mm (3:23).  Remaining\naxillary lymph nodes are stable.  Stable small thoracic inlet lymph nodes. \nThere are no chest wall abnormalities.  No atherosclerotic calcifications in\nthe head and neck arteries.  A right Port-A-Cath terminates in the lower SVC.\n\nMEDIASTINUM AND HILA:\nMultiple mediastinal lymph nodes larger in the interval, for example in the\nright lower paratracheal station (3:28) or in the prevascular station (3:23). \nNo enlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  Interval development of a moderate\npericardial effusion without evidence of cardiac tamponade.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  Aorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nDiffuse bilateral upper lobe predominant peripheral ground-glass opacities,\nwith associated left greater than right trace pleural effusions.  No lung\nnodules or masses.\n\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Mild biapical pleuroparenchymal\nscarring.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No bone lesions worrisome for\nmalignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals are out of field view.",
            "output": "Consolidations as findings are concerning for acute viral infection.  The\npattern of distribution and associated findings such as bilateral pleural\neffusions, developing moderate pericardial effusion and enlarging mediastinal\nlymph nodes suggest CMV or influenza as first possibilities, however, although\nthe findings are not typical for COVID-19, it should also be considered in the\ndifferentials.\n\nMild interval enlargement of the right axillary 10 mm lymph node, previously\nwas 7 mm.\n\nRight Port-A-Cath ending in the lower SVC.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:28 pm, 3 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CT of the chest with IV contrast:\nThere is no axillary, mediastinal or hilar lymphadenopathy. The pulmonary\narteries are opacified. There is a filling defect in the right lower lobe\npulmonary artery consistent with an embolus. There is atelectasis in the right\nlower lobe. There is a 3 mm nodule in the right middle lobe best seen on\nseries 5, ___ 76 no masses are seen. The depicted portions of the liver,\ngallbladder, spleen, pancreas, adrenal glands and right kidney are\nunremarkable. There is a 6 mm stone in the left kidney that is nonobstructing.\nThis is unchanged from ___",
            "output": "1. Pulmonary embolism to the right lower lobe.\n2. Nonobstructing stone in the left kidney unchanged from ___\n\nNOTIFICATION:   Findings were discussed with Dr. ___ by Dr. ___ at\n15:34 on ___ approximately 30 min after discovery."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The supra-aortic branches are unremarkable.  The\ncontours of the aorta are unremarkable.  The mediastinal fat shows normal\nsized lymph nodes (302, 80).  No mediastinal widening.  No evidence of\ncontrast extravasation.  Normal diameter of the main pulmonary artery.  The\nluminal aspect of the large mediastinal vessels are also unremarkable.  No\nevidence for dissection.  No incidental pulmonary embolism.  No substantial\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nSmall hiatal hernia.  Mildly steatotic liver.  No evidence of splenic lesions.\nSmall bilateral pleural effusions.  Mildly displaced left clavicular fracture\n(302, 21).  Slightly displaced left rib fractures (302, 153).  No right-sided\nrib fractures.  Moderate degenerative vertebral disease and mild scoliosis but\nno vertebral compression fractures.  Mild bilateral apical scarring.  Mild\nleft basal atelectasis but no evidence of pulmonary contusion.  The airways\nare patent.",
            "output": "Slightly displaced left rib fractures, slightly displaced left clavicular\nfracture.  Small bilateral pleural effusions, left more than right, with a\nmild left basilar atelectasis.  No evidence of vascular injury is, in\nparticular no evidence of aortic rupture or dissection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is enlarged.  No pericardial effusion.  Severe atherosclerotic\ncalcifications in all coronary arteries, moderate in the aorta and none in the\ncardiac valves.  Pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nwall thickening.  No bronchiectasis or mucus plugging.  2 mm subpleural nodule\nin the right upper lobe (5:131), 3 mm nodules in the right lower lobe (5:137,\n152) and in the left lower lobe (5:66).\n\nCHEST CAGE:\nModerate dorsal spondylosis and accentuated kyphosis.  No acute fractures.  No\nsuspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show diffuse atherosclerotic disease\nin the intra-abdominal vessels.  Nonobstructive right-sided renal calculus\nmeasuring up to 4 mm.",
            "output": "Severe widespread atherosclerotic disease within the thoracic and abdominal\narteries, notably in all coronaries.\nSmall lung nodules.  See recommendations below.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CTA CHEST:  The aorta and its major branch vessels are patent, with no\nevidence of stenosis, occlusion, dissection, or aneurysmal formation. There is\nno evidence of penetrating atherosclerotic ulcer or aortic arch atheroma\npresent.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nCHEST:  There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy. The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.  There is a calcified granuloma in the right\nmiddle lobe (series 5, image 104).  There are no suspicious pulmonary nodule\nseen.  There is bibasilar atelectasis left greater than right.\n\nLimited views of the upper abdomen demonstrate a small hiatal hernia.\n\nOSSEOUS STRUCTURES:  No lytic or blastic osseous lesion suspicious for\nmalignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bibasilar atelectasis left greater than right."
        },
        {
            "input": "A large, lobulated mass measuring 6.9 and 3.8 by 5.2 cm is present in the\nright upper hemi thorax, involving portions of the right anterior and middle\nmediastinum and extending into the adjacent right upper lobe lung parenchyma\nresulting in marked encasement, narrowing and compression of mediastinal\nvascular structures and right upper lobe bronchovascular structures.  The mass\nextends inferiorly to the level of the the right atrial appendage, and is\nassociated with direct contact with the right superior pulmonary vein which\nappears displaced and slightly narrowed by the mass.  Medially, it is in\ndirect contact with the superior vena cava and ascending aorta infiltrating\nthe mediastinal fat and resulting in compression of the superior vena cava\nwith associated narrowing.  The mass is heterogeneous in appearance with a\ndominant low-density region measuring approximately 3.7 x 2.8 cm with internal\nHounsfield units of 30.  The remainder of the mass demonstrates heterogeneous\nenhancement, particularly along its periphery.\n\nBorderline enlarged right hilar lymph nodes are present.  Heart size is\nnormal, and there is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning abnormalities are identified within this region on this limited\nassessment.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nskeletal lesions.\n\nWithin the lungs, aside from the above described findings in the right upper\nlobe, the remainder of the lungs are clear.",
            "output": "Large, partly necrotic/cystic and heterogeneously enhancing mass centered in\nthe right anterior mediastinum with extension into adjacent right upper lobe,\nwith associated encasement, compression and narrowing of adjacent mediastinal\nand pulmonary bronchovascular structures.\n\nThis most likely represents an aggressive mediastinal neoplasm such as\nmalignant germ cell neoplasm, lymphoma, or high-grade thymic neoplasm.  A\nprimary pulmonary neoplasm with secondary extension into the mediastinum is\nconsidered less likely, particularly in a patient of this age.\n\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 08:19 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Neck/cardiomediastinum:  The thyroid is unremarkable.  There is no axillary or\nsupraclavicular lymphadenopathy.  A right chest port terminates in the right\natrium.  The lymphoma aggregate in the right para aortic region measures 1.4 x\n3.6 cm (6:146), previously measuring up to 5.7 x 3.4 cm.  There are no other\nmediastinal or hilar lymph nodes that meet pathologic size criteria.  The most\nprominent lymph node is in the AP window and measures 8 mm (06:104), similar\nto prior.  The heart is normal in size.  The aorta and pulmonary artery are\nnormal in caliber.  There is no pericardial effusion.\n\nAirways/lung:  The tracheobronchial tree is patent to the subsegmental level. \nThere are no focal parenchymal consolidations.\n\nAbdomen:  Please see CT abdomen and pelvis dated same day.\n\nCardiothoracic cage/soft tissues:  There are no concerning osteoblastic or\nlytic lesions.",
            "output": "Substantial decrease in mediastinal mass size."
        },
        {
            "input": "As compared to ___, and low-density right anterior mediastinal\nlesion appears similar, measuring 3.6 by 1.4 cm (156, 7) similar to the prior\nexam.  More centrally and superiorly in the prevascular space anterior to the\nascending aorta is a rounded low-density with peripheral soft tissue rim,\nwhich appears slightly larger than on the prior study of ___ but is\nsubstantially smaller than on the ___ exam.  The low-density component\npreviously measured 10 x 8 mm in ___ and now measures 13 x 10 mm (127,\n7).  No new sites of nodal disease are evident in the mediastinal, hilar or\naxillary regions.\n\nWithin the lungs, no new concerning abnormalities are evident in the lung\nparenchyma or airways.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1. Continued decrease in size of dominant right anterior mediastinal nodal\nconglomerate.\n\n2. Midline prevascular low-density lesion has minimally increased in size\nsince ___ but remains smaller than in ___.  Consider PET-CT\ncorrelation if warranted clinically.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Previously described right\nanterior mediastinal mass that demonstrated increased FDG avidity has\ndecreased with residual 6 x 7 mm nodule that previously measured approximately\n15 x 12 mm.  Low attenuating rind along the prevascular ascending aorta has\nalso decreased in thickness previously 12 mm now measuring 5 mm.  Slight\nincrease in triangular soft tissue along the left mediastinum since the prior\nexamination may represent thymic rebound series, 2 image 30.  .  No\nmediastinal, hilar, axillary or supraclavicular lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. Right-sided Port-A-Cath\nterminates in the right atrium.  New, heterogeneous linear filling defects in\nthe right internal jugular line superior to the right-sided Port-A-Cath may\nrepresent thrombus.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent. The lungs are clear\nof interstitial or airspace opacity.  2 mm subpleural nodule in the left lower\nlobe is stable in retrospect, series 4, image 198.  No suspicious pulmonary\nnodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "Interval treatment response with decrease in the right anterior mediastinal\nnodal conglomerate and midline prevascular low-density lesion.\n\nNew triangular soft tissue thickening along the left anterior mediastinum is\nlikely thymic hyperplasia and could have follow-up CT thorax in 3 months to\nreassess.\n\nNew linear filling defect in the right internal jugular vein above the right\nPort-A-Cath, and should be correlated with ultrasound to assess for thrombus.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 12:14 ___, 15 minutes after discovery\nof the findings."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Several normal sized lymph nodes in the mediastinum.\nModerate aortic wall calcifications. No substantial coronary or valvular\ncalcifications. No pericardial effusion. The posterior mediastinum is\nunremarkable, with the exception of a small hiatal hernia. No relevant\nabnormalities in the upper abdomen.  No evidence of osteolytic lesions at the\nlevel of the ribs, the sternum or the vertebral bodies. Mild osteoporosis.\nThe severity of symmetrical apical thickening is constant.  The patient\ncontinues to show signs of mild chronic airways disease. Post wedge resection\nat the level of the right upper lobe, with unremarkable staple line.  The lung\nbases, in particular the middle and the lower lobes as well as the lingular\nshow mild bronchiectasis. The very extensive pre-existing bronchial and\nperibronchial opacities, combined to mucous plugging, peribronchial nodules,\nmild interstitial thickening and subtle ground-glass opacities have almost\ncompletely cleared. No major pleural irregularities. No pleural effusions. No\nnew opacities in the lung parenchyma.",
            "output": "Almost complete resolution of the pre-existing bilateral basal bronchocentric\nparenchymal opacities most consistent with healing an MAC infection.  No new\ninfectious foci."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar dependent atelectasis.  There are no focal\nmasses or consolidations.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are unremarkable.\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nThymic tissue is noted in the anterior mediastinum Heart, pericardium and\ngreat vessels are within normal limits. No hiatal hernia is present.\n\nCompared to the prior study the multifocal areas of ground-glass opacity in\nthe left upper and lower lobes have resolved; however there are new\nground-glass opacities in the left upper lobe and lingula. No pleural effusion\nor pneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "Previous multi focal ground-glass opacities in the left upper and lower lobes\nhave resolved; however, there is new ground-glass opacity in the left upper\nlobe and lingula likely related to the same infectious process as the prior\nstudy.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 3:05 ___, 30 minutes after discovery of the\nfindings."
        },
        {
            "input": "The imaged thyroid gland is unremarkable.\n\nHeart size is normal without significant pericardial fluid. Right internal\njugular approach Port-A-Cath tip terminates in the high right atrium. Main\npulmonary artery and thoracic aortic arch are normal in caliber. Involuted\nresidual thymic tissue is noted in the anterior mediastinum. There is no\nsupraclavicular, axillary, hilar or mediastinal lymphadenopathy by CT size\ncriteria.\n\nSmall area of bandlike linear atelectasis in the inferior lingular segment\ncorresponds to findings on yesterday's chest radiograph. Lungs are otherwise\nclear without focal consolidation or nodule. The pleural surfaces are clear\nwithout effusion or pneumothorax. Airways are patent to the subsegmental\nlevel.\n\nWhile the study is not tailored for subdiaphragmatic diagnosis, note is made\nof diffuse hypoattenuation of the liver compatible with steatosis.\n\nOsseous structures: There is no suspicious focal osseous lesion.",
            "output": "1. Focus of bandlike linear atelectasis in the inferior lingular segment\ncorresponds to findings on yesterday's chest radiograph. No evidence of\npneumonia.\n2. Hepatic steatosis."
        },
        {
            "input": "HEART AND VASCULATURE: There are filling defect in a subsegmental right lower\nlobe pulmonary artery branches (e.g.  3:137).  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Right chest wall\nPort-A-Cath device terminates in the superior right atrium.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild centrilobular emphysema.  Mild dependent atelectasis\nbilaterally.  Lungs otherwise clear.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for interval\nincrease in size and number of multiple hypoenhancing hepatic masses\nconcerning for metastases.  The largest in segment 2 measures up to 5.1 x 3.6\ncm, previously up to 3.2 cm.  There is also worsened intrahepatic biliary\ndilation.  Pancreatic tail mass measuring up to 2.5 cm appears increased in\nsize compared to prior when it measured up to 2.1 cm.  Abnormal soft tissue in\nthe porta hepatis is only partially visualized, likely representing\nlymphadenopathy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Subsegmental right lower lobe pulmonary emboli.\n2. Interval increase in size of a 2.5 cm pancreatic tail mass.\n3. Interval increase in size and number of multiple hepatic metastatic\nlesions, though only partially assessed."
        },
        {
            "input": "The thyroid gland is unremarkable.\n\nAtherosclerotic calcifications identified within the aortic arch, three-vessel\ntakeoff, aortic valve and coronary vessels. No intrathoracic aortic aneurysm\nor indirect evidence of dissection identified with maximal ascending aortic\ndiameter of 34mm.  Heart size is not enlarged and without pericardial\neffusion.\n\nThere is no axillary or supraclavicular lymphadenopathy.  Multiple scattered\nupper mediastinal lymph nodes are prominent in number but not pathologically\nenlarged, nor significantly changed.\n\nThe craniocaudal extent of esophageal wall thickening is difficult to assess\ngiven intraluminal fluid.  The most prominent circumferential thickening is\nwithin the subcarinal region with local extension of both tumor and adjacent\nconfluent adenopathy into the posterior mediastinum exerting stable mild mass\neffect on the descending thoracic aorta. Aggregate diameter of the esophageal\nmass and adjacent adenopathy measures 28 x 54 mm compared to 27 x 53 mm on the\n___ (5:160).  However, this measurement is exaggerated by gaseous\nexpansion of the esophagus and does not reflect the partial restoration of\nperiaortic fat planes. Individual mediastinal paraaortic lymph nodes are\nstable in size with representative measurement of a paraaortic lymph node of\n12mm (5:219).\n\nThe airways are patent to the subsegmental level.  Patient is status post\n\nright upper lobectomy.  On a background of severe centrilobular and paraseptal\nemphysema, there is decrease in size of the left upper lobe nodule measuring\n23 x 17 mm compared to 24 x 22 mm on prior (5:169) and the left lower lobe\nnodule measuring 3 x 7 mm compared to 5 x 7mm 5:214). A right lower lobe\nnodule measures 4 x 2mm decreased from 4 x 3 mm (5:249).  A 3 x 3 mm right\nlower lobe nodule has decreased in size from 5 x 4 mm (5:193).   The left\nsubpleural nodule measuring 7 mm is stable in size but demonstrates a notable\ninterval decrease in density, now ground-glass  (5:157).\n\nThere are no lytic or blastic bone lesions in the chest cage or soft tissue\nlesions in the chest wall suspicious for malignancy\n\nPlease refer to CT abdomen and pelvis done today for evaluation of the\n\nintra-abdominal structures.",
            "output": "1.  No clear change in size of locally invasive subcarinal esophageal mass;\nhowever there is slight interval restoration of surrounding fat planes.\nMediastinal lymphadenopathy is unchanged.\n\n2.  Interval decrease in size and/or density of all bilateral pulmonary\nnodules with most marked change in the dominant left upper lobe nodule. The\nappearance and singular response of that mass is more characteristic of a\nconcurrent bronchogenic carcinoma rather than metastatic esophageal carcinoma."
        },
        {
            "input": "The thyroid is normal.\n\nSupraclavicular and axillary lymph nodes are not pathologically enlarged\naccording to CT size criteria. Mediastinal and hilar lymph nodes are unchanged\nsince ___, the largest in the subcarinal station (series 04:  Image 30)\nwith short axis of 9 mm.  Also the aortic lymph nodes are unchanged since\n___, the largest in the right para-aortic space (04:42) which has a\nshort axis diameter of 13 mm.\n\nThe esophagus persists homogeneously thickened, especially in the lower third,\nright below the subcarinal space (04:33).\n\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.\n\n\n\nThere is no pericardial or pleural effusion.\n\n\n\nLUNG AND AIRWAYS\n\nPatient has had right upper lobectomy.  The bronchial stump has normal\nappearance without evidence of local recurrence. Airways are otherwise patent\nto subsegmental level bilaterally. Severe centrilobular and paraseptal\nemphysema are unchanged.\n\nLeft upper lobe juxta-hilar dominant lesion (05:163) has further decreased\nsince ___ measuring 1.2 x 1.6 cm was 1.4 x 2.1 cm. Left lower lobe\nnodule (05:20 1) is also smaller since ___ measuring 2 x 4 mm, was 3 x\n7 mm. Second left lower lobe nodule (05:139) is smaller since ___\nmeasuring 4 mm was 9 mm. Previously described right lower lobe nodule has\nresolved . There are no new lung nodules.  Area of parenchymal scarring with\ntraction bronchiectasis in the right middle lobe is unchanged since ___\n(05:151).\n\n\n\n\n\n\n\nUPPER ABDOMEN\n\nAbdominal findings are described in report of concurrent CT abdomen and pelvis\nclip ___.\n\n\n\n\n\nOSSEOUS STRUCTURES\n\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. All lung nodules have further decreased since ___, and a right lower\nlobe nodule described in ___ has disappeared.\n2. Patient has had a right upper lobectomy, the bronchial stump is\nunremarkable.\n3. Esophageal wall thickening, due to known malignancy, and mild\nlymphadenopathy are unchanged since ___"
        },
        {
            "input": "There is substantial interval progression of the bowel of the primary and\nmetastatic disease involving both mediastinum and lungs. Within the\nmediastinum there is interval increase of the left upper mediastinal lymph\nnode, series 5, image 17 from 5.5 mm to 18.6 mm, there is interval increase in\nthe bowel cough the tumor are surrounding the esophagus, series 5, image 35,\ncurrently approaching 6.2 by 3.2 cm with new invasion of the left atrium,\nseries 5, image 37 and patent esophageal lumen up to 1 cm in diameter, series\n5, image 37.  No evidence of esophageal obstruction is currently seen. There\nis bulk of the right hilar lymph nodes approaching 1.5 cm, new.\n\nThere is interval increase in the left upper lobe nodule, from 19 x 13 mm to\n27 x 32 mm, in the right lower lobe nodule, from 3-9 mm, in the left lower\nlobe nodule from 6-15 mm. There is a partially imaged interval substantial\nincrease in the liver metastasis, series 5, image 54 that will be assessed\nseparately as part of the CT abdomen\n\nAirways are patent to the subsegmental level bilaterally. The patient is after\nright upper lobectomy with predicted mediastinal shift\n\nAorta and pulmonary arteries reveal no appreciable abnormality and there is no\npericardial or pleural effusion.",
            "output": "Substantial progression of the disease involving mediastinum, lungs and liver\nas described seen details. For pre size assessment of the abdominal findings\nplease review CT abdomen and the corresponding report\n\nNo evidence at this point of esophageal obstruction\n\nInvolvement of the stomach potentially but these esophageal mass.\n\nNew involvement of the left atrium/left lower lobe pulmonary vein by the\ntumor."
        },
        {
            "input": "CT CHEST WITH CONTRAST: The thyroid is unremarkable. There is no\nsupraclavicular, or axillary lymphadenopathy.\n16 x 10 mm right lower paratracheal node previously measured 13 x 7 mm\n(5:110).\n17 x 16 mm subcarinal node (5:128) previously measured 14 x 11 mm.\n22 x 13 mm right hilar node (5:129) previously measured 17 x 8 mm.\n\nThe heart is not enlarged.  There is no pericardial effusion. Aorta and main\npulmonary arteries are normal in caliber. There are scattered atherosclerotic\ncalcifications of the coronary arteries.\n\nThere is no pleural effusion or pneumothorax. There are mild retained\nsecretions in the upper trachea. Moderate centrilobular emphysema is most\nprominent at the lung apices, right greater than left. There is increasing\nabnormal peribronchial soft tissue in the right hilum extending along right\nmiddle lobe and right lower lobe lobar and segmental branches. There is more\nconsolidated opacity at the posterior aspect of the right upper lobe which has\nworsened since ___ (08:24- 35). There is atelectasis in the right\nmiddle lobe, lingula and bases, right greater than left. There are scattered\nground-glass opacities at the left base possibly reflecting pneumonia. Prior\nopacities and areas of atelectasis in the right lower lobe are improved.\n\nA 3 mm nodule in the right middle lobe (5:183) is unchanged. Irregular\nsomewhat elongated 5 mm opacity in the lingula may be new, likely atelectasis\n(5:227). 7 mm right lower lobe (5:230) and 3 mm subpleural right lower lobe\n(5:177) nodules may have been present on the prior study but obscured by\natelectasis. There are multiple scattered granulomas suggest in the right\nupper lobe (10:9).\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions.\n\nThis study is not designed for assessment of the subdiaphragmatic structures.\nWithin this limitation the partially visualized stomach and solid organs are\nunremarkable.",
            "output": "1. Abnormal soft tissue in the periphery of the right lung is increased with\nassociated peribronchial soft tissue in the adjacent hilum suspicious for\nmalignancy. Transbronchial biopsy is recommended.\n2. Enlarging mediastinal and right hilar lymphadenopathy.\n3. Ground-glass opacities at the left base may reflect pneumonia in the right\nclinical setting.\n\nNOTIFICATION:   The findings were telephoned to Dr. ___ by\n___ at 545 ___, ___, 30 min after discovery."
        },
        {
            "input": "Visualized portions of the thyroid gland are normal. A single 8 x 9 mm right\nparatracheal lymph node is identified, and appears decreased in size as\ncompared to prior examination, previously measuring 16 x 10 mm (series 5,\nimage 112). A right-sided hilar lymph node now measures 18 x 10 mm, previously\nmeasuring 22 x 13 mm (series 5, image 134). Subcarinal lymph node has also\ndecreased in size (series 5, image 129). The esophagus is unremarkable. The\nthoracic aorta is normal in caliber with a typical 3 vessel takeoff from the\narch. The pulmonary arterial trunk is normal in caliber. The heart is normal\nin size without pericardial effusion.\n\nNote is made of multiple collaterals in the left upper chest wall.\n\nAgain seen is moderate centrilobular emphysema, most prominent at the lung\napices. Previously described peribronchial soft tissue in the right hilum,\nextending to the right middle and right lower lobe has improved as compared to\nprior CT. Ground-glass opacities in the left lower lobe however are again\nseen, some appear new. Additionally, note is made of cylindrical\nbronchiectasis at the left lower lobe which in conjunction with aforementioned\nground glass opacities is suggestive of recurrent aspiration pneumonia (series\n5, image 215). There is redemonstration of a 4 mm pulmonary nodule in the\nright apex (series 5, image 93). 4 mm nodule in the right middle lobe and 7 mm\nnodule in the right lower lobe are stable (series 5, image 196, 230).  A\nsmaller 2 mm subpleural nodule in the right lower lobe is unchanged (series 5,\nimage 177). The tracheobronchial tree is patent to the subsegmental levels.\nThe airways are normal in caliber. Scattered small calcified granulomas are\nagain seen. There is no pleural effusion or pneumothorax.\n\nNo blastic or lytic lesion suspicious for malignancy is present.\n\nAlthough this study is not tailored for evaluation of subdiaphragmatic\nstructures, evaluation of the upper abdomen is unremarkable.",
            "output": "1. Interval improvement of previously described peribronchial soft tissue in\nthe right hilar region and interval decrease in the mediastinal and right\nhilar lymph nodes, likely reflective of an infectious etiology which is now\nresolved.\n\n2. Persistent ground glass opacities in the left lower lobe some of which are\nnew since prior, with cylindrical bronchiectasis, findings are suggestive of\nrecurrent aspiration pneumonia."
        },
        {
            "input": "Subcentimeter mediastinal lymph nodes are present, including a 7 mm short axis\nlower right peritracheal note that previously measured 9 mm.  Borderline 10 mm\nright hilar lymph nodes are unchanged.  Heart size is normal, and diffuse\ncoronary artery calcifications are present.  There is no pericardial or\nsubstantial pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning findings are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.\n\nWithin the lungs, a 4 mm right middle lobe nodule (199, 5) a 2 mm right lower\nlobe nodule (190, 5), a 6 mm right lower lobe nodule (239, 5) And a 4 mm right\nupper lobe nodular opacity (102, 5) remain unchanged.  Nonspecific\ncentrilobular ground-glass opacities in the left lower lobe are again\ndemonstrated, some of which have a branching pattern suggestive of small\nairways disease. Adjacent areas of cylindrical bronchiectasis are again\ndemonstrated. Multifocal linear scarring and volume loss in the right lung are\nsimilar to the prior study. Upper lobe predominant emphysema also appears\nunchanged as well as nonspecific peripheral scarring in the right upper lobe.",
            "output": "1.  Further decrease in size of right peritracheal lymph node and stable\nborderline right hilar lymph nodes, which could previously decreased in size\ncompared to earlier CT.  As noted on the ___ report, these are\nlikely hyperplastic nodes.\n\n2.  Unchanged pulmonary nodules.\n\n3. Persistent left lower lobe centrilobular ground-glass opacities and mild\ncylindrical bronchiectasis suggesting the possibility of recurrent aspiration"
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the subsegmental\nlevel without filling defect to suggest pulmonary embolism. Pulmonary arteries\nare normal in caliber.\n\nA centrally hypodense likely necrotic left hilar lymph node is seen, measuring\n2.5 x 1.6 cm (2:50) is new since prior CT.  This lesion causes secondary\nnarrowing of 1 of the traversing pulmonary artery branches.  Diffuse\ncentrilobar emphysematous changes are noted as well as diffuse bilateral\nbronchiectasis with a lower lobe predominance.  Mucous plugging is identified\nat the left lung base.\n\nIn the left lower lobe, there is a peripheral wedge shaped density with\nirregular margins abutting the pleura measuring 2.7 x 1.3 x 1.6 cm.  This is\nseen in the region of prior infection.  Although some could be scarring given\nprior infection, the additional finding of necrotic hilar lymphadenopathy\nraises possibility of underlying malignancy.  Right middle lobe nodule is\nagain seen (2:73), unchanged in size from ___.  There is no\npleural effusion or pneumothorax.\n\nHeart is unremarkable.  Coronary artery calcifications are seen.  There is no\npericardial effusion.  There is no supraclavicular, axillary, mediastinal, or\nright hilar lymphadenopathy. Included portion of the thyroid is unremarkable.\n\nA new incompletely characterized ill-defined lesion is identified in right\nlobe of the liver (2:83).  Otherwise, the remaining portion the upper abdomen\nis unremarkable.\n\nA new lytic focally expansile lesion of the right lateral seventh rib (2:95). \nNo definite other focal osseous lesion is identified.  There is no fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Evidence of malignancy with metastatic disease including left hilar\nnecrotic adenopathy, right rib lesion and suspicious but incompletely\ncharacterized liver lesion.\n3. Relatively linear somewhat spiculated density at the periphery of the left\nlower lobe of the lung in region of prior infection, potentially scarring,\nalthough underlying malignancy in this region cannot be excluded.\n\nRECOMMENDATION(S):  Additional imaging of the abdomen should be considered to\nfurther evaluate liver lesion and possibility of additional lesions. \nAlternatively PET-CT may offer additional information."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts, there are no soft tissue abnormalities in the chest wall suspicious\nfor malignancy.  Heterogeneous enlargement of the left thyroid lobe, 16 x 24\nmm, and 19 x 21 mm, was 17 x 20 mm and 18 x 22 mm in ___.  Trachea is\ndisplaced slightly to the right but not appreciably narrowed.  Atherosclerotic\ncalcification is not apparent in head and neck or coronary arteries.  Aorta\nand pulmonary arteries are normal size.  Small pericardial effusion is\nunchanged since ___.  There is only a small residual right pleural\neffusion.  There is either a small hiatal hernia or epiphrenic esophageal\ndiverticulum.\n\n\nMediastinal lymph nodes are enlarged as follows, right upper and 8 mm,\npreviously 7 mm PET CT ___ ; subcarinal, 13 mm, previously\nsmaller but unmeasurable.  For no FDG positive lymph nodes were reported on\nthe PET CT.\n\nHypoattenuation of cardiac contents is consistent with anemia.\n\nExtensive, multifocal appear peribronchial infiltration is present in both\nright upper and lower lobes, more severe in the lower where there is also soft\ntissue component, probably consolidation or atelectasis.  The abnormality is\nprobably infectious, more likely virus or mycoplasma than bacterial.  Fungus\nis not all excluded, but less likely.\n\nThere no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Multifocal infection, right lower and upper lobes, more likely atypical than\nbacterial, probably responsible for slight increase in size of minimally\nenlarged mediastinal lymph nodes.\n\nStable small pericardial effusion.\n\nNOTIFICATION:   Dr. ___ reported the findings to ___  by\ntelephone on ___ at 4:23 ___, 2 minutes after discovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  Heart is\nmildly enlarged.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is diffuse mild airway bronchial thickening and subtle centrilobular\nnodular opacities in a ___ distribution throughout the lungs\nbilaterally.  No focal consolidation is demonstrated.  Minimal atelectasis\nseen in the medial right lower lobe.  The airways are otherwise patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen show cholecystectomy clips.  No gross\nabdominal abnormalities otherwise seen.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nAnterior bridging osteophytes are seen in the mid thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Diffuse mild airway wall thickening and subtle centrilobular nodular\nopacities throughout the lungs bilaterally, findings suggestive of small\nairways infectious or inflammatory disease.  Respiratory\nbronchiolitis-interstitial lung disease should be considered if the patient is\nan active smoker."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma but contains calcifications.  Aortic valve calcifications\nare seen.  There is mild cardiomegaly.  The pericardium and great vessels are\nwithin normal limits. No pericardial effusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: There are prominent mediastinal lymph nodes,\nlikely reactive, without evidence of lymphadenopathy by size criteria.  No\naxillary or hilar lymphadenopathy is present.  No mediastinal mass.\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis with mild bibasilar\nbronchial wall thickening.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild hepatic steatosis noted.  A tiny hypodensity at the\nsuperior aspect of segment 2 likely represents a small cyst.  No concerning\nlesions.  No intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains a gallstone without CT signs of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is been interval increase in the infrarenal abdominal aortic\naneurysm now measuring 4.9 x 4.5 cm, located just craniad to the iliac artery\nbifurcation. No evidence of leak.  Moderate atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is marked laxity of the abdominal wall with outpouching\nof stomach and bowel and no evidence of obstruction or incarceration.  No\nfrank hernia.",
            "output": "1. Interval increase of known infrarenal abdominal aortic aneurysm, now\nmeasuring 4.9 x 4.5 cm.\n2. No evidence of pulmonary embolus or acute aortic process.\n3. Marked laxity of the anterior abdominal wall with large outpouching and no\nfrank hernia.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ in ___ ___ at 11:32 am, 20 minutes after discovery\nof the findings."
        },
        {
            "input": "Heart is mildly enlarged without significant pericardial effusion.  There are\nmoderate coronary artery calcifications.  There are mild atherosclerotic\ncalcifications along a normal caliber thoracic aorta without aneurysm or\ndissection.  The pulmonary arteries are borderline in caliber, and there is no\ngross filling defect to the proximal segmental level, with more distal\nevaluation limited by extensive respiratory motion artifact.\n\nThere is no supraclavicular, axillary, hilar, or mediastinal lymphadenopathy\nby CT size criteria.\n\nThere is moderate dependent atelectasis in the lung bases.  Several areas of a\nmixed density and ground-glass attenuation are noted in the right upper lobe,\nnew compared the prior examination.  Mild emphysema is noted.  There is no\neffusion or pneumothorax.  No definite isolated pulmonary nodule is seen,\nthough evaluation is limited by the motion artifact.\n\nAlthough this study is not tailored for subdiaphragmatic analysis, the\nvisualized upper abdomen demonstrates no gross acute abnormality.  A\nsubcentimeter hypodensity in the left hepatic lobe is too small to\ncharacterize, though likely represents a cyst or a biliary hamartoma.\n\nThere is no acute fracture or suspicious focal bone lesion.",
            "output": "1. Motion degraded examination without acute aortic syndrome or pulmonary\nembolus to the proximal segmental level.  More distal evaluation is precluded\nby the extensive respiratory motion.\n2. Irregular areas of mixed ground-glass opacities in the right upper lobe,\nlikely infectious or inflammatory."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show no significant\nabnormal findings.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  Surgical clips in the mediastinum,\nwith thickened soft tissue around the trachea and main bronchi, larger than in\n___.  Right lower paratracheal enlarged lymph node measuring 1.1 cm,\nlarger than in ___.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion. \nModerate atherosclerotic calcifications in coronary arteries and mild in\nthoracic aorta.\nPLEURA: No pleural effusions.  Multiple surgical clips in the right apex, with\npleural thickening.\nLUNG:\n\n1. PARENCHYMA:  Unchanged appearance of right upper lobe wedge resection, with\na small rounded atelectasis associated.  Mild centrilobular and paraseptal\nemphysema.  New 3 mm nodule in the right upper lobe (302:63) and a 5 mm nodule\nin the posterior segment of the same lobe (302: 48).\n2. AIRWAYS:  New small nodularity in the carina measuring 4 mm.  Mucous\nsecretions in the right main bronchus and moderate diffuse wall thickening,\nnotably in the right upper bronchi.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "New endobronchial nodule and pulmonary nodules in the right upper lobe since\n___.  These are suspicious for disease recurrence.\n\nThicker soft tissue surrounding trachea and main bronchi can be post radiation\nchanges or even related to local malignancy recurrence."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary, or\nhilar lymphadenopathy.  A 10 x 17 mm pretracheal lymph node (05:40) is\nunchanged since ___. The aorta and pulmonary arteries are normal in\nsize. Coronary artery calcifications (05:52) and moderate aortic valve and\nannular calcifications (05:58) are again noted.  The heart size is normal and\nthere is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: Postsurgical changes related to left upper lobectomy in ___ are\nstable, with mediastinal sutures and normal appearance of the left upper lobe\nbronchial stump (6:95). A small amount of aerosolized secretions in the upper\ntrachea are noted (06:40). Right upper lobe predominant bronchiolar nodular\nopacities (6:95) and mild bronchial wall thickening are again noted. No\ndominant nodule or mass is identified.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.  Degenerative changes in the\nupper lumbar spine are again noted.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Stable postsurgical appearance following left upper lobectomy with no\nevidence of new or recurrent intrathoracic malignancy.\n2. Right upper lobe predominant bronchiolar nodules are stable since ___, likely due to underlying respiratory bronchiolitis or hypersensitivity\npneumonitis.\n3. Moderate atherosclerosis of the coronary arteries and aortic valve."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  A right lower paratracheal lymph node measures 1.0 cm\nin short axis, smaller compared to the most recent prior exam (series 3, image\n22).  A subcarinal lymph node is also smaller than on the prior exam, now\nmeasuring 8 mm in short axis (series 5, image 134) Aorta and pulmonary\narteries are normal size.  Minimal atherosclerotic changes of the\nbrachiocephalic and left subclavian arteries is noted.  Cardiac configuration\nis normal and there is moderate coronary artery and aortic valve\ncalcification.\n\nAirways are patent to the subsegmental levels bilaterally. The left hilum and\nbronchial stump site is stable after left upper lobectomy. Right upper lobe\npredominant peribronchiolar nodular opacities are minimally improved compared\nto the most recent prior exam and may be associated with respiratory\nbronchiolitis. A calcified granuloma is incidentally noted in the right upper\nlobe (series 5, image 115).    No new suspicious pulmonary nodules or masses\nare visualized.  There is no evidence for pneumonia.  There is no pleural\neffusion or pneumothorax.\n\nA hyperdense nodule, likely partly calcified, adjacent to the posterior right\nkidney is stable, measuring 7 mm (series 5, image 345) The visualized portion\nof the upper abdomen is otherwise unremarkable in appearance.  No suspicious\nlesion is seen the visualized osseous structures.  Obliteration of the L1-L2\ndisc space is worsened compared to the most recent prior exam.",
            "output": "1.  No evidence of malignancy in the chest.\n2.  Stable peribronchiolar nodules, predominantly in the right upper lobe,\ncompatible with persistent respiratory bronchiolitis or other cause of small\nairway inflammation.\n3.  Continued obliteration of L1-L2 disc space with partial ankylosis of the\nL1 and L2 vertebral bodies.  This may represent worsening degenerative change\nbut would be better characterized by MR if clinically indicated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneous.  Interval\nincrease in prominence of a 1.2 x 0.9 cm left supraclavicular lymph node\n(___), which demonstrated FDG uptake on recent PET-CT.  Interval increase in\nprominence of a 2.1 x 1.6 cm left infraclavicular lymph node (___), which\nalso demonstrated FDG uptake on recent PET-CT.\n\nUPPER ABDOMEN: There is a partially visualized gastrostomy tube which appears\nto be in appropriate position.  Small hiatus hernia.  The esophagus is\nthickened and dilated with food contents.  The distal esophagus is thickened,\nmeasuring 2.5 x 2.6 cm.  Please see same-day separately dictated CT abdomen\nand pelvis for other findings.\n\nMEDIASTINUM: There is an unchanged 2.0 x 1.3 cm right paratracheal lymph node\n(___) and an unchanged 1.3 x 1.1 cm left paratracheal lymph node (___). \nThere are multiple prominent, though nonenlarged, mediastinal lymph nodes. \nThere is continuous infiltrative adenopathy, extending from the lower\nparatracheal station inferiorly, which causes severe narrowing of the left\nlower lobe bronchus (___).  This adenopathy, which may partially represent\nesophageal metastases, demonstrates FDG uptake on recent PET-CT.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: There is calcification of the LAD and aortic valve and\ntrace calcification of the aortic arch and great vessels.\nPLEURA: There is a new 1.7 x 1.4 cm hyperdense lesion in the left pleura\n(___), concerning for pleural metastasis.  There is a small - moderate\nnonhemorrhagic left pleural effusion.  No right pleural effusion.  No\npneumothorax.  There are punctate calcifications layering along the left\nlateral pleura, which may represent sequelae of pleurodesis.\nLUNG:\n\n1. PARENCHYMA:  There are a few right apical blebs.  There is a new 0.9 x 0.5\ncm spiculated nodule in the left lower lobe (___), concerning for\nmetastasis.  There are scattered ground-glass nodules in the right upper lobe,\nlikely representing inflammation or infection (for example, ___/\n___)).  There is an unchanged 0.3 cm punctate calcified nodule in the right\nupper lobe (___), likely representing a calcified granuloma.  Unchanged\npostsurgical changes from left upper lobe VATS.  There is left basilar\natelectasis.\n2. AIRWAYS:  The previously seen adenopathy/ esophageal metastases again\ncauses narrowing of the left lower lobe bronchus.\n3. VESSELS:  No evidence of pulmonary embolism on this non PE protocol study.\nCHEST CAGE: No destructive focal osseous lesions concerning for malignancy\nwithin the imaged thoracic skeleton.  There are multilevel degenerative\nchanges of the visualized spine.",
            "output": "1. There is a new 0.9 x 0.5 cm spiculated nodule in the left lower lobe,\nconcerning for metastasis.\n\n2. There is a new 1.7 x 1.4 cm hyperdense lesion in the left pleura,\nconcerning for pleural metastasis.\n3. Interval increase in prominence of contiguous infiltrative\nadenopathy/esophageal metastases extending from the lower paratracheal station\ninferiorly, which causes severe narrowing of the left lower lobe bronchus. \nThere is left basilar atelectasis without lobar collapse.\n4. Interval increase in prominence of multiple supraclavicular,\ninfraclavicular and mediastinal lymph nodes, all of which demonstrated FDG\nuptake on recent PET-CT.\n5. There is scattered ground-glass opacity in the right upper lobe, likely\nrepresenting inflammation or infection."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Small lesion in the lower aspect of\nleft lobe of thyroid appears similar compared to prior.  Left supraclavicular\nlymph nodes (5, 5) appear similar compared to prior.  No axillary adenopathy. \nNo gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.  Note is made of a gastrostomy\ntube in situ.\n\nMEDIASTINUM: Distended esophagus containing food residue proximal to the lymph\nnode mass/ complex at the level of the carina.  The central mediastinal lymph\nnode complex just inferior to the carina is slightly decreased in size\ncurrently measuring 44 x 42 mm in the axial plane (previously 48 x 42 mm) (6,\n120).  This central lymph node mass complex obstructs the esophagus, encases\nand attenuates the left main bronchus and the upper lobe and lower lobe\nsegmental bronchi and the left pulmonary artery.  There is loss of the tissue\nplane between this mass and the proximal descending thoracic aorta, but no\nclear infiltration.  The lymph node posterior to the descending aorta (6159)\nis slightly increased in size compared to prior.  Small hiatal hernia and wall\nthickening of the distal esophagus.\n\nHILA: Left hilar lymphadenopathy appears relatively similar compared to prior.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  Trace\npericardial effusion.  Moderate aortic annular, mild aortic valve\ncalcification.  Mild coronary artery calcification.  No aneurysmal dilatation\nof the ascending aorta.\nPLEURA: Small left-sided pleural effusion is slightly decreased in size\ncompared to prior.\nLUNG:\n\n-PARENCHYMA:  There is diffuse peribronchial ground-glass and nodular airspace\nopacification involving all lung lobes suggesting bronchopneumonia, aspiration\npneumonia particularly given the peribronchial nodules in the dependent right\nlower lobe and retention of material in the very dilated esophagus.  New\nnodular interstitial thickening emanating from the left hilum could be\ninfectious or lymphovenous obstruction, including direct lymphangitic\ncarcinomatosis.\n-AIRWAYS:  Attenuation (but not complete obstruction) of the distal left main\nbronchus as well as the upper and lower lobe segmental bronchi by the central\ncentral lymph node complex.  Evidence of prior lingulectomy.\n-VESSELS:  The left pulmonary artery is encased by the central lymph node\ncomplex.  No obvious filling defects to suggest thrombosis.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "The central subcarinal lymph node complex is slightly decreased in size\ncompared to prior (currently measuring 44 mm in the AP plane, previously\nmeasuring 48 mm).  The left hilar, paratracheal and left supraclavicular lymph\nnodes appear relatively similar compared to prior; compromise of vital\nstructures unchanged is detailed above.  A single lymph node posterior to the\ndescending aorta is slightly increased in size.\n\nExtensive peribronchial airspace opacification suggest pneumonia.  The\ndistinctly peribronchial nodular opacifications in the dependent aspect of the\nright lower lobe, in the setting of the distended esophagus suggests\naccelerating aspiration and aspiration pneumonia.\n\nNodular interstitial thickening adjacent to the left hilum could be due to\nlung infection or lymphovenous obstruction, including direct lymphangitic\ncarcinomatosis.\n\nSmall left pleural effusion is slightly decreased in size compared to prior."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nLeft supraclavicular adenopathy appears relatively similar compared to prior\n(4, 32) no axillary adenopathy.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Right upper paratracheal lymph nodes (4, 58) are increased in\nsize currently measuring 28 x 17 mm (22 x 12 mm previously).  The subcarinal\nlymph nodes complex measuring 42 x 41 mm is similar compared to prior imaging.\nAttenuation of the left main bronchus and proximal left segmental bronchi\nappear similar compared to prior.  The esophagus appears infiltrated and\nnarrowed at the subcarinal level with proximal distention appearing relatively\nsimilar compared to prior.  Retroaortic descending aortic lymph nodes appear\nsimilar compared to prior.\n\nHILA: Left hilar soft tissues appear similar compared to prior.\n\nHEART and PERICARDIUM: Ballooning of the left ventricle suggesting prior LAD\ninfarction.  No pericardial effusion.  Moderate aortic valve calcification. \nNo aneurysmal dilatation of the ascending aorta.  No clear soft tissue plane\nbetween the descending aorta and the lymph node mass at the subcarinal level.\nPLEURA: Small left-sided pleural effusion is decreased in size compared to\nprior\nLUNG:\n\n1. PARENCHYMA:  The extensive bronchus centric nodules and opacities or appear\nmildly improved compared to prior.  The previously noted nodular lymphatic\nthickening in the left lower lobe is also improved.  Parahilar consolidation\nin keeping with postradiation changes are again noted.\n2. AIRWAYS:  Partial attenuation of the left main bronchus and proximal\nsegmental bronchi appear similar compared to prior.  Evidence of prior left\nupper lobectomy.\n3. VESSELS:  The pulmonary arteries not dilated.  No obvious filling defects\non this nondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions to suggest metastatic disease.",
            "output": "The subcarinal lymph node complex appears similar in size compared to prior.\nRight upper paratracheal lymph nodes are slightly increased in size.  Lymph\nnodes posterior to the descending thoracic aorta and left supraclavicular are\nunchanged.\nAttenuation of pericarinal structures are essentially unchanged.  Distended\nesophagus unchanged.\n\nMultifocal bronchus centric nodules and pulmonary opacities appear slightly\nimproved compared to prior.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis last evaluated by\na CT of the abdomen on ___, but shows no adrenal mass.\n\nThere are no thyroid abnormalities warranting further imaging evaluation.\n\nAtherosclerotic calcification is mild to moderate in head and neck vessels,\npresent also in at least left anterior descending coronary artery.  Aortic\nvalvular calcification is moderate to severe.  Aorta and pulmonary arteries\nand cardiac chambers are normal size.  Small pericardial effusion is slightly\nlarger today than on ___.  There is no pleural effusion.  Mild left\npleural thickening is stable.\n\nEsophagus once again is moderately distended with air and fluid to the  level\nof subcarinal adenopathy, and is a likely source of chronic aspiration. \nDistally it is generally thicker walled today than before, perhaps a function\nof inflammation due to chemotherapy or radiation.\n\nLymph nodes:\n\n18 mm wide conglomerate, right upper paratracheal station, 03:13, minimally\nlarger compared to ___.\n\nSubcentimeter right lower paratracheal station, 03:21, also minimally larger.\n\nLarge conglomerate of infiltrative adenopathy extending from the left lower\nparatracheal station to the subcarinal and upper paraesophageal stations and\ninto the left hilus, encasing and moderately narrowing the left main bronchus\nand postoperative remainder of the left bronchial tree is stable since ___.\n\n11 mm retroaortic node, 03:31, unchanged.\n\nLungs:\n\nExtensive peribronchovascular ground-glass abnormality, right upper lobe has\nworsened substantially, 5:61-134.  More discrete bronchiolar micro nodularity\nin the right middle lobe has also progressed.  Micro nodularity at the left\nlung base is relatively mild and unchanged since previous study.\n\nChest cage:\n\nGeneralized heterogeneity throughout the chest cage is due at least in part to\nsevere osteopenia.  Although there are no large destructive bone lesions,\npathologic or severe compression fractures, early metastases would go on\nnoticed.",
            "output": "Significant acceleration and spread of predominantly right upper lobe broncho\npneumonia.  Given the esophageal impairment and likely continued aspiration,\nthat would be the most probable explanation, but the distribution is non\ndependent and other possibilities should be considered, including hospital\nacquired bacterial pneumonia and viral infection.  Widespread bronchiolar\nnodulation well-established is attributable to chronic aspiration.\n\nMinimal growth in the non dominant areas of mediastinal lymph node enlargement\nare more likely due to inflammation than malignancy.  Chronic, treated tumor,\nleft hilus unchanged."
        },
        {
            "input": "10 mm left supraclavicular lymph node was 9 mm in on ___ mm on ___. right supraclavicular and axillary lymph nodes are not enlarged and there\nis no soft tissue abnormality in the chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head neck vessels, not apparent in\ncoronary arteries.  Aortic valvular calcification is mild.  Aorta and\npulmonary arteries are normal size.\n\nEsophagus is moderately distended above the level of enlarged subcarinal lymph\nnodes, and may be severely compromised.  Lower esophagus is the distended\nabove the nodular wall thickening at the gastroesophageal junction, 04:49.\n\nThere is no pericardial or right pleural effusion.  Small nonhemorrhagic\nlayering left pleural effusion ranges in attenuation from ___ ___,\nprobably not a simple transudate.\n\nLymph nodes:\n\nExtensive mediastinal adenopathy involving both upper paratracheal, right\nlower paratracheal subcarinal and paraesophageal stations is essentially\nunchanged.  Left main bronchus is mildly narrowed, as before.  Patient has had\nleft upper lobectomy and infiltrative adenopathy in the left hilus contiguous\nwith the subcarinal component is unchanged, severely narrowing the left lower\nlobe basal trunk bronchus and proximal segments.\n\nLungs:\n\nNew widespread discrete micro nodules and lymphatic distension in the left\nlower lobe suggest lymphangitic dissemination of tumor and would explain the\nassociated small left pleural effusion.\n\nExtensive right upper lobe broncho pneumonia has worsened.  Extensive new\nperibronchovascular ground-glass opacification and peripheral nodulation is\nprobably more pneumonia, rather than either edema or Lymphovenous congestion.\n\nChest cage:\n\nThere is no compression or pathologic fracture and no destructive bone lesion.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Progressive broncho pneumonia since ___, now involving all right lobes,\nattributable to chronic aspiration from esophageal obstruction by subcarinal\nlymph adenopathy.\n\nNew micro nodules and lymphatic distension, left lower lobe, probably\nlymphangitic tumor extension from the left hilus responsible for new small\nlayering left pleural exudate.\n\nNo change in extensive central adenopathy predominantly subcarinal and in the\ninfiltrative adenopathy throughout the left hilus compromising left lower lobe\nbasal trunk and segmental bronchi.\n\nNOTIFICATION:  The findings were discussed with ___, MD, M.D. by\n___, M.D. on the telephone on ___ at 3:51 pm, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  There is no axillary or supraclavicular adenopathy\n\nUPPER ABDOMEN: Imaged upper abdomen is unremarkable.\n\nMEDIASTINUM: Unremarkable.\n\nHILA: Unremarkable.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is a 5 mm nodule in the middle lobe (4:146 and a 4 mm\nnodule in the left upper lobe (4:65).  The lungs are otherwise clear.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  Aorta and main pulmonary artery are normal in caliber.\nCHEST CAGE: No aggressive osseous lesions.",
            "output": "1. The 5 mm middle lobe and  4 mm left upper lobe pulmonary nodules are\nstatistically likely benign, however comparison with prior chest CT is needed\nto confirm stability.  If prior chest CT is unavailable then follow-up should\nbe determined by ___ guidelines as detailed below.\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:30 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There is no evidence of nodule, mass or consolidation in the left infrahilar\nregion to correspond to the reported abnormality on outside chest radiograph,\nwhich is not available for direct at the comparison. However, within the right\nupper lobe, clustered centrilobular ground-glass opacities are present in just\nabove the level of the minor fissure. Remainder of the lungs are clear, and\nairways are widely patent.\n\nThere are no enlarged mediastinal hilar or axillary lymph nodes. Heart size is\nnormal, and there is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute\nconcerning abnormalities are evident in this region on this very limited\nassessment.\n\nSkeletal structures demonstrate no suspicious lytic or blastic lesions.",
            "output": "1. No CT evidence of a left infrahilar nodule, mass or consolidation.\n\n2.  Peripheral cluster of centrilobular ground-glass opacities in the right\nupper lobe, which could reflect an early or resolving infectious pneumonia in\nthe appropriate clinical setting. Localized pulmonary hemorrhage and\naspiration could produce a similar imaging appearance. This finding is likely\nbelow the resolution of a conventional chest radiograph, but short-term\nradiographic followup may still be of value to exclude a worsening\n/progressive abnormality in this region."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.\n\nHeart is mildly enlarged.  Coronary artery calcifications are present.  Dense\ncalcifications are also noted along the ascending aorta and ostium of branch\nvessels.\n\nThe airways are patent to subsegmental level.  Flame shaped airspace opacities\nin the posterior lower lobes likely represent atelectasis.  A small area of\n___ opacification in the right upper lobe (02:33) is likely\ninfectious/inflammatory.  Multiple scattered sub 4 mm pulmonary nodules are\nnoted (02:27, 33, 22).  These were not all present on the prior CT from ___. \nThere is no consolidation.\n\nA small high-density pleural right effusion adjacent to the rib fractures\nlikely represent a small pneumothorax.\n\nLimited view of the upper abdomen is notable for multiple gallstones and dense\ncalcifications along the abdominal aorta and iliac arteries.  A 5 mm right\nrenal stone is also noted.  Bilateral hypodense areas in the kidneys are\nincompletely characterized but likely cysts.\n\nMildly displaced fractures of the right ___ through 9th ribs are noted. \nAnterior compression wedge deformity of the T4 vertebral body is age\nindeterminate.  Scattered lytic lesions are seen scattered within the osseous\nstructures, consistent with the history of myeloma.",
            "output": "1.  Mildly displaced acute fractures of the right ___ through 9th ribs.  Mild\nanterior compression deformity of the T4 vertebral bodies age indeterminate.\n\n2.  Small right hemothorax.\n\n3.  Multiple sub 4 mm pulmonary nodules.  These were not all present on the\nprior examination from ___ suggest ___ year follow-up as clinically indicated.\n\n4.  Cholelithiasis.\n\n5.  5 mm right renal calculus without evidence of obstruction.\n\nRECOMMENDATION(S):  ___ year follow-up chest CT may be performed to follow-up\nsmall pulmonary nodules, as clinically indicated."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber. The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion.\n AXILLA, HILA, AND MEDIASTINUM: Scattered lymph nodes in both axilla are not\npathologically enlarged.  A right supraclavicular node measures 7 mm (06:32). \nRounded subpectoral lymph nodes are atypical in appearance (5:17, 5:24) and\nmeasure 7 x 7 mm on the right.\n\nHeterogeneous tissue in the anterior mediastinum may represent residual\nthymus. Prevascular and 2 epiphrenic lymph nodes are enlarged measuring 12 x\n10 mm and 12 x 12 mm and 20 x 10 mm, respectively (6:37, 6:158, 6:169).  No\nhilar lymphadenopathy is present.\n\nProminent diaphragmatic lymph nodes measures 7 x 11 and 5 x 8 mm (6:201,\n6:194).\n\nPLEURAL SPACES: A right anterior pleural nodule measures 11 x 24 mm (6:169). \nNo pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification. The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nA left upper lobe pulmonary nodule measure 3 mm (6:27) and right upper lobe\npunctate calcified nodule is consistent with a granuloma (6:152).\n\nBASE OF NECK:  The thyroid is normal.  Visualized portions of the base of the\nneck show no abnormality.\n\nABDOMEN:  Please see report from same day CT of the abdomen and pelvis for\ndescription of the subdiaphragmatic findings.  A large hepatic mass in the\nright lobe of the liver is better assessed on recent MRCP. Soft tissue mass in\nthe porta hepatis abuts the gastroesophageal junction with 1.5 x 1.0 cm\nhypodense area which may represent a necrotic lymph node (6:181).\n\nBONES: No suspicious osseous concerning for malignancy or acute fracture.\n\nSOFT TISSUES:  Bilateral breast implants are noted incidentally.  A right\ninternal mammary lymph node measures 5 mm in short axis (6:74).",
            "output": "1. Right anterior pleural mass and subpectoral/mediastinal lymphadenopathy are\nconcerning for metastasis. PET-CT could be considered for further delineation\nof disease extent.\n2. 3 mm left upper lobe pulmonary nodule is nonspecific.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:40 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Sub cm right sub\npectoral chest wall lymph node, 6:74 is slightly smaller today.  Otherwise,\nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy or\ninfection.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck or coronary arteries. \nAorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.  There is no pleural abnormality.\n\n\nPrevious 13 x 14 mm thoracic outlet lymph node is 6 x 9 mm today, 04:12.\n\nThere are no no longer any pathologically enlarged hilar or mediastinal nodes.\nA 6 x 10 mm right paramedian diaphragmatic node, 4:63, was 12 x 21 mm in ___,\nand an adjacent right lower internal mammary node, previously 14 x 25 mm,\n5:86, is 5 x 16 mm.\n\nMild bronchial wall thickening is widespread but there is no mucoid impaction\nor bronchiectasis.  Lungs are otherwise clear.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Substantial progression since ___ in previous lymph node enlargement at\nthe thoracic inlet, right diaphragmatic and internal mammary stations.\n\nMild generalized bronchial wall thickening.  No evidence of active infection\nor lymphoma involving the lung."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Bilateral breast prosthesis in situ. \nSmall soft tissue nodule medial to the right breast prosthesis (5, 27) appear\nsimilar compared to prior imaging.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No new or enlarging mediastinal lymph nodes.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nNo aortic valve calcification.  No coronary artery calcification.  Right-sided\nprepectoral Port-A-Cath in situ with the tip at the cavoatrial junction.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Small subpleural\nnodule (6, 132) is unchanged.  No new or enlarging pulmonary nodules or mass. \nMild, but diffuse bronchial wall thickening.  No interstitial lung disease.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: No lytic/destructive bony lesions to suggest metastatic disease.",
            "output": "No new or enlarging pulmonary nodules or masses or mediastinal or axillary\nadenopathy.\n\nFor abdominal findings please refer to abdominal CT report."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  The right chest port terminates at the superior cavoatrial\njunction.  Bilateral breast implants are noted.  There is no axillary,\nsupraclavicular, mediastinal, or hilar adenopathy.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Residual thymic tissue is noted in the anterior\nmediastinum.  Heart size is normal.  There are no appreciable coronary artery\ncalcifications.  There is no pericardial effusion.\n\nTracheobronchial tree is patent to the subsegmental level.  Small subpleural\nnodule (6:126) within the left upper lobe is unchanged.  The lungs are clear. \nThere is no pleural effusion or pleural abnormality.\n\nThere are no worrisome osseous lesions in the chest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.",
            "output": "No new or enlarging pulmonary nodules or adenopathy.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Bilateral breast prosthesis in situ. \nNo suspicious breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.  Anterior mediastinal soft tissue with\na normal configuration appear similar compared to prior.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo cardiomegaly.  No aortic valve or coronary artery calcifications.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No confluent airspace consolidation.  No diffuse lung disease.\nNo new or enlarging pulmonary nodules or masses.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  Mild, but\ndiffuse bronchial wall thickening.  No mucoid impaction.  No bronchiectasis.\n3. VESSELS:  The pulmonary arteries not dilated.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "Stable imaging findings of the thorax.  No new or enlarging pulmonary nodules\nor masses or mediastinal adenopathy to suggest disease recurrence.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Incidentally noted is an aberrant right subclavian\nartery.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  There are numerous bilateral nonenlarged axillary\nnodes.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nA sclerotic focus is noted in the manubrium, likely bone island (series 2: \nImage 25).",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Thyroid is small.  A left internal jugular venous catheter terminates in mid\nSVC.  There is a soft tissue structure measuring 1.7 cm inseparable from right\naxillary artery (03:15), unchanged.  Evaluation of supraclavicular lymph nodes\nare limited without contrast.  Coronary artery and thoracic aorta\ncalcification is severe.  Thoracic aorta and main pulmonary artery are normal\nsize.  There pericardial effusion is small with focal accumulation at the\nanterior aspect.\n\nThere is occlusion of right lower lobe segmental bronch.  Pleural effusions\nare small.  Areas of consolidation are identified involving right middle,\nright lower, left lingula, and left lower lobes, most severe in the right\nlower lobe.  Pulmonary emphysema is severe. Two 7 mm nodules in the left lower\nlobe (5:  230, 241) are stable.  New nodular opacities measuring a mm or less\nare identified in the right upper and middle lobes (5:128, 144, 203).\n\nTrace bilateral pleural effusions are noted.  Please refer to separate report\nfor CT abdomen and pelvis for abdominal findings.  No suspicious lesion is\nidentified in the bones or soft tissues.",
            "output": "1. Multifocal pneumonia in setting of severe emphysema.\n2. 3 nodular opacities in the right upper and middle lobes measuring 8 mm or\nless are new.  Follow-up CT is recommended after resolution of pneumonia. \nConsider contrast-enhanced CT for evaluation of impression 4 and 5.\n3. Previously seen two 7 mm pulmonary nodules are stable.\n4. A 1.7 cm right axillary soft tissue structure is incompletely evaluated in\nthis noncontrast exam.  Finding may be a vascular structure or enlarged lymph\nnode.\n5. Evaluation of supraclavicular structures including lymph nodes are limited\nin this noncontrast exam.\n\nRECOMMENDATION(S):  Follow-up CT after resolution of pneumonia.\n\nConsider contrast enhanced CT for better evaluation of right axilla and\nsupraclavicular region."
        },
        {
            "input": "The abnormality on the radiograph on the retrosternal region most likely\ncorresponds to summation of shadows and could represent focal fat in the\nanterior mediastinum.\n\nThere are no enlarged supraclavicular, mediastinal hilar lymph nodes. Heart\nsize is top-normal. There is coronary artery calcification. The multiple small\nmediastinal lymph nodes not enlarged by size criteria.\n There is no pericardial effusion.  There is no pleural effusion.\n\nDiffuse centrilobular emphysema with peripheral fibrosis in both lung bases. \nThere is mild bronchiolectasis.  There are also areas of alveolar ground-glass\nopacification in a centrilobular distribution in both lower lobes which could\nrepresent smoking related interstitial lung disease.\n\nThere is 6 mm subpleural nodule in the right middle lobe   (3:44).\n\nThere is a small hiatus hernia.\n\nReview of bones is unremarkable.\n\nLimited sections through the upper abdomen are unremarkable.",
            "output": "The nodular opacity on the radiograph in the retrosternal region most likely\ncorresponds to the retrosternal fat.\n\nModerate emphysema and peripheral fibrosis with scattered areas of\ncentrilobular ground-glass opacification which is most likely inflammatory and\ncould be related to aspiration.  The overall constellation of findings are\nsuggestive of smoking related interstitial lung disease.\n\n6 mm indeterminate pulmonary nodule in the right middle lobe\n\nSmall mediastinal lymph nodes could be reactive.\n\nSmall hiatus hernia\n\nFor incidentally detected single solid pulmonary nodule measuring 6 to 8 mm, a\nCT follow-up in 6 to 12 months is recommended in a low-risk patient,\noptionally followed by a CT in ___ months. In a high-risk patient, a CT\nfollow-up in 6 to 12 months, and a CT in ___ months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The stable moderate cardiomegaly.  Coronary artery calcifications\nagain seen.  There is no pericardial effusion.  The airways are patent up to\nthe subsegmental level.  There are multiple small mediastinal lymph nodes not\nenlarged by size criteria but unchanged since the prior study.  These could be\nreactive.  Small bilateral hilar lymph nodes are also stable.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is moderate emphysema with peripheral fibrosis, unchanged. \nPreviously visualized scattered areas of ground-glass opacity in both upper\nlobes right greater than left have improved.  No new consolidations the\nalveolar ground-glass opacification within both lower lobes is unchanged and\ncould be related smoking related interstitial lung disease.  Lungs are low in\nvolume.\n\n6 mm subpleural nodule in the right middle lobe (5, 33) is unchanged.  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with degenerative\nchanges involving the thoracic spine.  Mild wedge compression involving T7\nvertebral body is unchanged.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Interval resolution of the alveolar ground-glass opacities in posterior\naspects of both upper lobes right greater than left.  This was most likely\ninflammatory.\n\nNo interval change in the upper lobe predominant emphysema and peripheral\nfibrosis and alveolar ground-glass opacities in both lower lobes which is most\nlikely related smoking related interstitial lung disease lungs are low in\nvolume than on the prior study.\n\nStable 6 mm right middle lobe pulmonary nodule.  No new nodules or\nconsolidations\n\nOsteopenia with mild wedge compression involving T7 vertebral body\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "BASE OF NECK: The thyroid is unremarkable.  No supraclavicular lymphadenopathy\nis demonstrated.\n\nHEART AND VASCULATURE:  The thoracic aorta contains atherosclerotic\ncalcifications and is normal in caliber.  Dense coronary artery calcifications\nare visualized otherwise the heart, pericardium, and great vessels are within\nnormal limits based on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is re-demonstrated moderate emphysema with peripheral\nfibrosis, with bilateral lower lobe ground-glass opacities, compatible with\nknown biopsy-proven chronic hypersensitivity pneumonitis, and is unchanged\nfrom prior study with the exception of lower lung volumes.  Postsurgical\nchanges are visualized in the right upper and lower lobes (06:57, 6:104, and\n6:202) in keeping with known history of VATS wedge resection.  A 6 mm\nsubpleural right middle lobe pulmonary nodule is unchanged (6:60).\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: Diffuse osteopenia is visualized throughout without suspicious osseous\nabnormality seen.? There is no acute fracture.",
            "output": "1. Upper lobe predominant emphysematous changes and peripheral fibrosis with\nbilateral lower lobe alveolar ground-glass opacities consistent with known\nbiopsy-proven chronic hypersensitivity pneumonitis, grossly unchanged from\nprior aside from lower lung volumes.\n2. Stable 6 mm right middle lobe pulmonary nodule.  No new focal\nconsolidations or pulmonary nodules identified."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  A right lower lobe subsegmental pulmonary embolism is\nvisualized (series 3: Image 63).  No right heart strain.  The thoracic aorta\nis normal in caliber without evidence of dissection or intramural hematoma. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\npatient is status post sigmoid colectomy.  Intact colonic anastomosis is seen\nwithout a leak identified.  There is residual, small volume minimally complex\nfluid in the pelvis with adjacent peritoneal enhancement, overall\nsubstantially decreased in size when compared to the prior CT from ___.  Stool and fluid is visualized in the cecum.  The remaining large bowel\nappears normal.  Base of the appendix is top-normal in size measuring up to\n6-7 mm with the distal aspect appearing normal in caliber and lying adjacent\nto the minimally complex pelvic fluid.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Multiple soft tissue nodules are visualized throughout the\nabdomen and pelvis, for example series 5: Image 51, which measure up to 8 mm,\nbut decreased in size and number compared to the previous exam.  Otherwise,\nthere is no retroperitoneal or mesenteric lymphadenopathy.  There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is transitional lumbosacral anatomy with partial\nlumbarization of S1.  No acute fracture or suspicious osseous lesions\nidentified.  The abdominal and pelvic walls within normal limits.",
            "output": "1. Right lower lobe subsegmental pulmonary embolism.  No right heart strain.\n2. Status post sigmoid colectomy with intact anastomosis.\n3. Substantial decrease in size of mildly complex pelvic fluid with only a\nsmall residual amount seen in the pelvis, potentially reflecting resolving\nhematoma and/or seroma.  Adjacent peritoneal enhancement is likely reactive.\n4. Decreased in size and number of previously noted peritoneal soft tissue\nnodules."
        },
        {
            "input": "The thyroid gland is unremarkable.  Supraclavicular, axillary, mediastinal,\nand hilar lymph nodes are not enlarged.  Slightly prominent subcarinal lymph\nnode measures 6 mm in short axis (10:44).  Mild atherosclerotic calcifications\nare present at the aortic arch extending into the origins of the major branch\nvessels.  Coronary artery calcifications are severe.  Aortic annular\ncalcifications are also noted.  The heart is not enlarged.  There is no\npericardial effusion.\n\nLayering secretions are seen in the upper trachea.  The airways are otherwise\npatent to the subsegmental level.  Scattered peripheral subpleural nodules are\nidentified bilaterally with the largest measuring 7 mm in the right and left\nlower lobes (11:132, 220).  Others are smaller in size measuring 2-3 mm\n(11:68, 173, 191).  Bibasilar atelectasis.  No focal consolidation, pleural\neffusion, or pneumothorax is identified.\n\nPlease note that sub- diaphragmatic findings are reported separately.\n\nNo suspicious lytic or sclerotic osseous lesion is identified in the thorax.",
            "output": "1. Handful of new subpleural nodules measuring up to 7 mm concerning for\nmetastases. 2.  Severe coronary atherosclerosis."
        },
        {
            "input": "The thyroid gland is normal.  There is no supraclavicular or axillary\nlymphadenopathy.  There is no mediastinal or hilar lymphadenopathy.\n\nThe heart is normal in size without pericardial effusion, and moderate\ncoronary artery calcifications are noted.  The thoracic aorta is of normal\ncaliber throughout without evidence of air dissection.  Mild calcified\natherosclerotic disease of the thoracic aorta is noted.  The thoracic great\nvessels are within normal limits.\n\nA nasoenteric tube terminates below the diaphragm.  The esophagus is somewhat\npatulous.  A small amount of aerosolized secretions are noted in the left\ntrachea (series 5: Image 13).  The airways are patent to the segmental level.\n\nThere is a large right nonhemorrhagic pleural effusion which has enlarged\nsince the ___ examination, with associated partial collapse of the\nright lower lobe.  A small left nonhemorrhagic pleural effusion is noted. \nLinear areas of consolidation in the left lower lobe and upper lobe likely\nreflect atelectasis.  A anterior right upper lobe ground-glass opacity may\nreflect atelectasis, though infection is not excluded (series 5:image 23).\n\nNo focal osseous lesion is seen to suggest malignancy.",
            "output": "1. Large right and small left nonhemorrhagic pleural effusions with adjacent\nmoderate atelectasis, with the right side worsened in comparison to the ___ study.  Linear areas of consolidation in the left upper and lower\nlobe likely reflect atelectasis.\n2.  Small ground-glass opacity in the right upper lobe may reflect atelectasis\nthough infection is not excluded."
        },
        {
            "input": "The thyroid gland is unremarkable.  Supraclavicular, axillary, mediastinal,\nand hilar lymph nodes are not enlarged.  Slightly prominent subcarinal lymph\nnode measures 6 mm in short axis (10:44).  Mild atherosclerotic calcifications\nare present at the aortic arch extending into the origins of the major branch\nvessels.  Coronary artery calcifications are severe.  Aortic annular\ncalcifications are also noted.  The heart is not enlarged.  There is no\npericardial effusion.\n\nLayering secretions are seen in the upper trachea.  The airways are otherwise\npatent to the subsegmental level.  Scattered peripheral subpleural nodules are\nidentified bilaterally with the largest measuring 7 mm in the right and left\nlower lobes (11:132, 220).  Others are smaller in size measuring 2-3 mm\n(11:68, 173, 191).  Bibasilar atelectasis.  No focal consolidation, pleural\neffusion, or pneumothorax is identified.\n\nPlease note that sub- diaphragmatic findings are reported separately.\n\nNo suspicious lytic or sclerotic osseous lesion is identified in the thorax.",
            "output": "1. Handful of new subpleural nodules measuring up to 7 mm concerning for\nmetastases.\n\n2.  Severe coronary atherosclerosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThyroid is heterogeneous but there are no findings warranting further imaging\nevaluation.  Atherosclerotic calcification is moderately severe head neck\nvessels, and in the coronary arteries, most severe in the LAD.  Aorta and\npulmonary arteries are normal caliber.  There is no pericardial or pleural\neffusion.\n\nThere is no pathologic enlargement of lymph nodes in the chest.\n\nPulmonary metastases have progressed:\n\n14 mm subpleural right upper lobe nodule, 09:49, was 10 mm in ___ mm subpleural right upper lobe nodule, 9:71, was 2 mm.\n\n12 mm subpleural right lower lobe nodule, 9:221, was 7 mm.\n\n8 mm right lower lobe nodule, 9:160, is new or newly measurable.\n\n12 mm subpleural left lower lobe nodule, 9:222, was 7 mm.\n\nAlso larger, a 5 mm left lower lobe nodule, 9:98.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThere is no pathologic or compression fracture or destructive bone lesion to\nsuggest osseous metastasis.\n\n\n\n.",
            "output": "Half dozen pulmonary metastases have enlarged since ___, detailed\nabove.  No more than one new nodule.\n\nNo adenopathy or pleural abnormality.\n\nCoronary atherosclerosis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Small subcentimeter hypodense\nlesion in the left lobe of thyroid (5, 5).  No supraclavicular or axillary\nadenopathy.  Right prepectoral Port-A-Cath in situ with the tip in the SVC.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: New epicardial lymph node measuring 8 mm in diameter (5, 44)\n\nHILA: Necrotic left infra hilar lymph node measuring 16 x 15 mm (6, 141)\ninferior medial to the left lower lobe bronchus.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  No coronary artery calcifications.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  Numerous spiculated solid and part solid nodules with\nsurrounding bronchiolectasis (6, 35, 56, 79, 81, 92, 100, 101, 103, 105, 106,\n113,, 120, 133, 1 43, 147, 154, 161, 163, 176, 177).  The largest nodule in\nthe left upper lobe (6, 79) measures 17 x 10 mm and is new.  A few of the\nother nodules for example the part solid nodule in the right upper lobe (6,\n101) shows minimal interval increase in size with the solid component\ncurrently measuring 6 mm (3 mm previously).\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary trunk is not enlarged.  No filling defects.\nCHEST CAGE: No lytic/ destructive bony lesions.",
            "output": "New spiculated nodule in the left upper lobe.\nMultiple pre-existing nodules, some of them show mild interval increase in\nsize.These nodules do not have the typical appearance of metastases, but in\nthis setting, metastases should still be considered most likely because\nmucinous adenocarcinoma has been described to produce spiculated/part solid\nmetastatic nodules).\n\nNew necrotic left hilar lymph node and new (although subcentimeter) epicardial\nlymph node suggesting metastatic lymphadenopathy.\n\nThese findings should be interpreted in conjunction with abdominal findings.\nFor abdominal findings please see CT abdominal report."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.  Marked\ninterval increase in size of the left lower anterior chest wall lesion\ncurrently measuring 52 x 21 mm (27 x 18 mm previously) (5, 250).  Right-sided\nprepectoral Port-A-Cath in situ with the tip at the cavoatrial junction.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Moderate interval increase in size of the AP window lymph node\n(5, 92) subcarinal lymph nodes (5, 112), left infrahilar lymph nodes (5, 139)\n(currently measuring 26 x 20 mm, 18 x 15 mm previously), left pericardial\nlymph node (5, 196) (currently measuring 20 x 12 mm previously measuring 14 x\n9 mm), as well as left retrocrural (6, 231) lymph nodes.  Multiple enlarging\nlymph nodes in the cardiophrenic recess anterior and lateral.\n\nHILA: Left infrahilar lymph nodes demonstrate interval increase in size as\ndescribed above.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve or coronary artery calcification.\nPLEURA: No pleural effusion.  New left posterior pleural metastatic lesion (5,\n188) measuring 17 x 6 mm and left lateral costal pleura metastatic lesion\nmeasuring 19 x 10 mm (5, 236) and left lateral costal pleural lesion (5, 139).\nLUNG:\n\n-PARENCHYMA:  The spiculated soft tissue lesion in the left upper lobe (5, 74)\ndemonstrates interval increase in size currently measuring 17 x 10 mm\n(previously measuring 14 x 9 mm).  Multiple pre-existing smaller nodules are\nunchanged with surrounding bronchiolectasis (desmoplastic reaction).  Moderate\ncentrilobular and paraseptal emphysematous changes.  Mild, but diffuse\nbronchial wall thickening.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: No lytic/destructive bony lesions.",
            "output": "Interval increase in size of the spiculated mass in the left upper lobe.\nThe multiple pre-existing millimetric nodules are unchanged.\nMild interval increase in size of the metastatic mass involving the left\nanterior chest wall.\nMultiple metastatic mediastinal lymph as ascribed above.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nRight prepectoral Port-A-Cath in situ with the tip at the cavoatrial junction.\nNo supraclavicular or axillary adenopathy.  No gross breast lesions.  Large\nleft anterior chest wall soft tissue lesion appears relatively similar\ncompared to prior (4, 203).\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Interval decrease in size of the mediastinal lymph nodes for\nexample in the pericardial area (4, 186) measuring 10 mm in diameter\n(previously measuring 16 mm in diameter and in the right infrahilar area\npreviously measuring 22 mm in diameter, currently measuring 14 mm.  Residual\nanterior thymic tissue has a physiological shape.  Interval increase in size\nof aorta pulmonary window lymph node (currently measuring 10 mm and previously\nmeasuring 3 mm in diameter).\n\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve or coronary artery calcification.  No aneurysmal dilatation of\nthe ascending aorta.\nPLEURA: No pleural effusion.  Pleural metastatic lesions demonstrate an\nindifferent response with some of the pleural metastatic lesions being\nincreased in size for example in the left posterior costal pleura measuring 21\nx 12 mm (previously measuring 17 x 6 mm) and in the lateral lower costal\npleural also being slightly increased in size.  The previously noted pleural\nnodule in the lateral costal pleura adjacent to the mid left oblique fissure\nhas resolved.\n\nLUNG:\n\n1. PARENCHYMA:  Most of the pulmonary nodules demonstrate mild interval\nincrease in size, as well as multiple of the nodules demonstrate interval\ninternal cavitation.  The largest cavitary nodule in the left upper lobe\nmeasuring 18 x 8 mm (but mostly being cystic). Pulmonary nodule in the right\nlower lobe (4, 124) Measuring 6 mm in diameter (previously measuring 4 mm\ndiameter).  Trace centrilobular emphysematous changes.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects to\nsuggest pulmonary emboli.\nCHEST CAGE: No lytic/destructive bony lesions.",
            "output": "Mixed disease response, predominated by interval disease progression as\nevidenced by mild interval increase in size of multiple pulmonary nodules,\npleural nodules as well as some of the mediastinal lymph nodes.\nSome of the pleural nodules and mediastinal lymph nodes did show interval\nimprovement.\nThe left anterior chest wall lesion appears relatively similar in size\ncompared to prior.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "FINDINGS:\nNo suspicious thyroid lesions.  Right prepectoral Port-A-Cath in situ with the\ntip at the cavoatrial junction.  No supraclavicular or axillary adenopathy. \nNo gross breast lesions.  The left lower anterior chest wall lesion\ndemonstrates mild interval increase in size currently measuring 24 mm diameter\n(previously 21 mm) (6, 252).  Abdominal findings will be reported separately. \nRight epiphrenic lymph node (6, 241) demonstrates interval increase in size\ncurrently measuring 11 mm in diameter (9 mm previously).  Anterior thymic\ntissue appear similar compared to prior.  AP window lymph node is slightly\ndecreased in size currently measuring 9 mm in diameter (previously 10 mm). \nLeft infrahilar lymph node is slightly decreased in size.  Prevascular lymph\nnodes (6, 81) Slightly decreased in size.  Normal cardiac configuration.  No\npericardial effusion.  No cardiomegaly.  No aortic valve or coronary artery\ncalcification.  Subsegmental filling defect in the right lower lobe pulmonary\nartery (236) suggest a subsegmental pulmonary embolus.  No features of right\nheart strain.  No pleural effusion.  The central airways are patent.  Trace\ncentrilobular pulmonary emphysema.  Numerous pulmonary nodules demonstrate a\nmixed response.  In the right middle lobe there is a new pulmonary nodule\nmeasuring 17 x 15 mm concerning for a new metastatic lesion.  The pleural\nlesion adjacent to the left lower lobe (6, 255) appears very similar in size\ncompared to prior imaging.  The nodule in the peripheral aspect of the medial\nbasal segment of the left lower lobe (6, 204) Demonstrates mild interval\nincrease in size measuring 23 mm in length (previously 21 mm).  Some of the\nsmaller nodules are slightly decreased in size for example the nodule in the\nleft upper lobe (6, 147) previously measured 5 mm in diameter (currently\nmeasuring 4 mm in diameter.  The previously noted cavitary lesion in the left\nupper lobe (6, 98) Also demonstrate interval decrease in size.  No\nlytic/destructive bony lesions involving the thoracic spine.",
            "output": "Again a mixed disease response is demonstrated, but is predominated by disease\nprogression.\n\nOf concern is a new pulmonary nodule in the right middle lobe concerning for a\nnew metastatic nodule.\n\nThe left anterior chest wall lesion as well as the peripheral lesion in the\nposteromedial basal segment of the left lower lobe shows mild interval\nincrease in size as described above.\nThe left pleural-based lesion is essentially unchanged in size.\n\nMultiple of the small pulmonary nodules are unchanged, while some of the small\npulmonary nodules demonstrate mild interval decrease in size, as well as\ndecrease in size of the previously noted cavitary lesion in the left upper\nlobe.\nThe lymph nodes show a similar trend with some of them being increased in\nsize, while some of them are similar and others are slightly decreased in size\n(but the overall disease burden has slightly progressed).\n\nSmall subsegmental pulmonary embolus in the right lower lobe as described\nabove\n\nFor abdominal findings please refer to CT abdomen report.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with ___\n___ NP on the telephoneon ___ at 12:59 pm, 15 minutes after discovery\nof the findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nCardio mediastinum:\n\nLower esophagus is patulous, but not obstructed.  Areas of low attenuation in\nthe thyroid are smaller today than in ___.  Atherosclerotic calcification is\nminimal in right brachiocephalic artery, not apparent in coronary arteries. \nAorta and pulmonary arteries are normal size..  This study is not designed for\nevaluation of the pulmonary arterial circulation, but shows a small an embolus\nin a subsegmental right lower lobe pulmonary artery, 4:185, probably enlarged\nfrom a smaller embolus present on ___.  There are no central emboli.\n\nThoracic lymph nodes:\n\nThymic enlargement has decreased, probably in response to stress of therapy. \nMediastinal and hilar lymph nodes are not enlarged.  8 mm right juxta cardiac\ndiaphragmatic node, 4:185, was substantially larger, 13 mm.  Previous 15 x 9\nmm prevascular lymph node at level of the aortopulmonic window, 6:116 on ___\n___,  has resolved.\n\nLungs, airways, and pleura:\n\n2 peripheral, heterogeneously enhancing left sided masses  may have arisen in\neither lung or pleura.  The largest, at the anterior margin of the lingula, 17\nx 30 mm, is new, 4:186 and the other along the right lower lobe paravertebral\nperimeter 20 x 28 mm today, 4:159, was 16 x 28 mm in ___.\n\nNearly a dozen other tiny lung lesions, some cavitated cysts, some spiculated,\nnone greater than a cm, are all stable.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.\n\n2",
            "output": "2 large left pleuroparenchymal masses show progression of metastasis, one\nlarger, one new since ___.  More than a dozen tiny lung metastases, some\ncavitated, are unchanged.\n\n2 lymph nodes previously enlarged have decreased and resolved, respectively."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There is a right-sided\nPort-A-Cath with its tip in the cavoatrial junction.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural the aorta and pulmonary arteries are normal in\ncaliber\n\nLUNG: The left upper lobe pulmonary nodule with central cavitation has\nsignificantly increased in size and measures 19 mm.  The right lower lobe\npulmonary nodule has also significantly increased in size and measures 3.2 by\n5.1 cm.  It previously measured 2.1 x 2.8 cm.  The right pericardial nodule\nhas also significantly increased in size it previously measured 8 mm and now\nmeasures 4.0 cm.  The interstitium is prominent.  There is upper lobe\npredominant emphysema.\n\nBONES AND CHEST WALL : Review of bones shows a large soft tissue mass in the\nanterior chest wall, new since the prior study measuring 5.2 x 4.4 cm\nconcerning for metastasis.  Additionally there is a large soft tissue mass\ninvolving the lateral aspects of the 8 ninth and tenth ribs on the left\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is a left adrenal mass measuring 19 mm",
            "output": "Significant increase in size of the pulmonary metastasis as described above.\n\nLarge soft tissue mass in the anterior chest wall within the left rectus\nmuscle.\n\nLarge soft tissue mass along the anterolateral aspect of the 8 ninth and tenth\nribs on the left..\n\nLeft adrenal nodule.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Thyroid is normal.  A right-sided Port-A-Cath, terminates within the\ncavoatrial junction.  There is no axillary, or supraclavicular\nlymphadenopathy.  The esophagus is normal without evidence of wall thickening\nor a hiatal hernia.  Mild mediastinal lymphadenopathy is unchanged compared to\nthe prior exam.  There is no right hilar lymphadenopathy.  A left perihilar\nmass, has increased in size compared to the prior exam, now measuring 2.2 cm x\n1.1 cm, increased in size compared to the prior exam at which time this lesion\nmeasured no more than 1.1 cm.  This lesion appears to abut the pericardial\nsurface medially.  Lesion also abuts the left lower lobe bronchus however\nthere does not appear to be occlusion of the left lower lobe bronchus.\n\nThe large left upper lobe cavitary lesion measures 2.1 cm x 2.7 cm, overall\nnot significantly changed in size compared to the prior exam.  Previously a\ncentral thickened septation was seen, now appears to have migrated\nperipherally along the inferior aspect of the lesion.  There does however\nappear to be an interval increase in soft tissue component of this lesion\nalong the inferior aspect, with worsening extension to the pleural surface.  A\nleft pleural based mass measuring approximately 4.5 cm x 3.3 cm, series 6,\nimage 190 is unchanged compared to the prior exam.  No new underlying bony\nchanges are seen.  Along the anterior right pericardial region a large mass\nmeasures 3.3 cm by 3.4 cm, not significantly changed compared to the prior\nexam, series 6, image 234.  An anterior mass centered within the rectus\nmeasures 6.1 cm x 3.6 cm, not significantly changed compared to the prior\nexam.  A large left soft tissue mass involving the lateral aspects of the\neighth through tenth ribs measures 5.5 cm by 5.1 cm x 7.5 cm in the\ncraniocaudal dimension, increased in size compared to the prior exam at which\ntime this measured up to 6.6 cm in the craniocaudal dimension.\n\nA 6 mm right lower lobe nodule, series 6, image 146 is unchanged compared to\nthe prior exam.  A 4 mm right lower lobe nodule, series 6, image 136 is\nunchanged compared to the prior exam.  A 3 mm right lower lobe nodule, series\n6, image 109 is unchanged compared to the prior exam.  A 3 mm right upper lobe\nnodule, series 6, image 55 is unchanged compared to the prior exam.  A 3 mm\nright upper lobe nodule, series 6, image 98 is unchanged compared to the prior\nexam.  A 2 mm left upper lobe nodule, series 6, image 125 is unchanged\ncompared to the prior exam.  A 4 mm nodule in the left lung base, series 6,\nimage 193 is unchanged compared to the prior exam.  A 4 mm nodule in the left\nlower lobe, series 6, image 129 is unchanged compared to the prior exam. \nThere is no pleural effusion or pneumothorax.\n\nFor evaluation of subdiaphragmatic structures, please refer to dedicated CT of\nthe abdomen performed on same day.",
            "output": "Overall, there is evidence of progression of disease with interval increase in\nsoft tissue component of the large left upper lobe cavitary lesion, with\nextension to the lateral pleural surface.  A left perihilar mass has also\nincreased in size, now measuring 2.2 cm, previously measuring no more than 1.1\ncm.  Additional lesions including an anterior mass centered within the rectus\nas well as a large left soft tissue mass involving the lateral aspects of the\neighth through tenth ribs, now measuring up to 7.5 cm have also increased in\nsize compared to the prior exam."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged. \nFindings in the upper abdominal wall and below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels or coronary arteries.  Central venous\ninfusion catheter ends at the superior cavoatrial junction with no evidence of\nassociated thrombus.  Aorta and pulmonary arteries are normal size.  There is\nno pericardial effusion despite masses contiguous with pericardium at least 2\nlocations, deforming the right atrium displacing the left atrial appendage and\nsplaying the left inferior and superior pulmonary veins.  This mass grew from\n16 x 23 mm to 23 x 36 mm and has extended into the left hilum.\n\n\nTHORACIC LYMPH NODES: Mediastinal and right hilar lymph nodes are not\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions:\n\nSubcentimeter right upper and lower lobe nodules, is 7: 103, ___, 149\nare unchanged.\n\nCavitary 37 mm wide left upper lobe mass has grown, 7:94, was 30 mm across in\n___, although the lateral wall is appreciably thinner.\n\nLarge mass at the posterior periphery of the left lower lobe, invading the\npleura 53 x 79 mm, was 33 x 45 mm.\n\nSecond peripheral mass, along the right middle lobe, anterior costal and\nmediastinal pleural surfaces, 84 by 58 mm, 7:221, was 33 x 34 mm in ___.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Growing dominant cavitary left upper lobe pulmonary metastasis and 3 very\nlarge peripheral lung or pleural masses, details above.  Multiple smaller\npulmonary metastases are unchanged."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There is a right-sided Port-A-Cath\nwith its tip in the right atrium.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Paucity of\nmediastinal fat is noted.  The esophagus is mildly dilated with or contrast\nwithin it.  The aorta and pulmonary artery normal in caliber.  There is no\npericardial effusion.  Heart size is normal.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Multiple bilateral pulmonary metastasis are again seen.  The left upper\nlobe cavitary lesion has changed in morphology.  The cavity appears smaller\nbut there is increased wall thickening on the current study the lesion now\nmeasures 2.3 cm it previously measured 2.5 cm.  The larger metastasis in the\nleft lower lobe is unchanged.  The right middle lobe lesion has slightly\nincreased in size it previously measured 8.7 cm now measures 9.7 cm.  No new\npulmonary nodules.  Several other scattered smaller pulmonary nodules are\nslightly more prominent.  There is mild upper lobe predominant emphysema.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastases.  There is a large mass in the anterior chest wall\nmeasuring approximately 6.3 cm, it is slightly increased in size since the\nprior study.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is a large left adrenal mass measuring 3.7 cm.  Please refer\nto dedicated report on abdomen which has been dictated separately.",
            "output": "Altered morphology and increased wall thickness of the cavitary lesion in the\nleft upper lobe, remains concerning for progression rather than treatment\nresponse.\n\nMultiple other bilateral pulmonary metastases are again seen.  The left lower\nlobe lesion is unchanged in size however the right middle lobe mass has\nincreased in size.\n\nThe soft tissue mass in the anterior chest wall has also slightly increased in\nsize since the prior study.\n\nMild upper lobe predominant emphysema.\nLeft adrenal mass.  Please refer to dedicated report on abdomen which has been\ndictated separately."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart is mildly enlarged.  There is no pericardial\neffusion.  Right pulmonary artery is dilated up to 33 mm in diameter, similar\nto before.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Enlarged subcarinal lymph node measures 1.4 cm\nin short axis, similar to before. No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Diffuse ground-glass opacities and subpleural fibrosis are\nsuggestive of underlying chronic interstitial disease.\nA 6mm nodule in the right lower lobe (2a:69) is similar to before given the\ndifferences in study techniques.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 3.1 cm hypodensity in the upper pole left kidney is consistent with a simple\nrenal cyst.  Smaller hypodensities in bilateral kidneys are too small be\ncharacterized. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Hiatal hernia is small.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Colonic\ndiverticulosis is noted.  The appendix is not visualized.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: A borderline enlarged periportal lymph node measures 1.0 cm in\nshort axis (2b:149).  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. Anterior left fourth rib deformity is similar to before. The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolism or other acute pathology is identified.\n2. Diffuse ground-glass opacities and subpleural fibrosis are suggestive of\nchronic interstitial lung disease.\n3. Enlarged subcarinal and periportal lymph nodes are similar to prior and\nlikely reactive in setting of interstitial lung disease.\n4. A 6 mm right lower lobe nodule is stable since ___.  Given long-term\nstability, no additional followup needed.\n5. No findings in the abdomen/ pelvis to account for reported left upper\nquadrant pain."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small sliding hiatal hernia.  No adrenal lesions.  Left renal cystic\nlesion appear similar compared to prior.\n\nMEDIASTINUM: Mildly enlarged mediastinal lymph nodes are similar compared to\nprior imaging and most likely reactive.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  Severe aortic valve calcification.  No aneurysmal\ndilatation of the ascending aorta.  Moderate calcification of the aortic arch\nand supra-aortic vessels.  Moderate coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Diffuse/multifocal areas of pulmonary ground-glass\nopacification superimposed on interstitial thickening.  Subpleural micro\ncystic changes/bronchiolectasis. This process as a mild apical basal gradient\nand a definite subpleural predominance.  Lobular/subsegmental areas of\npulmonary hyperlucency suggesting air trapping. No classic stacked\nhoneycombing.  Mild, but diffuse cylindrical bronchiectasis.  6 mm pulmonary\nnodule in the right lower lobe (5, 81) is unchanged compared to ___.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  Mild, diffuse\ncylindrical bronchiectasis.\n3. VESSELS:  The pulmonary artery is enlarged measuring 31 mm and pulmonary\nhypertension should be excluded.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine. No\nlytic/destructive bony lesions.",
            "output": "Diffuse pulmonary ground-glass opacification with subpleural interstitial\nthickening and microcystic honeycombing/bronchiolectasis in keeping with a\ndiffuse interstitial lung disease.\nThere is mild progression of the subpleural bronchiolectasis/fibrotic\ncomponent compared to prior imaging done ___, but it is relatively\nsimilar compared to imaging done ___.\n\nIn the differential diagnosis consider a combination of cellular and mildly\nfibrotic NSIP, but with the finding of air trapping hypersensitivity\npneumonitis should also be considered.\n\nNo suspicious pulmonary nodules or masses.\n\nDilated pulmonary artery (in the setting of interstitial lung disease) is\nhighly suggestive of pulmonary hypertension.\n\nSmall sliding hiatal hernia.  Severe aortic valve calcification.  Moderate\ncoronary artery calcification."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable. \nThere is no supraclavicular or axillary pathologic enlargement of lymph nodes\nper CT size criteria.\nNo soft tissue abnormality chest wall.\n\nUPPER ABDOMEN: The liver is diffusely hypodense, representing hepatic\nsteatosis,  unchanged since ___.\nRemaining included upper abdominal organs are unremarkable within the\nlimitations of a study with no IV contrast.\nSmall hiatal hernia with collapsed esophagus.\n\nMEDIASTINUM: Several subcentimeter and borderline lymph nodes in the\nmediastinum  are unchanged since ___, the largest right upper\nparatracheal 1.5 cm (302:63).  Another example is right lower paratracheal 1.3\ncm and left hilum 1.1 cm (302:69, 98).\n\nHEART and PERICARDIUM: There is mild cardiomegaly.  Atherosclerotic\ncalcifications of the coronaries are dense and extensive, unchanged.\nsevere calcifications of aortic valve leaflets with same degree of\ncalcifications along normal caliber thoracic aorta and head and neck vessels\nMain pulmonary artery 3.1 cm, right pulmonary artery 3.4 cm, unchanged since\n___, suggesting pulmonary hypertension.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Major airways are patent.  Diffuse/multifocal areas of pulmonary\nground-glass opacifications superimposed on interstitial thickening. \nSubpleural micro cystic changes in the left upper lobe with the suggestion of\nminimal honeycombing.\nGround-glass opacifications has increased in comparison to ___,\nmaintaining apical basal gradient and subpleural predominance.  This worsening\naccentuates pre-existing mosaic pattern of attenuation representing areas of\nair trapping, as demonstrated on the expiration phase.\nTraction bronchiectasis and interstitial line thickening essentially\nunchanged.\n0.6 cm right lower lobe nodule is unchanged (302:113).\nThere is no evidence of a classic honeycombing, lung consolidations, cysts,\nnew or enlarging lung nodules.\n\nCHEST CAGE: Multilevel minimal degenerative changes of the spine with no\nevidence of bony destructive lesions.",
            "output": "Since ___ there has been mild progression of ground-glass\nopacifications with accentuation of pre-existing mosaic pattern of\nattenuation.\nTaking in consideration mild cardiomegaly and severe aortic valve\ncalcifications, this development could be due to mild pulmonary edema rather\nthan generalized progression of interstitial lung disease."
        },
        {
            "input": "CHEST:  The imaged base of neck including thyroid appear normal.  There is no\nmediastinal hematoma.  The mediastinal great vessels appear normal in course\nand caliber.  The heart is normal in size and shape.  No pleural or\npericardial effusion is seen.  No pneumothorax.  Lungs are clear without signs\nof focal injury.  No worrisome nodule, masses, or consolidation.  Micronodular\n___ opacity in the right lower lobe posterior basal segment may\nreflect atypical infection versus sequelae of aspiration.\n\nABDOMEN: The unenhanced appearance of the liver, spleen, gall bladder,\npancreas and adrenals is normal.  Kidneys appear intact.  No RP hematoma.  The\naorta is normal in course and caliber.  The stomach and duodenum are\ndecompressed.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal. No free pelvic fluid.  No free pelvic fluid.  Urinary bladder is only\npartially distended though appears intact.  No adenopathy.\n\nBONES: Multiple fractures are seen involving the left hand, better assessed on\nsame-day dedicated radiographs.  No fracture involving the imaged torso.",
            "output": "No acute sequelae of trauma.\nIncidental findings detailed above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mucous plugging is noted in the bilateral lower lobes, left\ngreater than right, with areas of ground-glass opacity, consistent with small\nairway disease.  Moderate upper lobe predominant emphysema is seen.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for pneumobilia in\nthe partially visualized liver, and a stomach distended with debris.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Left lower lobe mucoid impaction with foci of ground-glass opacity, likely\nreflecting inflammation or aspiration.\n3.  Moderate bilateral apical emphysema."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which would require mammography for evaluation, there\nare no soft tissue abnormalities in the chest wall concerning for malignancy. \nOf note skin thickening in the left lower breast, 03:35.\n\nLeft lobe of the thyroid is enlarged by 11 x 22 mm low-density lesion\nwarranting further evaluation with thyroid ultrasound.  Atherosclerotic\ncalcification is not apparent in head and neck vessels or appreciable in the\ncoronary arteries.  Aorta and pulmonary arteries are normal size.  Left atrium\nis mildly enlarged, transverse diameter 50 mm.  Pericardium is physiologic. \nThere is no pleural effusion.\n\nLymph nodes:\n\nMediastinal, hilar, and other thoracic lymph nodes are not pathologically\nenlarged by size criteria.\n\nLungs:\n\n2 punctate nodules, superior segment left lower lobe, 5:73.\n\nAside from a peripheral calcification in the left hemithorax which could be a\ngranuloma in the lingula or isolated pleural calcification, there are no other\nfocal pulmonary abnormalities.\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "No good evidence for intrathoracic malignancy.  2 adjacent punctate nodules\nleft lower lobe are indeterminate.\n\nPossible left thyroid nodule.\n\nMild left atrial enlargement.\n\nRECOMMENDATION(S):  Thyroid ultrasound.\n\nConsider cardiac evaluation for possible left atrial enlargement."
        },
        {
            "input": "CHEST PERIMETER: Hypodense region of the left thyroid lobe is not as apparent\non the contrast enhanced study today as on the noncontrast study in ___.  Overall ___ of the left thyroid lobe 32 x 17 mm today, were 28 x\n16 mm in ___ suggesting possible growth.  Thyroid ultrasound would be\nappropriate, if not recently performed.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Evaluation of the\nbreasts is reserved for mammography, however on today's study is skin of the\nbreast is symmetric.  This was probably an artifact of positioning on the\nprevious examination..  There are no soft tissue abnormalities elsewhere in\nthe imaged chest wall concerning for malignancy.  Findings below the diaphragm\nwill be reported separately.\n\nCARDIO-MEDIASTINUM:Mildly patulous esophagus is unremarkable at the age of\nthis patient.\n\nAtherosclerotic calcification is mild in head and neck vessels and coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged by\nsize criteria.\n\n\nLUNGS, AIRWAYS, PLEURAE: There are no lung nodules or other focal lung lesions\nof consequence.  Tracheobronchial tree is normal to subsegmental levels and\npleural surfaces are normal.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nPossible left thyroid nodule.  Consider thyroid ultrasound if not recently\nperformed.\n\nMild coronary atherosclerotic calcification."
        },
        {
            "input": "The thyroid gland is unremarkable.  No significant axillary, mediastinal or\nhilar lymphadenopathy is detected.  The esophagus is unremarkable.  The\nthoracic aorta is normal in caliber with a typical three vessel takeoff from\nthe arch.  The pulmonary arterial trunk is normal in caliber.  The heart is\nnormal in size without pericardial effusion.  There are dense calcifications\nof coronary arteries.\n\nThe airways are patent the subsegmental level. Note is made of an anomalous\norigin of the right upper lobe apical segmental bronchus from the right\nmainstem bronchus (601:84). The lungs are fully expanded and there is no focal\nconsolidation or pleural effusion.  However, there is minimal centrilobular\nemphysema and apical centrilobular ground-glass nodules in the setting of mild\nbronchial wall thickening. Two subpleural pulmonary nodules (one of which is\ncalcified) in the left lower lobe prior are stable since ___\n(4:154, 156). An additional tiny nodule in the same lobe is of uncertain\nchronicity (4:163).\n\nThis exam is not tailored for subdiaphragmatic evaluation, but note is made of\na partially imaged calcification within a tiny fluid collection in the\ngallbladder fossa, previously evaluated by ultrasound (2:65). The imaged\nportions the upper abdomen are otherwise normal. There is no osseous blastic\nor lytic lesion suspicious for malignancy.",
            "output": "1. No evidence of pneumonia or intrathoracic malignancy.\n2. Small centrilobular nodules and bronchial wall thickening are very likely\ndue to respiratory bronchiolitis in this patient with a smoking history.\n3. Coronary artery calcifications.\n4. Tiny left lower lobe pulmonary nodules which are statistically very likely\nbenign.\n5. Anomalous origin of the right upper lobe segmental bronchus from the right\nmainstem bronchus."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral atelectatic changes involving both lower lobes, as\nwell as the posterior aspect of the right upper lobe.  The posterior and\napical segments of the right upper lobe, small ___ nodules are seen,\nlikely due to atypical infection.  There is a 6 mm calcified granuloma in the\nlingula.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates splenomegaly,\nmeasuring at least 18 cm, since this isn't entirely imaged.\n\nBONES: Diffusely mottled appearance of the axial skeleton.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral atelectasis and right upper lobe ___ nodules, likely due\nto infective changes.\n3. Diffusely mottled appearance of the bones, unexpected given the patient's\nage. Correlate clinically with any history of chronic disease or marrow\nreplacing process."
        },
        {
            "input": "CTA Chest: The pulmonary arteries are well opacified to the subsegmental level\nand there is no filling defect to suggest pulmonary embolism. The thoracic\naorta and main pulmonary trunk are of normal caliber. The aortic arch is\nmoderate calcified however there is no evidence of aortic dissection or\naneurysm.\n\nCT Chest: Thyroid enhances homogeneously. Axillary, mediastinal, and hilar\nlymph nodes do not meet CT size criteria for lymphadenopathy. Heart is normal\nsize.  Mild to moderate pericardial effusion is stable. Mitral annular and\nmild coronary artery calcifications are noted.\n\nThe airways are patent to subsegmental level.  Lung volumes have increased\nhowever; there is persistent volume loss in the left hemithorax. There is\nbetter aeration of the left lower lobe.  A moderate left pleural effusion with\nadjacent atelectasis persists.  The left lung remains clear.\n\nLimited view of the upper abdomen is unremarkable.\n\nNo concerning lytic or sclerotic osseous lesion is present.  Multilevel\ndegenerative changes in the spine are noted.",
            "output": "1. No evidence of pulmonary embolism.\n\n2.  Increased lung volumes with better aeration of the left lower lobe.\nHowever there is persistent moderate left pleural effusion and adjacent\natelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The main PA is mildly enlarged and measures 3.6 cm.  The\nheart, pericardium, and remaining great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple nonenlarged lymph nodes are visualized\nin the mediastinum measuring up to 8 mm in the preaortic station (3:65).  No\naxillary, mediastinal, or hilar lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Consolidation is visualized in the left lower lobe consistent\nwith pneumonia are clear without masses or areas of parenchymal opacification.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Left lower lobe pneumonia.\n2. No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  There is a large\nheterogeneous right posterior chest wall hematoma measuring approximately 21.7\nx 8.4 x 16.0 cm, previously measuring 22.0 x 8.2 x 16.1 cm on prior study\ndated ___.  Heterogeneous density within the hematoma likely\nrepresents mixed age blood.  There is no evidence of contrast blush on the\narterial phase or contrast pooling on the delayed phase images to suggest\nactive arterial extravasation.  There is no evidence of new chest wall\nhematoma.\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen is notable for a 8 mm\nnodule in the medial limb of the right adrenal gland measuring 8 ___ in\ndensity, consistent with adrenal adenoma (302:211).  An IVC filter is in\nstable position.  There is diverticulosis involving the descending colon\nwithout evidence of diverticulitis (4:346).  Otherwise, the imaged portion of\nthe upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  There is no mediastinal\nmass.  The esophagus is mildly patulous.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The thoracic aorta is normal in caliber with minimal\ncalcifications along the arch.  There are moderate coronary artery\natherosclerotic calcifications.  The heart is mildly enlarged.  There is no\npericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the lung parenchyma is limited by respiratory\nmotion artifact.  Within these limitations there are no suspicious pulmonary\nnodules or areas of parenchymal consolidation.  A nodular opacity at the left\nlung base measuring 1.2 cm is unchanged from prior study and could represent a\nfocus atelectasis and less likely a pulmonary nodule.  Attention on follow-up\nimaging is recommended.\n2. AIRWAYS:  There is mild bibasilar atelectasis.  Otherwise, the airways are\npatent to the subsegmental bronchi bilaterally.\n3. VESSELS:  There is no evidence of pulmonary embolism to the subsegmental\npulmonary artery branches bilaterally.\n\nCHEST CAGE: There are multiple chronic healed right lateral and posterior\nsixth through tenth and left posterior eleventh rib fractures.  There is no\nacute fracture.",
            "output": "1. Large right posterior chest wall hematoma, not substantially changed in\nsize from prior study dated ___ and without evidence of active\narterial extravasation.\n2. Focal nodular opacity at the left lung base is unchanged from prior study\nand likely represents a focus of atelectasis and less likely a pulmonary\nnodule.  Attention on follow-up imaging is recommended.\n3. Multiple chronic bilateral rib fractures.\n4. Subcentimeter right adrenal gland nodule, likely an adrenal adenoma."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is prominent mediastinal fat.  Prominent\nmediastinal lymph nodes are not enlarged by size criteria.  No axillary or\nhilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Nodules measuring less than 2 mm in the right upper lobe are\nnoted (series 3, image 126 and 121).  Otherwise, lungs are clear without\nmasses or areas of parenchymal opacification.  There is mild central bronchial\nwall thickening bilaterally.  Otherwise, the airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild central bronchial wall thickening bilaterally which may represent mild\nbronchitis.\n3. 2 right upper lobe pulmonary lung nodules measuring less than 2 mm.  See\nrecommendations below.\n4. Probable hepatic steatosis.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A single punctate calcification is\nseen within the inferior right lobe of the partially visualized thyroid.  No\ndiscrete thyroid nodules are seen elsewhere.  No supraclavicular or axillary\nlymphadenopathy.  No suspicious chest wall masses.\n\nUPPER ABDOMEN: Please see separate same day report of the abdomen and pelvis\nfor description of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy or mass.  Tiny hiatal hernia.  The\nesophagus is unremarkable.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.  No\napparent coronary artery, aortic valvular, or mitral annular calcifications.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules or masses.  No consolidations.\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta is normal in caliber and course.  The main\npulmonary artery is normal in diameter.  Although this study is not optimized\nfor the evaluation of pulmonary emboli, the pulmonary vasculature is opacified\nto the segmental level bilaterally.\n\nCHEST CAGE: Punctate sclerosis within the T4 vertebra (3:48), anterolateral\nright fourth rib (3:81), posterior right seventh rib (3:117) likely represent\nbone islands.  No aggressive osseous lesions.  No acute fracture.",
            "output": "1. No evidence of malignancy within the chest.\n2. Punctate calcification without discrete nodule within the thyroid. \nUltrasound is recommended for further evaluation.\n3. Please see separate same day report of the abdomen and pelvis for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Punctate focus of calcification in\nthe right thyroid lobe, and in left thyroid lobe.  The partially imaged\nthyroid gland is otherwise normal.  No large or growing supraclavicular or\naxillary lymph nodes.  Right-sided chest port in situ, with the tip in the\nright atrium.  No soft tissue chest wall abnormality.  No atherosclerotic\ncalcification of the imaged neck arteries.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis report dated the same day for\nevaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Normal esophagus.  Stable 7 mm paraesophageal lymph node\n(11:192).  No enlarged or growing mediastinal lymph nodes.  No mediastinal\nmass.  The thoracic aorta and pulmonary arteries are normal in caliber.  No\natherosclerotic calcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size.  No coronary artery or cardiac valve\ncalcification.  The pericardium is physiologic.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: No pulmonary nodule or mass.  No consolidation.  Mild basal\nlinear atelectasis.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nNo bronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE: 4 mm sclerotic focus in the anterior aspect of the right third rib\n(11:105), 5 mm sclerotic focus in the posterior aspect of the right seventh\nrib (11:150), and a 3 mm sclerotic focus in T4 vertebral body (14:76), all\nstable and likely representing bone islands.  No lytic or sclerotic lesion\nconcerning for malignancy or infection.  No fracture.  Note is made of\ncalcification along the anterior longitudinal ligament.  Mild spondylosis.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  Several borderline sized lymph nodes in the\nmediastinum, for example in right paratracheal location (2, 9).  Other\nborderline sized lymph nodes are seen at the level of the aortopulmonary\nwindow and in pretracheal and precarinal location (2, 23).  Moderate\ncalcifications of the aortic wall.  Extensive paraesophageal varices.  Mild\ncoronary calcifications, mild aortic valve calcifications.  No pericardial\neffusion.  Unremarkable appearance of the posterior mediastinum.  The upper\nabdominal changes have been documented and reported on the CT examination from\n___.  No evidence of osteolytic lesions at the level of the ribs,\nthe sternum or the vertebral bodies.\nNo diffuse lung disease.  The airways are patent.  The pleural surfaces are\neven, no pleural thickening, no pleural effusions.  Minimal atelectasis at the\nright lung basis (4, 162).  No suspicious lung nodules or masses.",
            "output": "Moderate mediastinal lymphadenopathy.  No suspicious pulmonary nodules or\nmasses."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Further interval increase in\nmediastinal lymphadenopathy.  Index lymph nodes include right paratracheal\n(05:13) 25 mm previously 18 mm, conglomerate and right lower paratracheal\nlymph nodes (05:18) measuring 4.5 x 2.6 cm previously 2.6 x 1.5 cm there is\nalso substantial supraclavicular lymphadenopathy, index left supraclavicular\nlymph node (06:17) measuring 3.4 x 2.6 cm, retrocrural lymph node measuring 12\nmm (06:235), right hilar measuring 13 mm (06:162).  No axillary adenopathy.\n\nHEART AND GREAT VESSELS:\n Filling defects are seen within the bilateral main, lobar, and segmental\npulmonary arteries, as well as subsegmental pulmonary arteries in the right\nupper and right lower lobes, consistent with extensive pulmonary emboli.  The\nmain and right pulmonary arteries are normal in caliber.  Mild straightening\nof the interventricular septum, without evidence of reflux of contrast into\nthe IVC.   The heart is not enlarged.  There is coronary artery calcification.\nNew moderate pericardial effusion without CT evidence of tamponade.  No\npericardial enhancement or nodularity.\n\nPLEURA:  There is no pneumothorax.  Small bilateral pleural effusions are new.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild lower lobe\nbronchial wall thickening with mild atelectasis in the lower lobes\nbilaterally, right greater than left.  No acute airspace or interstitial\nopacity.  No pulmonary infarct.  No new or suspicious pulmonary nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "Further interval increase in the lymphadenopathy involving the\nsupraclavicular, mediastinal, hilar and retrocrural lymph node stations since\nearly ___.  New moderate pericardial effusion and small pleural\neffusions.\n\nGiven the rapid progression and extent of intrathoracic adenopathy and\neffusions, this raises alternative differential such as lymphoma as well as\nmetastatic adenopathy.  Infectious adenopathy is favored less likely given the\nabsence of parenchymal findings to suggest infection.  There are also no\nsuspicious pulmonary nodules or masses for malignancy.\n\nStable bilateral, extensive pulmonary embolism.\n\nRECOMMENDATION(S):  If this will influence clinical management, tissue\nsampling of the mediastinum lymph nodes could be considered.\n\nIf not already performed an echo could be considered to assess for right heart\nstrain and new pericardial effusion."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThere is a 3 mm nodule in the left lower lobe (5:170).  Respiratory motion\nlimits the evaluation of the lungs.  Mosaic pattern suggests small airways\ndisease, atrophy.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Non specific 3 mm nodule in the left lower lobe.  Attention in followup\nstudies is recommended.\nEvidence of small airways disease."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a probable 8 mm hypodense\nnodule in the right lobe of the thyroid.  There is no supraclavicular or\naxillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pleural abnormality.\nLUNG:\n\n1. PARENCHYMA: There is mild mosaic attenuation and bronchial wall thickening,\nsuggestive of small airways disease.  Mild atelectasis and scarring in the\nright middle lobe and lingula are noted.  Two 2 mm subpleural nodules at the\nright lung apex (series 5, image 46, 50) are unchanged.  A 2 mm right lower\nlobe pulmonary nodule (series 5, image 137) unchanged.  A 3 mm subpleural\nright lower lobe pulmonary nodule (series 5, image 142) is unchanged.  A 5 mm\nleft lower lobe pulmonary nodule (series 5, image 17) unchanged.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The aorta and main pulmonary artery are normal in size.  There is\nno central pulmonary embolus.\nCHEST CAGE: There is no evidence of osseous malignancy.  The superficial soft\ntissues are unremarkable.",
            "output": "1.  Multiple small pulmonary nodules are unchanged.  No new nodule.  No\nlymphadenopathy.\n2.  Mild mosaic attenuation and bronchial wall thickening, suggestive of small\nairways disease.\n3.  Please see CT abdomen and pelvis from the same date"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid appears within normal\nlimits.  No axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please see report from same day abdomen/pelvis CT scan for full\ndescription of intra-abdominal findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.  Coarse calcification of right hilar lymph\nnodes is noted.\n\nHEART and PERICARDIUM: The heart is normal size without evidence of\npericardial effusion.  Ascending and descending aorta are normal caliber no\nsignificant atherosclerotic calcifications noted.\nPLEURA: There is no pleural fluid.\nLUNG:\n\n1. PARENCHYMA:  Mild atelectasis and scarring in the right middle lobe and\nlingula are unchanged.  Two 2 mm subpleural nodules in the right lung apex\n(3:34, 36) are unchanged.  A calcified nodule in the right lower lobe (3:111)\nis likely a calcified granuloma.  A sub solid 0.4 cm nodule in the right lower\nlobe (3:116) is unchanged from ___.  A 4 mm left lower lobe pulmonary\nnodule (3:174) appears unchanged from ___.\n2. AIRWAYS:  The airway is patent to the level of the subsegmental bronchi\nbilaterally.\n3. VESSELS: The main pulmonary artery is normal caliber.\nCHEST CAGE: No suspicious osseous lesions or evidence for acute fracture.",
            "output": "No interval change in multiple small pulmonary nodules bilaterally.  No\nevidence for new pulmonary nodules or lymphadenopathy."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced. No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated. There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is demonstrated bilaterally, unchanged atelectasis in the\nlingula, series 5, image 167 with no definitive central obstruction is\nunchanged as well as mild mosaic attenuation bilaterally.  Right apical\nnodule, series 5, image 46 is 2.5 mm, stable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease.  No interval change in pre-existing pulmonary nodules and no new\nnodules demonstrated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not pathologically enlarged.\n\nMEDIASTINUM AND HILUM:  Mediastinal and hilar lymph nodes are not\npathologically enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There is a 2 mm right upper lobe nodule, unchanged from\nprior study (3, 60).  There is a 2 mm right apical nodule, unchanged from\nprior study (3, 24).  There is a 2 mm right lower lobe calcified nodule likely\nrepresenting a calcified granuloma, unchanged from prior study (3, 94).  There\nis a 4 mm left lower lobe nodule, unchanged from prior study (3, 147).  No new\nor developing pulmonary nodules.  There is no emphysema.  There is unchanged\nmild mosaic attenuation bilaterally.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.  There\nis unchanged diffuse bilateral bronchial wall thickening.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  Although there are no bone lesions in the imaged chest\ncage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.  Multilevel degenerative changes are\nmild.\n\nUPPER ABDOMEN:  Please refer to the same day CT abdomen and pelvis report for\nfurther details of subdiaphragmatic findings.",
            "output": "1. Unchanged subcentimeter pulmonary nodules with no new or growing nodules.\n2. Please refer to the same day CT abdomen and pelvis report for further\ndetails of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: Postsurgical changes are noted in the inferior\nleft thyroid lobe.  There is a 7 mm hypoattenuating nodule in the right\nthyroid lobe (6:4).  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:\n\nA 2 mm nodule in the left upper lobe (06:44) is unchanged.\n\nA 3 mm nodule in the right lower lobe (06:129) is unchanged.\nA 3 mm nodule in the right upper lobe (6:90) is unchanged.\nA 2 mm subpleural nodule in the right upper lobe (6:85) is unchanged.\nA 4 mm linear nodule in the right lower lobe (6:61) is unchanged.\n\nAdditional subcentimeter nodules are not definitively seen on the previous\nstudy, however, these are nonspecific and may be inflammatory in etiology. \nThese include:\nA 5 mm nodule in the right upper lobe (6:118).\nA 2 mm perifissural nodule in the right lower lobe (6:112).\n\nThere is unchanged mild mosaic attenuation bilaterally, likely due to small\nairway obstruction.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  Although there are no bone lesions in the imaged chest\ncage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.   Multilevel degenerative changes\nare mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Unchanged subcentimeter pulmonary nodules; no new suspect pulmonary\nnodules.\n2. Probable small airway obstruction.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged lower thyroid need any further\nimaging evaluation.  Supraclavicular and axillary lymph nodes not enlarged. \nBreast evaluation reserved exclusively for mammography.  No soft tissue\nabnormality in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Mid esophagus moderately patulous, unchanged, distended\nonly with air, not an indication obstruction.\n\nAtherosclerotic calcification not apparent in head and neck vessels or\ncoronary arteries.  Aorta and pulmonary arteries cardiac chambers are normal\nsize, aortic valve is not calcified and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing measurable lung nodules:\n\n2 x 4 mm nodule, right lower lobe, 6:164 stable since ___.\n\nTracheobronchial tree is normal to subsegmental levels there is no pleural\nabnormality.\n\nCHEST CAGE: No compression or pathologic fractures or destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.  Period",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmoderate coronary artery calcification.  There is no pericardial effusion. \nThe aorta and pulmonary arteries normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a 4 mm right middle lobe pulmonary nodule.  No new pulmonary\nnodules\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a left adrenal\nnodule which could represent an adenoma.  There is a left renal cyst.  Patient\nstatus post cholecystectomy",
            "output": "4 mm right middle lobe pulmonary nodule could represent an intraparenchymal\nlymph node.\n\nNo new pulmonary nodules.\n\n8 mm left adrenal nodule could represent an adenoma.\n\nLeft renal cyst.\n\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "THORACIC INLET: There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are multiple small mediastinal lymph nodes more abnormal in\nnumber than in size the largest measuring 8 mm.  There also calcified left\nhilar lymph nodes.  There is moderate coronary artery calcification.  There is\nmoderate cardiomegaly.  Is a small pericardial effusion.\n\n\nPLEURA: There are moderate bilateral effusions left greater than right.  A\nleft-sided the chest tube is in place.\n\nLUNG: There is near complete atelectasis of the right lower lobe. there is\nalso subsegmental atelectasis in the left lower lobe.  There is diffuse mild\npulmonary edema superimposed over upper lobe predominant emphysema.  No\nobvious nodules are seen\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Graded sections through the upper abdomen shows no focal liver\nlesions no adrenal masses are seen",
            "output": "Moderate bilateral pleural effusions right greater than left.  Passive\natelectasis of the right lower lobe.  Lack of intravenous contrast limits\nevaluation for an underlying mass.  Subsegmental atelectasis in the left lower\nlobe.\n\nSmall mediastinal and left hilar lymph nodes.\n\nLeft-sided chest tube in place.\n\nDiffuse ground-glass opacification bilaterally superimposed over upper lobe\npredominant emphysema most likely represents mild pulmonary edema."
        },
        {
            "input": "THORACIC INLET: Right-sided Port-A-Cath tip projects to the right atrium there\nare no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are stable small bilateral axillary lymph nodes.\n\nMEDIASTINUM: Patient is status post recent CABG surgery.  There is moderate\ncardiomegaly.  Small pericardial effusion is also seen.  There is stable small\nmediastinal lymph nodes.  Trace pneumomediastinum is seen in the retrosternal\nregion.  There is a calcified left hilar lymph node.\n\nNote is made of high-density material along the right lateral wall of the\ntrachea and also within the right mainstem bronchus and bronchus intermedius,\nthis most likely corresponds to aspirated oral contrast.  There is evidence of\nanemia.  The main pulmonary artery is enlarged but unchanged\n\n\nPLEURA: There are moderate bilateral pleural effusions the right is partially\nloculated.  The left has increased in volume since the prior study. \nLeft-sided PleurX catheter has been removed.\n\nLUNG: Dense consolidation in both lower lobes right greater than left most\nlikely represents atelectasis however superimposed pneumonia on the right\ncannot be excluded.  There is diffuse bilateral ground-glass opacification\nwith mild septal thickening which most likely represents pulmonary edema. \nThere is a new ground-glass somewhat nodular opacity in the left upper lobe\nwhich measures 19 x 16 mm which could represent an early pneumonia.  There is\nevidence of paraseptal emphysema.\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nSternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows trace ascites\nthere is evidence of anasarca.",
            "output": "Moderate bilateral pleural effusions right greater than left appears to be\npartially loculated.\n\nDense consolidation in both lower lobes right greater than left could\nrepresent atelectasis however superimposed pneumonia on the right cannot be\nexcluded.\n\nEvidence of a high-density material within the airways, most likely represents\naspirated oral contrast.\n\nDiffuse bilateral ground-glass opacification consistent with pulmonary edema. \nMore focal nodular opacity in the left upper lobe could represent early\npneumonia.\n\nEvidence of median sternotomy with evolving postsurgical changes following\nCABG surgery.  Small pericardial effusion.  Small volume pneumomediastinum is\npostsurgical.\n\nNOTIFICATION:  The findings were conveyed via email to Dr ___ by ___\n___, M.D. on the telephone on ___ at 12:08 pm, 2 minutes after discovery\nof the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Right-sided Port-A-Cath tip extends\nto the right atrium.  0.8 cm left supraclavicular lymph node is stable, not\npathologically enlarged (302:33).\nThere is no axillary lymphadenopathy.\n\nCHEST CAGE: Review of bones shows prior median sternotomy. Sternal sutures are\nintact.  There is no evidence of lytic or sclerotic osseous destructive\nlesions in the ribcage or thoracic vertebra.\n\nUPPER ABDOMEN: Imaged unenhanced upper abdominal organs are with no gross\nfindings.\n\nMEDIASTINUM: There are several lymph nodes in the mediastinum, measuring up to\n0.8 cm in the right lower paratracheal station, essentially unchanged since ___.  In the left hilum is a coarse calcified lymph node.\n\nHEART and PERICARDIUM: Patient is status post CABG.  There is moderate\ncardiomegaly, unchanged.  Minimal pericardial effusion is stable.  Prior trace\npneumomediastinum which was seen in the retrosternal region has resolved.\nRelative hypodensity of the blood pool relative to myocardium suggests anemia.\nThe main pulmonary artery is normal in diameter.\n\nPLEURA and LUNG:: Bilateral small layering pleural effusions, decreased since\n___, the subsequent consolidations of the lower lobes has improved as\nwell.  There is no pneumothorax.\nMinimal secretions along the trachea.\nBibasilar relaxation atelectasis/consolidations has improved since prior,\nhowever in the right lung base there remains subsegmental atelectasis. Prior\nleft upper lobe minimal opacity has resolved.\n\nThere is a minimal centrilobular and paraseptal emphysema which is worse in\nthe upper lobes.  No diffuse lung disease.\nFaint interlobular septal thickening in the lingula but no signs of overt\npulmonary edema, prior heterogeneous ground-glass opacities has essentially\nresolved.",
            "output": "Bilateral small layering pleural effusions slightly decreased.  Bilateral\nprior dependent consolidations reflecting atelectasis/pneumonia has improved\nalthough not resolved.\nNo signs of overt pulmonary edema."
        },
        {
            "input": "The thyroid is normal.  Redemonstrated is a 4.8 x 2.9 cm irregular, middle\nmediastinal mass within the aorticopulmonary window (2:19, 601b:61), which\nappears roughly unchanged from prior examination.  Several mildly prominent\nmediastinal lymph nodes appear unchanged from prior examination, and are not\npathologically enlarged by CT size criteria.  There are no pathologically\nenlarged supraclavicular, axillary, or hilar lymph nodes.\n\nThe aorta are normal in size.  Enlarged central pulmonary arteries, consistent\nwith pulmonary artery hypertension.  The heart is mildly enlarged and\ndemonstrates severe coronary artery calcifications.  The patient is status\npost CABG.  There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Lung windows demonstrate a dominant, 6 mm right lower\nlobe are nodule (4:163).  Several additional, smaller pulmonary nodules are\nidentified (02:29, 38, 68, 92, 98, 104).  Additionally, several ground-glass\nopacities are noted bilaterally (04:31 and 46).  There are few small\nsubpleural nodules.  A left lower lobe calcified granuloma is incidentally\nseen.  1 set of images was repeated secondary to motion, and images were\nobtained during and expiration which showed significant luminal narrowing of\nthe trachea and mainstem bronchi, consistent with tracheobronchomalacia. \nAreas of differential attenuation bilateral lungs, likely mosaic profusion. \nFew areas of subpleural scarring lower lungs.\n\nIndeterminate 1.0 cm sclerotic lesion posterior right seventh rib, similar.  .\nDemineralization.  Sternotomy.  .\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrates a tiny cyst within the right hepatic lobe and a tiny\ncalcification within the left hepatic lobe.  Thickening of the left adrenal\ngland is unchanged.",
            "output": "1.  Unchanged appearance of a large middle mediastinal mass, previously\ndemonstrating FDG avidity on PET-CT dated ___.\n2.  Multiple solid pulmonary nodules measuring up to 6 mm in the right lower\nlobe, not definitely well visualized on the prior PET scan, which may be\npartially secondary to differences in technique.\n3.  Status post CABG with mild cardiomegaly and severe coronary artery\ncalcifications.  Pulmonary artery hypertension.\n4. Indeterminate sclerotic lesion right seventh rib, similar.\n5. Tracheobronchomalacia."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The thyroid is minimally heterogeneous,\nparticularly the inferior right lobe.  There is no axillary adenopathy.  There\nis no supraclavicular lymphadenopathy.  A 6 mm left supraclavicular lymph node\nis prominent but does not meet criteria for pathologic enlargement.  There are\nnumerous enlarged mediastinal lymph nodes, the largest measuring up to 1 cm in\nthe AP window (04:25).  Prominent but not pathologically enlarged hilar lymph\nnodes are also demonstrated.  The esophageal wall appears minimally thickened.\n\nWithin the mediastinum, just inferior to the apex of the aortic arch and\nsuperior to the right main pulmonary artery is an approximately 4.2 x 2.6 cm\nsoft tissue mass with a irregular central low-density area.  This mass exerts\nmass effect upon the trachea and esophagus at that level.  The mass appears to\nabut the left tracheal cartilage invasion of the the trachea at that level\ncannot be excluded.  Of note, this mass appears overall stable in size from ___.\n\nHEART & VESSELS: The heart is moderately enlarged.  There is dense calcified\natherosclerosis of the coronary vessels.  The patient is status post CABG. \nThe main pulmonary artery is dilated up to 36 mm.\n\nLUNGS & AIRWAYS: Evaluation of the lungs is somewhat limited due to poor\ninspiration and breathing motion artifact.  There are diffuse subtle\nground-glass opacities throughout both lungs as well as mild septal thickening\nwhich suggests CHF and mild edema.  There is minimal bibasilar atelectasis. \nNo pleural effusions are seen.  No large focal consolidation is demonstrated. \nThere is no pneumothorax.\n\nUPPER ABDOMEN: The patient is status post cholecystectomy.  There is mild\nthickening of the left adrenal gland without a focal adrenal nodule\nidentified.  A subcentimeter hypodensity in the right lobe is too small to\ncharacterize.  Subcentimeter hypodensities in both kidneys are too small to\ncharacterize.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions are\ndemonstrated.",
            "output": "1. 4.2 cm mediastinal soft tissue mass is overall similar in size from ___.  The soft tissue lesion exerts mild mass effect upon the trachea and\nesophagus.  There is loss of fat plane between the left tracheal cartilage and\nthe mass, invasion of the trachea cannot be excluded.\n2. Enlarged and prominent mediastinal and hilar lymph nodes are re-\ndemonstrated.\n3. Low lung volumes with diffuse mild ground-glass opacity and septal\nthickening suggests mild edema.  There are no pleural effusions.\n4. The trachea, right and left mainstem bronchi appear almost completely\ncollapsed consistent with tracheobronchomalacia."
        },
        {
            "input": "HEART AND VASCULATURE:  Of note, the study is somewhat suboptimal due to\nrespiratory motion artifact.  Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe ascending aorta is dilated, measuring up to 4.3 cm (series 2: Image 52). \nThe main pulmonary artery is enlarged, measuring up to 3.1 cm (series 2: \nImage 54).  The heart is mild to moderately enlarged.  Mild coronary\natherosclerotic calcifications are noted. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are grossly clear without evidence of mass or focal\nconsolidation.  Respiratory motion artifact limits evaluation for pulmonary\nnodules.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK:  A 1.4 cm hypodensity is noted in the left thyroid gland, likely\nnodule.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes are noted in the thoracic spine.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  The main pulmonary artery is enlarged, measuring up to 3.1 cm, which can\nbe seen in pulmonary hypertension.\n3.  Aneurysmal ascending aorta, measuring up to 4.3 cm.\n4.  There is a 1.4 cm hypodensity in the left thyroid gland, likely nodule. \nRecommend dedicated thyroid ultrasound for further evaluation."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is enlarged measuring up to 3.6 cm, suggesting pulmonary\narterial hypertension.  Mild atherosclerotic calcifications of the aortic arch\nand at the origin of the head and neck vessels.  There also moderate coronary\ncalcifications.  The ascending aorta is dilated measuring up to 4.7 cm.  There\nis no evidence of dissection or intramural hematoma. limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Precarinal lymph node is borderline enlarged\nmeasuring 10 mm in short axis, indeterminate, but likely reactive (series 3,\nimage 82).  No other axillary, mediastinal, or hilar lymphadenopathy is\npresent.\n\nPLEURAL SPACES: Small left pleural effusion.  No right pleural effusion.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Dependent atelectasis within the left lower lobe.  No focal\nconsolidations.  4 mm solid nodule within the left lower lobe (series 3, image\n155).  Mild septal thickening at the bilateral lung bases likely reflects mild\nfluid overload.  Thickening of an insect streak fissure within the right lower\nlobe, which may be due to fluid.  Diffuse bronchial wall thickening may\nrepresent fluid overload or chronic airways disease.  Airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nABDOMEN: Coarse calcification adjacent to the greater curvature of the\nstomach, chronic, unclear etiology.  Otherwise, the included portion of the\nupper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.  No focal\nconsolidations.\n2. Septal thickening at the bilateral lung bases likely reflects mild fluid\noverload.  Diffuse bronchial wall thickening may also represent fluid overload\nor chronic airways disease.  Small left pleural effusion.\n3. 4 mm solid nodule within the left lower lobe, for which no follow-up is\nrecommended in a low risk patient.\n4. Enlarged ascending thoracic aorta measuring up to 4.7 cm.\n5. Enlargement of the main pulmonary arteries suggests pulmonary arterial\nhypertension.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient is asymmetrically positioned within the\nscanner unit.  Mild aortic wall calcifications.  Mild dilatation of the main\npulmonary artery.  No coronary calcifications, no valvular calcifications. \nThe breasts are unremarkable.  No pericardial effusion.  No abnormalities in\nthe posterior mediastinum.  The status post gastric surgery.  Status post\ncholecystectomy.  No osteolytic lesions at the level of the ribs, the sternum,\nor the vertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nIn the right upper lobe, the patient displays a widespread pattern of\nground-glass opacities, solid nodules, ___ opacities and small\nperibronchial consolidations, all of which are infectious in etiology.  There\nare scattered subpleural micronodules throughout the lung parenchyma but no\nevidence of suspicious pulmonary nodules or masses.  Minimal scarring is also\nnoted in the right lower lobe.  There is a calcified cyst in the liver (5,\n184).  No pleural effusions.  The airways are patent.  The soft tissues\nsurrounding the chest wall are unremarkable.  No evidence of masslike lesions.",
            "output": "Right upper lobe infectious process.  Scattered subpleural pulmonary\nmicronodules but no suspicious pulmonary nodules or masses.  No evidence of\nchest wall masses.  No pleural or interstitial lung disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMain pulmonary artery is dilated to 3.8 cm.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  Heart is\nmildly enlarged.  The pericardium and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent right upper paratracheal lymph node\nmeasures up to 11 mm, likely reactive.  No axillary or hilar lymphadenopathy\nis present.  No mediastinal mass.\n\nPLEURAL SPACES: Small bilateral pleural effusions, right greater than left,\nare present.  No pneumothorax.\n\nLUNGS/AIRWAYS: Mild compressive atelectasis is noted in both lower lobes. \nRemainder of the lungs are clear without masses or concerning areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Mild diffuse airway wall thickening is\npresent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates hypoattenuation\nof the liver suggestive of steatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Small bilateral pleural effusions, right greater than left, with bilateral\nlower lobe compressive atelectasis.\n3. Dilated main pulmonary artery could suggest pulmonary arterial\nhypertension.\n4. Mild diffuse airway wall thickening could suggest chronic airways disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nAgain seen is dilation of the main pulmonary artery measuring up to 3.6 cm\nwhich may represent pulmonary hypertension.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  Left chest wall ICD is noted with leads in the right\natrium, right ventricle, and coronary sinus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Debris is noted within the trachea.  Otherwise, the airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild degenerative changes are seen in the thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Dilated main pulmonary artery which may reflect pulmonary hypertension."
        },
        {
            "input": "The 5.1 x 3.0 x 5.9 cm right thyroid mass is essentially unchanged since\n___.  There is partial attenuation of the trachea at the level of\nthe thyroid, as before.  There are no pathologically enlarged axillary or\nsupraclavicular lymphadenopathy. Hilar lymphadenopathy is difficult to assess\ndue to lack of intravenous contrast. Subcarinal lymph node measures 15 mm\n(series 3, image 34), previously 14 mm, and AP window lymph node measures 8 mm\n(series 3, image 28), previously 7 mm. No new pathologically enlarged\nmediastinal lymph nodes are appreciated. The heart size is top normal, and\nthere are mild coronary artery, aortic valvular, aortic arch, and descending\nthoracic aortic atherosclerotic plaque.  Ascending aorta is top normal in\nsize.  Limited images of the upper abdomen demonstrate surgical clips at the\nleft hemidiaphragm, and a full report discussing findings within the abdomen\nand pelvis will be dictated separately.\n\nThe lung parenchyma demonstrates moderate to severe centrilobular emphysema,\npredominantly in the upper lobes.  small right pleural effusion, decreased\nsince the prior exam.  As before, right anterior and posterior upper lobe\npleural thickening and fibrotic changes are stable. Diffuse bronchiectasis is\nagain seen.  Compared to the prior study, the largest intraparenchymal\nabnormality in the right lower lobe has resolved. A subpleural nodule in the\nsuperior segment of the right lower lobe now measures 9 x 4mm (5:170) and is\nincreasing in size.  The spiculated nodule in the right upper lobe (5:90) as\nwell as the 4 mm subpleural nodule in the right upper lobe (series 5, image\n215) were present on the ___ CT, with the latter slightly larger.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1. Heterogeneous right thyroid mass unchanged since ___.\n\n2. Moderate centrilobular emphysema and fibrotic lung changes are stable. \nResolution of right lower lobe soft tissue abnormality, which may have been\natelectasis or inflammatory.\n\n3. Increasing size of subpleural nodule at the superior segment of the left\nlower lobe, for which attention should be paid on followup.  Other subpleural\nnodularities are stable."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  The lymph nodes in the axilla are borderline and\nincrease in number measuring up to 8 mm. Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal and there is no appreciable\ncoronary calcification.  The lungs are clear.  There is no pleural or\npericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without worrisome nodule, mass, or\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Incidental note is made of a bovine arch.  Aortic caliber is normal.\nThe main, right, and left pulmonary arteries are normal caliber.  There is no\nfilling defect within the pulmonary arteries to the subsegmental level.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.  There\nis no fracture.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "No acute cardiopulmonary process is identified."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma within limitation of a non-gated study.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Trace soft tissue in the\nanterior mediastinum likely reflects residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  No suspicious pulmonary nodules.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Esophagus\nappears unremarkable, not well assessed.\n\nBONES: No suspicious osseous abnormality.  No acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Esophagus is unremarkable on limited assessment."
        },
        {
            "input": "HEART AND VASCULATURE: The pulmonary arteries are patent to the subsegmental\nlevel without filling defects to suggest a pulmonary embolus.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are a few prominent prevascular lymph\nnodes measuring up to 8 mm (3:66), however, these are not pathologically\nenlarged by CT size criteria.  No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A punctate calcified granuloma is noted in the right upper\nlobe.  There is mild bibasilar dependent atelectasis.  Otherwise, the lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.  There is mild\nbronchial wall thickening, most pronounced in the bilateral lower lobes, which\nmay represent small airways inflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable aside from\nfocal fat adjacent to the falciform ligament.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality.\n\nNOTIFICATION:  The updated read was emailed to the ED QA nurses for\ncommunication to the patient's primary care provider."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no enlarged\nsupraclavicular or axillary lymph nodes.  The thyroid gland is unremarkable. \nAn endotracheal tube terminates appropriately above the carina.  Nasogastric\ntube courses below the diaphragm into the stomach.\n\nMEDIASTINUM:   There are no enlarged mediastinal lymph nodes.\n\nHILA: There are no enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart and pericardium are unremarkable and there is no\npericardial effusion.\nPLEURA: There are moderate simple bilateral pleural effusions.  The phase of\ncontrast is sub optimal for evaluation of empyema however there is no definite\nrim enhancement or loculation to suggest empyema.\nLUNG:\n\n-PARENCHYMA:  Consolidations involving the posterior upper lobes and lower\nlobes bilaterally are again noted, slightly improved compared to ___.  There is no pneumothorax.\n-AIRWAYS:  Airways are patent to the subsegmental levels.\n-VESSELS:  The aorta and pulmonary artery are of normal caliber mass\nincompletely evaluated on this exam.\nUPPER ABDOMEN: Evaluation of the upper abdomen demonstrates sutures at the\ngastric fundus.\n\nCHEST CAGE: There no concerning osseous lesions.",
            "output": "1.  Extensive consolidations in the upper lobes and lower lobes bilaterally\nthough somewhat improved compared to ___ which could be related to\ninfection, aspiration or hemorrhage.\n2.  Moderate bilateral pleural effusions.  Evaluation for empyema is limited\ngiven the phase of contrast however there is no abnormal enhancement or\nloculation to suggest empyema."
        },
        {
            "input": "THYROID:  Thyroid gland is homogeneous in attenuation throughout.\n\nLYMPH NODES:  Supraclavicular, axillary, and mediastinal lymph nodes are not\nenlarged by size criteria.  No evidence of hilar adenopathy.\n\nHEART AND GREAT VESSELS:\nHeart is normal in size, without a pericardial effusion.  Pacer leads\nterminate in the right atrium and right ventricle, as expected.  Heavy mitral\nannular calcifications.  Severe multifocal coronary artery calcifications are\nmost pronounced in the left anterior descending artery (LAD).  Pulmonary\narteries are enlarged, 44 mm main, 34 mm right, 26 mm on the left (4:103),\nwhich can be seen in the setting of pulmonary arterial hypertension.\n\nA prosthetic aortic valve dates back to ___.  Normal caliber thoracic\naorta.  Minimal intimal calcifications in the anterior wall of the ascending\naorta are seen approximately 3 cm cranial to the aortic valve.  Mild\ncalcification of the right paramedian and left lateral ascending aortic wall\nis present 1.5 cm above the aortic valve.\n\nAIRWAYS AND LUNGS:  Tracheobronchial tree is patent.  Diffuse bronchial wall\nthickening is mild.  Lungs are clear of consolidation.  There is a 2 mm nodule\nin the anterior segment of the right upper lobe (4:96), and a 3 mm subpleural\nnodule in the right middle lobe (4:129).\n\nPLEURA:  Pleural surfaces are smooth.  No effusion or pneumothorax.\n\nUPPER ABDOMEN:  A well-circumscribed fat attenuation mass measuring 26 x 21 mm\nadjacent to the pancreatic tail is most consistent with an intrapancreatic\nlipoma (2:58).  Origin of the superior mesenteric artery is moderately\nnarrowed by calcified plaque (4:255).\n\nBONES/SOFT TISSUES:  No suspicious lytic or sclerotic lesions are identified. \nLeft anterolateral sixth rib fracture is chronic (2:41).  Sternotomy wires are\nintact.  Chest wall is within normal limits.",
            "output": "1. Minimal intimal calcifications along the ascending aorta, approximately 3\ncm from the aortic valve.\n2. No thoracic aortic aneurysm.\n3. Severe multifocal coronary calcifications, most pronounced in the LAD.\n4. Probable pulmonary arterial hypertension.\n5. Two pulmonary nodules, 2 mm in the right upper lobe and 3 mm in the right\nmiddle lobe.  In high-risk patients, a follow-up chest CT is recommended in 12\nmonths.  No specific follow-up is indicated for non-smokers.\n6. Incidental finding of a probable intrapancreatic lipoma.\n7. Moderately narrowed superior mesenteric artery origin by calcified plaque.\n\nRECOMMENDATION(S):  Chest CT in 12 months if the patient is a smoker."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Re-demonstrated right hilar and mediastinal\nlymphadenopathy.  For example, an enlarged right paratracheal lymph node\nmeasures 2.8 by 2.0 cm, previously measuring 2.8 by 1.8 cm (series 2, image\n28). Prominent hilar lymph nodes are re-demonstrated and measure up to 1.3 cm\non the right.  Large subcarinal mediastinal lymph node measures 5.0 x 2.2 cm,\npreviously measuring approximately 5.2 by 2.5 cm (series 2, image 53) with\nevidence of central necrosis.  This mass appears to encircle and encase the\nright mainstem bronchus causing luminal narrowing (series 2, image 43) with\nnew intraluminal material in the bronchial lumen causing obstruction, not seen\non prior.  Additional mediastinal lymph nodes have not significantly changed.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Right apical and anterior upper lobe opacification with\ntraction bronchiolectasis is consistent with post radiation fibrotic changes. \nNew ground-glass opacity involving the right upper lobe posteriorly may be due\nto an infectious etiology, aspiration, or hemorrhage given recent biopsy. \nRe-demonstrated 1.8 cm right middle lobe oval-shaped lesion is not\nsignificantly changed in size compared to prior.  There is new obstructing\nintraluminal material within the right mainstem bronchus, extending into the\nright bronchus intermedius as well as part of the lower lobe and middle lobe\nbronchi (series 3, image 120 and 95).  Additionally, there is nonspecific mild\nairway thickening which could be related to bronchitis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nRight-sided breast implant is identified.",
            "output": "1. No evidence for pulmonary embolism or acute thoracic aorta pathology.\n2. New ground-glass opacity of the right upper lobe may be due to infection\nversus aspiration, however hemorrhage cannot be excluded considering recent\nbiopsy.\n3. New intraluminal obstructing material within the right mainstem bronchus\nwith extension to the right upper lobe bronchus and intermediate bronchus\nsuggestive of mucus plugging.\n4. Re-demonstrated right hilar and mediastinal lymphadenopathy, some of which\nis necrotic, with encasement and narrowing of the right mainstem bronchus by\nthe lymphadenopathy.\n5. Post radiation changes within the right apex and anterior right upper lobe."
        },
        {
            "input": "No incidental thyroid findings.  Moderate dilatation of the upper esophagus. \nThe conclusion right paramediastinal lymph node conglomerate has not\nsubstantially changed in size.  The conglomerate has a maximum diameter of\napproximately 4 cm.  Also overall unchanged are pre tracheal and precarinal\nlymph nodes.  Finally, the subcarinal lymph node conglomerate is also\nunchanged, having a diameter of approximately 5 cm.  No pericardial effusion. \nRight breast implant.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Stable postradiation scarring at the level\nof the right lung apex.  The right upper lobe bronchus is patent.  The\nbronchus intermedius is also patent (4, 98).  The middle lobe and lower lobe\nbronchi are also patent.  Smaller than on the previous examination is a\nperibronchial nodular structure in the right upper lobe (4, 122) with\nperipheral satellite opacities.  No pleural effusion.  No pleural thickening.",
            "output": "No change in size of the pre-existing mediastinal lymph node conglomerates. \nHowever, the bronchus intermedius as well as the right upper lobe, middle lobe\nand lower lobe bronchi are now patent.  A nodular lesion in the right upper\nlobe has slightly decreased in size, as have the peripheral right upper lobe\nsatellite opacities."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : Small bilateral axillary nodes are unchanged.  Patient\nstatus post right mastectomy with a right breast implant in place.\n\nMEDIASTINUM: The extensive mediastinal and right hilar adenopathy is\nunchanged.  The subcarinal node measures 2.8 cm.  A nodular opacity in the\nright middle lobe (2, 54) most likely represents a intraparenchymal lymph node\nand is also unchanged.\n\n\nPLEURA: There is is no pleural effusion.  There is no pericardial effusion.\n\nLUNG: There are stable post radiation changes to the right apex.  No new\npulmonary nodules.  Previously visualized scarring in the right upper lobe and\nright middle lobe is unchanged.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.  No lytic or\nsclerotic lesions concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable postsurgical changes following right mastectomy with a a breast implant\nin place.  Stable small bilateral axillary lymph nodes.\n\nExtensive mediastinal and right hilar adenopathy is unchanged.  A nodular\nopacity in the right middle lobe could also represent a lymph node and is also\nunchanged.  No new or growing pulmonary nodules.\nStable post radiation changes to the right middle lobe and right upper lobe."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A right chest wall port\nterminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are small bilateral pleural effusions, left greater than\nright with subjacent left lung base compressive atelectasis.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is bilateral septal thickening consistent with mild\ninterstitial edema.  A 4 mm pulmonary nodule seen in the left lower lobe. \nThere is biapical scarring.  Bilateral anterior subpleural fibrosis is noted,\nconsistent with a prior history of radiation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\n2.9 cm cyst is again seen in segment 3.  A smaller subcentimeter hypodensity\nin segment 2 is too small to characterize.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  There is large volume ascites, significantly increased\ncompared to prior study.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.8 cm cyst is seen in the midpole of the left kidney.  There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is seen, otherwise the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding.  Again seen is wall\nthickening of the distal ascending colon and proximal transverse colon which\nis not significantly changed compared to prior.  The appendix is normal. \nThere is no free air.  There is evidence of mesenteric stranding and\nnodularity and peritoneal thickening, consistent with peritoneal\ncarcinomatosis.\n\nPELVIS:\n\nThe urinary bladder is decompressed, the distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no mesenteric lymphadenopathy.  There is prominent\nretroperitoneal soft tissue density, likely representing confluent\nretroperitoneal lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine. \nMultiple sclerotic foci are seen throughout the spine and pelvis, consistent\nwith metastatic disease.  No signs of pathologic fracture.  The abdominal and\npelvic wall is within normal limits.",
            "output": "1.  No pulmonary embolism or acute aortic abnormality.\n2.  Interval increase in now large volume ascites and persistent mesenteric\nstranding and nodularity and peritoneal thickening consistent with peritoneal\ncarcinomatosis.\n3.  Diffuse small sclerotic foci throughout the spine consistent with\nmetastatic disease.\n4.  4 mm left lower lobe nodule, recommend attention on follow-up.\n5.  Mild interstitial pulmonary edema and small bilateral pleural effusions."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion.  There is global cardiomegaly,\nwith significant right and left atrial enlargement. The ventricles are not\nentirely visualized.\n\nThere is bibasilar atelectasis and right middle lobe collapse.  There is mild\nemphysema with no consolidation. There is no pleural effusion. The airways are\npatent to the subsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nLimited images of the upper abdomen are unremarkable, although there is a\nlarge amount of bowel in the right upper quadrant that is likely interposed\nbetween the diaphragm and liver.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is deformity of the sternal body and manubrium with likely an additional\npectus excavatum deformity, that is likely chronic in nature.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Significant global cardiomegaly that is partially visualized and\nparticularly prominent in the right and left atria.\n3.  Bibasilar atelectasis and right middle lobe collapse."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized portion of the base\nof the neck shows no abnormality.  The thyroid is unremarkable.  There is no\nsupraclavicular, infraclavicular, or axillary lymphadenopathy.\n\nMEDIASTINUM: Conspicuous, subcentimeter mediastinal lymph nodes do not meet CT\nsize criteria for pathologic enlargement, and are grossly similar to the prior\nstudy.  There is no mediastinal mass.  A large hiatal hernia appears similar\nto the study in ___.\n\nHILA: There is no mediastinal lymphadenopathy or masses.\n\nHEART and PERICARDIUM: The heart is mildly enlarged, although slightly smaller\nthan the prior study.  The pericardium is unremarkable and there is no\npericardial effusion.  The leads of a cardiac pacer device terminate in the\nright atrial appendage and apex of the right ventricle in standard position. \nThe patient is status post aortic valve replacement.  There is heavy\natherosclerotic calcification of all coronary distributions.  The thoracic\naorta is normal in caliber but mildly tortuous in course, and heavy\natherosclerotic calcifications are seen predominantly about the aortic arch\nand descending thoracic aorta.\n\nPLEURA: There is a small right pleural effusion.  No pneumothorax.  Mild\nbiapical pleural parenchymal scarring is seen.\n\nLUNG:\n\n-PARENCHYMA:  There is mild upper lobe predominant centrilobular emphysema. \nWithin the right lower lobe, there is a patchy parenchymal opacity (302:128)\nassociated with a region of peribronchovascular consolidation (302:140) which\nis predominantly seen at the branching point of the segmental bronchi.  It\nshould be noted that this region appears improved on the scout image compared\nto the recent radiograph.  Ground-glass opacities are also seen in the right\nmiddle lobe (302:141).  There are no definite nodules.  Relaxation atelectasis\nis seen adjacent to the small right pleural effusion.\n-AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n-VESSELS:  The vasculature is opacified to the subsegmental level without\nfilling defects.\nCHEST CAGE: The patient is status post T12 kyphoplasty.  There are no\nworrisome osseous abnormalities.\n\nUPPER ABDOMEN: Diffuse, nonspecific thickening of the left adrenal gland is\nunchanged, measuring 14 mm (302:220).",
            "output": "-Opacities within the right lower lobe, along with ground-glass opacities\nwithin the right middle lobe, likely represent improving infection or residual\npulmonary edema.  CT is recommended in 3 months for further evaluation.\n-Mild upper lobe predominant centrilobular emphysema.\n-Status post aortic valve replacement.  Severe coronary atherosclerotic\ncalcification.\n-Unchanged large hiatal hernia.\n-Nonspecific left adrenal thickening, stable since ___, is incompletely\ncharacterized on this examination.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:47 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The sternal and of the left clavicle is fractured (3, 5) and at least 3\ndisplaced bony fragments are noted (5, 28).  There is a moderate\nnonhemorrhagic soft tissue component surrounding the fractured bony\ncomponents, in direct comparison the sternoclavicular joint is minimally\nwidened on the left.  No evidence of associated pneumothorax.\n\nNo supraclavicular, infraclavicular or axillary lymphadenopathy.  The lymph\nnodes in the axillary regions as well as in the thoracic inlet are borderline\nin size.  The aortic wall shows mild calcifications.  Normal to borderline\nsized mediastinal lymph nodes are noted.  Severe coronary calcifications, mild\naortic valve calcifications, no pericardial effusion.  Small hiatal hernia. \nStatus post cholecystectomy.  Bilateral large kidney cysts (3, 86).  The upper\nand middle third of the esophagus are patulous.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  No evidence of rib lesions.\n\nMinimal paraseptal emphysema.  8 mm pleural right upper lobe solid nodule (5,\n54).  Bilateral subpleural interstitial opacities with minimal architectural\ndistortion and overlying ground-glass but without honeycombing.  The findings\nshow an increase in severity along an apical basal gradient.  No pleural\neffusions.  No additional or clearly suspicious pulmonary nodules or masses. \nThe airways are patent.  No bronchiectasis.",
            "output": "Complicated fracture of the sternal and of the left clavicle, with displaced\nbony fractures and a moderate nonhemorrhagic soft tissue component surrounding\nthe damage.\n\nSolitary solid pleural 8 mm right upper lobe nodule that requires follow-up.\n\nThe most relevant lung parenchymal finding, however, is an NSIP-like fibrotic\npattern of moderate severity that needs to be worked up by respiratory\nmedicine.\n\nRECOMMENDATION:\nFor incidentally detected single solid pulmonary nodule measuring 6 to 8 mm, a\nCT follow-up in 6 to 12 months is recommended in a low-risk patient,\noptionally followed by a CT in ___ months. In a high-risk patient, a CT\nfollow-up in 6 to 12 months, and a CT in ___ months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:  The imaged base of neck is unremarkable including the partially\nvisualized thyroid.  The thoracic aorta is normal in course and caliber\nwithout appreciable atherosclerotic calcification.  No signs of aortic injury.\nNo mediastinal hematoma.  Residual thymic tissue is noted in the anterior\nmediastinal space.  Main pulmonary artery and central branches are patent. \nThe heart is normal in size and shape.  No pleural or pericardial effusion. \nNo pneumothorax or pneumomediastinum.  The lungs are clear without worrisome\nnodule, mass, or consolidation.  No signs of contusion or laceration.  No\npneumothorax.\n\nABDOMEN:  The liver is intact and there are no concerning focal lesions.  The\ngallbladder is normal.  Main portal vein is patent.  No biliary ductal\ndilation.  The pancreas is normal.  The spleen is normal.  Adrenals are normal\nbilaterally.  The kidneys enhance symmetrically.  No retroperitoneal hematoma\nor signs of renal injury.  The abdominal aorta is normal in course and\ncaliber.  The stomach and duodenum appear normal.  No free air or free fluid.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is not definitively visualized though there are no secondary signs of\nappendicitis.  The colon is thin walled containing a mild fecal load.  Urinary\nbladder is partially distended appearing normal.  No free fluid in the pelvis.\nNo pelvic sidewall or inguinal adenopathy.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "No acute sequelae of trauma."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.  Mild bilateral Gynecomastia.\n\nUPPER ABDOMEN: Evaluation of the abdominal structures is limited given lack of\nIV contrast material.  No obvious abnormality is identified.\n\nMEDIASTINUM: Mild stranding is noted within the anterior mediastinum. \nScratched  Subcentimeter precarinal mediastinal lymph nodes are not enlarged\nby CT criteria.  Small pericardial lymph node is demonstrated measuring 8 mm. \nFew borderline sub- carinal lymph nodes, likely reactive.\n\nHILA: No obvious hilar adenopathy.\n\nHEART and PERICARDIUM: The patient is status post aortic valve replacement.  A\nfocus of calcification is noted along the anterolateral pericardium measuring\n5 mm.  Coronary artery calcification.  No pericardial effusion.\n\nPLEURA: A right-sided pleural pigtail catheter in the right lateral\nhemithorax.  There is mild right hydropneumothorax, similar to chest\nradiograph from earlier today.  Fluid appears to be nonhemorrhagic accounting\nfor some artifact secondary to adjacent to the related artifact.  Right\npleural effusion is partially loculated, with subpulmonic component, it\ncontains few loculated pockets of gas.  Mild pleural thickening.  Fluid is\nalso noted tracking along the right major fissure and trace fluid is noted\nalong the minor fissure.  There is trace left pleural effusion.\n\nLUNG:\n\n-PARENCHYMA:  Mild atelectasis is noted in the right lung base with inferior\ndisplacement of the minor fissure.  There is 0.2 cm nodule in the left upper\nlobe series 4, image 74.  The remainder of the right and left lungs are clear.\n-AIRWAYS:  Central airways are widely patent.\n-VESSELS:  Atherosclerotic disease is noted of the thoracic aorta.\nCHEST CAGE: Sternotomy wires are noted.  Sternotomy itself is not fully\nhealed, and there is osteolysis along its upper margin, of indeterminate\nsignificance, clinically correlate to exclude infection.  There is mild\nretrosternal stranding, without organized fluid collections or abscess. \nDegenerative changes are noted of the shoulder joints bilaterally.  Small\namount of subcutaneous emphysema is noted along the right chest wall.",
            "output": "1. Right chest tube in situ.  Complex mild nonhemorrhagic right\nhydropneumothorax is demonstrated with subpulmonic effusion component, and\npartially loculated fluid and air.\n2. Mild atelectasis in the right lung base.\n3. There is osteolysis along the manubrial component of sternotomy, up with\nadjacent mild stranding, clinically correlate to exclude subacute infection.\n4. Few mildly prominent lymph nodes in mediastinum, likely reactive.\n5. No evidence of pneumonia or malignancy in the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is homogeneous. \nThere is no supraclavicular and no axillary lymphadenopathy.  The patient\nappears cachectic.  Mild subcutaneous edema is diffuse and new since ___.\n\nUPPER ABDOMEN: Small quantity of ascites.  Remaining findings detailed in the\nconcurrent CT of the abdomen pelvis.\n\nMEDIASTINUM: Scattered borderline lymph nodes in the mediastinum are larger\nsince ___, measure up to and 1.3 cm in the subcarinal station and 1 cm\nin the left lower paratracheal station.\n\nHILA: Right hilum 1.7 x 2.1 cm and 0.8 x 1.5 cm lymph node or larger since\n___.  There is no left hilum lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Extensive dense\ncalcifications of the coronaries with moderate calcifications along the normal\ncaliber thoracic aorta and head and neck vessels.  There is no pericardial\neffusion.\n\nPLEURA: Trace bilateral pleural effusions.\n\nLUNG: Minimal secretions in the carina and main bronchi.  Mild diffuse\nbronchial wall thickening is suggestive of chronic bronchial inflammation such\nas chronic bronchitis.   Mild-to-moderate centrilobular emphysema is\npredominantly of the upper lobes.\nNo confluent consolidations concerning for pneumonia.\nMild branching opacities in the right lower lobe suggest minimal\nbronchiolitis.\nMicronodule in the right lower lobe and another adjacent to the major fissure\nare unchanged.\n\nCHEST CAGE: Mild-to-moderate multilevel degenerative changes of the spine with\nno evidence of osteo-destructive lesions in the ribs, sternum no or vertebra.",
            "output": "-Mild chronic bronchitis on a background of mild to moderate emphysema. \nMinimal right lower lobe pneumonia is disproportionate to the mediastinal and\nhilar lymphadenopathy which is more likely due to underlying CLL rather than\nreactive.\n-mild diffuse subcutaneous edema with trace pleural effusions.\n-Abdomen and pelvis reported separately."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is enlarged measuring 3.6 cm.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy.  A\nprominent right hilar lymph node measuring 2.3 x 2.2 cm, previously measuring\n2.4 x 2.1 cm in ___, is increased in size since ___.\n\nPLEURAL SPACES: Small right and trace left pleural effusions.  No\npneumothorax.\n\nLUNGS/AIRWAYS: There is mild interlobular septal thickening concerning for\nmild interstitial pulmonary edema.  There is severe centrilobular emphysema. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nUPPER ABDOMEN: Within the imaged portion of the upper abdomen, trace ascites\nand a slightly congested appearance of the upper abdominal fat may reflect\nmild heart failure.\n\nBONES: There is acute fracture through the anterior corner of the superior\nendplate of T12 with mild prevertebral hematoma (3:209), new since the prior\nstudy.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild interstitial pulmonary edema.\nSmall right and trace left pleural effusions.\n3. Acute T12 superior endplate mild compression fracture with associated\nprevertebral hematoma.\n4. Right hilar lymphadenopathy similar in size since the prior study from\n___, however increased in size since ___.  Consider 3 to\n6-month follow-up chest CT to ensure stability given presence of underlying\nsevere emphysema.\n5. Enlarged main pulmonary artery suggestive of pulmonary arterial\nhypertension.\n\nRECOMMENDATION(S):  3 to 6-month follow-up chest CT."
        },
        {
            "input": "No substantial change in the appearance of the mildly dilated main pulmonary\nartery up to 3.4 cm is demonstrated consistent with mild pulmonary\nhypertension.  Aorta is normal in diameter.  There is interval slight increase\nin size in bilateral pleural effusions, current ___ moderate on the right and\nsmall on the left.  Anemia is demonstrated.  No mediastinal pathologically\nenlarged lymph nodes present with several top-normal lymph nodes seen.  No\naxillary lymphadenopathy is demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nCentrilobular emphysema is moderate.  Diffuse bronchial wall thickening is\nnoted.  No new consolidations to suggest infectious process seen.",
            "output": "Interval increase in bilateral pleural effusion\n\nCoronary calcifications\n\nNo intrathoracic lymphadenopathy\n\nEmphysema and evidence of chronic bronchitis.\n\nPlease review CT abdomen and pelvis in the corresponding report."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The main\npulmonary artery measures approximately 3.3 cm, similar to prior.  No\npericardial effusion is seen.  Diffuse coronary artery and aortic\ncalcifications.  The study is nondiagnostic for evaluation of a pulmonary\nembolism.\n\nAXILLA, HILA, AND MEDIASTINUM: Several mediastinal lymph nodes are prominent,\nbut not pathologically enlarged.  No axillary lymphadenopathy is present.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: Compared to the most recent prior study, the bilateral pleural\neffusions have mildly increased, now moderate on the right and small on the\nleft.  Consolidations adjacent to these pleural effusions in the lower lungs\nare most likely atelectasis, although there may also be a component of\naspiration/pneumonia.  No pneumothorax.\n\nLUNGS/AIRWAYS: Moderate centrilobular emphysema is redemonstrated.  Nodular\nconsolidations within the right middle lobe are new from the prior study and\nmay be compatible with aspiration or pneumonia.  Mild left base opacity may\nrelate to atelectasis, but additional site of infection and/or aspiration is\nnot excluded.  An ET tube terminates approximately 4-5 cm above the carina. \nWithin the limitations of motion artifact, there may be possible aspirated\nmaterial within the right lower lobar bronchus and more distally to the\nsegmental level.\n\nABDOMEN: A nasogastric tube terminates in the stomach.  The patient's known\nretroperitoneal adenopathy is partially imaged and better assessed on the\nprior CT.  Perihepatic ascites is redemonstrated and partially imaged.\n\nBONES: Multilevel degenerative changes of the spine are redemonstrated.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nSOFT TISSUES: Diffuse, subcutaneous edema in the chest, which may be\ncompatible with anasarca.  New foci of gas within the anterior chest, at the\nlevel of the clavicles, are nonspecific, but may be compatible with venous gas\nfrom an IV.",
            "output": "1. In the absence of contrast, the study is nondiagnostic for evaluation of a\npulmonary embolism.\n2. New, nodular consolidations within the right middle lobe and possibly left\nlower lobe, which may be compatible with aspiration/pneumonia.\n3. A moderate right and small left pleural effusion have mildly increased in\nsize from the prior study.  Adjacent consolidations may be reflective of\natelectasis, although there may also be a component of aspiration/pneumonia.\n4. New foci of gas within the anterior chest, at the level of the clavicles,\nwhich are nonspecific, but may be compatible with venous gas from an IV. \nRecommend clinical correlation for any signs of infection."
        },
        {
            "input": "Soft tissues: The thyroid is homogeneous. There is a calcified nodal\nconglomerate in the left hilus which is unchanged since ___.  No\nmediastinal or hilar lymphadenopathy.  Aorta and main pulmonary artery are\nnormal in caliber.  Heart size is normal with no pericardial effusion.  There\nare heavy coronary artery calcifications.  The study is not dedicated for\nsubdiaphragmatic diagnosis and limited images of the upper abdomen are\nunremarkable.\n\nLungs: Since the prior CT from ___, the smooth pleural thickening\nalong the right lung has progressively calcified.  This was previously\nevaluated via PET-CT for the concern of mesothelioma, however was not FDG\navid.  Mildly calcified pleural plaque is also seen at the base of the left\nlung.  The airways are patent to the subsegmental level bilaterally no\nbronchial wall thickening or endobronchial secretions.  Linear opacities in a\nsubpleural location of the right middle and lower lobes, as well as the\nlingula and left lower lobe likely represent asbestos related interstitial\nchanges.  4 mm left lower lobe pulmonary nodule (5:152), and 3 mm perifissural\nleft lower lobe nodule (5:160), are unchanged since ___.  No new nodules are\nappreciated.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1. Bilateral partially calcified pleural plaque in keeping with history of\nasbestos exposure.\n2. Stable left lower lobe pulmonary nodule since ___ do not warrant further\nfollowup.\n3. Subpleural parenchymal changes bilaterally in keeping with asbestos related\nlung changes."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\npulmonary trunk and the bilateral main pulmonary arteries are enlarged,\nmeasuring 3.3 cm in diameter for the pulmonary trunk, 2.9 cm for the right\npulmonary artery, and 2.9 cm for the left pulmonary artery, which is\nsuggestive of pulmonary arterial hypertension.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  Poly\nchamber moderate cardiomegaly is demonstrated.  Coronary artery calcifications\nare seen diffusely.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Patulous esophagus,\nespecially at the level of the superior mediastinum.\n\nPLEURAL SPACES: Moderate to large right-sided pleural effusion and a\nmoderate-sized left pleural effusion with adjacent compressive atelectasis. \nThere is biapical pleuroparenchymal scarring.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is mild peribronchial thickening, smooth interlobular\nseptal thickening, and scattered regions of ground-glass opacities, suggestive\nof pulmonary edema.  There is compressive atelectasis adjacent to the\nbilateral pleural effusions and biapical pleuroparenchymal scarring with\ntraction bronchiectasis.  Otherwise, there are no large pulmonary nodules or\nmasses.  There is a triangular region of opacification within the right upper\nlobe (series 3, image 97), likely representing scarring.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  There is\nreflux of contrast into the hepatic veins, which suggests a component of right\nheart dysfunction.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. No aortic dissection or aneurysm.\n3. Bilateral moderate-sized pleural effusions, right greater than left.\n4. Enlarged pulmonary trunk and bilateral main pulmonary arteries, suggestive\nof pulmonary arterial hypertension.\n5. Cardiomegaly with pulmonary edema.\n6. Biapical pleuroparenchymal scarring.\n7. Patulous esophagus may suggest esophageal dysmotility."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is mildly calcified but is normal\nin caliber.  The heart, pericardium, and great vessels are within normal\nlimits based on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild left apical paraseptal emphysema.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced abdomen a surgically removed\ngallbladder, small bilateral Bochdalek's hernias, moderate atherosclerosis but\notherwise unremarkable.\n\nBONES: A bilateral shoulder prostheses.  There is stable anterolisthesis of L4\non L5.  No suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "No acute sequelae of trauma.  Incidental findings as described."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Mild heterogenous enlargement of\nthe thyroid gland with a hyperdense nodule seen in the left lobe measuring 4\nmm in diameter (correlation with thyroid ultrasound is advised).  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Subcentimeter para-aortic lymph nodes (the largest measures 8 mm\n(6, 14) are increased in number but not size.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcifications.  Minimal LAD calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Motion artifact obscures the pulmonary parenchyma.  2 mm\npulmonary nodule in the left lower lobe abutting the oblique fissure (8, 94). \nNo other pulmonary nodules or masses.  No coalescing airspace consolidation. \nNo diffuse lung disease.  Mild air trapping seen on this expiratory phase\nstudy.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is mildly dilated measuring 34 mm in diameter.\nMotion artifact partially obscures the pulmonary truncus.  No pulmonary\narterial filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "There is a single 2 mm pulmonary nodule seen in the left lower lobe which is\nindeterminate.\nPara-aortic mediastinal lymph nodes are normal in size, but increased in\nnumber and is of unknown importance.\nMild heterogenous enlargement of the thyroid gland.\nFor abdominal by findings please see abdominal CT report.\n\nRECOMMENDATION(S):  The single indeterminate pulmonary nodule and para-aortic\nmediastinal lymph nodes should be interpreted in conjunction with the extra\nthoracic findings.\n\nThyroid ultrasound advised."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Minimal decrease in size of the pre-existing\nnumeric early enlarged para-aortic lymph nodes.  No adenopathy in the\nmediastinum or at the level of the hilar structures.  No cardiac\nabnormalities.  The posterior mediastinum is unremarkable.  The upper abdomen\nis reported in detail in the dedicated abdominal CT report.  No abnormalities\nat the level of the soft tissues in the chest wall.  No osteolytic lesions at\nthe level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures. \nIncomplete inspiration, mild respiratory motion.  Areas of atelectasis in the\ndependent lung regions.  Stable 2 mm perifissural left-sided nodule (9, 109). \nNo diffuse lung disease.  No pleural effusions.  No suspicious lung nodules or\nmasses.",
            "output": "Stable 2 mm perifissural nodules.  Mild increase in number of mediastinal\nlymph nodes.  No new or growing lymph nodes or pulmonary nodules.  No pleural\nabnormalities."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\n\nFindings below the diaphragm will be reported separately.\n\nThyroid is mildly enlarged and heterogeneous but there are no discrete\nabnormalities large enough to warrant further imaging evaluation.\n\nAtherosclerotic calcification is not apparent head neck vessels nor is it\nappreciable in the coronary arteries aside from a small calcification at the\norigin of the left anterior descending.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  Pericardium is physiologic.  There is no\npleural abnormality.\n\nMediastinal lymph nodes are numerous in the prevascular station, but not\npathologically enlarged or changed.  Mediastinal nodes elsewhere, hilar nodes,\nand other thoracic lymph nodes are not enlarged.\n\nLungs are underinflated which could obscure tiny lung nodules, but there are\nno lung lesions of sufficient size to raise concern for intrathoracic\nmalignancy and no consolidation or diffuse pulmonary abnormality is present.\n\n There are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, but it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning..\n\nRight central venous catheter passes to the mid or lower portion of the right\natrium with no associated thrombus.",
            "output": "No evidence of intrathoracic malignancy.\n\nMinimal coronary artery calcification."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Extensive filling defects involving the right main\npulmonary artery (3:69), extending into the right middle and lower lobar\npulmonary arteries, into several segmental branches, with expansion of the\nvessels, compatible with acute pulmonary embolism.  Pulmonary embolus extends\nalso into the right upper lobe segmental branches (3:75-78.)  the main\npulmonary artery is dilated to 4.0 cm, previously up to 3.3 cm on ___ (3:65).  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Right-sided Port-A-Cath tip\nterminates in the lower SVC.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is no focal consolidation.  Respiratory motion artifact\nlimits evaluation of the lungs.  There is bibasilar atelectasis, right base\ngreater than the left.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nfocal deposit at the inferior edge of the liver measures 1.5 cm, seen on the\nprior study (2:96).  There is mild intrahepatic biliary dilatation in the\nsetting of prior cholecystectomy.\n\nPANCREAS: The pancreas has is somewhat atrophic with normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small and large bowel loops\nare impressed by the confluent intra-abdominal masses.  The appendix is\nnormal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nSince the study from ___, there appears to have been interval\ngrowth in the confluent intra-abdominal, mixed density mass, which now spans\nthe entire abdominal girth (2:122), not previously extending to this extent. \nAt this level it measures 18.2 x 32.5 cm, previously 23.3 x 14.9 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  The SMV appears attenuated.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.  Mild\ndegenerative changes in the imaged thoracolumbar spine.",
            "output": "1.  Extensive pulmonary embolism, right-sided.  Enlarged main pulmonary artery\nmay reflect pulmonary arterial hypertension.\n\n2.  Intervally increased size of intra-abdominal mass, current measuring 32.5\nx 18.2 cm, previously 23.3 x 14.9 cm on ___.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 20:05 on ___, 2 minutes after\ndiscovery."
        },
        {
            "input": "There is probably no supraclavicular lymph node enlargement, and no\nenlargement of lymph nodes in the axillae or any soft tissue mass in the\nimaged chest wall suspicious for malignancy.  In addition to anasarca, there\nare large intramuscular fluid collections in the chest wall muscles of the\nright, lateral, mid and lower back, incompletely imaged.  I cannot say whether\nthese are due to edema or abscess.  This study is not designed for\nsubdiaphragmatic diagnosis but shows ascites.\n\nIodine storage in the thyroid gland is diminished, sometimes a sign of hypo\nthyroidism. A left PIC line ends in the low right atrium and would need to be\nwithdrawn 3 cm to reposition it in the low SVC.\n\nAtherosclerotic calcification is minimal in the head and neck vessels,\nscattered in the coronaries. Aorta, pulmonary arteries and cardiac chambers\nare normal size. Small bilateral pleural effusions, left-greater-than-right\nlayer posteriorly. Along with a very small pericardial effusion the pleural\nfluid is nonhemorrhagic.  There is insufficient pericardial fluid to produce\ntamponade physiology, but with the exception of the atrial appendage, the\nright atrium is very small. This could be explained by decreased intravascular\nvolume, and the relative distension of the low attenuation appendage, -6 to 14\n___, 4: 93, could be due to a thrombus.\n\nEnlarged low-attenuation central lymph nodes are present in the prevascular\nstation, 10 x 18 mm, 4:65 and subcarinal and paraesophageal stations, 18 x 33\nmm, 4: 86.  These lymph nodes are either necrotic, seen with acute infection\nor, more likely edematous due to cardiac decompensation.\n\nExtensive ground-glass opacification is present in the mid and upper lung\nzones,, some perihilar and some peripheral. In these areas are many cystic air\ncontaining spaces, ranging from a few mm to 13 mm, 04:57. These are more\nlikely emphysematous bullae highlighted by the pulmonary abnormality, rather\nthan acute pneumatoceles and certainly not cavities. In terms of acute\ninfection, this is an occasional finding in pneumocystis pneumonia.\n\nAt the lung bases there is confluent consolidation on the left and less\nconfluent peribronchial infiltration on the right, either of which could be\npneumonia. There is no bronchial obstruction.\n\nThere are no bone lesions suspicious for malignancy or infection.",
            "output": "3 distinct pulmonary processes: Emphysema. Mid and upper lung ground-glass\nopacification, could be infectious, probably edema. Lower lobe consolidation\nand peribronchial infiltration, probably pneumonia, exacerbated by\natelectasis.\n\n5 abnormal fluid collections: Ascites, anasarca, right flank intramuscular\nfluid (could be a manifestation of anasarca), small pleural effusions,\ninsignificant pericardial effusion.\n\nSmall right atrium suggests intravascular hypovolemia.  Possible right atrial\nthrombus.  No useful information regarding pulmonary emboli.\n\nPossible hypo thyroidism.\n\nOne way to explain the rapid development of the more diffuse pulmonary\nabnormality documented by conventional radiographs before and after this study\nis that the patient was admitted with mild pneumonia, and chronic\nhypoalbuminemia, responded to fluid resuscitation and blood product\ntransfusion with pulmonary edema and possible transfusion reaction, severity\nexacerbated by hypoalbuminemia.\n\nAn alternative explanation would be an overwhelming viral infection leading\nquickly to ARDS.\n\nGiven the history of multiple DVT, the possibilities of right atrial thrombus\ncan be evaluated by echocardiography and CTA or VQ radionuclide scanning,\nrespectively."
        },
        {
            "input": "The thyroid is normal.  High right paratracheal lymph node has increased in\nsize measuring 12 mm, previously 7 mm, with greater craniocaudal extent likely\nreactive. Supraclavicular, axillary, and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Unchanged mild aneurysmal\nconfiguration of the left ventricular apex suggest prior myocardial\ninfarction. Coronary artery calcification is mild-to-moderate.  Trace\npericardial fluid is likely physiologic.\n\nLeft PICC terminates in the low SVC. Endotracheal tube terminates in the\nmidtrachea. 8 mm left aortopulmonary window lymph node is unchanged.\n\nCentral airways are patent to the subsegmental level. Bibasilar consolidations\nhave improved. The distribution of ground-glass opacities described on prior\nCT have worsened and currently involve the lungs diffusely. Superimposed\ncystic changes are re- demonstrated. More conspicuous cystic changes in the\nmid to lower lungs may represent active cystic disease versus increase\nconspicuity given background ground-glass opacity. Small left and trace right\npleural effusions are unchanged.\n\n\nThere is no sclerotic or lytic osseous lesion concerning for malignancy or\ninfection. Sternal irregularity on sagittal projection is secondary to motion\nartifact.\n\nSmall amount of perisplenic fluid is simple in attenuation. Nasogastric tip\nand side hole are within the stomach. This study is not designed for\nsubdiashragmatic diagnosis but shows no adrenal mass or abnormality in the\nimaged portions of the unenhanced solid organs in the upper abdomen.",
            "output": "1. Worsening distribution of bilateral ground-glass opacities now involving\nthe lungs diffusely with increased conspicuity of cystic airpaces suggest an\natypical infection, notably PCP.\n2. Improved bibasilar consolidation.\n3. Unchanged small bilateral simple pleural effusions.\n4. Enlarged mediastinal lymph nodes, including increase in size of left\nparatracheal, node are likely reactive in etiology.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 10:52 AM, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "No aortic dissection is seen.  The heart is mildly enlarged.  No pericardial\neffusion.\n\nFilling defect and distension of a left lower lobe segmental pulmonary artery\nand its subsegmental branches is consistent with acute pulmonary embolus (e.g.\n, series 3, image 113, 116, 119).  Otherwise, the remaining pulmonary arteries\nare well opacified to the subsegmental level.  The main and right pulmonary\narteries are normal in caliber.  No evidence of right heart strain.\n\nNo pathologically enlarged supraclavicular axillary lymph nodes.  Multiple\nmediastinal lymph nodes are again measurable  since ___ for example, a 9-mm\nright upper paratracheal node (series 3, image 56), a 9-mm left lower\nparatracheal node (series 3, image 71), and and 8-mm subcarinal node) series\n3, image 92).  A left hilar lymph node measures up to 8 mm in short axis, more\npronounced from the prior exam (series 3, image 91).  Right hilar soft tissue\nprominence is overall unchanged.\n\nThe thyroid gland is normal in appearance.\n\nBilateral, diffuse mosaic appearance of the parenchyma is nonspecific but is\nmost likely secondary to air trapping in the setting of small airways disease\nwith associated mild peribronchiolar wall thickening that is more pronounced\nin the bilateral lower lobes.  No interlobular septal thickening or pleural\neffusion to favor edema.  Linear bandlike opacities in the bilateral lower\nlobes and the right middle lobe and lingula is most likely atelectasis.  No\nfocal pneumonia.  No pneumothorax.  The airways are patent to at least the\nsubsegmental level.\n\nThis exam is not dedicated for imaging of the upper abdomen ; however, within\nthis limitation the attenuation of the hepatic parenchyma is markedly\ndecreased, consistent with steatosis.  In addition, multiple hepatic\nhypodensities are too small to accurately characterize on CT, but\nstatistically could represent cysts or biliary hamartomas, at least some of\nwhich were visualized on the prior CT (e.g. series 3, image 170, 149, 171).  A\n2.3 x 1.7 cm left adrenal nodule is of intermediate density (35 Hounsfield\nunits) and may be slightly larger since ___ (series 3, image 190).\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMild dextroconvex scoliosis of the upper thoracic spine is unchanged.",
            "output": "1.  Acute pulmonary embolus in a left lower lobe segmental pulmonary artery\nand its subsegmental branches.\n\n2.  Bronchiolar inflammation, probably small airways disease.\n\n3.  Prominent mediastinal lymph nodes and slightly larger left hilar lymph\nnode.  Could be reactive in the setting of chronic bronchial inflammation. \nClose attention on follow-up.\n\n4.  Hepatosteatosis.\n\n5.  2.3-cm indeterminate left adrenal nodule.  Recommend non-emergent\nevaluation with CT adrenal or MRI adrenal if not previously assessed.\n\nRECOMMENDATION(S):  Non-emergent CT or MRI for indeterminate left adrenal\nnodule.\n\nNOTIFICATION:   The findings and impression were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 3:19 ___, 1\nminutes after discovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is persistent filling defect/ pulmonary embolism affecting the left\nlower lobe segmental pulmonary arteries (3:104), as well as multiple\nsubsegmental branches (3:111).  Compared to the recent prior exam from ___, there is no significant increase in clot burden.  The main and right\npulmonary arteries are normal in caliber, without evidence of right heart\nstrain.\n\nMultiple mediastinal lymph nodes measure up to 8-9 mm, unchanged since the\nprior study (3:64).  A left hilar node measures 8 mm (3:74)  The thyroid gland\nappears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMultiple dense consolidations in the bilateral lungs are new since ___.  These involve the right middle lobe (3:98, right lower lobe (3:115),\nleft lower lobe (3:129, and lingula (3:111).  The airways are patent through\nthese consolidations.  Given the clinical history, these are concerning for\nmultifocal pneumonia.  However, the left lower lobe in the setting of known\nrecent pulmonary emboli, infarction is also considered.  There is also likely\na component of atelectasis associated with the consolidations.  Scattered\nareas of patchy ground-glass opacities throughout both lungs are slightly more\nprominent on today's exam and may be related to hypoventilation or small\nairways disease.\n\nLimited images of the upper abdomen are unremarkable, except for several\npreviously described hepatic hypodensities.  The previous left adrenal nodule\nis not imaged on the current study..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No significant change in the left lower lobe pulmonary emboli burden.  No\nnew pulmonary emboli detected.\n\n2.  Multiple dense consolidations involving the bilateral lower lobes, right\nmiddle lobe, and lingula are new since ___.  Given the clinical\nhistory, these are concerning for multifocal pneumonia, with a component of\natelectasis.  However, in the left lower lobe, consider infarction, given the\npresence of pulmonary emboli within the supplying segmental and subsegmental\npulmonary arteries.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ fellow) at 18:25 on ___, 2 min after\ndiscovery."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: A prominent subcarinal lymph node is unchanged since at least ___.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with no appreciable coronary artery calcifications. There is no\npericardial effusion.\n\nPLEURA: There is no pleural effusion or pneumothorax.  Thickening and small\ncalcifications of the pleura, particularly along the posterior aspect of the\nright upper lobe is unchanged since the prior study (2:15).\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Severe\nbilateral, upper lobe predominant, emphysema is unchanged.  Compared with the\noutside hospital study of ___, dense and more extensive\nground-glass opacities involving essentially the entire left lower lobe have\nbecome more extensive.  However, reticular and interstitial ground-glass\nopacities in the right upper lobe and right lower lobe have improved. No new\nsuspicious pulmonary nodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the spleen appears lobulated and enlarged, as\nseen on the prior study.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Mild to moderate multilevel degenerative changes of the thoracic\nspine are unchanged.",
            "output": "1.  Findings suggesting improvement in the right lung atypical pneumonia, but\nworsening of the same process in the left lung.\n\n2.  Severe emphysema.\n\n This preliminary report was reviewed with Dr. ___\nradiologist."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis a calcified granuloma in the left lower lobe.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST PERIMETER: No incidental thyroid findings.  No supraclavicular or\naxillary lymph node enlargement.  Breast evaluation is reserved exclusively\nfor mammography.  No soft tissue abnormalities elsewhere in the chest wall. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is mildly patulous at several levels otherwise\nunremarkable.  Atherosclerotic calcification not apparent in head and neck\nvessels or coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size and pericardium is physiologic.  Right head central\nvenous infusion port catheter ends in the mid right atrium with no evidence of\nthrombosis.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n7 x 12 mm right diaphragmatic lymph node, 3:157, was 4 x 10 mm in ___.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are fully expanded and clear.  Tracheobronchial\ntree normal to subsegmental levels.  No pleural abnormalities.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Slight interval growth, solitary subcentimeter right diaphragmatic lymph node\nmay be a function of subdiaphragmatic malignancy.  No other evidence of\nintrathoracic malignancy."
        },
        {
            "input": "THORACIC INLET: There is a right-sided central line with its tip in the right\natrium.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  Regression in size of the diaphragmatic lymph\nnode which now measures 3 mm.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  There are degenerative changes involving the\nthoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a small hiatus\nhernia with herniation of the bowel loops.",
            "output": "Regression in size of the right diaphragmatic lymph node which now measures 3\nmm.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is dilated and measures up to 3.3 cm.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a 0.6 x 1.0 cm\nright diaphragmatic node increased in size compared to prior.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 3 mm nodule along the fissure in the right middle\nlobe, unchanged (series 3, image 99).  There is a calcified granuloma in the\nleft lower lobe (series 3, image 111).  Otherwise, no focal consolidation is\nseen.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited views of the upper abdomen demonstrate mild perihepatic and\nperisplenic free fluid.  There is a partially imaged ventral hernia containing\ntransverse colon, as seen on prior (series 3, image 215).  Known lesion at the\nhepatic dome measures up to 1.6 cm, previously 1.7 cm is not well evaluated on\nthe current study.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic injury.\n2. Enlargement of the main pulmonary artery measures 3.3 cm, suggesting\npulmonary artery hypertension.\n3. Partially imaged abdomen demonstrates perisplenic and perihepatic\nfree-fluid, increased compared to prior.\n4. Partially imaged ventral hernia containing transverse colon in the upper\nabdomen, as seen on prior.  No findings to suggest obstruction at the level of\nthe hernia\n5. Right diaphragmatic lymph node measures 1.0 cm, increased in size compared\nto prior from ___, similar compared to more remote study of ___..\n6. Incompletely evaluated known right hepatic dome lesion was better assessed\non prior studies."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Is unchanged, 4 mm.  Heart\nsize is mildly enlarged.  Central venous line tip terminates in right atrium.\n\nLeft paracardiac lymph node has increased in size from 4 to 7 mm, series 303,\nimage 163.  Right paracardiac lymph node has increased in size from 6-10 mm,\nseries 303, image 180.  Otherwise, no pathologically enlarged mediastinal,\nhilar or axillary lymph nodes demonstrated.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval increase in size pericardiac lymph nodes as described.\n\nNo new nodules masses or consolidations or pleural effusion, as well as no\nother lymphadenopathy demonstrated.\n\nPlease review CT abdomen and pelvis and the corresponding report will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  The right and left pericardial\nlymph node are both decreased in size, now measuring up to 4 mm in short axis.\n\nHILA: No hilar lymphadenopathy.\n\nHEART AND VESSELS: The heart is normal in size.  No pericardial effusion is\nidentified.\n\nPLEURA: No pleural effusion is identified.\n\nAIRWAYS/LUNG: The central airways are patent.  There is no suspicious\npulmonary lesion or focal consolidation.  Calcified granulomas are noted\nwithin the left lower lobe.\n\nBONES: No acute fracture or suspicious osseous lesions are identified.  There\nis a healed fracture through the posterior aspect of the left eleventh rib.\n\nSOFT TISSUES: There is a right chest wall Port-A-Cath with the tip terminating\nin the right atrium.  No soft tissue abnormality.\n\nUPPER ABDOMEN: Please see separate report for recently performed CT Abdomen\nand Pelvis for findings below the diaphragm.",
            "output": "1.  No acute abnormality or evidence of new metastatic disease in the chest.\n2.  Interval decrease in the bilateral pericardial lymph nodes."
        },
        {
            "input": "Pleural parenchymal scarring is greater at the right apex. Three Small\nirregular opacities at the right apex, inferior to the bulk of the scarring\nand a 5 mm wide ground-glass nodule, 05:51, will require re-evaluation in 6\nmonths. An isolated enhancing 6 mm right upper lobe subpleural nodule, 5:134,\ncould be a solitary metastasis. Suture at the base of the left lung suggest\nprior wedge resection. If tumor was removed, there is no evidence of local\nrecurrence in the lung and the extent of local pleural thickening, when\ncomparing 5 mm thick sections, has not changed since ___. Aside from an\ninconsequential punctate nodule in the left upper lobe, 05:49, lungs are\notherwise clear. There is no pleural or pericardial effusion.\n\nThyroid is unremarkable. Supraclavicular and axillary, mediastinal and hilar\nlymph nodes, and nodes in the internal mammary, diaphragmatic, and retrocrural\nstations are not pathologically enlarged. There is no pleural or pericardial\neffusion. Aorta and pulmonary arteries are normal size. Atherosclerotic\ncalcification is minimal. Nevertheless the left ventricle appears enlarged.\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "I do not know the results of prior resection from the left lower lobe.\nCurrently a solitary 6 mm right upper lobe solid lung nodule is the only\ncandidate for metastatic colon carcinoma in the chest.\n\nSmall irregular nodules separated from right apical pleural parenchymal\nscarring and a single 5 mm ground-glass nodule should be re-evaluated with\nchest CT in 6 months. Contrast administration is not necessary for that study."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged in appearance, not dilated.  No\npathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated.  Heart size is mildly enlarged.  No pericardial pleural effusion\nis seen.  Image portion of the upper abdomen re- demonstrate hypodensity in\nthe left lobe of the liver, too small to characterize.  No other abnormalities\ndemonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  The patient is\nafter resection of subpleural nodule in the right lower lobe with unremarkable\nappearance of the sutures.  Additional sutures in the right upper and left\nlower lobe are also unremarkable\n\nBronchiectasis in the right upper lobe and in the right lower lobe are\npresent.  Extensive centrilobular nodules as well as bronchial impaction and\nperibronchial consolidations in the right lower lobe are present, consistent\nwith infectious process.  As compared to ___ the extent of\ninflammation/infection in the right lower lobe appears to be slightly\nprogressed.  A right upper lobe bronchiectasis and nodules appear to be\noverall similar to previous examination.  No new lesions demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Status post resection of the right lower lobe pulmonary nodule.\n\nInfectious process potentially reflecting chronic airway infection or\nrecurrent aspiration with bronchiectasis in the right upper and right lower\nlobe as described."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is upper limits\nof normal, and no pericardial or pleural effusion is evident.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.\n\nWithin the lungs, postoperative changes are present related to previous wedge\nresection procedures in the left lower lobe and right lower lobe, similar in\nappearance to the prior study.  Multilobar distribution of bronchiectasis is\nagain demonstrated with associated clustered tree in ___ bronchiolar opacities\nin the right upper and right lower lobes.  The bronchiectasis remains most\nsevere in the right lower lobe were is accompanied by severe bronchial wall\nthickening extending proximally to the segmental level.  Peribronchiolar\nconsolidation and ___ opacities in the right lower lobe.  Have\nslightly worsened laterally and minimally improved posterior medially.",
            "output": "1. Stable postoperative appearance at wedge resection sites.\n\n2.  Severe right lower lobe bronchiectasis with a waxing and waning\nperibronchiolar consolidation and small airways disease.  Although potentially\ndue to recurrent aspiration, note is made of the it a normal video swallowing\nstudy in ___.  Therefore, chronic infection such as MAC should be\nconsidered.  Note that the extent of right lower lobe abnormality could\npotentially obscure pulmonary nodules from metastatic disease.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nextensive atherosclerotic calcification throughout the ascending and\ndescending thoracoabdominal aorta.  The heart, pericardium, and great vessels\nare within normal limits based on an unenhanced scan.  There is moderate\natherosclerotic calcification of the coronary arteries.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  There is a mildly enlarged pretracheal lymph node measuring 1.1 cm\nin short axis (02:25), likely reactive.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a moderate left-sided pleural effusion.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is somewhat limited by\nrespiratory motion.  Lungs demonstrate diffuse septal thickening with\nground-glass opacities, suggestive of volume overload.  There is mild\nbibasilar atelectasis, with compressive atelectasis in the left lower lobe. \nMinimal emphysematous changes are noted.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nPatient is status post cholecystectomy.  There is a simple appearing exophytic\nrenal cyst on the left kidney measuring up to 2.4 cm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nModerate multilevel degenerative change of the thoracolumbar spine, including\nanterior osteophytosis and disc space narrowing with vacuum disc phenomena in\nthe lower thoracic spine.",
            "output": "1. No acute traumatic injury identified within the chest.  No fracture.\n2. Mild septal thickening with ground-glass opacities, suggestive of volume\noverload.\n3. Moderate left pleural effusion with adjacent compressive left lower lobe\natelectasis."
        },
        {
            "input": "There is no supraclavicular or axillary adenopathy or any soft tissue\nabnormality in the imaged chest wall suspicious for malignancy or infection. \nMuscular atrophy is noted in the left upper back and posterior shoulder. Both\nthyroid is unremarkable.  Tracheostomy is midline and there is no associated\nhematoma or fluid collection.  Lymph nodes in the mediastinum are numerous,\nbut range in diameter only up to 9 mm in the right upper paratracheal station,\nsmaller in the prevascular station, and 9 mm in the right hilus, 5:131, 136.\nAorta and pulmonary arteries are normal size. Left ventricle is probably\nenlarged.\n\nPericardial and right pleural effusions are small. There is no appreciable\nleft pleural effusion. Although there is a substantial left lower lobe\natelectasis in the posterior basal segment, there is also considerable\nheterogeneous consolidation in the superior and anteromedial basal segments of\nthe lower lobe and scattered in the left upper lobe, more likely pneumonia. \nHigh density material at the base of the atelectatic right lower lobe is\nprobably aspirated oral contrast agent. Secretions are collected in the lower\ntrachea. The left basal trunk bronchus is collapsed, but the remainder of the\nbronchial tree is intact.  There is no pulmonary edema. There is mild loss of\nheight in several thoracic and upper lumbar vertebral bodies, probably due to\nosteoporosis, but no considerable compression fracture and no bone lesions in\nthe chest cage suspicious malignancy.\n\nA left central venous line ends in the mid SVC.",
            "output": "Probable left upper and lower lobe pneumonia or massive aspiration. Bibasilar\natelectasis severe in the right lung, milder in the left. Pleural and\npericardial effusions are insignificant. No pulmonary edema.\n\nMild to moderate retention of secretions in the trachea. Tracheostomy tube has\na standard appearance ; no evidence of complications."
        },
        {
            "input": "THORACIC INLET: The tracheostomy tube projects approximately 4.7 cm from the\nentry site.  The cuff does not appear to be inflated.  There are secretions\nseen within the proximal airways.  There are no enlarged  supraclavicular\nlymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Multiple small mediastinal lymph nodes are unchanged.  There are\nsmall bilateral hilar lymph nodes\n\nHEART, VESSELS and PERICARDIUM: There is moderate cardiomegaly with stable\nshift of mediastinum to the left.  Coronary artery calcification is again\nseen.  There is atherosclerotic calcification involving the aorta.  There is a\ntrace pericardial effusion.\n\nPLEURA: There is no pleural effusion.  Pleural thickening is seen along the\nright posterior pleura associated with calcification which could be related to\nprior granulomatous disease.\n\nLUNG:\nEvaluation of lung parenchyma is somewhat limited by respiratory motion. \nThere is a consolidative opacity along the fissure in the left upper lobe\nwhich could represent pneumonia.  There is ___ nodularity in the\nposterior segment the right upper lobe, right middle lobe and also the lateral\nbasal segment the right lower lobe concerning for pneumonia and could be\nrelated to aspiration.  There is subsegmental atelectasis in the right lung\nbase and patchy parenchymal opacity in the in the left lung base.  There is\nmild peribronchial thickening in both lower lobes.\n\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows nonobstructing\nright renal calculus.  No adrenal masses are seen.  No focal liver lesions are\nseen.",
            "output": "Tracheostomy tube extends approximately 4.7 cm from the entry site.  The cuff\nis not inflated\n\nConsolidative opacity in the left upper lobe and a broad bronchus centric\nopacities throughout the right lung are concerning for aspiration pneumonia. \nFollow-up to complete resolution is recommended.\n\nPleural calcification in the right lower hemithorax related to prior\ngranulomatous disease or infection.  Consolidative opacity adjacent to it most\nlikely represents subsegmental atelectasis."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nThe central airways are patent.  Posterior pouching of the tracheal wall is\nnoted without concerning features.  Mild right basilar atelectasis is noted. \nAdditionally, a focal area of ground-glass opacities seen in the right upper\nlobe, which may reflect subclinical aspiration (series 4, image 105).  The\nlungs are otherwise clear without focal consolidation concerning for pneumonia\nor concerning nodules.  There is no pleural effusion or pneumothorax. \nElevation of the right hemidiaphragm with eventration is noted, with mild\nprotrusion of the upper right hepatic lobe (series 602b, image 45, series\n601b, image 51).\n\nThe upper esophagus is patulous and contains debris.  There is a small hiatal\nhernia.  The visualized portion of the upper abdomen is unremarkable. \nMultilevel degenerative changes are present in the midthoracic spine.  There\nare no suspicious osseous lesions.",
            "output": "1.  Right diaphragmatic eventration with mild protrusion of the upper right\nhepatic lobe.\n2.  Mild right basilar atelectasis may account for the radiographic finding.\n3.  Small ground glass opacity in the right upper lobe may reflect subclinical\naspiration."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nMild cardiomegaly with predominantly left-sided enlargement is unchanged. \nThere are extensive coronary artery and mild mitral annular calcifications.  A\nleft pectoral triple lead AICD is in place with associated tunneled external\npacing wires. There is no pericardial effusion. There is stable dilatation of\nthe main pulmonary artery to 3.2 cm. The thoracic aorta is top-normal caliber.\nNo incidental pulmonary embolus is identified.\n\nThe patient has had right upper lobectomy with a stable postoperative\nappearance of the bronchial stump in remaining right lung. The right middle\nlobe bronchus is markedly narrowed as in the past.  New left upper lobe\ncentrilobular nodularity is most likely infectious in etiology (5, 151).\nModerate apical predominant centrilobular emphysema is unchanged. All\npre-existing solid and sub-solid pulmonary nodules measuring up to 6 mm in the\nleft lower lobe are stable since ___, and are presumed benign (5: 47,\n63, 104, 170, 171, 216, 217, 218, 222, 282). A calcified right lower lobe\ngranuloma is incidentally noted. No new nodules are identified.\n\nImages of the upper abdomen show cholelithiasis and bilateral renal cysts,\nincompletely imaged on the right.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "New mild left upper lobe infection.\n\nNo evidence of local recurrence or metastasis.\n\nStable mild dilatation of the main pulmonary artery suggests pulmonary\narterial hypertension in the appropriate clinical setting.\n\nCholelithiasis."
        },
        {
            "input": "CHEST:  The thoracic aorta appears intact.  There is no mediastinal hematoma. \nThe heart is unremarkable.  There is no pericardial effusion.  There is no\nlymphadenopathy.  The imaged thyroid is normal.  Endotracheal tube is\nidentified with its tip located 4.5 cm above the carina.\n\nBilateral lower lung opacities likely reflect a combination of atelectasis and\naspiration.  Otherwise, the lungs are clear without worrisome nodule, mass, or\nconsolidation.  There is no evidence of contusion or laceration.  There is no\npneumothorax or pleural effusion.\n\nABDOMEN:  The liver is mildly fatty, but intact without focal lesion of signs\nof acute injury.  The spleen is intact and normal in size.  The gallbladder,\npancreas, and adrenals are unremarkable.  The kidneys enhance symmetrically\nand excrete contrast promptly without focal lesion or hydronephrosis.  There\nis no evidence of renal or collecting system injury.  There is some delayed\nexcretion of contrast from the bilateral kidneys.  The abdominal aorta is\nnormal in course and caliber with widely patent major branches.  No\nlymphadenopathy, free air, or free fluid.\n\nThe stomach and duodenum are unremarkable.  An NG tube terminates in the\nstomach.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable and\ndecompressed, without frank thickening.  The appendix is normal.  The urinary\nbladder is distended, but appears intact.  There is no pelvic free fluid.\n\nBONES:  There is no acute fracture.  Old left rib fractures with bony callus\nare identified (2:37, 39).  Chronic appearing compression deformity of a lower\nthoracic vertebral body (602b:40) is noted.  No focal suspicious osseous\nabnormality.",
            "output": "1.  Lower lung opacities likely atelectasis and aspiration.\n2.  Given delayed excretion of contrast from the bilateral kidneys, please\ncorrelate with serum creatinine.\n3.  ET tube tip 4.5 cm above the carina.  Consider advancement by 1 cm for\nmore optimal positioning."
        },
        {
            "input": "Examination is compared to ___.  Assessment of the lung\nparenchyma is severely limited by extensive respiratory motion artifact.\nA spiculated 1.5 cm pulmonary nodule, located in an emphysematous zone of the\nright upper lobe (4, 88) is unchanged in size and morphology.\nNo other suspicious lesions are visualized.\nOverall unchanged extensive heterogeneous areas of ground-glass opacities,\nwith interspersed overinflated and emphysematous lung regions, creating the\nmosaic like attenuation patent.  There is no substantial interstitial\ncomponent to these changes.\nThe airways show mild thickening of the walls but no endobronchial lesions are\nnoted.\nA small right pleural effusion is still visible but has decreased in extent. \nNo left pleural effusion.\nMassive mediastinal lymphadenopathy is seen in unchanged manner, in particular\nin the anterior and middle mediastinum as well as in the subcarinal area. The\nlargest lymph nodes continue to have diameters around 4 cm (3a, 18).\nModerate cardiomegaly persists.  The pulmonary artery continues to have a\ndiameter of over 3 cm, potentially indicating pulmonary hypertension.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  No\nevidence of rib or sternal lesions.",
            "output": "No relevant change as compared to the previous examination from ___. Unchanged 1.5 cm spiculated nodule in the right upper lobe. Unchanged\nmosaic like attenuation pattern of the lung parenchyma, reflecting\noverinflation, emphysema, and parenchymal inflammation.  Mild chronic airways\ndisease. Moderate cardiomegaly without pericardial effusion. Diffuse severe\nmediastinal lymphadenopathy.\n\nRECOMMENDATION:  Despite stability of the spiculated right upper lobe lesion,\nthe morphology pleurisy is still suspicious and, if biopsy is not an option,\nshort term CT follow-ups with maximal intervals of six-months should be\nperformed."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  Moderate cardiomegaly persists.  The pulmonary\nartery is enlarged, measuring 3.5 cm, potentially indicating pulmonary\nhypertension.  A trace pericardial effusion is noted.\n\nAXILLA, HILA, AND MEDIASTINUM: Massive mediastinal lymphadenopathy is\nunchanged compared to prior exams, with the largest lymph node measuring 4.2 x\n1.4 cm (2a:29). No axillary or supraclavicular lymphadenopathy is present.  No\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Redemonstrated spiculated right upper lobe pulmonary nodule is\nstable in appearance, currently measured at 1.7 cm (2a:36), previously 1.5 cm\nin ___.  No new pulmonary lesions are identified.  Emphysematous changes are\nagain seen in the lungs. The previously described mosaic attenuation pattern\nwithin the lungs is again seen.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder appears\ncontracted.  Small amount of simple attenuation perihepatic, ___, and\npelvic ascites is noted, possibly third spacing from cardiovascular or hepatic\ndisease.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nPunctate calcifications in the right lower calyx and left upper calyx\n(2a:134,149) may represent non-obstructing stones.  A 2.2 cm simple right\nrenal cyst is identified.   There is no evidence of hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is hazy appearance of\nthe mesentery, possibly due to third spacing. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nair in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.   A 1.7 cm non-aggressive appearing lytic\nlesion is incidentally noted in the right iliac crest, stable since ___\n(602b:75).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "CT Chest:\n\n1. Previously noted mosaic attenuation pattern within the lungs appears more\nprominent, with increase in ground glass opacities, compatible with chronic\nthromboembolic pulmonary diseaseUnchanged known mediastinal lymphadenopathy.\n2. Redemonstrated spiculated right upper lobe pulmonary nodule is stable.  No\nnew pulmonary lesions are identified.\n3. The pulmonary artery is enlarged at 3.5 cm, possibly indicating pulmonary\nhypertension.\n4. Moderate cardiomegaly\nCT abd/pelvis:\n\n1. No acute fracture is identified in the chest, abdomen, or pelvis.\n2. Small amount of simple attenuation perihepatic, ___, and pelvic\nascites is noted, possibly due to third spacing from cardiovascular or hepatic\ndisease.\n3. Hazy mesentery, possibly due to increased fluid in the abdomen and pelvis.\n4. Punctate calcifications in the right lower calyx and left upper calyx may\nrepresent non-obstructing stones.  2.2 cm simple right renal cyst. ."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Ascending aorta measures 3.9 cm. Pulmonary arteries\nare normal size. Cardiac configuration is normal and there is mild\ncalcification in the LAD. There is a small pericardial effusion. There is no\npleural effusion. Bronchiectasis are present in the right middle lobe.\nMultifocal diffuse atelectasis are present larger in the lower lobes\nThere is a tiny calcified granuloma in the right upper lobe. There is no\nevidence of pneumonia\nThis examination is not tailored for subdiaphragmatic evaluation, a 4 x 4.6 cm\nlesion in the left adrenal gland has coarse calcifications and focal areas of\nsoft tissue density and fat.  There is more soft tissue than usually present\nin a myelolipoma, likely due to less lipoid component and more myeloid\ncomponent resulting in predominantly soft tissue appearance of the lesion\n\nThere are no bone findings of malignancy",
            "output": "Ectasia of the ascending aorta\nLeft adrenal mass, most likely myelolipoma\nBibasilar atelectases larger in the lower lobes\nMinimal bronchiectasis in the right middle lobe.\n\nRECOMMENDATION(S):\nSulfoid coloid scan is recommended to evaluate adrenal lesion / confirm\ndiagnosis of myelolipoma.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is trace atelectasis at the left lung base.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The thyroid gland is unremarkable. No pathologically enlarged mediastinal,\nhilar, axillary or supraclavicular lymph nodes are seen.\n\nThere is a normal heart size with scattered coronary artery and aortic root\ncalcifications. There is no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal in caliber.\n\nEvaluation of the lungs demonstrates small subsegmental ground-glass opacities\nwith ill-defined margins in the right middle and lower lobes. Atelectatic\nchanges are also seen at both lung bases. Bilateral pleural plaques are\ncompatible with prior asbestos exposure. There is also abnormal anterior\nbowing of the trachea and narrowing of the bilateral mainstem bronchi, which\nraises concern for tracheomalacia. Retained secretions are noted in the\nproximal left mainstem bronchus.\n\nMultilevel spinal degenerative changes are present.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Multifocal pneumonia involving the right middle and lower lobes.\n\nBilateral calcified pleural plaques which are compatible with prior asbestos\nexposure.\n\nAbnormal anterior bowing of the trachea with narrowing of the mainstem bronchi\nraises concern for tracheomalacia. A dedicated tracheal CT may be performed\nfor further evaluation if clinically warranted."
        },
        {
            "input": "The thyroid gland is unremarkable. A borderline enlarged right hilar lymph\nnode is stable measuring 10 x 9 mm, previously 10 x 8 mm (5, 134). A\npathologically enlarged subcarinal lymph node is stable measuring 10 x 18 mm,\npreviously 10 x 18 mm (5, 148). A prevascular lymph node has not appreciably\ngrown since ___ measuring 8 x 9 mm, previously 7 x 9 mm (5, 99).\n\nHeart size is normal with no pericardial effusion.  The main pulmonary artery\nand thoracic aorta are normal caliber.  Moderate calcific atherosclerosis\ninvolves the thoracic aorta, with note made of a small penetrating ulcer at\nthe level of the aortic arch (2, 20).  No incidental pulmonary embolism is\nidentified.\n\nThe patient is status post interval left upper lobectomy with new fluid in the\nleft apical pleural space and a new small nonhemorrhagic left pleural\neffusion.  Basal predominant UIP pattern fibrosis is stable, characterized by\nperipheral interlobular septal thickening and honeycomb cyst formation. There\nis also mild apical centrilobular emphysema. Nodular right apical pleural\nscarring is stable since ___ (5, 47). There is also a stable 2.9 x 5.0\ncm right lower lobe bulla.\n\nThe patient is status post partial right hepatectomy with several punctate\nhepatic calcifications, presumably due to old healed granulomatous disease.  A\n10 mm hypodense liver lesion is stable (2, 52).\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "Status post interval left upper lobectomy with no evidence of local recurrence\nor lung parenchymal metastasis.\n\nStable mediastinal and borderline right hilar lymphadenopathy.\n\nStable UIP pattern fibrosis with mild apical centrilobular emphysema.\n\nNew small left pleural effusion."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there is no soft\ntissue abnormality in the imaged chest wall suspicious for malignancy. This\nstudy is not designed for subdiaphragmatic diagnosis, but shows there is no\nadrenal mass. 11 x 15 mm well-circumscribed hypo density in deep in the liver,\n05:20 40, is unchanged in size since ___\n\nModerate size loculated left apical postoperative pleural fluid collection has\nnot changed in size, but has increased in attenuation, consistent with\norganization of a fibrin clot.  There is new posterior parietal pleural\nthickening, 211 mm, 03:15, appear to 7 mm in ___.  Pleural thickening\nelsewhere in the left hemi thorax is confined to the lower chest, and stable\nsince ___.  Small dependent component of left pleural effusion is\nunchanged.\n\nThyroid is unremarkable. Atherosclerotic calcification is not apparent in head\nand neck vessels, relatively mild in the coronaries involving at least the\nleft anterior descending branch. There is no pericardial or right pleural\neffusion. Fusiform dilatation of the ascending thoracic aorta to maximum\ndiameter of 43 mm, 5:149 measured 45 mm previously.\n\nParaseptal emphysema is moderate throughout the lungs. Anatomic detail in the\nlower lungs is obscured by respiratory motion, making it difficult to compare\nthe status of fibrosing interstitial lung disease. There are no discrete lung\nlesions concerning for malignancy.\n\n9 mm right hilar nodes, 5:136, 151 are stable since ___. Left hilar\nnodes, previously up to 12 mm, have not changed. Left hilar stump has a normal\npostoperative appearance following left upper lobe resection.\n\nThere are no lung lesions currently suspicious for malignancy. 2 lateral left\nmiddle rib fractures are not fused.",
            "output": "Increase pleural thickening, alongside otherwise stable loculated left apical\npostoperative pleural fluid collection.  This very will be re-examined next\nroutine postoperative chest CT.\n\nNo other evidence of possible recurrent lung carcinoma, or new intrathoracic\nmalignancy.\n\nModerate to severe emphysema. Mild interstitial lung disease, probably\nfibrotic, little changed since ___. Patient must be instructed to take\nand folded deep breath during any subsequent CT scanning.\n\nSmall ascending thoracic aortic aneurysm, unchanged since at least ___.\n\nBorderline bilateral hilar lymph node enlargement, unchanged since ___."
        },
        {
            "input": "No incidental thyroid findings.  The thyroid is minimally enlarged. No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum.  Expected postoperative appearance of the\nvessels.  No incidental PE.  Moderate coronary calcifications, mild dilatation\nof the lower esophagus.  Known changes at the level of the liver stable as\ncompared to the previous examination.  Stable appearance of the left upper\nlobectomy.  The stump is unremarkable.  No evidence of local recurrence.  The\npostoperative pleural thickening on the left is stable as compared to the\nprevious examination.  The pre-existing both left and right moderate and the\npredominantly paraseptal pulmonary emphysema is stable.  No evidence of new or\ngrowing nodules.",
            "output": "Stable appearance of the left upper lobectomy.  No evidence of local\nrecurrence.  The extent of left postoperative pleural thickening is unchanged."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Severe atherosclerotic\nchanges involve ascending aorta.  Left mediastinal shift is stable.  Hilar\nlymph nodes are bilateral, similar to previous examination.  No new\nmediastinal, hilar or axillary lymph nodes demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe\nlobectomy side is unremarkable.  Severe emphysema is bilateral, paraseptal and\ncentrilobular.  No new pulmonary nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nLower vertebral body compression fracture is moderate, unchanged since ___.",
            "output": "Stable appearance of the post left upper lobectomy chest including apical\npleural fluid collection, a thorough sclerotic disease, stable lymph nodes,\ncoronary artery disease, severe emphysema and compression fracture of the\nlower thoracic vertebral body.\n\nPlease continue regular surveillance as clinically indicated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No pathologic enlargement of lymph\nnodes in the supraclavicular stations.  No lymphadenopathy in the axilla.\n\nCHEST CAGE: Mild multilevel spondylosis and demineralization.  There is no\nlytic or sclerotic osseous destructive lesions the level of the vertebra,\nsternum or ribs.  Left-sided 5- 6 rib healed surgical fractures.\n\nUPPER ABDOMEN: Patient's us post cholecystectomy.  Remaining included\nunenhanced upper abdominal organs are with no gross findings.\n\nMEDIASTINUM: In the mediastinum scattered subcentimeter lymph nodes measure up\nto 0.6 cm in the right lower paratracheal station (5:7) or 0.9 cm in the\nsubcarinal, not pathologically enlarged and stable.\nThe hilus silhouettes suggest no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is chronically deviated to the left, normal in\nsize.  Extensive calcifications of the coronaries, moderate along thoracic\naorta. Mild to moderate calcifications in the aortic valve annulus and\nleaflet.  There is fusiform ectasia of the ascending aorta measuring up to 4\ncm, unchanged.\nMain pulmonary artery is normal in diameter.\n\nPLEURA and LUNG: Patient is status post left upper lobectomy.  The left upper\nlobe bronchial stump is normal in appearance and stable.  No evidence of local\nrecurrence.\nLeft apical pleural chronic collection is long-standing the, unchanged.\nLeft lower lobe small pleural effusion is chronic as well with a mild\nthickening of the pleura and hypertrophy of the extra pleural fat.\n\nThe is moderate to severe predominantly paraseptal emphysema, mild diffuse\nbronchial wall thickening and irregularity is unchanged, suggesting chronic\nairway inflammation.  There are no confluent consolidations to suggest\npneumonia, no signs of airway infection.\nThere are no new pulmonary nodules.",
            "output": "Stable appearance of post left upper lobe lobectomy, including chronic left\napical and basilar loculated pleural fluid collections."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.\n\nThe heart is mild-to-moderately enlarged.  The dual lead cardiac pacemaker\ndevice is in appropriate position.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  A a 7-mm\nhypodense right thyroid nodule is of uncertain clinical significance (series\n601 B, image 33).  No mediastinal hematoma or pneumomediastinum.\n\nNo evidence of pericardial effusion.  No pleural effusion.  No pneumothorax.\n\nDetailed evaluation of the lung parenchyma is limited by respiratory motion\nartifact.  Right greater than left infrahilar/lower lobe ill-defined\nground-glass opacities likely reflect aspiration/blood products given the\nprovided history. There is also mild peribronchiolar thickening in the right\nlower lobe and debris within the bronchus intermedius and right lower lobe\nlobe bronchus.  Remaining airways are patent.  No pulmonary mass.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of acute pulmonary embolism or aortic abnormality.\n\n2.  Probable right greater than left lower lobe aspiration, perhaps of blood\nproducts.\n\n3.  Mild-to-moderate cardiomegaly.\n\n4.  No pulmonary mass.\n\n5.  7-mm hypodense right thyroid nodule is of uncertain clinical significance.\nGiven the patient's age in the size of this nodule, further evaluation with\nthyroid ultrasound would only be required if the patient is high risk.\n\nNOTIFICATION:   The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 2:35 AM, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Bilateral breast implants\nare seen.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis with scarring at the left\nlung base.  Otherwise, the lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nPartially imaged thyroid gland is grossly homogeneous.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Patient is status\npost right colectomy.  Anastomotic sutures in the right lower quadrant appear\nintact without evidence of extravasation of administered rectal contrast. \nMesenteric stranding in the lateral right mid abdomen is likely postsurgical. \nThe appendix is surgically absent.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS: The urinary bladder contains a focus of air along the anterior bladder\nwall.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Mild degenerative changes of the lumbar spine are noted. \nThere is mild stranding within the subcutaneous tissues and abdominal muscles\nunderlying the umbilicus likely postsurgical.",
            "output": "1. No evidence of pulmonary embolus.\n2. No evidence of right lower quadrant colonic anastomotic leak.  Postsurgical\nchanges seen.\n3. Small focus of gas in the nondependent portion of the urinary bladder may\nrelate to recent instrumentation/Foley catheter (correlate with history of\nsuch).  Can correlate with urinalysis to exclude infection."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild paraseptal emphysema which is upper lobe\npredominant.  There is moderate dependent atelectasis in the bilateral lower\nlobes.  There is a 4 mm nodule in the right middle lobe (3:104).  There is no\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild bronchial wall thickening may be related to airways\ninflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2.  For incidentally detected single solid pulmonary nodule smaller than 6 mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommend in a high-risk patient.   See the ___ ___ Society\nGuidelines for the Management of Pulmonary Nodules Incidentally Detected on\nCT\" for comments and reference: ___"
        },
        {
            "input": "Right thyroid gland contains calcified nodules.\n\nNo evidence of supraclavicular, axillary, mediastinal or hilar lymphadenopathy\nby CT size criteria, within the limitations of this noncontrast study.  Heart\nsize is mildly enlarged, without a pericardial effusion.  Thoracic aorta is\nnormal in course and caliber.  Main pulmonary trunk is normal in caliber.\n\nNote is made of mild narrowing/ posterior bowing of the upper thoracic trachea\n(4:45, 602b:78).  Airways are otherwise patent to the segmental bronchi\nbilaterally. Streaky atelectasis is noted in the right middle lobe, lingula,\nand the bilateral lung bases.  Calcified granuloma noted in the posterior left\nlower lobe (4:136).  No pneumothorax.\n\nSmall hiatal hernia.  Limited images of the upper abdomen are otherwise\nunremarkable.\n\nAcute fractures of the left posterolateral fifth, sixth and seventh ribs are\ncompletely displaced with bony overlap.  Left eighth and ninth rib fractures\nare mildly displaced.  Associated pleural thickening, likely representing\nhematoma.\nThere is a remote T7 spinous process fracture (606b:77).",
            "output": "1. Acute displaced fractures of the posterolateral left ___ ribs.  Left\n___ rib fractures are completely displaced with bony overlap.\n2. Associated pleural-based hematoma.\n3. No pneumothorax.\n4. Mild narrowing/posterior bowing of the upper thoracic trachea.  Recommend\ncorrelation with history of intubation or tracheomalacia.\n5. Calcified right thyroid nodules, incompletely evaluated.  Further\nevaluation with a dedicated thyroid ultrasound is recommended on a nonurgent\nbasis.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The partially visualized thyroid is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.  No suspicious\nchest wall masses.\n\nUPPER ABDOMEN: Please see separate same day report of the abdomen and pelvis\nfor description of subdiaphragmatic findings.\n\nMEDIASTINUM: A right pulmonary ligament lymph node measuring 1.1 cm is mildly\nenlarged, increased in size since the previous CT in ___ when it\nmeasured 0.3 cm.  Elsewhere, few prominent subcentimeter lymph nodes do not\nmeet CT size criteria for pathologic enlargement.  A partially visualized\nenteric tube descends into the opacified stomach.\n\nHILA: No hilar lymphadenopathy within the limitations of unenhanced scan.\n\nHEART and PERICARDIUM: Heart is borderline enlarged.  No pericardial effusion.\nThere are minimal aortic valvular calcifications.  No coronary artery\ncalcifications.\nPLEURA: There are small to moderate right and small left nonhemorrhagic\npleural effusions.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is moderate bilateral lower lobe atelectasis. \nAdditional heterogeneous opacification within the bilateral lower lobes, left\ngreater than right, may suggest aspiration/superimposed pneumonia.  Although\nlimited by severe respiratory motion, bilateral peribronchovascular\nground-glass opacities with interstitial thickening are most suggestive of\nalveolar pulmonary edema.\n2. AIRWAYS:  The tip of the endotracheal tube terminates approximately 2.7 cm\nabove the carina.  There is mild diffuse bronchial wall thickening.\n3. VESSELS:  The thoracic aorta is normal in caliber and course.  There are\nmild calcifications about the aortic arch.  Tip of left central venous\ncatheter terminates in the mid SVC.  The main pulmonary artery is normal in\ndiameter.\n\nCHEST CAGE: No acute fracture.  No suspicious lytic or sclerotic osseous\nlesions.",
            "output": "1. Moderate bilateral lower lobe atelectasis with adjacent heterogeneous\nopacification may suggest aspiration/superimposed pneumonia.\n2. Mild alveolar pulmonary edema and small bilateral nonhemorrhagic pleural\neffusions.\n3. Mildly enlarged inferior mediastinal lymph node, as above, is likely\nreactive.\n4. Please see separate same day report of the abdomen and pelvis for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The partially visualized thyroid is\nunremarkable.  No enlarged supraclavicular or axillary lymph nodes. No\nsuspicious chest wall masses.\n\nUPPER ABDOMEN: Please refer to the separate same day report of the abdomen and\npelvis for description of subdiaphragmatic findings.\n\nMEDIASTINUM: A mildly enlarged right pulmonary ligament lymph node measuring\n1.0 cm is essentially unchanged, previously measuring 1.1 cm.  Elsewhere, few\nprominent subcentimeter lymph nodes do not meet CT size criteria for\npathologic enlargement and are unchanged.  A partially visualized enteric tube\ndescends into the body of the stomach.\n\nHILA: No hilar lymphadenopathy within the limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Borderline enlarged heart is stable.  No pericardial\neffusion.  Minimal aortic valvular calcifications.  No coronary artery\ncalcifications.\n\nPLEURA: Small to moderate right and small left nonhemorrhagic pleural\neffusions are stable.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Comparison with the prior study is difficult given the\nrespiratory motion seen on the previous study.  However, allowing for this,\npatchy peribronchial ground-glass opacification and septal thickening appears\nsimilar to slightly improved compared to prior, suggestive of improving\nalveolar edema.  There has been interval increase in left lower lobe\natelectasis, which is now complete.  Patchy peripheral opacities within the\nposterior and lateral upper lobes, right greater left, appear similar.\n2. AIRWAYS:  Tip of the endotracheal tube terminates 3.2 cm above the carina. \nAirways are patent to the subsegmental level bilaterally.  There is mild\ndiffuse bronchial wall thickening.\n3. VESSELS:  Tip of left central venous catheter terminates in the mid SVC,\nunchanged.  A right IJ venous catheter terminates in the proximal right\natrium.\n\nCHEST CAGE: No acute fracture.  No suspicious lytic or sclerotic osseous\nlesions.",
            "output": "1. Similar to slightly improved peribronchial ground-glass opacification\nsuggestive of stable to improving alveolar edema.\n2. Interval increase in left lower lobe atelectasis which is not complete. \nSuperimposed pneumonia cannot be excluded in the appropriate clinical setting.\n3. Stable nonhemorrhagic pleural effusions, small to moderate on the right and\nsmall on the left.\n4. Please refer to the separate same day report of the abdomen and pelvis for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The partially visualized thyroid is\nunremarkable.  No enlarged supraclavicular or axillary lymph nodes. No\nsuspicious chest wall masses.\n\nUPPER ABDOMEN: Please refer to the separate same day report of the abdomen and\npelvis for description of subdiaphragmatic findings.\n\nMEDIASTINUM: A borderline enlarged right pulmonary ligament lymph node\nmeasuring 1.0 cm is unchanged (3:50) since ___.  Elsewhere few\nprominent subcentimeter mediastinal lymph nodes do not meet CT size criteria\nfor pathologic enlargement and are unchanged.  A partially visualized enteric\ntube descends into the stomach.  The esophagus is decompressed around the\nenteric tube, but appears grossly unremarkable.\n\nHILA: No hilar lymphadenopathy within the limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Borderline enlarged heart is stable.  No pericardial\neffusion.  Minimal aortic valvular calcifications.  No coronary artery\ncalcifications.\n\nPLEURA: Small to moderate right and small left nonhemorrhagic pleural\neffusions are stable since the initial study 4 days ago.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Respiratory motion limits evaluation of the right lung.  Faint\npatchy peribronchial ground-glass opacification and septal thickening appears\nsimilar to prior and likely reflects alveolar edema.  Patchy peripheral\nopacities within the posterior and lateral upper lobes, right greater than\nleft, also appears similar.  Complete atelectasis of the left lower lobe and\nmoderate atelectasis of the right lower lobe appears stable.\n2. AIRWAYS:  The endotracheal tube tip terminates approximately 2.3 cm above\nthe carina.  Increased narrowing of segmental bronchi within the bilateral\nlower lobes compared to the prior study may be due to late atelectatic\nchanges, although areas of bronchial irregularity (3:38) could suggest\nendobronchial secretions.\n3. VESSELS:  The thoracic aorta is normal in caliber and course.  The main\npulmonary artery is normal in diameter.  Tip of right IJ venous catheter\nterminates in the right atrium.  Interval removal of left central venous\ncatheter.\n\nCHEST CAGE: No acute fracture.  No suspicious lytic or sclerotic osseous\nlesions.  Diffuse anasarca",
            "output": "1. Persistent, similar mild alveolar pulmonary edema.  Essentially no change\nin superimposed patchy opacities worst in the posterior portions of the right\nupper lobe which could reflect superimposed aspiration/pneumonia.\n2. Unchanged complete left lower lobe and moderate right lower lobe\natelectasis.  Interval narrowing of the segmental bronchi within these regions\nof atelectasis is likely due to progressing atelectatic changes, although\nthere are some probable endobronchial secretions scattered throughout.\n3. Stable bilateral nonhemorrhagic pleural effusions, small to moderate on the\nright and small on the left.\n4. Slightly low positioning of the endotracheal tube 2.3 cm above the carina.\n5. Please refer to the separate same day report of the abdomen and pelvis for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Several axillary lymph nodes are up to 20 x 12 mm, mildly enlarged but have a\npreserved 20 hilus. Several small mediastinal lymph nodes are as less than 7\nmm in diameter. No hilar lymphadenopathy is present. Aorta is normal in\ndiameter. Pulmonary artery is 3.2 cm but compared to 2.5 cm of the aorta might\npotentially represent pulmonary hypertension. Heart size is normal. No\npericardial effusion is demonstrated. Small pleural fluid is present\nbilaterally, with no evidence of high pleural fluid that is most likely a\nnonhemorrhagic. Image portion of the upper abdomen will be reviewed separately\n\nAirways are patent to the subsegmental level bilaterally. Bilateral apical\nscarring is overall unremarkable. Diffuse bronchiolar nodular opacities\nthroughout both lungs as well as ___ opacities mostly pronounced in\nthe right middle in both lower lobes might potentially represent infectious\nprocess or airway inflammation without infection. No focal consolidations or\ndiscrete nodule seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Lymphadenopathy, axillary, borderline, correlation with ultrasound and\npotentially tissue biopsy is to be considered\n\nViral infectious process in the lung suspected although a atypical bacterial\nsuch as mycoplasma infection is a possibility as well as inflammatory known\ninfectious origin.\n\nSmall bilateral pleural effusion, potentially related to the\ninfectious/inflammatory process\n\nSuspected pulmonary artery dilatation, correlation with echocardiography is\nrecommended."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild coronary artery calcifications.  Heart,\npericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild centrilobular emphysema.  No focal masses or areas of\nconsolidative parenchymal opacification.  Punctate calcified granuloma in the\nleft lower lobe (4:176) is noted.  Unchanged 4 mm left lower lobe pulmonary\nnodule (4:175).  Moderate, lower lobe predominant, bronchial wall thickening\nis demonstrated with subtle tree in ___ ground-glass nodular opacities in the\nright lower lobe (4: 183) which may reflect small airways disease.  Otherwise\nthe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Mild central intrahepatic ductal\nprominence is related to prior cholecystectomy, unchanged.  There is no\nevidence of extrahepatic biliary dilatation.  The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 15.3 cm though demonstrates\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nfree intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is redemonstration severe compression deformity\nof L4 with unchanged 4 mm retropulsion, as well as a new severe compression\ndeformity of L2 with 5 mm of retropulsion.  Unchanged mild compression\ndeformity of T12, and moderate compression deformity of T11.  Tiny umbilical\nhernia containing fat is noted.",
            "output": "1. New severe compression deformity of L2 with 5 mm of retropulsion. \nUnchanged moderate compression deformity of T11, mild compression deformity of\nT12, and severe compression fracture of L4 with retropulsion.\n2. No acute intra-abdominal or pelvic abnormalities identified.\n3. No pulmonary embolism or acute aortic pathology.\n4. Unchanged splenomegaly.\n5. Moderate diffuse bronchial wall thickening suggestive of bronchitis. \nSubtle ___ ground-glass nodularity in the right lower lobe may reflect\nsmall airways disease which may be infectious or inflammatory in etiology.\n6. Mild centrilobular emphysema."
        },
        {
            "input": "The aorta is unremarkable without dissection or aneurysm. Great vessels are\nunremarkable.  The pulmonary arteries are well opacified to the subsegmental\nlevel without filling defect to suggest pulmonary embolism. Pulmonary arteries\nare normal in caliber.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Atelectasis is\nseen in the lung bases bilaterally.  There is no pleural effusion or\npneumothorax. The airways are patent to the subsegmental level.\n\nThere is moderate cardiomegaly.  There is no pericardial effusion.  There is\nno supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  Included\nportion of the thyroid is unremarkable.\n\nIncluded portion of the upper abdomen is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nThere is no fracture.",
            "output": "No acute findings.  No evidence of pulmonary embolism."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is remarkable for dense coronary arterial\ncalcifications.  There is no pericardial effusion.  The main pulmonary artery\nis normal in caliber.\n\nAXILLA, HILA, AND MEDIASTINUM:  Prominent but nonenlarged mediastinal lymph\nnodes are identified.  There is no axillary or hilar lymphadenopathy.\n\nPLEURAL SPACES:  There are bilateral pleural effusions, small, and symmetric.\n\n\nLUNGS/AIRWAYS:  There is a background of mild emphysema.  Scarring is noted in\nthe lingula.  There is bibasilar atelectasis, with slightly more hypoenhancing\ncomponents.  Infection is not excluded.  Scarring and atelectasis is seen in\nthe posterior right upper lobe.  No suspicious focal nodules are identified. \nThe airways are diffusely thickened to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is significant for a nodular\nliver contour.  There is small volume ascites.  These findings may be seen in\ncirrhosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is evidence of diffuse idiopathic skeletal hyperostosis.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Mild pulmonary edema.\n3.  Bilateral pleural effusions and associated consolidative volume loss. \nInfection is not entirely excluded.\n4.  Small airways disease.  Emphysema.\n5.  Question cirrhosis given nodular liver contour and small ascites."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Normal appearance of the large mediastinal vessels.\nMild to moderate coronary calcifications. No pericardial effusion. Small\nhiatal hernia. The posterior mediastinum is otherwise unremarkable. The\nabdominal findings are described in detail in the dedicated abdominal CT\nreport. Moderate degenerative vertebral disease. No vertebral compression\nfractures. No rib lesions, no sternal lesions. Massive respiratory motion\nartifact 's. No hilar or mediastinal lymphadenopathy. One 4 mm left upper lobe\nnodule (4, 101). Normal sized perihilar 4 mm right lymph node (4, 124). 2 mm\nright upper lobe nodule. Bilateral dorsal atelectasis. No pleural thickening,\nno pleural effusion. No evidence of diffuse lung disease.",
            "output": "4 mm left upper lobe nodule, followup with CT is recommended in ___ month.\n2 mm right upper lobe nodule, can be followed at the same examination.  No\nevidence of malignant thoracic disease.  No adenopathy.  No pleural effusions."
        },
        {
            "input": "The thyroid gland is unremarkable.  An enlarged subcarinal lymph node measures\n11 x 26 mm (5, 32).  There is no additional mediastinal, hilar, axillary or\nsupraclavicular lymphadenopathy.\n\nMild cardiomegaly with predominantly left-sided enlargement is present. \nExtensive coronary artery and aortic annular calcifications are present. Less\nextensive aortic valvular calcifications are also identified.  There is no\npericardial effusion.  The main pulmonary artery and thoracic aorta are normal\ncaliber. Moderate calcific atherosclerosis diffusely involves the thoracic\naorta and its branches. No incidental central pulmonary embolus is identified.\n\nThe esophagus is mildly distended with fluid which refluxes to the level of\nthe upper esophagus. For a detailed discussion of the upper abdomen, please\nrefer to the separate report from the CT abdomen/pelvis performed\nconcurrently.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.\n\nScant retained secretions layer dependently in the lower trachea.  There is\nmoderate centrilobular emphysema.  Multiple images are partially degraded by\nrespiratory motion artifact, however, there is a peripheral right upper lobe\nbandlike consolidation, and ___ opacities in the right upper, right\nmiddle and left lower lobes.  There are also several nodular opacities\nmeasuring up to 12 mm in the right lower lobe (6:77, 80, 99, 108, 109, 130,\n209, 216, 225). Small bilateral layering nonhemorrhagic pleural effusions\ncontribute to mild bilateral lower lobe passive atelectasis. Lower lobe\npredominant bronchial wall thickening is present.",
            "output": "Multifocal ___ opacities are likely due to infection or aspiration. \nAssociated bronchial wall thickening and mucoid impaction.\n\nAdditional nodular opacities may be infectious (bacterial, fungal, septic\nemboli), but a 3-month followup CT scan following appropriate antibiotic\ntherapy is recommended to ensure resolution and to exclude neoplasm.\n\nSmall pleural effusions.\n\nModerate centrilobular emphysema."
        },
        {
            "input": "LOWER NECK: Unremarkable\n\nAIRWAYS/LUNGS:\nUpper airways are patent.  There is small amount of mucus within the right\nmainstem bronchus extending into the bronchus intermedius.  Mucous plugging is\nnoted in the subsegmental bronchi of the lower lobes bilaterally.  There is\nbibasilar atelectasis.  There is no focal airspace consolidation.  There is no\nevidence of significant interstitial pulmonary edema.  No suspicious pulmonary\nnodules or mass identified.\n\nPLEURA:  There is extensive pleural calcifications bilaterally.  There is\nmoderate right and small left pleural effusions.\n\nLYMPH NODES and MEDIASTINUM: Note is made of calcified mediastinal and right\nhilar lymph nodes, likely related to prior granulomatous disease.  There is no\nevidence of lymphadenopathy.\n\nHEART and VASCULATURE: The heart is normal in size.  Mitral annular\ncalcifications are noted.  There is pericardial calcification and trace\npericardial fluid.\n\nCHEST WALL: unremarkable\n\nBONES:  No aggressive bony lesions.  Degenerative changes are noted in both\nshoulder joints.\n\nUPPER ABDOMEN: Please see separate report of CT abdomen/pelvis.",
            "output": "1. No evidence of pneumonia.\n2. Extensive pleural and pericardial calcifications are likely related to\nprior asbestos exposure.  There is moderate right and small left pleural\neffusions.  Primary pleural malignancy cannot be completely excluded in the\nabsence of IV contrast.  Diagnostic thoracentesis can be considered."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.  A few mildly\nprominent mediastinal lymph nodes are present. A representative subcarinal\nlymph node measures 8 x 20 mm, previously 9 x 18 mm (4, 93).\n\nHeart size is normal with no pericardial effusion. Pericardial thickening is\nstable.  The main pulmonary artery and thoracic aorta are normal caliber.\nModerate coronary artery calcifications are present.\n\nThere is stable anterior mediastinal band-like soft tissue thickening and\ncalcification which also involves the upper right major and minor fissures.\nThis is likely relate to prior radiation therapy. Diffuse parietal pleural\nthickening and calcification is unchanged, and again likely relates to prior\nradiation therapy. Bilateral upper lobe paramediastinal radiation fibrosis is\nalso stable. Mild right middle and right lower lobe lymphatic engorgement\nmarked by interlobular septal and bronchial wall thickening has slightly\nincreased since ___. There is no endobronchial lesion. The chronic small\nleft pleural effusion is stable.\n\nImages of the upper abdomen are unremarkable.\n\nThe bones are unremarkable.",
            "output": "Stable bilateral upper lobe paramediastinal fibrosis with additional pleural\nand pericardial manifestations of prior radiation therapy.\n\nSlightly increased lymphatic engorgement in the right middle and right lower\nlobes.\n\nChronic small left pleural effusion with adjacent pleural thickening and\ncalcification is stable."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nNo focal parenchymal opacification is seen in the lungs.  No concerning\nnodules or masses are seen.  There is moderate paraseptal and centrilobular\nemphysema. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nPatient is status post right mastectomy and right axillary node dissection\nwith right-sided flap reconstruction.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate emphysema."
        },
        {
            "input": "Within the superior segment of the lingula there is a subpleural, triangular\nshaped consolidation which has increased in size from prior, measuring 4.9 x\n2.6 x 2.6 cm, previously 2.4 x 2.1 cm. Areas of low attenuation within the\n___ the mass may reflect developing necrosis (6:212). The mass has a\nbroad based contact with the chest wall with pleural thickening and possible\nextension into the extrapleural fat (6:201). Medially, there is contact with\nthe pericardium, which appears thickened. Small peribronchial ground-glass\nopacities bordering the mass are worse from ___. A new consolidation\nin the middle lobe is likely a developing focus of the similar process\n(6:271). There is no pleural effusion.  There is no lymphadenopathy.\n\nVague, ground-glass peribronchiolar opacities within the right upper lobe have\nimproved from ___. (6:270). A small bulla within the posterior\nbasal segment left lower lobe is constant (6:272).\n\nA 9 mm hypodensity in the left thyroid lobe is unchanged and was previously\nshown to be non FDG avid. The heart is normal size and there is a trace,\nnonhemorrhagic pericardial effusion, similar to 10 days prior. The aorta and\nmain pulmonary artery are normal caliber.\n\nThe esophagus is slightly patulous but otherwise unremarkable. Included views\nof the unenhanced liver, gallbladder, spleen, pancreas and adrenal glands are\nunremarkable. There are no lytic or blastic osseous lesions within the chest.\nA linear band of sclerosis within the sternum may relate to prior trauma\n(8:61).",
            "output": "1.  Rapid increase in size of a mass-like area of consolidation in the lingula\nfrom 10 days prior with apparent mediastinal fat and early extrapleural\ninvasion.  The latter features raise the concern for an aggressive infection\nsuch as actinomyces or mucormycosis.  A rapidly progressive form of organizing\npneumonia is less likely and the rapid and dynamic evolutionary time course\nwould be highly unusual for malignancy.  Recommend correlation with results of\nplanned biopsy.\n2. New, focal middle lobe consolidation may be a new site of infection or\ndeveloping organizing pneumonia."
        },
        {
            "input": "Masslike consolidation in the lingula has increased in size it has more\nmediastinal.  Pericardial and pleural contact.   Again shows multiple areas of\nlow attenuation suggesting necrosis.\nDiffuse multifocal areas of ground-glass opacities in the right upper lobe\nhave minimally increased. Tree in ___ opacities in the medial left lower lobe\nhave increased. Faint ground-glass opacities in the right lower lobe are\nstable.\nMinimal peribronchial opacities in the medial right middle lobe are unchanged.\n\nHypodense nodule in the left lobe of the thyroid is unchanged.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nBorders line lymph nodes in the AP window measuring 7 mm and in the right\nupper paratracheal station measuring 6 mm are stable Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.\n\nThe esophagus is patulous as before\nSmall pericardial effusion is stable.\nThis examination is not tailored for subdiaphragmatic evaluation. . Upper\nabdomen is unremarkable.\nSclerotic irregular area in the sternum is unchanged. There are no other bone\nfindings of infection or malignancy. Healed left rib fractures are again\nnoted.",
            "output": "Continued progression of masslike consolidation in a lingula with increase in\nmediastinal and extrapleural invasion. differential diagnosis still includes\nprogressive organizing pneumonia or aggressive fungal infection."
        },
        {
            "input": "There is an 8 mm hypodense left thyroid nodule.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.  Few prominent mediastinal lymph nodes are seen and\nare likely reactive.\n\nThe great vessels are normal caliber.  There is no evidence of pulmonary\nembolism to the subsegmental level.\n\nThe heart size is normal.  No pericardial effusion.\n\nThere are diffuse consolidations throughout both lungs compatible with\nmultifocal pneumonia. The patient is status post vats and postsurgical\nchanges/surgical material is seen in the lingula.  There is persistent, dense\nconsolidation within the lingula and anterior segment of the left upper lobe. \nFluid collections with air fluid levels measuring up to 2.6 x 2.4 cm in the\nsuperior lingular segment are compatible abscesses.  There is a trace apical\nand anterior left-sided pneumothorax which is likely related to recent\ninstrumentation. Small bilateral pleural effusions, right greater than left.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.  Focus\nof calcification medial to the IVC (series 2, image 82) measuring 5 x 5 mm may\nrepresent a calcified lymph node.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.\n2. Diffuse consolidations affecting all lung lobes compatible with multifocal\npneumonia / ARDS. Postsurgical changes noted in the lingula with suture\nmaterial from vats. Dense consolidation remains most prominent in the lingula\nand anterior segment of the left upper lobe with numerous rounded fluid\ncollections with air fluid levels measuring up to 2.6 x 2.4 cm in the superior\nlingular segment compatible with abscesses. Shotty mediastinal lymphadenopathy\nis likely reactive to this process.\n3. Trace apical and anterior left-sided pneumothorax which may be related to\nrecent VATS.  Small pockets of left-sided pneumothorax.\n4. Small right greater than left simple density pleural effusions.\n5. 8 mm left thyroid nodule."
        },
        {
            "input": "The thyroid gland is unremarkable. Small mediastinal lymph nodes measure up to\n7 mm in short axis in the right lower paratracheal location. There are no\npathologically enlarged supraclavicular, mediastinal, hilar or axillary lymph\nnodes.\n\nA Swan-Ganz catheter terminates in the right pulmonary artery.  A left-sided\nPICC line enters the upper SVC.  Mild cardiomegaly with predominantly\nleft-sided enlargement is present. Extensive coronary artery and aortic\nvalvular calcifications are present. The main pulmonary artery and thoracic\naorta are normal caliber.  There is a trace physiologic pericardial effusion.\n\nAn endotracheal tube terminates in the mid trachea. Small right and trace left\nlayering nonhemorrhagic pleural effusions contribute to mild passive\natelectasis.  Some images are degraded by respiratory motion artifact, which\nmay limit detection of small nodules and subtle parenchymal lesions.  F aint\nground-glass opacities are visible in the nondependent aspect of the upper\nlobes (5, 75). A bandlike left lower lobe consolidation may be due to\ninfection, aspiration, or less likely atelectasis. A more discrete right lower\nlobe nodule is identified (5, 171).\n\nA nasogastric tube terminates in the stomach. There is mild smooth\ncircumferential wall thickening involving the lower esophagus.  Images of the\nupper abdomen show a partially imaged hyperdense cyst at the lateral right\nrenal upper pole, which likely contains hemorrhagic or proteinaceous material\n(3, 60).\n\nOld healed left anterior rib fractures are noted. Spinal degenerative changes\nare mild.",
            "output": "Motion limited examination.\n\nLeft lower lobe consolidation may be due to infection, aspiration, or less\nlikely atelectasis.\n\n5 mm right lower lobe nodule may be infectious process, but a short interval\nfollowup chest CT following appropriate treatment should be considered.\n\nSmall right and trace left layering nonhemorrhagic pleural effusions are\nassociated with mild passive atelectasis.\nMild lower esophageal wall thickening may be infectious or inflammatory.\n\nPartially imaged hemorrhagic or proteinaceous right renal cyst may be further\nevaluated with a dedicated renal ultrasound if clinically warranted.\n\nExtensive coronary artery and aortic valvular calcifications.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:46 ___, 10 minutes after discovery of the findings.\n\nRECOMMENDATION(S):  Dedicated renal ultrasound for further evaluation of\nhyperdense right renal cyst if clinically warranted.\n\nConsider short interval followup chest CT following appropriate treatment to\nreassess left lower lobe opacity and 5 mm right lower lobe nodule."
        },
        {
            "input": "Endotracheal tube terminates 2.7 cm above the carina.  An enteric tube\nterminates within the stomach.  A right-sided internal jugular catheter and\nleft-sided PICC terminate in the proximal SVC.\n\nThyroid:  The thyroid is normal.\n\nLymph Nodes: Axillary, supraclavicular, mediastinal, and hilar lymph nodes are\nnot pathologically enlarged.  Small mediastinal lymph nodes measuring up to a\n7 mm in the short axis are not significantly changed from the prior\nexamination.\n\nVessels: The great vessels are normal caliber.\n\nHeart and pericardium:  Mild cardiomegaly with left-sided enlargement is\nstable.  Extensive coronary artery and aortic valvular calcifications are also\nstable.  There is no pericardial effusion.\n\nAirways:  The airways are patent to subsegmental levels.\n\nLungs:  A nonhemorrhagic, moderate right pleural effusion is increased from\nthe prior examination.  Also increased from the prior examination is a small\nleft pleural effusion.  Right and left lower lobe pulmonary opacities are most\nconsistent with compressive atelectasis.  Scattered ground-glass and\nperibronchial opacities throughout the left upper lobe, lingula and right\nupper lobe (to a lesser extent) suggest infection.  There is no pneumothorax.\n\n Subdiaphragmatic structures will be detailed on the concurrent CT abdomen and\npelvis.\n\nOsseous structures:  No suspicious lytic or sclerotic lesions are identified.",
            "output": "Increasing, nonhemorrhagic bilateral pleural effusions and compressive\natelectasis involving the bilateral lower lobes.  Scattered peribronchial,\nground-glass opacities throughout the bilateral upper lobes suggests\ninfection."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  Small pericardial effusion.  The\nthoracic aorta is normal in caliber.  An intra-aortic balloon pump is noted,\nterminating just distal to the aortic arch.  The main pulmonary artery is\nmildly dilated with a diameter of 3.2 cm.  The pulmonary arteries are well\nopacified to the proximal subsegmental level, without evidence of filling\ndefect indicate the presence pulmonary embolism.  There is a stent in the left\nsubclavian vein, for which patency cannot be assessed on this CTA.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no mediastinal or hilar\nlymphadenopathy.  Prominent bilateral axillary lymph nodes are difficult to\ndiscretely measure, but are presumably reactive.\n\nPLEURAL SPACES: Small, right greater than left pleural effusions are\nincreased.\n\nLUNGS/AIRWAYS: An endotracheal tube terminates 1.8 cm proximal to the carina. \nThe airways are patent to the subsegmental level.  There is increased\ninterlobular septal thickening with a marked increase of diffuse ground-glass\nopacities involving all pulmonary lobes and multifocal consolidations most\nprominent in the right lower lobe posterior and lateral basal segments, but\nalso involving the right upper and left lower lobes.  A left upper lobe apical\nposterior segment air cyst is unchanged.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The partially imaged abdomen reveals intra-abdominal edema and\nprobable ascites, incompletely characterized.  An enteric catheter terminates\nin the distal thoracic esophagus.  An additional tear catheter courses into\nthe stomach and outside the field of view.\n\nBONES/SOFT TISSUES: No suspicious osseous abnormality is seen.? There is no\nacute fracture.  Significant increase in diffuse soft tissue edema of the\nchest wall.",
            "output": "1. Findings highly concerning for multifocal pneumonia with superimposed\nsevere pulmonary edema, or diffuse alveolar hemorrhage in the appropriate\nclinical setting.\n2. No evidence of pulmonary embolism.\n3. Severe anasarca.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:14 pm, approximately 15\nminutes after discovery of the findings."
        },
        {
            "input": "BASE OF NECK: The visualized base of the neck is unremarkable.\n\nTHORACIC LYMPH NODES: Mediastinal lymph nodes measure up to 1.5 cm in short\naxis, increased in size from ___.  A conglomerate of lymph nodes in the\nleft paratracheal region is difficult to measure.  A right hilar lymph node\n(4:32) measures up to 1 cm in short axis.  Supraclavicular, axillary, and\nhilar lymph nodes are not pathologically enlarged .\n\nCARDIO-MEDIASTINUM: The thoracic aorta is normal in caliber. The pulmonary\narteries are normal caliber.  The heart is not enlarged. There is no\npericardial effusion.\n\nLUNGS/AIRWAY: The airways are patent to the segmental level.  There is been\ninterval development of diffuse, extensive miliary opacities encompassing the\nbilateral lung fields.  There is a 1.1 cm right upper lobe nodular opacity\nwhich could also be infectious in origin.\n\nPLEURA: There is trace pleural effusion.\n\nCHEST CAGE: No worrisome lytic or sclerotic lesion is identified.\n\nUPPER ABDOMEN: Please refer to separate report on same-day CT abdomen/pelvis\nfor description of the abdominal findings.",
            "output": "Extensive, diffuse miliary opacities encompassing the lungs bilaterally.  In a\nfebrile, immunosuppressed patient, infectious etiology, including tuberculosis\nand other atypical organisms, is a concern.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:44 p.m."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: There has been significant interval decrease in size of\npreviously enlarged mediastinal lymph nodes.  For example, the 1.5 cm left\nlower paratracheal lymph node is now 0.5 cm (5:109), and the conglomerate of\nleft lower paratracheal lymph nodes previously measuring 2.3 x 2.0 cm are now\nseen as distinct individual left lower paratracheal lymph nodes that are\nnormal in size.\n\nThe esophagus is patulous.  There is a small hiatal hernia.\n\nHILA:   The contours of both nonenhanced hila, previously enlarged and\nlobulated, no longer suggest adenopathy. A right hilar lymph node is 0.8 cm\n(5:124).\n\nHEART and PERICARDIUM: Heart size is normal.  There is no pericardial\neffusion.  Atherosclerotic calcifications are noted involving the LAD.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There has been marked interval decrease in size and number of\nmiliary nodules, still profuse throughout both lungs.  Among multiple\nmeasurable lung nodules there has also been slight interval decrease in size\nof a 9mm right upper lobe nodule (5:61), previously 11 mm. While a 10mm left\nupper lobe nodule is stable (5:99), previously 10 mm.  Numerous smaller\nnodules scattered through the lungs, measuring up to 5 mm  (5: 63, 90, 94, 96,\n128, 146, 154, 158, 162, 169).  Although correlates for these nodules are\nretrospectively identified on ___ exam and appear stable (see ___ CT chest series 5:90, 122, 123, 159, 171, 181, 184, 188, 194),\ngiven the diffuse miliary nodular pattern of lung disease, these were not as\nconspicuous previously.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The thoracic aorta and pulmonary artery normal in caliber.\n\nCHEST CAGE: There are no suspect lytic or sclerotic osseous lesions. \nRedemonstration of a hemangioma within the T9 vertebral body (5:200).  There\nis no acute fracture.",
            "output": "1. Marked interval decrease in diffuse miliary lung nodules and resolution of\nmediastinal and hilar adenopathy, attributable to treatment of histoplasmosis.\n2. Multiple larger lung nodules, also presumably infectious are little\nchanged.  Recommend repeat CT in 6 months.\n\nRECOMMENDATION(S):  Recommend repeat CT chest in 6 months."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  No pericardial pleural effusion is demonstrated.  Heart size\nis normal.  Image portion of the upper abdomen will be reviewed separately is\npart of the CT abdomen and pelvis in corresponding report will be issued.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  Airways are\npatent to the subsegmental level bilaterally.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening and endobronchial secretions are bilateral.  There are mild\nexcept fall left lower lobe where ground-glass opacity is associated with\nbronchial wall thickening, series 4 images 271, ___, (endobronchial\nsecretions).\n\nMild centrilobular emphysema is present.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Left lower lobe ground-glass opacity in bronchial wall thickening consistent\nwith left lower lobe infectious process, giving the extent of ground-glass\nopacities, most likely viral.\n\nNo lymphadenopathy.\n\nExtensive coronary calcifications."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There are several perifissural nodules in the left lung\nmeasuring up to 3 mm, which are likely benign in this age group.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Patient is status\npost ileocecectomy and right lower quadrant ileostomy.  No evidence of\nparastomal hernia.  Intact appearing ileocolonic anastomosis is demonstrated\nalong the right lower quadrant with unremarkable appearance of the neoterminal\nileum.  At the level of the upper to mid rectum, there is diffuse presacral\nstranding with phlegmonous changes and multiple loculated and rim enhancing\nfluid collections compatible with abscesses.  The total span of the\nmultiloculated presacral abscesses measures approximately 10.8 x 3.6 x 10.2 cm\n(series 2, image 108; series 602, image 38) and extend into the piriformis\nmusculature bilaterally.  A more discrete focal perirectal abscess measures\n2.8 x 2.2 cm (series 2, image 113). While evaluation for fistulous disease is\nsomewhat limited on this exam, there is tethering of a portion of the rectum\nas well as small bowel loops to the region of presacral inflammation and\nphlegmon (602:37, 2:104, 2:114) concerning for fistulous disease. No free air.\nThere is mild mesenteric thickening.\n\n\nPELVIS:\n\nThe urinary bladder is distended.  The distal ureters are not well visualized.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits.  The adnexa are not\nwell visualized.\n\nLYMPH NODES: No lymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The visualized\nintra-abdominal and pelvic vasculature is within normal limits.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Right lower quadrant ileostomy.  No additional abnormalities\nwithin the abdomen or pelvic wall.",
            "output": "1. Extensive phlegmonous changes with multiple loculated and rim enhancing\ncollections in the presacral space spanning an area of approximately 10.8 x\n3.6 x 10.2 cm with involvement of the piriformis musculature bilaterally.  A\nfocal discrete perirectal abscess measures up to 2.8 cm.\n2. While assessment for fistulous disease is limited due to the lack of oral\ncontrast material, there are several areas of tethering of the rectum and\nsmall bowel loops to the region of presacral inflammation and phlegmonous\nchange suspicious for fistulous disease.  This could be better assessed with\nMRI with IV and oral contrast.\n3. No bowel obstruction.  No free air.  No large volume free fluid.\n4. Right lower quadrant ileocolonic anastomosis appears grossly intact."
        },
        {
            "input": "MEDIASTINUM/HEART: The FDG-avid right supraclavicular lymph node, described on\nPET-CT from ___, is instead a 1.7 cm heterogeneous right thyroid\nlobe nodule (4:21).  A cluster of left supraclavicular lymph nodes,\ncorrelating with the FDG-avid confluent nodes on the PET-CT, is much smaller\ncompared to the ___ chest CT. The largest node now measures 11\nmm (4:1). Axillary, mediastinal and hilar lymph nodes are not enlarged by CT\nsize criteria. Breast evaluation requires mammography.\n\nAorta and pulmonary arteries are normal in size. Heart size is normal with no\ncoronary calcification. No pericardial effusion.\n\nLUNGS/AIRWAYS: The airways are patent to the subsegmental level. A new cluster\nof pulmonary nodules in the left lower lobe, just above the diaphragm, could\nbe a nest of metastases or inflammatory bronchiolar nodules. A peripheral 3 mm\nleft upper lobe nodule is small enough to have been present but not imaged on\nthe prior CT chest from ___ performed elsewhere utililizing\ndifferent technique.\n\nMultiple small right pulmonary nodules are unchanged to slightly smaller since\n___. For reference, a 3 mm right upper lobe nodule (4:104) and a\n3 mm ___ right middle lobe nodule (4:108) are unchanged. A prior 4\nmm right lower lobe nodule is now 3 mm (4:125).\n\nUPPER ABDOMEN: Please see the dedicated CT abdomen and pelvis report from the\ncurrent date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Multilevel degenerative changes of the thoracic spine are present.",
            "output": "1.  Previously described right FDG-avid supraclavicular lymph node on PET-CT\nfrom ___ is a stable  right thyroid lobe nodule.  Thyroid ultrasound\nis recommended for further evaluation.\n\n2.  Remission of left supraclavicular lymph nodes, the largest of which now\nmeasures just 11 mm.\n\n3. New cluster of left lower lobe pulmonary nodules may be a nest of\nmetastases or inflammatory bronchiolar nodules. A 3 mm left upper lobe nodule\nmay have been present on the prior outside hospital CT chest from ___.\n\n4. Several stable to slightly smaller right pulmonary nodules.\n\n5. Please see the report of concurrent CT abdomen and pelvis for\nsubdiaphragmatic findings.\n\nNOTIFICATION:   The above findings were entered by Dr. ___ the\n___ Imaging Findings Dashboard for communication to the ordering\nclinician at 16:43 on ___."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The included portion of the thyroid is\nwithin normal limits.  There is no axillary or supraclavicular\nlymphadenopathy.  There is no mediastinal or hilar lymphadenopathy.\n\nHEART & VESSELS: The heart is mildly enlarged.  There is a small pericardial\neffusion.  The great vessels are normal in caliber.  There is a filling defect\nin a subsegmental branch of the right lower lobe pulmonary artery (3:177). \nSmall subsegmental left upper lobe pulmonary embolism is also noted (3:61). \nNo additional pulmonary arterial filling defects are identified.  There is no\nright heart strain.\n\nLUNGS & AIRWAYS: There is severe centrilobular emphysema affecting the\nbilateral upper lobes predominantly.  There is no focal consolidation, pleural\neffusion or pneumothorax.  Few, millimetric pulmonary nodules are seen\nthroughout the right lung, the largest within the right middle lobe measuring\n5 mm (3:167).  Two additional nodules are seen at the right apex measuring 5\nmm (03:39) and 3 mm (03:24).\n\nUPPER ABDOMEN: Limited views of the upper abdomen are notable for a tiny\nhyperenhancing focus in the right lobe of the liver which is likely due to\naltered perfusion.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions are\nidentified.  No fractures are demonstrated.",
            "output": "Pulmonary emboli involving right lower lobe and left upper lobe subsegmental\npulmonary artery branches.\n\nSevere, predominantly biapical centrilobular emphysema.  Multiple small\npulmonary nodules, the largest within the right middle lobe should be followed\nup with CT in 6 months for further evaluation.\n\nSmall pericardial effusion.\n\nRECOMMENDATION(S):   Follow-up chest CT in 6 months."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  There is a small pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is unchanged extensive apical predominant primarily\ncentrilobular emphysema.  Several millimetric solid nodules are again\ndemonstrated.  A right middle lobe nodule measures 4 mm, and a nodule at the\napex measuring 5 mm are unchanged (605: 5,24).  Lungs are otherwise clear\nwithout areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is heterogeneous with multiple subcentimeter\nhypodense nodules.\n\nABDOMEN: There is an unchanged hyperdensity at the dome of the liver, which\nprobably represents a perfusion anomaly (2:99).  Additional subcentimeter\nhypodensities in the liver are too small to characterize, but probably\nrepresent cysts.  The patient is status post cholecystectomy.  A 1 mm\nhypodensity in the spleen is incompletely characterized, but may represent a\nhemangioma or cyst.  A 2.7 cm hypodensity in the right upper renal pole is\nincompletely evaluated, but probably represents a cyst.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Severe centrilobular emphysema is unchanged.\n3. Multiple solid pulmonary nodules measuring up to 5 mm in the right upper\nlobe are unchanged in comparison with ___.\n4. Incompletely assessed right upper renal pole hypodensity could be further\nassessed on non-urgent outpatient renal ultrasound."
        },
        {
            "input": "There are no findings within the lungs to suggest the presence of active\npulmonary infection.  Respiratory and cardiac motion limits sensitivity for\ndetecting tiny pulmonary nodules in subtle interstitial lung abnormalities. \nLinear atelectasis is demonstrated in the inferior aspect of the lingula and\nleft lower lobe, an incidental note is made of calcified granulomas in the\nright upper lobe and lingula.\n\nNo enlarged intrathoracic lymph nodes.  Heart is normal in size, and no\npericardial or pleural effusion is evident.  Left hemidiaphragm is mildly\nelevated.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.  Left shoulder prosthesis is incidentally noted.",
            "output": "No CT evidence of active pulmonary infection.\n\nPlease see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "The patient is asymmetrically positioned within the scanner.  No incidental\nthyroid findings.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  All visible mediastinal lymph nodes (2, 19) Are normal in\nsize.  Normal appearance of the large mediastinal vessels.  Severe coronary\ncalcifications, mild aortic valve calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  Moderate bilateral pleural\neffusions.  No abnormalities in the upper abdomen.  No osteolytic lesions at\nthe level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  The lung\nparenchyma shows extensive pulmonary emphysema as well as bilateral apical\nnodular scarring with calcifications (302, 21).  The airways show wall\nthickening and irregularities.  Adjacent to the pleural effusions, areas of\natelectatic lung are visualized but there is no evidence of additional\nparenchymal abnormalities, notably none suggesting pneumonia.  No suspicious\npulmonary nodules or masses.",
            "output": "Pulmonary emphysema, signs of chronic bronchitis, no evidence of infectious\nlung disease.  Bilateral pleural effusions with adjacent atelectasis.  No\nsuspicious pulmonary nodules or masses."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  No enlarged lymph nodes in either the axilla or\nthoracic inlet.  There are no chest wall abnormalities.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Small central mediastinal lymph nodes, none\nenlarged by CT size criteria.  No enlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and mitral annulus,\nnone in the aorta.  Aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Mild bibasal subsegmental\natelectasis.  No lung nodules or masses.  No focal consolidations.  No pleural\neffusion or thickening.  Mild biapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nNo acute fractures.  Mild superior endplate deformity of the vertebral body of\nT12.  Moderate dorsal spondylosis.  No lytic or sclerotic bone lesions\nworrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "No lung nodules or masses.  No enlarged mediastinal or hilar lymph nodes.\n\nNo acute intrathoracic findings."
        },
        {
            "input": "The thyroid is normal.\n\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged\naccording CT criteria.  Right lower paratracheal node (series 4: Image 23) has\nshort axis of 5 degrees mm unchanged since ___.  Aorta and pulmonary\narteries are normal size.  Right internal jugular Port-A-Cath has tip ending\nin right atrium.\n\nCardiac configuration is normal and there is mild coronary calcification in\nthe left anterior and left circumflex coronary arteries, unchanged since ___.  Hypodense been shaped fluid density lesion in the subcarinal space is\n1.1 x 2.4 cm was 1.1 x 2.6 in ___, now with minimally increased density.\nThe is lesion is likely a pericardial recess or a small pericardial cyst,less\nlikely an enlarged lymph node being non FDG avid in PET-CT of ___.\n\nSmall pericardial effusion was moderate in ___, now small and not\nhemodynamically significant.  Left plural effusion, described in ___,\nhas completely resolved.\n\nLUNG AND AIRWAYS\n\nAirways are patent to subsegmental level bilaterally. Mild central right\nemphysema, upper lobe predominant, is stable since ___. Right lower lobe\npleura based, non FDG avid, lung nodule is overall unchanged since ___ measuring 1.3 x 1.7 cm, unlikely a metastasis or a malignant process.\nThis lesion is compatible with calcified granuloma, or a small infarct.\nTriangular shaped, pleural-based left lower lobe nodule (05:231) is likely a\nsmall atelectasis, residual of prior pleural effusion.  There are no lung\nnodules suspicious for malignancy or infection. Punctate subpleural upper\nlobes nodules (series 5: Images 32 and 47) are unchanged since ___, and\nlikely benign.\n\nUPPER ABDOMEN\n\nAbdominal findings are described in the report of concurrent CT abdomen pelvis\nclips number ___.\n\nOSSEOUS STRUCTURES\n\nThere are no bone lesions suspicious for malignancy or infections. Mild\ndegenerative changes of the mid thoracic spine and accentuated kyphosis are\nunchanged since ___.",
            "output": "1. No evidence of active intrathoracic infection or malignancy.\n2. Right lower lobe pleural-based non FDG avid partially calcified nodule is\nunchanged since ___ and compatible with granuloma or infarct.\n3. Left lower lobe that were shaped pleural-based nodule is residual\natelectasis due to prior pleural effusion, which is now completely resolved\n4. Low-density been-shaped subcarinal lesion is smaller since ___,\nwith minimal increased density and compatible with small pericardial cysts or\nrecess."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged.  Excluding the breasts\nwhich require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nThere are no lesions in the thyroid warranting further imaging evaluation. \nAtherosclerotic calcification is mild in the head and neck vessels and\ncoronaries involving at least the left anterior descending branch.  Aorta and\npulmonary arteries are normal size.  There is no pericardial or pleural\neffusion.\n\nMediastinal, hilar, internal mammary, diaphragmatic, and retrocrural lymph\nnodes are not enlarged.\n\nA 14 x 19 mm pleural-based soft tissue lesion in the posterior basal segment\nof the right lower lobe, containing a central calcification, is entirely\nunchanged since ___.  Could be post infectious or a previous pulmonary\ninfarct.  A small region of subsegmental atelectasis in the posterior basal\nsegment of the left lower lobe is unchanged since ___.\n\nCentrilobular emphysema is moderately severe in the upper lungs, milder\nelsewhere.  There are no lung lesions concerning for metastasis and the\ntracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nCoronary atherosclerosis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Aortic wall calcifications, no hilar or mediastinal\nlymphadenopathy.  Moderate coronary calcifications, moderate cardiomegaly.  No\npericardial effusion.  The posterior mediastinum is unremarkable.  The upper\nabdomen is reported in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.  Mild centrilobular pulmonary emphysema.  Mild subpleural right\napical scarring.  Mild irregularities and thickening of the airway walls, no\ndiffuse lung disease.  No suspicious pulmonary nodules or masses.  A partly\ncalcified an likely post infectious focus of pleural thickening at the level\nof the right lower lobe (7, 230) is stable.  Stable punctate subpleural left\nlower lobe scarring and subpleural granuloma (7, 235).",
            "output": "Stable appearance of the thorax as compared to ___.  No metastatic\ndisease to the thorax.  Likely post infectious spot of pleural thickening in\nthe right lower lobe as well as a small subpleural left lower lobe granuloma\nand scar are stable in appearance."
        },
        {
            "input": "Cluster of right axillary lymph nodes, ranging up to 3 cm in the superior\naspect in 3.5 cm in the inferior aspect is demonstrated.  No left axillary,\nsupraclavicular, subpectoral or mediastinal pathologically enlarged lymph\nnodes demonstrated.  Ascending aorta is 4.5 cm, mildly dilated.  Heart size is\nnormal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  10 mm right upper\nlobe nodule, series 6 image 124.  Para fissure all nodule in the right lower\nlobe, series 6, image 194 is 4 mm.  No other nodules demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Prominent disc osteophyte complex of T7-T6 is present,\nprotruding into the spinal canal better appreciated on the sagittal view.",
            "output": "Significant right axillary lymphadenopathy with no pathologically enlarged\nlymph nodes elsewhere in the chest\n\nRight upper lobe pulmonary nodule, large in should be reassessed in 3 months\nfor documentation of stability.  Otherwise, further management should be based\non the histology of the right axillary lymphadenopathy\n\nSpine osteophyte complex as described.  If patient is symptomatic, correlation\nwith thoracic spine MRI is to be considered\n\nPlease review CT abdomen and pelvis and the corresponding report will be\nissued separately.\n\nMild dilatation of the ascending aorta up to 4.5 cm, reassessment with chest\nCT in ___ year is recommended, ECG gated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber. The left\nsubclavian vein and left axillary vein are significantly narrowed by the left\naxillary collections.\n\nPULMONARY PARENCHYMA: There is mild atelectasis at the lung bases.  There is\nmild centrilobular emphysema.  2 mm nodule in the right upper lobe (4:119) is\nunchanged since ___.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  In the region of the left axilla, there is a large 12.9\nx 6.8 x 11.5 cm (4:118) soft tissue density structure/mass containing locules\nof gas with overlying skin defect along the left anterolateral chest wall.  An\nadditional smaller 2.8 x 4.0 cm (4:74) soft tissue density lesion is seen\nsuperiorly.  Lesions do not demonstrate rim enhancement.  There is no evidence\nof osseous invasion.  Multilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. A large heterogeneous 12.9 cm left axillary soft tissue density structure\ncontains locules of gas and tracks to an open skin defect.  The locules of gas\nmay be secondary to recent drainage.  A smaller heterogeneous 4.0 cm soft\ntissue density lesion is also in the left axilla just superior to the large\nlesion, worrisome for nodal mass, possibly necrotic.  The lesions do not\ndemonstrate rim enhancement and are concerning for soft tissue mass with\npossible hematoma.  Superimposed infection cannot be excluded.\n2. No evidence of adjacent osseous destruction.\n3. The left subclavian vein and left axillary vein appear compressed at the\nlevel of the axilla."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : The large left axillary mass measuring 10.1 x 5.6 cm\nappears decreased in density and there is increased necrosis within this and\nextension to the skin surface with evidence of ulceration.  Patient is status\npost excision of a left left axillary mass.  While this could represent\nevolving postsurgical changes with superimposed infection, recurrent disease\nwithin the area cannot be excluded\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Incidental note\nis made of a pulmonary embolism within the left lower lobe pulmonary artery\nextending into the segmental and subsegmental branches.  The the heart and\naorta are normal in caliber.  There is moderate cardiomegaly.  There is no\npericardial effusion.  There is mild coronary artery calcification.\n\n\nPLEURA: There is no pleural effusion.\nLUNG: A 2 mm left upper lobe pulmonary nodule (6, 73) is new.  A 1 mm\npulmonary nodule in the right middle lobe (6, 138 is also new.  The 2 mm left\nlower lobe pulmonary nodule (6, ___ may have been previously obscured by the\natelectasis.  The 2 mm right middle lobe pulmonary nodule (6, 191) is also\nnew.\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.  The manubrium has a mottled appearance (10,\n30), unchanged.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  Please refer to dedicated report on\nabdomen which has been dictated separately",
            "output": "Incidental note is made of pulmonary embolism involving the left lower lobe\nsegmental and subsegmental branches of the pulmonary artery. No evidence of\ninfarction.  No evidence of right heart strain.\n\nNo change in the size of the left axillary mass but altered configuration with\nincreasing hypodensity and a pockets of air and evidence of skin ulceration in\nthe left axilla.  While this could represent resolving postsurgical changes\nwith super added infection, however necrotic tumor cannot be excluded.\n\nSeveral tiny new pulmonary nodules ranging in size from 1-2 mm concerning for\nmetastasis.\n\nStable small mediastinal lymph nodes.\n\n\n\nStable mottled appearance of the manubrium sternum.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 12:20 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in both axilla or\nthoracic inlet.  The left anterior large axillary mass is significantly\nsmaller in size, now only remaining mild spiculated soft tissue measuring\napproximately 2.7 x 2.3 cm.  A new soft tissue mass is seen in the left\nanterior chest wall (6:157) measuring 2.4 x 1.9 cm.  Mild atherosclerotic\ncalcifications are seen in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  The entire\naorta is normal in caliber.  Mild atherosclerotic calcifications are seen in\nthe aorta and coronary arteries.  The pulmonary arteries are normal in\ncaliber.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Several nonenlarged small lymph nodes are seen\nin both retrocrural spaces, unchanged since prior.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchiectasis, no\nbronchial wall thickening or mucous plugging.\nMild dependent posterior atelectasis.  A subpleural 4 mm nodule in the right\nlung base (6:216) is unchanged.  No consolidations or lung masses.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Compared to prior study of ___, the large mass in the left axilla has\nsubstantially decreased in size, now only remaining as a mildly spiculated\nsoft tissue nodule.  However a solid nodule in the more inferior left chest\nwall is new and suspicious for metastatic spread.\n\nThe previously described tiny scattered pulmonary nodules are no longer seen,\nlikely representing resolving metastases.  Now only remains a subpleural tiny\nnodule in the middle lobe which is stable."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There are no\nsignificant coronary artery or valvular calcifications.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  A small amount of fluid in the\nupper esophagus, however esophagus cannot be optimally assessed without the\nadministration of oral contrast (05:52).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is small amount of atelectasis in the lingula.  There is\na 5 mm right middle lobe subpleural pulmonary nodule which is stable since\n___, and therefore benign.  Otherwise, lungs are clear without masses or\nareas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No acute thoracic process.\n\nNo thoracic findings attributable to patient's reported history of persistent\nchronic cough."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged mediastinal lymph nodes\nMEDIASTINUM:\nThere are small mediastinal lymph nodes not enlarged by size criteria. There\nis a 4 mm prevascular lymph node. Heart size is normal. There is moderate\ncoronary artery calcification.  There is no pericardial effusion. The aorta\nand pulmonary arteries are normal in caliber.\n\nPLEURA: There is no pleural effusion\n\nLUNG: There are several bilateral pulmonary nodules ranging in size from 4 mm\nto 11 mm concerning for metastasis.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  No lytic or sclerotic lesions concerning for metastasis\n\nUPPER ABDOMEN: It sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  There are gallstones.",
            "output": "Multiple bilateral pulmonary nodules concerning for metastasis.  The largest\nin the right middle lobe measuring 11 mm.\n\nSmall mediastinal lymph nodes not enlarged by size criteria."
        },
        {
            "input": "UPPER ABDOMEN: Please refer to the dedicated CT abdomen pelvis report from\nsame day for details of abdominal findings.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  No\nsupraclavicular, infraclavicular, or axillary lymphadenopathy.  No\natherosclerotic calcification of the head and neck vessels.  A right pectoral\nPort-A-Cath terminates within the right atrium.\nNo soft tissue abnormalities elsewhere in the chest wall concerning for\nmalignancy.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.  The esophagus is normal.\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  Coronary arteries are\nmoderately calcified.  No atherosclerotic calcification of the aortic valves\nor annulus.  No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Redemonstrated are multiple solid pulmonary nodules within\nboth lungs.  Some have remain millimetric in size, for example within the\nright upper, left lower lobes (6:78, 114, 162).  Larger solid pulmonary\nnodules measuring 5-6 mm within the right upper and lower lobes are minimally\ndecreased in size (6:149, 159).  In the area of some prior nodules, the\nnodules are no longer visualized; only a scar remains (right lower lobe 6:116\nand left lower lobe 6: 223, 224).  No new or growing pulmonary nodules.\nNo evidence of fibrotic lung disease or pleural abnormalities.\n\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber.  Mild\natherosclerotic calcification of the aortic arch.  No incidental pulmonary\nemboli on this nondedicated exam.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Overall improved disease burden within the chest.  Existing pulmonary nodules\nhave either been stable in size, mildly decreased, or are no longer visualized\nwith only a scar remaining in the area.  No new or growing pulmonary nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is redemonstration of a extensive type B aortic dissection extending\nfrom the aortic arch just distal to the left subclavian artery and extending\ninferiorly to at least the level of the mid abdominal aorta.  The dissection\nflap extends into the superior mesenteric artery.  The celiac artery arises\nfrom the false lumen.  Both renal arteries are supplied by the true lumen. \nThe descending thoracic aorta remains aneurysmally dilated to at least 4.6 cm.\nThe heart is normal in size with left ventricular hypertrophy.  Pericardium\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is extensive centrilobular emphysema throughout the lungs\nbilaterally.  There is a large dominant 5 cm subpleural bulla in the right\nlung apex, unchanged from prior study.  There is a small area of ground-glass\nopacity in the superior segment of the left lower lobe with multiple small\nadjacent bronchocentric nodules measuring up to 4 mm, nonspecific but\nsuggestive of a infectious or inflammatory small airways disease process\n(2:60).  There is an additional ground-glass nodule in the left upper lobe\nmeasuring 4 mm, unchanged from prior study (2:37).  There is linear\natelectasis in the right middle lobe.  Mild airway wall thickening is noted\ndiffusely.  Otherwise, the airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is nonspecific thickening of the bilateral adrenal glands\nwithout evidence of a discrete nodule.  Included portion of the upper abdomen\nis unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Nonspecific ground-glass opacity in the left lung with multiple small\nadjacent bronchocentric nodules measuring up to 4 mm, new from prior study. \nFindings are nonspecific but suggestive of an infectious or inflammatory small\nairways disease process.  See recommendations below.\n3. Redemonstration of extensive type B aortic dissection extending from the\ndistal aortic arch to at least the level of the mid abdominal aorta. \nUnchanged fusiform aneurysmal dilatation of the descending thoracic aorta. \nOverall, findings are not substantially changed from prior study dated ___.\n4. Severe centrilobular emphysema with a dominant 5 cm subpleural bulla in the\nright lung apex, unchanged from prior study.\n\nRECOMMENDATION(S):  For incidentally detected multiple subsolid nodules\nsmaller than 6mm, CT follow-up in 3 to 6 months is recommended. If the nodules\nare stable, CT follow-up in 2 and ___ years should be considered.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.\n\nThere is no abnormality in the right upper lobe which accounts for the opacity\nseen on recent chest x-ray. This opacity is most likely artifactual, due to\noverlap of an upper thoracic vertebral body transverse process and the spine.\nRight lower lobe ___ opacities and more discrete sub 3 mm nodules with\nsurrounding ground-glass opacities are most likely infectious or inflammatory\nin etiology (4: 141, 147, 163, 170). More discrete punctate nodules measuring\nno more than 2 mm have a very low index of suspicion for malignancy (4: 92,\n153, 164). A small left lower lobe subpleural band-like opacity may be due to\natelectasis or scarring (4, 180). There is minimal biapical pleural scarring,\nand no endobronchial lesion.\n\nImages of the upper abdomen show a nonobstructing 5 mm right intrarenal\ncalculus.\n\nThe bones are unremarkable.",
            "output": "There is no pulmonary abnormality which corresponds to the right lung apical\nopacity described on the recent chest x-ray.  This was probably artifactual.\n\nMild right lower lobe endobronchial spread of infection or inflammation.\n\nFew pulmonary micronodules do not warrant specific followup imaging in a low\nrisk patient.\n\n5 mm nonobstructing right intrarenal calculus.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 4:45 ___, 60 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  A part solid pulmonary nodule in the right lower lobe\nis unchanged from ___ requires no further follow-up with (4:143).  There is\nno emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "Unremarkable chest CT without evidence of intrathoracic mass or infection."
        },
        {
            "input": "THORACIC INLET: There are stable small left supraclavicular lymph nodes the\nlargest measuring 4 mm\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Right-sided\npacemaker lead projects to the right ventricle.\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  The right\nparatracheal lymph node measures 6 mm.  There are stable small hilar lymph\nnodes there is stable cardiomegaly.  Left-sided pacemaker leads\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is bibasilar atelectasis.  The ground-glass nodule in the right\nlower lobe has slightly increased in size since the prior study and now\nmeasures 17 x 13 mm as compared to the prior measurements 16 x 12 mm.  There\nis moderate upper lobe predominant emphysema.  The tubular opacity which most\nlikely represents bronchi with secretions within them in the lateral segment\nthe right middle lobe (3, 173) is new.  Stable 2 mm right lower lobe pulmonary\nnodule.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately",
            "output": "Slight increase in size and density of the ground-glass right lower lobe\nnodule which now measures 17 x 13 mm, could represent an adenocarcinoma in\nsitu.\n\nNew tubular opacity in the lateral segment right middle lobe could represent\nmucoid impaction within a dilated bronchus however an endobronchial lesion\ncannot be excluded.  Attention to this on follow-up imaging is recommended.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Right anterior ICD with\nlead in the right ventricle.  Moderate atherosclerotic calcifications in the\nhead and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is mildly enlarged with a dilated right and left atria.  No\npericardial effusion.  Mild atherosclerotic calcifications in the coronary\narteries and aorta, none in the cardiac valves.  The pulmonary arteries and\naorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.  Small left posterior\nBochdalek hernia.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Moderate centrilobular\nemphysema.  New subpleural nodularity measuring approximately 6 mm in the\nright lung base (4:216), possibly part of a linear atelectasis.  Small 5 mm\nground-glass nodule in the superior segment of the right lower lobe (04:140),\nunchanged.  Larger dominant part solid nodule also in the right lower lobe\nwith 6 mm unchanged solid component in total approximately ground-glass\nmeasurement of 2.0 x 1.6 cm (previously 1.7 x 1.1 cm) (4:175).  No new lung\nnodules.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.  Stable loss of height of T5 through T9 and T11.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No new lung nodules, lymphadenopathy or osseous lesions suspicious for\nintrathoracic metastatic disease.\nA part solid ground-glass nodule in the right lower lobe has grown slightly\ncompared to prior study and is suspicious for minimally invasive\nadenocarcinoma primary to lung.\n\nRECOMMENDATION(S):  Tissue sampling is recommended, with a thoracic surgery\nconsultation.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 11:10 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal. Supraclavicular\nand axillary nodes are not enlarged.  Right anterior chest ICD is similarly\npositioned.\n\nUPPER ABDOMEN: The imaged portion of the abdomen demonstrate moderate\natherosclerotic calcifications at the origin of the celiac axis.  Otherwise,\nthe imaged abdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.  A precarinal node again\nmeasures 7 mm (4:98).\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal size.  Lead of cardiac pacer terminates\nin the right ventricle apex coronary arteries are not calcified.  Trace\npericardial effusion is unchanged.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Extensive upper lobe dominant emphysema is unchanged.  Similar\nbiapical pleuroparenchymal thickening, greater on the right.  Partially solid\nground-glass opacity in the right lower increased size, now measuring 2.2 x\n1.8 cm, previously 2.0 x 1.6 cm, and the solid components measure up to 8 mm,\npreviously 6 mm (4: 172-175).  Subpleural nodularity in the right lower lobe\nfirst seen on the most recent prior study is less conspicuous and measures 5\nmm (4:216).  Other small nodules and calcified granulomas are overall\nunchanged (4: 80, 89, 180, 135, 183, 214, 28, 215).\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber.\nCHEST CAGE: Multilevel degenerative changes in the thoracic spine are\nunchanged since ___.  No pathologic or compression fractures or\ndestructive bone lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Increased size of right lower lobe ground-glass opacity with solid components,\nconcerning for progressive invasive adenocarcinoma."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is grossly\nunremarkable though there is an unchanged calcification within the left\nthyroid lobe.  Streak artifact from the implanted right chest wall pacer with\nsingle lead extending into the right ventricle.  The heart remains mildly\nenlarged with mild coronary artery, aortic valvular calcification noted.  No\npericardial effusion is seen.  The thoracic aorta contains moderate\natherosclerotic calcifications and appears normal in caliber.  The main\npulmonary artery is normal in size.  There is no mediastinal adenopathy.  No\naxillary adenopathy.  There is diffuse tracheobronchial tree calcifications. \nNo pleural effusion.  Small Bochdalek's fat containing hernias are noted\nbilaterally.\n\nThere is severe emphysema.  There is again noted to be a ground-glass lesion\nin the right lower lobe best seen on series 9, image 26 measuring 2.5 x 2.6 x\n2.3 cm, previously 2.5 x 2.7 x 2.0 cm.  While there has not been significant\nchange in overall size when compared with the most recent prior, when compared\nwith a prior from ___ this lesion has been slow growing.  No new\nnodule is seen.  Several punctate nodules for example in the right middle and\nlower lobes on series ___, image 28 are stable over multiple priors.\n\nWithin the imaged portion of the upper abdomen no abnormalities are seen.\n\nBones: No worrisome lytic or blastic osseous lesions seen.",
            "output": "Severe emphysema with ground-glass nodule in the right lower lobe which is\nstable from most recent prior though appears increased when compared with more\nremote priors suggesting slow growing malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is notable for\nunchanged coarse calcifications in the left lobe.  Supraclavicular and\naxillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  A prominent 0.9 cm\nprecarinal node is unchanged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is similar coronary arterial\nand aortic valvular calcification.  There is no pericardial effusion.  A right\nchest wall pacing device with single lead terminating in the right ventricle\nis unchanged.\n\nVESSELS: Aortic caliber is normal.  The main pulmonary artery caliber is\nnormal.\n\nPULMONARY PARENCHYMA:  The patient is status post right lower lobectomy,\nwithout evidence of local recurrence.  Scattered 1-2 mm nodules are stable,\nfor example, in the left upper lobe (10:52), right middle lobe (10:212) and\nleft lower lobe (10:264).  There are no new or enlarging pulmonary nodules. \nThere is severe emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.  There\nis diffuse calcification of the tracheobronchial tree, similar to prior.\n\nPLEURA:  There is a small right simple pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nModerate multilevel degenerative changes are unchanged.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Status post right lower lobectomy, without evidence of recurrence.\n2. Small right pleural effusion.\n3. Stable severe emphysema.\n4. Few scattered 1-2 mm pulmonary nodules are stable."
        },
        {
            "input": "The examination is compared to ___.  The examination is limited by\nthe lack of contrast.  The patient is intubated.  There is mild distension of\nthe esophagus.  Extensive aortic wall calcifications.  Stable borderline\ndiameter of the ascending aorta.  The remaining mediastinal are stable, and\ncoronary vessels continue to show moderate to severe calcifications.  The\npatient shows moderate bilateral pleural effusions.  Partially imaged is an\naortic stent graft.  The vertebral bodies show mild degenerative disease. \nExtensive bilateral lower lobe atelectasis adjacent to the pleural effusions. \nThe pre described right lower lobe mass is no longer visualized in the\ncollapsed lung parenchyma.  There is mild bilateral dependent interstitial\nthickening, suggestive of mild interstitial pulmonary edema.  Fluid marking of\nthe fissures.  Stable extensive pulmonary emphysema.",
            "output": "New bilateral moderate pleural effusions with adjacent atelectasis and signs\nindicative of mild interstitial pulmonary edema.  The pre-existing in pre\ndescribed right lower lobe mass is no longer visualized in the collapsed lung\nparenchyma."
        },
        {
            "input": "The thyroid gland is slightly enlarged (right lobe).  Aorta and pulmonary\narteries are normal in diameter.  No mediastinal pathologically enlarged lymph\nnodes present. Sub- carinal lymph nodes is 5 mm, left hilar lymph node is 7.4\nmm. Mild cardiomegaly is present. There is no pericardial pleural effusion\nnoted. Small hiatal hernia is present. Image portion of the upper abdomen will\nbe reviewed separately in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Assessment of the\nlung parenchyma demonstrate multiple bilateral pulmonary nodules, series 4,\nimages 143, 149, 159, 176, 183, 232, 245, 246, 252. There are multiple,\nbilateral and concerning for potential metastatic disease with the largest 1\nin the left lower lobe approaching 6 mm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\nAnterior rib fractures are present on the right, healed.",
            "output": "Mild for pulmonary nodules potentially representing metastatic disease\nespecially in the context of abnormal findings in the abdomen that will be\ndiscussed separately as part of the CT abdomen and corresponding report will\nbe issued.\n\nIn case malignancy is established, reassessment of those nodules in 3 months\nwith chest CT is required.\n\nNot pathologically enlarged mediastinal and hilar lymph node\n\nMild enlargement of the right thyroid gland"
        },
        {
            "input": "MEDIASTINUM: The thyroid gland is slightly heterogeneous, with minimal\nenlargement of the right thyroid lobe, unchanged from the prior study. There\nis no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The\naorta and pulmonary arteries are normal in size.   The heart size is normal\nand there is no pericardial effusion. Dense atherosclerotic calcification is\nnoted in the left anterior descending coronary artery (03:30).\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  Fibrosis in the medial right lower lobe along\nnumerous contiguous thoracic osteophytes are again noted (6:151), unchanged in\nconfiguration compared to the prior study.  There is no diffuse interstitial\nabnormality.  An 8mm right apical nodule was 7mm previously (6:72).  Numerous\nother bilateral small pulmonary nodules, all 5 mm in size or less, are\nunchanged since the prior study (6:29, 32, 83, 104, 111, 115, 123, 134, 159,\n162, 165, 166, 172, 181, 194). A calcified granuloma in the right apex is\nagain seen (06:39). No new nodules are identified.\n\nBONES: Unchanged compression deformity of the L1 vertebral body is again\nnoted.  No new lesions concerning for malignancy are identified.\n\nUPPER ABDOMEN:  Although not specifically tailored for the evaluation of\nsubdiaphragmatic structures, numerous calcified gallstones are present within\na decompressed gallbladder.  Numerous cystic lesions are again seen within the\npancreas, similar compared to the prior MRCP from ___.",
            "output": "1. 8mm apical nodule was 7mm previously.  Follow-up CT in 6months is\nrecommended.\n2. Numerous other small pulmonary nodules are unchanged compared to the prior\nstudy, and can be reassessed at the time of follow-up imaging.\n3. Numerous partially visualized pancreatic cystic lesions are better assessed\non prior MRCP from ___.\n4. Cholelithiasis.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 17:03 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Several small\nmediastinal lymph nodes are stable.  Coronary calcifications are extensive. \nHeart size is normal.  There is no pericardial pleural effusion.  Small hiatal\nhernia is present.\n\nImage portion of the upper abdomen demonstrate multiple calcified gallstones\nwith no CT evidence of cholecystitis.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are all stable, series 5, images 48, 84, 119, 128, 127, 161, 184, 196,\n203, 210, 225, with no new nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nCompression fracture of L1, mild to moderate is unchanged.",
            "output": "Stable appearing of multiple pulmonary nodules dating back to ___.  Final ___ yrs followup in ___ is recommended."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Mild enlargement of the thyroid\ngland appearing similar compared to prior.  No supraclavicular or axillary\nadenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  Hypodense lesion involving the medial limb of\nthe left adrenal (4, 209) representing a lipid rich adenoma.  Multiple\ncircumferentially calcified gallstones.  No features of cholecystitis. \nMultiple colonic diverticula.  Multiple pancreatic cysts and reference is made\nto previous MRCP done ___.  Small left renal cyst (2, 62).\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nNo aortic valve calcification.  Moderate right coronary artery calcification\nand severe left coronary artery calcification.  The ascending aorta is not\naneurysmal.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  All the pre-existing pulmonary nodules are unchanged with the\nlargest nodule measuring 6 mm in diameter in the left lower lobe (4, 156). \nMild, but diffuse bronchial wall thickening.  Mild bronchiectasis in the lower\nlobes are thought to be age related.  No diffuse lung disease.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.  Insufficiency type fracture of the superior endplate of L1 is\nunchanged.",
            "output": "All the pre-existing pulmonary nodules are unchanged since at least ___ and should be considered benign.  No new or enlarging pulmonary\nnodules or masses.  No confluent airspace consolidation.\n\nFor abdominal findings please refer to previous MRI abdomen done ___.\n\nRECOMMENDATION(S):  No further follow-up for the pulmonary nodules advised."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nsevere coronary artery calcifications.  Calcific atherosclerotic disease\ninvolving the aortic arch and descending thoracic aorta are moderate. \nOtherwise, the heart, pericardium, and great vessels appear within normal\nlimits based on an unenhanced scan.  Unenhanced scan. No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 2.2 cm cyst seen at the right lower lobe (4:168). \nMultiple bilateral pulmonary nodules measuring up to 5 mm in the right upper\nlobe are grossly unchanged compared to at least ___ (for example 4:\n92, 97, 113, 114, 115, 116, 121, 136, 160, 164, 174, 181).  The lungs are\notherwise clear without evidence of masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Previously described hypodensity in the right thyroid lobe is\nnot well seen on current exam.  Otherwise, the base of the neck is\nunremarkable.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for\nnodularity of the left adrenal gland which is unchanged compared to at least\n___.  Known pancreatic body cystic lesions are not substantially\nchanged compared to ___ are better evaluated on prior MRCP.  Known\nkidney cysts are also unchanged and better seen on prior MRCP.  Small hiatal\nhernia.\n\nBONES: Chronic deformity of the left tenth posterior rib likely reflects a old\nfracture (3:85).  No suspicious osseous abnormality is seen.? There is no\nacute fracture.",
            "output": "1. No acute fractures.  No acute traumatic injury within the chest.\n2. Multiple pulmonary nodules measuring to 5 mm in the right lower lobe are\ngrossly unchanged compared to at least ___.\n3. Stable nodular thickening of the left adrenal gland.\n4. Known pancreatic body cystic lesions are unchanged compared to ___,\nbetter evaluated on prior MRCP, and thought to reflect side-branch IPMN."
        },
        {
            "input": "There is a mildly displaced oblique fracture through the proximal to mid body\nof the sternum with moderate retrosternal hematoma tracking inferiorly the\nalong the anterior pericardial region to the inferior chest.  No pneumothorax\nis seen.  There is no pleural effusion.  No obvious mediastinal, hilar, or\naxial lymphadenopathy is seen given noncontrast enhanced CT.  Fracture of the\nanterior lateral left second rib is of indeterminate age.  There is a\ncompression fracture of the T12 vertebral body with mild loss of height\nsuperiorly, which may have acute component.\n\nThere is mild bilateral dependent atelectasis.  Mild linear\natelectasis/scarring is also seen in the lingula and right middle lobe.  The\nairways are patent to the subsegmental levels bilaterally.  Bronchotracheal\ntree calcification is seen.  The ascending aorta is slightly prominent in\ncaliber measuring 3.5 cm in diameter.\n\nNoncontrast enhanced images of the very upper abdomen are grossly unremarkable\naside for scattered aortic calcifications.  The upper abdominal aorta is not\naneurysmally dilated.",
            "output": "Noncontrast examination performed.  Mildly displaced oblique fracture through\nthe proximal to mid sternal body with moderate retrosternal hematoma seen\ntracking inferiorly to the pericardial region in the inferior-most aspect of\nthe chest.\n\nNondisplaced fracture of the anterolateral left second rib of indeterminate\nage, but may be old.\n\nCompression fracture of the T12 vertebral body with mild loss of height may\nhave acute component."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show no significant\nabnormal finding.\n\nMEDIASTINUM: Small hiatal hernia.  Esophagus is otherwise unremarkable.  Small\nmediastinal lymph nodes, none pathologically enlarged by size criteria.  No\napparent hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Micronodule (302:115) and calcified granuloma (302:92) in the\nright lower lobe.  Perifissural 3 mm triangular opacity, likely a lymphoid\naggregate.\nCentrilobular ill-defined nodules in the medial and posterior segment of the\nright lower lobe, also seen in the left lower lobe but less in number ___:\n168, 148, 143).\n2. AIRWAYS:  Small heterogeneous content adherent to the left lateral tracheal\nwall (302:53).\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "Centrilobular nodules in the medial and posterior segments of the right and\nleft lower lobes are suggestive of infectious process, likely aspiration due\nto distribution.  Follow up CT in 6 months is advised after proper GERD\ntreatment to assess for resolution.\nSmall lobulated heterogeneous opacity adhered to the left lateral tracheal\nwall that in the context of infection is most likely mucous secretions.\nTiny pulmonary nodule in the right lower lobe.\nFor incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nRECOMMENDATION(S):  Repeat Chest CT in six months."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  There is no\npericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\npulmonary nodule is stable, 2 mm, series 4, image 59.  Right lower lobe 2 mm\nnodule is stable, series 4, image 117.  Previously seen right lower lobe\nill-defined nodule has resolved or substantially decreased in size, series 4,\nimage 163 as well as associated opacity most likely representing area of\ninfection.  Left lower lobe nodule has resolved as well.  Left fissural nodule\nis 3 mm, stable, series 4, image 102.  Minimal bronchiectasis are present.  No\nnew nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval resolution of lower lobe opacities most likely representing\ninfectious process\n\nSeveral stable pulmonary nodules as discussed above\n\nMinimal bronchiectasis but no evidence of bronchitis demonstrated."
        },
        {
            "input": "MEDIASTINUM: The thyroid is unremarkable.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy, although evaluation limited\nwithout intravenous contrast.  The aorta and central pulmonary arteries are\nnormal in caliber.  There are minimal atherosclerotic calcifications of the\naorta.  Low density to the blood pool attenuation is consistent with anemia. \nThe heart size is normal.  There is a small to moderate nonhemorrhagic\npericardial effusion without pericardial thickening.  Extensive edema is noted\nalong the left axilla and more generally subcutaneous fat along the left\nlateral chest wall.  Substantial but less striking edema is also noted in the\nright axilla.  The musculature is also somewhat enlarged with surrounding\nedema, although there is no increased density to suggest hematoma.\n\nPLEURA:  There are scattered pleural calcifications on the left, seen as far\nback as ___. However, there is now marked circumferential pleural thickening\non the left, which was first partially imaged on ___.  Particularly in\nthe upper left hemithorax the thickening is mildly irregular in contour. \nThere is a large nonhemorrhagic left pleural collection with a relatively\nsmooth but thick wall that appears unchanged.  There is severe associated\ncompressive atelectasis of the left lung including persistent left lower lobe\ncollapse. This is unchanged from ___. There is no pneumothorax.\n\nLUNGS: In the small remaining portion of aerated lung parenchyma in the left\nupper lobe, there is airspace consolidation and ground-glass opacity with air\nbronchograms, concerning for pneumonia (4:86) or worsening atelectasis,\nalthough the pleural collection is probably unchanged in size. Evaluation for\npulmonary nodules/masses is limited by respiratory motion artifact and lack of\naeration in a significant volume of lung parenchyma although there is no clear\ndemonstration of a mass.\n\nBONES: As seen on the other CTs performed today, there is diffuse\nheterogeneity in bone density.  Although no acute fracture is seen, there has\nbeen interval progression of the T12 compression fracture noted on the ___ study (60___: 82).  There is no retropulsion or spinal canal stenosis.",
            "output": "1. Left pleural thickening and effusion, first noted on ___, in the\nsetting of pleural calcifications suggesting asbestos exposure, is concerning\nfor pulmonary malignancy or mesothelioma.  As was recommended on the prior\nstudy, oncologic workup is recommended.\n2. Superimposed on the significant compressive atelectasis caused by the\neffusion, including left lower lobe collapse, is consolidation in the left\nupper lobe concerning for pneumonia.  No convincing evidence is found for a\ncentral mass although the course of left lower lobe airways seems mildly\ndistorted, possibly more due to mass effect from pleural abnormalities,\nhowever.  A subtle mass is not excluded, however.\n3. Small to moderate nonhemorrhagic pericardial effusion.\n4. Extensive heterogeneity of bone density, in the context of the thoracic\nfindings, this concerning for metastatic disease.\n5. T12 compression fracture noted on the ___ study has progressed, but\nthere is no retropulsion or spinal canal stenosis.\n6. Extensive soft tissue edema, particularly striking along the left lateral\nsubcutaneous tissues and left chest wall musculature."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:\nThere is mild respiratory motion artifact, predominantly in the lower lobes.\nLungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Visualized portions of the upper abdomen demonstrate diffuse hepatic\nsteatosis.\n\nBONES:  Spinal fusion hardware is seen in the upper thoracic spine.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Hepatic steatosis."
        },
        {
            "input": "CHEST: The imaged portion of the thyroid gland is normal.  The thoracic aorta\nis normal in course and caliber without appreciable atherosclerosis.  The\nheart is normal in size and shape.  No pericardial or pleural effusion.  The\nmain pulmonary artery is normal in size with patent central branches. \nEvaluation of segmental and subsegmental branches is limited due to suboptimal\ncontrast timing.  There is no mediastinal, axillary or hilar adenopathy.\n\nThe lungs are clear bilaterally without worrisome nodule, mass, or\nconsolidation.  Minimal atelectasis is noted in the inferior lingula.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without focal concerning lesion. \nMain portal vein is not assessed.  No biliary ductal dilation.  Is not\nvisualized.\n\nPANCREAS: The pancreas enhances normally.  There is a periampullary duodenum\ndiverticulum noted.  No ductal dilation or signs of inflammation.\n\nSPLEEN:  The spleen is normal in size without focal abnormality.\n\nADRENALS: Adrenals are normal bilaterally.\n\nURINARY: The kidneys enhance symmetrically.  No focal renal lesion,\nhydronephrosis or signs of pyelonephritis.  A tiny stone is seen within the\nright lower pole calyx measuring 1-2 mm, nonobstructing.  No perinephric\nabnormality is seen.\n\nGASTROINTESTINAL: The stomach and duodenum are unremarkable though as stated\nabove there is a periampullary duodenal diverticulum.  The small bowel\ndemonstrates no signs of ileus or obstruction.  The appendix appears\ntruncated, and normal.  The colon is thin walled without significant fecal\nloading, signs of inflammation, or obstruction.  No free air or free fluid.\n\nPELVIS: The urinary bladder is well distended appearing normal.  Uterus is\nsurgically absent.  No adnexal mass.  No free fluid.  No pelvic sidewall or\ninguinal adenopathy.  There is hyperdense stranding at the left groin in this\npatient with recent hernia repair.  No drainable fluid collection.  No pelvic\nor retroperitoneal extension.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is normal in course and caliber without\nappreciable atherosclerosis.  An IVC filter is noted.\n\nBONES: Bony structures appear intact without worrisome lytic or blastic\nosseous lesion.  A defect in the left posterior iliac wing likely reflects\nprior bone graft harvest site.  Partially visualized fusion hardware in the\ncervicothoracic junction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Residual hyperdense stranding in the left groin related to recent femoral\nhernia repair.  No drainable fluid collection or signs of active bleeding.\n2. No central pulmonary embolism.  Please note evaluation somewhat limited for\nsegmental and subsegmental branches assessment given bolus timing.\n3. Punctate nonobstructing right kidney stone."
        },
        {
            "input": "The imaged portions of the thyroid gland are unremarkable.  A right lower\nparatracheal lymph node has increased in size measuring 11 x 17 mm, previously\n8 x 14 mm (2, 27). Difficult to delineate left hilar lymphadenopathy has also\nmore prominent on this exam (2, 31). Several coarse calcifications are noted\nat both hila.\n\nThere is new cardiomegaly with multichamber enlargement. Diffuse low\nattenuation of the blood within the heart suggests mild anemia. New mild\ndilatation of the main pulmonary artery to 3.2 cm may suggest early pulmonary\nhypertension. The thoracic aorta is normal in caliber. There is no pericardial\neffusion.\n\nSeveral images are partially degraded by respiratory motion artifact. There\nare several new peripheral opacities scattered throughout both lungs, several\nof which demonstrate cavitation. The largest 3.0 x 3.4 cm lingular cavitary\nopacity has surrounding ground-glass opacification, and corresponds to the\nabnormality seen on recent chest x-ray.  These findings are superimposed on\nmild centrilobular emphysema.  While there is some component of bibasilar\nplatelike atelectasis, there are also small bilateral lower lobe\nconsolidations which are likely due to infection versus aspiration. There is\nalso a trace left pleural effusion.\n\nImages of the upper abdomen are unremarkable.\n\nAn old right rib fracture is incidentally noted. There are no lesions in the\nrib cage worrisome for infection or malignancy.",
            "output": "Multiple bilateral nodular opacities, several of which demonstrate surrounding\nground-glass and cavitation. The largest lingular opacity corresponds to the\nabnormality seen on recent chest x-ray.  They are most likely due to septic\nemboli or other infectious etiology.  Vasculitis and malignancy are considered\nmuch less likely.  Followup to resolution is recommended.\n\nBilateral lower lobe patchy consolidations which are likely due to infection\nor aspiration.\n\nMediastinal and left hilar lymphadenopathy.\n\nMild centrilobular emphysema."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is calcified atherosclerotic plaque in the\ncoronary arteries.  The pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is severe centrilobular emphysema.  Scattered areas of\nground-glass and consolidation are most extensive in the right upper lobe,\nsuspicious for pneumonia.  Additional regions of consolidation noted at the\nlung bases dependently, somewhat more patchy at the left lung base and\ndependently in the left lower upper lobe.  These could represent additional\nareas of infection or aspiration versus atelectasis.  Central airways are\npatent.  There is opacification of the left lower lobe subsegmental bronchi.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder contains multiple\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis.  At the superior pole of the left\nkidney is a 4.2 cm, well-circumscribed hypodense lesion with a density of 20\nHounsfield units most consistent with a simple renal cyst, (series 601, image\n41) there is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a nasogastric tube that terminates in the mid\nstomach.  Otherwise, the stomach is unremarkable.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon is within normal limits.  There is moderate stool burden and distension\nof the rectum.  The appendix is not visualized though no inflammatory changes\nidentified in the right lower quadrant.  There is no free intraperitoneal\nfluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  The bladder is\ndecompressed by a Foley catheter.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is mild prostatomegaly.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Again seen, is an unchanged compression deformity of\nthe superior endplate of L3.  There is no evidence of worrisome osseous\nlesions or acute fracture.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1.  There is no evidence of bowel obstruction, however there is moderate stool\nburden distending the rectum.\n2.  Right upper lobe ground-glass and consolidation worrisome for pneumonia. \nAdditional regions of consolidation at the lung bases likely due to\ncombination of atelectasis with superimposed aspiration or infection.\n3.  Cholelithiasis without evidence of acute cholecystitis."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without evidence of\nfocal injury, dissection, or aneurysm.  There is no mediastinal hematoma.  The\nairways centrally patent.  The main pulmonary artery and central branches\nappear patent.  The heart is normal in size and shape.  No pleural or\npericardial effusion is seen.  A small 1 cm nodule is noted along the inferior\nleft thyroid lobe (2:5).\n\nLungs are clear bilaterally without focal contusion, laceration or\npneumothorax.  No worrisome nodule, mass, or consolidation.\n\nABDOMEN:  There is no intra-abdominal free air or free fluid. The liver and\nspleen appear intact without focal abnormality.  The gallbladder contains\nmultiple calcified gallstones, with no secondary signs of cholecystitis. The\npancreas appears normal. A 15 x 17 mm intermediate density nodule is noted in\nthe left adrenal gland (02:55). The right adrenal gland is unremarkable.\nIncidentally noted intermediate density renal lesions are seen in the\ninterpolar left kidney (2:68) and along the inferior pole of the right kidney\n(601:39). There is no hydronephrosis or traumatic renal injury bilaterally.\nThe The abdominal aorta is normal in course and caliber with widely patent\nmajor branches. There is no retroperitoneal hematoma or lymphadenopathy. No\nfree air or free fluid is seen.\n\nA small hiatal hernia is present. 2 duodenal diverticula are noted in the\nthird portion of the duodenum. The intra-abdominal loops of large and small\nbowel are unremarkable, with the exception of scattered colonic diverticula,\nwith no evidence of diverticulitis.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal. No free pelvic fluid.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "1. No evidence of acute traumatic injury in the torso.\n2. Incidentally noted lindeterminate eft adrenal nodule, and intermediate\nlesions in the bilateral kidneys can be further evaluated with an MRI non\nemergently if clinically indicated.\n3. Small hiatal hernia.\n4. 1 cm left thyroid lobe nodule."
        },
        {
            "input": "Postsurgical changes are consistent with provided history of minimally\ninvasive esophagectomy. There is a left paramidline upper thoracic surgical\ndrain.  Tip location of this drain is difficult to identify and may be\nintraluminal (2: 10- 15). There is no evidence of extravasated oral contrast\nin the mediastinum. There is no pneumomediastinum. Mild haziness of the\nsubcarinal soft tissues which may be postsurgical in nature. There is no focal\nfluid collection.\n\nRight chest chest tube is unchanged in positioning. There is a small simple\nright pleural effusion.  Mild right middle and right lower lobe atelectasis is\npresent.  Mild smooth thickening of right upper and middle lobe septa likely\nrepresents small amount of pulmonary edema.  There is no left pleural effusion\nor area consolidation.\n\nImaged thyroid is unremarkable. Central airways are patent. Heart is not\nenlarged. Thoracic aorta has normal course and caliber. There is no suspicious\nbone lesion concerning for malignancy or infection. There are no enlarged\naxillary, hilar or mediastinal lymph nodes.",
            "output": "1. Postsurgical changes consistent with esophagectomy.\n2. The location of the left upper thoracic JP drain tip is difficult to\ndiscern and may be intraluminal (___).  Recommend clinical correlation\nwith output.\n3. No mediastinal fluid collection or extravasated oral contrast, but a\nfluoroscopic study would be more sensitive for detecting a subtle leak.\n4. Mild pulmonary edema in the right lung.\n5. Please see separate reports for dedicated CT neck and CT abdomen and pelvis\nfindings."
        },
        {
            "input": "As compared to the previous examination, the soft tissue structures at the\nlevel of the upper anastomosis, located approximately at the upper aspect of\nthe aortic arch (3, 14) has minimally decreased in size.  The soft tissue\nstructure is homogeneous and does not show central necrosis or pathologic\ncontrast enhancement.  The gastric pull-through itself as well as the distal\nanastomosis are also unremarkable.  There is no abnormality of the adjacent\nmediastinum.  A precarinal lymph node (3, 20) is unchanged.  Normal appearance\nof the large mediastinal vessels.  No incidental pulmonary embolism.  Mild\nrespiratory motion are defects in the lungs.  Otherwise no relevant change. \nMild chronic airways disease.  No pleural effusions.  No pleural thickening,\nand minimal scarring at the bases of the middle lobe.  No suspicious lung\nnodules or masses.",
            "output": "Slight decrease in size of the soft tissue structure at the level of the upper\nanastomosis.  No lymphadenopathy.  No pulmonary abnormalities."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Prevascular lymph node, series\n2, image 21 has increased in size from 3.7-5.4 cm.  Sub- carinal lymph node\nhas minimal increased in size from 4-5.7 cm, series 2, image 22.  Esophagus is\npatent.  No definitive evidence stricture air can be seen on this study.  A\nleft hilar lymph node has minimally increased in size from 4-5.5 cm, series 2,\nimage 28.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Extensive\nopacities, ground-glass and centrilobular nodules in the left upper lobe and\nleft lower lobe are present and might be consistent with current infection or\nextensive aspiration.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Left lung infectious process as described.\n\nNo evidence of intrathoracic metastatic disease.\n\nNo definitive evidence of stricture.\n\nMinimal interval increase in lymphadenopathy potentially reactive in should be\nreassessed in 3 months for documentation of stability/resolution."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  The precarinal\nlymph node described on the previous examination (3, 21) is stable in size. \nThe pre described left hilar lymph node (3, 31) is decreased in size, however,\nthe lymph node is difficult to assess given the lack of contrast material. \nThe pre described sub- carinal lymph node is stable.  Stable appearance of the\nsoft tissue components of the esophagus, no evidence of new mediastinal\nlymphadenopathy.  The appearance of the upper abdomen, including the status\npost cholecystectomy is also stable.  Stable appearance of the heart.  No\nchanges in appearance of the chest wall.  No suspicious lung nodules or\nmasses.  Mild scarring adjacent to the postoperative neo esophagus. All\npre-existing ground-glass opacities in the left lung have completely resolved.\nNo pleural effusions.",
            "output": "Complete resolution of pre-existing left lung ground-glass opacities. \nStability in size of most pre-existing mediastinal lymph nodes, with the\nexception of a left hilar lymph node that has decreased in size."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is stable appearance of scarring adjacent to the neo\nesophagus on the right.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a linear lucency near the hilum in segments ___ and ___.  There is a\nsimilar hypodensity adjacent to the falciform ligament which has the typical\nlocation and appearance of focal fat.  A 15 mm lesion in segment VIII of the\nliver enhances on late arterial phase, consistent with hemangioma and seen on\nprior.  Compared to most recent prior, there is an increase in intrahepatic\nbiliary dilatation, specifically in the left lobe.  The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is status post pull-through for neo esophagus. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon and rectum are within normal limits.  The appendix is\nnormal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is no evidence of\nadnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No pulmonary embolism or acute aortic syndrome.\n2.  Linear hypodensities near the hilum in segments ___ and ___ of the liver\nmay represent liver lacerations given recent endoscopy.  There is no adjacent\nhematoma.  Alternatively, this may represent focal fat, though the\nconfiguration is unusual.  In light of the patient's history of malignancy,\nmetastatic lesion cannot be excluded.\n3.  Intrahepatic biliary dilatation in the left lobe is increased from most\nrecent prior.\n\nRECOMMENDATION(S):   Follow-up MR is recommended for further evaluation of\nlinear lucencies in the liver.  Biliary dilatation can be assessed at that\ntime as well.  Alternatively, if prior studies have been performed since ___,\ncomparison can be made to demonstrate stability of these findings.\n\nNOTIFICATION:   Updated wet read was discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 3:37 pm."
        },
        {
            "input": "Thyroid gland is unremarkable.  Appearance of the new esophagus is within\nnormal limits with no abnormal areas of thickening of the wall.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nAorta and pulmonary arteries are unremarkable.  Heart size is normal.  No\npericardial or pleural effusion is demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally lungs are clear.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of new\nlymphadenopathy, pulmonary nodules or masses.\n\nPatulous neoesophagus, unchanged in appearance.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nprovided separately."
        },
        {
            "input": "Small sub muscular hematoma lies alongside nondisplaced fracture of the left\nfirst rib.  There is no pleural hematoma.  Small regions of edema and\ninduration in the anterior chest and upper abdominal wall reflect recent\nsternotomy.  Sternal fragments are closely apposed.  There are no findings in\nthe chest wall to suggest infection.  A small retrosternal fluid collection at\nthe level of the xiphoid, 02:37, and a small pericardial effusion, including a\na component in the superior pericardial recess around the ascending aorta,\n02:23, are expected postoperatively.  Neither is hemorrhagic or contains any\ngas.  Moderate bilateral pleural effusions are nonhemorrhagic, layering\nposteriorly, are associated with moderately severe bibasilar atelectasis.\n\nThe moderate to severe cardiomegaly would require dedicated cardiac imaging,\nfor assessment .\n\nSub cm lymph nodes in the mediastinum are are numerous, not pathologically\nenlarged.\n\nInterstitial pulmonary edema is mild.\n\n2 right upper lobe nodules, 4 mm and 5 mm, 4:105, will need follow-up CT\nscanning in 6 months if the patient is a smoker, one year otherwise.\n\nBronchial tree is patent to subsegmental levels.\n\nThere no bone findings in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No pneumonia or evidence of other infection in the chest.\n\nModerate layering nonhemorrhagic pleural effusions,, pericardial effusion, and\nsmall retrosternal fluid collection, all all probably serous.\n\n2 small right upper lobe lung nodules will need CT follow-up.\n\nNondisplaced left first rib fracture with small associated hematoma, a common\nfinding after sternotomy in elderly patients.\n\nRECOMMENDATION(S):  Chest CT in 6 months if patient is a smoker, one year if\nnot."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.\n\nCoronary artery calcification is moderate with stents (or particular heavy\ncalcification) probably in the right circumflex and possibly in the left\nanterior descending coronary arteries. Heart is not enlarged. A superior vena\ncava stent is unchanged in position. Mildly thickened distal esophageal wall\nmay be secondary to under distended small hiatal hernia.\n\nThe central airways are patent to the subsegmental level. Diffuse patchy\nopacities on CT ___ have resolved. There is no area of\nconsolidation. 3 mm left upper lobe pulmonary nodule (05:48) is unchanged\nsince ___. Right middle lobe bronchial wall thickening is mild. Small\nlinear opacities in the inferior right middle lobe are likely atelectasis or\nscarring. There is no evidence of honeycombing or significant interstitial\nabnormality. There is no pleural effusion.\n\nThere are no bone lesions  concerning for malignancy or infection. There are\nanterior osteophytes of the lower thoracic spine. The native kidneys are\natrophic. This study is not designed for subdiaphragmatic diagnosis but shows\nno adrenal mass or abnormality in the imaged portions of the unenhanced solid\norgans in the upper abdomen.",
            "output": "1. Resolution of multiple airspace opacities from CT ___.\n2. No evidence interstitial lung disease.\n3. Distal esophageal wall thickening may be secondary to underdistention and\nhiatal hernia. If patient is symptomatic, finding could be further evaluated\nwith endoscopy or  contrast swallow.\n4. Moderate coronary artery calcification."
        },
        {
            "input": "The right brachiocephalic/SVC stent appears severely narrowed at the\nconfluence of the right subclavian vein, internal jugular vein, and anterior\njugular vein (307b:39).  Both anterior jugular veins and numerous veins in the\nanterior subcutaneous tissues are markedly dilated.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere are extensive coronary calcifications.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, or segmental\npulmonary arteries.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is a large thyroid pyramidal lobe with thyroid nodule (03:55).  The\nright and left thyroid lobes are unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.  Incidental note is made\nof an accessory spleen.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  There is severe narrowing of the right brachiocephalic/ SVC stent at the\nconfluence of the right subclavian vein, internal jugular vein, and an\nanterior jugular vein.\n2.  Large thyroid pyramidal lobe with a thyroid nodule.  Recommend correlation\nwith prior ultrasound.  If no priors available, thyroid ultrasound would be\nwarranted.\n\nRECOMMENDATION(S):  Recommend correlation with prior thyroid ultrasounds.  If\nno prior imaging available, thyroid ultrasound could be considered for the\npyramidal lobe of thyroid nodule."
        },
        {
            "input": "There are new multifocal opacities in the right lung with a few scattered\nopacities at the left base concerning for multifocal pneumonia.  No\npneumothorax.  There is a small right pleural effusion.\n\nThere is suggestion of a 6 mm right thyroid nodule.  Supraclavicular,\naxillary, mediastinal and hilar lymph nodes are not enlarged. Aorta and\npulmonary arteries are normal size.  There is dense atherosclerotic\ncalcification of the coronary arteries.\n\nThere are multilevel degenerative changes of the spine.\n\nEndotracheal tube terminates 2.5 cm above the carina.\n\nPlease see separate CT abdomen pelvis report for findings under the diaphragm.",
            "output": "1.  Multi focal lung opacities likely represent multifocal pneumonia with a\nsmall right pleural effusion.\n\n2.  Indeterminate 6 mm nodule in the right thyroid.  Thyroid ultrasound could\nbe obtained as clinically indicated.\n\n3.  Please see dedicated CT abdomen pelvis report for findings below the\ndiaphragm."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged in diameter.  Minimal interval\nincrease is the left pleural effusion.  Ascites is partially imaged will be\nassessed separately on CT abdomen.\n\nTracheostomy is in place.  Airways are patent to the subsegmental level\nbilaterally.  Bibasal areas of atelectasis are present but no discrete\nconsolidations to suggest infectious process.\n\nNo lytic or sclerotic lesions concerning for infection or neoplasm\ndemonstrated\nFat stranding is noted, might represent anasarca.\n\nNo areas to suggest hemorrhage demonstrated.",
            "output": "Within the limitations of this nonenhanced study no areas the can represent\nincreasing white blood cell count demonstrated.\n\nAtelectasis.  Please review the image portion of the upper abdomen separately\nas part of the CT abdomen"
        },
        {
            "input": "Postsurgical changes are seen along the left chest from prior dialysis\ncatheter placement.  There is a stent in the right internal\njugular/brachiocephalic vein and superior vena cava.  The stent is compressed\nat its superior-most aspect by the overlying scaling muscle, severely\nnarrowing the diameter of the superior-most stent and internal jugular vein. \nThe stent remains patent.  There is eccentric thrombus noted just distal to\nthis, occupying less than 50% of the stent luminal diameter.\n\nThe left brachiocephalic and subclavian vein is chronically occluded, without\nappreciable flow.  Distal left IJ is occluded.  Thrombus extends from the\nsubclavian vein, into the superior vena cava at their confluence, occupying\napproximately 25% of luminal diameter.  The right subclavian vein appears\npatent.\n\nThe left axillary vein is patent, with extensive collateralization along the\nsuperior mediastinum and anterior chest wall.\n\nThe thyroid is normal.  No axillary adenopathy.\n\nNo mediastinal or hilar adenopathy.  There is trace pericardial effusion. \nThoracic aorta is normal in caliber.\n\nThe central tracheobronchial tree is patent.  No pneumonia, effusion, or\npneumothorax.  Lingular and right middle lobe atelectasis noted.  Subsegmental\natelectasis noted at the lung bases bilaterally.  4 mm left apical nodule\n(image 34 of series 3) is unchanged since ___.\n\nLimited evaluation of the upper abdomen is notable for a small amount of\nperisplenic fluid, potentially related to peritoneal dialysis.\n\nNo concerning osseous lesions, noting T5 vertebral body hemangioma.",
            "output": "1.  Chronic occlusion of the left brachiocephalic and subclavian vein, with a\nsmall amount of thrombus extending through the patient's internal\njugular/brachiocephalic/SVC stent, into the superior vena cava.\n2.  Chronic compression of the superior most aspect of the stent, though\nslightly patent.  Please see curved planar reformations (series 203, 204) for\ndetails of right IJ stent an SVC patency.\n3.  Eccentric all stent thrombus at the level of the right subclavian vein,\noccupying less than 50% of the stent luminal diameter.\n4.  5 mm left apical pulmonary nodule, stable since ___."
        },
        {
            "input": "THORACIC INLET: The base of the neck is unremarkable.  The visualized thyroid\nis normal.\n\nTHORACIC LYMPH NODES:  No axillary, mediastinal, or hilar lymphadenopathy is\npresent.\n\nHEART, VESSELS and PERICARDIUM:\nAgain demonstrated is a right internal jugular stent extending into the SVC. \nThe thoracic aorta is mildly calcified with extensive coronary artery\ncalcifications.  The aorta is normal in caliber measuring 3.4 cm.  The main\npulmonary artery is unremarkable. There is no pericardial effusion.  A\ndialysis catheter is visualized in the right atrium extending down into the\nIVC.\n\nPLEURA: There is no evidence of pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Bilateral emphysema with bilateral small lung base\nopacifications that are unchanged since at least ___ likely\nrepresent foci of atelectasis or scarring (for example 5: 180, 193).\n2. AIRWAYS: The trachea is diffusely calcified.  Area of calcification in the\nleft lower lobe is unchanged since ___ and likely represents a bronchus\n(5:168).\n3. NODULES:  A left apical soft tissue density pulmonary nodule measuring 3 mm\nis unchanged since at least ___.\nCHEST WALL AND BONES: There are no worrisome osseous lesions.\n\nUPPER ABDOMEN: Limited views of the abdomen demonstrate a dialysis catheter in\nthe IVC and bilateral atrophic kidneys.",
            "output": "1. Emphysema with bibasilar atelectasis.  No evidence of consolidation, mass,\nor hemorrhage.  No specific pathology to explain patient's symptoms.\n2. 3 mm left apical pulmonary nodule is unchanged since ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber.  An SVC/right internal jugular vein stent\nis noted with a central venous catheter coursing within the stent and\nterminating in mid to lower SVC which appears occluded.  Multiple collaterals\nare seen in the anterior chest.  There are mild coronary artery\ncalcifications.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No enlarged supraclavicular, axillary, or\nmediastinal lymph nodes.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 3 mm nodule and micronodule in the left lung apex are\nunchanged since at least ___.  No new or growing pulmonary\nnodules.  There is bilateral dependent subsegmental atelectasis.  Otherwise no\nfocal consolidation.  Trace mucous is seen in the trachea (series 301, image\n49).\nABDOMEN: Findings of the upper abdomen are better evaluated on CT from ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Aside for scattered subsegmental atelectasis, no acute process within the\nchest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There are mild atherosclerotic calcifications of the\nthoracic aorta.  Heart size is normal.  There is no pericardial effusion. \nMild coronary calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: Numerous subcentimeter mediastinal lymph nodes\nare likely reactive.  Right hilar lymph node or nodal conglomerate measures 2\ncm.\n\nPLEURAL SPACES: Trace left pleural effusion with a left basilar pigtail\ndrainage catheter in place, significantly decreased compared to CT of the\nchest from ___.  Small left pneumothorax.  A right basilar pigtail\ndrainage catheter is also in place, with resolution of the previously seen\nright pleural effusion.  There is also a small right pneumothorax.\n\nLUNGS/AIRWAYS:\n\nAn endotracheal tube is in place, terminating 6 cm above the carina.\n\nThe right bronchus intermedius is completely occluded with secretions (___:38),\npreviously patent on CT of the chest from ___, and there is\nassociated complete atelectasis of the right middle and lower lobes.  There is\nalso a small amount of secretions in the right mainstem and upper lobar\nbronchus.  There are ___ nodules throughout the right upper lobe,\nwhich could be infectious, inflammatory or related to aspiration.  A 5 mm\nright lower lobe nodule is also likely associated with this process (6:142).\n\nThere is also occlusion of the left lower lobe posterior basal segmental\nbronchus, with associated segmental atelectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is small volume ascites in the visualized upper abdomen. \nEnteric tube courses through the esophagus, with the distal end out of the\nfield-of-view.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Occluded right bronchus intermedius secondary to secretions, with complete\ncollapse of the right middle and lower lobes.\n3. Occlusion of the left lower lobe posterior basal segmental bronchus, with\nassociated segmental atelectasis.\n4. ___ nodules in the right upper lobe, which could be infectious,\ninflammatory or related to aspiration.\n5. Bibasilar pigtail drainage catheters in place, with resolution of the right\npleural effusion, and trace residual left pleural effusion.  Small bilateral\npneumothoraces are present.\n6. Partially imaged abdominal ascites.\n\nNOTIFICATION SECTION   The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 12:47 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Mild atherosclerotic calcifications in the head and neck\narteries.  Mild diffuse anasarca.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus has an indwelling feeding tube, but is otherwise unremarkable. \nSmall mediastinal lymph nodes, none pathologically enlarged by CT size\ncriteria.  No hilar lymphadenopathy.\n\nPLEURA:\nModerate bilateral pleural effusions, nonhemorrhagic.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, mucous plugging or bronchiectasis.  Respiratory motion artifacts\nimpair optimal parenchymal evaluation.  Collapse of both lower lobes due to\ncompressive atelectasis.  No suspicious lung nodules or masses.  No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No evidence of intrathoracic infectious process.  Moderate bilateral pleural\neffusions and anasarca are likely associated to known septic shock."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild\ncoronary artery calcifications are re-demonstrated the heart, pericardium, and\ngreat vessels are within normal limits based on an unenhanced scan. No\npericardial effusion is seen.  A left subclavian central venous line is\ndemonstrated terminating at the distal SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No mediastinal, axillary, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.  An enteric tube\ncourses through the esophagus terminating within the stomach.\n\nPLEURAL SPACES: Bilateral pleural effusions are re-demonstrated, small in a\nright, and moderate on the left, with adjacent subsegmental atelectasis.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: The thyroid is unremarkable.  No supraclavicular lymphadenopathy\nis identified.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for a\npartially visualized 1.6 cm left adrenal nodule, unchanged from prior.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Redemonstrated bilateral pleural effusions, now smaller on the right, and\nmoderate on the left."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The aorta is normal in caliber throughout.  The pulmonary\narteries mildly dilated measuring 3.5 cm.\n\nMEDIASTINUM AND HILA:\nEnteric tube passing through the esophagus which is otherwise unremarkable. \nSmall mediastinal lymph nodes, none pathologically enlarged by CT size\ncriteria.  No hilar lymphadenopathy.\n\nPLEURA:\nRedemonstration of bilateral pleural effusions, smaller than prior study, left\ngreater than right.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Respiratory motion\nartifacts impair optimal parenchymal evaluation.  No bronchiectasis or mucus\nplugging.  No suspicious lung nodules or masses.  Partial compressive\natelectasis of the left lower lobe, unchanged.  New consolidations with air\nbronchograms in the posterior dependent segments of the right lower lobe\n(302:143).\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Slight interval improvement of the bilateral pleural effusions, left greater\nthan right.\nEnlarged main pulmonary artery, possibly related to pulmonary hypertension.\nNew consolidation in the right lower lobe, suggestive of aspiration related\npneumonia.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:05 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular adenopathy.  Subcentimeter axillary lymph nodes are noted. \nLeft subclavian central line in situ with the tip terminating in the central\nend of the left brachycephalic vein just proximal to the SVC.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Subcentimeter reactive lymph nodes are noted.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: No cardiomegaly.  No substantial pericardial effusion. \nRelative hypodensity of the blood pool suggesting anemia.  Mild coronary\nartery calcification.  Mild calcific atherosclerotic changes of the thoracic\naorta.\nPLEURA: Large left-sided pleural effusion and moderate right-sided pleural\neffusion are both increased in size compared to prior imaging.\nLUNG:\n\n-PARENCHYMA:  Complete atelectasis of the left lower lobe and almost complete\natelectasis of the right lower lobe is increased compared to prior.  Partial\natelectasis of the right middle lobe.  Without contrast it is difficult to\nexclude pneumonia superimposed on atelectasis.  No suspicious pulmonary\nnodules or masses.  Mild interstitial thickening may represent mild\ninterstitial pulmonary edema.\n-AIRWAYS:  The central airways are patent.\n-VESSELS:  The pulmonary artery is slightly dilated measuring 36 mm in\ndiameter and pulmonary hypertension should be excluded.\nCHEST CAGE: No suspicious bony lesions.",
            "output": "1. Large left-sided pleural effusion and moderate right-sided pleural effusion\nare markedly increased in size compared to prior imaging.\n2. Complete atelectasis of the left lower lobe and almost complete atelectasis\nof the right lower lobe as well as partial atelectasis of the right middle\nlobe are increased compared to prior.  Please note that without contrast it is\ndifficult to exclude superimposed pneumonia.\n3. Mild interstitial thickening may represent mild residual pulmonary edema.\n4. Mild dilatation of the pulmonary artery and pulmonary hypertension should\nbe excluded.\n5. Abdominal findings will be reported separately."
        },
        {
            "input": "CTA Chest:  Nonobstructive filling defects are present in the lobar,\nsegmental, and subsegmental branches of the left upper, left lower, right\nupper, right middle, and right lower lobes. There is bowing of the\ninterventricular septum towards the left ventricle suggestive of right heart\nstrain. The thoracic aorta and main pulmonary trunk are of normal caliber.\nThere is no evidence of aortic aneurysm or dissection.\n\nCT Chest: Thyroid enhances homogeneously. Axillary, mediastinal, and hilar\nlymph nodes do not meet CT size criteria for lymphadenopathy. Heart is normal\nsize. There is no pericardial effusion.\n\nThe airways are patent to subsegmental level. Heterogeneous dependent areas of\nopacification in bilateral bases appear plate like on the coronal and sagittal\nreformats most likely representing atelectasis; however, in the setting of\nwidespread pulmonary embolism small peripheral infarcts cannot be excluded. No\npulmonary nodule concerning for malignancy is identified. Trace pleural\neffusions are present bilaterally.\n\nLimited view of the upper abdomen is unremarkable.\n\nNo concerning lytic or sclerotic osseous lesion is present.",
            "output": "Nonobstructive filling defects in the lobar, segmental, and subsegmental\nbranches of the left upper, left lower, right upper, right middle, and right\nlower lobes, is concerning for extensive pulmonary embolism. There is bowing\nof the interventricular septum towards the left ventricle suggestive of right\nheart strain."
        },
        {
            "input": "The imaged base of neck including the thyroid is unremarkable aside from a\npunctate calcification in the inferior left thyroid lobe.  Thoracic aorta is\nnormal in course and caliber without significant atherosclerotic\ncalcification.  The main pulmonary artery and central branches are patent. \nExtensive segmental and subsegmental pulmonary emboli seen bilaterally most\nnotably involving the lower lobes with associated consolidation concerning for\na component of infarction and probable atelectasis.  No evidence of right\nheart strain.  The heart is within normal limits of size without pericardial\neffusion.  No lymphadenopathy.  No pleural effusion.  No worrisome nodule or\nmass.  No signs of pneumonia.  Airways centrally patent.\n\nWithin the upper abdomen, no abnormalities are detected.\n\nBones: Bony structures appear intact without worrisome lytic or blastic\nosseous lesion.",
            "output": "Bilateral segmental and subsegmental pulmonary emboli most notable in the\nlower lobes with areas of lower lobe infarction and atelectasis.  No signs of\nright heart strain.\n\nNOTIFICATION:  D/W ___ (MED STUDENT)"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nHeterogenous thyroid with several unchanged hypodense nodules.  Surgical clips\nnoted in the left axilla.  No enlarged lymph nodes in the right axilla or\nthoracic inlet.  Surgical clips are also noted in the left breast.  Mild\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  The entire\naorta is normal in caliber.  Mild atherosclerotic calcifications are noted in\nthe coronary arteries.  The pulmonary arteries are normal in caliber.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Borderline\nleft periesophageal lymph node measuring 9 mm in short axis diameter,\nunchanged.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental level however diffuse bronchial wall\nthickening is noted bilaterally.\nNumerous pulmonary nodules of varying sizes are seen in both lungs, most of\nwhich are smaller than in prior study for example the largest in the left\nlower lobe (6:178) now measures 2.4 x 2.2 cm (previously 3.6 x 3.4 cm).\nModerate centrilobular pulmonary emphysema, predominantly in the upper lobes.\n\nCHEST CAGE:\nNew sclerotic lesions seen in the thoracic spine, notably in T10, T8 and T3. \nStable loss of height of T12 and T11, with no signs of acute fractures. \nMultiple rib sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Most of the pre-existing pulmonary metastatic nodules are smaller compared to\n___.  However there are more sclerotic bone lesions, some associated\nwith loss of vertebral body height."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The thyroid remains heterogeneous with several\nhypodense nodules measuring up to 2.5 cm in the left lobe.  Surgical clips are\nseen in the left axilla.  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nMEDIASTINUM: A subcarinal node measures up to 5 mm in short axis, unchanged\n(05:23).  A left paraesophageal node has decreased in size, currently\nmeasuring 4 mm in short axis, previously 9 mm (6:123).  Mediastinal lymph\nnodes are not enlarged.  Similar to prior, there is a small hiatal hernia.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  There are mild\natherosclerotic calcifications in the aortic arch as well as at the origins of\nthe great vessels.  Aortic caliber is normal.  The main, right, and left\npulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There are innumerable bilateral pulmonary nodules of\nvarying sizes, which are stable to slightly decreased in size compared to\n___.  For example, the largest on the right measures 1.7 x 1.0 cm,\npreviously 1.7 x 1.2 cm (6:134).  The largest nodule on the left measures 1.7\nx 1.6, previously 2.2 x 2.2 cm (6:168).  Innumerable additional subcentimeter\npulmonary nodules are no longer visualized.  There is mild upper lobe\npredominant centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nHowever, diffuse bronchial wall thickening is noted bilaterally.\n\nPLEURA: Post radiation changes are noted in the left anterior chest wall. \nMild biapical scarring is unchanged.  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There has been interval progression of sclerosis in the\nvisualized cervicothoracic spine, most notably at C7, T3, T8, T10, T11 and\nT12.  No new sclerotic lesions are identified.  No pathologic fractures are\npresent.  Multilevel degenerative changes are moderate.  Postsurgical changes\nare again noted in the left breast including a surgical clips and mild skin\nthickening.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "-Pre-existing pulmonary metastatic nodules are similar to decreased in size\ncompared to ___.\n-Pre-existing osseous metastatic lesions demonstrate increased sclerosis\nlikely post treatment change.\n-Re-demonstration of a heterogeneous thyroid with a dominant left thyroid\nnodule measuring up to 2.5 cm.  Thyroid ultrasound may be obtained for further\nevaluation.\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "Biapical scarring is again demonstrated as well as discrete nodular opacities,\nincluding unchanged 5 mm and 3 mm nodular opacities at the right apex ___, 4).\nIrregularly marginated nodule just below this level is also unchanged,\nmeasuring 6 mm in greatest dimension (65, 4), as well as a 2 mm subpleural\nleft upper lobe nodule (152, 4) and a 2 mm right upper lobe posterior segment\nnodule (112, for).  .  A sub subpleural broad-base opacity in the periphery of\nthe right apex is also unchanged measuring approximately 1 point 4 cm (72, 4).\n\n\nMild diffuse bronchial wall thickening is again demonstrated along with\nmoderate paraseptal emphysema and minimal centrilobular emphysema.\n\nThere are no enlarged mediastinal, axillary or hilar lymph nodes.  Heart size\nis normal, and focal coronary artery calcifications are present.  There is no\npericardial or substantial pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning abnormalities are evident in this region.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1.  Unchanged small pulmonary nodules, which are statistically most likely\nbenign.\n\n2.  Focal coronary artery calcifications.\n\n3.  Emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Node is unremarkable.  There is no\nsupraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: Multilevel mild degenerative changes of the spine with no evidence\nof osteo-destructive lesions at the level of the ribs, sternum or vertebra.\n\nUPPER ABDOMEN: Few small calculi up to 0.6 cm in the left kidney with no\nevidence of hydronephrosis.  Small cortical cyst in the left kidney upper\npole.  Status post cholecystectomy.  Heavy calcifications of the included\nabdominal aorta and main branches.  Remaining included upper abdominal organs\nare unremarkable.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not pathologically enlarged\nmeasure up to 0.8 cm in the right pulmonary ligament station.\n\nHILA: There is no gross hilar lymphadenopathy\n\nHEART and PERICARDIUM: Heart and major vessels are within normal size.  Trace\npericardial effusion, unchanged since ___.\nDense calcifications of the aortic valve leaflets.\nThe normal caliber thoracic aorta and head and neck vessels are heavily\ncalcified.  At the level of the hiatus the descending aorta is least calcified\n(302:211).\nDense calcifications involve coronaries.  Main pulmonary artery is normal in\ndiameter.\n\nPLEURA: Right layering minimal pleural effusion.  No evidence of pneumothorax.\n\nLUNG: Airways are patent to the subsegmental level.  Smooth septal line\nthickening wall is predominantly in the lower lobes reflecting the mild edema.\nNo measurable nodules, no masses.",
            "output": "-Heavy discontinues calcifications of the aortic valve leaflets, normal\ncaliber aorta and main branches.  Relative sparing of the descending aorta\nclose to the hiatus(302:211).\n-Mild pulmonary edema with minimal right layering pleural effusion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Large hyperdense  loculated pleural effusion consistent with a\nlarge hemothorax  with adjacent compressive atelectasis.\n\nLUNGS/AIRWAYS: 1.7 x 2.0 cm (2; 72) pleural based and 1.5 x 1.0 cm\nintraparenchymal (2; 73) pulmonary nodules are similar in size compared to the\nrecent biopsy from ___.  However, there is a 0.6 cm  enhancing,\nround lesion posterior to the intraparenchymal nodule (2; 75) which is new\nsince the biopsy and  likely a pseudoaneurysm.  There is second, similar 3mm\nlesion more posterior (2;78) possibly a second pseudaneurysm. Tthere is\nhyperdense material extending from this presumed pseudoaneurysm to the larger\nloculated left hemothorax.\n\nDiffuse bronchial wall thickening within the lower lobe with distal mucus\nplugging may be secondary to small airways disease.  Bilateral atelectasis\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Large right hemothorax, likely secondary to two small pseudoaneurysms along\nthe posterior biopsy track of the more medially biopsied intraparenchymal\nnodule.\n\nNOTIFICATION:   The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 11:24 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is minimally calcified and normal in\ncourse and caliber.  The heart is normal in size.  There is coronary artery\ncalcification which is mild to moderate in overall extent.  The main pulmonary\nartery is normal in size.  The pulmonary arterial tree appears patent to the\nsegmental level without filling defect to suggest the presence of a pulmonary\nembolism.\n\nAXILLA, HILA, AND MEDIASTINUM: Right hilar adenopathy seen best on series 3,\nimage 114 measuring 15 x 22 mm, size stable.  Several mildly prominent\nmediastinal lymph nodes are unchanged.  No axillary adenopathy.  The esophagus\nis decompressed.\n\nPLEURAL SPACES: There is a persistent small right pleural effusion which is\nmarginally decreased.  No left-sided effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate to severe emphysema.  A subpleural right\nmiddle lobe pulmonary nodule is again seen measuring approximately 9 x 12 mm,\nunchanged from prior.  A second nodule seen on prior exam in the right middle\nlobe within the medial segment is no longer seen.  There is mild right\nposterior basal atelectasis.  No new or growing pulmonary nodule is seen. \nThere is no evidence of pneumonia.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. resolved medial segment right middle lobe pulmonary nodule and unchanged\nlateral segment right middle lobe pulmonary nodule measuring up to 22 mm. \nStable right hilar adenopathy.\n3. Trace right pleural effusion, decreased from prior with compressive\natelectasis.\n4. Moderate to severe emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The patient is status post\ntracheostomy with tube terminating within the mid trachea.  There is near\ncomplete collapse of the trachea distal to the tracheostomy tube.  There are\nno suspicious thyroid lesions.  There is no supraclavicular or axillary\nlymphadenopathy.  There are no suspicious chest wall lesions.\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen and pelvis\nperformed on the same day for description of the subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  There is no mediastinal\nmass.  The esophagus is unremarkable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The thoracic aorta is normal in caliber.  There are no\nsignificant atherosclerotic calcifications.  The heart and pericardium are\nwithin normal limits.  There is no pericardial effusion.\nPLEURA: There is large pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the lung parenchyma is limited by extensive\nrespiratory motion artifact.  There are diffuse bilateral ground-glass\nopacities, which are nonspecific but likely secondary to expiratory phase of\nimaging.  A linear consolidation in the right upper lobe tracking along the\nmajor fissure along the dependent lung likely represents atelectasis. \nOtherwise, there are no obvious suspicious pulmonary lesions.\n2. AIRWAYS:  There is mild bibasilar atelectasis.  Otherwise, the airways are\npatent to the subsegmental bronchi bilaterally.\n3. VESSELS:  The pulmonary vasculature is unremarkable.\n\nCHEST CAGE: There are extensive degenerative changes of the bilateral\nglenohumeral joints.  Otherwise, there are no suspicious lytic or sclerotic\nosseous lesions.  There is no acute fracture.",
            "output": "1. Limited study in the setting of extensive respiratory motion artifact and\nexpiratory phase of imaging.  Within these limitations, there is a linear,\ndependent consolidation in the right upper lobe, which most likely represents\natelectasis and less likely pneumonia.\n2. Near complete collapse of the trachea distal to the tracheostomy tube,\nsuggestive of underlying tracheomalacia.  Correlation with oxygen saturation\nlevels and adjustment of ventilator settings is recommended as clinically\nindicated.\n3. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for description of the subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: The study is limited by extensive respiratory motion\nartifact.  Within these limitations, the pulmonary vasculature is well\nopacified to the proximal segmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.  A\nleft-sided PICC line terminates within the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a trace left pleural effusion.  There is no right\npleural effusion.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited by extensive\nrespiratory motion artifact.  Diffuse bilateral ground-glass opacities are\nagain noted, likely due to expiratory phase of imaging.  Otherwise, there is\nno large pulmonary nodules or areas of parenchymal opacification.  The\npreviously noted consolidation in the right upper lobe has improved.  A\ntracheostomy tube is in stable position with normal caliber of the trachea\ndistal to the tube, significantly improved from prior study.  Mild bibasilar\natelectasis is unchanged.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is redemonstration of multilevel degenerative changes of the\nthoracic spine and bilateral glenohumeral joints.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "1. Limited study in the setting of extensive respiratory motion artifact. \nWithin these limitations, no evidence of pulmonary embolism to the segmental\nlevel bilaterally.\n2. Interval resolution of the previously seen right upper lobe consolidation.\n3. Stable position of the tracheostomy tube with normal caliber of the trachea\ndistally, significantly improved from prior study."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows a 13 x 21 mm\nlow attenuation nodule, 7 ___, in the right adrenal, probably an adenoma. \nExtra peritoneal bowel loops in the left upper anterior abdominal wall are\nincompletely imaged and could be an enterostomy or hernia.  Hepatic steatosis\nis noted.\n\nRight thyroid lobe is asymmetrically enlarged, 22 x 23 mm, mildly narrowing\nthe trachea, 09:10.  Findings most consistent with a benign goiter since there\nis no heterogeneity in the thyroid at that level.\n\nMediastinal and hilar lymph nodes are not enlarged.  Aorta and pulmonary\narteries are normal size.\n\nAtherosclerotic calcification is present in at least the left anterior\ndescending coronary artery.  Cardiac chambers are normal size.\n\nRight upper posterior costal pleural thickening and hypertrophy the\nextrapleural fat reflect prior partial rib resection and right upper lobe\nwedge resection.  There are no findings to suggest tumor recurrence.  Lungs\nare clear and the tracheobronchial tree is normal to subsegmental levels.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Normal postoperative appearance, right upper lobe wedge resection.  No\nevidence of intrathoracic malignancy.\n\nRight goiter mildly narrows the trachea.  Clinical evaluation recommended.\n\nRight adrenal adenoma.\n\nLeft anterior abdominal wall enterostomy or hernia, incompletely imaged.\n\nHepatic steatosis.\n\n\nRECOMMENDATION(S):   If the patient is ___ years old, has a smoking history\nof greater than 30 pack-years and has smoked within the past ___ years, the\npatient meets criteria for annual lung cancer screening with low-dose chest\nCT, now available at this hospital.  ."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Status post liver transplantation with stents and coil\nembolizations partially imaged.  Imaged portion of the unenhanced transplanted\nliver are unremarkable.\nMild paraesophageal varices of the lower esophagus, otherwise esophagus is\ncollapsed and unremarkable.\n\nMEDIASTINUM: There is no mediastinal, gross hilar lymphadenopathy per CT\ncriteria site.\n\nHEART and PERICARDIUM: Heart and major vessels within normal size.  No\natherosclerotic calcifications of the coronaries or thoracic aorta.\n\nPLEURA: Small right layering pleural effusion extending into the major fissure\nis slightly smaller since ___.\nThere is no left pleural effusion.\nThere is no pneumothorax.\n\nLUNG: Airways are patent to the subsegmental level.\nMinimal right lower lobe plate-like atelectasis.  mild smooth septal line\nthickening adjacent to a small right pleural effusion.\nThere are no clear consolidations to suggest pneumonia.\n\nCHEST CAGE: Unremarkable, no evidence of bony sclerotic or lytic destructive\nlesions.",
            "output": "Mild improvement in the right pleural effusion, now in small quantity with\nminimal adjacent plate-like atelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portions of the thyroid\ngland are unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separately reported CT abdomen-pelvis from the\nsame day.\n\nMEDIASTINUM: No lymphadenopathy or masses are seen within the mediastinum.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Physiologic amount of\npericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Lungs are clear without nodules or masses.\n2. AIRWAYS:  Airways are patent to subsegmental levels\n3. VESSELS:  Aorta and pulmonary artery are normal in size and configuration.\nBONES: No worrisome osseous lesions or fractures.",
            "output": "No abnormal thoracic findings.\n\nPlease refer to separately reported CT abdomen pelvis from the same day for\nfurther findings"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There are bilateral lower lobe consolidations/atelectasis,\nworse on the right.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation, with nodular contour\nin keeping with cirrhosis.  The patient is status post liver biopsy.  A small\namount of subhepatic fluid is noted posterior to the liver (2b:102) compatible\nwith recent percutaneous hepatic access.  There is no obvious active\nextravasation, although this study is not specifically tailored for its\nevaluation.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  Contrast is seen within the gallbladder without distention or\nwall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 15.2 cm.  It demonstrates homogeneous\nenhancement without focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  A small\namount of hyperattenuating free fluid is seen along the right colored cutter\n(2b:149) and in the pelvis (2b:155) consistent with blood.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.  There is a duplicated IVC.  There are sequela a of portal\nhypertension including esophageal varices and massively dilated splenorenal\nvarices.  Embolic material is seen within the splenorenal varices, but it is\nunclear if the shunt is still partially patent.  A filling defect is seen\nwithin the splenic vein (2:117 and 607:32 - 37) in keeping with splenic vein\nthrombosis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post liver biopsy with high attenuation fluid seen posterior to the\nliver, extending along the right colicky gutter into the pelvis in keeping\nwith blood.  There is no obvious active extravasation within the limits of\nthis non tailored study.\n2. Interval embolization of a left splenorenal shunt.  It is unclear if the\nshunt remains partially patent.\n3. Thrombosis within the splenic vein."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere are no enlarged supraclavicular or axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.\n\nHILA: The there are no enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart and pericardium are unremarkable and there is\nno pericardial effusion.  The blood is hypodense compared to the myocardium\nsuggestive of anemia.\n\nPLEURA:  Small right and trace left pleural effusions with subjacent\natelectasis, increased since the CTA of ___.  No pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  There are bilateral upper lobe predominant patchy airspace\nopacities concerning for the pneumonia and are new since ___. \nThere is no definite evidence of cavitation to suggest septic emboli.  A\nsubpleural 7 mm ground-glass opacity in the right middle lobe and a 5 mm solid\nnodule in the right upper lobe are also likely infectious in etiology.  There\nare bibasilar opacities likely atelectasis, right greater than left.\n-AIRWAYS:  Patent to the subsegmental levels.\n-VESSELS:  The aorta and pulmonary artery are of normal caliber.  Evaluation\nof the vasculature is limited without intravenous contrast.\nUPPER ABDOMEN: This study is not tailored for evaluation of subdiaphragmatic\nstructures but limited views demonstrate a cirrhosis of the liver. \nHigh-density fluid layering posterior to the liver is compatible with known\nintra-abdominal hemorrhage, incompletely evaluated.\n\nCHEST CAGE: There are no concerning lytic or sclerotic lesions.",
            "output": "1. Bilateral upper lobe predominant parenchymal airspace opacities consistent\nwith pneumonia, new since ___.  No definite cavitation to suggest\nseptic emboli.\n2. Interval increase in size of small right and trace left pleural effusions\nwith subjacent atelectasis.\n3. High-density fluid posterior to the liver compatible known intra-abdominal\nhemorrhage, incompletely visualized.\n\nNOTIFICATION:  These findings were discussed with ___, MD by Dr.\n___ via telephone at 17:59 on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is normal. Borderline\nleft axillary lymph node (4, 33).  No chest wall mass.\n\nMEDIASTINUM: No mediastinal mass.  No enlarged mediastinal lymph node. \nMultiple small mediastinal lymph nodes, which are likely reactive.\n\nHILA: No enlarged hilar lymph node.  No hilar mass.\n\nHEART and PERICARDIUM: Heart is normal size.  No pericardial effusion.\n\nPLEURA: Stable small right pleural effusion.  No left pleural effusion.  No\npneumothorax.\n\nLUNG:\nPARENCHYMA:  The previously noted peribronchial consolidation predominantly in\nthe anterior aspects of the right and left upper lobes have resolved.  New\nground-glass opacification with superimposed consolidation in the right upper\nlobe (4, 65), right middle lobe (4, 106) most likely represents developing\ninfection.  Background interstitial septal thickening with ground-glass\nchanges in keeping with pulmonary edema.\nMultisegmental atelectasis of the right lower lobe (all segments except the\nanterior basal segment) and subsegmental atelectasis in the left lower lobe\nwhich does not enhance homogeneously suggesting retained secretions or\nsuperimposed infection (pneumonia).\n\nAIRWAYS:  Patent through the subsegmental bronchi.  Endotracheal tube is in\nplace and is in appropriate position.  Minimal residual secretions in the\ntrachea.\n\nCHEST CAGE:  No soft tissue mass.  No concerning osseous lesion.\n\nUPPER ABDOMEN:  Refer to the concomitantly performed CT of the abdomen and\npelvis for evaluation",
            "output": "Previously noted peribronchiolar airspace consolidation in the anterior\naspects of the upper lobes have resolved.\n\nNew areas of ground-glass opacity with mild superimposed consolidation in the\nright upper and middle lobe are concerning for name infection.\n\nBackground of interstitial pulmonary edema\nMild left and moderate right basilar atelectasis as described above with\nsuspected superimposed infection.\nStable small right hemothorax/dense pleural effusion.\n\nNOTIFICATION:  The findings above were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 11:14 AM, 25 minutes\nafter discovery of the findings."
        },
        {
            "input": "New 3.3 x 2.2 cm (2:1) homogeneous fluid collection within the left lateral\nneck. Stable 1.1 x 1.3 cm anterior paratracheal lymph node and 1.1 x 0.5 cm\n(4:74) lymph node in the aortopulmonary window. No additional supraclavicular,\naxillary, mediastinal, or hilar lymph node enlargement by CT size criteria.The\nthyroid gland is unremarkable.\n\nThe heart size is normal without pericardial effusion. The aorta and its major\nbranch vessels are patent with no evidence of stenosis, occlusion, dissection,\nor aneurysmal formation. The pulmonary arteries are well opacified to the\nsubsegmental level, with no filling defect to suggest pulmonary embolism.\n\nNo pleural effusion.No pneumothorax.  Worsening obstruction of the right\nmiddle lobe bronchus with right middle lobe collapse (4:  119) due to\nsecretions. No evidence of pneumonia. Stable bronchial wall thickening and\nsubsequent narrowing of subsegmental branches of right upper lobe apical\nsegment with associated atelectasis (4:73). Stable narrowing of the posterior\nsegmental branch of right upper lobe with bronchial wall thickening (4:95) and\ncomplete obstruction of the anterior segmental right upper lobe bronchus. \nStable bronchial wall thickening at the medial basal segmental bronchus of\nright lower lobe (4:131), lingular bronchi, left upper lobe bronchi, and\nsubsegmental bronchi of the lower lobe.\n\nHeterogeneous air trapping is present. New ground-glass opacity within the\nright upper lobe (04:29) is present. Additional partial ground-glass opacity\nwithin the right middle lobe has decreased in size now measuring 4 mm (4:68)\n(previously 6 mm). Overall ___ opacities within the right middle and\nright lower lobes are stable with interval increase in left lower lobe\ninvolvement.\n\nStable 4 mm (4:99) right upper lobe nodule.  Previously identified cavitary\nlesion within the left lower lobe is now filled with fluid measuring 1 x 0.8\ncm (4:132).\n\nOSSEOUS STRUCTURES: Stable T7 anterior compression fracture. No retropulsion.\nNo lytic or blastic osseous lesions concerning for malignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "1.  Interval increase in ___ opacities within the left lower lobe with\nprogression of right middle lobe collapse from secretions is consistent with\nworsening ___. Consider bronchoscopy given progressing lobar collapse.\n2.  New 3.3 x 2.2 cm (2:1) homogeneous fluid collection within the left\nlateral neck. Recommend dedicated ultrasound for further evaluation.\n3.  Diffuse small airways disease with air trapping,\n4.  Stable mediastinal lymphadenopathy with bronchial wall thickening, mucous\nplugging, and atelectasis as described above.\n\n5.  Stable T7 anterior compression fracture without retropulsion, unchanged\nsince ___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, and hilar lymph nodes are\nnot enlarged.  Left lower paratracheal station lymph node measuring 16 x 11 mm\nand a 5 mm AP window lymph nodes are stable.  Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal and there is no appreciable\ncoronary calcification.\nCollapsed right middle lobe is chronic.  As before there is abrupt cut off of\nthe proximal right middle lobe bronchus.  There are calcifications within the\ncollapsed right middle lobe.  There is mild diffuse bronchial wall thickening.\nMultiple foci of impacted bronchi are present in the lower lobes bilaterally. \nMinimally heterogeneic density of the lung suggests air trapping/small airways\ndisease.  There is linear atelectasis in the lingula.  Cystic lesion in the\nlower lobes are stable (5:214), including largest with calcification in the\nleft lower lobe (5:167).  Previously described nodule in the left lower lobe\nhas almost completely resolved (5:163)\nThere is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation subcentimeter\nhypodense lesion in the left lobe of the liver (03:46) too small to be\ncharacterize.\nThere are no bone findings of malignancy wedge-shaped compression fracture in\nT7 is stable",
            "output": "Stable appearance of the right middle lobe collapse, diffuse bronchial wall\nthickening, multiple impacted bronchi and bilateral cystic lesions in the\nlungs.  The cystic lesions could be focal areas of emphysema.\nAlmost completely resolved irregular nodule and marked improved ___\nopacities previously seen in the left lower"
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.\n\nCARDIO-MEDIASTINUM:Supraclavicular and axillary lymph nodes are not enlarged. \nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.  This study is not appropriate for subdiaphragmatic diagnosis\nbut shows no abnormality involving the adrenals.Lower esophagus is moderately\npatulous but there is no associated mass or good evidence for obstruction.\nEsophageal function is assessed by a dynamic contrast swallow.\n\nTHORACIC LYMPH NODES: Mild enlargement of mediastinal lymph nodes from the\nthoracic inlet to the lower paratracheal stations is stable.\n\nLymph nodes at the lower pole of the left hilus are probably enlarged but\ndifficult to separate from adjacent atelectasis and difficult measure on this\nnoncontrast study.  They may be responsible for obstruction of the bronchi to\nthe superior and posterior basal segments, 4:139-162 which are intermittently\nimpacted beyond the hilus.  Adenopathy adjoining the chronically obstructed\nbronchus to the collapsed right middle lobe is likely, but grossly unchanged.\n\n\nLUNGS, AIRWAYS, PLEURAE: Bronchial wall thickening in many locations has\nprogressed, with new mucoid impaction, and the development of bronchiolar\nnodules more distally, such is anterior segment right upper lobe, 4: 83-70,\n4:101-118, also responsible for new atelectasis, 4:114.  In the left lung,\npredominantly the is superior and posterior segments of the lower lobe with\nboth central and subsegmental impaction and atelectasis, 4:136-197.\n\nThere are no lung findings particularly suspicious for parenchymal infection,\nand no appreciable bronchiectasis.\n\nPleural surfaces are normal.\n\nCHEST CAGE: Moderate compression mid thoracic vertebral body, generalized\nosteopenia, and probable M angioma or lymphangioma is in the thoracic spine\nare all unchanged since at least ___.  There are no new compression\nor pathologic fractures or destructive bone lesions to suggest either\nmalignancy or infection.",
            "output": "Generalized increase in bronchial inflammation, with considerable retention of\nsecretions at both the segmental and subsegmental levels, new atelectasis\nright upper and left lower lobes and new bronchiolar nodulation.  New hilar\nadenopathy is probably reactive, but may contribute to bronchial compromise. \nNo bronchiectasis or lung abscesses.\n\nIn addition to consideration of chronic endobronchial infection with\nnon-tuberculous mycobacterial species, consideration should be given to the\npossibility of allergic bronchopulmonary aspergillosis.\n\nModerate mid thoracic vertebral compression fracture unchanged."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is no pericardial effusion.  There is no pericardial effusion. \nThe aorta and pulmonary arteries are normal in caliber.\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is near complete atelectasis of the right middle lobe, unchanged. \nPreviously visualized peribronchial thickening in both lower lobes has\nimproved since the prior study with few areas of scarring and thickening still\nremaining.  Evidence of a partial atelectasis in the left lower lobe medially\n(4, 37) is again seen.  No new nodules or consolidations.  No new sites of\ndisease.  Stable scarring in the right upper lobe (4, 20).\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with degenerative\nchanges involving the thoracic spine.  There is evidence of wedge compression\ninvolving T6 vertebral body.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Improvement in the multifocal peribronchial thickening bilaterally and\nresolution of the peribronchial opacities with few remaining opacities within\nthe right upper lobe and right lower lobe.\n\nPersistent near complete atelectasis of the right middle lobe and partial\natelectasis centrally in the left lower lobe, unchanged since the prior study.\n\nNo new areas of ___ nodularity or atelectasis of peribronchial\nthickening.\n\nStable small mediastinal lymph nodes\n\nStable wedge compression involving T6 vertebral body."
        },
        {
            "input": "1 cm right lobe thyroid cystic lesion is incompletely characterized by CT. \nThere are no enlarged mediastinal, hilar, or axillary lymph nodes. A cluster\nof subcentimeter nodes in the right pericardial region is noted. There is no\npericardial or pleural effusion.  Heart is upper limits of normal in size, and\nfocal coronary artery calcifications are present.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.\n\nAssessment of the lungs is somewhat limited due to inadvertent expiratory\nphase of respiration.  This reduces the sensitivity for detecting small\npulmonary nodules.\n\nPeridiaphragmatic nodular opacities measuring 0.8 cm adjacent to the right\nhemi diaphragm (236, 5) and 0.7 cm adjacent to the left hemidiaphragm (241, 5)\nare unchanged since the recent abdominal CT.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but overall\nappearance is similar to the recent abdominal CT of 4 days earlier except for\nslight increase in volume of ascites. Other findings including liver\nhemangioma and too small to characterize hepatic lesions as well as omental\nand serosal implants are more fully evaluated by the abdominal and pelvic CT.",
            "output": "1. No additional findings in the thorax beyond those detected on recent\nabdominal CT of 4 days earlier. Specifically, no pulmonary mass or suspicious\nnodule to suggest a site of primary lung cancer.\n\n2. Bilateral peridiaphragmatic subcentimeter nodular opacities are\nnonspecific, but could potentially represent neoplastic involvement\nconsidering the presence of serosal and omental implants on recent abdominal\nand pelvic CT study. If PET-CT is obtained is part of a staging workup, or is\npart of a search for a primary neoplasm, these regions can be assessed for\nevidence of FDG avidity."
        },
        {
            "input": "Hypodense lesion in right lobe of thyroid is unchanged but would be more fully\ncharacterized by ultrasound. There are no enlarged mediastinal, hilar or\naxillary lymph nodes. Heart size is normal, and there is no pericardial or\npleural effusion. Coronary artery calcifications are present.\n\nOverall assessment of the lungs is somewhat limited due to submaximal\ninspiratory level, reducing sensitivity for detecting small pulmonary nodules\nin subtle interstitial abnormalities. Two previously reported bilateral\nperidiaphragmatic nodular opacities have decreased from 7 mm to 3 mm in the\nleft lung base (214, 5) and from 8 mm to 4 mm at the right lung base (207, 5).\nTiny calcified granuloma at the left apex is incidentally noted.\n\nNo new suspicious lytic or blastic skeletal lesions are detected within the\nthorax.",
            "output": "1.  Decrease in size of bibasilar perdiaphragmatic nodules.\n\n2. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, elsewhere in\nthe chest cage there are no soft tissue abnormalities concerning for\nmalignancy.\n\nFindings below the diaphragm will be reported separately.\n\nModerate size hiatus hernia is unchanged.  Above that level esophagus is only\nmildly patulous.  There are no thyroid findings warranting further imaging\nevaluation.  Atherosclerotic calcification is mild in the head neck vessels\nand scattered in coronary arteries.  Ascending aorta is normal size and the\naortic valve is not calcified.  Descending thoracic aorta has moderately heavy\ncalcified atherosclerotic plaque.  Mild dilatation of the intra pericardial\nright pulmonary artery is stable in probably not an indication of pulmonary\narterial hypertension.\n\nLungs, airways, and pleurae:\n\n11 x 8 mm subpleural left lower lobe nodule, 302:62 has enlarged since ___, when it was probably less than 5 mm in greatest diameter,\nimaged with different technique.  It contains no identifiable calcification or\nfat which would indicate a benign diagnosis.\n\nThere are no other lung lesions of consequence.  Tracheobronchial tree is\nnormal to subsegmental levels.  There is no pleural abnormality.\n\nChest cage:\n\nMultilevel disc degeneration, thoracic spine.  No evidence of intrathoracic\nmalignancy.",
            "output": "11 mm solitary cm size left lower lobe lung nodule, was 5 mm across in ___. \nThis is not a metastasis.  It could be a very slow growing primary lung cancer\nor, equally likely, benign.\n\nMild coronary atherosclerosis.\n\nRECOMMENDATION(S):  FDG PET CT, presumably planned for rectal carcinoma\nstaging, to assess left lower lobe lung nodule."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum and at\nthe level of the hilar structures.  Moderate aortic wall calcifications. \nCalcifications of the right breast (2, 22).  Mild coronary calcifications. \nNormal size of the heart.  Moderate hiatal hernia.  Status post\ncholecystectomy.  Stable right kidney cyst (2, 56).  Moderate scoliosis and\nmoderate degenerative vertebral disease.  No vertebral compression fractures.\nStable calcified right upper lobe granuloma (4, 53).\nThe previously 7 mm perifissural left lower lobe nodule (4, 75) has grown, the\nnodule is now 12 mm in diameter.  The adjacent fissure is not thickened and\nnot distorted.  The borders of the nodule continue to be relatively\nwell-defined.  The paramediastinal consolidation in the left upper lobe,\nwithout signs of stranding or invasion of the mediastinal fat (4, 75) is\nstable in extent and size as compared to the previous examination.  Stable\nsmall calcified pleural plaque at the level of the right upper lobe (4, 99). \nStable fissural middle lobe nodule (4, 141).  Stable mild left lower lobe\nscarring (4, 173).  No pleural effusions.  No diffuse lung disease.",
            "output": "Interval growth of a fissural left lower lobe nodule from approximately 7 to\napproximately 12 mm in diameter.  Despite measurable growth, the lesion causes\nno fissural distortion or fissural thickening.  Given long-term slow but\nmeasurable growth, FDG PET-CT would appear as a reasonable next step in\npatient workup, notably given the clinical background history of the patient."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  Small axillary and thoracic inlet lymph nodes\nare stable.  Excluding the breast tissue which is exclusive for mammography\nthere are no chest wall abnormalities.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nModerate hiatal hernia is unchanged.  Esophagus is mildly patulous.  Unchanged\nsmall mediastinal lymph nodes.  Hilar contours show no evidence of a large\nlymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion. \nLong-standing moderate atherosclerotic calcifications in the coronary\narteries, especially in the LAD.  Moderate aortic annulus calcifications are\nunchanged.  Aorta and pulmonary artery normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe left lower lobe 10 x 15 mm well-defined perifissural nodule is stable\ncompared to the immediate prior study (remeasured), with no fissure traction\n(5:95).  The left upper lobe paramediastinal soft tissue mass is stable in\nsize and morphology as well, without invasion of the subjacent mediastinal fat\n(5:96).  Two 2-8 mm right upper calcified and right middle lobe 6 mm\ntriangular perifissural nodules are stable as well (5:69, 169).  Left lower\nlobe scarring is unchanged (05:201-231).\n\nThe airways are patent to the subsegmental level, no bronchial wall\nthickening, bronchiectasis or mucus plugging.  No pleural effusions.  Mild\nbiapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nNo acute fractures.  Moderate dorsal spondylosis is stable.  No lytic or\nsclerotic bone lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show stable right kidney cyst and\nabsent gallbladder.  No focal hepatic or splenic lesions.  Adrenals are\nunremarkable.",
            "output": "No significant interval growth of the left lower lobe perifissural nodule and\nleft upper lobe paramediastinal soft tissue mass."
        },
        {
            "input": "Above the tracheostomy, larynx, including vocal cords, is radiographically\nunremarkable. Tracheostomy tube is midline, entering the airway between\nseverely enlarged thyroid lobes, just below below the cricoid.  Maximum\ndiameter of the airway at the level of tube entry is the same as the tube, no\nmore than 15 mm, for a length of approximately 2 cm. Over the next 3.5 cm the\nairway conforms to the overinflated per tracheostomy balloon, maximum\ndiameters of 31 x 37 mm. At this level the retroesophageal aberrant right\nsubclavian artery has not increased in caliber since chest CT 8 ___, previously 14 mm wide. The total endotracheal excursion of the\ntracheostomy tube is 6.5 cm. Below the overinflated cuff, previous severe\nmediastinal adenopathy has substantially improved and the tracheal\nconfiguration is now normal,, with characteristic diameters of 20 x 20 mm. The\nmain and lobar bronchi are also fully patent.\n\nSupraclavicular adenopathy is difficult to assess on this noncontrast\nexamination, probably not substantial low difficult to separate from thyroid\nlobes, 36 by of 42 mm on the left, smaller on the right. There is no axillary\nlymph node enlargement. Mediastinal adenopathy is mild, with diameters ranging\nup to 13 mm in the right lower paratracheal station, 12 mm on the left,\npreviously 18 and 15 mm, respectively. Subcarinal adenopathy is probably\ncomparable. The small nonhemorrhagic pericardial effusion is new, but may be\nchronic or exudate of, with attenuation values higher than serous fluid, 27\n___. There is no evidence of cardiac tamponade.  Atherosclerotic calcification\nis extremely heavy in at least the left main and anterior descending arteries.\nOverall however the heart is not grossly enlarged.\nSmall nonhemorrhagic left pleural effusion layers posteriorly.\n\nCourse and location of a variety of transvenous lines and tubes including\nright atrial and ventricular pacer leads, common dialysis and other central\nvenous catheters, is more readily determined by conventional radiographs.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows new\nmoderate splenomegaly.\n\nConsolidation in the apical posterior segment of the left upper lobe,\nperibronchial nodulation in the anterior segment of the right upper lobe and\nin the superior segments of both lower lobe suggests widespread pneumonia,\npossibly due to difficulty clearing secretions.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Midline, infracricoid tracheostomy tube, obturates a 2 cm long region of\npossible stenosis in the subglottic trachea.  Cuff overinflates the next 3.5\ncm of upper and mid trachea, malacic, terminates in the normal distal trachea.\n.\n\nMarked thyroid enlargement probably contributes to subglottic tracheal\nnarrowing, normal caliber aberrant right subclavian artery and improved\nmediastinal adenopathy do not.\n\nMulti focal pneumonia may be due in part to difficulty with clearing\nsecretions.\n\nSevere coronary atherosclerosis. Small but possibly exudate of pericardial\neffusion. No evidence of tamponade.\n\nSee report of conventional chest radiograph for details of any malpositioned\nlines, leads, and tubes."
        },
        {
            "input": "A dual-lead pacemaker/ ICD device and dialysis catheter appear unchanged.  The\npatient is status post tracheostomy.\n\nThe left lobe of the thyroid is enlarged with one or more nodules but not\nsignificantly changed.\n\nThe heart is mildly enlarged. Coronary arteries are calcified.\n\nMediastinal lymph nodes have increased. Although its morphology appears within\nnormal limits, a right lower paratracheal lymph node, measuring up to 26 x 20\nmm in axial ___ (3:15), previously only measured 16 x 13 mm.  Left\nhilar contours appear stable although not delineated in great detail due to\nlack of intravenous contrast administration.\n\nThere is a small pleural effusion on the left, decreased since the prior CT,\nbut crescentic in shape with discernible smooth rim suggesting long\nchronicity. On the right, there is a small pleural effusion.\n\nA small air-fluid level is present within the esophagus but without\nsubstantial dilatation.  Aerosolized secretions are noted at the tracheal\nbifurcation.\n\nIn the left upper lobe, previously there was a peripheral consolidation which\nhas largely resolved. Largest area of residual opacity along the posterior\nleft lung apex measures up to 11 x 11 mm in axial ___ (5:20).  However\na few nodular opacities in the left upper lobe suggest active infection.\n\nIn the right lower lobe bronchovascular opacities suggest active infectious\nprocess.  The appearance includes a few discrete nodules measuring less than 5\nmm (for example 5:83, measuring 4 mm).  Ground glass and bronchovascular\nopacities in the anterior segment of the right upper lobe show patchy\ninvolvement.  Bronchovascular nodules and opacities in the anterior and\nposterior segments of the right upper lobe suggest infectious process. Similar\nfindings are present in the right middle lobe.\n\nThere is extensive opacification with volume loss of the left lower lobe with\nsuggestion of round atelectasis that has worsened considerably since the prior\nCT. There is also opacities suggesting chronic volume loss in the lingula\nwhich has increased.\n\nGastrostomy tube is present in the stomach. Vascular calcifications are\nwidespread.\n\nThe bones appear demineralized. There are no suspicious bone lesions.",
            "output": "1.   Findings suggesting multifocal pneumonia although aspiration pneumonitis\nand infection could be considered as a possible etiology.\n\n2.  Increased but probably chronic atelectatic changes in the lingula and\nparticularly the left lower lobe with organized small residual left pleural\neffusion including well-defined rim.\n\n3.  Small free-flowing pleural effusion on the right.\n\n4.  New lymphadenopathy in the chest.\n\n5.  Left hilar contour is not well delineated but appears stable.\n\nGiven nodularity to findings, as well as new lymphadenopathy, athough\nsuspected to represent active infection, follow-up chest CT is suggested\nwithin three months to reassess.  If active infection is doubtful on clinical\ngrounds, PET-CT may alternatively be considered."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Heterogeneity of the thyroid.  The\ntip of an endotracheal tube extends to approximately 2 cm above the carina.  A\nnasogastric tube extends into the stomach.  The tip of a right internal\njugular catheter extends to the right atrium.  Multiple left-sided chest tubes\nare present as well as a right pleural pigtail catheter.\n\nUPPER ABDOMEN: The patient is status post splenectomy with the suggestion of a\nsmall amount of residual pancreatic tissue present.  Trace left upper quadrant\nascites.  Additional surgical clips project anterosuperior to the pancreas.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Small amount of fluid\nwithin the anterior mediastinum is noted without rim enhancement to suggest an\norganized collection.\n\nHILA: Soft tissue prominence around the right hilum.\n\nHEART and PERICARDIUM: There is a small pericardial effusion.  The heart is\nnot enlarged.  There is no evidence of central pulmonary emboli or and acute\naortic abnormality.\nPLEURA: There are trace bilateral pleural effusions.  Loculated fluid extends\nalong the left major fissure with enhancement of the pleura, suggestive of\nunderlying empyema (___:66).\nLUNG:\n\n1. PARENCHYMA:  Large nonenhancing consolidation involving the left lower lobe\nis in keeping with pneumonia.  Opacities in the right upper and left upper\nlobes are also highly suspicious for multifocal infection.  No pneumothorax.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  No evidence of pulmonary embolism or cute aortic abnormality. \nThe main pulmonary artery is not enlarged.\nCHEST CAGE: No suspicious osseous abnormality.  Compression deformities are\nnoted involving T7, T9, and T10 and are unchanged when compared to ___.  Bilateral symmetric gynecomastia.",
            "output": "1. Multifocal pneumonia, most conspicuous in the left lower lobe.\n2. Trace bilateral pleural effusions with loculated fluid tracking along the\nleft major fissure and demonstrating mild pleural enhancement, suspicious for\nan underlying empyema."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is moderate calcium burden along the aortic arch and major branch\nvessels.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  A\nfilling defect is seen in left upper lobe subsegmental pulmonary arteries\n(301:66).  An additional subsegmental filling defect is seen in the right\nlower lobe (2:66).  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nAn endotracheal tube terminates 3 cm above the carina.  3 left-sided chest\ntubes are again appreciated.  1 terminates adjacent to the mediastinum in the\nright superior hemithorax, 1 terminates posteriorly at the apex, and a third\nterminates in the left medial inferior hemithorax.  Again identified is a\nlarge nonenhancing consolidation comprising the majority of the left lower\nlobe, compatible with pneumonia.  A new nonenhancing consolidation in the\nright middle lobe is also concerning for pneumonia (02:57).  Additional\nconsolidations in the right upper and left upper lobes are similar to ___.\n\nThe airways are patent to the subsegmental level.\n\nThere is trace left-sided pleural effusion with loculated fluid running\nthroughout much of the major fissure (601:28).  This is similar in extent\ncompared to prior. There is an unchanged trace right pleural effusion.  There\nis a small pericardial effusion, which is not significantly changed compared\nto ___.\n\nThere is no supraclavicular or axillary lymphadenopathy.  The left mediastinal\nand hilar lymph nodes are not well appreciated.  The thyroid gland is\nheterogeneous.\n\nLimited images of the upper abdomen are unremarkable.\n\nMultiple compression deformities of T5, 7, 9 and 10 are unchanged.",
            "output": "1. Bilateral subsegmental pulmonary emboli, detailed above.\n2. Extensive consolidation comprising the majority of left lower lobe is\ncompatible with pneumonia, as on prior.  Loculated fluid in the major fissure\nis similar in extent to ___, and is concerning for empyema.\n3. Additional consolidations are seen in the left upper, right upper and right\nmiddle lobes concerning for multifocal pneumonia.  The right middle lobe\nconsolidation is new compared to ___.\n4. Trace bilateral pleural effusions.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 5:11 pm, 15 minutes after discovery of\nthe findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: Tracheostomy tube is in stable positions.  No\naxillary adenopathy.\n\nBREAST, CHEST WALL AND BONES: T4, T6, T8, T9 compression deformities are\nunchanged.  Multiple healed left rib fractures noted bilaterally.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART: Small pericardial effusion again noted.  There are extensive mitral and\naortic annular calcifications.\n\nLUNG/PLEURA:\n\nPigtail catheter terminates in a right pleural effusion which has increased in\nsized, with new loculated components extending superiorly.  There is new\nloculated small right pneumothorax.  The left basilar consolidation has\nimproved.  Loculated effusion in the left major fissure is not significantly\nchanged.  Left-sided chest tubes have been removed.  Extensive patchy and\nconfluent airspace opacities are seen and have significantly increased since\nthe prior CT scan.  Findings may represent multifocal pneumonia, pulmonary\nedema, or ARDS.\n\nUPPER ABDOMEN: Limited valuation of the upper abdomen is notable for a\nsurgically absent spleen.",
            "output": "1.  Interval development of loculated right pleural effusion.  Superimposed\ninfection/empyema is not completely excluded given the lack of intravenous\ncontrast.\n2.  Small loculated right apical pneumothorax.\n3.  Extensive patchy and confluent airspace opacities likely represent\npulmonary edema or ARDS.  Concomitant infection is not excluded, particularly\ngiven the patient's loculated effusions.\n4.  Improvement in left basilar consolidation.\n\nNOTIFICATION:  Findings were communicated to and acknowledged by ___,\nM.D.  by ___ at 23h00."
        },
        {
            "input": "Positioning of the arms across the upper abdomen causes significant streak\nartifact limiting evaluation.\n\nNECK, THORACIC INLET, AXILLAE: Tracheostomy in place.  The imaged thyroid is\nnormal. No adenopathy.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: Left PICC line is present with tip in the distal SVC. \nThe aorta and main pulmonary artery are normal in size.  Heart size is normal\nwith mild coronary artery calcifications. Small pericardial effusion. \nSuggestion of anemia.\n\nPLEURA: Interval placement of right pleural catheter which terminates in the\nposterior right lower chest.  There is moderate partially loculated right\npleural effusion with significant subpulmonic component, which is not\ncontrolled by the pleural catheter.  There multiloculated component extending\nalong the fissures on the right, also present on prior.  Overall right pleural\neffusion has worsened.  There is complex small left pleural effusion, with\nareas of pleural thickening, and areas of loculation along the left major\nfissure, also present on prior.\n\nLUNGS/AIRWAYS:  There are secretions within trachea, bilateral mainstem\nbronchi, more prominent on the left.  There mild secretions in bilateral lower\nlobes...  Extensive bilateral pulmonary infiltrates with areas of interstitial\nthickening, bronchial thickening, areas of consolidations with bronchovascular\ndistribution have mildly improved, best seen in the left lung, and right apex.\nThere is no inter posterior gradient on interlobular septal thickening. \nTracheostomy.\n\nUPPER ABDOMEN: See CT abdomen pelvis report from today\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Mild multilevel degenerative changes of the thoracic spine are\nunchanged.  Stable compression deformities at T4-T6, T8 and T9.  Stable left\nrib deformities.",
            "output": "Extensive bilateral pulmonary infiltrates have mildly improved, findings favor\nimproving infection or ARDS, less likely edema.  Normal heart size.\nRight pleural effusion has worsened, it is not controlled by the current\nposition of pleural catheter.  Partially loculated components of bilateral\npleural effusions are present, may be reactive, bilateral empyema cannot be\nexcluded.\nTracheal secretions."
        },
        {
            "input": "FINDINGS:\n\nThe aorta is normal in course and caliber.  Atherosclerotic changes are seen\nalong the aorta.  Patient is status post median sternotomy and CABG.  ICD\nleads are seen extending into the right atrium and right ventricle.  No\nmediastinal hematoma is seen.  There are scattered mediastinal lymph nodes\nwhich do not meet pathologic size criteria.  No hilar or axillary adenopathy\nis seen.\n\nThere is no pleural or pericardial effusion.\n\nHigh-density material is seen in the esophagus, ingested, alternatively\nrefluxed.\n\nCentral airways are patent.  No focal consolidation is seen.  There is minor\nleft base atelectasis.  There is a 3 mm calcified granuloma in the right\nmiddle lobe.  Biapical pleural calcifications are noted.  There is a 7 mm\nthin-walled cyst in the right lower lobe on series 5, image 45.  Mild\nperibronchial wall thickening is seen.\n\nNo pneumothorax is seen.\n\n7 mm hypodensity in the right lobe of the thyroid does not meet ACR size\ncriteria for follow-up in a patient of this age.\n\nUpper abdomen: Abdominal findings will be reported separately.\nOsseous structures: No concerning osteoblastic or lytic lesion is seen in the\nchest.  No acute fracture seen.",
            "output": "No chest CT findings to suggest metastatic disease.  No acute CT findings in\nthe chest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\npreviously seen segmental right upper lobe filling defect is not seen on\ntoday's study.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Soft tissue in the anterior\nmediastinum likely represents residual thymus.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  A 2 mm perifissural nodule in the left lower lobe is unchanged\n(3:82), likely a lymph node and of doubtful clinical significance.  The\nairways are patent to the level of the segmental bronchi bilaterally noting\nmild bronchial wall thickening, particularly to the right lower lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  Resolution of\npreviously seen right upper lobe pulmonary arterial filling defect."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Soft tissue within the anterior mediastinum\nappears similar to prior, likely residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No pulmonary embolus detected to the segmental level."
        },
        {
            "input": "The visualized thyroid is unremarkable.  There is no supraclavicular or\naxillary lymphadenopathy.  No hilar or mediastinal lymphadenopathy.  Soft\ntissue in the anterior mediastinum likely represents residual thymus.\n\nThe airways are patent to the subsegmental level.  There is a 2 mm left\nperifissural nodule (series 2, image 36).  The lungs are otherwise clear.\n\nThere is no pleural or pericardial effusion.  The aorta and main pulmonary\nartery are normal in size.  There is a partial filling defect (series 301,\nimage 57) in a right upper lobe segmental branch.  No additional pulmonary\nemboli identified.\n\nThe superficial soft tissues are unremarkable.  No suspicious osseous lesions.\nThe distal esophagus is mildly patulous.  Otherwise, views of the upper\nabdomen are unremarkable.",
            "output": "1.  Small, segmental right upper lobe pulmonary embolus.  No evidence of right\nheart strain or pulmonary infarction.\n2.  2 mm left perifissural nodule.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST: HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury. The heart, pericardium, and great vessels\ndemonstrate extensive atherosclerotic calcifications. There is a small, simple\npericardial effusion without rim enhancement.\n AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass or hematoma. PLEURAL SPACES: \nThere are small, bilateral, simple pleural effusions with mild associated\nrelaxation atelectasis.\n LUNGS/AIRWAYS:  Mild relaxation atelectasis associated with small bilateral\npleural effusions.  There is a 5 mm right upper lobe pulmonary nodule (series\n2, image 43).  There are scattered punctate granulomas, for example series 2,\nimage 73).  There are otherwise no focal areas of parenchymal opacification.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesion or laceration.  There is mild periportal edema.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.  There is trace nonspecific\npericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  A punctate calcification\nabutting the inferior aspect of the pancreatic body may be vascular or an\norigin or related to a prior episode of pancreatitis.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is a 1.7 cm simple cyst arising from the upper pole of the left kidney. \nNo hydronephrosis or perinephric abnormality.  Punctate calcifications in the\nbilateral renal hila appear vascular in nature.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There are 2 discrete gas and\nfluid-filled structures adjacent to the second portion of the duodenum at the\nlevel of the ampulla, possibly duodenal diverticula.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon and rectum are within normal limits.  The appendix is not visualized. \nThere is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Numerous retroperitoneal lymph nodes are not pathologically\nenlarged. No mesenteric, pelvic, or inguinal lymphadenopathy. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.\nExtensive atherosclerotic disease is noted.\n\nBONES:  There is focal irregularity of the anterior left second rib, lateral\nleft fourth rib and, lateral left seventh rib, and lateral left eighth rib\nwithout definite cortical discontinuity or displacement. Similarly, there is\nfocal irregularity of the lateral right fifth rib and posterolateral ninth rib\nwithout definite cortical discontinuity or displacement.  There is a moderate\nanterior L2 vertebral body compression fracture with no definite cortical\ndiscontinuity and a sclerotic superior endplate.  No focal suspicious osseous\nabnormality.\n\nSOFT TISSUES: There is mild subcutaneous edema overlying the bilateral gluteal\nregions.  There is a small, fat containing inguinal hernia.",
            "output": "1. L2 anterior compression fracture, likely chronic given contiguous superior\nendplate sclerosis and a lack of cortical discontinuity.  Correlation with\nexamination required.\n2. Focal irregularities involving multiple bilateral ribs, likely prior healed\nfractures given lack of definite cortical discontinuity or displacement.\nRecommend correlation with physical examination.\n3. Small simple bilateral pleural effusions with associated relaxation\natelectasis.\n4. Small simple pericardial effusion.\n5. Probable volume overload given presence of effusions, subcutaneous edema,\nperiportal edema, and trace pericholecystic fluid.\n6. A 5 mm right upper lobe pulmonary nodule warrants follow-up dedicated chest\nCT in 12 months to assess for stability per ___ Society\nrecommendations.\n7. Fluid and gas containing structures adjacent to the second portion the\nduodenum at the level of the ampulla likely reflect duodenal diverticula.\nHowever, this would be an atypical location and could be confirmed with\nnonurgent upper GI.\n\nRECOMMENDATION(S):  Fluid and gas containing structures adjacent to the second\nportion the duodenum at the level of the ampulla likely reflect duodenal\ndiverticula. However, this would be an atypical location and could be\nconfirmed with nonurgent upper GI.\n\nNOTIFICATION:  The updated findings recommendations regarding possible\nduodenal diverticula were emailed to the ED QA nurses by ___, M.D.\non the telephone on ___ at 9:11 AM, approximately 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, and hilar lymph nodes are\nnot enlarged.  Right upper and lower paratracheal lymph nodes are mostly\nstable compared to the prior exam in ___. However, a right upper\nparatracheal lymph node measures 13 mm  in short axis, previously measuring 6\nmm (series 2, image 13).  Calcification of a subcarinal lymph node is\nindicative of prior granulomatous exposure (series 2, image 29).  Aorta and\npulmonary arteries are both borderline enlarged.  Cardiac configuration is\nnormal and there is mild coronary and aortic valve calcification.  There is no\npericardial effusion.\n\nAirways are patent to subsegmental levels bilaterally.  Since the prior CT in\n___, there is been interval development of widespread nodular\nparenchymal opacities, more predominant in the upper lobes bilaterally, as\nwell as bibasilar atelectasis and small pleural effusions.  Given the\nwidespread parenchymal opacities as well as motion from breathing artifact, is\ndifficult to assess the previous existing pulmonary nodules.  However, a\nnodule in the left upper lobe nodule is slightly larger on the prior exam, now\nmeasuring 4 mm (series 4, image 66).  Several nodules are new, including a 6\nmm left upper lobe nodule, a 16 mm right upper lobe nodule, and a 7 mm right\nmiddle lobe nodule (series 4, image 38, 79, 113).  There is no pneumothorax.\n\nThe patient is status post right adrenalectomy and nephrectomy.  Server\nhydronephrosis of the left kidney with cortical thinning is stable since the\nprior study (series 2, image 62).  There is stable appearance of the mesentery\nwith mild haziness.  There is no osseous lesions suspicious for malignancy or\ninfection.",
            "output": "Widespread parenchymal opacities with small bilateral pleural effusions\nwithout significant mediastinal lymphadenopathy, new since ___. \nWhile there is a high chance this represents infection such as mycoplasma or\nviral infection, metastatic disease cannot be excluded.\n\nRECOMMENDATION(S):  Treatment for pneumonia with short-term interval follow-up\nchest CT in 2 weeks is recommended for further evaluation.\n\nNOTIFICATION:   The findings and were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 5:43 ___."
        },
        {
            "input": "Since the prior study.  No change in the appearance of the mediastinum has\nbeen demonstrated.  Assessment of the lung parenchyma reveals similar nodular\nopacities widespread with more rounded lesions such is in the right upper\nlobe, series 7, image 100 in 1 and some potentially cavitated nodules and\nperibronchial wall thickening, series 7, image 120.  No substantial change in\nthe distribution and appearance of the findings is demonstrated except for\npotential diffuse minimal improvement.\nAdditional findings that appear to be unchanged since the prior study are as\nfollowing:\n\n-10 mm enhancing pericardial likely lymph node (series 6, image 32). Prominent\nright paratracheal node measures 9 mm in short axis (series 6, image 12),\nlarger in comparison to CT from ___ (at that time, measuring 6 mm in\nshort axis). No other evidence of hilar, mediastinal, or axillary\nlymphadenopathy.\n-Unchanged small bilateral simple layering pleural effusions.\n-Unchanged left greater than right bibasilar atelectasis.\n-Unchanged calcified subcarinal lymph node (series 6, image 20).\n-7 mm right thyroid lobe hypoenhancing nodule (series 6, image 5).",
            "output": "Minimal interval improvement in widespread parenchymal opacities, does\npotentially the might represent improving infection but still underlying\nwidespread malignancy cannot be excluded.  As previously mentioned, the\nappearance of the widespread nodular parenchymal opacities might represent\nmycoplasma or viral infection, fungal infection is less likely.  Reassessment\nin 4 weeks after completion of antibiotic therapy would be been officially to\ndifferentiate between widespread metastatic spread versus infectious process."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is normal.  There are\nno enlarged supraclavicular or axillary lymph nodes.  Prominent left axillary\nlymph nodes are unchanged since the prior examination.\n\nUPPER ABDOMEN: Surgical clips are seen in the right upper quadrant.  Hazy\nstranding is seen in the mesentery, with a number of prominent mesenteric\nlymph nodes, unchanged since the prior examinations.  The right kidney is\nabsent.  There is left sided pelviectasis The spleen is atrophic, and possibly\nabsent.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes are seen.  Scattered,\nnonenlarged right paratracheal nodes are seen along with scattered AP window\nand paraesophageal lymph nodes as well.\n\nHILA: Calcified hilar lymph nodes are again seen.  Hilar lymphadenopathy is\ndifficult to assess given the lack of intravenous contrast.\n\nHEART and PERICARDIUM: The heart is normal in size.  There are aortic annular\ncalcifications.  Coronary calcifications are also seen.  There is no\npericardial effusion.\nPLEURA: A small left-sided pleural effusion is present, and La since the prior\nexamination.  There is no pneumothorax.\nLUNG:\n\n-PARENCHYMA:  In comparison to the most recent examination again seen are\ndiffuse, primarily peribronchovascular ground-glass opacities involving the\nupper lobes without marked consolidative component, improved.  This could\nrepresent residual findings from the prior infectious process and/or a new\ninfection.  A more extensive region of ground glass opacity in the right upper\nlobe (4:120) may represent acute infection.  Multiple solid lung nodules are\nstable since ___ (4:69, 74, 76, 84, 104, 129, 144) with the\nexception of a 2 mm right upper lobe nodule (04:52).\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The aorta is enlarged, measuring 42 mm.  The main pulmonary artery\nis slightly enlarged, measuring up to 32 mm.  Intravascular blood is somewhat\nhypodense, which may be indicative of anemia.\nCHEST CAGE: No suspicious bony abnormalities are identified.  A sclerotic\nfocus and upper thoracic vertebral body is unchanged since the prior\nexamination.  There is no acute fracture.",
            "output": "1.  Improved but persistent bilateral, upper lobe, primarily\nperibronchovascular ground-glass opacities without a marked consolidative\ncomponent may represent new, acute infection.  Much less likely is the sequela\nof a prior infectious process.\n2.  New, 2 mm right upper lobe nodule.  Attention on follow-up is recommended.\nMultiple other nodules are stable since ___."
        },
        {
            "input": "HEART AND VASCULATURE:  The study is limited by respiratory motion.  Equivocal\nfilling defects in two subsegmental branches of the posterior lateral basilar\nsegments of the right lower lobe may be artifactual (series 2, image 52, 63). \nThe pulmonary vasculature is otherwise well opacified to the segmental level. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  The visualized esophagus is\npatulous and fluid-filled to the level of the carina.  The visualized thyroid\nis unremarkable.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  Moderate bilateral pleural effusions left greater than right\nwith associated compressive atelectasis.\n\n\nLUNGS/AIRWAYS:  There are extensive predominantly centrilobular ground-glass\nopacities, some which have cavitary appearance (series 3, image 74, 70)\nscattered diffusely throughout the lungs, but worse at the right lung base.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  The stomach is significantly distended.  The remainder the\nvisualized abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Equivocal filling defects versus artifact are seen in two subsegmental\nbranches of the right lower lobe.\n2.  Extensive, ground-glass opacities, worse at the right lung base.  Findings\nare nonspecific and may represent infection, possibly atypical or inflammatory\nprocess, such as hypersensitivity pneumonitis.\n3.  The esophagus is fluid-filled to the level of the carina placing the\npatient at increased risk for aspiration."
        },
        {
            "input": "Heart size is normal.  Right upper paratracheal lymph node is stable. Aorta\nand pulmonary arteries are normal in diameter. Calcified paraesophageal lymph\nnode is unchanged. There is no pericardial pleural effusion. Substantial\namount of posterior mediastinal fat is unchanged.\n\nImaged portion of the upper abdomen demonstrate prior right nephrectomy, a\ntrophic left kidney and evidence of mesenteric stranding, similar to the prior\nstudy.\n\nAirways are patent to the subsegmental level bilaterally.  There are no lytic\nor sclerotic lesions worrisome for infection or neoplasm.  Several pulmonary\nnodules: 5:51, 95, 68, 107, 109, 118, 118, 171, 191 are stable. Previously\ndemonstrated right middle lobe and lingular consolidations have resolved. No\nnew nodules or masses or consolidations demonstrated.",
            "output": "1. Multiple stable pulmonary nodules, some of them calcified, potentially\nreflecting prior granulomatous exposure.\n\n1. Interval improvement ___ resolution of previous consolidation and\nground-glass nodules."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Mild lipomatosis of the mediastinum.  Unchanged\nappearance of the mildly calcified coronary arteries and the partially\ncalcified normal sized mediastinal and hilar lymph nodes (2, 33).  No\npericardial effusions.  No abnormalities at the level of the large mediastinal\nvessels.  No change in appearance of the upper abdomen. Status post right\nnephrectomy. Small left kidney.  No evidence of rib, sternal or vertebral\nlesions.\nThe multiple pre-existing pulmonary nodules, for example in the right upper\nlobe (4, 81) and in the left upper lobe (4, 84) are completely unchanged in\nmorphology. Some of these nodules are calcified. There is no evidence of newly\nappeared pulmonary nodules. The airways are patent but minimal thickening of\nthe airway walls could suggest the presence of chronic airways disease. The\npleural surfaces are even. No pleural thickening.  No pleural effusions.",
            "output": "No relevant change as compared to ___. Multiple partly calcified\npulmonary nodules, all stable in size and morphology.  No new pulmonary\nnodules.  Signs of mild chronic airways disease.  No pleural thickening or\npleural effusions."
        },
        {
            "input": "Ascending aortic dilatation up to 4.2 cm is demonstrated.  Coronary\ncalcifications are present.  Sub- carinal calcified lymph node is consistent\nwith prior nodules exposure in unchanged.  Anemia is noted.  No pericardial\npleural effusion is seen.  Spleen is small and calcified in is consistent with\nsequela of prior multiple infarcts.  Image portion of the upper abdomen\ndemonstrate unchanged left kidney hydronephrosis, chronic with thinning of the\nparenchyma.  There is also interval progression of mesenteric fat stranding\nand lymphadenopathy, series 2, image 68 as compared to ___\n\nAirways are patent to the subsegmental level bilaterally.  As compared to ___ and ___ there is substantial interval additional\nimprovement in widespread parenchymal opacities with still present substantial\ninvolvement of the lungs in diffuse matter with predominately\nperibronchovascular appearance.  No new lesions masses or consolidations\ndemonstrated.",
            "output": "The findings are consistent with gradually improving process, most likely\ninfectious with potentially elements of cryptogenic organizing pneumonia\ncurrently present.  Malignancy giving the lack of interval treatment would be\nless likely.\n\nInterval progression of mesenteric lymphadenitis.  .\n\nA trophic calcified spleen.  The finding itself would be consistent with\nsickle cell anemia although the patient might not reflect be appropriate\ndemographic group.  Please correlate with lobe border E findings."
        },
        {
            "input": "Mediastinal lymph nodes are not not enlarged, but there is probably a\nadenopathy in the left hilum.\n\nAll the basal segments of the right lower lobe are collapsed, with no\nbronchial obstruction with, perhaps function of the moderate layering\nnonhemorrhagic right pleural effusion.  Left pleural effusion is only a little\nsmaller and relaxation atelectasis in the left lower lobe is accordingly less.\nPleural surfaces are not thickened.  There is no pericardial effusion.\n\nSmall volume of secretions adheres to the upper trachea.  The tracheobronchial\ntree is otherwise normal to the segmental level, with mild thickening more\nperipherally in the right middle lobe and lingula and the aerated lower lobes.\n\nPredominantly ground-glass infiltration is relatively mild in several regions\nof both upper lobes, most severe on the left, 5:104-126.  Some of the smaller\nlesions are almost nodular, right upper lobe, 5:  84 -88.\n\nThyroid is unremarkable.  Borderline enlargement of the main pulmonary artery,\n33 mm can be seen in asymptomatic normal in within, but could also be a\nfunction of residual respiratory insufficiency.\n\nThere no bone lesions suspicious for malignancy or infection.",
            "output": "1.  Scattered, upper lobe airway centric ground glass opacities suggestive of\ninfectious etiology and multifocal pneumonia.  No interstitial abnormality is\nidentified.  Hemorrhage can result in similar ground glass opacities, not\nentirely excluded, felt less likely.\n\n2.  Bilateral moderate nonhemorrhagic and layering pleural effusions, right\ngreater than left responsible for basilar atelectasis, severe on the right,\nmilder on the left.  .  No obvious pleural abnormality or thickening, limited\nwithout contrast."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta contains diffuse calcifications but is normal caliber\nwithout evidence of aneurysm or dissection.  The main, lobar, segmental, and\nsubsegmental pulmonary arteries are well opacified without filling defect. \nThe remainder of the great vessels have a normal appearance.  A right internal\njugular central venous line terminates within the proximal right atrium.\n\nCHEST:\n\nThe thyroid is normal.  Numerous prominent mediastinal, bilateral hilar, and\naxillary lymph nodes are identified, some of which are enlarged by CT size\ncriteria. For example, a left infrahilar node measures 1.1 cm in short axis\n(3:80), and a sub-carinal node measures 1.0 cm in short axis (3:83) the\npatient is status post median sternotomy and CABG. The heart is normal in\nsize. The pericardium is intact without effusion.  Airways are patent to the\nsubsegmental levels.\n\nTrace bilateral pleural effusions with adjacent atelectasis is noted at the\nlung bases. Lung windows demonstrate innumerable bilateral solid and\nsemi-solid pulmonary nodules, seen in the subpleural, peribronchovascular, it\nintraparenchymal locations throughout the thorax. For reference, a mixed\ndensity opacity within the anterior left upper lobe measures 2.1 x 1.5 cm\n(3:72), a mixed density right perifissural nodule measures 1.4 x 1.1 cm\n(3:85), and a solid right upper lobe intraparenchymal nodule measures 6 mm\n(3:69). Moderate diffuse bronchial wall thickening is noted, generally smooth\nin appearance.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nAlthough this study is not tailored for the examination of subdiaphragmatic\ncontents, the imaged portions of the intra-abdominal organs are grossly\nunremarkable.  A prominent periportal lymph node is again identified,\nmeasuring 1.3 cm short axis.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Innumerable bilateral solid and subsolid pulmonary nodules. Given the\nrelative recent development of these nodules, findings may be infectious or\ninflammatory etiology. However, underlying malignancy should be considered.\n3. Trace bilateral pleural effusions with adjacent atelectasis."
        },
        {
            "input": "MEDIASTINUM: A tunneled double lumen right subclavian hemodialysis catheter\nterminates within the right atrium. The patient is status post median\nsternotomy and CABG. There is severe atherosclerotic calcification of the\ncoronary arteries and thoracic aorta. Dense annular calcifications of the\naortic valve are also present. The imaged thyroid is normal.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe aorta and pulmonary arteries are normal in size.   The heart size is\nnormal and there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  The diffuse perihilar ground-glass and\nmultifocal nodular opacities seen on the prior CT has completely resolved.  A\nsmall focus of lingular scarring was present back in ___.  There are no new\npulmonary nodules.  There is no diffuse interstitial abnormality.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen.  Within\nthese limitations, no acute findings in the imaged upper abdomen. Incidentally\nnoted is cholelithiasis and severe peripheral vascular disease.",
            "output": "The diffuse ground-glass and nodular opacities seen on the most recent prior\nCT angiogram of the chest have completely resolved, confirming the infectious\nor inflammatory etiology.  The lungs are now clear, without concerning\npulmonary nodules.  No further imaging followup is necessary."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nSOFT TISSUES: Bilateral subpectoral breast implants are in place and intact.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "Moderate right and small left pleural effusions.  No pericardial effusion.\nPatient is post CABG. Marked coronary arterial calcification. Mitral valvular\nand aortic valvular calcification, suggestive of valvular dysfunction. There\nis heavy calcification of normal caliber thoracic aorta.  Enlarged precarinal\nnode with fatty hilum, 1.8 cm short axis, stable since ___. 1.3 cm\ntracheoesophageal node (2, 19) is larger than prior study. Air-fluid levels\nwithin the esophagus, suggestive of reflux or dysmotility.\n\nPassive atelectasis of the right lower lobe. No endobronchial lesions. The\nsolid/ground-glass consolidation within the posterior segment right upper lobe\nis larger than the prior study, currently 6 x 4 x 4.6 cm, with air\nbronchograms, abutting the major fissure. Multiple small pulmonary nodules are\ndemonstrated within the right chest, largest 5 mm right middle lobe (4, 130).\n\nImaged upper abdomen demonstrates ingested material within stomach. Partially\nvisualized multiple renal cysts.  2.1 x 1.5 cm left adrenal nodule measuring 0\n___, present on prior study, compatible with adenoma.\n\nNo suspicious osseous lesions.",
            "output": "-Interval enlargement of right upper lobe solid/ground-glass opacity, as\ndetailed above, since ___. This is concerning for bronchogenic\ncarcinoma, with other considerations to include atypical processes such as\nsarcoid or lymphoma. Recurrent or chronic infectious process could also be\nconsidered.\n-Stable 1.8 cm a precarinal lymph node since prior. 1.3 cm tracheoesophageal\nnode is slightly larger than prior study, possibly reactive.\n-Moderate right pleural effusion.\n-Heavy thoracic aortic calcification. Post CABG. Heavy coronary arterial\ncalcification.\n-Air-fluid level within esophagus, suggestive of reflux or dysmotility.\n- Other findings as detailed above."
        },
        {
            "input": "CHEST:\n HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nheart and pericardium are within normal limits. No pericardial effusion is\nseen.\n\nMild atherosclerotic calcification of the thoracic aorta is seen.  There is no\nevidence of thoracic aortic aneurysm or dissection. The previously described\nfocal dissection of the descending thoracic aorta is favored to be related to\nartifact.\n AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass.  There are calcified\nmediastinal lymph nodes compatible with the sequela of prior granulomatous\ndisease.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification. The airways are patent to the level of the segmental bronchi\nbilaterally.  There is minor pleural based atelectasis and/or scarring along\nthe anterolateral margin of the right lower lobe.  A suture line is seen in\nthe right upper lobe.  There is platelike atelectasis in the left lower lobe. \nPlease note that the superior most aspect of both lung apices was not included\non the field of view.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nThere is a small hiatal hernia.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nare a few sub cm hypodensities throughout the liver which are too small to\ncharacterize by any imaging modality.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is mild nodular thickening of the left adrenal gland without a\ndiscrete nodule seen. The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no hydronephrosis. There is an indeterminate 1.0 cm lesion in the\nright kidney which measures higher than simple fluid.  Additional sub cm\nhypodensities in both kidneys are too small to characterize. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:  There is questioned thickening of the gastric antrum as\nwell as hyperemia of the distal antrum and first and second portions of the\nduodenum (series 10b, image 22 and series 10b, image 17). The remainder of the\nsmall bowel demonstrates normal caliber and thickness.  Diverticulosis of the\ncolon is noted, without evidence of wall thickening and fat stranding.  There\nis no free intraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.  There\nis a circumscribed 1.0 cm lesion in the right breast which measures higher\nthan simple fluid density.",
            "output": "1. There is no evidence of thoracic aortic aneurysm or dissection. The\npreviously described focal dissection of the descending thoracic aorta is  \nartifact.\n2. Suture line in the right upper lobe is compatible with prior wedge\nresection.\n3. Indeterminate 1.0 cm hypodensity in the right kidney measures higher than\nsimple fluid. Further evaluation with renal ultrasound is recommended.\n4. Thickening of the gastric antrum as well as apparent hyperemia of the\ndistal antrum and first and second portions of the duodenum.  While these\nfindings could be related in some degree to underdistention,\ngastritis/enteritis is also a consideration.\n5. Circumscribed 1.0 cm lesion in the right breast.  Correlate with prior\nbreast imaging."
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is no mediastinal\nhematoma.  There is no pericardial effusion.  There is no lymphadenopathy. \nThere is a 2.2 x 1.3 cm hypodense lesion within the right lobe of the thyroid.\nThe left lobe of the thyroid is within normal limits.  .\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  Airways\nare patent to the subsegmental level.  There is no evidence of contusion or\nlaceration.  There is no pneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  Sub cm hypodensities within\nthe kidneys are too small to characterize on CT.  The abdominal aorta is\nnormal in course and caliber with widely patent major branches.  No\nlymphadenopathy, free air, or free fluid.\n\nThe stomach and small bowel are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is normal.  The bladder is unremarkable.  There is no pelvic free\nfluid.\n\nBONES:  There is no acute fracture.  No focal suspicious osseous abnormality. \nNote is made of a large fat containing umbilical hernia.",
            "output": "No acute sequelae of trauma.  No rib fractures identified.\n\n2.2 cm hypodense lesion within the right lobe of the thyroid.\n\nLarge fat containing umbilical hernia.\n\nRECOMMENDATION(S):   Nonurgent thyroid ultrasound for further evaluation when\nclinically appropriate."
        },
        {
            "input": "CT CHEST WITHOUT IV CONTRAST: The thyroid is grossly normal.  There is no\nsupraclavicular axial lymphadenopathy.  Scattered mediastinal lymph nodes are\nnotable in number but are not pathologically enlarged.  For example, 1.4 x 1\ncm left lower peritracheal node (4:97).  These are unchanged since the outside\nCT of ___.  Within the limitations of a noncontrast enhanced study\nthere is no hilar lymphadenopathy.\n\nAgain there is a peripherally calcified prevascular mass measuring 4.5 x 2.8\ncm and approximately 30 Hounsfield units, contiguous with the anterior aortic\narch.  On ___ it measured 4.3 x 2.4 cm.\n\nThere is mild cardiomegaly without pericardial effusion.  There is stable\nasymmetric aneurysmal dilation of the aortic sinus or super annular ascending\naorta measuring 6.1 x 5.8 cm in the transverse plane, unchanged since ___. Aberrant right subclavian artery courses behind the esophagus.  There is\nno associated aneurysm; the maximum diameter measures 1.5 cm, unchanged.  The\nmain pulmonary artery is normal in caliber.  There are severe atherosclerotic\ncalcifications of the native coronary arteries in this patient status post\nCABG.\n\nSagittal elongation of the trachea ('saber sheath' morphology) reflects severe\ncentrilobular and paraseptal emphysema including large paraseptal bullae at\nthe lung apices.  There is no change in 2.6 x 1.8 cm right upper lobe\nground-glass opacity (02:20) since ___.\n\nOSSEOUS STRUCTURES: There is no worrisome blastic or lytic lesion.  Median\nsternotomy wires appear intact.\n\nUPPER ABDOMEN: This study is not optimized for evaluation of subdiaphragmatic\nstructures.  There is cholelithiasis.  The left kidney is atrophic as before. \nNonobstructing stone in the right kidney measures 2 mm.  Otherwise the\npartially visualized solid organs and stomach are grossly normal appear",
            "output": "1. No change in right upper lobe ground-glass opacity since ___. \nRecommend followup in ___ year.\n2. Slow interval growth of a peripherally calcified lesion in the anterior\nmediastinum isodense to the adjacent aorta.  This could be a saccular aneurysm\nor pseudoaneurysm or calcified mass such as thymoma or teratoma.  This should\nbe confirmed with CTA or MRA.\n3. Unchanged asymmetric aneurysmal dilation of the aortic sinus or supra\nannular ascending aorta.\n4. Severe centrilobular and paraseptal emphysema.\n5. 2 mm nonobstructing stone in the right kidney.\n6. Cholelithiasis\n\nRECOMMENDATION(S):\n1. Repeat chest CT in ___ year.\n2. CTA or MRA to evaluate indeterminate partially calcified prevascular\nmediastinal lesion.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 16:59 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels, but extensive in at least left anterior\ndescending and circumflex coronary arteries.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  Aortic valve is not calcified.  Pericardium\nis physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: No nodules or other focal lung lesions. \nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nExtensive atherosclerotic coronary calcification."
        },
        {
            "input": "The pulmonary vasculature is well opacified and without filling defect to\nsuggest embolism. No aortic pathology identified. Heart size is normal without\npericardial effusion.\n\nThe incompletely assessed thyroid gland is unremarkable.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy\nidentified. The central vessels are unremarkable. Heart size is normal and\nwithout pericardial effusion.\n\nAirways are normal and patent to the subsegmental levels.  Bibasilar dependent\nand peribronchial vascular opacifications identified in the lung bases, the\nlatter particularly on the left which may reflect atelectasis but cannot\nexclude superimposed infection particularly in the left lung base. No pleural\neffusion present.\n\nLimited assessment of the upper abdomen demonstrates no abnormality.\n\nNo suspicious lytic or blastic lesions identified. No superficial soft tissue\nmass is identified.",
            "output": "1.  No pulmonary embolism. Bibasilar opacification though slightly more\nbronchovascular distribution on the left may represent atelectasis though in\nthe correct clinical setting pneumonia is a consideration.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.  ___ the\ntelephone on ___ at 10:15 AM."
        },
        {
            "input": "The aorta and pulmonary arteries are of normal caliber.  The heart and\npericardium are unremarkable.  There are no enlarged mediastinal or hilar\nlymph nodes.  There are multiple enhancing, prominent lymph nodes in the left\naxillary region.  There is significant soft tissue stranding in this area\nwithout evidence of underlying collection.  Fat stranding occurs just inferior\nto the clavicle and extends inferiorly along the plane between the serratus\nanterior and latissimus dorsi.  There is minimal bibasilar atelectasis.  No\nevidence of consolidation throughout the remainder of the lungs bilaterally. \nNo evidence of pneumothorax or pleural effusion.  The airways are patent to\nthe subsegmental levels.  No evidence of acute fracture or concerning osseous\nlesions.\n\nImages of the upper abdomen are essentially unremarkable noting a\nsubcentimeter hypodensity in the right lobe of the liver which is incompletely\ncharacterized.  There is mild periportal edema.",
            "output": "Significant edema and fat stranding in the area of the left axilla tracking\ninferiorly between the latissimus dorsi and serratus anterior along the left\nchest wall.  No evidence focal collection.  Multiple enhancing, prominent\nlymph nodes in the left axilla."
        },
        {
            "input": "The thyroid is normal.\nSupraclavicular and axillary lymph nodes are not enlarged.  Mediastinal and\nhilar lymph nodes are smaller since ___, for example right lower\nparatracheal node (series 5: Image 20) is 1.6 x 2.2 cm was 1.9 x 2.4 cm;\nsubcarinal nodule (05:28) is 1.6 x 1.3 cm was 1.4 x 1.7 cm, right hilar node\n(05:28) is 1 x 1.2 cm was 1.3 x 1.9 cm.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.\n\nThere is no pericardial. Small pleural effusion is new since ___.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  Of innumerable\nbilateral metastatic nodules have had a mixed response to the treatment since\n___:\n- some nodules are larger, such as right upper lobe nodule (6:62) is 11 mm was\n8 mm ; left upper lobe nodule (6:71) is 10 mm was a 8 mm; right lower lobe\nnodule (series: 127) is 12 mm was 10 mm\n- some nodules are a smaller, such as right lower lobe nodule (06:161) is 13\nmm was 15 mm\n- while the majority of the nodules is stable.  There are no new lung nodules.\n\n\nUPPER ABDOMEN\nAbdominal findings are described in report of concurrent CT abdomen and pelvis\nclip ___\n\n\nOSSEOUS STRUCTURES\nMetastatic lytic and partially sclerotic vertebral lesion in T5 and L3\nvertebral bodies are stable since ___. 6 mm sclerotic lesion in the\nsternal manubrium (09:39) and 7 mm sclerotic lesion in the T10 vertebral body\n(series 6: image 219) are unchanged since ___",
            "output": "1. Since main ___ there has been a mixed response of the multiple bilateral\nlung nodules, some have increase and some have decreased, while the majority\nis stable.  There are no new lung nodules\n2. Hilar and mediastinal lymphadenopathy is minimally improved since ___\n3. T5 and L3 vertebral bodies lesions are stable since ___"
        },
        {
            "input": "The thoracic aorta is normal in course and caliber without appreciable\natherosclerotic disease. The heart is normal in size and shape. There is no\npericardial effusion. There is an enlarged pretracheal lymph node which\nmeasures 15 mm in short axis, previously 16 mm in short axis. There is an\nenlarged right hilar node which measures 13 mm in short axis, previously 15\nmm. A sub- carinal lymph node measures 12 mm in short axis, previously 13 mm.\nThere is no axillary lymphadenopathy. Central pulmonary arterial tree is\npatent. The esophagus appears unremarkable. The imaged thyroid gland appears\nnormal.\n\nThere is a small layering right pleural effusion with central density\nmeasurements suggestive of simple fluid. Multiple pulmonary nodules are again\nseen compatible with known metastatic disease. These uniformly exhibit\ndecrease in size compared with the recent prior exam suggesting treatment\nresponse. For example, a previous lesion in the right upper lobe measured 10 x\n13 mm, currently measures 8 x 8 mm on series 2, image 16.\n\nPlease note, CT abdomen pelvis performed same day will be dictated under a\nseparate report.\n\nBones:  Metastatic disease involving T5 appears grossly stable from prior\nexam. An expansile rib lesion involving the left fifth anterior rib is\nsignificantly improved from the prior exam. A sclerotic focus is also noted\nwithin the manubrium concerning for metastatic disease. Areas of subtle\nsclerosis involving the right third anterior rib arch and left first rib may\nrepresent sites of metastatic disease.   No pathological fracture is\nidentified.",
            "output": "1. Overall findings are suggestive of treatment response with decrease in\noverall number and size of pulmonary nodules as well as decreased size of left\nfifth rib lesion.\n2. Small layering right pleural effusion is new from prior.\n3. Please refer to separately dictated CT abdomen pelvis for further details\nregarding subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  A previously enlarged mediastinal lymph node (2,\n21) is unchanged in size and morphology, with a diameter of 20 x 15 mm.  A\nright hilar lymph node has minimally decreased in size (2, 29), from\npreviously 13 x 16 mm to now 12 x 11 mm.\nOn the right, previously he than by the pre-existing pleural effusion that has\nnot resolved, are enhancing pleural lesions, for example (2,29), reflecting\npleural implants.\nThere are several bilateral small newly appeared pulmonary nodules.  The vast\nmajority of the pre-existing pulmonary nodules has substantially increased in\nsize and density. For example, 1 reference lesion in the left upper lobe (4,\n34) has increased from previously 6 x 5 mm to now 11 x 13 mm.  The growth of\nthe pulmonary nodules is visually best noted in the right lung (4, 103).",
            "output": "As compared to ___, there is progression of disease with substantial\nincrease in number and size of the pulmonary nodules, as well as newly seen\npleural implants in the right hemithorax.  The pre-existing mediastinal and\nhilar lymph nodes are either stable or have minimally decreased in size."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is a stably enlarged skull\n22 x 15 mm precarinal lymph node (02:23). A right paraesophageal, 16 x 11 mm\nlymph node is also stable (02:30). There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta and pulmonary arteries are\nnormal in size.   The heart size is normal and there is no pericardial\neffusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  Although there is no change in the size\nand number of the multiple pulmonary nodules, there has been interval decrease\nin cellularity as evidenced by the reduction in the size of the solid\ncomponent of the nodules and newly indistinct hazy borders.\n\nBONES: Sclerosis of the T4 vertebral body is unchanged.  A well-circumscribed,\nrounded density in the renal may represent a (602b:45).  There are no new\ndefinite osseous lesions in the thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Although there is no change in the size and number of the multiple\npulmonary nodules, there has been interval decrease in cellularity as\nevidenced by the reduction in the size of the solid component of the nodules\nand newly indistinct hazy borders.  Therefore, this likely represents response\nto chemotherapy.\n2. Stable mediastinal lymphadenopathy."
        },
        {
            "input": "The thyroid gland is unremarkable.  A pathologically enlarged and right lower\nparatracheal lymph node is not appreciably changed measuring 13 x 22 mm,\npreviously 15 x 22 mm (2, 21).  A prominent right hilar lymph node is stable\nmeasuring 12 x 12 mm, previously 12 x 13 mm (2, 30).  Subcarinal\nlymphadenopathy stable with a representative node measuring 10 x 17 mm,\npreviously 11 x 16 mm (2, 29).  There is no supraclavicular, axillary or left\nhilar lymphadenopathy.\n\nHeart size is top-normal with no pericardial effusion.  Mild coronary artery\ncalcifications are stable. The main pulmonary artery is top-normal caliber\nmeasuring 3.1 cm.  There is no incidental pulmonary embolus.\n\nThere has been no appreciable interval change in size and number of numerous\npre-existing pulmonary metastases since ___. For reference, a right\napical nodule with a surrounding ground-glass halo is not appreciably changed\nmeasuring 6 x 7 mm, previously 7 x 8 mm, but there is a slightly increased\nground-glass halo which may be due to hemorrhage (4, 34). A posterior right\nupper lobe nodule is stable measuring 8 x 12 mm, previously 9 x 13 mm (4, 65).\nA right lower lobe nodule is stable measuring 11 x 14 mm, previously 11 x 13\nmm (4, 135). No new nodules are identified. A right anterior approach fissural\nchest tube is unchanged in position.  There is no appreciable pleural\neffusion.\n\nIngested contrast material is present in the lower to mid esophagus. For a\ndetailed discussion of the upper abdomen, please refer to the separate report\nfrom the CT abdomen/pelvis performed concurrently.\n\nSclerotic bone metastases involving the spine, sternum, and ribs are\nunchanged.  The pathologic fracture involving a left fifth rib anterolaterally\nremains nonunited. There are no new pathologic fractures.",
            "output": "No appreciable interval change in scores of pre-existing pulmonary metastases\nsince ___.  No new nodules identified.\n\nStable mediastinal lymphadenopathy.\n\nStable bone metastases involving the spine, sternum and ribs as described\nabove.\n\nEsophageal dysmotility or gastroesophageal reflux."
        },
        {
            "input": "The thyroid gland is unremarkable. A pathologically enlarged right lower\nparatracheal lymph node (2:23) is not appreciably changed measuring 21 x 14 mm\n(previously 22 x 13 mm). A prominent right hilar lymph node is stable\nmeasuring 12 x 12 mm (2:31). Subcarinal lymphadenopathy is stable with a\nrepresentative node measuring 17 x 10 mm (2:29). There is no supraclavicular,\naxillary or left hilar lymphadenopathy.\n\nHeart size is top-normal with no pericardial effusion. Mild coronary artery\ncalcifications are stable. The thoracic aorta and pulmonary artery are normal\nin caliber. There is no incidental pulmonary embolus.\n\nPulmonary metastases are numerous, several are minimally larger, most\nunchanged, none new: A dominant right lower lobe nodule (4:138) now measures\n17 x 11 mm, which is minimally increased in size (previously 11 x 14 mm). A\ndominant nodule in the right upper lobe with a ground-glass halo (4:109) now\nmeasures 18 x 13 mm (previously 16 x 12 mm). A nodule with a ground-glass halo\nin the left lower lobe (4:141) now measures 7 x 7 mm (previously 7 x 5 mm).  \nA right apical nodule with a surrounding ground-glass halo is not appreciably\nchanged measuring 6 x 8 mm, previously 7 x 8 mm (4:39). A posterior right\nupper lobe nodule is stable measuring 8 x 12 mm, previously 9 x 13 mm (4:67).\nNo new nodules are identified. A right anterior approach fissural chest tube\nis unchanged in position. There is no appreciable pleural effusion.\n\nIngested contrast material is present in the upper to lower thoracic\nesophagus. For a detailed discussion of the upper abdomen, please refer to the\nseparate report from the CT abdomen/pelvis performed concurrently.\n\nA predominantly sclerotic lesion of the vertebral body of T4 redemonstrates\ncortical breakthrough posteriorly without gross canal invasion (4:65), similar\nto prior studies. Sclerotic osseous metastases involving the sternum and ribs\nare unchanged. The pathologic fracture involving a left fifth rib\nanterolaterally remains nonunited. There are no new pathologic fractures.",
            "output": "1. Small interval growth in several of numerous pulmonary metastases compared\nto ___. No new nodules are identified.\n\n2. No appreciable change in mediastinal lymphadenopathy.\n\n3. T4 vertebral metastasis with posterior cortical breakthrough. Although\nthere is no gross canal invasion, dedicated neurological imaging to exclude\ncanal invasion.\n\n4. Intraabdominal findings are separately reported."
        },
        {
            "input": "The thyroid is normal.\n\nThere is no axillary are supraclavicular adenopathy. Enlarged mediastinal\nlymph nodes have not changed with the largest right lower paratracheal node\nmeasuring 14 x 20 mm (series 4, image 23).\n\nThe great vessels are normal in caliber. Coronary artery calcifications are\nmild. The heart is normal in size. There is no pericardial effusion.\n\nThe airways are patent and normal to the subsegmental level. There is no\nevidence of endobronchial lesion.\n\nPulmonary a metastases are numerous, but not significantly changed in size. A\nnewly cavitated, but stably sized, right lower lobe nodule measures 18 mm\n(series 5, image 135). Examples of additional stable nodules most with a solid\ncenter and halo of ground-glass include a 13 mm right upper lobe (series 5,\nimage 67), a 17 mm right lower lobe (series 5, image 169) and a 10 mm right\nbasilar nodule (series 5, image 232). No new nodules are identified. There is\nno focal consolidation, pneumothorax, or pneumomediastinum.\n\nThe esophagus remains patulous with layering oral contrast. The superficial\nsoft tissues are normal.\n\nOSSEOUS STRUCTURES:  A mixed lytic and sclerotic lesion in the T4 vertebral\nbody with cortical breakthrough posteriorly has not significantly changed.\nAlso stable are sclerotic lesions in the anterior left fifth and right third\nribs. A rounded area of sclerosis within the sternum is also unchanged.\n\nPlease see separate dictation for details on same day abdominal and pelvic CT.",
            "output": "1. Numerous pulmonary metastases, stable in size compared to ___. No new\nnodules identified.\n2. Unchanged enlarged mediastinal lymph nodes.\n3. Stable primarily sclerotic bony metastases, as detailed above."
        },
        {
            "input": "A reference mediastinal lymph node in pretracheal location (5, 22) measures 10\nx20 mm, as compared to 14 x 20 mm on the last examination.\nA reference right hilar lymph node (5, 31) measures 10 x 10 mm, as compared to\n13 x 10 mm on the last examination.\nThere is no evidence of newly appeared mediastinal or hilar lymph nodes.\nMany of the pre-existing pulmonary nodules are stable. Some of the pulmonary\nnodules have minimally increased in size. For example, a reference lesion in\nthe right upper lobe (6, 125) measures 11 x 14 mm on today's examination, as\ncompared to 7 x 11 mm on the previous examination.\nThe known cavitary nodule in the right lower lobe (6, 143) has also slightly\nincreased in size. Most of the pulmonary nodules have ground-glass halos on\ntoday's examination.  Adjacent to the pleural interface that some of these\nnodules show, there is mild local pleural thickening.  The right pleural drain\nis in unchanged position.  No pericardial effusion. Unchanged appearance of\nthe large mediastinal vessels and of the other mediastinal structures.\nThe posterior osteolytic aspect of the upper vertebral mixed sclerotic and\nlytic bone metastasis has slightly progressed. The lumbar vertebral metastasis\nis unchanged.  Unchanged right sclerotic rib lesion (10, 19). Unchanged\nsclerotic focus in the sternum.  Unchanged appearance of the known left rib\nlesions.",
            "output": "Overall stability of mediastinal lymph nodes.  Slight progression of a part of\nthe pulmonary metastases.  Progression of the T4 osteolytic component."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar and segmental\npulmonary arteries.  The opacification of the subsegmental pulmonary arteries\nare suboptimal because of motion artifact and linear atelectasis especially on\nthe anterior aspect of the left lower lobe.\n\nThe main and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There are bilateral small\npleural effusion slightly more increased on the right side.\n\nLinear atelectases in the left lower lobe especially in the anterior segment. \nTrace of atelectasis on the right lower lobe.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "-No evidence of pulmonary embolism or aortic abnormality with the limitation\nthat the subsegmental pulmonary arteries are not well opacified.\n-Small bilateral pleural effusion with linear atelectasis in the left lower\nlobe."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is calcified atherosclerotic plaque of the\ncoronary arteries.  The pericardium and great vessels are within normal\nlimits. No pericardial effusion is seen.  Heart is mildly enlarged.  The chest\nwall single lead pacing device is seen with lead tip in the right ventricular\napex.  Aortic valve calcifications are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is minimal apical scarring bilaterally.\nAdditionally, there is ground-glass opacification in the bilateral lower lobes\nwhich is likely due to atelectasis.  The right upper lobe pulmonary nodules\n(3:74, 117) are unchanged and require no additional follow-up.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatal hernia.  A 1.5 x 1.0 cm well-circumscribed\nhypodense lesion in the interpolar region of the left kidney is likely a cyst.\nThe other portions of the upper abdomen are unremarkable.\n\nBONES: Multilevel degenerative changes are demonstrated in the partially\nimaged thoracic spine.? There are no acute fracture or worrisome osseous\nlesions visualized.\n\nSoft tissues: In the anterior of the left chest is a pacemaker with a lead\nthat terminates in the right ventricle.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CTA THORAX:  The aorta and main thoracic vessels are well opacified.  The\naorta demonstrates normal caliber throughout the chest, without evidence of\nintramural hematoma or dissection.  There is a normal 3 vessel aortic arch,\nwith the partially imaged major branches appearing widely patent.  Moderate\natherosclerotic calcification is most prominent at the aortic arch.  The\npulmonary artery is well opacified to subsegmental levels.  There is no\nevidence of intraluminal filling defect in the main, right, left, lobar, or\nsubsegmental branches of the pulmonary.  No arteriovenous malformation is\nidentified.\n\nCT THORAX:  The thyroid is unremarkable.  There is a small hiatus hernia,\notherwise the imaged esophagus is normal.  There is no axillary,\nsupraclavicular, mediastinal, or hilar lymphadenopathy.  The imaged heart and\npericardium are unremarkable.  The airways are patent to subsegmental levels\n\nLung windows demonstrate multiple small subcentimeter lung nodules, including\na right middle lobe nodule measuring 5 mm (series 2, image 65), stable since\n___.  Similarly, two (2) smaller nodules, including a 4 mm nodule in\nthe right middle lobe more inferiorly near the fissure (series 2, image 75),\nin addition to a 3 mm nodule in the left lingula (series 2, image 77), are\nalso stable since ___.  Otherwise, the lungs are clear aside from\nminimal biapical pleural-parenchymal scarring.  There is no pneumothorax or\npleural effusion.\n\nThe partially imaged upper abdominal solid and hollow viscous organs are\nunremarkable.\n\nMUSCULOSKELETAL:  There is mild multilevel thoracic spine degenerative change.\nThere is no evidence of concerning focal lytic or sclerotic osseous lesion.",
            "output": "No evidence of pulmonary embolism or any other acute cardiopulmonary process."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  No coronary calcifications, minimal aortic\nvalve calcifications.  No pericardial effusion. Status post right hepatic\nresection.  No other abnormalities are noted in the abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Stable\nmild bilateral apical scarring.\nNew 15 mm ground-glass nodule in the left upper lobe (5, 56).\nModerate mucous accumulation in the larger airways (5, 79).\nCalcified right lower lobe granuloma, located in an area of mild\nbronchiectasis, bronchial wall thickening and ___ opacities (5, 124). \nThe stable 8 mm left lower lobe nodule is likely to reflect a pulmonary lymph\nnode.  Smaller pulmonary nodules in the left lower lobe are not substantially\nchanged.",
            "output": "Increasing severity of the pre-existing areas of bronchiectasis in the right\nlower lobe, new left upper lobe ground-glass nodule.  Both changes should be\nmonitored after treatment in approximately 6 months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\nCommon origin of the brachiocephalic and left common carotid artery (normal\nvariant).\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show unchanged\npostoperative appearance of right hepatic lobe resection.  Surgical absence of\nthe gallbladder.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes.\n\nHEART and PERICARDIUM:\nHeart is normal in size. No pericardial effusions.\nMinimal atherosclerotic calcifications in thoracic aorta and coronary\narteries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Multiple stable micronodules in all lobes (4: 73, 87, 100, and\n155) as well as calcified granulomas (4: 52, 76 and 115).  7 mm solid nodule\nin the left lung base (4:133), unchanged.\nStable ground-glass opacities in the left upper lung (04: 56 and 45).\nMild subpleural reticular opacities and distal bronchiolectasis in both lung\nbases.\n2. AIRWAYS:  Airways are patent to subsegmental levels.  New low-attenuation\nundulated secretion in the posterior trachea (04:51).\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "Stable appearance of all pre-existing pulmonary nodules and ground-glass\nopacities.\nSubpleural reticular opacities and distal bronchiolectasis in both lower\nlobes, also stable since ___.\nThe mild subpleural fibrosis and ground-glass subtle opacities can be related\nto early NSIP secondary to the patient's known diagnosis of rheumatoid\narthritis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Multiple pulmonary micronodules are redemonstrated, however due\nto motion artifact are suboptimally assessed.  7 mm solid nodule in the left\nlower lobe is unchanged (3; 117).  There are redemonstrated ground-glass\nopacities in the left upper lobe (3; 26, 42).  Bibasilar dependent atelectasis\nis seen.  Subpleural reticular opacities in distal bronchiolectasis at\nbilateral lower lobes is redemonstrated.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multiple pulmonary nodules and ground-glass opacities although grossly\nstable since ___, are somewhat suboptimally assessed due to motion artifact. \nThese opacities were thought to be related to early interstitial pneumonia, as\ncharacterized on prior CT.  Subpleural reticular opacities and distal\nbronchiolectasis in bilateral lower lobes are also stable since ___."
        },
        {
            "input": "The thoracic aorta is normal in caliber with minimal atherosclerotic\ncalcification.  The main, left, and right pulmonary arteries are normal in\ncaliber.  The heart size is normal.  No significant Coronary artery are valve\ncalcifications are identified.  No pericardial effusion.\n\nBilateral, left greater than right axillary lymph nodes are enlarged but\nmaintain their normal fatty hila.  Several, scattered mediastinal lymph nodes\nare prominent but not enlarged by CT size criteria.  No hilar or\nsupraclavicular lymphadenopathy.\n\nA 7-mm noncalcified nodule in the right middle lobe is overall unchanged\n(series 4, image 33).  A 2-mm right middle lobe pulmonary micronodule is\nunchanged (series 4, image 34).  A 7-mm peripheral pulmonary nodule in the\nleft lower lobe is also overall unchanged (series 4, image 36).  Several,\nbilateral small calcified granulomas are also unchanged (series 4, image 31,\n39, 15).  No new pulmonary nodules.  Minimal bilateral bronchioloectasis with\nbronchiolar centric micronodules is similar.  No evidence of interstitial lung\ndisease.\n\nThe airways are patent to at least the subsegmental level.  No pneumothorax or\npleural effusion.\n\nThe thyroid is unremarkable.  No suspicious lytic or sclerotic osseous lesion\nin the thorax.  Mild dextroconvex scoliosis of the upper thoracic spine is\nunchanged.  Vertebral body heights are preserved.  No lesion concerning for\nmalignancy in the thorax, excluding the breasts for which a dedicated\nmammography is needed as clinically indicated.\n\nThe partially visualized upper abdomen is unremarkable other than post\ncholecystectomy status and diffuse hypoattenuation of the hepatic parenchyma\nthat is consistent with hepaticsteatosis and nodularity of the liver surface\ncontour consistent with cirrhosis.  Coarse calcification in the hepatic\nparenchyma may reflect sequelae of prior granulomatous disease.",
            "output": "1.  No new nodule or change in the size of benign smaller pulmonary nodules\nsince ___.\n\n2.  Bilateral minimal peripheral bronchiectasis and bronchiolitis,\nnon-specific.  No evidence of interstitial lung disease.\n\n3.  Sequelae of prior granulomatous disease, unchanged.\n\n4.  Hepatosteatosis with nodular-appearing surface contour, which may suggest\ncirrhosis.  Correlate with clinical assessment and additional imaging as\nneeded."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Multiple bilateral pulmonary nodules measuring up to\n6-7 mm in the right middle lobe and left lower lobe are not significantly\nchanged (5:129, 168).  No new or growing pulmonary nodules.   A tiny nodular\nopacity at the left lung base likely represents atelectasis as it was not\npresent prone CTU performed less than 1 week prior (5:194).  There are\nmultiple small calcified granulomas, similar to prior.  No new focal\nconsolidation.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, again seen is a cyst containing\ncalcification in the right upper pole, a pancreatic lipoma, nodular contour of\nthe liver and calcification along the right hepatic lobe lobe, better\nevaluated on recent CT abdomen and pelvis.  The gallbladder is not visualized.\nThe included portions of the upper abdomen are otherwise grossly unremarkable.",
            "output": "Multiple bilateral pulmonary nodules are stable nearly ___ years.  No new or\ngrowing pulmonary nodules."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged by CT size criteria.  The thoracic aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.  No pericardial effusion.\n\nA pleural pigtail drainage catheter terminates in the right anterior\ncostophrenic sulcus.  There is a residual small right pleural effusion in the\ndependent posterior aspect of the right hemi thorax.  A small right\npneumothorax with predominantly apical air is likely related to catheter\nplacement.  The lung volumes are low with bibasilar atelectasis.  There is no\nconsolidation or concerning pulmonary mass.  A plate-like density in the right\nupper lobe (4:52) may represent an area of pleural-parenchymal scarring.\n\nOSSEOUS STRUCTURES:  There are no osseous lesions concerning for infection or\nmalignancy.  No acute fracture is detected.\n\nFor complete abdominal findings, please refer to separate report from same-day\nCT of the abdomen and pelvis.",
            "output": "1.  No evidence of active intrathoracic infection or malignancy.\n2.  Small right pneumothorax is likely related to placement of a right pleural\ndrainage catheter.\n3.  Residual small right pleural effusion posteriorly with the pleural\ncatheter terminating in the anterior costophrenic sulcus.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\nvia telephone on ___ at 2:04 ___, 15 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is heterogeneous.  No\naxillary adenopathy.  Within the right upper lateral right breast, there is an\nasymmetric nodularity measuring up to approximately 1.3 cm.  Correlation with\nprior mammograms are recommended.\n\nUPPER ABDOMEN: Nodular contour of the liver consistent with known patient's\ncirrhosis.  Numerous hepatic hypodensities are unchanged when compared to the\nMRI from ___ and compatible with cyst including a septated cyst\nin the right hepatic lobe measuring 2.9 cm, unchanged.  Small amount of\nperihepatic ascites.  Splenomegaly.  Trace perisplenic ascites.  Splenic cyst\nalong the lateral aspect of the spleen is re-demonstrated and measures 0.9 cm.\nGastroesophageal varices.  Additional upper abdominal varices are additionally\nnoted.  Small hiatal hernia.  Visualized adrenal glands and kidneys are within\nnormal limits.\n\nMEDIASTINUM: Moderate atherosclerotic calcifications of the aortic arch.  No\nmediastinal adenopathy.\n\nHILA: Limited evaluation of the hilar lymph nodes given lack of IV contrast.\n\nHEART and PERICARDIUM: Heart is normal caliber.  No pericardial effusion.\nLow-density blood relative to the cardiac musculature is suggestive of anemia.\nPLEURA: Interval increase, large, low-density right pleural effusion.  Small\nleft pleural effusion.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Moderate partial collapse of the right lower lobe and right\nmiddle lobes and to a lesser extent of the right upper lobe.  Mild left\ndependent atelectasis.  Along the lateral aspect of the right upper lobe there\nis a small area of hazy density likely representing atelectasis, however\ncannot exclude a superimposed inflammatory or infectious process.\n2. AIRWAYS:  Airways are centrally clear.  Mild narrowing of the distal\nairways in the right lower right middle lobe likely related to atelectasis.\n3. VESSELS:  Limited evaluation due to lack of IV contrast.\nCHEST CAGE: No suspicious osseous lesions",
            "output": "1. interval increase, large right pleural effusion with passive atelectasis of\nthe right lower and middle lobes and to a lesser extent of the right upper\nlobe.  Small left pleural effusion.\n2. Cirrhotic liver morphology with sequela of portal hypertension including\nsplenomegaly, varices, and ascites.\n3. Within the right upper lateral right breast, there is an asymmetric\nnodularity measuring up to approximately 1.3 cm. Correlation with prior\nmammograms are recommended.\n4. Additional findings as above."
        },
        {
            "input": "Lack of IV contrast limits evaluation.\n\nCHEST:\n\nThe thyroid is homogeneous.  Axillary, supraclavicular, mediastinal, and hilar\nlymph nodes are not pathologically enlarged by CT size criteria. . The\npericardium is intact without effusion. The airways are patent to the\nsubsegmental levels.\nSuture material is seen the right lower lobe. Several nodular opacities are\nseen in the anterior right middle lobe (2, 34), measuring up to 4 mm. There is\nno evidence of pleural effusion or pneumothorax.\n\nABDOMEN:\n\nNon contrast enhanced liver is normal in appearance and without focal\nabnormality.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is a calcified granuloma in the spleen. The noncontrast\nenhanced gallbladder, pancreas, bilateral adrenal glands, and kidneys are\nunremarkable.\nThe small and large bowel are unremarkable in appearance without dilation or\nwall thickening.  The appendix isnormal. There is no retroperitoneal\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum. The aorta and its major branches contain mild calcifications\nand are grossly patent.  There is mild ectasia of the left common iliac artery\nmeasuring 1.5 cm.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Moderate degenerative changes throughout the spine are seen.\nScoliosis. Non-displaced coccyx fracture (602b,38).",
            "output": "Non-displaced coccyx fracture.\n\nNo acute visceral injury in the chest, abdomen, or pelvis.\n\nLeft common iliac artery is borderline aneurysmal, not well evaluated without\nIV contrast.\n\nSmall cluster of nodular opacities are seen in the right middle lobe, likely\neither infectious or inflammatory in nature, the largest measuring 4 mm. \nRecommend 3 month follow up CT for further evaluation/to assess for\nstability/resolution.\n\nNOTIFICATION:  These findings were discussed with Dr. ___ by Dr. ___\nat 505pm on ___ by phone at time of discovery."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Consolidation is visualized in the right lower lobe which\nlikely represents sequelae of aspiration though superimposed infection cannot\nbe excluded.  The left lung is clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a partially visualized large rounded density in the\nleft base the neck that measures up to 4.5 x 3.2 cm in axial ___ and\nmay represent an enlarged thyroid nodule.\n\nABDOMEN:\n\nPlease note contrast phase through the abdomen appears washed out as a single\ncontrast bolus was given for CTA chest and CT abdomen pelvis.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is atrophic and hypoenhancing which may represent splenic\ninfarct.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy with surgical clips\nvisualized in the surgical bed.  The right kidney is of normal size with\nnormal nephrogram.  There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Multilevel degenerative changes visualized throughout\nthe imaged portion of the thoracolumbar spine without evidence of worrisome\nosseous lesions or acute fracture.  The abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Right lower lobe consolidation which is likely secondary to sequelae of\naspiration though superimposed infection cannot be excluded.\n2. Atrophic and hypoenhancing spleen may represent sequelae of splenic\ninfarct.\n3. No pulmonary embolus or acute aortic injury identified.\n4. Partially visualized large left base of neck mass which likely represents\nenlarged thyroid nodule for which follow-up nonemergent thyroid ultrasound\ncould be obtained for further characterization.\n\nRECOMMENDATION(S):   Recommend follow-up thyroid ultrasound for further\ncharacterization of left thyroid nodule."
        },
        {
            "input": "An endotracheal tube terminates in the carina.  Enteric tube terminates below\nthe diaphragm with the tip out of view.  Right-sided PICC courses into the\ncavoatrial junction with the tip limited due to overlying contrast.  Right\ncentral venous catheter terminates in the upper SVC.\n\nAORTA:\nThere is a circumferential periaortic fluid collection which is intermediate\ndensity which appears larger in size since ___.  At the level of\nthe main and right pulmonary arteries, this fluid collection, along with the\nthoracic ascending aorta, measures 7.2 x 5.8 cm (02:49), previously measuring\n5.5 x 4.7 cm at the same level on ___.  Bioglue is noted in the\nthoracic ascending the aorta.  There is no evidence of dissection or\nintramural hematoma of the thoracic ascending aorta.\n\nPatient's known chronic type B dissection is unchanged from ___.\nSmall intramural hematoma in the proximal thoracic descending aorta (02:31)\nand intermediate intramural hematoma in the distal thoracic descending aorta\n(2:80) are unchanged.  Dissection flap is unchanged with no evidence of\nextension into the abdominal aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nA prominent left supraclavicular node measures up to 7 mm across shortest\ndiameter (2:6) which is not pathologically enlarged by CT size criteria. \nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is a small right pleural effusion.  The heart is enlarged.  There is no\npericardial effusion.\n\nThere is atelectasis of the entire right lower lobe and atelectasis within a\nsignificant portion of the dependent aspect of the left lower lobe.\nAreas of ground-glass opacity are noted in the bilateral lungs, most severe in\nthe left upper lobe, (02:53, 63), may be compatible with aspiration.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.  Bilateral adrenal\nglands are normal.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nSternotomy wires are noted.",
            "output": "1.  Postoperative appearance status post type a dissection repair with\ncircumferential periaortic intermediate density fluid collection is larger as\ncompared to CTA chest ___ and may represent a postsurgical fluid\ncollection or hemorrhage.\n\n2.  Ground-glass changes in the bilateral lungs which are most severe in the\nleft upper lobe which most likely represent aspiration.\n\n3.  Stable appearance of patient's known type B dissection as compared to ___.\n\n4.  Atelectasis involving the entire right lower lobe and a large portion of\nthe left lower lobe.\n\n5.  Small right pleural effusion.\n\nRECOMMENDATION(S):  The findings were discussed by Dr. ___ with Dr.\n___ attending) on the telephone on ___ at 4:17 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: There is a new type A ascending aortic dissection with\na dissection flap originating superior to the level of the coronary artery\nostia. The dissection flap extends just proximal to the origin of the\ninnominate artery with no evidence of dissection flap extending into the great\nvessels, which appear patent. There is also no evidence of dissection\ninvolving the main pulmonary artery.  There is small volume hemopericardium\nwithout mass effect on the right atrium or ventricle.\n\nThe known chronic type B dissection has evolved since the ___ CTA.  In\nthe upper descending thoracic aorta, the false lumen has contracted, now\nrepresenting a small intramural hematoma (02:19).  In the lower thoracic\naorta, there has been somewhat similar retraction with intramural hematoma\n(2:70).  There is no evidence of dissection extending into the abdominal\naorta, which is without aneurysmal dilatation.  Moderate atherosclerotic\ndisease is noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Scattered, dependent, bibasilar opacities with associated\ninterlobular septal thickening may reflect mild fluid overload with\natelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout,\nnoting hepatic steatosis.  There is no evidence of focal lesion.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  Peripheral,\nbranching areas of intrahepatic gas likely reflect portal venous gas (for\nexample, 2:103). The gallbladder is not well distended, though there is\nsubstantial gallbladder wall edema.  There is trace perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS:  A 3.3 x 2.6 cm heterogeneously enhancing left adrenal mass is\nunchanged, incompletely characterized on this exam.  A 4 mm right adrenal\nnodule is also likely unchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nScattered hypoattenuating lesions are too small to completely characterize,\nbut statistically likely simple cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Intramural fat\nwithin the distal transverse colon, ascending colon, and cecum may reflect\nchronic inflammation.  The appendix is normal.  There is no evidence of\nmesenteric injury.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  A central venous catheter entering via a right\ninguinal approach terminates within the distal IVC.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. New type A ascending aortic dissection with extension the dissection flap\njust proximal to the origin of the innominate artery.  The dissection flap\noriginates superior to the coronary artery ostia.  There is associated small\nvolume hemopericardium without evidence of tamponade physiology.\n2. Evolution of the known type B descending aortic dissection with contraction\nof the previously identified false lumen and residual intramural hematoma\nformation.\n3. Probable mild fluid overload in the lungs with bilateral lower lobe\natelectasis.\n4. A small amount of portal venous gas may be related to to venous access in\nthe absence of evidence of ischemia.  Of note, extensive venous gas is noted\nwithin the internal mammary and brachiocephalic veins.\n5. Gallbladder wall edema without evidence cholecystitis, likely third spacing\nin the setting of concurrent periportal edema and trace perihepatic ascites.\n6. Fatty mural infiltration of the distal transverse colon, ascending colon,\nand cecum may reflect the sequela of chronic inflammation and clinical\ncorrelation is needed.\n\nNOTIFICATION:  The findings were discussed with the team at that time of image\nacquisition."
        },
        {
            "input": "The right lobe of the thyroid heterogeneously enlarged with multiple\nsubcentimeter nodule.  The airways\nare patent to the subsegmental level.  There are no enlarged mediastinal,\nhilar or axial lymph nodes.  Cardiac size is normal.  There is no pleural or\npericardial effusion.  Aorta is normal in caliber.\n\n2 mm nodule in the right upper lobe (6:97).  Calcified nodule in the right\nupper lobe (6:90) is stable.  Subpleural nodule in the right lower lobe is\nalso stable.  Bilateral lower lobe atelectasis is minimal.   There are no new\nlung nodules.  Mild\ndiffuse bronchial wall thickening, upper lobe predominant associated with few\ncentrilobular upper lobe predominant nodules is due to bronchitis.\n\nPlease refer to the concurrent abdominal CT for description of the\nintra-abdominal findings.\n\nSmall sclerotic foci in the lateral body of T2 is stable since ___.",
            "output": "Stable appearance of the thorax, no new pulmonary nodules, lymphadenopathy,\npleural or bony disease."
        },
        {
            "input": "There is stable enlargement and heterogeneity of the thyroid gland, reflective\nof multiple subcentimeter nodules.  The esophagus is within normal limits. \nThere is no hiatus hernia.  The aorta and pulmonary artery are normal in\ncaliber.  Major aortic arch branches are patent.  There is mild aortic arch\natherosclerotic calcification.  The heart and pericardium are normal.  Trace\npericardial fluid is within normal physiologic range.  There is no\nmediastinal, hilar, or axillary lymphadenopathy.\n\nMajor airways are patent to subsegmental levels bilaterally.  Bilateral, upper\nlobe predominant centrilobular subcentimeter nodules likely reflect\nrespiratory bronchiolitis.  A punctate right lower lobe subpleural nodule is\nunchanged (series 6, image 179).  The 3 mm right upper lobe nodule is stable\n(series 6, image 11).  A peripheral/subpleural right upper lobe punctate\nnodule is stable (series 6, image 97).  The 9 mm calcified right upper lobe\nnodule is stable (series 6, image 92), consistent with a calcified granuloma. \nThere is no focal pleural abnormality.  There is no pneumothorax or pleural\neffusion.\n\nThe imaged subcutaneous soft tissues of the chest wall, excluding the breasts\nwhich require evaluation by ultrasound, are unremarkable.  There is mild\nmultilevel thoracic spine degenerative change.  Alignment is normal. \nVertebral body heights are preserved.  No concerning focal lytic or sclerotic\nosseous lesions are seen.",
            "output": "1. Stable right lung solid subcentimeter pulmonary nodules.\n2. Bilateral subcentimeter upper lobe predominant centrilobular nodules likely\nreflect respiratory bronchiolitis.\n3. Stable CT appearance of a multinodular goiter.\n4. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Small left supraclavicular lymph\nnodes are stable\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes are unchanged in size.  A right\nparatracheal node measures 4 mm.  The subcarinal lymph node measures 9 mm. \nThere are small left hilar lymph nodes, unchanged.  The left lower lobe mass\nmeasuring 4.0 x 1.8 cm is unchanged in size since the prior study and abuts\nthe left lower lobe bronchus with extension into the lumen (6, 169.  The mass\nalso abuts medially the descending thoracic aorta.  The fat plane between the\naorta and the masses not well defined.  The conglomerate nodal mass in the AP\nwindow region is also unchanged\n\nThere is mild cardiomegaly.  There is moderate coronary artery calcification. \nThere is no pleural cardial effusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are multiple scattered bilateral parenchymal cysts.  A 2 mm\nsubpleural nodule in the right apex is unchanged.  A 2 mm triangular visual\nnodule in the right middle lobe is also unchanged.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions.  These could represent cysts.  No adrenal masses is\nseen.  The left adrenal is diffusely thickened.",
            "output": "No significant interval change in the left hilar mass with extension into the\nleft lower lobe bronchus with left hilar adenopathy.\n\nStable small mediastinal lymph nodes.\n\nScattered bilateral lung cysts.\n\n2 tiny nodules are in the right apex 1 in the right middle lobe are unchanged.\nNo new pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  There are multiple enlarged mediastinal lymph nodes.  For\nexample, a pretracheal node measures 1.1 cm (series 302, image 80).  A\nsubcarinal node measures 1.1 cm (series 302, image 99).  There is a small\nfocus pneumomediastinum without definite cause identified\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is a trace pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main pulmonary artery measures 3.5 cm (series 302, image 106).  The right\nand left pulmonary arteries are normal caliber.  A right IJ central venous\ncatheter terminates in the lower SVC.\n\nPULMONARY PARENCHYMA:  There is bilateral lower lobe consolidation with\nevidence of mucous plugging (series 302, image 138), consistent with\naspiration.  Diffuse centrilobular nodular and ___ opacities\nthroughout the lungs are concerning for multifocal infection.  Multiple\ncavitary nodules in the bilateral upper lobes (series 302, image 42, 86, and\n100) raise concern for possible septic emboli.  There is no emphysema.\n\nAIRWAYS:  Mucous plugging is seen in the right lower lobe.  Otherwise the\nairways are patent to the subsegmental level.  The endotracheal tube\nterminates approximately 5 cm above the carina.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nSignificant degenerative changes.\n\nUPPER ABDOMEN:  The enteric tube terminates in the stomach.  Otherwise limited\nevaluation of the upper abdomen is unremarkable.",
            "output": "1. Bilateral lower lobe consolidation with mucous plugging consistent with\naspiration.\n2. Diffuse centrilobular nodular and ___ opacities throughout the\nlungs, concerning for multifocal infection.  Multiple cavitary nodular\nopacities raise concern for septic emboli.\n3. Mediastinal lymphadenopathy, likely reactive.\n4. Small focus of pneumomediastinum without clear etiology."
        },
        {
            "input": "The thyroid is unremarkable.  There are enlarged mediastinal lymph nodes,\noverall unchanged in size compared to the prior CT.  Examples of the largest\nlymph nodes include a 1.4 cm lymph node in the right paratracheal station as\nwell as a 1.1 cm precarinal lymph node (series 302, image 82).\n\nThe heart is mildly enlarged.  There is no pericardial effusion.  The thoracic\naorta is normal in caliber and patent.  There are no significant\natherosclerotic calcifications.  The main pulmonary trunk is top-normal in\nsize measuring 3.0 cm.  Note that this study is not optimized for evaluation\nof pulmonary emboli.\n\nEndotracheal tube ends approximately 3.7 cm above the carina.  The airways are\npatent to the segmental level with bronchial wall thickening and mucous\nplugging at the lung bases.  Compared to the previous chest CT from ___, there has been interval improvement in multifocal primarily right upper\nlobe nodular opacities.  There are few persistent areas of nodular opacity and\n___ opacity most pronounced in the right posterior upper, right middle\nlobe, and the lingula.  Previously seen cavitary nodules have resolved.  There\nare consolidative opacities at the bilateral lung bases which are also\nimproved compared to the prior CT.  Bilateral pleural effusions have decreased\nin size.  There is no pneumothorax.  No pneumomediastinum is seen.\n\nThe thoracic esophagus is unremarkable.  Please see dedicated abdominal and\npelvic CT from same day for subdiaphragmatic details.\n\nOSSEOUS STRUCTURES: There are no suspicious bony lesions.  There is no\nsuperficial soft tissue abnormality.",
            "output": "1. Compared to ___, there has been significant interval improvement in\nmultifocal lung opacities with resolution of previously seen cavitary nodules.\n2. Persistent enlarged mediastinal lymphadenopathy, likely reactive.\n3. Near complete resolution of bilateral pleural effusions."
        },
        {
            "input": "Cysts there are no enlarged axillary, mediastinal, or hilar lymph nodes. Heart\nis upper limits of normal in size, and there is no significant pericardial\neffusion. Trace amount of pleural fluid is present bilaterally with adjacent\ndependent bibasilar atelectasis.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions within the thorax.\n\nAssessment of the lungs is somewhat limited due to inadvertent expiratory\nphase of respiration and respiratory motion, limiting sensitivity for\ndetecting small pulmonary nodules and subtle interstitial abnormalities. With\nthese limitations in mind, no suspicious nodules or masses are detected.  A\ndependent 4 mm diameter nonspherical opacity in superior segment left lower\nlobe is probably due to dependent atelectasis (image 61, series 4). 2 mm\nsubpleural right middle lobe lateral segment nodule (103, 4) is also\ndemonstrated.\n\nNote is also made of an endotracheal tube with tip in standard position, and a\nfeeding tube, terminating within a distended stomach.",
            "output": "1.  No CT evidence of primary lung malignancy.\n\n2.  2 mm right middle lobe lung nodule is very likely a benign finding. If the\npatient proves to have an extrathoracic primary neoplasm, this could be\nreassessed by followup CT in ___ months if warranted clinically. Otherwise, no\nspecific followup would be recommended in a patient of this young age."
        },
        {
            "input": "Please note that although the patient cooperated with breathing instructions,\nher expiration was not as forceful as that in ___.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneous.  No\nlymphadenopathy.\n\nUPPER ABDOMEN: There is an unchanged left lipid rich adrenal adenoma. \nVisualized portions of the abdomen on this noncontrast study are otherwise\nunremarkable.\n\nMEDIASTINUM: There are a few prominent, though nonenlarged, mediastinal lymph\nnodes.  No mediastinal mass.\n\nHILA:  There are a few prominent, though nonenlarged, left hilar nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  No\ncoronary artery or valvular calcifications.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Interval decrease in previously seen peribronchial\nground-glass opacities and nodules in the right middle and bilateral lower\nlobes.  There are new multiple punctate bronchiolar centrilobular nodules in\nthe right upper lobe (for example, ___, 158), concerning for repeated\naspirations.  There is minimal ground-glass opacity in the lingula (___),\nlikely representing inflammation or infection.  There is trace left basilar\natelectasis.\n2. AIRWAYS:  The stent measures approximately 3 cm.  Compared to ___, the previously seen tracheal stent arises approximately 1.8 cm distal to\nthe cricoid cartilage (___), previously 1.2 cm and approximately 4.7 cm\nsuperior to the carina, suggesting approximately 0.5 cm of inferior migration.\nNo significant peritracheal free air or fluid at the level of the stent.  The\nremainder of the tracheobronchial tree is patent.  No significant air trapping\non expiratory phase imaging.  As before, tracheal narrowing is noted\nimmediately inferior to the stent at approximately the level of the manubrium.\nAt this level, the axial ___ on inspiration are 0.8 x 0.9 cm for an\narea of 55.1 mm2.  During dynamic expiration, the axial ___ are 0.8 x\n0.8 cm for an area of 53.6 mm2.  The trachea collapses approximately 50% with\ndynamic maneuvers (dynamic airway collapse).  This is unchanged from ___.\n3. VESSELS:  No evidence of pulmonary embolism on this non - PE protocol\nstudy.  The pulmonary arteries are not enlarged.\nCHEST CAGE: No fractures.  No suspicious lytic or blastic bony lesions.",
            "output": "1. The previously seen tracheal stent has migrated inferiorly approximately\n0.5 cm.  No evidence of tracheobronchomalacia.\n2. Unchanged approximately 50% expiratory contraction of the trachea at the\nstricture immediately inferior to the stent with dynamic maneuvers (dynamic\nairway collapse).  Trachea otherwise normal.\n3. Ground-glass opacity and nodules in the lingula and right upper lobe, again\nsuggestive of chronic aspiration.\n4. Unchanged lipid rich left adrenal adenoma."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  No\nevidence of a pericardial effusion.\n\nNo supraclavicular, axillary, or hilar lymphadenopathy by CT size criteria. \nMediastinal lymph nodes are enlarged, measuring up to 11 mm in short axis in\nthe right peritracheal stations (series 601b, image 28; series 2, image 57). \nFat stranding in the anterior mediastinum prevascular space is nonspecific and\ncould be post surgical, however infection cannot be excluded in the\nappropriate clinical situation (series 2, image 47).  Right perihilar lymph\nnodes are prominent, measuring up to 12 mm.  No left hilar lymphadenopathy. \nThe thyroid is unremarkable.\n\nBilateral small pleural effusions, slightly greater on the right, are\nnonhemorrhagic.  Associated homogeneously enhancing parenchymal opacities in\nthe right and left lower lobes are consistent with relaxation atelectasis;\nhowever, concurrent aspiration in the appropriate clinical situation cannot be\nexcluded.  Other scattered areas of focal parenchymal linear opacities in the\nbilateral lungs is also likely atelectasis.  Ground-glass opacities in the\nright upper lobe (series 2, image 50, 53 and lingula (series 2, image 87, 84)\ncould represent aspiration/infection, new from the prior exam.\n\nThe airways are patent to at least the subsegmental level.  There is focal\nnarrowing of the trachea at the level of the thoracic inlet with surrounding\nfat stranding which could be postsurgical (series 2, image 30).  Postsurgical\nchanges extend anteriorly into the soft tissue of the anterior chest wall with\nsmall pockets of subcutaneous emphysema (series 2, image 36, 33, 28).  No\norganized or drainable fluid collections.  The AP diameter of the trachea at\napproximately the level of the manubrium measures up to 6 mm (series 602b,\nimage 36).  There is no evidence of a defect in the tracheal wall.\n\nStreak artifact from dental hardware limits detailed evaluation of the left\nupper neck.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Probable postsurgical changes after tracheal reconstruction with fat\nstranding and edema as well as subcutaneous emphysema in the anterior thoracic\nsoft tissues as well as fluid and fat stranding surrounding the trachea and in\nthe anterior mediastinum.  Close attention on follow-up is recommended as\ninfection cannot be completely excluded in the appropriate clinical situation.\n3.  No organized or drainable fluid collections.\n4.  No evidence of a defect in the tracheal wall or pneumomediastinum.\n5.  Focal narrowing of the trachea at the level of the manubrium/thoracic\ninlet, measuring about 6 mm in AP dimension (series 602b, image 36).\n6.  Bilateral small pleural effusions with adjacent compressive atelectasis. \nConcurrent infection/aspiration cannot be excluded.  Ground-glass opacities in\nthe right upper lobe and lingula are concerning for infection/aspiration.\n7.  Filling defect in the superior vena cava adjacent to the right PICC\n(series 3, image 108) could be artifactual from mixing contrast with\nnon-opacified blood.  Attention on follow-up is recommended.\n\nRECOMMENDATION(S):  Short interval follow-up chest CT."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria. A small amount\nof subcutaneous gas and stranding track along the anterior upper chest, likely\npostsurgical.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.  Small\namount of stranding is noted in the upper mediastinum, likely secondary to the\npatient's recent tracheal resection/reconstruction and is overall decreased\nsince the prior CT scan of ___.  Otherwise there is no abnormal\nmediastinal fluid or stranding to suggest mediastinitis.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with no significant coronary artery calcifications. There is no\npericardial effusion.  Unchanged hypodensity in the superior vena cava\nadjacent to the right PICC line (4: 54), likely reflecting thrombus.\n\nPLEURA: Trace bibasilar pleural effusions with overlying compressive\natelectasis.\n\nLUNGS/AIRWAYS:  Patient is post cervical tracheal reconstruction.  The airways\nare patent to the subsegmental level. There are scattered ground-glass\nopacities of both lungs, which have improved in comparison to the prior study\nfrom ___, and likely represent an infectious process related to the\npatient's recent tracheal resection and reconstruction. No focal\nconsolidation. No new suspicious pulmonary nodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, no significant abnormality is identified.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Mild multilevel degenerative changes of the thoracic spine are\nunchanged.",
            "output": "1.  Interval improvement of bilateral ground-glass opacities, likely due to an\ninfectious process.  No focal consolidation.\n2.  Trace bibasilar pleural effusions with overlying atelectasis.\n3.  No acute pulmonary embolism.\n4.  Unchanged hypodensity in the superior vena cava adjacent to the PICC line.\nGiven its unchanged appearance, nonocclusive thrombus is favored over mixing\nartifact.\n\nFindings were communicated to and acknowledged by Dr. ___ at 20h12 by\nK. ___, M.D."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced and normal in diameter.  Right\nlower paratracheal lymph node is stable and not pathologically enlarged,\nseries 3, image 23, 6 mm in diameter.  Heart size is normal.  There is no\npericardial effusion.  Left hilar lymph node is 6 mm, unchanged.  Image\nportion of the upper abdomen will be reviewed separately as part of the CT\nabdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bile.  Apical scarring, right\nmore than left is unchanged.  Centrilobular emphysema is mild to moderate,\nunchanged.  Pre-existing pulmonary nodules are all stable, series 5 images 46,\n52, 54, 69, 81, 215.  No new nodules masses or consolidations demonstrated.\n\nExtensive degenerative changes are demonstrated in the image portion of the\nspine.  No lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Stable pulmonary nodules with no evidence of new nodules, does most likely\nrepresenting benign etiology.\n\nUnchanged mild centrilobular emphysema.\n\nContinued annual screening as part of the low does lung cancer screening\nprotocol is recommended."
        },
        {
            "input": "5 and 6 mm bilateral supraclavicular lymph nodes are unchanged in size. \nSpecifically excluding the breasts which require mammography for evaluation,\nelsewhere in the chest wall there are no soft tissue abnormalities concerning\nfor malignancy.  Findings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels or coronary arteries. Aortic valve is not calcified. Aorta and\npulmonary arteries are normal size.\n\nPericardium is physiologic. There is no pulmonary abnormality. The posterior\nleft hemidiaphragmatic hernia (Bochdalek) transmits only subphrenic fat.\n\nLymph nodes:\n\n Subcentimeter lymph nodes in mediastinal paratracheal stations, and the left\nhilus are unchanged and not pathologically enlarged. There are no enlarged\nlymph nodes elsewhere in the chest.\n\nEsophagus is unremarkable.\n\nLungs:\n\nBiapical pleuroparenchymal scarring, bronchiectasis at the right apex is\nunchanged. Emphysema is moderate, widespread.\n\n2 and 3 mm nodules scattered in the lungs are unchanged, for example, right\nupper lobe, 05:46, left lower lobe, 5:89. There are no new or growing lung\nnodules or nodules large enough to raise concern for active malignancy.\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes. A few mildly\nprominent mediastinal lymph nodes measure no more than 5 mm in short axis.\nCoarsely calcified prevascular and AP window lymph nodes are incidentally\nnoted.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.\n\nThere is mild centrilobular and paraseptal emphysema. Biapical pleural\nscarring is present. A few pulmonary micronodules measuring up to 2 mm in the\nright upper lobe are present (04:  40, 43, 48, 98). A calcified left upper\nlobe granuloma is incidentally noted. There is no pleural abnormality.\n\nImages of the upper abdomen are unremarkable.\n\nThere is a small fissure in the left diaphragm transmitting only subphrenic\nfat.",
            "output": "No evidence of intrathoracic malignancy.\n\nA few punctate pulmonary micronodules measuring no more than 2 mm have a low\nindex of suspicion for malignancy.\n\nMild emphysema."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  Again seen is a calcified\nprevascular lymph node.\n\nThe aorta and pulmonary arteries are normal in size.  There is mild aortic\ncalcification.  The heart is normal in size and demonstrates no appreciable\ncoronary artery calcifications. There is no pericardial effusion.\n\nAgain seen is mild centrilobular emphysema.  Biapical pleural scarring is\nunchanged from prior.  A calcified left upper lobe granuloma is unchanged.  A\nfew solid micronodules are unchanged from prior, including a 2 mm nodule in\nthe left upper lobe (04:36), a 3mm nodule in the left lower lobe (04:206), and\nfive 2 mm nodules in the right upper lobe (04: 36, 38, 45, 80).  There no new\npulmonary nodules.  No pneumothorax or pleural effusion is identified. The\nairways are patent to the subsegmental level.\n\nIncidental note is made of a T9 hemangioma.  No suspicious osseous lesions are\nidentified.\n\nAgain seen is a small amount of subphrenic fat herniating through the left\ndiaphragm.  This examination is not tailored for the evaluation of\nsubdiaphragmatic contents.  Within this limitation, the included portions of\nthe upper abdomen are grossly unremarkable.",
            "output": "1.  Several pulmonary nodules measuring less than 3 mm are unchanged from the\nprior CT and have a very low likelihood of becoming clinically active cancer,\nfor which annual screening in 12 months is recommended.  No new or growing\npulmonary nodules.\n\n3.  Mild centrilobular emphysema, unchanged.\n\nRECOMMENDATION(S):  Continue annual screening with CT in 12 months"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is overall\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Diffuse hypodensity of the liver is noted consistent with\nhepatic steatosis.  Otherwise, visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal adenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  Moderate coronary\nartery calcifications are noted, most significant in the LAD.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Previously seen 1.1 cm FDG avid right upper lobe nodule\nmeasures 1.2 cm on today's exam (series 5; image 75).  There is no additional\n6 mm nodule at the right lung apex (series 5; image 48), which was not avid on\nPET.  Superior to this, there is an additional 6 mm nodule (series 5; image\n42), which was also not FDG avid on prior exam.  These areas may represent\napical scarring.  There is background, subpleural, lower lobe predominant\ncystic change with suggestion of pulmonary fibrosis.  There is no focal\nconsolidation or additional concerning areas nodularity.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Main, right, and left pulmonary arteries are normal in size.\nCHEST CAGE: There is mild kyphosis without acute compression fracture of the\nthoracic spine.  There is no concerning sclerotic or lytic lesion.",
            "output": "1. Re-demonstration of 1.1 cm FDG avid right upper lobe nodule, measuring 1.2\ncm on today's exam, without new or enlarging nodules.  Recommend tissue\nsampling of this right upper lobe nodule, if not previously performed.\n2. Multiple additional areas of nodularity at the right lung apex may\nrepresent scarring and attention on follow-up is recommended.\n3. Subpleural pulmonary fibrosis, with a lower lobe predominance, is seen\nthroughout both lungs and similar to PET-CT in ___.\n\nRECOMMENDATION(S):  Recommend tissue sampling of right upper lobe nodule,\nwhich is FDG avid, if not previously performed."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  The small anterior mediastinal lymph nodes are unchanged.  There is\nmild cardiomegaly.  There is moderate coronary artery calcification.  There is\nno pericardial effusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is evidence of wedge resection the right upper lobe in the\ninterim.  The right upper lobe pulmonary nodule has been resected.  Soft\ntissue surrounding the surgical sutures is unchanged.  No new or growing\npulmonary nodules.  The interstitial abnormality comprising of peripheral\nfibrosis with evidence of bronchiolectasis and bronchiectasis in both lower\nlobes is unchanged.  The interstitial lung disease could be related to\nfibrotic NSIP.  The the subtle ground-glass opacification seen on the prior\nstudy has improved in interim.  No new or growing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  There are degenerative changes involving the\nthoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of the liver.  No adrenal masses are seen.",
            "output": "Status post wedge resection in the right upper lobe in the interim.  No\nevidence of local recurrence.\n\nInterstitial abnormality comprising of peripheral fibrosis and\nbronchiolectasis bilaterally is unchanged most likely represents fibrotic\nNSIP.  No new or growing pulmonary nodules.\n\nFatty liver."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the imaged chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis but shows fatty liver and no adrenal mass.\n\nCARDIO-MEDIASTINUM:Esophagus at the level of the enlarging adjacent subcarinal\nmediastinal nodes is generally thickened, and may be infiltrated.  Above that\nlevel the esophagus is not distended.\n\nTHORACIC LYMPH NODES: 11 mm right posterior paraesophageal lymph nodes are\ngenerally larger, up to 12 mm, previously 7 mm.  Subcarinal lymph nodes 14 mm,\npreviously 11 mm.  Right diaphragmatic nodes 7 mm, previously 4 mm.\n\nLUNGS, AIRWAYS, PLEURAE: Extensive circumferential right pleural thickening\nand small effusion, have increased since ___, extending from the apex\nto the base and involving all pleural surfaces.\n\nNew tissue at the site of right lung wedge resection strongly suggests local\nmalignant recurrence, 5:108-119.\n\nNew peripheral consolidative lesions, right upper lobe anterior segment, and\nright lower lobe, lateral basal segment, 5:136, 237 could be pneumonia or\nrapidly developing malignancy.\n\nEmphysema and peripheral pulmonary fibrosis are chronic and severe.\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "New extensive right pleural thickening, moderate partially loculated right\npleural effusion and tissue deposited at the site of rightupper lobe lung\nresection are almost certainly malignant.  2 areas of new relatively high\nattenuation consolidation in the right lung could be infection or other\nrapidly growing tumor deposits.\n\nMild central lymph node enlargement.\n\nSevere emphysema and pulmonary fibrosis."
        },
        {
            "input": "HEART AND VASCULATURE: No definite evidence of arterial extravasation or\npseudoaneurysm is identified within the thorax.  Pulmonary vasculature is well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The patient is status post right upper lobe wedge resection. \nThere is a large right pneumothorax with near complete collapse of the right\nlung.  There is a heterogeneous, air containing right pleural effusion\ncontaining mixed density fluid, compatible with hemothorax, with high-density\nmaterial suggestive of an acute component.  No evidence of active\nextravasation.  A right-sided chest tube is seen with tip terminating within\nthe right upper lung.  There is diffuse centrilobular and paraseptal emphysema\nin the left lung.  Additionally, there is mild interval increase in peripheral\nfibrosis in the left lung.  Ill-defined ground-glass opacities in the left\nupper lobe are nonspecific but suggestive of an inflammatory or infectious\nprocess.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Large right hemothorax with a probable acute component, without evidence of\nactive extravasation, pseudoaneurysm, or other source for the hemorrhage.\n2. Large right pneumothorax with near complete collapse of the right lung. \nRight-sided chest tube appears in appropriate position.\n3. Ill-defined ground-glass opacities in the left upper lobe, nonspecific but\nsuggestive of an inflammatory infectious process.\n4. Diffuse emphysematous and peripheral fibrotic changes in the left lung."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Atherosclerotic calcifications of the coronary arteries\nand thoracic aorta noted.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is redemonstration of a large right hydropneumothorax\nwith a drain seen in situ.  There is thickening of the surrounding pleura,\nwhich is suggestive of an empyema, however the previously seen gas within the\npleural effusion is not seen on today's exam.\n\nLUNGS/AIRWAYS: Patient is status post right upper lobe wedge resection.  Again\nseen is complete collapse of the remaining right lung, similar in appearance\nto the prior exam.  There is substantial emphysema but even more striking is\nsimilar pulmonary fibrosis.  These are combine.  There is redemonstration of\nill-defined ground-glass opacities throughout the left lung, which have\nprogressed since the prior PET-CT from ___.  Some areas of\nground-glass opacities are more organized and demonstrate a crazy paving type\nappearance, particularly at the intersection of the upper and lower lobes. \nOverall, these have increased since the recent prior PET-CT.  Left-sided\nairways are patent to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Liver demonstrates substantial fatty infiltration\n\nBONES: There is a 1.1 cm and a 0.7 cm sclerotic lesion in the T11 vertebral\nbody.  Also seen is a 1.1 cm sclerotic lesion in the T3 vertebral body. \nAlthough these lesions were present on the prior PET-CT, they are new from the\nprior chest CT from ___.  Additional sclerotic metastasis involves the\nleft lateral ninth rib.  Sclerotic foci in the right third and fourth ribs, as\nwell as a sclerotic right lateral seventh rib lesion, have also appeared since\n___.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Ill-defined ground-glass opacities throughout the left lung, which have\nprogressed since the prior PET-CT.  Some areas demonstrate a crazy paving type\nappearance. Overall differential includes infectious etiology such as\ninfectious pneumonia versus drug (pembrolizumab) induced lung injury.  Less\nlikely etiologies include pulmonary edema or hemorrhage.\n3. Multiple sclerotic lesions consistent with metastatic disease.\n4. Redemonstration of a large right hydropneumothorax with a drain seen in\nsitu.  Thickening of surrounding pleura may suggest a empyema.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:15 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged although there is\nnew edema in the right lateral chest wall extending into the axilla.\n\nNew or growing subcutaneous nodules, sub muscular 2:73 and subcutaneous in the\nlateral thoracoabdominal wall, ___ are probably tumor implants.  This\nstudy is not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nmass.  Liver evaluation would require dedicated hepatic imaging.\n\nCARDIO-MEDIASTINUM: Circumferential wall thickening of the esophagus from\nlevel of the left main bronchus to the right superior pulmonary vein has\nimproved since ___.  Inferior to that the esophagus is moderately\npatulous in distended with air.  Findings suggest esophagitis perhaps\nradiation induced.\n\nAtherosclerotic calcification is mild to moderate in head and neck vessels,\nmore pronounced in at least left anterior descending coronary artery.  Aortic\nvalve is not calcified.  Aorta and pulmonary arteries are normal size. \nThickened pericardium encases a small residual pericardial effusion.\n\nTHORACIC LYMPH NODES: Tumor and atelectasis surrounding obscure the borders of\nthe right hilum.  Vascular clips denote prior resection, perhaps upper\nlobectomy, but there is no patent right bronchial tree below the level of the\nupper lobe bronchial takeoff.\n\nLUNGS, AIRWAYS, PLEURAE: Pulmonary fibrosis is severe.  Previous left lower\nlobe pneumonia has resolved.\n\nRight lung is now entirely collapsed.  More than half the volume of the right\nhemithorax is occupied by pleural fluid despite in the pleural drainage\ncatheter traversing most of the fluid loculation.  Circumferential pleural\nthickening has increased and adjacent induration in the right lateral chest\nwall, 2:92 suggests transthoracic extension of tumor and thoracic contents\ninto the chest wall musculature, 2:102.\n\nCHEST CAGE: New and growing blastic lesions and an adjacent to this is growing\nblastic lesions in the third and sixth thoracic vertebrae and a new lytic\nlesion in the eleventh vertebrae are presumably metastases, following\ntreatment.  Although there are no pathologic fractures there are new lytic and\nblastic severe pulmonary fibrosis.  In right third and fourth ribs due to\nmetastasis.",
            "output": "Progression since ___ of intrathoracic and chest wall malignancy,\ninvolving the right pleural space, now and completely filled with fluid and\nirregularly thickened pleura; right subcutaneous and sub muscular soft tissues\ncontaining growing; the right hilus with an enlarging mass, combining to\ncollapse the entire right lung; growing blastic and lytic osseous metastases,\nbut no vertebral compression fracture or clear evidence of vertebral canal\ninvasion..\n\nPrevious pneumonia left lung is resolved."
        },
        {
            "input": "HEART AND VASCULATURE: The right pulmonary arteries are not well evaluated\ngiven severe atelectasis of the right lung in the setting of a large right\npleural effusion, however there is no right mainstem pulmonary embolism. There\nis narrowing of the distal right main pulmonary artery and proximal branches. \nPostsurgical changes are seen in the right lung.  The left pulmonary artery is\nwell opacified to the segmental level without filling defect to indicate a\npulmonary embolus.  The subsegmental vessels are not well evaluated given\nsubstantial respiratory motion artifact.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: A large amount of right pleural fluid has a complex\nappearance, with layering hyperdensity, likely representing blood products..\n\nLUNGS/AIRWAYS: The patient is noted to be intubated.  There is occlusion of\nthe right mainstem bronchus and complete atelectasis of the right lung. \nSevere emphysematous changes of the left lung.  Numerous regions of\nground-glass attenuation in the left lung for example (series 3, image 44 in\nseries 3, image 63) may represent aspiration, multifocal infection, however in\nthe setting of recent rib trauma raise concern for developing pulmonary\ncontusions.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Fatty atrophy of the pancreas, otherwise included portion of the\nupper abdomen is unremarkable.\n\nBONES: Innumerable lytic and sclerotic lesions throughout the bones raise\nconcern for diffuse metastatic disease.  Acute fracture of the left anterior\nsecond, third, fourth and fifth ribs.  No additional fractures are identified.",
            "output": "1. Large right pleural fluid collection likely represents hemothorax.  A\nright-sided chest tube is noted.\n2. No evidence of pulmonary embolism in the right mainstem, the lobar and\nsegmental vessels are not well evaluated due to complete atelectasis of the\nright lung.  There is no central PE to the segmental level within the left\npulmonary arteries.  The subsegmental pulmonary arteries are not well\nevaluated secondary to motion artifact.  No acute aortic abnormality.\n3. Numerous regions of ground-glass attenuation in the left lung for example\n(series 3, image 44 in series 3, image 63) may represent multifocal aspiration\nor multifocal infection, however in the setting of recent rib trauma some of\nthese may raise concern for developing pulmonary contusions.\n4. Acute fracture of the left anterior second, third, fourth and fifth ribs. \nNo additional fractures are identified.\n5. Innumerable lytic and sclerotic lesions throughout the bones consistent\nwith diffuse metastatic disease.  Follow-up with PET-CT can be considered as\nclinically warranted."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  There are multifocal filling defects compatible with\npulmonary emboli.  The most proximal clots are seen within right middle and\nlower lobar pulmonary artery branches.  Subsegmental emboli identified in the\nright lower lobe.  Segmental pulmonary emboli are also identified in the left\nlower lobe.  There is no evidence of right heart strain.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Pulmonary emboli involving the right middle and lower lobar branches and\nsegmental branches of the of left lower lobe.  No evidence of right heart\nstrain.\n\nNOTIFICATION:  Findings discussed by Dr. ___ with Dr. ___ the phone\nat 19:30 on ___, 1 min after time of discovery."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a calcified granuloma in the left upper lobe measuring\n8 mm (series 2:31) there is mild dependent atelectasis in bilateral lower\nlobes..  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: The thyroid is enlarged and heterogeneous containing multiple\nhypoattenuated nodules measuring up to 1.1 cm in  the left lobe (series 3:21)\nand up to 1.2 cm in right lobe (series 3:9).\n\nABDOMEN: There is a partially visualized hypoattenuated rounded focus in the\nright kidney which likely represents a simple cyst (series 2:106).\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Heterogeneous and enlarged thyroid with multiple hypoattenuating nodules\nmeasuring up to 1.1 cm the left lobe and 1.2 cm right lobe.  The thyroid was\nincompletely imaged on multiple prior CTA chest.  Nonurgent outpatient thyroid\nultrasound is recommended for further characterization.\nStudy reviewed with Dr. ___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis in the bilateral lower\nlobes.  Lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Again seen are multiple hypodense thyroid nodules, which are\npartially obscured by streak artifact.  Hypodense nodule in the left thyroid\nlobe measures up to 1.5 cm.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Again seen are multiple hypodense thyroid nodules, measuring up to 1.5 cm. \nIn the absence of prior work-up, an outpatient nonemergent thyroid ultrasound\nmay be performed to further assess."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Note is made of aneurysmal appearance of peripheral\npulmonary arteries in the lung bases (right, 301:151; left 301:141), which are\nnonspecific but may be related to prior pulmonary embolism.  There is a subtle\ncentral filling defect in the former, probably representing sequelae from\nchronic PE.  The heart, pericardium, and great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is minimal dependent atelectasis.  There is a 7 mm\ncalcified granuloma in the left upper lobe (301:50), and right upper lobe\n(301:96) Which appears unchanged compared to prior.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid gland is heterogeneous and enlarged containing\nmultiple hypodense nodules measuring up to 1.5 cm (301:19), similar to prior..\nOtherwise, visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of acute pulmonary embolism or aortic abnormality.\n2. Small aneurysmal changes of a couple small pulmonary artery branches are\nnonspecific and may be related to prior episodes of pulmonary embolism. \nSubtle linear central nonocclusive filling defect at the right base may\nrepresent chronic sequelae from prior PE.\n3. Heterogeneous enlarged thyroid with multiple hypodense nodules measuring up\nto 1.5 cm."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nNote is made of somewhat aneurysmal appearance of the peripheral pulmonary\narteries at the lung bases bilaterally, left greater than right (3:165), which\nare nonspecific but may be related to prior pulmonary embolism.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis.  Redemonstrated is a 6 mm\ncalcified granuloma in the left upper lobe (3:63) and a 2 mm calcified\ngranuloma in the right upper lobe (3:115), unchanged.  Otherwise, the lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Redemonstrated is an enlarged thyroid, with multiple bilateral\nthyroid nodules, the largest measuring up to 2.0 cm in the right lobe of the\nthyroid, previously measuring up to 1.8 cm in ___.  Otherwise, the\nvisualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for scarring at the\nupper pole the right kidney.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Enlarged thyroid with multiple bilateral nodules, the largest measuring up\nto 2.0 cm in the right lobe of the thyroid, previously measuring up to 1.8 cm\nin ___.  If no ultrasound has been performed since ___, recommend\nobtaining a thyroid ultrasound for further evaluation.\n\nNOTIFICATION:  If no ultrasound has been performed since ___, recommend\nobtaining a thyroid ultrasound for further evaluation of the thyroid nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.  No focal soft tissue lesions.\n\nUPPER ABDOMEN: The partially visualized upper abdomen demonstrates a 5.2 cm\nsimple cyst in the superior pole of the left kidney.  No acute findings are\ndemonstrated.\n\nMEDIASTINUM: No mediastinal masses.  No pathologically enlarged\nlymphadenopathy by CT size criteria.  There is an enlarged esophagus\ncontaining secretions.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is mildly enlarged with moderate to severe\natherosclerotic calcifications.  There is a trace pericardial effusion.  The\nthoracic aorta demonstrates mild-to-moderate atherosclerotic calcification\nwithout evidence of acute  injury.  The proximal thoracic aorta dilated up to\n4.2 cm.\nPLEURA: Bilateral pleural effusions, small in volume, right greater than the\nleft.\nLUNG:\n\n1. PARENCHYMA:  There is a dense focal consolidative opacification along the\nposterior right upper lobe, with substantial surrounding ground-glass and some\nseptal thickening anteriorly.  No cavitation is demonstrated.  There are\nbilateral pleural effusions, right greater than the left, with overlying\npassive atelectasis more prominent on the left.  An additional small area of\nground glass in the anterior left upper lobe (302:65) is noted.  Respiratory\nartifact somewhat limits evaluation for small lesions, however no large mass\nlesions are demonstrated.\n2. AIRWAYS:  Visualization of airway slightly limited secondary to motion\nartifact, however the airway appears patent to the level of the subsegmental\nbronchi bilaterally.\n3. VESSELS:  The main pulmonary artery is normal caliber.  The pulmonary\narterial vasculature is grossly within normal limits.\nCHEST CAGE: No acute or displaced fractures.  No suspicious osseous lesions. \nDegenerative changes are mild-to-moderate throughout the thoracic spine.",
            "output": "1. Consolidative opacification along the posterior right upper lobe with\nsurrounding ground-glass and septal thickening is consistent with pneumonia.\n2. An additional focus of ground-glass in the anterior left upper lobe may\nrepresent a multifocal site of infection.\n3. No cavitation or empyema is demonstrated.  There are bilateral non\nloculated, small, low-density pleural effusions, right greater than left.\n4. Dilatation of the ascending aorta up to 4.2 cm.  Recommend annual follow-up\nfor surveillance."
        },
        {
            "input": "The thyroid is unremarkable.\n\nThere is no supraclavicular or axillary lymphadenopathy by CT size criteria. \nMediastinal and hilar lymph nodes are difficult to evaluate without\nintravenous contrast.\n\nThe heart is normal in size, and there is no pericardial effusion.  Mitral\nvalve calcifications are noted.  The intrathoracic aorta is normal in course\nand caliber, with mild scattered calcifications present throughout.  The\npulmonary trunk is enlarged, measuring up to 4.1 cm in diameter (04:22),\nsuggestive of pulmonary arterial hypertension.\n\nThe airways are patent to the subsegmental levels.  There are severe bullous\nemphysematous changes bilaterally, most prominent in the right upper lobe. \nAdditionally, there are reticular opacities and severe honeycombing\npredominantly in the subpleural regions and lung bases bilaterally, findings\nsuggestive of UIP pattern and possibly indicating superimposed idiopathic\npulmonary fibrosis.  There is confluent density surrounding areas of\nhoneycombing in right lower lobe and to a lesser extent right upper lobe. \nApart from these areas there is no focal consolidation, pleural effusion or\npneumothorax.\n\nLimited images of the upper abdomen demonstrate a small hiatal hernia.  There\nis a 2 mm granuloma in the right lobe of the liver (03:53).  Intraluminal\nstones are seen within the gallbladder.  There is extrahepatic biliary ductal\ndilation to 1.2 cm without intrahepatic biliary dilation.  The ampulla is not\nimaged.  Several simple cysts are partially visualized in the left kidney, the\nlargest of which measures at least 6.2 x 5.2 cm.\n\nAssessment of the osseous structures demonstrates mild degenerative changes\nthroughout the thoracic spine.  No suspicious lytic or sclerotic lesions are\nidentified.",
            "output": "1.  Bilateral subpleural and basilar predominant honeycombing, suggestive of\nUIP pattern and possibly representing superimposed idiopathic pulmonary\nfibrosis in the setting of severe upper lobe predominant bullous emphysematous\nchanges.\n2.  Cannot exclude superimposed pneumonia in right lower and right upper\nlobes.  No pleural effusion or pneumothorax.\n3.  Enlarged pulmonary trunk measuring up to 4.1 cm in diameter, suggestive of\npulmonary arterial hypertension.\n4.  Cholelithiasis.\n5.  Small hiatal hernia.\n6.  Simple cysts in the left kidney."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: Small hiatal hernia.  Large incompletely imaged left renal\ncysts.\n\nMEDIASTINUM: Multiple calcified subcentimeter mediastinal lymph nodes.\nHILA: Subcentimeter left hilar lymph node measuring 7 mm in diameter (4, 98).\n\nHEART and PERICARDIUM: Cardiomegaly.  Severe mitral annular calcification. \nModerate LAD calcifications.  Suspected right coronary artery stent. \nRight-sided IJV central line in situ with the tip at the cavoatrial junction. \nNo significant pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  The extensive upper lobe bullous changes appear similar compared\nto previous imaging as well as the extensive bilateral subpleural and basal\nhoneycomb cystic changes. There has been marked interval decrease in the\nsuperimposed consolidation or retained edema.  Mild residual interstitial\nthickening/ consolidation seen in  right upper lobe bullae.  No new areas of\nairspace consolidation to suggest pneumonia.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  Severely enlarged pulmonary artery measuring 42 mm suggestive of\npulmonary arterial hypertension.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Severe emphysema and pulmonary fibrosis.\n\nThe volume of consolidation or retained edema or consolidation in the cystic\nright lung is less today than it was on the CT performed ___. \nReview of chest radiographs in ___ and in ___ since ___ show parallel\nchanges one year apart, specifically heterogeneous consolidation that improved\nover several days.  This could be pneumonia, but given the severity of\nemphysema and pulmonary fibrosis, recurfent pulmonary edema is much more\nlikely.\n\nThe predominantly subpleural and basal honeycomb cystic changes do not show\nsignificant interval progression over the last year."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere are no enlarged supraclavicular or axillary lymph nodes.\n\nMEDIASTINUM: Again seen are calcified mediastinal lymph nodes.  Unchanged\nsince ___.\n\nHILA: Evaluation for hilar adenopathy is limited without contrast.\n\nHEART and PERICARDIUM: Re- demonstrated are coronary artery calcifications and\nmitral annular calcification.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG:\n\n-PARENCHYMA:  There is new extensive right upper lobe parenchymal\nconsolidation compatible with pneumonia.  There is no air-fluid level to\nsuggest an abscess.  Evaluation for necrotizing pneumonia is limited without\nIV contrast.  The extensive upper lobe bullous changes are similar to the\nprior study.  Extensive subpleural and basilar honeycomb cystic changes are\nrelatively unchanged.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-\nUPPER ABDOMEN: Re- demonstrated is a left renal cyst, incompletely imaged and\ncholelithiasis.\n\nOSSEOUS STRUCTURES:  No concerning osseous lesions.",
            "output": "1. Worsening extensive right upper lobe pneumonia without evidence of abscess\nformation.  Evaluation for necrotizing pneumonia is limited without IV\ncontrast.\n2. Severe emphysema and pulmonary fibrosis with subpleural basilar honeycomb\nchanges are stable compared to previous imaging.\n This preliminary report was reviewed with Dr. ___\nradiologist."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: Centrilobular emphysema in the upper lumps. \nParaseptal emphysema upper lungs, with large subpleural blebs.  There is\npulmonary fibrosis, with peripheral, subpleural distribution honeycombing more\nprominent in the lower lungs, suggesting UIP.  There is mild mucous plugging\nin the right lower lobe, new since prior.  There is increased volume of fluid\nwithin large cavitary area in the right lung apex compared with ___, is new since ___.  No definite soft tissue component or\ncalcification.  .  Surrounding area of consolidation, nodularity has improved.\nAdditional small opacities in the bilateral lower lobes are new, represent\ninfection or aspiration.\nVessels: Enlarged central pulmonary artery, consistent with pulmonary artery\nhypertension.  Aorta is of normal caliber.  There are coronary artery\ncalcifications.\n\nMediastinum and Hila: Stable partially calcified mediastinal lymph nodes.  .\n\nHeart and Pericardium: Heart is enlarged.  Coronary artery calcifications. \nSuggestion of anemia.\n\nPleura: No pleural effusions.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: Left PICC line in place tip in the\nlow SVC.  No mass.  No adenopathy.\n\nUpper Abdomen: Chololithiasis.  No pericholecystic inflammatory changes. \nThere is benign simple left renal cysts, partially seen, stable.  Pancreas is\natrophic.  Small esophageal hiatal hernia.\n\nChest Cage: Degenerative changes spine.",
            "output": "Increased fluid within right upper lung cavity, suggesting residual infection,\nwith improved surrounding launch consolidation.  Few small nodules in the\nbilateral lower lobes, likely infectious, possibly aspiration.  Mild mucous\nplugging in the right lower lobe.\nUpper lung emphysema with lower lung fibrosis, UIP pattern.\nPulmonary artery hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular lymphadenopathy.\nA 0.9 cm hypodense left thyroid nodule is unchanged from prior and too small\nto warrant additional imaging follow-up.  1.2 cm hypodense right thyroid\nnodule is also similar prior.  No axillary lymphadenopathy.\n\nUPPER ABDOMEN: Limited view of the upper abdomen is unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy within limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart is normal size.  There is no significant coronary\nartery calcification.  Trace pericardial fluid is likely physiologic.\nPLEURA: There is been slight interval decrease in size of a now moderate right\npleural effusion.  A right PleurX catheter has been removed.  Small foci of\npleural air likely related to the catheter removal.  No left-sided pleural\neffusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Left lung is clear.  Postsurgical changes from prior right\nupper lobectomy are stable.  There are persistent multifocal areas of\nconsolidation throughout the right lung.  In the superior segment of the right\nlower lobe this appears similar to minimally increased compared to prior. \nAdditional areas of ground-glass opacity in the right lower lobe are also\nstable from prior.  Areas of consolidation in the right middle lobe are\nunchanged from prior.  Areas of consolidation in the basilar right lower lobe\nare also unchanged.  A 5 mm right lower lobe ground-glass nodule (5:88) is\nunchanged.  Additional left-sided pulmonary nodules unchanged (5:79, 229).\n2. AIRWAYS:  Status post right upper lobectomy.  Airways are otherwise patent\nto subsegmental levels bilaterally.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are normal caliber. \nThere is mild atherosclerotic calcification of the aortic arch.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.  Chronic\nappearing anterior left-sided rib fractures are noted.",
            "output": "1. No significant change in multifocal areas of consolidation and ground-glass\nthroughout the right lung.  Given lack of involvement of the left lung and\nlack of significant change in the interval, findings are less likely to\nrepresent pneumonitis or pneumonia respectively and are favored to represent\ntumor recurrence.\n2. Slight interval decrease in size of a now moderate right-sided pleural\neffusion."
        },
        {
            "input": "There is a 13 mm hypodense right thyroid nodule.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe great vessels are normal caliber.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels.  Post surgical changes from\nright upper lobectomy are present. Linear scarring along the surgical margin\nis expected. Mild radiation fibrosis is noted in the peripheral right upper\nlobe (series 4, image 148). There is no evidence of disease recurrence. No\nsuspicious pulmonary nodules are identified. There is no focal consolidation,\npleural effusion, or pneumomediastinum.\n\nThe esophagus is unremarkable. Limited views of the upper abdomen are\nunremarkable. Mild thickening of the left adrenal gland is not changed dating\nback to ___.\n\nThe superficial soft tissues are normal.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Postsurgical changes from right upper lobectomy without evidence of disease\nrecurrence or intrathoracic metastatic disease.\n2. 13 mm right thyroid nodule.\n\nRECOMMENDATION(S):  Nonemergent thyroid ultrasound to evaluate 13 mm right\nthyroid nodule."
        },
        {
            "input": "MEDIASTINUM/HEART:  A 1.2 cm right thyroid nodule is unchanged since ___. Supraclavicular, axillary, mediastinal and hilar lymph nodes are not\nenlarged by CT size criteria.  The aorta and main pulmonary artery are normal\nin size.  No incidental pulmonary arterial filling defect detected.  Heart\nsize is normal with minimal coronary artery calcifications.  The pericardium\nis physiologic.\n\nLUNGS/AIRWAYS:  Again, the patient is post right upper lobectomy, with chemo\nradiation therapy.  Focal right-sided pleural thickening at the site of\nradiation fibrosis is unchanged.  No evidence of pneumothorax.\n\nThe bronchial stump is unchanged in appearance, with stable paramediastinal\nfibrosis.  The previous consolidation involving the medial right lower lobe is\nsimilar in appearance, with a triangular morphology and persistent central air\nbronchograms (4:106).  Given the history of radiation treatment, this likely\nreflects evolving radiation changes.\n\nThe previous punctate solid and ground-glass nodules throughout the bilateral\nlungs are unchanged (4:50, 63, 65, 66, 77, 119, 158, 178, 181, 188, 189).  No\nincrease in the solid components of the ground-glass nodules.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the visualized portions of the liver, spleen,\npancreas, and bilateral adrenal glands are unremarkable.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Multilevel mild degenerative changes of the thoracic spine are\nunchanged.",
            "output": "1.  Evolving radiation changes are denoted by slightly increased consolidation\ninvolving the medial right lower lobe.  Close attention on followup studies is\nrecommended to exclude recurrent disease.\n\n2.  Multiple nodules throughout the bilateral lungs are unchanged, without new\nsolid components in the ground-glass nodules."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodense right lobe of thyroid\nlesion unchanged.  No supraclavicular or axillary adenopathy.  No gross breast\nlesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Possible small hiatal hernia.  No adrenal lesions.\n\nMEDIASTINUM: No new or enlarging mediastinal adenopathy.\n\nHILA: No new or enlarging hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Minimal sub cardiac\npericardial fluid.  No aortic valve or coronary artery calcifications.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  There is complete atelectasis of the right middle lobe medially\nagainst the mediastinum.  The right perihilar confluent fibrosis appear\nsimilar compared to prior imaging.  Scarring and pre-existing millimetric\nnodules in the right lower lobe unchanged.  No new or enlarging pulmonary\nnodules.\nThe pre-existing ground-glass nodules in the left lung are stable.\n-AIRWAYS:  The middle lobe segmental bronchi are completely collapsed.\n-VESSELS:  The pulmonary artery is not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "There is complete collapse of the right middle lobe and attenuation of the\nmiddle lobe segmental bronchi.\n\nNo new or enlarging mediastinal or hilar adenopathy.  No new or enlarging\npulmonary nodules or masses.\n\nRECOMMENDATION(S):  Bronchoscopy advised to evaluate the etiology of the right\nmiddle lobe proximal segmental bronchial attenuation and lobar collapse"
        },
        {
            "input": "HEART AND VASCULATURE: Minimal atherosclerotic calcification of the thoracic\naorta.  Air within the main pulmonary artery is likely due to peripheral\ninjection.  The thoracic aorta is normal in caliber.  Otherwise, heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Status post right upper lobectomy.  Stable radiation fibrosis\nalong the right mediastinum and hilum including volume loss and traction\nbronchiectasis.  Stable scarring within the right lower lobe.  Numerous solid\nand ground-glass nodules throughout the lungs bilaterally are stable.  The\nlargest is a ground-glass nodule within the left lower lobe measuring 4 mm\n(series 5, image 236).  No new or growing nodules.  No new focal\nconsolidations.  The right upper lobe bronchial stump is normal in appearance.\nOtherwise, the airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Hypodense nodule within the right lobe of the thyroid measures\n13 x 8 mm, unchanged (series 5, image 36).\n\nABDOMEN: Mild thickening of the left adrenal gland is unchanged since at least\n___.\n\nBONES AND SOFT TISSUES: Coarse calcification within the left breast.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Status post right upper lobectomy with stable radiation fibrosis. Numerous\nsmall stable nodules throughout the lungs bilaterally measuring up to 4 mm. \nNo new or growing nodules.  No lymphadenopathy."
        },
        {
            "input": "HEART AND VASCULATURE: Minimal atherosclerotic calcification of the thoracic\naorta is again seen.  There is no evidence of pericardial effusion. \nOtherwise, the great vessels are within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary, mediastinal or hilar\nlymphadenopathy.\n\nPLEURAL SPACES: Small to moderate right pleural effusion, has progressed\ncompared to the prior exam, with increasing adjacent atelectasis.\n\nLUNGS/AIRWAYS: Patient is status post right upper lobectomy.  Radiation\nfibrosis along the right mediastinum and hilum including volume loss and\ntraction bronchiectasis is seen.  Scarring within the right lower lobe is also\nunchanged compared to the prior exam.  Multiple ground-glass nodules\nbilaterally are re-demonstrated.  For example:\n\n-a 6 mm ground-glass right upper lobe nodule, series 5, image 70 appears\nmillimetrically increased in size compared to the prior exam at which time\nthis measured up to 5 mm.\n\n-a 0.4 cm ground-glass nodule within the right middle lobe, series 5, image\n169 is unchanged compared to the prior exam.\n\n-right lower lobe ground-glass nodules measuring up to 4 mm, series 5, image\n135 appear grossly unchanged compared to the prior exam.\n\n-a mixed solid and ground-glass nodule within the right lower lobe, measures 5\nmm series 5, image 200, unchanged compared to the prior exam.\n\n-a 5 mm peripheral ground-glass nodule, series 5, image 203 within the right\nlower lobe, is unchanged compared to the prior exam.\n\n-a 3 mm ground-glass nodule within the peripheral aspect of the left lower\nlobe, is unchanged compared to the prior exam, series 5, image 171.\n\n-a 5 mm ground-glass nodule within left lower lobe, series 5, image 228 is\nunchanged compared to the prior exam.\n\nBASE OF NECK: A 0.9 cm lesion is seen within the inferior aspect of the right\nthyroid lobe.  A 0.5 cm hypodense lesion is seen within the mid aspect of the\nleft thyroid lobe.  There is no supraclavicular lymphadenopathy.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No focal lytic or sclerotic lesions are seen.",
            "output": "1. Overall, millimetric interval increase in a 6 mm ground-glass nodule within\nthe right upper lobe, compared to the prior exam.  The remainder of the\nnodules bilaterally are unchanged compared to the prior exam.\n2. Status post right upper lobectomy, with stable postoperative changes and\nradiation fibrosis.\n3. Interval increase in small to moderate pleural effusion localized to the\nright upper lobe.\n4. No lymphadenopathy."
        },
        {
            "input": "BASE OF NECK: The visualized portion of the thyroid is multinodular with a 6\nmm left thyroid nodule demonstrated.\n\nHEART AND VASCULATURE:  The thoracic aorta contains atherosclerotic\ncalcifications though is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  Patient is status post right upper lobectomy with surgical material\nand postoperative changes visualized along the right superior mediastinum.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: There is re-demonstration of a moderate right pleural effusion\nstatus post PleurX catheter placement with a catheter tip that terminates at\nthe right lung apex.\n\nLUNGS/AIRWAYS: Multifocal airspace consolidations are visualized in the right\nupper, right middle, and right lower lobes which may represent ongoing\ninfectious process though intraparenchymal hemorrhage cannot be excluded on\nthe basis of a nonenhanced scan.  5 mm right upper lobe ground-glass nodules\nunchanged (5:76).  Additionally, left lower lobe ground-glass nodules measures\n3 mm (5:176) in the peripheral aspect, and 5 mm (5:227) in the paramediastinal\naspect, and remain unchanged.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multifocal airspace consolidation in the right upper, right middle, and\nright basilar lung, which may reflect ongoing infectious process though\nintraparenchymal hemorrhage cannot be excluded and clinical correlation is\nrecommended.\n2. Moderate right pleural effusion status post PleurX catheter placement with\na catheter tip that terminates at the right lung apex for which repositioning\nmay facilitate further pleural drainage.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:34 pm."
        },
        {
            "input": "The exam is technically limited by a combination of inadvertent expiratory\nphase of respiration and motion artifact.  With these limitations in mind, an\nirregularly marginated, lateral segment right middle lobe nodule measuring 7\nmm x 5 mm (204, 5) has slightly grown from 6 mm x 4 mm in ___ and\nfrom 4 mm x 3 mm in ___.\n\nAssessment of the remainder of the lungs is remarkable for severe bullous\nemphysema and a focal area of nonspecific scarring at the left apex\nposteriorly.  As well as additional scarring the middle lobe and lingula.\n\nSoft tissue structures of the thorax demonstrate no enlarged intrathoracic\nlymph nodes.  Subcentimeter nodes are similar to ___ chest CT. \nHeart size is normal, and severe diffuse coronary artery calcifications are\npresent.  No pericardial or pleural effusion is seen.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of dependent calcified gallstones within the gallbladder.  Adrenal glands\nare not enlarged.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.  A small sclerotic focus in the lower thoracic spine is\nlikely a benign bone island in appears unchanged (76, 8).",
            "output": "1.  A right middle lobe lung nodule has substantially grown since ___\nand show slight interval growth since more recent CT of ___. \nBased on its morphology and growth over time, it is highly suspicious for a\nprimary lung cancer in this patient with advanced emphysema.\n\n2.  Diffuse coronary artery calcifications."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThis study is not appropriate for subdiaphragmatic diagnosis but shows normal\nsize adrenal glands.  Both breast prostheses have calcified capsules\nindicating low-grade inflammation perhaps due to micro perforation.  There is\nhowever no appreciable reaction in the adjacent soft tissue of the anterior\nchest wall.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is minimal in head and neck vessels not apparent\nin coronary arteries.  Aorta and main pulmonary artery are normal size. \nPericardium is physiologic.  There is no pleural effusion.  Multiple\nmediastinal lymph nodes are of measurable size, but not pathologically\nenlarged ranging in diameter up to 9 mm in the right lower paratracheal\nstation.  Hilar contours on this noncontrast study do not suggest appreciable\nlymph node enlargement.  There is no pathologic enlargement of lymph nodes\nanywhere in the chest.\n\nLungs:\n\nScar-like appearance at the site of several sites of lung wedge resection are\ngrossly unchanged since ___.  There are no comparable prior imaging\nstudies after the surgeries.\n\nUnremarkable post ablation enlargement of the left upper lobe nodule, now 13 x\n13 mm, 02:22, previously 9 x 12 mm.\n\n3 and 4 mm left upper lobe solid nodules, 2:23, 24, are unchanged ___.  A cluster of small nodules, 9 mm in diameter common the superior\nsegment of the right lower lobe, 4:101, is grossly unchanged since ___, but\nmore confluent than it was in ___.  .\n\nMultiple smaller nodules scattered through the lungs are too small to compare\nto any prior study.  A repeat chest CT in 6 months is recommended for that\ncomparison.\n\nA peripheral crescentic lesion at the right lung base, probably rounded\natelectasis, is bigger today than it was in ___.  There are no bone lesions\nin the chest cage suspicious for malignancy or infection.\n\n\n\n\n\n\n\n\n\n\n\n.",
            "output": "Left upper lobe lesion has unremarkable appearance following ablation in\n___.\n\nMultiple sites of lung wedge resection and many small lung nodules do not have\nsufficient antecedent imaging to make reliable comparison in order to detect\nunfavorable changes.  Other nodules are probably stable since ___.\n\nRECOMMENDATION(S):  Conventional chest CT in 6 months to compare multiple lung\nlesions to today's study.  Nodules were growth is detected can be re-evaluated\nwith FDG PET-CT scanning at that time."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Patient is status post resections of the right upper\nlobe, right lower lobe, left upper lobe, and left lower lobe as well as\nradiofrequency ablation of a left upper lobe nodule in ___ with scarring of\nthe lung parenchyma, similar in appearance compared to prior.\n\nPreviously ablated left upper lobe nodule measures 1.0 x 1.0 cm, slightly\ndecreased in size compared to ___ (4___ 89).  The adjacent slightly\nposterior 5 mm left upper lobe nodule (4; 32) is unchanged in size since ___.\nThere is a 1.0 x 0.6 cm left upper lobe nodule without significant change (4___\n89).  Slightly more inferior left upper lobe nodule measuring 5 mm is similar\nto prior (4; 101).  Additional micro nodules in the left lung are similar to\nprior.  Scattered bilateral ground-glass nodules are overall similar to most\nrecent prior.\n\nThere is an 8 mm right upper lobe nodule adjacent to suture line from prior\nwedge resection, measuring similar to prior (4; 61).\nRight lower lobe opacity previously noted to be rounded atelectasis is\nunchanged since ___ (4; 76).  Cluster of nodules in the right lower lobe\nmeasuring mm in diameter is relatively unchanged since ___.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: Bilateral densely calcified capsules of bilateral breast\nimplants are again noted.  In the anterior T3 vertebral body, there is a 0.7\ncm sclerotic focus similar in size to ___.  Multilevel degenerative\nchanges are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Overall no significant change in multiple bilateral pulmonary nodules\ncompared to prior from ___. No new pulmonary nodules were noted."
        },
        {
            "input": "CHEST PERIMETER: No thyroid lesions warrant further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not pathologically enlarged. \nSpecifically excluding the breasts-patient has bilateral mammary\nimplants-which require mammography for evaluation, elsewhere in the partially\nimaged chest wall there are no soft tissue abnormalities concerning for\nmalignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal abnormality.\n\nCARDIO-MEDIASTINUM:Esophagus is mildly patulous, as before.\n\nAtherosclerotic calcification is minimal in head and neck vessels, not\napparent in the coronary arteries.  Aorta and pulmonary arteries are normal\nsize.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: 11 mm wide right lower paratracheal lymph node, 4:84,\nunchanged since at least ___ is difficult to separate from the right\npulmonary artery on this noncontrast study.  9 mm right posterior\nparaesophageal node, 4:103, stable since at least ___.  Elsewhere in\nthe chest there are no pathologically enlarged or growing lymph nodes.\n\n\n\nLUNGS, AIRWAYS, PLEURAE:\n\nRight lung: Sites of wedge resection in the right upper and lower lobes are\nstable since ___.  Also stable are multiple right lung lesions,\nmostly ground-glass, but some soft tissue in texture, such as 10 mm lesion in\nthe right lower lobe superior segment, 4:97.  Substantially larger in the\nright lung is a peripheral lobulated opacity in the lower lobe which might\nhave been called atelectasis previously but now has a more masslike\nappearance, 16 x 26 mm at a level, 4:169, which was no larger than 9 x 17 mm\nin ___.  On the sagittal view, extension to the inter costal plane is\nevident, 602:27 and the diameters at a comparable comparable level, 21 x 16 mm\ntoday, compared to 12 x 15 mm, do not reflect the change in shape which\nindicates at least a doubling of volume.  There is no pleural effusion.\n\nLeft lung: The site of the large wedge resection in the left upper lobe\nincluding a nearby 6 mm nodule, 0 ___, is unchanged.  A subpleural mass\nin the posterior segment of the left upper lobe, is unchanged, 4:88.\nMany smaller lung nodules, mostly ground-glass in attenuation are stable and\nthere are no new lesions.\n\n\nCHEST CAGE: Solitary blastic lesion in an upper thoracic vertebral body is\nstable and has a benign appearance.  Although there are no bone lesions in the\nimaged chest cage suspicious for malignancy or infection, it should be noted\nthat radionuclide bone and FDG PET scanning are more sensitive in detecting\nearly osseous pathology than chest CT scanning.",
            "output": "Substantial interval growth of one solid mass, right lower lobe, with possible\npleural extension into the intercostal plane is concerning for malignancy.  If\ntreatment is contemplated, radionuclide FDG PET scanning or transthoracic\nneedle aspiration sampling is recommended for assessment to distinguish an\nunusual configuration of atelectasis from neoplasm.\n\nSites of multiple lung wedge resections and other small lung lesions, some\nground-glass, some solid, some mixed density are all stable since at least\n___."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are calcified bilateral breast implants.  There are\nno enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is no pericardial effusion.  The airways are patent up to the\nsubsegmental level.\n\n\nPLEURA: There is a small right pleural effusion, new since the prior study\n\nLUNG: Patient status post radiofrequency ablation of the right lower lobe mass\nin the interim.  The mass like opacity now measures 4.5 x 3.0 cm, most likely\nrepresents evolving post ablation changes however continued follow-up to\nexclude underlying recurrence is recommended.\n\nThere are stable postsurgical changes following wedge resection in both upper\nlobes.  Several nodular opacities adjacent to the surgical sutures in the left\nupper lobe are unchanged.  Several bilateral pulmonary nodules and nodular\nopacities ranging in size from 2 mm is 8 mm (3, 26) are also unchanged in\nsize.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows stable sclerotic focus within T4\nvertebral body (series 602, 66), unchanged since the prior study.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  No focal liver lesions are seen",
            "output": "Status post ablation of the right lower lobe nodule in the interim.  Evolving\npost ablation changes in the right lower lobe.  Continued follow-up to exclude\nlocal recurrence is recommended.\n\nStable postsurgical changes to both upper lobes.  Several pulmonary nodules\nranging in size from 2-8 mm are unchanged in size number and distribution\nsince the prior study.  No new pulmonary nodules.  Continued follow-up is\nrecommended.\n\nBilateral calcified breast implants."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is homogeneous in\nattenuation throughout.  Chest wall is unremarkable.  Supraclavicular and\naxillary nodes are not enlarged by size criteria.\n\nUPPER ABDOMEN:  Portions of the pancreatic body and tail are not visualized.\n\nMEDIASTINUM: Central lymph nodes are not enlarged, measuring up to 6 mm in the\nright lower paratracheal station.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Pericardium is physiologic. \nCoronary artery and aortic valvular calcifications are diffuse and severe. \nMitral annular calcifications are mild.\n\nPLEURA: Pleural surfaces are smooth, without pneumothorax or effusion.\n\nLUNG:\n\n1. PARENCHYMA:  Subpleural ground-glass opacities and cystic change in the\nanterior right upper lobe, consistent with post-inflammatory change (4:105). A\nleft lower lobe subpleural nodule measures less than 4mm on average (4:180).\n2. AIRWAYS:  Tracheobronchial tree is patent to the subsegmental levels. \nBronchial wall thickening is mild.\n3. VESSELS:  Pulmonary arteries are normal in caliber.  Ascending aorta\nmeasures up to 47 mm in diameter (4:125).  There are no appreciable wall\ncalcifications along the ascending aorta.\nCHEST CAGE: No suspicious lytic or sclerotic lesions are identified.",
            "output": "1. No appreciable anterior ascending aortic wall calcification beyond the\nheavily calcified aortic valve.\n2. Severe diffuse coronary artery calcifications\n3. Non-specific post-inflammatory changes in the anterior right upper lobe.\n4. Incidental sub-4 mm left lower lobe subpleural nodule.  A follow-up CT is\nrecommended if the patient is a smoker. No additional follow-up is indicated\nin low-risk patients.\n\nRECOMMENDATION(S):  In the case of nodule size <= 4 mm: No follow-up needed in\nlow-risk patients. For high risk patients, recommend follow-up at 12 months\nand if no change, no further imaging needed."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular lymph nodes are increased in number but normal in size and\nmorphology, likely reactive.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  The\npulmonary arteries are well opacified to the subsegmental level bilaterally\nwithout filling defect to suggest pulmonary embolism.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis mild dependent atelectasis bilaterally.  There is no emphysema.\n\nAIRWAYS:  There is diffuse mild bronchial wall thickening.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\npartially imaged probable splenomegaly with the spleen measuring up to 20 cm\nin axial ___ (4:203).  Small retroperitoneal and retrocrural lymph\nnodes do not meet CT size criteria for pathologic enlargement..",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Diffuse mild bronchial wall thickening may reflect small airways disease. \nNo consolidation to suggest pneumonia.\n3. Incompletely imaged moderate splenomegaly."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysm formation.  There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma .\n\nThe pulmonary arteries are poorly opacified due to bolus timing.  Consequently\nevaluation is only possible to the level of the lobar pulmonary arteries. \nWithin these limitations, there is no pulmonary embolism within the main, left\nor right pulmonary arteries.  The main pulmonary artery is not dilated.  There\nis no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is minimal bibasilar dependent atelectasis.  The airways are patent to\nthe subsegmental level.  Evaluation for small nodules is limited by\nrespiratory and cardiac motion.\n\nThere is a small hiatal hernia.  Otherwise the upper abdomen is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignan4cy is identified.",
            "output": "1. The pulmonary arteries are poorly opacified due to bolus timing,\nconsequently evaluation is only possible to the level of the lobar pulmonary\narteries.\n2. There is no pulmonary embolism within the main, left or right pulmonary\narteries.  There is no evidence of right heart strain.\n3. No aortic dissection."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart is\nmoderately enlarged.  The main pulmonary artery measures up to 3.1 cm.  The\nthoracic aorta is normal in caliber and contains calcifications.  No\npericardial effusion is seen.  A left-sided chest wall pacer and single lead\nappear in appropriate position.  There is heavy calcified atherosclerosis of\nthe coronary arteries.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is no axillary lymphadenopathy. \nScattered prominent and enlarged mediastinal lymph nodes are identified.  For\nexample, a 13 mm peritracheal node on the right is seen.  A 9 mm AP window\nlymph node is also demonstrated (02:20).  The evaluation for hilar adenopathy\nis limited in the absence of intravenous contrast.\n\nPLEURAL SPACES:  There is a small to moderate right pleural effusion and a\ntrace left pleural effusion.\n\n\nLUNGS/AIRWAYS:  Consolidation at the base of the right lung may reflect\ncompressive atelectasis adjacent to a moderate right pleural effusion.  There\nis minimal opacity at the base of the left lung which most likely reflects\natelectasis however could reflect a focus of aspiration or infection in the\nappropriate setting.\n\nBASE OF NECK:  Again there is a 1.5 cm hypodensity in the left lobe of the\nthyroid as well as a 6 mm hypodensity in the right lobe of the thyroid.\n\nABDOMEN:  There is a small amount of perihepatic fluid seen anteriorly.\n\nBONES:  Mild degenerative changes are seen along the thoracic spine.  Patient\nis status post sternotomy.  Old lateral right seventh and eighth rib fractures\nare seen.",
            "output": "1. Small to moderate right pleural effusion and trace left pleural effusion. \nOpacities involving the bilateral lower lobes likely reflect compressive\natelectasis however infection should be considered in the appropriate setting.\n2. Old lateral right seventh and eighth rib fractures.  No definite acute\nfracture seen.\n3. Scattered prominent and enlarged mediastinal lymph nodes measuring up to 13\nmm, as above, are nonspecific.\n4. Thyroid hypodensities as also seen on cervical spine CT, are incompletely\nevaluated.  Recommend nonurgent thyroid ultrasound.\n5. Small amount of anterior perihepatic fluid, which appears simple.\n6. Moderate cardiomegaly with heavy calcified atherosclerosis of the coronary\narteries."
        },
        {
            "input": "The thoracic aorta is normal in caliber with mild to moderate predominantly\nnoncalcified atherosclerotic plaque that is most prominent in the distal\nthoracic aorta.  No evidence of aortic dissection.  The main, left, and right\npulmonary arteries are normal in caliber without central filling defect to\nindicate any incidental central pulmonary embolus.  The heart is normal in\nsize.  Trace pericardial fluid is nonhemorrhagic and likely physiologic.\n\nNo evidence of axillary or supraclavicular lymphadenopathy.  An 1.8 x 1.1 cm\nright lower paratracheal station lymph node is enlarged (series 6, image 20). \nAn enlarged subcarinal lymph node measures up to 2.2 x 1.4 cm (series 6, image\n24).  Another right subcarinal lymph node measures 1.7 x 1.2 cm (series 6,\nimage 27, 28).  An enlarged left hilar lymph node measures up to 1.1 cm in\nshort axis (series 3, image 130).\n\nSoft tissue density in the right perihilar region narrows and occludes a right\nupper lobe segmental bronchus with associated right parasternal upper lobe\nparenchymal opacity which may reflect a combination of atelectasis and tumor\n(series 6, image 22; series 9b, image 29).  The tumor is difficult to measure,\nbut on the axial images measures approximately 3.5 x 2.1 cm (8:111).  There is\npostobstructive atelectasis or pneumonia.  An 1-cm ground-glass opacity in the\nright upper lobe has irregular margins and close approximation with the\nadjacent pleura which is slightly thickened, concerning for malignancy (series\n6, image 18).  Other smaller ground-glass opacities in the right lung are also\ndemonstrated.  A few sub- 4 mm ground-glass opacities are also seen in the\nleft lung.\n\nThe patient has a right posterior intercostal approach pigtail catheter with\nits tip in the anterior inferior pleural space.  A pneumothorax is small.  No\nsignificant pleural effusion.  Pleural thickening is mild.  Parenchymal\nopacity in the right lower lobe is likely atelectasis (series 6, image 40). \nNo evidence of tension pneumothorax.  No left pleural effusion.\n\nCircumferential thickening of a long segment of the esophagus is probably from\ninflammation, less likely infiltrative process.  The thyroid enhances normally\nand is not enlarged.  No evidence of a concerning thyroid mass.\n\nA lucent lesion in the left T2 vertebral body is probably an intraosseous\nhemangioma (series 8, image 36).  No evidence of cortical breakthrough.  No\nosseous lesions in the chest cage concerning for malignancy infection. \nMultilevel degenerative changes of thoracic spine are mild.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "1.  Right hilar ill-defined mass measuring up to 3.5 x 2.1 cm with associated\nright upper lobe atelectasis/ consolidation and right hilar, right\nparatracheal, left hilar and right subcarinal lymphadenopathy are concerning\nfor primary lung malignancy.\n\n2.  Bilateral ground-glass opacities measuring up to 1 cm could also be\nmalignant.\n\n3.  No significant pleural effusion after placement of a right pigtail\ncatheter.  Associated small right pneumothorax without evidence of tension.\n\n4.  Long segment circumferential esophageal wall thickening probably chronic\ninflammation, less likely infiltrative process.  Recommend direct\nvisualization with endoscopy as clinically indicated.\n\n5.  Likely intraosseous T2 vertebral body hemangioma.\n\n This preliminary report was reviewed with Dr. ___\nradiologist.\n\nRECOMMENDATION(S):  Direct visualization of the esophagus with endoscopy as\nclinically indicated."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is coronary artery calcification.  The heart,\npericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is mediastinal and supraclavicular\nlymphadenopathy.  For example enlarged node in the\nright lower paratracheal station measures 0.8 x 0.7 cm (___), previously\n1.8 x 1.1 cm.\nRight subcarinal nodal conglomerate measures 2.6 x 1.7 cm (___), previously\n2.2 x 1.4 cm.  Left supraclavicular enlarged lymph node measures 1.1 x 1.1 cm\n(___), previously 0.6 1.0 cm. No axillary lymphadenopathy is present.\n\nPLEURAL SPACES:  There is a new, moderate amount of loculated pleural effusion\nin the right hemithorax.  The patient is status post right-sided pleurodesis\nwith calcified material in the pleural space and thickening of the pleura. \nTrace left pleural effusion.  No pneumothorax.\n\n\nLUNGS/AIRWAYS:  Respiratory motion limits evaluation.  No significant change\nin right upper lobe/hilar malignancy with encasement and attenuation of the\nright-sided airways and right upper lobe atelectasis.  As before, this remains\ndifficult to measure, but grossly unchanged.  There is new consolidation in\nthe right upper lobe, concerning for pneumonia.  There is new soft tissue\nthickening along the right-sided bronchovascular bundles and worsening nodular\nseptal thickening in the right lung, concerning for lymphangitic spread.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is new prominence of the bilateral adrenal glands without\ndistinct lesion.  Recommend close attention on follow-up imaging.\n\nURINARY: There are few subcentimeter hypodense lesions in bilateral kidneys,\ntoo small to characterize.  The kidneys are of normal and symmetric size with\nnormal nephrogram.  No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatus hernia.  The stomach is relatively contracted,\nlimiting evaluation.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The colon and rectum are within normal\nlimits.  The appendix is normal.  There is possible nodularity in the omentum\nin the the right upper quadrant, which is indeterminate, but concerning for\nearly peritoneal disease (2 B/ 133).  No intraperitoneal free air.  There is a\nsmall volume of perihepatic and pelvic ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate remains minimally enlarged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate to severe diffuse\natherosclerotic disease is noted.  Again seen is thrombus in the right common\niliac artery with distal reconstitution (2 B/152).\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There are multilevel degenerative changes of the visualized\nspine.  Again seen is a deformity of the bilateral superior pubic rami with\nnear fusion of the pubic symphysis, likely sequelae of prior trauma. \nUnchanged sclerotic focus within the right sacrum (6 ___), likely\nrepresenting a bone island.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1.  No evidence of pulmonary embolism or small bowel obstruction, as\nclinically questioned.\n2.  New consolidation in the right upper lobe, concerning for pneumonia.\n3.  Similar appearance of right hilar/upper lobe mass with right upper lobe\natelectasis and new soft tissue thickening along the right bronchovascular\nbundles and worsening nodular septal thickening, concerning for lymphangitic\nspread of tumor.\n4.  Possible omental nodularity in the right upper abdomen, which is\nindeterminate, but concerning for early peritoneal spread.\n5.  Loculated moderate size right pleural effusion.  Trace left pleural\neffusion.\n6.  Small volume of free fluid in the abdomen and pelvis."
        },
        {
            "input": "The thyroid gland is mildly heterogeneous and contains punctate\ncalcifications. Multiple mildly prominent mediastinal lymph nodes are stable\nin size and number since in ___. A right upper paratracheal lymph node\nis stable measuring 10 x 11 mm, previously 9 x 11 mm (3, 15).  A right lower\nparatracheal lymph node is not appreciably changed measuring 9 x 14 mm,\npreviously 8 x 17 mm (3, 20).\n\nThe patient is status post median sternotomy. Heart size is normal with mild\ncoronary artery calcification. High density material related to the left\natrial wall may be postsurgical in nature (3, 33). The main pulmonary artery\nand thoracic aorta are normal caliber. There is no pericardial effusion.\n\nNumerous upper lobe predominant solid and sub-solid perivascular and\nsubpleural nodules have increased in size and number since ___. There is\nno cavitation or bronchial wall thickening. Previous small bilateral pleural\neffusions have resolved.\n\nImages of the upper abdomen are notable only for diverticulosis without\nevidence for diverticulitis. The patient has had prior cholecystectomy.\n\nBones are unremarkable.",
            "output": "Interval increase in size and number of upper lobe predominant pulmonary\nnodules since ___, which have a peribronchovascular and subpleural\ndistribution. The differential diagnosis includes vasculitis, cryptogenic\norganizing pneumonia, and atypical infection (e.g. viral pathogens).  Given\nthe previous history of atrial myxoma, echocardiography is advised to exclude\nright-sided recurrence with embolization.\n\nMildly prominent mediastinal lymph nodes may be reactive in nature.\n\nDiverticulosis.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 17:18 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: In the right lobe of the thyroid\n1.2 cm hypodensity and punctate calcifications essentially unchanged and do\nnot warrant further imaging.  There is no pathologic enlargement of lymph\nnodes in the supraclavicular or axilla.\n\nCHEST CAGE: Patient is status post sternotomy, there are multilevel mild\ndegenerative changes of the spine, predominantly at mid thoracic level.  There\nis no evidence of osteo destructive lesions in the chest cage.\n\nUPPER ABDOMEN: The patient is status post cholecystectomy.  Remaining included\nunenhanced upper abdominal organs are with no gross findings.\n\nMEDIASTINUM: There is no pathologic enlargement of lymph nodes in the\nmediastinum.  No gross hilar lymphadenopathy.  0.8 cm right paratracheal lymph\nnode is stable since ___, not pathologically enlarged (5:124).\nPosterior mediastinum is within normal limits.\n\nHEART and PERICARDIUM: Heart is normal in size.  Punctate calcification in the\nleft cardiac chambers is possibly in a papillary muscle.  There are moderate\ncalcifications predominantly in the left coronaries.  Pericardium is\nphysiologic.\n\nPLEURA: There are minimal biapical pleuroparenchymal scarring.  There is no\npleural effusion.\n\nLUNG: There is mild diffuse bronchial wall thickening with no signs of active\ninfection suche as retained secretions or bronchial opacities.  There is\nminimal paraseptal emphysema in the upper lobes.  Surgical clips in the right\nupper lobe post biopsy.\n\nThe previously demonstrated centrilobular and confluent ground-glass opacities\nwhich were more evident in the upper lobes, have almost completely resolved. \nFaint centrilobular ground-glass opacities remain in the upper lobes (5:85 for\nexample).\n\nSeveral pulmonary nodules measure up to 0.8 cm in the right upper lobe (5:80).\nOther examples include Micronodule in the left lung base (5:273), 0.3 cm in\nthe same lobe (5: 219).  Micronodules, 0.3, 0.5 and 0.6 cm nodules in the\nright lower lobe (5:213, 138: 128, 250).  Essentially unchanged comparison to\n___.  There are no clear new lung nodules.",
            "output": "-Almost complete resolution of previously demonstrated bilateral centrilobular\nupper lobe ground-glass opacities, faint opacities remaining are likely\nresidual of inflammation.\n-Numerous pulmonary nodules are essentially unchanged in comparison to\n___, for further follow-up.\n-Smoking cessation is recommended.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is unremarkable.  There are no pathologic axillary,\nsupraclavicular, or mediastinal lymphadenopathy.\n\nHeart is top-normal in size.  There is no pericardial effusion.  Coronary\nartery calcifications, particularly of the LAD are moderate.  The thoracic\naorta is normal in caliber with minimal atherosclerotic disease.  The main\npulmonary trunk is top-normal measuring 2.9 cm.\n\nThe airways are patent to the subsegmental level bilaterally.  The lungs are\nclear.  There is no pleural effusion or pneumothorax.  A 4 mm right lower lobe\npulmonary nodule is unchanged from abdominal CT from ___ (series 302, image\n103).  Additional 3 mm pulmonary nodule noted in the right upper lobe (series\n302, image 62).\n\nThe thoracic esophagus is mildly patulous.  Limited views of the upper abdomen\ndemonstrate cirrhotic liver morphology.  Mild thickening of the bilateral\nadrenal glands without discrete nodules is unchanged from prior CT.  Contrast\nis noted within the kidneys from prior abdominal CT from 1 day prior.\n\nSuperficial soft tissues are unremarkable.  There is no suspicious bony\nlesion.",
            "output": "1. No explanation for hemoptysis on chest CT.  No lung consolidation.\n2. Pulmonary nodules measuring up to 4 mm in the right lower lobe, in the\nabsence of known risk factors, no further followup is needed.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Subcentimeter retrocrural lymph nodes are unchanged\nfrom prior study. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is mild coronary calcification. There are\nminimal bibasilar atelectasis adjacent to the pleural effusions. There is a\ncalcified granuloma in the right upper lobe (4:43), in the right upper lobe\nnoncalcified nodule measures 3 mm (4:87),  there are two -  3 mm right\nperifissural nodes (4:127, 129).  There are small bilateral pleural and\npericardial effusions.\nThis examination is not tailored for subdiaphragmatic evaluation please refer\nto the description of complete CT abdomen from ___\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy.\nSmall bilateral pleural effusions"
        },
        {
            "input": "There is no axillary supraclavicular lymph node enlargement and there are no\nsoft tissue lesions in the chest wall suspicious for malignancy. Evaluation of\nthe breasts requires mammography.\n\nAtherosclerotic calcification is extremely heavy and neck vessels vertically\nof brachiocephalic artery, in the major coronary branches, annulus of the\nnormal caliber ascending aorta, and throughout the descending thoracic aorta\nwhich is dilated in a fusiform fashion to a diameter of 32 mm, compared to 28\nmm more proximal a, attention normal caliber at the diaphragm.  Small\npericardial effusion is stable. There is no pleural abnormality.  Pulmonary\narteries are normal size.  Atrioventricular pacer leads in standard positions.\n\nA peripheral right middle lobe soft tissue mass, previously 30 x 37 mm has\ngrown substantially, now 42 x 53 mm.  It has grown to greater extent into the\nanterior chest wall contiguous with a new, minimally displaced fracture of the\ndistal right fifth rib. There is also a longer extent of pleural thickening,\nand greater involvement of prevascular mediastinal fat which it has a in\nextremely irregular interface. At in the region of marked cystic destruction\nof the right lower lobe is an irregularly shaped region of soft tissue\nthickening, that is now 20 x 23 mm in aggregate diameters, 3:64, and was 14 by\n18 mm in ___. This could be inflammatory, but the paste of growth is also\nconsistent with malignancy. Left lung is essentially clear.\n\nAside from a large bone island in the the body of the lower thoracic vertebra,\nand the right rib fracture, the chest cage is unremarkable.",
            "output": "Over the course of 4 months right middle lobe mass has grown substantially in\nsize and a also into the right anterior chest wall ___ be responsible for new\nfracture of the adjacent fifth anterior rib.  There is also greater\ninvolvement of the local pleura and anterior mediastinal fat.\n\nGrowing right lower lobe lesion could be a second malignancy.\n\nSevere atherosclerosis, involving coronaries, head neck vessels, and aorta.\nStable fusiform aneurysm descending thoracic aorta.\n\nSevere emphysema."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nNo mediastinal, hilar or axillary lymphadenopathy is demonstrated.  No\npericardial pleural effusion is seen.  Image portion of the upper abdomen\nreveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nnodules in the upper lungs might potentially reflect smoking, please correlate\nclinically.  Lungs are essentially clear with stable right lower lobe\npulmonary nodule, series 4, image 145, 3.5 mm in diameter, right apical\nscarring, series 4, image 16 and left major fissure thickening, series 4,\nimage 59.  The appearance of the post surgical stump is unremarkable.  No new\nnodules masses are consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Stable appearance of the chest as described including 3 mm right lower lobe\nground-glass nodule.  Reassessment in ___ year is recommended."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no enlarged supraclavicular,\naxillary or mediastinal lymph nodes. The previously noted prominent right\nhilar lymph node measures 1.7 x 0.8 cm, previously 2.4 x 1.4 cm and is\nsmaller. There are mild coronary artery calcifications. The heart and\npericardium are otherwise unremarkable. There is no pericardial effusion. The\naorta and pulmonary artery are of normal caliber. The airways are patent to\nthe subsegmental levels.\n\nThe previously noted consolidation in the right lower lobe has resolved. There\nis minimal scarring in the right lower lobe. Within the right middle lobe are\na cluster of peribronchiolar ground-glass nodules with mild bronchiectasis\n(4:172) new since the pre prior study. There is scarring within the lingula.\nThere is no focal consolidationm, pleural effusion or pneumothorax.\n\nThis study is not tailored for evaluation of subdiaphragmatic structures.\nLimited views demonstrate a 4.3 x 2.3 cm fluid collection adjacent to the\npancreatic tail, likely a postoperative seroma.\n\nThere no concerning bone lesions. A hemangioma in the left aspect of the T12\nvertebral body is stable.",
            "output": "1. Interval resolution of right lower lobe consolidation and decreased size of\nright hilar lymph node, likely reactive.\n2. Small cluster of peribronchiolar ground-glass nodules in the right middle\nlobe which may represent early or resolving infection. Aspiration is felt to\nbe less likely given the nondependent location.\n3. Postoperative fluid collection adjacent to the pancreatic tail, likely a\nseroma."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Heterogenously enhancing right lobe\nof thyroid with an associated coarse calcification.  No supraclavicular or\naxillary adenopathy.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  Small nonspecific hypoechoic lesion in segment 2\nof the liver measuring 4 mm in diameter.  Suboptimal evaluation of the\nadrenals, but no obvious left adrenal lesion.\n\nMEDIASTINUM: No upper mediastinal adenopathy.  The right lower paratracheal\nstation is partially obscured by beam hardening artifact, but I get the\nimpression of an 11 mm node in this 4R station.\n\nHILA: Right hilar adenopathy measuring 15 mm in diameter.  Subcentimeter left\nhilar lymph nodes.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nNo aortic valve or coronary artery calcifications.  No aneurysmal dilatation\nof the ascending aorta.\nPLEURA: There is very small bilateral pleural effusions (right larger than\nleft).\nLUNG:\n\n-PARENCHYMA:  There is masslike consolidation in the superior and anterior\nbasal segments of the right lower lobe measuring approximately 75 x 33 mm in\nthe axial plane.  This masslike consolidation is continuous with the right\nhilar adenopathy.  The masslike consolidation encases and attenuates the right\ndescending pulmonary artery and lower lobe bronchi as described below.  The 2\nsmaller spiculated nodules in the posterior medial aspect of the right lower\nlobe measuring 24 x 12 and 14 x 10 mm respectively (4, 175).  2 smaller round\npulmonary nodule seen in the posterior basal aspect of the right lower lobe\nmeasuring 7 mm (4, 167) and 4 mm (4, 174).  There is nodular thickening of the\nright oblique and transverse fissures.  There are a few small indeterminate\nsub 4 mm subpleural nodules in the right upper and lower lobes (for example\n04:12 6, 149 and 122).  Mild nodular thickening also noted of the left oblique\nfissure (4, 125 on ___.  Interstitial thickening involving the right\nlower lobe distal to the mass may represent congestion or lymphatic spread of\ntumor.  Vague density in the left upper lobe which may represent atelectasis\nor a flattened nodule (4, 98).\n-AIRWAYS:  Patent to the subsegmental level.  The right basal truncus,\nsuperior and anterior basal segmental bronchi are partially attenuated by the\nmasslike consolidation.  Peribronchial thickening of the right lower lobe\nbronchi distal to this consolidation.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects.\n-\n-CHEST CAGE: Pectus excavatum deformity with a Haller index of 4. Sclerotic\nlesion suggestive of a chronic fracture of the anterior lateral aspect of the\nright fifth ribs.",
            "output": "Masslike consolidation in the superior segment and anterior basal segment of\nthe right lower lobe with associated right hilar and lower paratracheal\nadenopathy which most likely represents a primary bronchus carcinoma.\nMultiple smaller spiculated and round nodules in the right lower lobe\nsuggestive of metastasis.\nNodular thickening of the right oblique and transverse fissures.\nNonspecific sub 4 mm subpleural nodules in the right upper and middle lobes as\ndescribed above which may represent infection/ inflammation or metastasis.\nNodular thickening also noted of the left oblique fissure.\n\nRECOMMENDATION(S):  Correlation with histology advised."
        },
        {
            "input": "Limited preprocedural CT scan of the chest demonstrates small bilateral\npleural effusions, worse on the right.  The right lower lobe\nmass/consolidation has increased in size compared to previous PET-CT from ___.",
            "output": "The procedure could not be performed as the patient's cough could not be\ncontrolled.  The biopsy will be rescheduled with anesthesiology."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The right inferior pulmonary vein appears occluded from\nhilar mass.  The heart is normal in size.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are a number of prominent mediastinal\nlymph nodes, not significantly changed since the recent study.  There is no\naxillary lymphadenopathy.  Hilar lymphadenopathy is contiguous with a right\nhilar mass.\n\nPLEURAL SPACES:  There has been interval development of small to moderate\nbilateral pleural effusions, larger on the right than on the left.  There is\nno pneumothorax.\n\n\nLUNGS/AIRWAYS:  Again noted is an ill defined mass involving the right hilum,\nextending into the right lower lobe.  In this region, the right pulmonary\nartery is attenuated, but does not appear occluded.  In comparison to the\nprior examination, there is surrounding volume loss, with hypoenhancement,\nlikely due to hypoperfusion.  Smaller pulmonary nodules seen on the prior\nexamination are not well evaluated on this given new extensive\nperibronchovascular opacities, consistent with infectious process.  Re-\ndemonstrated is nodular thickening of the fissures on the right.  In addition,\nthere is new interlobular septal thickening, consistent with edema, though\nlymphangitic spread of disease is not excluded.  There is diffuse airways\nthickening as well, which is new since the prior examination.  The middle lobe\nis nearly entirely atelectatic.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolus.\n2.  Ill defined right hilar mass with hypoperfusing collapsed right lower\nlobe, like combination of postobstructive and related to venous congestion\ngiven right inferior pulmonary vein occlusion.\n3.  Interlobular septal thickening, bilateral pleural effusions, and\nperibronchial opacity consistent with a component of edema.  Cannot exclude\nlymphangitic spread of disease.\n4.  Bilateral, peripheral, peribronchovascular opacities, while could\npartially be explained by edema, likely represent a component of infection."
        },
        {
            "input": "CHEST: HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  There is mild prominence of\nthe main pulmonary artery which can be seen in pulmonary hypertension.\n AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Ill defined right hilar soft tissue, which\nobliterates fat planes with the mediastinum appears moderately decreased in\nsize with mildly improved narrowing of the right perihilar bronchi.  There is\nre- demonstrated occlusion of the right inferior pulmonary vein.\n PLEURAL SPACES:  There are moderate bilateral pleural effusions.  There is a\nmoderate right apical pneumothorax.  A chest tube is noted at the right lung\nbase.\n LUNGS/AIRWAYS:  There is diffuse septal thickening, some of which has a\nmildly irregular appearance, findings may represent predominately fluid\noverload but lymphangitic spread can't be excluded.  There is improved\naeration at the right lung base secondary to interval decrease in the right\nhilar mass with improved caliber of the central perihilar airways.\n\nWedge-shaped consolidation extending from the right hilus into the right lower\nlobe is decreased in extent from prior examination, likely post obstructive\nsecondary to the ill-defined right hilar soft tissue.  The degree of narrowing\nand obstruction of right hilar airways is unchanged.  Multiple peripheral\nnodules are significantly increased in size or new from the prior examination.\nFor example, a 19 x 7 mm nodule in the right upper lobe (series 5, image 140)\nand a 11 x 8 mm subpleural nodule in the right upper lobe (series 5, image\n151).  A 4 mm nodule in the right upper lobe (series 5, image 125) is\nincreased in size are new from the prior examination.  Numerous small nodules\nin the left lower (series 5, image 140, 153) and left upper lobe (series 5,\nimage 56, 114) are grossly unchanged from ___.\n\nExtensive diffuse bronchial wall thickening, worse at the right lung base is\nunchanged.\n\nBASE OF NECK:  15 x 14 mm right lobe thyroid nodule with dystrophic\ncalcification.  A 6 mm thyroid nodule is noted in the lobe of the thyroid.\n\nABDOMEN:  Please see CT abdomen and pelvis from the same date.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nChronic rib fractures are seen in the right lateral fifth, sixth and seventh\nribs and the left anterolateral fourth through sixth ribs.\n\nSOFT TISSUES: There is moderate diffuse anasarca.",
            "output": "1. Small to moderate right apical pneumothorax with a chest tube noted at the\nright lung base.\n2. Ill-defined right hilar mass overall appears decreased in size with  mildly\nimproved right bronchial narrowing and improved aeration of the right lung\nbase.  The right inferior pulmonary vein is again occluded.\n3. Numerous bilateral pulmonary nodules, some of which appear new or increased\nin size from ___.  Some of these nodules are significantly\nincreased in size and may represent infection, however other nodules appear\nmore stable over time and are more concerning for malignancy.  Three-month\nfollow-up CT is recommended to assess for stability."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer.  Mild atherosclerotic changes\nare noted.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMild centrilobular emphysema is again noted. The airways are patent to the\nsubsegmental level.  There is moderate bronchial wall thickening predominantly\nin the lower lobes.  Subsegmental atelectasis is seen at the lung bases.\n\nA patulous and circumferentially thickened esophagus is unchanged compared to\nprevious.  There is a small hiatal hernia.  The study is not tailored for\nevaluation of upper abdomen.  A 1 cm hyperenhancing focus within the right\nhepatic lobe is again noted (2:84).  A second 6 mm focus of hyper enhancement\nis seen in the left hepatic lobe (2:79).  These are indeterminate but appear\nunchanged compared to previous.  Additionally, a 7 mm focus of hyper\nenhancement is seen in the spleen (2:81).  This was not well visualized on the\nprevious studies due to a difference in contrast timing but may also have been\npresent.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Hyperenhancing foci within the liver, indeterminate but unchanged compared\nto previous.  An additional hyperenhancing foci within the spleen was not well\nvisualized previously.  Likely hemangiomas. These can be further evaluated\nwith a MRI of abdomen if clinically indicated.\n\nRECOMMENDATION(S):  Consider MRI for mor definitive evaluation/conformation of\nliver/spleen hemangiomas/vascular anomalies."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  A\nslightly enlarged lymph node is seen at the level of the right hilus (2 a,\n24).  The sub carinal and lower right hilar lymph nodes are unremarkable.\nUnremarkable appearance of the heart, no substantial coronary calcifications.\nNo pericardial effusion.  Normal appearance of the posterior mediastinum.  In\nthe upper abdomen, there is massive splenomegaly.  No evidence of osteolytic\nlesions at the level of the ribs, the sternum or the vertebral bodies.\n\nMild bilateral apical thickening. Several non characteristic subpleural\nmicronodules throughout the lungs.\n\nIn the right lower lobe, a conglomerate of cavitated thick-walled lesions is\nseen. The largest of these lesions is in subpleural location (4 8, 119).  And\nhas a diameter of approximately 2.5 cm. The lesions contain air-fluid levels\nand have relatively irregular borders.  They show a multitude of smaller\nsatellite lesions throughout the entire right lower lobe and have a clear an\ndistinct relation to the airways supplying the right lower lobe.  A second\nconglomerate of a similarly shaped lesions that are smaller in size are\nvisualized in the lateral and anterior portions of the right lower lobe (4 8,\n138). Finally, smaller similar conglomerates are seen at the bases of the\nright lower lobe.  At the level of the largest lesion, adjacent to the pleura,\nthe pleural is thickened but there is no evidence of pleural effusions.  Local\nmucous plugging of the airways is noted.\n\nNo diffuse lung disease.",
            "output": "Cavitated conglomerates of lesions in the right lower lobe. The multiplicity\nof the lesions, the presence of satellite lesions and the distribution\nthroughout the entire right lower lobe, as well as the bronchus centric nature\nof the lesions is in favor of an inflammatory disease, for example\ntuberculosis. However, the possibility of a cavitating squamous cell cancer\ncannot be completely discarded.  In any way, undelayed invasive further workup\nis required.\n\nSeveral non characteristic subpleural micronodules. No pleural effusions. \nMild right hilar lymphadenopathy.\n\nThe findings via added to the radiology dashboard."
        },
        {
            "input": "Contrast opacifies the segmental subsegmental pulmonary arterial tree without\nfilling defects to indicate a pulmonary embolus.  The aorta and main pulmonary\nartery are normal caliber.  Apparent filling defects within the left\nsubclavian vein (03:38) are likely from mixing artifact. There are multiple\nleft chest wall collaterals opacified with contrast.\n\nPatient is status post a left pectoral pacemaker placement with leads\nterminating in the right ventricle and right atrium. The heart is normal size\nand there is no pericardial effusion. Subcutaneous air is not unexpected after\nrecent procedure.\n\nThere is no supraclavicular, axillary or central lymphadenopathy.\n\nThe airways are patent to the subsegmental level. There is no pleural\neffusion, pneumothorax or evidence of active infection.  There are trace\nbilateral pleural effusions with overlying atelectasis.  There is no\npneumothorax.\n\nThe esophagus is patulous but otherwise unremarkable. Limited views of the\narterially enhanced spleen, right adrenal gland and stomach are unremarkable.\nA 8 mm hypodensity in the dome the liver is too small to characterize but is\npresumably a simple cyst or biliary hamartoma (2:69).",
            "output": "1.  No pulmonary embolus.\n2.  Filling defect within the left subclavian vein is likely mixing artifact. \nEarlier US examination of the left upper extremity also did not demonstrate\nthrombus.  Should there be subsequent new swelling of the left upper\nextremity, a followup CT chest venogram could be considered.\n\nNOTIFICATION:  Updated findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:29 AM, the day after initial interpretation."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are small left\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are small bilateral axillary lymph nodes not\nenlarged by size criteria\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.  The aorta and pulmonary arteries are normal in caliber.\nThere is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: No nodules or consolidations are seen.  There is no evidence of\nbronchiectasis fibrosis or emphysema.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  There is evidence of endplate sclerosis\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nintrahepatic biliary ductal dilatation.",
            "output": "No evidence of metastasis to the chest.\n\nIntrahepatic biliary ductal dilatation.  Please refer to dedicated report on\nabdomen which has been dictated separately."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\nregions.  Normal appearance of the large mediastinal vessels.  No incidental\npulmonary embolism.  Stable moderate to severe coronary calcifications, no\nvalvular calcifications, newly placed drain in the upper abdomen (2, 61).  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable mild degenerative vertebral disease. No vertebral compression\nfractures.  Minimal right apical scarring.  Mild irregularities of the airway\nwalls.  No pulmonary nodules or masses.  No pleural thickening, no pleural\neffusions.  No diffuse lung disease.",
            "output": "Stable examination of the thorax.  No evidence of thoracic metastatic disease."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : The there are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.  There is moderate coronary artery\ncalcification.  A small right pericardial lymph node measuring 6 mm (2, 47) is\nunchanged.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  No new or\ngrowing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine with evidence of endplate sclerosis at multiple\nlevels.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\npneumobilia.  A stent is seen within the CBD.  Gallstones are seen.  Please\nrefer to dedicated report on abdomen which has been dictated separately.",
            "output": "No new or growing pulmonary nodules.  Stable 6 mm right pericardial lymph\nnode.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmoderate coronary artery calcification.  Small right pericardial lymph nodes\n(5, 89) measuring up to 6 mm are unchanged.  There is no pericardial effusion.\nThe aorta and pulmonary arteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nintrahepatic biliary ductal dilatation.  Please refer to dedicated report on\nabdomen which has been dictated separately",
            "output": "Stable 6 mm pericardial lymph nodes.  No new pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid nodules requiring\nadditional imaging evaluation.  No axillary or thoracic inlet lymphadenopathy.\nNo chest wall lesions seen.\n\nUPPER ABDOMEN: Dictated separately including further details regarding\nintrahepatic biliary dilation, left hepatic lobe hypodense lesion with\nmetallic density clips, common bile duct stent, and common hepatic duct soft\ntissue mass.\n\nMEDIASTINUM: No lymphadenopathy.  Stable 6 mm pericardial lymph node since\n___, smaller than in ___.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly or pericardial effusion.\nPLEURA: No pleural effusion or nodularity.\nLUNG:\n\n1. PARENCHYMA: No new or growing pulmonary nodules.  Stable punctate pulmonary\nnodule in the left lung apex since at least ___.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta and main pulmonary trunk are normal in\ncaliber.  No incidental central pulmonary embolus.  Moderate coronary artery\ncalcifications in the LAD.\nCHEST CAGE: No suspicious osseous abnormality in the chest or acute fracture. \nDegenerative changes in the lower thoracic and lumbar spine.",
            "output": "1. No evidence of disease progression in the chest.\n2. CT of the abdomen and pelvis dictated separately."
        },
        {
            "input": "CHEST PERIMETER: Right anterior chest port is within the upper right atrium. \nSupraclavicular and axillary lymph nodes are not enlarged.\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:  There are no findings in the thyroid warranting further\nimaging evaluation.  Focus of ascitic fluid is noted anterior to the distal\nesophagus.  Otherwise, the esophagus is unremarkable. Moderate atherosclerotic\ncalcifications are seen in the coronary arteries.  The aorta, pulmonary\narteries, and cardiac chambers are normal size.\nNo pericardial effusion.\n\nTHORACIC LYMPH NODES: Non pathologically enlarged, including internal mammary\nand diaphragmatic stations.  Subcentimeter cardiophrenic lymph nodes are\nlargely unchanged.\n\nLUNGS, AIRWAYS, PLEURAE: Mild upper lobe dominant emphysematous changes.  Mild\ndependent atelectasis without consolidation.  The tracheobronchial tree is\npatent and normal to the subsegmental levels.\nNo pleural effusion or pneumothorax.\n\nCHEST CAGE: Multilevel degenerative changes without pathologic, acute\ncompression fractures, or destructive bone lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "1. No large or suspicious pulmonary nodules\n2. No lymphadenopathy or mediastinal mass to suggest chest metastasis."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There is a right-sided Port-A-Cath\nwith its tip in the SVC.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis top-normal.  There is moderate coronary artery calcification.  Small right\npericardial lymph node measuring 6 mm in short axis is unchanged.\n\n\nPLEURA: There is a small right pleural effusion, new since the prior study.\n\nLUNG: There is subsegmental atelectasis in the right lung base.  No new or\ngrowing pulmonary nodules are seen.\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  No lytic or sclerotic lesions concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows stents within\nthe biliary tree.  There is extensive ascites.  There is evidence of\nintrahepatic biliary dilatation the dilatation.  Please refer to dedicated\nreport on abdomen which has been dictated separately",
            "output": "New small right pleural effusion with right basilar atelectasis.\n\nStable 6 mm right pericardial lymph node.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet. A right-sided chest port is\nunremarkable with tip in the right atrium.  There are no abnormalities on the\nchest wall. Minimal atherosclerotic calcifications in the head and neck\narteries.  Note is made of a left vertebral artery arising from the aorta.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Moderate to\nsevere coronary artery calcifications particularly in the left main and LAD. \nThe aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  The previously seen right\npericardial lymph node is unchanged measuring 0.5 cm.  No hilar\nlymphadenopathy.\n\nPLEURA:\nThe previous right pleural effusion has resolved.  No left-sided pleural\neffusion..\n\nLUNGS:\nPrevious subsegmental atelectasis at the right lung base has improved.The\nairways are patent to the subsegmental levels. No bronchial wall thickening,\nbronchiectasis or mucus plugging. No suspicious lung nodules or masses. No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. There are no bone findings in the\nchest cage suspicious for malignancy or infection but it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous metastases than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to separate report for CT abdomen and pelvis acquired on the same\nday for findings below the diaphragm.",
            "output": "1. Resolution of previous right pleural effusion.\n2. Stable 5 mm pericardial lymph node.\n3. Please refer to separate report for CT abdomen and pelvis acquired on the\nsame day for findings below the diaphragm."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Right pectoral Port-A-Cath.  No enlarged lymph\nnodes in the mediastinum or at the level of the hilar structures.  The small\npre pericardial lymph node (5, 87) is virtually unchanged.  The upper abdomen\nis reported in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  The lung\nparenchyma shows normal attenuation values and architecture.  No evidence of\nsuspicious pulmonary nodules or masses.  No diffuse lung disease.  No pleural\nabnormalities.  The airways are patent.",
            "output": "Stable normal sized pre pericardial lymph node.  No suspicious pulmonary\nnodules or masses.  No pleural abnormalities."
        },
        {
            "input": "The partially imaged thyroid at the base of neck is unremarkable.  There is a\nright IJ access Port-A-Cath terminating in the right atrium.  Thoracic aorta\nis normal in course and caliber.  The heart is within normal limits of size\nand shape without pericardial effusion.  Moderate coronary artery\ncalcification is redemonstrated.  The main pulmonary artery is normal in size\nwith patent central branches.  There is no mediastinal, hilar, or axillary\nlymphadenopathy.  The esophagus is unremarkable.  The airways centrally\npatent.  Varices are noted adjacent to the distal esophagus.\n\nMild bronchial wall thickening is noted which could reflect a component of\nairways inflammation.  No significant mucous plugging.  There is no worrisome\nnodule, mass, or consolidation within the lungs.  Mild emphysema is present.\n\nPlease refer to separately dictated CT of the abdomen pelvis for findings\nbelow the diaphragm.\n\nBones: No worrisome lytic or blastic osseous lesions seen.",
            "output": "No new or growing pulmonary nodule.  Please refer to same-day CT abdomen\npelvis for findings below the diaphragm."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\n\nPost thoracic aortic repair changes are noted, without evidence of\ncomplication.  The heart is mildly enlarged.  Coronary artery calcifications\nare noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar dependent atelectasis is noted.  There are no new or\ngrowing lung nodules identified.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPatient is status post median sternotomy.",
            "output": "1. Post thoracic aorta repair changes, without evidence of complication.\n2. No evidence of new aortic aneurysm or aortic dissection."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is moderately calcified though normal in\ncourse and caliber.  Mediastinal clips reflect prior CABG.  The heart is\nmildly enlarged.  The main pulmonary artery is normal in caliber.  There is no\nfilling defect seen within the branches of the pulmonary arterial tree to\nsuggest the presence of a pulmonary embolism.  Bilateral moderate layering\nsimple appearing pleural effusions are noted bilaterally.  Areas of pleural\nbased calcification noted bilaterally.  There is no lymphadenopathy.  No\npericardial effusion.  Interlobular septal thickening is noted consistent with\nmild interstitial pulmonary edema.  Background emphysema is present.  No\nworrisome nodule mass or consolidation.\n\nWithin the imaged portion of the upper abdomen, cholelithiasis is noted. \nThere is trace perihepatic ascites.\n\nBones: No worrisome bony lesion.  Midline sternotomy wires are noted.",
            "output": "1. No pulmonary embolism or other acute process in the chest.\n2. Moderate layering pleural effusions with interstitial pulmonary edema and\nmild cardiomegaly.\n3. Emphysema."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThe heart is mildly enlarged.  There is no pericardial effusion.  The thyroid\nis unremarkable.\n\nA small left pleural effusion is new.  There is no right pleural effusion. \nThere is been resolution of the previously seen pneumothorax and extensive\npneumomediastinum and subcutaneous gas.\n\nET tube is present, terminating 5.1 cm above the carina.  The central airways\nare patent.  There is interval resolution of the left apical pulmonary\ncontusion.  Bibasilar consolidations are increased since the prior study, with\nair bronchograms on the left.  These consolidations appear homogeneous and are\nmost consistent with atelectasis.  No suspicious pulmonary nodule or mass is\npresent.\n\nAn enteric tube is present with tip terminating in the distal stomach near the\npylorus.  The upper abdomen is otherwise unremarkable in appearance.  Healing\nfracture of the left anterior ribs 1 through 3 noted.  No other fractures are\nvisualized.  Multilevel degenerative changes are mild-to-moderate.",
            "output": "1.  Basilar consolidations, most likely representing atelectasis. Small left\npleural effusion.\n2.  Resolution of left apical pulmonary contusion."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is enlarged. \nAortic valve calcifications are extensive.  No pericardial effusion is seen. \nMinimal right pleural effusion is present.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated as well as there is no\nsubstantial change since the previous examination.\n\nPreviously seen fracture of the first anterior portion of the rib as well as\nthe second rib are present, series 2, images 14, 17.  Additional fractures,\nseries 2, image 22, 28 are present, all of them subacute or acute was no\nevidence of callus formation.  No lytic or sclerotic lesions worrisome for\ninfection or neoplasm demonstrated.\n\nLeft basal consolidation is extensive and similar to previous examination. \nRight basal opacity is more prev aggressive and concerning for repeated\naspiration or infectious process.\n\nTracheostomy is in place.  The ET tube tip terminates approximately 3.4 cm\nabove the carina.  Note is made that the  tracheostomy  is pointing toward the\nposterior wall of the trachea, partially obstructed by the posterior tracheal\nwall.  No substantial change in the appearance of the trachea between dynamic\nexpiration and and inspiration demonstrated.",
            "output": "Tracheostomy is pointing toward the posterior wall of the trachea as described\nin might potentially be in part responsible for intermediate obstruction.\n\nBibasal consolidations, left more than right.  Right opacity has increased\nsince ___\n\nLeft rib assist described."
        },
        {
            "input": "CHEST:\nThere is no axillary, supraclavicular, mediastinal, or hilar lymphadenopathy\nby CT size criteria.\n\nHeart size is top normal, and there is no abnormal pericardial effusion. \nAortic valvular calcifications are noted.  Thoracic aorta contains mild\natherosclerotic calcifications, but is normal in course and caliber.  Main\npulmonary artery is normal in caliber.\n\nAirways patent to the subsegmental levels.  Extensive pneumomediastinum and\nsubcutaneous emphysema raises the possibility for underlying airway injury. \nWhile the defect is difficult to identify by CT, there may be subtle wall\nirregularity of the left proximal mainstem bronchus near the tracheobronchial\njunction (3:46) that may potentially represent a site of injury.  There is\npulmonary contusion in the left upper lobe (03:31).  No pulmonary laceration. \nSmall foci of air anterior to the left mediastinum (03:48), and along the\nanterior cardiac border (3:65) most likely represents extrapleural air rather\nthan pneumothorax ; this is similar in appearance compared to the reference CT\nperformed several hours earlier.  Bilateral dependent atelectasis.  No pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  Residual\nintravenous contrast is seen within the collecting system.  There is no\nhydronephrosis.  There is no nephrolithiasis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  The colon and rectum are within\nnormal limits.  Normal appendix.  No free fluid or free air within the\nperitoneal cavity.\n\nPELVIS: Previously administered intravenous contrast is present within the\nbladder.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES:  There is an acute mildly displaced fracture of the left first rib\n(604b:103).  There are also acute nondisplaced fractures of the left second\nand third ribs (604b:100, 102).  No other fractures are identified.",
            "output": "1. Acute mildly displaced left 1st rib fracture.  Acute non-displaced\nfractures of the left ___ and 3rd ribs.\n2. Extensive pneumomediastinum and subcutaneous emphysema in the neck and\nupper chest is suspicious for airway injury.  Possible wall irregularity in\nthe proximal left mainstem bronchus at the tracheobronchial junction may\nrepresent site of injury.\n3. Small focus of air along the left anterior cardiac border is likely\nextrapleural.  No pneumothorax.  Left apical pulmonary contusion.  No\npulmonary laceration.\n4. No sequela of trauma within the abdomen or pelvis.\n\nNOTIFICATION:  Updated findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 9:38 AM, 30 minutes after\nattending review."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect. The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The heart and mediastinum are normal.\nThe pericardium is intact without effusion. Airways are patent to the\nsubsegmental levels.\n\nThe lungs are clear without focal abnormality. There is no evidence of pleural\neffusion or pneumothorax.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nThe esophagus is within normal limits. Although this study is not tailored for\nthe examination of subdiaphragmatic contents, the imaged portions of the\nintra-abdominal organs are grossly unremarkable.",
            "output": "No evidence of pulmonary embolism or other acute cardiopulmonary process."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The main pulmonary artery is well opacified and normal\ncaliber.  Occlusive filling defects are demonstrated at the right lower lobar\nsegmental and subsegmental vessels (series 7, image 58, series 7, image 86). \nAn occlusive thrombus demonstrated at the lateral segment of the right middle\nlobe (series 7, image 65).  There are additional likely filling defects at\nseveral distal subsegmental apical segments (series 7 image 37).\n\nThe aorta is not well opacified secondary to contrast timing, however no focal\naortic abnormalities are demonstrated.  The aorta is normal caliber with\nmoderate atherosclerotic calcifications.  No pericardial effusion.  The heart\nis normal size.  No secondary signs of right ventricular strain.\n\nThere is an aberrant right subclavian artery (series 5, image 30).\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a moderate left simple pleural effusion.  There is a\nsmall right simple pleural effusion.  No pneumothorax.  Pleural calcification\nis seen along the right lower lobe.\n\nLUNGS/AIRWAYS: Streak like opacities are demonstrated at the bilateral lung\nbases consistent with atelectasis.  There is a low-density opacity along the\nright major fissure (series ___, image 39, which could represent a loculated\neffusion or less likely pneumonia.  Consolidation at the left lung base\noverlying the effusion is suspicious for overlying pneumonia (series 6, image\n99).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Visualized abdominal viscera are significant for a 6.6 cm simple\nright renal cyst as well as calcified granulomas within the liver.\n\nCHEST WALL: Focal irregularities at the lateral aspects of the right fourth\nand fifth ribs (series ___, image 60, 72) are likely healed rib fractures. \nThere is a coarse calcification as well as multiple smaller calcification seen\nwithin the left breast, may represent postsurgical changes.  Multilevel\ndegenerative changes throughout the thoracic spine including bridging anterior\nosteophytosis spanning T4-T12.",
            "output": "1. Pulmonary emboli within the segmental and subsegmental branches of the\nright lower and middle lobes.  Filling defects within the subsegmental left\napical branches are equivocal for pulmonary embolism.  No secondary signs of\nright heart strain.\n2. Left lower lobe pneumonia.\n3. Moderate left and small right simple pleural effusions.  Loculated\nlow-density fluid within the major fissure on the right is likely additional\npleural effusion.\n4. Multilevel bridging osteophytosis which is suggestive of diffuse idiopathic\nhyperostosis (DISH)."
        },
        {
            "input": "There is no evidence of a lung nodule or mass at the site of the apparent\nnodule on recent chest radiograph.  Correlating the chest radiograph with the\nCT scan, and probably reflected a nipple shadow.\n\nAssessment of the lungs is otherwise remarkable for mild, upper lobe\npredominant centrilobular emphysema, diffuse bronchial wall thickening,,\nprevious wedge resection in the right middle lobe, and adjacent volume loss\nand scarring in the right lower lung.  Note is also made of 2 mm and 7 mm\nground-glass nodular opacities in the right apex (images 50 and 88, series 5).\nAs well as several punctate 2-3 mm lower lobe the solid nodules, with\nrepresentative examples in the left lower lobe (230, 5) and right lower lobe\n(202, 5).  A cluster of small centrilobular opacities is also demonstrated in\nthe lateral segment right middle lobe.\n\nThere are no enlarged mediastinal, axillary or hilar lymph nodes.  Small\ncalcified right hilar lymph nodes are incidentally noted.  Heart size is\nnormal, and severe aortic valvular calcifications are present as well as\ndiffuse coronary artery calcifications.  Heart size is normal, and there is no\npericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning abnormalities are evident in this region on this limited\nassessment.\n\nThere are no suspicious lytic or blastic skeletal lesions in the thorax.  Mild\nbilateral gynecomastia is noted.",
            "output": "1.  Apparent lung nodule on previous chest radiograph likely represented a\nnipple shadow.\n\n2.  Several incidentally detected punctate solid and sub cm ground-glass\nnodular opacities elsewhere in the lungs are statistically very likely benign.\nIn the setting of emphysema, a followup CT is recommended in ___ year to\ndocument stability of these findings.\n\n3.  Heavily calcified aortic valve, consistent with the history of severe\naortic stenosis.  Coronary artery calcifications."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is moderate coronary artery calcification.  A\ntrace pericardial effusion is similar to prior.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  There is diffuse circumferential esophageal wall\nthickening of the mid to distal esophagus, similar to prior and consistent\nwith radiation esophagitis (6:137).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Areas of linear high-density consolidation in the right\nperihilar region involving the upper and lower lobes is new compared with\nprior and consistent with radiation fibrosis (6:64, 116, 127, 148, 173).  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK:  A 3 mm hypodense right thyroid nodule is unchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Small calcified splenic artery aneurysms measuring\nup to 1.1 cm are unchanged.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS:  The uterus is unremarkable.  Coarse calcifications in\nthe bilateral ovaries are similar to prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES:  Scoliosis and multilevel degenerative changes lumbar\nspine are similar to prior.  There is mild anterolisthesis of L4 on L5.  There\nis no evidence of worrisome osseous lesions or acute fracture.  The abdominal\nand pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolism or acute aortic abnormality.\n2. New radiation fibrosis changes in the right lung.\n3. Diffuse circumferential wall thickening of the mid to distal esophagus is\nsimilar to prior and consistent with radiation esophagitis.\n4. Diverticulosis, with no evidence of acute diverticulitis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is atherosclerotic calcification of the aorta and\nits branches.  Heart size is top normal.  There are coronary artery\ncalcifications.  The heart, pericardium, and great vessels are within normal\nlimits.  There is a trace pericardial effusion, similar to prior.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Again seen is diffuse\ncircumferential esophageal wall thickening of the mid to distal esophagus,\nsimilar to prior, and consistent with history of esophageal\nmalignancy/radiation esophagitis.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Again seen are areas of linear high density consolidation in\nthe right perihilar region, consistent with radiation fibrosis.  Bibasilar\natelectasis.  Lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK:  There is a subcentimeter hypodense lesion in the right hemi\nthyroid, of indeterminate clinical significance.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Again seen are radiation fibrosis changes in the right lung.  Lungs are\notherwise clear.\n3. Diffuse circumferential wall thickening of the mid to distal esophagus,\nunchanged from prior and consistent with esophageal malignancy/ radiation\nesophagitis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART AND VESSELS: The heart is normal in size.  No pericardial effusion is\nidentified.\n\nPLEURA: No pleural effusion is identified.\n\nAIRWAYS/LUNG:\n\nA 4 mm ground-glass opacity in the right upper lobe (series 3, image 85).\nA 2 mm nodule in the right middle lobe (series 3, image 129).\nA 2 mm pulmonary nodule in the right lower lobe (series 3, image 129).\nA 3 mm nodule in the left upper lobe (series 3, image 74).\nA 3 mm pulmonary nodule in the left upper lobe (series 3, image 84).\nA 3 mm nodule in the left lower lobe (series 3, image 145).\nA 4 mm pulmonary nodule in the left lower lobe (series 3, image 154).\n\nCalcified granuloma in the right upper lobe.\nBONES: No suspicious osseous lesions are identified.\n\nSOFT TISSUES: No soft tissue abnormality.\n\nUPPER ABDOMEN: Please see separate report for concurrently performed CT\nAbdomen and Pelvis for findings below the diaphragm.",
            "output": "1.  No evidence of primary malignancy in the chest.\n2.  Multiple pulmonary nodules scattered throughout the lungs measuring up to\n4 mm, which should be followed on subsequent staging studies."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with scattered coronary artery calcifications. There is\nno pericardial effusion. There is stable mild dilatation of the main pulmonary\nartery to 3.2 cm, which suggests pulmonary arterial hypertension in the\nappropriate clinical setting. The thoracic aorta is normal caliber.  No\nincidental pulmonary embolus is identified.\n\nTwo subcentimeter solid pulmonary nodules with a triangular configuration\nadjacent to a fissure are stable, and may represent lymphoid aggregates (6,\n151 and 162).  No new or worrisome pulmonary nodules are identified.  The\npreviously referenced ground-glass opacity at the right lateral costophrenic\nsulcus is less prominent on today's exam. Right middle and left lower lobe\nlinear atelectasis or scarring is improved. There is no endobronchial lesion\nor pleural effusion.\n\nThere are no bony lesions in the thorax worrisome for infection or malignancy.\nA small left posterior chest wall intramuscular lipoma is incidentally noted.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Stable exam with no evidence of pulmonary metastases.\n\nResolving ground-glass opacity at the lateral right costophrenic sulcus, which\nmay be infectious or inflammatory in etiology.\n\nStable dilatation of the main pulmonary artery suggests pulmonary arterial\nhypertension in the appropriate clinical setting."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes and central are not enlarged. Imaged\nportion of the thyroid is unremarkable. Atherosclerotic calcification is not\nevident in the aorta head and neck vessels, and mild in the coronaries. Aorta\nis normal size. Dilatation of the main pulmonary artery, 34 mm, and left\npulmonary artery, 25 mm, is stable since ___.\n\nAlthough distorted by pulsatile artifact, mild thickening of the lower\nanterior pericardium, 5:203, is unchanged since at least ___. There is\nno pleural abnormality.\n\n5 mm triangular soft tissue nodule in the right middle lobe, 5:153 wall was 8\nmm across in in ___. Heterogeneous subpleural opacification in both\nlung bases is probably atelectasis. Lungs are otherwise clear and the\ntracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy or infection. Per 5 mm right middle\nlobe lesions small right today than in ___ is presumably a benign\nlymphoid aggregate.\n\nStable mild pulmonary artery enlargement is indeterminate concerning pulmonary\narterial hypertension"
        },
        {
            "input": "There is no supraclavicular or axillary lymph node enlargement or any soft\ntissue lesion in the chest wall suspicious for malignancy or infection.\nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable. Atherosclerotic calcification is not apparent. Aorta\nand pulmonary arteries are normal size. There no filling defects in the\ncentral pulmonary arteries. There is no pericardial or pleural effusion.\nEsophagus is normal. Central lymph nodes in the mediastinum and hila and in\nthe internal mammary, diaphragmatic, and retrocrural stations are not\nenlarged. 5 mm triangular right middle lobe opacity, 6:188, was larger in\n___, presumably a benign lymphoid aggregate. Aside from mild dependent\natelectasis, lungs are clear. There is no evidence of infection.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\nPosterior diaphragmatic hernias transmits only subphrenic fat.",
            "output": "Normal chest CT"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe main pulmonary trunk is mildly dilated up to 31 mm.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma. \nHeart size is enlarged.  There is no pericardial effusion.  A mitral valve\nreplacement is present.  There are no significant Coronary artery\ncalcifications.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is no axillary or supraclavicular\nlymphadenopathy.  There are prominent mediastinal lymph nodes measuring up to\n10 mm in the prevascular space which have increased from ___ in may be\nreactive.\n\nPLEURAL SPACES:  There is no pneumothorax.  There are small bilateral pleural\neffusions right greater than left.\n\n\nLUNGS/AIRWAYS:  Airways are patent to the segmental level bilaterally.  There\nis mild bronchial wall thickening at the lung bases, which likely reflects\nchronic inflammation.  Centrilobular emphysema is mild.  There is interlobular\nseptal thickening with diffuse ground-glass opacity and mosaic attenuation,\nright greater than left.  There is no suspicious pulmonary nodule.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates cholecystectomy\nclips.  Subcentimeter hypodense liver lesions are too small to characterize..\n\nBONES:  Median sternotomy wires are intact.  There are no suspicious bony\nlesions.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Cardiomegaly, diffuse ground-glass opacity, and small bilateral pleural\neffusions, consistent with pulmonary edema.\n3. Enlarged main pulmonary trunk suggestive of pulmonary artery hypertension.\n4. Mildly enlarged mediastinal lymph nodes, likely reactive."
        },
        {
            "input": "HEART AND VESSELS: There is satisfactory opacification of the pulmonary\narteries. No filling defect to suggest acute pulmonary embolism. The main\npulmonary trunk is normal in caliber. No evidence of right ventricular strain.\nNo cardiomegaly. The aorta and major vessels to the neck are unremarkable.\n\nLUNGS AND AIRWAYS: There is multifocal bronchocentric ground-glass\nconsolidation throughout both lungs, there is more confluent consolidation\nalong the mediastinal aspect of the left lower lobe, which may account for the\napparent mediastinal widening on prior chest radiograph.  There are secretions\nnoted within the trachea (axial series 4, image 1). The tracheobronchial tree\nis patent.\n\nPLEURA/PERICARDIUM: No pleural or pericardial effusion.\n\nMEDIASTINUM: No hilar or mediastinal adenopathy.\n\nESOPHAGUS AND NECK: Unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious osseous or soft tissue lesion.\n\nUPPER ABDOMEN: Unremarkable.",
            "output": "Findings consistent with multifocal pneumonia.  Confluent consolidation along\nthe mediastinal aspect of the left lower lobe may account for apparent\nmediastinal widening on recent chest radiograph."
        },
        {
            "input": "The imaged thyroid is unremarkable.  Thoracic aorta is mildly calcified and\nmildly ectatic along the ascending segment measuring 3.9 cm in diameter.  The\naortic branch vessels appear widely patent with independent origin of the left\nvertebral artery.  There is no mediastinal hematoma or adenopathy.  The main\npulmonary artery measures within normal limits.  Filling defect within the\npulmonary arterial tree primarily seen within the left-sided lobar, segmental\nand subsegmental branches of the left lower lobe, to a lesser extent left\nupper lobe.  On the right, there is lobar and segmental clot within the right\nlower lobe and right middle lobe and to a lesser extent right upper lobe.  No\nsaddle pulmonary embolism.  The heart is within normal limits of size though\nthere is relative flattening of the interventricular septum which suggests\nright heart strain.  No pericardial or pleural effusion.  Airways appear\ncentrally patent.  No worrisome nodule, mass, or consolidation within the\nlungs.  There is no evidence of infarction or infection.\n\nIn the imaged portion of the upper abdomen, no abnormalities are seen.\n\nBones:  Chronic left ribcage deformity noted.  No worrisome bony lesion.  A\nprominent bone island is noted within T10 vertebra.  There is mild loss of\nvertebral body height at T8 likely chronic.",
            "output": "1. Extensive bilateral pulmonary embolism with probable right heart strain. \nPlease correlate clinically.\n2. Ectasia of the ascending aorta measuring up to 3.9 cm in diameter."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is mild motion at the left lung base which obscures detailed evaluation\nof the subsegmental branches.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The base of the visualized neck\nshows no abnormality.  The partially visualized thyroid is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: The distal esophagus is patulous but otherwise unremarkable.  A\nconspicuous but subcentimeter lower paratracheal lymph node does not meet CT\nsize criteria for pathologic enlargement and is unchanged (6:115).\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart, pericardium, and great vessels are within\nnormal limits.  No pericardial effusion is seen.  There is no significant\ncoronary atherosclerotic calcification.  The thoracic aorta is normal in\ncaliber and course without evidence of dissection or intramural hematoma.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  Multiple calcified and noncalcified pulmonary nodules are stable\nsince ___.  There are no new nodules.  Within the lateral segment of the\nright middle lobe, a calcified nodule has minimally increased in size,\npreviously measuring 3.9 mm, now measuring 5.1 mm (6:156), with similar\nsurrounding parenchymal scarring and adjacent calcified micronodule.  The\ncalcified nodule in the apical posterior segment of the left upper lobe is\nunchanged, previously measuring 5.4 mm, now measuring 5.6 mm (6:76).  2\nnodules in the right upper lobe are also unchanged, now measuring 4.1 mm\n(6:133) and 4.3 mm (6:74), previously measuring 3.9 mm and 4.1 mm,\nrespectively.  Within the lateral basal segment of the left lower lobe, the\n4.7 mm noncalcified solid nodule is unchanged, previously measuring 4.4 mm\n(6:177).  No focal consolidations.\n\n-AIRWAYS:  The airways are patent to the bilateral segmental bronchi.\n\n-VESSELS:  The diameter of the main pulmonary artery is within normal limits. \nAlthough not optimized for the detection of pulmonary emboli, the pulmonary\nvasculature is opacified to the level of the subsegmental arteries.\nCHEST CAGE: There are no worrisome osseous abnormalities.  There is no acute\nfracture.  Mild degenerative changes of the thoracic spine appear similar to\nthe prior study.\n\nUPPER ABDOMEN: Please refer to the same day report of the abdomen and pelvis\nfor subdiaphragmatic findings.",
            "output": "-Stable calcified and noncalcified pulmonary nodules since ___.  No new\nnodules.\n-Please refer to the same-day report abdomen and pelvis for subdiaphragmatic\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen and pelvis report\nperformed concurrently for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  The distal esophagus\nis patulous, though otherwise unremarkable.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  The\nthoracic aorta is normal in caliber without atherosclerotic plaque. \nRight-sided PICC line terminates at the low SVC.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Multiple calcified pulmonary nodules are stable since ___. \nThere is a calcified nodule within the lateral segment of the right middle\nlobe measuring 5.1 mm (302: 124), unchanged in size with similar surrounding\nparenchymal scarring.  A calcified nodule in the apical posterior segment of\nthe left upper lobe measures 5.4 mm (302:71), unchanged.  A right upper lobe\nnodule measures 4.6 mm (302:55) compared to 4.3 mm on prior study.  Another\nright upper lobe nodule measures 4.4 mm (302:103) compared to 4.1 mm on prior\nstudy.  There is a noncalcified solid nodule within the lateral basal segment\nof the left lower lobe, measuring 4.8 mm (302:145), compared to 4.7 mm on\nprior study.  No new pulmonary nodules or masses are identified.  No focal\nconsolidation.\n2. AIRWAYS: Airways are patent to the subsegmental level bilaterally.\n3. VESSELS: The main, right and left pulmonary arteries are normal in caliber.\nWhile this study is not optimized for the detection of pulmonary emboli, no\ncentral filling defect is seen.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion\nis detected.  There is mild degenerative change of the thoracic spine.",
            "output": "1. Stable appearance of calcified and noncalcified pulmonary nodules since at\nleast ___, as described above.  No new pulmonary nodules identified.\n2. For complete description of subdiaphragmatic findings, please see dedicated\nreport of CT abdomen/pelvis performed on the same day."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  There is re-demonstration of a right-sided PICC which\nterminates in lower SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple calcified and sub 5 mm solid pulmonary nodules are\nre-demonstrated and unchanged in size or appearance compared to multiple prior\nstudies.  No new nodules identified.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nCharacterization of subdiaphragmatic findings please refer to same-day CT\nabdomen pelvis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Stable appearance of numerous bilateral calcified and noncalcified\npulmonary nodules dating back to at least ___ with no new nodules identified.\n2. Please refer to same-day CT abdomen pelvis for characterization of\nsub-diaphragmatic findings."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, mediastinal, or hilar\nlymphadenopathy.  The heart size is normal.  There is no pericardial effusion.\nThe esophagus is grossly unremarkable.  There is a small hiatal hernia.  The\naorta is normal in caliber.  The main pulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nOverall, there has been no significant interval change in the appearance of\nthe calcified and noncalcified nodules compared to the prior exam.  For\nexample:\n\n-a 3 mm left lower lobe nodule, series 6, image 164 is unchanged compared to\nthe prior exam.\n-a mixed calcified and noncalcified nodule within the right middle lobe\nappears grossly unchanged compared to the prior exam from ___, with the\nnoncalcified portion measuring up to 7 mm, series 6, image 147.  There however\nappears to be slight interval increase in the noncalcified portion of this\nlesion compared to the exam from ___.\n\nNo new or growing pulmonary nodules are identified.  There is no pleural\neffusion or pneumothorax.",
            "output": "Overall, stable calcified and noncalcified nodules compared to the prior exam\nfrom ___.\n\nThe noncalcified portion of the mixed nodule within the right middle lobe\nmeasuring 7 mm (6; 147) appears unchanged compared to the exam from ___, however appears to be slightly increased in size compared to the exam\nfrom ___.\n\nContinued attention on follow-up in 3 months with chest CT is recommended."
        },
        {
            "input": "THYROID: Unremarkable.\n\nLYMPH NODES: No axillary or supraclavicular lymphadenopathy.  Calcified\nmediastinal and right hilar nodes suggest prior granulomatous exposure.  A few\nscattered mediastinal lymph nodes measuring up to 10 mm in the subcarinal\nstation may be reactive (302:99).\n\nMEDIASTINUM: There is no mediastinal hematoma.  A significant amount of fluid\ndistends the esophagus.\n\nHEART AND GREAT VESSELS: Heart is mildly enlarged.  No pericardial effusion. \nHeavy multifocal coronary calcifications are noted.  Aortic valve\ncalcifications are mild.  Thoracic aorta is normal in caliber with moderate\natherosclerotic calcifications throughout.  Main pulmonary artery is normal in\ncaliber.\n\nAIRWAYS AND LUNGS: Mild bronchial wall thickening in the lower lobes suggests\nsmall airways inflammation.  Evaluation of the lung parenchyma is notable for\nmild upper lobe predominant centrilobular emphysema.  There is a millimetric\ncalcified granuloma in the right upper lobe (302:140).  Bibasilar atelectasis\nis mild.  A 4 mm nodule is incidentally noted in the posterior segment right\nupper lobe (302:107).  Trace bilateral pleural effusions are not hemorrhagic.\n\nUPPER ABDOMEN: Please refer to the separate dictation for the CT\nabdomen/pelvis examination performed on the same day for details on\nsubdiaphragmatic findings.\n\nBONES AND SOFT TISSUES: Irregularity of the mid/distal right clavicle suggests\na likely remote fracture.  No suspicious lytic or sclerotic lesions are\nidentified.  Mild degenerative changes are noted throughout the thoracic\nspine.  Mild body wall edema.",
            "output": "1. No source of hemorrhage identified in the chest.\n2. Trace nonhemorrhagic bilateral pleural effusions.\n3. 4 mm right upper lobe pulmonary nodule.\n4. Fluid distension of the esophagus suggests reflux, and can be correlated\nclinically.\n5. Findings of prior granulomatous exposure.\n\nRECOMMENDATION(S):  For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no specific CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  There are minimal atherosclerotic calcifications of\nthe thoracic aorta and coronary arteries.  Otherwise, the heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Mild dependent atelectasis.  The triangular-shaped\nperifissural opacity within the left lung (series 2, image 69) likely\nrepresents atelectasis.  Otherwise, the are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: A subcentimeter hypodensity within the inferior liver (series\n2, image 142) is too small to characterize, but likely represents a cyst or\nbiliary hamartoma.  Otherwise, the liver demonstrates homogenous attenuation\nthroughout.  There is no evidence of focal lesion or laceration.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  There is\npossible sludge or small stones layering within the gallbladder (series 2,\nimage 148).  There is no evidence of cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A subcentimeter hypodensity within the lower pole of the left kidney\nis too small to characterize, but likely represents a simple cyst (series 2,\nimage 151).  Otherwise, the kidneys are of normal and symmetric size with\nnormal nephrogram.  There is no evidence of enhancing renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute traumatic injury within the chest, abdomen, or pelvis.\n2. Possible sludge or small stones layering within the gallbladder."
        },
        {
            "input": "There is a 14 mm hypodense thyroid nodule in the right thyroid lobe (5, 3). \nOther nodules are smaller.  The esophagus is mildly patulous. There is diffuse\nwall thickening of the distal esophagus (see series 5, image 31).  The aorta\nis normal in caliber throughout the chest.  Within the lumen of the distal\ndescending thoracic aorta near the esophageal hiatus, there is a large,\napproximately 3.2 x 1.5 x 1.1 cm (CC by TV by AP) (series 5, image 31 and\nseries 9, image 40) intraluminal thrombus which appears to arise in a\npedunculated fashion from the more superior and posterolateral wall of the\naorta (for example see series 6, images 132-135).  Major aortic arch branch\nvessels are grossly patent and within normal limits.  The pulmonary artery is\nnormal in caliber.  There are multiple bilateral pulmonary emboli;\nspecifically, thyroid emboli involving the segmental PA branch to the right\nmiddle lobe (6, 75) as well as subsegmental branches to the bilateral lower\nlobes (6, 112, 113, and 141, and 144).  No CT evidence of right heart strain. \nThere is moderate to severe global cardiomegaly.  A right PICC terminates at\nthe cavoatrial junction.  There is mild coronary artery calcification.  There\nis no focal cardiac or pericardial abnormality.  There is no pericardial\neffusion.  There is no mediastinal, hilar, axillary, or visible\nsupraclavicular lymphadenopathy.\n\nThere is mild leftward deviation of the upper thoracic trachea, apparently due\nto a tortuous innominate artery (for example see series 6, image 22).  The\ntracheal lumen is widely patent.  Otherwise, major airways are patent\nbilaterally.  Lung volumes are slightly low.  Streaky opacities at the lung\nbases are consistent with atelectasis.  There is a 1-2 mm right upper lobe\nnodule (6, 49).  Otherwise, there is no additional lung nodule or mass seen. \nThere is a trace layering left nonhemorrhagic pleural effusion.  There is no\nfocal pleural abnormality seen.\n\nAside from generalized soft tissue edema, there is no concerning focal\nsubcutaneous or musculoskeletal soft tissue abnormality.  The imaged thoracic\nvertebral bodies are normally aligned. There is mild multilevel degenerative\nchange. Vertebral body heights are preserved. No concerning focal lytic or\nsclerotic osseous lesions are seen.",
            "output": "1. 3.2 x 1.5 x 1.1 cm pedunculated intraluminal thrombus arising from the left\nposterolateral wall of the descending thoracic aorta.\n2. Additional 1.0 cm intraluminal thrombus in the very distal abdominal aorta\nnear the aortoiliac bifurcation is noted.  For further details of the\nsubdiaphragmatic findings, please see separate report for same-day CT\nabdomen/pelvis.\n3. Bilateral segmental and subsegmental pulmonary emboli involving the right\nmiddle, and bilateral lower lobe PA branches.  No CT evidence of right heart\nstrain.\n4. Diffuse, contiguous distal esophageal wall thickening is of uncertain\nsignificance, however submucosal malignancy is of primary concern.  Recommend\nendoscopy, if/when clinically indicated.\n5. No evidence of intrathoracic metastasis.\n6. Trace layering left nonhemorrhagic pleural effusion.\n7. 1-2 mm right upper lobe pulmonary nodule without suspicious features. \nAttention on follow-up imaging.\n8. Moderate-to-severe global cardiomegaly.\n9. 14 mm hypodense right thyroid lobe nodule.  Recommend nonurgent/routine\nthyroid ultrasound, if/when clinically appropriate, and if not performed\npreviously elsewhere.\n10. Generalized edema.\n\nRECOMMENDATION(S):  Recommend nonurgent/routine thyroid ultrasound, if/when\nclinically appropriate, and if not performed previously elsewhere.\nRecommend endoscopic evaluation of distal esophageal wall thickening, if/when\nclinically appropriate.\n\nNOTIFICATION:  The findings and recommendations above were discussed with\n___, M.D. by ___, M.D. on the telephone on\n___ at both 1:53 ___, and again at 3:10 ___, initially 5 minutes after\ndiscovery of the findings"
        },
        {
            "input": "CHEST:\n1.4 cm hypodense right thyroid nodule is again seen (3:6).\n\nThere is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy. \nThe thoracic aorta is unremarkable in caliber throughout the chest. \nPreviously demonstrated filling defect in the descending aorta at the\ndiaphragmatic hiatus is not seen on today's exam.  The pulmonary artery is\nnormal in caliber.  Previously demonstrated multiple bilateral pulmonary\nemboli are not seen on today's exam.  However, in the lower lobes bilaterally,\nthere is irregularity of the subsegmental pulmonary vasculature, likely\nreflecting sequelae of prior occlusive disease.  There is no evidence of right\nheart strain.  Mild coronary calcification is again noted.  There is no\npericardial effusion.  In the ___, near the cavoatrial junction, there is a\ntubular filling defect of 8 mm, though evaluation is limited due to cardiac\nmotion (3:87, 9:19), it may be a fibrin sheath.  There is stable moderate\ncardiomegaly.\n\nThe visualized airways are patent to the subsegmental levels.  There is\nminimal bibasilar atelectasis.  2 mm right upper lobe pulmonary nodule is\nagain seen (5:62), may represent plugged airway. There are multiple pulmonary\nnodules in the right middle lobe, right upper lobe (5:124, 170, 180), may\nrepresent plugged airway.   In the left lower lobe, there is a pleural-based\nnodule measuring up to 3 mm (3:66).  Otherwise, no additional lung nodules or\nmasses are seen.  There is no pleural effusion.\n\nOn the lateral right chest wall, there is a subcutaneous nodule measuring up\nto 1.4 cm (3:88).  Somewhat nodular appearance of the breast parenchyma is sub\noptimally evaluated on the CT and a dedicated mammography is needed for proper\nevaluation.\n\nThere is stable thoracic kyphosis seen.  Mild multilevel degenerative changes\nare again seen.  There is no concerning focal lytic or sclerotic osseous\nlesion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen is a 1.3 cm hypodensity in the left lobe of the liver (06:11),\nlikely a cyst.  There is mild fullness of the central intrahepatic biliary\nducts.  There is mild prominence of the extrahepatic biliary duct, measuring\nup to 7 mm.  The gallbladder is within normal limits.  There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nIn the upper pole of the left kidney, there is a partially exophytic\nhypodensity measuring up to 1.5 cm with a focal mural ___\nrepresenting a mural calcification (06:20).  In the midpole of the left\nkidney, there is a simple cyst measuring up to 3.8 x 3.1 cm.  Other\nsubcentimeter hypodensities in the left kidney are too small to characterize\nby CT.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  In the anterior\nintraperitoneal fat near the inferior edge of the right lobe near the\nfalciform ligament (06:28), and adjacent to the loop of transverse colon\n(6:29), there is increased soft tissue density within the fat (06:28), which\nmay represent postsurgical changes.  No definite nodularity is are seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis (6:66).\n\nREPRODUCTIVE ORGANS: Patient is status post bilateral salpingo-oophorectomy. \nThe uterus is grossly unremarkable with a calcified fibroid at the fundus.  No\nadnexal masses are seen.\n\nLYMPH NODES: There is no pathologic retroperitoneal or mesenteric\nlymphadenopathy.  There is no pathologic pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Patient status post infrarenal IVC filter placement.  The celiac\nartery, SMA, ___ and bilateral renal arteries are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute pulmonary embolism or acute aortic syndrome.\n2. No new adnexal masses.  Fat stranding in the anterior peritoneum, which may\nrepresent surgical changes.  No definite omental nodularity.  Attention to\nthis area on follow-up is recommended.\n3. Left renal lesion measuring up to 1.5 cm with tiny focus of mural\n___ that is likely calcification.  Dedicated ultrasound or attention\non follow-up CT exam is recommended.\n4. Previously demonstrated filling defect within the descending aorta at the\ndiaphragmatic hiatus is not seen on today's exam. Status post infrarenal IVC\nfilter placement.  Patent vasculature of the abdomen pelvis.\n5. Status post bilateral salpingo-oophorectomy with interval resolution of\nlarge volume ascites.\n6. Possible filling defect in the inferior ___ represent a fibrin sheath.\n7. Multiple pulmonary nodules, some of which may represent blood airway. \nAttention on follow-up imaging is recommended.\n\nRECOMMENDATION(S):\n1. No new adnexal masses. Fat stranding in the anterior peritoneum, which may\nrepresent postsurgical changes.  No definite omental nodularity.  Attention to\nthis area on follow-up is recommended.\n2. Left renal lesion with mural ___, measuring up to 1.5 cm.\nDedicated ultrasound or attention on follow-up CT exam is recommended.\n3. Multiple pulmonary nodules, some of which may represent blood airway. \nAttention on follow-up imaging is recommended."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  There\nis no pericardial pleural effusion.\n\nEsophagus appearance is overall within normal limits.\n\nThe most prominent feature of the examination is severe in terms of extension\nand amount of calcification mediastinal lymphadenopathy that involves left\nsupraclavicular lymph nodes, series 2, image 3, thoracic inlet, series 2,\nimage 7, continues in the prevascular space, right paratracheal location,\naortopulmonic window, sub- carinal and paraesophageal location.  The largest\nbulk of lymphadenopathy is in the left hilus where at conglomerate of it least\n___ year large lymph nodes approaching the size of 3.6 x 2.8 cm.  Airways are\npatent with no evidence of erosion of the calcified lymph nodes into the\nairways but the air definitely abutting the airways in the left lower lobe\nwith some minimal secretions demonstrated.  Calcified granuloma are in\nconsistent with prior granulomatous exposure.  Left upper lobe nodule, series\n4, image 63 is 3 mm in diameter.  Scattered small cysts are present, few.\n\nImage portion of the upper abdomen demonstrate splenic calcifications with\npotentially mild splenomegaly.  Nodularity of the liver is noted diffusely. \nSize of the liver is unremarkable.  Midline abdominal hernia contains part of\nthe stomach, partially imaged, series 2, image 64.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nSee by she is cyst in the right lower back, series 601b, image 96 is 1.5 x 1\ncm.",
            "output": "Extensive mediastinal calcified lymphadenopathy and left hilar lymphadenopathy\nas described.  Granulomatous exposure may be related to mycobacteria or\nhistoplasmosis exposure.\n\nNo evidence of tracheal esophageal fistula or tracheobronchial fistula seen on\nthe current study, although note is made that no oral contrast was provided.\n\nPer extreme ET and potential compression of airways of the left lower lobe and\nlingula bite the calcified conglomerate of the left hilus is present and might\nreflect the reason for cough\n\nLeft upper lobe nodule.  In the absence of history of smoking no further\nfollowup indicated\n\nSubstantial nodularity of the liver, that might reflect liver cirrhosis. \nCorrelation with low border testing in dedicated ultrasound is to be\nconsidered\n\nMidline hernia containing stomach partially."
        },
        {
            "input": "CTA: The pulmonary arteries are opacified to the segmental level bilaterally\nwithout filling defect.  Evaluation of the subsegmental pulmonary arteries is\nlimited by respiratory motion at the lung bases.  There is no aortic\nabnormality.\n\nCHEST: The left thyroid is unremarkable.  Right thyroid is atrophic.  There\nare no enlarged axillary lymph nodes.\n\nThere are extensive calcified mediastinal and left greater than right hilar\nadenopathy overall unchanged from ___.  Largest calcified lymph node in the\nleft hilum measures 2.8 x 3.4 cm.  Heart size is normal.  There is no\npericardial effusion.  The main pulmonary trunk is normal in caliber.  There\nare no significant aortic valvular or coronary artery calcifications.\n\nThe airways are patent to the segmental level bilaterally.  There is mild\nbronchial wall thickening in the lower lobe small airways.  There is no focal\nlung consolidation.  Scattered calcified granulomas are present with the\nlargest in the right upper lobe (series 6, image 57).  0.3 cm left upper lobe\npulmonary nodule is stable (series 6, image 63). There is mild bibasilar\natelectasis. A few scattered lung cysts are present.  There is no pneumothorax\nor pleural effusion.\n\nThere is a small hiatal hernia.  Limited views of the upper abdomen\ndemonstrate multiple calcifications within the spleen.  Pneumobilia is noted.\n\nThere is no superficial soft tissue abnormality.  There is no suspicious bony\nlesion.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Mild bibasilar atelectasis.\n3. Sequela of prior granulomatous infection including extensive calcified\nlymphadenopathy, calcified lung granulomas, and splenic calcifications."
        },
        {
            "input": "The patient is after median sternotomy and CABG.  Extensive Coronary\ncalcifications are present.  Aorta and pulmonary arteries are normal in\ndiameter.  No mediastinal, hilar or axillary lymphadenopathy is present. \nSevere calcifications of the aortic valve are noted.\n\nThere is no pericardial pleural effusion.  Image portion of the upper abdomen\nreveals no appreciable abnormality except for vascular calcifications.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe\nnodule, series 4, image 129 is 3.5 mm and series 4, image 145 is 3.5 mm. \nThere both noncalcified and with no radiologically concerning features.",
            "output": "Atherosclerotic disease, status post CABG\n\n2 pulmonary nodules in the right upper lobe.  Followup of the patient in ___\nyear according to the protocol is recommended"
        },
        {
            "input": "Two approximately 4 mm diameter right upper lobe nodules  (122 and 138, 5) are\nunchanged since ___.\n\nAssessment of the remainder of the lungs is remarkable for minimal biapical\nemphysema and scattered foci of nonspecific parenchymal scarring.  No new\nconcerning pulmonary nodules are detected.\n\nThere are no enlarged intrathoracic lymph nodes.  Subcentimeter nodes are\nunchanged.  Note is made of previous median sternotomy and coronary bypass\nsurgery with severe calcifications of the native coronary arteries.  Heart is\nupper limits of normal in size with configuration of left ventricle apex\nsuggesting the possibility of previous infarct.  Aortic valvular\ncalcifications are also noted.  There is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning findings are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate post sternotomy changes and\nmultilevel degenerative changes within the spine.",
            "output": "1.  ___ year stability of small pulmonary nodules, which require no further\nimaging followup according to the ___ guidelines.\n\n2.  Aortic valvular calcifications, in keeping with history of aortic\nstenosis.\n\n The ___ pulmonary nodule recommendations\nare intended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Confluent and patchy airspace opacities are present in the\nright middle and bilateral lower lobes, are new from the recent prior exam\nconcerning for pneumonia, possibly reflecting sequelae of aspiration.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Partially visualized hypodense lesions within the liver, largest in\nthe left lobe are stable when compared with the prior CT exam, previously\ncharacterized as simple cysts.\n\nBONES: Chronic rib deformities in the lateral aspect of the ___ through ___\nleft rib are noted, could reflect sequela of previous trauma.  Otherwise, no\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Lower lung consolidative opacities, new from recent prior concerning for\npneumonia versus sequelae of aspiration.\n3.  Similar appearance of partially visualized hepatic hypodense lesions,\nthought to reflect simple cysts on multiple priors.\n\nNOTIFICATION:  Changes from initial wet read regarding liver lesions may by\nphone with Dr. ___ at 14:09 on ___"
        },
        {
            "input": "The thyroid is enlarged for the patient's age and extends into the right\nsuperior mediastinum.  There is no axillary, supraclavicular, or mediastinal\nadenopathy.  Heart is mildly enlarged, specifically the left atrium.  There is\nno pericardial effusion.  Coronary artery calcifications are moderate.  Mitral\nannular calcifications are severe.  The thoracic aorta is moderately\ncalcified.  Incidental note is made of an aberrant right subclavian artery. \nThe main pulmonary trunk is normal in caliber.\n\nThe airways are patent to the subsegmental level bilaterally.  There is\nnarrowing of the left mainstem bronchus between the aorta and the left main\npulmonary artery.  Small to moderate bilateral nonhemorrhagic pleural\neffusions have mildly increased, right greater than left.  There is associated\natelectasis.  There is no pneumothorax.  There are no suspicious pulmonary\nnodules.\n\nThere is a large left diaphragmatic hiatal hernia containing the entire\nstomach as well as loops of large bowel and the first segment of the duodenum.\nThere is oral contrast from prior CT scan within dilated loops of large bowel\nwhich now measure up to 5.8 cm in the right upper quadrant.  There is no\npneumatosis or free air.  The thoracic esophagus is mildly patulous and\ncontains debris.\nViews of the upper abdomen are also notable for small volume intra-abdominal\nascites.\n\nOSSEOUS STRUCTURES:  Compression deformities of L1 and T12 are unchanged. \nThere are no suspicious bony lesions.",
            "output": "1. Large left diaphragmatic hernia containing the entire stomach, proximal\nduodenum, and portions of colon.  No CT evidence of ischemia.  Oral contrast\nfrom prior CT scan is seen within the colon.\n2. Small to moderate bilateral pleural effusions, right greater than left,\nincreased from ___.\n3. Increased dilation of upper abdominal colonic loops since ___ now\nmeasuring up to 5.8 cm, further evaluation with abdominal radiograph is\nrecommended.\n4. Focal narrowing of the left mainstem bronchus between the aorta and\npulmonary artery.\n5. Incidental note made of an aberrant right subclavian artery.\n\nRECOMMENDATION(S):  Abdominal radiograph to evaluate increasing colonic\ndilation."
        },
        {
            "input": "CHEST:\nThe thyroid gland is heterogeneous in appearance, and contains a 5 mm\nhypodense nodule on the right.\n\nThere is no axillary, supraclavicular, mediastinal or hilar lymphadenopathy by\nCT size criteria.  Heart size is normal, and there is no pericardial effusion.\nThe thoracic aorta contains mild atherosclerotic calcifications, but is normal\nin caliber.  Incidental note is made of an aberrant right subclavian artery, a\nnormal variant.  Intramural thrombus with calcification is noted along the\nanterior aspect of the proximal right subclavian artery (02:16).  Main\npulmonary artery is normal in caliber.  Please note that this study is not\ntailored for evaluation of pulmonary emboli.  The right lower lobe pulmonary\narterial branches are particularly difficult to evaluate.\n\nThere are moderately sized non-hemorrhagic pleural effusions with adjacent\natelectasis bilaterally.  No concerning parenchymal nodular opacities are\nidentified.  No pneumothorax.\n\nEvaluation of the chest wall demonstrates asymmetrically dense breast tissue\non the left (2:45), unchanged from the prior study.\n\nABDOMEN:\n\nThere is a very large diaphragmatic hernia that contains a portion of the\nstomach, pancreas, colon, and celiac axis through a 7.4 cm defect (___). \nThis is similar in appearance compared to the prior studies.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS:  Pancreatic parenchyma is homogeneous in attenuation throughout,\nwithout pancreatic ductal dilation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is an extrarenal pelvis on the right.  There is no evidence of focal\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL:  An enteric tube is present within the stomach, a portion of\nwhich is located within the diaphragmatic hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  The\ncolon is diffusely dilated from the cecum to the level of the descending\ncolon, measuring up to 9-10 cm in the cecum (601b:39).  There is no discrete\ntransition point, but there is rather smooth tapering towards the rectum. \nThese findings together suggestive of colonic pseudo-obstruction, rather than\na true mechanical obstruction.  No evidence of bowel wall ischemia.  There is\nno pneumoperitoneum.  Small volume ascites.\n\nThere are innumerable nodular soft tissue deposits scattered throughout the\nomentum and mesentery (02:51, 53, 55, 58, 69, 73, 81), suspicious for\nmalignancy, which is most likely metastatic, although primary omental neoplasm\nis another possibility.  The largest lesion is within the left upper quadrant\nmeasuring 2.8 x 4.0 x 7.3 cm TV x AP x CC (2:69, 601b:36).  There are\npostsurgical changes including soft tissue stranding, focal fluid and\nsubcutaneous air after right inguinal hernia repair on ___.  Of\nnote, there is a 2.2 x 1.9 cm soft tissue lesion immediately adjacent to the\nrecently placed inguinal plug (2:100), compatible with an additional deposit\nthat was likely recently surgically reduced.\n\nPELVIS:  The urinary bladder is largely collapsed around a Foley catheter.\n\nREPRODUCTIVE ORGANS:  The uterus is not visualized.   Ovaries are not\ndefinitely visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:  Abdominal aorta contains extensive atherosclerotic calcifications,\nbut is without in aneurysmal dilation.\n\nBONES:  Osseous structures are diffusely demineralized.  Old left inferior\npubic ramus fracture is noted (2:114).  T12 and L1 vertebral body compression\nfractures are unchanged from the prior study.  No lytic or sclerotic lesions\nthat are suspicious for malignancy are identified.\n\nSOFT TISSUES:  Postop changes as described above.",
            "output": "1. Diffuse colonic dilation with a smooth tapering at the level of the rectum,\nfindings suggestive of colonic pseudo-obstruction.  Cecum measures 9-10 cm in\ndiameter.  No evidence of ischemia or pneumoperitoneum.\n2. Large diaphragmatic hernia containing stomach, pancreas, colon, and celiac\naxis, similar to the prior study.\n3. Innumerable peritoneal and omental soft tissue deposits, the largest in the\nleft upper quadrant measuring 7.3 x 4.0 x 2.8 cm.  Of note, a 2.2 x 1.9 cm\ndeposit is adjacent to the recently placed inguinal canal plug.  These\nfindings are highly suspicious for metastatic disease, most commonly from\novarian or a GI/gastric primary.  Alternatively, primary omental\nadenocarcinoma is another possibility.  Further evaluation is recommended.\n4. Moderate non-hemorrhage bilateral pleural effusions with adjacent\natelectasis.\n5. Asymmetrically dense left breast tissue.\n\nNOTIFICATION:  Wet read was discussed by Dr. ___ with Dr. ___ in\n___ ___ at 12:30AM, 1 minutes after discovery of the findings.\n\nUpdated findings were discussed by Dr. ___ with Dr. ___ on the\ntelephoneon ___ at 9AM, 10 minutes after discovery of the findings."
        },
        {
            "input": "There is a heterogeneous right thyroid nodule which measures up to 18 mm in\ndiameter (05:29).  There are few additional smaller hypodense right thyroid\nnodules in the posterior right thyroid gland.  There are no pathologically\nenlarged supraclavicular, axillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  There are filling\ndefects in multiple left lower lobe segmental pulmonary arteries (5: 122,\n137).  The heart is normal in size and demonstrates no appreciable coronary\nartery calcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Evaluation of the lung parenchyma is slightly limited\nby respiratory motion.  Patient is status post left upper lobe segmentectomy. \nThere is scarring in the lingula and right middle lobe.  There are a few\nsubpleural pulmonary micronodules in the left lower lobe (5:140, 196).\n\nThere is a mixed lucent and sclerotic lesion in the T6 vertebral body,\nsuspicious for metastatic disease (08:56).  There is sclerosis along the\ninferior endplate of the T5 vertebral body which may also be due to metastatic\ndisease or degenerative change.  No acute fracture.\n\n Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "1. Left lower lobe segmental pulmonary emboli.\n2. Heterogeneous T6 vertebral body lesion, concerning for metastatic disease.\n3. Sclerosis along the inferior endplate of T5 vertebral body may be due to\nmetastatic disease or degenerative in nature.\n4. Few subpleural pulmonary micronodules.\n5. Heterogeneous right thyroid nodule measuring up to 18 mm. This could be\nfurther evaluated with thyroid ultrasound if clinically indicated.\n6. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Thyroid ultrasound if clinically indicated.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 10:31 am, 1 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is notable for a 1.8 cm\nheterogeneous nodule (06:14) and additional small hypodense nodules in the\nright lobe of the thyroid, unchanged.  Supraclavicular and axillary lymph\nnodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  No central\npulmonary embolus is identified.\n\nPULMONARY PARENCHYMA:  Multiple bilateral micro nodules are unchanged (for\nexample, 7:69, 134, 142, 155).  Stable appearance of scarring in the left\nupper lobe.  There is no emphysema.\n\nAIRWAYS:  There is mild diffuse peribronchial thickening with scattered areas\nof mucous plugging\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  Endplate sclerosis and Schmorl's nodes at T5 and T6\nlikely represent degenerative change, similar in appearance to prior.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Heterogeneous right thyroid nodule measuring 1.8 cm is unchanged, for which\nthyroid ultrasound can be performed for further evaluation if clinically\nindicated, as previously noted.\n2. Sclerosis of the T5 and T6 vertebral bodies in association with Schmorl's\nnodes of T6 most likely represent degenerative change, similar in appearance\nto prior.\n3. Multiple bilateral micro nodules are unchanged.  No new or enlarging\nnodules are demonstrated.\n4. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Thyroid ultrasound if clinically indicated."
        },
        {
            "input": "Stable right thyroid nodules.  Stable right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Multiple stable\nnormal sized mediastinal lymph nodes, no hilar or mediastinal lymphadenopathy.\nThe central vessels in the mediastinum are unremarkable.  Currently, there is\nno evidence of PE.  No signs indicative of right heart strain.  Severe\ncoronary calcifications, no pericardial effusion.  The posterior mediastinum\nis unremarkable.  The oval shin of multiple predominantly hypodense liver\nlesions as well as of renal cysts is described in detail in the dedicated\nabdominal CT report.  The appearance of the breast tissue is stable and\nunremarkable.  The known sclerotic lesion in L1 (11, 52) Has increased in size\nand density.  The mixed sclerotic and lytic lesions in T5 and T6 are stable. \nSclerotic lesions in T2 and T3 are newly visualized.   no evidence of\nvertebral compression.  The multiple pre-existing pulmonary nodules, for\nexample in the right upper lobe (8, 32) and in the right lower lobe (8, 92)\nare stable.  There is no evidence of new or growing nodules.  No pleural\nthickening, no pleural effusions.  The airways are patent.  Stable appearance\nof a partly calcified left lower lobe scar (8, 95).",
            "output": "Slight increase in extent of the bony metastasis, with increase in size and\nattenuation of the sclerotic lesion in L1 as well as newly visualized lesions\nin T2 and T3.  The size and number of the pre-existing pulmonary nodules is\nstable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Right thyroid nodules, one of which\nis calcified, are unchanged.  No axillary or supraclavicular adenopathy.\n\nUPPER ABDOMEN: Hypoattenuating liver lesions are partially visualized.  Please\nsee same day CT abdomen and pelvis for detailed findings.\n\nMEDIASTINUM: No mediastinal adenopathy\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Left atrium is enlarged.  Aortic valve calcification\nand coronary atherosclerotic calcifications are noted.  No pericardial\neffusion\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA: The 4 mm right apical nodule is stable.  Diffuse interlobular\nseptal thickening are consistent with mild bilateral interstitial pulmonary\nedema.\n2. AIRWAYS: Patent to the subsegmental level bilaterally.\n3. VESSELS:  Mild thoracic aortic atherosclerotic calcifications.\nCHEST CAGE: Multilevel blastic osseous lesions within the thoracic spine are\noverall similar to to the ___ chest CT.  Mild chronic, likely\npathologic, compression deformity of T6 is unchanged.",
            "output": "1. Solitary 4 mm right apical lung nodule stable since at least ___\nis unlikely to be a solitary metastasis from pancreatic carcinoma.  The need\nfor followup imaging depends on staging and management considerations\nregarding the patient's extrathoracic malignancy.  Otherwise ___\nguidelines for detection of pulmonary nodules would apply.  See\nRecommendations below.\n2. Cardiomegaly and mild bilateral interstitial pulmonary edema.\n3. Multiple sclerotic thoracic osseous lesions, no new lesions identified.  No\nnew pathologic compression fractures.\n4. Multiple hypoattenuating liver lesions are partially visualized.  Please\nsee same-day CT abdomen and pelvis for detailed abdominopelvic findings.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:13 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is heterogeneous, unchanged from prior.  No enlarged lymph nodes\nin either axilla.  Small lymph nodes in the thoracic inlet, the largest\nbetween the aorta and of the right subclavian and carotid arteries measuring\n0.7 cm in short axis diameter, larger than in prior study.  Right anterior\nport with tip the in the lower SVC.  No abnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes,, all unchanged\ncompared to prior study.  No hilar lymphadenopathy.\n\nPLEURA:\nNew moderate right pleural effusion.  Small loculated left pleural effusion,\ninsinuating into the left major fissure.).  No pleural effusion to the left.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Moderate diffuse bronchial\nwall thickening.  Mild interlobular septal thickening noted in both upper\nlobes associated to ground-glass opacities.  There is partial compressive\natelectasis of the right lower lobe.  Ground-glass opacities are also noted\nmore prominently in the left lower lobe.\n\nCHEST CAGE:\nNo acute fractures.  Stable sclerotic lesions scattered throughout the\nthoracic spine, most prominently in T5 and T6.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Slightly enlarged lymph nodes in the superior mediastinum associated to new\nmoderate right pleural effusion suggestive of metastatic disease progression.\nMild pulmonary edema.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 16:20 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: 6 mm wide low density lesion in the partially imaged left\nlobe of the partially imaged thyroid is not large enough to require further\nimaging evaluation.  3 and 4 mm left supraclavicular lymph nodes are not\npathologically enlarged.  No right supraclavicular or enlarged axillary nodes.\nBreast evaluation is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.  Findings below the diaphragm will\nbe reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels or in the coronary arteries.  Aorta\nand pulmonary arteries and cardiac chambers are normal size.\n\nTHORACIC LYMPH NODES: Well defined, 16 mm wide spherical nodule in the\nprevascular mediastinum has the attenuation characteristics of soft tissue or\nhighly proteinaceous fluid.  It could be a lymph node, thymic remnant, or\ncyst.\n\nNo lymph nodes in the chest are pathologically enlarged including 3 and 4 mm\nnodes at the thoracic inlet.\n\nLUNGS, AIRWAYS, PLEURAE: No nodules or other focal lung lesions of\nconsequence.\n\nTracheobronchial tree is normal to subsegmental levels.  There is no pleural\nabnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No good evidence for intrathoracic malignancy.  Solitary 16 mm prevascular\nsoft tissue nodule could be a lymph node, cyst, or thymic remnant. No other\nenlarged lymph nodes in the chest."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Anterior mediastinal lesion,\n17 mm in diameter, series 10, image 37 is stable.  No additional mediastinal,\nhilar or axillary lymph nodes demonstrated.\n\n  Airways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPotentially thymic cyst\n\nPlease review CT abdomen and pelvis in corresponding report for assessment of\nintra-abdominal pathology."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging. \nRight supraclavicular, bilateral axillary lymph nodes, and left\nsupraclavicular lymph node 7 mm, 3:3, are not pathologically enlarged.\n\nThere are no soft tissue abnormalities in the chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.\n\nAtherosclerotic calcification is moderately heavy in head and neck vessels and\nheavy in coronary arteries.  Aorta and pulmonary arteries and cardiac chambers\nare normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: As follows:\n\nPrevascular para-aortic, 7 mm, 03:20, 23, are not pathologically enlarged by\nsize criteria, but somewhat unusual as isolated measurable lymph nodes.  On\nthe other hand in the absence of lymph nodes elsewhere in the chest AR\nextremely unlikely to be related to subdiaphragmatic malignancy.\n\nLymph nodes elsewhere in the mediastinum, along the diaphragm, and in the\nretrocrural stations are not enlarged and hilar contours on this noncontrast\nstudy do not suggest adenopathy.\n\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions:\n\nMore than dozen tiny lung nodules, half smaller than 3 mm.  Larger lesions as\nfollows:\n\n4.3 mm, perifissural, right upper lobe, 5:163\n\n4 mm, right lower lobe, 5:156\n\n4 mm, perifissural, left lower lobe, 5:204\n\n3-4 mm, right upper lobe, 05:59\n\n4 mm, left lower lobe, 5:229\n\n5 mm, subpleural with minimal adjacent pleural thickening, right lower lobe,\n5:208.\n\n5 mm, left lower lobe, 5:256 compared\n\nAlso, sub-3 mm: Right upper lobe 5:159, right lower lobe 5:174, 205, 241,\nperifissural, left lower lobe 5:121, left upper lobe 5:132, right upper lobe\n5:160,\n\nCHEST CAGE:  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "More than a dozen tiny lung nodules, half smaller than 3 mm across, the\nremainder between 3 and 5 mm, suspicious for metastases.\n\nHeavy atherosclerotic calcification in head and neck vessels and coronary\narteries."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is mild in the head\nand neck vessels, scattered in multiple coronary branches.  Aorta and central\npulmonary arteries are normal size and subject to the technical limitations of\nthe study, free of filling defects.  Cardiac chambers are normal size.  There\nis no pericardial or pleural abnormality.  Central lymph nodes are not\nenlarged.\n\nEmphysema is mild.  Bronchial wall thickening is diffuse but mild.  Lungs are\notherwise clear.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild coronary atherosclerosis.\n\nMild emphysema.  Mild generalized bronchitis."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or axial\nlymphadenopathy is present.  Head size is normal.  No pericardial pleural\neffusion is seen.  Image portion of the upper abdomen will be reviewed\nseparately as part of the CT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There is no soft\ntissue abnormality in the imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.  Thyroid is\nunremarkable.  Atherosclerotic calcification is mild in head neck vessels and\nin at least the LAD and right coronary arteries.  Aorta and central pulmonary\narteries are normal size.  There is no pericardial or pleural abnormality.\n\nMediastinal, hilar, diaphragmatic, and retrocrural lymph nodes are not\npathologically enlarged.\n\nMidportion of the trachea is mildly enlarged in the sagittal dimension, an\noccasional finding with coughing due to chronic lung disease.  Bronchial wall\nthickening is generalized but mild and there is no mucoid impaction or\nperibronchial infiltration or bronchial dilatation.  Lungs are essentially\nclear.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild coronary artery calcification."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate aortic wall calcifications are unchanged. \nNo hilar or mediastinal lymphadenopathy.  Stable mild to moderate coronary\ncalcifications, no pericardial effusion.  No abnormalities in the posterior\nmediastinum.  Stable appearance of a 6 mm paraesophageal lymph node (2, 46). \nThe upper abdominal findings are described in detail in the dedicated\nabdominal CT report.\nNo osteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  Stable small border at the lung apices.  The lung parenchyma per\nse is unremarkable, in particular, there is no evidence for the presence of\nmalignant or metastatic lung nodules.  The patient continues to show signs of\nmoderate chronic airways disease, associated to the finding of a saber sheath\ntrachea.  No pleural effusions.  No pleural thickening.  No diffuse lung\ndisease.",
            "output": "Stable chronic airways disease with saber shape trachea.  No evidence of\nmetastatic disease to the thorax."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  A right\nchest wall Port-A-Cath catheter tip terminates in the cavoatrial junction.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  Small\nbullae are seen at the lung apices bilaterally, unchanged from prior studies. \nA 4 mm right upper lobe pulmonary nodule is unchanged from ___\n(05:49).\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nInspissated secretions are noted within the left mainstem bronchus (5:143). \nMild bronchial wall thickening and an abnormal sabre configuration of the\ntrachea are unchanged.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic metastatic disease.  4 mm right upper lobe\npulmonary nodule is unchanged from ___\n2. Stable appearance of chronic airways disease.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: There are multiple hypodense lesions within the thyroid, could\nrepresent a multinodular goiter.  There are no enlarged supraclavicular lymph\nnodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.  No obvious breast\nlesions are seen\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The\nascending aorta and pulmonary arteries are normal in caliber.  There is mild\ncoronary artery calcification.  There is moderate atherosclerotic\ncalcification involving the aorta.  Heart size is top-normal.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The abnormality seen on the radiograph done on ___ most\nlikely corresponds to summation of shadows.  No obvious lung nodules are seen.\nThere is minimal bibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of the liver.  The left adrenal is mildly thickened.  There is a\nsmall hiatus hernia",
            "output": "No abnormality corresponding to the nodules seen on the radiograph done on ___ it most likely represents a summation of shadows.\n\nNo lung nodules.\n\nFatty liver.\n\nAtherosclerotic calcification involving the descending thoracic aorta.\n\nSmall hiatus hernia"
        },
        {
            "input": "Aortic arch is calcified.  No pathologically enlarged supraclavicular,\nmediastinal or axillary lymph nodes demonstrated.  Heart size is normal. \nThere is no pericardial or pleural effusion.  Severe Coronary calcifications\nare noted especially in LAD.\n\nImage portion of the upper abdomen demonstrate pneumobilia, pancreatic stent\nand mild dilatation of the pancreatic duct but note is made that the study is\nnot dedicated for assessment of intra-abdominal pathology.  For pre size\ndetails please review CT abdomen and pelvis that we obtained in ___.\n\nAirways are patent to the subsegmental level bilaterally.  Mild centrilobular\nemphysema is present.  Mild interstitial changes are present at the level of\nthe lower lobes.\nPulmonary nodules are as following:\nRight upper lobe 1 mm nodule, series 4, image 72  .\nRight upper lobe 1 mm nodule, series 4, image 84  .\nLeft upper lobe 2 mm nodule, series 4, image 35  .\nDiffuse bronchial wall thickening is noted that might be consistent with\nchronic inflammation/infection.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic metastatic disease with several\nnonspecific pulmonary nodules that should be reassessed in 3 months for\ndocumentation of stability\n\nMild centrilobular emphysema\n\nEvidence of airway infection/inflammation\n\nSevere Coronary calcifications\n\nPneumobilia and CBD stent."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic malignancy or pulmonary manifestations of\nsarcoidosis.\n2. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "Right axillary lymph nodes ranging in diameter up to 5 mm, 05:14, previously 7\nmm and hyper enhancing.  Left axillary nodes are smaller than that and stable.\nThere are no soft tissue abnormalities in the wall chest wall suspicious for\nmalignancy.  Evaluation of the breasts would require mammography.\n\nSlight increase in bulk of the thymus is attributable to rebound in a patient\nreceiving chemotherapy. The configuration does not suggest adenopathy. There\nis no pathologic enlargement of mediastinal or hilar nodes, and the internal\nmammary, diaphragmatic, and retrocrural stations are normal also. There is no\npericardial or pleural abnormality.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nSclerotic foci in several thoracic vertebral bodies are unchanged since ___ except for the T4 lesion which is smaller, 09:32. There are no\nnew destructive lesions.",
            "output": "No evidence of progressive malignancy in the chest.  Right axillary lymph\nnodes, smaller today compared to ___ have harbored early\nmetastases even though not pathologically enlarged previously."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta and pulmonary arteries are\nnormal in size.   The heart size is normal and there is no pericardial\neffusion. A left chest wall port terminates in the low SVC.\n\nPLEURA:  There is no pneumothorax.  Small nonhemorrhagic bilateral pleural\neffusions are noted, with adjacent atelectasis (05:58).\n\nLUNGS: The airways are patent.  Bibasilar atelectasis is noted, left greater\nthan right (7:265). No consolidation concerning for pneumonia is identified. \nThere is no diffuse interstitial abnormality.  There are no concerning\npulmonary nodules.\n\nBONES: The punctate sclerotic foci throughout the thoracic spine are again\nnoted, unchanged compared to the prior CT from ___.\n\nUPPER ABDOMEN:  Though this study is not designed for evaluation of\nsubdiaphragmatic structures, the imaged upper abdomen is unremarkable.",
            "output": "1. Small bilateral nonhemorrhagic pleural effusions, with adjacent\natelectasis, left greater than right.\n2. No evidence of pneumonia.\n3. No intrathoracic malignancy is identified.\n4. Unchanged punctate sclerotic foci scattered throughout the thoracic spine\ncompared to the prior CT of the torso from ___. Correlation with\nrecent prior nuclear medicine performed on the same date demonstrated no\nactive osseous metastatic disease."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen\npelvis CT report dictated under clip ___\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nHeart, pericardium and great vessels are within normal limits. No hiatal\nhernia is present.  Triangular shaped soft tissue in the anterior mediastinum\nis consistent with thymic tissue with a 8 mm cyst, unchanged from prior.\n\nLung windows do not demonstrate any focal opacity. No pleural effusion or\npneumothorax is present.\n\nOsseous structures:  Punctate sclerotic foci within the thoracic spine are\nunchanged from prior. No new lytic or sclerotic lesions are identified.",
            "output": "1. Stable appearance of punctate sclerotic foci within the thoracic spine. No\nnew metastatic disease is identified.\n2. Interval resolution of bilateral pleural effusions."
        },
        {
            "input": "Left-sided Port-A-Cath tip ends in the mid SVC. The thyroid gland is normal.\nThe patient now has bilateral breast implants. 5 mm lymph node just adjacent\nto the implant is located in the inferior axilla.  This and several other\naxillary lymph nodes ,   not enlarged by CT size criteria, should be followed.\nThere are no pathologically enlarged mediastinal or hilar lymph nodes by size\ncriteria. The thoracic aorta is normal in caliber with a typical three vessel\ntakeoff from the arch. The pulmonary arterial trunk is normal in caliber. The\nheart is normal in size without pericardial effusion.  The esophagus is\nunremarkable.\n\nThe tracheobronchial tree is normal to the subsegmental level. The lungs are\nfully expanded and clear with the exception of subsegmental atelectasis in the\nleft base. There is no pulmonary nodule. The pleura are unremarkable.\n\nSubdiaphragmatic structures are described in a separate report. There is no\nblastic or lytic lesion suspicious for malignancy.",
            "output": "No evidence of intrathoracic metastasis. Left axillary lymph nodes described\nabove can be reassessed at the time of followup imaging."
        },
        {
            "input": "No incidental thyroid findings.  Bilateral breast implants.  The pre described\nleft axillary 5 mm lymph node (4, 17) is unchanged in size and morphology. A\nsecond 5 mm lymph node in the left axillary region (4, 26) is also unchanged.\nNo extra thoracic lymphadenopathy. No enlarged lymph nodes in the mediastinum\nand the hilar structures no coronary calcifications. No pericardial effusion.\nNo valvular calcifications.  Unremarkable posterior mediastinum. The large\nmediastinal vessels are unremarkable. The upper abdomen is described in detail\nin the dedicated abdominal CT report performed today. No osteolytic lesions at\nthe level of the ribs, the sternum, or the vertebral bodies.  Unchanged\nminimal bilateral apical scarring.  No pleural thickening, no pleural\neffusion.  The airways are patent.  There is no evidence of pulmonary nodules\nsuspicious for malignant or metastatic disease.  No evidence of diffuse lung\ndisease. Minimal left basilar atelectasis.",
            "output": "No relevant change as compared to ___.  No evidence of metastatic\ndisease to the thorax."
        },
        {
            "input": "Airways are patent to the subsegmental level bilaterally no lytic or sclerotic\nlesions worrisome for infection or neoplasm demonstrated.  Bilateral breast\nprosthesis appears to be stable.  Left axillary lymph node, series 2, image 35\nis 4 mm in diameter, unchanged.  Lungs are clear.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.\n\n\nAorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nThere is no pericardial pleural effusion.  No mediastinal, hilar or axillary\nlymphadenopathy is present.",
            "output": "Stable appearance of the chest was no evidence of intrathoracic metastatic\ndisease.  Diffuse thyroid enlargement with no evidence of discrete nodules. \nIf clinically warranted, correlation with thyroid ultrasound is to be\nconsidered."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinal or hilar\nregions.  Normal appearance of the large mediastinal vessels.  No substantial\ncoronary calcifications.  No pericardial effusion.  No valvular\ncalcifications.  Normal appearance of the posterior mediastinum.  The upper\nabdomen is described in detail in the dedicated abdominal CT report. No\nosteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.  Minimal bilateral apical scarring, no pleural thickening, no pleural\neffusions.  The airways are patent.  No diffuse lung disease.  No suspicious\nlung nodules or masses.  Status post bilateral breast implants.",
            "output": "No evidence of metastatic disease to the thorax, in particular no evidence of\nlymphadenopathy, parenchymal metastasis or pleural effusions."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with scattered coronary artery calcification. There is no\npericardial effusion.  The ascending thoracic aorta is mildly dilated to 4.1\ncm, unchanged. Of note, there are no appreciable aortic valvular\ncalcifications. The main pulmonary artery is normal caliber.  No incidental\ncentral pulmonary embolus is identified.  Mixing artifact is incidentally\nnoted in the superior vena cava.\n\nThe patient is status post left upper lobectomy with intercostal muscle\naugmentation with an unremarkable postoperative appearance. A retrospectively\nseen punctate 2 mm right upper lobe nodule is stable since ___ (5, 62).\nThere is new bilateral bronchial wall thickening with multifocal mucoid\nimpactions (5: 185, 200, 251, 268).  There is new nonspecific mild increase in\nthe tracheal AP diameter to 3.1 cm. An incidental subcentimeter calcified\nright lower lobe granuloma is noted (5, 223). These findings are superimposed\non mild centrilobular emphysema.\n\nBones and extrathoracic soft tissues are unremarkable.\n\nImages of the upper abdomen are unremarkable.",
            "output": "No evidence of intrathoracic metastases. Retrospectively seen 2 mm right upper\nlobe nodule is stable since ___.  No new nodules identified.\n\nNew moderate airways disease marked by bronchial wall thickening and\nmultifocal mucoid impactions.\n\nStable centrilobular emphysema.\n\nStable fusiform dilatation of the ascending aorta to 4.0 cm."
        },
        {
            "input": "Ascending aorta is dilated up to 4 cm.  This appearance is unchanged since the\nprior study.  The position of the mediastinum is stable.  Heart size is\nnormal.  Coronary calcifications are unchanged, moderate.  No pericardial\npleural effusion is seen.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nAirways are patent to the subsegmental level bilaterally.  Endobronchial\nsecretions in the right upper lobe was present.  Centrilobular emphysema is\nbilateral, moderate, primarily seen in the right upper lobe giving the\nprevious left upper lobe resection.  Bronchial wall thickening is diffuse and\nmight be consistent with chronic airway infection/inflammation.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nPostsurgical changes in the left hemi thorax are stable.\n\nThe patient is after left upper lobectomy there is also evidence of a left\nupper lung flap, series 2, image 27, with unchanged appearance as compared to\nprevious study.",
            "output": "Stable appearance of the chest with no evidence of valve new wall old\nintrathoracic metastatic disease.\n\nStable appearance of the left upper lobe stump with the flap.\n\nUnchanged dilatation of the ascending aorta up to 4.1 cm.\n\nSubstantial amount of endobronchial secretions consistent with airway\ninfection/inflammation"
        },
        {
            "input": "The patient is status post left upper lobe resection with associated flap\nplacement, with similar postoperative appearance at the operative site\nconsidering the absence of intravenous contrast on the current study.  There\nare no enlarged intrathoracic lymph nodes.  Heart size is normal, and coronary\nartery calcifications are again demonstrated.  Ascending aorta remains ectatic\nmeasuring about 4.1 cm in diameter, unchanged (37, 3).  There is no pleural\neffusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning findings are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate postthoracotomy changes in the\nleft hemithorax.  No new suspicious lytic or blastic lesions are detected.\n\nWithin the lungs, centrilobular emphysema and apical scarring are unchanged. \nA 2 mm solid right apical lung nodule is in retrospect unchanged since ___ (82, 5).  Incidental calcified granuloma in right lower lobe is also\nunchanged.  Edit\n\nIntrathoracic trachea is enlarged measuring just over 3 cm in transverse\ndimension above the level of the aortic arch.Diffuse bronchial wall thickening\nand irregularity are suggestive of chronic airways disease such as chronic\nbronchitis.  A few areas of localized intraluminal airway secretions are again\ndemonstrated with representative example in the left lower lobe posterior\nsegment (214, 5).",
            "output": "1. Unchanged postoperative appearance of the thorax following left upper lobe\nresection with no evidence of local recurrence or intrathoracic metastatic\ndisease.\n\n2.  Minimal dilation of ascending aorta is unchanged at 4.1 cm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nLarge number of small, not pathologically enlarged lymph node in the axilla,\nunchanged in comparison to prior and there is no supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Included upper abdominal organs are unremarkable.\n\nHEART and PERICARDIUM: There is no cardiomegaly.\nTrace pericardial effusion is slightly larger.\nModerate atherosclerotic calcifications of the coronaries.\nAscending aorta ectatic, 4.2 cm, in prior 4.1 cm, unchanged (4:159).\nMain pulmonary artery within normal size.\n\nMEDIASTINUM: There is no mediastinal, hilar or any other intrathoracic\nlymphadenopathy.\n\nPLEURA: There is no pleural thickening or effusion.\n\nLUNG: The patient is status post left upper lobectomy with associated\nintercostal augmentation, unchanged appearance in comparison to prior and no\nevidence of recurrence.\nMajor airways are patent, the trachea in lenticular shape.\nMild airway wall thickening, irregularity and scattered bronchi impactions\nassociated with moderate centrilobular emphysema suggesting chronic airways\ndisease such as chronic bronchitis.  No bronchiectasis.\nRight upper lobe micro nodule (4:65) is unchanged.\nThere are no new nodules or masses.\n\nCHEST CAGE: No evidence of bony destructive lesions.\nPost thoracotomy changes in the left hemithorax.\nMild S shaped scoliosis of thoracic spine.",
            "output": "Unchanged postoperative appearance of the thorax with no evidence of\nrecurrence.\nChronic airway disease on a background of moderate emphysema is also\nunchanged."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging evaluation. \n6 mm left supraclavicular lymph node, difficult to separate from non-opacified\nadjacent veins in the thoracic outlet is not pathologically enlarged by size\ncriteria.  Subcentimeter axillary lymph nodes are neither pathologically\nenlarged nor growing.\n\nNo soft tissue findings in the fat depleted chest wall are concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal abnormality.\nCARDIO-MEDIASTINUM:Mild circumferential wall thickening of the lower esophagus\nis unchanged in terms of overall esophageal ___, within normal limits. \nElsewhere the esophagus is unremarkable.\nAtherosclerotic calcification is minimal in head and neck vessels, but present\nin left main, anterior descending and circumflex coronary arteries.\n\nAortic valve is not calcified.  Noncalcified ascending thoracic aorta is\nmildly dilated in a fusiform fashion to maximum diameter of 44 mm, unchanged. \nPulmonary arteries and cardiac chambers are normal size and small stable\npericardial effusion is physiologic.\n\nTHORACIC LYMPH NODES: Subcentimeter left lower paratracheal nodes are\nminimally larger today.  12 mm wide lymph nodes in the upper pole the right\nhilus anterior to the upper lobe bronchus, 5:163 were 10 mm in ___. \nBronchus is intact.  Left hilum and bronchial stump have a normal\npostoperative appearance following upper lobectomy.  Lymph nodes elsewhere in\nthe chest are neither enlarged nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderately severe.  Mild bronchial wall\nthickening is generalized, slightly more pronounced today than before.  There\nis no bronchiectasis or retention of secretions or bronchiolar nodulation.\n\nPostoperative left lung is clear.  There is no pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of new or recurrent intrathoracic malignancy.  New, borderline\nenlargement of right hilar lymph nodes, contralateral to the side of previous\nmalignancy and surgery, is likely inflammatory.\n\nMild to moderate emphysema stable.  Mild generalized bronchial inflammation\nincreased, but no retention of secretions, bronchiectasis, bronchiolitis or\natelectasis.\n\nAtherosclerotic coronary calcification, showing at least left main and major\nbranches."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable multiple small axillary and thoracic inlet\nlymph nodes, none enlarged by CT size criteria.  There are no chest wall\nabnormalities.  Mild atherosclerotic calcifications in the proximal left\nsubclavian artery, brachiocephalic trunk and proximal right subclavian artery.\n\nMEDIASTINUM AND HILA:\nEsophagus is mildly patulous.  Stable small mediastinal lymph nodes, none\nenlarged by CT size criteria.  No hilar enlarged lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nHeart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, none in the cardiac\nvalves or ascending aorta.  Aorta is dilated measuring 41 mm.  Pulmonary\nartery normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nUnchanged appearance of the left upper lobe lobectomy with intercostal flap\npostsurgical changes and unremarkable bronchial stump.  Motion artifact limits\nthe proper assessment of the bilateral pulmonary parenchyma, within these\nlimitations there is no evidence of lung nodules or masses.  The airways are\npatent to the subsegmental levels with scattered endobronchial secretions\nprobably reflecting infection or aspiration. Unchanged mild bilateral\ncentrilobular emphysema with associated mild bronchial wall thickening. No\nfocal consolidations.  Small right lower lobe posterior subsegmental\natelectasis. No pleural effusions or thickening.  Mild biapical\npleuroparenchymal scarring.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals unremarkable.",
            "output": "No evidence of intrathoracic metastatic disease.  No pulmonary nodules.  No\nenlarged mediastinal lymph nodes.\n\nScattered endobronchial secretions most likely correspond to infection or\naspiration.\n\nDilated aorta measuring 41 mm. Annual follow and consultation with aortic\ncenter is recommended."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal nodes not enlarged by size criteria\nmeasuring up to 6 mm.  The aorta and pulmonary arteries are normal in caliber.\nThere is no pericardial effusion.  An anterior mediastinal lymph node measures\n6 mm in short axis.  Heart size is normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is moderate upper lobe predominant emphysema.  There is a 4 mm\nnodule in the right upper lobe (5, 103).  4 mm nodule seen the right middle\nlobe (5, 165).  There is no evidence of pneumonia.  There is no correlation to\nthe abnormality seen on the radiograph.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "No evidence of pneumonia.  No correlate to the abnormality seen on the\nradiograph.\n\n2 nodules measuring 4 mm each in the right upper and right middle lobe.\n\nUpper lobe predominant emphysema\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  There are mild coronary\nartery calcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate emphysema.  No focal consolidation.  No\nsuspicious pulmonary nodule or mass..  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes of the thoracic spine are moderate.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  No acute process within the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Status post anterior midline incision.  Mild atherosclerotic\ncalcifications in the head and neck vessels.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  Mild to moderate pericardial effusion, is\nminimally decreased since prior particularly along the left pericardium. \nStatus post CABG surgery.  Severe atherosclerotic calcifications in the\ncoronary arteries, mild in the aorta and none in the cardiac valves.  The\npulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nBilateral pleural effusions, moderate to the left and small to the right,\nslightly larger than on the prior study.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchiectasis or mucus\nplugging.  Mild diffuse bronchial wall thickening.  Mild paraseptal and\ncentrilobular emphysema.  2 mm lung nodule in the right upper lobe (302:95)\nand in the right lower lobe (302:149).  No suspicious lung nodules or masses. \nNo consolidations.  Partial compressive atelectasis of the left lower lobe.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  Old healed fractures in the right posterior\neighth and left posterior tenth and eleventh ribs.  No acute fractures.  No\nsuspicious lytic or sclerotic lesions.  Status post midline sternotomy with\nintact and aligned wires and well-opposed sternal halves.  There is minimal\nfluid in the anterior retrosternal space (302:189), unchanged since ___.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Status post CABG surgery with unremarkable appearance of midline sternotomy\nwith a very small fluid collection in the inferior retrosternal space,\nunchanged compared to ___, likely a postsurgical seroma.\nSmall bilateral pleural effusions, left greater than right.\nNo evidence of pneumonia or pulmonary edema.\nMinimally decreased size of the pericardial effusion, particularly along the\nleft pericardium"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is artifact due to motion affecting the right lower lobe segmental and\nsubsegmental branches..  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  Minimal atherosclerotic\ncalcifications noted at the aortic arch.  The left vertebral artery arises\ndirectly from the arch, a normal variant.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a large hiatal\nhernia containing a majority of the stomach and a portion of the transverse\ncolon which is nonobstructed.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification besides areas of atelectasis adjacent to the hiatal hernia\nbilaterally.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.  Limited\nevaluation of the right lower lobe segmental and subsegmental branches due to\nrespiratory motion.\n2. Large hiatal hernia containing majority of the stomach and a portion of the\nnonobstructed transverse colon."
        },
        {
            "input": "CHEST: The thyroid gland is homogeneous.  The great vessels opacify normally\nwithout intramural hematoma or dissection.  The heart mediastinum are normal\nwith no pericardial effusion. No axillary, mediastinal, or hilar\nlymphadenopathy is seen.\n\nAirways are patent to the subsegmental level bilaterally. Lung parenchyma is\nfree of consolidation, pleural effusion, or pneumothorax.  Sub 5 mm left\napical nodule (2:70) is noted.  Two acute right-sided lateral rib fractures\nare detected, in the fifth, minimally displaced, and tenth ribs. Old right rib\nfractures identified on the right.\n\nABDOMEN:\nThe liver, gallbladder, pancreas, spleen, and adrenal glands are normal. The\nkidneys enhance symmetrically with no hydronephrosis or lesions. The stomach\nand small bowel are normal in caliber. The large well not demonstrate\ninflammation. The appendix is normal. There is no mesenteric free fluid or\nlymphadenopathy.\n\nPELVIS: The distal ureters and urinary bladder are normal.  The uterus\ncontains partially calcified masses at the fundus, likely calcified fibroids.\nAdnexae are unremarkable. No pelvic free fluid or lymphadenopathy.\n\nVESSELS: The aorta demonstrates mild atherosclerotic calcification without\naneurysmal dilatation and its major branches are patent.\n\nOSSEOUS STRUCTURES: Levoconvex scoliosis is centered at L2-3. L3 through L5\nlaminectomies are noted with lumbosacral fixation hardware from L3 through S1\nwith no perihardware lucency or fracture.  No focal osseous lesion is\nidentified.  Rib fractures are as detailed above.",
            "output": "1. Acute appearing right fifth and tenth rib fractures.\n2. Sub 4 mm left apical pulmonary nodule warrants ___ year followup in a patient\nat high risk for lung cancer, otherwise no followup is necessary.\n3. Fibroid uterus.\n4. Lumbosacral spinal fixation hardware from L3 through S1 is noted."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Although not performed as a dedicated study, there is\nno evidence of pulmonary embolus of the central pulmonary arteries.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Aside from mitral annular calcifications and coronary\nartery calcification, the heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 3-4 mm pulmonary nodule in the lingula, otherwise\nthe lungs are unremarkable.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of suspicious focal lesions.  There is a rounded hypodensity in the\nspleen, likely representing a simple cyst.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is high-density\nmaterial within the bilateral renal pelvises, as well as dependently in the\nbladder possibly representing blood products, or in the correct clinical\nscenario, contrast from prior contrast administrations.  There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon is\nwithin normal limits, the rectum is distended and contains a large burden of\nstool.  The appendix is not visualized.  There is no free intraperitoneal\nfluid or free air.  No intra-abdominal hematoma is identified.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized, no adnexal abnormality is\nidentified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The right common iliac\nartery is noted to be ectatic, measuring up to 1.5 cm.  Moderate\natherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: Multiple calcifications within the soft tissues of the\nbilateral thighs and buttocks, may relate to prior trauma.  There is no\nevidence of worrisome osseous lesions or acute fracture.  Lumbosacral fusion\nhardware is noted.  A left inguinal hernia containing fat is noted.",
            "output": "1. No acute intra-abdominal or chest pathology.  Specifically, no evidence of\na hematoma.\n2. High density material is seen in the renal pelvises bilaterally as well as\ndependently in the bladder, and may represent blood or contrast from prior\ncontrast administrations in the correct clinical scenario.  Consider\ncorrelation with urinalysis.\n3. There is a 3-4 mm pulmonary nodule in the lingula (3: 62).\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:39 pm."
        },
        {
            "input": "CTA chest:\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. The pulmonary\narteries are also well opacified to the subsegmental level, with no evidence\nof filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  The heart and mediastinum are normal.\nThe pericardium is intact without effusion.\n\nSecretions are seen within the distal trachea. There is re-demonstration of a\nmultilocular pulmonary parenchymal cavitation at the right lung apex,\nunchanged since ___. There is now interval development of a\nconsolidation in the right lower lobe as well as multi focal areas of\nground-glass opacity and consolidation in the left upper and lower lobes.\nThese are new since ___ and are concerning for multi focal\npneumonia. There are moderate bilateral pleural effusions, increased since ___.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal abnormality. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder, pancreas, spleen, and bilateral adrenal\nglands are normal. The kidneys enhance symmetrically and are without\nsuspicious solid mass.\n\nThe stomach is grossly unremarkable in appearance.  There is a dilated loop of\nsmall bowel within the mid abdomen and pelvis measuring up to 3.4 cm with a\ntransition point in the pelvis concerning for small bowel obstruction (series\n2b, image 196). Distally the small and large bowel are collapsed. There is\nsigmoid diverticulosis without evidence of acute diverticulitis. There is a\nsmall amount of ascites. There is also mild enhancement of the peritoneum\nwhich may indicate peritonitis. No free air or abdominal wall hernias are\nnoted. The abdominal aorta is normal in caliber without aneurysmal dilatation.\nThe origins of the celiac axis, SMA, bilateral renal arteries, and ___ are\npatent. There is no retroperitoneal or mesenteric lymphadenopathy.\n\nPELVIS:\n\nThe bladder and distal ureters are unremarkable. There is no pelvic side-wall\nor inguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  There is diffuse anasarca.",
            "output": "1.  No evidence of PE or acute aortic pathology.\n\n2.  Interval development of consolidation and ground-glass opacities in the\nright lower lobe as well as the left upper and lower lobes concerning for\nmulti focal pneumonia.\n\n3.  Unchanged multi locular pulmonary parenchymal cavitation at the right\napex, which remain concerning for post primary tuberculosis.\n\n4.  Moderate bilateral pleural effusions, increased since ___.\n\n5.  Dilated loops of small bowel in the mid abdomen with a transition point in\nthe pelvis concerning for at least a partial small bowel obstruction, early\ncomplete obstruction cannot be entirely excluded.\n\n6. Interval development of small amount of ascites with mild enhancement of\nthe peritoneum which could reflect peritonitis in the appropriate clinical\nsetting.\n\nNOTIFICATION:  Updated findings were discussed with Dr. ___ by ___\ntelephone at 10:40am on ___ following attending review."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there are no soft\ntissue abnormalities in the chest wall suspicious for malignancy or infection.\nFindings below the diaphragm will be reported separately. Thyroid is\nunremarkable.  Atherosclerotic calcification is not apparent in the head and\nneck vessels but is substantial in the coronaries in at least the LAD.  Aorta\nand pulmonary arteries are normal size. Pericardium is physiologic.  There is\nno pleural abnormality.\n\nMediastinal lymph nodes are enlarged in the right upper paratracheal station,\n12- 13 mm, 05:30, 33. In the right lower paratracheal station, lymph nodes up\nto 18 x 24 mm, 05:38- 44 contain some calcifications which could pre date\ndevelopment of malignant adenopathy. 9 and 10 mm wide left lower paratracheal\nand prevascular nodes, 05:44 contain no calcifications. 9 mm posterior\nmediastinal pre aortic lymph nodes, 5:71 are particularly suspicious for\nmalignancy.  Retrocrural lymph nodes are 5 mm and smaller. There are no\nenlarged diaphragmatic nodes, but juxta caval and pre cardiac nodes are 6 and\n7 mm, 5:76, 79.\n\n\nFocal lung lesions are as follows:\n\nSeveral small calcified granulomata.\n\nSoft tissue lung nodules are:\n\n3.5 mm nodule, right middle lobe, 6:159.\n\nPossible punctate left lower lobe nodule, 6:177.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy. \nElongation, mild loss of height, and endplate irregularity of multiple\nthoracic vertebral bodies is probably long-standing Scheuermann Disease.",
            "output": "Multiple central lymph nodes in the chest or either enlarged or suspicious in\nlocation for malignancy.\n\nAt most 2 solid lung nodules, both less than 4 mm, significance\nindeterminate.\n\nCoronary atherosclerosis involving at least the LAD.\n\nCalcified pulmonary granulomata.  No evidence of active infection."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is dependent bilateral subsegmental and lingular\natelectasis.  Otherwise, lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUES: Significant asymmetric atrophy of the left rotator cuff\nmusculature (301:31).",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nNo acute thoracic process\n\nAsymmetric left rotator cuff musculature atrophy."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: Patient is status post CABG with a LIMA graft and an\nadditional free arterial bypass graft. The thoracic aorta is normal in\ncaliber.  Mild calcification of the aortic arch, descending thoracic aorta,\naortic annulus, and left subclavian artery. No evidence of pulmonary embolism\nto the segmental level.  The heart, pericardium, and great vessels are\notherwise within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy.  No mediastinal mass or hematoma.  Moderate\nsized hiatal hernia, increased from ___.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Multiple pleural plaques\nare noted within posterior left hemithorax, which may represent prior\ninfection or hematoma.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally with unchanged lower lobe predominant bronchiectasis.  Scarring at\nthe left lung base is unchanged.  Lungs are clear without masses or areas of\nparenchymal opacification. The lungs are hyperinflated bilaterally, consistent\nwith history of COPD.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.  Incidental\nnote is made of infrascapular a 7.1 x 2.0 x 7.7 cm (TV x AP x CC) lipoma\nwithin the left lateral posterior chest wall.\n\nBONES: Eight median sternotomy wires are intact. No suspicious osseous\nabnormality.? Mild-to-moderate degenerative changes of the thoracolumbar spine\nwith no acute fractures.  Chronic fracture to the left proximal clavicle.\n\nABDOMEN: Multiple hypodensities within the liver, with the largest measuring\nup to 3.6 cm with cystic attenuation (3:64), unchanged.  1.4 cm hypodensity\nwithin the upper pole of the right kidney (3:63), more conspicuous on ___, is concerning for malignancy. A partially imaged vascular stent courses\ntoward the left kidney. Patient is status post EVAR of the abdominal aorta,\nwhich is partially imaged.  Moderate calcifications around the celiac and SMA\norigins.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. 1.4 cm hypodensity within the upper pole of the right kidney, better\ndepicted on prior CT abdomen on ___, is concerning for malignancy.\n3. Moderate size hiatal hernia, increased from ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Streak artifact from the upper\nextremities limits evaluation of the base of the neck.  The imaged thyroid is\ngrossly unremarkable.  There is no supraclavicular or axillary\nlymphadenopathy.  The esophagus is unremarkable.\n\nUPPER ABDOMEN: Please refer to separate report for same day CT abdomen pelvis\nstudy for discussion of findings below the diaphragm.\n\nMEDIASTINUM: Multiple mediastinal lymph nodes are noted, measuring up to 9 mm\nin the prevascular station at the level of the AP window (305:101), but are\nnot enlarged by CT size criteria.  There is no mediastinal mass.\n\nHILA: An 11 mm right hilar lymph node (305:140) and a 9 mm left hilar lymph\nnode (305:133) are borderline in size.  No hilar mass is seen.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare severe.  The thoracic aorta is normal in caliber. There is no pericardial\neffusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Mild dependent atelectasis is noted.  No suspicious masses,\nnodules or focal consolidations are seen.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. No evidence of malignancy in the chest.\n2. Prominent mediastinal, and borderline hilar lymph nodes have a very low\nlikelihood of representing lymphoma.  However, follow-up chest CT in ___\nmonths is recommended for re-evaluation.\n3. Please refer to separate report for same day CT abdomen pelvis study for\ndiscussion of findings below the diaphragm.\n\nRECOMMENDATION(S):  Follow-up chest CT in ___ months for impression point 2."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Unchanged pleural and aortic wall calcifications. \nThe 4.4 cm diameter of the ascending aorta is stable.  Moderate coronary\ncalcifications persist.  Minimal aortic valve calcifications.  No pericardial\neffusion.  Small hiatal hernia (2, 54).  Status post cholecystectomy. \nDecrease in size of both kidneys, dilatation of the left renal collecting\nsystem.  No osteolytic lesions at the level of the ribs, the sternum or the\nvertebral bodies.  Sclerotic pre-existing vertebral lesion is unchanged (602\nB, 87).  Both lower lobes as well as the middle lobe continue to show moderate\nto severe areas of bronchiectasis.  However, the degree of mucous plugging,\nnotably at the level of the left lower lobe (4, 199) has markedly decreased. \nAs a consequence, the left lower lobe is substantially better ventilated than\non the previous examination.  In the middle lobe the peribronchial areas of\nscarring persist.  In the upper lobes, there is unchanged evidence of mild\nbronchial wall irregularities and bronchial wall thickening.  Mucous\naccumulations are seen in the larger airways (4, 49).  No pleural effusion. \nNo pleural thickening.  All pre-existing pulmonary nodules, some of which are\ncalcified, are unchanged.  No evidence of suspicious or malignant lung\nnodules.",
            "output": "On the basis of persistent chronic airways disease with relatively severe\nmiddle lobe and lower lobe predominant bronchiectasis the pre-existing mucous\nplugging predominating in the left lower lobe has substantially improved, with\nsubsequent improved ventilation of the left lower lobe.  No new focal\nparenchymal opacities.  Minimal scarring at the right lobe basis unchanged\npleural calcifications.  Unchanged mucous accumulations in the larger airways.\nThe pre-existing be 9 subpleural and partly calcified pulmonary nodules are"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Visualized upper abdomen shows severely atrophic bilateral\nkidneys, left worse than right.  Simple appearing fluid structure at the hilum\nof the left kidney likely represents hydronephrosis versus peripelvic cyst. \nPartially seen cholecystectomy clips.  Abdominal aorta appears ectatic\nmeasuring up to 3.5 cm in size.\n\nMEDIASTINUM: There is dilation of the ascending aorta, measuring 4.4 cm in\ndiameter (series 4; image 100), unchanged since ___.  There is no mediastinal\nlymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is top normal in size.  There are moderate\ncalcifications of the coronary arteries as well as the aortic valve leaflets\nand mitral annulus.\n\nPLEURA: There is no pleural effusion or pneumothorax.  Calcifications along\nthe costal pleura (series 4; image 179) are suggestive of prior asbestos\nexposure.\n\nLUNG: Evaluation of the lung parenchyma is mildly limited due to respiratory\nmotion.  There is calcified nodule in the right upper lobe (series 4; image\n122), likely sequela of prior granulomatous disease.  There is bibasilar\natelectasis, right greater than left.  Possibility of changes related to\naspiration cannot be excluded.  Again seen is a 8 mm nodule in the right\nmiddle lobe, unchanged since ___ (series 4; image 148).  Otherwise, within\nthe limitations of this scan, there are no concerning pulmonary nodules\nidentified.  There is bronchial wall thickening with mild mucous plugging in\nthe left lower lobe.  Both lower lobes as well as the right middle lobe show\npersistent bronchiectasis.\n\nCHEST CAGE: No rib fractures are identified.  There is mild-to-moderate\ndegenerative change of the visualized thoracic spine without acute compression\ndeformity.  The left posterior sixth and ninth ribs, there are sclerotic foci\nof unknown origin, likely bone islands.  An additional sclerotic focus is\nnoted in the anterior portion of the right second rib.  Sclerotic focus on the\nL1 vertebral body is also again seen.  These lesions are all unchanged\ncompared to ___.",
            "output": "1. No rib fractures identified.  No pneumothorax is seen.\n2. Aneurysmal dilatation of the thoracic and abdominal aorta, measuring up to\n4.4 and 3.5 cm, respectively, similar in appearance compared to ___.\n3. 8 mm nodule in the right middle lobe is unchanged since ___.\n4. Unchanged bronchiectasis in the bilateral lower lobes and right middle lobe\nwith bronchial wall thickening and mild mucous plugging.  No large focal\nconsolidation is seen.\n5. Calcification of the pleura is consistent with prior asbestos exposure."
        },
        {
            "input": "Small nodule in the right vocal cord, incompletely imaged larynx and neck, 5:\nOne.\n\nSupraclavicular and axillary lymph nodes are not pathologically enlarged. \nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nCardio mediastinum:\n\nEsophagus is unremarkable.\n\nAtherosclerotic plaque, calcified and noncalcified is moderately severe in\nhead and neck vessels particularly origin of the left Common carotid artery,\nsevere in all coronary arteries.  Aortic valvular calcification is especially\nsevere and presumably stenosing.  Evaluation of valves, enlarged cardiac\nchambers and dilated pulmonary arteries would require echocardiography. \nPericardium is physiologic.\n\nThoracic lymph nodes:\n\nNo lymph nodes in the chest are pathologically enlarged by size criteria.\n\nLungs, airways, and pleura:\n\nRespiratory motion might obscure fine anatomic detail but no lesion of\nsignificance in the lungs.\n\nLungs are clear, tracheobronchial tree is normal to subsegmental levels, and\nleft pleural effusion is minimal, clinically insignificant.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of intrathoracic malignancy or active infection.\n\nSevere calcific aortic stenosis, moderate cardiomegaly, pulmonary\nhypertension, and moderate to severe atherosclerosis including coronary\narteries.  No pulmonary edema or other evidence of acute cardiac\ndecompensation."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\n\nLUNGS AND PLEURA: Scattered calcified pulmonary nodules compatible with prior\ngranulomatous disease.  Small bilateral pleural effusions with associated\ndependent subsegmental atelectasis with more focal airspace disease within the\nleft lower lobe suspicious for superimposed pneumonia.  The lungs are\notherwise clear.  No pneumothorax.\n\nBASE OF NECK: Tiny nodules and/or colloid cysts are seen within the thyroid\ngland.  There is a 1.6 cm nodule within the lower pole of the left lobe of the\nthyroid which is demonstrated minimal interval enlargement compared to ___\nwhere it measured approximately 1.2 cm.  Visualized portions of the base of\nthe neck show no additional abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nSOFT TISSUES AND BONES: Dual lumen Port-A-Cath located within the subcutaneous\ntissues right anterior chest.  Soft tissues otherwise unremarkable.  Stable\ndegenerative change of the visualized osseous structures and old healed rib\nfractures.  No acute fracture or suspicious osseous lesion.",
            "output": "1.  Left lower lobe airspace disease corresponding to finding on MRI and\nsuspicious for pneumonia.  Correlate with fever and/or elevated white blood\ncell count.\n2.  Small bilateral pleural effusions which are likely reactive.\n3.  1.6 cm nodule left lobe of the thyroid gland which has demonstrated\nminimal interval enlargement compared to prior CT from ___ favoring a benign\nthyroid nodule.  Recommend non-urgent outpatient thyroid ultrasound for\nfurther characterization if not already performed.\n4.  Additional chronic changes as above."
        },
        {
            "input": "A heterogeneous lesion is seen arising from the left thyroid lobe measuring\napproximately 16 mm, unchanged compared to the prior exam.  The remainder of\nthe thyroid demonstrates heterogeneous lesions.  There is no axillary,\nsupraclavicular, mediastinal, or hilar lymphadenopathy.  The heart size is\nnormal.  There is no pericardial effusion.  The esophagus is normal without\nevidence of wall thickening or a hiatal hernia.  The aorta is normal in\ncaliber.  The main pulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on the same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nCompared to the exam performed on ___, there has been interval\nimprovement of the consolidation within the left lower lobe, now with mild\nresidual consolidations.  The extent of bilateral pleural effusion have also\nimproved, now with small residual pleural effusions, right greater than left. \nBilateral scattered calcified pulmonary nodules compatible with granulomatous\ndisease is re-demonstrated.  No evidence of pneumothorax.",
            "output": "-No evidence of new lymphadenopathy.\n-Interval improvement of the consolidations seen within the left lower lobe\nwith mild residual consolidations.\n-Interval improvement of the previously seen pleural effusions, now with small\nresidual bilateral pleural effusions, right greater than left."
        },
        {
            "input": "THORACIC INLET, AXILLAE, CHEST WALL: Multiple prominent sized supraclavicular\nlymph nodes seen bilaterally measuring up to 8 mm on the left (series 2, image\n1).  Few prominent axillary lymph nodes however not pathologically enlarged.\n\nMEDIASTINUM: Multiple mildly enlarged lymph nodes are seen throughout the\nmediastinum, largest measuring 1 cm in the right paratracheal location and\nmeasuring 1.1 cm in the subcarinal location, unchanged from prior CT.\n\nHILA: No significantly enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart remains enlarged with a small amount of\npericardial effusion.  There is evidence of tricuspid and mitral valve\nprosthesis.  Calcific atherosclerotic changes seen involving the coronary\nvessels and the thoracic aorta.  There\n\nPLEURA: There is a small right-sided pneumothorax, stable compared to the\nrecent radiograph.  There is a trace pleural fluid on the right with a chest\ntube in appropriate position.  There is a mild to moderate left pleural\neffusion.\n\nLUNGS: There is evidence of diffuse geographic ground-glass opacification of\nthe peripheral aspect of the right upper lobe, right middle and lower lobes\nwith areas of superimposed airspace opacification and prominent septal\nthickening, in keeping with crazy paving appearance.  These changes are prior\npredominantly limited to the right lung and are not seen on the left and are\nnew since the prior CT.  Multiple areas of linear subsegmental atelectasis are\nseen involving the left lung.\n\nAIRWAYS: The central tracheobronchial tree is patent.\n\nBONES: Evidence of median sternotomy with intact sternotomy wires.  Dish like\nchanges involving the thoracic spine.  Heterogenous density involving the\nsternum, the remaining bones are normal in appearance.\n\nUPPER ABDOMEN: Grossly unremarkable on this unenhanced study.",
            "output": "1. Diffuse crazy paving appearance involving the right upper middle and lower\nlobes, new since the prior CT from ___.  Differential concerns\ninclude atypical infection, pulmonary hemorrhage, drug-induced pneumonitis. \nRecommend clinical correlation with clinical exam and lab findings.\n2. Multiple prominent supraclavicular lymph nodes, and mediastinal lymph\nnodes, these are stable since the CT from ___ and may be related to\nthe patient's history of CLL.\n3. Interval resolution of the right-sided pleural effusion with a residual\nsmall pneumothorax. Mild-to-moderate left pleural effusion.\n4. Heterogenous appearance of the sternum, although stable compared to the\nprior chest CT from ___ is new compared to the CT from ___. \nThese findings could be related to prior median sternotomy although CLL\ninvolvement cannot be completely excluded.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ , 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "The appearance of the thoracic inlet is not substantially changed.  Radiodense\nmaterial continues to be seen in the left axilla (3, 14).  The left pleural\neffusion has increased in extent.  A previously resolved right pleural\neffusion has re-lapsed, both effusions are mild to moderate in extent.  The\nretrosternal space is stable and minimally heterogeneous, a millimetric fluid\ncollection in retrosternal location (3, 20) is stable in diameter.  In almost\nunchanged manner, multiple moderately enlarged mediastinal lymph nodes are\nvisualized.  A reference lymph node in precarinal location (3, 21) is stable\nin size.  Stable appearance of all cardiac structures.  No pericardial\neffusion.  The post sternotomy morphology is overall unchanged, the minimal\nspongiosal heterogeneities at the level of the manubrium (7, 62) are overall\nstable.  The visualization of the lung parenchyma is limited by massive\nrespiratory motion.  A previous right pneumothorax has completely resolved.  A\nnew is a nodular consolidation in left upper lobe perifissural location (5,\n81).  A similar lingular consolidation (5, 123) Is not substantially changed. \nSmall areas of consolidation and scarring, predominating in the left lower\nlobe (5, 203) are overall stable.  But most of the pre-existing ground-glass\nopacities and consolidations in the right lung have almost completely\nresolved.  Bilateral lower lobe predominant septal thickening (5, 224) is\nlikely the consequence of mild interstitial edema.",
            "output": "Near complete interval resolution of the pre-existing right predominant\nground-glass opacities and consolidations, with persistence of left lower lobe\nconsolidations.  The extent and severity of adenopathy in the mediastinum is\nstable, the pre-existing left pleural effusion has increased in size, the\nright pleural effusion has reoccurred.  Overall, the findings could reflect a\nresolving infectious process, combined to the sequelae of chronic cardiac\ninsufficiency."
        },
        {
            "input": "Thyroid is unremarkable.  Thoracic aorta and main pulmonary artery are normal\nsize.  Coronary artery calcification is heavy.  LAD is particularly\nhyperdense, unclear if due to presence of a possible coronary stent.  Aortic\nvalve calcification is moderate.  There is possible moderate mitral annulus\ncalcification.  Left atrium is mildly enlarged.  Left ventricle may also be\nenlarged, however dedicated cardiac imaging is necessary for definitive\nevaluation. There is no pericardial effusion.  Supraclavicular, axillary and\nmediastinal lymph nodes are not enlarged.\n\nAirways are patent to subsegmental levels.  There is no pleural effusion. \nSmall focus of subpleural interstitial abnormality in the lateral aspect of\nright middle lobe (4:147) may represent isolated, fibrotic scar. Minimal\nsubpleural atelectasis is noted in the posterior aspects of bilateral lungs.\n\nEsophagus distended with air. The study was not designed for subdiaphragmatic\nevaluation.  Limited evaluation of upper abdominal organs notable for a 2.2 cm\nright adrenal nodule of low density consistent with adrenal adenoma. Heavily\ncalcified atherosclerotic plaque is noted at the origin of celiac trunk and\nSMA.\n\nNo worrisome lesion is identified in the bones or soft tissue.",
            "output": "1.  No diffuse lung disease is identified to explain patient's symptoms. \nFocal area of interstitial fibrosis in the right middle lobe may be a sequel\nto prior infection.\n\n2.  No pulmonary edema or pleural effusion.\n\n3.  Heavy coronary artery calcifications.  Moderate calcification of aortic\nvalve and possibly mitral annulus.\n\n4.  Benign, right adrenal adenoma."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild cardiomegaly.  The pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.  Coronary artery\ncalcifications and probable stent are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is trace left pleural effusion.  No right pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is mild lower lobe bronchiolectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited sections through the upper abdomen demonstrate a 2.3 x 1.4\ncm, indeterminate nodule on the current exam but previously characterized as\nan adenoma.  A punctate calcification is noted in the anterior aspect of the\nperihepatic space.\n\nBONES: No suspicious osseous abnormality is seen.? Multilevel degenerative\nchanges noted.  There is no acute fracture.\n\nCHEST WALL: Surgical clips noted in the right breast.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormality in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: The overall caliber of the diffusely infiltrated 8 cm of\nesophagus has improved substantially since ___ and earlier.  Maximum\ndiameters are 39 x 32 mm today, 5:71, previously 49 x 54 mm in ___ and 48 x\n59 mm in ___.  Maximum wall thickness is 17 mm today, was 21 mm in ___. \nSurrounding edema has changed in distribution but not in overall severity.  4\nmm paraesophageal lymph node, 5:80, is unchanged.  Above the carina, there is\nno esophageal distension in wall thickening is mild.\n\nAtherosclerotic calcification is not apparent in head neck vessels or in the\ncoronary arteries.  Aorta and pulmonary arteries are normal size.  Cardiac\nevaluation would require echocardiography.  No aortic valvular calcification. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: New radiation pneumonia, with with traction\nbronchiectasis indicating probable developing fibrosis, paraesophageal and\nparaspinal superior and posterior basal segments right lower lobe.  A small\nregion of left lower lobe pneumonia could be radiation induced as well,\n6:242-268.\n\nBronchial wall thickening has been chronic.  Today, secretions are retained in\nthe anterior segmental bronchus right upper lobe.  No bronchiectasis or\nbronchiolar nodulation to suggest active bronchiolitis.\n\nCHEST CAGE: Nonunited fracture lateral left lower rib, 10:107, has been\npresent since at least ___.  No compression or pathologic fracture\nor destructive bone lesion.  Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.",
            "output": "Substantial improvement since ___, following treatment in the still large\ninfiltrative mass, lower esophagus.  Accompanying new radiation\npneumonia/fibrosis, right lower lobe.  No evidence of malignancy elsewhere in\nthe chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Prominent left upper paratracheal lymph node is slightly\nincreased in size compared to the prior examination currently measuring 0.6 cm\nin short axis, previously 0.3 cm (series 3, image 55).  A 0.8 cm lymph node at\nthe aortopulmonic window is also increased in size previously measuring 0.5 cm\nin short axis (series 3, image 97).  The esophagus remains circumferentially\nthickened although decreased in bulk, currently measuring approximately 2.0 x\n1.7 cm in thickness, previously 2.7 x 2.2 cm (series 3, image 179).  Adjacent\nmediastinal fat stranding also appears improved compared to the prior\nexamination.  A small paraesophageal lymph node measuring 0.5 cm in short axis\nis unchanged (series 3, image 194).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: The previously seen interstitial abnormality involving\nthe medial aspect of the right lower lobe has markedly improved compared to\nthe prior examination, now with minimal ground-glass opacification.  Findings\nare likely in keeping with improving radiation pneumonitis.  Compared to the\nprior examination, there are new scattered areas of ground-glass opacification\npredominantly involving the bilateral upper lobes (for example series 3, image\n86, 105).  Findings are concerning for atypical infection either viral or\nbacterial.  There is progressive consolidation and ground-glass opacification\ninvolving the left lower lobe which has progressed compared to the prior\nexamination, possibly reflecting cryptogenic organizing pneumonia (series 3,\nimage 177).\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Bulky esophageal soft tissue thickening has decreased in extent compared to\nthe prior examination from ___.\n2. New diffuse ground-glass opacities predominately involving the bilateral\nupper lobes is felt to reflect atypical infectious viral or bacterial\npathology.  COVID-19 testing is suggested, if not already performed, as\nfindings may reflect a viral pneumonia.\n3. Progressive consolidation and ground-glass opacification involving the left\nlower lobe may reflect developing cryptogenic organizing pneumonia.\n4. Interval improvement of post radiation changes of the right lower lobe.\n5. Interval increase in size of multiple mediastinal lymph nodes, likely\nreactive."
        },
        {
            "input": "THORACIC INLET: There are stable small bilateral supraclavicular lymph nodes. \nThe thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  The esophagus is dilated.\n\nThere is diffuse thickening of the distal esophagus starting from just below\nthe carina (3, 93 extending to the GE junction with evidence of\ncircumferential wall thickening.  A stent has been placed within the esophagus\nin the interim, extending from the lower esophagus to the GE junction however\nthe lumen of the stent appears to be occluded (3, 165).  The wall thickening\ninvolving the esophagus in the lower esophagus has progressed since the prior\nstudy.\n\nMultiple small periesophageal lymph nodes are unchanged.\n\n\nPLEURA: There is a trace right pleural effusion.\n\nLUNG: There is subsegmental atelectasis within both lower lobes right greater\nthan left.  Scattered ground-glass opacities are seen within both upper lobes\nin a bronchus centric distribution (5, 36) and in the right middle lobe and\nright upper lobe (5, 47).  Previously visualized parenchymal opacities in\ndependent portions of both lower lobes are again noted, some of them have\nimproved since the prior study, these remain concerning for recurrent\naspiration.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nsplenomegaly.  There is a tiny hypodense lesion in the right lobe of liver\nwhich is unchanged.",
            "output": "Progressive circumferential wall thickening involving the distal esophagus\nconsistent with known plasmacytic lymphoma.  Increase in wall thickening of\nthe esophagus.  Evidence of placement of a stent within the distal esophagus\nin the interim.  The lumen of the stent is more than 80% occluded.\n\nTrace right pleural effusion and trace pericardial effusion.\nScattered ground-glass opacities bilaterally in all lobes of the lung some of\nthem have improved and could be related to aspiration.\n\nStable small mediastinal and bilateral supraclavicular lymph nodes.\n\nEvidence of splenomegaly."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Normal thyroid gland. No enlarged\nor growing supraclavicular or axillary lymph nodes.  No soft tissue chest wall\nabnormality. No atherosclerotic calcification of the imaged neck arteries.\n\nUPPER ABDOMEN: Please see the CT torso report dated the same day for\nevaluation of the abdomen and pelvis.\n\nMEDIASTINUM: The distal esophageal stent is unchanged in position, and is more\nthan 80% occluded.  The distal esophageal concentric wall thickening is\nunchanged, starting just below the level of the carina, extending to the\ngastroesophageal junction.  Mildly patulous mid and upper esophagus, which is\nfluid and air-filled.  The patient is at risk of aspiration.  Multiple small\nperiesophageal lymph nodes are unchanged.  No enlarged or growing mediastinal\nlymph nodes.  The thoracic aorta and pulmonary arteries are normal in caliber.\nNo atherosclerotic calcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal heart size. No coronary artery or cardiac valve\ncalcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax. Mild biapical pleuroparenchymal\nscarring, stable.\n\nLUNG:\n\n1. PARENCHYMA: Scattered ground-glass opacifications are again noted, for\nexample in the left upper lobe (302:72).  Additional ground-glass opacities\nare noted in the right upper lobe (302:96), reduced in density.  There are\nscattered focal opacities throughout the right upper lobe, many of which were\nground-glass density on the prior study, and several of which are new, for\nexample a cluster of nodules at the right apex (___).  There is unchanged\nground-glass opacification medially in the right lower lobe, and scattered\nthroughout the left lower lobe.  No lung mass.  Mild bibasal atelectasis.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nDiffuse bronchial wall thickening, moderate in the lower lobes and mild\nelsewhere.  No bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  No fracture.  Old fracture of the left sixth rib laterally.  Mild\nspondylosis.",
            "output": "-Unchanged circumferential wall thickening involving the distal esophagus\nconsistent with the known plasmablastic lymphoma.\n-Unchanged position of the distal esophageal stent, which is again noted to be\nmore than 80% occluded. The extent of occlusion does appear progressed\ncompared to the prior exam.\n-Moderately patulous air and fluid-filled mid and upper esophagus.\n-Scattered bilateral ground-glass opacifications, with several new foci of\nconsolidation/nodulation in the right upper lobe, consistent with multifocal\naspiration.\n-Diffuse bronchial wall thickening, moderate in the lower lobes and mild\nelsewhere, likely inflammatory in nature."
        },
        {
            "input": "HEART AND VASCULATURE:  There is a filling defect within the posterior basal\nsegmental branch of the right pulmonary artery, consistent with a pulmonary\nembolism (2:62-65).  The main pulmonary artery is not enlarged.  This no\nevidence of right heart strain.  The remaining pulmonary vasculature is well\nopacified without filling defect. The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are scattered prominent mediastinal\nlymph nodes which do not meet CT size criteria for lymphadenopathy.  No\nmediastinal mass.\n\nPLEURAL SPACES: There is a small right pleural effusion.  No pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is a peripheral right lower lobe nonenhancing\nconsolidation and ground-glass, likely a pulmonary infarction secondary to an\nacute pulmonary embolism.  There is superimposed and adjacent linear\natelectasis in the right lower and middle lobes.  A few scattered nonspecific\nground-glass opacities noted within the lingula and left lower low.  Lungs are\notherwise clear.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for splenomegaly\nwith the spleen measuring 16.3 cm AP.  .\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Acute right lower lobe segmental pulmonary embolism with pulmonary\ninfarction and a small right pleural effusion.  No evidence of right heart\nstrain.\n2. Thickened distal esophagus may represent esophagitis.\n3. Splenomegaly as seen on prior."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Normal chest wall.  No adenopathy. \nNormal thyroid.\n\nUPPER ABDOMEN: 8 mm hypodensity at the liver dome, indeterminate, more\napparent compared with ___.  .  Mild splenomegaly.  There is mild\nthickening of the distal esophagus with a small hiatal hernia, similar,\nconsider esophagitis.  Mildly prominent distal paraesophageal lymph node all\nmeasuring 1.0 cm, compared with 0.9 cm on in ___.\n\nMEDIASTINUM: Few mildly prominent mediastinal lymph nodes may be reactive.\n\nHILA: No hilar adenopathy.  No mass\n\nHEART and PERICARDIUM: Normal heart size.  No pericardial effusion.\nPLEURA: There is large, partially loculated right pleural effusion,, with\nlinear pleural thickening and enhancement, new since prior, may be reactive,\nempyema cannot be excluded.  No pneumothorax.\nLUNG:\n\n-PARENCHYMA:  There are areas of right lower lobe nonenhanced in with few air\nlevel centrally, may represent sequela of pulmonary infarct, also seen on ___.  Necrotizing pneumonia could have similar appearance, clinically\ncorrelate.  Near complete atelectasis with consolidation the right lower lobe.\nAreas of atelectasis in the right upper lobe, right middle lobe adjacent to\npleural effusion.  Right upper lobe is still ventilated.  There are patchy\nground-glass opacities in the left lung, similar, may be infectious.\n-AIRWAYS:  Patent throughout\n-VESSELS:  Main pulmonary artery and aorta are normal caliber.  Right lower\nlobe pulmonary embolism was better seen on prior, still present.  There are no\ndefinite new pulmonary emboli.\nCHEST CAGE: No concerning osseous lesion",
            "output": "Zones of no enhancement within right lower lobe, likely sequela of pulmonary\ninfarcts, necrotizing pneumonia could have similar appearance, is less likely\ngiven configuration and appearance on CT from ___.\nLarge partially loculated right pleural effusion with areas of pleural\nthickening and enhancement, may be reactive, empyema cannot be excluded.\n\nStable right lower lobe pulmonary embolism.\n\nPatchy small areas of ground-glass opacity in the left lung, similar to prior,\nmay be infectious.  Follow-up chest CT without contrast in 3 months\nrecommended\n\nEsophageal thickening, indeterminate, consider esophagitis.  Prominent distal\nparaesophageal lymph node.  Consider EGD to exclude neoplasm.\n\nIndeterminate hepatic lesion, suboptimally evaluated.\n\nRECOMMENDATION(S):  Chest CT without contrast in 3 months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: Stable prominent mediastinal lymph nodes.\n\nHILA: Right hilum is poorly seen.  No definite left hilar adenopathy.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with  coronary artery calcifications. There is no pericardial\neffusion.\n\nPLEURA:  Interval placement of a right-sided pigtail catheter with the tip\nalong the lateral right costophrenic angle, we decrease and near resolution of\npreviously seen loculated component of pleural left effusion at this level. \nPosterior, upper right chest loculated pleural effusion persists.  There is no\nleft pleural effusion.  Trace volume pleural air, likely related to chest\ntube.\n\nLUNGS/AIRWAYS:  Airways are patent.  Right lower lobe atelectasis has\nsignificantly improved since yesterday.  Nodular and patchy lung opacities are\nsimilar, with areas of centrilobular, ___ opacities most apparent in\nthe right lung, more apparent since yesterday likely infectious.  Right middle\nlobe atelectasis has improved.  Interlobular septal thickening at the right\nlower lung, likely represents edema, possibly related to re-expansion.  Right\nlower lobe partially cavitated abnormalities stable.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, there is persistent splenomegaly measuring up\nto 13 cm the axial plane.  A small hiatal hernia is present.  Prominent distal\nparaesophageal lymph node measuring up to 1.1 cm, unchanged.  Esophageal\nhiatal hernia.  Stable thickening of the distal esophagus, indeterminate. \nSmall amount of high-density material layering within the gallbladder may\nrepresent retained contrast or gallstones.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  multilevel degenerative changes of the thoracic spine are\nunchanged.  Chronic left lateral sixth rib fracture.",
            "output": "Right lateral costophrenic angle pigtail catheter placement with interval near\nresolution of loculated basilar component of pleural effusion.  Additional\nloculated components in the posterior, right chest and along the major fissure\nremain.\nSignificant re-expansion of the right lung base, with mild re-expansion edema\nat the lower right lung.\nSmall nodular and ground-glass bilateral lung opacities, more apparent, likely\ninfectious, consider viral, typical, atypical organisms.\nSimilar right lower lobe partially cavitated lesions, likely pulmonary\ninfarcts, necrotizing pneumonia could have similar appearance, clinically\ncorrelate.\nStable mild mediastinal adenopathy.\nIndeterminate distal esophageal thickening, consider esophagitis, neoplasm\ncannot be excluded."
        },
        {
            "input": "With regards to the appearance of the chest wall, the heart, the mediastinum,\nand the bones, no change is seen as compared to the previous examination.\n\nWith regards to the right pleural effusion, an additional right-sided\nposterior chest tube (2, 30) has been inserted.  The extent of the pleural\neffusion has clearly decreased.  The effusion contains several small air\nbubbles (2, 31).  As far as this is possible to determine without\nadministration of contrast material, the effusion appears loculated, with a\nlarger posterior part and a smaller anterolateral part.  The extent of the\ncompressive atelectasis adjacent to the effusion has also decreased, the right\nlower lobe is better ventilated than on the previous examination.  With the\nexception of a minimally increased left-sided basilar atelectasis, no change\nhas occurred in the left hemithorax.",
            "output": "Insertion of an additional second right-sided chest tube.  The extent of the\nright pleural effusion has decreased.  Decrease of the adjacent compressive\natelectasis.  No relevant change in appearance of the left hemithorax."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level with a stable pulmonary embolism in a segmental branch of\nright pulmonary artery supplying the right lower lobe.  No new pulmonary\nemboli identified.  .  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  Multiple mediastinal lymph nodes slightly larger when compared to\nprior and likely reactive to the underlying inflammatory changes.  No\nmediastinal mass.\n\nPLEURAL SPACES:  Two right-sided chest tubes are identified in adequate\nposition not significantly changed from prior.  The extent of a small\nloculated right pleural effusion with pleural enhancement has not\nsignificantly changed from prior.  There is however worsening pneumothorax\nposteriorly.\nLUNGS/AIRWAYS:  Enhancing and nonenhancing lung parenchyma  adjacent to the\neffusion appears stable from prior and likely reflects compressive atelectasis\nand infarcted lung.  Ground-glass opacities in the right upper lobe and left\nupper lobe appear stable from prior.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSmall hypodensity within segment VIII (series 10, image 14) measuring 7 mm is\ntoo small to characterize, however stable from prior CT dated ___ and\nlikely represents a cyst/biliary hamartoma.  The remainder of the liver\nenhances homogeneously.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly measuring 17.5 cm, stable from prior CT.  It otherwise\nenhances homogeneously without focal mass lesion.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  There is thickening of the distal\nesophagus with surrounding edema in the lower posterior mediastinum, slightly\nworse when compared to prior which could be related to esophagitis.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon and rectum are within normal limits.  A substantial\namount of stool is present throughout the colon.  The appendix is normal. \nThere is no free intraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Small fat containing umbilical hernia as well as small\nbilateral fat containing inguinal hernias.",
            "output": "1.  Two right-sided chest tubes unchanged in position from prior. The extent\nof loculated right pleural effusion appears stable, however with increasing\npneumothorax posteriorly.  Compressive atelectasis in the right lung base is\nstable.\n2.  Ground-glass opacities in the upper lobes bilaterally are unchanged likely\ninfectious in etiology.\n3.  Unchanged pulmonary embolism in a segmental branch supplying the right\nlower lobe.  No new pulmonary emboli identified.\n4.  No worrisome findings in the abdomen or pelvis to explain patient's\nsymptoms.  Mild splenomegaly stable from prior.\n5.  Worsening thickening of the distal esophagus with surrounding edema likely\nrelated to esophagitis.  Clinical correlation is recommended."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall concerning for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis but shows normal\nsize adrenal glands.  8-9 mm low-density lesion in the right lobe of the liver\nis unchanged, as remeasured, since ___, not previously imaged.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are normal size.  Aorta is normal\nsize.  Main and lobar pulmonary arteries are free of filling defects, however\nthere is still nonocclusive, slowly resolving embolus in at least anterior and\nthe lateral basal or posterior basal subsegmental pulmonary artery branches,\n5:183-198.\n\nCentral lymph nodes are not enlarged, ranging in diameter up to 9 mm right\nesophageal diaphragmatic node, 5: 249, previously larger than 9 mm.\n\nLungs:\n\nMild scattered bronchiolar nodules, some with ground-glass halos, for example\n___, 98 probably new since ___, when the patient had a large right\npleural effusion and extensive pneumonia in the right lung, both since\nsubstantially improved.\n\nThe peripheral region of consolidation and adjacent abscess in the posterior\nbasal segment of the right lower lobe is substantially smaller today, 32 x 34\nmm, 5:228 compared to 74 x 87 mm on ___.  Adjacent pleural effusion is\nsmall, relatively high attenuation, 35-40 ___, and substantially smaller today\nthan on ___.  Residual pleural thickening is restricted to the\nposterior costal pleural surface in the lower chest and there is no secondary\natelectasis, except for what might be inseparable from residual pneumonia in\nthe right lower lobe.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\nMild widespread bronchial wall thickening, right upper and left lower lobes is\nmore pronounced today than on earlier studies.\n\nGeneralized wall thickening of the lower esophagus increases the overall\nesophageal ___, maximum 22 x 30 mm, 5:232 is probably unchanged since\n___.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Diffuse bronchiolitis and mild multifocal, bronchial wall thickening, probably\ninfectious, increased since ___.\n\nChronic, severe diffuse lower esophageal wall thickening.  Endoscopic\nevaluation advised.\n\nSlowly resolving right lower lobe pulmonary emboli.\n\nSubstantial involution since ___ in previously large abscess,\nassociated with improving right lower lobe pneumonia and substantially smaller\nright pleural effusion.\n\nLocalized of pleural thickening, right lower costal pleural surface, with no\nappreciable atelectasis.\n\n\n\n\n\n\n\n\nRECOMMENDATION(S):  Endoscopy for esophageal wall thickening.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:36 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "A PICC line terminates at the cavoatrial junction.\n\nThe heart is normal in size.  Great vessels are unremarkable.\n\nThere is a very small right-sided pleural effusion, no definite effusion on\nthe left.  There is no pericardial effusion.\n\nThere is a very large circumferential mass involving the distal esophagus\nincluding marked wall thickening.  The length of the mass is about 15 cm,\nextending from the mid esophagus to the gastroesophageal junction.  This\nconsists of wall thickening measuring up to 23 mm as well as right lateral and\nposterior satellite nodules which are confluent with the main hyperenhancing\nmass.  However, elsewhere there is no lymphadenopathy in the chest.  Esophagus\nupstream of the mass is mildly dilated but the mass is not very obstructing\ndespite its large size.\n\nIn the right lower lobe there is a cluster of ___ opacities. This\ncould be from mild, often subclinical aspiration versus infection or\ninflammation of lower airways.  Similar finding in the left lower lobe.\n\nThe abdomen is reported separately.\n\nThere are no suspicious bone lesions.  Small right-sided lucency in the T2\nvertebral body is new since ___, possible focus of lymphoma.",
            "output": "1.  Large esophageal mass in continuity with a few satellite nodules, but\notherwise, no definite evidence of malignancy in the chest.\n\n2.  Small new lucency in the T2 vertebral body, possible focus of lymphoma.\n\n3.   Small opacities in the lower lungs which suggest minor aspiration versus\npossibility of some other infectious or inflammatory process involving lower\nairways."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.  Left PICC line with tip in the\nlow SVC.  A thrombus is noted adjacent to the tip of the PICC (4:124)\nextending for approximately 1.5 cm.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe lower esophagus continues should be severely thickened, unchanged from\nprior.  The esophagus is fluid-filled until the superior third.  Small\nmediastinal lymph nodes, none pathologically enlarged by CT size criteria. No\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nwall thickening, bronchiectasis or mucus plugging. No suspicious lung nodules\nor masses. No consolidations or atelectasis.  Unchanged cluster of ___\nground-glass nodules noted in the right lower lobe.\n\nCHEST CAGE:\nNo acute fractures.  Old healed fracture in the left lateral sixth rib.  Mild\ndorsal spondylosis.  Several round small lytic lesions are seen in the\nthoracic spine, for example the vertebral body of T9 (6:80) and T11 (6:74),\nconcerning for foci of lymphoma.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Relatively unchanged appearance of a known esophageal mass compared to prior\nstudy.\nNew lytic lesions along the thoracic spine, concerning for new foci of\nlymphoma.\nNew thrombus noted adjacent to the tip of the left PICC..\nNo evidence of new pneumonia.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___  at 22:59."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  There are no chest wall abnormalities.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nLarge mass in the lower esophagus consisting of severe circumferential wall\nthickening is slightly smaller, now 6.6 x 4.2 cm, extending for a 9.5 cm\nlength, was 8.1 x 5.2 cm at a comparable level in the ___ study.\nNew, small gas-containing defect in the esophageal wall (2:44) is either an\nulcer or biopsy defect extending to the outer margin of the esophageal wall. \nThere is no gas, fluid collection, or infiltration of fat in the adjacent\nmediastinum to suggest through and through perforation or infection.  Previous\nmediastinal adenopathy adjacent to the esophageal mass had resolved by\n___ and has not recurred.  There are no newly enlarged or growing\nlymph nodes in the chest.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  Stable small pericardial effusion is\nstable.  No atherosclerotic calcifications in the coronary arteries, cardiac\nvalves or aorta.  Aorta and pulmonary arteries are normal size.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  Cardiac bronchus and\nsegment is noted as anatomic variant.  Secretions are noted in the proximal\nright main bronchus.  Right lower lobe pneumatocele and adjacent scarring\ntissue is residual from cavitary lesion described in prior examinations.\nModerate improvement of the mild bronchial wall thickening and centrilobular\nnodularity in the right lower lobe, most likely related to prior aspiration. \nThere is no evidence of active bronchial inflammation.  There are no\nmeasurable lung nodules and no focal consolidation.  Pleural surfaces are\nnormal.  No focal consolidations.\n\nCHEST CAGE:\nNo acute fractures.  No lytic or sclerotic bone lesions worrisome for\nmalignancy.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals are unremarkable.",
            "output": "Slight continuing involution of the still large lower esophageal mass\nconsisting of severe esophageal wall thickening.  No proximal esophageal\ndistension to document the complaint of obstruction.  New deep ulceration,\nprobably treatment or biopsy related, with no evidence of perforation or\ninfection, as yet.\n\nPlease refer to barium swallow examination from ___ for further\ncharacterization of swallowing physiology.\n\nNOTIFICATION:  The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 1:53 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Spleen is again enlarged measuring up to at least 16.7 cm in\nlength.  Although not fully visualized, this is thought, in all likelihood, to\nbe unchanged.\n\nMEDIASTINUM: The distal esophagus is markedly thickened measuring up to 3.4 cm\nin the thickest portion with associated moderate to high-grade narrowing of\nthe esophagus.  The entirety of the esophageal mass, including the lumen,\nmeasures approximately 4.2 x 5.5 cm in axial ___.  Length of the mass\nis approximately 9 cm.  There has been no definite change.  Contrast is seen\npassing through the stenosis into the stomach without evidence of pre stenotic\ndilation.  Redemonstrated is extension of contrast into the left anterior\nesophageal wall suggesting and ulceration or biopsy cavity, unchanged (series\n4, image 210).  A very small lymph node immediately anterior to the esophageal\nmass is unchanged.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion\nis identified.\n\nPLEURA: No pleural effusion is identified.\n\nLUNG: There is a focus of nodular consolidation and ground-glass opacity in\nthe right lower and left upper lobe concerning for aspiration or developing\ninfection.  These include sizable ___ nodules and opacities in\naddition to airway thickening.  There are few small ill-defined mixed\nattenuation nodules, one with cavitation in the left upper lobe (series 4,\nimage 130).  These opacities are not very suggestive of lymphoma.  Bibasilar\natelectasis.  Otherwise the airways are patent.\n\nCHEST CAGE: No suspicious osseous lesions are identified.  Nondisplaced left\nposterolateral tenth rib fracture is unchanged.",
            "output": "1. No definite change in esophageal mass.\n2. Focus of nodular consolidation with ground-glass opacity in the right lower\nand left upper lobes concerning for an infectious process, possibly related to\naspiration.  Atypical infectious processes should be considered depending on\nclinical circumstances."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormality in the chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis.  Partially imaged splenomegaly is comparable to\n___.\n\nCARDIO-MEDIASTINUM: Circumferential thickening of the esophageal wall from the\nlevel of the aortic arch to the diaphragm increased in bulk between ___\n___ and ___.  There is mild dilatation of the lumen above\nlevels where the lumen is completely obliterated, but there is been no change\nin overall size of the collapsed esophagus, for example 41 x 47 mm today, 3:39\nand 43 x 47 mm in ___.  Even at other levels of marked wall thickening,\nthere is a preserved lumen, so it is impossible to say where the lumen is\ncollapsed whether it is fully strictured or still elastic.  For that reason I\nwould recommend a contrast swallow.  At several levels there is more edema in\nthe periesophageal mediastinal fat, compare 2: 47, 48 today with 2:42 in\n___.  That edema is now accompanied by thickening of the right lower\nparaspinal and posterior costal pleura.  If this change is not explained by\nradiation therapy, it is quite likely due to local tumor activity.\nAtherosclerotic calcification is not apparent in head neck vessels or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal\ncaliber and small pericardial effusion is unchanged.\n\nTHORACIC LYMPH NODES: None pathologically enlarged or changing.  Subcentimeter\nparaesophageal node at the level of the diaphragm is stable\n\nLUNGS, AIRWAYS, PLEURAE: No lung nodules or consolidation or appreciable\nground-glass opacification.  Mild generalized bronchial wall thickening is\nprobably due to chronic aspiration, but there is no retained secretion or\nbronchial obstruction.  Minimal bronchiectasis in the posterior basal segment\nright lower lobe shows no indication of being suppurative.  Incidental note is\nmade of the an accessory bronchus originating from the bronchus intermedius.\n\nCHEST CAGE: No compression or pathologic fracture or destructive bone lesion. \nWell-healed fracture posterolateral left middle rib.",
            "output": "No overall progressive enlargement of severe, diffuse lymphoma infiltration of\nthe lower ___ of the esophagus.  At several levels the esophagus is entirely\ncollapsed but it is not possible to say whether the lumen is completely\nobliterated.  That is better determined by a real-time contrast swallow.\n\nPeriesophageal edema in the lower mediastinum contiguous with right pleural\nthickening, both new since ___.  Given the appropriate clinical history\nthis could be due to radiation therapy, but alternatively possible tumor\nextension.\n\nLower lobe bronchial inflammation is presumably due to chronic aspiration.  No\nevidence of lymphoma in the lungs."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is minimally\nenlarged.  There is no pericardial pleural effusion.  There is thickening of\nthe distal esophagus, series 2, image 48, please review the assessment of the\nupper abdomen including the liver as part of the CT abdomen and its\ncorresponding report.\n\nAirways are patent to the subsegmental level bilaterally.  Several pulmonary\nnodules are present, series 4, images 58, 137, 159 left upper lobe subpleural\ninterstitial changes will most likely representing previous breast radiation.\n\nThere are no lytic lesions worrisome for infection or neoplasm.  There is\nfocal area of sclerosis at T1, series 2, image 4, 2.5 mm in diameter most\nlikely representing bone islands.\n\nThe patient is after left axillary lymph node dissection and potential left\nbreast surgery please correlate with patient history.",
            "output": "Several pulmonary nodules, of nonspecific etiology and should be reassessed in\n3 months for documentation of stability.\n\nSclerotic focus in the first thoracic vertebral body, most likely bone islands\ncan be reassessed at the same time\n\nPrevious breast radiation and breast surgery on the left.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen corresponding report will be issued"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneous.  Unchanged\npostradiation and postsurgical changes in the left breast, including left\naxillary lymph node dissection.  No supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN:  Unchanged thickening of the distal esophagus.  Unchanged 1.9\ncm simple cyst in hepatic II.  Small hiatus hernia.  The bilateral adrenals\nare bulky without definite nodules.  Atherosclerotic calcification of the\naorta and its branches.  Otherwise, imaged portions of the upper abdomen are\nunremarkable.\nMEDIASTINUM: No lymphadenopathy or mass.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Extensive calcification of the coronary arteries\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\nPARENCHYMA:  No new or growing pulmonary nodules.  Multiple pulmonary nodules\nare unchanged:\n- 0.2 cm nodule in the right upper lobe (___)\n- 0.2 cm subpleural nodule in the right lower lobe (___)\n- 0.4 cm nodule in the right lower lobe (___)\n- 0.5 cm nodule in the right lower lobe (___)\n- 0.3 cm nodule in the left upper lobe (___)\nMultiple unchanged punctate calcified granulomas in the left lower lobe.  No\nevidence of active or reactive infection.  Unchanged left upper lobe\nsubpleural interstitial changes, likely secondary to prior breast radiation.\n\nAIRWAYS:  Patent to the subsegmental levels bilaterally.\n\nVESSELS:  The left pulmonary artery is at the upper limits of normal,\nmeasuring 2.5 cm.  No evidence of pulmonary embolism on this noncontrast\nstudy.\nCHEST CAGE: No suspect osseous lesions or fractures.  Unchanged mild\nmultilevel degenerative changes of the imaged spine.  Unchanged 0.5 cm\nsclerotic focus in the T1 vertebral body (___), likely representing a bone\nisland.",
            "output": "1. No new or growing pulmonary nodules.  Multiple unchanged nodules, measuring\nup to 0.5 cm.  Recommend follow-up noncontrast CT in ___ to document\n___ years of stability.\n2. Presumed postsurgical and postradiation changes in the left breast. \nRecommend correlation with mammography.\n\nRECOMMENDATION(S):  Recommend follow-up noncontrast CT in ___ to\ndocument ___ years of stability.\n\nRecommend correlation with mammography for presumed postsurgical and\npostradiation changes in the left breast.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 17:32 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, mediastinal, or hilar\nlymphadenopathy.  Heart size is normal.  Minimal coronary calcifications are\nseen.  There is no large pericardial effusion.  The esophagus is normal\nwithout evidence of wall thickening or a hiatal hernia.  The aorta is normal\nin caliber.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nA 57 x 44 mm left apical lesion with smooth borders and a Hounsfield unit of\n19 appears slightly increased in size, previously measuring no more than 53 x\n38 mm.  The lesion is inseparable from the upper esophagus and may represent a\nmediastinal or esophageal duplication cyst.\n\nSevere chronic scarring, bronchiectasis in the left upper lobe as well as\nsevere volume loss in the left lower lobe appears unchanged compared to the\nprior exam from ___ and may reflect sequela of prior tuberculosis infection. \nThe thick linear scar within the right lung apex as well as a ground-glass\nlingular irregular density appear unchanged compared to prior exam.  A linear\ndensity spanning approximately 1 cm within the right upper lobe, series 4,\nimage 35 with extension to the pleural surface appears new compared to the\nprior exam.  The remainder of the subcentimeter right lung nodules are\nunchanged compared to the prior exam.  There is no pleural effusion or\npneumothorax.",
            "output": "-New linear soft tissue density with nodularity within the right upper lobe\nspanning approximately 1 cm with extension to the pleural surface may be a\nfocus of scarring however recommend follow-up in 6 months for further\nevaluation.  The remainder of the right-sided lung nodules are unchanged.\n-Stable appearance of the bronchiectasis and atelectasis within the left lung,\nlikely secondary to prior tuberculous infection compared to the exam from ___.\n-Slight interval increase in the left posterior mediastinal lesion likely\nsecondary to an esophageal duplication or mediastinal cyst now spanning\napproximately 57 mm, previously measuring no more than 53 mm.\nRecommendations: Recommend six-month follow-up with chest CT."
        },
        {
            "input": "No incidental thyroid findings.  The cystic left-sided lesion is stable in\nsize, with an average diameter of 50 mm.  The surrounding of the lesion is\nstable.  Stable leftward deviation of the trachea and mediastinal structures. \nStable mild dilatation of the esophagus (2, 20).  No pathologic hilar or\nmediastinal lymph nodes, with the exception of a mildly enlarged right hilar\nlymph node (2, 27).  Stable mild to moderate aortic valve calcifications. \nMinimal coronary calcifications.  Stable appearance of the upper abdomen.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  The linea scar in the right lung apex (4, 46) is stable in size\nand morphology.  The areas of right centrilobular pulmonary emphysema and\nleft-sided fibrosis are stable.  Also stable are the nodular components of the\nleft-sided fibrosis (4, 75).  Again noted are several pre-existing pulmonary\nnodules, for example in the right upper lobe (4, 84), unchanged in size and\nmorphology.  Also stable in size are the multiple calcified granulomas (4,\n94).  Finally, a left basal pleural calcification is also stable.",
            "output": "Stability in size of a known left cystic apical lesion.  Stability in extent\nand severity of the left-sided fibrotic changes, combined to a leftward shift\nof the mediastinum.  Stable right-sided pulmonary emphysema.  Stable pulmonary\nnodules, some of which are calcified.  No new or growing nodules.  Stable left\npleural calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nLeft thyroid lobe heterogeneous 10 x 10 mm nodule and a left supraclavicular 7\nx 14 mm enlarged lymph node are better characterized on neck ultrasound from ___.  No enlarged lymph nodes in the axilla.  There are no chest wall\nabnormalities.  No atherosclerotic calcifications in the head and neck\narteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  No enlarged mediastinal or hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  Aorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Right middle lobe 2 mm\nperifissural nodule (5:146).  No focal consolidations.  No pericardial\neffusion.\n\nCHEST CAGE:\nNo acute fractures.  No lytic or sclerotic bone lesions worrisome for\nmalignancy..\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals are unremarkable.",
            "output": "No enlarged mediastinal or hilar lymph nodes.\n\nHeterogeneous left thyroid lobe nodule and associated left supraclavicular\nlymphadenopathy. Please see separately submitted neck CT report and previous\nneck ultrasound for better characterization on neck and thyroid findings."
        },
        {
            "input": "Mildly motion limited exam.\n\nHEART AND VASCULATURE: Pulmonary vasculature is adequately the segmental level\nwithout filling defect to indicate a pulmonary embolus.  Respiratory motion\nlimits evaluation for distal segmental and subsegmental pulmonary emboli in\nthe bilateral lower lobes.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  Heart size is enlarged with\npostsurgical changes of CABG.  There is no pericardial effusion.  There is a\npacemaker in the left chest wall with leads terminating in the right atrium,\nright ventricle and coronary sinus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: No focal consolidation.  No pulmonary edema.  There is a right\nupper lobe subpleural 2 mm nodule, of doubtful significance.  There is minimal\natelectasis in the bilateral posterior costophrenic angles.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There is a 6 mm left thyroid lobe nodule, not requiring routine\nevaluation at this size according to ACR guidelines.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes of the thoracic spine are moderate.  Post CABG with\nintact median sternotomy wires.",
            "output": "1.  No evidence of pulmonary embolism, noting that respiratory motion limits\nevaluation for distal segmental and subsegmental pulmonary emboli in the\nbilateral lower lobes.\n2.  No acute pulmonary parenchymal findings.\n3.  Cardiomegaly and postsurgical changes of CABG."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal in size.\nCardiac configuration is normal and there is no appreciable coronary\ncalcification. There is no pericardial effusion.\n\nCentral airways are patent to the subsegmental level. There is a 2 mm right\napical pulmonary nodule (09:17). No additional nodule is visualized. There is\nno consolidation.  There is no pleural effusion.\n\nThere is no evidence of osseous lesion involving the sternum or manubrium.\nThere are mild degenerative changes of the sternomanubrial joint and the first\nand second sternocostal joints. There are no bony lesions concerning for\nmalignancy or infection. There are degenerative changes of the lower thoracic\nspine.\n\n This study is not designed for subdiaphragmatic diagnosis but shows no\nadrenal mass or abnormality in the imaged portions of the unenhanced solid\norgans in the upper abdomen.",
            "output": "1. Degenerative changes of the sternomanubrial joint and sternocostal joints. \nNo evidence of sternal lesion.\n2. Otherwise unremarkable CT chest examination."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.   The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  There are no concerning pulmonary\nnodules.  There are a small number of punctate calcified granulomas in the\nright lower lobe (7:166, 252).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen. Within\nthese limitations no gross abnormality is seen.",
            "output": "1. Clear lungs an airways without imaging findings to explain the patient's\ncough.\n2. No hilar lymphadenopathy identified within the limitations of noncontrast\ntechnique.  The abnormal chest radiograph mentioned in the requisition was not\navailable for review in PACS during interpretation."
        },
        {
            "input": "The imaged thyroid gland is homogeneous.  There are no pathologically enlarged\nmediastinal, hilar, or axillary lymph nodes.  The aorta and pulmonary artery\nnormal in caliber.  There is no appreciable coronary calcium.  Heart size is\nnormal and there is no pericardial effusion.  Esophagus is normal in course\nand caliber.\nUnenhanced images of the upper abdomen demonstrate a normal liver,\ngallbladder, pancreas, bilateral partially imaged kidneys, bilateral partially\nimaged adrenal glands, and spleen as well as accessory spleen.\n\nThe airways are patent to the subsegmental level bilaterally.  There is no\nfocal consolidation, pleural effusion, or pneumothorax.  Several pulmonary\nnodules are identified, all measuring less than 5 mm.  Two of these nodules\nare perifissural in location, partially triangular-shaped, likely representing\nlymphoid aggregates rather than true nodules (5:140, 150).  The remainder of\nthe nodules are scattered in the left upper, right upper, left lower, and\nright middle lobes (5:74, 76, 94, ___.\n\nThere is a well-circumscribed lucency in the posterior aspect of the T11\nvertebral body corresponding to an intraosseous hemangioma.  Similar findings\nare seen throughout the thoracic spine, to a less prominent extent, and these\nmay represent smaller intraosseous hemangiomas.  There is no concerning lesion\nin the chest cage.  Multilevel degenerative changes in the thoracic spine are\nmild.",
            "output": "Sub 5 mm pulmonary nodules scattered throughout both lungs, none with\nparticularly concerning features.  Follow-up per the ___ society\nguidelines is recommended.\n\nRECOMMENDATION(S):  According to the ___ guidelines for incidentally\ndetected pulmonary nodules, if the patient has a history of smoking or other\nknown risk factors for malignancy, a follow-up chest CT in 12 months is\nrecommended.  In the absence of such risk factors, no follow-up is required."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.  Image portion of the upper abdomen reveals no\nappreciable abnormality\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules all stable with the largest 1 being in the right lower lobe\nin subpleural location, 4 mm in diameter, series 5, image 100 demonstrated.\n\nSebaceous cyst is demonstrated posteriorly, series 3, image 7.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nMinimal compression fractures of the mid thoracic vertebral bodies are similar\nto previous examination.",
            "output": "Stable pulmonary nodules.  No further followup indicated based on the size and\nmorphology\n\nSebaceous cyst."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\ndiffuse calcification of the intrathoracic aorta.  There is prominent mitral\nannulus and coronary artery calcification.  A dual lead left chest wall\npacemaker is noted with leads terminating in the right atrium and coronary\nsinus.  There is no pericardial effusion.  The pericardium is unremarkable. \nThe great vessels are within normal limits within the limitation of an\nunenhanced study.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy. \nConspicuous mediastinal lymph nodes are not enlarged by CT size criteria. \nThere is no mediastinal mass lesion or hematoma.\n\nPLEURAL SPACES: There is no evidence of pneumothorax.  There are bilateral\nmoderately sized nonhemorrhagic pleural effusions with associated compressive\natelectasis.\n\nLUNGS/AIRWAYS: The patient is status post endotracheal intubation and the ET\ntube terminates approximately 1 cm superior to the carina (601:56).  There are\na few scattered areas of peribronchial ground-glass opacities at the lung\nbases the sequelae of aspiration (02:39).  There is opacification of the left\nlower lobe bronchus likely reflecting aspiration or mucous plugging (601:70). \nNo suspicious pulmonary nodules on markedly limited assessment.  Calcified\ngranuloma left upper lobe.\n\nBASE OF NECK: There is a 2.4 x 1.8 cm hypodensity in the right thyroid lobe. \nPunctate foci of air in the right internal jugular vein likely related to\nprior venipuncture.  Visualized images of the upper neck are otherwise\nunremarkable.\n\nABDOMEN: There are extensive vascular calcifications in the partially\nvisualized abdominal aorta.  Included portion of the unenhanced upper abdomen\nis otherwise unremarkable.\n\nBONES: There is no evidence of acute fracture.  A sclerotic appearance of the\nlateral left ninth rib is unchanged from prior.  Post median sternotomy\nchanges are noted.",
            "output": "1. Patient is status post endotracheal intubation, the ET tube terminates\napproximately 1 cm superior to the carina.\n2. Large simple appearing pleural effusions with associated compressive\natelectasis.\n3. Scattered peribronchial of opacities in the lower lobe and opacification of\nthe left lower lobe bronchus raise the possibility of aspiration.\n4. No evidence of rib fracture.\n5. 2.4 cm hypodensity within the right thyroid lobe.  Non-emergent evaluation\nwith ultrasound is recommended if not already performed.\n\nRECOMMENDATION(S):   Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "CHEST PERIMETER: In a multinodular goiter, the dominant 20 mm low-density\nregion of the left thyroid lobe, 2:1, was not previously imaged by chest CT,\nalthough there has been regular thyroid ultrasound, most recently ___.  Subglottic trachea is deviated very slightly to the right, as before.\n\nOn this noncontrast study.  Small lymph nodes at the thoracic inlet would be\ndifficult to recognize or separate from vessels.  There are no pathologically\nenlarged lymph nodes in the axilla and the soft tissues of the chest wall are\nunremarkable.  This study is not designed for subdiaphragmatic diagnosis, but\nshows persistence of multiple small calcified stones in the gallbladder, with\nno evidence of active inflammation or established biliary obstruction.  No\nadrenal mass.  Low-density T lesion upper medial cortex of the left kidney was\nevaluated with renal ultrasound, ___.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels but is present in at least left main,\nand anterior descending coronary arteries.  Aortic valvular calcification is\nmild.  Aorta and pulmonary arteries and cardiac chambers are not enlarged and\npericardium is physiologic.\n\nTHORACIC LYMPH NODES: No mediastinal or other measurable lymph nodes are\npathologically enlarged by size criteria and hilar contours on this\nnoncontrast study do not suggest appreciable lymph node enlargement.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lesions as follows:\n\nSpiculated cavitated 11 mm wide nodule, superior segment right lower lobe,\n4:120, has not measurably changed since at least ___.  Its\nproximity to the adjacent pleura is probably determined by depth of\ninspiration rather than real change, and that pleura is not thickened nor is\nthere any pleural abnormality elsewhere.  Lungs are clear ever were else and\nthe tracheobronchial tree is normal to subsegmental levels.\n\nCHEST CAGE: Unremarkable.",
            "output": "Minimal changes in the appearance, if any, of the cavitated right lower lobe\nnodule over ___ years suggests that it is not malignant, and if infectious,\nextremely indolent, and giving no evidence of dissemination.\n\nAtherosclerotic coronary calcification.\n\nMultinodular goiter.  Ultrasound evaluation in ___ recommended\nfollow-up in one year"
        },
        {
            "input": "CT CHEST WITHOUT IV CONTRAST: The thyroid appears enlarged and heterogeneous\nbilaterally, left greater than right, with a 2.2 x 1.7 cm nodule in the left\nlobe (3:5).  There is no supraclavicular or axillary lymphadenopathy.  Within\nthe limitations of a noncontrast enhanced study there is no appreciable\nmediastinal or hilar lymphadenopathy.  There is mild bilateral gynecomastia,\nleft greater than right.  The esophagus is grossly normal.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta,\nproximal great vessels and main pulmonary artery are normal in caliber.  There\nare mild atherosclerotic calcifications of the coronary arteries.  There is\nminimal calcification of aortic valve.\n\nThere is no pleural effusion or pneumothorax.  The airways are patent to the\nsubsegmental level.  There is 1 cm focus of ground-glass in the right middle\nlobe (5:135).  There is a 1.1 x 0.9 cm opacity at the right base posteriorly\n(5:160) with a central cavity.  The peripheral rim of soft tissue is increased\nin thickness since the CT of the abdomen pelvis ___, previously 2 mm\nnow at least 3 mm.  There is some scarring in the medial portions of the right\nmiddle lobe.\n\nOSSEOUS STRUCTURES: There is a 1.2 cm central rounded defect in the mid to\ndistal portion of the sternum with well corticated margins is compatible with\na benign sternal foramen.\n\nUPPER ABDOMEN: This study is not optimized for evaluation of the\nintra-abdominal structures and is especially limited without IV contrast. \nHowever, the following findings are noted:  Gallstones in a nondistended\ngallbladder.  Partially imaged 4.3 x 3.6 cm exophytic cyst arising from the\ninterpolar region of the right kidney.  Probable 1.5 cm simple cyst in the\ninterpolar region of the left kidney (03:59).",
            "output": "1. 1.1 cm nodule at the right base with central cavitation and growing rim of\nperipheral soft tissue is worrisome for malignancy and warrants intervention,\neither biopsy or surgical resection.\n2. 2.2 x 1.7 cm left thyroid lobe nodule should be followed up with thyroid\nultrasound.\n3. Minimal bilateral gynecomastia, left greater than right.\n4. Cholelithiasis.\n\nRECOMMENDATION(S):\n1. Interventional Radiology (or Surgical) consultation for biopsy (excision)\nof slowly growing cavitary lesion in the right lower lobe.\n2. Thyroid ultrasound\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 17:08 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the chest wall suspicious for malignancy.  This study is\nnot appropriate for subdiaphragmatic diagnosis, but shows calcified stones in\na contracted gallbladder.\n\nThyroid enlargement, with a dominant nodule in the left lobe is grossly\nunchanged since ___.  Most recent thyroid ultrasound was reported as\na benign goiter on ___.\n\nAtherosclerotic calcification is not apparent head neck vessels, and is mild\nin left anterior descending coronary artery.  Aortic valvular calcification is\nmild.  Pulmonary arteries and aorta are normal size.  There is no pericardial\nor pleural abnormality.\n\nCentral lymph nodes are not pathologically enlarged in the mediastinum, hila,\ninternal mammary, diaphragmatic or retrocrural stations.\n\nSmall areas of ground-glass opacity that had appeared on the most recent prior\nchest CT, in ___, have resolved.  The only pulmonary abnormality is the\nsmall cavitary nodule, right lower lobe, 9 x 10 mm, 4:119, unchanged in size,\nmild spiculation, wall thickness compared 3 initial appearance on ___, after showing small transient increase in wall thickness in ___.\n\nAside from mild dependent subpleural atelectasis, lungs are otherwise clear.\n\nA new nodular opacity on the mucosal surface in the subglottic trachea just\nbeneath the anterior commissure to the right of the midline, 4:4 could be\nretained secretion.  Tracheobronchial tree elsewhere is normal to subsegmental\nlevels.",
            "output": "Cm size cavity, right lower lobe, centrally stable since ___. \nIndolent infection is still most likely diagnosis.  Routine chest CT in 6\nmonths would be appropriate follow-up, unless more remote CT images from a\nchest CT lower abdomen CT can be obtained to document longer stability.\n\nPossible new subglottic tracheal nodule can be evaluated at the time of repeat\nchest CT.\n\nPrevious ground-glass abnormalities have resolved, presumably acute\ninflammation.\n\nMild coronary atherosclerotic calcification and mild aortic valvular\ncalcification, unchanged.\n\nRECOMMENDATION(S):  Conventional chest CT, 6 months.  , intravenous contrast\nis not indicated."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the imaged unenhanced chest wall suspicious for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis, but\nshows there is no adrenal mass and stones filling a small gallbladder are\nunchanged since at least ___ with no evidence of either\ncholecystitis or biliary obstruction.\n\nThyroid is generally enlarged, particularly the left lobe, 35 x 42 mm at the\nlevel of its greatest cross-sectional area, roughly unchanged since ___,\ndisplacing the trachea mildly to the right.  .  It contains a partially\ncalcified partially hypodense well-circumscribed nodule, 18 x 23 mm, also\nunchanged, previously evaluated with thyroid ultrasound, most recently ___.\n\nAtherosclerotic calcification is not apparent in head and neck vessels, mild\nin the left and proximal LAD coronary arteries.  Aortic valvular calcification\nis very mild.  Aorta and pulmonary arteries and cardiac chambers are normal\nsize.  Pericardium is physiologic.  There is no pleural abnormality.\n\nMediastinal, diaphragmatic, and retrocrural lymph nodes are not pathologically\nenlarged.  Hilar contours do not suggest adenopathy.\n\n\nThe quality of lung imaging is limited by a low volume inspiration and some\nrespiratory motion, but I do not believe any significant findings would be\noverlooked.  These include:\n\n8 x 10 mm cavitated right lower lobe nodule, 4:122, has not grown since ___, but the wall is thicker, now 2-3 mm, previously one-2 mm and\nthe outer margin has a more spiculated interface with the surrounding lung. \nThese are indications of an active lesion, although one that is changing very\nslowly, since it was present on ___, and roughly the same size, but\nwith a much thinner wall.\n\nSeveral small regions of new ground-glass opacification have developed\nprimarily in the periphery of the upper lungs, for example the right upper\nlobe, 4:64- 72, 90-104, and left upper lobe, 4:  67.  There is no\nheterogeneity in the lung background to suggest air trapping and no bronchial\nwall thickening or other abnormality of the tracheobronchial tree to\nsubsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Wall thickening, and increased spiculation since ___ in\ncentimeter-sized right lower lobe cavitary nodule that has been present since\nat least ___.  Most likely explanation is the indolent infection,\nespecially non-tuberculous mycobacterial species or fungus (in the ___\n___ this would be coccidioidomycosis).  Lesion might be accessible to\nCT-guided transthoracic needle aspiration.\n\nThe new mild alveolar abnormality, upper lobes, would most commonly be due to\nrecent infection.  The rest of the differential diagnosis is broad common\nincluding pulmonary hemorrhage, early vasculitis, drug reaction.  Could\nexplain new pulmonary symptoms."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the chest wall concerning for malignancy or infection.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows normal\nsize adrenal glands and chronic calcified gallstones with no evidence of\neither acute cholecystitis or biliary obstruction.\n\nBoth lobes of the thyroid are enlarged and heterogeneous.  Dominant\nhypodensity in the incompletely imaged left thyroid lobe, 22 x 16 mm, 4:one,\nwas 18 x 26 mm in ___ 20 x 27 mm in ___.  Previous thyroid\nultrasounds and biopsies have been numerous since ___ most recently ___.\n\n\n\nAtherosclerotic calcification is not apparent head neck vessels, but is\npresent in the left main coronary artery.  Aortic valvular calcification is\nminimal.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.  There is no pleural effusion.\n\nMediastinal and other intrathoracic lymph nodes are not pathologically\nenlarged and hilar contours do not suggest adenopathy.\n\nSubglottic region where there is questioned nodule in ___, is not a imaged on\nthis study.\n\nLungs:\n\n9-10mm wide cavity, right lower lobe, 4:119, has a wall of uniform thickness,\nminimal spiculation into the surrounding lung, unchanged in morphology and\nslightly smaller than in ___ when it was 11 mm wide and new since an\nabdomen CT U performed ___.\n\nLungs are otherwise clear and the tracheobronchial tree is normal to\nsubsegmental levels.  There are no bone lesions in the chest cage suspicious\nfor malignancy or infection.",
            "output": "Centimeter-sized cavity, right lower lobe, entirely stable since at least\n___, new since ___.  No findings to suggest infiltration of\nthe local lung and No other lung lesions.  This is not the appearance of a\nmalignancy.  Instead I favor an indolent infection.  It would be reasonable to\nrepeat a chest CT in one year, and to keep this lesion in mind if the patient\ndevelops an unusual active pulmonary infection.\n\nGrossly stable large goiter.\n\nSubglottic nodule or secretions noted on the prior study was not in the field\nof imaging.  Although I expect this was due to retained secretions, we will\nattempt to contact the patient and schedule Supplementary scanning of the\nlower larynx and upper trachea."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is enlarged and\nheterogeneous.  Discrete nodules are difficult to discern on this examination.\nOverall, the thyroid is unchanged since the prior exam.  There is no\nsupraclavicular, axillary, or lower cervical lymphadenopathy.  The\nsubcutaneous tissues of the chest wall are unremarkable aside from mild\nbilateral gynecomastia.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen is notable for\ngallstones and cystic renal lesions.  A small accessory spleen is also noted.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: In the lack of intravenous contrast limits evaluation for hilar\nlymphadenopathy.  However, no definite hilar lymphadenopathy is noted.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Re-demonstrated is a 1.0 x 0.8 cm cavitary nodule in the right\nlower lobe (4:116) with a wall of uniform thickness.  The soft tissue\ncomponent of the lesion has increased in thickness since the most recent\ncomparison, though the lesion itself remains stable in size in totality.  No\nnew nodules are identified.  There is no consolidation.  Mild bibasilar\natelectasis is present.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery is borderline enlarged, and measures up\nto 3.3 cm.  The thoracic aorta is normal in caliber.\nCHEST CAGE: No suspicious osseous lesions or acute fractures are identified.",
            "output": "1.Mild increase in the soft tissue component associated with the right lower\nlobe cavitary nodule, though the nodule itself has not increased in size. \nGiven ___ year stability, malignancy is very unlikely.  Infectious\nconsiderations, including etiologies such as coccidioidomycosis, remain in the\ndifferential.  Consider percutaneous sampling if definitive diagnosis is\nclinically warranted.\n2.  Multinodular goiter."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent bibasilar atelectasis.  Otherwise, the\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is mild convex right curvature of the mid to upper thoracic\nspine.  No suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There are\ncoronary artery calcifications with possible stent of the LAD.  Otherwise, the\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Right hilar calcified nodes are redemonstrated.\nThe esophagus is mildly dilated and a stricture would be hard to exclude.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 4 mm sub solid nodule with hazy borders in the right\nlower lobe (series 4, image 169), not seen in ___.  There is minimal\nbronchial wall thickening.  Otherwise, the airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: A right thyroid nodule measures 1.6 cm, unchanged.\n\nABDOMEN: Please refer to separately dictated report of the abdomen performed\non the same day for the findings below the diaphragm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. There is a new 4 mm nodule in the right lower lobe.  The need for followup\nimaging depends on staging and management considerations regarding the\npatient's extrathoracic malignancy.  Otherwise ___ guidelines for\nmanagement of incidentally discovered pulmonary nodules would apply.  See\nRECOMMENDATIONS below.\n2. Moderate dilation of the esophagus.  This may be a sign esophageal\ndysmotility.\n3. Right thyroid nodule measures 1.6 cm and is unchanged compared to ___.  A thyroid ultrasound is recommended if not performed at outside\ninstitution.\n\nRECOMMENDATION(S):  - For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n- Thyroid ultrasound."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nHeterogeneous thyroid with a hypodense nodule in the right thyroid lobe\nmeasuring 1.6 cm.  No enlarged lymph nodes in either axilla or thoracic inlet.\nNo abnormalities on the chest wall.  Mild atherosclerotic calcifications in\nthe head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is top-normal in size.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, notably in the LAD,\nmild in the aorta and none in the cardiac valves.  The pulmonary arteries and\naorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  Secretions are noted in the\ntrachea.  No bronchiectasis or mucus plugging.  Mild diffuse bronchial wall\nthickening.\nMild centrilobular pulmonary emphysema.  Tiny immeasurable micro nodules\nscattered throughout the lungs.  4 mm nodule in the right lower lobe (04:37). \nNo consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show enlarged lymph nodes around the\nceliac trunk, the largest measuring 2.8 cm, ill-defined mass in the pancreatic\nhead.",
            "output": "Small nodule in the right lower lobe. Attention on follow-up studies.  No\nsuspicious lymphadenopathy or osseous lesions.\n\nThe numerous tiny micro nodules scattered throughout both lungs associated to\nmild diffuse bronchial wall inflammation are likely respiratory bronchiolitis\nsecondary to smoking.\n\nThryoid nodule for which correlation with thyroid ultrasound is recommended,\nif not already performed.\n\nFor more details on the subdiaphragmatic findings please refer to the MR\nreport dated ___."
        },
        {
            "input": "Hypodense nodule in the right lobe of the thyroid measures 14 mm.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAscending aorta measures up to 4.2 cm.  There is a tiny calcification in the\nmain left coronary artery.  Pulmonary arteries are normal size. Cardiac\nconfiguration is normal.\nIrregular reticulation adjacent to  osteophytes on the right lower lobe, could\nbe fibrosis.\n4 mm nodule in the right upper lobe is associated with adjacent irregular\nperibronchial ground-glass opacities (5:87).  There are several micronodules\n(5:73, 174, 181)\nSpiculated nodule in the in right lower lobe measures 7 x 4 mm is grossly\nunchanged from prior study allowing the difference in slice thickness\nThis examination is not tailored for subdiaphragmatic evaluation:  The upper\nabdomen reveals a in calcification in the left the kidney could be vascular or\na nonobstructing stone.  Left adrenal adenoma is a stable.  Splenomegaly is a\nstable",
            "output": "Stable spiculated nodule in the right lower lung\nRight upper lobe peribronchial solid and ground-glass opacities could be in\ninfectious in etiology, attention in followup is recommended to exclude\nmalignancy.\nCoronary calcification\nEctasia of the ascending aorta.\nThyroid nodule warrants further evaluation with ultrasound\nStable abdominal findings\n\nRECOMMENDATION(S):  Followup CT in 6 months to assess stability of lung\nnodules\nThyroid ultrasound\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:22 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  Subcentimeter\nleft supraclavicular lymph node (4, 5).  Multiple subcentimeter axillary lymph\nnodes.\n\nUPPER ABDOMEN: Will be reported separately.  Suspected small hiatal hernia.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  The heart is at the\nupper limits of normal.  Trace pericardial fluid.  No aortic valve or coronary\nartery calcifications.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Motion artifact may obscure small pulmonary nodules and fine\ninterstitial changes.  No confluent airspace consolidation.  Linear opacity in\nrelation to the inferior aspect of the left oblique fissure (5, 145) most\nlikely represent atelectasis.  No interstitial lung disease.  Mild mosaic\nattenuation pattern of the pulmonary parenchyma suggests mild air trapping.\n-AIRWAYS:  The study was performed during expiration.  Moderate narrowing of\nthe trachea at the level of the thoracic inlet.  No obvious associated\nexcessive collapsibility (this current study taken as an expiratory phase\nstudy and the CT neck done ___ taken as an inspiratory study) The\nairways are patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No lytic/\ndestructive bony lesions.",
            "output": "No features of pneumonia.\n\nNo pathologically enlarged mediastinal, hilar or axillary adenopathy.\n\nModerate narrowing of the trachea at the level of the thoracic inlet, but no\nobvious excessive collapsibility (on nondedicated studies."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There is no soft\ntissue abnormality in the upper chest wall suspicious for malignancy.  New\nsoft tissue infiltration 03:54- 64 in the flanks is edema or hemorrhage.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal abnormality or evidence of hemorrhage in the upper abdomen.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck or coronary arteries.  Aorta and pulmonary arteries are normal size. \nHypoattenuation of cardiac contents reflects anemia.  Heart is enlarged, would\nrequire echocardiography for assessment.  There is no pericardial or right\npleural effusion.  Dependent left pleural effusion is new but miniscule.\n\nMediastinal lymph nodes are not pathologically enlarged.  Hilar contours on\nthis noncontrast study do not suggest adenopathy.\n\nWidespread peribroncho vascular pulmonary opacification is a distributed in\nthe central portions of both lungs, generally in clusters of acinar size\nnodules, more severe on the right than the left.  The attenuation ranges in\nradiodensity from ground-glass, on the left where chest radiographs show it is\nmore recent, to nearly consolidative on the right, but there is no coalescent\nconsolidation and no cavitation.  Findings are entirely consistent with\ndiffuse pulmonary hemorrhage, but widespread viral infection, acute\ninterstitial or eosinophilic pneumonia, and leukemic infiltrates are\nalternatives.  In the absence of appreciable pleural or pericardial effusion,\ncardiogenic pulmonary edema is very unlikely.  Bacterial pneumonia is not a\nconsideration.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Widespread, severe alveolar pulmonary abnormality, most likely hemorrhage. \nDifferential diagnosis discussed above.\n\nNew hemorrhage, or edema, soft tissues of the flanks."
        },
        {
            "input": "FINDINGS:\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows no abnormality.\n\nMEDIASTINUM: Right IJ line has its tip terminating in the cavoatrial junction.\nThere is no mediastinal lymphadenopathy.\n\nHILA: No adenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion\nPLEURA: There is no pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Previously seen nodular bilateral extensive pulmonary\ninfiltrates have nearly completely resolved, few ill-defined ground-glass\nopacities remain more prominently in the right lung, particularly right middle\nlobe.  .  Few small areas of air-trapping is seen.  No evidence of edema.  No\nconsolidations.\n-AIRWAYS:  The airways are patent.\nCHEST CAGE: Degenerative changes are noted throughout the spine.",
            "output": "Few ill-defined ground-glass opacities remain in the lung, may be sequela of\nresolving process seen on ___, atypical infection cannot be\nexcluded.  No consolidations."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows no abnormality.\n\nMEDIASTINUM: Right IJ line has its tip terminating in the cavoatrial junction.\nHEART and PERICARDIUM: No pericardial effusion is seen.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Again noted are few ill-defined ground-glass opacities in the\nright middle and upper lobes, (04:32), stable since ___. \nAtypical i infectious process could have similar appearance.  No associated\nnodules or cysts.  Small cluster micro nodularity anteromedial left upper lobe\nseries 5, image 103 is more prominent, overall area measures 1.3 cm, no\nassociated consolidation.  No new opacities are seen.  There is an unchanged 2\nmm perifissural nodule (04:27) along the right major fissure.\n-AIRWAYS:  The airway is patent to the segmental level.\nBONE:  Degenerative changes again noted throughout the thoracic spine.",
            "output": "Ground-glass opacities in the right lung are stable since ___. \nFindings may be residua from process seen on ___, however,\ninterval development of atypical infection cannot be excluded.\nSmall cluster of micro nodules in the left upper lobe is more prominent,\nindeterminate, may represent infection, continued follow-up recommended."
        },
        {
            "input": "Thyroid gland is mildly enlarged and heterogeneous with small subcentimeter\nhypodensities bilaterally which are not fully characterized by CT.  There are\nno enlarged intrathoracic lymph nodes.  Heart is upper limits of normal in\nsize.  Coronary artery calcifications are diffuse.  There is no pericardial or\nsubstantial pleural effusion.  Probable very small hiatal hernia is\nincidentally noted.\n\nExam was not tailored to evaluate the subdiaphragmatic region, which is been\nmore fully evaluated by outside MR abdomen study of ___.  A biliary\nstent is in place.  The gallbladder is densely opacified presumably due to\nvicarious excretion of contrast.  Cystic lesions in both kidneys have been\nmore fully characterized by outside MR abdomen study.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine, but no suspicious lytic or blastic skeletal lesions.\n\nWithin the lungs, 3 mm solid lingular nodule (122 com 11) and 2 mm solid left\nlower lobe nodule (185, 11) are noted.",
            "output": "1.  2 mm and 3 mm left lower lobe and lingular nodules, which are nonspecific.\nIn the setting of a primary extrathoracic neoplasm, a followup CT in ___\nmonths is recommended to exclude small metastases.\n\n2.  Diffuse coronary artery calcifications.\n\n3.  Mild bilateral thyroid enlargement with small subcentimeter hypodensities\nwhich are not fully characterized by CT."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  There is stable mild\ndilatation of the ascending aorta measuring up to 4.4 cm, previously 4.3 cm. \nThere are similar mild atherosclerotic calcifications.  The main, right, and\nleft pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Re-demonstrated are multiple scattered pulmonary\nnodules, all under 4 mm in diameter, unchanged since ___.  For example there\nis a 4 mm nodule in the left upper lobe (04:41) and a 3 mm nodule in the right\nupper lobe (4:64).  No new or concerning pulmonary nodules are identified. \nBibasilar dependent atelectasis is noted.  A few scattered punctate, calcified\ngranulomas are noted in the right lower lobe.  There also clustered\ncentrilobular nodules in the posterior segment of the right upper lobe as seen\npreviously.  Linear opacity compatible scarring noted in the right middle\nlobe.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally. \nRe-demonstrated is diffuse moderate to severe bronchial wall thickening,\nprogressed since ___.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Multilevel bridging anterior\nosteophytes are noted in the visualized thoracic and upper lumbar spine,\nconsistent with DISH.\n\nUPPER ABDOMEN:  Please refer to CT abdomen pelvis performed on the same date\nfor description of subdiaphragmatic findings.",
            "output": "1. No focal consolidation.\n2. Multiple sub 4 mm pulmonary nodules are unchanged and likely secondary to a\nbenign process.  No new or suspicious pulmonary nodules are identified.\n3. Interval progression of chronic bronchitis since ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no\npenetrating atherosclerotic ulcer or aortic arch atheroma.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect. The main and right pulmonary arteries are normal\nin caliber, and there is no evidence of right heart strain. There is no\npericardial effusion.\n\nThere is mild emphysema and dependent atelectasis bilaterally. A 4 mm nodule\nis noted in the left lower lobe (2:51). There is no pleural effusion. The\nairways are patent to the subsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nLimited images of the upper abdomen show a 3.4 cm simple cyst in the upper\npole of the right kidney, previously 1.7 cm in ___.\n\nBONES:  No lytic or blastic osseous lesion suspicious for malignancy is\nidentified.",
            "output": "1. No pulmonary embolism or aortic abnormality.\n2. 4 mm pulmonary nodule in the left lower lobe.  Recommend follow-up with CT\nChest in ___ year."
        },
        {
            "input": "The lungs are well expanded.  A 4 mm nodule in the left lower lobe is\nunchanged (5:144).  No new pulmonary nodule, mass, or focal consolidation is\nidentified.  There is no pleural effusion or pneumothorax.\n\nTiny hypodensities are noted in the right thyroid lobe.  No axillary,\nsupraclavicular, or mediastinal lymphadenopathy is identified.  The heart is\nnormal in size without coronary artery calcification or pericardial effusion. \nThe great vessels are normal in caliber.\n\nThere is no focal lytic or sclerotic osseous lesion to suggest neoplasm or\ninfection.\n\nThis exam is not optimized for evaluation of infra diaphragmatic structures. \nIn the imaged portion the right kidney, an upper pole renal cyst demonstrates\nfine rim calcification (5:260).  Coarser calcification may be along a\nseptation(5:266).  This is incompletely evaluated on this exam.",
            "output": "1. ___ year stability of a left lower lobe nodule.\n2. Rim and possibly septal calcification of a right renal cyst, incompletely\nevaluated on this exam but likely Bosniak ___.\n\nRECOMMENDATION(S):  Dedicated renal ultrasound for further evaluation of a\ncomplicated right renal cyst.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 11:43 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Chest CTA:  The thoracic aorta is normal in course and caliber without\ndissection.  The main pulmonary artery is normal in size.  There is a patent\npulmonary arterial tree without filling defect to suggest a pulmonary\nembolism.  There is no lymphadenopathy in the chest.  The heart is normal in\nsize and shape.  No pericardial effusion is seen.  No pleural effusion.  There\nis a right apical nodule on series 3, image 38 measuring 8 mm.  Mild basal\ndependent atelectasis.\n\nABDOMEN:  The liver, gallbladder, pancreas, spleen appear normal.  Adrenals\nare normal bilaterally.  Right kidney is normal.  There is delayed excretion\nof contrast from the left kidney with mild left hydroureter which can be\ntraced to the level of a 4 mm stone within the left distal ureter seen best on\nseries 2b, image 160.  Left perinephric fluid suggestive of forniceal rupture.\nNo signs of pyelonephritis.  A tiny hypodensity in the upper pole of the right\nkidney is too small to characterize.\n\nThe stomach is distended with ingested content.  The duodenum is normal.  The\nabdominal aorta is normal in caliber without evidence of dissection. \nTortuosity of the iliac branches noted.  There is a retroaortic left renal\nvein.  No retroperitoneal or mesenteric adenopathy.\n\nPELVIS:  Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is normal.  The colon contains a moderate fecal load without wall\nthickening or signs of acute inflammation.  No free air or free fluid. \nUrinary bladder is moderately distended appearing normal.  A right ureteral\njet is seen.  No pelvic sidewall or inguinal adenopathy.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "Left distal ureteral stone measuring 4 mm causing mild left hydroureter and\nhydronephrosis. Left perinephric fluid suggests forniceal rupture.  No acute\naortic process."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Several mediastinal lymph nodes (2, 19) Are normal\nin size.  No abnormalities at the level of the large mediastinal vessels. \nMinimal coronary calcifications, no valvular calcifications, no pericardial\neffusion.  The posterior mediastinum is unremarkable, with the exception of a\nsmall hiatal hernia.  No acute abnormalities are noted in the upper abdomen. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.\nMinimal bilateral apical scarring.  A pre-existing an pre described part solid\nnodule in the right upper lobe (4, 62) is not substantially changed.  The\noverall nodule diameter is 6 mm, the solid component is 3 mm in diameter.  No\nother pulmonary nodules are present.  No diffuse lung disease.  Minimal\natelectasis at the right lung basis (4, 212).  No pleural thickening, no\npleural effusions.",
            "output": "Stable 6 mm part solid right apical nodule, with a solid component of 3 mm in\ndiameter.  No other lung parenchymal abnormalities.\n\nRECOMMENDATION:  For an incidentally detected single part-solid nodule bigger\nthan 6mm, CT follow-up in 6 to 12 months is recommended to confirm\npersistence. If the nodule is unchanged and the solid component remains\nsmaller than 6 mm, annual CT follow-up is recommended for ___ years.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "MEDIASTINUM:  Heterogeneous appearance of the thyroid with a nodule measuring\n12 x 12 mm. No pathologically enlarged supraclavicular, axillary, hilar or\nmediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta is not aneurysmal and the main pulmonary\nartery measures 3.6 cm The heart size is globally moderate and there is no\npericardial effusion. Severe atherosclerotic calcifications of the thoracic\naorta and of the coronary arteries.  Moderate severe calcifications of the\naortic valve and severe of the mitral annulus.  Focal attenuation of the\ncardiac blood pool can be seen with anemia.\n\nPLEURA:  There is no pneumothorax.  Small bilateral pleural effusions.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  He asymmetric\nelevation of the left hemidiaphragm with adjacent atelectasis.  No substantial\nbronchiectasis.  No honeycomb formation.  No acute parenchymal consolidation. \nSubpleural 3 mm nodule in the right upper lobe (04:55).  Scattered calcified\ngranulomas.\n\nMild centrilobular ground-glass opacity, slightly more pronounced in the upper\nlobes, is somewhat non-specific.  Given the patulous esophagus, this may be\npneumonitis from recurrent aspiration or mild atypical infection including\nviral or bacterial.\n\nBONES AND CHEST WALL: Numerous severe compression deformities involving\nmultiple vertebral bodies are age indeterminate. Notably, a moderate\ncompression deformity is seen of T5. More severe deformities are seen\ninvolving T7-T10 (series 602b, image 50), as well as L1 (series 602b, image\n55).  Chronic-appearing sternal fracture with evidence of healing (series\n602b, image 60).  Multiple bilateral healing rib fractures are also seen.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the esophagus is patulous and fluid-filled throughout its course. \nThe right kidney is atrophic.  The abdominal aorta is also heavily calcified. \nThe remaining upper abdomen is otherwise unremarkable.",
            "output": "Mild centrilobular ground-glass opacity, slightly more pronounced in the upper\nlobes, is somewhat non-specific and not suggestive of scleroderma related ILD.\nGiven the patulous esophagus, this may be pneumonitis from recurrent\naspiration or mild atypical infection including viral or bacterial, in the\nappropriate clinical setting.\n\nModerate to severe cardiomegaly, severe coronary artery disease, and pulmonary\nartery enlargement.\n\nMultiple wedge compression fractures, sternal and healing rib fractures.\n\nNOTIFICATION:  The updated findings were discussed by Dr. ___\nwith Dr. ___ on the ___ ___ at 9:58 AM, 25 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Aorta is tortuous with mild dilatation of ascending aorta up to 4.2 cm.\nPulmonary arteries are normal in diameter. Heart size is normal. There is no\npericardial effusion or pleural effusion. Within the limitations of the study\ntechnique there is no evidence of mediastinal or hilar pathologically enlarged\nlymph nodes. No axillary lymphadenopathy is demonstrated as well.\n\nImage portion of the upper abdomen reveals mild splenomegaly.  There is also a\nlarge cystic structure, partially imaged in the left mid abdomen,\ncorresponding to the distorted left kidney with marked hydronephrosis\nreflecting UPJ obstruction.\n\nAirways are patent to the subsegmental level bilaterally.  There are no bone\nlesions worrisome for infection or neoplasm\n\nMinimal apical scarring is present bilaterally. Several calcified nodules most\nlikely represent granulomas.  Left lower lobe posterior subpleural nodule most\nlikely reflect atelectasis or pleural plaque, a 7 mm in diameter.\n\nThere is no evidence of interstitial lung disease. Minimal bibasal atelectasis\nis associated with Bochdalek's hernia containing only fat",
            "output": "1.  No evidence of cyst mediastinal or parenchymal sarcoidosis\n2. No definitive findings that would require further followup identified."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with mild coronary artery calcification.  Trace\npericardial fluid is physiologic.  The ascending thoracic aorta is mildly\ndilated to 4.2 cm, unchanged. Minimal aortic valvular calcifications are\npresent. The main pulmonary artery is normal caliber.\n\nThere is no pulmonary nodule, mass or consolidation. Several calcified\ngranulomas are unchanged since ___. Airways are patent to subsegmental\nlevels. There is no endobronchial lesion or pleural abnormality.\n\nImages of the upper abdomen are notable only for a narrow based midline\nventral abdominal wall hernia containing fat and a new small amount of fluid\n(2, 57). There is also a small right Bochdalek hernia.\n\nMild spinal degenerative changes and mild levoscoliosis of the lumbar spine\nare unchanged.",
            "output": "No intrathoracic cause of worsening hypertension identified.\n\nStable fusiform dilatation of the ascending aorta to 4.2 cm.\n\nSmall narrow based midline ventral abdominal wall hernia containing fat and a\nnew small amount of fluid.  Correlate clinically for point tenderness in this\nregion to assess for possible incarceration with strangulation.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 09:25 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe ascending aorta is top normal for patient's age, measuring 4.2 cm,\nunchanged.  The pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates mild coronary artery calcifications. There is a trace\nnonhemorrhagic pericardial effusion, unchanged.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  There are multiple tiny scattered calcified\ngranulomas, unchanged.  No suspicious pulmonary nodules.  There is minimal\nbibasilar atelectasis.\n\nThere are nondisplaced fractures of the lateral fifth and ninth right ribs\n(4:59, 91).  There are minimally displaced fractures of the lateral sixth,\nseventh and eighth right ribs (4:64, 73, 84).\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, there is cholelithiasis, with no of acute\ncholecystitis.  Small fat containing ventral hernia.  The included portions of\nthe upper abdomen are otherwise grossly unremarkable.",
            "output": "1. Nondisplaced fractures of the lateral fifth and ninth right ribs, and\nminimally displaced fractures of the lateral sixth, seventh, and eighth right\nribs.  No pneumothorax or pulmonary contusion.\n2. Cholelithiasis, with no evidence of acute cholecystitis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is\nunremarkable.  There is no supraclavicular axillary lymphadenopathy.  Soft\ntissue density along the left chest wall likely represents atypical appearance\nof patient's nipple.\n\nUPPER ABDOMEN: Partially visualized upper abdomen shows gallbladder sludge\nwithout signs to suggest acute cholecystitis.  There is a small hiatal hernia.\nThere is bilateral renal cortical thinning and nonspecific renal stranding. \nOtherwise, visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is top-normal in size.  There is no pericardial\neffusion.  Patient shows moderate calcifications of the aortic valve and\nannulus.  There also moderate to extensive calcifications of the aortic arch.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is moderate background centrilobular emphysema, most\nsevere at the bilateral lung apices.  There is biapical pleuroparenchymal\nscarring.  There are a few pleural-based nodules, measuring up to 4 mm in the\nright upper lobe (series 4; image 42).\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  Pulmonary vasculature is normal in size.\nCHEST CAGE: Chronic rib deformities of the left lateral fourth through seventh\nribs are chronic.  No acute rib fractures are identified.  No acute\ncompression deformity of the thoracic spine.  Bones are diffusely osteopenic.",
            "output": "1. Chronic appearing fourth through seventh rib fractures on the left.  No\nacute rib fracture.  No pneumothorax.  No focal consolidation.\n2. Pleural base nodules measure up to 4 mm in the right upper lobe.  No\nspecific follow-up is recommended in low risk population.  See full set of\nrecommendations below.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Supraclavicular lymph nodes are not enlarged.  Bilateral axillary nodes\nincompletely imaged in the small scan field, range in diameter up to 7 mm. \nEvaluation of the breasts requires mammography.  Elsewhere in the chest wall\nthere are no findings consistent with malignancy or infection.  This study is\nnot appropriate for subdiaphragmatic diagnosis but shows no adrenal mass. \nFatty transformation in the liver is severe.\n\nThere are no lesions in the thyroid warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in the head and neck or coronary\narteries.  Pericardium and pleural surfaces are normal. Evaluation of possible\nleft ventricular enlargement would require dedicated cardiac imaging.\n\nMediastinal lymph nodes are not pathologically enlarged ranging in diameter up\nto only 8 mm in the prevascular station.  There is note diaphragmatic,\ninternal mammary, or retrocrural adenopathy and hilar contours do not suggest\nlymph node enlargement.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Normal CT of the chest.\n\nHepatic steatosis.\n\nRECOMMENDATION(S):  Correlate hepatic steatosis with laboratory testing."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Some of the mediastinal lymph nodes are calcified\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is coronary calcification and probably coronary stents.\nTwo lung nodules with a coarse calcifications in the left lower lobe measure\n22 x 11 mm (6:113) and 12 x 5 mm (6:94) the are associated with adjacent\nscarring.  Other smaller soft tissue lung nodules are as follows:  In the\nlingula (6:143), in the right upper lobe 5 mm (06:29) and 2 mm (6:82); in the\nright lower lobe 3 mm (6:90) and in the left lower lobe 3 mm (6:201)\nThere is no pleural or pericardial effusion.  Pacemaker lead is in standard\nposition\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "Evidence of prior granulomatous infection and unspecific lung nodules followup\nin 3 months is recommend.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:25 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nRECOMMENDATIONS:  FOLLOWUP CT IN 3 MONTHS"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Some of the lymph nodes are calcified.  Aorta and\npulmonary arteries are normal size. Cardiac configuration is unchanged with\nmild cardiomegaly.  Pacer leads are in standard position.  Coronary\ncalcifications are again noted\nTwo lung nodules with a coarse calcifications in the left lower lobe measure\n26 x 9 mm (5:118) it was 22 x 11 mm, and a stable 12 x 5 mm (5:103), are\nassociated with adjacent scarring.  Other smaller soft tissue lung nodules are\nas follows:  In the lingula (5:145), in the right upper lobe 5 mm (05:34) and\n2 mm (6:82); in the right lower lobe 3 mm (5:98) are stable.  Previously seen\nleft lower lobe nodule is not longer visualized .\nSubpleural ground-glass opacity in the right upper lobe is stable (05:51)\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Stable lung nodules\nCoronary calcifications\nNo new lung nodules\n."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is mild calcification in all coronary\narteries.  Bibasilar dependent atelectasis are larger on the right side.\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.  There is a small-to-moderate hiatal hernia\nThere are no bone findings of malignancy",
            "output": "Small to moderate hiatal hernia\nBibasilar atelectasis\nCoronary calcifications."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Suboptimal bolus timing limits the visualization of the\npulmonary vasculature, however within these limitations there is no evidence\nof filling defect to indicate a pulmonary embolus. The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma. The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  Lungs are otherwise clear\nwithout masses or areas of parenchymal opacification. The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is massively enlarged, measuring up to 31.2 cm (607:26).  A\nfocal region of hypodensity is located posteriorly, possibly concerning for\ninfarction (___).\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThe left kidney is displaced medially by the enlarged spleen.  There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe colon is noted, without evidence of wall thickening and fat stranding. \nThe appendix is normal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  A Schmorl's node is noted at the superior aspect of L4 and\nS1.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Massive splenomegaly measuring up to 31.2 cm, with a focal hypodense region\nlocated posteriorly, possibly concerning for infarction.\n2. Suboptimal bolus timing limits the visualization of the pulmonary\nvasculature, however within these limitations there is no evidence of filling\ndefect to indicate a pulmonary embolus."
        },
        {
            "input": "The study is significantly limited by motion artifact and suboptimal contrast\nopacification of the pulmonary arteries.\n\nThere is no main or lobar pulmonary embolism, and no major segmental filling\ndefect is identified.  However, sensitivity is limited by poor contrast\nopacification, and the subsegmental arteries are not adequately assessed.\n\nThere is no obvious abnormality of the thoracic aorta allowing for motion\nartifact.  The cardiac chambers are within normal limits.  There is no septal\ninversion or pericardial effusion.\n\nThere are no enlarged lymph nodes in the field-of-view, which excludes the\nuppermost and lowermost portions of the chest.\n\nThere is mild right basilar atelectasis.  Patchy opacity at the left base\nappears of predominantly related atelectasis but there is suspected to be a\ncomponent of airspace consolidation.  No focal pulmonary lesions are seen. \nThere is a new small left pleural effusion.\n\nOn limited images of the upper abdomen, there is again peripheral hypodensity\nin the posterosuperior aspect of the enlarged spleen.  This appears slightly\nmore extensive around the posterior aspect than on the previous CT, which\ncould reflect evolution of infarct or subcapsular/intraperitoneal fluid.  It\nis incompletely visualized.\n\nNo aggressive bone lesions are demonstrated.",
            "output": "1.  Suboptimal CTA due to technical factors.  No central PE and no obvious\naortic abnormality.  Distal segmental/subsegmental PE cannot be excluded.\n2.  Increased left basal opacity and new small left pleural effusion.  This\ncould be atelectasis secondary to an inflammatory process involving the\nmassively enlarged spleen (showing suspected infarct on recent abdominal\nimaging), or could reflect pneumonia/aspiration.\n3.  Slight evolution of partially visualized splenic hypodensity.  New\nassociated subcapsular fluid collection, not fully imaged and whose\nattenuation is difficult to assess, although there may be a hemorrhagic\ncomponent.\n\nRECOMMENDATION(S):  CT of the abdomen could be considered if there is\nsignificant suspicion for splenic subcapsular hematoma or hemorrhage as a\ncause for exertional tachycardia or for other clinical concern regarding the\nfinding.\n\nNOTIFICATION:  The key findings were discussed by telephone with the referring\nphysician ___ 19:25 on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is multinodular with\nthe largest nodule in the right thyroid lobe measuring 8 mm (302:16).  No\nsupraclavicular lymphadenopathy is identified.  No axillary lymphadenopathy is\npresent.  The soft tissues of the chest wall are notable for a left posterior\nchest wall lipoma measuring approximately 3.4 x 7.5 x 9.0 cm (302:148 and\n601:100).\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen is unremarkable.\n\nMEDIASTINUM/HILA: No mediastinal or hilar lymphadenopathy is demonstrated.\n\nHEART and PERICARDIUM: The heart is normal in size.  Mild coronary artery\ncalcifications are demonstrated.  Extensive aortic valvular calcifications are\npresent.  No pericardial effusion is seen.\n\nVESSELS: The aorta demonstrates mild fusiform aneurysmal dilation measuring up\nto 4.1 cm, with mild atherosclerotic calcifications at the aortic arch and\ndescending segments.\n\nPLEURA: No pneumothorax or pleural effusion is present.\n\nLUNG:\n\n1. PARENCHYMA:  Multiple pulmonary nodules are demonstrated bilaterally\nmeasuring up to 4 mm in the right upper lobe (302:97), 6 mm in the left lower\nlobe (302:127).  Additionally a 4 mm ground-glass opacity is demonstrated\nalong the major fissure of the left lung within the left lower lobe (302:66).\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\nCHEST CAGE: A 2.2 cm sclerotic lesion is visualized in the right lateral sixth\nrib likely representing fibrous dysplasia multilevel degenerative changes are\nvisualized throughout the thoracic spine without suspicious osseous lesion or\nacute fracture seen.",
            "output": "1. Mild fusiform aneurysmal dilation of the ascending aorta measuring 4.1 cm. \nDense atherosclerotic calcifications of the aortic valve consistent with\nreported history of aortic stenosis.\n2. Multiple bilateral pulmonary nodules measuring up to 6 mm in the left lower\nlobe in addition to a left upper lobe perifissural ground-glass opacity\nmeasuring 4 mm.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There are no suspicious cervical or supraclavicular lymph\nnodes.  Nonenlarged subpectoral lymph nodes are seen bilaterally.\n\nUPPER ABDOMEN: While this study is not tailored to evaluate the upper abdomen,\nno significant abnormalities, aside from a small hiatal hernia, are identified\nwithin the limitations of an unenhanced scan.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: Scattered calcified hilar lymph nodes are the sequela of prior\ngranulomatous disease.  Nonenlarged hilar lymph nodes are noted.\n\nHEART and PERICARDIUM: The heart is top-normal in size.  Coronary\natherosclerotic calcifications are seen.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  There is bibasilar scarring and atelectasis, as well as scarring\ninvolving the lingula and right middle lobe.  Scattered calcified granulomas\nare noted (for example 603B: 5).\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The main pulmonary artery is top-normal in size.  The aorta is\nnormal in caliber.  Mild-to-moderate calcified atherosclerosis is seen of the\ndescending thoracic aorta.\nCHEST CAGE: No definite fractures are identified.  No other fractures are\nidentified.  No definite left-sided rib fractures are identified.",
            "output": "1.  No definite rib fractures are identified."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is minimal\ncalcification at the aortic arch.  There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.  Coronary\ncalcifications are again seen.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\ntop normal in caliber, measuring up to 3.0 cm.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  The heart is mildly enlarged. \nThere is trace right pleural effusion.\n\nThere is mild bibasilar atelectasis.  Again seen are bibasilar and lingular\nscarring.  Scattered calcified granulomas are again noted, not significantly\nchanged compared to prior exam.  In the periphery of the bilateral lungs,\nthere are micronodular tree and ___ opacities with ground-glass opacities,\nlikely impacted terminal bronchi.  The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen demonstrate replaced left hepatic artery\narising from the left gastric artery.  Punctate calcifications in the spleen\nare likely a sequela of prior granulomatous disease.\n\nBones: No lytic or blastic osseous lesion suspicious for malignancy is\nidentified.  Vertebral body height loss at T6 is unchanged from ___.  A pectus excavatum deformity of the sternum is noted.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild cardiomegaly.\n3. Mild small airway disease.\n4. Tiny right pleural effusion, bibasilar atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: The main pulmonary artery is top normal in diameter\nmeasuring 3.0 cm, similar to prior.  There are few filling defects within\nsegmental and subsegmental pulmonary vasculature in the right lung which are\nnot well explained by artifact (3: 62, 78, 135) and likely represent very\nsmall emboli.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  Mild cardiomegaly is stable.  No definite\ncoronary artery calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  The esophagus is patulous\nand contains dependent fluid which may predispose to aspiration. \nAdditionally, there is mild circumferential esophageal wall thickening which\nmay suggest esophagitis.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild bibasilar atelectasis.  Scattered calcified granulomas are\nagain seen.  No suspicious pulmonary nodules or masses the airways are patent\nto the level of the segmental bronchi bilaterally.  There is mild\nbronchiectasis within the bilateral lower lobes.\n\nBASE OF NECK: Few subcentimeter hypoattenuating nodules within the right\nthyroid lobe do not require further imaging follow-up.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is a new moderate compression deformity of the T12 vertebra,\npredominantly affecting the anterior superior endplate, with approximately 3\nmm of bony retropulsion.  No suspicious osseous abnormality is seen.? pectus\nexcavatum.",
            "output": "1. Acute very small segmental and subsegmental pulmonary emboli within the\nright lung.  No evidence of right heart strain or pulmonary infarction.\n2. Age-indeterminate moderate compression fracture of the T12 vertebra, with\napproximately 3 mm of bony retropulsion is new since the prior study in ___.\n3. Top normal diameter of the main pulmonary artery may suggest pulmonary\nhypertension.\n\nNOTIFICATION:  Updated findings discussed with ___, MD by ___,\nMD via telephone at approximately 10:00 on ___, 5 minutes after\ndiscovery."
        },
        {
            "input": "Mild diffuse enlargement of the thyroid gland is present. Anterior mediastinal\nminimal soft tissue interspersed with fat is most likely consistent with\nthymic residual. Heart size is normal. No mediastinal, hilar or axillary\nlymphadenopathy is present. No pericardial pleural effusion is seen.\n\nAirways are patent. Lungs are clear. There are no lytic or sclerotic lesions\nworrisome for infection or neoplasm.",
            "output": "Normal chest CT."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall concerning for malignancy. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mucosa of the upper esophagus is moderately hyperemic, but\nthe wall is not thickened.  This could be due to mild inflammation.  Otherwise\nesophagus is unremarkable.  Atherosclerotic calcification is not apparent head\nand neck vessels or in the coronary arteries.  Aorta and pulmonary arteries\nare normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE:   Aside from mild nonobstructive atelectasis in the\nsuperior and posterior basal segments of the left lower lobe and subpleural\nregions of the dependent lungs, lungs are clear.  There is no consolidation or\nany lung nodule.  Tracheobronchial tree is normal to subsegmental levels and\npleural surfaces are normal.\n\nCHEST CAGE: Unremarkable.  Mild loss of height first lumbar vertebral body due\nto upper endplate impression was not previously imaged, does not look\npathologic.",
            "output": "No evidence of intrathoracic malignancy.\n\nPossible mild upper esophageal inflammation."
        },
        {
            "input": "Heterogeneity and enlargement of the thyroid gland is unchanged compared to\nthe prior exam.  There is no axillary, supraclavicular, mediastinal, or hilar\nlymphadenopathy.  The heart size is normal.  There is no pericardial effusion.\nSevere coronary calcifications are seen.  The esophagus is normal without\nevidence of wall thickening or a hiatal hernia.  The aorta is normal in\ncaliber.  The main pulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nThe patient is status post left upper lobe wedge resection.  Along the lateral\naspect of the suture margin pleural thickening is seen.  Within the left lower\nlobe, ill-defined nodular density measuring 15 mm by 11 mm appears unchanged\ncompared to the prior CT of the abdomen performed on ___.\n\nA 7 mm right perifissural nodule in the right middle lobe, series 6, image 153\nis unchanged compared to the prior exam.  A 2 mm right lower lobe nodule,\nseries 6, image 171 is unchanged compared to the prior exam.  There is no\npleural effusion or pneumothorax.",
            "output": "-Appropriate postsurgical changes status post left upper and lower lobe wedge\nresections.\n-Ill-defined nodular density within the left lung base measuring up to 15 mm\nis unchanged compared to the prior CT of the abdomen performed on ___ continued attention on follow-up."
        },
        {
            "input": "Diffuse thyroid enlargement is present.\n\nAorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes are present.\n\nAirways are patent to the subsegmental level bilaterally.  Postsurgical\nchanges in the left upper lobe are stable.  Left lower lobe sutures associated\nwith minimal atelectasis, series 6, image 213 are stable as well.  Right lower\nlobe 2 mm nodule, series 6, image 156 is stable.  Right middle lobe subpleural\nnodule, triangular in shape, series 6, image 145, 4.5 mm is stable.  No other\nnodules masses or consolidations demonstrated.  Heart size is normal. \nCoronary calcifications are moderate.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest including postsurgical changes in the\nleft lung and 2 right lung pulmonary nodules\n\nStable atelectasis of left lower lobe slightly nodular in shape.\n\nPlease review CT abdomen and pelvis in corresponding report will be issued\nseparately."
        },
        {
            "input": "THORACIC INLET: The thyroid is diffusely enlarged with multiple hypodense\nareas within it.  There is a right-sided Port-A-Cath with its tip in the SVC.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.  There is atherosclerotic calcification involving the\naortic annulus.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There are stable postsurgical changes following wedge resection in the\nleft upper lobe and left lower lobe.  The soft tissue surrounding the surgical\nsutures is unchanged.  The nodular opacity in the left lower lobe (3, 171) is\nalso unchanged.  The right middle lobe pulmonary nodule (3, 112) measuring 5\nmm is unchanged.  Stable 2 mm right lower lobe pulmonary nodule (3, 128).  No\nnew pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhypodense liver lesions.  No adrenal masses are seen.",
            "output": "Stable postsurgical changes following wedge resection the left upper lobe and\nleft lower lobe.  No evidence of local recurrence.  Stable soft tissue\nsurrounding the surgical sutures.\n\nStable 5 mm right middle lobe and 2 mm right lower lobe pulmonary nodules\n\nNo new pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "A new 1.9 cm x 0.9 cm nodule has developed in the periphery of the left upper\nlobe anteriorly (image 53, series 48).  The nodule is oval in shape, has\nlobulated and is spiculated borders, and contains internal cystic lucencies,\nsome of which are branching.  The of the lesion is in direct contact with the\nperipheral pleural surface, and is associated with localized minimal pleural\nthickening (image 46, series 4 a) and loss of fat planes with the adjacent\nchest wall structures, but no evidence of bone destruction.\n\n3 mm peripheral right lower lobe lung nodule is unchanged (104, 4 a, as well\nas a 6 mm nodule along the minor fissure (101, for a). Lungs are otherwise\nremarkable for minimal emphysema with centrilobular and paraseptal features.\n\nThyroid gland is enlarged and heterogeneous but not fully characterize by CT.\nThere are no enlarged mediastinal or axillary lymph nodes. Hilar nodes are not\noptimally assessed without intravenous contrast, there is no evidence of the\nbulky hilar lymphadenopathy. Heart size is normal, and diffuse coronary artery\ncalcifications are present. There is no pericardial or substantial pleural\neffusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of calcifications in the pancreas a possibly due to chronic pancreatitis.\nSmall hypodensities in the liver are unchanged since the prior cysts CT torso\nconsistent with a benign etiology such as cyst or hemangioma is. Tiny\ncalcified granuloma is present in the spleen.\n\nSkeletal structures demonstrate multilevel degenerative changes throughout the\nthoracic spine.",
            "output": "1. NEW 1.9 CM PERIPHERAL LEFT UPPER LOBE LUNG NODULE WITH INTERNAL CYSTIC\nLUCENCIES AND ADJACENT FOCAL PLEURAL THICKENING.  APPEARANCE IS MOST\nCONSISTENT WITH A PRIMARY LUNG CANCER.  FURTHER EVALUATION COULD BE PERFORMED\nBY PET CT OR A LUNG BIOPSY.\n\n2. LONG-TERM STABILITY OF 2 SUBCENTIMETER NODULES IN THE RIGHT LUNG,\nCONSISTENT WITH A BENIGN ETIOLOGY.\n\n3. CORONARY ARTERY CALCIFIC A\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 11:44 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "19 mm x 9 mm diameter.  Peripheral left upper lobe nodule is again\ndemonstrated with lobulated and spiculated borders, as well as persistent\ninternal cystic lucencies.  The lesion continues to be in direct contact with\nthe peripheral pleural surface, and is associated with persistent localized\nminimal pleural thickening as described previously.  3 mm peripheral right\nlower lobe nodule (143, 5), 6 mm nodule along the right minor fissure (137,\n5), a 2 mm left lower lobe nodule (30, 13) and a 2 mm nodular opacity along\nthe right major fissure (152, 5) are all unchanged and have shown long-term\nstability compared to older CT torso exam of ___. .  No new or\ngrowing lung nodules are detected during this short time interval.\n\nThyroid gland is again demonstrated to be enlarged and heterogeneous but not\nfully characterize by CT. There are no enlarged mediastinal or axillary lymph\nnodes. Heart size is normal, and diffuse coronary artery calcifications are\nagain demonstrated.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nfindings are evident in this region compared to the previous study from ___.\n\nSkeletal structures demonstrate multilevel degenerative changes within",
            "output": "Unchanged peripheral, 2 cm left upper lobe lung nodule, which remains highly\nconcerning for a primary lung cancer.  Differential diagnosis includes a\nlocalized region of organizing pneumonia.  Further evaluation with PET-CT or\nlung biopsy may be considered."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid gland is multinodular, with the largest in the\ninferior left lobe measuring 2.0 x 1.6 cm (5:6).  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size. There is mild atherosclerotic calcification of\nthe coronary arteries.  The heart size is normal and there is no pericardial\neffusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  The patient is status post left upper lobe\nwedge resection. There is no enhancing soft tissue at the resection margin,\nalthough close attention should be paid on followup examinations. There is new\nfocal consolidation in the periphery of the left lower lobe, measuring 2.1 x\n1.1 cm (6:204).  This abnormality is immediately anterior to a linear scar in\nthe posterior soft tissues, presumably at a VATS port site.  There is no\ncavitation.  There is a stable 6 mm perifissural nodule in the right lung\n(6:122).  There is no diffuse interstitial abnormality.  There are no\nconcerning pulmonary nodules.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.  There are exuberant anterior\nbridging osteophytes in the thoracic spine, consistent with DISH (diffuse\nidiopathic skeletal hyperostosis).\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. New nodular focal consolidation in the periphery of the left lower lobe\nlies immediately anterior to the scar from the posterior VATS port. However,\ngiven its morphologic similarity to the resected metastasis, this lesion\nshould be followed closely.  A follow-up CT in 3 to 6 months is recommended to\ndemonstrate resolution or improvement.\n2. Otherwise no definitive evidence of malignancy in the chest.\n3. See separate report for findings within the abdomen and pelvis."
        },
        {
            "input": "Thyroid nodules are unchanged demonstrated. Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged. Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.\nWedge resection in the left upper lobe is unremarkable.  There are few\nscattered tiny calcified nodules\nLung nodules are as follows\nIn the left lower lobe:\nSubpleural irregular 18 x 10 mm was 21 x 11 mm (5:212)\n5 mm subpleural nodular opacity (5:176) is a stable\n7 mm subpleural irregular nodular opacity (5:165) is stable\nIn the lingula subpleural elongated opacity is likely atelectases (5:177)\nPerifissural nodule in the right middle lobe measuring 5 mm is unchanged\nlikely an intrapulmonary lymph node (5:129)\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Previously described new subpleural opacity has decreased in size.  There are\nno new lung nodules:  Other new subpleural opacities are unchanged.  Follow-up\nin ___ months is recommended"
        },
        {
            "input": "The thyroid is stable in appearance with hypodense nodules, measuring up to\n0.9 cm.  There are no pathologically enlarged supraclavicular, axillary,\nmediastinal or hilar lymph nodes.  There is a small hiatal hernia.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Patient is status post left upper lobe which\nresection with stable postoperative appearance of the left hemithorax.  A 5 mm\nperifissural nodule in the right middle lobe is unchanged (4:119). A 8 mm left\nlower lobe subpleural nodule is not significantly changed from prior (4:136) .\nA 1.6 x 0.7 cm subpleural opacity in the lingula is stable from prior, and may\nrepresent atelectasis.  Irregular subpleural 1.7 x 0.9 cm opacity is not\nsignificantly changed from prior (4:170).  Several additional nodules\nmeasuring less than 2 mm in the right lung are unchanged (4:70 125, 135).  No\nnew suspicious pulmonary nodules.  There is minimal bronchiectasis in the\nbilateral lower lobes.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, two hypodensities in the right the left\nlobes of the liver are similar to prior, and the included portions of the\nupper abdomen are otherwise grossly unremarkable.",
            "output": "1. No evidence of recurrent metastatic disease in the thorax.\n2. Multiple subpleural nodules are stable since ___.  No new\nsuspicious pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is enlarged and\nmultinodular, similar to prior studies.  Supraclavicular and axillary lymph\nnodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  Aortic valvular calcification is mild.  There is no\npericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is\ntop-normal measuring up to 4 cm (02:25).  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  A right upper lobe subpleural opacity measuring up to 7\nmm is stable from multiple prior studies when measured in similar planes\n(4:115), likely an intrapulmonary lymphoid aggregate.  Subpleural opacities in\nthe lingula and left lower lobe are slightly more prominent compared with\nprior studies with a configuration suggesting rounded atelectasis.  Changes\nrelated to prior VATS are similar without new soft tissue density to suggest\nlocal disease recurrence.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  Moderate to severe right\nglenohumeral degenerative changes are noted.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Stable postsurgical changes without evidence of local disease recurrence or\ndistant metastatic disease within the chest.\n2. Slightly more prominent subpleural opacities in the lingula and left lower\nlobe likely represent rounded atelectasis.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is heterogeneous with\nnodules measuring up to 14 mm.  There is no supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen from the same date.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  Coronary\ncalcifications are moderate.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n-PARENCHYMA:  A 6 mm perifissural nodule in the right middle lobe (series 4,\nimage 105) unchanged.  A 2 mm pulmonary nodule at the periphery of the right\nlower lobe (series 4, image 124) is unchanged.  A 2 mm pulmonary nodule at the\nright lung base (series 4, image 199) is unchanged.  Parenchymal scarring\nassociated with suture chain is unchanged morphology from ___. \nSubpleural, slightly hyperdense nodules in the left lower lobe (series 4,\nimage 158, 134) are unchanged and likely represent atelectasis.\n-AIRWAYS:  The airways are patent the subsegmental level.\n-VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: The superficial soft tissues are unremarkable.  There is no\nosseous malignancy or infection.  There is DISH throughout the lower thoracic\nspine.",
            "output": "1.  No new or enlarging pulmonary nodules.\n2.  Heterogeneous thyroid with nodules measuring up to 14 mm.  Ultrasound is\nrecommended if not previously performed."
        },
        {
            "input": "The thyroid gland is heterogeneous, with the largest nodule measuring up to\n1.4 cm, unchanged compared to the prior exam.  There is no axillary, hilar, or\nmediastinal lymphadenopathy.  There is no supraclavicular lymphadenopathy. \nExtensive coronary calcifications are seen.  The heart size is normal.  There\nis no evidence of a pericardial effusion.\n\nThe esophagus is normal without evidence of wall thickening, or a hiatal\nhernia.\n\nPatient appears to be status post left upper lobe resection, with a focal\ncurvilinear area of nodularity measuring up to 0.5 cm.  Additional mild\nthickening along the suture line, also appears unchanged compared to the prior\nexam.\n\nA 0.6 cm for perifissural nodule in the right middle lobe, is unchanged\ncompared to the prior exam.\n\n-a 0.2 cm nodule within the superior segment of the right lower lobe, series\n6, image 158, is unchanged compared to the prior exam.\n\n-a 0.2 cm nodule within the right lung base, series 6, image 250 is unchanged\ncompared to prior exam.\n\n-pleural nodularity and thickening with a nodular component measuring up to\n0.8 cm within the left lung base, is unchanged compared to the prior exam.\n\n-a 0.2 cm nodule within the left upper lobe, posterior segment, series 6,\nimage 89 is unchanged compared to the prior exam.\n\nThere is no pleural effusion, or pneumothorax.\n\nThe airways are patent to the subsegmental levels.\n\nFor evaluation of the abdomen, please refer to dedicated CT of the abdomen\nperformed on the same day.\n\nOsseous structures: No focal lytic or sclerotic lesion is seen.  Severe right\nglenohumeral joint disease is unchanged.",
            "output": "Overall, stable bilateral pulmonary nodules measuring up to 0.6 cm compared to\nthe prior exam from ___.  No new concerning pulmonary nodule\nidentified.\n\nStable heterogeneity of the thyroid gland, with the largest right thyroid lobe\nnodule measuring up to 1.4 cm."
        },
        {
            "input": "Stable thyroid enlargement, multiple thyroid nodules had been documented on\nthe previous CT examination.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Stable mild\ndilatation of the main pulmonary artery.  Stable severe coronary\ncalcifications, moderate aortic valve calcifications.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  Stable cyst in the\nliver.  Stable slightly plump left adrenal but no evidence of focal adrenal\nlesions.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\n\nStatus post left upper lobe wedge resection.  At the lateral aspect of the\nsuture line, the soft tissue component surrounding the suture (5, 101) Has\nslightly increased.  The parenchymal opacities along the suture lines, as well\nas a minimal oval lesion (6, 75) are stable.  Stable zone of lateral pleural\nthickening (5, 65).  A left lower lung subpleural pulmonary nodule (5, 209)\nHas substantially increased in size and shows irregular borders.  The adjacent\npleura is not thickened.  A perifissural right-sided nodule (5, 133) Is\nstable.",
            "output": "Substantial interval growth of a left-sided basal lateral nodule with pleural\ncontact.  Minimal increase in soft tissue structures surrounding the lateral\naspect of the suture line.  All other pulmonary nodules are stable."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Moderate compressive atelectasis of the right lower lobe. \nThere is also subsegmental atelectasis in left lower lobe.  Lungs are\notherwise clear.  Calcified granuloma is noted along the right major fissure. \nAirways are patent subsegmental levels bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Calcifications along the posterior edge of the right lobe of the\nliver may reflect prior granulomatous disease.  Diffuse hypoattenuation liver\nsuggestive of steatosis.  Limited view of the upper abdomen is otherwise\nunremarkable.\n\nBONES: No acute fracture.  Benign-appearing peripherally sclerotic lesion in\nthe lateral aspect of the right fifth rib is noted, possibly reflecting\nfibrous dysplasia or an enchondroma.  (3:98, 602:9).",
            "output": "1. No pulmonary embolism.\n2. Small right pleural effusion with associated right basilar atelectasis.\n3. Benign-appearing peripherally sclerotic lesion in the lateral aspect of the\nright fifth rib may represent an enchondroma or fibrous dysplasia.\n\nRECOMMENDATION(S):  CT or MRI follow-up in 6 months to evaluate stability of\nthe benign-appearing lateral right fifth rib lesion."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta and pulmonary arteries are normal\nin caliber.  The heart is normal in size.  The reported left ventricular mass\nis not well seen on this noncontrast exam.  Marked calcification of mitral\nvalve is noted.  There is extensive atherosclerotic calcifications of coronary\narteries. There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a small left-sided pleural effusion with associated\nsubsegmental left lower lobe atelectasis.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is a calcified granuloma in the left upper lobe (series\n302, image 77).  There is discoid atelectasis in the lingula.  There is no\nfocal mass or consolidation.  The central airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrate\nprominent spleen which is incompletely included on this exam.  There are two\nlesions in the spleen with rim of calcifications measuring up to 6.9 cm may\nrepresent sequela of prior hematomas.\n\nBONES: Patient is status post sternotomy with midline sternotomy wires are\nseen.  No suspicious osseous abnormality is seen.? There are bilateral\ngynecomastia.",
            "output": "1. Small left pleural effusion with associated subsegmental left lower lobe\natelectasis.\n2. The reported left ventricular mass/thrombosis is not well seen on this\nnoncontrast exam."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There are coronary artery and mitral valve\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits.  Previously portal left ventricular mass is not\nappreciated on the study.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are small bilateral pleural effusions with associated\npassive subsegmental atelectasis.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Calcified granulomas are noted in the right lower lobe (02:87)\nand left lower lobe (02:77).  There is mild bronchial thickening..  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is slightly heterogeneous with a 1.3 cm hypodense\nnodule near the isthmus (02:20), for which no specific follow up is\nrecommended.\n\nABDOMEN: Again seen is a partially visualized prominent spleen with 2\nhypodense lesions with rim of calcifications measuring up to 2 7.0 cm, which\nare grossly unchanged compared to prior and may represent sequelae of prior\nhematomas.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere are mild-to-moderate multilevel degenerative changes of the thoracic\nspine.  The patient is status post median sternotomy.  There is bilateral\ngynecomastia.",
            "output": "1. No evidence of acute intrathoracic abnormality.\n2. Small bilateral pleural effusions with subsegmental atelectasis.  Although\nnew since ___, the right pleural effusion appears fairly chronic with\norganized rim.\n3. 1.3 cm thyroid nodule for which no specific follow up is recommended.  See\nrecommendations section\n\nRECOMMENDATION(S):\n Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The tip of the endotracheal tube\nlies 3.6 cm from the carina.  The tip of the feeding tube extends into the\ngastric body.  A right PICC line extends to the superior cavoatrial junction.\n\nHeterogeneous appearing thyroid without discrete nodules identified.\n\nDiffuse subcutaneous stranding, likely reflective of anasarca.\n\nUPPER ABDOMEN: Small amount of perihepatic fluid is noted anteriorly.  Small\nhiatal hernia.\n\nMEDIASTINUM: No size significant mediastinal lymph nodes.\n\nHILA: Lack of IV contrast limits the assessment for hilar adenopathy.\n\nHEART and PERICARDIUM: There is relative decreased density of the blood pool\nrelative to the intraventricular septum, consistent with anemia.  Coronary\narterial calcification is present, as is calcification of the aortic arch.\n\nPLEURA/ PARENCHYMA: Small bilateral pleural effusions, greater on the right\nwith overlying atelectasis.  A superimposed infection however cannot be\nexcluded on this noncontrast CT.  No pneumothorax.\nLUNG:\n\n-PARENCHYMA:  See above\n-AIRWAYS:  The proximal airways are patent.\n-VESSELS:  Limited evaluation of the intrathoracic vessels given the lack of\nintravenous contrast.\nCHEST CAGE: Mottled appearance of the vertebral bodies, likely secondary to\nrenal osteodystrophy.  Marked degenerative changes of T8 through T11 with\ncomplete disc space loss at T10-T11 as well as marked compression deformities\nof T9 and T10. This was partially imaged on the CT scan of the abdomen dated ___.",
            "output": "1. Small bilateral pleural effusions with overlying atelectasis.  Evaluation\nfor superimposed infection is limited given the lack of intravenous contrast.\n2. Vascular calcification.\n3. Anemia\n4. Anasarca"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Tracheostomy tube noted.  Thyroid\nis unremarkable.  PICC line is seen, its tip terminating in the right atrium.\n\nUPPER ABDOMEN: Please see CT abdomen from the same day.\n\nMEDIASTINUM: Surgical clips noted at the GE junction.  A small hiatal hernia\nis present.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is enlarged.  No significant pericardial\neffusion.  Coronary artery atherosclerotic calcifications are noted.\nPLEURA: Bilateral effusions have improved when compared to the prior\nexamination; small left and trace right.\nLUNG:\n\n-PARENCHYMA:  Bibasilar atelectasis noted.  Patchy parenchymal opacities are\nseen in the right greater than left upper lobes, and to a lesser extent in the\nright middle lobe.  This may represent pulmonary edema, or infection in the\nappropriate clinical setting.\n-AIRWAYS:  The central tracheobronchial tree is patent.\n-VESSELS:  Proximally patent.\nCHEST CAGE: No suspicious osseous lesions, noting severe kyphoscoliosis and\nunchanged thoracic compression deformities of T8 and T9.",
            "output": "Patchy parenchymal opacities, most confluent in the right upper lobe. \nFindings may be secondary to pulmonary edema.  Infection is not excluded."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable. \nCholecystectomy clips are noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The imaged base of neck including the thyroid gland appears normal. The\nthoracic aorta is normal in course and caliber without appreciable\natherosclerosis.  The heart is normal in size and shape without pericardial\neffusion.  The main pulmonary artery is normal in caliber. There is no filling\ndefect seen within the branches of the pulmonary arterial tree to suggest the\npresence of a pulmonary embolism.  No mediastinal, hilar or axillary\nlymphadenopathy is seen.  No pleural effusion or pneumothorax.  The lungs are\nclear bilaterally without worrisome nodule, mass, or consolidation.  No signs\nof contusion or laceration.\n\nWithin the imaged portion of the upper abdomen, clips in the gallbladder fossa\nnoted.  Otherwise no discrete abnormality is seen.\n\nBones: No fracture.  No worrisome lytic or blastic osseous lesions seen.",
            "output": "No pulmonary embolism or other acute process in the chest."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber with dense\natherosclerotic calcifications visualize.  The heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No mediastinal, axillary, or mediastinal\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 1.3 cm right upper lobe ground-glass pulmonary\nnodule (03:42).  Dependent bilateral atelectasis is visualized.  Lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES:  Anterolateral left rib fractures of the sixth and seventh ribs are\nvisualized.  Multilevel degenerative changes are visualized throughout the\nthoracic spine.",
            "output": "1. Anterolateral left rib fractures of the sixth and seventh ribs.\n2. Right upper lobe ground-glass pulmonary nodule measuring 1.3 cm for which\nfollow-up imaging is recommended.\n\nRECOMMENDATION(S):   For incidentally detected single ground-glass pulmonary\nnodule greater than 6 mm, a follow-up CT at ___ months to confirm persistence\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Aorta is calcified but not under is might take ___ dilated at its level of the\narch.  At the level of the ascending aorta distal ascending aorta is mildly\ndilated up to 4.2 cm.  Pulmonary arteries are normal in diameter.  The patient\nis after CABG.  Aneurysmal dilatation of the left subclavian artery up to 11\nmm is similar to previous studies, series 2, image 10.  Aortic valve\ncalcifications are extensive.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymphadenopathy is\nseen based on the CT size criteria.  Anterior mediastinal node is unchanged,\nseries 2, image 25, 14 mm in diameter in can be seen dating back to ___.\n\nAirways are patent to the subsegmental level bilaterally.  Scoliosis is\nextensive, unchanged.  Old rib fractures are unchanged.  Tortuosity of the\naorta is slightly exaggerated by the presence of the scoliosis in its\ndescending portion.\n\nInterval development of solid nodule in the left upper lobe in paramediastinal\nlocation is demonstrated within nodule having solid appearance and slightly\nbranching structure, series 302, image 26, approaching 15 x 16 x 16 mm, series\n601 image 59.  Ground-glass opacity in the right upper lobe is 16 x 13 mm,\nincreased in size as compared to 14 x 12 mm, series 302, image 58. There is\nminimal central increasing density, difficult to measure but denser as\ncompared to previous examination.",
            "output": "Interval development of solid nodule in the left upper lobe concerning for\nneoplasm\n\nInterval increase in size in density of the right upper ground-glass\npredominantly nodule concerning for neoplasm.\n\nCorrelation with thoracic surgery and or PET-CT and or tissue biopsy is\nrecommended\n\nMild dilatation of the ascending aorta up to 4.2 cm.  Aortic valve\ncalcifications concerning for hemodynamically significant aortic stenosis. \nStatus post previous bypass."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the imaged chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis but shows no adrenal mass or subphrenic collection.\nPatient has had median sternotomy and coronary bypass surgery.  There are no\nfindings to suggest operative complications.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately patulous in the midportion, but\nthere is no retention of fluid or other evidence of obstruction.\n\nAtherosclerotic calcification is moderately heavy in the head and neck\nvessels, in the native coronary arteries and grafts.  Aortic valvular\ncalcification is moderate to severe.  Aorta and pulmonary arteries are normal\nsize and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: 13 x 15 mm prevascular solid nodule in the mediastinum\nis unchanged in size since ___, either a benign thymic nodule or lymph node. \nNo other lymph nodes in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\nBranching, subpleural, left upper lobe lung lesion is smaller today than it\nwas in ___, ___ by 11 mm at the level of greatest bulk, 05:43, previously\n15 x 60 mm at a comparable level.  This is presumably an inflammatory lesion\nwith a component of bronchial impaction.\n\n3 mm nodule, lingula, 5:150 stable since ___ can be considered benign.\n\n14 x 16 mm mixed density nodule, right upper lobe, was 12 x 14 mm in ___ and 13 x 14 mm in ___.\n\nModerate non fibrosing interstitial pulmonary abnormality is confined to the\nlung bases, and has progressed only minimally since ___.\n\n\nCHEST CAGE: Unremarkable for age.",
            "output": "FDG avid solid left upper lobe lung lesion is considerably smaller today than\nin ___, indicating that it is a probably benign, inflammatory lesion,\nwith a shape suggesting mucoid impaction.\n\nMixed density right upper lobe lesion largely ground-glass, continues to grow\nslowly, probably an adenocarcinoma in situ.\n\nLocalized bibasilar interstitial lung disease, probably age-related,\nprogressing slowly.\n\nAortic valvular calcification is moderate to severe, but severity does not\ncorrelate closely with hemodynamic significance in a patient of this age.\n\nAtherosclerotic calcification involves coronary grafts as well as native\narteries.\n\nBenign thymic nodular prevascular mediastinal lymph node unchanged for nearly\n___ years."
        },
        {
            "input": "Mild upper lobe predominant centrilobular emphysema is accompanied by diffuse\nbronchial wall thickening. Scattered, poorly defined tiny centrilobular\nnodular opacities with upper lung predominance are also demonstrated as well\nas more discrete 2-3 mm diameter solid and ground-glass nodules with an upper\nlung predominance. Only 1 of these nodules is definitively calcified in the\nright apex ___, 4). Representative examples of these nodules are located in\nthe left upper lobe (image 40, 43, 46, 47, 50, 52), and right upper lobe (40,\n43, 45, 49, 50), on series 4. Additional 2-3 mm diameter lower lobe nodules\nare present bilaterally (image 117, series 4).\n\nSkeletal structures demonstrate multilevel degenerative changes in the spine.\n\nThere are no enlarged mediastinal, axillary or hilar lymph nodes. Heart size\nis normal, and diffuse coronary artery calcifications are present. There is no\npericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of a well-circumscribed 2.3 cm diameter left adrenal lesion with low\nHounsfield units of -8, suggestive of an adenoma. Incompletely imaged 12 mm\ndiameter low-density lesions are seen in the left renal mid pole as well as a\n1.5 cm diameter low-density lesion in the right mid pole region.",
            "output": "1. Multiple 2-3 mm diameter lung nodules, which are statistically very likely\nbenign. Some of these are centrilobular in distribution and could potentially\nbe due to respiratory bronchiolitis associated with cigarette smoking if the\npatient is an active smoker. These nodules may be reassessed by a followup CT\nscan in ___ year.\n\n2. Diffuse coronary artery calcifications.\n\n3. Incompletely imaged low-density renal lesions, possibly due to simple\ncysts, but not fully characterized. Renal ultrasound be suggested for further\nevaluation if not already performed.\n\n4. Low-density left adrenal lesion consistent with adenoma."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged.  Excluding the breasts\nwhich require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  This study is not\ndesigned for subdiaphragmatic diagnosis, but shows incompletely imaged,\napproximately 2 cm wide hypodense lesions in the posterior cortices of the\ninterpolar regions of both kidneys, 5:320, also present in ___ when\nultrasound evaluation was recommended in the report of that CT scan.\n\nThyroid gland is unremarkable.  Atherosclerotic calcification is moderate in\nhead and neck vessels, most pronounced in the left subclavian artery, and\nsevere in the coronaries, most marked in the LAD.  Thoracic aorta is normal\nsize, with most pronounced calcification in the arch and descending portion\nand more so in the abdominal portion.  Main pulmonary artery is top-normal\nsize, the right mildly dilated, 30 mm, unchanged since ___.\n\nMediastinal lymph nodes are not enlarged and hilar contours do not suggest\nadenopathy.  Pericardium is physiologic.  There is no pleural abnormality.  A\nesophagus is unremarkable.\n\nBronchiolar nodules are more numerous, now present in previously on involved\nareas such as the anterior segment right upper lobe, 5:124, and more numerous\nin the areas of most severe involvement previously.  This is accompanied by\nany increase in wall thickening of the entire bronchial tree.\n\nLesions concerning for possible malignancy are as follows:\n7 mm spiculated soft tissue nodule in the right lower lobe is new, 5:190.\n\n5 mm right lower lobe solid nodule, is new, 5:197.\n\n2mm right lower lobe subpleural nodule is new, 5:226.\n\n2 mm subpleural left upper lobe nodule, 5:134, unchanged.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Substantial progression of generalized bronchiolitis, with less pronounced\nupper lobe predominance, and widespread bronchial inflammation, without\nbronchiectasis.  Differential diagnosis includes respiratory bronchiolitis and\nnon-tuberculous mycobacterium infection.\n\n3 new right lower lobe nodules, the 2 largest of which are of greatest concern\nas possible new malignancy.  Suggest repeat chest CT in 3 months.\n\nPossible pulmonary arterial hypertension.\n\nCoronary atherosclerosis.\n\nBilateral renal lesions, not fully characterized, though not appreciably\nchanged since ___.  .\n\nRECOMMENDATION(S):  Renal ultrasound.\n\nRepeat chest CT in 3 months.\n\nClinical confirmation of continued smoking as an explanation for diffuse\nbronchiolitis and bronchial inflammation, or search for an alternative\ndiagnosis, including non-tuberculous mycobacterial infection or allergic\nasthma."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis.  The well circumscribed, largely\nfat attenuation left adrenal nodule, is unchanged since ___, it\nis ___ benign lesion, either a myelo lipoma or adenoma.  Kidneys are not\ncompletely imaged but both have benign cysts, also unchanged since ___. \nAbdominal aorta is heavily calcified but not enlarged.\n\nThyroid is unremarkable.  Atherosclerotic calcification is moderately severe\nin the left subclavian artery, milder in the other head and neck vessels.  It\nis severe in the coronary arteries.  Aorta is normal size.  Pulmonary arteries\nare moderately enlarged, right 32 mm, unchanged since ___.\n\nCentrilobular nodulation and mild, generalized bronchial wall thickening, most\npronounced in the upper lobes has improved.  This can be seen in cigarette\nsmokers with respiratory bronchiolitis to stop smoking or patients with\nhypersensitivity pneumonia who ovoid ascending materials.\n\n3 right lower lobe nodules that were new in ___ have all resolved, 7\nmm solid nodule, 5 mm solid nodule, and punctate solid nodule.  No followup is\nneeded for these lesions.  A dozen tiny lung lesions, mostly in the left upper\nlobe are all stable since ___ and there are no new lung nodules.\n\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "3 previous new lung nodules have resolved since ___ and the dozen\ntiny lung nodules all stable since ___ do not warrant follow-up\nimaging.\n\nInterval improvement in respiratory bronchiolitis or hypersensitivity\npneumonia.  Mild bronchial inflammation persists.\n\nPossible chronic pulmonary arterial hypertension.\n\nSevere coronary and left subclavian artery atherosclerosis.\n\nBenign left adrenal myelo lipoma or adenoma, stable since ___, does not need\nimaging evaluation.\n\n\nRECOMMENDATION(S):   If the patient is ___ years old, has a smoking history\nof greater than 30 pack-years and has smoked within the past ___ years, the\npatient meets criteria for annual lung cancer screening with low-dose chest\nCT, now available at this hospital."
        },
        {
            "input": "Aorta is calcified.  Main pulmonary artery is dilated up to 3.5 cm, unchanged\npotentially consistent with pulmonary hypertension.  Coronary calcifications\nare extensive.  Heart size is normal.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen re-demonstrate left adrenal hypodense\nlesion, 2.5 cm in diameter and 11 Hounsfield units in density at the maximum.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are stable.  No new nodules are seen.\n\nThere are no bone lesions worrisome for infection or neoplasm.\n\nImaged portion of the upper abdomen is stable, with unchanged appearance of\nleft adrenal adenoma.",
            "output": "Stable pulmonary nodules\nEmphysema moderate, respiratory bronchiolitis, minimal.\nLeft adrenal adenoma"
        },
        {
            "input": "CHEST PERIMETER:  There are no thyroid findings warranting further imaging\nevaluation. Supraclavicular and a handful of subcentimeter left axillary lymph\nnodes are neither pathologically enlarged nor growing.\n\nEvaluation of the breasts is reserved for mammography.  Elsewhere in the\npartially imaged chest wall there are no soft tissue abnormalities concerning\nfor malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, but shows no\nchange in the 22 mm wider hypoattenuating left adrenal nodule described as a\nbenign adenoma.  Right adrenal is normal.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis moderately heavy in head and neck vessels and substantial in at least left\nanterior descending and right coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size.  Pericardium is physiologic.\nTHORACIC LYMPH NODES:\n There are no lymph nodes in the chest pathologically enlarged or growing.\n\n\nLUNGS, AIRWAYS, PLEURAE: Scattered punctate and tiny clusters of inflammatory\nbronchiolar nodules are stable, but there are no new or growing lung nodules. \nBronchial wall thickening is mild and diffuse.  There is no bronchiectasis or\nmucoid impaction.\n\nCHEST CAGE: Unremarkable.",
            "output": "No new or growing lung nodules.  No focal lung lesions of consequence.\n\nNumerous tiny lung nodules, some inflammatory, are stable since at least ___ and described as stable at that time as well.  None of these lesions\nwarrants further imaging evaluation.\n\nSubstantial atherosclerotic calcification, head neck vessels and coronary\narteries.\n\nStable, benign left adrenal adenoma."
        },
        {
            "input": "HEART AND VASCULATURE: There are extensive filling defects bilaterally\nconsistent with pulmonary embolism.\nOn the left:\n-Originating at the left main pulmonary artery and into the superior lobar and\nsegmental branches (series 3, image 70).\n-Left lower lobar branch and left lower segmental vessels (series 3, image 85\nand 119).\nOn the right:\n-Right lower lobar artery that extends into multiple segmental and\nsubsegmental vessels (series 3, image 105 and 114).\n-Right middle lobar artery and segmental branch (series 3, image 114).\n\n2The main pulmonary artery is enlarged measuring 3.3 cm suggestive of right\nheart strain.  There is no evidence of pulmonary infarct.  The thoracic aorta\nis normal in caliber without evidence of dissection or intramural hematoma. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Redemonstrated are multiple pulmonary nodules in the bilateral\nlungs for example:\nRight:\n-series 3, image 54 measuring 4 mm\n-Series 3, image 60 measuring 4 mm\n-Series 3, image 117 measuring 3 mm.\nLeft:\n-series 605 image 7, measuring 3 mm\n-series 605, image 11 measuring 4 mm\n-series 605, image 12 measuring 2 mm\n-there is 605 image 14 measuring 4 mm.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Focal nodularity of the left adrenal gland measuring up to 2.2 cm\nwith macroscopic fat consistent with a myelolipoma.  With additional nodular\nappearance of the left lateral limb.  No discrete nodules in the right adrenal\ngland.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Extensive pulmonary embolism bilaterally extending from main pulmonary\nartery to the segmental level.  Enlarged main pulmonary artery and\nstraightened interventricular septum suggests right heart strain.  No evidence\nof pulmonary infarct.\n2. Multiple bilateral pulmonary nodules measuring up to 4 mm."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.  Severe coronary\ncalcification is noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.  Small thyroid\nhypodensities are visualized which are too small to characterize.  The\nesophagus is distended and fluid-filled without evidence of hiatal hernia or\nwall thickening.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is thickening of the left lower bronchus as well as\nconsolidation in the left lung base which may represent atelectasis versus a\ncomponent of aspiration in the setting of esophageal distention. Otherwise\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multifocal well-circumscribed hypodensities\nthroughout the hepatic parenchyma largest of which is located in hepatic\nsegment 4B  and measures approximately 2 cm, likely representing a simple\nhepatic cyst.  The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of concerning focal lesion or laceration.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis torturous without evidence of thickening or pericholecystic fluid (2:117).\n\nPANCREAS: The pancreas is atrophic and has normal attenuation throughout,\nwithout evidence of focal lesions.  There is mild prominence of the pancreatic\nduct measuring up to 3 mm.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder is distended.  The distal ureters are\nunremarkable.  There is a small amount of nonspecific free fluid within the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is a nondisplaced fracture at the right inferior pubic ramus\n(2:238).  There are two nondisplaced, minimally comminuted fractures at the\nmedial and lateral portion of the right parasymphyseal region (2:227).  There\nis a displaced, comminuted angulated fracture at the left inferior pubic ramus\n(2:237).  There is a possible nondisplaced fracture at the left parasymphyseal\nregion (2:226).  There is a fracture of the left anterior acetabulum (2:217). \nThere is a chronic minimally displaced fracture in the distal sacrum.  There\nis a minimally displaced fracture at the left distal ulna as described on the\nprior radiograph. There is no associated hematoma soft tissue stranding or\nbladder rupture. There are multilevel degenerative changes about the a\nthoracolumbar spine including osteophyte formation loss of intervertebral disc\nheight endplate sclerosis.  Vascular disc phenomenon is seen distal\nlumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multiple pelvic fractures. There is a nondisplaced fracture at the right\ninferior pubic ramus. There are two nondisplaced, minimally comminuted\nfractures at the medial and lateral portion of the right parasymphyseal\nregion. There is a displaced, comminuted angulated fracture at the left\ninferior pubic ramus. There is a possible nondisplaced fracture at the left\nparasymphyseal region. There is a fracture of the left anterior acetabulum. \nThere is no associated hematoma, soft tissue stranding, or bladder injury.\n2. The major organs within the abdomen and pelvis are without evidence of\ntraumatic focal lesion or laceration.  There is no evidence of mesenteric\ninjury.\n3. The urinary bladder is distended.  There is a small amount of nonspecific\nfree fluid within the pelvis.\n4. Esophagus is distended and fluid-filled without evidence of hiatal hernia\nor wall thickening.\n5. Thickening of the left lower bronchus as well as consolidation in the left\nlung base which may represent atelectasis versus a component of aspiration in\nthe setting of esophageal distention.\n6. Tortuous gallbladder without evidence of wall thickening or pericholecystic\nfluid.\n7. Known left distal ulnar fracture is re-demonstrated."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  There is no\npericardial or pleural effusion.  Image portion of the upper abdomen reveals\nno appreciable abnormality\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\nnodular consolidation which is located posteriorly and medially is 3.4 by 2.2\nx 1.8 cm, series 5, image 192.  8 has a swirling appearance and surrounded by\nfocal area of ground-glass as well as containing local calcification, series\n5, image 207.  No other pulmonary nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Right lower lobe nodular abnormality as described with associated hypodensity\nof the lungs most likely representing air trapping.  Differential diagnosis\nmight include focal area of atelectasis, sequestration, atelectasis or\nsubstantially less likely neoplasm.  Assessment of the patient with IV\ncontrast is recommended for precise characterization of potential vascular\nsupply of these abnormality."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  There is mild biapical scarring.  An irregularly\nshaped soft tissue lesion in the posterior right lower lobe measures 2.1 x 1.6\nx 3.0 cm, compared with 2.2 x 1.8 x 3.4 cm previously.  This lesion is\nsupplied by a large arterial branch arising from the lower thoracic aorta,\nsimilar in origin and course to the adjacent intercostal artery, but larger. \nOther tiny arterial branches from the intercostal artery cannnot be exlcuded. \nVenous drainage is to the right inferior pulmonary vein (2:44).  No new focal\nconsolidation.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "Right lower lobe intralobar sequestration, major, and possibly exclusive,\narterial supply from lower thoracic aorta, draining to right inferior\npulmonary vein."
        },
        {
            "input": "There is a large right pleural effusion with associated atelectasis.  The\nlungs are otherwise clear.  The trachea and central airways are widely patent.\n\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is mild coronary calcification.\n\nThis study is not tailored for subdiaphragmatic evaluation, but the visualized\nintra-abdominal organs are unremarkable.",
            "output": "1. No evidence of a mass lesion in the perihilar region or within the\ntracheobronchial tree on this exam.\n2. Large right pleural effusion with associated atelectasis."
        },
        {
            "input": "The left thyroid lobe enhances somewhat heterogeneously and punctate\ncalcification. There are no pathologically enlarged supraclavicular,\nmediastinal, hilar or axillary lymph nodes.\n\nThe heart size is normal with scattered coronary artery calcifications. There\nis no pericardial effusion. The main pulmonary artery and thoracic aorta are\nnormal caliber. Mild calcific atherosclerosis diffusely involves the aorta and\nits branches. No incidental central pulmonary embolism is identified.\n\nEvaluation of the lungs is somewhat limited by respiratory motion artifact.\nHowever, there are numerous bilateral upper lobe predominant centrilobular\nground-glass nodules which measure up to 6 mm. There is no obvious bronchial\nwall thickening, endobronchial lesion or pleural abnormality.\n\nThere is a small hiatal hernia. For a more detailed discussion of the upper\nabdomen, please refer to the separate report from the CT abdomen/pelvis\nperformed concurrently.\n\nThere are two hemangiomas involving the T1 and T3 vertebral bodies, and three\nhealing left rib fractures, but no bony lesions worrisome for infection or\nmalignancy.",
            "output": "Numerous bilateral centrilobular ground-glass nodules which are atypical for\nmetastases or a primary lung neoplasm. The differential diagnosis include\nrespiratory bronchiolitis, hypersensitivity pneumonitis and infection.\n\nSmall hiatal hernia."
        },
        {
            "input": "CTA thorax: The aorta and main thoracic vessels are well opacified. The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection.The pulmonary arteries are opacified to the segmental level,\nwithout filling defect to suggest pulmonary embolism.\n\nCT thorax:  The visualized thyroid gland is unremarkable.  The airways are\npatent.There is no mediastinal, hilar, or axillary lymph node enlargement by\nCT size criteria.The heart is mildly enlarged.  The great vessels are normal\nin caliber.No hiatal hernia or other esophageal abnormality is present.A\nground-glass opacity in the peripheral right middle lobe measures 7 x 11 mm\n(2a: 66), and could be infectious or inflammatory.  There is also a punctate\nnodular opacity in the right lower lobe (2a: 47) and a 4 mm nodule in the left\nlower lobe (2a:76).  There is no pleural or pericardial effusion.  No\npneumothorax is present.\n\nCT abdomen:  The liver demonstrates homogeneous attenuation, without\nconcerning focal lesion.  Scattered tiny hypodensities, the largest measuring\n6 mm, are too small to characterize but likely represent hepatic cysts or\nbiliary hamartomas.  The portal veins are patent.  There is periportal edema,\nlikely third spacing in the setting of fluid administration.  The nondistended\ngallbladder is without stone or gallbladder wall thickening.  The spleen is\nhomogeneous and normal in size.  The pancreas is normal in attenuation,\nwithout focal mass, ductal dilation, or peripancreatic stranding or fluid\ncollection.  The adrenal glands are normal in size and caliber.  The kidneys\ndemonstrate normal, symmetric nephrograms and excrete contrast promptly,\nwithout hydronephrosis or focal mass.  Small and large bowel loops are normal\nin caliber, without wall thickening or evidence of obstruction.  The appendix\nis not visualized, but there are no secondary signs of acute appendicitis. \nThere is no retroperitoneal or mesenteric lymph node enlargement by CT size\ncriteria.  The aorta and IVC is are normal in course and caliber.\n\nCT pelvis:  The urinary bladder is normal in appearance.  The uterus is\nretroflexed, with a circular hyperdense foreign body in the uterine cavity of\nunclear etiology.  There is no pelvic wall or inguinal lymph node enlargement\nby CT size criteria.  No pelvic free fluid is seen.\n\nOsseous structures: No focal osseous lesion concerning for malignancy is\npresent.  There is diffuse osteopenia.",
            "output": "1. No evidence of acute pulmonary embolism or acute intra-abdominal process to\nexplain the patient's presentation.\n2. A 7 x 11 mm ground-glass opacity in the peripheral right middle lobe could\nbe infectious or inflammatory.  4 mm nodule in the left lower lobe.\n\nNOTIFICATION:  A ground-glass opacity in the peripheral right middle lobe\nshould be followed up with CT chest in 3 months to document resolution.  At\nthis time, a 4 mm nodule in the left lower lobe can also be re-evaluated."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is a common origin of the brachiocephalic and left\ncommon carotid artery, a common variant.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis.  Otherwise, lungs are clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates oral contrast in\nthe stomach.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nMISCELLANEOUS: Incidentally noted partially visualized subcentimeter\ncalcification in the right axilla, of indeterminate clinical significance,\npossibly representing a calcified lymph node (___).",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No findings to explain patient's symptoms.  Apart from bibasilar\natelectasis, lungs are clear."
        },
        {
            "input": "There is slight interval decrease in focal right paraesophageal phlegmon at\nthe level of the thoracic inlet, corresponding to the area prior abscess,\nwithout discrete peripherally enhancing fluid collections to suggest\npersistent abscess (02:30).  There is mild leftward mass effect on the\nesophagus.  The area of background esophageal thickening appears similar to\nthe prior study, and is not progressed.\n\nIn addition, there is a new fluid collection retropharyngeal space extending\nfrom approximately the dense to the C5-C6 level measuring approximately 3.7 x\n1.2 x 7.8 cm (TRV X AP X CC) (02:13, 602:92).  This collection does not\ndemonstrate peripheral enhancement to suggest a definite abscess.  However,\nthere is mild mass effect on the posterior oropharynx.\n\nThere is a trace right pleural effusion with associated compressive\natelectasis.  There is mild left basilar atelectasis.\n\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nThe upper abdomen demonstrates a 2.0 x 2.3 cm very dense oval structure in\nmedial to the anterior spleen which likely represents a large splenic artery\naneurysm (302:233).",
            "output": "1. Slight interval decrease in paraesophageal phlegmon, residual from prior\ndeveloping abscess with background esophagitis.\n2. Retropharyngeal fluid collection does not demonstrate definitive signs of\nabscess and may represent reactive edema.  However, there is mild mass effect\non the oropharynx and close airway surveillance advised.\n3. Likely large splenic artery aneurysm.  Please note, however, current study\ndoes not substitute dedicated abdominopelvic imaging.\n4. Trace right pleural effusion with bibasilar atelectasis.\n\nRECOMMENDATION(S):  Close airway surveillance is advised secondary to\nretropharyngeal edema mass effect.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:56 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nThere is redemonstration of an ill-defined area of soft tissue at the site of\nprior right paraesophageal abscess at the level of the thoracic inlet (2:81,\n601:39), difficult to measure but overall decreased in size from prior and\nwith decreased mass effect on the adjacent esophagus. The previously seen\nretropharyngeal fluid collection is not appreciated on the current study.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Postsurgical change is noted at the right apex,\nconsistent with recent intervention.  There is mild bibasilar atelectasis. \nThere is no evidence of infection or malignancy.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is a trace right pleural effusion with associated compressive\natelectasis, similar to prior.  There is a trace right apical pneumothorax,\nnew from prior.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  There is small amount of\nsubcutaneous emphysema over the right chest wall, reflective of recent right\nVATS and prior chest tube.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable. \nThe previously described hyperdense structure medial to the spleen is not\nincluded on the current study.",
            "output": "1. Ill-defined soft tissue at the site of prior right paraesophageal abscess,\ndecreased in size from prior.\n2. Post-surgical changes at the right lung apex.\n3. Tiny right apical pneumothorax.\n4. Unchanged trace right pleural effusion."
        },
        {
            "input": "CHEST PERIMETER: There are no findings in the imaged portion of the thyroid\nwarranting further imaging evaluation.  Supraclavicular and subcentimeter left\nperipectoral and axillary lymph nodes are not pathologically enlarged. \nPrevious induration and small subcutaneous gas collection, right lateral chest\nwall has resolved.  There is no remaining soft tissue abnormality to suggest\neither infection or malignancy.\n\nEvaluation of the breast is reserved for mammography.  There are no soft\ntissue abnormalities elsewhere in the imaged chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis, but\nshows no adrenal mass.  Low-attenuation of the liver after contrast infusion\nthe indicates diffuse fatty infiltration, probably unchanged.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.There is no mediastinal fluid\ncollection or induration and mediastinal fat planes are generally well\npreserved, particularly adjacent to the esophagus.\n\nAtherosclerotic calcification is not apparent in head and neck vessels or\ncoronary arteries.  Aorta and pulmonary arteries are normal size and\npericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are now clear, tracheobronchial tree is normal\nto subsegmental levels and there is no longer pleural effusion or other active\npleural abnormality.  Minimal scarring is all that remains of the previous\nright upper posterior costal pleural collection and inflammatory thickening.\n\nCHEST CAGE: Unremarkable.  No evidence of infection or neoplasm.  Upper\nthoracic vertebral lymphangioma is clinically insignificant.",
            "output": "Essentially normal chest CT.  Previous abnormalities in the mediastinum,\nlungs, pleura, and right chest wall have all resolved since ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Subcentimeter hypodense lesion in\nthe left lobe of thyroid.  Retropharyngeal course of the carotid arteries\nbilateral.  No supraclavicular or axillary adenopathy.  No gross breast\nlesions.\n\nUPPER ABDOMEN: Bilateral hyper enhancing renal masses measuring 40 mm in\ndiameter on the left and approximately 26 mm on the right, but these lesions\nare incompletely imaged.  Dilated/aneurysmal segmental right renal artery\nmeasuring 9 mm diameter (3, 63).  Hypodense lesion in the anterior aspect of\nthe right kidney.  Hypodense lesion in segment 5 of the liver measuring 30 ___\nin density and 11 mm in diameter most likely representing a hepatic cyst. \nIndeterminate hypodense lesion in the inferior aspect of the spleen which\nappears to have internal septation.  Bulky appearance of the left adrenal. \nSmall hiatal hernia.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: Reactive right hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nMild aortic annular calcification.  Moderate mitral annular calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Consolidation with surrounding peribronchial nodules in the\nposterior aspect of the right upper lobe in keeping with pneumonia.  Posterior\nbibasal mild bronchiectasis with peribronchial nodules.  Indeterminate 2 mm\nround nodule in the left lower lobe (5, 198).\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  Sclerotic lesion seen\nin the left posterolateral aspect of the T1 vertebral body.",
            "output": "Bilateral enhancing renal masses are highly suggestive of malignancy and\ndedicated imaging is advised.\n\nConsolidation in the posterior segment of the right upper lobe with associated\nhilar adenopathy suggesting pneumonia.  No bronchial obstruction/endobronchial\nlesion to explain delayed resolution.\n\nMild bronchiectasis with associated peribronchial nodules is nonspecific and\nmost likely represents endobronchial spread of infection, but in this\ndistribution chronic aspiration should also be considered.\n\nIndeterminate nodule in the left lower lobe is most likely infective/secondary\nto aspiration but metastatic disease cannot be excluded with certainty:  If\nthe renal masses prove to be malignant then short-term interval follow-up CT\nimaging at 3 months is advised.\n\nRECOMMENDATION(S):  Dedicated imaging of the kidneys to assess for renal\nmalignancy bilateral.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:01 AM, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "The thyroid gland is unremarkable.  Bilateral axillary lymph nodes are notable\nfor their number but are not enlarged.  There is no supraclavicular,\nmediastinal, or hilar lymphadenopathy.  The aorta and main pulmonary vessels\nare normal in caliber.  Atherosclerotic calcifications of the aortic arch and\ncoronary arteries are moderate.  Calcifications of the aortic valve and the\nmitral valve are moderate.  The heart is normal in size.  There is no\npericardial effusion.\n\nThe central airways are patent.  Consolidation in the posterior aspect of the\nright upper lobe with surrounding peribronchial nodules has not improved since\nthe prior study from ___.  Scattered ground-glass nodules are\nnoted and slightly more conspicuous compared to the prior study measuring 2-3\nmm (05:109, 120, 154).  2 mm nodule in the left lower lobe is unchanged\n(05:207).  No large consolidation, pleural effusion, or pneumothorax is\npresent.\n\nThis study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate a 12 mm liver\ncyst, partially visualized right upper pole renal mass and a second mass in\nthe interpolar region of the left kidney.  12 mm splenic cyst is unchanged, as\nis diffuse nodular thickening of the left adrenal gland.  Scattered pancreatic\ncystic lesions are noted measuring up to 10 mm at the pancreatic body/tail,\nstatistically a side branch IPMN.\n\nNo suspicious lytic or sclerotic lesion is identified.  Dense sclerotic\nrounded focus is again noted at the T1 vertebral body, unchanged since ___.  No pathologic fracture.",
            "output": "1.  Non-resolving dense posterior right upper lobe consolidation, which\nappears to have progressed since ___.  Given the lack of improvement\ndespite treatment, other etiologies aside from bacterial pneumonia should be\nconsidered.  Differential include lymphoma, primary lung malignancy, lipoid\npneumonia, chronic aspiration, and tuberculosis.  Transbronchial biopsy is\nrecommended.\n\n2.  Scattered 2-3 mm pulmonary nodules are nonspecific.  Additional follow-up\nwould be based on biopsy results.\n\n3.  Sclerotic rounded focus at the T1 vertebral body, indeterminate. \nAttention on follow-up is recommended.\n\n4.  Bilateral renal masses, better evaluated on recent MRI.\n\nRECOMMENDATION(S):  Transbronchial biopsy is recommended.\n\nNOTIFICATION:  Findings were discussed with ___ by ___ phone at\n4:20pm on ___, 10 minutes following discovery."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary or supraclavicular\nadenopathy.  There are prominent mediastinal lymph nodes, as seen previously\nmeasuring up to 7 mm in the prevascular station, but none that are\npathologically enlarged.  Heart size is normal.  There is no pericardial\neffusion.  There is no thoracic aortic aneurysm.  There is minimal\natherosclerotic disease.  Main pulmonary trunk is normal in caliber.  There\nare moderate aortic valvular calcifications.  There are no significant\ncoronary artery calcifications.\n\nAirways are notable for mucous plugging in the right upper lobe posterior\nbronchi in the region of a dense consolidative opacity.  Overall extent of\nthis opacity has somewhat decreased from prior, for example in AP dimension\nthis now measures 2.7 cm, previously 3.1 cm.  There are new nodular opacities\nin the posterior left upper lobe (series 4, image 89).  4 mm left lower lobe\nand 2 mm right lower lobe pulmonary nodules are stable (series 4, image 164,\n110, 115).  There is no pleural effusion or pneumothorax.\n\nThe thoracic esophagus is mildly patulous.  Limited views of the upper abdomen\ndemonstrate a 1.5 cm right upper pole renal cyst.  Bilateral centrally located\nrenal masses are only partially imaged on this examination.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: Unchanged sclerotic lesion in the T1\nvertebral body.  Pathologic fracture.",
            "output": "1. Mild interval decrease in size of right upper lobe consolidative opacity\nfelt to represent pulmonary MAC, given transbronchial biopsy pathology.\n2. New small left upper lobe nodular opacities, likely reflects the same\ninfectious process.\n3. Unchanged sclerotic lesion in T1, continued attention on follow-up imaging\nis recommended.\n4. Incompletely evaluated bilateral renal masses.\n5. Stable millimetric pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized portions of the base\nof the neck show no abnormality.  The thyroid is unremarkable.  There is no\nsupraclavicular, infraclavicular, or axillary lymphadenopathy.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mass.  The distal\nesophagus is patulous and there is a tiny hiatal hernia.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART, PERICARDIUM, and VASCULATURE: The heart is normal in size.  The\npericardium is unremarkable and there is no pericardial effusion.  There is a\nsmall amount of atherosclerotic calcification within the region of the left\nmain coronary artery.  The thoracic aorta is normal in caliber and course with\nminimal scattered calcified plaques about the aortic arch and descending\nthoracic aorta.  The tip of a left IJ venous catheter terminates in the lower\nSVC.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  There are no focal consolidations.  A minimal amount of\ndependent atelectasis is seen in the lung bases.  Micronodule in the anterior\nsegment of the right upper lobe is unchanged (5:81).\n-AIRWAYS:  The airways are patent to the level of the bilateral segmental\nbronchi.\n-VESSELS:  The main pulmonary artery is normal in diameter.  The pulmonary\nvasculature is opacified to the subsegmental level without filling defects.\nCHEST CAGE: There are no suspicious osseous abnormalities.  No acute fracture.\n\nUPPER ABDOMEN: Please refer to the same day separate report of the abdomen and\npelvis for subdiaphragmatic findings.",
            "output": "-Stable right upper lobe micronodule is reassuring.  No definite evidence of\nmetastatic disease within the chest.\n-Please refer to the same day separate report of the abdomen and pelvis for\nsubdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  The visualized portions of the\nbase of the neck shows no abnormality.  There are no enlarged supraclavicular\ninfraclavicular or axillary lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  Previously\nvisualized tiny micronodule in the right upper lobe is no longer seen.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "No evidence of metastasis to the chest.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  Left-sided Port-A-Cath tip projects\nto the cavoatrial junction\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is normal.  There is mild coronary artery calcification.  There is no\npericardial effusion.  The aorta and pulmonary artery normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The airways are patent up to the subsegmental level.  Lungs are well\nexpanded and clear.  No new or growing lung nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "No evidence of metastasis to the chest.  Please refer to dedicated report on\nabdomen which has been dictated separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is minimal coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  No focal consolidation.  No suspicious pulmonary nodule\nor mass.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Limited evaluation of the upper abdomen demonstrates post\nradiofrequency ablation cavities in segment V and VII.  Otherwise the\nvisualized upper abdomen is unremarkable.  Please see same day MRI for more\ndetailed evaluation of the abdomen.",
            "output": "1. No evidence of metastatic disease within the chest.  No acute process\nwithin the chest.\n2. Please see same day MRI liver for more detailed evaluation of the abdomen."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging.\n\nSupraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities of concern in the imaged chest wall.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels and only mild in the coronary arteries. \nAorta and pulmonary arteries are normal size and pericardium is physiologic. \nAortic valvular calcification is mild.\n\nTHORACIC LYMPH NODES: Numerous lymph nodes in the mediastinum are measurable,\nbut not pathologically enlarged.  There is no lymph node enlargement in the\nchest.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions:\n\nBilobed 5 mm wide nodule, right lower lobe, 4:201, is new or substantially\nlarger today than in ___.  No other lung lesions of concern.\n\nTracheobronchial tree is normal to subsegmental levels.  There is no pleural\nabnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "5 mm right lower lobe lung nodule is new or substantially larger since ___.  Could be malignant or inflammatory.  No other findings suggest any\nintrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  Left pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  All mediastinal\nlymph nodes and hilar lymph nodes are normal in size.  No incidental pulmonary\nembolism.  Stable mild coronary calcifications, no pericardial effusion.  No\nvalvular calcifications, moderate interval enlargement of the known hepatic\nlesions and other abdominal findings are described in detail in the dedicated\nabdominal CT report.  No abnormalities in the posterior mediastinum.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable mild degenerative vertebral disease.  No vertebral compression\nfractures.\nNo diffuse lung disease.  No pleural effusions or other pleural abnormalities.\nThe airways are patent.  The pre-existing nodule in the right lower lobe basis\n(302, 161) has slightly increased in size and appears more bulky than on the\nprevious examination.  The current diameter of the nodule is approximately 8\nmm, as compared to 5 mm on the previous examination.  No other nodules\ncurrently visualized.",
            "output": "Interval growth of a solitary right lower lobe pulmonary nodule, from\napproximately 5 to approximately 8 mm in diameter.  No other nodules are\nvisualized.  No adenopathy.  No pleural abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Left anterior port with\ntip in the lower SVC.  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  Handful of pulmonary nodules scattered\nbilaterally, some of which have grown compared to prior, for example in the\nleft lower lobe (4:186) now measures 5 mm and has a small indwelling cavity,\nand in the right lung base measuring 1.0 cm (4:216), previously 0.8 cm.  Other\nstable pulmonary nodules as follows: 4 mm in the left upper lobe (4:64), 4 mm\nnodule in the middle lobe (4:128) and 3 mm in the right lower lobe (4:190). \nNo new nodules.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal MR report for subdiaphragmatic findings.",
            "output": "Compared to prior study of ___, two of the above-mentioned lung\nnodules have grown slightly, concerning for metastatic disease progression.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 17:03 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Several hypodense round lesions in the liver, the largest 1.8\ncm right lobe - will be reported separately in the same day CT of the abdomen\nand pelvis, accession # ___.\n\nMEDIASTINUM: There is no mediastinal, hila or any other intrathoracic\nlymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal size and there is no pericardial\neffusion.\nSpecks of calcifications in the coronaries including the left main coronary.\nMajor vessels are not distended.\n\nLUNG and PLEURA: Major airways are patent.\nMicro nodule in the right upper lobe (series 302, image 82), otherwise the\nlungs are clear.\nNo pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "-Right upper lobe micro nodule, otherwise no clear evidence of intrathoracic\nmalignancy, attention follow-up studies is recommended.\n-Please refer for the same day report of the CT of the abdomen and pelvis for\nfindings of the upper abdomen."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary lymph nodes are not enlarged.\nMediastinal lymphadenopathy is present, in the right upper paratracheal lymph\nnode measures 10 mm.  AP window lymph node measures 5 mm.  Right lower\nparatracheal station lymph node measures 9 mm.  Right hilar lymph node\nmeasures 22 x 21 mm.  Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nAside from a cluster of peribronchial micro nodules in the lingula (4:205) the\nlungs are clear.  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation splenomegaly\nhas worsened.  Now measures 16 cm.  Multiple hypodense lesions in the spleen\nare again noted also increase in size the largest now measuring 3.2 cm.  There\nare multiple pathologically enlarged retroperitoneal lymph nodes for example\nthe right periaortic node measuring 19 mm was 15 mm.  Lymph node in the\nsplenic hilum measuring 22 mm was 18 mm.  1.3 cm lesion in the left kidney is\nstable.\nThere are no bone findings of malignancy",
            "output": "Mediastinal and right hilar lymphadenopathy.  Worsening retroperitoneal lymph\nnodes, splenomegaly and splenic lesions still concerning for neoplastic\nprocess such as lymphoma.\nSmall cluster of micronodules in the lingula are likely infection"
        },
        {
            "input": "No incidental thyroid findings.  No axillary lymphadenopathy on today's\nexamination.  The size of the mediastinal lymph nodes has slightly decreased. \nFor example, a reference lesion in paratracheal location measures 5 mm in\ndiameter, as compared to 11 mm on the previous examination (2, 16).  Lower\nparatracheal lymph nodes have also decreased in size.  The previously enlarged\nright hilar lymph node (2, 29) is back to normal size.  In the posterior\nmediastinum, no evidence of lymphadenopathy is seen.  The previous abdominal\nlymphadenopathy (2, 70) as well as the splenic changes are addressed in the\ndedicated abdominal CT report.  Lytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.\nThe airways are patent.  No diffuse lung disease.  No pleural thickening, no\npleural irregularities.  The pre-existing clustered micronodules in the\nlingular have almost completely resolved.",
            "output": "Substantial decrease in size of the pre-existing mediastinal and hilar lymph\nnodes.  Resolution of the clustered micronodules in the lingula.  Upper\nabdominal lymph nodes and splenic abnormalities appear unchanged but are\ndescribed in detail in the dedicated abdominal CT report."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, LYMPH NODES: In the inferior aspect of the\nright hilum, 2.5 x 0.9 cm lymph node is larger since ___ when it measured\n1.6 x 0.4 cm (4:128).  Otherwise there has been no change in the left\nsupraclavicular 1.3 cm lymph node and few borderline mediastinal lymph nodes\n(04:22, 90). No axillary lymphadenopathy.\nImaged thyroid is unremarkable.\n\nUPPER ABDOMEN: Large hyperdense lesions replacing most of enlarged spleen\nwhich appears mildly larger since ___.  Please refer to separate detailed\nconcurrent CT of the abdomen and pelvis.\n\nHEART and PERICARDIUM: Heart and major vessels are normal in size and there is\nno pericardial effusion.\n\nPLEURA: There is no pleural space abnormalities.\n\nLUNG: Airways are patent the subsegmental level.\nNo new nodules identified, with pre-existing micronodule in the right upper\nlobe being stable since ___ (4:95).\n\nCHEST CAGE: Unremarkable with no evidence of lytic sclerotic bony destructive\nlesion in the vertebra, ribs or sternum.",
            "output": "-Right hilum lymph node and spleen are larger in comparison to ___ and\nconcerning for active lymphoid proliferation else there has been no change in\nthe borderline left supraclavicular and mediastinal lymph nodes.\n-No new lung lesions.\n-Subdiaphragmatic finding detailed in the concurrent separate report of CT of\nthe abdomen and pelvis."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall.  This study is not designed for\nabdominal evaluation, but shows no adrenal abnormalities, and significant\nimprovement in previous splenomegaly, incompletely imaged, but, for example,\n42 x ___ mm today on the lowest level of imaging, previously 103 x ___ mm in\n___.\n\nCARDIO-MEDIASTINUM:Lower esophagus is mildly thick-walled, and patulous.  This\ncould be in indication of early esophagitis.  Clinical assessment advised. \nAtherosclerotic calcification is not apparent head neck vessels.  Right\njugular central venous line ends in the right atrium but contrast infusion\nmakes it difficult to locate the tip precisely.  There is no obvious\nassociated thrombosis.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor clearly growing, as follows:\n\nRight lower paratracheal mediastinum, 7 x 13 mm, 4:95, was 11 x 16 mm in\n___.\n\n4 mm prevascular, 4:88, was 3 mm in ___.\n\nLeft hilum, 7 mm, was 11 mm in ___.\n\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are clear, tracheobronchial tree is normal to\nsubsegmental levels, there is no pleural abnormality.\n\nCHEST CAGE: Unremarkable.",
            "output": "Possible early esophagitis.\n\nNo evidence of intrathoracic malignancy.  Previous borderline lymph node\nenlargement and splenomegaly have receded, details above."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Esophagus is unremarkable.  Small morphologically normal\nmediastinal lymph nodes, measuring up to 5 mm.  No hilar lymphadenopathy.\n\nHEART and PERICARDIUM:\nHeart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.  Mild bilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  And least 4 small solid nodules, one of which is calcified,\nall measuring up to 3 mm and stable (4: 39, 61, 72 and 107).\n2. AIRWAYS:  Mucous secretions in trachea and main bronchi.  Diffuse bronchial\nwall thickening.\n3. VESSELS:  Mild pulmonary artery enlargement, with 3.2 cm.\nCHEST CAGE: Mild dorsal spondylosis.  No acute fractures.  No lytic or\nsclerotic lesions.",
            "output": "No signs of intrathoracic malignancies."
        },
        {
            "input": "HEART AND VASCULATURE: Calcific atherosclerotic changes involving the coronary\nvessels and the thoracic aorta.  Unenhanced appearance of the heart and\npericardium is within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Minimal subsegmental atelectasis anteriorly within the right\nupper lobe, otherwise the lungs are clear without masses or areas of\nparenchymal opacification. The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no significant\nabnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nRadiopaque anchors seen within the right humeral head are indicative of prior\nrotator cuff repair.",
            "output": "No evidence of primary malignancy within the thorax."
        },
        {
            "input": "The thyroid gland is unremarkable. A borderline enlarged right hilar lymph\nnode measures 9 x 11 mm, unchanged (6, 102). There are no pathologically\nenlarged supraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nThe heart size is top normal, and there are scattered coronary artery\ncalcifications. The main pulmonary artery is mildly dilated measuring up to\n3.1 cm in greatest transverse dimension. There is mild dilatation of the\nascending aorta relative to the descending aorta, with the maximal transverse\ndiameter of the ascending aorta measuring 3.7 cm. No incidental pulmonary\nembolism is identified.\n\nA 3 mm right upper lobe solid perivascular nodule (6, 99) and a 3 mm left\nlower lobe nodule (6, 150) are new since the prior exam. No endobronchial\nlesion or pleural abnormality is identified.\n\nMild distal esophageal wall thickening with associated submucosal varices are\nin keeping with the stated history of cirrhosis.\n\nFor a detailed discussion of the upper abdomen, including splenomegaly, please\nrefer to the separate report from the CT abdomen/pelvis performed\nconcurrently.\n\nThere are no bony lesions in the thorax worrisome for infection or malignancy.",
            "output": "Two new solid pulmonary nodules measuring up to 3 mm are concerning for\npossible small metastases. A three-month followup chest CT is recommended.\n\nCirrhosis with paraesophageal varices and splenomegaly.\n\nMild dilatation of the main pulmonary artery may suggest pulmonary arterial\nhypertension in the appropriate clinical setting."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size. There are atherosclerotic calcifications in the\nthoracic aorta and the coronary arteries.  The heart size is normal and there\nis no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  There are no concerning pulmonary\nnodules.  The perivesicular right upper lobe nodule in the left lower lobe\nnodule seen on the prior examination are no longer present.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "No evidence of intrathoracic malignancy.  Previously seen pulmonary nodules\nare no longer present, likely representing a resolving infectious or\ninflammatory process."
        },
        {
            "input": "The thyroid is unremarkable.  The axillary, supraclavicular, mediastinal and\nhilar lymph nodes are not pathologically enlarged.  The aorta is not\naneurysmal and main pulmonary artery is mildly enlarged measuring 3.2 cm. \nThere are atherosclerotic moderate to severe calcifications within the\ncoronary arteries, in the thoracic aorta.  The cardiac chambers are hypodense\nas compared to to myometrium, which is concerning for anemia.  The pericardial\neffusion is small in stable in appearance\n\nThe airways are patent to the subsegmental level.  Previously described 8 mm\nsubpleural ground-glass nodule in the left lower lobe has resolved. \nSubpleural 2 mm opacities in the right upper and middle lobe are stable.  No\nnew or growing pulmonary nodules.  Mild dependent atelectasis in the lower\nlobes\nSeveral 2 mm subpleural opacities in the\nright upper and middle lobe likely are  intrapulmonary\nlymph nodes.  There is a focal area of subpleural atelectasis in the right\nlower lobe stable in appearance.  There is no pneumothorax or\npleural effusion.\n\nMild degenerative changes within the cervical and thoracic vertebral bodies.\nNo suspicious osseous lesions within the thorax.\n\nThis examination is not tailored for subdiaphragmatic evaluation, There are\ntiny simple hepatic cysts.  Partially upper abdominal ascites has increased. \nMultiple surgical clips related to prior hepatic transplant.",
            "output": "Mild enlargement of the pulmonary arteries, bilateral hila are otherwise\nunremarkable.  No suspicious pulmonary nodules, lymph nodes or or bony\ndisease.\n\nSmall pericardial effusion is stable.\n\nPartially imaged upper abdominal ascites has increased."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Mild\nstable dilatation of the main pulmonary artery.  Severe coronary\ncalcifications, mild valvular calcifications.  No pericardial effusion.  No\nabnormalities in the posterior mediastinum.  Upper abdominal findings are\ndescribed in detail in the dedicated abdominal CT report.  Mild degenerative\nchanges at the level of the ribs, the sternum, or the vertebral bodies.  No\nvertebral compression fractures.  Mild bilateral apical scarring.  No pleural\nabnormalities.  No pleural thickening.  The airways are patent.  No diffuse\nlung disease.  Minimal non characteristic scarring in the anterior portions of\nthe right upper lobe (16, 79).  No suspicious lung nodules or masses.",
            "output": "Stable examination as compared to ___.  No metastatic disease to\nthe thorax."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is calcification of the mitral annulus.  The\nheart, pericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is dependent atelectasis bilaterally.  Scattered small\ngranulomas suggest prior granulomatous disease.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nA chronic compression deformity of T12 with approximately 5 mm retropulsion is\ngrossly similar to the prior study.  There is diffuse bridging osteophyte\nformation along the right aspect of the vertebral bodies.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No consolidations to suggest acute infection.\n3. Unchanged chronic compression deformity of T12.\n4. Diffuse idiopathic skeletal hyperostosis is noted."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  Supraclavicular\nand axillary lymph nodes are nonenlarged.\n\nUPPER ABDOMEN: Visualized solid organs are unremarkable.\n\nMEDIASTINUM: Multiple calcified mediastinal lymph nodes are consistent with\nprior granulomatous exposure.  Upper paratracheal lymph nodes are noted\nlargest measuring 1.7 cm (02:21).  No anterior mediastinal mass or hematoma.\n\nHILA:  Hilar lymph nodes are nonenlarged.  Multiple punctate calcifications\nare consistent with prior granulomatous exposure.\n\nHEART and PERICARDIUM:  Heart is mildly enlarged.  No pericardial effusion. \nMild aortic valve and mitral annular calcifications are present.  Mild\natherosclerotic calcifications present.  Ascending aorta is normal in caliber\nwithout aneurysmal dilatation.\n\nPLEURA: Small bilateral non hemorrhagic pleural effusions are noted.  No\npleural calcifications or irregular pleural thickening.  No pneumothorax.  No\nloculations.\n\nLUNG:\n\n-PARENCHYMA:  Minimal interlobular septal thickening with mild thickening of\nbilateral major fissures.  Mild lingular and bibasilar atelectasis is noted. \nNo consolidation.  Right apical pleuroparenchymal scarring is mild. 0.5 x 0.3\ncm left upper lobe lesion is noted (04:57).  0.3 cm triangular-shaped left\nperifissural nodule is consistent with lymphoid aggregate.  Subcentimeter\ncalcified granulomas, largest measuring 0.9 cm in the right middle lobe.\n-AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis or bronchial wall thickening.\n-VESSELS:  The main pulmonary artery is mildly dilated.\nCHEST CAGE:  Visualized soft tissues are notable for diffuse anasarca and\notherwise unremarkable.  No focal lytic or blastic lesions worrisome for\nmalignancy.  No acute fracture.  0.5 cm densely sclerotic posterior fifth rib\nlesion is consistent with a bone island.  Moderate degenerative changes\nthoracic spine with anterior osteophytes endplate sclerosis and disc space\nnarrowing.  There is a superior endplate compression fracture of T10 with 0.4\ncm retropulsion.",
            "output": "1.  Mild pulmonary edema with small bilateral pleural effusions, mild\ncardiomegaly, and mediastinal lymphadenopathy likely due to congestion.\n2.  0.5 cm left upper lobe lesion likely represents scar however primary\nmalignancy would be similar in appearance.\n3.  Mild superior endplate compression fracture of T10 with 0.4 cm\nretropulsion, of indeterminate age.\n4.  Findings suggestive of pulmonary hypertension.\n\nRECOMMENDATION(S):  1.  Recommend follow-up CT chest in 6 months to assess for\nchange in left upper lobe scar like lesion.\n2.  Clinical assessment for focal tenderness at T10 is recommended.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:22 ___, 15 minutes after\ndiscovery of the findings.\n\n The updated impression was discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:06 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is ulcerated atherosclerotic plaque along the aortic arch and descending\naorta.\n\nLimited study at the segmental and subsegmental pulmonary arteries of the\nbilateral lower lobes are not well opacified.  The pulmonary arteries are well\nopacified to the lobar level, with no evidence of filling defect within the\nmain, right, left, lobar, segmental or subsegmental pulmonary arteries.  The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere are subtle scattered central lobar pulmonary nodules in the right upper\nlung, may be due to small airway disease, small airways infection or\ninflammation, (series 3, image 92). The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are unremarkable.\n\nThe patient is status post CABG and median sternotomy with intact sternal\nwires.  No lytic or blastic osseous lesion suspicious for malignancy is\nidentified.",
            "output": "1. Limited study as the subsegmental and segmental pulmonary arteries in the\nbilateral lower lobes due to respiratory motion.  Within the limitation of the\nstudy, no evidence of central pulmonary embolism or acute aortic abnormality.\n2. Subtle scattered, millimetric centrilobular pulmonary nodules in the right\nupper lung may be due to small airway disease, small airways infection or\ninflammation.\n\nNOTIFICATION:  The ED nurse was emailed about the change in wet read and will\ninform the patient."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Median sternotomy and post CABG changes are noted.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  The esophagus is patulous.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A small group of pulmonary nodules measuring up to 4 mm in the\nright upper lobe (02:20) are unchanged since the prior CT from ___.\nThere is a 4 mm pulmonary nodule in the right middle lobe (02:55) is\nunchanged.  A 3 mm right perifissural nodule (02:45) is unchanged.  A 3 mm\npulmonary nodule in the left lower lobe (2:60), is unchanged since the prior\nstudy.  An 8 mm pulmonary nodule in the left lower lobe (02:50) is new since\nthe prior study from ___.  Chronic atelectasis/scarring in the\nright lower lobe is noted.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. 8 mm left lower lobe pulmonary nodule, new since the prior study.  Multiple\nadditional smaller scattered pulmonary nodules are unchanged since the prior\nstudy.\n For incidentally detected multiple solid pulmonary nodules measuring 6 to\n8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk patient,\nwith an optional CT follow-up in 18 to 24 months. In a high-risk patient, both\na CT follow-up in 3 to 6 months and in 18 to 24 months is recommended.\n3. Patulous esophagous.  Recommend swallowing study for evaluation of\naspiration.\n\nRECOMMENDATION(S):  Swallowing studies and esophagogram to assess for\naspiration"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe visualized thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMosaic parenchymal attenuation likely secondary to submaximal inspiration. \nPunctate focus of mucous impaction in a lateral basal subsegmental branch\nairway of the right lower lobe.  Airways are mildly thickened.  The airways\nare otherwise patent to the subsegmental level.\n\nSmall hiatal hernia.  Limited images of the upper abdomen are otherwise\nunremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small airways disease."
        },
        {
            "input": "CHEST:\nThere is interval increase in right pleural effusion and a new moderate-sized\nleft pleural effusion.\n\nPreviously visualized pulmonary emboli within the right upper lobar, segmental\nand subsegmental pulmonary arteries as well as within the lateral inferior\nright lower lobe pulmonary arteries have decreased in size significantly with\nonly thin nonocclusive residual emboli noted in the right upper lobar\npulmonary artery.  A linear filling defect within the main pulmonary artery is\nlikely an artifact due to this non gated study.\nNo new/progressive pulmonary emboli noted.\n\nThe main pulmonary artery measures 3 cm in diameter compared to a prior of 3.3\ncm.  There is no right heart strain pattern on today's exam.\n\nBibasilar dependent atelectasis seen.\nThe trachea and main bronchi are widely patent.\n\nThyroid: 8 mm left thyroid nodule remains unchanged.\n\nThere are no enlarged lymph nodes in the mediastinum or bilateral hila.\nNo pericardial effusion.\nMild atherosclerotic changes of the thoracic aorta noted.\n\nABDOMEN:\n\nGENERAL: There is a moderate amount of ascites, overall improved compared to\nthe prior exam.  No free intraperitoneal air.  Diffuse peritoneal\ncarcinomatosis noted.\nHEPATOBILIARY: The background hepatic parenchyma enhances homogeneously. \nThere are multiple new scattered hepatic hypodensities as seen on series 6,\nimage 10, 14, 19, 21 and 26.  The largest hypodensity in segment IV A/II\n(06:14) measures 1.2 cm in size.  These lesions are concerning for hepatic\nmetastases.\nThe hepatic veins are patent.  The portal vein and its branches are patent.\nThe gallbladder is surgically absent.\nPANCREAS: The pancreatic parenchyma enhances homogeneously without main duct\ndilation..\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY: No hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: The enteric tube terminates in the stomach.\nAgain visualized are multiple dilated and fluid filled obstructed loops of\nenhancing small bowel with a transition point in the right upper quadrant. \nThere is interval progression of small-bowel dilation, for example a dilated\nloop in the right lower quadrant measures 4.6 cm compared to a prior of 4.0\ncm.  No evidence of pneumatosis or perforation.\n\nThere is a peritoneal catheter in place terminating in the left hemiabdomen.\nLYMPH NODES: Numerous enlarged mesenteric lymph nodes and peritoneal nodules\nappear unchanged.  Bilateral enlarged inguinal lymph nodes also remain\nunchanged.\nVASCULAR: No significant atherosclerotic calcification identified.  The IVC is\nnarrow in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The uterus is\nenlarged and contains multiple fibroids, some of which are calcified.  Both\novaries are not visualized..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  Unchanged 5 mm rounded densely\nsclerotic focus within the T12 vertebral body (16:37) noted.\nNumerous subcutaneous soft tissue nodules, likely related to injection sites.",
            "output": "1. Interval near complete resolution of the previously noted pulmonary emboli\nwith no new or progressive pulmonary emboli along with decrease in caliber of\nthe main pulmonary artery without evidence of right heart strain on this exam.\n2.  New left pleural effusion and worsening right pleural effusion with\nbibasilar dependent atelectasis.\n3.  New scattered hepatic hypodensities, described in detail above, concerning\nfor metastases.  Enlarged mesenteric and bilateral inguinal lymph nodes are\nunchanged.\n4.  Moderate volume ascites has improved compared to prior, associated with\nperitoneal carcinomatosis.\n5.  Mechanical high-grade multisegmental small-bowel obstruction has\nprogressed compared to prior, without evidence of bowel wall ischemia or\npneumatosis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Both breasts\nhave not been completely imaged.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The aorta\nand pulmonary artery normal in caliber.  The main pulmonary artery measures\n3.4 cm.  There is no pericardial effusion.\n\n\nPLEURA: There is a small right pleural effusion.\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nNo obvious nodules or consolidations.  Minimal subsegmental atelectasis in the\nright lower lobe.\n\nBONES AND CHEST WALL : Review of bones.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of the liver.  Patient status post cholecystectomy.  There is\nevidence of ascites.",
            "output": "Small right pleural effusion with right basilar atelectasis.\n\nAscites."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level.  The\npulmonary trunk is prominent measuring 3.3 cm\nAgain seen are pulmonary emboli at the origin of the right upper lobe artery\nthat extend in the anterior, apical and posterior segmental arteries.  There\nis a new filling defect in a subsegmental lateral right lower lobe artery.  No\ndefinite pulmonary embolism on the left side.\nThere is a flattening of the interventricular septum.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Mild to moderate right pleural\neffusion slightly progressed since ___.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "-Right upper lobar, segmental and subsegmental pulmonary emboli which are\nsimilar to prior studies.  New right subsegmental lateral inferior right lower\nlobe pulmonary embolus.\n-Flattening of the interventricular septum which may represent right heart\nstrain\n-Slight progression of a right pleural effusion.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:18 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection. There are filling defects in several segmental branches of the\nright lower lobe, consistent with acute pulmonary thrombus (6:131, 153). \nThere are more equivocal filling defects in a small number of segmental\nbranches of the left lower lobe pulmonary arteries (6:117). The remaining\ngreat vessels are normal in appearance.\n\nCT CHEST WITH CONTRAST:\n\nThere is no axillary, supraclavicular, mediastinal, or hilar lymphadenopathy\nby CT size criteria. There is mild cardiomegaly, but no evidence of right\nheart strain. There is no pericardial effusion. There is minimal dependent\natelectasis in the right lower and middle lobes. There is a small\nnonhemorrhagic pleural effusion on the left. There is atelectasis as well as\nground-glass opacity and hypoperfused consolidation in the left lower lobe and\nlingula concerning for pneumonia. The airways are patent. There are no\nconcerning pulmonary nodules. There is no pneumothorax.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Acute pulmonary thrombus in the segmental branches of the right lower lobe,\nand possibly the left lower lobe, with no evidence of right heart strain.\n2. Areas of consolidation in the left lower lobe and lingula concerning for\npneumonia.\n3. Small nonhemorrhagic left pleural effusion with compressive atelectasis of\nthe adjacent left lower lobe.\n4. Mild cardiomegaly.\n\nNOTIFICATION:  Preliminary findings were communicated to Dr. ___ by\nDr. ___ phone on ___ at 5:32 ___, 2 minute(s) after discovery."
        },
        {
            "input": "The patient has a known pulmonary embolism.  This is best evaluated on the\noutside hospital CT.  The thoracic aorta is normal in caliber.  There are no\nenlarged mediastinal or axillary lymph nodes.\n\nThe central airways are clear.  There is no pericardial effusion.  There is a\nsmall left-sided pleural effusion.\n\nThere is parenchymal opacity with air bronchograms in the right middle lobe,\nlingula, right lower lobe, and left lower lobe.  This is most pronounced in\nthe left lower lobe.  This may partially reflect atelectasis, however on the\nleft there is superimposed pneumonia.  A developing infarct would also be in\nthe differential.\n\nThere is a 46 x 45 mm cyst in the left kidney.  The study is not tailored to\nsubdiaphragmatic evaluation.\n\nThere is a 16 mm right thyroid nodule.",
            "output": "Parenchymal opacity in the left lower lobe reflecting pneumonia superimposed\natelectasis although an evolving infarct in this region would be in the\ndifferential.\n\nSegmental atelectasis in the right lower lobe, right middle lobe, and lingula."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid gland is normal in appearance.  No enlarged lymph nodes in either the\naxilla or thoracic inlet.  There are no chest wall abnormalities.  Moderate\natherosclerotic calcifications in the neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Multiple mediastinal lymph nodes ranging up to 9\nmm in the aortopulmonary window and subcarinal stations (5:95, 116).  Hilar\ncontours show no evidence of enlarged lymph nodes, although evaluation is\nlimited by the absence of intravenous contrast.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Extensive\natherosclerotic calcifications in the coronary arteries, moderate in the\naortic arch and descending thoracic aorta.  Aorta and pulmonary arteries are\nnormal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nExtensive motion artifact limits assessment of the pulmonary parenchyma. \nWithin these limitations, a moderate loculated left pleural effusion with\nassociated atelectasis obscures the left lower lobe mass.  Given the absence\nof contrast a superimposed pneumonia can not be ruled out.  Small right\npleural effusion with associated mild compressive atelectasis are unchanged.\nNo focal consolidation in the right lower lobe to suggest aspiration.   Right\nmiddle lobe (5: 161, 163), left upper lobe (5: 44) and left lower lobe (5:160,\n163) nodules ranging from 3-12 mm.\n\nCHEST CAGE:\nDiffuse osteopenia is noted. Mixed density lesions with coarsened trabeculae\nin the vertebral bodies of T9 and T10 with associated height loss may\nrepresent hemangiomas.  Ligamentum flavum and dural calcifications are noted\nat the T5-6 through T7-8 levels.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show 23 mm hypodense lesion in the right\nhepatic lobe most likely representing a hepatic cyst.  Adrenals are\nunremarkable.",
            "output": "1.  Moderate loculated left pleural effusion and associated atelectasis\npartially obscure the left lower lobe mass.  Given the absence of contrast\nadministration, superimposed pneumonia cannot be ruled out.\n2.  No developing focal consolidation in the right lower lobe.\n3.  Unchanged small right pleural effusion.\n4.  Multiple pulmonary nodules measuring between 3 and 12 mm, as detailed\nabove."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Normal thyroid gland. No enlarged\nor growing supraclavicular or axillary lymph nodes.  Breast assessment is\nreserved for dedicated breast imaging. Excluding the breasts, no soft tissue\nchest wall abnormality.  Mild atherosclerotic calcification of the imaged neck\narteries.\n\nUPPER ABDOMEN: This examination is not tailored for subdiaphragmatic\nassessment.  Allowing for this; simple hepatic cysts, measuring up to 2.1 cm,\nare stable.  Mild atherosclerotic calcification of the imaged upper abdominal\nvessels.\n\nMEDIASTINUM AND VASCULATURE: Allowing for moderate respiratory motion\nartifact; the pulmonary vasculature is well opacified to the subsegmental\nlevel without filling defect to indicate a pulmonary embolus.  A small\nperipheral pulmonary embolus cannot be excluded.  Allowing for the non gated\nnature of the examination, there is no evidence of acute aortic dissection or\nintramural thrombus. The thoracic aorta and pulmonary arteries are normal in\ncaliber.  Moderate atherosclerotic calcification of the thoracic aorta. Normal\nesophagus.  Subcentimeter mediastinal nodes, measuring up to 9 mm (5:75), not\nenlarged by size criteria no enlarged or growing mediastinal lymph nodes. No\nmediastinal mass.  There is an increase in the degree of rightward mediastinal\nshift, secondary to the large left pleural effusion.\n\nHILA: No enlarged or growing hilar lymph nodes, by size criteria.\n\nHEART and PERICARDIUM: Normal heart size. Moderate coronary artery\ncalcification.  No cardiac valve calcification. Physiologic pericardium.\n\nPLEURA: Large loculated left pleural effusion, increased in size.  No right\npleural effusion.  No pneumothorax.  Slight increase in the size of the left\nposterior pleural metastasis, which extends through the left posterior chest\nwall, now measuring 4.5 cm x 2.9 cm (5:227), previously measuring 4.6 cm x 2.6\ncm.\n\nLUNG:\n\n1. PARENCHYMA: Increase in the size of the heterogenous, irregular, lobulated\nsoft tissue mass in the left lower lobe, now measuring 9.6 cm x 7.8 cm,\npreviously measuring 8.7 cm x 7.5 cm.  Tumor tracks along the pleura\ninferiorly to the pleural lesion the described above.  There is unchanged\nextension into the left T9-T10 neural foramen, and spinal canal.  This would\nbe better assessed with a dedicated MRI thoracic spine.  Stable 5 mm middle\nlobe nodule (5:159).  No additional lung nodule or mass.  The left lower lobe\nis almost completely collapsed, which is slightly more marked compared with\nprior.  Mild right basilar atelectasis.  No consolidation.\n2. AIRWAYS:  There is ongoing complete occlusion of the left lower lobe\nbronchus likely secondary to invasion by the adjacent left lower lobe mass. \nThe tracheobronchial tree is otherwise patent to the subsegmental level. \nDiffuse bronchial wall thickening, likely inflammatory in nature.  No\nbronchiectasis.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  Unchanged moderate wedge compression fracture at T10 vertebral\nbody and mild wedge compression fracture T9 vertebral body.  No fracture. Mild\nspondylosis.",
            "output": "-No acute pulmonary embolism.\n-Large loculated left pleural effusion, increased in size, with an associated\nincrease in the degree of rightward mediastinal shift.\n-Increase in the size of the left lower lobe mass, which causes complete\nocclusion of the left lower lobe bronchus, and almost complete collapse of the\nleft lower lobe.\n-Extension into the left T9-T10 neural foramen and the spinal canal.  This\nwould be better assessed with a dedicated MRI thoracic spine.\n-Pleural tumor involvement, with the large pleur"
        },
        {
            "input": "Supraclavicular  lymph nodes are not enlarged.  Enlarged axillary lymph nodes\nbilaterally are again noted right greater than left.  Left subpectoral lymph\nnodes measure up to 9 mm.  Increasing number of mediastinal lymph nodes are\nagain noted measuring up to 10 mm in the left lower paratracheal station, 13\nmm in the right lower paratracheal station.  Enlarge hilar lymph nodes are\nbetter seen in prior CT with IV contrast.  The aorta is normal in caliber. \nThe main pulmonary artery is top-normal measuring 3 cm in maximum diameter. \nDense calcification in all coronary arteries, the mitral annulus and aortic\nvalve are again noted.  Hypodensity of the cardiac chambers compared to the\nmyocardium suggests anemia.  There is no pericardial effusion. Moderate\ncardiomegaly is stable.  There has been interval decrease in size in right\npleural effusion after thoracentesis.  There is no pneumothorax.  Ground-glass\nopacities in the right middle lobe are likely re-expansion pulmonary edema. \nThere are mild atelectasis in the right lower lobe.  Right perifissural nodule\nmeasures 5 mm (4:155, 149).  There is a 5 mm nodule in the right middle lobe\n(4:183).  There are scattered calcified granulomas.  Spiculated nodule in the\nleft apex measuring approximately 22 x 14 mm is unchanged, worrisome for\nprimary lung malignancy\nThere are 2 mm subpleural nodule in the left apex (___), in the right upper\nlobe (4:72), in the left upper lobe (4:84)\n\nThis examination is not tailored for subdiaphragmatic evaluation.  There is a\nlarge hiatal hernia.  A complex cystic lesion in the pancreas was better seen\nin prior CT\nThere are no bone findings of malignancy.  Degenerative changes in the spine\nand glenohumeral joints are again noted.",
            "output": "Spiculated nodule in the left upper lobe is worrisome for primary lung\nmalignancy\nIn the right lung no worrisome lesions are identified after thoracentesis with\nresidual ground-glass opacities consistent with re-expansion pulmonary edema. \nThere are remaining atelectasis in the right middle and right lower lobes and\nsmall right effusion.\nCoronary calcifications\nCalcification of the aortic valve is of unknown hemodynamic significance\nLarge paraesophageal hiatal hernia\nPancreatic lesion better evaluated on prior CT"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is obscured by beam\nhardening artifact.  No suspicious pulmonary nodules.  No supraclavicular\nadenopathy.  Subcentimeter axillary lymph nodes.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.\n\nMEDIASTINUM: No mediastinal adenopathy. Minimal fatty thymic tissue present in\nthe anterior mediastinum.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve or coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  No diffuse lung disease.  Minimal\nscarring/atelectasis in the lingula.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  This study was not tailored to evaluate for pulmonary emboli. \nThe pulmonary artery measures at the upper limits of normal.  No filling\ndefects to suggest pulmonary emboli.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "No suspicious pulmonary nodule or mass.  No incidental finding of note.\n\nThe apparent density seen on the chest x-ray is represented by an en face\nblood vessel."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation of the lobar and segmental branches is\ndegraded by streak artifact and motion artifact, no central pulmonary\nembolism.  Scattered partial filling defects the lobar, and segmental branches\nof the right lower lobe and left upper ___ be artifactual. \nAtherosclerotic calcifications of normal caliber thoracic aorta. Marked\natherosclerotic calcifications of the coronary arteries.  No pericardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, or hilar lymphadenopathy is\npresent.  Scattered prominent mediastinal lymph node, largest is a right\nparatracheal lymph node measuring 1 cm short axis, likely reactive. \nEndotracheal tube in satisfactory position, terminating above the carina.\n\nPLEURAL SPACES: Trace bilateral pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: Study is limited with motion artifact.  Upper lobes predominant\nmild paraseptal emphysema.  Scattered nodular opacities with bronchial wall\nthickening in the lingula and right middle ___ reflect\ninfectious/inflammatory process.  Bibasilar atelectasis.\n\nBASE OF NECK: Partially visualized thyroid is unremarkable.\n\nABDOMEN: Partially visualized enteric tube terminating in the gastric body.\n\nBONES: Chronic appearing severe compression deformity involving vertebral body\nof T8 with over 80% vertebral body height loss.  Additional chronic appearing\nmoderate compression deformity involving superior endplate of T5. \nDegenerative changes of the thoracic spine.",
            "output": "1. No central pulmonary embolism. Scattered small partial filling defects\nnoted in the lobar and segmental branches of the right lower lobe and left\nupper lobe are most likely related to motion artifact.\n2. Scattered ground-glass opacities with mild bronchial wall thickening in the\nlingula and right middle ___ reflect infectious/inflammatory process,\nsuch as aspiration pneumonitis.\n3. Bibasilar atelectasis with trace bilateral pleural effusions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Extensive coronary artery\ndisease.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple borderline and enlarged lymph nodes,\nthe largest in the right upper and right lower paratracheal stations measuring\n12 x 11 mm respectively (6: 55, 88).  No axillary, or hilar lymphadenopathy is\npresent.  No mediastinal mass.  An NG tube is seen coursing along the\nesophagus and ending at the distal stomach.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Moderate upper lobe predominant centrilobular emphysema. \nBibasilar atelectasis with trace pleural effusions are noted again, as well as\nsubsegmental atelectasis in the medial superior segments of the lower lobes\nbilaterally and in the the posterior right upper lobe.  Scattered bilateral\nlower lobe and posterior right upper lobe peribronchovascular nodular\nopacities are again noted and may reflect a small component of small airways\ndisease or aspiration..  The airways are patent to the level of the segmental\nbronchi bilaterally.  Endotracheal tube is stable in position.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Compression fractures of the ___ and ___ vertebral bodies, and and\nhealed fractures of the ___ and ___ left ribs.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nRe-demonstrated bibasilar and posterior midlung pectus cysts with trace\npleural effusions and adjacent nodular opacities, most likely secondary to\naspiration pneumonitis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: Supraclavicular and axillary lymph nodes are\nnot enlarged by CT size criteria.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.\n\nHILA: There is bilateral hilar lymphadenopathy, measuring 1.3 x 0.8 cm on the\nleft (201:34) and 1.6 x 1.4 cm on the right (201:29).\n\nHEART and PERICARDIUM: There is an ascending aortic aneurysm, measuring up to\n5.7 cm in maximal diameter (202:66).  There is dissection isolated to the\nascending aorta, spanning approximately 4.5 cm, and extending from the site\njust superior to the left main coronary artery origin (series 206, images\n35-38; series 202, image 56).  No evidence of aortic arch or descending aortic\ndissection.  No incidental central pulmonary arterial filling defect\nidentified.  Trace pericardial effusion is likely physiologic.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Paraseptal and mild centrilobular emphysema is most pronounced\nin the lung apices.  Bronchiectasis is most predominant in the bilateral lower\nlobes, where there are peripheral areas of nodular opacification and\nground-glass opacification and bronchial wall thickening compatible with an\nacute infectious process.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the imaged upper abdomen is unremarkable.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Multilevel degenerative changes of the thoracic spine are mild.",
            "output": "1.  Ascending aortic dissection, extending from the site just superior to the\nleft main coronary artery origin.  The dissection spans approximately 4.5 cm\nin the craniocaudal dimension.  No evidence of aortic arch or descending\naortic dissection.\n\n2.  Ascending aortic aneurysm, measuring up to 5.7 cm in maximal diameter.\n\n3.  Extensive bronchiectasis, most predominant in the bilateral lower lobes,\nwhere there are areas of peripheral nodular opacification and ground-glass\nopacification.  Findings are compatible with small airways disease and acute\ninfection.  Hilar lymphadenopathy is likely reactive in this setting.\n\nNOTIFICATION:  The above findings were communicated in person by Dr. ___ to\nDr. ___ in person at approximately 16:40 on ___, at time of\ndiscovery."
        },
        {
            "input": "The thyroid is normal.  No lymphadenopathy.  The ascending thoracic aorta is\nectatic.  Aortic calcification is moderate.  Aortic valvular calcification and\ncoronary artery calcification is also noted with top-normal heart size.  There\nis no pericardial effusion.  No pleural effusion.  There is no pleural\neffusion or pneumothorax. The airways are patent to subsegmental levels.\n\nThere is mild emphysema.  No worrisome nodule, mass, or consolidation.  No\ncontusion or laceration.\n\nIn the imaged portion of the upper abdomen, note is made of colonic\ndiverticulosis and partially imaged rim calcified right renal cyst.\n\nOSSEOUS STRUCTURES:\nMinimally  displaced fractures are seen along the right eighth, ninth, and\ntenth ribs, posteriorly. Minimal adjacent callus formation suggests a subacute\ninjury.  Several old left rib deformities noted. No worrisome lytic or blastic\nbony lesion.",
            "output": "Minimally displaced right rib fractures, posteriorly, 8 through 10."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries, none in the aorta or\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Continued growth of a right lower paratracheal\nstation lymph node now measuring 2.0 x 1.6 cm (5:84) with a necrotic center. \nMultiple other smaller mediastinal lymph nodes are noted in the superior\nmediastinum, all with slightly chronic centers.  A right hilar lymph node is\nslightly more prominent than prior study measuring 0.6 cm (5:111).\n\nPLEURA:\nNo pleural effusions.  Small right Bochdalek hernia.  Mild bilateral apical\nscarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  No suspicious lung nodules or masses.  No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Continued growth of the previously mentioned lymph nodes in the superior\nmediastinum, now larger and showing a necrotic center, suggestive of\nmetastatic disease.\n\nNo new or growing lung nodules or osseous lesions.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 15:21 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  An enlarged lymph node within the superior mediastinum\nmeasures 16 mm x 14 mm, decreased in size compared to the prior exam at which\ntime this measured 20 mm x 16 mm.  There has been slight interval decrease in\nsize of a right hilar lymph node, now measuring 8 mm, previously measuring up\nto 10 mm.  A 7 mm subcarinal lymph node appears grossly unchanged compared to\nthe prior exam.  There is no left hilar lymphadenopathy.  The esophagus is\nnormal however note is made of a small hiatal hernia.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however please refer to the dedicated CT of the abdomen performed\non same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nNew small right pleural effusion is seen.  No concerning new or growing\npulmonary nodules are identified.",
            "output": "-Interval decrease in size of a metastatic mediastinal lymph node, now\nmeasuring 16 mm x 14 mm, previously measuring 20 mm x 16 mm.\n-New small right pleural effusion.\n-No concerning new or growing pulmonary nodules identified."
        },
        {
            "input": "No incidental thyroid findings.  The lymph nodes in the soft tissues as well\nas in the thoracic inlet are all normal to borderline in size. However, a\nright paratracheal lymph node has substantially increased in size and now has\na diameter of 23 mm (2, 17).  2 para-aortic lymph nodes (2, 19 have also\nincreased in size.  Stable mild coronary calcifications, no valvular\ncalcifications, the posterior mediastinum is unremarkable, with the exception\nof a small hiatal hernia.  No relevant abnormalities are noted in the upper\nabdomen.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Moderate degenerative vertebral disease.  No vertebral\ncompression fractures.  Mild bilateral apical scarring.  The airways are\npatent.  The lymphadenopathy does not compromise the trachea.  No suspicious\npulmonary nodules or masses.  No effusions, the airways are patent.  No\ndiffuse lung disease.",
            "output": "Substantial increase in size of a right paratracheal lymph node that is now 23\nmm in diameter.  2 para-aortic lymph nodes have also substantially increased\nin size.  No other lymphadenopathy is noted.  No pulmonary nodules or masses. \nNo pleural effusions.  No diffuse lung disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Redemonstration of an enlarged right\nparatracheal lymph node which measures up to 3.4 x 2.4 cm, increased from the\nprior PET-CT when it measured approximately 3.0 x 2.3 cm.  Additionally, two\npre-vascular periaortic nodes have increased from the prior PET-CT, now\nmeasuring up to 9 and 10 mm in greatest short axis ___, previously 8\nand 6 mm, respectively.  No axillary or hilar lymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Minimal atelectasis is seen in the dependent aspects of both\nlower lobes.  Lungs are otherwise clear without masses or consolidative areas\nof parenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  There is mild airway wall thickening\ndiffusely.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrate\nbilateral cervical lymphadenopathy, more pronounced on the left, better\nassessed on same day CT neck.  Thyroid gland is unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a 2.9 x 1.9 cm\nperisplenic node, minimally increased from the prior PET-CT when it measured\n2.7 x 1.4 cm..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild increase in size of mediastinal and perisplenic lymphadenopathy.\n3. Airways are patent without mass effect.  Mild airway wall thickening could\nsuggest mild chronic bronchitis.\n4. Extensive cervical lymphadenopathy is better assessed on same day CT of the\nneck."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are increased in size from prior,\nmeasuring up to 9 mm in the right upper paratracheal station (03:54),\npreviously 2 mm, and 9 mm in the subcarinal station (3:96), previously not\nmeasurable.  A right paraesophageal lymph node measures 9 mm (3:137),\npreviously 3 mm.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  There is nodular thickening of the\nposterior medial pleura bilaterally at the level of T8-10 (3: 121, 139, 157).\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Increased size of multiple mediastinal lymph nodes, while below threshold\nfor pathologic enlargement, most likely metastatic.  Nodular thickening of the\nposteromedial pleura is similarly suspect for malignancy.\n2. No pulmonary metastases.\n3. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "The thyroid gland is unremarkable.  A borderline right lower paratracheal\nlymph node has slightly decreased measuring 7 mm in short axis, previously 11\nmm (2, 19).  There is no supraclavicular or axillary lymphadenopathy.\n\nMild cardiomegaly with multichamber enlargement is stable. The patient is\nstatus post CABG with mitral valve replacement. Aortic annular and coronary\nartery calcification is moderate. A moderate pericardial effusion is not\nappreciably changed. Diffuse low attenuation of the blood in the heart\nsuggests anemia. The main pulmonary artery and thoracic aorta are top-normal\ncaliber. Mild calcific atherosclerosis discontinuous involves the thoracic\naorta with relative sparing of the ascending aorta.\n\nA right lateral approach chest tube coils in the posterior pleural space.\nThere remains only trace right pleural fluid with mild associated atelectasis.\nA small right pneumothorax has decreased with interval resolution of a small\npocket of loculated fluid and air in the major fissure. A left lateral\napproach chest tube terminates in the inferior pleural space. A small\nloculated nonhemorrhagic left pleural effusion is not appreciably changed.\n\nExtensive left lower lobe mucous plugging results in persistent complete left\nlower lobe atelectasis and increased near complete lingular atelectasis. \nIncreased subsegmental ground-glass opacities, interlobular septal thickening,\nand bronchial wall thickening in the right lung is likely due to pulmonary\nedema.\n\nImages of the upper abdomen are unremarkable.",
            "output": "Persistent extensive left endobronchial mucous plugging results in increased\nnear-complete left upper and complete left lower lobe atelectasis.\n\nIncreased right lung ground-glass opacities and interlobular septal thickening\nare most likely due to pulmonary edema.\n\nResolving right hydropneumothorax with chest tube in place.\n\nStable moderate partially loculated nonhemorrhagic left pleural effusion.\n\nStable moderate pericardial effusion.\n\nAnemia."
        },
        {
            "input": "Thyroid is homogeneous. Small scattered axillary and mediastinal lymph nodes\ndo not meet criteria for lymphadenopathy. Scattered amorphous hyperdensities\nwithin the mediastinum, not present on the prior study are likely related to\nthe recent lymphangiogram from ___.\n\nThere is a small residual hypodense pericardial effusion, decreased\nsubstantially compared to the prior study. Postoperative changes related to\nprior CABG and mitral valve replacement are again noted. Lack of intravenous\ncontrast limits evaluation of the great vessels. A drain tracking along the\nanterior mediastinum possibly within the anterior pericardial space along its\ncourse with tip terminating in presumed extrapleural location anteriorly on\nthe left.\n\nLeft basal collapse consolidation appears similar to previous. A loculated for\ncavity containing fluid and gas along the lateral aspect of the left upper\nlobe measuring 4.3 x 2.5 cm (05:107) is slightly smaller. Small left and\nmoderate right pleural effusions layering dependently including a loculated\npocket at the right base medially are unchanged. Previously noted right\npneumothorax has resolved. Mild-to-moderate centrilobular emphysema and\nbiapical scarring is evident.\n\nTiny nodular densities in the right lower lobe (series 5, image 223) and right\nmiddle lobe (series 5, image 173)\n\nThere is a study is not optimized for evaluation of subdiaphragmatic\nstructures however, no gross abnormality is identified.\n\nNo lytic or sclerotic osseous lesion concerning for malignancy identified.",
            "output": "1.  Substantial decrease in size of pericardial effusion.\n\n2.  Stable appearance of bilateral pleural effusions as described above.\n\n3.  Right pneumothorax has resolved.\n\n4.  Left basal collapse consolidation unchanged.\n\n5.  Residual gas and fluid containing cavity along the left upper lobe\ndecreasing in size (this is likely a loculated pleural cavity extending into\nthe lung).\n\n6.  Some tiny nodular densities the right base (lower and middle lobe) warrant\nattention on followup examinations."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  No enlarged lymph nodes in either the axilla or\nthoracic inlet.  There are no chest wall abnormalities.  Moderate\natherosclerotic calcifications at the origin both subclavian.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  No enlarged mediastinal or hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Minimal\natherosclerotic calcifications in the coronary arteries none in the cardiac\nvalves.  Moderate calcifications in aortic arch. Aorta and pulmonary arteries\nare in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels, no bronchial wall\nthickening, bronchiectasis or mucus plugging.  Right lower lobe 5 mm nodule\n(6:248).  No focal consolidations.  Mild left basal subsegmental atelectasis. \nNo pleural effusion.  Mild biapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nStriated pattern of osteopenia without evidence of compressive or pathologic\nfractures.  No acute fractures.  Mild dorsal spondylosis.  No lytic or\nsclerotic lesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Right lower lobe 5 mm nodule.  Three-month follow-up is recommended to assess\ninterval change.\n\nRECOMMENDATION(S):  3 month follow-up imaging to assess interval change of the\nright lower lobe 5 mm nodule.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:41 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer CT abdomen pelvis performed at the same day for\nfurther detail.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion\nis identified.  There is mild atherosclerotic calcification involving the\nthoracic aorta and coronary arteries.\n\nPLEURA: No pleural effusion is identified.\n\nLUNG: The central airways are patent.  A right lung base 4 mm nodule (series\n4, image 177) is stable from previous study in ___.  There are\nbilateral lung apical scarring versus atelectasis.  A right lung apex 3 mm\nnodule is stable from ___ (series 4, image 52).  There is mild\ncentrilobular emphysema.  There are bilateral lung parenchymal scarring.\n\nCHEST CAGE: No suspicious osseous lesions are identified.  There is mild\ndegenerative changes of the lower cervical spine.",
            "output": "1. Right lung base 4 mm nodule and right lung apex 3 mm nodule stable since is\n___.\n2. Mild centrilobular emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid contains small nodules\ntoo small to warrant sonographic evaluation.  Supraclavicular and axillary\nlymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  There is a moderate\nhiatal hernia.  The intrathoracic esophagus is patulous.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.  Heterogeneously enhancing\nmass extending from the intrahepatic IVC into the right atrium is\nre-demonstrated with similar extent into the right atrium, although the\nintra-atrial component is less conspicuous due to timing of the contrast bolus\nwith the enhancing mass similar in attenuation to background blood pool within\nthe right atrium (13:44).\n\nVESSELS: Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is a 3 mm right lower lobe pulmonary nodule\ncontacting the lateral pleural surface (11:165).  No other pulmonary nodules\nare identified.  There is mild apical predominant centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  A rudimentary right L1 rib is\nnoted, a normal anatomic variant.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Re-demonstration of the large enhancing mass extending from the upper pole\nof the right kidney into the intrahepatic IVC and into the right atrium.  No\nconvincing evidence for intrathoracic metastatic disease.\n2. 3 mm right lower lobe pulmonary nodule for which attention on follow-up\nimaging is recommended.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST PERIMETER: 12 mm long low-density lesion in the left thyroid lobe was 7\nmm in ___ and should be evaluated with ultrasound.  Adjacent soft tissue is\nnormal.  Supraclavicular and axillary lymph nodes are not enlarged.  Patient\nhas had median sternotomy in the interim and bony fusion has not been achieved\nalthough the incised surfaces are closely apposed and there is no bone\ndestruction or associated fluid collection to suggest any complications.\n\nBreast evaluation is reserved exclusively for mammography.  There are no soft\ntissue findings elsewhere in the chest wall.  This study is not appropriate\nfor subdiaphragmatic diagnosis, especially with regard to the liver.  A\n\n\nCARDIO-MEDIASTINUM: Above the small hiatus hernia, mid esophagus is moderately\ndilated with air, not an indication of obstruction.\n\nAtherosclerotic calcification is not apparent in the head neck vessels and\nonly mild in left anterior and right coronary arteries.  Aorta and pulmonary\narteries are normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged,\nincluding diaphragmatic and retrocrural stations.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderately severe.\n\nNo lung nodules or other focal lung lesions of consequence.  Tracheobronchial\ntree is normal to subsegmental levels and there are no pleural abnormalities.\nTiny right lower lobe lung nodule is actually a calcified granuloma, 5:185. \nThere is no evidence of intrathoracic infection.\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No evidence of intrathoracic malignancy.\n\nNo osseous fusion as yet following median sternotomy in ___.  No evidence of\ninfection or other wound complications."
        },
        {
            "input": "THORACIC INLET: There is a 6 mm hypodense lesion within the left lobe of\nthyroid.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  Patient status post cardiac surgery.  There's a small hiatus\nhernia.  There's no pericardial effusion.  The aorta and pulmonary arteries\nare normal.\n\n\nPLEURA: No effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  There is upper\nlobe predominant emphysema.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Sternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nlesion within the right lobe of liver.  Patient status post right nephrectomy.\nNo adrenal masses",
            "output": "Stable 6 mm hypodense lesion in the left lobe of thyroid.\n\nNo new or growing pulmonary nodules.\n\nStatus post median sternotomy with sternal sutures intact.  Status post right\nnephrectomy."
        },
        {
            "input": "CHEST PERIMETER: 6 mm left thyroid low-density lesion is stable.  No thyroid\nfindings require further imaging evaluation.  Supraclavicular and axillary\nlymph nodes not enlarged.  Breast evaluation reserved exclusively for\nmammography.  No soft tissue abnormalities in the chest wall.  Findings below\nthe diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: As before, gastric hiatus hernia is small, mid esophagus\nis moderately patulous but filled only with air, not an indication of\nobstruction.  Atherosclerotic calcification is not apparent head neck vessels\nor in the coronary arteries.  Aortic valve is not calcified.  Aorta and\npulmonary arteries are normal size.  Evaluation of right atrial enlargement\nwould require echocardiography.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: None pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderately severe. Two 3-4 mm nodules\nright upper lobe, 304:38, 32, are stable since ___, but only one is\nvisible on ___.  Although that lesion is small enough to have been\npresent but not imaged.  A punctate left upper lobe nodule, 304:34 is also\nstable and a faint 3 mm ground-glass nodule left upper lobe, ___, was\nprobably present in ___ but not comparable.\n\nLungs otherwise clear.  Tracheobronchial tree is normal to subsegmental levels\nand there are no pleural abnormalities.\n\nCHEST CAGE: Demineralization in the sternum, most pronounced in the manubrium\ndates from median sternotomy, and has improved.  The sternal fragments are\nclosely apposed but not fused.  Nevertheless, there is no erosion or soft\ntissue abnormality to suggest infection and the sternal wires are intact.\n\nNo pathologic or compression fractures or destructive bone lesions.  Although\nthere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Tiny upper lobe lung nodules stable since at least ___, some since ___ are unlikely to be metastases, but will need to be followed.\n\nUnfused sternotomy fragments.  No evidence of sternal instability or\ninfection.\n\nRight atrial enlargement would require echocardiography for assessment.\n\nModerate emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. No\nsupraclavicular or axillary lymphadenopathy.\nRight upper back surgical scar with expected mild fat stranding.\n\nUPPER ABDOMEN: Few cortical cysts in the left kidney, remaining included upper\nabdominal organs are unremarkable.\n\nMEDIASTINUM: Borderline lymph node in the mediastinum up to 1 cm in the right\nlower paratracheal station are reactive.\nThere are no mediastinal collections and mild soft tissue thickening along the\nposterior aspect of the trachea, around main bronchi and bronchus intermedius,\nthe expected appearance after tracheobronchoplasty.  There are no mediastinal\ncollections.\nUpper esophagus mildly patulous and is unchanged.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart and major vessels are within normal size.  No\nappreciable atherosclerotic calcifications in the coronaries.  Soft tissue\nplaques along the descending aorta.  There is no pericardial effusion.\nIn this nondedicated study there is no evidence of central pulmonary embolism.\n\nPLEURA: Small loculated right pleural effusion extends into the fissures. \nThere is no pneumothorax.\n\nLUNG: Minimal secretions in the upper trachea, otherwise airways are patent to\nsubsegmental level.\nMinimal atelectasis seen adjacent to the right small pleural effusion. Small\nleft lower lobe  consolidation with irregular margins is concerning for\npneumonia. Minimal heterogeneous ground glass opacities in the left upper lobe\nare concerning for additional foci of pneumonia.\n\nCHEST CAGE: Postsurgical changes in the right sixth rib.  Status post internal\nfixation of cervical vertebra.  No evidence of osteo-destructive lesions.",
            "output": "-Small right pleural effusion is partly loculated with adjacent minimal\natelectasis.\n-Left lung base consolidation and heterogeneous ground glass opacities in the\nleft upper lobe are concerning for pneumonia, possibly due to aspiration,\nparticularly in the presence of mild tracheal secretions."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild left basilar atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  There is a 4 mm\nright upper lobe perifissural nodule (6:95).  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  The common bile duct is mildly\nprominent measuring up to 7 mm (601:29), similar to prior exam.  No\nintrahepatic biliary ductal dilatation.  The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes related to Roux-en-Y with partial\ngastrectomy are demonstrated.  Postsurgical changes are also noted status post\nappendectomy.  Slight haziness of the fat along the appendectomy site is\nlikely postsurgical.  No drainable fluid collection is seen.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding.  The appendix is surgically absent.  There is no\nfree intraperitoneal fluid or free air.  No evidence of extraluminal contrast\nextravasation.  No bowel obstruction.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: 4 mm sclerotic focus in the T2 vertebra may reflect a\nbone island (605:36).  There is no evidence of worrisome osseous lesions or\nacute fracture.  Soft tissue densities in the left upper and lower anterior\nabdominal wall may be postsurgical in the setting of recent laparoscopic\nsurgery (02:45, 59).",
            "output": "1. No evidence of pulmonary embolism.\n2. No acute findings in the abdomen or pelvis to account for patient's\nsymptoms.  Specifically, no evidence of bowel obstruction.\n3. Postsurgical changes related to Roux-en-Y gastric bypass with partial\ngastrectomy as well as postsurgical changes status post appendectomy.  No\nevidence of free intraperitoneal air or extraluminal enteric contrast.  No\ndrainable fluid collection.\n4. 4 mm right upper lobe perifissural nodule.  Please refer to ___\ncriteria below for follow-up recommendations.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is heterogeneous with\nat least one discrete 0.6 cm hypoattenuating nodule in the left thyroid lobe\n(5:1) which does not warrant further sonographic evaluation. No\nsupraclavicular or axillary lymphadenopathy.  Evaluation of the breasts is\nreserved for mammographic evaluation.\n\nUPPER ABDOMEN: Please see separate same day report of the CT abdomen and\npelvis for description of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy or suspicious mediastinal mass. \nThe distal esophagus is patulous.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is a 4 mm right lower lobe pulmonary nodule (6:133). \nOtherwise, no masses or areas of parenchymal opacification throughout the\nbilateral lungs.\n2. AIRWAYS:  Airways are patent to the segmental level bilaterally.\n3. VESSELS:  The thoracic aorta is normal in caliber and course.  The main\npulmonary artery is normal in diameter.\nCHEST CAGE: No acute fracture.  No suspicious lytic or sclerotic osseous\nlesion within the sensitivity of CT.",
            "output": "1. 4 mm right lower lobe pulmonary nodule is indeterminate and was too small\nto characterize by recent PET-CT.  The need for further follow-up should be\nbased on management of extrathoracic primary malignancy.\n2. Please see separate same day report of the CT abdomen and pelvis for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Two 6 mm right supraclavicular lymph nodes, 06:44, are new since CT ___. There is no left supraclavicular or axillary lymph node enlargement and\nno soft tissues in the chest wall suspicious for malignancy. Evaluation of the\nbreasts requires mammography. Findings below the diaphragm will be reported\nseparately.\n\n9 x 11 mm left hilar lymph node, 6:154, is new. 7 x 11 mm right lower\nparatracheal node, 6:124, was 9 x 14 mm in ___. Small pericardial effusion\nis stable since ___. There is no pleural effusion. Atherosclerotic\ncalcification or mural thrombus is heavy at the origin of the left subclavian\nartery, 05:18, a chronic finding, and sporadic in the descending portion of\nthe thoracic aorta which is normal caliber through right lung is clear.\n\nThe volume of tissue in post treatment scarring in the left upper lobe\ncontinues to decrease, 05:25- 27. There are no left lung lesions concerning\nfor tumor recurrence.\n\nMild thickening of the wall of the lower esophagus is stable. There is no\nappreciable aortic valvular calcium. Pulmonary arteries are normal size.\n\nSclerosic healing of the large, expansile metastasis in the left second rib\nhas progressed. A 12 x 14 mm lytic metastasis in the T9 vertebral bodies\nminimally larger, but there is no loss of height. The 2 vertebrae below that\nshow mild central compressions, probably not pathologic. Findings in the\nlumbar spine will be reported separately. Sternum is intact.\n\n\n\n\n\n\n\n.",
            "output": "2 new sub cm right supraclavicular and 10 mm left hilar lymph nodes,\nsuspicious for malignancy.\n\nContinued involution, treated left upper lobe mass.\n\nSclerotic healing, expansile left second rib metastasis. Lytic T9 vertebral\nbody metastasis minimally larger."
        },
        {
            "input": "As compared to the previous CT examination from ___, any\nimprovement is noted.  The extent of the pre-existing left pleural effusion\nhas substantially decreased. The effusion is now small.  The pre-existing left\nlung parenchymal opacities and consolidations have almost completely resolved.\nCurrently subtle opacities are likely atelectatic and only seen adjacent to\nthe small left pleural effusion. The appearance of the right lung, including\nthe relatively extensive right pleural effusion is unchanged.\n\nUnchanged massive cardiomegaly. Overall, the extent of the pre-existing\npericardial effusion has not substantially changed.  The extent of the\neffusion is best assessed at the level of the left atrium and measures 3 cm in\ndiameter at its largest point.  A small subpleural air collection (2, 29)\ncould originate from a pericardial drain that was placed in the interval. The\n___ of the cardiac chambers as well as the positions of the pacemaker\nleads are constant. Unchanged appearance of the large mediastinal vessels.\nMild mediastinal adenopathy is present in almost unchanged manner. No change\nin appearance of the bones and of the upper abdomen.",
            "output": "The overall dimension of the known pericardial effusion has not substantially\nchanged. The maximum diameter of the effusion is still around 3 cm. \nSubstantial decrease in extent of the left pleural effusion. Almost complete\nresolution of the pre-existing left parenchymal opacities.  On the right, the\npre-existing effusion is unchanged."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple mediastinal lymph nodes are prominent for example, a 7\nmm prevascular lymph node (series 3, image 64).\n\nHILA:  Although difficult to discretely measure to the phase of IV contrast,\nthere is a moderate degree of right hilar adenopathy.  Left hilar lymph nodes\nare difficult to discretely measure given the phase of contrast, however\nappear prominent.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nExtending from immediately distal to the aortic arch there is crescentic mural\nthickening without enhancement, calcification or evidence of dissection. \nThese findings are most consistent with an atypical atheroma, however aortitis\ncannot be excluded.  The main pulmonary artery is within normal limits.  There\nis moderate enlargement of the right and left main pulmonary arteries\nmeasuring up to 3.2 cm.  Assessment for pulmonary embolus is limited by\npatient motion.\n\nPULMONARY PARENCHYMA:  The study is significantly limited by motion. \nExtensive bilateral subpleural ground-glass opacities likely represent\natelectasis.  There is no evidence of infection or malignancy.  There is no\nemphysema.\n\nAIRWAYS:  A rounded secretion is noted in the trachea immediately proximal to\nthe bifurcation.  The airways are patent.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  A large sclerotic lesion in the left proximal acromion\nmay represent a large bone island.\n\nUPPER ABDOMEN:  For evaluation of the abdomen please see the CT abdomen pelvis\nfrom the same date.",
            "output": "1. Crescentic thickening of the aortic wall without significant calcification\nor evidence of enhancement may represent an atypical atheroma, less likely\naortitis.  There is no evidence of dissection.  MR is recommended for further\nevaluation.\n2. There is extensive right hilar lymphadenopathy and prominent left hilar and\nmediastinal lymph nodes.  Clinical correlation is recommended.\n3. Prominence the right and left main pulmonary artery are suggestive of\npulmonary hypertension."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNone tracheal diverticulum (6, 41).\n\nBreast, chest wall and bones:\nStable normal sized mediastinal lymph nodes (3, 15).\n\nMediastinum:\nStable mild aortic wall calcifications.\n\nHila:\nNo abnormalities.\n\nHeart:\nStable moderate cardiomegaly.\nStable moderate coronary calcifications.\n\nUpper Abdomen:\nNo abnormalities.\n\nLung:\n\nNodules:\n\nDominant nodule:\nThe pre-existing 9 mm nodule in the right upper lobe has increased in size,\nfrom approximately 9 to approximately 15 mm.  The nodule is now irregular and\nspiculated.\n\nOther nodules:\nStable 2 mm solid nodule in the left lower lobe (6, 217).\nA pre-existing small left upper lobe nodule is no longer visualized on today's\nexamination.\n\nParenchyma:\nStable mild upper lobe predominant paraseptal pulmonary emphysema.\n\nPleura and airways:\nStable mild thickening and irregularities of the airway walls.",
            "output": "Growing and increasingly irregular right upper lobe pulmonary nodule.\n\nLUNG-RADS CATEGORY AND RECOMMENDATION:  Lung-RADS category: Lung-RADS 4X: The\nexamination will be presented at our weekly multidisciplinary thoracic\noncology conference where further management will be discussed.\n\n\n\nINCIDENTAL FINDINGS AND RECOMMENDATIONS:  None.\n\nManagement recommendations for incidental findings within the LungHealth\u00ae\nprogram are based on a multidisciplinary consensus document of our institution\nspecifically designed for this program.\n\nLUNG-RADS CATEGORIES, DESCRIPTION:  Lung-RADS 0: This category designates an\nincomplete or diagnostically insufficient CT examination.\nLung-RADS 1: This category designates the absence of nodules, or the presence\nof definitely benign nodules.\nLung-RADS 2: This category designates the presence of nodules with a very low\nlikelihood of becoming a clinically active cancer due to size or lack of\ngrowth.\nLung-RADS 3: This category designates probably benign nodules with a low\nlikelihood of becoming a clinically active cancer but with features that\nrequire confirmatory imaging follow-up.\nLung-RADS 4A: This category designates nodules that require additional\ndiagnostic imaging.\nLung-RADS 4B and 4X: This category designates nodules that require additional\ndiagnostic testing and/or tissue sampling. Nodules in this category are\npresented at the weekly multidisciplinary thoracic oncology conference of our\nprogram.\nS (with any category): This qualifier designates the presence of a relevant\nincidental (= distinct from lung cancer) finding, for which a specific\nmanagement recommendation is made.\nC (with any category): Prior diagnosis of lung cancer."
        },
        {
            "input": "THORACIC INLET: Partially imaged thyroid gland is homogeneous.Mildly prominent\nbut not pathologically enlarged left supraclavicular lymph node.\n\nBREAST AND AXILLA  : Small bilateral axillary lymph nodes are not\npathologically enlarged.\n\n\nMEDIASTINUM: Small scattered mediastinal lymph nodes are not pathologically\nenlarged no hilar lymphadenopathy is seen.\n\nHEART, VESSELS and PERICARDIUM: No pericardial effusion is seen.  Some\ncoronary calcifications are again seen.  There is small amount of focal\neccentric mural thrombus in the descending thoracic aorta, series 2, image 42.\n\nPLEURA: No pleural effusion or pneumothorax is seen.\n\nLUNG:\nPatient is status post interval right upper lobectomy with associated\npostsurgical changes.  Small amount of lung is herniated at the anterior rib\nspace between the right second and third ribs.  No definite evidence of\ndisease recurrence is seen.  There is no new worrisome pulmonary nodule.\n\nA small posterolateral right tracheal diverticulum at the thoracic inlet is\nredemonstrated.\nBONES : No concerning osteoblastic or lytic lesion is seen.\n\nUPPER ABDOMEN: Images of the upper abdomen demonstrate atherosclerotic changes\nalong the aorta.  There is a small hiatal hernia.  Punctate calcification in\nthe liver on series 2, image 60, again seen, possibly granuloma.",
            "output": "Status post right upper lobectomy with associated postsurgical changes.  No\nfindings to suggest disease recurrence."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid is\nunremarkable.  The thoracic aorta is normal in course and caliber without\nsignificant atherosclerotic calcification.  The heart is normal in size and\nshape without pericardial effusion.  There is moderate coronary artery\ncalcification.  The esophagus appears decompressed.  There is no mediastinal,\nhilar, or axillary lymphadenopathy.\n\nPostsurgical changes are seen within the right lung reflecting prior right\nupper lobectomy.  No pleural effusion or pneumothorax.  There is a right lower\nlobe nodule seen best on series 4, image 178 measuring 5 mm which is unchanged\nfrom the prior CT exam.  Another area of irregular nodular opacity in the\nright lower lobe is seen on series 4, image 169, unchanged, likely scarring. \nNo new or growing nodule is seen.\n\nWithin the imaged portion of the upper abdomen, there is no abnormality.\nBones: There is no worrisome lytic or blastic osseous lesion.  No fracture.",
            "output": "No new or growing pulmonary nodule.  Small irregular nodules in the right\nlower lobe appear unchanged.  Postsurgical changes related to prior right\nupper lobectomy."
        },
        {
            "input": "Aorta and great vessels are unremarkable without dissection or aneurysm.  The\npulmonary arteries are well opacified to the segmental level without filling\ndefect to suggest pulmonary embolism.  Subsegmental branches are not well\nassessed.  The pulmonary arteries are normal in caliber.\n\nHeart size is normal. There is no pericardial effusion.\n\nThere is no consolidation, pleural effusion or pneumothorax.  The airways are\npatent to the subsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nLimited images of the upper abdomen are unremarkable.  There is a small hiatal\nhernia.\n\nNo suspicious osseous lesions identified.  There is no acute fracture.",
            "output": "No pulmonary embolism or acute aortic abnormality.  No acute findings in the\nchest to explain symptoms."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size. \nThe heart size is normal and there is no pericardial effusion.\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild diffuse\nbronchial wall thickening.  Multiple calcified nodules scattered throughout\nthe lungs.  Additional sub 4 mm micro nodules that are noncalcified (05:37,\n105, 126, 131, 142, 169, 184).  Mild linear scarring and atelectasis of the\nlingula and lower lobes bilaterally.\n\nBONES AND CHEST WALL:  Along the left seventh rib laterally there is sclerosis\nalong the inferior margin (7:73) and was present in ___ abdominal\nCT.  There is also focal sclerosis involving the left sixth rib and right\neighth rib laterally also present in ___, have a benign appearance.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, left-sided Bochdalek's hernia containing only fat.  Multiple renal\ncysts in the right kidney are partially imaged.  Uncomplicated diverticulosis.\nSmall hiatal hernia.  The remaining upper abdomen is unremarkable.",
            "output": "Nonspecific sclerosis of the left sixth and seventh right a ribs stable since\n___ and have a benign appearance.\n\nMultiple calcified and noncalcified nodules likely related to prior\ngranulomatous exposure.\n\nLarge Bochdalek hernia containing only fat.\n\nMultiple renal cyst only partially visualized."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is mildly tortuous, otherwise\nnormal in caliber.  Mild atherosclerotic calcifications are seen at the\norigins of the right innominate and left subclavian arteries.  Coronary\narterial calcifications are also present.  The heart is mildly enlarged. \nThere is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent and borderline enlarged\nlymph nodes are noted within the mediastinum and hilar regions.  No\nmediastinal masses identified given limitations of noncontrast enhanced\nexamination.  A small hiatal hernia is present.  There is no axillary\nlymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is severe honeycombing throughout the lungs.  Extensive\nassociated traction bronchiectasis and bronchial thickening are present.  A\nlarge area of consolidation is identified in apical segment of the right lower\nlobe, corresponding to chest radiograph findings.  This was not present on the\nprior chest CT examination from ___.  There is dependent atelectasis\nwithin the right upper lobe.  Minimal scattered air bronchogram is noted\nwithin the consolidation.  No consolidative changes are apparent in the left\nlung. There is biapical scarring.  No definite discrete pulmonary nodule is\nidentified.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The included upper abdomen demonstrates cholelithiasis without\nfindings to suggest acute cholecystitis.  An 8 mm calcific density is noted\nwithin the herniating portion of the gastric fundus at the level of the\ndiaphragm.  This may relate to ingested material, however appears to be\nembedded within the posterior mucosal wall.  Several prominent crural lymph\nnodes are identified, measuring up to 0.9 cm in short axis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Large consolidation within the apical segment of the right lower lobe,\nfavoring pneumonia given clinical symptoms of infection.\n2.  Extensive interstitial fibrosis throughout bilateral lungs.\n3.  Small hiatal hernia with coarse calcification within the posterior mucosal\nwall, of uncertain significance.  Several prominent and enlarged crural lymph\nnodes are present. Nonurgent endoscopy can be considered if clinically\nindicated.\n\nRECOMMENDATION(S):  Followup chest CT should be obtained following treatment\nof presumed pneumonia to exclude an underlying mass."
        },
        {
            "input": "HEART AND VASCULATURE: Heart is mildly enlarged.  There is redemonstration of\natherosclerotic calcification involving the coronary arteries and thoracic\naorta.  The main pulmonary artery is mildly dilated measuring 3.1 cm\nsuggestive of pulmonary hypertension.  There is decreased attenuation of the\ngreat vessel lumen consistent with anemia.\n\nAXILLA, HILA, AND MEDIASTINUM: There are multiple enlarged mediastinum lymph\nnodes measuring up to 2.8 cm in short axis in the subcarinal region (series 2,\nimage 29).  There are bilateral axillary subcentimeter lymph nodes.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  There is redemonstration of bilateral lung diffuse honeycombing,\ntraction bronchiectasis and peribronchial wall thickening consistent with\npulmonary fibrosis.  There is redemonstration of right lower lobe apical\nsegment consolidation interval worsening from previous study.  There is\ninterval increased right small pleural effusion with associated atelectasis.\n\nABDOMEN: There is a small hiatal hernia.  The partially visualized liver,\nspleen, pancreas, adrenal glands, bilateral renal upper pole grossly\nunremarkable.  There is cholelithiasis in the partially visualized\ngallbladder.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is mild multilevel degenerative changes of the thoracic spine.",
            "output": "1. Similar to slightly increased in size of right lower lobe consolidation\nwith possible slight increase in size of right small pleural effusion.  Again\nfindings may represent pneumonia, but underlying neoplastic process is not\nexcluded.\n2. Grossly similar mediastinum lymphadenopathy measuring up to 2.8 cm in short\naxis at the subcarinal region.\n3. Other chronic/incidental findings described as in above."
        },
        {
            "input": "CHEST:  The thyroid is unremarkable.  There is no axillary, supraclavicular,\nor mediastinal adenopathy.  Heart size is normal.  There is no pericardial\neffusion.  Coronary artery calcifications are moderate.  Aortic valvular\ncalcifications are severe.  The main pulmonary trunk is not dilated.\n\nThe airways are patent to the subsegmental level bilaterally.  Paraseptal and\ncentrilobular emphysema is mild.  There is no focal lung consolidation.  There\nis no suspicious pulmonary nodule.  There is no pleural effusion,\npneumothorax, or pneumomediastinum.  There is mild bibasilar atelectasis.\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\nare normal.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.  A sclerotic lesion\nin the T5 vertebral body statistically likely represents a bone island.  There\nare multiple chronic compression deformities of the upper thoracic spine as\nwell as healed posterior left rib fractures.\n\nCTA:  The thoracic aorta is moderately tortuous with mild atherosclerotic\ncalcifications.\n\nCARDIAC MORPHOLOGY:  The right atrium is normal.  The right ventricle is\nnormal.  The left atrium is normal.  The left ventricle is normal.  No\nintraluminal thrombus is seen.  The pericardium is normal and there is no\npericardial effusion.  The aortic valve is tricuspid with leaflet\ncalcification.  Coronary artery calcification is conventional.\n\nMEASUREMENTS:\nAortic valve:  24 x 31 mm\nAortic annulus:  43 x 33 mm\nProximal ascending aorta:  40 x 38 mm\nMid ascending aorta:  44 x 42 mm\nDistal ascending aorta:  35 x 32 mm\nProximal aortic arch:  33 x 30 mm\nMid aortic arch:  32 x 30 mm\nDistal aortic arch:  31 x 29 mm\nProximal descending aorta:  30 x 28 mm\nDistal descending aorta:  25 x 27 mm",
            "output": "1. Ascending aortic aneurysm measuring up to 44 mm, followup CT is recommended\nin 1 months to evaluate for stability.\n2. Severe calcifications of the aortic valve.\n\nRECOMMENDATION(S):  ___ year followup chest CTA with EKG gating to re-evaluate\nstability of the ascending aortic aneurysm."
        },
        {
            "input": "There is a small apical left pneumothorax.  No evidence of tension is seen. \nThere are small to moderate bilateral pleural effusions with overlying\natelectasis.  No pericardial effusion is seen.\n\nThe heart is moderately to markedly enlarged.  Coarse aortic valve\ncalcification is seen.  There also coarse calcifications along the imaged\nthoracic aorta.  Coronary artery calcifications are seen.  The aorta is normal\nin course and caliber.\n\nMild to moderate centrilobular pulmonary emphysema is seen.  There is a subtle\nground-glass opacity left upper lobe, difficult to accurately measure,\npossibly approximately 1 cm; unclear whether this could represent small focus\nof infection/inflammation, or related slow-growing bronchioalveolar carcinoma.\nPunctate right middle lobe calcified granuloma is seen.\n\n\nNo acute rib fracture seen.  Chronic appearing deformity of the proximal to\nmid sternal body suggests old fracture.",
            "output": "1.Small left apical pneumothorax without tension.  No acute rib fracture seen.\nOld sternal fracture.\n\n2.  Small to moderate bilateral pleural effusions.\n\n3.  Subtle left upper lobe ground-glass opacity measuring approximately 1 cm,\ncould represent slow growing the bronchioloalveolar carcinoma versus small\nfocus of infection.\nIf clinically appropriate, for an incidentally detected single ground-glass\nnodule bigger than 6mm, CT follow-up in 6 to 12 months is recommended to\nconfirm persistence. If persistent, CT follow-up every ___ years until ___ years\nafter initial detection are recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n4.  Cardiomegaly and extensive atherosclerotic calcifications, including at\nthe aorta, aortic valve, and coronary arteries.\n\nRECOMMENDATION(S):  If clinically appropriate,\nFor an incidentally detected single ground-glass nodule bigger than 6mm, CT\nfollow-up in 6 to 12 months is recommended to confirm persistence. If\npersistent, CT follow-up every ___ years until ___ years after initial detection\nare recommended."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal diameter.  Severe\natherosclerotic calcification is seen within the thoracic aorta.  There also\nextensive valvular and moderate coronary calcifications.  The heart is\nenlarged.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple subcentimeter pretracheal and\nsubcarinal lymph nodes a likely reactive.  Limited evaluation for hilar\nlymphadenopathy in the absence of intravenous contrast.\n\nPLEURAL SPACES: Bilateral moderate pleural effusions, greater on the left.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Upper lobe dominant mild centrilobular emphysema is present. \nThere are scattered parenchymal cysts in the bilateral upper and lower lobes.\nSubsegmental atelectasis is seen in both lower lobes.\nAga there is fluid within the left horizontal fissure.  No focal consolidation\nis noted.  Scratch the airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Cholelithiasis noted.  The right kidney is atrophic and demonstrates\nmultiple hypodensities within it.  There is severe atherosclerotic\ncalcification of the upper abdominal aorta.\n\nBONES: Acute displaced fracture of the posterior left ___ and eleventh rib\n(series 2, image 60, 56).\nA nondisplaced fractures of the left posterior ___ through tenth left ribs\n(series 601, image 81, 80, 76).  There is a chronic fracture of the superior\nsternum.",
            "output": "1.  Acute displaced fracture of the posterior left eleventh and 12th rib and\nacute nondisplaced fractures of the posterior ___ through ___ left ribs.\n2.  Bilateral large pleural effusions, left greater than right similar to the\nprevious study from 2 days prior.\n3.  No pneumothorax."
        },
        {
            "input": "Supraclavicular and axillary new lymph nodes are not pathologically enlarged. \nThere are no soft tissue lesions in the chest wall suspicious for malignancy. \nThis study is not designed for subdiaphragmatic diagnosis.\n\nET tube is in standard placement.  Central lymph nodes in the chest are not\npathologically enlarged.\n\nAtherosclerotic calcification is minimal in head and neck vessels, but found\nin at least the left main and proximal anterior descending coronary arteries. \nVery small pericardial effusion is physiologic, but new since ___, along\nwith very small bilateral pleural effusions. Mediastinal and hilar lymph nodes\nare not pathologically enlarged, the former ranging in diameter up to 10 mm\nacross.  In the subcarinal station, 5:133. There is no bronchial narrowing or\nother interference with vital structures.\n\nThe bulk, if not all, of the dependent consolidation along the posterior chest\nwall and diaphragm is probably atelectasis but some consolidation deep in the\nlung bases, accompanied by mildly dilated bronchi could be pneumonia. Lungs\nare otherwise clear.\n\nET tube is in standard placement. There are no bone lesions in the chest cage\nsuspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nNew small pericardial and tiny pleural effusions could be due to hemodynamic\ndecompensation.\n\nBibasilar consolidation largely if not entirely atelectasis."
        },
        {
            "input": "An upper pole left posterior paratracheal oval shaped density measuring 1.9 x\n1.5 cm is unchanged since ___ image 9, series 2.  It is\ninseparable from the lateral wall of the esophagus at this level.\n\nHeart size is normal, and diffuse coronary artery calcifications are present. \nThere is no pericardial or substantial pleural effusion.\n\nWithin the lungs, scattered areas of linear scarring are again demonstrated as\nwell as mild emphysema with combined centrilobular and paraseptal features. \nNo new or growing pulmonary nodules are detected.  Skeletal structures of the\nthorax demonstrate no new suspicious lytic or blastic lesions in the thorax. \nMarked bilateral gynecomastia is noted.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but this region\nhas been fully assessed by a dedicated multiphasic CT of the abdomen ___.  In comparison to that study, within the limitations of this assessment,\nwith no new concerning findings are evident in the upper most portion of the\nabdomen.",
            "output": "1.  No new or growing pulmonary nodules to suggest metastases.\n\n2.   Upper mediastinal paraesophageal soft tissue density is unchanged since\n___.  Although not fully characterized on the CT, the long-term\nstability is highly suggestive of a benign etiology.  Differential diagnosis\nincludes a paraesophageal lesion such as a complex duplication cyst and a\nhyperplastic lymph node.\n\n3. Please see full report of recent abdominal CT of ___ for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Left paratracheal hypodensity is 15 x 19 mm, unchanged since previous\nexamination.  No mediastinal, hilar or axillary lymphadenopathy is present. \nSubstantial gynecomastia is unchanged.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  No concerning\npulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nExtensive degenerative changes in the left glenohumeral joint are present.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nUnchanged upper mediastinal paraesophageal soft tissue density.  The long-term\nstability is in favor of benign etiology.\n\nPlease see full report of the CT abdomen obtained on the same day for\nassessment of the upper abdominal findings."
        },
        {
            "input": "Subcentimeter supraclavicular and axillary lymph nodes are not enlarged. \nGynecomastia is severe and symmetric.  Elsewhere in the chest wall there are\nno soft tissue abnormalities concerning for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nThyroid is heterogeneous but there are no findings warranting further imaging\nevaluation.\n\nAtherosclerotic calcification is not apparent in head neck vessels but is\npresent in at least the proximal left anterior descending coronary artery. \nAorta and pulmonary arteries are normal size.  Left ventricle is probably\ndilated.  Air in the right ventricle and pulmonary outflow tract is not\nrelated to an intravenous injection, since contrast was not administered in\nour department.  An attempt was made to notify the referring physician of\npossible intravenous line complications.\n\nThe pericardium is physiologic.  There is no pleural effusion.\n\nEsophagus is unremarkable.\n\nIntrathoracic lymph nodes:\n\n14 x 25 mm soft tissue nodule or high attenuation cyst at the thoracic inlet,\n302:21, is unchanged.  Central lymph nodes are not enlarged.\n\nLungs and airways:\n\nParaseptal emphysema is mild.\n\nSubpleural ground-glass and higher attenuation opacification in the lower\nlungs is probably atelectasis.  Tracheobronchial tree is normal to\nsubsegmental levels.\n\nChest cage:\n\nUnremarkable.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nCoronary atherosclerosis.\n\nNOTIFICATION:  Four pages placed to the covering physician, ___\nproduced no response."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without evidence of\nfocal injury, dissection, or aneurysm.  There is no mediastinal hematoma.  The\nairways centrally patent.  The main pulmonary artery and central branches\nappear patent.  The heart is normal in size and shape.  No pleural or\npericardial effusion is seen.\n\nVery subtle ground-glass opacity within the right upper lobe is seen on series\n2 image 37 through 41 which could represent minimal contusion.  There is mild\nbasal dependent atelectasis.  No worrisome nodule or mass.  No evidence of\nlaceration or hemothorax.  No pneumothorax.\n\nABDOMEN:  The liver and spleen appear intact without focal abnormality.  The\ngallbladder, pancreas, adrenal glands appear normal.  The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis or focal\nlesion of concern. The abdominal aorta is normal in course and caliber with\nwidely patent major branches. There is no retroperitoneal hematoma or\nlymphadenopathy. No free air or free fluid is seen.\n\nThe stomach and duodenum are normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal. No free pelvic fluid.  Incidental note of colonic diverticulosis\nwithout evidence of diverticulitis.  Urinary bladder is partially distended\nappearing normal.  No pelvic free fluid.  Prostate is normal in size.  No\npelvic sidewall or inguinal adenopathy.\n\nBONES:  No osseous injury.  No worrisome bony lesions.  Mild-to-moderate\ndegenerative disc disease at L5-S1 is noted.",
            "output": "Very minimal ground-glass opacity in the right upper lobe could represent\nsubtle contusion.  Otherwise, no acute sequelae of trauma."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection. Evaluation of the pulmonary arterial tree is limited secondary to\nsuboptimal timing of the contrast bolus. Within this limitation, there is no\nevidence of central or segmental pulmonary embolism. The remainder of the\ngreat vessels have a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. Numerous enlarged bilateral axillary lymph nodes are\nnoted, measuring up to 1.2 cm. Multiple prominent mediastinal and\nsupraclavicular lymph nodes are noted, none of which are pathologically\nenlarged by CT size criteria. Bilateral hilar lymph nodes are grossly\nunremarkable in appearance. The heart and mediastinum are normal. The\npericardium is intact without effusion. Airways are patent to the subsegmental\nlevels.\n\nA calcified granuloma measuring 5 mm is again noted in the right lower lobe\n(2:76). Linear scarring versus atelectasis is seen within the lingula. The\nlungs are otherwise clear without focal abnormality. There is no evidence of\npleural effusion or pneumothorax.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nAlthough this study is not tailored for the examination of subdiaphragmatic\ncontents, the imaged portions of the intra-abdominal organs are grossly\nunremarkable.",
            "output": "1. Limited examination secondary to contrast bolus timing. No large central or\nsegmental pulmonary embolism.\n2. Bilateral axillary lymphadenopathy."
        },
        {
            "input": "CT thorax: The airways are patent to the subsegmental level. There is no\nmediastinal, hilar, or axillary lymph node enlargement.  The heart,\npericardium, and great vessels are within normal limits. Lung windows\ndemonstrate minimal focal areas of atelectasis within the right lower lung\nbase and left upper lung (3:176, 157, 143). No pleural or pericardial\neffusion. No pneumothorax.\n\nCTA thorax: Limited evaluation due to poor opacification of the main pulmonary\nartery. The aorta demonstrates normal caliber throughout the thorax without\nintramural hematoma or dissection. The pulmonary arteries are opacified to the\nsegmental level. No filling defect to suggest segmental pulmonary embolism. No\narteriovenous malformations seen.\n\nOsseous structures: No lytic or blastic lesions concerning for malignancy.\n\nAlthough the study is not designed for assessment of intra-abdominal\nstructures, moderate nonhemorrhagic free fluid is seen surrounding the spleen,\nliver, and pancreatic body and tail. Additional visualized solid organs are\nunremarkable. No hiatal hernia seen.  Mild diffuse soft tissue edema is\nconsistent with anasarca.",
            "output": "1. No evidence of pulmonary embolism up to the segmental level.\n\n2. Moderate nonhemorrhagic free fluid surrounding the spleen, liver, and\npancreatic body/tail with mild anasarca is likely related to patient's known\nhypoalbuminemia.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 9:45 ___, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is mildly dilated to 3.9 cm, without evidence of intramural\nhematoma or dissection..  The heart, and great vessels are within normal\nlimits.  There is trace pericardial fluid.\n\nAXILLA, HILA, AND MEDIASTINUM: There is several borderline right pericardial\nlymph nodes measuring up to 1.0 cm (series 301:171).  A 0.8 cm short axis\nright lower paratracheal lymph node (series 301:94).  No mediastinal mass.\n\nPLEURAL SPACES: There is a small right pleural effusion with associated\nrelaxation atelectasis.  No pneumothorax.  There is biapical scarring.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Subsegmental atelectasis is present particularly in the right\nlower lobe.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nThere is bilateral gynecomastia, new since ___.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Small right pleural effusion with associated relaxation atelectasis.\n3. Borderline enlarged right pericardial lymph nodes and prominent mediastinal\nlymph nodes, stable in size compared to PET-CT from ___.\n4. Stable dilatation of the ascending thoracic aorta to 3.9 cm.\n5. Bilateral gynecomastia, new/increased since ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  Please note\nthat the scan was not extended to cover the most inferior portions of the\nlungs, limiting evaluation of the distal most subsegmental arteries.  The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Please note that the distal-most subsegmental lower lobe pulmonary arteries\nwere not included in the field of the scan.  However, no evidence of pulmonary\nembolism, pulmonary parenchymal abnormality, or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid unremarkable.  No thoracic\ninlet or axillary lymphadenopathy.  Mild symmetric bilateral gynecomastia.\n\nUPPER ABDOMEN: Hyperattenuating right interpolar renal density, measuring 2 cm\ndifferentials include proteinaceous/hemorrhagic cyst versus solid lesion. \nLeft interpolar simple renal cyst measuring 2.5 cm.\n\nMEDIASTINUM: Marked atherosclerotic calcifications of ectatic thoracic aorta,\nascending thoracic aorta measures 4 cm.  Scattered prominent lymph nodes, not\nmeeting size criteria for lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.  With limited evaluation given unenhanced\nactinic.\n\nHEART and PERICARDIUM: No pericardial effusion.  No cardiomegaly.  Moderate\natherosclerotic calcifications of the coronary arteries.\nPLEURA: No pleural effusion.  No pneumothorax.  Biapical pleural scarring.\nLUNG:\n\n1. PARENCHYMA:  Lower lobes predominant subpleural coarse reticulation, and\nmild traction bronchiectasis, in addition to diffuse mosaic attenuation of\nground-glass opacities, findings likely reflecting active on chronic fibrosing\ninterstitial lung disease.  There may be a component of mild pulmonary edema. \nThere are no nodules.\n2. AIRWAYS:  Flattening of the posterior tracheal wall and bilateral mainstem\nbronchi, this may reflect early changes of tracheal bronchomalacia.\nCHEST CAGE: Degenerative changes of the thoracic spine.  No destructive\nosseous lesions.",
            "output": "1. Constellation of findings suggests acute on chronic fibrosing interstitial\nlung disease.\n2. Right upper pole hyperattenuating renal lesion measuring 2 cm, likely\nreflecting proteinaceous/hemorrhagic cysts.  Ultrasound follow-up is\nrecommended to exclude any solid lesion."
        },
        {
            "input": "CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  The heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\nLUNGS/AIRWAYS: There is minimal paraseptal emphysema.  3 mm micronodule in the\nright lower lobe is unchanged from ___ (2:73).  Focal opacity in the\nlingula likely represents atelectasis (2:73).  Bibasilar atelectasis is mild. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nScattered supraclavicular lymph nodes are not pathologic by CT size criteria,\nthough numerous.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  As previously, there is colovesicular fistula between the\nsigmoid colon and the bladder with a focal air along the left lateral dome of\nthe bladder.  There is persistent soft tissue thickening involving the bladder\ndome, unchanged from prior exam.  The soft tissue thickening and stranding\nanterior to the thickened bladder wall is stable.  There is no measurable\nfluid collection concerning for abscess.  Colonic diverticulosis throughout\nthe descending and sigmoid colon is unchanged.  The appendix is normal.  There\nis no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: There is stable asymmetric thickening of the left anterior bladder\ndome with fistulous connection to the sigmoid colon.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\nMultiple prominent periportal and portocaval nodes are not pathologic.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality. \nThere is healing fracture at left eleventh rib.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "-No acute fracture or acute abnormalities in the chest, abdomen or pelvis.\n-Stable appearance of the colovesicular fistula.  No drainable fluid\ncollection.\n-3 mm micronodule in the right lower lobe.  If patient is low risk, no further\nimaging is necessary.  If high risk, consider repeat imaging in 12 months."
        },
        {
            "input": "The thyroid gland is unremarkable.  There is extensive supraclavicular,\naxillary, and mediastinal lymphadenopathy.  These lymph nodes measure up to\n1.4 cm at the left axilla (02:14) and 1.2 cm at the right axilla (02:20).  In\nthe supraclavicular region these measure up to 1.5 cm on the left (2:2).  In\nthe mediastinum, there are large conglomerate of lymph nodes measuring up to\n1.7 cm (02:15).  There is also a large subcarinal lymph node conglomerate\nmeasuring 6.4 x 1.6 (4:91).  Hilar lymph nodes are not definitively enlarged.\n\nThe caliber of the aorta and pulmonary vessels are normal.  No significant\natherosclerotic calcifications are identified.  The heart is top-normal in\nsize.  There is no pericardial effusion.  Perihilar edema likely reflects for\nlymphatic drainage.\n\nThe central airways are patent.  Evaluation of lung parenchyma is somewhat\nlimited secondary to respiratory motion.  A 2.5 x 2.0 cm nodule is present in\nthe superior segment of the left lower lobe (4:99).  Small bilateral pleural\neffusions are nonhemorrhagic.  Small amount loculated fluid is present at the\nright major fissure.  Atelectasis at bilateral lower lobes is mild.  No\nchronic or acute changes related to tuberculosis on imaging.\n\nPlease refer to separate report on CT abdomen and pelvis performed on the same\nday for discussion of sub- diaphragmatic findings including splenomegaly and\nmoderate ascites, as well as extensive mesenteric and retroperitoneal\nlymphadenopathy.\n\nNo suspicious lytic or sclerotic osseous lesion is identified in the thorax.",
            "output": "1.  Extensive supraclavicular, axillary, and mediastinal lymphadenopathy\nconcerning for lymphoma.\n\n2.  2.5 x 2.0 cm nodule in the superior segment of the left lower lobe,\ndifferential considerations include infectious or neoplastic etiology. \nShort-term follow-up is recommended.\n\n3.  Small bilateral pleural effusions with a loculated component in the right\nmajor fissure."
        },
        {
            "input": "The imaged base of neck including the imaged portion of the thyroid is\nunremarkable.  The thoracic aorta appears normal in course and caliber with\nminimal atherosclerotic calcification.  The heart is normal in size and shape\nwithout pericardial effusion.  There is residual thymic tissue in the anterior\nmediastinal space.  The main pulmonary artery appears enlarged measuring\napproximately 3.5 cm in diameter, please correlate for pulmonary arterial\nhypertension.  There is no mediastinal or axillary lymphadenopathy.  The\nairway is centrally patent.  No significant mucous plugging.  The esophagus\nappears decompressed.\n\nModerate emphysema is noted.  There is mild atelectasis in the right middle\nlobe adjacent to a right diaphragmatic eventration.  A small left fat\ncontaining Bochdalek hernia is noted.  Several tiny nodules in the left lower\nlobe are seen, for example: A 4 mm nodule in the left lower lobe is seen on\nseries 5, image 245 and a 3 mm nodule in the left lower lobe on series 5,\nimage 228.  These nodules are likely inflammatory and reflect bronchiolitis. \nMild bronchiectasis is noted in the lower lungs likely the sequelae of chronic\nairways inflammation.\n\nThe imaged portion of the upper abdomen is unremarkable.\n\nBones: There is no worrisome bony lesion.  No fracture.",
            "output": "1.  Moderate emphysema, mild bronchiectasis in the lower lungs, likely the\nsequelae of chronic airways inflammation.  Tiny nodules in the left lower lobe\nlikely bronchiolitis related though ___ year follow-up may be obtained to ensure\nstability/resolution.\n2.  Enlarged main pulmonary artery, correlate for pulmonary arterial\nhypertension."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental\npulmonary arteries.  Evaluation of subsegmental pulmonary artery is limited\ndue to patient motion, and consolidation in the bilateral bases.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is trace nonhemorrhagic\nbilateral pleural effusions.\n\nEvaluation of the lungs are somewhat limited due to patient motion.  However,\nthere is mild septal thickening in the right upper lobe.  There is mild\nthickening of the fissures.\nThere is a 4 mm solid nodule in the right lower lobe (6:145).\nIn the right lower lobe, there is decreased enhancement of the consolidated\nlung, likely due to pneumonia.  The left lower lobe demonstrate subsegmental\nconsolidation/atelectasis, with opacification of the associated subsegmental\nbronchi.  In addition, there is fluid within the left mainstem bronchus and\nleft lower lobar bronchi.  The remaining airways are patent.\n\nLimited images of the upper abdomen demonstrated 1.6 cm and 1.2 cm ill-defined\nhypodensities within the right lobe and dome of the liver (06:209,175),\nrespectively.  The left hepatic artery arises from the left gastric artery. \nThere is a small hiatal hernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is chronic deformity of right eighth, ninth and tenth ribs.  There is\ndegenerative changes of the right shoulder joint.  There is posterior\nsubluxation of the left humeral head.",
            "output": "1. No evidence of acute pulmonary embolism to the segmental level.  Evaluation\nof subsegmental level pulmonary artery is limited due to patient motion and\nbibasilar atelectasis/consolidation.\n2. Likely pneumonia in the right lower lobe. Atelectasis/consolidation of the\nleft lower lobe. Fluid within the left mainstem bronchus and the left lower\nlobar and subsegmental bronchi.\n3. 4 mm solid nodule in the right lower lobe.  This can be re-evaluated on\nfollow up or dedicated imaging in ___ year may be obtained.\n4. Incompletely characterized ill defined hypodensities in the dome and the\nright lobe of the liver.  Correlation with prior imaging if available or MRI\nif patient can tolerate or multiple phasic liver CT.\n5. Mild pulmonary edema.\n\nRECOMMENDATION(S):\n1. 4 mm solid nodule in the right lower lobe.  This can be re-evaluated on\nfollow up or dedicated imaging in ___ year may be obtained.\n2. Incompletely characterized ill defined hypodensities in the dome and the\nright lobe of the liver.  Correlation with prior imaging if available or MRI\nif patient can tolerate or multiple phasic liver CT can be obtained for\nfurther evaluation.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:49 AM, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Borderline sized lymph node at the left aspect of\nthe supraaortic branches (2, 8).  Severe calcifications of the aortic arch and\nthe supraaortic vessels.  Status post CABG.  Minimal stranding in the anterior\nmediastinal fat (2, 14) but no evidence of fluid collection or hyperdense\nlesions suspicious for bleeding.  Severely enlarged.  Left atrium.  Pacemaker\nleads in situ.  No pericardial effusion.  Small hiatal hernia. Otherwise\nunremarkable posterior mediastinum.  No hilar or mediastinal lymphadenopathy. \nNo osteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies. Old healed left rib fractures. Minimal bilateral apical thickening.\nMild centrilobular right predominant pulmonary emphysema.  Mild irregularities\nand thickening of the airway walls, consistent with chronic bronchitis.\nBilateral posterior areas of atelectasis, left more than right, containing\nseveral punctate calcifications (4, 151).  In addition, mild scarring is seen\nat the left and right posterior lobe bases (4, 183). No lung nodules or masses\nsuspicious for malignant or metastatic disease. No diffuse lung disease.",
            "output": "No evidence of mediastinal bleeding.  Minimal mediastinal lymphadenopathy. \nStatus post CABG.  Bilateral areas of atelectasis and scarring at the lung\nbases.  No acute lung disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild aortic atherosclerosis is noted.  Mild cardiomegaly\nis again noted.  No pericardial effusion is seen.  Calcifications seen within\nthe left anterior descending coronary artery without significant luminal\nnarrowing.  There is a left chest wall pacer device with leads extending into\nthe right atrium, right ventricle and coronary sinus.  Prosthetic mitral and\ntricuspid valves are in place.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  There are small bilateral pleural effusion, right greater\nthan left.\n\n\nLUNGS/AIRWAYS:  Upper lobe predominant emphysema is noted.  There is mild\nseptal thickening indicative of interstitial pulmonary edema.  Mild basal\natelectasis is noted.  The airways are patent.\n\nBASE OF NECK:  Unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nChronic deformity of the left eighth rib  Sternotomy wires are seen.\n\nUPPER ABDOMEN:  Unremarkable.",
            "output": "1. No pulmonary embolism or acute aortic process.\n2. Mild cardiomegaly, small bilateral pleural effusion, and mild interstitial\npulmonary edema.\n3. Status post mitral and tricuspid valve replacement.\n4. LAD coronary artery calcification."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Moderate cardiomegaly.  The  pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIATINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate bilateral pleural effusions left greater than right\nwith overlying atelectasis..  No pneumothorax.\n\nLUNGS/AIRWAYS: Smooth septal thickening and bilateral ground-glass opacity the\nbases is suggestive of pulmonary edema.  Lungs are clear without masses or\nareas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral moderate pleural effusions, left greater than right.\n3. Mild pulmonary edema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nSubcentimeter right supraclavicular and bilateral axillary lymph nodes appear\nsimilar compared to prior imaging.  No gross breast lesions.\n\nUPPER ABDOMEN: Small diaphragmatic hernia/epiphrenic diverticulum.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes\n\nHILA: Subcentimeter hilar lymph nodes\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Mild aortic annular\ncalcification.  Moderate coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  There is bibasal curvilinear pulmonary opacities\nfavored to represent atelectasis.  Trace left-sided pleural effusion.\n2. AIRWAYS:  Airways are patent\n3. VESSELS:  Pulmonary artery is not enlarged.  No central filling defects.\n\nCHEST CAGE: Old sternal fracture.  No suspicious bony lesions.",
            "output": "No good evidence of pneumonia or sarcoidosis flare.\n\nCurvilinear opacities in the lung bases are favored to represent atelectasis. \nTrace associated left-sided pleural effusion.\n\nModerate coronary artery calcification.  Cardiology referral advised.\n\nSubcentimeter supraclavicular mediastinal and axillary lymph nodes appear\nsimilar compared to prior.\n\nRECOMMENDATION(S):  Cardiology referral advised."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:\nThe visualized base of the neck is unremarkable.  No supraclavicular\nlymphadenopathy.\n\nThere are enlarged axillary lymph nodes bilaterally.  For example, left\naxillary node (series 2, image 14) measures 13 mm in short axis, previously 4\nmm; right axillary lymph node (series 2, image 17) measures 9 mm, previously 3\nmm.\n\nUPPER ABDOMEN:\nThere is diffuse decreased attenuation of the liver, likely due to fatty\ninfiltration.\nThere are enlarged upper retroperitoneal lymph nodes.  for example, enlarged\nceliac axis node measures 12 mm in short axis, previously 6 mm.\nNo other significant abnormalities identified in the visualized upper abdomen.\n\nMEDIASTINUM:\nFew prominent mediastinal nodes are noted.  For example, right upper\nparatracheal node (series 2, image 7) measures 8 mm, previously 4 mm;\nsubcarinal node (series 2, image 22) measures 7 mm, previously 2 mm.\n\nHILA: There are no enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There are coronary artery\ncalcifications involving the LAD artery.  Trace pericardial effusion noted.\nPLEURA: There are small bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  There is bibasilar atelectasis.  The lungs are otherwise\nclear.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi.\n3. VESSELS:  Thoracic aorta and pulmonary vasculature are unremarkable.\nCHEST CAGE: No aggressive bone lesions.  Sclerotic lesion within the left T2\ntransverse process is unchanged and likely represents a bone island.",
            "output": "Enlarged mediastinal, axillary and upper retroperitoneal lymph nodes as\ndocumented above."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy, markedly improved compared to prior.  Largest\naxillary lymph node measures 0.8 cm in short axis in the left axilla.  There\nis no chest wall nodularity, although CT is not optimized for visualization of\nbreast parenchyma.\n\nUPPER ABDOMEN: Partially visualized upper abdomen shows hilar accessory\nspleen.  Otherwise, visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There are mild calcifications\nof the aortic annulus and coronary arteries.  There is trace pericardial\nfluid.\nPLEURA: There is trace bilateral pleural effusions and no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Again seen is bibasilar atelectasis.  Otherwise lung\nparenchyma is without large focal consolidation or concerning nodularity.  No\ninterstitial findings to suggest pulmonary sarcoidosis.\n2. AIRWAYS:  Airways are patent to the subsegmental level.  There is mild\nbronchial wall thickening diffusely.\n3. VESSELS:  No incidentally noted central pulmonary embolus is seen.  Main,\nleft, and right pulmonary arteries are normal in size.\nCHEST CAGE: There is no concerning lytic or sclerotic lesion.  There is no\nacute compression deformity of the thoracic spine.",
            "output": "1. Marked improvement in lymphadenopathy compared to ___.  No\nsupraclavicular, axillary, hilar, or mediastinal lymphadenopathy is seen on\ntoday's exam.\n2. Trace bilateral pleural effusions with bibasilar atelectasis without\nadditional focal consolidation or nodularity to suggest etiology for\nsubjective fevers.  Mild, diffuse bronchial wall thickening."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation is markedly limited secondary to respiratory\nmotion artifact.  The pulmonary arteries are adequately opacified to the lobar\nlevel without filling defect to indicate a pulmonary embolus.  Segmental and\nsubsegmental branches are not well evaluated.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  Heart size is\nnormal.  There are mild coronary calcifications.  No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent left axillary lymph nodes measuring\nup to 8 mm are similar to prior CT of the chest from ___.  There is no\nmediastinal or hilar lymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis.  There is no consolidation\nconcerning for pneumonia.  There is no pulmonary mass.  Respiratory motion\nartifact limits evaluation for small nodules.  Central airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  There is a\nsmall hiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Markedly limited evaluation secondary to respiratory motion artifact.  No\nevidence of central pulmonary embolism through the lobar level."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no axillary or\nsupraclavicular lymphadenopathy by CT size criteria.   Patient is status post\nminimally invasive esophagectomy and gastric pull-through, with expected\npostoperative fat stranding within the mediastinum. Numerous prominent\nmediastinal nodes are likely reactive.  Residual barium contrast material is\nseen within the residual native esophagus and neoesophagus, which slightly\nlimits the study.  The anastomosis appears intact.  No evidence of anastomotic\nleak.  The aorta and pulmonary arteries are normal in size.   The heart size\nis normal and there is no pericardial effusion.\n\nPLEURA:  There is a small right-sided pneumothorax, which is expected\npostoperatively.  A right-sided pleural drainage catheter is present.\n\nLUNGS: The airways are patent.  Mild emphysematous changes are present. \nAtelectasis involving the right lower lobe and to a lesser degree the right\nmiddle lobe reflect postoperative change.  No concerning pulmonary nodules are\nidentified.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen.  A\npartially imaged 5.9 x 4.3 cm cyst is seen arising from the upper pole of the\nleft kidney.",
            "output": "1.  Patient is status post minimally invasive esophagectomy and gastric\npull-through, with expected postoperative changes.  Residual barium contrast\nmaterial is seen within the residual native esophagus and the neoesophagus\nstatus post esophagram earlier on the same day, which slightly limits\nassessment.  The anastomosis appears intact without evidence of anastomotic\nleak.\n\n2.  Small right sided pneumothorax is expected postoperatively.  Right-sided\npleural drainage catheter is in place.\n\nRECOMMENDATION(S):\nIf concern remains for anastomotic leak, consider repeat esophagram in ___\n40 hr.\n\nNOTIFICATION:  Impression 1 was discussed with Dr. ___ by Dr. ___\ntelephone at 15:02 on ___, 5 min after discovery."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\nPatient is status post minimally invasive esophagectomy and gastric\npull-through, which appears unremarkable.  Previously seen mediastinal\nstranding has resolved.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. Minimal atherosclerotic\ncalcifications of the thoracic aorta and mild of the coronary arteries.\n\nPLEURA:  There is no pneumothorax.  Small right-sided pleural effusion and\ntiny pneumothorax have resolved.  Right pleural drainage catheter has been\nremoved.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.\nMild emphysema in the upper lobes bilaterally with mild bronchial wall\nthickening.  Atelectasis involving the right lower lobe and to a lesser degree\nthe right middle lobe have significantly improved.  3 x 2 mm right upper lobe\npulmonary nodule (05:109) is stable in appearance since  ___ PET-CT dated\n___.  No new pulmonary nodules are identified.\n\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.  Prior\nthoracotomy with rib deformities on the right.\n\nUPPER ABDOMEN:\nThis study is not tailored to evaluate the abdomen.  A partially imaged 5.9 x\n4.3 cm cyst is seen arising from the upper pole of the left kidney.",
            "output": "1.  Status post minimally invasive esophagectomy and gastric pull-through.\n\n2.  Stable right upper lobe pulmonary nodule.  No new pulmonary nodules,\nlymphadenopathy or pleural disease in the thorax."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are within normal\nlimits.  Mediastinal lymph nodes are not pathologically enlarged.  Heart size\nis normal.  There is no pericardial pleural effusion.  No hilar or axillary\nlymphadenopathy is present.\n\nThe appearance of the neo esophagus is within normal limits.  Image portion of\nthe upper abdomen will be reviewed separately as part of the CT abdomen\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is mild to moderate, bilateral.  Previously seen right upper lobe\nnodule, series 4, image 79 is stable, 4 mm.  Additional cluster of pulmonary\nnodules in the right upper lobe, series 4, image 84, 91, 93 approaching 7 mm\nis new.  No other new nodules masses or consolidations seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the neo esophagus.\n\nCluster of new nodules in the right upper lobe most likely infectious but\nreassessment in 3 months is required.\n\nPreviously seen right upper lobe nodule is stable.\n\nEmphysema.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Left supraclavicular 1 cm lymph\nnode is enlarged (302:29).  Otherwise no supraclavicular or axillary\nlymphadenopathy.\nOther than the breasts which must be evaluated by mammography there are no\nfocal findings in the chest wall to suggest metastasis.\nSevere subcutaneous edema involving both leads is grossly unchanged since\nprior.\n\nUPPER ABDOMEN: Mild increase in the ascites demonstrated on the ___ CT\nof the abdomen and pelvis. Otherwise little changed.\n\nMEDIASTINUM: Large number of new enlarging lymph nodes in the AP window\nmeasuring up to 1.1 cm, associated with enlargement of sub cm right lower\nparatracheal lymph node (302: 70, 72).\nThere is no new hilar lymphadenopathy.\n\n\nHEART and PERICARDIUM: Moderate cardiomegaly is mildly increased in comparison\nto prior, no pericardial effusion.\nLeft Port-A-Cath terminating in the right atrium.\nModerate to severe atherosclerotic calcifications of the LAD.\nMain pulmonary artery 4.2 cm, enlarged since ___, 3.4 cm suggesting\nworsening pulmonary hypertension.\nThere is no evidence of central pulmonary emboli in this non-dedicated study.\nThoracic aorta is normal diameter.\n\nLUNG and PLEURA: Major airways are patent.\nSmall bilateral pleural effusions with secondary compressive atelectasis and\nbibasilar subsegmental platelike atelectasis, right greater the left are\nmildly increased in comparison to ___.\nMild interstitial line thickening is in both lung bases suggesting congestion.\n\nBilateral new lung nodules of varying opacity, larger number in right lung,\nmeasuring up to 0.7 cm surrounded by minimal ground-glass opacity (302:78) or\nright upper lobe 1 cm nodule (302:98).\nThe are there are no clear consolidations or cavitations.\n\nCHEST CAGE: No evidence of suspicious lesions in the bones suggesting\ninfections or neoplasia.",
            "output": "-Several new lung nodules associated with new mediastinal lymphadenopathy\ncould represent -  1. lymphoma,  2.  metastatic disease or less probably 3. \nseptic emboli.\n-Small pleural effusions on a background of mild pulmonary edema."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  There is a moderate interval decrease in size of\nthe pre-existing mediastinal lymphadenopathy.  This is most obvious in\npara-aortic location (2, 15) As well as in right perihilar location (2, 18). \nThere is stable enlargement of the main pulmonary artery, likely reflecting\npulmonary hypertension.  Stable appearance of the calcified coronary arteries.\nStable appearance of the heart.  Moderate degenerative vertebral disease.  No\nvertebral compression fractures.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  The pleural effusion on the right\nhas almost completely resolved.  The small effusion on the left persists but\nthe previous consolidation in the left lower lobe is improved as compared to\nthe previous examination.  However, both the number and the size of pulmonary\nnodules, predominantly in the upper and middle zones of the lung, has\nsubstantially increased.  The relatively diffuse appearance of these changes\nas well as the upper lobe and middle lobe predominance favors infectious\ndisease or inflammatory disease over malignancy.  The large airways are\npatent.",
            "output": "The increase in number and size of pre-existing pulmonary nodules,\npredominating in the upper and middle lung zones.  The distribution and\nmorphology of the nodules favors infection or inflammation over metastatic or\nmalignant disease.  Interval decrease in size of the pre-existing mediastinal\nlymphadenopathy.  Near complete resolution of the previous right pleural\neffusion.  Mild decrease of the left lower lobe consolidation."
        },
        {
            "input": "UPPER ABDOMEN: Upper cuts through the abdomen demonstrate a moderate volume of\nascites with pneumoperitoneum, and peritoneal thickening. The findings are\nsuspicious for a perforated viscus.  There are multiple dilated bowel loops in\nthe upper abdomen, which are incompletely assessed.\n\nMEDIASTINUM: There are multiple subcentimeter mediastinal lymph nodes, likely\nreactive.  The esophagus is dilated, partially fluid filled.\n\nHILA: No size significant hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Coronary artery calcifications.  There is no\npericardial effusion.\nPLEURA: Moderate bilateral pleural effusions, left greater than right.\nLUNG:\n\n1. PARENCHYMA:  There are bilateral patchy mixed ground-glass/consolidative\nchanges in the upper and lower lobes.  Segmental atelectatic changes are seen\nin the bilateral lower lobes.\n2. AIRWAYS:  The airways are patent down to the subsegmental level.\n3. VESSELS:  The main pulmonary artery is dilated up to 3.7 cm, suggestive of\npulmonary hypertension.\nCHEST CAGE: No suspicious bony lesions.",
            "output": "There is a moderate volume of ascites with pneumoperitoneum and peritoneal\nthickening in the abdomen, compatible with a perforated viscus and\nperitonitis.  Multiple dilated small bowel loops are incompletely visualized.\n\nPatchy ground-glass/consolidative changes in the bilateral lungs, with a\ndilated, partially fluid-filled esophagus.  Given in the history of vomiting,\nthe findings could be due to aspiration versus multifocal pneumonia. \nSegmental atelectatic changes at the lung bases.\n\nBilateral moderate pleural effusions, left greater than right.\n\nRECOMMENDATION(S):  The findings were discussed with Dr. ___\nmedicine resident, at 2300h on ___.\n\nUrgent General surgery consultation was recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with  coronary artery calcifications. There is no pericardial\neffusion.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is no\nfocal consolidation.  Minor dependent atelectasis is seen posteriorly in both\nlower lobes.  No new suspicious pulmonary nodule detected.  There is a 6 mm\ncalcified granuloma in the right upper lobe on series 3 ___ 46.\n\nUPPER ABDOMEN : Please see abdominal CT for details of intra-abdominal\nfindings.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Multilevel degenerative changes are present in the thoracic spine",
            "output": "1. No evidence of malignancy or other significant thoracic findings.\n2. Please see abdomen for details of intra-abdominal findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  The\nthoracic aorta is normal in caliber.  The main pulmonary artery is top normal\nin caliber.  No central pulmonary embolism.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic.  No focal lesions or pancreatic ductal\ndilation identified.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypoattenuating renal lesions are too small to completely characterize, but\nstatistically likely reflect simple cysts.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The esophagus is dilated proximal to the gastroesophageal\njunction containing both solid material and liquid.  There is relatively\ndiffuse esophageal wall edema.  The stomach is collapsed and unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon and rectum are within normal limits.  The appendix is\nnot visualized.  there is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 6.2 x 4.1 cm right adnexal cyst (series 2,\nimage 93).  The left adnexa is unremarkable.  The uterus is not seen, likely\nsurgically resected or severely atrophic.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is an apparent spinal cord stimulator lead terminating\nin the spinal canal the level of the midthoracic spine distally and in the\nright anterior pelvic wall proximally.",
            "output": "1. Esophageal obstruction at the gastroesophageal junction, presumably caused\nby known achalasia, with superimposed esophagitis.  No evidence of\nperforation.\n2. Incidental 6.2 cm right adnexal cyst.  Recommend nonemergent pelvic\nultrasound for further evaluation.\n\nRECOMMENDATION(S):   Incidental 6.2 cm right adnexal cyst. Recommend\nnonemergent pelvic ultrasound for further evaluation."
        },
        {
            "input": "CT CHEST WITHOUT IV CONTRAST: The thyroid is grossly normal. There is no\nsupraclavicular, axillary, or mediastinal lymphadenopathy. There is no gross\nhilar lymphadenopathy within the limitations of a noncontrast enhanced study. \nThe esophagus is patulous.  There is focal thickening in the mid esophagus\nposteriorly (02:26).  There is a device implanted in the left chest wall\nwithout any discernible leads emanating from it.\n\nHeart size is mildly enlarged with trace pericardial effusion.  There is a\nstent within the LAD.  Hyperattenuation of the myocardium to blood pool\nsuggests anemia. The thoracic aorta and proximal great vessels are normal in\ncaliber. The main pulmonary artery is top normal in caliber.\n\nThe airways are patent to the subsegmental level.  There is no pleural\neffusion or pneumothorax. There is no bronchial wall thickening or\nbronchiectasis.  There are innumerable pulmonary nodules diffusely throughout\nall the lobes measuring from punctate up to 11 x 9 mm (4:107) and a\nconvincingly vascular distribution.\n\nOSSEOUS STRUCTURES: There is no evidence of osseous metastasis.  Mild\ndegenerative changes are noted without associated compression deformity.",
            "output": "1. Innumerable pulmonary nodules ranging from punctate up to just over a\ncentimeter in a convincingly vascular distribution compatible with hematogenic\nmetastatic spread.\n2. Trace non hemorrhagic pericardial effusion.\n3. Focal thickening of the midesophagus posteriorly could be further evaluated\nwith barium swallow or endoscopy if clinically appropriate.\n4. Evidence of anemia.\nKnown abnormalities in the abdomen are better evaluated on contrast-enhanced\nCT 3 days prior\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 17:17 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST CTA:   The thoracic aorta is normal caliber without evidence of aneurysm\nor dissection.  There is atherosclerotic disease within the thoracic aorta. \nThe main, lobar, segmental, and subsegmental pulmonary arteries are well\nopacified without filling defect.  The remainder of the great vessels have a\nnormal appearance.\n\nCHEST:  The thyroid is normal. Axillary, supraclavicular, mediastinal, and\nhilar lymph nodes are not pathologically enlarged.  The heart and mediastinum\nare normal. The pericardium is intact without effusion.  Airways are patent to\nthe subsegmental levels.  There are coronary artery calcifications.\n\nThere is mild centrilobular emphysema. There is 5mm lung nodule at the left\nlung base (series 3, image 216).  Otherwise, lungs are clear.\nNo pleural effusion, pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Mild degenerative changes are noted in the thoracic spine with\nanterior osteophytes.",
            "output": "1. No evidence of pulmonary embolism.\n2. Emphysema with 5mm left lower lobe pulmonary nodule; recommend followup CT\nin ___ months per ___ guidelines.\n3. Coronary artery calcifications.\n\nNOTIFICATION:  Updated findings impression # 2 were emailed to the ___ nurses\nby Dr. ___ on ___ at 910PM, 5 minutes after they were made."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is slightly ectatic 40 mm in diameter ascending portion.\n\nHeart is mildly enlarged.  Coronary artery calcifications are mild.  Central\npulmonary arteries are borderline enlarged.  There is no pericardial effusion.\nReflux of intravenous contrast into the IVC and hepatic veins suggests right\nheart dysfunction.\n\nAXILLA, HILA, AND MEDIASTINUM: Subcentimeter mediastinal and bilateral hilar\nlymph nodes are likely reactive.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is extensive pulmonary fibrosis bilaterally, associated\nwith subpleural cystic changes and traction bronchiectasis.  Asymmetrically\nincreased parenchymal opacities in the right lower lobe are noted with lesser\nopacity in the left lower lobe.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  An endotracheal tube terminates approximately\n3.2 cm above the carina.  Secretions are found within the trachea.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A partly imaged transesophageal enteric is seen extending into the\nstomach, with the distal tip out of the imaged field-of-view.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Extensive pulmonary fibrosis bilaterally, as well as probability of bone\nside airway disease.  This interstitial lung disease is characterized by\nextensive medium to large subpleural cysts which involve from the upper more\nthan lower lobes, although left lower lobe involvement is moderately\nextensive.  The right middle and lower lobes are somewhat spared.  There is\nalso widespread peripheral ground-glass as well as both central and peripheral\nof bronchiectasis.  This is atypical for usual interstitial\npneumonitis/idiopathic pulmonary fibrosis.  Other etiologies such as sequela\nof chronic hypersensitivity pneumonitis, or interstitial disease secondary to\ncollagen vascular disease or pneumoconiosis, may be considered given the\ndistribution among other subtypes of mostly fibrotic interstitial disease.\n3. Asymmetric, increased parenchymal opacities in the right lower lobe may\nreflect superimposed focal infection/aspiration, versus atypical pattern of\nedema.  The differential may also include active inflammatory component\nassociated with interstitial lung disease although this seems less likely.\n4. Findings suggestive of right heart dysfunction."
        },
        {
            "input": "HEART AND VASCULATURE: There are coronary artery calcifications.  The\nascending aorta measuring 4.1 cm.  The main pulmonary artery is enlarged,\nmeasuring 3.7 cm.  Calcifications involving the arch of the aorta and coronary\narteries.  No significant pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No significant axillary, hilar or mediastinal\nlymphadenopathy.  Previously seen lymphadenopathy has resolved, which was\nlikely reactive in etiology.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Extensive bilateral pulmonary fibrosis with subpleural cystic\nchanges and traction bronchiectasis and honeycombing.  Previously seen\nasymmetric parenchymal opacity in the right lower lobe has significantly\nimproved and ground glass opacities have resolved.  There are scattered\nnodular opacities which likely represents a conglomerate of fibrosis.  For\nexample a 1.4 cm opacity in the right upper lung field is identified (series\n5, image 92).  The airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.?",
            "output": "1. Extensive bilateral pulmonary fibrosis, with upper lobe predominance and\nhoneycombing is most typical of UIP.  Consolidative opacities likely represent\nconglomerates of fibrosis, however a three-month follow-up CT scan should be\nperformed to exclude pulmonary nodules.\n2. Previously seen parenchymal and ground-glass opacities have resolved.\n3. Evidence of pulmonary hypertension.\n4. Calcifications involving the coronary arteries are noted.  Given patient's\nage, an echocardiogram is recommended.\n\nRECOMMENDATION(S):\n1. Three-month follow-up CT chest.\n2. Echocardiogram."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal.  Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM:  The degree of leftward mediastinal shift and associated mass\neffect on the right atrium and right ventricle has significantly improved,\nwith only a mild degree of leftward shift persisting.  Mediastinal lymph nodes\nare not pathologically enlarged.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with mild coronary artery calcifications. There is no pericardial\neffusion.\n\nPLEURA:  Trace right pleural effusion with overlying compressive atelectasis.\n\nLUNGS/AIRWAYS:  Interval placement of endobronchial valves within the right\nupper lobe bronchi with improvement of the right pneumothorax.  A right-sided\nchest tube is present with associated subcutaneous emphysema.  No significant\nchange in left pneumothorax.  The airways are patent to the subsegmental\nlevel. There is extensive upper lobe predominant emphysematous changes with\nassociated multiple large bullae. No new suspicious pulmonary nodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, no significant abnormalities identified.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Multilevel degenerative changes of the thoracic spine are\nunchanged.  Multiple sternotomy wires are noted.",
            "output": "1. Interval placement of endobronchial valves within the right upper lobe\nbronchi and decreased size of the right pneumothorax.  A right-sided chest\ntube is unchanged position.  No significant change in the left pneumothorax.\n2. Small right pleural effusion with overlying compressive atelectasis.\n3. Near complete resolution of mass-effect on the right heart and leftward\nmediastinal shift."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE,: No axillary lymphadenopathy is noted.\n\nUPPER ABDOMEN: Limited images of the upper abdomen shows hypodense renal\nlesions bilaterally measuring up to 4.1 cm in the interpolar region of the\nright kidney suggestive of cysts.  There is a 2 mm nonobstructing left renal\nstone.\n\nMEDIASTINUM: There are subcentimeter mediastinal lymph nodes.  An aberrant\nright subclavian artery is incidentally noted\n\nHEART and PERICARDIUM: There is no evidence of pericardial effusion.\n\nPLEURA: A right-sided chest tube is again noted within the inferior aspect of\nthe right pleural space, however there has been significant interval increase\nin size of a right-sided pneumothorax, notably of its basilar component, with\nincreased mass effect on and contralateral shift of the heart.  There has been\nno significant interval change in multiloculated left-sided hydropneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  Again noted is extensive upper lobe predominant emphysematous\nchange, with multiple large bullae.\n-AIRWAYS:  The patient is status post endobronchial valve placement in the\nright upper lobe.\nCHEST WALL:  There has been mild interval improvement in the right-sided\nsubcutaneous emphysema.\n\nMild degenerative changes are noted throughout the thoracic spine.",
            "output": "1.  Right-sided chest tube in place with interval increase in size of a\nright-sided basilar pneumothorax with increased contralateral mediastinal\nshift suggesting a tension pneumothorax.\n2.  Multiloculated left-sided hydropneumothorax is overall unchanged.\n3.  Similar appearance of diffuse upper lobe predominant emphysematous changes\nin both lungs with multiple bullae.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:00 ___, 3 minutes\nafter discovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no evidence of\nsupraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Limited imaging of the upper abdomen demonstrates a hypodense\nlesion in the superior pole of the left kidney, partially visualized, likely\nrepresenting a cyst.  The remainder of the visualized upper abdomen appears\nunremarkable.\n\nMEDIASTINUM: Small subcentimeter mediastinal lymph nodes are noted. There is\nre- demonstration of an aberrant right subclavian artery.  There are\natherosclerotic changes of the aortic arch.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is no pericardial\neffusion.\nPLEURA: A right-sided chest tube is again seen within the anteroinferior\npleural space with is interval decrease in size of a right-sided pneumothorax.\nThere is however new loculated right pleural fluid containing gas bubbles\nextending along the lateral and posterior pleural surfaces as well as around\nthe tip of the pleural catheter.\nThe previously noted midline shift to the left has mostly resolved.  There is\nno significant interval change of a multiloculated left-sided\nhydropneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  There is re- demonstration of extensive upper lobe predominant\nemphysematous change with multiple large bullae.  Subsegmental atelectasis is\nseen in the dependent aspect of the right lower lobe.  There are no new areas\nof consolidation.  Endobronchial valves are again noted in the right upper\nlung.\n-AIRWAYS:  The patient is status post endobronchial valve placement in the\nright upper lobe.\nCHEST CAGE: The previously noted right-sided subcutaneous emphysema has\nresolved.  Degenerative changes are again seen throughout the thoracic spine.",
            "output": "1. Significant interval decreased size of a right basilar pneumothorax, with\nimprovement of left-sided mediastinal shift.\n2. New loculated right pleural fluid containing gas bubbles, for which\nsuperinfection is suspected given the provided clinical history.\n3. A multiloculated left-sided hydropneumothorax demonstrates similar\nappearance compared to previous.\n4. Extensive upper lobe predominant emphysematous changes with multiple\nbullae, not significantly changed compared to previous."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM:  There is mediastinal shift to the left associated mass effect on\nthe right atrium and right ventricle.  Mediastinal lymph nodes are not\npathologically enlarged.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis normal with mild coronary artery calcifications. There is no pericardial\neffusion.\n\nPLEURA:  No pleural effusion.\n\nLUNGS/AIRWAYS:  There is been interval placement of a right-sided chest tube\nwith subcutaneous emphysema overlying the anterior and posterior aspects of\nthe right hemithorax.  The airways are patent to the subsegmental level. There\nis extensive upper lobe predominant emphysematous changes with associated\nmultiple large bullae.  There are bilateral pneumothoraces, not significantly\nchanged from the prior CT from ___.  No new suspicious pulmonary\nnodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, there are exophytic and intraparenchymal\nhypodensities identified in both kidneys, largest of which is in the upper\npole of the right kidney measuring up to 3.5 cm, consistent with simple cysts.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  multilevel degenerative changes of the thoracic spine are\nunchanged.  Multiple sternotomy wires are noted.",
            "output": "1.  Severe emphysematous changes bilaterally with right greater than left\npneumothoraces. Associated mediastinal shift and mass effect on the right\nheart border is related to sequela of tension pneumothorax.\n2.  Interval placement of right-sided chest tube with overlying subcutaneous\nemphysema.\n3.  Bilateral renal cysts measuring up to 3.5 cm.\n\nNOTIFICATION:   The findings and recommendations were communicated to\n___ via telephone at 7:13 ___ on ___ by Dr. ___."
        },
        {
            "input": "The patient is intubated and the tip of the endotracheal tube is located 1.3\ncm above the carina.  An OG tube extends into the stomach with its tip\nexcluded from view.  The thoracic aorta is mildly calcified and normal in\ncourse and caliber.  The main pulmonary artery is normal in size and there is\nno filling defect within the pulmonary arterial tree to suggest the presence\nof a pulmonary embolism.  No lymphadenopathy is seen.  At the base of neck,\nthe partially visualized thyroid appears unremarkable.  There is a small\nsimple appearing left pleural effusion with associated compressive atelectasis\nin left lower lobe.\n\nThere is severe emphysema.   Suture in the left upper lobe in the region of\nthe inferior lingula is noted, correlate with history of prior surgical\ninterventions. Debris is noted within the bronchus intermedius, likely\nretained secretions. There is bronchial wall thickening with areas of mucous\nplugging in the lower lobes.  Areas of ill-defined nodularity within the right\nlower lobe and to a lesser degree left lower lobe most suggestive of\nbronchiolitis.  Scattered calcified granulomas are present.\n\nA hypodensity in the posterior aspect of the right hepatic lobe within segment\n7 is not fully characterized, though most likely represents a simple cyst.\n\nOsseous structures: No worrisome lytic or blastic osseous lesion.  No\nfracture.  Anterior bridging spurs span the mid thoracic spine.",
            "output": "1. Severe emphysema with debris within the bronchus intermedius, diffuse\nairways inflammation, mucous plugging in the lower lobes, scattered\nbronchiolitis in the lower lobes, small left pleural effusion with compressive\nlower lobe atelectasis.\n2. No pulmonary embolism or acute aortic process.\n3. ET and NG tubes positioned as described."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nNo incidental thyroid Findings.  Small lymph nodes in the thoracic inlet or\naxilla are not enlarged by CT size criteria.  No chest wall abnormalities. \nMild atherosclerotic calcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  No mediastinal or hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcification in the coronary arteries.  Extensive aortic\nvalve calcification and left atrium enlargement.  Aorta is normal in caliber\nthroughout.  Main pulmonary artery is top normal.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental level.  There is no pleural\neffusion.  Mild upper lobe predominant centrilobular emphysema.  Right\nparahilar 41 x 36 mm peripherally enhancing mass with hypodense central zone\n(302:102) located immediately below the posterior right upper lobe segmental\nbronchus and extends into the adjacent superior segment of the right lower\nlobe.  A smaller 12 x 8 mm nodule traversed by mildly dilated bronchi or small\nbullae is seen in the superior segment of the left lower lobe.  No other\nnodules, masses, or consolidations are present in the lungs parenchyma.\n\nCHEST CAGE:\nAcute fracture of lateral, right ___ to 8th ribs are not appeciably displaced\nand account for minimal bleeding thickening the adjacent pleural and\nsubmuscular chest wall.  Dorsal spondylosis is mild.  Although there are no\nbone lesions in the imaged chest cage suspicious for malignancy or infection,\nit should be noted that radionuclide bone and FDG PET scanning are more\nsensitive in detecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN:\nSmall right Bochdalek hernia.  Please refer to same day abdominal CT report\nwhich is dictated separately.",
            "output": "Right upper lobe 40 x 36 mm, posterior segment perihilar mass traversing the\nmajor fissure into the superior segment of the lower lobe is likely\nbronchogenic carcinoma, less likely a metastasis.  It should be accessible for\nsampling by bronchoscopy or by transthoracic image-guided biopsy.\n\nSmaller left lower lobe lesion is also possible bronchogenic carcinoma.\n\nRight ___ to ___ acute rib fractures.\n\nExtensive aortic valve calcification and left atrial enlargement warrant\nechocardiography.\n\nRECOMMENDATION(S):  Right upper lobe mass biopsy.\nEchocardiography to assess left heart hemodynamics."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive coronary\ncalcifications are present.  There is no pericardial or pleural effusion.  No\npathologically enlarged mediastinal lymph nodes but multiple mediastinal lymph\nnodes ranging up to 8 mm.  Bilateral hilar lymph nodes are up to 13 mm.\n\nImage portion of the upper abdomen demonstrate liver hypodensity, consistent\nwith cyst based on the density and otherwise unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Subpleural\ninterstitial changes and mild fibrosis appear to be similar in extent,\nperipheral with slight basal predominance compared to previous examination\nwith no substantial interval change.  No discrete nodules or masses to suggest\nneoplasm demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interstitial lung disease, present on previous examination and potentially\nslightly progressed with no massive fibrosis\n\nExtensive coronary calcifications\n\nBilateral top-normal hilar lymph nodes potentially reactive but reassessment\nin ___ months for documentation of stability is recommended\n\nLiver cyst."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged and\nthere are no soft tissue abnormalities in the imaged chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis but\nshows no adrenal mass.\n\nCARDIO-MEDIASTINUM:There are no thyroid findings warranting further imaging\nevaluation.  Atherosclerotic calcification is moderate in head and neck\nvessels particularly the subclavian arteries, and severe in the coronaries. \nAortic valvular calcification moderate to severe is not accompanied by any\ndilatation of the aorta.  Pulmonary arteries are normal size and pericardium\nis physiologic.  Esophagus is patulous enough, particularly the inferior\nportion to raise question about esophageal motility and gastroesophageal\nreflux.  There is no esophageal mass or adjacent lymph node growth, and no\nevidence of esophageal obstruction..\n\nTHORACIC LYMPH NODES: 15 mm right hilar and 11 mm left hilar lymph nodes were\nslightly larger in ___.  Subcentimeter right posterior paraesophageal\nmediastinal nodes are stable.\n\nLUNGS, AIRWAYS, PLEURAE: Moderately severe upper lobe predominant interstitial\ninfiltration is predominantly peripheral, greater in the upper than the lower\nlobes, and accompanied by mild traction bronchiectasis, 302:61, if any.  The\nonly conglomerate of fibrosis at the right apex, is probably unrelated\nscarring.  Mild generalized ground-glass opacification in the left lower lobe\nis stable, but overall background ground-glass opacification in the lungs\ngenerally has improved.  That might have been a function of underinflation or\neven mild pulmonary edema.\n\nThere are no lung nodules or other focal findings of consequence.\n\nThere has been no pleural effusion.\n\nCHEST CAGE: Unremarkable.",
            "output": "Severe coronary atherosclerosis and aortic valvular calcification, possibly\nhemodynamically significant.\n\nModerate mildly fibrosing, non dependent, interstitial lung abnormality\nunchanged since ___ does not have the configuration of UIP/IPF or\nchanges of chronic aspiration.  Interval improvement in background\nground-glass opacification could be due to resolving heart failure. \nNevertheless, the patulous esophagus and accompanying interstitial abnormality\ncould be due to connective tissue disease accompanied by NS IP.\n\nThe apparent changes in the generalized appearance of the lungs comparing\nchest radiographs from ___ to ___ could be due to an exacerbation\nof interstitial lung disease, but transient mild pulmonary edema is another\nexplanation, particularly given the severity of aortic valvular calcification\nand coronary atherosclerosis.  I would recommend getting another conventional\nchest radiograph, PA and lateral if full inspiration, now to see if there is a\npersistent change that would suggest that the interstitial lung disease is\nprogressing.  If the interstitial abnormality has return to the appearance in\n___ it should be possible to follow its progression with\nconventional radiographs rather than having to resort to chest CT.  If the\nappearance has not improved, repeat chest CT should be considered if the\nclinical parameters of restrictive lung disease require imaging correlation."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, or new hilar\nlymphadenopathy.  Mild right hilar adenopathy measuring up to 15 mm in short\naxis is unchanged compared to the prior exam. Mildly enlarged mediastinal\nlymph nodes are seen measuring up to 11 mm, series 302, image 83. The heart\nsize is normal. There is no pericardial effusion.  The esophagus is normal\nwithout evidence of wall thickening or a hiatal hernia. Severe coronary\ncalcifications are seen. The aorta is normal in caliber. The main pulmonary\nartery is normal in caliber.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however no acute abnormalities are identified.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nRe-demonstrated is moderate fibrosing non dependent interstitial lung\nabnormality with diffuse background ground-glass changes and subpleural\nreticulation.  The extent of the interstitial lung disease is unchanged\ncompared to the prior exam, greater within the upper than lower lobes and\naccompanied by mild traction bronchiectasis.  Conglomeration of fibrosis at\nthe right lung apex is unchanged compared the prior exam likely secondary to\nscarring.  There is no pleural effusion or pneumothorax.",
            "output": "Overall, stable appearance of the patient's known interstitial lung disease\ncompared to the exam from ___.\n\nStable mild mediastinal and hilar lymphadenopathy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Tracheostomy tube is in appropriate\nposition.\n\nUPPER ABDOMEN: Please refer to dedicated CT of the abdomen reported\nseparately.\n\nMEDIASTINUM: No enlarged mediastinal lymph node.\n\nHILA: No enlarged hilar lymph node.\n\nHEART and PERICARDIUM: Trace pericardial effusion is slightly increased from\nprior.\n\nPLEURA: There are new small bilateral pleural effusions.\nLUNG:\n\n-PARENCHYMA:  There is dependent atelectasis in bilateral lower lobes. \nNodular components along the bronchovascular bundles in bilateral lower lobes,\nand patchy ground-glass opacities in bilateral lower lobes, inferior right\nupper lobe.  Scratched\n-AIRWAYS:  Patent to the segmental level.\n-VESSELS:  No evidence of large central pulmonary embolism.\nBONE:  : No suspicious osseous lesion is seen.",
            "output": "1.  Interval development of small bilateral pleural effusion, with dependent\nmild atelectasis, and component of bilateral lower lobe pneumonia.\n2.  Please refer to report of  abdominal CT dictated separately.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:34 ___, 5\nminutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Diffuse heterogenous enlargement of\nthe thyroid gland with resultant tracheal narrowing with the trachea measuring\n2-3 mm in diameter appear similar as noted on prior neck CT done ___.  Supraclavicular adenopathy was better characterized on prior CT neck\nstudy (series 3, image 1).  No axillary adenopathy.\n\nUPPER ABDOMEN: Will be reported separately\n\nMEDIASTINUM: Centrally necrotic/hypodense lymph node in the anterior superior\nmediastinum (level 7) measuring 13 mm in diameter (series 2 image 12).  13 mm\nright upper paratracheal lymph node measuring 13 mm in diameter (series 2,\nimage 12).\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  A few nonsuspicious pulmonary nodules are noted in the left\nlung measuring up to 3 mm and may represent intrapulmonary lymph nodes (series\n302, image 46, 65, 146).  These nodules do not have a suspicious appearance. \nNo confluent airspace consolidation.  No interstitial lung disease.\n2. AIRWAYS:  Are patent to the subsegmental level.\n3. VESSELS:  Pulmonary arteries not dilated.  No filling defects on this\nnondedicated study.\nCHEST CAGE: No suspicious bony lesions.",
            "output": "Diffuse heterogenous enlargement of the thyroid gland with resultant tracheal\nnarrowing at the trachea measuring 2-3 mm in diameter, which appear similar as\nnoted on prior neck CT done ___.\n\nSupraclavicular and cervical adenopathy was better characterized on prior CT\nneck study.\n\nCorrelation with cytology is advised to exclude metastatic thyroid cancer.  In\nthe differential diagnosis consider infective/inflammatory process, though\nthis seems much less likely than malignancy.\n\nA couple of 13 mm superior mediastinal lymph nodes.\n\nNo mid to lower mediastinal or hilar adenopathy.\n\nNo suspicious pulmonary nodules or masses, only few very small nodules. \nFollowup of these could be considered if needed clinically.\n\nFor neck findings reference is made to CT neck report of the prior day.\n\nFor abdominal findings reference is made to CT abdomen report of the same\ndate."
        },
        {
            "input": "VASCULAR:\n\nThe study is slightly technically suboptimal due to delayed contrast timing. \nHowever, the images are felt to be adequate for the purposes of the exam. \nThere is a preserved fat plane between the right brachiocephalic artery and\ninfiltrative thyroid mass with associated adenopathy.  The course of the\nvessel is separate from the trachea in the region of the tracheostomy tube. \nThere is also no evidence of fistula between the trachea and other arch great\nvessels.  The bilateral common carotid and subclavian arteries are contrast\nopacified.\n\nAXILLA, HILA, AND MEDIASTINUM:\n\nThere is no mediastinal hematoma.  As demonstrated on recent prior imaging,\nthere is a diffusely infiltrative thyroid mass, encasing the proximal trachea\nand inseparable from the esophagus.  The tracheostomy tube is in stable\nposition compared with the PET-CT from ___.  There is extensive\npartially necrotic adenopathy in the neck and upper mediastinum.  These\nfindings have not significantly changed from the CT of ___, and\nthe extent of soft tissue involvement was better characterized on the MRI from\n___.\n\nThe tracheal lumen is opacified below the mid cricoid level over a 1.5 cm\nsegment proximal to the tracheostomy, likely related to secretions.  At the\nupper aspect of the tracheostomy tube, there is no significant airspace around\nthe tube, while at the distal aspect there is no tracheal narrowing.\n\nPLEURAL SPACES: There is no pleural effusion or nodularity.\n\nLUNGS/AIRWAYS: There are a few 3 mm nodules in both lungs, stable from ___.  There is new mild patchy airspace consolidation in the\nanterolateral left lower lobe, likely representing pneumonia.  There is mild\nbibasal atelectasis.  Areas of more patchy opacity at the medial left lung\nbase have improved.  The major bronchi are clear.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Slightly suboptimal study, but no evidence of tracheal-innominate fistula.\n2. There is no residual tracheal lumen proximal to the tracheostomy, which\nprobably relates to secretions although the soft tissue planes are not\nwell-defined.\n3. No significant change in infiltrative thyroid mass, extensive bilateral\nneck and upper mediastinum lymphadenopathy and small subcentimeter pulmonary\nnodules.\n4. Mild patchy consolidation in the left lower lobe (new in this location from\nthe PET-CT ___ most likely represents pneumonia.\n\nNOTIFICATION:  The findings were discussed with ___, the intern/resident\ncaring for the patient by ___, M.D. on the telephone on ___\nat 6:18 pm, 15 minutes after discovery of the findings."
        },
        {
            "input": "THORACIC INLET: There is diffuse enlargement of the thyroid, however the\nthyroid enlargement has decreased in size since the prior study.  The thyroid\nis hypodense in appearance, could represent treatment response.  A\ntracheostomy tube is in place.  The left supraclavicular lymph nodes have also\ndecreased in size the largest now measures 8 mm it previously measured 16 mm.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion\n\n\nPLEURA: There is a trace right pleural effusion\nLUNG: Evaluation of lung parenchyma is somewhat limited due to respiratory\nmotion artifact.  However several of the previously visualized nodular\nopacities in the left upper lobe have resolved and were most likely\ninflammatory.  Subsegmental atelectasis in the left lower lobe has also\nresolved.  There are several tiny 1-2 mm pulmonary nodules throughout the\nright middle and right lower lobe which are unchanged and bear watching to\nexclude metastasis.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a gastrostomy\ntube in place.  No focal liver lesions are seen.  No adrenal masses are seen.",
            "output": "Significant improvement in the overall size of the thyroid which now appears\nhypodense and decrease in size of the left supraclavicular lymph nodes,\nrepresents treatment response.\n\nTracheostomy tube remains in place.\n\nImprovement in the parenchymal opacities in the left upper lobe which are most\nlikely inflammatory.\n\nTiny 1-2 mm pulmonary nodules in the right middle and right lower lobe, bear\nwatching to exclude metastasis"
        },
        {
            "input": "The mixed fluid and soft tissue density at the thyroid site, surrounding the\ntracheostomy tube, shows an overall slight decrease in size.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Borderline\nsized right paratracheal lymph node (5, 10).  Stable appearance of the large\nmediastinal vessels without evidence of pulmonary embolism.  Stable appearance\nof the heart.  No pericardial effusion.  The posterior mediastinum is\nunremarkable, with the exception of a minimal hiatal hernia.  No change in\nappearance of the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Mild respiratory motion. \nCurrently, the lung parenchyma shows no evidence of infectious or inflammatory\ndisease.  Previously visualized micro nodules, for example in the right lower\nlobe (6, 153) are stable in size and extent.  There is no evidence of new\npulmonary nodules.  No pleural effusions.  No diffuse lung disease.",
            "output": "Slight decrease of the thyroid tissues surrounding the tracheostomy tube. \nComplete resolution of pre-existing pulmonary ground-glass opacities.  Stable\npulmonary micro nodules.  No pleural effusions.  No diffuse lung disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The mixed fluid and soft tissue\ndensity at the expected site of the thyroid surrounding the tracheostomy tube,\nunchanged in size and density.  The tracheostomy tube is in unchanged\nposition.  No supraclavicular or infraclavicular lymphadenopathy.  No axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: The study is not tailored for evaluation of the abdomen. \nAllowing for this, the partially visualized upper abdomen demonstrates no\ngross abnormality.\n\nMEDIASTINUM: There are multiple small mediastinal lymph nodes study do not\nmeet CT criteria for lymphadenopathy.  For example there is a 8 mm right\nparatracheal lymph node measures up to 8 mm in its short axis, (series 5,\nimage 15).  However there is dense stranding at the anterior mediastinum which\nmeasures 4.2 x 2.6 cm, unchanged.\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusions.  No\ncalcified atherosclerosis involving the coronary arteries.  The vascular\ncaliber of the ascending aorta, main pulmonary artery, descending aorta and\naortic arch are within normal limits.  There is no large central pulmonary\nembolus.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\nPARENCHYMA: The  examination is slightly limited by motion artifact. \nPulmonary micronodules at the right lower lobe are unchanged in size and\nextent, (series 6, image 160).  No new or growing pulmonary nodules.\n\n1. AIRWAYS:  The trachea demonstrates adherent, retained aerosolized\nsecretions surrounding the tracheostomy.  Otherwise, the patent to the\nsubsegmental level without\nCHEST CAGE: No fracture.  No vertebral compression fractures.  No lytic or\nsclerotic osseous lesions are demonstrated.",
            "output": "1. Stable micro pulmonary nodules at the right middle lobe unchanged in extent\nand size.\n2. Unchanged soft tissue and fluid density surrounding the tracheostomy tube. \nPlease refer to same day CT neck for a more detailed description of neck\nfindings.\n3. No evidence of focal consolidation or pleural effusions."
        },
        {
            "input": "CHEST PERIMETER: Findings in the neck extending to the thoracic inlet will be\nreported separately.\n\nSize of the large mass surrounding the lower larynx and upper trachea from the\nthoracic inlet to the level of the aortic arch is unchanged.  At the level of\nthe tracheostomy tube, the mass currently 49 x 58 mm, was previously 51 x 56\nmm.  It extends from the posterior margin of the clavicles to the anterior\naspect of the thoracic spine, without clear involvement of the chest cage at\neither level.\n\nProbable invasion of the tracheal wall, especially posteriorly and the upper\nesophagus at multiple levels is unchanged, ___.  The appearance of the\ncompromised airway is unchanged.  The caliber of the narrowed tracheal lumen\nconforms to the tracheostomy tube at the level of most severe narrowing, no\nmore than 12 mm.\n\nNo axillary adenopathy or other soft tissue abnormality in the imaged chest\nwall.  Findings below the diaphragm will be reported separately.\n\n\n\nCARDIO-MEDIASTINUM: Esophagus below the level of the aortic arch is\nunremarkable.\n\nAtherosclerotic calcification is mild in head and neck vessels and not\napparent in coronary arteries.  Aorta and pulmonary arteries are normal\ncaliber and the pericardium is physiologic.\n\nHyperplastic thymus is unchanged.\n\nTHORACIC LYMPH NODES: Below thoracic inlet, there are no lymph nodes in the\nchest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing lung nodules.  4 mm right lower\nlobe nodule unchanged.\n\nTracheobronchial tree is normal to subsegmental levels.  No pleural\nabnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No appreciable change since ___ in the large thyroid mass extending from\nthe thoracic inlet to the aortic arch with severe narrowing of the trachea and\nprobable invasion of both trachea and upper esophagus.\n\nNo new or growing pulmonary metastases.  Tiny lung nodules stable, nature\nindeterminate."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  No enlarged supraclavicular or axillary lymph nodes.\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen and pelvis from\nthe same date for description of subdiaphragmatic findings.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is mildly enlarged.  Coronary arteries are\nmoderate and diffuse.  Aortic annular and leaflet calcifications are mild.  No\npericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\nPARENCHYMA:  The lungs are clear without focal consolidation or mass. \nBibasilar atelectasis present.  Respiratory motion limits evaluation for small\npulmonary nodules.  No large pulmonary nodules are seen.\n\nAIRWAYS:  Airways are patent to the subsegmental level bilaterally.Mild\nbibasilar bronchial wall thickening is present.\n\nVESSELS:  The main, right and left pulmonary arteries are normal in caliber. \nWhile this study is not optimized for the evaluation of pulmonary vasculature,\nno central pulmonary embolism is seen.  The thoracic aorta is normal in\ncaliber.\n\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesion or acute fracture.",
            "output": "No evidence of intrathoracic malignancy or infection."
        },
        {
            "input": "The thyroid is normal.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe great vessels are normal caliber. Poor opacification of intrathoracic\nvenous vessels limits evaluation of occlusion. There is a stent in the left\nbrachiocephalic vein.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels.  There is no intrathoracic\nmass. There are subtle ground-glass nodular opacities involving the bilateral\nupper lobes (series 5, image 68, image 76). The remainder of the lungs are\nclear. There is no pleural effusion, pneumothorax, or pneumomediastinum.\n\nThe esophagus is unremarkable. The native kidneys are atrophic. Limited view\nof the abdomen is otherwise unremarkable.\n\nThe superficial soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Loss of vertebral body height in a lower thoracic vertebral body,\nwas present on chest radiograph from ___.",
            "output": "1. No evidence of compressive mass/intrathoracic malignancy.\n2. Venous vessel occlusion cannot be excluded on the basis of this study given\npoor contrast opacification.\n3. Subtle upper lobe ground-glass/nodular opacities, consistent with\nrespiratory bronchiolitis."
        },
        {
            "input": "HEART AND VASCULATURE: Multiple pulmonary emboli are seen involving the\nsegmental and subsegmental pulmonary arteries to all lobes (3: 43, 58, 92, 97,\n114, 121).  Main pulmonary artery diameter is normal.  There is no CT evidence\nof right heart strain.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart and pericardium are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis and biapical scarring are present. \nNo suspicious pulmonary masses or focal consolidations are seen.  There is no\ndiffuse lung disease.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A 1.3 cm cyst at the hepatic dome (03:141) is unchanged.  The\nremainder of the imaged upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Multiple pulmonary emboli involving the segmental and subsegmental pulmonary\narteries to the bilateral upper, lower and right middle lobes.  No CT evidence\nof right heart strain.\n\nNOTIFICATION:  The findings were communicated with ___, MD, by ___\n___, MD, on the telephone on ___ at 19:30."
        },
        {
            "input": "This exam is limited by respiratory motion artifact. Scattered ground-glass\nnodules in the right upper lobe likely reflect an inflammatory or infectious\nprocess. More consolidative opacities in the bilateral lower lobes and right\nmiddle lobe may be related to atelectasis and/or sequela of chronic\naspiration.  Nodules in the right and left lower lobes measuring up to 4 mm\n(6:264) and 6 mm (6:199), respectively, are more solid-appearing. There is no\nsupraclavicular, axillary, or hilar lymph node enlargement by CT size\ncriteria. Mediastinal lymph nodes are borderline enlarged, including a\nprevascular node measuring up to 13 mm (03:38), pretracheal node measuring 10\nmm (03:35), and subcarinal node measuring 1.4 cm (03:54). There is no pleural\neffusion or pneumothorax.\n\nThe thyroid is normal.  The aorta and pulmonary arteries are normal size.\nCardiac configuration is normal and there is no appreciable coronary\ncalcification.  No pericardial effusion is seen. No concerning focal lytic or\nsclerotic osseous lesion is identified.\n\nPlease see the dedicated CT abdomen/pelvis report from the same day for\ndetailed evaluation of infradiaphragmatic structures.",
            "output": "1. Nodules in the right and left lower lobes.  Followup with CT chest in 3\nmonths is recommended.\n2. Ground-glass nodules in the right upper lobe likely reflect an inflammatory\nor infectious process.\n3. More consolidative opacities in the bilateral lower lobes and right middle\nlobe may be related to atelectasis and/ or sequela of chronic aspiration.\n4. Borderline enlarged mediastinal lymph nodes."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  Patient is status post right\nmastectomy.  There are surgical clips in the right axilla.\n\nThe aorta and pulmonary arteries are normal in size.  There are thoracic aorta\nand coronary artery calcifications (6:28).  The heart is enlarged.  A right\natrial cardiac mass seen on echocardiogram on ___ is not well\nevaluated on CT.  There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  There is trace dependent atelectasis.  There is an\nimpacted bronchus in the left lower lobe (7:148).  There are two 3 mm solid\npulmonary nodule in the right upper lobe (7:130) and right lower lobe (7:153).\n\nSubchondral lucencies in the right shoulder are likely degenerative in nature\n(7:66).    There are multilevel degenerative changes throughout the thoracic\nspine, with anterior wedging of the T8 vertebral body.  No osseous lesions\nsuspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Please see separate dictation for CT abdomen and pelvis performed\non same day for description of subdiaphragmatic findings.",
            "output": "1. Two 3 mm solid pulmonary nodules.  3 month followup is recommended.\n2. Right atrial mass demonstrated on echocardiogram on ___ is not\nwell evaluated on CT.\n3. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Recommend three-month follow-up CT chest for re-evaluation\nof pulmonary nodules."
        },
        {
            "input": "Aorta and pulmonary arteries normal in diameter.  Left thyroid calcified\nnodule is stable.  No mediastinal, hilar or axillary lymphadenopathy is\npresent.  Small hiatal hernia is re- demonstrated, unchanged.  Heart size is\nnormal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen demonstrate multiple liver hypodensities,\nmeasuring fluid density in the vast majority of them, most likely consistent\nwith cysts.  No other abnormality demonstrated.  Splenial is present.\n\nDuring and inspiration trachea and airways are patent to the subsegmental\nlevel bilaterally.  There is no evidence of tracheal or bronchial wall\nthickening.  During dynamic expiration there is mild decrease in the area of\nthe trachea and diameter of the main bronchi but no findings that would be\nconsistent with more than 80% narrowing demonstrated.  Diffuse air trapping in\nparticular affect lower lobes.  Minimal left basal area of atelectasis\npresent.  No pulmonary nodules masses or consolidations seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of lymphadenopathy or tracheomalacia.\n\nInterval resolution of mediastinal lymphadenopathy that most likely was\nreactive.\n\nSmall hiatal hernia.\n\nUnchanged liver cysts."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No dilatation of the aorta\npulmonary arteries demonstrated.  No pathologically enlarged mediastinal,\nsupraclavicular, hilar or axillary lymph nodes seen.  Heart size is normal. \nThere is small bilateral pleural effusion, left greater than right.  Large\nhiatal hernia is present.\n\nImage portion of the upper abdomen demonstrate ascites.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\nexcept for bibasal atelectasis, secondary to pleural effusion.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Large hiatal hernia.\n\nBilateral pleural effusions, left more than right, small\n\nNo evidence of intrathoracic metastatic disease within the limitations of the\nstudy technique."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Mild linear atelectasis in the right lower lobe. \nOtherwise, there is no evidence of infection or malignancy.  There is no\nsignificant emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA: Compared to ___, interval resolution of left pleural effusion\nwith associated compressive atelectasis.  There is no pleural effusion.  No\npneumothorax.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN: Small hiatal hernia is again demonstrated.  Please see\nseparately submitted report of CT Abdomen and Pelvis from the same date for\ndescription of subdiaphragmatic findings.",
            "output": "1. No evidence of metastasis within the thorax.  No acute thoracic process.\n2. Small hiatal hernia.\n3.  Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, supraclavicular, hilar or axillary lymph nodes demonstrated. \nThere is no pericardial or pleural effusion.\n\nSome asymmetry in the right breast soft tissue is present but assessment with\ndedicated imaging is required.\n\nAirways are patent to the subsegmental level bilaterally.  Extensive\nsecretions are demonstrated at the level of the carina and main bronchi. \nLungs are clear.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nEndobronchial secretions\n\nPlease see separate report issued for CT abdomen and pelvis obtained on the\nsame day."
        },
        {
            "input": "SUBDIAPHRAGMATIC FINDINGS: Please refer to separate abdominopelvic CT report\nfrom same date for description of subdiaphragmatic findings.\n\nCHEST PERIMETER: There are no concerning thyroid nodules within the imaged\nportion of the thyroid.  There are no pathologic supraclavicular or axillary\nlymph nodes.\n\nCARDIO-MEDIASTINUM: The pericardium is normal.  The heart size is normal.  The\nmain, left, and right pulmonary arteries are normal in caliber.  The aorta and\ngreat vessels are unremarkable.  The esophagus is mildly patulous and there is\na small hiatus hernia.  There is no mediastinal lymphadenopathy.\n\nTHORACIC LYMPH NODES: There is no intrathoracic lymphadenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: The airways are clear to the subsegmental levels\nbilaterally.  There is no bronchial wall thickening or mucous plugging.  There\nis mild dependent atelectasis, but no pleural abnormality.\n\nCHEST CAGE: There is no sign of extrapulmonary soft tissue metastasis.  There\nis no suspicious osseous lytic or sclerotic lesion.",
            "output": "1.  There is no evidence of intrathoracic metastatic disease.\n\n2.  Please refer to the separate abdominopelvic CT report from same date for\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  There is a common origin of the right brachiocephalic artery and the\nleft common carotid artery, a normal anatomic variant.  Aortic caliber is\nnormal.  The main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is scattered geographic areas of ground-glass\nopacity within the right upper lobe and right middle lobe (6:92, 120, 137,\n139).  Small solid pulmonary nodules are noted, measuring up to 11 mm (6: 56,\n128, 181).  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There are small bilateral simple pleural effusions with associated\natelectasis.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Geographic areas of ground-glass opacity in the right upper and right\nmiddle lobes may represent developing hematogenously spread infectious\nprocess.\n2. Pulmonary nodules measure up to 11 mm for which follow-up chest CT is\nrecommended as below.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nbigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk\npatient, with an optional CT follow-up in 18 to 24 months. In a high-risk\npatient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe thoracic aorta is normal in caliber. The main pulmonary artery is slightly\nenlarged at 3.2 cm in diameter and the right pulmonary artery is also\nminimally enlarged measuring 2.9 cm in diameter.\n\nThe left atrium is moderately enlarged and the left ventricle is minimally\nenlarged. There is no pericardial effusion or abnormality.\n\nThe airways are patent to subsegmental levels.\n\nA moderate to large loculated right pleural effusion is minimally larger since\n___.  Adjacent parenchymal opacity is likely a combination of\natelectasis and possible infection in that area. Heterogeneity throughout the\nleft lung is likely due to air trapping.\n\nThis examination is not designed for subdiaphragmatic evaluation.  Air is seen\nwithin the collecting systems, consistent with prior intervention.\n\n\nOSSEOUS STRUCTURES: Compression deformities of few lower thoracic vertebral\nbodies are noted and are stable. There is no evidence of significant\nretropulsion at these levels.",
            "output": "Moderate to large loculated right pleural effusion is minimally larger since \n___. Adjacent consolidation is more likely atelectasis than\nbronchopneumonia.\n\nEnlarged left atrium and left ventricle, as before. Recommend correlation with\nechocardiogram."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nTrace bilateral pleural effusions.  No pneumothorax.  Mild bilateral apical\nscarring.\n\nLUNGS:\nThe central airways are patent.  There is scattered mucous plugging in the\nsegmental and subsegmental airways.  No bronchial wall thickening or\nbronchiectasis.  A 2 mm pulmonary nodule in the right lower lobe (4:222). \nPunctate calcified granuloma in the left apex (4:52).  Small 4 mm ground-glass\nnodule in the left upper lobe (4:69).  No suspicious lung nodules or masses.\nNo consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis.  Bone island in T4 (4:88).  No\nsuspicious lytic or sclerotic lesions.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n2.0 cm hypodense lesion in the hepatic dome (4:258), likely a cyst/biliary\nhamartoma.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Diverticulosis of the colon is\nnoted without evidence of wall thickening and fat stranding.  The rectum is\nunremarkable.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  Coarse calcification and a 2.7\ncm cystic structure noted in the left ovary (3:102, 105)..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDextroscoliosis of the lumbar spine with mild to moderate degenerative\nchanges.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. A 2.7 cm cystic lesion and coarse calcification in the left ovary. \nNonurgent pelvic ultrasound is recommended for further evaluation.\n2. Otherwise, no definitive evidence of malignancy or metastatic disease\nwithin the chest, abdomen or pelvis.\n3. A 2 mm pulmonary nodule in the right lower lobe and 4 mm ground-glass\nnodule in the left lung.  Please see recommendations below.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nTrace bilateral pleural effusions.  No pneumothorax.  Mild bilateral apical\nscarring.\n\nLUNGS:\nThe central airways are patent.  There is scattered mucous plugging in the\nsegmental and subsegmental airways.  No bronchial wall thickening or\nbronchiectasis.  A 2 mm pulmonary nodule in the right lower lobe (4:222). \nPunctate calcified granuloma in the left apex (4:52).  Small 4 mm ground-glass\nnodule in the left upper lobe (4:69).  No suspicious lung nodules or masses.\nNo consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis.  Bone island in T4 (4:88).  No\nsuspicious lytic or sclerotic lesions.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n2.0 cm hypodense lesion in the hepatic dome (4:258), likely a cyst/biliary\nhamartoma.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Diverticulosis of the colon is\nnoted without evidence of wall thickening and fat stranding.  The rectum is\nunremarkable.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  Coarse calcification and a 2.7\ncm cystic structure noted in the left ovary (3:102, 105)..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDextroscoliosis of the lumbar spine with mild to moderate degenerative\nchanges.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. A 2.7 cm cystic lesion and coarse calcification in the left ovary. \nNonurgent pelvic ultrasound is recommended for further evaluation.\n2. Otherwise, no definitive evidence of malignancy or metastatic disease\nwithin the chest, abdomen or pelvis.\n3. A 2 mm pulmonary nodule in the right lower lobe and 4 mm ground-glass\nnodule in the left lung.  Please see recommendations below.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  No soft tissue abnormalities\nelsewhere in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Just below the level of the carina, 302:85 there is either\nnodular thickening of the wall of the esophagus or a cluster of cm size lymph\nnodes, not appreciably changed.  Atherosclerotic calcification is not apparent\nhead neck vessels or in the coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size and aortic valve is not calcified.  Tiny\npericardial effusion is smaller today than on ___.\n\nTHORACIC LYMPH NODES: No lymph nodes elsewhere in the chest are pathologically\nenlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Calcified granuloma, left upper lobe.  No evidence of\nactive infection.  Faint ground-glass nodule left upper lobe, 4 mm across, and\npunctate nodule right lower lobe, 302:166  not large enough to warrant\nfollow-up.\n\nLungs are fully expanded and otherwise clear.  Tracheobronchial tree is normal\nto subsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE: Unremarkable.",
            "output": "Possible nodular wall thickening, mid esophagus does not warrant esophagoscopy\nat this time.  Repeat chest CT in ___ months with intravenous and oral\ncontrast agent would be sufficient.\n\nOtherwise, no evidence of intrathoracic malignancy or active infection.  No\nlung lesions large enough to warrant further imaging follow-up.\n\nRECOMMENDATION(S):  See IMPRESSION above."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There are multiple,\nenlarged axillary lymph nodes in the left, the largest measuring 6.9 x 4.9 x\n6.8 cm and up to 78 ___ (series 5, image 11, series 7b, image 11).  There are\nno findings to suggest areas of necrosis or that these reflect suppurative\nlymph nodes.   No adenopathy is seen within the right axilla, mediastinum or\nhila.  The esophagus is unremarkable.  The thoracic aorta is normal in caliber\nwith a typical 3 vessel takeoff from the arch.  The pulmonary arterial trunk\nis normal in caliber.  The heart is normal in size without pericardial\neffusion.\n\nThe tracheobronchial tree is normal to the subsegmental levels. The airways\nare normal in caliber.  Within the pulmonary parenchyma, there is no\ninterstitial abnormality.  No focal consolidation, pleural effusion or\npneumothorax is present.  There are no suspicious opacities, masses or pleural\nabnormalities.\n\nNo blastic or lytic lesion suspicious for malignancy is present.\n\nFor a full report on the abdominal portion of this examination, please refer\nto clip number ___.",
            "output": "Significant unilateral left axillary lymphadenopathy.  Differential\nconsiderations include systemic lymphoproliferative disease, however given its\nunilaterally other etiologies include local (upper extremity or\nthoracoabdominal wall) malignancy and infection, although there is no evidence\nfor necrosis or suppurative lymph nodes.  Further evaluation with tissue\nbiopsy should be strongly considered.\n\nNOTIFICATION:   Dr. ___ notified Dr.  ___ at 8:38 ___"
        },
        {
            "input": "No supraclavicular lymphadenopathy.  In unchanged manner, a borderline sized\nleft axillary lymph node is visualized (2, 10).  Unchanged mild thymic\nenlargement.  No enlarged lymph nodes in the hilar or mediastinal\ncompartments.  Unremarkable posterior mediastinum.  No coronary\ncalcifications, no pericardial effusion.  Normal size of the heart.  The upper\nabdomen is described in detail in the dedicated abdominal CT report.  No\nevidence of osteolytic lesions at the level of the ribs, the sternum, and the\nvertebral bodies.\nNew 5 mm part solid left upper lobe nodule (4, 52).  Minimal left lower lobe\nperibronchial parenchymal scarring (4, 143) unchanged as compared to the\nprevious examination.  Likewise, the minimal adjacent pleural thickening (4,\n169) is also unchanged.  No suspicious pulmonary nodules or masses.  No\nadditional pleural thickening.  The airways are patent.  No diffuse lung\ndisease.",
            "output": "Unchanged left lower lobe peribronchial scarring with nodular components. \nUnchanged as compared to the previous examination and likely infectious in\norigin.  New 5 mm part solid left upper lobe nodule.  Although the nodule is\nmore likely infectious than neoplastic, a 3 months followup should be\nperformed to confirm resolution or stability.  No suspicious lung nodules.  No\npleural effusions.  Unchanged borderline sized left axillary lymph nodes.\n\nRECOMMENDATION:  3 months follow-up over a 5 mm part solid left upper lobe\nnodule is recommended."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta and pulmonary arteries are normal\nin caliber.  No aortic dissection or significant atherosclerotic disease.  No\ncentral pulmonary embolism.  Borderline enlarged heart.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Bilateral hilar lymphadenopathy measuring up to\n2.5 cm on the right.  Prominent mediastinal lymph nodes measuring up to 0.9 cm\nthe right paratracheal station.  No significant axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Upper lobe predominant, bilateral perilymphatic nodular\nopacities along the bronchovascular bundles and along the pleural surfaces,\nconsist with sarcoidosis.  Additional areas of confluent conglomerate masslike\narea in the right perihilar region.  Biapical scarring is noted.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a 1.0 cm indeterminate hyperenhancing lesion in the right\nlobe of the liver.  There are prominent nodes around the celiac axis (series\n4, image 228).  Prominent periportal nodes measure up to 1.1 cm (series 4,\nimage 250).  The spleen measures 12.7 cm, which is top-normal in size.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Upper lobe predominant perilymphatic nodular opacities and hilar\nlymphadenopathy consistent with sarcoidosis.\n2. Prominent celiac axis and periportal lymph nodes.\n3. Top normal spleen size.\n4. 1 cm hyperenhancing lesion in the right lobe of liver.  If the patient has\nno hepatic risk factors, is likely benign and no further follow-up is needed. \nOtherwise, consider nonemergent MRI.\n\nRECOMMENDATION(S):  1 cm hyperenhancing lesion in the right lobe of liver. If\nthe patient has no hepatic risk factors, is likely benign and no further\nfollow-up is needed. Otherwise, consider nonemergent MRI."
        },
        {
            "input": "CHEST PERIMETER: 12 mm low-density lesion in the right thyroid lobe is\nincompletely imaged and therefore should be evaluated by thyroid ultrasound. \nAdjacent soft tissue is normal.  Supraclavicular and axillary lymph nodes are\nnot enlarged.  Breast evaluation is reserved exclusively for mammography.  No\nsoft tissue abnormality elsewhere in the partially imaged chest wall.  This\nstudy is not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nabnormality.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels and scattered in coronary arteries.  Aortic\nvalve not calcified.  Aorta and pulmonary arteries and cardiac chambers normal\nsize.  Pericardium physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Left hilum and bronchial stump have a normal\npostoperative appearance after upper lobectomy.  The carina between the upper\nlobe stump and lower lobe bronchus is thickened and may narrow the orifice to\nthe lower lobe to less than 4 mm, 5:97.  No atelectasis or postobstructive\nconsolidation.  Postoperative left lung is essentially clear.\n\nEmphysema in the right lung is moderate to severe in the upper lobe, milder\nelsewhere.  Diffuse bronchial wall thickening is most pronounced in the right\nlung, upper and and lower lobes.  There is also suggestion of inflammatory\nmicro nodules on the right.\n\nNo pleural abnormality.\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of recurrent intrathoracic malignancy.\n\nPossible postoperative narrowing, left lower lobe bronchus should be evaluated\nclinically, and if necessary with bronchoscopy.\n\nMild to moderate generalized bronchial inflammation, worse in the right lung,\naccompanied by inflammatory bronchiolar micro nodulation.  This can be due to\nbronchiolitis seen in active cigarette smokers.  Clinical correlation\nrecommended.\n\nRight thyroid nodule incompletely imaged.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  Respiratory motion limits evaluation of the subsegmental\nbranches.  There is no evidence of pulmonary embolism to the segmental level. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery stent is\nnoted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Patient is\nstatus post cholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism to the segmental level.  No other acute\nabnormality in the chest."
        },
        {
            "input": "The study is limited by body habitus.\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Cardiac size is normal.  Mild to moderate calcification\nof the coronary arteries most pronounced in the LAD.  The pericardium is\nphysiologic.  No pericardial effusion.  Great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A 2 mm subpleural pulmonary nodule is demonstrated in the right\nupper lobe, (series 3, image 127).  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates postoperative\nchanges status post cholecystectomy.  The rest of the upper abdomen is grossly\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. The study is limited by body habitus.  Within the limitation of study,\nthere is no evidence of pulmonary embolism or acute aortic abnormality.\n2. A 2 mm subpleural pulmonary nodules demonstrated within the right upper\nlobe.  Follow-up is in the recommendation section.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery\ncalcifications versus stent is noted in the LAD.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST CTA:\nVESSELS AND HEART:\nThere is suboptimal contrast opacification of the pulmonary vasculature. \nWithin the limits of the study, there is no evidence of central large\npulmonary embolism within the main, left or right pulmonary arteries.  The\nlobar and more distal pulmonary vasculature cannot be assessed.  The main\npulmonary artery is normal in caliber.\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection formation.  Cardiac chamber sizes are normal.\nNo pericardial effusion.  There is severe coronary artery calcification along\nthe LAD, advanced for patient's age.  Mild coronary artery calcification are\nalso seen in the proximal left circumflex artery.\n\nLUNGS: No pulmonary parenchymal abnormality.  Specifically, no evidence of\npulmonary infarct.  The airways are patent to the subsegmental level.\n\nPLEURA: No pleural effusion.\n\nMEDIASTINUM AND HILA: No mediastinal, or hilar lymphadenopathy.\n\nNECK AND CHEST WALL: No supraclavicular or axillary adenopathy. The thyroid\ngland appears grossly unremarkable.\n\nABDOMEN AND PELVIS:\nHEPATOBILIARY:  The liver has a normal appearance without focal lesion or\nevidence of diffuse disease. No intrahepatic or extrahepatic biliary dilation.\nThe gallbladder is surgically absent\nPANCREAS: The pancreas is normal in appearance, without focal lesion, duct\ndilation or evidence of parenchymal disease.\nSPLEEN:  The spleen is mildly enlarged, measuring up to 13.5 cm in the AP\ndimension.  The spleen otherwise demonstrates normal attenuation with no\nsuspicious focal lesions.\nADRENALS:  The right and left adrenal glands are normal in appearance.\nKIDNEYS: The kidneys have a normal appearance. No focal renal lesions or\nhydronephrosis.\nGASTROINTESTINAL:  The stomach is unremarkable.  Small and large bowel within\nthe abdomen are normal.  The appendix is normal.\nREPRODUCTIVE: The uterus is surgically absent.  No large adnexal\nabnormalities.\nRETROPERITONEUM AND PERITONEUM: No ascites.\nVASCULAR:  No abdominal aortic aneurysm.  Infrarenal IVC filter is patent and\nappears appropriately positioned on the coronal view.  Major arteries and\nveins of the abdomen show no concerning findings.\nLYMPH NODES: No lymphadenopathy evident.\n\nBLADDER: Urinary bladder shows no definite abnormalities.\nOTHER: There is a wide neck ventral abdominal hernia contains predominantly\nfat.\nLYMPH NODES: No lymphadenopathy evident.\n\nBONES AND SOFT TISSUES:\nNo suspicious lytic or sclerotic bone findings.  Mild degenerative changes of\nthe imaged spine.",
            "output": "1. Suboptimal contrast opacification of the pulmonary arterial vasculature. \nNo evidence of central pulmonary embolism within the main, left or right\npulmonary arteries.  The lobar and more distal branches cannot be assessed. \nNo evidence of pulmonary infarct or right heart strain.\n2. Severe LAD coronary artery calcifications, advanced for patient's age.\n3. An infrarenal IVC filter is present and appears appropriately positioned.\n4. No acute process within the abdomen or pelvis.\n5. Mild splenomegaly as before."
        },
        {
            "input": "Evaluation is mildly limited by motion artifact.\n\nA subcentimeter hypodensity in the right lobe of the thyroid (03:15) does not\nrequire further evaluation by ACR recommendations unless there is additional\nclinical concern.\n\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size.  The aorta is tortuous likely\ndue to underlying scoliosis.  The heart is mildly enlarged without appreciable\ncoronary calcification. A left chest wall dual lead pacemaker is present.\n\nThere is trace dependent atelectasis in the right lower lobe and lingula\n(3:22; 3:37).  No concerning masse is identified.  A punctate right apical\ncalcified nodule is consistent with a granuloma (03:14).  Two subpleural\npulmonary nodules in the right upper lobe measure 2 mm (5:73, 05:59).  A right\nupper lobe pleural nodule measures 2 mm (05:116).\n\nSevere scoliosis of the thoracic spine.  Healing right anterior fourth and\nfifth rib fractures are present (601b:33).  A sclerotic focus in the T11\nvertebral body is consistent with bone island (03:49).\n\nThis study is not tailored for evaluation of subdiaphragmatic structures.\nPlease see report from same day CT of the abdomen and pelvis for description\nof abdominal findings.",
            "output": "1. No evidence of primary thoracic malignancy.\n2. Healing right anterior fourth and fifth rib fractures.\n3. Two 2 mm subpleural pulmonary nodules, attention on followup suggested."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  The\nthoracic aorta is normal in caliber.  No appreciable aortic atherosclerosis. \nIncidental note is made of a common origin of left common carotid and\ninnominate arteries.  Main pulmonary artery is normal in caliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lung apices and bases were excluded per protocol.  Lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced and normal in diameter.  Heart\nsize is normal.  There is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Postradiation\nchanges in the right upper lobe are noted.  Nodular potentially atelectasis in\nthe left upper lobe is 7 mm, series 302, image 56.  Right middle lobe nodule,\n5 mm, series 302, image 136 also represent minimal atelectasis or\npostradiation changes.  No additional nodules masses or consolidations\ndemonstrated.  There is no evidence of supraclavicular, hilar dot, axillary\nlymphadenopathy.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued\n\nThere is evidence of right breast/axillary surgery.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic metastatic disease.\n\nPostradiation changes in the right upper lobe dot.\n\nSeveral pulmonary nodules as described, that alternatively might represent\nsmall areas of atelectasis in can be reassessed on the subsequent study.  The\ndo not have typical metastatic features.\n\nStatus post right breast surgery and right axillary surgery."
        },
        {
            "input": "Soft tissues:The thyroid is atrophic. No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes. Heart size is mildly enlarged and there is\na small pericardial effusion.  Extensive aortic valve and coronary artery\ncalcifications are noted.  Atherosclerotic calcification of the aortic arch\nand descending thoracic aorta is at least moderate.  Limited images of the\nupper abdomen are unremarkable.\n\nLungs: There is mild centrilobular emphysema, a small nonhemorrhagic left\npleural effusion, and bibasilar atelectasis.  Mild calcified pleural plaque is\nseen at the lung apices bilaterally.  Scattered pulmonary nodules, the largest\nin the left upper lobe, a semi solid nodule are essentially unchanged from\n___ and do not warrant further followup in a patient of this age. \nFor reference these are seen on series 4, image 39, 59, 95, 102, 134, 135, and\n170.\n\nBones: Extensive degenerative changes of the glenohumeral joints bilaterally. \nNo acute rib fracture.  Bilateral healed rib fractures are noted.  Multiple\ncompression deformities of the thoracic spine the are noted, and compared to\n___ the T7 compression deformity is new while the remaining\ncompression deformities of T3, T5 and T6 are unchanged.",
            "output": "1.  Bilateral healed rib deformities.\n2.  Multi level compression deformities of the thoracic spine, with the T7\ncompression deformity new since ___.  Correlate with physical exam\nand focal tenderness for evidence of acuity.\n3.  Small nonhemorrhagic left pleural effusion.\n4.  Multiple bilateral pulmonary nodules are essentially unchanged since\n___ and not warrant further followup in a patient of this age.\n5.  Extensive aortic valve and coronary artery calcification."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild diffuse bronchial wall thickening suggest small airways\ndisease.  The lungs are essentially clear.  Two subpleural 4 mm pulmonary\nnodules in the right upper lobe are noted incidentally (2:48, 2:75)\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small airways disease.\n3. Incidental 4 mm pulmonary nodules.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "FINDINGS:\n\nNo suspicious thyroid lesions.  No supraclavicular or axillary adenopathy. \nMild gynecomastia.  This study was not tailored to evaluate the\nsubdiaphragmatic organs.  Hypodense left adrenal lesion measuring negative\nHounsfield units suggesting that it is a lipid rich adrenal adenoma.  Small\nhypodense right adrenal nodule also most likely representing a lipid rich\nadenoma.\n\nNo pleural effusion.  No mediastinal adenopathy.  Normal cardiac\nconfiguration.  No cardiomegaly.  Intracardiac calcification in the left\nventricular papillary muscle.  Mild coronary artery calcification.  The\nascending aorta is not aneurysmal.  The pulmonary artery is dilated measuring\n32 mm in diameter suggesting pulmonary hypertension.  Mild atherosclerotic\nchanges involving the aortic arch and descending thoracic aorta.  The central\nairways are patent.  Small right upper paratracheal cyst/tracheal\ndiverticulum.\n\nSpondylotic changes of the thoracic spine.  No lytic/destructive bony lesions.\nAsymmetric calcified pleural plaques (left more than right) suggest either\nprior insult or asbestos exposure (but unilateral predominance would be\natypical).  Moderate biapical pleural-parenchymal scarring.  Confluent\ncentrilobular pulmonary emphysema with an upper lobe predominance.  Moderate\nand diffuse bronchial wall thickening suggesting bronchial\ninflammation/bronchitis.  Suspicious spiculated solid nodule in the right\nupper lobe (4, 100) measuring 8 mm in diameter.  A couple of smaller\nperibronchial nodules in the right upper lobe (4, 153) and left upper lobe (4,\n159).  Linear atelectasis in the right lung base.  Metallic clip in relation\nto the peripheral aspect of the right middle lobe (4, 234).",
            "output": "COPD as evidenced by confluent centrilobular emphysema and diffuse bronchitis.\n\nSuspicious pulmonary nodule measuring 8 mm in the right upper lobe.  Consider\nPET-CT, tissue sampling or follow-up CT in 3 months.\n\nA few indeterminate peribronchial nodules predominantly in the upper lobes are\nindeterminate and could be re-evaluated at next follow-up imaging visit.\n\nNo lobar consolidation to suggest pneumonia.  No diffuse bronchiectasis to\nsuggest fibrotic interstitial lung disease.\n\nDilated pulmonary arteries suggesting pulmonary hypertension.\n\nRECOMMENDATION(S):  Consider PET-CT, tissue sampling or follow-up CT in 3\nmonths.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:23 pm, 1 day after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber and\ndemonstrates moderate atherosclerotic calcification.  The heart is normal in\nsize and demonstrates moderate coronary artery calcification.  No pericardial\neffusion is seen.  The main pulmonary artery is mildly dilated up to 3.2 cm,\nsuggestive of pulmonary arterial hypertension.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  There is unilateral pleural calcification along the left\nupper and lower hemithorax, likely sequela of prior hemothorax or infection\n(3:45).  No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is severe centrilobular emphysema.  There are bibasilar\nconsolidative opacities, and a ill-defined opacity in the right middle lobe,\nconsistent with multifocal pneumonia (3:  52, 60, 61).  There is an irregular\nnodule in the right upper lobe measuring up to 7 mm (3:27).  There is an\nadditional 5 mm nodule at the right lower lobe (3:51).  There is lower lobe\npredominant bronchial wall thickening, however the airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  A 2.3 x 1.5 cm left adrenal nodule has a density of 18 ___ on\nnoncontrast imaging, incompletely characterized (2:68).  The partially\nvisualized right adrenal gland appears slightly nodular.  No additional\nabnormalities are seen in the upper abdomen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multifocal pneumonia involving both lower lobes and right middle lobe.\n2. Severe centrilobular emphysema.\n3. Multiple pulmonary nodules measuring up to 7 mm, for which follow-up CT is\nrecommended in 3 months per ___ society guidelines.\n4. 2.3 cm left adrenal nodule statistically likely represents an adrenal\nadenoma, however is incompletely characterized.  Recommend follow-up in ___ year\nwith dedicated CT or MR adrenal.\n5. Mildly dilated main pulmonary artery suggestive of pulmonary arterial\nhypertension.\n\nRECOMMENDATION(S):\n1. Recommend CT chest in 3 months per ___ society guidelines.\n2. Recommend dedicated CT or MR adrenal in ___ year."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Moderate\natherosclerotic calcification within the aorta and coronary arteries.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The right pulmonary artery is normal in\ncaliber, and there is no evidence of right heart strain.  Main pulmonary\nmeasures up to 3.1 cm which is stable compared to the prior exam.  This is\nsuggestive of mild pulmonary hypertension.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There are trace bilateral\npleural effusions, new.  There are bilateral pleural plaques, few are\ncalcified on the left side, noncalcified pleural plaque right upper chest.\n\nInterval increase in bibasilar consolidative and nodular opacities with areas\nof interstitial thickening, increased centrilobular, ___ pattern\nopacities right lower lobe, consistent with multifocal pneumonia ; consider\naspiration.  Some of the a worsening is likely from component of atelectasis. \nStable cluster of nodules in the lingula, likely infectious.  Mild improvement\nin right middle lobe infiltrate.  There is bronchial wall thickening, similar\nto mildly improved.  There is no mucous plugging.  There is an irregular\nnodule in the right upper lobe measuring up to 7 mm (2:49).  There is an\nadditional 6 mm nodule at the right lower lobe (2:86).  Extensive\ncentrilobular emphysema.  Biapical scarring\n\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen shows bilateral adrenal nodules which\nagain is incompletely characterized, larger measures 2.3 cm on the left. \nThere is cortical scarring of the left kidney.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2.  Bilateral lower lung pneumonia, mildly worsened, with increasing\nconsolidation, which is in part secondary to new atelectasis.  New trace\nbilateral pleural effusions.\n3. Severe centrilobular emphysema.  Suggestion of pulmonary artery\nhypertension.\n4. Multiple pulmonary nodules measuring up to 7 mm, for which follow-up CT is\nrecommended in 3 months per ___ society guidelines.\n5.  Indeterminate bilateral adrenal nodules, larger measures 2.3 cm,\nincompletely characterized.  Consider nonemergent CT adrenal mass protocol, or\nfollow-up at the time of pulmonary nodules follow-up."
        },
        {
            "input": "No supraclavicular, axillary, mediastinal, or hilar lymph node enlargement by\nCT size criteria.The thyroid gland is unremarkable.\n\nThe heart size is normal without pericardial effusion. The aorta and its major\nbranch vessels are patent with no evidence of stenosis, occlusion, dissection,\nor aneurysmal formation. The pulmonary arteries are well opacified to the\nsubsegmental level, with no filling defect to suggest pulmonary embolism.\n\nNo pleural effusion.No pneumothorax.  The central airways are patent.\n\nWithin the lungs, there is an approximately 4.7 x 3.7 cm (02:35) somewhat\nvaricoid and tubular, rounded, hypodense lesion within the superior segment of\nthe right lower lobe.  This lesion appears to contain predominantly fluid\ndensity with internal density values ranging from ___ ___.  A 3.4 x 2.5 cm\narea of ground-glass opacity with semi-solid components in the lingula (02:57)\nis worrisome for pneumonia. Additional smaller 0.9 x 0.4 cm opacity in the\nleft lower lobe is noted, possibly focal atelectasis.\n\nOSSEOUS STRUCTURES: No lytic or blastic osseous lesions concerning for\nmalignancy.  Sclerotic focus in the right 8th rib laterally likely reflects a\nbone island.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "1.  Somewhat tubular, rounded 4.7 x 3.7 cm well-marginated hypodense lesion in\nthe superior segment of the right lower lobe is most suggestive of a mucous\nimpacted, congenitally atretic bronchial segment (bronchocele). Neoplasm,\nhowever, cannot be completely excluded and therefore further assessment with\nbronchoscopy and pulmonary consultation is recommended.\n\n2.Lingular ground-glass opacity worrisome for pneumonia.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ 5minutes after discovery of the findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nSoft tissue in the anterior mediastinum represents residual physiologic thymic\ntissue.  Mild bronchial wall thickening is associated with faint centrilobular\nground-glass opacities.  Upper lobe predominant paraseptal emphysema is\nstable.  There is no pleural or pericardial effusion.  Tubular cystic lesion\nin the right lower lobe measuring approximately 4.6 x 3 cm is unchanged\n(02:34)\nThis examination is not tailored for subdiaphragmatic evaluation , the upper\nabdomen is unremarkable\nThere are no bone findings of malignancy",
            "output": "Resolved consolidation in the lingula.\nRight lower lobe cystic lesion unchanged from prior study\nChronic airways disease, bronchiolitis"
        },
        {
            "input": "HEART AND VASCULATURE:There are moderate coronary calcifications.  A left IJ\ncentral venous port tip is located within the right atrium.  Incidental note\nis made of a common origin of the left common carotid and innominate arteries.\nThe great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild peripheral fibrosis with associated traction\nbronchiectasis in the right middle lobe, reflecting postradiation changes. \nThe remaining lungs are clear\n\nABDOMEN: The liver appears cirrhotic, some prior exam although worse in\nappearance.  Mild splenomegaly is also worse.  Diminutive calcified soft\ntissue density posterior to the liver could reflect a dropped gallstone given\ncholecystectomy clips.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute rib\nfracture.\n\nSOFT TISSUES: There is a biopsy clip adjacent to a 1.2 x 0.7 cm enhancing,\nlobulated lesion in the right breast which corresponds to the known\nrecurrence.",
            "output": "1. No acute rib fracture, pneumothorax, pulmonary hemorrhage or findings to\nexplain hemoptysis.\n2. Cirrhotic liver morphology with evidence of portal hypertension including\nsmall volume ascites and splenomegaly.\n3. Small enhancing right breast lesion compatible with known breast cancer\nrecurrence."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  Mildly prominent mediastinal lymph nodes measuring up to 6\nmm in short axis are unchanged compared to the prior exam from ___. \nThe heart size is normal, unchanged compared to prior exam.  Severe coronary\ncalcifications are seen.  There is no pericardial effusion.  The esophagus is\nnormal without evidence of wall thickening or a hiatal hernia.\n\nThe airways are patent to the subsegmental levels.  Mild peripheral\nscarring/reticulation is seen anteriorly within the right upper lobe overall\nunchanged compared to the prior exam.  Mild bibasilar atelectasis is seen.  A\n2 mm left upper lobe nodule seen, series 4, image 64, not definitively seen on\nthe prior exam.  Note is made of lingular atelectasis.  A 3 mm left lower lobe\nnodule, series 4, image 52 is also unchanged compared to the prior exam. \nThere is asymmetric elevation of the left hemidiaphragm with an adjacent\nconsolidation, likely secondary to atelectasis.  There is no pleural effusion\nor pneumothorax.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however note is made of severe splenomegaly, cirrhosis and\nextensive varices concerning for portal hypertension.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "1. No concerning intrathoracic lesions identified to explain patient's left\nhemidiaphragm elevation.\n2. Incidental 2 mm left upper lobe nodule, was not definitively seen on the\nprior exam from ___.  The remainder of the sub 5 mm left-sided nodules\nare unchanged without evidence of concerning new or growing pulmonary nodules.\n3. Mild peripheral scarring/reticulation anteriorly within the right upper\nlobe is unchanged compared the prior exam.\n4. Cirrhosis, severe splenomegaly and varices suggestive of portal\nhypertension, incompletely evaluated on this exam."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\nRight total mastectomy with right axillary lymph node dissection.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: This study was not tailored for evaluation of subdiaphragmatic\nsections however it shows hepatic undulated contour, signs of cirrhosis.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes..\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nMild atherosclerotic calcifications in thoracic aorta and moderate in the\ncoronary arteries.\n\nPLEURA: New small left pleural effusion.  Mild left apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Linear atelectasis in the middle lobe associated with subtle\npleural scarring, sequelae of radiation treatment.\n2. New focal consolidation in the left upper lobe with associated ground glass\nopacities.\n3. Stable appearance of solid 2 mm nodule in the superior segment of the left\nlower lobe.\nLeft lower lobe compressive atelectasis secondary to pleural effusion.\n4. AIRWAYS:  Patent to the subsegmental levels except in left lower lobe.\n5. VESSELS:  Mild main pulmonary artery enlargement with 3.5 cm, slightly\nlarger than in ___.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions. \nMild dorsal spondylosis.",
            "output": "New small left pleural effusion since ___.\nNew focal consolidation in the left upper lobe is likely inflammatory in\nnature.  Repeat chest radiograph to access resolution is advised in 6 weeks.\nStable appearance of previously mentioned solid nodule since at least ___.\n\nRECOMMENDATION(S):  Baseline conventional chest radiographs now, repeated in 6\nweeks."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Two punctate calcified granulomas in the left upper lobe(2:27)\nand left lower lobe (2:63) are likely secondary to prior granulomatous\ndisease.  There is no consolidation.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nUPPER ABDOMEN: The bilateral adrenal glands are normal.  An accessory left\nhepatic artery originating from the left gastric artery is noted.",
            "output": "1. No evidence of pulmonary embolism.\n2. No consolidation of the lung parenchyma.\n3. Two punctate calcified granulomas in the left lung"
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without evidence of\nfocal injury, dissection, or aneurysm.  There is a small amount of\nretrosternal hematoma.  The airways centrally patent.  The main pulmonary\nartery and central branches appear patent.  The heart is normal in size and\nshape.  No pleural or pericardial effusion is seen.\n\nPosterior basal atelectasis noted, left greater than right.  No evidence of\ncontusion or laceration.  No worrisome nodule, mass, or consolidation.\n\nABDOMEN: The liver and spleen appear intact without focal abnormality.  The\ngallbladder, pancreas, adrenal glands appear normal.  The kidneys enhance\nsymmetrically without hydronephrosis or focal lesion of concern. The abdominal\naorta is normal in course and caliber with widely patent major branches. There\nis no retroperitoneal hematoma or lymphadenopathy. No free air or free fluid\nis seen.\n\nThe stomach and duodenum are normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction.  Colonic diverticulosis noted without evidence of diverticulitis.\nThere is no evidence of mesenteric injury. The appendix is normal. No free\npelvic fluid.  Small fat containing left inguinal hernia noted.\n\nBONES:There is a mildly displaced fracture involving the right seventh rib,\nseries 2, image 78.",
            "output": "1. Small retrosternal hematoma without sternal fracture or evidence of major\nvascular injury.\n2. Posterior basal atelectasis.\n3. Acute minimally displaced fracture of the right seventh rib lateral arch."
        },
        {
            "input": "Right pectoral Port-A-Cath.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes in the mediastinum or at the level\nof the hilar.  Mild aortic valve calcifications.  No abnormalities at the\nlevel of the pulmonary arteries.  Minimal coronary calcifications.  No\nvalvular calcifications.  No pericardial effusion.  Mild hiatal hernia.  The\nupper abdominal findings are described in detail in the dedicated abdominal CT\nreport.  Mild bilateral apical thickening.  Mild paraseptal emphysema.  No\npleural thickening.  No pleural effusion.  Signs of mild chronic airways\ndisease.  No pulmonary nodules or masses.  No diffuse lung disease.",
            "output": "No evidence of metastatic disease to the thorax."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nMild paraseptal emphysema is stable.  Punctate calcified granuloma is again\nnoted (7:77) is located in the left upper lobe.  There are no new lung\nnodules.  There is no pleural effusion.  There is trace pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy.   Old right right rib fractures are\nagain noted.\nCentral catheter tip is in the cavoatrial junction.",
            "output": "Minimal paraseptal emphysema. No evidence of active intrathoracic infection or\nmalignancy."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there are no soft\ntissue abnormalities in the chest wall suspicious for malignancy. \nSubcutaneous fat is severely depleted, progressed since ___ suggesting\nsevere weight loss.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels or in the coronary arteries.  Very small pericardial effusion is\nstable.  There is no pleural effusion.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged.  Left lower\nlobe pneumonia and mild left hilar adenopathy have substantially improved\nsince ___.  There are no left lung lesions concerning for malignancy. \nRight lung is clear.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nLeft lower lobe pneumonia nearly resolved since ___.\n\nFurther completion of subcutaneous fat since ___ one."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The thyroid gland is homogeneous. \nSupraclavicular and axillary nodes are not enlarged.  There is no\natherosclerotic calcification in the head and neck vessels.\n\nMEDIASTINUM:  Mediastinal nodes are not pathologically enlarged.\n\nHILA:  Hilar nodes are not pathologically enlarged.\n\nHEART:  Heart size is normal.  There is no coronary artery calcification. \nVery small pericardial effusion is stable.\n\nVESSELS:  Aorta is top-normal in size.  The main pulmonary artery is normal in\nsize.  An infusion catheter terminates at the cavoatrial junction.  There may\nbe some focal narrowing of the low superior vena cava.  However, if this is\npresent, it is likely not hemodynamically significant.\n\nPULMONARY PARENCHYMA:  Left lower lobe pneumonia has resolved.  Mild left\nhilar adenopathy is unchanged (5:153).  Right lung is clear.  There are no\nlung lesions concerning for malignancy.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There are no soft tissue abnormalities and chest wall\nsuspicious for malignancy.  Subcutaneous fat is severely depleted has\ncontinued to progress since ___, suggesting severe weight loss.  There are\nno bone lesions in the chest cage wall or thoracic spine suspicious for\nmalignancy.\n\nUPPER ABDOMEN:  The study is not appropriate for evaluation of\nsubdiaphragmatic structures.  Within this limitation, there is no adrenal\nadenoma.  Please see same day CT abdomen and pelvis for description of\nsubdiaphragmatic structures.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Resolved left lower lobe pneumonia.\n3. Mild left hilar adenopathy is unchanged.\n4. Progressive depletion of subcutaneous fat since ___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Right hilar lymph node measuring 9 mm is a stable. \nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.  Perifissural bilateral\nnodules are stable likely an intrapulmonary lymph nodes.  There is minimal\nbiapical scarring and few small bullas in the apices.  There is mild upper\nlobe predominant centrilobular emphysema.  There are scattered calcified\ngranulomas.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nRight rib deformity is again noted.\nCentral catheter tip is in the cavoatrial junction.",
            "output": "No evidence of active intrathoracic infection or malignancy.\nStable lung nodules.  No new lung nodules identified"
        },
        {
            "input": "The thyroid gland is within normal limits.  The esophagus is unremarkable. \nThe aorta demonstrates normal caliber throughout the chest.  Major aortic arch\nbranch vessels are grossly patent and unremarkable.  The pulmonary artery is\nnormal in caliber.  The heart is normal in size.  There is no pericardial\neffusion.  Scattered mediastinal and hilar lymph nodes are not pathologically\nenlarged.  There is no axillary lymphadenopathy.\n\nMajor airways are patent to subsegmental levels bilaterally.  There is mild\ndiffuse centrilobular and biapical paraseptal emphysema.  There is mild\npleural-parenchymal scarring seen in the lung apices.  A punctate, 1 mm left\nupper lobe nodule is unchanged since at least ___ (series 4, image\n114).  A 2 mm left lower lobe nodule is new (series 4, image 235).  There is\nno pleural effusion or pneumothorax.\n\nThere is generalized edema/anasarca.  There is no concerning focal\nsubcutaneous or musculoskeletal soft tissue abnormality.  There is a chronic,\nhealed fracture of the right posterior fourth rib, unchanged.  Also unchanged\nis a fracture of the right scapula.  There is mild thoracic spine degenerative\nchange.  Vertebral body heights are preserved and alignment is normal. No\nconcerning focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. Left-sided solid pulmonary nodules measuring up to 2 mm, at least one of\nwhich is new.  No lymphadenopathy within the chest.\n2. Mild centrilobular and paraseptal emphysema.\n3. Please see separate report for subdiaphragmatic findings from same-day CTA\nabdomen/pelvis."
        },
        {
            "input": "The thyroid is normal.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe ascending aorta is mildly ectatic measuring up to 4.1 cm. Pulmonary\narteries are not enlarged.\n\nThe heart is normal in size.  There is no pericardial effusion. Mild coronary\nartery calcifications are present.\n\nThe airways are notable for a tracheal diverticulum, but are otherwise patent\nand normal to the subsegmental level. Pre-existing less than 3 mm pulmonary\nnodules have not significantly changed in size (series 4, image 29, 26, 39,\n45, 69, 112, 119, 144 and 124) however, there are multiple new pulmonary\nnodules since ___. These nodules measure up to approximately 3 mm\nand are present on (series 4, image 37, 61, 63, 80, 86, 94, 109, 119, 121,\n131, 169)\n\nThere is no focal lung consolidation, pleural effusion, pneumothorax contour\npneumomediastinum.\n\nThe esophagus is normal without a hiatal hernia. Exophytic right renal cyst\nwith a coarse calcification is partially imaged (series 2, image 55). Imaged\nmesenteric lymph nodes has increased in size with the largest measuring 11 mm\n(series 2, image 51).\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Pre-existing pulmonary nodules have not changed since ___\nhowever, there are multiple new pulmonary nodules measuring up to 3 mm which\nrequire 3 month chest CT followup.\n2. Mild ectasia of the ascending aorta, unchanged from prior.\n\nRECOMMENDATION(S):  3 month followup chest CT to evaluate new pulmonary\nnodules."
        },
        {
            "input": "Thyroid is unremarkable.  Ascending aorta appears 41 mm in maximal diameter. \nMain pulmonary artery is normal size.  There is no large central pulmonary\nembolism.  Trace pericardial effusion is likely physiologic.\n\nThere are new lymphadenopathy in the axillary, mediastinal, and\nretroperitoneal region.  For example, A 16 mm prevascular node (02:19) is\nlarger (previously 6 mm).  A 15 mm left axillary lymph node (02:16) is also\nlarger (previously 11 mm).\nA conglomerate of right para-aortic lymph nodes measures 45 x 22 x 38 mm\n(02:58).  A conglomerate of portacaval lymph nodes measures 37 x 36 x 33 mm\n(02:54).\n\n The airways are patent to the subsegmental level bilaterally.  A large\ntracheal diverticulum is noted at the level of clavicles.  There are numerous\nnew pulmonary nodules.  For example, the 4 mm nodules and left upper lobe\n(4:67), 6 mm nodules in left lower lobe (4:123), 10 mm nodule in the right\nlower lobe (4:157) and 4 mm nodule in the right upper lobe are new.  Most of\npreviously seen pulmonary nodules are increased in size.  For example, a 5 mm\nnodule in the right lung apex (___) is larger (previously 3 mm).\n\nBONES/ SOFT TISSUE:  A 10 mm lucent lesion in T2 vertebral body with central\ndensity stable compared to prior. Sclerotic lesions in T7 and T9 vertebral\nbodies are stable.  A sclerotic lesion in the left acromion is also stable.\n\nABDOMEN:  The study was not designed for subdiaphragmatic evaluation.  Limited\nevaluation of upper abdominal organs show a 20 x 16 mm exophytic renal cyst in\nthe upper pole of right kidney, stable from CT abdomen and pelvis from ___. \nThere is a 6 mm nonobstructing stone adjacent to the lesion.  Partially imaged\ncommon bile duct is dilated up to 14 mm.  There is mild intrahepatic biliary\nduct dilation in the left lobe.  Left spigelian hernia is noted.",
            "output": "1.  Numerous new or increasing pulmonary nodules are concerning for\nmetastasis.\n\n2.  New mediastinal, axillary, and retroperitoneal lymphadenopathy are\nconcerning for metastasis.\n\n3.  Partially imaged common bile duct is dilated up to 14 mm.  Dedicated\nCT abdomen and pelvis is recommended for further evaluation."
        },
        {
            "input": "AORTA is NORMAL IN DIAMETER.  NO APPRECIABLE MEDIASTINAL, HILAR OR AXILLARY\nLYMPHADENOPATHY IS PRESENT.\n\nMain pulmonary arteries substantially distended up to 4.7 cm that might\nrepresent pulmonary hypertension.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen demonstrate superior pole of the right\nkidney cyst and diverticulosis with no other abnormalities detected.\n\nAirways are patent to the subsegmental level bilaterally.  Of note is\nsubstantial decrease in the size of the trachea at the level 1 cm above the\nacute large that might potentially represent tracheomalacia.  There is also\nnarrowing of bronchus intermedius potentially related to scoliosis.  Right\nupper lobe subpleural minimal interstitial changes might potentially represent\nprevious breast radiation, please correlate with patient history.  No\npulmonary nodules masses or consolidations demonstrated.\n\nCalcified mediastinal lymph nodes are consistent with prior granulomatous\nexposure.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nExtensive degenerative changes of the thoracic spine are noted associated with\nsevere scoliosis.  There are also substantial degenerative changes in the left\nshoulder.",
            "output": "Suspected tracheomalacia.\n\nNo evidence of pulmonary nodules or other findings that might potentially\nexplain hypernatremia.\n\nSubstantial distension of pulmonary artery that might be consistent with\npulmonary hypertension.\n\nSevere degenerative changes in the thoracic spine and left shoulder."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nBreast, chest wall and bones:\nNo abnormality\n\nMediastinum:\nNo abnormality\n\nHila:\nNo abnormality\n\nHeart:\nModerate coronary artery calcification.\n\nUpper Abdomen:\nNo abnormality\n\nLung:\n\nNodules:\n\nDominant nodule:\nNone\n\nOther nodules:\nStable 2 x 9 mm nodule along the left major fissure (5, 155, most likely\nrepresents pleural thickening.\n\nStable 2 mm right middle lobe pulmonary nodule (5, 182).  Stable 2 mm right\nlower lobe pulmonary nodule (5, 220).  No new pulmonary nodules.\n\nParenchyma:\nMild upper lobe predominant emphysema.\n\nPleura and airways:\nMild diffuse peribronchial thickening",
            "output": "Stable pulmonary nodules.  No new pulmonary nodules.\n\nMild upper lobe predominant emphysema.\n\nLUNG-RADS CATEGORY AND RECOMMENDATION:  Lung-RADS category: Lung-RADS 2: We\nrecommend continuing CT lung cancer screening in 12 months.\n\n\n\nINCIDENTAL FINDINGS AND RECOMMENDATIONS:  None\n\nManagement recommendations for incidental findings within the LungHealth\u00ae\nprogram are based on a multidisciplinary consensus document of our institution\nspecifically designed for this program.\n\nLUNG-RADS CATEGORIES, DESCRIPTION:  Lung-RADS 0: This category designates an\nincomplete or diagnostically insufficient CT examination.\nLung-RADS 1: This category designates the absence of nodules, or the presence\nof definitely benign nodules.\nLung-RADS 2: This category designates the presence of nodules with a very low\nlikelihood of becoming a clinically active cancer due to size or lack of\ngrowth.\nLung-RADS 3: This category designates probably benign nodules with a low\nlikelihood of becoming a clinically active cancer but with features that\nrequire confirmatory imaging follow-up.\nLung-RADS 4A: This category designates nodules that require additional\ndiagnostic imaging.\nLung-RADS 4B and 4X: This category designates nodules that require additional\ndiagnostic testing and/or tissue sampling. Nodules in this category are\npresented at the weekly multidisciplinary thoracic oncology conference of our\nprogram.\nS (with any category): This qualifier designates the presence of a relevant\nincidental (= distinct from lung cancer) finding, for which a specific\nmanagement recommendation is made.\nC (with any category): Prior diagnosis of lung cancer."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Extensive hilar lymph\nnodes are heavily calcified.  Mediastinal lymph nodes are multiple and some of\nthem are calcified as well, approaching 2 cm in the right paratracheal\nlocation, 15 mm in sub-carinal location, 16 mm in the paraesophageal location\nand 13 mm in the right upper paratracheal location.\n\nRight pleural effusion is demonstrated, small with associated rounded\natelectasis seen on the previous examination.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete nodules\nmasses or consolidations demonstrated.  Minimal interstitial septal thickening\nis present in the upper lobes but no evidence of masses or consolidations\npresent.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen demonstrates stigmata of cirrhosis,\npartially imaged due to lack of IV contrast including nodular liver, varices\nand splenomegaly.",
            "output": "Evidence of extensive mediastinal lymphadenopathy, hilar lymphadenopathy with\ncalcifications consistent potentially with history of sarcoidosis or prior\ngranulomatous infectious exposure.\n\nCirrhosis.\n\nNo discrete pulmonary nodules\n\nMost likely chronic small right pleural effusion with associated rounded\natelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is homogeneous in\nattenuation without focal nodularity.  There is no skull supraclavicular or\naxillary lymphadenopathy by CT size criteria.  There is gynecomastia, grossly\nsimilar compared to ___.\n\nUPPER ABDOMEN: Patient is status post cholecystectomy.  Multiple clips are\nagain noted in the anterior upper intra peritoneal fat and anterior abdominal\nwall.\n\nMEDIASTINUM: Again seen are multiple peripherally calcified lymph nodes and\nnoncalcified lymph nodes throughout the mediastinum.  The largest noncalcified\nlymph node measures 1.0 cm in the mid right posterior paratracheal station. \nCompared to prior exam, overall size and the number of the lymph nodes remain\nsimilar.\n\nHILA: There multiple peripherally calcified lymph nodes in the bilateral hila,\nunchanged from prior exam.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  No significant\npericardial effusion is seen.\nPLEURA: There has been interval improvement of pre-existing small\nnonhemorrhagic pleural effusion, now trace in amount.\nLUNG:\n\n1. PARENCHYMA:  Consolidation in the right lower lobe with associated pleural\neffusion is slightly decreased in size when compared to prior exam, thought to\nrepresent round atelectasis (4:181).  As previously, mild interstitial septal\nthickening and micro-nodularity is noted in the upper lobes and the fissures. \nHowever, no definite fibrosis is identified.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is not dilated.\nCHEST CAGE: There is chronic left healed rib fracture.  ACDF is partially\nimaged at C7.  There is no evidence of acute fracture or suspicious osseous\nlesion concerning for infection or malignancy.",
            "output": "1. No evidence of intraparenchymal fibrosis.  Stigmata of sarcoidosis\nincluding peripherally calcified lymph nodes, micro nodularity along the\nfissures and septa.\n2. Slightly decreased size of round atelectasis with associated trace pleural\neffusion at the right base."
        },
        {
            "input": "Extensive mediastinal and hilar lymphadenopathy in keeping with the stated\nhistory of sarcoidosis has not appreciably changed since ___.  For\nreference, a right lower paratracheal lymph node with sparse calcification is\nstable measuring 1.7 x 3.1 cm, previously 1.5 x 3.2 cm (2, 17).  A subcarinal\nlymph node with sparse calcifications measures 2.1 x 3.2 cm, previously 2.1 x\n3.2 cm (2, 28).  Multiple partially calcified bilateral hilar lymph nodes are\nalso present. There is no supraclavicular or axillary lymphadenopathy. The\nthyroid gland is unremarkable.\n\nHeart size is top-normal with scattered coronary artery calcification. There\nis no pericardial effusion. The main pulmonary artery and thoracic aorta are\nnormal caliber.\n\nSeveral images are partly degraded by respiratory motion artifact.  A region\nof confluent peribronchial infiltration in the superior segmehnt of the left\nlower lobe, 4:82-90, is more contracted than in ___. There has been no\nsignificant interval change in very mild upper and mid lung predominant\nperibronchovascular, subpleural and perifissural nodularity. New bilateral\nlower lobe interlobular septal thickening may be due to mild edema. A trace\nright pleural effusion contributes to minimal right lower lobe passive\natelectasis.  Increase in the apparent profusion of pulmonary nodules is due,\ninstead, to dilated small vessels. Minimal lingular and left lower lobe\nground-glass opacities are more likely due to pulmonary edema than infection\n(4, 139).\n\nImages of the upper abdomen show cirrhosis with large splenic and small\nparaesophageal varices. For a more detailed discussion of the upper abdomen,\nplease refer to the separate report of the CT abdomen/pelvis performed\nconcurrently.\n\nModerate bilateral gynecomastia is unchanged.\n\nThe bones are unremarkable.",
            "output": "Mild congestive heart failure explains new small right pleural effusion, small\nvessel plethora of the lungs and mild edema in the left lower lung.\n\nMild pulmonary sarcoidosis and extensive mediastinal/bilateral hilar\nlymphadenopathy are stable since ___.\n\nCirrhosis with large splenic and small paraesophageal varices."
        },
        {
            "input": "Tracheostomy tube is in place. An enteric tube is partially imaged,\nterminating in the stomach.\nA subxiphoid hematoma is again seen, extending to the upper anterior abdominal\nwall.\n\nNECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Unchanged appearance of mediastinal lymphadenopathy.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.  Aortic valve replacement is\nin place.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  The\nbronchial arteries are visualized and appear intact, and no discrete\nextravasation is evident.\n\nPULMONARY PARENCHYMA AND AIRWAYS: Again seen is luminal thrombus in the\ncarina, extending into the left mainstem bronchus with resultant luminal\nnarrowing and approximately 50% collapse of the left lung, predominantly the\nleft upper lobe, unchanged from prior.  There is improved aeration of the lung\nbases; consolidation in the lower lobes is decreased in severity.  Areas of\nopacity and consolidation in the right middle lobe are progressive compared to\nmost recent prior.  There is no emphysema.\n\nPLEURA:  There is a new small to moderate left pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nascites.",
            "output": "1. No discrete acute extravasation is evident.\n2. Decreased severity of consolidation in the bilateral lung bases, with\nprogression of right middle lobe areas of opacity and consolidation.\n3. Unchanged appearance of luminal thrombus in the carina extending into the\nleft mainstem bronchus with resultant collapse of approximately 50% of the\nleft lung, predominantly the upper lobe.\n4. New small to moderate left pleural effusion."
        },
        {
            "input": "Imaged part of the thyroid gland enhances homogeneously.\n\nBilateral axillary node are prominent, likely reactive.  There are also\nmultiple enlarged mediastinal lymph nodes that are more pronounced compared to\n___, measuring up to 1.2 cm in the right lower paratracheal station\n(02:43).\n\nHeart is mildly enlarged, without a pericardial effusion.  Thoracic aorta is\nnormal in caliber, containing mild atherosclerotic calcifications throughout. \nNo dominant tortuous bronchial artery is identified.  Pulmonary arteries are\nwell opacified to the segmental bronchi, without evidence of pulmonary\nembolism.\n\nLarge amount of secretions noted in the airway above the level of the\ntracheostomy tube (2:3).  Interval placement of an additional catheter within\nthe ___ the tracheostomy tube extends to the left mainstem bronchus,\nbypassing the area of luminal clot noted on the prior study.  The amount of\nclot in the left mainstem bronchus has decreased in the interim (3:93).\n\nDense consolidation in the bilateral lower lobes have significantly increased\nfrom ___, and likely represents a combination of atelectasis and\nsuperimposed infection or aspiration.  Additional scattered multifocal\nparenchymal opacities in the right lung have also progressed.  There is also\nmoderately severe background pulmonary edema.\n\nThe left lung is essentially entirely collapsed, with negligible aeration in\nthe left lower lobe (2:71).\n\nModerate left pleural effusion has increased in the interim.  No pleural\neffusion on the right.  There is no pneumothorax.\n\nModerate amount of ascites noted in the upper abdomen.  Enteric tube is post\npyloric in location.  Hyperdense material in the gallbladder represent sludge.\nSpleen is enlarged, measuring up to 13.8 cm.  Heterogeneous enhancement of the\nspleen likely reflects bolus timing.\n\nNo acute fractures identified.  Remote fracture of the right posterior\neleventh rib (2: 108).  Evaluation of the soft tissues reveals diffuse\nanasarca.",
            "output": "1. No dominant tortuous bronchial artery is identified.\n2. Dense heterogeneously enhancing consolidations at the bilateral lung bases\nin addition to worsening multifocal consolidations, suspicious for\ninfection/aspiration with superimposed atelectasis.\n3. Left lung is nearly entirely collapsed, with increased pleural effusion.\n4. Other findings of fluid excess including body wall edema, ascites, and\nworsening pulmonary edema.\n5. Luminal clot in the right and left mainstem bronchi, decreased from the\nprior study.\n6. Mild splenomegaly with heterogeneous enhancement, may be related to\ncontrast bolus timing."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Gynecomastia is\nmild to moderate, greater on the left, new since ___.  There are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows no adrenal\nmass.\n\nAtherosclerotic calcification in head and neck vessels and coronary arteries\nis moderately extensive and has progressed since ___.  LAD is stented. \nAorta, cardiac chambers, and pulmonary arteries are normal size.  There is no\npleural or pericardial effusion.\n\nSub cm mediastinal lymph nodes are more numerous today than in ___, but\nnot large enough to raise concern for malignancy or lymphoproliferative\ndisorder, presumably reactive.  There are no enlarged lymph nodes in the\ninternal mammary, diaphragmatic, or retrocrural stations.\n\nAside from a calcified granuloma in the left lower lobe, lungs are essentially\nclear.  Tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Clear lungs.\n\nInterval increase in number of sub cm lymph nodes since ___ is of no\nclinical significance.  Lymph node size does not approach the ___ of\nadenopathy present in ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nNo gross supraclavicular or axillary lymphadenopathy.\nMild diffuse subcutaneous edema of the chest wall.\n\nUPPER ABDOMEN: Small quantity of ascites improved in comparison to prior.\nSevere atherosclerotic calcifications of the subdiaphragmatic aorta and\nbranches.\nRemaining included upper abdominal organs with no gross findings within the\nlimitation of study with no IV contrast.\n\nMEDIASTINUM: Mediastinal lymphadenopathy up to 1 x 1.8 cm in the right upper\nparatracheal station, is unchanged in comparison to prior, probably reactive.\n\nHEART and PERICARDIUM: Right PICC line terminates in the right atrium.\nSubstantial cardiomegaly is unchanged in comparison to prior, no pericardial\neffusion.\nStatus post sternotomy and aortic and mitral valve replacement, Sternal wire\nintact and aligned.\nThere is no evidence of sternal destruction.\nSmall amount of retrosternal fluid and fat stranding is unchanged in\ncomparison to prior.\nNo evidence of organized collections.\nSevere extensive atherosclerotic calcifications with multiple stents.\nExtensive atherosclerotic calcifications of the normal caliber thoracic aorta\nand head and neck vessels.\nMain pulmonary artery within normal size.\n\nLUNG and PLEURA: Midline tracheostomy terminates in good position.\nLeft pigtail catheter through ___ intercostal space is adjacent to the\nspleen, although the possibility of being tucked deep in lateral pleural\nrecess or the upper abdomen. Decreased quantity of ascites in comparison to\nprior, relative stability in volume of pleural effusion suggest that the\ncatheter is subdiaphragmatic.\n\nLarge partially loculated left pleural effusion with compressive atelectasis\nof most of left lung is only mildly improved in comparison to ___.\nIn the collapsed left lung fluid bronchogram unchanged.\n\nLeft upper lobe bronchus completely occluded 1 cm from its origin by\nhigh-density foreign body, possibly endobronchial Spigot (02:24). Unchanged in\nappearance in comparison to prior, first noted on chest x-ray ___\n\nAdditional left upper lobe high-density foreign material is most probably in\nthe vessels and is unchanged in comparison to prior (02:18).\nLeft lower lobe bronchi are collapsed and filled with fluid.\n\nRight small pleural effusion with compressive atelectasis/consolidation of the\nright lower and upper lobes unchanged comparison to ___.\n\nGround-glass opacity with interlobular septal thickening in the right lung\ngrossly unchanged, suggesting pulmonary edema.\nNo evidence of bony destructive lesions.\n\nCHEST CAGE: No evidence of bony destructive lesion.",
            "output": "Left pigtail catheter might be subdiaphragmatic, reflected in the decreased\ndecreased quantity of ascites since its placement.\nLarge partially loculated left pleural effusion contributes to almost complete\ncollapse of the left lung is only minimally improved.\nLeft upper bronchus obstructed by retained device, and left lower bronchus by\nsecretions.\n\nRight small pleural effusion with atelectasis/pneumonia is unchanged in\ncomparison to prior.\nModerate pulmonary edema is also unchanged.\n\nRECOMMENDATION(S):  Repositioning of the left pigtail catheter.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by\n___, M.D. on the telephone on ___ at 4:05 pm, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK: Tracheostomy tube is in good position.  Thyroid gland appears\nunremarkable.  No supraclavicular adenopathy.\n\nAIRWAYS: Trachea appears to be clear.  Major airways on the right appear\npatent.  Mildly compressed left lower lobe bronchial secondary to atelectasis.\nLeft upper lobe bronchus is occluded by a radiopaque foreign body, which\nappears unchanged in position.\n\nMEDIASTINUM: Trace of pericardial effusion.  Marked coronary arterial\ncalcifications and mitral valve calcifications.  There are prominent\nmediastinal lymph nodes.\n\nLUNGS: Limited evaluation of the lung parenchyma due to motion.  Atelectatic\nchanges at bilateral lung bases left greater than the right.  Areas of\nground-glass opacities in the right upper lobe and right lower lobe, not\nsignificantly changed, reflective of pulmonary edema.  Scattered radiopaque\nforeign bodies within the left upper lobe appear unchanged as well.\n\nPLEURA: There is a small right-sided pleural effusion.  There has been\ninterval placement of a left-sided chest tube with improvement of left-sided\npleural effusion.  Small amount of hydro pneumothorax mostly at the apex is\nexpected postprocedure.\n\nOSSEOUS/SOFT TISSUES: Post CABG.  Osseous structures are unremarkable.\n\nUPPER ABDOMEN: Small amount of upper abdominal ascites.",
            "output": "Post left-sided chest tube placement with improved left-sided pleural\neffusion.  Expected left-sided hydro pneumothorax postprocedure.\n\nRemainder of the examination is overall unchanged."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A tracheostomy tube is in place.\n\nUPPER ABDOMEN: Upper cuts through the abdomen demonstrate at least a moderate\nvolume of ascites.\n\nMEDIASTINUM: A right-sided central line is in place, with the tip terminating\nin the right atrium.  There are subcentimeter mediastinal lymph nodes, likely\nreactive.\n\nHEART and PERICARDIUM: The heart is mild cardiomegaly.\n\nPLEURA: Small bilateral pleural effusions, stable to previous.  Unchanged\nappearance of a loculated left hydropneumothorax.  The left-sided pigtail\ncatheter has been removed.\n\nLUNG:\n\n1. PARENCHYMA:  Persistent left lower lobe collapse, with superimposed\npostobstructive pneumonia.  There are persistent consolidative changes in the\nremaining aerated portions of the left upper lobe, unchanged.  Segmental\natelectatic changes in the right upper and right lower lobes, with mosaic\nattenuation in the right lung, likely related to air trapping.\n2. AIRWAYS:  The major airways on the right appear patent.  There is near\ncomplete occlusion of the distal left mainstem bronchus.  High-density\nmaterial is noted in the distal left airways, likely related to aspirated\ncontrast material.\n3. VESSELS:  Heavy atherosclerotic changes of the thoracic aorta and its\nbranches, including heavy calcification of the native coronary arteries.\nCHEST CAGE: There are no suspicious bone lesions.",
            "output": "1. Occlusion of the distal left mainstem bronchus, with postobstructive\npneumonia/atelectasis in the left upper and left lower lobes, stable to\nprevious.\n2. Stable bilateral pleural effusions, with unchanged appearance of a\nloculated left hydropneumothorax."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: Please refer to concurrent CT abdomen report.\n\nMEDIASTINUM: Right upper paratracheal lymph node measures 1.4 cm.  No\nmediastinal mass.  A right cardiophrenic sulcus hematoma 3.4 x 7.5 cm. There\nare 2 tubes coursing through the esophagus below the GE junction, 1 of which\nends in the stomach in the other which ends in the duodenum.\n\nHILA:  No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is top normal.  There is coronary artery\ncalcification.  There is an aortic valve prosthesis.  No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There are moderate to severe bilateral dependent dense\nconsolidations with some air bronchograms.  There is diffuse ground-glass\nopacity essentially in all lobes where there is not consolidation.  There are\nalso diffuse interstitial opacities in the upper lobes bilaterally.  These\nfindings have gradually progressed since ___.\n2. AIRWAYS:  ET tube tip is approximately 4.5 cm above the carina.  The\nairways are patent to subsegmental levels.\n3. VESSELS:  Left subclavian approach pulmonary artery catheter tip is in the\nmain pulmonary artery (02:24).  The patient is status post CABG.  The great\nvessels are normal caliber.\nCHEST CAGE: No concerning lytic or sclerotic lesion.  No acute fracture.  The\npatient is status post median sternotomy.  Sternal wires are intact.  Mixed\ndensity fluid in the anterior mediastinum is within expected limits status\npost CABG.",
            "output": "1. Progression of previously unilateral pneumonia to current global airspace\nabnormality raises the possibility of pulmonary toxicity to amiodarone or\ndiffuse alveolar damage.\n2. Moderate to severe bilateral dependent consolidation could be due to\naspiration pneumonia.\n3. Diffuse ground-glass opacity bilaterally most likely represents concurrent\npulmonary edema.\n4. Left subclavian approach pulmonary artery catheter tip is in the main\npulmonary artery at the bifurcation.\n5. Right cardiophrenic sulcus hematoma."
        },
        {
            "input": "Tracheostomy tube midline with no evidence of complications.  Left central\nvenous catheter ends in the left brachiocephalic vein. Sternal fragments\nfollowing sternotomy are closely applied and the previous subxiphoid hematoma\nextending to the upper anterior abdominal wall is smaller, 4: 126-201.  There\nis no new bleeding or fluid collection in the mediastinum.\n\n Mediastinal lymph node enlargement, prevascular and right lower paratracheal\nmediastinal station unchanged.\n\nAnasarca is mild.  There are no fluid collections in the chest wall concerning\nfor infection or bleeding.\n\nThyroid is unremarkable.  Atherosclerotic calcification is heavy in head neck\nvessels and native coronary arteries.  Aortic valve replacement in place.  No\nassociated perivaginal via lower hematoma or fluid collection.  No pericardial\neffusion.\n\nSmall loculated right pleural collection is probably residual from previous\npleural drainage.\n\nLungs and airways:\n\nThe left main bronchial lumen is narrowed to transverse diameter of 5 mm,\npreviously 10 mm, by smooth thickening of the posterior wall, 4:96, possibly\nsubmucosal hemorrhage.  New, nodular, 9 mm wide intraluminal abnormality,\nprobably intraluminal clot, nearly occludes the origin of the left upper lobe\nbronchus, 4:98.  Beyond that point the superior division to the left upper\nlobe, 4:97 is completely occluded, and the lingular division, nearly occluded,\n4:106,, producing collapse of the entire left upper lobe.  Much of the\nobstruction is due to retained material in the bronchial tree, presumably\nhemorrhage.\n\nPrevious widespread global infiltrative pulmonary abnormality beaded to a\ncombination of edema and diffuse drug reaction or hemorrhage has largely\ncleared,.  The moderately large areas of consolidation persisting in primarily\nthe superior and posterior basal segments of both lower lobes were larger in\n___.  These are probably areas of slowly clearing pneumonia.  Bronchi to\nthese regions are intact.\n\nSome of the multiple one-2 cm well-circumscribed nodular abnormalities seen in\nthe right lung, upper lobe, 4:98, lower lobe, 4: 103,106, 116, may have been\npresent, but several of these lesions are probably new, such as the\nsubcentimeter lesion in the right middle lobe, 4:153.  The high attenuation,\n67 ___, raise the possibility of focal hemorrhage, an appearance seen with\nhemorrhagic vasculitis.\n\nNo bone findings in the chest cage suggesting infection or malignancy.",
            "output": "Complete collapse, left upper lobe, due to a combination of retained\nendobronchial clot in the upper lobe bronchus, and its superior and lingular\nbronchial divisions and submucosal narrowing at the origin of the left main\nbronchus, possibly bleeding or infection.\n\nSmall high attenuation nodular lung lesions, some unchanged since ___,\nsome probably new, could be focal hemorrhage, a finding seen with hemorrhagic\nvasculitis.\n\nInterval resolution of previous edema and severe infiltrative pulmonary\nabnormality attributed to either drug toxicity or alveolar hemorrhage.\n\nImproved but still substantial consolidation, both lower lobes, most likely\npneumonia.\n\nNo mediastinal no new mediastinal bleeding or fluid collection.  Sub xiphoid\nhematoma, extending to the upper abdomen, is somewhat smaller."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is\nunremarkable.  No axillary lymphadenopathy.  Small fluid collection superior\nto the mediastinum measuring 2.2 x 1.4 cm (image 36, series 302).  Status post\nmedian sternotomy.\n\nUPPER ABDOMEN: Partially visualized enteric tube noted in the stomach.\n\nMEDIASTINUM: Status post aortic root aneurysm repair, with edematous\nappearance of the mediastinum, there is a soft tissue focus along the superior\nleft mediastinum measuring approximately 5.2 x 3.7 cm (image 57, series 302,\nlikely reflecting a mediastinal hematoma.  No organized/rim enhancing fluid\ncollections within the mediastinum.  Right IJ central venous catheter\nterminating at the distal SVC.  Trace pericardial effusion.  No hilar\nlymphadenopathy.\n\nPLEURA: Trace bilateral pleural effusions.\n\nLUNG:  Scattered multifocal consolidative opacities noted in the right upper\nlobe, superior segment of the left lower lobe, in addition to posterior\nbibasilar atelectatic changes, findings may reflect infectious/inflammatory\nprocess, such as aspiration pneumonia.",
            "output": "1. Trace bilateral pleural effusions.\n2. Scattered multifocal consolidative opacities, in addition to posterior\nbibasilar atelectatic changes, findings may reflect infectious/inflammatory\nprocess such as aspiration pneumonia.\n3. Status post aortic root aneurysm repair, with edematous appearance of the\nmediastinum, this may reflect postsurgical change, however superimposed\ninfectious process cannot be completely excluded, no organized fluid\ncollections within the mediastinum.\n4. Soft tissue density along the superior left mediastinum, measuring up to\n5.2 cm, likely reflecting a mediastinal hematoma.\n5. Status post median sternotomy, with a small phlegmonous change/small fluid\ncollection along the superior aspect of the sternum, measuring up to 2.2 cm."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The patient is status post redo sternotomy, ascending\nthoracic aortic graft, aortic valve replacement, and CABG.  There has been\ninterval increase of circumferential perigraft fluid about the ascending\nthoracic aortic graft which demonstrates minimal complexity with a max density\nof 35 Hounsfield units.  The fluid collection measures up to 2.4 cm (series 4,\nimage 92) in greatest dimension at the level of the AP window, and previously\nmeasured up to 1.3 cm.  No evidence of active extravasation of contrast.  No\nevidence of rim enhancement.  There is a persistent complex mildly hyperdense\nfluid collection along the superior left mediastinum measuring approximately\n4.7 x 3.7 cm (AP by TRV) (series 4, image 51) which previously measured 5.2 x\n3.7 cm compatible with mediastinal hematoma from recent surgery.\n\nPulmonary vasculature is well opacified to the subsegmental level without\nfilling defect to indicate a pulmonary embolus.  Remainder of the thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  Cardiac size is moderately enlarged.  No pericardial effusion. The\nmain pulmonary artery diameter is within normal limits.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple subcentimeter mediastinal lymph nodes\ndo not meet CT criteria for lymphadenopathy.  No axillary, mediastinal, or\nhilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace left pleural effusion, decreased in size from prior. \nInterval resolution of the trace right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Slight interval improvement in previously noted consolidation\nin the left lower lobe.  Patchy opacity in the right upper lobe also appears\nminimally improved.  Atelectasis of the right lower.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia, otherwise the stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Fluid is noted throughout the colon.  The colon and rectum are\notherwise within normal limits. The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is small amount of non organized retroperitoneal fluid\nwhich extends along the bilateral psoas muscles with adjacent fat stranding\n(series 5 image 35 through 58).  No organized fluid collection.  There is a\nconspicuous portal caval lymph node which measures up to 6 mm in short axis\n(series 5, image 24).  There is no retroperitoneal or mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No active contrast\nextravasation or retroperitoneal hematoma.  Minimal flecks of calcification in\ndemonstrated within the abdominal aorta.\n\nBONES AND SOFT TISSUES: There are postprocedural changes which include fat\nstranding and clips within the bilateral groin areas. There is no evidence of\nworrisome osseous lesions or acute fracture. The patient is status post median\nsternotomy with sternal wires intact. Superior to the sternum is a 1.4 x 1.4\ncm fluid collection (series 4, image 34) which previously measured 2.2 x 1.4\ncm.",
            "output": "1. No evidence of pulmonary embolism.\n2. Interval increase in size of circumferential ascending aortic perigraft\nfluid which demonstrates minimal complexity.  No active extravasation or rim\nenhancement.  Please note that superimposed infection cannot be excluded on\nthe basis of this examination and clinical correlation is needed.\n3. Interval improvement in left lower lobe and right upper lobe opacities\nsuggestive of improving infection.\n4. Small volume, non organized fluid and fat stranding within the\nretroperitoneum which may reflect post endovascular procedural changes. \nDifferential consideration includes acute pancreatitis and correlation with\nserum amylase and lipase levels suggested.  No retroperitoneal hematoma.\n5. Interval decrease in size of left superior mediastinal hematoma.\n6. Interval decrease in size of a small fluid collection along the superior\naspect of the sternum which now measures up to 1.4 cm.\n7. Trace left pleural effusion."
        },
        {
            "input": "CHEST CAGE:\nThe sternotomy wires are well aligned and intact although there is a\npersistent sternal wound hypodensity indicating incomplete sternal fusion,\nsimilar to examination from ___.  No evidence of associated fluid\ncollections or soft tissue thickening.  The remaining bony structures show no\nacute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone lesions\nworrisome for malignancy.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Excluding the midline postsurgical changes, there\nare no other chest wall abnormalities.  No atherosclerotic calcifications in\nthe head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is mildly patulous. Stable multiple small central mediastinal lymph\nnodes. Hilar contours show no evidence of enlarged lymph nodes within the\nlimitations of a noncontrast study.\n\nHEART, PERICARDIUM AND VASCULATURE:\nMild cardiomegaly. Aortic mechanical valve, ascending aorta stent graft and\nCABG postsurgical changes are unchanged. No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries.  A para-aortic\nlow-density collection surrounding has substantially decreased in size in the\ninterval.  The overall aortic diameter now measuring 53 mm is consequently\ndecreased in size as well.  Pulmonary arteries are normal in caliber\nthroughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels. Bibasal subsegmental\natelectasis more evident on the left are moderately improved.  New right upper\nlobe ground-glass opacities most likely reflect mild infectious process\n(302:105).  No suspicious lung nodules or masses. No pleural effusions. Mild\nbiapical pleuroparenchymal scarring.\n\nUPPER ABDOMEN:\nThis study is not tailored for subdiaphragmatic assessment, within this\nlimitations there is no evidence of focal hepatic or splenic lesions and the\nadrenals are unremarkable.",
            "output": "Sternotomy wires are well aligned, however, the persistence of the sternal\nwound indicates incomplete sternal fusion.\n\nSubstantial interval size decrease of the para aortic low-density collection.\n\nNew right upper lobe ground-glass opacities most likely reflecting mild\ninfectious process.\n\nUnchanged appearance of aortic valve replacement, ascending aorta graft stent\nand CABG postsurgical changes."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable. Mild bilateral gynecomastia.\n\nUPPER ABDOMEN: The imaged upper abdomen is unremarkable.\n\nMEDIASTINUM: Multiple mediastinal nodes are prominent, but not pathologically\nenlarged.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Postsurgical changes following aortic graft, aortic\nvalve replacement, and CABG are again seen.  The thoracic aorta is otherwise\nnormal in caliber.  There is no pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Multiple bilateral pulmonary nodules appear new from the prior\nstudy.  For example, a ground-glass nodule within the left upper lobe measures\n7 mm (4:56).  Multiple additional pulmonary nodules measure up to 3 mm.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\n\nCHEST CAGE: Postsurgical changes following median sternotomy are\nredemonstrated.  The sternotomy wires appear intact.  Compared to the prior\nstudy, there appears to be bony bridging across the sternotomy site, denoting\ninterval healing.  No definite evidence of sternal nonunion.  No adjacent\nfluid collections.  No aggressive osseous lesions or acute fractures.",
            "output": "1. Interval healing of the sternum, following median sternotomy, without\nevidence of nonunion.  Intact sternotomy wires.  No evidence of associated\nfluid collections.\n2. Multiple new bilateral pulmonary nodules, including a left upper lobe\nground-glass nodule measuring 7 mm.  While these nodules are likely infectious\nor inflammatory in etiology particularly given the patient's age, a follow-up\nchest CT in 12 months is recommended to ensure resolution or stability.\n\nRECOMMENDATION(S):  For an incidentally detected single ground-glass nodule\nbigger than 6mm, CT follow-up in 6 to 12 months is recommended to confirm\npersistence. If persistent, CT follow-up every ___ years until ___ years after\ninitial detection are recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lung volumes are slightly low.  There is bibasilar dependent\natelectasis.  Mosaic attenuation of the lungs is likely due to expiratory\nphase.  Otherwise, lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES/soft tissues: No suspicious osseous abnormality is seen.? There is no\nacute fracture.  There post treatment changes in the right breast.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No evidence of traumatic injury.\n3. Scattered atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Moderate atherosclerotic disease is present in the\ndistal descending thoracic aorta.  The heart is moderately enlarged, similar\nto prior examination with marked left atrial enlargement.  Calcific density in\nthe left ventricular myometrium, likely corresponding to papillary muscles, is\nalso unchanged since prior examinations.  Aortic valve calcifications are\npresent.  Moderate coronary arterial calcifications are also seen.  Small\namount of pericardial effusion is present.  The pulmonary arteries are\nenlarged suggestive of pulmonary hypertension.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent nonenlarged mediastinal lymph nodes\nare similar to prior examination.  No evidence of mediastinal, hilar or\naxillary lymphadenopathy.  No mediastinal masses identified.  The esophagus\nappears patulous, increasing risk for aspiration pneumonia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral dependent atelectasis is present.  Area of\natelectasis in the left lower lobe (301: 114-161) shows mildly heterogenous\nenhancement, concerning for superimposed pneumonia.  No pulmonary mass/nodule\nis identified.  Motion artifact and expiratory phase of volume slightly limit\nevaluation of the parenchyma.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nCHEST WALL: A discrete simple fluid collection in the right breast is similar\nto prior examination of ___.",
            "output": "1.  No evidence of pulmonary arterial embolus or acute aortic abnormality.\n2.  Bibasilar pulmonary atelectasis, with suspicion for superimposed pneumonia\nin the left lower lobe.  A patulous esophagus increases risk for aspiration\npneumonia.\n3.  Stable moderate cardiomegaly.\n4.  Enlarged pulmonary arteries suggestive of pulmonary hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  Surgical clips in\nthe right breast are unchanged.  A right breast fluid collection has decreased\nin size compared to the study from ___.\n\nUPPER ABDOMEN: Limited view of the unenhanced upper abdomen shows multiple\ncalcifications in the liver and the spleen, likely the sequelae of prior\ngranulomatous infection.  There is no suspicious adrenal nodule.\n\nMEDIASTINUM: Mediastinal lymph nodes measure up to 8 mm, however none are\npathologically enlarged.  There is no mediastinal mass. The esophagus is\npatulous with an air-fluid level.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: The heart size is mildly enlarged.  A pericardial\neffusion is small.  Coronary artery calcifications are severe.  Aortic valve\ncalcifications are moderate.  Mitral annular calcifications are heavy.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is no evidence of interstitial lung disease.  Compared\nto the prior study bibasilar atelectasis has increased with near complete\ncollapse of the left lower lobe.\n2. AIRWAYS:  The central airways are patent.  Secretions/debris within the\nleft upper and bilateral lower lobe bronchi have increased compared to the\nprior study.\n3. VESSELS:  The thoracic aorta is of normal caliber with moderate\natherosclerotic disease.  The main pulmonary artery is enlarged measuring 3.6\ncm.  A right PICC tip terminates at the superior cavoatrial junction.\n\nCHEST CAGE: No acute fracture or aggressive osseous lesion.  Multilevel\nchronic vertebral body compression deformities are similar dating back to\n___.",
            "output": "1. No evidence of interstitial lung disease.\n2. Interval worsening in obstructive bibasilar atelectasis with increased\nsecretions/aspirated debris within left upper and lower lobe bronchi.\n3. Possible esophageal dysfunction and aspiration."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. No pathologically enlarged hilar or\naxillary lymph nodes are seen. Small mediastinal lymph nodes are not enlarged\nby CT size criteria.. The heart is top normal in size and there is a small\namount of pericardial fluid, likely physiologic.  Coronary artery\ncalcifications are diffuse and moderate. Mitral annular calcification is\nmoderate. The aorta and main pulmonary artery are normal in caliber.Limited\nviews of the upper abdomen demonstrate scattered calcified granulomas in the\nliver and spleen, and no other significant abnormality.\n\nLungs:The central airways are patent.  Linear consolidation in the right\nmiddle lobe, lingula, and more extensive consolidation in the left lower lobe\nmay represent atelectasis.  The left lower lobe consolidation could also\nrepresent pneumonia in the appropriate clinical setting.\n\nBones:No rib fractures are identified.  Compression deformities of the T5, T6,\nT8, and T12 vertebral bodies are noted. The compression deformity at T12 was\ninitially seen in ___, and has lost height between ___ and ___, but appears similar between ___ and today's examination.  The\ncompression deformity of the inferior endplate of the T6 vertebral body\nappears unchanged since ___. Compression deformities at T5 and T8 and\nwere not seen on the prior cross-sectional imaging, and are thus age\nindeterminate. Due to the sclerotic nature, they are possibly chronic.",
            "output": "1. Consolidation at the left lung base may represent atelectasis or pneumonia\nin the appropriate clinical setting.\n2. Moderate coronary artery and mitral annular calcifications.\n3. No rib fractures.\n4. Compression deformities at the T5 and T8 vertebral body were not seen on\nprior cross-sectional imaging but appear sclerotic, possibly chronic, but\noverall age indeterminate.\n5. Compression deformities at T6 and T12 are stable since ___, and\n___ respectively."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular or axillary\nlymphadenopathy. Multiple hilar and mediastinal lymph nodes have increased in\nsize since the prior study, including a 9 mm right upper paratracheal node\n(03:18), a 13 mm left upper hilar lymph node (03:24), and an 11 mm\nparaesophageal lymph node (03:22). The intra mediastinal right pulmonary\nartery is enlarged, measuring 28 mm, unchanged from the prior study.  The\nintrathoracic aorta is of normal caliber throughout its course.  The heart is\ntop-normal in size, with dense mitral annular calcifications, as well as\ncoronary arterial atherosclerotic calcifications (03:29).  A left PICC\nterminates just above the cavoatrial junction.  A tracheostomy tube is in\nappropriate position, with tracheal wall thickening noted along the tube tract\nand superiorly.  The esophagus is patulous, with no evidence of wall\nthickening, and there is a very small hiatal hernia.\n\nPLEURA:  There is no pneumothorax.  There is a trace right pleural effusion.\n\nLUNGS: Respiratory motion and expiratory phase of imaging limits assessment\nfor small pulmonary nodules and interstitial lung disease.\n\nThe central airways appear patent, although the distal trachea and bilateral\nmainstem bronchi are collapsable during this expiratory phase of imaging.\nWidespread ground-glass nodular opacities are noted in the bilateral upper and\nlower lobes in a peribronchial distribution, along with interlobular septal\nthickening, particularly at the apices (___:12). Focal small areas of\nconsolidation in the bilateral lung bases likely reflect atelectasis.  There\nis increased fullness in the suprahilar region adjacent to and just below the\nazygos vein (4:81).\n\nBONES: Multiple thoracic vertebral body compression deformities are again\nnoted, as well as compression deformity of the L1 vertebral body. There has\nbeen interval progression of height loss at the T4 level and inferior endplate\nof T10 (10b:81, 77). Healed right lateral fifth through tenth rib fractures\nare noted, likely the sequelae of trauma sustained in ___. No focal\nlytic or sclerotic lesion worrisome for osseous osseous malignancy is\nidentified.\n\nUPPER ABDOMEN:  Although this study is not tailored for the evaluation of\nsubdiaphragmatic structures, numerous punctate calcifications are again seen\nin the spleen and liver, likely reflecting prior granulomatous infection. The\ngallbladder is surgically absent.  The adrenal glands are unremarkable.",
            "output": "1. Widespread peribronchial ground-glass opacities are compatible with\nmultifocal infection.\n2. Right suprahilar opacification, adjacent to the azygos vein, which may\nrepresent a combination of peribronchovascular consolidation and reactive\nlymphadenopathy, however repeat Chest CT with IV contrast is recommended in\n___ weeks after adequate treatment for acute pneumonia to exclude a malignancy\nin this region.\n3. Findings compatible with tracehobronchomalacia. Tracheal wall thickening\nadjacent and superior to indwelling tracheostomy tube may reflect granulation\ntissue.  Correlation with recent bronchoscopic findings is recommended.\n4. Mild hydrostatic edema and trace right pleural effusion.\n5. Interval progression of compression deformities of the T4 vertebral body\nand inferior endplate of the T10 vertebral body. Other thoracic and lumbar\ncompression deformities unchanged in appearance.\n6. Healed right lateral fifth through tenth rib fractures."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nModerate mitral annular calcifications.  Moderate coronary arterial\narthrosclerotic calcifications.  Heart is significantly enlarged.  Stable\ncalcification of the left ventricular papillary muscle.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental\npulmonary arteries.  Mildly prominent main pulmonary artery, suggest pulmonary\nartery hypertension.\n\nInterval decrease in size of right upper paratracheal lymph node, measuring up\nto 7 mm (02:29) and left upper hilar lymph node measuring 6 mm (02:35). \nPreviously seen paraesophageal lymph node is decreased in size.  The thyroid\ngland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMotion artifact limits evaluation of the lung parenchyma.  There are extensive\nleft-sided bronchial secretions and mucous plugging including left upper lobe\nbronchus and left lower lobe, right lower lobe bronchi, most prominent in the\nleft lower lobe.  There is lingular and left lower lobe volume loss and\nconsolidation from atelectasis.  Mild atelectasis in the posterior right\ncostophrenic angle.  There is small cluster of centrilobular nodules,\n___ nodules in the posterior right upper lobe series 301, image 85,\nmay represent mucoid impaction or aspiration.  Chronic defect of the upper\ntrachea may be related to prior tracheostomy, there is mild tracheal\nnarrowing.  Tracheobronchomalacia was more evident on prior.\n\nLimited images of the upper abdomen demonstrate multiple calcified splenic and\nhepatic granulomas.  Small hiatal hernia with patulous esophagus.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nModerate multilevel degenerative changes of the visualized spine.  No\nsignificant change in multiple vertebral body compression deformities\ninvolving, greatest at T4 and T7.  Continued healing of right lateral fifth\nthrough tenth rib fractures.",
            "output": "1. No evidence of pulmonary embolism.\n2. Extensive mucous plugging in the lower lungs, most prominent in the left\nlower lobe, with moderate volume loss in the lingula, left lower lobe\npredominantly from atelectasis.  Small component of left basilar pneumonia\nfrom aspiration is possible\n3. Enlarged heart, suggestion of pulmonary artery hypertension.\n4. Patulous esophagus.\n5. Chronic compression fractures, similar."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: There is no significant change in 7 mm right upper paratracheal\nlymph node and left upper hilar 6 mm lymph node.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nNo incidental central pulmonary arterial filling defect identified. Heart size\nis mildly enlarged with moderate coronary artery calcifications. There is no\npericardial effusion.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are again seen left-sided bronchial secretions with\nmucous plugging in the left upper and lower lobe bronchi.  There is interval\ndevelopment of patchy and confluent consolidation in the right lower, left\nupper, lower lobes and lingula.  There is no new suspicious pulmonary nodule\ndetected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, multiple splenic and hepatic granulomas are\nidentified.\n\nCHEST CAGE/BONES:  No focal lytic or sclerotic lesion concerning for\nmalignancy. Moderate multilevel degenerative changes of the thoracic spine are\nunchanged.  No significant change in multiple vertebral body compression\ndeformities, greatest at T4 and T7.",
            "output": "1. Findings compatible with multifocal pneumonia.  Persistent extensive mucous\nplugging in the left upper and lower lobes.\n2. Mild cardiomegaly.\n3. No significant change in chronic vertebral body compression deformities"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Large right chest wall lipoma (3, 6) with a diameter\nof approximately 5 cm.  Diffuse thickening of the esophageal wall. No enlarged\nlymph nodes in the mediastinum and at the level of the hilar structures.\nBorderline sized lymph node at the lower aspect of the right hilus (3, 29).\nCalcified infraclavicular lymph node. Borderline diameter of the pulmonary\nartery.  No substantial coronary calcifications. No pericardial effusion. \nModerate hiatal hernia.  The upper abdomen is described in detail in the\ndedicated abdominal CT report. Moderate respiratory motion artifacts. No\nsuspicious lung nodules or masses. Several subpleural micronodules are non\nsuspicious and require no specific followup. Calcified subpleural granuloma in\nthe left lung (5, 145). No pleural thickening, no pleural effusions. Minimal\natelectasis at the right lung basis.",
            "output": "Moderate respiratory motion are defects.  No suspicious lung nodules or\nmasses.  No lymphadenopathy.  No pleural effusions."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.  Coronary calcifications are extensive.\n\nSmall amount of ascites is demonstrated potentially related to dialysis.\n\nAirways are patent to the subsegmental level bilaterally.  In bilateral apical\nareas of scarring are demonstrated.  No pulmonary nodules masses or\nconsolidations noted.  Slightly longitudinal scar in the superior segment of\nright lower lobe might potentially reflect the nodular opacity seen on the\nchest radiograph.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Extensive coronary calcifications\n\nSmall amount of ascites\n\nLinear areas of scarring in the lungs\n\nNo pulmonary nodules of concern."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid mildly heterogeneous. \nThere is no supraclavicular and no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Included unenhanced upper abdominal organs are unremarkable.\n\nMEDIASTINUM: There is no mediastinal and no gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is not pathologically enlarged.  Minimal coronary\ncalcifications.  Status post sternotomy and replacement of aortic valve. \nDense calcifications of the mitral valve.  Ascending aorta measures up to 4\ncm.  Main pulmonary artery within normal size.  Moderate atherosclerotic\ncalcifications along the thoracic aorta.  There is no pericardial effusion.\n\nLUNG AND PLEURA: Bilateral small pleural effusions, right greater than left\nwith adjacent small consolidations/compressive atelectasis of the lower lobes.\nEvaluation of progression or resolution of findings is not possible in the\nabsence of prior studies.\nMajor airways are patent and there is mild diffuse bronchial wall thickening. \nRespiratory motion artifacts limit evaluation of fine details.  Calcifications\nin the partially collapsed right lower lobe.\nWithin the limitation of study with no IV contrast there is no evidence of\nlung abscess, no cavitations.\n\nCHEST CAGE: No evidence of bony destructive lesions in the sternum, vertebral\nbodies or ribs.",
            "output": "1. Bilateral small pleural effusions, right greater than left with adjacent\nsmall consolidations of the lower lobes which could be seen in the setting of\na superimposed infectious process.\n2. Ascending aortic dilatation is seen measuring up to 4-cm."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare mild.  No pathologically enlarged supraclavicular, mediastinal, axillary\nor hilar lymph nodes demonstrated by CT criteria.  Coronary calcifications are\nmild.  Heart size is normal.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is demonstrated, consistent with provided history of COPD.\n\nExtensive centrilobular ground-glass nodules are consistent with respiratory\nbronchiolitis seen in the upper lobes.  7 mm calcified nodule in the right\nupper lobe is noted.  It is at series 5, image 147.  Additional noncalcified\nnodule is in the right lower lobe, series 5, image 176, 5 mm.  Superior\nsegment of left lower lobe calcification, series 5, image 78 most likely\nrepresent calcified granuloma as well.  Left upper lobe 3 mm nodule is\nnoncalcified.  Subpleural nodule in the left lower lobe is 5 mm, series 5,\nimage 191.\n\nThe emphysema is severe in the lower lobes more than in the upper lobes. \nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Severe respiratory bronchiolitis\n\nSevere   bronchitis\n\nSevere emphysema more in the lower lobes and upper lobes\n\nFindings might be potentially representing alpha 1 antitrypsin deficiency,\nplease correlate with clinical findings and laboratory testing."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nNo thyroid incidental Findings.  No enlarged lymph nodes in either the axilla\nor thoracic inlet.  No atherosclerotic calcifications in the head and neck\narteries.  No chest wall abnormality.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Small mediastinal lymph nodes, not enlarged by CT\nsize criteria.  No hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  Mild atherosclerotic calcification in\nthe coronary arteries.  None in the cardiac valves or aorta.  The aorta and\npulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental level.  Increased AP diameter of\nthe trachea in a saber sheath disposition.  Lower lobe predominant confluent\nemphysema with associated increased retrosternal space diameter.  Upper lobe\npredominant bronchial wall thickening with associated diffusely distributed\nmicro nodules concerning for respiratory bronchiolitis.  Stable randomly\ndistributed bilateral 2-8 mm nodules, the largest on the right lower lobe\nmeasuring 8 x 7 mm (5:195).\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Severe respiratory bronchiolitis and bronchitis are unchanged.\nLower lobe predominant panlobular emphysema concerning alpha-1 antitrypsin\ndeficiency.\nMild atherosclerotic calcification in the coronary arteries.\n\nSmall to related disease, consider combination of laboratory, imaging and\nclinical Findings for potential chronic obstruction pulmonary disease."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Stable biapical scarring with dependent bibasilar atelectasis\nand upper lobe ground glass opacification likely secondary to expiratory\nphase.  A 2 mm right upper lobe nodule (04:45) and a 3 mm left upper lobe\npulmonary nodule appear unchanged compared to ___ (4:69).  A 3 mm\nright middle lobe intrapulmonary lymph node (4:120) is stable.  A previously\ndescribed left lower lobe subpleural nodule is not well demonstrated on\ncurrent exam.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for a\nright upper pole simple renal cyst measuring 1.3 x 1.4 cm (2:61).\n\nBONES: No suspicious osseous abnormality is seen.? There is no definite acute\nfracture.  T5 and T6 superior endplate height loss is new compared to ___, but does not demonstrate CT evidence to suggest an acuity.",
            "output": "1. No evidence of acute fracture.\n2. Stable appearing bilateral pulmonary nodules measuring up to 3 mm compared\nto ___.\n3. T5 and T6 superior endplate height loss is new compared to ___\nwithout CT findings to suggest acuity though is age indeterminate.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:59 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The visualized thyroid gland is normal. There is no supraclavicular, axillary,\nmediastinal or hilar lymphadenopathy. The aorta and pulmonary arteries are\nnormal in caliber. There is minimal aortic atherosclerotic disease. There is a\nright-sided central venous line terminating at the cavoatrial junction.\n\nThe heart is normal in size. There is no pericardial thickening or effusion.\nThere are coronary artery vascular calcifications.\n\nThere is a right-sided chest tube in place which initially courses superiorly\nand medially and then descends inferiorly to abut the epicardial fat. There is\na persistent small pneumothorax. There is subcutaneous air dissecting within\nthe soft tissues of the right anterior chest. There is also air dissecting\naround the thyroid gland and trachea. This is likely related to the\npneumothorax. There is no significant pleural effusion.\n\nThe trachea and mainstem airways are patent. There is soft tissue density at\nthe carina likely representing postsurgical change from recent tracheoplasty.\nThere is bibasilar atelectasis. There is moderate to severe upper lobe\npredominant centrilobular emphysema. Sub 3 mm pulmonary nodules seen at the\nright apex (series 4, image 33) an left upper lobe (series 4, image 68) which\nwere described on the prior CT (___) and are stable in size.\n\nLimited views of the upper abdomen are unremarkable.\n\nThere are no suspicious bone lesions.",
            "output": "1. Right-sided chest tube as described above with persistent small\npneumothorax. There is extensive subcutaneous air in the of the right chest\nwall as well as a small amount of mediastinal air.\n2.  Bilateral moderate to severe centrilobular emphysema.\n3. Sub 3 mm pulmonary nodules, stable from the prior chest CT as described\nabove. Recommend ___ year CT followup for further evaluation."
        },
        {
            "input": "CTA THORAX: The aorta and main thoracic vessels are well opacified. The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection. The pulmonary arteries are opacified to the subsegmental level.\nThere is no filling defect in the main, right, left, lobar or subsegmental\npulmonary arteries.\n\nCT OF THE THORAX: The thyroid is unremarkable and there is no supraclavicular\nlymph node enlargement. The airways are patent to the subsegmental level.\nThere is no mediastinal, hilar or axillary lymph node enlargement by CT size\ncriteria. The heart, pericardium, and great vessels are within normal limits. \nThere is a small hiatal hernia.\n\nThere is no worrisome nodule, mass, or consolidation within the lungs. No\npleural effusion or pneumothorax is present.\n\nAlthough this study is not designed for assessment of intra-abdominal\nstructures, note is made of an incompletely imaged simple renal cyst within\nthe right interpolar region measuring up to 2.8 cm.\n\nOSSEOUS STRUCTURES: No focal osseous lesion concerning for malignancy.",
            "output": "No acute intrathoracic process, specifically no PE."
        },
        {
            "input": "There is a 2.6 x 1.7 cm hypoenhancing, lobulated mass within the posterior\nright lower lobe (6:185).  The mass measures 2.8 cm in maximum dimension on\ncoronal reformats and 2.0 cm in maximal straight craniocaudal dimension. \nThere are peripheral linear opacities that are likely atelectasis.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen reveal cirrhotic morphology of the liver. \nAssessment of vasculature is limited in this contrast phase, however the\nperiumbilical vein may be recanalized and there appear to be perigastric\nvarices, however this is uncertain as it is an arterial phase in the abdomen. \nThe scan was not timed for assessment of periesophageal varices.\n\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is bilateral acromioclavicular joint and glenohumeral joint degenerative\nchange.  Mild thoracic degenerative changes with a disc osteophyte complex at\nT9/10 with mild canal narrowing.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  A 2.8 cm hypoenhancing, lobulated mass within the posterior right lower\nlobe is concerning for primary pulmonary malignancy.\n\n3.  Cirrhotic morphology of the liver with some associated signs of portal\nvenous hypertension, not fully evaluated on this exam.\n\n\nRECOMMENDATION(S):  Biopsy of the right lower lesion for further\ncharacterization, which could be performed by CT guidance.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:17 pm,at the discovery of the\nfindings."
        },
        {
            "input": "No incidental thyroid findings.  No abnormalities of the chest wall.  Massive\ncalcified hilar and mediastinal lymphadenopathy.  Minimal coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  No\nabnormalities in the posterior mediastinum.  The upper abdomen shows a\nsclerotic liver and moderate perisplenic and perihepatic ascites.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  Moderate right pleural\neffusion.  Adjacent areas of atelectasis.  Several calcified bilateral\ngranulomas.  Mild bilateral subpleural scarring.  Moderate calcified pleural\nplaques on the left and on the right.  No systemic fibrosis.  No evidence of\ninfectious or neoplastic lung disease.",
            "output": "Extensive calcified lymphadenopathy.  Moderate right pleural effusion with\nsubsequent atelectasis.  Minimal scars, but no evidence of systemic fibrosis. \nCalcified granulomas, no neoplastic disease."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is suboptimally\nvisualized.  No supraclavicular adenopathy.  No axillary adenopathy.  Moderate\nto severe bilateral gynecomastia.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Cirrhotic appearance of the liver with moderate intra-abdominal\nascites appears relatively similar compared to prior.  No adrenal lesions. \nMild splenomegaly.  Recanalization of the umbilical vein in keeping with\nportal hypertension.\n\nMEDIASTINUM: Multiple mediastinal partially calcified lymph nodes appear\nsimilar compared to prior.  Non calcified pericardial lymph node (2, 35) Is\nslightly decreased in size compared to prior.\n\nHILA: Multiple partially calcified bilateral hilar lymph nodes appear similar\ncompared to prior.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve or coronary artery calcification.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: Small right-sided nonhemorrhagic pleural effusion is decreased in size\ncompared to prior.  Pleural thickening and mild enhancement in the posterior\nright lung is most likely secondary to longstanding pleural effusion.  Small\nnonhemorrhagic left-sided pleural effusion is new.  Bilateral calcified\ndiaphragmatic plaques are stable.\nLUNG:\n\n1. PARENCHYMA:  A couple of small, calcified pulmonary nodules in keeping with\nprior granulomatous infection or dust exposure are stable.  No new suspicious\npulmonary nodules or masses.  No confluent airspace consolidation.  Mild\nlinear atelectasis in the lung bases.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.  Old, lower right rib fractures.",
            "output": "No interval change in the partially calcified mediastinal lymph nodes or\ncalcified pulmonary granulomas.  This may represent a prior dust exposure or\ngranulomatous infection.  No new or enlarging pulmonary nodules or masses or\nconfluent airspace consolidation.  The chronic right-sided pleural effusion is\ndecreased in size compared to prior.  Small new left-sided pleural effusion. \nBilateral diaphragmatic calcifications in keeping with asbestos exposure.\n\nCirrhotic appearance of the liver with associated features of portal\nhypertension and moderate ascites appear similar compared to prior."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM/HILA:  Extensive partially calcified enlarged mediastinal and\nhilar lymph nodes are unchanged from prior studies in suggestive of prior\ngranulomatous infection or dust exposure.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Scattered parenchymal granulomas are similar to the\nprior study.  There is no new or worrisome solid pulmonary nodule.  There is\nbibasilar subsegmental atelectasis related to bilateral pleural effusions. \nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  A chronic right pleural effusion with associated pleural thickening\nhas increased slightly from the prior study, now moderate.  A small left\npleural effusion is unchanged.  Pleural calcification is present, and can be\nseen in the setting of prior asbestos exposure.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Moderate symmetric gynecomastia is\nunchanged.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for a\nlarge ascites, cirrhotic appearing liver, and a recanalized paraumbilical vein\nwith extensive associated varices.",
            "output": "1. Slight interval increase in chronic right pleural effusion, now moderate. \nUnchanged chronic left pleural effusion, still small.\n2. Unchanged mediastinal and hilar calcified lymphadenopathy with scattered\npulmonary parenchymal granulomas suggesting prior granulomatous infection or\ndust exposure.\n3. Partially imaged cirrhotic liver with large ascites and variceal formation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no pathologic enlargement\nof lymph nodes in the supraclavicular or axillary stations.  Bilateral minimal\nsymmetric gynecomastia is stable.\n\nCHEST CAGE: Mild sclerosis of the right 8 costal junction is new (302:95), and\ncould represent subacute nondisplaced fracture.  No fracture is in left ribs. \nThere is diffuse demineralization and mild degenerative changes but no\nworrisome lytic or sclerotic osseous destructive lesions the at the level of\nthe chest cage or vertebra.\n\nUPPER ABDOMEN: Patient is status post liver transplantation.  Enlargement of\nthe spleen measured in the axial plane up to 14 cm.  No calcifications in the\nimaged spleen.\n\nMEDIASTINUM: Stable massive calcified lymphadenopathy involves all mediastinal\nstations and both hila, vital structures are not compromised.  Superior\npre-vascular 0.8 cm lymph nodes are of not pathologically enlarged and\nlong-standing (302:60).\n\nHEART and PERICARDIUM: Heart is normal in size.  There is trace pericardial\neffusion.  Specks of calcifications in the coronaries as well as along\nthoracic aorta.  Punctate calcification in the aortic valve leaflets.  Main\npulmonary artery is normal in caliber.\n\nPLEURA: Bilateral small pleural effusion has decreased since ___. \nCurrently right is small and left is minimal.  Right smooth pleural thickening\nand mild extra pleural fat hypertrophy are unchanged, suggesting chronicity. \nLeft lung base moderate calcified pleural plaques and right minimal\ncalcifications suggest prior asbestos exposure.\n\nLUNG: The extensive bilateral parenchymal consolidations demonstrated on ___ are almost completely resolved, scattered subsegmental atelectasis\nand mild interstitial abnormalities remain, predominantly in both upper lobes.\nScattered calcified granulomas are stable.  No evidence of developing\nfibrosis.  There are no discernible pulmonary nodules.",
            "output": "-Mild sclerosis of the right 8 costal junction is new and could represent\nsubacute nondisplaced fracture.  No fractures of the left ribs.  Marking\npainful area and repeating rib radiographs might help in characterizing\npatient's complaints.\n-Prior extensive bilateral parenchyma consolidations largely resolved,\nscattered atelectasis remains predominantly in the upper lobes.\n-Bilateral pleural effusion has decreased since prior, now right is small and\nleft is minimal."
        },
        {
            "input": "THORACIC INLET: The thyroid has a heterogeneous appearance.  There are no\nenlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Both breasts\nhave heterogeneous retro year old tissue which could represent glandular\ntissue however correlation with mammography is recommended.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  Heart\nsize is normal.  The aorta and pulmonary arteries are normal in caliber. \nThere is no pericardial effusion.  There is mild coronary artery calcification\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: No obvious nodules or consolidations are seen.  There is minimal\nbibasilar atelectasis\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nlesion in the right lobe of liver.  Both adrenals are diffusely thickened\nwhich could represent adenomas.",
            "output": "No mass in the chest.\n\nModerate cardiomegaly.  Mild coronary artery calcification.\n\nHypodense lesion in the right lobe of liver could represent a cyst."
        },
        {
            "input": "The imaged portion of the thyroid gland is normal.  The thoracic aorta\nenhances normally with mild atherosclerotic calcification and no evidence of\ndissection or aneurysm.  The arch branches appear normal in caliber.  The main\npulmonary artery measures up to 3 cm in diameter.  There is no filling defect\nwithin the pulmonary arterial tree to suggest the presence of a pulmonary\nembolism.  The heart mildly enlarged.  Trace pericardial fluid and anterior\nmediastinal fluid may reflect recent CABG.  Lymph nodes in the mediastinum are\nnot pathologically enlarged.  No hilar or axillary adenopathy is seen.  The\nairways centrally patent.  There are small bilateral pleural effusions, left\ngreater than right.  Mild basal compressive atelectasis is noted in the lower\nlobes.  There is mild central peribronchovascular edema.  The lungs are\nessentially clear without signs of pneumonia or edema.  No worrisome pulmonary\nnodule or mass.\n\nIn the imaged portion of the upper abdomen, no abnormalities are detected.\n\nBones:  Unremarkable.  No worrisome lytic or blastic osseous lesion.  No\nfracture.  Midline sternotomy wires are present.",
            "output": "1. No pulmonary embolism.\n2. Mild cardiomegaly with small bilateral pleural effusions and mild central\ncongestion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Fluid collection with rim enhancement is identified at\nthe the right pericardial space measuring 6.8 x 3.7 x 5.9 cm.  The fluid\ntracks anteriorly to the sternotomy.  The fluid collection effaces the lateral\nwall of right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  Right pleural effusion is small.\n\n\nLUNGS/AIRWAYS:  Atelectasis is mild in right lower lobe.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for 7 mm hypodense\nlesion in the spleen which is unchanged..\n\nBONES:  Sternotomy wires are intact.  No suspicious osseous abnormality is\nseen.? There is no acute fracture.",
            "output": "1. Fluid collection with rim enhancement is identified at the the right\npericardial space measuring 6.8 x 3.7 x 5.9 cm. The fluid tracks anteriorly to\nthe sternotomy.  Findings may reflect pericardial abscess.\n2. No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Endotracheal tube tip is 5.8 cm\nabove the carina.\n\nThe visualized thyroid appears unremarkable.\n\nThere is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen pelvis report.\n\nEsophageal enteric catheter tip is within the lower esophagus.\n\nMEDIASTINUM: Increased numbers of nonenlarged mediastinal lymph nodes.\n\nHILA: No significant lymphadenopathy.\n\nHEART and PERICARDIUM: Mild coronary artery and aortic arch calcific\natherosclerosis.  Suggestion of anemia.  Increased heart size.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Peribronchovascular infiltrates, ground-glass opacities with\ninterlobular septal thickening in the right lower lobe consistent with\npneumonia or aspiration..  There is largely atelectasis in the left lower lobe\nwith some volume loss.  No cavitation is seen to suggest pulmonary abscess. \nMultiple small, 2 mm pulmonary nodules are seen within the right upper lobe\n(series 11b, image 17).  A 2 mm right lower lobe calcified granuloma is also\nseen.\n\n1. AIRWAYS:  Mild bilateral lower lobe air bronchograms with opacification of\nthe distal right lower lobe bronchi.  Airways are clear proximally.\n2. VESSELS:  No significant pulmonary arterial enlargement.\nCHEST CAGE: No displaced rib fracture.  Probable small sebaceous cyst\nposterior central upper chest.",
            "output": "1. Right lower lobe pneumonia or aspiration..  No evidence of pulmonary\nabscess or pleural effusion.\n2. Esophageal enteric catheter tip within distal esophagus.\n\nNOTIFICATION:  Esophageal enteric catheter findings were reported to clinical\nteam as per report of CT abdomen/pelvis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Few prominent mediastinal and hilar lymph nodes\nare noted, the largest measuring up to 11 mm in the infra carinal area.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multifocal consolidations and ground-glass opacities are noted\nthroughout the lungs especially in the right lower (series 302, image 100) and\nupper lobe (series 302, image 52) and left upper lobe (series 302, image 90). \nThis is highly concerning for multifocal pneumonia.  No cavitary lesion.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multifocal consolidations and ground-glass opacities are highly concerning\nfor multifocal pneumonia.\n2. Reactive hilar and mediastinal lymph node.\n\nRECOMMENDATION(S):  Imaging follow-up post treatment recommended."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the chest wall (3, 13)\nAre normal in size.  There is a moderate right pleural effusion (3, 21).  Also\nnoted are enlarged right hilar and paratracheal lymph nodes (3, 20).  No\nsubstantial coronary calcifications, no valvular calcifications,\ncircumferential thickening of the left ventricular myocardium. The posterior\nmediastinum is unremarkable.  Fatty liver, no acute abdominal findings.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Moderate\nrespiratory motion are defects.  The lung parenchyma on the left is virtually\nunremarkable, with the exception of a calcified left apical granuloma (5, 63).\nOn the right however, there are multiple nodules and masses, some of which are\nspiculated, for example in the right upper lobe (5, 94) and at the right upper\nlobe basis (5, 132).  Some of the nodular structures con fluid and build\nlarger conglomerates.  The smaller nodules show very lymphatic and subpleural\ndistribution (5, 181).  Finally, some of the nodules show direct pleural\ncontact (5, 238).  Mild narrowing of the airways in the right upper lobe.",
            "output": "Multiple right-sided nodules and masses, some of which are spiculated, and\nsome of which con fluids to larger consolidations.  The smaller nodules show\nvery lymphatic and subpleural distribution.  Overall, the unilaterality of the\nprocess is in favor of an infectious disease, however, given the highly\nsuspicious morphology of the lesions, bioptic proof should be obtained.  The\nright upper lobe lesions would be amenable to bronchoscopic biopsy."
        },
        {
            "input": "THORACIC INLET: There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are stable small bilateral axillary lymph nodes\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  The aorta and pulmonary artery normal in caliber.  There is no\npericardial effusion.  There is mild coronary artery calcification.\n\n\nPLEURA: The right pleural effusion has slightly decreased in volume.  The\npleural based metastasis along the lateral, mediastinal surface of the pleura\nand along the fissures have significantly improved since the prior study. \nSome of these lesions are barely perceptible on the current study.  The nodule\nalong the major fissure now measures 9 mm it previously measured 20 mm (6,\n160).\n\nLUNG: The dominant right upper lobe mass abutting the mediastinal pleura has\nalso significantly improved and now measures approximately 2.1 cm it\npreviously measured 3.1 cm.  The ground-glass opacification in the right\nparamediastinal region in the right upper lobe (6, 104) has also minimally\nimproved.  A calcified granuloma in the left upper lobe is unchanged.  No new\nsites of disease.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Significant improvement in the overall disease burden with decrease in size of\nthe dominant right upper lobe mass and right-sided pleural based metastasis\nand decrease in volume the right pleural effusion.  No new sites of disease.\n\nPlease refer to dedicated report on abdomen which has been dictated separately\nfor further details."
        },
        {
            "input": "The patient is status post interval stenting of the bronchus intermedius with\nmarkedly improved aeration of the right upper and middle lobes.  The stent is\nwidely patent but contains scant layering secretions distally.  Previously\nnoted post-obstructive pneumonia has largely resolved.  However, there is a\nfocal consolidation the right lower lobe associated with peribronchial\nthickening which likely represents residual infection. The reexpanded right\nupper lobe demonstrates diffuse interlobular septal thickening, scattered\nground glass opacities, central peribronchial thickening and a few branching\ntubular ___ opacities.  There is also thickening and nodularity of\nthe right major fissure superiorly, which raises concern for lymphangitic\nspread of metastasis.  Right lower lobe peribronchial thickening with central\nmucoid impaction and scattered focal ground glass opacities are also noted.\nMild biapical paraseptal emphysematous changes are present.\n\nTwo small cavitary lesions measuring up to 2.8 x 1.7 cm have developed in the\nposterior segment of the right upper lobe in areas that correspond to\npreviously seen metastatic nodules.  The larger cavitary lesion appears to\ncommunicate with abnormally dilated and thickened distal airways (6:101).\n\nThe difficult-to-delineate right perihilar mass has markedly decreased in size\nsince the prior exam measuring 3.5 x 2.4 cm, previously 4.9 x 3.8 cm (6:160). \nThe mass abuts and attenuates the distal main right pulmonary artery.  The\npreviously seen right pleural effusion with associated right lower lobe\npassive atelectasis has resolved.\n\nMediastinal lymphadenopathy has markedly improved since the prior exam.  For\nreference, a pathologically enlarged right upper paratracheal lymph node with\ncentral low attenuation has decreased in size measuring 3.7 x 2.7 cm,\npreviously 4.7 x 4.2 cm (6:102).  There is resultant decreased mass effect\nupon the trachea and right mainstem bronchus.\n\nThe heart size is normal, but there are scattered coronary artery and aortic\nroot calcifications.  There is no pericardial effusion.  The main pulmonary\nartery and thoracic aorta are normal in caliber.\n\nMultilevel spinal degenerative changes are present.  No destructive osseous\nlesion is identified.\n\nImages of the upper abdomen are unremarkable.",
            "output": "1. Status post interval placement of interlobar bronchus stent with markedly\nimproved aeration of the right lung as compared to ___.\n\n2. Near complete resolution of post-obstructive pneumonia with a small right\nlower lobe consolidation with associated peribronchial thickening, which is\nlikely due to residual infection.\n\n3. Right upper lobe interlobular and fissural thickening and nodularity, which\nraise concern for lymphangitic spread of metastatic disease.\n\n4. Markedly improved pulmonary metastases with interval development of two\ncavitary lesions in the posterior right upper lobe at the site of treated\nmetastases.\n\n5. Marked interval decrease in size of right perihilar mass and mediastinal\nlymphadenopathy as described above.\n\n6. Interval resolution of right pleural effusion."
        },
        {
            "input": "The thyroid gland is unremarkable. 4 mm thoracic inlet nodes are unchanged\n(03:10). Extensive central lymphadenopathy is unchanged or minimally smaller\nsince ___. For example, the 2.7 x 2.9 cm right lower paratracheal lymph\nnode conglomerate was 3.3 x 3.2 cm, and the contiguous right hilar lymph node\nconglomerate is 2.8 x 2.5 cm, previously 3.4 x 2.4 cm.  A 13 mm subcarinal\nlymph node is unchanged.  Local infiltration around the nodes is unchanged.\n\nA necrotic 18 x 18 mm right upper lobe nodule is unchanged in size but has\nnearly refilled with semisolid material (5:100).  There is been an increase in\nsoft tissue in the medial right lower lung, probably tumor extension along the\ninferior pulmonary ligament and along the diaphragmatic surface, and accounts\nfor the moderate, nonhemorrhagic right pleural effusion, previously trace.\n\nThe extensive right hilar lymphadenopathy still encases, but does not\nappreciably narrow the right main pulmonary artery and the bronchus\nintermedius, right middle and lower lobe bronchi without distal atelectasis. \nThe stent in the bronchus intermedius and basal trunk bronchi has not migrated\nand is widely patent but does contain a small amount of secretions.  This\nfinding may explain the new, reticulated, peribronchial, ground-glass\nopacities seen throughout the right the lung, mostly in the lower lobe.\n\nThe heart is normal size and there is no pericardial effusion. Focal coronary\nartery calcifications are mild.  The aorta and main pulmonary artery are\nnormal caliber.  Although this study is not designed for pulmonary artery\nevaluation there is no large, filling defect in the central arteries.\n\nThe imaged portions of the suboptimally enhanced liver, spleen, pancreas,\nkidneys and adrenal glands are unremarkable.  The included thyroid is normal. \nThere are no lytic or blastic osseous lesions in the chest cage. Anterior\nosteophytes in the thoracic spine are degenerative.",
            "output": "1. New multifocal right lower lung peribronchial infiltration due to aspirated\nsecretions or blood, probably the result of chronic bronchial stenting,\nalthough the stent is patent.  2. Growing tumor infiltration, right inferior\npulmonary ligament and adjacent diaphragmatic pleural surface, explains\nmoderate right pleural effusion. 3.  Extensive right lower mediastinal and\nright hilar adenopathy, minimally smaller."
        },
        {
            "input": "The thyroid gland is unremarkable. A pathologically enlarged right lower\nparatracheal lymph node is not significantly changed in size measuring 2.5 x\n3.1 cm, previously 2.7 x 2.9 cm (3, 21).  Right hilar lymphadenopathy has\nslightly decreased with a representative node measuring 1.9 x 2.1 cm,\npreviously 2.5 x 2.8 cm (3, 25). A 3.1 x 2.3 cm subcarinal lymph node is\nunchanged (5, 133). There is no supraclavicular, axillary, or left hilar\nlymphadenopathy.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolism is\nidentified.\n\nThere are increased ground-glass opacities, interlobular septal thickening and\nfocal consolidations involving the right upper, right middle and right lower\nlobes as compared to ___. An endobronchial stent extending from the\nbronchus intermedius remains patent and contains a small amount of layering\nsecretions. Diffuse bronchial wall thickening extending from the right hilus\nto involve several right lung lobar and segmental bronchi has also increased.\nA superior segment right lower lobe perifissural nodule no longer shows\ncavitation, but is stable in size measuring 1.7 x 1.7 cm, previously 1.8 x 1.8\ncm (5, 90).  Infiltrative opacities along the right inferior pulmonary\nligament have progressed, but a small right layering nonhemorrhagic pleural\neffusion has slightly decreased.\n\nThere are retained secretions in the upper esophagus.The adrenal glands are\nincompletely imaged, thereby limiting evaluation. Images of the upper abdomen\nare otherwise unremarkable.\n\nMultilevel spinal degenerative changes are stable.",
            "output": "Stable size of right lower lobe lung nodule, but worsening diffuse right lung\nopacities, which are likely due to evolving postradiation changes superimposed\nupon diffuse lymphangitic carcinomatosis.\n\nSlight interval decrease in small nonhemorrhagic right pleural effusion.\n\nStable mediastinal lymphadenopathy, but slightly improved right hilar\nlymphadenopathy."
        },
        {
            "input": "Assessment of the mediastinum demonstrate interval overall similar appearance\nof the right lower paratracheal lymph node, 21.6 x 18 mm, as compared to 25.7\nx 24 mm (minimal decrease. The in case segment of the right main bronchus by\nthe soft tissues similar, series 5, image 25 but there is minimal decrease in\nthe thickening of this encasement, from 6.8-5.3 cm. There is small amount of\nright pleural effusion demonstrated, overall unchanged since the prior study. \nThere is. No additional mediastinal or hilar or axillary lymph nodes are\npresent. Aorta and pulmonary arteries are unremarkable. No pericardial\neffusion is seen. Image portion of the upper abdomen will be reviewed\nseparately as part of the CT abdomen and corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally except for slight\nnarrowing of the right main bronchus. A right bronchial stent is in place. No\ndefinitive evidence of displacement or in grows of the stent demonstrated. As\ncompared to the prior study there is interval decrease in the widespread\nconsolidations most likely consistent with interval slight improvement in the\npostradiation changes and potentially resolution of coexisting infectious\nelement a fourth if was present. No new nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval improvement in postradiation extent of consolidations in the right\nlung\n\nMinimal decrease in the) tracheal dominant lymph node\n\nUnremarkable appearance of the right main bronchus stent.  It starts at the\nbifurcation of the right main bronchus into bronchus intermedius and right\nupper lobe pulmonary artery and continuous in 2 of the bronchus intermedius.\n\nPlease review CT abdomen separately with is description of multiple abnormal\nfindings within the abdomen"
        },
        {
            "input": "The thyroid gland is unremarkable.  A pathologically enlarged right lower\nparatracheal lymph node is not appreciably changed measuring 18 x 21 mm,\npreviously 18 x 22 mm (2, 19). Right hilar lymphadenopathy has also not\nappreciably changed, with a representative node measuring 13 mm in short axis\n(2, 28). A few punctate cardiophrenic lymph nodes measure up to 6 mm,\nunchanged (12, 212). There is no supraclavicular, axillary, or left hilar\nlymphadenopathy.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolism is\nidentified.\n\nAs compared to ___, there are increased ground-glass opacities,\ninterlobular septal thickening and focal consolidations involving the right\nupper, right middle and right lower lobes. There is new distal occlusion of an\nindwelling endobronchial stent extending from the right mainstem bronchus into\nthe bronchus intermedius.  Diffuse bronchial wall thickening extending from\nthe right hilus to involve several right lung lobar and segmental bronchi is\nunchanged. Nodular right lower lobe interlobular septal thickening and\nnodularity of the right major fissure is concerning for lymphangitic spread of\nmetastasis. The left lung remains relatively spared. A moderate right layering\nnonhemorrhagic pleural effusion has increased, contributing to increased right\nlower lobe atelectasis. There is also a new trace left pleural effusion.\n\nThere is low attenuation fluid in the lower esophagus. Images of the upper\nabdomen show a stable 2.3 cm left adrenal nodule (2, 64), and a stable 2.7 cm\nright adrenal nodule (2, 61).\n\nMultilevel spinal degenerative changes are stable.  No lytic or sclerotic\nosseous lesions are identified.",
            "output": "Interval worsening of pre-existing right lung ground-glass opacities and\nconsolidations since ___ suggests worsening infection or radiation\npneumonitis. Underlying lymphangitic spread of metastasis cannot be excluded.\n\nNew distal occlusion of the indwelling right endobronchial stent, which is\nmost likely due to mucous plugging.\n\nSubstantial interval increase in moderate layering nonhemorrhagic right\npleural effusion with increased right lower lobe passive atelectasis.  New\ntrace left pleural effusion.\n\nStable mediastinal and right hilar lymphadenopathy.\n\nStable bilateral adrenal metastases."
        },
        {
            "input": "A pathologically enlarged left supraclavicular lymph node (3:3) has grown\nsignificantly since the previous study, not previously measured. A\npathologically enlarged lower right paratracheal lymph node is only slightly\nlarger at 2.9 x 2.5 cm from prior 2.1 x 2.0 cm (02:18). A 2.5 cm right hilar\nnode (03:23) and other smaller mediastinal lymph nodes are not significantly\nchanged.\n\nA round, 0.9 cm lymph node at the inferior aspect of the left axilla was not\npreviously measurable (03:17).\n\nAorta and pulmonary arteries are normal size. Cardiac chambers are not\nenlarged. There is no pericardial effusion.\n\nEndobronchial stent in the right mainstem bronchus and bronchus intermedius\nappears patent. Areas of peribronchial consolidation in the right lung with\ngeographic distribution are similar to the prior exam and remain consistent\nwith radiation change. Small to moderate right pleural effusion is unchanged.\n\nHepatic lesions with surrounding ascites, adrenal lesions, and T12 vertebral\nbody compression deformity are described in a separate report for the abdomen\nand pelvis portion of the exam.",
            "output": "1. Interval enlargement of left supraclavicular lymphadenopathy. Other\nmediastinal lymph nodes and a right hilar node are unchanged to minimally\nlarger. A left axillary lymph node is small but suspicious on the basis of\nmorphology and interval growth.\n2. No significant change in right lung opacities likely reflecting sequela of\nradiation treatment.\n3. Persistent small to moderate right pleural effusion.\n4. Please refer to separate dictation for the CT abdomen and pelvis for\ndiscussion of findings below the diaphragm."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities elsewhere in the chest wall concerning for\nmalignancy or infection.  Findings below the diaphragm will be reported\nseparately.\n\nThere are no thyroid abnormalities warranting further imaging evaluation.\n\nAtherosclerotic calcification is not apparent in head and neck vessels\nincluding normal caliber retroesophageal right subclavian artery.  Coronaries\nare not calcified.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.\n\nEsophagus is unremarkable.\n\nThoracic lymph nodes:\n\nLymph nodes in the chest are not enlarged.\n\nPericardium and pleural surfaces are normal.\n\nLungs and airways:\n\n9 mm ground-glass nodule, left upper lobe, 302:52.\n\nThe tracheobronchial and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nLeft lung is otherwise clear.\n\nChest cage:\n\nNormal.",
            "output": "Subcentimeter ground-glass nodule left upper lobe could be an early neoplasm\nin the adenocarcinoma spectrum.  Lesion at this stage is unlikely to be\nresponsible for extrathoracic metastasis.\n\nRECOMMENDATION(S):  Repeat chest CT, 3 months, for evaluation of possible\nearly adenocarcinoma of the lung, assuming this is clinically appropriate\ngiven the patient's other medical conditions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Right upper lobe scarring with bronchiectasis is unchanged. \nThe airways are patent to the level of the segmental bronchi bilaterally.  A 3\nmm right lower lobe  (2:53) and 2 mm left upper lobe (3:92) nodules are\nunchanged since ___.\n\nBASE OF NECK:  Incidentally noted is a thyroid nodule measuring 4 mm in the\nleft lobe (2:3). Unless there is additional clinical concern, based on ACR\nguidelines further evaluation is not recommended given the patient's age\n(greater than ___ years old) and nodule size (less than 1.5 cm).\n\nABDOMEN:  A 4 mm hepatic segment 8 hyperenhancing focus is unchanged from\nprior examination (601b:19, 2:72).  Incidentally noted is a left adrenal\ncalcified focus, unchanged, likely sequela of prior injury or infection.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "There is a 3 mm hypodensity in the left lobe of the thyroid.  There is no\naxillary, supraclavicular, mediastinal or hilar lymphadenopathy.\n\nThe heart is normal in size.  There is no pericardial effusion.  The aorta and\nmain pulmonary artery are normal in size.  Apparent filling defects at the\nright lung apex (series 3, 63) are likely related to respiratory motion. \nThere is no pulmonary embolus.\n\nThe airways are patent to the subsegmental level.  Linear right upper lobe\nscarring is unchanged.  A 3 mm ground-glass opacity in the right upper lobe\n(series 3, 61) is unchanged.  A 2 mm nodule in the right upper lobe (series 3,\n82) is unchanged.  A 3 mm perifissural nodule in the minor fissure (series 3,\n111) is unchanged.  Significant respiratory motion limits assessment for\nadditional tiny pulmonary nodules.\n\nThere is no pleural abnormality or pleural effusion.\n\nA small hiatal hernia is unchanged.  A small left adrenal nodule with a \nhyperdense focus, likely representing calcification is unchanged.  Mild\nprominence of the main pancreatic duct is unchanged.  Otherwise, otherwise,\nlimited assessment of the abdomen is unremarkable.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST PERIMETER: Thyroid and thoracic inlet are substantially obscured by\ncontrast infusion artifact.  No enlarged lymph nodes in the axilla.  Breast\nevaluation is reserved for mammography.  No soft tissue abnormalities\nelsewhere in the chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis but shows no adrenal mass or subphrenic collection.\nAttenuation value of the perfused liver suggests severe hepatic steatosis.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels, minimal if any in left anterior\ndescending coronary artery.  Aortic valvular calcification is mild.\n\nPericardium is physiologic.\n\nPULMONARY ARTERIES:\nNo pulmonary emboli.  Main pulmonary artery normal caliber.\n\nTHORACIC LYMPH NODES: As follows:\n\nNo lymph nodes in the chest are pathologically enlarged ranging in diameter up\nto 15 mm in the subcarinal station, top-normal.\n\nLUNGS, AIRWAYS, PLEURAE: Focal abnormalities as follows:\n\nCluster of 3 adjacent similar size, nonenhancing subcentimeter nodules in the\nlateral basal segment of the right lower lobe, 3:121-131 range in attenuation\nfrom 10 ___ to 25 ___.  In the absence of a pulmonary artery emboli, these are\nunlikely to be infarcts.  The should be kept under close surveillance, to\ndetermine whether they are postinflammatory or active lesions.\n\nLungs otherwise clear.  Tracheobronchial tree is normal to subsegmental levels\nelsewhere.  No pleural abnormality.\n\n\n\nCHEST CAGE: Unremarkable.",
            "output": "No pulmonary emboli.  Normal thoracic aorta.\n\nHepatic steatosis.\n\nIncidental finding, 3 contiguous small nodules, right lower lobe, significance\nuncertain.  Chest CT otherwise normal.  See recommendations below.\n\nRECOMMENDATION(S):  I would obtain conventional chest radiographs now and if\nthe 3 right lower lobe nodules are visible, repeat the chest radiograph in 4\nweeks.  If the nodules are not visible, I would repeat a chest CT, contrast is\nnot necessary, in 3 months.\n\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 10 30 am, 30 minutes after a telephone\ncall was placed immediately following discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  Small axillary and thoracic inlet lymph nodes\nare stable.  Excluding the breast tissue which is exclusive for mammography\nthere are no chest wall abnormalities.  No atherosclerotic calcifications in\nthe head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Small mediastinal lymph nodes are unchanged. \nHilar contours show no evidence of enlarged lymph nodes within the limitations\nof a noncontrast study.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications the coronary arteries.  Moderate aortic valve\ncalcifications.  Aorta and pulmonary artery normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nRight lower lobe tubular nodules ending in a dilated sac are substantially\ndecreased, now measuring 6 x 8 mm most likely consistent with bronchiolar\nmucoid impaction.  The airways are patent to the subsegmental level, no\nbronchial wall thickening.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no focal liver or splenic\nlesions.  Adrenals are unremarkable.",
            "output": "Improving right lower lobe tubular nodules, most likely consistent with\nbronchiolar mucoid impaction.  Three-month follow-up is recommended to\ndocument complete resolution.\n\nNo new or growing nodules.  No enlarged mediastinal or lymph nodes."
        },
        {
            "input": "No supraclavicular, axillary, mediastinal, or hilar lymph node enlargement by\nCT size criteria.The thyroid gland is unremarkable.\n\nThe heart size is normal without pericardial effusion.  The aorta and its\nmajor branch vessels are patent with no evidence of stenosis, occlusion,\ndissection, or aneurysmal formation. The pulmonary arteries are well opacified\nto the segmental level, with no filling defect to suggest pulmonary embolism.\n\nNo pleural effusion.No pneumothorax.  The airways are patent to the segmental\nlevel.\n\nWithin the lungs, no focal opacity, pulmonary nodule, or mass seen.  Mild\nbilateral lower lobe atelectasis is present.  Heterogeneous air-filled area\nposterior to the left pectoralis minor muscle and superior to the left\nsubclavian artery is most consistent with small hematoma from known anterior\nentry site of bullet.  (5:  35).  No active extravasation seen.  Subcutaneous\nedema is seen surrounding the left axillary artery.\n\nOSSEOUS STRUCTURES:  Minimally posterior displaced comminuted fracture of the\nleft scapula is adjacent to the 1.5 x 1 cm (05:39) radiopacity most consistent\nwith bullet.  No surrounding hematoma.  No proximal humeral fracture.  No\nlytic or blastic osseous lesions concerning for malignancy.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is notable for a 1 x 0.7 cm (5:112) the\nright upper pole of the most consistent with a cyst.  Additional 0.5 x 0.6 cm\nincompletely characterized lesion in the left kidney demonstrates focal area\nof hyperdensity (5:  120).",
            "output": "1.  Minimally posteriorly displaced comminuted fracture of left scapula\nadjacent to a 1.5 cm bullet.\n2.  Heterogeneous air-filled area posterior to left pectoralis minor muscle\nand superior to left subclavian artery is most consistent with small hematoma\nfrom known anterior entry site of bullet with adjacent subcutaneous edema\nsurrounding the left axillary artery.  No evidence of active extravasation.\n3.  Few incomplete characterized renal lesions.  Recommend dedicated non\nurgent MR for further evaluation.\n\nNOTIFICATION:   The findings were conveyed by Dr. ___ with ED QA Nurses via\nemail on ___ at 3:11 ___, 15 minutes after discovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart is moderately enlarged with mild coronary\nartery calcifications.  Pericardium and great vessels are unremarkable.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a small left pleural effusion, (series 2, image 91). \nNo pneumothorax.\n\nLUNGS/AIRWAYS: There is evidence of mild centrilobular emphysema, (series 2,\nimage 24).  There are multiple, sub solid and followed, sub 6 mm pulmonary\nnodules in the right lower lobe (series 2, image 64, image 70), some of which\nwere present on the prior CT abdomen, but others of which were not imaged. \nMild smooth septal thickening at the lung bases suggests mild volume overload.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Re-demonstrated, is a multinodular thyroid gland that was better\nassessed on thyroid ultrasound dated ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation.  Again seen,\nmultiple well-circumscribed subcentimeter hypodense hepatic lesions consistent\nhepatic cysts or biliary hamartomas (series 2, image 102).  Re-demonstrated is\nsimilar intrahepatic and extrahepatic biliary dilatation with the common bile\nduct measuring up to 1.0 cm, (series 2, image 122), previously measured 1.2 cm\non prior CT abdomen and pelvis dated ___.  The gallbladder is\nmildly distended without free fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There multiple subcentimeter well-circumscribed hypodense lesions in\nthe kidneys are too small to characterize on CT.  The kidneys are of normal\nand symmetric size with normal nephrogram.  There is no evidence of concerning\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastrectomy and Roux-en-Y without\ncomplications.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThe appendix is normal.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is a small\namount of free fluid in the pelvis which may be physiologic.\n\nREPRODUCTIVE ORGANS: There are multiple calcifications in the uterus which\nappear vascular.  The bilateral ovaries are not well demonstrated.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate to severe atherosclerotic disease is noted.\n\nBONES: Again seen, is unchanged, mild grade 1 anterolisthesis of L4 on L5,\n(series 602, image 71).  No focal suspicious osseous abnormality or fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute traumatic injury identified within the torso.  Specifically, no\nsplenic injury or acute fractures.\n2. Multiple sub 6 mm, solid and sub solid pulmonary nodules in the right lower\nlobe, some of which appear unchanged from the prior CT from ___,\nothers of which were not previously imaged.  See recommendations below for\nneed for follow-up.\n3. Unchanged intrahepatic and extrahepatic biliary dilatation when compared to\nprior study dated ___.\n4. Mild centrilobular emphysema.\n5. Small left pleural effusion and mild fluid overload within the lungs.\n\nRECOMMENDATION(S):   For incidentally detected multiple subsolid nodules\nsmaller than 6mm, CT follow-up in 2 and ___ years can be considered if\nclinically indicated.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CTA CHEST: The aorta and major thoracic vessels are well opacified. The aorta\ndemonstrates normal caliber throughout the chest without evidence of\nintramural hematoma or dissection.  Arch branch vessels are patent and normal\nin caliber.  The pulmonary artery is well opacified to subsegmental levels. \nThere is no evidence of an intraluminal filling defect in the main, right,\nleft, lobar, or subsegmental pulmonary arterial branches.  No arteriovenous\nmalformation is identified.\n\nCT CHEST: The partially visualized thyroid is within normal limits.  The\nesophagus is unremarkable.  There is a small axial hiatus hernia.  The heart\nis normal in size.  No pericardial effusion.  No supraclavicular, mediastinal,\nhilar, axillary, or subpectoral lymphadenopathy.\n\nMajor airways are patent to subsegmental levels bilaterally.  There is mild\ndiffuse bronchial wall thickening which can be seen in setting of chronic\nairways disease.  2 mm calcified granuloma at the right lung apex (___). \n1-2 mm solid pulmonary nodule in the subpleural right upper lobe (4:85). \nThere is platelike atelectasis in the inferior lingula.  4 mm nodule versus\nfocal scarring at the left lung apex is noted (04:24).  No focal lung\nconsolidation.  No pleural effusion or pneumothorax.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously without evidence of concerning\nfocal lesion. There is no intrahepatic biliary ductal dilation. The portal\nvein is patent.  Patent hepatic veins.  No extrahepatic biliary ductal\ndilation.  The gallbladder surgically absent.\n\nPANCREAS: The pancreas enhances homogeneously. There is no peripancreatic\nstranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: Simple cyst in the left upper pole measures 14 mm.  Additional\nbilateral renal cortical hypodensities elsewhere are too small to accurately\ncharacterize by CT (for example see series 601, image 41 and 47).  Background\nrenal parenchyma enhances normally and symmetrically.  There is no\nhydronephrosis or hydroureter.\n\nGASTROINTESTINAL: Aside from small axial hiatus hernia, the stomach is\nunremarkable.  The duodenum is normal.  Non-dilated small bowel loops are\nnormal in course and caliber without evidence of wall thickening or\nobstruction.  The colon is unremarkable.  The appendix is normal.\n\nVASCULAR AND LYMPH NODES: The abdominal aorta is normal in caliber without\nevidence of aneurysm or dilation.  Major proximal tributaries are patent.  IVC\nis unremarkable.\n\nScattered retroperitoneal lymph nodes are not pathologically enlarged.  There\nis no mesenteric lymphadenopathy.  There is no free intraperitoneal air or\nfluid.\n\nCT PELVIS:\nBladder and terminal ureters are unremarkable.  Uterus is not well seen.  No\nfocal adnexal abnormality.  No pelvic or inguinal lymphadenopathy.  No free\npelvic fluid.\n\nMUSCULOSKELETAL: Calcifications and nodular opacities in the right and left\nflank soft tissues (05:54) may represent sequelae of prior trauma/dystrophic\ncalcifications or possibly sequelae of subcutaneous injections.  There are\npostsurgical changes along the anterior abdominopelvic wall including\nbroad-based fascial laxity/rectus abdominus diastasis measuring 7.7 cm across.\nLinear opacities in the subcutaneous fat in the midline likely reflect\nscarring.  No focal fluid collection.  No concerning focal lytic or sclerotic\nosseous lesions identified.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. No acute process identified in the abdomen or pelvis.  Normal appendix.\n3. Bilateral solid pulmonary nodules measuring up to 1-2 mm in the right upper\nlobe and 4 mm at the left lung apex.  Recommend correlation with patient risk\nfactors in consideration of follow-up dedicated CT chest imaging, as below.\n4. Mild diffuse bronchial wall thickening which can be seen in setting of\nchronic airways disease.\n5. Small hiatus hernia.  Other incidental findings, as above.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is normal.  There are mild coronary\ncalcifications.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is subsegmental atelectasis in the bilateral lung bases. \nThere are no parenchymal opacities concerning for infection.  Central airways\nare patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\nTrace fluid in the cholecystectomy bed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 10 mm right adrenal nodule, indeterminate.  The left adrenal gland\nis normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia containing the gastric fundus and\nbody.  Small bowel loops are normal in caliber.  Intramural fat deposition in\nthe descending and sigmoid colon is nonspecific, but can be seen in the\nsetting of chronic inflammation.  There is sigmoid diverticulosis, without\nfindings of acute diverticulitis.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 2.6 cm right adnexal cyst is noted.  The uterus and\nleft adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Marked thoracic dextroconvex and lumbar levoconvex\nscoliosis is noted.  There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nScattered subcutaneous air locules along the anterior abdomen and lower chest\nwall, likely iatrogenic from recent laparoscopic surgery.",
            "output": "-No evidence of pulmonary embolism.\n-Status post cholecystectomy.  Trace fluid in the gallbladder fossa, without\norganized fluid collection.\n-10 mm right adrenal nodule.  See below for recommendations.\n-2.6 cm right adnexal cyst.  In a postmenopausal female, further evaluation\nwith nonemergent pelvic ultrasound is recommended.\n-Scattered subcutaneous air locules along the anterior abdomen and lower chest\nwall, likely iatrogenic from recent laparoscopic surgery.\n-Moderate size hiatal hernia.\n\nRECOMMENDATION(S):  1. Incidentally discovered adrenal lesion without prior\nstudies for comparison measuring 1-2 cm. If there is no history of malignancy,\nthis is probably benign. Follow up dedicated adrenal CT in 12 months could be\nconsidered. If there is a history of malignancy, a dedicated adrenal CT is\nrecommended.\n\nRecommendations based on ___ ACR guidelines:\n___\n\n2.  Nonemergent pelvic ultrasound for evaluation of the right adnexal cyst."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. \nAtherosclerosis of the aorta.  The lungs are clear. Patient is status post\nmedian sternotomy. No suspicious osseous lesions are identified. There\nmultilevel degenerative disc disease throughout the thoracic spine.\n\nThe abdomen and pelvis portion examination dictated under separate report.\nPlease see dedicated report for full details.\n\nOf note, the mass seen on chest CT corresponds to thickened myocardium of the\nleft ventricle.  No mass is present.",
            "output": "The mass visualized on chest CT corresponds to thickened myocardium of the\nleft ventricle.  No mass is present.\n\nINDICATION:  chest mass partially visualized on neck CT for further\ncharacterization and evaluation."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta is normal size.  Main pulmonary artery is top\nnormal limits measuring 3 cm.  Cardiac configuration is normal and there is no\nappreciable coronary calcification.  The lungs are clear.  There is no pleural\nor pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "No acute finding in the chest"
        },
        {
            "input": "CHEST PERIMETER: Low-attenuation regions in both lobes of the thyroid, but\nespecially the dominant lesion in the left lobe extending into the isthmus are\nmore pronounced today than in ___.  Appropriateness of additional imaging\nevaluation would depend upon evaluation of the patient's general clinical\ncircumstances.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Anasarca has\nprogressed substantially since ___.  No pleural drainage catheter traverses\nthe chest wall any longer, there are no fluid collections are large masses in\nthe chest wall.\n\nCARDIO-MEDIASTINUM:Upper esophagus is moderately patulous.  Remainder the\nesophagus is unremarkable.  There is no associated mass or good evidence for\nobstruction.\n\nAtherosclerotic calcification is moderate in head and neck vessels and in all\nmajor coronary arteries.  Aorta and pulmonary arteries are top-normal size. \nEvaluation of chronic cardiomegaly would require echocardiography.  Aortic\nvalvular calcification is moderate, hemodynamic significance is indeterminate.\nPericardium is physiologic.  A new filling defect in the left atrial appendage\nis probably a 5 mm wide thrombus, 3:129.\n\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Except for increase in pleural fluid in the apex of\nthe right hemithorax, the right pleural effusion elsewhere has decreased\nsubstantially since ___, including the previous moderate circumferential\nand fissural components.  There is no pneumothorax currently.\n\nLeft pleural fluid loculations have generally improved, except adjacent to\nradiation fibrosis in the left upper lobe, suspicious for malignant\ninvolvement..\n\nCoarse reticular infiltration, left lower lobe, has been attributed to\ncarcinomatosis.  There is a new region in the superior segment of the left\nlower lobe, 3:110.  Radiation fibrosis anterior left upper lobe is stable.\n\nPrevious 14 x 17 mm mass, superior segment right lower lobe is a 10 x 15 mm\ntoday, 3:105.  Handful of small right lung nodules is stable. There has been\nsome increase in heterogeneously distributed edema in the right upper lobe,\nbut there has been improvement in the lower lobe, as well as in generalized\nbronchial cuffing.\n\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Severe anasarca has progressed since ___.\n\nNew lymphangitic carcinomatosis, superior segment left lower lobe.\n\nOther thoracic findings however have generally improved, especially the volume\nof now small right pleural effusion, redistributed to the apex of the chest,\nend the smaller left pleural effusion except for new pleural thickening\nadjacent to chronic radiation fibrosis left upper lobe.\n\nThe dominant right lower lobe lung mass is substantially smaller.  Handful of\nmuch smaller lung nodules is stable.\n\nUnevenly distributed mild pulmonary edema has improved, presumably due to\nlymphatic occlusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Several hypodense nodules in\nthyroid up to 1 cm in the left lobe not warrant further imaging.\nRight axilla lymphadenopathy up to 1.3 cm (02:15).  No lymphadenopathy in the\nleft axilla, likely resected, and no lymphadenopathy in the supraclavicular\nstation.\n\nUPPER ABDOMEN: Coarse calcification in the left lobe of the liver is\nunchanged.  Remaining included upper abdominal organs are unremarkable.\n\nMEDIASTINUM: Conglomerate of lymph nodes up to 1.5 x 1.9 cm in the right upper\nparatracheal station.  Soft tissue fullness in right lower paratracheal\nstation (5:131).\nSmall hiatal hernia, esophagus is collapsed and unremarkable.\n\nHILA: Borderline 1.4 cm lymph node in the right hilus.  There is no left hilus\nlymphadenopathy.\n\nHEART and PERICARDIUM: Heart and major vessels are within normal size. \nModerate coronary calcifications predominantly of the LAD and LCX with speck\nof calcification in the aortic valve leaflets. Dense calcifications along the\nthoracic aorta.\nPulmonary vasculature opacification is suboptimal but there is no evidence of\ncentral pulmonary embolism.\n\nPLEURA: Small left pleural effusion with minimal adjacent compressive\natelectasis.  There is no evidence of pleural nodulation or masses.\n\nLUNG: Airways are patent to the subsegmental level.  Postradiation changes\nwith volume loss are seen in the left upper lobe.\nInnumerable micro nodules and nodules involve both lungs, predominantly in the\nright upper and middle lobes where nodular interstitial line thickening is\ndemonstrated suggesting lymphangitic carcinomatosis.  Reference irregular\nnodules 2.1 cm right lower lobe nodule adjacent to major fissure (5:143), 0.6\ncm and 1.1 cm nodules in the right middle lobe (5:162, 187).\n\nCHEST CAGE: There is no evidence of osteo-destructive bony lesions in the\nvertebra, Ribs or sternum.\nDiffuse osteoporosis with mild degenerative changes of the spine.",
            "output": "-Innumerable micro nodules and nodules involving both lungs and concerning for\nmetastasis, predominantly in the right upper and middle lobes with suspected\nlymphangitic carcinomatosis.  In the presence of tongue cancer swallowing\ndifficulties and aspirations are likely, which could be at least in part\nresponsible for the pulmonary findings.  For clinical correlation.\n-Small left pleural effusion.\n\nRECOMMENDATION(S):  8 weeks follow up is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Supraclavicular lymph nodes are few\nand small measuring up to 0.6 cm (05:20).  Multiple axillary lymph nodes in\nthe right axilla measure up to 1 cm (5:66), slightly worse since prior. \nBreast evaluation is reserved for mammography.\n\nCHEST CAGE: There are multilevel degenerative changes of the vertebra, but no\nevidence of lytic or sclerotic osteo destructive lesions at the level of the\nribs, sternum or vertebra.  No pathologic compression fractures.\n\nUPPER ABDOMEN: Coarse calcification in the left lobe of the liver is\nunchanged.  Remaining included unenhanced upper abdominal organs are with no\ngross findings.\n\nMEDIASTINUM: Evaluation of mediastinum and hila is limited in the absence of\nIV contrast. Lmphadenopathy in the right paratracheal stations replacing\nmediastinal fat redemonstrated (5:96), largely unchanged.  Judging by the\nhilar contours there is no gross lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is a trace pericardial\neffusion.  Coronary calcifications extensive.  Thoracic aorta is top normal in\ndiameter, extensively calcified.\n\nPLEURA: Pigtail catheter through ___ intercostal space terminates in the\nposterior pleural space, adjacent to the aorta.  Pneumothorax is\nmoderate-to-large, pleural effusion is small and layering, containing several\nbubbles of air.\nPostradiation changes with volume loss are seen again in the left upper lobe.\n\nThere has been progression in the nodular interlobular thickening in the right\nlower lobe, middle lobe, and particularly in the right upper lobe. \nEssentially new lobular thickening in the left lower lobe could be exaggerated\nby overlapping pulmonary congestion.\n\nNodular opacity in the right lower lobe is 2 x 1.7 cm, in prior 2 x 1.2 cm\n(05:38).  Patchy nodularity in the right upper lobe has progressed, 5:97 for\nexample, where subpleural 1.5 cm nodule has increased in size and density.",
            "output": "Bilateral lymphangitic carcinomatosis and multiple metastatic nodules have\nprogressed since ___.\n\nLeft pleural pigtail catheter posteromedial within the pleural space where\nthere is a moderate left pneumothorax and small layering pleural effusion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in course and caliber.  No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nDiffuse, conglomerate mediastinal lymphadenopathy is again demonstrated. \nBilateral, right greater than left, hilar adenopathy is again demonstrated.\n\nPLEURAL SPACES: There has been interval movable left chest tube with residual\ntiny anterior pneumothorax.  There is interval increase in a small left\npleural effusion.  There is a new right, partially loculated, lateral small to\nmoderate pleural effusion.  No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: As demonstrated on chest CT from ___, there is\npersistent diffuse lymphangitic carcinomatosis and multiple multilobar\nmetastatic nodules/masses.  There is bibasilar mild compressive atelectasis\nassociated with adjacent pleural effusions.  Again seen, are post radiation\nchanges with volume loss in the left upper lobe.  There is increased\nbackground ground-glass opacities in predominantly the right upper lobe which\nmay represent progressive disease, asymmetric pulmonary edema, or pneumonia. \nThis may be secondary to post obstructive pneumonia as there is attenuation of\nthe inferior left upper lobe bronchus (3:99).\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Increased background right upper lobe ground-glass opacities may represent\nprogressive metastatic disease, asymmetric vascular edema or pneumonia.\n3. Larger, more loculated small to moderate right pleural effusion.\n4. Persistent left hydropneumothorax with interval decrease in pneumothorax\ncomponent and interval increase in pleural effusion.\n5. Re-demonstrated diffuse lymphangitic carcinomatosis with multilobular\nmetastatic nodules/masses.\n6. Persistent left upper lobe post radiation changes and volume loss."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Multiple bilateral thyroid nodules\nmeasure up to 1.1 cm (13:25, 13:1).  There is no supraclavicular or axillary\nlymphadenopathy.  The esophagus is unremarkable. Postradiation changes of the\nleft breast are seen.\n\nUPPER ABDOMEN: Please refer to the report of the same day abdomen and pelvis\nCT for subdiaphragmatic characterization.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber.  No aortic abnormality suggestive of aortitis.  There is no\npericardial effusion.  Extensive atherosclerotic disease involving the great\nvessels, aortic arch, and thoracic aorta.  Diffuse coronary artery\ncalcifications.\n\nPLEURA: Compared to the most recent prior study, the small to moderate right,\nloculated pleural effusion has mildly improved, with redistribution of pleural\nfluid into the fissural spaces.  Foci of air within the pleural effusion could\nbe related to superimposed infection or removal of pleural fluid.  A loculated\nleft pleural effusion is small, also demonstrating foci of air within.\n\nLUNG:\n\n1. PARENCHYMA: Bilateral pleural catheters are in place.  Diffuse septal\nthickening and multifocal consolidations and pulmonary nodules, most prominent\non the right, are compatible with the patient's known lymphangitic\ncarcinomatosis.  Compared to most recent prior study, the diffuse,\npredominantly right-sided ground-glass opacities, which may be compatible with\npulmonary edema, have improved.  Postradiation changes and volume loss of the\nleft upper lobe and lingula appears similar to prior.  Moderate bibasilar\natelectasis.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.  Multilevel degenerative changes of the thoracic spine.",
            "output": "1. No evidence of aortitis.\n2. Interval mild improvement and redistribution of the known, bilateral\nloculated malignant pleural effusions.  Foci of air within the pleural\neffusions could be compatible with superimposed infection.\n3. Redemonstration of known, diffuse lymphangitic carcinomatosis.\n4. Interval improvement of predominately right-sided ground-glass opacities,\nlikely compatible with pulmonary edema.\n5. Stable postradiation changes and volume loss of the left upper lobe and\nlingula.\n6. Please refer to the report of the same day abdomen and pelvis CT for\nsubdiaphragmatic characterization."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Anterior mediastinal soft\ntissue is triangular in shape, slightly dura genius and most likely represent\nthymus, 3.5 x 2.2 cm.  No pathologically enlarged mediastinal, hilar or\naxillary lymph nodes demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Minimal paraseptal\nemphysema a adjacent to major fissures, symmetric.  No pulmonary nodules\ndemonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Mild degenerative changes are present in the left humerus.",
            "output": "No definitive evidence of intrathoracic metastatic disease.  Minimal\nemphysema.\n\nAnterior mediastinal triangular soft tissue, most likely representing thymus. \nReassessment with chest CT or MRI in 3 months for documentation of stability\nis to be considered giving patient's history."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, or axillary lymph nodes demonstrated.  Heart size is normal. \nThere is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  New 7.5 mm nodule\nin the right lower lobe, series 6, image 236 is solid with well demarcated\nmargins.  Additional nodule in the right middle lobe, series 6, image 258 is 5\nmm, new as well.  No additional nodules demonstrated.\n\nAnterior mediastinal triangular soft tissues most likely consistent with\nthymus.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "2 new nodules in the right lower lobe and right middle lobe that in a\nconstellation of rising tumor markers would be concerning for new foci of the\ndisease."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: There are segmental and subsegmental right lower lobe\nfilling defects, consistent with pulmonary emboli.  The thoracic aorta is\nnormal in caliber . No pericardial effusion is seen.\n\nAXILLA, ___, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear opacity in the bilateral lung bases likely represent\natelectasis with superimposed pneumonia given the regions of hypoenhancement. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\n\nABDOMEN: The liver, pancreas, spleen and adrenal glands are unremarkable. \nThere is cholelithiasis, as on prior.\n\nURINARY: There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.  There is no nephrolithiasis.\n\nGASTROINTESTINAL: There is no bowel obstruction or ascites. The appendix is\nnormal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS: There is no free fluid in the pelvis.  Patient is status post left\norchiectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nThe abdominal and pelvic wall is within normal limits.",
            "output": "1.  Segmental and subsegmental right lower lobe pulmonary emboli\n2.   Linear opacity in the left lung base, likely atelectasis with\nsuperimposed pneumonia.\n3.   No acute intra-abdominal or intrapelvic process.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:10 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Minimal remnant thymic tissue.  Although\nthe protocol is not designed to detect PE, the current examination shows no\nsequela of a known embolic event, documented on the previous CT from ___.  Small splenule.  No other abnormalities are noted in the upper abdomen.\nMild degenerative vertebral disease.  No vertebral compression fractures.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.\nMild bilateral apical scarring.  Stable atelectasis at the left and the right\nlung bases (5, 223).  No pleural abnormalities.  No suspicious pulmonary\nnodules or masses.  No lymphadenopathy.  No diffuse lung disease.",
            "output": "No evidence of remnants from a previous episode of pulmonary embolism.  No\nadenopathy.  No evidence of metastatic disease to the lung parenchyma.  No\npleural abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.  Minimal remnant\nthymic tissue is again seen within the anterior mediastinum, similar to ___.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  Pulmonary\narterial vasculature is well opacified.\n\nPULMONARY PARENCHYMA: A 1 mm pulmonary nodule in the right lung base is stable\nsince at least ___ (3:207).  No concerning pulmonary nodules or masses\nare identified.  No abnormal parenchymal opacification.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Stable appearance of a 1 mm pulmonary nodule at the right lung base since\n___.  Otherwise, no evidence of intrathoracic metastatic disease.\n2. Please refer to separate report of CT abdomen pelvis for description of the\nsubdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Anterior mediastinal soft\ntissue is most likely consistent with thymic residual, stable.  No\nsupraclavicular, mediastinal, hilar or axillary lymph nodes demonstrated. \nHeart size is normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules masses or consolidations demonstrated.  Right lower lobe 1\nmm nodule seen on the previous study, series 4, image 233 is stable.  No new\nnodules masses or consolidations seen.",
            "output": "Stable appearance of the chest with no evidence of interval disease\nprogression including anterior mediastinal thymic tissue remnants and right\nlower lobe 1 mm pulmonary nodule."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Patient is status post CABG with intact median\nsternotomy wires..  There are diffuse calcifications in the native coronary\narteries.  The great vessels are within normal limits. No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: The entire thyroid is increased in size from prior.  The left\nthyroid lobe measures 5.4 x 5.3 cm, compared with 4.3 x 4.1 cm previously, and\nis causing displacement of the trachea to the right.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There are multiple tiny calcified granulomas in\nthe spleen.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is scarring in the bilateral kidneys.  There is a 3.4 cm simple\ncyst arising from the interpolar region of the right kidney.  Multiple\nadditional subcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however likely represent cysts.  There is no hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon and rectum are within normal limits.  The appendix is normal (2:135). \nThere is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.  There are multiple surgical clips are along the right\npelvic sidewall.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There are degenerative changes the thoracolumbar\nspine.  There is no evidence of worrisome osseous lesions or acute fracture. \nThe abdominal and pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolism or aortic dissection.\n2. No other acute process in the chest, abdomen or pelvis.\n3. Interval increase in size of patient's multinodular goiter which is causing\nincreased displacement of the trachea to the right.  Outpatient thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S):   Outpatient thyroid ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified without\nevidence of pulmonary embolism. Thoracic aorta is normal in caliber.  The main\npulmonary artery is normal in caliber. Patient is status post CABG.  Diffuse\ncalcifications are noted in the native coronary arteries. No pericardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification. There is dependent atelectasis predominantly in the lower lobes\nas well as bronchial wall thickening and bronchovascular crowding.\n\nBASE OF NECK: Thyroid is markedly enlarged bilaterally, increased from prior\nmeasuring up to 4.1 x 4.9 cm in axial diameter on the right and 5.8 x 5.8 cm\nin axial diameter on the left. Thyroid deviates the trachea to the right and\ncauses focal narrowing although the trachea does remain patent.\n\nABDOMEN: A simple renal cyst is noted extending from the interpolar region of\nthe right kidney. The kidneys demonstrate a multilobulated appearance.\nCalcific densities in the spleen may reflect granulomas. Reflux of contrast\ninto the hepatic veins is noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPatient is status post median sternotomy with intact sternotomy wires.",
            "output": "1. No evidence of pulmonary embolism.\n2. Interval increase in size of the patient's multinodular goiter. The\nenlarged thyroid deviates the trachea to the right and causes focal narrowing\nalthough the trachea remains patent."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. The tip of an accessed\nright pectoral MediPort extends into the right atrium.  The main pulmonary\nartery and thoracic aorta are normal caliber. No incidental pulmonary embolus\nis identified.\n\nA handful of solid pulmonary nodules measuring up to 6 mm in the subpleural\nleft lower lobe are worrisome for metastases (6: 192, 204, 219, 237, 250). \nThe largest 6 mm left lower lobe nodule is new since ___ (6, 250).\nNo endobronchial lesion or pleural effusion is present.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Handful of solid pulmonary nodules measuring up to 6 mm in the subpleural left\nlower lobe are highly worrisome for metastases.  A three-month followup chest\nCT is recommended.\n\nRECOMMENDATION(S):  Three-month followup chest CT to reassess pulmonary\nnodules."
        },
        {
            "input": "Supraclavicular lymph nodes are not enlarged.  Borderline right axillary\nnodes, 9 mm in diameter, 4:80, are unchanged since ___.\n\nExcluding the breasts which require mammography for assessment there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead neck vessels.  A right central venous infusion port catheter passes into\nthe right atrium where its course is obscured by contrast agent.\n\nCoronary calcification involves the LAD.  Aorta and pulmonary arteries are\nnormal size.  Aortic valvular calcification is minimal.  Pericardium is\nphysiologic.  There is no pleural abnormality.\n\nSub cm mediastinal lymph nodes are numerous ranging up to 8 mm in the right\nlower paratracheal and paraesophageal stations, all unchanged since ___. \nModerate circumferential wall thickening of the lower esophagus is more\npronounced now than in ___.\n\nSolitary 6 mm subpleural left lower lobe nodule, 4:207, unchanged since ___.  Other tiny benign subpleural lesions previously noted are of\nlittle concern for malignancy.  There are no new lung lesions.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "6 mm left lower lobe lung nodule, suspicious for primary or metastatic\nmalignancy, unchanged over 3 months.  Suggest repeat chest CT follow-up in 6\nmonths.\n\nCoronary atherosclerosis.\n\nIncrease lower esophageal wall thickening.  Suggest clinical correlation\nconcerning possible esophagitis.\n\nRECOMMENDATION(S):\nSuggest repeat chest CT follow-up in 6 months.\n\nSuggest clinical correlation concerning possible esophagitis."
        },
        {
            "input": "The thyroid is normal.  There is no axillary lymphadenopathy.  A left\nsupraclavicular lymph node measuring approximately 0.9 cm in short axis,\nseries 6 image 22 appears increased in size compared to the prior exam.\n\nMildly prominent mediastinal lymph nodes, have also progressed in size\ncompared to the prior exam.  The heart size is normal.  Small amount of\npericardial effusion is unchanged compared to the prior exam.  The right upper\nlobe is occluded by a dominant mass which appears inseparable from the\nadjacent collapsed lung however spanning approximately 7.6 cm x 5.9 cm,\nincreased compared to the prior exam at which time this measured up to 6 cm. \nThere has been interval improvement of the previously noted right pleural\neffusion, much of which appears to be loculated.  The right middle lobe\nbronchus appears to be narrowed by the inferior extent of the dominant mass. \nThere is also narrowing of the bronchus intermedius and right lower lobe\nbronchus, slightly progressed compared to the prior exam.\n\nThe aorta and main pulmonary artery are normal in caliber.  The extent of the\nmass, now appears to be contiguous with the esophagus however no definite\nesophageal obstruction is identified.\n\nOverall, compared to the prior exam from ___, there has been interval\nincrease in the size of the multiple bilateral pulmonary nodules.  For example\na left upper lobe nodule, series 6, image 114 now measures 1.2 cm x 1.1 cm,\npreviously measuring no more than 0.9 cm.  A left perifissural nodule, series\n6, image 147 has increased in size compared to the prior exam, now measuring\n1.1 cm x 0.9 cm, previously measuring no more than 0.9 cm.  Although difficult\nto compare, there has been interval increase in interstitial thickening at the\nright lung base and along the right minor fissure as well as a large\ncurvilinear right lung basilar pleural based soft tissue mass spanning\napproximately 9.3 cm, series 6, image 188.  A pigtail catheter is seen\nterminating within the right lung base.\n\nFor evaluation of the abdominal structures, please refer to the dedicated CT\nof the abdomen performed on the same day.\n\nOsseous structures: Sclerotic focus within the T6 vertebral body, appears\nunchanged compared to the prior exam.  No new concerning lytic or sclerotic\nlesions are identified.",
            "output": "1. Overall, compared to the prior exam from ___, there has been\nsignificant interval progression of metastatic lung cancer including the\ndominant right upper lobe mass which now contacts the esophagus, and is\ninseparable from the adjacent atelectasis.  Furthermore, there has been an\ninterval increase in diffuse predominantly right lung basilar interstitial\nthickening, concerning for lymphangitic spread of disease.\n2. Interval increase in multiple bilateral pulmonary nodules and\nlymphadenopathy, concerning for worsening of disease.\n3. Large curvilinear 9.3 cm soft tissue lesion within the right lung base, may\nreflect a combination of the patient's neoplasm with adjacent\nscarring/atelectasis.\n4. Interval improvement of large right-sided pleural effusion, status post\npigtail catheter placement at the right lung base.\n5. For evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  Previous 0.9  Cm left supraclavicular lymph node\nhas decreased in size, now 0.4 cm (6:27).\nExcluding the breast which must be evaluated by mammography there are no soft\ntissue abnormalities in the chest wall to suggest metastasis.\nSpeck of calcification in the right lobe of the thyroid is unchanged.\n\nUPPER ABDOMEN: No masses identified in the adrenal glands, remaining findings\nwill be reported separately in the same day CT of the abdomen and pelvis.\n\nHEART and PERICARDIUM: There is no cardiomegaly.  No pericardial effusion. \nAorta and main pulmonary artery are normal in size and there is no evidence of\ncentral pulmonary emboli in the main pulmonary artery.\n\nMEDIASTINUM and LUNGS: AP window 0.8 cm lymph node and right lower pulmonary\nligament 0.7 cm lymph node are smaller since prior (6:89, 221).\n\nRight upper lobe bronchial occlusion has improved since prior, although\nairways remain irregular due to the surrounding tumour.\nAlthough measurements might be exaggerated by the adjacent atelectasis the 7 x\n4 cm right upper lobe mass, interspersed with adjacent area of atelectasis, is\nsmaller in comparison to ___ when measured 6 x 8.7 cm (6:109 in\nprior; now 6:108).\n\nInnumerable pulmonary nodules are bilateral and less prominent in comparison\nto prior demonstrating with slight interval decrease in size or density.  For\nexample left upper lobe nodule 0.8 cm, in prior 1 cm (6:117).  1 cm left upper\nlobe nodules, although unchanged in size has decreased in density (6:146,\n169).  Left lower lobe 0.8 cm nodule has also decreased in density (6:196).\n\nPLEURA: Right pigtail through ___ intercostal space terminates in the right\nposterior costophrenic angle.  The right loculated pleural effusion mildly\nimproved since prior, now in small quantity, while the thickening and\nnodularity of the pleura is unchanged.\n\nCHEST CAGE: No new definitive lytic or sclerotic lesions concerning for\nmetastasis are demonstrated.  Sclerotic focus within midthoracic vertebral\nbody is stable.",
            "output": "-In comparison to ___ there had been interval improvement in the\nsize of the right upper lobe dominant mass with improvement of right upper\nlobe bronchial occlusion.\n-Right drained loculated pleural effusion is minimally decreased.\n-Innumerable bilateral pulmonary nodules has decreased in density more than in\nsize."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.5 cm left supraclavicular lymph\nnodes are unchanged and not pathologically enlarged, was larger on ___.  There is no new lymphadenopathy.  (06:34).\nNo axillary lymphadenopathy.\nSpeck of calcification in the right lobe of the thyroid is stable.\n\nCHEST CAGE: Mottled and sclerotic appearance of right ribs is likely reactive\nto adjacent chronic pleural effusion (11:13).\nSmall sclerotic focus in mid thoracic vertebral body, 11:37, Is stable since\n___.  There is no evidence of osteo destructive lesions.\n\nUPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: Right lower pulmonary ligament 0.4 cm and AP window 0.6 cm lymph\nnode, mildly smaller since ___, were 1.2 cm and 1.3 cm on ___ respectively (6:236, 117).\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  Thoracic aorta and main pulmonary artery are normal in caliber.  No\nincidental central pulmonary emboli in this nondedicated study.\n\nPLEURA: Right pigtail catheter through ___ intercostal space terminates in the\nright posterior costophrenic angle, unchanged.  Right hydropneumothorax has\nmildly decreased in size in comparison to ___.  Enhancement and\nthickening of the pleura is stable.  Mild loss of volume of the right\nhemithorax is stable since prior, progressively decreased since ___.\nThere is no new left pleural effusion.\n\nLUNG: Tracheobronchial tree is centrally patent.  Additional mild improvement\nin right upper lobe ventilation is demonstrated.\nMultiple metastatic nodules measure up to 0.9 cm in the lingula, appear\nunchanged in size but mildly decreased in density as compared to ___ (6:119).",
            "output": "-Mild additional decrease in the size of the mediastinal and right upper lobe\njuxtahilar mass.\n-Multiple metastatic nodules, although unchanged in size mildly decreased in\ndensity."
        },
        {
            "input": "HEART AND VASCULATURE: The study is severely limited by suboptimal contrast\nbolus timing.  Given the limitation, the central pulmonary arteries are\npatent.  Lobar pulmonary arteries appear grossly patent.  Segmental and\nsubsegmental pulmonary arteries cannot be evaluated.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  Mild\ncardiomegaly is unchanged.  Otherwise, the heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  No mediastinal mass.  Soft tissue density in the subcarinal station,\nlikely enlarged lymph node is unchanged, although the exact size is difficult\nto assess.  Additional scattered prominent mediastinal lymph nodes are\nunchanged. A 0.9 cm epicardial lymph node (series 6, image 235) is unchanged.\n\nPLEURAL SPACES: There is minimal decrease in size of the loculated right\nhydropneumothorax with chest tube in situ.  Pleural enhancement on the right\npersists.  No pleural effusion or pneumothorax on the left.\n\nLUNGS/AIRWAYS: There is right compressive atelectasis with overall similar\nvolume loss.  Again seen is right upper lobe mass, overall similar to ___.   Innumerable metastatic lesions throughout the remaining lungs\nare essentially unchanged.  Mild increased interlobular thickening in the\nright lower lobe (series 6, image 204) could represent pulmonary edema or\nlymphangitic spread of disease.\nThe right upper lobe bronchus surrounded by the mass appears patent with\npersistent irregular border.  Otherwise, the airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality\nexcept for a punctate calcification in the right thyroid lobe, unchanged.\n\nABDOMEN: Limited evaluation of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes of the thoracic spine are mild.  Nonspecific sclerotic\nfoci in the thoracic spine are unchanged compared to multiple prior studies.",
            "output": "1.  Study is severely limited by suboptimal contrast bolus timing.  Given the\nlimitation, no large central and lobar pulmonary emboli identified.  Segmental\nor subsegmental pulmonary emboli cannot be excluded.\n2.  Minimal decrease in size of the right empyema with chest tube in situ.\n3.  Grossly unchanged right upper lobe mass with innumerable metastatic\ndisease throughout the lungs.\n4.  Mild increased interlobular thickening in the right lower lobe could\nrepresent pulmonary edema or lymphangitic spread of disease."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and subcentimeter axillary lymph nodes are not\nenlarged.  Evaluation of the breasts is reserve for mammography.  Findings\nbelow the diaphragm will be reported separately.  There are no soft tissue\nabnormalities elsewhere in the chest wall concerning for malignancy.\n\nCARDIO-MEDIASTINUM:Moderate distension of the upper esophagus has improved\nsince ___, but there is still a conglomerate of subcarinal tissue\nwhich could be adenopathy interfering with swallowing.\n\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nSmall pericardial effusion is new, but there is no infiltration of epicardial\nfat or evidence of tamponade physiology.\n\nTHORACIC LYMPH NODES: Extent of the residual adenopathy in the subcarinal\nstation and right hilus is roughly unchanged.  A 10 mm right diaphragmatic\njuxta cardiac node, 6:214, is stable, and there are no other enlarged lymph\nnodes in the chest remote from these locations.\n\nLUNGS, AIRWAYS, PLEURAE: Small chronic loculated right apical pleural air\ncollection and large hydropneumothorax at the base persist despite the\nindwelling posterior pleural drainage tube.  The loculations at the base may\nhave been broken as the fluid component now has a level and the space contains\na larger component of air.  Extensive right pleural thickening is more\npronounced, particularly along the anterior chest wall.  There is no invasion\nof the ribs or chest wall musculature and there is no abnormality associated\nwith the pleural drainage insertion site along the right lower lateral chest\nwall.\n\nA score of small lung nodules in the left lung is unchanged.  Large scale\natelectasis in the right upper lobe and moderate atelectasis at the right lung\nbase are unchanged.  The upper lobe component is probably due to prior\nradiation fibrosis.\n\nCHEST CAGE: No new compression or pathologic fractures or destructive bone\nlesions.",
            "output": "The persistence of large right hydropneumothorax, predominantly basal, despite\nan apparent communicating pleural drainage tube in the right lower hemithorax,\nis probably a function of severe right pleural encasement and right upper lobe\ncollapse due to pulmonary fibrosis.  The tube may have succeeded in breaking\nup the adhesions in the pleural space since the dependent layering of a\nsmaller volume of fluid has replaced multi previous loculations.\n\nPersistent, treated central adenopathy.  Esophagus may be compromised by the\nresidual subcarinal nodal component.  No new adenopathy.  Multiple stable\nmetastases, easiest to recognize in the left lung."
        },
        {
            "input": "A right thyroid nodule is stable. Multiple prominent mediastinal lymph nodes\nare noted, measuring up to 1.0 cm in short axis (2:11). A right hilar lymph\nnode conglomerate measures 2.1 cm (2:24), slightly decreased in size and\npreviously measuring 2.5 cm. Axillary and supraclavicular lymph nodes are not\npathologically enlarged.  A sebaceous cyst is incidentally noted (02:12).\n\nThe great vessels are normal caliber. The heart size is normal.\nAtherosclerotic calcifications are seen within the thoracic aorta and coronary\narteries.  There is no pericardial effusion.\n\nThe patient is status post right middle and superior right lower lobe wedge\nresections with postsurgical changes. There is no evidence of pleural effusion\nor pneumothorax. The airways are patent to subsegmental levels.\n\nWithin the lungs, there are multiple consolidations within the right upper,\nmiddle, and lower lobes in the vicinity of the recent wedge resections, likely\nrepresenting a combination of post radiation changes, residual tumor, and\natelectasis. For example, an irregular appearing opacity abutting the right\nminor fissure measures approximately 2.4 x 1.9 cm (4:83). Multiple, mixed\nsolid and ground-glass opacities surround the surgical site (4: 70, 75, 79).\nIn addition, there are innumerable, bilateral, diffuse solid pulmonary\nnodules, similar to prior examination and likely representing metastatic\ndisease.\n\nOSSEOUS STRUCTURES:  There are no destructive focal osseous lesions concerning\nfor malignancy identified within the imaged thoracic skeleton.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. Within this limitation, a subcentimeter hypodensity seen within\nsegment VII of the liver is incompletely characterized, unchanged from prior\nexamination.",
            "output": "1.  Status post right middle and superior right lower lobe wedge resections\nwith postsurgical changes.\n2.  Multifocal consolidations within the right upper, middle, and lower lobes\nsurrounding the surgical site, compatible with a combination of local\nrecurrent disease, post radiation changes, and atelectasis.\n3.  Innumerable, bilateral solid pulmonary nodules consistent with diffuse\nmetastatic disease."
        },
        {
            "input": "Soft tissues:The thyroid is mildly heterogeneous with no discrete nodules.\nThere is no axillary lymphadenopathy.  Enlarged right upper paratracheal lymph\nnode (03:12) is unchanged, measuring 1 cm.  Precarinal lymphadenopathy\nmeasures 9mm in short axis (5:105), previously 8mm.  Right hilar\nlymphadenopathy has progressed, measuring 2.8 x 2.0 cm (5:115), previously 2.0\nx 1.4cm. The heart is normal in size and there is no pericardial effusion. The\naorta and main pulmonary artery are normal in caliber. Small hiatal hernia. \nPlease see a separate report discussing findings within the abdomen and\npelvis.\n\nLungs:Status post right upper and middle lobe wedge resection with adjacent\nradiation fibrosis.  Previously seen mass in the zone of radiation fibrosis\nnow measures 2.8 x 1.8 cm (5:101), previously 2.2 x 1.9 cm, and extends more\nsuperiorly into a new mass measuring at least 2.5cm (5:95).  The lung\nparenchyma demonsrates a random micronodule pattern consistent with metastatic\ndisease, with increase in number and size of the nodules.  There has been\nresolution of the small right pleural effusion seen previously.\n\nBones:A sclerotic focus in a lower thoracic vertebral body is unchanged\n(8:62).",
            "output": "1. Status post right upper and middle lobe wedge resection\n2. Increased in size of right upper lobe mass within a region of radiation\nfibrosis, and increase in right hilar lymphadenopathy.\n3. Increase in number and size of widespread micronodules, consistent with\nmetastatic disease."
        },
        {
            "input": "MEDIASTINUM: The thyroid is somewhat heterogeneous in appearance, with no\ndiscrete nodules identified. There is no supraclavicular or axillary\nlymphadenopathy.  An enlarged right upper paratracheal lymph node measures 11\nx 10 mm (03:13), unchanged.  Precarinal lymph node measuring up to 7 mm was 9\nmm previously (03:23).  Right hilar lymphadenopathy is similar, now 31 x 20 mm\n(5:122), previously 28 x 20 mm.  The heart is normal in size, there is no\npericardial effusion. The aorta and main pulmonary artery are within normal\nlimits in size. There is a small hiatal hernia (03:48).\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: Postsurgical changes related to right upper and middle lobe wedge\nresections with adjacent radiation fibrosis are stable since the prior study.\nAlthough difficult to measure, a confluent soft tissue mass in the region of\nradiation fibrosis in the peripheral right upper lobe is not significantly\nchanged since the prior study (03:20, 5:97). Widespread, innumerable bilateral\npulmonary micro nodules are again noted, with no appreciable change in size or\nnumber of nodules since the prior study.  The nodules appear somewhat greater\nin number on the right, with a more definable peribronchovascular\ndistribution, suggestive of a component of lymphagitic spread of disease.\n\nBONES: A well-circumscribed sclerotic focus in the superior aspect of the T8\nvertebral body (8:75) is unchanged dating back to most remote available prior\nimages from ___, likely a benign bone island. No other osseous foci\nsuspicious for malignancy are identified.\n\nUPPER ABDOMEN:  Although this study is not specifically tailored for\nevaluation of subdiaphragmatic structures, well-circumscribed right hepatic\nlobe hypodensity is compatible with a cyst (5:282). A subcentimeter\nhypodensity in the left hepatic lobe (5:246) is too small to characterize.",
            "output": "1. No significant interval change in appearance of the chest since the prior\nstudy from ___, including a right upper lobe mass within a region\nof radiation fibrosis, right hilar lymphadenopathy, and widespread bilateral\npulmonary micronodules suspicious for metastatic disease.\n2. Distribution of micronodules in the right lung suggest a component of\nlymphagitic carcinomatosis, as well as diffuse hematogenous metastatic spread\nbilaterally.\n3. Post treatment changes related to right upper and middle lobe wedge\nresection, with radiation fibrosis."
        },
        {
            "input": "Sub cm right supraclavicular lymph nodes, 3:5, are stable since ___. \nSupraclavicular and axillary nodes are not enlarged and there are no soft\ntissue abnormalities in the imaged chest cage suspicious for malignancy. \nEvaluation of the breast requires mammography.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows a stable\nfluid attenuation 15 mm wide nodule on the right lobe of the liver, 03:59 and\na 13 mm wide incompletely imaged lesion of the sub solid attenuation, 25 ___,\nalso in the right lobe, 3:68, 14 mm on ___, 5:337.\n\nRight lobe of the thyroid is heterogeneous, but the small areas of\nradiolucency are too small to warrant further imaging.  9 mm right thoracic\ninlet node, there is no good evidence for lymph node enlargement elsewhere in\nthe mediastinum.\n\nThe post treatment tissue conglomerate in the right hilus  is stable, bronchi\nare mildly dilated extending from the hilus to the peripheral target lesion,\nand there is no bronchial occlusion.\n\nThere is no pleural or pericardial effusion.  Small hiatus hernia and mild\ngeneralized esophageal wall thickening are stable.\n\nAorta and pulmonary arteries are normal size and there is no central filling\ndefect in the pulmonary arteries.\n\nThe treated right upper lobe mass, is unchanged since at least ___ x\n46 mm at the level of its greatest cross-sectional area, 04:23, unchanged. \nScores of tiny lung nodules are no more numerous.\n\nA well circumscribed sclerotic nodule in the upper aspect of a mid thoracic\nvertebral body, 8:65, has been present since at least ___ and may not\nbe a treated metastasis.  There are no lytic lesions and no pathologic\nfractures.",
            "output": "No change in the treated right upper lobe mass and right hilus since at least\n___, or in multiple small pulmonary metastases in both lungs.\n\nNo evidence of new osseous metastasis.  Solitary T-spine sclerotic lesion\nstable since ___ might not be malignant.\n\nUncharacterized right liver nodule, stable since at least ___ .  The\nabsence of change makes malignancy unlikely."
        },
        {
            "input": "Small thyroid nodules are unchanged.  Aorta and pulmonary arteries are\nunchanged.  Heart size is normal.  No pericardial effusion is seen.  Thickened\ndistal esophagus is unchanged with small hiatal hernia.\n\nImage portion of the upper abdomen re- demonstrate multiple liver\nhypodensities, prior cholecystectomy and mild thickening of left adrenal, all\nunchanged.\n\nNo interval increase in mediastinal or hilar lymphadenopathy is present.  No\npathologically enlarged axillary lymph nodes are seen.\n\nAirways are patent to the subsegmental level bilaterally.  No substantial\nchange in the right upper lobe postradiation changes and bronchiectasis\npresent.  Innumerable pulmonary nodules are bilateral and unchanged since\nprevious examination.  No interval increase in size and as much as possible to\ndefine including multiple micronodules a number of the coexisting nodules\ndemonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm have\ndeveloped in the interim.  Sclerotic focus in the mid thoracic vertebral body,\nseries 2, image 33 is unchanged.",
            "output": "Stable appearance of the chest including treated right upper lobe mass, right\nhilar those appearance and multiple small pulmonary nodules.\n\nUnchanged appearance of the liver hypodensities."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary, supraclavicular, or\nmediastinal adenopathy.  Heart size is normal.  There is no pericardial\neffusion.  Main pulmonary trunk is not dilated.  The thoracic aorta is normal\nin caliber without aneurysmal dilation.\n\nThe airways are patent.  Postsurgical changes related to right upper and\nmiddle lobe wedge resections and adjacent radiation fibrosis are stable. \nApparent changes to a confluent soft tissue density in the peripheral right\nupper lobe are related to changes in inspiration, but the overall bulk is the\nsame.  (series 4, image 85).  There is no pleural effusion, pneumothorax, or\npneumomediastinum.  Diffuse micronodules in the right greater than left lung\nare grossly unchanged and consistent with lymphangitis spread of disease,\nunclear if due to hematogenous spread or local lymphatic dissemination.  Few\nscattered larger nodules are also stable, for example a 4 mm left upper lobe\nnodule (series 4, image 73) and a 3 mm right lower lobe nodule (series 4,\nimage 89).\n\nThe thoracic esophagus is notable for a small hiatal hernia.  The patient is\nstatus post cholecystectomy.  Hypodensities in the right lobe of the liver,\nmeasuring fluid attenuation, are unchanged from prior.\n\nOSSEOUS STRUCTURES:  There is no acute fracture.  Sclerotic lesions of T8 and\nT3 are unchanged and statistically likely represent bone islands.",
            "output": "Overall stable examination with unchanged right upper lobe mass, post\nradiation changes, and predominantly right sided lymphangitic spread of\ndisease."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are noted but are not enlarged.\n\nThe aorta and pulmonary arteries are normal size. Cardiac configuration is\nnormal and there is no appreciable coronary calcification.\n\nThe airways are patent to the subsegmental level.  Postsurgical changes from\nright upper and middle lobe wedge resections and radiation treatment changes\nare unchanged.  The previously described soft tissue density adjacent to the\nradiation treatment region in the peripheral right upper lung (5:98) appears\nsmaller in bulk compared to ___, possibly representing local\nrecurrence.\n\nInnumerable small nodules in the bilateral lungs are seen, right greater than\nleft, likely representing lymphangitic spread and are unchanged from ___.  Previously noted larger nodules in the right lower lobe (5:107),\nmeasuring 3 mm, and left upper lobe (5:83), measuring 3 mm are unchanged.  A\ncalcified granuloma is stable in the right lower lobe. A small hiatal hernia\nis again visualized.\n\nSclerotic focus are seen in the T3 and T8 vertebral body, likely bone islands.\nNo sclerotic or lytic osseous lesions concerning for metastasis are seen.\n\nLimited views of the abdomen show stable hepatic hypodense lesions and\nevidence of cholecystectomy.",
            "output": "1. Overall, decrease in soft tissue bulk adjacent to the region of RFA in the\nright upper lobe with stable appearance of predominantly right sided\nlymphangitis spread since ___."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  A pre-existing borderline sized paratracheal lymph\nnode (2, 13) is stable.  Unchanged appearance of the mediastinum, including\nthe large mediastinal vessels and the coronary arteries.  No pericardial\neffusion.  Stable hiatal hernia.  Stable cyst in the liver.  No evidence of\nadrenal abnormalities.  No osteolytic lesions at the level of the ribs, the\nsternum or the vertebral bodies.  Mild degenerative vertebral disease.  Stable\nvertebral sclerotic foci, likely reflecting bony islands.\nThe right upper lobe parenchymal mass (4, 75) as well as the predominantly\nfibrotic postradiation changes, post RFA changes and post wedge resection\nchanges (4, 82) are stable in size and morphology.  The increasing lymphatic\ntissue at the upper aspect of the right hilus, surrounding in part the large\nairways structures (4, 85) is also stable.  Finally, stability seen of the\nposttreatment ground-glass opacities in the right lower lobe (4, 99).  No\npleural effusions.  No evidence of lymphangitis.  Several pre-existing\npulmonary nodules, including those in the left upper lobe (4, 92) are stable\nin size and morphology.  No new or growing pulmonary nodules.",
            "output": "Stability of the pre-existing post therapy changes in the right lung and right\nhilus.  No new or growing lesions.  Stability in appearance of the lymph nodes\nand of the pleura."
        },
        {
            "input": "The thyroid gland is unremarkable.  There is no supraclavicular, axillary,\nmediastinal, or definite hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in caliber.  The heart is normal in size.  There is no\npericardial effusion.\n\nThe airways are patent to the subsegmental level.  The right upper lobe\nparenchymal mass as well as post radiation changes in the paramediastinal\nregion are overall stable.  Post wedge resection changes are noted in the\nright upper lobe and unchanged.  Ground-glass opacities consistent with\nposttreatment changes in the right lower lobe are overall stable.  Again seen\nare numerous bilateral pulmonary nodules, some which are stable in size while\nothers have increased.  For example a nodule in the right upper lobe measured\n3 mm, now 5 mm (4:120).  In the right middle lobe, a nodule that previously\nmeasured 4 mm, now measures 5 mm (4:140).  A nodule in the left upper lobe\npreviously measured 3 mm, now measures 5 mm (4:118).  There is no pleural\neffusion or pneumothorax.\n\nThis study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate 2 hepatic\nhypodensities with the larger one measuring 15 mm (03:56).  These are stable\nand were not FDG avid on PET CT from ___ and likely represent cysts. \nCholecystectomy clips are identified.  There is a small hiatal hernia.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  A rounded bone\nisland is unchanged in the T8 vertebral body.",
            "output": "Subtle interval millimetric increased in size of the numerous metastatic\nnodules throughout both lungs.  The dominant mass in the right upper lobe as\nwell as post radiation changes are grossly stable."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No axillary\nadenopathy.  6 mm left supraclavicular lymph node unchanged.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.  Hypodense hepatic lesions\nappear similar compared to prior imaging.  Previous cholecystectomy.\n\nMEDIASTINUM: Suspicious 9 mm lymph nod no great vessel invasion.  E in the\nright paratracheal area (3, 15) unchanged compared to prior imaging.\n\nHILA: The soft tissue relation to the right hilum is unchanged.  Right\nperibronchial node measuring 9 mm in diameter unchanged (5, 160).\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcifications.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  The mass in the lateral aspect of the right upper lobe abutting\nthe visceral pleura measuring approximately 32 mm in diameter is unchanged. \nThe associated soft tissue extending inferior medially to the right hilum is\nalso unchanged.  The paramediastinal postradiation changes affecting the right\nupper and superior segment of the right lower lobes are unchanged.  Numerous\npulmonary nodular metastatic lesions involving all lung lobes with a maximal\ndiameter of 6 mm are stable.  Post right upper lobe wedge resection changes\nare stable\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is not dilated.  No filling defects.\nCHEST CAGE: Nonspecific sclerotic lesion seen in the superior aspect of the T8\nvertebral body is unchanged.  No lytic/ destructive bony lesions.  Spondylotic\nchanges of the thoracic spine.",
            "output": "Stable post treatment appearance of the right upper lobe mass, right\nparamediastinal and hilar regions.  The numerous sub 6 mm pulmonary nodules\ninvolving all lung lobes are unchanged."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.  Evidence of previous\ncholecystectomy.  Mildly lobulated renal outlines bilateral.  No perirenal\nstranding.  Hypodense cystic lesions in the liver are unchanged.\n\nMEDIASTINUM: No new or enlarging mediastinal adenopathy. Right paramediastinal\nfibrosis is stable.\n\nHILA: Right hilar soft tissues are unchanged\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  Trace\npericardial fluid.  No aortic valve calcification.  Small speck of LAD\ncalcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  The mass in the right upper lobe (5, 94) measuring approximately\n39 x 24 mm is similar compared to prior imaging.  Associated surgical suture\nmaterial in situ.  Right upper lobe, perihilar and paramediastinal radiation\ninduced fibrosis are stable. Thickening of the adjacent oblique and transverse\nfissures are unchanged.  Numerous pulmonary metastatic nodules involving all\nlung lobes are again noted, with most of these pulmonary nodules demonstrating\nslight interval increase in size for example in the left upper lobe (5, 121)\npreviously measuring 5 mm, now measuring 6 mm and in the right middle lobe (5,\n140) previously measuring 4 mm, now measuring 6 mm).\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: No lytic/destructive bony lesions.  Sclerotic lesion in the T8\nvertebral bodies unchanged.",
            "output": "The primary mass in the right upper lobe is essentially unchanged.  No new or\nenlarging mediastinal or hilar lymph nodes.\n\nNumerous pulmonary metastatic nodules involving all lung lobes, many of which\ndemonstrate slight increase in size (by 1-2 mm) with the largest metastatic\nnodules measuring up to 6 mm in diameter."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography, for example to evaluate small\nnodules in the right upper breast, 03:27, elsewhere in the chest wall there\nare no soft tissue abnormalities to suggest malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis but shows no adrenal mass.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head and neck vessels or\ncoronary arteries.  Aorta and pulmonary arteries are normal size.  There is no\npericardial abnormality or pleural effusion.\n\nPost treatment tissue in the nodal stations of the mediastinum, including a 9\nmm right paraesophageal and 8 mm right hilar lymph node, 5:165, 167, is all\nstable.  There is no pathologically enlarged central lymph node.\n\nSmall hiatus hernia is chronic and the esophagus is not appreciably distended.\n\nLungs:\n\nPost treatment diameter peripheral right upper lobe lung mass has decreased\nslightly, at comparable levels 30 x 36 mm today, 5:106, previously 30 x 40 mm.\nThe bulk of treated tissue from the mass to the enlarged right hilus is also\nunchanged.  Right upper lobe bronchus it is patent and radiation\nbronchiectasis stable.\n\nA score of a subcentimeter pulmonary metastases is still present, many are\nstable, but several have grown:  Right upper lobe, 8 mm, 5:150, at previously\n6 mm; left upper lobe, 7 mm, 5:161 previously 6 mm.\n\nA small sclerotic lesion in mid thoracic vertebral body, 8:63, stable since at\nleast ___ and may be benign.  There are no compression or pathologic\nfractures and no bone lesions diagnostic of metastasis.",
            "output": "Slight decrease in diameter of large right upper lobe mass since ___. \nSimultaneous slight growth of a handful of more than a score of subcentimeter\npulmonary metastases.  No new adenopathy.  Post treatment appearance of the\nright hilar and adjacent central lymph nodes is stable."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  There is no axillary or supraclavicular adenopathy.  A previously\n8 mm right hilar node (02:33) is stable.  Tissue within the nodal stations of\nthe mediastinum remain stable.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  Trace pericardial fluid is physiologic.  Heart size\nis normal.  There are no appreciable coronary artery calcifications.\n\nThere is evidence of disease progression with increased size of peripheral\nright upper lung mass, previously 30 x 36 mm currently 48 x 32 mm at the\napproximate same level (4:82).  Diffuse bilateral pre-existing pulmonary\nnodules have all increased in size including, for example, a 8 mm right upper\nlobe previously 5 mm (4:116) and an 8 mm left upper lobe nodule, previously 5\nmm (4:152).  Findings are associated with a new layering and nonhemorrhagic\nsmall right pleural effusion.\n\nSclerotic focus in the T8 vertebral body is unchanged.  There is no new\nsclerotic or lytic osseous lesion.  Vertebral body heights appear preserved.\n\nAlthough examination is not tailored for subdiaphragmatic evaluation, images\nof the upper abdomen demonstrate an unchanged 1.6 cm hypodensity within the\nright hepatic lobe peripherally (02:58), stable and likely hepatic cyst. \nThere is a small hiatal hernia.",
            "output": "Evidence of disease progression with increased size of right upper lobe mass\nand growth of pre-existing pulmonary nodules.A layering and nonhemorrhagic\nsmall right pleural effusion is new."
        },
        {
            "input": "Substantial interval increase in right pleural effusion is demonstrated with\nthe effusion currently being large and in part loculated.  Right upper lobe\nmass interspersed with adjacent area of atelectasis has increased, currently 6\nx 4.6 cm as compared to 3 by 4.5 cm although the measurement might be\nexaggerated by the a adjacent atelectasis.\n\nAorta and pulmonary arteries are well opacified.  Heart size is normal.  Left\nmediastinal shift is due to increasing right pleural effusion.  Image portion\nof the upper abdomen will be reviewed separately as part of the CT abdomen and\npelvis in corresponding report will be issued\n\nTrachea is patent.  Right upper lobe is occluded by the mass.  Right middle\nlobe and right lower lobe ends well as left lung bronchi are patent. \nInnumerable pulmonary nodules are bilateral with slight interval increase in\nsize, for example in the left upper lobe, from 6-8 mm, series 2, image 24, in\nright middle lobe, from 8-10 mm, series 2, image 26, in the left upper lobe,\nfrom 6 to 9 mm, series 2, image 32.  Additional innumerable pulmonary nodules\nare present.  There are potentially new smaller pulmonary nodules\ndemonstrated.\n\nNo definitive lytic or sclerotic lesions that would suggest bone involvement\nwithin the thorax demonstrated.",
            "output": "Interval progression of the metastatic lung cancer including the dominant\nmass, multiple pulmonary nodules and substantial interval increase of\ncurrently large right pleural effusion causing left mediastinal shift."
        },
        {
            "input": "EXTRACARDIAC FINDINGS:\n\nCT CHEST WITH CONTRAST: The imaged thyroid is normal.  There is no\nsupraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  Mild upper\nlobe predominant emphysematous changes are again seen, with right greater than\nleft apical scarring.  These are unchanged.  A calcified granuloma in the\nright upper lobe is also unchanged (9:37).  Subpleural reticular nodular\npattern in the right lower lobe with multiple unchanged nodules likely\nrepresent mild NSIP or recurrent aspiration, also unchanged.  The airways are\notherwise patent to the level of the segmental bronchi bilaterally.  There is\nno pleural effusion or pneumothorax.\n\nCT ABDOMEN WITH CONTRAST: The liver demonstrates homogeneous attenuation\nthroughout, without focal hepatic lesion.  There is no intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThis is normal in attenuation without focal pancreatic lesion or\nperipancreatic stranding.  The spleen is normal size.\n\nThe bilateral adrenal glands are normal in size and shape.  Multiple hypodense\nlesions in the kidneys measure up to 2.5 cm in the lower pole of the right\nkidney, compatible with a simple cyst.  Several smaller subcentimeter lesions\nare incompletely characterized by CT, but also likely cysts.  There is no\nhydronephrosis or perinephric abnormality.\n\nRe-demonstration of the known small hiatal hernia.  The small and large bowel\nloops are normal in caliber again seen is the known anastomosis in the sigmoid\ncolon.  The colon and rectum are otherwise within normal limits.\n\nCT PELVIS WITH CONTRAST: The urinary bladder is mildly distended and the\ndistal ureters are unremarkable.  A penile implant reservoir/prosthesis is\nagain noted the right lower pelvis.  The prostate is partially calcified, as\nbefore.  There is no retroperitoneal, mesenteric, pelvic, or inguinal\nlymphadenopathy.\n\nOSSEOUS STRUCTURES: Severe multilevel degenerative changes in the\nthoracolumbar spine are most pronounced at L4-L5 and L5-S1.  There is\nre-demonstration of grade 1 retrolisthesis of L2 on L3, L3 on L4, and L5 on\nS1.  Lesion in the L1 vertebral body is likely a small hemangioma, unchanged.\n\nThere is a small left fat and fluid containing left inguinal hernia. \nCalcifications in the subcutaneous tissues of the buttocks are likely related\nto prior injections.\n\nCTA:\n\nCARDIAC: The right atrium is normal. The right ventricle is mildly dilated.\nThe left atrium is normal. The left ventricle is dilated. The pericardium is\nnormal and there is no pericardial effusion. The aortic valve is is tricuspid\nwith leaflet thickening and calcification. Dominance of the coronary artery\nsystem is right with normal origins and course. Coronary artery calcification\nis mild-to-moderate.\n\nPULMONARY ARTERIES: The right and left pulmonary arteries are dilated up to\n2.7 cm, suggesting underlying pulmonary arterial hypertension.  The pulmonary\narteries appear patent centrally, without focal filling defect.\n\nAORTA: The thoracic and abdominal aorta is normal in size.  The distal\nthoracic aorta is severely tortuous (11:28).  Atherosclerotic calcifications\nin the aortic arch and abdominal aorta are mild.\n\nMEASUREMENTS: (3D imaging lab, accuracy +/- 5%)\nMajor aortic annulus diameter: 25.3mm\nMinor aortic annulus diameter: 18.9mm\nAortic valve area: 75.2mm 2\nAortic annulus perimeter: 422.2mm\nSinus of Valsalva height: 10.0mm\nSinus of Valsalva width: 34.4mm\nHeight of origin of coronary arteries from aortic valve: 12.3mm\nAscending aortic diameter approximately 4.5 cm from aortic valve: 32.0x32.6mm\n\nILIOFEMORAL ARTERIES:\nThe right side is patent at the common iliac, external iliac and common\nfemoral levels, calcifications are mild, tortuosity is moderate.\nRight common iliac minimal diameter: 10.8x11.5mm\nRight external iliac minimal diameter: 9.2x8.8mm\nRight common femoral minimal diameter: 8.2x8.9mm\n\nThe left side is patent at the common iliac, external iliac and common femoral\nlevels, calcifications are mild, tortuosity is moderate.\nLeft common iliac minimal diameter: 7.9x11.7mm\nLeft external iliac minimal diameter: 9.1x9.7mm\nLeft common femoral minimal diameter: 8.3x9.4mm\n\nSUBCLAVIAN ARTERIES:  The right subclavian artery is patent and slightly\nectatic. The left subclavian artery is patent. Calcifications are mild.\nTortuosity is mild.\n\nRight subclavian minimal diameter: 8.6x7.1mm\nLeft subclavian minimal diameter: 6.5x5.8mm",
            "output": "1.  Aortic valve stenosis without evidence of aortic aneurysm.  The aortic\nvalve leaflets are calcified and thickened.  The descending thoracic aorta and\nthe thoracoabdominal junction is very tortuous (see series 11, images ___.\nIt makes an almost 60 degree angle in the lower thorax.\n\n2.  Patent subclavian arteries without atherosclerosis.  Left subclavian\nminimal diameter is 5.8 mm.  Right subclavian minimal diameter 7.1 mm.\n\n3.  The common femoral arteries bilaterally with lumen diameter greater than 6\nmm. The iliac arteries are moderately tortuous bilaterally.\n\n4.  Similar appearance of mild NSIP or recurrent aspiration in the lungs.\n\n5. The left and right pulmonary arteries are dilated up to 2.7 cm, suggesting\npulmonary arterial hypertension."
        },
        {
            "input": "THORACIC INLET: Thyroid gland is homogeneous.  No supraclavicular\nlymphadenopathy is identified.\n\nBREAST AND AXILLA  : No axillary lymphadenopathy.\n\nMEDIASTINUM: Small mediastinal lymph nodes are not pathologically enlarged. \nThere is no hilar lymphadenopathy.\n\nHEART, VESSELS and PERICARDIUM: The aorta is tortuous.  Mild to moderate\natherosclerotic changes are seen along the thoracic aorta.  Aortic valve and\ncoronary artery calcifications are seen.  Pacer leads are seen extending to\nthe right atrium and right ventricle.  No pericardial effusion is seen.  The\nheart is mild-to-moderately enlarged.  The right and left pulmonary arteries\nare mildly enlarged.\n\nPLEURA: No pleural effusion or pneumothorax is seen.\n\nLUNG:\nCentral airways are patent.  There is mild bronchial wall thickening\nbilaterally.  Re-demonstrated are mild upper lobe predominant centrilobular\nemphysematous changes.  Again seen biapical pleuroparenchymal scarring, right\nslightly greater than left.  3-4 mm right upper lobe calcified granuloma is\nagain seen on series 6, image 59.\nRespiratory motion through the mid and lower lungs makes assessment slightly\nsuboptimal.  Given this, there is mild bibasilar atelectasis, right greater\nthan left and mild bilateral lower lung bronchiectasis, similar to prior. \nSubpleural reticulation is again seen peripherally bilaterally, with basal\npredominance, but also seen in the upper lungs.  Findings are similar compared\nto the prior study.  No definite new focal consolidation is seen.  There is no\nworrisome pulmonary nodule or mass.\n\nBONES : No concerning osteoblastic or lytic lesion is seen.  There are\nmultilevel degenerative changes along the imaged thoracic spine.\n\nUPPER ABDOMEN: Please refer to concurrent abdomen and pelvis CT for details of\nfindings below the diaphragm.",
            "output": "No worrisome pulmonary nodule or mass is seen in the chest.  No\nlymphadenopathy.\n\nRe-demonstrated mild chronic pulmonary findings."
        },
        {
            "input": "The patient is after CABG.  Sternal wires are intact.  Assessment of the\nsternum demonstrate relative lucency within the center although no abnormal up\nposition demonstrated.  The largest gap between the 2 sternal edges is 12.4 mm\nat the level of the manubrium.  Assessment of the mediastinum demonstrate\nanterior mediastinal fat stranding as well as substantial fat stranding within\nthe anterior chest wall at the mid line, concerning for inflammatory process,\nbut with no definitive collection.  The fat stranding is noted in the lower\nmediastinum and superior aspect of the peritoneum, series 2, image 47, close\nto the anterior chest wall incision.  Series 2 image 49.\n\nExtensive vascular calcifications are present.  Heart size is normal.  There\nis no pericardial pleural effusion.\n\nImage portion of the upper abdomen is overall unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Lingular\natelectasis present.  No discrete pulmonary nodules masses or consolidations\nseen.\n\nThe side the above described abnormality of the sternum there are no lytic or\nsclerotic lesions worrisome for infection or neoplasm.",
            "output": "Findings concerning for mediastinal infection giving the presence of fat\nstranding, more than few weeks after the CABG.\n\nWhen compared to the previous examination the extent of the anterior chest\nwall fat stranding has increased and the lucency within the midportion of the\nsternum has increased as well does osteomyelitis cannot be entirely excluded.\n\nStill no drain interval collection demonstrated.\n\nLingular atelectasis.\n\nInterval improvement of bibasal consolidations, pleural and pericardial\neffusion."
        },
        {
            "input": "The patient is after CABG.  Sternal wires are intact.  Stable 11 mm gap at the\nmanubrium (02:15) with persistent mild irregularity of sternotomy ends, with\nrelative normal apposition of the inferior sternum.  No progressing osteolysis\nor sclerosis.\nAnterior mediastinal fat stranding and stranding within the anterior chest\nwall at the mid line have slightly increased, without definitive collection in\nthe mediastinum or chest wall.  There is also focal thickening of the anterior\npericardium.  The fat stranding is noted in the lower mediastinum and superior\naspect of the peritoneum, close to the anterior chest wall incision.\n\nMild atherosclerotic calcifications of the arch and severe coronary artery\ndisease in the native coronaries. Heart size is normal.  There\nis no pericardial pleural effusion.\n\nImage portion of the upper abdomen is overall unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Lingular\natelectasis present.  No discrete pulmonary nodules masses or consolidations\nseen.\n\nThe side the above described abnormality of the sternum there are no lytic or\nsclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the sternum with persistent 10 mm gap and irregular\nmargins with associated bony sclerosis. Slight increase in fatty stranding in\nthe anterior chest wall, anterior mediastinum and adjacent pericardium when\ncompared to ___.  The bony dehiscence and subcutaneous stranding\nis new however when compared to ___ when there was normal apposition\nof the sternotomy and no subcutaneous fatty stranding.\n\nNo drainable collections."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy by CT size criteria.  The imaged portion of the chest\nwall is unremarkable.  The thyroid gland is homogeneous in attenuation without\nnodularity.\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen is unremarkable, aside\nfrom postsurgical changes from cholecystectomy and mild diverticulosis.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.\n\nHILA: There is no evidence of hilar lymphadenopathy, though evaluation is\nlimited due to lack of intravenous contrast.  However compared to ___, there is though interval change in the contour.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is trace\npericardial effusion, increased from ___.  coronary calcifications\nare minimal.  There is no significant valvular calcifications.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Again seen are sub 6 mm pulmonary nodules in the left upper\nlobe (02:13 and right upper lobe (02:19).  Due to respiratory motion,\nadditional pulmonary nodules are less conspicuous, for example in the right\nmiddle lobe (02:25, 32).  Aside from mild atelectasis at the bases, there is\nno large consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.  There is mild\nperibronchial thickening, likely chronic bronchitis.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is top normal in size, measuring 2.8 cm.\nCHEST CAGE: There is no suspicious osseous lesion concerning for acute\nfracture.  There is stable appearance of chronic cortical irregularity along\nthe inferior sternum.  There is near complete loss of vertebral body height at\nT11 with minimal retropulsion, not significantly changed from prior exam. \nThere is likely hemangiomas in the vertebral bodies, though the largest at T12\nand L1.",
            "output": "1. Persistent trace pericardial effusion.\n2. No evidence of pneumonia.  Minimal atelectasis.\n3. Multiple pulmonary nodules in the lungs, measuring up to 6 mm as previously\ndescribed.  Due to respiratory motion, some of the nodules are less\nconspicuous on today's exam.  Please refer to the prior exam on ___ for recommendations for follow-up."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe study is limited by motion artifact.  Within the limits of the study, the\npulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is a trace pericardial effusion, not significantly changed from prior\nCTA ___.  There is no pleural effusion.\n\nAgain seen are multiple bilateral pulmonary nodules, the largest measuring 5\nmm in the right upper lobe (02:35).  The nodules are unchanged from ___.  Respiratory artifact limits evaluation of some of the known nodules,\nmainly in the right lower lobe.  There are patchy opacities scattered in the\nlungs bilaterally, consistent with atelectasis.  The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen reveal a 2.5 cm right adrenal nodule,\nwhich attenuates to less than 10 Hounsfield units on recent noncontrast CT\nchest, consistent with unchanged adrenal adenoma.  Patient is status post\ncholecystectomy.  There is a small hiatal hernia.  Other imaged\nintra-abdominal viscera are unremarkable.\n\nSevere compression deformity of T11, unchanged from prior.",
            "output": "1.  No evidence of major pulmonary embolism, however study is limited by\nmotion artifact.\n\n2.  No significant change in multiple bilateral pulmonary nodules.  The\nlargest measures 5 mm and is within the right upper lobe.\n\n3.  Severe compression deformity of T11, which is unchanged from prior\nimaging.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are multiple nodules in the\nvisualized inferior right thyroid lobe, largest measuring 8 mm, not requiring\nfurther evaluation at this size per ACR guidelines.  There is no\nsupraclavicular or axillary lymphadenopathy.  Soft tissue structures of the\nchest wall are unremarkable.\n\nUPPER ABDOMEN: Please refer to the separate report of the abdomen and pelvis\nperformed today.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is normal and there is no pericardial\neffusion.\nPLEURA: There is very mild bilateral pleural effusions measuring 5 mm on the\nright and less than 1 mm on the left.\n\nLUNG:\n\n1. PARENCHYMA:  An 8 x 5 mm subpleural nodular density in the right upper lobe\nis favored to represent focal atelectasis or scarring (series 6, image 48). \nThere other scattered bilateral pulmonary nodules, for example a 3 mm\nperifissural nodule in the left upper lobe, two adjacent ___ nodules\nin the posterior left lower lobe measuring 5 mm and 4 mm (series 6, images 145\nand 147), 4 mm subpleural nodule in the left costophrenic angle (series 6,\nimage 197), 3 mm nodule along the right major fissure (series 6, image 76), 4\nmm subpleural nodule along the right hemidiaphragm (series 6, image 192). \nThere is no consolidation.  Minimal bilateral atelectatic changes, are seen\nmost pronounced in the bilateral posterior costophrenic angles.\n2. AIRWAYS:  Central airways are patent.\n3. VESSELS:  Top-normal main pulmonary artery at 29 mm.  The aorta is not\ndilated.\nCHEST CAGE: Multilevel degenerative changes involving the dorsal spine.  9 mm\nsclerotic focus involving the fifth left rib (series 6, image 89).",
            "output": "1.  No definite evidence of intrathoracic malignancy.\n2.  Bilateral pulmonary nodules and subpleural densities measuring up to 8 mm.\nSee below for recommendations.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8 mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged there are no soft\ntissue abnormalities in the chest wall suspicious for malignancy or infection.\nAnasarca is mild in the chest, more severe in the torso. Evaluation of the\nbreasts would require mammography.\n\nLeft-sided central venous catheter can be traced as far as the SVC, obscured\nby intravenous contrast agent it trans ports. ET tube in standard placement.\nNasogastric tube ends in the mid stomach. .\n\nThyroid is unremarkable. Atherosclerotic calcification is not apparent. Aortic\nvalvular calcification is mild. Aorta is normal size. Mitral annulus\ncalcification he is heavy. Pulmonary arteries are dilated, main 40 mm, right\n30 mm, consistent with pulmonary arterial hypertension, chronicity\nindeterminate. Mild cardiomegaly effects all chambers, particular the right\nventricle.\n\nThere is no pericardial effusion. Moderate bilateral pleural effusion, left\ngreater than right is nonhemorrhagic, layers posteriorly, responsible for\ncollapse of both lower lobes, the lingula, and some of the apical posterior\nsegment of the left upper lobe. Pleural surfaces are normal. Aside from the\nsevere atelectasis, lungs are clear. Tracheobronchial tree is unremarkable to\nthe segmental level.\n\nThe only central lymph node enlargement consists of edematous left lower\nparatracheal and subcarinal nodes, 12 mm in diameter, probably a function of\nvolume overload.\n\nDisk degeneration is responsible for severe narrowing endplate sclerosis in\nthe lower thoracic spine. There are no bone lesions in the chest cage\nsuspicious for malignancy or infection.",
            "output": "Moderate layering nonhemorrhagic bilateral pleural effusion, responsible for\nsevere atelectasis, no evidence of malignancy or infection in the pleural\nspace or elsewhere in the chest.\n\nProbable pulmonary arterial hypertension, chronicity indeterminate, could be\nexacerbated by severe atelectasis."
        },
        {
            "input": "Pacemaker leads terminate in the expected location of right atrium and right\nventricle.  Aorta and pulmonary arteries are top normal unchanged.  Severe\naortic calcifications are present.  Coronary calcifications are extensive. \nHeart size is normal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMR liver and corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Dominant lesion in\nin the lingula is currently 2.5 x 2.5 mm, minimally increased compared to most\nrecent previous examination.  Compare to ___ study ___ no\nappreciable change demonstrated as well.\n\nSeveral sub 3 mm nodules in the right upper lobe and dominant 6 mm nodule in\nthe right upper lobe are stable, series 302, images 23, 40, 39.  Left lower\nlobe 5 mm nodule is stable as well.  No new nodules masses or consolidations\ndemonstrated\n\nThere are no definitive lytic or sclerotic lesions worrisome for infection or\nneoplasm.",
            "output": "Stable appearance of the chest including the dominant lingular lesion, toe\nsclerotic disease, multiple small pulmonary nodules.\n\nPlease review MRI of the liver and the corresponding report that will be\nissued separately for assessment of intra-abdominal and intrapelvic pathology."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Left pectoral ICD.  Stable moderate aortic wall\ncalcifications.  Severe coronary calcifications.  Mild aortic valve\ncalcifications.  No pericardial effusion.  The cirrhotic liver and other\nabdominal findings are described in detail in the dedicated upper abdomen MR\n___. no osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  The dominant lingular lesion is stable in size and\nmorphology, with a diameter of 24 mm.  Also stable are other, smaller\npulmonary nodules.  Due to a lesser inspiratory effort, several pre-existing\nareas of scarring in the right lower lobe appear of higher attenuation than on\nthe previous examination (302, 181) there is no evidence of pleural effusions.\nThe airways are patent.",
            "output": "Stable pulmonary nodules.  No new or growing nodules.  No pleural effusions. \nNo adenopathy."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Moderate\ncalcification along the thoracic arch and descending aorta.  Mild aortic\nvalvular calcifications.  Severe coronary artery calcifications.  The main\npulmonary artery is at the upper limits of normal in size; the right and left\nmain pulmonary arteries are engorged, measuring up to 3 cm and 2.9 cm,\nrespectively.  This is unchanged from ___ and may reflect pulmonary\narterial hypertension.  The heart is top-normal in size.  The pericardium is\nwithin normal limits. No pericardial effusion is seen.  Distal leads of a left\nchest wall dual lead pacer terminate in the right atrium and right ventricle.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nMultiple subcentimeter mediastinal lymph nodes are unchanged from ___ and\ndo not meet CT size criteria for lymphadenopathy.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild biapical scarring.  The dominant lingular lesion measuring\n2.4 x 2.4 cm is unchanged since at least ___ (302:140).  Otherwise\nmultiple pulmonary nodules are stable, including 4 mm right upper lobe\n(302:22), 1 mm right upper lobe (302:44), and 5 mm left lower lobe (302:129). \nSimilar appearance of subpleural scarring in the right lower lobe.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.  Bilateral\ngynecomastia, in keeping with history of cirrhosis.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.\n\nABDOMEN: The liver is cirrhotic, better characterized on the same day MRI of\nthe liver.  Cholelithiasis without evidence for cholecystitis.  Splenomegaly\nis unchanged.  1.8 cm left adrenal mass was previously characterized as an\nadenoma on MRI.  1.8 cm simple renal cyst in the left upper pole is unchanged.\nModerate calcifications along the abdominal aorta and its principal branches.",
            "output": "Stable appearance of the chest, with the dominant lingular lesion measuring up\nto 2.4 cm, unchanged since at least ___.  Multiple pulmonary nodules\nare stable.  No new or growing pulmonary nodules.  No lymphadenopathy."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal. Moderate calcification is seen in all coronary\narteries. There is no pleural or pericardial effusion.\n21 mm lesion in the lingula, previously described as an hamartoma, is stable.\nThere are multiple new ground-glass centrilobular nodules in the upper lobes\nbilaterally, largest in the right apex (5, 7.2) measuring 5 mm.  These are\nmost likely infectious in etiology.  Followup is recommended\nThis examination is not tailored for subdiaphragmatic evaluation.  Patient has\nhad RFA in segment II and resection of segment VI.  There are stones within\nthe gallbladder. Renal cysts are better evaluated on prior MR from ___ . Focal liver lesions are difficult to evaluate in this non contrast\nstudy.   The liver has nodular contours.\nThere are no bone findings of malignancy",
            "output": "Multiple new ground-glass centrilobular nodules in the upper lobes likely\ninfectious in etiology of followup is recommended\nStable lingular hamartoma."
        },
        {
            "input": "Mild apical scarring is noted on the right. Ground-glass opacity in the right\nupper lobe is less confluent compared to ___ (4:36). Punctate\nnodular opacities in the right upper lobe were present on the prior exam\n(4:111, 104, 85). A 2.2 x 2.4 cm lingular lesion, previously described as a\nhamartoma, is unchanged in size and configuration (4:146, previously 2.3 x 2.3\ncm).  Secretions are seen within the large airways bilaterally. There is no\npneumothorax or pleural effusion.\n\nThe thyroid is normal. Supraclavicular, axillary, and mediastinal lymph nodes\nare not enlarged, with measurable mediastinal lymph nodes measuring up to 8 mm\nin the paratracheal station. The aorta is normal in size.  The pulmonary\nartery is mildly enlarged, unchanged, consistent with but not diagnostic of\npulmonary hypertension. Cardiac configuration is normal without pericardial\neffusion, and there is moderate coronary artery and valvular calcification. No\nconcerning focal lytic or sclerotic osseous lesion is identified.\n\nThis exam is not designed for the evaluation of the infra diaphragmatic\nstructures. A cirrhotic liver with hypodensity in the left lobe is consistent\nwith prior RFA treatment for ___. A 6 mm hyperdensity within the gallbladder\nis consistent with a gallstone. A 1.5 cm cyst in the upper pole of the left\nkidney is noted.  The left adrenal gland is thickened, but no discrete nodule\nis identified. A small amount of calcium is noted at ostium of the left renal\nartery. These are all unchanged.",
            "output": "1. Previously noted ground-glass nodules have changed in configuration, no\nlonger as confluent. These likely represent ongoing resolution of an\ninfectious process.\n2. Unchanged lingular lesion, previously characterized as a hamartoma.\n3. Unchanged abdominal findings, including an incompletely evaluated cirrhotic\nliver with sequela of prior RFA, cholelithiasis, and incompletely imaged renal\ncysts."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy or\ninfection.  Gynecomastia is mild and symmetric.  This study is not appropriate\nfor subdiaphragmatic evaluation.  MRI of the liver and upper abdomen was\nperformed ___.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head neck vessels but is considerable\nin at least left anterior descending, left main, circumflex, and right\ncoronary arteries.  Intracardiac calcification is probably in papillary muscle\ndue to prior infarction are overall heart size is not large aortic valvular\ncalcification is mild to moderate.  .  Transvenous pacer leads end in the\nright atrium and right ventricle.  There is no pericardial or pleural\nabnormality.  Mild enlargement of the pulmonary arteries, right and left both\n28 mm, unchanged, is consistent with but not diagnostic of pulmonary arterial\nhypertension.\n\nTracheal shape, an 80 lung gated superiorly and lenticular inferiorly could be\ndue to a chronic obstructive lung disease and indicate a propensity for\ntracheomalacia.\n\nMediastinal, internal mammary, diaphragmatic, retrocrural lymph nodes are not\nenlarged.  Hilar contours on this noncontrast study do not suggest adenopathy.\n\nWell-circumscribed 23 mm nodule in the lingula, 5:189 was 21 mm in ___, 22 mm\nin ___.  Attenuation values have been consistently less than 15.  This is\nconsistent with a benign neoplasm such as hamartoma with fat mixed with soft\ntissue, or a cyst.  Punctate right upper lobe nodules also been stable since\n___.  There are no new or growing lung nodules wishes for malignancy and no\nevidence of infection is present.\n\nBronchial wall thickening is widespread and mild to moderate in severity. \nEmphysema is also mild.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection",
            "output": "No evidence of intrathoracic malignancy.\n\nCoronary atherosclerosis.  The possible prior infarction involving the left\nventricular papillary muscle.\n\nOf mild generalized bronchial inflammation, mild emphysema, possible pulmonary\nhypertension.  Propensity for tracheomalacia, but this condition is not\nevaluated on this study.\n\nBenign lingular lung nodule, essentially stable since ___."
        },
        {
            "input": "Subcentimeter supraclavicular and axillary lymph nodes are unchanged since at\nleast ___.  There are no soft tissue abnormalities in the chest wall\nconcerning for malignancy.  Gynecomastia is mild and symmetric.\n\nEsophagus is unremarkable.\n\nThere are no thyroid findings warranting further imaging evaluation.  Pacer\nleads and in the right atrium and right ventricle respectively unchanged.\n\nAtherosclerotic calcification is mild to moderate in head and neck vessels and\nconsiderable in primarily left main anterior descending and circumflex\ncoronary arteries.  Aorta and pulmonary arteries are normal size and the\npericardium is physiologic.  There is no pleural effusion.\n\nThoracic lymph nodes:\n\nNo adenopathy by size criteria.\n\nLungs and airways:\n\nMild wall thickening of peripheral bronchi is widespread, most severe in the\nlower lobes where there is minimal bronchial dilatation, but unchanged since\n___ and free of appreciable retention of secretions.\n\nThere is no abnormality in the right lower lobe corresponding to the reported\nlesion on abdomen MR performed ___.\n\n25 mm wide well-circumscribed fluid attenuation lesion in the left in the\nlingula, is unchanged since at least ___, cited as previously stable\nsince ___.  Left lower lobe is clear.\n\nNon physiologic shape of the trachea, previously noted, could be in indication\nof a propensity to tracheomalacia, but this condition is not evaluated by this\nstudy.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No lung nodule of concern.  Long-standing hamartoma or other benign lesion\nlingula, stable since ___.\n\nCoronary atherosclerosis.\n\nMild bronchial wall thickening is chronic.\n\nNon physiologic shape of the trachea, previously noted, could be in indication\nof a propensity to tracheomalacia, but this condition is not evaluated by this\nstudy."
        },
        {
            "input": "Left pectoral ICD.  No incidental thyroid findings.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  Stable severe aortic wall\ncalcifications.  Stable normal sized mediastinal lymph nodes (2, 22).  Stable\nshape of the trachea, potentially indicative of tracheobronchomalacia.  Stable\nmoderate to severe coronary calcifications and mild aortic valve\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  Minimal bilateral apical scarring, with an\nunchanged nodular component on the right (302, 30).  Several right upper lobe\npredominant micronodules (302, 74) are unchanged and suggest mild respiratory\nbronchiolitis.  Moderate to severe chronic airways disease with thickened\nnuchal walls with irregular borders.  The known and previously pre described 2\ncm lesion at the bases of the lingula is stable in size and morphology.  There\nare no lung nodules concerning for malignant or metastatic disease.  No\npleural effusions.",
            "output": "Stable examination of the thorax.  No evidence of metastatic or malignant\ndisease.  Stable 2 cm structure at the lingular basis, likely reflecting a\nhamartoma.  Stable severe chronic airways disease."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Bilateral gynecomastia is moderate,\nsymmetric.  Extensive coronary calcifications are present.  There is no\npericardial pleural effusion.  Pacemaker leads terminate in right atrium and\nright ventricle.\n\nImage portion of the upper abdomen demonstrate stigmata of known cirrhosis,\npartially imaged giving the lack of IV contrast.\n\nAirways are patent to the subsegmental level bilaterally.  Diffuse bronchial\nwall thickening is moderate, similar or slightly worse than on previous\nexamination.  Lingular dominant lesion is 2.4 x 2.3 cm, unchanged since\nprevious examination.  No new lesions demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest.  Unchanged severe chronic airway\ndisease"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental.  There are filling defects seen extending from the left main\npulmonary artery into the left-sided lobar and distal branches of both lobes. \nSubsegmental filling defects noted in the right upper and lower lobes as well.\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Areas of consolidation noted at the periphery of the left upper\nlobe and in the left lower lobe compatible with infarcts.  Mild left basilar\natelectasis noted dependently.  Lungs are otherwise clear besides a\nperifissural nodule along the right minor fissure, likely a node, and a\ncalcified granuloma at the right lung base.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Bilateral pulmonary emboli extending from the left main pulmonary artery into\nthe lobar and distal branches of the upper and lower lobes.  Subsegmental\npulmonary emboli in the right upper and right lower lobes.  Left-sided upper\nlobe and lower lobe infarcts.  No evidence of right heart strain.\n\nNOTIFICATION:  Dr.  ___."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, or hilar lymph nodes. Mildly prominent bilateral\naxillary lymph nodes measure up to 8 x 31 mm on the right (7, 9).\n\nThe heart size is top-normal with a few mitral annular calcifications. There\nis no pericardial effusion. The main pulmonary artery and thoracic aorta are\nnormal caliber. No incidental pulmonary embolism is identified.\n\nA few subcentimeter solid pulmonary nodules measure as follows:\n\n2 mm right upper lobe (5, 42)\n4 mm left lower lobe pleural nodule (5, 158)\n\nMinimal peripheral septal thickening with associated ground-glass\nopacification is noted in the right lower lobe, and to a lesser extent, the\nright upper lobe. There is no endobronchial lesion or pleural abnormality.\n\nFor a detailed discussion of the upper abdomen, including cholelithiasis,\nplease refer to the separate report from the CT abdomen/pelvis performed\nconcurrently.\n\nThere is an old right posterior ninth rib fracture with associated pleural\nthickening.  Abnormal soft tissue in the spinal canal at the at the T11-T12\nlevel,  corresponds to the patient's known intradural tumor. There is no\nappreciable paraspinal or adjacent osseous involvement. No lytic or sclerotic\nosseous lesions are identified.",
            "output": "Indeterminate subcentimeter pulmonary nodules, measuring up to 4 mm in the\nleft lower lobe.  Short interval follow-up is recommended.\n\nRight lower lobe predominant ground-glass opacities, septal thickening and\npleural thickening, which may be posttraumatic in nature given the associated\nold healed right posterior ninth rib fracture.\n\nAbnormal soft tissue in the spinal canal at T11-T12 corresponds to the\npatient's known intradural tumor.\n\nCholelithiasis."
        },
        {
            "input": "Poor definition of soft tissue planes in the left supraclavicular region make\nit impossible to exclude adenopathy. There is no right supraclavicular or\naxillary lymph node enlargement, and no soft tissue abnormality in the imaged\nchest wall suspicious for malignancy. Vascular clips suggest prior exploratory\nsurgery or resection in the right axilla and breast. Evaluation of the breasts\nrequires mammography. Findings below the diaphragm will be reported\nseparately.\n\nThyroid is not fully imaged. Atherosclerotic calcification is not evident in\nhead and neck vessels.  Coronary atherosclerosis is present in at least the\nleft anterior descending coronary artery. Pericardium is physiologic and there\nis no pleural abnormality.\n\nCentral lymph nodes in the mediastinum are not pathologically enlarged and\nhilar contours do not suggest adenopathy. Aorta and pulmonary arteries are\nnormal size.\n\nMild gaseous distension of the upper ___ of the esophagus, is not explained by\na mass. Stricture is unlikely. It is probably functional.\n\nAside from a punctate subpleural right upper lobe nodule, 603b:16, and a\ncalcified granuloma, right lungs is clear. There is no evidence of active\ngranulomatous infection.\n\nIn the left lung are a 3 mm soft tissue left upper lobe nodule, 04:24 and\nlinear atelectasis or scarring in the left lower lobe.  Tracheobronchial tree\nis normal to subsegmental levels in both lungs.\n\nMisregistration is responsible for an offset in the mid portion of the sternal\nbody. There is no fracture. There is no bone lesion in the chest cage\nsuspicious for malignancy or infection.",
            "output": "No evidence of intrathoracic malignancy or infection.  Sub 4 mm lung nodules\ndo not warrant subsequent imaging evaluation.\n\nPossible esophageal dysmotility."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart is not enlarged and there is moderate coronary\narterial calcification.  There is no pericardial effusion.\n\nMEDIASTINUM:  There are multiple borderline enlarged mediastinal lymph nodes\nincluding a 1.2 cm node in the subcarinal station (5:66).\n\nHILA:  There are multiple subcentimeter lymph nodes bilaterally measuring up\nto 9 mm on the right (5:62) and 8 mm on the left (5:88).\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThere are moderate atherosclerotic calcifications in the aortic arch at the\norigins of the great vessels.  The main, right, and left pulmonary arteries\nare normal caliber.\n\nPULMONARY PARENCHYMA: There is bilateral apical pleural thickening is\nsymmetric, but in the left apex there is a large masslike region of\nconsolidation, roughly 33 x 15 mm and geographic in shape.  This could be\npleuroparenchymal scarring in the setting of a prior lung infection, but\nmalignancy is not excluded.  There are scattered nodular and ground-glass\nperibronchial opacities in the both upper lobes and both lower lobes,\nsuggestive of aspiration.  Mild centrilobular emphysema is diffuse.\n\nAIRWAYS: The tip of the endotracheal tube terminates within the low  trachea. \nThere is diffuse moderate bronchial wall thickening suggestive of small\nairways inflammation.  The airways are patent to the subsegmental level\nbilaterally.  Small focal outpouchings arising from the posterior aspect of\nthe trachea at the level of the carina (6:115, 117) likely represent bronchial\ndiverticula.\n\nPLEURA:  There is a moderate, nonhemorrhagic right pleural effusion and a\nsmall, nonhemorrhagic left pleural effusion with adjacent relaxation\natelectasis.  There is a tiny right pneumothorax.\n\nCHEST WALL AND BONES: A surgical sternal fixation plate is again noted.  There\nis no worrisome lytic or sclerotic lesion.  Multilevel degenerative changes\nare moderate.  There are diffuse anterior bridging osteophytes in the thoracic\nspine suggestive of diffuse idiopathic skeletal hyperostosis.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for an\nenteric tube within the stomach.",
            "output": "-No evidence of pulmonary embolism or aortic abnormality.\n-Simple appearing moderate-sized right pleural effusion and small left pleural\neffusion with adjacent relaxation atelectasis.\n-Bilateral apical pleural thickening; left apical masslike consolidation could\nbe scarring from prior infection, alternatively malignancy.  Recommend further\nevaluation with PET-CT or short-term CT follow-up in 3 months.\n-Scattered peribronchial nodular opacities suggestive of aspiration.\n-Borderline enlarged mediastinal and hilar lymph nodes are likely reactive.\n-Tiny right pneumothorax.\n-Likely mild centrilobular emphysema.\n\nRECOMMENDATION(S):  PET-CT versus short-term CT follow-up in 3 months.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:36 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "There is no evidence of pulmonary embolism.\n\nThe esophagus shows persistent dilatation.  There is no pleural or pericardial\neffusion.\n\nRight hilar lymphadenopathy is new.  The largest node measures 15 x 1 mm in\naxial ___ (2:48) compared to only 13 x 10 mm on the prior chest CT.\n\nPatchy subpleural opacities suggest minor scarring or atelectasis.\n\nThe liver is hypodense consistent with fatty infiltration.  Ill-defined\nhypodense metastases are detectable but hard to directly compare to prior\nstudies regarding any potential small changes.\n\nThere are no suspicious bone lesions.",
            "output": "1.  No evidence of pulmonary embolism.\n\n2.  New right hilar lymphadenopathy concerning for metastatic disease.\n\n3.  Fatty infiltration of the liver with ill-defined metastases, difficult to\ncompare directly to a recent study with regard to any potential small change\nis persist.\n\n4.  Persistent esophageal dilatation."
        },
        {
            "input": "CTA thorax:  The aorta and main thoracic vessels are well opacified.  The\naorta demonstrates normal caliber throughout the thorax without intramural\nhematoma or dissection. The pulmonary arteries are opacified to the segmental\nlevel, without filling defect to suggest pulmonary embolism.\n\nCT thorax: The airways are patent to the subsegmental level.  Nodular\nopacities in the right middle lobe measuring 3 and 5 mm are unchanged (5:189,\n200 to) a punctate nodular opacity in the right upper lobe (5:161) is also\nunchanged.  Multiple subpleural nodular opacities in the right lower lobe are\nsimilar in appearance.  Ground-glass opacity in the apical segment of the left\nlower lobe is similar to slightly decreased compared to ___, and may\nrepresent a resolving infectious or inflammatory process.  Peribronchiolar\nnodularity in the bilateral lower lobes is likely related to aspiration or\nsmall airways disease.  Right hilar lymph nodes are persistent but decreased,\nnow measuring up to 7 mm (previously up to 1.6 cm).  There is no\npathologically enlarged supraclavicular, axillary, or mediastinal lymph\nnode.The heart, pericardium, and great vessels are within normal limits,\nthough there is atherosclerosis.  A left chest wall port catheter terminates\nin the low SVC.Esophageal dilation is persistent.There is no pleural effusion\nor pneumothorax.\n\nCT ABDOMEN:\nLIVER: The hepatic parenchyma is diffusely heterogeneous, which may be related\nto contrast bolus timing.  There are again multiple hypodense lesions\nscattered throughout the liver, incompletely evaluated but consistent with\nmetastatic disease. The portal vein is patent.The nondistended gallbladder is\nwithin normal limits, without wall thickening or pericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is extremely atrophic, without mass or peripancreatic\nstranding or fluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:Ill-defined hypodense wall thickening along the lesser curvature of the\nstomach is consistent with known gastric cancer.The small and large bowel are\nwithin normal limits, without wall thickening or evidence of obstruction.No\nappendix is visualized, but there are no secondary signs of acute\nappendicitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, with mild atherosclerotic\ncalcifications.A para-aortic lymph node measuring 11 mm (09:27) is essentially\nunchanged, as is a gastrohepatic ligament lymph node, which is not as well\ndelineated on today's exam.\n\nCT PELVIS: The urinary bladder appears normal.Bilateral iliac chain lymph\nnodes are enlarged, measuring 1.2 cm on the left and 8 mm on the right.  These\nare similar compared to the most recent CT.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. No evidence of acute pulmonary embolism.  No acute intra-abdominal process\nto explain the patient's presentation.\n2. Ground-glass opacity in the apical segment of the left lower lobe is\nsimilar to slightly decreased compared to ___, possibly representing an\nimproving infectious or inflammatory process.  Likely sequela of aspiration or\nsmall airways disease.\n3. A gastric mass is grossly unchanged, better evaluated on prior MR. ___\nmetastatic disease and lymphadenopathy is also unchanged."
        },
        {
            "input": "CHEST:  The thoracic aorta appears intact, without evidence of intramural\nhematoma or dissection.  In the left lower lobe, an apparent filling defect in\na subsegmental pulmonary artery is felt to be artifactual due to motion\n(3:125).  The pulmonary arteries are otherwise opacified to the segmental\nlevel, without filling defect to suggest pulmonary embolism.  There is no\nmediastinal hematoma.  The heart is unremarkable.  There is no pericardial\neffusion.  Right hilar lymph node is persistently enlarged and unchanged.  No\nsupraclavicular or axillary lymphadenopathy.  The imaged thyroid is normal.\n\nMultiple new ill-defined centrilobular ground-glass opacities in the right\nupper lobe are consistent with small airways disease (3: 43, 46, 61).  Nodular\nopacities in the the right middle lobe measuring 3 and 5 mm are unchanged\n(3:125, 129).  Multiple subpleural nodular opacities in the right lower lobe\nwere also unchanged.  Vague ground-glass opacities in the left lower lobe are\nunchanged.  There is no evidence of contusion or laceration.  There is no\npneumothorax or pleural effusion.  A left chest wall port catheter terminates\nin the low SVC.\n\nABDOMEN:  The underlying liver is fatty.  The hepatic parenchyma is diffusely\nheterogeneous with multiple ill-defined lesions scattered throughout,\nconsistent with known metastatic disease.  The portal vein is patent.  The\nspleen is intact and normal in size.  The gallbladder and adrenals are\nunremarkable.  The pancreas demonstrates fatty replacement, but otherwise\nunremarkable.  The kidneys enhance symmetrically and excrete contrast promptly\nwithout focal lesion or hydronephrosis.  There is no evidence of renal or\ncollecting system abnormality.  The abdominal aorta is normal in course and\ncaliber with patent major branches.  Moderate atherosclerotic disease of the\nabdominal aorta and great vessels is identified.  The previously described\nborderline enlarged periaortic lymph node measures 1.0 cm (606b:44),\nunchanged.\n\nThere is ill-defined wall thickening of the lesser curvature of the stomach,\nconsistent with known gastric cancer (2:116).  Multiple surgical clips within\nthe left upper quadrant are identified.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is not visualized, but there are no secondary signs of appendicitis. \nThe bladder is collapsed around the Foley catheter.  There is no pelvic free\nfluid.\n\nBONES:  There is no acute fracture.  Remote bilateral rib fractures are re-\ndemonstrated.  No focal suspicious osseous abnormality.  Multilevel\ndegenerative changes of the lumbar spine are unchanged.",
            "output": "1.  No evidence of pulmonary embolism.  No acute aortic pathology.\n\n2.  New ill-defined centrilobular ground-glass nodular opacities in the right\nupper lobe are compatible with small airways disease, either infectious or\ninflammatory in etiology.\n\n3.  Unchanged hepatic metastatic disease."
        },
        {
            "input": "Aortic calcifications are extensive, unchanged.  Pulmonary arteries are\nunremarkable.  Aortic valve calcifications are present, extensive.  Diffuse\nthickening of the distal esophagus is unchanged.  Heart size is normal.  There\nis no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately and\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal opacities\nare similar to previous study in might represent recurrent\ninfection/aspiration.  Several pulmonary nodules are stable, for example\nseries 6, image 180, 221, 235 with 1 new nodule seen in the right lower lobe,\nseries 6, image 198, potentially representing part of the infection/aspiration\nprocess.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of intrathoracic metastatic disease.\n\nBibasal opacities most likely representing infectious process.  Aspiration,\nrecurrent, is another possibility.\n\nAortic valve calcifications, concerning for aortic stenosis, if clinically\nwarranted, correlation with echocardiography is to be considered.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Extensive aortic\narch calcifications are unchanged.  Aortic valve calcifications are also\nextensive.  Again seen is a left-sided port a catheter, with its tip\nterminating in the distal SVC/cavoatrial junction.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nProminent mediastinal lymph nodes are unchanged since ___ and are\nnot enlarged by CT size criteria.  There is no supraclavicular, axillary, or\nhilar lymphadenopathy.  The visualized thyroid is unremarkable.\n\nThere is no pleural effusion.\n\nFaint bibasilar opacities are similar in appearance since ___,\nsuggesting recurrent infection/aspiration.  Bibasilar dependent atelectasis is\nmild. The airways are patent to the subsegmental level.  Multiple previously\ndescribed pulmonary nodules have not changed since ___ (6:144,\n165, 191, 212, 218).\n\nLimited images of the upper abdomen demonstrate hepatic steatosis and the\npoorly defined areas of liver heterogeneity, correlating with known hepatic\nmetastases, better characterized on the recent CT torso.  Patient is post\nNissen fundoplication.  Fatty atrophy of the pancreas again seen.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMild to moderate degenerative changes of the visualized thoracic spine, with\nbridging osteophytosis, are unchanged.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n\n2.  Bibasilar opacities, most likely representing aspiration and/or infectious\nprocess are similar in appearance since ___.\n\n3.  Multiple pulmonary nodules are unchanged since ___.\n\n4.  Limited images of the upper abdomen demonstrate hepatic steatosis and\npoorly defined areas of liver heterogeneity, correlating with known hepatic\nmetastases.  These were better characterized on the recent CT abdomen pelvis\nof ___."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: Partially imaged left Port-A-Cath terminates in the\nlow SVC.  The partially imaged thyroid is unremarkable.  There is no\nsupraclavicular lymphadenopathy.  Scattered small axillary and mediastinal\nlymph nodes are not pathologically enlarged by CT size criteria.  There is no\nhilar lymphadenopathy.  The esophagus contains a small amount of retained\nenteric contrast.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta and\nproximal great vessels are well opacified and normal in caliber with moderate\nto severe atherosclerosis.  Aortic valve is calcified.  Atherosclerotic\ncalcification of the coronary arteries is moderate to severe.  The main\npulmonary artery is normal in caliber.\n\nThe airways are patent to the subsegmental level.  There is no pleural\neffusion or pneumothorax.  Incidentally there is incomplete right major\nfissure.  Bronchial wall thickening is mild.  Opacities at the left base are\nwaxing and waning with some areas of improvement and other areas of new\nopacification such as ___ opacities posteriorly (4:152).\n\n-3 mm right lower lobe perifissural nodule (4:114) unchanged\n-0.7 x 0.4 cm right lower lobe paramediastinal nodule (4:129) unchanged\n-4 mm right middle lobe nodule (4:148), unchanged\n-2 mm right middle lobe nodule (4:151), unchanged\n-3 mm right middle lobe nodule (4:116), unchanged\n-Other punctate right middle lobe pulmonary nodules are unchanged.\n-Scarring or atelectasis in the lingula (4:164), unchanged\nOSSEOUS STRUCTURES:  There is a new destructive lytic lesion in the posterior\nseventh left rib (4:119) measuring 4.7 x 1.9 cm with destruction of the\nanterior and posterior cortices and associated soft tissue extending beyond\nthe margins of the rib.\n\nThere is a healed right lateral sixth rib fracture and apparent nonunited\nright posterior fifth rib fracture.  These findings are unchanged.",
            "output": "1. New 4.7 x 1.9 cm destructive lytic lesion in the posterior left seventh rib\nwith associated expansile soft tissue component compatible with metastasis.\n2. Numerous small pulmonary nodules are all unchanged.\n3. Waxing and waning opacities at the left base with some areas showing\nimprovement and other areas of new opacification likely reflecting infection\nor aspiration.\n4. Please note CT of the abdomen and pelvis will be reported separately.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 11:20 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is normal.  Multiple, prominent mediastinal and bilateral axillary\nlymph nodes are noted, not pathologically enlarged by CT size criteria and\nunchanged from prior examination. There are no enlarged supraclavicular or\nhilar lymph nodes identified.\n\nThe great vessels are normal caliber. The heart size is normal.\nAtherosclerotic calcifications are seen within the thoracic aorta and coronary\narteries.  There is no pericardial effusion.  A left Port-A-Cath is noted\nterminating in SVC.\n\nThere is no evidence of pleural effusion or pneumothorax. The airways are\npatent to subsegmental levels.\n\nWithin the lungs, there is a new, right lower lobe 1.0 cm irregular pulmonary\nnodule (6:201). In addition, a new 5 mm left upper lobe pulmonary nodule is\nnoted (6:132). Multiple additional, small pulmonary nodules measuring up to 5\nmm are unchanged from prior examination (6: 145, 177, 181, 183, 199, 201, 250,\n273). Minimal ___ opacities within the left lower lobe (6:225) have\nmostly resolved as compared to the prior exam. A tiny calcified granuloma\nwithin the right lung base is unchanged (6:251). Mild, dependent bibasilar\natelectasis is noted.\n\nOSSEOUS STRUCTURES:  There are no destructive focal osseous lesions concerning\nfor malignancy identified within the imaged thoracic skeleton.  Multiple,\nchronic, left-sided rib fractures are unchanged.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. For further details, please see the concomitant dedicated CT\nabdomen and pelvis.",
            "output": "1. Interval development of a 1.0 cm right lower lobe and 5 mm left upper lobe\npulmonary nodule. Given the acuity of onset, these nodules may be infectious\nor inflammatory in nature. However, given the patient's underlying malignancy,\nmetastatic disease cannot be excluded.  Recommend follow-up CT in 3 months.\n2.  Multiple additional, sub-3 mm pulmonary nodules, stable since ___."
        },
        {
            "input": "Several mediastinal lymph nodes are stable, ranging up to 6 mm except for\nright paraesophageal lymph node and left hilar lymph nodes approaching 7 mm\neach.  No new lymph nodes noted. Aorta and pulmonary arteries are unchanged in\nappearance. Heart size is normal. There is no pericardial pleural effusion.\nSmall hiatal hernia and thickening of the esophagus is noted.  Please review\nCT abdomen for the corresponding dedicated report of the abdominal findings\nincluding upper abdomen\n\nAirways are patent to the subsegmental level bilaterally.  New nodule seen on\nthe prior examination have resolved.  On the other hand there is development\nof new consolidation and several pulmonary nodules in the left lower lobe,\nalso most likely malignant. Multiple additional pulmonary nodules are stable,\n6:53, 152, 172, 187, 194.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated. Evidence of previous right chest wall trauma is noted.",
            "output": "Interval resolution of newly developed on the prior study pulmonary nodules\nconsistent with the infectious/inflammatory etiology.\n\nMultiple stable pulmonary nodules\n\n___ a left lower lobe nodules and consolidation most likely infectious but\nreassessment in 3 months is a gain suggested."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild bilateral lower lobe atelectasis.  There is no focal\nconsolidation.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged and there is no soft\ntissue abnormality in the chest wall suspicious for malignancy.  Gynecomastia\nis mild on the right, moderate on the left, unchanged since ___. This study\nis not designed for subdiaphragmatic diagnosis, but there is no adrenal mass\nor heterogeneity in the liver.\n\nThyroid is mildly heterogeneous but there is no lesion large enough to to\nwarrant evaluation with further imaging.  Atherosclerotic calcification is not\napparent in head and neck vessels, and is mild in the coronaries.  Aorta and\npulmonary arteries are normal size.  Pericardium is physiologic.  There is no\npleural abnormality.\n\nMeasurable mediastinal lymph nodes are numerous ranging in size up to 6 mm in\nthe prevascular station and 7 mm in the right lower paratracheal, both stable\nsince ___.\n\nCentrilobular emphysema is severe in the upper lungs, moderate elsewhere. \nThere are no lung lesions concerning for malignancy or infection.\n\nClosely apposed but incompletely healed fractures of the right tenth and\neleventh ribs anterolaterally and laterally, respectively, 9:131- 134 do not\nappear pathologic and have no associated soft tissue abnormality.",
            "output": "Closely apposed but incompletely healed fractures of the right tenth and\neleventh ribs anterolaterally and laterally, respectively, 9:131- 134 do not\nappear pathologic and have no associated soft tissue abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: The heart and pericardium are within normal limits. No\npericardial effusion is seen.  The pulmonary artery and aorta are normal in\ncaliber.  Extensive atherosclerotic calcifications are seen in the aorta and\ncoronary arteries.\n\nAXILLA, HILA, AND MEDIASTINUM: There is circumferential wall thickening of mid\nto distal esophagus similar to prior exam likely suggestive of esophageal\ncarcinoma. There is associated obstruction of esophagus and dilatation of the\nupstream esophagus which contains fluid.  There is mild mass effect on the\nright pulmonary artery.  There is haziness of paraesophageal fat next to the\nmass suspicious for tumor infiltration.  There are mediastinal lymph nodes\nlargest in the subcarinal region measuring 1.8 cm (series 8, image 131).\n\nPLEURAL SPACES: There is a new small left pleural effusion with associated\nsubsegmental atelectasis.\n\nLUNGS/AIRWAYS: There is a 2 mm in the left upper lobe (series 8, image 99). \nNo other mass is seen. Ground-glass opacities are seen in the left upper lobe\nlikely due to aspiration or pneumonia.  There is endotracheal tube in place in\nappropriate position.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please refer to separate report of CT abdomen and pelvis performed\non the same day for description of the abdomen and pelvis findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nThere is a 1.1 cm soft tissue density in the left breast (series 6, image 33)\nindeterminate.",
            "output": "1. Stable circumferential wall thickening of mid to distal esophagus causing\nmild obstruction and fluid noted in the upstream esophagus suspicious for\nneoplasm.\n2. Mediastinal lymph nodes measuring up to 1.8 cm in subcarinal region are\nsuspicious for metastasis.\n3. New left pleural effusion with associated subsegmental atelectasis.\n4. Ground-glass opacities are seen in the left upper lobe which could be\ninfectious in etiology or due to aspiration.\n5. Left upper lobe micronodule measures 2 mm, indeterminate.\n6. Small 1.1 cm soft tissue density in the left breast, incompletely\ncharacterized on CT.  Mammogram should be performed.\n7. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for description of the abdomen and pelvis findings.\n\nRECOMMENDATION(S):  Recommend further evaluation with mammogram."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized inferior aspect of the thyroid\ngland is unremarkable.  There are subcentimeter bilateral supraclavicular\nlymph nodes.\n\nMEDIASTINUM:  Multiple mediastinal nodes have slightly increased in size\ncompared to ___.  For example a prevascular lymph node measures 1.1\nx 0.8 cm, previously 0.6 x 0.8 cm (5:109).  A second prevascular lymph node\nmeasures 1.3 x 1.1 cm, previously 1.2 x 1.0 cm (5:136).  There has been\ninterval placement of an esophageal stent, which contains moderate debris. \nRe-demonstrated is circumferential wall thickening involving the mid to distal\nesophagus, consistent with known esophageal malignancy.  There is persistent\nmild mass effect on the pulmonary arterial trunk.  Haziness of the surrounding\nmediastinal fat is suspicious for tumor infiltration.\n\nHILA:  There has also been interval increase in hilar lymph nodes.  For\nexample a left hilar lymph node measures 1.3 x 0.9 cm (5:136), previously 0.9\nx 0.7 cm.  A right hilar lymph node measures 1.6 x 1.3 cm (5:129), previously\n1.4 x 1.0 cm.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  There is mild\natherosclerotic disease involving the thoracic aorta, without aneurysmal\ndilatation.  The main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Patchy consolidation in the left lower lobe (5:192) is\ncompatible with pneumonia.  Additional peribronchovascular nodules and\nconsolidative opacities in the right lower lobe (5:121-134) and lingula\n(5:184), are concerning for additional areas of infection/aspiration. \nMultiple millimetric pulmonary nodules in the left upper lobe measuring up to\n3 mm (5:64, 96, 139) are unchanged.\n\nAIRWAYS: A Y-stent is again visualized in the trachea and mainstem bronchi,\npatent and in unchanged position.  Central airways remain patent, however\nthere are increased secretions in the bilateral mainstem bronchi.  The\nendotracheal tube has been removed.\n\nPLEURA:  There has been interval increase in size in moderate bilateral,\nnonhemorrhagic pleural effusions.\n\nCHEST WALL AND BONES: There is no suspicious osseous lesion.  There is an old\nfracture deformity of the left lateral sixth rib.  There are moderate\ndegenerative changes of the thoracic spine.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for a 1.9\ncm simple cyst in the left interpolar kidney.  There is moderate soft and\ncalcified atherosclerotic plaque in the abdominal aorta.  The splenic artery\nappears to arise independently from the aorta.  A gastrohepatic lymph node\nmeasures up to 7 mm, similar to prior (5:253).",
            "output": "1. Slight interval increase in mediastinal and hilar lymphadenopathy since ___.\n2. Re-demonstrated is circumferential esophageal wall thickening involving the\nmid to distal esophagus consistent with known esophageal malignancy.  Interval\nplacement of an esophageal stent, which contains moderate debris, but is\notherwise patent.\n3. Patchy consolidation in the left lower lobe, compatible with pneumonia.\nAdditional peribronchovascular nodules and consolidative opacities in the\nright lower lobe and lingula, concerning for additional areas of\ninfection/aspiration.\n4. Interval increase in size in moderate bilateral, nonhemorrhagic pleural\neffusions.\n5. Millimetric pulmonary nodules in the left upper lobe are unchanged.\n6. Patent Y-stent in unchanged position within the trachea and mainstem\nbronchi.  Increased secretions in the bilateral mainstem bronchi."
        },
        {
            "input": "BASE OF NECK: The thyroid is unremarkable.  No supraclavicular lymphadenopathy\nis identified.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, hilar, or mediastinal\nlymphadenopathy is present.  No mediastinal mass is present.\n\nPLEURAL SPACES: No pneumothorax present.  Small bilateral pleural effusions\nare seen, right greater than left.\n\nLUNGS/AIRWAYS: Bilateral, lower lobe predominant interlobular septal\nthickening with ground-glass opacities suggesting pulmonary edema.  There is\nbilateral lower lobe nodular atelectasis without masses or areas of focal\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for\nwhich shaped hypodensity in the spleen most likely representing infarct. \nRight lower pole renal lesions may also represent embolic infarct.  Please see\nsame day CT abdomen pelvis for further characterization of findings below the\ndiaphragm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Pulmonary edema and small bilateral pleural effusions with adjacent nodule\natelectasis.  No focal consolidation identified to suggest pneumonia.\n2. No findings of intrathoracic septic emboli are identified.  Evaluation for\ncardiogenic embolic process be correlated with echocardiography.\n3. Please see same day CT abdomen pelvis for characterization of\nsubdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.  No aortic dissection, penetrating atherosclerotic ulcers or\naneurysmal dilations.  No filling defect in the main pulmonary artery\nthroughout its subsegmental branches bilaterally.  No evidence of right heart\nstrain.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nSmall bilateral pleural effusions.  Moderate bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation. The\nairways are patent to the subsegmental vessels.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  2 mm micronodule in the left lower lobe\n(31:54).  No consolidations or atelectasis.\n\nCHEST CAGE:\nAccentuated kyphosis.  Mild dorsal spondylosis.  No acute fractures. \nCompression deformity in T11.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is top-normal.  No pericardial effusion.  A\nleft IJ central venous catheter tip is located in the right atrium.  The\nthoracic aorta is normal in caliber.  The main pulmonary artery is normal in\ncaliber.  No evidence of pulmonary embolus to the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nA presumed VP shunt catheter courses through the anterior chest wall",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no mediastinal, axillary, mediastinal,\nor hilar lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a ill-defined consolidation in the dependent portion\nof the left lower lobe.  Ill-defined linear opacities in bilateral lower lobes\nare most compatible with subsegmental atelectasis.  There is scarring the\nbilateral lung apices.  There is a ground-glass nodule measuring 5 mm in the\nright upper lobe (3:60), unchanged from ___.  There is a solid\nnodule measuring 5 mm in right upper lobe (03:51), unchanged from ___.  3 mm perifissural nodule in the right upper lobe (3:90) is unchanged\nfrom ___.   There is biapical scarring, unchanged (the airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There are multiple hypoattenuating nodules measuring up to 4 mm\nin the right lobe of the thyroid (2:8), unchanged dating back to chest CT ___.\n\nABDOMEN: There is a small hiatal hernia.  There are multiple subcentimeter\nhypoattenuating foci in the bilateral kidneys measuring up to 7 mm in the\nupper pole the right kidney (2:124) likely which are too small to\ncharacterize.\n\nBONES: There is a compression deformity of the T7 vertebral body which appears\nworse as compared to ___.   No suspicious osseous abnormality is\nseen.?",
            "output": "1. Ill-defined consolidation in the dependent portion of the left lower lobe\nis compatible with pneumonia versus aspiration.\n2. No evidence of pulmonary embolism or acute aortic abnormality.\n3. 3 nodules measuring up to 5 mm in the right upper lobe are all unchanged as\ncompared to chest CT ___.  Given the stability of these nodules, no\nadditional imaging follow-up is recommended.\n4. Multiple hypoattenuating nodules in the right lobe of the thyroid measuring\nup to 4 mm, unchanged dating back to chest CT ___.  Given the\nstability of these nodules, no additional imaging follow-up is recommended.\n5. There is a compression deformity of the T7 vertebral body which appears\nworse as compared to ___.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 5:30 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "Somewhat motion limited evaluation of the lung bases.\n\nNECK: Thyroid gland is unremarkable.  There are no supraclavicular adenopathy.\n\nAIRWAYS: Major airways are clear.  There is diffuse mild bronchial wall\nthickening, likely in keeping with mild bronchitis.\n\nMEDIASTINUM: There is trace of pericardial effusion.  There is marked coronary\narterial calcifications.  Atherosclerotic calcifications of the thoracic\naorta.  There is mild cardiomegaly.  There is no adenopathy.  Relative\nhypoattenuation of the blood pool relative to the myocardium suggestive of\nanemia.\n\nLUNGS: Interval resolution of left lower lobe consolidation.  There are\nscattered pulmonary nodules measuring less than 6 mm, stable.  There is\nresidual minimal opacity within the medial left lung base, likely reflective\nresidual atelectasis.\n\nPLEURA: There is no pleural effusion or pneumothorax.  There are no pleural\nplaques.\n\nOSSEOUS/SOFT TISSUES: There are no acute osseous abnormalities or suspicious\nosseous lesions.\n\nUPPER ABDOMEN: Unremarkable.",
            "output": "1. Bronchial wall thickening, likely reflective of mild infectious bronchitis.\n2. Marked coronary arterial calcifications and atherosclerotic disease of the\nthoracic aorta.\n3. Improved left lung base atelectasis with residual opacities along the\nmedial left lung base."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: There is thickening of the adrenal glands bilaterally.  Limited\nassessment of the intra-abdominal structures is otherwise unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  The midesophagus is mildly\npatulous.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is enlarged.  The left ventricle is dilated. \nNo pericardial effusion.  Coronary calcifications are severe.\n\nPLEURA: Small right pleural effusion noted.\nLUNG:\n\n1. PARENCHYMA:  Mild platelike atelectasis at the left lung base (series 2,\nimage 50).  A right upper lobe pulmonary nodule (series 302, image 66)\nmeasures up to 4 mm, unchanged from ___.  No new or suspicious pulmonary\nnodules.  Subpleural ground-glass at the left lung base, likely represents\nmild atelectasis.  A discrete 5 mm ground-glass right upper lobe pulmonary\nnodule (series 302, image 84), is unchanged from ___.  A few scattered\nlingular and bilateral lower lobe ground-glass opacities, may represent\nsequela of mild infection or inflammation (series 302, image 204, 212, 152).\n2. AIRWAYS: There is unchanged bronchial wall thickening.  Airways are patent\nto the subsegmental level.\n3. VESSELS:  Aorta and main pulmonary artery are normal in size.  Vascular\ncalcifications are moderate.\nCHEST CAGE: Diffuse osteopenia is noted.  A mild superior endplate compression\ndeformity of the T11 vertebral body is new compared to prior study.  A mild\nsuperior endplate compression deformity of T7 is unchanged.  Superficial soft\ntissues are grossly unremarkable.",
            "output": "1.  A few scattered lingular and bilateral lower lobe ground-glass opacities\nmay represent mild infection or inflammation.\n2.  Right upper lobe ground-glass and solid pulmonary nodules measuring 5 mm\nare unchanged from ___.\n3.  Mild superior endplate compression deformity of the T11 vertebral body,\nwhich is new compared to ___."
        },
        {
            "input": "CHEST PERIMETER: Low-density lesion in the right thyroid lobe is too small to\nneed any further imaging evaluation.  Supraclavicular and axillary lymph nodes\nare not enlarged.  No soft tissue abnormalities in the fat depleted chest\nwall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis moderately heavy in head and neck vessels and severe in at least left\nanterior descending and circumflex and distal right coronary arteries. \nDespite the severe, chronic left ventricular enlargement, the aorta and\npulmonary arteries are not enlarged, aortic valve is not calcified and there\nare no pericardial abnormalities.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: 6 mm ground-glass nodule right upper lobe, 5:85,\nunchanged since ___.  Aside from subpleural atelectasis at the base,\nleft lung otherwise clear.\n\nAtelectasis and mild bronchiectasis, in anteromedial basal segment, left lower\nlobe is chronic.  There is no bronchiectasis elsewhere.\n\n\nSmall bilateral pleural effusions layer posteriorly.  Attenuation values,\n___ ___ indicate that this is not acute serous pleural effusion.  The\neffusions are either chronic or exudative.\n\n10 x 8 mm pleural or subpleural lung nodule, left mediastinal pleural surface,\n5:274, though just inferior to region of chronic atelectasis and\nbronchiectasis in the left lower lobe is probably new.  No other pleural\nnodules.\n\n\n\nCHEST CAGE: Mild impression upper endplate, upper thoracic vertebral body\nunchanged since ___ does not look pathologic.  Chest cage otherwise\nunremarkable.",
            "output": "No good evidence in the chest for an explanation of weight loss.  Specifically\nno evidence of active infection or advanced malignancy.\n\nSevere left ventricular cardiomegaly is chronic and not accompanied by other\nfindings of acute cardiac decompensation.  Severe atherosclerotic coronary\ncalcification is also chronic.\n\nNew pleural or subpleural nodule at the left lung base could be an early\nmalignancy, but new small bilateral pleural effusions actually greater on the\nright, are unrelated.  They may instead be due to malnutrition.\n\n6 mm ground-glass right upper lobe nodule unchanged since ___.  I would\nnot recommend imaging follow-up."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nLimited evaluation of the subsegmental pulmonary arteries due to respiratory\nmotion.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  Redemonstration of cardiomegaly with\nsevere left ventricular enlargement, unchanged compared to prior studies. \nSevere coronary artery calcifications are again demonstrated.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Previous bilateral\npleural effusions have resolved.\n\nLUNGS/AIRWAYS: Compared to the prior study from ___, there are\nincreased ground-glass opacities in the perifissural left upper lobe,\nnonspecific, but could be infectious or inflammatory.  A 6 mm right upper lobe\nground-glass nodule is unchanged (series 3:64).  A 5 mm right upper lobe\npulmonary nodule is unchanged (series 3:50).  Detection of smaller pulmonary\nnodules is limited due to respiratory motion.  Previously seen pleural nodule\nat the left lung base measuring 8 mm is unchanged (Series 3:28).  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nNo thyroid findings that require further imaging.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild compression deformity of a mid upper thoracic vertebral body is\nunchanged.",
            "output": "1. No evidence of pulmonary embolism centrally through the segmental pulmonary\narteries.  Limited evaluation of the subsegmental pulmonary arteries due to\nrespiratory motion.  No acute aortic abnormality.\n2. Slight interval increase of ground-glass opacities in the perifissural left\nupper lobe, nonspecific but possibly infectious or inflammatory.\n3. Chronic severe left ventricular cardiomegaly, unchanged.\n4. Interval resolution of previous trace bilateral pleural effusions.\n5. Multiple pulmonary nodules, unchanged, as above.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "This evaluation is partially limited secondary to the lack of intravenous\ncontrast.\n\nCHEST:\n\nA 1.6 cm hypodense left thyroid nodule is noted (3:7).  A mildly hyperdense\nnodule in the anterior mediastinum may represent a thymic cyst. Axillary,\nsupraclavicular, and hilar lymph nodes are not pathologically enlarged by CT\nsize criteria. The great vessels are unremarkable. The heart and mediastinum\nare normal in size. Coronary artery calcifications are present.  The\npericardium is intact without effusion. The airways are patent to the\nsubsegmental levels.  There is a moderate hiatal hernia.\n\nThe lungs demonstrate bibasilar dependent atelectasis.  Bronchial wall\nthickening in the left lower lobe with peribronchial nodules likely reflect\natelectasis. Multiple pulmonary nodules are noted, including a 4 mm solid\nright middle lobe nodule (3:32) and a 2 mm posterior subpleural right lower\nlobe nodule (03:33). There is no evidence of pleural effusion or pneumothorax.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal abnormality. Patent. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder, pancreas, spleen, bilateral adrenal glands, and left kidney are\nnormal on this noncontrast examination. The patient is status post right\nnephrectomy with multiple surgical clips seen within the surgical bed.\n\nThe stomach is normal.  Extensive colonic diverticulosis is noted without\nevidence of acute diverticulitis. The small and large bowel are otherwise\nunremarkable in appearance without dilation or wall thickening.  The appendix\nis . There is no retroperitoneal lymphadenopathy by CT size criteria. There is\nno free abdominal fluid or pneumoperitoneum. The aorta and its major branches\ncontain calcifications.\n\nPELVIS:\n\nThe bladder is grossly unremarkable. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. An intact ventriculoperitoneal shunt\ncatheter is noted with tip terminating in the right lower pelvis. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES:  Extensive degenerative changes are noted within the lower\nthoracolumbar spine on, including near complete fusion of the L2-L3 vertebral\nbodies, osteophytosis, and endplate sclerosis. Degenerative changes are also\nnoted within the bilateral hips, including joint space narrowing and\nsubchondral cyst formation within the bilateral femoral heads. No focal lytic\nor sclerotic lesion concerning for malignancy.",
            "output": "1. No evidence of acute intrathoracic or intra-abdominal process on this non\ncontrast-enhanced CT examination.\n2. Multiple bilateral pulmonary nodules are noted, measuring up to 4 mm in\ndiameter. Recommend CT chest followup examination in ___ year if the patient is\nat high risk for lung cancer.  If the patient is at low risk for lung cancer,\nno folllow-up of the nodules is necessary.\n3. 1.8 cm indeterminate anterior mediastinal lesion, differential diagnosis\nincludes a thymic mass or lymphoma and further evaluation with\ncontrast-enhanced CT or MRI is recommended.\n4. 1.6 cm hypodense left thyroid nodule. Further evaluation with dedicated\nthyroid ultrasound is recommended on a nonurgent basis.\n5. Evidence of left lower lobe aspiration.\n6. Extensive atherosclerotic disease, post right nephrectomy changes, and\nosteoarthritis within the thoracolumbar spine.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to the ACS resident at\n05:30 on ___."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nThere is a small left pleural effusion, slightly increased in size.  There is\nbibasilar atelectasis, left greater than right increased from prior.  No focal\nconsolidation.  The airways are patent to the subsegmental level.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\n Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "-Small left nonhemorrhagic pleural effusion, slightly increased in size from\nprior.\n-Interval increased in bibasilar atelectasis, left greater than right.  No\nfocal consolidation.\n-Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\nThe aorta and pulmonary artery are normal in caliber.  There is moderate\ncardiomegaly.  There is no pericardial effusion.  There is no pleural effusion\n\nLUNG: There is moderate to severe diffuse emphysema.  Patient is status post\nleft thoracotomy and left lower lobe superior segmentectomy with mediastinal\nlymph node dissection on ___.  There is no evidence of local\nrecurrence.  There is stable scarring in the left lung base.  A 4 mm right\nmiddle lobe pulmonary nodule (3, 47) is unchanged.  A 2 mm calcified right\nupper lobe granuloma is unchanged.  A 4 mm right middle lobe pulmonary nodule\n(4, 124 is unchanged.  A 4 mm right lower lobe pulmonary nodule (4, 159) is\nalso unchanged.  There is minimal subsegmental atelectasis in the right lung\nbase.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Bones are osteopenic.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  No focal liver lesions are seen.",
            "output": "Status post left superior segmentectomy in the interim with stable\npostsurgical changes to the left lower lung.\n\nTiny pulmonary nodules measuring between 2-4 mm as described above are stable.\nNo new pulmonary nodules.\n\nModerate to severe upper lobe predominant emphysema."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Stable severe aortic wall calcifications. \nSevere coronary calcifications, mild valvular calcifications.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  No osteolytic lesions\nat the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Stable\nextensive pulmonary emphysema and mild apical scarring.  Status post left\nthoracotomy.  Status post left lower lobe superior segmentectomy.  The\ntriangular 8 mm pulmonary nodule in fissural location (4, 94) is not changed\nin size and morphology.  The partly lobulated appearance and the singular\npleural tag (4, 96 are also unchanged.  Stable postoperative lower lobe\nlesions are reflecting scar tissue.  Mild thickening and irregularities of the\nairway walls, no substantial mucous plugging.  An intrapulmonary lymph node at\nthe middle lobe basis (4, 183) is stable in appearance.  No pleural effusions.",
            "output": "Stable postoperative appearance of the left lung.  No new or growing nodules. \nStable intrapulmonary middle lobe lymph node."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid nodules requiring\nfollow-up imaging knee.  No axillary or thoracic inlet lymphadenopathy.  No\nchest wall lesions appreciated.  Limited assessment of the breasts on CT.\n\nUPPER ABDOMEN: This study is not tailored for subdiaphragmatic evaluation. \nWithin these limits, no abnormality is appreciated in the visualized upper\nabdomen.\n\nMEDIASTINUM: No lymphadenopathy.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly or pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Unchanged appearance of the left lower lobe superior\nsegmentectomy surgical suture with adjacent linear scarring. A right lower\nlobe subpleural pulmonary nodule has grown measuring 9 mm previously 4 mm\n(4:159).  Subpleural and perifissural nodules in the inferior right upper lobe\nand right middle lobe measure 4 to 6 mm (4:158; 4:160; 4:186), and a lobulated\nperifissural nodule with linear pleural tag in the inferior left upper lobe\nmeasuring 10 mm (4:96) are stable from ___.  Moderate to severe\nunderlying emphysema.\n2. AIRWAYS: Expected and unchanged appearance of the left lower lobe bronchial\nstump.  Otherwise, patent to the subsegmental level.\n3. VESSELS:  Severe coronary artery calcifications.  The thoracic aorta and\nmain pulmonary trunk are normal in caliber.  No pulmonary embolus.  Moderate\nto severe atherosclerotic calcification in the aortic arch and great vessels. \nDense calcification of the aortic annulus with trace calcification of the\naortic leaflets.\nCHEST CAGE: Sclerotic focus in the sternum is new from ___.  Chronic\nosseous changes the left anterior ribs are unchanged and likely postsurgical. \nNo acute fracture.",
            "output": "1. Stable left lower lobe postsurgical changes without evidence of local\nrecurrence in the resection bed.\n2. Grown right lower lobe pulmonary nodule measuring 9 mm, previously 4 mm.\n3. Other pulmonary nodules including a lobulated left upper lobe nodule\nalthough stable since ___ warrants continued follow-up on subsequent imaging\n4. A sclerotic sternal lesion is new from ___ and could represent\nmetastasis, bone infarct, or sequela of prior trauma.  Further evaluation with\nradionucleotide study such as bone scintigraphy or PET-CT and correlation with\nclinical history of trauma is recommended.  PET-CT may also help evaluate the\nright lower lobe nodule, which is borderline in size for assessment of PET\navidity.\n5. Severe coronary artery calcifications.\n6. Severe emphysema.\n\nRECOMMENDATION(S):  Radionucleotide study such as bone scintigraphy or PET-CT\nand correlation with clinical history of trauma to better assess the sternal\nlesion.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:29 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  Excluding the breast tissue which\nrequires mammography for evaluation,there are no abnormalities on the chest\nwall. Moderate atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Moderate to\nsevere atherosclerotic calcifications in the coronary arteries, cardiac valves\nand aorta.  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber with slight dilatation of the right and left pulmonary\narteries, equivocal for pulmonary hypertension.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThere is a background of severe emphysema.  Unchanged appearance of the left\nlower lobe superior segmentectomy, with unchanged orientation of the suture\nline and adjacent linear scarring.\n\nA left upper lobe perifissural lobulated nodule measures 7.7 x 7.2 cm, stable\nin size dating back to ___.  Of note, this nodule demonstrated SUV max\nof 2.1 on PET-CT from ___.\n\nA perifissural nodule in the right upper lobe measures 3 mm, previously 6 mm\non ___ (series 4:171).  A second perifissural right upper lobe\nnodule measuring 4 mm is unchanged (series 4:170).\n\nA 7 mm right middle lobe nodule previously measured 6 mm on ___\n(series 4:196).  A second 3 mm right middle lobe nodule is unchanged.  (Series\n4:210).\n\nPostsurgical change related to right lower lobe wedge resection appears\nunremarkable.  No consolidation to suggest pneumonia. The airways are patent\nto the subsegmental levels.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. Again seen is a sclerotic lesion\nin the sternum, similar to the prior study from ___, new from\n___.  This area was not particularly FDG avid on PET-CT from ___, but again could represent prior trauma, bone infarct, or less likely\nmetastasis.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "1. Stable left lower lobe postsurgical change without evidence of recurrence\nin the resection bed.\n2. Unremarkable appearance of right lower lobe wedge resection.\n3. Multiple stable pulmonary nodules, as above, including a lobulated left\nupper lobe nodule, which although remain stable since ___, warrants continued\nfollow-up on subsequent imaging.\n4. Stable appearance of sclerotic sternal lesion, which again could represent\nsequela of prior trauma, bone infarct, or less likely metastasis given no\nsignificant FDG uptake on PET-CT from ___.\n5. Severe coronary artery calcifications.\n6. Severe emphysema."
        },
        {
            "input": "CHEST PERIMETER: No abnormality in the imaged thyroid needs any further\nimaging evaluation.  Supraclavicular and axillary lymph nodes not enlarged. \nBreast evaluation reserved exclusively for breast imaging.  This study is not\nappropriate for subdiaphragmatic diagnosis especially evaluation of the liver\nbut shows no adrenal mass.  Abdominal aorta is extremely heavily calcified. \nNo aneurysmal dilatation in the imaged portion.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification is\nheavy in head and neck vessels and all coronary arteries.  Aorta and pulmonary\narteries are normal size.  There may be some calcification in the aortic\nvalve, hemodynamic significance uncertain.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: None pathologically enlarged or growing\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe.\n\nNew bronchial wall thickening, right upper lobe, is inflammatory, ___, 192.  A smaller region of peribronchial infiltration in the right\nupper lobe, 9:117, stable since ___ and ___ has grown slowly\ncompared to ___ and ___ and should be kept under surveillance.\nBronchial wall thickening in the superior segment of the right lower lobe is\nchronic but worsening, and there is new consolidation in the posterior basal\nsegment of the left lower lobe, 9:224-245.  There is no left pleural\neffusion..\n\n4 mm right upper lobe nodule, 9:219, stable since ___.  Site of right lower\nlobe resection has a normal and stable postoperative appearance, including\nsubpleural atelectasis.\n\n\n\n\n\nCHEST CAGE: No compression or pathologic fractures or destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Normal postoperative appearance following right lower lobe lung resection.  No\nevidence of local recurrence.\n\nNew multifocal peribronchial infiltration, small areas of consolidation and\nincreased bronchial wall thickening in the superior and posterior basal\nsegments left lower lobe.  Findings suggest chronic recurrent infection.\n\nSlowly growing small right upper lobe lung lesions stable for nearly a year is\nlarger than it was in ___ and should be kept on long-term surveillance, with\nread P chest CT in one year.\n\nHeavy atherosclerotic calcification in head and neck and all coronary\narteries.  Aortic valvular calcification, hemodynamic significance uncertain.\n\nSevere emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no pathologic enlarged\nlymph nodes in the supraclavicular or axillary stations.\n\nUPPER ABDOMEN: No adrenal glands masses identified, remaining findings\nreported separately in the same day CT of the pelvis.\n\nMEDIASTINUM: In comparison to ___ there has been interval improvement\nin mediastinal lymphadenopathy with right lower paratracheal lymph nodes 2.2 x\n1.4 cm, in prior 3.2 x 1.8 cm, inseparable from subcarinal 2 x 3.2 cm, which\nin the current study measures 1.1 x 2.5 cm.\nRight hilar 1.5 cm nodule is borderline and unchanged.\nThere is no new intrathoracic lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal with no pericardial effusion. \nModerate calcifications of the aortic valve annulus with extensive\ncalcifications of normal caliber thoracic aorta.\nExtensive calcifications also involve head and neck vessels with no\nsignificant stenosis.\nMain pulmonary artery within normal size.\nResidual PE in the right upper lobe pulmonary artery (6:169).  There is no\nevidence of residual left lower lobe pulmonary emboli in this nondedicated\nstudy.\n\nPLEURA: There is no pleural effusion. No pneumothorax.\n\nLUNG: The airways are patent to the subsegmental level bilaterally.\nSevere centrilobular emphysema affecting predominantly right upper lobe.\n\nLeft upper lobe 0.7 nodule is smaller since ___ when it measured 1.2 cm\n(6:72).\nRight upper lobe 0.7 cm nodule is unchanged (6:85), adjacent 0.5 cm nodule is\nmildly smaller in comparison to prior (6:109).\nRight lower lobe superior segment 0.7 spiculated mass has significantly\ndecreased in size with tethering of the major fissure and delicate pleural tag\nare still evident.  In ___ appeared as 2.1 x 1.9 cm lobulated mass with\nwide pleural base.\n\nMultiple nodules in the right lower lobe has resolved or decreased in size\nwith few nodules remaining measuring up to 0.4 cm for example series 6: 214,\n218, 222, 223, 250.\n\nBilateral lower lobes posterior linear consolidation were not demonstrated in\n___, decreased in size since ___ (6:268).  The linear\nmorphology of the lesions is particular, possibly not malignant but\ninflammatory in origin.\n\nCHEST CAGE: Multilevel degenerative changes spine with diffuse osteoporosis. \nMild compression fracture of T12 superior endplate minimally progressed since\nprior.\nNo evidence of lytic or sclerotic bone lesions.",
            "output": "-In comparison to ___ there has been improvement in mediastinal\nlymphadenopathy and bilateral multiple lung nodules and consolidations.\n-Tiny residual pulmonary emboli in the right upper lobe pulmonary artery with\nno new filling defects identified in this nondedicated study."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nHowever, due to extensive respiratory motion in the lower lobes assessment of\nthe subsegmental pulmonary arteries is limited.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: An enlarged right hilar node measuring 1.4 cm\nis unchanged (3:112).  There has been interval increase in a paraesophageal\nnode measuring up to 8 mm in short axis, previously 5 mm (3:86).  No axillary\nor mediastinal lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A left upper lobe nodule measuring 7 mm is unchanged since\n___ (03:40).  A 7 mm nodule in the right upper lobe is also\nunchanged (03:53).  An adjacent 5 mm nodule in the right upper lobe is\nunchanged (3:63).  A 3 mm nodule in the right lower lobe is also unchanged\n(3:192). The 7 mm superior segment right lower lobe spiculated mass is\nunchanged in size compared to ___.\n\nA 1.1 cm spiculated nodule in the posterior right upper lobe is new since\n___ (3:76).  A 5 mm nodule in the inferior right upper lobe is new\nsince the ___ study (3:119).  An additional 5 mm nodule in the left\nupper lobe is also new since the ___ study (3:84).\n\nThe airways are patent to the level of the segmental bronchi bilaterally. \nThere is diffuse bronchial wall thickening.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is a chronic fracture of the posterior right eleventh rib and the\nposterior left seventh rib.  No suspicious osseous abnormality is seen.? There\nis no acute fracture.",
            "output": "1.  Of note, assessment of subsegmental pulmonary embolism is limited due to\nextensive respiratory motion through the bilateral lower lobes. No evidence of\npulmonary embolism elsewhere.  No evidence of aortic dissection.\n2.  New bilateral pulmonary nodules, including a 1.1 cm spiculated nodule in\nthe posterior right upper lobe are concerning for disease progression.\n3.  Numerous additional subcentimeter nodules are unchanged since ___.\n4. Diffuse bronchial wall thickening suggests airways inflammation.\n5.  Similar, if not minimally increased, hilar and mediastinal lymphadenopathy\ncompared to ___."
        },
        {
            "input": "HEART AND VASCULATURE: There is a small filling defect peripherally and a left\nupper lobe segmental pulmonary arterial branch which is similar to prior from\n___ and likely represents a chronic embolus (02:38).  Otherwise,\nthe remaining pulmonary vasculature is well opacified to the subsegmental\nlevel without filling defect to indicate a pulmonary embolus.  The thoracic\naorta is extensively calcified but is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is right hilar adenopathy, similar to\nprior.  No axillary or mediastinal lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are multiple new bilateral pulmonary nodules, and a\nrandom pattern, which likely represents progression of metastatic disease.  In\naddition, there are multiple innumerable new bilateral ___ and\nground-glass opacities, with a lower lobe predominance (for example 2:97). \nThere is scattered mucoid impaction.  There is severe centrilobular emphysema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multiple new pulmonary nodules likely reflects progression of metastatic\ndisease.\n3. Innumerable new, predominantly lower lobe, ___ and ground-glass\nopacities likely represents atypical infection.\n4. Grossly unchanged lymphadenopathy.\n5. Severe emphysema.\n6. Focal segmental left upper lobe pulmonary artery filling defect likely\nrepresents a chronic embolus, unchanged compared to ___.\n\nNOTIFICATION:    Changes to initial preliminary read were discussed with the\n___ team by ___, M.D. on the telephone on ___"
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter and appearance. No\npathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated. Heart size is normal. There is no pericardial pleural effusion.\nImage portion of the upper abdomen demonstrate caudate lobe hypodensity, 10\nHounsfield units in density.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Normal chest CT. Image portion of the upper abdomen will be discussed at the\nCT abdomen report."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is normal. \nScattered axillary lymph nodes are not pathologically enlarged by CT size\ncriteria.  There are no pathologically enlarged supraclavicular, mediastinal\nor hilar lymph nodes.\n\nMEDIASTINUM: There are no pathologically enlarged mediastinal lymph nodes. \nThe esophagus is normal in caliber and course without a hiatal hernia.\n\nHILA: There are no pathologically enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart is normal in size, and there is no\nsignificant pericardial fusion.  The thoracic aorta is normal in caliber and\ncourse.\nPLEURA: There is no pleural effusion bilaterally.\nLUNG:\n\n-PARENCHYMA:  There is no focal consolidation or pulmonary nodule.\n-AIRWAYS:  The trachea and airways are patent to the subsegmental level. \nThere is mild narrowing of the trachea without definite signs of\ntracheobronchomalacia.\n-VESSELS:  The pulmonary artery and thoracic artery are normal in caliber.\nCHEST CAGE: There is no signs of metastatic disease along the thoracic chest\ncage.  There is no focal osseous lesion to suggest malignancy, and there are\nno rib fractures.",
            "output": "No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta is normal in size.  The main and right pulmonary arteries are\nmoderately enlarged.  The heart is moderately enlarged with focal enlargement\nof the left atrium.  Extensive aortic valvular, coronary arterial, and mitral\nannular calcifications are noted.  A moderate, transient pericardial effusion\nis unchanged.\n\nThere is a persistent, moderate, nonhemorrhagic right hydropneumothorax. A\nright-sided pigtail catheter terminates at the right lung base, with the\nmajority of the catheter noted to be external to the pleural effusion. No\nevidence of mediastinal shift to suggest tension physiology. The airways are\npatent to the subsegmental level.  Bibasilar atelectasis is noted, right\ngreater than left.  Persistent right middle lobe and right lower lobe\nground-glass opacities are minimally changed, and likely represent\nre-expansion pulmonary edema versus pulmonary hemorrhage.\n\nNumerous, contiguous, displaced lateral right rib fractures are again\nidentified.  No suspicious osseous lesions are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrates several small hepatic cysts.",
            "output": "1.  Status post right pigtail drainage catheter placement with a persistent,\nmoderate right nonhemorrhagic hydropneumothorax.  No evidence of mediastinal\nshift.  Note that the majority of the pigtail catheter is not within the\npatient's pleural effusion.\n2.  Unchanged right middle and right lower lobe ground-glass opacities\nadjacent regions of atelectasis, suggestive of re-expansion pulmonary edema or\npotentially pulmonary hemorrhage given the patient's history of trauma. \nSuperimposed infection is felt less likely.\n3.  Moderate cardiomegaly with extensive coronary artery, aortic valvular, and\nmitral annular calcifications.\n4.  Stable, moderate transudative pericardial effusion.\n5.  Moderate enlargement of the main and right pulmonary arteries, suggestive\nof underlying pulmonary arterial hypertension."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta is normal in size.  The main and right pulmonary arteries remain\nmoderately enlarged.  The heart is moderately enlarged with focal enlargement\nof the left atrium.  Extensive aortic valvular, coronary arterial, and mitral\nannular calcifications are again noted.  There is a moderate, transient\npericardial effusion, unchanged.\n\nIn addition to the patient's pre-existing right anterolateral pigtail drainage\ncatheter, there has been interval placement of a second, posterior pigtail\ndrainage catheter terminating at the medial right lung base.  There has been\nsignificant reduction of a now small, loculated, right hydropneumothorax.  The\nremains no evidence of mediastinal shift.\n\nGround-glass opacities in the right middle and right lower lobes are\nessentially unchanged from the prior examination.  Fluid is seen within the\nright minor and major fissures.  Persistent bibasilar atelectasis, right\ngreater than left is again noted.\n\nNo suspicious osseous lesions are identified.  Numerous, displaced right rib\nfractures are unchanged.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\nagain demonstrates several small hepatic cysts.",
            "output": "1.  Interval placement of a second, posterior right pigtail drainage catheter\nwith improvement in the now small residual right hydropneumothorax.\n2.  Bibasilar atelectasis and persistent right middle and lower lobe\nground-glass opacities likely reflecting re-expansion pulmonary edema versus\npulmonary hemorrhage, with infectious etiologies follows likely.\n3.  Moderate cardiomegaly with extensive coronary artery, aortic valvular, and\nmitral annular calcifications.\n4.  Unchanged, moderate pericardial effusion.\n5.  Enlargement of the main and right pulmonary arteries remains suggestive\nof underlying pulmonary arterial hypertension."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The mild ectasia of the thoracic aorta measuring 4.4\ncm.  The main pulmonary artery measures 3.2 cm.  The heart size is moderately\nenlarged and there is small to moderate pericardial effusion, unchanged since\nthe prior. Moderate atherosclerotic calcifications of the thoracic aorta and\nsevere coronary arteries.  Moderate severe calcifications of the aortic valve\nand mitral annular calcifications.\n\nPLEURA:  There is no pneumothorax.  Right-sided pigtail catheter has been\nremoved.  Interval increase in the right-sided pleural effusion which is small\nto moderate, with fluid tracking along the fissures.  Small right-sided apical\npneumothorax has resolved.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild apical pleural\nscarring.  Linear and peribronchial opacities in the right upper lobe, and\nright lower lobe have significantly improved since the prior examination. \nPunctate nodule in the left lower lobe (04:19 5).  No new or growing pulmonary\nnodules.\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton. \nMultiple healing rib fractures on the right are unchanged.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, multiple hepatic hypodensities scattered throughout the liver\nstable in are likely hepatic cysts.",
            "output": "1.  Removal of right pigtail drainage catheter with interval increase in\nmoderate right-sided pleural effusion.  Right apical pneumothorax has\nresolved.\n2.  Interval improvement in the right upper and lower lobe opacities.\n3.  Moderate cardiomegaly with extensive coronary artery, aortic valvular, and\nmitral annular calcifications.\n4.  Unchanged, moderate pericardial effusion.\n5.  Enlargement of the main and right pulmonary arteries remains suggestive\nof underlying pulmonary arterial hypertension."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Mediastinal lymph nodes are unchanged.  Heart size is normal. \nThere is mild coronary artery calcification.  There is no pericardial\neffusion.\n\n\nPLEURA: Is a stable small right pleural effusion which is most likely\npostsurgical.\n\nLUNG: Patient status post right lower lobectomy with stable postsurgical\nchanges to the right chest.  Mild upper lobe predominant emphysema.  No new or\ngrowing pulmonary nodules.  Stable bronchiectasis within the left lung base. \nA 2 mm subpleural nodule in the left lower lobe (7, 189) is unchanged.  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows an expansile lytic lesion\ninvolving the medial head of the left clavicle (7, 17), with slightly increase\nin volume of the soft tissue surrounding the lytic lesion.  Note is also made\nof a lytic lesion involving L1 vertebral body.  Please refer to dedicated\nreport on abdomen which has been dictated separately.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is a left adrenal nodule measuring 20 mm, has not been\ncompletely imaged.",
            "output": "Status post right lower lobectomy with stable postsurgical changes.  No\nevidence of local recurrence.\n\nStable focal bronchiectasis in the left lung base.  Stable tiny left lower\nlobe pulmonary nodule.  No new pulmonary nodules.  No new pulmonary nodules\n\nExpansile lytic lesion involving the medial head of the left clavicle with\nassociated soft tissue which is worsened since the prior study.\n\nLytic lesion involving L1 vertebral body.\n\nLeft adrenal nodule.  Please refer to dedicated report on abdomen which has\nbeen dictated separately"
        },
        {
            "input": "CHEST:\n\nThe thyroid is unremarkable and there is no supraclavicular lymph node\nenlargement. The airways are patent to the subsegmental level. No axillary,\nhilar or mediastinal lymph node enlargement by CT size criteria.  Multiple\ncalcified lymph nodes are noted in the mediastinum and hila. A core valve\ndevice is seen in unchanged position. There is extensive atherosclerotic\ncalcification of the coronary arteries as well as the aortic arch. Note is\nmade of a bovine type aortic arch. Numerous calcified granulomas are seen\nthroughout both lungs. There is a loculated appearing right nonhemorrhagic\npleural effusion with associated rounded atelectasis of the right lower lobe. \nNo pneumothorax is present.  The esophagus is patulous with an air-fluid\nlevel.  There is a moderate hiatal hernia.\n\nABDOMEN:\n\nEvaluation of the solid organs and tissues is limited without intravenous\ncontrast. The liver has a normal noncontrast appearance with no focal lesions\nor intrahepatic biliary dilatation. The gallbladder, pancreas, spleen and\nadrenal glands are unremarkable.  The kidneys are atrophic. There are numerous\ncystic structures on both kidney some of which are hyperdense including a left\nlower pole 19 mm lesion, a right upper pole 10 mm lesion and a right\ninterpolar 20 mm lesion.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  There is extensive diverticulosis without evidence of\ndiverticulitis. There is no retroperitoneal or mesenteric lymphadenopathy by\nCT size criteria.  There is a moderate amount of non hemorrhagic ascites. A\nperitoneal dialysis catheter is noted within the pelvis.  The abdominal aorta\ndemonstrates minimal ectasia with severe atherosclerotic calcification.  There\nis a small ventral hernia containing small bowel without evidence of\nincarceration.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.  An\nanterior compression deformity at T2 was better assessed on the cervical spine\nCT and appears unchanged from ___. There is a angulated fracture of\nthe left femoral neck which is acute. Multilevel degenerative changes of the\nthoracolumbar spine and degenerative changes of the bilateral shoulders are\nnoted.",
            "output": "1. Angulated acute left femoral neck fracture\n2. Chronic compression deformity of T2 vertebral body is unchanged from ___.\n3. Loculated right pleural effusion with rounded atelectasis\n4. Moderate hiatal hernia\n5. Multiple renal cysts, some of which are hyperdense likely hemorrhagic\n6. Moderate amount of ascites with peritoneal dialysis catheter in the abdomen\n7. Ventral hernia containing small bowel without evidence of incarceration\n8. No evidence of intrathoracic or abdominal injury.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 4:00 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable. A left-sided pacemaker device is in situ, with a single lead\nwires terminating at the apex of the right ventricle.\n\nUPPER ABDOMEN: A 1.3 cm simple cyst is noted in the left upper renal pole. \nCholelithiasis is again demonstrated.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy, within the limitations of\nunenhanced study.\n\nHEART and PERICARDIUM: There is severe cardiomegaly.  Patient is post aortic\nand mitral valve replacements.  Coronary calcifications are mild.  Small\nvolume air in the right atrium may be related to recent intravenous access. \nThe thoracic aorta is normal in caliber. There is no pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA/AIRWAYS: There are diffuse bilateral ground-glass opacities,\nmost prominent in the bilateral upper lobes.  The airways are patent to the\nsegmental level bilaterally.  There is mild atelectasis/scarring in the right\nlower lobe and lingula.  Mild biapical scarring is also noted.  Numerous solid\nnodules measuring up to 6 mm are seen in the bilateral upper lobes on the left\n(5:27, 35, 54, 66) and on the right (5:27, 35, 58).\n2. VESSELS: Main pulmonary artery diameter is enlarged at 3.3 cm.\nCHEST CAGE: No suspicious osseous lesions or acute fracture.  Post median\nsternotomy changes are noted.",
            "output": "1. Diffuse bilateral ground-glass opacities, most prominent in the bilateral\nupper lobes suggest multifocal atypical or viral infection.  Differential\nconsiderations also include an inflammatory process and pulmonary edema,\nalthough the distribution would be unusual for edema.  No pleural or\npericardial effusion.\n2. Multiple bilateral solid pulmonary nodules measure up to 6 mm.  Please see\nrecommendation below.\n3. Severe cardiomegaly.\n4. Cholelithiasis.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8 mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  There is redemonstration of severe cardiomegaly\nwith severe biatrial enlargement, similar to prior.  Patient is status post\naortic valve and mitral valve replacements.  The main pulmonary artery\nmeasures 3.4 cm, similar to prior.  The pericardium and great vessels are\nwithin normal limits. No pericardial effusion is seen.  There are severe\ncoronary artery calcifications again demonstrated.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Calcified granulomas again noted in the right lower lobe. \nThere are again multiple bilateral pulmonary nodules measuring up to 5 mm in\nthe right upper lobe (2; 11), similar to prior.  There is interval resolution\nin multiple bilateral ground-glass opacities compared to prior chest CT. \nThere is bilateral apical pleuroparenchymal scarring.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nA single right ventricular pacer lead is contiguous with a left chest wall\ngenerator.  Median sternotomy wires appear intact.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is focal cortical scarring in the right lower pole.  Otherwise,\nthe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno hydronephrosis.  In the right upper pole, there is a 1.5 x 1.6 cm lesion\nwith ___ of 52, which appears new compared to CT abdomen pelvis from ___ but\nmay have been present in ___, which may demonstrate a hemorrhagic\ncyst, but can not exclude possible hypoenhancing lesion.  Bilateral\nsubcentimeter hypodense lesions are seen in the kidneys, too small to\ncharacterize but likely representing renal cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Large calcified fibroid uterus, with a calcified fibroid\nmeasuring 6.7 x 9.3 cm along the posterior uterine wall.  No adnexal\nabnormalities identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality. \nModerate multilevel degenerative changes are noted in the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute traumatic abnormality is noted in the torso.\n2. Severe cardiomegaly with severe biatrial enlargement similar to prior.\n3. Stable bilateral pulmonary nodules measuring up to 5 mm.\n4. 1.6 cm right upper pole lesion likely represents a hemorrhagic cyst but\ncannot fully exclude possible hypoenhancing lesion.  Consider nonemergent\nrenal ultrasound for further characterization if clinically indicated."
        },
        {
            "input": "HEART AND VESSELS: Patient is status post open repair of thoracoabdominal\naortic aneurysm.  The distal thoracic/upper abdominal aorta is normal in\ncaliber measuring 3.0 cm.  Additional grafts are noted extending to the\norigins of the SMA and celiac trunk.  The aortic arch and major vessels to the\nneck appear unremarkable within the limitations of an unenhanced study. Mild\natherosclerotic calcification of the aortic arch.  The main pulmonary trunk is\nnormal in caliber. No evidence of right ventricular strain. No cardiomegaly.\nRight-sided PICC with its tip at the level of the mid SVC.\n\nLUNGS AND AIRWAYS: There is atelectasis involving the dependent portions of\nthe left upper lobe with near complete collapse of the left lower lobe.  The\ntracheobronchial tree is otherwise patent.\n\nPLEURA/PERICARDIUM: There is a large left-sided pleural effusion with\nhyperdense material in the dependent portions of the pleural fluid consistent\nwith hemothorax.  There is a small amount of gas within the nondependent\nportions of the left pleural effusion.  Trace right-sided pleural effusion. \nNo pericardial effusion.\n\nMEDIASTINUM: There is a low-attenuation structure with peripheral\ncalcification within the posterior mediastinum which appears to correspond to\nthe native descending thoracic/upper abdominal aorta, which has been\ndefunctioned.\n\nESOPHAGUS AND NECK: Unremarkable.\n\nBONES AND SOFT TISSUES: Subcutaneous emphysema within the left anterior chest\nwall with skin staples in situ.  There is mild soft tissue edema involving the\nlateral chest wall bilaterally.\n\nUPPER ABDOMEN: Right-sided hepatic cysts, largest measuring 4.5 cm.  Native\nproximal abdominal aorta is noted anterior to the site of graft repair with\nabandoned stent in situ (axial series 2, image 65).",
            "output": "1. Findings in keeping with left-sided hemothorax with near complete collapse\nof the left lower lobe.\n2. Status post open repair of thoracoabdominal aortic aneurysm, with synthetic\naortic graft.  Native descending thoracic/upper abdominal aorta with stent\nmaterial in situ, likely from a branch vessel."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The morphology of the postoperative or the the is\nnot substantially changed.  The appearance of the cardiac structures is also\nstable.  The loculated left-sided fluid collection has minimally decreased in\nsize but the overall extent is still substantial.  There is an anterior large\nair-fluid level (5, 230).  There is a small postoperative pericardial air\ninclusion (5, 248).  There also is substantial partial left lower lung\ncollapse.\n\nThe most concerning finding, however, are circumferential bubbly gas\ncollections around the descending aorta.  In addition, a small intra\npericardial air-fluid level is visualized.  The right pleural effusion is\nstable.",
            "output": "New circumferential bubbly gas collections around the descending aorta are\nhighly concerning for infection.  Given the vicinity of the changes to the\npostsurgical esophagus, a fistula formation would be an additional, although\nless likely differential diagnosis.\n\nLarge left anterior air-fluid level and small pericardiac air-fluid level. \nExtensive left lower lung collapse.  Stable small right pleural effusion.\n\nNOTIFICATION:  At the time of dictation and observation, 10:20, on the ___, the referring physician ___ was paged for notification\nand the findings were discussed 5 minutes later over the telephone."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged and\nthere is no soft tissue abnormality in the imaged chest wall concerning for\nmalignancy.  There is mild intramuscular edema in the muscles of the left\nlower lateral chest wall, just inferior to the left scapular tip 03:44;\ndelineation of a discrete fluid collection would require intravenous contrast\ninfusion but can be assessed with ultrasound.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, for which CTA is\nrecommended.\n\n\n\nCARDIO-MEDIASTINUM:  As far as one can tell on this noncontrast study, the\nesophagus is unremarkable despite adjacent abnormalities in the lower\nposterior mediastinum.\n\nPrevious tiny gas collections associated with the lower portion of the\nrepaired thoracic aorta have resolved although the lower portion of the\nthoracic aorta still resides in large, loculated, nonhemorrhagic fluid\ncollection that extends from the level of the cardiac apex probably extending\nthrough the diaphragm to the upper retroperitoneum.  Nearly all of what was\npreviously a large gas collection has been replaced by fluid, 03:31.\n\nInterposed between the esophagus and the descending thoracic aorta originating\nat the level of the left inferior pulmonary veins, and contiguous with the\nposterior pericardium is a persistent elliptical thick walled fluid\ncollection, 11 cm in length, extending below the diaphragm, containing small\nmetallic fragments, 03:40 ___.  On the previous study it contained air and\nfluid, but the air has been resorbed.  An earlier CT on ___\nshowed that it is communicating with the previous the hemorrhagic large left\npleural collection dissecting into both the posterior mediastinum and\nretroperitoneum, with a component posterior to the aortic graft in the\nabdomen, 5:326.  At the level of its greatest cross-sectional area, just at\nthe diaphragm,, where it is contiguous with the posterior pericardium\ndiameters are 57 x 26 mm, previously 24 x 66 mm.  There is no appreciable\npericardial effusion.\n\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderate to severe.  There are no focal\nfindings of consequence in the right lung.\n\nThe superior and posterior basal segments of the left lower lobe are still\nlargely collapsed and there is a smaller region of subpleural atelectasis in\nthe posterior segment a left upper lobe, all unchanged.  There is no good\nevidence for bronchial obstruction or bronchiectasis.\n\nLarge loculated pleural collection in the left hemithorax extends from the\nupper anterior costal pleural space involves the pleural space to the\ndiaphragmatic surface but may extend below the diaphragm, as before, to the\nretroperitoneum.  Nearly all of its previous large gas collection has\nresolved, but the fluid collection is slightly larger, at the diaphragm, level\nof its greatest cross-sectional area diameters are 79 x ___ mm today, 5:262,\npreviously 63 x ___ mm.\n\nSmall nonhemorrhagic posteriorly layering right pleural effusion slightly\nsmaller.\n\nCHEST CAGE: There are no findings in the chest cage to suggest infection or\nmalignancy.",
            "output": "The large left pleural collection, no longer hemorrhagic, has only a small\ncomponent of air but is slightly larger today than in on ___ and may\nextend below the diaphragm.  Chest CT on ___ showed that it is\ncontinuous with a persistent fluid collection interposed between the esophagus\nand the aorta in the lower posterior mediastinum extending to the\nretroperitoneum.  This collection no longer contains any gas end is entirely\nfluid-filled but has not decreased in size.  Inferiorly it is intimate with\nthe abdominal aortic graft.\n\nCollapse of the superior and posterior basal segments left lower lobe\nunchanged.\n\n\n\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:44 am, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Right-sided PICC line projects to the proximal\nSVC.  The ET tube and NG tube are in acceptable position.  The NG tube\nprojects to the state for stomach.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.  There are no\nenlarged hilar lymph nodes.  Heart size is normal.  Patient is status post\nrepair of a descending aortic aneurysm with a channel extending from the\ndescending aorta along the left lower posterior chest (3, 57).  Lack of\nintravenous contrast limits evaluation.  There is no pericardial effusion.\n\n\nPLEURA: There is a moderate volume loculated left pleural effusion with\naverage Hounsfield units of 14.  There is a minimal pleural thickening\nassociated with the pleural effusion which is most likely related the\nchronicity.  Tiny pockets of air are seen within the left pleural effusion\nwhich have decreased since the prior study.  Trace right pleural effusion is\nunchanged.\n\nLUNG: There is a new consolidative opacity in the right lower lobe (3, 49) and\nalso in the left upper lobe.  The left upper lobe consolidative opacity is\ninseparable from the previously visualized consolidation in the left lower\nlobe.  No new pulmonary nodules.  Mild interstitial edema\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a right\nhepatic cyst.  There is trace ascites.  There is stranding in the upper\nabdomen.",
            "output": "Increase in volume of the nonhemorrhagic left pleural effusion which is\npartially loculated.  Tiny pockets of air within the pleural space have\ndecreased in volume.\n\nStable small right pleural effusion\n\nNew consolidation in the right lower lobe and left upper lobe concerning for\npneumonia.  Consolidative opacity in the left upper lobe inseparable from the\nadjacent left lower lobe consolidation.\n\nStatus post repair of an endoleak of the aortic aneurysm.  Evaluation is\nlimited due to lack of intravenous contrast"
        },
        {
            "input": "Endotracheal tube appears appropriate. Enteric tube terminating within the\nstomach. Interval placement of a left basilar chest tube has resulted in\ninterval slight decreased decrease in pre-existing loculated pleural effusion\nat its posterior component.\n\nAlthough the fluid component of the loculated left pleural effusion with\ncircumferential pleural thickening has decreased, there is now a substantial\nvolume of intrapleural air, compatible with a hydropneumothorax. Air is seen\nalong the course of the chest tube as it enters the chest, which likely\naccounts for the intrapleural air.\n\nChest tube courses directly adjacent to the grafted descending aorta through\nthe created aortic hiatus, and into the upper abdomen (series 302, image 234).\nSmall amount of fluid surrounding the abdominal descending aorta, unchanged\ncompared to prior.\n\nThe dense opacification with air bronchograms in the bilateral lobes is\nsimilar compared to prior, left greater than right, with definitive concern\nfor pneumonia in the right lower lobe and a combination of pneumonia and\natelectasis in the left lung. There is slight progression of the opacification\nin the left upper lobe with ground-glass opacities and new smooth septal\nthickening which might reflect component of mild progressing pulmonary edema\nor still represent progression of infection in this location..\nPreviously seen collection in the posterior left mediastinum, series 3, image\n44 on the previous study has almost entirely resolved, a adjacent to the\nsurgical clips, series 2, image 48 in the current examination.\n\nSurgical fracture of posterior aspect of seventh rib, series 2, image 31 is\nunchanged.\n\nNo additional development of lymphadenopathy is present.  There is evidence of\nanemia.",
            "output": "Placement of the left chest tube with subsequent drainage of the large pleural\nloculation which is currently sub situated by the hydropneumothorax.\n\nSmall amount of fluid surrounding the abdominal descending aorta, unchanged\ncompared to prior.\n\nImproved collection in the left posterior mediastinum\n\nBilateral multifocal infection, minimally worse in the left upper lung. \nPotentially minimal interstitial pulmonary edema in the left upper lobe\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:36 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "The thyroid gland is surgically absent.  Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged. Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.  There is no pericardial effusion. Notice\nmade of a small hiatal hernia. Within the anterior chest wall, a VP shunt is\nseen.\n\nLung windows demonstrate no demonstrates mild centrilobular nodules\nbilaterally. No discrete nodules are demonstrated. There is no pleural\neffusion.\n\nNo suspicious lytic or blastic lesions are identified.\n\nFor complete subdiaphragmatic evaluation, please refer to CT abdomen and\npelvis performed on the same date, ___, clip number ___.",
            "output": "No radiographic evidence of intra thoracic metastatic disease.\n\nFor complete subdiaphragmatic evaluation, please refer to CT abdomen and\npelvis performed on the same date, ___, clip number ___."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere are no soft tissue lesions in the chest wall suspicious for malignancy\nor infection. Patient has had sternectomy.  There is no indication of\ninfection in the anterior chest wall or mediastinum.\n\nThis study is not designed for subdiaphragmatic diagnosis, but shows there is\nno adrenal mass. The imaged portion of the minimally enhanced liver is\nhomogeneous. Thyroid is unremarkable. Patient has had CABG. Atherosclerotic\ncalcification is moderately extensive in the native coronaries, but cannot be\nassessed in the grafts by this study. Aorta and pulmonary arteries are normal\nsize. A partially thrombosed left atrial appendage, 4:92- 102, should not be\nmistaken for mediastinal lymph node.\n\nAn 8 x 14 mm thoracic inlet lymph node, 04:31, was 7 x 18 mm in ___.\nOther Central lymph nodes are not pathologically enlarged. The right hilus and\nbronchial stump have a normal postoperative appearance following right upper\nlobectomy. There is no pleural or pericardial effusion.\n\nPunctate left lower lobe nodule, 4:126 and a calcified granuloma in the right\nlower lobe are stable since ___. Lungs are otherwise clear and the\ntracheobronchial tree is normal to subsegmental levels.",
            "output": "No evidence of new or recurrent intrathoracic malignancy.\n\nNo evidence of infection, following sternectomy.\n\nProgressive thrombosis left atrial appendage. Clinical correlation advised as\ntowhether echocardiography is indicated."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there are severe calcifications in all coronary\narteries. There is no pleural or pericardial effusion. Patient is status post\nCABG.\nPatient is status post right upper lobectomy. Small amount of soft tissue of\nprojecting in the right upper lobe stump is unchanged (2, 24 )\n2 mm subpleural nodule left lower lobe is stable (4:119)\nNew multiple ground-glass peribronchial and centrilobular opacities in the\nright lower lobe are likely infectious in etiology followup in 3 months is\nrecommended\nThere is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation there are\nstones within the gallbladder. A large stone in the left kidney is\nnonobstructing measures 10 mm\nThere are no bone findings of malignancy. Patient has had sternectomy.",
            "output": "Multiple new right lower lobe ground-glass nodules likely infection followup\nin 3 months after treatment is recommended.\nCholelithiasis\nNonobstructing stone in the left kidney\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ into the Department of Radiology critical communications system for\ndirect communication to the referring provider."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.  A right upper\nparatracheal lymph node measures 9 mm in short axis, previously 7 mm (3, 10). \nA 7 mm right hilar lymph node is stable (5, 125).\n\nThe patient has had prior median sternotomy with CABG.  Calcifications of both\nnative and grafted coronary arteries are extensive.  The main pulmonary artery\nis normal caliber.  There is stable mild dilatation of the ascending thoracic\naorta to 4.0 cm at the level of the main pulmonary artery.  There is no\npericardial effusion.\n\nThe patient has had prior right upper lobectomy with a stable postoperative\nappearance of the bronchial tree and remaining right lung. Previous right\nlower lobe ground-glass opacities and centrilobular nodules have resolved.\nThere is no evidence of local recurrence or metastasis. A punctate 2 mm left\nlower lobe subpleural nodule is stable dating back to ___ (5, 140). No\nnew nodules are identified. Punctate calcified granulomas are incidentally\nnoted.   There is no endobronchial lesion or pleural effusion.\n\nImages of the upper abdomen are unremarkable.\n\nOld healed bilateral rib fractures are present.  The patient has had a sternal\nresection.  Generalized osteopenia and multilevel loss of height involving\nseveral mid to lower thoracic vertebral bodies are unchanged.",
            "output": "Resolved infectious or inflammatory right lower lobe ground-glass nodules.\n\nNo evidence of local recurrence or metastasis."
        },
        {
            "input": "Right upper paratracheal lymph node is stable, series 2, image 10, not\npathologically enlarged.  Right lower paratracheal lymph nodes, series 2,\nimage 21 has slightly increased in size from 10 x 7.7 mm to 11 by out 12.8 mm.\nBronchial wall thickening surrounding the right main bronchus, series 2, image\n25 is similar to previous examination as well as a right hilar lymph node,\nseries 2, image 28, 12 mm in diameter.  No new mediastinal hilar or axillary\nlymph nodes demonstrated.\n\nAorta and pulmonary arteries are well enhanced.  The patient is after CABG. \nHeart size is normal.  Coronary calcifications are extensive.  There is no\npericardial pleural effusion.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nPostsurgical changes after right upper lobectomy are stable.  There are no new\nabnormalities in the side degenerative changes the skeleton is unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  No new pulmonary\nnodules masses or consolidations seen.\n\nImage portion of the upper abdomen demonstrate left kidney stone, series 2,\nimage 63 .  Sludge in the gallbladder is present.  No other abnormalities in\nthe image portion of the upper abdomen demonstrated",
            "output": "Stable appearance of the chest with no evidence of new pulmonary nodules O\nlocal or remote recurrence.\n\nLeft kidney stone.\n\nStatus post CABG with extensive calcifications of the native Coronary\narteries."
        },
        {
            "input": "No incidental thyroid findings.  No supra clavicular, infraclavicular or\naxillary lymphadenopathy.  Stable appearance of the heart after CABG.  Sternal\ndehiscence is stable.  No pericardial effusion.  No hilar or mediastinal\nlymphadenopathy.  The known gallstones are unchanged.  No abnormalities at the\nlevel of the adrenal glands.  No degenerative vertebral disease.  Stable\npostoperative changes at the right hilus.  No suspicious pulmonary nodules or\nmasses.  No pleural thickening, no pleural effusions, with the exception of\nminimal right basal pleural thickening that is stable.",
            "output": "Stable appearance of the thorax.  No at of recurrence."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate calcifications of the thoracic aorta. \nStatus post CABG.  Lack of sternal fusion.  No pericardial effusion.  No\nabnormalities in the upper abdomen, in particular there is no enlargement at\nthe level of the adrenal glands.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  The postoperative situs at the\nlevel of the right hilus is stable.  There is no evidence of recurrent\ndisease.  Expected postoperative scarring in the right lung parenchyma is\nstable.  No pleural abnormalities.  The airways are patent.",
            "output": "Stable examination of the thorax.  No evidence of recurrence."
        },
        {
            "input": "Images are degraded by respiratory motion artifact.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Moderate cardiomegaly with right atrial enlargement. \nThere is triple vessel coronary artery calcifications.  There is no\npericardial effusion.  There is mild atherosclerotic disease of the aortic\narch, also involving the great vessels.  The main pulmonary artery is normal\nin caliber, measuring 2.8 cm.\n\nAXILLA, HILA, AND MEDIASTINUM: There are multiple enlarged bilateral\nsupraclavicular, mediastinal and hilar lymph nodes.  Index nodes are provided\nas follows:\n- AP window, measuring 1.8 x 1.3 cm (301/64)\n- Subcarinal, measuring 1.3 x 1.3 cm (301/67)\n- Left hilar, measuring 1.9 x 1.2 cm (301/97)\n- Left supraclavicular, measuring 1.3 x 1.0 cm (30ddd1/19)\n\nThere is no axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusions or pneumothorax.\n\nLUNGS/AIRWAYS: There is extensive ground-glass and consolidative opacities and\ninterlobular septal thickening throughout both lungs, for which differential\nconsiderations include pulmonary edema, alveolar hemorrhage, or drug reaction.\nThere is moderate upper lobe predominant paraseptal emphysema.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is reflux of contrast into the hepatic veins.  Small hiatal\nhernia.  Status post cholecystectomy.  Included portion of the upper abdomen\nis otherwise unremarkable.\n\nBONES: No suspicious osseous abnormality or acute fracture.  There are\nmultilevel degenerative changes of the imaged spine.",
            "output": "1. Respiratory motion degraded images.  No evidence of pulmonary embolism to\nthe segmental level.\n2. Extensive ground-glass and consolidative opacities and interlobular septal\nthickening throughout both lungs.  Differential considerations include\npulmonary edema, alveolar hemorrhage or drug reaction.\n3. Moderate cardiomegaly with right atrial enlargement and reflux of contrast\ninto the hepatic veins, concerning for right heart dysfunction.\n4. Bilateral supraclavicular, mediastinal and hilar lymphadenopathy of\nindeterminate etiology.  While these could be reactive, lymphoproliferative\ndisease is unable to be excluded."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, and mediastinal lymph nodes\nare not enlarged. A right hilar lymph node measuring 1.3 cm is unchanged\ncompared to ___. Aorta and pulmonary arteries are normal size.\nCardiac configuration is normal and there is no appreciable coronary\ncalcification. No pericardial effusion. There are mild aortic plaques/ mural\nthrombus in the descending aorta, unchanged, without ulcerative plaque.\n\nThe airways are patent to the subsegmental level. Scarring at the lung apices\nis unchanged. A 2 mm left upper lobe nodule is unchanged compared to ___ (5, 110). A 2 mm left upper lobe nodule is unchanged compared to\n___ (5, 172).\n\nNo suspicious bony lesions.\n\nPlease refer to separate report for intra-abdominal findings.",
            "output": "No evidence for intrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum an at\nthe level of the hilar structures.  No coronary calcifications.  No\ncardiomegaly.  No valvular calcifications. The the posterior mediastinum shows\nthe known postoperative changes at the gastroesophageal junction. The upper\nabdomen is reported separately in a dedicated CT report.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  No pathologic changes\nat the level of the sternum and the ribs.\nMild bilateral apical scarring with several subpleural granulomas. Pre\ndescribed mostly subpleural millimetric micronodules are unchanged.  No\ngrowing or new nodules.  No diffuse lung disease.  No pleural thickening or\npleural effusions.  Mucosal accumulation in the trachea.  Mild irregularities\nand thickening of the airway walls, suggesting chronic airways disease. No\nevidence of metastatic thoracic disease.",
            "output": "No change in appearance as compared to the previous examination. All\nmillimetric micronodules are unchanged.  No evidence of suspicious or\nmetastatic lung nodules. No lymphadenopathy."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is minimal coronary calcification.\n\nAirways are patent to subsegmental levels bilaterally.  Biapical scarring is\nstable in appearance.  Multiple scattered millimetric pulmonary nodules are\nstable (series 6, image 45, 72, 111, 155).  No new pulmonary nodules or masses\nare present.  There is no evidence for pneumonia.  There is no pleural\neffusion or pneumothorax.\n\nPlease refer to concurrent CT abdomen pelvis report for discussion of findings\nin the upper abdomen.  No suspicious lytic or blastic lesion is present. \nSmall sclerotic foci in the T4 and T10 vertebral bodies is stable compared to\nthe prior study and consistent with bone islands.",
            "output": "1.  No findings concerning for gastric cancer recurrence in the chest.\n2. Stable millimetric pulmonary nodules."
        },
        {
            "input": "For details regarding the abdomen pelvis please see dedicated abdomen and\npelvis CT report dictated under clip ___\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nHeart, pericardium and great vessels are within normal limits. No hiatal\nhernia is present.\n\nBiapical scarring is unchanged. A calcified granuloma seen in the left upper\nlobe (06:17).  No pleural effusion or pneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "No evidence of intrathoracic malignancy. For details regarding the abdomen and\npelvis please see dedicated abdomen pelvis CT report"
        },
        {
            "input": "VASCULAR:\nRe-demonstration of the thoracic aortic stent graft in from the aortic arch to\nthe descending aorta to approximately the T10 vertebral body.  Descending\nthoracic aortic aneurysmal sac measures approximately 6.2 x 6.0 cm which is\nminimally decreased in size when compared to prior.\n\nThere is also redemonstration of an aortic bilateral iliac stent graft with\nadditional stent graft into the right common/external iliac artery.  The\ninfrarenal\nabdominal aortic aneurysm sac measures 6.1 x 3.8 cm which is significantly\ndecreased when compared to prior at 9.3 x 8.0 cm.\n\nAgain seen right common iliac aneurysm measuring up to 2.9 cm, similar to\nprior.\n\nPatient is status post coiling of the right internal iliac artery.  SMA and\nright renal artery stents are again seen.\n\nThere is a new surgical clip and a small volume fluid in the left groin,\nlikely postprocedural.\n\nCHEST:\nHEART AND VASCULATURE: Main pulmonary artery is of normal caliber.  The heart,\npericardium, and great vessels are within normal limits.  Coronary artery\ncalcifications are noted.  No pericardial effusion is seen.  Right PICC line\ntip is in the right axilla.  Right IJ central line tip mid SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small partially loculated left, trace right pleural effusions.\nNo pneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacities and micro nodules are seen in the\nposterior right upper lobe, right lower lobe, new since prior, consider\npneumonia or aspiration.  There is some right subsegmental bronchial mucous\nplugging.  There is mild right greater than left bibasilar atelectasis.\n\nBASE OF NECK: Patient is status post left hemithyroidectomy.  Poorly seen\nsubcentimeter hypodense nodule is again noted in the right thyroid lobe. \nInterval placement of an endotracheal tube with tip approximately 5 cm above\nthe carina.  Interval placement of an enteric tube with tip terminating in the\nregion of the stomach.  There is left chest wall tract from prior chest tube. \nPostoperative changes left lower ribs.\n\nABDOMEN:\nThere is a small amount of free air as well as a small amount of ascites. \nThese may be post surgical.\n\nHEPATOBILIARY: There are multiple hypodensities throughout the liver.  The\nlargest is within hepatic segment 8 and measures 4.8 x 3.9 cm.  These are\nbetter evaluated on the prior contrast enhanced exam and are likely to\nrepresent hepatic cysts.  There is no obvious intrahepatic or extrahepatic\nbiliary duct dilation.  The gallbladder is somewhat distended but is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic.  There is no main pancreatic dilation\nnoted.  Small volume fluid inferior to the pancreatic tail adjacent to\nsurgical suture line, likely postprocedural.  Consider pancreatitis if\nclinically appropriate.\n\nSPLEEN: Interval surgical removal of the spleen.\n\nADRENALS: The right adrenal gland is normal in size and shape.  Left adrenal\ngland is surgically absent.\n\nURINARY: Status post left nephrectomy.  Right kidney is of normal size. \nScattered hypodensities within the right kidney are not well evaluated on this\nnoncontrast exam.  Refer to prior contrast enhanced exam for further\nevaluation.  There is no right-sided hydronephrosis.\n\nGASTROINTESTINAL: There is a new left upper quadrant ostomy.  Interval\nresection of the sigmoid colon.  There is no evidence of obstruction.  There\nis edema noted within the bowel mesentery.  Small volume fluid is seen\nadjacent to the stomach.  Mild wall thickening few nondilated small bowel\nloops in the low pelvis.\n\nRETROPERITONEUM: There is retroperitoneal edema along the fascial planes\nassociated with recent surgical intervention.\n\nPELVIS: There is a Foley within the urinary bladder.  There is air within the\nurinary bladder.  There is a surgical drain coiled within the pelvis arising\nfrom the anterior midline abdominal wall.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with calcifications .\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are bilateral L5 pars defects with grade 1 anterolisthesis of L5 on S1,\nunchanged from prior.\n\nSOFT TISSUES: There are new surgical changes associated with the left lateral\nthoracic wall as well as the left anterior lower thoracic and abdominal wall. \nThere are screws and plates associated with 2 of the anterior lower left\nthoracic ribs.  Small fat only containing bilateral inguinal hernias.",
            "output": "1. Small volume fluid and several foci of free air, likely postsurgical. \nThere is no drainable collection.  Small volume fluid, mild stranding inferior\nto the pancreatic tail, left mesenteric, may be postsurgical, consider mild\npancreatitis if appropriate.  Mild wall thickening few nondilated small bowel\nloops in the low pelvis, may be reactive.\n2. Postsurgical changes are noted along the left lateral lower thoracic wall\nand along the left anterior lower thoracic wall and abdominal wall.  Partially\nloculated small left pleural effusion.\n3. There is a new left upper quadrant ostomy with a drain placed within the\npelvis.\n4. Minimal decrease in size of the descending thoracic aortic aneurysm sac and\nsignificant decrease in size of the abdominal aortic aneurysm sac.\n5. Scattered patchy ground-glass opacities, micro nodularity at the right\nupper, lower lobe may be due to aspiration.  Bibasilar atelectasis."
        },
        {
            "input": "VASCULAR:\nRe-demonstration of the thoracic aortic stent graft in from the aortic arch to\nthe descending aorta to approximately the T10 vertebral body.  Descending\nthoracic aortic aneurysmal sac measures approximately 6.2 x 6.0 cm which is\nminimally decreased in size when compared to prior.\n\nThere is also redemonstration of an aortic bilateral iliac stent graft with\nadditional stent graft into the right common/external iliac artery.  The\ninfrarenal\nabdominal aortic aneurysm sac measures 6.1 x 3.8 cm which is significantly\ndecreased when compared to prior at 9.3 x 8.0 cm.\n\nAgain seen right common iliac aneurysm measuring up to 2.9 cm, similar to\nprior.\n\nPatient is status post coiling of the right internal iliac artery.  SMA and\nright renal artery stents are again seen.\n\nThere is a new surgical clip and a small volume fluid in the left groin,\nlikely postprocedural.\n\nCHEST:\nHEART AND VASCULATURE: Main pulmonary artery is of normal caliber.  The heart,\npericardium, and great vessels are within normal limits.  Coronary artery\ncalcifications are noted.  No pericardial effusion is seen.  Right PICC line\ntip is in the right axilla.  Right IJ central line tip mid SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small partially loculated left, trace right pleural effusions.\nNo pneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacities and micro nodules are seen in the\nposterior right upper lobe, right lower lobe, new since prior, consider\npneumonia or aspiration.  There is some right subsegmental bronchial mucous\nplugging.  There is mild right greater than left bibasilar atelectasis.\n\nBASE OF NECK: Patient is status post left hemithyroidectomy.  Poorly seen\nsubcentimeter hypodense nodule is again noted in the right thyroid lobe. \nInterval placement of an endotracheal tube with tip approximately 5 cm above\nthe carina.  Interval placement of an enteric tube with tip terminating in the\nregion of the stomach.  There is left chest wall tract from prior chest tube. \nPostoperative changes left lower ribs.\n\nABDOMEN:\nThere is a small amount of free air as well as a small amount of ascites. \nThese may be post surgical.\n\nHEPATOBILIARY: There are multiple hypodensities throughout the liver.  The\nlargest is within hepatic segment 8 and measures 4.8 x 3.9 cm.  These are\nbetter evaluated on the prior contrast enhanced exam and are likely to\nrepresent hepatic cysts.  There is no obvious intrahepatic or extrahepatic\nbiliary duct dilation.  The gallbladder is somewhat distended but is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic.  There is no main pancreatic dilation\nnoted.  Small volume fluid inferior to the pancreatic tail adjacent to\nsurgical suture line, likely postprocedural.  Consider pancreatitis if\nclinically appropriate.\n\nSPLEEN: Interval surgical removal of the spleen.\n\nADRENALS: The right adrenal gland is normal in size and shape.  Left adrenal\ngland is surgically absent.\n\nURINARY: Status post left nephrectomy.  Right kidney is of normal size. \nScattered hypodensities within the right kidney are not well evaluated on this\nnoncontrast exam.  Refer to prior contrast enhanced exam for further\nevaluation.  There is no right-sided hydronephrosis.\n\nGASTROINTESTINAL: There is a new left upper quadrant ostomy.  Interval\nresection of the sigmoid colon.  There is no evidence of obstruction.  There\nis edema noted within the bowel mesentery.  Small volume fluid is seen\nadjacent to the stomach.  Mild wall thickening few nondilated small bowel\nloops in the low pelvis.\n\nRETROPERITONEUM: There is retroperitoneal edema along the fascial planes\nassociated with recent surgical intervention.\n\nPELVIS: There is a Foley within the urinary bladder.  There is air within the\nurinary bladder.  There is a surgical drain coiled within the pelvis arising\nfrom the anterior midline abdominal wall.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with calcifications .\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are bilateral L5 pars defects with grade 1 anterolisthesis of L5 on S1,\nunchanged from prior.\n\nSOFT TISSUES: There are new surgical changes associated with the left lateral\nthoracic wall as well as the left anterior lower thoracic and abdominal wall. \nThere are screws and plates associated with 2 of the anterior lower left\nthoracic ribs.  Small fat only containing bilateral inguinal hernias.",
            "output": "1. Small volume fluid and several foci of free air, likely postsurgical. \nThere is no drainable collection.  Small volume fluid, mild stranding inferior\nto the pancreatic tail, left mesenteric, may be postsurgical, consider mild\npancreatitis if appropriate.  Mild wall thickening few nondilated small bowel\nloops in the low pelvis, may be reactive.\n2. Postsurgical changes are noted along the left lateral lower thoracic wall\nand along the left anterior lower thoracic wall and abdominal wall.  Partially\nloculated small left pleural effusion.\n3. There is a new left upper quadrant ostomy with a drain placed within the\npelvis.\n4. Minimal decrease in size of the descending thoracic aortic aneurysm sac and\nsignificant decrease in size of the abdominal aortic aneurysm sac.\n5. Scattered patchy ground-glass opacities, micro nodularity at the right\nupper, lower lobe may be due to aspiration.  Bibasilar atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Stable appearance of thoracic aortic stent graft from\nthe aortic arch to the descending aorta with the sac measuring up to 6.1 cm,\nunchanged.  The heart, pericardium, and great vessels are within normal limits\nbased on an unenhanced scan. No pericardial effusion is seen.\n\nMain pulmonary artery is of normal caliber.  Coronary artery calcifications\nare noted.  No pericardial effusion is seen.  Right PICC line tip is in the\nright axilla.  Right IJ central line tip mid SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small bilateral pleural effusions have increased.  Left\npleural effusion is partially loculated.  No pneumothorax.\n\nLUNGS/AIRWAYS: Previously seen ground-glass opacities micro nodules in the\nposterior right upper lobe, right lower lobe were better seen on prior\nsecondary to motion seen today, and probable some interval resolution. \nBibasilar consolidations from atelectasis are mildly worsened bilaterally. \nMucous plugging in the right mainstem bronchus\n\nBASE OF NECK: Patient is status post left hemithyroidectomy.  Poorly seen\nsubcentimeter hypodense nodule is again noted in the right thyroid lobe. \nEndotracheal tube with tip above the carina.  Enteric tube with tip\nterminating in the stomach.  There is left chest wall tract from prior chest\ntube. Postoperative changes left lower ribs.\n\nABDOMEN: Please see the separately dictated report of the abdomen performed\nconcurrently.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are surgical changes associated with the left lateral\nthoracic wall as well as the left anterior lower thoracic and abdominal wall. \nThere are screws and plates associated with 2 of the anterior lower left\nthoracic ribs.",
            "output": "Interval increase in bilateral small pleural effusions, partially loculated on\nthe left.\nScattered ground-glass opacity and micro nodularity on the right is less\napparent, either from improvement or from motion seen today.\nWorsened bilateral lower lobe atelectasis.\nStable appearance of the thoracic aortic stent graft.\nAgain noted is the right PICC tip in the right axillary vein."
        },
        {
            "input": "Left thyroid is surgically absent.  There is no axillary, supraclavicular, or\nmediastinal adenopathy.  Heart size is normal.  There is no pericardial\neffusion.  Coronary artery calcifications and aortic valvular calcifications\nare moderate.  The pulmonary arteries are not dilated.  Please note this study\nis not optimized for the evaluation of pulmonary embolism.  A right IJ central\nvenous catheter ends in the low SVC.\n\nEndovascular stent graft present beginning at the level of the distal aortic\narch just beyond the takeoff of the left subclavian artery.  Stent graft is in\nplace without evidence of fracture.  Descending thoracic aortic aneurysm sac\nmeasures 6.0 x 6.1 cm, grossly unchanged compared to most recent prior chest\nCT.  Calcification is again noted along the medial aspect of the aneurysm sac.\n\nThe airways are grossly patent to the segmental level bilaterally.  There is a\nmoderate left and small right pleural effusion, similar to prior.  Again seen,\nis a small partially loculated component at the left lung base (series 2,\nimage 41).  There is associated bibasilar atelectasis.\n\nThe thoracic esophagus contains a nasoenteric tube.  Please see same-day\nexamination for details on intra-abdominal structures.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: There is no suspicious bony lesion.  There is\nno superficial soft tissue abnormality.",
            "output": "1. No significant change in appearance of thoracic component of a\nthoracoabdominal stent graft.  Stable descending thoracic aortic aneurysm sac\nmeasuring up to 6.1 cm.\n2. Moderate left and small right pleural effusions, with a small loculated\ncomponent at the left lung base, similar to prior.\n3. Unchanged bibasilar atelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The left thyroid is surgically absent.  The\nvisualized right thyroid is heterogeneous and nodular.  Supraclavicular and\naxillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There are moderate calcifications of the aortic valve.  There\nis no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  The patient is status post\nendovascular stent graft extending from just below the take-off of the left\nsubclavian artery to just superior to the left hemidiaphragm.  There is no\nevidence of stent fracture.  The descending thoracic aortic aneurysm sac\nmeasures 6.0 x 6.1 cm (304:114), unchanged from prior.  The main, right, and\nleft pulmonary arteries are normal caliber.  A right subclavian central venous\ncatheter terminates in the mid SVC, with no associated thrombus.\n\nPULMONARY PARENCHYMA AND PLEURA:   There is no evidence of infection or\nmalignancy.  There is no emphysema. There are moderate bilateral pleural\neffusions, partially loculated on the left, with associated bibasilar\natelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Endovascular aortic stent graft intact in the aneurysmal descending\nthoracic aorta.  Aneurysmal sac stable.\n2. Stable moderate, partially loculated small left pleural effusion.  Small,\nlayering right pleural effusion slightly larger.  Bibasilar atelectasis is\nstable.\n3. No new focal consolidations, lung abscesses, empyema, or other suggestion\nof intrathoracic infection.\n4. Please refer to separate report of CT Abdomen and Pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Patient is status post left\nhemithyroidectomy, without abnormality seen in the surgical bed.  The right\nthyroid lobe is heterogeneous and nodular.  There is no axillary or\nsupraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Postsurgical changes are seen in the imaged portion of the\nupper abdomen.  Please refer to separate report for same day CT abdomen pelvis\nstudy for detailed discussion of findings below the diaphragm.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy is seen.\n\nHILA: No hilar lymphadenopathy or mass is seen.\n\nHEART and PERICARDIUM: Heart size is normal.  Coronary artery calcifications\nare moderate.  Patient is status post aortic endovascular stent graft\nextending from just distal to the branch point of the left subclavian artery\nto just superior to the left hemidiaphragm.  There is no evidence of stent\nfracture.  The descending thoracic aortic aneurysm sac measures 6.7 x 5.7 cm\n(02:30), similar to prior.\n\nPLEURA: Moderate bilateral pleural effusions are again seen, similar to prior.\nNo pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: There is a small area of peribronchial ground-glass\nopacification at the right lung apex measuring up to 1.5 cm (304:83). \nCompressive atelectasis is seen adjacent to bilateral moderate pleural\neffusions, similar to prior.  No suspicious masses or nodules are seen.\n2. AIRWAYS:  The airways are grossly patent to the level of the segmental\nbronchi bilaterally.\n3. VESSELS:  Main pulmonary artery diameter is mildly enlarged at 3.3 cm\n(2:32).  Limited evaluation of the pulmonary vasculature demonstrates no\nevidence of central pulmonary embolism.\nCHEST CAGE: No acute fracture.  No worrisome osseous lesions are identified.",
            "output": "1. Small area of peribronchial ground-glass opacification at the right lung\napex, suspicious for a focus of infection.\n2. Moderate bilateral pleural effusions, with adjacent compressive\natelectasis, similar to prior.\n3. Dilatation of the main pulmonary artery of 3.3 cm, suggestive of pulmonary\narterial hypertension.\n4. Please refer to separate report for same day CT abdomen pelvis study for\ndiscussion of findings below the diaphragm.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:48 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Status post left lobe thyroid\nlobectomy.\nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: See accession number ___ for a dedicated concurrent Ct of\nthe abdomen and pelvis.\n\nMEDIASTINUM: There is no lymphadenopathy in the mediastinum or hila\nbilaterally.\n\nHEART and PERICARDIUM: There is no cardiomegaly and there is no pericardial\neffusion.\nSpecks of calcifications in the coronaries and aortic valve.\nPICC line terminating in the cavoatrial junction.\nAortic stent extending from the left subclavian artery origin to few cm above\nthe diaphragm.\nNo evidence of a stent fracture.\nNo clear evidence of endoleak although the study is not tailored for this\nspecific evaluation.\nThe excluded aorta measures up to 6.5 cm and is unchanged (5: 33).\n\nLUNG: Airways are patent to the subsegmental level bilaterally with minimal\nsecretions in the upper trachea.\nUnchanged bilateral layering small pleural effusions with adjacent passive\natelectasis.\nLeft pleural effusion is most probably partially loculated extending to the\nleft major fissure.\nThere is no clear evidence of pneumonia.\nNo evidence of pneumothorax.\nBilateral interlobular septal thickening with heterogeneous minimal\nground-glass opacity prominent in both upper lobes-minimal pulmonary\ncongestion.\nPlatelike subsegmental atelectatic changes in the right middle lobe.\n\nCHEST CAGE: Status post internal fixation of left anterior costochondral\njunction with unchanged small free bubbles of air and minimal quantity of\nfluid-could be infected, for clinical correlation.",
            "output": "Unchanged bilateral layering small pleural effusions with adjacent passive\natelectasis and signs of mild pulmonary congestion.\nThere are no signs of pneumonia.\nPossible infection of the left internal rib fracture internal fixation with\nbubbles of air and fluid surrounding it, for clinical correlation"
        },
        {
            "input": "VASCULATURE:Pulmonary arteries are normal in caliber with no filling defects\ndemonstrated in the central pulmonary arteries.The aorta is unremarkable\nwithout dissection or aneurysm. Great vessels are unremarkable.\n\nLUNGS/PLEURA: Apart from dependent atelectasis in both lower lobes, there is\nno evidence of concerning pulmonary parenchymal abnormality.  Scattered sub 6\nmm pulmonary nodules are re-demonstrated within both lower lobes and lingula\nand unchanged from the previous chest CT ___: 151, 168, 181, 183, 192, 199,\n201).  There is no pleural effusion or pneumothorax. The airways are patent to\nthe subsegmental level.\n\nMEDIASTINUM/HILA/AXILLA:  Heart is unremarkable.  There is no pericardial\neffusion. There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy. Included portion of the thyroid demonstrates a 12 mm left\nslightly hypodense thyroid nodule, as seen on the previous PET-CT.\n\nUPPER ABDOMEN: Included portion of the upper abdomen is unremarkable.  Patient\nis status post cholecystectomy.\n\nBONES/SOFT TISSUES: No lytic or blastic osseous lesion suspicious for\nmalignancy is identified. No acute fracture is seen.",
            "output": "1. No evidence for mass or infection.\n2. Unchanged 12 mm left hypodense thyroid nodule.  Per ACR criteria, this does\nnot require dedicated imaging follow-up.\n3. Unchanged scattered sub 6-mm pulmonary nodules and do not require dedicated\nimaging follow-up given interval stability."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are multiple prominent mediastinal lymph\nnodes measuring up to 10 mm in the subcarinal station, likely reactive. \nOtherwise, no axillary or hilar lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a dense consolidation in the anterior basal segment of\nthe right lower lobe, and a smaller dense consolidation in the lingula,\nconsistent with pneumonia.  Additionally, there are innumerable diffuse\nbilateral ___ peribronchovascular nodular opacities compatible with a\nwidespread infectious bronchiolitis.  Linear opacities at the lung bases\nlikely represent atelectasis.  There is bronchial wall thickening,\npredominantly in the lower lobes.  Otherwise, the airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Right lower lobe and lingular consolidations with diffuse bilateral\n___ nodularity, compatible with multifocal pneumonia with infectious\nbronchiolitis.\n2. No evidence of pulmonary embolism or acute thoracic aortic abnormality."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size within normal limits.  There are no coronary\ncalcifications.  No pericardial effusion.\nPLEURA: There is no pleural abnormality or pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  A left lower lobe subpleural pulmonary nodule or nodular\nscarring measures 12 x 7 mm is unchanged from ___.  There is mild atelectasis\nat the lung bases, bilaterally.  There is mild scarring in the right middle\nlobe.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: The superficial soft tissues are unremarkable.  No worrisome\nosseous lesions.",
            "output": "1.  Left lower lobe pulmonary nodule or nodular scarring, unchanged over 16\nmonths most likely but not definitely benign.\n2.  Please see CT abdomen and pelvis from the same date for assessment of the\nupper abdomen.\n\nRECOMMENDATION(S):  Chest CT in one year to assess stability of nodule left\nlower lobe lung lesion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Unchanged appearance of rounded\natelectasis in the lingula (5:171).  No new or growing lung nodules.  No\nconsolidations.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show diffuse hepatic steatosis and\nhyperenhancing hepatic nodules, previously described as hemangiomas in the\n___ MRCP.",
            "output": "Rounded atelectasis in the lingula, visualized in the abdominal CT from\n___ and stable since then.  No more follow-up is recommended."
        },
        {
            "input": "CTA CHEST WITH CONTRAST: There is no lymphadenopathy.  The esophagus is\ngrossly normal without hiatal hernia.\n\nHeart size is normal. There is no pericardial effusion. The aorta and main\nthoracic vessels are well opacified. The main pulmonary arteries are normal in\ncaliber and well opacified to the subsegmental level without pulmonary\nembolism.\n\nThere is no pleural effusion or pneumothorax. The tracheobronchial tree is\npatent to the subsegmental level. There is a 5 mm left upper lobe nodule\n(06:25), and more superiorly a 4 mm posterior nodule (6:7). There is a 3 mm\nnodule in the lingula (6:87).\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions.\n\nUPPER ABDOMEN: This study is not designed for evaluation of the\nsubdiaphragmatic structures, however the partially visualized solid organs and\npartially visualized stomach are grossly normal.",
            "output": "1. No pulmonary embolism or acute aortic syndrome.\n2. Several pulmonary nodules in the left lung, the largest 5 mm in the left\nupper lobe.\n\nRECOMMENDATION:  In the case of nodule size >4 - 6 mm: For low risk patients,\nfollow-up at 12 months and if no change, no further imaging needed. For high\nrisk patients, initial follow-up CT at ___ months and then at ___ months if\nno change\n\nNOTIFICATION:  WET READ:\n\n-No acute aortic abnormality or pulmonary embolus.\n-Solitary 5 mm perivascular nodule in the left apex, probably infectious or\ninflammatory. Followup CT is advised in 12 months for low risk patient and\n___ months for high-risk patients such as those with smoking history per\n___ society recommendations.\n The findings were discussed by Dr. ___ with Dr. ___ on the telephone on\n___ at 5:37 ___, 10 minutes after discovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\nregions.  No pericardial effusion.  No coronary calcifications, no valvular\ncalcifications, the posterior mediastinum is unremarkable.  No abnormalities\nare noted at the level of the upper abdomen, with the exception of a minimal\nrenal calcification on the left (2, 56) as well as small colonic diverticula.\n\nStability of a 4 mm left upper lobe nodule (4, 29).\nStability of a 2 mm subpleural left upper lobe nodule (4, 35).\nStability of a 3-4 mm left upper lobe nodule (4, 50).\nStability of a 2 mm nodule in the lingular (4, 109).\n\nNo pleural effusions.  No pleural thickening.  No diffuse lung disease.  The\nairways are patent.",
            "output": "Stability of all pre-existing pulmonary nodules.  If the patient is at the low\nrisk for lung cancer, no further CT followup is required, the recommendations\nof the ___ Society.\n\nRECOMMENDATION:  Stability of all pre-existing pulmonary nodules. If the\npatient is at the low risk for lung cancer, no further CT followup is\nrequired, the recommendations of the ___ Society."
        },
        {
            "input": "There is a tiny hypodensity in the right lobe of the thyroid. Supraclavicular,\naxillary, and hilar lymph nodes are not enlarged.  A pretracheal lymph node\nmeasures 1.4 cm is mildly increased from ___.  Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is mild\nappreciable coronary calcification.  There is no pleural or pericardial\neffusion.\nThere are no bone findings of malignancy.  Emphysema is moderate.\n\nMultiple pulmonary nodules are new or increased in size for example:\n\nA 4 mm subpleural left lower lobe nodule (series 7, image 269).\nA 3 mm partially solid ground-glass nodule in the left lower lobe (series 7,\nimage 138).\nA 2 mm perifissural nodule in the left lower lobe (series 7, image 110).",
            "output": "Multiple pulmonary nodules measuring up to 4 mm are new or increased in size\nfrom ___ and suspicious for malignancy.\n\nModerate emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Bilateral gynecomastia.\n\nUPPER ABDOMEN: There is cirrhotic liver morphology, partially visualized.  The\npatient is status post cholecystectomy.  The partially visualized spleen\nmeasures at least 17 cm, previously 16.2 cm on CT abdomen and pelvis from ___.  There are portosystemic collaterals in the upper abdomen.  There is\nat least moderate ascites.\n\nMEDIASTINUM: There are multiple prominent mediastinal lymph nodes, for example\na right paratracheal node measuring 1 cm in short axis.  These are likely\nreactive.\n\nHILA: Not well evaluated without IV contrast, but no gross lymphadenopathy.\n\nHEART and PERICARDIUM: Multi chamber dilation.  Mild proximal LAD\ncalcifications, possible circumflex calcifications.  No significant\npericardial effusion.\nPLEURA: There is a small left pleural effusion and trace right pleural\neffusion.\nLUNG:\n\n1. PARENCHYMA:  The right middle lobe is chronically atelectatic, but the\nlobar and segmental bronchi are patent.  There are multiple small patchy areas\nof ground-glass and nodular airspace consolidation in both lungs.  A few\nisolated nodular opacities, for example a 9 mm opacity in the left upper lobe\n(series 5, image 99) are likely inflammatory.  There is moderate bibasal\natelectasis.\n2. AIRWAYS:  The major airways are patent.\n3. VESSELS:  The pulmonary trunk is mildly dilated at 3.3 cm, which can be\nseen in pulmonary hypertension.\nCHEST CAGE: No aggressive bone lesion or acute fracture.",
            "output": "1. Mild bilateral patchy ground-glass and nodular airspace opacities are\nlikely inflammatory or infectious.  Follow-up CT chest could be obtained in 3\nmonths to confirm resolution.  Mildly prominent mediastinal lymph nodes are\nlikely reactive.\n2. Small free-flowing left pleural effusion.  Trace right pleural effusion.\n3. Findings of cirrhosis and portal hypertension with ascites on limited\nimages of the upper abdomen.\n\nRECOMMENDATION(S):  Follow-up CT chest in 3 months to confirm resolution of\nnodular airspace opacities."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Several borderline sized lymph nodes are seen in\nthe axillary region, as well as in the mediastinum and in the hilar areas. \nThere are overall unchanged.  Stable mild dilatation of the main pulmonary\nartery.  The left pleural effusion has moderately increased in size, the\nminimal the right pleural effusion is stable.  Hypertrophic breast tissue and\nascites as well as the known liver changes and splenomegaly are stable. \nStable appearance of the spine, the ribs and the sternum.  In the lung\nparenchyma, the pre-existing ground-glass opacities are now more consolidated,\nmore numerous, and more extensive.  Stable peripheral parenchymal opacities. \nThe airways continue to be patent.  No other changes are noted.",
            "output": "Progression of the multiple bilateral parenchymal opacities in both extent,\nnumber, and attenuation.  Increase in extent of the pre-existing left pleural\neffusion.  Overall, the findings and there evolution over time would be\nconsistent with organizing pneumonia.  Borderline sized lymph nodes are\nstable."
        },
        {
            "input": "Motion artifact degrades the diagnostic quality of the study.\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Right-sided PICC line in situ\nterminating in the cavoatrial junction.  Bilateral gynecomastia appear similar\ncompared to prior.\n\nUPPER ABDOMEN: Feeding tube in situ.  Cirrhotic morphology of the liver. \nPatient is status post cholecystectomy.  Sequela of portal hypertension in the\nform of mild ascites, splenomegaly and multiple portosystemic collaterals are\nagain noted.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes are decreased in size\ncompared to prior.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study. \nRight hilar adenopathy may be mildly improved.\n\nHEART and PERICARDIUM: Moderate aortic valve and mild coronary artery\ncalcification.  No substantial pericardial effusion.\nPLEURA: Right lower costal and diaphragmatic smooth circumferential pleural\nthickening appears fairly similar compared to prior.  No pleural calcification\nis previously noted trace right-sided pleural effusion and small left-sided\npleural effusion has resolved.\nLUNG:\n\n-PARENCHYMA:  The previously fairly diffuse ground-glass airspace\nopacification and consolidation has predominantly resolved with a few areas of\nfaint residual ground-glass opacity (series 5, image 71, 142, 97 and 169).  A\ncouple of millimetric nodules are nonsuspicious (for example series 5, image\n53).  Almost complete atelectasis of the right middle lobe is stable. \nSubpleural curvilinear atelectasis/scarring in the right lower lobe (series 5,\nimage 245) appear slightly improved.\n-AIRWAYS:  The major airways are patent.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal (34 mm)\nCHEST CAGE: No suspicious bony lesions.",
            "output": "1. Previously noted fairly diffuse ground-glass airspace opacification and\nconsolidation has predominantly resolved with a few areas of faint residual\nground-glass opacity.\n2. Previously noted small left and trace right pleural effusions have\nresolved.\n3. Near complete atelectasis of the right middle lobe is stable.\n4. Persistent right pleural thickening.\n5. Cirrhotic morphology of the liver with sequela of portal hypertension are\nagain noted."
        },
        {
            "input": "CTA CHEST: The pulmonary arteries are well opacified to the subsegmental\nlevel.  The main pulmonary trunk is normal in caliber.  There is no thoracic\naortic aneurysm.  There is mild atherosclerosis.  There is no aortic\ndissection.\n\nCHEST: Thyroid is notable for a millimetric hypodense right thyroid nodule,\nrequiring no specific followup.  There is no axillary, supraclavicular, or\nmediastinal adenopathy.\n\nPatient is post CABG.  Heart is mildly enlarged.  There is a small\nnonhemorrhagic pericardial effusion.\n\nThe airways are patent to the subsegmental level.  There is a small left\npleural effusion.  There is multifocal atelectasis involving the left greater\nthan right lower lobes, right upper lobe, and lingula.  No large pulmonary\nnodules are seen.  Limited evaluation for small pulmonary nodule due to\nrespiratory motion.\n\nThoracic esophagus is unremarkable.  Limited views of the upper abdomen are\nnormal.\n\nOSSEOUS STRUCTURES: Median sternotomy wires are intact.  There are no\nsuspicious bony lesions.  Superficial soft tissues are unremarkable.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Small pericardial and a small left pleural effusion.\n3. Multifocal atelectasis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits.  Trace simple fluid is seen in the pericardial recess\nanterior to the aortic arch.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Residual thymic tissue is seen in the anterior\nmediastinum.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrates several\nsubcentimeter hypodensities in the thyroid gland bilaterally measuring up to 7\nmm on the left.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume physiologic free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexa are unremarkable with multiple\nphysiologic ovarian cysts noted bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.  Reflux of contrast through distended\ngonadal veins are seen bilaterally with bilateral pelvic varices.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute traumatic injury within the torso.  No acute fracture.\n2. Multinodular thyroid gland.  Please see recommendations below.\n3. Dilated gonadal veins bilaterally with reflux of contrast and prominent\nbilateral pelvic varices.  Findings can be seen with pelvic congestion\nsyndrome in the correct clinical setting and clinical correlation is\nrecommended.\n\nRECOMMENDATION(S):  Thyroid nodule.  No ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "Scout view of this examination shows no definite change since the recent prior\nradiographs.\n\nHeart is borderline in size.  Mitral annulus is calcified.  Coronary artery\ncalcification is mild.  There is no pericardial effusion.  Aorta is normal in\ncaliber with mild atherosclerotic change.  Central pulmonary arteries are\nmildly enlarged.\n\nMedium-sized bilateral pleural effusions were partly imaged before and are\nprobably unchanged since the prior examinations.  No lymphadenopathy is\ndemonstrated in the chest.\n\nAt each lung base, opacities with volume loss in dependent areas are typical\nfor compressive atelectasis associated with bilateral pleural effusions. \nThere is mild bronchiectasis in the largely in the partly collapsed left lower\nlobe with heterogeneous attenuation which may in reflect some contribution by\ninfectious pneumonia, however. Mild vascular congestion and lesser areas of\nmultifocal atelectasis also identified in each lung.\n\nThe abdomen is reported separately.\n\nNo suspicious bone lesions are identified.  Changes associated with the renal\nosteodystrophy along the spine.",
            "output": "Pleural effusions with atelectasis.  Mild pulmonary edema.  Possible component\nof pneumonia within partly atelectatic left lower lobe, however."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma..  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  There is a prominent 1.3 cm\nleft epiphrenic/epicardial lymph node (2:70, 601:18) with adjacent cluster of\nlikely small lymph nodes just lateral to this.\n\nPLEURAL SPACES: There is a moderate size left pleural effusion.  No right\npleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is compressive atelectasis of the left lower lobe\nadjacent to an underlying pleural effusion.  There is a 1.1 cm left lower lobe\npulmonary nodule on series 2, image 63..  Punctate lateral right middle lobe\ncalcified granuloma.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\n\nSOFT TISSUES: There are flame like bilateral subareolar soft tissue densities\nare consistent with gynecomastia.\n\nABDOMEN: There is large volume abdominal ascites.  In addition, there is\nevidence of periumbilical abdominal varices (2:97, 601:12).  The liver is\nsomewhat shrunken and nodular consistent with cirrhosis.  The partially imaged\nspleen is enlarged, likely related to portal hypertension.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Moderate left pleural effusion with associated compressive atelectasis.\n3. 1.1 cm left lower lobe pulmonary nodule\nFor incidentally detected single solid pulmonary nodule bigger than 8mm, a\nfollow-up CT in 3 months, a PET-CT, or tissue sampling is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n4. Hepatic cirrhosis and sequela of portal hypertension including enlarged\npartially imaged spleen, ascites, and varices, including patent umbilical vein\nand paraesophageal varices.\n5. Left epiphrenic/epicardial lymphadenopathy.\n\nNOTIFICATION:  Additional findings and recommendation of the 1.1 cm left lower\nlobe pulmonary nodule were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:17 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart is\nnot enlarged.  Aortic valvular and mitral annular calcifications are mild. \nThere are moderate to severe coronary arterial calcifications, worst in the\nleft anterior descending artery.  No pericardial effusion is seen.  There are\nmoderate to severe atherosclerotic calcifications at the origin of the right\nsubclavian artery.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes measuring up to 0.8 cm\nin short axis in the prevascular station (2:23) are not pathologically\nenlarged by CT size criteria and are grossly unchanged in appearance as\ncompared to outside hospital CT chest ___.  There is no axillary or\nsupraclavicular lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung bases is limited due to degradation from\nrespiratory motion.  There is parenchymal scarring in the bilateral lung\napices. There is ground-glass opacity and consolidation in the apical segment\nof the right upper lobe. There is a small area of ground-glass opacity in the\nleft upper lobe (4:103).\n\nThere are areas of mucous plugging in the bilateral central airways and mucous\nplugging in the segmental and subsegmental airways of the bilateral lower\nlobes.  There is central and lower lobe predominant bronchiectasis with areas\nof mucous plugging in the right middle lobe and subsequent collapse of the\nlateral segment of right middle lobe, unchanged as compared to ___.\n\nBASE OF NECK: Hypoattenuated nodule in the left lobe of the thyroid measuring\nup to 0.6 cm across maximal diameter (2:3) is grossly unchanged in size as\ncompared to ___.\n\nABDOMEN: There is a small hiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is a chronic fracture along the lateral aspect of the fifth right rib\n(4:82).",
            "output": "1. Ground-glass opacities and consolidation in the right upper lobe and\nground-glass opacity in the left upper lobe, likely representing pneumonia.\n2. Central and lower lobe predominant bronchiectasis with associated mucous\nplugging, minimally changed as compared to outside hospital CTA chest ___, nonspecific in etiology but could represent allergic bronchopulmonary\naspergillosis.\n3. Segmental right middle lobe collapse secondary to mucous plugging in the\nsegmental airways, unchanged from ___."
        },
        {
            "input": "AIRWAYS: There is an 11 mm air containing pocket chest to the right\nposteromedial aspect of the upper trachea which was present on the prior\nstudies and most likely represents a small tracheal diverticulum.  The airways\nare otherwise patent.\n\nMEDIASTINUM: Patient is status post esophagectomy and gastric pull-up. \nMediastinal drain is in place from a right lateral chest wall approach.  Note\nis again made of a focal outpouching along the medial aspect of the\nanastomosis at the level of the carina (series 601, image 30) measuring\napproximately 15 mm in maximal dimension.  There is retained barium within\nthis pocket from the prior upper GI study.  There is otherwise normal passage\noral contrast through the conduit and into the distal stomach.\n\nLUNGS: There are atelectatic changes in the lung bases bilaterally.  2 x 1.1\ncm pocket of fluid in the right lung base (series 2, image 47) partially\nprojects within the lung parenchyma on axial images but on the coronal\nreformats appears to be tracking from the subpleural space (601:44).  There is\notherwise no focal airspace consolidation.\n\nPLEURA: There are multiple small pockets of loculated pleural fluid within the\nright posterior pleural space and along the minor and major fissures.  The\nlargest pocket along the minor fissure measures 5 x 4.6 x 2.3 cm.  There is no\nassociated rim enhancement to suggest an empyema.  Trace left pleural effusion\nnoted.\n\nLower neck: Right IJ central venous catheter is partially included in the\nfield of view with the tip in the lower SVC.\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.\n\nHEART and VASCULATURE:  No pericardial effusion.\n\nCHEST WALL: unremarkable\n\nUPPER ABDOMEN: Please refer to separate report for CT abdomen/pelvis.\n\nBONES: Right thoracotomy defect noted.  No aggressive bone lesions identified",
            "output": "1. Focal outpouching close to the anastomosis at the level of the carina\ncorrespond to the extraluminal contrast seen on upper GI study.  This would\nnot be a typical appearance for the esophagogastric anastomosis and remains\nsuspicious for a contained anastomotic leak.\n2. Bibasilar atelectasis.  No convincing heterogenous enhancement to suggest\nsuperimposed pneumonia..Small pockets of loculated pleural fluid within the\nright posterior pleura and along the minor and major fissures."
        },
        {
            "input": "NG tube passes through the proximal esophagus and then at the area of\nanastomosis, and then goes most centrally and terminates in the mediastinum\nmost likely outside of the neo esophagus and the location we previously\ncontrast collection was demonstrated, series to image 26.  The appearance of\nthe new esophagus is similar to previous examination.  Bilateral pleural\neffusion and loculated collections on the right are similar in size associated\nwith bibasal consolidations.  Left upper lobe opacities and apical opacities\nare new and might potentially represent new infectious process in the left\nupper lobe.  Extensive secretions in the airways are in favor of the same\nabnormality\n\nNo new lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Mediastinal/pleural drain tube located more inferiorly in the\nmediastinum on the current study as before terminating at the level of left\ninferior pulmonary vein as opposite to aortic arch on the previous\nexamination.\n\nPlease review CT abdomen and pelvis that will be reported separately and the\ncorresponding report.",
            "output": "NG tube terminates most likely outside of the esophagus in the mediastinum and\nshould be withdrawn\n\nNo discrete collection is demonstrated but might be drain by the NG tube.\n\nNew left upper lobe opacity concerning for infectious process.  Bibasal\nconsolidations and loculated pleural effusion on the right similar to previous\nexamination.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:08 am, 25 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation of the lingular vasculature is mildly\nlimited by cardiac and respiratory motion, making assessment of subsegmental\npulmonary arterial branches in this region suboptimal.  No evidence of\npulmonary embolism is seen elsewhere.  There is mild enlargement the main,\nleft, and right pulmonary arteries suggestive of pulmonary arterial\nhypertension.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  There is mild cardiomegaly.  There is a\ncommon origin of the right brachiocephalic artery and the left common carotid\nartery, a normal anatomic variant.  There is moderate coronary arterial\ncalcification.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Low lung volumes cause diffuse patchy ground-glass opacities\nand areas of subsegmental atelectasis, which limits sensitivity for small\npulmonary nodules.  There is no focal consolidation or interlobular septal\nthickening to suggest pneumonia or pulmonary edema, respectively.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK:  1.3 cm hypodensity in the right lobe of the thyroid is seen,\nwhich does not meet the ACR size criteria for specific followup.\n\nABDOMEN:  Included portion of the upper abdomen is notable for probable\nhepatic steatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nEvidence of DISH is seen along the thoracic spine.",
            "output": "1. Exam is mildly limited by low lung volumes causing diffuse ground-glass\nopacities in areas of subsegmental atelectasis.  Respiratory motion also\nlimits assessment of subsegmental lingular branches.\n2. Within these confines, no evidence of pulmonary embolism to the\nsubsegmental level or evidence of acute aortic abnormality.\n3. Enlargement of the pulmonary arteries bilaterally suggests underlying\npulmonary hypertension.\n4. Mild cardiomegaly and mild to moderate coronary arterial calcification.\n5. Probable hepatic steatosis."
        },
        {
            "input": "A spiculated 16 mm x 11 mm diameter lung nodule in the inferior segment of the\nlingula corresponds to the recent chest radiographic finding (image 198,\nseries 5). The nodule contains a prominent air bronchograms, and is associated\nwith pleural tags extending to the major fissure posteriorly and to the\nperipheral pleural surface laterally.\n\nWithin the left upper lobe, a second nodule is identified, with ground-glass\nattenuation and irregular margins. It measures 13 mm x 10 mm (image 126,\nseries 5). A 5 mm diameter ground-glass nodular opacity is also observed at\nthe right apex ___, 5). A 3 mm right upper lobe ground-glass nodule is also\ndemonstrated (140, 5)\n\nRight middle lobe scarring and volume loss are associated with varicoid\nbronchiectasis in this lobe. Minimal cylindrical bronchiectasis is also\npresent in the left lower lobe.\n\nThyroid gland is heterogeneous and is been more fully evaluated by a recent\nthyroid ultrasound. There are no enlarged mediastinal lymph nodes. Assessment\nof hilar nodes is suboptimal on this unenhanced study, but there is no bulky\nlymphadenopathy in this region. Main pulmonary artery is enlarged at 3.3 cm.\nHeart size is normal, and there is no pericardial or pleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but focal\ncalcifications in the right adrenal gland as well as mild adrenal thickening\nappears similar to older abdominal CT dating back to ___. Note is\nalso made of previous cholecystectomy procedure.\n\nThere are no suspicious lytic or blastic skeletal lesions within the thorax.",
            "output": "1. 16 mm spiculated lingular nodule is highly concerning for primary lung\ncancer, most likely adenocarcinoma subtype.\n\n2. 13 mm ground-glass left upper lobe lung nodule is concerning for a\nsynchronous primary lung neoplasm within the adenocarcinoma spectrum, such as\nadenocarcinoma in situ (AIS). 5 mm and 3 min right upper lobe ground-glass\nnodule may represent atypical adenomatous hyperplasia or AIS.\n\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 11:17 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nThere is no pericardial or pleural effusion.  Image portion of the upper\nabdomen reveals no appreciable abnormality.  The patient is after\ncholecystectomy.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nground-glass opacity, 11 mm in diameter is stable.  Right upper lobe nodule,\nseries 5, image 19, 3.5 mm in diameter is stable.  Right upper lobe\nground-glass opacity, 5 mm in diameter is unremarkable.  Bronchiectasis in the\nright middle lobe of within normal limits.  Left lower lobe ground-glass\nnodule, series 5, image 114 is stable.  There is unremarkable appearance after\nlingula ectomy with sutures and a adjacent soft tissue most likely\nrepresenting scarring.  Ground-glass opacity in the left upper lobe, series 5,\nimage 94 is demonstrated, and unclear if represent previously seen left upper\nlobe ground-glass, series 5, image 129 on the previous examination or\nunrelated.  Currently it appears to be 15 mm in diameter but the comparison is\nsub optimal giving the substantial change in the location of the ground-glass\nopacity as compared to previous study.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall unremarkable appearance after lingula ectomy.  Ground-glass opacity in\nthe left upper lobe, potentially representing previously seen left upper lobe\nground-glass opacity, reassessment in 3 months is recommended.\n\nStable pulmonary nodules\n\nRight middle lobe bronchiectasis.\n\nSeveral stable pulmonary nodules."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta is normal in size. The main and right pulmonary arteries are dilated\nto 3.3 cm and 2.7 cm, respectively.  The heart is normal in size and\ndemonstrates no appreciable coronary artery calcifications. There is trace\npericardial effusion.  In addition, a 2.1 x 1.2 cm region of soft tissue\ndensity material is noted in  the apical pericardium (03:37), which has\nincreased in conspicuity and size as compared to the past several\nexaminations.\n\nThe patient is status post lingulectomy with expected postoperative changes. \nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Bronchiectasis in the right middle lobe is unchanged.\nMild diffuse bronchial wall thickening is suggestive of chronic airways\ndisease.\n\nA 1.9 x 0.8 cm ground-glass opacity in the left upper lobe (5:92) is somewhat\nmore conspicuous and increased in size from the prior examination.  Multiple\nadditional ground-glass opacities an pulmonary nodules are stable (05:35, 84,\n111, 117).  No new suspicious pulmonary nodule or mass is identified.\n\nNo suspicious osseous lesions are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents. Within this limitation, the included portions of the upper abdomen\ndemonstrate subcentimeter hepatic hypodensities which are unchanged, and too\nsmall to characterize but likely cysts. The patient is status post\ncholecystectomy.",
            "output": "1.  Increased size of a now a 1.9 x 0.8 cm left upper lobe ground-glass\nopacity, concerning for active malignancy in the adenocarcinoma spectrum.\n2.  Stable appearance of numerous additional solid nodule and ground-glass\nopacities, unchanged from ___. No new suspicious pulmonary nodule or\nmass.\n3.  Increasing size and conspicuity of a now 2.1 x 1.2 cm soft tissue density\nin the apical pericardium.  This finding is of indeterminate clinical\nsignificance, but is concerning for malignancy given the history of lung\ncarcinoma in the resected, adjacent lingula.\n4.  Mild dilation of the main and right pulmonary arteries, compatible with\npulmonary arterial hypertension.\n\nRECOMMENDATION(S):  Echocardiography, for first imaging reevaluation of\npericardial soft tissue lesion.\\\nInvestigation either by needle biopsy or resection of growing left upper lobe\nlung lesion."
        },
        {
            "input": "A right thyroid nodule.  Is unchanged.  Aorta and pulmonary arteries are\nunchanged including mild dilatation of main pulmonary artery.  Heart size is\nnormal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen is unremarkable.  The patient is after\ncholecystectomy.\n\nAirways are patent to the subsegmental level bilaterally.  Minimal still into\nbronchiectasis in the right middle lobe, series 4, image 147 are unchanged and\nwith no evidence of infection.\n\nPost resection appearance of the left upper lung, series 2, image 33 is\nunchanged.  Right upper lobe ground-glass nodule, series 4, image 51 is 8 mm,\nminimally smaller than 9 mm on the previous study.  Left upper lung part are\nsurgical ground-glass opacity is currently 19 x 7 mm as compared to 19 x 8 mm,\nalso minimally smaller.  No new nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest after lingula ectomy.  No change in the\nstill suspicious left upper lobe ground-glass opacity.\n\nDilatation of the main pulmonary artery, unchanged consistent with pulmonary\nhypertension.\n\nResolution of previously seen pericardial apical opacity consistent most\nlikely with fluctuating pericardial effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged portions of the inferior\nthyroid are unremarkable.  There is no supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Visualized upper abdominal structures are unremarkable, noting\nthat this study is not tailored for subdiaphragmatic evaluation.\n\nMEDIASTINUM: There are numerous small to borderline mediastinal lymph nodes\nmeasuring up to 1 cm in short axis, likely reactive.  There is no mediastinal\nmass.\n\nHILA: There is no bulky hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is a small\npericardial effusion.\nPLEURA: There is a left basilar chest tube in place.  There is gas and a small\namount of complex fluid in the left pleural space.  There is no right pleural\neffusion.\nLUNG:\n\n1. PARENCHYMA:  Areas of consolidation in the left lower lobe, and to a lesser\nextent in the lingula and left upper ___ represent atelectasis and/or\npneumonia.  There the right lung is clear. There is no suspicious nodule or\nmass in the aerated lungs.\n2. AIRWAYS:  The central airways are patent.\n3. VESSELS:  There are no atherosclerotic calcifications of the thoracic\naorta.  There is no thoracic aortic aneurysm.  The main pulmonary artery is\nnormal in caliber, measuring 2.7 cm.\nCHEST CAGE: There is no suspicious osseous lesion or acute fracture.",
            "output": "1.  Left basilar chest tube in place.  Small amount of gas and complex fluid\nin the left pleural space.\n2.  Areas of consolidation in the left lower lobe, and to a lesser extent in\nthe lingula and left upper lobe, which may represent atelectasis and/or\npneumonia.\n3.  Numerous small to borderline mediastinal lymph nodes, likely reactive."
        },
        {
            "input": "CHEST:\n\nMEDIASTINUM: There is a nodule in the right lobe of the thyroid gland.  There\nis no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The\naorta and pulmonary arteries are normal in size.   The heart size is normal\nand there is no pericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  There are no concerning pulmonary\nnodules.\n\nABDOMEN:\n\nGENERAL:  There is no abdominal wall defect.  There is no ascites.  There is\nno intra- or retroperitoneal fluid collection.  There is no peritoneal\nthickening.\nHEPATOBILIARY:  The liver enhances homogeneously. There are no concerning\nfocal hepatic lesions.  The intrahepatic and extrahepatic bile ducts are\nnormal in caliber. The gallbladder appears normal and there are no gall\nstones.\nPANCREAS:  The pancreas appears normal.  There are no concerning focal\npancreatic lesions.  No peripancreatic fluid collection is present.  There are\nno signs of inflammation.\nSPLEEN:  The spleen enhances normally.  There is no concerning focal\nabnormality.  There is no splenomegaly.\nADRENALS:  There are no adrenal nodules.\nKIDNEYS:  Renal corticomedullary enhancement is normal bilaterally.  There are\nno concerning solid lesions.  There are no stones.  There is no hydronephrosis\nor hydroureter.  There is a 1.7 cm simple cyst in the right kidney.\nGASTROINTESTINAL:  The stomach appears normal.  There is no evidence of bowel\nobstruction.  The small and large bowel enhance normally.  There is no diffuse\nor focal wall thickening.  There is no mass.  There is no evidence of\ninflammation such as mural edema or mesenteric fat stranding.  There is no\nintraperitoneal fluid collection.\nLYMPH NODES:  There is no lymphadenopathy identified in the abdomen or pelvis.\nVASCULAR:  The abdominal aorta and its main branches are patent.  There is no\naneurysm or dissection.  The IVC is normal.  The main portal vein and its\nfirst order intrahepatic branches are patent.\n\nPELVIS:\n\nThere is no pelvic or inguinal lymphadenopathy.  There is trace simple free\nfluid in the pelvis, which is a normal the patient is premenopausal.\nGENITOURINARY:  The urinary bladder and distal ureters are unremarkable. \nFibroid uterus is noted..\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture.  There are no destructive osseous lesions\nconcerning for malignancy or infection.  There are no soft tissue masses.",
            "output": "1. No evidence of acute traumatic injury to the chest, abdomen, or pelvis.\n2. Thyroid nodule in the right lobe which should be correlated with prior\nexaminations or assessed with outpatient ultrasound."
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is no mediastinal\nhematoma.  There is no pericardial effusion.  There is no lymphadenopathy.  A\nsmall amount of residual thymic tissue is seen in the anterior mediastinum. \nThe imaged thyroid is normal.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  Airways\nare patent to the subsegmental level.  There is no evidence of contusion or\nlaceration.  There is no pneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  The gallbladder, pancreas, and\nadrenals are unremarkable.  The kidneys enhance symmetrically and excrete\ncontrast promptly without focal lesion or hydronephrosis.  There is no\nevidence of renal or collecting system injury.  The abdominal aorta is normal\nin course and caliber with widely patent major branches.  No lymphadenopathy,\nfree air, or free fluid.\n\nA small hiatal hernia is present.  Stomach is otherwise unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is normal.  The bladder is unremarkable.  There is no pelvic free\nfluid.  The prostate and seminal vesicles are normal.\n\nBONES:  There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES:  There is a superficial laceration posteriorly overlying the\nleft ninth through eleventh ribs with extensive subcutaneous emphysema,\ncompatible with provided history of a stab wound to this area.  However, there\nis no evidence of osseous or pleural-parenchymal injury in this region.",
            "output": "1.  Superficial laceration with extensive subcutaneous emphysema posteriorly\noverlying the region of the left ___ ribs, compatible with provided\nhistory of a stab wound to this area.  No evidence of underlying osseous or\npleural-parenchymal injury in this region.  No pneumothorax.\n2.  No sequelae of trauma in the abdomen or pelvis.\n3.  Small hiatal hernia."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Heart size is mildly enlarged.  No pericardial\neffusion.  The thoracic aorta is normal in caliber.  No evidence of thoracic\naortic dissection, aneurysm, or penetrating atherosclerotic ulcer formation. \nCalcified atherosclerosis of the thoracic aorta and coronary arteries is\nsevere.  The main pulmonary artery is normal in caliber.  No pulmonary embolus\nto the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  There are small\ncalcified pleural plaques raising the possibility of asbestos exposure.\n\nLUNGS/AIRWAYS: There is diffuse bronchial wall thickening with scattered\nsubsegmental mucous impaction.  There is moderate centrilobular pulmonary\nemphysema.  There is mild peripheral age-related fibrosis.  There are few\nscattered micro nodules.  No consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  No intrahepatic biliary ductal\ndilation.  Common hepatic and bile duct dilation is unchanged, a finding\nsometimes seen status-post cholecystectomy.  The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA right upper pole simple cyst is better assessed on same-day MRCP.  No\nevidence of focal lesions.  Symmetrically prominent collecting systems may be\nrelated to significant bladder distention.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia.  Patient appears\nstatus-post Roux-en-Y gastric bypass.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  There is severe\ndiverticulosis without focal wall thickening or adjacent fat stranding.  The\nappendix is normal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder is distended and otherwise unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: No adnexal mass identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe atherosclerotic\ndisease is noted.  There is a calcified infrarenal aortic dissection flap\nextending for approximately 2.7 cm.  The false lumen is patent.  There is\nsevere calcification at the origins of all major visceral arteries, which are\notherwise patent.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There are mild thoracic and lumbar spine degenerative changes\nincluding a posterior disc bulge at L4-L5 resulting in mild-to-moderate spinal\ncanal narrowing.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unchanged focal dissection along a 2.7 cm segment of the infrarenal\nabdominal aorta.  Severe calcified atherosclerosis which involves the origins\nof all major visceral arteries, which are otherwise patent.\n2. Common bile duct and hepatic duct dilation is better assessed on same-day\nMRCP, probably related to prior cholecystectomy.\n3. Small airway inflammation.\n4. Incidental findings include a moderate hiatal hernia and diverticulosis."
        },
        {
            "input": "A 10 mm right thyroid nodule is seen, series 4, image 23.  There is no\naxillary, or supraclavicular lymphadenopathy.  Mildly prominent mediastinal\nlymph nodes are seen measuring up to 0.9 cm.  There is no hilar\nlymphadenopathy.  Heart size is normal.  There is no pericardial effusion. \nMild coronary calcifications are seen.  The esophagus is normal without\nevidence of wall thickening or a hiatal hernia.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nGround-glass nodularity seen within the superior segment of the right lower\nlobe, series 4, image 108 spanning approximately 7 mm.  Additional subtle\nground-glass changes are seen within the lingula as well as the left lower\nlobe, series 4, image 158.  Mild diffuse centrilobular ground-glass nodularity\nis seen within the left lower lobe.  There is no pleural effusion or\npneumothorax.",
            "output": "-Subtle ground-glass changes within the lingula, right lower lobe and left\nlower lobe could be infectious/inflammatory in etiology.  Recommend\ncorrelation with outside hospital imaging for evaluate for interval changes.\n-Mild diffuse centrilobular ground-glass nodularity within left lower lobe\ncould be seen in setting of respiratory bronchiolitis.\n-No evidence of lymphadenopathy.  Mild prominent mediastinal lymph nodes are\nseen measuring up to 9 mm.\nRECOMMENDATIONS:\n\nRecommend correlation with outside hospital imaging to evaluate for interval\nchanges."
        },
        {
            "input": "The thyroid gland is unremarkable. Multiple nonspecific mildly enlarged\nmediastinal lymph nodes are seen, including a representative left lower\nparatracheal lymph node which measures 2.1 x 1.3 cm (3, 18).  A few of these\nnodes contain punctate coarse calcification.\n\nThere is cardiomegaly with multichamber enlargement and extensive coronary\nartery and aortic valve calcifications. There is no pericardial effusion. The\nmain pulmonary artery is dilated measuring up to 3.8 cm in greatest transverse\ndimension. The thoracic aorta is not enlarged, but is moderately involved with\natherosclerotic disease; a partially calcified atheroma is found in the\nproximal right subclavian artery.\n\nEvaluation of the lungs demonstrates new patchy ground-glass opacities\nscattered diffusely throughout the lungs. This is superimposed on diffuse\nperipheral interlobular septal thickening with peripheral cyst formation and\nmild diffuse traction bronchiectasis. There are new trace right and small left\npleural effusions. No central endobronchial lesion is identified.\n\nImages of the upper abdomen demonstrate small layering high-density material\nwithin the gallbladder, which may represent milk of calcium versus vicarious\nexcretion of previously administered intravenous contrast. There is also a\nsmall hiatal hernia and diffuse fatty infiltration of the pancreas.\n\nThe visualized bones demonstrate generalized osteopenia, and age-indeterminate\nmild compression deformities involving the superior endplates of the T3 and\nT12 vertebral bodies.",
            "output": "Mild acute CHF produces mild pulmonary edema and trace right and small left\npleural effusions.\n\nModerate UIP pattern pulmonary fibrosis.\n\nPulmonary hypertension.\n\nSmall hiatal hernia.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 11:20 AM, 5 minutes after discovery of the findings."
        },
        {
            "input": "The thyroid gland is unremarkable. Multiple nonspecific partially calcified\nmildly enlarged mediastinal lymph nodes are stable.\n\nThere has been interval placement of a ___ catheter which extends into\nthe left lower lobe segmental pulmonary artery. Cardiomegaly with multichamber\nenlargement and dense coronary artery calcifications is unchanged. The main\npulmonary artery is again dilated measuring 3.7 cm.  Dense coronary artery\ncalcifications is unchanged. There is no pericardial effusion.\n\nEvaluation of the lungs demonstrates interval worsening of diffuse bilateral\nground-glass opacities superimposed on stable chronic fibrotic changes. The\ntrace right pleural effusion has resolved, and the left pleural effusion has\ndecreased in size.\n\nImages of the upper abdomen redemonstrate mild diffuse fatty infiltration of\nthe pancreas, and decreased layering density material within the gallbladder,\nwhich may be due to sludge, milk-of-calcium, or vicarious excreted contrast. \nA small hiatal hernia is again noted.\n\nEvaluation the bones demonstrate mild degenerative changes, including stable\ncompression deformities at T3 and T12, and marked is thoracic spine kyphosis.",
            "output": "Interval worsening of diffuse bilateral ground-glass opacities which are\nlikely due to worsening edema.\n\nStable pulmonary fibrosis.\n\nStable pulmonary hypertension with ___-Ganz catheter in place terminating in\na left lower lobe pulmonary artery.\n\nInterval resolution of trace right and decreased now small left pleural\neffusions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Soft tissue density in the anterior mediastinum\nreflects residual thymus.\n\nPLEURAL SPACES: There is trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There are extensive consolidative and ground-glass opacities\nwith air bronchograms and atelectasis throughout the left lower lobe.  The\nlungs are otherwise well inflated and clear.  There is scattered segmental and\nsubsegmental mucous impaction in the left lower lobe.  The remaining airways\nare patent to the subsegmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Left lower lobe pneumonia with a trace pleural effusion.  Scattered areas of\nmucous impaction in the left lower lobe bronchi.  No central obstructing\nlesion identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  Supraclavicular\nand axillary lymph nodes are nonenlarged.\n\nUPPER ABDOMEN: Partially visualized.  Study demonstrates subtle fat stranding\nsurrounding the pancreatic head which is slightly full in appearance.  A 2.2 x\n1.5 cm node along the gastro hepatic ligament.  Additional visualized solid\norgans are unremarkable on this noncontrast study.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: The heart is normal in size.  Trace pericardial\neffusion is physiologic.  Mild coronary artery calcifications involving the\nleft anterior descending artery.  The ascending aorta is normal in caliber\nwithout aneurysmal dilatation.  Minimal atherosclerotic calcifications are\npresent.\n\nPLEURA: No pleural effusion, pleural calcifications, or irregular pleural\nthickening.  No pneumothorax.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleuroparenchymal scarring is noted.  No pulmonary\nmass, nodule, or consolidation.\n-AIRWAYS:  The airways are patent to the subsegmental level.  No bronchial\nwall thickening or bronchiectasis.\n-VESSELS:  Main pulmonary artery is normal in caliber.\nCHEST CAGE:  Visualized soft tissues are unremarkable.  No focal lytic or\nblastic lesions worrisome for malignancy.  No acute fracture.  Mild\ndegenerative changes of the thoracic spine with small anterior osteophytes,\nendplate sclerosis and disc space narrowing.  1.6 x 0.5 cm T6 hemangioma is\npresent.",
            "output": "1.  No intrathoracic evidence of malignancy.\n2.  Mild coronary artery calcifications involving left anterior descending\nartery.\n3.  Subtle fat stranding and fullness of pancreatic head, secondary to known\npancreatic duodenal adenocarcinoma.  2.2 cm necrotic node along gastrohepatic\nligament.  These findings have presumably been investigated on a prior CT\nexamination, which was not available at ___ PACS at time of this\ninterpretation."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: A 10 mm right hilar lymph node is moderately increased in size in\ncomparison the prior examination.  There is no left hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is no pericardial effusion.  There are mild\ncoronary calcifications.\nPLEURA: There is no pleural effusion.  There are small bilateral Bochdalek's\nhernias.\nLUNG:\n\n-PARENCHYMA:  No new or enlarging pulmonary nodules.\n-AIRWAYS:  The airways are patent the subsegmental level.\n-VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: The superficial soft tissues are unremarkable.  There is no\nosseous evidence of malignancy or infection.",
            "output": "1.  Interval increase in a single right hilar lymph node, not enlarged by CT\nsize criteria, is of indeterminate clinical significance.  No other evidence\nof intrathoracic malignancy."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are normal in\ndiameter and enhancement.  Right hilar lymph node is unchanged since previous\nexamination, series 4, image 46, 9 mm in diameter.  No other mediastinal hilar\nor axillary pathologically enlarged lymph nodes demonstrated.  Heart size is\nnormal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  There are no new\npulmonary nodules masses or consolidations.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, axillary, mediastinal, and hilar\nlymph nodes are not enlarged.  7 mm right hilar lymph node (03:57) is\nunchanged.  Thoracic aorta and main pulmonary artery are normal size.  There\nis no pericardial effusion.\n\nThere is no pleural effusion.  Airways are patent to subsegmental levels.  No\nsuspicious pulmonary mass or consolidation is identified.\n\nPlease refer to separate report for CT abdomen and pelvis for abdominal\nfindings.  6 mm lucent lesion in T9 vertebral body is unchanged.  Although\nthere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable. \nBilateral axillary lymph nodes are prominent but not enlarged by CT size\ncriteria.  There is no supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen and pelvis from the same date.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: Top normal right hilar lymph nodes are unchanged from ___.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is no pleural nodularity or pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No worrisome pulmonary lesions.\n2. AIRWAYS:  The airways are patent the subsegmental level.\n3. VESSELS:  The aorta and main pulmonary artery are normal in size.\nCHEST CAGE: The superficial soft tissues are unremarkable.  No evidence of\nosseous malignancy or infection.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No pathologically enlarged\naxillary, mediastinal or hilar lymphadenopathy is present.  Heart size is\nnormal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No CT evidence of intrathoracic metastatic disease"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.\nPatient is progressively more cachectic.\n\nUPPER ABDOMEN: Metastatic involvement of the liver has progressed in\ncomparison to ___ and reported separately in the same day CT of the\npelvis.\nInferior pericaval 1.7 x 0.7 cm lymph node is larger in comparison to ___, with measured 0.5 cm (7: 248).\n\nMEDIASTINUM: There is no new mediastinal, hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Right Port-A-Cath terminating in the right atrium.\nHeart is in normal size.  There is no pericardial effusion.  Specks of\ncalcifications in the coronaries.\nMajor vessels within normal size and there is no evidence of central filling\ndefects in the main pulmonary artery to suggest central emboli in this\nnondedicated study.\n\nPLEURA: Right minimal layering pleural effusion is new since ___.\nBiapical minimal pleural parenchymal fibrosis unchanged.\n\nLUNG: The airways are patent to the subsegmental level bilaterally.\nFew nodules are new in comparison to ___ for example right upper\nlobe micro nodule series 7:116, 0.4 cm lingular nodule the (7:170). Right\nupper lobe micro nodule (7:228).  Left lower lobe micro nodule (7:236).\nLeft upper lobe micro nodule is unchanged (7:186).\nSubsegmental platelike atelectasis and the of the right lower lobe adjacent to\nthe major fissure is also new.\n\nCHEST CAGE: Lucency in T8 vertebral body unchanged since ___.\nNo osteoblastic or osteolytic lesions identified concerning for metastases or\ninfection.",
            "output": "Indeterminate 3 new lung nodules as described above.  Given history of\nmalignancy these remain concerning for metastasis.  Continued follow-up is\nrecommended.\nNew trace right pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is minimal coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: A right Port-A-Cath catheter tip terminates in the right atrium. \nVascular configuration is conventional.  Aortic caliber is normal.  The main,\nright, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: Mild biapical scarring is stable.  No new or enlarging\npulmonary nodules.  Small nodules stable since ___, as follows: 4 mm\nright upper lobe (6:127), 6 mm lingula (6:175), 3 mm left lower lobe (6:195),\n4 mm right lower lobe (6:232), 3 mm left lower lobe (6:243).  There is no\nemphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: A solitary, indeterminate 1.5 x 0.9 cm lucent lesion in\nthe T8 vertebral body is stable since ___ (10:30).  Otherwise, there is no\nthe new worrisome lytic or sclerotic osseous lesion.  Multilevel degenerative\nchanges are mild.\n\nUPPER ABDOMEN:  Please see separately submitted report of CT Abdomen and\nPelvis from the same date for description of subdiaphragmatic findings.",
            "output": "1. Stable bilateral subcentimeter pulmonary nodules.  No new pulmonary\nnodules.\n2. Solitary, lucent thoracic spine lesion, significance indeterminate.\n3. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Mild atherosclerotic\ncalcifications in the aorta and head and neck vessels.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Small hiatal hernia.\n\nPLEURAL SPACES: No pneumothorax.  Small bilateral pleural effusions with\ncompressive atelectasis in both lower lobes.\n\nLUNGS/AIRWAYS: The lungs are otherwise clear, without masses or other areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The gallbladder drained by a catheter entering the right\nlateral abdominal wall with irregular thickened walls.The peripherally\nenhancing fluid collection in the gallbladder fossa which extends into the\nright lobe of the liver is slightly increased in size, now measuring 2.7 x 1.5\ncm (TR x SI), previously 2.2 x 1.0 cm (series 15, image 21).  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  Mild periportal\nedema is noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 6 cm cyst is seen in the left kidney with a single calcified septation.  A\nsmaller simple 2 cm cyst is also noted.  There is no evidence of\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\ncolon and rectum are within normal limits.  The appendix is normal.  There is\nno free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple metallic seeds in the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Metallic clips in the right anterior abdominal wall,\nlikely related to prior surgery.  There is dextroscoliosis of the lumbar spine\nwith mild-to-moderate multilevel degenerative changes.  Right hip prosthesis.",
            "output": "1.  Relatively unchanged appearance of perforated cholecystitis with remaining\nthick and irregular walls, with draining catheter in its lumen.\n2.  The perihepatic/hepatic abscess has slightly increased in size, now\nmeasuring up to 2.7 x 1.5 cm.\n3.  New small bilateral pleural effusions.\n4.  No pulmonary embolism."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Aside from mild cardiomegaly and diffuse atherosclerotic\ncalcifications in the coronary arteries, aortic arch and origins of the great\nvessels, the heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen. A right upper extremity central line tip\nterminates in the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax or pleural effusion.\n\nLUNGS/AIRWAYS: Aside from bibasilar dependent atelectasis, the lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  A percutaneous cholecystostomy tube is\nseen with tip in the gallbladder fundus.  The gallbladder remains mildly\ndistended with a mildly thickened and edematous wall.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRe-demonstrated is a 5.8 cm in the left interpolar region which contains a\nsingle calcified septation.  Additional 1.9 cm cyst is noted in the left lower\npole kidney with a focal coarse calcification.  A 3.8 cm parapelvic cyst is\nalso present on the left.  Additional subcentimeter hypodensities bilaterally\nare too small to characterize, statistically likely represent simple cysts. \nThere is no evidence of suspicious focal renal lesions or hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia.  Aside from evidence of\nmalrotation with small-bowel loops not crossing to the left of midline, the\nsmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding.  The appendix is not well visualized,\nhowever, there are no secondary signs of inflammation to suggest acute\nappendicitis.  There is no free intraperitoneal fluid or free air.  Surgical\nmesh is again seen in the right anterior abdominal wall.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are again seen within the prostate\ngland.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nRe-demonstrated is mild anterior loss of height in the T12 vertebral body. \nPartially visualized is a right hip arthroplasty.  The abdominal and pelvic\nwall is within normal limits.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic pathology.\n2.  Re-demonstrated is a percutaneous cholecystostomy tube with tip in the\ngallbladder fundus.  The gallbladder wall remains mildly distended with a\nthickened and edematous wall compatible with ongoing cholecystitis.  However,\nno abdominal fluid collections are seen.\n3.  Colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Patient is status post interval CABG, median sternotomy,\nand aortic valve replacement.  There is a small pericardial effusion which is\nminimally complex with ___ of 32 (2; 85).  There is mild cardiomegaly.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  There is a stable 1.2 x 1.6 cm superior pretracheal mediastinal\nlymph node (2; 27).  No mediastinal mass.\n\nPLEURAL SPACES: Moderate heterogeneous left pleural effusion with internal\nhyperdensity measuring up to ___ of 58 concerning for left hemothorax (2; 78). \nSmall right pleural effusion is minimally complex with ___ 29.  No\npneumothorax.  No active contrast extravasation.\n\nLUNGS/AIRWAYS: Evaluation of the parenchyma is mildly limited by respiratory\nmotion.  There is compressive atelectasis of the left upper and lower lobes. \nPeripheral opacity in the right lower lobe with heterogeneous enhancement is\nconcerning for pneumonia.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a 1.8 cm cyst in\nsegment V and a 1.4 cm hepatic cyst in segment VII.  Hyperdense material\nwithin the colon represents prior oral contrast material.\n\nBONES:  There is an interval fracture of the left first rib (2; 7).  Status\npost median sternotomy with intact median sternotomy wires.  No evidence of\nwound dehiscence.  No suspicious osseous abnormality is seen.?",
            "output": "1. No evidence of pulmonary embolism or acute thoracic aortic abnormality.\n2. New moderate size left hemothorax.  Minimally complex small right pleural\neffusion.\n3. Status post CABG and aortic valve replacement with interval development of\na mildly complex small pericardial effusion.\n4. Right lower lobe pneumonia.\n5. Interval acute left first rib fracture.  No pneumothorax.\n\n\nNOTIFICATION:   The findings were discussed with ___, N.P. by ___,\nM.D. on the telephone on ___ at 4:47 pm, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There are extensive coronary artery and aortic valve\ncalcifications.  The heart is mildly enlarged.  Pericardium and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse septal thickening with scattered ground-glass\nand nodular opacities bilaterally which likely represents mild pulmonary edema\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck a 1.4 x 1.6 soft\ntissue density which may be a nodule exophytic off the isthmus of the thyroid\nwhich also appears slightly thickened.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a tiny hiatal\nhernia.  There are two small hepatic hypodensities which cannot be\ncharacterized but may represent cysts.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild pulmonary edema and mild cardiomegaly. No pleural effusions.\n3. Probable exophytic thyroid nodule measuring up to 1.7 cm extending\ninferiorly off the isthmus which can be characterized by nonurgent, outpatient\nthyroid ultrasound.\n4. Extensive coronary artery and aortic valve calcifications.\n5. No evidence of traumatic injury."
        },
        {
            "input": "HEART AND VASCULATURE: Please note that the exam is limited secondary to the\npoor bolus timing/opacification.  Within these limitations, no large central\npulmonary emboli is identified.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart size is not\nenlarged.  There is no pericardial effusion.  The main pulmonary artery\nmeasures 3.5 cm, which can be seen in pulmonary artery hypertension.\n\nAXILLA, HILA, AND MEDIASTINUM: There are a few mediastinal prominent lymph\nnodes measuring up to 8 mm without meeting CT size criteria for\nlymphadenopathy, likely reactive.  No axillary lymphadenopathy is present.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild upper lobe predominance of centrilobular\nemphysema.  Consolidation is seen in the lingula, concerning for pneumonia. \nAdditionally, there are peribronchovascular opacities in the right upper lobe,\nconcerning for multifocal infection.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for a\nsubcentimeter hypodensity in the partially seen left kidney.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Please note that the exam is limited secondary to the poor bolus\ntiming/opacification.  Given this, no large central pulmonary emboli is\nidentified.\n2. Lingular consolidation is concerning for pneumonia.  Peribronchovascular\nopacities in the right upper lobe are also concerning for multifocal\ninfection.  There are prominent mediastinal and bilateral hilar lymph nodes,\nlikely reactive.\n3. The main pulmonary artery measures 3.5 cm, which can be seen in pulmonary\nartery hypertension.\n4. Mild centrilobular emphysema is upper lobe predominant."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is homogeneously\nattenuating without nodularity or mass.  No supraclavicular or infraclavicular\nlymphadenopathy.  No axillary lymphadenopathy.  There is mild calcified\natherosclerosis involving the vasculature of the head and neck.\n\nUPPER ABDOMEN:  The study is not tailored for evaluation of the abdomen. \nAllowing for this, the partially visualized upper abdomen demonstrates a small\nhiatus hernia.  Otherwise, the visualized upper abdomen demonstrates gross\nabnormality.\n\nMEDIASTINUM: There are multiple small lymph nodes within the mediastinum\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is top-normal.  No pericardial effusion. \nThere is mild calcified atherosclerosis of the coronary arteries.  The main\npulmonary artery measures up to 30 mm suggesting pulmonary artery\nhypertension.  No central pulmonary embolus is demonstrated.  The vascular\ncalibers of the ascending aorta, descending aorta and aortic arch are within\nnormal limits.\nPLEURA: No pleural effusion or pneumothorax.  Minimal left apical\npleuro-parenchymal scarring.\nLUNG:\n\n1. PARENCHYMA: Mild centrilobular emphysema.  The previous described\nconsolidations at the upper lobes have resolved.  A subtle 3 mm pulmonary\nnodule at the  right upper lobe is unchanged, (series 2, image 36).  No new or\ngrowing pulmonary nodules.\n2. AIRWAYS: The airways are patent to the subsegmental level.  No bronchial\nwall thickening, mucus plugging or bronchiectasis.\nCHEST CAGE: No suspicion lytic or sclerotic osseous abnormality is seen.  No\nacute fracture.",
            "output": "1. Interval resolution of previous multifocal infectious process.\n2. A 3 mm pulmonary nodule at the right upper lobe is unchanged.  No new or\ngrowing pulmonary nodules.\n3. Mild centrilobular emphysema.\n4. Interval decrease in size of the main pulmonary artery.  However it remains\nenlarged measuring up to 30 mm suggesting ongoing pulmonary artery\nhypertension."
        },
        {
            "input": "MEDIASTINUM/HEART:  The visualized thyroid is unremarkable. The previously\ndescribed hilar lymph nodes are difficult to distinguish from the pulmonary\nvessels without the administration of IV contrast.  Multiple enlarged\nmediastinum lymph nodes are again seen, by grossly unchanged.  For example, a\nparatracheal lymph node measures 1.7 x 1.2 cm (4:117), and an unchanged\nprevascular node measures 3.3 x 1.2 cm (4:114).  Axillary lymph nodes are not\nenlarged by CT size criteria.  Aorta is normal in size.  The main pulmonary\nartery is enlarged, but grossly unchanged in size, consistent pulmonary\narterial hypertension, presumably related to underlying lung disease. Heart\nsize is normal without pericardial effusion.  Suggestion of anemia is made,\nbased on relative hypodensity of the blood pool.\n\nLUNGS/AIRWAYS:  Diffuse cylindrical and saccular bronchiectasis, most markedly\nin the bilateral lower lobes, has progressed since the CT chest from ___.  As before, there is a significant amount of intraluminal fluid\nwithin the dilated lower lobe bronchi.  Compared with the prior CT, there has\nbeen interval worsening of the degree of parenchymal consolidation with\nnodular contours throughout the lower lobes bilaterally in a\nperibronchovascular distribution.\n\nThe previously described left upper lobe consolidation has improved, however\nthere are 2 new, separate left upper lobe regions of consolidation (4:72, 135,\nand 601b:68).  There is another new, large consolidation in the left lower\nlung (4:220).  Finally, there is a new right upper lobe consolidation (4:47). \nBullous changes of the bilateral lung apices are grossly unchanged.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures, particularly in the absence of IV contrast.  Within these\nlimitations, splenomegaly to 14.2 cm is again noted.  Visualized portions of\nthe liver and adrenal glands are unremarkable.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Although some prior areas of consolidation have improved or resolved,\nthere are multiple new areas of focal consolidation in the left upper, left\nlower, and right upper lobes, consistent with active infection superimposed on\nbackground diffuse bilateral bronchiectasis.\n\n2.  The degree of diffuse cylindrical and saccular bronchiectasis, most marked\ndid in the bilateral lower lobes, has worsened.\n\n3.  Pulmonary arterial hypertension, presumably due to underlying lung\ndisease.\n\n4.  Without the administration of IV contrast, assessment of lymphadenopathy\nis limited.  However, there has been no significant change in the size of the\nmeasurable mediastinal lymph nodes."
        },
        {
            "input": "Previously identified cluster of nodular opacities in the right middle lobe\n(inadvertently reported as right lower lobe on prior study) appear unchanged\n(image 117 through 114, series 4). The tubular quality of the opacities,\ncombined with lack of contrast enhancement on prior chest CT a suggests that\nthese are most likely due to localized mucoid impaction. A smaller branching\nopacity in the lateral segment right middle lobe near the diaphragm (137, 4),\nis also unchanged, as well as a focal area of mucoid impaction in the\nanteromedial basilar segment of the left lower lobe (125, for).\n\n3 mm right lower lobe noncalcified nodule near the diaphragm (140, 4) is in\nretrospect unchanged compared to the prior study as well as a small calcified\ngranuloma at the right lung base. Lungs are otherwise remarkable for moderate,\nupper lobe predominant centrilobular emphysema, and is nonspecific linear\nscarring at the bases. Mild lower lung predominant bronchial dilation is also\nwithout change.\n\nThe thyroid is normal.  Calcified right hilar and lower right paratracheal\nlymph nodes are present suggesting prior granulomatous exposure. Aorta and\npulmonary arteries are normal size. Cardiac configuration is normal and note\nis made of diffuse coronary calcification.\nSmall hiatal hernia is incidentally noted. Exam was not tailored to evaluate\nthe subdiaphragmatic region, but note is made of focal ectasia of the upper\nabdominal aorta without change, as well as diffuse aortic calcifications and\nother vascular calcifications in the upper abdomen.\n\nWedge compression deformity in the upper to mid thoracic spine is similar to\nthe prior study as well as the kyphoscoliosis.",
            "output": "Stable CT appearance of branching tubular opacities in the right mid lung,\nwhich likely reflect localized mucoid impaction."
        },
        {
            "input": "Aorta is tortuous.  Ascending aortic dilatation up to 4.4 cm is unchanged. \nThe patient is after transcatheter aortic valve replacement.  There is no\npericardial effusion.  There is no appreciable pleural effusion.\n\nThere is interval decrease in size in the supraclavicular lymph node currently\nmeasuring 11 mm as compared to 24 mm on the previous study, series 5, image 8.\nParatracheal lymph nodes are up to 3 mm no evidence of abnormal enlargement. \nAortopulmonic lymph node has decreased in size from 11-4 mm, series 5, image\n15.  No pathologically enlarged lymph nodes demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nelongated irregular nodule, 12 x 6.5 mm, series 6, image 53 is new compared to\n___ and has increased compared to ___.  Right lower lobe nodule,\nseries 6, image 170, 4.5 mm is unchanged dating back to ___.  Minimal\nbibasal linear atelectasis present.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Interval decrease in size in the dominant supraclavicular lymph node as well\nas in the aortopulmonic lymph node.  No lymphadenopathy currently seen based\non the CT size criteria\n\nSlight interval increase in size in the right apical nodule, attention on the\nsubsequent followup is recommended.  Stable right lower lobe pulmonary nodule.\n\nUnchanged tortuous aorta with dilated ascending component and status post\nreplacement of aortic valve.\n\nPlease review CT abdomen and pelvis and the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to concurrent CT abdomen report.\n\nMEDIASTINUM:  No mediastinal mass or lymphadenopathy.  Multiple millimetric\nlymph nodes are not enlarged; the largest is a lower right paratracheal 9 mm\nnode.\n\nHILA:  Evaluation is limited without IV contrast.\n\nHEART and PERICARDIUM: Heart size is normal.  Dense aortic valve\ncalcifications are similar to prior.  Small pericardial effusion is slightly\nlarger compared to prior.\n\nPLEURA: There are moderate layering bilateral nonhemorrhagic pleural\neffusions, slightly greater on the right than the left, with mild to moderate\nassociated atelectasis.  No pneumothorax.\n\nLUNG:  Evaluation is mildly limited by respiratory motion and inadvertent\nexpiratory phase imaging.\n\n1. PARENCHYMA:  There is hazy dependent ground-glass opacity, primarily in the\nlower lobes.  5 mm nodule in the right lower lobe (4:232) is similar to prior.\nNo focal consolidation.\n2. AIRWAYS:  The airways are patent to segmental levels.\n3. VESSELS:  The right pulmonary artery is enlarged up to 33 mm, similar to ___. The aorta is normal caliber.\nCHEST CAGE: No suspicious lytic or sclerotic lesion.  No acute fracture.",
            "output": "1. Hazy dependent ground-glass opacity most likely pulmonary edema.\n2. Moderate bilateral nonhemorrhagic pleural effusions, slightly greater on\nthe right than the left, with mild to moderate associated atelectasis, and\nsmall pericardial effusion likely the residual of heart failure, given severe\naortic valvular calcification, and presumed aortic stenosis..\n3. No pneumonia, abscess, empyema, or other source of infection identified."
        },
        {
            "input": "No evidence of intramural hematoma on this noncontrast scan. There is no\nmediastinal hematoma. There is diffuse atherosclerotic disease of the thoracic\naorta. The heart is enlarged. There is no pericardial effusion. Pacer wires\nare seen within the right atrium and right ventricle.\n\nThe lungs are clear without focal consolidation. Minimal dependent atelectasis\nis noted at the lung bases bilaterally. There is no pleural effusion. The\nairways are patent to the subsegmental level. No definite pulmonary nodules\nidentified.\n\nThere is no pneumothorax or pneumomediastinum.\n\nThere is no axillary, supraclavicular, or mediastinal lymph adenopathy by CT\nsize criteria.\n\nA enlarged multinodular goiter is seen.\n\nThe esophagus is unremarkable.\n\nLimited views of the upper abdomen demonstrate pneumobilia. Multiple calcified\nstones are seen within a distended gallbladder, no definite surrounding fat\nstranding. A rounded hyperdensity within the gallbladder neck measuring 3.7\ncm, unlikely to represent an additional noncalcified stone however a polypoid\nlesion is within the differential.\n\nOSSEOUS STRUCTURES: No compression deformity noted within the thoracic spine.\nMultilevel degenerative changes seen.  There is diffuse osteopenia. A\nhemangioma is present in the T6 vertebral body.",
            "output": "1. No evidence of intramural hematoma on this noncontrast study. No\nmediastinal hematoma.\n2. Cardiomegaly.\n3. Distended gallbladder with multiple calcified stones as well as a 3.7 cm\nrounded hyperdense region within the gallbladder neck which could represent a\npolypoid mass lesion, recommend right upper quadrant ultrasound for further\nevaluation.\n4. Pneumobilia, correlate with history of prior sphincterotomy.\n5. Enlarged multinodular thyroid, further evaluation with thyroid ultrasound\ncan be obtained if clinically indicated.\n\nNOTIFICATION:  Findings discussed with Dr. ___ by Dr. ___ the\ntelephone on ___ at 12:00, 5 min after discovery."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No size significant axillary, mediastinal, or\nhilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Background moderate to severe centrilobular emphysema.  There\nare segmental atelectatic changes in both lower lobes.  Dependent secretions\nmucus present in the trachea, extending into the bilateral mainstem bronchi,\nleft greater than right.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a 6 mm\nhypodensity in segment ___ of the liver, too small to characterize, however\nlikely represents either a small cyst or hemangioma.\n\nBONES: The patient is post lower cervical fixation.  Postoperative changes are\npresent in the overlying subcutaneous tissues.",
            "output": "No evidence of pulmonary embolism.\n\nSecretions/mucus present in the trachea and bilateral mainstem bronchi. \nClinical correlation for aspiration is recommended.  Segmental atelectatic\nchanges at both lung bases."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is normal.  No\nsupraclavicular or axillary lymphadenopathy.  No worrisome soft tissue mass\nlesions within the chest wall.\n\nUPPER ABDOMEN: Visualized portions of the upper abdominal organs appear\ngrossly unremarkable.\n\nMEDIASTINUM: No size significant mediastinal lymph nodes.  No mediastinal\nmass.  No mediastinal hematoma.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusions. \nModerate coronary calcifications.\nPLEURA: Small bilateral pleural effusions, partially loculated on the left.  .\nNo pneumothorax.\nLUNG:\n\n-PARENCHYMA:  There is bilateral lower lobe atelectasis, with subpleural and\nlinear bands, and associated volume loss.  Component of pneumonia is unlikely,\nunless strongly suspected clinically.  4 mm lung nodule within the left upper\nlobe (series 5, image 108).  No lung mass.\n-AIRWAYS:  Mild mucoid impaction within the segmental branches of the right\nlower lobe (series 5, image 142).  Remainder airways are patent to\nsubsegmental level\n-VESSELS:  Ascending aorta is normal in caliber measuring 2.5 cm.  There is a\nfleck calcium involving anterior midline wall of the ascending aorta series 5,\nimage 125.  There is mild atherosclerotic calcifications within the aortic\narch and descending thoracic aorta.  Note is made of a bovine aortic arch.\nCHEST CAGE: Exaggerated thoracic kyphosis.  No osteolytic or osteoblastic\nlesions to suggest malignancy.  No acute fractures.  There is mild deformity\nof the upper T12 vertebral endplate, likely Schmorl's node, there is no\nparavertebral edema.",
            "output": "1.  There is tiny fleck of calcium of the anterior wall of mid ascending\naorta.\n2.  Small bilateral pleural effusions, partially loculated on the left.\n3.  Consolidations in bilateral lower lobes with mild volume loss are most\nlikely from atelectasis.  Component of pneumonia is unlikely unless strongly\nclinically suspected.  There is minimal mucous plugging in the right lower\nlobe.\n4.  4 mm lung nodule in the left upper lobe.  If there is no history of\nsmoking or malignancy, no further follow-up is indicated.  If there is history\nof smoking,, follow-up CT chest in 12 months is recommended.\n\nRECOMMENDATION(S):  If patient is high risk, follow-up CT chest in 12 months\nis recommended to follow-up a 4 mm lung nodule."
        },
        {
            "input": "THORACIC INLET: There are no enlarged supraclavicular lymph nodes. Thyroid is\nunremarkable.  The abnormality on the radiograph corresponds to a tortuous\nright brachiocephalic vessel.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes not enlarged by size\ncriteria the largest measuring 4 mm.  There is moderate cardiomegaly. \nModerate to severe coronary artery calcification is seen.  There is moderate\nmitral annulus calcification and aortic annulus calcification.  There is no\npericardial effusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Consolidative opacities in both lung bases could represent atelectasis\nhowever aspiration pneumonia cannot be excluded.  Correlation with history is\nrecommended.  There is a 2 mm nodule in the right lower lobe (5, 121).\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.",
            "output": "Consolidative opacities in both lower lobes most likely represent atelectasis\nhowever superimposed pneumonia cannot be excluded.\n\nThe abnormality on the radiograph corresponds to a tortuous brachiocephalic\nvessels.\n\nNew small mediastinal lymph nodes not enlarged by size criteria."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Persistent left superior vena cava, an anatomical\nvariant.  No supraclavicular, infraclavicular or axillary lymphadenopathy.  No\nenlarged lymph nodes in the mediastinum or at the level of the hilar\nstructures.  Normal appearance of the heart, no coronary calcifications, no\npericardial effusion.  The large mediastinal vessels are unremarkable.  No\nevidence of pulmonary embolism.  The posterior mediastinum shows a minimally\nwidened esophagus and a borderline sized pre esophageal lymph node (2, 44). \nThe upper abdomen shows multiple hypodense liver lesions. No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Mild\nthickening and irregularities at the lung apices.  Several 1-2 mm\nmicronodules, for example in the right lung apex ___, 48) and in the left\nlower lobe (302, 170).  No suspicious pulmonary nodules or masses.  Minimal\nscarring at the bases of the lingula and of the right lower lobe (302, 139). \nNo pleural thickening, no pleural effusions.  The airways are patent.",
            "output": "Several non suspicious micronodules.  No suspicious pulmonary nodules or\nmasses.  Borderline pre esophageal upper abdominal lymph node and multiple\nknown hypodense liver lesions.  No evidence of thoracic metastatic disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The included thyroid is with no\nincidental findings.\nThere is no supraclavicular or axillary lymphadenopathy.\nExcluding the breasts which must be evaluated by mammography the chest wall is\nwith no focal soft tissue abnormalities to suggest malignancy.\n\nUPPER ABDOMEN: Nodule number of hypodense metastasis of varying sizes involve\nthe liver, better evaluated on CT of the abdomen and pelvis reported on the\nsame day.\n\nMEDIASTINUM: There is no mediastinal, hilar or any other intrathoracic\nlymphadenopathy.\nLower paraesophageal upper abdomen 0.8 cm lymph node is unchanged.\nThe esophagus is collapsed and unremarkable.\n\nHEART and PERICARDIUM: Heart and major vessels within normal size.\nThere are no appreciable atherosclerotic calcifications of the coronaries or\nthoracic aorta.\n\nVariant-double SVC.\nRight Port-A-Cath terminates in the junction of brachiocephalic and SVC.\nLarge number of collaterals in the right upper extremity.\nContrast was injected through the right arm, not through the port-A-cath thus\nits patency cannot be evaluated.\nThere is a linear hypodensity extending from the tip of the port with contrast\nsurrounding it, better evaluated on coronal reconstruction, 07:25 and is\nsuspicious for clot.\n\nPLEURA: Mild biapical pleural parenchymal fibrosis in unchanged.\nThere is no pleural effusion.\n\nLUNG: Airways are patent to subsegmental level.\nRight hemidiaphragm is elevated, 4.5 cm higher than left, with adjacent\nsubsegmental passive atelectasis.\n\nLeft upper lobe subpleural 0.4 cm nodule is larger by virtue of mm in\ncomparison to ___ (5:130).\nRemaining bilateral micro nodules are unchanged for example right upper lobe\n05:58, 75, right lower lobe image 155.\nLeft lower lobe 0.4 mm nodule is stable (05: 180).\nThere are no new lung masses, no lung opacifications.\n\nCHEST CAGE: There is new T6 vertebral sclerotic lesion, with no pathologic\nfracture and there is no evidence of spinal cord compression.  The adjacent\nright ___ ribs are also involved.  New sclerotic lesion in the sternum.",
            "output": "-Linear hypodensity extending from the tip of the port in a patent SVC,\nsuspicious for clot.\n-New sclerotic metastasis to the sternum, T6 vertebra and adjacent right 6 and\n7 ribs.  No pathologic fracture.\n-Left upper lobe subpleural 0.4 cm nodule is larger by virtue of mm in\ncomparison to ___, remaining pre-existing nodules are unchanged.\n-There is no new mediastinal lymphadenopathy and lower paraesophageal sub cm\nlymph node is unchanged.\n-Please refer to the same day CT of the abdomen and pelvis report.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:40 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  Heart size is normal.  There is no pericardial effusion. \nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.\n\nThe airways are patent to the subsegmental levels.\n\nMultiple pulmonary nodules are re-demonstrated within the lungs bilaterally. \nFor example series 6, image 83, 77, 63, 126, 40, 33, 171.  No concerning new\nor growing pulmonary nodules are seen.\n\nThere is no pleural effusion or pneumothorax.\n\nOsseous structures: Sclerotic focus within the T6 vertebral body, is unchanged\ncompared to the prior exam.  Re-demonstrated is involvement of the right sixth\nand seventh ribs.  Sclerotic lesion within the sternum also appears grossly\nsimilar in size to the prior exam.\n\nFor evaluation of subdiaphragmatic structures, please refer to dedicated CT of\nthe abdomen performed on same day.",
            "output": "1. Overall, no significant interval change in the extent of pulmonary nodules\ncompared to the exam from ___.  No concerning new or growing\npulmonary nodules identified.\n2. Re-demonstrated are bony metastases."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Right pectoral Port-A-Cath.  No other abnormalities\nin the thoracic inlet.  No enlarged lymph nodes in the mediastinum and at the\nlevel of the hilar structures.  1 borderline sized lymph node continues to be\nseen in left paratracheal location.  No cardiac abnormalities.  No pericardial\neffusion.  Extensive metastatic liver disease.  The known bony metastases have\nnot substantially progressed.\nThe pre-existing multiple pulmonary nodules are overall stable in size and\nmorphology.  None of the nodules has grown.  There are no new pulmonary\nnodules.  In unchanged manner, there is mild scarring of the lung parenchyma\nat the lung bases.  No pleural thickening, no pleural effusions.",
            "output": "Stable examination of the thorax, with known bony metastasis, known pulmonary\nnodules that are all stable.  And known metastatic liver disease.  No new or\ngrowing lung nodules."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is stable small left supraclavicular lymph nodes. \nIncidental note is made of bilateral SVC.\nThere is a trace pericardial effusion.\n\nPLEURA: There are new small bilateral pleural effusions right greater than\nleft.  There is subsegmental atelectasis in both lung bases.\n\nLUNG: There is mild interstitial prominence there is no significant interval\nchange in the scattered 2-3 mm bilateral pulmonary nodules.  No new pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones shows a sclerotic lesion involving T6\nvertebral body concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows multiple\nhepatic metastasis.  There is evidence of ascites.  There is anasarca.",
            "output": "No significant interval change in scattered 2-3 mm bilateral pulmonary\nnodules.\n\nNew small bilateral pleural effusions right greater than left.\n\nNumerous hepatics metastasis.  Ascites.\n\nAnasarca.\n\nSclerotic lesion in T6 vertebral body could represent osseous metastasis and\nis unchanged."
        },
        {
            "input": "Study is moderately degraded by motion.\n\nHEART AND VASCULATURE:  The ascending thoracic aorta is ectatic measuring 3.7\ncm. The heart and pericardium are within normal limits based on an unenhanced\nscan.  There is extensive coronary artery calcification.  There is extensive\natherosclerotic calcification of the aortic arch and descending aorta.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Multiple calcified nodes are noted within the\nright axilla.  There is no axillary or mediastinal or mediastinal\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES:  There is a small right pleural effusion and trace left\npleural effusion.  There is no pneumothorax.\n\n\nLUNGS/AIRWAYS:  Motion limits evaluation of the lung parenchyma.  A 4 mm\npulmonary nodule in the left lower lobe is noted (03:52). Ground-glass\nopacities in bilateral upper and lower lobes concerning for patchy airspace\ndisease secondary to pneumonia or pulmonary edema.  There is interstitial\nthickening diffusely in bilateral upper and lower lobes likely secondary to\nvolume overload.  There is severe bronchiolar wall thickening.  There is\nlayering debris in the upper trachea.\n\nBASE OF NECK: Multiple hypodense nodules in the thyroid, the largest measuring\n1.7 cm in the right thyroid lobe are noted.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates\nthickening of the left adrenal gland without discrete nodule which may\nrepresent an adrenal adenoma.\n\nBONES: A mild compression deformity of T12 and involving the mid thoracic\nspine is likely chronic.  The bones are moderately diffusely demineralized.",
            "output": "1. No evidence of acute fracture.  Chronic fractures of the right posterior\neleventh and left posterior ninth and tenth ribs are noted.\n2. Small right pleural effusion and trace left pleural effusion. No\npneumothorax.\n3. Ground-glass opacities in bilateral upper and lower lobes concerning for\npatchy airspace disease secondary to pneumonia or pulmonary edema. There is\ninterstitial thickening diffusely in bilateral upper and lower lobes likely\nsecondary to volume overload\n4. Severe bronchiolar wall thickening compatible with bronchitis.\n5. The ascending thoracic aorta is mildly ectatic measuring 3.7 cm.\n6. Thickening of the left adrenal gland without discrete nodule which may\nrepresent an adrenal adenoma.  Coronal findings to prior imaging studies or\nfollow-up imaging to ensure stability.\n7. A mild compression deformity of T12 is likely chronic.\n8. Multiple hypodense nodules in the thyroid, the largest measuring 1.7 cm in\nthe right thyroid lobe.  Recommend thyroid ultrasound for further evaluation.\n9. A 4 mm pulmonary nodule in the left lower lobe is noted.  Per ___\ncriteria guidelines, for low risk patients, follow-up at 12 months and if no\nchange, no further imaging needed. For high risk patients, initial follow-up\nCT at ___ months and then at ___ months if no change.\n\n\nRECOMMENDATION(S):  Thyroid ultrasound.\n___ criteria guidelines as recommended above."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  There is a patulous\nintrathoracic esophagus, which may predispose to aspiration.\n\nHILA:  Hilar lymph nodes are not enlarged.  Right hilar lymph node measuring\nup to 8 mm in short axis contains small calcifications suggesting prior\ngranulomatous disease.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the segmental level bilaterally.  There\nmultiple subsegmental areas of mucous plugging bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nscattered hepatic hypodensities likely representing simple cysts or biliary\nhamartomas.",
            "output": "1. No evidence of active infection or malignancy within the chest. \nSpecifically, no suspicious lymphadenopathy.\n2. Subsegmental areas of mucous plugging with a patulous intrathoracic\nesophagus suggesting ongoing aspiration."
        },
        {
            "input": "THORACIC INLET: The thyroid is enlarged with multiple hypodense areas within\nthe left lobe of the thyroid.  There are no enlarged supraclavicular lymph\nnodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is moderate to severe cardiomegaly with moderate\natherosclerotic calcification involving the descending aorta and the coronary\narteries.  There is evidence of prior cardiac surgery.  The esophagus is\npatulous and dilated.  There are no enlarged mediastinal hilar lymph nodes. \nThe aorta and pulmonary arteries are normal in caliber.  There is no\npericardial effusion\n\n\nPLEURA: There is a moderate right and small left pleural effusion with\nsubsegmental atelectasis in both lower lobes.  The left pleural effusion\nappears to be partially loculated and is associated with pleural thickening\nand pleural calcification.\n\nLUNG: There is mild diffuse interstitial thickening which could represent\nedema.  No new nodules or consolidations.  There are several tiny bilateral\npulmonary nodules 2 mm right upper lobe (302, 46) 2 mm right lower lobe\npulmonary nodule (302, 135).  4 mm left lower lobe pulmonary nodule (302, 187)\n2 mm calcified right middle lobe pulmonary nodule (302, 169) 6 mm left lower\nlobe pulmonary nodule (302, 137) calcified 1 mm right upper lobe pulmonary\nnodule (302, 41).\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine.  There is evidence of internal fixation of the\nthoracic spine.  Sternal sutures are intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no obvious\nliver lesions.  There are multiple bilateral renal cysts.  There is a\nhyperdense lesion in the right kidney which could represent a proteinaceous\ncyst",
            "output": "Moderate right and small left pleural effusion with passive atelectasis in\nboth lower lobes.\n\nMultiple bilateral pulmonary nodules ranging in size from 2-6 mm.\n\nMultiple bilateral renal cysts.\n\nModerate to severe cardiomegaly with evidence of prior cardiac surgery."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is redemonstration of moderate to severe\ncardiomegaly.  Moderate atherosclerotic calcification involving the thoracic\naorta and coronary arteries is again demonstrated.  Postsurgical changes after\nprior cardiac surgery again noted.  Esophagus is patulous and dilated.  There\nis a left chest wall pacing device.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There are bilateral pleural effusions, large on the right and\nsmall on the left.  There is a drainage catheter no at noted terminating along\nthe inferior right chest wall.  Collapsed right lower lobe is likely\natelectatic.  Overall the pleural effusion is increased in size on the right\nfrom ___ and new on the left.\n\nLUNGS/AIRWAYS: There are consolidative opacities bilaterally, most prominent\ninferior right upper lobe and inferior left lower lobe, which are worsened\nfrom prior and concerning for infectious etiology. Scattered foci of\nground-glass in a peribronchovascular vascular distribution with small amounts\nof ___ opacities likely represent further infectious foci.  Secretions\nare demonstrated within the bronchi within the trachea (series 3, image 26).\n\nBASE OF NECK: Multiple hypodense lesions within nonenlarged thyroid are\nunchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder demonstrates\npericholecystic edema, new from prior, which may reflect sequela of heart\nfailure.  There is new low-density perihepatic and intra-abdominal ascites, at\nleast moderate.  Reflux of contrast in the IVC and extending into the hepatic\nveins on the CTA portion of the study is worrisome for poor cardiac\nfunction/right-sided heart failure.\n\n\n\nPANCREAS: The pancreas is atrophic diffusely.  There is a focal cystic lesion\nagain demonstrated at the pancreatic head/neck, measuring approximately 3.4 x\n3.4 cm, with multiple other apparent cystic lesions demonstrated.  There is\nheterogeneous hypodensity of the distal pancreas, which may be similar to\nprior, however assessment is limited due to differences in contrast\nadministration.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally, similar to prior.  No\nhydronephrosis.  Hypodense cortical lesions measure up to 2.2 cm.  There is a\nintermediate density cortical lesion at the interpolar region of the right\nkidney measures 1.3 cm, which appears similar in size to prior (series 5,\nimage 35).\n\nGASTROINTESTINAL: No bowel obstruction is seen.  Free fluid is seen.  No free\nair seen.\n\nPELVIS:\n\nThe urinary bladder contains a inflated Foley catheter.  There is air within\nthe bladder, presumably secondary to catheterization.  Moderate intrapelvic\nascites.\n\nREPRODUCTIVE ORGANS: No gross abnormalities within prostate.\n\nLYMPH NODES: No lymphadenopathy by ct size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe and diffuse\natherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: No acute fractures.  Posterior thoracic and lumbar\nfixation hardware is again demonstrated, no discrete sign of perihardware\nfailure.  There is diffuse osteopenia and degenerative disease, which appears\ngrossly unchanged from prior study.  Redemonstration of diffuse idiopathic\nskeletal hyperostosis (DISH) in the thoracic spine.  High-density material\nwithin the bilateral iliac wings was present on the prior CT abdomen and\npelvis from ___, likely represent bone cement or other postsurgical\nsubstance.  There is diffuse anasarca, worsened from prior, as well as a\npaucity of subcutaneous fat.  Anterior chest wall postsurgical changes again\ndemonstrated.",
            "output": "1. Multifocal consolidative opacities likely represent infectious process,\nwith numerous bilateral ground-glass and ___ opacities, which are new\nfrom prior.\n2. Interval worsening of bilateral pleural effusions, now large on the right\nand small on the left. Right pleural drainage catheter appears to terminate\nanteriorly, however the drain demonstrates sideholes which are within the\neffusion.\n3. Moderate-severe cardiomegaly with reflux of contrast into the hepatic\nvasculature on the CTA images is worrisome for poor cardiac output. There is\nnew diffuse anasarca and pericholecystic fluid, which may be a component of\nthird-spacing or fluid overload.\n4. New low-density intra-abdominal ascites.\n5. Cystic, macrolobulated pancreatic head/neck mass again demonstrated, if\ndeemed clinically appropriate, an MRCP may be obtained to further evaluate.\nHeterogeneous appearance of the distal pancreas, felt to exclude component of\npancreatic ductal dilatation or parenchymal abnormality, however this appears\nto have been present on the prior study from ___.\n6. Intermediate density right renal cortical cyst would be amenable to further\nevaluation if an MRCP is obtained.\n7. No pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is heterogeneous\nwithout dominant nodule greater than 1.5 cm for which follow-up would be\nrecommended.  There is no supraclavicular or axillary lymphadenopathy.  Rim\nenhancing, hypodense collection in the area of the pectoralis minor on the\nright is likely a subcoracoid bursa.  Similar findings are noted on the left\nas well.\n\nUPPER ABDOMEN: Please see concurrent CTA abdomen and pelvis for full\ndescription of subdiaphragmatic findings.\n\nMEDIASTINUM: Enlarged precarinal node measures approximately 1.3 cm in short\naxis, grossly unchanged.  Multiple prominent mediastinal lymph nodes are seen,\nno others which meet CT size criteria for enlargement.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is enlarged.  Patient is status post prosthetic\nvalve replacement of both the mitral and aortic valves.  Moderate to extensive\ncoronary artery calcifications are again seen.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is bibasilar atelectasis without focal parenchymal\nopacification.  Remaining lung parenchyma is limited due to extensive\nrespiratory motion.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Main, left main, and right main pulmonary arteries are enlarged,\nmeasuring 4.8, 2.8, and 3.3 cm, respectively, likely sequela of pulmonary\narterial hypertension.\nCHEST CAGE: Patient is status post plate and screw fixation of prior right\nhumeral fracture.  There are multiple old healed bilateral rib fractures.  No\nacute fractures identified.  Vertebroplasty changes noted at T11 and T12.",
            "output": "1. No acute intrathoracic sequela of trauma are identified.\n2. Multiple incidental findings, as above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.  There is evidence of atherosclerotic calcification involving\nthe wall of aorta.  Moderate coronary artery calcification.  There is linear\ncalcification along the medial leaflet of the mitral valve.\n\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a 2 mm nodule in the right upper lobe (301, 47).  There is\nbibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones or shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  No focal liver lesions are seen.",
            "output": "The no evidence of pulmonary embolism.\n\nModerate coronary artery calcification.  Moderate mitral valve calcification.\n\n2 mm right upper lobe pulmonary nodule, could represent a granuloma."
        },
        {
            "input": "The thyroid gland appears unremarkable.  There is no axillary or\nsupraclavicular adenopathy.  A right hilar node measures 2.0 x 0.8 cm,\npotentially representing to adjacent nodules (03:28).  Lower paratracheal\nnodes are not pathologically enlarged. There is no retrocrural or\nsubdiaphragmatic adenopathy.\n\nHeart size is within normal limits.  There is no pericardial effusion. \nCoronary artery calcifications are mild and most pronounced within the left\nanterior descending coronary artery.  The ascending aorta is non aneurysmal\nand the pulmonary artery is within normal limits in caliber.  No esophageal\nabnormality is identified.\n\nAirways are patent to the subsegmental level.  Paraseptal emphysema is\nlocalized to the left apex.  Bilateral apical pleural-parenchymal scarring is\nmild and symmetric.  Bibasilar atelectasis is for pronounced within the left\nlower lobe, mild.  Punctate calcified nodules are most consistent with\ngranulomas (5:86, 244).  A 3 mm nodule within the right upper lobe\nperipherally(5:94), a 2mm nodule within the right upper lobe anteriorly\n(5:84), and a 2 mm nodule within the left upper lobe (5:97) are noted.  There\nis no pleural effusion or pleural abnormality.\n\nNo lytic or sclerotic osseous lesion worrisome for malignancy or infection is\nidentified.\n\nPlease refer to CTA Abdomen performed ___, clip number ___,\nfor complete subdiaphragmatic findings.",
            "output": "1. Scattered nodules measure up to 3mm.\n2.  Several hilar lymph nodes, boderline, to be followed in 3 months, same as\npulmonary nodules.\n2. Paraseptal emphysema is mild and localized to the left apex.\n3. Please refer to CTA Abdomen performed ___, clip number ___,\nfor complete subdiaphragmatic findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Several normal sized lymph nodes are seen in the\naortopulmonary window and at the level of the right hilus.\n\nThe aorta and pulmonary arteries are of normal size.  Pulmonary arteries are\nopacified to the subsegmental level without evidence of occlusion.  Cardiac\nconfiguration is normal and there is no evidence of pericardial effusion. \nCoronary calcifications are noted.  No esophageal abnormality is seen.\n\nParaseptal emphysema is localized to the left lung apex.  Additionally,\npanlobular emphysema is identified in the bilateral lung bases.  Incidental\nfindings of millimetric ground glass opacities are seen in the right upper\nlobe (5:77) and in the left upper lobe (5:99).\n\nThe airways are patent to the subsegmental level. Bilateral mild apical\nscarring is incidentally seen.  There is bilateral dependent atelectasis.  No\nevidence of diffuse lung disease.  No pleural effusion or pleural thickening.\n\nA sclerotic focus is seen in the T2 vertebral body, unchanged from prior study\nin ___.  No lytic or sclerotic lesion concerning for malignancy is\nidentified.\n\nLimited views of the upper abdomen reveal a mass in the caudate lobe of the\nliver, likely site of known HCC.  Please refer to dedicated CT Abdomen and\npelvis for full description of intraabdominal and intrapelvic findings.",
            "output": "1. No evidence of metastatic disease in the chest.\n2. Incidental findings of 2 millimetric ground glass nodules are noted in the\nright and left upper lobes.\n3. Paraseptal and panlobular emphysema is again identified.\n4. Unchanged coronary calcifications.\n5. Please refer to same day dedicated CT abdomen and pelvis for full\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in enhancement and diameter. \nAtherosclerotic disease of the aorta is present.  Heart size is normal.  No\npericardial pleural effusion is seen.\n\nImage portion of the upper abdomen partially demonstrates heterogeneous liver\nwith evidence of previous treatment and multiple areas of enhancement.  For\npre size details please refer to MRI of the liver from ___.\n\nAirways are patent to the subsegmental level bilaterally.\n\nRight lower lobe pulmonary nodule has substantially increased in size from 2.8\nmm to 5 mm, series 4, image 25.  Left lower lobe nodule is new, series 4,\nimage 237, 2.7 mm.\n\nRight upper lobe nodule, series 4, image 89 is 3 mm, stable as well as left\nupper lobe, series 4, image 94, 3 mm in diameter.\n\nThere are no lytic or sclerotic lesion worrisome for infection or neoplasm.",
            "output": "Interval increase in size in 1 nodule in the right lower lobe and development\nof a new nodule in the left lower lobe.  Findings are concerning for\nprogression of metastatic disease.\n\nUnchanged hilar lymph nodes and 2 upper lobe nodules, most likely unrelated to\nmetastatic disease.\n\nLimited assessment of multiple liver lesions with increase in decreased\nenhancement.  For pre size details please review to MRI of the liver from ___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to concurrent CT abdomen report.\n\nMEDIASTINUM:  No mediastinal mass or lymphadenopathy.\n\nHILA:  No hilar lymphadenopathy.  9 mm right hilar lymph node is similar to\nprior.\n\nHEART and PERICARDIUM: Heart size is normal.  There is coronary artery\ncalcification.   No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Multiple bilateral scattered pulmonary nodules (10:59, 138,\n163, 177, 199, 200, 232) are larger compared to prior, the largest in the\nright lower lobe measuring up to 7 mm, which was 5 mm on prior.  No focal\nconsolidation.  Other pulmonary nodules are similar to prior (10:79, 81, 138,\n195, 196).  Right apical ground-glass opacity (10:44) is similar to prior.\n2. AIRWAYS:  The airways are patent to subsegmental levels.\n3. VESSELS:  The great vessels are normal caliber.  Other than a few left\nlower lobe subsegmental pulmonary arteries which are not well evaluated, there\nis fairly good contrast opacification of the other pulmonary arteries and no\nfilling defect to suggest pulmonary embolism.\nCHEST CAGE: No suspicious lytic or sclerotic lesion.  No acute fracture.",
            "output": "Interval enlargement of multiple bilateral pulmonary nodules, presumably\nmetastases."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  Minimal soft tissue\ndensity in the anterior mediastinum to remnant thymus.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Minimal biapical scarring is present.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  The colon and rectum are within normal limits.  The appendix\nis not visualized.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.  No retroperitoneal\nmass/fluid collection is identified.\n\nPELVIS: The urinary bladder mildly distended.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no gross lymphadenopathy. Innumerable nonenlarged\nmesenteric and retroperitoneal lymph nodes are identified, and there is mild\nperivascular fat stranding surrounding the celiac axis SMA, nonspecific\nfindings.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No traumatic injury to chest with the limitation of an unenhanced scan.\n2.  Innumerable, not enlarged mesenteric and retroperitoneal lymph nodes,\nnonspecific but likely reactive."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysm formation.  There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present. There is\na common origin of the brachiocephalic and left common carotid artery.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  Lobulated areas of predominantly\nfatty tissue seen in bilateral breasts, not well evaluated on CT.\n\nThere is a small pericardial effusion.  There is no pleural effusion.\n\nMild bibasilar atelectasis noted.  The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMild degenerative changes of the thoracic spine noted.  Mild T11 compression\ndeformity is unchanged since ___.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Lobulated predominantly fatty appearing tissue seen in bilateral breasts,\ncan be correlated with prior breast imaging and/or history of surgery."
        },
        {
            "input": "Image thyroid gland is unremarkable. There are nonenlarged paratracheal lymph\nnodes. There are no enlarged mediastinal, axillary, or hilar lymph nodes.\n\nHeart size is within normal limits. There is severe extensive aherosclerotic\ncalcification of the coronary arteries. Postsurgical changes are consistent\nwith sternotomy.\n\nThere is mild atherosclerotic calcification of the aortic ring and valve\nleaflets.  There is atherosclerotic calcification of aortic arch and\ndescending thoracic aorta with more prominent calcification of the imaged\nproximal abdominal aorta. There is no evidence of aneurysmal dilatation.\n\nThere is no consolidation. There is no pulmonary nodule or mass. There is mild\nbilateral subpleural fibrosis, right greater than left. There is irregularity\nmild wall thickening throughout the lobar and segmental bronchi suggestive of\nchronic airway disease. There is no pleural or pericardial effusion.\n\nThere is bilateral gynecomastia. There is no osseous lesion concerning for\nmalignancy or infection. There are degenerative changes of the lower thoracic\nspine\n\nEvaluation of abdominal organs is limited due to lack of intravenous contrast\nand imaging of only the upper abdomen as part of CT chest. There is a 3.2 cm\nmidline fat containing hernia. There is a dependent gallstone within the\ngallbladder without evidence of cholecystitis.",
            "output": "1. Mild calcification of the aortic leaflets and ring, unlikely to be of\nrelevant clinical significance.\n2. Mild bilateral subpleural fibrosis, right greater than left.\n3. Areas of mild irregular bronchial wall thickening suggestive of chronic\nairway disease.\n4. Extensive atherosclerotic calcification of the coronary arteries.\nAtherosclerotic calcification of thoracic, descending thoracic aorta, and\nproximal abdominal aorta."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there is no soft tissue\nabnormality in the chest wall suspicious for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows normal\nsize adrenal glands.  Patient has had cholecystectomy.\n\nThyroid is un are.  Atherosclerotic calcification is moderate in head neck\nvessels particularly the origin of the left common carotid artery, present\nalso in the majority of coronary arteries.  Aorta is normal size and the\naortic valve is not calcified.  Pulmonary arteries and cardiac chambers are\nnormal size.  Pericardium and pleura are physiologic.\n\nMediastinal lymph nodes are not pathologically enlarged and hilar contours do\nnot suggest adenopathy.\n\nEmphysema is mild to moderate, most severe in the upper lobes.\nApical pleural parenchymal scarring is relatively mild.\n\nA small region of peribronchial infiltration, micro nodulation and\nground-glass opacity in the axillary subsegment of the left upper lobe, 5:90,\nis the residual of a remote, left upper lobe pneumonia in ___, probably\nnot active infection.\n\nA spiculated, stellate 10 x 15 mm opacity in the superior segment of the left\nlower lobe is unchanged since ___, but substantially larger than it\nwas on ___.  There is local extension to minimally thickened\npleura, but no pleural effusion or distinct pleural nodulation.\n\nThere are no new lung lesions.  Mild bronchial wall thickening and retention\nof secretions in the right lower lobe indicate relatively mild bronchial\ninflammation.  Otherwise lungs are clear of new abnormalities.\n\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  A discrete subcortical lucency in the posterior aspect of a mid\nthoracic vertebral body, 8:67, 5:141, is unchanged since ___, not an\nactive lesion.",
            "output": "10 x 15 mm lung lesion, superior segment left lower lobe, stable since\n___, but substantially larger since ___, concerning for\nslowly developing malignancy, with possible local extension to the pleura,\ncould alternatively be an indolent infections, caused by pathogen like\nnon-tuberculous mycobacterial infection.  Transthoracic or transbronchial\nsampling should be considered.  No lymphadenopathy.\n\nModerate emphysema.\n\nAtherosclerosis, particularly severe left common carotid artery and\ncoronaries.\n\nMild bronchial inflammation.\n\nRECOMMENDATION(S):  Sampling of slowly growing left lower lobe lung lesion."
        },
        {
            "input": "The thyroid gland is unremarkable.  Axillary, supraclavicular, mediastinal,\nand hilar lymph nodes are not enlarged.  Surgical clips are present at the\nright and left hila compatible with prior resection.  The caliber of the aorta\nand main pulmonary vessels are not enlarged.  Atherosclerotic calcifications\nof the aortic arch and the coronary arteries are moderate.  Heart size is\nnormal.  There is no pericardial effusion.  Note is made of rebound thymic\nhyperplasia.\n\nThe airways are patent to the subsegmental level.  Background apical\npredominant centrilobular emphysema is moderate.  Bi-apical scarring is\nrelatively mild.  There is diffuse bronchial wall thickening and irregularity\nwith more focal areas of mucoid impaction in the left lower lobe (5:196-197). \nPatient is status post left lower lobe superior segmentectomy with surrounding\nscarring.  A small region of peribronchial infiltration, micronodulation and\nground-glass opacity in the left upper lobe (5:84) is unchanged and likely\nreflect residual scarring from a remote left upper lobe pneumonia.  Scattered\npulmonary nodules measuring 2 mm are not definitely seen on the prior study\n(5:52, 51, 86, 101, 219), possibly inflammatory in etiology.  In the left\nlower lobe, in the posterior basal segment, there is a nodular area which\nmeasures 11 x 6 mm (5:244) which could represent nodular scarring.  This\nlesion demonstrates mild contrast enhancement.  No large consolidation,\npleural effusion, or pneumothorax.\n\nThe study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate\npost-cholecystectomy changes with a prominent common bile duct but is\notherwise unremarkable.  Bilateral adrenal glands are normal.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  Thoracotomy\nchanges in the left posterior ninth rib are noted.",
            "output": "Status post left lower superior segmentectomy.  No lymphadenopathy.  11 x 6 mm\nnodular opacity in the left lower lobe posterior basal segment which could\nreflect mucoid impaction or scarring but attention on follow-up studies is\nwarranted.  Scattered 2 mm pulmonary nodules not definitely seen on the prior\nstudy are likely inflammatory in etiology but attention on follow-up is also\nrecommended to ensure stability/resolution.\n\nRECOMMENDATION(S):  Repeat chest CT is recommended in 3 months."
        },
        {
            "input": "The left thyroid gland is heterogeneous, with a hypodense lesion measuring up\nto 1.3 cm. There is no axillary, mediastinal, supraclavicular, or hilar\nlymphadenopathy. The heart size is normal. The pericardium is intact without\nevidence of effusion. Note is made of a small hiatal hernia. The esophagus is\notherwise normal without evidence of wall thickening.\n\nCTA:  Multiple filling defects within the pulmonary arterial tree noted\nbilaterally. These are most notable in the lower lobes with lobar and\nsegmental filling defect present. Additionally, involvement of the right\nmiddle lobe and to a lesser extent right upper lobe noted. No saddle pulmonary\nembolism is seen. The main pulmonary artery is mildly enlarged measuring up to\n3.6 cm, concerning for pulmonary hypertension. There is no definite evidence\nof right heart strain. The aorta is normal without evidence of dissection or\naneurysm.  No evidence of pulmonary infarction.\n\nThe airways are patent to the subsegmental levels. No nodules concerning for\nmalignancy are identified. A granuloma is seen in the left lower lobe\nmeasuring 2 mm, series 3, image 71.  There is no pleural effusion or\npneumothorax. Note is made of mild bibasilar atelectasis.\n\nThe study is not tailored for the evaluation of subdiaphragmatic structures,\nhowever no acute intra-abdominal abnormalities identified.\n\nOSSEOUS STRUCTURES: No lytic or blastic lesions concerning for malignancy is\nidentified.",
            "output": "1.  Lobar and segmental pulmonary emboli most notable in the lower lobes\nwithout evidence of infarct or acute right heart strain.\n2.  Left thyroid nodule measuring up to 1.3-cm, which can be further evaluated\nby ultrasound.\n\nNOTIFICATION:  ___ were d/w Dr. ___ at 8p on the day of the exam by phone\napproximately 5-minutes after the exam was performed."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis in the bilateral lower\nlobes and subsegmental atelectasis in the right middle and left upper lobes. \nThere is no airspace consolidation.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThyroid is unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Thyroid is generally enlarged, producing minimal narrowing of the upper\ntrachea.  Calcifications and a 12 mm hypodensity in the larger right lobe do\nnot warrant further imaging evaluation.\n\nAtherosclerotic calcification is moderately extensive in the head and neck\nvessels, and severe in the major coronary branches.  Aortic valvular\ncalcification is heavy and most likely hemodynamically significant.  Heavy\ncalcification in the mitral annulus is of uncertain clinical significance. \nThe thoracic aorta is normal caliber reaching a maximum diameter in the\nascending portion of 37 mm which is minimally calcified.  Heart is at least\nmoderately enlarged, especially the left atrium and ventricle.  Pulmonary\narteries are normal size.  There is no pericardial or pleural effusion.\n\nAtherosclerotic calcification is also heavy in the abdominal arteries,\nparticularly the renal arteries, which may be substantially narrowed. \nLow-attenuation lesions in the interpolar regions of both kidneys are\npresumably cysts.\n\nEsophagus is unremarkable.  A 12 x 24 mm right lower paratracheal lymph node\nis the only good evidence for central adenopathy.\n\nPrevious pulmonary edema has essentially resolved since ___.  Mild\nheterogeneity in the background density of the lungs vertically inferiorly\ncould be due to air trapping or residual edema.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.  There\nis severe disc degeneration in the lower thoracic and lumbar spine\ncharacterized by large osteophytes, endplate irregularity with large disc\nintrusions, and vacuum discs.",
            "output": "Severe aortic valvular calcification, probably stenotic.  Severe coronary\natherosclerosis.  Heavy mitral annulus calcification, could contribute to\nmitral regurgitation.  Little if any residual pulmonary edema currently.\n\nNo evidence of lung disease.\n\nPossible atherosclerotic renal artery stenosis."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  There is no axillary, supraclavicular, mediastinal, or hilar\nadenopathy.\n\nAortic valvular calcifications are mild.  The ascending aorta is non\naneurysmal in the main pulmonary artery within normal limits in caliber. \nTrace pericardial fluid is physiologic.  Heavy atherosclerotic calcific\nstations involve the aortic arch.  Heart size is within normal limits.\n\nTracheobronchial tree is patent.  Moderate centrilobular emphysema is diffuse.\nA 3 mm nodule within the right middle lobe (02:22) is noted.  There is no\npleural effusion.  There is no pneumothorax.\n\nExamination is limited in the absence of intravenous contrast.  Allowing for\nthis, the liver is homogeneous in attenuation without a focal lesion.  There\nis no intrahepatic duct dilation.  There is no radiopaque cholelithiasis.  The\npancreas is without pancreatic duct dilation.  The spleen and bilateral\nadrenal glands are unremarkable.  There is no nephrolithiasis.  There is no\nperinephric abnormality.  Unenhanced kidneys appear symmetric in size without\na focal lesion.\n\nThe stomach, duodenum, and loops of small bowel are grossly normal.  The\nappendix is difficult to visualized.  There is moderate fecal loading within\nthe cecum and rectum.  There is no abdominal free fluid or air.\n\nExtensive atherosclerotic calcifications involve the abdominal aorta which is\nnon aneurysmal.  There is no retroperitoneal or mesenteric adenopathy.\n\nThe bladder is moderately well distended, grossly unremarkable.  There is no\npelvic free fluid.  There is no adnexal mass.  There is no inguinal or pelvic\nsidewall adenopathy.\n\nThere is no rib fracture.  Compression deformities of the L5 and L1 vertebral\nbodies appear stable since ___.  T4 compression fracture appears to have\nprogressed minimally since examination dated ___.  Relative to ___, there is\na new T9 vertebral body compression fracture, age-indeterminate.  There is no\nlarge prevertebral hematoma.  No worrisome osseous lesion is identified.",
            "output": "1.  Compression fracture of the T9 vertebral body is new since ___ but remains age-indeterminate.  There is no large prevertebral hematoma. \nCompression deformity of T4 appears to be minimally progressed.  L1 and L5\ncompression deformities are stable.\n2.  Diffuse moderate centrilobular emphysema.\n3.  Extensive atherosclerotic calcifications involve the aortic arch and\nabdominal aorta which is nonanuerysmal.\n4.  Moderate stool burden within the colon."
        },
        {
            "input": "HEART AND VASCULATURE: No pericardial effusion.  The thoracic aorta is normal\nin caliber.  Aortic valve calcifications are moderate.  Coronary artery\ncalcifications are mild.  Aortic arch and great vessel origin calcifications\nare moderate with mild stenosis of the left subclavian artery origin.  No\nevidence of thoracic aortic dissection.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild biapical scarring and moderate upper lobe\npredominant centrilobular emphysema.  There is a 5 mm left upper lobe\npulmonary nodule (series 3, image 100) and a 4 mm right upper lobe pulmonary\nnodule (series 3, image 71).  There are a few other scattered pulmonary micro\nnodules.  A 1.3 cm predominantly fatty pulmonary nodule in the left lower lobe\nposterior basal segment is consistent with a pulmonary hamartoma.  There is\nmild basilar interlobular septal thickening.  There is mild diffuse bronchial\nwall thickening and subsegmental mucous impaction.  There are calcified\npunctate biapical pulmonary granulomas.\n\nABDOMEN: The liver demonstrates multiple hypodense lesions too small to\ncharacterize and in a right hepatic hemangioma with an adjacent perfusion\ndefect.  The spleen, pancreas, adrenal glands and right kidney are\nunremarkable except for a hypodense right renal and splenic lesion too small\nto characterize.\n\nThere is a 1.2 x 1.2 cm heterogeneous lesion in the interpolar left kidney\n(series 2, image 145; series 607, image 35).  A hypoattenuating lesion in the\nright kidney is too small to completely characterize.\n\nNo infrarenal abdominal aortic aneurysm.\n\nGASTROINTESTINAL: There is no small intestinal obstruction or ascites, however\nthe stomach is at least moderately distended with fluid. Incidental small\nperiampullary duodenal diverticulum.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid.  Hysterectomy changes are present. \nThere is a 2.5 cm left ovarian cystic lesion.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen. \nSequela of prior surgery seen in the anterior abdominal wall.  There are\nsmall, fat containing bilateral inguinal hernias.  A calcified nodule\noverlying the left gluteus maximus musculature probably reflects an injection\nsite granuloma.  Lateral right fourth and fifth rib fractures appear chronic.",
            "output": "1. Moderate centrilobular emphysema. Mild basilar interstitial pulmonary\nedema. No pulmonary embolus.\n2. Moderate distention of the stomach which is filled with fluid, raising\nconcern for gastric outlet obstruction, particularly in the setting of\nmultiple episodes of nausea and vomiting.  Consider endoscopy if one has not\nbeen performed recently.\n3. Additional incidental findings as follows:  1.3 cm heterogeneous left renal\nlesion raises possibility of a solid renal mass. Nonemergent MRI is\nrecommended.  Pulmonary nodules and micro nodules measure up to 5 mm. For\nincidentally detected multiple solid pulmonary nodules smaller than 6mm, no CT\nfollow-up is recommended in a low-risk patient, and an optional CT follow-up\nin 12 months is recommended in a high-risk patient. 1.3 cm left ovarian cystic\nlesion.  At this age, consider ultrasound in ___ year for follow-up. \nAlternatively, all these findings could be followed with a CT to reassess for\ninterval change.\n\nRECOMMENDATION(S):\n1. A 1.3 cm heterogeneously hypoenhancing lesion in the interpolar left kidney\nis most concerning for papillary renal cell carcinoma with other differential\nconsiderations including an oncocytoma or fat poor angiomyolipoma. Recommend\nnonemergent renal MRI for further evaluation.\n2. Pulmonary nodules and micro nodules measure up to 5 mm. For incidentally\ndetected multiple solid pulmonary nodules smaller than 6mm, no CT follow-up is\nrecommended in a low-risk patient, and an optional CT follow-up in 12 months\nis recommended in a high-risk patient.\n3. There is a 1.3 cm left ovarian cyst. Recommend follow-up pelvic ultrasound\nin one year.\n4. The stomach is distended with fluid.  Recommend nonemergent upper\nendoscopy.\n\nNOTIFICATION:  The updated recommendation regard were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 8:52\nam."
        },
        {
            "input": "Patient has right humeral head metallic prosthesis, beam hardening artifact\nlimits assessment of the thoracic inlet. Within this limitation, the thyroid\nappears normal.\nThere is extensive peripheral and central lymphadenopathy. Right axillary\nlymph node (series 2: Image 17) is 11 x 21 mm; left axillary lymph node is 35\nx 40 mm (02:14) ; left supraclavicular lymph node (2:80) is 10 x 14 mm;\nprevascular lymph node 02:20) is 25 x 18 mm; right hilar lymph node (02:25) is\n18 x 28 mm; left hilar lymph node (02:24) is 14 x 16 mm.\nAorta and pulmonary arteries are normal size.  Heart size mildly enlarged, and\nthere is mild coronary calcification in the mid left anterior descending\ncoronary artery.\n\nThere is no pericardial. Moderate nonhemorrhagic pleural effusion is layering\nin the dependent left lung regions, and compressing the left lower lobe which\nis almost completely collapsed except for part of the superior segment.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally. Severe breathing\nartifact limits assessment of lung parenchyma.  Within this limitation there\nare no lung nodules suspicious for malignancy. Partial consolidation of the\nmedial segment of the right middle lobe is compatible with pneumonia (series\n4: Image 136). There is partial atelectasis of the posterobasilar segment of\nthe right lower lobe (04:18 9).\n\n\nUPPER ABDOMEN\nAbdominal findings as described in report of concurrent CT abdomen and pelvis\n___. NG tube has tip ending in the distal gastric cavity.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. Extensive peripheral and central lymphadenopathy is concerning for a\nlymphoproliferative disorder.\n2. Moderate left plural effusion produces almost complete collapse of the left\nlower lobe\n3. Consolidation in the medial segment of the right middle lobe is compatible\nwith pneumonia.\n4. Despite the severe breathing artifact, there is no definite evidence of\nlarge malignant lesion within the lung parenchyma"
        },
        {
            "input": "BASE OF NECK, THYROID, LYMPH NODES: There is no supraclavicular or axillary\nlymphadenopathy.\nMediastinal lymphadenopathy is extensive for example -  AP window lymph node\nup to 2.8 x 1.6 cm (04:48), or in the right upper and lower paratracheal\nstations 2.2 x 1.7 cm.  In the right hilum 2.6 x 1.6 cm lymph nodes.  Smaller\nlymph node in the left hilum up to 1.2 cm.\nVital structures are not compromised.\nIn comparison to CT head and neck ___ there has been no significant\nchange in the imaged lymph nodes.\nThyroid was not imaged.\n\nUPPER ABDOMEN: Mild nodular contour of the liver with relative enlargement of\nthe left lobe suggest cirrhosis.  0.5 cm hypodense lesion in the right lobe of\nthe liver is too small to characterize.\nRemaining included upper abdominal organs are unremarkable.\nSmall left Bochdalek hernia transmitting only fat.\n\nHEART AND PERICARDIUM: The heart is normal in size, there is no pericardial\neffusion.  Extensive atherosclerotic calcifications of the coronaries\npredominantly of the LAD and RCA.  Dense calcifications of mitral valve,\npapillary muscles and aortic annulus.  Extensive calcifications noted also\nalong the normal caliber thoracic aorta and head and neck vessels.\nMain pulmonary artery 3.4 cm, suggesting pulmonary hypertension.\nThere are no central, lobar, segmental filling the to suggest pulmonary\nemboli.\n\nLUNG PLEURA: Airways are patent to the subsegmental level bilaterally.  Mild\ndiffuse airway wall thickening associated with diffuse septal line thickening\nand extensive mosaic pattern of attenuation. The no consolidations.\nMinimal bilateral thickening of the pleura with most probably microatelectasis\nand no pleural effusion. No pneumothorax.\n\nCHEST CAGE: Multilevel moderate degenerative change of the spine with no\nevidence of lytic or sclerotic bone lesions.  No evidence of compression\nfractures",
            "output": "-No evidence of central, lobar, segmental pulmonary emboli.\n-Main pulmonary artery mildly dilated suggesting pulmonary hypertension.\n-Interstitial line thickening and mosaic pattern of attenuation suggest\npulmonary congestion.  No pleural effusion.\n-Mediastinal and hilar lymphadenopathy with the upper mediastinal lymph node\nunchanged since ___, which could represent lymphadenopathy of chronic\ncongestion.  Differential diagnosis includes reactive lymphadenopathy,\nsarcoidosis or low grade lymphoma.\n-Mild nodular contour of the liver with relative enlargement of the left lobe\nsuggest cirrhosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal mass.\n\nEsophagus is unremarkable.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is moderate to heavy in head and neck vessels\nand coronary arteries.  Aortic valvular calcification is mild.  Ascending\nthoracic aorta is normal size, maximum diameter, 36 mm, at the pulmonary\nartery bifurcation.  Intimal calcification is minimal, extending superiorly\nfor only 3 mm above the level of the right coronary orifice.  Intimal\ncalcification is substantially heavier in the aortic arch and descending\nthoracic aorta.\n\nPericardium is physiologic.  There is no pleural abnormality.\n\nThoracic lymph nodes:\n\nNo adenopathy by size criteria.\n\nLungs and airways:\n\nRespiratory motion might obscure tiny nodules and wall thickening of small\nbronchi, but in all other respects, lungs are clear.  Tracheobronchial tree is\npatent to subsegmental levels.\n\nChest cage:\n\nUnremarkable.",
            "output": "Ascending thoracic aorta normal caliber, no appreciable intimal calcification.\n\nModerate to heavy atherosclerotic calcification, head and neck and coronary\narteries."
        },
        {
            "input": "The patient is status post left hemithyroidectomy. The right thyroid is\nheterogeneous without discrete nodules. Median sternotomy wires are present.\n\nAxillary, supraclavicular, and hilar lymph nodes are not pathologically\nenlarged. Mediastinal lymph nodes are top normal in size measuring up to 9 mm,\nlikely reactive.\n\nAn endotracheal tube terminates in appropriate position.\n\nThe great vessels are normal caliber.  Dense thoracic aorta, aortic valve,\nmitral annular, and coronary calcifications are present.\n\nThe heart size is top-normal in size.  No pericardial effusion.\n\nThere is narrowing of the right and left mainstem bronchus, compatible with\nbronchomalacia.\n\nA left posterior tube is present.  The left pleural effusion has nearly\nresolved. A small amount of fluid remains in the fissure and laterally.\n\nA small to moderate nonhemorrhagic right pleural effusion is stable. Severe\nbibasilar consolidation has progressed with more narrowing of the bronchial\ntree peripherally. Bronchiolar nodulation in the lingula has increased.\n\nThere is no pneumomediastinum or pneumothorax.\n\nThe esophagus are unremarkable.  There is an atrophic right kidney.  An\norogastric tube coils within the stomach.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Subtle areas of sclerosis within the inferior and superior\nendplates of the vertebral bodies as well as lucency along the sternum,\npossibly related to chronic renal failure.",
            "output": "1. Substantial evacuation of left pleural effusion, particularly the\nsubpulmonic component, after basal chest tube placement, with a small fissural\nand upper lateral component remaining.\n2. Stable small to moderate nonhemorrhagic right pleural effusion.\n3. Worsening bibasilar consolidation, likely a combination of infection and\ncollapse."
        },
        {
            "input": "The patient is intubated.  Mildly enlarged right thyroid.  Unchanged\nappearance of the large mediastinal vessels.  Unchanged partly calcified and\npartly borderline sized to slightly enlarged mediastinal lymph nodes (2, 28). \nBorderline diameter of the pulmonary artery.  Massive coronary calcifications,\nstatus post CABG.  Moderate to severe aortic valve calcifications.  Stable\nbilateral pleural effusions that are likely an capsulated.  The subsequent\nareas of parenchymal atelectasis, predominating in the lower lobes, are also\nconstant.  A pre-existing cluster of parenchymal opacities in the apical\nsegment of the left lower lobe (2, 29) has decreased in extent and severity. \nPre-existing ground-glass opacities in the upper lobes are less widespread and\nmore nodular in appearance on today's examination (2, 17).  Unchanged\nappearance of the bones.",
            "output": "Unchanged mild mediastinal adenopathy.  Status post CABG with severe coronary\nand aortic valve calcifications.  The partly loculated bilateral pleural\neffusions with subsequent areas of parenchymal consolidation are constant. \nThe pre-existing parenchymal opacity in the apical segment of the left lower\nlobe is better defined and smaller than on the previous examination.  The\npre-existing upper lobe ground-glass opacities are less extensive than on the\nprevious examination and show a more nodular appearance."
        },
        {
            "input": "a 12 mm hypodense nodule in the right lobe of the thyroid unchanged from\nprior.  Tracheostomy tube is in standard position.  Left central catheter tip\nis in the IVC.  There is mild cardiomegaly.  Hypodensity of the cardiac\nchambers compared to the myocardium suggests anemia.  There is dense\ncalcification of the mitral annulus.  Mild calcification of the aortic valve\nis of unknown hemodynamic significance. there are severe calcifications in all\ncoronary arteries.  There is no pericardial effusion.  Large non-hemorrhagic\nlayering right pleural effusion has increased from prior.  Small left effusion\nis grossly unchanged there is a basal left pleural catheter .  Mediastinal\nlymph nodes are unchanged.  The aorta is normal in caliber.  The main\npulmonary artery is enlarged as before measuring 3.5 cm.\nLoculated left basal pneumothorax is new.  Atelectasis in the left base is\ngrossly unchanged.  Right lower lobe atelectasis has increased.  Opacities in\nthe upper lobes left greater than left have worsened consistent with worsening\npneumonia.  Right middle lobe atelectasis has worsened.\nThe shape of the trachea and marked collapsibility of the bronchus\nintermedius, right lower lobe bronchi and right middle lobe suggests\nbronchomalacia, this study is not tailored to evaluate these pathology\nBilateral enlarge axillary lymph nodes are unchanged\nThis examination is not tailored for subdiaphragmatic evaluation.  The\nvisualized upper abdomen is unremarkable.\nExtensive increased density of all the visualized bones, likely is related\nwith renal function.  Sclerotic focus at T5 and T12 are more conspicuous than\nbefore.",
            "output": "Increased right pleural effusion\nNew loculated left Basal pneumothorax.\nTip of the left central catheter is in the IVC\nCalcification of the in the aortic valve is of unknown hemodynamic\nsignificance\nEnlarged pulmonary artery suggests pulmonary hypertension\nIncreased opacities in the upper lobes are worrisome for worsening multifocal\npneumonia\nIncreased right middle lobe, right lower lobe atelectasis\nFindings suggestive of tracheobronchomalacia"
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The para opacification\nof the aorta is suboptimal however no obvious dissection flap is seen.  There\nis atherosclerotic calcification involving the descending thoracic aorta\n\nTHORACIC INLET: Patient status post total laryngectomy, in the interim.  There\nare also a post radiation changes to the left apex\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  A right paratracheal\nnode measures 7 mm.  A prevascular node measures 9 mm.  Another pre-vascular\nnode measures 9 mm.  There is moderate cardiomegaly.  The main pulmonary\nartery measures 38 mm.  There is evidence of right ventricular dilatation\nwhich could be related to right heart failure.  There is no pericardial\neffusion.\n\nThe esophagus is dilated in the upper aspect of the chest the esophagus is\npatulous and dilated, could be secondary to motility disorder.\nThere is evidence of tracheal esophageal fistula at the level of the thyroid\ncartilage (4, 7).  Confirm Asian within endoscopy is recommended.  Significant\namount of secretions are seen within the trachea bilaterally.\n\nPLEURA: There is no pleural effusion.  There are calcified and noncalcified\nbilateral pleural plaques related to prior asbestos exposure.\nLUNG: There is diffuse ___ nodularity throughout the right lung which\nis most likely related to aspiration and represents an aspiration pneumonia.\n\nThe there is extensive destruction of the lung parenchyma in the left upper\nchest with evidence of a traction bronchiectasis and fibrosis within the left\nlung which could be related to see clear of prior infection or radiation. \nEvidence of ___ nodularity within the left lower lobe could also\nrepresent aspiration.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Patient status post median sternotomy.  Sternal sutures\nare intact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable\n\n THORACIC INLET: Patient status post laryngectomy in ___ for small SCC. \nThere are no enlarged supraclavicular lymph nodes.",
            "output": "Status post total laryngectomy in the interim with evidence of a\ntracheoesophageal fistula at the level of the thyroid cartilage (4, 7). \nConfirmation with endoscopy is recommended.\n\nSecretions within the trachea and both mainstem bronchi.  Evidence of\naspiration to both lungs with significant aspiration pneumonia throughout the\nright lung and left lower lobe.  Evidence of parenchymal destruction and\ndistortion with evidence of fibrosis within the left upper lobe could be\nsecondary to prior infection or radiation therapy.\n\nSmall mediastinal lymph nodes slightly increased in volume since the prior\nstudy could be reactive.\n\nEvidence of pulmonary arterial hypertension and right heart failure, could be\nsecondary to parenchymal abnormality and could represent cor pulmonale.\n\nCalcified and noncalcified pleural plaques bilaterally related to prior\nasbestos exposure.\n\nPatulous dilated esophagus could be related to motility disorder."
        },
        {
            "input": "Air is demonstrated within the left lower neck, as well as along the aortic\narch branches, continuing along the aortic arch as well as in the posterior\nmediastinum surrounding esophagus and aorta, with the most substantial amount\nof posterior mediastinal air as well as intraperitoneal air demonstrated,\nincreased as compared to chest radiograph obtained the same day early a,\nseries 2, images 53.  There is small amount of left pleural effusion,\nnonhemorrhagic containing small amount of contrast potentially reflecting the\ncontrast material.\n\nImage portion of the upper abdomen reveals evidence of substantial amount of\nmesenteric and retroperitoneal air.  The air is demonstrated surrounding the\ngreater and lesser curvature of the stomach as well as the duodenum and can\nalso be seen along the portal veins.  No other abnormalities within the\nabdomen demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete nodules\nor masses demonstrated.  Bibasal areas of atelectasis are present.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\ndetected within the bones.",
            "output": "Substantial amount of pneumomediastinum predominantly in the lower mediastinum\nsurrounding the gastroesophageal junction continuing to warrant the\nretroperitoneum with extensive involvement of the retroperitoneum tracking\naround the stomach the duodenum and the hepatic vasculature.  Most likely the\nlocation of the tear is in the distal esophagus around the gastroesophageal\njunction.\n\nSmall amount of left pleural effusion with minimal amount of contrast,\npotentially related to the esophagram.\n\nUnremarkable appearance of sternotomy and sternotomy wires.\n\nCompression fractures of the mid thoracic vertebral bodies."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  Heart size is normal.  There is no pericardial pleural\neffusion.  Large hiatal hernia is re- demonstrated.\n\nImage portion of the upper abdomen reveals no appreciable abnormality\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  Airways are\npatent to the subsegmental level bilaterally.  Right middle lobe area of\natelectasis is similar to previous examination. Right lower lobe pulmonary\nnodule is unchanged, series 4, image 144, 5.5 mm. No new pulmonary nodules,\nmasses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of nodules progression.\n\nLarge hiatal hernia"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nSubpleural dependent posterior opacities in the lower lobes bilaterally are\nlikely atelectasis.  Largest opacity in the right lower lobe correspond to\natelectasis..  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "A PICC line terminates at the junction of the subclavian and right internal\njugular veins.  Dialysis catheter terminates in the mid to lower superior vena\ncava.\n\nPercutaneous ICD noted. Tip projects over the right upper chest. Device\nprojects over left lateral soft tissues.\n\nHeart is mildly enlarged, especially the left atrium.  Mitral and aortic\nvalves are calcified.  The aorta is normal in caliber with patchy\ncalcification.  Central pulmonary arteries are also normal in caliber.\n\nNo enlarged lymph nodes are identified.  There is no pericardial effusion. \nBilateral pleural effusions are medium in size with associated volume loss\ninvolving basilar segments of each lower lobe.  Motion artifact obscures\nparenchymal detail to a large extent.  However a couple of very small nodules\nare suspected: A possible 3 mm right upper lobe nodule (302:74) and a possible\nnodule measuring 4 mm in the left upper lobe (302:57).  These are probably not\nsignificant clinically.\n\nSmall to medium-sized hiatal hernia.\n\nAbdomen is reported separately.\n\nBones appear demineralized.  There are no suspicious bone lesions.",
            "output": "1.  Medium-sized bilateral pleural effusions without opacities at each lung\nbase.  These are highly characteristic of atelectasis.  Although doubtful,\npresence of superinfection cannot be excluded by this study.\n\n2.  Mildly enlarged heart.\n\n3.  Couple of small suspected nodules measuring up to 4 mm.  If there are risk\nfactors such as smoking, occupational exposure or family history of pulmonary\nmalignancy then follow-up chest CT could be given consideration in ___ year.\n\n4.  Hiatal hernia."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.   The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There are\nno findings of diffuse lung disease.  A few punctate pulmonary nodules are\nseen bilaterally (7:87, 196, 202).  A 5 mm poorly characterized opacity in the\nright upper lobe (7:113) may represent a nodule.  Calcified granulomas are\nseen in the right lung, the right hilus, and a sub- carinal lymph node,\nwithout evidence of active infection.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.  In the medial left breast\nthere is a 1.4 x 1.3 cm hypodense fluid collection containing a punctate\nhyperdense focus centrally.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1.  A 5 mm poorly characterized opacity in the right upper lobe may represent\na nodule.  A few additional punctate pulmonary nodules are seen bilaterally. \nRecommend followup CT in ___ months to evaluate stability.\n\n2.  1.4 cm hypodense fluid collection in the medial left breast containing a\npunctate hyperdense focus consistent with an abscess or post biopsy seroma. \nRecommend correlation with history, physical exam, and mammography for further\nevaluation.\n\n3.  Findings within the abdomen and pelvis will be reported separately by the\nAbdominal Radiology division.\n\nRECOMMENDATION(S):  1.  A 5 mm poorly characterized opacity in the right upper\nlobe may represent a nodule. Recommend followup CT in ___ months to evaluate\nstability.\n\n2.  1.4 cm hypodense fluid collection in the medial left breast containing a\npunctate hyperdense focus may be consistent with an abscess or post biopsy\nseroma.  Recommend correlation with history, physical exam, and mammography\nfor further evaluation.\n\n\n\nNOTIFICATION:  These findings were discussed with Dr.  ___ by Dr. ___\ntelephone at 10:45 on ___, 10 minutes after discovery."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is top-normal.  No pericardial effusion is\nseen.  Main pulmonary artery is dilated measuring up to 3.6 cm.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate bilateral nonhemorrhagic pleural effusions.  No\npneumothorax\n\nLUNGS/AIRWAYS: There is mild interlobular septal thickening predominantly in\nthe upper lungs, where there is also ground-glass opacities suggesting mild\npulmonary edema.  Atelectasis in the lower lobes likely compressive in the\nsetting of moderate layering pleural effusions.  Notable bronchiectasis in the\nright lower lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for arterially\nenhancing subcentimeter lesion in the left lobe of the liver, nonspecific but\nlikely benign is absence of history of malignancy.  Subcentimeter hypodensity\nin the right lobe of the liver appear since a simple cyst or biliary\nhamartoma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Top normal heart size, moderate layering pleural effusions, mild pulmonary\nedema, compressive lower lobe atelectasis.\n3. Right lower lobe bronchiectasis."
        },
        {
            "input": "Aorta is minimally dilated up to 4.1 cm.  Pulmonary arteries are unremarkable.\nCoronary calcifications are extensive.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality but will\nbe discussed separately as part of the CT abdomen and corresponding report\nwill be issued.  There is no pericardial effusion.  No mediastinal, hilar or\naxillary lymphadenopathy is present.\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules masses or consolidations demonstrated.  Heterogeneous E of the lung\nparenchyma reflecting mosaic attenuation in this patient with a study obtained\nin suboptimal inspiration might reflect small airway disease.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic malignancy.\n\nMinimal dilatation of ascending aorta, overall unchanged.\n\nResolution of pericardial in pleural effusion previously seen.\n\nMosaic attenuation, potentially reflecting small airway disease."
        },
        {
            "input": "There are no pathologically enlarged axillary, supraclavicular, mediastinal,\nor hilar lymph nodes by CT criteria. Heart is normal size. Diffuse coronary\nartery calcifications are present. There is no pericardial effusion. Thoracic\naorta and main pulmonary artery are of normal caliber.\n\nAirways are patent to subsegmental level.  Scattered ill-defined heterogeneous\nareas within the lung parenchyma showing different degrees attenuation, mosaic\npattern, are most consistent right air-trapping. There is no nodule concerning\nfor malignancy. No  Focal consolidation. Minimal dependent atelectasis. No\npleural effusion.\n\nThis study is not optimized for evaluation of subdiaphragmatic structures\nhowever, limited assessment of partially imaged upper abdomen is remarkable.\n\nNo lytic or sclerotic osseous lesion concerning for malignancy identified.\nDegenerative changes in the spine are noted.",
            "output": "No evidence of pneumonia or concerning pulmonary nodules."
        },
        {
            "input": "Study is slightly limited by breathing motion.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present. However,\nthere is moderate amount of calcified atherosclerotic plaques in the coronary\narteries.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion.\n\nBased on axial view, there appears to be a cavitary nodule (image 3:168), but\nin conjunction with sagittal and coronal views this lesion appears more like\nchronic scarring which is similar in appearance from ___ study. There are\notherwise no lung parenchymal changes. There is no pleural effusion. The\nairways are patent to the subsegmental level.\n\nThere are small mildly prominent mediastinal lymph nodes. There is no\nsupraclavicular, axillary or hilar lymphadenopathy.\n\nThe thyroid gland appears unremarkable.\n\nThe liver is unremarkable.\n\nPancreatic calcifications are again seen, consistent with history of\npancreatitis. There is no adjacent acute inflammatory changes to suggest acute\npancreatitis by imaging. There is a lesion arising from the pancreatic tail,\nwith ill-defined borders but measuring up approximately 1.7cm TV x 1.6 cm AP,\nwhich is new since ___ (image 2:118). As this study is not designed for the\nevaluation of subdiaphragmatic structures, we would recommend dedicated CT or\nMRI (as patient just received contrast) for further characterization. \nHowever, per conversation with Dr. ___ has already\nobtained a dedicated MRI study from OSH which showed this lesion to be more\nconsistent with sequela of chronic pancreatitis.\n\nNo osteolytic or osteoblastic osseous lesion suspicious for malignancy is\nidentified. Osteophytosis and endplate changes are seen in the lower thoracic\nspine.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Moderate coronary atherosclerotic disease.\n3.  Hypodense lesion arising from the pancreatic tail, measuring 1.7cm TV x\n1.6 cm AP, new since ___.  Per conversation with Dr. ___\nhas a recent OSH MRI study which showed this lesion to be more consistent with\nchronic pancreatitis.\n\nNOTIFICATION:  Findings communicated with Dr. ___ by Dr. ___\nthe telephone at 10:40 on ___, 15 minutes after images were\nreviewed."
        },
        {
            "input": "Left-sided PICC line terminates at the cavoatrial junction. The heart is\nnormal in size. There is no pleural pericardial effusion. Coronary artery\ncalcifications are present. There is no lymphadenopathy.\n\nA 2-3 mm nodule in the right upper lobe is probably calcified and appears\nunchanged (5:69) suggesting a granuloma. At the right apex there is a small\ncavitating nodule which measures 4 mm in diameter (5:55) which is unchanged in\nsize although the cavitation is new. Although a cavitary lesion in the left\nupper lobe has increased in size (the mid to lower portion can be measured as\nup to 22 x 14 mm in axial ___ compared to 16 x 11 mm before) there is\nmarked decrease in surrounding ground-glass and the solid components and\ndebris within it have decreased mostly. In the lingula there is an additional\nlesion and the type of evolution is very similar. On this study the lesion\n(5:158) measures up to 20 x 18 mm compared to 18 x 13 mm before but debris and\nsoft tissue components have again markedly decreased. The lesion does show\nmildly irregular wall thickening with a rim measuring up to 3 mm. Ground-glass\nhas also decreased.\n\nA tiny nodule in the inferior left lower lobe (5:280) measures only 3 mm. An\nadditional nodule in the left lower lobe measures 5 mm (5:243) and appears\ntriangular, possibly a incidental nodule. Also in the left lower lobe is a\nslightly larger irregular nodule, now measuring 7 by 6 mm (5:212) which is\nunchanged in size to slightly increased from 5 x 6 mm but similar to other\nchanges, mainly again noteworthy for new cavitation. Additional left lower\nlobe cavitating nodule measures 5 mm (5:167), unchanged side again cavitation\nis new. An increased soft tissue nodule measures 7 mm compared to 6 mm before\n(5:154) and does not show cavitation. In the right upper lobe a 2 mm nodule\nwith pleural tagging (5:114) appears unchanged suspected to be incidental.\nPatchy medial left lower lobe opacity suggests minor unchanged atelectasis.\n\nCalcifications of the pancreas suggest chronic pancreatitis. The spleen is\nnormal in size.\n\nThere are no suspicious bone lesions.",
            "output": "1.  Existing pulmonary nodules show interval enlargement and cavitation but\nwith decrease in surrounding ground glass and internal solid elements.  This\nis suspected to reflect a positive treatment effect.  One soft tissue nodule\nin the left lower lobe shows minimal increase without cavitation, however. \nDifferential considerations including angioinvasive Aspergillus, which would\nfit several features well including initial presentation with ground glass and\nevolution to cavitating nodules, although there are a number of possible\ncauses of cavitating nodules including fungal infection, septic emboli, and\nvasculitis.\n\n2.  Coronary artery calcifications."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is mild calcification in the LAD.  There is\nno pleural or pericardial effusion.\nFocal area of peribronchial ground-glass opacities in the paraspinal left\nlower lobe inferiorly (5:243) has minimally increased from prior study, of\nnote the soft tissue rounded component seen in ___ is smaller\n(5:265).\nCavitary nodules present in prior study have resolved, in some of them, very\nfaint ground-glass opacities remain .  There are no new lung nodules.  Minimal\nscarring in the subpleural regions of the right middle lobe and right lower\nlobes is unchanged.  Few scattered micronodules are stable (5:66, 73, 82)\nThere is diffuse bronchial thickening.\nThis examination is not tailored for subdiaphragmatic evaluation, there is\nfatty infiltration of the liver; multiple coarse calcifications are again\nnoted through the pancreas.\nThere are no bone findings of malignancy",
            "output": "Resolved cavitary lung nodules.  No new lung nodules identified.\nMinimally increased in Ground-glass opacity in the paraspinal region left\nlower lobe, attention in followup studies is recommended\nHepatic steatosis"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue findings in the chest wall, including right thoracostomy tube insertion\nsites suspicious for malignancy or infection.  This study is not appropriate\nfor subdiaphragmatic diagnosis.\n\nThyroid is heterogeneous but there are no findings warranting further imaging\nevaluation.  Atherosclerotic calcification is not apparent in head and neck\nvessels, but is present in at least left anterior descending and circumflex\ncoronary arteries.  Aorta and pulmonary arteries are not enlarged.  Luminal\npatency is not evaluated.  Maximum diameter noncalcified ascending aorta is 30\nmm.\n\nSmall to moderate nonhemorrhagic pericardial effusion is not accompanied by\ncalcification or infiltration of epicardial fat or evidence of cardiac\ntamponade.\n\nNonhemorrhagic moderate left and very small right pleural effusions are\ndistributed dependently.\n\nRight pleural drainage tube enters the lower hemithorax posteriorly ascends\nalong the lateral chest wall to the apex, abutting the mediastinum at the\nthoracic inlet.  Pleural air collection is minimal.\n\nMultiple relatively well-circumscribed to lung lesions with cavitation range\nin size from 5 to 20 mm and in attenuation of the contents from ___ ___. \nThese are lung abscesses, some of which may contain a component of hemorrhage.\nLarge scale consolidation in the left lower lobe is probably relaxation\natelectasis, but smaller non continuous areas of consolidation in the right\nlower lobe and in the anterior aspect of the right middle lobe, 4:176, could\nbe pneumonia.\n\nInterestingly, there is no appreciable pulmonary edema.\n\nCentral left adenopathy is mild in the mediastinum, substantial in the hila,\nparticularly the left, but bronchi are not compromised.\n\nThere are no compression or pathologic fractures or destructive bone lesions\nor periosteal reaction to suggest early infection.",
            "output": "Normal caliber noncalcified thoracic aorta.\n\nSmall to moderate pericardial effusion, moderate left pleural effusion. \nMinimal right pleural effusion and tiny pneumothorax in the right hemithorax\nwith a apical pleural drainage catheter.\n\nMultiple lung abscesses presumably septic emboli, some of which may have a\nhemorrhagic component.  Large scale relaxation atelectasis left lower lobe. \nProbable pneumonia right middle and lower lobes.\n\nReactive central adenopathy particularly in the left hilus."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Supraclavicular and axillary lymph\nnodes are not enlarged.  Thyroid is heterogeneous without suspicious nodules. \nThe chest wall is unremarkable.  Patient is status post removal of the right\nchest tube.  Left upper extremity PICC line tip terminates at the cavoatrial\njunction.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen and pelvis exam\nobtained on the same day for details sub-diaphragmatic findings.\n\nMEDIASTINUM: Scattered mildly enlarged mediastinal lymph nodes, measuring up\nto 7 mm are likely reactive.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.  Valvular abnormalities are not well evaluated on the current study.\n\nPLEURA: Since removal of the right chest tube, there is accumulation of\nnonhemorrhagic right pleural effusion, now small to moderate.  There is stable\nmoderate nonhemorrhagic pleural effusion on the left.  There is no\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Again seen are multiple cavitary lung lesions ranging in size\nfrom 5-20 mm with nonenhancing internal contents.  However, new since ___, the consolidation in the right middle and lower lobe demonstrate\ncavitation (304:165, 172).  There is persistent atelectasis of the left lower\nlobe with rounded hypoenhancing areas with foci of air, likely representing\nlung abscesses/cavitary lesions.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  There is small amount of filling defect, which may be\nnonocclusive thrombus versus valve at the SVC at the junction of\nbrachiocephalic vein and SVC, and at the origin of the right subclavian vein,\nand at the right internal jugular vein.  The ascending and descending aorta\nare not aneurysmal.  The main and the right pulmonary arteries are normal in\ncaliber.\nCHEST CAGE: Patient is status post laminectomy at T11 through L1 with\npostsurgical changes.  Disc spacer is seen at L1-L2.  Patient is status post\nmedian sternotomy with sternal cerclage wires aligned intact.",
            "output": "-Interval development of cavitation of pre-existing lung abscess in the right\nmiddle and right lower lobe.  Otherwise, overall unchanged appearance of\nmultiple cavitary lung lesions.\n-New small to moderate right pleural effusion since removal of the chest tube.\nStable moderate left pleural effusion.\n-Small amount of filling defect in the SVC, origin of the right subclavian\nvein and the right internal jugular vein, which may be nonocclusive thrombus\nversus valves.  If clinically indicated, ultrasound may be helpful.\n\nRECOMMENDATION(S):  Small amount of filling defect in the SVC, origin of the\nright subclavian vein and the right internal jugular vein, which may be\nnonocclusive thrombus versus valves. If clinically indicated, ultrasound may\nbe helpful.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:17 pm, 2 minutes after discovery\nof the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  3 mm right middle lobe pulmonary nodule is noted (3:89).  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. 3 mm right middle lobe pulmonary nodule.  Please refer to ___\ncriteria below for follow-up recommendations.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: There is poor opacification and motion artifact\nlimiting evaluation of the segmental and subsegmental pulmonary artery\nevaluation.  Within this limitation, the central pulmonary vasculature is well\nopacified without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is severely limited secondary\nto respiratory motion artifact, predominantly at the lung bases.  Within this\nlimitation, no obvious masses or areas of parenchymal opacification are\ndemonstrated.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Suggestion of mosaic attenuation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Suboptimal evaluation of the segmental and subsegmental pulmonary arteries\nsecondary to poor opacification and motion artifact.  Within this limitation,\nthere is no evidence of lobar or larger pulmonary embolism.\n\nNo large lung consolidation or mass within limitations of examination. \nSuggestion of mosaic attenuation as can be seen in air-trapping."
        },
        {
            "input": "Soft tissues: The thyroid is homogeneous. There is marked vocal cord\nasymmetry, which may correspond to vocal cord paralysis or dysfunction.\nEnlarged thoracic lymph nodes are seen at the thoracic inlet (06:39), upper\nparatracheal station (6:62), measuring 17 x 14 mm, and prevascular station\n(6:81). Heart size is top-normal on there is mild coronary artery and aortic\nannular calcification. No pericardial effusion.  The esophagus follows a\nnormal course in is normal in caliber.  Please see a separate report\ndiscussing the subdiaphragmatic findings.\n\nLungs: There is a small loculated left pleural effusion in the upper left\nlung, with a thick surrounding pleural rind with scattered calcifications. \nThere is considerable consolidation, in a rounded configuration, in the left\nupper and lower lobes, resulting in displacement of adjacent bronchovascular\nstructures. The consolidation enhances homogeneously, and is reflective of\natelectasis. No mass is seen.  On the right, there is heterogeneity in the\nright middle lobe with air trapping reflective of small airways disease. \nPunctate nodule in the right upper lobe is unchanged from ___.\n\nPleural calc, chronic pleurisy, reactive lymph nodes\nAlert for tuberculus pleurisy, ensure adequeat treatment.\n\nBones: Compression deformity of the T12 vertebral body is unchanged from ___\nand heterogeneity of the T7 vertebral body is unchanged, may be secondary to\nan intraosseous hemangioma.",
            "output": "Loculated nonhemorrhagic left pleural effusion with a thick pleural rind\ncontaining scattered calcifications. This reflects chronic pleural reaction to\na remote insult, such as empyema or hemothorax. The adjacent left upper and\nlower lobe consolidation represents rounded atelectasis, not a mass. This was\nlikely secondary to the pleural reaction, a phenomenon termed \"folded lung\".\nEvaluation of the patient's history for prior tuberculous or pyogenic empyema\nis recommended to ensure that optimal treatment was rendered.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid nodules.  Subcentimeter\nsupraclavicular and axillary lymph nodes.\n\nUPPER ABDOMEN: Hypodense cystic lesion in the medial aspect of the left kidney\nmeasuring 23 mm in diameter and 9.3 Hounsfield units and appears similar\ncompared to previous imaging.  No adrenal lesions.\n\nMEDIASTINUM:  Multiple mediastinal lymph nodes with the largest measuring 11\nmm in diameter seen pretracheal (2, 22), AP window (2, 25) and sub carinal (2,\n35).  Subcentimeter posterior mediastinal lymph node seen adjacent to the\naorta the largest measuring 7 mm in diameter (2, 48)\n\nHILA: Subcentimeter hilar lymph nodes.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.  Right\ncoronary artery stent in situ.  Mild to moderate aortic annulus and left\ncoronary artery calcifications.  Calcification of the aortic arch.\nPLEURA: Smooth pleural thickening measuring 4 mm in diameter noted anterior to\nthe right middle and upper lobes.\nLUNG:\n\n-PARENCHYMA:  Bilateral apical pleural calcifications unchanged.  There are\nmultiple, new subcentimeter coalescing airspace nodules, many with \nsurrounding ground-glass halo,  seen in the posterosuperior aspect of the\nright upper lobe (4, 53), mid aspect of the right upper lobe (4, 91) posterior\nsegment of the right upper lobe (4, 105), superior segments of the lower lobes\nright (4, 119) and left (4, 105), and in the basal aspect of the left lower\nlobe (4, 176).   Similar nodules with surrounding ground-glass was previously\nnoted in the apical posterior segment of left upper lobe which shows interval\nresolution.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  Mildly dilated.\nCHEST CAGE: Spondylotic changes of the thoracic spine.",
            "output": "Multiple, new subcentimeter, coalescing airspace nodules with surrounding\nground-glass, and a single similar lesion  (in the apical posterior aspect of\nthe left upper lobe) resolved since ___.\n\n  In the differential diagnosis consider infection (fungal), vasculitis,\nlymphomatoid granulomatosis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible axillary lymph nodes (2, 14).  Are\nnormal and stable in size.  No mediastinal lymphadenopathy.  The pre-existing\nborderline mediastinal lymph nodes (2, 23) are stable.  The aortopulmonary\nwindow lymph nodes (2, 24 are also stable.  Mild aortic valve calcifications\nand coronary calcifications.  No pericardial effusion.  No abnormalities in\nthe upper abdomen.\nThe pre-existing opacities in consolidation in the posterior aspect of the\nright upper lobe (4, 72) are almost completely resolved.  No recurrent or new\nparenchymal opacities.  Mild scarring in the posterior aspect of the right\nlower lobe.  Signs of airway wall irregularities and minimal thickening\nsuggest chronic airways disease.  No pleural thickening or pleural effusions,\nareas of subpleural fat (4, 253) are stable.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  No osteolytic lesions at the\nlevel of the ribs, the sternum or the vertebral bodies.",
            "output": "Near complete resolution of the obviously infectious right upper lobe opacity\nand consolidation.  Stable mild to moderate chronic airways disease."
        },
        {
            "input": "AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar adenopathy. \nAn enteric tube is present.\n\nHEART AND VASCULATURE: No pericardial effusion.  Right IJ catheter terminates\nin the high right atrium.  Left-sided central venous catheter terminates in\nthe proximal SVC.  Mild atherosclerotic calcifications of the aorta. \nProminence of the heart muscular suggest anemia.\n\nPLEURAL SPACES: Small bilateral right greater than left pleural effusions.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Endotracheal tube terminates 1.8 cm above the carina.  Small\namount secretions within the right lower lobe.  Bilateral compressive\natelectasis related to pleural effusions versus consolidation which is\ndifficult to distinguish due to the lack of intravenous contrast.  There is\nincreased prominence of the pulmonary arteries around the airway which could\nbe mild central venous congestion versus vascular crowding from low lung\nvolumes.\n\nABDOMEN:  Please see dedicated abdominal CT report for details of the abdomen.\n\nBONES: No suspicious osseous lesions.",
            "output": "1. Small bilateral pleural effusions with compressive airspace disease at the\nlung bases.  Due to the noncontrast evaluation of the chest, this is limited\nfor the evaluation of pneumonia which should then be considered in the\nappropriate clinical setting.\n2. Lines, tubes and additional findings above.  Please note the tip of the\nenteric tube is at the carina."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Normal appearance of the large mediastinal\nvessels.  Minimal coronary calcifications, no valvular calcifications, no\npericardial effusion.  The posterior mediastinum is unremarkable.  The upper\nabdomen is reported in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.\nNo diffuse lung disease.  No pleural thickening, no pleural effusions.  The\nairways are patent.  No pulmonary nodules or masses.",
            "output": "Minimal coronary calcifications.  No adenopathy.  No evidence of neoplastic or\nchronic infectious disease of the thorax."
        },
        {
            "input": "The thyroid gland is unremarkable. No pathologically enlarged supraclavicular,\nmediastinal, hilar or axillary lymph nodes are seen.\n\nThere is a normal heart size with dense coronary artery, aortic valve, and\nmitral annular calcifications. There is no pericardial effusion. No central\npulmonary embolism is identified. The main pulmonary artery and thoracic aorta\nare normal in caliber.\n\nThe patient is status post right upper lobectomy and VATS with a stable\npostoperative appearance. Linear postsurgical scarring is decreased since the\nprior exam. Scattered medial right lower lobe ground-glass opacities likely\ndue to minimal aspiration. No new or suspicious lung nodule, mass or\nconsolidation is identified. There is stable mild centrilobular emphysema.\nThere is no central endobronchial lesion or pleural effusion. The previously\nseen small to moderate loculated right pleural effusion with associated\npartial passive atelectasis has resolved.\n\nImages of the upper abdomen demonstrate unchanged mild hepatic steatosis.\n\nNo destructive osseous lesions are identified.",
            "output": "Stable examination with no evidence of intrathoracic metastatic disease.\n\nResolved right pleural effusion and associated atelectasis.\n\nA few scattered medial right lower lobe ground-glass opacities which are\nlikely due to aspiration.\n\nMild hepatic steatosis."
        },
        {
            "input": "Aorta and pulmonary arteries are stable and normal in diameter.  Mediastinal\nlymph nodes, in the right lower paratracheal area are stable.  No\npathologically enlarged mediastinal lymph nodes are noted. Paraesophageal\nlymph nodes are 6 mm in diameter, stable.  No hilar or axillary\nlymphadenopathy is present. Aortic valve calcifications are noted. Bilateral\ngynecomastia is symmetric. Mediastinal lipomatosis is suspected. No\npericardial pleural effusion is seen.\n\nLow density of the liver is noted in might be consistent with CT infiltration.\n\nAirways are patent to the subsegmental level bilaterally. Centrilobular\nemphysema is bilateral, left more than right. Resected (wedge resection) right\nupper lobe area appears to be stable. All no new O nodules masses are\nconsolidations demonstrated. Right lower lobe subpleural nodular atelectasis\nis stable. Lingular atelectasis is stable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest including mediastinal non\npathologically enlarged lymph nodes, status post right upper lobe wedge\nresection, mediastinal lipomatosis and hepatic steatosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged, and there is no\nsoft tissue abnormality in the imaged portion of the chest wall suspicious for\nmalignancy or infection.  Moderate gynecomastia is symmetric and somewhat\ndecreased since ___.\n\nThyroid is unremarkable.  Atherosclerotic calcification is mild in the head\nand neck vessels, and moderate in the coronaries in at least the LAD.  Aortic\nvalvular calcification is mild.  Aorta and pulmonary arteries are normal size.\nThere is no pericardial or pleural abnormality.\n\nThis study is not designed for subdiaphragmatic diagnosis, but shows severe\nfatty infiltration of the liver and no adrenal mass.\n\nEmphysema is mild.  The site of the right upper lobe wedge resection has a\nnormal postoperative appearance, with less soft tissue adjacent to suture\ntoday than in ___.  Small regions of atelectasis at the base the right\nlung and in the lingula are unchanged.  A nodular region at the base of the\nright lung anteriorly on ___ (4:185), has resolved indicating it also\nis atelectasis.  There are no lung nodules.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nCoronary atherosclerotic calcification.  Mild aortic valvular calcification."
        },
        {
            "input": "No change in the appearance of the thyroid gland, aorta and pulmonary arteries\ndemonstrated.  No interval increase in mediastinal lymphadenopathy seen. \nMediastinal lipomatosis is unchanged.  Coronary calcifications are moderate as\nwell as aortic valve calcifications.  Inter arterial septal lipomatous\nhypertrophy is unchanged.  No pericardial pleural effusion is noted.\n\nImage portion of the upper abdomen reveals porta axis lymph node, series 2,\nimage 68, unchanged as well as decreased density of the liver most likely\nconsistent with fatty infiltration.\n\nAirways are patent to the subsegmental level bilaterally.  Severe emphysema,\npredominantly panlobular is re- demonstrated.  Right upper lobe post surgical\nchanges, series 4, image 87 are similar to previous examination with no\nevidence of local recurrence.  No new pulmonary nodules masses are\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nBilateral gynecomastia is extensive but symmetric.",
            "output": "Unchanged appearance of the chest CT with no evidence of intrathoracic\nmalignancy.\n\nSubstantial calcifications of the aortic valve that should be correlated with\nechocardiography to exclude the possibility of hemodynamically significant\nstenosis."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  As previously mentioned, heavy\ncalcifications of the aortic valve might be sign of clinically significant\naortic valve stenosis, please correlate with echocardiography.\n\nMultiple mediastinal lymph nodes are not pathologically enlarged and stable. \nHeart size is normal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen demonstrate liver hypodensity and otherwise\nis unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Substantial\nemphysema is similar to previous examinations.  Lingular atelectasis is\nminimal.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of local disease recurrence or\nnew remote pulmonary nodules"
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  A right PICC terminates within the mid superior vena cava. \nScattered axillary nodes are not pathologically enlarged.  There is no\nsupraclavicular adenopathy.  Multiple mediastinal nodes are present, some\nwhich are mildly enlarged.  These nodes are increased in size relative to\nexamination dated ___ including a  2.0 x 1.0 cm aortopulmonary\nnode (02:29) a right upper paratracheal station 9 mm node (02:17), a right\nlower paratracheal 1.1 cm node (02:25), a subcarinal node which measures 2.2 x\n1.0 cm (02:30).  There is also bilateral hilar adenopathy, a left hilar node\nwhich measures 2.4 x 1.1 cm (02:34).  Mild bilateral gynecomastia is stable\nand symmetric.\n\nThe ascending aorta is mildly aneurysmal measuring up to 4.2 cm, marginally\nincreased relative to stay ___.  The main pulmonary artery is\nupper limits of normal in caliber.  There is a small pericardial effusion\nwhich is stable.  Heart is mildly enlarged.  Moderate atherosclerotic\ncalcifications are noted as are aortic valve and mitral annular\ncalcifications.  Aortic valvular calcifications are of unknown hemodynamic\nsignificance, better evaluated by echocardiography.\n\nThe tracheobronchial tree is patent to the subsegmental level.  Centrilobular\nemphysema is moderately severe and upper lobe predominant.  There are diffuse\nbronchocentric ground-glass and some solid opacities throughout bilateral\nlungs, worst within the right hemithorax.  A more consolidated process is\nnoted within the right lower lobe anteriorly.  There are scattered centrally\ncystic nodular opacities which are typical for septic emboli (302:89). \nBilateral layering and nonhemorrhagic pleural effusions are small and fairly\nsymmetric.  Mild interlobular septal thickening is most pronounced at the\nbases of the lungs.  Note is made of suture material within the right upper\nlobe, the suture line similar relative to prior examination.\n\nAlthough examination is not tailored for subdiaphragmatic evaluation, note is\nmade of a cirrhotic morphology of the liver with fluid layering about the\nliver and spleen.  Sludge or stones are present within the gallbladder without\nevidence of acute cholecystitis.  Peripheral wedge shaped hypodensity within\nthe spleen anteriorly is new, worrisome for infarction.\n\nThere are no osseous lesions in the chest cage worrisome for malignancy.",
            "output": "1.  Constellation of findings id compatible with septic emboli and pulmonary\nedema.  More consolidative process in the right lower lobe anteriorly suggest\nlikely pneumonia.  Examination was not performed with contrast and therefore\nunable to evaluate for pulmonary emboli.  If suspicion is high, this study can\nbe performed at no additional cost.\n\n2.  Wedge-shaped hypodensity involving the anterior aspect of the spleen\n(2:69) is new since prior examination and suspicious for splenic infarction.\n\n3.  Severe aortic valvular calcifications, of indeterminate hemodynamic\nsignificance.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:20 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nmoderate cardiomegaly without pericardial effusion.  There is dilation of the\nmain pulmonary artery.  There is severe coronary artery calcifications and\nmild aortic valve calcifications.  Moderate calcifications are seen within the\naorta.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  There is scarring in the bilateral bases, right worse than left\nas on prior.  Again seen are 2 calcified granulomas in the right middle lobe\n(5; 188 and 131).\n\nBASE OF NECK: Thyroid is unremarkable.  Irregular contour of trachea may be\nconsistent with tracheobronchomalacia.  No lymphadenopathy in the chest wall.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for left\nkidney cysts.  There is a small hiatal hernia.  SMA and celiac artery stents\nare noted.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.",
            "output": "1.  Scarring in bilateral lung bases, with the right worse than left and is\nstable compared to prior.  There is no evidence of malignancy.\n2.  Irregular contour of the trachea may be consistent tracheobronchomalacia."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  There\nare filling defects within the right pulmonary artery extending into the\nupper, middle and lower lobar and segmental branches, compatible with\npulmonary emboli.  There are also emboli within the left upper and lower lobar\nand segmental branches.  The main and right pulmonary arteries are normal in\ncaliber.  There is ballooning of the right atrium, with straightening of the\ninterventricular septum, suggestive of right heart strain.  In addition, there\nis contrast reflux into the IVC.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There are small pleural\neffusions, right greater than left, with associated dependent passive\natelectatic changes.\n\nThere is no evidence of pulmonary parenchymal abnormality. The central airways\nare patent.  There are few scattered areas of mucous plugging, for example in\nthe right upper lobe (02:25).\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Bilateral lobar and segmental pulmonary emboli.\n\nBallooning of the right atrium with straightening of the interventricular\nseptum, suggestive of right heart strain.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:00 am, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nSpecifically excluding the breasts which must be evaluated with mammography,\nthere are no soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThyroid is heterogeneous but there is no abnormality warranting further\nimaging evaluation.\n\nAtherosclerotic calcification is not apparent head neck vessels, but is severe\nin at least the left anterior descending and circumflex coronary arteries, as\nbefore.  Small pericardial effusion is unchanged since ___.  Hypoattenuation\nof cardiac contents indicates anemia.  Aorta and pulmonary arteries are normal\nsize.  There is no pleural effusion.\n\nLymph nodes:\n\nSubcentimeter lymph nodes in upper and lower paratracheal and subcarinal\nstations and slightly larger lymph nodes at the upper pole of the right hilus\nare not appreciably changed.\n\nLungs:\n\nBronchiolar nodulation, right lower lobe, 4:132-143 and small irregular\nperibronchial opacity, right lower lobe, 4:149 are new, inflammatory, as is a\nregion of central peribronchial ground-glass opacification in the left upper\nlobe, 4:119.\n\nThere are no lung lesions concerning for malignancy and the likelihood of\nopportunistic infection is small.\n\nBronchial wall thickening is mild, generalized.\n\nChest cage:\n\nThere are no bone lesions concerning for malignancy or infection.",
            "output": "Nonspecific inflammatory findings, mild localized bronchiolitis, right lower\nlobe, and mild alveolitis left upper lobe.  Suggest concurrent chest\nradiograph in follow-up if symptoms persist.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  No adrenal lesions.  A couple of small calcified\ngallstones in the neck of the gallbladder.  The gallbladder is not distended. \nNo CT features of cholecystitis\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo cardiomegaly.  Severe calcification of the coronary arteries.  Moderate\ncalcification of the aortic valve.  No aortic malformation of the ascending\naorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  No diffuse lung disease.  Platelike/subsegmental\natelectasis in the right lung base (302, 33).\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "No suspicious pulmonary nodules or masses concerning for malignancy.  No\nmediastinal adenopathy.\n\nModerate aortic valve and severe coronary artery calcification.\n\nNon complicated calcified gallstones."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  Mild paraseptal emphysema.  No suspicious\nlung nodules or masses.  No consolidations or atelectasis.  Tiny measurable\ncentrilobular nodules representing respiratory bronchiolitis.\n\nCHEST CAGE:\nExpansile lesions in the right anterior first, second and left anterior third\nand left posterior eighth ribs extending to the adjacent soft tissues.  The\nmoderate dorsal spondylosis.  Large ___ lesions are also noted in the\nvertebral bodies of T7, T9 and T11.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Expansile lytic lesions in the bilateral ribs in thoracic vertebral bodies\nsuggestive of metastatic disease.  No evidence of a primary malignancy within\nthe chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is\nunremarkable.  No axillary or thoracic inlet lymphadenopathy.  Symmetric\nbilateral gynecomastia.\n\nUPPER ABDOMEN: Cirrhotic morphology of the liver, status post TIPS placement. \nCholelithiasis.  Moderate amount of upper abdomen ascites.  Enteric tube\nterminating in the gastric body.\n\nMEDIASTINUM: Right IJ central venous catheter terminating in the cavoatrial\njunction.  No mediastinal lymphadenopathy.  Normal caliber thoracic aorta.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.  Moderate\natherosclerotic calcifications of the coronary arteries.  Calcifications of\nthe aortic valve.\nPLEURA: Small right pleural effusion.\nLUNG:\n\n1. PARENCHYMA: Bilateral lower lobes atelectasis with volume loss, and\nsuperimposed consolidative opacities bilaterally, concerning for aspiration\npneumonia.\n2. AIRWAYS: Endotracheal tube in satisfactory position above the carina. \nTrachea and mainstem bronchi are patent.\nCHEST CAGE: Acute, mildly displaced fracture involving the sternum. \nMultilevel compression deformities involving the thoracolumbar spine, most\nsevere at level T7 vertebral body, with moderate to severe compression\ndeformity involving the superior endplate, age indeterminate, likely chronic. \nAcute mildly displaced fractures involving the second through the seventh\nright anterolateral ribs.",
            "output": "1. Bilateral lower lobes atelectasis with volume loss, and superimposed\nconsolidative opacities, concerning for aspiration pneumonia.\n2. Small right pleural effusion.\n3. Cirrhotic morphology of the liver with moderate ascites.\n4. Cholelithiasis without evidence of cholecystitis.\n5. Multilevel compression deformities involving the thoracolumbar spine, most\nnoted at level T7 with moderate to severe compression deformity, not\nsignificantly changed compared to CT from ___.  Clinical correlation\nis recommended.\n6. Acute mildly displaced fractures involving the sternum, and 2 to 7 right\nanterolateral ribs."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The left-sided chest tube is seen. \nThe intrathoracic portion of the chest tube demonstrates increased density\nwithin the tube, likely fluid.  Slight subcutaneous emphysema is noted of the\nleft chest wall.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen demonstrates no\nabnormality.\n\nMEDIASTINUM: Unremarkable.\n\nHILA: Limited evaluation for hilar adenopathy without intravenous contrast.\n\nHEART and PERICARDIUM: Normal heart size.  No pericardial effusion.\nPLEURA: Trace left pleural effusion.  Slight atelectasis is noted in both\nlower lobes.  Again noted is a small left-sided pneumothorax, slightly\nimproved from the prior CT from ___.\nLUNG:\n\n1. PARENCHYMA:  There is again ground-glass opacity in the left lower lobe\nadjacent to the rib fractures that is decreased from the prior studies\ncompatible with improving hemorrhage/contusion.\n2. AIRWAYS:  Patent to the subsegmental levels.\n3. VESSELS:  Inadequately evaluated without contrast.\nCHEST CAGE: Several displaced and nondisplaced left-sided rib fractures are\nagain noted.",
            "output": "Displaced and nondisplaced left-sided rib fractures with underlying\nsubcutaneous edema and improving left lower lobe pulmonary\ncontusion/hemorrhage.\n\nThere is a left-sided chest tube.  However, the intrathoracic portion of the\nchest tube contains fluid density material.  Additionally, the left-sided\npneumothorax is only slightly improved from the prior chest CT."
        },
        {
            "input": "CHEST PERIMETER:  No thyroid findings need any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM:Mid and lower esophagus may moderately patulous, distended\nonly with air.  No evidence of obstruction or mass.\n\nAtherosclerotic calcification mild in head neck vessels, scattered throughout\ncoronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: None pathologically enlarged\n\nLUNGS, AIRWAYS, PLEURAE: Aside from several small clusters of branching\ndendridiform pulmonary calcification, some present since ___, a benign\ncondition, lungs are clear.  There are no findings suggestive of malignancy.\n\nTracheobronchial tree is normal to subsegmental levels and there is no pleural\nabnormality.\n\nCHEST CAGE: No pathologic or compression fractures.  No destructive bone\nlesions.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nRelatively mild atherosclerotic coronary calcification."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest cage suspicious for malignancy. Thyroid is\nunremarkable.  Atherosclerotic calcification is not apparent.\n\nProgressive enlargement of the main pulmonary artery, 36 mm, 05:26, compared\nto 33 mm in ___ and ___, would raise the possibility of\ndeveloping pulmonary arterial hypertension except that the right and left\npulmonary arteries are normal size and unchanged. Mediastinal and hilar lymph\nnodes and lymph nodes in the internal mammary, diaphragmatic, and retrocrural\nstations, are not pathologically enlarged. There is no pleural or pericardial\nabnormality. Aorta is normal size.\n\nAside from a 3 mm subpleural left lower lobe nodule, 6:206, stable since at\nleast ___, the lungs are clear, and the tracheobronchial tree is normal\nto subsegmental levels. There are no bone lesions in the chest cage suspicious\nfor malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nInterval growth of moderately enlarged main pulmonary artery, as isolated\nfinding, does not necessarily indicate developing pulmonary arterial\nhypertension.  Clinical correlation advised."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissue abnormalities in the chest cage suspicious for malignancy. Thyroid is\nunremarkable.  Atherosclerotic calcification is not apparent.\n\nEnlargement of the main pulmonary artery measuring 3.4 cm. Mediastinal and\nhilar lymph\nnodes and lymph nodes in the internal mammary, diaphragmatic, and retrocrural\nstations, are not pathologically enlarged. There is no pleural or pericardial\nabnormality. Aorta is normal size.\n\nAside from a 3 mm subpleural left lower lobe nodule, 6:270, stable since at\nleast ___, the lungs are clear, and the tracheobronchial tree is normal\nto subsegmental levels. There are no bone lesions in the chest cage suspicious\nfor malignancy.\n\nPlease refer to the separate abdominal and pelvis CT report.",
            "output": "Stable appearance of the thorax, no evidence of recurrent lymphoma.\n\nStable enlargement of the main pulmonary artery."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the partially imaged thyroid warrant any\nfurther imaging.  Supraclavicular and axillary lymph nodes are not enlarged. \nNo soft tissue abnormalities in the chest wall.  Findings below the diaphragm\nwill be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck or coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Small region of peribronchial infiltration and micro\nnodulation, right lower lobe, 5:203-224, is is probably new since ___.\nLungs otherwise clear.  Tracheobronchial tree is normal to subsegmental levels\nand there is no pleural abnormality.\n\nCHEST CAGE: Unremarkable",
            "output": "The diagnosis of a new, small region of broncho centric infiltration right\nlower lobe is indeterminate, but in most clinical situations this would be\nconsidered a small region of infection, probably viral pneumonia.  There is no\nadenopathy or pleural add abnormality or any lung nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Filling defects within the pulmonary arteries at the\nsubsegmental level in the right lower lobe are suspicious for small pulmonary\nemboli (series 3, image 92).  The remainder of the pulmonary vasculature is\nwell opacified to the segmental level without addition filling defects to\nindicate a large pulmonary embolus.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Filling defects within subsegmental pulmonary arteries in the right lower lobe\ncompatible with small pulmonary emboli."
        },
        {
            "input": "Calcified mediastinal non enlarged lymph nodes. No axillary adenopathy. Right\nbreast prosthesis. No pericardial or pleural effusion.\n\nMild patchy ground-glass opacification in the lower lobes, middle lobe and\nleft upper lobe. Slightly more dense patchy infiltrate with some mild\nassociated atelectasis in the posterior right lower lobe. No significant\npleural effusion. No concerning lung masses identified. Small calcified\ngranuloma left lower lobe series 2, image 235. No aggressive bone lesion. Mild\ndegenerative change in the thoracic spine.\n\nLimited visualized non-contrast upper abdomen unremarkable except for partly\nvisualized atrophic appearing native right kidney.",
            "output": "Patchy inflammatory changes. Recommend radiographic followup to assess for\nresolution."
        },
        {
            "input": "Patient has had right mastectomy and prosthetic implant.  There is no\nsupraclavicular or axillary lymph node enlargement and no soft tissue\nabnormality in the imaged chest wall suspicious for malignancy.  Breast\nevaluation requires mammography. This study is not designed for\nsubdiaphragmatic diagnosis but shows atrophic kidneys, no adrenal mass, heavy\natherosclerotic calcification in the superior mesenteric normal splenic\narteries.\n\nThere is no thyroid mass. Atherosclerotic calcifications are not evident in\nhead and neck vessels, but are heavy in the coronaries.\n\nAn 11 mm wide fluid attenuation nodule in the prevascular mediastinum, 02:18\nwas 4 mm on ___, presumably a necrotic lymph node, but conceivably\npericardial recess. There is no appreciable pleural effusion elsewhere, nor\nmore than a trace left pleural effusion.\n\nOther mediastinal the other lymph nodes are normal size common despite heavy\ncalcification in many of them.  There is no bronchial impingement. Aorta and\npulmonary arteries are normal size. Does not designed for cardiac evaluation\nbut left ventricular enlargement is likely.\n\nLargely interstitial infiltration involving much of both lower lobes has\nprogressed or recurred since ___. Consolidation, previously in the\nlateral basal segment of the right lower lobe is now in the posterior, so I\nsuspect at least this component is new infection.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "New or progressive bilateral lower lobe pneumonia, more extensive than in\n___. The dominant pattern is interstitial, favoring virus or pneumocystis,\nbut there may be concurrent bacterial infection in the right lower lobe.\n\nPrior right mastectomy. No good evidence for metastasis.\n\nSevere atherosclerosis, coronaries, superior mesenteric and splenic arteries.\n\nExtensive granulomatous lymph node calcifications. Lung findings do not\nsuggest tuberculosis or histoplasmosis."
        },
        {
            "input": "Save mediastinal calcified lymph nodes are unchanged with no new or enlarging\nlymph nodes seen.  Extensive Coronary calcifications are present.  Aorta and\npulmonary arteries are normal in diameter.  Heart size is normal.  No\npericardial pleural effusion is seen.\n\nThe appearance of the right breast prostheses is unchanged.  The chest wall\nappearance overall is unchanged.\n\nImage portion of the upper abdomen re- demonstrate a trophic kidneys\nbilaterally and heavy vascular calcifications.\n\nAirways are patent to the subsegmental level bilaterally.  Since the prior\nstudy there is substantial interval decrease in diffuse ground-glass opacities\naffecting the lungs bilaterally on the previous examination.  Faint opacities\nin the right lower lobe, series 4, image 114, in the lingula, series 4, image\n115 are present as well as left basal opacity, series 4, image 149, findings\nthat are most likely representing residua of previous process.  No new or\nworsening areas demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Substantial interval improvement of diffuse ground-glass opacities as\ndescribed consistent with resolution of the process in potentially residual\nscarring.\n\nNo evidence of interstitial lung disease currently present\n\nEvidence of previous granulomatous exposure expressed as diffuse mediastinal\ncalcified lymph nodes\n\nExtensive vascular calcifications including coronary arteries.\n\nBilateral atrophic kidneys"
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  Mild calcifications of the mitral\nannulus, aortic valve and moderate calcification of the coronary vasculature.\n\nAXILLA, HILA, AND MEDIASTINUM: Unchanged appearance of calcified mediastinal\nlymph nodes, likely consistent prior granulomatous disease.  Tracheobronchial\ntree calcifications are noted.  No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Few small, calcified granulomas are noted within the lung\nparenchyma (4:41).  Mild atelectasis involving the right middle and lower\nlobes.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Severely atrophic bilateral kidneys are noted.  Moderately calcified\nsplenic artery.  Otherwise, included portion of the unenhanced upper abdomen\nis unremarkable.\n\nBONES: No evidence of acute fractures.  Multilevel mild degenerative changes\nare noted of the visualized spine.  No suspicious osseous abnormality is\nseen.?\n\nSOFT TISSUE: Right breast implant appears intact.",
            "output": "No acute sequelae of trauma.  No displaced rib fracture.  Intact appearance of\nright breast implant."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is normal.Two 0.7 cm\nright thoracic inlet lymph nodes are noted.  Left supraclavicular and\nbilateral axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Please refer to separate CT abdomen/pelvis report for details.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.  No mediastinal mass\nor hematoma.\n\nHILA: Hilar lymph nodes are nonenlarged.\n\nHEART and PERICARDIUM: Heart is normal in size without pericardial effusion. \nNo coronary artery calcifications.  Ascending aorta is normal in caliber\nwithout aneurysmal dilatation.  No atherosclerotic calcifications.\n\nPLEURA:  No pleural effusion, pleural calcifications, or pleural thickening. \nNo pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  Biapical pleuroparenchymal scarring is mild.  Mild paraseptal\nemphysema noted.  No pulmonary mass or consolidation.  Bibasilar, lingular,\nand medial right middle lobe atelectasis is mild.\n-AIRWAYS:  Focal areas of mucoid impaction at the subsegmental level involving\nthe apical segment of right upper and medial basal segment of left lower\nlobes.  The airways are otherwise patent to the subsegmental level.  No\nbronchiectasis or bronchial wall thickening.\n-VESSELS:  Main pulmonary artery is dilated measuring 3.3 cm with normal right\nand left pulmonary arteries.  Main pulmonary artery is well opacified to the\nsegmental level without filling defect to suggest pulmonary embolism.\nCHEST CAGE: Visualized soft tissues are unremarkable.  No focal lytic or\nblastic lesions worrisome for malignancy.  Pectus excavatum deformity noted. \nNo acute fracture.",
            "output": "1.  No evidence of intrathoracic malignancy.\n2.  Top-normal right thoracic inlet lymph nodes measuring 0.7 cm.  Typically\nfurther workup of these is not performed, however if workup for primary\nmalignancy is negative, biopsy can be considered.\n3.  Mild emphysema with focal areas of mucoid impaction."
        },
        {
            "input": "The thyroid is normal. Supraclavicular and axillary lymph nodes are not\nenlarged.  The hila are prominent, bilaterally, suggestive of lymphadenopathy.\nThe main pulmonary artery measures 4.4 cm in diameter, enlarged suggestive of\npulmonary hypertension.  Cardiac configuration is normal.  Coronary\ncalcifications are mild.  There is no pericardial effusion.  The spleen is\npartially imaged, however is significantly enlarged.\n\nExtensive bilateral, ground-glass opacities, with air bronchograms are worse\nin the region of the hila bilaterally.",
            "output": "1.  Extensive bilateral ground-glass opacities with air bronchograms are\nconsistent with multifocal pneumonia given the patient's clinical history. \nFollow up to resolution is recommended.\n\n2.  The main pulmonary artery is enlarged, suggestive of pulmonary\nhypertension.\n\n3.  Massive splenomegaly.\n\n4.  Mild coronary calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The study is not optimized for the evaluation of\nsubdiaphragmatic structures.  With this limitation, a calcified lesion in the\nright hepatic lobe is compatible with the site of prior chemoembolization. \nThe liver demonstrates cirrhotic morphology.  Pneumobilia is present, related\nto hepaticojejunostomy.  There is a left upper pole renal cyst.\n\nMEDIASTINUM: A subcarinal lymph node measures up to 2.3 cm, and measured up to\n2.0 cm on ___.  Additional prominent but not pathologically enlarged\nmediastinal lymph nodes measure up to 0.8 cm (02:20).\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  There are moderate\natherosclerotic calcifications in the coronary arteries.  Mild aortic annular\ncalcifications are also demonstrated.  No pericardial effusion\nPLEURA: There are small bilateral pleural effusions.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  An area of consolidated lung at the right base adjacent to the\nsmall pleural effusion is most likely rounded atelectasis.  This is unchanged\nin comparison with ___.  There are multiple millimetric pulmonary\nnodules in the left upper lobe measuring up to 3 mm, which unchanged since ___ (04:24, 50).\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  There is no central pulmonary embolism.  The ascending aorta is\nmildly dilated, measuring up to 4.1 cm.  There is moderate atherosclerotic\ncalcification along the thoracic aorta.\nCHEST CAGE: There is no suspicious lytic or sclerotic osseous lesion or acute\nfracture.  Degenerative changes of the thoracic spine are noted.",
            "output": "1. 2.3 cm subcarinal lymph node is slightly increased in size in comparison\nwith ___ when it measured 2.0 cm.\n2. Small bilateral pleural effusions with adjacent rounded atelectasis at the\nright lung base.\n3. Multiple millimetric left upper lobe pulmonary nodules measuring up to 3 mm\nare unchanged since ___.\n4. Cirrhotic liver with post chemoembolization changes noted in the right\nhepatic lobe chest and pneumobilia related to hepaticojejunostomy."
        },
        {
            "input": "NECK, THORACIC INLET, CHEST WALL: The thyroid is unremarkable.  Apparent\nfilling defect in the right internal jugular vein is new since the prior\nstudy, and may represent mixing artifact or thrombus in the appropriate\nclinical context.  There is no lower cervical, supraclavicular, or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen demonstrates a\ncirrhotic liver morphology with evidence of post TACE changes.  Mild\npneumobilia was also seen on the prior study, and related to prior\nhepaticojejunostomy.  A bowel anastomosis is unchanged.  Renal cysts are\nnoted.\n\nMEDIASTINUM: The most prominent subcarinal lymph node measures 2.3 x 3.0 cm,\npreviously 2.3 x 3.2 cm.  No other enlarged mediastinal lymph nodes are\nidentified.\n\nHILA: There is no definite hilar lymphadenopathy.\n\nHEART AND PERICARDIUM: The heart is enlarged.  There is no sizable pericardial\neffusion.\n\nPLEURA: Bilateral pleural effusions have minimally increased in size.  There\nis no pneumothorax.\n\nLUNGS: The airways are patent to the subsegmental level.  Rounded atelectasis\nat the right lung base is unchanged.  There is minimal left basilar\natelectasis, also unchanged.  No definite focal pulmonary nodule is identified\nto suggest thoracic metastasis.  Possible millimetric left upper lobe\npulmonary nodules (for example 02:16) are likely unchanged since the most\nrecent prior, though direct comparison is difficult given the lack of thin\nsections on the reference examination.  The thoracic aorta and main pulmonary\nartery are normal in caliber.\n\nBONES: There is no acute fracture or suspicious osseous abnormality. \nPosterior osteophytes in the midthoracic spine narrow the central canal.",
            "output": "-Unchanged subcarinal lymph node measures 2.3 x 3.0 cm is likely reactive.\n-Filling defect in the right internal jugular vein may be related to mixing\nartifact or thrombus in the appropriate clinical context.  Ultrasound can be\nobtained for further evaluation.\n-Cirrhotic liver morphology post chemoembolization.\n-Slight increase in bilateral pleural effusions with associated compressive\natelectasis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 4:39 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable. Diffuse subcutaneous edema.\n\nUPPER ABDOMEN: Please refer to the separate report of the CT abdomen and\npelvis performed on the same day for subdiaphragmatic characterization.\n\nMEDIASTINUM: Multiple mediastinal nodes are enlarged and hyperemic, measuring\nup to 1.2 cm, for example in the right lower paratracheal station (302:98). \nThere is no mediastinal mass.  Of note many central lymph nodes are highly\nvascular, an occasional feature of reactive lymphadenopathy, but also seen in\nCastleman disease and angio immuno blastic lymphadenopathy, a benign B-cell\nlymphoproliferative condition, and a malignant T-cell lymphoma, respectively.\n\nHILA: Right hilar nodes are enlarged to 1.6 cm.  There is no hilar mass.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.   The thoracic aorta is\nnormal in caliber. There is no pericardial effusion.\n\nPLEURA: Moderate bilateral pleural effusions with associated atelectasis.  No\npneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Multiple, bilateral multifocal opacities, many with central low\nattenuation and at least one with cavitation (302:37), measure up to 2.8 cm,\nconcerning for septic emboli.  Diffuse septal thickening and bilateral\nground-glass opacities are most prominent within the right middle and\nbilateral lower lobes, likely compatible with pulmonary edema.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no definite\nevidence of large central pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. Multiple necrotic lung lesions, some nodular, some consolidative, probably\na disseminated infection largely due to septic emboli\n2. Diffuse septal thickening and bilateral ground-glass opacities, likely \npulmonary edema.\n3. Highly vascular, mediastinal and hilar lymphadenopathy, could be reactive;\ndifferential diagnosis includes Castleman's disease and angio immuno blastic\nlymphadenopathy.\n4. Moderate bilateral pleural effusions with associated atelectasis.\n5. Please refer to the separate report of the CT abdomen and pelvis performed\non the same day for subdiaphragmatic characterization.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:08 pm, 5 minutes after discovery\nof the findings.\nAdditional findings were discussed by Dr. ___ with the covering medical\nresident, and 09:00 on ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid appears\nunremarkable.  Surgical clips are present in both axillary regions.  There is\nno suspicious chest wall lesion.  No supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Please refer to the report from the concurrent CT scan of the\nabdomen and pelvis for abdominopelvic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or hematoma.  Numerous\nsmall lymph nodes which do not need size criteria for lymphadenopathy are\npresent and are likely reactive.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is a small pericardial effusion.  Calcification\nof the mitral and aortic valves are noted.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Since prior, there is a new 1.0 x 0.8 cm low-density opacity\nin the right upper lobe which on the coronal images appears to be somewhat\nbranching in configuration.  Distal to this lesion are several nodular\nopacities and septal thickening which may be postobstructive in nature.  A 3\nmm nodule is seen in the right lower lobe adjacent to the major fissure\n(302:84).\n2. AIRWAYS:  The central airways are patent through the subsegmental level.\n3. VESSELS:  The size of the thoracic aorta is within normal limits. \nCalcifications are noted at the aortic arch.  The pulmonary arteries are\nunremarkable.\nCHEST CAGE: There is no suspicious osseous lesion or acute fracture.",
            "output": "New low-density lesion in the right upper lobe measuring up to 1 cm with the\nappearance of adjacent post obstructive change may reflect mucous plugging\nversus an endobronchial lesion.  Further evaluation with a short-term\nfollow-up CT chest, or PET-CT is recommended.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 20h00pm, 60 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no pathologically enlarged\nlymph nodes in supraclavicular or axillary stations.  Multiple bilateral\naxillary surgical clips.\n\nCHEST CAGE: Multilevel mild degenerative change of the vertebra with mid-level\nmild wedge compression fractures and prominent kyphosis.  No evidence of osteo\ndestructive lesions in the chest cage.\n\nUPPER ABDOMEN: Patient is status post liver transplant and bowel surgeries. \nStent in the main portal vein is unchanged.  Remaining included unenhanced\nupper abdominal organs with no gross findings.\n\nMEDIASTINUM: There is no lymphadenopathy in the mediastinum.  No gross hilar\nlymphadenopathy.  Subcentimeter paraesophageal lymph nodes are stable\n(302:134).\n\nHEART and PERICARDIUM: The heart is normal in size.  Dense calcifications of\nmitral valve annulus and moderate calcifications of aortic valve leaflets. \nModerate atherosclerosis in the coronaries and predominantly along the aortic\narch.  Pericardium is physiologic.  Main pulmonary artery is normal in\ncaliber..\n\nPLEURA: No pleural space abnormalities.\n\nLUNG: Right hemidiaphragm is chronically elevated, minimal subsegmental\natelectasis of right lung base is subsequent and chronic.\nTracheobronchial tree is centrally patent.  Right upper lobe nodule\nhypodensity measure 3 ___ (302:41), is mildly larger since prior, 1.5 x 0.6 cm.\nDistal branching bronchial opacities have coarsened and are associated with\nnew subtle subsegmental atelectasis.\n0.5 cm nodule in the base of lingula 302:154, appear slightly more pronounced,\nattention on follow up.\nNo new lung nodules.\n\nRight middle lobe subsegmental platelike atelectasis or scarring is stable.\nPunctate calcified granuloma in the right upper lobe (302:52) is unchanged.",
            "output": "Hypodense branching nodule in the right upper lobe is mildly increased since\n___, concerning for worse tenacious infection such as mycobacterial\ninfection, likely atypical.  Neoplastic lesion remains in the differential.\n\nRECOMMENDATION(S):  Bronchoscopy with tissue sampling is recommended."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging.  No\nsupraclavicular or axillary adenopathy.  No soft tissue abnormality in F fat\ndepleted chest wall.  This study is not appropriate for subdiaphragmatic\ndiagnosis but shows no adrenal mass or subphrenic fluid collection.  It is not\nadequate for hepatic evaluation.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent.  Aorta and pulmonary arteries and cardiac chambers are normal\nsize and there is no pericardial abnormality.\n\nTHORACIC LYMPH NODES: None pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Region of consolidation in the posterior segment of\nthe right upper lobe, 302:114-129 at corresponds to finding which developed on\n___, consistent with an acute pneumonia.  Extensive bronchial wall\nthickening and retained secretions, occlude the most of the basal bronchi in\nboth lower lobes as well as the left lower lobe bronchus.  Bronchiolar\nnodulation is also seen in the lower lobes, much more pronounced on the left. \nThere is no pleural effusion.\n\nCHEST CAGE: Unremarkable",
            "output": "Acute pneumonia, right upper lobe and severe lower lobe bronchial inflammation\nincluding obstructive mucous retention and bronchiolitis.\n\nNo findings to suggest septic emboli."
        },
        {
            "input": "This examination is limited due to motion artifact.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus on\nthe right.  Mild atherosclerotic calcification is seen at the aortic arch. \nAlthough this examination is limited due to motion artifact, the thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  There is a trace pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES:  There is a large nonhemorrhagic left pleural effusion with\nnear complete collapse of the left lung, which is new compared to ___.  No pneumothorax.\n\n\nLUNGS/AIRWAYS:  The left lung is nearly completely collapsed due to\ncompressive atelectasis from the large pleural effusion.  Mild dependent\natelectasis within the right, but no focal consolidations or suspicious lung\nnodules.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK:  The patient is status post partial thyroidectomy.  The\nremaining thyroid is normal in appearance.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES:  Anterior cervical fixation hardware is partially visualized without\nany evidence of hardware malfunction.  Sternotomy wires appear intact and\nappropriately aligned.  No suspicious osseous abnormality is seen.? There is\nno acute fracture.",
            "output": "1. Limited examination due to motion artifact.  Within these limitations, no\nevidence of pulmonary embolism or gross evidence of acute aortic dissection.\n2. Large nonhemorrhagic left pleural effusion with near complete collapse of\nthe left lung, which is new compared to the CT dated ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nPatient is status post left hemithyroidectomy.  The remaining right thyroid\ngland is unremarkable.  The surgical bed is unremarkable with surgical suture\nin place.\n\nThere is no evidence of pericardial effusion.  The heart size is within normal\nlimits.  There is postsurgical changes from prior CABG with dense\ncalcifications in the native coronary arteries.  There is no pleural effusion.\n\n7 mm intraparenchymal pulmonary cyst in the left lower lobe is unchanged from\n___.  There is mild ground-glass opacities in the dependent\nportions of the right upper lobe and bilateral lower lobes, likely\nrepresenting atelectasis.  The airways are patent to the subsegmental level. \nMild diffuse airway thickening is most notable in the right upper lobe and\nbilateral lower lobes.\n\nLimited images of the upper abdomen are unremarkable, aside from collapsed\ngallbladder.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nPatient is status post median sternotomy with cerclage wires intact in\naligned.\n\nSkin thickening, and defect along the inferior right breast is likely related\nto history of prior pyoderma to the breast.",
            "output": "No evidence of acute pulmonary embolism.  No pleural effusion or focal\nconsolidation."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar or segmental\npulmonary arteries.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular or axial lymphadenopathy.  Right paratracheal\nlymph nodes are enlarged measuring up to 11 mm (series 3, 56).  A right hilar\nlymph node measures up to 12 mm (series 3, image 83).  There is no left hilar\nlymphadenopathy.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a small right pleural\neffusion with associated pleural calcifications, suggesting possible prior\npleurodesis at the right lung base.\n\nThere is bilateral dependent atelectasis.  Evaluation is severely limited by\npatient respiratory motion and low lung volumes. A tracheostomy tube ends the\nmid thoracic trachea.  There is a moderate amount secretions in the trachea.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  The study is significantly limited by low lung volumes and respiratory\nmotion.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Mild right hilar and mediastinal lymphadenopathy.\n3.  Small right pleural effusion with associated moderate pleural thickening\nand calcification at the right lung base."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  A right-sided Port-A-Cath tip\nterminates in the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple subcentimeter mediastinal lymph nodes\nare noted.\n\nPLEURAL SPACES: Small bilateral pleural effusions are present.  There is no\npneumothorax.\n\nLUNGS/AIRWAYS: Consolidation in the posterior right lower lobe may represent a\natelectasis however a superimposed infectious process cannot be excluded.  An\nendotracheal tube is noted.  Diffuse ground-glass opacities in the right lung\nlikely represents pulmonary edema.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: The partially visualized thyroid demonstrates subcentimeter\nhypodensities in bilateral lobes.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: There is no acute fracture.  There is diffuse osteopenia.  Degenerative\nchanges of bilateral shoulders noted.",
            "output": "1. Consolidation in the posterior right lower lobe likely represents\natelectasis.  A superimposed infectious process cannot be ruled out.\n2.  Diffuse ground-glass opacities in the right lung likely represents\npulmonary edema.\n3. Small bilateral pleural effusions.\n4. Partially visualized thyroid demonstrates subcentimeter hypodensities in\nbilateral lobes."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE:The thoracic aorta is normal in caliber.  No pericardial\neffusion is seen.  Partially visualized left pectoral cardiac pacing device..\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: Moderate to large volume right pleural effusion.  No left\npleural effusion.  No pneumothorax..\n\nLUNGS/AIRWAYS: Centrally predominant, peribronchovascular trace opacities .The\ntrachea and mainstem bronchi are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES/SOFT TISSUES:  No destructive osseous lesions.  Bilateral gynecomastia.\n\nUPPER ABDOMEN: Nodular hepatic contour, concerning for for underlying chronic\nliver disease.  Splenorenal shunt.  Left interpolar high-density renal lesion\nmeasuring 2.2 cm (image 88, series 601), with differentials to include\nhemorrhagic/proteinaceous cyst, solid renal lesion can not be completely\nexcluded, further evaluation is recommended.  Bilateral renal cysts in the\nleft upper pole measuring 1.8 cm, and right upper pole measuring 3.3 cm. \nSplenomegaly measuring up to 15.6 cm.",
            "output": "1. Centrally predominant, peribronchovascular\n opacities, these findings are nonspecific, and may reflect an organizing\npneumonia or pattern of amiodarone toxicity in the appropriate clinical\nsettings.  This pattern can also be seen in the setting of ___'s sarcoma.\n2. Moderate to large volume right pleural effusion.\n3. Cirrhotic morphology of the liver with manifestations of potential portal\nhypertension, demonstrated by splenomegaly, and left splenorenal shunt. \nClinical correlation is recommended.\n4. Incompletely characterized left interpolar renal lesion measuring 2.2 cm,\ndedicated renal ultrasound is recommended for further evaluation."
        },
        {
            "input": "Visualized portions of the thyroid gland are unremarkable in appearance.  No\nsupraclavicular or axillary lymphadenopathy seen.\n\nThere is mild atherosclerotic calcification in the thoracic aorta.  No\naneurysmal dilatation or dissection seen.  The origin of the great vessels is\nconventional.  Endotracheal tube is in-situ, this terminates approximately 2\ncm above the level of the carina.  An enteric tube is in-situ, this terminates\nin the distal stomach.\n\nNo mediastinal or hilar lymphadenopathy seen.  No pericardial or pleural\neffusion seen.\n\nThe airways are patent to a subsegmental level.  No no consolidation or\nground-glass opacity seen.  There is mild dependent atelectasis.  No pulmonary\nnodules measuring greater than 6 mm.\n\n\nPlease see the separate report of the CT abdomen and pelvis.\n\nBony structures: No destructive lytic or sclerotic bone lesion seen.  No\nfracture seen.",
            "output": "1. No acute cardiopulmonary process seen.  No abscess seen."
        },
        {
            "input": "Left thyroid nodule is 14 x 8 mm, stable.\n\nAorta and pulmonary arteries are well enhanced.  Coronary calcifications are\nextensive.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes are\ndemonstrated.  Anterior paracardiac lymph node, series 3 image 81 is\nunchanged, 8 mm.  Right paracardiac mediastinal lymph node is 10 mm,\nunchanged.\n\nThere is no pericardial pleural effusion.\n\nPlease review CT abdomen and pelvis report that will be issued separately.\n\nAirways are patent to the subsegmental level bilaterally\n\nCentrilobular emphysema is moderate, unchanged\n\nDiffuse bronchial wall thickening is moderate consistent with chronic\ninfection\n\nRight apical 2.8 mm nodule is stable, series 4, image 53\n\nRight lower lobe subpleural nodule is 4 mm, decreased in size compared to 6 mm\npreviously, series 4, image 134.",
            "output": "Interval stability of right apical nodule and decrease in size in the right\nlower lobe subpleural nodule\n\nNo evidence of additional intrathoracic metastatic disease concerns\n\nStable paracardiac lymph nodes as described"
        },
        {
            "input": "THORACIC INLET: There is a stable hypodense lesion within the left lobe of\nthyroid.  There are small left supraclavicular lymph nodes measuring 4 mm (3,\n11), unchanged.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal nodes are unchanged.  Heart size is normal. \nThere is no pericardial effusion.  Small bilateral hilar lymph nodes are\nunchanged in size.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is mild upper lobe predominant emphysema.  There is a stable 2 mm\nright upper lobe pulmonary nodule (3, 25).  The 3 mm right lower lobe\npulmonary nodule (3, 65) has slightly decreased in size since the prior study.\nNo new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\npneumobilia.  No adrenal masses.",
            "output": "Stable 2 mm right upper lobe pulmonary nodule.  Slight decrease in size of the\nright lower lobe pulmonary nodule.  No new pulmonary nodules.\n\nStable small mediastinal lymph nodes.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No enlarged supraclavicular or\naxillary lymphadenopathy.  Stable hypodense lesion in the left lobe of the\nthyroid.  Left-sided Port-A-Cath terminates in the superior cavoatrial\njunction.  No abnormal findings in the soft tissues of the chest.\n\nUPPER ABDOMEN: Please refer to separately reported abdominopelvic CT performed\non the same day for subdiaphragmatic findings.\n\nMEDIASTINUM: Small mediastinal nodes are unchanged.\n\nHILA: No hilar adenopathy or abnormal contours.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  Thoracic aorta is normal in caliber.  Moderate calcifications and\nsoft plaques are noted in the thoracic aorta.  Atherosclerotic calcified\nplaques also include the right brachycephalic and left subclavian arteries.\nPLEURA: There is no pleural effusion or thickening.\nLUNG:\n\n1. PARENCHYMA:  Upper lobe predominant mild centrilobular emphysema. Stable 3\nmm nodules in the right upper lobe (03: 28 and 50), and also 3 mm subpleural\nnodule in the right lower lobe (3:129).\n2. AIRWAYS:  Airways are patent to subsegmental level without bronchiectasis.\n3. VESSELS:  Main pulmonary artery is normal in caliber.  There are no filling\ndefects in the pulmonary vasculature.\nCHEST CAGE: No fractures or suspicious bone lesions in the osseous structures\nof the chest.  Abnormal contour of the left seventh rib is stable and may\nreflect old fracture.",
            "output": "1. Stable 3 mm pulmonary nodules.  No new pulmonary nodules.\n2. Please refer to separately reported abdominopelvic CT performed on the same\nday for subdiaphragmatic findings."
        },
        {
            "input": "A hypodense lesion is seen within the left thyroid lobe measuring\napproximately 10 mm, unchanged compared to prior exam.  There is no axillary,\nsupraclavicular, mediastinal, or hilar lymphadenopathy.  The heart size is\nnormal.  There is no pericardial effusion.  The esophagus is normal without\nevidence of wall thickening or a hiatal hernia.  The aorta is normal in\ncaliber.  The main pulmonary artery is normal in caliber.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures however please refer to dedicated CT of the abdomen performed on\nthe same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\n3 mm right upper lobe nodule, series 3, image 37 is unchanged compared to the\nprior exam.  A 3 mm right upper lobe nodule, series 3, image 58 is unchanged\ncompared to prior exam.  A subpleural 3 mm nodule within the right lower lobe,\nseries 3, image 144 is unchanged compared to the prior exam.\n\nThe lungs demonstrate diffuse centrilobular emphysema.  No concerning new or\ngrowing pulmonary nodules are identified.  There is no pleural effusion or\npneumothorax.",
            "output": "Overall, stable millimetric right-sided pulmonary nodules without evidence of\nconcerning new or growing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere is a 10 mm mm low attenuating nodule in the left thyroid lobe, unchanged\nprior exam.  There are multiple prominent left supraclavicular lymph nodes\nthat do not meet pathologic size criteria.  No enlarged lymph nodes in either\naxilla or thoracic inlet.  Excluding the breast tissue which requires\nmammography for evaluation, there are no soft tissue abnormalities in the\nchest wall.  There is left pectoral porta catheter that terminates in the mid\nSVC.  No atherosclerotic calcifications in the head and neck arteries.  There\nis mild atherosclerotic calcification of the innominate artery and proximal\nleft subclavian artery.\n\nCHEST CAGE:\nNo acute fractures.  Although there are no bone lesions in the imaged chest\ncage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Multivessel\natherosclerotic calcifications in the LAD, left circumflex and right coronary\narteries.  Mild calcification of the aortic valve annulus there is\natherosclerotic calcification of the ascending aorta and aortic arch..  The\naorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is normal.  There is no hiatal hernia..  Small mediastinal lymph\nnodes, none pathologically enlarged by CT size criteria. No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions or pneumothorax. Mild bilateral apical scarring.\n\nLUNGS:\nThere is diffuse centrilobular emphysema.  There is bibasilar atelectasis. \nThe tracheobronchial airways are patent to the subsegmental levels.  There is\nmild lower lobe predominant cylindrical bronchiectasis, similar to prior\nexamination.  No bronchial wall thickening or mucus plugging. No suspicious\nlung nodules or masses. No focal consolidation.\n\nThere is a stable calcified granuloma in the right upper lobe (series 3:76).\n\n3 mm right upper lobe nodule (series 3: 143) is stable in size since ___.  Stable 3 mm right upper lobe subpleural solid nodule (series 3; 146)\nthat is stable in size and appearance from ___.  5 mm right lower lobe\nsubpleural nodule (series 3; 130), has remained stable in size since ___.\n\nUPPER ABDOMEN:\nThere is an ulcerated atherosclerotic plaque in the abdominal aorta.  Please\nrefer to separate report for CT abdomen and pelvis acquired on the same day\nfor findings below the diaphragm.",
            "output": "1. No new pulmonary nodules or evidence of intrathoracic metastatic disease.\n2. Hypodense lesion within the left thyroid lobe measuring approximately 1 cm.\n3. Ulcerated atherosclerotic plaque in the abdominal aorta.\n4. Multiple prominent left supraclavicular lymph nodes, similar to prior that\ndo not meet pathologic size criteria.\n5. Bibasilar atelectasis with associated bronchiectasis.\n6. Please refer to separate report for CT abdomen and pelvis acquired on the\nsame day for findings below the diaphragm."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nmild atherosclerotic calcifications involving the aortic valve, coronary\narteries and aortic arch.  The heart, pericardium, and great vessels are\nwithin normal limits.  No pericardial effusion is seen.  Redemonstrated\nulcerated atherosclerotic plaque in the distal thoracic aorta.\n\nAXILLA, HILA, AND MEDIASTINUM: Left chest wall catheter is seen with tip\nterminating in the mid SVC.  A right hilar lymph node measures 1.1 cm.   No\naxillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse centrilobular emphysema is redemonstrated.  There is\nbibasilar atelectasis.  The airways are patent.  No bronchial wall thickening.\nMultiple nodules are redemonstrated in stable.  For example 2 right middle\nlobe nodules measure 3 mm and are unchanged (series 5, images 180 and 171).  A\n5 mm right lower lobe subpleural nodule is stable.\n\nBASE OF NECK: Unchanged 8 mm nodule in the left thyroid lobe.  Prominent\nsupraclavicular lymph nodes are not enlarged by size criteria and are\nunchanged.\n\nABDOMEN: Please refer to separately dictated report of the abdomen and pelvis\nperformed the same day for the findings below the diaphragm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Stable pulmonary nodules.  No new pulmonary nodules.\n2. Stable 8 mm left thyroid lobe nodule.\n3. Ulcerated atherosclerotic plaque in the abdominal aorta is redemonstrated.\n4. Please refer to separately dictated report of the abdomen and pelvis\nperformed on the same day for the findings below the diaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Left supraclavicular 0.6 cm lymph\nnodes are not pathologically enlarged (04:27).  1.5 cm nodule in the left lobe\nof thyroid (03:12).\n\nCHEST CAGE: Multilevel degenerative changes but no evidence of lytic or\nsclerotic osteo destructive metastasis at the level of the sternum, ribs or\nthoracic vertebra.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings..\n\nMEDIASTINUM: Scattered subcentimeter lymph nodes in the mediastinum measure up\nto 0.4 cm,  located in the prevascular space, right lower paraesophageal\nstation (3:98) and pericardiac station (3:86). There is no lymphadenopathy in\nthe hila.\n\nHEART and PERICARDIUM: Heart is normal in size. Minimal calcifications of the\ncoronaries.  Thoracic aorta is moderately calcified, calcifications extend\ninto head and neck vessels, predominantly the left subclavian artery.  Soft\nplaques in the descending aorta.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Moderate centrilobular and paraseptal emphysema is most significant in\nupper lobes is minimal diffuse bronchial wall thickening but no signs of\ninfection.  No evidence of pneumonia.\nTwo 0.4 cm nodules in the middle lobe (4:154, 160) and 0.6 cm right lower lobe\ndependent subpleural nodule (4:150).",
            "output": "-Few pulmonary nodules measure between 0.4-0.6 cm are seen, attention on\nfollow-up.\n-Moderate emphysema.\n3 - month follow up with chest CT is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nS/p right mastectomy.\nThickened skin of the left breast is most probably post radiation and the\nbreast itself better evaluated by a dedicated mammography.\n\nUPPER ABDOMEN: Unchanged small left renal pelvis stone with no signs of\nhydronephrosis.\nLeft upper pole cyst with small calcification grossly unchanged.\nRemaining included upper abdominal organs with no gross findings.\n\nMEDIASTINUM: few measurable lymph nodes in the mediastinum are not\npathologically enlarged and unchanged.\nNo internal mammary lymphadenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly no pericardial effusion.  Severe\natherosclerotic calcifications of the LAD and LCX.\nModerate atherosclerotic calcifications along the thoracic aorta.\nMajor vessels within normal size.\n\nLUNG and PLEURA: Diffuse airway wall thickening associated with moderate\ncentrilobular emphysema affecting predominantly the upper lobes.\nBiapical moderate, right greater than left pleural parenchymal fibrosis is\nunchanged.\nPostradiation fibrotic changes with right side calcifications, affecting\npredominantly the anterior subpleural upper lobes.\nLeft postradiation changes are new in comparison to prior, the right sided are\ngrossly unchanged.\nAnterior subpleural 0.5 cm nodule in the right upper lobe is new in comparison\n(5:140).\nBilateral micro nodules and tiny calcified granulomas are unchanged for\nexample left lower lobe (5:137) and right upper lobe (5:96).\nNo new lung nodules or masses.\nBibasilar unchanged mosaic pattern of attenuation.\nNo pleural effusion.\n\nCHEST CAGE: Healed right ___ and left likely subacute ___ rib fractures, for\nclinical correlation.\nNo evidence of obstructive lesions.",
            "output": "-New right upper lobe nodule for which a ___ month follow up is recommended.\n-Stable postradiation changes in the right upper lobe and new postradiation\nchanges in the left upper lobe in comparison to ___.\n-Left ___ rib fractures likely subacute, for clinical correlation.\n-Left breast postradiation changes are better evaluated by dedicated\nmammographic study.\n\nRECOMMENDATION(S):\n1. ___ month follow up with chest CT.\n2. Clinical correlation for possibly subacute left ___ and 6th rib fractures.\n3. Evaluation of left breast findings (nodularity and skin thickening) by\nmammography."
        },
        {
            "input": "THORACIC INLET: There are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : Patient is status post right mastectomy and right\naxillary node dissection.  There is also evidence of skin thickening overlying\nthe left breast which could be related to radiation therapy.  The left breast\nhas not been completely imaged.  Correlation with mammography is recommended. \nThere are no enlarged axillary or internal mammary lymph nodes\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is upper lobe predominant centrilobular and paraseptal emphysema. \nThere is evidence of prior wedge resection in the right upper lobe.  Scarring\nin the anterior aspect of the left upper lobe is also related to prior\nradiation therapy.  There is stable scarring in the right lung base.\n\n3 mm subpleural left upper lobe pulmonary nodule (5, 81) is unchanged 2 mm\nright upper lobe pulmonary nodule (5, 92) is also unchanged.  A 2 mm left\nlower lobe pulmonary nodule (5, 109) is also unchanged.  The previously\ndescribed 5 mm nodule in the anterior aspect of the right middle lobe (5, 139)\nis unchanged.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows an old healed fracture involving\nthe lateral aspects of the fifth and sixth ribs on the left.  There is also an\nold healed fracture involving the lateral aspect of the fourth and fifth rib\non the right.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows left renal\ncyst.  No adrenal masses is seen.  No focal liver lesions are seen.  No\nadrenal masses are seen.",
            "output": "Status post right mastectomy with right axillary node dissection and\npostsurgical and post radiation changes to the left breast.  Diffuse\nthickening overlying the left breast could be related to prior radiation\ntherapy.  The left breast has not been completely imaged.\n\nStable pulmonary nodules ranging in size from 2-5 mm.  No new pulmonary\nnodules.\n\nStable healed bilateral rib fractures.\n\nContinued follow-up in view of history of malignancy is recommended.  ___\nmonth follow-up may be helpful"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging. \nSupraclavicular and at axillary lymph nodes are not enlarged. Patient has had\nright mastectomy. Left breast evaluation is reserved exclusively for\nmammography.  No soft tissue abnormalities elsewhere in the chest wall.  This\nstudy is not designed for subdiaphragmatic diagnosis, but shows no adrenal\nmass or subphrenic collection.  Dilated left renal pelvis is grossly similar\nto ___.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately patulous but there is no retention\nof fluid or other evidence of obstruction or mass.  Atherosclerotic\ncalcification is very heavy in head and neck vessels, grossly unchanged, in\nthe aortic arch and descending aorta and throughout coronary arteries, grossly\nunchanged.\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing\n\nLUNGS, AIRWAYS, PLEURAE: 7 mm wide subpleural right upper lobe nodule adjacent\nto scarring presumably due to prior radiation, 4:122 was 6 mm in ___.  Although this slight change is not a reliable indication of growth,\nlesion was only 3 mm wide in ___, 4:115.\n\nPatient has moderately severe emphysema and bilateral subpleural fibrosis is\npredominantly in the upper lobes.  On the right this is the adjacent to region\nof pleural calcification.\n\nNo pleural effusion.  Central tracheobronchial tree is unremarkable.\n\nCHEST CAGE: Despite severe osteoporosis, there is no compression or pathologic\nfracture.  And no destructive bone lesion.\n\nMultiple bilateral fractures lateral middle ribs are all healed except for a\nan incompletely fused remote fracture on the left.",
            "output": "Continued extremely slow growth solitary subcentimeter right lung nodule, from\n3 mm in ___ and ___ mm today.  Follow-up with a repeat chest CT in one year\nis indicated.\n\nAnterior subpleural fibrosis in both lungs with the distribution suggesting\nprior tangential breast radiation.\n\nModerate emphysema.\n\nExtensive atherosclerotic coronary calcification, head and neck and coronary\narteries.\n\nSevere spinal osteoporosis.  No compression fractures.  Although there are no\nbone lesions in the imaged chest cage suspicious for malignancy or infection,\nit should be noted that radionuclide bone and FDG PET scanning are more\nsensitive in detecting early osseous pathology than chest CT scanning."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  There\nis opacification of multiple right chest wall, breast and upper arm collateral\nvessels from the contrast injection.  The thoracic aorta is normal in caliber\nwithout evidence of dissection.  There are moderate atherosclerotic\ncalcifications of the thoracic aorta.  The brachiocephalic artery and left\ncommon carotid artery share a common origin, anatomic variant.  The heart is\nmildly enlarged.  There are dense mitral annular calcifications.  No\npericardial effusion is seen.  A large bore left central venous catheter\nterminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy. \nMediastinal lymph nodes are nonenlarged by size criteria.  There is no\nmediastinal mass.  There is no hilar lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis.  Other areas of bandlike\nconsolidation in bilateral lower lobes and lingula also likely represent\natelectasis, with superimposed infection unable to be excluded in the\nappropriate clinical setting.  The central airways are patent.  Evaluation of\ndistal airways are limited due to expiratory phase and motion artifact.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is diffuse fatty replacement of the pancreas.  There is no\npancreatic duct dilation.  There is a 1.2 cm hypodense lesion in the\npancreatic body (304:32), likely representing a cystic lesion such as a\nside-branch IPMN.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size.  Multiple subcentimeter\nhypodensities are noted in bilateral kidneys are too small to characterize. \nThere is no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate size hiatal hernia.  An enteric tube\nterminates in the stomach.  Small bowel loops demonstrate normal caliber and\nwall thickness throughout.  There are numerous sigmoid diverticula with\nassociated wall thickening.  The colon and rectum are otherwise unremarkable. \nThe appendix is not visualized.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Partially calcified subserosal fibroid is noted in the\nleft uterine body.  There is no adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted, also involving the takeoffs of the celiac artery, SMA and\nbilateral renal arteries.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There there is mild S-shaped curvature of the thoracolumbar\nspine and mild multilevel degenerative changes.\n\nBilateral rectus sheath hematomas are smaller compared to CTA of the\nabdomen/pelvis from ___.  For example, the right rectus sheath\nhematoma measures 3.9 cm in maximum thickness (304:43), previously 5.6 cm. \nLeft rectus sheath hematoma measures 3.9 cm in maximum thickness, previously\n5.1 cm.\n\nThere are small bilateral fat containing inguinal hernias.",
            "output": "1. No evidence of pulmonary embolism through the segmental level.\n2. Areas of bandlike consolidation in bilateral lower lobes and lingula likely\nrepresent atelectasis, with superimposed infection unable to be excluded in\nthe appropriate clinical setting.\n3. Interval decrease in size of bilateral rectus sheath hematomas compared to\nprior CTA from ___.\n4. 1.2 cm hypodense lesion in the pancreatic body, likely representing a\ncystic lesion such as a side-branch IPMN.  Follow-up MRCP is recommended in 6\nmonths.\n\nRECOMMENDATION(S):  MRCP in 6 months."
        },
        {
            "input": "A 6 mm hypodense lesion is seen within the right thyroid lobe.  The left\nthyroid lobe is normal.  There is no axillary, supraclavicular, or mediastinal\nlymphadenopathy.  Mildly prominent right hilar lymph nodes are seen measuring\nup to 1.1 cm.  There is no left hilar lymphadenopathy.  Note is made of a\nmoderate hiatal hernia.  The proximal aspect of the esophagus is unremarkable.\nThe heart size is normal.  There is no evidence of pericardial effusion. \nModerate coronary calcifications are seen.\n\nThe airways are patent to the subsegmental levels.  Incidental note is made of\na fluid attenuation lesion within the posterior mediastinum measuring 2.4 cm x\n1.3 cm, series 6, image 122, likely secondary to a bronchogenic cyst.\n\nGranulomatous disease is seen within the anterior aspect of the right upper\nlobe, series 6, image 137.  A 2 mm right upper lobe nodule is seen, series 6,\nimage 156.  A 4 mm right upper lobe ground-glass nodule is seen, series 6,\nimage 110.  A 3 mm ground-glass nodule seen within the medial apex of the\nright lung, series 6, image 53.  A second 4 mm ground-glass nodule is seen,\nseries 6, image 114 within the right upper lobe.\n\nThere is no pleural effusion or pneumothorax.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on the same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are seen.",
            "output": "1. Nodules of ground-glass attenuation within the right lung are seen\nmeasuring up to 4 mm and solid attenuation measuring up to 2 mm.\n2. Evidence of prior granulomatous disease.\n3. Moderate hiatal hernia.\n\nRECOMMENDATION(S):  Recommend three-month follow-up with chest CT given\npatient's history of malignancy."
        },
        {
            "input": "CHEST PERIMETER: Hypodensity in the left thyroid lobe is too small to warrant\nfurther imaging.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved for mammography.  Elsewhere in the chest wall there are no soft\ntissue abnormalities concerning for malignancy.  Findings below the diaphragm\nwill be reported separately.\n\n\nCARDIO-MEDIASTINUM:\nUpper stomach is transmitted through a hiatus hernia. Upper esophagus is\nmoderately patulous, but there is no retention of fluid to suggest\nobstruction.\n\nAtherosclerotic calcification is moderately heavy in head neck vessels\nespecially left subclavian artery, found also in at least left anterior\ndescending and circumflex and right coronary arteries. Aorta and pulmonary\narteries are normal size. Pericardium is physiologic.\n\nElliptical d 26 x 14 mm posterior mediastinal, paraspinal fluid attenuation\nlesion, in the lower hemithorax is unchanged, either lymphocele or mediastinal\ncyst including duplication cyst.  It is not a mass.\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing lung lesions.  No diffuse pulmonary\nabnormality.  No consolidation.\n\nFocal lung lesions as follows:\n\n5 mm wide ring shadow, right upper lobe, 7:98, previously characterized as a\nground-glass nodule, is probably a small cavity, unchanged since ___ mm solid right upper lobe nodule, 7:103, unchanged.  Calcified granulomata,\nmost numerous in the right middle lobe, unchanged.\n\n3 mm solid nodule, right middle lobe, 7:133, unchanged.\n\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "5 mm right upper lobe cavity and two 3 mm solid right lung nodules, all\nunchanged since ___ are unlikely to be active.  Repeat chest CT scan in\ntwice the previous surveillance interval, one year, would be reasonable.\n\nLarge hiatus hernia.\n\nBenign paravertebral posterior mediastinal cyst.\n\nAtherosclerotic calcification, including head and neck and coronary arteries.\n\nPulmonary granulomata.  No evidence of active infection.\n\nRECOMMENDATION(S):  Repeat chest CT in one year."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes in the mediastinum or at the\nlevel of the hilar. No evidence of chest wall abnormalities, in particular no\nevidence of breast lesions. Calcified millimetric nodule in the left breast\n(3, 29).  The large mediastinal vessels are unremarkable. No incidental\npulmonary embolism. Normal appearance of the heart. Normal appearance of the\nposterior mediastinum, with the exception of a small hiatal hernia.  The upper\nabdomen is reported in detail in the dedicated abdominal CT report.  Mild\ndegenerative vertebral disease. No vertebral compression fractures. No\nosteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.  Minimal bilateral apical thickening.  Several millimetric subpleural\nmicronodules are non suspicious.  No suspicious lung nodules or masses.  No\nevidence of diffuse lung disease. No pleural thickening, no pleural effusions.\nThe airways are patent.",
            "output": "No evidence of suspicious pulmonary nodules or masses. No evidence of\nmalignant thoracic disease."
        },
        {
            "input": "Lower left axillary lymph nodes have gotten smaller, the largest currently 11\nx 15 mm, 04:21, was 17 x 26 mm in ___.  The soft tissue surrounding the\npathologic fracture of the left anterior fourth rib, 38 x 38 mm, was 32 x 28\nmm in ___.  There are no other soft tissue lesions in the chest wall\nsuspicious for malignancy. Lytic lesions in the mid portion of the left tenth\nrib, in the underside of the tenth vertebral body, and the left humeral head,\nas well as the small blastic lesion in the body of T11 are unchanged.\n\nThyroid is unremarkable. 12 mm left internal mammary node, 13 mm right lower\nparatracheal midline mediastinal node, 13 mm right hilar node are stable. 18 x\n30 mm subcarinal node was 21 x 34 mm in ___ x 16 mm paraesophageal node\nwas 15 x 19 mm. 4 mm superior segment right lower lobe and punctate lower lobe\nnodule, 4: 35 and 44, are new. Other nodules are is follows,\n\n11 mm left upper lobe, 04:24, previously punctate.\n\n8 mm left lower lobe, 04:37, previously 6 mm.\n\n11 mm, left lower lobe, 04:44, previously 10 mm. 2 mm, left lower lobe, 04:52,\nnew. A handful of other sub cm nodules is stable.\n\nBorderline enlarged pulmonary arteries, right pulmonary artery 26 mm,\npreviously 30 mm. Atherosclerotic coronary calcification is extensive. There\nis no pleural or pericardial abnormality.\n\n.\n\n.",
            "output": "Mixed therapeutic response.  Axillary and mediastinal nodes are smaller though\nstill pathologically enlarged.  Lung nodules are larger and more numerous.\n\nStable bone metastases, including pathologically fractured left fourth rib\nwith a large transthoracic soft tissue mass, and the large lytic lesion in the\nhead of the left humerus."
        },
        {
            "input": "NECK AND THORACIC INLET: No incidental thyroid findings, no supraclavicular\nand infraclavicular lymphadenopathy.\n\nAXILLAE, CHEST WALL, AND BONES: Interval growth of axillary lymph nodes. For\nexample the approximately 12 mm lymph node seen on the previous examination\nhas grown to 25 mm on today's examination (3, 17).  The osteo destructive soft\ntissue lesion of the chest wall with a large soft tissue component, previously\n35 mm now measures 45 mm in diameter (3, 26). The known osteodestructive bone\nlesions show no substantial progression.\n\nMEDIASTINUM: The mediastinal lymph nodes, described as enlarged on the\nprevious examination, are either stable in size or show minimal growth. These\ngrowth, however, is less obvious than the chest wall and axillary lesion.  The\nlarge mediastinal vessels are unchanged in appearance.\n\nHILA: Mild and overall unchanged right hilar lymphadenopathy.\n\nHEART: Unchanged appearance of the heart.\n\nLUNG:\n\n-PARENCHYMA:  The pre-existing pulmonary nodules show minimal growth. For\nexample a left upper lobe nodule (3, 23), previously 11 mm now measures 14 mm\nin diameter.  A left lower lobe nodule (3, 36), previously 8 mm now measures\n12 mm in diameter.  Unchanged severe emphysema.\n-AIRWAYS:  The airways are patent.\n-VESSELS:  No incidental PE, no vascular abnormalities.\nPLEURA: No pleural effusions.\n\nUPPER ABDOMEN: Abdominal findings are given in detail in the dedicated\nabdominal CT report.",
            "output": "Progression as compared to ___.  Mild to moderate growth of\npre-existing lymph nodes, chest wall lesions and pulmonary nodules."
        },
        {
            "input": "An endotracheal tube ends 6 cm above the carinal.The left lower lobe bronchus\nis occluded. The left lower lobe is consolidated and partially collapsed. A\nsmall to moderate left pleural effusion is loculated. There is marked scarring\nin the right lung and dependent atelectasis. Marked emphysematous changes\nthroughout both lungs are most prominent in the lung apices.\n\nIn the right middle lobe a 5 mm nodule is noted (series 6, image 146) which is\nnew since ___. An additional nodule in the right middle lobe measuring 7 mm\n(series 6, image 25) has increased in size, previously measuring 5 mm. Another\nnodule in the right middle lobe measuring 9 mm (series 6, image 215) has also\nincreased in size, previously measuring 6 mm.\n\nThere is no pneumothorax.  The heart size is top normal. The coronary arteries\nare calcified. There is no pericardial effusion. The aorta is normal in\ncaliber but contains moderate atherosclerotic calcifications. The main\npulmonary artery is normal in caliber.\n\nThe thyroid is normal. A left axillary lymph node has markedly increased in\nsize, currently measuring 3 x 3.6 cm and previously measuring 2.4 x 2 cm. \nThere is internal mammary A lipoma in the right subscapularis muscle is noted.\n\nOsseous structures: A lytic lesion in the left humeral head has become more\nlytic since ___. Multiple additional metastatic lesions in the right first\nrib the sternum, T11 vertebral body and multiple ribs appear stable.",
            "output": "1. The left lower lobe is consolidated and partially collapsed. A small to\nmoderate left pleural effusion is loculated. There is mild right lower lobe\natelectasis.\n\n2. Multiple right lung nodules and a left axillary lymph node have increased\nin size since ___. A lytic lesion in the left humeral head has become more lytic since ___\nand is concerning for impending pathological fracture. Multiple additional\nmetastatic bone lesions are stable.\n\n4. No findings to explain a drop in hematocrit."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nAgain seen is an injury to the aortic isthmus/proximal descending thoracic\naorta with a small medial projecting pseudoaneurysm and associated intimal\ntear, not significantly changed (601:30; 602:41).  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  A small mediastinal hematoma is not significantly\nchanged.\n\nPLEURAL SPACES: Compared with CT ___, patient has undergone interval\nplacement of a right-sided chest tube which terminates in the right anterior\nmedial pleural space, just anterior to the mediastinum.  There is a trace\nresidual right apical pneumothorax, significantly decreased in size from\nprior.\n\nLUNGS/AIRWAYS: There are homogeneously enhancing small consolidations at the\nlung bases compatible with atelectasis.  Additionally, there is atelectasis\nalong the right chest tube pathway.  No suspicious consolidations.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Multiple surgical clips are again seen in the left upper quadrant and\nat the hepatic hilum.  Patient again appears to be status post splenectomy\nwith small amount of splenosis in the left upper quadrant.  Included portion\nof the upper abdomen is otherwise unremarkable.\n\nBONES: Again seen are fractures of the inferior T2 vertebral body, left second\nthrough tenth ribs and fifth through ninth right ribs.",
            "output": "1. No significant change in appearance of an acute aortic injury at the aortic\nisthmus/proximal descending thoracic aorta with a small pseudoaneurysm and\nsmall associated mediastinal hematoma.\n2. Trace residual right apical pneumothorax status post right chest tube\nplacement, with interval resolution of previously seen leftward midline shift.\n3. Trace left pleural effusion.  Bilateral atelectasis.\n4. Redemonstration of multiple bilateral rib fractures as well as a fracture\nof the inferior T2 vertebral body."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  Patient is anemic.  There is moderate coronary artery calcification. \nThere is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Patient is status post right upper lobectomy.  Extensive bronchiectasis\nwithin the right middle lobe is unchanged.  Areas of bronchiectasis with\nperibronchial thickening throughout the right lower lobe with paucity of\nvasculature, within the lingula and left lower lobe are unchanged.  The\ncavitary lesion within the right upper lung has increased in volume since the\nprior study the cavity now has a volume of 240 cc.  There is evidence of\nbronchopleural fistula from multiple small subsegmental bronchi within the\nright middle lobe to the cavity.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Stable postsurgical changes following right upper lobectomy with evidence of\nbronchopleural fistula from the subsegmental bronchi to the right upper pleura\nwith increase in size of the cavity within the right upper chest. No evidence\nof abnormal wall thickening or recurrent aspergilloma.\n\nMultifocal bronchiectasis within the right middle lobe right lower lobe and\nleft lung is again seen.  Previously visualized parenchymal opacities in both\nlower lobes which most likely represented pneumonia have resolved.\n\nNo new consolidations"
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan.  Moderate coronary artery calcifications are stable.  Hypoattenuation of\nthe blood pool relative the myocardium is suggestive of anemia.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patient is status post right upper lobe lobectomy.  There is\nextensive bronchiectasis with areas of mucous plugging, worst in the right\nmiddle lobe.  There are areas of ground-glass and ___ opacities\nbilaterally, worse in the left lung compared with prior.  Compared with ___, a cavitary lesion within the right upper lobe has decreased in volume. \nThere are new areas of consolidation within the cavitary lesion in the right\nupper lobe (4:82; 601: 60, 524).  The loss of volume in the right hemithorax\nhas resulted in increased rightward midline shift of mediastinal structures.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable. \nThere is mild atherosclerotic calcification in the visualized abdominal aorta.\n\nBONES/SOFT TISSUE: There are stable postsurgical changes in the right lateral\nchest wall. No suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "1. Interval decrease in size of a right upper lobe cavitary lesion, with\nresultant increased rightward midline shift of mediastinal structures.\n2. New areas of consolidation in the right upper lobe cavitary lesion,\nconcerning for recurrent aspergillosis.\n3. Extensive bronchiectasis with areas of mucous plugging and waxing and\nwaning ground-glass and ___ opacities, worst in the left lung compared\nwith prior, concerning for bronchogenic infection including atypical\nmycobacterium."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries, mild in the aorta and\nnone in the cardiac valves.  The pulmonary arteries and aorta are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Several enlarged mediastinal lymph nodes,\napparently unchanged, the largest in the right upper paratracheal station\nmeasuring 14 mm (302:42).  No apparent hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions or pneumothoraces.  Moderate left apical scarring.\n\nLUNGS:\nStatus post right upper lobectomy with unremarkable bronchus stump and suture\nlines.  Extensive bronchiectasis is again redemonstrated, stable, notably in\nthe subpleural areas of the right lower lobe and middle lobe.  The cavitary\nlesion in the right lung has slightly decreased in size.  Centrilobular\nnodules with ___ pattern in the left lower lobe (302:121) are\nunchanged.\n\nCHEST CAGE:\nStable surgical changes to the right anterior ribs.  No acute fractures.  No\nsuspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Status post right upper lobectomy due to a previous aspergiloma. \nRedemonstration of stable extensive bronchiectasis, mostly peripheral and\ncentrilobular nodules with ___ pattern in the left lower lobe.\nThe cavity to the right lung has shown mild decrease in size compared to prior\nstudy of ___.\nThere is no current evidence of superimposed infection.\nStable mediastinal lymphadenopathy, likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in the either axilla or\nthoracic inlet.  Postsurgical appearance of resection of the right anterior\nchest wall, unchanged.  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  Moderate atherosclerotic calcifications\nin the coronary arteries, none in the aorta or cardiac valves.  The pulmonary\narteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, the largest in the right upper\nparatracheal station measuring up to 0.7 cm (302:70).  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Moderate apical scarring in the left.\n\nLUNGS:\nStatus post right upper lobectomy with unremarkable bronchus stump. \nRedemonstration of a large cavity in the right apex, slightly larger than\nprior study, now containing semi liquid material.  The middle lobe is\ncollapsed around severe bronchiectasis.  Redemonstration of peripheral\nbronchiectasis, some are larger than prior study, for example in the right\nlower lobe (302:181) with progressive wall thickening and peribronchial\ninfiltration.  Multiple other centrilobular nodules are noted, more prominent\nthan in prior study, especially in the left lower lobe.  Peripheral confluent\nsmall consolidations with ground-glass opacities (302:167, 198 and 210) are\nlarger.\n\n___ be a small broncho pleural connection to the long-standing large right\napical pleural air collection, 302:79.\n\nCHEST CAGE:\nPrior surgical resection of the right anterior third through fifth ribs.  No\nacute fractures.  No suspicious lytic sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Findings consistent with active suppurative multifocal bronchiectasis, worse\nthan in prior study, left greater than right, with an increase in the size of\nthe bronchiectasis and in the extent of bronchogenic dissemination of\ninfection to the left lung.\n\nThe large cavity to the right now shows new secretions and larger size also,\nsupporting evidence of active infection, as well as possible small\nbronchopleural connection, 302:79.\n\n\n\nDifferential diagnosis of infection includes virtually any organism, including\nbacteria, fungus, and both tuberculosis and non-tuberculous mycobacteria.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:16 pm."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber , measuring up to 3.2 cm without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral dependent atelectasis is noted.  A calcified\ngranuloma is noted in the left lower lobe. The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a 1.3 cm\nhypodensity in the liver without arterial enhancement (03:45) likely\nrepresenting a cyst/biliary hamartoma.  The gallbladder is distended without\nwall thickening.  Colonic diverticulosis is noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  The ascending aorta\nis tortuous, however not aneurysmally dilated.  No follow-up is recommended."
        },
        {
            "input": "BASE OF NECK: The visualized base of the neck is unremarkable.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged .\n\nCARDIO-MEDIASTINUM: The thoracic aortic is normal in caliber with mild\natherosclerotic calcification.  The pulmonary arteries are normal caliber. The\nheart is not enlarged. There is no pericardial effusion or wall thickening.\n\nAIRWAY: The airways are patent to the segmental level.\n\nLUNGS: There are bilateral lung apical scarring.  There is a right lung apex 2\nmm solid nodule (series 5, image 44).  There is a right upper lobe 3 mm nodule\n(series 5, image 97).  There is a right upper lobe 1 mm nodule (series 5,\nimage 123).  There is a right lower lobe 5 mm nodule (series 5, image 177). \nThere is a right lower lobe 5 mm nodule (series 5, image 141).  There is left\ninferior lingular and left base linear atelectasis.  There is a left lower\nlobe 2 cm cyst (series 5, image 194).  There is no pleural effusion or pleural\nthickening.\n\nBONES: There multiple lucent lesions involving the thoracic spine T2, T3 and\nT5 likely representing hemangioma.\n\nSOFT TISSUE: The chest wall soft tissue is grossly unremarkable.\n\nUPPER ABDOMEN: There is contrast material visualized in the partially\nvisualized gallbladder.  The partially visualized liver, spleen, pancreas,\nadrenal glands and bilateral kidneys are grossly unremarkable.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Multiple small lung nodules with detailed description as in above. \nFollow-up in 3 months is recommended.\n\nRECOMMENDATION(S):  Multiple small lung nodules with detailed description as\nin above.  Follow-up in 3 months is recommended."
        },
        {
            "input": "The thoracic aorta demonstrates normal caliber.  Mild to moderate\ncalcifications are seen throughout the thoracic aorta worse at the aortic\narch.  No significant calcifications are seen in the ascending aorta.  Severe\ncalcifications are throughout the coronary arteries.  Prominence of the\npulmonary trunk is again noted suggestive of pulmonary arterial hypertension. \nThe pulmonary trunk measures 4.3 cm, as on prior.\n\nThere is no adenopathy in the chest.  No pericardial or pleural effusion. \nThere is new mild left pleural thickening.\n\nThe lungs are clear.  A 2 mm pleural based right pulmonary nodule on series\n302, image 175 is stable dating back to ___.  Regions of air trapping\nsubsegmental atelectases and subpleural reticulation are present.  Mild\nsubpleural reticulation is likely due to very mild fibrosis..\n\nLimited images of the upper abdomen are unremarkable aside for a left renal\ncyst as seen on prior MRI.  Cholecystectomy changes are again seen.\n\nNo worrisome osseous lesions are demonstrated.",
            "output": "Mild-to-moderate thoracic aortic calcifications.  Severe coronary arterial\ncalcifications.\n\nMild subpleural reticulations, indicative of mild early fibrosis.  New mild\nleft pleural thickening, regions of air trapping and dependent subsegmental\natelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy by CT size criteria.  The mid\nesophagus is mildly patulous, suggestive of dysmotility and likely related to\nthe patient's hiatal hernia.\n\nHILA: A right hilar lymph node measures up to 1.5 cm in short axis, not\ndefinitely seen in ___ within limitations of a noncontrast study.  No left\nhilar lymphadenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.\n\nPLEURA: No pleural effusion.\n\nLUNG:\nPARENCHYMA:  A right middle lobe pulmonary nodule measures 9 mm (series 6,\nimage 393), moderately increased from ___ (previously 6 mm). \nAdditional, small pulmonary nodules measure up to 6 mm, some of which are sub\nsolid (series 6, image 386, 352) and not definitely seen in ___.  Platelike\natelectasis is noted in the lingula.\n\nAIRWAYS:  Airways are patent to the subsegmental level.\n\nVESSELS:  The aorta is mildly ectatic measuring 4.1 cm.  The main pulmonary\nartery is mildly enlarged measuring up to 3.1 cm, which can be seen in the\nsetting of pulmonary hypertension.  The study is moderately limited by the\ncontrast bolus timing and respiratory motion.  Within these limitations no\npulmonary embolus.\n\nMUSCULOSKELETAL: Severe degenerative change at the glenohumeral joints,\nbilaterally.  Multilevel moderate to severe loss of disc height with moderate\nendplate spurring throughout the lower thoracic spine.  No acute fracture,\ndislocation or suspicious osseous lesion.\n\nUPPER ABDOMEN: Moderate to large hiatal hernia noted.  Otherwise, limited\nassessment of the upper abdomen is grossly unremarkable.",
            "output": "1.  Study is limited by respiratory motion and the phase of contrast.  Within\nthese limitations, no central pulmonary embolus or acute cardiopulmonary\nabnormality.\n2.  9 mm right middle lobe pulmonary nodule, not well assessed on the prior\nstudy from ___, but appears moderately increased in size.  Right hilar lymph\nnodes measure up to 1.5 cm.  Additional, small pulmonary nodules, measure up\nto 6 mm not seen in ___, including a ground-glass, right lower lobe, 6 mm\npulmonary nodule, which could be infectious or inflammatory.  Please see\nrecommendations below.\n5.  Moderate to large hiatal hernia.\n6.  Severe degenerative change at the glenohumeral joints.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nbigger than 8mm, a follow-up CT in 3 months or PET-CT."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged portion of the neck base\nis unremarkable.  Axillary and supraclavicular lymph nodes are not enlarged. \nThe remainder of the chest wall is unremarkable.\n\nUPPER ABDOMEN: This study is not optimized for the evaluation of abdominal\nstructures.  There is a moderate least sized hiatal hernia, otherwise the\nimaged upper abdomen is unremarkable..\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  There is no\nmediastinal hematoma.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  Trace pericardial fluid is noted. \nThe ascending thoracic aorta measures up to 4.2 cm, which is mildly dilated. \nThere is mild atherosclerotic calcification of the aortic arch and descending\nthoracic aorta.  Mild coronary artery calcifications are noted.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\nNo focal consolidation.  Atelectasis in the medial left base is unchanged.  A\n1 cm right middle lobe pulmonary nodule is unchanged (4:103).  A 3 mm right\nlower lobe nodule was not definitely seen previously (04:134).  A ground-glass\nnodule measuring 3 mm in the right lower lobe is unchanged (03:54).  3 mm left\nlower lobe pulmonary nodule (4:184) may have been obscured by\nmotion/atelectasis on the last exam.\n\nRight upper lobe predominant centrilobular nodularity is not appreciably\nchanged from prior, and could reflect respiratory bronchiolitis.\n\nCHEST CAGE: No acute fracture or aggressive osseous lesion is identified. \nMultilevel degenerative changes of the thoracic spine are present.",
            "output": "1. No rib fractures are identified.\n2. Multiple pulmonary nodules are re-demonstrated, the largest measuring up to\n1 cm in right middle lobe.  This is unchanged in comparison with ___. \nPET-CT is recommended for more complete evaluation.\n3. Unchanged mild dilation of the ascending aorta, measuring up to 4.2 cm.\n\nRECOMMENDATION(S):  PET-CT."
        },
        {
            "input": "CHEST PERIMETER: No findings in lower thyroid require any further imaging\nevaluation.\n\nNo supraclavicular or axillary adenopathy.  Breast evaluation is reserved\nexclusively for breast imaging.  No nodules or soft tissue abnormalities\nelsewhere in the chest wall.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately to severely distended with air and\nfluid above a moderate size hiatus hernia, more so today than on ___,\nsuggesting dysmotility, possible reflux, and susceptibility to aspiration.\n\nAtherosclerotic calcification not apparent head and neck vessels or coronary\narteries.  Aorta is not dilated.  Mild enlargement pulmonary arteries, main 34\nmm, right 26 mm, unchanged.  Aortic valve not calcified.  Pericardium\nphysiologic.\n\nTHORACIC LYMPH NODES: Changes as follows:\n\nRight upper paratracheal mediastinum, 12 mm, 03:12, previously 9 mm.\n\nRight hilum, 20 mm, 5:102, not readily compared to prior chest noncontrast\nchest CTs.\n\n\nLUNGS, AIRWAYS, PLEURAE:\nExtensive bronchial wall thickening and scattered bronchiolar nodulation, as\nwell as new acinar nodulation in the right lower lobe, could be due to\natypical pneumonia either viral or mycoplasma or multifocal aspiration.\n\nAtelectasis in the superior segment of the left lower lobe is due to larger\nhiatus hernia.\n\nSolitary 10 mm wide right hilar or juxta hilar middle lobe nodule, 5:125,\npresent ___ otherwise of uncertain chronicity.\n\nNo pleural abnormality.\n\nCHEST CAGE: No evidence of malignancy or infection in the chest cage.",
            "output": "Widespread bronchial and bronchiolar inflammation as well as early broncho\npneumonia, right lower lobe could be due to viral or mycoplasma pneumonia,\nalternatively gastroesophageal reflux and aspiration, in the setting of\nworsening esophageal distension and larger hiatus hernia.\n\nMild central lymph node enlargement reflecting active pulmonary inflammation."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Mild\ncardiomegaly.  The pericardium, and great vessels are within normal limits\nbased on an unenhanced scan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Normal morphology lymph nodes in the\nmediastinum, for example a pretracheal lymph node measuring 1.1 cm.  No\naxillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nLUNGS AND PLEURA: Opacity abutting the oblique fissure in the right lower lung\nlikely represents a combination of segmental atelectasis of the right middle\nlobe with possible adjacent fluid.  Lungs are otherwise clear without masses\nor areas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.  Significant motion artifact limits\ndetailed examination of lungs\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Large hiatal hernia unchanged from prior study.\n\nBONES: Multilevel degenerative changes of the thoracic spine most prominent at\nT6 through 12 with joint space narrowing and osteophyte formation.  There is\nno acute fracture.",
            "output": "1. No evidence of pneumonia.\n2. Small amount of atelectasis in the right middle lobe with likely trace\nfissural fluid on the right.\n3. Large hiatal hernia."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Scattered morphologically normal all\nmediastinal lymph nodes are likely reactive.  No axillary, mediastinal, or\nhilar lymphadenopathy by size criteria.  There is a small hiatal hernia, with\napparent thickening of the distal esophagus.  This could be due to collapsed\nhernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout,\nmost commonly seen in the setting of hepatic steatosis.  There is no evidence\nof focal lesion or laceration.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small fibroid noted at the fundus of the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Old right anterior rib fractures noted.  No focal suspicious osseous\nabnormality.\n\nSOFT TISSUES: Mesh noted in the anterior abdominal wall.  There is a small,\nfat containing ventral hernia at the superior margin of the mesh.",
            "output": "1. There is apparent thickening of the distal esophagus, which may represent\ncollapsed hiatal hernia.  Endoscopy is recommended for further evaluation.\n2. Hepatic steatosis.\n\nRECOMMENDATION(S):  Endoscopy is recommended for further evaluation of\napparent distal esophageal thickening.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 20:54 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no cervical,\nsupraclavicular, or axillary lymphadenopathy.  The chest wall is intact.\n\nUPPER ABDOMEN: Please see report from dedicated CT of the abdomen and pelvis\nfor findings in the upper abdomen.  There is asymmetrical wall thickening of\nthe distal esophagus which could represent a collapsed hernia but further\nevaluation by means of a endoscopy is recommended.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.\n\nHILA: There is no hilar lymphadenopathy.  One prominent right hilar lymph node\nmeasures 8 mm in short axis.\n\nHEART and PERICARDIUM: The heart is normal in appearance.\nPLEURA: There is no evidence of pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  There is no evidence of consolidation.  No suspicious nodules\nare identified.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The aorta is normal in caliber.  The pulmonary artery is also\nnormal in caliber.\nCHEST CAGE: No bony abnormalities are identified.  There is no evidence of\nfracture.",
            "output": "No evidence of malignancy in the chest."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  No evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present.  Common\norigin of the left common carotid artery and brachiocephalic trunk is a normal\nvariant.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The\nthyroid gland appears unremarkable.\n\nNo evidence of pericardial effusion.  No pleural effusion.\n\nThe lung posterior bases are not included in the scan.  Regarding the\nremaining portions of the visualized lung:\n\nA right lower lobe subpleural nodule measures 4 mm (series 3, image 108). \nOther right lower lobe pulmonary nodules measures 3 mm and 4 mm, respectively\n(series 3, image 82, 95).  A left lower lobe superior segment perifissural\nmicronodule measures 2 mm (series 3, image 90).  A right lower lobe calcified\ngranuloma is tiny.\n\nLinear parenchymal opacities in the left lower lung and lingula as well as\nright middle lobe medial segment are compatible with atelectasis.  Bibasilar\natelectasis is mild.  No evidence to suggest focal pneumonia.  The airways are\npatent to the subsegmental level.  No pneumothorax.\n\nLimited images of the upper abdomen are unremarkable other than a small hiatal\nhernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nVertebral body heights appear preserved.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  Bilateral pulmonary nodules under 6 mm, nonspecific.\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n3.  Small hiatal hernia."
        },
        {
            "input": "Multiple hypodense thyroid nodules measuring up to 7 mm on the left are\nunchanged.  Small mediastinal lymph nodes measure up to 7 mm in short axis in\nthe right lower paratracheal location.  There is no pathologic lymph node\nenlargement in the thorax.\n\nModerate cardiomegaly with multichamber enlargement is stable.  Diffuse low\nattenuation of the blood in the heart suggests anemia.  Moderate coronary\nartery calcifications are present.  The main and right pulmonary arteries are\nnormal caliber, however there is stable mild dilatation of the left pulmonary\nartery to 2.8 cm, decreased from 3.1 cm.  There is no pericardial effusion.\n\nIn comparison to the study of 3 days ago, the overall density of multifocal\nground-glass opacities with superimposed interlobular septal thickening has\ndecreased. The distribution and extent of the ground-glass opacities are\nsimilar in the upper lobes, but has decreased in the right middle and\nbilateral lower lobes. An unchanged left lower lobe consolidation is likely\ndue to a combination of infection and atelectasis. Moderate lower lobe\nbronchial wall thickening with small bronchial impactions is not appreciably\nchanged. A nodular opacity along the nondependent aspect of the proximal right\nmain bronchus is most likely due to retained secretions (4, 86). Attention at\nfollowup is advised. Left lower lobe linear atelectasis is new.\n\nA small hiatal hernia is present.  Images of the upper abdomen are otherwise\nunremarkable.\n\nThe patient has had prior lumbar spine fusion.  The appearance of multiple\nspinal hemangiomas is unchanged.  Multilevel spinal degenerative changes are\nalso stable.",
            "output": "Stable left lower lobe pneumonia or aspiration.  The other improving\nground-glass opacities are either due to resolving pulmonary edema or\nhemorrhage.\n\nStable small hiatal hernia.\n\nAnemia.\n\nStable isolated dilatation of the left pulmonary artery raises concern for\npulmonic stenosis.  Consider echocardiographic correlation."
        },
        {
            "input": "No incidental thyroid findings.  Status post sternotomy.  Moderate bilateral\npleural effusions.  Several borderline sized lymph nodes in the mediastinum. \nStatus post valvular replacements.  Mild pericardial effusion.  Postoperative\npunctate paraesophageal hyperdensity (2, 32).  Otherwise unremarkable\nposterior mediastinum.  The soft tissues of the chest wall are unremarkable. \nThere is minimal left fluid or pneumothorax without evidence of tension. \nExtensive respiratory motion.  Mild interstitial pulmonary edema.  Relatively\nextensive left lower lobe atelectasis.  No evidence of pneumonia.",
            "output": "Status post mitral valve replacement.  Minimal left fluid or pneumothorax\nwithout evidence of tension.  Mild postoperative pericardial effusion.  Status\npost sternotomy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nHowever, due to suboptimal phase of contrast, this study is nondiagnostic for\nevaluation of the subsegmental pulmonary arteries.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma. \nModerate atherosclerotic disease is noted involving the LAD.  No pericardial\neffusion is seen.  The thoracic aorta and pulmonary trunk are normal in\ncaliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  A measurable 7 mm left axillary lymph node is\nvisualized, likely reactive.  No mediastinal mass.  There is a small hiatal\nhernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  No suspicious or growing pulmonary nodules are identified.  A\nbroad-based, triangular-shaped 5 mm subpleural nodule is noted abutting the\nright middle lobe (5:200), likely representing a lymphoid aggregate.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The hepatic parenchyma is relatively hypointense compared to the\nspleen, representing hepatic steatosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Hepatic steatosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged.\n\nThyroid is unremarkable. There is no pathologic enlargement of lymph nodes by\nsize criteria in the mediastinum, hila, internal mammary, or diaphragmatic\nstations by size criteria. Numerous retrocrural and right posterior\nmediastinal, para aortic lymph nodes range in size up to 8 x 13 mm, 4N:195, 6\nx 12 mm, 4N:204, and a cluster, 7 x 13 mm in aggregate, 4N:219. These are\nsuspicious for malignancy.\n\nThere are no lung nodules and the tracheobronchial tree is normal to\nsubsegmental levels.\n\nThere are no bone lesions or soft tissue lesions in the chest cage suspicious\nfor malignancy.",
            "output": "A handful of sub cm right retrocrural and posterior mediastinal lymph nodes is\nsuspicious for malignancy, by virtue of number and location, rather than size."
        },
        {
            "input": "The thyroid gland is unremarkable. Several mildly prominent retrocrural lymph\nnodes are not appreciably changed in size and number since ___. A\nrepresentative node now measures 7 x 11 mm, previously 6 x 13 mm (4, 197).\nThere are no supraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.\n\nPrevious right upper and lower lobe ground-glass opacities have resolved.\nHowever, there are new left upper and left lower lobe ground-glass opacities. \nTwo new pulmonary nodules measure up to 3 mm in the subpleural left upper lobe\n(4, 50 and 56).  A few stable triangular-shaped nodules measuring up to 5 mm\nwhich are closely apposed to the major fissures are more characteristic of\nbenign lymphoid aggregates (4:  149, 161 and 167). No endobronchial lesion or\npleural abnormality is identified.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the abdominal MRI performed concurrently.\n\nThe bones are unremarkable.",
            "output": "Multiple prominent retrocrural lymph nodes are stable in size and number since\n___. These remain worrisome for intrathoracic metastasis.\n\nNew indeterminate pulmonary nodules measure up to 3 mm in the subpleural left\nupper lobe.  Short interval followup as per clinical protocol is advised.\n\nInterval resolution of right upper and lower lobe ground-glass opacities with\nnew left upper and left lower lobe ground-glass opacities suggests an\ninfectious or inflammatory etiology.  Pulmonary hemorrhage is possible; acute\nallergic alveolitis, is less likely because of the limited area of lung\ninvolvement."
        },
        {
            "input": "Axillary and supraclavicular lymph nodes are not pathologically enlarged and\nthere is no soft tissue abnormality in the imaged chest wall suspicious for\nmalignancy. This study is not designed for subdiaphragmatic diagnosis but\nshows there is no adrenal mass.\n\nThyroid is unremarkable. Central lymph nodes are not pathologically enlarged.\nSub cm para-aortic posterior mediastinal, and retrocrural lymph nodes are\nunchanged since ___, smaller and less numerous than in ___.\nAorta and pulmonary arteries are normal size. There is no pericardial or\npleural effusion.\n\nThe biapical pleural parenchymal scarring is unchanged. Right lung is\notherwise clear. 2 tiny nodules that appeared on ___ have\nresolved. Previous alveolitis in the lingula has also cleared. Mineral minimal\nfissural pleural thickening is smaller.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Normal chest CT. Previous new tiny pulmonary nodules and prior pneumonia have\nresolved since ___"
        },
        {
            "input": "CHEST PERIMETER: Prior right thyroid lobe resection.  No thyroid findings need\nany further imaging.  No supraclavicular or axillary lymph node enlargement. \nNo soft tissue abnormalities in the chest wall.  This study is not designed\nfor subdiaphragmatic diagnosis but shows no adrenal mass.  Exophytic 3 cm\nlesion, lateral cortex interpolar left kidney and adjacent high attenuation\nlesion, 302: 309-317 should be evaluated with renal ultrasound.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent in head neck vessels or coronary arteries.  Aortic valve is not\ncalcified.  Maximum diameter noncalcified ascending thoracic aorta, 42 mm. \nPulmonary arteries normal size.  No pericardial abnormality.  Enlarged left\nventricle and left atrium have presumably been thoroughly evaluated by\nechocardiography.\n\nTHORACIC LYMPH NODES: Numerous measurable mediastinal lymph nodes are not\npathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are well expanded and clear, tracheobronchial\ntree is normal to subsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE: Unremarkable",
            "output": "Noncalcified ascending thoracic aorta maximum diameter 42 mm.\n\nLeft renal abnormalities should be evaluated by ultrasound."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nAtherosclerotic calcification is not apparent in head neck vessels and is mild\nin the coronaries, present in at least the LAD.  There is no pericardial or\npleural effusion.  Sub pleural atelectasis should not be mistaken for\nposterior costal pleural thickening.  Small left pleural calcifications,\nanteriorly, antral laterally, and along the diaphragm 5:  87, 115-130, 144 are\ntypical of asbestos related pleural plaque.  There is no pleural mass, or a\ngood evidence for asbestosis.\n\nCentral lymph nodes are not pathologically enlarged in the mediastinum, hila,\nretrocrural, or diaphragmatic stations.\n\n3 mm perifissural right lower and middle lobe nodules, 5:109, 115 are only\nfocal lung lesions.  Tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No good evidence for intrathoracic malignancy or infection.\n\nWith calcified plaque suggesting prior asbestos exposure, 2 3 mm nodules in\nthe right Lung should be kept under surveillance with repeat chest CT in 6\nmonths.  No evidence of these a fairly ___ or asbestosis.\n\nMild coronary atherosclerosis.\n\nRECOMMENDATION(S):  Repeat noncontrast chest CT in ___ months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodense thyroid nodules measure\nup to 1.2 cm.  Enlarged right lower cervical/supraclavicular nodes measure up\nto approximately 3.0 x 2.9 cm in conglomerate.  The esophagus is unremarkable.\n\nUPPER ABDOMEN: Please refer to the separately dictated CT abdomen and pelvis\nperformed on the same day for subdiaphragmatic characterization.\n\nMEDIASTINUM: Enlarged masses with central low density within the mediastinum\nare difficult to discretely measure, some appearing contiguous with a right\nupper lobe mass, which may either reflect extension of the mass, described in\nfurther detail below, or enlarged mediastinal nodes.\n\nHILA: There is no left hilar mass or lymphadenopathy.  See below for\nevaluation of the right hilum\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.  Coronary artery calcifications.\n\nPLEURA: Trace right pleural effusion.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: A large, lobulated, heterogeneous mass within the right upper\nlobe, extending superiorly into the right lung apex and inferiorly to the\nright hilus, is difficult to discretely measure, but the dominant component\nmeasures approximately 9.0 x 6.7 x 8.1 cm (302:92, 601:26).  The mass appears\nto extend into the mediastinum, as described above, and attenuates the right\nupper lobe bronchus and right upper lobe pulmonary artery.  There are 2 areas\nof focal attenuation of the SVC (302:81, 302: 95) likely secondary to direct\ninvasion from the mediastinal mass/lymphadenopathy and right hilar lesion\nrespectively.  The right superior pulmonary vein is not well visualized, with\nhypodensity within the expected origin, and within the atrium, concerning for\ninvasion or intraluminal thrombus.  Multiple nodular opacities are seen\nadjacent to the mass, within the right upper lobe and superior segment of the\nright lower lobe.  The left lung appears clear.\n2. AIRWAYS:  Aside from the aforementioned findings, the airways are patent to\nthe level of the segmental bronchi bilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits. Aside\nfrom the aforementioned abnormalities, suboptimal evaluation of the pulmonary\nvasculature demonstrates no evidence of central pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. Large, lobulated, heterogeneous low-density mass centered within the right\nupper lobe, with the dominant component measuring approximately 9.0 x 6.7 x\n8.1 cm, and with extension into the mediastinum and possible invasion through\nthe SVC and right superior pulmonary vein into the left atrium.  The lesion\nexerts adjacent mass effect, with attenuation of the right upper lobe bronchus\nand none opacification of the right upper lobe pulmonary artery.\n2. Mediastinal and right cervical/supraclavicular lymphadenopathy is\nconcerning for nodal involvement.\n3. Trace right pleural effusion.\n4.  Please refer to the separate report of the CT abdomen and pelvis performed\non the same day for subdiaphragmatic characterization."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is incompletely\nvisualized.  No supraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Possible small hiatal hernia.  Hypodense left adrenal lesion\nmeasuring -2 Hounsfield units suggestive of a lipid rich adenoma, which\nappears relatively similar in size compared to previous CT abdomen done ___. \nSmall diverticulum arising from the fundus of the stomach with dependent\nhyperdensity suggesting gastroliths.\n\nMEDIASTINUM: No enlarged mediastinal lymph nodes.  No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Mild aortic annular and\ncoronary calcifications.  Ectatic ascending aorta measuring 43 mm.  Mild\ncalcification of the aortic arch.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  No interstitial or diffuse lung disease.  No confluent airspace\nconsolidation.  There is a single 1 mm nodule in the right upper lobe (9, 77).\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  Not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nlesions.",
            "output": "No features of interstitial or diffuse lung disease.  No confluent airspace\nconsolidation.  There is a single indeterminate 1 mm pulmonary nodule.\n\nEctatic ascending aorta measuring 43 mm diameter."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is top-normal in size, without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are low volume, with dependent atelectasis bilaterally. \nNo mass, pulmonary nodule, or focal consolidation is seen.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: This exam is not optimized for evaluation of infra diaphragmatic\nstructures.  Within these limitations, the visualized upper abdomen is\nremarkable only for a gastric diverticulum.\n\nBONES: No suspicious osseous abnormality is seen.? There is an acute fracture\nof the left anterolateral seventh rib.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Acute nondisplaced fracture of the left anterolateral seventh rib."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is significant dependent atelectasis in the posterior lungs. There is no\nevidence of pulmonary parenchymal abnormality. The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No pneumonia or other acute pulmonary abnormality.\n3. Significant dependent atelectasis in the posterior lungs."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  There is trace pericardial fluid, likely physiologic.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is minimal bilateral dependent atelectasis.  Lungs are\notherwise clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nBreast, chest wall and bones:\nNo abnormality\n\nMediastinum:\nStable dilated ascending aorta measuring 4.6 cm\n\nHila:\nNo abnormality\n\nHeart:\nSevere coronary calcifications.  Papillary muscle calcifications, unchanged\n\nUpper Abdomen:\nNo abnormality\n\nLung:\n\nNodules:\n\nDominant nodule:\nThe left upper lobe pulmonary nodule has slightly increased in size now\nmeasures 1.3 x 0.7 cm with a solid component of 5x11 mm as compared to the\nprior measurements of 4 x 7 mm, is concerning for adenocarcinoma.\n\nOther nodules:\nThe right upper lobe pulmonary nodule measuring 7 mm (5, 37) is unchanged. \nStable ground-glass nodules in the right upper lobe (5, 56).  Stable solid 5\nmm right upper lobe pulmonary nodule (5, 56.\n\nStable 5 mm ground-glass nodule along the fissure in the right upper lobe (5,\n100).  No new pulmonary nodules.\n\nParenchyma:\nStable scar-like opacity in the right apex (5, 37) measuring 2.3 x 1.8 cm. \nStable upper lobe predominant emphysema.\n\nPleura and airways:\nNo abnormalities.",
            "output": "Progressive slow increase in size of the left upper lobe nodule with increase\nin size of the solid component which now measures 11 x 5 mm, the lesion is\nconcerning for adenocarcinoma.\n\nAll the other solid and part solid lesions in both upper lobes are unchanged\nin size density and morphology.\n\nStable scar-like opacity in the right apex.\n\nUpper lobe predominant emphysema.\n\nStable mild bronchiectasis\n\nLung-RADS category: 4 X\n\nRECOMMENDATION(S):  Recommendations will be provided after discussion at the\nmultidisciplinary surgical oncology conference.\n\nIncidental findings**:\nNone\n\n\n\n___ Radiology is an ACR accredited CT lung cancer screening site.\n**All recommendations regarding incidental findings are based on ACR\nguidelines for the management of these findings."
        },
        {
            "input": "THORACIC INLET: There is a stable small calcification within the right lobe of\nthyroid.  There are no enlarged supraclavicular lymph nodes..  There are no\nenlarged axillary lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is mild atherosclerotic calcification involving the aorta. \nThere is heavy coronary artery calcification.  There is no pericardial\neffusion.  The ascending aorta is mildly ectatic but unchanged\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Biapical pleuroparenchymal scarring.  There are multiple bilateral\nnodules and nodular opacities in both upper lobes which are unchanged and\ncould be related to patient's known history of sarcoidosis.  Patient status\npost ablation of a left upper lobe nodule in the interim.  The nodule appears\nlarger than on the prior study and more solid and now measures 2.1 x 1.3 cm\nand most likely represents evolving post ablation changes.  Attention to this\non follow-up imaging is recommended.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Status post ablation of a left upper lobe nodule in the interim with evolving\npost ablation changes.\n\nAll the other multiple bilateral pulmonary nodules are unchanged in size and\nmorphology, could be related to sarcoidosis.  Continued follow-up is\nrecommended.\n\nNo new pulmonary nodules.\n\nStable ectatic ascending aorta measuring up to 4.3 cm."
        },
        {
            "input": "CTA CHEST: Evaluation of the subsegmental pulmonary arteries in the bilateral\nlower lobes, left more than right, is limited due to atelectasis. The\nremainder of the pulmonary arterial vasculature is well visualized without\nfilling defect to suggest pulmonary embolism.  The thoracic aorta and\npulmonary artery are normal in caliber without significant aortic\natherosclerotic calcifications.  The heart and pericardium are within normal\nlimits without pericardial effusion.  No pathologically enlarged axillary,\nmediastinal or hilar lymph nodes are identified, ranging up to 7 mm in the\nright hilum. There are bilateral pleural effusions, large and partially\nloculated on the left and small on the right, with adjacent compressive\natelectasis and left lower lobe collapse.  There is a tiny left pneumothorax. \nApparent filling defect in the left internal jugular and left brachiocephalic\nveins is likely due to mixing of opacified and unopacified blood. No nodules\nare seen in the imaged thyroid gland.\n\nA calcified granuloma is seen in the right upper lobe (3:77).  Central airways\nare patent. A PICC ends in the SVC.\n\nNo abnormality is seen in the imaged upper abdomen. Subcutaneous air and fluid\nin the left chest wall are likely postsurgical.\n\nBONE WINDOWS: Lower thoracic spinal fusion hardware is incompletely evaluated.\nPost surgical changes are noted in the spine with areas of blood.",
            "output": "1. No acute aortic pathology or pulmonary embolism.\n\n2. Large, partially loculated left pleural effusion with tiny left\npneumothorax and left lower lobe collapse.\n\n3.  Small right pleural effusion with adjacent atelectasis.\n\n4.  Postsurgical changes in the spine, incompletely evaluated.\n\nNOTIFICATION:  Updated findings after attending review were discussed by Dr.\n___ with ___ (APN for Ortho Spine) on the telephone on\n___ at 9:48 AM."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  At the\nligamentum arteriosum is a smooth subtle bulging along the inferior aspect of\nthe aorta, which may be a congenital ductus diverticulum or a small\nposttraumatic pseudoaneurysm (series 602b, image 48).  Cardiac configuration\nis normal and there is no appreciable coronary calcification.\n\nAirways are patent to subsegmental levels bilaterally.  There is no pulmonary\nnodule or mass suspicious for malignancy or infection.  Bibasilar platelike\natelectasis is noted.  There is no pleural effusion or pneumothorax.\n\nPlease refer to concurrent CT abdomen pelvis for discussion of findings in the\nupper abdomen.  Postsurgical changes are noted with T7-9 laminectomy with\nadjacent edema and soft tissue gas.  Left paraspinal mass at these levels is\nbetter assessed on recent MRI.  There is no CT abnormality at the T8 vertebra\nthat correlates to the abnormal signal on MRI.",
            "output": "1.  No lymphadenopathy, pulmonary nodules, or new findings concerning for\nmalignancy in the chest.\n2.  Redemonstration of the left posterior paraspinal mass after T7-9\nlaminectomy with expected postoperative changes.\n3.  Small aortic ductus diverticulum or focal pseudoaneurysm, which may be\nposttraumatic."
        },
        {
            "input": "Aorta is minimally calcified.  Main pulmonary arteries substantially dilated\nup to 3.5 cm with no significant change since the prior study.  Substantial\ndilatation of the left main pulmonary artery up to 3 cm is demonstrated. \nCoronary calcifications are extensive.  There is no pericardial pleural\neffusion.  Image portion of the upper abdomen reveals no appreciable\nabnormality except for left kidney superior pole.  Cyst.  The patient is after\ncholecystectomy.\n\nAirways are patent to the subsegmental level bilaterally.  Severe emphysema,\nright more than left is centrilobular and panlobular.  Right upper lobe linear\natelectasis is unchanged.  Bronchial wall thickening is diffuse, unchanged. \nGround-glass opacity in the superior segment of left lower lobe, series 5,\nimage 138 is 13 x 9 mm, slightly increased since the prior study, a adjacent\nto the pulmonary artery segmental branch.  Right lower lobe nodule, subpleural\nis stable.  No new nodules masses are consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Severe emphysema.\n\nScarring/ atelectasis in the right upper lobe.\n\nGround-glass opacity in the superior segment of left lower lobe, minimally\nincreased in size but continuous surveillance is recommended in reassessment\nin 6 months would be justified.  Stable right lower lobe subpleural nodule.\n\nMost likely present pulmonary hypertension.\n\nCoronary calcifications."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.\n\nAorta is normal in size with moderate atherosclerotic calcifications.  The\nmain, right, left pulmonary arteries are markedly enlarged, stable from prior\nstudies with the left main pulmonary artery measuring up to 3.5 cm (04:25). \nCardiac configuration is otherwise normal with extensive coronary arterial\ncalcification.  Diffuse low-attenuation of the blood pool suggests anemia.  A\npartially imaged tunnelled right IJ central venous catheter tip terminates in\nthe low SVC.\n\nThe airways are patent to the subsegmental level bilaterally without focal\nconsolidation.  Increased areas of ground-glass opacity in the posterolateral\nleft upper lobe, the superior subsegment of the left lower lobe, and the\nposterior right upper lobe are increased from the prior study and may\nrepresent a viral infectious process (5:167, 191).  Severe right greater than\nleft apical predominant bullous emphysema is stable from prior studies. \nLinear atelectasis or scarring of the right upper lobe is unchanged.  The\npreviously noted ground-glass opacity in the superior subsegment of the left\nlower lobe is grossly stable from the prior study (04:31).  A 5 mm subpleural\nright lower lobe pulmonary nodule is stable (5:215).\n\nLimited images of the upper abdomen demonstrate cholecystectomy clips and are\notherwise unremarkable.",
            "output": "1. Subtle new areas of ground-glass opacity bilaterally in the setting of\nsevere emphysema are consistent with a new infectious process, likely viral,\ngiven the distribution.\n2. Unchanged severe emphysema.\n3. Stable right upper lobe scarring or atelectasis.\n4. Coronary arterial calcifications.\n5. CT evidence of anemia.\n6. Enlarged pulmonary arterial tree suggesting pulmonary hypertension."
        },
        {
            "input": "There is unchanged evidence of severe pulmonary emphysema cannot partly\ncalcified right predominant scarring (6, 57).  The pre described ground-glass\nopacities in the remaining relatively normal areas of lung parenchyma (6, 139)\nhave minimally decreased in severity but are still clearly visible.  There is\nno evidence of suspicious or growing lung nodules.  The airways are patent and\ndo not show visually obvious signs of small airways disease.  No pleural\neffusions.  No pleural thickening.  No incidental thyroid findings.  No\nsupraclavicular infraclavicular or axillary lymphadenopathy.  Several\nborderline sized lymph nodes are seen in the mediastinum.  Mild dilatation of\nthe main pulmonary artery, suggesting likely pulmonary hypertension. \nUnchanged calcification in the right breast (3, 31).  Mild aortic valve\ncalcification, moderate to severe coronary calcifications, no pericardial\neffusion.  Status post cholecystectomy.  No evidence of osteolytic lesions. \nNo osteo destructive processes at the level of the scapula or the shoulder.",
            "output": "Minimal decrease in extent of the inflammatory ground-glass opacities that\nnonetheless still persist.  No new opacities, no suspicious nodules.  No\npleural effusions.  Unchanged evidence of pulmonary hypertension."
        },
        {
            "input": "The thyroid is normal.  Left PICC terminates at the cavoatrial junction. \nAscending aorta is within normal size limits.  Mildly dilated main pulmonary\nartery is similar to before.  Coronary artery calcification is severe.  There\nis no pericardial effusion.  Supraclavicular, axillary, and mediastinal lymph\nnodes are not enlarged.\n\nAirways are patent to subsegmental levels.  There is no pleural effusion. \nThere is severe pulmonary emphysema and right upper lung calcified scarring. \nThe previously described ground-glass opacities are similar to before (5:143).\nA 4 mm nodule in the right upper lobe (5:149) is new.  A 3 mm nodule at the\nright minor fissure (5:172) may be atelectasis.  Several millimetric calcified\ngranulomas are noted.\nLimited assessment of upper abdominal organs are unremarkable.\n\nThere is no suspicious lesion in the bones or soft tissues.  Multiple\ncalcifications in bilateral breasts are similar to before.",
            "output": "1. No new evidence of infection is identified. Mild inflammatory ground-glass\nopacities are similar to ___.\n2. Severe emphysema and mildly dilated pulmonary artery are unchanged.\n3. A 4 mm right upper lobe pulmonary nodule is new.  Attention on follow up\nimaging is recommended."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy or\ninfection.  Evaluation of the breasts requires mammography.\n\n\n\nThyroid is heterogeneous but there are no findings large enough to warrant\nfurther imaging evaluation.  Atherosclerotic calcification is moderately heavy\nin head and neck vessels and more severe in all major coronary arteries. \nAorta is normal size. Pulmonary arteries are chronically dilated, main 38 mm,\nleft 32 mm.  Since the right pulmonary artery is normal size, 24 mm, the\npattern of asymmetric pulmonary artery enlargement raises question of pulmonic\nstenosis, which would require dedicated cardiac imaging.  There is no pleural\nor pericardial abnormality.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged.  There is\nno adenopathy in the internal mammary, diaphragmatic, or retrocrural stations.\n\nEmphysema is severe.  A band of scarring or atelectasis in the apical segment\nof the right upper lobe, containing calcification or suture is stable since at\nleast ___.\n\n\nThere is no pneumonia or bronchial wall thickening.  An elliptical 2 x 4 mm\nnodule in the right and upper lobe, 6:121, developed between ___ and\n___, when it was 6 mm long, presumably inflammatory and resolving.  There\nare no other lesions like it.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nDilatation of main and left pulmonary artery raise possibility of pulmonic\nstenosis.\n\nCoronary atherosclerosis.\n\nSevere emphysema.\n\nRight upper lobe scarring stable since at least ___."
        },
        {
            "input": "Massive pulmonary emphysema persists.  Also unchanged is a calcified right\nupper lobe scar.  There currently is no evidence of pulmonary infection.  The\nenlargement of the main pulmonary artery reflect pulmonary hypertension, there\nis a known history of pulmonary stenosis.  Moderate coronary calcifications. \nKnown bilateral breast calcifications.  No hilar or mediastinal\nlymphadenopathy.  Small hiatal hernia.  No abnormalities at the level of the\nchest wall.  The larger airways are patent the smaller airways show signs of\nmild chronic airways disease.",
            "output": "No relevant change since ___.  Massive pulmonary emphysema.  Likely\npulmonary hypertension.  No pulmonary infection."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nEvaluation of the breasts requires mammography.  Findings below the diaphragm\nwill be reported separately.\n\nLymph nodes at all stations in the chest have increased moderately in size,\nfor example thoracic inlet, 11 mm, previously 9 mm, right lower paratracheal\nstation 12 x 22 mm, previously 6 by 16 mm subcarinal, 15 mm, previously 11 mm.\nThere is no lymph node enlargement at the hila, in the retrocrural,\ndiaphragmatic or internal mammary stations.\n\nAtherosclerotic calcification is moderately heavy in head neck vessels and\nsevere in the coronaries.  Aorta is normal size.  Main and left pulmonary\narteries are chronically enlarged, attributed to pulmonic stenosis.\n\nMinimal pericardial effusion is physiologic.  Small layering nonhemorrhagic\nleft pleural effusion is new.\n\nEmphysema is severe.  Bulky partially calcified scar in the right upper lobe\nis chronic, unchanged since at least ___.\n\nA generalized increase in radiodensity of all constituents of the lung,\nincluding greater background density to alveolar components, substantial\nthickening of septal and interest septal interstitial constituents involves\nall areas of lung relatively evenly.  There is no consolidation or nodulation\nand no peribronchial infiltration to suggest most forms of infection and\nalthough global infection, such as virus or pneumocystis is by no means\nexcluded, this appearance suggests an alternative explanation for generalized\ninflammation, such as auto immune therapy or drug hypersensitivity, or\npulmonary edema.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "New generalized interstitial and alveolar abnormality does not suggest fungal\nor bacterial infection.  Differential diagnosis includes pulmonary edema not\nnecessarily cardiogenic, noninfectious inflammation related to drug therapy,\nor global infection due to virus or pneumocystis.  These causes are consistent\nwith a new small left pleural effusion as well as interval increase in central\nlymph node size.\n\nSevere chronic emphysema.\n\nSevere coronary atherosclerosis.  Reported pulmonic stenosis."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Mediastinal lymph nodes are stable\nin size right upper paratracheal measuring 6 mm and right lower paratracheal\nmeasuring 12 mm.  Subcarinal lymph node has decreased now measuring 13 mm\npreviously 15 mm.\n\nHEART AND GREAT VESSELS: The aorta is non aneurysmal and pulmonary arteries\nenlarged with the main pulmonary artery measuring 3.7 cm.  The heart size is\nnormal and there is no pericardial effusion. Mild atherosclerotic\ncalcifications of the thoracic aorta and moderate to severe coronary arteries.\nLow attenuation of the cardiac blood pool can be seen with anemia. \nRight-sided subclavian line terminates in the mid SVC.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusions, previously\nseen small left effusion has resolved.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Widespread\nground-glass opacities with interlobular septal thickening (crazy paving\npattern) have not substantially changed and may be marginally worse in the\nperiphery and lung bases for example series 5, image 192 as well in the lung\nbases series 5, image 230.  Mild diffuse bronchial wall thickening.  Severe\npanlobular emphysema with substantial hyperinflation of the right upper lobe. \nSubpleural nodular opacities in the anterior left upper lobe series 5 image\n104 have not substantially changed since most recent prior examination however\nare new since ___.  Bulky partially calcified scar in the right upper\nlobe\nis chronic, unchanged since at least ___.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton. \nBilateral punctate calcifications within the breasts are incompletely\nassessed.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable prior cholecystectomy and\notherwise within normal limits.",
            "output": "Widespread ground-glass opacities and interlobular septal thickening have not\nsubstantially changed and may be marginally worse in the lung bases, related\nto atelectasis.  Small left effusion has resolved.  Atypical infection\nincluding viral, or PJP or drug reaction are favored over pulmonary edema\ngiven the persistence of these interstitial changes and interval resolution of\neffusion.\n\nMarked pulmonary artery enlargement with crazy paving pattern can also be seen\nin pulmonary ___ disease (PVOD) although favored much less likely\ngiven the rapid development of the interstitial changes appear"
        },
        {
            "input": "Numerous supraclavicular and axillary lymph nodes are not pathologically\nenlarged and stable in number since at least ___.  Excluding the breasts\nwhich have a large number of calcifications and require mammography for\nevaluation, elsewhere in the chest wall there are no soft tissue abnormalities\nconcerning for malignancy.  This study is not appropriate for subdiaphragmatic\ndiagnosis but shows no enlargement of adrenal glands or heterogeneity in in\nthe imaged regions of unenhanced liver and borderline enlarged spleen.\n\nSolitary enlarged central lymph node, 10 mm at the thoracic inlet of the\nmediastinum, 3:7, is unchanged.  Smaller lymph nodes elsewhere are numerous,\nranging up to 9 mm in the right lower paratracheal station, previously 11 mm,\nbut not pathologically enlarged.\n\nAtherosclerotic calcification is moderately severe in head and neck vessels,\nand even heavier in the coronary arteries and descending thoracic aorta. \nAorta is normal size.  Pulmonary artery enlargement, main pulmonary artery 40\nmm, 3:  27, unchanged, reflects pulmonary arterial hypertension.\n\nHypo attenuation of cardiac contents reflects anemia.  Small pericardial\neffusion is minimally larger but there is no infiltration of epicardial fat or\nevidence of cardiac tamponade.  There is no pleural abnormality.\n\nEmphysema is severe, particularly right upper lobe, causing chronic\natelectasis in the apical  segment.  Widespread interstitial pulmonary\nabnormality has changed somewhat in distribution, improved minimally in the\nlower lobes, but more severe in the anterior segment of the right upper lobe,\n5:138.  It consists of primarily linear interstitial abnormality with\nthickening of both intra lobular septi and intra lobular lines, primarily in\nthe mid lungs as well as background ground-glass opacification more pronounced\nat the bases.  This does not conform to the findings on conventional\nradiographs which showed this definite improvement in the widespread pulmonary\nabnormality when comparing conventional radiographs ___ and ___.  This\nsuggests at least a component of interstitial pulmonary edema was present and\nimproved between ___ and ___, but the residual abnormality is much more\nsuggestive of inflammation, including virus and pneumocystis infection.  There\nis no consolidative or nodular abnormality to suggest bacterial or fungal\ninfection.\n\nThere are no bone findings in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Review conventional radiographs show at least a component of pulmonary edema\nimproved between ___ and ___, however non dependent interstitial\npulmonary abnormality is a generally persistent since ___, with some\nworsening in the anterior segment of the right upper lobe concerning for\nactive infection, virus and pneumocystis most likely pathogens.\n\nSevere bullous emphysema, causing chronic segmental collapse, right upper lobe\nand pulmonary hypertension.\n\nSevere atherosclerosis, particular in the coronary arteries.\nAnemia."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Borderline lymph nodes are stable.  Aorta is normal\nsize.  Main pulmonary artery is enlarged measures 3.2 cm.  Cardiac\nconfiguration is normal and there is moderately severe calcifications in all\ncoronary arteries.  Hypodensity of the cardiac chambers compared to the\nmyocardium suggests anemia .\nSevere upper lobe predominant centrilobular emphysema and chronic atelectasis\nin the superior aspect of the right upper lobe are unchanged.  Peribronchial\nopacities in the periphery of the right upper lobe likely infection, or\ninflammation are also stable.  There is minimal improving in the peripheral\ncentrilobular ground-glass opacities and interlobular septal thickening\nthroughout the lungs consistent with improving infection or pulmonary edema. \nThere are no new lung abnormalities.  Subpleural interstitial abnormality\nmainly located in the right upper lobe is unchanged\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy\nCentral line tip is in the cavoatrial junction\nThere are calcifications in the breasts bilaterally",
            "output": "Improved centrilobular ground-glass opacities and interlobular septal\nthickening consistent with improving pulmonary edema, less likely infection\nPeripheral right upper lobe consolidation is a stable.\nSevere emphysema\nPulmonary hypertension\nSubpleural reticulation in the right upper lobe is unchanged.\nNo new lung abnormalities"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Main pulmonary artery is slightly enlarged which may\nbe seen in setting of pulmonary hypertension.  Cardiac configuration is\nnormal. Coronary artery calcifications are dense. There are dense\natherosclerotic calcifications of the aortic arch, ascending aorta, and\ndescending thoracic aorta.\n\nAreas of consolidation in the lingula and left lower lobe have increased\nslightly since ___. There is no new area of consolidation. The the\nsmall focus of consolidation and surrounding ground-glass within the medial\naspect of the right lower lobe is unchanged.\n\nCentral airways are patent to the subsegmental level. There is severe,\nbilateral emphysema. There is no pleural or pericardial effusion.",
            "output": "1. Areas of consolidation in the lingula and left lower lobe have increased\nslightly in size. No new area of consolidation. No pleural effusion.\n2. Severe emphysema."
        },
        {
            "input": "Small bilateral unchanged thyroid nodules. No supraclavicular, infraclavicular\nor axillary lymphadenopathy. All lymph nodes in the mediastinum are normal in\nsize. Severe aortic calcifications.  Signs of mild pulmonary hypertension, as\nreflected by an enlargement of the main pulmonary artery.  Moderate coronary\nand aortic valve calcifications. No pericardial effusion. The posterior\nmediastinum is unremarkable. No relevant abnormalities in the upper abdomen. \nNo evidence of osteolytic lesions in the ribs, the sternum and the vertebral\nbodies.\n\nThe known left lingular parenchymal consolidation with surrounding\nground-glass opacities has moderately decreased in size, from approximately\n2.8 to approximately 2 cm.  The morphology of the lesion suggests infection.\nHowever, given the masslike appearance, the lesion as to be followed by\nimaging until complete resolution.  Also minimally decreased in size and\nextent is a pre-existing focus of consolidation in the left lower lobe (4,\n48). An area of paravertebral right-sided fibrosis is unchanged. Also\nunchanged is a band like parenchymal scar in the right upper lobe as well as\nthe severe underlying pulmonary emphysema, predominating in the right upper\nlobe and the signs suggesting airways disease.  No pleural effusions. No\npleural thickening.  Unchanged right breast calcifications",
            "output": "Minimal decrease in size of the known consolidations in the left lower lobe\nand the lingular since ___. Because of the masslike appearance of\nthe lesions, however, the must be followed by imaging until complete\nresolution is documented. Severe underlying pulmonary emphysema and airways\ndisease."
        },
        {
            "input": "The imaged thyroid gland is unremarkable. The ascending thoracic aorta is top\nnormal in caliber, measuring 3.9 cm. Scattered aortic calcifications are\nnoted. The main pulmonary artery is mildly enlarged, measuring 3.2 cm. The\nheart size is normal. There is a trace quantity of pericardial fluid, likely\nphysiologic. Small mediastinal lymph nodes measure up to 7 mm in the lower\nright paratracheal station (02:20). Assessment for hilar lymphadenopathy is\nlimited given the lack of intravenous contrast material. There are no\npathologically enlarged axillary lymph nodes. The mid to lower esophagus is\nmildly patulous, containing both air and layering debris (02:20 - 38).\n\nThe study was not optimized for evaluation of the subdiaphragmatic contents.\nSub 5 mm calcified granulomas are seen within the left hepatic lobe. There\nremainder the imaged upper abdomen is unremarkable.\n\nExtensive lower lung predominant subpleural coarse reticulation and\nhoneycombing are with compatible with interstitial fibrosis and responsible\nfor some traction bronchiectasis. Biapical scarring is mild moderate. A 9 x 6\nmm spiculated opacity within the left upper lobe is closely associated with\nmild bronchiectasis and may be an area of cicatricial atelectasis (04:58),\nalthough a genuine pulmonary nodule is not excluded.  There is also a 23 x 9\nmm subpleural nodular opacity along the confluence of the right major and\nminor fissures (4:124). No suspicious pulmonary nodules elsewhere in the\nlungs. There are no pleural effusions.\n\nNo suspicious lytic or blastic lesions are identified. There is a compression\ndeformity of the T8 vertebral body with approximately 40% loss of height\ncentrally, new compared to the radiographs from ___. There is\nalso new concavity along the superior endplate of the T4 vertebral body, with\napproximately 60% loss of height centrally. There is no associated\nretropulsion at either level.",
            "output": "1. Extensive lower lung predominant subpleural coarse reticulation, traction\nbronchiectasis, and honeycombing, compatible with UIP.\n2. 9 x 6 mm spiculated left upper lobe opacity and 23 x 9 mm right\nperifissural nodular opacity could be areas of atelectasis/scarring, although\ngenuine pulmonary nodules are not excluded. A followup CT in 3 months is\nrecommended.\n3. New compression deformities of the T4 and T8 vertebral bodies, age\nindeterminate, although new compared to radiographs from ___. No\nassociated retropulsion.\n4. Mildly dilated main pulmonary artery, not necessarily diagnostic of\npulmonary hypertension.\n5. Patulous esophagus could be due to esophageal dysfunction.\n\nNOTIFICATION:  Pertinent findings and recommendations were added to the online\nrecord of critical results for notification to the ordering health provider."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged. There are no soft\ntissue lesions in the chest wall suspicious for malignancy. Evaluation of the\nbreasts would require mammography.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows no\nabnormality in the imaged portions of the nonenhanced upper liver, kidneys,\nand other solid organs of the upper abdomen.\n\nThyroid is unremarkable. Atherosclerotic calcification in the head and neck\nvessels and coronary arteries is minimal, and not appreciated in the\ncoronaries. Aorta and pulmonary arteries are top normal size. There is no\nclear cardiomegaly and no pleural abnormality. Very small pericardial effusion\nis stable.\n\nAn irregularly shaped region of peribronchial infiltration in the left upper\nlobe, aggregate diameter at the level of greatest cross-sectional area 6 x 11\nmm, 4:60, is stable since ___, 8 x 10 mm. This lesion should be followed\nclosely because of than increased incidence of bronchogenic carcinoma among\npatients with pulmonary fibrosis. Moderately severe pulmonary fibrosis\nunchanged since ___.\n\n Peripheral reticulation due to honeycombing is moderately severe at the lung\nbases and middle lobe, milder elsewhere in the lower lobes and restricted to\nthe anterior subpleural surface of the both upper lobe anterior segments is\nbeen no change in the appearance of the lungs since ___. There is no\npneumonia or bronchiectasis is or any pulmonary nodules.\n\nModerately severe central compression of the T4 and T8 vertebral bodies is\nunchanged since ___ and there are no new bone lesions, and specifically\nno findings to suggest malignancy.",
            "output": "Small peribronchial lesion, left upper lobe, unchanged since ___, but\nsuspicious for carcinoma primarily because of its shape. Suggest followup\nchest CT in no more than 6 months.\n\nModerate pulmonary fibrosis, confined to the lower lungs, not appreciably\nchanged since ___.\n\nModerately severe central compressions, T4 and T8 vertebral bodies, unchanged\nsince ___.  No new lung lesions."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere is no soft tissue abnormality in the imaged portion of the chest wall\nsuspicious for malignancy. Evaluation of the breasts requires mammography.\nThis study is not designed for subdiaphragmatic diagnosis, but shows there is\nno adrenal mass.\n\nThere are no lesions in the thyroid large enough to warrant ultrasound\nevaluation.\n\nEnlargement of the pulmonary arteries, main 39 mm, is unchanged since ___.\nAorta is normal size. Left ventricular enlargement, 03:38, is unchanged.\n\nModerate to severe pulmonary fibrosis, at the periphery of the mid and lower\nlung zones, has progressed. String of sub cm nodules at the left lung apex,\n05: 38-44 is stable since at least ___. Small region of\nperibronchial infiltration and traction bronchiectasis in the left upper lobe\nis also unchanged, 5:64.\n\nThe lesion of concern for malignancy, also in the left upper lobe, 7 x 12 mm\nat the level of its greatest cross-sectional area, 5:84, has not changed since\n___. I would repeat another chest CT scan in one year 's time to confirm\nthat despite its worrisome morphology it is an inert lesion.\n\nModerate compression of one upper and one mid thoracic vertebral body is\nchronic, reflected in anterior osteophyte formation, and has not progressed\nsince ___.",
            "output": "Worsening moderate to severe pulmonary fibrosis. Likely pulmonary fibrosis.\n\nSmall possible lung mass, left upper lobe stable since ___ should be\nkept under surveillance, with repeat chest CT in one year 's time.\n\n2 moderate, stable moderately compress thoracic vertebrae."
        },
        {
            "input": "Subpleural and basilar predominant fibrotic interstitial lung disease appears\nsimilar to ___, with major features of reticulation, traction\nbronchiectasis, and honeycombing.  Right lung continues to be involved to a\ngreater degree than the left, with associated asymmetrically reduced lung\nvolume on the right compared to the left PICC\n\n10 mm x 7 mm diameter left upper lobe nodule is unchanged (image 82, series\n5). 8 mm Nodular opacity along the left major fissure also remains unchanged\n(148, 5). No new or growing nodules are detected.\n\nStrands of thymic tissue in the anterior mediastinum have increased in extent\nsince ___ and are suggestive of thymic hyperplasia.  Enlarged main\npulmonary artery suggestive of pulmonary term hypertension.  Patulous lower\nthoracic esophagus is again demonstrated. There is no pleural or pericardial\neffusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but focal\ncalcifications in the left lobe Of the liver appear unchanged.\n\nCompression fractures in the mid and lower thoracic spine are unchanged.",
            "output": "1.  Similar appearance of basilar and subpleural predominant fibrotic lung\ndisease compared to ___.  Pattern and distribution are most\nconsistent with UIP.  In the setting of a patulous lower thoracic esophagus,\nscleroderma or mixed connective tissue disorder should be considered.\n\n2.  Although a 1 cm diameter left upper lobe nodule has not changed in size,\nits morphology raises the concern for lung cancer in this patient at risk for\nthis diagnosis based on the presence of fibrotic lung disease.  With this in\nmind, a PET CT is recommended if warranted clinically.\n\n3.  Thymic hyperplasia\n\n4. Enlarged pulmonary artery suggestive of pulmonary arterial hypertension.\n\n5. Unchanged compression deformities in the thoracic spine as detailed above."
        },
        {
            "input": "Pre-existing fibrotic lung disease with subpleural and basilar predominance\nappears similar to ___, but widespread ground-glass opacities and\nsmooth thickened septal lines are new.\n\nLinear irregularly marginated nodule in the left upper lobe is is similar in\nsize, measuring approximately 12 mm by 8 mm in diameter (75, 5).\n\nHeterogeneity of thyroid gland is unchanged.  Soft tissue stranding in the\nanterior mediastinum may reflect a component of thymic hyperplasia and appears\nunchanged.  Heart remains enlarged and there is no evidence of pericardial or\npleural effusion.  Thoracic esophagus appears patulous.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning abnormalities are identified in this region on this limited\nassessment.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.  Compression deformity is within the spine are similar to the\n___ exam.",
            "output": "1.  Superimposed upon pre-existing fibrotic lung disease are diffuse\nground-glass opacities and smooth septal thickening.  Considering clinical\nsuspicion for infection, these findings are concerning for pneumocystis\npneumonia or other opportunistic infection.  Differential diagnosis includes\nacute exacerbation of ILD, hydrostatic edema, and, in the appropriate clinical\nsetting, pulmonary hemorrhage.\n\n2.  Persistent left upper lobe pulmonary nodule, which was not FDG avid on ___ PET-CT.  Recommend continued surveillance by followup CT in 6 months\nto exclude the possibility of an indolent lung neoplasm."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Bilateral\nsubpleural areas of fibrosis and nodular opacity are unchanged consistent with\ninterstitial lung disease potentially UIP.  Left upper lobe more nodular\nopacity, series 5, image 72 is 15 x 9.6 mm, overall similar to previous study.\nPreviously demonstrated ground-glass opacity has resolved.  No substantial\ninterval progression of honeycombing is demonstrated.  Traction bronchiectasis\nare bilateral.  No new pulmonary nodules masses are consolidations seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nCompression fracture in the superior midportion as well as lower portion of\nthe thoracic spine are unchanged.",
            "output": "Interval resolution of the ground-glass opacity consistent with improvement of\nthis infectious or inflammatory etiology.\n\nUnchanged left upper lobe nodule.\n\nOverall no substantial progression of extensive fibrotic interstitial lung\ndisease most likely consistent with UIP."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  A few small coarse calcified hepatic granulomas\nsuggesting prior granulomatous exposure.  A few subcentimeter para-aortic\nlymph nodes.\n\nMEDIASTINUM: Mildly patulous appearance of the esophagus.  Subcentimeter\nmediastinal lymph nodes.  Suspected minimal anterior mediastinal thymic tissue\nmost likely representing hyperplasia/rebound.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve calcification.  Minimal coronary artery\ncalcification.  Mild dilatation of the ascending aorta measuring 37 mm in AP\ndiameter.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  The moderate predominantly subpleural fibrotic interstitial\nlung disease with an apical basal gradient appears similar compared to prior\nimaging.  Associated architectural distortion, bronchiectasis as well as\nbronchiolectasis/honeycombing.  Multiple irregular pulmonary nodules appear\nsimilar compared to prior (this may represent confluent fibrosis).  No\nfeatures of superimposed pneumonia.\n2. AIRWAYS:  The central airways are patent.  Extensive\nbronchiolectasis/honeycombing in the subpleural aspect of the mid to lower\nlung zones.\n3. VESSELS:  Marked dilatation of the pulmonary artery measuring 34 mm\ndiameter strongly suggestive of pulmonary hypertension in the setting of\ninterstitial lung disease.\nCHEST CAGE: Spondylotic changes of the thoracic spine with endplate\ninsufficiency fractures appearing similar compared to prior.  No\nlytic/destructive bony lesions.",
            "output": "Moderate fibrotic interstitial lung disease appear similar compared to prior\nimaging.\n\nThe previously noted pulmonary nodules are unchanged most likely represent\nconfluent fibrosis.\n\nDilated pulmonary artery suggests pulmonary hypertension.\n\nSmall hiatal hernia and mildly patulous appearance of the esophagus:\nEsophageal dysmotility should be excluded.\n\nDegenerative bony changes as described above."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is\nunremarkable.  Supraclavicular and axillary lymph nodes are nonenlarged. \nChest wall is unremarkable.\n\nUPPER ABDOMEN: Although not tailored to evaluate the subdiaphragmatic organs,\na small hiatal hernia is noted.  Additionally there are few punctate\ncalcifications in the liver consistent with prior granulomatous exposure.  1.1\ncm accessory spleen noted.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  No anterior\nmediastinal mass.\n\nHILA: Assessment of the hila is limited due to noncontrast study however no\nlarge hilar mass identified.\n\nHEART and PERICARDIUM: Heart is normal in size without pericardial effusion. \nNo aortic valvular or mitral annular calcifications.  Minimal coronary\ncalcifications are noted.\nPLEURA: Trace right pleural effusion.  No left pleural effusion.  No pleural\ncalcifications.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Again seen is subpleural interstitial fibrotic changes with a\nbasilar predominance, associated architectural distortion and\nbronchiectasis/honeycombing.  In comparison to prior examination there is\ninterval increase in interlobular septal thickening the lower lobe\npredominance suggestive of vascular congestion or atypical pneumonia. \nMultiple pulmonary nodules are similar to prior examination, with largest\nsubpleural nodule measuring 1.2 x 0.5 cm in the left lower lobe (5:122) and\nlikely represents focal fibrosis.  No new pulmonary nodule.\n2. AIRWAYS:  Airways are patent to the subsegmental level.  Persistent\nhoneycombing and bronchiectasis involving the mid to lower lung zones is\nunchanged since ___.\n3. VESSELS:  Thoracic aorta is unchanged measuring 3.7 cm. Main pulmonary\nartery is mildly dilated suggestive of pulmonary artery hypertension.\nCHEST CAGE: Chronic superior endplate compression fracture of T4 and T8 are\nunchanged since prior examination.  No retropulsion.  Soft tissues are\nunremarkable.",
            "output": "1.  Vascular congestion or atypical pneumonia superimposed on background of\nmoderate fibrotic interstitial lung disease, worst along the right lower lobe.\nNo lobar pneumonia.\n2.  Multiple pulmonary nodules similar to prior, largest subpleural nodule\nmeasures 1.2 x 0.5 cm in left lower lobe and likely represents focal fibrosis.\n3.  Small hiatal hernia."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum,\nincluding the pretracheal area (3, 22) are normal in size.  Mild vascular\ncalcifications.  Status post aortic valve replacement and sternotomy.\nBorderline size of the heart.  No pericardial effusion.  The pre-existing\ndilatation of the esophagus has massively increased (5, 78).  No evidence of\nadrenal lesions.  No osteolytic lesions at the level of the ribs, the sternum\nand the vertebral bodies.  Moderate degenerative vertebral disease.  Status\npost sternotomy.\n\nThe appearance of the lung parenchyma shows a massive progression.  The known\nright upper lobe lesion is now cavitated and substantially increased in size. \nThe diameter of the lesion is approximately 6 cm.  The wall of the cavity is\nirregular.  There is metallic material at the posterior aspect of the\ncavitation (5, 64) and calcifications are seen at the apical part of the\nlesion (5, 37).  The lesion is surrounded by areas of fibrosis, bronchiectasis\nand mucous plugging (5, 78).  The lower portion of the right upper lobe (5,\n106) shows multiple parenchymal micronodules that could represent satellite\nlesions.  In the lingular, the middle lobe, as well as in the right and left\nlower lobe, there are areas of parenchymal ground-glass opacities and\nconsolidations, predominating in the peribronchial areas and accompanied by\nsmall nodular pattern.  And airway wall thickening and plugging, strongly\nsuggestive of recurrent aspiration events (5, 188).  Similar but smaller areas\nof parenchymal changes are seen in the more peripheral aspect of the lower\nlobes (5, 238).  Unchanged mild scarring at the right lung base.  In the\ninterval, the patient has developed a small right pleural effusion.  No\nsuspicious lung nodules.",
            "output": "Substantial interval increase of the now cavitated 6 cm lesion in the right\nupper lobe.  The lesion shows an irregular wall as well as very focal fibrosis\nand small satellite lesions.  New multifocal bronchus centric opacities,\nstrongly suggestive of recurrent aspiration events.  Interval development of a\nsmall right pleural effusion, the pre-existing esophageal distension has\nincreased in the interval."
        },
        {
            "input": "The thyroid is within normal limits.  Moderated esophageal dilation of the\nupper and mid esophagus is similar in appearance to prior exams, extending to\nthe level of the left atrium.  There is no hiatus hernia.  A prosthetic aortic\nvalve is noted.  The aorta and pulmonary artery are normal in caliber.  There\nis no pericardial effusion.  Paratracheal, axillary, and anterior\nmediastinal/prevascular lymph nodes are not pathologically enlarged.\n\nThe major airways are patent to subsegmental levels.  The irregularly\nthick-walled cavitary lesion in the peripheral right upper lobe is stable in\nsize, 7.6 x 5.0 cm in axial ___ (series 4, image 40), although some of\nthe very nodular wall thickening and tissue projecting into the cavity has\ndecreased and there is no longer the very small fluid collection that pooled\nin the cavity on ___.  The extents of adjacent pleural thickening,\nright upper lobe lung parenchymal fibrosis and bronchiectasis, along with\ncalcification both in the wall of the cavity and the pleura are all stable.\n\nLeft upper lobe subcentimeter calcified granulomas are stable.  Multiple foci\nof centrilobular nodularity with surrounding ground-glass, and some regions of\nbranching bronchiolar nodularity are the same and others are decreased (left\nlower lobe), but in the right lower and right middle lobes, such regions are\nnew or larger.  A small, loculated, right pleural effusion is unchanged. \nThere is a new small layering left nonhemorrhagic pleural effusion.\n\nMedian sternotomy hardware and bony fusion have a normal postoperative\nappearance and there is no associated fluid collection or soft tissue\nabnormality.   A 9 mm hypodensity in the left hepatic lobe is nonspecific,\npossibly a simple hepatic cyst or biliary hamartoma.  A hypodensity arising\nfrom the right upper renal pole may reflect a simple renal cyst, however\nsuboptimally evaluated on the current study.  Additional upper abdominal solid\nand hollow viscous organs are unremarkable.  There is moderate multilevel\nthoracic spine degenerative change, including flowing anterior thoracic spine\nosteophytes.  Alignment is normal.  Vertebral body heights are preserved.  No\nconcerning focal lytic or sclerotic osseous lesions are identified.",
            "output": "1. 7.6 x 5.0 cm thick-walled cavitary right upper lobe, this size stable, wall\nthickening improved, small fluid collection resolved.  Nevertheless the\noverall progression of disseminated broncho centric infection suggests it is\nthe reservoir.\n2. Persistent multifocal bronchogenic infection, some areas of which are\nimproved, some of which are worse since prior exam, as above.\n3. Persistent small loculated right pleural effusion.  New small left\nnonhemorrhagic layering pleural effusion.\n4. Stable esophageal dilation."
        },
        {
            "input": "No incidental findings at the level of the neck or the thoracic inlet.  The\npatient is of the CABG, sternotomy and aortic valve replacement.  Stable\nappearance of the large mediastinal vessels and of the heart.  Stable\nesophageal dilatation.  A pre-existing left pleural effusion has almost\ncompletely resolved.  On the right, a small pleural effusion persists.  Stable\nappearance of the upper abdomen.  The known right upper lobe cavitary lesion\n(4, 52) is stable in size.  The irregularities of the wall, with calcific\nspots and a somewhat retractile reaction is stable.  Localized areas of\nbronchiectasis (4, 72) is unchanged.  The airways continue to show irregular\nbut nonthickened walls.  Foci of mild peribronchial nodularity (4, 121) are\nalso stable.  Stability of small non characteristic areas of parenchymal\nscarring (4, 146) but a previous consolidation at the level of the middle lobe\n(4, 172) has completely resolved.  Areas of parenchymal opacities in both\nlower lobes have decreased in extent and severity but are still visualized at\nthe bases of the left lower lobe (4, 202).  A calcified left upper lobe\ngranuloma is stable.",
            "output": "Stability of the cavitary right upper lobe lesion.  Stability of mild chronic\nairways disease.  Stability of several clustered peribronchial micronodules\nsuggest mild recurrent infection.  Several areas of previous consolidation,\nfor example at the bases of the middle lobe and at the bases of the right\nlower lobe have almost completely resolved.  Near complete resolution of the\npre-existing left pleural effusion."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  The patient is after\naortic valve replacement.  No mediastinal, hilar or axillary lymphadenopathy\nis present.  There is no pericardial effusion.  There is small left pleural\neffusion but increased as compared to previous examination\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\n\nDistended esophagus is fluid filled and most likely represent Raf flux and\npotential aspiration\n\nAirways are patent to the subsegmental level except for several endobronchial\nimpactions at the sub subsegmental level in particular in the right lower\nlobe, series 5, image 168.  ___ opacities in the right lower lobe and\nright upper lobe, series 5, image 93, 138, 159 might represent infection\nversus recurrent aspiration\n\nBronchiectasis, cylindrical, in particular in the right lung are present and\nmight reflect recurrent aspiration as well\n\nThere is stable appearance of the right upper lobe cystic lesion, 6 x 5 cm\nsimilar in size, shape and lack of content as compared to previous\nexamination.  More nodular aspect, at its lateral angle, series 5 image 52,\nposteriorly, series 5, image 55 are stable.  No new nodules masses or\nconsolidations demonstrated.",
            "output": "Stable appearance of right upper lobe cavitary lesion\n\nEvidence of recurrent aspiration or current infection\n\nInterval slight increase in left pleural effusion and unchanged minimal right\npleural effusion although potential slight increase is a possibility\n\nStatus post aortic valve replacement\n\nExtensive degenerative changes in the spine\n\nBronchiectasis that might reflect recurrent aspiration as well."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection. \nEccentric, lobulated mural thrombus is seen in the descending thoracic aorta\n(image 80, 94, series 2).  The heart, pericardium, and great vessels are\nwithin normal limits.  Trace pericardial effusion is seen.  No evidence for\nright heart strain.  Right IJ ___ catheter is coiled is looped in the\nproximal left main pulmonary artery, and tip is level of the right ventricular\noutflow tract, as seen on the radiograph ___ at 14:28.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  Small bilateral effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS:  There are extensive symmetric consolidations over nearly\nentire bilateral lower lobes, with more fluffy central perihilar\nconsolidations and interlobular septal thickening in the apices.  Findings\nfavor ARDS.  Perihilar edema, pneumonitis cannot be excluded.  .  There is no\nmucous plugging.  Paraseptal emphysematous changes noted at the lung apices. \nEndotracheal tube noted.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: There is suggestion of 2 low-attenuation lesions at the left\nhepatic dome, larger measures 2.0 cm.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Area of decreased attenuation of the posterior margin of the spleen,\nmay represent postsurgical change or infarct.  .\n\nADRENALS:  The adrenals are hyper enhancing, consistent with shock physiology.\n\nThere is a large hematoma along the left flank measuring approximately 7.3 cm\nAP x 4.5 cm transverse by approximately 13.5 cm craniocaudal.  Hematoma\nextends from the iliac crest, to the mid spleen.  2 surgical drains terminate\nin the retroperitoneum, posterior to the spleen, in the superior portion of\nthis hematoma.  There is infrarenal aortic aneurysm.  There is hyperdense\nblood in the retroperitoneum, along the aorta, at the level of the aneurysm,\nconsistent with rupture.  Suggestion of active contrast extravasation along\nthe left margin of the aorta at the level of aneurysm, images 122-127 of\nseries 2).\n\nSubcutaneous emphysema and retroperitoneal air is likely related to recent\noperative intervention.\n\nURINARY: Multiple bilateral renal cysts.  Cysts measure up to 6.6 cm in the\nright kidney.  There is a cyst with a calcified septation in the upper pole of\nthe right kidney.  Similarly, there is a 3.6 cm cyst with a calcification in\nthe midpole of the left kidney.  There is no evidence of focal renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the stomach.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nThickening, hyperemia multiple small bowel loops, of the transverse, splenic\nflexure, proximal descending of the colon is likely related to recent shock. \nThere is mild ascites.\n\nPELVIS: Foley catheter noted in the bladder.  Free fluid is of intermediate\ndensity within the pelvis, likely hemo peritoneum.\n\nREPRODUCTIVE ORGANS: Surgical clips noted in the pelvis, in the region of the\nadnexae.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Again seen is an infrarenal abdominal aortic aneurysm, with\nextensive mural thrombus.  Aneurysm sac size measures approximately 5.4 cm AP\nby 5.7 cm transverse.\n\nThere is a 1 cm saccular aneurysm at the origin of the right common iliac. \nThere is a 1.4 cm saccular aneurysm at the proximal left common iliac.\n\nLeft common femoral arterial catheter noted.\n\nBONES AND SOFT TISSUES: Fracture of the left eleventh rib noted, anteriorly.\nMultilevel degenerative changes noted.  Postsurgical changes are seen along\nthe left flank, with subcutaneous emphysema.  Epidural catheter is in place. \nThere is chronic AVN of the left femoral head.",
            "output": "1.  Ruptured 5.7 cm abdominal aortic aneurysm.  Extensive retroperitoneal\nhematoma and strong suggestion of active contrast extravasation.\n2.  Mild ascites, pelvic component is consistent with hemo peritoneum\n3.  Dense lung consolidations, likely ARDS.  Component of edema or pneumonitis\nnot excluded.\n4.  No evidence for pulmonary embolism.\n5.  Wall thickening, hyperenhancement small bowel loops, colon, adrenals,\nconsistent with shock physiology.\n7.  Fracture of the left eleventh rib, likely related to recent resuscitation.\n8. Suggestion of 2 low-attenuation lesions in the liver, larger measures 2.0\ncm.\n9. Postsurgical change versus infarct posterior margin of the spleen.\n10. Swan-Ganz catheter is coiled in the main pulmonary artery, tip at the\nright ventricular outflow tract.\n\nNOTIFICATION:  Findings discussed with Dr. ___ by ___, M.D. ___, at approximately 22:45, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.  Calcified hilar\nlymph node related to prior granulomatous exposure.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. No atherosclerotic calcifications\nof the thoracic aorta and of the coronary arteries.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent. The lungs are clear\nof interstitial or airspace opacity.  Calcified granuloma in the right upper\nlobe series 4, image 70.  Triangular perifissural nodule in the right middle\nlobe series 4, image 126. Subpleural 2 mm nodule in the lingula series 4,\nimage 158.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.  Mild\nsymmetric gynecomastia.  Minimal multilevel degenerative changes of the\nthoracic spine. With\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "No evidence of active intrathoracic infection or malignancy.\n\nMillimetric pulmonary nodules all with benign morphology including central\ncalcifications and perifissural location .\n\nPrior granulomatous exposure.\n\nRECOMMENDATION(S):  Repeat Chest CT in one year, only if patient is a smoker."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nGynecomastia is minimal and symmetric.  This is not appropriate for\nsubdiaphragmatic diagnosis but shows normal size adrenal glands.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head and neck or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.  There is no pleural abnormality.\n\nLymph nodes:\n\nThoracic lymph nodes are not enlarged.\n\nLungs:\n\nThere are no new or growing lung nodules aside from a small cluster of faint\ninflammatory bronchiolar nodules, right upper lobe, 5:172.\n\nFewer than a dozen lung nodules, none larger than 4 mm, are all unchanged\nsince ___, 5:121, 194, 222, 228, and can be considered benign.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\nThere are no bone lesions in the chest cage suspicious for malignancy. \nPosterior projecting degenerative osteophyte in the lower thoracic spine,\n8:82, unchanged since at least ___ may impinge on the left neural\nforamina and nerve root at that level, 5:308.\n\nAlso unchanged in the thoracic spine are several mild disc intrusions and mild\nloss of height in 3 thoracic vertebrae, 8:76.\n\n.\n.",
            "output": "Incidentally discovered sub 5 mm lung nodules stable since ___ can\nbe considered benign and do not warrant further evaluation.  There are no new\nor growing lung nodules concerning for malignancy.  Minimal bronchiolar\nnodulation in the right upper lobe is inflammatory.\n\nStable posteriorly projecting thoracic vertebral osteophyte may impinge on\nleft lower thoracic neuroforamen and nerve root.\n\nRECOMMENDATION(S):  Suggest clinical inquiry regarding signs or symptoms of\nStable posteriorly projecting thoracic vertebral osteophyte that may impinge\non left lower thoracic neuroforamen and nerve root.\n\n If the patient is ___ years old, has a smoking history of greater than 30\npack-years and has smoked within the past ___ years, the patient meets criteria\nfor annual lung cancer screening with low-dose chest CT, now available at this\nhospital.  Study can be ordered on POE or OMR."
        },
        {
            "input": "Right upper extremity access PICC line is noted terminating at the cavoatrial\njunction.  The imaged base of neck including the partially visualized thyroid\nis notable for a small calcified nodule in the posterior left lobe measuring\n11 mm.  The thoracic aorta is normal in course and caliber without significant\natherosclerotic calcification.  The heart is normal in size and shape without\npericardial effusion.  The main pulmonary artery is normal in size.  There is\na small amount of residual thymic tissue in the anterior mediastinal space. \nThere is no axillary, mediastinal or hilar adenopathy.  Airways centrally\npatent.  The esophagus appears decompressed.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  No\npleural effusion or pneumothorax is seen.  A calcified granuloma in the right\nupper lobe noted on series 304, image 57.  Mild dependent basal atelectasis is\npresent.\n\nPlease refer to same-day CT abdomen pelvis for details below the diaphragm.\n\nBones: Surgical anchors in the humeral heads noted bilaterally.  No worrisome\nlytic or blastic osseous lesion is seen.",
            "output": "No evidence of metastatic disease in the chest.  Incidental findings as\ndescribed above."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal.  Pacer leads are in unchanged position. There are\nmoderate calcifications in the LAD and left circumflex coronary arteries.\nThere is no pleural or pericardial effusion. Moderate calcification of the\naortic valve is of unknown hemodynamic significance\nTiny punctate bilateral subpleural nodules are stable not required followup.\nMinimal atelectasis is present in the medial right upper lobe. Mild bronchial\nwall thickening is present in the lower lobes bilaterally. There is a small\narea of peribronchial and centrilobular ground-glass opacities in the lingula\n(4, 129) atelectases are present in the lingula.\nThis examination is not tailored for subdiaphragmatic evaluation, there is\nfatty infiltration of the liver. Bilateral parapelvic renal cysts are\npartially imaged. There is a small hiatal hernia.\nThere are no bone findings of malignancy",
            "output": "Peribronchial and centrilobular ground-glass opacities in the lingula likely\naspiration.\nBronchial wall thickening is consistent with inflammatory changes of the\nairways.\nCoronary calcifications\nCalcification of the aortic valve is of unknown hemodynamic significance\nFatty liver\nHiatal hernia"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Left anterior pacemaker\nwith leads in the right atrium and ventricle.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the aorta, moderate in the aortic and mitral\nannulus and coronary arteries.  The pulmonary arteries and aorta are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild diffuse bronchial\nwall thickening, no bronchiectasis or mucoid impaction.  Small scattered\ncalcified granulomas, for example in the right lower lobe (4:139).\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show mild diffuse hepatic steatosis.",
            "output": "No change compared to prior study in mild bronchial inflammation in keeping\nwith known diagnosis of asthma."
        },
        {
            "input": "There is no axillary or supraclavicular lymphadenopathy.  There are scattered\nmediastinal lymph nodes but none that are pathologically enlarged.  The\nthyroid is unremarkable.\n\nHeart is moderate to severely enlarged.  There is a trace pericardial\neffusion, likely within physiologic limits.  Aortic valvular and coronary\nartery calcifications are severe.  The main pulmonary trunk measures up to 3.6\ncm.  There is mild atherosclerotic disease of the ascending aorta.\n\nLung volumes are extremely low.  The airways are patent to the subsegmental\nlevel bilaterally.  Calcified granuloma is within the lungs are likely sequela\nof prior granulomatous disease (series 5, image 44).  There is no pleural\neffusion.  There is no focal lung consolidation.  There is mosaic attenuation\nof the lung parenchyma.  In addition, there is septal thickening at the lung\nbases.\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\nare unremarkable.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.",
            "output": "1. Extremely low lung volumes with septal thickening at the lung bases, likely\nrepresenting mild pulmonary edema.  No pleural effusions.\n2. Cardiomegaly.\n3. Severe coronary artery and aortic valvular calcifications.\n4. Enlarged main pulmonary trunk suggestive of pulmonary artery hypertension."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Right mediastinal shift\nis substantial, unchanged.  No pathologically enlarged mediastinal, hilar or\naxillary lymph nodes demonstrated.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen demonstrate previous cholecystectomy and\nleft renal cortical cyst, stable, 3.5 cm.\n\nTrachea, right middle lobe, right lower lobe, and left bronchial tree are\nunremarkable.  Right upper lobe cystic bronchiectasis are similar to previous\nexamination, series 5 images ___ with no evidence of internal inflammation\nor thickening.  Right upper lobe 4 mm solid nodule is stable, series 5, image\n66.  No additional nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Unchanged appearance of cylindrical bronchiectasis associated with volume loss\nand atelectasis in the right upper lobe.  This might potentially be a source\nof hemoptysis.\n\nStable right upper lobe pulmonary nodule"
        },
        {
            "input": "Dilatation of the azygos vein is unchanged.  Aorta is calcified. Pulmonary\narteries are normal in diameter. Coronary calcifications are extensive and\nunchanged. No pericardial pleural effusion is demonstrated. Image portion of\nthe upper abdomen will be reviewed separately and corresponding report will be\nissued.\n\nSlight interval decrease in the right mom artery an pulmonary nodule is noted,\nfrom 7.6-7 mm.  The right pericardiac lymph node, series 3, image 41 is\nunchanged, 7.5 mm.  No definitive hilar or axillary lymphadenopathy present\nwithin the limitations of this unenhanced study.\n\nAirways are patent to the subsegmental level bilaterally. Secretions in the\ntrachea present.\n\nNo definitive lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Right retroperitoneal lymph node is unchanged, series 4, image\n234, 10 x 20 mm in diameter. Right ___ area N lymph node superior in the\nchest, series 4, image 75 is 13 x 7 mm in diameter, unchanged.\n\nCentrilobular and panlobular emphysema is moderate.  Right middle lobe nodule\nhas slightly decreased in the interim, up 11 by ___ by 8 mm. The more\nsuperior nodularity of the fissure is unchanged but the more inferior\nnodularity has improved.  Right middle lobe more nodular opacity is unchanged,\nseries 4, image 191, 11 x 6 in 0.5 mm.  Lingular atelectasis is unchanged.\n\nNo new nodules masses are consolidations demonstrated.",
            "output": "Overall unchanged appearance of the right middle lobe opacity, emphysema and\nbronchial wall thickening, multiple pulmonary nodules as well as mom are a an\nand pleural/retroperitoneal lymph nodes with minimal interval decrease in the\nright middle lobe superior portion pulmonary nodule"
        },
        {
            "input": "An 8 mm right pericardial lymph node is unchanged (series 2, image 40). There\nis no axillary, supraclavicular, mediastinal, and hilar lymph adenopathy.\n\nThere are dense coronary artery and descending aorta atherosclerotic\ncalcification. The great vessels are normal in caliber. There is azygos\ncontinuation of the IVC.\n\nThe heart size is normal.  Atrioseptal lipomatous infiltration is unchanged. \nNo pericardial effusion.\n\nThere is moderate centrilobular and panlobular emphysema.\n\nTriangular shaped lingular opacity is unchanged (series 4, image 133) as is a\nlinear opacity in the posterior left upper lobe (series 4 image 86) and a 5 mm\nright upper lobe pulmonary nodule (series 4, image 86). A\n\nAgain seen, is a polygonal shaped nodular opacity in the inferior aspect of\nthe medial segment of the right middle lobe in close approximation to the\npericardial fat.  Since prior, there is increased linear opacification in this\nregion with associated bronchial wall thickening, likely due to atelectasis.\nWhile a 1.0 x 0.8 cm nodule opacity along the right minor fissure is unchanged\nthere is also increased atelectasis in this region.\n\nSince prior, there is increased pleural thickening along the right lower\nlateral costal pleural surface, suspicious for progressive tumor involvement,\nalong with associated subpleural atelectasis (series 2, image 46), but no rib\ninvasion. .\n\nThere is no pneumomediastinum or pneumothorax.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nPlease see the separate dictation from same day for details all\nintra-abdominal and pelvic structures.",
            "output": "1. Progressive costal pleural thickening since ___ in the right lower\nchest, is more likely malignant than post inflammatory since it preceded the\ndevelopment of sub pleural atelectasis.  A PET CT scan would be helpful both\nin making the distinction and to localize a biopsy.\n2. Stable right middle lobe nodular opacity measuring 11 mm, with increased\natelectasis in this region, could also be elucidated by PET CT.\n3. Moderate centrilobular emphysema."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal.\nThere is no pericardial effusion. Extensive Coronary calcifications are\npresent.\n\nNo mediastinal hilar or axillary lymphadenopathy is present. There is small\nright pleural effusion that appears to be slightly increased since the prior\nstudy.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally. Secretions are noted\nin the mid to lower trachea.  Centrilobular emphysema is extensive, moderate.\nSince the prior examination there is additional interval progression in right\nmiddle lobe and right lower lobe areas of atelectasis, series 4, image 174,\n179, 195, 217, 234. Although all of those areas can potentially represent\nprogression of rounded atelectasis, the cancellation of increasing pleural\neffusion progression of the atelectasis and a adjacent abnormal rib would\nrequire further correlation with tissue diagnosis or PET-CT. Stable pulmonary\nnodules are present in the left upper lobe, series 4, image 94, ground-glass\nopacity, right upper lobe, series 4, image 119, 124, right middle lobe, series\n4, image 160. No new nodules masses are consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nThe only area of concern is lateral aspect of the tenth rib on the right. The\ndemonstrate mottled appearance and potential fracture, more pronounced than on\nthe prior study. Also lucency in the right scapular, series 3, image 6 is\npresent, 5 mm in diameter, unchanged since previous examination.",
            "output": "Interval progression of lytic lesion with fracture in the tenth right rib that\npotentially might represent metastatic disease\n\nProgression of rounded atelectasis, right pleural effusion, concerning for\nmetastatic disease.\n\nBoth findings can be assessed with PET-CT\n\nMultiple stable pulmonary nodules\n\nCentrilobular emphysema, unchanged."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  A 1 cm paratracheal node (series 2,\nimage 23) is stable from the prior examination in ___.  A sub centimeter\npericardial lymph node is unchanged in size.\n\nThe great vessels are normal caliber.  There is moderate calcified\natherosclerosis of the thoracic aorta.  The heart size is normal.  No\npericardial effusion.  There is significant calcified atherosclerosis of the\ncoronary arteries.\n\nThe airways are patent to subsegmental levels.   There is moderate emphysema,\nsimilar in appearance to the prior study.\n\nA moderate, nonhemorrhagic, dependent right pleural effusion is increased from\nthe prior examination done in ___.  Evaluation for pulmonary nodules at the\nbase of the right lung is somewhat limited in the absence of intravenous\ncontrast and an increasing right pleural effusion however there is at least 1\narea with a nodular configuration within the right middle lobe (series 2,\nimage 38), which could represent a metastatic focus.\n\nPulmonary nodules: (series 4)\n7 mm spiculated nodule in the right upper lobe is stable (image 103)\n6 mm left upper lobe ground-glass nodule is stable (image 70)\n\nProminent retroperitoneal lymph nodes are unchanged from the prior study.  The\npatient is status post cholecystectomy.  There is azygos continuation of the\nIVC and polysplenia, unchanged in appearance from the prior examination.  The\npatient is status post right radical nephrectomy and adrenalectomy with\nsurgical clips in the nephrectomy bed.  Right abdominal wall hernia is stable.\nThere is marked calcified atherosclerosis of the abdominal aorta.\n\n\nOSSEOUS STRUCTURES: Sclerosis and irregularity within the lateral tenth rib is\nagain seen and similar appearing to the prior CT examination.  No other\nsuspicious osseous lesions are identified.",
            "output": "1. Dependent, moderate-sized, nonhemorrhagic right-sided effusion has\nincreased from the prior examination done in ___. Pulmonary nodules as described above are stable in size.  A 7 mm spiculated\nnodule in the right upper lobe is unchanged since the recent CT but has\nchanged since more remote studies.  Morphology and time course of change are\nmore suspicious for a primary lung malignancy than a focus of metastatic\ndisease.\n3. Multiple enlarged lymph nodes are stable from the prior examination.\n4. Focal nodularity within the right middle lobe adjacent to the effusion is\nconcerning for a potential metastatic focus, similar appearing to the prior\nexamination.\n5. Sclerosis and irregularity of the lateral tenth rib is stable from the\nprior exam and remains concerning for a metastatic focus."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The multiple small mediastinal lymph nodes.  A right upper\nparatracheal node measures 10 mm.  There are small 7 mm right lower\nparatracheal lymph nodes.  The subcarinal node measures 13 mm.  There are\nsmall hilar lymph nodes not enlarged by size criteria.  Heart size is normal. \nThere is no pericardial effusion. The aorta and pulmonary artery normal in\ncaliber.\nThe airways are patent up to the subsegmental level\n\nPLEURA: There is no pleural effusion\nLUNG: There is a bilateral perihilar ground-glass opacification left greater\nthan right predominantly within both upper lobes however there are few\nscattered patchy areas of ground-glass opacity in the right lower lobe and the\nright middle lobe.  There is subsegmental atelectasis in the left lung base. \nA 6 mm pulmonary nodule is seen in the right lower lobe (301, 34).\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "Bilateral perihilar opacities with an upper lobe predominance could represent\na resolving pneumonia, and could represent an atypical bacterial or viral\npneumonia.  The differential diagnosis could include noncardiogenic edema.\n\n6 mm right lower lobe pulmonary nodule.\n\nRECOMMENDATION(S):   Direct comparisons with the outside CT scan would be\nhelpful."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are small bilateral axillary lymph nodes.\n\nMEDIASTINUM: Heart size is normal.  There is no pericardial effusion.  The\naorta and pulmonary artery normal in caliber.  The airways are patent up to\nthe subsegmental level.  There is no pericardial effusion.  There are no\nenlarged mediastinal hilar lymph nodes.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.\n\nBONES AND CHEST WALL : Review of bones is also unremarkable.  No obvious\nfractures are seen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Normal CT chest."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary nodes are not enlarged. There\nis increasing number of mediastinal and hilar lymph nodes measuring up to 9 mm\nin the right hilum, 6 mm left lower paratracheal station, 8 mm in the\nsubcarinal station, 14 mm in the left hilum.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.\nThere is no pleural or pericardial effusion.\nSemi-solid lesion in the subpleural region of the right upper lobe measures 19\nmm,  the solid portion measures 8 x 10 mm (4, 115)\nSoft tissue mass in the left hilum obstructing the superior segment bronchus\nof the left lower lobe is difficult to measure, it is continuous to a large\narea of postobstructive pneumonia and atelectasis , measuring approximately\n3.8 cm in maximum diameter\nMild to moderate centrilobular emphysema is upper lobe predominant.\nBronchial wall thickening is more prominent in the lower lobes bilaterally\nThere is biapical scarring\nSoft tissue nodule in the subcutaneous tissues of the posterior left upper\nback measures 14 mm (2:1)\nSub 3 mm nodules in the right upper lobe (4: 46, 56) and in the left upper\nlobe (series 4: 48, 81) are noted\nThis examination is not tailored for subdiaphragmatic evaluation there is a 9\nmm nonobstructing stone in the upper pole of the right kidney\nHardware in the left humerus is partially imaged. There is a healed fracture\nin the lateral right 9 rib",
            "output": "Left lower lobe mass with associated postobstructive pneumonia.\nSemi-solid lesion in the right upper lobe is also concerning for malignancy\nEmphysema"
        },
        {
            "input": "There is no filling defect within the pulmonary arterial tree to suggest the\npresence of a pulmonary embolism. The thoracic aorta is normal in course and\ncaliber without evidence of dissection.\n\nThere is are unchanged prominent mediastinal and left hilar lymph nodes. There\nis a new stent within the left lower lobe bronchus. There is no pericardial\neffusion. The imaged portion of the thyroid gland is unremarkable.\n\nThere is centrilobular and paraseptal emphysema.  In the left lower lobe,\nthere has been progression of the ill-defined soft tissue density/mass with\nlikely surrounding atelectasis and areas of consolidation/ postobstructive\npneumonitis posteriorly.  The lesion measures approximately 4.8 x 6.4 cm\nversus 3.7 x 6.3 cm previously although its borders are ill-defined (3:119). \nThere is an adjacent small left pleural effusion.\n\nIn the right lung, there is a grossly stable mixed ground-glass/solid nodule\nin the lateral aspect of the right upper lobe measuring 1.8 x 2.0 cm (3:91). \nThere are new scattered ground glass opacities posteriorly in the right upper\nlobe and right lower lobe.\n\nThere is an unchanged nonobstructing 10 mm renal stone in the upper pole of\nthe right kidney (3:238 ). There is mild extrahepatic biliary dilatation and\ncentral intrahepatic biliary dilatation that is slightly progressed from\nprevious, with the common bile duct measuring up to 12.5 mm.\n\nThe remainder of the examination is unchanged compared to previous.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Large left lower lobe mass with adjacent atelectasis and post obstructive\npneumonitis, which is increased since previous.\n3.  Interval stability of mixed solid/ground glass nodule in the right upper\nlobe that is also suspicious."
        },
        {
            "input": "HEART AND VASCULATURE:  Right internal jugular central venous catheter\nterminates in the lower SVC.  Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n AXILLA, HILA, AND MEDIASTINUM:  Bilateral axillary lymph nodes are not\npathologically enlarged.  No mediastinal or hilar lymphadenopathy is present.\nNo mediastinal mass. PLEURAL SPACES:  Moderate left loculated pleural effusion\nof intermediate density up to 45 ___ with pockets measuring up to 6.7 x 2.4 cm\n(02:22) and areas containing locules of gas (2:29, 601b:40, 601b:39).  Small\nlow-density right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Extensive consolidation the left base likely with element of\nvolume loss. Moderate atelectasis adjacent to the pleural effusion in the\nright the lower lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Hypodensity with adjacent hypoenhancement in the spleen was not well\nseen on prior CT in ___, partially visualized.\n\nBONES:  Posterior spinal hardware limits evaluation.  Extensive post surgical\nchanges in the thoracic spine are re- demonstrated with evidence osteolysis\nconsistent with known osteomyelitis.  Several left rib deformities are present\nwell corticated edges posteriorly (02:49, 02:53, 02:28).\n\nSOFT TISSUES:  Intermediate density fluid collection along the left lateral\nchest wall measures approximately 6.8 x 2.8 x 6.8 cm (2:41, 601b:37).  A drain\nposterior to the surgical hardware is partially visualized.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate loculated left pleural effusion containing locules of gas\nsuspicious for infection.\n3. Extensive consolidation at the left lung base likely represents combination\nof severe lower lobe atelectasis and infection.\n4. Fluid collection in the left lateral chest wall may be postsurgical,\nsuperinfection not excluded.\n5. Several left rib deformities likely represent old trauma, but given\nadjacent infection, osteomyelitis could be considered.\n6. Partially visualized splenic hypodensity could represent hemangioma or\ninfarct."
        },
        {
            "input": "The patient was consented for a drainage of a loculated left pleural effusions\nseen on the previous CT scan from ___.  The patient was placed on\nto the CT scanner in the right lateral decubitus position and a limited pre\nprocedural noncontrast CT scan was performed.\n\nThe scan demonstrated interval decrease in size of a left-sided pleural\neffusion, which is now too small to be drained.  We discussed this with the\ntreating team, and a decision was made to cancel the procedure.\n\nAdditional findings on this limited study include persistent\nconsolidation/atelectasis at the left lung base.  There is a small fluid\ncollection along the left chest wall which is unchanged compared to previous. \nThere is Re- demonstration of extensive hardware for posterior spinal fusion,\nwith extensive postsurgical changes and changes consistent with the patient's\nknown osteomyelitis.  A small persistent right pleural effusion is also noted.",
            "output": "Drainage of a loculated a left pleural effusion was not performed due to\ninterval decrease in size of the effusion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. A\nfew segmental vessels are not well evaluated due to streak artifact from\nspinal hardware.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:Prominent bilateral axillary lymph nodes that\nmeasure top-normal are most likely reactive, and appear similar to prior. \nThere is no supraclavicular,mediastinal, or hilar lymphadenopathy.\n\nPLEURAL SPACES:  Compared to ___, there has been nearly complete\nresolution of the left-sided loculated pleural effusion, with a trace pleural\neffusion on the left side (3:98, 602b:49).  The previously seen right-sided\npleural effusion has resolved.\n\n\nLUNGS/AIRWAYS:  There has also been interval reduction in the left lower lobe\nconsolidation, which is most likely atelectasis although a superimposed\ninfectious process cannot be excluded. Atelectasis is also seen in the\nlingula. There has also been interval decrease in the degree of dependent\natelectasis in the right lung.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES:  Extensive spinal hardware is again seen, extending from the posterior\nelements of T4 to at least T10.  There is no evidence of hardware fracture or\nperihardware lucency.  Prevertebral soft tissue swelling persists in the\nmid-to-lower thoracic spine, which is most likely post-surgical.  No drainable\nfluid collection is identified.  Soft tissue swelling and skin staples are\nseen along the posterior midline.  There is no discrete fluid collection.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Interval decrease in the size of the loculated left pleural effusion with\nonly a trace effusion remaining.\n3. Interval decrease in the left basilar consolidation, which most likely\nrepresents atelectasis although a superimposed infectious process cannot be\nexcluded.\n4. Extensive thoracic spine surgical changes are noted with no evidence of\nhardware loosening or fracture.  There is no focal fluid collection in the\nanterior or posterior soft tissues."
        },
        {
            "input": "The pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental\npulmonary arteries.  The main pulmonary artery is dilated, measuring 3.6 cm,\nsuggestive of underlying pulmonary hypertension, improved compared to CT of\nthe chest from ___, at which time it measured 4.4 cm.  There is\nno evidence of right heart strain.\n\nThe aorta is normal in caliber.  There is no evidence of dissection or\nintramural hematoma.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThe heart is normal in size.  There is no pericardial effusion.\n\nThere are small right and trace left pleural effusions.\n\nThere are diffuse ground-glass opacities in both lungs, compatible with mild\npulmonary edema.\n\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo suspicious osseous lesion is identified.",
            "output": "1.  No evidence of pulmonary embolism through the segmental level.\n\n2.  Diffuse ground-glass opacities in both lungs, compatible with mild\npulmonary edema.\n\n3.  Small right and trace left pleural effusions.\n\n4.  Dilated pulmonary artery, measuring 3.6 cm, suggestive of underlying\npulmonary hypertension, improved compared to CT of the chest from ___."
        },
        {
            "input": "The imaged portion of the thyroid gland appears normal.  There is marked\nenlargement of the main pulmonary artery which measures 4.4 cm in diameter. \nPlease correlate for pulmonary arterial hypertension.  The thoracic aorta is\nnormal in course and caliber without appreciable atherosclerosis.  The heart\nappears mildly enlarged.  No pericardial effusion.  No gross mediastinal or\naxillary lymphadenopathy.  Small bilateral pleural effusions are present.\n\nThere is dense airspace consolidation within the right middle and right lower\nlobes compatible with pneumonia.  Evaluation for pulmonary alveolar hemorrhage\nis limited given presence of significant pneumonic consolidation in the right\nlower lung.  Difficult to exclude a component of alveolar hemorrhage.  The\nleft lung appears clear.  No worrisome nodule.\n\nIn the imaged upper abdomen, the spleen appears enlarged though is not fully\nimaged.  No additional abnormalities in the upper abdomen.\n\nBones:  No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Dense airspace consolidation within the right middle and right lower lobes\nconcerning for pneumonia.  Difficult to exclude a component of alveolar\nhemorrhage.\n2. Marked enlargement of the main pulmonary artery measuring up to 4.4 cm,\ncorrelate for pulmonary arterial hypertension.\n3. Mild cardiomegaly with small bilateral pleural effusions.\n4. Partially visualized splenomegaly in the upper abdomen."
        },
        {
            "input": "The aortic valve is heavily calcified consistent with history of severe aortic\nstenosis.  Calcifications in the thoracic aorta are mild in the ascending\nregion, moderate in the aortic arch, and marked in the descending thoracic\naorta.  Heart is upper limits of normal in size, and diffuse severe coronary\nartery calcifications are present.\n\nThere are no enlarged intrathoracic lymph nodes.  Small hiatal hernia is\nincidentally noted as well as distension of the thoracic esophagus suggesting\ndysmotility.  Trace left pleural effusion is present.\n\nWithin the lungs, a sub solid, poorly defined mass is present in the left\nupper lobe with irregular margins and internally dilated air bronchograms, as\nwell as pleural tags and distortion of the major fissure.  The mass is\npredominantly solid in attenuation with a lesser ground-glass component and\nmeasures approximately 3.1 cm in greatest a craniocaudad, transverse and\nanterior posterior ___ (image 91, series 5 and image 98, series 6 b). \nSmaller foci of ground-glass opacity in the left upper lobe measuring up to 9\nmm (image 129, 5) are nonspecific but could potentially represent multicentric\nlung adenocarcinoma.  Calcified granulomas incidentally noted in the right\nlung apex.\n\nAssessment of the lungs is otherwise remarkable for mild emphysema.  Mild\nsubpleural reticulation and minimal dilation of the bronchi could potentially\nbe age related in a patient of ___ years of age.\n\nExam was not tailored to evaluate the sub- diaphragmatic region, but no acute,\nconcerning abnormalities are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.",
            "output": "1.  3.1 cm mixed attenuation mass in the left upper lobe is consistent with\nprimary lung adenocarcinoma.  Consider PET-CT for staging purposes if\nwarranted clinically.\n\n2.  Other smaller appear ground-glass opacities in the left upper lobe are\nnonspecific but could potentially represent multicentric disease.\n\n3. Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis.  Atheromatous calcifications of the thoracic aorta as detailed\nabove.  These images are available for review.\n\n4.  Severe diffuse coronary artery calcifications.\n\n5.  Trace left pleural effusion.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:38 ___, 5 minutes after\ndiscovery of the findings.  ."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  Supraclavicular and axillary lymph nodes are\nnot enlarged.  Retained debris is seen in the distal esophagus.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  The study is\nlimited by patient motion, however there is no evidence of pulmonary embolism.\n\nPULMONARY PARENCHYMA:  A left upper lobe solid and ground-glass consolidation\nis increased in size measuring 3.8 x 2.7 cm (previously 3.2 x 2.0 cm). \nExtensive bilateral ground-glass opacities are significantly increased worse\nin the left upper and right upper lobes.\n\nAIRWAYS:  There is extensive bronchial wall thickening, worse in the right\nlung base.\n\nPLEURA:  Bilateral pleural effusions are moderate and increased.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen. \nThere is a small hiatal hernia.",
            "output": "1. Diffuse ground-glass opacifications are significantly increased from ___.  This could represent multifocal pneumonia, however asymmetric\npulmonary edema or hemorrhage cannot be excluded given the history.\n2. The dominant left upper lobe mixed attenuation mass is increased in size\nfrom ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Scarred mild centrilobular emphysema.  Lungs are clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited sections through the upper abdomen show subcentimeter left\nhepatic lobe hypodensities, too small to characterize.\n\nBONES: T2 vertebral body hemangioma is unchanged.  Please refer to recent ___\nPET-CT for evaluation of lytic lesions.  No acute fractures.",
            "output": "1. No pulmonary embolism or aortic injury.\n2. No acute fractures involving the osseous structures of the chest.  Please\nrefer to recent ___ F FDG PET-CT from ___ for evaluation of osseous\nlesions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  The thoracic aorta is normal in caliber.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No enlarged lymph nodes.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There is a hypoattenuating nodule in the right thyroid lobe\nmeasuring 11 mm, which does not require follow-up.\n\nABDOMEN: Patient is status post cholecystectomy, and there is a common bile\nstent in place.  The previously seen biloma has decreased in size, measuring\n5.0 x 2.3 x 4.1 cm, previously 7.1 x 5.8 cm.  A small focus of gas within the\ncollection may be related to instrumentation or infection.  Perihepatic\nascites and stranding has decreased.  The spleen is mildly enlarged, measuring\nup to 13.4 cm.\n\nBONES: No worrisome osseous lesions.",
            "output": "1. No evidence of pulmonary embolism.\n2. Interval decrease in the size of a biloma and perihepatic\nascites/stranding."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The patient is status post CABG.  Mild cardiomegaly is\nstable.  The pericardium and great vessels are within normal limits. No\npericardial effusion is seen.  There is extensive atherosclerotic\ncalcifications in the aorta, aortic valve, and coronary arteries.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple upper normal to minimally enlarged\nmediastinal lymph nodes in the pretracheal and subcarinal stations up to 1.2\ncm in the subcarinal station (series 2, image 49) are noted.  No axillary or\nhilar lymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: There are bilateral pleural effusions, right more than left. \nNo pneumothorax.\n\nLUNGS/AIRWAYS: Emphysema noted.  Multifocal consolidation is concerning for\npneumonia.  Findings most confluent in the right upper lobe.  A\nperibronchovascular distribution (series 3, image 91, 108, 141) with scattered\nnodular and ill-defined opacities is present, suggesting both typical and\natypical agents.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates multiple hepatic\ncysts up to 2.5 cm (series 2, image 75) unchanged dated ___. \nOtherwise the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMidline sternotomy wires are intact.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Multifocal pneumonia, with probable atypical component.  Follow-up to\nresolution advised.\n3.  Minimally enlarged mediastinal lymph nodes, likely reactive.\n4.  Bilateral small pleural effusions, right greater than left."
        },
        {
            "input": "There are 2 left upper lobe calcified granulomas. The lungs are otherwise\nclear without consolidation, effusion, or pneumothorax. The central airways\nare patent.\n\nThere is no axillary or mediastinal adenopathy. There is no evidence of\nmediastinal hematoma and no findings to explain the chest x-ray findings which\nmay have been projectional. The unenhanced heart and great vessels are grossly\nunremarkable.\n\nIncluded portion of the unenhanced upper abdomen is notable for a right renal\nhemorrhagic cyst.\n\nThere is diffuse abnormality throughout the osseous lucent lesions structures\nwith lucent lesions throughout compatible with patient's multiple myeloma.\nCompression deformity seen at T11 without CT findings to suggest that it is\nacute. Soft tissue extension seen at the inner margin of the right anterior\nseventh rib.",
            "output": "1. No findings to explain patient's chest x-ray abnormality which was likely\nprojectional. No mediastinal hematoma.\n2.  Diffuse lytic lesions throughout the bones compatible the patient's\nhistory of for multiple myeloma. T11 compression deformity which may be old.\nSoft tissue extension along lesion of the anterior right seventh rib."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is\nunremarkable.  Supraclavicular and left axillary lymph nodes are nonenlarged. \nMultiple abnormal enlarged right level 1 axillary lymph nodes measure up to\n2.3 x 1.7 cm (03:25).  Level 2 axillary nodes measure up to 0.9 cm in short\naxis however demonstrate loss of central fatty hilum (03:15) and are\nsuspicious for disease involvement.  Along the right lateral chest wall is a\n5.1 x 4 cm irregular mass.  (03:40).\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen/pelvis for details.\n\nMEDIASTINUM: Mediastinal lymph nodes are nonenlarged.  No anterior mediastinal\nmass.\n\nHILA: Hilar lymph nodes are nonenlarged.\n\nHEART and PERICARDIUM: Small pericardial effusion noted.  The heart is normal\nin size.  Mild coronary artery and aortic valvular calcifications are noted.\nPLEURA: No pleural effusion or pleural calcification.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar atelectasis is noted.  No suspicious mass.\n2. AIRWAYS:  The airways patent to the segmental level.  No bronchiectasis.\n3. VESSELS:  Thoracic aorta is normal in caliber without aneurysmal\ndilatation.  Main pulmonary artery is normal in caliber.\nCHEST CAGE: Soft tissues are otherwise unremarkable.  No focal lytic or\nblastic osseous lesions suspicious for malignancy.  There are severe\ndegenerative changes throughout the right glenohumeral joint (series 3, image\n11).",
            "output": "1.  5.1 cm right breast mass with right level 1 and level 2 axillary\nlymphadenopathy.  No distal metastasis.\n2.  Small pericardial effusion."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber.  Trace pericardial fluid is likely\nphysiologic.  A left chest wall port device terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Previously seen right axillary adenopathy no\nlonger visualized post axillary dissection.  Numerous surgical clips are noted\nin the right axillary region.  Previously seen right breast masses are not\nseen post partial right mastectomy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild perihilar groundglass opacities are suggestive of\npulmonary edema.  There is mild dependent atelectasis bilaterally.  Lareas of\nbronchiectasis in the left lower lobe are again noted.\n\nBASE OF NECK: A few diminutive thyroid nodules are again seen.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.?",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Mild pulmonary edema."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified and without filling defect. The remaining great vessels are\nnormal in appearance.\n\nCT CHEST WITH CONTRAST:\n\nThe thyroid gland is heterogeneous. There is mild high right hilar and\nmediastinal lymphadenopathy with lymph nodes measuring up to 12 mm. The heart\nis structurally normal and there is no pericardial effusion. There is\natelectasis in the bilateral lower lobes and in the right middle lobe.  There\nare scattered areas of reticular and ground-glass opacities in both lungs. The\nairways are patent. There are no concerning pulmonary nodules. There is no\npneumothorax or pleural effusion.\n\nThere is a small hiatal hernia. The upper abdominal structures are\nunremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No pulmonary embolism or acute aortic syndrome.\n2. Scattered areas of ground-glass and reticular opacities which are likely\ninflammatory and may represent early  atypical pneumonia.\n3. Enlarged right hilar and mediastinal lymph nodes are likely reactive."
        },
        {
            "input": "The aortic valve is heavily calcified, consistent with history of severe\naortic stenosis.  The ascending aorta is ectatic, measuring up to 4 cm in\ngreatest dimension.  Moderate atheromatous calcifications are present in the\nascending aorta.  Additionally, the aortic arch is heavily calcified with\ncalcifications extending into the origin of the branch vessels of the aorta. \nModerate calcifications are also demonstrated within the descending thoracic\naorta which measures up to approximately 3 cm in diameter and has extensive\natheromatous plaque.\n\nThe heart is upper limits of normal in size and note is made of diffuse\ncoronary artery calcifications.  There is no pericardial or pleural effusion. \nLeft hemidiaphragm is mildly elevated, of uncertain chronicity.\n\nThyroid gland is mildly enlarged with a partially calcified 1.6 cm nodule in\nthe right lobe.  There are no enlarged intrathoracic lymph nodes.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of multiple cystic lesions within the right kidney with the largest\nmeasuring 6.4 cm containing and eccentric curvilinear calcification inferiorly\n(image 61, series 2), incompletely imaged on this exam.\n\nSkeletal structures of the thorax demonstrate a small sclerotic focus on a\nlower right posterior rib (image 33, series 2), most likely a benign bone\nisland.\n\nAssessment of the lungs is limited by respiratory motion, reducing sensitivity\nfor detecting small pulmonary nodules and subtle interstitial lung\nabnormalities, particularly within the mid and lower lungs.",
            "output": "1.  Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis.  Ectatic thoracic aorta with atheromatous calcifications as\ndescribed above.  These images are available for review for preoperative\nplanning.\n\n2.  Diffuse coronary artery calcifications.\n\n3.  Partially calcified 1.6 cm right lobe thyroid nodule, incompletely\ncharacterized on this CT exam.\n\n4.  Partially imaged 6.4 cm cystic lesion in the right kidney, with an\neccentric calcification.  Consider renal ultrasound for more complete\ncharacterization if not already performed at an outside institution."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  At the site of\nvascular clips in the left breastd is a 25 x 32 mm lesion which could be a\npostoperative artifact or malignancy.  Patient is receiving routine\nmammographic evaluation for this lesion and any other breast findings. \nElsewhere in the imaged chest wall there are no soft tissue findings\nconcerning for malignancy.\n\nCardio mediastinum:\n\nHiatus hernia is small.  Adjacent to it is 7 mm wide lymph node, chronicity\nindeterminate.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head and neck vessels, and present in\nat least the left anterior descending, left circumflex, and right coronary\narteries.\n\nLeft atrium is probably enlarged.  Cardiac evaluation requires\nechocardiography.\n\nPericardium is physiologic.\n\nThoracic lymph nodes:\n\nThe only clearly enlarged mediastinal lymph nodes are in the prevascular\nspace, at the level of the aortic arch and aortopulmonic window, where the\nlargest is a 16 x 27 mm cluster, 5:90.  Mildly enlarged lymph nodes are\nprobably present in the left hilus, but cannot be measured on this noncontrast\nstudy.  Bronchi are not compromised.\n\nLungs, airways, and pleura:\n\nIn the presence of mild, diffuse bronchial wall thickening, micro nodules and\nseptal thickening in the upper lobes could be other manifestations of the\ninflammation typically seen in cigarette smokers.  However a spiculated 14 x\n21 mm soft tissue mass at the anterior periphery of the left upper lobe, 5:73,\nslightly thickening the local pleura, 5:80, is malignant until proved\notherwise.  Serration of the pleural surface more inferiorly is often seen\nwith subpleural fibrosis following radiation of breast carcinoma, but could be\nmalignant as well.  There is no pleural effusion.  In the setting of likely\nleft hilar adenopathy, spiculated thickening of the left major fissure, 5:124\nis also suspicious for malignancy.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.\n\nSevere degeneration is responsible for narrowing of multiple disc spaces and\nanterior ankylosis in the thoracic spine.",
            "output": "Peripheral left upper lobe lung mass, malignant until proved otherwise,\nprobably involves pleural locally, but ribs are intact, accompanied by\nenlargement of mediastinal lymph nodes in the drainage pathway in the\nprevascular mediastinum and probably in the left hilus.  ___ also be\ninvolvement of the pleura remotely and in the left major fissure.\n\nFindings consistent with prior radiation surgery raise possibility of\nradiation induced malignancy, but there are other findings that suggest a back\n0 smoking, specifically micro nodules in the upper lobes and bronchial wall\nthickening.\n\nLeft breast abnormalities including dominant mass like lesion are reviewed by\nregular mammography, most recently ___.\n\n\nNOTIFICATION:  In The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:05 am, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Included portions of the thyroid gland enhance homogeneously.  No\nsupraclavicular, axillary or mediastinal lymphadenopathy by size criteria. \nScattered mediastinal lymph nodes measure up to 7 mm in the left prevascular\nstation.  There is a 14 mm hilar lymph node on the right (3:99), likely\nreactive.\n\nHeart is normal in size, without a pericardial effusion.  Left ventricular\nmyocardium appears thickened.  Coronary calcifications are noted.  Thoracic\naorta is normal in course and caliber with no evidence for dissection or\nintramural hematoma.  Main pulmonary trunk is dilated, measuring up to 3.9 cm\nin diameter (3:78), suggestive of pulmonary arterial hypertension.  There are\nextensive segmental and subsegmental pulmonary emboli involving all pulmonary\narterial branches.  On the left, there is central extension of clot burden\ninto the left main pulmonary artery (3:80).  There is no evidence of right\nheart strain.\n\nAirways are patent to the segmental bronchi bilaterally.  Scattered\nparenchymal abnormalities are noted.  Several wedge-shaped peripheral\nopacities in the right lower lobe and left lower lobe likely represent small\npulmonary infarcts (02:59, 74, 79).  There is a 5 mm mixed attenuation nodule\nin the right middle lobe (3:88).  Several additional opacities are nonspecific\nand may represent an underlying inflammatory process ; for instance, there is\na lobulated 1.1 x 0.8 cm perifissural opacity in the inferior right upper lobe\n(3:99) and an additional 0.7 cm nodular opacity in the posterior segment of\nthe right upper lobe (3:67).\n\nSmall pleural effusion on the left.  No pleural effusion on the right.  No\npneumothorax.\n\nLimited images of the upper abdomen reveals a diffusely hypoattenuating liver,\nsuggestive of hepatic steatosis.\n\nNo fractures are identified.  Degenerative changes throughout the thoracic\nspine.  There is a 1.4 cm skin lesion extending into the subcutaneous fat\nalong the central upper back (3:61), which may represent a sebaceous cyst.",
            "output": "1. Extensive bilateral segmental and subsegmental pulmonary emboli, with\ncentral extension into the left main pulmonary artery.\n2. Dilatation of the main pulmonary artery however no evidence of right heart\nstrain.\n3. Bilateral scattered wedge-shaped peripheral parenchymal opacities,\nsuspicious for pulmonary infarcts.  Additional parenchymal opacities in the\nright upper lobe are of unclear etiology and may represent nonspecific\ninflammation.  A follow-up chest CT in 3 months is recommended to evaluate\nresolution.\n4. 5 mm mixed attenuation nodule in the right middle lobe, which could also be\nre-evaluated at time of follow-up.\n5. Prominent right hilar lymph node is likely reactive.\n6. Small left pleural effusion.\n7. Hepatic steatosis.\n8. 1.4 cm superficial skin/subcutaneous lesion along the central upper back,\nmay represent a sebaceous cyst.\n\nRECOMMENDATION(S):  Chest CT in 3 months."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.\n\nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal mass or subphrenic collection.  Steatosis of the liver is severe.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels, but is scattered in at least left anterior\ndescending coronary artery.  Aorta is normal size and the lumen is intact. \nDilatation of the main pulmonary artery, 35 mm, has improved since ___,\npreviously 39 mm, when the patient had multiple pulmonary emboli.  Left atrium\nis newly enlarged, 51 mm in transverse diameter, previously 38 mm.  Right\nventricle is not enlarged.  Cardiac evaluation would require echocardiography.\n\nPULMONARY ARTERIES:\n\nMain, right, left, and lobar pulmonary arteries are normal.  Right and left\ndescending pulmonary arteries are normal.  Because of severe respiratory\nmotion, small filling defects are impossible to separate from motion artifacts\nin the lower lobes.  Even if present one would not expect these to have much\nclinical impact.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are grossly clear. Tracheobronchial tree is\nnormal to subsegmental levels and there is no pleural effusion or other\npleural abnormality.\n\nCHEST CAGE:\n No evidence of malignancy or infection.  No compression fracture.",
            "output": "No pulmonary emboli in major pulmonary vessels.  Subsegmental emboli not\nexcluded in the lower lobes because of motion artifact.\n\nPrevious pulmonary artery dilatation has improved.\n\nNew left atrial enlargement.  No pulmonary edema.  Echocardiography\nrecommended."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged.\nThere is no soft tissue abnormality in the chest cage suspicious for\nmalignancy. Findings below the diaphragm will be reported separately.\n\nThyroid is unremarkable. Fusiform dilatation of the ascending thoracic aorta\nto 43 mm is unchanged since ___. Pulmonary arteries normal size.\n\nHyperemic paraesophageal lymph node in the upper mediastinum, 5:7, 17 mm\ntoday, was 20 mm in ___ and ___.\n\n15 mm hyperemic left hilar lymph node, 05:23, was 24 mm in ___. A\nsecond, 13 x 16 mm left hilar node, 05:30, was 14 x 18.\n\nThere is no pleural or pericardial effusion.\n\nAmong more than a score of lung nodules, the most significant changes are:\n\n17 x 18 mm right middle lobe nodule, 05:34, was 22 x 25 mm.\n\n18 x 21 mm left upper lobe nodule, 6:128, was 21 x 24 mm in ___ x 10 mm left upper lobe nodule, 6:169, was 10 x 12 mm.\n\nAdjacent left lower lobe juxta hilar masses, currently 23 x 25 mm, 6:192 and\n19 x 25 mm, 6:186, were 32 x 30 mm and 20 x 24 mm, respectively.\n\nThere are no obvious new pulmonary metastases.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Extensive metastases, primarily mediastinal and hilar lymph nodes and\npulmonary nodules, generally smaller today than in ___, details above."
        },
        {
            "input": "A known retrotracheal lymph node (2, 0 9).  Is unchanged in size.  The\npre-existing 13 x 16 mm left hilar lymph node now measures 11 x 16 mm.  A\npre-existing right hilar lymph node, previously measuring 19 x 20 mm now\nmeasures 13 x 14 mm in diameter.  Unchanged appearance of the heart and of the\nlarge mediastinal vessels.\nSeveral known pulmonary nodules, most of which have decreased in size. For\nexample, a reference lesion at the level of the aortopulmonary window (4, 87)\nhas decreased from 12 x 16 to 12 x 12 mm in diameter.  The same magnitude of\ndecrease is observed with respect to other pre-existing pulmonary nodules, for\nexample in the left upper lobe (4, 104).  Unchanged parenchymal opacities at\nthe right lung bases. Unchanged fibrotic changes in the left lower lobe.  The\nlargest pulmonary nodule is located at the bases of the middle lobe (4, 143)",
            "output": "Mild decrease in size of the pre-existing hilar lymph nodes and pulmonary\nnodules."
        },
        {
            "input": "The examination is compared to ___.\nUnchanged size and morphology of the known retro tracheal lymph node (5, 11),\nwith a diameter of 16 x 15 mm.  Unchanged size of the left hilar lymph node,\nwith a maximum diameter of 13 mm (5, 33).  Unchanged size of a left upper\nhilar lymph node (5, 26), with a diameter of 9 mm.  No new or growing hilar or\nmediastinal lymph nodes.\nThe supraclavicular and axillary regions are unremarkable.  No evidence of\nchest wall lesions.  Normal appearance of the large mediastinal vessels. \nUnchanged mild elevation of the right hemidiaphragm.  Unchanged appearance of\nthe vertebral bodies, the ribs and the sternum.\nThe known pulmonary nodule in the left upper lobe (6, 145) shows an unchanged\ndiameter of 12 mm.  The other pulmonary nodules, for example in the middle\nlobe (6, 191) are also stable in size and morphology.  There is no evidence of\nnew or growing lung nodules.  Postoperative scars in the left lower lobe (6,\n206).  No pleural effusion.  No diffuse lung disease.",
            "output": "As compared to ___, there is stability in size and morphology of the\nknown pulmonary nodules and the hilar and mediastinal lymphadenopathy.  No new\nor growing nodules or nodes."
        },
        {
            "input": "The thyroid is normal.  A retrotracheal lymph node measuring 1.5 x 1.3 cm\n(04:19), with essentially stable from the prior examination.  Similarly, a 1.3\nx 0.9 cm left hilar lymph node (04:39) is also stable.  No new or enlarging\nmediastinal lymph nodes are identified.  There are no pathologically enlarged\nsupraclavicular or axillary lymph nodes.\n\nThe aorta is normal in size.  The main and right pulmonary arteries are\ntop-normal in size.  There is a new pulmonary embolism identified within right\nlower lobe pulmonary artery (5:201).  The heart is normal in size and\ndemonstrates no appreciable coronary artery calcifications. There is no\npericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Lung windows demonstrate numerous solid pulmonary\nmetastatic deposits, which grossly appear unchanged from the prior\nexamination.  For example, a 1.7 x 1.6 cm right level middle lobe nodule\n(5:224) previously measured 1.7 x 1.6 cm.  Similarly, a 1.3 cm left upper lobe\nnodule (5:180), previously measured 1.3 cm.  Innumerable additional, bilateral\nnodules also remains stable.  Postoperative changes are again noted in the\nleft lower lobe.\n\nDiffuse sclerotic osseous metastatic disease is again noted throughout the\nthoracolumbar spine and pelvis, minimally increased from the prior\nexamination.\n\nFor further evaluation of the abdomen, including hypodensities within the\npancreatic body, please see the separate CT abdomen and pelvis examination\nperformed on the same day.",
            "output": "1.  New, lobar pulmonary embolism within the pulmonary artery supplying the\nright lower lobe.\n2.  Stable diffuse pulmonary metastases and mediastinal/left hilar\nlymphadenopathy, unchanged from ___.\n3.  Modest interval progression of diffuse osseous metastatic disease.\n4.  For description of the intra-abdominal contents, please see the separate\nCT abdomen and pelvis examination performed on the same day.\n\nNOTIFICATION:  The findings were convedy via telephone by Dr. ___\nto the ___, RN on the telephoneon ___ at 2:24 ___, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "The thyroid is not identified and may be surgically absent or atrophic. \nSupraclavicular and axillary lymph nodes are not enlarged.  Mediastinal and\nhilar lymphadenopathy are stable from prior studies, including a partially\nnecrotic left hilar lymph node measuring up to 1.8 x 0.9 cm (301:120).  The\npulmonary arteries are normal in size.  The previously seen pulmonary embolism\nis no longer identified, however this study is not tailored for the evaluation\nof pulmonary embolism and poor bolus timing limits the evaluation of pulmonary\narterial patency.  Fusiform dilatation of the ascending aorta measures up to\n4.3 cm, similar to prior studies (301:137).  Cardiac configuration is normal\nwith moderate coronary calcification.  An enhancing soft tissue nodule\nadjacent to the upper esophagus measures 1.7 x 2.0 cm, unchanged from the\nprior study when measured in similar planes (301:40).  A small hiatal hernia\nis noted.\n\nThe airways are patent to the subsegmental bilaterally.  Previously seen right\nbase atelectasis and peribronchiolar soft tissue density surrounding the\nsegmental right lower lobe pulmonary bronchi has improved.  There is no\npleural or pericardial effusion.  Numerous pulmonary metastases are stable\nfrom the prior study of ___.  The largest right-sided lesion in\nthe right upper lobe measures 1.6 x 1.6 cm (301:141), previously 1.7 x 1.6 cm.\nThe largest left-sided lesion is located within the left lower lobe infrahilar\nregion measuring up to 2.0 x 1.8 cm (301:154), previously 2.0 x 1.8 cm.  No\nnew or enlarging metastatic deposits are identified.\n\nDiffuse, generally sclerotic osseous metastatic disease is generally stable\nfrom ___, however a lytic lesion involving the superior endplate of\nT6 has increased compared with the prior study, now measuring 2.6 x 1.9 cm\n(301:110) compared with 2.0 x 1.3 cm previously.  There is no new osseous\nlesion.  Moderate underlying degenerative changes are stable.\n\nPlease see separately submitted report of CT Abdomen and Pelvis from the same\ndate for description of subdiaphragmatic findings.",
            "output": "1. Stability of numerous pulmonary and soft tissue metastases.  No new or\nenlarging lesions.\n2. Interval increase in size of lytic T6 osseous metastasis, now measuring up\nto 2.6 cm, osseous metastases are otherwise stable.\n3. Interval improvement in right base atelectasis and peribronchiolar soft\ntissue density.\n4. Fusiform dilatation the ascending aorta measuring to 4.3 cm.\n5. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No abnormalities at the level of the large\nmediastinal vessels.  No evidence of pulmonary embolism.  Moderate coronary\ncalcifications.  Stable appearance of the heart.  No pericardial effusion. \nThe posterior mediastinum is unremarkable.  The upper abdomen is reported in\ndetail in the dedicated abdominal CT report.  The known pulmonary nodules are\neither stable or slightly increased in size.  For example, a left upper lobe\nlesion (6 x ___ continues to measure 10 x 12 mm in diameter.  A second\nreference lesion in the left lower lobe (6, 137) has slightly increased in\nsize, from or regionally 9 x 12 to now 14 x 18 mm.  This lesion has a\nhypodense center.  A third reference lesion in the right lung (6, 162)\npreviously 15 x 16 mm in diameter now measures 18 x 18 mm in diameter.  Other\nnodules show a similar behavior.  Nodular growth is visually more obvious for\nthe smaller lung nodules (6, 212).  The areas of scarring and atelectasis at\nthe right lung bases are stable.  No evidence of pleural abnormalities. \nStable postoperative appearance of the left lung basis.  The known vertebral\nlesions (9, 37) are stable in size.  Moderate degenerative vertebral disease. \nNo vertebral compression fractures.",
            "output": "Stable vertebral part lytic and part sclerotic lesions.  Most pre-existing\nlung nodules have slightly grown in size.  No evidence of pleural effusions."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  A borderline sized upper paraesophageal lymph node\n(5, 8) is stable in appearance.  Growth of a upper left perihilar lymph node\n(5, 21), now measuring 13 x 12 mm.  Growth of a left lower hilar lymph node\n(5, 28) from 10 x 19 to now 15 x 21 mm.  Stability in size of a left lower\nperihilar lymph node (5, 36).  Upper abdominal findings are described in\ndetail in the dedicated abdominal CT report.  No specific cardiac\nabnormalities.  No incidental pulmonary embolism.\nMild bilateral apical scarring.  Interval growth of a left upper lobe\npulmonary nodule, from previously 15 x 16 to now 20 x 20 mm (6, 121). \nStability in size of a pre-existing middle lobe nodule close (6, 165).  Stable\n5 mm left lower lobe nodule (6, 203).  Interval growth of a second left lower\nlobe nodule from previously 3 x 3 to now 7 x 9 mm (6, 218).  Several smaller\npulmonary nodules (6, 238) are stable.",
            "output": "Moderate interval growth of several pre-existing hilar lymph nodes as well as\npre-existing pulmonary nodules since an outside hospital CT examination\nperformed on ___."
        },
        {
            "input": "CHEST:\nThe thyroid is not imaged.\n\nA 1.9 x 1.9 cm paraesophageal lymph node previously measured 1.7 x 1.7 cm\n(series 4, image 25).  There is no supraclavicular or axillary\nlymphadenopathy.  There is no additional mediastinal lymphadenopathy. \nPartially necrotic left hilar lymph nodes, measure up to 1.7 cm in short axis,\npreviously 1.5 cm (series 2, image 22, 30).\n\nThere is no thoracic aortic aneurysm.  The main pulmonary artery is within\nnormal limits.  No pulmonary embolus is seen.  Airways are patent to the\nsegmental level.  There is mild bronchiectasis at the right lung base\nassociated with compressive atelectasis.\n\nNumerous pulmonary nodules are unchanged, for example a right middle lobe\nnodule measuring up to 20 x 19 mm (previously 21 x 19 mm) (series 4, image\n104, 132, 174, 178).\n\nMultiple additional pulmonary nodules are new or increased in size (series 4,\nimage 143, 138, 118).  For example, a 25 x 22 mm left lower lobe nodule\n(previously 24 x 21 mm) (series 4, image 143).\n\nSclerotic foci in the second and sixth ribs on the left, as well as the third\nand seventh rib on the right are unchanged from the prior examination, but\nconcerning for metastatic disease (series 4, image 119, 108, 68, 20). An\nexpansile soft tissue mass obliterating the right posterior eighth rib has\nprogressed from prior examination, but does not demonstrate evidence of\npleural invasion.\n\nNumerous sclerotic foci in the vertebral bodies are also concerning for\nmetastatic disease and are grossly unchanged in size and extent.  For example,\nsclerotic foci in the T3 and T5-T10 vertebral bodies.\n\nA new 5 mm hyperdense focus in the right infraspinatus (series 4, image 73) is\nconcerning for metastatic disease.\n\nFor assessment the abdomen please see CT abdomen pelvis from the same date.",
            "output": "1. Moderate interval increase in multiple pulmonary nodules.\n2. Progression of osseous metastases, including progression of a destructive\nmetastasis in the right eighth rib.\n3. New hyperdense focus in the right infraspinatus muscle, concerning for\nmetastatic disease."
        },
        {
            "input": "The thoracic aorta is normal in caliber.  Common origin of the brachiocephalic\ntrunk and left common carotid artery is a normal variant.  The main, left, and\nright pulmonary arteries are normal in caliber without evidence of a filling\ndefect indicate any incidental acute central pulmonary embolus.  The heart is\nmildly enlarged.  Scattered Coronary artery calcifications are mild on this\nnondedicated exam.  No evidence of a pericardial effusion.\n\nA 18 x 17 mm paraesophageal lymph node at the level of the thoracic inlet has\nminimally increased in size, previously 18 x 16 mm (series 4, image 43).  The\nlymph node exerts mass effect on the right upper thoracic esophagus,\ncompressing the lumen and distorting the esophageal wall, similar to the prior\nexam (series 4, image 43).  The fat plane between the lymph node and the right\nesophageal wall remains obliterated and neoplastic invasion cannot be\nexcluded.  Moreover, the esophageal wall is uniformly thickened.  No specific\nevidence of esophageal perforation.  No pneumomediastinum.  No mediastinal\nfluid collections.  Other mediastinal lymph nodes are prominent but not\npathologically enlarged by CT size criteria.\n\nA left suprahilar lymph node with areas of necrosis has grown, now 15 x 13 mm,\npreviously 13 x 10 mm (series 4, image 106).  A 24 x 16 mm left hilar necrotic\nlymph node is overall unchanged (series 4, image 139).  There is soft tissue\nfullness surrounding the right hilum but no discrete lymphadenopathy.  No\nevidence of compromise to adjacent bronchovascular structures by these\nenlarged lymph nodes.\n\nMultiple bilateral pulmonary nodules consistent with metastases are again\ndemonstrated, majority of which are similar in size, at least 2 which is\nminimally smaller, and several which have grown.  Index examples include:\n- a 5 mm right upper lobe perifissural nodule has grown, previously less than\n2 mm (series 4, image 118).\n- a 5 mm left upper lobe nodule was previously less than 2 mm (series 4, image\n130).\n- A 2.1 x 1.8 cm necrotic metastasis in the left lower lobe was previously 2.2\nx 2.2 cm (series 4, image 173).\n- a 2 mm right upper lobe nodule was previously 3 mm (series 4, image 92).\n- A 2 x 1.8 cm right middle lobe necrotic metastasis is unchanged (series 4,\nimage 151).\n\nRight lower lobe mild bronchiectasis and nonobstructive atelectasis is\nunchanged (series 4, image 170, 159).  Ground-glass opacity in the right lower\nlobe is likely also related to atelectasis, similar the prior exam.\nThe airways are patent to at least the subsegmental level.  No pneumothorax. \nNo pleural effusion.\n\nNumerous osseous lesions consistent with metastases are again demonstrated,\nsome of which are new, some of which are larger, and others of which are\nunchanged:\n- Lytic, expansile lesion with sclerosis in the right third and seventh\nSclerotic lesion in the right third lateral rib is unchanged (series 4, image\n82).\n- However, 6-mm adjacent lytic lesion without cortical breakthrough in the\nsame rib is new or more pronounced (series 4, image 87).\n- Small lucent lesion in the right sixth posterior rib is new (series 4, image\n126).\n- Mixed sclerotic and lytic lesion in the right posterior seventh rib is\noverall unchanged since of cortical breakthrough (series 4, image 140).\n- An expansile, enhancing soft tissue metastasis in the right posterior eighth\nrib with associated destruction/slices of the rib and probable pathologic\nfracture (series 4, image 164, 170, 175 ; series 602b, image 31) appears\nslightly larger, expanding the rib more laterally compared to the prior exam\n(series 4, image 175).  The mass extends into the subpleural fat, similar the\nprior exam (series 4, image 166); however, there is no definite evidence of\npleural invasion.\n- Sclerotic lesions in the left second, sixth, and eighth posterior ribs are\nunchanged (series 4, image 39, 129, 170).\n\n- Tiny lytic lesion through the left scapula with probable associated\npathologic fractures new (series 4, image 132).\n- Small lytic lesions in the right scapula are new with cortical breakthrough\nbut no soft tissue extension (series 4, image 125).\n\n- T7 and T11 vertebral body lytic lesions have grown (series 602b, image 49,\n48).  A T10 lesion appears new (series 602b, image 45).  Multiple other lytic\nand mixed sclerotic and lytic lesions in the thoracic spine vertebral bodies\nare again demonstrated, overall similar.  No evidence of pathologic fracture\nof the thoracic spine.  The spinal canal appears patent.\n\n- A small lytic lesion with destruction of the anterior cortex of the sternum\nis new (series 602b, image 49).  Other lucencies within the manubrium and\nsternum are more pronounced and likely metastases as well.\n\nA small soft tissue nodule and posterior to the sternomanubrial joint has\nincreased in size, now measuring up to 4 mm, suspicious for metastasis (series\n602b, image 51 ; series 4, image 96).  Nonspecific focal areas of skin\nthickening in the chest wall are unchanged (e.g.  , series 4, image 133).  The\n6 mm hyperdensity in the right infraspinatus muscle is less conspicuous but\ncould suggest interval treatment change (series 4, image 85).  Bilateral\ngynecomastia is mild.\n\nA hiatal hernia is small (series 4, image 227).\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "1.  Overall interval progression of disease as above with at least to growing\npulmonary nodules, slight interval increase in lymphadenopathy, multiple new\nbone metastases, and a 4 mm soft tissue nodule anterior to the sternal\nmanubrial joint that is suspicious for metastasis.\n\n2.  Of note, new pathologic fracture of the left scapula.\n\n3.  Minimally larger paraesophageal lymph node at the level of the thoracic\ninlet, compressing the right wall of the esophagus with loss of fat plane for\nwhich tumor extension cannot be excluded.  This likely explains the patient's\ndysphagia."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  The large mediastinal vessels are\nunremarkable.  No incidental pulmonary embolism.  Mild coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable.  Small cystic lesion in the spleen (2,\n39).  Chronic wedge-shaped deformity of a middle thoracic vertebral body (602,\n71).  Moderate degenerative vertebral disease.  No evidence of osteolytic\nlesions.  No pleural thickening, no pleural effusions.  The airways are\npatent.  Moderate respiratory motion artifacts at the level of the lung bases.\nNo suspicious pulmonary nodules or masses.  No evidence of infectious changes.",
            "output": "No suspicious pulmonary nodules or masses.  No thoracic lymphadenopathy.  No\npleural abnormalities.  No evidence of acute or chronic infection.  Chronic\nwedge-shaped deformity of a middle thoracic vertebral body."
        },
        {
            "input": "The ascending thoracic aorta is 4.1 cm in diameter, at the upper limit of\nnormal for a patient of this age.  There are mild atherosclerotic\ncalcifications along its course.  The 3 vessel takeoff from the aortic arch is\nunremarkable aside from mild calcifications at the origin of the left\nsubclavian artery, which is patent.  There is no evidence of dissection,\naneurysm, pseudoaneurysm or intramural hematoma.\n\nEvaluation of the bilateral lower lobes subsegmental pulmonary arteries is\nlimited by basilar opacities.  Remainder of pulmonary arteries are well\nvisualized to the subsegmental level.  There is no filling defect to suggest\npulmonary embolism.  The main pulmonary artery is enlarged to 3.2 cm and the\nright pulmonary artery is enlarged to 2.8 cm, in keeping with echo findings of\npulmonary arterial hypertension.\n\nSupraclavicular, axillary, mediastinal, and hilar lymph nodes are not enlarged\nby CT size criteria.\n\nMild aortic valve calcifications are of unknown hemodynamic significance. \nThere is no evidence of pericardial effusion.\n\nSmall bilateral nonhemorrhagic pleural effusions have increased in size since\n___.  Bilateral adjacent consolidation with volume loss is likely\natelectasis with near complete collapse of the right lower lobe and partial\ncollapse of the left lower lobe.  Supervening infection cannot be excluded. \nCentral airways are patent.\n\nLimited evaluation of the upper abdomen again demonstrates abnormal location\nof the sigmoid colon in the right upper quadrant.  Oral contrast from CT ___ has reached the sigmoid colon.  Hepatic hypodensities, most likely\ncysts, are again noted.\n\nNo bone finding suspicious for infection or malignancy is identified.  The\nbones are diffusely demineralized.  Healing fractures of the right seventh,\neighth and ninth ribs are noted.  Multiple compression deformities in the\nthoracic spine are similar to ___ and better evaluated on MRI ___.\n\nThere is bilateral gynecomastia.",
            "output": "1.  No acute aortic pathology or pulmonary embolism.\n\n2.  Small bilateral pleural effusions have increased from ___ with\nnear complete right lower lobe collapse and partial left lower lobe collapse. \nSupervening infection cannot be excluded.\n\n3.  Enlarged main and right pulmonary arteries, in keeping with known\npulmonary arterial hypertension."
        },
        {
            "input": "CHEST:\nThere is a right central venous catheter with the tip at the cavoatrial\njunction. There is an esophageal tube that terminates within the stomach with\none of the side holes 2 cm from the GE junction for which advancement is\nrecommended.\n\nPULMONARY ARTERIES/AORTA: No acute pulmonary emboli identified.  There is no\nacute aortic syndrome.\n\nNECK: There is a 6 mm left thyroid hypoenhancing nodule.  There are no\nsupraclavicular adenopathy.\n\nAIRWAYS: Minimal mucosal secretions are present within the right mainstem\nbronchus and extending into the right lower lobe bronchi.  There is also mild\nperibronchial wall thickening of the right lower lobe bronchi which can be\nexplained if the patient is having episodes of aspiration.  Similar findings\nare noted on the left however to a lesser extent.\n\nMEDIASTINUM: There is no pericardial effusion and no cardiomegaly.  There are\nmild coronary arterial calcifications.\n\nLUNGS: There are bibasilar atelectatic changes that had worsened since prior\nexamination.  There are scattered pulmonary micro nodules which are\nnonspecific.  There are also scattered calcified granulomas.  There is a focal\nlung nodularity along the apical segment of the left lower lobe measuring 0.9\ncm, may represent an area of atelectasis.\n\nPLEURA: There is trace of bilateral pleural effusions.\n\n\nABDOMEN:\nHEPATOBILIARY: There is homogeneous hepatic enhancement with no suspicious\nmass lesions.  Portal vein and hepatic veins are patent.  There is no biliary\nductal dilatation.  Gallbladder is minimally distended with layering high\ndensity material, may represents sludge.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: Spleen is normal in size.\n\nADRENALS:   Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis.  There is a stable right interpolar renal\ncortical cyst.\n\nGASTROINTESTINAL: Stomach is under distended.  Small bowel loops are scared\nhowever, not dilated.  Patient is status post left colonic resection with a\nleft lower quadrant colostomy tube in place.  Right hemicolon and transverse\ncolon demonstrate moderate amount of stool mixed with oral contrast.  There\nare scattered colonic diverticula.  There is no evidence of bowel obstruction\nor perforation.  Colostomy appears unremarkable.\n\nPERITONEUM: Two drains are identified within the abdomen.  The largest drain\nterminates in the pelvis and a smaller drain is noted to track into the\nsubcutaneous soft of the anterior abdomen.  There has been marked interval\nimprovement in the complex collections within the lower abdomen mixed with\nair.  There are expected post surgical foci of air in the subcutaneous tissues\nand in the peritoneal cavity.  There remains mild peritoneal enhancement with\nsmall locule of intraperitoneal fluid that are scattered within the abdomen. \nSome of these collections are not well-formed and others demonstrate a rim of\nenhancement.  These collections measure between 2-3 cm.  Representative are as\nfollow (2:164, 166, 143 and 151).  Additionally, there is a fluid collection\naround the colostomy measuring up to 5 cm with rim of enhancement.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Status post left colonic resection.  Rectal stump appears unremarkable\nand filled with small amount of contrast.  Air is noted within the urinary\nbladder where a Foley catheter is in place.\n\nBONES:There are no acute osseous abnormalities.  There are no suspicious\nosseous lesions.  There are degenerative changes at L5-S1.\n\nSOFT TISSUES: Midline surgical scar is present.  Extensive postsurgical\nchanges are noted along the anterior abdominal wall.  No identifiable\nabdominal wall muscles noted.  The small bowel loops protrude into the\nsubcutaneous tissues.  Fluid within the subcutaneous tissues as well as\nlocules of air which are expected given the recent surgery.",
            "output": "1. Post colonic resection and intraperitoneal washout with resolution of\ncomplex pelvic collections mixed with air. Foci of intraperitoneal air\nexpected in a postsurgical abdomen.\n2. Several 2-3 cm rim enhancing fluid collections in the intraperitoneal\ncavity, consistent with residual peritonitis postsurgery.  These may be\ninfected.\n3. Larger fluid collection with rim enhancement in the subcutaneous soft\ntissues around the colostomy measuring up to 5 cm may be infected.\n4. No evidence of pulmonary emboli.\n5. Findings concerning for aspiration pneumonia in the right lung base or\ninfectious bronchitis.\n6. Recommend advancement of esophageal tube where one of the sideholes is\nwithin 2 cm of the GE junction."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Scattered subcentimeter axillary\nlymph nodes are not pathologically enlarged by CT size criteria and grossly\nunchanged in appearance as compared to CTA chest ___.  There is no\nsupraclavicular lymphadenopathy.  0.6 cm hypodense nodule in the left lobe of\nthe thyroid (2:7), is unchanged from CTA chest ___\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes measuring up to 0.6 cm in the right lower\nparatracheal station (02:23), are unchanged from ___.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There are severe aortic valvular calcifications and\nmoderate coronary arterial calcifications.\n\nPLEURA: There is a trace right pleural effusion\nLUNG:\n\n1. PARENCHYMA: There are diffuse centrilobular nodules.  There is atelectasis\nof the right lower lobe and subsegmental atelectasis in left lower lobe. \nThere is a 4 mm nodule in the left lower lobe (3:156).  There are subtle\nground-glass opacities in the lingula.\n2. AIRWAYS:  There is diffuse bronchial wall thickening with secretions and\nobstruction of the airways in the right lower lobe.\n3. VESSELS:  The main pulmonary artery is not enlarged.\nCHEST CAGE: There is no acute osseous abnormality.",
            "output": "1. Diffuse bronchial wall thickening with secretion and obstruction of the\nairways, particularly in the right lower lobe, which is worsened as compared\nto CT chest ___.  In addition, there ill-defined ground-glass\nopacities in the lingula.  This could represent chronic aspiration. \nBronchoscopy is recommended.\n2. Trace right pleural effusion.\n3. Diffuse centrilobular nodules likely representing chronic bronchitis.\n4. Please refer to dedicated CT abdomen and pelvis report on same day for\nsubdiaphragmatic findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nStudy is significantly degraded by respiratory motion artifact.  Within this\nlimitation, no large central pulmonary embolus.  Main pulmonary artery is\nmildly dilated measuring up to 3.6 cm, increased from recent prior when it\nmeasured up to 2.8 cm.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a new large right\npleural effusion.  Trace left pleural effusion is also new from prior.\n\nThere is persistent diffuse airway opacities, with relative sparing of the\nright middle lobe, though new nodular opacities are seen in the periphery of\nthe right middle lobe.  There is significant compressive atelectasis at the\nright base due to the large pleural effusion.  The airways are patent to the\nsegmental level.\n\nLimited images of the upper abdomen is notable for cirrhotic liver morphology\nwith TIPS in place.  There is moderate volume abdominopelvic ascites.  The\nspleen is markedly enlarged measuring up to 17.2 cm an enteric tube passes\ninto the stomach, though its tip is not imaged.  Numerous esophageal varices\nare noted.  Gallstones are also noted.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Study is limited by significant respiratory motion artifact.  Within this\nlimitation, no large central pulmonary embolism.\n2. Persistent diffuse airway opacities with relative sparing of the right\nmiddle lobe, possibly reflecting sequela of aspiration, multifocal pneumonia,\nor ARDS.\n3. New large right and trace left pleural effusions.\n4. Interval increase in main pulmonary artery diameter suggesting pulmonary\nhypertension.\n5. Cirrhosis with moderate volume abdominopelvic ascites and marked\nsplenomegaly as well as esophageal varices noted in the partially imaged upper\nabdomen."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  No obvious\nbreast lesions are seen.  Although breast is better evaluated by mammogram\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The aorta\nand pulmonary artery normal in caliber.  There is no appreciable coronary\nartery calcification.  There is no pericardial effusion.  There is a small\nhiatus\n\nPLEURA: There is no pleural effusion\n\nLUNG: There are numerous bilateral pulmonary nodules ranging in size from 2 mm\nto 9 mm the largest in both lower lobes.  These are concerning for metastasis.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows heterogeneous\nappearance of the liver.  There is hypodense lesion along the inferior aspect\nof the liver (2, 62) which could represent a peritoneal implant.  There are\nsmall retroperitoneal lymph nodes.  No adrenal masses are seen.",
            "output": "Multiple bilateral pulmonary metastasis ranging in size from 2-9 mm.\n\nHypodense lesion along the right lobe of liver could represent a peritoneal\nimplant.  Please refer to dedicated report on MR of the abdomen for further\ndetails"
        },
        {
            "input": "A 1.3 cm calcified nodule is identified in the left thyroid lobe.  A 1.0 cm\ncoarse calcification at the inferior margin of the right thyroid lobe may be a\ncalcified thyroid nodule or adjacent calcified lymph node.  Supraclavicular,\naxillary, and mediastinal lymph nodes are not enlarged.\nA left PICC terminates in right atrium.  Thoracic aorta and main pulmonary\nartery are normal size.  Small amount of pericardial fluid is physiologic. \nCoronary artery calcification is mild.\n\nTrace right and small left pleural effusions are identified.\nMotion artifact limits evaluation of airway and lung parenchyma details.  Left\nmain stem bronchus is occluded, likely with secretions.  Right airways appear\npatent.  There is complete consolidation of the left lung with air\nbronchograms noted.  Multiple small areas of geographic opacities are present\nthroughout the right lung.\n\nThe esophagus is diffusely dilated.\n\nLimited evaluation of upper abdomen is notable for a 1.0 cm coarse\ncalcification in the left kidney which is likely a nonobstructing stone.\n\nSevere thoracic spine scoliosis is noted.  No suspicious bone lesion is\nidentified.  Heterogeneous lucent changes of the bones is probably reflect\ndemineralization.",
            "output": "1. Left mainstem bronchus is occluded, probably with secretions.  Left lung is\ncompletely consolidated, possibly a combination of atelectasis and pneumonia\n(given the presence of consolidations in the right lung).\n2. Multiple opacities throughout the right lung are suspicious for pneumonia.\n3. Dilated esophagus.\n4. Severe thoracic spine scoliosis and demineralization.\n5. Nonobstucting left renal calculus.\n6. Calcified thyroid nodules as described above."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  A\nright-sided PICC line terminates within the proximal right atrium.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer.\n\nThere are discrete filling defects in several subsegmental right upper lobe\npulmonary arteries, consistent with emboli.  There is poor opacification of\ndistal subsegmental arteries in other lobes but there are no additional\ndefinitive emboli.  The main pulmonary artery measures 3.5 cm, raising the\npossibility of pulmonary hypertension.  There are no findings of acute right\nheart strain.\n\nThere are a few mildly prominent mediastinal lymph nodes, including an 8 mm\nright paratracheal node.  These are nonspecific but most likely reactive. \nThere are coarse calcifications in the right thyroid lobe, within an 8 mm\narea.  These are associated with a 6 mm hypodensity inferiorly the left\nthyroid lobe appears homogeneous allowing for streak artifact from contrast\nbolus.\n\nThere is no evidence of pericardial effusion.  There are tiny bilateral\npleural effusions.\n\nThere is patchy airspace consolidation in the right upper lobe, including a\nfew confluent areas of nodular dense consolidation posteriorly, and there is\nmilder patchy consolidation in the left upper lobe.  There is posterior\nsegmental/subsegmental atelectasis in both lower lobes associated with\nmultifocal bronchial plugging, which could be related to aspiration.\n\nOn limited images of the upper abdomen, the visualized liver is diffusely\nhypoattenuating, in keeping with steatosis.\n\nNo aggressive bone lesions.",
            "output": "1.  Subsegmental PE in the right upper lobe.\n\n2.  Multifocal airspace consolidation, mainly in the right upper lobe, is most\nconcerning for pneumonia.  Bibasal atelectasis with bronchial plugging may\nrepresent aspiration.\n\nRECOMMENDATION(S):  Radiographic follow-up to resolution of airspace\nopacities.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:20 am, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular or axillary lymphadenopathy.  Redemonstration of right\nmastectomy and right-sided subpectoral breast implant.\n\nUPPER ABDOMEN: Patient is status post bilateral adrenalectomy.  There is a\nsmall hiatal hernia.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  There is no mediastinal\nmass.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Since ___, there has been overall slight interval progression\nof pulmonary metastases.  For example, the dominant right middle lobe mass\nmeasures 3.5 x 2.6 cm (5:140), previously 2.6 x 1.9 cm.  The dominant left\nlingular mass measures 4.4 x 3.1 cm, previously 4.0 x 3.1 cm.  There has been\ninterval decrease in size and calcification a left lower lobe superior segment\nnodule, which now measures up to 1.6 cm in diameter, previously 2.4 cm. \nHowever, numerous additional pulmonary nodules scattered throughout the\nbilateral lungs are new or mildly enlarged since ___.\n2. AIRWAYS:  There is external compression a left upper lobe lingula inferior\nsegment bronchus, a right middle lobe lateral segment bronchus, and a right\nupper lobe anterior segment bronchus (5:132,141,155), in the areas of the\ndominant pulmonary nodules/masses.  There is associated subsegmental\natelectasis of the lung parenchyma peripheral to the narrowed bronchi.  The\nremaining airways are patent to the segmental level.\n3. VESSELS:  The thoracic aorta and pulmonary trunk are normal in caliber. \nMild atherosclerotic disease is noted involving the aortic arch and descending\nthoracic aorta.  There is minimal coronary artery and mitral annulus\ncalcification.\n\nCHEST CAGE: There is no suspicious sclerotic or lytic osseous lesion.  There\nis no acute fracture.",
            "output": "1. Since ___, there is been slow interval progression of numerous pulmonary\nnodules/masses, reportedly biopsy proven to represent breast cancer\nmetastasis.  This would be consistent with slow progression of metastatic\ndisease.\n2. There is external mass-effect on several subsegmental bronchi secondary to\nthe pulmonary nodules/masses, with subsegmental atelectasis of the more\nperipheral pulmonary parenchyma."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  A right breast\nimplant is noted.\n\nUPPER ABDOMEN: Limited view of the unenhanced upper abdomen is unremarkable. \nThere are no suspicious adrenal nodules.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mediastinal mass. \nThere is a small hiatal hernia.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  Focal hypodensity along the left\nventricular apex may reflect a small chronic infarct.  No pericardial\neffusion.  Coronary artery calcifications are mild.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Bilateral paramediastinal masses are again seen measuring 3.6\nx 2.6 cm in the right upper lobe and 4.2 x 3.2 cm in the left upper lobe\n(5:141, 144).  There are numerous stable pulmonary nodules, for example a 1.8\ncm left upper lobe nodule (5:90), a 1.1 cm right lower lobe nodule (5:98), a\n1.6 cm left lower lobe nodule with dystrophic calcification (5:127), and a 1.8\ncm right middle lobe nodule (5: 157).  There are no new pulmonary nodules.\n2. AIRWAYS:  Again noted is compression of several bronchi in the right middle\nlobe and lingula by the dominant pulmonary masses with associated atelectasis.\nElsewhere the airways are patent to the subsegmental level.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are of normal\ncaliber.  Mild atherosclerotic disease noted along the aortic arch and great\nvessels.\n\nCHEST CAGE: No acute fracture or aggressive osseous lesion.",
            "output": "1. Stable numerous bilateral pulmonary metastases.  No new pulmonary nodules."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: No hiatal hernia.  No adrenal lesions.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration. Left ventricular\nenlargement.  Severe calcification of the aortic valve. No significant\ncalcification of the ascending aorta.  Fusiform aneurysmal dilatation of the\nascending aorta measuring 50 x 47 mm in the axial plane with the descending\nthoracic aorta a comparative level measuring 33 x 32 mm.  The coronary\narteries arise from their respective coronary sinuses.  Moderate calcification\nof the left and right coronary arteries.  Moderate calcification of the aortic\narch.  Mild thickening of the anterior pericardium measuring 2 mm in diameter.\nNo pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild paraseptal emphysematous changes in the upper lobes.  Round\n13 x 10 mm pulmonary nodule in right lung base (5, 253).  Irregular spiculated\nnodule/scar in relation to the superior aspect of the right oblique fissure\n(5, 110) measuring 14 x 8 mm.  Millimetric nodules in the lung apices (5, 41).\nSub 4 mm solid pulmonary nodules in the left upper lobe (5, 136, 173) and left\nlower lobe (2 5, 229).  No diffuse lung disease.  No confluent airspace\nconsolidation.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Severe aortic valve calcification in keeping with aortic stenosis.  Fusiform\ndilatation of the ascending aorta measuring 50 x 47 mm in the axial plane.  No\nsignificant calcification of the ascending aorta.\n\nSuspicious round 13 x 10 mm pulmonary nodule in the right lung base.\nIrregular spiculated nodules/scarring motion to the superior aspect of the\nright oblique fissure.\n\nSub 4 mm pulmonary nodules could be reassessed at follow-up studies for the\nabove more concerning nodules.\n\nRECOMMENDATION(S):  PET-CT advised for the evaluation of the above described\nnodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 1.3 cm nodule in the left lobe of\nthe thyroid is of insufficient size to warrant further imaging.\nLeft supraclavicular 0.9 cm lymph node is not pathologically enlarged (5:6). \nRight axilla round enhancing lymph nodes measuring up to 1.1 cm (5:71, 80).\nAnterior presternal subcutaneous round hypodense lesion measuring 1.6 cm is\nlikely sebaceous cyst (5:82).\n\nCHEST CAGE: Moderate multilevel degenerative changes of thoracic vertebra.  At\nthe level of the lumbar spine severe degenerative and postsurgical changes\nincluding multilevel ankylosis.  No evidence of osteo destructive lesions at\nthe level of the ribs, vertebra or sternum.\n\nUPPER ABDOMEN: Multiple variable size of hypodensities in the liver are too\nsmall to be characterized.  Please see separately dictated CT of the abdomen\nand pelvis for complete description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal borderline lymph nodes measure 1.1 cm in the\nsubcarinal station, 0.8 cm in the right upper paratracheal station (5:70). \nSubcentimeter lymph nodes in the posterior mediastinum (5:204) and in the\nsupradiaphragmatic stations (5:233).\nLeft hilus 1.3 cm, 1.6 cm with 0.9 cm right hilus lymph nodes (5:149).\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  Severe calcifications of the LAD, minimal along the normal caliber\nthoracic aorta.  Main pulmonary artery is normal in diameter.\n\nPLEURA: Multiple calcified and noncalcified pleural plaques involve both\npleural spaces represent prior asbestos exposure (5: 218) For example).  Left\ntrace pleural effusion.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.\n0.3 cm nodule in the right lower and upper lobes (5:171, 131).",
            "output": "-Borderline mediastinal and hilar lymph nodes, mildly increased since ___, the differential diagnosis includes low grade lymphoma and/or reactive\nlymph nodes.\n-prior asbestos exposure."
        },
        {
            "input": "Stable right thyroid nodule.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  The size of the mediastinal lymph nodes is decreased.  For\nexample, a reference lesion in pretracheal location has decreased from 9-5 mm\nin diameter (2, 13.  There is no evidence of new or growing lymph nodes. \nStable normal appearance of the large mediastinal vessels.  No incidental\npulmonary embolism.  Moderate coronary calcifications, no pericardial\neffusion.  The posterior mediastinum is unremarkable.  Stable appearance of\nthe known calcified pleural plaques.  Stable cystic liver lesions and status\npost cholecystectomy.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.\nThe lung parenchyma shows stable normal architecture and attenuation.  No\nevidence of suspicious pulmonary nodules or masses.  No diffuse lung disease,\nnotably no evidence of pulmonary fibrosis.  Airways are patent.  Pleural\neffusions.",
            "output": "Decrease in size of the pre-existing mediastinal lymph nodes.  All mediastinal\nand hilar lymph nodes are normal in size.  No further workup is required. \nStable extensive bilateral pleural calcifications.  No suspicious lung nodules\nor masses."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Diffuse enlargement of the thyroid\nwith a nodular appearance as well as retrosternal extension most likely a\nmultinodular goiter.  No obvious infiltration of the surrounding structures.\nLeft pectoral dual lead pacemaker in situ with the lead tips seen in the right\natrium and right ventricle.  The pacemaker results in beam hardening artifact\nobscuring the left pectoral region.  There is mild attenuation of the trachea\nas passes through the goiter.\n\nUPPER ABDOMEN: This study was not designed to evaluate the subdiaphragmatic\norgans and taking that into account:  hypodense hepatic cysts appear similar\ncompared to previous ultrasound.  Previous cholecystectomy.  No adrenal\nlesions.  Small hiatal hernia\n\nMEDIASTINUM: There is rightward deviation of the trachea due to an elongated,\nunfolded aortic arch.  No tracheal attenuation\n\nHILA: No hilar adenopathy\n\nHEART and PERICARDIUM: Cardiomegaly.  Ectasia of the aortic root measuring 45\nmm in diameter.  Trace pericardial effusion is physiologic.  Moderate\ncalcification of the coronary arteries.  On this nongated study I get the\nimpression of an anomalous (malignant) origin of the right coronary artery. \nModerate calcification of the aortic arch and supra-aortic vessels.\nPLEURA: No significant pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Pulmonary nodule in the left upper lobe measuring 3 mm (4, 46). \nSpiculated pulmonary nodule in the left upper lobe (4, 65) measuring 7 mm in\ndiameter.  6 mm nodule in the lateral basal aspect of the left lower lobe (4,\n129).  3 mm nodule in the left lower lobe (4, 107).  Multiple smaller sub 4 mm\nnodule in the posterior basal aspect of the left lower lobe.  2 mm nodule in\nthe right lung apex.  6 mm nodule in the right upper lobe (4, 48).  Movement\nartifact degrades the diagnostic quality of the imaging through the lower lung\nlobes.  Bibasal atelectatic changes.  No confluent airspace consolidation\n-AIRWAYS:  The trachea and bronchi are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery measures within normal limits.  A single\nlocule of air seen in the pulmonary artery in keeping with air injection.\nCHEST CAGE: Marked spondylotic changes of the thoracic spine.  Spinal\nasymmetry.  No lytic/ destructive bony lesions.",
            "output": "Multinodular goiter with mild attenuation of the trachea.\n\nThe rightward displacement of the trachea at the level of the superior\nmediastinum is due to an elongated, unfolding aortic arch.  No significant\nattenuation of the trachea at this level.\nNo mediastinal masses.\n\nMultiple pulmonary nodules the largest in the left upper lobe measuring 7 mm\nand the right upper lobe measuring 6 mm.  Follow-up should be determined in\nthe clinical context of the patient."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is no pericardial effusion.  Aortic arch\ncalcifications are mild.\n\nAXILLA, HILA, AND MEDIASTINUM: There is mediastinal invasion from the left\nhilar and pulmonary parenchymal mass, which will be described below.  Left\npara-aortic heterogeneous lymph node conglomeration measures approximately 4.0\nx 1.3 cm (301:29). An upper right paratracheal lymph node measures 2.5 x 1.7\ncm (301:35) an enlarged subcarinal node measures 1.7 x 2.4 cm (301:49).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Opacification mass lesion along the left major fissure,\npredominantly involving the left hilus, is difficult to measure accurately,\nbut spans approximately 6.7 x 4.0 cm (AP by TRV) (301:46), with an associated\nnodular component in the apical left upper lobe (301:26), measuring 2.9 x 2.1\ncm.  There is associated left major fissural thickening and nodularity\n(602:57).  There is associated encasement of the left main pulmonary artery,\nas well as the left lingular, lower lobar, and upper lobar pulmonary arteries.\nThe mass extends into the left and superior aspect of the mediastinum. There\nis associated narrowing of the left upper lobe bronchus (301:46).\n\nBASE OF NECK: Subcentimeter left thyroid hypodensity is nonspecific, likely a\nsmall nodule, but does not meet size criteria for thyroid ultrasound.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating, suggesting hepatic\nsteatosis.  A subcentimeter hypodensity in segment VIII is incompletely\ncharacterized, but likely a biliary hamartoma or hepatic cyst.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 13.7 cm.\n\nADRENALS: The right adrenal gland is unremarkable.  The left adrenal gland is\nthickened, without definite nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 4.9 x 3.3 cm left lower renal cyst is partially exophytic.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is partial\ncecal thickening with a 3.5 x 3.2 cm hypodense mass involving the appendix\n(607:26, 304:59).  There is no adjacent fat stranding.  There appear to be 2\ntablets adjacent to the mass (304:53, 54).  No evidence of bowel obstruction. \nThere is no free peritoneal air or fluid.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Note is made of hyperdense mesh material along the anterior\nabdominal wall, likely due to prior hernia repair.",
            "output": "1.  Ill-defined left hilar mass with associated nodularity and opacification\nalong the left major fissure and extension into the superolateral left aspect\nof the mediastinum.  Mass encases the left main pulmonary artery, as well as\nthe left lingular, lower lobar, and upper lobar pulmonary arteries.\n\n2.  Notably, the mass also causes significant narrowing of the left upper\nlobar bronchus (see series 301, image 46).\n\n3.  Associated enlarged left para-aortic, right upper paratracheal, and\nsubcarinal mediastinal lymph nodes.\n\n4.  Incidentally noted 3.5 x 3.2 cm hypodense mass involving the appendix,\nwithout adjacent fat stranding (see series 304, image 59).  This is worrisome\nfor a separate neoplasm.  Less likely metastasis, but this possibility is not\nexcluded.\n\n5.  No evidence of pulmonary embolism.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 13:40 on ___, 5 minutes after discovery."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is normal in size.  Moderate coronary\ncalcifications.  Small pericardial effusion appears overall stable.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate left pleural effusion has grown from ___.\nLeft-sided soft tissue pleural based masses appear overall similar to prior\nPET-CT on ___.  No pneumothorax or right pleural effusion.\n\nLUNGS/AIRWAYS: Left hilar soft tissue has grown from PET-CT in ___\nnarrowing numerous bronchi. Left lung opacities may represent post obstructive\npneumonia or atelectasis.  Few nodular opacities in the right upper lung may\nreflect underlying infectious process.  Septal thickening in the apices may\nsuggest mild pulmonary edema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Left hilar soft tissue has grown from PET-CT in ___ narrowing numerous\nbronchi. Left lung opacities may represent post obstructive pneumonia or\natelectasis.  Scattered right lung opacities likely reflect ongoing\ninfectious/inflammatory process.\n3. Mild pulmonary edema in the lung apices.\n4. Moderate left pleural of effusion has grown from ___.\n5. Left-sided soft tissue pleural based masses appear overall similar to prior\nPET-CT on ___."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation.  20\nmm left supraclavicular lymph node, 5:16, was 20 mm in ___.  No right\nsupraclavicular or axillary lymph nodes.  Left pectoral infusion port in\nplace.  No evidence of complications.  Left mid and lower posterior rib\nmetastases have extended into the sub muscular left chest wall, 5:81-103.\n\n5 x 3.5 cm left adrenal mass, incompletely imaged, 5:142, was 3 x 4.5 cm in\n___.\n\n\nCARDIO-MEDIASTINUM: The eccentric lumen of the gastroesophageal junction raise\npossibility of mass in the lower esophagus and anterior wall of the junction,\n5:107-115.\n\nThere is no esophageal distension proximally however.\n\nAtherosclerotic calcification not apparent in head and neck vessels is\nconsiderable in coronary throughout the coronary arteries.  Aorta is normal\nsize.  Small pericardial effusion has increased since ___. \nEchocardiography is recommended for hemo dynamic assessment.\n\nPULMONARY ARTERIES:\n\nNormal caliber.\n\nNo pulmonary emboli.  Left pulmonary artery is moderately narrowed by left\nhilar mass, 5:54.\n\n\n\nTHORACIC LYMPH NODES: Large left hilar mass is inseparable from tumor\ninfiltrating the left upper and lower lobes.  No discrete lymph node\nenlargement in the mediastinum.  Borderline lymph node enlargement right hilum\nunchanged since ___.\n\nLUNGS, AIRWAYS, PLEURAE: Infiltrative left hilar mass, inseparable from mass\nin left upper and lower lobes has grown substantially since ___, now\noccluding both left upper and lower lobe bronchi and replacing large areas of\nprevious aeration in both lobes.  Moderate nonhemorrhagic left pleural\neffusion has changed in distribution but not in overall size probably\nloculated inferiorly.  Small dependent right pleural effusion is new.\n\n\nModerately severe pulmonary edema and multiple irregular metastatic lung\nmasses in the right lung are new.\n\n\nCHEST CAGE: Lytic lesions arising from posterior left ninth and tenth and\nribs, including at least two pathologic fractures have extended into both\npleura and sub muscular chest wall, 5:75-105. No compression fractures or\nlarge lytic lesions in the thoracic spine.",
            "output": "No pulmonary emboli.\n\nSubstantial progression of widespread malignancy in the chest since at least\n___: Greatly enlarged left hilar mass infiltrating left upper and\nlower lobes, obstructing left upper and lower lobe bronchi.  A enlarging lytic\nmetastases, at least 2 left ribs with soft tissue extending into both pleural\nspace and sub muscular chest wall.  Multiple metastases, right lung. \nIncreasing pericardial effusion, hemodynamics significance uncertain.\n\nModerate acute pulmonary edema.\n\n\n\nRECOMMENDATION(S):  Echocardiography for evaluation of pericardial effusion.\n\nNOTIFICATION:  The findings were discussed with ___ Hospital On\nPage by ___, M.D. on the telephone at 11 a.m. after pages placed\nimmediately following discovery of the findings."
        },
        {
            "input": "The thyroid gland is heterogeneous in attenuation and enlarged, previously\nfurther evaluated by thyroid ultrasound dated ___.\n\nThere is no axillary or supraclavicular adenopathy.  Central nodes are not\npathologically enlarged, a right lower paratracheal station node measures 7 mm\n(02:23), present previously marginally increased since ___.  There is no\nappreciable hilar adenopathy.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  There is no pericardial effusion.  Mild\natherosclerotic calcifications involving the coronary artery is diffusely are\nnew since ___.  There are no appreciable aortic valvular calcifications. \nHeart size is within normal limits.\n\nParaseptal apical emphysema is minimal.  Diffuse small airway thickening and\nnodularity is moderate to severe and suggestive of chronic inflammation. \nSecretions are noted within the airways supplying the lingula.  Lungs are\notherwise clear without a focal consolidation, mass, or worrisome nodule. \nThere is no pleural effusion or pleural abnormality.\n\nThere are no worrisome osseous lesions in the chest cage.  Vertebral body\nheights are preserved.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, images of the\nupper abdomen demonstrate bilateral adrenal gland thickening not appreciably\nchanged.",
            "output": "1. No evidence of intrathoracic malignancy or active infection.\n\n2. Minimal paraseptal apical emphysema.\n\n3. Chronic small airways inflammation is diffuse and moderate to severe,\nprobably contributes to patient symptomatology."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.  .\nThere is no pericardial effusion.  Small bilateral effusions are larger the\nright side.\nExtensive peribronchial diffuse consolidations with central dominant\ndistribution with sparing of the subpleural regions, have improved in the\nupper lungs.\nStranding of the subcutaneous fat and fat throughout the mediastinum suggests\nanasarca.\nThis examination is not tailored for subdiaphragmatic evaluation the upper\nabdomen is normal\nThere are no bone findings of malignancy",
            "output": "Minimally improved organizing pneumonia.\nStranding of the subcutaneous fat and fat in the mediastinum suggests\nanasarca.\nSmall right pleural effusion has decreased"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 1.1 cm hypodense nodule right lobe\nof the thyroid not warranting further imaging.  There is no supraclavicular\nand no axillary lymphadenopathy.\n\nCHEST CAGE: Mild multilevel degenerative change of the spine with increased\nkyphosis.  No evidence of osteo destructive lesions at the level of the ribs,\nvertebral or sternum.\n\nUPPER ABDOMEN: In the left partially imaged kidney there is impression of 3.3\nx 2.8 cm round lesion (02:54).\nA small hiatal hernia, esophagus is collapsed with NG tube extending into the\nstomach and out of view.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes are not pathologically\nenlarged, measuring up to 0.8 cm in the subcarinal station.\n\nHILA: No gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  There is no pericardial effusion. \nElectrodes terminating in the right atrium and ventricle.  Dense\ncalcifications of the coronaries as well as along the head and neck vessels\nand normal caliber thoracic aorta.\n\nPLEURA: Trace right layering pleural effusion.  No evidence of pneumothorax.\n\nLUNG: Endotracheal tube terminates in good position.  Extensive consolidation\ncontaining air bronchograms involve the right lung, predominantly the\ndependent portions of all 3 lobes.  In the right lower lobe 2.8 cm lucency\nwith air-fluid level is likely small focus of necrotizing pneumonia (302:136).\nMild dependent atelectasis in the left lower lobe.\nCentrilobular and paraseptal emphysema is mild-to-moderate and predominantly\nof the upper lobes.",
            "output": "-Extensive pneumonia, possibly due to aspiration involving the dependent\nportions of all 3 right lobes, with small focus of necrotizing pneumonia in\nthe right lower lobe.\n-In the left partially imaged kidney possible solid round lesion is partially\nimaged.\n\nRECOMMENDATION(S):  US of the kidneys"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:   A well-circumscribed\nhypodensities demonstrated at the right thyroid lobe measuring 1.6 x 1.1 cm,\n(series 3, image 4) most consistent with a thyroid nodule the rest of the\nthyroid is heterogenous with multiple subcentimeter well-circumscribed\nhypodensities which likely represent thyroid nodules.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  No calcified atherosclerosis\ninvolving the supraclavicular vasculature.  Breast tissue is best evaluated by\nmammography.\nUPPER ABDOMEN: Please refer to same-day CT abdomen and pelvis for detailed\nreport of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion. \nModerate calcification of the coronary arteries most pronounced at the LAD. \nMild calcification at the aortic annulus.  No calcification at the aortic\nvalves.  The vascular caliber of the ascending aorta, main pulmonary artery,\ndescending aorta are within normal limits.  No evidence of pulmonary embolism.\n\nPLEURA: Mild biapical pleuroparenchymal scarring.  No pleural effusion or\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:\nA 2 mm pulmonary nodule in the left upper lobe, (series 302, image 46).\nA 2 mm pulmonary nodule at the left upper lobe, (series 302, image ___) is left\n2 cm from the pleura and may represent a pulmonary lymph node.\nA 5 mm pulmonary nodule is demonstrated at the left lower lobe, (series 302,\nimage 129).\n\n2. AIRWAYS:  The airways are patent to the subsegmental levels without\nbronchial wall thickening, bronchiectasis or mucus plugging.\nCHEST CAGE: The visualized osseous structures are diffusely demineralized. \nThere is severe degenerative changes of the thoracic spine including\nintervertebral disc space narrowing and osteophytosis.  No acute fracture.  No\nsuspicious sclerotic or lytic osseous lesions to suggest malignancy or\ninfection.",
            "output": "1. Multiple pulmonary nodules measuring up to 5 mm, are indeterminate.\n2. No evidence of intrathoracic lymphadenopathy.\n3. Multinodular thyroid gland with the largest thyroid nodule measuring up to\n1.6 cm.\n\nRECOMMENDATION(S):  A follow-up chest CT in 3 months is recommended.\n\nThyroid nodule.  Follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:55 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "THORACIC INLET: There stable hypodense lesions within the right lobe of\nthyroid and multiple tiny hypodense lesions within the left lobe of the\nthyroid..  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  There is no pericardial effusion.  There is mild coronary artery\ncalcification.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The 5 mm left lower lobe pulmonary nodule is unchanged (302, 139) Could\nand could represent an intraparenchymal lymph node.  A 1 mm left upper lobe\npulmonary nodule is unchanged (302, 47).  Another 1 mm left upper lobe\npulmonary nodule is also unchanged (302, 46).  No new pulmonary nodules. \nMinimal bibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine..\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable tiny pulmonary nodules the largest measuring 5 mm in the left lower\nlobe.  No new pulmonary nodules.\n\nStable multinodular goiter.\n\nNo new sites of disease.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST PERIMETER: No findings in the lower part of the partially imaged thyroid\nneed any further imaging evaluation.  No pathologic enlargement of\nsupraclavicular or axillary lymph nodes.  No soft tissue abnormalities in the\nchest wall.  This study is not appropriate for subdiaphragmatic diagnosis, but\nshows no abnormality in the upper abdomen.\n\n\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification\nmild in head and neck vessels, is considerable in major coronary artery\nsegments.  Aorta is normal caliber.  Main pulmonary artery is moderately\nenlarged, 32-36 mm in diameter.  Right and left pulmonary arteries are\ntop-normal size.  Aortic valve is not calcified.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Measurable central lymph nodes are numerous and\ntop-normal size in lower paratracheal, prevascular, and subcarinal stations.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nLung abnormalities:\n\nHandful of punctate in the upper lungs, 302:27, 58, 22, 39 would not be\nvisible on conventional chest radiographs.\n\nPosterior projection of the right first costo sternal junction was\nmisinterpreted as a lung nodule on the preliminary report.\n\nTracheobronchial tree is normal to subsegmental levels.  Small nonhemorrhagic\npleural effusions layer posteriorly, and 0 responsible for mild to moderate\nbibasilar relaxation atelectasis.\n\nCHEST CAGE: 2 small dense well-circumscribed blastic nodules in first and\nfourth thoracic vertebrae have no aggressive features.  Chest cage otherwise\nunremarkable.",
            "output": "Small layering nonhemorrhagic pleural effusions.  No pleural mass.  No\nevidence of cardiac decompensation.\n\nExtensive coronary atherosclerotic calcification.  Mild pulmonary artery at\ndilatation.  No obvious explanation for pulmonary arterial hypertension.\n\nThe posterior projection of the right costosternal junction was this\ninterpreted as a lung nodule on the pulmonary report and there is no finding\ncorresponding to the lung nodule questioned on the lateral conventional chest\nradiograph performed ___..\n\nHandful of tiny upper lung nodules and top-normal lymph node size are of\nuncertain significance.  Although malignancy is unlikely, I would recommend\nfollow-up protocol for incidental pulmonary nodules.\n\nSmall sclerotic lesions in the thoracic spine have no aggressive features. \nConceivably metastatic prostate carcinoma could present in this fashion and it\nwould be reasonable to make a clinical assessment concerning that diagnosis.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___.\n\nSee IMPRESSION for other recommendations."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.   The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There are\nno findings of diffuse lung disease. There is a punctate calcified granuloma\nin the right lower lobe. The 2 mm nodule is seen in the left lower lobe\n(5:191).  Additionally, there are two 2mm pleural based nodules in the left\nlower lobe (5:119, 133).\n\nBONES AND SOFT TISSUES: There are no destructive focal osseous lesions\nconcerning for malignancy within the imaged thoracic skeleton.  No soft tissue\nabnormality is detected.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. There is a 2 mm nodule in the left lower lobe, which is of indeterminate\nsignificance. If discovered incidentally, in and of itself this finding would\nnot merit additional followup.\n2. Please note that findings in the abdomen and pelvis will be reported\nseparately."
        },
        {
            "input": "Neck and cardiomediastinum: The thyroid is normal.  There is no\nsupraclavicular, axillary, prevascular, paratracheal, hilar, retrocrural, or\ndiaphragmatic lymphadenopathy.  The heart is normal in size.  The aorta is\nnormal in caliber with normal 3 vessel arch.  The pulmonary arteries normal in\ncaliber.  The central pulmonary arteries are normal in caliber and subject to\nthe limitation of this study, free of intraluminal defects. A left subclavian\ncentral line ends in the lower svc. There is no pericardial effusion.\n\nLungs/airways:  The tracheobronchial tree is normal to subsegmental levels. \nAside from a 2 mm calcified granuloma in the right lower lobe (4:173), the\nlungs are clear.  Focal pleural thickening the left major fissure is\nunchanged, and should not be mistaken for lung nodules. (series 4:105, 118).\n\nAbdomen:  Findings below the diaphragm will be reported separately.\n\nChest wall/cage: There are no lesions in the soft tissues or chest cage\nsuspicious for malignancy or infection.",
            "output": "No evidence of intrathoracic malignancy.  For details regarding the abdomen\npelvis please see the same-day abdomen/pelvis report."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nBilateral perifissural nodules are stable measure less than 4 mm and likely\nrepresent intrapulmonary lymph nodes.  2 mm subpleural nodule in the right\nupper lobe is new (4:80).  Calcified nodule in the right lower lobe (4:174) is\nunchanged.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy\nPort a cath tip is in the lower SVC",
            "output": "New subpleural lung nodule in the right upper lobe, followup CT  in 3 months\nis recommended.\n\nRECOMMENDATION(S):  Followup CT in 3 months\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Gynecomastia is\nmild and symmetric.  There are no soft tissue abnormalities in the imaged\nchest wall suspicious for malignancy.  This study is not appropriate for\nsubdiaphragmatic diagnosis.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head and neck vessels or in\nthe coronary arteries.  Aorta and pulmonary arteries are normal size. \nPericardium is physiologic.  There is no pleural abnormality.  Left central\nvenous infusion port catheter ends in the low SVC, with no associated\nthrombus.\n\nMediastinal and hilar and other thoracic lymph nodes are not pathologically\nenlarged.\n\nLungs:\n\n 2 mm right subpleural nodule previously reported as new is still present,\n5:114.  Shape has changed slightly.  Follow-up advised, in another 6 months.\n\nPunctate Left fissural nodule, 05:12 53, is slightly larger today.  Second\npunctate left fissural nodule, 5:168 is stable.\n\n2 mm right middle lobe nodule, 5:189 is stable since at least ___.\n\nThere are no new lung nodules.  Tracheobronchial tree is normal to\nsubsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Two 2 mm and smaller lung nodules are minimally larger today than in ___,\nand there are no new lung nodules.  This is unlikely to be due to active\nmetastasis.  6 month follow-up would be sufficient.\n\nRECOMMENDATION(S):  Chest CT in 6 months."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are normal in\ndiameter.  Heart size is normal.  There is no mediastinal, hilar or axillary\nlymphadenopathy.  There is no pericardial or pleural effusion.\n\nPre-existing pulmonary nodules are all stable, series 4, image 111, 186, 197,\n233 with no new nodules masses or consolidations demonstrated.\n\nImage portion of the upper abdomen reveals no appreciable abnormality within\nthe limitations of the study technique that was not designed for assessment of\nintra-abdominal pathology.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm",
            "output": "Unchanged appearance of the chest with similar pulmonary nodules and no new\nnodules demonstrated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable.\n\nUPPER ABDOMEN: Please refer to separate report for same day CT abdomen pelvis\nstudy for discussion of findings below the diaphragm.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.\n\nHILA: A borderline right infrahilar node measures up to 0.9 cm, unchanged. \nThere are no enlarged left hilar nodes.  No hilar masses seen.\n\nHEART and PERICARDIUM: Heart size is normal.  There are no significant\ncoronary artery or valvular calcifications.  The caliber of the thoracic aorta\nis within normal limits.  Small pericardial fluid is likely physiologic.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Posterior bilateral subpleural nodularity new (5: 141, 153,\n177, 184, 191, 192, 195, 208).  A 2 mm left lower lobe solid nodule is new\n(5:233).  A 5 mm anterior right upper lobe subpleural nodule is unchanged\n(5:96).  2 mm left fissural nodes are unchanged (5:141, 155).  A 2 mm left\nlingula nodule is unchanged (5:229).  A 2 mm left lower lobe nodule is\nunchanged (5:196).  A 2 mm right middle lobe nodule is unchanged (5:171).  No\ndiffuse lung disease.\n2. AIRWAYS:  The airways are patent to the level subsegmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is normal.  Suboptimal evaluation\nof the pulmonary vasculature demonstrates no evidence for central pulmonary\nembolism.\nCHEST CAGE: No acute fracture.  No worrisome osseous lesions are identified.",
            "output": "1. New nodularity of the posterior pleura bilaterally compared to ___\nis likely secondary to respiratory variation.  However, attention on follow-up\nimaging recommended.\n2. New 2 mm left lower lobe solid nodule, with additional bilateral pulmonary\nnodules that are unchanged, as detailed above.\n3. Please refer to separate report for same day CT abdomen pelvis study for\ndiscussion of findings below the diaphragm."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Normal\nappearance of the large mediastinal vessels.  No incidental pulmonary\nembolism.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  Stable appearance of the upper abdomen.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  No osteolytic lesions\nat the level of the ribs, the sternum, or the vertebral bodies.  Minimal\nbilateral apical scarring.\nStable 5 mm nodule in the right upper lobe (4, 83).\nStable 3 mm right lower lobe pulmonary nodule (4, 152).\nSeveral millimetric micronodules, for example in the middle lobe (4, 144) are\nalso stable.\nNo pleural thickening, no pleural effusions.  The airways are patent.  No\ndiffuse lung disease.",
            "output": "All pre-existing pulmonary nodules are stable.  No new or growing nodules.  No\npleural abnormalities.  No adenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.  Mild bilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Subpleural nodule right upper lobe (6:103) is larger than the\nprior study, now measuring 8 mm (previously 5 mm).  3 mm nodule also in the\nright upper lobe (6:133) is stable.\n2. AIRWAYS:  Airways are patent to subsegmental levels.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions.",
            "output": "There has been interval enlargement of right upper lobe solid nodule since\n___ lesions suspicious for metastatic disease.  Differential\ndiagnosis includes primary lung cancer..\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 17:16 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Unremarkable.\n\nMEDIASTINUM: No abnormal mediastinal masses or mediastinal adenopathy.\n\nHILA: No abnormal hilar masses or hilar adenopathy within the limitations of\nthis noncontrast enhanced scan.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Re-demonstrated in the subpleural anterior segment of the\nright upper lobe is the previously described 8 mm nodule (5:105, 7:104) which,\nalthough unchanged in size from ___, has grown when compared to\n___ chest CT when it measured 6 mm.  Additionally, just inferior to\nthe dominant nodule in the anterior segment of the right upper lobe is a\nslowly growing 5 mm nodule which measured 4 mm (5:138, 7:111) in ___.  A 3 mm left lower lobe fissural nodule is stable.  No other nodules\nidentified.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  Unremarkable\nCHEST CAGE: No aggressive osseous lesions or acute fracture.  Mild bilateral\ngynecomastia is incidentally noted.",
            "output": "1. Very slow growth of two subcentimeter right upper lobe pulmonary nodules\nover more than a year is more characteristic of indolent lung malignancy or\ninfection than metastasis.  Histologic diagnosis is recommended.\n2. No lymphadenopathy within the imaged thorax.\n3. Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.\n\nRECOMMENDATION(S):  Image guided biopsy or resection of right upper lobe lung\nnodules.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:33 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusions.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Baseline of s/p wedge resection\nto the right upper lobe with soft tissue thickening surrounding the suture\nlines.  Small scattered calcified granulomas, for example in the right lower\nlobe (4:142).  No new nodules.  The previously mentioned 5 mm nodule also in\nthe right upper lobe is not well characterized on the current study.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Baseline study post wedge resection to the right upper lobe of a known\nmetastatic nodule.  No new nodules are identified in the current study.\nThe previously mentioned 5 mm nodule also in the right upper lobe is not\ncurrently identified and could have been either resected along with the wedge\nor displaced cranially and obscured by the current scarring surrounding the\nsuture lines.  Attention on follow-up studies."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Normal appearance of the large mediastinal\nvessels.  No substantial coronary calcifications, no valvular calcifications,\nno pericardial effusions.  The posterior mediastinum is unremarkable.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  The soft tissue structures surrounding the right upper lobe wedge\nresection suture has decreased as compared to the previous examination.  The\nlocal parenchymal distortion (302, 75) is overall stable.  The lung parenchyma\nshows no evidence of new pulmonary nodules or masses.  The airways are patent.\nNo evidence of focal or diffuse lung disease.",
            "output": "Decrease in extent of the soft tissues surrounding the suture line after right\nupper lobe wedge resection.  No evidence of recurrence.  No new or growing\npulmonary nodules.  No pleural abnormalities.  No lymphadenopathy."
        },
        {
            "input": "CHEST PERIMETER: No thyroid abnormalities need any further imaging evaluation.\nNo supraclavicular or axillary adenopathy.  No soft tissue abnormalities in\nthe chest wall.  This study is not appropriate for subdiaphragmatic diagnosis\nlast evaluated by an abdomen CT on ___.  There is no adrenal mass or\nsubphrenic collection today.\n\nCARDIO-MEDIASTINUM: Esophagus is mildly patulous but there is no retention of\nfluid or other findings to suggest obstruction or associated mass. \nAtherosclerotic calcification is not apparent in head neck vessels or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size,\naortic valve is not calcified, and pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Wedge resection site, right upper lobe, has a normal\npostoperative appearance.  No increasing soft tissue.\n\nHandful of tiny lung nodules are stable, 5: 205, 218, 88, 164, 162, as is a\nsmall number of calcified granulomata, as expected.  No new or growing lung\nnodules.  No evidence of granulomatous infection.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No evidence of intrathoracic malignancy, including site of prior right upper\nlobe wedge resection.\n\nCalcified pulmonary granulomata and sub 3 mm lung nodules are stable.  No\nevidence of active infection."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  No coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  No abnormalities in the chest wall.  Upper abdominal findings\nare described in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  The\npatient has undergone right upper lobe wedge resection.  The staples along the\nresection line (302, 57) are stable.  No change in appearance of the\npostoperative right upper lobe scarring.  No suspicious pulmonary nodules or\nmasses.  Stable several subpleural micro nodules.  No new or growing nodules. \nThe airways are patent.  No evidence of pleural abnormalities.  No diffuse\nlung disease.",
            "output": "Stable examination of the thorax.  Status post right upper lobe wedge\nresection.  Several micro nodules but no new or growing nodules.  No pleural\nabnormalities.  No adenopathy."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymphadenopathy is present.\n\nAirways are patent to a the subsegmental level bilaterally.  Postsurgical\nchanges in right upper lobe are stable.  No new pulmonary nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.",
            "output": "No evidence of new pulmonary nodules masses or consolidations.\n\nStable appearance of the postsurgical changes in the right upper lobe which\nresection."
        },
        {
            "input": "Assessment of the lungs is remarkable for faint centrilobular upper lobe\npredominant opacities and diffuse bronchial wall thickening, which may\nrepresent respiratory bronchiolitis if the patient is a cigarette smoker.\n\nAdditionally, two solid right middle lobe nodules are identified, 1 measuring\n2 mm (126) and the second measuring 3 mm (137), both on series 5.\n\nA well-defined 1 cm low-density lesion in left lobe of thyroid gland is not\nfully characterized by CT, as well as multiple subcentimeter hypodensities in\nboth lobes.\n\nThere are no enlarged mediastinal or hilar lymph nodes.  Heart size is normal,\nand there is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nin the spine.",
            "output": "1.  2 mm and 3 mm right middle lobe lung nodules are nonspecific findings. \nSurveillance CT in 3 months may be helpful to exclude the possibility of small\nmetastases.\n\n2.  Upper lobe predominant centrilobular ground-glass opacities and diffuse\nbronchial wall thickening are suggestive of respiratory bronchiolitis if the\npatient is a cigarette smoker.  These findings may also be reassessed at the\ntime of future surveillance CT.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months to reassess small pulmonary\nnodules."
        },
        {
            "input": "Left thyroid nodule is unchanged.  Overall thyroid continues to be\nheterogeneous.  Aorta and pulmonary arteries are unremarkable.  Heart size is\nnormal.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Previously seen sub\n3 mm pulmonary nodules in the right lung are stable.  No increase in\nmediastinal, hilar or axillary lymphadenopathy is demonstrated.  Calcified\nmediastinal and hilar lymph nodes are consistent with previous granulomatous\nexposure.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No intrathoracic evidence of metastatic disease.\n\nFor pre size assessment of the upper abdominal findings please review CT\nabdomen and pelvis and the corresponding report."
        },
        {
            "input": "CT CHEST:  ET tube terminates approximately 2.5 cm from the carina. Right\ninternal jugular central venous catheter terminates in mid SVC.  Enteric tube\ncourses through the esophagus and into the stomach.\n\nThe thyroid is grossly normal.  There is no supraclavicular, axillary,\nmediastinal or hilar lymphadenopathy within the limitations of a noncontrast\nenhanced study.\n\nThere is mild cardiomegaly without pericardial effusion.  Hyperattenuation of\ncardiac myocardium relative to blood pool may be seen in the setting of\nanemia.  The thoracic aorta and proximal great vessels are normal in caliber. \nThe main pulmonary artery is mildly dilated measuring 3.1 cm.\n\nThe central airways are patent.  Upper lobe bronchi are normal in caliber\nwithout wall thickening.  There is mild mucous plugging at the lung bases\n(4:157).  There is no pneumothorax.  There is moderate bibasilar atelectasis,\nright greater than left.  There is an irregularly shaped subpleural posterior\nconsolidation in the left upper lobe measures 3 x 1.4 cm (04:47).  There is\nminimal, nonspecific, pleural thickening or scarring at the right apex\n(___).  There are small pleural effusions.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver is suboptimally evaluated on this noncontrast\nenhanced study.  Within these limitations there is no evidence of intrahepatic\nbiliary duct dilation.  The liver contour is smooth.  No large hepatic mass is\ndetected.  The portal vein cannot be evaluated.\n\nGALLBLADDER:  There is gallbladder wall edema in a nondistended gallbladder\nwhich can be seen with systemic causes, chronic liver disease, chronic or\nacute cholecystitis are less likely.\n\nSPLEEN:  Normal in size and attenuation\n\nADRENAL GLANDS:  Normal\n\nPANCREAS:  Normal in size and attenuation without peripancreatic stranding.\n\nKIDNEYS:  Kidneys are normal in size without hydronephrosis.  The proximal\nureters are normal in caliber.\n\nSTOMACH AND BOWEL:  The stomach is normal in caliber containing enteric\ncontrast.  Enteric tube terminates in the gastric antrum.  Included loops of\nsmall and large bowel are normal in caliber without evidence obstructs of\nobstruction.  Enteric contrast is seen to the level of the mid small bowel. \nFatty infiltration in the wall of the descending colon may reflect sequela of\nprevious inflammation, no definite evidence of acute process.  Normal\nappendix.\n\nLYMPH NODES:  There is no mesenteric or retroperitoneal lymphadenopathy. \nSmall porta hepatic lymph nodes are not pathologically enlarged by CT size\ncriteria measuring up to 9 mm (02:54).\n\nVASCULAR:  The abdominal aorta is normal in caliber but cannot be further\nevaluated.  The hepatic vasculature cannot be evaluated.\n\nOSSEOUS STRUCTURES:  There is no worrisome sclerotic or lytic lesion.  There\nis no significant degenerative change in the thoracic or lumbar spine.  There\nis diffuse subcutaneous edema.",
            "output": "1. Mild cardiomegaly without pericardial effusion.  Suggestion of anemia.\n2. Suggestion of pulmonary hypertension.\n3. Moderate bibasilar atelectasis and mild mucous plugging, right greater than\nleft.  An underlying infection or aspiration cannot be excluded in the proper\nclinical setting.\n4. Subpleural posterior consolidation in the left upper lobe could reflect\natelectasis but warrants follow-up in 3 months to exclude an underlying\nmalignancy.\n5. No acute abnormality in the abdomen.  Nondistended gallbladder with\ngallbladder wall thickening likely related to to clinical history of liver\ndisease, or systemic causes ; cholecystitis is unlikely.  .\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months after resolution of acute\nillness."
        },
        {
            "input": "CT CHEST:  ET tube terminates approximately 2.5 cm from the carina. Right\ninternal jugular central venous catheter terminates in mid SVC.  Enteric tube\ncourses through the esophagus and into the stomach.\n\nThe thyroid is grossly normal.  There is no supraclavicular, axillary,\nmediastinal or hilar lymphadenopathy within the limitations of a noncontrast\nenhanced study.\n\nThere is mild cardiomegaly without pericardial effusion.  Hyperattenuation of\ncardiac myocardium relative to blood pool may be seen in the setting of\nanemia.  The thoracic aorta and proximal great vessels are normal in caliber. \nThe main pulmonary artery is mildly dilated measuring 3.1 cm.\n\nThe central airways are patent.  Upper lobe bronchi are normal in caliber\nwithout wall thickening.  There is mild mucous plugging at the lung bases\n(4:157).  There is no pneumothorax.  There is moderate bibasilar atelectasis,\nright greater than left.  There is an irregularly shaped subpleural posterior\nconsolidation in the left upper lobe measures 3 x 1.4 cm (04:47).  There is\nminimal, nonspecific, pleural thickening or scarring at the right apex\n(___).  There are small pleural effusions.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver is suboptimally evaluated on this noncontrast\nenhanced study.  Within these limitations there is no evidence of intrahepatic\nbiliary duct dilation.  The liver contour is smooth.  No large hepatic mass is\ndetected.  The portal vein cannot be evaluated.\n\nGALLBLADDER:  There is gallbladder wall edema in a nondistended gallbladder\nwhich can be seen with systemic causes, chronic liver disease, chronic or\nacute cholecystitis are less likely.\n\nSPLEEN:  Normal in size and attenuation\n\nADRENAL GLANDS:  Normal\n\nPANCREAS:  Normal in size and attenuation without peripancreatic stranding.\n\nKIDNEYS:  Kidneys are normal in size without hydronephrosis.  The proximal\nureters are normal in caliber.\n\nSTOMACH AND BOWEL:  The stomach is normal in caliber containing enteric\ncontrast.  Enteric tube terminates in the gastric antrum.  Included loops of\nsmall and large bowel are normal in caliber without evidence obstructs of\nobstruction.  Enteric contrast is seen to the level of the mid small bowel. \nFatty infiltration in the wall of the descending colon may reflect sequela of\nprevious inflammation, no definite evidence of acute process.  Normal\nappendix.\n\nLYMPH NODES:  There is no mesenteric or retroperitoneal lymphadenopathy. \nSmall porta hepatic lymph nodes are not pathologically enlarged by CT size\ncriteria measuring up to 9 mm (02:54).\n\nVASCULAR:  The abdominal aorta is normal in caliber but cannot be further\nevaluated.  The hepatic vasculature cannot be evaluated.\n\nOSSEOUS STRUCTURES:  There is no worrisome sclerotic or lytic lesion.  There\nis no significant degenerative change in the thoracic or lumbar spine.  There\nis diffuse subcutaneous edema.",
            "output": "1. Mild cardiomegaly without pericardial effusion.  Suggestion of anemia.\n2. Suggestion of pulmonary hypertension.\n3. Moderate bibasilar atelectasis and mild mucous plugging, right greater than\nleft.  An underlying infection or aspiration cannot be excluded in the proper\nclinical setting.\n4. Subpleural posterior consolidation in the left upper lobe could reflect\natelectasis but warrants follow-up in 3 months to exclude an underlying\nmalignancy.\n5. No acute abnormality in the abdomen.  Nondistended gallbladder with\ngallbladder wall thickening likely related to to clinical history of liver\ndisease, or systemic causes ; cholecystitis is unlikely.  .\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months after resolution of acute\nillness."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Endotracheal tube tip is in the\nproximal right mainstem bronchus.  NG tube is noted with tip in the stomach. \nA right internal jugular central venous line is noted with tip in the upper\nsuperior vena cava.  Thyroid is unremarkable.  No supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen and pelvis\nperformed the same day for description of the findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiomegaly is again noted.  Suggestion of anemia.  No\npericardial effusion.  The visualized thoracic aorta and great vessels are\nunremarkable.  The main pulmonary artery is dilated measuring 3.5 cm,\npreviously measuring 3.1 cm.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Focal consolidation and adjacent nodularity in the posterior\naspect of the left upper lobe is not significantly changed compared to the\nprior exam.  Linear and ground-glass opacities noted in both lung bases have\nimproved, consistent with atelectasis ; infection, should be considered. \nPattern not typical of pulmonary hemorrhage.  .\n-AIRWAYS:  Motion artifact in the lung bases is demonstrated but there appears\nto be improvement in mucus plugging compared to the prior.\n-\nCHEST CAGE: No acute osseous or abnormality.",
            "output": "1. Proximal right mainstem bronchus intubation, endotracheal tube should be\npulled back.\n2. Consolidation, adjacent nodularity in the posterior left upper lobe is\nunchanged, is indeterminate, follow-up exam is recommended.\n3. Improvement in bibasilar atelectasis ; residual ground-glass opacities may\nbe sequela of re-expansion; infection is less likely.  .\n4. No new acute abnormality in the chest.\n\nRECOMMENDATION(S):  Follow-up of left upper lobe consolidation with CT in 3\nmonths time.\n\nNOTIFICATION:   The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 6:37 ___, 10 minutes after discovery\nof the findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  There is\nmild coronary artery calcification the aorta and pulmonary arteries are normal\nin caliber.  There is no pericardial effusion.  The airways are patent up to\nthe subsegmental level..\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is minimal biapical pleuroparenchymal scarring.  Mild upper lobe\npredominant paraseptal emphysema is seen.  There is a 2 mm nodule in the left\nlower lobe (4, 150).\n\nBONES AND CHEST WALL : Review of bones shows mild degenerative changes\ninvolving the thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a large cyst\ninvolving the right lobe of liver.  No adrenal masses are seen.  Additional\nsmaller hypodense lesions are seen within the liver which could also represent\ncysts.",
            "output": "Mild upper lobe predominant emphysema.\n\nIndeterminate 2 mm left lower lobe pulmonary nodule.\n\nLargest cyst within the liver.\n\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  There is no\npericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Left basal\ncylindrical bronchiectasis and atelectasis are noted lungs are clear.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately"
        },
        {
            "input": "Aorta and pulmonary arteries are not enhanced but within those limitations\nthere is evidence of top-normal ascending aorta, up to 4 cm in diameter. There\nis also extensive tortuosity of the descending aorta up that at certain\nportion of its course crosses the spine toward the might and constitutes with\nthe abnormality demonstrated on the chest radiograph. Small hiatal hernia is\nnoted.  The combination of the hiatal hernia and the aorta is responsible for\nthe chest radiograph findings. Heart size is normal. There is no pericardial\npleural effusion. No mediastinal or hilar lymphadenopathy demonstrated with\nseveral lymph nodes being sub cm in diameter.  Image portion of the upper\nabdomen demonstrate right kidney hypodense lesion, most likely consistent with\ncysts, partially imaged, approaching at least 6 cm in diameter.  No other\nappreciable abnormalities demonstrated except for diverticulosis of the\nsplenic flexure, partially imaged\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are\nessentially clear except for calcified pulmonary nodules, most likely\nconsistent with prior granulomatous exposure.\n.\nThere are no lytic or sclerotic lesion worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Very tortuous aorta with mild dilatation of the ascending aorta, findings in\nconjunction with hiatal hernia contributing to abnormal mediastinal contour.\nNo masses or lymphadenopathy demonstrated.\n\nPartially imaged right kidney cyst.\n\nDiverticulosis with no evidence of diverticulitis\n\nSeveral calcified pulmonary nodules, most likely consistent with prior\ngranulomatous exposure."
        },
        {
            "input": "Left axillary lymph nodes range in diameter up to 11 mm.  Right axillary and\nsupraclavicular lymph nodes are not enlarged.  There are no other soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Intramuscular\nbleeding and a very small amount of extra pleural bleeding lie alongside an\noblique fracture through the lateral aspect of left seventh rib, 02:42.\n\nChest cage is otherwise intact, including the thoracic spine.\n\nSmall posteriorly layering left pleural effusion is relatively homogeneous in\nattenuation, ___ ___, which is below the level level seen with frank\nhemorrhage, unless the patient is profoundly anemic.  It could be a pleural\neffusion mixed with a small amount of blood.  There is no pericardial or right\npleural effusion and no evidence of bleeding in the left upper abdominal\nquadrant, although this study is not designed for subdiaphragmatic diagnosis.\n\nThere is no evidence of mediastinal bleeding.  Subcentimeter mediastinal lymph\nnodes are numerous and subcarinal nodes may be as large as 16 mm in diameter. \nIf there is hilar lymph node enlargement, difficult to exclude on a\nnoncontrast study, it is of the same order of size.  No vital structures are\ncompromised.\n\nPatient did not cooperate with instructions to suspend respiration, and\ntherefore tiny lung lesions might be missed, but atelectasis is limited to the\nposterior basal segment of the left lower lobe, and there is no pulmonary\ncontusion, edema or evidence of aspiration.",
            "output": "Small posteriorly layering left pleural effusion is not frank hemothorax. \nSmall amount of intramuscular hematoma and minimal extrapleural bleeding are\ndue to the mildly displaced fracture through the lateral aspect of the left\nseventh rib.\n\nMild central lymph node enlargement usually does not warrant further imaging\nin the absence of associated radiologic or clinical findings.\n\nRECOMMENDATION(S):   The findings were discussed with ___ CARE NP by\n___, M.D. on the telephone on ___ at 5:13 ___, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Diffuse mediastinal and bilateral hilar lymphadenopathy are\npresent. Mediastinal nodes measure up to 1.7 cm in the subcarinal region and\n1.8 cm in the right paratracheal region. Multiple additional mediastinal\nnodes are present at other stations. Bilateral hilar lymphadenopathy is more\nprominent on the left than the right, with left hilar nodes measuring up to 13\nmm in short axis. Clustered calcification right paratracheal nodes suggest\nprevious granulomatous exposure. Heart size is normal, and there is no\npericardial or substantial pleural effusion.  Main pulmonary artery is\nenlarged measuring 3.3 cm.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no\nconcerning abnormalities are identified in this region on this very limited\nassessment.\n\nAssessment of the lungs demonstrates diffuse bilateral lung abnormalities,\nincluding upper lobe predominant centrilobular and paraseptal emphysema which\nhas slightly progressed. Additionally, widespread ground-glass\nopacities are present with mid and lower lung predominance combined with\ndiffuse reticular opacities may reflect DIP.  Previously described\nconsolidation in the right upper lobe has changed in morphology with slight\nincrease in subpleural opacity superiorly series 4, image 67 and substantial\ndecrease in the irregular consolidation in the posterior segment of the right\nupper lobe.\nAirways are remarkable for diffuse bronchial wall thickening. No obstructing\nendobronchial abnormalities are detected.\nRetained secretions are present within the trachea.\n\nSkeletal structures demonstrate no suspicious focal lytic or blastic lesions.\n\nPrior abdominal CT from ___ has become available for comparison.\nBilateral lower lung predominant ground-glass opacification and reticulation\nwere present on the prior study but have progressed since that time.",
            "output": "1. Interval improvement of right upper lobe pneumonia.\n\n2.  Moderate to severe centrilobular and paraseptal emphysema.\n\n3.  Widespread ground-glass opacities have not substantially changed, may\nreflect smoking related interstitial lung disease including DIP.  No\nhoneycombing or bronchiectasis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nMinimal atherosclerotic disease is noted.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar, or segmental\npulmonary arteries.  Apparent filling defect within the right lower lobe\nsubsegmental pulmonary artery (2:  85) is due to respiratory motion.  The main\npulmonary artery is dilated measuring 3.3 cm suggestive of pulmonary artery\nhypertension, unchanged since prior examination.\n\nNo supraclavicular or axillary lymphadenopathy.  Again seen are multiple\nenlarged mediastinal and bilateral hilar lymph nodes.  Representative right\npretracheal lymph node measures 2 cm (02:36) (previously 2 cm),\naorticopulmonary node measures 1.3 cm (02:35) (previously 1 cm), subcarinal\nnode measures 2.1 cm (previously 1.9 cm) (2:61), right hilar node 1.3 cm,\npreviously 1.3 cm) (02:47) and left hilar node measuring 1 cm (02:58)\n(previously 1 cm).  The thyroid appears unremarkable.\n\nThere is no evidence of pericardial effusion.  The heart is normal in size. \nMinimal coronary artery calcifications are noted.  There is no pleural\neffusion.\n\nNew subtle left upper lobe ground-glass opacity is noted.  Again seen are\ndiffuse bilateral lung abnormalities with bilateral upper lobes with\nparaseptal and centrilobular emphysema as well as diffuse bilateral reticular\nopacities predominantly involving the superior segments of the lower lobes. \nNo honeycombing.  Again seen is a confluent right upper peripherally located\nopacity with extension to the pleural surface (02:45) measuring 6 x 1.7 x 3.2\ncm (previously 6 x 1.7 x 3.2 cm). The airways are patent to the subsegmental\nlevel.  No pleural effusion.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2.  New subtle left upper lobe ground-glass opacity could be in part due to a\natelectasis although developing infection is possible.\n3. No interval change in peripheral right upper lobe opacity which may\nrepresent pneumonia in the appropriate clinical setting.  Given persistence\nsince ___ differential includes obstructive pneumonia from an\nendobronchial lesion and adenocarcinoma.\n4. Paraseptal and centrilobular emphysema with an apical predominance.\n5.  Extensive reticulation is consistent with interstitial lung disease,\nunchanged since prior examination\n6. Bulky mediastinal and hilar lymphadenopathy may be reactive given\nunderlying interstitial lung disease and possible infection.\n7.  Findings suggestive of pulmonary artery hypertension.\n\nRECOMMENDATION(S):  Recommend follow-up chest radiograph 6 weeks after\nresolution of symptoms to assess for interval change."
        },
        {
            "input": "There is moderate centrilobular emphysema.  Paraseptal emphysema is also seen\nboth upper lobes medially left greater than right.  The subpleural parenchymal\nopacity in the right upper lobe measuring 4.2 x 1.4 cm is slightly decreased\nin size since the prior study.  Patient is status post right-sided\npleurodesis.  No pneumothorax is seen.\n\nThere are no enlarged supraclavicular, lymph nodes.  The thyroid is\nunremarkable.  Multiple small mediastinal lymph nodes not enlarged by size\ncriteria are unchanged in size and could be reactive.  There is coronary\nartery calcification.  Unenhanced vascular structures are unremarkable. The\nmain pulmonary artery measures 3 cm\n\nReview of bones shows degenerative changes involving the thoracic spine.\n\nLimited sections through the upper abdomen are unremarkable.  Visualized parts\nof the liver spleen and pancreas unremarkable.  No adrenal masses are seen",
            "output": "Decrease in size of the subpleural opacity in the right upper lobe which is\nmost likely inflammatory.\n\nModerate to severe centrilobular emphysema with a slight upper lobe\npredominance.\n\nNo evidence of pneumothorax.\n\nStable small mediastinal lymph nodes which are most likely reactive."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or supraclavicular lymphadenopathy.\nMultiple mediastinal adenopathy measure up to 2 cm in the right lower\nparatracheal nodal station and up to 1.4 cm in the subcarinal nodal station,\nnot significantly changed from prior CT chest.  Some lymph nodes appear\ncalcified in the paraesophageal and epicardial fat.  Right hilar adenopathy\nmeasures up to 1.5 cm, appears unchanged from prior.  No left hilar\nadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Severe centrilobular and paraseptal emphysema is upper lobe\npredominant.  Subpleural parenchymal opacity in the right upper lobe is more\nextensive than on prior, now extending more posteriorly and along the major\nfissure.  No new opacities involving the left lung.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout.  Tiny small\nhypodensities along the pancreatic body measure up to 5 mm, could represent\nside branch IPMN.  There is no peripancreatic stranding or pancreatic duct\ndilation..\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple exophytic renal cyst arising from the left kidney measure up to 1.6\ncm.  There is no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Fusiform aneurysmal dilation of the infrarenal abdominal aorta\nmeasuring up to 2.9 cm (602:101) and up to 2.5 cm distally (602: 95).  Ectatic\nleft common iliac artery measures up to 1.5 cm is stable since ___. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  Degenerative changes are most pronounced\nat L4-L5 and L5-S1 with mild retrolisthesis of L5 on S1, posterior spondylosis\nand vacuum phenomenon.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No abnormal findings as sequela of trauma.\n2. Chronic lung disease with worsening opacity in the right upper lobe in\ncomparison to ___.\n3. Mediastinal and right hilar adenopathy are unchanged, could be reactive in\nthe setting of chronic lung disease."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nBreast, chest wall and bones:\nNo abnormal\n\nMediastinum:\nNo abnormal\n\nHila:\nNo adenoid\n\nHeart:\nNo ab\n\nUpper Abdomen:\nNo abnormality\n\nLung:\n\nNodules:\n\nDominant nodule:\nNone\n\nOther nodules:\nStable 2 mm left upper lobe pulmonary nodule (6, 51).\n\nParenchyma:\nPreviously visualized ground-glass opacity in the left upper lobe has resolved\nand most likely represented a pneumonia\n\nPleura and airways:\nNo abnormality",
            "output": "Stable 2 mm left upper lobe pulmonary nodule.  No new pulmonary nodules.\n\nLUNG-RADS CATEGORY AND RECOMMENDATION:  Lung-RADS category: Lung-RADS 2: We\nrecommend continuing CT lung cancer screening in 12 months.\n\n\n\nINCIDENTAL FINDINGS AND RECOMMENDATIONS:  None\n\nManagement recommendations for incidental findings within the LungHealth\u00ae\nprogram are based on a multidisciplinary consensus document of our institution\nspecifically designed for this program.\n\nLUNG-RADS CATEGORIES, DESCRIPTION:  Lung-RADS 0: This category designates an\nincomplete or diagnostically insufficient CT examination.\nLung-RADS 1: This category designates the absence of nodules, or the presence\nof definitely benign nodules.\nLung-RADS 2: This category designates the presence of nodules with a very low\nlikelihood of becoming a clinically active cancer due to size or lack of\ngrowth.\nLung-RADS 3: This category designates probably benign nodules with a low\nlikelihood of becoming a clinically active cancer but with features that\nrequire confirmatory imaging follow-up.\nLung-RADS 4A: This category designates nodules that require additional\ndiagnostic imaging.\nLung-RADS 4B and 4X: This category designates nodules that require additional\ndiagnostic testing and/or tissue sampling. Nodules in this category are\npresented at the weekly multidisciplinary thoracic oncology conference of our\nprogram.\nS (with any category): This qualifier designates the presence of a relevant\nincidental (= distinct from lung cancer) finding, for which a specific\nmanagement recommendation is made.\nC (with any category): Prior diagnosis of lung cancer."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. There is\nno supraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: Multiple typical myelomatous lytic lesions involving the skeleton,\nthe larger involve the left transverse process and costovertebral junction of\nT7 (5:151) spinal canal evaluation is limited and spinal canal invasion is\npossible.\nAdditional larger lytic lesions at the level of the manubrium with associated\npathologic fracture (5:80), right distal clavicle (05:21).  Multiple bilateral\nrib fractures with no significant displacement.\nCompression fracture T12 with more than 50% loss of height.\n\nUPPER ABDOMEN: Included unenhanced upper abdominal organs are unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: No gross hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Mild hypodensity of cardiac\nchambers suggest minimal edema.  Moderate calcifications of the coronaries. \nThoracic aorta and main pulmonary artery are normal in diameter.\n\nPLEURA: Minimal bilateral layering pleural effusions.  Biapical\npleuroparenchymal fibrosis is minimal.\n\nLUNG: Mild diffuse bronchial wall thickening and irregularity suggest chronic\nairway disease such as chronic bronchitis.  Panlobular emphysema is more\nsevere in the upper lobes.  Large bullae noted also in the subpleural lower\nlobes.\nNo lung nodules identified.\nNo focal consolidations concerning for pneumonia.  Scattered millimetric\ncalcified granulomas (5:115).",
            "output": "-Extensive skeletal myelomatous disease.  The larger lytic lesion at the level\nof the left transverse process and costovertebral junction of T7, possibly\ninvading the spinal canal, for further evaluation by MRI as clinically\nindicated.\n-Panlobular emphysema with concurrent mild bronchitis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Previous cholecystectomy.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve or coronary artery calcifications.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  The 5 mm nodule\nseen on previous abdominal CT in the right middle lobe (5, 178) is unchanged\nand most likely represents an intrapulmonary lymph node.  Multiple small\nindeterminate intrapulmonary nodules (5, 56, 68, 120, 124, 134, 140, 178 and\n268) with the largest nodule measuring 6 mm in diameter (5, 138).  No\nconfluent airspace consolidation.  No diffuse lung disease.  No\nbronchiectasis.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary truncus is not dilated.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "The previously noted 5 mm pulmonary nodule in the right middle lobe seen on CT\nabdomen done ___ is unchanged and most likely represents an\nintrapulmonary lymph node.\n\nMultiple other indeterminate pulmonary nodules identified (which was not\nincluded in the scan volume of the previous CT abdomen) with the largest\nmeasuring 6 mm in average diameter.  This nodule is not spiculated and\nconforms to pulmonary architecture, which is reassuring but does not obviate\nfollow-up imaging.  .\n\nRECOMMENDATION(S):  Follow-up CT study in 6 months recommended."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  All\nvisible mediastinal lymph nodes (2, 21) are normal in size.  No substantial\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  No abnormalities are noted in the\nupper abdomen.  Status post cholecystectomy.  No lytic lesions at the level of\nthe ribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.\nThere is stable bilateral apical scarring with nodular components (5, 31).\nStable 3 mm left upper lobe nodule (5, 62).\nStable 1 mm right upper lobe nodule (5, 125).\nStable 3-5 mm perifissural nodules in the middle lobe (5, 141).\nStable 2 mm right upper lobe nodule (5, 145).\nStable 3 mm subpleural middle lobe nodule (5, 184).\nSeveral other millimetric nodules are also stable.  No new or growing nodules.\nNo pleural thickening, no pleural effusions.  The airways are patent.  No\ndiffuse lung disease.",
            "output": "Stable millimetric pulmonary nodules.  No new or growing nodules. Stability of\nthe nodules should be confirmed at a CT followup of the ___ years (___).  No lung parenchymal or airway abnormalities."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes measuring up to 6\nmm in short axis.  Heart size is normal.  There is no pericardial effusion. \nThe aorta and pulmonary arteries are normal in caliber.  There is a small\nhiatus hernia.  There is minimal wall thickening involving the distal\nesophagus which could represent reflux esophagitis.\n\n\nPLEURA: No pleural effusion\n\nLUNG: There is stable biapical pleuroparenchymal scarring.  The 3 mm left\nupper lobe pulmonary nodule (5, 61) is unchanged.  The 3 mm right upper lobe\npulmonary nodule (5, 127) is also unchanged.  The 5 mm right middle lobe\npulmonary nodule (5, 127) is also unchanged.  The 5 mm perifissural nodule in\nthe left upper lobe (5, 143) is also unchanged.  A subpleural right middle\nlobe pulmonary nodule (5, 170) is also stable.  There is another right middle\nlobe pulmonary nodule (5, 130) which is also unchanged.  No new pulmonary\nnodules.  Several other bilateral pulmonary nodules are unchanged.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "Stable bilateral pulmonary nodules ranging in size from 1-5 mm.  No new\npulmonary nodules.\n\nStable biapical pleuroparenchymal scarring.\n\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Axillary lymph nodes are not\npathologically enlarged by CT size criteria.  There is no supraclavicular\nlymphadenopathy.  The thyroid is unremarkable.  There is no suspicious chest\nwall lesion.\n\n\nMEDIASTINUM: Mediastinal lymph nodes are pathologically enlarged by CT size\ncriteria.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is severe calcification of the aortic annulus and\naortic valve.  There is severe calcification of the left anterior descending,\nright coronary, and left circumflex arteries.  There are moderate to severe\natherosclerotic calcifications within the aortic arch and origins of the great\nvessels in the head and neck.\n\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA: There is mild biapical scarring.  There is no suspicious lung\nnodule.  There is no consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS: There is fusiform dilatation of the thoracic ascending measuring\n4.6 x 4.4 cm (302:131) and of the proximal aortic arch measuring 4.0 cm\n(302:86).  In the thoracic ascending aorta ascending 2.5 cm from the origin of\nthe right coronary artery, there is intimal calcification of the right lateral\nwall extending across midline to the left side.  Above this level, the\nascending aorta is essentially clear of calcification.  An aberrant right\nsubclavian artery measures 1.6 cm (302:68).\nCHEST CAGE: There is no suspicious osseous abnormality\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.",
            "output": "1. Aberrant right subclavian artery measures 1.6 cm in maximal diameter\n(series 302:68).\n2. Fusiform dilatation of the thoracic ascending aorta measuring up to 4.6 cm\nand the proximal aortic arch measuring up to 4.0 cm.\n3. There is intimal calcification of the thoracic ascending aorta from the\norigin of the right coronary arteries ascending 2.5 cm superiorly.  Above this\nlevel, the ascending aorta is essentially clear calcifications.\n4. Severe calcifications of the coronary arteries and aortic valve."
        },
        {
            "input": "There is no axillary, mediastinal or hilar adenopathy. Heart size is within\nnormal limits. Coronary artery calcifications are mild. Trace pericardial\nfluid is physiologic. The aorta is within normal limits in caliber although\nnotable for atherosclerotic calcifications throughout its course. Pulmonary\nartery is enlarged to at least 3.5 cm suggesting pulmonary hypertension as\nseen on prior.\n\nRespiratory motion limits sensitivity. Airways are patent to the subsegmental\nlevel. A vertically oriented opacity which extends from the right lung apex\nand centrally to the right hilar region surrounds the bronchovascular\nstructures, present on prior study dated ___ and unchanged. Within\nthe left lower lobe, there is an approximately 1.5 x 1.6 cm lobulated opacity\nand adjacent medially a cluster of smaller nodules.  There is no pleural\neffusion or abnormality.\n\nThe study suboptimal in the evaluation of subdiaphragmatic viscera, image\nportions of the liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable.  A previously noted left juxtaadrenal nodule not fully\ncharacterized but unchanged\n\nOsseous structures demonstrate no suspicious lytic or blastic lesion.",
            "output": "1.  Vertically oriented opacity which extends from the right lung apex and\ncentrally to the right hilar region surrounding the bronchovascular structures\npresent on prior study dated ___ and unchanged. This is thought to\nreflect a recurrent focus of atelectasis versus scarring given persistence.\n2.  Small opacities in the left lung base may reflect small focus of\naspiration.  Consider followup imaging to document resolution.\n3.  Enlarged pulmonary artery suggesting pulmonary hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary\nlymphadenopathy.  The partially visualized thyroid is unremarkable\n\nUPPER ABDOMEN: Patient is status post cholecystectomy.  The liver demonstrates\nlow attenuation, compatible with hepatic steatosis.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Specifically, there has\nbeen interval resolution of mediastinal lymphadenopathy since CTA chest ___.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is not enlarged.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Linear opacities in the right middle lobe (5:132) likely\nrepresents subsegmental atelectasis.  There is no lung consolidation or\nsuspicious pulmonary nodule.  Specifically, there has been interval resolution\nof right upper lobe consolidation and left upper lobe consolidation since ___.\n2. AIRWAYS:  Airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal caliber.\nCHEST CAGE: There is no suspicious osseous abnormality.  There are moderate\nmultilevel degenerative changes of thoracic spine.",
            "output": "Interval resolution of mediastinal lymphadenopathy and consolidation since\nchest CTA ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level although the evaluation is limited in the right upper lobe\ndue to airspace disease.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary supraclavicular\nlymphadenopathy.  There are multiple enlarged mediastinal lymph nodes, for\nexample right upper paratracheal lymph node measuring up to 1.1 cm in short\naxis (series 301; image 47).  These lymph nodes are possibly reactive. \nAdditionally, there are prominent right-sided hilar lymph nodes measuring up\nto 0.8 cm.  No left hilar lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is confluent opacification of the right upper lobe,\nconsistent with previously diagnosed right upper lobe pneumonia.  Additional\nareas of peribronchovascular, nodular, ___ opacities are seen in the\nleft upper lobe (series 301; image 75, suggestive of an additional focus of\ninfection/inflammation.\n\nBASE OF NECK: Heterogeneous, multi-nodular thyroid gland.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Right upper lobe pneumonia. No pulmonary embolus demonstrated within the\nlimitations described above.\n2. Multiple enlarged mediastinal lymph nodes, for example right upper\nparatracheal lymph node, measuring up to 1.1 cm, possibly reactive.\n3. Heterogeneous, multi-nodular thyroid gland.\n\nRECOMMENDATION(S):  Recommend 3 month follow-up CT chest to ensure resolution.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 09:46 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Evaluation is mildly limited by motion.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nsubsegmental pulmonary arteries are limited by motion.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nmain pulmonary trunk is dilated measuring 3.4 cm.  The heart is top-normal in\nsize or mildly dilated.  Trace pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy by CT size criteria.  A preaortic lymph node measuring 9 mm in\nshort axis is not pathologically enlarged and nonspecific.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple areas of ground-glass opacities in the bilateral upper\nlobes with diffuse interlobular septal thickening.  Mild dependent bibasilar\natelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a 1.4 cm hyperenhancing lesion in the right lobe of the\nliver on series 4, ___ 105.  This most likely represents a flash filling\nhemangioma.\n\nBONES: No suspicious osseous abnormality is seen.  There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Mild to moderate pulmonary edema and possible superimposed multifocal\ninfection in this clinical setting.\n3. Findings may suggest pulmonary arterial hypertension.\n4. 1.4 cm enhancing liver lesion most consistent with a flash filling\nhemangioma.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:01 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The tracheobronchial Y stent is patent and has not migrated since ___. \nIt extends from the lower trachea into the both main bronchi, on the right to\nthe origin of right upper lobe bronchus, and on the left beyond the mid\nportion of the main bronchus short of the upper lobe orifice.  Maximum\ntracheal narrowing just above the stent is unchanged at 12 x 22 mm (2,22). The\nbulk of nodular enhancing peritracheal tumor remains the same as compared to\nrecent PET-CT, extending from the level of the mid trachea to the level of the\nbilateral mainstem bronchi. Tumor surrounds and mildly narrows the right upper\nlobe bronchus.  Although the luminal diameter has not changed, there is more\nsurrounding soft tissue.\n\nUpper lobe predominant paramediastinal ground-glass opacities, interlobular\nseptal thickening, and subpleural reticulation are likely due to radiation\nfibrosis. Right lower lobe subsegmental peribronchovascular ground-glass\nopacities may be due to radiation pneumonitis, but, if that is outside the\nradiation portal, infection or aspiration is more likely. Mild centrilobular\nemphysema is unchanged. The trace left pleural effusion has resolved, but the\nsmall right pleural effusion remains.\n\nBilateral hypodense thyroid nodules measuring up to 6 mm on the right are\nbetter seen on today's exam.  A necrotic right lower paratracheal lymph node\nwith central low attenuation is not appreciably changed when allowing for\ndifferences in technique measuring 16 x 24 mm, previously 15 x 26 mm (2, 27).\nA prevascular lymph node is smaller measuring 7 mm in short axis, previously 9\nmm (2, 24). There are no pathologically enlarged supraclavicular, hilar or\naxillary lymph nodes.\n\nHeart size is top-normal with no pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal caliber. No incidental pulmonary embolus\nis identified. Incidental note is made of a common origin of the innominate\nartery and the left common carotid artery, which is a normal anatomic variant\n(bovine arch).\n\nThe wall of the esophagus below the aortic arch is diffusely, severely\nthickened, and the interface between the esophageal wall and surrounding soft\ntissue is obliterated.  For a detailed discussion of the upper abdomen, please\nrefer to the separate report from the CT abdomen/pelvis performed\nconcurrently.\n\nNo destructive bone lesions are identified.",
            "output": "New right lower lobe ground-glass opacities may be due to radiation\npneumonitis, but more likely infection or aspiration.\n\nPatent tracheobronchial Y-stent stable since ___. Enhancing treated\ncentral adenopathy extending from the mid trachea along both main bronchi, now\nencases the right upper lobe bronchus but moderate narrowing of that bronchus\nis stable.  Otherwise this is unchanged since ___.\n\nSevere circumferential esophageal wall thickening may be due to\nradiation-induced or infectious esophagitis, or alternatively, tumor invasion.\n\nEvolving upper lobe predominant paramediastinal radiation fibrosis.\n\nStable mild centrilobular emphysema.\n\nResolved left and stable trace right pleural effusions."
        },
        {
            "input": "Unchanged small right thyroid nodule.  Unchanged appearance of the soft tissue\nmediastinal mass surrounding the tracheal Y stent.  Unchanged appearance of\nthe large mediastinal vessels. Unchanged extent of the known small pleural\neffusion.  No change in appearance of the posterior mediastinum and the upper\nabdomen.  Unchanged moderate bilateral apical scarring. Right more than left. \nThe right lower lobe peribronchial parenchymal opacities have slightly\nincreased in extent and severity (5, 138).  The consolidation component is\nalso more severe than on location of the previous examination. Slight mucous\naccumulation in the left main bronchus.  The extent of paramediastinal and\nperihilar right-sided parenchymal fibrosis is constant.  No changes are noted\nin the left lung",
            "output": "Progression of the pre-existing right lower lobe parenchymal opacity that\nlikely is infectious in origin.  Unchanged extent of the right pleural\neffusion.  The appearance of the right central mass around the trachea is\nconstant. Also constant is the right upper lobe paramediastinal fibrosis."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  There is no incidental\npulmonary embolism.  The heart is normal in size and demonstrates no\nappreciable coronary artery calcifications.  A small pericardial effusion is\nstable.\n\n\nA tracheal Y stent is unchanged in position, and surrounded by a\ncircumferential soft tissue mass (for example, 02:21).  Soft tissue density\nnoted within the left mainstem bronchus may represent secretions versus tumor.\nThe airways remain patent to the subsegmental levels.  Bilateral,\nparamediastinal fibrosis and bronchiectasis is unchanged.\n\nNo pneumothorax or left pleural effusion is identified. The airways are patent\nto the subsegmental level.  Right lower lobe peribronchial soft tissue and\ndistal consolidative opacities are more confluent and associated with loss of\nvolume compared to the prior examination.  There is no new pulmonary nodule\nidentified.  Pleural thickening and trace amount of fluid on the right are\nunchanged\n\nNo suspicious osseous lesions are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrate hepatic steatosis.",
            "output": "1.  Increasing consolidative appearance of airspace opacities in the right\nlower lobe, which may be secondary to volume loss and radiation fibrosis.  I\ndoubt there is tumor progression.\n2.  Persistent, essentially unchanged appearance of a mediastinal soft tissue\nmass encasing the distal trachea and bilateral mainstem bronchi, with\nextension into the right hilum.\n3.  Stable position of a tracheal Y-stent with patent distal airways.\n4.  Hepatic steatosis."
        },
        {
            "input": "The thyroid gland is unremarkable.  Multiple pathologically enlarged\nmediastinal lymph nodes are noted. For reference, an enlarged right lower\nparatracheal lymph node measures 25 x 27 mm (3, 23).  A prevascular lymph node\nmeasures 14 x 29 mm (3, 20). A mildly prominent right supraclavicular lymph\nnode measures 10 x 13 mm (3, 16).\n\nThere is a small amount of right supracervical subcutaneous emphysema, which\nis likely due to the recent percutaneous intervention. A left subclavian\ncentral venous catheter terminates in the mid SVC. Heart size is normal with\nno pericardial effusion. The main pulmonary artery and thoracic aorta are\nnormal caliber.\n\nAn endotracheal tube extends to the level of the lower trachea. There is\nnear-complete right lower lobe atelectasis with evidence of ill-defined soft\ntissue partially obstructing the proximal right mainstem bronchus (5, 113). \nEndobronchial soft tissues is contiguous with extensive right lower\nparatracheal lymphadenopathy. Distal to the point of obstruction, are retained\nsecretions which occlude the common basal trunk, and several distal right\nlower lobe segmental bronchi.  Superior segment right lower lobe ground-glass\nopacities and focal consolidations may be due to aspiration or pneumonia. \nCannot exclude that the irregular nodule in the superior segment RLL represent\na tumor.  Ground-glass opacities in the lingula are also likely due to\ninfection or aspiration. There is also a small layering right pleural\neffusion, and a trace left pleural effusion with minimal left lower lobe\npassive atelectasis. These findings are superimposed on mild apical\npredominant centrilobular emphysema and mild diffuse bronchial wall\nthickening.\n\nImages of the upper show an enteric tube terminating in the gastric body.\n\nThe bones are unremarkable.",
            "output": "Near complete atelectasis of the right lower lobe secondary to an occlusive\nsoft tissue lesion with endobronchial extension at the level of the proximal\nright mainstem bronchus.  Bronchoscopy is recommended.\n\nPneumonia or aspiration involving the superior segment right lower lobe and\nlingula.\n\nSmall right and trace left pleural effusions.\n\nExtensive mediastinal lymphadenopathy is worrisome for metastasis.\n\nMild apical predominant centrilobular emphysema and mild bronchial wall\nthickening."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible axillary lymph nodes (4, 15) are normal\nin size.  Normal appearance of the large mediastinal vessels.  Mild coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  Upper\nabdominal findings are reported in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  There is minimal ground-glass nodularity in the upper\nlobes.  No evidence of diffuse or interstitial lung disease.  The airways are\npatent.  No suspicious lung nodules or masses.  No pleural thickening, no\npleural effusions.",
            "output": "Minimal ground-glass nodularity in the upper lobes is likely caused by\nrespiratory bronchiolitis.  No evidence of hemorrhage.  No infection.  No\nfibrosis or other diffuse lung disease."
        },
        {
            "input": "CHEST:\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. \nAtherosclerotic calcifications seen along the course of the thoracic aorta and\norigins of the great vessels.  The aorta and pulmonary arteries are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThere is patchy consolidation in the left lower lobe.  Right basilar\natelectasis is noted.  A 4 mm nodule seen along the left major fissure, likely\na lymph node.  The lungs are otherwise clear.  Central airways are patent. \nEndoluminal debris noted in the left lower lobe bronchus.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\n\nABDOMEN:\nThe following observations are made based on limitation of an unenhanced exam.\nAdditionally, there is relative paucity of ___ fat further\nlimiting evaluation.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Hypodensity at the\nlower pole of left kidney is incompletely characterized though likely a cyst. \nThere is no evidence of other focal renal lesions within the limitations of an\nunenhanced scan.  There is no hydronephrosis.  There is no nephrolithiasis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nDuodenal diverticulum is noted.  There is a right inguinal hernia containing\nnonobstructing loop of distal small bowel.  The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder contains a Foley catheter.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes noted throughout the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Left lower lobe consolidation worrisome for either infection or aspiration.\nEndoluminal debris in the left lower lobe bronchus.\n2. Otherwise no acute intrathoracic or ___ processed within the\nlimitation of an unenhanced scan.\n3. Nonobstructed small bowel containing right inguinal hernia."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level with small nonocclusive filling defect in the distal right\nmain pulmonary artery (series 3, image 106 and 105) extending into a segmental\nbranch of the right upper lobe (series 3, image 101), compatible with acute\npulmonary embolism.  There is small pulmonary embolus in the very distal brain\nage left upper lobe series 3, image 71.  The main pulmonary artery is not\ndilated.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.  Note is made of\nlipomatous hypertrophy of the interatrial septum (series 3, image 138).  There\nare coronary artery calcifications right PICC line tip in the low SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  There is bilateral small pleural effusions, left greater than\nright.  No Pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is bibasilar atelectasis.  No focal consolidation.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show multiple\nnodules in the right thyroid lobe, the largest measuring 1.8 x 1.3 cm\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is focal area of scarring at the lower pole of the right kidney.  There\nis no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  There\nis evidence of prior small bowel resection with anastomosis.  Status post\npartial colectomy with a colostomy in the left hemi abdomen.  Submucosal fatty\nlesion within the distal rectum, likely a small lipoma (series 2b, image 165).\nThere is no free air or free fluid in the abdomen.\n\nPELVIS: Urinary bladder is collapsed around a Foley's catheter.  There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Postsurgical changes in the anterior abdominal wall.  Diffuse\nanasarca.  A right femoral central line is noted in situ.  There is small\nnonocclusive acute DVT in the left femoral vein.  There is healing fracture of\nthe anterior left sixth rib.",
            "output": "1.  There are few small acute pulmonary emboli.  Small nonocclusive DVT in the\nleft femoral vein.  .\n\n2.  Bilateral small pleural effusions, left greater than right.\n\n3.  No acute intra-abdominal findings.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:03 ___, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Due to positioning of the patient,\ndirect comparisons of the previously demonstrated thyroid hypodensities are\ndifficult.  However, right lobe hypodensity appear overall similar, measuring\nup to 2.5 cm (03:12).  There is no supraclavicular or axillary lymphadenopathy\nby CT size criteria.  Scattered supraclavicular lymph nodes measure up to 6\nmm.  There are multiple dense and linear calcifications in the bilateral\nbreasts, incompletely imaged and suboptimally evaluated on the current\nmodality.  There are multiple enhancing soft tissue nodules in the\nsubcutaneous tissue of the left forearm, the largest measuring 17 x 10 mm\n(03:23).  There is diffuse stranding in the subcutaneous tissue, which may be\nrelated to volume overload.\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen and pelvis from the\ndated same day for details on subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.  The\nlargest lymph node in the lower pretracheal station measures up to 7 mm\n(03:16).\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  New since ___, there is asymmetric thickening of the posterior pericardium, measuring\nup to 1.4 cm with fluid density and mild enhancement of the periphery, may\nrepresent loculated pericardial effusion.  There is mild coronary artery\ncalcifications.  Aortic valve calcifications are mild.\nPLEURA: Decreased since ___, there is persistent small, dependent\nleft nonhemorrhagic pleural effusion and small to trace right nonhemorrhagic\nlayering pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There are no suspicious lung nodules that require follow-up. \nCompared to prior exam on ___, there is increased consolidation\nin the right lower lobe with diffuse ground-glass opacities in the right lung,\nworse in the right lower lobe, which may be a combination of atelectasis and\nbreathing motion.  On left, there is mild atelectasis in the left lower lobe. \nThe lingula is clear.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain and right pulmonary arteries are normal in caliber.  Moderate\ncalcifications at the aortic arch is seen.  There is common origin of the\ninnominate and left common carotid artery, which is mildly dilated, measuring\nup to 16 mm, grossly unchanged from prior exam.  While this exam is not\ntailored for evaluation of pulmonary embolism, no large filling defects are\nseen in the central pulmonary arteries.\nCHEST CAGE: There are no worrisome osseous lesions for infection or\nmalignancy.  No acute fracture is seen.  Multilevel degenerative changes of\nthe cervical, thoracic and sternoclavicular joint are noted.",
            "output": "-Pericardial effusion with enhancing pericardium.  Possible pericarditis.  No\nevidence of cardiac tamponade.  Further evaluation with echocardiogram is\nrecommended.\n-Bibasilar atelectasis and pleural effusions, decreased from prior. \nPersistent lymphovascular congestion of the right lower lobe.\n-Right thyroid hypodensity measuring up to 2.5 cm.  Dedicated ultrasound is\nrecommended on nonurgent basis.\n-Left upper arm nodule. Clinical exam of this area is recommended.\n\nRECOMMENDATION(S):  Echocardiogram for pericardial effusion.\n\nRight thyroid hypodensity measuring up to 2.5 cm. Dedicated ultrasound is\nrecommended on nonurgent basis.\n\nLeft upper arm nodule. Clinical exam of this area is recommended.\n\nNOTIFICATION:   The findings were discussed with BROWN, ___, M.D.\nby ___, M.D. on the telephone on ___ at 4:08 pm, 20 minutes\nafter discovery of the findings."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta and pulmonary arteries are\nnormal in size. Mild atherosclerotic calcifications are noted in the coronary\narteries and aortic valve.  The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  Trace bilateral nonhemorrhagic pleural\neffusions are of low attenuation (-20 ___, possibly chylous fluid.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  Focal areas of bronchiectasis are noted\nin the right upper lobe (06:105), and right lung base (6:226) There are no\nconcerning pulmonary nodules.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  The imaged upper abdomen is unremarkable.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Trace bilateral low-density pleural effusions, possibly chylous fluid.\n3. Mild coronary artery and aortic valve calcification, clinical significance\nindeterminate radiographically."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  There are no\nfilling defects within the pulmonary arterial tree through the subsegmental\nlevel.  The main pulmonary arteries not dilated and there are no signs of\nright heart strain.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There are trace bilateral pleural effusions with sub segmental\natelectasis.  The atelectasis is greater on the left.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen. \nSurgical clips project adjacent to the gastroesophageal junction.  The patient\nis also likely post cholecystectomy..",
            "output": "1. No evidence of acute pulmonary embolism or other acute intrathoracic\nabnormality.\n2. Trace bilateral pleural effusions with subjacent atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Severe atherosclerotic calcifications of the aortic\nvalve and thoracic aorta.  The thoracic aorta is normal in caliber.  There\nalso mitral annular calcifications.  Mild coronary calcifications.  The heart\nis moderately enlarged.  Otherwise, the heart, pericardium, and great vessels\nare within normal limits based on an unenhanced scan.  There is a small\nnonhemorrhagic pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  There are\nmultiple prominent mediastinal nodes, nonspecific.  The largest mediastinal\nlymph node conglomerate measures approximately 1.5 x 1.6 cm at the precarinal\nstation (series 3, image 45).  No mediastinal mass or hematoma.  Small hiatal\nhernia.  The upper esophagus is patulous and air-filled.\n\nPLEURAL SPACES: Moderate right and small left pleural effusions.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Mild dependent atelectasis bilaterally.  Pleuroparenchymal\nscarring at the bilateral lung apices.  No focal consolidations.  No\nsuspicious lung nodules.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Multinodular thyroid gland with a large hypodense nodule on the\nright measuring up to 3.0 cm with coarse calcifications.\n\nABDOMEN: Multiple cysts are seen within the liver.  Small accessory spleen\nanteriorly.  There is trace perihepatic free fluid.  No other abnormalities\nwithin the partially visualized upper abdomen.\n\nBONES: There are acute fractures of the right posterior sixth through ninth\nribs.  No other acute fractures are visualized.  Degenerative changes within\nthe thoracolumbar spine with moderate S shaped scoliosis.  No suspicious\nosseous abnormality is seen.?",
            "output": "1. Acute fractures of the right posterior sixth through ninth ribs.  No\npneumothorax.\n2. Moderate right and small left pleural effusions.  Small pericardial\neffusion.\n3. Multinodular thyroid with a large hypodense nodule on the right measuring\nup to 3.0 cm with calcifications which should be further evaluated with a\nthyroid ultrasound, if not already performed.\n\nRECOMMENDATION(S):  Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is a filling defect in a right lower lobe subsegmental pulmonary artery,\nconsistent with pulmonary embolism (___).  No evidence of right heart\nstrain.\n\nThe pulmonary arteries are otherwise well opacified to the subsegmental level,\nwith no evidence of filling defect within the main, right, left, lobar or\nsegmental pulmonary arteries.  The main pulmonary artery is enlarged,\nmeasuring 3.2 cm, suggestive of pulmonary arterial hypertension.\n\nThere is a 1.3 x 1.2 cm left hilar lymph node (___) and a 1.1 x 0.9 cm right\nhilar lymph node (___).  There are multiple prominent, though nonenlarged,\nmediastinal lymph nodes.  There is no supraclavicular, axillary or mediastinal\nlymphadenopathy.  Imaged portions of the thyroid demonstrate a heterogeneous\nright thyroid lobe lesion, measuring 1.7 x 1.5 cm (___).\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nDiffuse moderate upper lobe predominant centrilobular emphysema.  There is\nbibasilar atelectasis.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a left adrenal 1.5 x 1.0 cm\nlesion, incompletely characterized on this single-phase study.\n\nThere is extensive atherosclerotic calcification of the coronary arteries and\nimaged portions of the abdominal aorta, including extensive calcification at\nthe ostia of the celiac artery and SMA.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. There is a filling defect in a right lower lobe subsegmental pulmonary\nartery, consistent with pulmonary embolism.  No evidence of right heart\nstrain.\n2. Diffuse moderate upper lobe predominant centrilobular emphysema.\n3. Heterogeneous right thyroid lobe nodule, measuring 1.7 x 1.5 cm.  If not\npreviously performed, consider thyroid ultrasound for further evaluation on a\nnonemergent basis.\n4. There is a 1.5 x 1.0 cm lesion in the left adrenal gland, incompletely\ncharacterized on this single-phase study.  Consider dedicated adrenal CT for\nfurther evaluation on a nonemergent basis.\n5. The main pulmonary artery is mildly enlarged, suggestive of pulmonary\narterial hypertension.\n6. Hilar lymphadenopathy, possibly reactive.\n\nRECOMMENDATION(S):  If not previously performed, consider thyroid ultrasound\nfor further evaluation on a nonemergent basis.\nConsider dedicated adrenal CT for further evaluation on a nonemergent basis.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 7:34 pm, 2 minutes after discovery of\nthe findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Central venous line\nterminates in lower SVC.  Heart size is normal.  No pericardial pleural\neffusion is demonstrated.  Image portion of the upper abdomen reveals no\nappreciable abnormality as well as no substantial change since the prior\nstudy.  Again note is made of partially imaged enlarged spleen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\nAirways are patent to the subsegmental level bilaterally.\n\nLeft, lingular nodule, series 4, image 186 is 6.6 mm in diameter is stable. \nAdditional pulmonary nodules are noted, in the right apex, series 4, image 27,\nin the right upper lobe, series 4, image 44, 58, in the right lower lobe\nsuperior segment series 4, image 102, right middle lobe, series 4, image 132,\n137 and in right lower lobe at the basal segments series 4, image 179.",
            "output": "Multiple pulmonary nodules as described with stable lingular nodule.  Based on\nthe size reassessment in 6 months for documentation of stability of all the\nnodules would be justified."
        },
        {
            "input": "20 x 28 mm spiculated mass in the right axilla at the margin of the pectoralis\nmajor was 20 x 30 mm in ___.  Overlying skin is retracted and may be\nulcerated. The axillary vein is undisturbed. There is no new adenopathy\nlocally. Supraclavicular and left axillary nodal stations are unremarkable.\nThere are no soft tissue lesions in the chest wall elsewhere suspicious for\nmalignancy, however the progressive, generalized increase in skin thickness in\nthe right anterior and lateral chest wall is probably due to radiation\nreaction.\n\nExtensive new well-circumscribed peripheral consolidation in a non anatomic\ndistribution in the right posterolateral lung, at several nearly contiguous\nlevels, from the aortic arch nearly to the diaphragm is also strongly\nsuggestive of radiation injury. If patient has not had radiation to this\nregion within the past year, I would suggest multi focal pneumonia as an\nalternative rather than tumor infiltration, since the local pleural surface is\nunremarkable, aside from a new, tiny layering, right pleural effusion. A 6.5\nmm right lower lobe lung nodule, 4:218, was 3 mm in ___, and a 6 mm left\nlower lobe nodule, 4:216 is new, both probably metastases.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent.\nAortic valvular calcification is mild. Moderate cardiomegaly has increased.\nFluid is retained in the esophagus above a moderate size hiatus hernia. There\nis no evidence of esophagitis. Aorta and pulmonary arteries are normal size\nand there is no large pulmonary embolus.\n\n12 x 18 mm right hilar node, 4:121, was 10 x 11 mm in ___ and 11 x 13 mm left\nhilar node, 4:119, was 6 x 9 mm. 11 x 20 mm prevascular mediastinal node,\n4:129, was 9 x 21 mm. There are no enlarged lymph nodes in the other\nmediastinal stations, internal mammary, retrocrural or diaphragmatic stations.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Compared to ___:\n\n1 growing and 1 new 6 mm lung nodule, probably metastases.\n\nExtensive new peripheral consolidation right lung most likely extensive\nradiation pneumonia.\n\nSlight increase 3 widely separated central lymph nodes could be malignant,\nmore likely reactive to radiation pneumonia.\n\nModerate cardiomegaly increased may be related to aortic valvular\ncalcification. Clinical correlation advised."
        },
        {
            "input": "Supraclavicular lymph nodes are not pathologically enlarged.  19 x 29 mm\nspiculated soft tissue mass at the lateral periphery of the right pectoralis\nmuscles reaching the reaching the surface of the axillary scan which may be\nulcerated, also measured 19 x 29 mm in ___.\n\nThere are no other soft tissue abnormalities in the chest wall suspicious for\nmalignancy or infection. This study is not designed for subdiaphragmatic\ndiagnosis, shows there is no adrenal mass. The poorly enhanced liver is\nhomogeneous.\n\nNew vocal cord asymmetry may indicate early paresis, 2:5. Clinical correlation\nadvised. Thyroid is unremarkable. Atherosclerotic calcification is scattered\nin the head and neck vessels, not apparent in the coronary arteries. Aortic\nvalvular calcification is mild. There is no pericardial or pleural\nabnormality.\n\nRadiation fibrosis in the axillary in apical regions of the right upper lobe\nis stable. Adjacent ribs are intact. More inferiorly, consolidation of a\nsharply marginated 2 cm deep band at the periphery of both the posterior\nsegment of the right upper lobe and the right lower lobe nearly to the\ndiaphragm has grown considerably more extensive. The configuration of this\nabnormality suggests radiation change as well.\n\nMost of a handful of small lung nodules has appeared or increased in size, but\nsome are stable, represented by the following with respect to ___:\n\n9 mm right middle lobe nodule, 4:181, new.\n\n10 mm right lower lobe nodule, 4:188, new or substantially larger.\n\n4 mm right middle lobe nodule, 4:188, previously 2 mm.\n\n11 mm right lower lobe nodule, 4:216, previously 7 mm.\n\n6 mm left lower lobe nodule, 04:20 25, unchanged.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.\n\nImpression treated right axillary mass unchanged. New or larger",
            "output": "Treated right axillary mass unchanged.\n\nRoughly a dozen cm size pulmonary nodules, presumed metastases, ___ new, ___\nlarger, ___ unchanged since ___.\n\nConsiderable progression in in the inferior component of extensive radiation\nfibrosis, right lung.\n\nNew vocal cord asymmetry should be evaluated clinically for developing vocal\ncord palsy."
        },
        {
            "input": "Vocal cords are fully apposed.  Thyroid is unremarkable. Supraclavicular and\nleft axillary lymph nodes are not enlarged.  The residual stellate soft tissue\nat the surgical site in the right axilla, slightly different in shape,\nprobably due to different position of the arm, is roughly the same size.  It\ndoes however extend all the way to the skin surface at several levels where\npreviously subcutaneous fat was interposed, compare 3:22- 26 today with\n___ on ___. Adjacent 6 x 11 mm lymph node, 5:125, is unchanged.\n\nThis study is not designed for subdiaphragmatic diagnosis. A small papillary\nright renal stone is unchanged.\n\nCentral lymph nodes are not pathologically enlarged. 2 adjacent right hilar\nlymph nodes, 17 mm in aggregate diameter, 5:148, are unchanged.\n\nSmall hiatus hernia is stable. A 16 x 19 mm well-circumscribed oval lesion\nwith attenuation characteristics a cyst, 15 ___, 05:30 9, is unchanged since\n___.\n\nRadiation reaction at the lateral and posterior perimeters of the right upper\nand lower lobes has decreased substantially since ___, particularly at\nthe level of the aortic arch, and the aortic valve\n\nFocal lung lesions are as follows compared to ___:\n\n6 mm right middle lobe nodule, 5:229, previously 7 mm, was 5 mm in ___,\npresumably benign.\n\n 5 mm right lower lobe nodule, 5:246, not identifiable previously.\n\n5 mm right lower lobe nodule, 5:262, previously 11 mm in the setting of more\npronounced radiation pneumonia, and 6 mm in ___.\n\n4 mm right lower lobe nodule, 5:285, previously 5 mm, and 4 mm in ___.\n\n4 mm left upper lobe nodule, 5:233, previously 5 mm, was 4 mm in ___ also\npresumably benign.\n\n7 mm and 8 left lower lobe nodules, 5:266, 268, both unchanged, and in ___, 6 mm and 7 mm. .\n\n6 mm left lower lobe nodule, 5:278, previously 4 mm, and 4 mm in ___.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Compared to ___, among a handful of small pulmonary nodules, one is\nnew, one substantially smaller, 3 minimally smaller, one minimally larger, two\nstable. However all but one of these nodules, the 5 mm right lower lobe\nnodule, 5:246, was present and comparable in size in ___. It would be a\nmistake to assume that the other nodules, present more than ___ years have been\nindolent pulmonary attest disease.\n\nThe post treatment right axillary lesion has not changed appreciably in size\nbut has other grown through some of the subcutaneous fat, or the fat has an\natrophied.\n\nSubstantial involution of radiation pneumonia right lung.\n\nNOTIFICATION:   Dr. ___ reported the findings to Dr. ___ by telephone on\n___ at 11:24 AM, 5 minutes after discovery of the findings."
        },
        {
            "input": "The known post treatment right axillary lesion continues to be adjacent to the\nsubcutaneous tissue and has not substantially changed in size (2, 22).\nSeveral known supra and infraclavicular lymph nodes mainly located between\nbranches of the supraaortic vessels are also unchanged.\nNo enlarged hilar or mediastinal lymph nodes.  The appearance of the large\nmediastinal vessels is unchanged.  Unchanged normal appearance of the heart,\nwith only mild aortic valve calcifications.  A moderate hiatal hernia is\nconstant in appearance.  Unchanged dilatation of the esophagus.  Unchanged\ncystic transformation of the right kidney, small renal calcification on the\nright.\nNo evidence of osteolytic rib lesions.  Mild degenerative vertebral disease. \nNo vertebral compression fractures.  No sternal abnormalities.\nThe severity of the known right apical lateral postradiation fibrosis is\nconstant.  Borderline sized right hilar lymph node (4, 115).  No pleural\neffusions.  The airways are patent but show evidence of mild chronic airways\ndisease.  There is no substantial overall change in size and number of the\npre-existing multiple pulmonary nodules.  For example, a reference lesion in\nthe middle lobe (4, 180) continues to have a diameter of approximately 3-4 mm.\nAny change in size is of millimetric ___ and could be due to technical\nvariability.\nNo evidence of diffuse lung disease.  The airways are patent.",
            "output": "No change in size and number of the multiple pre-existing pulmonary nodules. \nUnchanged size and morphology of the known posttreatment right axillary\nlesion.  Unchanged aspect of the right apical postradiation fibrosis."
        },
        {
            "input": "Aorta and pulmonary arteries are stable in appearance.  Preaortic lymph node\nis unchanged.  Heart size is normal.  No pericardial or pleural effusion is\ndemonstrated.  Small hiatal hernia is unchanged.  Right kidney nonobstructing\nstone is present.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm present. \nDiffuse osteopenia is demonstrated by extensive trabeculations of the thoracic\nspine.\n\n\nAirways are patent to the subsegmental level bilaterally.  Traction\nbronchiectasis in right upper lobe are related to postradiation fibrosis. \nRight lower lobe traction bronchiectasis are most likely due to scarring and\nsubpleural rounded atelectasis.  Right lower lobe nodule, series 4, image 223\nis triangular, unchanged as well as additional right lower lobe nodule, series\n4, image 238.  Left lower lobe nodules, series 4, image 217 are both stable. \nNo new nodules masses are consolidations demonstrated.\n\nRight upper lobe subpleural interstitial opacities are unchanged in the prior\nstudy consistent with postradiation changes.  Appearance of the right axilla\nis similar to previous examination with no evidence of growing lesion.  Small\nsupraclavicular lymph nodes are unchanged.  Right hilar lymph node is\nborderline, unchanged.  The patient is demonstrated extensive degenerative\nchanges in the right shoulder.",
            "output": "Overall stable appearance of the chest including the postradiation changes,\npulmonary nodules and right axilla."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Postradiation changes in the right lung from treatment of\nsquamous cell carcinoma appear stable.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Adjacent to the diaphragmatic crura and the aorta is a cystic\nstructure measuring 1.4 x 2.2 cm (series 2, image 116) which is unchanged\nsince ___.  There is a small hiatal hernia.  A 6 mm hypodensity in the spleen\nmost likely represents a simple for hemangioma.  A 1.3 cm hypodensity arising\nfrom the upper pole the right kidney is unchanged since at least ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  No supraclavicular lymphadenopathy.  No axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: The study is not tailored for examination of intra-abdominal\nfindings.  Within this limitation: There is a large hiatal hernia.  The\nesophagus is opacity and there is aerosolized material which is concerning for\naspiration and there is mass effect on the left main bronchus anteriorly (3;\n33), cannot exclude esophageal wall thickening or mass.  Gallbladder appears\ndistended without gallbladder wall thickening or pericholecystic fluid.  Fatty\nliver.  The kidneys are atrophic.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  Aortic valve calcifications\nare noted.  No pericardial effusion.\nPLEURA: Trace right pleural effusion is similar to prior.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar atelectasis and scarring is similar to prior. \nScarring and traction bronchiectasis and post radiation changes in the right\nupper lung from prior treatment of squamous cell carcinoma is similar to prior\nfrom ___. 3 mm left lower lobe nodule (5; 240) is seen.  A 4 mm left upper\nlobe nodule is similar to ___ (5; 254).  5 mm right middle lobe pulmonary\nnodules unchanged since ___ (5; 224).  A small right middle lobe nodule\n(5:228) is also unchanged.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The aorta is normal in caliber and main pulmonary artery is\nnormal in caliber.\nCHEST CAGE: Again seen is a compression deformity of T12 the with\napproximately 40% loss of height and vacuum phenomenon.  There is extension of\nair into the retroperitoneal soft tissues with surrounding soft tissue\nstranding and prominence around T11 and T12.  Moderate to severe right\nglenohumeral joint degenerative changes are noted with a small to moderate\njoint effusion (5; 55).  No suspicious osseous abnormality.  No acute\nfracture.",
            "output": "1. No focal consolidation.\n2. Esophagus is opacified and containing aerosolized material which puts the\npatient at risk for aspiration.  The dilated esophagus causes mild mass effect\non the left mainstem bronchus, and an esophageal wall mass or esophagitis\ncannot be excluded.\n3. Bilateral pulmonary nodules, overall similar to ___.\n4. Compression deformity of T12, progressed since ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Severe fatty hepatic infiltration and hepatomegaly. There is\nmild upper abdominal ascites.  Limited assessment of the upper abdomen is\notherwise unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy within the limitations of this noncontrast CT.\n\nHEART and PERICARDIUM: No pericardial effusion.  Mild coronary artery\ncalcification.\nPLEURA: There is a small right low-density pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Evaluation is moderately limited by respiratory motion. \nDiffuse ground-glass opacities worse at the lung bases, may represent sequela\nof low volumes or mild edema and appears similar to prior examination.\n2. AIRWAYS:  Retained secretions are noted in the right mainstem bronchus\n(series 302, image 85).  There is increased bronchial wall thickening at the\nright lung base with new platelike consolidation in the right lower lobe.\n3. VESSELS:  There is mild ectasia of the ascending aorta up to 4.2 cm.  The\nmain pulmonary artery is mildly enlarged.\nCHEST CAGE: Old anterior right healed rib fracture (series 601, image 29)\nnoted.  A 10 mm lucency (series 601, image 88) within the T10 vertebral body\nlikely represents small vertebral hemangioma and is unchanged from ___.",
            "output": "1.  Increased moderate bronchial wall thickening and platelike consolidation\nat the right lung base, may be due to aspiration or infection.\n2.  Bilateral ground-glass opacities are similar to ___ and may\nrepresent low lung volumes or mild edema.\n3.  Severe fatty liver infiltration and hepatomegaly, related to known\nalcoholic cirrhosis.  Mild upper abdominal ascites."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Normal\nappearance of the large mediastinal vessels.  No coronary or valvular\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable, as are the displayed parts of the upper abdomen.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nModerate scoliosis with mild secondary degenerative vertebral changes.  Mild\nbilateral apical scarring.  The airways are patent.  2 mm solid left upper\nlobe nodule.  2 mm solid pleural left lower lobe nodule (4, 178).  No\noverinflation.  No evidence of chronic airway changes.  No diffuse lung\ndisease.",
            "output": "2 small non suspicious pulmonary nodules that do not require follow-up.  No\nevidence of suspicious nodules or masses.  No evidence of acute or chronic\nairways disease.  No adenopathy.  No diffuse lung disease.  No pleural\nabnormalities."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE:  No enlarged axillary or supraclavicular lymph\nnode is seen.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen shows a 1.0 cm\nhypodense lesion in segment 2 of the liver, likely representing a cyst.\n\nMEDIASTINUM/HEART /PERICARDIUM:  The patient is status post CABG There is a\n10.2 x 4.0 x 7.0 cm hematoma within the anterior mediastinum extending from\nthe level of the aortic arch to the level of the inferior heart border.  The\nhematoma abuts the anterior aspect of the heart, however no significant mass\neffect is noted.  There is also a 3.7 x 2.6 cm hematoma along the pericardium,\nabout the right atrium (03:31).  There is a small to moderate pericardial\neffusion,  with areas of increased attenuation suggesting hemorrhage (03:33). \nThere is also a 3.9 x 2.4 x 3.8 cm subxiphoid hematoma (7b:80).  There is\ntrace pneumomediastinum.  Subcentimeter mediastinal lymph nodes are likely\nreactive.  Right PICC line has its tip terminating in the cavoatrial junction.\nHILA: Evaluation of the hila is limited given the absence of IV contrast.\n\nPLEURA: There are small bilateral partially loculated hydropneumothoraces.\nLUNG:\n\n-PARENCHYMA:  Consolidative opacities in both lower lobes likely represent\natelectasis, however superimposed infection cannot be completely excluded.\n-AIRWAYS:  Patent to the segmental level.\nCHEST CAGE: Median sternotomy wires are in place without evidence of wire\nfracture or sternal dehiscence.  Mild soft tissue stranding in the anterior\nchest wall bilaterally in keeping with postsurgical changes.",
            "output": "1.  Status post CABG with a 10.2 x 4.0 x 7.0 cm retrosternal hematoma, along\nwith a 3.9 x 2.4 x 3.8 cm subxiphoid hematoma.  The anterior mediastinal\nhematoma abuts the anterior aspect of the heart, however no significant mass\neffect is noted.\n2.  Small-to-moderate pericardial effusion along with a focus of\nhemopericardium and a 3.7 x 2.6 cm hematoma about the right atrium.\n3.  Trace pneumomediastinum and small bilateral partially loculated\nhydropneumothoraces.\n4.  Consolidative opacities in both lower lobes likely represent atelectasis,\nhowever superimposed infection cannot be completely excluded\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:03 ___, 3\nminutes after discovery of the findings."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without signs of\ninjury or mediastinal hematoma.  Residual thymic tissue is seen in the\nanterior mediastinal space.  The main pulmonary artery is normal in caliber. \nMildly prominent hilar lymph nodes are likely reactive.  No axillary or\nmediastinal lymphadenopathy is seen.  No pneumothorax or pneumomediastinum.\nThe the heart is mildly enlarged consistent with history of hypertrophic\ncardiomyopathy.  An AICD in the left chest wall noted with lead extending into\nthe right ventricle.  No pericardial or pearl oral effusion.\n\nThe lungs are clear without signs of focal injury.  Mild basal dependent\natelectasis is noted.  A thin walled cyst is noted within the right upper\nlobe.  No worrisome nodule, mass, or consolidation is seen.\n\nABDOMEN:  The liver and spleen appear intact without focal injury or adjacent\nfluid.  Main portal vein is patent.  No biliary ductal dilation.  The\ngallbladder, pancreas, and both adrenal glands appear normal.  There is duplex\nleft kidney with atrophic upper pole moiety.  No signs of renal injury.  Tiny\ncortical hypodensities are too small to characterize.  The abdominal aorta is\nnormal in course and caliber with widely patent major branches.  Duplicated\nright renal artery noted.  There is no retroperitoneal hematoma or adenopathy.\nThe stomach and duodenum appear normal.\n\nPELVIS:  Small enlarged bowel appear normal in course and caliber.  The\nappendix is normal.  Colonic diverticulosis without diverticulitis noted.  No\nsigns of bowel or mesenteric injury.  No pelvic free fluid.  The urinary\nbladder is only partially distended though appears normal.  No pelvic sidewall\nor inguinal adenopathy.\n\nBONES:  Mildly displaced fractures involving the left L1 and L2 transverse\nprocess noted.  No body wall hematoma.  Gas within the SI joints like yearly\ndue to vacuum phenomena and.  Small amount of extruded gas abuts the right SI\njoint.  Correlate for focal pain.\n\nMild gynecomastia noted bilaterally.",
            "output": "1. Minimally displaced fractures involving the left L1 and L2 transverse\nprocess.\n2. Mild cardiomegaly with AICD extending into the right ventricle.\n3. Duplex left renal collecting system with atrophic upper pole moiety."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are unremarkable.\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nSubcentimeter prevascular lymph nodes are unchanged compared to prior. Right\nhilar lymphadenopathy is difficult to separate from a known paramediastinal\nlung mass. Moderate cardiomegaly with biapical enlargement is unchanged. A\nprostatic mitral valve is noted. No pericardial effusion. No hiatal hernia is\npresent.\n\nThere has been interval removal of the right-sided chest tube with some\nreaccumulation of the small pleural effusion with fluid layering dependently\nat the lung base and within the major fissure. Again seen is irregular\nconsolidation within the right upper paramediastinal region of in the upper\nlobe corresponding to site of mass with associated radiation fibrosis. The\noverall configuration appears similar to the prior study. Bilateral\nground-glass nodules are similar compared to ___. Examples include a\nleft upper lobe ground-glass nodule measuring 11 x 8 mm (5:61) and an 14 x 11\nmm ground-glass nodule (5:77). Moderate centrilobular emphysema is unchanged.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.  Patient is status post median sternotomy with intact sternotomy\nwires.",
            "output": "1.  Similar appearance of right upper lobe lobe non-small-cell lung carcinoma\nwith associated radiation fibrosis\n\n2.  Slight interval reaccumulation of small right pleural effusion after\nremoval of PleurX catheter.\n\n3. Numerous ground-glass nodules concerning for bronchoalveolar cell carcinoma\nare unchanged since ___. Recommend continued attention on followup.\n\n4.  Stable cardiomegaly with severe biatrial enlargement\n\n5.  Unchanged moderate centrilobular emphysema"
        },
        {
            "input": "The most significant change since ___ has been the marked\nprogression of what was previously minimal and scattered ground-glass\nopacification, now involving most of the left lung, and large areas of the\nright lower lobe. Also new is consolidation at the posterior periphery of the\nleft lower lobe from the superior segment to the lung base.  The wide\ndistribution of this abnormality in the setting of hemoptysis suggests a\nbleeding diathesis, such as chemo toxicity, excessive anti coagulation, or\nthrombocytopenia. Concurrent pneumonia is not excluded, but is less likely.\n\nThere has been a slight the increase in the ___ of the conglomerate of\ntreated tumor and atelectatic lung in the right paramediastinal lung, more\nlikely due to greater atelectasis, but making it it impossible to exclude\nlocal recurrence at both the upper and lower poles of the right hilus.\nThickened pleura at the right apex is stable and there is no bone destruction\nto suggest local tumor recurrence in this location. Moderate volume of right\npleural fluid in the lower hemi thorax is stable, pleural calcification\nsuggesting prior pleurodesis.\n\nAdenopathy throughout the right paratracheal region is stable. There is no new\nadenopathy centrally. Deformity and narrowing of the superior segmental\nbronchus of the right lower lobe is stable. Left bronchial tree is patent.\n\nSmall left pleural effusion is new, but pleural surfaces are smooth. Severe\ncardiomegaly, predominantly biatrial, is chronic. There is no pericardial\neffusion. The thoracic aorta and pulmonary arteries are normal caliber. There\nare no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Generalized alveolar opacification, sparing on the right upper lung, is either\nentirely new or significant progression since ___ most likely\ndiffuse pulmonary hemorrhage.  Differential diagnosis discussed above.\n\nPossible local tumor recurrence, juxta hilar right lung, difficult to\nexcavatum distinguish from worsening atelectasis following T more radiation.\n\nIncreased small left pleural effusion. Stable moderate right pleural effusion,\nprobably loculated in the right lower hemi thorax, and apical pleural\nthickening.\n\nSevere biatrial cardiomegaly.\n\nNOTIFICATION:  Dr. ___ reported the findings to Dr ___ by telephone on\n___ at 5:45 ___,  minutes after discovery of the findings."
        },
        {
            "input": "There is no supraclavicular or axillary adenopathy or any soft tissue\nabnormality in the imaged chest wall suspicious for malignancy. This study is\nnot designed for subdiaphragmatic diagnosis, but shows no adrenal mass.\n\nThyroid is unremarkable. Atherosclerotic calcification is not apparent.\nPatient has had mitral valve replacement. Thoracic aorta is normal size.\nSevere cardiomegaly persists predominantly involving the left atrium and right\natrium. There is no appreciable pericardial or left pleural effusion. Moderate\nright pleural effusion with a fissural and apical component has developed mild\npleural calcification in the right upper chest suggests previous pleurodesis.\n\nSevere right upper lobe atelectasis is attributable to radiation fibrosis. The\nright middle lobe occupies most of the right anterior chest, and the lower\nlobe, occupies the posterior chest aside from radiation fibrosis in the\nsuperior segment.\n\nIt is difficult to distinguish residual or recurrent right hilar mass from\ndensely opacified collapsed lung, but there has been no change in contour or\nnarrowing of previously patent bronchi to suggest local recurrence at the\nhilus.\n\nSince ___, more than a dozen ground-glass lung nodules, mostly in the\nleft upper lobe are stable in approximate volume although diameters may\nchange, for example 10 x 12 mm, 05:38, previously 8 x 14 mm, and 8 x 20 mm,\n05:51, previously 11 x 17 mm.  None of these lesions has developed soft tissue\ncomponents to suggest transformation from carcinoma in situ to locally\ninvasive carcinoma. However there is a handful of new 2-4 mm solid nodules\npredominantly in the left lower lobe, 5: 158, 187, 198, 246, which could be\nhematogenous metastases.\n\nThis study is not designed for subdiaphragmatic diagnosis. Assessment of the\nliver would require dedicated abdominal imaging\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "New small left lower lobe lung nodules could be hematogenous metastases.\n\nModerate right pleural effusion with fissural and apical components, increased\nsince ___, not necessarily malignant, given severe cardiomegaly.\n\nSevere radiation fibrosis right upper lobe, superior segment right lower lobe.\n\nChronic ground-glass lung nodules, presumably multi focal adenocarcinoma\nspectrum malignancy, unchanged since ___ with no features to suggest\ntransformation from adenocarcinoma to invasive carcinoma.\n\nChronic severe cardiomegaly, predominantly biatrial."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta is normal in size throughout\nits intra thoracic course, with mild calcifications in the ascending aorta and\narch. The heart is severely enlarged, predominantly due to biatrial\nenlargement, unchanged since the prior study.  There is no pericardial\neffusion. Median sternotomy changes and prosthetic aortic valve are stable.\n\nPLEURA:  Moderate right pleural effusion with extensive fissural component is\nsimilar in volume compared to the prior study, with interval development of\nsmall loculated component along the anterior right lower lobe (02:44).  There\nis no left pleural effusion.\n\nLUNGS: Extensive right upper lobe atelectasis due to radiation fibrosis is\nsimilar in contour since the prior study, with no definitive evidence of local\ndisease recurrence.\n\nIncreased soft tissue in the superior segment of the right lower lobe is noted\nsince the prior study, now 21mm in axial dimension, slightly increased\ncompared to the prior study, but particularly more conspicuous compared to the\nstudy from ___ (4:136). There is slightly nodular interlobular\nseptal thickening in the right lung base (4:198), which has also progressed\nsince the prior study, raising concern for lymphangitic carcinomatosis\n(4:198).\n\nNumerous previously described ground-glass nodules in the left upper lobe are\nall similar in appearance, with internal nodular component of the largest such\nnodule in the left upper lobe (04:53), currently 16 x 9 mm in aggregate\ndimension, concerning for malignancy. Minimal interval growth of a single left\nlower lobe nodule from 3 mm to 5 mm is also noted (4:212).\n\nOther ground-glass nodules in the left upper lobe are stable, for example\n(04:55, 42, 71), as are small solid pulmonary nodules in the left upper and\nlower lobes are (4:95, 96, 99, 123, 141, 152, 154, 160, 180). Background\nemphysematous changes are again noted.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of subdiaphragmatic\nstructures, however no gross abnormalities are detected.",
            "output": "1. Increased confluent soft tissue consolidation in the superior segment of\nthe left lower lobe, concerning for disease recurrence.\n2. Minimal interval growth of a 5 mm left lower lobe nodule, and nodular\ncomponent of a predominately ground-glass nodule in the left upper lobe are\nalso concerning for malignancy.\n3. Other solid and ground-glass nodules are stable since the prior study from\n___.\n4. Moderate volume right pleural effusion, now with small loculated component\nalong the anterior right lung base.\n5. Stable severe cardiomegaly."
        },
        {
            "input": "Aorta and pulmonary arteries are stable in appearance, unremarkable. \nPrevascular lymph node is stable, 8 mm, series 2, image 21.  The soft tissues\nsurrounding the right hilus is similar to previous examination size wise,\nseries 2, image 29 although slightly denser than on the previous examination,\n2.3 cm in diameter.  Hyperdense focus in the superior portion of the soft\ntissues surrounding the right hilus, series 2, image 21 is unchanged.\n\nLeft atrial enlargement is substantial, unchanged. The patient is after mitral\nvalve replacement. Pacemaker lead terminates in the right ventricle.  Image\nportion of the upper abdomen reveals no appreciable abnormality. Right pleural\neffusion is similar to previous examination with hyperdense foci, most likely\nconsistent with pleurodesis.\n\nAirways are patent on the left to the subsegmental level. On the right right\nupper lobe airways are patent although there are traction bronchiectasis and\nalmost complete atelectasis of the right upper lobe. Right middle lobe airways\nare patent with mild bronchiectasis in right lower lobe airways are\nsubstantially attenuated by the soft tissue.\n\nLeft upper lobe ground-glass opacities some of them of 's with central solid\ncomponent are stable as well as left apical nodule, series 4, image 39.\nMultiple scattered pulmonary nodules in particular in the left upper lobe are\nsimilar to previous examination with no interval increase in size or new\nnodules development. Cystic structures are scattered throughout the lungs,\nunchanged. No substantial difference is demonstrated in the appearance of the\nright lower lobe with more confluent opacity, with septal thickening that\nmight reflect the presence of the tumor and lymphangitic spread locally. The\nonly new nodule demonstrated is a adjacent to the inferior pulmonary ligament\nin the left lower lobe, series 4, image 209 and currently 5 mm in diameter,\nattention to this area on the subsequent study is recommended.\n\nSeveral hyperdense foci are noted in the image portion of the skeleton, the\nare unchanged since the previous examination and potentially might represent\nbone islands rather than metastatic spread.",
            "output": "Overall stable appearance of the chest except for new nodule in the left lower\nlobe adjacent to the inferior pulmonary ligament as described in details\nabove.\n\nLeft pectoral enlargement in a patient with most likely presents with history\nof prior mitral valve stenosis.\n\nMultiple solid and ground-glass nodules are unchanged.\n\nUnchanged right pleural effusion with evidence of previous pleurodesis"
        },
        {
            "input": "Nodular appearance of right thyroid lobe is unchanged. A prominent prevascular\nnode (3:23) is unchanged.\nPatient has had mitral valve replacement.  Pacemaker lead terminates in the\nright ventricle.  There is cardiomegaly with enlarged right and left atria. \nPulmonary artery is top normal size.\n\nAirways are patent to the subsegmental levels on the left.  On the right,\nthere is right upper lobe bronchiectasis.  Right middle lobe airways is\npatent.  Right lower lobe airways are proximally narrowed with distal\nbronchiectasis.  Small right pleural effusion with hyperdense foci is\nconsistent with pleurodesis.\n\nThe large area of chronically collapsed right juxtamediastinal lung which\ncould  ___ a mass is largely unchanged.  The septal thickening of right\nlower lobe, consistent with lymphangitic spread of tumor, is increased\ncompared to prior.\nLeft upper lobe multi focal ground-glass opacities appear similar to prior.\nCystic changes throughout the lungs and radiation related changes in the right\nmiddle lobe are similar to prior.  There are mild numerous solid lesions\nthroughout the lung.  A 7 mm nodule in the left lower lobe (3:47) is larger\n(previously 5 mm).  Other nodules appear similar to prior.\n\nBONES/ SOFT TISSUE:  Multiple sclerotic bone lesions in the spine and ribs\nappear similar to prior.\n\nABDOMEN: Please see report for CT abdomen and pelvis obtained on the same day\nfor details of abdominal findings.",
            "output": "1.  Increased right lower lobe septal thickening since ___ is consistent\nwith slow progression of known malignancy.  At least one pulmonary nodule is\nincreased in size.  Numerous other pulmonary nodules appear similar to prior.\n\n2.  Large area of chronically collapsed, irradiated right   which may\nharjuxtamediastinal lung which could ___ residual  mass is largely\nunchanged."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest cage suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows no adrenal\nmass.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck or in coronary arteries.  Patient has had median sternotomy and\nmitral valve replacement.  Cardiomegaly predominantly biatrial, is unchanged. \nThere is no pericardial effusion.  Pulmonary arteries and thoracic aorta are\nnormal caliber and free of central filling defects.\n\nThe right upper lobe is chronically atelectatic due to radiation fibrosis. \nThe residual tumor at the upper pole of the right hilus, has not grown since\n___.  Inferiorly in the right hilus at the level of the superior segment\nto the lower lobe is a 22 mm mass, 03:32, which although slightly smaller than\nit was in ___ mm, still obstructs the segmental bronchi to the superior\nand posterior basal segments in severely compromises the basal trunk.  This\nappearance is unchanged since at least ___.  Segment and severely\ncompromises the basal trunk.   Small right pleural effusion and pleural\nthickening, with calcification indicating prior pleurodesis, is essentially\nunchanged.\n\nIrregularly thickened septal lines interspersed with many small nodules in the\nright lower lobe, unchanged since ___, is probably local lymphangitic\ncarcinomatosis.  Scores of tiny lung nodules throughout the remainder of the\nlungs, are unchanged, for example 5 mm left lower lobe nodule, 5:248.\n\nSmall blastic nodules are more numerous in the thoracic spine, presumably\ntreated metastases.  There are no appreciable lytic lesions and no compression\nfractures.",
            "output": "Lower pole right hilar mass is slower, and an increase in number of blastic\nbone lesions is probably in indication of treatment effect on previously in\napparent lytic lesions.\n\nNo evidence of worsening since ___ in extensive metastatic non-small\ncell lung carcinoma:  Right hilar masses with lower lobe bronchial\nobstruction, right lower lobe lymphangitic carcinomatosis, multiple metastatic\npulmonary nodules.  Stable right pleural thickening and small effusion."
        },
        {
            "input": "Thyroid gland is unremarkable.\n\nHeart size is enlarged, without pericardial effusion.  Mild atherosclerotic\ncalcifications are noted in the thoracic aorta, which is without aneurysmal\ndilation.  Main pulmonary artery is normal in caliber.  No evidence of\npulmonary embolism to the proximal subsegmental levels.  Evaluation of the\ndistal subsegmental levels is slightly limited by respiratory motion.\n\nThere is no evidence of axillary or supraclavicular lymphadenopathy.\nCentrilobular emphysema is moderate in severity. Diffuse confluent soft tissue\nwithin the mediastinum extends to the subcarinal region is likely related to\npost radiation change. Volume loss and fibrotic changes are again noted in the\nright upper lobe.  No significant interval change in size of residual right\nperihilar tumor which obstructs the adjacent segmental superior and posterior\nbasal segmental bronchi.  There is thickening of the interlobular septa with\ninnumerable micronodules predominantly in the right lower lobe, suggestive of\nlymphangitic carcinomatosis.  Numerous additional scattered nodules are not\nsignificantly changed.\n\nLimited images of the upper abdomen demonstrate no gross abnormalities.\n\nEvaluation of the osseous structures demonstrates numerous sclerotic\nmetastases scattered throughout the thoracic spine.  There are also sclerotic\nlesions in the right ___ and 7th ribs (Se 9: Im 6, 8).  These are not\nsignificantly changed appearance compared to ___.",
            "output": "1. No evidence of pulmonary embolism to the proximal subsegmental level. \nEvaluation of the distal subsegmental levels is slightly limited by\nrespiratory motion.\n2. Otherwise no significant interval change in the known right perihilar mass\nwith suggestion of lymphangitic carcinomatosis and innumerable scattered\nnodules.\n3. Scattered sclerotic metastases involving the thoracic spine, and right ___\nand 7th ribs.\n\nNOTIFICATION:  Findings regarding sclerotic metastases were discussed by Dr.\n___ with Dr. ___ on the telephoneon ___ at 12:15 ___,\n1 minutes after discovery of the findings."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without a focal lesion\nidentified.  There is no axillary or supraclavicular adenopathy.  A left chest\ncardiac device is identified, its lead which terminates within the right\nventricle.\n\nHeart size is enlarged.  There is prominent biatrial enlargement.  Mild\natherosclerotic calcifications are identified within the visualized thoracic\naorta as well as involving the lateral aortic arch.  Patient is status post\nmedian sternotomy and mitral valve replacement.  Trace pericardial fluid is\nphysiologic.\n\nHigh density is identified involving the right pleura predominantly\nposteriorly and superiorly as well as adjacent to the mediastinum.  Findings\nmay reflect calcifications or alternatively sequela of pleurodesis.\n\nBilateral nonhemorrhagic pleural effusions are present, the left which is\nsmall and layering.  There is near complete collapse of the right upper lobe\nas well as the right middle lobe.  Nonhemorrhagic fluid is identified within\nthe minor and major fissures.\n\nLung windows are motion degraded.  There is mild to moderate background\ncentrilobular emphysema.   Scattered peribronchiolar opacities within the left\nupper and lower lobes are noted with a more focal consolidation within the\nlingula where air bronchograms are present.  A large consolidation is present\nwithin the right lower lobe superiorly with scattered areas of aerated\nalveoli.  A known right hilar mass is difficult to delineate.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, no appreciable\nabnormality is identified.\n\nSclerotic foci within the T1 vertebral body appear stable.  A sclerotic focus\nwithin the seventh right rib laterally (03:43) is unchanged.  Scattered\nsclerotic foci within the visualized thoracolumbar spine are presumably\nmetastatic.  Vertebral body heights are however preserved.",
            "output": "1.  Near complete collapse of the right upper lobe and probably right middle\nlobe with severe narrowing of the associated bronchi at the level of the right\nhilum.\n2. A known right hilar mass is obscured by a large consolidation within the\nright lower lobe superior.  Scattered peribronchiolar opacities within the\nleft upper and lower lobes as well as a consolidation within the lingula\nassociated with air bronchograms is worrisome for multifocal pneumonia.\n3.  Bilateral pleural effusions, right greater than left.  FLuid is present\nwithin the minor and major fissures but not definitely loculated.  The left\npleural effusion is layering, nonhemorrhagic and small.\n4.  Multiple sclerotic lesions within the thoracolumbar spine and right ribs\nworrisome for metastatic disease, unchanged."
        },
        {
            "input": "The intrathoracic aorta demonstrates calcified atherosclerotic disease without\nassociated aneurysmal changes. This study is not optimized for assessment of\nthe pulmonary emboli and patient motion limits evaluation. However, perfusion\ndefects are seen within the right and left main pulmonary arteries, concerning\nfor PE. The great vessels are otherwise unremarkable. Heart is normal in size\nwithout pericardial effusion.\n\nThere are multiple pathologically enlarged central lymph nodes. For example, a\nright peritracheal lymph node measures 2.5 x 3.1 cm (06:21). A prevascular\nnode measures 1.8 x 2.1 cm (06:21). There is a pathologically enlarged right\nsupraclavicular lymph node measuring 1.8 x 1.8 cm (06:12).\n\nThere is a dominant mass in the right lower lobe measuring 2.6 x 4.1 x 5.3 cm\nextending to the pleural surface. There is a spiculated nodule at the right\nlung apex measuring approximately 9 mm (8:91). An additional spiculated part\nsolid part ground-glass nodule is seen in the right upper lobe measuring 1.6 x\n1.5 cm extending to the pleural surface (08:13 10). Centrilobular emphysema is\nmost pronounced in the upper lobes. There is no focal consolidation or pleural\neffusion.\n\nOsseous structures: No suspicious lytic or sclerotic bony lesion is seen.",
            "output": "1. Dominant mass in the right lower lobe , suggestive of primary lung\nmalignancy. Two additional suspicious spiculated nodules are seen in the right\nupper lobe.\n2. Bilateral PE.\n3. Central and right supraclavicular lymphadenopathy.\n\nNOTIFICATION:  Findings discussed with Dr. ___ At 18:00 ___ by\nphone immediately after discovery."
        },
        {
            "input": "CT CHEST WITH CONTRAST: There is no supraclavicular, axillary, mediastinal or\nhilar lymphadenopathy. There is a right breast implant.\n\nThe heart is not enlarged and there is no pericardial effusion. The aorta and\nmain thoracic vessels are well opacified and normal in caliber. The pulmonary\narteries are normally opacified to the subsegmental level without filling\ndefect.\n\nThe lungs show no focal consolidation. There is no pleural effusion or\npneumothorax. Atelectasis at the lung bases is mild. The tracheobronchial tree\nis patent to the subsegmental level. Minimal mosaic attenuation of the lung\nbases but may be secondary to imaging during expiratory phase or relate to\nminimal pulmonary edema or air trapping.\n\nOSSEOUS STRUCTURES: There are no worrisome blastic or lytic lesions.\n\nUPPER ABDOMEN: This study is not designed for evaluation of the\nsubdiaphragmatic structures however the partially upper abdomen is\nunremarkable.",
            "output": "1. No evidence of pulmonary embolism.\n2. Minimal mosaic attenuation of the lung bases but may be secondary to\nimaging during expiratory phase or relate to minimal pulmonary edema or air\ntrapping."
        },
        {
            "input": "Widespread severe pulmonary abnormality involves all lobes, most pronounced in\nthe posterior and dependent lungs, where it has a peripheral distribution, but\nthere is also extensive peribronchial vascular distribution, such as in the\nposterior subsegment left upper lobe, 4:96 and in the superior segment of the\nright lower lobe, 4:132.  The abnormality consists of clear reticulation\ninvolving thickening of the interlobular septi and intra lobular lines, with\nthe background attenuation ranging from ground-glass to consolidation. It has\na fibrosing component, reflected in traction dilatation of peripheral bronchi\nfor example right lower lobe posterior basal segment, 4:140 -156, and left\nlower lobe posterior basal segment, 4:151- 154. Although I do not believe\nthere is genuine honeycombing, there are some large subpleural cystic spaces\nin the left lower lobe predominantly posterior basal segment, 4:173- 187 and\nright lower lobe posterior basal segment, 4:184-196.\n\nThere is no supraclavicular or axillary lymphadenopathy and there are no soft\ntissue abnormalities in the chest wall suspicious for malignancy, although\nevaluation of the breast requires mammography. This study is not designed for\nsubdiaphragmatic diagnosis but shows normal-size adrenal glands and spleen.\n\nCentral lymph nodes are enlarged as follows:\n\nPrevascular station up to 12 x 21 mm, 4:85.\n\nRight lower paratracheal station up to 9 x 13 mm, 4:98.\n\nRight hilus, 11 x 16 mm, 04:10 9.\n\nThere is no internal mammary retrocrural lymph node enlargement. Minimal\npericardial effusion is physiologic. Dilated main pulmonary artery, 33 mm,\nsuggest pulmonary arterial hypertension. Ascending thoracic aorta is non\ncalcified, top normal size, 40 mm. Atherosclerotic calcification is seen in\nthe left main, left anterior descending coronary arteries are although this\nstudy is not designed for cardiac evaluation it shows global moderate\ncardiomegaly.\n\nThere are no bone findings in the chest cage suspicious for malignancy or\ninfection. ,",
            "output": "Interpretation of the considerable radiographic findings on the CT scan would\nbe improved given the opportunity to review passed imaging, both remote and\nrecent.\n\nFINDINGS in the lungs are not typical of sarcoidosis, but certainly not\nimpossible of chronic disease. They are more suggestive of fibrosing\nnonspecific interstitial pneumonitis or the organizing stage following\nrecovery from ARDS or acute and chronic drug injury. Concurrent infection,\nparticularly with pneumocystis could be contributing some of the findings, but\nwould not be responsible for the total picture of pulmonary abnormality since\nthis condition really gives such well-defined reticulation. This extremely\nbroad differential diagnosis would be significantly narrowed by a review of\nprior imaging and correlation with detailed clinical history.\n\nDetermining the cause of the mild to moderate mediastinal, minimal hilar\nadenopathy, chronicity indeterminate, is probably of less consequence than\ndiagnosing the lung disease, since the lymph nodes are most likely either\nreactive to the lung condition or the residual of remote sarcoidosis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The inferior neck is largely\nobscured by streak artifact from bilateral shoulder prostheses.\n\nUPPER ABDOMEN: There is no gross abnormality of the visualized upper abdominal\nstructures.\n\nMEDIASTINUM: There is postoperative pneumomediastinum.  Prominent mediastinal\nlymph nodes, for example a 1.1 cm short axis right precarinal lymph node\n(series 3, image 24), are likely reactive.\n\nHILA: There is no bulky hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  There is no pericardial\neffusion. There are epicardial pacer wires.\nPLEURA: There are small bilateral pleural effusions.  There is a small left\npneumothorax.\nLUNG:\n\n-PARENCHYMA:  There is moderate atelectasis of both lower lobes and other\nscattered subsegmental atelectasis in both lungs.  Superimposed infection is\nnot excluded in the appropriate clinical setting.  There is no mass or\nsuspicious nodule within the aerated lungs.\n-AIRWAYS:  The central tracheobronchial tree is patent.\n-VESSELS:  There are postsurgical changes of ascending aorta/proximal arch\nreplacement.  There is postoperative fluid adjacent to the graft, with varying\nattenuated representing hematoma or seroma.  A right PICC terminates at the\ncavoatrial junction.\nCHEST CAGE: There are postsurgical changes of median sternotomy. Note is made\nof 4 mm separation of the manubrium and 8 mm separation of the xiphoid.  The\nremainder of the sternum remains apposed.  The sternotomy wires are intact.",
            "output": "1.  Postsurgical changes of ascending aorta/proximal arch replacement. \nExpected postoperative findings, including pneumomediastinum, fluid adjacent\nto the graft (hematoma or seroma), and small left pneumothorax.\n\n2.  Median sternotomy with 4 mm separation of the manubrium an 8 mm separation\nof the xiphoid.  The remainder of the sternum remains apposed.  Intact\nsternotomy wires.\n\n3.  Moderate atelectasis of both lower lobes and other scattered subsegmental\natelectasis.  Superimposed infection is not excluded in the appropriate\nclinical setting.  Small bilateral pleural effusions."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  A\nprominent left supraclavicular lymph node measures 6 mm on the current\nexamination (09:46), and is unchanged since the prior exam.  There is no lower\ncervical or axillary lymphadenopathy\n\nUPPER ABDOMEN: Please see report from dedicated CT of the abdomen and pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Prominent paratracheal\nlymph nodes are unchanged.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Name the heart is normal in size.  The patient has\nundergone prior aortic root aneurysm repair, without evidence of complication\non this non dedicated examination.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Mild emphysema is re-demonstrated.  There are no nodules or\nconsolidations.  Minimal bibasilar atelectasis is present.\n2. AIRWAYS:  The airways are patent to the subsegmental level, though are\ndiffusely thickened.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are normal in\ncaliber.\nCHEST CAGE: Midline sternal wires are intact and aligned.  No acute fracture\nor suspicious focal osseous lesions are identified.  There is chronic, mild\nwedging of several upper thoracic spine vertebral body.",
            "output": "1.  No evidence metastatic disease in the chest.\n2.  Please see report from dedicated CT of the abdomen"
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged.  There are no soft tissue\nabnormalities in the chest imaged chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\n Low density lesion in the left thyroid lobe is too small to warrant further\nimaging evaluation.  Atherosclerotic calcification in the head and neck\nvessels and in the coronaries is not apparent.\n\nAorta and central pulmonary arteries are normal size and free of filling\ndefects.  Cardiac chambers are not enlarged.  Pericardium is physiologic. \nThere is no pleural abnormality.\n\nCentral lymph nodes are not pathologically enlarged.\n\nBiapical pleural parenchymal scarring is symmetric and unchanged.  Right lung\nis essentially clear aside from mild atelectasis or scarring adjacent to the\nmediastinum in the medial segment of the right middle lobe.\n\n10 mm bilobed left upper lobe spiculated lung mass, 9 x 23 mm at the level of\nits greatest cross-sectional area was 21 x 25 mm in ___.  The lesion is\nprobably growing endobronchially, and its point of origin in the apical\nposterior segmental bronchus to the left upper lobe, seen on image 6:125 is\nalso smaller.  In ___, the left upper lobe mass was 52 x 49 mm.  There are\nno new left lung lesions and no bone lesions in the chest cage suspicious for\nmalignancy.",
            "output": "Continued involution, left upper lobe lung mass, and no evidence of new or\nprogressive intrathoracic malignancy."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nDiffuse low-attenuation of the blood pool suggests anemia, correlate with lab\nvalues.\n\nThere is mild thickening of the proximal to mid esophagus (5:71).  A\nspiculated left upper lobe mass measuring 19 x 9 mm (5:110) corresponds to the\nknown non-small-cell lung cancer and is slightly smaller compared with ___, previously measuring 23 x 9 mm.  Mild apical predominant centrilobular\nemphysema is stable.  Pulmonary nodules measuring 3 mm and 2 mm in the right\nupper lobe are stable from the prior study (5:91, 122).  No additional\npulmonary nodules are identified.",
            "output": "1. Spiculated left upper lobe mass measuring up to 19 mm is slightly smaller\ncompared with ___.\n2. No evidence of new or progressive intrathoracic malignancy.\n3. Mild mid and proximal esophageal wall thickening compatible with history of\n___ esophagitis.\n4. CT evidence of anemia, correlate with lab values.\n5. Stable sub 4 mm pulmonary nodules as described above.\n6. Please see the separately submitted report of the same day CT Abdomen and\nPelvis for findings below the diaphragm."
        },
        {
            "input": "A 1.2 cm hypodense nodule in the left lobe of the thyroid appears similar to\nprior.  No supraclavicular, axillary, mediastinal or hilar lymphadenopathy by\nCT size criteria.  Normal heart size and normal caliber of the great vessels. \nMild coronary artery calcifications.  No pleural or pericardial effusion.  The\nesophagus appears mildly thickened, similar to prior.\n\nThe airways are patent to the subsegmental level.  Subpleural emphysema is\nstable.  The dominant spiculated nodule in the left upper lobe has decreased\nin size measuring 0.8 x 1.6 cm, previously 1.1 x 2 cm.  Small subpleural\nnodules measuring up to 3 mm are unchanged (3:37, 83, 141, 184 and 234).  No\nnew or growing nodules are identified.\n\nFor details regarding the abdomen pelvis please see dedicated abdomen pelvis\nCT report.\n\nMinimal irregularity of the left ninth rib is unchanged (3:282).  No lytic or\nsclerotic lesions suspicious for metastasis is identified.",
            "output": "1. Decreased size of spiculated left upper lobe nodule consistent with\npatient's known non-small-cell lung cancer.\n2. Unchanged small subpleural nodules.  No new or growing nodules.\n3. Persistent mild esophageal thickening, which could reflect esophagitis in\nthe correct clinical setting."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Satisfactory position of\nendotracheal tube.  Otherwise unremarkable.\n\nUPPER ABDOMEN: See separate CT abdomen report.\n\nMEDIASTINUM: Stable scattered subcentimeter lymph nodes most primary involving\nthe right low paratracheal change.  No suspicious lymphadenopathy.  No mass. \nLeft central venous catheter terminates within the cavoatrial junction. \nEnteric tube in place terminating within the stomach.\n\nHILA: Normal.\n\nHEART and PERICARDIUM: Heart size is stable.  Stable degree of coronary artery\nand valvular calcifications.  No significant pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  6 mm pulmonary nodule left upper lobe series 302, image 73. \nNo additional pulmonary nodules.  Dependent subsegmental atelectasis/scarring\ninvolving the left greater than right lower lobes.  Scattered ground-glass\nopacities throughout both lungs could be related to breathing motion and\nexpiration phase the CT.\n2. AIRWAYS:  Normal.\n3. VESSELS:  Normal.",
            "output": "NO ACUTE INTRATHORACIC PROCESS IDENTIFIED ON THIS NONCONTRAST CT OF THE CHEST.\nSPECIFICALLY, NO EVIDENCE OF INFECTION.\n\n6 MM PULMONARY NODULE LEFT UPPER LOBE FOR WHICH FOLLOW-UP CT IS RECOMMENDED in\n___ months.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is unremarkable. Axillary, supraclavicular, mediastinal, and hilar\nlymph nodes are not pathologically enlarged.  There is calcification of the\naortic valve and coronary arteries. Per medical record, patient has anomalous\norigin of the left circumflex coronary artery arising from the right coronary\ncusp, however this is not clearly delineated in this study.  The heart and\nmediastinum are otherwise unremarkable. The pericardium is intact without\neffusion.  There is mild bibasilar atelectasis and bronchial wall thickening\nwith mucous plugging.\n\nThere is mild diffuse centrilobular emphysema. The pleura is intact without\neffusion. No pneumothorax or pneumomediastinum.  Bibasilar opacities are\nlikely due to atelectasis.\n\nThe esophagus is notable for a small hiatal hernia.  There is a replaced left\nhepatic artery arising from left gastric artery.  There are prominent\nperiportal and celiac lymph nodes, which are nonspecific, up to 1.3 cm in\nshort axis. Gallbladder contains gallstones without evidence of cholecystitis.\nOther visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Old left seventh and eighth rib fractures are noted.",
            "output": "1. No evidence of pulmonary embolism.\n\n2. There is bibasilar bronchial wall thickening with mucous plugging,\nsuggestive of small airways inflammation or bronchitis.\n\n3. There are prominent periportal and celiac lymph nodes, which are\nnonspecific.\n\n4. There is aortic valve calcification. Known anomalous left circumflex\ncoronary artery is not clearly delineated in this study.\n\nNOTIFICATION:   The updated wet read was discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 2:20pm 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "The thyroid is normal.\n\nThough this study is not designed for cardiac chamber evaluation, the heart\nappears mildly enlarged. There is a moderate sized, nonhemorrhagic pericardial\neffusion. Bilateral internal jugular approach central catheters. The right\nSwan-Ganz catheter terminates in the proximal right main pulmonary artery and\nthe left internal jugular central catheter terminates in the distal SVC.\nAortic valve replacement is in place. 3 vessel coronary artery calcifications\nare mild. Epicardial leads terminate in the anterior mediastinum in the region\nof the an intermediate density, postoperative fluid collection.\n\nThere is no pathologic supraclavicular, axillary, hilar or mediastinal\nlymphadenopathy.\n\nSecretions occlude the right bronchus intermedius and the right middle lobar\nbronchus with associated complete atelectatic collapse of the right lower lobe\nand partial atelectatic collapse of the right middle lobe. Dependent\ncompressive atelectasis in the right upper lobe is mild. Left chest tube\npigtail terminates posteriorly in the left apex. There is a trace left-sided\npleural effusion. Nonhemorrhagic right sided pleural effusion is moderate to\nlarge. Dependent left-sided atelectasis is mild. There is no nodule. There is\nno pneumothorax.\n\nWhile this study is not tailored for subdiaphragmatic diagnosis, the imaged\nupper abdomen is notable for cholelithiasis, as well as a few, scattered, non\nenlarged porta hepatis lymph nodes.\n\nBones and soft tissues: Median sternotomy wires are intact. The thoracic cage\nis intact without suspicious focal lesion. The bones are generally\ndemineralized. Thoracic degenerative changes are moderate.",
            "output": "1. Secretions occlude the right bronchus intermedius and the right middle\nlobar bronchus with associated complete atelectatic collapse of the right\nlower lobe and partial atelectatic collapse of the right middle lobe.\nSuperimposed infection cannot be excluded in the appropriate clinical\ncircumstance.\n2. New moderate to large right-sided and trace left-sided nonhemorrhagic\npleural effusions with associated adjacent compressive atelectasis.\n3. Moderate, partially hemorrhagic postsurgical fluid collection in the\nanterior mediastinum.\n4. Cholelithiasis.\n5. Postoperative changes of the thorax, as above.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with ___, PA, on\nthe telephone on ___ at 10:48 AM, 2 minutes after discovery of the\nfindings."
        },
        {
            "input": "The examination is compared to ___.\nThe left pigtail catheter has been removed. As a consequence, the extent of\nthe left pleural effusion has increased.  On the other hand, the extent of the\nright pleural effusion is almost unchanged. Both effusions now occupy\napproximately ___ percent of the respective hemithoracic volumes.  Areas of\ndorsal atelectasis are seen in unchanged manner. Also unchanged is the extent\nand severity of the pericardial effusion.  Unchanged cardiomegaly.  Status\npost sternotomy and valvular replacement, the extent of the retrosternal fluid\ncollection (5, 32) is only minimally decreased.  The pre-existing secretions\nin the right-sided bronchial system and in the larger airways is no longer\nvisualized. Areas of extensive atelectasis at seen at both lung bases.  In\naddition, new bronchus centric opacities are seen in the right lung,\npotentially reflecting additional atelectasis or aspiration.  No pneumothorax.\nThe appearance of the large vessels is unchanged.",
            "output": "Minimal decrease in extent of the right pleural effusion but increase of the\nleft pleural effusion, of the removal of a pleural pigtail catheter.  Subtle\nnew parenchymal opacities on the right may reflect new atelectasis or\naspiration.  Unchanged pericardial effusion. Minimally decreased retrosternal\nfluid collection.  No pneumothorax."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate enlargement of the main pulmonary artery,\nunchanged as compared to the previous examination.  Mild coronary\ncalcifications, no valvular calcifications.  Mild enlargement of the right\natrium.  Overall borderline size of the cardiac silhouette.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  No enlarged hilar or\nmediastinal lymph nodes.  Mild bilateral adrenal enlargement, the upper\nabdominal findings are described in detail in the dedicated abdominal CT\nreport.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.  No osteolytic lesions at the level of the ribs, the sternum or the\nvertebral bodies.  Suboptimal inspiratory have Ford.  Resulting attenuation\nheterogeneities in the lung parenchyma.  No evidence of suspicious lung\nnodules.  No masses.  No pleural thickening.  No pleural effusions.  The\nairways are patent.  No diffuse lung disease.",
            "output": "No evidence of intra thoracic malignancy.  Moderate dilatation of the main\npulmonary artery, suggesting pulmonary hypertension.  No lymphadenopathy.  No\npleural pathology."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.   The main pulmonary artery is top normal\nmeasuring 3.4 cm across maximal diameter (3:83).\n\nThere are prominent axillary lymph nodes measuring up to 7 mm across shortest\naxis(3:78) which are not pathologically enlarged by CT size criteria there is\nno supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.  The\nthyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion. \nHeart is mildly enlarged.\n\nThere is minimal  atelectasis in the right lower lobe adjacent to an\nosteophyte (02:55).  There is interlobular septal thickening and mild\nbronchial wall thickening either secondary to mild pulmonary interstitial\nedema versus a reactive small airway disease.   Mosaic like changes are likely\ndue to air trapping The airways are patent to the subsegmental level.\n\nThere is nodular hyperplasia of the left adrenal gland.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary emboli.\n2.  Cardiomegaly.\n3.  Interlobular septal thickening and mild bronchial wall thickening likely\nsecondary to mild interstitial edema versus small airway disease.\n4.  Likely nodular hyperplasia of the left adrenal gland."
        },
        {
            "input": "The thyroid is normal.  There are several enlarged mediastinal lymph nodes\nidentified, for example, a 1.0 cm sub-carinal lymph node (6:130). There are\nmultiple prominent bilateral axillary lymph nodes, not enlarged by CT size\ncriteria.\n\nThe great vessels are normal caliber. The heart size is normal. \nRedemonstrated is a trace pericardial effusion.\n\nThere has been interval placement of a right-sided chest tube terminating at\nthe right lung base, in addition to right-sided pleurodesis.  A remnant, small\nright pleural effusion has significantly decreased in size compared to prior\nexamination. However, there has been an interval development of a significant\nright lower lobe consolidation. Additionally, there is now fluid seen within\nan area of focal bronchiectasis in the superior left lower lobe (03:28).\n\nRedemonstrated are multiple right lung pulmonary nodules, compatible with the\npatient's known metastatic disease and without significant interval change as\ncompared to the prior examination performed on ___. There is a\npersistent, ill-defined right hilar soft tissue lesion with adjacent\nthickening extending along the right mainstem bronchus causing resultant mild\nnarrowing without focal lesion. Persistent septal thickening and nodularity is\nnoted within the right lung, compatible with lymphangitic carcinomatosis.\nThere is underlying moderate-severe centrilobular emphysema.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. However, within this limitation, the visualized portions of the\nintra-abdominal organs are within normal limits.",
            "output": "1.  Interval development of a large right lower lobe consolidation and fluid\nfilled left lower lobe bronchiectasis, highly concerning for an underlying\ninfectious etiology.\n2. Status post right chest tube placement and right pleurodesis with a small\nresidual right pleural effusion and.\n3.  Innumerable, confluent metastatic deposits within the right lung and\nmediastinal lymphadenopathy, largely unchanged compared to the prior\nexamination.\n4.  Moderate-severe centrilobular emphysema.\n\nNOTIFICATION:  Findings were entered into the radiology dashboard by Dr.\n___ at 14:54 on ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple enlarged paracardiac lymph nodes are\nnoted the largest measuring 5.3 x 4.2 cm (6:198).  Enlarged internal mammary\nlymph nodes are also noted measuring up to 2.0 cm (6:76).  A rounded right\naxillary node measures 8 mm.\n\nPLEURAL SPACES: Large bilateral pleural effusions are noted, left greater than\nright.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis, left greater than right, are noted.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates partially imaged\nhypodensities in the spleen better evaluated on outside hospital CT abdomen\nand pelvis from ___.  Perihepatic and perisplenic ascites is also\nnoted.\n\nBONES: No suspicious osseous abnormality is seen.  There is a chronic right\nclavicle fracture.  A lower thoracic vertebral body hemangioma is noted. \n?There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Paracardiac and internal mammary lymphadenopathy concerning for malignancy.\n3. Moderate to large bilateral pleural effusions, left greater than right.\n4. Bibasilar consolidations, left greater than right, likely reflecting\natelectasis.\n5. Partially imaged upper abdomen demonstrates multiple splenic hypodensities\nand perihepatic/perisplenic ascites better evaluated on outside hospital CT\nfrom ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Right anterior port with\ntip in the cavoatrial junction.  No atherosclerotic calcifications in the head\nand neck arteries.  Left PICC line ends in the lower SVC.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  Pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nEnteric tube passing through the esophagus which is otherwise unremarkable. \nSmall mediastinal lymph nodes, none pathologically enlarged by CT size\ncriteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe patient is intubated and the ET tube is appropriately placed.  Secretions\nare noted above the endotracheal tube cuff.  Diffuse and extensive\nground-glass opacities at the bilateral and symmetrical distribution with no\nassociated interstitial component.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Diffuse and extensive bilateral ground-glass opacities with no\nanterior-posterior gradient and no associated pleural effusions are concerning\nfor PCP.\n\nNOTIFICATION:  The findings were discussed with ___ M.D. by ___\n___, M.D. on the telephone on ___ at 2:43 pm."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout. \nNo filling defects in the main pulmonary artery throughout and subsegmental\nbranches bilaterally.  No aortic dissection, aneurysmal dilation or\npenetrating atherosclerotic ulcers.  No evidence of right heart strain.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Right anterior port with\ntip in the cavoatrial junction.  No atherosclerotic calcifications in the head\nand neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe endotracheal tube has been removed.  Airways are now patent to the\nsubsegmental levels with no bronchiectasis, bronchial wall thickening or\nmucous plugging associated.  Redemonstration of bilateral ground-glass\nopacities, symmetrical and with subpleural sparing, significantly improved\ncompared to prior study though still extensive.  No suspicious lung nodules or\nmasses.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nFindings.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nWidespread, but improved, previously severe generalized pneumonitis and/or\nedema."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout. \nNo aortic dissection, aneurysmal dilation or penetrating atherosclerotic\nulcers.  There are no filling defect in the main pulmonary artery throughout\nand subsegmental branches bilaterally.  No evidence of right heart strain.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Right anterior port with tip of in the cavoatrial junction. \nNo atherosclerotic calcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEnteric tube passing through the esophagus which is otherwise unremarkable. \nNew gas foci are noted in the mediastinum, notably in the superior aspect\n(04:32).  No enlarged mediastinal lymph nodes by CT size criteria.  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe patient is intubated with appropriate placement of the T-tube.  Secretions\nare noted above the endotracheal tube cuff.  The airways are patent to the\nsubsegmental levels with no bronchial wall thickening or mucoid impaction. \nMild diffuse bronchiectasis is noted in the lower lobes.  Bilateral diffuse\nextensive ground-glass opacities are worse when compared to prior study.  No\ngrossly large suspicious lung nodules or masses.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show small hypodense nodule in the\nleft hepatic lobe measuring 1.4 cm (4:105), likely a cyst or biliary\nhamartoma.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nWorsening diffuse extensive bilateral ground glass opacities are concerning\nfor interstitial pneumonitis.  Differential diagnosis includes GVHD , drug\ntoxicity and ARDS.\nNew pneumomediastinum, most likely related to barotrauma.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:31 pm."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged portion of the thyroid need further\nimaging.  Fluid pools in the airway above and otherwise unremarkable looking\ntracheostomy.  No supraclavicular or axillary adenopathy. New small right\nparamedian subcutaneous soft tissue nodules from the level of the sternal\nnotch to the carina, 5:76-108, could be areas of early infection, fat\nnecrosis, or bleeding if patient had chest compressions since ___.  There\nare no fractures.\n\nThe region around the right pectoral subcutaneous infusion port is\nunremarkable.\n\nCARDIO-MEDIASTINUM:Esophagus is traversed by an enteric drainage tube that\npasses into the stomach and out of view.  Atherosclerotic calcification is not\napparent in head and neck vessels or the coronary arteries.  Previous\npulmonary artery dilatation has decreased from 36 to 32 mm, probably\nreflecting decrease pulmonary vascular resistance and hypertension.  Aorta and\ncardiac chambers are normal size.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: None enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Widespread one non depend ground-glass opacification,\nis the dominant pulmonary abnormality, very similar in severity in\ndistribution to ___.  However changes include more peripheral involvement,\nleft upper lobe anterior segment, 5:100-127 interstitial infiltration, right\nlung base, and mild traction bronchiectasis inferior to that, 5:159, 190. \nSmall nonhemorrhagic layering bilateral pleural effusions are new.  There is\nno pleural enhancement to suggest infection.\n\nThere is no consolidation to signal pneumonia or any findings of septic or\nother pulmonary emboli.\n\n\nCHEST CAGE:",
            "output": "Mild progression, mild fibrosis associated with persistent severe alveolitis. \nNo evidence of pneumonia.\n\nSubcutaneous paramedian nodules, right upper chest could be due to to early\ninfection, fat necrosis, or residual bleeding from trauma such as chest\ncompressions, given the appropriate clinical history.\n\nNew small nonhemorrhagic pleural effusions, absent any findings of active\ncardiac decompensation."
        },
        {
            "input": "Multiple thyroid hypodensities measuring up to 1.0 cm are better appreciated\non CT ___.  There is no supraclavicular or axillary\nlymphadenopathy.\n\nMultiple mediastinal lymph nodes measure up to 1.4 cm in short axis.  For\nexample, a 1.4 cm prevascular lymph node (series 2, image 20) and a 1.4 cm\nsubcarinal node (series 2, image 30), which are unchanged.  Hilar nodes appear\nsomewhat prominent, although are difficult to discretely measure without\nintravenous contrast.\n\nAorta is normal in size.  The patient is status post aortic valve repair,\nunchanged.  The main pulmonary artery measures up to 3.2 cm suggestive of\npossible pulmonary hypertension, unchanged.  Cardiac configuration is normal. \nExtensive coronary artery calcifications are noted.\n\nThere is no pericardial effusion.  A right simple pleural effusion is moderate\nto large, increased from prior.  A left pleural effusion is small and\ndecreased in size.\n\nEvaluation of the lung parenchyma somewhat limited due to motion.\n\nA 4.1 x 2.1 cm bulla in the superior aspect of the left lower lobe (series 5,\nimage 110) is unchanged.  Centrilobular emphysema is most pronounced in the\nupper lobes, bilaterally.  Nodular consolidation worse in the anterior aspect\nof the left upper lobe, associated with metallic densities is difficult to\ndiscretely measure.  The bulk of the consolidation which closely abuts the\nmetallic densities appears unchanged, however there is significantly increased\nconsolidated lung in the left apex and numerous nodular left upper lobe\nopacities, which appear mildly increased and more confluent (series 5, image\n63).  For example, a 3.4 x 1.5 cm focus of consolidation in the left upper\nlobe is significantly increased in size (series 5, image 83).\n\nGround-glass and nodular consolidations in the left lower lobe are slightly\nincreased.  For example, a paramediastinal nodular consolidation (series 5,\nimage 206) measures 1.4 x 1.2 cm (previously 1.1 x 1.2 cm).  Atelectasis is\nnoted at the dependent portion of the left lung base.  A partially calcified\n1.5 x 1.5 cm nodule in the left lower lobe (series 5, image 165) appears\nunchanged.\n\nExtensive consolidation throughout the right lower lobe is significantly\nincreased from prior examination with opacification numerous subsegmental\nbronchi and bronchioles.  The remainder the airway is patent.\n\nA 4 mm nodule in the right middle lobe (series 5, image 174) is unchanged.\n\nA 4 mm nodule in the right upper lobe is unchanged (series 5, image 119).\n\nA tracheostomy tube ends in the mid thoracic trachea.  An enteric tube ends in\nthe stomach.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.  A\nsclerotic lesion in the right lateral fifth rib (series 5, image 157) likely\nrepresents a bone island.  Extensive degenerative changes are noted throughout\nthe axial skeleton.",
            "output": "1.  Treatment changes in the anterior left upper lobe are largely unchanged,\nhowever adjacent nodular consolidation is increased which could represent\nworsening infection and/or recurrence.\n\n2.  Bilateral lower lobe consolidation and ground-glass opacities, right\nsignificantly worse than left, is new or increased and is concerning for\ninfectious or aspiration pneumonia.\n\n3.  A moderate to large right pleural effusion is significantly worsened in\ncomparison to the prior examination.\n\n4.  Multiple pulmonary nodules are unchanged or increased in size, as detailed\nabove.  Mediastinal lymphadenopathy is unchanged."
        },
        {
            "input": "The airway above the tracheostomy is obliterated entirely by tissue and the\nleft wall of the trachea is a severely displaced inward.  Severe enlargement\nof the thyroid gland has improved slightly since ___.  Prior mediastinal\nadenopathy has improved for example 8 mm in the left upper paratracheal\nstation, 02:19, previously 11 mm and 13 mm in the right paraesophageal\nstation, 02:29, previously 18 mm.\n\nThere is no pericardial effusion.  Small right pleural effusion, layering\nposteriorly, has decreased substantially.  Small left pleural effusion has\nresolved, left pleural thickening and calcifications are unchanged.\n\nAtherosclerotic calcification is heavy in head neck vessels and the aortic\narch descending aorta and visceral arteries of the upper abdomen.  Patient has\nhad T AVR.  Aorta is normal size.  Pulmonary arteries are mildly enlarged,\nunchanged.  Evaluation of the heart would require dedicated cardiac imaging. \nModerate size in a hiatus hernia is larger today than on ___ when a\nnasogastric drainage tube was in place, replaced by a percutaneous gastrostomy\ntube ending in the stomach.\n\nTracheobronchial tree to the segmental level is patent.\n\nEmphysema is moderately severe.\n\nThere no bone lesions in the chest cage suspicious for malignancy.\n\nFocal lung lesions are as follows:\n\n17 mm wide region of mass like consolidation in the posterior segment of the\nright upper lobe, 4:86, was normal in ___, and obscured by a\npneumonia in ___.  It is most likely organized pneumonia.  2 similar\nabnormalities cyst in the rib right middle lobe along the major fissure,\n4:130, are probably due to infection, conceivably resolving at.  Large scale\nconsolidation present in ___ in the right lower lobe has cleared.\n\nA cluster of lung nodules at the left apex, the largest 11 x 22 mm, 04:43 are\nmore numerous and larger than in either ___ or ___.\n\nA dumbbell-shaped soft tissue lesions in the left upper lobe, 16 x 24 mm,\n4:79, was only 10 mm in diameter in ___.\n\nA region of sub segmental collapse in the anterior segment of the right upper\nlobe is stable but had adjacent masslike consolidation, 4:63, substantially\nlarger.\n\nThere are no compression or pathologic fractures or large lytic lesions in the\nchest cage.  What",
            "output": "Extremely unusual pattern of pulmonary abnormalities.  I am confident that\nprevious extensive right-sided pneumonia has largely cleared, along with\nnearly all of the previously large right pleural effusion.\n\nUnexplained are the mass like lesions growing in the left upper lobe and\npersistent segmental upper lobe atelectasis without obvious bronchial\nobstruction.  The progression over just 5 weeks is unusual for most\nmalignancies, but lymphoma can grow this fast.\n\nAlso unexplained is the material occluding the lower larynx and upper trachea,\neither tumor or inspissated secretions."
        },
        {
            "input": "Multinodular enlarged thyroid is unchanged.  Prominent sub cm mediastinal\nlymph nodes are stable compared to ___.  Prosthetic aortic valve is\nnoted.  Coronary artery calcification is heavy.  There is no pericardial\neffusion.  The aorta and main pulmonary artery are normal size.\n\nTracheostomy tube has been removed.  Airways are patent to segmental levels. \nSmall right pleural effusion is smaller compared to ___.\nMultiple lobulated opacities in the left upper low are slightly larger\ncompared to ___.  For example, the largest confluence of opacities in the\nleft upper lobe anteriorly measures 4.2 x 3.5 cm (5:70), minimally larger\n(previously 4.1 x 3.5 cm).  A 2.4 x 1.7 cm lesion in the left upper lobe\n(5:100) was previously 2.4 x 1.6 cm.\nOther smaller pulmonary opacities in the left lung are stable (05:48, 135,\n146, 156).\nSeveral small pulmonary opacities in the right lung are substantially smaller\ncompared to before.  For example, a 0.7 cm opacity in the posterior segments\nof the right upper lobe was previously 1.7 cm.  The pulmonary opacities in the\nright middle lobe are also smaller (5:178, 180).\nArea of consolidation in the medial left upper lobe is unchanged.  Emphysema\nis moderately severe.\nHiatal hernia is moderate sized.  Limited evaluation of upper abdominal organs\nare notable for the gallstones in the gallbladder.  Percutaneous gastric tube\nterminates in the stomach.\n\nNo suspicious bone lesion is identified.",
            "output": "1. Multifocal bilateral pulmonary opacities are identified.  The pulmonary\nlesions in the left upper lobe are slightly larger compared to ___. \nOther small pulmonary nodules in the left lung are stable.  Small pulmonary\nnodules in the right lung are smaller.  Possibility of infection and/or\nmalignancy remains in the differential.  Consider bronchoscopy for further\nevaluation.\n2. Prominent subcentimeter mediastinal lymph nodes are similar to ___.\n3. Moderately severe emphysema.\n4. Cholelithiasis.\n\nRECOMMENDATION(S):   Consider bronchoscopy."
        },
        {
            "input": "No incidental thyroid findings.  Moderate diffuse thyroid enlargement.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy. Normal sized l 2\nborderline sized ymph nodes are seen in the mediastinum, for example in right\nparatracheal location (3, 14) as well as in pre tracheal location (3, 24). \nStatus post aortic valve replacement.  Severe coronary calcifications, no\npericardial effusion.  The posterior mediastinum appears unremarkable.  Small\nleft adrenal adenoma.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Moderate degenerative vertebral disease. \nNo vertebral compression fractures.\n3 x 4 cm solid and lobulated left upper lobe lesion with several small\nsatellite.  Lesions.  Paramediastinal second left upper lobe consolidation,\nwith a fiducial marker (4, 19).  The consolidation is caused by an obstructed.\nSegmental left upper lobe bronchus (4, 22).  There is an additional lung\nparenchymal 1.5 cm lesion in the left lower lobe (4, 43) with a suspicious\nmorphology.  Minimal dorsal dependent left basilar atelectasis (4, 50).",
            "output": "Large lobulated left upper lobe mass, paramediastinal partial left upper lobe\nconsolidation, following bronchial obstruction.  Suspicious 1.5 cm lesion in\nthe left lower lobe."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  An aortic\nprosthetic valve is noted.  There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland is mildly enlarged and there is a 1.5 cm nodule in the right\nlobe, similar to ___.\n\nThere is no evidence of pericardial effusion.  There is a trace right pleural\neffusion.\n\nAgain seen is a large left upper lobe soft tissue mass measuring 4.9 x 4.7 cm,\nunchanged since ___.  Multiple satellite lesions are again noted. \nThe largest of these lesions is in the left upper lobe and measures 3.4 x 2.7\ncm but has decreased in size since the previous exam when it measured 3.7 x\n3.5 cm.  A second left upper lobe satellite lesion with a calcification\nmeasuring 1.7 x 1.5 cm is similar to the previous study (series 5, image 50). \nLeft lower lobe nodule measuring 1.7 x 1.5 cm is also similar to the previous\nstudy.  The distal aspect of the left upper lobe bronchus remains obstructed. \nThe remainder of the airways are patent to the subsegmental levels.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is\nidentified.Diffuse osteopenia and DISH.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Large left upper lobe mass and consolidation following bronchial\nobstruction is similar to the previous study.  Multiple satellite lesions are\nnoted, 1 of which in the left upper lobe has decreased in size.  The remainder\nare stable."
        },
        {
            "input": "EXTRACARDIAC FINDINGS:\n\nCT CHEST WITH CONTRAST: Redemonstrated is diffusely enlarged multinodular\nappearance of the thyroid gland.  There is no axillary lymphadenopathy. \nNumerous small and mildly enlarged mediastinal lymph nodes measuring up to 1.4\nx 1.8 cm in the subcarinal station are overall stable in size and morphology. \nSeveral prominent hilar lymph nodes are also unchanged.  Heart is normal size.\nExtensive calcifications of the aortic valve leaflets are again noted.  There\nis no pericardial effusion.  The airways are patent.  Postradiation changes\nsurrounding a fiducial marker in the left upper lobe are stable.  A 1.6 x 1.5\ncm left perihilar nodule containing a focus of calcification is unchanged in\nappearance dating back to ___.  Hyperdense left upper lobe nodules,\nlikely granulomas, measuring up to 5 mm are also stable in size.  A small\nnonhemorrhagic left pleural effusion persists.\n\nCT ABDOMEN WITH CONTRAST: The liver, gallbladder, spleen, pancreas, and\nadrenal glands are within normal limits.  Kidneys enhance symmetrically. \nThere is no hydronephrosis.  A simple right parapelvic cyst is again noted. \nPreviously reported hypodensity in the interpolar left kidney is less\nconspicuous on the current study and is not well evaluated.  Loops of bowel\nare normal in course and caliber.  There is colonic diverticulosis without\ndiverticulitis.  There is no lymphadenopathy or free fluid.\n\nCT PELVIS WITH CONTRAST: Evaluation of the pelvis is limited by extensive\nstreak artifact from a right total hip arthroplasty.  The prostate is\nenlarged.\n\nOSSEOUS STRUCTURES: There are multilevel degenerative changes in the spine. \nNo suspicious lytic or sclerotic osseous lesion is identified.\n\nCTA:\n\nCARDIAC:  The right atrium is normal.  The right ventricle is normal.  The\nleft atrium is normal.  The left ventricle is hypertrophied.  The pericardium\nis normal and there is no pericardial effusion.  The aortic valve is is\ntricuspid with leaflet thickening and calcification.\n\nPULMONARY ARTERIES:  The main, right and left pulmonary arteries are normal\nand appear patent to the subsegmental level without filling defects.\n\nAORTA:  The thoracic and abdominal aorta are normal in size an contain\nmoderate atherosclerotic calcifications.  Measurements of the ascending aorta\nand the sinuses of Valsalva were provided on the gated study from ___.\n\n\nILIOFEMORAL ARTERIES:\nThe right side is patent at the common iliac, external iliac and common\nfemoral levels, calcifications are mild, tortuosity is mild.\nRight common iliac minimal diameter: 5x7mm\nRight external iliac minimal diameter: 3x6mm\nRight common femoral minimal diameter: 5x9mm\n\nThe left side is patentat the common iliac, external iliac and common femoral\nlevels, calcifications are moderate , tortuosity is mild.\nLeft common iliac minimal diameter: 6x4mm\nLeft external iliac minimal diameter: 5x6mm\nLeft common femoral minimal diameter: 5x9mm\n\nSUBCLAVIAN ARTERIES:  The right subclavian artery is patent. The left\nsubclavian artery is patent.  Calcifications are moderate.  Tortuosity is\nmild.\n\nRight subclavian minimal diameter: 5x6mm\nLeft subclavian minimal diameter: 5x9mm",
            "output": "1. Aortic valve thickening and calcifications without evidence of aortic\naneurysm.  Please refer to recent gated chest CTA for measurements of the\nascending aorta and sinuses of Valsalva.\n\n2.  Stable mediastinal lymphadenopathy and post treatment changes in the left\nupper lobe.  Stable small left pleural effusion.\n\n3.  Stable appearance of partially calcified 1.5 x 1.6 cm left perihilar\nnodule.  Attention on followup is recommended.\n\n4.  Previously noted hypodensity in the interpolar left kidney is less\nconspicuous on the current study in part due to suboptimal phase of contrast. \nA dedicated renal ultrasound can be considered for further evaluation as\npreviously recommended."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\nFindings below the diaphragm will be reported separately.\n\nSecretions are pooled above the tracheal balloon which may distend the\ntrachea.  Tip is approximately 3 cm from the carina..\n\nThere are no findings in the thyroid warranting further imaging evaluation. \nMediastinal and hilar and other thoracic lymph nodes are not enlarged.\nNasogastric drainage tube ends in moderately distended stomach.\n\nAtherosclerotic calcification is not apparent in head neck vessels, but is\npresent in at least left anterior descending, left circumflex, and right\ncoronary arteries.\n\nAorta and cardiac chambers are top-normal size.  Pericardium is physiologic.\nThere is no appreciable pleural effusion.\n\nLungs:\n\nHomogeneously enhancing subpleural consolidation in both lower lobes is\nprobably dependent microatelectasis.",
            "output": "No evidence of intrathoracic malignancy, primary or metastatic.\n\nMild bibasilar atelectasis is more likely explanation for pulmonary findings\nat than pneumonia.\n\nET tube cuff may be hyperinflated.  Secretions are pooled above the cuff."
        },
        {
            "input": "The thyroid is normal.  There is no supraclavicular, axillary or hilar\nlymphadenopathy.  There are multiple enlarged mediastinal lymph nodes\nmeasuring 1.1 cm (series 4, image 78) and 1.4 cm (series 4, image 79), which\nare likely reactive in nature.  The esophageal wall is not thickened, and\nthere is no hiatal hernia.\n\nThe heart is not enlarged and there is no pericardial effusion.  There is\nmoderate atherosclerotic calcification of the aortic arch.  There is no\nthoracic aortic aneurysm.  The main pulmonary artery is enlarged, measuring\n3.9 cm, suggesting pulmonary hypertension.\n\nThe airways are patent to the subsegmental level bilaterally.  There are\ninnumerable subcentimeter nodules bilaterally which are unchanged compared to\nprior, and are likely the result of prior granulomatous infection.  There is\npersistent bronchiectasis and scarring involving the right middle lobe, likely\nthe sequela of prior infection.  There is new partial right middle lobe\ncollapse.  There is also  loss of volume involving the superior segment of the\nright lower lobe.\n\nThere is a large loculated left pleural effusion, which has significantly\nincreased in size compared to the abdominal CT dated ___.  There is\nassociated compressive atelectasis.  There are rounded areas adjacent to the\neffusion, which likely represents loculated fluid, however an underlying mass\nor infection cannot be ruled out.\n\nThere are no abnormalities within the partially visualized upper abdomen. \nThere are no suspicious osseous lesions.",
            "output": "1. Large loculated left pleural effusion with associated compressive\natelectasis.  Underlying mass or infection cannot be ruled out.\n2. New partial right middle lobe collapse and volume loss involving the\nsuperior segment of the right lower lobe.\n3. Mediastinal lymphadenopathy as detailed above, which is likely reactive in\nnature.\n4. Enlargement of the main pulmonary artery, suggesting pulmonary\nhypertension."
        },
        {
            "input": "The thyroid is normal.  There is no supraclavicular, axillary or hilar\nlymphadenopathy.  There are multiple prominent mediastinal lymph nodes, which\nare little changed from the prior CT and likely reactive in nature.  The\nesophageal wall is not thickened, and there is no hiatal hernia.\n\nThe heart is not enlarged and there is no pericardial effusion.  There is\nminimal atherosclerotic calcification of the aortic arch.  There is no\nthoracic aortic aneurysm.  The main pulmonary artery is borderline enlarged,\nmeasuring 3.1 cm.\n\nThe airways are patent to the subsegmental level bilaterally.  There is\npersistent bronchiectasis and scarring involving the right middle lobe and\nright lower lobe, likely the sequela of prior infection.  Complete right\nmiddle lobe collapse is unchanged.  There is also similar loss of volume\ninvolving the superior segment of the right lower lobe.\n\nThere is minimal interval decrease in size of a large loculated left pleural\neffusion compared to the prior CT of ___.  There is associated\ncompressive atelectasis.  A pigtail pleural drainage catheter has been placed\nsince ___ with the pigtail positioned in the anterior lateral aspect\nof the effusion.  Residual fluid is located dependently, posterior to the\ndrainage catheter.  Superimposed infection cannot be excluded.  There is no\ndominant underlying mass.\n\nSmall axial hiatal hernia.  There are no other abnormalities within the\npartially visualized upper abdomen.\n\nThere are no suspicious osseous lesions.",
            "output": "1.  Minimal interval decrease in size of the large loculated left pleural\neffusion following interval chest tube placement, with pigtail drain in place\nin anterolateral position.\n2.  Complete right middle lobe collapse and volume loss involving the superior\nsegment of the right lower lobe.\n3.  Stable prominent mediastinal lymph nodes, likely reactive."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  A prominent left axillary lymph node measures\n10 mm in short axis (series 2, image 8) nonspecific.  No mediastinal or hilar\nlymphadenopathy is present.  No mediastinal mass.\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Please note the extreme lung apices and bases are not included\non this examination.  Mild dependent atelectasis on the left.  Otherwise, the\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Of note, this is a suboptimal study due to poor bolus opacification. \nVolumetric analysis could not be performed due to poor bolus timing/vessel\nopacification.  Depending on the objectives of the study, we can discuss what\nadditional imaging is clinically appropriate.  Fusiform dilatation of the\nascending aorta reaches 5.1 cm just proximal to the arch (series 6: Image 70).\nGiven the absence of prior images, it is difficult to determine whether this\naneurysm is increased or stable in size compared to the prior exam.\n\nAdditionally, there is a posterolateral bulge of the descending thoracic aorta\nwhich is either a small dissection, not necessarily active, or aneurysm\n(series 6: Image 72-73).  The heart is moderately to severely enlarged.  There\nare dense atherosclerotic calcifications in the coronary arteries and aortic\nannulus, but there is no appreciable intimal calcification of the ascending\naorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, without\nevidence of a filling defect.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland is unremarkable.\n\nA small nonhemorrhagic right pleural effusion is dependent.  There is no\npericardial effusion.\nLong pleural calcifications of the left costal and diaphragmatic surfaces are\nprobably restrictive, responsible for atelectasis, predominantly in the left\nlower lobe and lingula.  Diffuse centrilobular emphysema is upper lobe\npredominant.\n\nLimited images of the upper abdomen are unremarkable.\n\nAn age-indeterminate moderate compression fracture involves the T11 or T12\nvertebral body.  Additionally, there is a deep Schmorl's nodule invaginating\nthe upper end plate of the L1-2 L2 vertebral level.  No lytic or blastic\nosseous lesion suspicious for malignancy is identified.",
            "output": "1.  Of note, this is a suboptimal study due to poor bolus opacification.\nVolumetric analysis could not be performed due to poor bolus timing/vessel\nopacification. Depending on the objectives of the study, a discussion can be\ninitiated regarding additional imaging as clinically necessary.\n2.  5.1 cm fusiform ascending thoracic aortic aneurysm ends just proximal to\nthe aortic arch.  Given the absence of prior studies, it is difficult to\ndetermine whether this aneurysm is increased or stable in size.\n3.  Small dissection (not necessarily active) or small aneurysm, descending\nthoracic aorta, incompletely evaluated.\n4.  Diffuse centrilobular emphysema.\n5.  Moderate compression fracture, T11 or T12 vertebral body.\n6.  Restrictive, calcific, left pleural thickening. Small dependent,\nnonhemorrhagic right pleural effusion."
        },
        {
            "input": "HEART AND VASCULATURE:  a the ascending thoracic aorta measures 3.4 cm in\ndiameter.  The descending thoracic aorta and aortic arch are normal in caliber\nwith mild calcified atherosclerotic plaque within them.  The main pulmonary\nartery is normal in caliber with no filling defects within it to suggest\npresence of underlying pulmonary emboli.\n\nAXILLA, HILA, AND MEDIASTINUM: A few prominent mediastinal lymph nodes are\nseen without meeting CT size criteria for lymphadenopathy, and the largest is\nmeasuring up to 8 mm.  No axillary lymphadenopathy is present.\nA small fluid collection is seen on the left the proximal trachea (series 2,\nimage 34 causing indentation on the left lateral wall of the trachea.  There\nis no mediastinal mass.\n2 linear streaks of air in the mediastinum to the left (series 2, image\n40/series 601, image 67) are seen parallel to the esophagus and may either be\nin the wall of the esophagus or in the lumen, around a nondistended esophagus.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Please note that the exam is mildly limited due to respiratory\nmotion artifact which limits evaluation of intrathoracic structures.  Within\nthese limitations, no focal consolidation identified.  There is mild evaluate\natelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck is remarkable for\ndiffuse left-sided subcutaneous edema.  There is no evidence discrete fluid\ncollection.  No well demarcated hematoma is identified. The left internal\njugular vein demonstrates poor opacification, which can be concerning for\nthrombus.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is remarkable for\ncholecystectomy clips.  There is bilateral gynecomastia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes are seen in the visualized spine.",
            "output": "1. Diffuse left-sided subcutaneous edema seen along the left neck and\nextending to the left upper chest wall as well as into the superior and\nanterior mediastinum, along the left side of the trachea indenting the\ntracheal wall.  No discrete fluid collection to suggest presence of an\nunderlying abscess.  No mass lesions identified.\n2. There is asymmetric lack of opacification of the left internal jugular\nvein, which can be concerning for thrombus, a dedicated ultrasound with\nDoppler may be obtained to evaluate the left internal jugular vein.\n3. Ascending thoracic aortic aneurysm measuring up to 3.7 cm in diameter.\n\nRECOMMENDATION(S):  A dedicated ultrasound can be obtained for further\nevaluation of the left internal jugular vein.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:29 am, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nImproving edema in the left lateral neck.  The thyroid is unremarkable.  No\nenlarged lymph nodes in either axilla or thoracic inlet.  Moderate bilateral\ngynecomastia, symmetrical.  No atherosclerotic calcifications in the head and\nneck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  There is no contrast extravasation in the\nmediastinum.  Small mediastinal lymph nodes, none pathologically enlarged by\nCT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nSmall left pleural effusion.  No pleural effusion to the right.  Mild\nbilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Stable micronodule in the left\nupper lobe (4:67).  No new suspicious lung nodules or masses.  No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show colonic diverticulosis with no\nassociated inflammatory signs.",
            "output": "No evidence of esophageal perforation.\nThe left-sided subcutaneous edema along the left neck has improved compared to\nprior."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild atherosclerotic calcifications are seen in the\ncoronary arteries and descending thoracic aorta.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Patulous esophagus.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Unchanged size of a 4 mm micronodule in the left upper lobe\n(series 3, image 47).  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES/SOFT TISSUE: No suspicious osseous abnormality is seen.? There is no\nacute fracture.  Redemonstration of bilateral gynecomastia.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No parenchymal consolidations, pneumothorax, or pleural effusions."
        },
        {
            "input": "CHEST:\n\nThere is a large heterogeneously hypoenhancing nodule in the right lobe of the\nthyroid.  There is no axillary or supraclavicular adenopathy.\n\nThere is no mediastinal or hilar adenopathy.  There is no pericardial\neffusion.  There is no pleural effusion.\n\nPatchy parenchymal opacity at the right lung base is suggestive of a small\nlung contusion in the setting of trauma.  There is no pneumothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThere is trace perihepatic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney enhances normally and contains multiple subcentimeter\nhypodensities compatible with renal cysts.  A large cyst at the lower pole of\nthe left kidney measures 8.1 cm contains a possible thin septation and\nperipheral calcification.  There are multiple hypodensities in the right\nkidney also compatible with renal cysts.  There is a cystic structure in the\nmid right kidney which measures 3.4 cm with an internal rounded hyperdense\ncomponent.  While this likely represents hemorrhage into a cyst, an underlying\nenhancing mass is not completely excluded.  There is an area\nhemorrhage/laceration extending through an adjacent cyst into the renal\npelvis(series 4, image 22, series 5, image 49) with hemorrhage in the\ncollecting system.  There is a small amount of perinephric fluid on the right\nside compatible with a small perinephric hematoma (series 4, image 24).\n\nGASTROINTESTINAL: Congenital malrotation is again noted.  There is no evidence\nof bowel obstruction.  Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Possible hydroceles are noted in the scrotum.  However,\nthe scrotum is not well evaluated by CT.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is an acute appearing minimally displaced fracture of the right\neighth rib posteriorly.  There is a probable right ninth posterior rib\nfracture.  Evaluation of some of the ribs is limited due to motion.\n\nSOFT TISSUES: There are changes from prior hernia repair in the right inguinal\nregion.",
            "output": "1. Findings compatible with renal laceration with acute hemorrhage in a renal\ncyst extending into the renal collecting system.  There is a small amount of\nassociated perirenal hemorrhage.  Pre and postcontrast MRI would be helpful to\nexclude underlying solid renal lesion.\n2. Minimally displaced acute fracture of the right eighth and ninth ribs\nposteriorly.\n3. Probable small lung contusion at the right lung base.\n4. Congenital malrotation without bowel obstruction.\n5. Large heterogeneously enhancing right thyroid nodule.  This could be\nfurther evaluated with thyroid ultrasound.\n\nRECOMMENDATION(S):\n1. Follow-up MRI of the kidneys with and without contrast would be helpful to\nexclude underlying renal tumor.\n2. Follow-up thyroid ultrasound can be performed on a nonemergent basis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild coronary artery calcification.  The heart,\npericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Mild biapical scarring and bibasilar atelectasis.  Incidental\nnote is made of a 3 mm left upper lobe nodule (3:108).  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nModerate degenerative changes of the lower thoracic spine with prominent\nanterior osteophytosis.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. 3 mm upper lobe pulmonary nodule.  Please see recommendations below.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "THORACIC INLET:Visualized portions of the base of the neck show no\nabnormality.  The thyroid gland appears heterogeneous, stable compared to\n___.  Supraclavicular lymph nodes are not enlarged.\n\nTHORACIC LYMPH NODES: No axillary or hilar lymphadenopathy.  Prominent\nmediastinal lymph nodes measure up to 1.3 cm in short axis in the prevascular\nstation, minimally changed compared to ___ where it measured up to 1.0\ncm (4:60)..\n\nHEART, VESSELS and PERICARDIUM: The ascending aorta and main pulmonary artery\nare of normal caliber.  Mild cardiomegaly is unchanged.  Coronary artery\ncalcifications are extensive.  Moderate calcifications of the aortic valve are\nnoted.  No pericardial effusion.\n\nPLEURA:  No pleural effusion or pneumothorax.\n\nLUNG: There is chronic complete collapse of the right lower lobe, unchanged\ncompared to prior exam.  Expected compensatory hyperinflation of the right\nupper and middle lobes is noted.  There are areas of diffuse nodular and\n___ opacification in the bilateral upper lobes and left lower lobe. \nThe endobronchial tree is heavily calcified.  Extensive endobronchial\nsecretions are demonstrated within the left lower lobe.\n\n2 mm right middle lobe pulmonary nodule (4:125) and 3 mm left lower lobe\npulmonary nodule (4:157), and are unchanged compared to ___.\n\nCHEST WALL AND BONES: Chronic left anterior rib fractures are noted.  Severe\nleft-sided glenohumeral degenerative changes.  Exaggerated thoracic kyphosis.\n\nUPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for a\nnonobstructing 2 mm right renal stone (4:213).  Small bilateral renal cortical\nhypodensities are too small fully characterize.  1.0 cm right adrenal adenoma\nis unchanged (4:202).  There is mild thickening of the left adrenal gland\nwithout discrete nodule.",
            "output": "1. Bronchocentric opacities in the bilateral upper lobes and left lower lobe\nare likely related to pneumonia, possibly from aspiration.\n2. Stable chronic complete atelectasis of the right lower lobe, unchanged\ncompared to at least ___.\n3. Bilateral pulmonary nodules measure up to 3 mm in the left lower lobe and\nare unchanged compared to ___.\n4. Severe coronary artery calcifications.\n5. Nonobstructing 2 mm right renal stone.\n6. Stable 1.0 cm right adrenal adenoma.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:48 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nNo mediastinal, hilar, axillary or supraclavicular lymphadenopathy is present.\nThere is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Extensive\ncentrilobular nodules are demonstrated bilaterally, consistent with\nrespiratory bronchiolitis.  There is minimal centrilobular emphysema.  No\npulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Findings consistent with respiratory bronchiolitis, please correlate with\nhistory of smoking.\n\nNo discrete pulmonary nodules demonstrated.  If additional examinations become\navailable, addendum will be gladly added after reviewing the cases."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacities are seen in the dependent portions of\nboth lungs, likely atelectasis.  Evaluation of the lung parenchyma is somewhat\nlimited by respiratory motion.  Pleural based 2 mm node in the right upper\nlobe is stable (3:89) the airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable, except note a\nreplaced left hepatic artery arising from the left gastric artery.  The right\nhepatic artery likely arises from the superior mesenteric artery although the\nsuper origin is not included on these images.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.    The pericardium and\ngreat vessels are within normal limits. No pericardial effusion is seen. \nPulmonary artery is top normal.  Moderate coronary vascular calcifications are\nnoted.  Moderate calcifications also at the aortic valve and mitral\nannulus.Cardiomegaly is noted.  Incidental note of an aberrant course of the\nright subclavian artery.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nMediastinal lymph nodes are noted, though nonpathologic by CT criteria.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Again noted is a 3 mm pulmonary nodule in the right upper lobe,\nas seen on same day CT cervical spine.  Smooth septal thickening may suggest\nmild volume overload.  Otherwise, the lungs are clear without masses or areas\nof parenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of solid focal lesion or laceration within the limitation\nof an unenhanced scan.There is no perihepatic free fluid.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are thickened bilaterally,\nunchanged.\n\nURINARY: The kidneys demonstrate mild atrophy bilaterally.  There is an 8 mm\nhyperdense, well-circumscribed lesion of the interpolar region of the left\ncortex, likely hemorrhagic cyst (2:107).  There is no evidence of concerning\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  The appendix is normal.  There is no evidence of mesenteric\ninjury.  Extensive diverticula within the descending and sigmoid colon without\nevidence of diverticulosis.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, calcified fibroid uterus. No\nadnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: Grade 1 anterolisthesis of L4 on L5, unchanged.  There is no acute\nfracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Soft tissue edema is noted diffusely, likely anasarca.  The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute intrathoracic or intraabdominal injury within the\nlimitation of an unenhanced scan.  Specifically, no evidence of a hematoma or\nacute fracture.\n2. Mild fluid overload within the lungs and diffuse anasarca.\n3. 3 mm right upper lobe pulmonary nodule noted in the right apex.  See\nrecommendations below.\n\nRECOMMENDATION(S):  For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The main pulmonary artery measures 3.5 cm, which is\nborderline enlarged.  The heart and pericardium are unremarkable.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is no axillary or hilar lymphadenopathy.\nProminent mediastinal lymph nodes, particularly in the right peritracheal\nregion, measure up to 1.3 cm in short axis.  There is no mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  The lungs are clear aside from mild bibasilar atelectasis.  No\nsuspicious nodules are identified.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is significant for calcified\ngallstones.  A hepatic cyst is noted, unchanged since the prior examination. \nOn this arterial phase examination, there is a discontinuous delayed,\nperipherally enhancing lesion in the posterior portion of the right hepatic\nlobe, which may represent a hemangioma.  A small left-sided Bochdalek hernia\nis noted..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolism.\n2. Hepatic hemangiomas."
        },
        {
            "input": "CHEST PERIMETER: No thyroid abnormalities need any further imaging evaluation.\nSupraclavicular and axillary lymph nodes not enlarged. Breast evaluation is\nserved exclusively for breast imaging. Vascular clips denote prior left breast\nsurgery.  No soft tissue abnormalities elsewhere in the chest wall.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately patulous but not appreciably\ndistended.  There is no associated mass.\n\nAtherosclerotic calcification is not apparent in head and neck vessels or in\nthe coronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.  Pericardial effusion is small.  There is no infiltration of\nepicardial fat, any pericardial calcification or evidence of tamponade\nphysiology.\n.\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Solitary calcified granuloma left lung.  No evidence\nof granulomatous infection.  Aside from minimal atelectasis in the right\nmiddle lobe, lungs are clear.  The tracheobronchial tree is normal to\nsubsegmental levels and there is no pleural abnormality.\n\nCHEST CAGE: Unremarkable",
            "output": "No evidence of intrathoracic malignancy or infection"
        },
        {
            "input": "Left thyroid 4 mm nodule is present.  No pathologically enlarged mediastinal,\nhilar or axillary lymph nodes demonstrated. Heart size is normal. No\npericardial pleural effusion is seen. Small hiatal hernia is present. Image\nportion of the upper abdomen will be reviewed separately as part of the CT\nabdomen and corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\nRight apical nodule is 2 mm, series 5, image 20. Linear atelectasis in the\nright upper lobe was present. This right lower lobe pulmonary nodule is 2.5\nmm, series 5, image 143.   Minimal lingular atelectasis is present.",
            "output": "2 pulmonary nodules, indeterminate, that giving the patient history should be\nreassessed in 3 months for documentation of stability.\n\nNo definitive evidence of metastatic disease within the chest"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and subcentimeter axillary lymph nodes not pathologically\nenlarged.  This study is not designed for subdiaphragmatic diagnosis but shows\na feeding tube ending in the second portion of the duodenum.  No subphrenic\ncollection or splenomegaly.\n\nCARDIO-MEDIASTINUM: Feeding tube traverses the esophagus which is otherwise\nunremarkable.  Atherosclerotic calcification not apparent head and neck\nvessels, but is scattered in all major coronary arteries.  Aortic valvular\ncalcification is mild to moderate.  Aorta and pulmonary arteries and cardiac\nchambers are normal size and free of filling defect subject to the technical\nlimitations of this study.  Pericardium is physiologic.\n\nA central venous catheter ends in the region of the superior cavoatrial\njunction.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Aside from mild atelectasis, lungs are clear. There\nis no consolidation or lung abscess.  Tracheobronchial tree is normal to\nsubsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE: Patient has had lumbar laminectomy and a stabilization device\nbridging from the T8-9 level into the lumbar spine is incompletely imaged. \nThe upper aspect of the midline fluid collection in the back at the lumbar\nlevel is also incompletely imaged; it contains a small amount of gas, 302: 43\nand is indistinctly marginated with subcutaneous fat, probably edema.  It is\nno less than 39 x 85 mm at the level of its greatest cross-sectional diameter,\n302:253, where it is continuous with the surgical plane in the midline,\nextending to the resected spinous process.\n\nThere is no associated internal para vertebral collection.  There are no prior\nCT scans including this area so the extent of bony healing, any bone erosion,\nat the level of surgery, and the chronicity of the vacuum disc and\ndegenerative changes at the T8-9 level are also indeterminate as to age.\n\nIntramuscular lipoma or possible posterior abdominal wall fat herniation,\n300-253 is noted.",
            "output": "No evidence of pneumonia, template or other infection in the chest.\n\nPerioperative fluid collection, midline back, lumbar level could be infected. \nDedicated to imaging of the lumbar spine would be necessary for assessment of\nthe fluid collection and lumbar stabilization surgery.\n\nWidespread atherosclerotic coronary calcification.  Aortic valvular\ncalcification is mild, but could be a nidus for infection.\n\n\nRECOMMENDATION(S):  Dedicated lumbar spine imaging there is concern for\nperioperative infection."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nOther than mild bibasilar atelectasis, no evidence of pulmonary parenchymal\nabnormality. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nA 3.6 cm well-circumscribed ovoid soft tissue density lesion the left\nparaspinal region could represent a complex sebaceous cyst (see series 2,\nimage 49).",
            "output": "1.  No evidence of acute pulmonary embolism or aortic abnormality.\n2.  3.6-cm soft tissue, ovoid mass in the left paraspinal region in the mid\nthorax.  Could represent a complex sebaceous cyst.  Correlate with clinical\nassessment."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal.  There\nis no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Left basal linear 6\nmm opacity most likely consistent with atelectasis.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic abnormality that might explain patient's\nsymptoms.  Specifically no CT evidence of neoplasm or infectious process."
        },
        {
            "input": "The ascending aorta is mildly dilated at 4.2 cm. The descending thoracic aorta\nis of normal caliber but appears mildly ectatic. Only a minimal degree of\natheromatous calcification is present in the thoracic aorta, predominantly at\nthe aortic arch.\n\nThe heart size is normal, and note is made of a coronary artery stent as well\nas focal coronary artery calcifications. There is no pericardial or pleural\neffusion. Small hiatal hernia is incidentally noted.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of a large incompletely imaged 6.2 cm cystic lesion in the upper left\nkidney, containing peripheral calcifications (image 70, series 2). Remaining\nimaged upper abdomen is unremarkable on this limited assessment.\n\nMultilevel degenerative changes are present within the spine.\n\nWithin the lungs, it minimal nonspecific reticulation is present in the lower\nlungs and may possibly be age related.  Several on the sub 4 mm pulmonary\nnodules are identified, located in the left lower lobe (3 mm, image 200),\nright middle lobe adjacent to the minor fissure (166) com left lower lobe\nalong the major fissure (3 mm, 147) and right apex (2 mm, 87), on series 4. .",
            "output": "1. Mild dilation of ascending aorta. Focal atheromatous calcifications are\nevident at the level of the arch.\n\n2. Coronary artery calcifications\n\n3. Several sub 4 mm noncalcified pulmonary nodules are statistically most\nlikely benign. However, if the patient has a history of smoking or other risk\nfactors for primary lung cancer, a ___ year followup CT would be recommended\naccording to the ___ guidelines.\n\n4. 6 cm incompletely imaged left renal cyst with peripheral calcifications.\nRenal ultrasound is recommended for more complete characterization.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 09:47 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: There is diffusely decreased attenuation of the visualized\nliver consistent with fatty liver disease.  There is thickening of the left\nadrenal gland without focal nodularity.  Otherwise, visualized upper abdomen\nis unremarkable.\n\nMEDIASTINUM: There are multiple prominent mediastinal lymph nodes, none of\nwhich meet CT size criteria for enlargement.  All mediastinal lymph nodes are\nnormal in their morphology.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.  There are extensive coronary artery calcifications, most notable in\nthe LAD territory.\n\nPLEURA: There are no pleural effusions or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Patient is status post prior right upper lobectomy and\nmediastinal lymph node dissection with multiple surgical clips in the area the\nright suprahilar region.  There are no parenchymal opacifications concerning\nfor underlying infection.  There is a left lower lobe nodule which measures up\nto 6 mm in size (series 4; image 174) and is unchanged dating back to ___.\n2. AIRWAYS:  Airways are patent to the subsegmental level.  There is no\nevidence of foreign body within the visualized airways.\n3. VESSELS:  There is mild enlargement of the main and left main pulmonary\narteries, measuring 3.2 and 2.6 cm, respectively.\nCHEST CAGE: No acute compression deformity of thoracic spine.  There is no\nconcerning lytic or sclerotic lesions.",
            "output": "1. No foreign body is identified.\n2. Patient is status post right upper lobectomy and mediastinal lymph node\ndissection without evidence of recurrence.\n3. Mild dilatation the main pulmonary artery unchanged, could suggest\npulmonary arterial hypertension.\n4. 6 mm nodule in the left lower lobe is unchanged dating back to ___.\n5. Fatty liver."
        },
        {
            "input": "MEDIASTINUM/HEART:  The imaged thyroid is normal.  Comminuted, expanded\nappearance of the right clavicular head, with surrounding soft tissue density,\nis compatible with known history of sternoclavicular joint debridement for\nacute osteomyelitis in ___. Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged by CT size criteria. Aorta and pulmonary\narteries are normal in size.  Atherosclerotic calcifications are mild in the\naortic arch and coronary arteries. Heart size is normal with no pericardial\neffusion.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is\nbibasilar dependent atelectasis. No pulmonary nodules detected.\n\nUPPER ABDOMEN:  Please see the dedicated CT abdomen and pelvis report from the\ncurrent date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Superior endplate deformities of the T4 and T5 vertebral bodies\nare of indeterminate age.  Old healed left rib fractures are identified.\n\nBilateral gynecomastia is likely related to end-stage liver disease.  Multiple\nparaesophageal varices are also likely sequela of liver disease.",
            "output": "1.  No evidence of intrathoracic malignancy or metastatic disease.\n\n2.  Comminuted expanded appearance of the right clavicular head is compatible\nwith known history of sternoclavicular joint debridement for acute\nosteomyelitis in ___.\n\n3.  Superior endplate deformities of the T4 and T5 vertebral bodies are of\nindeterminate age."
        },
        {
            "input": "MEDIASTINUM/HEART:  The imaged thyroid is normal.  Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged by CT size criteria. \nCalcified hilar lymph nodes related to prior granulomatous exposure.  Aorta is\nnot aneurysmal and pulmonary arteries is enlarged measuring 3.6 cm. \nAtherosclerotic calcifications are mild in the aortic arch and coronary\narteries. Heart size is normal with no pericardial effusion.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. There is\nbibasilar dependent and lingular atelectasis.  5 x 4 mm nodule in the lingula\nseries 6, image 131 has increased from the prior examination where it measured\n2 x 2 mm in retrospect.  Nodule Calcified granuloma in the left lower lobe\n\nUPPER ABDOMEN:  Please see the dedicated CT abdomen and pelvis report from the\ncurrent date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  New right second rib fracture is non displaced with adjacent soft\ntissue stranding and thickening, can be acute injury.  No discrete lytic\nlesion.\nSuperior endplate deformities of the T4 and T5 vertebral bodies are of\nindeterminate age.  Old left rib fractures have demonstrated further healing. \nComminuted, expanded appearance of the right clavicular head, with surrounding\nsoft tissue density, is compatible with known history of sternoclavicular\njoint debridement for acute osteomyelitis in ___.\n\nBilateral gynecomastia is likely related to end-stage liver disease.  Multiple\nparaesophageal varices are the sequela of liver disease.",
            "output": "Interval growth of the lingular nodule, in the setting of rising AFP, is\nconcerning for metastatic disease.\n\nNew right second fracture is non displaced with adjacent soft tissue stranding\nand thickening, can be acute trauma.  No discrete lesion in the bone to\nsuggest pathologic fracture.\n\nMultiple healing left rib fractures."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  All\nvisible mediastinal and hilar lymph nodes are normal in size (2, 15). \nBorderline sized pretracheal lymph node (2, 22).  The patient shows signs of\ngynecomastia.  Severe coronary calcifications, aortic valve calcifications. \nNo pericardial effusion.  Moderate perisplenic and perihepatic ascites. \nCirrhotic contour of the liver.  Mild to moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  The airways are\npatent.  No abnormalities are seen in the lung parenchyma, except for areas of\natelectasis adjacent to the pleural effusions. No suspicious lung nodules. \nThe airways are patent.  No diffuse lung disease.",
            "output": "Ascites.  Left pleural effusion with adjacent compressive atelectasis.  The\nextent of the effusion is minimally decreased as compared to the previous\nexamination.  No lung parenchymal abnormalities."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Moderate\ngynecomastia is symmetric and unchanged.  No soft tissue abnormalities\nelsewhere in the chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis.\n\nCARDIO-MEDIASTINUM:  Esophagus is unremarkable. Atherosclerotic calcification\nis moderately heavy in head neck vessels, severe in the aortic annulus and\nthroughout the coronary arteries. Aortic valve is heavily calcified. Minimal\npericardial effusion is unchanged.\n\nTHORACIC LYMPH NODES: Subcentimeter mediastinal lymph nodes in the lower\nparatracheal and prevascular stations are stable.  No lymph nodes in the chest\nare pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Right lung is clear.  Tracheobronchial tree is normal\nto subsegmental levels.  There is no right pleural effusion.\nModerate nonhemorrhagic layering left pleural effusion is unchanged,\nresponsible for dependent atelectasis, limited to the posterior basal segment.\nNo pleural nodularity.\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..  Despite generalized moderately severe\nosteopenia, especially in the thoracic spine, there is no compression or\npathologic fracture.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nPersistent, dependent, moderate non serous left pleural effusion responsible\nfor relatively mild left basal atelectasis.\n\nSevere aortic valvular calcification, presumably hemodynamically significant. \nSevere atherosclerotic calcification involving coronaries.  Abdominal\natherosclerosis is not fully evaluated by this study."
        },
        {
            "input": "THORACIC INLET: Stable and unremarkable.\n\nBREAST AND AXILLA  : No axillary lymphadenopathy.\n\nMEDIASTINUM: Redemonstrated 9 mm precarinal lymph node, series 5, image 115. \nStable 6 mm prevascular lymph node on series 5, image 115.  No new\nlymphadenopathy seen.\n\nHEART, VESSELS and PERICARDIUM: Extensive coronary and aortic annulus\ncalcifications are seen.  There are calcifications along the aortic arch and\nascending aorta.\n\nPLEURA AND LUNGS: Small left pleural effusion, with overlying atelectasis is\nredemonstrated.  No pericardial effusion is seen.  2 mm subpleural right upper\nlobe pulmonary nodule on series 5, image 87, is stable, and may represent a\ngranuloma; finding is stable since at least ___.\n\nBONES : Evidence of DISH is seen along the thoracic spine.  No concerning\nosteoblastic or lytic lesion is seen in the chest.\n\nUPPER ABDOMEN: Please refer to abdomen/liver MRI performed this same date for\nfindings of the upper abdomen.  Extensive splenic artery calcifications seen. \nPartially imaged ascites.  Partially imaged cirrhotic liver.",
            "output": "Redemonstrated is a small left pleural effusion with overlying atelectasis.\n\nStable subcentimeter mediastinal lymph nodes.\n\nStable 2 mm subpleural right upper lobe pulmonary nodule may represent a\ngranuloma.\n\nRedemonstrated severe aortic valvular and aortic/coronary artery\ncalcifications."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Severe calcifications of\nthe aorta are re-demonstrated as well as severe calcifications of coronary\narteries.  Right lower paratracheal lymph node is 12 mm, enlarged but\nunchanged.  Aortopulmonic lymph node is 9 mm, minimally increased compared to\n8 mm.  Pre-vascular lymph nodes are 5 mm, unchanged.  Subcarinal lymph node is\n5 mm, unchanged.  Overall the heart size is normal.  There is severe\ncalcifications of the aortic valve and mitral annulus that might be\nhemodynamically significant.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\ncalcified nodule is stable, series 10, image 15.\n\nLeft pleural effusion has substantially increased in the interim, consistent\nnow with loculation and with also internal dense components that might be\nconsistent with extensive septations as better depicted on the liver MRI.\nRight pleural effusion is small but new. Similar dense areas are demonstrated\nwithin the right pleural effusion also demonstrated as septations or on liver\nMRI, please review the corresponding report.  Adjacent left basal atelectasis\nhas increased since previous examination, rounded, secondary to pleural\neffusion.  Minimal right basal atelectasis is present as well.  No new\npulmonary nodules or masses have been demonstrated.\n\nAscites and liver lesions are partially imaged, please review MRI of the liver\nthat was obtained on ___ in the corresponding results.  Substantial\ngynecomastia is bilateral, symmetric.",
            "output": "Interval increase in size in the loculated left pleural effusion with\nassociated rounded atelectasis\n\nInterval development of new right pleural effusion.\n\nBoth pleural effusions have internal septations as demonstrated on liver MRI\n\nPlease review liver MRI and the corresponding report for assessment of\nintra-abdominal findings."
        },
        {
            "input": "THORACIC INLET:Visualized portions of the base of the neck show no\nabnormality.   The visualized thyroid is normal.  Supraclavicular lymph nodes\nare not enlarged.\n\nTHORACIC LYMPH NODES:  No axillary lymphadenopathy.  Multiple prominent\nmediastinal lymph nodes measure up to 1.7 x 0.9 cm in the right lower\nparatracheal station, essentially unchanged compared to at least ___\n(series 302 image 81).  No hilar adenopathy.\n\nHEART, VESSELS and PERICARDIUM: The ascending thoracic aorta is normal in\ndiameter with severe near circumferential atherosclerotic calcification as\nseen on the prior examinations.  There is marked calcification of the mitral\nannulus and aortic valve.  Coronary artery calcifications are extensive.  No\npericardial effusion is seen.\n\nPLEURA: Small right and moderate left bilateral pleural effusions.  The left\nappears to be loculated and demonstrate internal septations, which are\nslightly more pronounced on the prior examination.  The overall size of the\npleural fluid appears similar to slightly decreased in size compared to the ___ examination.  Small right pleural effusion, similar to slightly\nincreased compared to the prior exam.  No definite internal septations are\nidentified.\n\nLUNG: Near complete collapse of the left lower lobe is again seen with\natelectasis overlying the pleural fluid.  Minimal right basilar atelectasis. \nCalcified granuloma in the right upper lobe is unchanged (series 302, image\n60).  No new or enlarging pulmonary nodules.  Central airways are patent.\n\nCHEST WALL AND BONES: Right and moderate left there is no worrisome lytic or\nsclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted abdomen MRI report for\nsubdiaphragmatic findings.",
            "output": "1. Loculated small to moderate  left pleural effusion with internal septations\nappears similar to minimally decreased in size compared to the ___\nexam.\n2. Small right pleural effusion appears similar to slightly increased compared\nto the prior examination.\n3. Prominent mediastinal lymph nodes are not appreciably changed since at\nleast ___.\n4. Please refer to separately submitted MRI abdomen for description of the\nsubdiaphragmatic findings."
        },
        {
            "input": "CTA thorax:The aorta and main thoracic vessels are well opacified.  The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection.The pulmonary arteries are opacified to the segmental level,\nwithout filling defect to suggest pulmonary embolism.\n\nCT thorax: The airways are patent to the subsegmental level.There is no\nmediastinal, hilar, or axillary lymph node enlargement by CT size\ncriteria.Calcified right hilar nodes are noted.  The heart, pericardium, and\ngreat vessels are within normal limits.No hiatal hernia or other esophageal\nabnormality is present.No focal opacity, pleural effusion, or pneumothorax is\nidentified.  Two small right lung calcified granulomas are identified. Minimal\ndependent atelectasis is noted at the right base. There is a 4 mm hypodensity\nwithin the lower pole of the left lobe of the thyroid gland.\n\nOsseous structures: No focal osseous lesion concerning for malignancy is\npresent.\n\nAlthough this study is not designed for the assessment of intra-abdominal\nstructures, the visualized solid organs and stomach are unremarkable.",
            "output": "No evidence of pulmonary embolism or acute aortic syndrome."
        },
        {
            "input": "The imaged thyroid is unremarkable.  The thoracic aorta is normal in course\nand caliber without appreciable atherosclerosis.  The heart is normal in size\nand shape with trace pericardial fluid.  The main pulmonary artery is top\nnormal at 3 cm in diameter. There are multiple filling defects within the\npulmonary arterial tree involving all lobar and majority of segmental\nbranches.  There is no CT evidence of right heart strain or evidence of\npulmonary infarction.  No adenopathy is seen.  The airway is centrally patent.\n\nLungs are clear without worrisome nodule, mass, or consolidation.  A tiny\nright upper lobe nodule on series 2, image 42 is unchanged measuring 4 mm. \nThere is a nodule in a left lower lobe on series 2, image 96 measuring 5 mm\nalso unchanged.\n\nIn the imaged upper abdomen, no discrete abnormalities are detected.\n\nBones:  No worrisome bony lesion.  No fracture.",
            "output": "1. Multiple bilateral pulmonary emboli without CT evidence of right heart\nstrain or signs of infarction.\n2. Small pulmonary nodules which are size stable from ___ CT, requiring no\nadditional followup imaging."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is mildly limited by\nrespiratory motion.  Within these confines, calcified granuloma within the\nright lower lobe.  Multiple bilateral pulmonary nodules measuring 5 mm (3:169)\nappear stable.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. Multiple, bilateral pulmonary nodules measuring up to 5 mm appear stable."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  A single borderline left upper para\ntracheal lymph node measures 13 x 12 mm, not significantly changed dating back\nto ___, when it measured 12 x 11 mm. Otherwise, there is no supraclavicular,\nmediastinal, axillary, or hilar lymphadenopathy. Trace nonhemorrhagic\npericardial fluid is likely physiologic (05:39). A left chest wall pulse\ngenerator is unchanged in position, with dual pacer leads terminating in the\nright atrium and right ventricle.  A right chest wall Port-A-Cath terminates\nin the right atrium.  The aorta and pulmonary arteries are normal in size.\n\nPLEURA:  Trace bilateral nonhemorrhagic pleural effusions are new (05:38).\nThere is no pneumothorax.\n\nLUNGS: The airways are patent to the subsegmental level, with lower lobe\npredominant bronchial wall thickening, right greater than left, and adjacent\nareas of atelectasis, some of which is more nodular in appearance and new\ncompared to the prior study (6:180) in the right lung base. Otherwise, no\nconcerning pulmonary nodules or masses are identified. Mild background\nheterogeneous aeration of the bilateral lungs is noted, unchanged.\n\nBONES: Multilevel degenerate changes are again noted throughout the thoracic\nspine, with sclerotic foci noted in multiple thoracic vertebral bodies, which\nare stable, likely bone islands.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Lower lobe predominant bronchial wall thickening, right greater than left,\nwith bronchiolectasis and atelectasis.  Increased nodular consolidation in the\nright lung base since the prior study suggests a pneumonia due to chronic\ninflammatory airways disease.  Because of its nodular appearance, chest\nradiographs after treatment are recommended to ensure resolution of the\nlesion.\n2. Other than the above described nodular consolidations in the right lung\nbase, no nodules concerning for malignancy are identified.\n3. New trace non-hemorrhagic bilateral pleural effusions, possibly due to\nunderlying cardiac disease."
        },
        {
            "input": "A 13 x 10 mm left paratracheal lymph node is unchanged from ___ (04:23).\nOtherwise, there is no axillary, supraclavicular or central lymphadenopathy. \nThe heart is normal size. Trace fluid is seen within the superior pericardial\nrecesses, physiologic.  A left pectoral pacemaker is constant and right\nMediPort courses into the right atrium.\n\nAtelectasis in the lingula and linear atelectasis in the middle lobe are\nunchanged. There is improved aeration of the left lung base with a small\namount of residual atelectasis. A linear opacity along the superior aspected\nof the left major fissure is likely dependent atelectasis (5:82).  The\npreviously described nodular consolidation within the right upper lobe is\nimproved, albeit persistent (5:118). There is persistent airway irregularity\nand bronchial wall thickening, compatible with chronic bronchitis.  Moderate\nchanges of centrilobular emphysema predominate the lung apices and are\nunchanged.  There are no lung nodules or masses of concern.  Bilateral pleural\neffusions have decreased in size, now trace.\n\nThe esophagus is unremarkable. The intra abdominal findings are described\nindependent of this report.\n\nA punctate sclerotic focus within T7 is unchanged from ___ and is\npresumably a bone island. There is persistent posterior wedging of T11.  There\nare no lytic or blastic osseous lesions concerning for metastatic disease\nwithin the chest.",
            "output": "1. Improving opacities in the right upper lobe which may reflect resolving\ninfection.\n2.   No evidence for metastatic disease within the chest.\n3.  Decrease in volume of bilateral pleural effusions from ___.\n4. Abdominal findings reported separately."
        },
        {
            "input": "There are no enlarged mediastinal or hilar lymph nodes. Previously enlarged\nlower left paratracheal lymph node has decreased in short axis dimension from\n10 mm to 8 mm (25, 2).  Heart size is normal, and a small pericardial effusion\nhas developed since the prior CT. Additionally, small bilateral pleural\neffusions have increased in size in the interval.\n\nNo new suspicious lytic or blastic skeletal lesions have developed in the\nthorax since the prior CT.  Small sclerotic foci in the mid thoracic spine\n(32, 2) and adjacent posterior right rib (29, 2) are unchanged, as well as a\nsmall sclerotic focus at the level of T3\n\nWithin the lungs, severe emphysema is again demonstrated with upper lung\npredominance.  A bandlike area of atelectasis is present in the right upper\nlobe posteriorly at a site of previous ground-glass opacification.  Minimal\nadjacent small airways disease is present as well as bronchial wall thickening\nin the right upper lobe superimposed upon chronic diffuse airway wall\nthickening. Chronic scarring in the middle lobe and lingula are unchanged, and\na bandlike area of atelectasis in the right lower lobe is new. .",
            "output": "1.  Localized bronchial wall thickening and small airways disease in posterior\nright upper lobe, which may be due to aspiration or localized infection.\n\n2.  New small pericardial effusion and increase in size of small bilateral\npleural effusions.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThis study is somewhat limited by motion artifact, which may limit sensitivity\nfor small subsegmental pulmonary emboli.  Allowing for this, the pulmonary\narteries appear well opacified with no evidence of filling defect within the\nmain, right, left, lobar, segmental or subsegmental pulmonary arteries. The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no evidence of pericardial effusion.  There is cardiomegaly with\ndiffuse coronary arterial calcifications.\n\nThere is no evidence of pulmonary parenchymal abnormality. There is no pleural\neffusion. The airways are patent to the subsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nLimited images of the upper abdomen demonstrate a 1.2 x 1.0 cm hypodense\nlesion within the lateral spleen that measures fluid density, compatible with\na simple cyst.  Cholelithiasis without cholecystitis is noted. The esophagus\nand visualized upper abdominal organs are otherwise unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMultilevel degenerative changes are mild.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality on this mildly\nlimited study.\n2. 1.2 cm splenic hypodensity likely represents a simple cyst.\n3. Cholelithiasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is grossly\nunremarkable.  There is no axillary lymphadenopathy.  The soft tissues of the\nvisualized lower neck and chest wall are grossly unremarkable.\n\nUPPER ABDOMEN: Though this study is not tailored for subdiaphragmatic\nanalysis, the visualized upper abdomen is notable for scattered bilateral\nrenal cystic lesions, the largest measuring 18 mm, some intermediate in\ndensity and some too small to characterize, likely represent a mix of simple\nand proteinaceous/hemorrhagic renal cyst.  There is also thickening of the\nleft-greater-than-right adrenal glands without frank nodularity.  There are\nscattered colonic diverticula.  Vascular calcifications are identified.  The\nremainder the visualized upper abdomen is grossly unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no gross hilar lymphadenopathy given confines of a noncontrast\nexamination.\n\nHEART and PERICARDIUM: The heart is mild-to-moderately enlarged.  There are\nsevere coronary artery calcifications.  There are mild aortic valvular\ncalcifications.  There is no significant pericardial effusion.\nPLEURA: There is a trace left-sided effusion.  There is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild left-greater-than-right lung base atelectasis\nalso with mild lingular atelectasis.  There is a 1 mm perifissural right\nmiddle lobe nodule (04:34).  There is a 2 mm right apical nodule (04:56). \nThere is another 1 mm right upper lobe subpleural nodule (4:66).  No\nsuspicious nodularity is identified.  There is no dense consolidation\nworrisome for pneumonia.\n2. AIRWAYS:  The central airways are patent.  There is mild diffuse bronchial\nwall thickening suggestive of chronic small airway disease.\n3. VESSELS:  There are mild to moderate atherosclerotic calcifications along a\nnormal caliber thoracic aorta.  The main pulmonary artery is top normal\ncaliber.\nCHEST CAGE: Thoracic cage is intact without acute fracture or suspicious bony\nlesion.  Are mild multilevel thoracic degenerative changes.  Schmorl's nodes\nare seen at multiple levels.",
            "output": "1. No acute findings in the chest.  No fracture, pneumothorax, or pneumonia.\n2. Scattered 1-2 mm pulmonary nodules.\n3. Mild bronchial wall thickening suggestive of chronic small airways disease.\n4. Trace left-sided pleural effusion.\n5. Bilateral probable proteinaceous/hemorrhagic renal cyst.  If confirmation\nis warranted, renal ultrasound can be performed."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nMild-to-moderate atherosclerotic calcifications of the aortic arch, great\nvessels, and descending aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nEvaluation of the lung parenchyma is mildly limited by respiratory motion. \nWithin this limitation, there is probable biapical pleural scarring.  Mild,\nbilateral dependent atelectasis.  Otherwise, there is no evidence of pulmonary\nparenchymal abnormality. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The thyroid is unremarkable.  A tracheostomy tube is in place.  There are no\nenlarged supraclavicular lymph nodes.  Left-sided PICC line projects with its\ntip to the right atrium.  There are multiple small mediastinal lymph nodes\nranging in size up to 1 cm in short axis.  There is moderate cardiomegaly. \nCoronary artery calcification is seen.  There is no pericardial effusion.\n\nThere are bilateral pleural effusions right greater than left\n\nThere is subsegmental atelectasis in the right upper lobe and both lower\nlobes.  Evaluation of lung parenchyma is somewhat limited due to respiratory\nmotion.  There is evidence of pulmonary edema.\n\nReview of bones is unremarkable.\n\nLimited sections through the upper abdomen are also unremarkable.",
            "output": "Small bilateral pleural effusions with bibasilar atelectasis. Mild\ninterstitial edema.  Subsegmental atelectasis along the fissures in both upper\nlobes right greater than left.  Low lung volumes.\n\nTracheostomy tube in place."
        },
        {
            "input": "Aorta and pulmonary artery are well opacified.  Mediastinal lymph nodes are\ntop-normal, minimally increased as compared to previous examination. Heart\nsize is enlarged.  There is no pericardial effusion.\n\nBilateral pleural effusions are moderate to large and appear to be minimally\nincreased as compared to previous examination.\n\nET tube tip is in place.  Assessment of the lung parenchyma shows similar\nbibasal consolidations most likely atelectasis 730 tube the bilateral\neffusion.  There is slight increase in right middle lobe ground-glass opacity\nbut overall diffuse ground-glass opacities and septal thickening is similar to\nprevious examination the only area where the consolidation has increased is in\nthe right apex concerning for developing infection, series 2, image 17.\n\nDiffuse subcutaneous fat stranding is consistent with anasarca.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen pelvis in corresponding report will be issued.",
            "output": "Unchanged or minimally increased bilateral large pleural effusions\n\nMost likely interstitial and minimal alveolar pulmonary edema\n\nWorsening consolidation in the right apex concerning for infectious process."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.\n\nAtherosclerotic calcification is not apparent in head and neck View vessels\nbut is present in the left anterior descending coronary artery.  The  aorta is\nnormal size.  Pulmonary artery dilatation, main 34 mm, is unchanged.  Once\nagain the esophagus is severely distended to the level of the carina.  The\nvery large intrathoracic stomach, traversing the esophageal hiatus to the\nright of the midline is smaller today than it was on ___.\n\nLungs:\n\nLinear scarring at the lung apices, right greater than left, is unchanged.\n\nPrevious consolidation posterior segment right upper lobe has improved. \nBibasilar has atelectasis, left greater than right, is unchanged.  There is\nnew ground-glass opacification in the superior segment left lower lobe that\ncould be recent aspiration, or alternatively atelectasis.  Left upper lobe is\nlargely clear.\n\nSevere compression of the T12 thoracic vertebra with minimal retropulsion is\nnew since ___, but stable since ___.",
            "output": "Volume of distended stomach traversing the hiatus hernia into the right lower\nparamedian chest has decreased.\n\nPrevious right upper lobe pneumonia has resolved.\n\nNew alveolar opacification superior segment left lower lobe could be recent\naspiration or early pneumonia.\n\nSubstantial bibasilar atelectasis unchanged."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. There are no pathologically enlarged\naxillary, mediastinal, or hilar lymph nodes. The heart size is normal and\nthere is no pericardial effusion. Coronary artery calcifications are mild.\nMain pulmonary artery and ascending aorta caliber is normal.  Distal esophagus\nand limited views of the upper abdomen are unremarkable.  No significant soft\ntissue abnormality in the chest wall.\n\nLungs: Biapical scarring is minimal and unchanged.  Airways are patent to the\nsubsegmental level bilaterally. Aside from nodules, detailed below, the lung\nparenchyma is clear. There is no pleural effusion or pneumothorax. Irregular\nthickening of the pleural margin along the posterior right lower lobe may be\natelectasis or lymphoid deposits, stable in comparison to the prior exams.\n\nPulmonary nodules:\n\nLeft upper lobe, ground glass (05:55) measures 6mm, previously 10mm.\n\nLeft upper lobe, ground glass (05:81) measures 7mm, previously 6mm.\n\nLeft upper lobe, partially solid (05:85) measures 6mm, previously 6mm.\n\nRight upper lobe, ground glass (5:76), measures 4mm, previously 4mm.\n\nRight upper lobe, solid (5:145) measures 5mm, previously 5mm.\n\nLingula, partially solid (5:124) measures 7mm, previously 7mm.\n\nLingula, ground glass (5:146) measures 6mm, previously 6mm.\n\nRight lower lobe, ground glass (5:190) measures 4mm, previously 4mm.\n\nNo new nodules are identified.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "Stability of ground glass and solid pulmonary nodules has been established for\n___ years. Follow up in ___ year is recommended to establish ___ year stability."
        },
        {
            "input": "The thyroid gland is unremarkable. No axillary, mediastinal or hilar\nlymphadenopathy is detected.  There is a small hiatal hernia. The thoracic\naorta is normal in caliber with a typical 3 vessel takeoff from the arch. The\npulmonary arterial trunk is normal in caliber. The heart is normal in size\nwithout pericardial effusion.  Calcifications at the bifurcation of the left\nmain coronary artery are mild.\n\nThe tracheobronchial tree is patent to the subsegmental levels bilaterally. \nMild biapical scar remains unchanged.  The airways are normal in caliber.\nWithin the pulmonary parenchyma, there is no interstitial abnormality. No\npleural effusion or pneumothorax is present.\n\nThe following pulmonary nodules are again seen:\n\n9 mm left upper lobe ground-glass nodule (series 4, image 39), previously\nmeasuring 6 mm, and 10 mm in ___.\n\n6 mm left upper lobe ground-glass nodule (series 4, image 61), previously 7\nmm.\n\n7 mm partially solid left upper lobe nodule (series 4, image 64), previously 7\nmm, however appears slightly denser in the anterior aspect.\n\n5 mm right upper lobe ground-glass nodule (Series 4, image 56), previously 4\nmm.\n\n5 mm right upper lobe wedge-shaped nodule (series 4, image 112), previously 5\nmm and 4 mm in ___. However, the nodule now contains an area of\nsurrounding ground-glass opacity which appears increased since CT examination\nfrom ___.\n\n7 x 8 mm partially solid nodule in the lingula (series 4, image 95),\npreviously 7 mm, and measuring 6 x 4 mm in ___, increased in size.\n\n7 mm ground-glass nodule in the lingula (series 4, image 115), previously 6\nmm, and measuring 4.5 mm in ___, increased in size.\n\nPreviously described right lower lobe ground-glass nodule is not clearly\nidentified on today's examination.\n\nNo new nodules identified.\n\nNo blastic or lytic lesion suspicious for malignancy is present.\n\nAlthough this study is not tailored for evaluation of subdiaphragmatic\nstructures visualized upper abdominal organs are grossly unremarkable.",
            "output": "1.  Multiple subcentimeter  ground-glass and partially solid pulmonary\nnodules, some slightly larger, particularly that those of mixed attenuation,\nraising concern for slow progression along the adenocarcinoma spectrum. \nInterval followup recommended with chest CT examination in no more than 6\nmonths.\n\n2. C  alcification at the bifurcation of the left main coronary artery, could\nbe hemodynamically significant."
        },
        {
            "input": "The imaged thyroid gland appears homogeneous.  There is no axillary or\nsupraclavicular adenopathy.  A 0.6 x 0.3 cm node within the prevascular space\n(03:24) appears stable, present on examinations through ___.  A right\nlower paratracheal node measures 0.6 cm in short axis (03:26), unchanged. \nThere is no hilar adenopathy.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits in caliber.  The heart is normal in size.  Trace pericardial\nfluid is physiologic.  Coronary artery calcifications are moderate to severe\nand involve predominantly the left main coronary artery bifurcation.  The\nposterior descending coronary artery appears additionally heavily calcified.\nCalcifications involving the aortic arch are mild.\n\nAirways are patent to the subsegmental level.  Ground-glass opacities are\nidentified bilaterally.  A 0.4 cm opacity within the right upper lobe (5:82) a\n0.3 cm ground-glass nodule within the right middle lobe (5:211), and a 0.5 cm\nground-glass opacity within the right lower lobe (5:245) appear to have been\npresent on examinations dated through ___, stable.  Ill-defined\nground-glass opacities within the left upper lobe (5:63, 78) are not\nsignificantly changed.  Numerous ground glass nodules within the left upper\nlobe include a 0.7 cm ground-glass nodule peripherally, a 0.7 cm  ground-glass\nnodule adjacent to the pericardium (5:131), a 0.5 cm  ground-glass nodule\nanteriorly and peripherally (5:155), all appear to have been present on\nexamination dated ___, unchanged.  A 0.6 cm partially solid and\npartially ground glass nodule adjacent to the major fissure (5:92) is compared\nto to chest CT dated ___.  While stable in size, this appears\nslightly more conspicuous and denser, potentially due to differences in\ntechnique. There is no new pulmonary nodule or opacity.  There is no pleural\nabnormality or effusion.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, imaged\nportions of the liver, gallbladder, pancreas, spleen, and bilateral adrenal\nglands are unremarkable.\n\nOsseous structures demonstrate no lytic or blastic lesion worrisome for\nmalignancy or infection.  Bones are diffusely demineralized.",
            "output": "1.  Within the left upper lobe adjacent to the major fissure is a 0.6cm partly\nsolid, partially ground glass nodule which appears stable in size of\nexaminations dated through ___ though more conspicuous and increased in\ndensity overall, potentially sequela of differences in technique.  A one year\nfollow up is advised after which point, if stability is demonstrated,\nsurveillance can be discontinued.\n\n2.  Numerous stable right and left ground glass opacities which demonstrate\nstability through ___.\n\n3.  Moderate to severe coronary artery calcifications involving the\nbifurcation of the left main coronary artery."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the imaged chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis but shows normal\nsize and.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels but is present\nin at least left main, anterior descending and circumflex coronary arteries. \nAorta is normal size in the valve is not appreciably calcified.  Pulmonary\narteries and cardiac chambers are not enlarged.  Pericardium is physiologic. \nThere is no pleural abnormality.  Esophagus is unremarkable.\n\nMediastinal another intrathoracic lymph nodes are not enlarged and hilar\ncontours on this noncontrast study do not suggest adenopathy.\n\nLungs:\n\nCentrilobular micro nodulation is chronic, often seen in smokers with\nrespiratory bronchiolitis or patients with severe allergies.\n\nPotentially significant lung lesions:\n\n2 mm solid right upper lobe nodule, 5:75, stable since at least ___ can be\nconsidered benign.\n\n5 x 9 mm ground-glass nodule, left upper lobe, 5:62, stable since at least\n___.\n\n5 x 8 mm ground-glass left upper lobe nodule, 5:91, was 7 x 8 mm in ___,\nand 6 x 8 mm in ___.\n\n6 x 8 mm ground-glass nodule, left upper lobe, 5:92, unchanged since at least\n___.\n\nSub solid elliptical 4 x 7 mm left upper lobe nodule, 5:131, was 4 x 8 mm in\n___ and 6 x 8 9 mm in ___.\n\n6 x 10 mm ground-glass nodule, left upper lobe, 5:154, was 6 x 10 mm in ___ and 6 x 8 mm in ___.\n\nThere are no new lung nodules of note.  Tracheobronchial tree is patent to\nsubsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection",
            "output": "No measurable growth in a half dozen ground-glass and sub solid nodules since\n___.  A solitary lesion, in the left upper lobe stable since ___, grew\nminimally after ___.  The overall impression is of a patient with\npostinflammatory lung lesions or atypical adenomatous hyperplasia who has\nshown no evidence of developing malignancy since ___.  Newly published\nguidelines recommend surveillance of such lesions for a total of ___ years, at ___\nyear intervals if stable.  Therefore a final the examination in ___ years should\nstatus 5 criteria for labeling these lesions inert .\n\nCoronary atherosclerosis.\n\nChronic mild bronchiolitis, usually smoking or allergy related.\n\nRECOMMENDATION(S):  Repeat, noncontrast chest CT in ___ years."
        },
        {
            "input": "The visualized aorta and its major branch vessels are patent with no evidence\nof stenosis, occlusion, dissection, or aneurysm.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  Questioned filling defects bilaterally are\nconsistent with laminar flow artifact.  The main and right pulmonary arteries\nare normal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThe heart size is normal. There is no pericardial or pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Normal Chest CT. No evidence of active intrathoracic infection or pulmonary\nembolism."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  There is new bulky mediastinal\nlymphadenopathy.  A pretracheal lymph node measures 11 mm (series 5, image\n35).  An aortopulmonary window lymph node measures 1.6 cm (series 5, image\n48).  A subcarinal lymph node measures 1.3 cm (series 5, image 58).  A lymph\nnode just anterior to the right mainstem bronchus measures 1.5 cm (series 5,\nimage 49).  A right hilar lymph node measures 1.9 cm in short axis (series 5,\nimage 61).  An anterior mediastinum lymph node measures 1.0 cm in short axis\n(series 5, image 53).\n\nPLEURAL SPACES:  There is a new, small, right pleural effusion.\n\nLUNGS/AIRWAYS:  There are numerous new bilateral pulmonary nodules.  The\nlargest confluence of nodules spans 2.7 x 1.9 cm in the right lower lobe\n(series 5, image 87).  Otherwise, there is mild bibasilar atelectasis. The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK:  There is a 5 mm hypoattenuating left thyroid lobe nodule.\n\nABDOMEN:\n\nHEPATOBILIARY:  There are innumerable new heterogeneously enhancing hepatic\nlesions replacing much of the hepatic parenchyma.  An example dominant lesion\nin segment IV measures 7.1 x 4.4 cm (series 10, image 24).  A previously seen\nfluid attenuating lesion in the anterior aspect of segment IV is displaced by\nadjacent lesions, but otherwise unchanged and likely reflects a cyst or\nbiliary hamartoma (series 10, image 32).  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is collapsed with a\nradiopaque stone within the gallbladder neck, unchanged compared to prior\nexaminations.  The hepatic veins are markedly attenuated, but grossly patent. \nThe hepatic portal veins appear patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Nodular thickening of the left adrenal gland is unchanged since\n___.  The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypoattenuating lesion arising from the upper pole the left kidney is too\nsmall to completely characterize, but statistically likely reflects a cyst.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is a right lower\nquadrant ileostomy.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The colon and rectum are within normal\nlimits.  The appendix is normal.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS: Patient is status-post cystectomy and total abdominal hysterectomy\nwith bilateral salpingo-oophorectomy.  Lesions adjacent to the vaginal cuff\nwhich were previously seen on PET-CT have minimally increased in size, now 2.1\nx 1.6 cm (series 10, image 81), 1.4 x 1.2 cm (series 10, image 83), and 2.4 x\n2.0 cm (series 10, image 79).\n\nREPRODUCTIVE ORGANS: Patient is status-post total abdominal hysterectomy and\nbilateral salpingo oophorectomy.\n\nLYMPH NODES: There is an interval increase in size of multiple retroperitoneal\nlymph nodes, most prominently of the celiac axis node measuring up to 9 mm in\nshort axis.  Multiple lymph nodes in the porta hepatis are also enlarged and\nmeasure up to 1.2 cm in short axis (series 10, image 37).  A left internal\niliac lymph node measures 1.7 cm in short axis (series 10, image 69). \nAdditional smaller perirectal lymph nodes, for example series 10, image 82,\nare abnormal in morphology. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  Mild atherosclerotic\ndisease is noted.  Incidental note is made of a circumaortic left renal vein.\n\nBONES:  There are new sclerotic lesions within multiple vertebral bodies\nincluding T1, T2, T5, and T10.  The T1 lesion measures 1.3 x 1.2 cm (series 5,\nimage 12).  The T5 lesion measures 1.5 x 1.0 cm (series 5, image 49).  The T10\nlesion measures 1.4 x 1.3 cm (series 10, image 13). Heterogeneous sclerosis of\nthe proximal left femur involving the lesser trochanter is unchanged since\n___, possibly reflecting in previously treated lesion is documented in the\nelectronic medical record.  A small sclerotic lesion in the right lesser\ntrochanter is unchanged.  A small sclerotic lesion within the posterior right\nacetabulum is unchanged since ___ and likely reflects a small bone island.  A\nsmall sclerotic lesion in the lateral left seventh rib is unchanged since ___\nand likely reflects a small bone island.  Sclerosis along the posterior margin\nof the ischial tuberosity is also unchanged.\n\nSOFT TISSUESThere is a right lower quadrant ileostomy which is grossly\nunremarkable.  Incidental note is made of a 3.4 x 1.7 cm lipoma within the\nright vastus intermedius.  A soft tissue nodule in the anterior abdominal wall\nmeasuring 6 x 6 mm is new (series 10, image 9).",
            "output": "1. Marked progression of metastatic disease including bilateral pulmonary\nnodules, mediastinal and hilar lymphadenopathy, innumerable hepatic lesions,\nand  multilevel vertebral body lesions. Local recurrence in the pelvis also\ndemonstrates progression given intervally increased size of lesions adjacent\nto the vaginal cuff.\n2. No pulmonary embolism.\n3. Nodular thickening of the left adrenal gland is unchanged since ___,\nreflecting adenomas or adenomatous hyperplasia given stability in the setting\nof markedly progressive metastatic disease.\n4. Cholelithiasis.\n5. Diverticulosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:29 ___, a less than 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "LUNGS: There are bilateral compressive atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent and normal centrally.\n\nPLEURAL SPACES: There are small bilateral pleural effusions.  No pneumothorax.\n\nHEART AND VASCULATURE: The ascending thoracic aorta measures 3.3 x 3.2 cm\n(series 2, image 25).  The descending thoracic aorta measures 2.3 x 2.2 cm\n(series 2, image 25).  There are extensive atherosclerotic calcification\nthrough the thoracic aorta.  There are multiple discontinuous area of\natherosclerotic calcifications throughout the descending thoracic aorta with\nonly small area of relatively sparing, for example at the level of T8\nvertebral body on series 602, image 83.\nAtherosclerotic calcifications in the subclavian arteries are mild.  Severe\nmitral valve calcification is noted.  Heart is normal in size.  There is small\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: There are multiple midline enlarged mediastinal\nlymph nodes measuring up to 1.2 cm in the pretracheal station (series 4, image\n73), likely reactive.\n\nBASE OF NECK: There is a 2.3 x 1.5 cm hypoattenuating thyroid nodule in the\nleft lobe of the thyroid (series 2, image 6).  Otherwise neck base is\nunremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality. ? There are level degenerative\nchanges of the thoracic spine.",
            "output": "1.  Multiple discontinuous areas of atherosclerotic calcifications throughout\nthe descending thoracic aorta with an area of relative sparing at T8 level.\n2.  Bilateral small pleural effusions with compressive atelectasis.\n3.  Borderline enlarged mediastinal lymph nodes measuring up to 1.2 cm, likely\nreactive.\n4.  2.3 x 1.5 cm thyroid nodule in the left lobe of the thyroid.  If no prior\nworkup has been performed, non urgent ultrasound can be performed for further\nassessment."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  There is\nnormal variant of azygos continuation of the IVC.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of acute pulmonary embolism or aortic abnormality.\n\n2.  Azygos continuation of the IVC, normal variant."
        },
        {
            "input": "CT CHEST:  The thyroid is unremarkable.  There is no axillary or\nsupraclavicular adenopathy.  There is no mediastinal or hilar adenopathy. \nHeart size normal.  There is no pericardial effusion.  The main pulmonary\ntrunk is mildly enlarged measuring 3.3 cm.\n\nThe airways are patent to the subsegmental level bilaterally.  The lungs are\ngrossly clear.  There is mild bibasilar atelectasis.  There is no pleural\neffusion, pneumothorax, or pneumomediastinum.  There is a calcified granuloma\nin the right upper lobe (series 3, image 22).\n\nThe thoracic esophagus is mildly tortuous.  Limited views of the upper abdomen\nare normal.\n\nCTA CHEST:  There are no coronary artery calcifications.  Again noted, are\naortic valvular calcifications.  There is a fusiform aneurysm of the ascending\naorta, unchanged in size compared to ___ with comparison to 3D\nmeasurements.  There is dilation of the left atrium.  There is mild\natherosclerotic disease of the thoracic aorta.\n\nMEASUREMENTS:\nAortic annulus:  17 x 27 mm\nAortic valve:  36 x 32 mm\nProximal ascending aorta:  38 x 36 mm\nMid ascending aorta:  47 x 46 mm\nDistal ascending aorta proximal to the brachiocephalic artery:  34 x 36 mm\nAortic arch:  28 x 25 mm\nAortic arch distal to the left subclavian:  24 x 22 mm\nDescending thoracic aorta:  21 x 22 mm\nDistal descending thoracic aorta:  20 x 19 mm\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.",
            "output": "1. Unchanged fusiform ascending thoracic aortic aneurysm measuring up to 47\nmm, followup CT is recommended in 6 months to evaluate for stability.  This\nscan should be ECG gated.\n2. Mildly enlarged main pulmonary trunk, suggestive of pulmonary artery\nhypertension.\n3. Aortic valve calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\nNo axillary or supraclavicular lymphadenopathy.\nNo abnormalities on the chest wall.\nEndotracheal tube.  Esophageal feeding tube ends in the stomach.\nLeft IJ catheter ends in superior vena cava.\nModerate atherosclerotic calcifications in the head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT for subdiaphragmatic\nfindings.\n\nMEDIASTINUM: The esophagus is unremarkable.\nNo enlarged mediastinal lymph nodes.\n\nHILA: No hilar lymphadenopathies.\n\nHEART and PERICARDIUM: Heart normal in size and appearance.  No pericardial\neffusion.\nModerate atherosclerotic calcifications in thoracic aorta and coronaries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Moderate centrilobular and paraseptal emphysema, with some\nbullae in the apices measuring up to 3 cm.\nBibasilar atelectasis, more significantly on the right base, but also in the\nsuperior segment of the left lower lobe.\nSmall ground-glass opacities gravity dependent in the left upper lobe.\nCalcified granulomas in the right lower lobe.\n2. AIRWAYS:  The airways are patent to subsegmental level.\n3. VESSELS:  Slightly enlarged pulmonary artery, measuring 3.3 cm.\nCHEST CAGE: Old healed fractures in fifth, seventh and eighth right ribs.\nSevere degenerative changes should in dorsal spine.",
            "output": "There is significant atelectasis in both lung bases and in the left lower\nlobe.\nGround-glass opacities in the left upper lobe could represent inflammatory\nchanges or aspiration."
        },
        {
            "input": "The thyroid gland is mildly enlarged resulting in mild compression of the\ntrachea. There is no discrete nodule. Right axillary lymph nodes do not meet\nstrict CT size for pathology, the largest 9mm in short axis (3:13). There is\nno supraclavicular, mediastinal or hilar adenopathy. The esophagus is\nunremarkable. Heart size is normal. The aorta and pulmonary artery are within\nnormal limits in caliber. There is no pericardial effusion. The\ntracheobronchial tree is patent to the subsegmental level.\n\nSubsegmental atelectasis within the left lower lobe is noted. Lungs are\notherwise clear with no suspicious nodule or consolidation. The pleura is\nwithout abnormalities or effusion.\n\nAlthough study not tailored for subdiaphragmatic evaluation, notice made of\ntwo fiducial markers in the left and right hepatic lobes and thickening of the\ngallbladder wall fundus, present prior examination dated ___ and\nunchanged. A 1.8 cm left superior pole renal cyst is stable.\n\nOsseous structures demonstrate no suspicious lytic or blastic lesions.",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "There are no enlarged mediastinal, axillary, or hilar lymph nodes. Heart is\nnormal in size, and there is no pericardial or pleural effusion.\n\nWithin the lungs, there are no new or growing pulmonary nodules or masses.\nFocal linear scar atelectasis is noted in the left lower lobe.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but fiducial\nseeds within the liver, gallbladder wall thickening, a stent within the\ninferior vena cava, and a 1.8 cm diameter cystic lesion in the upper pole of\nthe left kidney all appear unchanged.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.",
            "output": "1.  No CT evidence of intrathoracic metastatic disease.\n\n2.  Please see separately dictated MRI of the abdomen for complete description\nof subdiaphragmatic findings."
        },
        {
            "input": "There are no enlarged mediastinal, hilar or axillary lymph nodes.  Heart is\nupper limits of normal in size, and there is no pericardial or pleural\neffusion.  Exam was not tailored to evaluate the subdiaphragmatic region,\nwhich is reported separately on the dedicated MRI of the abdomen performed the\nsame date.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic skeletal lesions in the thorax.\n\nAssessment of the lungs is limited by respiratory motion, reducing sensitivity\nfor detecting small pulmonary nodules and subtle interstitial lung\nabnormalities.  With this limitation in mind, no new or growing nodules are\ndetected on this limited assessment.  Focal linear scarring at the left base\nis unchanged.",
            "output": "1.  Technically limited CT due to respiratory motion.  No gross evidence of\npulmonary metastases.\n\n2.  Please see separately dictated MRI of the abdomen for assessment of the\nsubdiaphragmatic region."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThere is no pleural or pericardial effusion.  Subpleural likely minimal\nfibrosis in the right lower lobe medially adjacent to an osteophyte is\nunchanged.\nPlease refer to the concurrent abdomen MR for complete description of the\nintra-abdominal findings.  There is excreted gadolinium in the in collecting\nsystems bilaterally\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities elsewhere in the chest wall suspicious for\nmalignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis last evaluated\nwith an MR of the abdomen on ___.  Today's study shows no adrenal\nmass.  Inferior vena caval graft noted, but not evaluated on this noncontrast\nstudy.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in head neck or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nMinimal pericardial effusion is physiologic.  There is no pleural abnormality.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy.\n\nNormal chest CT."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in.  Heart size is normal.  There is\nno mediastinal, hilar or axillary lymphadenopathy.  Image portion of the upper\nabdomen will be reviewed separately as part of the MR abdomen and\ncorresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  There are no lytic\nor sclerotic lesions worrisome for infection or neoplasm.\n\nLungs are clear.  No pulmonary nodules masses or consolidations demonstrated.",
            "output": "Normal chest CT with no evidence of intrathoracic metastatic disease.\n\nFor pre size assessment of the upper abdomen please review MRI of the abdomen\nthat would be obtained and reported separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.  In\nthe right axilla mildly enlarged lymph nodes measure up 1.4 and 1.3 cm (05:37,\n22), larger in comparison to prior study.  No lymphadenopathy in the left\naxilla.  Excluding the breasts which must be evaluated by mammography there\nare no concerning soft tissue abnormalities in the chest wall.\n\nCHEST CAGE: Mild multilevel degenerative changes of the vertebra, there is no\nevidence of osteo destructive lesions at the level of ribs, sternum or\nvertebra.\n\nUPPER ABDOMEN: Included unenhanced upper abdominal organs show stent in IVC,\nsurgical clips in the area of the liver hilus.  Please see separately dictated\nMRI of the abdomen for complete description of subdiaphragmatic findings.\n\nMEDIASTINUM: There is no pathologic enlargement of lymph nodes in the\nmediastinum.  Posterior mediastinum is unremarkable.  Evaluation of the hila\nis limited in the absence of contrast, but there is no evidence of gross hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  Pericardium is physiologic. \nThere are no appreciable atherosclerotic calcifications of the coronaries. \nMain pulmonary artery and thoracic aorta are normal in caliber.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  No\nmeasurable pulmonary nodules.  Dependent basilar Microatelectasis.",
            "output": "-No evidence of intrathoracic metastatic disease.\n-Few prominent lymph nodes in the right axilla are mildly larger, for\nultrasound or mammographic correlation if not recently performed."
        },
        {
            "input": "HEART AND VASCULATURE:  This examination is limited due to motion artifact and\nbolus timing.  There are no large central filling defects to suggest pulmonary\nembolism.  Atherosclerotic calcifications are noted at the aortic arch and the\norigin of the head and neck vessels.  Otherwise, the thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is a 2.4 x 1.7 cm focus of dense opacification within\nthe left lower lobe (series 5, image 98), which is triangular in shape, and\nlikely represents pneumonia.  There is adjacent atelectasis within the left\nlower lobe.  There is a 6 x 5 cm mixed density nodule with spiculation within\nthe right upper lobe (series 5, image 25).  A large thin-walled cyst is seen\nwithin the right lower lobe measuring up to 3.7 cm (series 5, image 64).  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  A 4.2 cm simple cyst is seen within the right lobe of the liver. \nOtherwise, the included portion of the upper abdomen is unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  Battery pack from a neuro stimulation device seen\noverlying the right chest.",
            "output": "1. Severely limited examination due to motion artifact and bolus timing. \nWithin these limitations, no large central filling defects to suggest\npulmonary embolism.\n2. Dense consolidation within the left lower lobe measuring up to 2.4 cm,\nwhich is triangular in shape.  Although this likely represents\npneumonia/aspiration, pulmonary infarction remains within the differential. \nThis consolidation should be followed to resolution with a chest CT in 3\nmonths.\n3. 6 cm spiculated mixed density nodule within the right upper lobe, which\nshould also be followed up with a chest CT.\n\nRECOMMENDATION(S):  Chest CT is recommended in 3 months."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and numerous subcentimeter axillary lymph nodes\nare not enlarged.  Evaluation of the breasts is reserved for mammography. \nVascular clips denote prior left breast surgery.  This study is not\nappropriate for subdiaphragmatic diagnosis but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM:Upper esophagus is mildly patulous, but there are no\nfindings to suggest obstruction.\n\nAtherosclerotic calcification is not apparent head and neck vessels or the\ncoronary arteries.  Aorta and pulmonary arteries are normal size and\npericardium is physiologic.\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged by\nsize criteria.\n\nLUNGS, AIRWAYS, PLEURAE: 4 mm subpleural nodule, left lower lobe, 4:161, is\nthe only focal pulmonary abnormality of consequence.  There is no interstitial\nabnormality.\n\nBronchial wall thickening is minimal and there is no bronchiectasis or\nretention of secretions.\n\nThere are no pleural abnormalities.\n\nCHEST CAGE: Unremarkable",
            "output": "No bronchiectasis, diffuse lung disease or other explanation for chronic\ncough.\n\nSolitary 4 mm left lower lobe lung nodule.  See recommendations below\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged, ranging in diameter\nup to 8 mm in the right peripectoral region, 5:85.  Excluding the breasts\nwhich require mammography for evaluation there are no soft tissue\nabnormalities in the imaged chest wall suspicious for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nBoth lobes of thyroid are moderately enlarged, left greater than right with a\n13 mm hypodensity requiring further imaging evaluation, 05:31.  The trachea is\ndisplaced moderately rightward and mildly narrowed by the enlarged thyroid.\n\nAtherosclerotic calcification is not apparent in head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are normal size.  There is no\npericardial or pleural abnormality.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged, despite\nsome granulomatous calcifications.  The only right lung nodule is a calcified\ngranuloma close to the minor fissure.\n\nRespiratory motion and low lung volumes compromise the technical quality of\nlung imaging, but a large enough lung lesion to be clinically significant\nwould not be missed.  The only left lung nodule is a 4 mm soft tissue nodule\nin the subpleural left lower lobe, 5:97.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy.  Right lung nodule is a benign\ncalcified granuloma.  3 mm left lower lobe lung nodule is too small to warrant\nfurther imaging evaluation.\n\nModerately large goiter with possible left thyroid nodule.\n\n\nRECOMMENDATION(S):   Thyroid ultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nMain pulmonary artery is enlarged, measuring 3 cm.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Calcified right hilar lymph nodes are\nunchanged, and suggest prior granulomatous infection.  No axillary,\nmediastinal, or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Airways are patent centrally.  There is mild bronchial wall\nthickening.  Diffuse mosaic appearance of the lung parenchyma is consistent\nwith air trapping.  A perifissural calcified granuloma is seen in the right\nupper lobe, unchanged from prior.  No concerning pulmonary nodules are\npresent.\n\nBASE OF NECK:  Again seen is an enlarged thyroid gland, with an ill-defined\n1.4 cm hypodense lesion in the left lobe of the thyroid.\n\nABDOMEN:  Included portion of the upper abdomen are notable for a small hiatal\nhernia.  Several calcifications are seen within the spleen, compatible with\nprior granulomatous infection.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Enlarged main pulmonary artery suggests pulmonary arterial hypertension.\n3. Mosaic appearance of the lung parenchyma with mild bronchial wall\nthickening suggests air trapping in the setting of small airways disease.\n4. Ill-defined 1.4 cm hypodense left thyroid nodule.  Recommend nonurgent\nthyroid ultrasound for further evaluation, if this has not already been\nperformed.\n\nRECOMMENDATION(S):\n1. Ill-defined 1.4 cm hypodense left thyroid nodule.  Recommend nonurgent\nthyroid ultrasound for further evaluation, if this has not already been\nperformed."
        },
        {
            "input": "The thyroid is minimally heterogeneous with subcentimeter hypodense lesions in\nthe right lobe. Supraclavicular, axillary, mediastinal and hilar lymph nodes\nare not enlarged. Aorta is normal size.  Main pulmonary artery is enlarged\nmeasures 3.2 cm Subcarinal bronchogenic cyst measuring 2.6 x 3.7 cm has grown\nfrom 2.3 x 2.6 cm.  Cardiac configuration is normal and there is no\nappreciable coronary calcification.  Polygonal shaped subpleural nodule in the\nleft lower lobe likely an intrapulmonary lymph node (4:217).  3 mm subpleural\nnodule in the right lower lobe (4:235) is  stable, otherwise the lungs are\nclear.  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation there is a\nsmall hiatal hernia.  There are multiple tiny calcified granulomas in the\nspleen\nThere are no bone findings of malignancy",
            "output": "Mild increase in size in known subcarinal bronchogenic cyst.\nSmall Hiatal hernia\n3 mm nodule in the right lower lobe, stable since ___ is benign in etiology"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nUnchanged appearance of the heterogeneous thyroid gland with scattered micro\nhypodense nodules. Stable small axillary and thoracic inlet lymph nodes.  No\nchest wall abnormalities.  Minimal atherosclerotic calcifications in the\nproximal left subclavian and distal brachiocephalic trunk arteries.\n\nMEDIASTINUM AND HILA:\n The known 38 x 26 mm subcarinal foregut duplication cyst is stable in size\nwhen compared to the ___ study but mildly increased in size when\ncompared to the ___ study when it was 26 x 27 mm (3:28). Stable small\nhiatal hernia, otherwise esophagus is unremarkable.  No enlarged mediastinal\nor hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Minimal\natherosclerotic calcifications in the coronary arteries, mild in the mitral\nannulus and in the aortic.  Aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  The right lower lobe 5 mm and\nright upper lobe 4 mm subpleural nodules are stable since the ___\nexamination (5:41, 222).  No suspicious lung nodules or masses.  No pleural\neffusion.  No focal consolidations.  Mild biapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nStriated pattern of osteopenia without evidence of compressive or pathologic\nfractures.  No acute fractures.  Severe dorsal spondylosis.  No lytic or\nsclerotic bone lesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic lesions. \nScattered calcifications throughout the splenic parenchyma are unchanged,\nlikely related to prior granulomatous infection.  Adrenals unremarkable.",
            "output": "Stable size and morphology of the 38 x 26 mm subcarinal bronchogenic cyst from\n___ study, but mildly increased in size when compared to the one from\n___.\n\nStable right upper and lower lobe 4-5 mm subpleural nodules since ___."
        },
        {
            "input": "The ETT terminates approximately 4.8 cm above the carina.  An NG tube is seen\ncoursing below the diaphragm and terminating within stomach.\n\nCHEST:\n\nHEART AND VASCULATURE:  This examination is limited due to motion artifact and\nbolus timing.  Pulmonary vasculature is well opacified to the segmental level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nmain pulmonary artery is mildly enlarged measuring 3.2 cm, suggesting\npulmonary arterial hypertension.  Otherwise, the heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Multiple subcentimeter lymph nodes are seen\nwithin the axilla bilaterally, nonspecific.  Prominent lymph nodes within the\nanterior mediastinum measuring up to 1.3 cm in short axis (series 3, image 59)\nare likely reactive in nature.  No hilar lymphadenopathy.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There are dense consolidations with air bronchograms within\nthe dependent portion of the lower lobes bilaterally, left greater than right,\nlikely representing pneumonia/ aspiration.  There are multifocal nodular\ncentral peribronchial opacities, most severe within the right upper lobe\n(series 3, image 49), right middle lobe, right lower lobe, and posterior\nsegments of the left upper lobe also likely representing multifocal infection\nor aspiration.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic in appearance.  No focal lesions,\nalthough this examination is limited by bolus timing.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 15.3 cm.  No focal lesions.  Numerous\nperisplenic varices.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple hypodensities within the left kidney are too small to\ncharacterize, but likely represent simple cysts.  Otherwise, the kidneys are\nof normal and symmetric size with normal nephrogram.  There is no evidence of\nsolid renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: Bladder is decompressed by a Foley, and cannot be adequately\nevaluated.  Air within the bladder lumen is likely due to recent\ncatheterization.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Numerous subcentimeter retroperitoneal lymph nodes are\nvisualized, nonspecific.  There is no mesenteric lymphadenopathy.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: No evidence of acute fracture.  Severe disc space\nnarrowing at L5-S1.  There is extensive cortical irregularity involving the\ninferior endplate of L5, and the superior endplate of S1 with sclerosis (608 B\nimage 41).  There is no associated soft tissue component.  There is a fat\ncontaining umbilical hernia with a fascial defect measuring 1.9 cm.",
            "output": "1. Limited examination due to motion artifact and bolus timing.  Within these\nlimitations, no evidence of large central pulmonary embolism.\n2. Multifocal central peribronchial nodular opacities, most severe in the\nright upper lobe, in addition to dense consolidations with air bronchograms\nwithin the lower lobes bilaterally, likely representing multifocal pneumonia\nor aspiration.\n3. Severe disc space narrowing and cortical irregularity at L5-S1.  Although\nthese findings may be degenerative in nature, there is only minimal\ndegenerative disc disease at other levels, raising suspicion for\ndiscitis-osteomyelitis at L5-S1 in a patient with the given history.  There is\nno associated soft tissue component.  MRI lumbar spine should be considered.\n4. Cirrhotic appearing liver or with sequela of portal hypertension including\nsplenomegaly and varices.\n\nRECOMMENDATION(S):  MRI lumbar spine should be considered."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  The heart, pericardium,\nand great vessels are within normal limits.  There is decreased attenuation of\nthe blood pool, suggestive of anemia.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: In the left supraclavicular region, there is a\n4.3 x 3.2 cm soft tissue density, less likely a hematoma, more likely an\nenlarged lymph node (02:11) as it is well demarcated on neck CT where it is\nbetter evaluated.  No axillary lymphadenopathy is present.  No mediastinal\nmass or hematoma.\n\nPLEURAL SPACES: There is a small right pleural effusion. There is no\npneumothorax.\n\nLUNGS/AIRWAYS: In the right middle lobe, there is a 2.8 x 1.5 cm elongated\nnodule (2:61), potentially an impacted enlarged bronchus or from an underlying\nparenchymal nodule and/or atelectasis.  In the right upper lobe, there is a\n0.9 cm calcified granuloma.  In the left upper lobe, there is a 2 mm pulmonary\nnodule (2:51).  There is interlobular septal thickening and ground-glass\nopacity consistent with pulmonary edema.  There is dependent ground glass\nopacity with areas of consolidation bilaterally, right greater than left,\nlikely atelectasis, however, aspiration or infection cannot be excluded. \nThere is debris in the distal trachea.  An endotracheal tube terminates in the\ndistal trachea.\n\nBASE OF NECK: There is a multinodular thyroid.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is not\nvisualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The enteric tube terminates in the stomach.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nStreak artifact from right hip arthroplasty limits evaluation of the pelvis.\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: There is soft tissue edema overlying the right hip and gluteal\nmuscles; there is no frank hematoma.",
            "output": "1. No evidence of an acute intrathoracic or intra-abdominal bleed. Right hip\nand gluteal soft tissue edema; no frank hematoma. The right thigh hematoma is\nnot visualized.\n2. Mild pulmonary edema.  Small right pleural effusion.  Debris in the distal\ntrachea.  Aspiration or infection cannot be entirely excluded.\n3. A 4.3 cm soft tissue density in the left supraclavicular region likely\nrepresents an enlarged potentially neoplastic lymph node.  Hematoma is less\nlikely as it is well demarcated on concurrent neck CTA.\n4. A 2.8 cm elongated nodule in the right middle lobe of the lung is of\nuncertain significance and could represent an impacted dilated bronchus versus\npulmonary nodule and/or atelectasis.  Three-month follow-up CT is recommended.\n\nNOTIFICATION:   The impression and recommendations for follow up were\ndiscussed with ___, M.D. by ___, M.D. on the telephone\non ___ at 2:52 pm, 5 minutes after discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is enlarged with a dilated left atrium.  No pericardial effusion. \nNo atherosclerotic calcifications in the coronary arteries or cardiac valves,\nmild in the aorta.  The pulmonary artery is dilated measuring 3.5 cm.  The\naorta is normal in caliber throughout.  There is no evidence of dissection,\naneurysmal dilations are penetrating atherosclerotic ulcers.  Filling defect\nis noted in the inferior segment of the right inferior artery (301:96).  No\nother filling defects are noted in the mid pulmonary artery throughout its\nother subsegmental branches.\n\nNECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is heterogeneous with large hypodense nodules bilaterally.  No\nenlarged lymph nodes in either axilla or thoracic inlet.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEnteric tube passing through the esophagus which is otherwise unremarkable. \nLarge lymphadenopathy in the left upper paratracheal station measuring 1.3 cm\nin short axis diameter (301:32).  No hilar lymphadenopathy.\n\nPLEURA:\nBilateral pleural effusions, right greater than left and moderate.  No apical\nscarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  Mild to moderate diffuse\nbronchial thickening.  No bronchiectasis or mucus plugging.  Ground-glass\nopacities associated to mild interlobular septal thickening are noted in the\nright upper and left lower lobes.  Coarse calcified granuloma in the right\nupper lobe (31:62).  Partial compressive atelectasis is noted in both lower\nlobes.  There are consolidations in the middle lobe and in the right lower\nlobe.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Pulmonary embolus in a segment of the right inferior pulmonary artery.\nCardiomegaly with predominant enlargement of the right chambers and left\natrium.\nEnlarged pulmonary arteries suggestive of chronic pulmonary hypertension.\nGiven the above-mentioned chronic findings, right heart strain evaluation is\nimpaired.\n\nMild pulmonary edema most pronounced in the right upper lobe suggestive of\nassociated mitral valve dysfunction.\nConsolidations noted in the right lower and middle lobes suggestive of\nmultifocal pneumonia.\nBilateral pleural effusions, right greater the left.\nMediastinal lymphadenopathy, likely reactive to both pulmonary edema and\npneumonia.\n\nRECOMMENDATION(S):  Recommend further evaluation with echocardiogram.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:12 pm."
        },
        {
            "input": "There are no pathologically enlarged supraclavicular or axillary lymph nodes;\nalthough nodes are numerous in the left axilla, none exceeds 4 mm in diameter.\nA focal relatively hyper attenuating (50 ___ swelling in the right lower chest\nwall musculature, could be is large as 25 x 41 X 20 mm, 6:180-194 has a\ncircumscribed, 13 mm wide, lower attenuating (20 ___ focussed at its inferior\nextent, 6:192 that could be region of necrosis in a mass or, less likely,\nfocal infection. The adjacent subcutaneous fat and eighth rib are undisturbed.\n\nFindings below the diaphragm will be reported separately. Thyroid is\nunremarkable. Aorta and pulmonary arteries are normal size. Atherosclerotic\ncalcification is minimal. There is no pleural or pericardial abnormality.\nMediastinal and hilar and internal mammary, diaphragmatic, and retrocrural\nlymph nodes are not enlarged. A pericardial process at the level of the right\ninferior pulmonary vein should not be mistaken for a hilar lymph node.\n\nLungs are essentially clear.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Intramuscular mass (or abscess), right chest wall, could be a primary or\nmetastatic malignancy. Clinical inspection recommended. The lesion should be\nreadily accessible to needle aspiration.\n\nNo evidence of primary or metastatic intrathoracic malignancy"
        },
        {
            "input": "The aorta is normal in course and caliber.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental\npulmonary arteries.  Evaluation of the subsegmental arteries is limited.  The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nTracheostomy tube is in place.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nProminent mediastinal lymph nodes do not meet CT size criteria for pathologic\nenlargement, but are likely reactive.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no large pleural\neffusion.\n\nThere is atelectasis of the left lower lobe, and dense atelectasis of the\nposterior basal segment of the right lower lobe.  The patient is intubated.\nThe airways are patent to the segmental level.\n\nLimited images of the upper abdomen reveal a partially nodular hepatic\ncontour.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nSeveral old healed right posterior rib fractures are noted.  There may be a\nnon-displaced sternal fracture, which is not well assessed due to patient\nmotion.",
            "output": "1.  No evidence of pulmonary embolism to the subsegmental level or acute\naortic abnormality.\n\n2.  Left lower lobe collapse.  Dense atelectasis in the posterior basal\nsegment of the right lower lobe.  Findings could also be related to bilateral\naspiration.\n\n4.  Partially nodular liver contour, likely due to underlying hepatic disease.\n\n5.  There may be a small non-displaced sternal fracture, although poorly\nassessed due to patient motion.\n\nNOTIFICATION:  The updated findings were communicated via telephone by Dr.\n___ to Dr. ___ at 17:06 on ___, 2 min after discovery."
        },
        {
            "input": "Although this study is not the site for assessment of the abdomen, limited\nviews of the upper abdomen are notable for a shrunken nodular liver compatible\nwith history of cirrhosis, splenomegaly, bilateral nonobstructing renal stones\nand diverticulosis.  For details regarding the abdomen please see abdomen MRI\nreport from same day.\n\nCT chest: The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nHeart, pericardium and great vessels are within normal limits.  Note is made\nof moderate coronary artery calcifications. No hiatal hernia is present.\n\nA 3 mm calcified granuloma is noted at the left lung base and in the right\nupper lobe (3:45 and 04:47 respectively). Lung windows otherwise do not\ndemonstrate any focal opacity. No pleural effusion or pneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesion suspicious for malignancy is\npresent. Multilevel degenerative changes of the thoracic spine are noted. \nBilateral gynecomastia is noted.",
            "output": "1. No evidence of intrathoracic malignancy.\n2. Cirrhosis and splenomegaly. For details regarding the abdomen please see\nconcurrent abdomen MRI."
        },
        {
            "input": "Small mediastinal lymph nodes are stable.  None of them pathologically\nenlarged.  Coronary calcifications are extensive.  No hilar axillary or\nsupraclavicular lymphadenopathy present.  Aorta and pulmonary arteries are\nunremarkable.  Heart size is top-normal.  No pericardial of pleural effusion\nis seen.  Image portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\nwith no pulmonary nodules masses or consolidations.  Right middle lobe\natelectasis is present.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "No evidence of intrathoracic metastatic disease"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Mild\naortic wall calcifications, moderate coronary calcifications.  Mild aortic\nvalve calcifications.  No pericardial effusion.  Status post liver transplant.\nNormal appearance of the posterior mediastinum. No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  No diffuse lung\ndisease.  No evidence of airways disease.  Mild respiratory motion.  No\nsuspicious pulmonary nodules or masses.  No pleural thickening, no pleural\neffusions.",
            "output": "Stable appearance as compared to ___.  No metastatic disease to\nthe thorax."
        },
        {
            "input": "The left hemithorax is completely opacified secondary to large heterogeneously\ndense pleural effusion consistent with hemorrhagic component. Rightward\nmediastinal shift is moderate. Accounting for differences in technique, left\npleural catheter is unchanged since same day radiograph.\n\nSmall right pleural effusion is not hemorrhagic in density and results in mild\nright lower lobe atelectasis.  Calcified pleural plaques are unchanged. The\ntrachea is patent. There is significant narrowing of the main bronchi. Left\nupper and left lower lobe bronchi are opacified. Right lower lobe spiculated\nnodule (4:140) is unchanged currently measuring 12 x 16 mm.\n\nRight internal jugular vein catheter terminates in the low SVC. The thyroid is\nnormal. Supraclavicular, axillary, and right hilar lymph nodes are not\nenlarged.  Left hilar lymph nodes cannot be evaluated due to large left\npleural effusion. Enlarged lower right paratracheal lymph nodes are unchanged.\nPrevascular lymph nodes have decreased in size currently measuring 6 mm,\npreviously up to 10 mm. Aorta and pulmonary arteries are normal size. \nCalcifications of thoracic aorta and great vessel origins are dense. Aortic\ncaliber is normal. Aortic valve calcification is moderate. Diffuse coronary\nartery calcifications are dense.  There is a small nonhemorrhagic pericardial\neffusion.\n\nSmall to moderate amount of intraperitoneal free air is present anterior to\nthe left hepatic lobe and falciform ligament (02:56). There is a small amount\nof simple perihepatic and perisplenic ascites. 2.1 x 3.8 cm left adrenal\nnodule is unchanged since PET-CT ___. Calcification of the proximal\nabdominal aorta is dense including dense calcified atherosclerotic plaque of\nthe superior mesenteric artery origin.\n\nThere is no osseous lytic or blastic lesion concerning for malignancy or\ninfection. There is severe degenerative changes of the thoracic spine.",
            "output": "1. Large hemorrhagic left pleural effusion occupying the entire left\nhemithorax with mild to moderate right mediastinal shift. Nonhemorrhagic small\nright pleural effusion with underlying mild right basilar atelectasis.\n2. Small to moderate volume intraperitoneal free air projecting over the left\nhepatic lobe and falciform ligament.  Finding could be further evaluated with\nCT abdomen and pelvis.\n3. Grossly unchanged right lower lobe spiculated mass currently measuring 12 x\n16 mm.\n4. Dense atherosclerotic calcification of the thoracic aorta, great vessel\norigins, and coronary arteries.\n\nRECOMMENDATION(S):\nSmall to moderate volume intraperitoneal free air projecting over the left\nhepatic lobe and falciform ligament.  Finding could be further evaluated with\nCT abdomen and pelvis.\n\nNOTIFICATION:  Dr ___ the findings with the ICU clinical care\nteam at 08:30."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Stable left pectoral Port-A-Cath.  Stable severe\naortic wall calcifications and severe coronary calcifications, no aortic valve\ncalcifications.  The remaining cardiac structures are unremarkable.  Normal\nappearance of the posterior mediastinum, no acute abnormalities are noted in\nthe upper abdomen.  Normal appearance of the soft tissues, including the\nvisible parts of the breasts.  No osteolytic lesions at the level of the ribs,\nthe sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  The lung windows show new\nmultifocal parenchymal opacities with predominantly peripheral distribution\nand both solid and ground-glass components.  Some of the abnormalities are\nbronchus centric.  The margins of the abnormalities are ill-defined.  Stable\nsmall lymph node calcifications (4, 125) And parenchymal consolidation (4,\n124).  There are new bilateral pleural effusions, right more than left.  No\nsuspicious pulmonary nodules or masses.",
            "output": "New multifocal parenchymal opacities with mixed attenuation and both\nperipheral and peribronchial distribution.  The findings are likely to\nrepresent multifocal pneumonia, most likely of bacterial origin.  New right\nmore than left pleural effusions.  No adenopathy.  Calcified normal sized\nmediastinal lymph nodes."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable. There are no enlarged supraclavicular\nlymph nodes. There is a left-sided Port-A-Cath with its tip in the right\natrium.\n\nBREAST AND AXILLA  : Both breasts are heterogeneous breast tissue, no obvious\nmasses or adenopathy\n\nMEDIASTINUM: There are several small stable small calcified mediastinal lymph\nnodes.  There is moderate cardiomegaly.  Severe coronary artery calcifications\nagain seen.  There is no pericardial effusion.  The aorta is mildly ectatic\nwith evidence of atherosclerotic calcification involving the descending\nthoracic aorta.  There is no pericardial effusion\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is stable 2 mm left lower lobe pulmonary nodule (6, 171).  A 4 mm\ncalcified left lower lobe pulmonary nodule is also unchanged.  No new\npulmonary nodules.  Previously visualized ground-glass opacity in the left\nupper lobe has resolved.\n\nBONES AND CHEST WALL : Review of bones shows stable calcification in the left\nhumeral head which could represent an enchondroma.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Stable 2 mm left lower lobe pulmonary nodule.\n\nEvidence of prior granulomatous disease.\n\nStable enchondroma within the left humeral head.\n\nLeft-sided Port-A-Cath with its tip in the right atrium.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "CT CHEST WITHOUT IV CONTRAST: The thyroid is unremarkable.  There are\npersistently borderline enlarged right axillary lymph nodes measuring up to 11\nmm in short axis.  There are several left axillary lymph nodes but these are\nnot enlarged.  Within the limitations of a noncontrast CT there is no obvious\nmediastinal or hilar lymphadenopathy.  Mediastinal lymph nodes seen on prior\nCT are more difficult to see today.\n\nHeart size is normal with trace pericardial effusion.  The thoracic aorta and\nproximal great vessels are normal in caliber.  The main pulmonary artery is\nnormal in caliber.  Right PICC terminates in the upper right atrium.\n\nPigtail pleural drain terminates at the right base.  There is trace residual\npleural effusion and significant right basilar atelectasis.  As before there\nis a background of moderate centrilobular emphysema.  New interlobular septal\nthickening in the right lung could reflect asymmetric pulmonary edema.\n\nAlthough less well evaluated without IV contrast right upper lobe abscess\nmeasures approximately 6.2 x 3.3 cm, previously 4.9 x 2.6 cm.\n\nOSSEOUS STRUCTURES: There is no worrisome blastic or lytic lesion.\n\nUPPER ABDOMEN: There is a 2.9 x 2.7 cm left adrenal nodule which is better\nseen on contrast-enhanced CT of the chest from ___.",
            "output": "1. Interval enlargement of right apical lung abscess.  Consideration may be\ngiven to percutaneous drainage if clinically appropriate.\n2. Moderate emphysema. New interlobular septal thickening in the right lung\ncould reflect mild asymmetric pulmonary edema.\n3. Borderline enlarged right axillary lymph nodes, likely reactive.\n4. 2.9 x 2.7 cm left adrenal nodule warrants further evaluation with dedicated\ntriphasic CT of the abdomen or MRI non urgently.\n\nRECOMMENDATION(S):  Nonurgent CT or MRI for 2.9 x 2.7 cm left adrenal nodule."
        },
        {
            "input": "The thoracic aorta is normal in caliber.  The main, left, and right pulmonary\narteries are normal in caliber.  The heart is normal in size.  No pericardial\neffusion.\n\nNo axillary supraclavicular lymphadenopathy.  Enlarged subcarinal lymph nodes\nare unchanged, measuring up to 12 mm in short axis and likely reactive.  No\nhilar lymphadenopathy.\n\nThe known empyema in the right upper lobe that was completely drained on\n___ has reaccumulated and now measures 5.6 x 3.4 cm on axial images with a\nnew air-fluid level (series 2, image 13; series 601b, image 64).  In the right\nposterior lower lobe at the site of a prior pigtail catheter, another\npleural-based fluid collection with locules of air and surrounding thickened\nand hyperenhancing pleura is consistent with an empyema, new from the prior\nexam, measuring 5.3 x 2.2 cm on axial images (series 2, image 36; series 601b,\nimage 76).  No evidence of extension of the empyema into the adjacent chest\nwall soft tissue or ribs.\n\nEmphysema is moderate.  Right lower lobe bandlike parenchymal opacities is\nconsistent with atelectasis.  No left pleural effusion.  The airways are\npatent to at least the segmental level.\n\nA heterogeneously enhancing left adrenal nodule measures up to 2.9 x 2.1 cm,\nsimilar to the prior exams only recently dating of to ___ (series 2,\nimage 51).\n\nNo osseous lesion concerning for malignancy are infection.",
            "output": "1.  Re-accumulation of a right upper lobe empyema, now with air-fluid level\nsince prior complete drainage on ___, measuring 5.6 x 3.4 cm.\n\n2.  New 5.3 x 2.2-cm right lower lobe empyema at the site of prior pigtail\ndrain.\n\n3.  Emphysema.\n\n4.  2.9-cm heterogeneously enhancing left adrenal nodule for which further\nevaluation with nonemergent adrenal MRI is recommended.\n\nRECOMMENDATION(S):  1.  Empyemas are amenable to image-guided drainage.\n2.  Non-emergent adrenal MRI to further evaluate left nodule.\n\nNOTIFICATION:   The findings, impression, and any recommendation were\ndiscussed with ___, M.D. by ___, M.D. on the telephone on\n___ at 4:45 ___, 1 minutes after discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Prominent right hilar lymph nodes are likely reactive (4:91).\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  There is an independent origin of the left vertebral artery, a\nnormal anatomic variant.  Aortic caliber is normal.  The main, right, and left\npulmonary arteries are normal caliber.  There are no pulmonary arterial\nfilling defects to suggest pulmonary emboli.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis moderate to severe underlying centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  Loculated right-sided empyemas are redemonstrated.  The right upper\nlobe collection is overall similar in size to the prior study measuring\napproximately 5.7 x 2.6 cm (04:44), with increased fluid within the loculated\ncomponent and associated adjacent interlobular septal thickening.  Loculated\nfluid and gas is seen inferior to this with associated atelectasis could\noverall smaller from the prior study (4:100, 116, 144).\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for an\nunchanged enhancing 2.8 x 2.3 cm left adrenal nodule (02:53).",
            "output": "1. Right upper empyema is similar in size within increased fluid component and\nadjacent interlobular septal thickening suggesting active infection.\n2. Small right lower empyema is overall decreased in size.\n3. Short interval stability of a left-sided adrenal nodule for which dedicated\nadrenal CT or MRI is recommended.\n\nRECOMMENDATION(S):  Nonemergent dedicated adrenal CT or MRI is recommended for\nfurther evaluation of a left adrenal nodule."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions. Left\nsupraclavicular lymph nodes (2, 15) appear similar compared to prior.  No\naxillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  Left adrenal lesion measures 26 x 21 mm.  The\nadrenal lesion enhances to 90 ___ on this contrasted study.  The lesion\nmeasures slightly smaller in size compared to prior, but this is most likely\ntechnical in nature.  The adrenal lesion measured 40 ___ on the noncontrast\nstudy done ___ suggesting it is not a lipid rich adenoma.\n\nMEDIASTINUM: No new or enlarging mediastinal lymph nodes.  Subcarinal lymph\nnodes are unchanged.\n\nHILA: Right hilar lymph nodes are unchanged.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  No coronary artery calcification.  No\naneurysmal malformation of the ascending aorta.\nPLEURA: No pleural effusion. Mild residual pleural thickening in relation to\nthe posterior aspect of the right upper lobe (602 B, 51) but no abnormal\npleural enhancement or collections.\nLUNG:\n\n-PARENCHYMA:  Marked centrilobular emphysematous changes.  Multifocal areas of\nground-glass opacity in the right upper lobe, right middle lobe and lingula. \nMild, but diffuse bronchial wall thickening with mild retained secretions.  No\nbronchiectasis.  Multiple peribronchial nodules in the lingula (4, 168).\n-AIRWAYS:  Airways patent to the subsegmental level.  Minimal retained\nsecretions present in the cervical trachea (2, 13).\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Interval resolution of the previously noted pleural collection/empyema.\n\nMultifocal areas of ground-glass opacity in the upper and mid lung zones,\nbronchial wall thickening and retained secretions.  In the differential\ndiagnosis consider infective bronchiolitis and respiratory bronchiolitis\ninterstitial lung disease (in the setting of marked centrilobular emphysema).\n\nSolid left adrenal lesion measuring 26 x 21 mm.  This lesion is not a lipid\nrich adenoma as evidenced by ___ value of 40 on the previous noncontrast\nstudy done ___.\nThe lesion demonstrates avid enhancement to 90 ___.  Referral for biochemical\nworkup and possible tissue sampling advised."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level.  No large, central pulmonary embolus is identified.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Scattered, prominent mediastinal lymph nodes\nare noted, measuring less than 1 cm in short axis.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is bibasilar atelectasis.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.  A 5 mm subpleural nodule is noted\nin the right middle lobe (3:115), which is likely benign.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No pulmonary embolus or aortic abnormality."
        },
        {
            "input": "THORACIC INLET: There is a is approximately 16 x 14 mm hypodense lesion in the\nleft lobe of thyroid.  The superior extent of the lesion has not been imaged. \nThe NG tube projects below the left hemidiaphragm and out of field-of-view. \nThere are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  A right lower\nparatracheal node measures 7 mm.  There is a trace pericardial effusion. \nThere are no enlarged hilar lymph nodes.  The aorta and pulmonary arteries are\nnormal in caliber.  There is atherosclerotic calcification involving the\ndescending thoracic aorta.\n\nPLEURA: There are no pleural effusions\n\nLUNG: There is a 3.5 x 1.6 cm tubular opacity in the right upper lobe with\ndystrophic calcification along the lateral aspect, is indeterminate but is\nconcerning for malignancy.  The mass abuts the posterior subsegmental bronchus\nof the right upper lobe.  There is bibasilar atelectasis.  No other lung\nnodules are seen.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  There is mild intrahepatic biliary ductal dilatation.  Please refer\nto dedicated report on abdomen which has been dictated separately.  The left\nadrenal is thickened and nodular.",
            "output": "1.6 x 1.4 cm mass in the posterior segment the right upper lobe abutting the\nposterior subsegmental bronchus of the right upper lobe is indeterminate but\nconcerning for malignancy.\n\nBibasilar atelectasis.\n\nSmall mediastinal lymph nodes.\n\nIncompletely visualized left thyroid nodule.\n\nLeft adrenal nodule.  Please refer to dedicated report on abdomen which has\nbeen dictated separately."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Patient has had\nleft mastectomy.  Right breast evaluation is the reserved for mammography.  No\nsoft tissue abnormalities elsewhere in the chest wall.\n\nThis study is not designed for subdiaphragmatic diagnosis, especially\nregarding the liver, but shows no adrenal mass or subphrenic collection.\n\nCARDIO-MEDIASTINUM: Hiatus hernia is small.  Esophagus is unremarkable. \nAtherosclerotic calcification is moderate in head and neck vessels and native\ncoronary arteries.  Patient has had median sternotomy, CABG and aortic valve\nreplacement.  Atrial ventricular pacer leads are in place.  No evidence of\noperative complications in the chest wall or mediastinum.  Pericardium is\nphysiologic.  Evaluation of fusiform enlargement ascending thoracic aorta to\n48 mm and dilated pulmonary arteries and cardiomegaly is reserved for\nechocardiography.\n\nTHORACIC LYMPH NODES: Subcentimeter thoracic lymph nodes in the mediastinal\nlower paratracheal and posterior paraesophageal stations are not\npathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Extensive, heterogeneous ground-glass opacification\nis generally subpleural except for relatively symmetric peribronchial vascular\ncomponents in the anterior segments of both upper lobes.  There is no septal\nthickening or pleural effusion to support a diagnosis of pulmonary edema.\n\nTracheobronchial tree is patent to subsegmental levels with no appreciable\nthickening or retained material.\n\nCHEST CAGE: Unremarkable.",
            "output": "No endobronchial lesion or discrete pulmonary abnormality to explain\nhemoptysis.  Generalized ground-glass abnormality could be atypical edema,\nabsent septal thickening or pleural effusion, or, alternatively, diffuse\npulmonary hemorrhage or micro vasculitis.  Nonspecific interstitial\npneumonitis and drug reaction are alternative diagnoses, not usually causing \nhemoptysis.\n\nSevere dilatation ascending thoracic aorta.  No evidence of bleeding. \nCardiomegaly and pulmonary artery enlargement.  No pericardial effusion."
        },
        {
            "input": "Stable right pectoral ICD.  Status post sternotomy.  Massive calcification of\nthe thoracic aorta, status post CABG.  Mild dilatation of the main pulmonary\nartery.  Massive calcifications of the native coronary arteries.  Borderline\nsize of hilar lymph nodes.  Status post aortic valve replacement.  The upper\nabdomen, including the status post cholecystectomy is described in detail in\nthe dedicated abdominal CT report.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  The lung parenchyma continues to show signs of mild interstitial\nfluid overload.  The extent of the pre-existing ground-glass opacities,\nhowever, has substantially decreased but not completely resolved.  There is no\nevidence of new parenchymal abnormalities and no evidence of suspicious\npulmonary nodules or masses.  A pleural effusion on the left has newly\nappeared.",
            "output": "Decrease but no complete resolution of the pre-existing parenchymal opacities.\nThe opacities are most likely infectious.  New small left pleural effusion. \nNo new parenchymal or intrabronchial abnormalities.  Stable severe pre\ndescribed aortic and coronary calcifications."
        },
        {
            "input": "A left thyroid nodule is incidentally noted. Axillary, supraclavicular,\nmediastinal, and hilar lymph nodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is normal.  There is no\npericardial effusion.\n\nThere is no evidence of pleural effusion or pneumothorax. The airways are\npatent to subsegmental levels.\n\nWithin the lungs, there is no focal consolidation, pulmonary nodule, or mass\nidentified.  Significant bibasilar atelectasis is new as compared to the prior\nexamination, and may be secondary to her now postoperative state.  Tubular\nbronchiectasis is noted bilaterally.\n\nOSSEOUS STRUCTURES:  There are no destructive focal osseous lesions concerning\nfor malignancy identified within the imaged thoracic skeleton.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. Within this limitation, a prominent extrahepatic CBD, bilateral\nrenal cysts, and colonic diverticulosis are unchanged.",
            "output": "1. No evidence of pathologic lymphadenopathy or intrathoracic metastatic\ndisease.\n2.  Mild, bilateral bronchiectasis is stable from the previous examination,\nlikely age related.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___ telephone\nat 12:57 on ___."
        },
        {
            "input": "Mild unchanged enlargement of the thyroid with several hypodense nodules.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes at the level of the mediastinum and the hilar structures. No\npericardial effusions.  The upper abdomen is reported in a dedicated abdominal\nCT report.  No osteolytic lesions at the level of the ribs and the sternum. \nUnchanged solitary sclerotic lesion (9, 46) in T10.  Minimal apical\nthickening.  Normal attenuation of the lung parenchyma.  No lung nodules or\nmasses.  The pleural surfaces are even.  No pleural thickening, no pleural\neffusions.  The airways are patent.  No diffuse lung disease.",
            "output": "No evidence of malignant or metastatic disease to the thorax."
        },
        {
            "input": "Diffuse thyroid enlargement with left thyroid nodule is pronounced but\nunchanged.  Mediastinal silhouette is unremarkable.  No lymphadenopathy is\nseen.  Heart size is normal.  There is no pericardial pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.\n\nLungs are clear.\n\nThere is is soft tissue nodule in the right posterior back, series 5, image\n49, 17 x 14 mm in diameter increased as compared to 11 x 9 mm back on ___.  The nodule can be seen back to ___ and giving the proximity\nof a skin fold as might represent growing progression cyst.  No other similar\nfindings demonstrated.",
            "output": "Growing nodule in the right lower back as described, potentially representing\nis a brushes cyst but still concerning for potential metastatic focus,\ncorrelation with dedicated ultrasound is recommended.\n\nNo other abnormalities within the chest noted."
        },
        {
            "input": "Chest perimeter:\n\nSupraclavicular and numerous small bilateral axillary lymph nodes are not\nenlarged.  Specifically excluding the breasts which must be evaluated with\nmammography, there are no soft tissue abnormalities in the imaged chest wall\nsuspicious for malignancy.  All findings below the diaphragm will be reported\nseparately.\n\nCardio mediastinum:\n\nThe persistently bulbous character of the gastroesophageal junction, indenting\nthe left wall of the lower esophagus, could be due to a benign sub mucosal\nmass or anatomic variant.  The overall diameter of the junction and any\npossible mass is 24 mm, 6:214.  It has had the same appearance since at least\n___, measuring 26 mm, 4:183.  The only way to determine whether this\nis a normal variant or an abnormality would be endoscopic observation.\n\nAbove that level the esophagus is generally unremarkable, mildly patulous at\nthe level of the left main bronchus.\n\nThe thyroid is generally enlarged and what was a discrete 17 mm wide\nhypodensity in ___, 06:32, is smaller.  Nevertheless ultrasound\nevaluation would be appropriate, if not recently performed.\n\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are not enlarged.  Small pericardial\neffusion is physiologic.\n\nThoracic lymph nodes:\n\nNo enlargement.\n\nLungs, airways, and pleura:\n\nLungs clear.  Airways patent to the subsegmental level.  No pleural\nabnormality.\n\nChest cage:\n\nSmall sclerotic lesion, lower thoracic vertebral body, 09:45, unchanged since\nat least ___, can be considered benign.  No osseous lesions concerning\nfor malignancy or infection.  No pathologic or compression fracture.",
            "output": "No evidence intrathoracic metastasis.\n\nLong-standing abnormality, gastroesophageal junction stable since at least\n___ could nevertheless be a benign submucosal mass.  Esophagoscopy\nrecommended if the patient is symptomatic.\n\nAbnormality, left thyroid lobe should be evaluated with ultrasound, if not\nrecently performed.\n\nRECOMMENDATION(S):  Thyroid ultrasound.\n\nConsider esophagoscopy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Minimal lymph node enlargement in the mediastinum. \nA reference lesion in the aortopulmonary window (2, 24) measures 13 x 16 mm. \nModerate dilatation of the main pulmonary artery.  Severe coronary\ncalcifications, mild aortic valve calcifications.  Moderate cardiomegaly. \nSevere aortic wall calcifications.  In the upper abdomen, there is evidence of\nperihepatic and perisplenic ascites.  Moderate degenerative vertebral disease.\nNo vertebral compression fractures.  Mild bilateral apical scarring, with\ncalcifications on the right (4, 40).  Multiple millimetric and partly\ncalcified subpleural granulomas.  Mild to moderate centrilobular pulmonary\nemphysema.  The airways show evidence of bronchial wall thickening and\nbronchial wall irregularities, consistent with chronic bronchitis.  In the\nlower lobes, there is minimal interstitial thickening, consistent with mild\ninterstitial pulmonary edema.  Most importantly, however, there is a diffuse\ninterstitial micronodular pattern, best seen along the fissures and at the\nlevel of the interlobular septa in the lower lobes.  The micronodules are no\nnew more flows and only few of them are calcified.",
            "output": "Mild to moderate centrilobular emphysema, combines to mild chronic airways\ndisease.  Diffuse interstitial micronodules could indicate the presence of\nsarcoid, but the tear radical possibility of miliary TB should not be\nexcluded."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  Heart size\nis normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.  1\nmm left upper lobe nodule, series 302, image 63 is noncalcified, the only\ndiscrete nodule seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease with a 1 mm nodule in the left\nupper lobe unlikely to represent clinical significance.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in enhancement and diameter. Several\nmediastinal lymph nodes in anterior mediastinum are stable, and not\npathologically enlarged. No hilar or axillary lymphadenopathy is present.\nThere is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally. Right upper lobe\npulmonary nodule is stable, series 3 image 145, 4 mm. No additional pulmonary\nnodules masses or consolidations demonstrated.\n\nThere is no pleural effusion. There is no pneumothorax.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\nNo definitive evidence of rib fracture or chest wall abnormality noted.",
            "output": "Overall unremarkable chest CT"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Patient is status post\nthyroidectomy.  No axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please see same day CT abdomen and pelvis for detailed\nabdominopelvic findings.\n\nMEDIASTINUM: Unremarkable\n\nHILA: Unremarkable\n\nHEART and PERICARDIUM: Unremarkable\nPLEURA: Unremarkable\nLUNG:\n\n1. PARENCHYMA: 4 mm right upper lobe nodule remains stable dating back to\n___ chest CT (4:147).  No other nodules or suspicious pulmonary masses\nare identified.\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  Unremarkable\nCHEST CAGE: No aggressive osseous lesions.",
            "output": "1. Stable 4 mm right upper lobe nodule.  No new nodules or masses identified.\n2. Please see same-day CT abdomen and pelvis for detailed abdominopelvic\nfindings."
        },
        {
            "input": "Scattered subcentimeter mediastinal, axillary and hilar lymph nodes are\ndecreased in number and size compared to ___. Heart size is\nnormal, and there is no pericardial or pleural effusion.  Small hiatal hernia\nis incidentally noted.\n\nNo new suspicious lytic or blastic skeletal lesions are detected within the\nthorax.\n\nWithin the lungs, no new suspicious nodules or masses are identified.",
            "output": "1.  No CT evidence of intrathoracic malignancy or active pulmonary infection.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.  Mild\nasymmetry of the breast parenchyma.\n\nUPPER ABDOMEN: Will be reported separately\n\nMEDIASTINUM: No mediastinal adenopathy.  Epiphrenic lymph nodes are unchanged.\n\nHILA: Right hilar lymph nodes are unchanged.\n\nHEART and PERICARDIUM: Normal cardiac configuration. No pericardial effusion. \nNo aortic valve calcification.  Mild coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA: No suspicious pulmonary nodules or masses.  A few punctate,\ncalcified granulomas.  Mild, diffuse bronchial wall thickening. Mild\ncylindrical bronchiectasis in the lower lobes.  Mild mosaic attenuation\npattern of the lower lobes suggesting air trapping.\n-AIRWAYS: Patent to the subsegmental level.\n-VESSELS: The pulmonary arteries not enlarged. No filling defects.\nCHEST CAGE: No lytic/destructive bony lesions.",
            "output": "No suspicious pulmonary nodules or masses. No pneumonia.\n\nThe mediastinal, epiphrenic and hilar lymph nodes are unchanged compared to\nimaging done ___, but decreased in size compared to imaging done ___."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  The heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Punctate calcified granulomas identified in the right upper\nlobe (2:48).  The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild dependent bilateral subsegmental atelectasis is noted.\n\nBASE OF NECK:  A 3-4 mm rounded calcification is noted adjacent to the right\nthyroid lobe.  Adjacent to this, there is likely a 3 mm hypodense thyroid\nnodule (2:3), described on previous ultrasound.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  The colon and rectum are within normal limits.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: Evaluation of the pelvic parenchyma is limited due to streak artifact\nfrom the right hip arthroplasty.  Within this limitation, the urinary bladder\nand distal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild to moderate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  Patient is post total right hip\narthroplasty.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute intrathoracic or intraabdominal injury.\n\nNOTIFICATION:  The above findings were communicated in person by Dr. ___\nto Dr. ___ surgery) at 09:45 on ___, 2 min after discovery."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\ncardiomegaly with enlargement of the pulmonary trunk to 3.7 cm.  The right\nchest wall port terminates in the low SVC.  The pericardium and great vessels\nare otherwise within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a prominent left axillary lymph node\nmeasuring 1.1 cm in short axis (2:23). There is no right axillary or\nmediastinal lymphadenopathy present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are peribronchial consolidations in the left lung base\nwith left lung base and lingular bronchiectasis.  There are tubular locules of\ngas just anterior to the thoracic aorta, which likely represent post treatment\nbronchiectasis or less likely pneumatocele.  There is a 2.5 x 2.9 cm lobulated\nleft lung base soft tissue density, incompletely characterized in the absence\nof intravenous contrast, measuring 2.7 x 2.5 cm on the outside CT report from\n___ (2:63).  The airways are patent to the level of the segmental\nbronchi bilaterally.  Unchanged 2 mm right middle lobe nodule (2:61).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: The included portion of the unenhanced upper abdomen is notable for\nlow-density adrenal nodules, unchanged compared to prior. There are punctate\ncalcifications in the right renal parenchyma, likely the sequela of prior\ninfarct or trauma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere are multilevel degenerative changes of the thoracolumbar spine with\ndegenerative disc change, facet arthropathy and osteophytosis.  Punctate\nsclerotic focus in the left anterior fifth rib likely represents a sclerotic\nbone island.",
            "output": "1.   1. No acute fracture or traumatic injury.\n  2. Left lung base and lingula peribronchial consolidations with left lung\nbase predominant bronchiectasis. Findings most likely reflect post treatment\nchanges, however superimposed pneumonia or aspiration cannot be excluded.\nRecommend correlation with clinical symptoms for signs of infection.\n  3. 2.9 cm left lung base soft tissue nodule, better described on CT chest\nperformed at an outside institution on ___.  Prior images not\navailable for comparison.\n  4. Bilateral low-density adrenal gland nodules consistent with benign\nadrenal lesions such as adenomas and are unchanged compared to chest CT from\n___.\n  5. Prominent left axillary lymph node.\n  6. Mild cardiomegaly with enlargement of the main pulmonary artery, which\ncan be seen in the setting of pulmonary hypertension.\n  7. Right prepectoral port terminates in the low SVC."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymph nodes\nwhich appear pathologic or are enlarging.  No mediastinal mass.\n\nPLEURAL SPACES: There is a small left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: In the left lower lobe there is a 3.0 cm soft tissue mass which\nappears grossly unchanged compared to ___.  There are peribronchial\nconsolidations and bronchiectasis in the left lower lobe and lingula which are\nlikely secondary to post treatment changes and overall unchanged compared to\nprior.  It would be difficult to exclude superimposed consolidation secondary\nto infection, however stability over time speaks against this possibility.  2\nmm nodule in the right middle lobe is unchanged.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There is a 1.6 cm left thyroid nodule.  There is no\nsupraclavicular lymphadenopathy.  There is a right chest wall port which\nenters the right IJ and terminates at the distal SVC.  The soft tissues of the\nchest wall are otherwise unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is notable for low density\nadrenal nodules, unchanged compared to prior.  Regions of cortical thinning\nsuggesting scar noted at the upper pole the right kidney.\n\nBONES: No suspicious bone lesions are seen.? There is a new mildly displaced\nfracture of the lateral left seventh rib.  Focal sclerotic irregularity of the\nanterolateral left sixth rib likely also represents a fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. New mildly displaced fracture of the lateral left seventh rib and likely\nnondisplaced fracture of the anterolateral left sixth rib.\n3. 3 cm mass in the left lower lobe is unchanged.  Adjacent post treatment\nradiation fibrosis changes are stable.\n4. 1.6 cm left lobe of the thyroid nodule for which dedicated thyroid\nultrasound can be performed as clinically indicated.\n\nRECOMMENDATION(S):  1.6 cm left lobe of the thyroid nodule for which dedicated\nthyroid ultrasound can be performed as clinically indicated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Port-A-Cath noted in right upper\nchest wall with lead terminating in distal SVC.  Thyroid gland are\nunremarkable.  No axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report for\ndetails intra-abdominal findings are\n\nMEDIASTINUM: Study is limited for evaluation of pulmonary embolism.  Normal\ncaliber thoracic aorta.  Slight interval increase in size AP window lymph\nnode, measuring 11 mm in short axis previously measured 9 mm (series, image\n37).\n\nHILA: No suspicious adenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.  Mild cardiomegaly.\nPLEURA: Trace left-sided pleural effusion.  No right-sided pleural effusion. \nNo pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Redemonstrated is left lower lobe lobular density measuring\n4.2 x 4.1 cm x 5.0 cm (transverse, AP, cc) previously measured 3.8 x 3.3 x 4.6\ncm (___).  Redemonstrated patchy areas of consolidation/atelectasis\nand bronchiectasis surrounding the lobular mass, not significantly changed\ncompared to prior imaging.  Lingular atelectasis, unchanged.  Punctate nodule\nin the left upper lobe is unchanged (6:74) right middle lung 5-6 mm\nground-glass nodule, unchanged (series 5, image 54).  Mild right basilar\natelectasis.  No new focal consolidation.\n2. AIRWAYS: The central airways are patent.\n\nCHEST CAGE: Redemonstrated is mildly displaced left anterior lateral sixth and\nseventh rib fractures.  Multilevel degenerative changes involving thoracic\nspine.",
            "output": "1. Slight interval increase in size of left lower lobe relatively hyperdense\nlesion with peripheral enhancement, measuring 4.2 x 4.1 x 5.0 cm, previously\n3.8 x 3.3 x 4.6 cm (___).\n2. Persistent unchanged left lower lobe atelectasis/consolidation with\ntraction bronchiectasis.\n3. Slight interval increase in size of AP window lymph node measuring 11 mm,\npreviously measured 9 mm in short axis.\n4. Mildly displaced, healing sixth and seventh anterolateral left rib\nfractures, unchanged compared to prior imaging.\n5. Please refer to dedicated CT abdomen and pelvis report for details\nintra-abdominal findings."
        },
        {
            "input": "There is a right IJ access right chest wall Port-A-Cath which terminates in\nthe lower SVC.  At the imaged base of neck, the imaged thyroid notable for a\nleft thyroid nodule measuring up to 12 mm.  The thoracic aorta is normal in\ncourse and caliber without significant atherosclerotic calcification.  The\nheart is normal in size and shape without pericardial effusion.  There is\nhypodense appearance of the intracardiac blood pool suggesting anemia.  The\nmain pulmonary artery appears normal in size.  No axillary or mediastinal\nadenopathy is seen.  The esophagus is decompressed.  The airways centrally\npatent.  There is interval increase in left pleural effusion, which appears\nslightly loculated, and now appears moderate in size.\n\nThis patient is known to have a mass in the left lower lobe which is difficult\nto accurately measure given absence of IV contrast though overall, this mass\nappears increased in size measuring approximately 6.9 x 5.6 x 8.1 cm compared\nto a prior measurement of approximately 4.8 x 4.1 x 5.0 cm at a similar level.\nThere is new atelectasis in the inferior lingula and increased atelectasis in\nthe left lower lobe.  Please note a component of pneumonia is difficult to\nentirely exclude on the basis of this appearance.  There is subsegmental\natelectasis within the right lower lobe.\n\nWithin the imaged portion of the upper abdomen, a right renal nonobstructing\nstone is noted as well as a parenchymal calcification along the posterior\nquestion.  Adrenal nodules appear grossly unchanged.\n\nBONES: There is no worrisome lytic or blastic osseous lesion.  Incompletely\nhealed fracture of the left seventh rib is noted along the lateral arch. \nSclerosis involving the left anterolateral sixth rib likely reflects the\npresence of a healed fracture.  Multilevel degenerative changes within the\nthoracic spine.",
            "output": "1.  No acute fracture.  Subacute fracture of the left seventh rib.  Chronic\nfracture deformity of the left sixth rib.\n2.  Left lower lobe mass appears increased in size compared with prior, please\nnote evaluation limited in the absence of IV contrast.\n3.  Increased atelectasis in the left lower lung as described, a component of\npneumonia not excluded.  Subsegmental atelectasis in the right lower lobe also\nnoted.\n4.  Hypodense appearance of the intracardiac blood pool suggests anemia.\n5.  Bilateral adrenal nodules appear grossly unchanged in size."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  The tip of a right-sided\nvenous catheter terminates in the low SVC, with the port in the subcutaneous\ntissues of the upper right chest wall.  The left lower lobe pulmonary artery\nand the left pulmonary vein are compressed by the left lower lobe necrotic\nmass.\n\nAXILLA, HILA, AND MEDIASTINUM: A mediastinal lymph node measures 0.8 cm in\nshort axis (2:48), and a left axillary lymph node measures 1.0 cm in short\naxis (601:56).\n\nPLEURAL SPACES: No pneumothorax.  There is now a large multi loculated\nhydropneumothorax within the left pleural space with thickened pleura\nparticularly seen posteriorly.  Separate loculated components are seen\nanteriorly, the left lateral lung base, and posteriorly with likely 2 separate\ncomponents.\n\nLUNGS/AIRWAYS:  Redemonstration of a large complex mass within the left lower\nlobe, with new rupture into the pleural space. In comparison to CTA of the\ntorso from ___, there are multiple new locules of gas within\nthis mass, suggestive of the development of communication with the airways. \nThere is a 6 mm nodule in the right lower lobe (2:75). There is increased\nvolume loss in comparison to the study from 2 weeks prior.  The right airways\nare patent to the level of the segmental bronchi.  The left bronchi are\nlargely obliterated at the subsegmental level because of the mass, volume\nloss, and effusion.\n\nBASE OF NECK: In the inferior left lobe of the thyroid, there are 2 hypodense\nlesions measuring 1.0 cm and 0.7 cm.  There is a 3 mm hypodense lesion in the\nlower right thyroid lobe.  Visualized portions of the base of the neck show no\nabnormality.\n\nABDOMEN: There are nonobstructive calculi in the right kidney measuring up to\n6 mm.  There are bilateral adrenal nodules, unchanged since ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere are multiple degenerative changes of the visualized thoracolumbar spine,\nincluding loss of disc space height, endplate sclerosis, and osteophytosis.",
            "output": "1. Redemonstration of a complex mass within the left lower lobe, with rupture\ninto the pleural space and new communication with the airways.  Multiloculated\nhydropneumothorax.\n2. Mediastinal and axillary lymphadenopathy, as before.\n3. 6 mm pulmonary nodule in the right lower lobe.\n4. Nonobstructive renal calculi in the right kidney measuring up to 6 mm.\n5. Thyroid nodule.  No follow up recommended. Absent suspicious imaging\nfeatures, unless there is additional clinical concern, ___ College of\nRadiology guidelines do not recommend further evaluation for incidental\nthyroid nodules less than 1.0 cm in patients under age ___ or less than 1.5 cm\nin patients age ___ or ___. Suspicious findings include: Abnormal lymph nodes\n(those displaying enlargement, calcification, cystic components and/or\nincreased enhancement) or invasion of local tissues by the thyroid nodule. \n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "The imaged portion of the thyroid gland is normal.  There has been recent CABG\nwith new midline sternotomy wires noted.  Mild adjacent fatty infiltration of\nthe chest wall and small anterior mediastinal hematoma reflect recent CABG. \nThoracic aorta opacifies normally with mild calcification and no dissection. \nThe main pulmonary artery is normal in caliber with patent pulmonary arterial\ntree demonstrating no filling defect to suggest the presence of a pulmonary\nembolism.  Mild prominence of mediastinal nodes, up to 11 mm in short axis\nlikely reactive in this patient with recent CABG.  Heart is normal in size\nwithout pericardial effusion.  Airways centrally patent.\n\nEmphysema is noted with scattered areas of raising potential concern for\npulmonary fibrosis.  There is an 8 mm nodule in the right upper load best seen\non series 3, image 95.  Tiny calcified granuloma noted in the right lower lobe\nNo pleural effusion is seen.\n\nIn the imaged portion of the upper abdomen, there are no worrisome findings.\n\nBones:  No worrisome lytic or blastic osseous lesion.",
            "output": "1. Emphysema with features of mild pulmonary fibrosis.\n2. 8 mm right upper lobe pulmonary nodule.  Followup CT in 3 months\nrecommended.\n3. No pulmonary embolism.\n4. Recent CABG with healing sternotomy and small anterior mediastinal\nhematoma."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\nareas.  Borderline sized lymph node in the anterior mediastinum (6, 25).  No\nabnormalities at the level of the large mediastinal vessels.  No cardiac\nabnormalities.  No pericardial effusion.  No abnormalities in the posterior\nmediastinum, with the exception of a minimal hiatal hernia.  The upper abdomen\nis reported separately in a dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nMinimal bilateral apical scarring.  No pleural thickening, no pleural\neffusions.  No diffuse lung disease.  The large airways are patent.  Small\nareas of dependent atelectasis.  No suspicious lung nodules or masses.  Small\nleft basal focal thickening of the diaphragm (7, 260).",
            "output": "No evidence of metastatic disease to the thorax."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\ncompartments.  The large mediastinal vessels appear unremarkable.  No\nabnormalities in the breast tissue, with the exception of a left-sided\npunctate calcification (5, 23).  No coronary abnormalities.  No pericardial\neffusion.  The posterior mediastinum is unremarkable.  The upper abdomen is\nreported in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies. \nMinimal bilateral apical scarring.  A nodular density in the left upper lobe\n(6, 54) Is vascular in origin.  No metastatic lung nodules or masses.  No\ndiffuse lung disease.  The airways are patent.  A previously seen focal\nthickening of the left hemidiaphragm has decreased in size (6, 260).",
            "output": "Stable examination as compared to ___.  No metastatic disease to\nthe thorax."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The right chest port catheter terminates in the right\natrium.  The thoracic aorta is normal in caliber.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nImaged portions of the thyroid are unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is an unchanged subcentimeter hypodense lesion in the midpole\nof the right kidney, too small to characterize.  The kidneys are of normal and\nsymmetric size with normal nephrogram.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized, but there\nare no secondary signs of appendicitis.\n\nPERITONEUM: Multiple previously seen peritoneal implants are no longer\nvisualized.  A solitary remaining right pelvic peritoneal implant has\ndecreased in size and is now calcified (___).  There is a 0.7 cm hyperdense\nlesion immediately inferior to the spleen, unchanged since ___\nand represents an accessory spleen (___).\n\nPELVIS: The bladder is massively distended.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post TAH/BSO.\n\nLYMPH NODES: Interval decrease in size of multiple retroperitoneal lymph\nnodes:\n-left periaortic lymph node, measuring 0.6 cm, previously 1.1 cm (___)\n-right aortocaval lymph node, measuring 0.5 cm, previously 0.8 cm (___)\n-left periaortic lymph node, measuring 0.8 cm, previously 1.0 cm (___)\nNo mesenteric lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Compared to ___ the patient has undergone TAH/BSO as well as\ntotal omentectomy.  Multiple previously seen peritoneal implants are no longer\nvisualized.  1 solitary remaining right pelvic peritoneal implant has\ndecreased in size and is now calcified.\n2. Interval decrease in size of multiple retroperitoneal lymph nodes.\n3. No evidence of intrathoracic metastasis."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The right chest port catheter terminates in the right\natrium.  The thoracic aorta is normal in caliber.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nImaged portions of the thyroid are unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is an unchanged subcentimeter hypodense lesion in the midpole\nof the right kidney, too small to characterize.  The kidneys are of normal and\nsymmetric size with normal nephrogram.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized, but there\nare no secondary signs of appendicitis.\n\nPERITONEUM: Multiple previously seen peritoneal implants are no longer\nvisualized.  A solitary remaining right pelvic peritoneal implant has\ndecreased in size and is now calcified (___).  There is a 0.7 cm hyperdense\nlesion immediately inferior to the spleen, unchanged since ___\nand represents an accessory spleen (___).\n\nPELVIS: The bladder is massively distended.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post TAH/BSO.\n\nLYMPH NODES: Interval decrease in size of multiple retroperitoneal lymph\nnodes:\n-left periaortic lymph node, measuring 0.6 cm, previously 1.1 cm (___)\n-right aortocaval lymph node, measuring 0.5 cm, previously 0.8 cm (___)\n-left periaortic lymph node, measuring 0.8 cm, previously 1.0 cm (___)\nNo mesenteric lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Compared to ___ the patient has undergone TAH/BSO as well as\ntotal omentectomy.  Multiple previously seen peritoneal implants are no longer\nvisualized.  1 solitary remaining right pelvic peritoneal implant has\ndecreased in size and is now calcified.\n2. Interval decrease in size of multiple retroperitoneal lymph nodes.\n3. No evidence of intrathoracic metastasis."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  The heart size is normal.  Pericardium is intact without\nevidence of an effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.  The aorta and main pulmonary artery are normal\nin size.\n\nThe airways are patent to the subsegmental levels.\n\nBiapical pleuroparenchymal scarring is seen.  There is no pleural effusion or\npneumothorax.  No concerning new or growing pulmonary nodules are identified.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures however please refer to the dedicated CT of the abdomen performed\non same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "No concerning new or growing pulmonary nodules identified."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  No\npericardial pleural effusion is seen.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nThere is no fracture identified.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nPlease review CT abdomen and pelvis and the corresponding report that will be\nissued separately.",
            "output": "No abnormalities concerning for intrathoracic metastatic disease."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Multiple collaterals are seen in the lower neck,\nmost likely secondary to power injector.  There is no evidence of a SVC\nobstruction\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal vascular structures are unremarkable.  There are\nstable small mediastinal lymph nodes.  A prevascular node measures 5 mm. \nThere are no enlarged hilar lymph nodes.  There is moderate cardiomegaly. \nThere is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is minimal bibasilar atelectasis.  No lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones are unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "No evidence of metastasis to the chest.  Please refer to dedicated report on\nabdomen which has been dictated separately for further details."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  Heart size is normal.  There is no pericardial effusion. \nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.\n\nThe aorta is normal in caliber.  The main pulmonary artery is normal in\ncaliber.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nRe demonstrated are multiple collaterals in the lower neck likely secondary to\npower injector.\n\nBibasilar atelectasis is overall unchanged compared to the prior exam.  No\nconcerning new or growing pulmonary nodules are identified.  There is no\npleural effusion or pneumothorax.",
            "output": "No concerning new or growing pulmonary nodules identified.  Stable bibasilar\natelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: A right Port-A-Cath terminates in the cavoatrial junction.  Aortic\ncaliber is normal.  The main, right, and left pulmonary arteries are normal\ncaliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis bilateral lower lobe atelectasis.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Ectasia of the right jugular vein.  Right anterior port with\ntip in the lower SVC.  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No suspicious lung nodules or\nmasses.  No consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No interval change compared to prior study of ___.\nNo evidence of intrathoracic metastatic disease.\nNo suspicious lung nodules, lymphadenopathy or osseous lesions."
        },
        {
            "input": "Right pectoral Port-A-Cath.  No incidental thyroid findings.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum or at the level of the hilar structures.  No\nincidental pulmonary embolism.  No valvular or substantial coronary\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No abnormalities in the soft tissues are at the level of\nthe breast.  Bilateral small breast calcifications (6, 24).  No osteolytic\nlesions at the level of the ribs, the sternum, or the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  Minimal\nbilateral apical scarring.  No suspicious pulmonary nodules or masses.  The\nairways are patent.  No diffuse lung disease.  No pleural thickening, no\npleural effusions.",
            "output": "Stable normal examination of the thorax.  No adenopathy.  No parenchymal\nmetastasis.  No pleural pathology."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Right hilar lymph node has decreased from 12 to 9 mm.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is mild calcification in the LAD.  6 mm nodule in the right middle\nlobe is stable (5:152).  There is diffuse mild bronchial wall thickening. \nMild to moderate upper lobe predominant centrilobular emphysema is unchanged. \nCentrilobular ground-glass opacities in the upper lobes suggests respiratory\nbronchiolitis has mildly improved from prior study.  4 mm right perifissural\nnodule is stable (5:140).  There is a 2 mm subpleural nodule in the right\nupper lobe (5:141).  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation , there is\nstable thickening of the left adrenal gland.\nThere are no bone findings of malignancy",
            "output": "Emphysema\nCoronary calcification\nImproved respiratory bronchiolitis\nBronchial wall thickening reflect chronic airways inflammation\nDecrease in size in right hilar lymph node\nStable lung nodules followup in ___ year is recommended\n\nRECOMMENDATION(S):  Followup CT in ___ year"
        },
        {
            "input": "Evaluation of the breasts requires mammography. Numerous subcentimeter\nsupraclavicular lymph nodes are not pathologically enlarged.  Numerous mildly\nenlarged lymph nodes in both axillae and upper chest walls are new or newly\nenlarged, for example right axilla 11 mm, 05:36, right chest wall, 10 mm,\n5:74, 13 mm, 5:95; left chest wall, 11 mm, 5:73.\n\n Elsewhere in the partially imaged chest wall there are no soft tissue\nabnormalities concerning for malignancy.  Moderate to severe edema is now\npresent in the right upper and midline abdominal wall, with a a healing\nincision reflecting recent surgery, 04:44.\n\nLeft thyroid lobe is moderately enlarged, but there are node discrete\nabnormalities warranting further imaging evaluation.  Atherosclerotic\ncalcification is not apparent in head and neck vessels, but is scattered in\nthe coronary arteries.  Aorta and cardiac chambers and pulmonary arteries are\nnormal size\n\nPericardium is physiologic.  There is no pleural effusion.\n\nThoracic lymph nodes:\n\n7 mm right diaphragmatic node, 5:185 is new but not pathologically enlarged\nand is probably due to recent abdominal surgery.\n\nLungs and airways:\n\nSolitary right middle lobe nodule adjacent to the medial segmental bronchus\nand artery in the middle lobe measured in conjunction with the middle lobe\nartery is 6 x 7 mm today, 5:143, unchanged since ___.  There is no\natelectasis distal to this lesion to suggest that it has significant\nimpairment of the bronchus.\n\nMajor pulmonary abnormalities are moderate emphysema, apical predominant, and\ngeneralized bronchial wall thickening, basal predominant.  There is no mucoid\nimpaction or peribronchial infiltration to suggest suppurative bronchitis. \nFindings do not suggest active respiratory bronchiolitis.\n\nChest cage:\n\nThere are no bone lesions concerning for malignancy or infection no pathologic\nor substantial compression fracture.  Mild compression due to upper endplate\ndeformity in the upper thoracic spine is unchanged.",
            "output": "One lung lesion warrants an additional year of imaging follow-up to document\nthat it is benign, a peribronchovascular 6 mm right middle lobe nodule.\n\nModerate emphysema.\n\nExtensive bronchial wall thickening denotes continued bronchial inflammation.\n\nNew mild enlargement of lymph nodes in both axillae and both sides of the\nchest wall is more suggestive of reactive than malignant adenopathy.  Imaging\nfollowup is not needed unless there is reason to suspect lymphoproliferative\nconditions.\n\nRECOMMENDATION(S):  Repeat chest CT in one year.  Intravenous contrast should\nbe administered if tolerated."
        },
        {
            "input": "THORACIC INLET: A subcentimeter left supraclavicular lymph nodes are\nunchanged.  There is a stable hypodense lesion in the left lobe of thyroid.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is no pericardial effusion.  The aorta and pulmonary artery\nnormal in caliber.  There is no pericardial effusion.  There is moderate\ncoronary artery calcification\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is moderate upper lobe predominant emphysema.  No new pulmonary\nnodules.  Previously visualized 6 mm nodule in the right middle lobe adjacent\nto a dilated bronchus (5, 138) Is unchanged.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Stable 6 mm nodule in the right middle lobe with adjacent mild bronchiectasis.\n\nModerate emphysema.\n\nStable small axillary lymph nodes not enlarged by size criteria.\n\n\n\n\nRECOMMENDATION(S):  Follow-up in ___ year is recommended\n\nFor incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is moderate atherosclerotic burden in the thoracic aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary artery is enlarged\nmeasuring up to 3.4 cm across maximal diameter (05:44).\n\nIn the superior mediastinum, there is a heterogeneous enhancing mass which is\ncontiguous with the left lobe of the thyroid (___) which measures 6.1 x 7.0\ncm (AP x TV, 05:19) and its craniocaudal length is incompletely visualized on\nthis study.\n\nThere are multiple subcentimeter right paratracheal lymph nodes measuring up\nto 6 mm in shortest diameter (05:34) which are not pathologically enlarged by\nCT size criteria.  A subcarinal lymph node (5:54) measures 1.2 x 0.9 cm. There\nis a right hilar lymph node measuring 8 mm in short axis (05:49) which is not\npathologically enlarged by CT size criteria.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.\n\nThere is significant centrilobular and paraseptal emphysematous changes in the\nlungs. There is heterogeneous consolidation in the left lower lobe with\nbulging of the major fissure likely representing pneumonia.  Of note, there is\nalso debris noted in the segmental airways to the left lower lobe (05:59). \nThere is also mild bronchial wall thickening compatible with reactive airway\ndisease.\n\nThere is no evidence of pericardial effusion.  Small right and trace left\npleural effusions.  Heart is enlarged.\n\nLimited images of the upper abdomen are unremarkable.  There is a small hiatal\nhernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is a superior endplate deformity of the L1 vertebral body without\nretropulsion.",
            "output": "1.No evidence of pulmonary embolism or aortic abnormality.\n\n2.  A heterogeneous superior mediastinal mass which appears to be contiguous\nwith the left lobe of the thyroid which measures 6.1 x 7.0 cm (AP x TV) and is\nsuspicious for goiter versus thyroid neoplasm.  Thyroid ultrasound and\nsampling is recommended.\n\n3.  Heterogeneous consolidation of the left lower lobe with debris noted in\nthe segmental airways to the left lower lobe compatible with aspiration\npneumonia.\n\n4.  Significant emphysematous changes of the lungs, mild pulmonary edema, and\nbronchial wall thickening which likely represents react small airway disease.\n\n5.  Age indeterminate superior endplate deformity of L1.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 7:51 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Large heterogenous soft tissue mass\nextending from the inferior aspect of the thyroid suspicious for a\nmultinodular goiter (malignancy can't be excluded with absolute certainty). \nNo gross supraclavicular or axillary adenopathy.  Asymmetrical breast\nparenchyma.\n\nUPPER ABDOMEN: The study was not tailored to evaluate the subdiaphragmatic\norgans.  Mildly increased hepatic density measuring 66 ___ (normal is 55).  No\nadrenal lesions.\n\nMEDIASTINUM: Retrosternal extension of thyroid measuring approximately 69 x 54\nmm in the axial plane (2, 15).  Mass effect on the adjacent trachea as\ndescribed below.  Subcentimeter mediastinal lymph nodes.\n\nHILA: Difficult to comment on hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Small pericardial effusion is new.  Cardiomegaly.  Mild\naortic annular calcification.  Mild coronary artery calcification.  Moderate\ncalcification of the mitral annulus.  No aneurysmal malformation of the\nascending aorta.  Moderate calcification of the aortic arch and supra-aortic\nvessels.\nPLEURA: Small nonhemorrhagic pleural effusions are minimally increased\nbilateral.\nLUNG:\n\n-PARENCHYMA:  Severe centrilobular and paraseptal emphysematous changes. \nPreviously noted airspace opacification in the basal aspect of the left lower\nlobe demonstrates interval improvement.  Airspace opacification in the basal\naspect of the right lower lobe shows mild interval progression.  Round 5 mm\npulmonary nodule in the right upper lobe (4, 116).  Indeterminate sub 4 mm\npulmonary nodules (4, 40, 61 and 98) could be re-evaluated on follow-up\nimaging.\n-AIRWAYS:  The superior aspect of the intrathoracic trachea is displaced to\nthe right and attenuated by the large retrosternal goiter.  Tracheal stent in\nsitu starting approximately 23 mm distal to the beginning of the tracheal\nattenuation and extending 8 mm distal to the tracheal attenuation.  The\nbronchial tree is patent.  Retained secretions present in the bronchus\nintermedius and right lower lobe bronchi (4, 134).  Mild bronchial wall\nthickening.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal (31.5\nmm).\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.  Superior endplate insufficiency type fracture involving the T12\nvertebral body",
            "output": "Large heterogenous soft tissue mass extending from the inferior aspect of the\nthyroid suspicious for a multinodular goiter (malignancy can't be excluded\nwith absolute certainty).\nThe superior aspect of the intrathoracic trachea is displaced to the right and\nattenuated by the large retrosternal goiter. Tracheal stent in situ starting\napproximately 23 mm distal to the beginning of the tracheal attenuation and\nextending 8 mm distal to the tracheal attenuation.\n\nRound 5 mm pulmonary nodule in the right upper lobe requires follow-up\nimaging.\n\nFor imaging findings of the neck please refer to the CT neck report.\n\nRECOMMENDATION(S):   The ___ pulmonary nodule recommendations\nare intended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed.\n\nIn the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12\nmonths and if no change, no further imaging needed. For high risk patients,\ninitial follow-up CT at ___ months and then at ___ months if no change.\n\nIn the case of nodule size >6 - 8 mm: For low risk patients, initial follow-up\nCT at ___ months and then at ___ months if no change. For high risk\npatients - initial follow-up CT at ___ months and then at ___ and 24 months\nif no change.\n\nIn the case of nodule size > 8 mm: Follow-up CTs at around 3, 9, and 24 months\nor consider dynamic contrast enhanced CT, PET, and / or biopsy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Evidence of previous left\nthyroidectomy.  Hypodense collection in the left thyroid bed measuring 48 x 33\nmm (2, 6).  The fluid extends inferiorly to the level of the aortic arch. \nJust above the level of the aortic arch there is curvilinear hyperdensity (4,\n60) which may represent residual thyroid tissue or hemorrhage.  Decreased\nrightward displacement of the trachea compared to prior imaging.  The proximal\ncervical trachea is narrowed in the coronal plane.  Mildly heterogenous\nappearance of the right lobe of thyroid.  Subcutaneous gas seen in the\nanterior neck soft tissues (2, 2).  No axillary adenopathy.  No gross breast\nlesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Nasogastric tube in situ in the proximal stomach, with the side hole\nat the level of the gastroesophageal junction.  No adrenal lesions.\n\nMEDIASTINUM: Postsurgical collection in the left thyroid bed extends\nretrosternally into the mediastinum as described above (2, 13).  Decreased\nrightward displacement of the trachea.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nModerate mitral annular calcification.  No aortic valve calcification.  Mild\nleft coronary artery and right coronary artery calcification.  Heart size is\ntop normal.\nPLEURA: Small bilateral pleural effusions are nonhemorrhagic.\nLUNG:\n\n-PARENCHYMA:  Severe centrilobular and panacinar emphysematous changes. \nMultiple sub 5 mm ground-glass densities noted in the lung apices (some of\nwhich are new).  Complete atelectasis of the left lower lobe most likely\nsecondary to aspiration all mucous plugging.  Retained secretions in the\nbronchi.  Subsegmental atelectasis of the posterior basal aspect of the right\nlower lobe.  Minimal atelectasis in the medial aspect of the lingula.\n-AIRWAYS:  Endotracheal tube in situ with the tip 23 mm proximal to the\ncarina.  Decreased mass effect on the proximal trachea.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.  Mild spinal curvature in the coronal plane.",
            "output": "Residual postsurgical fluid collection in the area of previous thyroidectomy. \nMass effect on the trachea is decreased compared to prior.  There is residual\nnarrowing in the coronal plane of the proximal trachea.\n\nComplete atelectasis of the left lower lobe and subsegmental atelectasis of\nthe posterior basal aspect of the right lower lobe with associated small\npleural effusions.\n\nMarked centrilobular and panacinar emphysematous changes with a few associated\nground-glass pulmonary nodules in the lung apices which may represent\nrespiratory bronchiolitis or infection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland shows a\n1.4 cm hypodense nodule in the right lobe for which no specific follow up is\nrecommended.  Coarse calcification is noted in the right thyroid lobe.  There\nis no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The esophagus is patulous with circumferential wall thickening\nthroughout its course, consistent with esophagitis.  There is a metallic stent\nwhich extends from the distal esophagus into the gastric body.  Oral contrast\nappears to traverse this stent without evidence of obstruction or extraluminal\nextravasation.  Known gastric cardia tumor is not well visualized on this\nnoncontrast exam.  Patient is status post cholecystectomy.  Multiple large\nduodenal diverticula are noted.  There is a simple cyst on the left kidney,\nwhich is partially visualized and appears similar dating back to ___.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There is a small pericardial effusion.  Heart is normal\nin size.  There is severe calcification of the aortic annulus and mild\ncalcifications of the aortic valve.  There are extensive coronary artery\ncalcifications.  There are severe calcifications of the aortic arch and\nvisualized descending aorta.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG: In the right upper lobe, there is a pleural based, cavitary nodule which\nmeasures 2.6 x 1.3 cm (series 4; image 107).  Inferior to this nodule, there\nis subpleural fibrosis and traction bronchiectasis, possibly due to radiation\ntreatment for the patient's prior breast cancer.  There is an additional,\npleural based right middle lobe nodule which measures 1.4 x 1.1 cm (series 4;\nimage 137) subjacent to an area of traction bronchiectasis and fibrosis. \nThere is mild background centrilobular emphysema.  There are faint\ncentrilobular ground-glass opacities throughout the lungs with an upper lobe\npredominance, suggestive of respiratory bronchiolitis/respiratory\nbronchiolitis-interstitial lung disease if the patient is an active smoker. \nThere are multiple additional calcified granulomas throughout the lung fields.\nAirways remain patent to the subsegmental level.  Pulmonary vasculature is\nnormal in size.\n\nCHEST CAGE: There are no concerning sclerotic or lytic lesions identified.  No\nacute bony fracture.  Incidentally noted within the spinal canal is a spinal\nstimulator wire which traverses the subcutaneous tissue toward the left lower\nquadrant without evidence of fracture.",
            "output": "1. Esophageal stent extends from the distal esophagus to the level of the\ngastric body and appears patent with contrast seen distal to the stent within\nthe gastric lumen.  Known tumor of the gastric cardia is not visualized on\nthis exam.\n2. Circumferential wall thickening of the esophagus is consistent with\nesophagitis.\n3. Radiation fibrosis changes in the periphery of the right upper and middle\nlobes with subjacent 2.6 x 1.3 cm pleural based, cavitary nodule in the right\nupper lobe and 1.4 x 1.1 cm pleural based, solid nodule in the right middle\nlobe.  One of these lesions was previously biopsied at ___\n___, but the images are not available for direct review.  Recommend\ncorrelation with prior imaging findings and biopsy results.\n4. Mild background emphysema.\n5. Findings suggestive of respiratory bronchiolitis/respiratory\nbronchiolitis-interstitial lung disease if the patient is an active smoker. \nIf not an active smoker, hypersensitivity pneumonitis is a also consideration."
        },
        {
            "input": "7 mm left supraclavicular lymph node is unchanged since ___.  There are no\nother lymph nodes in the supraclavicular or axillary stations of appreciable\nsize.  This study is not appropriate for subdiaphragmatic diagnosis, but shows\ngranulomatous calcifications in liver and the absence of any adrenal mass.\nDilated calices and infiltration of the surrounding fat in the upper pole the\nright kidney is unchanged since ___. Torso CT in ___ showed large a\nlarge right renal pelvis and mild caliectasis. I would recommend ultrasound\nevaluation to exclude ureteral obstruction.\n\nThyroid is unremarkable. Aorta and pulmonary arteries are normal size, but\nmild annular et ectasia is difficult to exclude because of cardiac motion.\nAtherosclerotic calcification is present in at least the left main am proximal\nanterior descending coronary arteries. Calcification in the left ventricle is\nprobably in the chordopapillary structures, an indication of previous\ninfarction, although left ventricular size is not clearly enlarged. Mild\nenlargement of the right pulmonary artery, 27 mm, is unchanged.  There is no\npleural or pericardial effusion.\n\nAn 11 x 22 mm right lower paratracheal lymph node was 9 x 19 mm. There are no\nother enlarged central lymph nodes.\n\nSevere pan acinar emphysema, with basal predominance is the classic\ndistribution of alpha 1 antitrypsin deficiency.\n\nThe following punctate lung nodules are stable:\nRight upper lobe, 5:61(2), 71, 104, 131\nLeft upper lobe, 5:143\n\nAn indistinctly marginated ground-glass opacity in the right upper lobe, 5:83,\nis unchanged in appearance since ___ and does not have the\nqualities of a discrete lung mass or nodule. Bronchial wall thickening in the\nsegmental bronchi of the right middle lobe is slightly more pronounced today\nthan in ___, particularly in the lateral segment explaining chronic\natelectasis. Even more pronounced bronchial wall thickening is present in both\nlung bases medially, accounting for chronic paraspinal atelectasis. There is\nalso subsegmental atelectasis in the inferior subsegment of the lingula,\nunchanged.\n\n5 mm left lower lobe nodule, 5:194, is unchanged since ___. There are no\nnew lung lesions of concern for malignancy.\n\nBased on the appearance of coronal views from the previous study there has\nbeen no change in the extent of mild to moderate loss of height in a lower\nthoracic vertebral body and deep disc intrusions on the upper endplates of the\n3 others. There are no bone lesions in the chest cage suspicious for\nmalignancy.\n\nRight-sided central venous catheter ends in the mid SVC.",
            "output": "5 mm left lower lobe nodule unchanged. Right upper lobe ground-glass lesion\ndoes not have characteristics suggestive of malignancy.  Handful of punctate\nlung nodules, too small to warrant the followup, is unchanged since at least\n___.\n\nMulti focal bronchial wall thickening, both lower lobes, worsened in the right\nmiddle lobe producing more chronic right middle lobe atelectasis.  Mild\nenlargement solitary mediastinal lymph node probably due to chronic bronchial\ninflammation and atelectasis.\n\nSevere panacinar emphysema. Mild pulmonary artery enlargement suggests but\ndoes not diagnosis pulmonary arterial hypertension.\n\nCoronary atherosclerosis. Probable prior myocardial infarction involving the\npapillary muscles."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  Choroid Coronary\ncalcifications are extensive.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen reveals relatively high density of the\nliver with multiple calcifications consistent with prior granulomatous\nexposure.\n\nCentral airways are patent.  Bibasal bronchiectasis are similar to previous\nexamination.  Interval decrease in the cluster of the right upper lobe nodules\nis consistent with its inflammatory etiology, series 4 image 148.  Multiple\npulmonary nodules are unchanged, series 4, image 54, 73, 110, 141, 145, 155.\n\nSevere panlobular emphysema in the lower lobes is associated with alpha 1\nantitrypsin deficiency primarily affecting right lower lobe.  Interval partial\nresolution of right medial basal atelectasis is consistent most likely with\nimprovement of the infection in this area.  Upper lobes are affected by\ncentrilobular emphysema in moderate to severe extent.\n\nCentral venous line tip terminates at the level of lower SVC.  There are no\nlytic or sclerotic lesions worrisome for infection or neoplasm.  Old fracture\nof the left clavicle is partially imaged, most likely healed.  Osteopenia is\nextensive as demonstrated on the sagittal projection with mild compression\nfractures of the mid thoracic vertebral bodies which are unchanged and new\ncompression of the lower thoracic vertebral body.  No retropulsion detected.",
            "output": "Interval resolution of right upper lobe cluster of pulmonary nodule consistent\nwith its infectious/inflammatory etiology.\n\nMultiple pulmonary nodules, stable.\n\nSevere lower low predominant panlobular emphysema worse in the right lower\nlobe consistent with provided history of alpha-1 antitrypsin deficiency.\n\nBibasal primarily bronchiectasis with bronchial wall thickening, consistent\nwith the same etiology.  Plugging of the left upper lobe subsegmental\nbronchus, series 4, image 57, unchanged.\n\nOsteopenia with pre-existing and new mild compression fractures."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Main pulmonary artery diameter is normal.  Heart size is\nnormal.  Coronary artery calcifications are moderate.  Aortic and mitral\nannular calcifications are mild.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax.  Small dependent bilateral pleural effusions\nare mildly bigger.\n\nLUNGS/AIRWAYS: Respiratory motion limits detailed evaluation. \nRe-demonstration of severe panlobular emphysema in the lower lobes, worse on\nthe right, consistent with history of alpha 1 antitrypsin deficiency. \nModerate to severe centrilobular emphysematous changes are noted in the\nbilateral upper lobes.\n\nRedemonstration of linear, streaky parenchymal opacifications in the bilateral\nlower lobes, lingula and right middle lobe, which are similar to prior and\nlikely represent chronic scarring/atelectasis.  Mild interlobular septal\nthickening in the bilateral upper lobes is improved.\n\nA 4 mm nodule in the right upper lobe is smaller (301:33), previously 8 mm.  A\n6 mm left posterolateral lower lobe nodule (301:46) is unchanged.  A 5 mm left\nposterior lower lobe nodule (301:201) is minimally smaller.  No new or growing\nnodules are seen.\n\nThe central airways are patent.\n\nBASE OF NECK: The imaged thyroid is unremarkable.\n\nABDOMEN: Small scattered calcified granulomas are again seen in liver.\n\nBONES: No suspicious osseous abnormality is seen.? Mild-to-moderate height\nloss of the T9 vertebral body unchanged.  Redemonstration of recent acute\nfractures of the right anterior fourth, fifth and sixth ribs.  Chronic\nleft-sided rib fractures are again noted.  No new acute fractures are seen.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild pulmonary edema is improved from ___.\n3. Small dependent bilateral pleural effusions are mildly bigger.\n4. Re-demonstration of severe predominantly basilar emphysematous changes, as\ndetailed above.\n5. Previously noted pulmonary nodules are similar or decreased in size.  No\nnew or enlarging pulmonary nodules."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  Mild\ncalcified coronary atherosclerosis.  The thoracic aorta is normal in caliber\nand mildly calcified.  No evidence of dissection or penetrating\natherosclerotic ulcer formation.  The main pulmonary artery is normal in\ncaliber.  No evidence of pulmonary embolus to the segmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is subsegmental mucous impaction in the left upper lobe. \nThere is mild biapical scarring.  A 6 mm pulmonary nodule in the left upper\nlobe is unchanged since ___ (series 2, image 84).  There is basal predominant\npanlobular emphysema.  There is platelike atelectasis and/or scarring in the\nright middle lobe, lingula, and bilateral lower lobes associated with\narchitecture distortion.  There is interlobular septal thickening and mild\nground-glass opacification at the apices, likely reflecting mild fluid\noverload.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There are scattered\npunctate calcifications likely reflecting calcified granulomas.  There is a\ntransient hepatic attenuation difference or focal fat deposition adjacent to\nthe groove of the falciform ligament in segment IV.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: A small hyperenhancing lesion in the anterior/inferior aspect of the\nspleen measuring 5 mm likely reflects a hemangioma (series 2, image 150).  The\nspleen is otherwise normal in size and unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nUnchanged moderate right hydronephrosis since ___ compatible with a\nureteropelvic junction obstruction.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Normal sized prostate with fiducial markers noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: Acute T2 compression fracture with slightly more than 50% loss of\nvertebral body height and 1 mm of retropulsion into the spinal canal causing\nmild spinal canal narrowing.  Mild associated paravertebral soft tissue\nswelling.  There is also a slightly comminuted, nondisplaced fracture in the\nright superior articular process extending to the facet at T2 without facet\njoint subluxation.  Multiple other thoracic spine compression deformities of\nT5, T6, T8, and T9 appear chronic.  Chronic appearing distal left clavicle\ndeformity with well corticated margins and nonunion.  Multiple chronic\nnondisplaced rib fractures bilaterally.  Mild thoracic and lumbar spine\ndegenerative changes.  Mild bilateral hip joint degenerative changes.\n\nSOFT TISSUES: The soft tissues are unremarkable.",
            "output": "1. Acute T2 compression fracture with 1 mm of retropulsion causing mild spinal\ncanal narrowing.\n2. Slightly comminuted, nondisplaced, fracture through the right superior\narticular process of T2 extending to the facet without facet joint\nsubluxation.\n3. No other acute traumatic abnormalities of the chest, abdomen, or pelvis\nidentified.\n4. Unchanged moderate right hydronephrosis since ___ compatible with a\nureteropelvic junction obstruction.\n5. Severe panlobular emphysema.\n6. Unchanged 6 mm left lower lobe pulmonary nodule since ___.  No follow-up\nimaging recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized lower neck appears\nnormal.  No axillary lymphadenopathy.\n\nUPPER ABDOMEN: Multiple low-density lesions in the liver, some of which are\ncysts but some are too small to characterize.  Remaining visualized upper\nabdomen appears normal.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  No mediastinal mass.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart appears normal.  No pericardial effusion.\n\nPLEURA: Left pleural effusion, decreased when compared to prior, with a chest\ndrain in situ.  There is a small left pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  The right lung appears normal.  There is a 2.3 x 1.9 x 1.6 cm\nspiculated soft tissue density lesion in the left upper lobe which is tethered\nto the lateral aspect of the pleura and the major fissure and is concerning\nfor a primary lung neoplasm.  Several nodules measuring up to 2 mm, some of\nwhich are calcified, are noted in the bilateral lung apices.  There is a 2 mm\npulmonary nodule in the right upper lobe (302:90).  There is a 2 mm pulmonary\nnodule in the right upper lobe (302:109).  There is a 3 mm pulmonary nodule in\nthe right middle lobe (302:164).  There is a 3 mm and a 2 mm pulmonary nodule\nin the right lower lobe (302:131 and 170).\n2. AIRWAYS:  Patent.\n3. VESSELS:  No central pulmonary embolus.\n\nCHEST CAGE: Subcutaneous emphysema along the left lateral chest wall around\nthe chest drain insertion site.  Small lucent lesions measuring up to 5 mm in\nthe T2, T7 and T9 vertebral bodies are too small to characterize.  There is an\nintraosseous hemangioma within the T4 vertebral body.",
            "output": "1. Spiculated left upper lobe nodule suspicious for primary lung neoplasm.\n2. Persistent small volume left pleural effusion with chest drain in situ.\n3. Small left pneumothorax.\n4. Multiple scattered pulmonary nodules measuring up to 3 mm, which should be\nfollowed on subsequent restaging study.\n5. Small lucent vertebral body bone lesions measuring up to 5 mm, which are\ntoo small to characterize.  MRI thoracic spine with contrast can be performed\nfor further evaluation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  Supraclavicular\nand axillary nodes are not pathologically enlarged by CT size criteria.\n\nUPPER ABDOMEN: Unchanged multiple low-density lesions in the liver.  Further\nevaluation and further findings below the diaphragm will be reported\nseparately.\n\nMEDIASTINUM and HILUM: New prominent mediastinal lymph nodes in the aortic\npulmonary window, measuring up to 8 mm (6:112).  New prominent bilateral hilar\nlymph nodes measuring up to 7 mm each (6: 141, 147).\n\nHEART and PERICARDIUM: No coronary calcifications.  No atherosclerotic\ncalcification of the aorta.  Pericardium is physiologic.\n\nPLEURA: Slight interval increase in size of the loculated left pleural\neffusion.  The previously noted small left pneumothorax is resolved since\n___.  A 4 mm left subpleural nodule (6:129) demonstrates slight\ninterval increase in size (previously 2 mm).\n\nLUNG:\n\n1. PARENCHYMA:  There is a 2.4 x 1.8 x 1.9 cm spiculated soft tissue density\nlesion in the left upper lobe tethered to the lateral aspect of the pleura and\nmajor fissure (6:154, 9:18), unchanged in size (previously 2.3 x 1.9 x 1.9\ncm), consistent with the known primary lung neoplasm.  Interval worsening of\nthe left interseptal nodular thickening, consistent with lymphangitic spread. \nThere is a 1.4 x 2.5 cm linear band of soft tissue thickening extending from\nthe left hilum and left upper lobe pleural surface (6:151) that demonstrates\ninterval increase in size since ___.  A 2 mm right upper lobe\npulmonary nodule (6:146) and 3 mm right upper lobe pulmonary nodule (6:124)\nare unchanged.  A 3 mm pulmonary nodule in the right middle lobe (6:193) is\nunchanged.  A 2 mm pulmonary nodule (series 6:146) and a 2 mm pulmonary nodule\n(6:97) both in the right lower lobe are unchanged.\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: Aorta and pulmonary artery are normal in caliber.\n\nCHEST CAGE: Previously noted lucent lesions in T2, T7, and T9 vertebral bodies\nare not well appreciated on today's study.  The intraosseous hemangioma within\nthe T4 vertebral body is unchanged.  Otherwise, no worrisome osseous lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "1. The dominant left upper lobe spiculated nodule is unchanged in size;\nhowever, there is interval worsening of the left pleural effusion, left\ninterseptal nodular thickening, and linear band of soft tissue, raising\nconcern for worsening disease.\n2. New prominent mediastinal lymph nodes, measuring up to 8 mm, and new\nprominent bilateral hilar lymph nodes, measuring up to 7 mm, also raise\nconcern for worsening disease.\n3. Left subpleural nodule demonstrates slight interval increase in size since\n___.  The multiple other scattered pulmonary nodules are unchanged in\nsize.\n4. Intraosseous hemangioma within the T4 vertebral body.  Otherwise, no\nevidence of worrisome osseous lesions.  Specifically - the previously seen\nsuspicious bony lesions are not well discerned on this exam.\n5. Please refer to same day CT abdomen/pelvis for further details regarding\nsubdiaphragmatic findings.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 17:34 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nLeft supraclavicular lymph nodes up to 7 mm, and numerous subcentimeter\nbilateral axillary lymph nodes, are unchanged since at least ___\n19.  Mild edema in the soft tissue of the chest wall is slightly more\npronounced.  No discrete soft tissue masses elsewhere in the chest wall. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately patulous at several levels, as\nbefore, more likely due to dysfunction than obstruction.  Atherosclerotic\ncalcification is not apparent in the head neck vessels and minimal if at all\nin left anterior descending coronary artery.  Aorta and pulmonary arteries are\nnormal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically enlarged\nor growing compared to ___ were slightly smaller in ___ which may\nindicate a reaction to chemotherapy rather than malignant involvement of lymph\nnodes.\n\n\nLUNGS, AIRWAYS, PLEURAE: Except for a new punctate nodule in the right middle\nlobe, 3:195, right lung is clear.\n\n22 x 24 mm nodule in the lingula, 3:129 was 20 x 25 mm in ___.  Small\nleft pleural effusion was substantially larger and there was greater\natelectasis in the left lung in ___.  Whether there is still irregular\npleural thickening and nodular infiltration of the left lung base suggesting\nmalignant involvement of the pleura and adjacent lung, but no clear\nprogression since ___.  A second possible lung lesion in the superior\nsegment of the left lower lobe, adjacent to the major fissure is 8 x 10 mm\ntoday, 3:94, was 12 x 13 mm in ___.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Since ___ left lung lesions, the larger in the lingula, smaller in\nsuperior segment left lower lobe have both decreased in size and there is\nsubstantially less pleural effusion, though malignant pleural thickening and\nlocal invasion of the left lower lobe are still likely.\n\nNo lymphadenopathy.  Previous mild generalized lymph node enlargement in the\nchest and axillae is probably a function of chemotherapy.\n\nProbable esophageal dysfunction.  Consider swallowing evaluation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable. \nProminent subcentimeter supraclavicular and bilateral axillary lymph nodes\nmeasuring up to 6 mm are unchanged since at least ___.  Injected\nair is seen within the right axillary vein.  There is persistent focal skin\nthickening along the left lateral chest wall at the level of the ninth rib\n(3:197), likely sequela of prior chest tube placement.  Additionally, there is\npersistent focal thickening of the skin overlying the left paraspinal muscles\n(3:135), approximately at the level of the T8 vertebra, which is nonspecific\nbut unchanged since ___.\n\nUPPER ABDOMEN: Please see separate same day report of the abdomen and pelvis\nfor description of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymph nodes or masses.  The esophagus is patulous\nat several levels, as before, most likely due to dysfunction rather than\nobstruction.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  There\nare minimal coronary artery calcifications.  No apparent valvular\ncalcifications.\n\nPLEURA: Mild biapical pleuroparenchymal scarring.  There is marked interval\nimprovement in now trace, if any, pleural thickening and nodular infiltration\nof the left lung base.\n\nLUNG:\n\n1. PARENCHYMA:  A 2.4 x 2.1 cm nodule within the superior lingular segment is\nstable since the most recent prior and to at least ___ when it\nmeasured 2.2 x 2.4 cm and 2.0 x 2.5 cm, respectively.  Allowing for\ndifferences in technique, a second lesion along the major fissure within the\nsuperior segment of the left lower lobe is slightly decreased in size\nmeasuring 1.0 x 0.4 cm (3:95), previously 1.0 x 0.8 cm.  A 1.3 x 0.5 cm\nnodular opacity within the inferior segment of the lingula (3:183) is\nunchanged compared to prior, previously measuring 1.5 x 0.5 cm, and may\nrepresent atelectasis or scarring.  A 2 mm nodule within the left lower lobe\n(3:152) is unchanged since the most recent prior, but was likely obscured on\nprior examinations.  An additional 2 mm nodule within left lower lobe (3:182)\nwas not seen on previous studies.\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The thoracic aorta is normal in caliber and course.  The main\npulmonary artery is normal in diameter.  Although not optimized for the\nevaluation of pulmonary emboli, the pulmonary vasculature is well opacified\nwithout filling defect to the segmental level bilaterally.\n\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous\nlesions.",
            "output": "1. Stable masslike lesions within the lingula, as described above.  A 2 mm\nnodule within the left lower lobe was not seen on the prior study, but lies\nwithin a region which was likely obscured on previous studies.  Attention on\nfollow-up recommended.\n2. Marked interval improvement in now trace, if any, thickening and nodular\ninfiltration of the left pleura.\n3. Nonspecific focal skin thickening overlying the left paraspinal muscles, as\ndescribed above, is unchanged since ___.  Direct inspection\nrecommend"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and numerous subcentimeter axillary lymph nodes are not\npathologically enlarged or growing.  No soft tissue abnormality elsewhere in\nthe chest wall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Mid and lower esophagus moderately patulous distended only\nwith air.  Atherosclerotic calcification in the head and neck vessels is mild,\nnot apparent in coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers normal size.  Aortic valve not calcified.  Pericardium physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Right lung is clear and and its pleural surfaces are\nnormal.\n\nNodular tissue in the superior segment of the left lower lobe extending into\nthe major fissure which involuted between ___ and ___ is\nsubsequently unchanged.  Pleural thickening extends to the costal pleural\nsurface, mild, unchanged, not accompanied by pleural effusion.  16 x 20 mm\nspiculated mass in the lingula, 3:116 was 17 x 25 mm in ___ and 21 x 29 mm in\n___.  There are no new or growing lesions elsewhere in the left lung. \nTracheobronchial tree is normal to subsegmental levels.\n\nCHEST CAGE: Sclerosis of the underside of the midportion of the left ninth rib\nis stable, did not appear malignant.  No pathological compression fractures or\ndestructive bone lesions.  Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.",
            "output": "Continued involution, mass in the lingula.  Extent of pleural involvement of\nthe major fissure and costal pleural surface decreased between ___ in\n___, subsequently stable.  No new or growing lesions in the lungs, pleural\nspace, or central lymph nodes.  No evidence of osseous metastasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unenhanced appearance of the\nthyroid gland is unremarkable.  No supraclavicular or axillary\nlymphadenopathy.  Small amount of subcutaneous emphysema along the left chest\nwall are related to a chest tube placement.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are notable for a 7\nmm hypodensity in the left hepatic lobe, which is incompletely evaluated on\nthis study.\n\nMEDIASTINUM: No mediastinal adenopathy.  Mediastinum is in midline position,\nimproved from ___.\n\nHILA: No hilar adenopathy within the limitations of a nonenhanced CT.\n\nHEART and PERICARDIUM: The heart is normal in size.  Trace pericardial\neffusion is within physiological range.\n\nPLEURA: Large left pleural effusion with a small apical component of\npneumothorax is improved from ___.  Trace right pleural without\npneumothorax.  There is small left apical a left-sided chest tube is in place\nand terminates in the medial and inferior aspect of the pleural cavity against\nthe wall.\n\nLUNG:\n\n1. PARENCHYMA:  Left lower lobe collapse likely due to large pleural effusion.\nIll-defined ground-glass opacities in the left upper lobe and lingula.  Right\nlung is clear.\n2. AIRWAYS:  Airways are patent to subsegmental level.\n3. VESSELS:  Thoracic aorta is normal in caliber.\n\nCHEST CAGE: No osseous lesions or fractures.",
            "output": "1. Left large pleural effusion with small component of apical pneumothorax\nstatus post chest tube drain improved from ___.  The chest tube\ndrain terminates in the inferior medial left pleural space.\n2. Left lower lobe collapse."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  The heart and mediastinum are normal. \nA trace pericardial effusion is noted, decreased from the prior examination. \nAirways are patent to the subsegmental levels.\n\nLung windows demonstrate a background of paraseptal and centrilobular\nemphysematous changes. Diffuse, mild bronchial wall thickening is noted. There\nis linear, bandlike atelectasis noted at the bilateral lung bases. There is no\nevidence of pleural effusion or pneumothorax.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nThe esophagus is within normal limits. Although this study is not tailored for\nthe examination of subdiaphragmatic contents, a subcentimeter hypodensity\nnoted within the superior left hepatic lobe is too small to characterize but\nlikely a cyst and stable. The remainder of the imaged portions of the\nintra-abdominal organs are grossly unremarkable.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Bibasilar bandlike atelectasis. No pleural effusion or lobar\nconsolidation.\n3.  Stable, mild-moderate centrilobular and paraseptal emphysema.\n4.  Mild diffuse bronchial wall thickening, suggestive of chronic small airway\ndisease.\n5.  Trace pericardial effusion, decreased as compared to the prior\nexamination."
        },
        {
            "input": "The new esophagus looks unremarkable along its course.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes present.  There is no\npericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  New right upper\nlobe subpleural 1 mm nodule is at series 302, image 64.  There is interval\ndevelopment of the left upper lobe nodule in the para fissure location, series\n302, image 118, 7 mm.  There is also interval increase in previously existing\n3 mm right lower lobe pulmonary nodule 2 currently 9 mm pulmonary nodule,\nseries 302, image 130.  No additional nodules masses or consolidations\ndemonstrated.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval development of 3 pulmonary nodules too small to characterize. \nShort-term followup in 3 months is recommended for assessment of the stability\n\nUnremarkable appearance of the new esophagus.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal pathology."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis, but shows no adrenal mass or adenopathy in the\nupper abdomen..\n\n\nCARDIO-MEDIASTINUM:Caliber and a degree of retention in the neo esophagus have\nnot changed since ___.  There is no wall thickening or abnormality in\nthe adjacent mediastinum, including development of measurable, new or growing\nlymph nodes at any level.\n\nTiny pericardial effusion is slightly larger, probably of no significance. \nAtherosclerotic calcification is mild in head and neck vessels, but not\napparent in coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size.\n\nTHORACIC LYMPH NODES: Subcentimeter lymph nodes in the lower paratracheal\nstations are stable.  No lymph nodes in the mediastinum are pathologically\nenlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE:\n\n10 x 4 mm mixed density right upper lobe lung nodule was 8 x 5 mm in ___. \nIn addition to the 2-3 mm solid component there are now 2 tiny new specks of\nsoft tissue, 4:122.  The combination of changes is concerning for an active\nlesion, especially adenocarcinoma, alternatively infection.\n\n6-7 mm solid subpleural nodule, right lower lobe, 4:138 was 8 mm in ___.\n\nLeft lung is clear.  Tracheobronchial tree is normal to subsegmental levels\nand there are no pleural abnormalities.\n\n\n\nCHEST CAGE: Unremarkable.",
            "output": "Slowly growing small mixed density right upper lobe lung nodule concerning for\nearly adenocarcinoma of the lung.\n\nSecond right lung nodule smaller today than in ___ is unlikely to be\nmalignant.\n\nNormal postoperative appearance, neo esophagus.  No findings suggest\nmetastatic esophageal carcinoma."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: Patient status post esophagectomy and gastric pull-up.  The new\nesophagus is unremarkable.  There are no enlarged mediastinal hilar lymph\nnodes.  There is a trace pericardial effusion which is unchanged.  Unenhanced\naorta and pulmonary arteries are normal in caliber.\n\nPLEURA: There is a trace right pleural effusion with associated pleural\nthickening.\n\nLUNG: Previously visualized part solid right upper lobe nodule measuring 11 mm\nwith an 8 mm solid component has minimally increased in size since the prior\nstudy.  The appearance is concerning for slow growing adenocarcinoma spectrum\nlesion.  The triangular opacity in the right lower lobe measuring 9 mm (302,\n137) is unchanged.  The subpleural left lower lobe parenchymal opacity (302,\n218) is also unchanged.  No new pulmonary nodules.\n\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows mild\nperinephric stranding.  No adrenal masses.",
            "output": "Status post esophagectomy and gastric pull-up.  The new esophagus is\nunremarkable.  No evidence of local recurrence.\n\nMild increase in size of the right upper lobe part soft pulmonary nodule which\nnow measures 11 mm with an 8 mm solid component, most likely represents an\nadenocarcinoma spectrum lesion.  The other triangular opacities in the right\nlower lobe and left lower lobe are unchanged in size and density.  No new\npulmonary nodules."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there is no soft tissue\nabnormality in the chest wall suspicious for malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis, last evaluated on a CT of the\nabdomen and pelvis ___.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head and neck vessels, but present in\nat least the LAD and left circumflex coronary arteries.\n\nAorta is normal size.  Aortic valvular calcification is mild.  Pulmonary\narteries are normal size.\n\nSubcarinal mediastinal lymph node is 27 x 17 mm.  Subcentimeter right\nretrocrural lymph nodes, 4:191 are equivocal.  Other mediastinal nodes are not\npathologically enlarged and   Hilar contours do not suggest adenopathy despite\ngranulomatous lymph node calcifications on the left.\n\nPartially calcified biapical pleural parenchymal scarring is symmetric.\n Aside from scattered calcified pulmonary granulomata, lungs are clear.  There\nare no lung nodules.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Enlarged subcarinal mediastinal lymph node is the only suggestion of\nintrathoracic malignancy.\n\nCoronary atherosclerosis.\n\nMild aortic valvular calcification."
        },
        {
            "input": "Lower pole of left thyroid lobe and lower pole of right thyroid lobe nodules\nare suspected, 10 and 8 mm each.\n\nAorta and pulmonary arteries are unremarkable.  Several small mediastinal\nlymph nodes are not pathologically enlarged except for sub- carinal lymph node\nthat continues to be enlarged measuring 2.6 x 1.3 cm, stable as compared to\nprevious examination.  Coronary calcifications are unchanged.  Heart size is\nnormal.  No pericardial pleural effusion is seen.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nnodules might be consistent with respiratory bronchiolitis, minimal infection,\nor reaction to time interval chemotherapy.  The findings is similar to\nprevious examination.  Right lower lobe calcification is consistent with\nprevious granulomatous exposure similar to the presence of the left hilar\ncalcified lymph nodes.  Left apical calcifications, series 8, image 50 might\nbe related to previous granulomatous exposure as well.  No discrete pulmonary\nnodules masses or consolidations seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nLeft breast calcifications are unchanged.\n\nImage portion of the upper abdomen will be discussed separately as part of the\nCT abdomen and corresponding report will be issued.",
            "output": "Unchanged appearance of the chest including enlarged but similar to previous\nexaminations sub- carinal lymph node.  No other evidence of metastatic disease\nwithin the chest demonstrated."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, elsewhere in the chest wall\nthere are no soft tissue abnormalities suspicious for malignancy or infection.\n\n7 mm hypodensity in the left thyroid lobe is not large enough to warrant\nfurther imaging evaluation.  Atherosclerotic calcification is mild in head\nneck vessels, except at the origin of the left subclavian artery, present a\nleast in the left anterior descending coronary artery.  Aorta and pulmonary\narteries are normal size.  Aortic valvular calcification is mild to moderate\nin severity.  There is no pericardial or pleural abnormality.\n\n14 x 31 mm subcarinal sub soft tissue mass, well circumscribed, mildly\nenhancing, 57 ___ compared to 45 ___ on a noncontrast study in ___, when it\nmeasured 18 x 28 mm, is not a cyst.  It is stable since ___.  No\nother central lymph nodes, or nodes in the retro crural or diaphragmatic\nstations are pathologically enlarged.\n\nBiapical partially calcified pleural parenchymal scarring is stable.\n\nOnce again there is a suggestion of mild bronchiolar nodulation in the upper\nlobes.  A sub- 2 mm peripheral nodule in the right upper lobe, 15:83, is new\nbut of a size that still could be an inflammatory lesion, rather than a\nmetastasis.  There are no other nodules concerning for malignancy.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Subcarinal mediastinal mass,, larger today than in ___, is presumed\nmalignant.  No other central adenopathy.\n\nNo definite pulmonary metastases.  New 2 mm right upper lobe nodule it is\nequivocal."
        },
        {
            "input": "HEART AND VASCULATURE:  No central or segmental pulmonary embolism.\nCalcifications of the coronary arteries, aortic annulus, aortic arch, and\ngreat vessels are mild.  The thoracic aorta is normal in caliber.  No\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy.  The\nsubcarinal mass measures 2.8 x 1.3 cm, unchanged from ___ and ___ (5:155). \nNo new or growing mediastinal lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Biapical calcified scarring is unchanged.  Multiple pulmonary\nnodules are unchanged from ___ and ___, the largest of which measures 3 mm\nin the right upper lobe (5:84).  No new or growing nodules.\n\nBASE OF NECK:  A 1 cm left thyroid nodule does not require follow-up by ___\nguidelines unless there is additional clinical concern.  Visualized portions\nof the base of the neck show no abnormality.\n\nABDOMEN:  Please see report from same day CT of the abdomen and pelvis for\ndescription of the subdiaphragmatic findings.\n\nBONES: No osseous abnormality concerning for malignancy.  No acute fracture.",
            "output": "Pulmonary nodules and subcarinal lymphadenopathy stable since ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Poorly defined hypodense lesions in\nthe thyroid (5:15, 33 and 36).  No supraclavicular or axillary adenopathy. \nBilateral coarse breast calcifications.\n\nUPPER ABDOMEN: Will be reported separately.  Small hiatal hernia.\n\nMEDIASTINUM: Subcarinal lymph nodes (5, 148) measuring 14 mm in diameter is\nunchanged.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No cardiomegaly.  No pericardial effusion.  Mild to\nmoderate aortic valve calcifications.  Mild coronary artery calcification.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Biapical pleural-parenchymal scarring with associated\ncalcification.  The pre-existing solid pulmonary nodules are stable. \nGround-glass nodule in the left lower lobe (5, 233) is unchanged.  No new or\nenlarging pulmonary nodules or masses.  No confluent airspace consolidation. \nNo diffuse lung disease.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "No findings to suggest intrathoracic metastatic disease.\n\nFor abdominal findings please refer to abdominal CT report."
        },
        {
            "input": "The thoracic aorta is normal in caliber with mild and moderate calcifications\nin the aortic arch and proximal descending aorta.  The origin of the left\nsubclavian artery is at least moderately calcified with also noncalcified\nplaque.  The main, left, and right pulmonary arteries are normal in caliber\nwithout filling defect indicate the presence of any incidental acute central\npulmonary embolus.  The heart is normal in size.  Coronary artery\ncalcifications are scattered in at least mild on this nondedicated exam. \nAortic valve calcifications are mild.  No pericardial effusion.\n\nNo axillary, supraclavicular, or hilar lymphadenopathy by CT size criteria.\nA 3 x 1.4 cm sub-carinal structure does not enhance when compared with the\nprior exam is overall similar in size since ___, either a\nnonspecific enlarged lymph node or proteinaceous cyst (series 6, image 160).\n\nNo new or growing pulmonary nodules.  Calcified granulomas are unchanged\n(series 6, image 245).  Small left apex nodule is unchanged (series 6, image\n74).  Small right lower lobe nodule is also unchanged (series 6, image 147).\n\nThe airways are patent to at least the subsegmental level.  No pleural\neffusion or pneumothorax.  No evidence of active infection.\n\nMillimetric nodule in the right thyroid lobe is unchanged (series 6, image\n51).  Left thyroid nodules measuring up to 11 mm are also unchanged (series 6,\nimage 58, 68).\n\nNo osseous lesions concerning for malignancy or infection in the chest cage. \nThe bones are diffusely demineralized.  Multilevel degenerative changes of\nthoracic spine are mild-to-moderate.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "1.  No new or growing pulmonary nodules.\n\n2.  3 x 1.4 cm subcarinal structure is overall unchanged since ___\nand could be a proteinaceous cyst or nonspecific enlarged lymph node.  Given\nstability over ___ year, metastasis is extremely unlikely.\n\n3.  Moderate to severe calcified and noncalcified atherosclerosis at the\norigin of the left subclavian artery.\n\n4.  Unchanged left thyroid nodules, < 11 mm for which no specific imaging\nfollow up is required.\n\n5.  Probable sequelae of prior granulomatous disease exposure."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodense thyroid nodules appear\nsimilar compared to prior.  No supraclavicular or axillary adenopathy.  No\ngross breast lesions.  Coarse calcification in the lateral aspect of the left\nbreast (4, 71).\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Hypodense subcarinal lesion/lymph node measuring 27 x 15 mm\nappear similar compared to prior.  No new or enlarging mediastinal lymph\nnodes.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo cardiomegaly.  Minimal aortic valve calcification.  Mild coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.  Mild\ncalcific atherosclerotic changes of the intrathoracic aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  No diffuse lung disease.  Mild biapical\npleural-parenchymal scarring.  A few pre-existing millimetric pulmonary\nnodules are unchanged.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects to\nsuggest pulmonary emboli.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "Stable imaging findings of the chest.\n\nChronic, benign, subcarinal cyst or lymph node is unchanged compared to prior\nimaging.\n\nNo new or enlarging pulmonary nodules or masses or mediastinal lymph nodes.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "Bilateral thyroid nodules are unchanged.  Aorta and pulmonary arteries are\nunremarkable.  Sub-carinal lymph node is slightly decreasing, 10 mm as\ncompared to 14 mm, series 6, image 48.  No hilar or axillary lymphadenopathy\nseen.\n\nThere is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Bilateral upper\nlobe centrilobular nodules are stable.  Right lower lobe calcified granuloma\nis unchanged.  No new pulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest was no evidence of intrathoracic disease\nprogression.\n\nPlease review CT abdomen and pelvis and the corresponding report for\nassessment of intra-abdominal pathology that will be discussed the separately.\n\nUnchanged bilateral thyroid nodules.\n\nSlight interval decrease in the sub-carinal structures that might represent\nlymph node versus cyst"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is notable for multiple\nbilateral hypodense nodules measuring up to 1.3 cm in the left lobe and 8 mm\nin the right lobe, unchanged.  Supraclavicular and axillary lymph nodes are\nnot enlarged.\n\nMEDIASTINUM:  A subcarinal lymph node measures 1.4 cm in short axis (06:51),\nunchanged from prior when measured with similar technique.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Scattered bilateral pulmonary nodules measuring up to 2\nmm are unchanged.  No new or enlarging pulmonary nodules or consolidations are\ndemonstrated.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  Mild pleural calcifications at the\nbilateral apices are re-demonstrated.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Unchanged coarse calcifications in\nthe bilateral breasts, incompletely evaluated by CT.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Stable subcarinal lymph node measuring 1.4 cm in short axis.  No new or\nenlarging lymph nodes are identified.\n2. Unchanged bilateral thyroid nodules.\n3. Please refer to separate report of CT abdomen and pelvis performed same day\nfor description of subdiaphragmatic findings."
        },
        {
            "input": "Chest: The thoracic aorta is normal in caliber without appreciable\natherosclerosis, dissection, or aortic intramural hematoma. The heart is\nnormal in size though there is a moderate pericardial effusion. Consider\npericardiocentesis with fluid analysis. The pulmonary arterial tree is patent\nwithout filling defect to suggest the presence of a pulmonary embolism. There\nis extensive mediastinal edema without convincing evidence for mediastinal\nhematoma on the noncontrast series. There is no pneumomediastinum. This\noverall appearance raises strong concern for mediastinitis though the etiology\nis unclear.\n\nThere are bilateral pleural effusions with a loculated appearance of the left\neffusion. Interlobular septal thickening and ground-glass opacities likely\nreflect pulmonary edema. There is no convincing evidence for pneumonia.\n\nAbdomen: Evaluation of the abdominal parenchyma is somewhat limited due to\narterial phase imaging. The liver enhances normally without definite focal\nlesion. The gallbladder, pancreas, and spleen appear normal. The adrenal\nglands are mildly thickened bilaterally which could be due to hyperplasia. The\nkidneys enhance symmetrically without focal lesion or hydronephrosis. The\nabdominal aorta is normal in course and caliber with widely patent major\nbranches. There is no retroperitoneal hematoma or lymphadenopathy.\n\nThe stomach appears normal with mild fluid distension. The duodenum is normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction.\nThere is no mesenteric free fluid or free air. The colon contains a mild fecal\nload. The appendix is normal. Urinary bladder is mostly decompressed.\n\nBones: Unremarkable.",
            "output": "1.  Extensive mediastinal edema raising concern for mediastinitis.\n2.  Moderate pericardial effusion - consider pericardiocentesis with fluid\nanalysis.\n3.  Bilateral pleural effusions, small to moderate, loculated on the left. \nEmpyema difficult to exclude.\n4.  Pulmonary edema.\n5.  No abnormalities in the abdomen/pelvis.\n\nRECOMMENDATION(S):  Findings were discussed with Dr. ___ at the time of\ninitial review."
        },
        {
            "input": "The thyroid gland is unremarkable.\n\nHeart size is normal with redemonstration of small pericardial non hemorrhagic\neffusion, reduced in volume compared to ___. Left subclavian central\nvenous catheter terminates at the cavoatrial junction. There is no\nsupraclavicular, axillary, hilar or mediastinal lymphadenopathy. Extensive\nmediastinal edema appears similar to prior study. The thoracic aortic arch and\nmain pulmonary artery are normal in caliber. There is no central pulmonary\nembolus.\n\nContrast material opacifies the entirety of the esophagus and there is no\nextraluminal contrast to suggest leak.\n\nEndotracheal tube tip terminates 25 mm cranial to the carinal. Bilateral chest\ntubes are in place. Right-sided chest tube extends along the major fissure\nterminating in the lung apex. Left chest tube extends along the pleural\nsurface terminating laterally at roughly the level of the left third rib. \nAnother chest tube is present at the left base.  There are residual small\nbilateral pleural effusions, improved on the left with some persistent areas\nof loculation. There is no appreciable pneumothorax.\n\nThere has been interval development of bilateral lower lobar, hypoenhancing\nconsolidations involving nearly all segments and there has been interval\ndevelopment of new left upper lobe perihilar consolidation as well as\nperihilar consolidation in the right middle lobe, right upper lobe and\nscattered peribronchial ground-glass opacities in bilateral upper lobes\ncompatible with multifocal pneumonia.\n\nOsseous structures: There is no suspicious focal osseous lesion. Note is made\nof mild thoracic levocurvature.",
            "output": "1. Prominent hypoenhancing bilateral lower lobar consolidations with other\nscattered consolidations and ground-glass opacities, as above, compatible with\nmultifocal pneumonia.\n2. No active extraluminal leak of ingested barium contrast to suggest current\nesophageal leak.\n3. Persistent prominent mediastinal edema suggestive of mediastinitis.\n4. Fissural location of right chest tube.\n5. Interval reduction in volume of a now small pericardial effusion.\n6. Persistent bilateral effusions, improved on the left with persistent areas\nof loculation.\n7. For abdomen and pelvis findings, please refer to the dictation under clip\nnumber ___.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 12:06 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid gland is unremarkable. A prominent prevascular lymph node is\nstable measuring 9 mm (2, 18). Bilateral axillary lymph nodes are mildly\nenlarged, but have a normal morphology.  A right lower paratracheal lymph node\nis also stable measuring 11 mm in short axis (2, 19). Right hilar\nlymphadenopathy is not appreciably changed with a representative node\nmeasuring 13 x 17 mm, previously 11 x 15 mm (2, 27).\n\nA left sided PICC line ends in the upper right atrium. Heart size is\ntop-normal an increased moderate pericardial effusion. Diffuse pericardial\nenhancement raises concern for pericarditis. The main pulmonary artery and\nthoracic aorta are normal caliber. No incidental pulmonary embolus is\nidentified.\n\nInfiltration of the mediastinal fat has not appreciably changed, however\nloculated mediastinal fluid has slightly increased. For reference, a\nloculation at the right heart border has slightly increased measuring 1.8 x\n6.3 cm, previously 1.5 x 5.9 cm (2, 32).\n\nThe esophagus is underdistended and non-opacified, thereby limiting\nevaluation. However, there is no new paraesophageal fluid collection or air.\nThe esophagus appears diffusely thick-walled as in the past.\n\nA tracheostomy tube ends in the mid trachea. Bilateral chest tubes have been\nremoved. Small bilateral loculated pleural effusions have not appreciably\nchanged. Given the suggestion of mild pleural enhancement, developing empyema\ncannot be excluded.\n\nAeration of the bilateral lower lobes has improved, revealing widespread\ninterlobular septal thickening, bronchial wall thickening, and ground-glass\nopacities. Similar though less extensive findings are present in the right\nmiddle and bilateral upper lobes.\n\nImages of the upper abdomen are unremarkable.\n\nConfluent dependent anasarca is unchanged.\n\nA left posterior surgical rib fracture remains distracted and nonunited.",
            "output": "Resolving multifocal pneumonia with improved aeration of the bilateral lower\nlobes.  Superimposed pulmonary edema is likely.\n\nIncreased moderate pericardial effusion since ___ with diffuse\npericardial enhancement raises concern for pericarditis.\n\nPersistent findings of the mediastinitis with slight interval increase in\nloculated mediastinal fluid collections.\n\nLimited assessment of the esophagus shows no evidence of new paraesophageal\nfluid collection. However, there is likely persistent diffuse esophagitis.\n\nStatus post removal of bilateral chest tubes with stable loculated bilateral\npleural effusions. Empyema cannot be excluded."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: There is extensive mucous plugging in the right lower\nlobe, new since prior exam, with complete right lower lobe consolidation and\nvolume loss, most consistent with atelectasis.  There is minimal mucous\nplugging in the right middle lobe, right upper lobe anteriorly, left upper\nlobe in the apex, lingula.  There is moderate mucous plugging in the left\nlower lobe, new since prior, with moderate volume loss from atelectasis. \nThere are infiltrates in the superior segment of the left lower lobe, right\nupper lobe, more prominent posteriorly, consistent with pneumonia, consider\naspiration if clinically appropriate.  There is moderate centrilobular\nemphysema.  Few benign calcified granulomas are seen.\nVessels: Right main pulmonary artery is enlarged, suggesting pulmonary artery\nhypertension.  Normal size aorta with moderate atherosclerotic calcifications\nextending into the great vessels.  Saccular aneurysm versus penetrating\natheromatous ulcer arising from the left margin of the undersurface aortic\narch, measures 1 cm in depth, stable compared with ___, compared\nwith 0.6 cm on ___.\n\nMediastinum and Hila: No adenopathy\n\nHeart and Pericardium: Normal heart size.  Suggestion of anemia.  Coronary\nartery calcifications.  Mitral annular and aortic valve calcifications.  No\npericardial effusion.\n\nPleura: There are mild bilateral pleural effusions, new since prior CT,\npresent on radiograph from yesterday.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: No mass, no adenopathy.\n\nUpper Abdomen: Partially seen 8 cm well-circumscribed low-attenuation cyst\nabutting left kidney, likely exophytic renal cyst, stable since ___.  2 smaller benign simple cyst in the right kidney.  There is large\nesophageal hiatal hernia, similar compared to most recent exam.\n\nChest Cage: Degenerative changes spine.",
            "output": "There are infiltrates in superior segment of left upper lobe, right upper\nlobe, consistent with pneumonia.\nThere is complete collapse of the right lower lobe with extensive mucous\nplugging.  Moderate volume loss, moderate mucous plugging in the left lower\nlobe with atelectasis.\nMild bilateral pleural effusions, partially loculated.\nModerate centrilobular emphysema.\n1 cm left inferolateral margin aortic arch pseudoaneurysm versus penetrating\natheromatous ulcer."
        },
        {
            "input": "Examination is compared to a noncontrast scan performed on ___.\nUnchanged mild diffuse enlargement of the thyroid gland.  No focal thyroid\nlesions. Known origin of the left vertebral artery from the aortic arch, which\nis a normal anatomical variant.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All lymph nodes in the mediastinum and at the level\nof the hilar are normal in size.  No lymphadenopathy.  There is a moderate\nenlargement of the main pulmonary artery that has a diameter of 3.5 cm.  No\nincidental pulmonary embolism. Moderate coronary calcifications.  No\npericardial effusion.  Concentric hypertrophy of the left ventricle.  Mild\nhiatal hernia.  1 cm left adrenal but a normal. Small splenium. Status post\ncholecystectomy.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  No osteolytic lesions at the level of the sternum and\nthe ribs.  Sclerotic bone island in to right-sided ribs, unchanged as compared\nto the previous examination, series 3 image 28 and 19. Old left-sided rib\nfractures.\nUnchanged mild bilateral apical scarring.  Unchanged predominantly\ncentrilobular pulmonary emphysema. Several pre-existing millimetric\nmicronodules, for example at the level of the right upper lobe (4, 43) are\nunchanged in size and morphology.  Several clustered peribronchial\nmicronodules (4, 71) are also unchanged.  There are no newly occurred lung\nnodules. Extensive mucosal in the airways (4, 146) the airway walls are\nthickened and show irregularities, consistent with chronic airways disease. \nThe more peripheral pulmonary arteries are minimally dilated but the lung\nparenchyma shows no evidence of parenchymal consequence is of pulmonary\nhypertension. The pleural surfaces are even, there are no pleural effusions.\nNo evidence of fibrotic lung disease.  No incidental pulmonary embolism.",
            "output": "No relevant change as compared to ___.  Diffuse thyroid\nenlargement. Dilatation of the main pulmonary artery that could be reflecting\npulmonary hypertension. Moderate coronary calcifications.  Diffuse pulmonary\nemphysema.  No lymphadenopathy.  Unchanged size and morphology of pre-existing\npredominantly subpleural and peribronchial micronodules.  Moderate to severe\nchronic airways disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\nChest wall is unremarkable.\n\nUPPER ABDOMEN: Few cortical cyst in both kidneys.\nIn both adrenal glands 1.6 cm or masses measuring 7 and 4 Hounsfield units,\nunchanged adenomas.\nStatus post cholecystectomy.\nRemaining included upper abdominal organs with no gross findings.\n\nMEDIASTINUM: Large number of borderline lymph nodes in the mediastinum are\nmildly enlarged and increase in number in comparison to ___.  For\nexample right upper paratracheal 1.2 cm lymph node (5:110), sub aortic 0.9 cm\nlymph node, as well as sub carinal 1.1 cm and probable bilateral hilar lymph\nnodes.\n\nHEART and PERICARDIUM: No cardiomegaly and no pericardial effusion.\nModerate to severe calcifications of the coronaries.\nMain pulmonary artery dilated to 4.5 cm, in the prior 3.5 cm, enlarged -\nsuggesting worsening pulmonary hypertension.\n\nLUNG: Major airways are patent.\nDiffuse airway wall thickening suggesting chronic bronchitis.\nNo clear evidence of bronchiectasis.\nDiffuse severe centrilobular and paraseptal emphysema affecting predominantly\nthe upper lobes.\n\nNew right pleural soft tissue thickening with adjacent minimal pleural\neffusion.\nMinimal left pleural effusion with adjacent compression atelectasis.\nMild bilateral smooth interstitial line thickening suggesting mild pulmonary\nedema.\nNo lung consolidation to suggest pneumonia.\nScattered tiny calcified granulomas.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "Mild pulmonary edema associated with minimal bilateral pleural effusions and\nworsened pulmonary hypertension on a background of severe centrilobular and\nparaseptal emphysema.\nLarge number of borderline lymph nodes in the mediastinum, enlarged and\nincreased in number in comparison to prior, could be reactive to pulmonary\nedema but nonspecific.  Needs to be followed with chest CT.\n\nRECOMMENDATION(S):  3 month follow-up is recommended after appropriate\ntreatment."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Motion artifact limits assessment of the segmental and\nsubsegmental pulmonary arteries, especially in the posterior basal segments. \nWithin limits of the study, no discrete pulmonary embolism is detected.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: A pretracheal lymph node measures 1.5 cm in the\nshort axis (series 4, image 69).  The subcarinal lymph node measures up to 1.1\ncm in the short axis (4:163).  Overall, lymphadenopathy appears similar to\nprior.  There is a calcified hilar lymph node.\n\nPLEURAL SPACES: There is a small right pleural effusion, which is bigger than\nthe prior study.  A left effusion has resolved.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis.  No suspicious lung masses. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is diffusely heterogeneous, calcified and enlarged,\nmeasuring up to 4.9 x 2.6 cm.\n\nABDOMEN:\n\nHEPATOBILIARY:\nAn irregular, peripherally enhancing mass in the left hepatic lobe measures\n6.0 x 3.5 cm, not significantly changed from prior, consistent with the biopsy\nproven cholangiocarcinoma (series 5, image 24).  There is associated capsular\nretraction as well as focal area where there is bulging of the hepatic contour\nwhich may represent extra capsular extension, unchanged (series 5, image 25).\nPosteriorly within the central right lobe of the liver, there is a hypodense\narea likely reflective of a hematoma again demonstrated, measuring\napproximately 10.7 x 5.1 cm, mildly decreased in size from the prior study\nwhich measured 12.3 x 7.7 cm.  The adjacent liver demonstrates a somewhat\nheterogeneous enhancement pattern, which may be perfusional and appears\nsimilar to the prior study.  The portal venous vasculature appears patent.  No\nevidence of active extravasation.  No intrahepatic ductal dilatation.  The\ngallbladder is decompressed, with cholelithiasis and no evidence of\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: No pathologically enlarged lymph nodes within the abdomen or\npelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is a 4.9 cm anterior rectus diastasis with adjacent\noverlying fascial defect and probable small ventral fat containing hernia.",
            "output": "1. Study limited by motion artifact.  Within the limits of the technique, no\ndiscrete filling defects to indicate pulmonary embolism.\n2. Interval decrease in size of a right hepatic hematoma now measuring 10.7 x\n5.1 cm.\n3. Redemonstration of a biopsy confirmed cholangiocarcinoma of the left\nhepatic lobe measuring 6.0 x 3.5 cm with possible extracapsular spread.\n4. No significant change in mediastinal lymphadenopathy.\n5. Diffusely heterogeneous and calcified multinodular thyroid.  Recommend\ncorrelation with thyroid ultrasound.\n6. Cholelithiasis without evidence of cholecystitis.\n7. Minimal increase in size of small right pleural effusion and resolution of\npreviously noted small left pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nDiffusely enlarged thyroid gland, unchanged compared to prior study and\napparently not compressing the trachea.  No enlarged lymph nodes in either\naxilla or thoracic inlet.  Right anterior port with lead in the cavoatrial\njunction.  No atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the aorta, none in the coronary arteries or\ncardiac valves.  The pulmonary artery and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Several mediastinal and hilar lymph nodes, the\nlargest in the right lower paratracheal station measuring 2.4 x 1.3 cm (11:84)\nrelatively unchanged compared to prior study.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  No consolidations.  Mild dependent\nposterior atelectasis.  No suspicious lung nodules or masses.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No significant interval change compared to prior study of ___.\nNo new or growing pulmonary nodules, lymphadenopathy or osseous lesions.\nLarge stable goiter in thyroid gland."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Diffusely enlarged thyroid gland\nmeasures 5.0 x 3.9 cm, previously 4.8 x 3.7 cm on ___, and extends\nto down to the level of the aortic arch, causing mild narrowing and rightward\nposterior displacement of the trachea.  No supraclavicular or axillary\nlymphadenopathy.\n\nMEDIASTINUM: Normal three-vessel arch.  Esophagus is patulous.  Multiple\nmediastinal nodes are seen.  The largest is located in the right lower\nparatracheal station, measuring 2.3 x 1.7 cm, previously 2.3 x 1.3 cm on ___ and 2.1 x 1.4 cm on ___ (series 303, image 34). \nDiaphragmatic lymph node measures 1.2 x 0.6 cm, previously 1.7 x 0.8 cm on ___ (series 203, image 76).  Left lower paratracheal station lymph\nnode measures 0.9 x 0.7 cm, unchanged from ___ (series 303, image\n33).\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Tip of a right chest wall intravenous infusion port\nterminates at the right atrium with no associated thrombus. The heart is\nnormal in shape and size.  Aortic valve is normal.  Small calcifications in\nLAD is unchanged. No pericardial effusion.  No enlargement of the pulmonary\nartery or aorta.  Stable calcification of the aortic arch.\nPLEURA: No pleural effusion or pleural thickening.\nLUNG:\n\n1. PARENCHYMA:  Dependent posterior atelectasis has resolved.  New linear\natelectasis in the right lower lobe.  Punctate left lower lobe nodule is\nstable from ___ (series 306, image 161).\n2. AIRWAYS:  Mild narrowing of the trachea as mentioned above.\n3. VESSELS:  No pulmonary embolism.\nCHEST OSSEOUS STRUCTURES: No acute fractures. Although there are no bone\nlesions in the imaged chest cage suspicious for malignancy or infection, it\nshould be noted that radionuclide bone and FDG PET scanning are more sensitive\nin detecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN: Please refer to same-day abdominal CT report for\nsubdiaphragmatic findings.",
            "output": "1.  No evidence of recurrent or metastatic disease.\n2.  Stable, mildly enlarged bilateral lower paratracheal station lymph nodes. \nDecreased diaphragmatic lymph node.\n3.  Very large goiter, mild narrowing and displacement of the trachea\nunchanged since ___.\n4.  Stable punctate nodule in the left lower lobe.\n5. Please refer to same-day abdominal CT report for subdiaphragmatic findings."
        },
        {
            "input": "The thyroid is enlarged and heterogeneous, measuring 45 x 34 mm with mild\ndisplacement of the trachea overall similar in appearance compared to the\nprior exam.  There is no axillary, supraclavicular, or hilar lymphadenopathy. \nA 20 mm x 15 mm right lower paratracheal lymph node, series 11, image 78\nappears grossly unchanged compared to the prior exam.  Additional diffuse mild\nmediastinal lymphadenopathy is also unchanged compared to the prior exam.  The\nheart size is normal.  There is no pericardial effusion.  The esophagus is\nnormal without evidence of wall thickening or a hiatal hernia.  The aorta is\nnormal in caliber.  The main pulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nNo concerning new or growing pulmonary nodules are identified.  There is no\npleural effusion or pneumothorax.",
            "output": "-No concerning new or growing pulmonary nodules identified.\n-Stable mild mediastinal lymphadenopathy.\n-Similar appearance the large thyroid goiter with mild narrowing and\ndisplacement of the trachea."
        },
        {
            "input": "Stable multinodular goiter (5, 12).  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Right pectoral Port-A-Cath.  Stable mild\nmediastinal lymphadenopathy.  No abnormality at the level of the large\nmediastinal vessels.  Stable mild coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  The lung parenchyma continues to show no\npulmonary nodules or masses suspicious for metastatic disease.  No diffuse\nlung disease.  The airways are patent.  The pleural surfaces are even. No\npleural thickening, no pleural effusions.",
            "output": "Stable examination of the thorax.  No evidence of metastatic disease."
        },
        {
            "input": "CHEST PERIMETER: Unchanged since at least ___, severe generalized,\nheterogeneous enlargement of the thyroid displaces the trachea posteriorly,\nbut only mildly decreases its sagittal diameter.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Evaluation of very\nasymmetric breast is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.  Findings below the diaphragm will\nbe reported separately.\n\n\n\nCARDIO-MEDIASTINUM: Lower esophagus is mildly patulous, but contains only air,\nnot an indication of obstruction.\n\nAtherosclerotic calcification is mild in head and neck vessels, and mild in\nleft anterior descending coronary artery as well..  Right supraclavicular\ncentral venous infusion catheter ends at the superior cavoatrial junction with\nno associated thrombosis.  Aorta and pulmonary arteries are normal size. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Right lower paratracheal lymph nodes, 12 mm, unchanged. \nNo lymph nodes elsewhere in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE:\n\n3-4 mm solid nodule with than irregular ground-glass halo in the left upper\nlobe, 20:121, is new.\n\nNo other lung nodules or any focal lung lesions of any consequence. \nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities.\n\nCHEST CAGE: Unremarkable.  Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.",
            "output": "New, solitary tiny mixed density left lung nodule, significance uncertain.  It\ncould well be inflammatory.  No other findings to suggest intrathoracic\nmalignancy.\n\nStable, large multinodular goiter displaces but does not appreciably narrowing\nthe trachea\n\nRECOMMENDATION(S):  The need for followup imaging depends on staging and\nmanagement considerations regarding the patient's extrathoracic malignancy. \nOtherwise ___ guidelines for management of incidentally discovered\npulmonary nodules would apply.\n\nIn the absence of an extrathoracic malignancy, repeat chest CT in 6 months\nwould be appropriate."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes at the level of the hilar\nor mediastinal level.  No abnormalities at the level of the posterior\nmediastinum.  No upper abdominal abnormalities, with the exception of\nbilateral small kidney stones.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  No diffuse lung disease.  The\nairways are patent.  No suspicious pulmonary nodules or masses.  No pleural\nabnormalities.\n\nAt the level of the main pulmonary artery the ascending aorta has a diameter\nof 38 x 37 mm.  At the same anatomical level, the descending aorta has a\ndiameter of 20 5 times 26 mm.  The pulmonary artery has a diameter of 33 mm. \nSevere coronary calcifications, severe aortic valve calcifications.",
            "output": "Aortic ___ are reported, as requested.  No infectious or neoplastic\nchanges in the thorax."
        },
        {
            "input": "The imaged base of the neck including the imaged portion of the thyroid is\nunremarkable.  The thoracic aorta is normal in course and caliber without\nsignificant atherosclerotic calcifications.  The main pulmonary artery appears\nnormal in size.  The heart is within normal limits of size with areas of\nmitral annular calcification.  There is no pericardial or pleural effusion.\nThere is no mediastinal or axillary lymphadenopathy.  A small amount of\naerosolized material is seen in the lower trachea at the level of the right\nmainstem bronchus.\n\nThe lungs are clear without worrisome nodule mass or consolidation.  Several\ncalcified granulomas, for example in the right upper lobe on series 4, image\n113.\n\nWithin the imaged portion of the upper abdomen, there is no discrete\nabnormality.\n\nBones: There is no worrisome lytic or blastic osseous lesions seen.  Chronic\nleft rib deformity noted at the seventh posterior arch.",
            "output": "1. No worrisome nodule, mass, or consolidation.\n2. Aerosolized material in the lower trachea may predispose to aspiration.\n3. Mild mitral annular calcification."
        },
        {
            "input": "There is a right-sided aortic arch with a two vessel branching pattern (normal\nvariant bovine arch). The thoracic aorta is normal in caliber without evidence\nof significant atherosclerotic disease.  There is minimal calcification\nassociated with the left anterior descending coronary artery.\n\nThis study is not optimized a for pulmonary artery opacification patency\nassessment. Accounting for this limitation, there is no evidence of central or\nsegmental pulmonary embolus.\n\nThe lung parenchyma is clear without airspace opacity, nodule or mass\nidentified. There is evidence of centrilobular emphysema, most severe at the\nlung apices. There is no pleural effusion or pneumothorax.\n\nThe heart is normal in size without pericardial effusion.\n\nThere is no mediastinal, hilar, axillary or supraclavicular lymphadenopathy.\n\nLimited views of the upper abdomen demonstrate abdominal ascites with several\nperitoneal soft tissue implants (5:106). There is pneumobilia. Abdominal\nfindings are described in detail in the concurrent CT abdomen pelvis.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Centrilobular emphysema.  No pulmonary mass or evidence of pulmonary\nmetastatic disease."
        },
        {
            "input": "CHEST:\n\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery\ncalcifications are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  Small left and trace right pleural effusions.  No\npneumothorax.\n\n\nLUNGS/AIRWAYS:  Diffuse apical predominant centrilobular emphysematous changes\nare present.  Left greater than right basilar dependent atelectatic changes. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver is small with a nodular contour.  There is\nleft-sided predominant pneumobilia.  Left percutaneous transhepatic biliary\ncatheter is present.  A common bile duct drain is also present.  The\ngallbladder contains a trace foci of gas.\n\nPANCREAS:  The previously identified hypodense pancreatic mass is difficult to\nmeasure but decreased in size compared to prior CT abdomen ___.  The\nremainder of the pancreas is atrophic without significant pancreatic ductal\ndilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.    There is no free intraperitoneal air.\n\nPELVIS: The urinary bladder is non-distended but grossly unremarkable.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The pancreas mass abuts the portal vein at the confluence without\nattenuation.  No significant arterial involvement is identified.  .  Mild\natherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits. \nCachexia.\n\nLarge volume ascites is present.",
            "output": "1.  No pulmonary embolism.  Small left and trace right pleural effusions with\ndependent basilar atelectasis.\n2.  Diffuse apical predominant centrilobular emphysematous changes are\npresent.\n3.  Cirrhotic morphology of the liver.\n4. Pancreatic head mass is not as well visualized as on prior scan, but\nsignificantly decreased in size.  The remainder the pancreas is atrophic\nwithout significant pancreatic ductal dilatation.  Previously seen peritoneal\nimplants are also not definitely identified, although there is some linear\nnodularity in the right pelvis of uncertain etiology.\n4.  Large volume ascites."
        },
        {
            "input": "The thyroid is normal.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Mediastinal nodes\nare numerous, but still within normal limits.  Aorta and pulmonary arteries\nare normal size. Cardiac configuration is normal and there is no appreciable\ncoronary calcification.  Left breast metallic clips are due to prior breast\nsurgery in patient with history of breast cancer. 2 x 2.7 cm solid nodule in\nthe left breast warrants correlation with most recent mammography.\n\nThere is no pericardial or pleural effusion.\n\nLUNG AND AIRWAYS\n\nAirways are patent to subsegmental level bilaterally.  Right middle lobe\nperifissural nodule (series 5: Image 151) is unchanged since ___ and\nnot concerning for malignancy. Right lower lobe nodule has largely decreased\nsince ___, now barely visible.  This nodule is likely inflammatory.\nSecond left upper lobe nodule is not visible, was likely inflammatory. There\nare no other lung nodules.\n\nUPPER ABDOMEN\n\nEven though this exam is not tailored for abdominal imaging, the upper abdomen\nis unremarkable.\n\nOSSEOUS STRUCTURES\n\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. There is no evidence of intrathoracic malignancy. Right lower lobe nodule\nhas slightly decreased since ___, was likely inflammatory. Left upper\nlobe nodule has disappeared, was inflammatory.\n2. 2 x 2.7 cm solid nodule in the left breast, adjacent to 2 metallic clips,\nimpression with history of breast surgery for breast cancer, warrants\ncorrelation with most recent mammography."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved for mammography.  No soft tissue abnormalities elsewhere in the\nchest wall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent head and neck vessels, minimal in left anterior descending coronary\nartery.  Aorta and pulmonary arteries and cardiac chambers are normal size,\naortic valve is not calcified and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing lung nodules or other focal lung\nlesions of consequence, as follows:\n\nSub 4 mm solid nodule, right middle lobe, 3:188, unchanged since at least ___.\n\n4-5 mm solid left lower lobe nodules, 3:152, 167 unchanged since at least\n___.\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of active intrathoracic malignancy, including 3 tiny solid lung\nnodules, 2 stable since ___ and one since at least ___."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Heart size is normal.  There\nis no pericardial or pleural effusion.\n\nNo pathologically enlarged supraclavicular, mediastinal, hilar or axillary\nlymph nodes demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Left lower lobe 4\nmm nodule, series 3, image 142 is stable.  New 1 mm nodule is demonstrated in\nsub fissural location in the right middle lobe, series 3, image 164.  No\nadditional nodules masses or consolidations demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis and corresponding report will be issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "New 1 mm right middle lobe nodule and stable 4 mm left lower lobe nodule. \nProvided patient history of malignancy, short-term follow-up in 3 months with\nchest CT is recommended for assessment of the behavior of new right middle\nlobe nodule.\n\nPlease review CT abdomen and pelvis from the same day and the corresponding\nreport that will be issued separately"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Structures at the base of the neck\nare unremarkable.  No infraclavicular or infraclavicular lymphadenopathy. \nMultiple subcentimeter axillary lymph nodes are again demonstrated.  Breast\nevaluation is reserved exclusively for breast imaging.  The distal esophageal\nis mildly patulous and demonstrates aerosolized secretions.\n\nUPPER ABDOMEN: The study is not tailored for evaluation of the abdomen. \nAllowing for this, the partially visualized upper abdomen demonstrates\npostsurgical changes following partial left nephrectomy.  Unchanged\ndistribution of multiple surgical clips in the left retroperitoneum.\n\nMEDIASTINUM: No evidence of mediastinal lymphadenopathy or mass.\n\nHILA: No hilar lymphadenopathy or mass demonstrated.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No evidence of a pericardial\neffusion.  Few flecks of calcification are demonstrated within the coronary\narteries, (series 4, image 120).  The pericardium is physiologic without\nevidence of pericardial effusion.  The vascular calibers of the ascending\naorta, descending aorta and main pulmonary arteries are within normal limits.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\nPARENCHYMA: Evaluation of the lung parenchyma is mildly limited by motion\nartifacts secondary to breathing.\n There has been interval development of two new pulmonary nodules as detailed\nbelow.\nA solid, 4 mm subpleural pulmonary nodule in the left lower lobe, (series 4,\nimage 128).\nA solid, 1  mm pulmonary nodule is demonstrated immediately adjacent and\nanterior to the right diaphragmatic dome, (series 4, image 150).\n\nThere has been no interval change of the previously described pulmonary\nnodules.  A solid 1 mm perifissural pulmonary nodule is demonstrated adjacent\nto the right major fissure, in the right middle lobe (series 4, image 114),\nunchanged from prior.\nA 4 mm subpleural pulmonary nodule in the left lower lobe is unchanged when\ncompared to prior, (series 4, image 114).\nAIRWAYS:  The airways are patent to the subsegmental level without evidence of\nbronchiectasis, bronchial wall thickening or mucus plugging.\n\nCHEST CAGE: A well-corticated deformity of the anterior right tenth rib is\nunchanged over several examinations and is likely congenital, (series 4, image\n274).  Redemonstration of partially visualized levoscoliosis of the thoracic\nspine.  Moderate to severe degenerative changes of the thoracic spine include\nintervertebral disc space narrowing, osteophytosis and vacuum phenomena.",
            "output": "1. Interval development of new, solid 4 mm subpleural pulmonary nodule in the\nleft lower lobe and 2 mm solid pulmonary nodule in the right lower lobe.\n2. No interval change in size of a 1 mm perifissural pulmonary nodule in the\nright middle lobe and 5 mm pulmonary nodule in the left lobe.\n3. The patient is status post partial left nephrectomy with stable\npostsurgical changes.\n\nRECOMMENDATION(S):  Given this patient history of malignancy and the\ndevelopment of two new pulmonary nodules, a follow-up chest CT without\ncontrast in 3 months is recommended."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced and normal in diameter.  Heart\nsize is normal.  There is no pericardial or pleural effusion. No\nsupraclavicular, mediastinal, hilar or axillary lymphadenopathy demonstrated. \nThere is no pericardial or pleural effusion.\n\nImaged portion of the upper abdomen reveals no appreciable abnormality within\nthe limitations of the study technique that was not designed to assess\nintra-abdominal pathology.\n\nAirways are patent to the subsegmental level bilaterally.  Several pulmonary\nnodules are present all of them are stable except for increasing right middle\nlobe 4 mm nodule, previously 2 mm, series 5, image 192.  Stable nodules are as\nseries 5, image 167, 189, 204.  No new nodules.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable pulmonary nodules except for 1 please add nodule from 2 mm to 4 mm in\nthe right middle lobe.\n\nNo lymphadenopathy in the thorax."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with presence of a slightly increased small pericardial\neffusion. There is no evidence of tamponade or epicardial infiltration. The\nmain pulmonary artery and thoracic aorta are normal caliber.  No incidental\npulmonary embolus is identified.\n\nA few solid nodules pulmonary nodules measuring up to 4 mm in the lower lobes\nare stable since ___, and are presumed benign (6: 56, 168, 189, 235).\nNo new nodules are identified. No endobronchial lesion or pleural abnormality\nis identified.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThere is mild S-shaped scoliosis of the thoracolumbar spine.  No lytic or\nsclerotic osseous lesions are identified.",
            "output": "No evidence of intrathoracic metastases.\n\nHandful of solid nodules measuring up to 4 mm in the lower lobes are stable\nsince ___, and may be presumed benign.\n\nSlightly increased small pericardial effusion."
        },
        {
            "input": "The examination is compared to ___.\nNo incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes at the level of the hilar\nor mediastinal structures.  The large mediastinal vessels are unremarkable. \nNo incidental pulmonary embolism.  Minimal coronary calcifications.  No\nvalvular calcifications.  No pericardial effusion.  The ___ of the\ncardiac structures are normal.  No abnormalities in the posterior mediastinum.\nThe upper abdominal is discussed in detail in the dedicated abdominal CT\nreport.  No evidence of osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease. \nMinimal unchanged bilateral apical thickening.  Minimal tracheal diverticulum\nat the level of the carina.  The pre described ground-glass and ___\nopacities are no longer visualized.  Respiratory motion artifact are present\nat the lung bases.  Minimal lingular scarring.  The presence of several and up\nto 4 mm large pulmonary nodules is unchanged, for example in the left lower\nlobe (7, 199 and 179) and in the right upper lobe (7, 58).  No new or growing\nnodules.  The airways are patent.  No pleural effusions.  No pleural\nthickening.",
            "output": "Several pre-existing pulmonary nodules are unchanged in size and morphology. \nNo new or growing nodules.  No lymphadenopathy.  No pleural effusions."
        },
        {
            "input": "There are no enlarged mediastinal, axillary, or hilar lymph nodes.  Small\npericardial effusion has increased in size since ___.  Heart size is\nnormal, and focal coronary artery calcifications are present.  There is no\npleural effusion.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.\n\nWithin the lungs, several sub 5 mm nodular opacities are again demonstrated\nand appear unchanged.  Representative examples are located in the superior\nsegment right lower lobe (86), right apex (___), and lateral segment left lower\nlobe (199 and 176), series 6.  No new or growing nodules are detected\nDependent opacities in the lower lobes likely reflect dependent atelectasis.",
            "output": "1.  Continued CT stability of small pulmonary nodules, with no new or growing\nlung nodules.\n\n2.  Slight increase in size of small pericardial effusion.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: There is no supraclavicular, axillary, hilar or\nmediastinal lymphadenopathy.  Heart size is normal.  Unchanged feathery\nappearing soft tissue in the anterior mediastinum likely reflects residual or\nhyperplastic thymic tissue.  Small pericardial effusion is decreased in size\nsince the prior study. The thoracic aorta, great vessels and main pulmonary\nartery are normal caliber.  The esophagus is unremarkable.\n\nThe tracheobronchial tree is patent to the subsegmental level.  4 mm left\nlower lobe nodule (4:156) is unchanged.  Another 4 mm left lower lobe nodules\nis also unchanged (4:140). Punctate right upper lobe nodule (04:51) is\nunchanged.  Atelectasis at the lung bases is mild.\n\nOSSEOUS STRUCTURES: There is no worrisome blastic or lytic lesion.",
            "output": "1. No new or growing lung nodules. Two left lower lobe pulmonary nodules are\nunchanged.\n2. Small pericardial effusion is slightly decreased in size.\n3. Small amount of residual or hyperplastic thymic tissue in the anterior\nmediastinum.\n4. Please note CT of the abdomen and pelvis will be reported separately."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinal or hilar\ncompartments.  The appearance of the pericardium has changed for now normal. \nNormal appearance of the large mediastinal vessels.  No abnormalities of the\nposterior mediastinum.  Upper abdominal findings are described in detail in\nthe dedicated abdominal CT report.  No osteolytic lesions at the level of the\nribs, the sternum or the vertebral bodies.  No substantial degenerative\nchanges.  Unchanged subpleural left lower lobe 2 mm nodule.  However, 1 left\nlower lobe subpleural nodule (6, 209) might have slightly increased in size. \nNo pleural effusions.  No pleural thickening.",
            "output": "Interval increase in size of 1 pulmonary nodule located in the left lower lobe\nrequires a CT followup in 3 months.  Other pre-existing nodules are stable. \nNo adenopathy.  No pleural effusions."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  There\nis no pericardial or pleural effusion.  There are no mediastinal, hilar or\naxillary lymphadenopathy.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Previously\nincreased left lower lobe nodule has currently decreased in size, approaching\n3.5 x 2.8 mm as compared to 4.2 x6.8 mm, series for age image 164 additional\nright upper lobe nodule, series 4, image 57 and right lower lobe nodule,\nseries 4, image 242, both 1 mm, are unchanged.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval decrease in size in the left lower lobe pulmonary nodule that in the\nabsence of chemotherapy might represent its non neoplastic nature.\n\nStable 2 right lung nodules.  No new nodules demonstrated."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Numerically increased number of bilateral axillary\nlymph nodes (2, 17), all of which are normal in size.  The large mediastinal\nvessels are unremarkable.  Mild coronary calcifications.  No pericardial\neffusion.  No other cardiac abnormalities.  The posterior mediastinum is\nnormal.  The upper abdomen is reported in detail in the dedicated abdominal CT\nreport.  Normal appearance of the chest wall soft tissues.  Moderate\ndegenerative vertebral disease.  No vertebral compression fractures.  No\nosteolytic lesions at the level of the ribs, the sternum, and the vertebral\nbodies.  Mild bilateral apical scarring.  Stable appearance of a 2 mm solid\nleft lower lobe nodule (4, 150), the morphology is highly suspicious of an\nintrapulmonary lymph node.  Stable appearance of a 4 mm left lower lobe nodule\n(4, 168), with a morphology that is again suspicious of a pulmonary lymph\nnode.  A pre-existing 1 mm right basal nodule (4, 238) is stable in size and\nmorphology.  No new or growing lymph nodules.  No pleural effusions.  No\ndiffuse lung disease.",
            "output": "Stability of the pre-existing pulmonary nodules, 2 of which could reflect\npulmonary lymph nodes.  No new or growing nodules.  No pleural abnormalities. \nNo abnormalities of the lymph nodes."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Pre-existing axillary lymph nodes are stable and\nnormal in size.  No enlarged hilar or mediastinal lymph nodes.  Stable correct\nappearance of the large mediastinal vessels.  Minimal coronary calcifications,\nno pericardial effusions.  No abnormalities in the posterior mediastinum.  The\nupper abdomen is reported in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  Minimal bilateral apical scarring.  The pre-existing millimetric\nand mostly subpleural pulmonary nodules are all stable in size and morphology,\na reference lesion is located in the left lower lobe (4, 153).  A second\nreference lesion is located at the basis of the left lower lobe (4, 169).  No\nnew or growing lesions.  No pleural thickening, no pleural effusions.  The\nairways are patent.",
            "output": "Stable examination of the thorax.  No evidence of metastatic disease.  Stable\nappearance of several small subpleural pulmonary nodules, the reflect\nintrapulmonary lymph nodes."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Normal appearance of the large mediastinal\nvessels.  No incidental pulmonary embolism.  No pericardial effusion.  The\nposterior mediastinum is unremarkable, with the exception of a small hernia. \nThe upper abdomen is reported in detail in the dedicated abdominal CT report. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.  Several pre-existing micro nodules are stable.  Reference\nmicronodules are seen in the left upper lobe (6, 80) and in the left lower\nlobe (6, 178).  Small subpleural atelectasis in the left lower lobe (6, 121). \nNo new or growing pulmonary nodules.  The airways are patent.  No diffuse lung\ndisease.",
            "output": "Stability in size and morphology of all pre-existing pulmonary nodules.  No\nnew or growing nodules."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The visible lymph nodes in the axillary regions (5,\n12) are all normal.  Normal appearance of the vascular and bronchial\nmediastinal structures.  No evidence of PE.  No hilar or mediastinal\nlymphadenopathy.  Mild coronary calcifications, no valvular calcifications, no\npericardial effusion.  The posterior mediastinum is unremarkable.  Normal\nappearance of the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.\nMinimal bilateral apical scarring.  Several pulmonary micronodules, for\nexample in the right lower lobe (6, 220) are unchanged in size and morphology.\nA small linea left lower lobe scar (6, 245) is also unchanged.  No new or\ngrowing nodules.  No pleural abnormalities.  No pleural effusions.  No diffuse\nlung disease.",
            "output": "Stability in size and morphology of all pre-existing pulmonary micronodules. \nNo new or growing nodules.  No adenopathy.  No pleural abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Visualized upper abdomen shows some evidence left renal\ncortical thinning and scarring.  Otherwise, partially visualized evident\nunremarkable.  Please see dictation from concurrent CT abdomen pelvis for full\ndescription of subdiaphragmatic findings.\n\nMEDIASTINUM: There are multiple small mediastinal lymph nodes without\nmediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is a trace pericardial\neffusion.  There are mild coronary artery calcifications, most severe in the\nleft anterior descending.\nPLEURA: Pleural spaces are normal.\nLUNG: Lungs are clear of concerning parenchymal consolidation or new\nnodularity.  Airways are patent to the subsegmental level.  Pulmonary\nvascularity is top-normal in size.  There are 2 unchanged 4 mm nodules in the\nleft lower lobe (series 3; images 136 and 153).  Small linear left lower lobe\nscar is unchanged compared to prior (series 3; image 190).\n\nCHEST CAGE: There is no concerning sclerotic or lytic lesions.  No acute\ncompression deformity is identified.",
            "output": "Stability in size and morphology of all pre-existing pulmonary nodules.  No\nnew or growing nodules.  No adenopathy.  No pleural abnormalities. 6-month\nfollow-up is recommended to ensure continued stability."
        },
        {
            "input": "HEART AND VASCULATURE:\n\nThere is significant respiratory motion artifact which limits\ninterpretability.  For example, apparent filling defect in the right middle\nlobe artery (3:135) is favored to be artifactual.  There is no evidence of\nmain or lobar embolism but smaller emboli cannot be reliably excluded.\n\nThe pulmonary trunk is normal caliber at 2.5 cm. The thoracic aorta is normal\nin caliber without evidence of dissection.  There is mild calcified\natherosclerotic plaque.  Cardiac chambers are grossly within normal limits. \nThere is multivessel coronary calcification.  There is no pericardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is moderate left basal atelectasis, which appears chronic\nin comparisons with prior chest radiographs.  There is milder patchy\natelectasis at the right base associated with multifocal bronchial plugging,\nwhich could be partially chronic though there may be a minor acute component\nof consolidation.  There is mild atelectasis in the lingula.  No worrisome\nnodules within the limits of the study.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable aside from a\nsmall right upper pole renal cortical hypodensity, incompletely characterized\nbut likely a cyst.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPrior median sternotomy noted.",
            "output": "1. Limited study due to respiratory motion artifact.  There is no central PE\nbut segmental/subsegmental emboli cannot be excluded.\n2. Chronic left basal atelectasis.  Patchy opacity at the right posterior lung\nbase appears to be a combination of atelectasis and mild consolidation,\npossibly due to aspiration.  Pneumonia is less likely but not excluded if\nthere is strong clinical suspicion.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:33 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued\n\nBilateral nipple rings are present.  No lytic or sclerotic lesions worrisome\nfor infection or neoplasm demonstrated.  Extensive network of venous\ncollaterals is demonstrated in the upper left chest with no obvious reason to\nexplain it.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.",
            "output": "Essentially normal chest CT.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged and\nthere are no soft tissue abnormalities in the imaged chest wall concerning for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Neo esophagus and upper esophagus have normal postoperative\nappearance.  Periesophageal fat planes are normal.  There is no postoperative\nmediastinal fluid collection or pneumomediastinum.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels or coronary arteries.  Aorta and pulmonary arteries are normal\nsize and free of filling defects.  There is no pericardial abnormality.\n\n\nTHORACIC LYMPH NODES: None measurable or new since ___.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs clear.  Tracheobronchial tree normal to\nsubsegmental levels.  No pleural abnormality.\n\nCHEST CAGE: Unremarkable compared",
            "output": "Normal postoperative appearance following esophagectomy.  No evidence of\nintrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The anastomotic areas at the level of the\npostoperative esophagus are unchanged and without evidence of recurrence.  The\nparaesophageal soft tissues are also unremarkable.  No abnormalities are noted\nin the upper abdomen, small splenule.  Status post cholecystectomy.  No\nenlarged lymph nodes in the mediastinum and at the level of the hilar\nstructures.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.  The lung parenchyma is unremarkable.  There is no\nevidence of suspicious pulmonary nodules or masses.  The airways are patent. \nNo diffuse lung disease.  Minimal postoperative scarring in the right lower\nlobe (5, 220), unchanged previous examination.",
            "output": "Stable normal postoperative appearance following esophagectomy.  No evidence\nof intrathoracic malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  The pulmonary arteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nStatus post partial esophagectomy with gastric pull up and unremarkable suture\nlines.  The remaining esophagus is mildly patulous, with a notable air-fluid\nlevel.  No enlarged mediastinal lymph nodes are seen.  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.\nMild right basilar linear atelectasis.  New ill-defined ground-glass opacities\nin the lingula (3:136).  Scattered small calcified granulomas, for example in\nthe middle lobe (03:54).\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Stable postoperative appearance of partial esophagectomy with gastric pull-up\nwith unremarkable suture lines.\n\nNew ground-glass opacities in the lingula, likely reflecting new pneumonia.\n\nOtherwise, no significant interval change.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 12:23 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged portion of the thyroid need any\nfurther imaging evaluation.  No supraclavicular or axillary lymph nodes are\nenlarged.  No soft tissue abnormalities in the imaged chest wall.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Caliber of the neo esophagus is comparable.  No\nextravasation.  No wall thickening.  No abnormality in the adjacent\nmediastinal tissue.\n\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aortic valve is not calcified.  Aorta and pulmonary arteries are\nnormal caliber.  Pericardium is physiologic.  No mediastinal fluid\ncollections.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing, including periesophageal some stations.\n\nLUNGS, AIRWAYS, PLEURAE: Aside from minimal atelectasis of the right lung\nbase, lungs are clear.  No lung nodules.  No evidence of aspiration.  No\npleural abnormalities.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.  Normal postoperative appearance\nfollowing esophagectomy and gastric pull-up."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Incidental\nnote is made of a sebaceous cyst in the right anterior chest wall.\n\nMEDIASTINUM: Patient status post esophagectomy and gastric pull-up.  There is\nno evidence of local recurrence.  The in the esophagus is unremarkable.  The\naorta and pulmonary arteries are unremarkable.  There is no pericardial\neffusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is minimal subsegmental atelectasis in both lung bases right\ngreater than left.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.",
            "output": "Status post esophagectomy and gastric pull-up.  No evidence of local\nrecurrence.  No evidence of metastasis to the chest."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Patient status post esophagectomy and gastric pull-up.  Small\nmediastinal lymph nodes are unchanged.  Heart size is normal.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.  Minimal pleural thickening in the right\nlung base is unchanged and is most likely post\n\nLUNG: Lungs are clear.  No new or growing pulmonary nodules are seen.\n\nBONES AND CHEST WALL : To review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows status post\ncholecystectomy.  No adrenal masses are seen",
            "output": "Status post esophagectomy gastric pull-up.  No evidence of local recurrence. \nNo new pulmonary nodules.\n\nNo evidence of metastasis to the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  There\nis no emphysema.  Low lung volumes cause bronchovascular crowding and\ndependent atelectasis.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no fracture.  There is no worrisome lytic or\nsclerotic lesion.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized unenhanced upper abdomen is\nunremarkable.",
            "output": "Low lung volumes.  Normal chest CT without evidence of thoracic spine or rib\nfracture."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta demonstrates severe atherosclerotic disease and is normal in size. \nThe main and right pulmonary arteries are mildly enlarged compatible with\nchronic underlying pulmonary hypertension.\n\nThe patient is status post median sternotomy and CABG.  The heart is severely\nenlarged and demonstrates severe aortic valvular and coronary artery\ncalcifications.  The patient is status post aortic and mitral valve repair. \nThere is no pericardial effusion.\n\nModerate right and small left pleural effusions are noted, with adjacent\ncompressive atelectasis.  No pneumothorax is identified. The airways are\npatent to the subsegmental level.  Mild interlobular septal thickening is\nnoted with associated ground-glass opacities, compatible with mild pulmonary\nedema.  Solid pulmonary nodules measuring 4 mm within the right upper lobe\n(302:75, 105) are age-indeterminate.\n\nNo suspicious osseous lesions are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\ndemonstrate perihepatic free fluid.",
            "output": "1.  Severe cardiomegaly, severe multivessel coronary calcifications, mild\ninterstitial pulmonary edema, and residual aortic valvular calcifications\nfollowing aortic and mitral valve repair.\n2.  Moderate right and small left pleural effusions with adjacent compressive\natelectasis.\n3.  Two 4 mm right upper lobe solid nodules, of unknown chronicity.  If the\npatient is at high risk for malignancy, recommend follow-up CT in ___ year to\ndocument stability.\n4.  Mild enlargement of the main and right pulmonary arteries, compatible with\nunderlying chronic pulmonary hypertension."
        },
        {
            "input": "The patient is after aortic and mitral valve replacement (redo)\n\nSternotomy wires in situ. There is a retrosternal fluid collection measuring\nin the vicinity of 20 ___ and extends almost the entire height of the sternum\nmeasuring approximately 2 cm in the AP diameter most likely representing a\nhematoma. Please note that active extravasation cannot be assessed due to the\nnon contrasted nature of the study\n\nSmall pericardial effusion which may be hemorrhagic in nature.\n\nRight-sided pleural effusion is decreased in size. Left-sided pleural effusion\nslightly increased in size, being moderate with associated partial atelectasis\nof the left lower lobe. The effusions are not hemorrhagic. Mild relative\nhypodensity of the blood pool suggesting anemia.\n\nRight IJV CVP in situ with the tip in the right atrium\n\n\nLeft basal atelectasis is noted, secondary to loculated effusion.  Emphysema\nand ground-glass opacities in the upper lobes might represent mild pulmonary\nedema.  Right upper lobe 4 mm nodule is unchanged since recent prior study.",
            "output": "Retrosternal fluid collection measuring in the vicinity of 20 Hounsfield units\nthat extending almost along the entire length of the sternum and potentially\nrepresent hematoma.\n\nPotential hemorrhagic pericardial effusion.\n\nMild edema\n\nAnemia"
        },
        {
            "input": "PULMONARY ARTERIES/AORTA: There are no acute pulmonary emboli.  There is no\nacute aortic syndrome.  There are marked coronary arterial calcifications.  \nContrast is noted to opacify the coronaries.\n\nAIRWAYS: Major airways are clear with no endotracheal or endobronchial\nlesions.\n\nMEDIASTINUM: There is no adenopathy.  There is no cardiomegaly or pericardial\neffusion.\n\nLUNGS: Lungs are clear.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nOSSEOUS/SOFT TISSUES: There is a chronic compression deformity of mid thoracic\nvertebra.\n\nUPPER ABDOMEN: Unremarkable",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Marked coronary artery disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Moderate cardiomegaly is unchanged since ___. \nPericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Respiratory motion degrades the assessment of the pulmonary\nparenchyma.  No areas of parenchymal consolidation or large pulmonary nodules\nwith the limitations of the study.  Patchy areas of ground-glass could\nrepresent expiration versus air trapping.  The airways are patent centrally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality.  Areas of\nrelative ground glass most likely relate to expiratory phase of scan versus\nair trapping."
        },
        {
            "input": "The examination is compared to ___.\nUnchanged 3 mm hypodense right thyroid nodule.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  All lymph nodes in these regions\nare normal in size.  Unchanged morphology of the VP shunt and of the right\nbreast implant.\nThe previously massive mediastinal lymphadenopathy has substantially improved.\n1 large reference lesion in pre bronchial location on the right (2, 21)\nmeasures 8 x 9 mm, as compared to 20 x 28 mm on the previous examination. \nLikewise, a right para aortic lymph node (2, 21) measures 4 x 4 mm on today's\nexamination, as compared to 11 x 10 mm on the previous examination.  There is\nno evidence of new or growing lymph nodes.\nUnchanged morphology of the large mediastinal vessels.  The pre-existing\nembolic changes in both lower lobes are no longer visible.  Unchanged\nappearance of the heart.  No pericardial effusion.  Unchanged fatty liver.  A\npreviously described hyperenhancing lesion in the right lobe of the liver is\nno longer clearly visualized.\nNo osteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.\nMinimal bilateral apical scarring, unchanged as compared to the previous\nstudy.  Also unchanged is the larger right apical scar in subpleural location\n(5, 65).  A previously described left lower lobe scar (5, 156) is unchanged in\nextent and severity.  The more proximal nodular lesion located adjacent to the\nscar (previous examination series 3, image 116) has almost completely\nresolved.  Unchanged areas of bilateral atelectasis in the dependent lung\nregions as well as minimal scarring at the bases of the lingular.  No new or\ngrowing lung nodules.  No pleural effusions.  The airways are patent.",
            "output": "Substantial decrease in size of pre-existing, previously enlarged mediastinal\nlymph nodes.\nNear complete resolution of a nodular component of scarring in the left lower\nlobe.\nNo new or growing nodules or lymph nodes.\nThe pre-existing bilateral lower lobe emboli are no longer visible.\nUnchanged areas of parenchymal scarring, notably in the right upper lobe."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.  An index mediastinal lymph node\nin the right peritracheal station is again identified, measuring 9 x 6 mm\n(4:83), previously measuring 9 x 9 mm on ___.\n\nThe aorta and pulmonary arteries are normal in size.  No incidental pulmonary\nembolism is identified.  The heart is normal in size and demonstrates no\nappreciable coronary artery calcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Subpleural right upper lobe scarring (for example,\n4:62) is unchanged.  Similarly, postsurgical changes and scarring at the left\nlung base (for example, 4:129) is also unchanged.  Linear bibasilar\natelectasis is noted.  No new, suspicious pulmonary nodules or masses are\nidentified.\n\nNo suspicious osseous lesions are identified.  The patient is status post\nright mastectomy and saline breast implantation.  A ventriculoperitoneal shunt\ncatheter is incompletely imaged but unchanged in position.\n\nFor description of the intra-abdominal contents, please see the separate CT\nabdomen and pelvis examination performed on the same day.",
            "output": "1.  Stable appearance of right upper and left lower lobe scarring.\n2.  No evidence of new suspicious pulmonary nodules or masses.\n3.  For description of the intra-abdominal contents, please see the separate\nCT abdomen and pelvis examination"
        },
        {
            "input": "Thyroid nodule at the right anterior aspect of the thyroid gland is unchanged.\nAorta and pulmonary arteries are overall unremarkable.  Heart size is normal. \nThere is no pericardial or pleural effusion.  Right breast implant is\nunchanged.  Image portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Stable appearance\nof the scarring in the right upper lung and absence of new pulmonary nodules\nare in consistency with lack of interval progression of disease.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of new nodules or masses to\nsuggest interval progression of lung cancer.\n\nFor description of the intra-abdominal contents please review the separate CT\nabdomen and pelvis examination and the corresponding report."
        },
        {
            "input": "The thoracic aorta is normal in caliber without evidence of dissection or\natherosclerotic calcification.  The main, left, and right pulmonary arteries\nare normal in caliber without a filling defect to indicate central pulmonary\nembolus.  The heart size is normal.  No evidence of coronary artery or cardiac\nvalve calcifications.  There is a trace pericardial effusion.\n\nA prominent 5-mm right lower paratracheal lymph node is unchanged (series 2,\nimage 27).  No pathologically enlarged axillary, supraclavicular, mediastinal,\nor hilar lymph nodes.\n\nThe airways are patent to at least the subsegmental level.  Right apex\nfibrosis and scarring with adjacent coarse calcifications with are unchanged\n(e.g.  Series 4, image 78, 87).  Opacity in the left lower lobe infrahilar\nregion is also unchanged since at least ___, likely reflecting\nparenchymal scarring (series 4, image 152).  No new or suspicious pulmonary\nnodule or mass.  No pleural effusion or pneumothorax.\n\nThe thyroid is heterogeneous with multiple right thyroid nodules, the largest\nmeasuring 1.3 cm, grossly unchanged.  The right saline breast implant is\nunchanged.  An incompletely visualized ventriculoperitoneal shunt catheter\ntraverses the subcutaneous tissues of the anterior left hemithorax.  No\nsuspicious lytic or sclerotic osseous lesion.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of below the diaphragm findings.",
            "output": "1.  Stable interval appearance of thorax without evidence to suggest disease\nrecurrence or metastasis in the thorax.\n\n2.  Left lower lobe opacity is likely scarring.\n\n3.  Heterogeneous thyroid for which thyroid ultrasound is recommended to\nfurther evaluate.\n\n4.  Please refer to the dedicated CT abdomen and pelvis report from the same\nday for a description of sub-diaphragm findings.\n\nRECOMMENDATION(S):  Thyroid ultrasound for further evaluation of\nheterogeneous-appearing thyroid.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:24 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Multiple hypodense thyroid nodules are again noted.  Axillary, mediastinal, or\nhilar lymph nodes are not pathologically enlarged.  Heart size is normal. \nThere is no pericardial effusion.  Thoracic aorta and main pulmonary arteries\nare normal in caliber.\n\nThe airways are patent to subsegmental level.  Scarring in the posterior right\nupper lobe with associated calcifications is unchanged (4:65).  A wedge-shaped\nopacity in the posterior left lower lobe is also unchanged and consistent with\nan area of scarring (4:128).  There are no new or growing pulmonary nodules. \nNo consolidation or pleural effusion.\n\nThe skeletal structures of the thorax do not show suspicious lytic or\nsclerotic lesions.  Right breast implant is unchanged.  Partially imaged\nventriculoperitoneal shunt courses in the subcutaneous tissues of the anterior\nchest wall.\n\nPartially imaged upper abdomen is unremarkable.",
            "output": "1.  Stable appearance of the thorax without evidence of residual or recurrent\ndisease.\n\n2.  Please refer to separately dictated CT abdomen and pelvis report for full\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Multiple thyroid small\nnodules, unchanged.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Scarring of the right upper lobe with calcifications are\nunchanged compared to ___.  There is left lower lobe subsegmental\natelectasis.  Otherwise no focal consolidation to suggest pneumonia.  No\npulmonary edema.  No suspicious pulmonary nodule or mass.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Multiple hypoattenuating nodule in the right thyroid lobe are\nagain noted measuring up to 0.9 cm.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nStatus post right mammoplasty.  A ventriculostomy catheter is seen coursing\nthrough the anterior midline chest toward the left-sided abdomen and out of\nview.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Chronic scarring with calcifications in the right upper lobe, similar 2\nprior CT of ___."
        },
        {
            "input": "The thyroid is stable in appearance. Supraclavicular, axillary, and hilar\nlymph nodes are not enlarged.  There is new mediastinal lymphadenopathy with\nan enlarged lymph node in the right lower paratracheal station, measuring 1.9\nmm (series 2, image 20). Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nAirways are patent to subsegmental levels. Scarring at the right lung apex is\nstable in appearance.  In the site of previously treated malignancy in the\nleft lower lobe is a linear opacity without nodular or spherical contours,\nwhich appears similar to the prior exam when comparing using same slice\nthickness.  There are no additional new or enlarging nodules concerning for\nmalignancy. There is no pleural effusion or pneumothorax.\n\nNo osseous lesion suspicious for malignancy or infection are present. A small\nsclerotic focus at T5 is noted, stable since ___ (series 602b, image\n45). A right breast implant is present. For description of findings in the\nupper abdomen, please see concurrent CT abdomen pelvis report.",
            "output": "1.  New lower right paratracheal mediastinal lymphadenopathy, highly\nsuspicious for metastatic involvement.\n2.  Stable appearance of prior treated malignancy in the left lower lobe.\n3.  No evidence of new pulmonary metastases."
        },
        {
            "input": "Filling defects are noted in the right middle lobar pulmonary artery, as well\nas multiple bilateral segmental and subsegmental pulmonary arteries,\nconsistent with pulmonary emboli. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThere is no supraclavicular, axilla, or hilar lymphadenopathy. Again seen is\nan enlarged right lower paratracheal lymph node, measuring approximate 1.6 cm\n(2:32).\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThe airways are patent to the subsegmental level. Right apical, lingular and\nbibasilar atelectasis is new over the interval.\n\nLimited images of the upper abdomen are unremarkable.  Patient is status post\nright mastectomy with implant reconstruction.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.  A\nstable sclerotic focus T5 is again noted.",
            "output": "1.  Filling defects in the right middle lobar pulmonary artery, as well as\nmultiple bilateral segmental and subsegmental pulmonary arteries are\nconsistent with pulmonary emboli. No CT evidence of right heart strain.\n\n2.  Right apical, lingular, and bibasilar atelectasis is new over the\ninterval.\n\n3.  Stable enlarged right lower paratracheal lymph node.\n\nNOTIFICATION:  Impression point 1 was discussed with Dr. ___ by Dr. ___\n___ telephone at 9:40am on ___, 2 minutes after discovery.\n\nAdditionally, these findings were discussed with Dr. ___ by Dr. ___\ntelephone at 11:15 on ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level. Bilateral\npulmonary emboli are reidentified in the left apicoposterior, left medial\nlower lobe (6:161) and medial right lower lobe (6:176) arteries. Additional\nemboli described on recent CT chest ___ are no longer identified.\nBibasilar aeration is improved with mild residual atelectasis and likely\nsuperimposed infarct. The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThe airways are patent to the subsegmental level. Detailed evaluation of lower\nright paratracheal lymph node is obscured by beam hardening artifact from\ncontrast in the superior vena cava, however node appears unchanged since\nrecent CT chest.  Prominent right hilar lymph node tissue is similar to prior\nCT. There is no supraclavicular or axillary lymphadenopathy. Hypodense 7 mm\nposterior right lobe thyroid nodule is similar to CT ___.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nRight breast prosthesis is unchanged. Catheter tubing overlying the right\nanterior chest wall is consistent with ventricular shunt.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Bilateral segmental and subsegmental pulmonary emboli with decreased\nembolic distribution and burden compared to recent CT chest ___.\n2. No acute aortic pathology.\n3. Improved bibasilar aeration. Residual bibasilar peripheral opacities likely\nsecondary to infarct with superimposed atelectasis.\n4. Unchanged right paratracheal lymph node."
        },
        {
            "input": "The thyroid is normal.\n\nHeart size is normal without significant pericardial fluid. 3 vessel coronary\nartery calcifications are severe. Aortic annular calcifications are mild.\nThoracic aortic arch is normal caliber with mild to moderate of scarring\ncalcifications. The right main pulmonary artery is ectatic measuring up to 26\nmm in diameter.\n\nIndistinctly marginated mass in the mid esophagus, starting just below the\nlevel of the carina, it is roughly 24 x 20 x 48 mm (6:28, 601b:31). It is\nresponsible for mild distension of the mid esophagus proximal to it. The poor\ndefinition of surrounding tissue planes suggests extension into the\nmediastinal fat and probably into the external layers of the adjacent trachea,\nleft main bronchus which it narrows mildly, and even the aorta.\n\nThere is a small left paraesophageal lymph node adjacent to the caudal portion\nof the mass measuring 12 x 6 mm (06:33). Adjacent subcarinal lymph node is top\nnormal measuring 20 x 9 mm (06:33). Pretracheal lymph node at the level of the\ncarinal measures 13 x 9 mm (06:28).  11 mm right hilar lymph node is enlarged\n(06:30). There is no definite pathologic supraclavicular, axillary, left hilar\nor mediastinal lymphadenopathy. Mildly hyperemic 6 mm right axillary lymph\nnode is not pathologically enlarged.\n\nThe airways are patent to the subsegmental level. There is trace biapical\nscarring. Apical predominant centrilobular emphysema is moderate to severe.\nDominant nodule measures 11 x 8 mm (5:176) in the lateral basal segment of the\nright lower lobe (5:176) has increased in size compared to ___\nwhere it measured 9 x 7 mm.  Other scattered right-sided nodules measure up to\n4 mm in the right lung base (5: 72, 93, 185). There is no pleural effusion or\npneumothorax.\n\nBones and soft tissues: Thoracic cage is intact without focal lesion.",
            "output": "1. Indistinct 24 x 20 x 48 mm mid-esophageal mass, likely invades mediastinum\nlocally, including the outer layers of the lower trachea, left main bronchus\nand possibly the descending thoracic aorta. Mildly prominent subcarinal,\npretracheal and left paraesophageal and right hilar lymph nodes are suspicious\nfor local metastasis.\n2. Dominant 11 x 8 mm nodule in the lateral basal segment of the right lower\nlobe has increased compared to ___ where it measured 9 x 7 mm.\nGiven the very slow increase in size, this nodule is indeterminate for\nmetastasis and could be a primary bronchogenic carcinoma.\n3. Other scattered nodules measures up to 4 mm in the right lung base, as\nabove.\n4. Moderate to severe emphysema.\n5. Severe 3 vessel coronary artery atherosclerotic calcifications.\n6. Probable pulmonary hypertension."
        },
        {
            "input": "Since ___ 2 stents of been inserted.\n\nThe esophageal stent, 27 mm in diameter, extends from 3 cm above the apex of\nthe aortic arch, approximately 12 cm, to the level of the left lower lobe\nsuperior segmental bronchus.  Superiorly the mucosal in growth narrows the\neffective lumen from ___ 15 mm, 2a:12.  At the level 4.5 cm from the\nproximal and, the lumen is entirely occluded by fluid,, but the distal 4 cm of\nthe stent is occluded by high attenuation material, either thrombus or tumor.\nNarrowing of the lumen from 25 mm at the level of the aortic arch to 20 mm at\nthe level of the stented left main bronchus suggests extrinsic tumor as well.\n\nThe 15 mm wide left bronchial stent extends from the carina to the origin of\nthe left upper lobe bronchus, fully patent to with a luminal diameter of 10\nmm.\n\nPatient was unable to cooperate for dynamic expiratory imaging. Both the end\ninspiration and intended expiratory imaging show normal caliber trachea and\nmain and lobar bronchi.\n\nEmphysema is severe. Previously imaged, 8 x 10 mm right lower lobe lung\nnodule, 48:168, is unchanged. There are no other lung lesions of concern for\nmalignancy, no consolidation, and no findings of aspiration, despite\nesophageal obstruction.\n\nThere is no supraclavicular lymph node enlargement. Numerous sub cm axillary\nnodes range in diameter up to 7 mm on the left, 4a: 58,, previously 5 mm.\nThere has been a substantial increase in the overall bulk of periesophageal\ntissue from the level of the carina to the insertion of the left superior\npulmonary vein into the left atrium below the esophageal stent.  For example\nat the level of the aortopulmonic window, the aggregate diameter of this\ntissue and the esophagus within is 37 x 36 mm, 4a:97, previously 20 x 28 mm,\nand adjacent lymph nodes in the aortopulmonic window measuring up to 7 mm,\nwere 5 mm and less in ___ ; a 9 mm right lower paratracheal node, 4a:\n106, is unchanged. .\n\nThere is no pericardial effusion. A small right pleural effusion is new.\n\nAorta and pulmonary arteries are normal size.  Aortic valvular calcification\nis mild to moderate, coronary artery atherosclerotic calcification is heavy.\n\nThis study is not designed for subdiaphragmatic diagnosis, but shows there is\nno adrenal mass. There are no bone lesions in the chest cage suspicious for\nmalignancy.",
            "output": "Patient could not comply with instructions for dynamic expiratory imaging. \nThere is no evidence on inspiratory images of tracheal or bronchial narrowing\nor a propensity toward tracheo-bronchomalacia.\n\nLeft main bronchial stent intact.  Mid esophageal stent occluded, probably by\nintrinsic and extrinsic tumor, associated with substantial increase in\nperiesophageal mediastinal tumor since ___.\n\nSevere emphysema. No pneumonia or evidence of aspiration."
        },
        {
            "input": "Central venous catheter terminates in the upper right atrium.  The right\ninternal jugular vein is markedly narrowed which may explain relatively large\nright external jugular vein, which carries flow immediately upstream into the\nright subclavian.\n\nHeart is normal in size.  There is a very small but increased pericardial\neffusion.  Great vessels are unremarkable.\n\nRim calcified nodule measures 16 mm in the right lobe the thyroid.\n\nThis necrotic prevascular lymph node measuring up to 39 x 26 mm in axial\n___ (12:45) appears stable.  Is also an unchanged conglomerate of\nnecrotic right a sided mediastinal lymphadenopathy.  Representative of this is\na component measuring up to 25 x 21 mm (12:141), also unchanged in size.  No\nhilar lymphadenopathy.\n\nRight upper lobe nodule (20:8) measures up to 17 x 11 mm in axial ___,\nperhaps minimally decreased.  Medial right apical nodules, which mostly appear\nto be endobronchial, appear stable.  Posterior right upper lobe subpleural\nnodule (20:133 close) measures 18 x 17 mm in axial ___, compared to 21\nx 21 mm before, mildly decreased.  A right lower lobe nodule measuring 4-5 mm\n(20:236) previously measured 7-8 mm, so decreased, although it is hard to\nexclude the possibility that this may to some extent be due to a resolving\nmucous plugging.  Additional nodules in each lung show no definite change. \nThese include a 10 mm nodule in the lingula.  Unchanged calcified granuloma at\nthe left lung apex.\n\nThe abdomen is reported separately.\n\nThere are no suspicious bone lesions.",
            "output": "Minimal decreases detectable among a few of the pulmonary nodules, otherwise\nno visible change.  Stable necrotic mediastinal lymphadenopathy."
        },
        {
            "input": "Extensive enlargement of the right thyroid gland is demonstrated, with\nmultiple low-density nodules, and overall size of 4.3 x 4.3 by 5.3 cm, with no\nsubstantial abnormality demonstrated within the left contralateral thyroid\ngland.  No pathologically enlarged mediastinal hilar lymph nodes seen. Aorta\nis normal in diameter.  There are multiple pulmonary emboli E demonstrated in\nsegmental and subsegmental branches of the lower lobes, that can be detected\ndespite the TECHNIQUE of the studies not be inked optimal for assessment of\npulmonary embolism, series 4, image 41, 42, 43, findings which are new as\ncompared to the prior study. The image portion of the upper abdomen will be\nreviewed separately and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.\n\nNo definitive lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\nThere is interval increase in left lower lobe pulmonary nodule, from 5-7.5 mm,\nseries 4, image 44.  There is also interval increase in right apical nodule,\nseries 4, image 19, currently 6.5 mm as compared to 4.8 mm on the prior study.\nAdditional triangular nodule in the right lower lobe, series 4, image 32 is\nstable.",
            "output": "Interval progression of pulmonary nodules including the size, concerning for\nmetastatic disease\n\nSubsegmental and segmental bilateral lower lobe pulmonary emboli\n\nSubstantial enlargement of the right thyroid a gland, unclear if represent\nmetastatic involvement or thyroid disease."
        },
        {
            "input": "A well-circumscribed, chronic right thyroid mass, 42 x 53 mm today, 05:11, was\n44 x 51 mm in ___, 37 x 52 mm in ___, narrowing the coronal diameter of\nthe trachea to 14 mm, unchanged. Adjacent vasculature is dilated, but node is\n4 mm or less. Supraclavicular and axillary lymph nodes are not enlarged.\nAxillary nodes are numerous, but no larger than a 8 mm in diameter or with\nlarge fatty hila, an indicatioh of a  benign diagnosis, but all unchanged\nsince at least ___. There are no soft tissue lesions in the chest\nwall suspicious for malignancy. Findings below the diaphragm will be reported\nseparately.\n\nAorta is normal size. The moderately enlarged pulmonary artery, 36 mm, was 35\nmm in ___ and ___. Right and left pulmonary arteries are normal\ncaliber, and I doubt pulmonary hypertension. Mediastinal and hilar lymph nodes\nare not enlarged. There is no pleural or pericardial abnormality. Heart size\nis top-normal.\n\nSuture at the site of resection of the left lower lobe nodule has a normal\npostoperative appearance. Handful of sub cm nodules is little changed since\n___, as follows:\n\n8 mm, right upper lobe, 6:96.\n\n6 mm, right upper lobe, 6:140.\n\n6 x 7 mm, right upper lobe, 6:159.\n\nThere are no new lung nodules.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "3 stable sub cm lung nodules.  No evidence of tumor regrowth the complication\nof the site of resected left lower lobe nodule.\n\nA large right thyroid mass, has not grown or increased mild tracheal narrowing\nsince"
        },
        {
            "input": "MEDIASTINUM: A 4.7 x 4.4 cm mass centered in the right thyroid lobe is similar\ncompared to the prior study, when it measured 5.3 x 4.2 cm, again mildly\nnarrowing the mid trachea at that level (05:10). There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy. A right paraesophageal lymph\nnode is slightly smaller compared to the prior study from ___, more\nrecently stable. The aorta and pulmonary arteries are normal in size.  The\nheart size is normal and there is no pericardial effusion.\n\nPLEURA: There is no pneumothorax. There is no pleural effusion.\n\nLUNGS: The airways are patent. Postsurgical changes related to prior left\nlower lobe wedge resection are similar in appearance. There is no diffuse\ninterstitial abnormality. No focal consolidation is identified.\n\nMultiple previously seen bilateral pulmonary nodules include:\n4 mm calcified left apical nodule (06:58), unchanged.\n9 mm right apical nodule, previously 8 mm (6:90).\n5 mm pleural-based right upper lobe nodule (06:106) and adjacent 3 mm\npleural-based right upper lobe nodule (6:112), both unchanged.\n7 x 10 mm right upper lobe nodule (6:150), previously 6 x 7 mm.\n5 mm lingular nodule (6:176), previously 3 mm.\n2 mm nodule in the superior segment of the right lower lobe, adjacent to the\nhorizontal fissure (06:202), unchanged.\n3 mm right lung base nodule (6:229), unchanged.\n6 mm left basilar nodule, adjacent to scarring from prior left lower lobe\nresection (6:253), previously 3 mm.\n6 x 6 mm nodule in the left base (6:231), previously 4 mm.\n2 mm lingular nodule (6:194), stable.\n\nNew pulmonary nodules include:\n4 mm nodule in the posterior left upper lobe (06:106).\n2 mm nodule in the right middle lobe (6:183).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN: Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. 4 mm left upper lobe and 2 mm right middle lobe nodules are new since the\nprior study, and a few of the multiple previously seen pulmonary nodules have\nincreased in size, compatible with progression of pulmonary metastatic\ndisease.\n2. Right thyroid lobe mass mildly narrows the cervical trachea, similar\ncompared to the prior study. Pathology report in the ___ medical record\nreveals no evidence of malignancy from samples obtained during prior outside\nbiopsy."
        },
        {
            "input": "Soft tissues:The thyroid is again demonstrated is enlarged heterogeneous right\nthyroid lobe measuring 31 x 26 mm.  The left lobe is homogeneous.  There are\nno pathologically enlarged mediastinal, hilar, or axillary lymph nodes.  The\nheart is normal in size and there is no pericardial effusion.  The aorta and\nmain pulmonary artery are normal in caliber. Please see a separate report\ndiscussing the subdiaphragmatic findings, including the stable gastrohepatic\nligament lymph node.\n\nLungs:The airways are patent to the subsegmental level bilaterally. There is\nevidence of a wedge resection at the left lung base.  Calcified granuloma is\nnoted left apex.  Previously seen right upper lobe nodule has significantly\ndecreased in size, now measuring 4 mm (6:91), previously 9 mm.  Posterior\nright upper lobe lesion measures 3 mm (06:107), previously 6 mm.  Second\nposterior right upper lobe lesion (6:111) measures 3 mm, stable.  Left upper\nlobe lesion measures 3 mm (06:105), previously 4 mm. No pulmonary nodules are\nidentified. Dominant lesion in the lower aspect of the right upper lobe as\nwell as several millimetric lesions in the lingula and lower lobes bilaterally\nhave resolved.\n\nBones: No radiographic evidence of osseous metastasis in the chest.",
            "output": "1.  Interval decrease of several bilateral pulmonary nodules as noted above. \nThere has also been resolution of several millimetric bilateral lower lobe\nnodules.\n2.  No evidence of new pulmonary lesions.\n3.  No radiographic evidence of osseous metastasis in the chest.\n4.  Please see a separate report discussing findings within the abdomen and\npelvis."
        },
        {
            "input": "The thyroid again demonstrates a 3.1 x 2.6 cm heterogeneous right thyroid lobe\n(05:11), unchanged from prior examination. Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged. Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.\n\nThere is no evidence of pericardial effusion.  No pneumothorax or pleural\neffusion is identified.  The airways are patent to the subsegmental level. \nThe patient remains status post left lower lobe wedge resection.  A calcified\nleft apical granuloma (06:59) is unchanged.\n\nTwo, residual, 3-4 mm subpleural right upper lobe pulmonary nodules are\nunchanged (6: 110, 131).  A 7 mm posterior left upper lobe nodule (6:103)\npreviously measured 3 mm in ___ multiple additional millimetric nodules\nare noted bilaterally. Multiple previously identified pulmonary nodules have\nresolved.  No new pulmonary nodules are identified.\n\nThere is no suspicious osseous lesion identified. For description of the\nintra-abdominal contents, please see the separate CT abdomen and pelvis\nexamination performed on the same day.",
            "output": "1.  Mixed interval change of numerous pulmonary nodules, including enlargement\nof a 7 mm left upper lobe nodule with interval resolution or stability of the\nnumerous additionally documented bilateral nodules.\n2.  No new pulmonary lesion is identified.\n3.  For description of the intra-abdominal contents, please see the separate\nCT abdomen and pelvis examination performed on the same day."
        },
        {
            "input": "There is unchanged enlargement heterogeneity involving the right lobe of the\nthyroid. There are no pathologically enlarged supraclavicular, axillary,\nmediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. \nMinimally increased, small pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level. Lung windows demonstrate no parenchymal abnormality. \nThe patient is status post left lower lobe wedge resection. Multiple bilateral\ncalcified granulomas are unchanged in appearance.\n\nSeveral bilateral subpleural nodules measuring up to 7 mm in the posterior\nleft upper lobe (4:92), are unchanged. This includes multiple subpleural right\nupper lobe nodules measuring 6 mm (4:105) and 4 mm (4:126), respectively.\nMultiple additional, sub-3 mm nodules are stable bilaterally (for example,\n4:47, 101, 179).  No new suspicious pulmonary nodules or masses are\nidentified.\n\nNo suspicious osseous lesions are identified.\n\nFor description of the intra-abdominal contents, please see the separate CT\nabdomen and pelvis examination performed on the same day.",
            "output": "1.  Stable appearance of numerous bilateral pulmonary nodules, measuring up to\n7 mm in the posterior left upper lobe.  No new suspicious pulmonary nodules or\nmasses.\n2. Minimally increased, small pericardial effusion.\n3.  For description of the intra-abdominal contents, please see the separate\nCT abdomen and pelvis examination."
        },
        {
            "input": "There is unchanged enlargement heterogeneity involving the right lobe of the\nthyroid. There are no pathologically enlarged supraclavicular, axillary,\nmediastinal or hilar lymph nodes.  Left pectoral lymph node (02:18) has\ndecreased measuring 6 mm in short axis previously 9 mm.  Right hilar lymph\nnode has also decreased now measuring 5 mm previously 7 mm.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications.\nPericardial effusion has resolved.  Right-sided port with the tip in the right\natrium.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level. Lung windows demonstrate no parenchymal abnormality. \nThe patient is status post left lower lobe wedge resection. Multiple bilateral\ncalcified granulomas are unchanged in appearance.\n\nSpiculated nodule in the superior segment of the left lower lobe (4:95)\nmeasuring 5 x 7 mm has not significantly changed. Subpleural nodule in the\nlingula (04:14 6) measuring 3 x 2 mm previously 2 x 1 mm.  Subpleural nodules\nin the right upper lobe (04:121 and 101) have also increased in size now\nmeasuring 6 x 6 mm previously 4 x 4 mm, and 7 x 6 mm previously 4 x 6 mm\nrespectively.  Additional sub 4 mm subpleural pulmonary nodules are stable.\n\nNo suspicious osseous lesions are identified.\n\nFor description of the intra-abdominal contents, please see the separate CT\nabdomen and pelvis examination performed on the same day.",
            "output": "Multiple pulmonary nodule have demonstrated slight interval growth since most\nrecent prior in ___, however definite interval growth since ___.\n\nSmall pericardial effusion has resolved\n\nSubcentimeter left pectoral and right hilar lymph node have decreased."
        },
        {
            "input": "Hypodense thyroid.  Right pectoral Port-A-Cath.  No adenopathy in the hilar or\nmediastinal region.  Minimal coronary calcifications.  No valvular\ncalcifications.  Mild cardiomegaly.  A pre-existing sub carinal lymph node (2,\n31) is completely unchanged in size and morphology.  Mild hiatal hernia. \nUnchanged appearance of a para esophageal lymph node (2, 50).\nNo osteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.  Unchanged left apical calcified granuloma.\nSlight decrease in size of a pre-existing left upper lobe pulmonary nodule (4,\n81) from 7-5 mm in diameter.\nSlight decrease in size of a pre-existing subpleural right upper lobe nodule\n(4, 107) from 6-5 mm in diameter.\nThe other pre-existing pulmonary nodules show similar behavior.  Unchanged\nsuture line of the segmentectomy in the left lower lobe.  No pleural\nthickening, no pleural effusions.  The airways are patent.  No diffuse lung\ndisease.",
            "output": "Slight interval decrease in size of the pre-existing pulmonary nodules.  No\nnew or growing nodules.  Stable appearance of normal hilar and mediastinal\nlymph nodes.  No pleural thickening, no pleural effusions."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Right pectoral Port-A-Cath.  Pre-existing normal\nsized mediastinal lymph nodes (5, 27) show no change in appearance.  Also\nunchanged is the dimension of a known sub- carinal lymph node (5, 33).  No\npericardial effusion.  Borderline size of the cardiac silhouette.  No\nincidental pulmonary embolism.  No chest wall abnormalities.  No osteolytic\nlesions at the level of the ribs, the sternum or the vertebral bodies.  The\nappearance of the lumbar spine is unchanged.  Minimal bilateral apical\nthickening.  Stability in size and morphology of the pre-existing pulmonary\nnodules.  A reference lesion in the left upper lobe (6, 110) continues to have\na diameter of 6 mm.  A second reference lesion in the right upper lobe (6,\n140) continues to have a diameter of approximately 5 mm, for example at the\nlevel of the right lower lobe (6, 199) are also stable.  The post resection\nchanges at the level of the left lower lobe (6, 222 are stable. No pleural\neffusions.  No pleural thickening.  No new or growing nodules.",
            "output": "Stability in size and morphology of the pre-existing pulmonary nodules.  No\nnew or growing nodules.  No pleural effusions.  Stable size of mediastinal\nlymph nodes."
        },
        {
            "input": "Thyroid is fairly homogeneous but low attenuation where visualized.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy present.  The\nheart and pericardium are unremarkable.  There is no evidence of pericardial\nor pleural effusion.  A right-sided IJ central venous catheter is present,\nwith the tip in the right atrium.\n\nCentral airways appear patent to the segmental levels bilaterally.\n\nRight upper lobe subpleural pulmonary nodule (series 6, image 129) measures 9\nx 8 mm, unchanged.\nCalcified 5 mm left apical nodule (series 6, image 51) is unchanged.\n8 x 6 mm spiculated nodule in the left lower lobe superior segment (series 6,\nimage 96) is unchanged.\nA 4 x 5 mm subpleural nodule in the lingula (series 6, image 153) is\nessentially unchanged (previously 5 x 5 mm).\n\nSurgical suture changes again seen in the left lower lobe.\n\nThere is no worrisome lytic or sclerotic osseous lesion within the thoracic\nvisualized thoracic structures.\n\nPlease note that upper abdominal structures are reported separately.",
            "output": "Stable pulmonary nodules.  No findings to suggest progression of metastatic\ndisease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  Right\ncentral venous catheter terminates in the right atrium, unchanged in position.\n\nPULMONARY PARENCHYMA:  There again seen are multiple pulmonary nodules.\nRight lobe:\nRight upper lobe nodule measures 4 mm, unchanged (06:45).  6 mm calcified\nright lower lobe nodule is unchanged (6:197).  Right lower lobe subpleural\nnodule measuring 8 mm is stable (6:124).  3 mm nodule in the right middle lobe\n(6:162), is stable.\n\nLeft lobe:\nSubpleural lingular nodule (6:169) has decreased previously measuring 5 mm now\nmeasures only up to 3 mm. Left lower lobe nodule measuring up to 6 mm is\nmildly enlarged (6:219).   Left upper lobe calcified nodule measuring 5 mm is\nunchanged (06:56).  Left lingular nodules are unchanged (6:89, 111, 173, 183,\n225, 227). Left lower lobe nodule on in the superior segment measuring up to 7\nmm is unchanged (6:99). Left lower lobe nodule measures up to 5 mm, not\nchanged (6:247).  Surgical suture and postop changes are again seen in the\nleft lower lobe.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Interval decrease in lingular subpleural nodule.\n2. Interval enlargement of left lower lobe nodule measuring to 6 mm.\n3. Short-term interval follow-up in 3 months is recommended.\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.\n\nRECOMMENDATION(S):  Short-term interval follow-up in 3 months is recommended.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 17:22 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see concurrent CT abdomen report.\n\nMEDIASTINUM: Prominent right pretracheal lymph node is similar to prior.  No\nmediastinal lymphadenopathy.  No mediastinal mass.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal size.  No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Right upper lobe nodule measures 4 mm (04:56), compared to 3\nmm on prior.  Left upper lobe nodule (4:66) measures 4 mm, compared to 2 mm on\nprior.  Multiple other nodules appear similar in size compared to prior, the\nlargest in the inferior right upper lobe measuring up to 8 mm.  These nodules\ninclude a mixture of calcified and noncalcified granulomas as well as\npulmonary nodules representing metastatic disease.\n2. AIRWAYS:  Patent to subsegmental levels.\n3. VESSELS:  Right chest port catheter tip is at the SVC/RA junction.\nCHEST CAGE: No suspicious lytic or sclerotic lesion.  No acute fracture.",
            "output": "1. Some of the previously seen pulmonary nodules are increased in size since\nprior.  These are likely due to metastatic disease.\n2. Other nodules representing a mixture of calcified and noncalcified\ngranulomas are similar in size compared to prior.\n3. The vast majority of nodules are unchanged."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, axillary, mediastinal, and hilar\nlymph nodes are not pathologically enlarged.  Thoracic aorta and main\npulmonary artery are normal size.  Right pectoral infusion port terminates in\nright atrium.  There is no pericardial effusion.\n\nAirways are patent to subsegmental levels.  There is no pleural effusion.\nSurgical suture is noted at the left lower lobe, unchanged.\n\nMultiple pulmonary nodules are identified, most of which are stable, although\nsome are slightly larger or smaller.\nFor example, the largest nodule measuring 7 mm in the right upper lobe (4:98)\nis stable.\nA 4 mm nodule in the right upper lobe (4:99) is larger (previously 3 mm).\nA 3 mm nodule in the right middle lobe (4:121) is larger (previously 2 mm)\nA 2 mm nodule in the left lower lobe at the major fissure (4:156) is smaller\n(previously 3 mm).\n\nPlease refer to the report for CT abdomen and pelvis obtained at the same time\nfor abdominal findings.  Fusion of bilateral first and second rib is are\nnoted, likely congenital.",
            "output": "Multiple subcentimeter pulmonary nodules consistent with pulmonary metastasis\nare overall stable, although few of them are slightly larger or smaller."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  No axillary adenopathy.  Right prepectoral\nPort-A-Cath in situ with the tip in the right atrium.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Right lower paratracheal lymph node measuring 24 x 17 mm\n(previously 19 x 14).  Subcentimeter right upper paratracheal lymph node (12,\n14) unchanged.\nHILA: Hilar lymph nodes unchanged\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No aortic valve or\ncoronary artery calcifications.  No pericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Numerous pulmonary nodules involving all lung lobes with the\nlargest nodule measuring 10 mm in the superior aspect of the right upper lobe\n(6, 93).  All of the nodules are unchanged in size except for 1 nodule in the\nright upper lobe (6, 144) which shows interval decrease in size previously\nmeasuring 5 mm, currently measuring 3 mm.  No new or enlarging pulmonary\nnodules or masses.  No confluent airspace consolidation.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  Mildly dilated measuring 32 mm in diameter.  No filling defects to\nsuggest pulmonary emboli.\nCHEST CAGE: No lytic/ destructive bony lesions.  Spondylotic changes at the\nT12-L1 level.",
            "output": "Mixed treatment response as evidenced by:\nAll the pulmonary nodules except for 1 are unchanged in size, except for\n1 slightly smaller small pulmonary nodule (from 5 mm to 3 mm).\nMild interval increase in size of large right lower paratracheal lymph node\nmetastasis.\nThe hilar lymph nodes are unchanged in size.\n\nPlease see abdominal CT report for abdominal findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Large right paratracheal\nlymph node is unchanged as compared to previous examination, currently 2.2 x\n1.9 cm.  New lymph node is demonstrated in the immediate sub- diaphragmatic\nareae a adjacent to the esophagus, series 3, image 48, 1.5 x 1.2 cm and will\nbe described in details as part of the CT abdomen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are all stable, series 4, images 55, 71, 75, 85, 97, 123, 160, 169,\n174, 214, 224, 253, 272.  No new or growing nodules demonstrated.",
            "output": "Interval development of new lymph node in the sub- diaphragmatic area, please\nreview separate report for CT abdomen pelvis.\n\nUnchanged large right paratracheal lymph node and multiple pulmonary nodules."
        },
        {
            "input": "The thyroid gland is grossly unremarkable.  Prominent axillary lymph nodes are\nidentified but are morphologically normal.  Supraclavicular lymph nodes are\nnot enlarged.  There is persistent mediastinal lymphadenopathy with a right\nparatracheal lymph node measuring 2.4 x 1.9 cm, previously 2.2 x 1.9 cm,\nunchanged (05:25).  There is also right hilar lymphadenopathy with a dominant\nnode measuring 1.5 x 1.3 cm (05:29), previously 1.3 x 1.2 cm, not\nsignificantly changed in size.  Lymph node in the gastrohepatic ligament is\nagain noted and measures 1.4 x 0.9 cm, slightly decreased in size compared to\nthe prior study (05:48).  The aorta and pulmonary arteries are normal in\ncaliber.  The heart is normal in size.  There is no pericardial effusion.\n\nThe airways are patent to the subsegmental level.  Patient is status post\nwedge resection in the left lower lobe.  Innumerable nodules are identified\nthroughout the lungs compatible with metastatic disease.  These are all\nunchanged since the prior study.  A few scattered partially calcified nodules\nare also unchanged (06:52, 190).  A largest nodule measures 11 mm in the right\nupper lobe (6:78), previously 10 mm.  Other nodules are as follows (06:45, 62,\n72, 80, 90, 95, 124, 149, 153, 156, 169, 179, ___, 209, 210, 215, 218,\n239).  No new nodules identified.  Bibasilar atelectasis is noted.  There is\nno large consolidation, pleural effusion, or pneumothorax.\n\nPlease refer to separate report on CT abdomen and pelvis performed on the same\nday for discussion of sub- diaphragmatic findings.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  A right chest\nPort-A-Cath terminates in the proximal right atrium.",
            "output": "1.  No significant interval change to the diffuse metastatic nodules measuring\nup to 11 mm in the right upper lobe.  No new nodules identified.\n\n2.  Unchanged right paratracheal and hilar lymphadenopathy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Right prepectoral Port-A-Cath in\nsitu with the tip in the mid right atrium.  Hypodense appearance of the\nthyroid which appear similar compared to prior.  No supraclavicular\nadenopathy.  Subcentimeter axillary lymph nodes are unchanged.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Right lower paratracheal lymph node (300 B, 68) shows interval\nincrease in size measuring 25 x 17 mm (previously measuring 14 x 11 mm) and\njust inferior to this an adjacent lymph node currently measures 21 x 22 mm\n(300 B, 90) previously measuring 20 x 17 mm.  Subcarinal lymph nodes also\ndemonstrate mild interval increase in size.\n\nHILA: Right hilar lymph node demonstrates mild interval increase in size\nmeasuring 17 mm in diameter (300 B, 107) previously measuring 16 mm.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  No\npericardial effusion.  No aortic valve or coronary artery calcifications.\nPLEURA: No pleural effusion\nLUNG:\n\n-PARENCHYMA:  Most pre-existing pulmonary nodules are larger by 1-2 mm with\nthe largest nodule in the right upper lobe measuring 12 mm in length (300 B,\n47) previously measuring 11 mm.  No new lesions.  No confluent airspace\nconsolidation.  No diffuse lung disease.  Mild passive micro atelectasis in\nthe lung bases.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal.  No\nfilling defects on this nondedicated study.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.  Fusion of the mid and anterior aspects of the\nfirst and second rib",
            "output": "Disease progression evidenced by interval growth of both mediastinal lymph\nnodes and mild enlargement of many of numerous pulmonary nodules.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "As compared to the previous study right upper paratracheal lymph node, series\n2, image 21 has slightly increased from 21 x 20 mm to 27 x 22.5 mm. \nParaesophageal lymph node, series 2, image 31 is 10 mm as compared to 8.6 mm. \nNo axillary or a additional hilar lymph nodes demonstrated.  Right hilar lymph\nnode, series 2, image 29 is 18 mm, unchanged.\n\nCentral venous line terminates in the right atrium.  Image portion of the\nupper abdomen will be reviewed as part of the CT abdomen and pelvis in\ncorresponding report will be issued\n\nNo pericardial pleural effusion is demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nmetastasis are unchanged, ranging up to 12 mm.  No definitive new pulmonary\nnodules demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Interval progression of the disease demonstrated as slight interval increase\nin mediastinal lymphadenopathy.  No change in pre-existing pulmonary\nmetastasis."
        },
        {
            "input": "Stable appearance of the thyroid.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  A single right\naxillary lymph node (2, 16) is stable in size.  The known enlarged mediastinal\nlymph node has minimally increased in size, from previously 26 x 22 mm to now\n27 x 27 mm in diameter (2, 20).  The size of the infra carinal lymph nodes as\nwell as of the enlarged right hilar lymph nodes (2, 28) is stable.  Stable\nsmall hiatal hernia.  No new mediastinal lymph nodes.  The abdomen is reported\nin detail in the dedicated abdominal CT report.  Stable appearance of the\ncardiac structures.  No pericardial effusion.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Known vertebral\nchanges at the level of L2 and L4 are stable.  Stable calcified granuloma in\nthe left lung apex.  Stable nodular subpleural thickening in the right lung\napex (3, 68).  Stable size of the known right upper lobe reference lesion (3,\n82).  Stable size of the known left upper lobe lesion (3, 98).  Other nodules\nin the lung parenchyma, for example in the right lower lobe (3, 129) Are also\nstable in size and morphology.  Evidence of new pulmonary nodules.  No pleural\nthickening, no pleural effusions.  Status post left lower lobe wedge resection\n(3, 192).",
            "output": "Minimal interval growth of a pre-existing enlarged paratracheal lymph node. \nRight hilar and sub-carinal lymph nodes are stable.  Stability in size and\nmorphology of pre-existing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.  The thyroid is unremarkable.\n\nMEDIASTINUM: A enlarged right upper paratracheal lymph node measures 3.6 x 3.0\ncm (05:23), increased in size from chest CT ___, previously\nmeasuring 2.8 x 2.7 cm.\n\nHILA: Right hilar lymph node measures 2.4 x 2.0 cm (05:31), grossly unchanged\nfrom ___.\n\nHEART and PERICARDIUM: There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Right upper lobe nodules measuring 1.0 cm (6:86) and 0.9 cm\n(6:71) are unchanged from ___.  9 mm nodule in the left upper lobe\n(6:97) is unchanged.  Multiple other pulmonary nodules (6:130, ___, 251,\n233, 194) are unchanged.  Patient is status post wedge resection of the left\nlower lobe.  There is no new or growing nodule.  There is mild dependent\natelectasis in bilateral lower lobes.\n2. AIRWAYS:  Airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery is borderline in size measuring 2.9 cm\n(05:29)\nCHEST CAGE: There is no suspicious osseous lesion.  Endplate irregularities of\nthe L2 and L4 vertebral bodies are likely representative of Schmorl's nodes\nsecondary to degenerative change.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings. The esophagus is thick-walled.",
            "output": "1. Right paratracheal lymph node measuring 3.6 x 3.0 cm is increased in size\nfrom chest CT ___, previously measuring 2.8 x 2.7 cm.  Right hilar\nlymph node is grossly unchanged.\n2. Multiple pulmonary nodules measuring up to 1.0 cm in the right upper lobe\nare unchanged from ___.  No new or growing pulmonary nodule."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are neither enlarged nor growing. \nThere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.  Findings below the diaphragm will be reported separately.\n\nCardio mediastinum:\n\n Small hiatus hernia is slightly larger today.  Esophagus is mildly patulous\nin the upper third, but there is no evidence for obstruction or compromised by\nadjacent adenopathy.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and central pulmonary arteries are normal size and free of\nfilling defects.  Small pericardial effusion is larger, but conceivably\nphysiologic.\n\nThoracic lymph nodes:\n\n40 x 46 mm right upper paratracheal mediastinal node, 03:22, was 33 x 37 mm in\n___ x 33 mm right hilar conglomerate, 4:152, was 20 x 28 mm.\n\n14 x 16 mm right posterior paraesophageal node, 4:170, was 7 x 10 mm in ___.\nNo other central lymph nodes are pathologically enlarged or larger.\n\nLungs, airways, and pleura:\n\nAmong approximately a dozen pulmonary metastases, several are measurably\nlarger, for example right upper lobe, 11 mm, 4:83, previously 9 mm; left upper\nlobe, 14 mm, 4:97, previously 9 mm.  The remainder are stable or minimally\nenlarged.  None is smaller and none is new.\n\nThe left lower lobe wedge resection site is a normal postoperative appearance.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Since ___, some enlarged mediastinal lymph nodes have grown, right\nhilar lymph nodes are stable.  No vital structures are compromised.\n\nAmong approximately a dozen pulmonary metastases,  some are measurably larger,\nsome minimally larger or stable, but none is smaller or new."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. There is\nno supraclavicular and no axillary lymphadenopathy.  Chest wall with no soft\ntissue abnormalities concerning for metastasis.\n7.5 x 2.7 cm right chest wall lipoma is unchanged (02:58).\nRight pectoral Port-A-Cath terminates in the right atrium.\n\nUPPER ABDOMEN: Status post left nephrectomy.  1.3 cm lymph node in the\ngastrohepatic ligament is unchanged (2:46), remaining included unenhanced\nupper abdominal organs are unremarkable.\n\nMEDIASTINUM: Mediastinal lymph nodes are mildly smaller in comparison to ___.  The largest lymph node is right upper paratracheal and\nmeasures 3.5 x 3.5 cm, in prior 4 x 4.6 cm (4:74).\n\nHILA: Evaluation of the hila is limited in this non enhanced study, by\nevaluation of hilar contours right hilar 1.4 cm nodule is likely smaller in\ncomparison to prior when it measured 1.9 cm (4:106).  Right pulmonary ligament\nlymph node is also smaller, 1.5 x 1 cm, in prior 1.5 x 1.4 cm (4:115).\n\nHEART and PERICARDIUM: Heart is normal in size.  Trace pericardial effusion\nmildly increased since prior.  Major vessels are within normal size.\n\nPLEURA: There is no pleural effusion.  No pneumothorax.\n\nLUNG: Airways are patent to the segmental level.  Status post left lower lobe\nwedge resection with no evidence of local recurrence.  In comparison to ___ the largest metastatic nodules decreased in size.\nReference nodules are in right upper lobe nodule 0.9 cm, in prior 1.1 (04:55),\nleft lower lobe superior segment 1 cm, in prior 1.2 (4:64).\nThe remainder are stable for example 1 cm right upper lobe subpleural nodule\n(4:80).\nNone is new.\n\nCHEST CAGE: There is no evidence of lytic or sclerotic bony destructive\nlesions in the ribs, sternum or vertebra.",
            "output": "Mediastinal lymphadenopathy decreased in size.\nMultiple lung metastasis, the larger have decreased in size however the\nsmaller are essentially unchanged. No new lung nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Rich thyroid is unremarkable. \nThere is no pathological nodes in the supraclavicular or axillary stations. \nIn the right flank subcutaneous 2.2 x 7.2 cm lipoma is stable (5:201).\n\nCHEST CAGE: There is no evidence of osteo destructive lesions at the level of\nthe ribs, vertebra or sternum., And a multilevel mild degenerative changes\nmore pronounced at the level of the lumbar vertebra.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymphadenopathy has mildly decreased in comparison to\n___.  Right paratracheal 1.6 x 2.6 cm lymph node, in prior 3.5 x\n3.5 cm (5:89).  The lower right paratracheal station lymph node is 2.4 cm,\nessentially unchanged (5:111).\nAbsence of IV contrast infusion limits evaluation of the hila, but previously\n1.4 cm right hilar lymph node is probably smaller, 1 cm today's study (5:129).\nRight lower pulmonary ligament 1 cm lymph node is stable (5:141).\n\nHEART and PERICARDIUM: Heart is normal in size.  The right pectoral\nPort-A-Cath terminates in right atrium.  Prior trace pericardial effusion has\ndecreased.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: The patient is status post left lower lobe wedge resection with no\nevidence of local recurrence.\nIn comparison with ___ left upper lobe previously measuring 1.3\ncm nodule, has decreased in size, currently 0.7 cm (5:79).\nRemaining multiple pulmonary metastasis are essentially unchanged, examples\ninclude right upper lobe 1 cm nodule (5:64), left lower lobe superior segment\n0.9 cm nodule (5:93), right upper lobe posterior subpleural 1 cm nodule\n(5:109), right lower lobe 1 cm nodule (5:178).\nThere are no new metastatic nodules.",
            "output": "-Mediastinal lymphadenopathy has decreased in size.  Other than single left\nupper lobe metastatic nodule which has decreased in size, the multiple\nremaining pulmonary metastatic nodules are unchanged."
        },
        {
            "input": "THORACIC INLET: The thyroid is diffusely enlarged and has a heterogeneous\nappearance, unchanged., This could be related to thyroiditis.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Right-sided\nPort-A-Cath tip projects to the right ventricle\n\nMEDIASTINUM: The mediastinal lymph nodes have slightly decreased in size since\nthe prior study for example the right paratracheal node now measures 19 mm it\npreviously measured 27 mm.  Similarly the subcarinal lymph node is also\ndecreased in size.  Small bilateral hilar lymph nodes have also regressed. \nHeart size is top-normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: The right upper lobe pulmonary nodule has increased in size and now\nmeasures 13 mm previously measured 10 mm.  Similarly all the other previously\nvisualized pulmonary metastasis have also increased in size.  The right upper\nlobe pulmonary nodule measuring 10 mm (4, 89) is new since the prior study. \nThe right lower lobe nodule measures 13 mm it previously measured 10 mm. \nThere is evidence of prior wedge resection in the left lower lobe.  The right\nlower lobe nodule has also increased in size.\n\nBONES AND CHEST WALL : Review of bones shows mild degenerative changes\ninvolving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows status post\nleft nephrectomy.  Please refer to dedicated report on abdomen which has been\ndictated separately",
            "output": "Mixed response to therapy.  Decrease in size of the mediastinal lymph nodes\nwhile the lung nodules have increased in size and at least 1 lung nodule in\nthe right upper lobe is new.\n\nStatus post left nephrectomy.  Please refer to dedicated report on abdomen\nwhich has been dictated separately."
        },
        {
            "input": "THORACIC INLET: The right lobe of thyroid is enlarged with a hypodense area\nand calcification within it measuring 17 mm.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The mediastinal lymph nodes have significantly increased in size\nsince the prior study for example a prevascular node now measures 3 cm in\nshort axis, was not even seen on the current prior study.  The right\nparatracheal lymph node has slightly increased in size since the prior study\nand measures 2.1 cm it previously measured 19 mm.  Another right lower\nparatracheal lymph node has slightly increased in size since the prior study\nthere is a new right suprahilar lymph node measuring 22 mm.  It previously\nmeasured 8 mm and was not in the large by size criteria.  The main pulmonary\nartery is mildly enlarged but unchanged.  The aorta is unchanged in\nappearance.  There is a right-sided Port-A-Cath with its tip in the SVC. \nThere is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are multiple bilateral pulmonary metastasis, increased in size\nsince the prior study for example a right upper lobe nodule now measures 19 mm\nit previously measured 13 mm (5, 59).  Similarly all the other previously\nvisualized pulmonary nodules have increased in size.  The right lobe posterior\nupper lobe nodule measures 20 mm as opposed to 13 mm on the prior study. \nEvidence of prior wedge resection the left lower lobe.  A right lower lobe\npulmonary nodule measures 12 mm it previously measured 2 mm.  No new pulmonary\nnodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  No lytic or sclerotic lesions concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a right\nadrenal nodule measuring 4.8 cm.  Please refer to dedicated report on abdomen\nwhich has been dictated separately.",
            "output": "Significant increase in size of the mediastinal adenopathy and the pulmonary\nmetastasis as described above in the interim.\n\nSeveral new mediastinal nodes are seen.  No new pulmonary nodules.\n\nRight-sided Port-A-Cath with its tip in the SVC.\n\nStable hypodense lesion within the right lobe of thyroid.\n\nRight adrenal nodule.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is notable for a\nhypoattenuating calcified nodule measuring 1.5 cm, similar to the ___ examination but increased in calcification compared to the ___\nexam (series 15, image 55).  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nMEDIASTINUM: Multiple mediastinal lymph nodes appear more necrotic compared to\nthe prior examination, and the majority decreased in size. For example a left\nperiaortic lymph node measures 3.8 x 2.8 cm, previously 4.5 x 2.9 cm (series\n15, image 168).  1.5 x 1.1 cm right paratracheal lymph node previously\nmeasured 1.7 x 1.4 cm (series 15, image 135).\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  Right chest\nPort-A-Cath terminates in the upper right atrium.\n\nPULMONARY PARENCHYMA: Redemonstration of changes related to prior left lower\nlobe wedge resection.  A 2.4 x 2.1 cm right lower lobe subpleural pulmonary\nmetastasis is slightly increased in size compared to prior examination where\nit measured 2.1 x 1.6 cm (series 15, image 151).  Otherwise, the remaining\nmultiple bilateral pulmonary metastases are similar or decreased in size\ncompared to the prior examination with representative examples as follows:\n\n-1.8 x 1.2 cm right upper lobe pulmonary nodule is slightly decreased in size,\nmeasuring 1.9 x 1.5 cm on the prior examination (series 15, image 96).\n-1.0 x 0.7 cm left upper lobe pulmonary nodule previously measured 1.1 x 1.0\ncm (series 15, image 213).\n-0.3 cm right lower lobe subpleural nodule previously measured 0.5 cm (series\n15, image 279).\n\nAIRWAYS: Again seen is occlusion of the right upper lobe airways by necrotic\ntumor which appears similar to slightly decreased in extent, specifically in\nits proximal portion (series 8, image 48).\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Slight interval increase in size of a right lower lobe subpleural\nmetastasis compared to the prior examination.\n2. Remainder of the bilateral pulmonary metastases are similar or slightly\ndecreased in size compared to ___.\n3. Multiple necrotic mediastinal lymph nodes are overall decreased in size\ncompared to the prior examination.\n4. Slight interval decrease in endobronchial tumor involvement of the right\nupper lobe bronchus.\n5. Please refer to separately reported CT abdomen pelvis for description of\nthe subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are small bilateral thyroid\nlobes.  There is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer CT abdomen pelvis performed at same time for\nfurther detail.\n\nMEDIASTINUM: There are multiple prominent mediastinum lymph nodes with no\nevidence of lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is moderate enlarged.  There is dense\natherosclerotic calcification involving the coronary arteries and mitral valve\nannular.  Decreased attenuation of the great vessel lumens is observed\nsuggestive of anemia.  The main pulmonary artery is dilated measuring 3.3 cm. \nNo pericardial effusion is observed.  There are surgical clips visualized in\nthe anterior and superior mediastinum.\n\nPLEURA: No pleural effusion is identified.\n\nLUNG: The central airways are patent.  There are bilateral lungs mild\nperibronchial wall thickening.  There are bilateral lung scattered linear\natelectasis.  No focal consolidation is observed.\n\nCHEST CAGE: There are age indeterminate left seventh and ninth ribs fracture. \nPlease correlate with clinical tenderness.",
            "output": "1. No evidence of pneumonia or significant pulmonary edema.\n2. Moderate cardiomegaly with dilated pulmonary artery likely representing\npulmonary hypertension.\n3. Anemia.\n4. Left seventh and ninth ribs age indeterminate fracture.  Please correlate\nwith clinical tenderness."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta is normal size. Main pulmonary artery is\nminimally enlarged measures 32 mm. There is mild cardiomegaly. Severe\ncalcification is present in the mitral annulus. Moderate calcifications are\npresent in all coronary arteries.\nMosaic pattern suggest presence of air trapping and small airways disease.\nThere is mild diffuse upper lobe predominant peribronchial ground-glass\nopacities.\nLung nodules are as follows:  2 mm subpleural right apex (5:37),  in the right\nlower lobe 2 mm (5, 173) and 2 mm subpleural left lower lobe (5, 116)\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra Edit\nThere are no bone findings of malignancy",
            "output": "Unspecific lung nodules followup in 3 months is recommended.\nSmall airways disease, air trapping, component of inflammatory process or\naspiration could be present"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta demonstrates atherosclerotic calcification most prominent\nthe arch, which appears unchanged from prior.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:\nThere are areas of multifocal ground-glass opacity in the right upper and left\nlower lobes are demonstrated, which may represent multifocal pneumonia.  There\nis mild bilateral airway thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Redemonstration of a infrarenal fusiform aneurysm measuring up to\n4.7 cm, previously 5.0 cm.  Status post endovascular aorto bi-iliac stent.  No\nextravasation to indicate endoleak.  Extensive atherosclerotic disease is\nnoted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.  There\nis grade 1 anterolisthesis of L5 over S1.",
            "output": "1. No pulmonary embolism.\n2. Areas of multifocal ground-glass opacity in the right upper and left lower\nlobes are demonstrated, which may represent multifocal pneumonia. Mild\nbilateral airway thickening.\n3. No large endoleak or evidence of extravasation within the abdomen or\npelvis. Grossly stable appearance of atherosclerotic disease within the\nthoracic aorta.\n4. Infrarenal abdominal aorta status post aorto bi-iliac stenting measuring up\nto 4.7 cm, previously 5.0 cm."
        },
        {
            "input": "HEART AND VASCULATURE:\nThe heart is normal size and shape.  Trace pericardial effusion physiological\nlimits.  Severe atherosclerotic calcifications in all coronary arteries, mild\nin the aorta and none in the cardiac valves.  The aorta is normal caliber\nthroughout.  No aneurysmal dilations, dissection or penetrating\natherosclerotic ulcers.  No filling defects in the main pulmonary artery\nthroughout its subsegmental branches bilaterally.  The of pulmonary arteries\nnormal in caliber.\n\n NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation. The\nairways are patent to the subsegmental levels.  Mild bronchial wall\nthickening, no bronchiectasis or mucus plugging.  Coarse calcified granuloma\nnoted in the left lower lobe.  No suspicious lung nodules or masses. No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show hepatic steatosis.  No other\nsignificant abnormal findings.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.\n2. Hepatic steatosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.5 cm lymph node in the left\nsupraclavicular station is not pathologically enlarged (05:10).  There is no\npathologic enlargement of lymph nodes in the axilla.\n\nCHEST CAGE: Mild multilevel degenerative changes of the vertebra are\npredominantly of mid and lower thoracic level.  There is no evidence of osteo\ndestructive lesions.\n\nUPPER ABDOMEN: Imaged upper abdominal organs are with no gross findings.\n\nMEDIASTINUM: There is no intrathoracic lymphadenopathy.  Posterior mediastinum\nis unremarkable.\n\nHEART and PERICARDIUM: Although the heart is top-normal in diameter, the left\nventricle is mildly enlarged.  There are severe calcifications of the aortic\nleaflets, consistent with the history of bicuspid valve.\nThe study is nongated, and mild pulsation artifacts of the aorta influence its\nmeasurements. There are moderate calcifications of the aortic valve leaflets.\nMid ascending aorta measures 4.4 cm (reconstructions series 305).\nDistal ascending aorta, proximal to the right brachiocephalic artery 3 cm.\nProximal descending aorta 2.2 cm.\nMain pulmonary artery is normal in caliber.\nPericardium is physiologic.\n\nPLEURA: No pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  0.5 cm\nnodule in the right lower lobe is adjacent to the major fissure (5:86).",
            "output": "-Calcifications of aortic valve leaflets, no dissections or other acute\nfindings.\n-Mild fusiform ectasia of the ascending aorta up to 4.4 cm.  Follow-up studies\nshould be gated.\n-0.5 cm right lower lobe nodule.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.\n\nThere is no pericardial or pleural effusion.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally. Patient has had a wedge\nresections of the lingula and the left lower lobe, the resection sites denoted\nby suture have stable appearance since ___ without new surrounding soft\ntissue.\n\n4 mm solid pulmonary nodule in the right lower lobe (05:201) is stable since\n___, likely a treated metastasis. Other two punctate subpleural\nnodules in the right upper lobe (05:127) and in the left upper lobe (05:149)\nare also stable since ___.  There are no new lung nodules.\n\nUPPER ABDOMEN\nAbdominal findings are described in a report of concurrent CT abdomen and\npelvis clips ___.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. There is no evidence of new or recurrent intrathoracic metastatic disease.\nThree smaller than 4 mm lung nodules, stable since at least ___ are\nprobably treated metastases.\n2. There is no lymphadenopathy or new bony metastasis"
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.  No incidental pulmonary embolus is\nidentified.\n\nThe patient has had prior left upper and left lower lobe wedge resections.\nPre-existing solid pulmonary nodules measuring up to 4-5 mm in the right lower\nlobe are stable since ___ (6: 142, 157, 211). A few calcified nodules\nare also stable (6:  93, 132, 137, 192).  No new nodules are identified.  Mild\ndiffuse bronchial wall thickening is unchanged. There is no endobronchial\nlesion or pleural abnormality.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "Pre-existing solid pulmonary nodules measuring up to 4-5 mm in the right lower\nlobe are stable since ___.  No new nodules identified."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nNo mediastinal, hilar or axillary lymphadenopathy demonstrated.  No\npericardial pleural effusion is seen.  Image portion of the upper abdomen will\nbe reviewed separately in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\nnodule, series 4 image 98, 3.7 mm in diameter has slightly increased compared\nto 3.2 mm although it might represent slightly different slice selection. \nAdditional right lower lobe nodule (cluster of nodules, series 4, image 158 is\n5.7 mm in diameter, unchanged since the prior study.  Left lower lobe\nsubpleural atelectasis is unchanged.  Lingular nodule, series 4, image 117,\n1.5 mm in diameter is unchanged.  The appearance of the lingular sutures is\nstable.  Subpleural nodule in the left lower lobe, series 4, image 142, has\nincreased in size as compared to previous study, currently 3.4 mm as compared\nto 2.5 mm.  Sutures in the left lower lobe are unremarkable.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval progression in 2 pulmonary nodules as described, in the left lower\nlobe and in the right lower lobe with additional pulmonary nodules being\nentirely stable.  Close follow-up within 3 months with chest CT is highly\nrecommended."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are unremarkable.\nHeart size is normal.  No pericardial pleural effusion is seen. There is no\nmediastinal, hilar or axillary pathologically enlarged lymph nodes present. \nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing right\nlower lobe nodule has substantially increased, from 5.6 x 5.7 mm to 12.7 x 7.3\nmm, series 4, image 163.  Pre-existing left lower lobe nodule has increased as\nwell, from 3.4 x 4 mm to 5.3 x 4.5 mm, series 4, image 145.  Pre-existing\nsuperior segment right lower lobe nodule is stable.  No other new nodules\nmasses are consolidations demonstrated.  Suture site in the left lower lobe\nfrom has unremarkable appearance.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval increase in size in 2 pulmonary nodules."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderately an large lymph nodes with moderate\ncontrast enhancement are newly appeared at the level of the right hilus and in\nthe sub- carinal region (5, 30).  Enlarged paraesophageal lymph nodes are also\nvisible (5, 34).  Mild coronary calcifications, no valvular calcifications, no\npericardial effusion.  The upper abdomen is described in detail in the\ndedicated abdominal CT report.  No evidence of osteolytic lesions at the level\nof the ribs, the sternum or the vertebral bodies.  The patient has undergone\nmulti lobar segmentectomy.  Minimal increase in size of a known right lower\nlobe nodule (6, 166).  Moderate increase in size of a second known right lower\nlobe nodule, from previously 7 x 12 to now 16 x 33 mm (6, 212).  A\npre-existing left lower lobe nodule (6, 224) has been resected in the\ninterval.  No pleural effusions.  No evidence of new pulmonary nodules.",
            "output": "Progression of disease with newly appeared markedly enlarged right hilar and\nsub- carinal lymph nodes.  Status post resection of a left lower lobe nodule. \nTo pre-existing right lower lobe nodules have slightly increased in size."
        },
        {
            "input": "NECK AND THORACIC INLET: Unremarkable\n\nAXILLAE, CHEST WALL, AND BONES: Degenerative changes are present in the spine.\n\nMEDIASTINUM/HILA: There is enlargement of the mediastinal adenopathy including\nthe sub carinal region measuring 1.6 x 3.9 X 3.6 cm in aggregate.  This is\nseen best on series 5, image 29 and series 9, image 44.  There is stable right\nhilar adenopathy.  There is no left hilar adenopathy.\nHEART: Unremarkable\n\nLUNG:\n\n-PARENCHYMA:\nThe right lower lobe irregular density present on the earlier study has\ndecreased in size and currently measures 2.2 x 1.2 X 1.8.\n5 mm nodule, right middle lobe, 06:  129.\n5 mm nodule, right lower lobe, 6:145\n-AIRWAYS:  Patent\n-\nPLEURA: Minimal stable scarring is present.\n\nUPPER ABDOMEN: Please see the dedicated abdomen pelvic CT for full discussion.",
            "output": "1.  There is enlargement of the subcarinal adenopathy present on the earlier\nstudy.  There is stable right hilar adenopathy.\n\n2.  The previously noted right lower lobe irregular density is smaller than on\nthe earlier exam.\n\n3.  Small stable nodules are present in the right middle and lower lobes.\n\n4.  Please see the dedicated abdomen pelvic CT for full discussion."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary lymph nodes are not enlarged.\nConglomerate of heterogeneous partially necrotic lymph nodes in the subcarinal\nregion measuring 3.8 x 2 cm is unchanged from prior study.  Right hilar\npartially necrotic lymph node measuring 12 mm was 10 mm Aorta and pulmonary\narteries are normal size. Cardiac configuration is normal and there is no\nappreciable coronary calcification.\nLung nodules are as follows :\n5 mm right upper lobe (4:119) is stable\n5 mm right lower lobe (4:129) is stable\n2 mm left lower lobe (4:110) stable\n2 mm right middle lobe (4:169) is stable\n2 mm right lower lobe (54:176) is slightly more conspicuous than before\nsubpleural 2 mm nodule in the lingula (4:134) is stable\nSubpleural micro nodule in the lingula (4:127) is stable\nThere are no new lung nodules\nThere is mild bronchial wall thickening\nAmount of soft tissue adjacent to surgical chains is stable .There is no\npleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy",
            "output": "Right hilar lymphadenopathy is larger than before, a lung nodule in the right\nlower lobe is more conspicuous than before, otherwise stable appearance of the\nchest."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Subcarinal hypervascular lymph nodes (6, 163) are unchanged.\n\nHILA: Right hilar hypervascular lymph nodes are slightly increased in size for\nexample (6, 143) measuring 16 mm in diameter (previously measuring 14 mm in\ndiameter).\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  No coronary artery calcifications.  The aorta\nis not dilated.  Mild calcification of the supra-aortic vessels.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Numerous pulmonary nodules are again noted with most of these\nnodules demonstrating mild interval increase in size for example the nodule in\nthe right upper lobe (6, 151) measuring 7 mm in diameter (previously 5 mm) and\nnodule in the right lower lobe (6, 169) currently measuring 7 mm (previously 6\nmm).  New soft tissue thickening in relation to the left oblique fissure (6,\n173).  Postsurgical scarring in the lower lobes are unchanged.  Mild, diffuse\nbronchial wall thickening.  No mosaic attenuation of the pulmonary parenchyma.\nNo diffuse lung disease.\n-AIRWAYS:  Patent to the subsegmental level.  Mild, diffuse bronchial wall\nthickening.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects.\n-CHEST CAGE:  Mild spondylotic changes of the thoracic spine.  No lytic/\ndestructive bony lesions.",
            "output": "Slight increase in size of the numerous pulmonary metastatic nodules.\n\nInterval increase in size of the right hilar lymph nodes.\n\nMediastinal (subcarinal) lymph nodes are stable.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nHypervascular 6 mm left supraclavicular lymph node is increased in size\ncompared to prior (previously measuring 3 mm).  No axillary adenopathy.  No\ngross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Right upper paratracheal lymph node is increased in size\ncurrently measuring 11 mm in diameter (previously measuring 7 mm). \nSubcentimeter right lower paratracheal lymph nodes appear relatively similar\ncompared to prior.  Subcarinal lymph nodes measuring 27 mm is slightly\nincreased in size.\n\nHILA: Right hilar adenopathy is slightly increased in size.  These lymph nodes\nencase the bronchus intermedius and proximal right lower and middle lobe\nsegmental bronchi, and incompletely attenuate them\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nApparent filling defect in the right atrium may be artifactual (motion\nartifact) in nature.  No aortic valve or coronary artery calcification.  No\naneurysmal malformation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  All the pre-existing metastatic pulmonary nodules are\nunchanged (the largest nodule measuring 7 mm in diameter).  Postobstructive\npneumopathy (obstruction/infection) in the superior segment of the left lower\nlobe.  Associated interstitial thickening most likely represents lymphovenous\ncongestion, but lymphangitic carcinomatosis could be considered in the\ndifferential diagnosis.  Mild interval increase in size of the soft tissue in\nrelation to the sutures in the right lower lobe (___) suggesting recurrence\nin relation to prior resection.\n2. AIRWAYS:  Partial attenuation of the bronchus intermedius and right middle\nand lower lobe proximal segmental bronchi by the right hilar adenopathy. \nMild, but diffuse bronchial wall thickening suggest bronchial inflammation.\n3. VESSELS:  The right descending pulmonary artery is partially attenuated by\nthe right hilar adenopathy, but there is no obvious filling defects to suggest\npulmonary emboli.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "Mild interval progression of metastatic malignancy as evidenced by mild\ninterval increase in size mediastinal and hilar lymph nodes, and the mild\ninterval increase in size of the area of the previously resected nodule in the\nright lower lobe suggesting local recurrence.  Metastatic pulmonary nodules\nare essentially unchanged in size.\n\nIncrease in right hilar adenopathy results in partial attenuation of the\nbronchus intermedius, right middle lobe and lower lobe bronchi with suspected\npostobstructive pneumopathy in the superior segment of the right lower lobe.\nThe associated lymphatic thickening is most likely due to lymphovenous\ncongestion.\n\nRecognizing the recent echocardiographic findings, the previously questioned\nfilling defect in the right atrium is most likely artifactual.  The next CT\nstudy may be performed ECG/cardiac gated to confirm this.\n\nFor abdominal findings please refer to CT abdomen report.\n\nRECOMMENDATION(S):  Consider whether follow-up chest CT, as indicated by\nclinical management of metastatic malignancy, should be performed with\nintravenous contrast agent and gating."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  No\nappreciable coronary calcification.  The thoracic aorta is normal in caliber. \nAortic arch calcifications are minimal.  The main pulmonary artery is normal\nin caliber.  Lymph nodes adjacent to the right pulmonary artery do not alter\nits caliber.  No central pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: Right upper paratracheal lymph nodes are\nunchanged in size, but decreased in attenuation centrally (series 3, image\n14).  Lower pretracheal lymph nodes are slightly more prominent, but\nsubcentimeter in size (series 3, image 17).  Subcarinal lymph nodes are\nminimally changed in size and enhancement measuring up to 2.1 x 2.7 cm (series\n3, image 31).  Right hilar lymphadenopathy is minimally changed, measuring up\nto 1.4 x 1.4 cm (series 3, image 31).  Attenuation of the adjacent bronchus\nintermedius and proximal right lower and middle lobe segmental bronchi is\nunchanged.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Thoracotomy changes in\nthe posterolateral right chest wall are noted.\n\nLUNGS/AIRWAYS: Mild attenuation of the bronchus intermedius and proximal\nsegmental right middle and lower lobe bronchi is unchanged.  Postobstructive\npneumopathy is decreased compared to the prior examination.  Confluent soft\ntissue adjacent to apparent radiopaque suture material in the right lower lobe\nis decreased since the prior examination.  Scattered pulmonary nodules have\nsignificantly decreased in size, including the right upper lobe measuring 5 mm\nand previously measuring 7 mm (series 4, image 133), right lower lobe\nmeasuring 6 mm and previously measuring 9 mm (series 4, image 145), right\nlower lobe measuring 4 mm and previously measuring 7 mm (series 4, image 207),\nlingula measuring 3 mm and previously measuring 5 mm (series 4, image 155),\nand lateral lingula measuring 2 mm and previously measuring 3 mm (series 4,\nimage 155).  No new or enlarging pulmonary nodules.  The airways are patent to\nthe subsegmental level with mild scattered bronchial wall thickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Decreased size of all previously known pulmonary nodules, soft tissue adjacent\nto the right lower lobe suture material, and postobstructive consolidation as\nwell as increased central hypodensity of some mediastinal lymph nodes are all\ncompatible with treatment response. No new or enlarging pulmonary nodules or\nother new evidence of metastasis."
        },
        {
            "input": "The thyroid is normal.  There is no axillary lymphadenopathy.  There has been\nan interval increase in left supraclavicular lymphadenopathy.  For example a\nlymph node lateral to the left internal carotid artery now measures 1.4 cm x\n1.3 cm, series 4, image 5, previously measuring no more than 0.4 cm.  A right\nparaesophageal lymph node now measures 1.4 cm x 1.4 cm, increased in size\ncompared to the prior exam at which time this measured no more than 0.5 cm,\nseries 4, image 27.  This lesion appears to abut the adjacent esophagus with\nobscuration of the fat plane however there does not appear to be upstream\nobstruction.  Extensive mediastinal necrotic lymphadenopathy has significantly\nprogressed compared to the prior exam.  For example a right paratracheal\nnecrotic lymph node measures 2.1 cm x 1.9 cm, increased in size compared to\nthe prior exam at which time this measured no more than 1.1 cm.  Extensive\nsevere necrotic pretracheal, precarinal and subcarinal lymphadenopathy has\nsignificantly progressed compared to the prior exam.  Severe necrotic right\nhilar lymphadenopathy appears to have slightly progressed compared to the\nprior exam.  Prominence of the left hilar lymph nodes appear grossly unchanged\ncompared to the prior exam.  A conglomerate of the subcarinal necrotic lymph\nnode mass measures 5.7 cm x 3.4 cm, increased in size compared to the prior\nexam at which time this measured up to 5 cm, series 4, image 142.  The heart\nsize is normal.  The pericardium is intact without evidence of an effusion. \nThe subcarinal lymph node mass appears to contact and possibly invade the\nesophagus however there is no evidence of upstream obstruction.\n\nThe airways are patent to the subsegmental levels.  The necrotic right hilar\nlymph nodes exerts mass effect on the right bronchus intermedius and lower\nlobe bronchi which however otherwise appear patent.  Mild narrowing is seen\ninvolving the right middle lobe bronchi.  The extent of bronchial narrowing is\ngrossly unchanged compared to the prior exam.\n\nPatient is status post right lower lobe resection, with interval increase in\nthe size of soft tissue density in relation to the sutures, measuring 2.1 cm\nby 1.1 cm, previously measuring no more than 1.5 cm, series 4, image 177 lung\nthe superior segment of the right lower lobe, there has been interval increase\nin diffuse soft tissue density, measuring 3.8 cm by 1.6 cm, previously\nmeasuring up to 3.4 cm x 1.2 cm.  An adjacent spiculated subpleural soft\ntissue nodule measures 1.6 cm x 1.1 cm, increased in size compared to the\nprior exam which time this measured up to 0.8 cm in short axis, series 4,\nimage 159.  Associated diffuse interstitial thickening appears progressed\ncompared to the prior exam.  Remainder of the subcentimeter bilateral\npulmonary nodules are grossly unchanged compared to the prior exam.\n\nRe-demonstrated is partial attenuation of the right descending pulmonary\nartery by the right hilar lymphadenopathy however no definite filling defect\nis identified.  Scarring and interstitial soft tissue thickening along the\nsuperior segment of the left lower lobe appears grossly unchanged compared to\nthe prior exam.  There is no pleural effusion or pneumothorax.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.",
            "output": "1. Overall, interval increase in size in extensive necrotic lymphadenopathy\nincluding in the supraclavicular, mediastinal, and right hilar regions, as\ndescribed in detail above is concerning for progression of disease.\n2. Interval increase in soft tissue density adjacent to the right lower lobe\nsuture material and opacities well as increased soft tissue nodularity along\nthe major fissure, which also may be secondary to a combination of progression\nof disease and postobstructive consolidations."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal.  Multiple\nnecrotic-appearing supraclavicular lymph nodes have decreased in size.  For\nexample.  2 left supraclavicular lymph nodes measure 1.1 x 0.9 cm and 1.1 x\n1.0 cm respectively (series 4, image 41 and 53), previously 1.4 x 1.3 cm and\n1.2 x 1.3 cm respectively.  No new supraclavicular lymphadenopathy. No\naxillary lymphadenopathy.\n\nMEDIASTINUM:  Again seen are multiple necrotic appearing mediastinal lymph\nnodes, all of which have decreased in size compared to ___.  For\nexample, a lymph node in the thoracic inlet (series 4, image 66) measures 1.2\nx 1.0 cm, previously 1.4 x 1.4 cm.  A right paratracheal lymph node measures\n1.6 x 1.5 cm (series 4, image 97), previously 2.1 x 1.9 cm.  A subcarinal\nlymph node measures 4.3 x 2.1 cm (series 4, image 170), previously 5.7 x 3.4\ncm.\n\nHILA:  1.8 x 1.0 cm and 1.1 x 1.1 cm right hilar lymph nodes have decreased in\nsize (series 4, image 184 and 183), previously 2.0 x 1.4 cm and 1.1 x 1.1 cm\nrespectively.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  The patient is status post bilateral lower lobe and\nlingula wedge resections.  A 4 cm right upper lobe pulmonary nodule is\nunchanged in size but demonstrates central cavitation (series 4, image 168). \nA 0.3 cm left upper lobe nodule (series 4, image 187) is also unchanged.  No\nnew or growing pulmonary nodules.  Opacities along the right lower lobe suture\nlines have decreased in size.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  No acute fractures.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Interval decreased in size of multiple necrotic appearing supraclavicular,\nmediastinal, and right axillary lymph nodes.  No new enlarged lymph nodes.\n2. Stable pulmonary nodules.  No new or growing pulmonary nodules.\n3. Interval decrease in size of the opacities along the right lower lobe\nsuture lines."
        },
        {
            "input": "CHEST PERIMETER: 14 mm left supraclavicular lymph node was 13 mm in ___. \nThere are no thyroid findings warranting further imaging evaluation. \nEvaluation of the breasts is reserved for mammography.  Elsewhere in the chest\nwall including the axillae, there are no soft tissue abnormalities concerning\nfor malignancy.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable despite adjacent adenopathy that\nwill be described subsequently.  Atherosclerotic calcification is not\nappreciated in head neck vessels or coronary arteries.  Aorta and pulmonary\narteries are normal size.  This examination is not designed for evaluation of\nthe pulmonary circulation.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Enlarged lymph nodes at lymph nodes at multiple stations\nin the mediastinum, thoracic outlet, right upper and both lower paratracheal,\nsubcarinal and right posterior paraesophageal stations, has been persistently\nenlarged.  There has been mild growth in the left lower paratracheal station\n5, from 5-7 mm, 02:21, in the left hilus from 7-10 mm, 4:141, and the largest\ncentral lymph node group, in the subcarinal station from 42 x 20 mm to 41 x 24\nmm, 02:29.  Right hilar adenopathy is stable.  There is no compromise of vital\nstructures or areas of new lymph node enlargement..\n\nLUNGS, AIRWAYS, PLEURAE: There has been no right lower lobe wedge resection. \nAlthough the tissue at the site of resection is stable, more superiorly,\nirregular small masses have grown, the largest 20 x 7 mm today, previously a 4\nx 6 mm, with greater interstitial infiltration and small nodules all\nsuggesting local tumor invasion.  There are no discrete lesions in the left\nlung concerning for malignancy.\n\nThere is no pleural mass or effusion.\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Interval increase in size of irregular masses in the right lower lobe, close\nto the site of previous wedge resection, concerning for local tumor\ninfiltration.\n\nExtensive central adenopathy is generally stable, except for slight increases\nas described above.  There are no findings to suggest compromise of vital\nstructures."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Is increased size of a left\nsupraclavicular node measuring up to 16 mm, previously up to 10 mm (04:11). \nThere is new/worsened right supraclavicular lymphadenopathy measuring up to 13\nmm, previously up to 7 mm (4:9).  Imaged thyroid gland is unremarkable.  No\naxillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to concurrent report from separate CT abdomen\npelvis for description of findings below the diaphragm.\n\nMEDIASTINUM: Multiple, large, necrotic and/or highly vascular mediastinal\nlymph nodes have grown. For example, nodes have grown as follows: right upper\nparaesophageal station, now 15mm was 10 mm (04:36), right upper paratracheal\nconglomerate now 2.3 x 2.9 cm, previously 1.8 x 2.1 cm (4:69); subcarinal\nconglomerate now 4.9 x 3.0 cm was 3.9 cm (4:145).\n\nHILA: Bilateral hilar adenopathy has worsened: left hilus, up to 16 mm,\npreviously up to 10 mm (4:145), and right hilus up to 16 mm, previously up to\n10 mm (04:130).\n\nHEART and PERICARDIUM: Heart is normal size.  No significant coronary artery\ncalcifications.  No pericardial effusion.\nPLEURA: There is a new small right pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA AND AIRWAYS: Centrilobular emphysema is mild.  Postsurgical\nchanges in the left lower lobe and lingula are stable.  At the site of wedge\nresection in the right lower lobe  there is considerably more tissue, (4:170),\nprobably a combination of tumor recurrence and post obstructive pneumonia due\nto moderate compromise of middle and lower lobe bronchi by surrounding hilar\nlymphadenopathy.  New postobstructive consolidation along the fissure in the\nright lower lobe obscures the previous masses in this location, in particular\nalong the fissure.\nA 4 mm nodule in the lingula is unchanged (4:160). Unchanged right middle lobe\nmicronodule (4:209).  A 5 mm right upper lobe nodule is increased in size\ncompared to prior when it measured 4 mm (04:34).  Perifissural right upper\nlobe micronodule is barely visible on the prior exam (4:148).  Several small\nright lower lobe perifissural nodules are also more prominent compared to\nprior (4:78).\n\n1. VESSELS:  Thoracic aorta and main pulmonary artery are normal caliber.  No\nlarge central pulmonary embolism on this non tailored exam.  There is minimal\natherosclerotic calcification of the aortic arch.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.  Please note that\nradionuclide bone scan are more sensitive for detecting early osseous\nmetastatic disease.",
            "output": "1. Interval worsening of supraclavicular, mediastinal, and bilateral hilar\nlymphadenopathy.\n2. Worsened right hilar and mediastinal lymphadenopathy narrows the right\nmiddle and lower lobe bronchi.  Recurrent, peribronchial tumor, particularly\nin the lower lobe is difficult to separate from postobstructive consolidation,\nbut has increased particularly at the right lower lobe wedge resection site.\n3. Several right pulmonary nodules are new or slightly increased in size\ncompared to prior as above.\n4. New small right pleural effusion.\n5. Please refer to concurrent report from separate CT abdomen pelvis for\ndescription of findings below the diaphragm."
        },
        {
            "input": "The thyroid gland is unremarkable.  Intra thoracic aorta is normal in caliber.\nGreat vessels appear normal. The heart is normal in size without pericardial\neffusion.  There is no axillary or central lymphadenopathy. The\ntracheobronchial tree is patent to the subsegmental levels.  There is no focal\nconsolidation or pleural effusion.  No suspicious pulmonary mass or nodule is\nidentified. Nodular opacities in ___ distribution in the left lower\nlobe (03:34), may represent inflammation, infection or aspiration.\n\nOsseous structures: No suspicious lytic or sclerotic bony lesion is seen.",
            "output": "1. Nodular opacities in the left lower lobe in ___ distribution,\nsuggestive of infection, inflammation or aspiration. No focal consolidation or\npleural effusion.\n\n2. Abdominal findings are reported separately.\n\nNOTIFICATION:  Findings discussed with Dr. ___ by Dr. ___ at 6:20\npm ___ by phone immediately after discovery."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  Mild thickening at the GE junction may be consistent\nwith patient's known malignancy.  The aorta is normal in caliber.  The main\npulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to the\ndedicated CT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nIll-defined ground-glass changes are seen within the left upper lobe, new\ncompared to the prior exam.  There is no pleural effusion.  No discrete\nnodular densities are seen.",
            "output": "-Ill-defined ground-glass changes within left upper lobe may be\ninfectious/inflammatory in etiology, however are new compared to the prior\nPET-CT.  No discrete pulmonary nodule seen.\n\nRECOMMENDATION(S):  Chest CT in 3 months is recommended for further\nevaluation."
        },
        {
            "input": "There is moderate cardiomegaly.  No evidence of pericardial effusion. \nModerate calcified atherosclerosis of the coronary arteries.  The aorta and\nits major branch vessels are patent, with no evidence of stenosis, occlusion,\ndissection, or aneurysmal formation.  There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.\n\nThe study is moderately degraded by motion decreasing the ability to evaluate\nthe pulmonary arteries at the subsegmental level.  The pulmonary arteries are\nwell opacified to the segmental level, with no evidence of filling defect\nwithin the main, right, left, lobar, segmental pulmonary arteries.  The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is a calcified thyroid nodule which measures 18 x 12 mm, unchanged when\ncompared to prior ___.\n\nThere is mild apical scarring at the left upper lung, unchanged when compared\nto most recent prior.  There is no pleural effusion.\n\nEvaluation of the lung parenchyma is limited by motion artifact.  There is\nmoderate bibasilar atelectasis.  Otherwise, there is no evidence of pulmonary\nparenchymal abnormality. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a small hiatus hernia.  There\nmultiple areas of cortical atrophy in the left kidney which are likely sequela\nof prior insult, (series 5, image 258,259)\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. The study is degraded by motion artifact decreasing the ability to evaluate\nthe pulmonary arteries at the subsegmental level.  Within the limitation of\nthe study, there is no evidence of pulmonary embolism at the segmental level\nor aortic abnormality.\n2. Evaluation of the pulmonary parenchyma is moderately limited by motion\nartifact.  However within this limitation, there is no evidence of an acute\nintrathoracic process.\n3. The calcified left thyroid nodule is unchanged when compared to prior CT\nchest dated ___."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer.  There are extensive\ncalcifications of the aorta and great vessels.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is a prominent right paratracheal lymph node measuring 10 mm in short\naxis and bilateral hilar lymph nodes measuring 10 mm in short axis, minimally\nenlarged compared to CT chest obtained ___.  Other scattered\nmediastinal lymph nodes are not pathologically enlarged.  The heavily\ncalcified left thyroid lobe is unchanged.  The right thyroid lobe appears\nunremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nScattered areas of ground-glass attenuation in the peripheral lung zones and\nsome minimal interlobular septal thickening raise the question of pulmonary\nedema or impaired lymphatic drainage.  There is minimal dependent atelectasis\nbilaterally. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are mostly unremarkable.  Both kidneys\ndemonstrate marked patchy cortical thinning indicative of prior insults, most\ncommonly infectious or vascular.  Incidental note is made of a replaced left\nhepatic artery arising from the left gastric artery.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is a compression deformity of the anterior aspect of L2, stable since at\nleast ___.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Scattered areas of ground-glass attenuation in the peripheral lung zones\nwith associated interlobular thickening raise the question of pulmonary edema\nor impaired lymphatic drainage.\n3.  Prominent right peritracheal and bilateral hilar lymph nodes as described\nabove.\n4.  Stable compression deformity of the L2 vertebral body"
        },
        {
            "input": "MEDIASTINUM:  Large calcified nodule in the left lobe of the thyroid gland. \nMultiple enlarged mediastinal lymph nodes including right paratracheal\nmeasuring 13 mm and 11 mm (03:15).  Subcarinal lymph node measuring 8 mm\n(03:20).  Numerous subcentimeter prevascular lymph nodes have also increased\nin size.\n\nHEART AND GREAT VESSELS:  The aorta is not aneurysmal the main pulmonary\nartery is not enlarged.  The heart size is normal and there is no pericardial\neffusion. Moderate atherosclerotic calcifications of the thoracic aorta and\nsevere coronary arteries. Right-sided PICC with the tip in the right atrium\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Widespread\nground-glass opacities with smooth interlobular septal thickening have\nmarginally worsened, although some of the increased ground-glass opacities can\nbe related to expiratory phase of CT scan.  No focal consolidation.  Mild\ndependent atelectasis in the lung bases.  Mild air trapping on this expiratory\nscan, can be seen with small airways disease.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen is unremarkable.",
            "output": "Widespread ground-glass opacities with interlobular septal thickening have\nmarginally worsened.  The absence of pleural effusions can suggest against\ncardiogenic pulmonary edema.  The differential could include atypical\ninfection, including viral or PCP, given the fevers the immunosuppression\nversus noncardiogenic edema."
        },
        {
            "input": "Calcified left thyroid nodule is unchanged.  Intrathoracic lymph nodes are\nstable to decreased in size in the interval.  Heart size is normal, and\ndiffuse coronary artery calcifications are present.  Small will left and trace\nright dependent pleural effusions have decreased in size since abdominal CT of\n___.  Small hiatal hernia is incidentally noted.\n\nWithin the imaged upper abdomen, there are no concerning new findings.  This\narea has been more fully assessed by a recent abdominal CT of 6 days earlier. \nMild distention of gallbladder is noted without evidence of stones.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.\n\nAssessment of the lungs is limited by inadvertent expiratory phase of\nrespiration.  Widespread pulmonary abnormalities are evident, including new\npoorly defined nodular foci of consolidation bilaterally, with upper and mid\nlung predominance.  The largest focal consolidative opacities at the right\napex measuring about 2 cm (28, 4).  These findings are superimposed upon\ndiffuse ground-glass opacities and septal thickening.",
            "output": "1. New poorly defined nodular opacities are concerning for angio invasive\nfungal infection such as Aspergillus, particularly if the patient is\nneutropenic.  Other infectious organisms are also possible.\n\n2.  Diffuse ground-glass opacities with septal thickening may reflect\ncoexisting pulmonary edema.  Differential diagnosis includes atypical and\nopportunistic infection, pulmonary hemorrhage, and drug reaction.\n\n3.  Small left and trace right pleural effusions have improved compared to\nabdominal CT of ___.  It with radial via branching the sole she is\npoorly defined nodules when she is neutropenic delay is it via the which is\nshe is coexisting with pulmonary edema but that is quite is nodule is it\ninsert out subtle a head communicate the acute\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 11:39 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Calcified left thyroid nodule is unchanged.  Intrathoracic lymph nodes are\ndecreased in size in the interval.  Heart size is normal, and\ndiffuse coronary artery calcifications are present.  Bilateral pleural\neffusions have resolved.  Small hiatal hernia is incidentally noted. \nRight-sided PICC terminates in the cavoatrial junction.\n\nWithin the imaged upper abdomen, there are no concerning new findings.  This\narea has been more fully assessed by a recent abdominal on ___.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.\n\nWidespread pulmonary ground-glass opacities with interlobular septal\nthickening, as well as nodular foci of consolidation have all improved.  Mild\nmulti focal ground glass opacities persist slightly upper lobe predominant. \nNo new consolidation pulmonary nodules.",
            "output": "Interval resolution of pulmonary edema and bilateral pleural effusions.\n\nMultifocal nodular opacities have also significantly improved, in keeping with\ntreated infection."
        },
        {
            "input": "A calcified thyroid nodule is identified within the left lobe measuring 2.0 x\n1.5 cm, which is unchanged since at least ___.  There is no\nsupraclavicular or axillary lymphadenopathy.  Extensive mediastinal\nlymphadenopathy is again identified with the largest right paratracheal lymph\nnode measuring 1.1 x 1.5 cm (7:66).  There is soft tissue density in the\nbilateral hila extending along the bronchovascular bundles, slightly increased\nsince the prior study.\n\nThe aorta and main pulmonary artery are normal in caliber.  Minimal\natherosclerotic calcifications are seen at the aortic annulus.  No large\ncentral filling defect is identified within the pulmonary arteries.  The heart\nis normal in size.  There is no pericardial effusion.\n\nEvaluation of the lung parenchyma is limited due to respiratory motion.  There\nare more focal opacities in the right middle and left lower lobes, concerning\nfor developing consolidations.  There are now small to moderate bilateral\npleural effusions.  No pneumothorax is seen.\n\nThe study is not designed for evaluation of intra-abdominal structures but the\nlimited included upper abdomen is grossly unremarkable.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.",
            "output": "1.  Slightly increased soft tissue in the bilateral hila extending along the\nbronchovascular bundles.\n\n2.  No significant change to mediastinal lymphadenopathy.\n\n3.  New bilateral small to moderate pleural effusions.\n\n4.  Focal consolidations in the right middle and left lower lobes, while these\nmay represent areas of atelectasis, developing pneumonia in the appropriate\nsetting cannot be excluded.\n\nRECOMMENDATION(S):  Bronchoscopy with sampling of the peribronchovascular\ntissue is recommended, as before."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  Aorta and pulmonary arteries\nare normal in caliber.  The airways are patent up to the subsegmental level\n\nPLEURA: No pleural effusion\n\nLUNG: There is bibasilar atelectasis.  No consolidation concerning for\npneumonia.  No evidence of an pneumonia edema or bronchiectasis.  Mild\nperibronchial in both lower lobes.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "No evidence of pneumonia.  Minimal bibasilar atelectasis"
        },
        {
            "input": "No incidental thyroid findings.  Massive soft tissue stranding with several\nborderline sized lymph nodes in the right axillary region (3, 10).  Several\nborderline sized lymph nodes (3, 14) Are seen in the mediastinum, notably in\npretracheal location (3, 22).  Moderate calcifications of the aortic wall. \nSevere coronary calcifications.  Mild aortic valve calcifications.  The\nposterior mediastinum shows a moderate hiatal hernia.  Abundant ascites and\nother abdominal findings are described in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\n2 mm left upper lobe calcified granuloma (5, 63).  2 mm calcified granuloma at\nthe basis of the left lung (5, 211).  3 mm subpleural granuloma in the middle\nlobe (5, 179).  No nodules or masses suspicious for metastatic disease. \nModerate right pleural effusion with areas of adjacent atelectasis (5, 191). \nMild parenchymal scarring at the basis of the middle lobe (5, 153).  The\nairways are patent.",
            "output": "Moderate right pleural effusion with subsequent atelectasis.  Mild scarring at\nthe bases of the middle lobe.  Several micronodules, some of which are\ncalcified.  No larger pulmonary nodules or masses suspicious for malignant\ndisease.  Extensive stranding of the connective tissue at the level of the\nright axilla, with several borderline sized locoregional and mediastinal lymph\nnodes."
        },
        {
            "input": "Radiodense material is seen anteriorly and laterally of the left thyroid lobe\n(2, 1).  Moderate calcifications of the supraaortic branches.  Borderline\nsized lymph nodes in the thoracic inlet (2, 13).  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  Moderate coronary\ncalcifications, mild aortic valve calcifications, no abnormalities in the\nposterior mediastinum.  Minimal left-sided and moderate right-sided pleural\neffusion, effusion is comparable to the previous examination.  Again noted is\nsubstantial perihepatic and perisplenic ascites.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.\nCalcified millimetric left upper lobe granuloma (302, 39).  A 3 mm subpleural\nnodule in the middle lobe (302, 157) is likely a intrapulmonary lymph node. \nNo other pulmonary nodules or masses.  Rounded atelectasis in the right lower\nlobe (302, 187), adjacent to the pleural effusion.  The airways are patent. \nNo diffuse lung disease.",
            "output": "Minimal left and moderate right pleural effusion, with accompanying rounded\natelectasis.  The airways are patent.  No diffuse lung disease.  No suspicious\npulmonary nodules or masses."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  Mild coronary\ncalcifications are noted.  There is no pericardial effusion.\n\nRight pleural effusion is small.  Please review CT abdomen and pelvis for\nassessment of intra-abdominal findings and the corresponding report that will\nbe issued separately\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal cylindrical\nbronchiectasis, mild, do not demonstrate evidence of infection.  Rounded\natelectasis in the right lower lobe is unchanged.  No new pulmonary nodules\nmasses or consolidations demonstrated.\n\nThere are no lytic or sclerotic new lesions developed that would be worrisome\nfor neoplasm.\n\nExtensive network of venous collaterals is demonstrated most likely related to\nsubstantial narrowing of right brachycephalic vein.",
            "output": "Stable appearance of the chest as described with no evidence of intrathoracic\nmetastatic disease\n\nPlease review CT abdomen and pelvis and the corresponding report for\nassessment of intra-abdominal pathology."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not not enlarged.  There is no\nsoft tissue abnormality in the chest wall suspicious for malignancy or\ninfection.  This study is not appropriate for subdiaphragmatic diagnosis.\n\nThyroid is unremarkable.  Thymus is edematous and mildly enlarged, but not\nmass like.\n\nAtherosclerotic calcification is not apparent head neck or coronary arteries. \nMediastinal and hilar lymph nodes are numerous, but not pathologically\nenlarged, presumably reactive.  Aorta is normal size, but biventricular\ncardiomegaly and dilated pulmonary arteries are best evaluated with dedicated\ncardiac imaging.  No filling defects are seen in the central pulmonary\narteries.\n\nSmall nonhemorrhagic right pleural effusion is mostly fissural.  Left pleural\neffusion is minimal.  There is no pericardial effusion.\n\nWidespread pulmonary consolidation is severe.  The right lower lobe is almost\nentirely airless ; the left lower lobe is heterogeneously consolidated in the\nsuperior segment and the basal segments are nearly airless.  The attenuation\nof both lower lobes, 25 ___, is lower than that generally seen with atelectasis\nand suggests pneumonia except that this is a young patient whose hypoxic vaso\nconstriction may decrease pulmonary blood flow more efficient with only see in\nolder patients.  Nevertheless there is sufficient the consolidation in the\nupper lobes to suggest widespread pneumonia.\n\nPeribronchovascular ground-glass opacification also prominent in the upper\nlobes suggests a different process, sensitivity or toxicity.\n\nThere no bone lesions in the chest cage suggesting infection or malignancy.",
            "output": "Severe nearly global bibasilar consolidation could be pneumonia or pneumonia\nwith substantial atelectasis.  Multi focal pneumonia elsewhere, predominantly\ndependent upper lobes.\n\nWidespread peribronchovascular edema or pneumonitis could be due to diffuse\nalveolar damage from widespread pneumonia or toxic inhalation.  This is less\nlikely pulmonary hemorrhage alone because of its symmetric distribution.\n\nSmall nonhemorrhagic pleural effusions, not concerning for infection.\n\nBiventricular cardiomegaly and probable pulmonary arterial hypertension. \nEchocardiography recommended.\n\nMild reactive central adenopathy.\n\nRECOMMENDATION(S):  Echocardiography."
        },
        {
            "input": "As compared to the previous examination, the size of the pre-existing lymph\nnodes has substantially decreased.  At the level of the hilar structures, the\nlymph nodes have returned to normal.  Insert in compartments of the\nmediastinum (2, 15, the lymph nodes are still borderline.  Overall, however,\nlikely improvement is seen.  No pathological cardiac changes.  Fatty liver\npersists no pericardial effusion.  The soft tissues of the chest wall are\nunremarkable.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  The pre described on displaced rib fracture is no longer\nvisualized.  In the lung parenchyma, no relevant change is noted. No\nsuspicious pulmonary nodules or masses.  No diffuse lung disease.  The airways\nare patent.  No pleural effusions.  No pleural thickening.",
            "output": "Substantial decrease in size of the pre-existing hilar and mediastinal lymph\nnodes.  No lung parenchymal pathology."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: Minimal mucous plugging right upper lobe.  Otherwise\npatent.  There is mild atelectasis in the right middle lobe.  0.4 cm nodule in\nthe right upper lobe series 5, image 91.  0.2 cm nodule left lung apex series\n5, image 56.  0.5 cm subpleural nodule left lower lobe image 181.  Minimal\natelectasis in the lingula.  0.2 cm nodule left lower lobe image 92.  Few\nadditional tiny 0.1 cm, 0.2 cm nodules in the apices.  There is mild\nsubpleural scarring bilateral lungs, more prominent in the lower lungs, with\nmild traction bronchiectasis, may be sequela of chronic heart dysfunction, or\nchronic inflammatory process.  No honeycombing.  No evidence of centrilobular\nemphysema.  Mild interlobular septal thickening in the apices may represent\nmild edema..  No pleural effusion.\nVessels:\nThere is small arterial wall calcification immediately above origin of the\nright coronary artery.  Small focus of calcification involving right lateral\nwall of the aorta at the level of the right coronary artery origin long\nsegment calcification involving anterolateral wall of the aorta approximately\n0.8 cm above the origin of the right coronary artery, extending superiorly and\nmore anteriorly to approximately midline position, terminating 2.6 cm above\nright coronary artery origin level.  There is heavy calcification of the\naortic wall at the level, and extending immediately above origin of the left\nmain coronary artery along the lateral wall, extending more in the\nposterolateral wall is extends upwards.  There few additional small flecks of\naortic wall calcification higher up in the ascending aorta, involving\nanterior, anterolateral right and anterolateral left wall.  There is heavy\ncalcification at the aortic arch, some calcification of the right common\ncarotid, innominate, subclavian, left subclavian, left common carotid\narteries, as well as descending thoracic aorta.  Ascending aorta is normal\ncaliber, measuring 3.0 cm.\nBorderline size main pulmonary artery, 3.0 cm.\n\nMediastinum and Hila: No adenopathy.\n\nHeart and Pericardium: Normal heart size.  There are heavy coronary artery\ncalcifications.  Mitral annular calcification.  Suggestion of chronic infarct\ninvolving interventricular septum.\n\nPleura: No effusion.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: No mass, no adenopathy.\n\nUpper Abdomen: Exophytic benign simple cyst upper pole left kidney.  Arterial\ncalcifications upper abdomen.  Probable nonobstructing stone upper pole left\nkidney.  No hydronephrosis.  There is diffuse atrophy of the pancreas.  There\nis mild rounded fullness in the pancreatic tail, well-circumscribed, measuring\n1.8 cm, may represent normal pancreatic parenchyma there is not atrophied. \nHowever, neoplasm cannot be excluded.  Further evaluation with MRI abdomen\nrecommended., series 3, image 57\n\nChest Cage: Degenerative changes spine, bilateral shoulders.  Mild\nthoracolumbar kyphosis centered at T12.  Demineralization.",
            "output": "Calcifications involving wall of the ascending aorta.\nHeavy coronary artery calcifications.  Suggestion of chronic infarct of\ninterventricular septum.\nFew small lung nodules, largest measures 0.5 cm, should be benign, no further\nfollow-up is indicated in the absence of history of malignancy.\nMild fullness of the pancreatic ___ represent relative preservation of\nnormal pancreatic parenchyma in the setting of a trophic remainder of the\npancreas, however, nodule/mass cannot be excluded.  MRI abdomen recommended.\n\nRECOMMENDATION(S):  MRI abdomen"
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  There is scattered atherosclerotic plaque which is calcified and\nnoncalcified involving the descending thoracic aorta.  The main, lobar,\nsegmental, and subsegmental pulmonary arteries are well opacified without\nfilling defect.  The remainder of the great vessels have a normal appearance.\n\nCHEST:\nThe thyroid gland is heterogeneous in appearance, particularly the left lobe,\nwith no discrete nodule seen. Axillary, supraclavicular, mediastinal, and\nhilar lymph nodes are not pathologically enlarged. The heart is moderately\nenlarged and there is no pericardial effusion.\n\nThe lungs are clear with small bilateral pleural effusions and adjacent\natelectasis at both bases. Scattered calcified granulomas are noted\nbilaterally.  No evidence of pneumonia, pneumothorax, or concerning pulmonary\nnodule.\n\nThe esophagus is dilated and fluid-filled, to the level of the thoracic inlet,\nwith a thickened wall (wall thickness up to 8mm).There is an air-fluid level\nsuperiorly and the esophagus impresses into the posterior tracheal lumen and\nthere is also significant mass effect in the posterior left mainstem bronchus\nversus filling defect in the bronchus. No mediastinal air is visible. A\nmoderate size hiatal hernia is present more inferiorly and it appears the\nstomach may be fluid-filled but is mostly excluded from view of this chest\nscan.\nLimited view of the upper abdomen also demonstrates a few tiny areas of\nintrahepatic air, most likely biliary. (MRCP from ___ indicates\npatient had gallstones)\n\nOSSEOUS STRUCTURES:  Bones are markedly diffusely demineralized and\ndegenerative endplate changes are seen but thoracic vertebral bodies are\nmaintained height and alignment.",
            "output": "1. No evidence of acute aortic pathology or pulmonary embolism.\n\n2.  Dilated, fluid-filled esophagus with prominent circumferential wall\nthickening may be consistent with esophagitis but neoplasia is not excluded. \nFurther evaluation with upper endoscopy may be prudent in view of mass effect\non the posterior airway and associated fluid filled, incompletely imaged\nstomach in this patient with clinical notes indicating possible GIST tumor in\nthe fundus. Column of fluid in the esophagus up to the level of the thoracic\ninlet makes the patient prone to aspiration.\n3. Small bilateral pleural effusions with adjacent atelectasis.\n\nNOTIFICATION:  Called ___ emergency room at ___ twice before\n09:10 on ___ but unable to speak to any clinician, thus, change in\nemphasis in IMPRESSION and recommendations for endoscopy entered into critical\nresults dashboard at 9:15am"
        },
        {
            "input": "CHEST:  There is an ascending thoracic aortic aneurysm, measuring up to 5.3 cm\n(series 2, image 24).  The aortic arch and descending thoracic aorta is\nheavily calcified.  There is a normal 3-vessel aortic arch, with major\nbranches appearing widely patent.  The main pulmonary artery is dilated to 4.5\ncm (series 2, image 25).  There is no mediastinal hematoma.  There is severe\nglobal cardiomegaly.  There is no pericardial effusion.  There is no\nmediastinal, hilar, axillary, or supraclavicular lymphadenopathy.  The thyroid\nis unremarkable.\n\nNo focal consolidation is seen.  There are small bilateral layering simple\npleural effusions with adjacent relaxation atelectasis.  There is no\npneumothorax.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nThe spleen is intact and normal in size.  Multiple gallstones are seen within\nthe gallbladder lumen.  There is no evidence of wall thickening or gallbladder\ninflammation.  The adrenal glands are normal.  The kidneys enhance\nsymmetrically and excrete contrast promptly without focal lesion or\nhydronephrosis.  There is no evidence of renal or collecting system injury. \nThere is fusiform aneurysmal dilation/ectasia of the infrarenal abdominal\naorta to 2.5 cm (see series 2, image 60).  There is heavy atherosclerotic\ncalcification which is most prominent in the infrarenal abdominal aorta and\nproximal common iliac arteries.  Major proximal tributaries are patent.  No\nlymphadenopathy, free air, or free fluid.\n\nThe small bowel is unremarkable, without ileus or obstruction.  There is no\nevidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is normal.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nPELVIS:  The imaged pelvic organs, including bladder and terminal ureters, are\nintact and normal appearing.  There is no pelvic sidewall or inguinal\nlymphadenopathy by CT size criteria.  There is no free pelvic fluid.\n\nBONES:  There is a soft tissue 10 x 6 cm hematoma in the right gluteal region,\nwith adjacent soft tissue and fat stranding.  There is no evidence of active\nextravasation or vascular injury.  Evaluation for subtle/non-displaced rib\nfractures is somewhat limited due to motion artifact.  There is no evidence of\ndisplaced rib fracture.  There is no evidence acute fracture elsewhere.  There\nis moderate thoracic and lumbosacral spine degenerative change, with flowing\nanterior osteophytes consistent with diffuse idiopathic skeletal hyperostosis\n(DISH).  Alignment is normal.  There is no evidence of concerning focal lytic\nor sclerotic osseous lesion.",
            "output": "1. Right gluteal region 10 x 6 cm hematoma.  No evidence of active\nextravasation.  Otherwise, no acute visceral injury.\n2. Ascending thoracic aortic aneurysm, measuring 5.3 cm.\n3. Main pulmonary artery dilation to 4.5 cm.\n4. Severe global cardiomegaly.\n5. Fusiform infrarenal abdominal aortic aneurysm/ectasia measuring up to 2.5\ncm.\n6. Trace bilateral simple layering pleural effusions.\n\nNOTIFICATION:  The findings, including update to wet read above regarding\nright gluteal hematoma, were discussed by Dr. ___ with Dr. ___ On the\ntelephone on ___ at 5:53 ___, 15 minutes after discovery of the findings."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  No\nmediastinal, hilar or axillary lymphadenopathy is present.  No pericardial\npleural effusion is seen.  Port-A-Cath catheter tip terminates in the right\natrium.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Left apical nodule,\nseries 6, image 53 is 4 mm, stable.  No new nodules masses are consolidations\nseen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of metastatic disease.\n\nFall assessment of the sub- diaphragmatic findings, please refer to CT abdomen\nand pelvis performed on the same day and the corresponding report."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  A 2 mm perifissural nodule along the minor fissure (series 6,\nimage 152) is unchanged.  Lungs are otherwise unremarkable.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please see CT abdomen and pelvis from the same date.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: A Port-A-Cath terminates in the right atrium.",
            "output": "1. Indeterminate 2 mm pulmonary nodule unchanged over 6 months.  No additional\nevidence of metastatic disease within the chest.\n2. A Port-A-Cath terminates in the right atrium."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  An accessed\nright pectoral Port-A-Cath catheter tip terminates in the right atrium.\n\nPULMONARY PARENCHYMA:  There are 3 small pulmonary nodules.  A 2 mm pulmonary\nnodule within the minor fissure with a is stable from ___\n(3:126).  A 6 x 6 mm right upper lobe pulmonary nodule near the right hilum is\nmore conspicuous on the present study, previously measuring 4 x 5 mm (3:91). \nA 4 x 4 mm left lower lobe pulmonary nodule in the superior segment adjacent\nto the major fissure is more conspicuous, previously measuring 2 mm (3:105). \nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Right upper lobe and left lower lobe pulmonary nodules measuring up to 6 mm\nand 4 mm, respectively, and larger since ___ are suspicious for\nmetastatic disease.\n2. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.\n\nNOTIFICATION:  The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 11:45 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable. No\npathologic enlargement of lymph nodes in the supraclavicular or axillary\nstations.\n\nCHEST CAGE: There is no evidence of osteo destructive lesions, lytic or\nsclerotic, at the level of ribs, sternum or vertebra.  Minimal degenerative\nchanges in the right shoulder.\n\nUPPER ABDOMEN: Persistence of small nodule in the lateral limb of the right\nadrenal, as discussed in reports of recent abdominal CT scans.  Remaining\nincluded upper abdominal organs unremarkable.\n\nMEDIASTINUM: No pathologic enlargement of lymph nodes in the mediastinum or\nhila.  Posterior mediastinum is unremarkable.\n\nHEART and PERICARDIUM: Heart is normal in size.  Right pectoral Port-A-Cath\nterminates in the right atrium.  Pericardium is physiologic.  Main pulmonary\nartery and thoracic aorta are normal in caliber.\n\nPLEURA: Minimal biapical pleuroparenchymal scarring is stable.  There are no\npleural effusions.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.\n0.7 cm right upper lobe nodule (4:95), was 0.6 cm on ___, 0.5 on\n___.\n0.5 cm left lower lobe superior segment perifissural nodule was 0.4 in prior,\n0.2 cm on ___ (4:107).\nNo new lung nodules.",
            "output": "Minimal progressive enlargement of pre-existing two lung nodules. No new lung\nnodules or other new foci of disease in the thorax."
        },
        {
            "input": "Right upper lobe pulmonary nodule has minimally decreased from 7-6 mm, series\n4, image 95.  Left lower lobe is unchanged, 5 mm, series 3, image 110\n\nAorta and pulmonary arteries are within normal limits.  No mediastinal, hilar\nor axillary lymphadenopathy is present.  Central venous line tip is in the\nright atrium.  Heart size is normal.  There is no pericardial pleural\neffusion.\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nOld left rib fractures are stable.",
            "output": "Minimal interval change in the pre-existing 2 pulmonary nodules as described. \nNo other evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nThere is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMRI of the abdomen and pelvis in corresponding report will be issued.\n\nNo pathologically enlarged mediastinal, hilar or axillary lymph nodes present.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nnodule has minimally increased in size from 4 x 6 mm to 8 x 8 mm, series 5,\nimage 107 with spiculated and lobulated appearance.\n\nLeft lower lobe 4.5 mm nodule is stable, series 5, image 231.\n\nNo discrete lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Old rib fracture on the left, series 3, image 32, 37 are\nlacking pathological fracture appearance.",
            "output": "Slight interval increase in size in the right upper lobe nodule, concerning\nfor metastatic deposit.\n\nStable left lower lobe nodule\n\nShort-term 3 months followup is recommended.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nRight-sided Port-A-Cath terminates in the right atrium.  No pathologically\nenlarged or growing supraclavicular or axillary lymph nodes\n\nUPPER ABDOMEN: Please to same-day CT abdomen and pelvis for detailed report of\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Interval increase of the prevascular lymph node currently\nmeasures 7 mm on short axis, (series 2, image 19) and previously measured 4 mm\non short axis most recent prior CT chest.  However the pre-vascular lymph\nnodes not meet CT criteria for lymphadenopathy.\n\nHILA: On noncontrast CT, the hilar contours do not suggest hilar\nlymphadenopathy.  The right hilum has expected appearance following right\nupper lobe segmentectomy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion.  No\nevidence of calcified atherosclerotic disease of the coronary arteries.  No\nevidence of valvular calcifications.\nPLEURA: No pleural effusion or pleural mass.  Mild biapical pleuroparenchymal\nfibrosis.\nLUNG:\n\n1. PARENCHYMA:  A 5 mm solid perifissural pulmonary nodule in the left lower\nlobe, (series 302, image 105), unchanged when compared to ___.\n2 mm solid perifissural right middle lobe, (series 2, image 123), new compared\nto ___.\n2. AIRWAYS:  Airways are patent the subsegmental level.  No evidence of\nbronchial wall thickening.\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesions are demonstrated.",
            "output": "1. Patient is status post upper lobe segmentectomy for removal of pulmonary\nmetastasis with expected postsurgical changes.  No evidence of local\nrecurrence.\n2. Stable perifissural left lower lobe pulmonary nodule since ___.  New 2 mm visual right middle lobe pulmonary nodule.  The bilateral\nperipheral pulmonary nodules are less likely to represent intrathoracic\nmetastatic disease given the location and morphology.\n3. Please refer to same-day CT abdomen and pelvis for detailed report of\nsubdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary or supraclavicular lymph nodes\ndemonstrated.  Central venous line tip terminates in the right atrium.  There\nis no pericardial pleural effusion.\n\nImage portion of the upper abdomen demonstrate previous right most likely\nadrenalectomy and otherwise is unremarkable within the limitations of this\nstudy technique.  Atrophic pancreas is also noted.\n\nAirways are patent to the subsegmental level bilaterally.  Postsurgical\nchanges in the right upper lobe are stable.  Dominant left lower lobe\nsubpleural 7 mm nodule has minimally increased in size compared to 5 mm\npreviously, series 5, image 143 although it might represent slice selection by\nus.  Additional pulmonary nodules are sub 3 mm and stable, series 5, image 91,\n127 with no new nodules masses or consolidations..\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Questionable minimal increase in the left lower lobe nodule.  Reassessment in\n3 months is required."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings.  Supraclavicular and axillary lymph\nnodes are not enlarged.  F no soft tissue abnormalities in the chest wall. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent head neck vessels.  Catheter from right pectoral infusion port ends\nin the mid right atrium.  Any associated thrombus would not be evident on this\nnoncontrast study.\n\nNo coronary calcification or aortic valvular calcification.  Aorta and\npulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic.\nTHORACIC LYMPH NODES:\nNo lymph nodes in the chest are pathologically enlarged or growing including\ndiaphragmatic, retrocrural and posterior mediastinal stations.\n\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\nPerifissural micro nodulations, right major fissure, 302:70, 117, 142\nunchanged since ___..\n\nNodule resection sites, right upper and left lower lobes, normal postoperative\nappearance.\n\nNo pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Normal postoperative appearance following resection of nodules, right upper\nand left lower lobes.  Stable micro nodular fissural pleural nodules.  No good\nevidence for intrathoracic malignancy."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is a\nsmall hiatus hernia.  There is no pericardial effusion.  The aorta and\npulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.  There is no pericardial effusion\n\nLUNG: Is evidence of a resection of the right upper lobe with stable\npostsurgical changes surrounding the surgical sutures.  There is also evidence\nof prior wedge resection in the left lower lobe with stable postsurgical\nchanges.  No evidence of local recurrence.  A 1 mm perifissural nodule in the\nlingula (302, 135) Is unchanged.  No new or growing pulmonary nodules.\n\nBONES AND CHEST WALL : Revealed bones shows degenerative changes involving the\nthoracic spine.  No lytic or sclerotic lesions concerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows patient status\npost right nephrectomy.  No renal masses are seen.  No focal liver lesions\nseen.",
            "output": "Stable postsurgical changes following wedge resection in the right upper lobe\nand left lower lobe.  No evidence of local recurrence.  Stable 1 mm nodule\nalong the right major fissure.  No new pulmonary nodules.\n\nPlease refer to dedicated report MRI of the abdomen which is being done\nseparately for further details."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nStudy is limited by respiratory/motion artifact, however the pulmonary\narteries remain well opacified to the subsegmental level, with no evidence of\nfilling defect within the main, right, left, lobar, segmental or subsegmental\npulmonary arteries.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  A nasogastric tube is seen coursing\nwithin the esophagus, with tip at the level of the gastric antrum.\n\nA right-sided PICC line is seen with tip at the distal SVC.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is diffuse centrilobular emphysema.  A 4 mm nodule is seen at the right\nmiddle lobe (series 2, image 56).  Based on the underlying emphysema, ___ year\nfollow-up is recommended for reassessment. There is mild bibasilar atelectatic\nchange. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate moderate amount of ascites in\nthe.  In addition, there is a partially visualized prominent CBD which does\nnot appear changed when compared to most recent priors, however it is\nincompletely evaluated on the current evaluation.  There is mild stranding at\nthe level of the omentum, although this can be seen in patients with ascites. \nRemains incompletely characterized on this study.  There is a replaced left\nhepatic artery arising from the left gastric artery.  There are metallic clips\nnoted in and around the diaphragmatic hiatus, please correlate with surgical\nhistory.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate amount of ascites.\n3. Incompletely evaluated prominent CBD measuring up to 1.7 cm, unchanged when\ncompared to recent priors but incompletely evaluated current study.  Please\nrefer to prior MRCP for better characterization of the spine.\n4. 4 mm right middle lobe nodule as detailed above, for ___ year follow-up chest\nCT.\n\nRECOMMENDATION(S):  Follow-up CT chest in ___ years time as above."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heavy Coronary\ncalcifications are demonstrated.  No substantial aortic calcifications are\nseen within the thoracic aorta.  Heart size is normal.  No pericardial\neffusion is seen.  Bilateral pleural effusion is demonstrated, right more than\nleft, moderate on the right and small to moderate on the left.\n\nAssessment of the left ventricle demonstrate increased density of the\nmyocardium, concerning for anemia.  Mitral annulus calcification is extensive\n\nMultiple mediastinal lymph nodes are present, borderline ranging up to 15 mm\nalthough containing fatty hilus.\n\nNo axillary or hilar lymphadenopathy is present.  Image portion of the upper\nabdomen reveals extensive vascular calcifications and otherwise unremarkable. \nCoarse calcifications within the kidneys most likely represent vascular\ncalcifications and less likely to represent kidney stones.\n\nAirways are patent to the subsegmental level bilaterally.  Bronchial wall\nthickening is diffuse and might reflect interstitial edema.  Diffuse septal\nthickening is small spur, and represent interstitial edema, as reflected on\nboth recent chest radiographs.  In addition to septal thickening there are\nminimal areas of ground-glass opacities.  Bibasal more consolidative areas are\nmost likely representing areas of atelectasis.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Evidence of interstitial edema, mild.\n\nBilateral pleural effusions.\n\nLeft upper lobe nodule, series 4, image 38, 3 mm in diameter.\n\nBorderline mediastinal lymph nodes that potentially can be reactive to\npulmonary edema\n\nSuspected anemia.  Extensive Coronary calcifications."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the anterior mediastinum\nor the paratracheal groups.  Calcified right hilar lymph node (3, 26).  Mild\naortic wall calcifications.  No substantial coronary calcifications, mild\naortic valve calcifications.  The posterior mediastinum is unremarkable, with\nthe exception of a small hiatal hernia.  The patient shows calcified\nright-sided pleural plaques (3, 35).  No osteolytic lesions at the level of\nthe ribs, the sternum, or the vertebral bodies.  Wedge like deformity of a\nmiddle thoracic vertebral body (602, 73).  Mild bilateral apical scarring.  8\nmm irregular right lower lobe nodule (302, 122).  Mild posterior right lower\nlobe scarring adjacent to the calcified plaque (302, 140).  Non characteristic\nscars at the bases of the right lower lobe and the middle lobe (302, 158). \nSmall right Bochdalek hernia.  4 mm calcified right lower lobe granuloma (302,\n143).",
            "output": "In the right lower lobe, there is a small calcified granuloma, a calcified\npleural plaque with adjacent parenchymal scarring, as well as an ill-defined 8\nmm spiculated nodule with suspicious morphology.  If possible, the nodule\nshould be further evaluated by PET-CT and/or tissue analysis.\nNon characteristic scarring.  No lymphadenopathy.  No pleural effusions."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse mosaic attenuation likely secondary to expiratory phase\nacquisition.  Otherwise, lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CT CHEST WITHOUT CONTRAST: The image portion of the thyroid is unremarkable.\n\nHeart size is top normal without significant pericardial effusion. Note is\nmade of prominent mitral annular calcifications as well as moderate\ncalcifications of the left main, LAD and left circumflex coronary arteries.\nThe thoracic aorta is normal in caliber with moderate wall calcification. \nNote is made of a standard a 3 vessel arch.  There is no supraclavicular,\naxillary, hilar or mediastinal lymphadenopathy by CT size criterion.  The main\npulmonary artery is ectatic, measuring 3.7 cm in maximum diameter.\n\nThough this study is not tailored for subdiaphragmatic diagnosis, note is made\nof a simple density cystic lesion in the superior aspect of the spleen\nmeasuring 1.1 cm. Additionally, there are innumerable cystic appearing\nbilateral renal lesions in the visualized portion of the kidneys, some simple\ndensity and some intermediate in density all likely representing simple and\nhemorrhagic or proteinaceous cysts. The largest of these is exophytic\nmeasuring approximately 4 cm in the left interpolar kidney.  The underlying\nrenal parenchyma is severely atrophied bilaterally.\n\nThe airways are patent to the subsegmental level. Scattered areas of\nmillimetric ___ nodules are seen in the right upper, middle and lower\nlobes as well as the anterior segment of the left upper lobe.  Lungs are\notherwise clear without dominant nodule.  Pleural surfaces are clear without\neffusion or pneumothorax.\n\nOSSEOUS STRUCTURES: There is no suspicious focal osseous lesion.\n\nPULMONARY VEIN ANATOMY:  There are 5 pulmonary veins entering the left atrial\nhilum: 3 right pulmonary veins and 2 left pulmonary veins.\n\nThere is no evidence for pulmonary vein stenosis.\n\nBidirectional measurements of the pulmonary veins are as follows:\nRight superior: 18.5x17.9 mm\nRight inferior: 21.5x16.6 mm\nLeft superior: 19.8x15.4 mm\nLeft inferior: 21.0x16.8 mm\nThere is a single accessory right middle pulmonary vein measuring 16.1 x 8.8\nmm in diameter.\n\nRight superior saddle: 2.8mm\nRight inferior saddle: 1.6 mm\nLeft saddle: 5.8mm\n\nLEFT ATRIUM:  The left atrium ismoderately enlarged and is normally opacified.\nThe left atrial appendage is normally opacified. The calculated volume is\n209.5cc with the left atrial appendage and 193.8cc without.\n\nSVC anomalies are absent. IVC anomalies are absent.",
            "output": "1. Variant pulmonary venous anatomy with a single accessory right middle\npulmonary vein.\n2. No evidence for pulmonary vein stenosis.\n3. No left atrial or appendageal thrombus\n4. Ectatic main pulmonary artery which may suggest chronic pulmonary\nhypertension.\n5. Scattered bilateral areas of millimetric ___ nodularity which is\nnon-specific and could be representative of inflammatory small airways\ndisease.  Though the distribution is not characteristic for granulomatosis\nwith polyangiitis, given the history this remains a differential possibility. \nIf the patient is symptomatic, dedicated HRCT with expiratory phase would be\nreasonable for further characterization.\n6. Prominently atrophied bilateral kidneys with innumerable simple and\nhemorrhagic and/or proteinaceous cysts.\n7. Well-circumscribed splenic cystic lesion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable. The soft tissues of the chest wall are unremarkable, excluding\nthe breasts, which require separate dedicated imaging detailed evaluation.\n\nUPPER ABDOMEN: A 5 mm hypodensity in the right lobe of the liver (3:63) is too\nsmall to characterize, but unchanged going back to at least ___, and\nlikely represents a cyst or biliary hamartoma.  The superior aspect of a\npartially imaged IVC filter is noted.  The imaged portion of the upper abdomen\nis otherwise unremarkable.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. There are no significant coronary\nartery or valvular calcifications.  The thoracic aorta is normal in caliber.\nSmall pericardial fluid is likely physiologic.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: A pyramidal, peripheral 3.4 x 2.2 x 2.5 cm (tv x ap x cc) left\nbasilar lung lesion, new since the abdomen CT in ___, probably\noriginating in the anteromedial segment of the lower lobe is inseparable from\nthe adjacent diaphragmatic and mediastinal pleura.  A few small lung nodules\nmeasuring up to 4 mm are unchanged since ___ (5: 64, 136, 192) and can be\nconsidered benign.  Bibasilar linear atelectasis/scarring is unchanged.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild endobronchial impaction are noted in small airways, for\nexample in the middle lobe (5:185).\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. A new, peripheral 3.0cm  left basal lung lesion, either a very aggressive\nmalignancy or unusual infection.\n2. A few solid lung nodules measuring up to 4 mm are unchanged from ___ can\nbe considered benign.\n\nRECOMMENDATION(S):  Consult interventional pulmonology or thoracic surgery for\nsampling of new left lung lesion.\nConcerning FDG PET scanning before an invasive procedure, consider whether the\nabsence of FDG avidity on PET imaging or, alternatively, detection of FDG avid\ncentral lymph nodes would influence the decision about tissue sampling."
        },
        {
            "input": "The thyroid is unremarkable.  There are no enlarged supraclavicular,\nmediastinal hilar lymph nodes.  Heart size is normal.  There is no pericardial\neffusion.  There is no pleural effusion.  The airways are patent up to the sub\nsegmental level.  The aorta and pulmonary arteries are normal in size\n\nThe left lower lobe masslike consolidation abutting the left ventricle has\ndecreased in size since the prior study and now measures 2.2 x 1.3 cm as\ncompared to the prior measurements of 3.8 x 2.3 cm this could represent a\nresolving inflammatory process however follow-up to complete resolution in ___\nweeks is recommended.\n\nNo new consolidations.  A subpleural ground-glass opacity in the right lower\nlobe (image 37 series 4) is unchanged.  Tiny left upper lobe pulmonary nodules\n(image 53 series 5 are unchanged in size.  2 mm nodule along the fissure on\nthe right (127, 5) is also unchanged.  No new nodules\n\nThere is minimal bibasilar atelectasis.  No new pulmonary nodules.\n\nRight-sided Port-A-Cath with its tip in the SVC.",
            "output": "Significant decrease in size of the masslike consolidation in the left lower\nlobe.  There is a could represent a resolving inflammatory process. Follow-up\nto complete resolution in ___ weeks is recommended.\n\nStable tiny pulmonary nodules.  No new pulmonary nodules.  These nodules are\nunchanged in size since ___.\n\nFocal ground-glass opacity in the right lower lobe is also unchanged.\n\nRECOMMENDATION(S):  Follow-up to complete resolution in ___ weeks is\nrecommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland appears homogeneous.\n\nUPPER ABDOMEN: A 5 mm hypodensity in the right lobe of the liver is due to\nsmall to characterize, but likely represents hepatic cyst or biliary\nhamartoma.\n\nMEDIASTINUM: No evidence of mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The cardiac size is normal in caliber.  There is no\npericardial effusion\nPLEURA: No evidence of pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is unchanged appearance of a 4 mm sub solid nodule in\nthe right lower lobe (4:158).  A 3 mm nodule is stable in the left lower lobe\n(4:104).  A couple of 2 mm millimetric pulmonary nodules are also unchanged,\nfor example, in the left upper lobe (04:49) and along the right major fissure\n(4:71).  The previously described left basilar mass appears is decreased in\nsize, measuring 2.3 x 1.2 x 3.0 cm (TV x AP x CC) as compared to the prior\nstudy in ___ and vastly decreased in size since ___,\npossibly representing either malignancy or impacted bronchus with distal\nobstructed consolidation.  Linear atelectasis is also seen in the left lower\nlung.\n2. AIRWAYS:  The airways appear patent to the subsegmental level.  There are\nmild bronchial secretions with mild associated bronchial wall thickening,\nparticularly in the right upper lobe, compatible with mild bronchitis. \nIncidental note is made of a couple tiny right sided tracheal diverticula.\n3. VESSELS: There is no evidence of enlargement of the thoracic aorta.  The\nmain pulmonary artery appears normal in caliber.  There is no central\npulmonary embolus.\nCHEST CAGE: No evidence of concerning sclerotic or lytic osseous lesion.",
            "output": "1. Interval decrease in size of the left basilar mass, now measuring 2.3 x 1.2\nx 3.0 cm, since ___, possibly representing either malignancy or\nimpacted bronchus with distal obstructive consolidation.  If there is clinical\nconcern for malignancy, a dedicated PET CT could be obtained for further\nevaluation.\n2. Known pulmonary nodules are unchanged since the prior exam.  No new\npulmonary nodules are identified.\n3. Bronchial secretions with mild bronchial wall thickening, particularly in\nthe right upper lobe, are compatible with mild bronchitis.\n\nRECOMMENDATION(S):   If there is clinical concern for malignancy, a dedicated\nPET CT could be obtained for further evaluation.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:30 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Right central venous access line.  Mild aortic wall\ncalcifications, no enlarged hilar or mediastinal lymph nodes.  No substantial\ncoronary or valvular calcifications.  No pericardial effusion.  The posterior\nmediastinum is unremarkable.  Decreased attenuation of the liver parenchyma. \nNo osteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable bilateral apical scarring.  Stable pleural micronodule at the\nbases of the right upper lobe (4, 129).  A pre-existing ground-glass nodule in\nthe right lower lobe (4, 184) is stable.  Also stable is a 3 mm nodule in the\nleft lower lobe (4, 124).  The left basal parenchymal consolidation is\nminimally decreased in size (4, 219).  No diffuse lung disease.  Small\ntracheal diverticular continue to be visualized.",
            "output": "Minimal decrease in size of a pre-existing left basal consolidation.  Small\npre-existing bilateral lung nodules are also stable.  No new or growing\nnodules.  No lymphadenopathy."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Endobronchial opacification is noted most pronounced in the\nright lower lobe but also seen in the right middle lobe, right upper lobe, and\nleft lower lobe.  Findings are concerning for aspiration sequelae.  Developing\npneumonia is noted in the right lower lobe.  Aerosolized material is also\nnoted in the mid to lower trachea.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Sequelae of aspiration most pronounced in the right lower lobe with associated\nright lower lobe aspiration pneumonia.  No pulmonary embolism or acute aortic\nprocess."
        },
        {
            "input": "BASE OF NECK: The visualized base of the neck is unremarkable.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged .\n\nCARDIO-MEDIASTINUM: The thoracic aortic is normal in caliber. The pulmonary\narteries are normal caliber.  The heart is not enlarged. There is no\npericardial effusion.  There is extensive coronary artery and aortic valve\ncalcification.\n\nLUNGS/AIRWAY: The airways are patent to the segmental level.  Motion artifact\nlimits evaluation of the parenchyma.  Bilateral lower lobe opacities are\nlikely consistent with atelectasis.  Multifocal ground-glass opacities, most\nnotably in the right upper and middle lobes, are decreased when compared to\nthe prior study.  Additional opacities in the left lung are not well\nvisualized due to motion but appear overall unchanged to mildly improved.\n\nPLEURA: Moderate left greater than right pleural effusions are unchanged.\n\nCHEST CAGE: There is left-side predominant soft tissue subcutaneous edema,\nsimilar to prior.  No worrisome lytic or sclerotic lesion is identified.\nModerate degenerative changes are noted.\n\nUPPER ABDOMEN: Please refer to separate report on same-day CT abdomen/pelvis\nfor description of the abdominal findings.",
            "output": "1. Multifocal ground-glass opacities, improved on the right and unchanged on\nthe left.  Persistent moderate bilateral pleural effusions.  The differential\nincludes infection, drug-related pneumonitis, or GVHD inflammatory response.\n2. Extensive coronary artery and aortic valve calcifications."
        },
        {
            "input": "Secondary to the patient's arms being by his side.  FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  A\nright internal jugular central venous catheter extends to the cavoatrial\njunction.  Artifact throughout the scan is secondary to the patient's arms\nbeing by his side.  There is no supraclavicular or axillary lymphadenopathy. \nAnasarca is noted.\n\nUPPER ABDOMEN: There is upper abdominal ascites.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: No hilar adenopathy given the limitations of noncontrast technique.\n\nHEART and PERICARDIUM: The heart is mildly enlarged and there is trace\npericardial fluid.  Dense calcification of the coronary arteries and aortic\nvalve are noted.\nPLEURA: There is a large left and moderate right pleural effusion with\nsubjacent atelectasis.\nLUNG:\n\n-PARENCHYMA:  The nearly the entirety of the left lung is atelectatic. \nBreathing motion obscures evaluation of the right lung parenchyma. \nAtelectasis at the right lung base is noted.\n-AIRWAYS:  There is occlusion/debris within the left mainstem bronchus just\ndistal to the carina.  The right main stem bronchus and right distal branches\nare grossly patent.\n-VESSELS:  The thoracic aorta is nonaneurysmal.\n\nCHEST CAGE: No suspicious osseous lesions.  No acute fracture.",
            "output": "Mucous plugging in the left mainstem bronchus.  Large left pleural effusion\nand atelectatic left lung.\n\nModerate right pleural effusion with subjacent atelectasis."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.\n\nCoronary calcifications are extensive. Pericardial effusion is small with no\nCT evidence of tamponade.\n\nAortic valve calcifications are moderate to severe.  Left pleural effusion is\nsmall.\n\nAirways are patent to the subsegmental level bilaterally.  Upper lobe\nperibronchial opacities are extensive, ground-glass predominantly with some\nelements of solid component, series 5, images 75-109.  No involvement of the\nlower lobes present.  No discrete nodules demonstrated except for left lower\nlobe solid nodule, 5 mm in diameter, series 5, image 221\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Bilateral upper lobe ground-glass/solid opacities.  Findings are nonspecific\nand might represent a typical infection (including fungal infection) as well\nas breast 6 is City, or less likely organizing pneumonia.  The findings were\nnot present clearly on the radiograph from ___.\n\nSolid nodule in the left lower lobe might represent similar or different\netiology in should be reassessed in 3 months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.  Right anterior port with tip in\nthe lower SVC.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  Mild pericardial effusion, slightly\nlarger compared to prior.  No evidence of cardiac tamponade.  Moderate\natherosclerotic calcifications of the coronary arteries, mild in the aorta and\nin the aortic valve.  The pulmonary arteries and aorta are normal caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucous plug.  The previously described\nground-glass opacities in both upper lobes have slightly improved compared to\nprior, now with no less consolidative component.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show moderate atherosclerosis in the\nabdominal arteries.",
            "output": "Slight interval improvement in the ground glass opacities in both upper lobes\nsuggestive of improving infectious process.\nSmall pericardial effusion, slightly larger than in prior study.\nModerate coronary atherosclerotic disease.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 17:07 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Right-sided PICC line terminates at the cavoatrial junction.\n\nHeart is normal in size.  Aortic valve is again heavily calcified.  Coronary\ncalcification is moderate in severity.\n\nAorta is normal in caliber. Great vessels and central pulmonary arteries are\nalso unremarkable.\n\nSmall pericardial effusion is mildly increased with faint early rim along the\nanterior inferior margin but mostly without evidence for any organization. \nThere is a very small right-sided pleural effusion.  Left-sided pleural\neffusion is small to medium in size.  No lymphadenopathy.\n\nPosterior left basilar lower lobe opacification with volume loss is favored to\nrepresent atelectasis rather than infection.  Minimal right posterior\ndependent change.  Lungs are otherwise essentially clear.\n\nPartly imaged moderate ascites is new since the prior CT.  Limited views of\nthe upper abdomen are otherwise unremarkable.\n\nThere are no suspicious bone lesions.",
            "output": "Small, mildly increased, pericardial effusion with very early organization. \nNew pleural effusions since the prior CT, left greater than right, with left\nlower lung opacity which is very likely due to atelectasis.  New ascites."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is only partially\nseen.  Right sided PICC terminates in the superior cavoatrial junction.  There\nis no supraclavicular or axillary lymphadenopathy.  Improved anasarca.\n\nUPPER ABDOMEN: Small amount of ascites is improved from prior.  Extensive\nvascular calcifications are noted in the abdomen.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: Within the limitations of a nonenhanced CT, the hilar contours are\nnormal.\n\nHEART and PERICARDIUM: Heart is normal in size with extensive coronary\ncalcifications and aortic valve replacement.  Moderate amount of pericardial\neffusion is unchanged from prior measures simple fluid in density.\nPLEURA: Increased small right pleural effusion, unchanged left small pleural\neffusion, both measure simple in density.\nLUNG:\n\n1. PARENCHYMA:  Small bibasilar consolidations, greater on the left.  There\nare no pulmonary nodules.\n2. AIRWAYS:  Airways are patent to subsegmental level without bronchial wall\nthickening, bronchiectasis or mucus plugging.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are normal in caliber\nand configuration.\nCHEST CAGE: Degenerative changes no suspicious lesions in the osseous\nstructures of the chest.  Thoracic spondylosis is similar to prior.",
            "output": "1. Interval increase of the small right pleural effusion and similar left\npleural effusion.\n2. Bibasilar consolidations are likely atelectasis rather than pneumonia.\n3. Stable moderate pericardial effusion.\n4. Interval improvement of the ascites and anasarca."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged lower thyroid need any further\nimaging evaluation.  Supraclavicular and axillary lymph nodes are not\nenlarged.  No mass or fluid collection in the soft tissues of the chest wall. \nModerate edema in the left lower anterior chest wall is slightly improved.\n\nCARDIO-MEDIASTINUM: Esophagus is generally mildly distended with air.  There\nis no fluid retention or associated mass to suggest obstruction.  Esophageal\nwall is not appreciably thickened and there is no associated mass.\n\nAtherosclerotic calcification is not apparent in head and neck vessels, but is\npresent in left anterior descending, circumflex and right coronary arteries. \nHeavy aortic valvular calcification is sufficient to cause stenosis.  Small to\nmoderate nonhemorrhagic pericardial effusion is stable.  No pericardial\ncalcification, infiltration of mediastinal fat or evidence of tamponade\nphysiology.\n\nTHORACIC LYMPH NODES: No lymph nodes in the mediastinum no measurable lymph\nnodes in the mediastinum are pathologically enlarged or growing.  Hilar\ncontours do not suggest adenopathy.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nLayering nonhemorrhagic pleural effusions, small on the right stable, small to\nmoderate on the left increased.\n\nRelaxation atelectasis right lower lobe confined to the superior segment,\nspares only the superior segment in the more severely atelectatic left lower\nlobe, worsened since ___.\n\nNo consolidation or lung nodules.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy or infection.  Relaxation atelectasis,\nmild right lower lobe unchanged, severe left lower lobe increased.\n\nStable small right pleural effusion, stable moderate pericardial effusion,\nincreased small to moderate left pleural effusion and persistent left chest\nwall edema suggest volume overload or cause of fluid third-spacing.\n\nSevere aortic valvular calcification, suspect stenosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially imaged thyroid is\nunremarkable.  No axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separately dictated CT abdomen and pelvis from\nthe same day.\n\nMEDIASTINUM: Right internal jugular central venous catheter, with tip\nterminating at the mid to distal SVC.  No mediastinal lymphadenopathy. \nAtherosclerotic calcifications of the coronary arteries.  Annular\ncalcifications of aortic and mitral valves.  Trace pericardial effusion. \nNormal caliber thoracic aorta.\n\nHILA: No hilar lymphadenopathy\n\nPLEURA: Persistent small right and moderate left pleural effusions.  No\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Motion artifact limiting evaluation.  Left lower lobe\nconsolidation.  Right basilar compressive atelectasis and consolidation.  In\naddition, there are multifocal small consolidative opacities, for example in\nthe anterior right upper lobe (image 96, series 5), and lateral right upper\nlobe (image 64, series 5)\n2. AIRWAYS:  Trachea and mainstem bronchi are patent.\nBONES: Multilevel degenerative changes of the thoracolumbar spine.  No\ndestructive osseous lesions.",
            "output": "1. Bilateral lower lobe consolidations, in addition to small multifocal\nconsolidative opacities, concerning for an infectious process.\n2. Persistent moderate left and small right pleural effusions."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan.  There is extensive coronary artery calcification.  Mild pericardial\neffusion is seen.  There is a left internal jugular central venous catheter\nterminating in the upper superior vena cava.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Moderate bilateral pleural effusions are present, increased\nsince the prior study.  No pneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacities in the right upper lobe persist, however\nheavy less consolidated appearance compared to the prior study (5:121, 5:91). \nGround-glass opacities are also seen in the left upper lobe (5:76, 5:93,\n5:108), difficult to compare to the prior study due to motion.  An\napproximately 5.7 x 2.4 cm ground-glass opacity in the right middle lobe\n(5:143) appears new since the prior study.  There is mild-to-moderate\ncompressive atelectasis of the right lower lobe, similar to the prior study. \nThere is near complete collapse of the left lower lobe, new since the prior\nstudy.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Calcified granulomas are noted in the right lower lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen demonstrates mild\nto moderate perihepatic and perisplenic ascites.  There is extensive\ncalcification of the splenic artery.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multifocal ground-glass opacities in bilateral lungs, some of which are new\nsince the prior study, concerning for multifocal pneumonia.\n2. Mild to moderate right lower lobe atelectasis and near complete left lower\nlobe collapse, significantly increased since the prior study.\n3. Moderate bilateral pleural effusions, increased since the prior study.\n4. Partially imaged name abdomen demonstrates moderate perihepatic and\nperisplenic ascites better evaluated on CT abdomen and pelvis from ___.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:00 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  There is evidence of anemia. \nCoronary calcifications are moderate.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nImage portion of the upper abdomen reveals prior cholecystectomy and otherwise\nis unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal minimal\ncylindrical bronchiectasis are present.  Centrilobular emphysema is mild to\nmoderate.  Diffuse bronchial wall thickening might potentially represent\nchronic bronchitis.  There is no evidence of infectious process or\ninterstitial lung disease.  No pulmonary nodules demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm noted.",
            "output": "Emphysema, chronic bronchitis and coronary calcifications.\n\nMinimal bronchiectasis."
        },
        {
            "input": "The thyroid gland is unremarkable. A few nonspecific mildly prominent\nmediastinal lymph nodes are present, none of which are pathologically\nenlarged. There are no pathologically enlarged supraclavicular, hilar or\naxillary lymph nodes.\n\nThere is moderate cardiomegaly with multichamber enlargement. Dense coronary\nartery and extensive aortic valve calcifications are noted. Despite the\nextensive aortic valve calcification, there is no dilatation of the moderately\ncalcified thoracic aorta. However, the right pulmonary artery is markedly\nenlarged measuring 4.5 cm in greatest transverse dimension. The main and left\npulmonary arteries are dilated to a lesser extent measuring 3.3 and 2.8 cm\nrespectively. There is a small intact fusiform aneurysm of the descending\naorta at the level of the GE junction which measures up to 3.7 cm in greatest\ntransverse dimension.\n\nModerate centrilobular emphysema and mild diffuse bronchial wall thickening,\nmost pronounced in the right lower lobe, is in keeping with the known history\nof COPD. There are several punctate solid pulmonary nodules, many of which are\ncalcified and do not require followup (5: 102, 106, 126 and 165). The\nremaining noncalcified nodules measure up to 2 mm (5: 104, 162, 166, and 209).\nMild diffuse interlobular septal thickening, most notably in the bilateral\nupper lobes, is likely due to pulmonary edema. There is right posterior\npleural thickening with trace pleural fluid. In the presence of mild right\nlower lobe volume loss, atelectasis and swirling of the bronchovascular\nstructures, these findings may be a precursor to rounded atelectasis. There is\nalso mild traction bronchiectasis.\n\nImages of the upper abdomen demonstrate two small right renal upper pole\ncysts, one of which is simple, but the other is hyperdense measuring 13 mm.\nThe spleen is extensively scarred and contains a coarse calcification. There\nis also a more rounded 9 mm calcification at the inferior aspect of the\nspleen, which may represent a calcified splenic artery aneurysm.\n\nCongenital fusion of the right fifth and sixth anterior ribs is incidentally\nnoted. No destructive osseous lesions are identified.",
            "output": "Moderate cardiomegaly with mild pulmonary edema.\n\nExtensive calcification of the aortic valve suggests aortic stenosis.\n\nPulmonary hypertension.\n\nModerate atherosclerosis with an intact 3.7 cm descending aortic aneurysm.\n\nModerate centrilobular emphysema with chronic airways disease, which are in\nkeeping with the known history of COPD.\n\nSeveral small noncalcified pulmonary nodules measuring up to 2 mm, which in\nthe absence of risk factors for malignancy, do not require further followup.\n\nSplenic scarring of unknown etiology with suspected 9 mm calcified splenic\nartery aneurysm."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the proximal\nsegmental level without convincing evidence of filling defect to indicate a\npulmonary embolus, allowing for extensive streak artifact.  Apparent filling\ndefects in the right upper lobe extend across the vessel multiple levels and\nis favored to be artifactual.  The heart appears normal.  No flattening of the\ninterventricular septum.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Soft tissue in the anterior mediastinum likely\nreflects residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  A 2 mm right lower lobe calcified granuloma is noted.\n\nBASE OF NECK:\nThe thyroid appears enlarged and slightly nodular in contour, possibly\nreflecting a goiter. This may be correlated with thyroid function testing and\nnonemergent thyroid ultrasound.\nOtherwise, visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY:The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Limited evaluation for pulmonary embolism given timing of the contrast\nbolus and extensive streak artifact, however no pulmonary embolus detected"
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  No\nappreciable coronary calcification.  Mild mitral annulus calcification.  No\naortic valve calcification.  The thoracic aorta is normal in caliber.  Aortic\narch calcification is minimal.  The main pulmonary artery is normal in\ncaliber.  No central pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  A nonenlarged, rounded 7 mm\nleft axillary lymph node is unchanged.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Images were probably obtained during expiration given a small\namount of physiologic airway collapse and mild parenchymal air-trapping. The\nairways are patent to the subsegmental level.  Mild diffuse bronchial wall\nthickening.  Mild apical scarring.  Fibrotic changes and traction\nbronchiectasis in the left upper lobe related to breath striation therapy is\nunchanged.  Right upper lobe subpleural fibrosis is unchanged.  Bilateral\nlower lobe subpleural fibrosis and traction bronchiectasis are minimally\nchanged.  No definite pulmonary nodules identified.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small hiatal hernia.  Mild, partially imaged intrahepatic biliary\nductal dilation and pancreatic ductal dilation is unchanged.  Please refer to\nseparate report for same-day CT abdomen/pelvis for description of the\nabdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild thoracic spine osteophytosis.  Please refer to the separate report for\nsame day bone scan for description of any additional skeletal findings.\n\nSOFT TISSUES: Calcifications in the anterior left chest wall musculature are\nnot appreciably changed (series 5, images 26 through 34).",
            "output": "1. No definite evidence of intrathoracic metastasis.\n2. Minimally changed subpleural fibrosis and traction bronchiectasis.  Mild\npersistent bronchial wall thickening suggests chronic inflammation.  Mild air\ntrapping.  No definite dominant nodule."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. Fusiform dilatation of the left main\npulmonary artery up to 2.4 cm is unchanged from prior an likely representative\nof pulmonary hypertension.  Otherwise the great vessels are normal in caliber.\nThe heart size is normal. No pericardial effusion.\n\nThe airways are patent to subsegmental levels. Concentric nodular left pleural\nthickening is similar to prior and in keeping with history of pleural\nmetastatic disease. Nodularity along the left major fissure is also similar to\nprior.  Adjacent geographically marginated opacities in the anterior\nparamediastinal region are stable and likely related to radiation fibrosis.\nDiffuse mosaic attenuation pattern of the lung parenchyma is reflective of\nair-trapping. Right upper lung peripheral scarring is stable. No new pulmonary\nnodule, focal consolidation, pleural effusion, or pneumothorax.\n\nPostlumpectomy changes of the left breast and subjacent soft tissue thickening\nand deformity of the anterior left chest wall are stable. The esophagus is\nunremarkable.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nFor the subdiaphragmatic findings, please refer to the separately issued\nabdominal CT report.",
            "output": "1. No evidence of lymphadenopathy or lung parenchymal metastasis.\n\n2. Stable left-sided nodular and concentric pleural thickening, consistent\nwith known history of pleural metastases."
        },
        {
            "input": "The thyroid gland is normal. There is no axillary or supraclavicular\nadenopathy. Central lymph nodes are not pathologically enlarged, the largest\nwithin the right paratracheal station measuring 7 mm in short axis (3:19). \nHeart is normal in size. The aorta and pulmonary artery are normal in caliber.\nTrace pericardial fluid is physiologic. There is no appreciable coronary\nartery calcifications. A small hiatal hernia is stable.\n\nThe tracheobronchial tree is patent to the subsegmental level. Diffuse mosaic\nattenuation is most commonly secondary to air trapping. Circumferential, \nnodular left pleural thickening is similar in appearance to prior study and in\nkeeping with history of pleural metastatic disease. Nodularity along the left\nmajor fissure (4:112) is stable. Additional para-mediastinal geographic\nopacities are similar in appearance and in keeping with radiation fibrosis. No\nnew pulmonary nodule is identified. Lungs are otherwise clear. There is no\npleural effusion.\n\nPostsurgical changes within the left breast and soft tissue thickening within\nthe anterior left chest wall are unchanged in appearance. There are no\nsuspicious lytic or blastic lesion is identified.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen pelvis\ndated same ___, ___, clip number ___.",
            "output": "1. No evidence of metastatic disease within the lung parenchyma.\n2. Stable  nodular, circumferential left pleural thickening in keeping with\nknown history of pleural metastasis. No pleural effusion.\n3. Stable left anterior chest thickening, unchanged in appearance.\n3. For complete subdiaphragmatic findings, please refer to CT abdomen pelvis\ndated same ___, ___, clip number ___."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  No\npericardial or pleural effusion is seen.  No mediastinal, hilar or axillary\nlymphadenopathy is present.  Left breast postsurgical appearance is similar to\nprevious examination.  Image portion of the upper abdomen will be reviewed\nseparately is part of the CT abdomen corresponding report will be issued\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Subpleural\ninterstitial changes and mosaic attenuation are similar to previous\nexamination.  New right upper lobe ill-defined opacities are present, series\n6, image 89.  Anterior pleural thickening in the left upper lobe is similar to\nprevious examination.  Pleural thickening along the left major fissure, series\n6, image 145 is similar.  Substantial motion artifact in the lower lobes are\nnoted in prevented from pre size relation but mosaic attenuation seems to be\npresent.  Questionable new nodule in the left lower lobe, series 6, image 186\nis demonstrated versus small area of atelectasis.  Fibrosis in the lower lobes\nin subpleural location is similar to previous examination.",
            "output": "Overall stable appearance of the chest except for new right upper and left\nlower lobe nodules.  Be potentially might represent infectious process in\nreassessment in 3 months is recommended.  For pre size assessment of sub-\ndiaphragmatic findings please refer to CT abdomen pelvis obtained the same\nday."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the anterior\nmediastinum.  Stable mild aortic wall calcifications, the post resection area\nat the level of the left upper lobe (3, 26) is unchanged.  Stable borderline\nsized lymph nodes at the level of the left hilus and in the sub-carinal region\n(3, 28).  Mild coronary calcifications, no pericardial effusion.  The\nposterior mediastinum appears unchanged.  Stable left adrenal lesion (3, 51). \nStable right kidney cyst.\nThere is stable severe pulmonary emphysema.  The known right hilar mass is\nmorphological is stable in its upper aspect (5, 121), the lower aspect of the\nmass (5, 138) with a more nodular appearance is also stable.  Signs suggestive\nof local lymphangitis have not substantially changed.  The post resection left\nlung parenchyma is of stable morphology.  No evidence of pleural effusions. \nSeveral pre-existing subpleural millimetric micronodules are stable.  No new\nor growing nodules.",
            "output": "Stable left upper lobectomy site.  Stable appearance of a known right\nparamediastinal and right hilar mass.  No measurable growth.  Pleural\neffusions.  No new or growing pulmonary nodules."
        },
        {
            "input": "The thyroid gland is unremarkable. A prominent subcarinal lymph node measures\n2.0 x 0.9 cm, previously 2.2 x 0.6 cm (2, 28). More prominent but difficult to\ndelineate soft tissue at both hila may be due to a combination of\nlymphadenopathy and scarring.\n\nThe heart size is normal, and there is a new small pericardial effusion. The\nmain pulmonary artery and thoracic aorta are normal caliber.\n\nThe patient is status post right lower lobe wedge resection and left upper\nlobectomy with new diffuse left bronchial wall thickening, worrisome for local\ntumor recurrence.\n\nNew right paramediastinal traction bronchiectasis, scarring, septal thickening\nand posterior pleural thickening are most likely due to radiation fibrosis.\nThere is new septal thickening in the right upper lobe apex, which may be due\nto scarring versus evolving radiation fibrosis (4, 56).  There is also new\nright lower lobe bronchial wall thickening with peripheral peribronchial\nnodularity.\n\nModerate apical predominant centrilobular emphysema is unchanged. Two solid\nnodules measuring up to 2 mm in the right lower lobe are stable since ___ (4:  85, 117). Nodular subpleural scarring in the left upper lobe is also\nstable (4, 108). Two punctate calcified left lower lobe granulomas are\nincidentally noted (4: 170 and 168).\n\nImages of the upper abdomen show nonspecific bilateral perinephric fat\nstranding and a partially imaged right renal upper pole cyst. A non FDG-avid\n1.3 x 1.6 cm hypodense left adrenal nodule is stable since ___, and\nis probably a small adenoma (2, 50).\n\nModerate multilevel spinal degenerative changes are stable.",
            "output": "Evolving right lung paramediastinal radiation fibrosis with new traction\nbronchiectasis, scarring and septal/pleural thickening.\n\nRight lower lobe bronchial wall thickening and peripheral peribronchial\nnodularity may be due to radiation pneumonia, however, lymphangitic spread of\nmetastasis is not excluded.\n\nNew left bronchial wall thickening and difficult to delineate left hilar\nlymphadenopathy is worrisome for local tumor recurrence.\n\nStable moderate centrilobular emphysema.\n\nStable left adrenal adenoma.\n\nNew small pericardial effusion."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy. This study is not designed for subdiaphragmatic diagnosis, of the\nleft adrenal gland, 13 x 19 mm and 9 x 14 mm, 03: 53, 57,, were 13 x 16 mm and\n14 x 17 mm in ___.\n\nThyroid is heterogeneous, particular the right lobe, but there is no lesion\nlarge enough to to warrant evaluation with ultrasound. Atherosclerotic care\ncalcification is not apparent. Previous small pericardial effusion is almost\nresolved. Minimal right pleural effusion is also smaller.\n\nAorta and pulmonary arteries are normal size. Left hilus and bronchial stump\nhave a normal postoperative appearance following left upper lobe resection.\nMaterial thickening the posterior wall of the right main bronchus originating\nat the carina, 5:128- 134 contains bubbles, characteristic of retained\nsecretions. Sub cm subcarinal lymph nodes are smaller than in ___. There\nhas been a slight increase in the bulk of soft tissue in the right juxta hilar\nregion of resection, medial and inferior to the low or suture role. Whether\nthis is local tumor recurrence or progressive radiation fibrosis is uncertain,\nbut there is no associated bronchial row occlusion or peripheral atelectasis.\nBronchiolar nodulation peripherally is in the lower lobe is stable.\n\n6 x 6 mm right middle lobe nodule, 5:129 is stable since at least ___. A new 8 mm nodule in a region of prior bronchiectasis, 5:189, could be\neither impaction or tumor.\n\nThere are no bone lesions in the chest cage to suggest new metastasis.",
            "output": "Increased soft tissue in the region of radiation and fibrosis in the right\nlower lobe could be more atelectasis or fibrosis stomach this area was not FDG\navid on the PET scan ___.\n\nRight middle lobe nodule stable 16 months.  New sub cm right lower lobe nodule\ncould be impaction in bronchiectasis or a soft tissue lesion.\n\nInterval decrease in 2 left adrenal nodules could be treated metastasis.\n\nSevere emphysema."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the chest wall suspicious for malignancy.\n\nThis study is not designed for subdiaphragmatic diagnosis, but shows greater\nheterogeneity in the small nodule on the right adrenal since ___, but no\nchange in the 14 x 18 mm left adrenal nodule.  The liver is not evaluated by\nthis study.  A large exophytic right renal cyst is unchanged.\n\nThyroid is unremarkable.  Atherosclerotic calcification in head and neck\nvessels is mild, present in the coronaries in at least the left circumflex\nartery.  Minimal pericardial and small right pleural effusion are unchanged. \nSmooth right pleural thickening posteriorly is stable.\n\nMediastinal lymph nodes are not enlarged.  Normal postoperative appearance of\nthe left hilus and bronchial stump are stable.\n\nRight lower lobe retro hilar mass or mass like consolidation at the site of\nsuture is more confluent and larger than in ___.  At comparable levels,\nit is 33 x 50 mm today, 5:125, previously 39 x 43 mm and now extends to and is\ninseparable from the right hilus where there could be new adenopathy. \nNumerous peripheral nodules in the right lower lobe are stable in size and\nnumber.  This is more likely bronchiolitis than tumor spread.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Increase in size and bulkiness of right lower lobe perihilar mass or masslike\nconsolidation since ___.  This could represent Organization of radiation\npneumonia, but it lacks bronchiectasis and is more concerning for tumor\nrecurrence common and may be accompanied by new right hilar adenopathy.  It is\nprobably responsible, what ever its cause, for bronchiolar nodulation in the\nright lower lobe, unchanged since ___.\n\nSmall pericardial and pleural effusions and smooth right pleural thickening\nall unchanged.  Stable left adrenal nodule.  Slight interval involution, right\nadrenal nodule.\n\nCoronary atherosclerosis."
        },
        {
            "input": "Aorta and pulmonary arteries are stable in appearance.  Several mediastinal\nlymph nodes are not pathologically enlarged and stable.  Mediastinal shifting,\nslight to the left is unchanged.  No pericardial pleural effusion is seen. \nHeart size is normal.  Coronary calcifications are unchanged.\n\nSmall hiatal hernia is re- demonstrated.  Image portion of the upper abdomen\nreveals focal thickening of the left adrenal, unchanged and otherwise is\nunremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  The left upper\nlobectomy stump is unremarkable.  Right infrahilar changes I similar to\nprevious exam as well as nodules in the right lower lobe that might\npotentially represent impacted airways.  No new nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stability with no evidence of interval progression of the disease."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not appropriate for subdiaphragmatic diagnosis.  3 low-attenuation\nleft adrenal nodules, -12 ___ to 12 ___, 16 and 12 mm, 5:254, 265, 274, are\nprobably benign adenomas and a fluid density exophytic right upper pole renal\ncyst is also benign.\n\nThere no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is mild to moderate in head and neck vessels,\nand in at least left main and left circumflex coronary arteries.  There is no\npericardial or pleural effusion.  Right pleural thickening is mild in the\nlower chest posteriorly.\n\nHiatus hernia is small.\n\nPatient has had left upper lobectomy.  Bronchial stump has a normal\npostoperative appearance.\n\nRight juxta hilar mass at the site of surgical suture, extending into the\nhilus is smaller, comparable diameters 27 x 59 mm today, 5:134, 35 x 63 mm in\n___.  Lymph nodes elsewhere in the mediastinum, and are not enlarged. \nSpiculations of tumor extension into the adjacent right lower lobe are\ncomparable.  At the base of the right lung, interstitial infiltration is\nparticularly concerning for local lung involvement, but it is unchanged since\n___.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Significant decrease in size, treated right juxta hilar and hilar mass. \nProbable the tumor extension into the right lower lobe, as remote has the\nbasal segments, unchanged since ___.\n\nCoronary atherosclerosis.\n\nNormal postoperative appearance, left upper lobectomy."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not appropriate for subdiaphragmatic diagnosis, but it shows study\nbenign low-attenuation 14 mm nodule at the upper pole of the left adrenal\ngland is unchanged.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head and neck vessels, minimal in the\ncoronaries.  Aorta and pulmonary arteries are normal size.  Pericardium is\nphysiologic.  There is no pleural effusion.\n\nLymph nodes:\n\nLeft hilus and bronchial stump have a normal postoperative appearance\nfollowing upper lobectomy.\n\nMediastinal nodes are not pathologically enlarged ranging in diameter up to 13\nmm in the subcarinal station.\n\nCombination of infiltrative right hilar adenopathy and juxta hilar mass has\ngrown by approximately one/fourth ; the diameter at the level of resection\nsuture, 40 mm today, 5:140, was 35 mm in ___.\n\nLungs:\n\nPeribronchial infiltration around mildly ectatic bronchi extends further into\nthe right lung, presumably radiation effect, but 3 in nodular interstitial\nabnormality at the perimeter of the right lower lobe is more likely tumor\ninfiltration, and this has remained relatively stable.  Centrally the right\nbronchial tree is patent.  The tumor surrounds the right descending pulmonary\nartery.  Its impact on flow is indeterminate on this non contrast study.\n\nEmphysema is moderately severe.  There is no evidence of the infection or\nmetastasis in the left lung.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Right hilar adenopathy and juxta hilar mass has grown by 25%.  Approximately\n25% since ___.  The only other evidence of intrathoracic malignancy is\nprobable carcinomatosis in the right lower lobe, grossly unchanged.  Right\nbronchial tree is still patent.  Left lung has a normal postoperative\nappearance following upper lobectomy.\n\nModerate emphysema."
        },
        {
            "input": "CT chest without contrast:  Heart size is normal without significant\npericardial fluid.  3 vessel coronary artery calcifications and aortic annular\ncalcifications are noted.  Abdominal aorta and pulmonary artery are normal in\ncaliber.\n\nVisualized portion the thyroid is unremarkable.  No supraclavicular, axillary,\nhilar or mediastinal lymphadenopathy by CT size criteria.\n\nMild bibasilar atelectasis and linear atelectasis in the right lower lobe and\nlingula.  Lungs are otherwise clear.  Airways are patent to the subsegmental\nlevel.  No pleural effusion or pneumothorax.\n\nCT abdomen without contrast:  Prominent dilatation of the common bile duct to\n24 mm, tapering distally, with associated moderate intrahepatic biliary\ndilatation.  Liver is otherwise without obvious mass.  Gallbladder is not\nseen.\n\nSpleen, pancreas and adrenal glands are unremarkable.  Kidneys are grossly\nunremarkable without stone, hydronephrosis or obvious mass.\n\nTrace hiatal hernia.  Stomach, duodenum and small bowel is grossly\nunremarkable without evidence of obstruction.  Postsurgical changes from prior\nright hemicolectomy.  Large bowel is grossly unremarkable.\n\nModerate atherosclerotic calcifications along a normal caliber abdominal\naorta.  No mesenteric or retroperitoneal lymphadenopathy by CT size criteria. \nRectus diastases without frank hernia.  No ascites or pneumoperitoneum.\n\nCT pelvis without contrast:  Bladder is unremarkable.  Uterus and ovaries are\nnot seen.  Rectum is prominently distended to 85 mm with stool impaction.  No\nfree pelvic fluid or air.  No inguinal or pelvic sidewall lymphadenopathy by\nCT size criteria.\n\nBones and soft tissues:  Thoracic cage is intact.  Vertebral body heights are\npreserved.  Multilevel degenerative changes of the thoracolumbar spine,\nmoderate in the lumbar spine.  Disc space narrowing and osteophyte formation\nmost prominent at L3-L4.  Pelvic ring is intact.",
            "output": "1. No acute sequelae of trauma.\n2. Prominent dilatation of the common bile duct to 24 mm with associated\nmoderate intrahepatic biliary dilatation without obvious obstructing lesion. \nThis may be further evaluated by MRCP.\n3. Prominent rectal distention with stool impaction.\n\nRECOMMENDATION(S):  Prominent intra and extrahepatic biliary dilatation may be\nfurther evaluated by MRCP."
        },
        {
            "input": "HEART AND VASCULATURE: Of note, this is a limited exam due to artifact from\nbody habitus.  Given these limitations, no definite central pulmonary embolus\nis identified.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, or hilar lymphadenopathy is\npresent.  There is a prominent prevascular node measuring up to 1.5 x 1.2 cm\nwithin the anterior mediastinum to the left of midline possibly reactive in\nnature which could be reassessed on follow-up imaging..\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Micronodules are seen in the left lung base (Series 2: Image 65)\nwhich is not seen on a prior exam in ___.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for a calcified\naneurysm of the splenic artery, measuring up to 9 mm (series 2: Image 91). \nThere is a cirrhotic appearing liver with splenomegaly, measuring up to 16 cm.\nPatient is status post cholecystectomy.\n\nBONES:  There is no acute fracture.  There is discogenic sclerosis of the\nlower thoracic spine.",
            "output": "1. Of note, this is a limited exam due to artifact from body habitus.  Given\nthese limitations, no definite evidence of central pulmonary embolism.\n2. Prominent prevascular node measuring 1.2 x 1.5 cm and Micronodules are seen\nin the left lung base.  Recommend a dedicated CT chest exam in 6 months for\nfollow-up.\n3. Cirrhotic appearing liver with splenomegaly, measuring up to 16 cm\n4. Incidental note is made of a 0.9 cm calcified splenic artery aneurysm.\n\nRECOMMENDATION(S):  Recommend a follow up CT in 6 months for a dedicated CT\nChest for the prominent prevascular node, micronodules in the left lung base\nand reassessment of the calcified splenic artery aneurysm."
        },
        {
            "input": "The thyroid gland is unremarkable.  Prominent mediastinal lymph nodes appear\nsmaller than on prior study and are not enlarged by size criteria.  The\nesophagus is unremarkable.  The thoracic aorta is normal in caliber with a\ntypical three vessel takeoff from the arch.  Better demonstrated on the prior\nCTA is a large pulmonary vascular malformation in the right lower lung. The\nmain right pulmonary artery is hypoplastic with prominent peribronchial\nvessels draining into the left atrium. The right lung itself is also\nhypoplastic with dextrocardia. Note is also made of a coronary artery\ncalcification (3:29).\n\nA tracheal bronchus supplies the apical segment of the right upper lobe\n(5:91). Bronchial wall thickening in this area is similar prior. There is also\nmild to moderate bronchi wall thickening in the other segmental bronchi of the\nright lung. The previously described pulmonary nodules have resolved.  However\nthere is diffuse interlobular septal thickening throughout the right lung.\nThere are also some areas of subpleural scarring (5:73,206). No pleural\neffusion or pneumothorax is present.\n\nThis exam is not tailored for subdiaphragmatic evaluation, however there are\nnumerous surgical clips surrounding the gastroesophageal junction. Diffuse low\nattenuation the liver is consistent with fatty deposition. There is no blastic\nor lytic lesion suspicious for malignancy.",
            "output": "1. Vascular anomaly in the right lower lung, for which the classification as\nan arterial venous malformation or an isolated pulmonary vein anomaly is\ndifficult due to absence of intravenous contrast on the current exam and\nsuboptimal contrast opacification of the pulmonary arteries on the prior CTA.\nGiven history of anaphylaxis with IV contrast, consider echocardiogram bubble\nstudy for initial further assessment.\n2. Previously described pulmonary nodules have resolved and are most likely\ninfectious/inflammatory.\n3. Hypoplastic right lung and dextrocardia.\n4. Tracheal bronchus supplying the apical segment of the right upper.\n5. Diffuse bronchial wall thickening and interlobular septal thickening\nthroughout the right lung,  likely due to impaired lymphatic drainage in the\nsetting of above congenital findings.\n6. Coronary artery calcification, noteworthy in a patient of this age.\n7. Fatty liver.\n\nNOTIFICATION:   Findings were discussed by Dr. ___ to Dr. ___\n___ by phone at 11:55 on ___."
        },
        {
            "input": "FINDINGS: Mildly bulky appearance of the thyroid: Inferior nodular extension\nof the thyroid at the level of the isthmus, but this appears similar compared\nto prior imaging.  Better assessment may be performed with ultrasound.  No\nsupraclavicular or axillary adenopathy.  Breast tissue is suboptimally\nassessed on CT and correlation with prior mammography is advised. This study\nwas not tailored to evaluate the subdiaphragmatic organs.  Suspected prior\nanti reflux surgery.  No adrenal lesions.  Mildly hypodense appearance of the\nliver suggesting steatosis.  Mediastinal shift to the left.  Normal cardiac\nconfiguration.  Dextro position of the heart secondary to a congenitally small\nright lung.  No pericardial effusion.  No aortic valve calcification. \nModerate coronary artery calcification.  No aneurysmal dilatation of the\nascending aorta.  Moderate calcific atherosclerotic changes of the aortic\narch.  The pulmonary truncus is not dilated.  Hypoplastic appearance of the\nright pulmonary artery.  Multiple subcentimeter mediastinal lymph nodes.  It\nis difficult to comment on hilar adenopathy on this noncontrast study.  Azygos\nfissure on the right.  Right tracheal bronchus (5, 104).  Moderate, diffuse\nbronchial wall thickening.  No bronchiectasis.  Tortuous appearance of the\nright pulmonary vein with a meandering coarse draining to the left inferior\npulmonary vein.  Mild-to-moderate spondylotic changes of the thoracic spine. \nNo lytic/destructive bony lesions.  Mild right apical pleural-parenchymal\nscarring.  Mild, but diffuse bronchial wall thickening.  No suspicious\npulmonary nodules or masses.  No confluent airspace consolidation. \nMild-to-moderate air trapping on expiratory imaging.  No abnormal of\nappearance of the trachea to suggest tracheobronchomalacia.",
            "output": "Right lung hypoplasia with associated decrease in size of the right pulmonary\nartery suggest a congenital anomaly.\nThere is consequent rightward shift of the mediastinum with dextroposition of\nthe heart, but a normal cardiac configuration (levocardia).\nThere is an anomalous  single pulmonary vein on the right taking a meandering\ncourse draining to the left inferior pulmonary vein.   There is a reported\nassociation with an anomalous single pulmonary vein and pulmonary hypoplasia.\nNo pulmonary AVM suspected (to further support this the echocardiography\nbubble study was negative).\n\nIncidental finding of a right tracheal bronchus supplying a right azygos lobe.\n\nMild, but diffuse bronchial wall thickening with mild to moderate air trapping\nsuggests bronchial inflammation and small airways disease.\n\nNo features of tracheobronchomalacia.  No diffuse lung disease/lung fibrosis.\n\nModerate coronary artery calcification."
        },
        {
            "input": "AXILLA, HILA, AND MEDIASTINUM: No axillary, hilar or mediastinal adenopathy.\n\nHEART AND VASCULATURE: No pericardial effusion.\n\nPLEURAL SPACES: Small to moderate left and trace right pleural effusions.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Bilateral left greater than right compressive atelectasis. \nMild perihilar ground-glass opacities are noted, likely due to mild pulmonary\nedema.  Prominence of the pulmonary vasculature relationship to the airways. \nBandlike atelectasis at the right lung base.  Calcified granuloma in the left\nupper lobe.\n\nABDOMEN:  Please see dedicated report for details.  Nodular liver contour and\nascites is noted.\n\nBONES/SOFT TISSUE: No suspicious osseous lesions.  Mild anasarca.",
            "output": "1. Small to moderate left and trace right pleural effusions.\n2. Mild pulmonary edema."
        },
        {
            "input": "MEDIASTINUM: A calcified left thyroid lobe nodule is incidentally noted\n(04:50).  There is no supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.    Significant aortic valve calcifications as well as less\nextensive coronary arterial calcifications.   The heart size is normal and\nthere is no pericardial effusion.\n\nAlthough this study was not optimized for evaluation of the pulmonary\narteries, there are focal filling defects within bilateral lobar and segmental\npulmonary arterial branches (4:70, 72, 77, 116, 137). The right pulmonary\nartery measures up to 35 mm, suggestive of underlying pulmonary arterial\nhypertension. There is no evidence of right heart strain.\n\nPLEURA:  There is no pneumothorax.  Small bilateral nonhemorrhagic layering\npleural effusions are present.\n\nLUNGS: The airways are patent.  Mild bronchial wall thickening is predominant\nin the bilateral lung bases, where there is mild inspissated secretions.\nSubsegmental atelectasis is present in the lung bases bilaterally.  There are\nno concerning pulmonary nodules or masses. A calcified granuloma is noted in\nthe right lung base.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. Bilateral lobar and segmental pulmonary emboli.  No evidence of right heart\nstrain.\n2. No evidence of intrathoracic malignancy.\n3. Small nonhemorrhagic bilateral pleural effusions, with minimal adjacent\natelectasis.\n4. Findings suggestive of pulmonary arterial hypertension.\n5. Aortic valve and coronary arterial calcifications.\n\nNOTIFICATION:   The findings were discussed via telephone by Dr. ___ with\nDr. ___ on ___ at 6:04 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The aortic valve is heavily calcified consistent with history of severe aortic\nstenosis.  The ascending aorta is nondilated, measuring up to 3.6 cm in\ngreatest dimension, and demonstrates mild peripheral atheromatous\ncalcifications.  Mild to moderate atheromatous calcifications are also evident\nin the aortic arch and mild calcifications are present in the descending\nthoracic aorta.  Heart is upper limits of normal in size and severe diffuse\ncoronary artery calcifications are present.\n\nNumerous subcentimeter mediastinal lymph nodes are present in multiple\ncompartments, similar to ___ CT.  Trace bilateral pleural effusions\nare present, slightly decreased from the prior CT scan.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no new\nconcerning findings are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nin the spine and evidence of previous sternotomy, likely related to previous\nCABG.  Mild compression deformity in the mid thoracic spine is unchanged since\nrecent chest radiograph of ___ as well as older CT torso of ___.\n\nWithin the lungs, diffuse ground-glass opacities are present as well as\nscattered thickened septal lines, likely due to hydrostatic edema.  Mild\ndiffuse bronchial dilation is potentially age related in a patient of this\nage.",
            "output": "1. Heavily calcified aortic valve, consistent with history of severe aortic\nstenosis.  The ascending thoracic aorta is of normal caliber in demonstrates\nmild atheromatous calcifications.  These images are available for preoperative\nplanning.\n\n2.  Ground-glass opacities and septal thickening are suggestive of hydrostatic\nedema."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Secretions are seen within the trachea\n\nBREAST AND AXILLA  : There are small bilateral axillary lymph nodes which\ncould be reactive.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  The\nesophagus is patulous, could be related to motility disorder.  There is no\npericardial effusion.  There are no enlarged hilar lymph nodes.  There is a\nsmall hiatus hernia.\n\n\nPLEURA: There is a small right pleural effusion there is a trace left pleural\neffusion.\nLUNG: There is moderate to severe upper lobe predominant emphysema.  The\nnodules seen on the radiograph corresponds to a well-defined nodule measuring\n9 mm in the left upper lobe with central calcification, could represent a\ngranuloma.  There is an the noncalcified nodule in the right middle lobe (3,\n29) Measuring 4 mm.  There is subsegmental atelectasis in both lung bases\nright greater than left.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with degenerative\nchanges involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses seen.  There are gallstones",
            "output": "9 mm nodule in the left upper lobe with central calcification could represent\na granuloma.\n\nNoncalcified right middle lobe pulmonary nodule measuring 4 mm is\nindeterminate.  Three-month follow-up is recommended.\n\nSmall diffuse moderate to severe centrilobular emphysema.\n\nSmall bilateral axillary lymph nodes are most likely reactive.\n\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  Excluding the breast tissue which\nrequires mammography for evaluation,there are no abnormalities on the chest\nwall. No atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Moderate\natherosclerotic calcifications in the coronary arteries.  Minimal\natherosclerotic calcifications in the aortic arch..  The aorta and pulmonary\narteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Very small hiatal hernia.  Small mediastinal\nlymph nodes, none pathologically enlarged by CT size criteria. No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThere is a background of moderate upper lobe predominant emphysema.  A 9 mm\nleft upper lobe nodule with central calcification is stable (series 4:64).  A\n4 mm right upper lobe nodule appears dense and partly calcified, unchanged\n(series 4, 111).  Several calcified nodules in the right upper and right\nmiddle lobe likely represent calcified granulomas and are stable (see series\n04:38, 49, 167).  The airways are patent to the subsegmental levels.  Mild\nbronchial wall thickening suggests chronic airway disease.  Minimal\nsubsegmental atelectasis at the lung bases, right greater than left.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "1. Stable appearance of 9 mm left upper lobe nodule with central calcification\nand 4 mm right upper lobe dense, partly calcified nodule.  Recommend follow-up\nCT chest in ___ year to assess stability.\n2. Moderate emphysema.\n\nRECOMMENDATION(S):  Follow-up CT chest in ___ year"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Hypoattenuating soft tissue in the anterior\nmediastinum likely represents residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild subsegmental atelectasis versus scarring in the\nleft upper lobe and right middle lobe.  There is also dependent atelectasis in\nthe bilateral, right greater than left, lung bases.  There also scattered\nperibronchial nodular and ground-glass opacities in the right middle lobe. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a subcentimeter\nhypodensity in the right hepatic lobe (7:191), which is incompletely\ncharacterized, but may represent a hepatic cyst or biliary hamartoma.  A\nsubcentimeter hypodensity in the left upper pole is too small to characterize.\nThere is focal cortical scarring in the left upper pole kidney.\n\nBONES: The bones are diffusely heterogeneous with mixed areas of sclerosis,\nlikely consistent with patient's history of sickle cell.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Right middle lobe peribronchial opacities, likely infectious or\ninflammatory in etiology.\n3. Mild bibasilar atelectasis, right greater than left."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  There is residual thymic tissue in the anterior\nmediastinum.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Atelectasis is seen in the lung bases bilaterally, left greater\nthan right.  Lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nThe airways are patent to the subsegmental level.  There is an area of\nperipheral opacity in the right middle lobe compatible with pulmonary\ncontusions secondary to the rib fracture.  There is no large consolidation,\npleural effusion, or pneumothorax.\n\nThis study is not designed for evaluation of intra-abdominal structures,\nhowever the included views of the upper abdomen are unremarkable.\n\nThere is a mildly displaced fracture of the right fifth rib laterally.  The\nright 6th rib is also fractured but minimally displaced.  There is associated\nminimal subcutaneous emphysema at the right lateral chest wall.  No additional\nfracture is identified.  No suspicious lytic or sclerotic lesion is\nidentified.",
            "output": "Mildly displaced right fifth rib fracture with associated underlying right\nmiddle lobe pulmonary contusion.  Minimally displaced fracture of the right\nsixth rib."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart is\nnormal in size.  The heart and mediastinum have shifted to the\nmidline/slightly right-side of the chest status post right pneumonectomy.  Two\nmediastinal drains are present, one terminating anteriorly and one terminating\nposteriorly.  Epicardial pacing wires are present.  No pericardial effusion is\nseen.  Bilateral central venous catheters terminate in the low SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass.  There is stranding in the mediastinum\ncompatible with recent surgery and mediastinal drain placement.\n\nPLEURAL SPACES: A right sided chest tube terminates in the posterior right\npleural space.  The right hemithorax is filled with mixed density right\npleural fluid compatible with simple fluid and blood products status post\nright pneumonectomy.  There is a small amount of air in the right pleural\ncavity.  There is a trace left pleural effusion.\n\nLUNGS/AIRWAYS: Status post right pneumonectomy.  There are ground-glass\nopacities in the posterior left upper lobe as well as in the left lower lobe. \nThere is a trace consolidation overlying a trace pleural effusion at the left\nlung base, likely compressive atelectasis.  A endotracheal tube terminates\nabove the carina.  There are secretions in the trachea, left mainstem\nbronchus, left lingular and lower lobe bronchi and segmental and subsegmental\nbronchial of the left lower lobe.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: Status post median sternotomy.  No suspicious osseous abnormality is\nseen.? There is no acute fracture.",
            "output": "1. Postsurgical changes status post right pneumonectomy including mixed\ndensity fluid filling the right hemithorax compatible with simple pleural\nfluid and blood products, and mediastinal shift to the midline/slight right\nside of the chest.\n2. Ground-glass opacities in the posterior left upper lobe in the left lower\nlobe, which may represent aspiration given the presence of secretions in the\ntrachea and left airways, or edema or hemorrhage.\n3. Trace left pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A thyroid nodules fire of requiring\nadditional imaging.  Mild edema in the left axilla and chest wall.  No\ndrainable fluid collection.\n\nMEDIASTINUM: Postsurgical changes.  No mediastinal hematoma.  Slight leftward\nshift since prior CT accounting for pneumonectomy.\n\nHILA: Postsurgical changes in the right hilum.  No left hilar lymphadenopathy\nidentified within limits of noncontrast CT.\n\nHEART and PERICARDIUM: Stable small pericardial effusion.\nPLEURA: Small to moderate amount of air in the right chest pneumonectomy bed. \nNo left pleural effusion or pneumothorax.  In the right pneumonectomy bed,\nthere is an 8.1 x 6.6 cm heterogeneous hyperdense region measuring nearly 70\nHounsfield units with focal areas of low density within it demonstrating\nair-fluid levels (02:27, 23).\nLUNG:\n\n1. PARENCHYMA:  Ground-glass in the perihilar region of the left lung has\nimproved since prior with mild residual.\n2. AIRWAYS:  Unchanged postsurgical appearance of the right bronchial stump. \nPatent trachea and left bronchi to the subsegmental level.  The patient is\nintubated.\n3. VESSELS:  Normal caliber aorta.  Dilated main pulmonary trunk to 3.4 cm. \nBilateral internal jugular central venous catheters terminate in the lower\nSVC.\nCHEST CAGE: Redemonstrated sternotomy wires.  No acute fracture or concerning\nlesions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nmild bilateral hydronephrosis, which appears minimally increased from prior\nPET-CT.  There is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the stomach.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder contains a Foley catheter and locules of gas\ncompatible with recent instrumentation.  The distal ureters take an unusual\ncoarsened insert inferomedially on the bladder.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Injection sites noted in the anterior abdominal wall.  No\ndrainable fluid collection.  Mild left greater than right flank edema.",
            "output": "1. Findings concerning for recent bleeding in the right pneumonectomy bed with\n8.1 x 6.6 cm hematoma especially in light of interval washout.\n2. Small to moderate air in the right chest, slightly increased from prior.\n3. Slight leftward mediastinal shifting relative to prior CT.\n4. Improved left perihilar ground-glass opacities.\n5. No acute intrabdominopelvic process.\n6. Mild bilateral hydroureteronephrosis, minimally increased from prior PET-CT\ngiven differences in technique.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 5:19 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "THORACIC INLET: The small left supraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes\n\nMEDIASTINUM: Multiple enlarged mediastinal lymph nodes.  The subcarinal node\nmeasures 3 cm.  The right paratracheal lymph node measures 12 mm.  The small\nbilateral hilar lymph nodes.  The aorta and pulmonary arteries are normal in\ncaliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a large right lung mass measuring 9.4 x 8.5 x 8.3 cm which is\ncontiguous with the right hilum, the mass invades the left atrium with\nextension into the left atrium (2, 33).  The mass extends into the subcarinal\nregion and encases the bronchus intermedius and partially obstructs the right\nmiddle lobe bronchus with complete atelectasis of the right middle lobe. \nThere is subsegmental atelectasis in the right upper lobe secondary to\nobstruction of the right upper lobe bronchus.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Large right upper lobe mass extending into the mediastinum, with evidence of\ninvasion of the left atrium, and extension into the subcarinal region and into\nthe bronchus intermedius.  There is a partial atelectasis of the right middle\nlobe and subsegmental atelectasis in the right upper lobe.  The mass extends\ninto the subcarinal region, encases the right main pulmonary artery in causes\nsevere narrowing of the right middle lobe proximal right upper lobe pulmonary\narteries.\n\nFindings are concerning for a poorly differentiated lung cancer or a sarcoma. \nCorrelation with history is recommended.\n\nSmall left supraclavicular lymph nodes and small mediastinal lymph nodes"
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart and aorta\nare normal in size.  The main pulmonary artery is mildly enlarged but\nunchanged since the prior study and measures 3.3 cm.  There is no pericardial\neffusion.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Patient is status post right intrapleural pneumonectomy in the interim\nwith complete opacification of the pneumonectomy space and shift of\nmediastinum to the right.  Left lung is clear.  No new or growing pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.  Patient status post\nmedian sternotomy.  Sternal sutures are intact\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows triangular\nhypodense perfusion the abnormality in the right lobe of liver please refer to\ndedicated report on abdomen which has been dictated separately.",
            "output": "Status post right pneumonectomy in the interim with shift of mediastinum to\nthe right.  ___ postoperative baseline scan.\n\nSmall mediastinal hilar lymph nodes.\n\nNo new pulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bilateral dependent atelectasis.  Otherwise the\nbilateral lung parenchyma are within normal limits.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? Compression deformity in T8\nand T9 status post vertebroplasty is noted.  T11 and T12 compression deformity\nis also demonstrated, similar to prior radiograph dated ___.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Unchanged T8 and T9 compression deformity status post vertebroplasty and\nT11 and T12 compression deformity.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:48 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Included views of the thyroid are within normal limits.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nThe heart size is normal.  There is no pericardial effusion.  No significant\ncoronary atherosclerotic calcifications are seen.\n\nThe great vessels are patent and normal in caliber.  There is minimal\natherosclerotic calcification along the aortic arch.  There is no dissection. \nThe main pulmonary arteries are normal in caliber.  No pulmonary embolus is\ndetected to the proximal segmental levels.\n\nThere is no pneumothorax, focal consolidation, or pleural effusion.  There is\nmild dependent atelectasis a low the bilateral lower lobes.  There is no\nconcerning nodule or mass.\n\nThe liver density is within normal limits.  There is mild periportal edema. \nThere is no intra extrahepatic bile duct dilation.  The gallbladder is normal.\nNo radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  There is a 5 mm exophytic fat containing lesion arising from\nthe interpolar aspect of the right kidney, most compatible with an\nangiomyolipoma (series 2, image 58).  A 3 mm hypodensity along the periphery\nof the posterior interpolar aspect of the right kidney is indeterminate,\nstatistically likely a benign cyst (series 2, image 59).\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  The appendix is normal (series 601, image 22).  There\nis no focal gastrointestinal lesion.  The sigmoid colon is moderately\nredundant (series 601, image 15).\n\nThe bladder is decompressed, and appears grossly normal.  The uterus is not\nvisualized, likely post hysterectomy.  No concerning adnexal lesions are\ndetected.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  The portal and hepatic veins are\npatent.\n\nThere are no osseous lesions concerning for malignancy or infection.  There is\nbeen interval T12 kyphoplasty since the ___ examination.  T8 and T9\nkyphoplasty changes are again demonstrated, unchanged from prior.  Moderate\ncompression deformity of T11 appears stable.  Kyphoplasty changes at L4 are\npresent.  There is a moderate compression deformity of L2.",
            "output": "1. No concerning pulmonary nodule or mass correlating to the focal opacity\nseen on the recent chest radiograph.  No acute intrathoracic process.\n2. No intrathoracic or abdominopelvic malignancy identified.  No\nlymphadenopathy.\n3. Mild periportal edema.\n4. 5 mm right interpolar renal angiomyolipoma."
        },
        {
            "input": "Included views of the thyroid are within normal limits.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nThe heart size is normal.  There is no pericardial effusion.  No significant\ncoronary atherosclerotic calcifications are seen.\n\nThe great vessels are patent and normal in caliber.  There is minimal\natherosclerotic calcification along the aortic arch.  There is no dissection. \nThe main pulmonary arteries are normal in caliber.  No pulmonary embolus is\ndetected to the proximal segmental levels.\n\nThere is no pneumothorax, focal consolidation, or pleural effusion.  There is\nmild dependent atelectasis a low the bilateral lower lobes.  There is no\nconcerning nodule or mass.\n\nThe liver density is within normal limits.  There is mild periportal edema. \nThere is no intra extrahepatic bile duct dilation.  The gallbladder is normal.\nNo radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  There is a 5 mm exophytic fat containing lesion arising from\nthe interpolar aspect of the right kidney, most compatible with an\nangiomyolipoma (series 2, image 58).  A 3 mm hypodensity along the periphery\nof the posterior interpolar aspect of the right kidney is indeterminate,\nstatistically likely a benign cyst (series 2, image 59).\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  The appendix is normal (series 601, image 22).  There\nis no focal gastrointestinal lesion.  The sigmoid colon is moderately\nredundant (series 601, image 15).\n\nThe bladder is decompressed, and appears grossly normal.  The uterus is not\nvisualized, likely post hysterectomy.  No concerning adnexal lesions are\ndetected.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  The portal and hepatic veins are\npatent.\n\nThere are no osseous lesions concerning for malignancy or infection.  There is\nbeen interval T12 kyphoplasty since the ___ examination.  T8 and T9\nkyphoplasty changes are again demonstrated, unchanged from prior.  Moderate\ncompression deformity of T11 appears stable.  Kyphoplasty changes at L4 are\npresent.  There is a moderate compression deformity of L2.",
            "output": "1. No concerning pulmonary nodule or mass correlating to the focal opacity\nseen on the recent chest radiograph.  No acute intrathoracic process.\n2. No intrathoracic or abdominopelvic malignancy identified.  No\nlymphadenopathy.\n3. Mild periportal edema.\n4. 5 mm right interpolar renal angiomyolipoma."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild upper lobe predominant centrilobular emphysema with\nscattered parenchymal cysts.  Otherwise, lungs are clear without masses or\nareas of parenchymal opacification.  Multiple right-sided pulmonary nodules\nmeasure up to 3 mm (series 4, image 60, 84, 86).  There is mild right\nperifissural thickening measuring up to 7 mm (series 4, image 113).  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck is notable for\nheterogeneous enlargement of the left thyroid gland with rightward deviation\nand mild narrowing of the trachea without evidence of a discrete nodule\n(series 2, image 8).\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.  There is a nondisplaced\nfracture of the anterior left fifth rib (series 3, image 63).",
            "output": "1. Nondisplaced fracture of the anterior left fifth rib.\n2. No evidence of pneumothorax or pulmonary contusion.\n3. Multiple right-sided pulmonary nodules measure up to 3 mm.  Please refer to\n___ criteria below for follow-up recommendations.\n4. Enlarged left thyroid gland.  Recommend further evaluation with dedicated\nthyroid ultrasound.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in ___ months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "There is a 9 mm hypodensity within the left thyroid lobe, not significantly\nchanged since prior examination (series 2, image 10). The remaining thyroid\ngland appears normal.  No significant axillary lymphadenopathy is detected.\nNumerous mediastinal lymph nodes are smaller in size as compared to prior CT\nexamination, for example a right paratracheal lymph node now measures 11 mm,\npreviously measuring 13 (series 2, image 22). Left hilar lymphadenopathy has\nalso improved since prior examination, with a stable appearance of the right\nhilar lymphadenopathy.  There is a small hiatal hernia. The thoracic aorta is\nnormal in caliber. The pulmonary arterial trunk is normal in caliber. Focal\ncoronary artery calcifications are seen.  The heart is normal in size without\npericardial effusion.\n\nThe tracheobronchial tree is patent to the subsegmental levels. Again seen are\nnumerous perilymphatic lung nodules, which are similar in appearance and\ndistribution as compared to prior study from ___, and occupying\npredominantly the upper lobes, left worse than right. The largest in the right\nupper lobe measures approximately 9 x 6 mm and the largest in the left upper\nlobe measures approximately 6 x 6 mm (series 4, image 69). The conglomerate of\nbronchovascular nodules in the left perihilar region is again predominant,\nhowever not significantly changed since prior study. Again seen are scattered\ngranulomas. No definite new pulmonary nodules are identified. There is no\npleural effusion or pneumothorax.\n\nAlthough this study is not targeted for evaluation of subdiaphragmatic\nstructures, there is a 2.0 x 1.4 cm hypodensity in the right hepatic lobe.\nOtherwise, the remaining visualized solid organs of the upper abdomen are\nnormal.\n\nNo blastic or lytic lesion suspicious for malignancy is present.",
            "output": "1. Diffuse intrathoracic lymphadenopathy, with interval improvement of\nmediastinal and left hilar lymphadenopathy.\n\n2. Diffuse perilymphatic and bronchovascular nodules, not significantly\nchanged in distribution or appearance and suggestive of sarcoidosis."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The esophagus is normal without evidence of wall thickening or a\nhiatal hernia.  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are seen.\n\nA 12 mm x 8 mm nodular density is seen at the left lung base (4; 178) with a\nvessel which appears to be terminating in this region.  Biapical\npleuroparenchymal scarring is seen.  There is no pleural effusion or\npneumothorax.",
            "output": "12 mm x 8 mm nodular density at the left lung base with a vessel which appears\nto be terminating in this region.  Although this could be secondary to a soft\ntissue nodule, a vascular lesions/aneurysm could also be considered.\n\nRecommendations:\n\nFurther evaluation with contrast enhanced CT scan is recommended to assess for\na possible vascular lesion.\n\nAlso recommend comparison to prior outside hospital imaging when available."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  Excluding the breast tissue which\nrequires mammography for evaluation, there are no abnormalities on the chest\nwall. No atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta. The aorta and pulmonary arteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nA 9 x 13 mm left lower lobe well-circumscribed, homogeneous, hypervascular\nnodule within inflow and outflow track the is seen.  The tortuous vessels\nextend into the inferior lingula (3, 43).  No other similar lesions are noted\nin the remaining lung parenchyma.The airways are patent to the subsegmental\nlevels. No bronchial wall thickening, bronchiectasis or mucus plugging. No\nsuspicious lung nodules or masses. No consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Enhancing nodule in the left lower lobe has increased in size since the prior\nstudy, has an inflow and outflow track and the tortuous vessels extend up to\nthe inferior lingula.  This is concerning for an pulmonary arteriovenous\nmalformation.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 11:45 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LUNGS: Extensive pleural plaque on the right is present. Pleural plaque is\nalso noted on the left, but more minimal. On the left, there is a small\npleural effusion. Bibasilar consolidations are present. There are no worrisome\nmass lesions within the lungs. Biapical scarring is present.  Intralobular\nseptal thickening is noted, likely from mild fluid overload.\n\nMEDIASTINUM: The patient is intubated with the ET tube in appropriate\nposition.  Given the lack of IV contrast, evaluation for hilar lymphadenopathy\nis limited. A top-normal 10 mm precarinal node is noted (03:23).  The heart is\nslightly enlarged.  Calcifications of the aortic valve as well as the coronary\narteries are noted. There is no pericardial effusion.  The subclavian line is\nin place terminating at the cavoatrial junction.\n\nUPPER ABDOMEN: An NG tube is probe within the stomach. Otherwise, limited\nevaluation of the abdomen is within normal limits.\n\nBONES: There is a sclerotic T4 vertebral body with wedge compression fracture\n(602:65).",
            "output": "1. Bibasilar opacities likely represents combination of scarring/aspiration.\nPneumonia should be considered in the correct clinical and cannot be excluded.\nNo mass lesion. Extensive pleural plaques.\n\n1. Sclerotic T4 vertebral body wedge compression fracture. Given the history\nof lymphoma, this could represent lymphoma or treated lymphoma or chronic\ncompression deformity. Recommend comparison with prior scans if available."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nA right chest wall MediPort extends into the right atrium. The tip of a\nleft-sided PICC line extends to the superior cavoatrial junction. Moderate\ncardiomegaly with multichamber enlargement is unchanged. Scattered coronary\nartery calcifications are unchanged. There is no pericardial effusion. The\nmain pulmonary artery remains mildly dilated to 3.2 cm. The descending\nthoracic aorta becomes mildly dilated just proximal to the gastroesophageal\njunction, measuring up to 3.2 cm in greatest transverse dimension. There is\nmoderate atherosclerosis with both calcified and noncalcified intimal plaques.\n\nThe patient has been extubated since the prior exam. Respiratory motion\nartifact limits evaluation of fine detail in the lungs. However, mild diffuse\nground-glass opacities and interlobular septal thickening are unchanged. \nNonhemorrhagic layering pleural effusions have increased bilaterally. The\nmoderate left pleural effusion results in increased partial left lower lobe\npassive atelectasis. The partially loculated nonhemorrhagic small right\npleural effusion is accompanied by dense pleural calcifications, which suggest\nprior asbestos exposure. A few left pleural calcifications are also present.\nThere is increased collapsibility of the right bronchus intermedius and right\nlower lobe bronchi, which may suggest bronchomalacia.\n\nGeneralized osteopenia and multilevel spinal degenerative changes are stable. \nA mild chronic compression deformity of an upper thoracic vertebral body\ncontributes to moderate thoracic spine kyphosis.\n\nImages of the upper abdomen are unremarkable.",
            "output": "Interval increase in a moderate nonhemorrhagic left pleural effusion results\nin increased partial compressive atelectasis of the left lower lobe.\n\nInterval increase in size of partially loculated small right pleural effusion\nwith associated partial right lower lobe passive atelectasis.\n\nBilateral pleural plaques, right greater than left, suggest prior asbestos\nexposure.\n\nStable mild pulmonary edema.\n\nIncreased collapsibility of the right bronchus intermedius and right lower\nlobe bronchi suggests bronchomalacia.\n\nModerate atherosclerosis with mild fusiform dilatation of the descending\nthoracic aorta to 3.2 cm.\n\nStable mild dilatation of the main pulmonary artery suggests pulmonary\narterial hypertension in the appropriate clinical setting."
        },
        {
            "input": "Visualized portions of the thyroid gland are within normal limits.  A 14 x 12\nmm subcarinal lymph node is stable (series 4, image 91). No significant\naxillary or hilar lymphadenopathy is detected.  An orogastric tube courses\nthrough the esophagus and terminates at the gastric fundus.  Although this\nstudy is not designed for cardiac assessment there is cardiomegaly, most\npronounced at the left atrium. The pulmonary arterial trunk is normal in\ncaliber. The ascending aorta is circumferentially calcified. MOderate\natherosclerotic calcifications are seen throughout the aortic arch,  aortic\nvalve, and coronary arteries. There is a small pericardial effusion. Again\nseen is mild fusiform dilation of the descending thoracic aorta measuring up\nto 3.2 cm.  A right-sided internal jugular venous approach catheter terminates\nin the mid to low SVC.\n\nEndotracheal tube terminates at the mid trachea. Note is made of expected\ntracheal calcifications.  Mucous secretions are seen in the left lower lobe\nbronchus with secondary left lower lobe collapse (series 4, image 112). The\ntracheobronchial tree is otherwise patent.  Pulmonary edema has improved.\nSmall to moderate nonhemorrhagic left-sided pleural effusion layering\nposteriorly is decreased in size. A partially loculated nonhemorrhagic small\nright pleural effusion is also decreased in size.  There is mild atelectasis\nat the right lung base. No new focal consolidation or pneumothorax is present.\nMultiple calcified granulomas are again seen and most striking at the lung\napices bilaterally. Extensive calcified pleural plaques seen bilaterally,\nright worse than left, is suggestive of prior asbestos exposure.\n\nCompression deformity at an upper thoracic vertebral body, is again seen,\ncontributing to moderate thoracic kyphosis. No blastic or lytic lesion\nsuspicious for malignancy is present.\n\nAlthough this study is not tailored for evaluation of subdiaphragmatic\nstructures, note is made thickened paraspinal and retroperitoneal tissues on\nthe left, worsened since prior study from ___ (series 2, image\n61).",
            "output": "1.  Left lower lobe collapse secondary to retained secretions in the left\nlower lobe bronchus.\n\n2.  Small to moderate nonhemorrhagic left pleural effusion and small loculated\nright sided pleural effusion, both decreased in size.\n\n3.  Thickened paraspinal and retroperitoneal soft tissues on the left worsened\nsince prior study from ___, dedicated abdominal imaging should be\nconsidered for further assessment of possible lymphoma recurrence.\n\n4.  Bilateral calcified pleural plaque, right greater than left, suggestive of\nprior asbestos exposure.\n\n5.  Improved pulmonary edema, now minimal.\n\n6.  Moderate atherosclerosis and fusiform dilation of the descending aorta.\n\nNOTIFICATION:   Dr. ___ notified findings ___ to Dr. ___\nat 8:02 ___"
        },
        {
            "input": "Anasarca is new.  There is no supraclavicular or axillary adenopathy or soft\ntissue mass in the chest wall suspicious for malignancy.  I cannot tell\nwhether there is skin ulceration or just ___ skin folds in the left upper\nchest wall laterally, a region easily examined clinically.\n\nThyroid is unremarkable. There is no lymph node enlargement in the mediastinum\nor hila. Aorta and pulmonary arteries are normal size and all other this study\nis not designed to detect pulmonary emboli, no large emboli are seen in the\ncentral pulmonary arteries. Aortic valvular calcification is heavy. Aorta is\nnormal size. Atherosclerotic calcification is not appreciable. Small bilateral\nnonhemorrhagic pleural effusions layer posteriorly, right greater than left,\nand a are probably responsible for mild bibasilar atelectasis. Lungs are\notherwise clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest wall suspicious for malignancy. .",
            "output": "New global anasarca.\n\nHeavy aortic valvular calcification could be hemodynamically significant.  No\npulmonary edema currently.\n\nRedundant skin folds or ulceration left upper chest wall laterally can be head\ndistinguish by clinical inspection."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is slight underinflation of the lungs, with a subsegmental area of\natelectasis within the left lung base (5:67).  Otherwise, there is no evidence\nof pulmonary parenchymal abnormality. The airways are patent to the\nsubsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  Minimal left basilar\natelectasis."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nAxillary,  mediastinal, and hilar lymph nodes are not pathologically enlarged.\nThe heart and mediastinum are normal. The pericardium is intact without\neffusion.  Airways are patent to the subsegmental levels.\n\nThe lungs are clear without focal or diffuse abnormality. The pleura is intact\nwithout effusion. No pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Normal chest CTA with no signs of pulmonary embolism.\nNormal CT of the chest although the upper cysts and costophrenic angles are\nnot included as per CTPA protocol."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic and abdominal aorta are normal in caliber and without evidence of\naneurysm or dissection.  The pulmonary artery is well opacified to the\nsubsegmental level without filling defect to suggest pulmonary embolism.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  The heart and mediastinum are normal.\nThe pericardium is intact without effusion.  Airways are patent to the\nsubsegmental levels.\n\nThe lungs demonstrate moderate dependent atelectasis and small bilateral\npleural effusions.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal abnormality. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Mild periportal edema likely reflects volume status. The\ngallbladder, pancreas, spleen, and bilateral adrenal glands are normal. The\nkidneys enhance symmetrically and are without suspicious solid mass.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening. The appendix is\nnormal. There is no retroperitoneal lymphadenopathy by CT size criteria. There\nis no free abdominal fluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.  The uterus is enlarged compatible with the recent\npostpartum state.  A hypodense component of the endometrial stripe measures\n2.2 cm and may represent blood components or clot (13:36). The posterior\nborder of the endometrium is irregular, and retained products of conception\ncannot be excluded by CT appearance (13:36-38).\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  No pulmonary embolism.\n\n2.  Postpartum uterus with thickened hypodense endometrial stripe which may\nreflect blood components / clot.\n\n3.  Irregular posterior endometrial border, retained products of conception\ncannot be excluded by CT appearance.\n\n4.  No abscess or thrombophlebitis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. \n___ on the telephone on ___ at 10:17 AM, 10 minutes after the\ndiscovery of the findings."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified and without filling defect. The remaining great vessels are\nnormal in appearance.\n\nCT CHEST WITH CONTRAST:\n\nThe imaged thyroid is normal. There is no axillary, supraclavicular,\nmediastinal, or hilar lymphadenopathy by CT size criteria. The heart is\nstructurally normal and there is no pericardial effusion.  There is a cardiac\npacemaker in place. 5 mm right upper lobe ground-glass pulmonary nodule is\nnonspecific. The lungs are otherwise clear without parenchymal or interstitial\nabnormality. The airways are patent. There are no concerning pulmonary\nnodules. There is no pneumothorax or pleural effusion.\n\nThe esophagus and visualized upper abdominal organs are remarkable only for a\nstable hemangioma in the anterior aspect of the left lobe of the liver.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No pulmonary embolism or acute aortic abnormality.  No acute process in the\nchest."
        },
        {
            "input": "There is no filling defect within the pulmonary arterial tree to suggest the\npresence of a pulmonary embolism. The thoracic aorta is normal in course and\ncaliber without evidence of dissection. There is no lymphadenopathy. The\nairway is centrally patent. No pleural or pericardial effusion is seen. The\nimaged portion of the thyroid gland is unremarkable.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  A\nperifissural nodule in the right lower lung on series 2, image 41 measuring 4\nmm likely represents an intrapulmonary lymph node. Mild basilar atelectasis is\nnoted.\n\nThe imaged portion of the upper abdomen is unrevealing. Incidental note is\nmade of a replaced left hepatic artery which arises from the celiac trunk and\ngives rise to the left gastric artery.\n\nBones: Unremarkable.",
            "output": "No pulmonary embolism or other acute process in the chest."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the proximal\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is mildly enlarged.  No pericardial\neffusion..  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is scattered bilateral areas of ground-glass with\nperipheral predominance.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout with\nlobular contour..  There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis collapsed without surrounding fat tissue stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Bilateral ground-glass opacification with peripheral predominance,\nconcerning for COVID-19.  Other viral pneumonias can have similar radiological\nappearance.\n2. Otherwise, no acute findings in the chest, abdomen or pelvis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is atelectasis in the right lower lobe superiorly.  A 4\nmm subpleural nodule in the left upper lobe is stable since at least ___. \nThe lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for cholelithiasis.\nThere is also a small hiatal hernia.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar or segmental\npulmonary arteries.  Subsegmental branches are suboptimally opacified.  The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Minimal\nsubsegmental atelectasis is noted at the dependent portions of both lungs. \nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nNote is made of gas within the spinal canal, likely from recent epidural\ncatheter placement.",
            "output": "1. No evidence of pulmonary embolism within the main, right, left, lobar or\nsegmental pulmonary arteries.\n2. No evidence of active lung disease."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged although sub cm\naxillary nodes are numerous bilaterally.  There is no soft tissue abnormality\nin the chest wall suspicious for malignancy.  This study is not appropriate\nfor subdiaphragmatic diagnosis but shows no adrenal mass.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Hypoattenuation of cardiac contents is often an indication of\nmyeloma.  Small intra cardiac calcification in the left ventricle is probably\ndystrophic calcification in the papillary papillary muscle and could indicate\nremote infarction.  Evaluation of enlarged heart chambers requires dedicated\ncardiac imaging such as echocardiography.  Small pericardial and non\nhemorrhagic, layering pleural effusions are present.\n\nAscending thoracic aorta and pulmonary arteries are borderline enlarged. \nBrachiocephalic artery, the not calcified, is generally enlarged, 2 cm across.\n\nMeasurable lymph nodes are present in all mediastinal stations, most in the\nsub cm range,, but 12 mm in the left lower paratracheal and 13 mm in the\nprevascular station at the level of the aortopulmonic window.  There is\nprobably equivalent size right hilar lymph node enlargement,, not measurable\non this noncontrast study.  Bronchi are not compromised.\n\nSmall hiatus hernia contains a radio-opaque capsule.  Above that level the\nesophagus is not distended.\n\nEmphysema is mild.\n\n5 mm ring shadow in the right middle lobe, 5:226 is probably inflammatory\nperibronchial thickening.  There is no lung nodule.  Mild thickening of\ninterlobular septi at the lung bases is of uncertain chronicity, could be the\nvestiges of acute edema or remote episodes of edema.\n\nThere are no bone lesions suspicious for infection or malignancy.  Should be\nnoted that MR imaging is more sensitive in detection of myeloma lesions than\nchest CT.",
            "output": "No lung lesion corresponding to left lung nodule questioned in the report of\n___ chest radiograph.  This is probably the left nipple.\n\nMild central adenopathy can sometimes be seen with acute or chronic congestive\nheart failure.  No evidence of intrathoracic malignancy.\n\nProbable anemia.\n\nMild emphysema.\n\nDystrophic calcification left ventricular papillary muscles could be due to\nremote myocardial infarction.\n\nMild to moderate cardiomegaly, bilateral pleural effusions pericardial\neffusion and septal thickening, indicate cardiac insufficiency, chronicity\nindeterminate.\n\nSmall hiatus hernia may interfere with swallowing function."
        },
        {
            "input": "Thyroid is unremarkable.  Numerous small mediastinal lymph nodes are notable\nfor number but are not pathologically enlarged and unchanged from before. \nThoracic aorta and main pulmonary arteries are normal size.  Calcification of\nthe left ventricular papillary muscle is again noted which may reflect remote\nmyocardial infarct.  Aortic valve calcification is mild.  Blood pool is lower\nin density than the myocardium, which may reflect anemia.  Pericardial\neffusion is small.  Heart is mildly enlarged.\n\nAerosolized secretion is noted in the trachea.  Airways are patent to\nsubsegmental levels.  Mild pulmonary emphysema is noted.  There is no pleural\neffusion.  No consolidation is identified.\n\nThere is distal esophageal diverticulum or hiatal hernia with air-fluid level,\nunchanged.  Limited evaluation of upper abdomen is unremarkable.  A small\nlucent lesions in the lateral left sixth rib (02:37) and anterior left seventh\nrib (02:52) are unchanged.",
            "output": "1. No evidence of infection is identified.\n2. Prominent mediastinal lymph nodes are unchanged.\n3. Probable anemia.\n4. Mild emphysema.\n5. Epiphrenic esophageal diverticulum or small hiatal hernia is unchanged."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No calcification in the head neck\nvessels.  Thyroid gland is homogeneous without discrete nodule.  There is no\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Soft tissue the\nchest wall unremarkable without evidence of metastatic involvement.\n\nUPPER ABDOMEN: Please see separate, same-day CT abdomen and pelvis report for\nfurther description of subdiaphragmatic findings.\n\nMEDIASTINUM: Multiple prominent style lymph nodes, unchanged from prior study,\nare not pathologically enlarged.\n\nHILA: No pathologically enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is mildly enlarged.  Hypoattenuation of the blood\npool may reflect anemia.  Calcification of the left ventricle papillary muscle\nmay reflect remote myocardial infarction.  Otherwise, no coronary arterial\ncalcification.  Mild aortic valve annular calcification.  Small nonhemorrhagic\npericardial effusion has mildly increased since prior study.\n\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular emphysema.  No confluent airspace\nconsolidation.  No new or enlarging pulmonary nodules or masses.  No diffuse\nlung disease.\n2. AIRWAYS:  Mild aerosolized secretions within the trachea.  Otherwise, I\nairways are patent to the subsegmental level bilaterally.\n3. VESSELS:  Aorta and pulmonary arteries are normal size.\nCHEST CAGE: Bones of the chest cage are unremarkable without lesions\nsuspicious for malignancy or infection.\n\nSPINE:  No osseous lesions suspicious for malignancy or infection.  No lytic\nlesions identified.  Mild-to-moderate degenerative changes of the visualized\nspine.",
            "output": "1. No evidence of intrathoracic malignancy or infection.  Stable prominent\nmediastinal lymph nodes.\n2. Mild centrilobular emphysema."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nNo pericardial pleural effusion is seen.  Image portion of the upper abdomen\ndemonstrate prior cholecystectomy and otherwise no appreciable abnormalities. \nThe demonstrated within the limitations of the study technique that was not\ndesigned for assessment of intra-abdominal pathology.\n\nAirways are patent to the subsegmental level bilaterally.  Right middle lobe\nand right lower lobe minimal ground-glass opacities are present at the level\nof the basis with minimal ground-glass seen at the level of previously\nsuspected pulmonary nodule but with no discrete nodule present.  No specific\npulmonary nodules masses or consolidations seen.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "No pulmonary nodule demonstrated in this location suspected on the previous\nstudy.  Evidence of minimal ground-glass in this area might be consistent with\nresolving inflammation/ infection.\n\nNo other abnormalities demonstrated."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcifications are present primarily in\nthe LAD distribution.  Otherwise the heart, pericardium, and great vessels are\nwithin normal limits.  There is a small pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple nonenlarged mediastinal lymph nodes\nare demonstrated.  No axillary, mediastinal, or hilar lymphadenopathy is\npresent.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild bronchiectasis, atelectasis, and peribronchovascular\nopacities are demonstrated in the right middle lobe likely reflecting\ninfectious versus inflammatory process.  Otherwise the lungs are clear without\nmasses or areas of focal consolidation.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is unremarkable.  No supraclavicular lymphadenopathy\nis present.\n\nABDOMEN:  Included portion of the upper abdomen is notable for an accessory\nsplenule medial and inferior to the spleen, as well as a thickened left\nadrenal gland without focal nodularity identified.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild focal right middle lobe bronchiectasis atelectasis, and\nperibronchovascular opacities suggestive of infectious versus inflammatory\nprocess, possibly atypical pneumonia.\n3. Small pericardial effusion."
        },
        {
            "input": "10 x 15 mm left axillary node, 02:10, was 10 x 18 mm on ___. An\nadjacent 6 x 13 mm node, 02:14, was 11 x 19 mm last year. The same is true for\nsimilar size right axillary nodes, all stable or smaller and it is generally\ntrue that though enlarged nodes have substantial hilar fat, an indication of a\nbenign diagnosis. Supraclavicular lymph nodes are not enlarged and there are\nno soft tissue abnormalities in the imaged chest wall suspicious for\nmalignancy. This study is not designed for subdiaphragmatic diagnosis but\nshows there is no adrenal mass or heterogeneity in the imaged portions of the\nsuboptimally liver. Evaluation of the breasts would require mammography.\n\n9 mm nodule or cyst in the right thyroid lobe was 11 mm in ___, and does\nnot warrant further evaluation the absence of growth.\n\nAtherosclerotic calcification is not evident. Aorta, pulmonary arteries common\ncardiac chambers are normal size. There is no pleural or pericardial\nabnormality.\n\nPatient has had a superior segment sparing right lower lobectomy. The right\nhilus and operative site of a normal postoperative appearance. Small region of\nscarring with bronchiectasis in the right lower lung anteriorly, 4:149 and\nbronchiectasis probably in the right middle lobe superior segment of the lower\nlobe, 4:150- 167, are stable for at least ___ year. Lungs are otherwise clear\nand the tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of new or recurrent intrathoracic malignancy."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion.\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE:\nPatient has had a superior segment sparing right lower lobectomy. The right\nhilus and operative site of a normal postoperative appearance. Small region of\nscarring with bronchiectasis in the right lower lung anteriorly, and small\nbronchiectasis in the right middle lobe and right lower lobe, are stable for\nat least ___ year. Lungs are otherwise clear and the tracheobronchial tree is\nnormal to subsegmental levels.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, nonobstructing left 1 mm renal stone unchanged.  The upper abdomen\nis otherwise unremarkable.",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "The thyroid gland is unremarkable.  Scattered prominent axillary lymph nodes\nare identified but these have normal fatty hila and are not enlarged by CT\nsize criteria.  There is no supraclavicular, mediastinal, or hilar\nlymphadenopathy.  The calibers of the aorta and pulmonary artery are normal. \nThe heart is mildly enlarged.  There is no pericardial effusion.\n\nThe airways are patent to the subsegmental level.  Patient is status post\nsuperior segment sparing right lower lobectomy.  There appears to be slightly\nincreased soft tissue at the bronchial stump and at least 2 locations (5:176,\n190) compared to the prior study.  3 mm nodule in the right upper lobe (5:101)\nis unchanged since ___.  Pleural based nodules in the posterior left\nlower lobe (5:130, 166) are new since the prior study and could reflect areas\nof nodular atelectasis.  Other tiny 1-2 mm nodules are also unchanged since\nthe prior study (5:144, 177).  No large consolidation, pleural effusion, or\npneumothorax is identified.\n\nThe study is not designed for evaluation of subdiaphragmatic structures but\nthe limited included views of the upper abdomen demonstrate bilateral\nnonobstructing renal calculi.\n\nNo suspicious lytic or sclerotic lesion is identified.",
            "output": "Slightly increased soft tissue at the right lower lobe lobectomy bronchial\nstump.  Short-term follow-up CT is recommended in 3 months to assess for\ninterval change.  Scattered nodules are stable.\n\nRECOMMENDATION(S):  Short term follow-up CT chest is recommended in 3 months"
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are normal in\ndiameter.  Heart size is normal.  There is no appreciable pericardial pleural\neffusion.\n\nImage portion of the upper abdomen demonstrate nonobstructing right kidney\nstones, multiple.\n\nAirways are patent to the subsegmental level bilaterally.  There are no new\npulmonary nodules masses or consolidations.  Overall there is no evidence of\ninfectious process.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nThe patient is after right lower lobe partially sparing lobectomy with stable\nappearance of the stump and no evidence of local recurrence.",
            "output": "Stable postsurgical appearance of the chest with no evidence of active\nintrathoracic infection or malignancy."
        },
        {
            "input": "The thyroid is unremarkable.  There is no axillary, supraclavicular, or\nmediastinal adenopathy.  Heart size is normal.  There is no pericardial\neffusion.  Thoracic aorta and main pulmonary trunk are normal in caliber. \nThere is minimal atherosclerotic disease.  There are no coronary artery or\naortic valvular calcifications.\n\nPostsurgical changes from superior segment sparing right lower lobectomy are\npresent.  Airways are otherwise unremarkable.\n\nSoft tissue density at the inferoposterior aspect of the surgical site\nlocations has mildly increased compared to ___, measuring up to 10 mm,\npreviously 8 mm (series 5, image 174).  Additionally, there is a new 5 mm\nright middle lobe perifissural nodule (series 5, image 150).  4 mm right\napical pulmonary nodule is stable as are other small pulmonary nodules (series\n5, image 93, 172).  There is no pleural effusion or pneumothorax.  There is no\nfocal lung consolidation.\n\nThe thoracic esophagus is unremarkable.  Superficial soft tissues are normal. \nLimited views of the upper abdomen demonstrate calcification in the spleen,\nlikely from prior granulomatous infection.  There are bilateral non\nobstructing renal calculi.\n\nThere are no suspicious bony lesions.",
            "output": "1. Continued increased soft tissue adjacent to the right lower lobectomy\nsurgical site compared to prior.\n2. New 5 mm perifissural right middle lobe pulmonary nodule, attention on\nfollow-up imaging.  Other pulmonary nodules are stable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is grossly\nhomogeneous.  There is no axillary lymphadenopathy.  No supraclavicular\nlymphadenopathy is seen.\n\nUPPER ABDOMEN: Partially imaged kidneys demonstrate punctate bilateral\nnonobstructing renal calculi.  Subtle 4 mm hypodensity seen in segment 4A/8 of\nthe liver on series 2, image 51 is too small to further characterize, but\nlikely stable as compared to ___, and may represent a cyst. \nPunctate splenic calcification likely relates to prior granulomatous disease.\n\nMEDIASTINUM: No mediastinal lymphadenopathy or mass is seen.\n\nHILA: Again seen are postsurgical changes status post superior segment sparing\nright lower lobectomy. There appears to be continued very subtle slight\nincrease in soft tissue at the surgical site, along the inferoposterior\naspect.  Otherwise, no hilar adenopathy seen.\n\nHEART and PERICARDIUM: Very trace pericardial fluid is seen.  Thyroid is\nnormal in configuration.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: New since the prior studies is cluster of small nodular\nopacities opacities in the left upper lobe, series 4, image 90, suggesting\nsmall aiways infection or inflammation.  On series 4, image 87, there is a 5\nmm lateral left upper lobe pulmonary nodule which may relate to the above\ncluster of nodules or may be a new separate pulmonary nodule.  The previously\ndescribed 5 mm right middle lobe perifissural nodule has decreased in size,\nnow measuring 3 mm, and is less conspicuous on the current study, series 4,\nimage 119. Right perifissural atelectasis is seen on series 4, image 106. \nMinimal biapical pleural thickening/scarring is re-demonstrated.\n\n1. AIRWAYS:  Again seen are postsurgical changes status post superior segment\nsparing right lower lobectomy. There appears to be continued very subtle\nslight increase in soft tissue at the surgical site, along the inferoposterior\naspect.  Areas are otherwise unremarkable.\n2. VESSELS:  Aorta is normal course and caliber.  There are minimal\natherosclerotic changes along the aorta.",
            "output": "New cluster of nodular opacities in the left upper lobe suggests small airways\ninfection or inflammation.Attention at followup.\n\nContinued slight increase in soft tissue adjacent to the right lower lobectomy\nsurgical site.\n\nPreviously described 5 mm right middle lobe perifissural nodule has decreased\nin size, now measuring 3 mm, is less conspicuous on the current study.\n\nNOTIFICATION:  Findings submitted to radiology critical findings dashboard"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathy in the thoracic inlet.\n No abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: The limited sections of the upper abdomen show hypodense 8 mm\nnodule in the right hepatic lobe, unchanged, likely represents a cyst. \nBilateral kidney stones.  No adrenal lesions.\n\nMEDIASTINUM: Esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by size criteria, measuring up to 5 mm.  No apparent\nhilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.  Mild bilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Mild centrilobular emphysema.\nUnchanged superior segment sparring right lower lobectomy with stable soft\ntissue surrounding suture lines.\nMicronodule in the middle lobe (5:122), unchanged since ___.\nMild reticular opacities in the left lung base may represent scarring.\n2. AIRWAYS: Unremarkable right lower bronchus stump.\n3. VESSELS: Mildly enlarged pulmonary arteries.\nCHEST CAGE: Diffuse osteopenia.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.",
            "output": "Stable postoperative appearance of superior segment sparing right lower\nlobectomy with unremarkable bronchus stump.\n\nPreviously mentioned perifissural nodule in the middle lobe is no longer seen\nand likely represented a lymphoid aggregate.\n\nPulmonary arteries are mildly enlarged.  This could be related to pulmonary\nhypertension but is also seen in healthy assymptomatic patients."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nNo incidental thyroid Findings.  Axillary lymph nodes are stable in\nappearance.  No atherosclerotic calcifications in the head and neck arteries. \nThe visualized portions of chest wall show no abnormal Findings, however,\nassessment is not complete because is out of the field with.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  No mediastinal or hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  There are no atherosclerotic\ncalcifications in the coronary arteries, cardiac valves or aorta.  Aorta and\npulmonary artery are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nUnremarkable appearance of the right lower lobe bronchus stump, otherwise the\nairways are patent to the subsegmental level.  There is no pleural effusion or\nthickening.  Re-demonstrated mild upper lobe predominant emphysema.  Right\nlower lobe lobectomy with sparing of the superior segment postsurgical changes\nand adjacent soft tissues are stable in appearance since at least ___. \nA right middle lobe micronodule visualized on previous studies has resolved. \nNo new or growing nodules.  No bronchial wall thickening, bronchiectasis or\nmucus plugging.\n\nSubpleural interstitial reticular opacities visualized predominantly in the\nleft lower lobe (4:209) but also in and lesser extent in the lingula and right\nmiddle lobe (4:181) have substantially progressed in the interval, and are\nconcerning for progressing interstitial lung disease.  The reason of\nasymmetric presentation is probably secondary to the right lower lobe\nlobectomy.\n\nCHEST CAGE:\nGeneralized moderate diffuse osteopenia is stable in appearance.  There are no\nacute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Substantial progress in the subpleural reticulations of basilar predominant\ninterstitial lung disease.\n\nOverall stability of the postsurgical lower lobe lobectomy changes since at\nleast ___.\n\nRight middle lobe micronodule resolution in the interval."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal. No\nsupraclavicular or infraclavicular lymphadenopathy.  Unchanged prominent\naxillary lymph nodes measuring up to 15 mm on the right, but with fatty hila\nand no other pathological features.  No atherosclerotic calcification of the\nhead and neck vessels.\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.\n\nMEDIASTINUM/HILA: No mediastinal mass or lymphadenopathy. No hilar mass or\nlymphadenopathy.  Esophagus is normal.\n\nHEART and PERICARDIUM: Cardiac size is normal.  Punctate calcification of the\nLAD.  The aortic valves and annulus are noncalcified. No pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Mild upper lobe predominant centrilobular emphysema.  New\nsided-side or conglomerate 8-9 mm right upper lobe pulmonary nodule(s). \nStatus post right lower lobe segmentectomy with unchanged appearance of the\nright lower lobe stump.  Prior reticulated opacities predominantly within the\nleft lower lobe, but also lingula and right middle lobe are persistent but\nmildly improved.  Several millimetric nodules are unchanged, for example (5:\n36, 152, 224).  No new or growing nodules. No new consolidations.  No\nsuspicious pulmonary nodules.\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber.\n\nCHEST CAGE: Diffuse osteopenia.  No pathologic or compression fractures or\ndestructive bone lesions.  Bone island in the manubrium unchanged since at\nleast ___.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.\n\nUPPER ABDOMEN:\nPlease refer to dedicated CT abdomen pelvis report from the same day for\ndetails of intra-abdominal findings..",
            "output": "1. Prior reticulated opacities predominantly within the left lower lobe, but\nalso lingular and right middle lobe are similar to mildly improved.\n2. New 8-9 mm right upper lobe nodularity.  Please see recommendations below. \nNo interval growth of existing millimetric pulmonary nodules.\n3. No new consolidations.\n4. Status post right lower lobe segmentectomy with stable appearance around\nthe suture line.\n\nRECOMMENDATION(S):  Repeat CT chest in 3 months."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for breast imaging.  No soft tissue abnormality\nelsewhere in the chest wall.  This study is not appropriate for\nsubdiaphragmatic diagnosis.  It shows no adrenal mass or subphrenic\ncollection.  Imaging of the abdomen which today shows multiple small\ncalcifications and low-density areas in the kidneys was last provided by a CTU\non ___.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels and only minimal in left anterior\ndescending coronary artery.  Aorta and pulmonary arteries and cardiac chambers\nare normal size and small pericardial effusion unchanged since at least ___ is probably physiologic.  Slight increase in the bulk of the\nthymus is probably reactive.  It does not have masslike features\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing. .\n\nLUNGS, AIRWAYS, PLEURAE: Right hilum and bronchial stump have a normal\npostoperative appearance following segmentectomy, including minimal ectasias\nof segmental bronchi in the postop lower lobe.\n\n3 mm right upper lobe nodule, 4:77, is unchanged.  Previous 8 mm right upper\nlobe nodule has resolved.  There are no new or growing lung nodules.\n\nMild subpleural interstitial abnormality is predominantly in the left lower\nand also right middle lobes improved in the left lower lobe since ___.\nThere are no findings to suggest fibrosis.\n\n\n\nCHEST CAGE: No evidence of infection or malignancy.",
            "output": "No evidence of infection or malignancy.\n\nMild non fibrosing interstitial pulmonary abnormality improved since ___."
        },
        {
            "input": "Moderately enlarged.  Left thyroid lobe.  Status post sternotomy.  Left\npectoral pacemaker in place.  Status post CABG.  Moderate calcifications of\nthe ascending aorta, minimal calcifications of the aortic arch and the\ndescending aorta.  Approximately 1 cm above the valvular level, the ascending\naorta has a diameter of 3 cm.  At the same level, the descending aorta has a\ndiameter of 22 mm.  The pulmonary trunk has a diameter of 20 mm.  The aortic\nvalve is massively calcified.  Normal ___ of the heart.  No pericardial\neffusion.  No evidence of supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged lymph nodes at the level of the hilar or in the\nmediastinum.  Normal posterior mediastinum.  No relevant findings in the upper\nabdomen, with the exception of a status post cholecystectomy.  No evidence of\nosteolytic lesions at the level of the ribs and the vertebral bodies. Status\npost sternotomy and post sternotomy changes.\n\nMinimal irregularities of the airways, suggesting mild chronic airways\ndisease. The airways, however, are patent. Normal attenuation of the lung\nparenchyma.  No evidence of focal or diffuse lung disease.  Minimal areas of\natelectasis at the left lung basis.  No evidence of suspicious lung lesions. \nNo pleural thickening, no pleural effusions.  No interstitial abnormalities.",
            "output": "Mild calcifications of the ascending aorta, which as a normal diameter. \nSevere aortic valve calcifications.  Status post CABG with typical sternal and\nmediastinal changes.  The lung parenchyma is unremarkable, without evidence of\nacute or chronic lung disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: No subdiaphragmatic pathology identified.\n\nMEDIASTINUM: The patient is status post CABG and central sternotomy. \nSternotomy wires in situ.  No wire fracture.  There is incomplete ___ of the\nmanubrium of the sternum (series 3, image 16).  The body of the sternum is\nwell opposed.  Small fluid collection seen in the anterior mediastinum deep to\nthe sternum (series 3, image 21) measuring 12 mm in diameter.  There also a\nsmall collection measuring 15 x 20 mm anterior to the superior aspect of the\nmanubrium (series 5, image 51).  It is difficult to assess for infection\nwithout contrast.  No gas locules are noted.  No prior cross-section imaging\navailable to correlate with this is decreasing or increasing in size.  No\nclear fistulous tract identify.\n\nNo mediastinal adenopathy.\n\nHILA: No obvious hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: Patient is status post CABG.  Severe calcification of\nthe native coronary arteries.  Trace pericardial fluid.\n\nPLEURA: Loculated left pleural effusion being present in the left major\nfissure, dependently, nondependent (series 5, image 106) as well as\nsubpulmonic.  No right pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA:  Mild emphysema.  Airspace opacification in the left lower lobe\nmost likely represent atelectasis, but infection cannot be excluded without\ncontrast.  A few millimetric pulmonary nodules (series 5, image 128, 145, 33)\nare nonsuspicious.\n2. AIRWAYS:  The major airways are patent.\n3. VESSELS:  The pulmonary arteries not enlarged.  Fusiform dilatation of a\nright lower lobe pulmonary vein/artery (series 5, image 151) difficult to\nassess without contrast, most likely of no clinical significance.\nCHEST CAGE: Patient is post sternotomy as described above.  Marked\ndegenerative changes of the thoracic spine.",
            "output": "1.  Slight cortical offset of the manubrial osteotomy, which may be within\nnormal limits.  The body of the sternum is well opposed.\n2.  A small fluid collection in the anterior mediastinum deep to the sternum\nas well as a small fluid collection anterior to the manubrium sternum, as\ndescribed above.  Evaluation for infection is limited without contrast.  No\ngas locules to suggest infection.\n3.  Loculated left pleural effusion.  Suspected associated left lower lobe\natelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Punctate hyperdensities adjacent to the anterior aortic\narch correspond to areas of calcification as seen on recent noncontrast CT\nchest dated ___ (301:53, 55).  Patient is status post CABG. \nSevere calcifications of the native coronary arteries are again seen.  Trace\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: A loculated left pleural effusion in the major fissure is\nslightly decreased in size compared to ___.  Trace dependent  left\npleural effusion is unchanged.\n\nLUNGS/AIRWAYS: The mild left basilar atelectasis.  Multiple millimetric\npulmonary nodules are not substantially changed compared to prior exam\n(301:18, is the 93, 106).  Tiny left upper lobe granuloma is also unchanged\n(301:78).  There is mild predominantly centrilobular emphysema.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Postsurgical changes of a median sternotomy are again demonstrated. \nThere is stable appearance of a likely small amount of substernal hemorrhage\n(602:31, 301:62).  No evidence of a rim enhancing fluid collection.  No\naggressive osseous lesions are identified.  Multilevel degenerative changes of\nthe thoracic spine are not substantially changed.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Interval decrease in size of the loculated left pleural effusion in the\nmajor fissure with stable appearance of trace dependent left pleural fluid.\n3. Trace pericardial effusion.\n4. Postsurgical changes of a CABG with severe calcification of the native\ncoronary arteries."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Ill-defined partially wedge-shaped hypodensity at the superior aspect\nof the spleen measures 2.6 x 2.3 cm (2:99).  It is not associated with\nadjacent perisplenic fluid.  No active extravasation.  The spleen otherwise\ndemonstrates normal size and attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: Nondisplaced posterior rib fractures involving the left second, third,\nfifth, and sixth ribs are noted (03:11, 18, 38, 46). Multilevel Schmorl's\nnodes in the thoracic and lumbar spine are noted. No focal suspicious osseous\nabnormality.\n\nSOFT TISSUES: Subcutaneous stranding noted overlying the left iliac wing\nwithout frank hematoma.  The abdominal and pelvic wall is otherwise within\nnormal limits.",
            "output": "1. Multiple nondisplaced posterior rib fractures are noted in the left second,\nthird, fifth, and sixth ribs.  No pneumothorax.\n2. Ill-defined hypodensity the superior aspect of the spleen measures up to\n2.6 cm and has an appearance of a splenic infarct, although in the setting of\ntrauma a splenic laceration cannot be entirely excluded.  No perisplenic nor\nintra-abdominal fluid."
        },
        {
            "input": "CHEST:  Patient is intubated with the endotracheal tube tip located\napproximately 4 cm above the carina.  An orogastric tube extends along the\nthoracic midline with its tip at the level of the gastroesophageal junction. \nThe thoracic aorta opacifies normally without significant atherosclerosis. \nThere is no aortic dissection or aneurysm.  The main pulmonary artery is\nnormal in caliber without signs of central pulmonary embolism.  There is no\nadenopathy or mediastinal hematoma.  The heart is mildly enlarged without\npericardial effusion.\n\nThere is significant consolidation in the right upper lobe and right lower\nlobe likely reflecting aspiration.  Aspirated material noted within the right\nsided central bronchi.  Left-sided aspiration is also noted to a lesser\nextent, posteriorly.  Mild ground-glass opacity in the left upper lobe is\nnonspecific.  No pneumothorax.  No large effusion.\n\nABDOMEN:  The liver appears intact and without focal abnormality.  The main\nportal vein is patent.  There is mild periportal edema.  The spleen is normal.\nThe gallbladder, pancreas and both adrenal glands appear normal.  The kidneys\nenhance symmetrically without focal abnormality.  There is no excretion of\ncontrast noted from either kidney.  The abdominal aorta and major branches\nappear widely patent with minimal atherosclerosis.  No retroperitoneal\nhematoma or adenopathy.  No free air or free fluid.\n\nThe stomach and duodenum appear normal.  Of note, the orogastric tube\nterminates at the level of the GE junction.  No definite CT signs of shock\nidentified.\n\nPELVIS:  Loops of small bowel demonstrate no signs of ileus or obstruction. \nNo signs of mesenteric or bowel injury.  The appendix is normal.  The colon is\nthin walled with diverticulosis.  A rectal catheter is in place.  Streak\nartifact through the pelvis from bilateral hip replacement noted.  Fat\ncontaining inguinal hernias, left greater than right noted with high riding\nleft testicle noted.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "1. Appropriately positioned endotracheal tube. OG tube terminates at the GE\njunction.  Advancement is recommended for more optimal positioning.\n2. Extensive bilateral lung consolidation likely reflecting the sequelae of\naspiration.\n3. No acute sequelae of trauma.\n4. Additional nonemergent findings as described above.\n\nNOTIFICATION:  Findings discussed in person with the trauma team."
        },
        {
            "input": "The thoracic aorta is normal in caliber with mild atherosclerotic\ncalcifications along its course. The three-vessel takeoff demonstrates patent\nvessels with no significant atherosclerotic calcifications at their origins.\n\nEvaluation of the bilateral lower lobe subsegmental pulmonary arteries is\nlimited by respiratory motion. No filling defect is seen to the segmental\nlevel to suggest pulmonary embolism. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nSupraclavicular, axillary, mediastinal, and hilar lymph nodes are not enlarged\nby CT size criteria.\n\nCoronary artery calcifications in the LAD are of unknown hemodynamic\nsignificance. There is no evidence of pericardial effusion.\n\nThe previously seen right thyroid nodule it is not well visualized on this\nstudy due to streak artifact from the contrast bolus.\n\nAgain noted is panlobular emphysema with lower lobe predominance. Subpleural\nopacity with a coarse calcification in the superior segment of the left lower\nlobe (06:35), an ill-defined nodular opacity in the peripheral left upper lobe\n(6:85), and a 6 mm ground-glass nodule in the right upper lobe (6:103) are all\nstable since ___.  A 5 mm right upper lobe nodule (6:63) is not\nclearly seen on the prior studies from ___ and ___.  There is\nbi-apical pleuroparenchymal scarring. Small nodular opacity in the right lower\nlobe (5:83) may represent small focus of aspiration given areas of mucus\nplugging in the right lower lobe bronchioles.  Central airways are patent.  No\nconsolidation is identified.\n\nThere is moderate to severe stenosis at the origin of the celiac artery\nspanning 12 mm with post-stenotic dilation (9:90). Otherwise, the imaged upper\nabdomen is unremarkable.\n\nNo bone finding suspicious for infection or malignancy is identified. A\nnon-aggressive appearing sclerotic focus in the left ___ eighth rib\n(5:125) is unchanged.",
            "output": "1. No acute aortic pathology or pulmonary embolism.\n2. 5 mm right upper lobe nodule, not clearly seen on prior studies. Followup\nwith dedicated chest CT is recommended in 6 months.  Additional pulmonary\nnodules are stable since at least ___.\n3.  Small focal right lower lobe aspiration.  No consolidation.\n4. Panlobular emphysema with lower lobe predominance, typically seen in alpha\n1 antitrypsin deficiency, but per the medical record, there is no history of\nthis.\n5. Moderate to severe stenosis at the origin of the celiac axis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows normal-size\nadrenal glands.  Hiatus hernia is small.\n\nThyroid is unremarkable.  Atherosclerotic calcification is minimal in head\nneck vessels, substantially more severe in the coronaries in at least the left\nanterior and right coronary branches.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  Pericardium is physiologic.  Mediastinal\nnodes are not enlarged, hilar contours do not suggest lymph node enlargement\nnor is there adenopathy in the internal mammary, retrocrural, or diaphragmatic\nspaces.\n\nPanacinar emphysema is severe, and lower lung predominant.  2 previous tiny\nright upper lobe lung nodules have resolved.  Left lower lobe collapse is new,\nwith mild retention of secretions but no obstructing mass.  Patient may have\naspirated.\n\nSevere tracheomalacia was demonstrated during the expiratory phase of previous\nimaging at deep inspiration on today's study the central airways are patent.",
            "output": "2 previous right upper lobe nodules of resolved.  No evidence of intrathoracic\nmalignancy.\n\nNew left lower lobe collapse probably due to aspiration or retained\nsecretions.  Severe tracheal malacia may be contributory.\n\nSevere panacinar emphysema.\n\nNo pulmonary hypertension.\n\nCoronary atherosclerosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged.\nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows normal-size\nadrenal glands.  Hiatus hernia is small.\n\nThyroid is unremarkable.  Atherosclerotic calcification is minimal in head\nneck vessels, substantially more severe in the coronaries in at least the left\nanterior and right coronary branches.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  Pericardium is physiologic.  Mediastinal\nnodes are not enlarged, hilar contours do not suggest lymph node enlargement\nnor is there adenopathy in the internal mammary, retrocrural, or diaphragmatic\nspaces.\n\nPanacinar emphysema is severe, and lower lung predominant.  Multiple \nsubcentimeter nodules with surrounding ground-glass involving the upper lobes\nbilaterally including image 80, 70, 58, 44 all in series 5 are new.  These can\nrepresent mild multifocal bacterial or viral infection.  Left upper lobe sub\nsolid nodule (5:98) measuring 14 x 8 mm has not substantially increased since\n___.  Previous left lower lobe collapse has resolved.\n\nMild increased concavity of the mid to lower thoracic vertebral body with\nslight increase in kyphosis likely related to osteoporosis.",
            "output": "New multifocal nodules in the upper lobes can be bacterial or viral infection.\nIf the findings persist, alternative diagnoses such as vasculitis can be\nconsidered.\n\nStable sub solid left upper lobe nodule dating back to ___.\n\nSevere panacinar emphysema in the lower lobes, suggestive of alpha-1\nantitrypsin deficiency."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged.\nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis but shows normal-size\nadrenal glands.  Hiatus hernia is small.\n\nThyroid is unremarkable.  Atherosclerotic calcification is minimal in head\nneck vessels, substantially more severe in the coronaries in at least the left\nanterior and right coronary branches.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.  Pericardium is physiologic.  Mediastinal\nnodes are not enlarged, hilar contours do not suggest lymph node enlargement\nnor is there adenopathy in the internal mammary, retrocrural, or diaphragmatic\nstations.\n\nPanacinar emphysema is severe, and lower lung predominant.  Previously\ndescribed subcentimeter upper lobe nodules with ground-glass halos in the\nright upper lobe have decreased or resolved, persistent 2 mm nodule in the\nright upper lobe series 4, image 68 has decreased from 4mm.  Left upper lobe\npart solid nodule (4:90) measuring 14 x 8 mm has increased in attenuation,\nalthough not substantially in size since ___ and has remained stable\nsince ___.  Diffuse bronchial wall thickening can be chronic airways\ndisease.\n\nStable of the mid to lower thoracic vertebral body with stable kyphosis likely\nrelated to osteoporosis.",
            "output": "Near complete resolution of previously described multifocal nodules can be\ntreated infection.  No new nodules or consolidation.\n\nPart solid nodule in the left upper lobe slowly increased in attenuation since\n___ and stable since ___ could still be an indolent low-grade\nneoplasm.  Given the slow growth of this lesion, ongoing follow-up CT thorax\nin no more than one year is suggested.\n\nSevere pan acinar emphysema, lower lung predominant.\n\nRECOMMENDATION(S):  Follow-up CT thorax in no more than one year to reassess\nleft upper lobe nodule."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion. \nCoronary calcifications are similar to prior.\n\nSevere panacinar emphysema, predominantly in the lower lungs, is similar to\nprior.  Compared with CT chest on ___, there is new left lower\nlobe collapse (3:127, 601b:33), with soft tissue density in the left lower\nlobe bronchus, however no definite mass visualized (3:119, 601b: 29).  The\nremainder of the airways are patent.  Diffuse bronchial wall thickening is\nsimilar to prior, and likely secondary to underlying chronic airway disease.\n\nA previously described 2 mm nodule in the right upper lobe has resolved. A 1.4\nx 0.8 cm part solid nodule in the left upper lobe is stable from ___, however has increased in attenuation since ___ (3:90).\n\nLimited images of the upper abdomen are unremarkable.\n\nDiffuse osteopenia, dextroscoliosis, and degenerative changes in the thoracic\nspine are similar to prior.  No lytic or blastic osseous lesion suspicious for\nmalignancy is identified.  Motion related artifact limits evaluation for\nfracture.",
            "output": "1. Left lower lobe collapse related to soft tissue density in the left lower\nlobe bronchus, with no definite enhancing mass visualized, likely represents\nmucous plugging, however bronchoscopy is recommended, that may both as\ndiagnostic (to rule out an endobronchial mass) as well as therapeutic.\n2. No evidence of pulmonary embolism or aortic abnormality.\n3. Severe panacinar emphysema with a lower lobe predominance, unchanged.\n4. 1.4 cm part solid nodule in the left upper lobe is unchanged since ___, and not significantly changed since ___, however has increased\nattenuation compared with ___.  Recommend follow-up CT in ___ year\n(___) for re-evaluation given stability since ___.\n\nRECOMMENDATION(S):\n1. Recommend bronchoscopy.\n2. Recommend follow-up CT in ___ for re-evaluation of left upper lobe\nnodule."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare present.  There is no appreciable pericardial effusion.  No mediastinal,\nhilar or axillary lymphadenopathy is present.\n\nLeft mediastinal shift is unchanged and related to complete collapse of the\nleft lower lobe, unchanged as compared to ___,\nprogressed substantially a since ___ and ___.  No\ndiscrete mass is demonstrated but substantial amount of secretions in the left\nlower lobe bronchus proximally is continuing to increase.  Trachea, rest of\nthe main airways are patent but containing substantial amount of secretions. \nAlso substantial amount of endobronchial secretions and bronchial wall\nthickening and more distally is associated with severe air trapping and\nsubstantial emphysema.  No appreciable pleural effusion is demonstrated\nneither on the right nor on the left.\n\nSubstantial interval improvement in the left lung consolidations is\ndemonstrated with only minimal residual opacities currently present, series 4,\nimage 99, 121.  On the other hand new opacities such is nodule in the right\nmiddle lobe, series 4, image 180, 8 mm and subpleural opacity in the right\nlower lobe, series 4, image 92 are present.  Giving the flow station and a\nrelatively short appeared of time repeated infection/ aspiration is most\nlikely possibility.\n\nLeft upper lobe ground-glass opacity with peripheral solid component, series\n4, image 97 is similar to previous examination.\n\nImage portion of the upper abdomen demonstrate no appreciable abnormality\nwithin the limitations of the study technique that was not designed for\nassessment of intra-abdominal pathology.\n\nNo new lytic or sclerotic lesions in the image portion of the skeleton\ndemonstrated.",
            "output": "Continues complete collapse of left lower lobe as described.\n\nImproved left lower lobe which new right lower lobe and right middle lobe\nopacities concerning for recurrent aspiration\n\nSevere bronchial secretions, bronchial wall thickening and focal areas of\nobstruction more distally associated with severe air trapping and severe\nemphysema.\n\nSolid/ ground-glass (mixed density) nodule in the left lower lobe, unchanged\nat least when compared to ___ but the solid component is new when\ncompared to ___.  The patient can continuous surveillance with\npotential reassessment in ___ months.  Alternatively, tissue diagnosis would\nbe suggested if clinically feasible."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No pathologic changes in the chest wall.  No hilar\nor mediastinal lymphadenopathy.  The visible hilar and mediastinal lymph nodes\nare normal to borderline in size (3, 24).  Severe bronchial wall\ncalcifications.  Moderate coronary and aortic wall calcifications.  Mild\ncardiomegaly.  No pericardial effusion.  No acute changes in the upper\nabdomen.  Mild dilatation of the right renal pelvis.  Moderate bilateral\npleural effusions.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  Mild bilateral apical scarring. Extensive\nbilateral lower lobe consolidations, additional consolidative foci are\nvisualized at the basis of the middle lobe and the lingular (5, 182).  Massive\npulmonary emphysema persists.  No convincing evidence for malignancy.",
            "output": "Borderline sized mediastinal lymph nodes.  New multifocal pneumonia. \nSubsequent areas of consolidations and opacities in the middle lobe, the\nlingular and the left and right lower lobe.  Accompanying moderate pleural\neffusions.  Moderate coronary and aortic wall calcifications."
        },
        {
            "input": "Tiny right thyroid nodule containing calcification is again noted.  The\nthoracic aorta is normal in course and caliber with mild calcification.  The\nheart is within normal limits of size.  The main pulmonary artery is normal in\ncaliber.  There is no filling defect within the pulmonary arterial tree to\nsuggest the presence of a pulmonary embolism.  There is no mediastinal or\nhilar adenopathy.  No axillary lymphadenopathy is seen.\n\nAs seen on same-day chest radiograph, there is a small right pneumothorax,\nwith a small right pleural effusion.  No signs of tension.  A right lower lobe\nmass is noted containing an area of central cavitation.  This mass measures\napproximately 8.0 x 3.9 x 3.8 cm.  There is near-complete collapse of the\nright lower lobe with extensive bronchial opacification extending into the\nright middle and lower lobe bronchus as well as the bronchus intermedius. \nThere is airspace consolidation in the right middle lobe and also in the right\nlower lobe abutting the aforementioned mass which is concerning for a\npostobstructive pneumonia.  Background of severe emphysema is noted.  There is\nchronic collapse of the left lower lobe.\n\nIn the imaged portion of the upper abdomen, no acute abnormality is\nidentified.\n\nBones:  No worrisome lytic or blastic osseous lesion.  No fracture.",
            "output": "1. Emphysema with newly conspicuous right lower lobe mass measuring up to 8 cm\nwith central cavitation, highly concerning for malignancy.\n2. No pulmonary embolism or acute aortic process.\n3. Persistent small right pneumothorax with small right pleural effusion.\n4. Extensive bronchial opacification with near complete collapse of the right\nand new airspace opacities in the right middle and lower lobe concerning for\npneumonia.\n\nNOTIFICATION:  D/w Dr. ___ at the time of initial review."
        },
        {
            "input": "The thyroid gland is within normal limits.  The esophagus is patulous and\nair-filled otherwise unremarkable.  The aorta demonstrates normal caliber\nthroughout the chest.  The aorta is moderately calcified.  The heart is mildly\nenlarged.  There is severe coronary artery calcification prominently affecting\nthe LAD.  There is a small pericardial effusion which is unchanged.  Scattered\nmediastinal lymph nodes are not pathologically enlarged by size criteria.\n\nThere is persistent mucous plugging of the entire right bronchial tree\nbeginning with the bronchus intermedius and and all bronchi leading to the\nright lower lobe (for example see series 5, image 139 as well as image 164). \nThere is persistent complete postobstructive collapse/ atelectasis of the\nright lower lobe lobe.\n\nAppearing centered within the anterior basilar segment of the right lower lobe\nis a 5.8 x 5.3 cm thick-walled air containing abscess (5, 172).  Nodular\nconsolidative opacities scattered throughout the right middle lobe are\nextensive and unchanged, concerning for sequelae of aspiration and/or\nsuperimposed infection.\n\nLeft lower lobe is entirely collapsed also due to extensive mucous plugging. \nPeribronchovascular consolidated nodularity within the inferior aspect of the\nleft upper lobe is unchanged from ___ but new since ___\n(5, 146), likely infectious.\n\nThere is a minimal persistent trace medial right lung base pneumothorax\n(series 3, image 27).  Right chest wall subcutaneous and deep soft tissue\nemphysema is noted, new since prior, consistent with recent right chest tube\nplacement.  The right pigtail pleural drain is seen within the right basilar\npleural space posterolaterally (series 3, image 35), alongside trace residual\nright pleural effusion.  There is no left pneumothorax.\n\nThere is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality.  Mild S-shaped scoliosis is unchanged.  The imaged thoracic\nvertebral bodies are normally aligned. There is moderate multilevel\ndegenerative change.  No concerning focal lytic or sclerotic osseous lesions\nare seen.\n\nThe partially imaged solid and hollow viscous organs of the upper abdomen are\nwithout acute focal abnormality on limited noncontrast evaluation.",
            "output": "1. No change in 6 cm right lower lobe abscess since at least ___.\n2. Severe mucous impaction, both bronchial trees beyond the upper lobe\nbronchi, responsible for bilateral lower lobe collapse and postobstructive\npneumonia in the right middle lobe.\n3. Small residual right basal pleural effusion and tiny loculated paraspinal\npneumothorax, right basal pigtail pleural drain in place.\n4. Severe coronary artery calcification.\n\n5. Severe emphysema.\n6. Small pericardial effusion unchanged.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:17 ___, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "The thyroid gland is within normal limits.  The esophagus is mildly patulous\nwith areas of intraluminal fluid fluid, including an air-fluid level in the\nmid thorax (3, 30), but otherwise unremarkable.  There is no hiatus hernia. \nThe aorta demonstrates normal caliber throughout the chest.  The aorta is\nmildly calcified along its descending portion.  The pulmonary artery is normal\nin caliber.  The heart is mildly enlarged.  There is severe coronary artery\ncalcification most prominently affecting the LAD.  Small pericardial fusion is\nunchanged.  Scattered mediastinal lymph nodes are not technically\npathologically enlarged.\n\nRe-identified is extensive proximal medial basilar segmental airway mucous\nplugging (see series 3, image 33) with distal postobstructive collapse of the\nmedial basilar segments of the left lower lobe.  The anterior and possibly the\nlateral segment of the left lower lobe appears aerated.  On the right, there\nis a similar appearance of mucous plugging of the very proximal medial and\nlower lobe airways as well as the basilar trunk and more distal basilar\nsegmental airways (see series 3, image 32 and 33).  Mucous plugging also\ninvolves the airway branches to the right middle lobe.  There is complete\ncollapse of the right lower lobe which is unchanged.  Although assessment is\ndifficult in the absence of IV contrast, there is no appreciable interval\nchange in the appearance of the rounded, approximately 5.6 x 4.4 cm opacity\nwith internal foci of air concerning for intrapulmonary abscess (series 3,\nimage 34) in the right lower lung, probably within the anterior basilar\nsegment.  Extensive mixed consolidative and ground-glass opacities involving\nthe right middle lobe are mildly worsened extent and remain concerning for\nongoing infection and/or sequelae of aspiration.  Left mid lung consolidative\nnodularity is unchanged in appearance and likely reflects a small focus of\ninfection (series 3, image 30). The right pigtail chest tube has been removed\nsince the prior exam.  There is no evidence of residual pneumothorax.  Small\nlayering nonhemorrhagic right pleural effusion is mildly larger since the\nprior exam.  There is no left pneumothorax.\n\nRight chest wall subcutaneous emphysema is re-identified.  There is no\nconcerning focal subcutaneous or musculoskeletal soft tissue abnormality. \nMild S-shaped scoliosis is unchanged.  The imaged thoracic vertebral bodies\nare normally aligned. There is moderate multilevel degenerative change.  No\nconcerning focal lytic or sclerotic osseous lesions are seen.\n\nStomach is full of ingested contents, partially imaged.  Otherwise, the\npartially imaged solid and hollow viscous organs of the upper abdomen are\nwithout acute focal abnormality on limited noncontrast evaluation.",
            "output": "1. Unchanged appearance of extensive areas of bilateral proximal airway mucous\nplugging, involving the medial basilar segmental airway branches to the left\nlower lobe as well as the right middle and lower lobe.\n2. Unchanged postobstructive collapse/atelectasis of the right lower lobe,\nwith a grossly unchanged appearance of a rounded opacity with internal foci of\nair likely within the anterior segment measuring 5.6 x 4.4 cm, which remains\nconcerning for intrapulmonary abscess.\n3. Mildly worsened mixed consolidative and ground-glass opacities in the right\nmiddle lobe concerning for infection and/or aspiration pneumonitis.\n4. Unchanged postobstructive collapse of the medial basilar segments of left\nlower lobe, with hyperexpansion of the more anterolateral left lower lobe.\n5. Small layering right pleural effusion is larger since ___.\n6. Mildly patulous esophagus with an air-fluid level in the mid thorax.\n7. Mild cardiomegaly.\n8. Severe coronary artery calcification, prominently affecting the LAD.\n9. Unchanged small pericardial effusion.\n This preliminary report was reviewed with Dr. ___\nradiologist."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged in diameter.  Heart size is normal.\nThere is no pericardial pleural effusion.\n\nTrachea and main bronchi are patent.  As compared to the previous study there\nis substantial improvement in the right lower lobe consolidation and decrease\nin the impaction of the right lower lobe bronchi with only minimal area of\natelectasis present.  No cavitation is currently seen as well as no free right\npleural effusion demonstrated.  Loculated pleural effusion is re- demonstrated\nin the right major fissure, series 3, image 35.\n\nLeft upper lobe is essentially clear.  There is unchanged appearance of the\npartial atelectasis of left lower lobe, involving the majority of the left\nlower lobe.  Ground-glass opacity in the left upper lobe in subpleural\nlocation, series 5, image 120 is 12 x 10.5 mm, and although might represent\npart of the infectious process might in fact be related to different a\netiology giving it present back on ___ chest CT and ___\nchest CT with minimal interval progression (9 x 11 mm back on ___,\ndoes concerning for gradually progressing lung neoplasm.\n\nNo lytic or sclerotic lesions demonstrated worrisome for infection or\nneoplasm.\n\nImage portion of the upper abdomen reveals minimal scarring in the left kidney\nand otherwise is unremarkable.",
            "output": "Interval improvement in the right lung consolidation m resolution of pleural\neffusion but still present pleural loculation.  No evidence of cavitation. \nSubstantial improvement of atelectasis\n\nPersistent partial atelectasis of the left lower lobe as described.\n\nGrowing ground-glass opacity in the left upper lobe as described concerning\nfor unrelated neoplastic origin."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcifications of the thoracic\naorta.  There is moderate coronary calcification.  There is also moderate\ncalcification of the aortic annulus.  Heart is mildly enlarged.  The thoracic\naorta is normal in caliber.  Otherwise, the heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  The esophagus is patulous and\nfluid-filled distally.\n\nPLEURAL SPACES: Loculated pleural fluid within the right major fissure has\ndecreased in size, now small.  Pneumothorax.\n\nLUNGS/AIRWAYS: Severe centrilobular emphysema.  Biapical scarring is\nunchanged.  Atelectasis on of the left lower lobe is unchanged.  Atelectasis\nwithin the right lower lobe has improved compared to ___.  There\nis persistent severe bronchial impaction involving the lower lobes\nbilaterally.  No new focal consolidations.  A peripheral ground-glass opacity\nwithin the left lower lobe measures 12 x 11 mm (series 5, image 154),\nunchanged.  Smaller ground-glass opacification within the right upper lobe is\nalso unchanged (series 5, image 142).  3 mm right upper lobe solid nodule,\nstable (series 5, image 106).  Subpleural triangular focus of opacification\nwithin the right upper lobe likely represents an intrapulmonary lymph node\n(series 5, image 125).  Diffuse bronchial wall thickening likely reflects\nchronic airways disease.  Otherwise, the airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: Moderate dextroconvex scoliosis of the thoracic spine.  Mild\nanterolisthesis of C3 on C4, unchanged since ___.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Persistent bilateral lower lobe atelectasis, improved on the right, stable\non the left, with extensive bronchial wall thickening and impaction.  Given\nthe patulous and fluid-filled esophagus, this likely represents chronic\naspiration.\n2. Loculated pleural effusion within the right major fissure has decreased,\nnow small.\n3. Stable 12 mm left lower lobe ground-glass opacification, which may be\ninfectious or inflammatory in nature, but remains suspicious for a slow\ngrowing neoplasm.\n\nRECOMMENDATION(S):  Barium esophagram can be considered to evaluate the extent\nof esophageal dysmotility."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  There is subcutaneous emphysema in the anterior and\nlateral left chest wall secondary to prior placement of a chest tube.  The\nthyroid is unremarkable.\n\nUPPER ABDOMEN: No abnormality of the visualized upper abdominal structures.\n\nMEDIASTINUM: A 9 mm in short axis precarinal lymph node is likely reactive\n(series 2, image 30).  There is no other mediastinal lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  There are coronary\ncalcifications involving the RCA and LAD.  There is no pericardial effusion.\nPLEURA: Loculated fluid within the right minor fissure remains unchanged. \nOtherwise there is no pleural effusion.  There is no residual pneumothorax.\nLUNG:\n\n1. PARENCHYMA: There is severe centrilobular emphysema.  There is biapical\npleural-parenchymal scarring.  Again seen is atelectasis of the posterior left\nlower lobe, with areas of increased aeration since the prior CT of the chest\nfrom ___.  There is a new 4.0 x 3.3 x 6.2 cm cystic space within\nthe left lower lobe containing an air fluid (hemorrhage) level, and may\nreflect a post traumatic pneumatocele from her recent chest tube.\nMild scattered subsegmental atelectasis of the right lower lobe has slightly\nworsened, and there is new subsegmental atelectasis of the right middle lobe. \nThere is no pulmonary mass or suspicious nodule.  A 1.0 x 0.7 cm ground-glass\nopacity in the left upper lobe remains unchanged dating back to ___.\n\n1. AIRWAYS:  Again seen is mucous plugging within the right interlobar\nbronchus and segmental branches, and left lower lobar segmental branches,\nslightly improved on the left and worsened on the right.\n2. VESSELS:  There are mild atherosclerotic calcifications of the thoracic\naorta.\nCHEST CAGE: There is S-shaped scoliosis of the thoracic spine and multilevel\nspinal degenerative changes.",
            "output": "1.  Mucous plugging within the right interlobar bronchus and segmental\nbranches, and left lower lobar segmental branches, slightly improved on the\nleft and worsened on the right compared to the prior CT of the chest from ___.  Redemonstration of atelectasis of the posterior left lower\nlobe, with areas of increased aeration since the prior study.  New\nsubsegmental atelectasis of the right middle lobe.\n\n2.  Left lower lobe pneumatocele containing air and hemorrhage, likely related\nto the recent chest tube.\n\n3.  Subcutaneous emphysema in the anterolateral left chest wall secondary to\nprior placement of chest tube.  No residual pneumothorax."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nSubcentimeter partially calcified right lobe of thyroid nodule.  No\nsupraclavicular or axillary adenopathy.  Breast tissue is suboptimally\nassessed on CT, but no gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Moderate hiatal hernia.  Medical capsules present in the stomach.  No\nadrenal lesions.  Mildly hyperdense appearance of the liver.\n\nMEDIASTINUM: Fluid filled esophagus with an associated air-fluid level (2, 25)\nhighly suggestive of esophageal dysmotility.  Subcentimeter mediastinal lymph\nnodes.  Reactive hilar lymph nodes.\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly.  Trace\npericardial fluid is physiologic.  Mild relative hypodensity of the blood pool\nsuggesting anemia.  Mild aortic valve calcification.  Moderate coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.  Moderate\ncalcific atherosclerotic changes of the intrathoracic aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  The previously noted mildly hyperdense partially fluid filled\nlesion in the left lower lung zone (previously described as pneumatocele\ncontaining blood) is again visualized but demonstrates interval decrease in\ndensity, as well as a change in orientation being related to the left oblique\nfissure and most likely representing an encysted pleural (fissural) fluid\ncollection (4, 144) measuring 42 x 41 mm (It is relatively similar in size\ncompared to prior imaging).  There is a similar but smaller encysted/loculated\neffusion in the right oblique fissure (4, 140) Measuring 19 x 11 mm, which is\nalso decreased in size compared to prior.  Mild biapical pleural-parenchymal\nscarring.  Interval mild re-expansion of the left lower lobe (4, 147).  There\nis still significant atelectasis of the lateral basal aspect of the left lower\nlobe (4, 188).  Severe pulmonary emphysema with a bilateral lower lobe\npredominance suggest panlobular emphysema (suspected alpha 1 antitrypsin\ndeficiency).  Partially solid nodule in the lateral aspect of the left upper\nlobe (4, 91) Appears similar compared to prior imaging and may represent a\nlesion in the adenocarcinoma spectrum or scarring.  This lesion measures 10 mm\nin average diameter with the solid component measuring 3 mm.  Previously noted\nairspace opacification in the right upper lobe is improved.\n2. AIRWAYS:  Minimal residual secretions present in the tracheobronchial tree\nfor example left main bronchus (4, 116).  Marked interval improvement in the\npreviously noted impacted right middle and bilateral lower lobe bronchi.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Spondylotic changes of the thoracic spine with an associated\ncurvature in the coronal plane.  No suspicious bony lesions.  Bilateral old\nlower rib fractures..",
            "output": "The previously noted hyperdense cystic lesion in the basal aspect of the left\nlung most likely represents a loculated fluid collection in the left oblique\nfissure (encysted pleural effusion).  It is relatively similar in size\ncompared to prior imaging, but demonstrates decreased density (cystic\ntransformation of hemorrhage).\n\nMarked interval improvement in bibasal bronchial impaction and peribronchial\nairspace opacification as well as atelectasis.  However a large amount of left\nlower lobe atelectasis persist.\n\nBibasal predominant pulmonary emphysema suggests panlobular emphysema (alpha 1\nantitrypsin deficiency).\n\nPart solid nodule in the lateral aspect of the left upper lobe is concerning\nfor a lesion in the adenocarcinoma spectrum (adenocarcinoma in situ) and ___\nmonths follow-up CT is advised.\n\nModerate hiatal hernia with a patulous appearing esophagus containing\nair-fluid levels suggesting esophageal dysmotility."
        },
        {
            "input": "There is a calcified 0.5 x 0.7 cm right thyroid nodule requiring no specific\nfollowup.  There is no axillary, supraclavicular, or mediastinal adenopathy. \nHeart is mildly enlarged.  There is no pericardial effusion.  Coronary artery\nand aortic valvular calcifications are severe.  The main pulmonary trunk is\nnot dilated.  There is no thoracic aortic aneurysm.  There is mild\natherosclerosis of the descending thoracic aorta.\n\nThe airways are patent to the subsegmental level bilaterally.  There is\nbibasilar scarring.  There is moderate background emphysema, bibasilar\npredominant, suggesting panlobular emphysema.  There is an unchanged\nsemi-solid nodule in the lateral aspect of the left upper lobe measuring 0.8\ncm (series 4, image 110).  Millimetric right lower lobe pulmonary nodule\nstable (series 4, image 203).  There is loculated pleural in the right oblique\nfissure, as seen previously (series 4, image 172).  There is no pneumothorax\nor pleural effusion.\n\nThe thoracic esophagus is patulous with a large hiatal hernia.  Limited views\nof the upper abdomen are unremarkable.  There is unchanged morphology of the\nspleen.\n\nThe superficial soft tissues are unremarkable.\n\nPost kyphoplasty changes are noted at T5 and T7, without evidence of\ncomplication or increasing loss of vertebral body height.  Mild loss of\nvertebral body height at T12 with 0.3 cm of posterior bony retropulsion is\nunchanged.  No new compression fracture is seen.  No acute left-sided rib\nfracture is seen.  A chronic fracture of the anterolateral tenth left rib.",
            "output": "1. No CT explanation for left-sided rib pain.  No evidence of new acute\nfracture or plasmacytoma.  Post kyphoplasty changes, as described above.\n2. Chronic anterolateral tenth left rib fracture.\n3. Stable semi-solid nodule in the left upper lobe measuring 0.8 cm, follow-up\nchest CT is recommended in ___ year to ensure stability.\n4. Large hiatal hernia with a patulous esophagus, suggesting dysmotility.\n5. Bibasilar scarring.\n\nRECOMMENDATION(S):  Chest CT in ___ year for semi-solid left upper lobe\npulmonary nodule."
        },
        {
            "input": "THORACIC INLET: There is a stable 0.5 x 0.7 cm calcified nodule in the right\nlobe of thyroid noted further follow-up is needed.\n\nThere are no enlarged supraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate cardiomegaly.\nModerate coronary artery calcification is seen.  The main pulmonary artery and\nthe aorta are normal in caliber.  There is a moderate to large hiatus hernia,\nunchanged.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The airways are patent up to the subsegmental level.  There is stable\nbibasilar atelectasis.  There is moderate diffuse lower lobe predominant\npanlobular emphysema.  The ground-glass nodule measuring 1 x 0.9 cm in the\nleft upper lobe (4, 109) is unchanged.  Another nodular opacity adjacent to\nthe fissure in the left lower lobe (4, 120 is unchanged.  There is\nsubsegmental atelectasis in both lower lobes.  There is mild bronchiectasis\nwith peribronchial thickening in both lower lobes.  No new pulmonary nodules.\n\n\nBONES AND CHEST WALL : Review of bones shows severe osteopenia.  There are\nextensive degenerative changes involving the thoracic spine.  There is wedge\ncompression involving several vertebral bodies with evidence of kyphoplasty\ninvolving T4 and T6 vertebral bodies with a decrease in height of less than\n50%.  The wedge compression involving T10 vertebral body is also unchanged\nsince the prior study.\n\nThere is a new displaced fracture involving the body of the sternum with\nanterior displacement of the distal fragment.\n\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is stable mild splenomegaly.  No adrenal masses are seen.",
            "output": "New displaced fracture involving the body of the sternum with anterior\ndisplacement the distal fragment.\n\nSevere osteopenia.\n\nPart solid nodule measuring 1 x 0.9 cm in the left upper lobe is unchanged in\nsize, morphology and density and could represent adenocarcinoma in situ. \nContinued follow-up is recommended.\n\nNOTIFICATION:  The report was sent via e-mail to Dr. ___ SKYE"
        },
        {
            "input": "The thyroid is normal.  There is no axillary, hilar, or mediastinal\nlymphadenopathy.  The heart size is normal.  There is no evidence of\npericardial effusion.  There is a moderate hiatal hernia.  The esophagus is\nmildly patulous.  Severe coronary calcifications are seen.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however incidental note is made of a large abdominal wall hernia,\nincompletely evaluated on this exam.\n\nOsseous structures: Subacute fracture of the left lateral ninth rib is\nunchanged compared to the prior exam.  The proximal aspect of the body of the\nsternum demonstrates an interval increase in combination and angulation with\nslight interval worsening of overlying soft tissue swelling and thickening. \nInferiorly, the mildly displaced fracture involving the body of the sternum\nwith anterior displacement of the distal fragment appears grossly unchanged. \nPatient is status post kyphoplasty involving the T5 vertebral body. \nHypoplastic changes are seen involving the T7 vertebral body.  Compression\ndeformity involving the T9 and superior endplate of the T10 vertebral bodies\nare unchanged compared to the prior exam.  Compression deformity of the T12\nvertebral body is stable.\n\nThe airways are patent to the subsegmental levels.  There is stable bibasilar\natelectasis.  Moderate diffuse lower lobe predominant panlobular emphysema is\nseen.  A ground-glass nodule measuring 1.1 cm by 0.9 cm within the left upper\nlobe appears unchanged compared to the prior exam.  A 1 cm nodule within the\nleft lung base, series 4, image 107 is unchanged.  A right-sided perifissural\nnodule measuring 1.2 cm x 0.7 cm is stable.  There is no pleural effusion or\npneumothorax.",
            "output": "1. Newly comminuted and angulated fracture is seen involving the upper\nfragment of the previously fractured body of the sternum.  The previously seen\nfracture along the mid body of the sternum with mild displacement appears\nsimilar the prior exam.\n2. Stable compression deformities throughout the thoracic spine compared to\nthe exam performed 3 weeks prior.\n3. Stable 1.1 cm ground-glass nodule within left upper lobe.\n4. Moderate hiatal hernia.\n5. Large ventral abdominal wall hernia, containing loops of large bowel is\nincompletely evaluated on this exam.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 08:41 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  Extensive coronary\nartery and aortic valvular calcifications.  Heart is top-normal in size. \nInterval increase in small pericardial effusion of indeterminate density.\n\nAXILLA, HILA, AND MEDIASTINUM: No pathologically enlarged or growing\nmediastinal lymph nodes.  No axillary lymphadenopathy.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Moderate centrilobular emphysema.  There is bibasilar linear\natelectasis and/or scarring.  Subpleural opacity in the left upper lung\n(02:48) likely represents atelectasis as well.  Otherwise, lungs are clear\nwithout masses or areas of parenchymal opacification.  There is mild bibasilar\nbronchiectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Chronic mild bronchial wall thickening appears stable.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout,\nthough it is attenuation is increased relative to the spleen.  There is no\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.There is no perihepatic free fluid.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is not well seen, either\ncontracted or absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Large hiatal hernia is again seen.  No evidence of\nobstruction.  The appendix is not seen.  There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.  Pelvic assist device is again seen.\n\nREPRODUCTIVE ORGANS: Multiple calcified fibroids appears similar.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is an acute comminuted right intertrochanteric femur fracture\n(2:185) with external rotation and varus deformity.  Deformities of the\nbilateral inferior pubic rami appear chronic.  Chronic healing sternal\nfracture is grossly unchanged in alignment (602:82).  There are multiple\nsubacute and chronic rib fractures involving the right ribs.  There is a new\nsubacute fracture of the posterolateral left third rib (03:18).  Subacute to\nchronic fracture of the posterolateral left fifth rib is again seen.  Allowing\nfor differences in positioning and technique, multiple vertebral compression\ndeformities and vertebroplasty changes appear similar.  Chronic deformity of\nthe right transverse process of L2 is again seen.  There are bilateral L5-S1\npars defects with stable moderate anterolisthesis of L5 on S1.\n\nSOFT TISSUES: There is thickening and increased density within muscles of the\nright gluteal region (3:165) suggesting intramuscular hematoma.",
            "output": "1. Acute comminuted, mildly displaced right intertrochanteric femur fracture.\n2. Likely intramuscular hematoma within the right gluteal region muscles.  No\nevidence of retroperitoneal bleeding.\n3. New subacute fracture involving the posterolateral left third rib. \nMultiple other bilateral subacute and chronic rib fractures appear similar in\nalignment.\n4. No definite acute vertebral compression fracture.  Multiple vertebral\ncompression deformities and vertebroplasty changes appear grossly similar.\n5. Stable moderate anterolisthesis of L5 on S1 likely due to L5-S1 pars\ndefects.\n6. Interval increase in small pericardial effusion of indeterminate density.\n7. Large hiatal hernia.\n8. Emphysema."
        },
        {
            "input": "The known multinodular thyroid gland which displaces the trachea posteriorly\nwas previously evaluated with ultrasound on ___. Supraclavicular,\naxillary, mediastinal and hilar lymph nodes are not enlarged. The heart is\nmoderately enlarged.  The aorta is normal in caliber.  The main pulmonary\nartery measures 4.0cm and the right pulmonary artery measures 3.0cm suggestive\nof underlying pulmonary arterial hypertension.  This is a chronic finding\ngiven stable appearance since ___.  Atherosclerotic calcifications of\nthe aortic annulus, aortic arch, RCA, LAD and left circumflex arteries are\nnoted. There is no pericardial effusion.\n\nThe airways are patent to the subsegmental level.  Incidental note is made of\nan accessory fissure in the right lower lobe. Moderate emphysematous changes\nare noted predominantly in the upper lobes bilaterally with a few bulla in the\nleft lower lobe. Bibasilar atelectasis, left greater than right, is noted. \nScattered parenchymal calcifications versus aspirated barium are present in\nthe left lower lobe. There is no focal consolidation or pulmonary edema, nor\nis there a pleural effusion or pneumothorax.\n\nNo lytic or sclerotic osseous lesion suspicious for malignancy is identified.\n\nThis study is not designed for evaluation of the intra-abdominal structures\nbut the included upper abdomen is notable for atherosclerotic calcifications\nof the abdominal aorta extending into the major side branches.",
            "output": "1.  No pleural effusion, pulmonary edema, or focal consolidation. Moderate\nupper lobe predominant emphysematous changes.\n\n2.  Moderate cardiomegaly.  Chronic pulmonary arterial hypertension.\n\n3.  Severe atherosclerotic calcifications of the thoracic aorta and coronary\narteries.\n\n4.  Multinodular thyroid gland, previously evaluated with ultrasound on ___."
        },
        {
            "input": "CHEST:\n\nThe known multinodular thyroid gland displaces the trachea posteriorly. There\nis no axillary, supraclavicular, mediastinal, or hilar lymphadenopathy by CT\nsize criteria. The heart is moderately enlarged, unchanged.  The main\npulmonary artery again measures 4.1 cm, consistent with pulmonary artery\nhypertension. Atherosclerotic calcifications of the aortic annulus, aortic\narch, RCA, LAD, and left circumflex arteries are again seen. No pericardial\neffusion.\n\nThe airways are patent to the subsegmental level. Moderate emphysematous\nchanges are noted predominately in the upper lobes bilaterally, with a few\nbulla in the left lower lobe. Bibasilar atelectasis, left greater than right,\nis again seen.  There is scarring in the left base.  Scattered parenchymal\ncalcifications are again noted, and may be consistent with prior granulomatous\ndisease versus aspirated barium. There are no concerning pulmonary nodules.\nThere is no pneumothorax or pleural effusion.  There is no focal\nconsolidation, evidence of pulmonary edema, pleural effusion, or pneumothorax.\n\nABDOMEN:\n\nAssessment intra-abdominal viscera is limited without intravenous contrast.\n\nHEPATOBILIARY:  The liver is normal in size and homogeneous in attenuation,\nwith no focal lesions..  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right adrenal gland is unremarkable.  There is stable\nhyperplasia of the left adrenal gland, as well as a nodule measuring 2.3 x 1.4\ncm, appearing unchanged from ___, previously characterized as an ademona.\n\nURINARY: The kidneys are normal in size and shape.  No hydronephrosis or\nperinephric abnormalities are present. No renal stones identified. The ureters\nare normal in caliber along their visualized course to the bladder..\n\nGASTROINTESTINAL:  The stomach is unremarkable. The unenhanced small and large\nbowel are normal in course and caliber. There is diverticulosis without\ndiverticulitis. Appendix is not definitely visualized.\n\nRETROPERITONEUM:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is heavy calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no evidence\nof pelvic or inguinal lymphadenopathy.  There is no free fluid in the pelvis.\nA pessary device is again noted.\n\nBONES AND SOFT TISSUES:\n\nSmall amount of stranding seen in the soft tissues of the posterior right\nlower thorax, which may be related to ecchymosis in the setting of recent\nfall.  No acute fracture is identified. No concerning lytic or sclerotic\nlesions.",
            "output": "1.  Small amount of stranding seen in the soft tissues of the posterior right\nlower thorax, which may be related to ecchymosis in the setting of recent\nfall.\n2.  No acute fracture detected.\n3.  No acute intrathoracic, intraabdominal, or intrapelvic process.\n4.  Multinodular thyroid gland.\n5.  Moderate cardiomegaly. Enlarged pulmonary artery, consistent with\npulmonary arterial hypertension.\n6.  Moderate pulmonary emphysema.\n7.  Left adrenal hyperplasia and adenoma, stable since ___.\n8.  Colonic diverticulosis without diverticulitis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present. Note is\nmade of variant arch anatomy with the common takeoff of the innominate and\nleft common carotid as well as origin of the left vertebral artery directly\nfrom the aortic arch.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion.\n\nA 3 mm nodule is noted in the right apex (___). A 2 mm granuloma is noted in\nthe left lung base. Lungs are otherwise clear. There is no pneumothorax. There\nis no pleural effusion. The airways are patent to the subsegmental level.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThere is mild heterogeneity of the thyroid gland with a 4 mm hypodense nodule\nin the left lobe.\n\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen appears unremarkable with the exception\nof a subcentimeter hypodensity in the left lobe of the liver which is not\nfully characterize but likely represents a cyst. .\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere are healing posterior left eighth, ninth and tenth rib fracture",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Healing posterior left eighth, ninth and tenth rib fractures.\n3. 3 mm right apical nodule does not need to be followed in the absence of\nhigh risk factors, such as smoking or known prior malignancy, but otherwise\nchest CT could be considered in one year."
        },
        {
            "input": "The thyroid is somewhat heterogeneous.  There is a discrete 6 mm left thyroid\nnodule, requiring no specific followup.  There is no axillary or\nsupraclavicular lymphadenopathy.  There are enlarged mediastinal lymph nodes\nmeasuring up to 1.6 cm in the lower pretracheal station mildly enlarged\ncompared to prior (series 2, image 18).  Heart is mildly enlarged.  There is\nno pericardial effusion.  Coronary artery and aortic valvular calcifications\nare severe.  Main pulmonary trunk is dilated to 3.3 cm.  Although not\noptimized for the evaluation of pulmonary embolism, no central embolus is\nseen.  The thoracic aorta is normal in caliber with moderate atherosclerotic\ncalcification.\n\nThe airways are patent to the segmental level with bronchial wall thickening,\nmost pronounced at the lung bases.  There is a right basilar chest tube in\nplace with the tip ending along the posteromedial aspect of the right upper\nlobe.  There has been significant interval decrease in a now small right\npleural effusion.  There are few areas of loculated fluid seen particularly\ninvolving the major and minor fissure and at the right lung base (series 302,\nimage 150).  Along the major fissure there is a 2.6 x 1.8 cm loculated fluid\ncollection with scattered foci of air (series 601, image 73).\n\nNew from prior chest CT is a right basilar consolidative opacity which lacks\nenhancement and is concerning for infection.  There is also mild bibasilar\natelectasis.  Peripheral reticular opacity in the lingula, is unchanged, and\nlikely represents atelectasis (series 302, image 69 through 93).\n\nPleural effusion on the left is small, mildly increased from prior..\n\nA triangular 4 mm right anterior upper lobe nodule, is consistent with an\nintrapulmonary lymph node (series 302, image 56).\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\nare notable for atherosclerosis of the abdominal aorta and splenic artery.\n\nOSSEOUS STRUCTURES: There are no suspicious bony lesions.  Again seen are\nmultiple right sided acute rib fractures.  There is comminuted fracture\nthrough the posterior right ninth, eighth, and seventh ribs.  There are\nhealing nondisplaced/minimally displaced fractures through the right lateral\nfifth, sixth, seventh, and eighth ribs.  No left-sided rib fractures are seen.",
            "output": "1. Right posterior chest tube in place.  Significant decrease in now small\nright pleural effusion with a few small areas of loculated fluid, particularly\nin the fissures and at the right lung base.  A discrete locule measuring 2.6 x\n1.8 cm along the right major fissure contains several of locule of internal\ngas and me be related to placement of the initial chest tube.\n2. Consolidative opacity at the right lung base, concerning for pneumonia.\n3. Small left pleural effusion, increased from prior CT.\n4. Re-demonstrated multiple right-sided rib fractures, detailed above.\n5. Enlarged mediastinal lymph nodes, increased from prior chest CT, likely\nreactive."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Several normal sized lymph nodes, numeric early\nincreased, are visualized in the mediastinum.  Mild aortic valve\ncalcifications.  Mild coronary calcifications, no pericardial effusion.  Small\nhiatal hernia.  Normal sized para- aortic lymph nodes (2, 42).  Calcified\ngallstone (2, 61).  2 cm left kidney cyst.  Splenomegaly.\nMild bilateral apical scarring.  Minimal paraseptal pulmonary emphysema. \nStable 2 mm solid left lower lobe nodule (4, 74).  Stable 1 mm subpleural left\nupper lobe nodule (4, 80).  Stable left lower lobe lung cyst.  The airway\nwalls are thickened and mildly irregular.  No pleural effusions.  No pleural\nthickening.",
            "output": "Several stable non suspicious pulmonary nodules.  No pleural abnormalities. \nNo parenchymal changes suggesting infection or diffuse lung disease."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  Evaluation of several right upper lobe\nsubsegmental pulmonary arteries is limited secondary to streak of artifact\nfrom the adjacent intravenous contrast bolus.  The main and right pulmonary\narteries are normal in caliber, and there is no evidence of right heart\nstrain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate mild uniform thickening of the\nbilateral adrenal glands without a focal nodule.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Left atrial enlargement\nis substantial no pathologically enlarged mediastinal, hilar or axillary lymph\nnodes demonstrated.  Anterior mediastinal nodule, 8 x 6 mm in diameter most\nlikely represent lymph node and less likely represent thymoma.\n\nPacemaker lead terminates in right ventricle and right atrium.\n\nAirways are patent to the subsegmental level bilaterally.  There is no\nevidence of interstitial lung disease.  There is no substantial air trapping.\n\nLeft upper lobe lesion, 8 x 6 mm, series 6, image 50 is of intermediate\ndensity, with solid and ground-glass components.  No other nodules masses or\nconsolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "No evidence of interstitial lung disease.\n\nLeft upper lobe nodule as described, of mixed density.\n  For an incidentally detected single ground-glass nodule bigger than 6mm, CT\nfollow-up in 6 to 12 months is recommended to confirm persistence. If\npersistent, CT follow-up every ___ years until ___ years after initial detection\nare recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A few clusters of subcentimeter ground-glass bronchocentric\nnodules are noted in the right middle lobe and right lower lobe, which is\nnonspecific, but may suggest small airways infection or inflammation.  Diffuse\nmild bilateral bronchial wall thickening indicates airways inflammation with\nmucous plugging in the lower lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Diffuse bronchial wall thickening, consistent with airways inflammation,\nwith mucous plugging in the lower lobes.\n3. A few clusters ground-glass bronchocentric nodules are noted in the right\nmiddle lobe and right lower lobe which may represent small airways infection\nor inflammation."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes the\ntracheostomy tube is unchanged.  Secretions are seen within the proximal\ntrachea (303, 63)\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The main pulmonary artery is\nmildly enlarged and measures 3.1 cm it previously measured 2.7 cm.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are low volume with minimal bibasilar atelectasis.  There is\ndiffuse bilateral ground-glass opacification which could represent hemorrhage.\nThere is subsegmental atelectasis in the right middle lobe.  Previously\nvisualized consolidation in both lower lobes has resolved.\n\nBONES AND CHEST WALL : Review of bones shows evidence of internal fixation of\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No evidence of a pulmonary embolism, or aortic injury.  No obvious\npseudoaneurysm seen.\n\nThe main pulmonary artery is mildly enlarged and now measures 3.1 cm as\ncompared to the prior measurements of 2.7 cm.\n\n\nDiffuse bilateral ground-glass opacification new since the prior study and\ncould represent hemorrhage.\n\nSecretions within the trachea and mainstem bronchi.\n\nPreviously visualized consolidations in both lower lobes have resolved.\n\nEvidence of internal fixation of the thoracic spine."
        },
        {
            "input": "The imaged thyroid gland is without nodularity.  There is no axillar or\nsupraclavicular adenopathy.  A right hilar node measures 1.2 x 1.4 cm, present\npreviously and unchanged as are borderline enlarged prevascular station nodes.\n\nThe ascending aorta is non aneurysmal and the main pulmonary artery within\nnormal limits in caliber.  There are no appreciable coronary artery\ncalcifications.  Trace atherosclerotic calcifications at the aortic root are\nnoted.  A right innominate artery stent is present with an apparent filling\ndefect within the stent.  Distally the right subclavian and carotid arteries\nare opacified.  Extensive artifact in this region limits evaluation.  Heart\nsize is within normal limits.  There is no pericardial effusion.  There is a 3\nvessel aortic arch.  Within the limits of this examination, there is no\npulmonary embolism or aortic dissection.\n\nScarring at the apices bilaterally is symmetric.  There is mild to moderate\ncentrilobular and paraseptal emphysema which is apical predominant.  Bronchial\nwall thickening with mild centrilobular nodulation is noted.  Bibasilar\natelectasis is mild and symmetric.  There is no suspicious nodule, mass, or\npulmonary consolidation.  There is no pleural effusion or abnormality.\n\nA 8.4 x 4.8 cm right anterior cardiosthenic pericardial cyst (5:245) is\nwithout internal complexity, stable since prior study and previously\ncharacterized by MR dated ___ as a pericardial cyst.\n\nThere are no osseous lesions were in the chest cage worrisome for malignancy\nor infection.\n\nAlthough examination is not tailored for subdiaphragmatic evaluation, images\nof the upper abdomen demonstrate no appreciable abnormality.",
            "output": "1.  Stable appearance of previously characterized right cardiosthenic\npericardial cyst.\n\n2.  Mild centrilobular and paraseptal apical predominant emphysema with\nbronchiole wall thickening and centrilobular nodulation, the latter consistent\nwith respiratory bronchiolitis. Cigarette smoking or severe allergies could be\nresponsible for aforementioned findings and result in symptomatic small\nairways obstruction.\n\n3.  Apparent filling defect in the innominate artery stent, evaluation limited\nsecondary to extensive artifact in the region, could be further evaluated with\nCT angiogram.\n\nRECOMMENDATION(S):  Consider further investigation of apparent filling defect\nwithin right innominate artery stent.\n\nNOTIFICATION:   The findings were reported to Dr. ___. by ___\n___, M.D. by email on ___ at 4:46 ___, 5 minutes after discovery of\nthe findings.  Dr. ___ the person covering for him were unavailable\nby page at the time report was generated and study interpreted."
        },
        {
            "input": "CTA CHEST:\n\nThe thoracic aorta is normal in caliber, without evidence of aneurysm or\ndissection. The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified and without filling defect. The remaining great vessels are\nnormal in appearance.\n\nCT CHEST WITH CONTRAST:\n\nThe imaged thyroid is normal. There is no axillary, supraclavicular,\nmediastinal, or hilar lymphadenopathy by CT size criteria. There is no\npericardial effusion. The lungs are clear without parenchymal or interstitial\nabnormality. The airways are patent. There are no concerning pulmonary\nnodules. There is no pneumothorax or pleural effusion.\n\nThe visualized very upper abdomen is unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No acute aortic syndrome or pulmonary embolism.  Lungs are clear."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Incidental note is again made of an aberrant course of\nthe right subclavian artery traversing posterior to the esophagus.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild biapical scarring is noted.  Solid nodules measuring up to\n6 mm in the middle lobe are unchanged from ___ (5:129, 52), and can be\nconsidered benign.  Mild scarring is again seen in the lower middle lobe and\nlingula and posterior right lower lobe.  There is no diffuse lung disease. \nThe airways are patent to the level of the segmental bronchi bilaterally. \nBronchiectasis and scarring are again seen in the superior segment of the\nright lower lobe, similar to ___.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDiffuse osseous demineralization is noted.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Stable mild chronic changes of the lungs and airways, as detailed above."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The tip of the endotracheal tube\nextends to the midthoracic trachea.  A feeding tube extends at least to the\nproximal stomach.  The visualized thyroid is slightly heterogeneous with no\ndiscrete nodules identified.  There is no supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Coarse calcifications are seen within the spleen and slight\nmesenteric edema is seen in the left upper quadrant.\n\nMEDIASTINUM: There are enlarged mediastinal lymph nodes.  For example a right\nparatracheal lymph node measures 1.2 cm in short axis.  An AP window lymph\nnode measures 1.1 cm in short axis.\n\nHILA: Limited evaluation for hilar adenopathy on this noncontrast study.\n\nHEART and PERICARDIUM: The heart is not particularly enlarged.  Dense\ncalcification of the aortic valve is noted.  Calcification of the thoracic\naorta and coronary arteries are also present.  There is no pericardial\neffusion.\nPLEURA: There a small right nonhemorrhagic pleural effusion and trace left\nnonhemorrhagic pleural fluid.  No pneumothorax.\nLUNG:\n\n-PARENCHYMA:  Diffuse bilateral airspace consolidations and ground-glass\nopacities have increased since prior with more dense consolidation is seen at\nthe lung bases (right greater than left).\n-AIRWAYS:  The airways are patent through the subsegmental levels.\n-VESSELS:  The thoracic aorta is unremarkable apart from mural calcification. \nThe main pulmonary arteries not enlarged.\n\nCHEST CAGE: There is an acute nondisplaced fracture of the left lateral fourth\nand fifth ribs as well as a fracture of the anterolateral left 6 rib. \nAdditionally, fracture deformities appearing more chronic are seen in the\nright anterior second third and fourth ribs.  There is no acute compression\ndeformity.  No suspicious osseous lesion.",
            "output": "Interval increase in diffuse bilateral ground-glass and consolidative\nopacities throughout both lungs.  Differential considerations continue to\ninclude diffuse alveolar hemorrhage, atypical infection or less likely\npulmonary edema given the distribution.\n\nInterval development of acute fractures of the left fourth fifth and sixth\nribs."
        },
        {
            "input": "5 mm right thyroid nodule (2a, 1).  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe hilar level.  Mild coronary calcifications.  Mild aortic annulus\ncalcifications.  No pericardial effusion.  Normal size of the heart.  Normal\nappearance of the posterior mediastinum.  No abnormalities in the upper\nabdomen.  Diffuse punctate calcifications in the liver parenchyma.  Clips\nafter cholecystectomy.  No osteolytic lesions at the level of the ribs, the\nsternum or the vertebral bodies.\nNo pulmonary emphysema.  No several millimetric micronodules in subpleural\nlocation (for example 4 a, 104).  Non characteristic platelike scar in the\nright lower lobe.  No suspicious lung nodules or masses.  No pleural\nthickening, no pleural effusion.  The airways are patent.  No signs of chronic\nairways disease.  No pulmonary fibrosis",
            "output": "No suspicious lung nodules or masses.  No parenchymal or airway changes\ncommonly associated with smoking.  Mild coronary calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a 0.9 cm hypodense nodule\nin the right lobe of the thyroid gland as well as an additional 0.6 cm nodule\nof the thymic isthmus for which no specific follow up is recommended.  There\nis no supraclavicular or axillary lymphadenopathy.  There is no soft tissue\nnodularity of the chest wall.\n\nUPPER ABDOMEN: Please see dictation from concurrent CT abdomen and pelvis for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: In the superior mediastinum, there is a pretracheal lymph node\nconglomerate or small mass has increased in size compared to ___, measuring\n2.2 x 1.6 cm (previously 1.9 x 1.2 cm).\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Mild-to-moderate coronary artery calcifications are\nnoted, similar in appearance to ___.  Heart is normal in size.  There is no\npericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is a small calcific, nodular density in the left lower\nlobe (series 4; image 197), which is consistent with a small granuloma.  No\ngross consolidation is identified.  No suggestion of metastatic disease to the\npulmonary parenchyma.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS: The main, left, and right pulmonary arteries are normal in size.\nCHEST CAGE: No concerning sclerotic or lytic lesions.  Sclerotic focus is\nnoted within the vertebral body of T6 consistent with small bone island.  No\nthoracic spine compression deformity.  Although there are no bone lesions in\nthe imaged chest cage suspicious for malignancy or infection, it should be\nnoted that radionuclide bone and FDG PET scanning are more sensitive in\ndetecting early osseous pathology than chest CT scanning.",
            "output": "1. Pretracheal lymph node conglomerate or small mass in the superior\nmediastinum has increased in size compared to ___, measuring 2.2 x 1.6 cm\n(previously 1.9 x 1.2 cm).  This is unlikely to be a metastasis from urinary\ntract malignancy.  Chest CT in six months would help determine if it is ab\nactive process, such as an extremely slow growing neoplasm.\n2. No evidence in the chest of metastatic renal cancer.\n3. Please see separate dictation from concurrent CT abdomen and pelvis for\nsubdiaphragmatic findings.\n\nRECOMMENDATION(S):  Chest CT in six months, with intravenous contrast agent,\nIF TOLERATED."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the imaged portion of the incompletely\nimaged thyroid.  Supraclavicular and axillary lymph nodes are not enlarged and\nthere are no soft tissue abnormalities in the chest wall concerning for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is mildly patulous, otherwise unremarkable. \nAtherosclerotic calcification is mild in the head and neck vessels, a but\npresent in all major coronary segments.  Aortic valve is mildly calcified. \nAorta and pulmonary arteries and cardiac chambers are normal size and\npericardium is physiologic.  The triangular configuration of the thymus at the\npericardial reflection is unchanged and not pathologic.\n\nTHORACIC LYMPH NODES:\n\nPretracheal, 15 x 23 mm and 13 mm wide lymph nodes at the thoracic inlet are\nunchanged in size since at least ___.\n\nNo lymph nodes elsewhere in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: There are no nodules or other focal lung lesions of\nconsequence.  Tracheobronchial tree is normal to subsegmental levels and there\nis no pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic metastases.  The only enlarged lymph nodes, in\nthe upper mediastinum at the thoracic inlet are stable since ___.  This\nwould be extremely unusual manifestation metastatic renal cell carcinoma.\n\nCoronary atherosclerosis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nHeterogeneous thyroid with hypodense nodules in the right lobe measuring up to\n8 mm, unchanged.  No enlarged lymph nodes in either axilla.  Two enlarged\nlymph nodes in the anterior neck (302: 40 and 47) the largest measuring 23 x\n13 mm, unchanged.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  Small pericardial effusion, likely\nphysiological, unchanged.  Moderate calcifications in the coronary arteries,\nmild in the aortic valve in aortic.  The aortic pulmonary arteries are normal\nin caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchiectasis, bronchial\nwall thickening or mucous plugging.\nNo consolidations, atelectasis, lung nodules or masses.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show status post cholecystectomy. \nMultiple tiny calcified granulomas in the spleen.  Moderate atherosclerotic\ndisease in the splenic artery.",
            "output": "No interval change compared to prior study of ___.  No evidence of\nintrathoracic metastatic disease.\nStable appearance of enlarged lymph nodes in the anterior neck.\nWidespread atherosclerotic disease, notably in the coronary arteries."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  Moderate atherosclerotic calcifications at the origin of the\nsupra-aortic vessels.  There are no chest wall abnormalities.\n\nMEDIASTINUM AND HILA:\nEsophagus is mildly patulous and fluid-filled along its course, likely related\nto dysmotility disorder.  A 12 mm nodule is unchanged since ___ in\ncould represent retrosternal extension thyroid gland or less likely a\nlongstanding enlarged lymph node.  Remaining mediastinal lymph nodes range\nfrom 2-5 mm are stable as well.\n\nHEART, PERICARDIUM AND VASCULATURE:\nHeart is normal in size and shape.  No pericardial effusion.  Severe\natherosclerotic calcifications in the coronary arteries, minimal in the aortic\nvalve leaflets, and mild in the aortic annulus and arch.  Aorta and pulmonary\narteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No lung nodules or masses.  No\nfocal consolidations, pleural effusions or pneumothorax.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Prevascular 12 mm nodule is stable since at least ___ could represent\na retrosternal extension of the thyroid goiter due to its longstanding\nstability or less likely a longstanding enlarged lymph node.\n\nNo evidence of metastatic disease to the chest.\n\nStable severe coronary artery atherosclerotic disease.\n\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "CTA THORAX: The aorta and main thoracic vessels are well opacified. The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection. The pulmonary arteries are opacified to the subsegmental level.\nThere is no filling defect in the main, right, left, lobar or subsegmental\npulmonary arteries. No arteriovenous malformation is seen.\n\nCT OF THE THORAX:  The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nThe heart, pericardium, and great vessels are within normal limits. No hiatal\nhernia or any other esophageal abnormality is present. There are 2 adjacent\nnodules in the right lung apex which span up to 4 mm (series 3, image 5). A 3\nmm nodule is seen in the right upper lobe (series 3, image 87). Additional 4\nmm nodule is seen in the right lower lobe (series 3, image 145) and 3 mm\npulmonary nodule is seen in the right middle lobe (series 3, image 125).\n\nLung windows do not demonstrate any focal opacity. No pleural effusion or\npneumothorax is present.\n\nAlthough this study is not designed for assessment of intra-abdominal\nstructures, the visualized solid organs and the stomach are unremarkable.\n\nOSSEOUS STRUCTURES: No focal osseous lesion concerning for malignancy.",
            "output": "1.  No evidence of pulmonary embolism or any other acute cardiopulmonary\nprocess.\n\n2.  Multiple 4 mm pulmonary nodules in the right lung; if high risk patient,\nsuch as history of known malignancy, followup CT should be performed in 12\nmonths although these are of doubtful significance in this age group."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluations pulmonary vasculature is significantly\nlimited by respiratory motion artifact.  No filling defect to the level of the\nmain and segmental pulmonary arteries. The thoracic aorta is normal in caliber\nwithout evidence of dissection.  Post CABG and aortic valve replacement.\n\nAXILLA, HILA, AND MEDIASTINUM: No enlarged axillary, hilar mediastinal lymph\nnodes.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Limited evaluation the presence of respiratory motion artifact.\nA 4 mm right middle lobe pulmonary nodule is unchanged (series 3, image 127). \nA punctate lateral left lower lobe pulmonary nodule is also unchanged (series\n3, image 111).  There is bibasilar segmental atelectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no enlarged\nlymph nodes.\n\nABDOMEN: There is a small hiatal hernia and incidental lesser curvature\ngastric wall lipoma measuring 3.6 x 1.7 cm in the axial plane.  Small right\nserratus anterior lipoma.\n\nBONES: No aggressive osseous lesions seen.? There is no acute fracture. \nMedian sternotomy wires are seen.",
            "output": "Examination is significantly limited by respiratory motion artifact. No\nevidence of pulmonary embolism as described."
        },
        {
            "input": "Heart size and mediastinum unremarkable.  Aorta and pulmonary arteries are\nwithin normal limits.  There is no pericardial pleural effusion.  Image\nportion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nbilateral nodules are present as well as endobronchial secretions.  Subpleural\nnodule in the left upper lobe, series 5, image 116 is unchanged, 6 mm, might\npotentially represent pleural thickening versus atelectasis.  No additional\ndiscrete pulmonary nodules demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm",
            "output": "No definitive evidence of intrathoracic malignancy.\n\nCentrilobular marked ___ nodules in conjunction with bronchial wall\nthickening might represent respiratory bronchiolitis or drug reaction (smoking\nversus recent new chemo other therapy.\n\nLeft upper lobe subpleural nodule versus atelectasis is unchanged."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is normal.  No\npericardial or pleural effusion is evident.  A very small hiatal hernia is\nincidentally noted.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.  Mild bilateral gynecomastia is present.\n\nWithin the lungs, no new suspicious pulmonary nodules are detected.  A\npreviously reported subpleural nodular opacity in the periphery of the left\nupper lobe remains unchanged (image 80, series 4).  A juxta fissural nodular\nopacity along the left major fissure is unchanged since ___ and\nlikely represents an intrapulmonary lymph node.",
            "output": "1. No CT evidence of intrathoracic metastatic disease.\n\n2. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Mild gynecomastia.\n\nUPPER ABDOMEN: Will be reported separately.  Suspected small hiatal hernia.\n\nMEDIASTINUM: No mediastinal adenopathy.  No anterior mediastinal mass.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Punctate calcification of the LAD (2D, 35).\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  No suspicious\npulmonary nodules or masses.  Suspected perifissural lymph node (4, 139) is\nunchanged.  No confluent airspace consolidation.  No diffuse lung disease.  No\nbronchiectasis.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "Stable imaging findings of the chest.  No findings to suggest intrathoracic\nmetastatic disease.\n\nPunctate calcification of the LAD is concerning for coronary artery disease in\na young individual.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  No axillary adenopathy.  No gross breast lesions.\nMild bilateral gynecomastia.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal mass or adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Punctate LAD calcifications again noted.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Multiple small\ncentrilobular pulmonary nodules with associated diffuse bronchial wall\nthickening suggests respiratory bronchiolitis.  There is focal, subsegmental\nbronchial impaction/peribronchial opacities with mild distal atelectasis in\nthe right middle lobe and lingula which is mild and new.  Mild associated\natelectasis.  No CT features of metastatic disease.  No diffuse lung disease.\n2. AIRWAYS:  Airways are patent to the subsegmental level.  No diffuse\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: No lytic/destructive bony lesions.",
            "output": "No CT features concerning for intrathoracic metastatic disease.\n\nThere is a new, mild subsegmental peribronchial opacities/bronchial impaction\nin the right middle lobe and lingula with mild distal bronchiectasis and\nassociated atelectasis.  This does not have the appearance of metastatic\ndisease, but is concerning for low-grade/atypical infection.  The distribution\nis suggestive ___ but this is typically seen in middle-aged females.\n\nMultiple small centrilobular nodules with associated diffuse bronchial wall\nthickening suggest respiratory bronchiolitis.  If the patient is a smoker this\nshould be discouraged.\n\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.  3\nmm perifissural nodule is likely an intrapulmonary lymph node (5:161) The\nlungs are otherwise clear.  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation, known\nretroperitoneal lesion was minimally imaged in this study\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy.\nknown retroperitoneal lesion was minimally imaged in this study"
        },
        {
            "input": "*Review of the patient's OMR detailed additional pertinent information that\nthe patient has a recent diagnosis of gastric cancer, not provided in the\nclinical indication.\n\nNECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM: Scattered nonenlarged mediastinal lymph nodes appear stable\nwithout any new pathologically enlarged adenopathy.  There is a small amount\nof fluid seen within the distal esophagus.\n\nHILA: Evaluation for hilar lymph nodes is limited without IV contrast.\n\nHEART AND VESSELS: Right chest port is again seen with its distal tip\nterminating in the cavoatrial junction.  The heart is normal in size.  There\nare calcifications of the thoracic aorta which appears diffusely ectatic,\nsimilar to previous examination no pericardial effusion is identified.  There\nare extensive coronary artery calcifications.  Hypodensity of the blood pool\nrelative to the myocardium suggests anemia.\n\nPLEURA: There is trace pleural fluid without overt pleural effusion\n\nAIRWAYS/LUNG: The tracheobronchial tree is grossly patent.  Evaluation of the\nlungs is suboptimally evaluated secondary to respiratory motion artifact. \nThere is mild worsening dependent and scattered atelectatic changes without\ndiscrete focal airspace consolidation.  Previously described subcentimeter\npulmonary nodules appear unchanged from prior CT dated ___.  No new\npulmonary mass.\n\nBONES: Multilevel degenerative changes of the visualized thoracic spine. \nStable bilateral healed rib fractures.  A right posterior chest wall\nlipomatous lesion is unchanged measuring 4.7 x 2.1 cm.\n\nUPPER ABDOMEN: For intra-abdominal findings, please refer to dedicated CT\nabdominal pelvis report.",
            "output": "1.  No CT evidence of an acute intrathoracic process."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. Mild atherosclerotic\ncalcifications of the thoracic aorta and moderate of the coronary arteries. \nMild aortic valvular calcifications\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild bronchial wall\nthickening.  The lungs are clear of interstitial or airspace opacity. No\nsuspicious pulmonary nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the recent MRI report of the abdomen.",
            "output": "No evidence of active intrathoracic infection or malignancy.\n\nModerate coronary artery disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: 4 mm pulmonary nodule in the right upper lobe is unchanged\nsince ___ (03:37).  Left lower lobe atelectasis is minimal. Lungs\nare clear without masses or areas of parenchymal opacification.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nFindings below the diaphragm will be reported separately.\n\nThere are no adrenal abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is mild in head neck vessels, but very severe in\ncoronary arteries.  Aorta is normal size, main pulmonary artery top- normal,\nright pulmonary artery enlarged, 36 mm, previously 34 mm.\n\n___ small pericardial effusion is unchanged.  Small nonhemorrhagic pleural\neffusions layer posteriorly.  No appreciable pleural thickening.\n\nLeft hemidiaphragm is still markedly elevated due to subphrenic mass effect,\nresponsible for persistent atelectasis in the lingula and left lower lobe\nlungs are otherwise clear.  .\n\nCentral lymph nodes are not enlarged.\n\nBones are generally osteoporotic he.  Mild central impression mid thoracic\ncurve vertebral body is not pathologic, unchanged since ___.\n\n\n\n.",
            "output": "No evidence of intrathoracic malignancy.\n\nPersistent small pleural effusions, nonhemorrhagic.\n\nSevere coronary atherosclerosis.\n\nPossible pulmonary arterial hypertension."
        },
        {
            "input": "Right paratracheal lymph node, series 9, image 14 is 14.7 x 17 mm, increased\nin size since the prior study.  Aortopulmonic lymph nodes are 1 cm in\ndiameter, increased in size as well.  Left hilar lymph node conglomerate is\n11.6 x 20 mm, unchanged.  Right hilar lymph nodes although difficult to\ncompare with the previous study that was obtained without contrast is\ncurrently 25.7 x 17.4 mm, increased in size as compared to 21 mm previously. \nParaesophageal lymph node has increased in size from 6.6-13 mm.  Additional\ninferior right hilar lymph node has increased in size as well.\n\nThere is no pericardial pleural effusion.  Heart size is normal.  Aorta and\npulmonary arteries are overall unremarkable.\n\nImage portion of the upper abdomen will be reviewed as part of the CT abdomen\nand corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Narrowing of the\nright middle lobe origin bronchus is due to surrounding lymph nodes is\nunchanged.  Several pulmonary ___ nodules are present, series 10, images 43,\n112, 195, 215 (the largest nodule, 6 mm), 249.  The nodules were a up sent on\nthe chest CT from ___ in can be seen on ___, minimally\nincreased in particular the larger ones.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval progression of the chest involvement giving the progression of the\nmediastinal lymph nodes and gradual increase in size of the pulmonary nodules."
        },
        {
            "input": "LUNGS/VESSELS: Significant interval increase in the size and number of\nmultiple large pulmonary parenchymal nodules, and bilateral juxta hilar\nmasses, with soft tissue tracking along the bronchovascular structures.  These\njuxta hilar masses result in severe compression, and in places obliteration,\nof bilateral segmental and subsegmental pulmonary arteries, without a definite\ndistinct filling defect identified.  Furthermore, these juxta hilar masses\ncause marked attenuation, and in places obliteration, of lower lobe bronchi.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Multiple enlarged mediastinal lymph nodes\nappear slightly larger as compared to prior.  For example, a right lower\nparatracheal lymph node conglomerate measures 2.6 x 1.4 cm, previously 2.5 x\n1.5 cm.  No significant axillary lymphadenopathy or supraclavicular\nlymphadenopathy.\n\nPLEURAL SPACES:  There is trace left pleural thickening versus effusion. \nThere has been interval decrease in the size of the pericardial effusion,\nwhich is now within the physiologic range.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  The esophagus appears diffusely thickened, most severely in the its\nlower third.  There is a small hiatal hernia.  Multiple hypodense lesions\nwithin the dome of the liver are new over the interval, and are concerning for\nmetastatic disease.  These lesions measure up to 2 x 1.7 cm in segment 8.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Significant interval increase in the size and number of metastatic lesions\nwithin the pulmonary parenchyma as well as bilateral juxta hilar masses.  The\njuxta hilar masses result in compression, and in places obliteration, of\nbilateral bronchovascular structures, without definite distinct filling defect\nseen to suggest the presence of acute pulmonary embolism.\n\n2.  Multiple enlarged mediastinal lymph nodes appear slightly larger as\ncompared to prior.\n\n3.  Interval development of multiple hypodense lesions within the liver which\nare concerning for metastatic disease.\n\n4.  Diffuse thickening of the esophagus is most severe in the lower third. \nThis may relate to reflux esophagitis in the setting of a hiatal hernia.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. in person on ___ at 11:10 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Few small calcified thyroid nodules\nbilaterally.\nNo abnormal findings in the chest wall.\n\nUPPER ABDOMEN: pancreatic head hypodense mass and splenic flexure large bowel\npneumatosis coli - grossly unchanged in comparisons to the CT of the abdomen\ndated ___ where the remaining findings are better demonstrated.\n\nMEDIASTINUM: There is no lymphadenopathy in the mediastinum, hila or axilla\nbilaterally.\n\nHEART and PERICARDIUM: There is no cardiomegaly or pericardial effusion.\nMajor vessels are within normal limits.\n\nLUNG: Airways are patent to the subsegmental level bilaterally.\nThe lungs are clear, no evidence of nodules or masses.\nThere is no pleural effusion\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "CHEST:\n\nLINES AND TUBES: Esophageal tube terminates within the stomach.  Endotracheal\ntube is in proper position above the level of the carina.\n\nNECK: The thyroid gland appears unremarkable.\n\nAIRWAYS: Major airways are clear with no endotracheal or endobronchial\nlesions.  There is mild peribronchial wall thickening of the lower lobe\nbronchi.\n\nMEDIASTINUM: There is no mediastinal hematomas.  There is no cardiomegaly or\npericardial effusion.  No mediastinal adenopathy.\n\nLUNGS: There is dependent atelectasis bilateral lung bases with no pulmonary\ncontusions or lacerations.  There is mild biapical scarring.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\n\n\nABDOMEN:\n\n\nHEPATOBILIARY: The unenhanced liver is unremarkable.  There are no subcapsular\nhepatic hematomas.  Gallstone is noted.\n\nPANCREAS: Pancreatic contours are unremarkable with no peripancreatic fat\nstranding.\n\nSPLEEN: Spleen is normal in size with no perisplenic hematomas.\n\nADRENALS:   Mild bilateral adrenal gland hyperplasia.\n\nURINARY:Contrast is noted to be excreted from the renal collecting system from\nearlier contrast injection at the time of CTA head and neck.  There is no\nhydronephrosis or renal parenchymal changes.  Urinary bladder is under\ndistended due to a Foley catheter in place.  There is a small right posterior\nbladder diverticulum or distal ureterocele.\n\nGASTROINTESTINAL: No bowel obstruction and no ascites.  Scattered colonic\ndiverticulosis.\n\nPERITONEUM: No free air no ascites.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber.\n\n\n\nPELVIS: Prostate is mildly enlarged.  Rectum is unremarkable.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: No soft tissue abnormality identified.",
            "output": "1. No acute intrathoracic, intra-abdominal or pelvic injury.  No acute osseous\nabnormality.\n2. Dependent atelectatic changes at the lung bases.\n3. Gallstone.\n4. Posterior right urinary bladder diverticulum or ureterocele. ."
        },
        {
            "input": "The imaged portion of the thyroid is unremarkable.  The thoracic aorta is\nnormal in course and caliber without significant atherosclerotic\ncalcification.  The heart is normal in size and shape.  The main pulmonary\nartery is normal in size.  The central branches of the pulmonary arterial tree\nappear grossly patent.  No mediastinal or axillary lymphadenopathy is seen.\n\nThere is a heterogeneously enhancing mass in the left lower lobe measuring\napproximately 4.4 x 3.9 cm.  Allowing for slight differences in technique,\nthis lesion is not significantly increased in size from prior exam.  This\nlesion is consistent with primary tumor and this lesion abuts the left lower\nlobe bronchus and the superior segment of the left lower lobe is completely\ncollapsed.  There is subjacent atelectasis.  There is a small to moderate left\npleural effusion.  Small right pleural effusion is also noted with compressive\nlower lung atelectasis.  Background emphysema is mild.\n\nPlease refer to separately dictated CT of the abdomen pelvis for findings\nbelow the diaphragm.\n\nBones: There is a large destructive lesion which appears to arise from the\nright scapula measuring approximately 12.7 x 11.5 x 8.6 cm.  There are large\ncystic components concerning for necrotic tumor.  The lesion extends deep to\nthe right scapula.  A separate satellite implant is seen in the right\nsupraclavicular fossa measuring 4.0 x 3.6 cm on series 6, image 21.  Also\nnoted is a destructive bony lesion at the left posterior acromion best seen on\nseries 6, image 42 measuring 4.3 x 2.5 cm.  There is a rib lesion at the left\neighth anterolateral arch.  A lesion is seen involving the inferior aspect of\nthe left scapula.  A lesion is seen involving the right fifth rib along the\nlateral arch.  A metastatic lesion is seen within the T1 vertebral body.  Also\nnoted in the T5 vertebral body is a lytic lesion involving the left transverse\nprocess, pedicle and lamina.  Moth-eaten appearance of the T12 spinous process\nis noted.  Overall, there has been no significant change from recent PET-CT\nexam.",
            "output": "Left lower lobe mass consistent with primary tumor with associated\npostobstructive collapse of the superior segment of the left lower lobe. \nSmall bilateral pleural effusions, left greater than right.  Extensive bony\nmetastatic disease described with large soft tissue component at the right\nscapula.\n\nWhen compared with most recent PET-CT exam, the overall disease burden appears\nsimilar, though lack of IV contrast and thin reformations on PET-CT limits\naccurate comparison."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary emboli are seen in subsegmental and segmental\nright lower and middle lobe branches as well as a subsegmental left lower lobe\nbranch (5:132).  Thoracic aorta is mildly dilated measuring up to 3.3 cm.  The\nmain pulmonary artery is top normal in caliber measuring up to 3.0 cm.  Right\nventricular size is roughly equal to that of the left ventricle and there is\nflattening of the left ventricular septum as well as reflux of contrast into\nthe IVC and hepatic veins suggesting right heart strain.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass.  A 1.8 cm subcutaneous nodule\nin the right lateral chest wall likely represents an epidermoid cyst (04:33). \nPLEURAL SPACES: Small to moderate right greater than left-sided pleural\neffusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is compressive atelectasis of the bases bilaterally. \nThere is mild scattered areas ground-glass opacity appropriate bronchial\ndistribution left upper lobe (e.g.  04:46).  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Thyroid gland is enlarged and heterogeneous.  No discrete\nnodules are seen.\n\nABDOMEN: Included portion of the upper abdomen is notable for 1.8 cm left\nadrenal adenoma.  A for minimally a stone is noted in the upper pole of the\nleft kidney.  Pneumobilia is presumably related to recent ERCP.\n\nBONES: No recent osseous lesions are seen.  There are chronic appearing\ncompression deformities of the T10, T9, T8, T7, T6, T5, T4, and T3 vertebral\nbodies associated with severe thoracic kyphosis.",
            "output": "1. Bilateral segmental and subsegmental pulmonary emboli.  Flattening of the\ninterventricular septum and reflux of contrast into the IVC suggest right\nheart strain.\n2. Small to moderate right greater than left-sided pleural effusions with\nassociated compressive atelectasis at the bases bilaterally.\n3. Mild peribronchial ground-glass opacity in the right upper lobe may\nrepresent pneumonia in the appropriate clinical setting.  Recommend follow-up\nchest CT in 3 months to assess for resolution.\n4. Multiple compression deformities of thoracic vertebral bodies, likely\nchronic.\n5. Pneumobilia presumably related to recent ERCP, left-sided nephrolithiasis,\nand left adrenal adenoma incidentally noted in the partially imaged upper\nabdomen.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:30 pm, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "There is no concerning consolidation or lung nodules. There is mild bibasilar\natelectasis and small nonhemorrhagic pleural effusions. There is no\npneumothorax. The airways are patent to the segmental level.\n\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nare no filling defects in the pulmonary arteries concerning for pulmonary\nemboli. Cardiac configuration is normal and there is no appreciable coronary\ncalcification.\n\nRelative osteopenia is again noted.\n\nThis study is not designed to evaluate the upper abdominal contents.  Colonic\nwall thickening and ascites are better characterized on the prior CT abdomen\nand pelvis of ___.",
            "output": "Small non-hemorrhagic pleural effusions. No evidence of intrathoracic\nmalignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM/Hila: Prominent mediastinal and hilar lymph nodes are likely\nreactive.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  The ascending aorta is\nmildly dilated measuring up to 4.0 cm.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  ___ nodular opacities diffusely in the right\nlung and in the left lung base are compatible with an infectious process. \nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  An azygos fissure is incidentally\nnoted.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates an 8 mm\nhepatic hypodensity too small to characterize.  There is also a small hiatal\nhernia.",
            "output": "___ nodular opacities diffusely in the right lung and at the left lung\nbase compatible with multifocal infectious process with both typical and\natypical organisms.."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcifications re-demonstrated otherwise\nthe heart, pericardium, and great vessels are within normal limits. A\nprominent azygos vein and azygos lobe is visualized.  No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Enlarged bilateral hilar lymph nodes are again\nvisualized measuring up to 1 cm on the right (02:54).  No axillary or\nmediastinal lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is re-demonstration of ___ nodular opacities\nthroughout the right lung and at the left lung base is well as smaller regions\nof focal consolidation in the right lung suggestive of an ongoing infectious\nprocess.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for multiple\nsubcentimeter hepatic hypodensities likely compatible with hepatic cysts\nversus biliary hamartomas.  Small hiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Re-demonstration of ___ nodular opacities diffusely in the right\nlung and at the left lung base with smaller regions of focal consolidations in\nthe right lung suggestive of an ongoing infectious process not significantly\nchanged from study of ___.\n2. No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is top-normal.  Trace pericardial fluid is\nwithin physiologic limits.  Calcified coronary atherosclerosis is at least\nmoderate.  The ascending thoracic aorta is mildly dilated with a diameter\nmeasuring 4.1 cm.  Main pulmonary artery is normal in caliber.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the subsegmental level.  Marked\ninterval improvement in centrilobular pulmonary nodules, now minimal seen most\nprominently in lower lungs. There is a punctate micronodule in the medial\nsegment of the right middle lobe (series 4, image 176). There is a punctate\nmicronodule in the posterior segment of the right upper lobe (series 4, image\n88).   Incidental azygos lobe.  Mild dependent atelectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small hiatal hernia with diffuse esophageal wall thickening. \nHypoattenuating lesions in the liver are unchanged since ___,\nprobably reflecting cysts or biliary hamartomas.  Punctate nonobstructing\nbilateral nephrolithiasis.  Diverticulosis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nFew scattered sclerotic rib in vertebral body lesions are compatible with\nbenign bone islands.",
            "output": "1. Marked improvement in diffuse centrilobular pulmonary nodules and tree-in\n___ opacities.\n2. Tiny unchanged right upper and middle lobe micronodules.  For incidentally\ndetected multiple solid pulmonary nodules smaller than 6mm, no CT follow-up is\nrecommended in a low-risk patient, and an optional CT follow-up in 12 months\nis recommended in a high-risk patient.\n3. Small hiatal hernia with evidence of reflux esophagitis.\n4. Punctate nonobstructing nephrolithiasis.\n5. Mild fusiform aneurysmal dilation of the ascending thoracic aorta.\n\nRECOMMENDATION(S):  Tiny unchanged right upper and middle lobe micronodules. \nFor incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is minimal dependent atelectasis and upper lobe\npredominant paraseptal emphysema.  Lungs are clear without masses or areas of\nparenchymal opacification.  There is no evidence of airspace consolidation. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  The\nbilateral adrenal glands are unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUES: There are skin laceration and stranding of the anterior chest\nwall overlying the sternum (4:79, 111 and 606b:82)).   There is no evidence of\na hematoma in the subcutaneous tissues.",
            "output": "1. Skin lacerations and mild  stranding in the anterior chest wall overlying\nthe sternum are compatible with reported stab wounds.\n2. No evidence of visceral injury in the chest.  No pneumothorax or\npneumomediastinum.  No evidence of hematoma or pericardial effusion.\n3. No fracture."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMild subsegmental bibasilar dependent atelectasis is noted.  Peripheral\natelectasis is also noted in the lingula.  There is no focal consolidation. \nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are notable for two subcentimeter\nhypodensities in the liver, incompletely characterized by CT, statistically\nlikely hepatic cysts or biliary hamartomas.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nUnremarkable bilateral breast implants.",
            "output": "No evidence of acute aortic abnormality or pulmonary embolism to the segmental\nlevel."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Left pectoral Port-A-Cath.  Mild aortic wall\ncalcifications.  Mild dilatation of the main pulmonary artery.  Mild coronary\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is described in detail in the dedicated\nabdominal CT report.  Minimal right pleural effusion.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  Old healed rib\nfracture (603, 56).\nModerate bilateral apical scarring.  Mild paraseptal pulmonary emphysema.  8\nmm pleural based irregular and slightly spiculated left upper lobe nodule\n(302, 100).  Similar nodules are seen in the right upper lobe (302, 105), the\nmiddle lobe (302, 154) and in the right lower lobe (302, 137, 302, 208 and\n148).  There also is a regular nodule with 4 mm in diameter in the right lower\nlobe (302, 169).  The right lower lobe shows multisegmental mucous plugging of\nthe airways (302, 183).",
            "output": "Multiple, partly ill-defined and slightly spiculated pulmonary nodules,\npredominating in the right and left upper lobe as well as in the middle lobe\nand the right lower lobe.  Because of the background history of the patient, a\n3 months follow-up must be performed.  Small left pleural effusion.  No\nadenopathy.  Multisegmental mucous airways plugging."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Mild calcific\natherosclerosis in the descending thoracic aorta.  The heart, pericardium, and\ngreat vessels are within normal limits. No pericardial effusion is seen.  The\ndistal tip of a left chest wall Port-A-Cath terminates in the upper to mid\nSVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy.  No mediastinal mass or hematoma.  Evaluation\nof hilar lymphadenopathy is limited on this unenhanced study, although left\nhilar contour is suggestive of lymphadenopathy.\n\nPLEURAL SPACES: Small right nonhemorrhagic pleural effusion.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Moderate biapical scarring and mild paraseptal pulmonary\nemphysema is unchanged.\n\nInterval increase in size of multiple pulmonary nodules from ___, for\nexample:\n2.2 x 1.2 cm pleural-based irregular slightly spiculated nodule in the right\nupper lobe (4:162), previously 1.5 x 1.0 cm.\n0.6 x 0.5 cm right middle lobe nodule (4:218), previously 0.5 x 0.5 cm.\n0.6 x 0.8 cm right lower lobe subpleural nodule (4:203), previously 0.6 x 0.6\ncm.\n0.5 cm right lower lobe subpleural nodule (4:240), previously 0.4 cm.\n\n1.0 x 0.6 cm pleural-based irregular slightly spiculated nodule in the left\nupper lobe (4:153) and 0.5 x 0.5 cm right lower lobe nodule (4:201)\ndemonstrate no significant change in size.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.  Incidental\nnote is made of minimal body fat.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture.  Mild\ndegenerative changes of the thoracic spine.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.",
            "output": "Interval increase in size of multiple pulmonary nodules from ___,\nconcerning for progressive metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No pericardial effusion.  Mild\nto moderate calcified coronary atherosclerosis.  The thoracic aorta is normal\nin caliber.  Incidental note is made of an aberrant right subclavian artery. \nThe main pulmonary artery is normal in caliber.  No central pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: Right axillary, left axillary, mediastinal, and\nhilar lymphadenopathy is minimally changed with many nodes unchanged and few\nlymph nodes minimally enlarged.  A dominant right axillary lymph node measures\n1.5 cm, left axillary lymph node measures 1.5 cm, right upper paratracheal\nlymph node measures 1.4 cm, right hilar lymph node measures 1.6 cm, and\nsubcarinal lymph node measures 1.2 cm (series 4, images 6, 12, 14, 26, and\n28).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Supraclavicular lymphadenopathy is partially imaged, but not\nappreciably changed.\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Minimally changed supraclavicular, axillary, mediastinal, and hilar\nlymphadenopathy with many nodes unchanged and few nodes minimally enlarged."
        },
        {
            "input": "THORACIC INLET:Visualized thyroid is unremarkable.  Bilateral supraclavicular\nlymphadenopathy, the largest measuring up to 1.0 cm in the right\nsupraclavicular region (05:10).\n\nTHORACIC LYMPH NODES:  Bilateral axillary lymphadenopathy, the largest on the\nright measuring 1.5 cm (05:12), and the largest on the left measuring 1.8 cm\n(05:15).  Multiple other enlarged axillary lymph nodes are identified for\nexample (05:10, 15, and 22).  Numerous small mediastinal lymph node are also\nidentified, for example a paratracheal lymph node measures 0.9 cm (05:23).  A\nsubcarinal lymph node measures 1.2 x 1.9 cm (05:29).  Small bilateral\npericardial lymph nodes are not pathologically enlarged by CT size criteria.\n\n\nHEART, VESSELS and PERICARDIUM: The heart is not enlarged.  There is mild\ncoronary artery calcification.  The ascending aorta measures 3 cm and is\nnormal.  The main pulmonary artery measures 2.5 cm and is also of normal\ncaliber.  There is no pericardial effusion.  Incidental note is made of an\naberrant right subclavian artery, a normal anatomic variant.\n\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: The lungs are clear without suspicious masses or areas of\nparenchymal opacification.\n2. AIRWAYS: Airways are patent to the level of the segmental bronchi\nbilaterally.\nCHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.\n\nUPPER ABDOMEN: The visualized upper abdomen demonstrates numerous enlarged\nlymph nodes as well as splenomegaly.  Please refer to separate report of CT\nabdomen and pelvis for description of the subdiaphragmatic findings.",
            "output": "1. Multiple pathologically enlarged supraclavicular, subpectoral, axillary,\nand mediastinal lymph nodes.\n2. No other evidence of intrathoracic metastatic disease.\n3. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for description of the subdiaphragmatic findings."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There is no axillary\nlymphadenopathy. There is a 6 mm subcarinal lymph node. No other prominent\nmediastinal lymph nodes are identified.  These do not meet criteria for\npathologic enlargement. There is no hilar lymphadenopathy or hilar mass.\n\nThe heart is normal in size. There is no pericardial effusion. Severe\natherosclerotic calcifications are noted along the coronary arteries and mild\ncalcifications are noted along the aortic valve. The thoracic aorta is normal\nin caliber with moderate atherosclerotic calcifications. The main pulmonary\nartery trunk is normal in diameter.\n\nThe airways are patent to the subsegmental levels. There is mild irregularity\nand bronchial wall thickening, consistent with chronic small airways disease.\nThere is minimal emphysema.  Additionally, there are diffuse centrilobular\nground-glass nodules in the upper lobes, consistent with respiratory\nbronchiolitis. This is not significantly changed from prior CT.  Linear\nopacities in the left lower lobe and right middle lobe are most consistent\nwith atelectasis. There is no large opacity or pulmonary mass.\n\nThere several sub 4 mm pulmonary nodules, one of which is calcified (4; 19,\n35, 42, 47, 50, 60, 63, and 87). Some of these are likely related to the\nrespiratory bronchiolitis, though some are subpleural in location and more\ndiscrete. A few are new since ___.\n\nThere is no pulmonary edema, pleural effusion, or pneumothorax.\n\nThis exam is not tailored to evaluate the subdiaphragmatic structures. Within\nthe limitations, the imaged portions of the liver are normal. The patient is\nstatus post a cholecystectomy. The spleen, pancreas, and adrenal glands are\nnormal.  Two simple cysts, measuring 23 mm and 19 mm, are noted in the left\nkidney.  A 4 mm hyperdense rounded lesion in the upper pole of the left kidney\n(2, 47) is unchanged from ___, suggesting it is benign and likely a\nhemorrhagic or proteinaceous cyst. The large bowel at the splenic flexure is\ndilated and air-filled, measuring 7.9 cm.\n\nThere are no concerning lytic or sclerotic osseous lesions.  Nondisplaced\nremote fractures of the left tenth and eleventh ribs are new since ___.\nPeriosteal reaction around the left humerus is consistent with a healing\nfracture. There is no evidence of a compression fracture in the spine.\nModerate degenerative changes are noted in the thoracic spine with disc\nosteophyte complexes causing mild to moderate multilevel spinal canal\nnarrowing.",
            "output": "1. No pulmonary mass is identified to explain the possible paraneoplastic\nsyndrome. Multiple sub-4-mm pulmonary nodules are identified, as described\nabove.  Per the ___ guidelines, a CT of the chest is recommended in one\nyear.\n2.  Respiratory bronchiolitis, mild emphysema, and mild chronic small airways\ndisease.\n3.  Severe coronary artery calcifications.\n4.  Healing left humerus and left posterior tenth and eleventh rib fractures.\nNo acute fracture."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.  The heart and mediastinum are normal.\nThe pericardium is intact without effusion.  Airways are patent to the\nsubsegmental levels.\n\nThere is minimal scarring at the bilateral lung apices.  The lungs are clear\nwithout focal or diffuse abnormality. The pleura is intact without effusion.\nNo pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No evidence of aortic dissection.  No acute intrathoracic process."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  A PICC\nis present with tip in the mid SVC.  Cardiac configuration is normal.\n\nAirways are patent to subsegmental levels.  Again seen are innumerable small\nnodular opacities throughout the lungs, in a similar distribution to the prior\nstudy.  Since the prior study, the opacities have more of a ground-glass\nquality.  More confluent areas opacity are seen at the lung bases and\nperipheral upper lobes.  There is no pleural effusion or pneumothorax.\n\nCalcified granulomas in the spleen are consistent with prior granulomatous\nexposure.  A calcification is also seen in the liver.  A focal hypodensity in\nthe left lobe of the liver measuring 5 mm is too small for further\ncharacterization.\n\nMultilevel degenerative changes are present throughout the thoracic spine\nwithout fracture.",
            "output": "Diffuse miliary nodules, now more ground-glass in appearance than on the prior\nstudy.  Differential remains the same and includes fungal and viral etiologies\nas well as atypical bacteria such as Nocardia."
        },
        {
            "input": "MEDIASTINUM/HEART:  The imaged thyroid is normal.  Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged by CT size criteria.  The\nascending aorta is dilated to 4.5 cm.  The main pulmonary artery is normal in\nsize.  Heart size is normal with extensive, unchanged coronary artery and\nmoderate aortic arch calcifications.  Aortic valve calcifications are mild. \nNo pericardial effusion detected.\n\nLUNGS/AIRWAYS:  Compared with the 2 most recent chest CTs, the infiltrative\nprocess initially identified on ___ has substantially cleared. \nSpecifically, previous numerous small lung nodules and ground-glass opacities\nthroughout both lungs are no longer present.  However, previous coalescent\nopacities have grown into areas of dense irregular peribronchial infiltration\npredominantly affecting the periphery of both lower lobes and lung apices\n(5:57, 68, 116, 158, 208, 271, 283).  Scattered punctate calcified granulomas\nare unchanged since the prior study (5:146, 159).\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, the previous 6 mm hypodensity in the left\nhepatic lobe is not as conspicuous on the current study (3:54).  Multiple\ncalcified granulomas in the spleen, and 1 in the liver, are unchanged (3:61).\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. A sclerotic bone island in the left scapula is unchanged in\nappearance since at least ___ (7b:169). Multilevel\nmild-to-moderate degenerative changes of the thoracic spine are unchanged.",
            "output": "1.  The infiltrative process initially identified on ___ has\nsubstantially cleared, evidenced by resolution of multiple ground-glass\nopacities.\n\n2.  However, previous coalescent opacities have progressed to more dense,\nirregular peribronchial infiltration, primarily in the peripheral upper and\nlower lobes.  It is unclear if this represents progression of the infection,\nor new infection with another pathogen.  Alternatively, a developing fibrotic\nreaction is possible, although architectural distortion and retraction and\ntraction bronchiectasis reflecting fibrosis are not present."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged ranging up to the 7\nmm in the right axilla, 9 mm on the left.\n\nThere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis,\n\nAtherosclerotic calcification is mild in head neck vessels but is present in\nat least left anterior descending and right coronary arteries.  Aortic\nvalvular calcification is minimal.  Ascending thoracic aorta is dilated in a\nfusiform fashion to maximum diameter of 50 mm, unchanged since ___, 46\nmm in ___.\n\nCentral lymph nodes are not pathologically enlarged.\n\nLungs are fully expanded and clear and tracheobronchial tree is normal to\nsubsegmental levels.\n\nMild subpleural interstitial abnormality, particularly in the costal surfaces\nof the right upper lobe, are attributable to degenerative changes of aging\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  .",
            "output": "No evidence of intrathoracic malignancy or active infection.\n\nSlow progression over nearly ___ years in moderate, fusiform aneurysm of the\nascending thoracic aorta.\n\nCoronary atherosclerosis."
        },
        {
            "input": "The thyroid is normal.  There are prominent mediastinal lymph nodes, though\nthere are not pathologically enlarged.  There is no significant axillary or\nsupraclavicular lymphadenopathy.  The ascending aorta is dilated, similar to\nprior. Pulmonary arteries are normal size. Cardiac configuration is normal and\nthere is mild coronary calcification.  The arch of the aorta is moderately\ncalcified.\n\nEvaluation of the lungs shows innumerable, tiny hazy pulmonary nodular\nopacities scattered throughout the lungs in a diffuse pattern, possibly with a\nslight peripheral prominence.  More confluent areas of opacity are seen at the\nbilateral bases as well as in the peripheral upper lobes.  The airways are\npatent to the subsegmental level.\n\nLimited evaluation of the upper abdomen shows evidence of prior granulomatous\ndisease with calcified granulomas in the liver and spleen.  Minimal,\nnonspecific perinephric stranding is seen around the left kidney.  A\nnonobstructive renal calculus is noted.\n\nEvaluation of the bones shows degenerative changes throughout the thoracic\nspine without acute fracture.",
            "output": "The innumerable, small hazy pulmonary nodular opacities in a miliary pattern. \nIn this immunocompromised patient with fever, infectious differential includes\nfungal and viral etiologies as well as more atypical bacteria such as\nnocardia."
        },
        {
            "input": "There is a punctate coarse calcification in the right thyroid lobe. The gland\nis not enlarged. There is no supraclavicular, mediastinal, hilar or axillary\nlymphadenopathy.\n\nHeart size is normal with aortic root and scattered coronary artery\ncalcifications. There is no pericardial effusion. Main pulmonary artery and\nthoracic aorta are normal caliber.\n\nSeveral newly identified noncalcified pulmonary nodules measure up to 4 mm in\nthe right lower lobe are  (6: 48, 73, 85, 93, 121, 125, 144). The largest left\nlower lobe nodular opacity with indistinct borders has slightly increased\nsince the CT abdomen/pelvis of ___ (6, 198).  A 4 mm right lower lobe\nnodule is new since ___ (6, 218), however, a 2 mm left lower lobe\nsubpleural nodule is stable (6, 252). There are questionable 1-2mm\ncentrilobular ground-glass nodules in the bilateral upper lobes. A few\ncalcified granulomas are also identified bilaterally (06: 37 and 152).\n\nModerate thoracic spine kyphosis with multilevel spinal degenerative changes\nare present.\n\nUpper images of the upper abdomen are unremarkable.",
            "output": "Interval increase in size of indeterminate left lower lobe nodular opacity\nwith indistinct borders since ___, which may be inflammatory in\netiology.  A ___ month followup chest CT is recommended.\n\nAdditional indeterminate solid pulmonary nodules measuring up to 4 mm in the\nright lower lobe, one of which in the right lower lobe is new since ___.\n\nQuestionable 1-2 mm centrilobular nodules in the bilateral upper lobes may be\ninflammatory in etiology. The differential diagnosis would include smoking\nrelated lung injury (e.g. respiratory bronchiolitis) and hypersensitivity\npneumonitis."
        },
        {
            "input": "Again identified within the right thyroid lobe, there is a 4 mm coarse\ncalcification noted. The thyroid gland is otherwise unremarkable. No axillary,\nsupraclavicular, mediastinal or hilar pathologically enlarged nodes are\nidentified. The heart is within upper limits of normal in size. The aorta and\npulmonary arteries are normal in caliber. Calcifications of the coronary\narteries as well as aortic valve are noted. Mild atherosclerotic\ncalcifications involving the aortic arch are seen. The esophagus is without in\nabnormality. The airways are patent to the subsegmental level.\n\nBiapical scarring is identified. Again identified are several calcified\ngranuloma within the right lower lung. (4:24, 28, 38, 58, 117). Again\nidentified are noncalcified pulmonary nodules measuring up to 4 mm within the\nright lower lobe (4:  36, 57, 63, 74, 91, 101 and 117) which appear stable. \nWithin the left lower lobe, a subpleural 2 mm nodule (4:194) is unchanged.  A\npreviously seen nodule left lower lobe nodular opacity is no longer present. \nNo focal consolidation is identified.\n\nOsseous structures demonstrates no suspicious lytic or blastic lesion. Re-\ndemonstration of thoracic spine is kyphosis with multilevel degenerative\nchanges as demonstrated by endplate sclerosis and disk space narrowing.\n\nNo study not tailored for subdiaphragmatic evaluation, no abnormality is\ndetected.",
            "output": "1. Several bilateral pulmonary nodules identified. Previously seen left lower\nlobe nodular opacity no longer present, thought likely inflammatory nodule.\nRecommend dedicated Chest CT in ___ for continued surveillance.\n\n2. Coarse calcification within the right thyroid lobe is unchanged."
        },
        {
            "input": "A 5 mm coarsely calcified nodule in the right lower lobe is stable in size\nfrom the prior examination when it measured 5 mm.  The thyroid gland is\notherwise unremarkable.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe great vessels are normal caliber.  Calcification of the coronary arteries\nas well as at the aortic valve are noted.  Mild atherosclerotic calcifications\nof the aortic arch are unchanged.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels.\n\nBiapical scarring is unchanged.  Several calcified granulomas are seen within\nthe right lung (series 4, image 19, 23, 33, 53, 115) unchanged in size.  No\nfocal consolidation, pleural effusion or pneumothorax is identified Multiple\nnoncalcified pulmonary nodules are identified as follows:\n\nRight lower lobe:  Series 4\n1 mm nodule is stable (image 32)\n3 mm nodule is decreased was previously 4 mm (image 53)\n2 mm nodule is stable (image 62)\n2 mm nodule is stable (image 70)\n3 mm nodule is stable (image 90)\n4 mm nodule is decreased and was previously 5 mm (image 98)\n1 mm nodule is stable (image 116)\n\nLeft lower lobe: Series 4\n3 mm nodule is stable (image 191)\n\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Numerous calcified and noncalcified pulmonary nodules are not significantly\nchanged from the prior examination in ___.\n\nCoarse calcification within the right thyroid lobe is stable.\n\nNOTIFICATION:  Recommend CT in one year for continued evaluation of multiple\npulmonary nodules."
        },
        {
            "input": "A 5 mm coarsely calcified nodule in the right lower lobe is stable in size\nfrom the prior examination when it measured 5 mm.  The thyroid gland is\notherwise unremarkable.\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.\n\nThe great vessels are normal caliber.  Calcification of the coronary arteries\nas well as at the aortic valve are noted.  Mild atherosclerotic calcifications\nof the aortic arch are unchanged.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels.\n\nBiapical scarring is unchanged.  Several calcified granulomas are seen within\nthe right lung.  No focal consolidation, pleural effusion or pneumothorax is\nidentified Multiple noncalcified pulmonary nodules are identified as follows:\n\nPre-existing millimetric nodules measuring up to 4 mm are all stable in size\nand morphology including right upper lobe series 4, image 39, 60, 70, right\nmiddle lobe series 4, image 99 right lower lobe series 4, image 77, 106 and\nleft lower lobe series 4, image 194.  No new pulmonary nodule.\n\n\nThe esophagus is patulous and visualized upper abdominal organs are\nunremarkable.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Stable appearance of the millimetric pulmonary nodules dating back to ___.  No further imaging follow-up required as per ___ guidelines."
        },
        {
            "input": "AORTA:  The ascending aorta and hemi-arch have been replaced with a Gelweave\ntube in ___ for repair of an aneurysm.  Distally in the descending\nintrathoracic aorta, an endovascular graft was placed for treatment of a\npenetrating ulcer with contained rupture in ___.  No evidence of endoleak.\n\nThere is limited assessment of the intrathoracic aorta on the most recent CT\ndated ___ due to lack of intravenous contrast.  However, in comparison to\nthe prior CTA chest from ___, the grafted ascending aorta at the level of\nthe distal trachea just proximal to the carina (5:33) demonstrates a highly\nirregular contour with a beaked appearance posterolaterally.  It is also\nlarger in diameter, now measuring up to 6.2 cm (5:30), previously 5.5 cm\n(6:52, ___ CTA).  These findings together are highly concerning for\nimpending rupture.  No active extravasation is seen.  The visualized portion\nof the intra-abdominal aorta is overall unchanged in size.\n\nPULMONARY ARTERIES:  The pulmonary arteries are well opacified to the\nsubsegmental level, with no evidence of filling defect within the main, right,\nleft, lobar, segmental or subsegmental pulmonary arteries. The main and right\npulmonary arteries are normal in caliber, and there is no evidence of right\nheart strain.\n\nHEART:  Heart size is moderately enlarged, unchanged.  No pericardial\neffusion.\n\nLUNGS:  Since the most recent CT chest on ___, there has been interval\nplacement of a tracheostomy tube, which appears to course through the\nheterogeneous multinodular thyroid gland (5:2).  The Y-tracheal stent is\nunchanged in position, with the airways patent to the subsegmental levels. \nPneumomediastinum persists, although significantly decreased compared to the\nprior study performed 1 week earlier. There is a small amount of intermediate\ndensity secretions layering posteriorly in the dependent portion of the\ntrachea at the level of the aortic arch (5:25).  No high-density contrast is\nseen within the airways to suggest aorto-tracheal fistulization.\n\nModerate nonhemorrhagic bilateral pleural effusion has slightly increased\nsince the most recent CT.  Adjacent atelectasis is noted.  New since the prior\nstudy is a 0.9 x 1.1 cm nodular density in the right middle lobe (5:60) that\nappears to be located immediately distal to a distal branch of the right\nmiddle lobe bronchus, and is compatible with fluid/mucous impaction.\n\nLYMPH NODES:  Lymph nodes within the bilateral axillary regions and right\nhilar station are again demonstrated.\n\nABDOMEN: Limited images of the upper abdomen demonstrated a large simple cyst\narising from the upper pole of the left kidney.  An enteric tube extends to at\nleast the stomach.\n\nBONES/SOFT TISSUES:  Degenerative changes are noted throughout the thoracic\nspine.  No lytic or blastic osseous lesion suspicious for malignancy is\nidentified.",
            "output": "1.  Interval enlargement of previously grafted ascending aorta now with\nirregular contours medially that is new since ___ and highly concerning\nfor impending rupture.\n2.  No evidence of aorto-tracheal/aorto-bronchial fistula.\n3. Interval placement of a tracheostomy tube, which appears to penetrate\nthrough the multinodular thyroid gland.\n4.  Improving pneumomediastinum.\n5. A 0.9 x 1.1 cm right middle lobe soft tissue density, likely representing\nmucous impaction of the bronchus.\n6. Mild interval increase in bilateral non-hemorrhagic pleural effusions with\nadjacent atelectasis.\n\nNOTIFICATION:  Findings telephoned to Dr. ___ by ___ on ___\nat 5:22pm, immediately after discovery of findings."
        },
        {
            "input": "In the setting of a large multi nodular goiter, dilated head and neck vessels,\nand anasarca, detection of adenopathy particularly in the supraclavicular\nstations and thoracic inlet is not possible on a noncontrast study.  If the\npatient can tolerate intravenous contrast infusion it should be administered\non subsequent chest CT scanning.  Both the very large goiter and axillary\nlymph nodes in the diameter range of 10-15 mm have been present since at least\n___.\n\nThe large chronic aortic aneurysm with maximum diameters 60 mm at the origin\nof the aortic arch, 4:71, and 61 mm just above the diaphragm at the distal end\nof the endo graft, 4:184 are unchanged since ___.  On ___ they\nwere 55 mm and 59 mm ,respectively.  There has been no migration or change in\ncaliber or configuration of the aortic endo graft since at least ___\noriginating at the junction of the arch and descending aorta extending nearly\nto the diaphragm.  In the absence of intravenous contrast infusion, one cannot\nassess either extravasation or the aortic lumen, especially regarding\nthrombosis or plaque ulceration.  There has been no change in the periaortic\nmediastinal tissue to suggestive a significant new hemorrhage since ___,\nbut a high density component in the aortic wall on the medial aspect of the\nlower stent, 146- 157 has been present since ___ at least ___, and is\nprobably a stable, intramural hematoma.\n\nA sub cricoid tracheostomy tube has a roughly 5 cm intra tracheal excursion,\nwith its tip abutting the posterior tracheal wall less than a cm above the\norigin of the tracheobronchial Y stent. Immediately below the tip of the\ntracheostomy and extending into and nearly occluding the orifice of the Y\nstent is a 15 x 9 x 11 plug of granulation tissue or organized thrombosis,\n04:42, 602b:61, new since ___.\n\nBelow the orifice, ingrowth of tissue in the tracheal and bronchial portions\nof the Y stent is much thinner.  Caliber of the lumen of the tracheal portion\nis no less than 11 mm, and of the bronchial portions, the smallest is in the\nleft main bronchus, 6 mm, 4:98.  The right bronchial portion extends beyond\nthe origin of the upper lobe bronchus to the bronchus intermedius which,\nbeyond the tip of the stent has a collapsed luminal diameter of 3 mm.  The\nleft bronchial portion ends midway between the carina and the origin of the\nleft upper lobe, beyond which the left main bronchial lumen narrows to less\nthan 3 mm, 4:105.  There is no clear discontinuity in the tracheobronchial\ntree either at the level of the Y stent or elsewhere.  There is no mediastinal\ngas to suggest a tracheobronchial perforation.  Detection of a small amount of\nfluid in the mediastinum is not possible however.\n\nSmall nonhemorrhagic layering left pleural effusion has decreased\nsubstantially since ___ and right pleural effusion has nearly resolved. \nThere is no pericardial effusion.  Moderate cardiomegaly is stable.  Aortic\nvalvular calcification is relatively mild.  Moderate atherosclerotic\ncalcification in at least the left anterior descending coronary artery is\nunchanged.\n\nNew region of ground-glass opacification in the apical posterior segment of\nthe left upper lobe, 602b:33-49 could be atelectasis or aspiration.  Small\nareas of peribronchial consolidation at the base of the left lung could be\nresidual atelectasis or early pneumonia,, and the adjacent small bronchi are\npartially impacted with secretions, 4:170- 185.",
            "output": "The origin of the tracheobronchial Y stent is nearly occluded by granulation\ntissue or organized thrombus, new since ___.  Intraluminal material more\ndistally in the bronchial portions is less pronounced.  Otherwise the stent is\nintact.  Distal to the bronchial portions of the stent, the bronchus\nintermedius and left main bronchus are severely malacic.\n\nNo evidence of discontinuity in the tracheobronchial tree.\n\nDiffusely aneurysmal thoracic aorta, large aortic endo graft, and mural\nhematoma in the distal thoracic aorta are all the stable since ___.  No\nevidence of active aortic bleeding into the mediastinum.  Aneurysmal\nprogression since ___ has been minimal.\n\nRelatively mild impaction of distal bronchi, left lower lobe and possible\nsmall regions of pneumonia at the base and aspiration in the apical posterior\nsegment of the left upper lobe, all new ___.\n\n\n\n\n\n\n\n\nNOTIFICATION:   Dr. ___ reported the findings t the next foreign preop\nhiatus with a CT of the agent aneurysm and stare there o  ___ by\ntelephone on ___ at  10:20AM, 20 minutes after the initial page\nimmediately following the discovery of the findings."
        },
        {
            "input": "A chronic thoracic aortic aneurysm with an endovascular stent extending from\nthe distal half of the aortic arch to just above the diaphragm is overall\nsimilar to the prior exam.  The descending thoracic aorta is tortuous, similar\nto the prior exam.  No evidence of extraluminal contrast extravasation or\nintraluminal thrombus.  No evidence of a fistula connection between the\nthoracic aorta and trachea or mainstem bronchi; fat planes appear preserved\nbetween the structures.  No high density contrast material is noted within the\nairways.  No evidence of a mediastinal hematoma.\n\nThe pulmonary arteries appear patent on this nondedicated exam.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.  Atherosclerotic calcifications are again noted.  No\npneumomediastinum.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland is enlarged and heterogeneous, consistent with multinodular\ngoiter, similar to the prior exam.\n\nNo evidence of pericardial effusion.  No pleural effusion.\n\nA tracheostomy tube tip ends approximately 4 cm above the carina.  The\ntracheal Y-stent appears patent and in similar position.  Small secretions,\npredominantly around the right mainstem bronchus portion of the stent is noted\n(e.g., Se 2, Im 62, 54).  The airways are patent to the subsegmental level. \nBilateral, and diffusely scattered ground-glass opacities, most prominent in\nthe lower lungs is more extensive compared to the prior exam.  Scattered\nparenchymal opacities in the infrahilar region, greater on the right compared\nto the left is new (series 2, image 111).  Left dependent basilar atelectasis\nis mild.  No pneumothorax.\n\nLimited images of the upper abdomen are unremarkable other than the large left\nupper renal pole cystic lesion, similar to the prior exam.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nScoliosis of the visualized spine is unchanged.  Multi-level degenerative\nchanges are also unchanged in the spine.",
            "output": "1.  No evidence of contrast extravasation into the trachea to indicate a\nfistula between aorta and trachea.\n2.  Diffuse, bilateral ground-glass opacities, more prominent and new from the\nprior exam.  Given the provided history, concerning for pulmonary hemorrhage. \nOther causes include infection or edema.\n3.  Stents appear patent and similar to the prior exam.\n4.  Chronic thoracic aortic aneurysm with graft, overall similar to the prior\nexam.  No extraluminal extravasation.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ in ___ ___ at 4:08 AM, 1 minutes after discovery of the\nfindings.\nFindings were also discussed via telephone with Zac from the MICU on ___\nat 439 am."
        },
        {
            "input": "Enlarged and heterogeneous thyroid gland appears unchanged, but is\nsuboptimally evaluated without intravenous contrast. Similarly, post stent\nappearance of the thoracic aorta is unchanged, but not optimally assessed\nwithout contrast. Dilation of the ascending aorta between the graft and stent\nis similar at approximately 5.5 cm in diameter\n\nBilateral axillary and subpectoral lymph node have slightly increased in size\nsince the previous studies. For example, an 11 mm short axis lymph node in the\nsuperior left axillary region previously measured 9 mm in ___. Known\nright hilar lymph node enlargement is difficult to measure in the absence of\nintravenous contrast.\n\nSkeletal structures demonstrate previous sternotomy. No new suspicious lytic\nor blastic skeletal lesions are detected within the thorax.\nDiffuse coronary artery and aortic valvular calcifications are present. Heart\nis upper limits of normal in size. There is no pericardial or substantial\npleural effusion.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but a large\ncyst in the upper pole portion of the left kidney is incompletely\ncharacterized but unchanged\n\nWithin the lungs, 2 recently described new lung nodules in the right apex and\nleft lower lobe have resolved.",
            "output": "1. Resolution of 2 lung nodules that were newly detected in ___.\n\n2. Slight increase in size of bilateral axillary lymph nodes. Suboptimal\nassessment of right hilar lymph node enlargement due to absence of intravenous\ncontrast.\n\n3.  Suboptimal assessment of thoracic aorta in this patient status post\nascending arch repair and descending graft. Dilation of ascending aorta\nbetween the graft and stent is approximately similar to ___, but aorta\nwould be more ideally assessed with dedicated CTA study.\n\n4. Enlarged, heterogeneous thyroid gland consistent with history of\nmultinodular goiter."
        },
        {
            "input": "The ascending aorta measures 4.5 cm.  The main pulmonary artery is top-normal\nin size.  The thyroid is normal. Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged.\n\nCardiac configuration is normal and mild coronary artery calcifications are\nseen.  No pericardial effusion.  The pulmonary parenchyma is notable for\nbilateral lower lobe atelectasis.  No pleural effusion.\n\nThe osseous structures are unremarkable.  No focal lytic or blastic lesions. \nNo rib fractures.",
            "output": "1.  Ascending aorta measuring 4.5 cm, not meeting size criteria for aneurysm\nwhen adjusted for age.\n2.  No rib fracture.\n\nRECOMMENDATION(S):  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 9:46 AM"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion. The heart is top-normal in size.\nCoronary artery calcifications are mild.\n\nThere are moderate bilateral non hemorrhagic pleural effusions on the right\ngreater than the left with associated compressive atelectasis of the bilateral\nlower lobes moreso than the upper lobes. There are widespread heterogeneous\nground-glass and reticular opacities in the bilateral upper lobes.  The\nopacities are confluent throughout the left upper lobe and lingula but patchy\nin the right upper lobe, right middle lobe and left lower lobe. The airways\nare patent to the subsegmental level.\n\nProminent mediastinal lymph nodes measure 0.8 cm in short axis in the right\nupper paratracheal station (02:17) and 1.1 cm in short axis in the right lower\nparatracheal station (02:39). There is no supraclavicular, axillary, or hilar\nlymphadenopathy. The thyroid gland appears unremarkable.\n\nLimited images of the upper abdomen demonstrate a TIPS and small volume\nperihepatic ascites.  There is a small hiatal hernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.  A\nhealed right posterior rib fractures are noted. There are multilevel\ndegenerative changes of the thoracic spine.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Heterogeneous ground-glass opacities most pronounced in the upper lobes,\nwhich have developed in short interval since ___, may represent areas\nof infection, hemorrhage or edema.\n3.  Prominent mediastinal lymph nodes are likely reactive.\n4.  Bilateral moderate pleural effusions with associated compressive\natelectasis."
        },
        {
            "input": "The thoracic aorta is normal in caliber with mild atherosclerotic\ncalcifications along its course.  The main pulmonary artery is normal in\ncaliber.\n\nNo pathologically enlarged supraclavicular, axillary, or mediastinal lymph\nnodes are identified.  Evaluation for hilar lymphadenopathy is limited on this\nnonenhanced CT, but the hilar contours are within normal limits.\n\nHypoattenuation of the blood pool relative to cardiac musculature is\ncompatible with known anemia.  Moderate coronary artery calcifications are of\nunknown hemodynamic significance.  There is no pericardial effusion.\n\nLarge bilateral pleural effusions have increased since ___.  Adjacent\nconsolidation is most likely atelectasis given the volume loss, but concurrent\ninfection cannot be excluded.  The right lower lobe is not aerated, and there\nis little aeration of the left lower lobe.  Diffuse ground-glass opacities in\nthe bilateral upper lobes, left more than right, as well as the lingula are in\na similar distribution to opacities seen on CT ___.  These opacities\nhad resolved on CXR ___ and appear to have recurred.  No consolidation\nis seen.  Central airways are patent.\n\nLimited imaging of the upper abdomen demonstrates a TIPS stent, incompletely\nevaluated.  The stomach is distended with fluid.\n\nNo bone finding suspicious for infection or malignancy is seen.  Degenerative\nchange is noted in the lower thoracic spine.",
            "output": "1.  Large bilateral pleural effusions with adjacent consolidation, most likely\natelectasis given the volume loss.  Concurrent infection cannot be excluded. \nThe right lower lobe is collapsed.  There is little aeration of the left lower\nlobe.\n2.  Heterogeneous ground-glass opacities in the bilateral upper lobes, left\nmore than right, have improved since ___ and are nonspecific.  Given\nthat these opacities had a similar distribution but resolved on CXR ___ and have recurred, and appear to have worsened notably over the prior 3\ndays, they more likely represent edema, although infection or hemorrhage could\nhave a similar appearance."
        },
        {
            "input": "The thyroid gland is unremarkable.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy\nidentified.  A right-sided approach central venous catheter terminates in the\ndistal SVC. The central vessels are otherwise unremarkable. Heart size is\nnormal and without pericardial effusion.  Enteric catheter terminates in the\nbody of the stomach.\n\nEndotracheal tube terminates 4.5 cm above the carina. Airways are normal.\nBilateral large pleural effusions are stable in size though with increased\nadjacent atelectasis.  Effusions measure with increased density which\ngenerally represents non serous fluid, however this may be artifactually\nincreased due to patient's body habitus and arm position.\n\nA large left posterolateral chest wall hematoma measuring 8.3 (TRV) x 17.4\n(AP) x 36.0 (CC) cm all contains mixed internal density consistent with a\nlayering hematocrit.  Hematoma is increased in size compared to outside\nhospital CT performed ___ with greater circumferential and caudal\nextent (exact comparative measurements are not possible as the hematoma is not\nentirely included on the prior scan). Given lack of intravenous contrast,\nunable to assess for active extravasation.\n\nNo suspicious lytic or blastic lesions identified. No intra thoracic fracture\npresent.  Bilateral gynecomastia is not unexpected in setting of cirrhosis.\n\nPlease see concurrent CT abdomen pelvis for additional findings.",
            "output": "1. Large left posterolateral chest wall hematoma growing since ___. \nNo fractures. Mass, responsible for bleeding, would be difficult to identify,\nbut there is no evidence of one.\n\n2. Non serous, large layering pleural effusions with increased adjacent\natelectasis.\n\nPlease see concurrent CT abdomen pelvis for additional findings."
        },
        {
            "input": "The right thyroid enlargement is unchanged.  Small upper mediastinal lymph\nnodes are stable. Prevascular lymph node, series 4, image 21 is stable.  Sub-\ncarinal lymph node is stable.\n\nNo hilar or axillary lymphadenopathy seen.\n\nAorta and pulmonary arteries are normal in diameter. Heart size is normal.\nThere is no pericardial or pleural effusion demonstrated.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued. 10 cm mass in the upper abdomen is not\nfully imaged.\n\nAirways are patent to the subsegmental level bilaterally.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nSevere centrilobular and panlobular emphysema is unchanged.  Left apical\nslightly spiculated 19.4 x 9.5 mm nodule has minimally increased in size by 3\nmm in each direction.  A right upper lobe lobulated nodule, series 6, image 76\nis currently 10 x 9.4 mm as compared to 8.3 x 7.6 mm, minimally increased\nsince the prior study. Additional posterior segment right upper lobe nodule\nhas substantially increased from 12 x 9 mm to 6 in 0.5 x 14.3 mm.  The extent\nof emphysema is primarily affecting upper lobes with lower lobes involved a\nsubstantially less degree. Multiple cystic lesions in the lungs can\npotentially reflect marrow fibromatosis but a combination of emphysema and\nneurofibromatosis would be another possibility.\n\nSubcutaneous nodules are bilateral and small, overall unchanged since the\nprior study, consistent with provided history of neurofibromatosis as well as\nthe paraspinal lesions, series 4, image 48. The largest lesion in the\nsubcutaneous location, series 4, image 48 is 43 x 18.7 mm and appears to be in\nminimally decreased in size as compared to prior study (43 x 23 mm although it\nmight reflect slight lead different distension and orientation.",
            "output": "Interval increase in pulmonary nodules\n\nNo substantial change in cystic lung disease potentially representing\nemphysema all combination of emphysema and neurofibromatosis.\n\nMultiple subcutaneous nodules, with the dominant 1 being minimally decreased\nsince the prior study.\n\nPartially imaged right upper abdomen most likely pancreatic mass"
        },
        {
            "input": "Unchanged appearance of the thyroid. Left pectoral Port-A-Cath. Unchanged\nappearance of the mediastinum and the hilar structures, without evidence of\nlymphadenopathy. Unchanged appearance of the cardiac structures. Unchanged\nsmall hiatal hernia. The posterior mediastinum is unremarkable. Known multiple\nsubcutaneous nodules, the largest of which is located in the left aspect 's of\nthe chest wall (4, 49) and has not substantially changed in size and\nappearance. The abdominal findings are reported in detail in the abdominal CT\nreport. No evidence of osteolytic lesions at the level of the sternum, the\nribs, and the vertebral bodies.\nMany of the pre-existing pulmonary nodules are unchanged in size and\nmorphology. A larger nodule in the right upper lobe (5, 121) has increased\nfrom 16-20 mm in diameter. No evidence of newly appeared lung nodules. No\npleural effusions.  No pleural thickening. The airways are patent.",
            "output": "As compared to ___, 1 of the larger pulmonary nodules has grown.\nThe remaining lung nodules are stable. Stable size of the left lateral\nsubcutaneous lesion."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThe heart size is normal and there is no pericardial effusion.\n\nThere is focal consolidation of the left lower lobe, which may represent\nresidual post-procedure hemorrhage as noted on the prior CXR dated ___.\nHowever, infection should certainly be considered in the appropriate clinical\nsetting.  Other subtle areas of ground-glass opacity in the right upper lobe\n(2:36, 2:38) and left upper lobe (2:31) may be due to the expiratory phase of\nthe scan versus mild pulmonary edema. There is no pleural effusion. No\npneumothorax. The airways are patent to the subsegmental level.\n\nThere is a 3.1 x 2.9 cm well-circumscribed simple fluid collection containing\nperipheral calcifications in the right axilla, overall stable since the prior\nPET-CT dated ___ this most likely represents a postsurgical\nseroma.  There are no abnormally enlarged axillary, supraclavicular or\nmediastinal lymph nodes by CT size criteria. The thyroid gland appears\nunremarkable.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No pulmonary embolism or acute aortic pathology.\n2. Focal consolidation in the left lower lobe may represent resolving\npost-operative hemorrhage, but superimposed infection should certainly be\nconsidered in the appropriate clinical setting.  Several other subtle areas of\nground-glass opacity as described above may be due to the expiratory phase of\nthe scan versus mild pulmonary edema.\n3. Overall stable appearance of right axillary simple fluid collection, which\nmost likely represents a postsurgical seroma."
        },
        {
            "input": "CTA:  The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThere is mild atherosclerotic calcification of the descending portion.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nCHEST:  An endotracheal tube is appropriately positioned.  Nasoenteric to\nenters the stomach.  Partially image thyroid is unremarkable.  There is no\naxillary or supraclavicular adenopathy.  There are scattered mediastinal lymph\nnodes measuring up to 7 mm in the prevascular space.\n\nHeart is mildly enlarged.  There is no pericardial effusion.  Coronary artery\ncalcifications are severe.\n\nAirways are patent to the segmental level bilaterally.  There is septal\nthickening with diffuse upper lobe predominant ground-glass opacity.  There\nare moderate bilateral pleural effusions right greater than left with\nassociated atelectasis.  Within the areas of atelectasis there are more focal\nheterogeneously enhancing regions of lung medially on the left and laterally\non the right (series 601b, image 33, 128).  No suspicious pulmonary nodules\nare seen.  There is no pneumothorax or pneumomediastinum.\n\nViews of the upper abdomen are unremarkable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Findings concerning for bilateral lower lobe pneumonia.\n3. Background pulmonary edema with moderate bilateral pleural effusions, right\ngreater than left."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.\nBase of neck and chest wall are unremarkable.\n\nUPPER ABDOMEN: Tiny calcified granuloma and too small to characterize\nhypodense lesion in the right lobe of the liver (2:63).\nRemaining included upper abdominal organs are unremarkable within the\nlimitation of study without IV contrast infusion.\n\nMEDIASTINUM: Several sub cm lymph nodes in the mediastinum, not pathologically\nenlarged up to 0.8 cm in the right lower paratracheal station.\nThere is no gross hili lymphadenopathy.\n\nHEART and PERICARDIUM: Mild to moderate cardiomegaly, no pericardial effusion.\nStatus post sternotomy and bypass, extensive dense atherosclerotic\ncalcifications of the native coronaries and grafts.\nDense calcifications also noted aortic valve leaflets.\nCalcifications also noted in the mitral valve.\nModerate calcifications along normal caliber thoracic aorta and head and neck\nvessels.\nMain pulmonary artery 3.3 cm, suggesting pulmonary hypertension.\n\nPLEURA: Bilateral moderate pleural effusions, right greater the left. \nSubsequent subsegmental platelike atelectasis of the lower lobes.\n\nLUNG: Major airways are patent to the subsegmental level bilaterally.\nSmooth septal line thickening as well as heterogeneous ground-glass opacities\nand mosaic pattern of attenuation over both lungs suggesting pulmonary edema,\nless probably infection.\nNo focal consolidations.\n\nCHEST CAGE: Multilevel degenerative changes of the spine, osteoporosis and\nincreased kyphosis.\nNo evidence of sclerotic or lytic bone lesions suspicious for infections or\nmetastasis.",
            "output": "-Moderate cardiomegaly with bilateral moderate pleural effusions, right\ngreater the left, associated with septal line thickening and heterogeneous\nground-glass opacities suggesting pulmonary edema, much less probably\ninfection.\n-Note, upper lobe edema is more common in severe mitral valve regurgitation.\n-Extensive calcifications of native coronaries and grafts, dense\ncalcifications of the aortic valve leaflets."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Extensive\natherosclerotic disease is present.  There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nenlarged and unchanged from previous examination.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable. There is no evidence of pericardial\neffusion.\n\nTrace bilateral pleural effusions are present. Bilateral anterior focal\natelectasis likely due to mucous plugging is present (3:150). Bibasilar\natelectasis and scarring is present.  Moderate to severe centrilobular\nemphysematous changes are unchanged.\n\nLimited images of the upper abdomen indicate stable bilateral renal cysts.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nDegenerative changes of the spine are present.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral anterior focal atelectasis likely due to mucous plugging.\n3. Trace bilateral pleural effusions.\n4. Moderate to severe centrilobular emphysematous changes, unchanged."
        },
        {
            "input": "HEART AND VASCULATURE: The main pulmonary artery is mildly enlarged measuring\n3.1 cm (3:101).  Pulmonary vasculature is well opacified to the subsegmental\nlevel without filling defect to indicate a pulmonary embolus.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mural thrombus in the aortic arch (03:58) and descending\nthoracic aorta (3:82) is noted.  Heart and mediastinal structures are\ndisplaced to the left by a large right lower hemithorax mass.  Heart size is\nnormal.  Mild coronary artery calcifications are present.  Pericardium and\ngreat vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Left lower pretracheal lymph node conglomerate\nmeasures up to 1.3 cm in short axis diameter (3:75).  A subcarinal lymph node\nmeasures up to 1.2 cm in short axis diameter (3:90).  No definite left hilar\nlymphadenopathy.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: There is a small right subpulmonic pleural effusion which is\ngrossly unchanged.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is a large lobulated heterogeneously enhancing mass\n(3:128) which encompasses nearly the entire right lower hemithorax extending\nto the right hilum and measures approximately 12.1 x 8.2 x 10.0 cm (601:27,\n3:115).  This mass encases a branch of the inferior right pulmonary veins\n(3:96).  Air within the mass centrally is likely secondary to recent biopsy\nrather than necrosis.  Distal to the mass in the right lower lobe, there is\nheterogeneously enhancing consolidation which may represent atelectasis, with\npneumonia not excluded.  There is complete occlusion of the right middle lobe\nbronchus with collapse of the right middle lobe.  Additionally, there is mass\neffect upon the right lower lobe bronchus.  Left-sided airways are patent to\nthe level of the segmental bronchi.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. 12.1 cm heterogeneously enhancing intrathoracic mass involving nearly the\nentire right lower hemithorax extending from the right hilum, grossly similar\nin size compared to the CT-guided biopsy performed 4 days prior, in keeping\nwith known malignancy.  Gas within the mass is compatible recent biopsy.\n3. This mass results in complete obstruction of the right middle lobe bronchus\nwith resultant collapse as well as right lower lobe atelectasis, though\npneumonia in the right lower lobe cannot be excluded in the proper clinical\nsetting.\n4. Small right subpulmonic pleural effusion is grossly stable.\n5. Mild enlargement of the main pulmonary artery may suggest pulmonary\nhypertension.\n6. Aortic arch and descending thoracic aorta atheromas.\n7. Mediastinal lymphadenopathy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no abnormality in the\nvisualized lower leg.  Specifically, the thyroid appears unremarkable.  There\nare bilateral subclavian artery calcifications.\n\nUPPER ABDOMEN: The visualized portions of the upper abdomen are unremarkable.\n\nHILA: There is obliteration of the right hilum secondary to the known large\nmediastinal mass, better seen on the recent dedicated CTA chest exam. The\nunenhanced left hilum is unchanged since prior exam.\n\nHEART, MEDIASTINUM, and PERICARDIUM: There is leftward shift of the heart,\nsecondary to mass effect from a large lobulated mediastinal mass encompassing\nnearly the entire right hemithorax, and measuring approximately 13.3 x 10.1 cm\naccounting for differences in acquisition and measuring technique, better\nassessed on the CTA from ___.  There is an enlarged pre-carinal lymph\nnode measuring 1.6 cm (4: 113), similar to the prior exam in ___, which\nmeasured 1.4 cm.\n\nPLEURA: Again seen is a right moderate dependent, layering, nonhemorrhagic\npleural effusion with associated right lower lobe volume loss, which is\nincreased since the prior CTA in ___. Additionally, there is a new\nsmall left pleural effusion with associated left lower lobe volume loss.  No\npneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: There is lower lobe volume loss, right greater than left,\ncompatible with relaxation atelectasis.   There are increased opacities in the\nleft lower lobe with areas of bronchial plugging, likely representing\naspiration.  No focal parenchymal consolidation concerning for pneumonia.\n2. AIRWAYS: There is mild diffuse bronchial wall thickening, likely reactive.\n3. VESSELS:  Please note that the exam is limited for evaluation the\nvasculature secondary to lack of intravenous contrast.  Within these\nlimitations, there are dense atherosclerotic calcifications seen along the\naortic arch and coronary arteries.  The thoracic aorta does not appear\nenlarged.  The main pulmonary artery is mildly enlarged, measuring 3.1 cm,\nwhich can be seen in pulmonary hypertension.\nCHEST CAGE: There is an old prior fracture of the right humerus.  Degenerative\nchanges are seen along the visualized spine.  There is no concerning osseous\nlesion identified.",
            "output": "1. There is interval increase in a moderate right pleural effusion and a new\nsmall left pleural effusion since prior study in ___ with associated\nlower lobe volume loss, right greater than left.\n2. Left lower lobe opacities with areas of bronchial plugging are suspicious\nfor aspiration.\n3. Given limited assessment on this non-contrast exam, there is stable\nappearance of a known large mediastinal mass, better evaluated on the CTA from\n___."
        },
        {
            "input": "Examination is moderately degraded by motion.  Within these confines:\n\nNECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Enlarged precarinal lymph node measures up to 1.3 cm, similar to\nprior exam (4:103).  There has been interval decrease in size of a large right\nmediastinal mass measuring approximately 8.2 x 4.6 cm, previously 13.3 x 10.1\ncm (4:161).\n\nHILA:  Persistent obliteration of the right hilum secondary to the known large\nmediastinal mass.  Unremarkable appearance of the left hilus.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  There is\nextensive calcific and noncalcific plaque involving the aortic arch and\ndescending thoracic aorta.  A right chest wall Port-A-Cath terminates in the\nright atrium.\n\nPULMONARY PARENCHYMA: There is mild left basilar atelectasis.  Mild\ninterlobular septal thickening is likely compatible with pulmonary\ninterstitial edema, however this is limited in assessment due to extensive\nrespiratory motion artifact.  Ground-glass and consolidative opacities in the\nright lung base are new compared to prior exam and are associated with areas\nof heterogeneous pulmonary parenchymal consolidation and atelectasis involving\nthe right middle and lower lobes, concerning for infection.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  Trace left pleural effusion.  There is a loculated small right\npleural effusion extending along the anterior and dependent portions of the\nright hemithorax.  A right posterior approach pleural drainage catheter is\nseen with the tip terminating in the pleura in the posterior right lung base. \nAir is seen encompassing the periphery of the chest tube tract within its most\nproximal pleural course (4:200).  Locules of air also demonstrated within the\ninferior-most and dependent portions of the right pleural collection (4: 237).\n\nCHEST WALL AND BONES: Chronic deformity of the right humeral head is again\nnoted.  There is no aggressive osseous lesion.  Multiple small foci of air are\ndemonstrated along the subcutaneous course of the right pleural catheter.  No\norganized collection is identified.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\nmoderate calcific and noncalcific plaque involving the upper abdominal aorta. \nThere is thickening of the left adrenal gland, similar to prior CT abdomen\npelvis performed ___.",
            "output": "1. Moderately motion degraded study.\n2. Ground-glass and consolidative opacities with heterogeneous attenuation of\nthe right middle and lower lobe pulmonary parenchyma is concerning for\npneumonia.\n3. Increased loculation of a small right pleural effusion with right posterior\napproach pleural drainage catheter in place.  Air is seen encompassing the\nperiphery of the catheter tract with locules of air seen within the pleural\ncollection at the right lung base.  Superimposed infection of the pleural\nfluid is not entirely excluded.\n4. Interval decrease in size of a previously seen right mediastinal mass, now\nmeasuring up to 8.2 cm in maximum dimension, previously 13.3 cm on exam\nperformed ___.\n5. Mild pulmonary interstitial edema.\n6. Trace left pleural effusion.\n7. Multiple small foci of air are seen along the subcutaneous course of the\nright pleural catheter.  No organized collection is identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The right chest wall Port-A-Cath\ntip terminates at the distal SVC.\n\nUPPER ABDOMEN: Unremarkable.\n\nMEDIASTINUM: No mediastinal masses or mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Aortic root and coronary vascular calcifications are\nnoted.  The heart is otherwise unremarkable without pericardial effusion.\n\nPLEURA: No pleural effusion.\n\nLUNGS:\nThere is a 3 mm (05:43) and a 2 mm nodule in the middle lobe (05:41) which are\nunchanged since ___ PET-CT.  No consolidation or findings to suggest\npneumonia.\n\nAirways are patent to subsegmental level.",
            "output": "1. No evidence of pneumonia.\n2. 2 mm and 3 mm nodule in the right middle lobe are unchanged since ___ PET-CT."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland is unremarkable.\n\nUPPER ABDOMEN: Please see the separate report for the same day CT abdomen and\npelvis for subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  The Port-A-Cath\nterminates in the SVC and the right IJ line terminates in the upper right\natrium.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  Moderate coronary artery and\naortic valve calcifications are noted.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is no focal consolidation or pulmonary mass.  The 2 mm\nand 3 mm right middle lobe pulmonary nodules are stable (4; 166, 174).  There\nare no concerning pulmonary nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The main, left, and right pulmonary arteries are of normal\ncaliber.  The thoracic aorta is of normal caliber without evidence of\naneurysm.\nCHEST CAGE: No acute fracture. There are mild multilevel degenerative changes\nof the thoracic spine.",
            "output": "1. No acute intrathoracic abnormality.\n2. Stable right middle lobe pulmonary nodules measuring up to 3 mm."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels or coronary arteries.  Aortic valvular\ncalcification is mild.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size and the pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are clear aside from mild dependent subpleural\natelectasis.  Tracheobronchial tree is normal to subsegmental levels and there\nis no pleural abnormality.\n\nCHEST CAGE: Unremarkable",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nMild aortic valvular calcification.  No aortic dilatation.  Hemodynamic\nsignificance indeterminate.  Clinical correlation recommended."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, or mediastinal lymph nodes.  There are prominent but not\npathologically enlarged bilateral hilar lymph nodes measuring up to 9 mm\nbilaterally (302:103, 113).  An enteric tube is present the esophagus and\nterminates below the level of the diaphragm..\n\nThe aorta and pulmonary arteries are normal in size.  There is no central\npulmonary embolism.  The heart is normal in size and has mild coronary artery\ncalcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified.  There is mild bronchial\nwall thickening in the lower lobes.  The airways are patent to the\nsubsegmental level.  Lung volumes are low.  There is septal thickening, most\nprominent at the lung bases.  There are scattered areas of ground-glass\nopacities in the left upper lobe as well as in the right upper lobe.  There\nare additional areas of linear atelectasis in the bilateral lower lobes in the\nright middle lobe.\n\nNo osseous lesions suspicious for infection or malignancy are identified. \nThere is a healed fracture through the posterior aspect of the right tenth\nrib.  There is bilateral gynecomastia, slightly more present on the left than\nthe right.\n\nPlease see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "1. Scattered areas glass opacity in the bilateral upper lobes, left greater\nthan right, nonspecific and may be due to atypical infection or inflammation.\n2. Prominent but not pathologically enlarged bilateral hilar lymph nodes are\nlikely reactive.\n3. Bilateral gynecomastia, left greater than right.\n4. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesion.  No\nsupraclavicular adenopathy.  Subcentimeter axillary lymph nodes.  No gross\nbreast lesions.  Mild gynecomastia.\n\nUPPER ABDOMEN: The study was not tailored to evaluate the subdiaphragmatic\norgans.  Reference is made to previous CT abdomen done ___.  No\nadrenal lesions.  Arterially enhancing lesion measuring 9 mm in diameter in\nthe right lobe of the liver (3, 48) most likely represents a flash filling\nhemangioma.\n\nMEDIASTINUM: Right foregut duplication cyst adjacent to the right atrium\nmeasuring 54 x 20 mm.  Borderline right paratracheal lymph nodes (5, 88).\n\nHILA: Subcentimeter hilar lymph nodes.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve or coronary artery calcifications.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Motion artifact may obscure small pulmonary nodules or fine\ninterstitial changes, taking this into account no suspicious pulmonary nodules\nor masses.  Increase in lung density, mild peribronchial thickening and\ndependent atelectasis is thought to be secondary to lower lung volumes (study\nwas performed during expiration)\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  Mild dilatation of the pulmonary artery measuring 31 mm.  No\nfilling defects.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No lytic/\ndestructive bony lesions.",
            "output": "No findings to suggest intrathoracic metastatic disease.\n\nForegut mediastinal duplication cyst."
        },
        {
            "input": "FINDINGS:\n\nNo suspicious thyroid lesions.  No supraclavicular or axillary adenopathy.  No\ngross breast lesions.  The abdominal findings will be reported separately. \nVery small hiatal hernia.  Subcentimeter mediastinal lymph nodes appear\nsimilar compared to prior.  Cystic lesion adjacent to the right atrium\n(suspected foregut duplication cyst) appear similar compared to prior imaging.\nThe heart size measures at the upper limits of normal.  No pericardial\neffusion.  No aortic valve calcification.  Suspected minimal coronary artery\ncalcification.  No aneurysmal dilatation of the ascending aorta.  No aortic\nvalve calcification.  The pulmonary artery measures at the upper limits of\nnormal and pulmonary hypertension should be excluded.  No central pulmonary\narterial filling defects on this nondedicated study.  No suspicious bony\nlesions.  Subacute to chronic anterior left seventh rib fracture (6, 238). \nThe central airways are patent.  No bronchiectasis.  No suspicious pulmonary\nnodules or masses.  No confluent airspace consolidation.  No diffuse lung\ndisease.  No pleural effusion.",
            "output": "1. No intrathoracic metastasis.\n2. Cystic lesion adjacent to the right atrium (suspected foregut duplication\ncyst) is unchanged from the prior study.\n3. Subacute to chronic anterior left seventh rib fracture.\n4. For abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The great vessels are normal caliber.\n\nThe heart size is normal.  No pericardial effusion.\n\nThe airways are patent to subsegmental levels. Incidentally noted is a 2.1 x\n1.0 cm pleural-based lipoma overlying the right upper lobe (3:30). No focal\nconsolidation, pleural effusion, or pneumothorax.  Punctate calcified\ngranuloma identified at the right lung base.\n\nThere is a 1.3 cm myelolipoma within the right adrenal gland. The esophagus\nand visualized upper abdominal organs are otherwise unremarkable.\n\nOSSEOUS STRUCTURES:  Multilevel degenerative changes are seen within the\nthoracic spine, including bridging anterior osteophytes suggestive of diffuse\nidiopathic skeletal hyperostosis. No focal lytic or sclerotic lesion\nconcerning for malignancy.  There is no fracture.",
            "output": "No evidence of acute intrathoracic process.  No fracture."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  There is a small hiatal hernia.  The aorta is normal in caliber. \nThe main pulmonary artery is normal in caliber.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\n3 mm right lung base nodule, series 4, image 213 is unchanged compared to the\nprior exam.  Diffuse random,  perilymphatic nodularity is seen throughout the\nlungs bilaterally.  A 3 mm nodule seen within the right upper lobe, series 4,\nimage 71.  A 3 mm right upper lobe nodule seen, series 4, image 93.  5 mm left\nupper lobe nodule seen, series 4, image 73.  There is no pleural effusion or\npneumothorax.",
            "output": "-Diffuse bilateral nodularity could be seen in the setting of pulmonary\nsarcoidosis.  Differential considerations also include respiratory\nbronchiolitis (infectious vs inflammatory process).\n-Small bilateral pulmonary nodules are seen measuring up to 5 mm.\n\nRECOMMENDATION(S):  Six-month follow-up with chest CT is recommended."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging. \nSupraclavicular adenopathy, most severe on the left ranging up to 17 x 24 mm,\n3:4.  No definite  axillary or other adenopathy in the partially imaged chest\nwall.  Evaluation of the breasts is reserved exclusively for mammography.\n\nThis study is not designed for subdiaphragmatic diagnosis but shows no\nsplenomegaly or left adrenal mass.  Right renal fossa is abnormal, could be a\nright adrenal mass, is incompletely imaged.  Suggest reference to abdominal\nCT.\n\nCARDIO-MEDIASTINUM:Hiatus hernia is small.  Above that level esophagus is\nunremarkable.  Atherosclerotic calcification is not apparent head neck vessels\nor in the coronary arteries.  Aorta is normal size and valve is not calcified.\nPulmonary artery is enlarged, main 39 mm, right 34 mm.  Cardiac chambers are\nroughly normal size.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: Enlarged as follows:\n\nPosterior para aortic, 14 mm, 03:16, 13 mm, 03:25.\n\nPosterior paraesophageal, 15 mm, 03:26.\n\nRight, retrocrural, 8 mm, 03:52.\n\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Small layering nonhemorrhagic pleural effusions,\nright greater than left, larger today than on ___.  No clear pleural\nnodulation or mass.\n\nInflammatory micro nodulation in the lung apices and accompanying bronchial\nwall thickening suggest inflammation, often seen in cigarette smokers or\npatients with severe allergies.\n\nMeasurable nodules as follows:\n\n4-5 mm, left upper lobe, 05: 69, 83, both largely soft tissue with small\nground-glass halos.\n\nNo pulmonary consolidation.  Right basal atelectasis, is moderate, left is\nminimal.\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..  Considerable degenerative disc space\nnarrowing and secondary osteophyte formation is present in the mid and lower\nthoracic spine.",
            "output": "Left supraclavicular adenopathy is the most pronounced in the chest. \nMediastinal lymph node enlargement in posterior para aortic and\nparaesophageal, unusual locations, suggesting malignancy, either lymphoma or\nmetastatic from the abdomen, rather than reactive to lung infection.\n\nInflammatory micro nodules and bronchial wall thickening upper lungs usually\nseen in smokers (respiratory bronchiolitis) or patients with severe allergies.\n\n2, sub 5 mm lung nodules, significance indeterminate, could be long-standing\nand benign, infectious, lymphoma, or extremely early adenocarcinoma. \nAppropriate follow-up depends upon results of the subsequent diagnostic\nworkup.\n\nRefer to abdominal CT for evaluation of possible right adrenal nodule."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Small amount of\npneumomediastinum within the anterior mediastinum may be related to recent\nsurgery.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small amount of pneumoperitoneum is likely postsurgical.  Patient is\nstatus post gastric bypass.  Otherwise, included portion of the upper abdomen\nis unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small amount of pneumomediastinum and free intraperitoneal air, likely\npostoperative in etiology."
        },
        {
            "input": "HEART AND VASCULATURE: The right PICC line is seen terminating at the\ncavoatrial junction.  Severe atherosclerotic calcification of the thoracic\naorta.  The patient is status post aortic valve and mitral valve replacements.\nSevere coronary calcifications are seen.  The thoracic aorta is normal in\ncaliber.  The heart is mildly enlarged.  Stranding of the pericardial fat is\nlikely postsurgical.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits based on an unenhanced scan. No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a moderate amount of anterior\nmediastinal fat stranding, which is likely postsurgical in nature.  No\naxillary or mediastinal lymphadenopathy is present.  No mediastinal mass or\nhematoma.  Small hiatal hernia.\n\nPLEURAL SPACES: There are small bilateral nonhemorrhagic pleural effusions\nwith associated atelectasis.  Fluid within the major fissure on the left.  No\npneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited due to respiratory\nmotion artifact.  Ground-glass opacities within the dependent portion of the\nlungs bilaterally, likely atelectasis.  There are also mild ground-glass\nopacities within the upper lobes bilaterally with smooth septal thickening,\ncompatible with mild interstitial pulmonary edema.  No focal consolidations. \nNo suspicious lung nodules.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Patient is status post right hemithyroidectomy.  There are\nmultiple left thyroid nodules.  The largest hypodense left thyroid nodule\nmeasures approximately 2.5 x 2.1 x 2.8 cm, better evaluated on the ultrasound\ndated ___.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: The patient is status post median sternotomy.  Sternotomy wires appear\nintact.  There is mild separation of sternal fragments at the superior most\naspect measuring approximately 9 mm (series 302, image 28).  There is close\napproximation of the lower sternal fragments without evidence of dehiscence. \nThere is surrounding presternal and retrosternal fat stranding, however this\nis likely postoperative.  There are no focal fluid collections.  There is a\ntiny focus of gas within the right pectoralis muscle superomedially, however\nthis is likely postsurgical in nature (series 302, image 30).  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Status post median sternotomy.  Mild separation of sternal fragments at the\nsuperior most aspect, however sternotomy wires appear intact and the lower\nsmall fragments are closely approximated without evidence of dehiscence. \nSurrounding fat stranding is likely postoperative.  No focal fluid\ncollections.  Tiny focus of air, likely postsurgical.\n2. Ground-glass opacities with smooth septal thickening in the lungs\nbilaterally, compatible mild interstitial pulmonary edema. Small bilateral\npleural effusions.\n3. Status post right hemithyroidectomy.  Multiple left thyroid nodules\nmeasuring up to 2.8 cm, better evaluated on the ultrasound dated ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The patient is status post right\nhemithyroidectomy.  Multiple hypodense left thyroid nodules are again seen,\nthe largest measuring up to 2.8 cm, unchanged.  Supraclavicular and axillary\nlymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  The patient is status post aortic valve and mitral valve\nreplacements.  There is no pericardial effusion.  Stranding of the pericardial\nfat is improved from prior.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Ground-glass opacities suggestive of pulmonary edema in\nthe upper lobes are improved.  There is mild bilateral dependent atelectasis,\nalso improved.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  Right pleural effusion has resolved, and there is a trace left\npleural effusion.\n\nCHEST WALL AND BONES:  The patient is status post median sternotomy, with\npersistent separation of sternal fragments at the superior aspect, measuring 9\nmm, similar to prior (302:34).  The lower sternal fragments are closely\napproximated, as before.  There has been dehiscence of the overlying skin\nincision.  There is no drainable fluid collection.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Status post median sternotomy, with similar appearance of mild separation\nof the superior most sternal fragments, with close approximation of the\ninferior fragments, and intact sternal wires.  There is dehiscence of the\noverlying skin incision.  No drainable fluid collections.\n2. Improved pulmonary edema.\n3. Resolved right pleural effusion.  Trace residual left pleural effusion.\n4. Unchanged multiple left thyroid nodules, better evaluated on thyroid\nultrasound from ___."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged. What was questioned\nas a small, presternal, subcutaneous nodule on the ___ chest CT, is\nprobably a small varix, 6:80. There is no other associated soft tissue\nabnormality.\n\nThe right thyroid lobe has been resected. There is no evidence of tumor\nrecurrence in the surgical bed. Left lobe of the thyroid is enlarged by a well\ncircumscribed, heart shaped hyperlucency, 10 x 11 mm, 4:6, which, though it\nhas not grown since ___, should still be evaluated by ultrasound if not\nalready performed.\n\nAorta and pulmonary arteries are normal caliber. Heart is top-normal size,\nwith a suggestion of left atrial enlargement. Atherosclerotic calcification is\nheavy in at least the left main, anterior descending, circumflex and proximal\nright coronary arteries. There is no pleural or pericardial abnormality.\n\nCentral lymph nodes in the mediastinum and hila, internal mammary,\ndiaphragmatic and retrocrural stations are not enlarged.\n\nLungs are clear of focal abnormality although heterogeneity in the background\ndensity of the lower lung suggests air trapping.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No radiographic explanation in the chest for weight loss, unless the patient\nis hyperthyroid from a possible left thyroid nodule, stable in size since\n___. No evidence of recurrent or metastatic thyroid carcinoma\nfollowing right thyroid lobectomy.\n\nCoronary atherosclerosis, probably clinically significant.\n\nSmall presternal varix, unchanged since ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable. \nThere is no supraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: S shaped scoliosis with mild spondylosis.  No evidence of osteo\ndestructive lesions.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the pelvis.\n\nMEDIASTINUM: Patient status post gastric pull-through, anastomosis at the\nlevel of carina.  1.4 cm lymph node in the right upper paratracheal station is\nlarger and enhancing (6:84), measured in prior 0.4 cm (04:58 in prior).\nNo additional pathologically enlarged lymph nodes identified in the\nmediastinum or hila.\n\nHEART and PERICARDIUM: Heart is normal in size.  Right Port-A-Cath terminates\nin right atrium.  No pericardial effusion.  Thoracic aorta and main pulmonary\nartery are normal in diameter.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: 0.7 cm tracheal diverticulum in the right upper trachea (06:43).  No new\nlung nodules.",
            "output": "1.4 cm lymph node in the right upper paratracheal station is larger since\n___, highly concerning for metastasis.  Could correlate with PET\nCT."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Incidental note is made of a\ntracheal diverticulum.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Patient is status post esophagectomy and gastric pull-up.  There\nis no evidence of local recurrence.  The right upper paratracheal node (3, 67)\nmeasuring 9 x 10 mm has slightly decreased in size previously measured 14 x 12\nmm.  There are no other enlarged mediastinal lymph nodes.  There are no\nenlarged hilar lymph nodes.  Heart size is top-normal.  There is mild\nscoliosis.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is minimal subsegmental atelectasis in the left lung base.  No new\nconsolidations or nodules are seen.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "Mild decrease in size of the right upper paratracheal lymph node which now\nmeasures 10 x 9 mm as compared to the prior measurements of 14 x 12 mm.  No\nother enlarged lymph nodes.  No other sites of disease within the chest.\n\nStatus post esophagectomy and gastric pull up.  Stable postsurgical changes.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "No incidental thyroid findings.  Stable right pectoral Port-A-Cath (4, 7). \nThe pre-existing borderline sized lymph node in paratracheal location (4, 20)\nhas again decreased in size and is now completely normal.  Status post gastric\npull-through the cranial anastomosis is unremarkable (4, 27).  Stable\nappearance of the cardiac structures.  However, the now is mild-to-moderate\npericardial effusion as well as a moderate left pleural effusion that is new. \nThe distal anastomosis adjacent to the pleural effusion is an increasing\nparenchymal atelectasis (4, 44).  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate scoliosis with secondary\ndegenerative vertebral disease.\nNo suspicious pulmonary nodules or masses.  No diffuse lung disease.  Minimal\nnon characteristic scarring at the bases of the left lower lobe.  Stable\ntracheal diverticulum (6, 48).",
            "output": "New mild left pleural effusion and mild pericardial effusion, combined to\nincreasing left lower lobe atelectasis.  Decrease in size of the pre-existing\nborderline paratracheal lymph node.  No abnormalities at the level of the neo\nesophagus."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Right anterior port with tip in the lower SVC.\nNo atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusions.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nStatus post partial esophagectomy with gastric pull-up.  A soft tissue nodule\ncranial to the suture lines measures 9 mm (302: 68) measures 9 mm and is\nunchanged compared to prior.  No enlarged mediastinal or hilar lymph nodes by\nCT size criteria.\n\nPLEURA:\nNo pleural effusions.  No apical scarring.\n\nLUNGS:\nSmall right posterior diverticulum in the superior trachea.  The airways are\notherwise patent to subsegmental levels.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  No consolidations or lung nodules.  Mild\nlinear subsegmental atelectasis in the middle lobe.  More consolidation is\nseen in the left lower lobe, adjacent to the gastric pull-up, most likely\natelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  S-shaped\nscoliosis of the thoracic and lumbar spine.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No significant interval change compared to prior study of ___.  Stable\npostoperative appearance of partial esophagectomy and gastric pull-up.  A soft\ntissue nodule is noted cranially to the suture lines and is unchanged.  No new\nor growing lung nodules."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A partially imaged venous\ncentral catheter tip terminates at the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: A subcentimeter soft tissue nodule superior to\nthe esophagectomy suture line is stable compared to prior (03:44).  Otherwise,\nno axillary, mediastinal, or hilar lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is enhancing consolidation in the left lower lobe\nconsistent with partial left lower lobe collapse.  No evidence of obstructing\nbronchial lesion.  There is new subpleural opacity in the posterior left upper\nlobe which likely represents atelectasis pleural thickening (2:7).  Otherwise,\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen again demonstrates post is\nesophagectomy and gastric pull lobe with postsurgical changes.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere is stable moderate dextroscoliosis of the thoracic spine.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality.\n\nPartial left lower lobe collapse.  No obstructing lesion seen.\n\nStatus post esophagectomy with gastric pull-up with stable postsurgical\nchanges."
        },
        {
            "input": "CHEST PERIMETER: No findings in the thyroid warrant any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\n\nCARDIO-MEDIASTINUM:Upper esophagus is only mildly dilated, filled with air,\nand there is no longer any retention of fluid in the esophagus above the level\nof surgery or any clear associated mass in or outside the conduit.\n\nNo calcification in head neck vessels or coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size.  No pericardial\nabnormality.\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Aside from minimal atelectasis in the middle lobe,\nright lung is clear.  Atelectasis in the left lower lobe, above the\npersistently elevated left hemidiaphragm has improved, now involves only parts\nof the part of superior and 2 basal segments has improved.  Left lung is\nclear.  There are no nodules or other focal lung lesions of consequence.\n\nTracheobronchial tree is normal to subsegmental levels.\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No evidence of obstruction or tumor recurrence involving neo esophagus.\n\nImproved left lower lobe atelectasis, attributable to chronic elevation of the\npostoperative left hemidiaphragm."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Incidental note is made of a tracheal\ndiverticulum.\n\nBREAST AND AXILLA  : There is no axillary adenopathy\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Patient is\nstatus post esophagectomy and gastric pull-up.  The new esophagus is\nunremarkable.  There is a small pericardial effusion which is physiological. \nThere no enlarged mediastinal hilar lymph nodes.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  There is\nminimal bibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\npneumobilia.  A CBD stent is in place.  Please refer to dedicated report on\nabdomen which has been dictated separately",
            "output": "Status post esophagectomy and gastric pull-up.  No evidence of local\nrecurrence.\n\nNo evidence of metastasis to the chest.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Right anterior port with\ntip in the lower SVC.  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nS/p esophagectomy with gastric pull up and a questionable new soft tissue\nthickening surrounding the anastomosis (5:114).  The esophagus is patulous but\notherwise unremarkable.  Small mediastinal lymph nodes, none pathologically\nenlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  New peribronchial consolidation\nin the left lower lobe with a suggestion of a small cavitation measuring at\nleast 1.0 cm (5:176).  New pleural-based nodule measuring 1.5 x 1.3 cm in the\nright lower lobe (5:234).\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  S shaped\nscoliosis of the thoracolumbar spine.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "New right pleural base nodule concerning for developing metastatic disease.\nAlso of note there is a questionable soft tissue thickening surrounding the\nposterior suture lines of the gastric esophageal anastomosis for which\ncorrelation with an endoscopic study is recommended.\n\nPeribronchial consolidation in the left lower lobe with a small indwelling\ncavity concerning for aspiration related pneumonia.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:43 am."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lung apices which are partially visualized.  Otherwise,\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  No definite\nesophageal mass to correspond with history of esophageal cancer.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDextroscoliosis and mild degenerative changes of the thoracic spine noted.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Ascending aorta is mildly\nenlarged, 4.1 cm, appears to be increased as compared to 3.6 cm on previous\nstudy from ___.  Pulmonary arteries are normal in diameter.\n\nCoronary calcifications involve LAD.  Heart size is normal.  There is no\npericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple solid\npulmonary nodules are stable, series 302, images 53, 153, 54.  New 1 mm nodule\nin the right upper lobe, series 302, image 73 is noted.  No other new nodules\ndemonstrated\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "New 1 mm nodule in right upper lobe.  Reassessment in 3 months for\ndocumentation of stability is recommended.\n\nDilated ascending aorta, with current diameter of 4.1 cm, increased by 6 mm\nsince ___.  Consultation with aortic center is recommended."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormality elsewhere in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis, especially with regard to the liver, but shows no\nadrenal mass.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent in head neck vessels only minimal in left anterior descending\ncoronary artery.  Aortic valve is not calcified.  Maximum diameter ascending\nthoracic aorta stable 40 mm at the level of the intra pericardial right\npulmonary artery, 5:146.\n\nPulmonary arteries and cardiac chambers normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest pathologically enlarged or\ngrowing.\n\nLUNGS, AIRWAYS, PLEURAE: Faint right upper lobe nodule, new in ___ is\nunchanged, too small to warrant further imaging, 5: 64.\n\n6 mm wide dumbbell-shaped lesion right middle lobe, 5:190 stable since ___,\ncan be considered benign, does not warrant follow-up.\n\nIn addition to stable pleuroparenchymal scarring, left lung apex, 2 x 3 mm\nnodule, 5:66, stable since ___ can be considered benign.\n\nTracheobronchial tree is normal to subsegmental levels.  No pleural\nabnormalities.\n\nCHEST CAGE: Unremarkable.",
            "output": "No new or growing lung nodules.  Previous small lung nodules, including a one\nmm lesion detected in ___ are stable and can be considered benign.\n\nAlso stable, 40 mm wide noncalcified ascending thoracic aorta.  No aortic\nvalvular calcification.  Imaging follow-up is not indicated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No lymphadenopathy.  The visualized\nstructures of the neck are unremarkable.  The thyroid is homogeneous.  Soft\ntissue structures of the chest wall are unremarkable.\n\nUPPER ABDOMEN: Please refer to the separate report from the CT abdomen and\npelvis, performed concurrently.\n\nMEDIASTINUM: There is a 3-4 mm diameter linear high-density structure\nconnecting the aortic arch and the origin of the left pulmonary artery, likely\na patent ductus arteriosus.  No mediastinal mass or adenopathy.\n\nHILA: Unremarkable.\n\nHEART and PERICARDIUM: No pericardial effusion.  Cardiac chambers appear\ngrossly within normal limits.  There are coronary artery calcifications,\nprimarily in the LAD distribution.\n\nPLEURA: Tiny right pleural effusion.  No left pleural effusion.  No definite\npleural nodularity allowing for subpleural pulmonary lesions.\nLUNG:\n\n1. PARENCHYMA:  There are numerous small bilateral pulmonary nodules, many\nwith ill-defined margins and some showing central lucency consistent with\ncavitation.  However, number of these are solid in not extremely small such is\nan 8 mm nodule in the right middle lobe (6:151).  Clustered nodular opacities\n(example in Left upper lobe on 6:117 close) show cavitation, as an example of\ncavitating opacities..\n2. AIRWAYS:  The major airways are clear.  There is mild bilateral multifocal\nbronchial plugging at the lung bases.\n3. VESSELS:  Pulmonary vascular structures are unremarkable.\nCHEST CAGE: No evidence of osseous metastatic disease.  There are old\nbilateral rib fractures.",
            "output": "1.  Extensive bilateral pulmonary nodules.  Although differential includes\nmetastatic disease at least for some of this appearance, many of the nodular\nopacities have a ___ appearance which is generally associated with\ninfectious and inflammatory processes rather than malignancy.  Differential\nmay accordingly exclude a chronic infectious process.  Short-term follow-up\nreassessment is suggested if clinically appropriate.  Correlation with prior\nimaging would also be helpful, if available.\n2.  Incidental note of probable small patent ductus arteriosus."
        },
        {
            "input": "The thyroid gland is heterogeneous has hypodense nodules largest in the left\nmeasuring 3.5 cm.  . Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis mild calcification in the aortic arch and the descending thoracic aorta. \nAscending aorta measures up to 3.6 cm.  Cardiac configuration is normal and\nthere are moderate calcifications in all coronary arteries.  .\nSmall bilateral effusions are associated with adjacent atelectasis\nSmooth interlobular septal thickening and faint ground-glass opacities\nrepresent mild interstitial edema\nThere are 3 mm nodules in the right middle lobe (4:121, 128, 155)\nRight lower lobe lung nodules measure 4 mm (4:107)\n\nThis examination is not tailored for subdiaphragmatic evaluation, the upper\nabdomen is unremarkable\nThere are no bone findings of malignancy",
            "output": "Mild interstitial edema\nSub 4 mm lung nodules if no risk of lung malignancy no followup is recommended\nCoronary calcifications.\nThyroid nodules, ultrasound can be performed"
        },
        {
            "input": "CHEST:  The heart and great vessels are unremarkable.  There is no mediastinal\nhematoma.  There is no pericardial effusion.  There is no lymphadenopathy. \nThe imaged thyroid is normal.\n\nThe lungs are clear without worrisome nodule, mass, or consolidation.  Airways\nare patent to the subsegmental level.  There is no evidence of contusion or\nlaceration.  There is no pneumothorax or pleural effusion.\n\nABDOMEN:  The liver is intact without signs of acute injury.  A small\nhypodensity in hepatic segment VII is incompletely characterized, but likely a\nhemangioma (2:120).  The spleen is intact and normal in size.  The\ngallbladder, pancreas, and adrenals are unremarkable.  The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis.  Small\nsubcentimeter right lower renal pole hypodensity is incompletely\ncharacterized, but likely a cyst.  There is no evidence of renal or collecting\nsystem injury.  The abdominal aorta is normal in course and caliber with\nwidely patent major branches.  No lymphadenopathy, free air, or free fluid.\n\nThe stomach is unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  The\nappendix is normal.  The bladder is unremarkable.  There is no pelvic free\nfluid.\n\nBONES:  There is a mildly displaced angulated fracture through the superior\npubic ramus (601b:42, 2:230.  In addition, a vertical fracture of the left S1\nsuperior articular facet (601b:60), extending into the left sacrum, is\nidentified.  Thoracic spinal scoliosis is again noted.",
            "output": "1.  Mildly displaced, angulated fracture through the superior pubic ramus,\nwith a vertical fracture of the left S1 superior articular facet, extending\ninto the left sacrum.  No evidence of spinal compression deformity.\n\n2.  No other acute sequela of trauma in the chest, abdomen, or pelvis.\n\nNOTIFICATION:  The above findings were communicated in person by Dr. ___\nto Dr. ___ and to Dr. ___ at the time of the scan."
        },
        {
            "input": "There is stable heterogeneous enlargement of the right thyroid lobe with\npresence of a 1.8 by 2.2 cm mixed attenuation nodule.  The left thyroid lobe\nremains normal. Multiple enlarged mediastinal lymph nodes have slightly grown\nsince ___. For reference, a prevascular lymph node measures 13 x 27\nmm, previously 11 x 23 mm (4, 23). A right lower paratracheal lymph node has\nalso grown measuring 11 x 19 mm, previously 9 x 12 mm (4, 25). Subcarinal\nlymphadenopathy measures 16 mm in short axis, previously 13 mm (4, 30).\nBilateral axillary lymph nodes are prominent in number, although none meet\ncriteria for pathologic enlargement.\n\nMild cardiomegaly with multichamber enlargement is stable. The patient has had\nprior aortic valve replacement. Extensive coronary artery calcifications are\npresent. A left pectoral pacemaker has leads extending to the right atrium and\nright ventricle. There is no pericardial effusion.\n\nThere is stable subpleural reticulation and scarring adjacent to a spinal\nosteophyte in the right lower lobe (5, 177). Mild bilateral lower lobe\ncylindrical bronchiectasis is unchanged. Subpleural reticulation and scarring\nin the anterior aspect of the left upper lobe is stable, and may relate to\nprior radiation therapy. Dependent reticular opacities may be due to\natelectasis or scarring. A punctate with left lower lobe calcified granuloma\nis incidentally noted.  The previous moderate left pleural effusion has\nresolved, and there is now a trace right pleural effusion.\n\nImages of the upper abdomen show a broad-based midline ventral abdominal wall\nhernia containing fat. The anterior aspect of the distal stomach and\ntransverse colon approach but do not enter the hernia.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThe patient has had prior cervical spine fusion. Multilevel spinal\ndegenerative changes are stable.",
            "output": "Slight interval increase in mediastinal lymphadenopathy since ___,\nwhich is overall not appreciably progressed in severity.\n\nStable enlargement of the right thyroid lobe secondary to a heterogeneous\nnodule previously characterized as a cold nodule on thyroid uptake and scan in\n___.\n\nBroad-based midline ventral abdominal wall fat containing hernia.\n\nUnchanged minimal lingular fibrosis, possibly related to prior radiation\ntherapy."
        },
        {
            "input": "HEART AND VASCULATURE: Patient is status-post aortic valve replacement. \nCoronary artery calcifications are severe.  Pacemaker leads are located within\nthe right ventricle and right atrium.  The thoracic aorta and main pulmonary\nartery are normal in caliber.  Aortic arch and great vessel origin\ncalcifications are moderate to severe.\n\nAXILLA, HILA, AND MEDIASTINUM: A lower paraesophageal lymph node has slightly\nincreased in size, now 1.1 cm and previously 0.9 cm (series 2, image 38). \nConfluent sub-carinal lymphadenopathy is minimally changed, now 1.7 cm and\npreviously 1.6 cm (series 2, image 26).  Precarinal lymphadenopathy is\nminimally changed, now 1.2 cm and previously 1.1 cm (series 2, image 22). \nPeriaortic lymphadenopathy has minimally changed, now 1.4 cm and previously\n1.3 cm (series 2, image 19).  AP window lymphadenopathy has minimally changed,\nnow 1.4 cm and previously 1.3 cm (series 2, image 20).  A right paratracheal\nlymph node is unchanged and measures 9 mm (series 2, image 12).  Mild\nnarrowing of a proximal right upper lobe bronchus is slightly greater today\nthan previously.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/PERIPHERAL AIRWAYS: There is mild bibasilar scarring with traction\nbronchiectasis there is a 3 mm left lower lobe pulmonary nodule, possibly\nscarring, not well evaluated on prior examinations due to atelectasis and/or\npleural effusion.  There is a small calcified granuloma in the left lower lobe\n(series 4, image 179).\n\nBASE OF NECK: A large heterogeneous right thyroid nodule is unchanged since at\nleast ___.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.  Incidental note is made of marked\ndiastasis of the midline upper abdominal wall.\n\nBONES: The osseous structures remains somewhat heterogeneous.  No discrete\nlesions are identified.  No evidence of acute fracture.  Median sternotomy\nwires are noted.",
            "output": "1. Minimally growth mediastinal and lower paraesophageal lymphadenopathy, on\nthe order of 1-2 mm.  Prominent axillary lymph nodes are unchanged.\n2. Increase in moderate narrowing, right upper lobe bronchus, could be\ninflammatory or related to adjacent adenopathy.\n3. Unchanged large, heterogeneous right thyroid nodule."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  There is trace biapical emphysema.  Bilateral lungs are clear. \nThere's no focal consolidation.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a subcentimeter low-attenuation lesion adjacent to the gallbladder,\ntoo small to characterize.  There is mild periportal edema..  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.  There is no\nfree intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.  There\nis minimal degenerative changes of the thoracolumbar spine.",
            "output": "1. No acute intrathoracic or abdominopelvic process.\n2. No pulmonary arterial embolus or acute aortic process.\n3. Mild bilateral apical emphysema.\n4. Minimal degenerative changes of the thoracolumbar spine."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  Several mediastinal lymph nodes\nare visualized but not pathologically enlarged.  No supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta and pulmonary arteries are\nnormal in size.   The heart size is normal.  No coronary artery\ncalcifications.  No pericardial effusion.\n\nPLEURA:  No pneumothorax.  No pleural effusion.\n\nLUNGS: The airways are patent to at least the subsegmental level.  No diffuse\nlung disease. A 7-mm right upper lobe (apex) ground-glass opacity is\nnon-specific (Series 4, Image 24) and is new since ___.  Right middle lobe\nscarring is new and mild (Series 4, Image 164).  No mass or nodule is\nidentified to correspond with the nodule seen on recent radiograph.\n\nBONES: No suspicious lytic or sclerotic osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.  Dextroconvex scoliosis of the\nthoracic spine is mild.\n\nUPPER ABDOMEN:  A 3.3 x 3.2-cm homogeneous, intermediate density,\nnon-calcified round, lesion with apparent mass effect on the stomach lumen\nappears new since ___ (Series 2, Image 55; Series 602b, Image 80; Series\n601b, Image 37).  Evaluation of this lesion is limited without intravenous or\noral contrast and a non-distended, near completely collapsed stomach, but the\nlesion or region of asymmetric thickening appears to arise from the stomach\nwall and could represent a gastrointestinal stromal tumor.  The fat planes\nwith the adjacent pancreas, colon, and small bowel are preserved.  The spleen\nis unremarkable. The kidneys are incompletely visualized. A 4-mm left\nmid-pole, non-obstructing renal stone appears to have been present in ___,\nunchanged (Series 2, Image 58).  Another tiny left upper renal pole\nnon-obstructing stone is also unchanged (Series 2, Image 53).  The attenuation\nof the liver is homogeneously reduced and may suggest mild fatty infiltration.\nNo obvious liver lesion or mesenteric lymphadenopathy on this non-dedicated,\nnon-contrast study.",
            "output": "1.  7-mm ground glass opacity in right upper lobe.\n2.  No CT correlate for the nodule seen on radiograph.\n3.  3.3-cm homogenous soft tissue lesion, likely from stomach, could be a\ngastrointestinal stromal tumor on this non-dedicated, non-contrast study.\n4.  4-mm non-obstructing left renal stone, unchanged.\n\nRECOMMENDATION(S):  1.  Follow-up chest CT in 3 months for ground glass\nopacity to evaluate stability/resolution.\n\n2.  CT abdomen/pelvis with intravenous and oral contrast to evaluate possible\nstomach lesion.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the level of\nthe subsegmental pulmonary arteries.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No pathologically enlarged axillary\nlymphadenopathy.  Prominent mediastinal lymph nodes involve the prevascular,\nright lower paratracheal, and subcarinal stations.  Several right hilar lymph\nnodes are prominent measuring 7 mm and 9 mm in short axis although the latter\npossibly reside within the pulmonary parenchyma (4:96, 4:107). No AP window or\nleft hilar lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Corresponding findings on prior chest radiograph, there is\ncomplete collapse of the right upper lobe with evidence of volume loss. \nLikely longstanding hypoattenuating soft tissue encases and severely narrows\nthe right upper lobe bronchus and distal bronchi and encase/mildly narrow the\nbronchus intermedius and middle/lower lobe bronchi (4:75, 601:54, 4:62, 4:96,\n601:54).  A portion of right upper lobe consolidation is hypoenhancing as well\n(4:62, 601:56).  A 2 mm right lower lobe pulmonary nodules present (04:140). \nNo definite additional pulmonary nodules although several right perihilar soft\ntissue nodules may represent lymph nodes or a reside in the parenchyma. The\nright middle/lower lobes and left lung are well expanded and essentially\nclear.  Diffuse bronchial wall thickening suggests small airways disease in\nkeeping with history of asthma.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Ill-defined soft tissue in the right hilum and suprahilar regions severely\nnarrows right upper lobe bronchus and subsegmental bronchi causing complete\nupper lobe collapse, also encasing and mildly narrowing the bronchus\nintermedius and lower and middle lobe bronchi.  This is concerning for\nmalignancy although a less other likely consideration would be tuberculosis or\nIgG4 related disease.  Transbronchial biopsy recommended.  IgG4 possibility\nmay be further explored via blood test.\n2. Hypoenhancing regions in the collapsed right upper lobe makes superimposed\npost obstructive pneumonia possible in the right clinical scenario.\n3. Prominent right hilar and mediastinal lymph nodes although the right hilar\nsoft tissue nodules may also reside within the pulmonary parenchyma.\n4. Right lower lobe 2 mm pulmonary nodule.\n5. Small airways disease.\n\nRECOMMENDATION(S):\n1. Transbronchial biopsy.\n2. Laboratory evaluation for IgG4 fibroinflammatory disease\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:22 pm, 25 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable\n\nUPPER ABDOMEN: Unremarkable\n\nMEDIASTINUM: There are enlarged AP window/prevascular lymph nodes measuring up\nto 1.2 cm short axis diameter.  Coarse calcifications are seen inferior to the\ncarina which may represent calcifications within a subcarinal lymph node. \nThere is mild tracheal deviation to the left.\n\nHEART and PERICARDIUM: A small pericardial effusion is noted.  There are\nprominent cardiophrenic lymph nodes measuring up to 9 mm (02:51).\n\nLUNG AND PLEURA:  There is a large right pleural effusion occupying almost the\nentire right hemithorax.  There is mild pleural enhancement with small pockets\nof air within the pleural collection, concerning for empyema.  There are no\npleural masses or nodular pleural thickening.  Near the right lung apex\nanteriorly, there is a second smaller loculated component containing multiple\npockets of gas with air-fluid levels.\n\nThere is obstruction of the right mainstem bronchus with complete collapse of\nthe right lung.  Small foci of calcification are seen within the collapsed\nright lung.  The proximal right mainstem bronchus is filled with low-density\ndebris and tiny pockets of air.\n\nBONES:  There is collapse of the superior endplates of the T3, 6, and 8\nvertebral bodies, likely chronic.  No evidence of suspicious bony lesions.",
            "output": "1. Large right pleural based air-containing fluid collection concerning for\nempyema.  A second smaller loculated component is seen near the right apex\nanteriorly, and contains air fluid levels.\n2.  Obstruction of the right main stem bronchus containing secretions.\n3.  Enlarged mediastinal lymph nodes."
        },
        {
            "input": "The visualized aorta and its major branch vessels are patent, with no evidence\nof stenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are poorly opacified, limiting evaluation the\nsubsegmental pulmonary arteries.  Within these limitations, there is no\nevidence of pulmonary embolism to the segmental branches.  The main and right\npulmonary arteries are normal in caliber, and there is no evidence of right\nheart strain.\n\nThere is an unchanged 1.1 cm AP window lymph node (___).  There are multiple\nother prominent, though nonenlarged, mediastinal lymph nodes, including\nmultiple nodes with calcifications.  There is no supraclavicular, axillary or\nleft hilar lymphadenopathy.  Evaluation for right hilar lymphadenopathy is\nlimited.  There is an unchanged 6 mm periaortic lymph node (___).  The\nthyroid gland appears unremarkable.\n\nThere is a moderate right pleural effusion, which is decreased in size\ncompared to ___ status post placement of a chest tube.  There is\nmoderate hydropneumothorax in the right lung with mild pleural enhancement and\nsmall pockets of air within the pleural collection, again concerning for\nempyema.  For example, see ___.  There is extensive subcutaneous emphysema\nalong the right chest wall.  No left pleural effusion.  There is persistent\nopacification of the right mainstem bronchus, causing postobstructive collapse\nof multiple right lung segments.\n\nRespiratory motion limits evaluation of fine lung detail.  Within this\nlimitation, there is centrilobular and paraseptal emphysema with multiple\nbullae, right greater than left.\n\nThere is a tiny pericardial effusion, slightly decreased from ___. \nPreviously seen cardiophrenic lymph nodes are less prominent on today's study\nwith the largest measuring 6 mm in short axis (___).\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nAgain seen is collapse of the superior endplates of the T3, T6 and T8\nvertebral bodies, likely chronic.  There is a healed posterior right eleventh\nrib fracture.",
            "output": "1.  Evaluation for pulmonary embolism is limited due to contrast bolus timing.\nWithin this limitation, there is no evidence of pulmonary embolism to the\nsegmental branches.\n\n2.  Compared ___, there has been interval placement of a right\nchest tube.  There is a moderate hydropneumothorax with loculations and mild\npleural enhancement and small pockets of air within the collection, again\nconcerning for empyema.\n\n3.  Extensive subcutaneous emphysema along the right chest wall.  Please\nensure the last side hole is within the pleural space.\n\n4.  Persistent opacification of the right mainstem bronchus with\npostobstructive collapse of the multiple right lung segments.\n\n5.  Evaluation for recurrent malignancy is limited.  Recommend follow-up CT\nonce acute loculated effusion and empyema has resolved."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Residual subcutaneous emphysema seen\nin the right chest wall (but this appears decreased compared to prior\nimaging).\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  No subdiaphragmatic pathology.\n\nMEDIASTINUM: Multiple marginally enlarged AP window lymph nodes the largest\nmeasuring 11 mm in diameter (2, 20) which appear similar compared to prior\nimaging.  Soft tissue mass/ lymph node complex in relation to the right hilum\nand subcarinal areas.  Calcified right hilar lymph nodes again noted.\n\nHEART and PERICARDIUM: Pericardial effusion measuring 18 mm adjacent to the\nright ventricle  in diameter and 8 Hounsfield units which is enlarged compared\nto previous imaging.  Normal cardiac configuration.  Mild mitral annular\ncalcification.  No coronary artery or aortic valve calcification.\nPLEURA: The amount of pus in the right pleural space shows interval decrease\nin volume with a larger component of air seen in the right pleural cavity. \nMarked thickening of the visceral and parietal pleura.\nLUNG:\n\n-PARENCHYMA:  Volume loss of the right hemithorax with mediastinal shift to\nthe right.  The right upper lobe shows mild improved aeration/expansion, but\nthere is marked bullous/architectural distortion of this right upper lobe. \nThere is occlusion of the right bronchus intermedius stent with collapse\nconsolidation of the right middle and lower lobes.  The collapse consolidation\nof the right middle and lower lobes makes assessment of the known bronchus\ncarcinoma difficult, but the right lower lobe has an abnormal rounded\nappearance.  Compensatory hyperinflation of the left lung.  Paraseptal and\ncentrilobular emphysematous changes in the left upper lobe.  Motion artifact\ncomplicates interpretation of the left lung parenchyma.  Ground-glass\nopacification with a centrilobular distribution seen in the left lung apex (2,\n10), left upper lobe (2, 17), superior segment of the left lower lobe (2, 24)\nand left lower lobe (2, 33) which was not seen on previous imaging.  Trace\nleft-sided pleural effusion with adjacent atelectasis.\n-AIRWAYS:  Occlusion of the right bronchus intermedius stent as described\nabove with associated collapse consolidation of the right middle and lower\nlobes.  Multiple punctate calcific densities seen in relation to the right\nlower lobe bronchi.\n-VESSELS:  Suboptimal opacification of the pulmonary artery but there is no\nobvious filling defects.  Pulmonary artery is mildly enlarged measuring 32 mm\nin diameter.\nCHEST CAGE: Spondylotic changes of the thoracic spine, but no lytic/\ndestructive bony lesions.  Most likely chronic fractures of the superior\nendplates of T3, T6 and T8.  Healed posterior right eleventh rib fracture.",
            "output": "The amount of fluid in the right pleural space has decreased, but more locules\nof gas are seen in the right pleural cavity compared to prior study.  This is\nmost likely iatrogenic, although infection from a gas producing organism is an\nadditional consideration in the appropriate clinical setting.\n\nThere is marked thickening of the visceral and parietal pleura with only\nminimal re-expansion of the right upper lobe suggesting a trapped lung,\nespecially within the right middle and right lower lobes.\n\nNew centrilobular ground-glass densities seen in the left upper and lower\nlobes suggesting aspiration or infection.\n\nPersistent occlusion of the right bronchus intermedius stent with collapse\nconsolidation of the right middle and lower lobes unchanged compared to prior.\nExtent of known lung cancer is difficult to assess in this setting."
        },
        {
            "input": "Supraclavicular and left axillary and numerous sub cm right axillary lymph\nnodes are not pathologically enlarged or growing.\n\nThere is no soft tissue abnormality in the chest wall suspicious for\nmalignancy or infection, including the course of the tunneled pleural drainage\ncatheter that enters the right lower chest anterolaterally and ascends to the\nanterior pleural space.\n\nA moderate to large right nonhemorrhagic pleural effusion has grown larger\nsince ___, replacing the some of the previous large pockets of pleural\nair, containing smaller pockets of air.  It lies primarily posterior and\ninferior to the right lung, which is encased in thickened visceral pleura. \nParietal pleura is particularly thickened with induration of the extra\npleural, intrathoracic soft tissue, but no extravasation of fluid or\ninfiltration involving the chest wall.  Largest discrete air and fluid\ncollection is in the upper right posterior hemi thorax, probably in the\npleura, although given the severity of bullous emphysema, a superinfected\nbulla is not excluded.\n\nSmall pericardial effusion is stable but there is an increase in edema of\nepicardial fat, suggesting inflammation.  There is no evidence of tamponade\nphysiology.  The left pleural space is normal.\n\nThyroid is unremarkable.  Atherosclerotic calcification is moderately heavy in\nhead and neck vessels but not evident in coronary arteries.  Aorta is normal\nsize.  Main pulmonary artery is mildly dilated, 34 mm today, 33 mm on ___.\n\nA large infiltrative right hilar mass contiguous with extensive subcarinal\nmediastinal adenopathy obstructs the right bronchial tree below a short stent\nin the bronchus intermedius, occluding both the middle and lower lobe bronchi\nand major segments.  The right main bronchus and upper lobe bronchus are\nsurrounded by tumor, but are less narrowed today than on ___. \nNevertheless large portion of the right upper lobe is collapsed against the\nmediastinum, perhaps due to prior radiation therapy,Although this history is\nnot provided to me. Right middle and lower lobes are entirely collapsed.\n\nThere is lesser adenopathy in the prevascular mediastinum and left hilus,\nunchanged. In addition to previously described large scale subcarinal\nadenopathy, also stable is mild adenopathy in the prevascular mediastinum and\nleft hilus.  Dystrophic calcifications lie in lymph nodes medial to the\nbronchus intermedius.  Left bronchial tree is patent.\n .  .\n Emphysema is severe in the aerated right upper lobe, less pronounced\nthroughout the left lung.  There is no pneumonia or nodulation in the left\nlung.\n\nLoss of height in several thoracic vertebrae is due to depression of there\nsuperior endplates, unchanged in severity since ___, and not necessarily\ndue to tumor infiltration.  A sclerotic expansion of the posterior aspect of a\nright lower rib is a healed fracture, possibly pathologic.  There are no other\nosseous lesions in the chest cage concerning for metastasis or infection.",
            "output": "Increase in fluid volume of large probably multiloculated right hydro\npneumothorax, most of which is remote from the plane of the lateral and\nanterior position of the tunneled right pleural drainage catheter.\n\nNew epicardial edema.  Even though the volume of right pericardial effusion is\nsmall, it should be monitored with echocardiography to detect any evidence of\ndeveloping purulent pericarditis.\n\nThe bronchus intermedius is stented.  Narrowing of the right main and upper\nlobe bronchi has improved.  Right hilar mass still occludes right middle and\nlower lobe bronchi and those lobes are collapsed."
        },
        {
            "input": "Overall volume of the extensive right hydro pneumothorax has decreased\nslightly since ___, but there is still a moderately large volume of\nfluid with multiple small gas loculations and severe restrictive pleural\nthickening partially responsible for contraction of the right hemi thorax and\nrightward shift of the mediastinum.  The largest pleural fluid collection, in\nthe apex is smaller, largely replaced by air.  The right pleural drain\nentering anterolaterally and ascending anterior to the right upper lobe is\nunchanged in position and there is no the fluid or other abnormality\nassociated with its tunneled course in the right chest wall.\n\nSmall to moderate pericardial effusion is unchanged.  There is no\ncalcification the and no increase in the mild edema of epicardial fat or any\nevidence of tamponade.\n\n\n Short bronchial stent in the bronchus intermedius is unchanged.  The\ninfiltrative peribronchial tissue in the right hilus with a masslike\nappearance is inseparable from atelectasis.  Bronchial patency has definitely\nimproved in the right middle lobe and superior and basal segments of the lower\nlobe although the lower lobe remains a largely collapsed.  Left lung is clear\nof focal abnormality.  Other findings are unchanged since ___.",
            "output": "Slight decrease in overall volume and in the fluid component of multiloculated\nright hydro pneumothorax.  No change in position of course of the right\npigtail drainage catheter.\n\nBronchus intermedius stent unchanged in position.  Improved patency to right\nmiddle lobe bronchus and right lower lobe segmental bronchi."
        },
        {
            "input": "Pigtail pleural drainage catheter entering the low right anterior hemithorax\nand curling in the lower anterior pleural space is unchanged in position. \nNevertheless there has been a substantial increase in the volume of the large\nright nonhemorrhagic pleural effusion sparing only the apex of the right\nhemithorax. There is no longer any air in the pleural space.  The effusion is\npresumably loculated by virtue of a very thick pleural rind.  There is no soft\ntissue abnormality or fluid collection in the chest wall, specifically along\nthe course of the catheter.\n\nDiscrete mediastinal lymph nodes above the carina restricted to the\nprevascular station, ranging in diameter up to 8 in 10 mm, previously 8 and 7\nmm respectively.  More inferiorly infiltrative adenopathy in the right lower\nparatracheal and subcarinal stations is inseparable from tumor in the right\nhilus.  The tumor encases the upper lobe bronchus which is patent but\nobstructs the sub divisions of the anterior segment.  A short bronchial stent\nin the bronchus intermedius is patent and has not migrated but the bronchus\nsurrounding it is more narrowed and there is extensive occlusion of the\nbronchial tree distal to the stent.\n\nSmall pericardial effusion is stable.  There is no left pleural effusion.\n\nEmphysema is moderately severe in the upper lungs.  Milder elsewhere. \nAeration in the right lung is limited to midportion of the anterior segment of\nthe right upper lobe.  The remainder is atelectatic.  Left lung is grossly\nclear.\n\n\nModerate  compression of several thoracic vertebral bodies due to upper\nendplate depression is unchanged since at least ___.  It does not\nlook pathologic.  There are no destructive bone lesions elsewhere in the chest\ncage.",
            "output": "Increase in large probably loculated right pleural effusion since ___\ndespite indwelling pleural drainage catheter, unchanged in position.\n\nInfiltrative tumor and adenopathy, centered at the right hilus extending into\nthe mediastinum and surrounding the entire right bronchial tree.  Stent in the\nbronchus intermedius is intact, but there is more occlusion of the divisions\nof the lower lobe.  Middle and lower lobe and substantial portions of the\nupper lobe are collapsed by virtue of combination of bronchial occlusion and\ndisplacement of pleural fluid and restriction by thickened pleura."
        },
        {
            "input": "CHEST:   The previously noted right pleural drainage catheter has been\nremoved.  The overall size of the loculated right pleural effusion is\ndecreased from prior though remains moderate in size.  The overall extent of\nright pleural thickening is not significantly changed.  A short stent is again\nnoted within the bronchus intermedius though there is minimal aeration of the\nlower lobe and right middle lobe bronchi with significant collapse and\nprobable rounded atelectasis as seen on prior.  Severe emphysema again noted\nwith clear left lung.\n\nThe imaged thyroid is unremarkable.  The thoracic aorta is mildly calcified\nand normal in caliber.  The heart is normal in size with small pericardial\neffusion again seen.  The main pulmonary artery is mildly prominent measuring\nup to 3.2 cm in diameter which could reflect pulmonary arterial hypertension. \nEvaluation for pulmonary embolism is markedly limited due to phase of imaging.\nCalcified right hilar nodes noted.  The esophagus appears grossly\nunremarkable.  Prevascular lymph nodes measuring up to 9 mm in short axis\nappear similar to prior and are likely reactive.\n\nUpper abdomen:  Within the imaged portion of the upper abdomen, no gross\nabnormalities detected though motion artifact limits assessment.\n\nBones:  No worrisome lytic or blastic osseous lesion.  Stable mild compression\ninvolving superior endplates in the thoracic spine T8, T6 and T3.  Bilateral\ngynecomastia is mild.",
            "output": "1. Persistent moderate right empyema appears slightly decreased from prior. \nInterval removal of right chest tube.\n2. Significant collapse of the right lower and right middle lobes as seen on\nprior.  Bronchus intermedius stent remains in place though branching distal\nbronchi are minimally patent.\n3. Small pericardial effusion unchanged.\n4. Severe emphysema with mildly dilated main pulmonary artery suggestive of\npulmonary arterial hypertension."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is within normal limits. Coronary artery calcifications are\nsevere.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Detailed evaluation limited by respiratory motion.  There is\nmild atelectasis in the bilateral lower lobes.  No focal consolidations.  The\ncentral airways are patent.  There is mild diffuse bronchial wall thickening,\nworse in the lower lobes.\n\nBASE OF NECK: Two hypoattenuating nodules in the left thyroid lobe measure up\nto 1.3 cm (301:18, 36) and are nonspecific.\n\nABDOMEN: A partly imaged simple cyst is seen in the right kidney.  Otherwise\nthe imaged upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. No focal consolidation. Mild bronchial wall thickening, worse in the lower\nlobes, suggests bronchitis."
        },
        {
            "input": "The lung volumes are normal.\nNo incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hila.  Normal appearance of the cardiac structures and of the\nposterior mediastinum. The abdominal findings are reported in detail in the\nabdominal CT report of the examination performed today.  Minimal degenerative\nchanges of the vertebral bodies.  No abnormalities at the level of the ribs\nand the sternum.\n\nMinimal bilateral apical scarring, symmetrical in distribution. Unremarkable\nappearance of the lung parenchyma.  No pleural thickening, no pleural\neffusions, no pulmonary nodules or masses suspicious for malignancy. The\nairways are patent.",
            "output": "No suspicious lung nodules or masses.  No pleural lesions or lymphadenopathy."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Multiple mediastinal lymph\nnodes are present although none of them is pathologically enlarged.  No hilar\nlymph nodes seen.\n\nHeart size is normal.  There is no pericardial or pleural effusion.  Extensive\ncoronary calcifications and most likely stent in the LAD is present as well.\n\nAirways are patent to the subsegmental level bilaterally.\n\nNo pulmonary nodules masses or consolidations demonstrated.\n\nImage portion of the upper abdomen demonstrate right kidney cyst.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report for assessment\nof intra-abdominal and intrapelvic pathology."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is no pericardial effusion.  There is moderate coronary artery\ncalcification.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  There are degenerative changes involving the\nthoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.",
            "output": "No evidence of metastasis to the chest\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is moderate coronary\nartery calcification.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows right renal\ncyst.  No adrenal masses are seen.  Patient status post cholecystectomy.",
            "output": "No evidence of metastasis to the chest.  Please refer to dedicated report on\nabdomen which has been dictated separately"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent bilateral axillary lymph\nnodes are unchanged from ___.  No mediastinal or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lung apices and bases are incompletely imaged.  Mild\ndependent atelectasis is noted.  The lungs are otherwise clear.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Unremarkable appearance of the heart and pericardium.\n3. Mild dependent atelectasis, otherwise the imaged lungs are clear.\n4. Prominent bilateral axillary lymph nodes are unchanged from ___."
        },
        {
            "input": "LOWER NECK: Unremarkable\n\nAIRWAYS/LUNGS:\nThe airways are patent to the subsegmental level.\nThere is diffuse peribronchial and interlobular septal thickening bilaterally.\nThere are patchy ground-glass opacities in the upper and lower lobes as well\nas patchy and confluent consolidative airspace opacities in the lower lobes\nbilaterally.  There is subsegmental atelectasis at the lung bases.\n\nPLEURA:  There is moderate right and small left simple pleural effusions.\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.  Note is again made of partially calcified mediastinal\nand bilateral hilar lymph nodes likely related to prior granulomatous disease.\n\nHEART and VASCULATURE: The heart is not enlarged.  Coronary artery\ncalcifications are noted.  There is no pericardial effusion.\n\nBONES/ CHEST WALL:  No aggressive bony lesions.\n\nUPPER ABDOMEN: Unremarkable.",
            "output": "1. Diffuse interlobular septal thickening bilaterally is consistent with\ninterstitial pulmonary edema.\n2. Ground-glass and consolidative airspace opacities bilaterally may be\nsecondary to alveolar edema.  Multifocal pneumonia is less favored in the\nsetting of background interstitial edema.\n3. Moderate right and small left pleural effusions."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue abnormalities in the imaged chest wall concerning for\nmalignancy.  This study is not appropriate for subdiaphragmatic diagnosis. \nEvaluation of periportal edema and heterogeneous attenuation in the kidneys\nwould require ultrasound to see if additional abdominal imaging is necessary.\n\nCARDIO-MEDIASTINUM:Upper esophagus is moderately distended, as before. \nRemainder the esophagus is unremarkable despite adjacent adenopathy.\n\nAtherosclerotic calcification is mild in head and neck vessels.  And extensive\nin the coronary arteries.  Aorta and pulmonary arteries are normal size. \nHypoattenuation of cardiac contents indicates anemia.  Small pericardial\neffusion is unchanged.\n\nCentral catheter from a right infusion port ends in the right atrium.  There\nis no fluid collection around the subcutaneous port.\n\nTHORACIC LYMPH NODES: Calcification is present in many thoracic lymph nodes in\nmultiple mediastinal and both hilar stations.  As before, the largest nodes\nare in the subcarinal and upper right posterior paraesophageal station,\nranging in diameter up to 17 mm today, 02:30, previously 19 mm.  General lymph\nnode size has decreased.\n\nLUNGS, AIRWAYS, PLEURAE:\nRight lung is grossly clear.  There was previously a large nonhemorrhagic\nright pleural effusion. Today there is a very small, nonhemorrhagic effusion\nwith high attenuation of the pleural surfaces suggesting interval pleurodesis.\n\nLarge region of dense consolidation extending from the superior to the\nposterior basal segment of the left lower lobe, accompanied by interstitial\ninfiltration is probably pneumonia.  Dependent, nonhemorrhagic left pleural\neffusion is small.\n\nA small nodular consolidation in the lingula, probably another focus of\ninfection, is also new, 5:258,\n\n\nCHEST CAGE: No compression or pathologic fracture.  No findings to suggest\neither infection or malignancy in the chest cage.",
            "output": "New pneumonia, predominantly left lower lobe, small component in the lingula.\n\nPrevious extensive infection and pulmonary edema have resolved since ___.\nOnly small bilateral pleural effusions remain.  Mediastinal adenopathy,\npredominantly subcarinal, has also improved.\n\nMultiple calcified central lymph nodes suggest sarcoidosis or previous,\ntreated lymphoma."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Coronary artery\ncalcifications are noted.  Right chest wall port is noted with catheter tip in\nthe right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: Partially calcified mediastinal and bilateral\nadenopathy is again noted, not significantly changed since last month's exam.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Prior bilateral pleural\neffusions have resolved.\n\nLUNGS/AIRWAYS: There is been near resolution of the opacity in the basilar\nsegments of the left lower lobe.  Some residual opacity identified at the\nmedial aspect of the superior segment of the left lower lobe.  There is new\nperipheral consolidation laterally within the superior segment of the left\nlower lobe (3:93).  Right lower lobe calcified nodules are again noted. \nAdjacent linear opacity is likely mucous plugging within dilated distended\ndistal branchial.  The central airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Near resolution of previously seen small bilateral pleural effusions\npartial clearance of previously seen left basilar consolidation.\n3. New region of consolidation in the superior segment of the left lower lobe\nsince prior suggesting new pneumonia.\n4. Mediastinal and bilateral partially calcified lymphadenopathy as seen\npreviously."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Small\nbilateral axillary nodes are most likely reactive in are unchanged.\n\nMEDIASTINUM: Small mediastinal lymph nodes are also unchanged.  Some of the\nmediastinal nodes have dystrophic calcification within them.  Small bilateral\nhilar lymph nodes some of which are calcified are all are also unchanged in\nsize since the prior study.  There is stable mild cardiomegaly.  Stable\nmoderate coronary artery calcification.  The esophagus is patulous and , could\nbe related to motility disorder.  There is no pericardial effusion\n\nUnenhanced pulmonary artery and aorta are normal in caliber.  There is a\nright-sided Port-A-Cath with its tip in the SVC.\n\n\nPLEURA: There are moderate bilateral pleural effusions left greater than\nright, new since the prior study.\n\nLUNG: Consolidative opacity in the left lower lobe is disproportionate to the\nmoderate fluid and could represent combination of atelectasis and pneumonia. \nConsolidation in the right lung base most likely represents atelectasis. \nPatchy parenchymal opacity in the superior segment the right lower lobe (3,\n31) most likely represents pneumonia.  There are few scattered patchy\nground-glass opacities in the right upper lobe (3, 12) new since the prior\ncould also could be inflammatory.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "New bilateral pleural effusions left greater than right.  Dense consolidation\nof left lower lobe most likely represents combination of effusion and\natelectasis.\n\nSubsegmental atelectasis in the right lung base.\n\nConsolidation in the superior segment the right lower lobe and patchy\nparenchymal opacities in the right upper lobe could also represent an evolving\npneumonia.\n\nFollow-up to complete resolution in ___ weeks after completion of antibiotics\nis recommended.\n\nRight-sided Port-A-Cath with its tip in the SVC.\n\nEvidence of prior granulomatous disease"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged neck base is\nunremarkable.  Axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: There is a small hiatal hernia.  Otherwise, the imaged upper\nabdomen is unremarkable.\n\nMEDIASTINUM: Numerous mediastinal lymph nodes are unchanged, some of these\nhave dystrophic calcification.  The esophagus is patulous.\n\nHILA: Bilateral hilar lymphadenopathy, including many calcified hilar lymph\nnodes are also unchanged.\n\nHEART and PERICARDIUM: The heart remains mildly enlarged.  Severe diffuse\ncoronary artery calcifications are re-demonstrated.  Hypodensity of the blood\npool is suggestive of anemia.  The thoracic aorta is normal in caliber.  A\nright internal jugular approach Port-A-Cath terminates in the right atrium. \nPericardium is physiologic.\n\nPLEURA: Bilateral pleural effusions have decreased, and are now trace. There\nis no pneumothorax.  Bi apical pleural scarring is re-demonstrated.\nLUNG:\n\nLeft lower lobe consolidation has improved.  A right lower lobe opacity has\nalso improved.  There is mild dependent pulmonary edema.  Patchy ground-glass\nopacities in the right upper lobe have improved.  A calcified granuloma is\nre-demonstrated and right middle lobe.  No suspicious pulmonary nodules.\n\nCHEST CAGE: No aggressive osseous lesion or acute fracture.",
            "output": "1. Improving bilateral lower lobe consolidations.  Interval decrease in the\nsize of bilateral pleural effusions.\n2. Similar mediastinal and hilar lymphadenopathy with calcification, possibly\nrelated to treated lymphoproliferative disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Re-demonstrated are coronary artery calcifications and\nmild cardiomegaly.  A right IJ central venous line again terminates in the\nright atrium.  The pericardium and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nNumerous mediastinal lymph nodes are unchanged, some of which contain\ndystrophic calcifications.  For example, a prevascular lymph node measures up\nto 1.1 cm in short axis (05:58).  Bilateral hilar lymphadenopathy is also\nunchanged.  As before, there are multiple calcified hilar lymph nodes\nbilaterally.  For example, there is a partially calcified right hilar node\nmeasuring up to 1.2 cm in short axis (5:80).\n\nPLEURAL SPACES: No pneumothorax.  There has been interval increase in\nbilateral pleural effusions, now moderate.\n\nLUNGS/AIRWAYS: Re-demonstrated is biapical pleural scarring.  Bilateral lower\nlobe ground-glass opacities have increased since the prior study.  New since\nthe prior study are diffuse nodular opacities scattered throughout the\nbilateral lung fields, measuring up to 1.2 cm in the right upper lobe (6:94)\nand 1.0 cm in the left lower lobe (6:189).  A punctate granulomas again seen\nin the right middle lobe (6:138).  Bilateral lower lobe compressive\natelectasis is also noted.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  New, diffuse nodular opacities scattered throughout the bilateral lung\nfields are consistent with an infectious process.  Given the patient's\nhistory, fungal infection is a possibility.\n3.  Interval increase in bilateral pleural effusions, now moderate.\n4.  Similar appearance of mediastinal and hilar lymphadenopathy with\ncalcifications, likely related to treated lymphoproliferative disease.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:36 pm, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Unremarkable.  Right Port-A-Cath in\nplace.\n\nUPPER ABDOMEN: Please refer to separate abdominal pelvis CT done the same day.\n\nMEDIASTINUM: Again seen are numerous mediastinal and bilateral hilar lymph\nnodes containing dystrophic calcifications suggestive of prior granulomatous\ndisease.  No mediastinal collection.\n\nHEART and PERICARDIUM: Extensive coronary calcifications.  No pericardial\neffusion.  No cardiomegaly.\nPLEURA: Interval resolution of the bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  In the interim, the previously described bilateral pulmonary\nnodules are less conspicuous on today's exam.  There are no new pulmonary\nnodules.  Again seen is a left lower lobe consolidation.\n2. AIRWAYS:  The proximal bronchi and trachea are patent.\n3. VESSELS:  The aorta is normal in caliber.\nCHEST CAGE: No bone lesions or fracture.",
            "output": "1. Interval improvement of the pulmonary nodules and resolution of the\nbilateral pleural effusions.  The interval improvement likely suggests an\ninfectious process.\n2. Persistence of a left lower lobe consolidation.\n3. Please refer to separate abdominal pelvis CT done the same day.\n\nRECOMMENDATION(S):  Chest CT in ___ weeks to follow the parenchymal\nabnormalities.\n\nNOTIFICATION:\n___"
        },
        {
            "input": "Central venous line terminates in the right atrium.  There is suspected anemia\ngiving the high density of the myocardium.  Extensive Coronary calcifications\nare present.  Multiple calcified mediastinal lymph nodes are re-demonstrated\nin mediastinum and hila bilaterally.  No axillary or supraclavicular\nlymphadenopathy is present.\n\nThere is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen demonstrate no appreciable abnormality\nexcept for vascular calcifications.\n\nAirways are patent to the subsegmental level bilaterally.  Left basal\nconsolidation appears to be extensive associated with scarring but overall\nimproved slightly since previous examination, series 4, image 137.  Multiple\npulmonary nodules are either unchanged or slightly decreased in size.  The\nnodules that have decreased in size are as following:\n\nSeries 4, image 70, 169, 184, 219, 84, 80, 152, 199, 240.\n\n1 minimal area of interval increase in size in opacity is in the base of the\nleft lower lobe, series 4, image 251 but might potentially represent\natelectasis.  No new consolidations or nodules demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Slight interval decrease in size in the size of the multiple pulmonary nodules\nthat might represent minimal gradual improvement of infectious process\n\nInterval improvement of the dominant left lower lobe consolidation\n\nMinimal focal area of increasing in opacity in the left lung base that might\nrepresent focus of infection or potentially atelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No enlarged supraclavicular or\naxillary adenopathy.  Thyroid gland is normal in nonenhanced CT.  Right-sided\nPort-A-Cath terminates in the superior cavoatrial junction.  No abnormal soft\ntissue findings in the chest wall.\n\nUPPER ABDOMEN: Bilateral renal hyperdensities at the corticomedullary junction\nmay reflect nephrolithiasis or vascular calcifications. Heavily calcified\nsplenic artery and SMA.  No lesions in the liver in nonenhanced CT.\n\nMEDIASTINUM: Multiple calcified lymph nodes in the mediastinum and bilateral\nhila are unchanged.\n\nHEART and PERICARDIUM: Heart is mildly enlarged.  Heavy calcifications are\nseen in the coronary arteries.  Thoracic aorta is normal in caliber.  Few\ncalcified plaques are seen in the descending aorta.  There is no pericardial\neffusion.\nPLEURA: No pleural effusion.  Mild pleural thickening on the left the left.\nLUNG:\n\n1. PARENCHYMA:  Interval improvement of the left basal consolidation and\nnodules in the left lower lobe (4:127, 245) with ground-glass opacities and\nsubsegmental consolidations still present.  Near resolution of a 10 mm right\nlower lobe nodule (4:214) with some ground-glass still present.  The 3 mm\nnodule in the right lower lobe is no longer seen.  Few scattered calcified\ngranulomas are stable in the right lower lobe (4:183) and left upper lobe\n(4:144).  Stable 4 mm nodule in the left upper lobe (4:67)\n2. AIRWAYS:  Multiple areas of mucous plugging in the lingula, left lower\nlobe, right lower lobe, and mild central bronchial wall thickening.\n3. VESSELS:  Pulmonary artery is normal in caliber.\nCHEST CAGE: No suspicious bone lesions or new fractures.  Generalized bone\ndemineralization.",
            "output": "1. Interval improvement of the left lower lobe the fungal infection with\nremnant subsegmental consolidations still present.  Near resolution to\ncomplete disappearance of multiple nodules seen in the right lower lobe and\nleft lower lobe.\n2. Unchanged mediastinal and bilateral hilar calcified lymph nodes which are\nmost likely related to histoplasmosis, although sarcoid or silicosis are also\nin the differential diagnosis."
        },
        {
            "input": "Soft tissues:  Thyroid gland is homogeneous.  There are no pathologically\nenlarged mediastinal or hilar lymph nodes.  Heart size is normal and there is\nno pericardial effusion.  Aorta and main pulmonary artery are normal in\ncaliber.  There is no coronary artery or valvular calcification. Limited\nimages of the upper abdomen demonstrate a simple cyst at the upper pole of the\nleft kidney.  Curvilinear density at the lateral aspect of the spleen is\nlikely a sequelae of prior trauma.\n\nLungs:  There is a small left pneumothorax and small left mildly complex\npleural effusion, likely hemothorax. Multiple bilateral pulmonary parenchymal\ncontusions are appreciated in the right middle lobe (02:33) and in the left\nupper lobe (02:39).  Atelectasis of the right lower lobe is noted.\nEndobronchial secretions in the airways of the left lower lobe result in lobar\ncollapse.  Calcified granuloma is seen within the right upper lobe.  4 mm left\nupper lobe pulmonary nodule (03:20) is noted.\n\nBones:  There are multiple left-sided rib fractures involving the third,\nfourth, fifth, sixth, seventh, and eighth ribs laterally as well as the\nseventh rib posteriorly.  Right eighth and ninth ribs demonstrate remote\nfractures in the process of healing.  The thoracic spine is intact without\ncompression deformity or fracture.  The imaged clavicles are intact.",
            "output": "1. Multiple contiguous left-sided rib fractures including segmental fractures\nof the left seventh rib with adjacent small left hemopneumothorax and areas of\npulmonary contusion bilaterally.\n2. Left lower lobe collapse with endobronchial secretions in the left lower\nlobe airways.\n\n3. 4 mm left upper lobe pulmonary nodule.  If the patient is at high risk for\nlung malignancy, a followup chest CT in ___ year is recommended.  Otherwise, no\nfurther followup is needed.\n\nRECOMMENDATION(S):\n4 mm left upper lobe pulmonary nodule. If the patient is at high risk for lung\nmalignancy, a followup chest CT in ___ year is recommended.  Otherwise, no\nfurther followup is needed.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 3:46 ___, 2 minutes after discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Re-demonstrated is mediastinal lymphadenopathy\nincluding subcarinal, pre-carinal and right paratracheal lymph node stations.\nThere is no axillary lymphadenopathy.  Esophagus remains patulous.\n\nSUPRACLAVICULAR: Re-demonstrated is left supraclavicular lymphadenopathy\n(3:19).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Again seen is right apical scarring radiation fibrosis changes\nin the right apex and anterior right upper lobe.  There is a stable 3 mm\npulmonary nodule within the left upper lobe (3:86). The lungs are otherwise\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: The patient is status post total thyroidectomy, postsurgical\nclips are seen.  Otherwise, the partially visualized base of the neck is\nunremarkable.\n\nABDOMEN:  Included portion of the upper abdomen demonstrated a nodular\nheterogeneous appearance of the liver compatible with pseudocirrhosis, as seen\npreviously.  Trace ascites is also identified.\n\nBONES AND SOFT TISSUES: Diffuse osseous metastatic disease throughout the\nvertebral bodies and ribs appears grossly similar to the prior study dated ___.  A known pathologic compression fracture at the level of T6,\nhowever, appears more compressed in comparison to the prior (602:30).  Patient\nis status post right mastectomy.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Re-demonstrated mediastinal and supraclavicular lymphadenopathy.\n3. Diffuse osseous metastatic disease with increased compression of a\npathologic compression fracture involving T6 vertebral body.\n4. Pseudocirrhosis with ascites, incompletely evaluated on current study.\n5. Airways appear patent throughout."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged and unremarkable in appearance. \nExtensive network of collaterals (venous) are present and at the a left hemi\nthorax, most likely due to abnormalities within the brachycephalic or axillary\nveins on the left.  No mediastinal, hilar or axillary lymphadenopathy is\npresent.  The appearance of the right breast after surgery its mid unchanged\n(reconstruction).  Heart size is normal.  There is no pericardial pleural\neffusion seen.  Image portion of the upper abdomen will be reviewed separately\nas part of the CT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\nwith no evidence of pulmonary nodules masses or consolidations.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm have been\ndemonstrated.  Right apical scarring is present, unchanged.",
            "output": "No evidence of intrathoracic metastatic disease.  Liver lesions that will be\ndescribed separately as part of CT abdomen and corresponding report.  Stable\nappearance of the right apex scarring."
        },
        {
            "input": "Surgical clips are present in the region of the thyroid.  A hyperenhancing on\nthe right axillary lymph node measuring up to 6 mm, not significantly changed\nfrom ___ but new since ___.  There is no mediastinal\nadenopathy.  Mediastinal clips are unchanged.  Heart size is normal. There is\nno pericardial effusion. There are no significant coronary artery or aortic\nvalvular calcifications.  The main pulmonary trunk is not dilated.\n\nThe airways are patent to the subsegmental levels bilaterally.  Right apical\nscarring and post radiation changes are stable.  There is no focal\nconsolidation, pleural effusion, pleural thickening, pneumothorax, or\npneumomediastinum.  4 mm left lower lobe (series 4, image 192) and 2 mm left\nupper lobe pulmonary nodules (series 4, image 94) are stable dating back to\n___ and therefore benign.\n\nThe thoracic esophagus is mildly patulous with debris. Please see separate\ndictation for details on intrathoracic structures.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Attention on followup to a 6 mm hyperenhancing axillary lymph node stable\nsince ___."
        },
        {
            "input": "Patient is status post thyroidectomy with no abnormal soft tissue seen in the\nsurgical bed.  Three right axillary lymph nodes measuring less than 6 mm are\nstable since CT chest on ___.  There are no pathologically enlarged\nsupraclavicular, axillary, mediastinal or hilar lymph nodes.  Patient is\nstatus post right axillary dissection and right breast reconstruction, with\nstable appearance of the breasts.\n\nThe aorta and pulmonary arteries are normal in size.  Mediastinal clips are\nunchanged.  The heart is normal in size and demonstrates no appreciable\ncoronary artery calcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Scarring at the right apex is unchanged and likely\nrelated to prior radiation therapy.  A 3 mm nodule in the left lower lobe and\na 2 mm nodule in the left upper lobe are unchanged since CT chest on ___ (4:96, 186).  A 3 mm left perifissural nodule in a 3 mm left lower lobe\nsubpleural nodule are stable since at least CT chest on ___ (4:64,\n67).  There are no new suspicious pulmonary nodules.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Please see separate dictation for CT abdomen and pelvis performed\non same day for description of subdiaphragmatic findings.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. Right axillary lymph nodes and multiple small pulmonary nodules are stable.\nNo new lymphadenopathy or suspicious pulmonary nodules.\n3. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged ranging in diameter\nup to 8 mm in the left axilla, 04:19, unchanged since at least ___. \nPatient has had right mastectomy and reconstruction warranting mammography for\nevaluation.  Elsewhere in the chest there are no soft tissue abnormalities\nsuspicious for malignancy.  Findings below the diaphragm will be reported\nseparately.  Catheter of a new left subclavian infusion port ends in the upper\nright atrium.\n\nAtherosclerotic calcification is mild in the head neck vessels, not apparent\nin the coronary arteries.  Aorta and central pulmonary arteries are not\nenlarged.  There is no aortic valvular calcification.  Cardiac evaluation\nwould require dedicated cardiac imaging.  There is no pericardial or pleural\neffusion.\n\nCentral lymph nodes are numerous and not pathologically enlarged, but several\nare slightly bigger today than on ___ including 8 mm subcarinal\nmediastinal node, previously 5 mm and and a 12 x 13 mm right hilar nodal\ncluster, previously 8 x 13 mm.  There are no enlarged internal mammary,\ndiaphragmatic, or retro crural lymph nodes.\n\nRight apical pleural parenchymal scarring, including calcification, is\nlong-standing.  Mild subpleural fibrosis in the right upper lobe anteriorly is\ndue to prior tangential breast radiation.\n\nFocal lung lesions are as follows:\n\n2-3 mm left upper and left lower subpleural lung nodules, 5:85, unchanged\nsince at least ___.\n\n6 mm, Left lower lobe lung nodule, 5:242, also stable.\n\nThere are no new lung nodules.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  .",
            "output": "No evidence of intrathoracic malignancy.  3 tiny lung nodules are stable since\nleast ___.\n\nSlight increase in caliber of sub cm mediastinal and right hilar lymph nodes,\nsignificance indeterminate."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Subcentimeter mediastinal\nand hilar nodes are unchanged.  Postoperative changes in the right breast and\naxilla are similar to the prior CT, and small axillary lymph nodes are also\nunchanged in the interval.  Heart size is normal, and no pericardial or\npleural effusion is present.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.\n\nWithin the lungs, postradiation changes in the right lung, most notable at the\napex, appear unchanged.  The previously reported tiny nodular opacities are\nunchanged, located in the left upper lobe (64), left lower lobe (64), left\nupper lobe (114) and left lower lobe (226), all on series 6.  No suspicious\nnew or growing nodules are detected.",
            "output": "1. Stable CT appearance of the chest, with no new or growing pulmonary\nnodules.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Thyroid has been resected.  Supraclavicular lymph nodes are not enlarged, and\na 5 mm left supraclavicular node, 04:17 was.  Enlarged left hilar nodes have\nbenign morphology, with large fatty hila, and are unchanged since at least\n___.  subcentimeter right peripectoral lymph node, 04:48 is also\nunchanged and not concerning for malignancy.  Postoperative appearance of the\nright breast axilla and chest wall is stable.  There are no soft tissue\nabnormalities elsewhere in the chest wall concerning for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nAtherosclerotic calcification in head neck vessels mild, not apparent in\ncoronary arteries.  Left trans jugular central venous infusion catheter ends\nin the upper right atrium, with no associated thrombus.  Aorta is normal\ncaliber.  Main pulmonary artery is top-normal.  Right and left pulmonary\narteries are normal size.  There is no pericardial or pleural effusion.\n\nIntrathoracic lymph nodes are not enlarged.\n\nLungs:\n\nScarring in the right apex and anterior right lung due to radiation is stable.\n\n5 mm subpleural left lower lobe lung nodule, 4:160, has been stable since at\nleast ___.\n\nThere are no new or growing lung nodules and no other lesions in the lungs the\nor bony chest cage concerning for metastasis.",
            "output": "No evidence of intrathoracic malignancy.  5 mm left lower lobe nodule has been\nstable since at least ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the proximal\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nDistal subsegmental branches cannot be well evaluated due to suboptimal bolus.\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Right apical scarring is noted.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: An FDG avid left supraclavicular lymph node seen on PET-CT from\nsame day is not well-visualized due to artifact in the upper left shoulder and\nanterior chest.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates nodular\nappearance of the liver, compatible with pseudocirrhosis better evaluated on\nprior MR. ___ ascites are also partially imaged.\n\nBONES: Diffuse osseous metastatic disease throughout the ribs and vertebral\nbodies markedly progressed since ___.  There is osseous destruction\nof the posterior elements of the T6 vertebral body involving the left\ntransverse process and pedicle and abutting the thecal sac without obvious\nnarrowing of the spinal canal.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.  Distal subsegmental\nbranches are not well evaluated due to suboptimal bolus timing.\n2. Diffuse osseous metastases have markedly progressed since ___. \nOsseous destruction of the posterior elements of the T6 vertebral body abuts\nthe thecal sac without obvious narrowing of the spinal canal.  Correlate with\nneurologic symptoms at this level.\n3. An FDG avid left supraclavicular lymph node seen on PET-CT from same day is\nnot well-visualized due to artifact in the upper left shoulder and anterior\nchest.\n4. Nodular liver, reflecting pseudocirrhosis better, previously evaluated on\nMRI.\n5. ___ ascites is partially imaged.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 13:53 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with punctate coronary artery calcifications. There is no\npericardial effusion. The main pulmonary artery and thoracic aorta are normal\ncaliber. A normal variant left aortic arch with aberrant right subclavian\nartery is incidentally noted.\n\nInterlobular septal thickening is most pronounced at the lung periphery and in\nthe lung apices. There are branching calcifications in the bilateral upper\nlobes which are intimately related with the interlobular septae. Several\npunctate calcified granulomas are identified bilaterally. Mild to moderate\nemphysema is apical predominant. There is no endobronchial lesion or pleural\neffusion.\n\nImages of the abdomen upper abdomen demonstrate an indeterminate subcentimeter\nhypodense right hepatic lobe lesion which is too small to characterize (3,\n53), cholelithiasis, and unchanged mild dilatation of the partially imaged\nright renal collecting system.\n\nMultilevel spinal degenerative changes are present. However, there are no bony\nlesions in the thorax worrisome for infection or malignancy.",
            "output": "No evidence of pulmonary metastases.\n\nApical predominant branching parenchymal calcifications may be seen in the\nsetting of disseminated pulmonary calcification, which is associated with a\nnumber of secondary diagnoses, including chronic renal failure and\nhyperparathyroidism.\n\nMild to moderate apical predominant centrilobular emphysema."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged.  In the midline, at the\nthoracoabdominal junction, surrounded by preserved abdominal wall fat is a 14\nx 21 by 41 mm calcified structure, previously 14 x 20 by 40 mm on ___.  It was 18 x 20 by 44 mm on ___ but had less calcium at that\ntime.  Excluding the breasts which require mammography for evaluation, there\nare no other soft tissue lesions in the chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis.  Those findings\nwere evaluated on the recent interpretation of an outside torso CT.\n\nThyroid is larger and more heterogeneous today than it was in ___ and a\nhypodense lesion in the left lobe, 12 mm, is new or larger and warrants\nultrasound evaluation.\n\nAtherosclerotic calcification is not apparent in the head and neck vessels or\ncoronary arteries. Retroesophageal right subclavian artery is not enlarged. \nAorta is normal size.  The intra pericardial right pulmonary artery is large,\n29 mm, 5:121, 28 mm in ___.\n\nThere is no pericardial or pleural effusion.\n\nSub cm mediastinal and hilar lymph nodes are numerous, but not pathologically\nenlarged.  A 19 x 30 mm conglomerate of right hilar lymph nodes is not\nevaluated on the previous noncontrast chest CT.\n\nEmphysema is moderately severe.  The Very unusual, heavy branching\ncalcification, most pronounced in the upper lobes, and scattered elsewhere in\nthe lungs is better recognized on the noncontrast study in ___.  Some appears\nto be in the walls of dilated bronchi.  It has not improved and may have\nworsened.  There is also a multi focal non calcified branching due to\nbronchiolitis.\n\nBoth of these pulmonary abnormalities make it difficult to recognize new, non\ncalcified, non vascular nodular lesions in the lung, but I see several of\nthese, although there may be others:\n\n4 and 3mm, right upper lobe, 05:44, 55\n\nThe largest, 7 x 5 mm, superior segment right lower lobe, 5:143.\n\nMild bronchial wall thickening in the lobar and segmental bronchi is\nunchanged.  There are no bone lesions in the chest cage suspicious for\nmalignancy.",
            "output": "3 sub cm soft tissue lung nodules, new since ___ could be metastases.\n\nProgressive ossification, but no overall growth of nonaggressive, midline\nsubdiaphragmatic lesion in the anterior abdominal fat.  Could be a benign\nteratoma or ossifying hematoma.  If the patient is being evaluated for\npossible metastatic ovarian carcinoma, the lesion should be evaluated by\nPET-CT scan.\n\nNew mild multi focal bronchiolitis, most commonly seen with non-tuberculous\nmycobacterial infection.\n\nPersistent, severe, unexplained bronchovascular calcification, some associated\nwith non suppurative, bronchiectasis predominantly upper lobes, not\nappreciably changed since ___.\n\nModerate emphysema."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. In the mediastinum, multiple borderline size to\nslightly enlarged lymph nodes are visualized (2, 14). Normal appearance of the\nlarge mediastinal vessels.  No incidental pulmonary embolism. Moderate\ncoronary calcifications, no valvular calcifications, no pericardial effusion.\nThe posterior mediastinum is unremarkable. Upper abdominal findings, including\nthe large multicentric hepatic and splenic masses are described in detail in\nthe dedicated abdominal CT examination performed today.  Moderate degenerative\nvertebral disease.  No vertebral compression fractures.  No osteolytic lesions\nat the level of the ribs, the sternum, or the vertebral bodies.  Mild\nrespiratory motion.\n3 mm perifissural left upper lobe nodule (4, 33).\n5 mm left lower lobe part solid nodule (4, 38).\n2 mm solid subpleural middle lobe nodule (4, 108).\n2 mm lingular pulmonary lymph node (4, 115).\n2 mm lingular calcified granuloma (4, 155).\n4 mm solid subpleural left lower lobe nodule (4, 161).\nThe airways are patent.  No pleural thickening, no pleural effusions.  No\ndiffuse lung disease.",
            "output": "Mild mediastinal lymphadenopathy.  Several small pulmonary nodules, the 5 mm\nleft lower lobe nodule (4, 38) should receive attention on future follow-ups\nto exclude the possibility of primary lung cancer."
        },
        {
            "input": "THYROID: The thyroid is unremarkable.\n\nLYMPH NODES: There is no axillary, or supraclavicular lymphadenopathy by CT\nsize criteria.  Scattered but not pathologically enlarged mediastinal lymph\nnodes are identified.  Right hilar lymph nodes are prominent but not\npathologically enlarged.\n\nHEART AND VESSELS: As before there is an aberrant right subclavian artery. \nThere is no evidence of pulmonary embolism to the segmental level.  Evaluation\nof subsegmental branches is somewhat limited due to respiratory motion\nartifact.  The great vessels are normal in caliber.  The heart is normal in\nsize is there is no pericardial effusion.\n\nLUNGS & AIRWAYS: Geographic areas of ground-glass opacity has increased in\noverall distribution from prior exam.  Within these segments of affected lung\nis bronchiectasis increased in overall extent.  As before, the disease is most\nextensive in the anterior portions of the upper lobes.  There is a stable\nright upper lobe nodule measuring 5mm (2:16), unchanged from ___. There are\nno pleural effusions.  No pneumothorax.\n\nUPPER ABDOMEN: Limited views of the upper abdomen are within normal limits.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No evidence of suspicious osseous lesions.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nProgression of fibrosis in this patient with hypersensitivity pneumonitis."
        },
        {
            "input": "There is no mediastinal, hilar, or axillary lymphadenopathy by CT size\ncriteria. Again seen is extensive atherosclerotic disease of the aorta,\ncoronary arteries, and the origin of the great vessels. Aortic valve\ncalcifications are also noted. The heart remains moderately enlarged.\n\nAirways are patent to the subsegmental levels. Again seen is significant\nbullous and centrilobular emphysema. Multiple stable appearing lung nodules\nare seen in the right lower lobe, unchanged from ___. The left lower lobe\nmalignancy treated with CyberKnife is grossly unchanged in size and\nappearance. The second lesion in the right upper lobe treated with CyberKnife\nis also grossly unchanged in size and appearing. There has been interval\nimprovement in right lower lobe ground-glass opacities and interlobular septal\nthickening.  Atelectasis versus scarring is seen at the right base.\n\nThe patient has previously undergone esophagectomy with gastric pull-through.\nAlthough the study is not tailored for assessment of subdiaphragmatic\nstructures, a left kidney cyst appears stable. There is a 6 mm hypodense\nlesion in segment 7 of the liver, which is stable. Again seen is the somewhat\nlobular contour for of the posterior right lobe of the liver, which is\nincompletely characterized on this study.\n\nNo rib fractures are identified. No concerning lytic or sclerotic lesions are\nseen.",
            "output": "1.  No rib fracture identified.\n\n2.  Interval improvement of right lower lobe ground-glass opacities and\ninterlobular septal thickening.\n\n3.  Significant bullous and centrilobular emphysema.\n\n4.  Stable lung nodules in the right lower lobe and stable appearance of right\nupper lobe and left lower lobe malignant nodules status post CyberKnife\ntreatment.\n\n5.  Persistent lobular contour of the posterior right lobe of the liver, which\nis incompletely characterized on this study. Recommend attention on followup."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular lymph nodes are unremarkable.  Axillary lymph nodes are\nincreased in number and top-normal in size with normal morphology.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nA focal area of penetrating atherosclerotic ulcer formation is noted the\ndistal aortic arch (302:75).  The main, right, and left pulmonary arteries are\nnormal caliber.\n\nPULMONARY PARENCHYMA:  There is no evidence of infection or malignancy.  4 mm\nnodule in the left upper lobe is noted (302:66).  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is a small left pleural effusion with associated atelectasis.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  A 6 x 4 mm nodule in the lower\nouter right breast is noted for which mammographic correlation is recommended\n(302:158).\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. No convincing evidence of intrathoracic malignancy.\n2. Small nodule in the lower outer right breast is noted for which\nmammographic correlation is recommended.\n3. Small left pleural effusion.\n4. 4 mm left upper lobe pulmonary nodule may represent an incidental finding. \nAttention on follow-up imaging is recommended.\n5. Penetrating atherosclerotic ulcer in the aorta in the distal aortic arch.\n6. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  There is mild diffuse\nbronchial wall thickening and several hazy peribronchial opacities within the\nlower lobes bilaterally and inferior posterior upper lobes, suggestive of\nbronchitis/small airway disease.  No large consolidation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Incidental\nnote is made of an independent origin of the left gastric artery from the\naorta.  There is accessory left renal artery.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nBronchial wall thickening and hazy nodular opacities suggestive of\nbronchitis/small airways disease."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland was not imaged in the current study.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality in the field severe.\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.  No acute infectious\nprocess or evidence of malignant/metastatic disease in the chest."
        },
        {
            "input": "2 6 mm hypodense thyroid nodules, in the left lobe and at the level of the\nisthmus (4, 8).  Stable borderline sized bilateral axillary lymph nodes (4,\n16).  No enlarged lymph nodes in the mediastinum or at the level of the hilar\nstructures.  Stable normal appearance of the breast parenchyma.  No coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nhilar structures are unremarkable.  No pericardial effusion.  Unremarkable\nposterior mediastinum.  Moderate splenomegaly.  Several borderline sized lymph\nnodes in the upper abdomen (4, 61).  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Mild bilateral apical scarring.\nModerate respiratory motion.  No pleural thickening, no pleural effusions.  No\nsuspicious pulmonary nodules or masses.  No evidence of infectious lung\ndisease.  No diffuse lung disease.  The airways are patent.",
            "output": "Stable borderline sized bilateral axillary lymph nodes.  No hilar or\nmediastinal lymphadenopathy.  No infectious or neoplastic disease of the lung\nparenchyma.  Borderline sized upper abdominal lymph nodes are described in\ndetail in the dedicated abdominal CT report."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nBilateral hypodense thyroid nodules are stable in appearance.  Bilateral\naxillary lymph nodes are moderately decreased in size in the interval.  No\natherosclerotic calcifications in the head and neck arteries.  Right\nsubclavian vein is occluded causing contrast redistribution, since there is no\nmass or endovascular filling it is most likely due to sclerosis by previous\nvenous catheter.\n\nMEDIASTINUM AND HILA:\nMildly homogeneously enhanced soft tissue 69 x 28 mm mass in the thymic bed\n(05:19).  Esophagus is mildly patulous in its upper third most likely\nreflecting dysmotility disorder.  No mediastinal or hilar lymphadenopathy.\n\nHEART, PERICARDIUM AND VASCULATURE:\nHeart is normal in size and shape.  There is no pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  Aorta and pulmonary artery are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental level.  No bronchial wall\nthickening, mucous plugging or bronchiectasis.  No suspicious nodules or\nmasses.  Increased diffuse density in the posterior lower lungs is most likely\ndue to low lung volumes.  No pleural effusion.  Mild biapical\npleuroparenchymal thickening.\n\nCHEST CAGE:\nNo acute fractures.  Generalized diffuse osteopenia with height loss in the\nvertebral bodies T4, T6, T8 and T12.  No evidence of pathologic fracture or\ndestructive lesion.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Mildly enhanced soft tissue 69 x 28 mm mass in the thymic bed could be due to\nlymphoma recurrence or thymic hyperplasia, however, the lack of evidence of\nprevious thymic hyperplasia makes the latter somewhat less likely.\n\nDiffuse osteopenia with multiple vertebral body height loss.  No evidence of\npathologic fracture or destructive lesion.\n\nRECOMMENDATION(S):  MRI for better characterization of the prevascular\nsoft-tissue mass.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:23 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "No supraclavicular, infraclavicular or axillary lymphadenopathy.  The\npre-existing soft tissue mass in the thymic bed has minimally decreased in\nsize.  The most notable zones of decrease are located in the area ventral to\nthe pulmonary artery (4, 26).  However, the decrease in size is in millimetric\n___.  No hilar or mediastinal lymphadenopathy.  Normal appearance of\nthe large mediastinal vessels.  No incidental pulmonary embolism.  The\nposterior mediastinum is unremarkable.  Intra and retroperitoneal adenopathy\nand other abdominal findings are described in detail in the dedicated\nabdominal CT report.  No substantial progression of the multi segmental\nvertebral height reductions, status post vertebroplasty (8, 41).  Mild\nbilateral apical scarring.  The assessment of the lung parenchyma is limited\nby moderate respiratory motion artifacts.  No suspicious pulmonary nodules or\nmasses.  No pleural abnormalities.  The airways are patent.",
            "output": "Only minimal decrease of a soft tissue mass in the thymic bed, no\nlymphadenopathy.  No vascular abnormalities.  Stable height reduction of\nmultiple vertebral bodies."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.  Mild subpleural\nfibrosis involving the right upper lobe is likely due to prior radiation\ntherapy. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\nIncidental note is made of an 8 mm spiculated density in the right breast\nwhich appears to extend to the skin surface (3:80).",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Spiculated density in the right breast, with suspected postradiation\nsubpleural fibrotic changes in the right upper lobe, likely a scar. Please\ncorrelate with any history of breast cancer and treatment, as well as prior\nmammograms, and pursue mammography for further evaluation, if necessary.\n\nRECOMMENDATION(S):  Correlation with prior mammograms and clinical history is\nrecommended, and if needed, additional right mammograms can be obtained.\n\nNOTIFICATION:  The above findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ at 19:57 on ___, 5 min after\ndiscovery."
        },
        {
            "input": "Imaged thyroid is unremarkable.  The thoracic aorta is dilated along its\nascending segment measuring 4.7 cm in transverse dimension at the level of the\nmain pulmonary artery.  The descending thoracic aorta measures 3.8 cm in\ntransverse diameter.  There is no dissection.  Aortic arch branches are\ntortuous.  No significant atherosclerotic calcification is seen.  The main\npulmonary artery is normal in size.  There is no filling defect within the\npulmonary arterial tree to suggest the presence of a pulmonary embolism. \nThere is no adenopathy.  No pleural or pericardial effusion is seen.\n\nMild dependent basal atelectasis noted.  There is no worrisome nodule, mass,\nor consolidation.  A nodular opacity within the right upper lobe seen on\nseries 2, image 46 measures approximately 5 mm in maximal dimension.\n\nIn the imaged portion of the upper abdomen, cysts within the liver are\npartially visualized.  No additional findings of concern.\n\nBones:  No acute findings.  No worrisome lytic or blastic osseous lesion.",
            "output": "1. No PE or acute aortic process.  Dilated ascending thoracic aorta measuring\nup to 4.7 cm.\n2. 5 mm right upper lobe pulmonary nodule, requires ___ year followup CT to\nensure stability."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK:The visualized thyroid is unremarkable. No supraclavicular\nlymphadenopathy is identified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no free\nintraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is trace free\nfluid in the pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No focal acute abnormalities identified within the chest, abdomen, or\npelvis to correlate with patient's symptoms.\n2. No findings of pulmonary embolus or other vascular abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the thyroid gland\nis unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: A limited view of the upper abdomen is notable for trace\nperihepatic ascites, similar to prior CT abdomen pelvis.  There is also a\nmildly dilated loop of small bowel seen in the upper abdomen also not\nsignificantly changed compared to prior.  Small hiatal hernia is noted.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart appears mildly enlarged.  No pericardial\neffusion.\nPLEURA: There is trace right pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Mild right greater than left-sided basilar atelectasis.  Lungs\nare otherwise clear.  A 9 mm nodule is noted in the left lower lobe (302:120)\nlikely represents an intrapulmonary lymph node.\n2. AIRWAYS:  Airways are patent to subsegmental levels bilaterally.  Mild\nbronchial wall thickening is noted in the right lower lobe.\n3. VESSELS:  Left upper extremity PICC terminates at the cavoatrial junction. \nThoracic aorta and main pulmonary artery are of normal caliber.  No large\ncentral pulmonary embolism on this non tailored exam.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "1. 9 mm left lower lobe pulmonary nodule likely represents an intrapulmonary\nlymph node.\n2. Trace right pleural effusion and mild bibasilar atelectasis.\n3. Trace perihepatic ascites and mild dilation of a small-bowel loop similar\nto prior CT abdomen pelvis are noted in the partially imaged upper abdomen."
        },
        {
            "input": "The thoracic aorta is normal in caliber, without evidence of dissection,\naneurysm, or atherosclerotic disease.\n\nEvaluation for pulmonary embolism is limited by suboptimal timing of the\ncontrast bolus and respiratory motion.  No filling defects are seen through\nthe proximal segmental level.  The main pulmonary artery is normal in caliber.\nThere are no CT findings of right heart strain.\n\nHeart size is normal.  There is no pericardial effusion.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe a 3.3 x 2.2 cm hypodensity adjacent to the distal esophagus may represent\nloculated fluid or duplication cyst.  There is a small to moderate size hiatal\nhernia.\n\nVisualized base of the neck structures are unremarkable.  The thyroid gland\nappears unremarkable.\n\nInterlobular septal thickening in the bilateral lung apices suggest mild\nedema.  There is minimal dependent atelectasis.  There is no consolidation\nconcerning for infection.  There is a 5 mm left lower lobe nodule (series 5,\nimage 56).\n\nThe airways are patent to the subsegmental level.\n\nThere is a trace left pleural effusion.  There is no right pleural effusion.\n\nLimited images of the upper abdomen are unremarkable.\n\nThere is no suspicious osseous lesion or acute fracture.",
            "output": "1.  Limited evaluation for pulmonary embolism secondary to suboptimal timing\nof the contrast bolus and respiratory motion.  No central pulmonary embolism.\n2.  5 mm left lower lobe pulmonary nodule.  See below for recommendations.\n3.  Mild edema in the bilateral lung apices.  Trace left pleural effusion.\n4.  Small to moderate size hiatal hernia.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Acute pulmonary emboli are seen involving the segmental\nbranch to the superior segment of the right lower lobe and basilar segmental\nbranches of the left lower lobe (6:160), and their distal branches.  Main\npulmonary artery diameter is normal.  No CT evidence of right heart strain.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.\n\nThe heart size is normal.  Coronary artery and aortic annular calcifications\nare mild.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a small dependent left pleural effusion.  No\npneumothorax or right pleural effusion.\n\nLUNGS/AIRWAYS: Scattered areas of nonenhancing parenchymal opacification in\nthe left lower lobe (6:197) likely reflects infarction.  Mild bibasilar\natelectasis is noted.  No suspicious masses or nodules are seen.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Acute pulmonary emboli involving the segmental branch to the superior\nsegment of the right lower lobe and basilar segmental branches of the left\nlower lobe.  No CT evidence of right heart strain.\n2. Scattered areas of nonenhancing parenchymal opacification in the left lower\nlobe most likely represent pulmonary infarction."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the axillary regions (5,\n15) Are normal in size.  Small thymic remnant (5, 16).  No abnormalities at\nthe level of the large mediastinal vessels.  No coronary or valvular\ncalcifications, no pericardial effusion.  No cardiomegaly.  The posterior\nmediastinum is unremarkable.  No abnormalities are noted in the upper abdomen.\nNo relevant abnormalities at the level of the vertebral bodies, the ribs, and\nthe sternum.\n2 mm left apical ground-glass nodule (7, 44).\n2 mm left apical calcified granuloma (7, 61).\n3 mm right lower lobe perifissural nodule (7, 134).\n2 mm subpleural solid left lower lobe nodule (7, 193).\nMinimal non characteristic scarring at the bases of the left lower lobe (7,\n176) and at the medial aspect of the middle lobe that persist on the prone\nseries.  No pleural thickening, no pleural effusions.  No evidence of fibrotic\nlung disease.  No diffuse lung disease.  The large airways are patent.  On the\nexpiratory series there is no evidence of increased collapsibility of the\ntrachea all the large airways.  The extent of air trapping is within the\nnormal physiological range.",
            "output": "Several non suspicious pulmonary nodules.  No evidence of large or small\nairways disease.  No fibrotic or diffuse lung disease.  No adenopathy.  No\npleural abnormalities."
        },
        {
            "input": "CHEST CTA:\nThe examination is partially limited by respiratory motion. The thoracic aorta\nis normal in caliber without dissection or intramural hematoma. The aortic\narch vessels are normal appearing. The pulmonary artery enhances without\nfilling defect centrally. There is no evidence of filling defects in the lobar\nor segmental pulmonary arteries.\n\nCHEST:\nThere are numerous enlarged mediastinal, prevascular, paratracheal, and hilar\nlymph nodes in keeping with sarcoidosis.  Lymphoid tissue has increased over\ntime since the prior CTA, particularly in the left perihilar region.  This\nresults in attenuation of the ___ order airways of the right upper lobe, which\nare normal in caliber peripherally.  The esophagus follows a normal course and\nis normal in caliber. Heart is normal in size with no pericardial effusion.\nLimited views of the upper abdomen demonstrate hypodensities in the liver\nwhich are incompletely characterized.\n\nThe lungs demonstrate heterogeneous micronodules in a bronchovascular\ndistribution in the right upper and lower lobe. Scattered micronodules are new\nin the lingula and left lower lobe. Irregular solid nodule at the right lung\napex (2:2) measures 14 x 12 mm, appearing slightly different in morphology\nfrom ___. There is no pleural effusion or pneumothorax.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nWorsening sarcoid\nLiver hypodensities, not able to characterize,",
            "output": "1. Limited examination secondary to respiratory motion, however no evidence of\ncentral, lobar, or segmental pulmonary embolism.\n2. Diffuse micronodules in a peribronchovascular distribution, worsened since\nthe prior CTA of the chest, compatible with worsening of known sarcoidosis.\n3. Significant increase in perihilar lymphoid tissue, with compression on the\n___ order airways of the right upper lobe."
        },
        {
            "input": "As compared to the recent examination from ___, the morphology and\nsize of the mediastinal lymph nodes is overall unchanged.  At the level of the\nhilar nodes, the size might have minimally decreased.  In particular the\nparenchymal consolidation at the lateral and lower aspect of the right hilus\n(4, 24) has decreased in extent.  The surrounding interstitial micronodules in\nthe lung parenchyma are not changed.  There is a minimal decrease in\nmicronodules in the right upper lobe.\nNo pleural effusions.  No evidence of fibrosis.  No pleural irregularities or\nbronchial changes.",
            "output": "Decrease in micronodules in the right upper lobe.  Decrease in extent of a\nright consolidation.  Minimal decrease in size of the pre-existing hilar lymph\nnodes.  The mediastinal lymph nodes are unchanged in size."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nA 1.1 cm subcarinal node is not substantially changed from prior, likely\nreflective of known sarcoidosis.  No mediastinal mass.  Hilar lymph nodes are\nconspicuous, but not abnormally enlarged as before.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Peribronchovascular linear parenchymal opacity and micronodules,\nmost prominent in the right lower lobe, have decreased since ___.  This\nlikely reflects improvement of underlying sarcoidosis.  Of note, lung apices\nare excluded from view.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? No acute fracture.\n\nABDOMEN: Small hiatal hernia.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.  No acute intrathoracic\nprocess.\n2. Peribronchovascular linear parenchymal opacity and micronodules, most\nprominent in the right lower lobe, have decreased since ___.  Together\nwith decreased hilar lymphadenopathy, the findings reflect interval\nimprovement of underlying sarcoidosis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Mild\natherosclerotic disease of the aortic arch and descending thoracic aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main pulmonary artery is enlarged\nmeasuring 3.5 cm, with enlargement of the right and left main pulmonary\narteries compatible with pulmonary arterial hypertension. There is right\natrial and right ventricular enlargement.  Note is made of a mitral valve\nreplacement.  The heart is enlarged.  No pericardial effusion.\n\nThere is no supraclavicular, or axillary lymphadenopathy.  Few calcified\nmediastinal lymph nodes likely related to old granulomatous disease.  There\nare few slightly prominent mediastinal lymph nodes the largest in the\nprevascular space measuring 8 mm in short axis diameter, however not\npathological by size criteria.  No hilar lymphadenopathy..  Few small\nhypodense nodules in the thyroid gland.\n\n There is no pleural effusion.\n\nThere are patchy ground-glass opacities, nonspecific in appearance.  There is\nmild smooth interlobular septal thickening suggestive of mild pulmonary edema.\nNo focal consolidation.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrates a 12 mm nodule in the left\nadrenal gland stable in size when compared to prior CT from ___ where\nit measured -1 Hounsfield units on the prior compatible with an adrenal\nadenoma.  Partially visualized hypodense lesion in the upper pole of the right\nkidney measuring 2.3 cm, stable from prior most likely a renal cyst.  There is\na small hiatal hernia..\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is depression of the articular surface of the right humeral head with\nremodeling likely related to old fracture or avascular necrosis.  There is\nsevere degenerative changes at the glenohumeral joints bilaterally, not\nsignificantly change from prior.  Sclerotic foci within the left eleventh and\ntenth ribs stable from prior.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Mild pulmonary edema.  Patchy areas of ground glass change are noted\nthroughout both lungs, likely reflecting alveolar pulmonary edema but other\ndifferential considerations would include small airways infection or\ninflammation.\n3.  Pulmonary arterial enlargement and cardiomegaly compatible with pulmonary\narterial hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No supraclavicular lymphadenopathy seen.  No axillary\nlymphadenopathy.  There is extensive subcutaneous emphysema which extends into\nthe base of the neck and is worst in the pectoral region bilaterally as well\nas along the right chest wall.  Subcutaneous emphysema also extends into the\nright greater than left-sided paraspinal musculature.  Right anterior basal\napproach chest tube passes near the right lung apex and terminates near the\nright lung base posteriorly.\n\nUPPER ABDOMEN: Few colonic diverticula are noted.\n\nMEDIASTINUM: There is extensive pneumomediastinum.  No new mediastinal\nlymphadenopathy is seen.\n\nHILA: No hilar lymphadenopathy within limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart is of normal size.  There are mild coronary\nartery calcifications.  No pericardial effusion.\nPLEURA: There is a small right-sided pneumothorax.  There are small likely\nextrapleural locules of gas along the posterior right upper lobe.  There is\ntrace right pleural fluid.\nLUNG:\n\n1. PARENCHYMA:  There is bibasilar atelectasis, significant in the left lower\nlobe which is almost collapsed.  Lungs are otherwise clear.  Few nodules are\nunchanged compared to the prior exam e.g. (302:72, 123).\n2. AIRWAYS:  Airways appear patent to subsegmental levels bilaterally. \nEndotracheal tube terminates approximately 3.5 cm above the level of the\ncarina.  Significant diffuse thickening of the ltrachea and both main bronchi,\nprogressed compared to preoperative study.  Although some narrowing is an\nexpected function of airway augmentation, the diameter of the tracheal airway\nbelow the level of the an endotracheal tube, measures as little as 2 mm in\ndiameter (302:58).  No source of presumptive air leak is identified.  Mild\nbronchiectasis is noted in the right lower lobe.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are of normal caliber.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "1. Small right pneumothorax.  Extensive subcutaneous air and extensive\npneumomediastinum.  No source of air leak identified.  Right chest tube in\nplace.\n2. Significant narrowing of the lower trachea below level of endotracheal tube\ndue to postoperative increase in diffuse thickening of the trachea and both\nbronchi.\n3. Bibasilar atelectasis worse on the left with almost complete collapse of\nthe left lower lobe.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:01 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "THORACIC INLET: Patient is status post tracheal resection and reconstruction,\ncomplicated by extensive subcutaneous emphysema and re-intubation.\n\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Patient is status post tracheal reconstruction.  Previously\nvisualized extensive subcutaneous emphysema has resolved.  An ET tube is in\nplace extending up to 1 cm from the carina.  There is diffuse circumferential\nwall thickening involving the airways extending from the false vocal cords to\nthe carina.  The wall thickness measures measures approximately 9 mm.  There\nare multiple is enlarged mediastinal lymph nodes which are most likely\nreactive.  The esophagus is also diffusely thickened.  An NG tube is in place.\nSmall pockets of air are tract around the ETT and the tracheal wall.\n\nThe wall thickening involving the right and left mainstem bronchi and the\nbronchus intermedius is unchanged since the prior study.\n\nThere is moderate cardiomegaly.  There is moderate coronary artery\ncalcification.  There is no pericardial effusion.\n\nPLEURA: There are small bilateral pleural effusions right greater than left. \nThe right is partially loculated.\n\nLUNG: Consolidative opacities in both lower lobes right greater than left most\nlikely represent atelectasis.  There is subsegmental atelectasis in the right\nmiddle lobe and lingula.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows hyperenhancing\nlesion in the right lobe of liver which most likely represents a meningioma. \nNo adrenal masses are seen.",
            "output": "Status post tracheal reconstruction surgery with diffuse circum for an wall\nthickening involving the entire trachea extending from the vocal cords to the\ncarina, concerning for tracheal inflammation superimposed infection and\nnecrosis cannot be excluded.\n\nExtensive subcutaneous emphysema has resolved.\n\nWall thickening involving the esophagus could be related to esophagitis.\n\nSmall mediastinal bilateral hilar lymph nodes are most likely reactive.\n\nBilateral pleural effusions right greater than left.  The right is partially\nloculated.\n\nConsolidative opacities in both lower lobes most likely represent atelectasis.\n\nHyperenhancing lesion in the right lobe of liver could represent a hemangioma."
        },
        {
            "input": "BASE OF NECK: The thyroid is unremarkable.  No supraclavicular lymphadenopathy\nis identified.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Previously visualized mediastinal lymph nodes\nhave decreased in size from prior measuring up to 6 mm (302:58), previously 10\nmm.  No axillary or hilar lymphadenopathy is present.  No mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Interval improvement of previously demonstrated atelectasis is\ndemonstrated with only mild left lower lobe atelectasis remaining.  No focal\nconsolidations or pulmonary masses are identified.\n\nPatient status post tracheobronchoplasty with interval removal of previously\ndemonstrated ETT.  Persistent though improved circumferential tracheal wall\nthickening is seen throughout, measuring up to 6 mm (302:85), previously 8 mm,\nwhich correlates with focal narrowing in the mid trachea measuring up to 9 mm\nand likely also correlates to findings of pseudo membrane on same-day\nbronchoscopy.  Distance of this focal narrowing from the vocal cord measures\napproximately 10 cm.  No paratracheal collections or fistulous formation\nidentified.\n\nIn addition, the previously visualized narrowing in the superior to mid\ntracheal segments which contained the endotracheal tube has intervally\nimproved where as the lower segments just superior to the carina appears to\nhave minimally narrowed from prior.  Diffuse, lower lobe predominant small\nairway thickening is visualized bilaterally with focal bronchiectasis in the\nbilateral lower lobes which may be post infectious in etiology.  The airways\nare otherwise patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for\nre-demonstrated hyperenhancing lesion in the, likely representing hemangioma,\nunchanged from prior.\n\nBONES: Patient is status post right thoracotomy with expected postoperative\nchanges demonstrated through the right lateral chest wall.  Pseudo joint\nformation is visualized between the first and second ribs.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Status post tracheobronchoplasty with intervally improved, though\npersistent, diffuse circumferential tracheal thickening with associated\nnarrowing in the mid trachea approximately 10 cm from the vocal cords which\nlikely corresponds to area of pseudo membrane formation demonstrated on\nsame-day bronchoscopy.\n2. Bilateral lower lobe bronchiectasis is likely postinfectious in etiology,\nwith improved small residual left lower lobe atelectasis\n\nRECOMMENDATION(S):  CT trachea is recommended, as clinically indicated, when\npatient's clinical status allows.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:00 pm."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced, non-gated scan.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  5 mm right upper lobe nodule (3; 19).  In addition, there are\nfew scattered pulmonary micro nodules (2:35).\n\nBASE OF NECK: There is a 1.5 cm calcified nodule in the right lobe of the\nthyroid (2:9).\n\nABDOMEN: Included portions of the upper abdomen are unremarkable.\n\nBONES: There is a displaced fracture through the inferior angle of the left\nscapula (3:50).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Minimally displaced fracture through the inferior angle of the left\nscapula.\n2. No other evidence of traumatic injury to the chest within limitation of a\nun-enhanced, non-gated exam.\n3. 1.5 cm calcified nodule in the right lobe of the thyroid, follow-up with\ndedicated ultrasound is recommended as outlined below.\n4. 5 mm pulmonary nodule.  Recommendation per below.\n\nRECOMMENDATION(S):  Thyroid nodule.  Follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\n-----\n\nFor incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  Recommendation for follow-up thyroid ultrasound was entered\ninto the ED QA nursing system at 10:06 a.m. on ___ by ___\n___ MD."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is heterogeneous with\nlikely 2.2 cm lesion in the left lobe of the thyroid (06:49) and dense\ncalcification.  1.5 cm nodule in the right lobe of thyroid.  For further\ncharacterization by dedicated ultrasound.\n\nMultiple millimetric lymph nodes in the supraclavicular are not pathologically\nenlarged.  There is no pathologic enlargement of lymph nodes in the axilla.\n\nCHEST CAGE: Multilevel demineralization the of the vertebra.  Vertebral body\nhemangioma in T8.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.\n\nUPPER ABDOMEN: Retrocrural soft tissue, 6:260 ___ in the upper\nretroperitoneum does not extend above the level of the diaphragm.  Please see\nseparately dictated CT of the abdomen and pelvis for complete description of\nsubdiaphragmatic findings.\n\nMEDIASTINUM: 1.2 cm mid posterior paraesophageal lymph node (6:129) is\nsuspicious for malignancy.  There is no pathologic enlargement of lymph nodes\nelsewhere in the chest.\n\nHEART and PERICARDIUM: Heart is normal in size.  Pericardium is physiologic. \nThoracic aorta and main pulmonary artery are normal in diameter.  Specks of\ncalcifications in the coronaries.  No evidence of central filling defects in\nthe suboptimally evaluated pulmonary vasculature.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Tracheobronchial tree is patent to the subsegmental level.  Mild but\ndiffuse bronchial wall thickening and irregularity is suggestive of chronic\nairway inflammation.  Subtle architectural cylindrical bronchiectasis in lower\nlobes with no signs of active infection such as retained secretions or\nbranching bronchial opacities.\nSubsegmental platelike atelectasis in the right middle lobe and lung bases. \nNo measurable pulmonary nodules.",
            "output": "-Posterior paraesophageal mediastinal lymph node is the only pathologically\nenlarged lymph node in the chest.  No other evidence of intrathoracic\nmalignancy.\n-Retrocrural adenopathy does not extend above the diaphragm.\n-Thyroid abnormalities up to 2.2 cm should be evaluated by ultrasound.\n\nRECOMMENDATION(S):  Ultrasound of the thyroid."
        },
        {
            "input": "HEART AND VASCULATURE: Slightly motion limited exam particularly at the lung\nbases.  Pulmonary vasculature is well opacified to the segmental level without\nfilling defect to indicate a pulmonary embolus. The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma. The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass.  A posterior paraesophageal\nlymph node that was previously enlarged now measures 5 mm, within normal\nlimits (04:50).  Right chest wall port device has leads terminating in the\nright atrium.  PLEURAL SPACES: Small left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Mild compressive atelectasis at the left base.  Lungs are\notherwise clear without masses or areas of parenchymal opacification. The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Thyroid gland is heterogeneous and enlarged on the left side\nhypoenhancing nodule measures up to 1.5 cm, not significant changed from\nprior.  There is also calcifications in the left thyroid lobe.\n\nABDOMEN: Three hypodense lesions in the liver measuring up to 1.9 cm (4:112,\n4:105, 4:101) are stable from prior exams and not FDG avid on recent PET\nimaging.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality. No e vidence\nof septic emboli.\n2. Previously seen enlarged posterior paraesophageal lymph node is now within\nnormal limits.\n3. Small left pleural effusion."
        },
        {
            "input": "Left thyroid enlargement and calcification is unchanged.  Aorta and pulmonary\narteries are normal in diameter.  No pericardial pleural effusion is seen.  No\npathologically enlarged mediastinal, hilar or axillary lymphadenopathy is\npresent.  No pericardial pleural effusion is seen.  Heart size is normal.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  The ___\nopacities in the right lower lobe, series 6, image 197 are concerning for\ninfectious process or aspiration as well as bibasal atelectasis most likely\ndue to endobronchial secretions, right more than left.  No new nodules\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nCentral venous line tip terminates in the right atrium.",
            "output": "Right lower lobe infectious process, most likely atypical pneumonia\n\nNo evidence of mediastinal lymphadenopathy."
        },
        {
            "input": "BASE OF NECK: There is re-demonstrated multinodular thyroid gland with a\ndominant 1.7 cm hypodense thyroid nodule with associated calcification,\nunchanged from prior.  No supraclavicular lymphadenopathy is identified.\n\nHEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Dense\ncoronary artery calcifications are visualized otherwise the heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  Right pectoral infusion catheter is\nre-demonstrated with the catheter tip terminating in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse ground-glass opacities are visualized there are likely\nsecondary to poor inspiratory effort which limits assessment though no focal\npulmonary nodularity or consolidation identified.  The airways are patent to\nthe level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Diffuse ground-glass opacities, likely secondary to poor inspiratory effort\nwhich limits assessment though no focal pulmonary nodularity or consolidations\nidentified.  If clinical concern for pneumocystis pneumonia persists recommend\nanalysis via lab work."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Again demonstrated is very\nheterogeneous thyroid.\n No lymphadenopathies in the thoracic inlet.\nPort-A-Cath in right anterior chest wall, ends in right atrium.\nNo atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerosis in thoracic aorta or coronary arteries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Wedge middle lobe and linear bibasilar atelectasis.\n2. AIRWAYS:  Mild bronchial wall thickening and bronchiectasis, notably in the\nlower lobes.\n3. VESSELS:  Pulmonary artery is not enlarged.\nCHEST CAGE: No lytic lesions.  Small sclerotic lesion in the posterior\nsternum, unchanged, probably benign.",
            "output": "No signs of disease recurrence are seen."
        },
        {
            "input": "Stable right pectoral Port-A-Cath.  Stable multinodular goiter (2, 7).  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum or at the level of the hilar structures.  Mild\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  Stable hypodense liver lesion (2,\n43) and other abdominal findings are reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Status post vertebroplasty (602, 45).  Mild\nbilateral apical scarring.  No pleural thickening, no pleural effusions.  Mild\nscarring at the bases of the middle lobe.  Suspicious pulmonary nodules or\nmasses.  No diffuse lung disease.  The airways are patent.",
            "output": "No lymphadenopathy.  No pleural abnormalities.  No suspicious pulmonary\nnodules or masses."
        },
        {
            "input": "CTA CHEST:\n\nPulmonary emboli in the segmental right upper lobe pulmonary arteries appear\nnew from the prior study (03:103).  Changes related to chronic pulmonary\nemboli are stable from the prior study (3:91, 126).  Filling defects seen\nwithin the left lower lobe segmental pulmonary arteries appear unchanged from\nthe prior study (3:81).  Filling defects within the subsegmental pulmonary\narteries on the left are also unchanged from the prior study (3:155, 72).  The\nright ventricle is larger than the left ventricle with mild leftward bowing of\nthe interventricular septum (3:156).  These changes were present on the prior\nstudy but appear more pronounced suggesting acute on chronic right heart\nstrain.  No focal opacity is seen to suggest acute pulmonary infarction.\n\nDiffuse nodular ground-glass opacities are seen bilaterally, most confluent in\nthe left lower lobe, concerning for multifocal infection, superimposed\naspiration or minor edema not excluded.\n\nThe thoracic and abdominal aorta are normal in caliber and without evidence of\naneurysm or dissection. The celiac axis, SMA, bilateral renal arteries, and\n___ are grossly patent. The thyroid is normal. Axillary, supraclavicular,\nmediastinal, and hilar lymph nodes are not pathologically enlarged.  The\nmediastinum is normal. The pericardium is intact without effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in appearance.  An 8 mm hypodensity in segment VI is\ntoo small to fully characterize but likely represents a simple cyst or biliary\nhamartoma (2b:124).  No suspicious liver lesion is identified.  The portal and\nhepatic veins are patent.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains stones and is\notherwise normal.  The pancreas, spleen, and bilateral adrenal glands are\nnormal. The kidneys enhance symmetrically and are without suspicious solid\nmass.  Two hypodensities within the left kidney are too small fully\ncharacterize but likely represent simple cysts.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening. The appendix is\nnormal.  Colonic diverticulosis is present without evidence of diverticulitis.\nThere is no retroperitoneal lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1. Acute pulmonary emboli in the right upper lobe.  Dilated right heart with\nbowing of the interventricular septum raises concern for right heart strain,\nwhich can be further evaluated for on echocardiogram.\n2. Diffuse ground-glass opacities bilaterally are concerning for multi-focal\npneumonia, superimposed aspiration not excluded..  Pulmonary hemorrhage is\npossible in the proper clinical setting.\n3. Chronic changes related to prior pulmonary emboli are stable.\n4. No acute intra-abdominal process."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there is no soft\ntissue abnormality in the chest wall suspicious for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels, but is present in at least the left anterior descending coronary\nartery.  Pulmonary arteries are enlarged, main 41 mm, right 32 mm, unchanged\nsince ___.  Aorta is normal size.  There is no pleural or pericardial\nabnormality.\n\n\nCentral lymph nodes are not pathologically enlarged in the mediastinal, hilar,\ninternal mammary, diaphragmatic or retrocrural stations.\n\nPrevious widespread multifocal broncho centric ground-glass and consolidative\nabnormalities have resolved, presumably acute pneumonia.  Minimal bronchiolar\nnodulation is present in the left apex, often found in smokers or patients\nwith severe allergies.  Mild mosaicism in the lungs may be a function of\npulmonary arterial hypertension.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nProbable pulmonary arterial hypertension, may explain mosaic pulmonary\nprofusion.\n\nMild bronchiolar nodulation, left apex, often a sign of cigarette smoking or\nsevere allergy."
        },
        {
            "input": "HEART AND VASCULATURE: There are multiple bilateral segmental pulmonary emboli\nin the left upper lobe, right middle, and right lower lobe without evidence of\npulmonary infarct or right heart strain.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The main\npulmonary is enlarged measuring 39 mm, not significantly changed from prior\nstudy, suggestive of underlying pulmonary artery hypertension.  The heart, in\npericardium are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Multiple bilateral segmental and subsegmental pulmonary emboli in the left\nupper and left lower lobes as well as the right middle and right lower lobes\nlower lobe without evidence right heart strain.\n2. Stable enlarged main pulmonary artery suggestive of underlying pulmonary\nartery hypertension.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 1:22 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "HEART AND VASCULATURE: Compared to ___, there is decreased clot\nburden in the pulmonary arterial vasculature.  However, scattered areas of\nchronic thrombus remain in bilateral segmental and subsegmental arteries to\nthe right lung.  Main pulmonary artery diameter remains dilated at 3.8 cm,\npreviously 3.9 cm.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Heart size is normal.  There is no evidence of right\nheart strain.  LAD calcifications are severe.  There is no pericardial\neffusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Scattered areas of ground-glass opacification, predominantly in\nthe left upper lobe (3:105) are nonspecific.  No focal consolidations or large\nsuspicious masses are seen.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  There is diffuse mild bronchial wall\nthickening.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for gallstones.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Compared to ___, overall decreased clot burden in the pulmonary\narterial vasculature with some residual chronic clot in the segmental and\nsubsegmental branches to the right lung.\n2. Scattered ground-glass opacities in the left upper lobe in combination with\nmild bronchial wall thickening likely represents bronchiolitis."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nmild cardiomegaly.  The great vessels are within normal limits.  No\npericardial effusion is seen.  A left chest wall pacemaker with dual pacing\nleads terminating in the right atrium and right ventricle is noted.  There is\nno central filling defect within the main pulmonary artery or its principal\nbranches.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes measure up to 1.1 cm in\nthe right paratracheal station.  No substantial hilar or axillary\nlymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  No empyema.\n\nLUNGS/AIRWAYS: There are dense consolidations at the bilateral lower lobes,\nwith air bronchograms concerning for multifocal pneumonia.  There is\nadditional central peribronchovascular opacification and ground-glass seen in\nthe inferior left upper lobe and predominately within the right middle lobe.\n\nBASE OF NECK: Please see dedicated neck CT performed the same day.\n\nABDOMEN: No acute intra-abdominal findings within the visualized upper\nabdomen.  Percutaneous gastrostomy catheter is appropriately position within\nthe stomach.  A nonobstructing calculus is seen in the upper pole of the left\nkidney measuring 4 mm.  A left renal cyst exophytic from the anterior\ninterpolar aspect measures up to 4.8 cm.  An IVC stent is demonstrated in\nsitu.\n\nBONES: No suspicious osseous abnormality is seen.? Multilevel degenerative\nchanges are present.  No acute fractures.",
            "output": "1. Findings concerning for severe multifocal pneumonia involving primarily the\nlower lobes bilaterally, right middle lobe and inferior left upper lobe.\n2. No pleural effusion or empyema.\n3. Mildly enlarged mediastinal lymph nodes are likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: Patient is status post left tonsillar resection\nand bilateral neck dissection with submental flap.  No enlarged\nsupraclavicular lymph nodes are noted.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Subpleural and basilar reticulations are seen\npredominantly along the lower lobes which may represent a combination of\natelectasis and interstitial lung disease.  Presence of interstitial disease\nseems unlikely although not well assessed.  Dilated peripheral airways\nsuggests traction bronchiectasis.  Particularly in the right mid to upper\nlung, additional non dependent subpleural opacities with faint ground-glass\nconfirm the probability of interstitial disease, probably with a nonspecific\ninterstitial pneumonitis pattern.  This pattern is mild-to-moderate in\nseverity perhaps but not well characterized.  Prone imaging may be helpful if\nneeded clinically.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  A 1.0 cm lucent lesion with associated sclerosis is\nunchanged since ___.  Multilevel degenerative changes are moderate. \nSubacute or older fracture has appeared since ___ which involves the left\nlateral ninth rib without displacement.  Bones appear demineralized.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen. \nSmall to medium-sized hiatal hernia.  Allowing for this, the partially\nvisualized upper abdomen demonstrates a gastrostomy tube.  A nonobstructing\nstone is seen in the left kidney.  A 5.8 cm exophytic cyst is seen in the left\nkidney.  An IVC filter is partially imaged.",
            "output": "1. Nondisplaced left lateral ninth rib fracture.\n2. Hiatal hernia.\n3. Enlarged heart.\n4. Suspected interstitial disease characterized by peripheral reticulation at\nthe lung bases with suspected traction bronchiectasis, mild-to-moderate in\nseverity but not well characterized.  This may be evaluated better with prone\nimaging if needed clinically.\n\n\nNOTIFICATION:  Findings in the final report discussed with Dr. ___ at\n12:15 a.m. on ___ by telephone."
        },
        {
            "input": "Imaged base of neck including the thyroid appears normal.  Several mildly\nprominent mediastinal lymph nodes are again noted, likely reactive.  For\nexample a pretracheal lymph node on series 3, image 22 measures 7 mm in short\naxis, similar to prior.  A superior mediastinal lymph node seen on series 3,\nimage 13 abutting the esophagus measures 9 mm in short axis.  A lymph node at\nthe right base of neck at the level of the thyroid is seen on series 3, image\n9 measuring 9 mm in short axis.  There is a patulous, dilated appearance of\nthe esophagus which appears similar to the prior which contains debris\nthroughout.  This appearance is not significantly changed from prior although\nthe amount of retained debris is increased.  Thoracic aorta is normal in\ncourse and caliber without significant atherosclerotic calcification.  The\nheart is normal in size and shape with trace pericardial effusion versus\nthickening.  The main pulmonary artery is normal in size measuring 2.5 cm in\ndiameter.  The airway is centrally patent.  There is no pleural effusion or\npneumothorax.\n\nFibrosis again noted to be basal predominant, left greater than right, with\nmild progression compared with the ___ exam.  Mucous plugging in the right\nmiddle lobe noted on series 5 image 208 simulating a pulmonary nodule.  A\nsmall focus of scarring is noted in the right upper lobe abutting the fissure\non series 5, image 161.\n\nImaged upper abdomen is unremarkable.  The left kidney is not located in the\nleft renal fossa as patient is known to have a left pelvic kidney.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Mild progression of interstitial fibrosis with basal predominant pattern,\nleft greater than right.  Minimally prominent mediastinal lymph nodes are\nlikely reactive.\n2. Patulous, dilated appearance of the esophagus containing debris, likely\nreflecting known scleroderma."
        },
        {
            "input": "CHEST: The thyroid gland is unremarkable there no enlarged supraclavicular,\naxillary mediastinal or hilar lymph nodes. The heart and pericardium are\nunremarkable and there is no pericardial effusion. There is no focal\nconsolidation, pleural effusion or pneumothorax. There are secretions within\nthe trachea and within the right mainstem bronchus. Bibasilar atelectasis is\nnoted. No foreign bodies identified.\n\nABDOMEN:The non contrast appearance of the liver is unremarkable.   Patient is\nstatus post cholecystectomy. The pancreas and adrenal glands unremarkable. \nThe spleen is enlarged measuring 15.1 cm.  The kidneys are unremarkable\nwithout evidence of stones or hydronephrosis.  The stomach, small an\nintra-abdominal large bowel are unremarkable.  There is no free fluid, free\nair lymphadenopathy within the abdomen.  The aorta is of normal caliber\nwithout evidence of aneurysm or significant atherosclerotic disease. No\nforeign bodies identified.\n\nPELVIS: The bladder, rectum, sigmoid colon are unremarkable.  The reproductive\norgans are unremarkable. There is no free fluid, free air lymphadenopathy in\nthe pelvis.\n\nOSSEOUS STRUCTURES: There is no acute fracture concerning lesions.",
            "output": "1. No evidence of foreign body. No acute process.\n2. Splenomegaly."
        },
        {
            "input": "Status post thyroidectomy (2, 6).  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinal and\nhilar compartments.  No substantial coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  No hiatal hernia.  Upper abdominal findings are reported in\ndetail in the dedicated abdominal CT report from ___.  No osteolytic\nlesions at the level of the ribs, the sternum, and the vertebral bodies.  Mild\ndegenerative vertebral disease.  No vertebral compression fractures.  2 mm\nright upper lobe subpleural granuloma (4, 44).  No diffuse lung disease.  The\nairways are patent.  No pleural thickening, no pleural effusions.  No\nsuspicious lung nodules or masses.",
            "output": "2 mm right upper lobe granuloma, non suspicious in appearance.  No suspicious\nlung nodules or masses.  No pleural abnormalities.  No lymphadenopathy."
        },
        {
            "input": "Surgical clips are seen within the expected location of the thyroid consistent\nwith prior total thyroidectomy.  The esophagus is within normal limits.  The\naorta demonstrates normal caliber throughout the chest.  Major aortic arch\nbranch vessels are widely patent and unremarkable.  The pulmonary artery is\nnormal in caliber.  The heart and pericardium are within normal limits.  There\nis no pericardial effusion.  There is no mediastinal, discernible hilar,\naxillary, or visible supraclavicular lymphadenopathy.\n\nMajor airways are patent to subsegmental levels bilaterally.  There is a 2 mm\nnodule in the right upper lobe (series 5, image 122), unchanged.  A 2-3 mm\nrounded density in the right upper lobe, not seen on prior from ___, is\nfavored to represent a small focus of small airway mucous plugging rather than\na genuine solid pulmonary nodule (series 5, image 125).  Otherwise, lungs are\nclear.  There is no pleural effusion or pneumothorax.\n\n There is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality.  The imaged thoracic vertebral bodies are normally aligned. \nThere is mild thoracic spine degenerative change.  Vertebral body heights are\npreserved.  No concerning focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. 2 mm nodule, right upper lobe, stable at least four months.  No suspicious\nlung nodules or masses.\n2. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis."
        },
        {
            "input": "Status post thyroid surgery.  No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  Borderline sized left and right axillary lymph nodes are\nstable (6, 30).  No enlarged lymph nodes in the mediastinum.  No abnormalities\nat the level of the large mediastinal vessels.  No incidental pulmonary\nembolism.  Stable morphology of the mildly enlarged heart.  New mild right and\nminimal left pleural effusion.  Stable appearance of the posterior\nmediastinum.  Minimal site as and other abdominal findings are reported in\ndetail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Moderate respiratory\nmotion.  Stable small right upper lobe nodule (7, 53).  Areas of moderate\ndependent parenchymal atelectasis.  No evidence of suspicious pulmonary\nnodules or masses.  No evidence of pneumonia.  The airways are patent.",
            "output": "New mild right and minimal left pleural effusion with adjacent areas of\natelectasis.  No suspicious lung nodules or masses.  No incidental pulmonary\nembolism."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Evidence of prior thyroidectomy. \nNo supraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  No aneurysmal dilatation of the ascending\naorta.  Mild atherosclerotic changes of the aortic arch.\nPLEURA: No pleural effusion\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  No diffuse lung disease.\n2. AIRWAYS:  The airways are patent to the subsegmental level. Minimal\nendobronchial secretions (series 5, image 85, 89 and 125). No bronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: No lytic/destructive bony lesions mild spondylotic changes of the\nthoracic spine.",
            "output": "No suspicious pulmonary nodules or masses or mediastinal adenopathy to suggest\nintrathoracic metastatic disease.\nThe previously noted pleural effusions have resolved.\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "The thyroid is surgically absent.  Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification.  The lungs are clear.  There is no pleural or pericardial\neffusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The patient is status post\nthyroidectomy with multiple surgical clips in the thyroid bed.  There is no\nsupraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to dedicated report for CT of the abdomen/pelvis\nfor evaluation of subdiaphragmatic structures.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mass.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is no pulmonary nodule or mass.  Note is made of a 4 mm\nfocus of subpleural scarring in the right apex (series 5, image 61), unchanged\ncompared to multiple prior chest CTs dating back to ___.  A nonspecific\nmildly thick walled pulmonary cyst in the left upper lobe (series 5, image\n150) also remains unchanged.  There is no airspace consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  There are minimal atherosclerotic calcifications of the aortic\narch.  There is no thoracic aortic aneurysm.  The main pulmonary artery is\nnormal in caliber.\nCHEST CAGE: There is no acute fracture or suspicious osseous lesion in the\nchest cage.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "CHEST PERIMETER: Patient has had thyroidectomy.  ___ be a small residual of\nleft thyroid tissue, 04:11.  There are no nodules.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  There are no soft\ntissues in the imaged chest wall concerning for malignancy.  Findings below\nthe diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck or coronary arteries.  Aorta and pulmonary\narteries and cardiac chambers are normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: None pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Solitary 7 mm wide thin walled ring shadow in the\nleft upper lobe, 04:48, is unchanged ___, probably residual of prior\ninfection.  No other pulmonary abnormalities of consequence.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of active intrathoracic malignancy.\n\nSubcentimeter cavity, left upper lobe, stable since at least ___ is\nprobably residual of previous infection, with no evidence of activity."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcifications of the aortic arch.\nThe thoracic aorta is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits based on an unenhanced scan. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple punctate nodules within the lungs bilaterally, some of\nwhich are calcified, all of which are unchanged compared to the CT dated ___ (series 4, image 72, 97, 107, 166).  Unchanged small thin-walled\ncyst within the left upper lobe (series 4, image 112).  No new or growing\npulmonary nodules.  No focal consolidations.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: The patient is status post thyroidectomy.  There is a small\namount of residual thyroid tissue bilaterally (series 4, image 27), unchanged\ncompared to prior.\n\nBONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is\nno acute fracture.  Note is made of bilateral gynecomastia.",
            "output": "1. No evidence of metastatic disease within the chest.  Multiple punctate\nnodules within the lungs bilaterally, unchanged compared to ___. \nNo lymphadenopathy.\n2. Please refer to the abdominal CT with the same date for evaluation\nintra-abdominal structures."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  A right Port-A-Cath terminates in the\nmid SVC.  Mild atherosclerotic calcifications of the aortic arch and aortic\nvalve.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple, bilateral punctate nodules, some of which are\ncalcified, appear unchanged from the most recent prior study (for example,\n4:90, 4:115).  An approximately 8 mm left upper lobe cyst (4:126) is\nunchanged.  Otherwise, the lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: The patient is status post thyroidectomy with surgical clips\nseen in the neck.  Otherwise, visualized portions of the base of the neck show\nno abnormality.\n\nABDOMEN: The previously characterized approximately 1.5 cm hypodense lesion\nconcerning for metastasis in segment VII (02:52), along with implants along\nthe posterior liver, are better assessed on the prior CT.  The patient is\nstatus post Whipple procedure, and the gallbladder is surgically absent.  An\napproximately hyperdense 1.2 cm cyst of the interpolar left kidney (2:65)\nappears unchanged, characterized as a hemorrhagic cyst on the prior MR.\n___ of the ascending colon, without evidence of acute\ndiverticulitis.  The remaining included portion of the unenhanced upper\nabdomen is unremarkable.\n\nBONES: Right posterior twelfth rib deformity appears unchanged and is chronic.\nMild, multilevel degenerative changes of the cervical and thoracic spine.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No acute intrathoracic abnormality.\n2. Possible hepatic metastatic disease is better assessed on the prior CT.\n3. Unchanged, multiple, bilateral punctate pulmonary nodules. No new\nsuspicious nodules."
        },
        {
            "input": "The thyroid is slightly heterogeneous as before with subcentimeter hypodense\nlesion in the right lobe..  Supraclavicular, axillary, mediastinal and hilar\nlymph nodes are not enlarged. Aorta and pulmonary arteries are normal size.\nCardiac configuration is normal and there is mild calcification in all\ncoronary arteries.  There are no lung consolidations or worrisome lung\nnodules.  Previously described peripheral ground-glass opacities have\nresolved.  There is minimal bronchial wall thickening.  Centrilobular\nemphysema is very mild..  There is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation there is\nfatty liver.  Cholelithiasis is partially imaged.  Hypodense bilateral renal\nlesions are likely cysts.\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy.\nPreviously described retrocardiac opacities likely represented superimposed\nnormal structures or resolved atelectasis.\nVery minimal centrilobular emphysema\nFatty liver\nCholelithiasis\nCoronary calcifications"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is notable for tiny\nhypodense nodules and a coarse calcification in the left lobe. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is minimal coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is mildly ectatic, measuring 4.0 cm.  The main, right,\nand left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There are multiple bilateral pulmonary nodules\nmeasuring up to 3 mm (for example, 04:31, 101: 143, 149), as well as are\nscattered punctate calcified granulomas.  There is right basilar atelectasis. \nThere is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally. There\nare multiple small tracheal diverticulae.\n\nPLEURA:  There is a small right pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for large\nvolume ascites and peritoneal soft tissue deposits.  A 3.5 x 2.2 cm hypodense\nlesion in VI/VII of the liver is partially imaged.",
            "output": "1. Multiple bilateral pulmonary nodules measuring up to 3 mm.  Attention on\nfollow-up imaging is recommended.\n2. Small right pleural effusion with compressive atelectasis.\n3. Partially imaged 3.5 x 2.2 cm hypodense lesion in segment VI/VII of the\nliver, incompletely evaluated on this single-phase study.\n4. Peritoneal carcinomatosis with large volume ascites and peritoneal\ndeposits.\n5. Mildly ectatic ascending aorta measuring 4.0 cm."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No mediastinal, hilar or\naxillary lymphadenopathy is demonstrated.  Heart size is normal.  There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Tracheal\ndiverticulum is demonstrated, series 7, image 19.  Right upper lobe nodule is\nstable, series 7, image 45.  Subpleural right upper lobe area of nodular\natelectasis is demonstrated, series 7, image 50.  Right middle lobe nodule is\nstable, 2 mm, series 7, image 188 left upper lobe subpleural nodules 2 mm,\nseries 7 image 40.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of intrathoracic\nmetastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "CHEST PERIMETER: Roughly 25 mm wide low density region in the left lobe of the\nthyroid is more conspicuous today than it was in ___ or ___,\nperhaps due to differences in contrast timing, but should be evaluated by\nthyroid ultrasound.  No adjacent soft tissue abnormality.  String of 6-7 mm\nlymph nodes posterior to the left common carotid artery, ___, are\nunchanged over that period of time.  There is no supraclavicular or axillary\nlymph node enlargement.  Breast evaluation is reserved exclusively for\nmammography.  No soft tissue abnormalities elsewhere in the chest wall. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is moderately patulous but there is no retention\nof fluid to suggest obstruction.  Functional assessment would require a\ncontrast swallow.\n\nAtherosclerotic calcification is not apparent in head and neck vessels, but is\npresent in at least the left anterior descending coronary artery.  Aortic\nvalve is not calcified.  Aorta is top-normal size. Pulmonary arteries and\ncardiac chambers are not enlarged and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: None enlarged.\n\n\n\nLUNGS, AIRWAYS, PLEURAE: 9 mm wide air-filled structure, to the right of\nmidline just above the thoracic inlet, 302:20, is probably a tracheal\ndiverticulum, usually of no clinical significance.\n\n3 sub mm nodules, right lung, 302:114, 121, 156 and one in the left upper\nlobe, 302:60, are all stable since ___.  2 them are sufficiently\nradiodense to be calcified.\n\nThere are no new or growing lung nodules.  Lungs are otherwise clear. \nTracheobronchial tree is normal to subsegmental levels and there is no pleural\nabnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning..",
            "output": "No evidence of intrathoracic malignancy.  Tiny lung nodules stable since\n___, 2 of which are calcified, probably benign granulomas.\n\nMinimal atherosclerotic calcification, LAD.\n\nAbnormal thyroid, stable adjacent subcentimeter lymph nodes.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "Stable thyroid nodules with calcification (5, 3).  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  No enlarged lymph nodes in the\nmediastinum or at the level of the hilar structures.  All visible mediastinal\nlymph nodes are normal in size (5, 22).  Normal appearance of the large\nmediastinal vessels.  No incidental pulmonary embolism.  No coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable.  Stable mild hiatal hernia (5, 47).\nIncreasing perihepatic ascites and a hepatic hemangioma are described in more\ndetail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  Mild bilateral apical\nscarring with nodular components (6, 35).  Stable tracheal diverticulum (6,\n27).  Small pulmonary micro nodules, for example in the left upper lobe (6,\n58) are all stable in size and morphology.  Some of the micro nodules (6, 117)\nare calcified.  No evidence of suspicious pulmonary nodules or masses.  No\ndiffuse lung disease.  No pleural abnormalities.  The airways are patent.",
            "output": "Stable pulmonary micro nodules, some of which are calcified.  No suspicious\npulmonary nodules or masses.  No adenopathy.  No pleural abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland appears stable with\nmultiple subcentimeter hypodensities and a calcification in the left thyroid.\n\nUPPER ABDOMEN: Please refer to separate dictation of same day.\n\nMEDIASTINUM: Precarinal lymph node measures 0.8 cm in short axis,\napproximately stable, and not enlarged by CT criteria.\n\nHILA: Right hilar lymphoid tissue measures 1.1 x 1.1 cm, approximately stable.\n\nHEART and PERICARDIUM: Right Port-A-Cath terminates in the right atrium. \nHeart size is normal.\nPLEURA: No pneumothorax or pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There is mild centrilobular emphysema.  3 mm medial right\nupper lobe subpleural nodule, 3:68 appears stable.  Additional scattered micro\nnodules are stable including right upper lobe, 3:49, right upper lobe, 3:51,\nleft upper lobe, 3:45 and 3:47.  There scattered calcified granulomas.  There\nis mild biapical pleuroparenchymal scarring.\n2. AIRWAYS:  Stable right paratracheal diverticulum.  The airways are patent\nto the subsegmental level.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal in\ncaliber.  There are moderate atherosclerotic calcifications of the thoracic\naorta.\n\nCHEST CAGE: There is generalized osteopenia.  There are no suspicious\nosteolytic or osteoblastic lesions seen.",
            "output": "1.  Grossly stable examination of the chest.  No suspicious pulmonary lesions.\n\n2.  Stable 1.1 cm right hilar lymphoid tissue which may be reactive.\n\n3.  Please refer to separately dictated CT abdomen and pelvis of same day."
        },
        {
            "input": "THORACIC INLET: Right-sided Port-A-Cath tip projects to the right atrium. \nThere are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  The right hilar lymph node is also unchanged.  The ascending aorta is\nmildly ectatic and measures 3.7 cm, unchanged.  Heart size is normal.  There\nis no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized pulmonary nodules are unchanged.  A 3 mm right\nupper lobe subpleural pulmonary nodule (302, 79) is unchanged.  A 2 mm left\nupper lobe pulmonary nodules (302, 50) are also unchanged.  A 2 mm nodule\nalong the mediastinal surface of the right upper pleura (302, 69 is also\nstable.  No new pulmonary nodules.  Stable 2 mm calcified granuloma in the\nright middle lobe (302, 99).  Lungs are low volume.  No new consolidations.\nBONES AND CHEST WALL : Review of bones shows a stable sclerotic lesion along\nthe inferior endplate of T11 vertebral body (602, 76) with slight increase in\nsize and bears watching to exclude metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows hypodense\nlesion within the right lobe of liver.  Please refer to dedicated report on\nabdomen which has been dictated separately.",
            "output": "Stable 1-3 mm pulmonary nodules.  No new pulmonary nodules.\n\nStable small mediastinal lymph nodes.\n\nStable small right hilar lymph node.\n\nSclerotic lesion within T11 vertebral body is slightly more prominent, could\nbe degenerative however bears watching to exclude metastasis.\n\nHypodense lesions within the liver.  Please refer to dedicated report on\nabdomen which has been dictated separately."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection, aneurysm\nor intramural hematoma.  There is a focal linear intraluminal hypodensity\nwithin the descending thoracic aorta which is felt likely to represent\nintraluminal thrombus (3:123, 601:42, 602:46).  The heart, pericardium and\ngreat vessels are within normal limits.  No pericardial effusion is seen. \nThere is a small hiatal hernia.\n\nAXILLA, HILA, AND MEDIASTINUM: There is a 1 cm mediastinal lymph node in the\nAP window which is likely reactive in etiology (02:35).  Otherwise, there is\nno axillary or hilar lymphadenopathy.  No mediastinal masses are seen.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar dependent atelectasis. Lungs are otherwise clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: There is a large hypodense thyroid nodule measuring up to 4 cm\nin largest diameter within the left lobe of the thyroid with mass effect upon\nthe trachea.  Otherwise, the visualized portions of the base of the neck show\nno abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of aortic dissection, aneurysm or intramural hematoma.\n2. Focal linear intraluminal thrombus within the descending thoracic aorta.\n3. 4 cm left lobe thyroid nodule.  Further evaluation with thyroid ultrasound\nis recommended per ACR criteria as noted below.\n\nRECOMMENDATION(S):\n1. Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  Heart size is normal.  No pericardial pleural effusion is\nseen.  No mediastinal, hilar or axillary lymphadenopathy is present.\n\nImage portion of the upper abdomen demonstrate substantial decrease in the\nliver density consistent with fatty infiltration.\n\nAirways are patent to the subsegmental level bilaterally.  Endobronchial\nsecretions are extensive involving both lower lobes.  Apical emphysema is\nmoderate.  Subpleural interstitial changes are present, involving both upper\nand lower lobes.  No discrete pulmonary nodules masses are consolidations\ndemonstrated.  The only nodule seen is in the left upper lobe, series 5, image\n75, 3 mm.  No lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Interstitial opacities as described, most consistent with nonspecific\ninterstitial pneumonia.\n\nMild emphysema.\n\nLeft upper lobe pulmonary nodule that should be reassessed in ___ months for\ndocumentation of stability.\n\nEndobronchial secretions, most likely consistent with chronic airway\ninfection/inflammation"
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Borderline diameter of the main pulmonary\nartery.  Moderate coronary calcifications, no valvular calcifications, no\npericardial effusion.  The posterior mediastinum is unremarkable.  No abnormal\nfindings in the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum, and the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Stable predominantly paraseptal\npulmonary emphysema.  The millimetric ground-glass nodule in the left upper\nlobe (6, 57) is stable in appearance.  Calcified millimetric right upper lobe\ngranuloma (6, 56).  The degree of bilateral subpleural parenchymal fibrosis,\nreflecting an NSIP like pattern, is stable.  There continues to be minimal\npredominant bronchiectasis.  Changes are not progressive.  There are no\npleural effusions.",
            "output": "Stable appearance of the overall mild fibrotic changes in subpleural location.\nThe left upper lobe nodule is also stable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No atherosclerotic calcifications in the head and neck\narteries.  No abnormalities on the chest wall.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Small\nmediastinal lymph nodes, not pathologically enlarged by CT size criteria.  No\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Nodular opacity in the place of\nthe previously described focal ground-glass opacity in the right upper lobe\n(5: 112).  No suspicious lung nodules or masses.  No consolidations.  Small\nscattered calcified granuloma, for example in the left lower lobe (5:201).\n\nCHEST CAGE:\nOld healed fractures in the right anterior ribs.  The previously mentioned\nfracture in the distal right clavicle is not imaged in the current study.  No\nsuspicious lytic or sclerotic lesions.  Mild dorsal spondylosis.  Stable loss\nof height of T6 through T8.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Small nodular opacity in the right upper lobe.  In the setting of prior\ntrauma, this could represent a resolving small lung contusion however more\nfollow-up studies are necessary to exclude possibility of underlying\nmalignancy.\n\nRECOMMENDATION(S):  Chest CT follow-up in 6 months.\nAlternatively, a baseline chest radiograph PA and lateral could be acquired at\nearliest convenience and, if clearly visible, a follow-up in 3 months should\nbe performed.  Then of lesion has resolved, no additional imaging would be\nnecessary.  If it persists a chest CT should be performed 3 months later."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging.  No\nsupraclavicular or axillary lymph node enlargement.  Breast evaluation is\nreserved exclusively for mammography.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in the head and neck vessels or the coronary arteries.  Aorta\nand pulmonary arteries are normal size, aortic valve is not calcified and\npericardium is physiologic.\n\nTHORACIC LYMPH NODES: None pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nPunctate nodule, right upper lobe, 05:56, unchanged since at least ___.\n\n6 x 12 mm, arrowhead shaped lesion, anterior segment right upper lobe, 5:114\nis identical in appearance to ___ although on ___, 3\nmonths later it had either grown or was subsumes by a new contiguous lung\nlesion.  Perhaps this is a very small region of bronchiectasis and there was\nassociated bleeding.\n\nLungs are otherwise clear, tracheobronchial tree normal to subsegmental\nlevels.  No pleural abnormality.\n\nCHEST CAGE: Unremarkable.",
            "output": "Interval reversion of previously larger, 6 x 12 mm right upper lobe lesion to\nits smaller size in ___.  I can't explain the sequence of changes\nfor what is almost certainly a benign lesion.  It would be reasonable to\nrepeat chest CT in one year to confirm that.\n\nRECOMMENDATION(S):  Consider repeat chest CT, intravenous contrast agent not\nnecessary, in one year."
        },
        {
            "input": "AXILLA, HILA, AND MEDIASTINUM: No adenopathy in the chest.\n\nHEART AND VASCULATURE:  Trace pericardial effusion is minimally increased\nsince the prior study.\n\nPLEURAL SPACES: Left chest tube with tip in the pleura overlying the left\nlower lobe with some of the side holes outside of the pleural space; the tube\nappears to have been partially pulled back.  There is interval decreased size\nof partially loculated left pleural effusion.  The fluid in the area of the\npigtail catheter is nearly completely resolved with some residual fluid along\nthe medial posterior left pleural space and along the diaphragm.  Small amount\nof fluid within the inferior left major fissure has decreased in size.  There\nis no pleural effusion on the right.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar segmental airspace disease, worse on the\nleft.  The pleural based airspace opacity in the right upper lobe is unchanged\nthis is worse compared to prior.  Superimposed pneumonia should be considered\nin the appropriate clinical setting given the lack of intravenous contrast on\nthis exam.\n\n\nUnchanged 0.6 cm right upper lobe pulmonary nodule (302:9).  Unchanged\nperifissural 3mm right middle lobe nodule (302:128).\n\nABDOMEN:  Limited noncontrast evaluation of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous lesions",
            "output": "1. Interval decreased size of loculated left pleural effusion.  The pigtail\ncatheter is partially pulled back which may be related to the small size of\nthe loculated effusion.  Additional loculations are similar to mildly\ndecreased in size.\n2. Stable pleural based right upper lobe opacity.  Worsening of bibasilar\nsegmental airspace disease which favors atelectasis.  Superimposed pneumonia\nshould be considered in the appropriate clinical setting contrast on current\nexam\n3. Additional findings as above."
        },
        {
            "input": "A right-sided PICC line terminates in the lower SVC.  Mildly prominent\naxillary and hilar lymph nodes demonstrated a fatty hilum and do not appear to\nbe pathologically enlarged.  Heart size is normal.  There is no pericardial\neffusion.  The thoracic aorta and pulmonary arteries are normal in caliber.\n\nThe airways are patent to subsegmental level.  Previously seen solid\nperipheral nodular opacity at the right apex measuring 12 x 8 mm is slightly\nsmaller and now demonstrates central cavitation (series 302, image 41).  A 5\nmm perivascular nodule right upper lobe is also slightly smaller (302:100). \nThese are both likely infectious in nature.  The bilateral lower lobes and\nlingula are better aerated compared to the prior examination of ___ with scattered residual bandlike areas of consolidation.  There is no\npleural effusion.\n\nLimited noncontrast images through the upper abdomen are unremarkable.\n\nThere are no concerning osseous lesions.",
            "output": "1. Improved aeration of bilateral lower lobes and lingula with residual band\nlike areas of consolidation, which could represent pneumonia and/or\natelectasis.  No pleural effusions.\n2. Slight interval decrease in size of a 12 x 8 mm right apical nodule (which\nnow demonstrates central cavitation) and a 5 mm right upper lobe perivascular\nnodule, likely infectious in nature."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: The visualized upper abdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pericardial\neffusion.\n\nPLEURA: There is a small to moderate left-sided low-density pleural effusion\nloculated along the left lateral apex and left lung base.  No evidence for\nempyema.\n\nLUNG:\n\n1. PARENCHYMA:  There is an 11 mm pulmonary nodular opacity at the right lung\napex (series 4, image 45).  There is a 6 mm right upper lobe nodule (series 4,\nimage 87).  There is a 3 mm perifissural nodule right middle lobe (series 4,\nimage 110).  Homogeneous opacification at the left lung base likely reflects\ncompressive atelectasis secondary to the loculated pleural fluid.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The aorta and main pulmonary artery are unremarkable.\nCHEST CAGE: The superficial soft tissues are unremarkable.  No worrisome\nosseous lesion.",
            "output": "1.  Small to moderate simple pleural effusion loculated within the left\nlateral apex and left base.  Associated compressive atelectasis in the left\nlung base.\n2.  Multiple pulmonary nodules measuring up to 11 mm, which may be infectious\nor inflammatory in etiology.  Please see recommendations below regarding need\nfor chest CT follow-up.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules bigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there is no soft tissue\nabnormality in the chest cage suspicious for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nLeft lobe of the thyroid is enlarged and over issued artifacts makes it\ndifficult to say whether there could be a 18 mm wide nodule, 05:21. \nUltrasound is recommended for evaluation.  Atherosclerotic calcification is\nnot apparent in the head and neck vessels.  Measurable mediastinal lymph nodes\nare numerous but not pathologically enlarged.  There is no hilar lymph node\nenlargement.\n\nA cluster of tiny right diaphragmatic lymph nodes, no more than 4 mm across,\n5:184 is concerning because of location.  Aorta and pulmonary arteries aorta\nand central pulmonary arteries are normal size and free of filling defects. \ncoronary arteries are not calcified.  Heart size is normal.\nThere are no bone lesions in the chest cage suspicious for malignancy but\nshould be noted that radionuclide PET and bone scanning are more sensitive in\ndetecting early metastases than chest CT.",
            "output": "Possible left thyroid nodule.\n\nTiny right diaphragmatic lymph nodes could be an early manifestation of\nmalignancy the where clearly not pathologically enlarged.\n\nRECOMMENDATION(S):  Thyroid ultrasound ."
        },
        {
            "input": "MEDIASTINUM:  Heterogeneous left thyroid gland without discrete nodule. No\npathologically enlarged supraclavicular, axillary, hilar or mediastinal lymph\nnodes. A cluster of tiny right diaphragmatic lymph nodes, that are unchanged\n(4:46).\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion.  Right-sided Port-A-Cath tip in\nthe right atrium.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent. The lungs are clear\nof interstitial or airspace opacity. No suspicious pulmonary nodules.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "No evidence of metastatic disease in the thorax."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and, excluding the\nbreasts, which require mammography for evaluation, there are no soft tissue\nabnormalities in the imaged chest wall suspicious for malignancy.\n\nHeterogeneous lucency of the lower pole of the left thyroid lobe extending\ninto the isthmus is slightly more extensive today than in ___.  It has\nbeen evaluated with needle biopsy.  There are no enlarged adjacent lymph nodes\nor pathologically enlarged lymph nodes in the hila or mediastinum or\ndiaphragmatic stations.  There are no new nodules or other lesions of concern\nfor malignancy.  Lungs are clear and the tracheobronchial tree is normal to\nsubsegmental stations.\n\nAorta and pulmonary arteries are normal size.  Atherosclerotic calcification\nis not apparent in the coronary arteries.  Central venous catheter ends in the\nmid right atrium, with no associated thrombus.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of primary or metastatic intrathoracic malignancy.\n\nAbnormality in the left thyroid lobe slightly larger today than in ___,\nwhen it was biopsied.  Clinical correlation recommended.\n\nRECOMMENDATION(S):  Consider slight interval enlargement of left thyroid\nabnormality in light of recent biopsy results.  Follow-up thyroid ultrasound\nmay be warranted."
        },
        {
            "input": "Mildly increased nodular left thyroid lobe, unchanged as compared to the\nprevious examination.  Right pectoral Port-A-Cath.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  All visible lymph nodes in the\nmediastinum are normal in size.  Normal appearance of the large mediastinal\nvessels.  Minimal coronary calcifications, no valvular calcifications, no\npericardial effusion.  Status post gastric banding.  Unchanged right lobar\nliver hemangioma.  No osteolytic lesions at the level of the ribs, the sternum\nor the vertebral bodies.  Moderate degenerative vertebral disease.  No\nvertebral compression fractures.  No pleural thickening, no pleural effusions.\nNo diffuse lung disease.  No suspicious lung nodules or masses.  The airways\nare patent.",
            "output": "Unchanged nodular an enlarged left thyroid lobe.  No pleural effusions.  No\npleural thickening.  No adenopathy.  No suspicious lung nodules or masses."
        },
        {
            "input": "MEDIASTINUM: The left thyroid gland is heterogeneous. No pathologically\nenlarged supraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. No substantial atherosclerotic\ncalcifications of the thoracic aorta and of the coronary arteries. \nRight-sided port terminates in the right atrium.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Pre-existing\nmillimetric pulmonary nodules in the right upper lobe series 6, image 42, 146,\n197, 198 are stable.  The lungs are clear of interstitial or airspace opacity.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "Stable appearance of the thorax, no evidence of metastatic disease."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, axillary, and mediastinal lymph\nnodes are not enlarged.  Thoracic aorta and pulmonary artery are normal size. \nThere is no significant coronary artery calcification.  A right pectoral\ninfusion port terminates in upper right atrium.  Pericardial effusions are\nsmall.\n\nAirways are patent to subsegmental levels.  Bilateral pleural effusions are\nsmall.  Several solid pulmonary nodules measuring 2 mm or less are stable\n(5:92, 128, 146, 179, 205).  Multiple new ill-defined ground-glass opacities\nare identified in subpleural distribution, predominantly in upper and mid\nlungs bilaterally.  (5:68, 80, 109, 122, 138).\n\nLimited evaluation of included upper abdomen is notable for bilateral\nnonobstructing renal stones, unchanged from ___.  Bilateral pelvic renal\ncysts are again noted.  Lap band is in place.  An 8 mm hypodensity in the\nhepatic segment 4A is unchanged.",
            "output": "1. Multiple ill-defined small ground-glass opacities with subpleural\npredominance are new.  Findings may reflect early manifestation of drug\ntoxicity.  Other possible etiologies include atypical/opportunistic infection\nor inflammatory process, including organizing pneumonia.  Atypical\nmanifestation of metastasis is less likely.\n2. Several pulmonary nodules measuring 2 mm or less are stable."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum.  No hilar lymphadenopathy.  No abnormalities\nat the level of the large mediastinal vessels.  Mild coronary calcifications,\nno valvular calcifications, no pericardial effusion.  Small hiatal hernia and\ngastric banding.  Upper abdominal findings, including a hypodense liver lesion\n(6, 48) are described in detail in the dedicated abdominal CT report.  No\nevidence of osteolytic lesions.\nThe vast majority of the pre described ground-glass opacities in subpleural\nlocation has completely resolved.  Only in the left upper lobe, a small\nsubpleural ground-glass nodules remains visible.  No evidence of new\nground-glass opacities.  No fibrosis.  No pleural thickening, no pleural\neffusions.  Complete resolution of pre-existing pleural effusions.  Small\nbilateral pulmonary nodules are stable.  No new or growing nodules.  The\nairways are patent.",
            "output": "Complete interval resolution of the pre-existing pleural effusions.  Nearly\ncomplete resolution of the pre-existing ground-glass opacities.  No\nlymphadenopathy.  No new or growing lung nodules."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Small left lobe thyroid nodule\nmeasuring up to 8 mm.  There is no axillary or supraclavicular\nlymphadenopathy.\n\nUPPER ABDOMEN: Please see CT abdomen pelvis from the same date.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: No significant coronary calcification.  There is a\nsmall pericardial effusion.  A right chest port terminates in the right\natrium.\nPLEURA: No pleural effusion.  No pleural abnormality.\nLUNG:\n\n-PARENCHYMA:  Mild scarring is noted in the right middle lobe along the minor\nfissure.  Ill-defined ground-glass opacities at the left lung base (series 5,\nimage 215, 216, 221, 223, 200, 185, 178) measure up to 5 mm and are more\nconspicuous in comparison to the prior examination.  A paramediastinal nodule\nat the left lung base (series 5, image 216) allowing for technical differences\nis likely unchanged.  A 3 mm ground-glass subpleural nodule left upper lobe\n(series 5, image 124) is unchanged.  A 3 mm nodule the left lung base (series\n5, image 219) is unchanged.\n-AIRWAYS:  The airways are patent subsegmental level.\n-VESSELS:  The aorta and main pulmonary artery are within normal limits. \nThere is no central pulmonary embolus.\nCHEST CAGE: The superficial soft tissues are unremarkable.  No concerning\nosseous lesions.",
            "output": "1.  Multiple new clustered ground-glass nodules all at the left lung base,\nsuggest infection or inflammation, possibly aspiration given prior bariatric\nsurgery.  Attention on follow up is recommended.\n2.  Previously documented small nodules are unchanged.\n3.  Small pericardial effusion, minimally increased."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which must be evaluated by mammography, elsewhere in the\nchest wall there are no soft tissue abnormalities concerning for malignancy\n\nA right central venous infusion catheter ends in the upper right atrium.\n\nThyroid is heterogeneous but there are no lesions large enough to warrant\nfurther imaging evaluation.  Atherosclerotic calcification is not apparent in\nhead and neck vessels or coronary arteries.  Aorta, central pulmonary arteries\ncommon cardiac chambers are normal size.  No pleural or pericardial\nabnormality is present.\n\nMediastinal, hilar common other thoracic lymph nodes are not pathologically\nenlarged.\n\nLungs:\n\nRight lung is essentially clear.\n\n6 mm heterogeneous, mixed density left upper lobe nodule is new, 4:87.\n\nPrevious areas of ground-glass opacification scattered in the left lower lobe\nhave resolved.  Evidence of prior aspiration has resolved elsewhere\n\nPatient has had gastric banding surgery.  Esophagus is not distended.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "6 mm left upper lobe nodule of mixed attenuation, is new since ___. \nBecause of its morphology it is more likely inflammatory than malignant.\n\nEvidence of prior aspiration elsewhere has resolved."
        },
        {
            "input": "Right pectoral Port-A-Cath. No incidental thyroid findings. No\nsupraclavicular, infraclavicular or axillary lymphadenopathy. All visible\nmediastinal lymph nodes are normal in size.  No coronary calcifications, no\nvalvular calcifications, no pericardial effusion. Status post bariatric\nsurgery.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  The previously seen mixed attenuation nodule in the\nleft upper lobe (5, 102) is slightly smaller and less dense than on the\nprevious examination.  There is no evidence of new or growing nodules.  No\npleural effusions.  No airways disease.  No diffuse lung disease.",
            "output": "Interval decrease in size and decrease in attenuation of the pre-existing left\nupper lobe nodule.  The course of the changes suggests the presence of an\ninflammatory nodule.  No new or growing nodules.  No pleural abnormalities. \nNo adenopathy."
        },
        {
            "input": "FINDINGS:\n\nNo suspicious thyroid lesions.  No supraclavicular or axillary adenopathy.  No\ngross breast lesions.  This study was not tailored to evaluate the\nsubdiaphragmatic organs.  Anti reflux/bariatric gastric device in situ.  For\nabdominal findings please refer to ___ report of the same date.  Minimal\nperihepatic free fluid.  Multiple bilateral nonobstructing renal calculi in\nrelation to the renal calyces, the largest in the right kidney measuring 4 mm\nin diameter.  No hydronephrosis.  Normal cardiac configuration.  No\ncardiomegaly.  Trace pericardial fluid is physiologic.  No aortic valve or\ncoronary artery calcification.  The aorta measures 35 mm in AP diameter at the\nlevel of the pulmonary truncus.  The pulmonary arteries not dilated.  No\ncentral pulmonary arterial filling defects on this nondedicated study.  No\nmediastinal adenopathy.  No hilar adenopathy.  The airways are patent to the\nsubsegmental level.  Mild bronchial wall thickening.  Moderate spondylotic\nchanges of the thoracic spine.  No lytic/destructive bony lesions.  Mild\nbiapical pleural-parenchymal scarring.  All the pre-existing pulmonary nodules\nare essentially unchanged.  The previously noted nodule in the left upper lobe\ndemonstrates continued interval decrease in size and density.  A couple of\nground-glass opacities (sub 5 mm) in the upper lung zones may represent\nrespiratory bronchiolitis if this patient is a smoker.",
            "output": "Stable imaging findings of chest.  No findings to suggest intrathoracic\nmetastatic disease.\nThe previously noted nodule in the left upper lobe demonstrates continued\ninterval decrease in size and density.\nMultiple nonobstructing renal calculi the largest measuring 4 mm in diameter\nin the right kidney.\n\nA couple of ground-glass opacities (sub 5 mm) in the upper lung zones may\nrepresent respiratory bronchiolitis if this patient is a smoker.\n\nFor abdominal findings please refer to MR report of the same date."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  Trace pericardial fluid is\nwithin physiologic limits.  The thoracic aorta is normal in caliber.  No\nappreciable calcified atherosclerosis.  The main pulmonary artery is normal in\ncaliber.  No large central pulmonary embolus.  A right portacath tip is\nobscured by the IV contrast bolus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild biapical scarring.  Punctate pulmonary nodules are\nunchanged (series 4, images 105, 88, 198).  A punctate granuloma abuts the\ndescending thoracic aorta (series 4, image 164).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small volume ascites.  Gastric band.  Partially imaged right\nnephrolithiasis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of intrathoracic metastasis.  Tiny scattered pulmonary nodules\nare unchanged.\n2. Partially imaged abdominal ascites.\n3. Partially imaged right nephrolithiasis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, particularly\nin view of asymmetric, nodular breasts, there are no soft tissue abnormalities\nelsewhere in the imaged chest wall suspicious for malignancy.\n\nRight transjugular central venous infusion catheter ends close to the inferior\ncavoatrial junction.  There may be small associated thrombi, 02:29.\n\nFindings below the diaphragm will be reported separately.  Large hiatus hernia\nabove gastric banding is unchanged.  Esophagus above that level is not\ndistended.\n\nAtherosclerotic calcification is not apparent in head and neck vessels or\ncoronary arteries.  Aorta and central pulmonary arteries are normal size. \nExtensive thrombosis is in the pulmonary arterial circulation, left upper\nlobe, 302:78, right middle lobe, 302:99, right lower lobe, 302:101-115 is\nsubstantially more extensive today than on ___ (appreciated\nretrospectively).\n\nLungs, airways, and pleurae:\nNo lung nodules.  Tracheobronchial tree is normal to subsegmental levels. \nSmall nonhemorrhagic bilateral pleural effusions are new, probably due to\nsubstantial ascites.\n\n\nThoracic lymph nodes:\n\nLow-attenuation 10 mm right lower paraesophageal lymph node, 302:93 is larger\ntoday than in ___.  No other thoracic lymph nodes are enlarged.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Extensive new pulmonary emboli.\n\nSmall bilateral pleural effusions attributable to ascites.\n\nNo evidence of intrathoracic malignancy.\n\nNOTIFICATION:  The findings were discussed with       ?      ___  \n, M.D. by ___, M.D. on the telephone on ___ at 9:59 am, 1 minutes\nafter discovery of the findings."
        },
        {
            "input": "There is a 9 mm hypodense lesion in the right thyroid lobe (series 4:image\n23).  There is no axillary or supraclavicular lymphadenopathy.  There are no\npathologically enlarged mediastinal hilar lymph nodes.  The heart is mildly\nenlarged with a small pericardial effusion noted.  There are severe coronary\nartery calcifications, and aortic valvular calcifications are also noted.  The\nesophagus is normal without hiatal hernia.  The airways are patent to the\nsegmental level.  The thoracic aorta is normal in course and caliber, and\nmoderate-severe atherosclerotic calcifications are noted along the aortic arch\nand descending aorta.  The main pulmonary artery is mildly dilated measuring\n3.2 cm (series 4: Image 94).\n\nThere are small-moderate pleural effusions, right larger than left.  Adjacent\ncompressive atelectasis is seen.  No focal consolidation is noted.  There is\nno pneumothorax.  Respiratory motion limits evaluation of the lung parenchyma,\nand no suspicious pulmonary nodules are noted.\n\nDegenerative changes of the thoracic spine are noted, and no suspicious lytic\nor blastic osseous lesions are noted.\n\nAlthough this exam is intended for the evaluation of the upper abdominal\norgans, a 1.3 cm hypodense lesion noted in the left hepatic lobe likely\nreflects a cyst.  Smaller previously seen hepatic hypodensities are not well\nvisualized on this exam.  Multiple hypodense lesions throughout the right\nkidney are likely to reflect cysts as noted on prior exams.  A round\nwell-defined hyperdense cortical lesion in the left kidney may reflect a\nproteinaceous or hemorrhagic cyst (series 4:Image 214).  Left adrenal gland\nthickening is noted, possibly reflective of hypoplasia.",
            "output": "1.  Cardiomegaly with a small pericardial effusion and moderate right and\nsmall left pleural effusions.\n2.  No focal consolidation to suggest pneumonia.\n3.  Mildly dilated main pulmonary artery may reflect pulmonary hypertension.\n4.  Multiple renal cysts including a hyperdense left cortical lesion, likely\nreflecting a hemorrhagic or proteinaceous cyst, which could be evaluated with\nMRI or or renal ultrasound.  Comparison with prior outside examinations if\navailable may also be able to further assess stability or for hyperdense cyst."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level.  A single subsegmental filling defect is demonstrated in\nthe right lower lobe pulmonary arterial branch (5:167, 7:88). The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma. The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Subsegmental atelectasis is noted.  There is a 4 mm right upper\nlobe nodule (05:24).  There is no focal consolidation or mass.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Right lower lobe subsegmental pulmonary embolism. No CT evidence of\npulmonary infarction, pulmonary arterial hypertension or right ventricular\nstrain.\n2. 4 mm right upper lobe nodule.  An optional CT chest in 12 months is\nrecommended in a high risk patient, no CT follow-up is recommended in a low\nrisk patient according to ___ guidelines.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: The study is not tailored for the evaluation of\nsubdiaphragmatic structures.  Within this limitation, there is cholelithiasis\nwithout evidence of cholecystitis.  A small hiatus hernia is also\ndemonstrated.  Mild lobulation at the gastroesophageal junction is\nnonspecific, but unchanged.  The included upper abdomen is otherwise grossly\nunremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  The esophagus is diffusely\npatulous, similar to prior studies.  At the gastroesophageal junction, there\nis nodularity which appears similar to prior studies (4:214).\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Mild cardiomegaly is unchanged.  Coronary artery\ncalcifications are diffuse and mild.  There are also extensive aortic annular\nand leaflet calcifications.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  As on prior studies, there is basilar-predominant subpleural\nfibrosis, honeycombing and traction bronchiectasis.  In comparison with ___, there has been an interval reduction in the degree of\nsurrounding ground-glass opacity and peribronchial thickening suggestive of\nreduced inflammation and an increase in the caliber of traction bronchiectasis\nand honeycomb spaces.  There are no new sites of ground-glass opacity,\nhoneycombing or subpleural fibrosis.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery remains dilated, measuring up to 3.5 cm\nsuggestive of pulmonary arterial hypertension.  The right pulmonary artery is\nalso dilated measuring up to 3 cm.  The thoracic aorta is normal in caliber\nand demonstrates moderate-to-severe atherosclerotic calcification.\nCHEST CAGE: There is no suspicious lytic or sclerotic osseous lesion or acute\nfracture.  There is diffuse osseous demineralization.  Degenerative changes of\nthe thoracic spine are demonstrated.",
            "output": "1. Subpleural, basilar predominant fibrotic lung disease with traction\nbronchiectasis in a pattern typical for usual interstitial pneumonia (UIP). \nIn comparison with prior studies, there is reduced ground-glass opacity in the\nlung bases and decreased peribronchial thickening suggestive of reduced\ninflammation.\n2. Patulous esophagus with nodularity at the gastroesophageal junction has\nbeen previously evaluated by barium esophagram.  If there is concern for a\nmalignant nodule, correlation with barium esophagram or endoscopy may be\nperformed.\n3. Extensive aortic valvular calcification is of indeterminate hemodynamic\nsignificance based on this study.  Recommend correlation with physical\nexamination for evidence of aortic stenosis murmur and if clinically indicated\nechocardiography may be performed.\n4. Dilated main and right pulmonary arteries as on prior studies suggestive of\npulmonary arterial hypertension.\n5. Cholelithiasis.\n\nRECOMMENDATION(S):  Consider contrast swallow or esophagoscopy to evaluate\ngastroesophageal junction as well as changes in swallowing function."
        },
        {
            "input": "CHEST PERIMETER: No findings in the partially imaged lower thyroid warrant any\nfurther imaging.  Supraclavicular and axillary lymph nodes are not enlarged. \nBreasts are not evaluated by this study, which is also not designed for\nsubdiaphragmatic diagnosis.  There is no adrenal abnormality.  Large calcified\ngallstone is still present, absent any findings of cholecystitis or biliary\nobstruction in the partially imaged liver..\n\n\nCARDIO-MEDIASTINUM:Above the small gastric hiatus hernia, the esophagus is\nmoderately distended with air in the upper portion, less distended inferiorly\ntoday than it was in ___.  There is no associated mass and\nassessment of swallowing function was most recently performed with a contrast\nswallow in ___ showing moderate to severe esophageal dysmotility and\na small hiatal hernia.\n\nAtherosclerotic calcification is moderately heavy in head and neck vessels,\nincluding mildly but stably dilated right subclavian artery.  Coronary\ncalcification is minimal.  Pulmonary artery caliber is top-normal.  Aortic\nvalvular calcification is moderate.  Aorta is normal size.  Evaluation of\ncardiomegaly would require echocardiography.  Pericardium is physiologic.\n\n\n\nTHORACIC LYMPH NODES: Thoracic lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Moderately severe pulmonary fibrosis, including\ntraction bronchiectasis and honeycombing, is restricted to the extreme lung\nbases and is not changed in either volume or overall severity compared to\nprior scans in ___ and ___.  What has changed is the\nappearance of mildly dilated bronchi in areas of peripheral honeycombing.  In\n___ there was considerable bronchial wall thickening and some retention\nof secretions.  That resolved entirely in ___.  Today some\nbronchial wall thickening has recurred, not nearly as severe as it was in ___\nand there is no obvious retention of secretions.  Mild ground-glass\nopacification in adjacent areas suggests active alveolar or interstitial\ninflammation.\n\nThere are no lung nodules, any consolidation, or other focal lung lesions of\nconsequence.  Pleura and central tracheobronchial tree are normal.\n\nMinimal differences in lung volumes on intended end inspiratory and end\nexpiratory scans suggest patient did not cooperate with instructions to\nexhale.\n\n\n\n\n\nCHEST CAGE: Unremarkable.",
            "output": "Partial recurrence, since ___ of bronchial inflammation that was\nsevere int ___, in the regions of otherwise stable pulmonary fibrosis\nrestricted to the lung bases.  Active alveolar or interstitial inflammation in\nthose regions is new.\n\nRECOMMENDATION(S):  Echocardiography to evaluate aortic valve and\ncardiomegaly.\n\nUnless expiratory scanning is critical to evaluate possible air trapping,\nsubsequent chest CT scans can be conventional rather employ than the protocol\nfor diffuse lung disease.\n\nModerate aortic valvular calcification is sufficient to cause aortic stenosis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nSmall lymph nodes noted in the mediastinum.  , pretracheal and subcarinal,\nlikely inflammatory.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nDiffuse ground-glass opacity of the lower lobes bilaterally consistent with\nsmall airways disease is possibly some fluid overload.  Small 4 mm nodule in\nthe right lower lobe, image ___ which requires no further follow-up in in\nlow risk for malignancy patient. The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple subcentimeter mediastinal lymph nodes measuring up to\n0.9 cm in the pretracheal station (series 302, image 64) and 0.9 cm in the AP\nwindow (series 302, image 62) are unchanged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Patient is status post\naortic valvular replacement.  The ascending thoracic aorta is dilated to 4.8 x\n4.7 cm.  The main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  Bilateral bronchiectasis and bronchiolectasis with\nground-glass opacities demonstrate apical basal gradient without significant\nhoneycombing.  When compared to ___, findings are overall\nunchanged.  No suspicious pulmonary nodule or mass.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  Cortical thickening of the left humeral head, scapula,\nand T7 vertebral body could represent Paget's disease.  Multilevel\ndegenerative changes are moderate.  No acute fractures.\n\nUPPER ABDOMEN:  Status post cholecystectomy.  3.3 cm left simple renal cyst. \nOtherwise limited evaluation of the upper abdomen is unremarkable.",
            "output": "1. Bilateral bronchiectasis and bronchiolectasis with ground-glass opacity\nwithout significant honeycombing, which could represent a chronic cystic\npneumonitis or fibrotic NSIP.  No significant interval changes when compared\nto ___.\n2. Similarly dilated ascending thoracic aorta to 4.8 cm."
        },
        {
            "input": "Thyroid gland is not visualized.\n\nAxillary and mediastinal lymph nodes are not pathologically enlarged by CT\nsize criteria.  No hilar lymphadenopathy.\n\nHeart size is normal, and there is no pericardial effusion.  Thoracic aorta is\nnormal in course and caliber.  Main pulmonary trunk is normal in caliber.  No\nevidence of pulmonary embolism to the subsegmental levels.\n\nAirways are patent to the subsegmental levels.  No concerning parenchymal\nopacity or nodules are identified.  Mild bibasilar dependent atelectasis.  No\nright pleural effusion or pneumothorax.  There is a trace left pleural\neffusion.\n\nImaged upper abdominal structures are unremarkable.\n\nNo acute fracture.  No suspicious lytic or sclerotic lesions are identified. \nChest wall is unremarkable.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:   Limited evaluation of the thyroid\ngland demonstrates a 5 mm calcified focus within the right thyroid lobe.  The\nvisualized supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Please see same-day CT abdomen and pelvis full detailed\nintra-abdominal findings.\n\nMEDIASTINUM: There is no mediastinal adenopathy.\n\nHILA: There is no hilar adenopathy.\n\nHEART and PERICARDIUM: The heart is enlarged.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA: Minimal atelectasis is noted in the lung bases.  There is no\nparenchymal consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS: There is no aortic aneurysm..\nCHEST CAGE: Unchanged multilevel degenerative disc disease of the thoracic\nspine.",
            "output": "1. No lymphadenopathy within the thorax.\n2. No parenchymal consolidation.\n3. 5 mm calcification within the right lobe of partially visualized thyroid\ngland."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, there are no supraclavicular or axillary\nlymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separately reported abdominopelvic CT for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  Mild nodularity in the anterior\nmediastinum, could represent thymus gland.  Esophagus appears within normal\nlimits.\nMultiple rim enhancing fluid collections are noted in the posterior\nmediastinum, for instance lateral to T10-T11 vertebral bodies on the right\nthere are multiple confluent collections measuring approximately 2.7 x 2.7 x\n1.8 cm containing fluid and air; on the left 3 x 1.7 x 1.6 cm peripherally\nhyperdense collection containing fluid on the left, concerning for abscesses.\n\nHILA: Small calcified bilateral hilar lymph nodes are noted..  Tiny calcified\ngranulomas are seen in the left apex, right middle lobe.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Bilateral subsegmental atelectasis noted in both lower lobes. \nSpiculated nodule containing punctate calcifications is seen in the left  apex\n2. AIRWAYS:  Airways are patent to subsegmental level without bronchiectasis,\nmucous plugging or bronchial wall thickening.\n3. VESSELS:  No large filling defects noted in the central pulmonary\nvasculature.  Thoracic aorta and pulmonary arteries are normal in caliber.\nCHEST CAGE: Discitis osteomyelitis centered at T10-T11 vertebral bodies with\nfracture and surrounding soft tissue thickening status post posterior spinal\nfixation via bilateral pedicle screws and fusion rods spanning from T8 through\nL1 with T10-T11 laminectomy.  Air within the spinal canal is expected after\nsurgery.  Enhancement is noted in the posterior aspect of the thecal sac\nhowever this is not well characterized given surrounding artifact.  An\nepidural catheter is incompletely visualized.",
            "output": "1. Discitis-osteomyelitis centered at T10-T11 vertebral bodies with fractures\nof both vertebrae, and surrounding soft tissue thickening is now fixated via\nT8 through L1 posterior fusion hardware as well as status post T10-T11\nlaminectomy.\n2. Possible enhancement of the posterior aspect of the thecal sac is not well\ncharacterized on this study.  Partially seen epidural catheter.\n3. Multiple rim enhancing collections in the posterior mediastinum bilaterally\nare concerning for abscesses.\n4. 1.4 cm spiculated calcified nodule in the left apex of the lung small\ncalcified hilar lymph nodes are likely related to granulomatous disease.\n5. Bibasilar atelectasis.\n6. Please refer to separately reported abdominopelvic CT performed at the same\ntime for subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All lymph nodes in the chest wall (2, 21) Are\nnormal in size.  Normal appearance of the large mediastinal vessels.  No\nincidental pulmonary embolism.  Stable minimal anterior mediastinal nodularity\n(2, 20), likely caused by at thymic remnant.  The metallic components of the\nknown vertebral fixation are in stable position.  There is a single rim\nenhancing enlarged lymph nodes in left paravertebral location (2, 40) but\notherwise the pre-existing paravertebral soft tissue thickening seen on the\nprevious examination has substantially improved and decreased in extent. \nCompletely resolved on today's examination are areas of pre-existing\natelectasis.  The lower lobes are now fully ventilated.  Only at the lateral\naspect of the right lower lobe (3, 194) small scarring is visualized.  Stable\nmillimetric calcified lymph nodes and subpleural granulomas (3, 128).  Stable\nspiculated and partly calcified left upper lobe nodule (3, 36).",
            "output": "Complete resolution of pre-existing bilateral lower lobe consolidations. \nSubstantial decrease of the paravertebral soft tissue swelling surrounding a\nstabilized Pott fracture.  Solitary remnant left paravertebral rim enhancing\nlymph node.  Stable partly calcified and spiculated left upper lobe nodule."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis but shows no adrenal mass or splenomegaly.  Liver\nevaluation would require dedicated hepatic imaging.\n\nCARDIO-MEDIASTINUM: Esophagus moderately patulous in the midportion, distended\nonly with air not usually an indication of obstruction.  Atherosclerotic\ncalcification is not apparent in head and neck vessels or in the coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers normal size. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Respiratory motion artifact is severe enough to\nobscure very small lung nodules, for example left lower lobe 302:131, but no\nlesion larger than 5 mm would be missed entirely.\n\n6 mm nodule right upper lobe, 302:88, unchanged since ___, too small\nto characterize for contents.\n\nPossible 4 mm left upper lobe nodule, 302:114 common region not previously\nimaged.  Band of the atelectasis is the only abnormality in the left lower\nlobe.  No pleural abnormalities.\n\nCHEST CAGE: Unremarkable.",
            "output": "6 mm right upper lobe lung nodule unchanged since ___.  Probable 4 mm\nleft upper lobe lung nodule, not previously imaged.  Nature and chronicity of\nthese nodules are indeterminate.  Findings are insufficient to suggest whether\nthese are related to disseminated infection."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  The large mediastinal vessels are\nunremarkable.  Minimal coronary calcifications, minimal aortic valve\ncalcifications, no pericardial effusion.  Moderate hiatal hernia.  The upper\nabdominal findings are described in detail in the dedicated abdominal CT\nreport.  Mild stable bilateral apical scarring.  Mild centrilobular pulmonary\nemphysema.  No pleural effusions, no pleural thickening.  There continues to\nbe substantial lower lobe predominant mucous airway plugging (5, 191).  The\nknown pre-existing clustered pulmonary nodules in the left lower lobe (5, 210)\nis stable.  There is no measurable enlargement of these nodules as compared to\nthe previous examination.  No evidence of new pulmonary nodules.  Mild basal\nlateral scarring in the left lower lobe.  No new or growing nodules.",
            "output": "Stable left lower lobe clustered pulmonary nodules.  No new or growing\nnodules.  No pleural abnormalities.  No lymphadenopathy."
        },
        {
            "input": "The thyroid is normal.  There is no supraclavicular lymphadenopathy.  Small\naxillary lymph nodes bilaterally are not pathologically enlarged.  There is no\nhilar lymphadenopathy.  Small mediastinal lymph nodes are more notable for\nnumber than for size.  A small prevascular lymph node is also notable for\nlocation although it remains small, measuring 6 mm in short axis (series 6,\nimage 27).  The aorta and pulmonary artery maintain normal caliber.  The heart\nis normal in size, and there is no pericardial effusion.\n\nAirways are patent to subsegmental levels bilaterally.  Centrilobular\nemphysema is mild.   Two large pulmonary nodules are noted in the left lower\nlobe, consistent with metastatic disease.  The more inferior nodule measures\n10 x 18 mm (series 7, image 215) and the more superior nodule measures 12 x 13\nmm (series 7, image 204). A punctate nodule is noted in the left upper lobe\n(series 7, image 41).  Atelectasis or scarring is also present at the left\nlung base.  There is no pleural effusion or pneumothorax.\n\nA moderate to large hiatal hernia is present.  Please refer to concurrent CT\nabdomen pelvis for discussion of findings in the upper abdomen.  No lytic or\nblastic lesions suspicious for metastasis is present in the visualized osseous\nstructures.  Subcutaneous soft tissue stranding is present in the posterior\nsoft tissues in the mid thoracic spine extending inferiorl.",
            "output": "Two large left lower lobe pulmonary nodules, consistent with pulmonary\nmetastases."
        },
        {
            "input": "The thyroid is normal.  Multiple small mediastinal lymph nodes are identified,\nstable from the prior examination and non-pathologically enlarged. There are\nno pathologically enlarged supraclavicular, axillary, or hilar lymph nodes.\n\nThe aorta is normal in size.  The pulmonary arteries are mildly enlarged,\nsuggestive of underlying pulmonary arterial hypertension.  No incidental\npulmonary embolism is detected.  The heart is normal in size and demonstrates\nno appreciable coronary artery calcifications. There is no pericardial\neffusion.\n\nNo pneumothorax or pleural effusion is identified.  Lung windows again\ndemonstrate 2 dominant left lower lobe nodules.  The larger, more inferior\nlesion measures 1.7 x 0.9 cm (6:226), previously 1.8 x 1.0 cm.  The smaller\nand more superior lesion measures 0.8 x 0.6 cm (6:220), previously measured\n1.3 x 1.2 cm.  Several tiny adjacent nodules appear grossly unchanged.\n\nModerate centrilobular emphysematous changes are again seen.  Atelectasis\nversus scarring is seen within the lingula.  Mild bronchial wall thickening is\nsuggestive of chronic airways disease.  Clustered micronodules and mucous\nplugging is noted at the right lung base (example, 6:212), which may represent\naspiration.\n\nNo suspicious osseous lesions are identified.\n\nFor description of the intra-abdominal contents, please see the separate CT\nabdomen and pelvis examination performed on the same day.",
            "output": "1.  Modest interval decreased size of two dominant left lower lobe pulmonary\nnodules.\n2.  Bronchial wall thickening with focal mucous plugging and micronodularity\nat the right lung base likely reflects a sequelae of aspiration.  No new\nsuspicious pulmonary nodules are identified.\n3. For description of the intra-abdominal contents, please see the separate CT\nabdomen and pelvis examination performed on the same day."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Borderline diameter of the main pulmonary\nartery.  Minimal coronary calcifications.  No pericardial effusion.  Small\nhiatal hernia.  The upper abdomen is described in detail in the dedicated\nabdominal CT report.\n\nAt the level of the left lower lobe, an embolus is visualized in the lower\naspect of the left lower lobe artery an in at least 2 segmental arteries.  No\nother emboli are seen.\n\nUnchanged bilateral apical scarring.  Unchanged mild to moderate centrilobular\npulmonary emphysema.  Unchanged evidence of lower lobe predominant mucous\nplugging.  The larger of the 2 left lower lobe reference nodules (6, 243) has\ndecreased from 20 to 11 mm in diameter.  The smaller more apical nodule has\nalmost completely resolved.\n\nNo pleural effusions or pleural thickening.",
            "output": "Left lower lobe pulmonary embolism, involving at least 2 segmental arteries.\nDecrease in size of a left lower lobe reference nodule.\nNo new or growing nodules.\nUnchanged lower lobe predominant mucous plugging.\nNo pleural effusions.\n\nNOTIFICATION:  At the time of dictation and observation, 15:40, on the ___, the referring physician ___ was paged for notification\nand the findings were discussed over the telephone 6 min later."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart is upper limits of\nnormal in size and there is no pericardial or substantial pleural effusion. \nSmall hiatal hernia is again demonstrated.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nin the spine.\n\nWithin the lungs, biapical scarring and mild emphysema are similar to the\nprior study.  An enhancing left lower lobe pulmonary nodule measuring 11 mm in\ndiameter is similar to the prior CT ___, 301).  Bronchial wall thickening\nwith areas of mucoid impaction are again demonstrated in the lower lobes, most\nmarked in the right lower lobe posterior and lateral segments.  Multifocal\nlinear atelectasis and or scarring is unchanged in the mid and lower lungs.",
            "output": "1. No interval change in 11 mm left lower lobe lung nodule compared to ___ chest CT.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Small calcified right hilar\nnodes are incidentally noted.  Heart size is normal, and no pericardial or\npleural effusion is evident.  Moderate hiatal hernia is noted.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nwithin the spine.  No new suspicious lytic or blastic lesions are detected.\n\nWithin the lungs, a lobulated 11 mm left lower lobe nodule with heterogeneous\nat enhancement is unchanged.  A punctate, 2 mm peripheral right lower lobe\nnodule is apparently new (240, 5).  .  Centrilobular emphysema is again\ndemonstrated as well as nonspecific biapical scarring.  The",
            "output": "1.  Unchanged left lower lobe nodule.  New 2 mm right lower lobe nodule. \nRecommend surveillance CT in ___ months to reassess the new nodule.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Stable\nappearance of the large mediastinal vessels, with borderline diameter of the\nmain pulmonary artery.  Mild coronary calcifications, no pericardial effusion.\nNo abnormalities of the posterior mediastinum, with the exception of a small\nhiatal hernia.  Upper abdominal organs are described in detail in the\ndedicated abdominal CT report.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  The lung parenchyma continues to\nshow minimal apical scarring and minimal pulmonary emphysema.  The pre\ndescribed 1-2 mm solid nodule in the right lower lobe (6, 208) is stable in\nappearance.  The morphology and size of the known lobulated left lower lobe\nnodule (6, 221) is also stable.  No pleural effusion.  No diffuse lung\ndisease.  No new or growing nodules.",
            "output": "Stability of a punctate right lower lobe and a known lobulated left lower lobe\nnodule.  No new or growing nodules.  No adenopathy.  No pleural effusions."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged,\nspecifically excluding the breasts which require mammography for evaluation,\nelsewhere in the chest there are no soft tissue abnormalities concerning for\nmalignancy or infection.  Findings below the diaphragm will be reported\nseparately.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is moderate in head neck vessels but not\napparent in the coronary arteries.  Aorta and pulmonary arteries are normal\nsize and subject to the technical limitations of this study free of central\nfilling defects.  No aortic valvular calcification.  Pericardium is\nphysiologic.  Moderate gastric hiatus hernia is larger.  Esophagus is\nunremarkable.\n\nSmall persistent left-sided superior vena cava is a clinically insignificant\nanatomic variant.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged by size\ncriteria.\n\nEmphysema is moderately severe in the upper lobes, milder elsewhere.\n\nA complex of lung nodules in the posterior basal segment right lower lobe,\n4:191- 211, is larger today, ranging in maximum size up to 9 x 15 mm, 4:203\npreviously 7 x 11 mm.\n\nElsewhere in the lungs there are no new lung nodules.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\n.",
            "output": "Cluster of long-standing left lower lobe lung nodules, previously decreased\nbetween ___ and ___ has increased in overall and individual\nsize since ___.  No new lung nodules or other manifestations of metastasis\nin the chest.\n\nModerate emphysema."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.\nEvaluation of the subsegmental level is somewhat limited by respiratory\nmotion.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  Extensive partially calcified\natherosclerotic disease is noted.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.  A left IJ central\nvenous catheter terminates in the SVC.  A left PICC terminates at the\ncavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is\npresent.  A 1.2 cm right lower paratracheal lymph node is likely reactive\n(02:47).  No mediastinal mass.\n\nPLEURAL SPACES:  Moderate, right greater than left, loculated nonhemorrhagic\npleural effusions are present.  There is no pneumothorax.\n\n\nLUNGS/AIRWAYS:  Extensive airspace opacification has progressed markedly\ncompared with the prior study of ___ involving all lobes, worst in the\nleft upper lobe and right lower lobe.  There are extensive areas of\nground-glass opacity and more confluent consolidation.  There is underlying\nsevere centrilobular emphysema.  Evaluation for pulmonary nodules is precluded\nby the diffuse parenchymal abnormality.  The tracheostomy tube terminates 6.1\ncm from the carina.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for partially\nimaged G-tube and severe partially calcified atherosclerotic plaque in the\nabdominal aorta, including multiple areas of atherosclerotic ulcer formation\n(2:  111).  An enteric tube terminates at the GE junction.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Extensive airspace opacities for which the differential includes severe\nmultifocal pneumonia, extensive aspiration, or diffuse alveolar hemorrhage.\n2. No evidence of contrast extravasation to suggest fistulization between the\ntrachea and any major blood vessel.\n3. Moderate bilateral loculated pleural effusions.\n4. Extensive atherosclerotic disease including multiple areas of penetrating\natherosclerotic ulcer formation.\n5. Enteric tube terminates at the GE junction.\n This preliminary report was reviewed with Dr. ___\nradiologist."
        },
        {
            "input": "Ascending aorta is overall calcified at the very proximal aspect.  Distal\nascending aorta is spared from calcifications but aortic arch is heavily\ncalcified.  Descending aorta is calcified.  No aortic dilatation present.\n\nCoronary calcifications are extensive.  Inter atrial septal hypertrophy is\nsubstantial and potentially might represent septal lipoma, approaching 3 x 3.3\ncm in diameter.  Heart size is overall normal.  There is no pericardial\neffusion.  There is potential left ventricular apical aneurysm, series 2,\nimage 36.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  No pleural\neffusion is seen.\n\nImage portion of the upper abdomen reveals extensive vascular calcifications.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is moderate to severe.  Bibasal atelectasis is mild to moderate with\nleft lung base more affected than the right, the findings most likely\nrepresenting pure atelectasis but infectious process or aspiration is a\npossibility.  0.9 x 0.6 cm (series 4, image 142) linear/nodular opacity within\nthe right lower lobe likely represents focal atelectasis however differential\nincludes mixed density solid/ground-glass pulmonary nodule.  Close attention\non follow-up is recommended.  Left upper lobe nodule, series 4, image 28 is 5\nmm in diameter, primarily ground-glass.  Additional left upper lobe nodule,\nseries 4, image 67 is 13 mm in diameter, predominantly solid with some\nground-glass component and might represent focus of infection versus true\npulmonary nodule.\n\nRight PICC line tip terminates at the level of cavoatrial junction.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Very proximal ascending aorta and aortic arch are heavily affected by\ncalcifications with sparing of the distal ascending aorta.\n\nMultiple nodules versus multifocal infectious process.  Reassessment of the\npatient in 3 months is required.\n\nBibasal areas of atelectasis that potentially might represent infectious\nprocess.\n\nSevere emphysema.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:23 ___, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST: The thyroid is unremarkable.  There is no axillary or supraclavicular\nadenopathy.  There are prominent, but not pathologically enlarged lymph nodes.\nHeart size is normal.  There is no pericardial effusion.\n\nAn endotracheal tube is in appropriate position.  There is debris within the\ntrachea.  Airways are notable for mucous plugging at the lung bases\nbilaterally.\n\nThere is a moderate left pneumothorax.  There is multifocal consolidative\nairspace opacity, most pronounced at the lung bases.  In addition in the lung\napices and superior segment of the right lower lobe, there are also scattered\nregions of ground-glass opacity.  Note is made of an azygos lobe on the right.\n\nThe thoracic esophagus is notable for distal wall thickening.\n\nThere are two pleural-based masses in the right lower hemithorax measuring 1.9\nx 1.7 and 1.1 x 1.3 cm (series 3B, image 300)\n\nVASCULAR: There is no active extravasation of IV contrast.  The portal vein is\npatent.  Hepatic arterial anatomy is conventional.  There is one renal artery\nbilaterally.  There is mild atherosclerotic disease.  There is no abdominal\naneurysm.  Thoracic aorta is normal in caliber.  There is no aneurysmal\ndilation.  There is no significant atherosclerotic disease.  Pulmonary\narteries are well opacified to the segmental level bilaterally.  There is no\nevidence of filling defect.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.  There is small volume ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance symmetrically.  There are subcentimeter\nhypodensities bilaterally, statistically likely simple cysts.  In addition,\nthere is a wedge-shaped area of hypodensity involving the right lower pole,\nconsistent with a renal infarct ___ B, image 81).\n\nGASTROINTESTINAL: Distal esophagus is thickened.  There is a small hiatal\nhernia.  Small and large bowel are fluid-filled.  There is no evidence of\nobstruction.  Bowel wall is hyperenhancing.  There is no bowel wall\nthickening.  Appendix is normal.  There is no intra-abdominal free fluid or\nfree air.\n\nRETROPERITONEUM: There are enlarged low-density lymph nodes measuring 1.1 and\n1.5 cm adjacent to the diaphragm (series 3B, image 323).  There is also an\nenlarged gastric lymph node measuring 1.3 cm (series 3A, image 108).\n\nPELVIS: The bladder is decompressed with a Foley catheter.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.  There is a large right\nhydrocele with septations.\n\nBONES: There are fractures of the left anterior second, third, fourth, fifth,\nsixth, seventh ribs, almost all significantly displaced.  There also fractures\nof the anterior right second, third, fourth, fifth, and sixth ribs, mildly\ndisplaced.  There is a nondisplaced sternal fracture.  There is soft tissue\nnodularity posterior to the left sixth ribs in continuity with the pleura, of\nuncertain significance (series 3A, image 97).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Moderate left pneumothorax.\n2. Multiple bilateral displaced rib fractures, worse on the left. \nNondisplaced sternal fracture.\n3. No evidence of active extravasation of contrast.\n4. Sequela of aspiration in the lungs.  Additional ground-glass opacities in\nthe lungs, could also be related to aspiration however, pulmonary hemorrhage\nis not excluded.\n5. Small right lower pole renal infarction.\n6. Thickening of the distal esophagus with enlarged crural and gastric\nlymphadenopathy, recommend non-emergent EGD to exclude underlying mass.\n7. Large septated right scrotal hydrocele, non-emergent scrotal ultrasound is\nsuggested.\n8. Two right lower hemithorax pleural-based masses measuring up to 1.9 cm, of\nuncertain significance, possibly nerve sheath tumors, correlate with prior\nimaging evaluate for stability.\n\nRECOMMENDATION(S):  EGD and non-emergent scrotal ultrasound.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:33 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Supraclavicular lymph nodes enlarged at one time are normal size today.\nNumerous axillary lymph nodes mostly subcentimeter in size, range in diameter\nup to 13 x 18 mm on the right, 04:39, previously 13 x 20 mm and 9 x 11 mm on\nthe left, 04:52, previously 12 x 13 mm in ___.  In the hila and\nmediastinum there are no pathologically enlarged nodes, nor are there any in\nthe diaphragmatic, internal mammary, or retrocrural stations.\n\nThyroid is unremarkable. Aorta and pulmonary arteries are normal size.\nAtherosclerotic calcification is undetected. There is no pleural or\npericardial abnormality.\n\nThree foci of irregular masslike consolidation in the left lower lobe, are\nnew, 14 x 28 mm and 23 x 28 mm in the lateral basal segment, 4: 202 and 210,\nand 23 x 21 mm in the posterior basal segment, 4: 211. There may be tiny\ncavities in the latter 2 lesions. There is small bronchiolar nodulation and\nscattered ground-glass opacification surrounding the larger lesions, and even\nthough they extend to the pleural surfaces there is no effusion or appreciable\nthickening. A geographic 8 x 7 mm ground-glass lesion in the superior segment\nof the left lower lobe, 4:160 and ground-glass and peribronchial opacification\nsurrounding the subsegmental bronchial divisions in the lateral basal segment\nof the left lower lobe, 4:169- 176, causing narrowing of the subsegmental\nbronchi are all new and presumably manifestations of the same infection\ncausing the larger lesions. The findings below the diaphragm will be reported\nseparately. Bochdalek's diaphragmatic hernias are of little clinical\nsignificance.\n\nA 4 mm right apical nodule, 04:57 and a 3 mm right lower lobe nodule, 4:145,\nhave been present since ___, not appreciably changed, are\ninsignificant.\n\nThere are no findings in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Large areas of new infection, left lower lobe, could be bacterial or fungal.\n\nContinued involution of a adenopathy, now restricted to the axillae\n\nNOTIFICATION:   Dr. ___ reported the findings to ___ by telephone\non ___ at 8:51 AM, 5 minutes after discovery of the findings."
        },
        {
            "input": "The thyroid gland is unremarkable. A previously referenced right hilar lymph\nnode has decreased in size measuring 7 mm, previously 10 mm (4, 138). This may\nreflect improvement in a reactive response rather than decreased involvement\nby CLL. Bilateral axillary lymphadenopathy is stable as compared to ___.\nA representative right axillary lymph node is not significantly changed in\nsize measuring 1.4 x 1.0 cm, previously 1.3 x 1.2 cm (4, 43).\n\nThere is mild cardiomegaly with multi-chamber enlargement and scattered\ncoronary artery calcifications. There is no pericardial effusion. The main\npulmonary artery is within normal limits. However, the ascending aorta is\nmildly ectatic measuring up to 3.7 cm in greatest transverse dimension.\n\nEvaluation of the lungs demonstrates interval improvement in previously seen\nbranching tubular ___ opacities with near complete resolution of\nassociated consolidations. The remaining ___ opacities predominantly\ninvolve the bilateral lower lobes, and to a lesser extent, the lingula and\nright middle lobe. There is worsening of traction bronchiectasis and\nsubsegmental atelectasis involving the medial segment right middle lobe with\nresultant volume loss.  Bilateral lower lobe peribronchial thickening and mild\nbronchiectasis is unchanged. Bilateral basal segmental bronchi mucoid\nimpaction has resolved. There is no pleural effusion.\n\nMild multilevel spinal degenerative changes are most pronounced at L5-S1.\n\nFor a detailed discussion of the subdiaphragmatic and supraclavicular soft\ntissues, please refer to the separate reports from the CT abdomen/pelvis and\nneck CT's performed concurrently.",
            "output": "Stable mild bilateral axillary lymphadenopathy compatible with the known\nhistory of CLL.\n\nInterval improvement in multifocal pneumonia with persistent evidence of\ninfectious small airways disease, which may reflect chronic aspiration.\n\nWorsening traction bronchiectasis and subsegmental atelectasis of the medial\nsegment right middle lobe due to chronic infection."
        },
        {
            "input": "The thyroid is normal.  Bilateral mild axillary lymphadenopathy is unchanged.\nFor example, a representative left axillary lymph node measures 1.2 cm (4:29),\npreviously measuring 1.1 cm in ___. There are no pathologically enlarged\nsupraclavicular, mediastinal, or hilar lymph nodes identified.\n\nThe ascending aorta is mildly ectatic measuring up to 3.8 cm in maximum\ndiameter (2:29). The main pulmonary artery is normal in caliber. The heart\nsize is normal.  There is no pericardial effusion.\n\nThere is no evidence of pleural effusion or pneumothorax. The airways are\npatent to subsegmental levels.\n\nWithin the lungs, there has been interval improvement and near complete\nresolution of the previously seen consolidations and ___ opacities\npredominantly affecting the bilateral lower lobes. Unchanged traction\nbronchiectasis and focal scar within the medial segment of the right middle\nlobe is unchanged in appearance as compared to the prior exam. A stable 4 mm\npulmonary nodule is again noted within the posterior right upper lobe (4:62).\nBibasilar atelectasis is noted, more significant on the left.\n\nOSSEOUS STRUCTURES:  There are no destructive focal osseous lesions concerning\nfor malignancy identified within the imaged thoracic skeleton.\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. For further details, please see the concomitant dedicated CT\nabdomen and pelvis.",
            "output": "1.  Mild bilateral axillary lymphadenopathy consistent with known CLL.\n2.  Near-complete resolution of prior multifocal pneumonia.\n3. Focal scar and traction bronchiectasis within the medial segment of the\nright middle lobe, unchanged from the prior examination.\n4. Stable 4 mm solid pulmonary nodule within the right upper lobe."
        },
        {
            "input": "Bilateral increase in number axillary lymph nodes have minimally decreased in\nsize on the right measuring up to 8 mm were 10 mm on the left measuring 6 mm\nwas 7 mm\nPeribronchial opacities and minimal bronchiectasis in the right middle lobe\nare unchanged. There are no new lung nodules end tiny calcified nodule in the\nright upper lobe and the triangular opacity measuring 2 mm in the right lower\nlobe are unchanged (4:150 there are no new lung nodules .\nThere is a tiny calcified granuloma in the left upper lobe (4:74\n\nThe thyroid is normal. Supraclavicular, mediastinal and hilar lymph nodes are\nnot enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.  .\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Mild decrease in size in bilateral axillary lymphadenopathy.\nNo new or growing lung nodules"
        },
        {
            "input": "Supraclavicular lymph nodes are not enlarged.  Axillary nodes are numerous but\nsmaller.  The largest on the right is 7 mm in short axis diameter, previously\n11 mm on ___.  There no other soft tissue abnormalities in the\nimaged chest wall suspicious for malignancy.  Findings in the neck and abdomen\nwill be reported separately.  Note is made of congenital right posterior\ndiaphragmatic (Bochdalek) hernia.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in the\nhead and neck vessels, but is present in the coronaries at least in a branch\nof the left anterior descending artery.  Aorta and pulmonary arteries are\nnormal caliber and free of filling defects centrally.  There is no pericardial\nor pleural abnormality.\n\nCentral lymph nodes in the mediastinum and hila and in the internal mammary,\ndiaphragmatic and retrocrural stations are not enlarged.\n\nRight lung is clear aside from atelectasis in the middle lobe.  Left lung is\nclear.  Tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Continued regression of previous axillary adenopathy.  No evidence of active\nthoracic malignancy or infection.\n\nCoronary atherosclerotic calcification."
        },
        {
            "input": "The thyroid is unremarkable.  Non pathologically enlarged axillary lymph nodes\ncontinue to decrease in size for example, the largest lymph node in the right\naxilla measures 7 mm (series 4, image 13) and was 10 mm on ___. \nThere is no supraclavicular or mediastinal adenopathy.  Heart size is normal. \nThere is no pericardial effusion.  Coronary artery calcifications are mild. \nThe great vessels are unremarkable.\n\nAirways are patent and normal to the subsegmental level bilaterally.  Right\nmiddle lobe scarring is unchanged.  A 4 mm right upper lobe pulmonary nodule\nis stable dating back to at least ___ (series 5, image 75).  A calcified left\nupper lobe granuloma is unchanged as expected.  There is no focal\nconsolidation, pneumothorax, or pneumomediastinum.\n\nThe thoracic esophagus contains a tiny diverticulum.  There is a small left\nBochdalek's hernia.  Please see separate dictation for subdiaphragmatic\ndetails.\n\nOSSEOUS STRUCTURES:  There are no suspicious bony lesions.",
            "output": "Continued regression of axillary lymphadenopathy."
        },
        {
            "input": "Numerous bilateral axillary lymph nodes are again demonstrated, none of which\nindividually meet size criteria for enlargement.  As compared to 2 ___ CT, the lymph nodes are similar in size and number.  No enlarged\nmediastinal or hilar nodes are identified.  Heart size remains normal, and\nthere is no pericardial or substantial pleural effusion. Ascending aorta is\nectatic measuring up to 4.0 cm in greatest diameter, unchanged.\n\nSkeletal structures of the thorax demonstrate no new suspicious lytic or\nblastic lesions.\n\nWithin the lungs, as a 4 mm right upper lobe nodule is unchanged (87, 6). \nLocalized scarring and cylindrical bronchiectasis in the right middle lobe is \nunchanged compared to ___ chest CT as well as mild cylindrical\nbronchiectasis in both lower lobes.",
            "output": "1.  Stable CT appearance of the chest compared to ___ with\nunchanged subcentimeter bilateral axillary lymph nodes.\n\n2.  Please see separately dictated CT of the neck, abdomen and pelvis for\ncomplete description of extrathoracic findings."
        },
        {
            "input": "Current study demonstrate no mediastinal or hilar lymphadenopathy.  Multiple\nsmall axillary lymph nodes are bilateral and although small, all sub 10 mm in\ndiameter appears to be minimally increased by a virtue of 1-2 mm as compared\nto previous study.  Heart size is normal.  There is no pericardial or pleural\neffusion.\n\nAorta is 4 cm in diameter at the level of the ascending aorta and although not\nenlarged by the CT criteria appears to be substantially bigger than the a\nadjacent pulmonary artery (2.4 cm).\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\nnodule is stable, series 4, image 156 as well as right middle lobe focal area\nof atelectasis/scarring, series 4, image 172.  No new nodules masses or\nconsolidations demonstrated.\n\nExtensive network of the venous collaterals corresponds to narrowing in the\nlevel of the left subclavian vein.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Not enlarged but multiple and minimally increased since the prior study\nbilateral axillary lymph nodes.\n\nTop-normal aorta.  Continues annual surveillance is to be considered with CT\nangiography of the chest.\n\nStable right lower lobe pulmonary nodule and right middle lobe area of\natelectasis."
        },
        {
            "input": "The imaged thyroid gland is homogeneous in attenuation without focal\nnodularity.  Numerous bilateral scattered axillary nodes bilaterally are\nstable in size and number relative to prior examination dated ___. \nThere is no supraclavicular adenopathy.  Central nodes are not pathologically\nenlarged, the largest within the right lower paratracheal station measuring 3\nmm (02:22).  There is no appreciable hilar adenopathy.\n\nAscending aorta is top normal in diameter, stable since prior study and not\nenlarged by CT criteria.  Mild coronary artery calcifications involve the left\nanterior descending coronary artery.  Heart size is normal.  There is no\npericardial effusion.\n\nTriangular 2 mm perifissural nodule within the right middle lobe (4:171) is\nstable.  Right middle lobe focal area of atelectasis/scarring (4:  220) is\nunchanged. Punctate calcified granuloma within the left upper lobe (4:96) is\nstable as expected.\n\nBibasilar bronchiectasis in the lower lobes is chronic with platelike\nbilateral subsegmental atelectasis grossly symmetric in appearance.  Scattered\nsecretions within the bronchi are associated with trace secretions within the\ntrachea.  Subtle but present centrilobular ground glass opacities in the right\nlower lobe are also new.  There is no pleural effusion or pleural abnormality.\n\nThere are no worrisome osseous lesions in the chest cage.\n\nThere is a small hiatal hernia.  Although examination is not tailored for\nsubdiaphragmatic evaluation, images of the upper abdomen, punctate\ncalcification in the posterior aspect of the image left upper kidney is noted,\npresumed previously unchanged.",
            "output": "1. Chronic lower lobe bronchiectasis and subsegmental atelectasis associated\nwith scattered secretions within the bronchi.  Findings in the setting of\nsubtle ground glass centrilobular opacities suggest chronic aspiration with\nlikely superimposed infectious component.\n\n2. Stable not enlarged axillary nodes bilaterally, nonspecific.\n\n3. Top normal aorta, unchanged.\n\n4. No new or growing pulmonary nodules."
        },
        {
            "input": "CT CHEST WITHOUT IV CONTRAST: The partially imaged thyroid is unremarkable.\nThere is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy.\nEsophagus is grossly normal.\n\nHeart size is normal without pericardial effusion. The thoracic aorta and\nproximal great vessels are normal in caliber. The main pulmonary artery is\nnormal in caliber.\n\nThe airways are patent to the subsegmental level.  There is no pleural\neffusion or pneumothorax.  There are extensive multifocal but predominantly\nperipheral opacities with ground-glass, reticulation and areas of more dense\nconsolidation.  Some peribronchial opacities are also seen.  These findings\nare most severe in the lower lobes.  There is minimal bronchial wall\nthickening and no bronchiectasis.\n\nOSSEOUS STRUCTURES: There is no worrisome skeletal lesion.\n\nUPPER ABDOMEN: This study is not optimized for evaluation of subdiaphragmatic\nstructures and is especially limited without IV contrast. Within these\nlimitations the partially visualized solid organs and stomach are grossly\nnormal.",
            "output": "Diffuse predominantly peripheral opacities most severe in the lower lobes.\nDifferential includes organizing pneumonia, NSIP or eosinophilic pneumonia;\ninfection is thought less likely but parasitic infection should be considered\ngiven provided clinical history. Tissue diagnosis is recommended for\nconfirmation."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodense lesion in the central\naspect of the thyroid gland measures 16 mm in diameter and is unchanged\ncompared to prior.  No supraclavicular or axillary adenopathy.  No gross\nbreast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Small hiatal hernia.  No adrenal lesions.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nMinimal aortic annular calcification.  No coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  3 mm pulmonary nodule seen in the right upper lobe (5, 159) and\n2 mm nodule in the left upper lobe (5, 41).  These nodules appear similar\ncompared to prior imaging done ___.  No new or enlarging pulmonary\nnodules or masses.  No confluent airspace consolidation.  No diffuse lung\ndisease.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not enlarged\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "The previously noted sub 4 mm nodules are unchanged.\n\nHypodense lesion in the central aspect of the thyroid gland: please correlate\nwith previous thyroid ultrasound and biopsy.\n\nRECOMMENDATION(S):  No further follow-up recommended for the pulmonary\nnodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary artery is mildly dilated measuring 3.4 cm.  The aorta\nis normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Multiple small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.\n\nLUNGS:\nAtelectasis with indwelling traction bronchiectasis and calcifications in the\nleft upper lobe, likely a sequela from prior granulomatous infection.  5 mm\nnodule in the right upper lobe (4:70).  The remaining airways are patent to\nsubsegmental levels.  Partial atelectasis in both lower lobes is noted.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "No evidence of current acute pneumonia.\nSmall 5 mm solid nodule.  Follow-up is recommended below.\nAtelectasis with indwelling traction bronchiectasis and calcified granulomas\nin the left upper lobe, likely sequela from prior granulomatous infection.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The aorta and its major branch vessels are patent, and unremarkable. There is\nno evidence of penetrating atherosclerotic ulcer or aortic arch atheroma\npresent.\n\nThe pulmonary arteries are well opacified with filling defects evident in the\ndistal right and left main pulmonary arteries extending into the segmental and\nsubsegmental arteries with heavy is clot burden extending into the bilateral\nlower lobes. The main, left, and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThe lung apices are excluded from the field of view.  Mild dependent\natelectasis is seen bilaterally.  A peripheral opacity in the left lung base\nmost likely represents atelectasis, however a small pulmonary infarction is\npossible (3:138).  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "Pulmonary emboli in the distal right and left main pulmonary arteries\nextending into the segmental and subsegmental branches bilaterally, most\nsignificantly at affecting the lower lobes.  A small opacity at the left lung\nbase may represent atelectasis, however a small pulmonary infarction is\npossible.  No evidence of right heart strain."
        },
        {
            "input": "The thyroid gland is unremarkable.  A few mildly prominent mediastinal lymph\nnodes measure up to 10 mm in short axis in the right lower paratracheal\nlocation.  There are no pathologically enlarged supraclavicular, axillary, or\nhilar lymph nodes.\n\nCardiomegaly with predominantly right-sided enlargement is mild. A left\npectoral pacemaker sends leads to the right atrium and right ventricle. Aortic\nvalvular calcifications are mild, but coronary artery calcifications are\nextensive. There is trace physiologic pericardial effusion. The main pulmonary\nartery and thoracic aorta are normal caliber.\n\nMild to moderate centrilobular and paraseptal emphysema is most extensive at\nthe left apex. There are retained secretions in the trachea. Moderate diffuse\nbronchial wall thickening is present. Left posterior/basal pleural\ncalcifications and thickening are present. There is also left-sided volume\nloss with presence of a 1.3 x 1.9 cm rounded opacity at the peripheral aspect\nof the left lower lobe (5, 255). This opacity is associated with swirling of\nthe bronchovascular structures.  A few punctate pulmonary micronodules\nmeasuring no more than 2 mm are identified (5: 97, 126, 183, 196). Left upper\nlobe linear atelectasis is incidentally noted.\n\nImages of the upper abdomen show a 3 cm right hepatic lobe cyst. The liver is\nnormal in size and attenuation.\n\nGeneralized osteopenia and multilevel spinal degenerative changes are\nmoderate. No destructive bone lesions are identified.",
            "output": "No evidence of amiodarone toxicity.\n\nLeft lower lobe rounded atelectasis with associated pleural thickening and\ncalcification.\n\nMild to moderate centrilobular and paraseptal emphysema is most extensive in\nthe left upper lobe.\n\nModerate diffuse bronchial inflammation.\n\nHandful of pulmonary micronodules measuring no more than 2 mm do not warrant\nspecific followup in a low risk patient."
        },
        {
            "input": "HEART AND VASCULATURE: Examination is slightly limited in the setting of\nrespiratory motion artifact.  Within this limitation, the pulmonary\nvasculature appears well opacified to the segmental level without filling\ndefect to indicate pulmonary embolus.  The main pulmonary artery is normal in\nsize.  The thoracic aorta is normal in caliber without evidence of dissection\nor intramural hematoma.  A right-sided central venous catheter is seen\nterminating in the right atrium.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple enlarged axillary lymph nodes\nmeasuring up to 1.2 cm in short axis on the left are increased in size\ncompared to ___ (for example 03:28, 37).  Multiple mediastinal and hilar\nlymph nodes, some of which demonstrate coarse calcification, measure up to 1.4\ncm in the subcarinal station are also enlarged compared to prior PET-CT\nperformed ___ (3:73, 66, 86, 91, 95).\n\nPLEURAL SPACES: Small right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of lung parenchyma is limited secondary to\nrespiratory motion artifact.  Ill-defined opacity in the right upper lobe is\nconcerning for pneumonia.  (For example 3:72).  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a large distal\nesophageal lymph node measuring 2.6 x 3.4 cm with internal hypodensity and\nmild surrounding soft tissue stranding, concerning necrosis and inflammation\n(2:75).  This is new compared to prior PET-CT.  Multiple retro-crural and\nporta hepatic lymph nodes are increased in size compared to ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Multiple enlarged axillary, mediastinal, and hilar lymph nodes are\nincreased in size compared to PET-CT performed ___, concerning for\nprogression of disease.\nRight upper lobe consolidation concerning for pneumonia.\n3. Prominent large necrotic and inflamed distal esophageal lymph node is new\ncompared to ___.\n4. Small right pleural effusion.\n\nNOTIFICATION:  The updated findings were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at\n11:18 pm, 5 minutes after discovery of the findings."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Mediastinal lymph nodes are\nmultiple, decreased in the interim since previous examination and some of them\ncalcified.  There is substantial interval decrease in size in the axillary\nlymph nodes even more pronounced than in mediastinal lymph nodes.  For example\nleft axillary lymph nodes have decreased in size from 11 to 9 mm, series 4,\nimage 12, from 14 till 7 mm.  Mediastinal lymph nodes have decreased from 11\nto 8 mm, series 4, image 20.\n\nHeart size is normal.  There is no pericardial or pleural effusion.\n\nSmall hiatal hernia is present.  Image portion of the upper abdomen will be\nreviewed separately as part of the CT abdomen pelvis in corresponding report\nwill be issued.\n\nAirways are patent to the subsegmental level bilaterally.  There is interval\nresolution of bilateral pleural effusions and consolidations.  No new nodules\nmasses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval decrease in size of mediastinal and high axillary lymph nodes as well\nas resolution of consolidations and pleural effusion.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "Port terminates at the cavoatrial junction.\n\nHeart is borderline in size. Coronary artery calcification is mild.  Great\nvessels are normal in caliber.\n\nA subcarinal lymph node or conglomerate of nodes measures up to 32 by 12 mm in\naxial ___ (2:26), not significantly changed.  Additional small\nmediastinal lymph nodes are largely calcified.  Small bilateral hilar lymph\nnodes are also again calcified.  Some of the noncalcified or only minimally\ncalcified nodes have slightly decreased.  For example, a left paratracheal\nlymph node measured 17 x 14 mm in axial ___ on the prior study and now\nonly 13 x 11 mm.  A small anterior node, previously 8 mm, now measures 6 mm\n(2:17), as a second example.\n\nThere is no pericardial effusion.  A right-sided pleural effusion is new but\nvery small.  Trace new left-sided pleural effusion.\n\nUnchanged minor platelike atelectasis in the anterior segment of the right\nupper lobe. Minor atelectasis at each lung base, right greater than left,\nassociated with small right-sided pleural effusion. New small subpleural\nnodular opacity in the lingula measuring 6 mm (4:101), likely inflammatory. In\nthe left lower lobe, additionally, in the superior segment, new patchy\nbronchovascular opacities are more suggestive of an infectious or inflammatory\netiology, possibly aspiration, more so than lymphoma.\n\nRetrocrural nodes are essentially unchanged.  Largest is on the right and\nmeasures 28 x 14 mm, not significantly changed.  A second example is a left\nposterior medial node that measures 23 x 15 mm, also unchanged.  A number of\nsmall celiac nodes are not well resolved, probably unchanged.\n\nPartly imaged spleen is probably enlarged.  There is small hiatal hernia.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.  Vertebral\nbodies are preserved in height.",
            "output": "Slight decrease in mediastinal nodes.  Small new right-sided pleural effusion.\nNew patchy bronchovascular opacities in the superior segment of the left lower\nlobe, suggesting infectious or inflammatory process, perhaps minor aspiration.\nCorrelation with clinical circumstances is recommended."
        },
        {
            "input": "THORACIC INLET: There is no change in the small bilateral supraclavicular\nlymph nodes the largest on the left measures 6 mm.\n\nBREAST AND AXILLA  : Small bilateral axillary and subpectoral lymph nodes\nmeasuring 6 mm in short axis are also unchanged.\n\nMEDIASTINUM: The mediastinal lymph nodes are also unchanged in size these\nrange in size from 9 mm stable to 17 mm.  Some of the mediastinal lymph nodes\nhave central calcification within them.  Small bilateral hilar lymph nodes are\nalso unchanged.  Again some of the hilar nodes have central calcification. \nThere is a small hiatus hernia.  There is moderate cardiomegaly.  There is no\npericardial effusion.  There is a right-sided Port-A-Cath with its tip in the\nSVC.  The retrocrural lymph nodes are also unchanged largest on the right\nmeasures 12 mm.  Several small left retrocrural lymph nodes are also\nunchanged.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Multiple tiny 1-2 mm bilateral pulmonary nodules are unchanged.  There\nis a stable band of atelectasis within the right middle lobe.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  There are degenerative changes involving the\nthoracic spine.  There is mild wedge compression involving L2 vertebral body,\nunchanged\n\nUPPER ABDOMEN: Sections through the upper abdomen shows evidence of\nsplenomegaly.  Please refer to dedicated report on abdomen which has been\ndictated separately.",
            "output": "No significant interval change within multi station adenopathy within the\nchest lower neck and upper abdomen.\n\nNumerous tiny pulmonary nodules ranging in size from 1-2 mm, could be\ninflammatory..\n\nStable small hiatus hernia.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is normal.  Overall\ndecrease in size and number multiple prior subcentimeter supraclavicular,\nsubpectoral, and axillary lymph nodes.  No atherosclerotic calcification of\nthe head and neck vessels.  Right pectoral Port-A-Cath terminates at the caval\natrial junction.\nNo soft tissue abnormalities elsewhere in the chest wall concerning for\nmalignancy.\n\nMEDIASTINUM/HILA: No mediastinal mass.  Several subcentimeter, partially\ncalcified lower paratracheal lymph nodes noted.  Overall decreased size of\nmultiple prior mediastinal lymph nodes.  For example, subcarinal lymph node\nmeasures 10 mm (previously 15 mm), retroesophageal and right hilar lymph nodes\nmeasuring 6-7 mm (previously 11 mm).  No hilar mass or lymphadenopathy.  Small\nhiatal hernia\n\nHEART and PERICARDIUM: Mild cardiomegaly..  Coronary arteries are minimally\ncalcified.  The aortic valves and annulus are noncalcified. No pericardial\neffusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  No focal consolidation.  Re-demonstrated right middle lobe\nscarring.  No diffuse lung disease.  Multiple 1-2 mm pulmonary nodules are\nunchanged.  No new or growing nodules.\n2. AIRWAYS: Tracheobronchial tree is patent to the subsegmental level.\n3. VESSELS: The aorta and pulmonary artery are normal caliber.  No incidental\npulmonary emboli on this non-dedicated study.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.  Stable chronic mild anterior wedging of L1.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.\n\nUPPER ABDOMEN:\nPlease refer to dedicated CT abdomen pelvis report from the same day for\ndetails of intra-abdominal findings..",
            "output": "1. Overall improved disease with decrease in size and number of the previously\nmentioned supraclavicular, subpectoral, axillary, and mediastinal lymph nodes.\n2. Multiple 1-2 mm pulmonary nodules are unchanged.  No new or growing\nnodules.\n3. Please refer to dedicated CT abdomen pelvis report from the same day for\ndetails of intra-abdominal findings.."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  Conglomerate of upper paratracheal lymph nodes measuring\napproximately 17 mm x 17 mm (6; 96) appears increased in size compared to the\nprior exam at which time this measured up to 12 mm.  Subcarinal\nlymphadenopathy has also increased in size compared to the prior exam, now\nmeasuring up to 15 mm x 25 mm.  Mildly prominent right hilar lymph nodes are\nunchanged compared to the prior exam.  There has been slight interval increase\nin the size of the left hilar lymph nodes compared to the prior exam (6; 127)\nmeasuring up to 12 mm.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.  The aorta is normal in caliber.  The main\npulmonary artery is normal in caliber.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nA new 9 mm nodular opacity seen within the right lower lobe (6; 186).  There\nis no pleural effusion or pneumothorax.",
            "output": "-Interval progression of mediastinal and left hilar lymphadenopathy compared\nto the exam from ___, concerning for progression of disease.\n-New 9 mm nodular opacity within the right lower lobe, could be inflammatory\nin etiology however a three-month follow-up with chest CT is recommended for\nfurther evaluation\n\nRecommendations:\n\nThree-month follow-up with chest CT is recommended."
        },
        {
            "input": "THORACIC INLET: There is a right-sided prior Port-A-Cath with its tip in the\ndistal SVC.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes some with areas of calcification\nare unchanged in size.  The subcarinal lymph node measures 15 x 25 mm,\nunchanged.  There is the left para-aortic lymph node measuring 5 mm (5, 42)\nslightly more prominent than on the prior study.  1 of the right hilar lymph\nnodes have significantly increased in size since the prior study and now\nmeasures 2.0 x 2.0 it was barely perceptible on the prior study.  All the\nother previously visualized small  hilar lymph nodes are unchanged in size. \nStable.  Some of these have dystrophic calcification within them.  The\nesophagus is patulous and dilated.  There is no pericardial effusion.  Stable\nsmall right retrocrural lymph node.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are well expanded.  There is linear subsegmental atelectasis\nwithin the right middle lobe and the right lung base.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows mild left\nadrenal thickening.  Please refer to dedicated report on abdomen which has\nbeen dictated separately.",
            "output": "Increase in size of a right hilar lymph node which now measures 2 x 2 cm, new\nsince the prior study concerning for recurrent lymphoma.  1 of the para-aortic\nlymph nodes are slightly more prominent.  All the other previously mediastinal\nlymph nodes are unchanged.  Small bilateral hilar lymph nodes are also stable.\nSome of the nodes in the mediastinum hilum have a dystrophic calcification\nwithin them.  Stable subcentimeter right retrocrural lymph node.\n\nLinear subsegmental atelectasis in the right lung base.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.\n\nBilateral hilar calcified lymph nodes are similar to previous chest CT from ___ but there is substantial interval decrease in size in the\nnoncalcified hilar lymphadenopathy, for example in right hilum, where the\nlymph node has decreased from 2.52 0.9 cm, series 5, image 45, in the\nsubcarinal location the lymph node has decreased from 11-5 mm, series 5, image\n43, and in aortopulmonic window the lymph node has decreased from 15-10 mm,\nseries 5, image 30.  No axillary or supraclavicular lymphadenopathy\ndemonstrated.\n\nCentral venous line of the Port-A-Cath terminates in the right ventricle. \nHeart size is normal.  There is no pericardial or pleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  New extensive\ninvolvement of the lungs by multifocal opacities is demonstrated in the upper\nlobes, series 6, image 56, 82, 105 as well as in lower lobes, series 6, image\n114, 155, 174, 193, findings consistent with extensive infectious process and\nless likely aspiration.  Neoplasm is extremely unlikely.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval substantial decrease in size in the right hilar lymph node and\nadditional lymph nodes as described\n\nMultifocal infection, extensive.  The findings are more consistent with\nbacterial infection and less consistent with viral infection, please correlate\nwith patient's symptoms.  Aspiration is less likely.  Follow-up with chest CT\nin 8 weeks is recommended for documentation of resolution\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The visualized thyroid gland is unremarkable. \nThere is no supraclavicular or axillary lymphadenopathy.  Please see separate\nsame day CT neck report for further description of the neck findings.\n\nMEDIASTINUM: There are multiple calcified and noncalcified mediastinal lymph\nnodes including a 1.1 x 1.4 cm left lower paratracheal node (series 3, image\n71) (previously 1.1 cm), a 0.9 x 2.0 subcarinal node (series 3, image 99)\n(previously 9 mm).  No new or enlarging lymph nodes identified.  Small hiatal\nhernia.\n\nHILA: No hilar lymphadenopathy.\n\nHEART AND VESSELS: The heart is normal in size.  No pericardial effusion is\nidentified.  Mild coronary artery calcifications.  The tip of the right\npectoral Port-A-Cath terminates in the cavoatrial junction.  The thoracic\naorta is normal in caliber and has mild atherosclerotic calcification.  The\nmain pulmonary artery is normal in caliber.\n\nPLEURA: No effusion or pneumothorax.\n\nAIRWAYS/LUNG: The lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the subsegmental level bilaterally. \nThe previously seen scattered bilateral pulmonary opacities have resolved and\nwere likely infectious.\n\nBONES: No suspicious osseous lesions are identified.\n\nSOFT TISSUES: No soft tissue abnormality.\n\nUPPER ABDOMEN: Please see separate same day CT abdomen/pelvis report for\ndescription of the subdiaphragmatic findings..",
            "output": "1. Stable mildly enlarged mediastinal lymph nodes, as above.  No new or\nenlarging axillary, hilar, or mediastinal lymph nodes.\n2. Interval resolution of the previously seen scattered pulmonary opacities. \nNo new masses or areas of parenchymal opacification.\n3. Please see separate same day CT abdomen/pelvis report for description of\nthe subdiaphragmatic findings.\n4. Please see separate same day CT neck report for further description of the\nneck findings."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\na trace pericardial effusion.\n\nA right lateral approach chest tube is noted, coiling in what appears to be\nthe inferior right subpleural space.  There is a moderate large residual\nhydropneumothorax identified on the right. A small to moderate left pleural\neffusion is also noted.  There is near complete collapse of the right lower\nlobe and partial collapse of the right middle lobe with associated\nconsolidation. Similarly, left lower lobe consolidation is noted adjacent the\npleural effusion.\n\nNo suspicious osseous lesions are identified.  Subacute right eighth and ninth\nrib fractures are noted.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents. Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "1.  Right chest tube terminating in the inferior right subpleural space.\nModerate to large residual right and small to moderate left pleural effusions.\n2.  Consolidations involving the right middle, right lower, and left lower\nlobes demonstrate air bronchograms and are worrisome for partial atelectasis\nwith superimposed pneumonia.\n3.  Subacute rib fractures involving the lateral aspects of the right eighth\nand ninth ribs."
        },
        {
            "input": "The partially imaged thyroid is unremarkable.  There is diffuse mild\nesophageal dilation throughout the chest without focal lesion.  There may be a\nsmall hiatus hernia.  The aorta and pulmonary artery normal in caliber.  Major\naortic arch branch vessels are widely patent.  There is no significant\nthoracic aortic and mild coronary artery atherosclerotic calcification.  The\nheart is unremarkable.  Trace pericardial fluid is within normal physiologic\nrange.  A prominent precarinal lymph node measures 9 mm in short axis (series\n6, image 22).  Otherwise, there is no mediastinal, hilar, axillary, or\nsupraclavicular lymphadenopathy.\n\nMajor airways are patent to subsegmental levels.  Upper lobe predominant\nparamediastinal pleural thickening and subpleural fibrotic change likely\nrelates to prior radiotherapy.  Left-sided irregular pleural thickening is\nparticularly prominent at the posterior left upper lobe, and extends\ninferiorly. There is a left upper lobe 5 mm nodule (series 7, image 41). \nThere is an 8 x 5 mm nodule in the subpleural left upper lobe (series 7, image\n116).  More inferiorly, a subpleural 2- 3 mm nodule is identified (series 7,\nimage 138).  A superior left perifissural nodule measures 4 mm (series 7,\nimage 125).  A more inferior left perifissural nodule measures 2-3 mm (series\n7, image 169).  The left lung base subpleural nodule is 3 mm (series 7, image\n223).  Smaller, 1- 2 mm left lung base subpleural nodule is noted (series 7,\nimage 215).  At the left lung base along the medial pleural surface abutting\nthe posterior right ventricular pericardium is a 2.8 x 2.5 cm enhancing nodule\n(series 7, image 220).  There is a trace layering left pleural effusion. \nThere is no pneumothorax.\n\nThe patient is status post right mastectomy with reconstruction and\nprosthesis.  Otherwise, the imaged subcutaneous soft tissues of the chest wall\nare within normal limits.  There is mild multilevel thoracic spine\ndegenerative change.  Alignment is normal.  There is an 11 x 6 x 9 mm\nsclerotic lesion centered at the base of the T2 spinous process.  No\nadditional focal osseous lesions are identified.",
            "output": "1. Left lung base 2.8 cm enhancing nodule is highly concerning for pulmonary\nmetastasis.\n2. Irregular and prominent posterior left pleural thickening is worrisome for\npleural metastatic involvement.\n3. Multiple additional solid left-sided pulmonary nodules measure up to 8 mm,\nas above.\n4. Trace left layering pleural effusion.\n5. 1.1 cm sclerotic focus centered in the T2 spinous process is most likely a\nbenign bone island given nonvisualization on recent bone scan.  Attention on\nfollow-up.\n6. Upper lobe predominant paramediastinal subpleural fibrotic change likely\nreflects prior radiotherapy.\n7. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Patient has had\nright mastectomy.  There is no evidence of local recurrence.  Anterior ribs\nare intact.  Excluding the left breast which requires mammography for\nevaluation, there are no soft tissue lesions in the chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in the head and neck vessels,\npresent in the coronaries in at least the left anterior descending branch. \nAortic valve is not calcified.  Aorta and pulmonary arteries are normal size.\n\nA large mass at the base of the left hemi thorax involving lung pleurae and\npericardium has grown from 19 x 30 mm to no less than 28 x 30 mm.  It is\nprobably responsible for increase in small to moderate posteriorly layering\nleft pleural effusion.  There are no other large pleural implants.  Small\npericardial effusion has grown, particularly just above the left atrium,\n04:32, but there is no good evidence for invasion of the epicardial fat and no\nfindings of cardiac tamponade.  Right pleural space is unremarkable.  There is\nno evidence of chest wall invasion, but there is thickening of the diaphragm\nand peritoneum anterior to the stomach that may indicate extension\nsubdiaphragmatically, 04:57.\n\nScarring in the upper lobes adjacent to the mediastinum could, given the\nappropriate clinical history be due to prior radiation.  A 6 mm left upper\nlobe nodule, 5:127, was 8 mm on ___.  Punctate left upper lobe nodule,\n5:147, was 2 mm.  2 fissural nodules in the left major fissure are stable.\n\nAlthough there is no pathologic or compression fracture or any lytic lung\nlesion, it should be noted that radionuclide scanning is more sensitive in\ndetecting early osseous metastasis than chest CT.",
            "output": "Interval growth of left pleural or peripheral lung mass and increase in small\nto moderate left pleural effusion and small pericardial effusion, and possible\nleft hemidiaphragm invasion, since ___.\n\n6 mm left upper lobe nodule, was 8 mm in ___.  Punctate left lung and\npleural nodules unchanged.  Would\n\nCoronary atherosclerosis.  Would"
        },
        {
            "input": "Left pleural effusion has increased in the interim, currently moderate to\nlarge.  Minimal amount of pericardial effusion has increased as well, still\nwithout evidence of thumb pronounced physiology based on the CT criteria. \nAorta is overall unremarkable.\n\nRight upper lobe segmental branch of  pulmonary artery demonstrate area flow\ndensity,7 series 4, image 82, concerning for potential pulmonary embolism,\nseries 4, image 81.  In addition subsegmental branch of the pulmonary artery\nin the right lower lobe, series 4, image 157 demonstrate low-density\nconcerning for pulmonary embolism as well.\n\nMediastinal lymph nodes have increased, in the right lower paratracheal area\nfrom 8-11 mm and in sub- carinal area from 6.3 to 8 mm.  No hilar or axillary\nlymphadenopathy is currently seen.\n\nRight breast prostheses is unremarkable.  Image portion of the upper abdomen\nwill be reviewed separately in corresponding report will be issued as part of\nthe CT abdomen and pelvis.\n\nAirways are patent to the subsegmental level bilaterally.  Paramediastinal\nareas of fibrosis are similar to previous examination.\n\nThere is interval increase in pleural nodularity on the left, series 4, image\n35, 40, 127, 163.  Left apical nodule is unchanged, series 4 image 30.  A left\nupper lobe pulmonary nodule, series 4, image 89 is 7.3 mm, minimal increase\ncompared to 6 mm on the previous study.  A left lower lobe mass is currently\nat least 3.4 x 3.7 cm as compared to 3.1 x 3.2 cm, pass increase, series 4,\nimage 161.  Adjacent atelectasis is related to pleural effusion.  Right lower\nlobe subpleural nodule, series 4, image 80 has increased substantially from 4\nto 8 mm, series 4, image 80.  Additional right lower lobe nodule, series 4,\nimage 134 has increased from 3-5 mm, additional right lower lobe nodules,\nseries 4, image 172 have increased from 3 to 5.6 mm and from 2.8-9 mm\nrespectively.  Several additional nodules are present in the right lower lobe,\npole most likely new at the supradiaphragmatic posterior area.\n\n\n\nThere are sclerotic lesions in the skeleton, unchanged, potentially\nrepresenting bone island although sclerotic metastatic disease is a\npossibility, series 602b image 41.",
            "output": "Overall progression of the disease both  in the left hemi thorax including\npleural nodularity and increased pleural effusion as well as in bilateral lung\nparenchyma given the increase in the size and number of pulmonary nodules.\n\nConcern for right upper lobe segmental and right lower lobe subsegmental\npulmonary embolism.  This study was not targeted for assessment of the\npulmonary embolism, thus for presize assessment of the   clot burden dedicated\nCT pulmonary angiography is indicated, also especially if there is a high risk\nassociated with anticoagulation treatment.\n\nNOTIFICATION:  The findings were discussed with O' ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:41 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid gland lesions.  No\nsupraclavicular or axillary adenopathy.\n\nUPPER ABDOMEN: Study was not tailored to evaluate the subdiaphragmatic organs.\nNo adrenal lesions.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Evidence of previous\naortic valve replacement.  Aortic annular calcification.  Suspected LAD and\nright coronary artery stents.  Moderate circumflex calcifications.  No mitral\nannular calcification.  Enlarged left atrium measuring 56 mm in the AP plane. \nNo pericardial effusion.  Aneurysmal dilatation of the ascending aorta\nmeasuring 48 mm in diameter.  3 hyperdense pledgets seen in the anterior\naspect of the ascending aorta in keeping with previous AVR.  Minimal\ncalcification of the inferior aspect of the aortic arch.  No porcelain aorta. \nAnatomical variant: Common origin of the brachiocephalic trunk and the left\ncommon carotid artery (pseudo bovine arch).  Tortuous descending thoracic\naorta.\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace consolidation.  Bandlike and subpleural subsegmental atelectasis seen\nin the lower lung zones.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is enlarged measuring 35 mm in diameter\nsuggestive of pulmonary arterial hypertension.\nCHEST CAGE: Evidence of previous median sternotomy with no evidence of sternal\ndehiscence.  Discontinuity of the inferior-most sternal wire.  Old nonunited\nright posterior seventh, eighth and ninth rib fractures.  Mild spondylotic\nchanges of the thoracic spine with an associated kyphotic deformity.",
            "output": "Aneurysmal dilatation of the ascending aorta measuring 48 mm in diameter.\n\nStable post AVR changes.  3 hyperdense pledgets seen in the anterior aspect of\nthe ascending aorta.  Minimal calcification at the inferior aspect of the\naortic arch.  No porcelain aorta.\n\nNo acute pleural-parenchymal disease."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued2.\n\nAirways are patent to the subsegmental level bilaterally.\n\nNo definitive lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.  Left upper lobe 2.5 mm nodule is stable, series 3, image 50. \nNo other nodules masses or consolidations demonstrated.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separately."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is heterogeneous but there are no findings needing\nany further imaging evaluation.  Supraclavicular and axillary lymph nodes not\npathologically enlarged.  Breast evaluation reserved exclusively for breast\nimaging.  No soft tissue abnormality or fluid collection elsewhere in the\nchest wall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus mildly patulous in the midportion, probably not\nclinically significant.  Atherosclerotic calcification not apparent head neck\nvessels is detected only in the posterior descending coronary artery.  Aorta\nand pulmonary arteries and cardiac chambers are normal size, aortic valve is\nnot calcified and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Sub 3 mm subpleural nodule, left upper lobe, 5:27,\nunchanged since at least ___.  Lungs otherwise clear. \nTracheobronchial tree normal to subsegmental levels.  No pleural\nabnormalities.\n\n\nCHEST CAGE: No pathological compression fracture or destructive bone lesion. \nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of intrathoracic malignancy.  Normal chest CT."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  No incidental pulmonary embolism.  No\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nThe posterior mediastinum is unremarkable.  No abnormalities are noted in the\nupper abdomen.  No no osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  Millimetric right upper lobe nodules (5, 36\nand 32).  No suspicious pulmonary nodules or masses. 10 mm ground-glass nodule\nin the right lower lobe (5, 178).  No pleural effusions, no pleural\nthickening, no diffuse lung disease.",
            "output": "10 mm ground-glass nodule in the right lower lobe.  No evidence of metastatic\ndisease.\n\nRECOMMENDATION:\nFor an incidentally detected single ground-glass nodule bigger than 6mm, CT\nfollow-up in 6 to 12 months is recommended to confirm persistence. If\npersistent, CT follow-up every ___ years until ___ years after initial detection\nare recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the thyroid need any further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged. \nBreast evaluation is reserved exclusively for mammography.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels or the coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\n\nLUNGS, AIRWAYS, PLEURAE: Punctate subpleural nodule, left upper lobe, 6:65\nunchanged or smaller since ___, probably a benign lymphoid aggregate. \nLungs are otherwise clear.  Region of ground-glass opacification right lower\nlobe in ___ has resolved, could have been due to aspiration or the\nremnants of pneumonia.\n\nTracheobronchial tree is normal to subsegmental levels.  Isolated small\npleural calcification, right lung base, 6:294, present since ___,\nunlikely to be clinically significant.\n\nCHEST CAGE: Unremarkable.  Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning..",
            "output": "No evidence of intrathoracic malignancy.  Previous ground-glass abnormality,\nright lower lobe, is resolved since ___."
        },
        {
            "input": "CT Thorax:  The thyroid gland appears heterogeneous. There is a focal\nhypodensity within the right mid thyroid gland which measures 6 x 9 mm (3:6).\nAt this level posteriorly, 80 3 mm calcification is noted. The airways are\npatent to the subsegmental level.  There is no mediastinal, hilar, or axillary\nlymph node enlargement by CT size criteria.  The heart, pericardium and great\nvessels are within normal limits.  Calcifications within the coronary arteries\nare noted. There is no pericardial effusion.  No esophageal abnormality is\nidentified.\n\nLung windows demonstrate a 3 mm nodule within the right lower lobe (4:40). \nRight upper lobe nonspecific ground glass opacities are seen.  There is a 6 mm\nground glass nodular in the posterior segment of the RUL (4:18) that requires\na non-emergent 3-month follw up.  Mild bronchiectasis is noted.   Trace\nbibasilar atelectasis is seen. There is no pleural effusion or pneumothorax.\n\nThough study is not tailored for subdiaphragmatic evaluation, imaged portions\nof the liver pancreas spleen adrenal glands and kidneys are unremarkable.\n\nOsseous structures:  No suspicious lytic or blastic lesion is identified. A\ncompression deformity of the T6, T10, and T12 vertebral bodies are noted.\nThese are age indeterminate. No significant retropulsion is seen. Degenerative\nchanges about the remaining vertebral bodies with disc space narrowing and\nanterior osteophytosis is seen. Minimal anterolisthesis of T3 on T4 is seen.",
            "output": "1.  3mm nodule within the right lower lobe and 6 mm ground glass nodular in\nthe posterior segment of the RUL that requires a non-emergent 3-month follw\nup.\n2.  No focal opacity is identified within lung windows suggestive of a\nvascilitis.\n3.  6 x 9 mm nodule within the right thyroid lobe for which correlation with\nthyroid function tests is recommended.  Ultrasound can be helpful for further\ncharacterization and evaluation.\n4.  Several anterior compression deformities throughout the thoracic spine,\nage indeterminate.\n\nNOTIFICATION:  Follow-up requirement entered in Notification of Critical\nRadiology Findings module."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced and normal in diameter. \nMultiple enlarged mediastinal lymph nodes are demonstrated, ranging up to 7 x\n16 mm in the prevascular area, 10 mm in the right lower paratracheal area, 10\nmm in the subcarinal area and 14 x 10 mm in the right hilus, series 2, images\n33-49.\n\nHeart size is normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality within\nthe limitations of the study technique that was not designed for assessment of\nintra-abdominal pathology.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nAnterior abdominal soft tissue fat stranding, series 2, image 174 is of\nunclear etiology might potentially represent area of previous injection, or\ninfection, 15 x 17 mm.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules or masses demonstrated.  Subpleural reticulations,\nbilateral, predominantly in the lower lobes are most likely consistent with\nnonspecific interstitial pneumonia.  No definitive honeycomb being\ndemonstrated.",
            "output": "No evidence of intrathoracic metastatic disease\n\nMost likely presence of nonspecific interstitial pneumonia.\n\nMediastinal and right hilar lymphadenopathy.  Although it might be reactive to\nthe interstitial lung disease, especially the right hilus is concerning and\nshort-term follow-up in 3 months is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Normal thyroid gland. No enlarged\nor growing supraclavicular or axillary lymph nodes.  Breast assessment is\nreserved for dedicated breast imaging.  Excluding the breasts, no soft tissue\nchest wall abnormality.  Narrowing of the right brachiocephalic vein, and a\nlinear filling defect within the imaged inferior aspect of the right internal\njugular vein, in keeping with thrombus.  No atherosclerotic calcification of\nthe imaged neck arteries.\n\nUPPER ABDOMEN: This examination is not tailored for subdiaphragmatic\nassessment.  Allowing for this; millimetric calcified gallstones noted in the\ngallbladder.  No evidence of acute cholecystitis.  Mild atherosclerotic\ncalcification of the imaged upper abdominal vessels.  The imaged upper\nabdominal structures are otherwise normal.\n\nMEDIASTINUM: Normal esophagus. 8 mm subcarinal lymph node (4:100), slightly\nincreased in size compared to prior.  Numerous stable conspicuous mediastinal\nlymph nodes, not enlarged by size criteria, for example; an 8 mm left\npre-vascular lymph node (2:44).  No mediastinal mass.  The thoracic aorta and\npulmonary arteries are normal in caliber.  No atherosclerotic calcification of\nthe thoracic aorta.\n\nHILA: Enlarged right hilar lymph node, measuring 1.9 cm by 0.7 cm (4:115),\nslightly smaller compared to prior.  No enlarged or growing left hilar lymph\nnodes.\n\nHEART and PERICARDIUM: Normal heart size. No coronary artery or cardiac valve\ncalcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Mild subpleural reticulation, with bibasal predominance,\nallowing for the expiratory phase of the prior CT chest, stable.  No lung\nnodule or mass.  No consolidation.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nNo bronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE:  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  No fracture.  Mild spondylosis.  Mild dextroscoliosis of the mid\nthoracic spine and mild levoscoliosis of the lower thoracic and upper lumbar\nspine.",
            "output": "-Narrowing of the right brachiocephalic vein, and a linear filling defect\nwithin the imaged inferior aspect of the right internal jugular vein, in\nkeeping with thrombus.\n-Enlarged right hilar lymph node, slightly smaller compared with prior. \nMildly enlarged subcarinal lymph node, slightly larger compared to prior. \nNumerous additional conspicuous mediastinal lymph nodes are stable.  No lung\nnodule or mass.\n-Stable subpleural reticulation with bibasal predominance, likely representing\nNSIP.\n-Millimetric calcified gallstones in the gallbladder, without evidence of\nacute cholecystitis.\n\nNOTIFICATION:  An E-mail was sent to ___, MD at 15:57, ___, regarding the above findings.\n\n Pertinent critical findings were posted by Dr. ___ on ___ at\n15:57 to the Department of Radiology online critical communications system for\ndirect communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The ascending aorta is mildly dilated measuring 4.2 cm in\nmaximal diameter.  The pulmonary arteries and descending aorta are normal in\ncaliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.\n\nPLEURA:\nNo pleural effusions.  No apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Small lung nodules measuring up\nto 4 mm in the right upper lobe (6:63 and 181), in the left lower lobe\n(6:122).  Mild atelectasis in the lung bases.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  Prior anterior approach\ncervical arthrodesis.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nRedemonstration of large lesions in the right hepatic lobe.  Please refer to\nsame day abdominal CT report for more details on the subdiaphragmatic\nfindings.",
            "output": "At least 3 small lung nodules suspicious for metastatic disease.  Attention on\nfollow-up studies.  Recommend short-term follow-up CT in 3 months.\nDilated ascending aorta measuring 4.2 cm.  Consider referral to aortic center.\nAnnual surveillance is recommended.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 16:27 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings are large enough to require further\nimaging evaluation.  No supraclavicular or axillary lymph nodes are\npathologically enlarged.  No soft tissue abnormalities in the imaged chest\nwall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Esophagus is patulous, severe in the midportion, moderate\ndistally, unchanged since ___.  There is no retention of fluid to\nsuggest obstruction or any associated mass.  Atherosclerotic calcification is\nmild in head neck vessels, most extensive in the left anterior descending and\ncircumflex coronary arteries.\n\nAscending thoracic aorta top-normal size, 43 mm probably larger than in\n___.  Aortic valve is not calcified.  Pulmonary arteries, main normal\nsize, right 27 mm, previously 31 mm.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nincluding subcentimeter diaphragmatic nodes slightly smaller today than in\n___\n\n\nLUNGS, AIRWAYS, PLEURAE: Lung nodules:\n\n4-5 mm, right upper lobe, 04:59, was 3 mm in ___ mm, superior segment left lower lobe, was less than 4 mm in ___ mm right middle lobe was less than 3 mm in ___.\n\nNo new lung nodules.  Lungs otherwise clear.  Tracheobronchial tree normal to\nsubsegmental levels.  No pleural mass or effusion.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Growth since ___ small pulmonary nodules, likely metastases.  No new\nmetastases.\n\nRelatively severe dilatation of the esophagus, without retention, suggests\ndysmotility.\n\nAtherosclerotic coronary calcification, especially LAD.\n\nNew mild dilatation ascending thoracic aorta.  Referral to ___ aorta service\nshould be considered"
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable there are no enlarged supraclavicular\nlymph nodes.\n\nBREAST AND AXILLA  : The left axillary lymph nodes have increased in size\nsince the prior study and 1 of the lymph nodes now measures 11 x 16 mm and\nabuts the skin surface with evidence of skin thickening overlying the skin,\ncould be consistent with lymphadenitis.  The other left axillary lymph nodes\nhave also increased in size and are enhancing.\n\nMEDIASTINUM: The mediastinal lymph nodes have decreased in size since the\nprior study.  The hilar lymph nodes have also significantly regressed in size.\nThere is no pericardial effusion.  The aorta and pulmonary arteries are normal\nin caliber.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized bilateral consolidative opacities and scattered\nparenchymal opacities consistent with multifocal pneumonia have resolved. \nMinimal bibasilar atelectasis and scarring.  No new nodules or consolidations.\nFew scattered residual opacities are seen bilaterally.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  No obvious paraspinal opacities or abscess is\nseen.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows visualized\nliver is unremarkable.  There are small upper abdominal lymph nodes.  No\nadrenal masses are seen.  The spleen is normal in size.",
            "output": "Interval increase in size of the left axillary lymph nodes with evidence of 1\nof the lymph nodes directly communicating with the skin surface and evidence\nof skin thickening overlying the lymph node, concerning for lymphadenitis.\n\nNear complete resolution of the multifocal pneumonia.\n\nRegression in size of the mediastinal lymph nodes in the interim, there are\nmost likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There has been interval decrease in size of left axillary lymph\nnodes, largest measuring 7 mm.\n\nMEDIASTINUM: There is grossly stable mediastinal lymphadenopathy.  The largest\nlymph node is located subcarinal (4:143) measuring 9 mm in the short axis and\nis grossly unchanged from the prior exam.  The endotracheal tube terminates\napproximately 3.5 cm above the carina.  The enteric tube terminates within the\nstomach.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion\nis identified.  There is moderate coronary, aortic valve, and aortic\natherosclerotic calcification.\n\nPLEURA: No pleural effusion or pneumothorax is identified.\n\nLUNG: There are extensive ground-glass opacities with superimposed ___\nnodules involving all lobes of the lungs.  More confluent opacities are seen\nin the right lower lobe, series 4, image 23.  There is additionally system\natelectasis of the lung bases.  Also seen is bronchiectasis with bronchial\nwall thickening, most pronounced at the bilateral lung bases.\n\nCHEST CAGE: No suspicious osseous lesions are identified.  Healing\nnondisplaced fractures of the anterior right second, third, and fourth ribs\nare noted.\n\nUPPER ABDOMEN: Please see separate dictation for CT abdomen/pelvis.",
            "output": "1. Extensive ground-glass opacities with ___ opacities involving all\nlobes of the lungs, and confluent right lower lobe opacities is concerning for\nmultifocal pneumonia.\n2. Bronchial wall thickening and bronchiectasis is suggestive of an\ninflammatory or infectious airway disease.\n3. Interval decrease in left axillary lymphadenopathy.  Grossly stable\nmediastinal lymphadenopathy with largest lymph node measuring 9 mm in the\nshort axis.\n4. Appropriate position of the endotracheal and enteric tubes.\n5. Multiple healing nondisplaced right rib fractures."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are several prominent and borderline\nenlarged mediastinal lymph nodes, for example, a 1.1 cm left lower\nparatracheal lymph node (301:78), a 0.9 cm lymph node in the aortopulmonary\nwind2ow (301:78), 1.4 cm left lower paratracheal lymph node (301:84), a 0.9 cm\nright lower paratracheal lymph node (301:86), a 1.2 cm subcarinal lymph node\n(301:105), and a 1.2 cm posterior paraesophageal node (301:106).  These lymph\nnodes are mildly increased in size since prior exam, for example, the 1.4 cm\nleft lower paratracheal lymph node previously measured 0.9 cm and the 0.9 cm\nright lower paratracheal lymph node had previously measured 0.7 cm.  There is\na prominent 0.7 cm right hilar lymph node (301:124), but no enlarged hilar\nnodes are identified.  Axillary lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: Since ___, there has been interval development of\nsmall bilateral nonhemorrhagic pleural effusions.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: Since ___, bibasilar atelectasis, left greater than\nright, is new.\n\nWidespread bronchial wall thickening, severe bronchiolar nodulation and\nseveral ground-glass opacities scattered throughout all lobes of both lungs is\nall similar, minimally improved in some areas suggestive of continue\nwidespread viral infection.\n\nThere are several new small foci of more consolidative opacity within the\nright middle lobe (301:82, 89, 98) and right lower lobe (301:109), concerning\nfor foci of bacterial superinfection.  Retained tracheal secretions are\nminimal (301:69), but there are more substantial secretions peripherally\n(301:93, 106), slightly increased from prior.  Redemonstration diffuse mild\nbronchial wall thickening and moderate bronchiectasis.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  An enteric\ntube is seen coursing through the esophagus and stomach and passing out of the\nfield of view.\n\nBONES: No suspicious osseous abnormality is seen.? Redemonstration of healing\nright second, third, and fourth anterolateral rib fractures.",
            "output": "1. No evidence of pulmonary embolism.\n2. Continued, relatively stable widespread infection, probably viral,\nprimarily affecting the bronchial tree, with heavy bronchiolar nodulation and\nretained secretions, less so the lungs.  Reactive adenopathy is mild.\n3. Small foci of possible bacterial super infection are new, and need to be\nmonitored.\n4. New, substantial bibasilar atelectasis, probably not obstructive, probably\naccounts for new small bilateral pleural effusions unless there was\nintervening pulmonary edema.\n5. Healing right second through fourth rib fractures."
        },
        {
            "input": "CTA: Imaged base of neck including the partially visualized thyroid is\nunremarkable.  The NG tube extends into the stomach with tip just beyond the\nGE junction.  Thoracic aorta is normal in course and caliber.  The main\npulmonary artery is normal in size.  There is no filling defect within the\nbranches of the pulmonary arterial tree to suggest the presence of a pulmonary\nembolism.\n\nThere is diffuse bronchial wall thickening with moderate areas of mucous\nplugging.  Extensive multifocal peribronchovascular opacities concerning for\npneumonia and most confluent in the left and right lower lobes.  The\nappearance favors a bronchopneumonia though other etiologies not excluded.  No\npleural effusion.\n\nAbdomen: The liver enhances normally without focal concerning lesion. \nGallbladder contains a gallstone though there is no CT evidence for acute\ncholecystitis.  The pancreas appears normal.  The spleen is normal.  Adrenals\nare normal bilaterally.  Kidneys enhance symmetrically.  No hydronephrosis or\nsigns of pyelonephritis.  A nonobstructing stone is noted within the lower\npole of the right kidney best seen on series 608, image 37.  The abdominal\naorta is moderately calcified and is without aneurysm.  Retroperitoneal lymph\nnodes are not enlarged.  Feeding tube terminates within the proximal stomach. \nThe stomach is decompressed.  The duodenum appears normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is normal.  The colon contains several fluid levels.  The uterus is\natrophic.  No adnexal mass.  Foley catheter is seen within the urinary\nbladder.  No pelvic free fluid.  No pelvic sidewall or inguinal adenopathy. \nThere is mild pelvic floor descent.\n\nBones: There is no worrisome lytic or blastic osseous lesion.",
            "output": "1.  Multifocal pneumonia most confluent in the lower lobes, likely bacterial. \nExtensive bronchial wall thickening with moderate mucous plugging.  Reactive\nlymph nodes.\n2.  No pulmonary embolism or acute aortic process.\n3.  No acute findings in the abdomen/pelvis.  Incidental findings as detailed\nabove."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are stable nonenlarged mediastinal lymph\nnodes without pathologically enlarged hilar, mediastinal, or axillary\nlymphadenopathy.\n\nAIRWAYS/LUNGS/PLEURA: The tracheobronchial tree redemonstrates mucous plugging\nwhich appears to have slightly improved in the right lower lobe, however\nappears worsened in the left lower lobe with interval complete atelectasis of\nthe left lower lobe.  There appears to be worsening multifocal ground-glass\nopacities most pronounced throughout the right lung.  There are worsening\nsmall bilateral pleural effusions, left greater right with adjacent\ncompressive atelectasis.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates partially\nvisualized trace perihepatic ascites.\n\nBONES: No acute fracture or suspicious osseous lesion.  There are\nsubacute/healing right anterior rib fractures.\n\nSOFT TISSUES: There is diffuse subcutaneous chest wall edema.\n\nOTHER: The endotracheal tube and left internal jugular central venous catheter\nare in stable position. The enteric tube crosses the diaphragm and terminates\noutside of the field of view.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Worsening mucous plugging of the left lower lobe with interval complete\nleft lower lobe atelectasis.\n3.  Worsening multifocal ground-glass opacities, most pronounced throughout\nthe right lung compatible with multifocal pneumonia.\n4.  Worsening small pleural effusions, left greater than right."
        },
        {
            "input": "Neck and cardiomediastinum:  The thyroid is unremarkable.  There is no\naxillary or supraclavicular lymphadenopathy.  Several subcentimeter para\naortic lymph nodes measure up to 5 mm.  A pre SVC lymph node measures 7 mm,\nlikely reactive.  Subcarinal lymph nodes measure up to 1.1 cm.  There is no\nsignificant hilar lymphadenopathy.   The heart is top-normal.  The ascending\naorta is normal in caliber.  The main pulmonary artery is enlarged measuring\n3.5 cm, raising possibility of pulmonary hypertension.  There is no\npericardial effusion.\n\nLung/ airways: Enteric tube, endotracheal tube and right PICC line are\nunchanged in position as compared to recent radiograph.  The airways are\npatent to at least the segmental level.  There are diffuse bilateral upper\nlobe predominant ground-glass opacities with an element of septal thickening. \nSeptal thickening is most conspicuous at the lower lobes.  There are bilateral\nsmall layering nonhemorrhagic pleural effusions with adjacent\natelectasis/consolidation.  More confluent regions of consolidation are seen\npredominately in the superior segment of the right lower lobe, lingula and\nlower bilateral lobes.\n\nAbdomen:  This examination is not tailored for the evaluation of infra\ndiaphragmatic structures.  The imaged liver, spleen and adrenal glands are\nunremarkable, allowing for motion artifact better\n\nSkin in soft tissues:  There are no lesion suspicious for malignancy or\ninfection.",
            "output": "1. Parenchyma opacities have improved as compared to recent chest x-ray. \nMultifocal opacities continue to be consistent with pneumonia.\n2. Pulmonary edema has fluctuated since admission.  The edema may be improved\non this examination.\n3. Bilateral small nonhemorrhagic pleural effusions."
        },
        {
            "input": "The patient is intubated and carries now is a gastric tube.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Normal sized\nlymph nodes are seen in the mediastinum.  Mild aortic wall calcifications. \nMild dilatation of the main pulmonary artery.  Mild coronary calcifications. \nThe posterior mediastinum is unremarkable.  No abnormalities are noted in the\nupper abdomen.  Stable appearance of the bony structures.  The previously\nnormal lung parenchyma is now highly abnormal.  There are geographically\ndistributed ground-glass opacities with overlying interstitial opacities.  The\nchanges affect all anatomic compartments of the lungs, in addition small areas\nof consolidations are seen in the lower lobes.  The larger airways are patent.\nThere is no evidence of pleural effusions.",
            "output": "Diffuse ground-glass opacities with overlying interstitial thickening but\nwithout pleural effusions.  Additional consolidations are seen in the\ndependent lung regions.  The changes could reflect multifocal infection, COPD\nexacerbation, or, potentially, parenchymal hemorrhage."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No enlarged lymph nodes within the\naxilla or supraclavicular stations.  The thyroid is normal.  No suspicious\nsoft tissue lesions in the chest wall.\n\nUPPER ABDOMEN: The enteric tube terminates within the gastric body.  The\nesophagus is patulous with some contrast noted within the lower lumen.  Please\nsee separate report for same-day CT abdomen and pelvis.\n\nMEDIASTINUM: Subcarinal lymph nodes measuring up to 1.4 cm are likely\nreactive.\n\nHILA: Hilar lymph nodes measure up to 1.0 cm in the right hilum, unchanged\nfrom prior and likely reactive.\n\nHEART and PERICARDIUM: Normal sized heart without pericardial effusion.  The\nthoracic aorta is normal caliber with moderate atherosclerotic calcifications,\nas well as eccentric atherosclerotic plaque (series 601, image 30).  A left\ninternal jugular venous catheter terminates within the low SVC/cavoatrial\njunction.  A right internal jugular venous central catheter terminates near\nthe cavoatrial junction.\nPLEURA: There are small bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  There is increase in consolidation of the bilateral lower\nlobes, with air bronchograms seen within the left lower lobe consolidation. \nThe left lower lobe consolidation is hypodense.  Diffuse ground-glass\nopacities geographically distributed throughout both lungs are again noted,\nand somewhat less prominent than on the prior study.  There are focal areas of\nair trapping along the periphery.\n2. AIRWAYS:  The endotracheal tube terminates within the midthoracic trachea. \nThe large airways are patent.\n3. VESSELS:  The main pulmonary artery measures 3.2 cm in diameter, consistent\nwith pulmonary hypertension.  No filling defects are demonstrated within the\nlarge pulmonary arterial branches.\nCHEST CAGE: No acute fractures.  No suspicious osseous lesions.",
            "output": "1. Interval worsening of the left lower lobe consolidation, probably pneumonia\nand atelectasis.  Underlying small bilateral serous pleural effusions.  The\nright lower lobe consolidation likely represents atelectasis.\n2. Similar distribution of diffuse, non dependent ground-glass opacities\nthroughout both lungs, slightly less prominent than on the prior study but\nwith areas of focal air-trapping.  Findings could represent noncardiogenic\nedema, other etiologies include multifocal infectious process or pulmonary\nhemorrhage."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Calcified and noncalcified plaque is present at the\nlevel of the aortic arch.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.  Right internal jugular\nvenous catheter terminates in the SVC.  A left internal jugular venous\ncatheter terminates in the SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymphadenopathy may be reactive. \nThe largest conglomerate of subcarinal lymph node measures 3.5 x 2.7 cm\n(302:112).\n\nPLEURAL SPACES: Bilateral pleural effusions are small.\n\nLUNGS/AIRWAYS:Moderate nonenhancing consolidations of the lower lobes\nbilaterally are suspicious for pneumonia.  There are extensive multifocal\nmixed ground-glass, reticular, and dense opacities throughout bilateral lungs\nconcerning for pneumonia.  The findings have progressed compared to ___ tracheostomy tube is in place.  Bilateral lower lobe subsegmental airways\nare intermittently occluded.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for partially\nimaged percutaneous G tube.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral lower lobe consolidations and multifocal ground-glass and dense\nopacities in bilateral lungs have progressed compared to ___,\nconcerning for progression of multifocal pneumonia.\n3. Mediastinal lymphadenopathy is likely reactive in setting of pneumonia."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.  The tip of the\nendotracheal tube is appropriately positioned within the mid intrathoracic\ntrachea.\n\nMEDIASTINUM:  There are multiple enlarged mediastinal lymph nodes including a\n1.2 cm left paratracheal node (02:26) as well as a 2.0 x 3.7 cm subcarinal\nlymph node conglomerate (02:32).  These appear similar to decreased in size\ncompared to ___.\n\nHILA:  Evaluation of hilar lymphadenopathy is mildly limited on this\nnoncontrast study.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThere are mild atherosclerotic calcifications in the aortic arch and at the\norigins of the great vessels.  The main pulmonary artery is dilated, measuring\nup to 3.3 cm.  The right and left pulmonary arteries are normal in caliber.\n\nPULMONARY PARENCHYMA: There is marked respiratory motion artifact.  There has\nbeen interval progression of bilateral, extensive ground-glass and reticular\nopacity throughout all lung segments.  Dense consolidations in the dependent\nbilateral lower lobes remain suspicious for pneumonia.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There are small to moderate bilateral, nonhemorrhagic pleural\neffusions, increased in size compared to ___.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Significant interval progression of multifocal pneumonia.\n2. Interval increase in small to moderate bilateral, nonhemorrhagic pleural\neffusions.\n3. Dilation of the main pulmonary artery suggestive of pulmonary hypertension.\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "The heart is mildly enlarged.  Great vessels are unremarkable.\n\nThere is no lymphadenopathy.  There is no pleural or pericardial effusion.\n\nOpacities in each lower lobe, left greater than right, are most suggestive of\natelectasis.\n\nAbdomen is reported separately.\n\nThere are no suspicious bone lesions.",
            "output": "No evidence of malignancy in the chest."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild cardiomegaly.  The pericardium is physiologic.  No\npericardial effusions.  And great vessels are within normal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are scattered areas of ground-glass opacity within upper\nlobes concerning for multifocal pneumonia.  Areas of segmental atelectasis\nnoted in the bilateral lower lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe thyroid is unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Scattered ground-glass opacities within the upper lobes concerning for\nmultifocal pneumonia.  Nota segmental ble areas of atelectasis in the\nbilateral lower lobes.\n3. Mild cardiomegaly."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: A heterogeneous cystic mass arises\nfrom the left thyroid gland measuring 2.2 x 0.5 cm (02:10), with scattered\ncalcifications, previously characterized as a benign multinodular goiter on\nultrasonography dated ___.  No supraclavicular or axillary\nlymphadenopathy.  Bilateral calcifications within the breast parenchyma, no\nevidence of malignancy on mammography dated ___.\n\nUPPER ABDOMEN: Imaged abdominal viscera is unremarkable.Assessment of stomach\nwall limited due to decompression.\n\nMEDIASTINUM: No mediastinal lymphadenopathy\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There heart is normal size, without evidence of\npericardial effusion.  Moderate atherosclerotic calcification noted of the\ncoronary arteries and thoracic aorta, increased from prior imaging, with heavy\ncalcification at the origin of left subclavian artery.  Minimal calcification\nof the aortic valve without atrial enlargement.\nPLEURA: Focal pleural thickening and pleural fat expansion at the right apex. \nThere is nodular pleural thickening with calcifications in the right lung\nbase.  No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Linear opacifications are present in the right apex, with\nscattered nodularity and calcification that appears unchanged from ___.  The\nlateral pleura adjacent to the nodularity is mildly thickened, with evidence\nfor expansion of pleural fat.  There is associated traction bronchiectasis in\nthe area.\nA nearby 0.4 cm calcified nodule likely represents a calcified granuloma\n(04:37).  A 0.5 cm nodule in the right upper lobe (4:127) is also unchanged\nfrom ___.  There is a 0.2 cm nodule in the right upper lobe which appears new\nfrom ___ (4:90).  A 0.4 cm perifissural nodule in the left lower lobe is\nunchanged from ___ (03:22).  Multiple right lower lobe calcifications likely\nrepresent calcified granulomas.  A right hilar coarse calcification has\nenlarged, without evidence of bronchial involvement (4:118).\n2. AIRWAYS:  The airways patent to the level of the subsegmental bronchi\nbilaterally.\n3. VESSELS:  The main, right and left pulmonary arteries are normal caliber.\nCHEST CAGE: No suspicious osseous lesions or acute fractures.surg hardware rt\nhumerus",
            "output": "1.  In a region of right apical pleuroparenchymal scarring and bronchictasis,\ngenerally unchanged since ___, mild increase in one small nidus of pleural\nthickening is also likely benign scarring as evidenced by interval expansion\nof pleural fat.  Only because of patient's local symptoms, a follow-up CT scan\nis recommended in ___ months.\n\n2.  New 0.2 cm right upper lobe nodule, which does not meet size criteria for\nfollow-up however attention can given if follow-up CT is performed for above\nfindings.\n\n3.  Multiple calcified granulomas and unchanged nodules as described above.\n\n4.  Increase in moderate calcification of the coronary arteries and thoracic\naorta and heavy calcification at the origin of the left subclavian artery. \nMinimal calcification at the aortic valve without atrial dilatation.\n\nRECOMMENDATION(S):  Repeat Chest CT in ___ months, with intravenous contrast\nagent, if tolerated."
        },
        {
            "input": "The imaged portion of the thyroid is unremarkable.\n\nHeart size is normal without significant pericardial fluid.  There are mild\naortic annular calcifications.  There is no supraclavicular, axillary, hilar\nor mediastinal lymphadenopathy by CT size criteria.\n\nThere is mild bilateral lower lobe bronchiectasis with focal mucous impaction\nof a posterior basal segmental right lower lobe bronchus.  The airways are\notherwise patent to the subsegmental level.  A 5 mm left apical nodule is\nunchanged (04:32).  1 mm nodule in the right apex unchanged (04:24). \nScattered peribronchial ground-glass opacities in the right upper lobe\nmeasuring up to 5 mm in the right apex (___) are unchanged.  Remainder of\nthe smaller ground-glass nodules, some also in the left apex also appear\nunchanged.  2 mm nodule in the left upper lobe is unchanged (4:71).  Several\nother scattered punctate nodules are also unchanged.  The scattered solid and\nground-glass nodules are unchanged since ___.\n\nThe imaged portion of the upper abdomen demonstrates a punctate calcification\nin the right interpolar kidney, which may represent a small nonobstructing\ncalculus.  Hiatal hernia is small.  Remainder of the visualized upper abdomen\nis grossly unremarkable.\n\nBones and soft tissues:  Deformities are present from old posterior lateral\nright fifth and sixth rib fractures with bridging of the right fifth and sixth\nribs posteriorly and laterally.  There is no suspicious focal bone lesion.  \nNo radiopaque foreign body is noted.",
            "output": "1. No acute findings.  Specifically, no evidence of pneumonia or aspirated\nforeign body.\n2. Stable scattered solid and ground-glass nodules, unchanged since ___,\npresumed benign.\n3. Mild bilateral lobe of bronchiectasis with a focal mucous impaction of a\nposterior basal segmental branch of the right lower lobe bronchus."
        },
        {
            "input": "The left thyroid lobe is absent.  The right thyroid lobe is unremarkable. \nThoracic aorta is normal in course and caliber without significant\natherosclerotic calcification.  Multiple small mediastinal and axillary lymph\nnodes are present not meeting size criteria for pathologic enlargement.  Main\npulmonary artery appears normal in size.  The heart appears mildly enlarged\nwith trace pericardial effusion.  There are small layering bilateral pleural\neffusions with associated compressive lower lung atelectasis.  Mild edema is\nsuspected.  No worrisome nodule, mass, or consolidation is seen.\n\nWithin the imaged portion of the upper abdomen, there are no acute\nabnormalities.  The stomach is distended with ingested content.\n\nBones: No worrisome lytic or blastic osseous lesion.",
            "output": "1. Mild cardiomegaly with trace pericardial effusion, small bilateral pleural\neffusions and compressive lower lobe atelectasis.\n2. Mild pulmonary edema.  No evidence of pneumonia.\n3. Multiple prominent though not pathologically enlarged mediastinal lymph\nnodes."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A right Port-A-Cath\nterminates in the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or supraclavicular lymphadenopathy.\nEnlarged mediastinal and hilar lymph nodes are again noted which were FDG avid\non recent PET-CT from ___.  For example, a prevascular node\n(series 3, image 74) measures 1.5 cm.  A subcarinal node (series 3, image 103)\nmeasures 0.8 cm.  A right hilar lymph node (series 3, image 100) measures 1.0\ncm.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A dominant 3.2 x 2.2 cm mass in the right upper lobe (series 3,\nimage 71) appear FDG avid on recent PET-CT.  Numerous FDG avid pulmonary\nnodules are also noted throughout both lungs with some examples listed below:\nRight lower lobe: Series 3, image 136, 156, and 161\nLeft upper lobe: Series 3, image 97 and 122\nLeft lower lobe: Series 3, image 176 and 182\nAdditional subcentimeter pulmonary nodules are also demonstrated.  Overall\ngiven differences in modalities, no gross changes are seen compared to the\nprior PET-CT from ___.\n\nNo focal consolidation to suggest pneumonia. The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Limited evaluation of the upper abdomen demonstrates a 2.1 cm\nhypoattenuating lesion in the spleen, which was not FDG avid on recent PET-CT.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nNo significant degenerative changes.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Extensive mediastinal and hilar lymphadenopathy and multiple pulmonary\nnodules and dominant right upper lobe mass, consistent with patient's known\nHodgkin's lymphoma.  When compared to the prior PET-CT from ___,\nthe extent of disease is grossly unchanged given differences in modalities."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Partially seen right\nPort-A-Cath terminates at the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present.  A\nenlarged mediastinal hilar lymph nodes are again demonstrated. 1.1 cm\nmediastinal lymph node appears new compared to most recent prior (5; 106). \nThe remaining mediastinal lymph nodes are similar to prior for example, a\nprevascular lymph node measures 1.4 cm in short axis similar to prior (5; 26).\nA subcarinal lymph node 1.0 cm in short axis similar to prior (5; 62). \nProminent right hilar lymph node measures 0.9 cm in short axis (5; 59) similar\nto prior.  No left hilar lymphadenopathy.\n\nPLEURAL SPACES: No pneumothorax.  There is a moderate left pleural effusion\nnew since prior.\n\nLUNGS/AIRWAYS: The right upper lobe dominant mass measures 2.2 x 3.0 cm,\npreviously measuring 2.2 x 3.2 cm (5; 20), similar to prior.\n0.5 cm right middle lobe pulmonary nodule similar to prior (5; 73).  1.1 x 1.6\ncm nodule in the right lower lobe is similar to prior (5; 140).\n\nThere is been interval decrease in size of right lower lobe pulmonary nodule\nmeasuring 0.7 cm (5; 30), previously measuring 1.1 cm.  An adjacent right\nlower lobe pulmonary nodule measures 0.8 x 0.7 cm, previously measuring 0.8 x\n1.0 cm (5; 35) and also appears to have minimally decreased in size.  A 1.2 x\n0.6 cm right lower lobe nodule previously measured 1.4 x 1.0 cm (5; 104).\n\n There is a 1.0 x 1.1 cm left upper lobe pulmonary nodule, similar to prior\n(5; 47).  Left lingular nodule measuring 0.6 x 1.7 cm previously measuring 1.4\nx 2.1 cm.\n\nThere is new compressive atelectasis of the left lower lobe.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  1.7 x 2.0 cm\nhypodense lesion within the spleen is again demonstrated (9; 32) likely a\nhemangioma or cyst, similar to that in ___.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Visualized loops of small and\nlarge bowel appear unremarkable.  The appendix is surgically absent.  There is\nno free intraperitoneal fluid or free air.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is diffusely increased sclerosis of the T12\nvertebral body, new since ___, may be post treatment changes.  The abdominal\nand pelvic wall is within normal limits.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. New moderate left pleural effusion with adjacent atelectasis.\n3. New mediastinal lymph node measuring 1.1 cm in short axis.\n4. Re-demonstration of multiple bilateral pulmonary nodules, a few of which\nhave slightly decreased in size compared to prior.\n5. No evidence of splenic infarct."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: Patient is status post median sternotomy.  Sternal sutures are\nintact.  There is moderate cardiomegaly.  There are multiple enlarged\nmediastinal lymph nodes a prevascular node measures 11 mm.  The right\nparatracheal node measures 9 mm.  A left paratracheal node measures 8 mm.  The\nsubcarinal node measures 6 mm.  There are also small bilateral hilar lymph\nnodes.  There is no pericardial effusion.\n\nPLEURA: There are small bilateral pleural effusions right greater than left\nwith consolidative opacities in both lower lobes right greater than left\nrepresenting subsegmental atelectasis.  There is also subsegmental atelectasis\nin the right middle lobe\n\nLUNG: Lungs are low volume with subsegmental atelectasis in the right lower\nlobe and right middle lobe.  There is also subsegmental atelectasis in the\nleft lung base.  There is no evidence of pneumonia.  Bilateral chest drains\nare in place.  There is a trace right pneumothorax.\n\nBONES AND CHEST WALL : Patient is status post median sternotomy.  Sternal\nsutures are intact.  There is a mild stranding in the anterior abdominal wall\nwhich most likely represents anasarca.  There is a fracture involving the\nright anterior first and second ribs.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nascites.  Please refer to dedicated report on abdomen which has been dictated\nseparately\n\nLines and tubes: The bilateral chest tubes and a mediastinal drain are\nvisualized. Small focus of intrapleural air at the right base anteriorly\n(series 3, image 101). The patient is intubated and the ET tube terminates\njust above the carina, consider retraction. Right IJ PA catheter is seen\nterminating in the right main pulmonary artery. An enteric tube is visualized\ncoursing below the diaphragm.",
            "output": "Trace bilateral pleural effusions right greater than left, consolidative\nopacity in the right lower lobe and right middle lobe most likely represents\natelectasis.  Subsegmental atelectasis in the left lower lobe.  No evidence of\npneumonia.\n\nSmall mediastinal lymph nodes could be reactive.\n\nThe ET tube terminates just above the carina consider retraction.  All the\nother lines and tubes are in acceptable position.\n\nAscites.  Please refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Although this study is not designed for assessment of intra-abdominal\nstructures, the visualized upper abdomen is notable for hepatic steatosis.\n\nCHEST:\nThe thyroid is unremarkable and there is no supraclavicular lymph node\nenlargement. The airways are patent to the subsegmental level. There is no\nmediastinal, hilar or axillary lymph node enlargement by CT size criteria. The\nheart, pericardium and great vessels are within normal limits. No hiatal\nhernia is present.\n\nThere is bilateral dependent atelectasis. No pleural effusion or pneumothorax\nis present.\n\nCTA CHEST:\nThe aorta and main thoracic vessels are well opacified. The aorta demonstrates\nnormal caliber throughout thorax without intramural hematoma or dissection.\nThe pulmonary arteries are opacified to the subsegmental level. There is no\nfilling defect in the main, right, left, lobar or subsegmental pulmonary\narteries.\n\nOSSEOUS STRUCTURES: No lytic or sclerotic lesion concerning for malignancy is\npresent.",
            "output": "1.   No evidence of pulmonary embolism.\n2.  Hepatic steatosis"
        },
        {
            "input": "Heart is normal in size.  Pericardium is physiologic.  No appreciable\natherosclerotic calcifications along the coronaries.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma. The\nceliac artery show mild ectatic dilatation (8:97).\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental\npulmonary arteries.  The main and right pulmonary arteries are normal in\ncaliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMild but diffuse bronchial wall thickening and scattered secretions (4:94). \nThere is moderate centrilobular and paraseptal emphysema, worse in the upper\nlobes, and in the apices bullae up to 4.4 cm are demonstrated.\n\nLeft lower lobe medial para-aortic 0.9 x 1.4 cm nodule (5:99, 8:115, 7:94)\nmeasures low-density.\n\nLimited images of the upper abdomen are unremarkable with the exception of\nmultiple cortical cysts in partially imaged kidneys.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMild multilevel degenerative changes of the spine and mild right-sided\nscoliosis of the upper thoracic vertebra.",
            "output": "No evidence of aortic abnormality.\nModerate centrilobular and paraseptal emphysema.\nLeft lower lobe para-aortic 1.4 cm nodule is indeterminate, possibly scar due\nto its low density - for further follow-up.\n\nRECOMMENDATION(S):  3-month follow-up is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  No axillary adenopathy.\n\nUPPER ABDOMEN: Tiny stones within the gallbladder without evidence of acute\ncholecystitis.  Hepatic steatosis.  Multiple bilateral hypodense renal cyst\nand a 3 mm cortical stone within the midpole of the right kidney.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: Limited evaluation of the hilar structures in this noncontrast CT.\n\nHEART and PERICARDIUM: Heart is mildly enlarged.  No pericardial effusion..\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA: Moderate centrilobular and paraseptal emphysema as evidence by\nlarge bilateral upper lobe bullae and smaller peripheral bullae noted within\nany dependent aspects of the bilateral lower lobes.  Re-demonstrated along the\nmajor fissure of the left lung is a 1.1 x 0.8 cm nodule (03:25) which is\nstable in size, previously measuring 1.2 x 0.9 cm.\n2. AIRWAYS:  Patent to subsegmental level bilaterally.\n3. VESSELS: Dilated ascending aorta measures 4.2 cm (02:32).\nCHEST CAGE: No aggressive osseous lesions.",
            "output": "1. Stable 1.1 x 0.8 cm nodule along the left major fissure, similar in size\nand appearance when compared to the ___ chest CT.  This nodule is\nsuspicious for malignancy, three-month imaging follow-up or tissue sampling is\nrecommended.\n2. Moderate upper lobe predominant centrilobular and paraseptal emphysema.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:47 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "A standing aorta is 4.7 x 4.9 cm as compared to 4.8 x 4.6 cm, that is\nconsistent with minimal interval increase.  The findings might be related to\ndifferent portion of the cardiac cycle, does further assessment with ECG\ngated.  CT aorta is acquired.  Aortic valve calcifications are unchanged. \nHeart size is normal.  No pericardial pleural effusion is seen.  No\nmediastinal, hilar or axillary lymphadenopathy is present.  Image portion of\nthe upper abdomen demonstrate a liver hypodensity, series 2, image 57, stable\nas well as partially imaged right renal cyst.\n\nAirways are patent to the subsegmental level bilaterally.  Bilateral pleural\nplaques, borrowed and calcified are unchanged.  There\n\nSeveral pulmonary nodules, in left apex, series 4, image 51, 61, she are\nstable.  No new nodules muscle consolidation demonstrated.\n\nNo atypical sclerotic lesions worrisome for infection or neoplasm is\ndemonstrated.",
            "output": "Minimal interval increase in the size of the thoracic aorta as described. \nReassessment in 6 months with dedicated ECG gated CT angiography of the chest\nis required."
        },
        {
            "input": "CHEST CTA:\n\nAgain seen, is an ascending aortic aneurysm overall not significantly changed\nfrom ___.  At the level of the main pulmonary trunk the ascending aorta\nmeasures 4.6 x 4.5 (series 3, image 135).  At the level of the pulmonary\nartery bifurcation the aorta measures 4.4 x 4.5 cm (series 3, image 19).  At\nthe level of the carina the descending aorta measures 2.8 x 2.8 (series 3,\nimage 103).  A penetrating atherosclerotic ulcer at the level of the proximal\narch (series 2, image 51), not significantly changed.  There is no pulmonary\nartery filling defect to suggest embolism.\n\nCHEST:\n\nThe thyroid is normal.  There are scattered axillary lymph nodes but none that\nare pathologically enlarged.  There are no enlarged mediastinal or hilar lymph\nnodes.\n\nHeart size is normal.  There is no pericardial effusion.  There are no\nsignificant Coronary artery calcifications.  The main pulmonary artery is\nnormal in caliber.  The lungs are grossly clear with minimal dependent\natelectasis.  A 6 mm calcified granuloma is present in the left lower lobe. \nAdditionally there are left-sided pleural plaques, some of which are\ncalcified(series 2, 59).\n\nThe thoracic esophagus is mildly patulous.  Limited views of the upper abdomen\ndemonstrate a peripheral 13 mm hypodensity in the left lobe of the liver\ncompatible with a simple cyst.  Multiple bilateral renal cysts are also seen\nwith the largest in the right upper pole measuring 2.6 cm.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Multilevel degenerative changes are present",
            "output": "1. No change in size to a ascending thoracic aortic aneurysm measuring 4.6 x\n4.5 cm in greatest dimension.\n2. Primarily left sided pleural plaques, some which are calcified, compatible\nwith a history of prior asbestos exposure."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nA left supraclavicular lymph node measures 24 x 17 mm (05:14).  There are\nseveral mildly enlarged left axillary lymph nodes the largest of which\nmeasures 20 x 11 mm (5:71).  There also several prominent right axillary lymph\nnodes with the largest conglomerate measuring 19 x 15 mm (5:81).  The\nsuperficial soft tissues of the visualized lower neck and chest wall are\notherwise grossly unremarkable.\n\nUPPER ABDOMEN: Please refer to the separately dictated report for\nabdominopelvic findings.\n\nMEDIASTINUM: There are several prominent/enlarged mediastinal lymph nodes with\nthe largest conglomerate in the subcarinal station measuring approximately 28\nx 15 mm (11:113).\n\nHILA: A right hilar nodal conglomerate measures 27 x 21 mm (11:110).  A left\nhilar nodal conglomerate measures 21 x 15 mm (11:120).\n\nHEART and PERICARDIUM: Heart size is normal without significant pericardial\neffusion.\nPLEURA: Pleural surfaces are clear without effusion pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is trace apical scarring.  There is also mild anterior\nscarring at the base of the right middle lobe.  Few scattered 2 mm nodules are\nseen.  Lungs are otherwise clear without concerning consolidation or dominant\nfocal nodule.\n2. AIRWAYS:  The central airways are patent.\n3. VESSELS:  There is trace atherosclerotic calcification along a normal\ncaliber thoracic aorta.  The main pulmonary artery is enlarged to 39 mm. \nThere is no central pulmonary artery filling defect.\nCHEST CAGE: Thoracic cage is intact without acute fracture or suspicious focal\nbone lesion.",
            "output": "1. Left supraclavicular, mediastinal, bilateral axillary, and bilateral hilar\nlymphadenopathy, concerning for lymphoma.\n2. Few scattered 2 mm nodules without suspicious features.\n3. Dilated main pulmonary artery which can be seen in the setting of pulmonary\nhypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable. Within the subcutaneous tissues of the chest are numerous\nperipherally enhancing, centrally hypodense nodules measuring up to 1.4 cm\n(for example, 4:75), new from the prior study ___.\n\nUPPER ABDOMEN: The imaged upper abdomen is unremarkable.\n\nMEDIASTINUM: A prominent para-aortic node measures approximately 6 mm (4:133).\nThere is no mediastinal mass or lymphadenopathy.\n\nHILA: A prominent left hilar node appears stable (4:128).  There is no hilar\nmass.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.  Minimal atherosclerotic\ncalcifications of the thoracic aorta.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Probable pleural thickening within the right lower lobe\n(4:236).  Stable sub 3 mm pulmonary nodules within the left upper lobe (04:42)\nand right upper lobe (04:58).  Stable 3 mm ground-glass pulmonary nodules\nwithin the right upper lobe (4:66, 4:81).  Slight interval increase in size of\na 3 mm right lower lobe ground-glass pulmonary nodule (4:113), previously\nmeasuring 2 mm.  Calcified granuloma within the left lower lobe (4:150). \nStable 2 mm pulmonary nodule within the left lower lobe (4:95).  Stable 2 mm\npulmonary nodule within the left upper lobe (04:37).  No new pulmonary nodules\nidentified.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "1. New, numerous subcutaneous, peripherally enhancing, centrally necrotic\nnodules within the chest wall, highly concerning for metastatic disease. \nRecommend further evaluation with biopsy.  An approximately 0.9 cm nodule\nwithin the right lateral chest, inferior to the right axilla (4:114), may be\nmost amenable to ultrasound-guided biopsy.\n2. Slight interval increase in size of a 3 mm right lower lobe ground-glass\npulmonary nodule, previously measuring 2 mm.  Multiple other indeterminate\nbilateral pulmonary nodules measuring up to 3 mm appear stable.  No new\nnodules identified.  Recommend attention on follow-up imaging.\n\nRECOMMENDATION(S):  An ultrasound-guided biopsy is recommended for further\nevaluation of new subcutaneous nodules within the chest wall.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:14 pm, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There is a left supraclavicular\nlymph node measuring 8 mm (5, 6).\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The esophagus is mildly\nthickened.  Pulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a pleural based lesion measuring 2.9 x 14 mm in the right lower\nlobe (6, 191), could represent focal pleural thickening or could represent\npartial volume averaging through peritoneal thickening evaluation of lung\nparenchyma is limited by respiratory motion.  There is a 2 mm indeterminate\npulmonary nodule in the right upper lobe (6, 66).  There is another 2 mm\nnodule in the left upper lobe (6, 50).  There is minimal biapical parenchymal\nscarring.\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows\nretroperitoneal adenopathy.  Please refer to dedicated report on abdomen which\nhas been dictated separately.",
            "output": "7 mm left supraclavicular lymph node.\n\n2.9 x 14 mm pleural based lesion along the right lower pleura could represent\na pleural metastasis.\n\n2 mm indeterminate right upper lobe pulmonary nodule.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is small.  There are no findings warranting further\nimaging evaluation.  Supraclavicular nodes are not enlarged.  Scores of soft\ntissue peripherally enhancing subcutaneous and intramuscular masses in the\nchest wall ranging in diameter up to 3 cm, are more numerous and substantially\nlarger today than on ___, consistent with aggressive metastases.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head and neck vessels or in the coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic despite growing adjacent mediastinal lymph nodes.\n\nTHORACIC LYMPH NODES: As follows:\n\nPrevascular mediastinum, 13 x 17 mm, 04:32, previously 4 x 10 mm.  Right\ndiaphragmatic, 6 x 10 mm, 04:51, previously 3 mm.  No vital structures are\ncompromised by adenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs grossly clear.  No pleural effusion or primary\npleural lesion.  Is a the a submuscular metastasis in the left anterior chest\nwall bulges into the anterior costal pleura, 5:134.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Major site of rapidly progressive metastasis are scores of subcutaneous and\nintramuscular nodules in the chest and upper abdominal wall.\n\n2 nodal stations in the mediastinum have small growing lymph node metastases. \nNo vital structures compromised."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nMultiple enhancing soft tissue nodules scattered throughout the chest wall,\nthe largest in the right subpectoral region measuring 7.4 x 5.1 cm (05:45). \nThe majority of the soft tissue nodules have grown compared to prior study of\n___.  One of these nodules is adjacent to the left anterior chest\nwall, invading the subjacent third intercostal space, possibly invading the\nlocal pleural.  There is diffuse anasarca.  The thyroid is unremarkable.  No\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNew small left pleural effusion.  No right pleural effusion.  No apical\nscarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Partial compacted atelectasis\nof the left lower lobe.  Multiple new nodules scattered throughout the lungs,\nas follows: 4 mm nodule in the right upper lobe (5:110), 5 mm nodule in the\nright lower lobe (5:137) in the right upper lobe measuring up to 5 mm (05:39,\n54, 67)..\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Numerous soft tissue nodules in the chest wall have grown compared to prior\nstudy associated to diffuse anasarca in invasion of the left anterior chest\nwall.  Additionally, new small pulmonary nodules are noticed since ___, measuring up to 5 mm.  All of these findings suggest disease\nprogression.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 11:11 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: In the left supraclavicular station\n0.7 cm lymph nodes, not pathologically enlarged (05:26).  There is no axillary\nlymphadenopathy.  There are no soft tissue metastatic deposits in the chest\nwall.\n\nCHEST CAGE: Multilevel mild-to-moderate degenerative changes of the mid and\nlower thoracic vertebra but there is no evidence of lytic or sclerotic osseous\ndestructive metastatic lesions at the level of the ribs, vertebra or sternum.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: There is extensive mediastinal and hilar lymphadenopathy,\nessentially new since ___, including the right upper paratracheal\nstation 4 x 3.3 cm conglomerate and  subcarinal 5 x 1.8 cm conglomerate.  The\nSVC is patent, and there is no significant compression of the carina and\ncentral bronchi.\n\nHILA: The there is extensive hilar lymphadenopathy.  Lingular 7 cm metastatic\ndeposit continuous within the left hilus, obstructing the subsegmental bronchi\n(5:143).  In the right hilus 6 by 3.5 cm mass extends into the right upper\nlobe narrowing and displacing the right upper lobe bronchi which remain\npatent.\n\nHEART and PERICARDIUM: Heart is normal in size.  Multiple metastatic deposits\nlocated in the lingula and right lower lobe for example abut the pericardium,\nbut there is no pericardial effusion or clear evidence of pericardial\ninvasion.\nRight Port-A-Cath terminates in the right atrium.  Sub optimal opacification\nof pulmonary vasculature is no filling defects in the in the main pulmonary\narteries or central branches.  Some of the metastatic deposits exert\nmass-effect on pulmonary arteries and veins (5:156 for example).\n\nLUNG and PLEURA: Tracheo bronchial tree is patent centrally.  As mentioned\nabove the lingular perihilar mass obstructs subsegmental bronchus with no\nsignificant atelectasis.  Other are subsegmental obstruction in the right\nlower lobe (5:159).  There are numerous large metastatic deposits involving\nboth lungs which are essentially new in comparison to ___.  Examples\ninclude the right lower lobe 5 x 4 cm mass (5:159), left lower lobe 4.3 x 2.5\ncm mass (5:193).\nThere is no pleural effusion.  Biapical pleuroparenchymal scarring is stable.",
            "output": "Extensive metastatic disease in the thorax involve the lungs, mediastinum and\nhila,  essentially new in comparison to ___."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Other than minimal linear atelectasis in the lingula, the lungs\nare clear without masses or areas of parenchymal opacification.  Azygos lobe\nnoted incidentally.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The heart is mildly enlarged.  The aorta is normal in caliber.  Central\npulmonary arteries are also normal in caliber.\n\nThere is a trace barely detectable right-sided pleural effusion and a very\nsmall effusion on the left.  No pericardial effusion.  There is no axillary,\nhilar or mediastinal lymphadenopathy.  Although perhaps slightly prominent,\nbilateral axillary lymph nodes are normal in size and morphology.\n\nConsolidation in the left lower lobe is consistent with pneumonia and very\nsimilar to what was found on the recent prior radiographs allowing for\ndifferences in modality.  There is a surrounding ground-glass component a\nsmall area of cavitation in the midst of the consolidative component.  Air\nbronchograms are present.\n\nA nodule along the minor fissure measures up to 4 mm (302:92). A right middle\nlobe nodule (302:114) measures 6 mm. Left right lower lobe nodule along the\nmajor fissure measures 4 mm (302:118). Patchy peripheral opacities in the\nanterior segment of the right lower lobe are very limited and probably due to\nvery small additional foci of pneumonia.\n\nLimited views of the upper abdomen are on remarkable.\n\nThere are no suspicious bone lesions.  Vertebral body heights and interspaces\nappear preserved in height.\n\nAn additional fissural nodule measures up to 6 mm (302:117).  Posterior\nconsolidation with ground-glass component in the left lower lobe demonstrates\na cavitating components raising concern for necrotizing infection.",
            "output": "1.  Moderately extensive consolidation in the left lower lobe suggesting\npneumonia including small cavitating component.  Follow-up radiographs are\nrecommended to show resolution.  If pneumonia is doubted on clinical grounds\nthan inflammatory pneumonitis such as organizing pneumonia could be considered\nwith the seems much less likely than an infection.\n\n2.  Pulmonary nodules measuring up to 6 mm.  Follow-up chest CT surveillance\nis recommended in ___ months.\n\nRECOMMENDATION(S):  Follow-up of small, probably benign pulmonary nodules with\nCT is recommended in ___ months.  Short-term follow-up radiography is\nrecommended to reassess pneumonia."
        },
        {
            "input": "BASE OF NECK: The visualized base of the neck is unremarkable.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged .  Left axillary lymph nodes measure up\nto 9 mm, decreased in size (4:50).\n\nCARDIO-MEDIASTINUM: The thoracic aortic is normal in caliber. The pulmonary\narteries are normal caliber.  The heart is not enlarged. There is no\npericardial effusion.\n\nLUNGS/AIRWAY: The airways are patent to the segmental level.  There is\nsignificant interval improvement to the multifocal opacities in the right\nlower lobe anterior segment, now residual ground-glass opacities (4:176). \nThere has also been significant interval improvement to the left lower lobe\nconsolidation, now with predominantly ground-glass residual opacifications\n(4:157) Nodules include:\n\n-4 mm right middle lobe, previously 6 mm (4:127)\n-3 mm right lower lobe perifissural, previously 4 mm (4:128)\n\nPLEURA: There is no pleural effusion.\n\nCHEST CAGE: No worrisome lytic or sclerotic lesion is identified. Evaluation\nof breast is reserved exclusively for mammography.\n\nUPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Substantial clearing since ___ of previous large left lower lobe\npneumonia and smaller regions of infection in the right lower lung, (4:157,\n170).\n2. Interval decrease in size of 3-4 mm right middle and lower lobe nodules,\nwhich could also be inflammatory/infectious.\n3. Left axillary lymph nodes measure up to 9 mm, decreased in size from prior\n(4:50).  Mammography, if not recently performed obtained, is recommended to\ndetect any occult breast malignancy .\n\n\nRECOMMENDATION(S):  Conventional chest radiographs now to serve as a baseline\nfor follow-up imaging in at least 2 months, sooner if  clinical findings\nsuggest recurrent infection or complications.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___ on\n___ at 15:58 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal nodes measure up\nto 8 mm (2:39), similar to prior, likely reactive.  Prominent left axillary\nnodes measure up to 9 mm.  There is no hilar lymphadenopathy.  No mediastinal\nmass.\n\nPLEURAL SPACES: Small to moderate bilateral pleural effusions, new since the\nstudy from 2 weeks ago.  No pneumothorax.\n\nLUNGS/AIRWAYS: Mild diffuse bronchial wall thickening. The airways are\notherwise patent to the level of the segmental bronchi bilaterally.  Mild\nseptal thickening most pronounced within the bilateral upper lobes, new since\nthe exam from 2 weeks ago, could reflect pulmonary edema.\n\nThere are bibasilar opacities, new since exam from 2 weeks ago,, likely\ncompressive atelectasis given the pleural effusions.  In addition there are\nnew is the predominantly upper or middle lobe opacities, which are also new. \n4 mm right upper lobe paraseptal node, likely lymph node is stable (2; 33).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.\n2. New hazy, predominantly upper and middle lobe opacities in combination with\nnew small bilateral pleural effusions and mild pulmonary edema, raises concern\nfor a new infectious/inflammatory process superimposed on the resolving left\nlower lobe pneumonia."
        },
        {
            "input": "Diffuse thyroid enlargement is present.  .  Small mediastinal lymph nodes are\nnot pathologically enlarged.  Aorta is heavily calcified as well as the\nCoronary arteries in particular LAD.  No pericardial pleural effusion is seen.\nHeart size is normal.\n\nImage portion of the upper abdomen demonstrate a trophic left kidney, please\ncorrelate with renal ultrasound from ___.\n\nRest of the image portion of the upper abdomen reveals diffuse adrenal\nthickening, of mixed density ranging between 12 and 21 ___ units.\n\nAirways are patent to the subsegmental level bilaterally.  Substantial\ncentrilobular emphysema is bilateral.  Left upper lobe minimal ground-glass\nopacities series 6, image 58 most likely represent focal area of infection and\nunlikely to represent neoplasm giving its ill-defined borders.  No discrete\npulmonary nodules demonstrated.\n\nDiffuse bronchial wall thickening is consistent with airway\ninfection/inflammation.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nOld rib fracture on the left is unchanged.",
            "output": "Severe centrilobular emphysema.\n\nGround-glass opacity in the left apex might potentially represent infectious\nprocess, unlikely represent malignancy.  Reassessment in 6 months is\nrecommended\n\nDiffuse severe atherosclerotic disease.\n\nLeft adrenal lesion, with severe is stained City, correlation with dedicated\nadrenal imaging is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  There are increasing number of borderline mediastinal lymph\nnodes, the largest a right paratracheal lymph node measuring 0.9 x 1.5 cm (4;\n19)\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is decreased density of blood pool with respect to the\nmyocardium suggestive of anemia.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There is diffuse bilateral ground-glass opacities\nprimarily in the upper lobes with dense consolidations in bilateral lower\nlobes.  There is no evidence of infection or malignancy.  There is no\nemphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen and\nis limited partially by motion.  Allowing for this, the partially visualized\nupper abdomen is unremarkable.",
            "output": "1. Diffuse ground-glass opacities in bilateral lobes with dense consolidations\nin bilateral lower lobes most concerning for Pneumocystis jiroveci pneumonia\nin given patient's history."
        },
        {
            "input": "4 mm and 3 mm hypodensities in the right lobe of the thyroid gland are\nrelatively stable as compared to prior examination from ___\n(series 4, image 10, 12). The thyroid gland is otherwise unremarkable.  No\nsignificant axillary, mediastinal or hilar lymphadenopathy is detected.  The\nesophagus is unremarkable.  The thoracic aorta is normal in caliber with a\ntypical 3 vessel takeoff from the arch.  The pulmonary arterial trunk is\nnormal in caliber.  The heart is normal in size without pericardial effusion.\n\nThere is redemonstration of minimal scarring and mild bronchiectasis in the\nmedial segment of the right middle lobe (series 5, image 204). There is\nminimal atelectasis at the left lung base.  The tracheobronchial tree is\npatent to the subsegmental levels. Within the pulmonary parenchyma, there is\nno interstitial abnormality.  No focal consolidation, pleural effusion or\npneumothorax is present.  There are no suspicious opacities, masses or pleural\nabnormalities.\n\nA 7 mm sclerotic focus seen at the L1 vertebral body appears slightly more\nconspicuous on today's examination and the finding appears new since prior\nbone scan (series 9, image 32 ; series 5, image 310). There is redemonstration\nof a 6 mm lucent lesion in the T8 vertebral body, unchanged since prior\nexamination from ___.\n\nFor a full report on the abdominal and pelvic findings of this examination,\nplease refer to the dedicated abdominal/pelvic CT performed on the same day.",
            "output": "1.  No evidence of intrathoracic malignancy.\n\n2. 7 mm sclerotic focus within the L1 vertebral body appears more conspicuous\non today's examination and new since prior bone scan. Further examination with\nbone scan recommended to rule out a new area of metastatic involvement.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 18:26 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There are no enlarged intrathoracic lymph nodes.  Heart size is normal, and\ncoronary artery calcifications are present.  There is no pericardial or\npleural effusion.\n\nSkeletal structures of the thorax demonstrate sclerotic foci at T5 and T10\ncorresponding to areas of increased FDG uptake on PET-CT of ___. \nBoth lesions appear larger and more dense than on ___.\n\nWithin the lungs, nonspecific biapical scarring is unchanged.  Cylindrical\nbronchiectasis persists within the right middle lobe with associated mucoid\nimpaction and adjacent atelectasis and or scarring.  A cluster of broad-based\ndependent opacities in the left lower lobe posteriorly are likely due to\ndependent nodular atelectasis.",
            "output": "1. Sclerotic lesions at T5 and T10 have increased since ___ chest CT\nbut are similar to the more recent PET-CT of ___.\n\n2. Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable.\nSupraclavicular and axillary lymph nodes are nonenlarged.\n\nUPPER ABDOMEN: Please refer to separate CT abdomen/ pelvis for details.\n\nMEDIASTINUM:  Mediastinal lymph nodes are nonenlarged.  No mediastinal mass or\nhematoma.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: The heart is mildly enlarged with trace pericardial\nwhich is likely physiologic.  Mild coronary artery calcifications involving\nthe left anterior descending artery.  The ascending aorta is normal in caliber\nwithout aneurysmal dilatation.\n\nPLEURA: No pleural effusion, pleural thickening, or pleural calcifications. \nNo pneumothorax.\n\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleuroparenchymal scarring is stable.  Cylindrical\nbronchiectasis within the right middle lobe with associated mucoid impaction\nand adjacent atelectasis/ scarring is unchanged.  Mild left lower lobe\natelectasis is noted.  No pulmonary mass, consolidation, or pulmonary nodules.\n-AIRWAYS:  Airways are patent to the subsegmental level.  No bronchiectasis.\n-VESSELS:  The main pulmonary artery is normal in caliber and well opacified\nto the segmental level without filling defect to suggest pulmonary embolism.\nCHEST CAGE:  Visualized soft tissues are unremarkable.  No acute fracture.  No\nnew focal lytic or blastic lesions worrisome for malignancy.  0.9 x 0.9 cm T5 \n(previously 0.9 x 0.9 cm) and 0.5 x 0.6 cm (previously 0.5 x 0.6 cm) T10\nsclerotic lesions are unchanged in size however demonstrate increased density\nsince ___.",
            "output": "1.  Increased density with stable size of T5 and T10 sclerotic lesions may\nrepresent posttreatment changes.  No new metastatic lesions.\n2.  Please refer to separate CT abdomen/pelvis for additional details."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which require mammography for evaluation, elsewhere in\nthe chest wall there are no soft tissue abnormalities concerning for\nmalignancy or infection.  Findings below the diaphragm will be reported\nseparately.\n\nThyroid gland is heterogeneous but there are no focal abnormalities large\nenough to warrant further imaging evaluation.\n\nAtherosclerotic calcification is minimal in head and neck vessels, present in\nat least the left anterior descending coronary artery.  Aorta and pulmonary\narteries are normal size and subject to the technical limitations of this\nstudy, free of central filling defects.  Mild-to-moderate cardiomegaly is best\nevaluated by echocardiography.\n\nMinimal pericardial effusion is is physiologic.  There is no pleural effusion.\n\nSubcentimeter mediastinal lymph nodes are not pathologically enlarged nor\ngrowing.  There is no adenopathy in the hila, internal mammary, diaphragmatic\nor retrocrural lymph node stations.\n\nSmall hiatus hernia is stable.  Esophagus above that level is mildly patulous\nbut otherwise unremarkable.\n\nLungs:\n\nAtelectasis in the right middle lobe distal to mild chronically impacted\nbronchiectasis is unchanged.  In the lateral basal segment of the right lower\nlobe however is a new, roughly 10 x 15 by 22 mm flame shaped homogeneous, soft\ntissue opacity, incorporating a mildly dilated impacted bronchus, probably the\nvestiges of a recent pneumonia.\n\nLeft lung is otherwise clear.\n\nChest cage:\n\nBlastic lesions in the spine, including vertebral bodies, L1, T10, T5, and\nleft pedicle L2 overall unchanged since at least ___.  There are\nno new bone lesions.",
            "output": "No good evidence for new intrathoracic malignancy.  Blastic spinal lesions are\nall stable since at least ___.\n\nNew soft tissue lesion, right lower lobe most likely residual from pneumonia,\nmay be related to chronic bronchiectasis and mucoid impaction in the right\nmiddle lobe.\n\nRECOMMENDATION(S):  Conventional chest radiographs now in hopes of providing\nthe baseline for subsequent follow-up of new right lower lobe lesion."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular adenopathy.  No axillary adenopathy.  Dense breasts are\nsuboptimally evaluated on CT.\n\nUPPER ABDOMEN: Will be reported separately.  Note is made of a suspected small\nhiatal hernia/patulous distal esophagus.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Mild coronary artery calcification.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Airspace\nopacification in the right lung base in the right middle lobe both appear\nimproved compared to prior representing improving infection.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary arteries not enlarged.  No pulmonary arterial\nfilling defects.\nCHEST CAGE: Sclerotic T5 vertebral body lesion measures approximately 16 x 10\nmm in the sagittal diameter and appear similar compared to prior imaging. \nSclerotic lesion in the T10 vertebral body measuring approximately 8 x 6 mm\nappear similar compared to prior imaging.  Multiple small lytic vertebral body\nlesions (for example lytic lesion in T8 series 6, image 155) appearing similar\ncompared to prior.  No pathological fractures.",
            "output": "Interval improvement/resolving right lower lobe respiratory tract infection.\n\nNo new suspicious pulmonary nodules or mediastinal lymph nodes.\n\nLytic and sclerotic osseous lesions appear similar compared to prior.\nPlease note that MRI and bone scan are the 2 optimal imaging studies to assess\nfor bony metastatic disease.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and pelvis and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nPre-existing metastatic bone lesions are unchanged.",
            "output": "No interval progression of the disease within the thorax with unchanged\nappearance of lytic and sclerotic lesions in the bones and no new\nlymphadenopathy of pulmonary nodules."
        },
        {
            "input": "The thyroid is unremarkable.  There is diffuse skin thickening overlying the\nleft breast, most likely related to prior radiation therapy changes.  There\nare no enlarged axillary lymph nodes.  There are no enlarged internal mammary\nlymph nodes.  There is also skin thickening overlying the right breast also\nunchanged.\n\nThe aorta and pulmonary arteries are unremarkable.  There are no enlarged\nmediastinal hilar lymph nodes.  There is soft the gas is diffusely thickened,\ncould be related to esophagitis.\n\nThere is no pericardial effusion.  There is no pleural effusion.  Nodular\nopacity in the right middle lobe is unchanged (image 43 series 4).  No new\nlung nodules are seen.  There is minimal bibasilar atelectasis.\n\nReview of bones shows essentially stable sclerotic osseous metastasis. \nOsseous metastasis involving T6, T11, L2 and L4 vertebral bodies. Correlation\nwith bone scan is recommended.  Limited sections through the upper abdomen\nshows a hypodense lesion in the right lobe of liver.  The left adrenal is\nmildly thickened.  Please refer to dedicated report on abdomen which has been\ndictated separately.",
            "output": "Stable skin thickening overlying the left breast most likely related to prior\nradiation therapy changes.  Patient is status post left lumpectomy and\nradiation therapy to the left breast.\n\nNodular opacity in the right middle lobe is unchanged (image 43 series 4).  No\nnew pulmonary nodules.\n\nOsseous metastasis involving T6, T11, L2 and L4 vertebral bodies.  Sclerotic\nlesion involving these left iliac bone and acetabulum.  Correlation bone scan\nis recommended"
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not pathologically\nenlarged.  Specifically excluding the breasts which are evaluated with\nmammography, there are no soft tissue abnormalities elsewhere in the imaged\nchest wall concerning for malignancy.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head and neck vessels and present in at least left anterior\ndescending coronary artery.  Aorta and pulmonary arteries are normal size. \nEvaluation of the heart, including an enlarged left ventricle would require\nechocardiography.\n\nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Cm size right lower paratracheal mediastinal lymph nodes\nare not pathologically enlarged.  Dilated pericardial recesses in the\nsubcarinal and right lower paratracheal station should not be mistaken for\nadenopathy.\n\nThere are no lymph nodes in the chest pathologically enlarged by size\ncriteria.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nThere are no lung lesions concerning for malignancy.\n\nMild biapical pleuroparenchymal scarring is symmetric and unchanged. \nTriangular sub pleural abnormality in the right middle lobe extending to the\nanterior and diaphragmatic pleural surfaces has enlarged progressively since\n___.  Proximal to it are small impacted bronchi suggesting that the lesion is\ninflammatory, either infection or atelectasis, rather than malignant.\n\nSubpleural ground-glass opacities in the left lower lobe are probably\ninflammatory, perhaps due to aspiration.\n\nCHEST CAGE: Progressive blastic transformation lower thoracic vertebral body,\n602:34, probably T10 is likely due to treatment impact of occult metastasis. \nMore severely blastic T5 vertebral body is stable.  Neither shows any volume\nloss.  There is no pathologic fracture or new destructive bone lesion.",
            "output": "No evidence of active intrathoracic malignancy.\n\nTreatment impact in thoracic vertebral bodies, increased increased in T10,\nstable in T5.  No new or growing bone lesions.\n\nSmall region of infection or chronic atelectasis in the right middle lobe\nprobably related to chronic endobronchial infection proximal to it.\n\nCardiomegaly involving at least left ventricle.\n\nRECOMMENDATION(S):  Consider echocardiography, if not recently performed."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymph nodes demonstrated.  Heart size\nis normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen was reviewed separately and dictated as\npart of the CT abdomen and pelvis.\n\nThyroid is heterogeneous containing multiple nodules\n\nAirways are patent to the subsegmental level bilaterally.  Interval increase\nin size in the right middle lobe nodule, series 5 image 157 from 5-7 mm is\ndemonstrated.  Endobronchial secretion, series 5, image 185 is noted as well\nas volume loss and nodule consolidation that continues to decrease current ___\n9 mm as compared to 14 mm on the previous study, series 5, image 204.  No\nadditional pulmonary nodules masses or consolidations demonstrated.\n\nThere is overall no substantial change in the appearance of the sclerotic\nmetastatic disease in T5 and T10, series 8, image 31.  No evidence of new\nsclerotic or lytic lesions demonstrated.",
            "output": "Most likely infectious process in the right middle lobe with interval\nimprovement of the dominant lesion.  Slight interval increase in 1 of the\nnodules might still reflect infectious process.  Reassessment in 3 months is\nrecommended\n\nUnchanged sclerotic metastatic disease in the thoracic spine.\n\nNo additional neoplastic or infectious intrathoracic lesions noted."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Numerous bilateral heterogeneous\nthyroid nodules measuring up to 0.9 cm in the right inferior lobe (06:33) are\nsimilar.  There is no supraclavicular or axillary lymphadenopathy.  The\nesophagus is unremarkable. A right Port-A-Cath device is in situ, with the\ncatheter tip terminating at the superior cavoatrial junction.\n\nUPPER ABDOMEN: Please refer to separate report for same day CT abdomen pelvis\nstudy for discussion of findings below the diaphragm.\n\nMEDIASTINUM: A 2.8 x 0.8 cm enhancing soft tissue mass in the right paraspinal\nspace based spanning the T9-T10 levels is minimally bigger (6:191, 9:25).  No\npathologically enlarged mediastinal lymph nodes are seen.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare moderate.  The thoracic aorta is normal in caliber. There is no\npericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is mild biapical scarring and bibasilar atelectasis. \nNodular consolidation at the base of the right middle lobe (6: 195) is further\nimproved.  No new or enlarging nodules are seen.  No new focal consolidations.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.  Endobronchial secretions are again noted in the right middle\nlobe (6:62, 168).\n3. VESSELS:  Main pulmonary artery diameter is within normal limits. No\ncentral pulmonary embolism.\nCHEST CAGE: Multiple sclerotic lesions in the thoracic spine, bilateral ribs\nand left scapula appear similar.  Enhancement of the soft tissue around the\nleft scapular lesion is again noted, compatible with soft tissue extension of\ndisease.  No new suspicious osseous lesions identified.",
            "output": "1. Re-demonstration of multiple sites of osseous metastatic disease in the\nthoracic spine, bilateral ribs and left scapula.  No new suspicious osseous\nlesions identified.\n2. A 2.8 cm enhancing soft tissue mass in the right paraspinal space spanning\nthe T9-T10 levels is minimally bigger, likely representing soft tissue\nmetastasis in the posterior mediastinum or soft tissue extension of adjacent\nosseous metastatic disease.\n3. Continued improvement in nodular consolidation in the right middle lobe,\nlikely reflecting evolving sequela of a prior infectious process.\n4. Please refer to separate report for same day CT abdomen pelvis study for\ndiscussion of findings below the diaphragm."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved for mammography.  There are no soft tissue abnormalities in the\nchest wall.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis mild in head neck vessels, present in at least left anterior descending\ncoronary artery.  Aorta and pulmonary arteries are normal size.  Small\npericardial effusion is physiologic.  Central venous infusion catheter ends in\nthe right atrium with no evidence of thrombosis.\n\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE: String of small consolidative opacities in the\ninferior right middle lobe, 12:200-219 is unchanged since ___ and ___, but\nwas slightly larger in ___, either improved metastasis or organized\npneumonia.  There are no new lung lesions concerning for malignancy and\ntracheobronchial tree is normal to subsegmental levels.\n\nSmall layering nonhemorrhagic pleural effusions are new.\n\nA band of hyperenhancing tissue anterior to the right of the lower thoracic\nvertebral body which has shown chronic blastic metastasis is unchanged since\n___, presumably extension of malignancy into extrapleural\nmediastinum.\n\n\n\nCHEST CAGE: Despite  chronic blastic metastasis in several mid thoracic\nvertebral bodies and scattered in the ribs, all grossly unchanged since\n___, there is no compression or pathologic fracture or new large osseous\nmetastases in the chest cage.",
            "output": "Osseous metastases and extrapleural paraspinal tumor extension stable since at\nleast ___.\n\nOrganized pneumonia or involuted metastases, right middle lobe, unchanged\nsince at least ___.  No definite pulmonary metastases or other evidence\nof new metastasis."
        },
        {
            "input": "The thyroid demonstrates a tiny hypodensity in the right lobe which is too\nsmall to characterize by CT. Supraclavicular, axillary, mediastinal and hilar\nlymph nodes are not enlarged. Aorta and pulmonary arteries are normal size.\nCardiac configuration is normal and there are coronary calcifications. Small\nhiatal hernia is incidentally noted.\n\nNo suspicious lytic or blastic skeletal lesions are detected within the\nthorax. Post surgical changes in the left breast appear similar to prior CT,\nthere and more fully evaluated by mammogram study ___.\n\nWithin the lungs, localized scarring and mild bronchiectasis in the medial\nsegment of right the right middle lobe is unchanged. No new or growing lung\nnodules are detected.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "The thyroid gland is normal. There are no pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes by size criteria. The thoracic aorta is\nnormal in caliber with a typical three vessel takeoff from the arch. The\npulmonary arterial trunk is normal in caliber. The heart is mildly enlarged\nwith a trace pericardial effusion.  The esophagus is unremarkable.\n\nThe tracheobronchial tree is normal to the subsegmental level. The subpleural\nopacities in the dependent left lower lobe are indeterminate, but could\nrepresent atelectasis (6:163). The there is no pleural effusion.\n\nSubdiaphragmatic structures are described in a separate report. There is no\nblastic or lytic lesion suspicious for malignancy.  6 mm lucent lesion in the\nT8 vertebral body is stable since ___ (10:28).",
            "output": "No evidence of intrathoracic metastasis"
        },
        {
            "input": "The thyroid is normal.  There are few scattered small mediastinal nodes,\nlikely reactive.  There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications.  There is\na small pericardial effusion (8:19).  There is abnormal thickening and\nenhancement of the superior and anterior portion of the pericardium (8:51,\n10:42).  There is no mediastinal fluid collection or definite mediastinal\nstranding identified.\n\nThere are small bilateral pleural effusions.  No pneumothorax.  There is mild\ndiffuse bronchial wall thickening, however the airways are patent to the\nsubsegmental level.  There are heterogeneously enhancing consolidations at the\nbilateral lung bases, right greater than left.  There is mild diffuse septal\nthickening, likely reflecting mild edema.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "-Small pericardial effusion, primarily in the anterior superior pericardial\nrecess and at the posterior inferior pericardial space.\n-Abnormal thickening and enhancement of the anterior superior portion of the\npericardium may be reactive to an infectious process in the mediastinum,\nhowever no mediastinal fluid collection or definite mediastinal stranding is\nidentified.\n-Bibasilar consolidations, right greater than left, are concerning for\npneumonia.\n-Scattered small mediastinal nodes are nonspecific, may be reactive to either\na process in the mediastinum or the lungs.\n-Small bilateral pleural effusions and mild pulmonary edema.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 9:37 am, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Posterior to the right lobe of the\nthyroid 1.9 cm nodule is most probably hyperparathyroid nodule (05:36).\nThere is no axillary lymphadenopathy.\nNo incidental findings in the chest wall.\n\nUPPER ABDOMEN: Too small to characterize hypodense round lesion in the left\nlobe of the liver most probably cyst.\nBoth kidneys atrophic.\nRemaining included upper abdominal organs with no gross findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\nTiny few small calcified granulomas in the left hilus.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nSpecks of calcifications in the coronaries.\nMajor vessels within normal size.\nLUNG: Major airways are patent.\n5 mm subpleural lingular calcified granuloma (5:165).\nSubpleural right lower lobe micro nodule (5:217).\nNo lung masses to suggest neoplasia, no lung consolidations to suggest\npneumonia.\nPleural effusion.\n\nCHEST CAGE: Relatively large number of Schmorl nodes in the thoracic spine.\nDiffusely mild sclerosis of the vertebra suggesting renal osteodystrophy.",
            "output": "Tiny few small calcified granulomas in the left hilus associated at left lung\nsmall calcified granuloma suggesting old granulomatous disease.\nNo evidence of active infection.\nProbably right hyperparathyroid nodule for further sonographic evaluation."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta is normal size.  Main pulmonary artery is\nenlarged measures 3.2 cm\nThere is moderate to severe cardiomegaly.  There is moderate to severe\ncalcification in all coronary arteries.  The left atrium is markedly enlarged.\nRight pleural effusion is small and associated with adjacent minimal\natelectasis.  Moderate to severe centrilobular and paraseptal emphysema is\nupper lobe predominant.  3 mm perifissural nodule on the left represents an\nintrapulmonary lymph node (5:159).  Atelectasis is in the left lower lobe is\nminimal, adjacent to the descending aorta.\nFew 11 nodule in the a posterior segment right upper lobe measures 10 x 8 mm\n(5:134)\nIrregular subpleural nodule in the right middle lobe measures 5 mm (5:191)\nThis examination is not tailored for subdiaphragmatic evaluation small\nsubcapsular hypodense lesion in the liver is a stable (3:63).  Bilateral renal\ncysts are partially imaged.  Small hiatal hernia.\nThere are no bone findings of malignancy",
            "output": "Moderate to severe Emphysema\nNo evidence of pulmonary edema or pneumonia\n10 mm nodule in the right upper lobe warrants further evaluation with PET-CT.\nCardiomegaly\nCoronary calcifications\nSmall hiatal hernia\n\nRECOMMENDATION(S):  PET-CT\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:10 ___, 2 minutes after discovery of the findings."
        },
        {
            "input": "5 mm left thyroid nodules (2, 6).  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate calcifications of the aortic arch. \nModerate dilatation of the main pulmonary artery.  Moderate cardiomegaly. \nModerate coronary calcifications.  No pericardial effusion.  Tortuosity of the\ndescending aorta.  Increase in size of the pre-existing right pleural\neffusion.  No osteolytic lesions at the level of the ribs, the sternum, or the\nvertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.  Severe apical predominant pulmonary emphysema.  A\npartly spiculated solid right upper lobe nodule, previously measuring 10 mm in\ndiameter, has grown in size and now measures 15 x 16 mm in diameter.  The\nnodule is adjacent to the right major fissure (4, 99).  Signs of mild chronic\nairways disease are present.  Several smaller pulmonary nodules, for example\nin the lateral aspect of the middle lobe (4, 146) Appears stable.  Small basal\npneumothorax with a small medial air-fluid level (4, 214).",
            "output": "Interval growth of the dominant right upper lobe nodule.  Other pre-existing\nnodules are not substantially changed.  New small basal pneumothorax with\nmedial air-fluid level."
        },
        {
            "input": "HEART AND VASCULATURE: There is severe cardiomegaly.  No pericardial effusion.\nThe ascending thoracic aorta is normal in caliber.  The thoracic aorta is\nseverely calcified.  The coronary arteries are severely calcified.  The main\npulmonary artery is mildly dilated with a diameter measuring up to 3.5 cm,\nunchanged.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a small right hydropneumothorax decreased in size\nsince 1 day prior.  A pigtail pleural drainage catheter is coiled anteriorly\nwith its tip located in the minor fissure.  No left pneumothorax.  Trace left\npleural effusion.\n\nLUNGS/AIRWAYS: There is severe paraseptal and centrilobular emphysema.  In the\nlocation of a spiculated pulmonary nodule which has been growing in size ___, there is a spiculated area of opacification measuring up to at least\n4.8 x 4.8 cm with resulting occlusion of the right upper lobe posterior\nsegment bronchus (series 302, image 102).  Difficult to distinguish between\npresumed growth of the pre-existing nodule into a mass and associated\npostobstructive atelectasis.  A right middle lobe lateral segment pulmonary\nnodule is increased in size and measures 0.7 cm, previously 0.5 cm (series\n302, image 145).  Interlobular septal thickening is more prominent in the left\nlung.  Peripheral ground-glass opacities in the left upper lobe apicoposterior\nsegment could reflect developing infection or sequela of aspiration.  A small\nconsolidation in the right lower lobe lateral basal segment could reflect\nsequela of aspiration or isolated atelectasis.\n\nBASE OF NECK: Unchanged multinodular thyroid gland with a possible left lower\npole nodule measuring up to approximately 1.8 cm.\n\nABDOMEN: Hypoattenuating hepatic lesions are too small to completely\ncharacterize, but statistically likely reflect cysts or biliary hamartomas. \nPartially imaged simple appearing renal cysts measure up to 6.0 cm.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUES: Adjacent to the course of a right anterior approach chest tube,\nthere is subcutaneous emphysema tracking along the right pectoralis major and\nminor fascial planes.",
            "output": "1. Difficult to distinguish between presumed interval growth of a pre-existing\nright upper lobe pulmonary nodule into a larger mass and its resulting\npostobstructive atelectasis, noting obstruction of the adjacent right upper\nlobe posterior segment bronchus.  The confluent area of opacification measures\napproximately 4.8 cm and neoplasm cannot be excluded.  Consider further\nevaluation with bronchoscopy.\n2. A right middle lobe pulmonary nodule has slightly increased in size and\nmeasures 0.7 cm.\n3. A small right hydropneumothorax is decreased in size since radiographs\nobtained 1 day prior status-post pigtail pleural drainage catheter placement.\n4. Ground-glass opacities in the peripheral left upper lobe apicoposterior\nsegment could reflect sequela of aspiration or developing infection.\n5. Severe centrilobular and paraseptal pulmonary emphysema.\n6. Severe calcified coronary and aortic atherosclerosis.\n7. Unchanged main pulmonary artery enlargement suggests pulmonary\nhypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is enlarged with dilated right and left atria.  No pericardial\neffusion.  Moderate atherosclerotic calcifications of the coronary arteries\nand aorta, none in the cardiac valves.  The pulmonary artery is dilated\nmeasuring 3.3 cm.  The aorta is normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.  Linear calcifications\nto the right pleura, sequela from prior pleurodesis.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  The airways are patent to\nthe subsegmental levels.  Mild diffuse bronchial thickening.  No\nbronchiectasis or mucus plugging.  Moderate severe centrilobular and\nparaseptal emphysema, upper lobe predominant, associated to large bilateral\napical bulla, right greater than the left.  Redemonstration of an ill-defined\nsoft tissue thickening in the right upper lobe, in proximity to the right\nhilum, measuring 4.1 x 3.8 cm, relatively unchanged in size compared to prior.\nStable 7 mm nodule in the middle lobe (5:187).  Mild interlobular septal\nthickening in both lung bases, likely age-related interstitial disease.  Other\nsmaller nodules scattered in the lungs, in the left upper lobe (5:169) in the\nmiddle lobe (5:151 and 223) and in the left lower lobe (5:65) are stable since\nat least ___.  No new nodules.\n\nCHEST CAGE:\nModerate dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show stable cysts in the left kidney\nmeasuring 5.7 cm (5:341) with mild parietal calcifications.",
            "output": "Stable post radiation appearance of the right upper lobe secondary to a\nsuspected lung cancer.  All pre-existing small lung nodules measuring up to 7\nmm are stable since ___.\nNo new or growing lymphadenopathy or osseous lesions.\n\nStable appearance of pleural calcifications, sequela from prior pleurodesis.\n\nEctasia of the main pulmonary artery which may be related to pulmonary\nhypertension.  If there is clinical concern for such, consider correlation\nwith an echocardiogram."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: There is a 4 mm hypoattenuating nodule in the\nright thyroid gland (6:64).  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nMEDIASTINUM: Similar to prior, there is a moderate-sized hiatal hernia, which\ncontains a small amount of simple free fluid.  Mediastinal lymph nodes are not\nenlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There are minimal mitral annular calcifications.  There is no\npericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  There is mild\natherosclerotic disease in the aortic arch.  Aortic caliber is normal.  The\nmain pulmonary artery is mildly dilated measuring up to 3.2 cm.  A left upper\nextremity PICC terminates in the superior vena cava.\n\nPULMONARY PARENCHYMA: There are punctate, calcified granulomas in the right\nupper lobe, left upper lobe and right lower lobe (6: 78, 153, 172).  There is\nno evidence of infection or malignancy.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There are small left and trace right nonhemorrhagic pleural effusions\nwith associated atelectasis..\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are minimal.  Chronic nondisplaced healed rib\nfractures are noted bilaterally.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Small left and trace right nonhemorrhagic pleural effusions.\n2. Mild enlargement of the main pulmonary artery is suggestive of underlying\npulmonary hypertension.\n3. No evidence of lymphadenopathy in the chest.\n4. Redemonstration of a moderate-sized hiatal hernia.\n5. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "A PICC line terminates in the lower superior vena cava.  Port terminates in\nthe upper most right atrium.\n\nThe heart is normal in size.  Aorta is normal in caliber.  Minimal mural\ncalcification along the arch.  Central pulmonary arteries are unremarkable.\n\nNo lymphadenopathy is found in the chest.  Medium quantity of non organized\nnonspecific fluid in the lower mediastinum, nonspecific.\n\nThere are trace, barely detectable bilateral pleural effusions.  No\npericardial effusion.\n\nMild multifocal atelectasis in the right middle lobe, lingula and bilateral\nbasilar lower lobes.\n\nThe abdomen is reported separately.\n\nThere are no suspicious bone lesions.  Bones are probably demineralized to\nsome extent.",
            "output": "No specific evidence for lymphoma found in the chest.  Moderate non organized\nfluid of low attenuation in the lower mediastinum."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no axillary lymphadenopathy.\n\nMEDIASTINUM: Borderline to mildly enlarged mediastinal lymph nodes have\nincreased in size compared to CT of the chest from ___, likely\nreactive.  For example, a 1.2 cm precarinal lymph node (6:131) previously\nmeasured 0.7 cm.  A 0.8 cm prevascular lymph node (6:118) is new.  A 0.7 cm\nsubcarinal lymph node (6:155) previously measured 0.5 cm.\n\nHILA: No hilar lymphadenopathy.\n\nHEART, PERICARDIUM, VESSELS: The heart is normal in size.  There is no\npericardial effusion.  There is a right chest wall Port-A-Cath with tip in the\nproximal right atrium.  There is a right IJ approach central venous catheter\nwith tip in the distal SVC.  There are mild atherosclerotic calcifications of\nthe thoracic aorta.  The thoracic aorta is normal in caliber.  The main\npulmonary artery is borderline dilated, measuring up to 3.2 cm, unchanged. \nThough not specifically tailored for evaluation of the pulmonary arterial\ntree, no central filling defects are seen.\n\nPLEURA: There are moderate bilateral pleural effusions, right greater than\nleft.  There is no pneumothorax.\n\nLUNGS, AIRWAYS: There is a 3.8 cm consolidation in the posterior right upper\nlobe (6:102), as well as multiple smaller, rounded consolidations with\nsurrounding ground-glass change scattered throughout all lobes, for example,\nin the right upper lobe (6:106, 125), right middle lobe (6:166), right lower\nlobe (6: 198, 163), left upper lobe (6:89), and left lower lobe (6:155). \nThere is mild compressive atelectasis associated with the bilateral pleural\neffusions.  There is smooth interlobular septal thickening, most pronounced in\nthe lung apices, compatible with interstitial edema.  Central airways are\npatent.\n\nCHEST CAGE: There is no suspicious osseous lesion or acute fracture.  There is\nan old fracture deformity of the left lateral ninth rib.\n\nUPPER ABDOMEN: This study is not tailored for subdiaphragmatic evaluation. \nSmall amount of abdominal ascites is noted.",
            "output": "1. Multifocal rounded consolidations with surrounding ground-glass change\nthroughout both lungs, most pronounced in the right upper lobe.  Fungal\npneumonia is a consideration.  Covid-19 can have this appearance, though\nbilateral pleural effusions are not typical.\n2. Interstitial edema.\n3. Moderate bilateral pleural effusions, right greater than left.\n4. Borderline to mildly enlarged mediastinal lymph nodes are likely reactive.\n5. Small amount of upper abdominal ascites.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:12 pm, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "Neck/ cardiomediastinum:  The thyroid is unremarkable.  There are no\npathologically enlarged supraclavicular or axillary lymph nodes.  There is no\nmediastinal or hilar lymphadenopathy.  The heart is normal in size. The main\npulmonary artery is normal in caliber.  The ascending aorta is top-normal. \nThere is no central pulmonary arterial filling defect.  Conventional 3 vessel\naortic arch anatomy is demonstrated.  There is no pericardial effusion.\n\nLungs/airways:  The trachea bronchial tree is patent to the subsegmental\nlevel.  There are no lung lesions concerning for malignancy.  Dependent\nbibasilar atelectasis is minimal.\n\nAbdomen:  This exam is not tailored for the evaluation of infra diaphragmatic\nstructures. Please see same-day abdomen/pelvic report for infra diaphragmatic\ndetails.\n\nBone/soft tissues:\nA solitary, small, benign sclerotic rib region  (4:95) is stable since at\nleast ___ (6:119).  There are no lesions suspicious for malignancy\nor infection.",
            "output": "No evidence for intrathoracic malignancy. Please see abdomen/pelvic CT dated\nsame day for infra diaphragmatic details."
        },
        {
            "input": "AIRWAYS: Unremarkable.\n\n\nLUNGS:\n\nNo focal nodule or infiltrates.  Minimal dependent atelectasis bilaterally,\nagain seen.\n\nPLEURA:  No effusion.\n\nLower neck: Unremarkable\n\nLYMPH NODES and MEDIASTINUM: No pathologically enlarged mediastinal, hilar, or\naxillary lymph nodes.\n\nHEART and VASCULATURE: Dense coronary artery calcifications again noted.  No\npericardial effusion.\n\nUPPER ABDOMEN: See abdomen pelvic CT report performed same date.\n\nBONES:  A few bilateral sclerotic foci in the ribs are stable since ___,\nprobably benign",
            "output": "No evidence of intrathoracic malignancy.  See abdomen pelvic CT, performed\nsame day, for subdiaphragmatic findings."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: There are new ground-glass and nodular infiltrates in\nthe posterosuperior left upper lobe, lingula, left lower lobe, consistent with\npneumonia.  Previously seen areas of nodular infiltrates have resolved since\n___.  Airways are patent without evidence of mucous plugging.  There is mild\nbibasilar atelectasis.  VP shunt is seen coursing through anterior right chest\nwall.\nVessels: There are no pulmonary emboli.  Main pulmonary artery is of normal\ncaliber.  Normal aorta and great vessels.\n\nMediastinum and Hila: No adenopathy\n\nHeart and Pericardium: Normal heart size, no effusion.\n\nPleura: Trace bilateral pleural effusions.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: No adenopathy or mass.\n\nUpper Abdomen: There is diffuse fatty liver.\n\nChest Cage: Laminectomies in the upper thoracic spine, partially seen.  There\nis no paraspinal fluid collection.  There is sheet like area of calcification\ninvolving posterior thecal sac in the mid thoracic spine, new since ___,\nlikely treatment related.",
            "output": "Infiltrates in the left upper lobe, left lower lobe, consistent with\npneumonia.\nNo pulmonary emboli.\nTrace pleural effusions.\nFatty liver.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:56 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Heart size is normal.  No pericardial effusion. \nModerate to severe calcified coronary atherosclerosis.  Mild aortic valve\ncalcification.  The thoracic aorta is normal in caliber and moderately\ncalcified.  No evidence of dissection or aneurysm formation.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Airways are patent to the subsegmental level.  Moderate\ncentrilobular emphysema.  Mild atelectasis.  No consolidations, contusions, or\nlacerations.  Incidental 5 mm right lower lobe posterior basal segment\npulmonary nodule (series 2, image 94).\n\nBASE OF NECK: Multinodular thyroid gland with individual nodules measuring up\nto approximately 1.3 cm.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are indeterminate hypoattenuating lesions in the right hepatic lobe\nmeasuring 8 mm (series 2, image 119), 9 mm (series 2, image 130), 1.6 cm\n(series 2, image 133), and 2.0 cm (series 2, image 137).  Other\nhypoattenuating lesions are too small to completely characterize, but could\nreflect cysts or biliary hamartomas on the basis of there subjectively lower\nattenuation.  There is no evidence of laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is diffusely atrophic.  Along the dorsal aspect of the\nproximal pancreatic tail, there is a 1.9 x 1.4 cm hypoattenuating lesion. \nThere is no main pancreatic ductal dilation.  There is no peripancreatic\nstranding.\n\nSPLEEN: There is a 1.8 x 1.5 cm hyperenhancing lesion in the anterolateral\naspect of the spleen (series 2, image 107).  The spleen is otherwise\nunremarkable.  No free evidence of laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: In the medial upper pole of the left kidney, there is a 2.8 x 2.4 cm\nhyperenhancing lesion (series 2, image 117).  The kidneys are otherwise\nsymmetric in size.  Some hypoattenuating lesions are too small to completely\ncharacterize, but probably reflect cysts.  No hydronephrosis.  No evidence of\nlaceration.  Incidental accessory left renal artery.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nA space of Retzius hematoma measures up to approximately 8.3 cm.  Immediately\nposterior to the left pubic bone and inferior pubic ramus, along the course of\nthe left internal pudendal artery, there are multiple foci of contrast\nextravasation, possibly arterial given contrast bolus timing.  More superiorly\nwithin the hematoma, anterior to the right aspect of the bladder, there is a\n1.0 cm rounded focus of relatively lower hyperattenuation which could reflect\nvenous extravasation (series 2, image 200; series 601, image 43).  There are\nalso small hematomas anterior and inferior to the pubic symphysis and adjacent\nto/involving the left iliacus, obturator internus, and piriformis musculature.\n\nREPRODUCTIVE ORGANS: There is severe prostatomegaly.\n\nLYMPH NODES: There is a nonspecific 1.2 cm left pelvic sidewall lymph node\n(series 2, image 196).  There is a nonspecific 1.0 cm right pelvic sidewall\nlymph node (series 2, image 194).  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is diffuse aneurysmal\ndilation of a severely tortuous common iliac arteries measuring up to 1.9 cm\nin diameter bilaterally.  Extensive atherosclerotic disease is noted. \nIncidental accessory left renal artery.\n\nBONES: There is a T12 burst fracture without osseous retropulsion.  There may\nalso be a subtle L1 burst fracture near the superior endplate (series 605,\nimage 68; series 607, image 83).  There is a fracture extending through the\nsuperior aspect of the T12 spinous process, through the T11 spinous process,\nand extending into the left T11 inferior articular process. There is a right\nT12 transverse process fracture and there are bilateral L1 transverse process\nfractures.  Incidental note is made of transitional anatomy at the lumbosacral\njunction with a pseudoarticulation between the left L5 transverse process and\nleft iliac bone.\n\nThere is a comminuted left acetabular fracture extending into the left iliac\nwing.  No definite fracture involving the left obturator ring.  There is mild\npubis diastasis with slight anterior displacement of the left pubis with\nrespect to the right.  There is a subtle nondisplaced fracture of the inferior\nright acetabulum. Contrast extravasation and hematomas as described above.\n\nScattered lucencies probably reflect osteopenia. No expansile lucent lesion or\nlucent lesions scalloping the adjacent cortex.\n\nSOFT TISSUES: Incidental 2.2 x 0.8 cm left quadratus femoris lipoma.  Small,\nfat containing umbilical hernia.  Small amount of hematoma extends along the\nleft spermatic cord.",
            "output": "1. Space of Retzius hematoma with contrast extravasation along the course of\nthe distal left internal pudendal the artery, adjacent to the left pubic\nbone/inferior pubic ramus. Small additional hematoma anterior and inferior to\nthe pubic symphysis.  Pubic symphysis diastasis noted.\n2. Comminuted left acetabulum fracture extending into the left iliac wing with\nhematomas adjacent to/involving the left iliacus, obturator internus, and\npiriformis musculature.\n3. Subtle nondisplaced inferior right acetabulum fracture.\n4. T12 burst fracture without osseous retropulsion. Subtle L1 burst fracture\nnear the superior endplate. Additional fractures include the T11 and T12\nspinous processes, left T11 inferior articular process, and T12 and L1\ntransverse processes.\n5. A 2.8 cm left renal mass is very concerning for a clear cell renal cell\ncarcinoma.\n6. Right hepatic lobe lesions measuring up to 2 cm are indeterminate. Consider\nMRI for further evaluation.\n7. Indeterminate 1.9 cm hypoattenuating lesion along the dorsal aspect of the\nproximal pancreatic tail. Consider MRI for further evaluation.\n8. A 1.8 cm hyperenhancing lesion in the spleen could reflect a hemangioma,\nbut in the presence of a probable left clear cell renal cell carcinoma,\nmetastasis cannot be excluded. Recommend attention on additional imaging as\nrecommended above.\n9. Incidental 5 mm right lower lobe pulmonary nodule with moderate\ncentrilobular emphysema. For incidentally detected single solid pulmonary\nnodule smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT in 12 months is recommended in a high-risk\npatient.\n10. Multinodular thyroid gland with individual nodules measuring up to 1.3 cm.\nPer ACR guidelines, no specific follow-up imaging is recommended.\n11. Diffuse fusiform aneurysmal dilation of the very tortuous bilateral common\niliac arteries.\n12. Mild nonspecific enlargement of bilateral pelvic sidewall lymph nodes.\n13. Severe prostatomegaly.\n\nRECOMMENDATION(S):\n1. A 2.8 cm left renal mass is very concerning for a clear cell renal cell\ncarcinoma.  Urology consult.\n2. Right hepatic lobe lesions measuring up to 2 cm are indeterminate. Consider\nMRI for further evaluation.\n3. 1.9 cm hypoattenuating lesion along the dorsal aspect of the proximal\npancreatic tail.  This could also be evaluated on the MRI performed for the\nhepatic lesions.\n4. A 1.8 cm hyperenhancing lesion in the spleen could reflect a hemangioma,\nbut in the presence of a probable left clear cell renal cell carcinoma,\nmetastasis cannot be excluded. Recommend attention on MRI.\n5. Incidental 5 mm right lower lobe pulmonary nodule with moderate\ncentrilobular emphysema. For incidentally detected single solid pulmonary\nnodule smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT in 12 months is recommended in a high-risk\npatient.\n\nNOTIFICATION:  The findings were discussed with the trauma surgery team by\n___, M.D. In person on ___ immediately upon completion of\nimage acquisition."
        },
        {
            "input": "HEART AND VASCULATURE: Evaluation of the subsegmental pulmonary vasculature is\nlimited at the lung bases.  Within this limitation, no evidence of pulmonary\nembolism to the segmental level.  The thoracic aorta is normal in caliber with\nmoderate to severe calcified plaque.  No acute aortic abnormality.  The heart\nis mildly enlarged with moderate coronary artery calcifications, moderate\naortic valvular calcifications, and dense mitral annular calcifications.  No\npericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  The esophagus is mildly\npatulous.\n\nPLEURAL SPACES: Small left and trace right pleural effusions are present.  No\npneumothorax.  Biapical pleural scarring is noted.\n\nLUNGS/AIRWAYS: There is a background of moderate emphysema.  Bibasilar left\ngreater than right consolidations most likely reflect atelectasis, although\naspiration or superimposed pneumonia could be considered if clinically\nappropriate.  Airways are patent the subsegmental level.\n\nBASE OF NECK: Left thyroid nodules measure up to 1.2 cm, and not require\nspecific follow-up unless clinically indicated.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Minimally displaced left posterior ninth, tenth, and possibly eleventh\nrib fractures are noted.  There are also bilateral L1 transverse process\nfractures.  Additionally, there is a mildly displaced T12 spinous process\nfracture (602:42).  Burst fracture of the T12 vertebral body extending to the\nposterior elements and compression fracture of the L1 vertebral body are\nre-demonstrated.  The epidural hematoma seen on MRI is not well appreciated on\nCT, but may be seen on series 602, image 41.",
            "output": "1. No evidence of pulmonary embolism to the segmental level, with limited\nassessment at the lung bases due to respiratory motion.\n2. Bibasilar consolidations are likely predominantly atelectasis, although\nsuperimposed aspiration or pneumonia could also be considered if clinically\nappropriate.\n3. Small left and trace right nonhemorrhagic pleural effusions.\n4. Minimally displaced left ninth through eleventh rib fractures.\n5. Bilateral L1 transverse process fractures.\n6. T12 spinous process fracture.\n7. Re-demonstrated burst fracture of T12 extending to the posterior elements\nand compression fracture of L1.  The known epidural hematoma is not well\nassessed on CT.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:12 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present. A left\nport tip in the right atrium.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nInterval increase in size of a 1.4 x 1.3 cm (previously 0.8 x 0.8 cm) (02:32)\nanterior paratracheal lymph node.  Multiple prevascular and anterior\nmediastinal lymph nodes are top-normal in size and do not meet CT size\ncriteria for enlargement however have increased since previous examination. \nThere is no supraclavicular, axillary, or hilar lymphadenopathy. The thyroid\ngland is heterogeneous and notable for a 0.7 x 0.5 cm (2:7) hypodensity within\nthe left thyroid lobe.\n\nThere is no evidence of pericardial effusion.  A trace right and small left\nnon hemorrhagic pleural effusion is new since ___.\n\nPulmonary nodules are as follows:  new 3 mm left lower lobe pulmonary nodule\n(3:62), stable 3 mm left upper lobe nodule (03:54 ),stable 4 mm (03:43) right\nupper lobe nodule, and stable 3 mm (03:41) right upper lobe nodule.\n\nMild bilateral lower lobe atelectasis is present.  Heterogeneous lung\nparenchyma is most consistent with areas of air trapping and can be seen in\nthe setting of small airways disease.\n\nThere is no additional evidence of pulmonary parenchymal abnormality. The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen is notable for diffuse ascites which is\nnew since ___ and previously identified on ___\nultrasound.  There are multiple scattered hypodensities throughout the liver\nand spleen which may have slightly improved however direct comparison is\nlimited.\n\nDiffuse sclerotic lesions throughout the osseous structures is most consistent\nwith metastatic disease, unchanged in appearance since ___.  No\npathologic fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Increase in size of 1.4 cm anterior paratracheal lymph node and smaller\nmediastinal node since ___ is worrisome for disease progression.\n3.  Multiple liver and splenic hypodensities are worrisome for metastatic\ndisease and may have slightly improved in appearance however direct comparison\nis limited.\n3.  Large volume ascites.\n4.  Diffuse osseous metastatic disease, unchanged in appearance since ___.\n5.  New 3 mm left lower lobe pulmonary nodule with multiple stable pulmonary\nnodules as described above.\n6.  Evidence of small airways disease.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 1:25 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare noted minimal as well as aortic calcifications.  Heart size is normal.  No\npericardial pleural effusion is seen.  No mediastinal, hilar or axillary\nlymphadenopathy is present.\n\nAirways are patent to the subsegmental level bilaterally.  Multiple pulmonary\nnodules are present, series 4, images 21, 23, 26, 28, 30, 31, 34, 35, 38, 44,\n45, 50, 53, 57, 58, 67, 69, 74, 82, 85, 89, 94, 97, 99 (4.5 mm), 105, 107,\n115, 117, 121, 130, 133, 136, 137 (5.4 mm), 150, 152, 159, 170, 174.  Some of\nthe nodules (the largest 1 can be seen on the previous study) but the small a\n1 cannot be found most likely due to different study technique.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen demonstrates liver hyperdensity consistent\nwith CT infiltration and minimal hiatal hernia with no other abnormalities\nnoted.",
            "output": "Multiple pulmonary nodules as described with no specific features concerning\nfor malignancy.  Giving the difficulty in comparison was ___ CT\nabdomen reassessment in ___ year based on the size of the largest nodules is\nrecommended for documentation of at least ___ year stability."
        },
        {
            "input": "There has been substantial decrease in volume of right pleural effusion which\nis however now somewhat loculated. A small simple left pleural effusion is\npresent, similar to prior. There is passive bibasilar atelectasis. Focal\nsubpleural opacity in the right middle lobe likely reflects atelectasis\n(series 4, image 133). No concerning pulmonary nodule or pneumothorax is\nidentified. The central tracheobronchial tree is patent.\n\nHeart size is normal. There is a moderate pericardial effusion which is\noverall unchanged in appearance when compared to prior examination. Coronary\nartery calcifications are present. The ascending thoracic aorta is at the\nupper limits of normal measuring 4.0 cm in greatest dimension. The pulmonary\nis normal in size.\n\nThe thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. The esophagus is unremarkable. Incidental note is made\nof a right upper pole renal cyst. Remainder of the visualized upper abdomen is\nunremarkable.",
            "output": "1.  Substantial decrease in volume of right pleural effusion residual small\nvolume loculated right pleural effusion.\n2.  Small simple left pleural effusion.\n3.  Moderate pericardial effusion, essentially unchanged.\n4.  Atelectasis bilaterally most marked at the lung bases."
        },
        {
            "input": "The aorta and its major branch vessels are patent, however there is grossly\nunchanged extensive atherosclerotic calcifications at the origins of the major\nbranch vessels.  Extensive coronary artery calcifications and mild\ncardiomegaly with left ventricular hypertrophy are also present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nMultiple prominent mediastinal lymph nodes are similar in appearance since\n___.  There is no supraclavicular, axillary, or hilar\nlymphadenopathy.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is mild emphysema. Thickening of the airways is likely due to\ninflammation.\n\nLimited images of the upper abdomen demonstrate unchanged thickening of the\nleft adrenal gland, without discrete nodule.  The left hepatic artery arises\nfrom the left gastric artery.\n\nMultiple healed bilateral rib fractures are again seen.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n\n2.  Airway wall thickening is likely due to inflammation.\n\n3.  Prominent mediastinal lymph nodes and thickening of the left adrenal gland\nas on prior imaging."
        },
        {
            "input": "The exam is mildly limited as portions of the lung apices and lung bases are\nexcluded.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the proximal\nsegmental level without filling defect to indicate a pulmonary embolus. \nDistal segmental and subsegmental branches are not particularly well assessed\ndue to the attenuation of the beam due to body habitus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal nodes are\ndemonstrated, which are stable since at least ___.  A right paratracheal node\nmeasures 1.2 cm in the short axis (series 302 image 73).  A left prevascular\nnode measures 0.9 cm in the short axis.  No anterior mediastinal masses.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is multifocal air trapping bilaterally, which is\nunchanged compared to a prior study from ___ is likely accentuated by non\nbreath-holding technique.  No focal consolidation or suspicious soft tissue\nmasses.  The airways are patent to the level of the subsegmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA ill-defined, 2.3 cm hypodensity at the left inferior renal pole near the\ncollecting system is unchanged compared to the prior study and likely\nrepresents a parapelvic cyst.  No suspicious focal lesions.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: There are bilateral adnexal lesions, which are somewhat\nill-defined with substantial mesenteric stranding surrounding.  The right\nadnexal lesion demonstrates internal hypodensity and measures approximately\n8.4 x 5.6 cm, previously 7.5 x 6.0 cm.  The left adnexal lesion measures\napproximately 6.0 x 5.6 cm, previously 4.8 x 4.4 cm.\n\nLYMPH NODES: Retroperitoneal nodes are prominent, a left periaortic node\nmeasures 2.1 cm in the short axis (series 304, image 33, which are likely\nreactive.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No substantial\natherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is a lower anterior abdominal wall fat and bowel\ncontaining hernia without secondary obstruction.  The extent of the peritoneum\nand soft tissues are not completely visualized secondary to the patient's body\nhabitus abutting the CT gantry.  No large soft tissue lesions are\ndemonstrated.  No acute fracture or focal osseous lesions.  There are\ndegenerative changes seen throughout the lumbar spine.",
            "output": "1. No evidence of pulmonary is an embolism or acute aortic injury.\n2. Redemonstration of ill-defined bilateral adnexal masses, previously\ndescribed as tubo-ovarian abscesses, which are mildly increased in size\ncompared to the prior study from ___.  The right adnexal lesion\nmeasures 8.4 x 5.6 cm, the left adnexal lesion measures 6.0 x 5.6 cm.  There\nis increased mesenteric stranding surrounding the structures compared to the\nprior study.  Findings are concerning for acute on chronic infectious process.\n3. Lower anterior abdominal wall hernia containing fat and nonobstructed\nbowel."
        },
        {
            "input": "CTA: Within the limitations of significant streak artifact from the patient's\nbody habitus, no definitive pulmonary embolism is seen.  Evaluation of the\nsegmental and subsegmental branches is very limited  The main pulmonary artery\nis enlarged, indicative of pulmonary hypertension.\n\nLUNGS: Bibasal atelectasis.  No worrisome lesions.  No pneumothorax.  Areas of\nair-trapping are noted.  No pleural effusion.\n\nMEDIASTINUM: Scattered top-normal mediastinal lymph nodes measuring up to 1.2\ncm in the prevascular space and 1 cm in the precarinal space.  Heart is of\nnormal size.  Aorta is of normal caliber.  No pericardial effusion.\n\nUPPER ABDOMEN: Limited evaluation with no pathology identified.\n\nBONES: No suspicious bony lesions.",
            "output": "1.   Extremely limited study due to the patient's body habitus.  No evidence\nof pulmonary embolism within these limitations\n\n2.  Evidence of pulmonary arterial hypertension.\n\n3. Areas of air trapping and atelectasis.\n\n4.  Slightly enlarged mediastinal lymph nodes."
        },
        {
            "input": "HEART AND VASCULATURE: Of note, this is a suboptimal study due to patient body\nhabitus which limits evaluation of intrathoracic structures.  Given these\nlimitations, the pulmonary vasculature is well opacified to the lobar level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart is mildly enlarged, but unchanged since the prior exam in ___.  The\nmain pulmonary artery is mildly enlarged measuring up to 3.5 cm (series 301:\nImage 104), which can be seen in pulmonary artery hypertension.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are prominent mediastinal lymph nodes\nwithout meeting CT size criteria for lymphadenopathy.  No axillary or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are scattered regions of air trapping seen bilaterally. \nHowever, no focal parenchymal opacification is identified.  Regions of\nscattered atelectasis are seen in the upper and lower lobes.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is grossly unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of significant central pulmonary embolus within the limitations\nof the exam.\n2. The main pulmonary artery is mildly enlarged, measuring up to 3.5 cm, which\ncan be seen in pulmonary artery hypertension."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThe lungs are clear.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Normal Chest CT. No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "Since a recent study of 1 week earlier, a right internal jugular catheter has\nbeen placed, terminating within the right atrium.  There is otherwise been no\nchange in the appearance of the chest since the recent CT performed 7 days\nearlier when consideration is given to the absence of intravenous contrast on\nthe current exam.",
            "output": "1. Interval placement of right internal jugular catheter with tip terminating\nin the right atrium.\n\n2. Otherwise unchanged appearance of the chest since the recent CT of 7 days\nearlier with no findings to suggest active infection or the intrathoracic\nmalignancy."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nHypodensity of the cardiac chambers compared to the myocardium suggests\nanemia.  The lungs are clear.  There is no pleural or pericardial effusion\nThis examination is not tailored for subdiaphragmatic evaluation.  The upper\nabdomen is unremarkable\nThere are no bone findings of malignancy\nRight central catheter tip is in the right atrium",
            "output": "anemia. No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "The partially imaged thyroid gland is within normal limits.  The esophagus is\nunremarkable.  There is no hiatus hernia.  The ascending thoracic aorta is\nmildly dilated with fusiform morphology, measuring 4.2 cm in diameter.  There\nis dense aortic valvular calcification.  There is mild aortic calcification. \nThe pulmonary artery is normal in caliber.  The heart is normal in size. \nThere is moderate to severe coronary artery calcification.  There is no\npericardial effusion.  There is no mediastinal, hilar, axillary, or visible\nsupraclavicular lymphadenopathy.\n\nAn approximately 5 mm metallic-density foreign body is seen within the\nproximal aspect of the first medial branch off of the right lower lobe lateral\nbasilar segmental bronchus (5, 260).  Subsegmental airway branches distal to\nthis appear opacified by secretions and mucous.  There is diffuse bronchial\nwall thickening, likely reflecting airways inflammation.  Otherwise, major\nairways are patent to subsegmental levels bilaterally.  Within the medial and\nposterior basilar right lower lobe, there are persistent but decreased\n___ nodules, with a more confluent posteromedial right lung base\nopacity, likely reflecting sequelae of postobstructive pneumonia (for example\nsee series 5, image 307 and 323).  Elsewhere, there is other additional focal\nconsolidation.  There is mild to moderate centrilobular and mild paraseptal\nemphysema worst at the lung apices.  Scattered apical predominant bronchialar\nmicronodules nodules are likely related to history of tobacco use.  Other\nbilateral solid pulmonary nodules are noted, measuring 1 mm in the left lung\napex (5, 42), 1-2 mm in the right upper lobe (5, 56), 2 mm at the posterior\nright upper lobe (5, 75), 2-3 mm in the peripheral right upper lobe (5, 123),\n2 mm in the inferior aspect of the right upper lobe (5, 175), and 2 mm in the\nlingula (5, 196).  Scattered punctate calcified granulomas are seen.  There is\nno pleural effusion or pneumothorax.\n\nThere is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality.\n\nDiffuse hepatic steatosis is incidentally noted.  Otherwise, the partially\nimaged solid and hollow viscous organs of the upper abdomen are without acute\nfocal abnormality on limited noncontrast evaluation.  The imaged thoracic\nvertebral bodies are normally aligned. There is mild-to-moderate multilevel\ndegenerative change. Vertebral body heights are preserved. No concerning focal\nlytic or sclerotic osseous lesions are seen.",
            "output": "1. 5 mm metallic density foreign body within the proximal aspect of the first\nmedial branch off of the right lower lobe lateral basilar segmental bronchus.\n2. Mucous plugging of the airways distal to the foreign body, with sequelae of\npost-obstructive pneumonia at the posteromedial right lung base.\n3. Dense aortic valvular calcification.  Recommend echocardiogram for further\nevaluation.\n4. Mild fusiform dilation of the ascending thoracic aorta measuring 4.2 cm in\ndiameter. In the absence of imaging prior to this, recommend ___ year follow-up\nchest CT to confirm stability.\n5. Bilateral solid pulmonary nodules measuring up to 2 mm.  These should be\nre-assessed at time of ___ year follow-up for stability.\n6. Scattered biapical bronchialar micronodules are due to respiratory\nbronchiolitis.\n7. Mild to moderate centrilobular and mild paraseptal biapical-predominant\nemphysema.\n8. Incidentally noted diffuse hepatic steatosis.\n\nRECOMMENDATION(S):\n1. Echocardiogram is recommended for further evaluation of dense aortic\nvalvular calcification.\n2. In the absence of imaging performed prior to this, recommend ___ year\nfollow-up chest CT to re-evaluate mild ascending aortic dilation (4.2 cm) and\nbilateral pulmonary nodules measuring up to 2 mm.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 12:15 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "The previously seen metallic foreign body in the right lower lobe bronchial\nsystem is no longer visualized.  A pre-existing right lower lobe parenchymal\nopacity has substantially decreased in extent and severity, an adjacent area\nof pleural thickening with several calcifications (4, 199) is stable.  Also\nstable are signs indicative of moderate to severe chronic airways disease,\nmucous plugging, ___ opacities and mucous retention in the larger\nairways.  The airway lumina are narrowed, but no foreign bodies of high\nattenuation are detected in the bronchial system.  Stable millimetric\nsubpleural nodules, stable apical predominant centrilobular emphysema as well\nas paraseptal emphysema at the lung apices (4, 26).  Stable position form\ndilatation of the ascending aorta, stable moderate aortic valve and coronary\ncalcifications, no pericardial effusion.  No lymphadenopathy.  Fatty liver. \nModerate degenerative vertebral disease.",
            "output": "The previously seen metallic foreign body in the right lower lobe is no longer\nvisualized.  No new foreign bodies.  Partial resolution of a pre-existing\nright lower lobe opacity.  Moderate to severe chronic airways disease with\nmucous plugging.  Mild apical predominant centrilobular emphysema."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are notable for surgical clips in the gallbladder\nfossa consistent with prior cholecystectomy.\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level.  Bulky\nmediastinal and hilar lymphadenopathy is not significantly changed from prior\nwith the largest right paratracheal lymph node measuring 3.1 x 2.3 cm (03:14).\nThere is no axillary lymphadenopathy.  Heart, pericardium and great vessels\nare within normal limits. No hiatal hernia is present.\n\nThere is stable appearance of a perilymphatic distribution of nodules in an\nupper and mid lung predominance. The scan was not obtained in full inspiration\nand mosaic attenuation is seen in the lungs, as seen on the expiratory phase\nof the prior study. No new nodules are identified.  No endobronchial lesion. \nNo new parenchymal or interstitial opacity. No pleural effusion or\npneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "Stable appearance of the chest with persistant bulky mediastinal and hilar\nlymphadenopathy and a perilymphatic distribution of nodules consistent with\nsarcoidosis.\n\nMild air trapping, unchanged from the prior examination.\n\nNo acute infection or endobronchial lesion."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are notable for surgical clips in the gallbladder\nfossa consistent with prior cholecystectomy.\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level.  Bulky\nmediastinal and hilar lymphadenopathy is not significantly changed from prior\nwith the largest right paratracheal lymph node measuring 3.1 x 2.3 cm (03:19).\nThere is no axillary lymphadenopathy.  Heart, pericardium and great vessels\nare within normal limits. No hiatal hernia is present.\n\nThere is stable appearance of a perilymphatic distribution of nodules in an\nupper and mid lung predominance. The scan was not obtained in full inspiration\nand mosaic attenuation is seen in the lungs, as seen on the expiratory phase\nof the prior study. No new nodules are identified. No pleural effusion or\npneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "Stable appearance of the chest with persist bulky mediastinal and hilar\nlymphadenopathy and a perilymphatic distribution of nodules consistent with\nsarcoidosis."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Bilateral breast prosthesis in situ. \nDense breast tissue is suboptimally assessed on CT, but no gross breast\nlesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Free air in the abdomen in keeping with recent C-section.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Mild cardiomegaly.  No\npericardial effusion.  No aortic valve or coronary artery calcification.  No\naneurysmal dilatation of the ascending aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Mild linear\natelectasis in the lung bases.  No confluent airspace consolidation.  No\nsuspicious pulmonary nodules or masses.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary artery is mildly dilated.  No features of right\nheart strain.  No pulmonary arterial filling defects to suggest pulmonary\nemboli.\nCHEST CAGE: No lytic/destructive bony lesions.",
            "output": "No pulmonary arterial filling defects to suggest pulmonary emboli.  The\npulmonary artery is mildly dilated.  No features of right heart strain.\n\nNo CT features of pneumonia.  Mild atelectasis in the lung bases.  No other\nfindings explaining the patient's shortness of breath.\n\nIntra-abdominal free air in keeping with recent C-section."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  Severe mediastinal lymphadenopathy is seen, measuring up to\n1.8 cm in short axis within the right paratracheal region additional extensive\npre vascular lymphadenopathy is identified.  Severe bilateral hilar\nlymphadenopathy is seen, with a large left perihilar mass measuring up to 3\ncm.  Severe enlarged subcarinal lymph nodes are seen which measure up to 5 cm\nin conglomerate, series 3, image 145.  The heart size is normal.  The\npericardium is intact without evidence of an effusion.  Multiple masses are\nseen within the mediastinum inseparable from the esophagus however there is no\ndefinite evidence of esophageal obstruction.  Multiple bilateral medial\npleural-based masses are seen, abutting the pericardium.\n\nThe airways are patent to the subsegmental levels.  Innumerable large\nbilateral pulmonary masses are identified.  For example:\n\n-a large mass within the right lower lobe measures 3.3 cm x 3.9 cm, series 3,\nimage 176.\n\n-a large mass within the superior segment of the right lower lobe measures 3.2\ncm x 2.2 cm, series 3, image 151.\n\n-right upper lobe mass measures 1.6 cm x 2.1 cm.\n\n-a large left lower lobe mass measures 2.1 cm x 2.6 cm.  Enlarged left upper\nlobe mass measures 1.8 cm x 2.2 cm.\n\nThere is a moderate right pleural effusion.  There is no evidence of\npneumothorax.\n\nFor evaluation of the abdomen, please refer to the dedicated CT of the abdomen\nperformed on same day.\n\nOsseous structures: No definite concerning bone lesions are identified however\nplease note that a bone scan or PET-CT would be more sensitive.",
            "output": "1. Innumerable large bilateral pulmonary masses are identified affecting every\nlobe of the lungs.  A large left perihilar mass is seen measuring up to 3 cm,\ncould be accessible by bronchoscopy for biopsy.\n2. Moderate right pleural effusion.\n3. Severe mediastinal and hilar lymphadenopathy, concerning for metastasis and\ninvolvement of the underlying neoplastic process.\n4. Moderate right pleural effusion."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  There is no axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: This study is not optimized for evaluation of subdiaphragmatic\nstructures.  Please see the dedicated abdominal CT report of ___\nfor a complete description of subdiaphragmatic findings.  Briefly, the large\nhypodense hepatic mass replacing much of the liver is again demonstrated as\nwell as pneumobilia.  Atrophic kidneys and a thickened right adrenal gland are\nagain seen.\n\nMEDIASTINUM: Extensive mediastinal lymphadenopathy is unchanged.  Reference\nnodes include a right paratracheal node measuring up to 2.3 cm in short axis,\nunchanged (03:24).  A bulky subcarinal lymph node conglomerate measures\napproximately 2.2 x 4.9 cm, unchanged (03:33).\n\nHILA: Large left hilar mass has grown slightly compared to ___\n(5:141).  Upper lobe anterior segmental bronchus is still occluded, but there\nis minimal atelectasis.\n\nHEART and PERICARDIUM: Heart size is normal.  Diffuse coronary artery\ncalcifications are mild.  There is no pericardial effusion.\nPLEURA: A moderate nonhemorrhagic right pleural effusion has increased since\n___.  There is no left pleural effusion.\nLUNG:\n\n1. PARENCHYMA: There has been an increase in atelectasis at the right lung\nbase. Numerous bilateral pulmonary masses are more numerous and some are\nslightly larger, for example:\n\n3.8 x 3.0 cm, superior segment of the right lower lobe previously 3.2 x 2.2 cm\n(5:167).\n\nA mass in the right upper lobe measures 1.7 x 1.9 cm, previously 2.1 x 1.6 cm\n(05:35).\n\nIn the left upper lobe, and mass measures 2.8 x 2.2 cm, previously 2.6 x 2.1\ncm (5:181).\n\nA second left upper lobe mass measures 2.1 x 2.2 cm, previously 2.2 x 1.8 cm\n(03:22).\n2. AIRWAYS:  Airways are patent to the subsegmental levels.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in the\ncaliber.  The thoracic aorta is normal in caliber with mild atherosclerotic\ncalcification.\nCHEST CAGE: No suspicious lytic or sclerotic osseous lesions or acute\nfractures are demonstrated.  Extensive degenerative changes of the thoracic\nspine with ossification of the anterior longitudinal ligament are again\ndemonstrated.",
            "output": "1. Overall increase in the size and number of the numerous pulmonary\nmetastases. No pulmonary edema, pericardial effusion or evidence of venous\nocclusion.\n2. Increase in the size of a moderate right pleural effusion and atelectasis\nat the right lung base.\n3. Unchanged severe mediastinal and left hilar lymphadenopathy in keeping with\nmetastatic disease.\n4. No suspicious lytic or sclerotic osseous lesions or acute fractures are\nidentified, however bone scan or FDG PET-CT is more specific for early osseous\nmetastatic disease.\n5. Please see the separately dictated abdominal CT report from ___ for a complete description of subdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, supraclavicular, axillary or hilar lymph nodes demonstrated. \nHeart size is normal.  There is no pericardial or pleural effusion.  Small\nhiatal hernia is present.\n\nAirways are patent to the subsegmental level bilaterally.  Postradiation\nchanges in the right upper lobe anteriorly related to breast cancer therapy. \nBibasal cylindrical bronchiectasis are minimal.  No discrete pulmonary nodules\nmasses or consolidations demonstrated.\n\nRight breast lesion, series 4, image 29 is 15 x 13 mm, located adjacent to the\nchest wall/rib cage.  The lesion is assessed in details on the multiple\nprevious dedicated breast imaging studies, please continues surveillance.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease\n\nStatus post right breast cancer treatment.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nissued separate on the study obtained the same day."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMain pulmonary artery diameter is normal.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.\n\nHeart size is normal.  There are no significant coronary artery\ncalcifications.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Enlarged epicardial lymph nodes in the left\nanterior cardiophrenic recess (4:160) appears similar.\n\nPLEURAL SPACES: There is a trace dependent right pleural effusion.  No\npneumothorax or left pleural effusion.\n\nLUNGS/AIRWAYS: 4 mm right upper lobe ground-glass nodule (4:82) and 2 mm right\nlower lobe nodule (4:99) are unchanged.  Scattered calcified granulomas are\nagain noted.  Redemonstration of subsegmental atelectasis in the bilateral\nlower lobes, lingula and middle lobe.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Redemonstration of moderate volume abdominal ascites and omental\ncaking, consistent with abdominal metastatic disease.  There is a small hiatus\nhernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\n\nCHEST WALL: A 1.7 cm soft tissue density lesion in the right breast (4:87) is\nunchanged, previously evaluated on mammography.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Similar appearance of abdominal metastatic disease and enlarged left\nanterior epicardial lymph nodes to prior CT abdomen pelvis from ___.\n3. No specific evidence of metastatic disease in the chest."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is a moderate to large hiatus hernia.  There is no\npericardial effusion.  There is moderate coronary artery calcification. \nLeft-sided PICC line projects to the azygos vein.\n\nPLEURA: There are small bilateral pleural effusions, the right is increased in\nvolume ended the and the left pleural effusion new since the prior study.\n\nLUNG: There is bibasilar atelectasis.  A scar-like opacity in the right upper\nlobe (3, 19) with a linear pleural tag is unchanged.  No new pulmonary\nnodules.  No new consolidations\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no adrenal\nmasses.  No focal liver lesions are seen.",
            "output": "Small bilateral pleural effusions right greater than left with bibasilar\natelectasis.\n\nNo evidence of recurrent lymphoma in the chest\n\nStable scar-like opacity in the right upper lobe.\n\nLeft-sided PICC line with its tip in the azygos vein"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No pathologic enlargement of lymph\nnodes in the supraclavicular or axillary stations.  There is new mild diffuse\nchest wall edema which is more pronounced at the level of the flanks.\n\nCHEST CAGE: Minimal degenerative changes at the level of the thoracic\nvertebra.  L1 severe wedge compression fracture is mildly more sclerotic in\ncomparison to ___.  There is no evidence of lytic or sclerotic\nmetastatic osseous destructive lesions the level of the ribs, sternum or\nvertebra.\n\nUPPER ABDOMEN: There is relative atrophy of the partially imaged right kidney\nwhich is stable.  Increased fat stranding surrounding the left kidney is\nnonspecific, for clinical correlation since could represent infection.\nRemaining unenhanced upper abdominal organs are with no gross findings.\n\nMEDIASTINUM: Almost the entire stomach included a in large hiatal hernia,\nunchanged since prior and upper esophagus is patulous as before.  There is no\nlymphadenopathy in the mediastinum and hilar silhouettes suggest no gross\nlymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There are signs of mild\nanemia.  Patient is status post sternotomy and CABG, there are extensive dense\ncalcifications of native coronaries.  There is no pericardial effusion. \nMinimal calcifications along the normal caliber thoracic aorta,  main\npulmonary artery is normal in caliber.\n\nPLEURA and LUNG: Bilateral small layering pleural effusions are larger since\nprior, right greater the left.  Adjacent consolidations containing air\nbronchograms reflect pneumonia, particularly in the left lower lobe (4:149),\npossibly due to aspirations, particularly in the presence of large hiatal\nhernia.\nTracheobronchial tree is centrally patent.\nIn the right upper lobe linear scar-like opacity with linear pleural tag is\nunchanged since ___ (4:109).  No new pulmonary nodules.",
            "output": "-Bilateral small layering pleural effusions are larger since prior, right\ngreater the left. Adjacent consolidations, left greater than right are likely\ndue to aspirations, particularly in the presence of large hiatal hernia.\n-Increased fat stranding surrounding the partially imaged left kidney could\nrepresent infection, for clinical correlation."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: Right upper extremity PICC seen with its tip in\nproximal right atrium.  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.\n\nPLEURAL SPACES: Moderate pleural effusions bilaterally with minimal increase\nin the amount compared to the recent prior CT..\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Again seen is evidence of airspace opacification involving the\nleft lower lobe.  There are few new scattered areas of ground-glass opacities\nfor example in the right upper lobe (series 3, image 93, right middle lobe\n(series 3, image 166 and 188).  Stable appearance of bilateral subsegmental\npassive atelectasis in both lower lobes.\n\nABDOMEN: Large hiatus hernia with stomach filled with oral contrast seen above\nthe diaphragmatic hiatus.  Please refer to the separately dictated report of\nCT abdomen and pelvis.\n\nBONES: Stable significant wedge compression fracture involving L1 vertebral\nbody with more than 75% vertebral body height loss and buckling of the\nposterior cortex.  Stable appearance of the median sternotomy wires in situ.",
            "output": "Compared to 3 days prior:\n\n1. No evidence of lymphadenopathy.\n2. Stable airspace opacification in the left lower lobe suggestive of\nconsolidation.  New small scattered areas of ground-glass opacities in the\nright upper and middle ___ represent infectious etiology.  Clinical\ncorrelation recommended.\n3. Mild interval increase in bilateral pleural effusions which are moderate. \nStable bibasilar passive atelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is mildly enlarged.  No pericardial\neffusion.  Severe native calcified coronary atherosclerosis.  Status-post\nCABG.  The thoracic aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.  An apparent filling defect in the lingular segmental\npulmonary artery reflects motion artifact.  No other evidence of possible\npulmonary embolus to the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Trace right pleural effusion.  No left pleural effusion.  No\npneumothorax.\n\nLUNGS/AIRWAYS: A right upper lobe apical segment pulmonary nodule measuring 8\nmm is unchanged at least ___.  Otherwise, no significant pulmonary nodules or\nconsolidations.  There is substantial right lower lobe atelectasis adjacent to\na large hiatal hernia.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Large hiatal hernia containing ingested material.  There is extensive\nomental nodularity and fat stranding.  No dilated loops of large or small\nbowel in the upper abdomen.  No upper abdominal retroperitoneal or mesenteric\nlymphadenopathy.  The imaged portion of the pancreas, spleen, and liver are\nunremarkable.  Incidental replaced common hepatic artery arising from the\nsuperior mesenteric artery.  Small amount of perihepatic free fluid is noted.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No pulmonary embolism noting limited evaluation of lingular segmental\npulmonary artery branches due to motion.  No evidence of acute aortic\nsyndrome.\n2. Extensive omental nodularity and fat stranding raising the possibility of\ncarcinomatosis with an unknown primary.  If clinical concern for acute or\nsubacute abdominopelvic pathology, recommend dedicated CT abdomen/pelvis with\noral and IV contrast.  Otherwise, recommend nonemergent CT evaluation for\nmalignancy.\n3. An 8 mm right upper lobe apical segment pulmonary nodule is unchanged since\nat least ___.\n\nRECOMMENDATION(S):  Extensive omental nodularity and fat stranding raising the\npossibility of carcinomatosis with an unknown primary. If clinical concern for\nacute or subacute abdominopelvic pathology, recommend dedicated CT\nabdomen/pelvis with oral and IV contrast. Otherwise, recommend nonemergent CT\nevaluation for malignancy."
        },
        {
            "input": "There is no supraclavicular or axillary adenopathy or soft tissue abnormality\nin the chest wall suspicious for malignancy. This study is not designed for\nsubdiaphragmatic diagnosis, but shows normal-size adrenal glands, large cystic\nlesions in both kidneys, and a solitary calcified stone in a small\ngallbladder.\n\nThyroid gland is normal except for a solitary calcification in a slightly\nenlarged lower pole the right lobe. Atherosclerotic calcification is heavy at\nthe bifurcation of the brachiocephalic artery and in the coronaries. Non\ncalcified ascending thoracic aorta is generally large, reaching maximum\ntransverse diameter, 49 mm, at the level of the intra pericardial right\npulmonary artery, mildly enlarged in the descending portion, 32 mm across,\nnormal caliber but heavily calcified in the upper abdomen.\n\nPulmonary arteries only mildly dilated, main 35 mm, intra pericardial right\npulmonary artery, 28 mm.\n\nThere is no pericardial pleural effusion. All chambers of the heart are\ndilated, particularly the right ventricle, in deviating the interventricular\nseptum posteriorly.\n\nThere are no findings of either diffuse lung disease or air trapping to\nsuggest obstructive or small airways disease. Small regions of pleural\nthickening could be asbestos related pleural plaques but there are no findings\nin the lungs to suggest asbestosis. Marked decrease in pulmonary vascular\ncaliber and profusion is consistent with pulmonary hypertension, perhaps\nidiopathic.\n\nLungs are clear pulmonary nodules on the tracheobronchial tree is normal to\nsubsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of interstitial or obstructive lung disease.\n\nMild pulmonary artery dilatation.  Multi chamber cardiomegaly, vertical right\nventricular enlargement.\n\nCoronary atherosclerosis.\n\nGeneral thoracic aortic ectasia.  Maximum diameter 48 mm fusiform ascending\nthoracic aorta.\n\nPossible asbestos related pleural plaques.  No evidence of asbestosis."
        },
        {
            "input": "Supraclavicular and right axillary lymph nodes are not enlarged.  Stellate,\nroughly 18 x 37 mm soft tissue lesion at the site of previously resected large\nleft axillary mass extends from retracted skin to the sub muscular layer. \nThis could be entirely scar, but residual tumor could be present.  Follow-up\nis advised.\n\nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall suspicious\nfor malignancy.  Findings of the thoracic inlet and below the diaphragm will\nbe reported separately.\n\nEsophagus is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels or coronary arteries.  Aorta and pulmonary arteries are normal\nsize.  Small pericardial effusion has increased since ___.  There is no\npleural effusion.\n\nThoracic lymph nodes:\n\nNo adenopathy.\n\nLungs and airways:\n\nGround-glass opacification and subpleural atelectasis, left upper anterior\nchest wall at the level of just above the level of tumor resection could given\nthe appropriate clinical history be due to radiation.\n\n5 mm subpleural right lower lobe nodule, ___ mm in ___.\n\n3 mm right lower lobe nodule, 4:151 new since ___.\n\nPunctate nodule, left lower lobe, 4:116 is small enough to been present but\nnot imaged in ___, or it could be new.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "3 tiny lung nodules, one minimally larger, 2 probably new compared to ___, suspicious for metastases.\n\nResidual tissue, left axilla following resection and possible treatment could\nbe entirely scar or may ___ residual or recurrent malignancy.  Suggest\nevaluation with either FDG PET-CT or follow-up chest CT.\n\nRECOMMENDATION(S):  Suggest evaluation of post treatment left axilla with\neither FDG PET-CT or follow-up chest CT."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Left axillary soft tissue has decreased\nin size as compared to previous examination, currently 29 by 16 mm as compared\nto 37 x 18 mm, series 2, image 17.  Substantial skin thickening over the left\nbreast has noted, minimally different from previous examination at its\nsuperior portion but slightly increased in its inferior portion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Right lower lobe\npulmonary nodule, series 302, image 131 is 3.5 mm as compared to 5 mm,\ndecreased in size.  Previously seen right lower lobe nodule adjacent to the\nright hemidiaphragm is not present on the current examination.  Left lower\nlobe nodule, series 302, image 136 is 3 mm, unchanged.  No new nodules masses\nor consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval decrease in size in right lower lobe pulmonary nodule, red resolution\nof additional right lower lobe pulmonary nodule and unchanged appearance of\nleft lower lobe nodule\n\nInterval decrease in size in the right axillary tissue and unchanged\nappearance of postradiation fibrosis in the left upper lobe."
        },
        {
            "input": "The imaged base of neck is unremarkable.  The thoracic aorta is normal in\ncourse and caliber without significant atherosclerotic calcification.  The\nheart is within normal limits of size.  There is trace pericardial fluid.  The\nmain pulmonary artery is normal in caliber.  There is no filling defect seen\nwithin the pulmonary arterial tree to suggest the presence of a pulmonary\nembolism.  There is no mediastinal, hilar or axillary lymphadenopathy.  A\nfocus of scarring is again seen at the left axilla.\n\nA right lower lobe pulmonary nodule is best seen on series 3, image 115\nmeasuring 5 mm, unchanged from prior.  There is mild right basal dependent\natelectasis.  No new or growing pulmonary nodule is seen.\n\nIn the imaged portion of the upper abdomen, no discrete abnormality is seen.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Skin thickening\nis noted along the left breast which may reflect prior treatment, unchanged\nfrom prior.",
            "output": "1. No pulmonary embolism or acute aortic process.\n2. Trace pericardial fluid\n3. Size stable right lower lobe pulmonary nodule, 5 mm.\n4. Scarring at the left axilla, may reflect history of left axillary melanoma,\nplease correlate clinically."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and right axillary lymph nodes are not\nenlarged.  Volume of stellate soft tissue deep in the left chest wall beneath\nthe retracted left axillary and breast fold, 5:72-111 is not bulky year at any\nlevel than comparable images from ___.  Compared to ___ however\nat the most inferior extent of the post treatment soft tissue, 5:88-107, there\nis conglomerate soft tissue, 27 x 26 mm, thicker today with more surrounding\nedema than it was in ___.  Excluding malignant recurrence in\ndistinguishing it from progressive scarring is difficult, since concurrent\nthickening of the skin of the left breast is an indication of active\ninflammation and scarring rather than tumor recurrence.\n\nRight axilla is unremarkable.\n\nSpecifically excluding the breasts which require mammography for evaluation,\nthere is no soft tissue abnormality elsewhere in the partially imaged chest\nwall concerning for malignancy.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM:Esophagus is mildly patulous at several levels.  There are\nno thyroid findings warranting further imaging evaluation.  Atherosclerotic\ncalcification is not apparent in head and neck vessels or coronary arteries. \nAorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: None pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE:\n\n6-7 mm nodule soft tissue nodule, superior segment right lower lobe, 5:136 i\nunchanged since ___ and ___, was 5 mm in ___ and 4 mm in ___, imaged with slightly different technique.\n\nNo new or recently growing lung nodules.  No focal pulmonary abnormalities of\nconsequence.\n\nTracheobronchial tree is normal to subsegmental levels.  There is no pleural\nabnormality.\n\nCHEST CAGE: No pathologic or compression fractures or destructive bone\nlesions.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "7 mm right lower lobe lung nodule has not grown since ___, but was 5 mm in\n___ and 4 mm in ___.  This could be a very slowly growing\nmetastasis, particularly if patient is on effective chemo therapy.\n\nMild interval enlargement, post treatment tissue left axilla, compared to\n___.  Whether this is maturation of a post therapeutic response or\nlocal recurrence is indeterminate with conventional radiography.  Radionuclide\nFDG PET CT scanning might be helpful in distinguishing between these 2\npossibilities."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and axillary lymph nodes are not enlarged. \nStellate-shaped soft tissue along the left chest wall, beneath the retracted\nleft axillary and breast fold, is similar in size and morphology compared to\nthe study from ___.  The soft tissue conglomerate at the most\ninferior extent now measures 2.5 x 2.6 cm (series 6, image 73), previously 2.6\nx 2.7 cm.  Heterogeneous lucency along the inner medial aspect of this tissue\nconglomerate could represent postoperative changes.  Thickening of the skin of\nthe left breast has decreased. Specifically excluding the breasts which\nrequire mammographic for evaluation, there are no soft tissue abnormalities\nelsewhere in the chest wall concerning for malignancy.\n\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: The esophagus is mildly patulous.  There are no findings\nin the thyroid warranting further imaging evaluation. Aorta, pulmonary\narteries, and cardiac chambers are normal in size. Pericardium is physiologic.\nAtherosclerotic calcification is not apparent in head and neck vessels, or in\nthe coronary arteries.\n\nTHORACIC LYMPH NODES: Non pathologically enlarged, including internal mammary\nand diaphragmatic stations.\n\nLUNGS, AIRWAYS, PLEURAE: Slight interval decrease in size of the soft tissue\nnodule in the superior segment of the right lower lobe, now measuring 4-5 mm,\npreviously 6-7 mm (series 6, image 144).  Otherwise, lungs are clear,\ntracheobronchial tree is normal to subsegmental level. No pleural effusion or\nother abnormality.  No evidence of new nodules or lesions.\n\nCHEST CAGE: Multilevel degenerative changes in the thoracic spine without\npathologic or compression fractures or destructive bone lesions. Although\nthere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting early or shows pathology then chest CT\nscanning.",
            "output": "1. Improved induration and slight interval decrease in size of the\nposttreatment conglomerate of tissues in the left axilla, compared to ___.\n2. Interval decrease in size of nodule in the superior segment of the right\nlower lobe, now measuring 5 mm, previously 7 mm."
        },
        {
            "input": "The stellate soft tissue structure in the left axilla, located near an area of\nskin retraction (5, 15) is overall stable in extent.  The degree of\narchitectural distortion in this area is also stable.  No evidence of\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum or at the level of the hilar structures. \nNormal appearance of the large mediastinal vessels.  Mild coronary\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Moderate degenerative vertebral disease. \nNo vertebral compression fractures.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.\nSeveral pulmonary micro nodules are miniscule and have not increased in size\nas compared to the previous examination.  Currently there is no evidence of\npulmonary nodules suggestive of metastatic disease.  No pleural thickening or\npleural abnormalities.  No diffuse lung disease.  The airways are patent.",
            "output": "Stability in size of a known left axillary lesion.  No interval growth of\nthoracic lymph node or pulmonary nodules.  No pleural abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.\nStable postoperative changes to the left axilla.\nNo abnormalities on the chest wall.\n No atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: The esophagus is unremarkable.  No pathologically enlarged\nmediastinal or hilar lymph nodes by CT size criteria.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nNo atherosclerotic calcifications in thoracic aorta and coronary arteries.\nPLEURA: No pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  No consolidations or atelectasis.  Subpleural micronodule in\nthe right lower lobe (6:156), unchanged.\n2. AIRWAYS:  Airways are patent to subsegmental levels.\n3. VESSELS:  Pulmonary arteries are not enlarged.\nCHEST CAGE: No acute fractures.  No suspicious lytic or sclerotic lesions. \nMild dorsal spondylosis.",
            "output": "No interval change compared to prior study ___.\nStable scarring in the left axilla.\nPre-existing pulmonary nodule is unchanged.  No new or growing nodules were\nidentified."
        },
        {
            "input": "Supraclavicular and right axillary lymph nodes are not enlarged.  Spiculated 3\nx 3 cm soft tissue lesion with a low-density center and poor separation from\nthe adjacent chest wall musculature,, ___, is new following resection of\nprevious left axillary and upper chest wall mass, 41 x 76 mm.  It is difficult\nto distinguish seroma from abscess from residual and/or recurrent tumor. \nThere are no  enlarged lymph nodes elsewhere in the left axilla and no other\nsoft tissue abnormalities in the chest wall.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent in the head and neck or coronary\narteries.  Aorta and pulmonary arteries are and cardiac chambers are normal\nsize.  Pericardium is physiologic and there is no pleural abnormality. \nEsophagus is unremarkable.\n\nMediastinal, hilar, and other thoracic lymph nodes including internal mammary\nchain are not enlarged.\n\nLungs:\n\n3-4 mm subpleural right lower lobe nodule, 13b:128.  Lungs are otherwise clear\nand the tracheobronchial tree is normal to subsegmental levels.\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous metastases than chest\nCT scanning.",
            "output": "Solitary, indeterminate 3-4 mm right lower lobe nodule is the only abnormality\nno other findings to suggest intrathoracic malignancy.\n\nLarge indeterminate postoperative lesion left axilla could be seroma, abscess,\nor even recurrent necrotic malignancy.  Patient's physician, particularly\nsurgeon, would be in a better position to make the likely diagnosis, and the\nlesion should be easily accessible to sampling if that is in doubt."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is enlarged.  There is calcification of the\ncoronary arteries and aortic valve.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No mediastinal lymphadenopathy.  1.2 cm right\nhilar lymph node is mildly enlarged, image 2:52.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lung bases are not fully included on the images.  Central\nairways are patent.  There is a symmetric bronchial wall thickening with foci\nof bronchial plugging in the left lower lobe.  There is diffuse centrilobular\nmicro nodularity indicating small airways disease.  There is also mild\ncentrilobular emphysema.\n\nThere are lingular ground-glass opacities (series 3 image 125, 143, 189, 193)\nwith scattered foci of ___ nodularity.  There also scattered\n___ opacities in the left lower lobe.  More discrete solid nodules\nmeasure up to 7 mm in the lingula (series 3, image 140) and up to 7 mm in the\nleft lower lobe (series 3, image 193).  There are also scattered ___\nnodules and small ground-glass opacities in the right upper lobe.  There is\nill-defined ground-glass opacity in the medial basal right lower lobe, image\n3:91.\n\nMild-to-moderate pleural/parenchymal scarring lung apices has progressed\ncompared to the ___ CT even allowing for differences in modalities.  There\nare 2 coarse calcifications in the right apical pleural thickening on image\n2:16.  There is a small focus of calcified pleural thickening at the level of\nthe lingula on image 2:65, which was thickened but not definitively calcified\non the ___ CT.\n\nBASE OF NECK: Visualized portions of the base of the neck appear unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There is anterior wedging of the T3 vertebral body (series 602, image\n37), of indeterminate chronicity.  Well-defined, densely sclerotic 3 mm lesion\nin the T6 vertebral body on image 602:36 is new since ___, but statistically\nlikely a bone island.  Subcentimeter sclerotic lesion in T12 vertebral body is\nunchanged since the ___ CT (image 602:34).",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Mild centrilobular emphysema and diffuse centrilobular micro nodularity\nindicating small airways disease.\n3. Asymmetric bronchial wall thickening and peripheral bronchial plugging in\nthe left lower lobe.\n4. Ground-glass opacities and ___ nodularity in the lingula and left\nlower lobe, with small foci of involvement in the right upper lobe and medial\nbasal right lower lobe, suggesting atypical infection.  Discrete nodules are\nalso present in the lingula and left lower lobe, which require follow up to\nexclude malignancy.\n5. Slightly increased, mild-to-moderate biapical pleural/parenchymal\nthickening with calcifications the right apex, and a small focus of calcified\npleural thickening at the level of the lingula.  These may be postinflammatory\nat the apices and postinflammatory or posttraumatic at the level of the\nlingula.  Sequela of asbestos exposure are less likely given the limited\ndistribution.\n6. Mild anterior wedging of T3 vertebral body is new compared to the CT from\n___, but otherwise of unknown chronicity.\n7. Well-defined, densely sclerotic 3 mm lesion in the T6 vertebral bodyis new\nsince ___, but statistically likely a bone island.\n\nRECOMMENDATION(S):  Follow up chest CT in 3 months."
        },
        {
            "input": "Descending aorta is mildly enlarged, 3 cm, stable.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  Heart size is\nnormal.  Coronary calcifications are extensive.  There is no pericardial\npleural effusion.\n\nThere is interval decrease in size in currently normal mediastinal lymph\nnodes.  No hilar, axillary or supraclavicular lymphadenopathy is present.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Biapical scarring\nis stable.  Lingular nodules present on the previous examination has resolved,\nseries 4, image 139.  Additional lingular nodule has resolved as well, series\n4, image 195.  Left lower lobe mixed density nodule has resolved, series 4,\nimage 188 almost completely.  No new nodules masses or consolidations\ndemonstrated.\n\nPleural calcification is minimal, series 4, image 128 is no associated pleural\neffusion.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval decrease in size in mediastinal lymph nodes and pulmonary nodules.\n\nUnchanged mild anterior wedging of T3 vertebral body."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No evidence of enlarged lymph nodes the\nmediastinum.  The dimension of the right hilar lymph nodes are borderline (3,\n25).  No abnormalities at the level of the large mediastinal vessels.  No\nincidental pulmonary embolism.  Known moderate coronary calcifications, no\npericardial effusion.  Normal appearance of the heart.  In the upper abdomen,\nnote is made of a 3-4 mm left adrenal adenoma (3, 52), unchanged as compared\nto the previous PET-CT examination.\n\nStable mild to moderate pulmonary emphysema.  As compared to the previous\nexamination, the known right lower lobe mass (5, 121) has substantially\ndecreased in size.  At a comparable anatomical level, the mass now measures 2\nx 2 cm, as compared to 25 x 27 mm on the previous examination.  The\nspiculations of the mass, as well as the retractile behavior with regard to\nthe major fissure, however, are unchanged.  No new lung nodules.  Stable mild\nchronic airways disease.  No pleural effusions.",
            "output": "Interval decrease in size of the known right lower lobe mass.  Stable\nappearance of the remaining lung.  No lymphadenopathy.  No pleural\nabnormalities."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Incidental note is\nmade of variant origin of the left vertebral artery directly off the aortic\narch.  There is no evidence of penetrating atherosclerotic ulcer or aortic\narch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no evidence of pericardial effusion.\n\nEndotracheal tube is in place. There is complete bilateral lobe collapse.\nSeveral scattered densities measuring up to 2 cm in the right upper lobe along\nwith more prominent partial consolidation of the posterior segment of the\nright upper lobe with surrounding ground-glass densities, compatible with\nprogressive pulmonary contusion. Few scattered ground-glass densities in the\nleft upper lobe also likely represent contusion. There is a small simple\ndensity right-sided pleural effusion. Left -sided chest tube is in place.\nThere is no pneumothorax. There is a small amount of pneumomediastinum which\nis new.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nScattered mediastinal lymph nodes are not pathologically enlarged. The thyroid\ngland appears unremarkable.\n\nLimited images of the upper abdomen re- demonstrated a small perihepatic and\nperisplenic hemoperitoneum. There is partial visualization of the previously\nnoted hepatic and splenic lacerations. Embolization coil is noted in the\nsplenic artery. Upper enteric tube is in place.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\nRib fractures as noted on prior study are not imaged. No other fracture is\nidentified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Complete bilateral lobe collapse. Progression of right upper lobe pulmonary\ncontusions. Few scattered ground-glass densities in the left upper lobe are\nminimally progressed, also compatible with contusions.\n3. New small pneumomediastinum.\n4. Left-sided chest tube in place without pneumothorax. Small simple density\nright-sided pleural effusion.\n5. Similar appearance of hepatic and splenic lacerations with small\nsurrounding hemoperitoneum.\n6. Previously noted rib fractures are not imaged on this study. No other\nfractures identified.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:59 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "CHEST CTA:\nThere are diffuse bilateral pulmonary emboli in the lobar, segmental, and\nsubsegmental levels.  There is borderline right heart strain.  The ascending\nand descending thoracic aorta are normal with no evidence of dissection or\nintramural hematoma.\n\nCHEST:\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The heart and mediastinum are normal.\nThe pericardium is intact without effusion.\n\nThe lung parenchyma demonstrates scattered areas of consolidation,\npredominantly at the posterior bases, which likely represent atelectasis. \nParticularly in the right upper lobe, there are small ground glass opacities\nwhich could represent infection.  There is a small amount of fluid in the left\nmajor fissure.  Evaluation for small nodules is limited by respiratory motion.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Extensive bilateral lobar, segmental, and subsegmental pulmonary emboli\nwith borderline right heart strain.\n2.  Ground glass opacities in the right upper lobe concerning for infection.\n\nNOTIFICATION:  Findings were discussed with Dr. ___ by Dr. ___ in\nperson at 217am on ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings in the\nthyroid.\nNo evidence of supraclavicular lymphadenopathy.\n\nA right breast heterogeneous mass measuring 3.9 x 3.8 cm involving pectoralis\nmajor with fat stranding surrounding it is seen.  The fat plane between the\nmass and the rib is lost with no clear adjacent rib destruction (series 6,\nimage 23).\nThere is no axillary lymphadenopathy.\n\nUPPER ABDOMEN: Small hiatal hernia and the esophagus is patulous containing\ncontrast extending up to the level of the carina.\nUpper abdominal organs reported separately in the concurrent dedicated CT of\nthe abdomen and pelvis accession number ___.\n\nMEDIASTINUM: There is no internal mammary lymphadenopathy.\nThere is no mediastinal or hilar lymphadenopathy.\n1.1 cm right hilar lymphnode is mildly enlarged.\n\nHEART and PERICARDIUM: The heart is not enlarged and there is no pericardial\neffusion.\nThe no obvious atherosclerotic calcifications the coronaries or in the major\nvessels.\nMajor vessels are within normal size.\n\nLUNG: Airways are patent to the subsegmental level bilaterally.\nThere are no concerning lung nodules or masses, no lung opacifications to\nsuggest infectious process or malignancy.\nThere is no pleural effusion.\n\nCHEST CAGE: Sclerotic lesion in the right part of the T5 vertebral body with\nno cortical destruction is nonspecific (7:94).\nAnother small right sided T2 sclerotic lesion measuring 0.5 cm and 0.2\nsclerotic focus in T11 (7:45).",
            "output": "-No signs of intrathoracic malignancy and no pleural effusion.\n-Nonspecific sclerotic lesions in the few vertebral bodies.  It should be\nnoted that radionuclide bone and FDG PET scanning are more sensitive in\ndetecting early osseous pathology than chest CT scanning. Please see\nconcurrent bone scan for further evaluation.\n-Large right 3.9 cm heterogeneous breast mass involving the pectoralis major\nand loss of fat plane between the mass and the adjacent rib is seen.  No\ndefinite underlying bony abnormalities identified."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there are moderate calcifications in all coronary\narteries.  The lungs are clear.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy cervical spinal hardware is partially\nimaged",
            "output": "No evidence of active intrathoracic infection or malignancy.\nCoronary calcifications"
        },
        {
            "input": "The thyroid gland is homogeneous in attenuation without focal nodularity. \nThere is no axillary or supraclavicular adenopathy.  Central nodes are not\npathologically enlarged, the largest at the right lower paratracheal station\nwhich measures 6 mm (04:22), present previously and not significantly changed.\nThere is no appreciable hilar adenopathy.\n\nThe ascending aorta is non aneurysmal and the main pulmonary artery is within\nnormal limits in caliber.  Moderate coronary artery calcifications are present\ndiffusely.  Heart size is within normal limits.  There is no pericardial\neffusion.\n\nTracheobronchial tree is patent to the subsegmental level.  There is no\nworrisome nodule, mass, or consolidation.  There is no pleural effusion or\npleural abnormality.\n\nAnterior cervical fusion hardware is partially imaged.  There are no worrisome\nosseous lesions within the chest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently, clip number ___.  Not is made of large midline\nbowel containing anterior abdominal wall hernia.",
            "output": "1. No evidence of active intrathoracic malignancy or infection.\n\n2. Coronary atherosclerosis.\n\n3. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed concurrently, clip number ___."
        },
        {
            "input": "There are no enlarged mediastinal, hilar, or axillary lymph nodes.  Heart size\nis normal, and severe diffuse coronary artery calcifications are present. \nThere is no pericardial or substantial pleural effusion.  Mild elevation of\nleft hemidiaphragm is unchanged.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine and postoperative changes partially imaged in the\ncervical spine.\n\nWithin the lungs, no new or growing pulmonary nodules or masses are\nidentified.  Minor atelectasis is present at the left lung base adjacent to\nthe elevated left hemidiaphragm.",
            "output": "1.  No CT evidence of recurrent lymphoma in the thorax.\n\n2. Severe diffuse coronary artery calcifications.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "CT chest with IV contrast:  There are no filling defects in the pulmonary\narteries.  The mediastinal vessels are unremarkable.  There are no pleural\neffusions.  Ther is no mediastinal or hilar lymphadeonpathy.  There are no\nmasses.  A 3 mm nodule is seen in the right lower lobe ___ 67, Se 2).\n\nThe depicted abdominal organs are normal.  There are no osteolytic or\nosteo-sclerotic lesions.",
            "output": "1.  No pulmonary embolism\n\n2.  3mm lung nodule most likely represents a granuloma, however comparison\nwith prior outside studies or ___ months follow-up is recommended to ensure\nstability of this finding and exclude metastasis."
        },
        {
            "input": "The thyroid is enlarged and contains multiple hypodense nodules, largest in\nthe isthmus measures 20 x 25 mm.  An enlarged right supraclavicular mass has\ndecreased in size measuring 41 x 56 mm previously 51 x 58 mm (3:9).  The mass\nis involving the right clavicle and first rib with localized osteolysis. \nThere is significant skin thickening and break down of the skin approximately\n2 cm deep.  The mass is also abutting the right common carotid and subclavian\narteries.  The right internal jugular vein is attenuated.  Right upper\nparatracheal lymph node has decreased in size now 7 mm previously 11 mm. \nNumerous subcentimeter lymph nodes in the right axilla.\n\nHeart size is normal.  Mild coronary artery calcifications.  There is no\npericardial effusion.  Thoracic aorta and main pulmonary arteries are normal\nin caliber.  The airways are patent to\nsubsegmental level.\n\nMinimal paraseptal emphysema.\nThere is biapical pleuroparenchymal scarring is worse on the right, did not\ndemonstrate FDG PET avidity.  Numerous punctate pulmonary nodules were not\ndefinitely seen on the prior examination, however there was substantial\nmotion.  Punctate nodules include series 5, image 55,  59, 78, 87, 122, 136,\n142, 151, 183. Minimal centrilobular emphysema and diffuse bronchial\nirregularity.  Mosaic attenuation of the lungs can be small airways disease.\n\n11 x 10 mm nodule in right breast laterally is stable and was not PET avid. \nAdditional 3 x 3 mm nodule in the medial breast also stable.",
            "output": "Interval decrease in the right supraclavicular mass with localized destruction\nof the first right rib and clavicle and significant skin thickening with\nulceration.  Right internal jugular vein is completely attenuated.  Right\ncommon carotid and subclavian arteries appear patent.  Right upper\nparatracheal lymph node has also decreased.\n\nNumerous punctate pulmonary nodules were not definitely seen on the prior\nexamination, however there was substantial motion.  Suggest follow-up CT\nthorax in 3 months to reassess.\n\nMild emphysema, and small airways disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:\nThere is a heterogeneously enlarged thyroid gland with multiple hypodense\nnodules including a 2.4 x 2.3 cm isthmus hypodense nodule (series 5:image 4).\n\nThere is a 5.5 x 3.0 cm soft tissue mass in the right supraclavicular fossa\n(series 5:image 5).  As patient positional differences limit evaluation of the\nlesion, there does not appear to be significant interval growth or reduction\nin size of the mass.  There does to be increased prominence of the overlying\nwound and clavicle osteolysis following recent biopsy. The mass contacts the\nright internal carotid artery and right supraclavicular artery and occludes\nthe right internal jugular vein.\n\nThere are prominent and mildly enlarged right axillary lymph nodes including a\n18 x 12 mm right axillary lymph node, similar to prior exam (series 5:image\n24).  There is no left axillary or supraclavicular lymphadenopathy.\n\nMEDIASTINUM: There is no pathologically enlarged mediastinal lymph node.  The\npreviously FDG-avid right paratracheal lymph node continues to decrease in\nsize and now measures 3 mm (series 5: Image 9).  The esophagus is normal in\ncaliber and course.\n\nHILA: There are no pathologically enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart is normal in size, and mild coronary artery\ncalcifications are noted.  There is no significant pericardial effusion.\n\nPLEURA: There is no pleural effusion, and right apical scarring is similar to\nprior exam.\nLUNG:\n\n-PARENCHYMA:  There are multiple stable bilateral pulmonary nodules measuring\nup to 4 mm in size (series 6:image 71, 77, 29, 120, 174, 197).  No new or\nenlarging pulmonary nodules are seen, and no focal consolidation is noted to\nsuggest infection.  There is mild paraseptal and centrilobular emphysema. \nCentrilobular nodules are again noted possibly reflecting respiratory\nbronchiolitis.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The main pulmonary artery is normal in caliber, and no filling\ndefect is noted to suggest pulmonary embolism.\nCHEST CAGE: Multiple right breast nodules are noted including a stable right\nlateral 12 mm breast nodule, which were better evaluated on the recent\nmammogram (series 5:image 42).  Osteolysis of the medial clavicle is again\nnoted, and no other focal osseous lesion is noticed to suggest metastatic\ndisease.",
            "output": "1.  Similar appearance of the right supraclavicular mass with overlying medial\nclavicle osteolysis and skin wound.  The right internal jugular vein is\noccluded secondary to this lesion.\n2.  Stable mildly enlarged right axillary lymph nodes including a 12 mm lymph\nnode.\n3.  Continued decrease in size of the right paratracheal lymph node.\n4.  Multiple unchanged pulmonary nodules.  No new or enlarging pulmonary\nnodules.\n5.  Heterogeneous thyroid with multiple hypodense nodules including a 2.4 cm\nisthmus nodule."
        },
        {
            "input": "The thyroid is enlarged and heterogeneous, with multiple nodules.  Compared\nwith ___ the hypodense nodule in the isthmus appears slightly\nincreased in size, measuring 2.7 x 2.4 x 2.7 cm, compared with 2.4 x 2.3 x 2.5\ncm previously.  An additional hypodense nodule in the more inferior thyroid\nisthmus measures 1.7 x 1.4 cm compared with 1.3 x 1.1 cm previously.  A 1.3 x\n1. 0 cm hypodense right thyroid nodule is not significantly changed (5:1).\n\nAn ill-defined soft tissue mass in the right supraclavicular fossa is larger,\napproximately 5.8 x 3.5 cm overall, 5.5 x 3.3 cm previously (5:7).  The mass\nagain contacts the right internal carotid and right subclavian arteriies and\noccludes the right internal jugular and subclavian veins.  An anterior nodular\ncomponent of the mass is 2.6 x 2.3 cm, previously 1.8 x 1.7 cm and laterally,\nthere is a new 2.6 x 2.4 cm, nodular component of the mass  in the region of\nprevious soft tissue wound (5:11).\n\nThere is no significant change in numerous right axillary nodes, some of which\nare enlarged, including a 1.6 x 1.2 cm node and a 1.8 x 1.0 cm node (5:22,\n26).  There no pathologically enlarged left axillary or left supraclavicular\nlymph nodes.\n\nThere are no pathologically enlarged mediastinal or hilar lymph nodes.  A\npreviously FDG avid right paratracheal lymph node measures 3 mm, stable\ncompared with ___, however decreased compared with ___ (5:9).\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Right apical scarring is similar to prior.  Multiple\nbilateral pulmonary nodules measuring up to 4 mm in size are not significantly\nchanged (6:61, 64, 67, 121, 170, 194).  There are no new pulmonary nodules. \nMild centrilobular and paraseptal emphysema is similar to prior.  There is\nsubsegmental atelectasis in the right upper lobe.\n\nOsteolysis of the medial right clavicle is again seen.  No osseous lesions\nsuspicious for infection or malignancy are identified.\n\nA 1.2 x 1.1 cm right breast nodule contains a new tiny calcification,\nconsistent with history of interval biopsy in ___ (5:42).\n\nPlease see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings, including the imaged left\nadrenal thickening.",
            "output": "1. Interval increase in size of a right supraclavicular mass, with extension\nof the mass into the prior skin wound overlying the right clavicle.  The right\ninternal jugular and right subclavian veins are still occluded by the mass. \nThe right internal carotid and right subclavian arteries are contacted by the\nmass but patent.\n2. Stable right axillary lymphadenopathy.\n3. Stable previously FDG avid 3 mm right paratracheal lymph node.\n4. Multiple bilateral pulmonary nodules measuring up to 4 mm are stable.  No\nnew or enlarging pulmonary nodules.\n5. Heterogeneous thyroid, with interval increase in size of multiple hypodense\nnodules.\n6. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:17 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: The thyroid is enlarged and shows\nnumerous large hypodense nodules, increasing in size from the prior\nexamination in ___.  For example a a large nodule arising from the isthmus\nmeasures 4.1 x 3.1 cm (previously 3.7 x 2.7 cm (06:16).\n\nAn ill-defined soft tissue mass within the right supraclavicular fossa is\noverall increased in size from ___ and now measures approximately 7 x\n2.4 cm at its largest ___ (5:3, 4), previously 6.6 x 2.3 cm on the\nprior study.  An anterior nodular component of the mass measures 2.9 x 3.0 cm,\nminimally increased from the prior examination when it measured 2.6 x 2.4 cm\n(5:5).  As before, the mass contacts the right internal carotid and right\nsubclavian arteries and occludes the right internal jugular and right\nsubclavian veins.  A right axillary lymph node conglomerate has increased in\nsize from the prior examination and now measures 1.7 x 1.2 cm (05:10).  There\nare no pathologically enlarged mediastinal or hilar nodes.  There is no left\naxillary lymphadenopathy.\n\nHEART & VESSELS: The heart is normal in size. The great vessels are normal in\ncaliber.\n\nLUNGS & AIRWAYS: Breathing motion artifact limits evaluation for small\npulmonary nodules.  Given that, there are no focal consolidations or pleural\neffusions.  Right apical scarring is overall similar to the prior exam (6:6). \nMultiple bilateral pulmonary nodules are stable given comparison limitations\ndue to respiratory motion (6: 62, 159, 211).  A 4 mm perifissural nodule\nappears slightly larger than on the prior examination when it measured 3 mm. \nThere is minimal atelectasis in the right middle lobe.  There are no new\npulmonary nodules.  Finally, there is subtle ground-glass opacity involving\nthe right upper lobe at the apex, suggesting pneumonitis or bronchiolitis.\n\nUPPER ABDOMEN: Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: As before, there is osteolysis of the\nmedial right clavicle.  No additional suspicious osseous lesions identified. \nHealing fractures involving the lateral left fourth and fifth ribs are new\nfrom the prior examination.",
            "output": "1. Interval increase in size of a right supraclavicular soft tissue mass, with\npersistent occlusion of the right internal jugular and right subclavian veins.\nThe right internal carotid and right subclavian arteries are contacted by the\nmass but remain patent.\n2. Increase in right axillary lymphadenopathy.\n3. Significant breathing motion artifact limits evaluation small pulmonary\nnodules.  Given that, multiple pulmonary nodules are stable from the prior\nexamination with no definite new or enlarging pulmonary nodules identified.  A\n4 mm right perifissural nodule may be slightly larger from the prior\nexamination.  Attention on follow-up.\n4. Subtle ground-glass opacity involving the right upper lobe at the apex may\nbe related to the radiation pneumonitis or mild bronchiolitis.\n5. Markedly heterogeneous and enlarged thyroid within a interval increase in\nmultiple hypodense nodules.\n6. Healing fractures involving the lateral fourth and fifth ribs on the left\nare new from the prior examination.  Osteolysis of the medial right clavicle\nis stable.  No additional suspicious osseous lesions are identified."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:  Large, heterogeneous thyroid mass\nis slightly smaller.  The largest nodule, arising from the isthmus, measures\n3.4 x 2.7 cm, previously 4.1 x 3.1 cm.\n\nCompared to ___, the large right supraclavicular soft tissue mass\nhas grown (___).  The anterior nodular component of the mass is 3.6 x 2.6 cm\n(___), previously 2.9 x 1.8 cm.  The mass again contacts the right internal\ncarotid and right subclavian arteries, however, the degree of compression has\ndecreased.  The mass still occludes the right internal jugular and right\nsubclavian veins.\n\nSlight interval increase in a 2.3 x 1.2 cm right axillary lymph node\nconglomeration, previously 1.7 x 1.2 cm (___).  Unchanged 1.0 cm nodule in\nthe right breast (___) with breast biopsy clip.\n\nUPPER ABDOMEN: Please see same-day separately dictated CT abdomen and pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: Multiple unchanged mediastinal lymph nodes, measuring up to 0.7\ncm (___), not pathologically enlarged.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  The\nLAD, RCA and aortic valve contain mild calcifications.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\nPARENCHYMA:  Upper lobe predominant centrilobular emphysema is mild and\nunchanged.\n\nBipartite, scar like tissue at the right apex is unchanged since ___, but larger compared to ___, particularly in the\nposterolateral aspect of the right lung apex (compare ___ to ___ from ___.\n\nNo new or enlarging nodules.  0.7 cm nodule in the right lower lobe (___)\nand multiple smaller pulmonary nodules are unchanged (for example, ___, 75,\n85, 96, 118, 124, 142, 198, 196).  Index nodules:\n- right middle lobe, measuring 0.5 cm (___)\n- right middle lobe, measuring 0.5 cm (___)\n- left lower lobe, measuring 0.3 cm (___)\n\nAIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n\nVESSELS:  No evidence of pulmonary embolism on this non PE protocol study.\n\nCHEST CAGE: There is osteolysis of the medial right clavicle and new adjacent\nsubcutaneous gas suggesting biopsy.  No new suspect osseous lesions. \nUnchanged healed left fourth and fifth anterolateral rib fractures.  No new\nfractures.",
            "output": "1. Compared to ___, interval increase in a right ill-defined soft\ntissue supraclavicular mass.  Interval decrease in compression of the right\ninternal carotid and right subclavian arteries.  Unchanged occlusion of the\nright internal jugular and right subclavian veins.\n2. Slight interval increase in a 2.3 x 1.2 cm right axillary lymph node\nconglomeration, previously 1.7 x 1.2 cm.\n3. Bipartite, scar-like tissue at the right lung apex is unchanged since ___, but larger compared to ___.  It could be a primary\ncarcinoma, presenting with disproportionately large metastasis to the\nsupraclavicular space.\n4. No new or enlarging nodules.  Multiple unchanged indeterminate bilateral\npulmonary nodules, measuring up to 0.7 cm.\n5. There is osteolysis of the medial right clavicle with new adjacent\nsubcutaneous gas.  This may represent post biopsy changes, although recent\nbiopsy has not been documented in the OMR."
        },
        {
            "input": "The massive thyroid changes are stable in size and extent.  The right cervical\nmass has minimally increased in size, from previously 25 x 41 to now\napproximately 29 x 46 mm in diameter (5, 7).  The more ventral lymph node\nconglomerate (5, 7) is overall stable in size but the previous air inclusion\nhas resolved.  The contralateral chest wall lymph nodes (5, 13) are stable and\nnormal in size.  Stable appearance of the mediastinal structures, notably the\nvessels, with no evidence of incidental pulmonary embolism.  Stable appearance\nof the moderately calcified coronary arteries and of the posterior mediastinum\nas well as of the upper abdomen.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Mild degenerative vertebral\ndisease.  No vertebral compression fractures.  Stable moderate apical scarring\nwith right predominance.  A stable platelike scar in the right lung apex (6,\n41).  Minimal fibrotic changes in the posterior aspect of the right lung (6,\n72) could be the sequela of radiation.  Pre-existing small pulmonary nodules,\nfor example in the left upper lobe (6, 99) are stable in size.  No new or\ngrowing nodules.  No evidence of pleural thickening or pleural effusions.  A\nlarger approximately 8 mm nodule in the right lower lobe (6, 161) stable.  No\nnew or growing nodules.",
            "output": "Stable extensive thyroid changes.  Increase in size of a pre-existing\nright-sided cervical mass.  The lymph node conglomerate posterior to this mass\nis overall unchanged.  Several small pulmonary nodules are stable.  New mild\nconsolidation in the dorsal portions of the right lung might be caused by\nradiation."
        },
        {
            "input": "Again demonstrated occlusion of the right internal jugular and subclavian\nveins by a right neck soft tissue mass - best demonstrated on the dedicated\nconcurrent CT of the neck accession number ___.\nVascular collaterals along the right anterior chest are again noted.\n\nThe deep ulceration in the anterior chest wall extends to the first\ncostochondral junction with known destruction of the sterno-clavicular joint.\nThe ulceration is deeper with more tissue expansion superficial to the sternum\nin comparison to the previous study.\nThe mass  measures 6 x 3.6 cm in comparison to 5.4 x 3.2 cm previously.\nThere are no other bony destructive lesions.\nThyroid with multiple hypodense nodules in various sizes - the larger\nhypodense nodule has enlarged and is suspicious for tumor invasion and\nprogression.\nIn the right breast a nodule measuring 1 cm with tiny calcification -\nunchanged.\n\nThere is no mediastinal, hilar or axillary lymphadenopathy.\nCalcified granuloma in the right hila represent old granulomatous disease.\nThe heart is not enlarged and there is no pericardial effusion.\n\nThe airways are patent to the subsegmental level.\nCicatricial fibrotic changes in the right apex- postradiation changes grossly\nunchanged.\nThere is mild centrilobular and paraseptal emphysema predominantly in the\nupper lobes.\nScattered pulmonary nodules are unchanged-for example in the left lower lobe\nmeasuring 3 mm (4:162), right lower lobe measuring 7 mm (4:114),\nThere are no lung masses.\nPlatelike subsegmental atelectatic change in the left lower lobe.\nThere is no pleural effusion.\n\nIn the right lobe of the liver again noted small hypodense lesion - too small\nto characterize.\nBoth adrenal glands are diffusely thickened.\nThe infrarenal aorta is dilated up to 3.5 cm with atherosclerotic\ncalcifications and soft plaques, unchanged since ___.\nOther upper abdomen organs included are within normal limits.",
            "output": "Progression of right upper cervicothoracic chest wall mass, includingdeeper\nulceration with more tissue expansion superficial to the sternum, and greater\ntumor invasion into the thyroid."
        },
        {
            "input": "CT CHEST WITHOUT CONTRAST: There is no lymphadenopathy.  There is no\nsuspicious pulmonary nodule or consolidation.  Scattered bilateral pleural\npartially calcified pleural plaques are often associated with prior asbestos\nexposure.  There is no pleural or pericardial effusion.\n\nOSSEOUS STRUCTURES: No suspicious osseous lesion is identified.\n\nPULMONARY VEIN ANATOMY:  There are 4 pulmonary veins entering the left hilum:\n2 right pulmonary veins and 2 left pulmonary veins.\n\nThere is no evidence for pulmonary vein stenosis.\n\nBidirectional measurements of the pulmonary veins are as follows:\nRight superior: 18x16 mm\nRight inferior: 21x18 mm\nLeft superior: 27x16 mm\nLeft inferior: 17x14 mm\n\nRight saddle: 6.3mm\nLeft saddle: 7.0mm\n\nLEFT ATRIUM:  The left atrium isnormal in size and is normally opacified.  The\nleft atrial appendage is normally opacified. The calculated volume is 95cc\nwith the left atrial appendage and 88cc without.\n\nSVC anomalies are absent.  IVC anomalies are absent.\n\nThere is fusiform dilatation of the ascending aorta measuring 4 cm in\ndiameter.",
            "output": "1.  Fusiform dilatation of the ascending aorta measuring 4 cm in diameter.\n\n2. Normal pulmonary venous anatomy."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nCoronary calcifications are present.  No pericardial pleural effusion is seen.\nImage portion of the upper abdomen was reviewed on CT of the abdomen from ___ and MRCP from ___.  Currently stent is demonstrated at the\ndistal aspect of the common bile duct, in pneumobilia is noted.\n\nAirways are patent to the subsegmental level bilaterally.  Apical scarring is\npresent, a relatively symmetric, with inferior more nodular component, series\n5, image 44, also relatively symmetric.  Diffuse segmental and subsegmental\nbronchial wall thickening is demonstrated bilaterally.  Right upper lobe\nnodule, series 5, image 130 to is 2.5 mm in diameter, para fissure all.  Right\nlower lobe para fissure all nodule is 4 mm, series 5, image 176.  Additional\nnodules are series 5, image 65, 109, 132, 176, 187, 238.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Several nonspecific pulmonary nodules, that giving the a predominant upper\nzone re- distribution in appearance less likely to represent metastatic\ndisease but giving the provided history reassessment in 3 months is\nrecommended\n\nMild centrilobular emphysema and bronchial wall thickening, concerning for\nchronic inflammatory or potentially infectious process."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification in the head and neck\nvessels is mild, but present in the coronaries in at least the left anterior\ndescending branch.  Aorta and pulmonary arteries are normal size and free of\ncentral filling defects.  Cardiac chambers are normal size.  There is no\npericardial or pleural abnormality.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged ranging up\nto 10 mm in the upper pole of the right hilus and less than 10 mm in several\nlocations in the mediastinum.\n\nBiapical pleural parenchymal scarring is stable though extending more\ninferiorly than generally seen, 301:51, unchanged since ___.\n\nRight lung is clear.  Tracheobronchial tree is normal to subsegmental levels.\n\nThese lesions in the left lung are stable:\n\nPunctate, Left upper lobe, 390 01:59,\n\n4 mm, pleural or subpleural, left upper lobe, 301:110,\n\n3 mm, left upper lobe, 301:115,\n\n3 mm, pleural or subpleural, left lower lobe, 301:193.\n\nThere are no new lung lesions.",
            "output": "No good evidence for intrathoracic malignancy.  Tiny lung lesions and\nsubpleural lesions, all stable since ___, are of low malignant potential.\n\nCoronary atherosclerosis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification in the head and neck\nvessels is mild, but present in the coronaries in at least the left anterior\ndescending branch.  Aorta and pulmonary arteries are normal size and free of\ncentral filling defects.  Cardiac chambers are normal size.  There is no\npericardial or pleural abnormality.\n\nMediastinal and hilar lymph nodes are not pathologically enlarged ranging up\nto 11 mm in the upper pole of the right hilus and less than 8 mm in several\nlocations in the mediastinum.\n\nMild centrilobular emphysema.  The patient exhaled causing mild breath motion\nartifact and widespread ground glass.  Biapical pleural parenchymal scarring\nis stable though extending more inferiorly than generally.\n\nRight lung is clear.  Tracheobronchial tree is normal to subsegmental levels.\n\nThese lesions in the left lung are stable:\n\nPunctate, Left upper lobe, 4:55,\n\n4 mm, pleural or subpleural, left upper lobe, 4:103\n\n3 mm, left upper lobe, 4:99\n\n3 mm, pleural or subpleural, left lower lobe, 4:201\n\n5 mm right upper nodule 4:104\n\nThere are no new lung lesions.",
            "output": "Stable appearance of the thorax, no good evidence for intrathoracic\nmalignancy."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. Mild atherosclerotic\ncalcifications of the thoracic aorta and moderate coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Biapical scarring is\nmild.  Mild centrilobular emphysema and chronic airways disease.  New\npulmonary nodules including 4 x 3 mm nodule in the right upper lobe series 5,\nimage 101 with central cavitation, 2 x 2 mm nodule in the left upper lobe\nseries 5, image 97, 3 x 4 mm nodule in the right lower series 5, image 162, 5\nx 4 mm nodule in the right lower lobe series 5, image 174.  Ill-defined\nground-glass opacities in the right lower lobe series 5, image 142 have also\nslightly increased may represent localized infection in the appropriate\nclinical setting.\nPreviously described subpleural and perifissural nodules including series 5,\nimage 75 in the left upper lobe, series 5, image 133, 135 and 142 are stable\nin appearance.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "Several new small pulmonary nodules, concerning for  metastatic disease.\n\nIncreasing ill-defined ground-glass opacity in the right lower lobe may\nreflect localized infection/inflammation, and should be reassessed for\nresolution at the time of the next scheduled surveillance CT in order to\nexclude an atypical manifestation of metastatic disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  There is a common origin of the right brachiocephalic artery and the\nleft common carotid artery, a normal anatomic variant.  Aortic caliber is\nnormal.  The main, right, and left pulmonary arteries are normal caliber. \nThis study was not optimized for the detection of pulmonary embolism, however\nno pulmonary embolism is identified to the subsegmental level.\n\nPULMONARY PARENCHYMA:  Multiple centrally cavitating pulmonary nodules have\nincreased in size compared with ___:  the right upper lobe nodule\nmeasures 8 x 6 mm, previously 6 x 4 mm (4:79); the right lower lobe nodule\nmeasures 9 x 8 mm, previously 7 x 5 mm (4:132) stomach and a 4 mm right upper\nlobe pulmonary nodule has also increased in size (4:137).  Biapical pleural\nand parenchymal scarring is unchanged.  There is mild centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Continued interval increase in size of pulmonary nodules concerning for\nmetastatic disease.\n2. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is mild calcification in the LAD.  There is\nno pleural or pericardial effusion.  New diffuse ground-glass attenuation\nthroughout the lungs and sent tubular upper lobe predominant nodules reflect\nbronchiolitis\nIrregular thick-walled and right upper lobe cavitary lesion measuring 9 x 7 mm\nwas 8 x 6 mm (4:71).\n5 mm cavitary lesion in the right lower lobe was 4 mm (4:145)\n9x9 mm thick wall cavitary lesion in the right lower lobe was 8 x 9 mm (4:138)\nRight perifissural nodules (4:102, 140) are stable likely an intrapulmonary\nlymph node\nThis examination is not tailored for subdiaphragmatic evaluation pneumobilia\nhas minimally improved from ___.  Hypodense lesion in the periphery\nof the right lower lobe (02:15 9 is new, cannot be further characterized in\nthis study.  Granulomas in the spleen are again noted.  Patient is status post\nWhipple procedure and hepaticojejunostomy.  Mild bile duct dilatation is\nstable.  Atrophy of the remaining pancreas and pancreatic ductal dilatation is\nstable.\nThere are no bone findings of malignancy",
            "output": "Increase size and cavitary component of lung nodules / metastasis.\nNew diffuse ground-glass nodules and attenuation throughout the lungs upper\nlobe predominant likely reflect drug reaction\nNew hypodense lesion in the right lobe of the liver cannot be further\ncharacterized in this exam\nThe biliary stent has been removed"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and, excluding the\nbreasts which require mammography for evaluation, there is no soft tissue\nabnormality in the imaged, unenhanced chest wall suspicious for malignancy.\n\nModerate size heterogeneous pleural fluid collection lies posterior to the\nleft lower lobe.  Previous anterior component of left pleural effusion has\nbeen drained an the fissural component is minimal.\n\nSubstantial atelectasis at the base of the left lung has improved.  Left\npigtail pleural drainage catheter enters the posterior inferior hemi thorax\nascending along the aortic to the level of the carina traversing posterior\npleural fluid loculation.  There is no soft tissue fluid collection.  Second\nleft pigtail pleural drainage catheter and enters posterolaterally, running\nalong the inner margin of the lateral ribs to the level of the left atrium. \nThe second tube is probably not in communication with the residual pleural\ncollection.  There is no pneumothorax.\n\nModerate mediastinal adenopathy in the lower paratracheal and prevascular\nstations of the mediastinum and probably the upper pole of the left hilus are\nunchanged.  Bronchial tree is not compromised.  There is no pericardial or and\nno appreciable right pleural effusion.\n\nAtherosclerotic calcification is moderate in head neck vessels and at least in\nthe left main and circumflex coronary arteries.  Punctate calcification in the\nmitral apparatus may indicate previous infarction.  Calcification in the\naortic valve is moderately severe.  Hypoattenuation of cardiac contents is due\nto anemia.  Emphysema is moderately severe.  Septal thickening indicates mild\nedema.  Subpleural atelectasis in the right lower lobe is stable.\n\nThere are no findings in the chest cage suspicious for active infection or\nmalignancy.  Severe a compression fracture and disc space fusion in the\nthoracic spine and fracture deformity of the manubrium reflect remote severe\ntrauma.",
            "output": "Following insertion of second left pigtail pleural drainage catheter previous\nanterior and fissural components of left pleural effusion have nearly\nresolved.  Large posterior collection remains.  The new paraspinal drainage\ncatheters at the margin of this effusion.  The indwelling lateral drainage\ncatheter is probably isolated from this collection.\n\nMild pulmonary edema.  Coronary atherosclerosis.  Aortic valvular\ncalcification, possibly hemodynamically significant.\n\nModerate emphysema."
        },
        {
            "input": "Multiple prominent mediastinal lymph nodes in the pre aortic, aortic or\npulmonary, precarinal, subcarinal stations are grossly unchanged compared to\nthe prior examination.  The hilar contours are stable.  There is no axillary\nor supraclavicular lymphadenopathy.  The heart is not enlarged.  There is no\npericardial effusion.  Coronary artery calcifications are noted.  Thoracic\naorta and main pulmonary artery are normal in caliber.\n\nSmall amount of aerosolized secretions is present in the trachea.  The airways\nare patent to subsegmental level.  Emphysema is moderately severe and diffuse\nseptal thickening suggests mild edema.  A loculated left pleural effusion and\nadjacent subsegmental atelectasis have decreased in size.  A pleural catheter\nin the posterior left base is no longer in communication with the residual\npleural fluid, and the catheter is partly withdrawn from the chest cavity with\nsideholes in the subcutaneous tissues.  There is adjacent subcutaneous\nemphysema.  A catheter in the left base laterally remains within a recess of\nthe pleural fluid.  It sideholes closely approach the parietal pleural margin.\nSmall right pleural effusion and mild adjacent atelectasis however also\nmarginally improved.  There is no interval consolidation.\n\nLimited noncontrast view of the upper abdomen is unremarkable.\n\nSevere kyphotic angulation and compression deformities of the thoracic spine\nare chronic.  Old rib fractures are again noted.",
            "output": "1.  Decreased size of loculated left pleural effusion and adjacent\nsubsegmental atelectasis.  The left posterior pleural catheter is no longer in\ncommunication with the residual pleural fluid and is partly withdrawn from the\npleural cavity with sideholes in the subcutaneous tissues which likely\naccounts for adjacent subcutaneous emphysema.  This should be removed or\nrepositioned.  A second pleural catheter is in shallow position with sideholes\nclosely approaching the parietal pleura as well.\n\n2.  Moderate centrilobular emphysema and superimposed mild pulmonary\ninterstitial edema, unchanged.\n\nNOTIFICATION:  The findings in the impression #1 were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 11:19 AM, 3\nminutes after attending discovery of the findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular adenopathy.  Indeterminate right axillary soft tissue (3, 20)\nappear similar compared to prior.  Atrophic changes of the muscles of the\nright shoulder girdle as well as right serratus anterior.  Soft tissue nodule\nin the right anterior lower chest subcutaneus soft tissue is mildly increased\nin size currently measuring 10 mm in diameter (previously measuring 6 mm in\ndiameter).  The subcutaneous soft tissue nodule posterior to the left scapular\nspine (5, 24) was incompletely imaged.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Retrocrural lymph node (5, 213) appear similar\ncompared to prior.\n\nMEDIASTINUM: Mediastinal and hilar lymph nodes are marginally increased in\nsize for example the right hilar lymph node complex currently measuring 35 mm\nin AP diameter (previously measuring 32 mm in diameter) with the right\ninferior pulmonary vein now being totally occluded (was wispy on their\nprevious study).\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial fluid.\nNo aortic valve or coronary artery calcifications.  Left prepectoral\nPort-A-Cath in situ with the tip terminating in the mid right atrium.\nPLEURA: Right-sided pleural effusion is small, but slightly increased in size\ncompared to prior imaging.  The loculated pleural effusion in the right lung\napex is also slightly increased in size.\nLUNG:\n\n-PARENCHYMA:  Most of the pulmonary metastatic nodules and masses demonstrate\nmild interval increase in size for example the mass in the left lower lobe (5,\n205) currently measures 42 by 38 mm (previously 40 x 38 mm) a second index\nnodule in the right upper lobe (5, 107) currently measures 20 x 18 mm\n(previously 18 x 17).\n-AIRWAYS:  The right anterior and medial basal segmental bronchi and most of\nthe left lower lobe basal segmental bronchi are attenuated by the infrahilar\nbilateral lower lobe metastatic nodules and masses.  No postobstructive\npneumopathy.\n-VESSELS:  The pulmonary arteries not enlarged.  The pulmonary arteries are\npartially attenuated by the bilateral hilar metastatic disease, but no obvious\ninfiltration.  No filling defects to suggest pulmonary emboli.  The inferior\npulmonary veins are markedly attenuated bilateral (right more than left).\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.  New left lateral sixth and seventh rib fractures and\nanterolateral right seventh rib fractures.",
            "output": "Mild interval increase in size of the mediastinal and hilar adenopathy,\npulmonary masses and right loculated and dependent pleural effusions as\ndescribed above indicating mild disease progression.\n\nNew bilateral rib fractures as described above (they do not appear\npathological)."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nLeft Port-A-Cath in situ with the tip terminating in the mid right atrium.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  There is mild attenuation of a few branches\nof the pulmonary vasculature related to the large pulmonary masses, however no\nocclusion.  The main and right pulmonary arteries are normal in caliber, and\nthere is no evidence of right heart strain.\n\nThere is no supraclavicular or axillary lymphadenopathy. Indeterminate right\naxillary soft tissue appears similar compared to prior (series 4, image 36).\n\n3.5 x 3.2 cm right hilar lymphadenopathy appears stable from prior with\ncomplete occlusion of the inferior pulmonary vein.   Enlarged left hilar\nlymphadenopathy measuring 3.3 x 2.5 cm stable from prior, with narrowing of\nthe left inferior pulmonary vein, however still patent.  Multiple enlarged\nmediastinal lymph nodes, largest in the subcarinal location measuring 2.6 x\n1.8 cm (series 4, image 48).  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  Small right pleural effusion,\nstable from prior.  There is also a loculated pleural effusion at the right\nlung apex, unchanged in size when compared to prior.\n\nMultiple metastatic pulmonary nodules and masses appear grossly stable when\ncompared to prior, for example in the left lower lobe measuring 4.1 x 4.1 cm\n(series 4, image 85). A second index nodule in the right upper lobe (series 4,\nimage 42) measuring 2.4 x 2.0 cm.  The right anterior and medial basal\nsegmental bronchi as well as most of the left lower lobe basal segmental\nbronchi are attenuated due to hilar nodes and lower lobe metastatic pulmonary\nmasses.\n\nWhen compared to prior study, there are new patchy ground-glass opacities\nwithin both lungs, predominantly in the upper lobes.\n\nLimited images of the upper abdomen are unremarkable.  A 2 x 1.3 cm\nretrocrural lymph node (series 4, image 92) appears stable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nUnchanged bilateral rib fractures.  Atrophic changes of the muscles of the\nright shoulder girdle.  A soft tissue nodule posterior to the left scapular\nspine measuring 2 cm appears slightly larger when compared to prior CT dated\n___.  A 9 mm soft tissue nodule in the anterior chest wall on the\nright (series 4, image 102) is also stable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.  There is mild\nattenuation of a few subsegmental branches of the pulmonary arteries related\nto the large pulmonary masses, however no occlusion.\n2.  Multiple pulmonary masses, hilar and mediastinal lymphadenopathy grossly\nunchanged when compared to prior.\n3.  New patchy ground-glass opacities within both lungs predominantly in the\nupper lobes.  This could be related to a noncardiogenic pulmonary edema,\nhowever infectious etiologies not excluded.\n4.  Small right pleural effusion as well as a loculated effusion in the right\nlung apex, grossly stable compared to prior."
        },
        {
            "input": "By by aorta and pulmonary arteries are within normal limits except for\nattenuation of the lower lobe vessels by massive lymphadenopathy.  Heart size\nis normal.  There is no pericardial effusion.  There is a trace of bilateral\npleural effusion, minimally increased since the prior study.\n\nAirways are patent bilaterally except for some segmental branches in the lower\nlobes which also obstructed by massive metastatic disease.  The invasion of\nthe right chest wall extent is similar, series 3, image 16\n\nExtensive involvement of the lungs by metastatic masses appears to be slightly\nprogressed as compared to previous examination, for example the lesion in the\nright lower lobe is currently 4 x 4 cm as compared to 3.6 x 3.7 cm.  The\noverall dimension of the mass in the left lower lobe is approximately 6.2 x\n3.7 cm as compared to 3.2 x 5.5 cm.  The right apical mass is 4.8 x 4.9 cm as\ncompared to 4 x 4.3 cm.\n\nAs compared to prior previous examination there is overall interval\nimprovement in the ground-glass opacities previously seen primarily in the\nleft lung.  Right lower lobe increase in septal thickening in and nodularity\nis most likely consistent with progression of lymphangitic spread.",
            "output": "Massive metastatic disease involving the chest with gradual progression of\nmultiple masses as described\n\nAttenuation of the lower lobe pulmonary arteries bilaterally as well as of the\ninferior pulmonary veins.\n\nAnterior abdominal wall central nodule has increased in size as well from\n9-11.5 mm, series 3, image 45."
        },
        {
            "input": "The thyroid is normal.\n1.8 x 2.8 cm right axillary lymph node conglomerate (series 3: Image 12) is\nminimally larger since ___, when was 1.5 x 2.6 cm.  Us is recommended\nfor further characterization. Mediastinal and hilar lymph nodes are not\nenlarged according CT criteria.  Quadrilateral shaped thymus gland is\nunchanged since ___.  Aorta and pulmonary arteries are normal size. \nLeft internal jugular Port-A-Cath has tip ending in lower SVC (series 3: Image\n32).  Cardiac configuration is normal and there is no appreciable coronary\ncalcification.\n\nThere is no pericardial or pleural effusion.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  Patient has had right\nupper lobe wedge resection, the surgical suture has stable appearance since\n___ without evidence of local recurrence.\nLeft lower lobe 6 mm solid nodule was less than 4 mm in ___. There is\ninterval increase is concerning for malignancy, therefore short-term followup\nis recommended.\nSmall bilateral perifissural nodules are all unchanged since ___ and\nnot concerning for malignancy.\n\n\n\nUPPER ABDOMEN\nEven though this exam is not tailored for abdominal imaging, it shows stable\nbilateral nodular thickening of the  adrenal glands (series 3: Image 54),\nunchanged since ___ and likely due to small adenomas. The upper abdomen is\notherwise unremarkable.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. Patient has had right upper lobe wedge resection, the surgical suture has\nstable appearance without evidence of local recurrence.\n2. Interval increase of left lower lobe solid nodule since ___ is\nconcerning for malignancy. Short-term followup is recommended.\n3. Right axillary lymph node conglomerate is minimally increased since ___. Ultrasound is recommended for characterization.\n4. Bilateral small perifissural nodules are all unchanged since ___ and not\nconcerning for malignancy.\n5. Bilateral thickening of the adrenal glands is also unchanged since ___, likely due to small adenomas."
        },
        {
            "input": "The thyroid gland is unremarkable.  A cluster of enlarged right axillary lymph\nnodes has grown slightly in overall size since ___,, now 26 x 36 mm at\nthe level of greatest cross-sectional area, 5:73, compared to 20 x 36 mm in\n___ and several individual nodes have grown substantially, for example\nan 11 x 12 mm wide node at the lower pole of the cluster, 5:86, was no more\nthan 7 x 8 mm on ___. There are no pathologically enlarged left axillary,\nmediastinal, or hilar lymph nodes.\n\nThe tip of  left subclavian MediPort ends in the right atrium. The heart size\nis normal with no pericardial effusion. The main pulmonary artery and thoracic\naorta are normal in caliber. No incidental pulmonary embolus is identified.\n\nThe patient is status post right upper lobe wedge resection with no evidence\nof local recurrence. A previously documented left lower lobe solid nodule has\nnot grown since in ___ measuring 6 x 6 mm, previously 6 x 6 mm (5, 210).\nNo additional pulmonary nodules are identified. There are no endobronchial\nlesions or pleural abnormalities.\n\nImages of the upper abdomen are unremarkable.\n\nMultilevel spinal degenerative changes are present. No destructive osseous\nlesions are identified.",
            "output": "Stable 6 mm left lower lobe nodule with no new pulmonary nodules identified.\n\nProgressive right axillary lymphadenopathy, presumably malignant."
        },
        {
            "input": "The thyroid is normal.  Scattered measurable mediastinal lymph nodes ranging\nup to 7 mm are noted in the right paratracheal station. There is no\nsupraclavicular, hilar, or left axillary lymphadenopathy. Patient is status\npost right axillary lymph node resection with stranding in the surgical bed.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.  There is no pericardial\neffusion.\n\nThe patient is status post wedge resection in the right upper lobe. The\nairways are patent to the subsegmental level. The previously seen left lower\nlobe solid nodule has increased in size in the interim and now measures 10 x 9\nmm, previously 6 x 6 mm (series 5, image 209). In addition, there are several\nsatellite nodules surrounding this lesion, also increased in size. Scattered\nsmall new nodules measuring up to 3mm are identified (series 5, images 59,\n107, and 228). A tiny nodule in the right upper lobe (5:64) is stable since\n___. There are ground-glass opacities with areas of consolidation in\nthe superior segment of the right lower lobe and the right upper lobe\ncompatible with infectious process. There is no pleural effusion or\npneumothorax.\n\nNo lytic or sclerotic osseous lesions suspicious for malignancy is identified.\nA left chest Port-A-Cath terminates within the right atrium.\n\nStudy is not designed for evaluation of intra-abdominal structures, however\nnote is made of a 8 mm left adrenal adenoma.",
            "output": "1.  Interval increase in size of the left lower lobe nodule now measuring 10\nmm and scattered surrounding satellite nodules and small new nodules measuring\nup to 3mm compatible with progression of metastatic disease.\n\n2.  Right upper and lower lobe ground-glass opacities with areas of\nconsolidation in the superior segment of the right lower lobe compatible with\ninfectious process.\n\nNOTIFICATION:  Findings were discussed with ___ by ___ telephone\nat 1:40pm on ___, 30 minutes following discovery."
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There is no axillary,\nmediastinal, or hilar lymphadenopathy. The largest mediastinal lymph node is a\nright paratracheal lymph node which measures 5 mm (3, 17), and is unchanged\nfrom the prior exam.\n\nThe heart is normal in size. There is no pericardial effusion. The thoracic\naorta is normal in caliber without significant atherosclerotic calcifications.\nThe main pulmonary artery trunk is normal in diameter. A left Port-A-Cath is\npresent with the tip the cavoatrial junction.\n\nThe airways are patent to the subsegmental levels. Since a prior exam, there\nhas been slight interval progression of disease with slight enlargement of all\npreviously identified nodules. For example, the dominant nodule in the left\nlower lobe measures 11 x 10 mm. It previously measured 10 x 9 mm. The adjacent\nsatellite nodules have also slightly increased in size. A left upper lobe\nnodule measures 5 mm (5, 97) and previously measured 3 mm.  A right lower lobe\nnodule measures 4 mm (5, 194) and previously measured 2 mm.\n\nThe opacity in the superior segment of the right lower lobe has improved,\nsuggesting it was infectious or inflammatory.  There are residual peripheral\nopacities, including a 6 x 5 mm nodular opacity in the periphery of the right\nlower lobe (5, 112) that was not present on the prior exam.  Additionally, in\nthe periphery of the right upper lobe, there is a new 4 mm nodule (5, 56), 2\nmm nodule (5, 61), and 3 mm nodule (5, 52). These nodules have some\nsurrounding ground-glass opacification and ill-defined borders.\n\nThere is no pulmonary edema, pleural effusion, or pneumothorax.\n\nThis exam is not tailored to evaluate the subdiaphragmatic structures. Within\nthe limitations, the imaged portions of the liver, gallbladder, pancreas,\nspleen, adrenal glands, and kidneys are normal.\n\nThere are no concerning lytic or sclerotic osseous lesions. No fracture is\nidentified. Mild degenerative changes are noted in the thoracic spine.  Please\nsee the separate CT report for a description of the findings in the right\nupper extremity.",
            "output": "1.  Mild interval progression of disease with slight enlargement of the\npreviously identified pulmonary nodules.\n2.  The largest region of the previously identified right lower lobe opacity\nhas improved, suggesting an infectious or inflammatory process, though there\nare residual nodular opacities in the are right lower lobe, as well as new\nperipheral nodular opacities in the right upper lobe. It is unclear if these\nrepresent persistent infection or inflammation. Worsening metastatic disease\nis also a consideration. If indicated, a repeat chest CT could be obtained in\n___ months to assess for interval change."
        },
        {
            "input": "A scar-like lesion in the right axilla at the lateral margin of the pectoralis\nmuscles, 02:19 is unchanged since ___. In ___ there was\nsubstantial adenopathy in this location. Supraclavicular and axillary lymph\nnodes are not currently pathologically enlarged and, excluding the breast\nwhich require mammography for evaluation, there are no soft tissue lesions in\nthe imaged chest wall suspicious for malignancy. This study is not designed\nfor subdiaphragmatic diagnosis but shows hypo attenuating 13 mm wide nodule in\nthe medial limb of the left adrenal, unchanged since ___, probably an\nadenoma.\n\nThe thyroid is unremarkable. Atherosclerotic calcification is not apparent in\nhead neck vessels and minimal in the coronaries. There is no pericardial or\npleural abnormality. Aorta and pulmonary arteries are normal size. Left sided\ncentral venous infusion port catheter ends in the mid right atrium.\n\nThey largely fatty thymus is unchanged in size since ___. Sub cm\nmediastinal lymph nodes in the upper and lower paratracheal and subcarinal\nstations are stable.\n\nPatient has had wedge resection from the right upper lobe. There is extensive\nnew multifocal nodular consolidation throughout the right upper middle and\nlower lobes. The clustering of much of this consolidation in the lateral\naspect of the lung suggests radiation therapy. However no information has been\nprovided in that regard.\n\nAmong more than a dozen small lung nodules, characteristic changes are as\nfollows:\n\n5 x 9 mm subpleural left upper lobe lung nodule, 03:21, previously 3 x 4 mm.\n\n3 x 6 mm subpleural left lower lobe nodule, 4:86, previously 2 x 2 mm.\n\n13 mm left lower lobe nodule, 4:166, previously 10 mm, contiguous with a\nlinear array of adjacent nodules, 19.5 mm in aggregate diameter, 4:175,\nunchanged.\n\nA 6 mm subpleural right lower lobe nodule, 4:182, previously less than 2 mm\nacross.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Multiple small pulmonary nodules have grown since ___ consistent with\nprogressing metastases.\n\nNew multifocal nodular consolidation, predominantly in the lateral periphery\nof the right upper, middle, and lower lobes.This would be a very unusual\nconfiguration for metastasis and suggests instead an inflammatory cause,\nincluding both active infection andcryptogenic organizing pneumonia."
        },
        {
            "input": "A left-sided chest port is present, with the catheter tip terminating in the\nright atrium.  The the right lobe of the thyroid is diminutive in comparison\nto the left.  Supraclavicular lymph nodes noted, they are nonenlarged. \nSubcentimeter mediastinal lymph nodes are stable since ___.  Again\nnoted is a largely fatty thymus, unchanged since ___.  Aorta and\npulmonary arteries are normal size. Cardiac configuration is normal.  There\nare mild coronary arterial calcifications.\n\nThe patient has undergone prior right upper lobe wedge resection.  Post\nradiation changes are noted, stable since prior examination.  The airways are\nminimally thickened but patent.  Again seen are multiple pulmonary nodules\nscattered bilaterally.  They are as follows:\n\nNodules which have increased in size:\n\n1.  Right lower lobe pleural nodule (4:57), previously 6 mm, now 9 mm\n2.  Right lower lobe nodule (4:77), previously 6 mm, now 7 mm\n3.  Right upper lobe nodule (4:86), previously 8 mm, now 11 mm\n4.  Right lower lobe nodule (4:120) previously 12 mm , now 15 mm\n5.  Right lower lobe nodule (4:133) previously 5 mm, now 7 mm\n6.  Left lower lobe nodule (4:133) previously not noted, now 6 mm\n7.  Left lower lobe pleural-based nodule (4:167), previously 8 mm, now 9 mm\n8.  Left lower lobe nodule (4:181), previously 7 mm, now 8 mm\n9.  Left lower lobe nodule (4:184), previously 11 mm, now 14 mm\n10.  Left upper lobe pleural-based nodule (4:86), previously 6 mm, now 8 mm\n11.  Right lower lobe pleural-based nodule (04: 174) previously 6 mm, now 7 mm\n12.  Left upper lobe pleural based nodule (4:87) previously 11 mm, now 14 mm.\n13.  Right upper lobe nodule (4:106) previously 3 mm, now 5 mm\n14.  Left lower lobe nodule (4:167), previously 12 mm, now 15 mm\n\nNodules which have remained stable or decreased in size:\n\n1.  Right upper lobe soft tissue irregularity at site of prior wedge resection\n(4:79), previously 7 mm, now 5 mm.\n2.  Right-sided perifissural soft tissue (4:82), previously 2 cm, now 12 mm\n3.  Right lower lobe nodules (4:97), previously 5 and 6 mm respectively, now 6\nand 4 mm respectively\n4.  Right lower lobe nodule (4:138) previously 7 mm, now 6 mm\n5.  Left lower lobe nodule (4:164), previously 9 mm, now 8 mm\n6.  Left lower lobe nodule (4:176), previously 7 mm, now 5 mm\n7.  Left lower lobe nodule (4:184), previously 4 mm, now 4 mm\n8.  Left upper lobe nodule (4:120), previously 6 mm, now 3 mm\n9.  Right lower lobe nodule (4:157), previously 7 mm, now 7 mm\n\nLimited evaluation of the upper abdomen shows no significant abnormalities.\n\nMultilevel degenerative changes are seen in the visualized thoracic spine,\nwithout significant vertebral body height loss.  No suspicious osseous lesions\nare noted.",
            "output": "Numerous pulmonary nodules, most of which have increased in size and some of\nwhich have remained stable or decreased in size, overall consistent with\nworsening disease in the chest."
        },
        {
            "input": "No incidental thyroid findings, known small right thyroid lobe.  Left pectoral\nPort-A-Cath.  The appearance of the large mediastinal vessels is stable. \nMinimal coronary calcifications.  No pericardial effusion.  A pre esophageal\nlymph node (2, 43) has slightly increased in size.  Unchanged appearance of\nthe upper abdomen.  No osteolytic lesions at the level of the ribs, the\nsternum or the vertebral bodies.  Status post upper lobe wedge resection.  The\npostradiation changes in the right subpleural lung apex (4, 41) are stable.\nThe multiple pulmonary nodules show a mixed behaviour.  Some of the nodules\nhave increased in size.  For example, a reference lesion in the right lower\nlobe apex (4, 74).  Has increased from ___ mm.  Other nodules have decreased\nin size.  For example, a right lower lobe nodule (4, 93) measured 5 mm in\ndiameter and is now 3 mm in diameter.  A third group of nodules (for example\nin the right lower lobe.  Series 4, image 131) is stable.  The largest lesion\n(4, 174) continues to be located in the left lower lobe, this lesion B lungs\nto the group of stable lung nodules (14 mm).  There is no evidence of new\npulmonary nodules.  No pleural effusions.  The airways are patent.",
            "output": "As compared to ___, the known pulmonary nodules show a mixed\nresponse.  While some of the pulmonary nodules are stable in size, others have\nin part increased and in part decreased.  Increase in size of a paraesophageal\nlymph node.  No pleural effusions."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.\n\nExcluding the breasts which are asymmetric and require mammography for\nevaluation, there are no lesions in the chest wall suspicious for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis.\n\nRight thyroid lobe is atrophic.  There are no findings in the thyroid\nwarranting further imaging evaluation.  Mediastinal lymph nodes are not\npathologically enlarged, however the right hilus at the level of the right\ninferior pulmonary vein has enlarged presumably due to adenopathy.  The\naggregate diameters of lymph nodes and mediastinal vessels are 19 x 25 mm\ntoday, 02:30, previously 14 x 18 mm.  This nodal mass narrows the origin of\nthe bronchus to the medial basal segment of the right lower lobe.\n\n\nRadiation fibrosis and the wedge resection site in the right upper lobe are\nunchanged.  As before, there is a are more than a score of lung nodules, most\nunchanged, but several smaller nodules have grown, for example a 6 x 10 mm\nleft upper lobe nodule, 4:96, was 4 x 8 mm, and a 10 x 7 mm left lower lobe\nnodule, 4:216 was 5 x 6 mm in ___.  There are no new lung nodules.\n\nA central infusion port catheter ends in the right atrium.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Multiple pulmonary metastases, non smaller, some larger, non new.\n\nEnlarging right hilar adenopathy mildly narrowing a segmental bronchus.\n\nRadiation fibrosis, right upper lobe and wedge resection site, stable."
        },
        {
            "input": "The right thyroid lobe is atrophic, unchanged.  Compared with ___,\nthere has been interval increase in hilar lymphadenopathy.  For reference, a\nconglomerate of nodes in the right hilus at the level of the right inferior\npulmonary vein is increased in size, measuring 3.2 x 2.4, compared with 2.5 x\n1.9 cm previously (3:28).  A more superior right hilar node is also increased\nin size, measuring 2.0 x 1.5 cm, compared with 1.2 x 1.2 cm previously (3:19).\nA left hilar nodal conglomerate measures 2.5 x 1.8 cm, compared with\napproximately 1.2 x 1.1 cm previously (3:31).  There are no pathologically\nenlarged supraclavicular, axillary or mediastinal nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.  A left-sided Port-A-Cath terminates in the right\natrium, with no associated thrombus.\n\nPatient is status post right upper lobe wedge resection, with postsurgical\nchanges and radiation fibrosis in the left lung.  Compared with ___,\nthere is increase in left-sided pleural thickening, and increase in thickening\nof the adjacent lateral chest wall soft tissues, concerning for a\ntransthoracic spread of disease (3:20, 7:75).  There has been interval\nincrease in size and number of pulmonary nodules.  For reference, a right\nlower lobe nodule measures 1.5 x 1.2 cm, compared with 1.1 x 0.8 cm previously\n(5:63).  A right upper lobe nodule measures 1.8 x 1.5 cm, compared with 1.2 x\n1.1 cm previously (5:94).  A 1.1 x 1.0 cm right middle lobe nodule is new\n(5:117).  A conglomerate of nodes in the right lower lobe measuring 2.3 x 1.5\ncm is new compared with prior (5:160).  A conglomerate of nodes in the left\nlower lobe measures 1.1 x 0.7 cm, compared with 0.9 x 0.6 cm previously. \nThere is increase in size and number of nodes in a cluster of nodes in the\nleft lower lobe, with coalescence of part of the cluster in a nodal mass,\nmeasuring 3.5 x 3.1 cm (5:209).   No pneumothorax or pleural effusion is\nidentified. The airways are patent to the subsegmental level.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents.  Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "1. Interval progression of disease, with increase in size and number of\nmultiple pulmonary metastases, and increase in hilar lymphadenopathy compared\nwith ___.\n2. Increase in left pleural thickening and thickening of the soft tissues of\nthe adjacent lateral chest wall, concerning for transthoracic spread of\ndisease.  No bony erosions.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 14:30 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "This examination is limited due to patient's body habitus and motion artifact.\n\nHEART AND VASCULATURE:  A Port-A-Cath terminates in the right atrium. \nPulmonary vasculature is well opacified to the segmental level without filling\ndefect to indicate a pulmonary embolus.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  The right peritracheal mediastinal lymph node\nmeasuring 10 mm in short axis is new (series 2, image 26) a paraesophageal\nlymph node is stable measuring 12 mm in short axis (series 2, image 79) the\nright hilar lymph node conglomerate and has increased in size measuring 3.6 x\n2.5 cm on today's examination (series 2, image 55), previously measuring 2.9 x\n2.3 cm, and causes mass effect on the right hepatic veins.  The left hilar\nlymph node conglomerate has also increased in size (series 2, image 57).  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  Patient is status post right upper lobe resection with\nadjacent scarring and pleural thickening, which is stable.  There is\nincreasing thickening of the right chest wall soft tissues, concerning for\nmetastatic involvement.  For instance, a right chest wall nodule measures 2.0\nx 1.9 cm on today's examination (series 2, image 30), previously measuring 1.5\nx 1.4 cm.  There are numerous pulmonary metastatic lesions bilaterally, which\nmay have also increased in size and distribution.  In addition, there are\nnumerous foci of peribronchial ground-glass opacities and consolidations\nwithin the lower lobes bilaterally, which are new since ___, and\nraise concern for multifocal pneumonia.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK:  The right lobe of the thyroid is atrophic.  The remaining\nthyroid is within normal limits.  Otherwise, visualized portions of the base\nof the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Limited examination due to the patient's body habitus and motion artifact.\n2. Within these limitations, no evidence of large central pulmonary embolism.\n3. Extensive hilar lymphadenopathy, which has progressed compared to ___.  Numerous pulmonary metastatic lesions bilaterally, which seem to have\nincreased.  Right chest wall involvement, which has also progressed.\n4. New peribronchial ground-glass opacities and consolidations within the\nlower lobes bilaterally, which raise concern for superimposed multifocal\npneumonia in the appropriate clinical setting."
        },
        {
            "input": "The thyroid is normal.  Compared with ___, there has been interval\nincrease in confluent bilateral hilar lymphadenopathy.  For reference, the\nright hilar lymph node measures 4.1 x 3.7 cm, compared with 3.6 x 2.5 cm\npreviously, and again causes mass effect on the right pulmonary veins. \n(4a:27).  A left hilar nodal conglomerate is also increased in size, measuring\n4.1 x 3.2 cm, compared with 2.4 x 2.1 cm previously (4a:28).  A 1.0 cm right\nlower paratracheal and 1.1 cm paraesophageal node are not significantly\nchanged.  There are no pathologically enlarged supraclavicular or axillary\nlymph nodes.\n\nThe aorta and pulmonary arteries are normal in size.  The heart is normal in\nsize and demonstrates no appreciable coronary artery calcifications. There is\nno pericardial effusion.  A left-sided Port-A-Cath terminates at the\ncavoatrial junction.\n\nPatient is status post right upper lobe resection, with pleural thickening and\nscarring along the right chest wall.  There has been interval increase in size\nof numerous pulmonary nodules.  For example, pulmonary nodules in the left\nlower lobe have increased in size, and have coalesced to form a conglomerate\nmeasuring approximately 5.7 x 3.9 cm (41:37).  A right lower lobe nodule is\nincreased in size, measuring 3.4 x 2.8 cm, compared with 2.7 x 2.2 cm\npreviously, and is now continuous with an adjacent right hilar nodal\nconglomerate (41:29).  Few small nodules in the right lower lobe appear new\n(5a:128, 142, 151). Bilateral lower lobe consolidations seen in ___\nhave improved.  A small right pleural effusion is new compared with prior.  No\npneumothorax. The airways are patent to the subsegmental level.\n\nCompared with ___, a right chest wall nodule is slightly increased\nin size, measuring 2.4 x 2.2 cm, compared with 2.0 x 1.9 cm previously.  A 9\nmm soft tissue nodule along the subcutaneous tissues of the upper right\nanterior abdominal wall is new compared with prior (5a:210).  A nondisplaced\nfracture of the lateral right seventh rib appears new compared with prior,\nhowever likely subacute (4a:38).\n\nThis examination is not tailored for the evaluation of subdiaphragmatic\ncontents. Within this limitation, the included portions of the upper abdomen\nare grossly unremarkable.",
            "output": "1. Interval progression of disease, with increase in bilateral confluent hilar\nlymphadenopathy, interval increase in size and number of pulmonary nodules,\nand interval increase in size of a right chest wall nodule.\n2. New small right pleural effusion.\n3. A nondisplaced fracture of the right lateral seventh rib appears new\ncompared with prior, however likely subacute.\n4. A 9 mm indeterminate soft tissue nodule in the subcutaneous tissues of the\nright upper anterior abdominal wall is new compared with prior.\n5. Interval resolution of bilateral lower lobe pneumonia compared with CTA\nchest ___."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: Atrophic right thyroid gland is re-\ndemonstrated.  Compared to the recent prior examination on ___\nthere has not been no substantial interval change in the extensive bilateral\nhilar lymphadenopathy.  Enlarged subcarinal lymph node is also similar.  There\nis no supraclavicular lymphadenopathy.\n\nHEART & VESSELS: Aorta and pulmonary arteries are normal in size.  No evidence\nfor aortic dissection or intramural hematoma.  The heart is normal in size. \nThere is no pulmonary embolism to the subsegmental level.  A left-sided\nPort-A-Cath terminates at the cavoatrial junction.  No pericardial effusion.\n\nLUNGS & AIRWAYS: The patient is status post right upper lobe wedge resection\nwith continued right lateral pleural thickening and scarring along the right\nchest wall.  A right pleural effusion is slightly increased from the prior\nexamination, now moderate to large in extent.  Multiple pulmonary nodules\nthroughout both lungs are overall not substantially changed and compatible\nwith metastatic disease.  The central airways are slightly attenuated due to\nthe bilateral hilar lymphadenopathy however the airways remain patent to the\nsubsegmental level.  There is no focal pulmonary consolidation to suggest\npneumonia.\n\nUPPER ABDOMEN: Limited views of the upper abdomen are within normal limits.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions seen. \nNondisplaced fracture of the lateral right seventh rib is unchanged.  New from\nthe prior examination is minimally displaced fracture of the left sixth rib\nwith underlying sclerosis suggesting pathologic fracture.  Mild sclerosis of\nthe left seventh rib also suggests metastatic disease.  A subcutaneous nodule\nalong the upper right anterior abdominal wall is re- demonstrated measuring 8\nmm.  Nodular soft tissue within the right lateral chest wall and axillary\nregion appears grossly unchanged, and remains suspicious for transthoracic\nspread of disease (3:67).",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Right pleural effusion is mildly increased from the prior examination, now\nmoderate to large in size.\n3. Metastatic disease within the chest appears grossly unchanged from prior\nwith similar appearance of multiple bilateral pulmonary lesions, bulky hilar\nlymphadenopathy and nodular soft tissue along the right lateral chest wall.\n4. New from the prior examination is a minimally displaced fracture of the\nleft sixth rib with underlying sclerosis suggesting a pathologic fracture. \nSclerosis of the left seventh rib is new and also suggests an additional focus\nof osseous metastatic involvement."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate aortic wall calcifications.  Moderate\ncoronary calcifications.  Interposition of colon between the liver and the\nabdominal wall.  The upper abdomen is described in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, and the vertebral bodies.  Multiple partly calcified right upper lobe\ngranulomas (302, 32).  Small non characteristic scar at the bases of the right\nlower lobe (302, 118).  No evidence of thoracic malignancy.  No evidence of\nmetastatic disease.  No pleural thickening, no pleural effusions.",
            "output": "No evidence of malignant disease in the thorax."
        },
        {
            "input": "2 left axillary lymph nodes, at 8 and 10 mm wide each, 05:11, have strongly\nenhancing perimeters.  Patient has had bilateral mastectomy and breast\nimplantation. Lateral to the left pectoralis minor, abutting the anterior\nchest wall, high in the left axilla, is a 25 x 41 mm heterogeneously enhancing\nsoft tissue mass, just inferior to the 2 previously described lymph nodes,\n___. The adjacent ribs are intact. The mass is separated from the\nperiscapular musculature by a thin fatty plane. There is no infiltration of\nthe adjacent left anterior second and third ribs. There are no other soft\ntissue lesions in the chest wall suspicious for malignancy.\n\nThe thyroid is unremarkable. Head and neck vessels, aorta are free of\natherosclerotic calcification which is mild in the coronaries predominantly\nthe left anterior descending branch. Moderate nonhemorrhagic pericardial\neffusion does not infiltrate the epicardial fat no is there evidence of\ntamponade physiology. There is no pleural effusion.\n\nIf the small irregularly shaped lesion at the right lung base posteriorly is\nprobably scar atelectasis. Lungs are otherwise clear and there is no\nabnormality of the bronchial tree to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy. 10 mm\nwide lucency in the anterior aspect of the L1 vertebral body, 6: 284 and\n11:36, will be evaluated by the radionuclide scattered performed later today.",
            "output": "2.5 x 4 cm left upper chest wall/ axillary perimuscular mass, presumably\nmetastatic breast carcinoma. Adjacent hypervascular mediastinal nodes\nsuspicious for malignancy.\n\nL1 vertebral body lytic lesion, to be evaluated by radionuclide bone scanning.\n\nAtherosclerotic LAD coronary calcifications."
        },
        {
            "input": "Bilateral breast prostheses are in place.  21 x 38 mm left axillary mass,\n6:74, had diameters of 21 x 34 mm in ___ x 39 mm in ___, but it has\na narrower waist today and is part probably smaller than it was in ___,\nand 2 adjacent lymph nodes, 6 and 7 mm each, 6:64, were 7 and 8 mm in\n___. The lesion is inseparable from the outer margin of the adjacent\nribs but there is no bone destruction. Right axillary and supraclavicular\nlymph nodes are not pathologically enlarged. A right central venous infusion\nport catheter ends in the upper right atrium.\n\nFindings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not evident in head\nand neck vessels, present in the coronaries in at least the left anterior\ndescending branch. Moderate pericardial effusion is stable. There is no\nappreciable pericardial nodularity or calcification and there are no findings\nto suggest cardiac tamponade. There is no pleural effusion, but there may be a\nnew, mild costal pleural thickening in the posterior, left lower hemi thorax.\n\nThere has been a substantial increase in interstitial abnormality in the lower\nlungs consisting of lymphatic thickening of the septae, peribronchial cuffing,\nand the caliber of a large tubular opacity in the left lower lobe, 6:83 7 x 34\nmm today, previously 8 x 28 mm, and the bulbous termination of the dilated\npulmonary vein in the right lower lobe, 6:163.  A new, irregularly enhancing\n11 x 11 mm These findings are most readily explained by disseminated\ncarcinomatosis.\n\nLymph nodes in the mediastinum, hila, internal mammary, diaphragmatic, and\nretrocrural stations are not pathologically enlarged.\n\nA new, 11 x 11 mm, heterogeneously enhancing, irregularly marginated lesion in\nthe lingula, 6:174, could be a metastasis or infection, but another new,\nlarger, 16 x 22 mm, mixed density lesion in the right upper lobe, 6:114 is\nmore likely pneumonia.\n\nThere are no new bone lesions in the chest cage suspicious for malignancy.\nIncreasing radiodensity of the previously lytic T3 vertebral body lesion,\n09:33, 06:51, is probably treatment effect. The posterior cortex of the\nvertebral body is eroded, as before, but there is no clear evidence of\ninvolvement of the vertebral canal. Spinal MRI it would be the most reliable\nway to assess that.",
            "output": "Small right upper lobe pneumonia.\n\nSubstantial progression of likely pulmonary carcinomatosis.\n\nStable or decreased left axillary mass.\n\nNo new bony metastasis in the thoracic spine.  Healing effect, T3 vertebral\nbody metastasis."
        },
        {
            "input": "The thyroid gland is unremarkable.  There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar, internal mammary or axillary lymph nodes.\n\nHeart size is normal with a slightly decreased small pericardial effusion.  A\nright pectoral MediPort terminates in the upper right atrium. No incidental\ncentral pulmonary embolus is identified. The main pulmonary artery and\nthoracic aorta are normal caliber. Mild coronary artery calcifications\npredominantly involve the left anterior descending coronary artery.\n\nA right upper lobe ground-glass opacity has resolved. There is stable\nelevation of the right hemidiaphragm with adjacent right lower lobe partial\npassive atelectasis.  No pulmonary nodule, mass or consolidation is\nidentified. Bandlike atelectasis in the lingula is unchanged. A small layering\nnonhemorrhagic effusion with minimal adjacent partial passive atelectasis is\nnew.  Airways are patent to the subsegmental level.\n\nThe patient has had prior breast implantation with stable cachexia.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nA lytic lesion involving the T3 vertebral body is unchanged. Additional lytic\nlesions involving the lumbar spine will be discussed in further detail in the\nseparate report of the CT abdomen/pelvis.",
            "output": "Interval resolution of previous right upper lobe ground-glass opacity, which\nwas likely infectious or inflammatory in etiology.\n\nNew small left layering nonhemorrhagic pleural effusion with minimal\nassociated partial passive atelectasis.\n\nDecreased small pericardial effusion.\n\nStable T3 vertebral body metastasis."
        },
        {
            "input": "HEART AND VASCULATURE:  Of note, this is a suboptimal study due to poor\nopacification of the vasculature from contrast bolus timing.  Given these\nlimitations, the pulmonary vasculature appears opacified to the segmental\nlevel without filling defect to indicate a pulmonary embolus.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart is mild to moderately enlarged.  The great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM:  Prominent axillary and mediastinal lymph nodes\nare noted bilaterally.  A residual thymus is noted.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  Mild atelectasis noted in the bilateral lung bases.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for\ncholelithiasis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Cholelithiasis\n3.  Prominent bilateral mediastinal and axillary lymph nodes are noted, of\nuncertain etiology.  Clinical follow up of axillary lymph adenopathy is\nrecommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.\n\nUPPER ABDOMEN: There is a 2.6 cm left upper pole hypodense renal cyst (3:19).\n\nMEDIASTINUM: No mediastinal masses or mediastinal adenopathy.\n\nHILA: No hilar masses within the limitations of this noncontrast enhanced\nscan.\n\nHEART and PERICARDIUM: The heart appears mildly enlarged in size.  There is no\npericardial effusion.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Atelectasis of the dependent lung bases bilaterally.  There is\nan incidental 2 mm nodule in the right upper lobe (2:60).  Few calcified\nsubcentimeter granulomas are noted bilaterally.\n2. AIRWAYS:  Patent to the segmental level bilaterally.\n3. VESSELS:  Unremarkable.\n\nCHEST CAGE: There is an displaced right posterior 11th rib fracture (series 2,\nimage 103).",
            "output": "1. There is an acute displaced posterior right 11th rib fracture.\n2. Mild subsegmental atelectasis of the dependent lung bases bilaterally.\n3. Incidental 2 mm right upper lobe nodule. For incidentally detected single\nsolid pulmonary nodule smaller than 6 mm, no CT follow-up is recommended in a\nlow-risk patient, and an optional CT in 12 months is recommended in a\nhigh-risk patient.\n\nRECOMMENDATION(S):  Incidental 2 mm right upper lobe nodule.\nFor incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  The updated impression #1 was discussed by Dr. ___ with\nDr. ___ at 9:19am ___."
        },
        {
            "input": "HEART AND VASCULATURE: Study is limited by poor contrast opacification the\npulmonary arteries, but there is no evidence of a central PE.  Evaluation of\nthe segmental and subsegmental pulmonary arteries is limited.  The heart is\nborderline enlarged.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are ill-defined consolidations in the bilateral left\ngreater than right lower lobes likely representing pneumonia.  A 5 mm\nperifissural nodule along the right minor fissure (3:80) likely represents\nintraparenchymal lymph node.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Consolidations in the bilateral left greater than right lower lobes likely\nrepresent multifocal pneumonia.\n2. No evidence of a central pulmonary embolism evaluation of the segmental and\nsubsegmental pulmonary arteries is limited due to poor contrast opacification\nof pulmonary arteries."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is unremarkable.  No evidence\nof pathologically enlarged supraclavicular or axillary lymph nodes.  The\npatient is status post tracheostomy which terminates in the upper trachea. \nLeft-sided PICC terminates in the proximal right atrium.\n\nUPPER ABDOMEN: Please refer to same-day CT abdomen and pelvis for dedicated\nreport of subdiaphragmatic findings.\n\nMEDIASTINUM: An upper right paratracheal lymph node measures up to 11 mm,\n(series 4, image 85) and is likely reactive.\n\nHILA: On noncontrast CT, the hila contours do not suggest lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No evidence of pericardial\neffusion.  The coronary arteries demonstrate mild calcified atherosclerosis.\nPLEURA: Small bilateral pleural effusions, left greater than right.\nLUNG:\n\n1. PARENCHYMA:  Study is limited by motion which decreases the ability to\nfully evaluate the lung parenchyma.  Within the limitation of the study are\nconsolidations adjacent to the bilateral pleural effusions which may represent\naspiration/pneumonia with a component of atelectasis.\nAIRWAYS: The airways are patent the subsegmental level bilaterally.\n2.\nOsseous structures: No suspicious lytic or osseous lesions are demonstrated.",
            "output": "1. The study is moderately limited by a motion.\n2. Small bilateral pleural effusions with adjacent consolidations which may\nrepresent aspiration/infection with a component of atelectasis.\n3. There is mediastinal lymphadenopathy which is likely reactive.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:56 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "Endotracheal tube is high, tip at the thoracic inlet. NG tube terminates in\nthe stomach dual chamber pacer leads are in appropriate position.  No\nsignificant axillary, mediastinal, or hilar lymphadenopathy is detected.   The\nthoracic aorta is normal in caliber with a typical three vessel takeoff from\nthe arch.  The pulmonary arterial trunk is enlarged, measuring 3.9 cm.  The\nheart is normal in size without pericardial effusion.  Coronary artery\ncalcifications are noted.\n\nIn addition to right lower lobe consolidation shown on prior CT-abdomen/pelvis\nthere are now additional peribronchial opacities in a ___ distribution\ninvolving the remainder of the right lower lobe and the right upper lobe.  The\nlower lobe opacities are worsened compared to the included portions of lungs\non the prior from 3 days ago.  There are secretions layering in the bronchus\nintermedius and irregular bronchiectases of the segmental and subsegmental\nbronchi of the right lower lobe. The left long shows only scattered areas of\nsubsegmental atelectasis\n\nSubdiaphragmatic structures described in a separate report. There is no\nblastic or lytic lesion suspicious for malignancy.",
            "output": "1. Right lower lobe consolidation with ___ opacities in the right\nupper and right lower lobe. Findings are likely infectious.\n2. ETT tip is high. Recommend advancing 2 cm for better positioning.\n3. Evidence of pulmonary arterial hypertension.\n4. Please correlate with separate CT abdomen/pelvis report regarding\nsubdiaphragmatic findings.\n\nNOTIFICATION:   Findings were relayed by Dr. ___ to Dr. ___\n___ by phone at 12:10 p.m. on ___ (approximately 5 minutes\nafter discovery)."
        },
        {
            "input": "A 0.8 cm hypodense nodule seen within the right thyroid lobe.  The there is no\naxillary, mediastinal, or hilar lymphadenopathy.  There is no supraclavicular\nlymphadenopathy.\n\nThe heart size is normal.  The pericardium is intact without evidence of\neffusion.  The aortic size is normal.  Mild prominence of the main pulmonary\nartery measuring up to 3.3 cm, is unchanged compared to the prior exam. \nRe-demonstrated is a thrombus within the left main pulmonary artery, with\nextension into the lingula, with improved cannulization of the vessels\ncompared to the prior exam, suggestive of a chronic thrombus.  No definite new\nthrombus is seen, however please note that this study is not tailored for the\ndetection of a pulmonary embolus.\n\nRe-demonstrated is diffuse interstitial lung disease, with traction\nbronchiectasis and honeycombing seen in the upper lobes bilaterally as well as\nthe lower lobes, right middle lobe, and lingula.  Regions of diffuse\nground-glass opacity, are overall similar to the prior exam however there has\nbeen interval improvement of the previously seen confluent consolidations.  A\nprominent ___ seal is again seen in the left lung base.  No nodules\nconcerning for malignancy are identified.\n\nPlease refer to the dedicated CT of the abdomen performed the same day for\nevaluation of the abdominal structures.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are seen.",
            "output": "1. No concerning pulmonary nodules identified.\n2. Stable diffuse moderate to severe interstitial lung disease compared to the\nprior exam from ___, with interval improvement of the previously seen\nfocal consolidations.  No new concerning consolidations identified.\n3. Chronic pulmonary embolus involving the left main pulmonary artery with\nextension into the lingula with improved canalization of the vessels."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.  There is moderate to severe\ncalcification of the mitral annulus.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are increased caliber suggesting\nunderlying pulmonary hypertension.\n\nPULMONARY PARENCHYMA:  Extensive geographic areas of ground-glass opacity and\nbronchiectasis are similar to prior studies and consistent with interstitial\nlung disease.  Left lobe predominance causes leftward mediastinal shift,\nunchanged.  In the superior subsegment of the left lower lobe there is a more\nconfluent area of airspace opacity that has increased compared with the prior\nstudy measuring up to 2.2 x 2.0 cm (04:46), previously resembling minimal\natelectasis involving an area of 1.2 x 1.2 cm.  There is increased retraction\nof the major fissure at this level.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "Increased confluent opacity in the superior subsegment of the left lower lobe\nwith associated fissural retraction may represent progressive interstitial\nlung disease, an enlarging metastatic lesion, or a primary lung malignancy. \nSubsequent management will depend upon the clinical context.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 14:44 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.8 cm hypodense nodule in the\nright lobe of the thyroid is unchanged and too small to warrant further\nimaging (14:12).  No supraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: No concerning lytic or sclerotic lesions are seen.  Degenerative\nchanges of the left shoulder with small free corticated bodies, unchanged.\n\nUPPER ABDOMEN: Dictated separately in the same day CTA abdomen pelvis.\n\nMEDIASTINUM: There is no mediastinal or hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is normal.  The pericardium is intact\nwithout evidence of effusion.  The aortic size is normal.  Mild distension of\nthe main pulmonary artery up to 3.7 cm, is essentially unchanged in compared\nto the prior exam.\nRe-demonstrated is a flat wall thrombus within the left main pulmonary artery,\nwith extension into the lingula (02:32, 29), suggestive of a chronic thrombus.\nNo definite new thrombus is seen in this non-dedicated study.\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Re-demonstrated is diffuse interstitial lung disease, with traction\nbronchiectasis and honeycombing seen in the upper lobes bilaterally as well as\nin the lower lobes, right middle lobe, and lingula.  Findings are more\nprominent in the left lung with unchanged moderate left lower lobe loss of\nvolume as well as ipsilateral mild mediastinal shift.\nExtensive geographic ground-glass opacities, are overall similar to the prior\nexam.  A prominent cyst/pneumatocele is again seen in the left lung base\n(14:189).\n\nIn the superior segment of the left lower lobe there is irregular focal\nopacity that has mildly increased in size, currently 2.1 x 2.8 cm; in ___ 2 x 2.2 cm; in ___ 1.1 x 1.3 cm (14:55).  Retraction\nof the major fissure at this level is re-demonstrated.",
            "output": "-Left lower lobe superior segment irregular soft tissue lesion has\nprogressively increased in size since ___, and may represent\nprimary lung malignancy, metastatic lesion.\n-Interstitial lung disease is stable."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta is mildly ectatic measuring 4.3 cm.  The\npatient has had prior aortic valve replacement.  The pulmonary arteries are\nnormal in size. No large central filling defects in the pulmonary arteries.\nThe heart size is enlarged with the left atrium measuring 5.5 cm and there is\nno pericardial effusion.  Mild to moderate calcifications of the mitral\nannulus.  There also calcifications of the left papillary muscle.  Moderate\natherosclerotic calcifications of the thoracic aorta and severe of the native\ncoronary arteries.  Prior coronary artery bypass grafting saphenous vein to\ndistal right coronary artery.  The ostium of the saphenous vein graft the rise\nis off the ascending aorta approximately 1.3 cm from midline and and 3.8 cm\nfrom the sternal manubrial joint.  There is a stent in the RCA and left\ncircumflex.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent, the trachea has a\nphysiologic lunate appearance.  Minimal linear atelectasis/scar in the medial\nsegment of the right middle lobe and focally in the posterior segment of the\nlingula.  Calcified granuloma in the left upper lobe.  No suspicious pulmonary\nnodules or masses.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.  Prior\nmedian sternotomy, with intact sternal wires and well opposed sternum. \nHealing left rib fracture.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen demonstrates bilateral renal cysts.  The\nremaining visualized upper abdomen is unremarkable.",
            "output": "No evidence of active intrathoracic infection or malignancy.\n\nPrior coronary artery bypass grafting saphenous vein to distal right coronary\nartery and aortic valve replacement with median sternotomy. 3D\nreconstructions, multiplanar reformatted and volume rendered images were\ncreated in the 3D imaging lab and are available for review."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is a small left-sided\npleural effusion.\n\nThere is a large, dense focal consolidation with air bronchograms in the left\nlower lobe suggestive of acute lobar pneumonia.  There are multiple\nground-glass opacities within the lingula and right upper and right middle\nlobe, which may represent additional inflammatory/infectious foci.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality.  Large, dense\nfocal consolidation with air bronchograms in the left lower lobe suggestive of\nacute lobar pneumonia with an associated small left parapneumonic pleural\neffusion.  Multiple ground-glass opacities within the lingula and right\nupper/middle lobes may represent additional foci of inflammation/infection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe unenhanced thyroid gland appears unremarkable.  No enlarged lymph nodes in\neither axilla or thoracic inlet.  Excluding the breast tissue which requires\nmammography for evaluation,there are no abnormalities on the chest wall. No\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Severe\ncoronary artery calcifications.  The aorta and pulmonary arteries are normal\nin caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No right hilus is somewhat bulky\nbut no discrete lymphadenopathy within the limitations of a nonenhanced scan.\n\nPLEURA:\nSmall bilateral nonhemorrhagic pleural effusions, slightly enlarged.  Mild\nbilateral apical scarring.\n\nLUNGS:\nCompared to the study from ___, there is improvement of the\npreviously seen bilateral ground-glass opacities and peribronchovascular\nconsolidations predominately in the upper lobes, consistent with resolving\nmultifocal pneumonia.  No new focal consolidation is seen.The airways are\npatent to the segmental levels, with evaluation of the smaller airways limited\ndue to motion.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "1. Residual but improved bilateral ground-glass opacities and\nperibronchovascular consolidations, consistent with resolving multifocal\npneumonia.  No new consolidation.\n2. Small bilateral nonhemorrhagic pleural effusions are slightly worsened.\n3. Severe coronary artery calcifications."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Moderate to severe coronary\nartery calcifications noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate bilateral pleural effusions with associated\ncompressive atelectasis.  No pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral ground-glass opacities and peribronchovascular\nconsolidations predominantly in the right upper lobe.  Mild pulmonary edema. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality given the motion\nartifact limitations.\n\nBilateral ground-glass opacity and peribronchovascular consolidations\npredominantly in the right upper lobe are concerning for multifocal pneumonia."
        },
        {
            "input": "CHEST PERIMETER: Right thyroid lobe is enlarged but there are no findings\nwarranting further imaging evaluation.  Supraclavicular and numerous\nsubcentimeter bilateral axillary lymph nodes are not pathologically enlarged. \nBreast evaluation is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.  Study is not designed for\nsubdiaphragmatic diagnosis.  Shows an incompletely evaluated, well\ncircumscribed, 3 x 2.5 cm soft tissue mass, hypodense, 50 ___, to the adjacent\ntail of the pancreas, 87 ___, 4:216-232.  This lesion needs to be evaluated\nwith dedicated abdominal cross-sectional imaging.\nCARDIO-MEDIASTINUM: Lower esophagus is patulous, filled with air.  Same is\ntrue for mid esophagus.  There is no fluid retention to suggest obstruction or\nany associated mass.\n\nThoracic aorta is normal caliber.  The descending portion is tortuous,\naccounting for the  lower thoracic aortic aneurysm questioned in the report of\nthe recent prior chest radiographs.  Adjacent to it is mild left lower lobe\natelectasis.\n\nAtherosclerotic calcification is not apparent head neck vessels or in the\ncoronary arteries.  Small pericardial effusion could be physiologic. \nEvaluation of cardiomegaly would require echocardiography.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: There are no lung nodules or other focal lung lesions\nof consequence.\n\nBronchial wall thickening is mild in several locations but there is no\nbronchiectasis, retention of secretions peribronchial infiltration.  Lower\nlobes are under inflated, without evidence of obstruction.  There is no\npleural abnormality\n\nCHEST CAGE: Unremarkable",
            "output": "Possible pancreatic or peripancreatic mass.  Dedicated abdominal CT\nrecommended.\n\nNo thoracic aortic aneurysm.  Lower thoracic aorta is tortuous.\n\nModerately patulous esophagus, could be an indication of a motility disorder. \nClinical assessment advised.\n\n\nRECOMMENDATION(S):  Abdomen CT.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___ on\n___ at 08:27 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Aorta and pulmonary arteries are stable in appearance with mild dilatation of\npulmonary artery.  Varices are present in the mediastinum as well as\npotentially enlarged bronchial arteries.  Heart size is normal.  There is no\npericardial or pleural effusion.  Image portion of the upper abdomen will be\nreviewed separately as part of the CT abdomen and corresponding report will be\nissued.\n\nHypodense lesions in the left thoracic inlet area most likely represent venous\nstructures but alternatively might represent lymph nodes, similar to previous\nexamination, series 6, image 19.\n\nAirways are patent to the subsegmental level bilaterally.  Small left pleural\neffusion is demonstrated, new.  No new pulmonary nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nThe varices.\n\nQuestionable veins versus lymph nodes at the thoracic inlet on the left.\n\nPlease see separate report discussed in findings within the abdomen and the\npelvis"
        },
        {
            "input": "The examination is compared to an outside hospital CT from ___.  No\nincidental thyroid findings. No supraclavicular, infraclavicular or axillary\nlymphadenopathy. No enlarged lymph nodes in the mediastinum or at the level of\nthe hilar structures. Several calcified sub carinal normal-sized lymph nodes\nare noted (6, 41). The large mediastinal vessels appear unremarkable there is\nno incidental pulmonary embolism. Normal cardiac structures. No pericardial\neffusion. The esophagus shows a hiatal hernia (6, 73) and no wall is slightly\nthickened. The upper abdomen is reported in detail in the dedicated abdominal\nCT report of the examination performed today. Normal appearance of the chest\nwall. The ribs, vertebral bodies and the sternum show no abnormalities\nsuggestive of osteolytic lesions. Mild bilateral apical scarring. Mild to\nmoderate respiratory motion artifacts. Several 1-2 mm mostly subpleural\npulmonary micronodules, for example in the right upper lobe (7, 95). No\nsuspicious lung nodules or masses. No pleural thickening or pleural effusions.\nThe airways are patent.",
            "output": "No suspicious lung nodules or masses.  Calcified subcarinal lymph nodes.  No\npleural effusions.  No lymphadenopathy."
        },
        {
            "input": "Soft tissues: The thyroid is homogeneous. No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes.  Calcified subcarinal lymph nodes are again\nseen.  The heart is normal in size and there is no pericardial effusion. No\nsignificant coronary artery or valvular calcification. The aorta and main\npulmonary artery are normal in caliber.Small hiatal hernia is noted. Please\nsee a separate report discussing the subdiaphragmatic findings.\n\nLungs: The airways are patent to the subsegmental level bilaterally.  Multiple\ncentrilobular nodules have the appearance of a bronchiolitis, possibly related\nto tobacco use or allergic in nature.  Aside from mild dependent atelectasis\nbilaterally, the lungs are clear with no consolidation, pleural effusion, or\npneumothorax.  No concerning pulmonary mass or nodule is identified.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Redemonstration of calcified subcarinal lymph nodes.  No evidence of\nintrathoracic metastasis.\n2.  Please see a separate report discussing findings within the abdomen and\npelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.  There is a calcified left hilar\nlymph node, consistent with history of prior granulomatous disease.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is a 5 mm nodule in the left upper lobe (4:90) as\nwell as a 3 mm nodule in the right lung apex (___).  There are punctate\ngranulomas in the right upper lobe (4:88) and right middle lobe (4:160.\n\nThe patient appears to be status post left upper lobectomy with loss of volume\non the left and subsequent leftward mediastinal shift.  There are unilateral\npleural calcifications in the left apex and along the posteromedial aspect of\nthe left hemithorax consistent with calcified fibrothorax. There is moderate\nbronchiectasis and chronic appearing interstitial abnormality in the left\nlower lobe.  Diffuse, mild airway wall thickening suggests chronic\ninflammation/bronchitis.\n\nRe-demonstrated is a 1.0 cm spiculated nodule in the right lung apex (___). \nBronchocentric nodules in the right upper lobe suggest small airways disease,\nwhich can be infectious or inflammatory in etiology.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable\naside from a tiny hiatal hernia.",
            "output": "1. Previously seen 1.0 cm spiculated nodule in the right lung apex may\nrepresent scarring.  However, recommend comparison to prior imaging to assess\nfor stability.  If clinically indicated, this can be further evaluated with a\nfollow up with CT in 3 months or PET-CT.\n2. Patient appears to be status post left upper lobectomy with evidence of\ncalcified fibrothorax on the left.\n3.  For the additional incidentally detected subcentimeter solid pulmonary\nnodules, no CT follow-up is recommended in a low-risk patient, and an optional\nCT follow-up in 12 months is recommended in a high-risk patient.\n4. Diffuse mild airway wall thickening suggests chronic\ninflammation/bronchitis.\n5. Bronchocentric nodules in the right upper lobe are suggestive of small\nairways disease, which can be infectious or inflammatory.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:24 am, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Re-demonstrated is a mixed lesion in the left upper lobe which\nmeasures 1.3 x 0.8 cm, unchanged since the prior study (02:23).  A\nground-glass nodule in the right upper lobe (02:52) not definitively\nidentified on the prior examination is noted, and is nonspecific, measuring up\nto 3 mm.\n\nBASE OF NECK: The right lobe of the thyroid is surgically absent.  The left\nlobe is unremarkable.\n\nABDOMEN:  Included portion of the upper abdomen is notable for multiple\nhypodense lesions in the liver, which are essentially unchanged since the\nprior PET CT.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic dissection.\n2.  Unchanged mixed left upper lobe nodule warrants continued anatomic\nfollow-up.\n3.  Right upper lobe ground-glass nodule is nonspecific."
        },
        {
            "input": "Atherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta, main pulmonary arteries and cardiac chambers are normal\nsize.  Very small pericardial effusion is new, but probably physiologic. \nSmall layering nonhemorrhagic pleural effusions, right greater than left, are\nnew as well.\n\nThymic hyperplasia was present in ___.  The ___ of the enlarged\nthymus are unchanged but the soft tissue bulk has increased, replacing some of\nthe fat.  The\n\nSubcentimeter central lymph nodes in the right paraesophageal station of the\nmediastinum and right hilus are unchanged.  There is no new central\nadenopathy.\n\nLungs:\n\nMild biapical micro nodulation is unchanged since ___.  This is most\ncommonly seen in cigarette smokers.  A new region of masslike consolidation in\nthe superior segment of the right lower has an irregular but homogeneous\ncentral component, roughly 16 x 16 mm, 9:151, surrounded by ground-glass\nperibronchial opacification.\n\nThere are no other focal lesions of note in the lungs.\n\nThere are no bone lesions concerning for malignancy or infection.",
            "output": "Combination of chronic, worsened axillary adenopathy, thymic enlargement, and\nsplenomegaly (to be reported separately) suggest a long-term\nlymphoproliferative or hyper immune condition.\n\nNew left lower lobe lung lesion should be considered infectious, monitored\nwith conventional radiographs, and treated presumptively before additional CT\nimaging.\n\nRECOMMENDATION(S):  New left lower lobe lung lesion should be considered\ninfectious, monitored with conventional radiographs, and treated presumptively\nbefore additional CT imaging.\n\nNOTIFICATION:  The findings were discussed with     ?      ___ , M.D.\nby ___, M.D. on the telephone on ___ at 8:52 am, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nhomogeneous in attenuation without focal nodularity.  There is no\nsupraclavicular lymphadenopathy.  There are multiple mildly enlarged axillary\nlymph nodes, decreased in size compared to prior exam on ___ and\n___, now measuring up to 8 mm.  Right upper extremity PICC line\nterminates at the cavoatrial junction.  The chest wall is unremarkable.\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen demonstrate mild\nenlargement of the spleen, measuring up to 12.9 cm.  Please refer to the\ndedicated CT abdomen and pelvis report on the same day for details on\nsubdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria. \nThere has been interval decrease in the amount of soft tissue density in the\nanterior mediastinum, likely involution of thymic tissue.  Previously\ndemonstrated mildly enlarged mediastinal lymph nodes have decreased in size.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.  There has been\ninterval decrease in scattered enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no significant\nvalvular or coronary calcifications.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There has been interval near complete resolution of the focal\nground-glass opacity in the left lower lobe with a residual 3 mm ground-glass\nnodule in the left lower lobe (05:43).  However, there are 2 small foci of\nill-defined ground-glass opacities in the lingula, measuring up to 7 mm\n(5:165, 191).  Millimetric subpleural nodule in the right upper lobe is\nunchanged from prior exam (05:29).  Ill-defined ground-glass nodule in the\nright lower lobe measuring up to 4 mm in the peribronchovascular distribution\nis likely new (5:143), likely inflammatory.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.  No\nendobronchial lesions.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain and right pulmonary arteries are normal in caliber.  No significant\naortic arch calcifications are noted.  There is common origin of the left\ncommon carotid artery and the innominate artery.\nCHEST CAGE: There are no osseous lesions concerning for malignancy or\ninfection.",
            "output": "-Interval near complete resolution of focal ground-glass opacity in the left\nlower lobe, likely representing infectious etiology rather than malignancy.\n-Ill-defined ground-glass nodule in the right lower lobe, likely inflammatory.\n-Stable millimetric subpleural nodule in the right upper lobe."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes at the hilar or mediastinal\nlevel.  Mild dilatation of the main pulmonary artery.  Moderate coronary\ncalcifications, no valvular calcifications.  No pericardial effusion. \nUnremarkable posterior mediastinum.  The upper abdominal organs are described\nin detail in the dedicated abdominal CT report.  No osteolytic lesions at the\nlevel of the ribs, the sternum or the vertebral bodies.  Mild degenerative\nvertebral disease.  No pleural effusions.  No pleural thickening. The larger\nairways are patent.  No diffuse lung disease.  Minimal atelectasis at the\nright lung basis (5, 199).  No suspicious lung nodules or masses.",
            "output": "No lymphadenopathy.  No suspicious lung nodules or masses.  No pleural\nabnormalities."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings require any further imaging evaluation. \nNo supraclavicular or axillary adenopathy.  Breast evaluation is reserved\nexclusively for mammography.  No soft tissue abnormality in the chest wall\ndespite multiple left rib fractures.  Study is not designed for evaluation of\nthe abdomen but there is no adrenal mass or immediate subphrenic collection.\n\nCARDIO-MEDIASTINUM:Hiatus hernia is small.  Esophagus is unremarkable. \nAtherosclerotic calcification is mild in head and neck vessels.  Patient has\nhad median sternotomy for CABG..  Sternum is well-healed and there are no\nfindings to suggest wound complications.  Native coronary arteries are heavily\ncalcified.  Aorta and pulmonary arteries are normal size.  Cardiac evaluation\nwould require echocardiography.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: None enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Moderate size layering nonhemorrhagic left pleural\neffusion has enlarged since ___ when it was partially hemorrhagic.\n\nLeft lower lobe is now entirely collapsed, although there is no responsible\nbronchial obstruction.\n\nTwo small regions of new consolidation at the right apex are active or\nresidual pneumonia, ___.  Another small region of peribronchial\ninfiltration with a ground-glass halo, right upper lobe, 5:72 could be\nresidual edema or either active or residual pneumonia.  Right middle lobe\natelectasis above the elevated right hemidiaphragm has increased.  No\nbronchial obstruction present.  Mild subpleural atelectasis in the right lower\nlobe is new.\n\n\n\nCHEST CAGE: More than half a dozen fractures lateral and posterolateral left\nmiddle and lower ribs are no more displaced today than on ___,\nincluding the most severe, proximal left tenth rib, displaced more than the\nwidth of the rib, 5:215.  Nevertheless there is no associated fluid or soft\ntissue abnormality in either the chest wall or the extrapleural space. \nModerate loss of height lower thoracic vertebral body due to upper endplate\ndepression, no vertebral canal compromise, unchanged, probably chronic,\n10:103.",
            "output": "New left lower lobe collapse accompanied by increase in moderate\nnonhemorrhagic layering left pleural effusion.\n\nSeveral very small foci possible pneumonia, right lung.\n\nMultiple, mid and lower left rib fractures, stable since ___, no\nevidence of associated bleeding."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nThe patient has had prior median sternotomy with CABG. The pledget is 6.5 cm\nfrom the plane of the aortic valve.  Coronary artery, aortic valvular and\nmitral annular calcifications are extensive. Diffuse low attenuation of the\nblood in the heart suggests anemia. The main pulmonary artery is top normal\ncaliber measuring 3.0 cm. The ascending thoracic aorta is mildly ectatic,\nmeasuring 3.9 cm at the level of the main pulmonary artery. Mild calcific\natherosclerosis involves the ascending thoracic aorta. Moderate discontinuous\ncalcification involves the aortic arch and descending thoracic aorta, with\nextensive calcification at the ostium of the celiac and left renal arteries.\n\nSeveral pulmonary nodules measuring up to 4 mm in the right lower lobe are\nidentified (4: 69, 73, 105, 116, 130, 141, 145, 147, 154, 155, 171, 173, 184).\nThere is no endobronchial lesion or pleural abnormality. Mild diffuse\nbronchial wall thickening is present.\n\nImages of the upper abdomen show moderate nonspecific bilateral perinephric\nstranding.\n\nNo destructive bone lesion is identified. Moderate right shoulder degenerative\nchanges are noted.",
            "output": "Extensive aortic valvular calcifications are in keeping with the provided\nhistory of aortic stenosis.  Ectatic descending thoracic aorta measures 3.9 cm\nat the level of the main pulmonary artery.\n\nMild atherosclerotic calcification of the ascending thoracic aorta.\n\nMultiple indeterminate solid pulmonary nodules measuring up to 4 mm in the\nright lower lobe warrant further re-evaluation with a 12 month followup chest\nCT.\n\nMild diffuse bronchial inflammation.\n\nAnemia."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  There is no coronary artery\ncalcification.  The aorta and pulmonary artery normal in caliber.\n\n\nPLEURA: There is no pleural a\n\nNo nodules consolidations are seen.  There is no evidence of interstitial lung\ndisease.  On expiratory images there is no evidence of air trapping.  There is\nminimal by basilar atelectasis\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "No explanation for patient's productive cough and fever.\n\nNo evidence of interstitial lung disease or pneumonia"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is heterogeneous with a 1.8 cm nodules to the left, somewhat is of\nfatigue (302:1).  No enlarged lymph nodes in either axilla or thoracic inlet. \nNo abnormalities on the chest wall.  Moderate atherosclerotic calcifications\nin the head and neck arteries.  Large-bore catheter in the right jugular vein\nwith tip in the lower SVC.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries and aorta, none mild\nin the aortic valve.  The pulmonary arteries and aorta are normal caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, the largest\nmeasuring up to 1.2 cm in the right lower paratracheal station.  No hilar\nlymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchiectasis or mucus\nplugging.  Mild bronchial wall thickening.  Mild interlobular septal\nthickening associated to scattered ground-glass opacities bilaterally.  More\nnodular ground-glass opacities are noted in the left lower lobe (302:120). \nThere is moderate background centrilobular and paraseptal emphysema, upper\nlobe predominant.  5 mm and 3 mm subpleural nodule in the middle lobe (302:78\nand 102).\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show severe atherosclerotic disease\nin the intra-abdominal vessels.  Left adrenal myelolipoma measuring 2.0 cm\n(02:54).",
            "output": "No evidence of mediastinal bleeding.  Appropriately placed hemodialysis\nlarge-bore catheter in the right jugular vein.\nModerate bilateral pulmonary edema with likely reactive mediastinal\nlymphadenopathy.\nThere are nodular ground-glass opacities in the left lower lobe that might\nrepresent superimposed infectious/inflammatory process.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:50 pm."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  Heart size is normal. \nThere are no enlarged hilar lymph nodes.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is evidence of paraseptal emphysema.  There is mild peribronchial\nthickening.  No lung nodules are seen.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Please refer to dedicated report on abdomen which has been\ndictated separately",
            "output": "Paraseptal emphysema.\n\nMild peribronchial thickening.\n\nNo lung nodules"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited by motion\nartifact.  Approximately 0.4 cm pleural based pulmonary nodule of the right\nmiddle lobe (3:91).  Approximately 0.8 cm pulmonary nodule of the right upper\nlobe (3:67).  Mild, bibasilar atelectasis.  Otherwise, the lungs are clear\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nApproximately 0.7 cm right thyroid nodule (2:9).\n\nABDOMEN: Hepatic steatosis.  Otherwise, the included portion of the upper\nabdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "Within the confines of a motion limited study:\n\n1. No evidence of pulmonary embolism to the segmental level.\n2. Multiple pulmonary nodules of the right lung, measuring up to 0.8 cm.\n3. Hepatic steatosis.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bilateral dependent atelectasis.  Lungs are\notherwise clear without masses or areas of parenchymal opacification. The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Calcified coronary atherosclerosis is mild.  The\nthoracic aorta is normal in caliber.  Incidental note is made of a common\norigin of the left common carotid and innominate arteries.  The main pulmonary\nartery is normal in caliber.  No evidence of pulmonary embolus to the\nsubsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is substantial airway secretions including the bilateral\nmainstem bronchi with complete opacification of the right lower lobe bronchus\nand multiple segmental and subsegmental lower lobe bronchi.  There is\nextensive associated bronchial wall thickening and scattered subsegmental\natelectasis in the affected pulmonary segments.\n\nBASE OF NECK: A hypodense right thyroid lobe nodule measures 1.5 cm (series 2,\nimage 7).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No aggressive osseous lesions.",
            "output": "1. No evidence of pulmonary embolism.  Extensive airway secretions with\nassociated bronchial wall thickening and subsegmental atelectasis most\nprominent in the dependent portions of the lungs compatible with substantial\naspiration.\n2. 1.5 cm right thyroid lobe nodule.  If not previously performed, recommend\nnonemergent thyroid ultrasound for further evaluation per ACR guidelines on\nincidentally discovered thyroid nodules.\n\nRECOMMENDATION(S):  1.5 cm right thyroid lobe nodule. If not previously\nperformed, recommend nonemergent thyroid ultrasound for further evaluation per\nACR guidelines on incidentally discovered thyroid nodules."
        },
        {
            "input": "The thyroid is normal.  No axillary adenopathy.  No mediastinal or hilar\nadenopathy.  There is trace pericardial effusion.\n\nThe thoracic aorta is normal in caliber.\n\nNo pleural effusion.\n\nThe central tracheobronchial tree is patent.\n\nThere is an atelectatic segment right middle lobe seen on image 41 of series\n602.  Atelectasis/scarring is noted left lower lobe.  Linear atelectasis is\nnoted in left mid lung right upper lobe.\n\nMild ground-glass opacities with a perivascular distribution and basilar\npredominance are noted, nonspecific, potentially a small amount of pulmonary\nedema or hemorrhage.\n\nSclerotic appearance the sternum, ribs, vertebral bodies and H-shaped\nvertebral bodies are compatible with the patient's history of sickle cell\ndisease.\n\nLimited evaluation of the upper abdomen is notable for an auto infarcted\nspleen and vicarious excretion of contrast into the gallbladder.",
            "output": "1.  Mild perivascular ground glass opacities, nonspecific, potentially related\nto microvascular occlusion in the setting of sickle cell, mild pulmonary\nedema, or other infectious/inflammatory etiology.\n2.  Multiple foci of atelectasis/scarring as above.\n3.  Additional chronic sequelae of sickle cell disease as above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There similar scattered areas of subsegmental atelectasis and\nparenchymal scarring.  Otherwise, the remaining lungs are clear without masses\nor areas of parenchymal opacification.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Again demonstrated, H-shaped configurations of the vertebral bodies,\nsclerotic appearance of the sternum and ribs, and atrophied spleen consistent\nwith patient's known history of sickle cell disease.  Otherwise, no suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "There are no enlarged mediastinal or hilar lymph nodes.  Bilateral small\naxillary lymph nodes are increased in number but do not meet individual size\ncriteria for enlargement.  Note is made of a 9 mm x 7 mm right subpectoral\nlymph node (61, 4).\n\nHeart is normal in size, and focal coronary artery calcifications are present.\nThere is no pericardial or pleural effusion.  Small hiatal hernia is noted.\n\nAssessment of the lungs is somewhat limited due to inadvertent expiratory\nphase of respiration.  Within this limitation, note is made of apparent\nbronchial wall thickening as well as mild mucoid impaction within the lower\nlobe airways.  There are no focal areas of consolidation within the lungs. \nIncidental calcified granulomas present left lower lobe and note is made of\napparent intrapulmonary lymph nodes along the right major fissure (117, 4).  .\nModerate expiratory air trapping is consistent with small airways disease.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning findings are evident in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate degenerative changes within the\nspine.",
            "output": "1. Technically limited CT due to inadvertent expiratory phase of respiration. \nThis reduces the sensitivity for detecting subtle interstitial lung\nabnormalities and small pulmonary nodules.\n\n2. Bilateral lower lobe bronchial wall thickening may reflect acute or chronic\nairway inflammation.  In the setting of unexplained cough and the presence of\na small hiatal hernia, aspiration is an additional consideration.\n\n3. Bilateral small axillary lymph nodes and prominent right subpectoral lymph\nnode are nonspecific findings.  Consider a screening mammogram, especially if\nthe patient has not undergone mammography in the past year."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Left ventricular\nenlargement is unchanged.  No mediastinal, hilar or axillary lymph nodes\ndemonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Minimal diffuse\nbronchial wall thickening is present.  No bronchiectasis is seen.\n\nThe study was obtained with suboptimal inspiration.  Within those limitations\nthere are no pulmonary nodules demonstrated.  No interstitial lung disease is\npresent.  No consolidations to suggest infection are noted.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm\nidentified.\n\nImaged portion of the upper abdomen demonstrate no appreciable abnormality\nwithin the limitations of the study technique that was not designed for\nassessment of intra-abdominal pathology.\n\nAtherosclerotic disease of the aorta and coronary arteries is present.",
            "output": "Minimal diffuse bronchial wall thickening that might be consistent with\nchronic airway disease but no evidence of bronchiectasis or current pneumonia.\n\nAtherosclerotic disease."
        },
        {
            "input": "MEDIASTINUM:  Heterogeneous enlargement of the thyroid with mild tracheal\ndeviation to the right and minimal narrowing.  No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.  Calcified hilar\nand mediastinal lymph nodes related to prior granulomatous exposure.\n\nHEART AND GREAT VESSELS:  The ascending aorta measures 3.7 cm and maximal\ndiameter.  No aortic valvular calcifications.  No calcifications of the\nascending aorta.  Minimal calcifications of the aortic arch.  The heart is\nenlarged.  No substantial coronary artery calcifications.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: Assessment of the lungs is somewhat limited\nby inadvertent expiratory phase of respiration and mild motion artifact,\nreducing sensitivity for very small pulmonary nodules and subtle interstitial\nlung abnormalities.\n\nMild paraseptal and centrilobular emphysema with mild diffuse bronchial wall\nthickening.  Punctate nodule is in the left upper lobe series 4, image 36. 3 x\n6 mm perifissural nodule in the right lower lobe series 4, image 97.  4.5 mm\nnodule in the right lower lobe series 4, image 122.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, right adrenal low-attenuation nodule consistent with adenoma. \nLeft adrenal nodule also of low attenuation consistent with adenoma.  The\nright kidney is atrophic and heavily calcified with dystrophic calcifications.\nThe remaining upper abdomen is unremarkable.",
            "output": "The ascending aorta is not aneurysmal.  No appreciable aortic valvular\ncalcifications.\n\nMultiple pulmonary nodules measuring up to 5 mm, suggest follow-up CT thorax\nin 6 months time to reassess pulmonary nodules.\n\nMultinodular goiter, with minimal rightward tracheal shift and narrowing.  If\nnot already performed could be correlated with thyroid ultrasound.\n\nIncidental bilateral adrenal adenomas.\n\nSignificant atrophy and dystrophic calcifications of right kidney.\n\nRECOMMENDATION(S):  Follow-up CT thorax in ___ months time.\n\nIf not recently performed thyroid ultrasound for multinodular goiter."
        },
        {
            "input": "Aorta is normal in course and caliber.  Atherosclerotic calcifications are\ndiffuse and moderate.  The heart is enlarged.  The patient has had prior\nmedian sternotomy, mitral valve replacement, and has a left pectoral pace\nmaker with one lead ending in the right atrium and the other in the right\nventricle.  Coronary artery calcifications are moderate.  No evidence of a\npericardial effusion.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary are somewhat\ndilated which can be seen with pulmonary arterial hypertension.\n\nNo supraclavicular or axillary lymphadenopathy.  Multiple mediastinal lymph\nnodes are measurable, the largest up to 7 mm in the right upper paratracheal\nstation (series 2, image 33).  Right hilar soft tissue is prominent with\nextension up to the subcarinal station (series 601b, image 36; series 2, image\n63, 59).  No left hilar lymphadenopathy.\n\nDetailed evaluation of the pulmonary parenchyma is limited secondary to\nrespiratory and cardiac motion artifact.  Streak like, linear opacity in the\nleft lower lobe is compatible with subsegmental atelectasis and similar\natelectasis in the left upper lobe.  Mosaic appearance of the lungs might\nreflect air trapping or edema.  The airways are patent to the subsegmental\nlevel.  No pneumothorax or pleural effusion.  There is a 3-mm right middle\nlobe subpleural nodule (series 2, image 64).\n\nThe thyroid is unremarkable.\n\nAlthough this exam is not dedicated for imaging of the abdomen, limited images\nof the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion concerning for malignancy or infection is\nidentified.  Multilevel degenerative changes of thoracic spine are moderate. \nPatient is status post median sternotomy.",
            "output": "1.  No evidence of pulmonary embolism or aortic dissection.\n\n2.  Cardiomegaly.\n\n3.  Mosaic attenuation of the lungs, which could be seen with air trapping and\nchronic small airways disease or edema.  No pleural effusion or focal\npneumonia.\n\n4.  Nonspecific mediastinal and right hilar soft tissue prominence.  Recommend\nPET-CT or follow-up chest CT in 3 months to further assess nonspecific\nmediastinal and right perihilar soft tissue prominence/lymphadenopathy.\n\n6.  3-mm right middle lobe subpleural nodule.  If the patient is low risk, no\nfollow-up is needed.  If the patient is high risk, per ___ society\nguidelines, follow-up chest CT in 12 months is recommended.\n\nRECOMMENDATION(S):  Follow-up chest CT in 12 months for the right middle lobe\n3 mm nodule if the patient is high risk.  Attention on follow-up of\nmediastinal and right hilar soft tissue prominence.\n\nPET-CT or follow-up chest CT in 3 months to further assess nonspecific\nmediastinal and right perihilar soft tissue prominence/lymphadenopathy."
        },
        {
            "input": "The thyroid gland is unremarkable.\n\nNo supraclavicular, axillary, mediastinal, or hilar lymphadenopathy\nidentified.\n\nExtensive calcified atherosclerotic disease is present within the coronary\narteries.  Heart size is normal and without pericardial effusion.\n\nMultiple filling defects evident within the pulmonary vasculature involving\nthe right main pulmonary artery with extension into the right upper, lower,\nmiddle lobar branches as well as the segmental and subsegmental levels.\nPossible scattered subsegmental involvement on the left. The interventricular\nseptum is not straightened. There is reflux of intravenous contrast into the\ncephalad IVC and hepatic veins which may be suggestive of right heart strain;\nhowever given the high rate of injection required for multiphasic pancreatic\nstudy, this is a less specific sign of cardiac strain. Lungs are clear.\nAirways are normal and patent to the subsegmental levels. No pleural effusion\npresent.\n\n Please see concurrent CT/abdomen pelvis for full discussion of\nintra-abdominal findings.\n\nNo suspicious lytic or blastic lesions identified.  There is a stable mid\nthoracic vertebral sclerotic focus unchanged since ___ and likely\nrepresenting bone island as well as a vertebral hemangioma without associated\ncompression deformity. No superficial soft tissue mass is identified.",
            "output": "1.  Multiple large pulmonary emboli involving right main pulmonary artery\nextending through the lobar, segmental and subsegmental branches. Possible\nsubsegmental involvement on the left. No interventricular straightening\npresent. Intravenous contrast reflux into the hepatic veins can be normal with\nhigh- rate contrast injection (part of normal pancreatic multiphase CT) but\nmay also be indicative of right heart strain.\n\n2.  No evidence of active intrathoracic infection or malignancy.\n\nNOTIFICATION:  ___ discussed these findings with ordering\nphysician, ___ t 11:51 on ___ via telephone 5 minutes after\ninterpretation."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is left ventricular hypertrophy and the heart is\nmildly enlarged.  Mild calcification of the mitral annulus is demonstrated. \nOtherwise, the pericardium and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Left ventricular hypertrophy."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Central venous line tip\nis at the lower SVC level.  Coronary calcifications are minimal.  Left\nventricle is denser than the blood in the cardiac time per, most likely\nconsistent with anemia.\n\nMediastinal lymph nodes are borderline, symmetric, none of them exceeding 1\ncm.  There is no pericardial pleural effusion.  Image portion of the upper\nabdomen will be reviewed separately in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is primarily affecting right upper lobe and in symmetric fashion. \nIn addition to the emphysema either also areas of ground-glass opacity\nasymmetrically affecting right upper lobe.  The a chronicity is unclear but in\nthe absence of previous imaging the assumption should be made that the\nrepresent acute process.  No other pulmonary nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Right upper lobe emphysema in ground-glass opacity.  The findings are\nconcerning for infectious process, potentially viral.  Alternatively\npneumocystis pneumonia cannot be entirely excluded.  8 patient has prior\ncross-sectional imaging date can be brought to our review, addendum will be\ngladly added.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and corresponding report will be issued.\n\nEvidence of anemia."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of the base of the\nneck is unremarkable.  No supraclavicular or axillary lymphadenopathy.\n\nIMAGED UPPER ABDOMEN: Unremarkable.\n\nMEDIASTINUM:  No mediastinal mass or lymphadenopathy.\n\nHILA:  Evaluation is limited without IV contrast, but is grossly unremarkable.\n\nHEART and PERICARDIUM: Heart size is normal.  There is minimal coronary artery\ncalcification.  Tiny pericardial effusion is likely physiologic.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  There is mild centrilobular emphysema predominantly in the\nright upper lobe.  No focal consolidation.\n2. AIRWAYS:  The airways are patent to subsegmental levels.\n3. VESSELS:  The great vessels are normal caliber.\nCHEST CAGE: No concerning lytic or sclerotic lesion.  No acute fracture.",
            "output": "No evidence of infection."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Incidental note is made of a lipoma in the right\nupper posterior back.  Left-sided PICC line projects to the cavoatrial\njunction\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart and\naorta are normal in caliber.  There is a small pericardial effusion.  The\npulmonary arteries are normal in size.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG:\nThere are new bronchus centric opacities with a ___ distribution in\nthe right upper lobe 0 (5, 119.\n\nThere is a new tiny nodule in the right upper lobe (5, 65).  Another 2 mm\nnodule is seen in the right upper lobe (5, 97).  There is minimal subsegmental\natelectasis in the right lung base.  A right lower lobe nodule measuring 4 mm\n(5, 188) is also new.\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen",
            "output": "New parenchymal opacities in a bronchus centric distribution associated with\n___ nodularity in the posterior segment the right upper lobe\nconcerning for bacterial pneumonia.  Few scattered nodules throughout the\nright lung could represent part of the same process.\n\nLeft-sided PICC line with its tip in the SVC"
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There nose axillary lymph nodes.  There is a left-sided\nPICC line with its tip in the cavoatrial junction.\n\nMEDIASTINUM: Small mediastinal nodes are stable and most likely reactive. \nHeart size is normal.  There are no enlarged hilar lymph nodes.  There is\nmitral annulus calcification and aortic annulus calcification.  There is mild\ncoronary artery calcification.  There is no pericardial effusion. The aorta\nand pulmonary arteries are normal in caliber.\n\nPLEURA: There is no pleural effusion\n\nLUNG: Previously visualized consolidative opacity in the posterior segment the\nright upper lobe has evolved and is consistent with an the resolving\npneumonia.  However there are new secretions and thickening within the right\nlower lobe bronchi and mild a peribronchial thickening in the lateral segment\nright middle lobe and also the right lower lobe which could be related to\nbronchitis.  No evidence of air trapping\n\nBONES AND CHEST WALL : No other consolidations are seen.  There is no evidence\nof air trapping.  There is no evidence to suggest interstitial pneumonitis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Evolving consolidation in the right middle lobe consistent with a resolving\npneumonia.  Follow-up to complete resolution is recommended.\n\nDiffuse peribronchial thickening in the lateral segment right middle lobe and\nboth lower lobes associated with increased secretions could be related to\nbronchitis.\n\nStable small mediastinal lymph nodes are most likely reactive.\n\nNo evidence of interstitial pneumonia pneumonitis or interstitial abnormality\nto suggest GVHD."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There is a left-sided PICC line\nwith its tip projecting to the cavoatrial junction\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes are unchanged.  Heart size is\nnormal.  There is no pericardial effusion.  There are no enlarged hilar lymph\nnodes.  There is no pericardial effusion\n\n\nPLEURA: There are no pleural effusions\n\nLUNG: There is bibasilar atelectasis.  There is mild upper lobe predominant\nemphysema.  No new consolidations concerning for pneumonia\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Pitted sections through the upper abdomen are unremarkable",
            "output": "No evidence of pneumonia.\n\nStable small mediastinal lymph nodes.\n\nLeft-sided PICC line with its tip in the cavoatrial junction."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.  The\ntip of a left central venous catheter projects over the right atrium.\n\nUPPER ABDOMEN: The visualized abdomen unremarkable exam.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mediastinal hematoma.\n\nHILA: There is no adenopathy given the limitations of the noncontrast\ntechnique.\n\nHEART and PERICARDIUM: Heart is not enlarged.  Mitral annular calcification is\npresent.  There is mild calcification the ascending.  No pericardial effusion.\nPLEURA: There is a small left pleural effusion, minimally increased since the\nPET-CT.  The previously seen right pleural effusion has resolved.  There is no\npneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is mild to moderate emphysema, most notable in the upper\nlobes.  Breathing motion limits assessment of the lung parenchyma.  There are\npersisting branching opacities in the posterior segment of the right upper\nlobe, improved since prior.  No new consolidations or nodules identified.\n2. AIRWAYS:  The airways are patent through the subsegmental level.\n3. VESSELS:  The size of the thoracic aorta and the pulmonary arterial trunk\nwithin normal limits.\nCHEST CAGE: There is no acute fracture.  No suspicious osseous lesion.",
            "output": "The since the PET-CT dated ___:\n\nInterval decrease in extent of the previously described consolidations with\nminimal amount of persisting consolidation in the posterior segment of the\nright upper lobe.  No new consolidation.  The right pleural effusion has\nresolved.  Persisting small left pleural effusion."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  Small lymph nodes in the lower paratracheal station\nare again noted, unchanged since the prior study. Evaluation of the\nmediastinum is limited in the absence of IV contrast. However patient is\nstatus post CABG. Coronary calcifications are noted. Calcification of thoracic\naorta is unchanged.\n\nAirways are patent to subsegmental levels. A area of focal ground-glass\nopacity in the right upper lobe measures 1.0 cm and is stable compared to the\nprior study (series 4, image 25). Additional right upper lobe subpleural\nnodules are also stable (series 4, image 41, 70).  No new suspicious nodules\nare present.  Several additional small focal areas of ground-glass opacity are\nalso again noted (series 4, image 68). Bibasilar atelectasis is noted.\n\nThis exam was not tailored for evaluation of subdiaphragmatic structures.  The\npatient is status post cholecystectomy. Cysts are noted within both kidneys.\nAtherosclerotic calcification abdominal aorta is present.\n\nNo suspicious lesion is seen in the visualized osseous structures. There is no\nvertebral body or rib fracture. Degenerative changes are again seen, most\nsevere in the mid thoracic spine, slightly progressed compared to prior.\nMedian sternotomy wires are intact.",
            "output": "1. No thoracic vertebral body or rib fracture.  No acute process.\n2. Stable appearance of right upper lobe ground glass nodule.  No new\nconcerning nodules."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Note is made of\ncalcified and soft plaque throughout the thoracic aorta, which appears\ntortuous.  There is no evidence of penetrating atherosclerotic ulcer or aortic\narch atheroma present.\n\nAssessment of segmental and subsegmental pulmonary arteries is limited\nsecondary to respiratory motion.  There is no filling defect in the main or\nlobar pulmonary arteries.\n\nThere is no supraclavicular, axillary, or hilar lymphadenopathy by CT size\ncriteria.  Numerous prominent although not technically enlarged mediastinal\nlymph nodes are present, and have a similar appearance to ___.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion. \nThe heart appears enlarged.  There is no pericardial effusion.  Note is made\nof diffuse coronary artery calcifications as well as aortic valvular\ncalcifications.\n\nThe airways are patent at least to the lobar level; assessment of smaller\nairways is limited secondary to respiratory motion.  Note is made of small\nbibasilar consolidative opacities containing air bronchograms, and trace\nbilateral pleural effusions.  A focal ground-glass opacity in the right upper\nlobe appears grossly unchanged from ___.\n\nThis study is not tailored for assessment of subdiaphragmatic structures.  The\npatient is status post cholecystectomy.  Multiple renal cysts are seen\nbilaterally, and are not fully characterized on this study.  The spleen is\ntop-normal in size.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nCompression deformities of the mid thoracic vertebral bodies appear chronic in\nnature.",
            "output": "Please of the study is limited secondary to respiratory motion artifact.\n\n1.  No evidence of pulmonary embolism to the lobar level.\n2.  Bibasilar consolidative opacities, right greater than left, likely reflect\na combination of atelectasis and respiratory motion, however pneumonia could\nbe considered in the appropriate clinical setting.\n3.  Focus of ground-glass in the right apex is unchanged from ___."
        },
        {
            "input": "Neck/ cardiomediastinum:  The thyroid is unremarkable.  There are no\npathologically enlarged supraclavicular or axillary lymph nodes.  Prevascular\nlymph nodes measure up to 6 mm.  An AP window lymph node measures 7 mm\n(4:115), previously 5 mm.  There is a pericardial lymph node measuring 5 mm,\nnot definitely seen on the prior.  The aorta is normal in caliber.  The main\npulmonary artery is top-normal.  The central pulmonary arteries are without\nfilling defect.  Soft tissue infiltration of the right peritracheal and right\nhilar lymph node stations has substantially decreased since prior, but is\nstill persistent.  The right superior vena cava is widely patent, with much\ndecreased mass effect as compared to prior.  The heart is normal in size.\nThere is a small right-sided pericardial effusion (4:229), which is stable.\n\nLungs/airways:  The bronchial stent begins proximal to the right upper lobe\nbronchus and terminates proximal to the right middle lobe bronchus.  The right\nupper lobe bronchus is patent.  The bronchial stent is predominantly patent. \nThere is minimal soft tissue density layering within the mid and distal\nbronchial stent measuring up to 2 mm, may represent secretions or tumor.  The\nright upper, mid and lower lobe central bronchi have diffusely thickened\nbronchial walls.  There is a 2 mm right upper lobe (4:72) nodule and a right\nlower lobe 3 mm endobronchial soft tissue (4:167) nodule that may represent\nsecretions or tumor.  The right juxta hilar soft tissue mass measures\napproximately 1.0 x 3.3 cm, infiltrating diffusely to the right upper\npara-tracheal lymph node station, right lower paratracheal station and sub\ncarinal stations.  There is a small right pleural effusion, similar in\nappearance to ___.  Juxta right hilar opacity is consistent with\nprior radiation.  Predominately right upper lobe septal thickening may\nrepresent lymphatic obstruction or lymphangitic tumor spread.\n\nAbdomen:  This examination is not tailored for the evaluation of infra\ndiaphragmatic structures.  There is 3 mm pericaval lymph node (4:221).  The\nadrenals are unremarkable.  There is an accessory spleen at the posterior\nmargin (04:302), stable since at least ___.\n\nBones/soft tissues:  There is mild to moderate dextro-scoliosis in the\nthoracic spine.  There are no suspicious lesions for infection or malignancy.",
            "output": "1. Interval placement of bronchus intermedius stent, with proximal portion\ntraversing the origin of the right upper lobe bronchus, and terminal portion\nabove the origin of the right middle lobe bronchus.\n2. Substantial decrease in right hilar mass size and adjacent mass effect on\nthe superior vena cava.  There is still substantial soft tissue infiltration\nwithin the right peritracheal, right hilar and subcarinal lymph node stations.\n3. Right lung nodules, as detailed above.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with NP ___\non the telephone on ___ at 12:10 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "New lymph node enlargement any have developed in the right supraclavicular\nstation.  There is no axillary adenopathy.  Excluding the right breast and the\nleft-sided implant, which require mammography for evaluation, there are no\nsoft tissue lesions in the chest wall suspicious for malignancy.  Findings\nbelow the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck vessels or in the coronaries.  Aorta and the central pulmonary\narteries are normal size and free of filling defects.  Small pericardial\neffusion is minimally larger today than in ___.  There is no pleural\nabnormality.\n\nThe volume of residual, infiltrative, mediastinal nodal tissue, predominantly\nsurrounding the right hilar structures and indenting the posterior wall of the\nleft atrium is stable or slightly smaller.  A solitary, discretely nodular\nprevascular node was 7 mm in diameter in ___, only 5 mm today, 6:96.\n\nThere is no vascular compromise Right bronchial stent has been removed and the\nbronchi are patent.  Bronchiolar nodulation is scattered throughout both\nlungs, unchanged since ___.  These findings can be seen in signet smokers. \nThere are no discrete lung nodules concerning for malignancy.\n\nAlthough no bone lesions in the chest cage suspicious for malignancy it should\nbe noted that radionuclide bone or PET scanning is more sensitive in detecting\nopen metastases than chest CT.",
            "output": "Bronchial tree is patent following removal of right bronchial stents. \nResidual infiltrative the the right hilar and mediastinal adenopathy,\nsubstantially improved since ___ is stable or slightly smaller since\n___.\n\nMild generalized bronchiolitis, often seen in cigarette smokers, unchanged."
        },
        {
            "input": "CARDIOVASCULAR:  The thoracic aorta is normal in caliber with moderate\nscattered atherosclerotic calcifications.  No evidence of aortic dissection. \nThe main, left and right pulmonary arteries are normal in caliber.  No\nincidental central pulmonary embolus.  The heart is normal in configuration\nand size.  A moderate, nonhemorrhagic pericardial effusion has increased from\nthe prior exam; no pericardial nodulation is seen.  No evidence of heart\nstrain or hemodynamic compromise on CT.\n\nMEDIASTINUM, HILA, LYMPH: Amorphous, soft tissue in the lower paratracheal and\nsubcarinal mediastinum--post-treatment residual of adenopathy extending into\nthe right hilum is similar compared to the prior exam (series 4, image 120,\n113, 97).  A 5-mm, round paraaortic node is unchanged (4, image 1 of 2).  No\nleft hilar lymphadenopathy.  No supraclavicular or axillary lymphadenopathy.\n\nPARENCHYMA, AIRWAYS, PLEURA: The airways are patent to at least the\nsubsegmental level.  A right, non-hemorrhagic pleural effusion is small.  No\npneumothorax.  There is mild bronchiectasis in the right lung.  Several\nperipheral nodules all less than 4 mm in the right lung not clearly seen on\nthe previous exam could be new.\n\nSOFT TISSUES AND BONES:  The thyroid is unremarkable.  Surgical clips in the\nleft breast and left axilla indicate prior surgery.  No suspicious lytic or\nsclerotic osseous lesion.  Moderate, broad dextroconvex scoliosis of the lower\nthoracic and levoconvex scoliosis of the cervical thoracic spine are unchanged\nwith associated distortion of the thoracic cage.\n\nLIMITED UPPER ABDOMEN: Mild central hepatic biliary ductal dilatation is\nunchanged from the prior exam.  The patient is status-post cholecystectomy\nwith clips in the gallbladder fossa.  An incidental splenule is unchanged. \nLimited images of the upper abdomen are otherwise unremarkable.",
            "output": "1.  Several, sub-4-mm right pulmonary nodules could be new since ___,\npossible metastases.\n\n2.  Stable post treatment appearance of paratracheal mediastinal and right\nhilar adenopathy.\n\n3.  Persistent, mild bronchiectasis.\n\n4.  Moderate nonhemorrhagic pericardial effusion, increased from the prior\nexam without evidence of heart strain or pericardial nodules, significance\nuncertain.\n\n5.  Small right pleural effusion.\n\n6.  Unchanged mild central biliary ductal dilatation."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  There\nis no pericardial or pleural effusion demonstrated.  No appreciable\nmediastinal hilar or axillary pathologic lymphadenopathy seen.  Image portion\nof the upper abdomen will be reviewed separately is part of the CT abdomen and\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  No new nodules\nmasses are consolidations demonstrated.  Thickening surrounding the right\nhilus is stable as well as multiple pulmonary nodules some of them\ncentrilobular and some of them discrete, series 9, images 91, 122, 145, as\nwell as endobronchial secretions in the right lower lobe, series 9, image 146.\n\nNo a new abnormalities within the chest demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nScoliosis is substantial, unchanged.",
            "output": "Unchanged pulmonary nodules.\n\nStable appearance of paratracheal mediastinal and right hilar lymph nodes with\nno interval increase.\n\nUnchanged bronchiectasis.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.\n\nPreviously seen pericardial effusion has resolved with currently no\npericardial effusion seen and no pleural effusion demonstrated."
        },
        {
            "input": "No supraclavicular or axillary adenopathy.  Patient has had left mastectomy. \nExcluding the breasts, there is no soft tissue abnormality the chest wall\nsuspicious for malignancy.  This study is not appropriate for subdiaphragmatic\ndiagnosis, but shows no adrenal mass.\n\nThere are no thyroid abnormalities warranting further imaging evaluation. \nAtherosclerotic calcification is mild in the head and neck vessels and not\napparent in the coronary arteries.  Small pericardial effusion is unchanged. \nThere is no pleural effusion.  Residual mediastinal adenopathy inseparable\nfrom the right wall of the esophagus at the subcarinal level and extending\nalong the right main bronchus and bronchus intermedius is unchanged.  There is\nno bronchial compromise.  There are no newly enlarged mediastinal nodes.\n\nAorta and pulmonary arteries and cardiac chambers are normal size.\n\n2 mm right upper lobe lung nodule is stable.  There are no new lung lesions. \nMild bronchial wall thickening predominantly in the right lung is unchanged\nand there are no mucoid impactions.  There no bone lesions in the chest cage\nsuspicious for malignancy.  Moderate to severe rotatory scoliosis is\nlong-standing",
            "output": "No evidence of intrathoracic malignancy.  Treated subcarinal mediastinal\nadenopathy stable since ___, previously decreased compared to ___."
        },
        {
            "input": "Post-treatment appearance in the lower paratracheal, pre/subcarinal, and right\nhilar regions are unchanged.  Surgical clips are again noted in the left\naxillary region.  Small pericardial effusion is similar to before.  Thoracic\naorta and main pulmonary artery are normal size.  There is no significant\ncoronary artery calcification.\nPostradiation changes in the adjacent paramediastinal right lung are similar\nexcept for new peribronchial ground glass opacity in the superior segment of\nright lower lobe (7:146).  This finding in setting of right sided intraluminal\nairway secretions probably reflects aspiration.  A nonspecific apparently\ngrowing nodule in the left lingula (7:179) was 2 mm in ___.\n\nPlease see separate report for CT abdomen and pelvis obtained at the same time\nfor abdominal findings.  No suspicious bone lesion is identified.  Left\nmastectomy changes are stable.",
            "output": "1. Focal new peribronchial ground glass opacity in the superior segment of\nright lower lobe within radiation port.  In the setting of intraluminal\nsecretions in the airways, this probably reflects localized aspiration. \nAttention to this region on the next scheduled surveillance CT is recommended\nto ensure resolution.  A 3 mm lingular nodule may also be reassessed at that\ntime.\n2. Posttreatment changes in the mediastinal and right hilar regions are\nunchanged."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Post left mastectomy and axillary\nclearance changes.  No new gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Mediastinal soft tissue (4, 83) appears similar compared to prior\nimaging.  No new or enlarging mediastinal adenopathy.\n\nHILA: Right perihilar soft tissues (4, 88) is slightly more prominent compared\nto the most recent prior study (___) but appears similar compared to\nstudy done ___.\n\nHEART and PERICARDIUM: Small sub pericardial pleural effusion is unchanged. \nMild aortic annular calcification.  Minimal LAD calcification unchanged.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Scarring involving in the right perihilar pulmonary parenchyma\nis unchanged.  No new or enlarging pulmonary nodules or masses.\n-AIRWAYS:  Patent to the subsegmental level.  Retained secretions in the right\nlateral aspect of the trachea (2, 15) and anterior aspect of the cervical\ntrachea (2, 7).  Thickening of the posterior wall of the left main bronchus\nand bronchus intermedius (4, 88) is slightly more prominent compared to\nprevious imaging, but this may be positional in nature.\n-VESSELS:  The pulmonary arteries not enlarged.  No filling defects.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  Scoliotic deformity of\nthe spine.  No lytic/destructive bony lesions.",
            "output": "There is no definitive evidence of disease recurrence.\n\nEquivocal increase in the amount of soft tissue present anterior to the right\nhilus and along the posterior wall of the right main bronchus and right\nbronchus intermedius since ___ could potentially be due to technical\ndifferences between the scans as a similar appearance was present on an\nearlier CT in ___.  Recommend continued close monitoring of this region\nat the next scheduled surveillance CT.\n\nFor abdominal findings please refer to abdominal CT report."
        },
        {
            "input": "As compared to the previous examination, the right hilar soft tissue\nstructures ventral to the right main bronchus (2, 23) are stable.  The small\nsoft tissue band dorsal to the bronchus are also stable.  At the level of the\nmiddle lobe bronchus, the soft tissue material surrounding the airways\ncontinues to be unchanged.  Mediastinal lymph node morphology is stable. \nStable postsurgical left-sided chest wall morphology (2, 25).  Severe\nscoliosis continues to be present.  No evidence of osteolytic lesions. \nMinimal apical scarring.  Postradiation changes in the right lung apex (4,\n23).  Stable peribronchial right upper lobe scarring and bronchial wall\nthickening (4, 75).  The signs of mucous airway retention have decreased,\nthere is a newly appeared small polypoid lesion (4, 90) in the right main\nbronchus.  The postradiation scarring at the level of the right lower lobe (4,\n118) is stable.  No pleural effusions.",
            "output": "No evidence of disease progression on the right.  However, there is a new\nsmall polypoid endoluminal right main bronchus lesion, that should be followed\nin 3 months, to exclude endobronchial recurrence."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is normal.  No appreciable coronary\ncalcification.  The thoracic aorta is normal in caliber.  Aortic arch and\ngreat vessel origin calcifications are mild.  Incidental note is made of a\ncommon origin of the left common carotid and innominate arteries.  The main\npulmonary artery is normal in caliber.  Trace pericardial fluid is within\nphysiologic limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Surgical clips are seen in\nthe left axilla and left chest wall.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild biapical scarring.  Unchanged thickening at right mainstem\nbronchus bifurcation. No evidence of a discrete endobronchial lesion.  Soft\ntissue thickening encasing the carina, mainstem bronchus, proximal left upper\nlobe bronchus, and bronchus intermedius is unchanged since ___, at\nwhich point it had improved compared to the most recent priors.  Perihilar\npost radiation changes including scarring and bronchiectasis, predominantly\nsuperior segment right lower lobe, are unchanged.  A 3 mm right upper lobe\npulmonary nodule is unchanged since ___.  No new or enlarging pulmonary\nnodules.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Please refer to separate report for same-day CT abdomen/pelvis for\ndescription of the abdominal findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThoracic scoliosis..",
            "output": "1. Soft tissue thickening at the right mainstem bronchus bifurcation appears\nunchanged over multiple prior examinations, best appreciated in the coronal\nplane.  Findings on the most recent CT probably appeared more conspicuous as a\nconsequence of volume averaging.\n2. No evidence of progressing malignancy.  Soft tissue encasing the carina and\nproximal right bronchi is unchanged since ___ following treatment. \nThe bronchi and pulmonary arteries are marginated, but not compromised."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings.  Supraclavicular and axillary lymph\nnodes are not enlarged.  Specifically excluding the breasts which require\nmammography for evaluation (patient appears to have had left mastectomy and\nreconstruction), there are no soft tissue abnormalities elsewhere in the\nimaged chest wall concerning for malignancy.  Findings below the diaphragm\nwill be reported separately.\n\nMEDIASTINUM:Esophagus is mildly patulous superiorly and marginated by residual\nsubcarinal adenopathy but not clearly invaded or obstructed.\n\nAtherosclerotic calcification is not apparent head neck vessels, and mild in\nat least left anterior descending coronary artery.  Aortic valve is not\ncalcified.  Aorta and pulmonary arteries are not enlarged and subject to the\nlimitations of this study free of filling defects.  Anterior and posterior\nsegmental branches of the right upper lobe pulmonary artery traverse residual\nright hilar adenopathy but are not narrowed.\n\nSmall pericardial effusion is slightly larger but not necessarily pathologic. \nNo infiltration of epicardial fat or any evidence of cardiac tamponade.\n\n\n\nTHORACIC LYMPH NODES: There is no new or growing intrathoracic adenopathy. \nResidual infiltrative adenopathy or mediastinal tumor starting in the right\nlower paratracheal station, marginating the carina, right main bronchus and\nright wall of the esophagus is unchanged.\n\n\n\nLUNGS, AIRWAYS, PLEURAE: Mild right perihilar fibrosis in the right upper lobe\nand superior segment of the right lower lobe is unchanged.  There are no lung\nnodules or other focal lung lesions of consequence.\n\nNo pathologic or compression fractures or destructive bone lesions.  Although\nthere are no bone lesions in the imaged chest cage suspicious for malignancy\nor infection, it should be noted that radionuclide bone and FDG PET scanning\nare more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of active intrathoracic malignancy.  Post treatment residual\ntumor/adenopathy, right hilus and adjacent mediastinum unchanged.  Right main\nbronchus and esophagus are marginated by tumor but not clearly invaded or\ncompromised."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  Left breast\nreconstruction noted.  Breast evaluation is reserved for mammography. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mid esophagus is patulous at a level of persistent to the\ninfiltrative adenopathy.  It does not appear obstructed.\n\nAtherosclerotic calcification is not apparent in the head neck vessels, but is\npresent in at least left anterior descending coronary artery.  Minimal\npericardial effusion is stable.  There is no calcification or infiltration of\nepicardial fat or evidence of tamponade physiology.\n\nTHORACIC LYMPH NODES: Residual treated, infiltrative mediastinal adenopathy\nencasing the lower trachea below the level of the aortic arch extending along\nthe right main bronchus and into the subcarinal station, inseparable from the\nlocally patulous esophagus is unchanged.\n\nPeribronchial infiltration at the lower pole of the right hilum at the level\nof previous radiation has progressed, compare 6:139 today with 6:144 in\n___.\n\nThere is no new adenopathy or definite compromise of vital structures.  Lymph\nnodes elsewhere in the chest are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Bronchiolar micro nodulation has developed in the\nleft upper lobe.  This can be seen in cigarette smokers or patients with\nsevere allergies.\n\nThere are no discrete lung lesions of consequence.\n\nBronchial wall thickening right lower lobe is continuous with possible\nrecurrence right hilar adenopathy.\n\nThere is no pleural abnormality.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "New infiltrative tissue lower pole right hilus could be local nodal\nrecurrence.\n\nBronchiolar inflammation, particularly left upper lobe can be seen in\ncigarette smokers or due to allergies.\n\nMild atherosclerotic coronary calcification."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Redemonstration of post treatment changes with\ninfiltrative mediastinal adenopathy that encases the lower trachea near the\ncarina.  A soft tissue nodule along the right epicardium (series 5, image 27)\nmeasures 1.1 cm in the short axis and is new from prior.  No discrete left\nhilar lymphadenopathy.  No axillary or supraclavicular lymphadenopathy.\n\nPLEURAL SPACES: There is a small, low-density right pleural effusion. Patchy\nareas of enhancement are seen along the right inferior pleura, within the area\nof the effusion (series 5, image 34).  No left pleural effusion demonstrated. \nNo pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse opacification of the inferior right upper\nlobe, right middle lobe and right lower lobes.  Heterogeneous enhancement is\ndemonstrated diffusely, with relatively increased enhancement centrally. \nNodular opacities in ground-glass are seen throughout the remaining\nnon-opacified right upper lobe.  There is collapse of the right middle lobe\nand partial collapse of the right lower lobe.  Tracheal deviation toward the\nright appears unchanged from ___.  There is compression and\nnonvisualization of the distal airways most prominently in the right bronchus\nintermedius right middle and lower lobar branches.  The trachea is clear.  The\nleft lung airway is intact.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Redemonstration of a patulous esophagus.  Please see dedicated\nabdominal/pelvic CT report for full description of intra-abdominal findings.\n\nBONES/SOFT TISSUES: No suspicious osseous abnormality is seen.? There is no\nacute fracture.  Status post left breast reconstruction and left axillary\ndissection.",
            "output": "1. Interval opacification of the entire right lower, right middle and much of\nthe right upper lobe, with nodular opacification, irregular intra and\ninterlobular septal thickening and ground-glass throughout the remaining\naerated right upper lobe is concerning for lymphangitic spread of the known\nmalignancy with mass effect on the right-sided airway. Enhancement in a\ncentral distribution throughout the lung and along the pleura inferiorly are\nconcerning for possible underlying mass.\n2. New soft tissue nodule along the right epicardium.\n3. Atelectatic collapse of right middle lobe, with mild collapse of the right\nlower lobe."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  Numerous\nmediastinal lymph nodes are noted, including a 15 mm subcarinal lymph node\n(3:101).  There is also left hilar lymphadenopathy measuring up to 12 mm\n(3:91).  Right hilar lymph nodes are not well seen due to adjacent\nconsolidated lung.\n\nPLEURAL SPACES: Moderate right pleural effusion, increased from prior.  No\nleft pleural effusion.\n\nLUNGS/AIRWAYS: There is complete opacification of the right middle and lower\nlobes as before, with mass effect upon the right middle and lower lobe\nbronchus.  Overall, the appearance is slightly worsened in comparison with 1\nmonth prior.  In addition, there is extensive interlobular septal thickening\nwhich is nodular in appearance extending into the right upper lobe concerning\nfor lymphangitic spread of tumor.  It is difficult to see a discrete mass.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Numerous hepatic metastases appear increased in both size and number.\nBulky retroperitoneal lymphadenopathy is partially imaged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Re-demonstrated ill-defined right hilar mass producing mass effect upon the\nright middle and lower lobes, with complete opacification of both of these\nlobes.  Re-demonstrated nodular interlobular septal thickening in the right\nupper lobe concerning for lymphangitic tumor spread, as before.  Moderate\nright pleural effusion, increased from prior.  It is difficult to exclude\nsuperimposed postobstructive infection.\n3. Increasing hepatic metastases.  Re-demonstrated retroperitoneal bulky\nlymphadenopathy."
        },
        {
            "input": "CHEST:  The imaged base of neck is unremarkable.  A Port-A-Cath is seen in the\nright chest wall with catheter tip extending into the right atrium.  Thoracic\naorta contains mild atherosclerotic calcifications.  The heart is normal in\nsize and shape without pericardial effusion.  The main pulmonary artery is\nnormal in caliber with patent central branches.  There is malignant soft\ntissue encasement of the lower trachea and right mainstem bronchus again\nnoted.\n\nThere is interval improvement in aeration within the right lower lobe and\nright middle lobe though there is persistent consolidation in the right lower\nlobe and in the perihilar region likely representing known malignancy.  Also\nnoted is interstitial nodular thickening concerning for lymphangitic\ncarcinomatosis with slight improvement in overall extent compared with most\nrecent prior exam.  The left lung remains clear.  Right pleural effusion is\nmoderate in size and appears slightly loculated.\n\nPlease refer to separately dictated CT abdomen pelvis for findings below the\ndiaphragm.\n\nBONES:  Dextroscoliosis of the thoracic spine noted.  No fracture or evidence\nof lytic or blastic osseous lesion.  Surgical clips are noted in the left\naxilla.",
            "output": "1.  Improved aeration of the right lung with persistent right perihilar and\nlower lobe opacities concerning form known malignancy.  Lymphangitic\ncarcinomatosis within the right lung appears slightly improved.\n2.  Persistent moderate right effusion, partially loculated.\n\nPlease refer to separately dictated CT abdomen pelvis for findings below the\ndiaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nA right chest wall port is in place with its tip in the low right atrium. \nSurgical clips are again noted in the left axilla.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Soft tissue surrounding\nthe lower trachea and right mainstem bronchus is not changed compared to the\nprior exam.\n\nHEART and PERICARDIUM: The heart is normal in size, without pericardial\neffusion.\nPLEURA: A moderate right pleural effusion with loculation is not significantly\nchanged since ___.  There is no pneumothorax.\n\nLUNG: Consolidation in the right lower lobe and right perihilar region is\nunchanged compared to the prior exam.  Small nodular opacities in the right\nlower lobe concerning for lymphangitic carcinomatosis are not significantly\nchanged.  The overall aeration of the right lung is also similar to the prior\nexam.  The left lung is clear.\n\nHEPATOBILIARY: The hypodense metastatic lesion in segment 4 of the liver is\nincreased in size, now measuring 2.3 cm (5: 16), previously 1.6 cm.  A 1.9 cm\n(5:16) hypodense metastatic lesion in segment 7 of the liver has also\nincreased in size, previously measuring 1.2 cm.  The hypodense lesion in\nsegment 6 is also increased slightly in size, now measuring 0.8 cm (05:31),\npreviously 0.7 cm.  No new hepatic lesions are identified.  The gall bladder\nis surgically absent.  Mild intra and extrahepatic biliary duct dilatation is\nsimilar to the prior exam.\n\nSPLEEN: The spleen is normal in size, and enhances homogeneously, without\nevidence of focal lesion.\n\nPANCREAS: The pancreas demonstrates homogeneous enhancement throughout, with\nno evidence of focal lesion.  There is no pancreatic ductal dilatation.  There\nis no peripancreatic stranding.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys are normal in size and enhance symmetrically.  There is\nno focal renal lesion or evidence of hydronephrosis.\n\nPELVIC ORGANS: The urinary bladder and distal ureters are unremarkable.  The\nuterus is normal.  There is trace free fluid in the pelvis.\n\nGI TRACT: The bowel is normal in course and caliber, without evidence of\nobstruction.\n\nLYMPH NODES: Retroperitoneal lymphadenopathy continues to decrease.  For\nexample, the previously described aortocaval lymph node has decreased in size,\nnow measuring 0.5 cm (05:30), previously 1.2 cm.\n\nBONES: Sclerotic lesions in the left ischium and left sacral ala are unchanged\n(5: 54, 76).  There are multilevel degenerative changes in the spine.\n\nSOFT TISSUES: The right abdominal rectus muscles were previously harvested.",
            "output": "1.  No significant change in thoracic findings, with right lower lobe and\nright hilar consolidation likely representing known malignancy.\n2.  Interval increase in size of known hepatic metastases.  No new metastatic\nlesions are identified.\n3.  Interval decrease in retroperitoneal lymphadenopathy.\n4.  No change in sclerotic foci in the left ischium and left sacral ala."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nA right chest wall port is in place with its tip in the low right atrium. \nSurgical clips are again noted in the left axilla.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Soft tissue surrounding\nthe lower trachea and right mainstem bronchus is not changed compared to the\nprior exam.\n\nHEART and PERICARDIUM: The heart is normal in size, without pericardial\neffusion.\nPLEURA: A moderate right pleural effusion with loculation is not significantly\nchanged since ___.  There is no pneumothorax.\n\nLUNG: Consolidation in the right lower lobe and right perihilar region is\nunchanged compared to the prior exam.  Small nodular opacities in the right\nlower lobe concerning for lymphangitic carcinomatosis are not significantly\nchanged.  The overall aeration of the right lung is also similar to the prior\nexam.  The left lung is clear.\n\nHEPATOBILIARY: The hypodense metastatic lesion in segment 4 of the liver is\nincreased in size, now measuring 2.3 cm (5: 16), previously 1.6 cm.  A 1.9 cm\n(5:16) hypodense metastatic lesion in segment 7 of the liver has also\nincreased in size, previously measuring 1.2 cm.  The hypodense lesion in\nsegment 6 is also increased slightly in size, now measuring 0.8 cm (05:31),\npreviously 0.7 cm.  No new hepatic lesions are identified.  The gall bladder\nis surgically absent.  Mild intra and extrahepatic biliary duct dilatation is\nsimilar to the prior exam.\n\nSPLEEN: The spleen is normal in size, and enhances homogeneously, without\nevidence of focal lesion.\n\nPANCREAS: The pancreas demonstrates homogeneous enhancement throughout, with\nno evidence of focal lesion.  There is no pancreatic ductal dilatation.  There\nis no peripancreatic stranding.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys are normal in size and enhance symmetrically.  There is\nno focal renal lesion or evidence of hydronephrosis.\n\nPELVIC ORGANS: The urinary bladder and distal ureters are unremarkable.  The\nuterus is normal.  There is trace free fluid in the pelvis.\n\nGI TRACT: The bowel is normal in course and caliber, without evidence of\nobstruction.\n\nLYMPH NODES: Retroperitoneal lymphadenopathy continues to decrease.  For\nexample, the previously described aortocaval lymph node has decreased in size,\nnow measuring 0.5 cm (05:30), previously 1.2 cm.\n\nBONES: Sclerotic lesions in the left ischium and left sacral ala are unchanged\n(5: 54, 76).  There are multilevel degenerative changes in the spine.\n\nSOFT TISSUES: The right abdominal rectus muscles were previously harvested.",
            "output": "1.  No significant change in thoracic findings, with right lower lobe and\nright hilar consolidation likely representing known malignancy.\n2.  Interval increase in size of known hepatic metastases.  No new metastatic\nlesions are identified.\n3.  Interval decrease in retroperitoneal lymphadenopathy.\n4.  No change in sclerotic foci in the left ischium and left sacral ala."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  No suspicious lung nodules or\nmasses.  No consolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nFindings.",
            "output": "Unremarkable chest CT."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Right anterior port with\ntip in the lower SVC.  No atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta cardiac valves.\nThe pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  No suspicious lung nodules or masses.  No\nconsolidations.  Mild linear atelectasis in the lingula.\n\nCHEST CAGE:\nMild dorsal spondylosis.  No acute fractures.  No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show unchanged hypodense nodule in\nthe right hepatic lobe showing peripheral enhancement (5:260), likely a\nhemangioma.",
            "output": "No interval changes compared to prior study of ___ with no evidence\nof intrathoracic metastatic disease."
        },
        {
            "input": "HEART AND VASCULATURE: Right chest wall Port-A-Cath terminates in the right\natrium.  Pulmonary vasculature is well opacified to the segmental level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is a small amount of bibasilar atelectasis.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for hypodense\nnodule in the right hepatic lobe showing peripheral enhancement (2:82), likely\na hemangioma, similar to ___.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  There is a right-sided central line with its tip\nin the cavoatrial junction\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  Aorta and pulmonary arteries\nare normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Lungs are well expanded.  No lung nodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nlesion in the right lobe of liver.",
            "output": "No evidence of metastasis to the chest.\n\nRight-sided Port-A-Cath with its tip in the cavoatrial junction\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "THORACIC INLET: There is a right-sided Port-A-Cath with its tip in the SVC. \nThe thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper are also unremarkable. \nPlease refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "No evidence of metastasis to the chest.\n\nRight-sided Port-A-Cath with its tip in the SVC.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  No pathologically enlarged\nmediastinal, supraclavicular, axillary or hilar lymph nodes demonstrated.\n\nEsophagus is fluid filled but not distended with no mass demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nCentral venous line tip terminates in lower SVC.\n\nImaged portion of the upper abdomen reveals no appreciable abnormality within\nthe limitations of the study technique that was not designed for assessment of\nintra-abdominal pathology.",
            "output": "Normal chest CT."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is moderate coronary artery calcification.  No pericardial\neffusion seen.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is a new focal ground-glass opacity in the left lower lobe, new\nsince the prior study.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.  Bones are osteopenic.  Please refer to dedicated\nreport on MRI of the spine done on the same day regarding details on the\nmarrow.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Focal parenchymal opacity in the left lower lobe is new since the prior study,\ncould be inflammatory or could be related to radiation therapy.\n\nPlease refer to dedicated report on MR of the spine regarding details on the\nbones."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmild coronary artery calcification.  There is no pericardial effusion.  The\naorta and pulmonary arteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: A focal patchy parenchymal opacity adjacent to an osteophyte in the\nright lower lobe medially (5, 199) is new since the prior study.  This could\nrepresent a radiation pneumonitis.  Patient has had radiation therapy to the\nlumbar spine.  The parenchymal opacity extends along the right side of the\nthoracic spine.  No new or growing pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with mild degenerative\nchanges involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows fatty\ninfiltration of the liver.  No adrenal masses are seen.",
            "output": "New ground-glass opacification in the right paraspinal region along the right\nlower lobe, could be secondary to radiation therapy.\n\nNo new or growing pulmonary nodules.\n\nFatty liver\n\nStatus post laminectomy in the lumbar spine."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are enlarged right hilar (series 3; image\n86) and right paratracheal lymph nodes (series 3; image 62) measuring up to 15\nmm, likely reactive.  No axillary lymphadenopathy.  No mediastinal mass. \nThere is a moderately sized hiatal hernia.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a large, 4.1 x 2.8 cm homogeneous consolidation\n(series 3; image 88) with air bronchograms in the right lower lobe. \nAdditionally, there is a consolidative opacity with surrounding ground-glass\nin the right middle lobe (series 3; image 106).  Additional, more inferior\nconsolidations are seen in the right lower lobe.  An additional consolidative\nopacities seen in the left lower lobe (series 2; image 71).\n\nThe central airways are clear.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  There is a\nleft posterior Bochdalek's diaphragmatic hernia, which contains only fat.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Multifocal opacities most likely reflecting multifocal pneumonia. \nFollow-up chest CT in 3 months is recommended to ensure resolution.\n\nRECOMMENDATION(S):  Recommend follow-up chest imaging in ___ weeks to ensure\nresolution of consolidative opacities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a an 11 mm hypodense\nnodule in the inferior right lower lobe of the thyroid which does not require\nfurther imaging workup per ACR recommendations.  There is no supraclavicular\nor axillary lymphadenopathy.  Please note that evaluation of the breast tissue\nis reserved exclusively for dedicated breast imaging such as mammography. \nPost median sternotomy. Sternal wires are intact and aligned. The soft tissues\nof the chest wall are otherwise unremarkable.  There is a small fat containing\nsuperior midline abdominal wall hernia.\n\nUPPER ABDOMEN: There is a small left Bochdalek hernia and a small hiatal\nhernia.  The imaged upper abdomen is otherwise unremarkable.\n\nMEDIASTINUM: AP window lymph node measures 11 mm in short axis.  There are\nmultiple prominent prevascular lymph nodes which have increased slightly in\nsize compared to prior, with the superior-most node measuring 10 mm in short\naxis and other nodes measuring up to 6 mm.  Pretracheal lymph node is\nunchanged in size and appears benign.\n\nHILA: Lack of contrast limits evaluation for small hilar lymph nodes.  Right\nhilar lymph node previously measuring 11 mm appears grossly similar to prior.\n\nHEART AND VESSELS: Post CABG appearance of the heart is as expected.  No\nevidence of pericardial effusion. The main pulmonary artery and thoracic aorta\nare not enlarged.  There is mild aortic atherosclerosis.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\nThere is a left upper lobe likely Pancoast tumor which is uncertain in size\nbecause of the lack of IV contrast and surrounding left upper lobe atelectasis\nmedially and at the apex.  Atelectasis is also seen along the major fissure in\nthe left upper lobe in the perihilar region..  The tumor appears to invade the\nmediastinum superior to the aortic arch, contacting the aortic arch and the T2\nvertebral body and second third costovertebral joints.  There is no fat plane\nbetween soft tissue and a significant portion of the left subclavian artery,\nraising concern for its involvement..  There is dependent atelectasis\nbilaterally and linear atelectasis of the right lower lobe.  3 mm right lower\nlobe nodule was not well seen previously, though there was pneumonia in this\narea (3:65).  3 mm perifissural nodule in the left lung apex is new too\n(3:23).\n\nCHEST CAGE: No acute fractures are identified.  No lytic or osteoblastic bone\nlesions are identified.",
            "output": "Likely left upper lobe Pancoast tumor that appears to invade the upper\nmediastinum to the level of T2, the aortic arch, and the left subclavian\nartery.  Recommend non-urgent MRI chest without and with contrast to establish\nextent of invasion.\n\nEnlarged upper mediastinal lymph nodes concerning for nodal involvement.\n\n2 small pulmonary nodules that attention can be paid to on follow-up.\n\nRECOMMENDATION(S):  Recommend nonurgent MRI without with contrast of the chest\nto establish extent of left upper lobe Pancoast tumor.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:31 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The mediastinal lymph nodes have significantly decreased in size\nand were reactive.  Heart size is normal.  There is no pericardial effusion. \nThe aorta and pulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Previously visualized left upper lobe consolidation has significantly\nimproved with minimal residual opacities along the mediastinal surface of the\npleura and most likely represents a resolving inflammatory process.  Follow-up\nto complete resolution in 3 months is recommended.  No new consolidations or\nnodules\n\nBONES AND CHEST WALL : Review of bones is unremarkable.  Sternal sutures are\nintact.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hiatus\nhernia.  No adrenal masses are seen.  There is a left-sided Bochdalek's hernia",
            "output": "Significant improvement in the consolidation in the left upper lobe with\nminimal residual linear opacities in the left outer upper lobe along the\nmediastinal surface of the pleura which most likely represents a resolving\ninflammatory process.\n\nFollow-up to complete resolution in ___ months is recommended.\n\nDecrease in size of the mediastinal lymph nodes which were reactive.\n\nModerate-sized hiatus hernia.\n\nLeft-sided fat containing Bochdalek's hernia."
        },
        {
            "input": "Small right axillary lymph nodes are numerous, but no lymph nodes in the\nsupraclavicular or axillary stations are pathologically enlarged and there is\nno soft tissue abnormality in the chest wall suspicious for malignancy.  This\nstudy is not there are no thyroid lesions warranting further imaging\nevaluation.  Atherosclerotic calcification is not apparent head neck vessels\nor coronary arteries.  Aorta and pulmonary arteries and cardiac chambers are\nnormal size.  Pericardium is physiologic.\n\nThere is no appreciable pleural effusion.  Lower esophagus is appropriate for\nsubdiaphragmatic diagnosis, but shows no adrenal mass mild to moderate\ndistension of the esophagus at multiple levels suggests that the esophagus is\npatulous and may have a motility disorder, but there is no appreciable\nretention of food material.\n\nOther than a solitary 11 mm left hilar lymph node, 5:152, mediastinal and\nhilar lymph nodes are not enlarged.\n\nSoft tissue pleural thickening of the right posterior costal pleural surface,\nextending into the right major fissure, 5:112 is contiguous with one of many\nblastic metastases, presumably local pleural tumor invasion.  There is a\nsecond probable pleural deposit long the right diaphragmatic pleural surface,\n5:296, and other very small regions, along the right anterior and left lateral\ncostal pleural surfaces, 5:316.\n\nThere are no lung nodules or evidence of active infection.  Small collection\nof aspirated barium is present at the left lung base.\n\nDespite extensive blastic metastases throughout the chest cage, there is no\npathologic or compression fracture.",
            "output": "Multiple small pleural tumor deposits related to local invasion of extensive\nblastic metastases throughout the chest cage.  No appreciable pleural\neffusion.\n\nNo lung lesions.\n\nSolitary borderline enlarged left hilar lymph node, significance\nindeterminate."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Mild dilatation of the esophageal wall. \nNo esophageal wall thickening.  Mild coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The posterior mediastinum is\nunremarkable.  The upper abdomen is reported in detail in the dedicated\nabdominal CT report.  Massive predominantly sclerotic metastatic disease to\nthe bones, involving all visible bony structures.  Mild bilateral apical\nscarring.  Minimally calcified pleural plaques at the level of the right apex\n(6, 71).  Moderate pleural thickening on the right (6, 119). 2 mm middle lobe\nperifissural nodule (6, 257).  Small calcified left lower lobe parenchymal\nscar (6, 304).",
            "output": "Massive generalized metastatic bone disease.  Several right areas of pleural\nthickening.  No suspicious lung nodules or masses."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, : Thyroid is unremarkable.  0.8 cm right\nsupraclavicular lymph node is minimally larger (06:23).  In the right axilla\n1.5 x 1.9 cm lymph node is significantly larger since prior, when measures 0.4\ncm (6:86).\n\nCHEST WALL and CHEST CAGE: The skeleton is extensively involved by numerous\nsclerotic metastasis, and is mildly worse in comparison to prior, there are no\npathologic compression fractures.\nSoft tissue surrounds the right ___ costochondral junction and sternal\nmetastatic lesion has increased since prior (6:210).\nThe soft tissue around the right sixth rib metastatic lesion is grossly\nunchanged.\n\nUPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: Mediastinal lymphadenopathy is significantly worse in comparison\nto prior, prevascular 1.3 cm lymph node in prior millimetric (6:129),\nsubcarinal 1.3 cm lymph node is also larger (6:1066).  Right internal mammary\n1 cm lymph node is new.\n\nIn the posterior mediastinum extensive lymphadenopathy is significantly worse\nsince prior including the paravertebral soft tissue metastatic deposits\nmeasuring up to 3.5 x 1.7 cm in the right paravertebral stations (6:101), or\n1.6 x 2.6 cm the left (6:201).  Periaortic lymph nodes measure 1.2 x 2.1 cm\n(6:221).\nSome of the paravertebral metastatic deposits narrow and possibly penetrate\nthe spinal canal, for example series 6, image 101.\n\nHEART and PERICARDIUM: Heart is normal in size.  Trace pericardial effusion\nminimally increased.  Specks of calcifications in the coronaries.  Thoracic\naorta is normal in diameter.  Main pulmonary artery is normal diameter with no\nevidence of central pulmonary embolism in this nondedicated study.\n\nLUNG and PLEURA:  Airways are patent to the subsegmental level.\nMultiple pleural based metastasis are new since prior for example on the left\nseries 6:173, on the right image 191 and the small bilateral pleural effusion,\nright greater the left is new.  Multiple new micro nodules along the fissures\nsuggest additional pleural seeding (6:268, 263, 237 for example).\nno masses identified in the lungs.",
            "output": "-Progression includes new mediastinal lymphadenopathy, pleural seeding with\nnew bilateral pleural effusions and worse skeletal metastatic involvement.\n-Soft tissue surrounds the right ___ costochondral junction and sternal\nmetastatic lesion has increased since prior and are likely responsible for the\nanterior chest wall pain.\n-Narrowing with suspected invasion of the right T5-6 neural foramina for\nfurther evaluation by MRI.\n\nRECOMMENDATION(S):  MRI of the thoracic spine"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.8 cm right supraclavicular lymph\nnode is stable (03:30).  In the right axilla 1.5 x 1.2 cm hyperenhancing lymph\nnode, in prior 1.5 x 1.9 cm (3:75). Thyroid is unremarkable.\n\nCHEST WALL and CHEST CAGE: The skeleton is extensively involved by numerous\nsclerotic metastasis,  essentially unchanged in comparison to prior (reference\nlevels are 602:50 on today's study, 09:39 on ___.  There are no\npathologic compression fractures.\nSoft tissue paravertebral  deposits are essentially unchanged (3:121, 100,). \nThe soft tissue around the right sixth rib deposit is grossly unchanged as\nwell.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymphadenopathy is unchanged in comparison to ___, although increased in comparison to ___.  Examples of\nstability include prevascular 1.3 cm lymph node (3:106), subcarinal 1.5 x 2.2\ncm lymph node (3:133).  Right internal mammary 1 cm lymph node is stable as\nwell.\n\nIn the posterior mediastinum extensive soft tissue deposits essentially\nunchanged in comparison to ___, although worse in comparison to ___.  Examples include paravertebral soft tissue deposits measuring up to 3.5\nx 1.7 cm in the right paravertebral stations (3:83), or 1.6 x 2.6 cm the left\n(3:163).\nPeriaortic lymph nodes measure 1.2 x 2.1 cm (3:179).  Some of the\nparavertebral deposits narrow and possibly penetrate the spinal canal,\nunchanged, for example series 3, image 82.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is a small stable\npericardial effusion.  Scattered calcifications in the coronaries.  Main\npulmonary artery is normal in caliber and there is no evidence of incidental\ncentral filling defects.\n\nPLEURA and LUNG: Tracheobronchial tree is patent to the segmental level. \nRight moderate layering pleural effusion has increased in comparison to prior,\nwith subsequent compressive atelectasis.  Left small layering pleural effusion\nis larger as well.\nMultiple pleural deposits are re-demonstrated, essentially unchanged (3:121\nfor example).  Nodularity along the fissures suggest additional pleural\nseeding (3:215, 209, 186 for example).\nNo masses in the lungs.",
            "output": "-Extensive metastatic disease including multiple sclerotic skeletal\nmetastasis, mediastinal lymphadenopathy and pleural metastasis are essentially\nunchanged, there are no pathologic compression fractures.  Bilateral pleural\neffusions, right moderate, left small are mildly increased.\n-Multiple paravertebral metastatic deposits have unchanged but could be\nextrapleural hematopoiesis. Narrowing with suspected invasion of the right\nT5-6 neural foramina is re-demonstrated.  For further evaluation by MRI as\nclinically indicated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is extensive supraclavicular\nand axillary lymphadenopathy, most prominent on the right with largest\nsupraclavicular lymph node measuring 1.0 cm in short axis (series 302; image\n40) and largest axillary lymph node measuring up to 1.4 cm in short axis on\nthe right (series 301; image 73).  These findings are minimally progressed\ncompared to prior.  Visualized thyroid gland is unremarkable.\n\nUPPER ABDOMEN: Multiple liver hypodensities are noted, measuring up to 1.5 cm\nin segment ___, which are new compared to ___ and concerning for new\nmetastatic disease.  Otherwise, visualized upper abdomen is without acute\npathology.\n\nMEDIASTINUM: Mediastinal lymphadenopathy has worsened compared to prior, with\nlargest lymph node measuring up to 1.2 cm in short axis (series 302; image\n114), concerning for worsening metastatic disease.\n\nHILA: There is bilateral hilar lymphadenopathy, measuring up to 1.1 cm in the\nleft hilus (series 302; image 136).  These findings are more prominent\ncompared to prior exam.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is some evidence of\ncoronary artery calcification.  There is a small, serous pericardial effusion.\n\nPLEURA: There is a large right and moderate left pleural effusion, which\nappears serous in nature.  Pleural effusions are increased in size compared to\n___.  There is no pneumothorax.  Multiple pleural metastatic deposits\nare again noted, similar compared to prior.  Nodularity along the pleural\nfissures (for example series 302; image 195 on the left) is suggestive of\nadditional pleural seeding.\n\nLUNG:\n\n1. PARENCHYMA:  No masses are identified in the lungs.  There is nodular\ninterlobular septal thickening concerning for underlying lymphangitic spread. \nHyperdense material at the bilateral lung bases is concerning for prior\naspiration events.\n2. AIRWAYS:  Airways remain patent to the segmental level.\n3. VESSELS:  Pulmonary arteries are normal in size.\nCHEST CAGE: Widespread sclerotic osseous metastases are again seen, not\nsignificantly changed compared to prior.  No compression deformity or acute\nfracture is identified within the bony thorax.  Paravertebral soft tissue\nlesions are grossly unchanged as well as a soft tissue mass involving the\nright posterior sixth rib.",
            "output": "1. Widespread sclerotic osseous metastases, not significantly changed compared\nto prior.  No acute fracture is noted within the bony thorax.\n2. Worsening supraclavicular, axillary, mediastinal, and hilar\nlymphadenopathy, concerning for worsening metastatic disease.\n3. Multiple liver hypodensities are seen, all of which are new compared to\n___, measuring up to 1.5 cm in segment ___.  These findings are\nincompletely characterized on today's exam, but are highly concerning for new\nmetastatic disease.  Further evaluation can be performed by contrast enhanced\nCT exam on a nonemergent basis.\n4. Interval increase in now large right and moderate left pleural effusions. \nPleural thickening and nodularity as well as paravertebral soft tissue lesions\nare difficult to compare to prior exam, but overall appear grossly stable.\n5. No pulmonary masses are identified.  There is nodular interlobular septal\nthickening concerning for underlying lymphangitic spread.\n\nRECOMMENDATION(S):  Multiple liver hypodensities are seen, all of which are\nnew compared to ___, measuring up to 1.5 cm in segment ___. These\nfindings are incompletely characterized on today's exam, but are highly\nconcerning for new metastatic disease. Further evaluation can be performed by\ncontrast enhanced CT exam on a nonemergent basis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.PLEURAL SPACES: No pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not identified.  There is no\nfree intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.\n\nBONES: Transitional anatomy is noted at the lumbosacral junction.  For sake of\nconsistency, the postoperative level is assigned L4-5.  Bilateral L4 and L5\npedicle screws with transfixing rods identified without evidence of hardware\nrelated complication.  Intervertebral disc spacer also noted at this level. \nObvious hardware related complications noted.  There is no acute fracture.  No\nsuspicious osseous abnormality is identified.\n\nSOFT TISSUES: Surgical staples are seen overlying the posteriorly lumbar area.\nThe abdominal and pelvic wall is within normal limits.",
            "output": "1. No pulmonary embolism.  No acute findings in the chest.\n2. Postoperative changes in the lower lumbar spine.\n3. No acute intra-abdominal process."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  Mild atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  Patient is status post aortic valve\nreplacement.  No pericardial effusion.  Moderate atherosclerotic\ncalcifications in the coronary arteries, mildly in the aorta and aortic\nannulus.  The pulmonary arteries and aorta are normal caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, not\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Moderate bilateral apical scarring.\n\nLUNGS:\nPartial subsegmental atelectasis of the middle lobe associated to air\nbronchograms and bronchiectasis.  4 mm calcified granuloma in the right apex\n(___).  8 mm subpleural nodule in the right lower lobe (5:82).  2 mm nodule\nin the left lower lobe (5:246 and 247).  All of these nodules are stable since\nat least ___.\nThe remaining airways are patent to subsegmental levels.  No bronchial wall\nthickening or mucous plugging.\n\nCHEST CAGE:\nStable appearance of midline sternotomy with intact and aligned wires. \nAccentuated kyphosis.  Mild dorsal spondylosis.  No acute fractures.  No\nsuspicious lytic or sclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show colonic diverticulosis with no\nassociated inflammatory signs.",
            "output": "The nodule in the right apex previously mention in a chest radiograph dated ___ corresponds to calcified granuloma, which is a benign lesion and\nhas been present and unchanged since the chest CT of ___.\nAll the other pulmonary nodules are also unchanged since ___.  No\nfollow-up is recommended for these nodules.\nPartial atelectasis of the middle lobe associated to indwelling bronchiectasis\nhas been stable since ___ also and is likely post infectious\nscarring."
        },
        {
            "input": "There is an 8 mm hypodensity within the left lobe of the thyroid. Otherwise,\nimaged portions of the thyroid gland are normal.  No significant axillary,\nmediastinal or hilar lymphadenopathy is detected.  An orogastric tube courses\nthrough the esophagus and terminates in the gastric fundus. A right subclavian\napproach central venous catheter terminates in the mid SVC. The heart is\nenlarged. There is no pericardial effusion. The thoracic aorta is normal in\ncaliber with a typical 3 vessel takeoff from the arch.  The pulmonary arterial\ntrunk is normal in caliber.\n\nAn endotracheal tube terminates at the mid trachea. The airways are normal in\ncaliber. There are moderate-sized bilateral dependent non hemorrhagic pleural\neffusions with associated relaxation atelectasis and collapse of both lower\nlobes.  There is mild edema in the left upper lobe. No pneumothorax is\npresent.  There are no suspicious opacities or masses.\n\nNo blastic or lytic lesion suspicious for malignancy is present.\n\nFor a full report on the abdominal component of this examination, please refer\nto clips number ___.",
            "output": "1. Moderate-sized bilateral dependent non hemorrhagic pleural effusions with\nassociated lower lobe collapse.\n\n2. Adequate position of endotracheal tube and lines as described above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  There is moderate to severe diffuse atherosclerotic\ncalcification and mural plaques along the aortic arch and descending thoracic\naorta.  Moderate atherosclerotic narrowing involving the proximal left\nsubclavian artery.  Moderate calcification at the origin of the celiac trunk\nand SMA.  The heart is mildly enlarged with diffuse coronary artery\ncalcifications.  Pericardium and remaining great vessels are within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild opacification at the left lung base is likely compatible\nwith atelectasis.  Lungs are otherwise clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Diffuse airway wall thickening is present.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Patulous\nesophagus and moderate-sized hiatal hernia are noted.  There is severe\nnarrowing of the celiac artery and moderate to severe narrowing of the\nproximal SMA.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Patulous esophagus with moderate hiatal hernia.\n3. Moderate to severe atherosclerotic disease.\n4. Diffuse airway wall thickening suggests chronic bronchitis."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nMinimal residual thymic tissue seen in the anterior mediastinum.  The thyroid\ngland is not visualized.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion. \nThe heart appears normal in size.\n\nOf note, the extreme lung bases as well as the extreme lung apices are not\nimaged based on this protocol.There is no evidence of pulmonary parenchymal\nabnormality. The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nLimited evaluation of the subsegmental pulmonary arteries due to poor\nopacification due to timing of the contrast bolus.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of consolidation to\nsuggest pneumonia.  There is subsegmental atelectasis at the right lung base. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThere are no thyroid findings that require further imaging.\n\nABDOMEN: There is a small hiatal hernia.  Hepatic steatosis.  Otherwise,\nincluded portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nPatient is status bilateral mastectomies.",
            "output": "1. No evidence of pulmonary embolism centrally through the proximal segmental\npulmonary arteries.  Distal segmental and subsegmental branches are not well\nassessed due to timing of the contrast bolus.  No aortic abnormality.\n2. No acute intrathoracic process.\n3. Small hiatal hernia."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "CHEST CTA:\n\nAlthough slightly limited by bolus timing, the thoracic aorta is normal\ncaliber without evidence of aneurysm or dissection.  The main, lobar,\nsegmental pulmonary arteries are well opacified without filling defect.  The\nremainder of the great vessels have a normal appearance.\n\nCHEST:\n\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The heart is top-normal in size.  The\npericardium is intact without effusion.  Airways are patent to the\nsubsegmental levels.\n\nThe lungs are clear without focal or diffuse abnormality. The pleura is intact\nwithout effusion. No pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Degenerative changes at multiple levels within the mid thoracic\nspine including Schmorl's nodes.",
            "output": "No evidence of aortic dissection."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged lower thyroid need any further\nimaging evaluation.  Supraclavicular and axillary lymph nodes not\npathologically enlarged.  Moderate gynecomastia, left greater than right.  No\nsoft tissue abnormalities elsewhere in the partially imaged chest cage.  This\nstudy not appropriate for subdiaphragmatic diagnosis.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification not\napparent in head and neck vessels but present in at least left anterior\ndescending and right coronary arteries.  Aortic valvular calcification is\nmild.  Hypoattenuation of cardiac contents consistent with anemia. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: Top-normal size lymph nodes in the mediastinum measure\nup to 10 mm in the prevascular and right lower paratracheal stations, perhaps\nup to 17 mm in the right posterior paraesophageal mediastinal stations.  Hilar\ncontours on this noncontrast study do not suggest appreciable lymph node\nenlargement there.\n\nLUNGS, AIRWAYS, PLEURAE: No measurable lung nodules or other focal lung lesion\nof any consequence.  Mild heterogeneity in background lung density at the\nbases is probably due to small airway obstruction and mild air trapping. \nTracheobronchial tree as imaged is unremarkable.  No pleural abnormality.\n\nCHEST CAGE: No pathologic or compression or other fracture and no destructive\nbone lesion.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nAsymmetry in moderate gynecomastia is not unusual in patients with liver\nfailure.\n\nProbable small airway obstruction."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  The thyroid gland is unremarkable.  Superficial\nsoft tissue structures of the chest wall are unremarkable.\n\nUPPER ABDOMEN: Please see separate report for CT of the abdomen and pelvis\nperformed the same day.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There are no pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  There are subsegmental dependent atelectatic changes at both\nlung bases.  There is no pulmonary mass or nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are normal in\ncaliber.\nCHEST CAGE: There are no suspicious bone lesions.",
            "output": "No evidence of primary malignancy or metastatic disease in the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a right port catheter with\ntip in the right atrium.  The thyroid is outside the field of view.  There is\na borderline 0.9 x 0.9 cm right axillary lymph node ___.  No supraclavicular\nlymphadenopathy.\n\nUPPER ABDOMEN: Please see separately dictated CT abdomen and pelvis for\ndescription of multiple calcific densities in the liver and spleen, likely\nrepresenting sequelae of prior granulomatous disease and multiple hypodense\nlesions in the bilateral kidneys.\n\nMEDIASTINUM:  There are a few borderline mediastinal lymph nodes. There is a\n1.1 x 0.9 cm right subcarinal lymph node (___).  The esophagus is dilated, as\nbefore.\n\nHILA:  There are multiple prominent, though non-enlarged, bilateral hilar\nlymph nodes.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.  No\nvalvular or coronary artery calcification.\nPLEURA: No pleural effusion.  No pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is severe centrilobular emphysema.  There is bibasilar\natelectasis.  No nodules.\n2. AIRWAYS:  Patent to the subsegmental levels.\n3. VESSELS:  No pulmonary embolism is identified on this non PE protocol\nstudy.\nCHEST CAGE: No fractures.  There are mild degenerative changes of the\nvisualized spine.",
            "output": "1. There a few borderline enlarged mediastinal, hilar and right axillary lymph\nnodes.  No frank lymphadenopathy.\n2. Please see same day CTs of the neck and abdomen-pelvis for other findings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is suboptimally\nvisualized.  No supraclavicular adenopathy.  Right axillary lymph node\nmeasuring 9 mm diameter (4, 21) Is slightly increased in size compared to\nprior (previously measuring 6 mm in diameter) and should be correlated with\nFDG avidity on the PET-CT.  The left axillary lymph nodes appear similar\ncompared to prior.  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Patulous appearance of the esophagus.  No new or enlarging\nmediastinal adenopathy.\n\nHILA: No hilar adenopathy\n\nHEART and PERICARDIUM: Trace pericardial fluid.  No cardiomegaly.  No aortic\nvalve calcification.  Minimal right coronary artery calcification. \nRight-sided prepectoral Port-A-Cath in situ with the tip in the distal right\natrium.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Moderate\ncentrilobular emphysematous changes with an upper lobe predominance. \nPre-existing sub 4 mm nodules (4, 71 and 49) are unchanged.  Sub 4 mm\nindeterminate pulmonary nodule (4, 69 and 86) are new.  Bibasal subpleural\nground-glass changes may be related to passive atelectasis, but please note\nthat it may also be related to silent aspiration (in the setting of a patulous\nesophagus and endobronchial aspirate/secretions..\n2. AIRWAYS:  Endobronchial aspect/secretions present in the left main bronchus\n(4, 93) And in the posterior basal segmental and subsegmental bronchi (4,\n138).  No overt bronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects to\nsuggest pulmonary emboli.\nCHEST CAGE: No clear CT correlate seen for the apparently FDG avid lesion in\nthe right T6 vertebral body (4, 94).  No other lytic/destructive bony lesions.",
            "output": "Indeterminate slight increase in size of a right axillary lymph node and\ncorrelation with FDG avidity on PET-CT is advised.\n\nThis finding should be interpreted in conjunction with the CT neck, abdomen\nand pelvis findings.\n\nPatulous esophagus, endobronchial secretions as noted above and posterior\nbasal ground-glass changes suggest aspiration.\n\n2 small sub 4 mm nonsuspicious pulmonary nodules are indeterminate, but new\nand could be re-evaluated at next follow-up imaging visit.\n\nNo clear CT correlate found for the FDG avidity in the T6 vertebral body.\n\nFor neck, abdomen and pelvis findings please refer to their respective\nreports.\n\nPlease also refer to CT PET study done on the same day.\n\nRECOMMENDATION(S):  Consider evaluation for aspiration."
        },
        {
            "input": "Obliteration of fat plane in the right thoracic outlet adjacent to the right\nsubclavian artery has not changed appreciably since the prior study. There was\nno FDG avidity in this region at the time making adenopathy doubtful, but the\nmore recent FDG PET CT should be consulted for current findings..  Previous\nsolitary enlarged right upper chest wall lymph node lymph node is no longer\nevident and there are no soft tissue abnormalities elsewhere in the chest wall\nconcerning for malignancy.  Evaluation of the breasts requires mammography. \nFindings in the neck and abdomen will be reported separately.\n\nCardio mediastinum:\n\nAs before the upper esophagus is quite patulous retaining air and fluid above\nthe level of the carina.  There is no associated mass.\n\nThyroid will be reported separately.  Atherosclerotic calcification is not\napparent in head and neck vessels or coronary arteries.  Aorta and pulmonary\narteries are not dilated and the.  Pericardium is physiologic.\n\nThoracic lymph nodes:\n\nNo thoracic lymph nodes are pathologically enlarged.\n\nLungs, airways, and pleura:\n\nEmphysema is severe in the upper lobes milder elsewhere.\n\nNew homogeneously enhancing consolidation at the base of the right lung is\nprobably atelectasis although on the last study there was ground-glass\nopacification in the same region ascribed to recurrent aspiration.  Micro\natelectasis at the left lung base is not as extensive.\n\nNo lung nodules or evidence of infection.\n\nPleural surfaces are normal.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of lymphoma or infection.  Previous right upper chest wall lymph\nnode has involuted.\n\nPersistent dilatation upper esophagus with no obstructing mass suggest\nesophageal dysmotility."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no pathologic enlargement\nof lymph nodes in the supraclavicular or axillary stations.\n\nCHEST CAGE: There is no evidence of osteo destructive lesions at the level of\nthe vertebra, ribs or sternum.  Mild upper thoracic scoliosis.\nNo suspicious lytic or sclerotic bony destructive lesions.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: No pathologic enlargement of lymph nodes in the mediastinum or\nhila.  Posterior mediastinum is unremarkable.\nUpper esophagus is mildly patulous with few air-fluid levels, with no\nobstructing mass, unchanged since prior.\n\nHEART and PERICARDIUM: Heart is normal in size.  Right pectoral Port-A-Cath\nterminates in the right atrium.  Faint calcifications of the coronaries. \nMinimal calcifications along the normal caliber thoracic aorta.  Main\npulmonary artery is top normal diameter.  Pericardium is physiologic.\n\nPLEURA: Subtle biapical pleuroparenchymal scarring is unchanged.  No pleural\neffusion.\n\nLUNG: Mild diffuse bronchial wall thickening with no signs of active infection\nsuch as mucoid impactions or branching opacities, suggest mild chronic airway\ndisease.  Delicate cylindrical bronchiectasis in the lower lobes.\nEmphysema is severe in the upper lobes, milder elsewhere.\nUnchanged atelectasis in the right lung base and medial right middle lobe, is\nlikely subsequent to mildly elevated right hemidiaphragm.\nNo measurable lung nodules.  No evidence of infection.",
            "output": "-No evidence of lymphoma in the thorax.\n-Upper esophagus is mildly patulous with no obstructing mass, possibly due to\ndysmotility.\n\nRECOMMENDATION(S):  Clinical evaluation for possible esophageal dysmotility."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is incompletely\nvisualized.  Left supraclavicular lymph node measuring 9 mm in diameter (3,\n4).  Subcentimeter axillary lymph nodes.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Mildly patulous appearance of the esophagus.  Air intermixed with\ngastric content and a gastric bezoar should be clinically excluded.  Multiple\nsubcentimeter splenic and hepatic granulomas.  Hypodense hepatic lesions (3,\n51, 54 and 62) suggestive of hepatic involvement.  Para-aortic adenopathy is\nagain noted (3, 67).  Hypodense lesion in relation to the upper pole of the\nright kidney (3, 67) is unchanged.\n\nMEDIASTINUM: Mediastinal lymphadenopathy (for example 3, 9) is unchanged\n\nHILA: Suspected hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No cardiomegaly. \nAsymmetrically distributed pericardial effusion most prominent anterior to the\nright ventricle measuring 12 mm in diameter (3, 50), but the effusion is\ndecreased in size compared to prior.  Mild relative hypodensity of the blood\npool suggesting anemia.  Mild calcification of the aortic annulus.  Mild\ncalcification the right coronary artery.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Multiple spiculated pulmonary nodules involving all lung lobes\nthe largest in the right lower lobe measuring 16 x 16 mm (5, 215) and\nsubpleural in the left lower lobe measuring 22 x 7 mm (5, 166) both of these\nnodules appearing slightly increased in size.  Moderate centrilobular\nemphysematous changes.  Mild, but diffuse bronchial wall thickening.  Mild,\nbut diffuse cylindrical bronchiectasis.  No air trapping on the expiratory\nviews.  Bilateral posterior basal micro atelectasis.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not dilated.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/ destructive\nbony lesions.",
            "output": "Numerous spiculated pulmonary nodules may have enlarged since ___ but\nscans are not technically comparable.  These nodules may be metastatic\n(lymphoma or second primary) or infective in nature and correlation with\nhistology is advised.\n\nModerate centrilobular emphysematous changes.  Mild, but diffuse cylindrical\nbronchiectasis and mild bronchial wall thickening.  No air trapping.  No\ninterstitial lung disease.\n\nMediastinal and hilar adenopathy.  Multiple hypodense hepatic lesions\nsuggesting hepatic involvement.\n\nPara-aortic lymphadenopathy in the upper abdomen.\nHepatic and splenic granulomas."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nEvaluation at the subsegmental level is limited due to multifocal\nconsiderations, described below. The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Several prominent axillary nodes measuring up\nto 1 cm on the right are noted (03:14).  Also noted are prominent prevascular\nand paratracheal nodes not meeting CT criteria for lymphadenopathy.  There 2\nfoci of coarse calcifications near the left hilum (03:45, 52), likely due to\ncalcified hilar lymph nodes.  There is no hilar or mediastinal mass.\n\nPLEURAL SPACES: A loculated left pleural effusion is again demonstrated,\nassociated with a subtle peripheral enhancement, similar in size compared to\nthe prior study.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: Scattered irregular multifocal consolidations involving all\nlobes but most prominent in the bilateral upper lobes, right middle and right\nlower lobe, suggestive of multifocal pneumonia.  There is minimal dependent\natelectasis at the left lung base.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: Low attenuation of liver compatible with steatosis.  There is\nno evidence of focal lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size.  There has been interval decrease in\nsize in the perisplenic fluid collection with the tip of a posterior approach\npigtail catheter similarly positioned.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nPreviously-seen delayed nephrogram on the left has essentially resolved. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The small bowel anastomosis is\nagain noted in the mid abdomen and appears intact.  There is mild dilatation\nof the small bowel loop at the level anastomosis, likely postsurgical and\nunchanged from prior.  There is no evidence of obstruction.  Again\ndemonstrated is a similarly positioned anterior approach pigtail drain\nterminating in the inner aspect of anterior abdominal wall, without associated\ncollection.  The previously noted crescent-shaped collection associated with\nthis drain has resolved.  A moderate fecal load in the ascending and\ntransverse colon.  Residual rim enhancing fluid collection noted adjacent to\nthe descending measuring approximately 2.8 x 4.8 cm (05:31) is unchanged from\nprior.  Otherwise, the remaining small and large bowel loops are unremarkable.\nThe appendix is not definitely visualized.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post TAH-BSO.\n\nLYMPH NODES: Multiple prominent mesenteric lymph node not meeting CT criteria\nfor lymphadenopathy are noted.  There is no retroperitoneal or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. Postoperative changes associated with the incision in the low\nmid abdominal wall are noted, where a wound VAC is present.",
            "output": "1. Multifocal consolidations involving all lobes, most prominently the\nbilateral upper and right middle lobes, consistent with multifocal pneumonia.\n2. Not significantly changed left rim enhancing loculated pleural effusion.\n3. Interval decrease in size of perisplenic collection with similarly\npositioned pigtail drain.\n4. Resolution of previously noted crescent collection in the left mid abdomen\nassociated with anterior approach pigtail drain.\n5. No significantly changed small rim enhancing fluid collection adjacent to\nthe descending colon measuring approximately 2.8 x 1.8 cm, previously 3.2 x\n2.0 cm.  No drain is associated with this collection.\n6. Postoperative changes of the low mid abdominal wall without evidence of\nsubcutaneous collections.\n7. No pulmonary embolism."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular\nand axillary lymph nodes are not enlarged by CT size criteria. The tip of a\nright PICC line is again noted to extend up into the right internal jugular\nvein, the tip is however out of view.\n\nMEDIASTINUM: Mediastinal lymph nodes are not pathologically enlarged.\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: Patient is post replacement of ascending aorta and\nhemiarch with graft repair and reimplantation of the innominate artery.  No\nnew aortic dissection is identified.  There is a new large pericardial\neffusion with mild apparent mass effect on the adjacent right atrium.  Foci of\nair (02:17) within the superior aspect of the pericardial effusion are likely\nis related to recent surgery.  No incidental central pulmonary arterial\nfilling defect identified.\n\nPLEURA: Bilateral pleural effusions, left greater than right.  No\npneumothorax.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level. Bilateral\nlower lobe atelectasis.  No new suspicious pulmonary nodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, multiple low attenuating lesions scattered\nthroughout the liver are too small to accurately characterize, but likely\nrepresent cysts or biliary hamartomas.\n\nCHEST CAGE/BONES: Median sternotomy wires are present.  No focal lytic or\nsclerotic lesion concerning for malignancy. Mild multilevel degenerative\nchanges of the thoracic spine are unchanged.  Postsurgical changes in the\nright axilla from right axillary cannulation.  Bilateral retropectoral\nsilicone implants are present.  Curvilinear hyperdense material is seen\nmaterial within the left breast implant.",
            "output": "1.  Large nonhemorrhagic pericardial effusion with apparent mild mass effect\non the adjacent right atrium.  Several small locule of gas are noted within\nthe effusion, likely postsurgical.\n2.  Postsurgical changes in the right axilla from right axillary cannulation.\n3.  Bilateral retropectoral silicone implants.  Curvilinear hyperdense\nmaterial is seen within the left implant.  If there is clinical concern for\nintracapsular implant rupture, a breast MRI could be obtained for further\nevaluation.\n\nNOTIFICATION:   The findings were discussed with ___, NP by Dr. \n___. on the telephone on ___ at 5:55 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: The patient is status post repair of an ascending\naortic dissection with reimplantation of the right brachiocephalic artery. \nThere is no evidence of recurrent dissection.  There is a small amount of\nresidual simple pericardial fluid, significantly decreased in size since ___.  Pulmonary vasculature is well opacified to the subsegmental level\nwithout filling defect to indicate a pulmonary embolus.  The thoracic aorta is\nnormal in caliber.  Otherwise,  heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild scattered subsegmental atelectasis, predominantly within\nthe lower lobes.  A few calcified granulomas are visualized.  Otherwise, the\nlungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: A multinodular thyroid gland is re-demonstrated, with the\nlargest hypodense nodule measuring 12 mm on the left.\n\nABDOMEN: A partially imaged peripherally hyperenhancing lesion within the\nright lobe of the liver measures approximately 2.6 x 2.1 cm (series 2, image\n106), likely representing a hemangioma.  Multiple additional cysts are seen\nwithin the liver.  An additional punctate hyperenhancing focus (series 2,\nimage 98) also likely represents a hemangioma.  No other abnormalities within\nthe partially visualized upper abdomen.\n\nBONES AND SOFT TISSUES: Sternotomy wires appear intact and appropriately\naligned.  No suspicious osseous abnormality is seen.? There is no acute\nfracture.  Again, the patient is status post bilateral retropectoral breast\nimplants with a serpiginous density seen on the left, which may represent an\nintracapsular implant rupture.",
            "output": "1. Status post repair of an ascending aortic dissection without evidence of\nrecurrent dissection.\n2. Small residual pericardial effusion.\n3. Multinodular thyroid.\n4. Peripherally enhancing lesion within the right lobe of the liver measuring\nup to 2.6 cm, likely a hemangioma.\n5. Unchanged curvilinear hyperdense material within the left retropectoral\nbreast implants, which may represent an intracapsular implant rupture."
        },
        {
            "input": "MEASUREMENTS OF THE THORACIC AORTA:\nAortic Valve: 3.1 x 2.2 cm\nAortic Sinuses: 3.7 x 3.3 cm\nSinotubular Junction: 3.1 x 2.9 cm\nMid Ascending Aorta: 3.1 x 3.0 cm\nPost-Innominate Origin: 2.8 x 2.6 cm\nPost-Left Subclavian Origin: 2.5 x 2.2 cm\nProximal Descending Aorta: 3.1 x 3.0 cm\nMid Descending Aorta: 2.3 x 2.1 cm\n\nThe patient is status post repair of an ascending aortic dissection and\nreimplantation of the right brachiocephalic artery, which are unremarkable in\nappearance.  There is no evidence of recurrent dissection.  Otherwise, the\naorta and its major branch vessels are patent, with no evidence of stenosis,\nocclusion, or aneurysmal formation.  There is no evidence of penetrating\natherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nSurgical clips are seen within the right axilla.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  Multiple hypodense nodules\nare seen within the thyroid measuring up to 11 mm within the left lobe (series\n2, image 7).\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nMild dependent atelectasis.  No focal consolidations.  No suspicious lung\nnodules.  The airways are patent to the subsegmental level.\n\nMultiple hypodensities are seen within the liver, incompletely characterized\non this examination, but likely hepatic cysts.  No other abnormalities within\nthe partially imaged upper abdomen.\n\nNote is made of bilateral breast implants, which are unremarkable in\nappearance.  Sternotomy wires appear intact and appropriately aligned.  No\nlytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. Status post ascending aortic repair without evidence of recurrent\ndissection.\n2. Multiple hypodense nodules within thyroid measuring up to 11 mm.\n\nRECOMMENDATION(S):   Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: Esophagus is unremarkable.\n\nNODES: There are no enlarged mediastinal hilar lymph nodes.  Small mediastinal\nlymph nodes are not enlarged by size criteria\n\nHEART, VESSELS and PERICARDIUM: There is moderate cardiomegaly.  Moderate\ncoronary artery calcification is seen.  There is no pericardial effusion\n\nPLEURA: There is no pleural effusion\n\nLUNG:\n\n1. PARENCHYMA:  There is biapical pleural parenchymal scarring.  There is mild\ndiffuse bronchiectasis with peribronchial thickening which could be related to\nbronchitis.  ___ nodularity seen in the posterior segment the right\nupper lobe which could also be related to bronchitis.Focal peribronchial\nopacities in the right middle lobe associated with some ground-glass opacities\ncould be related to bronchiolitis\n2. AIRWAYS:  The airways are patent up to the subsegmental level\n3. VESSELS:  Pulmonary artery is normal in caliber.\n4. BONES : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable",
            "output": "Diffuse mild bronchiectasis with peribronchial thickening with associated\n___ nodularity in the posterior segment the right upper lobe and right\nmiddle lobe is most likely related to bronchi bronchitis.  Subtle ground-glass\nopacities in the right middle lobe are most likely inflammatory.  Comparison\nwith outside CT is recommended."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is stable small mediastinal lymph nodes not enlarged by\nsize criteria.  There are no enlarged hilar lymph nodes.  Heart size is\ntop-normal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  There is mild diffuse\nbronchiectasis with peribronchial thickening which could be related to chronic\nbronchitis.  ___ nodularity in the posterior segment the right upper\nlobe is unchanged.  The right middle lobe a ___ opacities and\nground-glass opacities have resolved in the interim and were most likely\ninflammatory.  Stable calcified granuloma in the right lung base.  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows extensive degenerative changes\ninvolving the thoracic spine\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  There is a small left periesophageal lymph node which measures 8 mm.",
            "output": "Resolution of the ground-glass opacities in the right middle lobe which are\nmost likely inflammatory.\n\nDiffuse mild bronchiectasis with peribronchial thickening bilaterally which\ncould be related to chronic bronchitis.\n\n8 mm periesophageal lymph node, is indeterminate and may be followed up in 3\nmonths."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is stable small mediastinal lymph nodes not enlarged by\nsize criteria.  There are no enlarged hilar lymph nodes.  Heart size is\nnormal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber.\nThe left periesophageal lymph node measuring 8 mm is unchanged (2, 49).  There\nis no pericardial effusion\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  No lung nodules.  Diffuse\nmild bronchiectasis with peribronchial thickening has minimally improved.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable small 8 mm left periesophageal lymph node.\n\nNo new lung nodules.\n\nImprovement in the mild diffuse peribronchial thickening which could represent\nchronic bronchitis."
        },
        {
            "input": "HEART AND VASCULATURE: There is no evidence of anomalous pulmonary venous\nreturn or intraparenchymal vascular shunt.  Pulmonary vasculature is well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  There is a calcified granuloma in the right upper lobe\nmeasuring 3 mm (5:82).  A 3 mm subpleural nodule in the right upper lobe may\nrepresent a focus of atelectasis (5:177).  A 2 mm left perifissural nodule\nlikely represents a perifissural lymph node.  No suspicious pulmonary nodules\nidentified.  There is a small tracheal diverticulum measuring approximately 6\nmm (4:18).  Otherwise, the airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: There is a 7 mm hypodense nodule in the right thyroid lobe, not\nrequiring additional follow-up imaging (5:12).  Otherwise, visualized portions\nof the base of the neck show no abnormality.\n\nABDOMEN: There are multiple hypodense lesions throughout the liver with\ndominant lesions in the right hepatic lobe measuring 1.9 cm and in the left\nhepatic lobe measuring 2.0 cm (5:262 and 240), compatible with hepatic cysts. \nAdditional subcentimeter hypodense lesions are too small to characterize. \nIncluded portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of anomalous pulmonary venous return or intraparenchymal vascular\nshunt."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged portion of thyroid gland is\nunremarkable in appearance.  There is no supraclavicular or axillary\nlymphadenopathy.  Other than mild dependent subcutaneous edema, the chest wall\nis unremarkable.\n\nUPPER ABDOMEN: There is trace upper abdominal ascites surrounding the liver\nand spleen.  Included images of the upper abdomen are otherwise unremarkable.\n\nMEDIASTINUM: Multiple mediastinal lymph nodes are present, some of which are\nmildly enlarged, likely reactive.  For example, the largest is a right lower\nparatracheal node measuring up to 1.6 cm (4:75).  A left prevascular node\nmeasures up to 1.3 cm (4:73).  The esophagus is patulous, containing\nsecretions.\n\nHILA: There is no evidence of hilar lymphadenopathy, within the limitations of\nthis noncontrast study.\n\nHEART and PERICARDIUM: Heart size is mildly enlarged, with trace pericardial\neffusion.  Coronary artery calcifications are diffuse.  A stent is noted in\nthe right coronary artery.  There are also substantial aortic valvular and\nmitral annular calcifications.\n\nPLEURA: There is no pneumothorax.  Bilateral pleural effusions, moderate on\nthe right and trace on the left.\nLUNG:\n\n-PARENCHYMA:  Dense consolidation adjacent to the right pleural effusion\nlikely represents compressive atelectasis.  There is a calcified granuloma in\nthe right upper lobe (04:58).  Linear areas of atelectasis versus scarring are\nseen in the right middle lobe and lingula.  Diffuse scattered areas of\nground-glass opacity may reflect a combination of expiratory air trapping and\npulmonary edema, particularly in the setting of background smooth interlobular\nseptal thickening.\n-AIRWAYS:  Airways are patent to the segmental bronchi bilaterally.\n-VESSELS:  Thoracic aorta is normal in course and caliber.  Ascending aorta\nmeasures up to 3.7 cm in greatest dimension.  Atherosclerotic calcifications\nare present throughout the entire aorta.  In the ascending aorta, the wall\ncalcifications are thin and circumferential, more pronounced along the\nposterior wall.  Extensive atherosclerotic calcifications are seen along the\naortic arch and descending aorta.  Main pulmonary trunk is prominent,\nmeasuring up to 3.8 cm in diameter (4:95), suggestive of pulmonary arterial\nhypertension.\nCHEST CAGE: There is no acute fracture.  No concerning lytic or sclerotic\nlesions that are suspicious for malignancy.  Moderate to severe degenerative\nchanges and noted throughout thoracic spine.  There is also evidence of severe\nglenohumeral joint osteoarthritis bilaterally, partially imaged.",
            "output": "1. Diffusely calcified thoracic aorta, measuring up to 3.7 cm in the ascending\naorta.  Wall calcifications are thin and circumferential along the ascending\naorta, more pronounced posteriorly.  Calcifications along the arch and\ndescending aorta are extensive.\n2. Severe aortic valvular and diffuse coronary artery calcifications.\n3. Mild cardiomegaly.\n4. Probable pulmonary arterial hypertension.\n5. Findings consistent with fluid overload including mild pulmonary edema,\nright greater than left pleural effusions, upper abdominal ascites, and\nsubcutaneous edema.\n6. Mildly enlarged mediastinal lymph nodes, likely reactive."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection.  No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lung apices and portions of the lung bases were not\nincluded.  The visualized lungs are clear aside for mild dependent\natelectasis..\n\nABDOMEN: The partially visualized upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism."
        },
        {
            "input": "CHEST PERIMETER: Supraclavicular and subcentimeter axillary lymph nodes are\nnot pathologically enlarged and there are no soft tissue abnormalities in the\nimaged chest wall concerning for malignancy.  This study is not appropriate\nfor subdiaphragmatic diagnosis, especially involving the liver, but shows no\nadrenal mass.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  9 x 22 mm low-density lesion in\nthe left thyroid lobe warrants ultrasound evaluation.  Atherosclerotic\ncalcification in head neck vessels is mild, present in at least left anterior\ndescending and right coronary arteries.  Mild decrease in attenuation of\ncardiac contents suggests anemia.  Pericardium is physiologic.\n\n\n\nTHORACIC LYMPH NODES: Subcentimeter mediastinal lymph nodes are numerous in\nthe upper and lower paratracheal stations, ranging in diameter up to 10 mm in\nthe prevascular station of the mediastinum, probably equivalent size in the\nlower pole of the non enhanced left hilus.\n\n\n\n\nLUNGS, AIRWAYS, PLEURAE:\n\nEmphysema is severe.\n\nThe upper pole now of the left hilus is normal, but in the anterior segment of\nthe left upper lobe extending to the hilus and the mediastinal pleura and\noccluding a medial subsegmental division of the anterior segmental bronchus,\n5:147, is large region of dense, mass like, homogeneous consolidation which\ncould occlude a mass as large as 33 x 37 mm, 5:163. Administration of\nintravenous contrast might have helped clarify this picture at the periphery\nof this abnormality are regions of clear pneumonia, including possible\nsuperinfection of bullae containing exudate, 5:141.\n\nThere is more pneumonia in the superior subsegment of the lingula, 03:34 and\nthe extensive bronchial wall thickening in the lower lobes, left greater than\nright.  Small nonhemorrhagic left pleural effusion layers posteriorly.\n\n\nCHEST CAGE: No focal lesions of consequence in the right lung.  No evidence of\nchest cage malignancy or infection. Healed lateral right middle rib fracture.\nPrior cement infusion moderately compressed mid thoracic vertebral body.",
            "output": "Multifocal pneumonia left upper lobe.  Possible left upper lobe mass, anterior\nsegment.  No extensive central adenopathy.  Bronchial inflammation both lower\nlobes, chronicity indeterminate.\n\nSevere emphysema.\n\nRECOMMENDATION(S):  Antibiotic treatment to for pneumonia, if indicated,\nfollowed closely with conventional radiographs.  If there is inadequate\ntreatment response, suggest either bronchoscopy or repeat chest CT after\npreparation for intravenous contrast infusion.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 11:42 am, 1 minutes after discovery of\nthe findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The thyroid is enlarged with multiple\nhypoattenuating nodules measuring up to 1.6 cm in the right lobe (series 2,\nimage 4).  Supraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  The mediastinal lymph nodes are neither enlarged or growing.\n\nHILA:  Hilar lymph nodes are neither enlarged or growing.\n\nHEART:  The heart is not enlarged and there is mild coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber. \nAtherosclerotic calcifications throughout the thoracic aorta is most severe in\nthe aortic arch.\n\nPULMONARY PARENCHYMA: The consolidation in the anterior segment of the left\nupper lobe has significantly improved with mild residual consolidation and\nareas of ground-glass opacity (series 4, image 142).  No new focal\nconsolidation is identified.  Severe emphysema is unchanged.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: No acute fracture.  Healed right-sided rib fractures\nunchanged.  Diffuse osteopenia is severe.  T5 vertebroplasty is noted.  There\nis no worrisome lytic or sclerotic lesion.  Multilevel degenerative changes\nare moderate.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Significant improvement of the left upper lobe pneumonia with mild residual\nconsolidation and ground-glass opacity along medial subsegmental division of\nthe anterior segmental bronchus.  No new focal consolidation.\n2. Unchanged multinodular thyroid measuring up to 1.6 cm in the right lobe. \nThyroid ultrasound is recommended for further evaluation if not previously\nperformed.\n\nRECOMMENDATION(S):  Thyroid ultrasound if not previously performed."
        },
        {
            "input": "THORACIC INLET: The thyroid is heterogeneous with a stable 1.6 cm hypodense\nlesion in the right lobe of thyroid.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The there\nis atherosclerotic calcification involving the aorta.  There is moderate\ncoronary artery calcification.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is upper lobe predominant paraseptal emphysema.  A left upper lobe\npulmonary nodule (4, 29) is unchanged.  Previously visualized left upper lobe\npneumonia has resolved.  No new consolidations.  The lingular and right lower\nlobe consolidative opacities have also resolved.  There is minimal peripheral\nfibrosis in both lung bases which is unchanged.  No new nodules or\nconsolidations\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.  There are\ndegenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  No adrenal masses are seen.  There are gallstones.",
            "output": "Complete resolution of the left upper lobe and bilateral lower lobe\nparenchymal opacities which most likely represented a pneumonia.  No new\nconsolidations.\n\nStable multinodular goiter.\n\nStable left upper lobe pulmonary nodule.  No new pulmonary nodules.\n\nDiffuse osteopenia consistent with known history of multiple myeloma.\n\nModerate to severe diffuse centrilobular and paraseptal emphysema\n\nGallstones"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. No enlarged lymph\nnodes in either axilla or thoracic inlet.  Excluding the breast tissue which\nrequires mammography for evaluation,there are no abnormalities on the chest\nwall. Mild atherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. Trace pericardial effusion. Moderate\natherosclerotic calcifications in the coronary arteries and aortic arch. \nMinimal calcifications in the aortic annulus..  The aorta and pulmonary\narteries are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria. No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Biapical pleuroparenchymal scarring is again noted.\n\nLUNGS:\nThere is a background of moderate to severe emphysema.  A small amount of\nsecretions are seen within the right main bronchus.Near complete resolution of\nthe previous lingular consolidation. There is mild diffuse bronchial wall\nthickening suggesting bronchial inflammation.  There is more focal\nperibronchial opacification in the right lower lobe which likely reflects\ninflammation and possible impaction of small airways (series 4:112), likely\nrepresenting aspiration.  No discrete consolidation.  There is no mucus\nplugging.\n\nA 4 mm left lower lobe nodule is stable (series 4:174).  There are 2 new left\nlower lobe nodules, including a 6 mm sub solid nodule with part ground-glass\ncomponent (series 4:147), and a 6 mm solid nodule (series 4:152), which are\nnot clearly demonstrated on the prior study.\n\nCHEST CAGE:\nNo acute fractures. Moderate dorsal spondylosis.  Status post vertebral\naugmentation of T5 vertebral body.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show cholelithiasis without evidence\nof acute cholecystitis.  Several calcifications in the kidneys are likely\nvascular.",
            "output": "1. Near complete resolution of the previous lingular consolidation/pneumonia. \nNo new consolidation.\n2. Findings consistent with aspiration in the right lower lobe, including\nsecretions in the right main bronchus, and evidence of bronchial inflammation\nand impaction of small airways.  No discrete associated consolidation.\n3. Newly seen 6 mm solid left lower lobe nodule and 6 mm sub solid left lower\nlobe nodule, for which 3 month CT follow-up is recommended to assess\nstability.\n4. Moderate to severe emphysema.\n\nRECOMMENDATION(S):  Follow-up CT chest in 3 months to assess stability of\nnewly seen nodules.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:20 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST PERIMETER: 17 mm low-density lesion left thyroid lobe has been present\nsince at least ___ but should be evaluated with ultrasound. The no\nsupraclavicular or axillary lymph nodes are enlarged or growing.  No soft\ntissue abnormalities in the chest wall.  Findings below the diaphragm will be\nreported separately.\n\nCARDIO-MEDIASTINUM: Esophagus unremarkable.  Atherosclerotic calcification is\nmild in head and neck vessels, present in at least left anterior descending\nand right coronary arteries.  Descending thoracic aorta is normal size.  Main\npulmonary artery top-normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing, including multiple measurable lymph nodes in the lower\nparatracheal and prevascular stations.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is severe in the upper lobes, milder\nelsewhere.  Bronchial wall thickening is moderate to severe in the lower\nlobes, improved on the right more recent on the left compared to ___ suggesting chronic inflammation, sometimes due to aspiration.\n\nPrevious 6 mm mixed density left lower lobe nodule, 4:152 in ___ is now\nsmaller and more clearly defined as impaction in a tiny bronchus, 4:151, 152. \nPunctate and smaller branching nodules elsewhere in the left lower lobe,\n4:150, 156, 157, 164, 202 are either new or sufficiently changed in appearance\nto attribute to bronchial inflammation.  Unfortunately and a tiny early lung\ncancer would not be appreciated under these circumstances.\n\nThere is no consolidation in the lungs to suggest an active pneumonia despite\nsevere bronchial inflammation.\n\nCHEST CAGE: Despite severe osteopenia, most pronounced in the thoracic spine,\nthere is no compression or pathologic fracture or clear large destructive bone\nlesion.  Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide \nFDG PET scanning is much more sensitive in detecting early osseous pathology\nthan chest CT scanning.",
            "output": "No good evidence for intrathoracic malignancy.  Persistent but variable\nbronchial inflammation, now most pronounced in the left lower lobe suggests\nchronic bronchitis, often seen with aspiration.  Multiple small lung nodules\nare generally impacted distal bronchi.  No lesion has behaved in a fashion to\nsuggest an early malignancy though given the large number of small nodules,\nearly detection would be difficult.\n\nModerate to severe emphysema.\n\nLeft thyroid lesion though long-standing should be evaluated with thyroid\nultrasound."
        },
        {
            "input": "CHEST CTA:\n\nPulmonary arterial vasculature is well-visualized to the subsegmental levels\nbilaterally.  No filling defects are identified to suggest the presence of\npulmonary embolism.  The aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The great vessels are unremarkable.\n\nCHEST:\n\nThere is diffuse pulmonary septal thickening, bilateral pleural effusions, and\ncardiomegaly, consistent with moderate pulmonary edema. Compressive\natelectasis is seen in the bilateral lung bases. No definite focal\nconsolidation is seen. The airways are patent to the subsegmental levels\nbilaterally.  No pathologically enlarged axillary, mediastinal, or hilar lymph\nnodes are identified.\n\nThe study is not tailored for subdiaphragmatic evaluation, but the visualized\nintra-abdominal organs are unremarkable.\n\nBONE WINDOWS:  No focal lytic or sclerotic osseous lesion suspicious for \ninfection or malignancy is seen.",
            "output": "1.  No evidence of pulmonary embolism.\n\n2. Moderate pulmonary edema with bilateral mild to moderate pleural effusions.\n\nNOTIFICATION:  Findings communicated to Dr. ___ at 3:57 a.m. on ___ by phone."
        },
        {
            "input": "Imaged portion of thyroid gland is unremarkable.  Thoracic aorta is normal in\ncourse and caliber without dissection or aneurysm.  No significant\natherosclerosis.  The main pulmonary artery is normal in caliber.  The\npulmonary arterial tree opacifies normally without filling defect to suggest\nthe presence of a pulmonary embolism.  No adenopathy.  Heart is normal in size\nand shape.  No pleural or pericardial effusion.\n\nLungs are clear without worrisome nodule, mass, or consolidation.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, imaged\nportions of the liver, spleen, pancreas, bilateral adrenal glands and left\nkidney are unremarkable.\n\nBones: Unremarkable.",
            "output": "No pulmonary embolism or acute aortic process."
        },
        {
            "input": "Thyroid is moderately enlarged, but uniform and does not appreciably narrow\nthe trachea.  Supraclavicular and axillary nodes are not enlarged and there\nare no soft tissue abnormalities in the chest wall suspicious for malignancy. \nThis study is not designed for subdiaphragmatic diagnosis.\n\nAtherosclerotic calcification is not apparent head neck vessels or in the\ncoronary arteries.  There is no pleural or pericardial abnormality.\n\nLymph nodes in the mediastinum, hila, and in the internal mammary,\ndiaphragmatic and retrocrural stations are not enlarged.\n\nAside from a solitary calcified granuloma right upper lobe, lungs are clear\nand the tracheobronchial tree is normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.\n\n.",
            "output": "Normal CT of the chest.  No evidence of intrathoracic malignancy."
        },
        {
            "input": "Thyroid is moderately enlarged, but uniform and does not appreciably narrow\nthe trachea.  Supraclavicular and axillary nodes are not enlarged and there\nare no soft tissue abnormalities in the chest wall suspicious for malignancy.\n\nAtherosclerotic calcification is not apparent head neck vessels or in the\ncoronary arteries.  There is no pleural or pericardial abnormality.\n\nLymph nodes in the mediastinum, hila, and in the internal mammary,\ndiaphragmatic and retrocrural stations are not enlarged.\n\nAside from a solitary calcified granuloma right upper lobe, lungs are clear\nand the tracheobronchial tree is normal to subsegmental levels.\n\nLytic lesion within the T4 transverse process extending to the pedicle has\nmildly enlarged when compared to the prior examination.  Please refer to the\nbone scan from the same day.\n\nPlease refer to the separate CT report of the abdomen and pelvis",
            "output": "Lytic lesion within the T4 transverse process appears slightly larger.  No\npathologic fracture.  No additional lytic lesions in the thorax, please refer\nto the separate bone scan report from the same day.\n\nNo new pulmonary nodules, lymphadenopathy or pleural abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is atelectasis at the left lung base.  Ground-glass\nmosaic pattern at the left lung base likely represents poor expiration or air\ntrapping.  Mild micronodular opacities predominantly in the upper lung fields\nmay represent respiratory bronchiolitis.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic dissection.\n\nSubtle centrilobular micronodularity predominantly in the upper lung fields,\nnonspecific, but may represent respiratory bronchiolitis.\n\nGround-glass mosaic pattern at the left lung base may relate to expiration or\nair trapping."
        },
        {
            "input": "3-4 mm well-defined hypodense thyroid nodule in the right lobe.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Aortic\ncalcifications.  Otherwise normal appearance of the large mediastinal vessels.\nNo incidental pulmonary embolism.  Mild enlargement of the right heart.  No\npericardial effusion.  No enlarged lymph nodes in the hilar regions and in the\nmediastinum.  The posterior mediastinum is unremarkable, with the exception of\na small hiatal hernia.  Upper abdominal findings are reported in detail in the\nabdominal CT report.  Severe scoliosis with moderate degenerative vertebral\ndisease.  No evidence of vertebral compression fractures.  No osteolytic\nlesions at the level of the ribs and the sternum.\n\nModerate bilateral apical scarring, on the right with several calcific spots. \nMild centrilobular emphysema.\nCalcified granuloma in the left upper lobe (8, 122).\nCalcified granuloma in the middle lobe (8, 143).\nPost infectious ___ changes in the periphery of the middle lobe (8,\n179).\n2 mm triangular subpleural nodule in the right lower lobe (8, 205).\nNo other pulmonary nodules or masses.  No pleural effusions. No pleural\nthickening. The airways are patent.",
            "output": "Several calcified and millimetric subpleural granulomas but no evidence of\nnodular lesions suspicious for metastatic or malignant disease.  Centrilobular\nemphysema. Bilateral partly calcified apical scarring.  No pleural effusions,\nno pleural thickening. No hilar or mediastinal adenopathy."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nThe heart is moderately enlarged, and in particular in the right atrium and\nright ventricle.   However, mixing of contrast within the proximal and mid\ndescending thoracic aorta is suggestive of heart failure with a low ejection\nfraction.  Contrast reflux within the IVC and hepatic veins with layering of\ncontrast in the IVC further supports this possibility.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion or\npneumothorax.\n\nMild centrilobular emphysematous changes are upper lobe predominant.  The\npreviously seen PET-positive 4 mm right lower lobe pulmonary nodule is no\nlonger discretely identified.  5 mm right middle lobe perifissural nodule\n(3:111) appears unchanged.  Mild diffuse bronchial wall thickening suggests\nairways inflammation.  Atelectasis is seen within the lingula.  A l trace left\npleural effusion is noted.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate numerous bilateral renal cysts\nwhich appear unchanged from ___.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nDegenerative changes are noted at multiple levels within the visualized\nthoracolumbar spine.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  Moderate cardiomegaly and evidence of heart failure complicated by a low\nejection fraction, as suggested by contrast reflux into the IVC and hepatic\nveins with layering contrast in the IVC in addition to poor forward flow in\nthe descending thoracic aorta.  Recommend correlation with echocardiogram.\n3.  Mild-to-moderate peripheral and centrilobular emphysema.\n4.  Diffuse mild bronchial wall thickening suggests airways disease.\n5.  Previously noted right lower lobe PET-positive pulmonary nodule is no\nlonger identified.  Unchanged 5 mm right middle lobe perifissural nodule.\n\nRECOMMENDATION(S):  Moderate cardiomegaly and evidence of heart failure\ncomplicated by a low ejection fraction, as suggested by contrast reflux into\nthe IVC and hepatic veins with layering contrast in the IVC in addition to\npoor forward flow in the descending thoracic aorta. Recommend correlation with\nechocardiogram."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Cardiomegaly is mild.  The heart, pericardium, and great\nvessels are otherwise within normal limits. No pericardial effusion is seen. \nThere is a left anterior chest wall cardiac device with lead tips in the right\natrium and right ventricle, similar to prior.\n\nAXILLA, HILA, AND MEDIASTINUM:  Multiple calcified mediastinal and left hilar\nlymph nodes are similar to ___.  No axillary lymphadenopathy is\npresent.  No mediastinal mass.\n\nPLEURAL SPACES:  There are moderate bilateral nonhemorrhagic pleural\neffusions, left slightly greater than right, with mild to moderate associated\natelectasis, similar to priors.  No pneumothorax.  Mild biapical scarring is\nsimilar to ___.\n\n\nLUNGS/AIRWAYS:  No focal consolidation.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a right upper\npole renal hypodensity which is partially imaged but similar to prior.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nOld right humeral fracture is similar to ___.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. There are moderate bilateral nonhemorrhagic pleural effusions, left\nslightly greater than right, with mild to moderate associated atelectasis,\nsimilar to priors."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either the axilla or\nthoracic inlet.  No chest wall abnormalities.  Moderate calcification in the\nleft subclavian and left carotid arteries and at the distal brachiocephalic\ntrunk.\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Small mediastinal lymph nodes, none enlarged by CT\nsize criteria.  Hilar contours show no evidence of enlarged lymph nodes within\nthe limitations of a noncontrast study.\n\nHEART, PERICARDIUM AND VASCULATURE:\nAortic fusiform dilatation measuring 40 mm.  Mild aortic annulus\ncalcifications.  No atherosclerotic calcifications in the ascending aorta\nproximal to the brachiocephalic trunk.  Discontinuous areas of calcifications\nalong the arch and descending aorta.  The heart is normal in size and shape. \nThere is no pericardial effusion.  Severe atherosclerotic calcifications in\nthe coronary arteries.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  Mild upper lobe predominant\ncentrilobular emphysema.  Right upper lobe 2 mm solid nodule (302:31).  Small\nbibasal posterior subsegmental atelectasis.  No pleural effusion.  Mild\nbiapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nSevere dorsal spondylosis with endplate degeneration of T12 and inferior\nendplate of T11.  No acute fractures. Endplate sclerosis.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show an absent gallbladder.  No focal\nhepatic or splenic lesions.",
            "output": "No calcifications in the ascending aorta from the sinuses of Valsalva to the\naortic arch.  Discontinuous areas of calcifications along the arch and\ndescending aorta.\n\nSevere coronary artery atherosclerotic disease.\n\nRight upper lobe solitary 2 mm nodule."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Patient has had\nright mastectomy and reconstruction.  Excluding the regions of the breasts,\nwhich require mammography for evaluation, elsewhere in the chest wall there is\nno soft tissue abnormality concerning for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nFocal hypodensity in the right thyroid lobe is stable since at least ___ and too small to warrant further imaging evaluation.\n\nAtherosclerotic calcification in head and neck vessels is moderate to severe,\nparticularly in the left subclavian artery and present in all the major\ncoronary arteries.  Aortic valve is not calcified.  Aorta and pulmonary\narteries are normal size.  Pericardium is physiologic.  There is no pleural\neffusion.  Right pleural thickening is extensive, particularly at the apex of\nthe right lung, but involving costal and diaphragmatic pleural surfaces as\nwell.  This has been entirely stable since ___ in the adjacent bony\nstructures are intact.  Calcification in the thickened pleura suggests there\nhas been previous pleurodesis.  Left pleural surfaces are normal.\n\nBorderline lymph node enlargement\nat multiple mediastinal stations has not progressed since ___, ranging in\ndiameter up to 9 mm at the thoracic inlet, 05:13, and the right hilus, 10 mm. \nThere are no enlarging or new pathologically enlarged mediastinal nodes.\n\nLungs:\n\nMild bronchiectasis, posterior segment right upper lobe, 6:119, is unchanged\nsince ___.  There is insufficient peribronchial infiltration or any\nbronchial secretions to suggest that it is actively suppurative.\n\nNodules:\n\nThere are no new or growing lung nodules.\n\n4 mm, and 6 mm, superior segment right lower lobe, 6:171, 184, unchanged since\n___.\n\nSubpleural left atelectasis in the right lung probably rib is due to prior\npleural abnormality, now includes a small region of rounded atelectasis,\nposterior basal segment right lower lobe, 6:227.\n\nThere are no bone findings in the chest cage suspicious for malignancy.  Mild\nloss of height in mid thoracic vertebral bodies is long-standing.",
            "output": "No evidence of intrathoracic malignancy.  2 small lung nodules a been stable\nsince ___.  There are no new or growing lung nodules.  2 subcentimeter right\nlung nodules, Extensive right pleural thickening and Borderline adenopathy\nthroughout the mediastinum has all been stable since ___.\n\nAtherosclerotic calcification, moderate to severe in the head and neck\narteries and moderate in the coronaries.\n\nMild bronchiectasis, right lung, probably inert."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen\npelvis CT report dictated under clip ___.\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement. The airways are patent to the subsegmental level.  A right\nperiesophageal lymph node at the thoracic inlet remains stably enlarged\nmeasuring 10 mm in short axis (5:9). Other mediastinal lymph nodes are notable\nfor number rather than size and appear unchanged. There is no mediastinal,\nhilar or axillary lymph node enlargement by CT size criteria. Heart,\npericardium and great vessels are within normal limits. Moderate coronary\nartery calcifications and descending thoracic aortic calcifications are\nunchanged.  No hiatal hernia is present.\n\nThere is stable appearance of multiple pulmonary nodules in the right upper\nlobe (6: 103 and 134), in the right lower lobe (6:166 and 177), in the left\nupper lobe (6:96 and 146) and a granuloma in the left lower lobe.  No new\nnodules are detected. No pleural effusion or pneumothorax is present.\n\nOsseous and soft tissue structures: No lytic or sclerotic lesions suspicious\nfor malignancy is present.  Right mastectomy and flap reconstruction noted.",
            "output": "Stable appearance of the chest with unchanged borderline lymph nodes in the\nmediastinum and hila and stable pulmonary nodules."
        },
        {
            "input": "Patient has had right mastectomy and reconstruction.  There is no\nsupraclavicular or axillary lymph node enlargement or any soft tissue lesion\nin the chest wall suspicious for malignancy. Evaluation of the breasts\nrequires mammography.\n\nFindings below the diaphragm will be reported separately. Small low\nattenuation lesion in the right lobe of the thyroid is unchanged since at\nleast ___. No additional investigation is recommended. \nAtherosclerotic calcification is generally mild in the head and neck vessels\nbut significant in the left common carotid artery, 5:1, mild and mild in the\ncoronary arteries.  Aorta and pulmonary arteries are normal size.  There is no\npericardial or pleural abnormality. Central\n lymph node enlargement has changed minimally:\n\nAt the thoracic inlet 10 x 21 mm, 04:14, previously 10 x 17 mm ;\n\nIn the right upper paratracheal station, 9 x 14 mm, 04:20, previously 8 x 10\nmm;\n\nRight hilus, 11 x 17 mm, 5:138, previously 14 x 15 mm.\n\nMultiple cm size or smaller lymph nodes in the lower paratracheal stations are\nstable.\n\nThere are no new lung nodules, and a handful of sub cm lung nodules is\nunchanged in size (5: 117, 132, 173, 185)\n\nThere are no bone lesions in the chest cage suspicious for malignancy. Mild\ncompression of several mid thoracic vertebral bodies is unchanged since\n___.",
            "output": "No strong evidence for active intrathoracic malignancy. With the exception of\nslight growth in a solitary thoracic inlet lymph node, mildly enlarged and\nborderline size mediastinal lymph nodes and sub cm lung nodules continue to be\nunchanged, stable since ___.\n\nHeavy calcification, left common carotid artery, could be hemodynamically\nsignificant."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged, and.  However it is\ncalcified granuloma Excluding the breasts which require mammography for\nevaluation, there are no soft tissue abnormalities in the chest wall\nsuspicious for malignancy.  Findings below the diaphragm will be reported\nseparately.\n\nSmall lucencies in the thyroid do not warrant further imaging evaluation. \nAtherosclerotic calcification is moderate to heavy in the head and neck\nvessels, particularly so in the midportion of the left subclavian artery which\nmay be occluded.  Atherosclerotic calcification is much less severe in the\ncoronaries involving at least the LAD and right coronary branches.  Aorta and\npulmonary arteries are normal size and free of central filling defects.\n\nCharacteristic among numerous, measurable central lymph nodes are as follows:\nThoracic inlet, 14 x 22 mm, 05:56, was 12 x 26 mm in ___ and 10 x 25 mm in\n___.\nRight upper paratracheal, 9 x 11 mm, 5:87, unchanged since ___.\nUpper pole right hilus, 16 x 21 mm, 5:123, was 11 x 17 mm in ___.\nLower paraesophageal, 14 x 16 mm, 5:213, was 8 x 14 mm in ___.\n\nMild circumferential right pleural thickening is stable since ___ and there\nis no appreciable effusion.\n\nThere are no lung nodules suspicious for malignancy.\n\nSmall region of peribronchial thickening and minimal bronchiectasis in the\nright upper lobe, 5:103, it is stable.  Linear scarring in the right middle\nlobe is been present since at least ___.\n\nA sub cm triangular nodule in the lingula, 5:153 is unchanged since at least\n___, probably a benign lymphoid aggregate\n\nCalcified granuloma in the left lower lobes unchanged.  There is no evidence\nof active granulomatous infection.\n\nMild loss of height in several mid and lower thoracic vertebral bodies is\nunchanged since at least ___ and does not appear pathologic.  There are\nno destructive bone lesions.",
            "output": "Among many long-standing, borderline and mildly enlarged mediastinal lymph\nnodes, only 2 are minimally larger today than in ___ and there are no newly\nenlarged lymph nodes.\n\nNo lung or bone lesions suspicious for malignancy.\n\nAtherosclerosis involving the coronaries, but most seriously the left\nsubclavian artery."
        },
        {
            "input": "MEDIASTINUM/HEART:  Two small right thyroid nodules, the largest of which\nmeasuring 6 mm, are unchanged since the prior study (5:8).  The aorta and main\npulmonary artery are normal in size.  No pulmonary artery filling defect\ndetected.  Heart size is normal.  The left coronary artery is heavily\ncalcified.  Atherosclerotic calcifications are moderate in the head and neck\nvessels and in the aortic arch.  No pericardial effusion.\n\nMultiple previous central lymph nodes have decreased in size, as follow:\n18 x 11 mm thoracic inlet (6:50), previously 22 x 14 mm\n9 x 8 mm right upper paratracheal (6:83), previously 11 x 9 mm\n19 x 11 mm upper right hilar node (6:125), previously 21 x 16 mm\n15 x 9 mm lower paraesophageal (6:214), previously 16 x 14 mm\n\nLUNGS/AIRWAYS:  Mild right basilar atelectasis/ scarring is unchanged.  No\npleural effusions.  Previous area of peribronchial thickening and minimal\nbronchiectasis in the right upper lobe is unchanged (6:113).  Linear scarring\nin the right middle lobe has been present since at least ___. \nTriangular lymphoid aggregates in the left upper lobe and lingula are\nunchanged since ___ (6:136, 196).  No new or growing nodule\ndetected.  Left lower lobe calcified granuloma is unchanged since the prior\nstudy (6:196).\n\nUPPER ABDOMEN:  Please refer to the dedicated CT abdomen and pelvis report of\nthe current date for the subdiaphragmatic findings.\n\nSOFT TISSUES/BONES:  Patient is post right mastectomy with reconstruction. \nLoss of height of several mid and lower thoracic vertebral bodies is unchanged\nsince at leads ___ and does not appear pathologic.  Multiple small bone\nislands in the right humeral head are unchanged.  No focal blastic or lytic\nlesion concerning for malignancy.",
            "output": "1.  No evidence of active malignancy or active granulomatous infection.\n\n2.  Please refer to the dedicated abdomen and pelvis report of the current\ndate for the subdiaphragmatic findings."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are normal in\ndiameter.  No pathologically enlarged supra clavicular, mediastinal or hilar\nlymph nodes demonstrated.  Heart size is normal.  There is no pericardial\npleural effusion.\n\nAirways are patent to the subsegmental level bilaterally.  3 mm solid\npulmonary nodule, series 3, image 42 is in left upper lobe.  No other nodules,\nmasses or consolidations demonstrated.\n\nThe patient is after right breast surgery and right upper lobe subpleural\ninterstitial opacities consistent with postradiation changes after breast\ntreatment.  There are no lytic or sclerotic lesions worrisome for infection or\nneoplasm.",
            "output": "No evidence of intrathoracic metastatic disease definitely seen.\n\nLeft upper lobe single nodules at this exam most likely benign\n\nStatus post right breast surgery and right breast radiation with mild\npostradiation changes."
        },
        {
            "input": "MEDIASTINUM/HEART:  The thyroid is normal. Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged by CT size criteria. Aorta\nand pulmonary arteries are normal in size.  Coronary artery and aortic valve\ncalcifications are present. Heart size is normal without pericardial effusion.\nIncidental note is made of the right chest port, with tip terminating in the\nmid to lower SVC.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level.  There\nposterior bowing of the tracheal wall.  There is very mild dependent bibasilar\natelectasis. Lungs are otherwise clear without focal consolidation or pleural\neffusion. No pulmonary nodules detected.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate subdiaphragmatic\nstructures.  Within these limitations, note is made that the patient is post\ncholecystectomy and prior hepaticojejunostomy.  The spleen measures 12.3 cm,\npreviously 12.7 cm.  The pancreas is atrophic but unremarkable.  The adrenals\nare unremarkable.  Visualized portions of the kidneys are unremarkable.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Moderate degenerative changes of the thoracic spine, including\ndisc space narrowing, osteophytosis, and vacuum disc phenomena, are present. \nVacuum phenomenon and degenerative change in the left glenohumeral joint.",
            "output": "1.  No evidence of pulmonary mass or nodules.\n2.  No lymphadenopathy detected.\n3.  Possible tracheomalacia."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain. \nSpecifically, the abnormality noted on CTA head and neck from ___\nis artifactual.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There trace bilateral\nnonhemorrhagic pleural effusions.\n\nModerate left lower lobe and lingular atelectasis with mild right lower lobe\natelectasis is noted.  Scattered ground-glass opacities involving the right\napical and right upper lobe posterior segments are noted (06:55, 84).  No\ncavitary lesion.  No pneumatocele.  The airways are patent to the subsegmental\nlevel.\n\nLimited images of the upper abdomen are notable for diffuse hepatic steatosis.\n\nThere are minimally displaced left anterior second and third rib fractures\nwith nondisplaced fractures along the anterior fourth, fifth and sixth ribs. \nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Multiple left-sided rib fractures involving the anterior second through\nsixth ribs.  No pneumothorax.\n3.  Ground-glass opacities in the right apical and right lobe posterior\nsegment suggestive of pulmonary contusion given recent chest trauma however\naspiration and early pneumonia would be similar in appearance.\n4.  Hepatic steatosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:54 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The abnormality detected on the recent chest radiograph corresponds to on\nosseous excrescence at the third and fourth costovertebral joints with\nassociated joint space narrowing and sclerosis extending into the adjacent\nribs.  There is no evidence of a discrete lung parenchymal abnormality in this\nregion such as a mass or consolidation.\n\nLungs are notable for several calcified granulomas in the right upper lobe,\nand the presence of 2 mm noncalcified nodules in the right middle lobe (112,\n4) and right upper lobe (87, 4), and a 3 mm right middle lobe nodule (134,4). \nAdditionally, a larger subpleural nodular opacity is present in the left lower\nlobe posteriorly measuring 7 mm in greatest width with contiguous linear\nopacities (116, 4) and an adjacent area of smooth pleural thickening and\nincreased extrapleural fat.  Although nonspecific, this is most likely due to\nan area of nodular scarring or atelectasis.  A small juxta fissural nodular\nopacity in the left lower lobe is likely an intrapulmonary lymph node.\n\nThere are no enlarged intrathoracic lymph nodes.  Heart size is normal, and no\npericardial or pleural effusion is evident.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of an atrophic appearance of the patient's native kidneys as well as\nsmall focal calcifications in the midpole portion of both kidneys.  The liver\nis relatively hyperdense suggesting the possibility of amiodarone therapy or\niron overload syndromes.\n\nNo suspicious lytic or blastic skeletal lesions are detected.  Multilevel\ndegenerative changes are present in the spine.",
            "output": "1.  Chest radiographic abnormality corresponds to degenerative osseous\nchanges.  There is no evidence of active pulmonary infection.\n\n2.  Evidence of previous granulomatous exposure, with small calcified\ngranulomas.\n\n3.  Noncalcified nodular opacities measuring up to 7 mm are statistically very\nlikely benign.  In the absence of older CT scans for comparison, consider a\n___ month follow-up CT to ensure stability."
        },
        {
            "input": "HEART AND VASCULATURE: Mild atherosclerotic calcifications of the thoracic\naorta and at the origin of the head and neck vessels.  Severe coronary\ncalcifications.  Moderate calcifications of the aortic annulus.  The ascending\naorta is dilated measuring 4.0 x 3.9 cm.  There is also borderline enlargement\nof the main pulmonary artery, which suggests pulmonary arterial hypertension. \nOtherwise, the heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The patient is status post right lower lobe wedge resection. \nNodular consolidation with traction bronchiectasis within the right lower lobe\nis stable since ___ compatible with radiation fibrosis.  Multiple small\npulmonary nodules are stable compared to the CT dated ___.  The\nlargest within the right middle lobe measures 6 mm (series 4, image 119). \nMultiple calcified granulomas bilaterally.  No new or growing lung nodules. \nNo new focal consolidations.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Gallbladder is collapsed, however there is gallbladder wall\nthickening, similar compared to ___.  No other abnormalities\nwithin the partially visualized upper abdomen.\n\nBONES AND SOFT TISSUES: A punctate calcification is seen within the left\nbreast.  Suture anchors are seen within the right humeral head.  Severe\ndegenerative changes within the shoulder joints bilaterally.  No suspicious\nosseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Status post right lower lobe wedge resection with atypical radiation\nfibrosis, stable since ___.  Pulmonary nodules measuring up to 6 mm, also\nstable since ___.  No new or growing nodules.  No lymphadenopathy.\n2. Dilated ascending aorta measuring 4.0 cm.\n3. Gallbladder wall thickening, similar compared to ___, but should be\nfollowed up with a right upper quadrant ultrasound if not already performed.\n\nRECOMMENDATION(S):  Right upper quadrant ultrasound."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nwithin normal limits.  There is no axillary or supraclavicular\nlymphadenopathy.  There is no soft tissue chest nodularity.  CT is not\noptimized for visualization of breast parenchyma; however, left breast\npunctate calcification is again seen.  Correlation with mammography may be\nhelpful\n\nUPPER ABDOMEN: Partially visualized upper abdomen is without acute pathology. \nGallbladder remains collapsed.\n\nMEDIASTINUM: Subcarinal lymph node measures 1.4 cm in short axis (series 5;\nimage 119).  An additional pretracheal lymph node is mildly enlarged,\nmeasuring 1.1 cm in short axis (series 5; image 103).  Both of these lymph\nnodes are unchanged compared to ___.  There are stable small\nmediastinal lymph nodes.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There are extensive coronary artery calcifications,\nsimilar to prior exam.  Heart is top-normal in size.  No pericardial effusion.\nThe ascending aorta remains d top-normal in size, measuring 4.0 cm in\ndiameter.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\n\nPARENCHYMA: Patient is status post right lower lobe wedge resection.  Adjacent\nto this wedge resection, there is increasing infiltrative consolidation with\nincreasing soft tissue component, which has slowly grown since ___, and now\nmeasures  5.0 x 6.8 x 3.5 cm (previously 3.3 x 6.7 x 2.8 cm in ___,\nand most likely represents lepidic adenocarcinoma carcinoma of the lung.\n(series 7; image 76).\n\nThere is a 7 mm nodule in the right upper lobe (series 5; image 143,\npreviously 7 mm in ___.  There are additional 4 mm (series 5; image\n134) and 3 mm nodules (series 5; image 152) in the right upper lobe, unchanged\ncompared to prior in ___.  There is a 4 mm nodule in the left upper lobe\n(series 5; image 133), unchanged.  An additional left upper lobe nodule\nmeasures 3 mm (series 5; image 136) and is also unchanged.  Multiple bilateral\ncalcified granulomas are again seen, unchanged.\n\nAIRWAYS:  Airways are patent to the subsegmental level.\n\nVESSELS:  Main pulmonary artery is also top-normal in size, which may\nrepresent sequela of pulmonary hypertension.\n\nBones:: There are no concerning sclerotic or lytic lesions.  There is no\nthoracic compression deformity.",
            "output": "1. Status post right lower lobe wedge resection with increasing infiltrative\nconsolidation and soft tissue opacity adjacent to the surgical sutures.  This\narea has slowly grown since ___ and now measures 5.0 x 6.8 x 3.5 cm\n(previously 3.3 x 6.7 x 2.8 cm in ___.  These findings are concerning\nfor recurrence and could represent lepidic adenocarcinoma.\n2. Stable pulmonary nodules.  No new pulmonary nodules.\n3. Stable small mediastinal lymph nodes.\n4. Unchanged dilation of the ascending aorta, measuring 4.0 cm."
        },
        {
            "input": "CHEST PERIMETER: No detectable thyroid.  Super clavicular and axillary lymph\nnodes are not enlarged.  Breast evaluation is reserved exclusively for\nmammography.  There are no findings elsewhere in the chest wall concerning for\nmalignancy. This study is not appropriate for subdiaphragmatic diagnosis, but\nthere is no adrenal mass.\n\nCARDIO-MEDIASTINUM:Mid esophagus is moderately patulous, distended with air,\nnot fluid.  There is no indication of obstruction but functional assessment\nwould require a contrast swallow.\n\nAtherosclerotic calcification is moderately heavy in head and neck vessels,\nsevere in the coronary arteries.  Ascending thoracic aorta is mildly dilated\nin a fusiform fashion, up to 42 mm, unchanged, above the level of a minimally\ncalcified aortic valve.  Hypoattenuation of cardiac contents indicates anemia.\nPulmonary arteries are normal size.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are neither pathologically\nenlarged nor growing, ranging in diameter up to 11 mm in the subcarinal\nstation, previously 13 mm.\n\nLUNGS, AIRWAYS, PLEURAE: Mild-to-moderate generalized subpleural interstitial\npulmonary abnormality is unchanged since ___, slightly more severe today\nthan in ___.  There are no clear findings of fibrosis.  Abnormality could be\nrelated to aging, cigarette smoking, or asbestosis.  Clinical correlation\nadvised..\n\nThe overall volume of the region of irregular consolidation in the right lower\nlobe extending from the superior segment to lateral basal segment has not\nchanged since ___.  It grew from ___ to ___, and before that\nit changed in consistency but not overall size between ___ in ___.  Adjacent pleura is thickened and partially calcified, but there is no\neffusion and the adjacent ribs are intact.  This is probably a chronic and\nstable abnormality, best explained if patient has a history of local\nradiation.\n\nVery small pleural calcifications are scattered elsewhere in the chest.  The\ndistribution is not typical of asbestos related plaques, but the diagnosis is\nnot excluded.\n\nThere are no new or growing lung nodules.  3-5 mm solid nodules, left upper\nlobe, 4:64, 92, 95, 110 are all unchanged since ___.\n\n\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Long-standing right lower lobe consolidation has not expanded further since\n___, relatively unlikely to represent tumor recurrence, best confirmed\nby either PET CT scanning or direct sampling.  Differential diagnosis includes\nchronic infection or recurrent aspiration or (given the appropriate clinical\nhistory) chronic radiation change.  Adjacent band of pleural calcification is\nprobably related to the underlying pulmonary pathology.\n\nAtherosclerosis, severe in coronary arteries.  Stable mild dilatation\nnoncalcified ascending thoracic aorta.\n\nProbable anemia.\n\nScattered small pleural calcifications could be due to asbestos exposure. \nRaise possibility that the mild persistent interstitial abnormality is\nactually asbestosis rather than smoking or age related interstitial disease."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Left breast implant (2, 12).  Mild\ndilatation of the main pulmonary artery.  Extensive coronary calcifications,\nmoderate aortic valve calcifications.  No pericardial effusion.  The posterior\nmediastinum is unremarkable.  No acute abnormalities in the upper abdomen. \nModerate scoliosis and moderate to severe degenerative vertebral changes.\nStable small calcifications.  Stable mild subpleural fibrosis, predominating\nin the subpleural lung zones and showing several areas of more nodular\nconsolidations (4, 98) all of which are stable.  The fibrosis is more\nexpressed adjacent to the wedge resection site in the right lower lobe. \nStable appearance of several partly lobulated pulmonary nodules, for example\nin the right lower lobe (4, 127).  No new or growing nodules.  No pleural\neffusions.  The airways are patent.",
            "output": "Stable appearance of the known subpleural fibrosis.  Stable consolidation\nadjacent to resection area in the right lower lobe.  Stable partly lobulated\nand calcified pulmonary nodules"
        },
        {
            "input": "HEART AND VASCULATURE: Mild cardiomegaly.  No pericardial effusion. Severe\ncalcified coronary atherosclerosis.  Mild aortic valve calcification. \nUnchanged mild dilation of the ascending thoracic aorta with a diameter of 4.2\ncm.  No evidence of dissection or penetrating atherosclerotic ulcer formation.\nMild aortic and great vessel origin atherosclerosis.  The main pulmonary\nartery is mildly dilated to 3.1 cm, unchanged.  No evidence of pulmonary\nembolus to the subsegmental level.\n\nAXILLA, HILA, AND MEDIASTINUM: Unchanged 1.1 cm subcarinal lymph node (Series\n3, image 44).  Prominent right hilar lymph nodes measure up to 9 mm, as seen\npreviously.  No axillary lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Compared to 2 days prior, there is new and increased diffuse\nbronchial wall thickening.  There is mild interlobular septal thickening. \nThere is unchanged subpleural likely age-related fibrosis.  A right lower lobe\nconsolidation adjacent to a right lower lobe wedge resection appear slightly\nincreased since 2 days prior, previously unchanged since at least ___,\npossibly related to volume overload or decreased lung volumes.  There are\nmultiple small pulmonary nodules measuring up to 6 mm in the right middle lobe\n(series 4, image 106).  No new or enlarging nodules.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Incidental replaced right hepatic artery arising from the superior\nmesenteric artery.  Small hiatal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild thoracic spine degenerative changes.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Mild new pulmonary edema.\n3. Apparent increase in a chronic right lower lobe consolidation may be due to\ndecreased lung volumes.\n4. Unchanged pulmonary nodules measuring up to 6 mm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Evaluation of the thyroid gland is\nlimited due to streak artifact from dental amalgam.  No evidence of axillary\nor supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Severe atherosclerotic calcifications of the abdominal aorta. \nOtherwise, the abdomen is unremarkable.\n\nMEDIASTINUM: Paratracheal lymph nodes measuring up to 6 mm is unchanged from\nprior (series 4, image 79).  No evidence of mediastinal lymphadenopathy.\n\nHILA: No evidence of hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is mildly enlarged.  There is severe coronary\nartery atherosclerotic disease.  No pericardial effusion.\nPLEURA: Small bilateral pleural effusions.  No evidence of pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Patient is status post right lower lobe wedge resection. \nAdjacent to the right lower lobe wedge resection is a region of consolidation\ndemonstrating increased bronchiectasis and minimally increased in size\nmeasuring 6.3 x 5.0 cm (series 4, image 130) by the view to of 5 mm in each\ndirection.   Additional regions of subpleural fibrosis along the right upper\nlobe with regions of nodularity is overall unchanged compared to prior (series\n4, image 86), as well as bilateral subpleural areas of interstitial fibrosis..\nUnchanged 7.0 cm nodule with adjacent ground-glass opacity (series 602, image\n39 and series 4, image 109).  Left lower lobe 3 mm nodule, series 4, image 136\nis stable.  Septal wall thickening is demonstrated in the lower lobes\nbilaterally.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  Evaluation of the vasculature is limited given lack of\nintravenous contrast.  Redemonstrated ascending aortic aneurysm measures 4.4\ncm, previously 4.2 cm.\n\nCHEST CAGE: No evidence of fracture or suspicious osseous lesion.",
            "output": "1. Redemonstrated region of consolidation in the right lower lobe adjacent to\nprevious right lower lobe wedge resection demonstrates increased\nbronchiectasis and minimal increase in size from prior.\n2. Regions of subpleural fibrosis, predominantly in the right upper lobe, are\nstable as well as subpleural interstitial changes in both upper lobes and left\nlower lobe..\n3. Mild septal thickening in the lower lobes suggests mild pulmonary edema.\n4. 4.4 cm ascending aortic aneurysm is stable.\n5. Mild cardiomegaly with severe coronary artery atherosclerotic disease"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nheart is normal in size.  There is mild atherosclerotic calcification\ninvolving the thoracic aorta and coronary arteries.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally.  Limited evaluation of lung parenchyma due to expiratory phase\nscanning and respiratory motion artifact.  There are bilateral lung scattered\nground-glass opacities in a peripheral distribution and most significant in\nbilateral lower lobe consistent with known COVID-19 pneumonia.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a gastric tube partially visualized.  Included portion of\nthe upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nThere are moderate multilevel degenerative changes of the lower cervical and\nthoracic spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral lungs scattered ground-glass opacities in a peripheral\ndistribution and most significant in bilateral lower lobe consistent with\nknown COVID-19 pneumonia."
        },
        {
            "input": "The base of neck is unremarkable.  The thoracic aorta is normal in course and\ncaliber without appreciable atherosclerosis.  The heart is normal in size and\nshape without pericardial effusion.  The main pulmonary artery measures 2.6\ncm.  There is no filling defect within the pulmonary arterial tree through the\nsegmental level.  Distal valuation is limited due to patient motion.  There is\nno mediastinal, axillary or hilar adenopathy.  A tiny righta posterolateral\ntracheal diverticulum is noted in the base of neck.\n\nMild emphysema noted.  No worrisome nodule, mass, or consolidation is seen\nwithin the lungs.\n\nBones: Unremarkable.",
            "output": "No pulmonary embolism or other acute process in the chest.  Motion limited\nexam."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:   There is mild centrilobular emphysema.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Normal sized mediastinal lymph nodes are\nvisualized (2, 22).  No coronary calcifications.  Mild aortic valve\ncalcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  No osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.  Mild degenerative vertebral disease.  No vertebral\ncompression fractures.\nMinimal scarring at the lingular basis (4, 121).  No suspicious pulmonary\nnodules or masses.  No other parenchymal abnormalities, in particular no\nevidence of pneumonia.  The airways are patent and unremarkable.",
            "output": "Mild scarring at the lingular basis.  No evidence of pneumonia.  No airway\nabnormalities.  No lymphadenopathy.  No pleural abnormalities."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged. \nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities elsewhere in the chest wall concerning\nfor malignancy.\n\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is mildly patulous but otherwise unremarkable. \nAtherosclerotic calcification is not apparent in head and neck or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: No thoracic lymph nodes are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: 3 mm subpleural nodule right lower lobe, 3:219, is\nnew or newly apparent since imaging in ___ using thicker, 3 mm,\ncollimation.  14 mm solid right lower lobe nodule, 3:250, is new.\n\nNew in the left lung are these nodules, 5 mm, left lower lobe, 3:226, and 10\nmm, left upper lobe, 3:155.\n\nTracheobronchial tree is normal to subsegmental levels.  Pleural surfaces are\nnormal.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Four small lung nodules, in 4 different lobes, new since ___ are most\nlikely metastases.  No adenopathy or pleural abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings in the\nthyroid.  There is no pathologic enlargement of lymph nodes in the\nsupraclavicular or axillary stations.  No evidence of metastasis in the chest\nwall.\n\nCHEST CAGE: There is no evidence of osteo destructive lesions at the level of\nvertebra, ribs or sternum.\n\nUPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for\ncomplete description of subdiaphragmatic findings.\n\nMEDIASTINUM: There is no pathologic enlargement of lymph nodes in the\nmediastinum.  Posterior mediastinum is unremarkable.  Bilateral hilar lymph\nnodes measure up to 0.8 cm, unchanged and not pathologically enlarged (3:137,\n123).\n\nHEART and PERICARDIUM: The heart is normal in size.  There are no appreciable\natherosclerotic calcifications of the coronaries.  Main pulmonary artery is\nnormal in diameter, and suboptimal opacification of pulmonary vasculature\nreveals no central filling defects.  There is no pericardial effusion.\n\nPLEURA: There is no pleural effusion.  The mild biapical pleuroparenchymal\nscarring is stable.\n\nLUNG: Multiple pre-existing metastatic nodules are larger in comparison to\n___, the largest is 4.1 x 2.7 cm left lower lobe mass, in prior 0.6\ncm (3:173), the mass abuts the left ventricle pericardium but there is no\npericardial and no pleural effusion or any other signs of invasion.\nLeft upper lobe 1.4 cm metastatic nodule was 1 cm in prior (03:118).\nAnother example is a right lower lobe dependent 2.7 cm metastatic nodule, in\nprior 1.4 cm (3:106).  The nodule abuts the pleura but there are no signs of\npleural or chest wall invasion.  Adjacent 0.5 cm right lower lobe nodule is\nmildly larger (3:172).\nThere are no new measurable pulmonary nodules.",
            "output": "Disease progression with interval enlargement of multiple pre-existing\npulmonary metastasis measuring up to 4.1 cm in the left lower lobe.  While the\nlargest mass in the left lower lobe abuts the left ventricle pericardium,\nthere is no evidence of pericardial or pleural invasion, attention on follow\nup. No new measurable pulmonary metastasis."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no stable small bilateral axillary lymph nodes.\nMEDIASTINUM:  There are stable small mediastinal lymph nodes.  Heart size is\nnormal. There is no pericardial effusion.  The aorta and pulmonary arteries\nare normal in caliber. The airways are patent up to the subsegmental level.\nThere is no pericardial effusion.\n\nPLEURA: There is no pleural effusion\n\nLUNG: Multiple bilateral pulmonary metastasis are again seen.  The left lower\nlobe mass now measures 6.4 x 4.6 cm as compared to the prior measurements of\n4.5 x 3.5 cm.  The right lower lobe mass has also increased in size and now\nmeasures 3.6 cm it previously measured 2.6 cm.  The left upper lobe nodule now\nmeasures 1.7 cm as compared to the prior measurements of 1.4 cm.  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Patient status post left nephrectomy.",
            "output": "Progressive increase in size of multiple pulmonary metastases as described\nabove.  No new pulmonary nodules.\n\nStatus post left nephrectomy.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  Main\npulmonary artery diameter is normal.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.\n\nHeart size is normal.  There are no significant coronary artery or valvular\ncalcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral lung metastases are bigger, with measurements as\nfollows:\n\n1. A dominant mass in the left lower lobe measures 7.6 x 5.7 cm (5:233),\npreviously 5.7 x 4.3 cm\n2. A posterior right lower lobe mass measures 4.3 x 2.5 cm (5:247), previously\n3.4 x 2.1 cm\n3. A 2.1 cm left upper lobe mass, abutting the mediastinum (5:163) previously\nmeasured 1.9 cm.\n4. A 0.8 cm right lower lobe mass (5:210), previously measured 0.5 cm\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is post left nephrectomy, without evidence of recurrence in\nthe surgical bed.  The right kidney is normal in size and demonstrates a\nnormal nephrogram.  No focal right renal lesions are seen.  There is no right\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  There is large stool burden.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES:  There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of pulmonary embolism.\n2. Interval enlargement of bilateral lung metastases, as detailed above,\ncompatible with progression of disease.\n3. No evidence of metastatic disease in the abdomen or pelvis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 5:23 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the imaged portion of the thyroid warrant\nany further imaging. Supraclavicular and axillary lymph nodes are not\nenlarged. Breast evaluation is reserved for mammography.  Findings below the\ndiaphragm will be reported separately.  Hypervascularity in the right lower\nparaspinal chest wall musculature is probably related to the adjacent lung and\npleural mass, despite interval involution. There is no clearly discernible\nmass in the soft tissues of the chest wall.\n\nCARDIO-MEDIASTINUM:Mid and lower esophagus are moderately patulous but there\nis no retention of fluid or other evidence of obstruction.\n\nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are normal size.  This study is not\ndesigned for pulmonary arterial evaluation but does show that there is no\nlarge filling defect in central pulmonary vessels.  There is no pericardial\neffusion despite large contiguous masses.  In the mediastinum and left lung.\n\nTHORACIC LYMPH NODES:\nNo new or growing central adenopathy.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\n6 mm right lower lobe nodule, 4:213, was 8 mm in ___.\n\n32 x 20 mm right lower lobe nodule, inseparable from the adjacent, non\nthickened pleura, was 37 x 26 mm in ___ x 23 mm left upper lobe mass, 4:153, was 14 x 19 mm in ___, and now has\ngreater extension into the mediastinum, and is inseparable from the left\natrial appendage.\n\n47 x 65 mm left lower lobe mass, previously 43 x 57 mm, has extended to a\ngreater degree in 2 pericardium perhaps the posterior wall of the left atrium\nand the underside of the left hilum.  However her contiguous mass, in the left\nlower lobe has involuted substantially, previously 18 x 20 mm, currently only\n3 x 20 mm.\n\nNo pleural effusion or nodulation remote from lesions with probable direct\npleural involvement.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Mixed treatment response relative to ___, as follows: 2 right lung\nmetastases are smaller, 2 left lung lesions are larger with greater local\npleural extension into the mediastinum, and one left lung lesion is\nappreciably smaller."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No other abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, aorta or cardiac\nvalves.  The pulmonary arteries and aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  Mild bilateral apical scarring.\n\nLUNGS:\nMetastatic lesions to the lungs, previously mentioned, as follows: Small\nsubpleural nodule measuring 6 mm in the right lower lobe (4: 185), unchanged. \nSubpleural lung mass in the right lower lobe (4:210) measuring 3.1 x 2.1 cm,\nrelatively unchanged.  Subpleural paramediastinal mass in the left upper lobe\n(4:159) is larger and now measures 2.7 x 1.1 cm (previously 2.1 x 1.2 cm). \nThe large perihilar mass in the left lower lobe (4:209) is smaller and now\nmeasures 5.9 x 4.7 cm (previously 6.5 x 4.7 cm) however shows now new adjacent\nconsolidations extending to the left lung base (4:246).\nThe airways are patent to subsegmental levels with no bronchiectasis, mucous\nplugging or bronchial wall thickening.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "Mixed response of several metastatic subpleural lung lesions.  New\nconsolidations in the left lung base are very low in attenuation and could\neither represent postobstructive infection or new metastatic disease.\nNo new lymphadenopathy or osseous lesions."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is a small pericardial effusion which has slightly increased\nin volume since the prior study.  The aorta and pulmonary arteries are normal\nin caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Multiple bilateral pulmonary masses have increased in size example the\nmass abutting the left ventricle now measures 3 cm it previously measured 2.7\ncm.  Similarly the mass in the left lower lobe abutting the left ventricle has\nalso increased in size and now measures 6.2 x 4.8 cm as compared to the prior\nmeasurements of 5.9 x 4.7 cm.  The right lower lobe mass has also increased in\nsize and now measures 3.3 by 2.3 cm it previously measured 3.1 x 2.3 cm.  The\nlow-density lesions peripherally in the left lower lobe are unchanged.  No new\npulmonary metastasis are seen.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with degenerative\nchanges involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows patient status\npost left nephrectomy.",
            "output": "Mild increase in size of multiple bilateral pulmonary metastasis. No new\npulmonary nodules.\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The head is unremarkable.  No\nevidence of axillary or supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: The study is not tailored for evaluation of the abdomen. \nAllowing for this, the partially visualized upper abdomen demonstrates\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: Evaluation of the hila is  limited by lack of intravenous contrast.  The\nhilar contours are within normal limits.\n\nHEART and PERICARDIUM: Cardiac size is within normal limits.  No interval\nchange of known pericardial effusion.  The aorta and pulmonary arteries are\nnormal in caliber.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  There are numerous pulmonary masses which have demonstrated no\ninterval increase in size.  For example the pulmonary mass that abuts the left\nventricle history is 6.0 x 4.6 cm, (series of image 236) and previously\nmeasured 6.2 x 4.8 cm.  At the right lower lobe could be pulmonary mass that\nmeasures 3.2 x 2.2 cm, (series 5, image 264) ,previously measured 3.3 x 2.3\ncm, relatively unchanged when accounting for differences in measuring\ntechnique.  At the lateral basal segment of the right lung is a 7 mm\nsubpleural pulmonary nodule (series 5 image 220), unchanged.\n\n\n1. AIRWAYS:  The airways are patent the subsegmental level\nCHEST CAGE: The soft tissue structures are mildly diffusely demineralized.  No\nevidence of concerning osseous lesion.",
            "output": "No interval increase in size or number of bilateral pulmonary metastasis.  No\nevidence of new pulmonary metastasis or pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is\nunremarkable.  Supraclavicular and axillary lymph nodes are not enlarged.\n\nUPPER ABDOMEN: Please see the separately dictated CT abdomen and pelvis report\nperformed concurrently for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.\n\nHILA: Hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is mildly enlarged, unchanged.  Further\ninterval increase in size of a large pericardial effusion, currently measuring\nup to 1.8 cm adjacent to the left ventricle (02:52), previously measuring 1.2\ncm.  The thoracic aorta is normal in caliber without atherosclerotic plaque.\n\nPLEURA: No pneumothorax.  Trace left pleural effusion.\n\nLUNG:\n\n1. PARENCHYMA: Mild biapical pleuroparenchymal scarring.  Numerous pulmonary\nmasses remain overall unchanged compared to prior study.  For instance, the\nnecrotic mass abutting the left ventricle measures 6.0 x 4.6 cm (302:202),\nwith concern for possible pericardial invasion (302:185), unchanged.  The\nnecrotic mass abutting the left atrium measures 3.2 x 1.8 cm (302:147),\nunchanged.  A necrotic subpleural mass at the right lower lobe measures 3.0 x\n2.1 cm (302:215), unchanged when accounting for differences in measurement\ntechnique.  There is a 6 mm subpleural nodule at the posterior right lung base\n(302:188), also unchanged.  No new suspicious pulmonary nodules or masses\nidentified.  Mild bibasilar atelectasis.\n2. AIRWAYS:  Airways are patent to the subsegmental level bilaterally.\n3. VESSELS:  The main, right and left pulmonary arteries are normal in\ncaliber.  While this study is not optimized for the detection of pulmonary\nemboli, no central filling defect is seen.\nCHEST CAGE: No acute fracture or suspicious lytic or sclerotic osseous lesion\nis detected.",
            "output": "1.   Interval increase in size of a large pericardial effusion.  No definite\ncompression of the heart is seen on imaging, however close attention on\nfollow-up is recommend.\n2. Stable appearance of numerous necrotic pulmonary masses as described above,\nunchanged compared to prior study from ___.  The largest mass\nabutting the left ventricle measures up to 6.0 cm with concern for possible\npericardial invasion.\n3. No evidence of new pulmonary nodules or masses identified.\n4. Trace left pleural effusion.\n5. For complete description of subdiaphragmatic findings, please see dedicated\nreport of CT abdomen/pelvis performed concurrently the same day."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.  Large pericardial effusion is stable in appearance.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small bilateral pleural effusions, new since the prior CT with\nnew atelectasis at each lung base, left greater than right..  No pneumothorax.\n\nLUNGS/AIRWAYS: Again seen are multiple pulmonary masses, overall similar in\nsize to prior study.  The dominant mass in the left lower lobe measures 3.8 x\n5.9 cm.  The lesion abuts the pericardium with possible invasion.  The\ndominant right-sided subpleural mass measures 2.2 x 3.4 cm (series 2, image\n88).  Other metastases are also not significantly changed within anticipated\nmeasurement reproducibility over the short time frame.  No evidence of new\npulmonary nodules.  Bibasilar atelectasis without evidence of focal\nconsolidation.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Partly imaged stomach is mildly distended.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No definite short-term change in metastatic necrotic pulmonary metastasis.\n3. Large pericardial effusion is stable in appearance.\n4. Small new bilateral pleural effusions with atelectasis, left greater than\nright."
        },
        {
            "input": "BASE OF NECK: The visualized base of the neck is unremarkable.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged .\n\nCARDIO-MEDIASTINUM: The thoracic aortic is normal in caliber. The pulmonary\narteries are normal caliber. The heart is not enlarged. There is no\npericardial effusion.\n\nAIRWAY: The airways are patent to the segmental level.\n\nLUNGS: Multiple pulmonary masses are again seen, including:\n\n-7 mm pleurally based right lower lobe, unchanged (302:148)\n-3.3 x 1.9 cm pleurally based right lower lobe, previously 2.9 x 1.7 cm\n(302:173)\n-2.1 x 1.8 cm left upper lobe abutting the pericardium with possible invasion,\npreviously 3.0 x 2.2 cm (302:120)\n-4.7 x 5.4 x 6.0 cm left lower lobe abutting the pericardium with possible\ninvasion, previously 4.6 x 5.9 x 6.6 cm (302:175)\n-3.3 x 1.2 cm pleurally based left lower lobe, previously 3.5 x 1.5 cm\n(302:201)\n\nPLEURA: There is no pleural effusion.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning. Evaluation of breast is reserved exclusively\nfor mammography; there is a new 0.8 cm enhancing lesion in the right breast.\n\nUPPER ABDOMEN: Please refer to separate report on same-day CT abdomen/pelvis\nfor description of the abdominal findings.",
            "output": "1. Interval decrease in size of multiple metastatic pulmonary masses.  No new\nmasses are identified.\n2. Interval resolution of bilateral pleural effusions.  Interval resolution of\npericardial effusion.\n3. No evidence of pulmonary embolism or aortic abnormality.\n4. New 0.8 cm enhancing lesion in the right breast.  Diagnostic Breast Care\nevaluation is recommended.\n\nRECOMMENDATION(S):  Diagnostic Breast Care evaluation as described above.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:36 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "HEART AND VASCULATURE: Study is mildly limited in the setting of motion\nartifact.  Within these limitations, the pulmonary vasculature appears well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  Extensive left hilar lymphadenopathy is new compared to the prior\nstudy, with greater invasion of the mediastinum and pericardium (401: 237,\n257).  The more superior lymph node appears to impinge upon the left atrium\n(401:237).\n\nPLEURAL SPACES: No pneumothorax.  Small nonhemorrhagic left pleural effusion\nis new compared to the prior study, likely reactive.\n\nLUNGS/AIRWAYS: Mild biapical pleuroparenchymal scarring.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nMultiple pulmonary masses are overall increased in number and size compared to\nthe prior study.  For instance:\n\n-A subpleural right lower lobe nodule measures 7 mm (401:269), unchanged from\nprior study.\n-A pleural-based right lower lobe mass measures 2.9 x 1.7 cm (401:310),\nunchanged.\n-Similar appearance of a left upper lobe mass abutting the pericardium with\npossible invasion, measuring 2.4 x 1.8 cm (401:220), previously measuring 2.1\nx 1.8 cm.\n-A large left lower lobe mass abutting the pericardium with possible invasion,\nmeasuring 4.4 x 5.3 x 6.6 cm (41:300, 402:78), previously measuring 4.7 x 5.4\nx 6.0 cm.\n-A pleural based mass in the left lower lobe measures 3.2 x 1.3 cm (401:338),\nunchanged.\n-Multiple additional new nodular opacities in the left lower lobe appear\nhighly concerning for worsening metastatic disease, much less likely to\nrepresent postobstructive areas of infection.  For instance, there is a\nconfluent opacity measuring up to 3.0 cm at the right lung base (401:337), and\nsmaller opacities measuring 12 mm (401:297), 15 mm (41:310), and 14 mm\n(401:310), all of which are new compared to the prior study from ___.\n\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please note that the current study is not tailored for\nsubdiaphragmatic evaluation.  Within these limitations, the included portion\nof the upper abdomen appears unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Study is mildly limited in the setting of motion artifact.  Within these\nlimitations, no evidence of pulmonary embolism or acute aortic abnormality.\n2. Multiple metastatic pulmonary masses as described above, overall increased\nin number and size compared to the prior study.  Multiple additional new\nnodular opacities in the left lower lobe appear highly concerning for\nworsening metastatic disease.  Findings are much less likely to represent\npostobstructive areas of infection, however this cannot be excluded.\n3. New extensive left hilar lymphadenopathy with greater invasion of the\nmediastinum and pericardium, severely impinging on the left atrium.\n4. Small nonhemorrhagic left pleural effusion, new compared to the prior study\nand likely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid gland is hypotrophic without evidence of large nodules.  Stable small\naxillary and thoracic inlet lymph nodes.  Partially imaged chest wall shows no\nabnormalities.  No atherosclerotic calcifications in head and neck arteries.\n\nMEDIASTINUM AND HILA:\nEsophagus is mildly patulous without evidence of distal obstruction.  A large\nmultilobular soft tissue mass extends inferiorly from the left prevascular\nspace lateral to the pulmonary artery for over 10 cm now losing the previously\npreserved fat plane with the pericardium posterior to the left ventricle\n(3:47), thus suggesting pericardial infiltration.  The bulk of this mass\nprotrudes into the left lower lobe and left hilum encasing but not externally\ncompressing the bronchovascular structures.  The complete mass is difficult to\nmeasure due to widespread distribution but ___ up to 10.6 x 5.4 x 6.1\ncm (5:163, 196, 8:81).  There are no other mediastinal or right hilar enlarged\nlymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nHeart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in coronary arteries, cardiac valves and aorta.\nAorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No evidence of diffuse\nground-glass opacities that could suggest exogenous pneumonitis.  No bronchial\nwall thickening, bronchiectasis or mucus plugging.  No pleural effusions or\nthickening.  Mild biapical pleuroparenchymal scarring.\n\nStable right lower lobe 7 mm nodule (5:190).  The right lower lobe 17 x 29 mm\n(5: 223) and the left lower lobe 33 x 14 mm (5:252) subpleural masses are\nunchanged in the interval.  Left lower lobe nodular opacities described as new\nin the prior report most likely represented a pulmonary venous infarction\nsecondary to subsegmental pulmonary vein thrombosis, now evolved into a 16 mm\nconsolidated cavitated nodule (5:253).  Adjacent to it, a new 20 x 24 mm\npleural based soft tissue nodule is concerning for new metastatic involvement\n(5:253), however, it could also correspond to sequelae from infarction.  A new\nadjacent small left pleural effusion has developed in the interval.\n\nCHEST CAGE:\nNo acute fractures.  Minimal dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals are unremarkable.",
            "output": "Large mediastinal soft tissue lesion extending inferiorly from the left\nprevascular space into the left hilum and posterior to the pericardium is not\nsignificantly changed in size or morphology, however, there is loss of the fat\nplane with the pericardium posterior to the left ventricle suggesting\ninfiltration.\n\nThe evolving left lower lobe consolidative opacity appears denser today with\ninternal cavitation and is most likely sequelae of prior venous infarction.  A\nnew adjacent soft tissue mass, although possibly related to a second sequelae\nof pulmonary venous infarction, could also correspond to a new metastatic\nlesion.  The remaining bilateral pleural based metastatic nodules are stable\nin the interval.\n\nNo evidence of pneumonitis."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are multiple small mediastinal lymph nodes, not\nsignificantly changed since the prior study.  The right lower paratracheal\nnode measures 6 mm in short axis.  The subcarinal lymph node measures 1 cm in\nshort axis.  The left hilar lymph nodes have significantly decreased in size\nsince the prior study.\n\n\nPLEURA: The left pleural effusion has significantly improved since the prior\nstudy and is now trace volume.\nLUNG: The dominant left lower lobe mass encasing the left lower pulmonary\nvein, abutting the descending thoracic aorta has significantly decreased in\nsize since the prior study, it now measures approximately 4.6 x 4.5 cm in its\nwidest ___ it previously measured 4.7 x 4.5 cm.  The extension of the\nmass along the descending thoracic aorta has significantly improved (3, 76).\n\nMultiple bilateral pulmonary metastasis predominantly within both lower lobes\nare again seen the right lower lobe mass has decreased in size it now measures\n2.4 cm it previously measured 2.9 cm.  Similarly all the nodules and masses\nwithin the left lower lobe have also improved.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Please refer to dedicated report on abdomen which has been\ndictated separately for further details.",
            "output": "Significant decrease in size of the left lower lobe mass which extends along\nthe left inferior pulmonary vein and abuts the descending thoracic aorta.\nNear complete resolution of the left pleural effusion.\n\nMultiple pulmonary metastasis within both lower lobes have decreased in size. \nNo new pulmonary nodules\n\nPlease refer to dedicated report on abdomen which has been dictated separately\nfor further details."
        },
        {
            "input": "The thyroid is not visualized.\n\nThere is no axillary or mediastinal lymphadenopathy.\n\nA 2.2 x 1.7 cm left perihilar lesion abutting the mediastinum previously\nmeasured 2.1 x 1.5 cm at the same level (series 14, image 140).  A left lower\nhilar mass or node measures 2.4 x 2.2 cm, previously 2.3 x 1.8 cm (series 14\nimage 180).\n\nA left basilar mass measuring 3.9 x 3.9 cm previously measured 4.1 x 4.0 cm at\nthe same level (series 14, image 223).  Adjacent atelectasis and fibrosis\nappears grossly similar in comparison to the CT from ___ (series 14,\nimage 254, 226).  Areas of soft tissue thickening related to the fibrosis and\natelectasis measure up to 8 mm in thickness, similar to the prior study\n(series 14, image 267).\n\nA subpleural right lower lobe mass measuring 2.2 x 1.7 cm previously measured\n2.3 x 1.8 cm (series 14, image 253).\n\nA 0.5 x 0.5 cm right lower lobe subpleural nodule previously measured 0.6 x\n0.6 cm (series 14, image 222).\n\nNo new pulmonary nodule or mass is seen.\n\nThe great vessels are patent and normal in caliber.  No pulmonary embolus is\ndetected to the proximal subsegmental levels.\n\nThe airways appear patent to the subsegmental levels, with the exception of\nthe left lower lobe, where there is atelectasis associated with the main mass,\nas detailed above.\n\nThere are no osseous lesions concerning for malignancy or infection.\n\nPlease refer to the separate abdominopelvic dictation regarding\nsubdiaphragmatic findings.",
            "output": "1. Known left perihilar, left lower lobe, and right lower lobe masses and\nnodules are minimally changed in comparison to the CT examination from ___, as detailed above.  There is no CT evidence of disease progression in\nthe chest.\n2. Please refer to the separate abdominopelvic dictation regarding\nsubdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: The first set of images were limited due to poor\ncontrast timing.  On these images, there was a possible filling defect within\nthe left main pulmonary artery (series 2 image 24).  The subsequent images\nwere severely limited due to respiratory motion artifact.  However, on these\nimages the left main pulmonary artery appears patent without filling defects. \nNo other evidence of large central pulmonary embolism within the above\nlimitations.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Please note the lung apices are not completely imaged on this\nexamination.  Mild dependent atelectasis.  No focal consolidations.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "The first set of images were limited due to poor contrast timing. On these\nimages, there was a possible filling defect within the left main pulmonary\nartery (series 2 image 24).  The subsequent images were severely limited due\nto respiratory motion artifact. However, on these images the left main\npulmonary artery appears patent without filling defects.  No other evidence of\nlarge central pulmonary embolism within the above limitations."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The large mediastinal vessels are unremarkable.  No\nincidental pulmonary embolism.  All visible lymph nodes in the mediastinum (5,\n18) and at the level of the hilar structures are normal.  Moderate coronary\ncalcifications, normal size of the cardiac structures.  No pericardial\neffusion.  The posterior mediastinum is unremarkable, with the exception of a\nsmall hiatal hernia.  Upper abdominal findings, including a noncontrast\nopacified spot in the right renal vein, are described in detail in the\ndedicated abdominal CT report.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.\nThe assessment of the lung parenchyma is limited by moderate respiratory\nmotion artifacts.  Minimal left apical scarring.  No suspicious pulmonary\nnodules or masses.  No diffuse lung disease.  The airways are patent.  No\nevidence of pleural abnormalities.",
            "output": "No lymphadenopathy.  No pleural abnormalities.  No suspicious lung nodules or\nmasses.  A contrast void in the right pulmonary vein is described in detail in\nthe dedicated abdominal CT report."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is\ntop-normal.  There is prominence of the left ventricular apex, unchanged since\nprior examination.  There is interval development of moderate right pleural\neffusion and ascites.\n\nThe studies done during end expiration.  The trachea and bronchi are in the\nshape of expiration.  There is extensive areas of air trapping.  No\nconsolidations, masses or pulmonary nodules seen.  No interstitial abnormality\npresent.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nNo pathologically enlarged mediastinal, hilar or axillary lymphadenopathy is\npresent.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval development of moderate right pleural effusion and partially imaged\nascites\n\nLeft ventricular enlargement\n\nDiffuse air trapping.  No new pulmonary nodules masses or consolidations\ndemonstrated."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.\n\n THORACIC INLET: Left-sided pacemaker is unchanged.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is moderate to severe cardiomegaly.  There is diffuse\nthickening of the distal esophagus which could represent a small hiatus\nhernia.  No pericardial effusion.  There is moderate coronary artery\ncalcification\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Evaluation of lung parenchyma is somewhat limited by respiratory motion.\nThere is bibasilar atelectasis.  No new or growing pulmonary nodules are seen.\nMinimal bibasilar atelectasis\n\nBONES AND CHEST WALL : Review of bones shows evidence of median sternotomy. \nSternal sutures are intact.",
            "output": "No evidence of pulmonary embolism.  Discontinuous atherosclerotic\ncalcification involving the arch and descending thoracic aorta.  No evidence\nof aortic aneurysm or dissection.\n\nModerate to severe cardiomegaly.  Left-sided pacemaker.\n\nNo new or growing pulmonary nodules.  No evidence of edema."
        },
        {
            "input": "Heterogeneous appearance of the right lobe of the thyroid is unchanged.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size.  There is mild cardiomegaly. \nThere are severe calcifications in all coronary arteries.  Patient is status\npost CABG.  Pacer leads are in standard position.  Few micronodules are stable\n(4:97).  Small area of subpleural ground-glass opacity in the superior segment\nof the left lower lobe is more conspicuous than before, could correspond\natelectasis but attention in followup study is recommended (4:95).  There is\nno pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation , there is\nsmall hiatal hernia, there is fatty infiltration of the liver.  Right adrenal\nnodule is stable, an adenoma measuring 9 mm.\nThere are no bone findings of malignancy",
            "output": "Subpleural ground-glass opacity in the superior segment left lower lobe is\nmore conspicuous than before followup in 6 months is recommended could be\natelectasis, small area of hemorrhage (4:95) indolent malignancy cannot be\ntotally excluded\nStable right adrenal nodule\nFatty liver\n\nRECOMMENDATION(S):  Followup CT in 6 months"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions. \nLeft prepectoral biventricular pacemaker in situ with the tips in the\nappropriate positions.  No axillary adenopathy.  Mild bilateral gynecomastia.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No hiatal hernia.  Evidence of prior cholecystectomy.  Small\nsubcentimeter hepatic hypodense lesion (cyst or hamartoma) in the right lobe\nof liver.  Evidence of prior cholecystectomy.  No adrenal lesions.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: No pericardial effusion.  Enlarged left atrium.  Severe\ncalcification of the native coronary arteries.  Evidence of prior CABG\nprocedure.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  The previously noted ground-glass opacity in the superior\nsegment of the left lower lobe (5, 113) Is less conspicuous compared to prior\nstudy done ___.  Minimal residual ground-glass opacity in the lung\nbases in the previously noted areas of consolidation/pneumonia.  No confluent\nairspace consolidation.  No diffuse lung disease.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Evidence of prior midline sternotomy.  Mild spondylotic changes of\nthe thoracic spine.  No lytic/destructive bony lesions.",
            "output": "The previously noted ground-glass opacity in the superior segment of the left\nlower lobe is less conspicuous compared to prior study done ___. \nNo further follow-up required.\n\nContinued resolution of the previously noted bilateral lower lobe airspace\nconsolidation/pneumonia."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare extensive.  Heart size is normal.  There is no mediastinal, hilar or\naxillary lymphadenopathy.  No pericardial pleural effusion is present.\n\nImage portion of the upper abdomen reveals no appreciable abnormality\n\nAirways are patent to the subsegmental level bilaterally.  There is interval\nresolution of left lower lobe consolidation.  No new pulmonary nodules masses\nor consolidations seen.\n\nNo lytic or sclerotic lesion worrisome for infection or neoplasm demonstrated.",
            "output": "Interval resolution of left lower lobe pneumonia.  Essentially clear lungs. \nUnchanged findings associated with previous CABG and pacemaker placement."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  The left-sided PICC line tip is\nprojecting cranially, the distal tip is not visualized on the scan.  It needs\nto be repositioned\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal or hilar lymph nodes.  The\nesophagus is patulous and dilated with oral contrast extending up to the neck.\nSurgical clips are seen along the descending thoracic aorta (2, 15), most\nlikely related to prior surgery.  There is moderate cardiomegaly.  There is\nmoderate coronary artery calcification.  There is no pericardial effusion.\n\n\nPLEURA: There are small bilateral pleural effusions left greater than right.\nLUNG:\nEvaluation of lung parenchyma is limited by respiratory motion.  No large\nmasses or nodules are seen. Bands of atelectasis are seen in the right upper\nlobe lingula and both lung bases and also the right middle lobe.\n\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows ascites. \nThere is stranding in the abdomen",
            "output": "Small bilateral pleural effusions with bibasilar atelectasis.\n\nThe left-sided PICC line projects cranially and needs to be repositioned.  The\nteam is aware of the abnormal position of the PICC line.\n\nBibasilar atelectasis.  Limited evaluation due to respiratory motion. \nScattered bands of atelectasis.\n\nDistended stomach.\n\nAscites.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "Supraclavicular nodes are not enlarged.  Axillary nodes range up in diameter\nup to 8 and 9 mm on the left, 03:12, 17, 19.\n\nExcluding the breasts which require mammography for evaluation, there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic diagnosis, recently assessed by CT\nof the abdomen and pelvis on ___, reported separately.\n\nAtherosclerotic calcification is not apparent in the head and neck vessels or\ncoronaries.  Thyroid is unremarkable.  Aorta, pulmonary arteries and cardiac\nchambers are normal size.  Mediastinal and hilar lymph nodes are not enlarged\nand there is no adenopathy in the internal mammary, retrocrural, or\ndiaphragmatic stations.  Minimal pleural effusions layer posteriorly, not\nclinically significant.  There is no pericardial abnormality. Hiatus hernia is\nsmall.\n\nThere are no focal pulmonary abnormalities.  Mild heterogeneity in the\nbackground density of the left lower lobe could be due to scattered areas of\natelectasis or, less likely, air trapping.\n\nThere are no bone abnormalities in the chest cage suspicious for malignancy or\ninfection.  The extradural in the cervicothoracic spine is better demonstrated\non the MR of that area, ___, reported separately.",
            "output": "Minimal bilateral pleural effusion, probably not clinically significant.  No\nadenopathy or other evidence of intrathoracic malignancy.\n\nCervicothoracic extradural spinal mass, better demonstrated on MR, ___,\nreported separately."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\n\nAxillary, supraclavicular, mediastinal, and hilar lymph nodes are not\npathologically enlarged.  Mild to moderate cardiomegaly is seen. The\npericardium is intact without effusion.  Airways are patent to the\nsubsegmental levels.\n\nBibasilar atelectasis is again noted.  Subtle 7 mm ground-glass opacity in the\nright upper lobe is unchanged from prior and likely represents scarring (5:7).\nLeft lingular nodular opacities is again seen and stable (05:50). The pleura\nis intact without effusion. No pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  H-shaped appearance of the vertebral bodies are compatible with\nknown sickle cell.",
            "output": "1. No evidence of pulmonary embolism.\n2. Mild to moderate cardiomegaly.\n3. Subtle ground glass opacity in the right upper lung and nodular left\nlingular opacity are stable.\n4. H-shaped vertebral bodies compatible with known sickle cell disease."
        },
        {
            "input": "CTA THORAX: The main thoracic vessels are well-opacified.  The aorta\ndemonstrates normal caliber without evidence of intramural hematoma or\ndissection.  The aortic arch branches are normal in appearance.  The main,\nright, and left pulmonary arteries are well-opacified. There is no evidence of\nlobar, segmental, or subsegmental intraluminal filling defect. No\narteriovenous malformation is detected.\n\nCT OF THE THORAX:  The airways are patent to subsegmental levels. \nWell-demarcated anterior mediastinal soft tissue density may represent thymic\nhyperplasia, and is unchanged since ___. There is moderate to severe\ncardiomegaly, with biventricular enlargement.  There is no pericardial\neffusion.  There is no mediastinal, hilar, axillary, or supraclavicular\nlymphadenopathy.  The esophagus is normal without evidence of hiatus hernia.\n\nIll-defined nodular opacities in the right middle and lower lobe could\nrepresent a very early pneumonia.  Streaky opacities at the lung bases are\ncompatible with dependent atelectasis.  The remainder of the lungs are clear.\nThere are right greater than left small bilateral layering simple pleural\neffusions.\n\nAlthough this study is not designed for assessment of intra-abdominal\nstructures, the visualized solid organs and the stomach are unremarkable.\n\nOSSEOUS STRUCTURES:  The imaged thoracic vertebral bodies demonstrate normal\nalignment. H-shaped vertebral bodies are compatible with known sickle cell\ndisease, unchanged from prior exam. There is no evidence of fracture. There\nare no concerning osteolytic or osteosclerotic lesions identified.",
            "output": "1. No evidence of pulmonary embolism.\n2. Ill-defined nodular opacities within the right middle and lower lobes may\nrepresent early pneumonia.\n3. Moderate to severe cardiomegaly.\n4. Small right greater than left layering simple pleural effusions.\n5. Anterior mediastinal soft tissue may represent thymic hyperplasia,\nunchanged since prior exam."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  The aorta measures\n3.2 cm with no evidence of penetrating atherosclerotic ulcer or aortic arch\natheroma present.\n\nThe main pulmonary artery is normal in caliber measuring 2.9 cm in diameter.\nThe left and right pulmonary arteries are normal in caliber. The pulmonary\narteries are well opacified to the subsegmental level, with no evidence of\nfilling defect within the main, right, left, lobar, segmental pulmonary\narteries.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nResidual thymic tissue is again seen.  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There are bilateral small\npleural effusions and a small amount of fluid is seen tracking into the right\noblique fissure.\n\nStable nodular opacity/scarring in the right apex (series 301, image 35). \nThere are a few punctate nodules peripherally in the right upper lobe (for\nexample series 301, image 56 and 69), these are nonspecific.  No new focal\nairspace opacification/consolidation seen.  Again seen is a area of airspace\nopacification in left lung base which likely represents atelectasis.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a calcified shrunken spleen.\n\nAgain seen are the H-shaped vertebral bodies and multiple areas of sclerosis\ninvolving the sternum and ribs, in keeping with history of sickle cell\ndisease.",
            "output": "No evidence of pulmonary hypertension or aortic abnormality.  No acute\npulmonary parenchymal abnormality seen.\n\nSmall bilateral pleural effusions and subsegmental atelectasis in the left\nlung base.\n\nUnchanged findings as described above consistent with the known history of\nsickle cell disease."
        },
        {
            "input": "HEART/VASCULATURE:\n\nAssessment of the pulmonary vasculature is partially degraded by motion\nartifact.  The pulmonary arteries are well opacified to the segmental level\nwith no evidence of filling defect within the main, right, left, lobar or\nsegmental pulmonary arteries.  Subsegmental arteries are inadequately\nassessed.  The main and right pulmonary arteries are normal in caliber.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. No other acute\naortic abnormality or significant aortic atherosclerosis evident.\n\nThere is moderate global cardiomegaly.  There is no evidence of right\nventricular strain.  There is no pericardial effusion.\n\nAIRWAYS/LUNGS:\nThe airways are patent to the subsegmental level.\nLung apices are excluded from the field of view.  There is opacification of\nthe lung parenchyma in the of lower lobes bilaterally which demonstrate\nadequate enhancement.  There is small bilateral pleural effusions.\n\nMEDIASTINUM/LYMPH NODES:\nNo mediastinal, or hilar lymphadenopathy. No other mediastinal abnormality.\n\nBONES/CHEST WALL:\nNote is again made of H-shaped vertebral bodies and patchy sclerosis\nthroughout the vertebra, sternum and bilateral ribs in keeping with history of\nsickle cell disease.  There is no destructive bone lesion.\n\nUPPER ABDOMEN:\nLimited images of the upper abdomen demonstrates hepatomegaly and absence of\nthe spleen consistent with sickle cell disease.",
            "output": "1. No evidence of pulmonary embolism in the main, right, left, lobar or\nsegmental pulmonary arteries.\n2. Small bilateral pleural effusions.\n3. Opacification of the lung parenchyma in the lower lobes may be secondary to\ncompressive atelectasis although acute chest syndrome cannot be excluded.\n4. Global cardiomegaly, bony sclerosis, H-shaped vertebral bodies and absence\nof the spleen consistent with sequela of sickle cell disease."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  There is\ncardiomegaly.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There are small bilateral\npleural effusions decreased from prior study.\n\nThere is minimal bibasilar atelectasis improved from prior study.  The airways\nare patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate a small calcified spleen\nconsistent with auto infarction..  Incidental note is made of a replaced left\nhepatic artery on series 5 ___ 99.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is increased sclerosis in the vertebral bodies and ribs in keeping with\na history of sickle cell disease.  There are H-shaped vertebrae.  These\nchanges are stable.",
            "output": "1.  no evidence of pulmonary embolism or aortic abnormality.\n2.  small bilateral pleural effusions decreased from prior study\n3.  Improved atelectasis in the lower lobes\n4.  stable cardiomegaly, osseus sclerosis an H-shaped vertebral body and small\ncalcified spleen consistent with sickle cell disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart size is moderately enlarged.  The main\npulmonary artery is 3.4 cm, which can be seen in pulmonary artery\nhypertension.  No pericardial effusion is seen.  There is mild thymic\nhyperplasia.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is interval decrease in size of previously seen small\nbilateral pleural effusions from ___, now trace in size.\n\nLUNGS/AIRWAYS: Stable nodular opacity or scarring is noted in the right upper\nlobe (3:48).  There is a stable 2 mm pulmonary nodule in the right upper lobe\n(3:14).  There is mild atelectasis in the dependent lung bases.  Otherwise,\nthe lungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Diffuse sclerotic and heterogeneous appearance of the osseous\nstructures likely reflect bone infarcts from known sickle cell disease.  There\nis no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Moderate cardiomegaly, trace pleural effusions.\n3. Dilated main pulmonary artery is 3.4 cm, likely reflect pulmonary arterial\nhypertension.\n4. Diffuse sclerotic and heterogeneous appearance of the osseous structures in\nkeeping with bone infarcts from known sickle cell disease."
        },
        {
            "input": "There are no enlarged mediastinal, hilar, or axillary lymph nodes.  Heart size\nis normal and there is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.  Paucity of subcutaneous fat in the chest and abdominal wall is\nconsistent with reported anorexic state.\n\nAssessment of the lungs is somewhat limited due to respiratory motion, most\nmarked in the lower lungs, reducing sensitivity for small pulmonary nodules\nand subtle interstitial abnormalities.  With this limitation in mind, there is\nno CT evidence of suspicious lung nodule or mass to suggest primary or\nmetastatic malignancy in the thorax.  Note is made of mild centrilobular\nemphysema, nonspecific biapical scarring, and minimal bibasilar linear\natelectasis.",
            "output": "1.  No CT evidence of primary lung malignancy.  Motion artifact limits\nassessment of the lung bases.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Thyroid gland enhances homogeneously.\n\nNo axillary lymphadenopathy.  Mediastinal lymph nodes are not pathologically\nenlarged by CT size criteria.  The largest right paratracheal node measures up\nto 7 mm in short axis (3:60).  There are also There is bilateral hilar\nlymphadenopathy, 1.1 cm on the right, and 1.3 cm on the left.\n\nHeart size is normal.  Coronary artery calcifications are diffuse.  There is a\nsmall nonhemorrhagic pericardial effusion, minimally increased from ___.  Thoracic aorta is normal in course and caliber, containing moderate\natherosclerotic calcifications along course.  There is a filling defect in the\nmedial segmental branch of the right middle lobe pulmonary artery (3:137),\nconcerning for pulmonary embolism.  No other filling defects are identified.\n\nThere is diffuse bronchial wall thickening, with areas of probable mucous\nplugging in the segmental left lower lobe bronchi (3:158).  Evaluation of the\nlung parenchyma reveals moderate background centrilobular emphysema. \nPreviously noted ___ opacities in the right upper lobe have improved. \nHowever, there are persistent areas of centrilobular nodularity posteriorly in\nthe right upper lobe (02:38).  There is a moderately-sized right pleural\neffusion, nonhemorrhagic, which has increased from ___.  There is\nadjacent compressive atelectasis.  Areas of nodular pleural thickening along\nthe right upper lobe are again noted, biopsy-proven adenocarcinoma.  No\npneumothorax.\n\nThere is osseous destruction of the right ___, and 9th ribs (3:161,\n602b:10), unchanged from ___.  There is also a mildly displaced\nfracture of the right lateral third rib (3:63), which is new from ___,\nand likely pathologic given the surrounding soft tissue mass.",
            "output": "1. Filling defect in medial segmental branch of the RML pulmonary artery,\nconcerning for pulmonary embolism.  No other filling defects identified.\n2. Diffuse bronchial wall thickening, with probable areas of mucous plugging\nin the segmental left lower lobe bronchi.\n3. Marked nodular pleural thickening along the right upper lobe, biopsy-proven\nadenocarcinoma.\n4. Persistent ___ opacities and centrilobular nodularity in the\nposterior right upper lobe, although improved from ___.\n5. Moderately-sized nonhemorrhagic right pleural effusion with adjacent\natelectasis, increased.\n6. Small nonhemorrhagic pericardial effusion, minimally increased from ___.\n7. Unchanged osseous destruction of the left ___ and 9th ribs. \nMildly displaced left third rib fracture is new from ___.  All are\nlikely pathologic.\n8. Coronary artery calcifications."
        },
        {
            "input": "CHEST:\n\nCoronary artery calcifications noted. Scattered calcifications of the thoracic\naorta, particularly arch, and proximal great vessels.\n\nRight posterolateral chest wall hematoma measuring 16.2 x 5.6 cm (2b:135),\nlocated at or just deep to the latissimus dorsi. No definite active\nextravasation is identified.\n\nModerate right and small left pleural effusions with some compressive\natelectasis. The lung parenchyma is otherwise unremarkable. No pneumothorax.\n\nThe main pulmonary artery is enlarged measuring 4.3 cm. No evidence of\npulmonary embolism.\n\nNo mediastinal, hilar, or axillary lymphadenopathy.\n\nThe partially visualized thyroid is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  Mildly thickened but no discrete lesion is identified.\n\nURINARY:  Multiple renal hypodensities bilaterally, most too small to\naccurately characterize and likely cysts.  There is no evidence of concerning\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Multiple fiducial metallic markers are seen in the\nprostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. IVC filter is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nDegenerative changes of the lumbar spine.\n\nSOFT TISSUES:  Diffuse body wall edema. Multiple small anterior abdominal wall\nhernias containing fat.\n\nThere is a small amount of free fluid in the abdomen and pelvis.",
            "output": "1. Large hematoma in the posterior lateral lower right chest wall. No definite\nactive extravasation is identified.\n2. Moderate right and small left pleural effusions with some compressive\natelectasis.  Overall anasarca.\n3. Multiple small anterior abdominal wall ventral hernias containing fat and\nsome fluid.\n4. No acute intra-abdominal or pelvic process is identified.\n5. Enlarged pulmonary arteries, with the main pulmonary artery measuring up to\n4.3 cm in width."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe main pulmonary artery is dilated to 3.7 cm, suggesting component of\npulmonary hypertension.  There is partial anomalous pulmonary venous return of\nthe left upper lobe with left upper lobe pulmonary vein draining to the left\nbrachiocephalic vein.  The thoracic aorta is normal in caliber without\nevidence of dissection.  The heart is mildly enlarged.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is mild bilateral dependent atelectasis.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nThe partially imaged thyroid gland is grossly unremarkable.\n\nSoft tissues: On series 2, image 39, there is a 1.3 cm soft tissue nodule in\nthe right breast tissue.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates the partially\nimaged liver is diffusely hypodense, suggesting fatty infiltration.  The\npatient is status post cholecystectomy and surgical clips are seen in the\ngallbladder fossa.\n\nBONES: No concerning osteoblastic or lytic lesion is seen.? There is no acute\nfracture.",
            "output": "No evidence of pulmonary embolism or acute aortic dissection.\n\nDilated main pulmonary artery suggests underlying pulmonary hypertension.\n\n1.3 cm right breast soft tissue nodule, no prior for comparison.  Recommend\nfurther assessment with dedicated breast imaging, mammography and possible\nultrasound.\n\nPartial anomalous pulmonary venous return of the left upper lobe with left\nupper lobe pulmonary vein draining to the left brachiocephalic vein."
        },
        {
            "input": "The right lobe of the thyroid is slightly heterogeneous as before. \nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta is normal size.  Main pulmonary artery is enlarged as before measuring\n3.1 cm in maximum diameter.  Cardiac configuration is normal and there is no\nappreciable coronary calcification.  The lungs are clear.  There is no pleural\nor pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nThere are no bone findings of malignancy\nSurgical clips and stranding the fat in the right breast are new.  Fluid\ncollection in the deep subcutaneous tissues in the right breast measuring 6.3\nx 1.4 cm correspond to a seroma",
            "output": "Postoperative changes in the right breast with a small seroma\nStable enlarged main pulmonary artery suggesting the presence of pulmonary\nhypertension.\nNo lung nodules identified"
        },
        {
            "input": "HEART AND VASCULATURE: The main pulmonary artery is dilated, measuring up to\n3.4 cm, previously up to 3.1 cm, which may suggest pulmonary hypertension. \nPulmonary vasculature is well opacified to the subsegmental level without\nfilling defect to indicate a pulmonary embolus.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  There is\nmild cardiomegaly.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bibasilar atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: As before, the right lobe of the thyroid is slightly\nheterogeneous.\n\nABDOMEN: There is hepatic steatosis.  Patient is status post cholecystectomy.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nChest wall: The patient is status post right mastectomy with ___ flap and\nleft breast reduction mammoplasty.  There are multiple clips and\ncalcifications throughout the right breast.  No focal fluid collections are\nseen in the surgical beds.  Soft tissue thickening and stranding in the right\naxilla is likely postsurgical.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Although difficult to clearly assess due to motion, there is possible\nslight interval increase in known main pulmonary artery dilatation suggestive\nof pulmonary hypertension.\n3. Status post right mastectomy with ___ flap without apparent explanation\nfor the patient's right upper extremity swelling.  Soft tissue thickening and\nstranding in the right axilla is likely postsurgical.  However, mammography is\nmore sensitive for the assessment of the breasts and axilla.\n4. Hepatic steatosis."
        },
        {
            "input": "Aorta is normal in contour and caliber.  Central pulmonary arteries are normal\nin size without filling defects.  Previously central pulmonary arteries were\nsubstantially enlarged, which has resolved.  The heart also substantially\nenlarged before also resolved.  The heart is now normal in size.\n\nPatient is status post mastectomies with breast reconstructions, unchanged.\nScar tissue in the right axilla has retracted somewhat.\n\nThere is no pleural or pericardial effusion.  No enlarged lymph nodes are\nfound.\n\nLungs appear clear.\n\nLimited views of the upper abdomen demonstrate persistent probable fatty\ninfiltration based on relative hypoattenuation of the parenchyma.  Patient is\nalso status post prior cholecystectomy.\n\nThere are no suspicious bone lesions.",
            "output": "No evidence of metastatic disease."
        },
        {
            "input": "Aorta is calcified.  No pathologic dilatation of the aorta is demonstrated. \nMain pulmonary artery is dilated up to 3.5 cm concerning for pulmonary\nhypertension.  Left atrial enlargement is more pronounced than on the prior\nstudy, with overall mild dilatation of the heart.  There is no pericardial\npleural effusion.\n\nImage portion of the upper abdomen demonstrates stigmata of known cirrhosis,\nevidence of embolization.  The assessment is difficult in the absence of IV\ncontrast.  Splenomegaly and varices only partially imaged.\n\nFat stranding in the right abdomen is re-demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  Emphysema is\nbilateral predominantly in the upper lobes.  Nodular opacity in the right\nlower lobe most likely represent atelectasis and appears to be improved since\nprevious examination.  Slight interval increase in the atelectasis posterior\nto the aortic arch, series 302, image 71 is noted but no discrete nodule is\npresent.  Potential nodule versus a recess of the pericardial effusion\nanterior to the descending aorta, series 302, image 143 is unchanged.  No new\nnodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No interval progression of metastatic disease demonstrated.\n\nNew areas of atelectasis as described\n\nEnlarged left atrium.\n\nEmphysema"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  The main pulmonary artery is\ndilated, measuring 3.3 cm.  The right pulmonary artery measures 3.0 cm.  Mild\ncalcifications are noted at the aortic valve.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small amount of right dependent nonhemorrhagic pleural\neffusion is new since ___.  No pneumothorax.\n\nLUNGS/AIRWAYS: Anterior segment of the right lower lobe consolidation is\nincreased since prior exam and demonstrate homogeneous attenuation, likely\natelectasis.  Subcentimeter cyst in the left lower lobe is unchanged.  Small\namount of consolidation in the lingula is likely atelectasis.  Centrilobular\nand paraseptal emphysema is noted in the bilateral upper lobes, right greater\nthan left.  Mild peripheral septal thickening is likely due to pulmonary\nedema.  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is diffuse thickening of the peribronchial wall right\ngreater than left.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for nodular liver. \nCalcification between the right and left lobe of the liver is unchanged from\nprior exam and may be posttreatment changes.  The spleen is enlarged,\nmeasuring 14.4 cm.  Trace perihepatic and perisplenic ascites are noted. \nPortacaval lymph node measures up to 10 mm, likely reactive..\n\nBONES: No suspicious osseous abnormality is seen.  There are minimally\ndisplaced fractures of the anterior right second, third and fourth ribs.",
            "output": "1. Minimally displaced fractures of the anterior right second, third and\nfourth ribs.\n2. New small simple appearing right pleural effusion, compressive atelectasis\nin the right lung base.\n3. Mild interstitial pulmonary edema.\n4. No acute pulmonary embolism.\n5. Enlarged pulmonary artery, suggestive of pulmonary arterial hypertension.\n6. Cirrhosis, partially visualized ascites and splenomegaly."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The main,\nleft, and right pulmonary arteries are enlarged.  No pericardial effusion is\nseen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes are\nnoted measuring up to 1.4 cm, similar to prior, and likely reactive.  No\naxillary lymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: There is a moderate nonhemorrhagic right pleural effusion,\nincreased in size compared to prior study.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is compressive atelectasis of the right lower lobe with\nnear complete collapse.  Bilateral septal thickening is consistent with\ninterstitial edema.  Areas of ground-glass opacification are seen in bilateral\nlungs, for example in the right middle lobe (4; 118) and in the left upper\nlobe (4; 94) which may represent alveolar edema, infection, or less likely\nareas of pulmonary contusion.  There is a focal consolidation with air\nbronchograms in the left lower lobe, likely atelectasis or pneumonia.  A cyst\nis again seen in the left lower lobe.  Again seen is peribronchial thickening\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show 2 hypodensities\nin the right thyroid lobe measuring up to 1 cm.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen show a large 1.8 cm\ncalcification between the left and right hepatic lobes, similar to prior\nstudy.  The liver is nodular in appearance.  Hypodensity seen along the\nexpected course of the right portal vein may represent known thrombus.  The\nSMV is not well assessed on this study.  The spleen is enlarged measuring 14.7\ncm.  There is trace perihepatic and perisplenic ascites, similar to prior.\nSoft tissue stranding along the right anterior abdominal wall secondary to\nrecent trauma.  Hyperdensity seen along the undersurface of the diaphragm is\nunchanged compared to prior studies likely of benign etiology.\n\nBONES: No suspicious osseous abnormality is seen.? Anterior right second and\nthird rib fractures are more displaced.  A anterior fracture through the\nfourth rib is similar to prior.",
            "output": "1. Moderate nonhemorrhagic right pleural effusion, increased in size compared\nto prior study, with near complete collapse of the right lower lobe.\n2. Septal thickening consistent with interstitial edema.  Multifocal\nground-glass opacifications may represent alveolar edema and/or areas of\ninfection, pulmonary contusions are less likely.\n3. Left lower lobe focal consolidation may represent atelectasis or pneumonia\nin the appropriate clinical setting.\n4. Prominent mediastinal lymph nodes are likely reactive.\n5. Enlarged pulmonary artery suggestive of pulmonary artery hypertension.\n6. Cirrhotic liver morphology with trace ascites and splenomegaly.\n7. Increased displacement of anterior right second and third ribs.  Stable\nanterior right fourth rib fracture."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is\nunremarkable.  There is no axillary supraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: The liver is cirrhotic.  The lesions described on prior MRI\nliver dated ___ are poorly delineated on this noncontrast CT. \nTreatment cavity in the right lobe of the liver with dense material is again\nnoted..  There is splenomegaly and abdominal varices.\n\nMEDIASTINUM: Mediastinal lymph nodes measuring up to 1.3 and 1.2 cm in the\nright lower paratracheal and subcarinal stations (302:71 and 89) are grossly\nunchanged from CT chest ___.\n\nHILA: No evidence of hilar lymphadenopathy is seen, although evaluation is\nlimited by the absence of intravenous contrast.\n\nHEART and PERICARDIUM: There are mild calcifications of the aortic valve and\ncoronary arteries.  There is no pericardial effusion.\nPLEURA: There is a tiny right anterior pneumothorax.  There is a trace\nnonhemorrhagic right-sided pleural effusion, significantly decreased in size\ncompared to prior chest CT on ___.\nLUNG:\n\n1. PARENCHYMA:  Right-sided chest tube terminates in the right lung base. \nThere are ground-glass opacities in dense consolidations in the right lower\nlobe, improved from ___.  Ground-glass opacities in the lingula are\nnoted and improved in appearance from ___.  Previously characterize\nconsolidation and ground-glass opacity in the left lower lobe has almost\ncompletely resolved.  There is dependent atelectasis in bilateral lower lobes.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery is dilated measuring up to 3.2 cm\n(302:88).\nCHEST CAGE: Subcutaneous emphysema along the right flank is noted, as expected\ngiven interval right-sided chest tube placement.  Acute minimally to mildly\ndisplaced fractures along the anterolateral aspects of the right second\nthrough fourth ribs are grossly unchanged from ___.",
            "output": "1. Status post interval chest tube placement with a tiny anterior right\npneumothorax.  Trace nonhemorrhagic right pleural effusion is significantly\ndecreased in size as compared to CT chest ___.\n2. Ground-glass opacities and consolidation in the right lower lobe are mildly\nimproved since ___ and favor atelectasis rather than infection.\n3. Ground-glass opacities are mildly improved in the lingula and nearly\ncompletely resolved in the left lower lobe compared to CT on ___. \nFindings may represent resolving infectious or inflammatory processes.\n4. Right second through fourth rib fractures are unchanged in alignment.  No\nnew or worsening fracture.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 10:02 pm, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "CHEST PERIMETER: Discrete defects in the right lobe of the thyroid are\nslightly too small to warrant further imaging.  Supraclavicular and axillary\nlymph nodes are not enlarged.  Breast evaluation is reserved for mammography. \nNo soft tissue abnormalities elsewhere originating in the soft tissues of the\nchest wall.  This study is not designed for subdiaphragmatic diagnosis,\nprovided by MR of the liver performed today and reported separately.\n\nCARDIO-MEDIASTINUM:Mid esophagus is more patulous today than before, but free\nof retained fluid.  There is no associated mass and probably no obstruction.\n\nAtherosclerotic calcification is heavy in head and neck vessels, especially\nthe origin of the left subclavian artery.  If atherosclerotic calcification is\nsubstantially less pronounced in left anterior descending and right coronary\narteries.  Aorta is normal size, pulmonary arteries borderline enlarged, but\nas far as one can tell on this study, free of filling defects.\n\nTHORACIC LYMPH NODES: No central lymph nodes are growing.  Numerous cm size\nnodes in the lower paratracheal station and smaller lymph nodes elsewhere are\nstable or decreased in size.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderately severe.\n\nFocal lung lesions as follows:\n\n8 x 4 mm nodule, right lower lobe, 4:160, unchanged since ___.\n\n6 mm right lower lobe nodule, 4:163, previously 4 mm.\n\n7 mm nodule, right middle lobe, 4:180, previously less than 6 mm.\n\nChronic atelectasis right lung base unchanged.\n\nLarge destructive mass, left upper chest centered proximal fourth rib and\npleura extends both into the lung and transthoracicly to the deep musculature\nof the left upper back.  Proximal fourth rib is widely destroyed and there is\ninvasion of at least the left transverse process, though no clear extension\ninto the vertebral canal.  It appears larger, but there is probably an\nartifact of interval biopsy, since the greatest diameter is 50 mm today, and\n44 mm chest 10 days ago.\n\nCHEST CAGE: Healing fracture, lateral aspect right second rib, might not be\npathologic.  No other osseous bone lesions removed from the destructive lesion\nin the left upper back.",
            "output": "Interval growth, since ___ of both the large mass involving lung,\npleura, proximal rib and transverse process, T4 level left upper back.\n\nInterval growth, 2 of the 3 subcentimeter lung nodules right lung.\n\nSevere atherosclerotic calcification head neck vessels, especially left\nsubclavian artery.  Substantially less extensive atherosclerotic calcification\nin the coronaries."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Coronary artery calcifications are mild.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy.  Prominent\nparatracheal and subcarinal lymph nodes measuring up to 1.0 cm in short axis\nare not substantially changed compared to ___ (3:66, 91).  No hilar\nlymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: Trace right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral upper lobe predominately peripheral cystic changes\nare again noted and are not substantially changed.  Atelectasis of the right\nlung base is noted.  New large enhancing mass arising from the posterior wall\nof the left upper lobe measures 3.9 x 3.5 x 3.0 cm and is associated with\nunderlying destruction of the left fourth rib (AP by TRV by SI, 3:41, 602:45).\nNew scattered bilateral pleural nodules are concerning for metastatic foci,\nincluding a small group of pulmonary nodules in the right lower lobe measuring\nup to 9 mm in greatest diameter (3:117).  Additional pulmonary nodules are\nseen as follows 3: 69, 83, 133, 163.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrate a 6 mm\nhypodensity in the right thyroid lobe, which is unchanged compared to ___.\n\nABDOMEN:  Included portion of the upper abdomen is notable for cirrhotic liver\nmorphology as described on prior MRI liver dated ___, trace\nascites, prominent retroperitoneal lymph nodes measuring up to 9 mm, and\nsplenomegaly.  Prominence of the intrahepatic biliary ductal system may be\nsecondary to patient's post-cholecystectomy status.\n\nBONES: There is cortical destruction of the posterior left fourth rib. \nChronic appearing deformity of the anterior left seventh rib is noted. \nChronic anterior right deformities of the second, third, and fourth ribs are\nagain demonstrated.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. New large enhancing mass arising from the posterior wall of the left upper\nlobe with underlying cortical destruction of the left fourth rib is concerning\nfor a new metastatic foci given the history of HCC.\n3. Multiple bilateral pulmonary nodules are new compared to ___ and\nare also suspicious for new foci of metastatic disease.\n4. Trace right pleural effusion.  Trace ascites.\n5. Cirrhotic liver morphology and splenomegaly are better evaluated on prior\nMRI of the liver performed ___.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:21 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is mildly enlarged with mild coronary artery\ncalcifications.  Pericardium and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple enlarged mediastinal lymph nodes are\nnoted as before.  For example a pretracheal node measures 1.0 cm (series 3,\nimage 87).  A subcarinal node measures 0.9 cm (series 3, image 102). \nProminent right hilar lymph node measuring up to 0.7 cm noted.  No axillary\nlymphadenopathy.  No supraclavicular lymphadenopathy.  No mediastinal mass.\n\nPLEURAL SPACES: There is new moderate complex left pleural effusion, with more\ndependent dense material near the lung base which may reflect blood products. \nNo right pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Again seen are multiple pulmonary nodules in the right lung,\nsome which have potentially increased in size while the others are stable. \nSome examples of enlarging nodules are: two 5 mm right lung apex nodules have\nincreased in size on series 3, image 47 and image 40.  A right lower lobe 5 mm\npulmonary nodule has also increased in size.  There is bibasilar atelectasis. \nOtherwise no focal consolidation.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  There is diffuse bronchial wall thickening\nwith scattered mucous plugging in the bilateral lower lobes as before, which\ncould represent chronic airways inflammation/infection.\n\nBASE OF NECK: Visualized portions of the base of the neck again demonstrate\nmultiple hypodense nodules in the right thyroid gland, unchanged, and do not\nmeet size criteria for sonographic imaging follow-up.\n\nABDOMEN: Limited evaluation of the upper abdomen demonstrates cirrhotic liver\nwith a segment IV treatment cavity and additional arterially hyperenhancing\nfoci, better evaluated on prior MRI from ___.  Mild splenomegaly.\nBiliary dilatation is also re-demonstrated.  A ventral hernia containing a\nnonobstructed small bowel loop is also noted.\n\nBONES: Again seen is the large 5.3 x 3.7 cm heterogeneously enhancing mass\ncentered in the left posterior fourth rib involving the adjacent pleura and\nmusculature with osseous destruction, potentially increased in size since ___ at which time it measures 4.9 x 3.8 cm in the the largest\ndimension.  Redemonstration of multiple healed right-sided rib fractures.  No\nnew osseous lesions.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. New, moderate size, complex left pleural effusion which contains layering\nhyperdense material, potentially hemothorax.\n3. Apparent increase in size of the left fourth rib destructive mass and\nmultiple right lung pulmonary nodules worrisome for disease progression.\n4. Stable diffuse bronchial wall thickening with scattered areas of mucous\nplugging, which could represent chronic airways inflammation and/or infection.\n5. Cirrhotic liver with known treatment cavity and small arterially\nhyperenhancing foci, better evaluated on liver MRI from ___.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:44 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts new which require mammography for evaluation, there are\nno soft tissue abnormalities in the chest wall suspicious for malignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, particular in\nlight of a long history of complicated abdominal pathology.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is extremely heavy in head neck vessels, less so\non the coronary arteries.  Aorta and pulmonary arteries are normal size. \nThere is no pericardial or pleural effusion despite ascites small component of\nwhich extends into the foramen of Morgagni just inferior to the xiphoid\nprocess.\n\nCentral adenopathy is new, ranging in diameter up to 16 mm in the right lower\nparatracheal station, 4:  79, smaller in the left lower paratracheal station,\ntop-normal in the subcarinal station, 17 mm in the right paraesophageal\nmediastinal station, 4:127, contiguous with new 15 mm right hilar nodes.  The\nright lower lobe basal trunk is circumferentially narrowed and\nlymphadenopathy, and this is contiguous with wall thickening extending to the\nsegmental right lower lobe bronchi.  Extensive bronchogenic infection,\nconsisting of numerous bronchiolar nodules was present in ___.  This\ncondition has advanced is substantially since then, now affecting all segments\nin both lower lobes except the superior, and the right middle lobe.  There is\nmarked retention of bronchial secretions and large areas of confluent\nconsolidation and particularly deep in the lung bases in both lower lobes and\nin the middle lobe that could be active pneumonia.\n\nWith the severe bronchogenic infection, small lung nodules would be missed but\nthere are several small nodular opacities where it is difficult to distinguish\nthe soft tissue nodule from a mucoid impaction, such as right upper lobe\n4:114.  Nevertheless I favor infection as the cause of all the apical lung\nabnormalities.\n\nThere are no pathologic or compression fractures and no destructive lesions in\nthe chest cage suspicious for malignancy.",
            "output": "Marked worsening of chronic bronchogenic infection, now involving all the\nbasal segments of the lower lobe much of the right middle lobe and even some\nof the right upper lobe.  The pathogens to consider include all mycobacterial\nspecies, including tuberculosis.  New right hilar and mediastinal adenopathy\nis probably reactive.\n\nNOTIFICATION:   Pertinent critical findings were posted by Dr. ___ on\n___ at 09:21 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid is heterogeneous as before. Supraclavicular, axillary, mediastinal\nand hilar lymph nodes are not enlarged. Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal and there is mild calcification\nin all coronary arteries.\nUpper lobe centrilobular emphysema is stable\nBronchiectasis, bronchial wall thickening , multifocal areas of impacted\nbronchi ground-glass opacities throughout the lungs, worse in the lower lobes\nand minimal subpleural reticulation in the lower lobes bilaterally and\n___ opacities in the right lower lobe are grossly unchanged consistent\nwith pneumonia / chronic aspiration.  6 mm nodule in the right lower lobe is\nstable (5:  221)\nThere is no pleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation evidence of\ncirrhosis, splenomegaly and ascites again noted.  Patient has had liver\nresection.  Previously seen lesion in the dome of the liver is not\ndemonstrated in the current study due to the difference in time of the\nacquisition\nThere are no bone findings of malignancy",
            "output": "Emphysema\nBronchiectasis and multifocal pneumonia, grossly unchanged from prior study. \nAs before this is most consistent with recurrence / relapse of infection\nand/or chronic aspiration"
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Evidence of prior hepatic and right upper abdominal surgery. \nPerihepatic free fluid is decreased compared to prior imaging.  Splenomegaly.\n\nMEDIASTINUM: Borderline mediastinal lymph nodes for example right lower\nparatracheal measuring 10 mm in diameter, all demonstrating interval decrease\nin size.  Mildly patulous esophagus.\n\nHILA: Right hilar fullness suggesting right hilar adenopathy, but this also\ndemonstrates interval improvement.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nMild aortic annular calcification.  Mild coronary artery calcification.  No\naneurysmal dilatation of the ascending aorta.  Moderate atherosclerotic\nchanges of the aortic arch and supra- aortic vessels as well as the descending\nthoracic aorta.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Moderate\ncentrilobular and paraseptal emphysematous changes with interstitial\nthickening suggesting smoking related interstitial fibrosis.  All the\nperibronchial nodules, some of which are in a tree in ___ distribution in the\nanterior aspect of the right upper lobe, right middle lobe and bilateral lower\nlobes show interval improvement in size and density.  Mild residual airspace\nopacification in the right lung base (4, 173).  No lobar airspace\nconsolidation.\n-AIRWAYS:  Retained secretions/aspirate present in the right upper lobe, right\nmiddle lobe and bilateral lower lobe segmental and subsegmental bronchi with\nmild cylindrical bronchiectasis as well as bronchial wall thickening in the\nlower lobes bilateral.\n-VESSELS:  The pulmonary artery measures at the upper limits of normal.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Anterior segment of right upper lobe, right middle lobe and bilateral lower\nlobe retained bronchial secretions/ aspirate, bronchial wall thickening,\ncylindrical bronchiectasis and peribronchial nodules most marked in the lung\nbases demonstrating interval improvement compared to most recent CT done ___.\nPlease note that similar changes (but to a lesser degree) were seen on the CT\ndone ___ suggesting chronic, mildly progressive disease with\n___ exacerbations which may represent either recurrence/ relapsing\ninfection or chronic aspiration or a combination of the two processes."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits.  The main pulmonary\nartery is dilated, measuring 3.2 cm across maximal diameter (series 302:85). \nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Mediastinal lymph nodes measuring up to 0.6 cm\nacross short axis in the right lower paratracheal station (series 302:67) are\nnot pathologically enlarged by CT size criteria.  There is no axillary,\nsupraclavicular, or hilar lymphadenopathy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Upper lobe predominant paraseptal emphysema is again noted. \nThere are subpleural reticular changes in the bilateral right worse than left\nlower lobes.  Subsegmental atelectasis is noted in the right lower lobe. \nThere is dependent and subsegmental atelectasis in the right lower lobe.  A\nbleb measuring 1.9 cm across maximal diameter is noted in the left lower lobe\n(series 302:165).  There is no airspace consolidation or suspicious pulmonary\nnodule.  Previously noted subpleural nodule measuring 6 mm seen on CT chest ___ is not visualized.   Bronchiectasis with bronchial wall\nthickening are again noted.\n\nBASE OF NECK: Heterogeneous enhancement of thyroid gland is again noted.\n\nABDOMEN: Patient is status post right partial hepatectomy and TACE. \nPreviously characterized portal venous thrombosis is poorly visualized on this\nstudy due to phase of the study.  Please refer to dedicated CT abdomen and\npelvis yesterday for intra-abdominal findings.  The spleen is enlarged\nmeasuring 14.0 cm across maximal diameter.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of metastatic disease in the chest.  Of note, there is\nsubsegmental atelectasis in the right lower lobe.  Previously characterized 6\nmm nodule in the right lower lobe is poorly visualized due to atelectasis.\n2. Upper lobe predominant paraseptal emphysema and bronchiectasis with\nbronchial wall thickening most prominent in the bilateral lower lobes are\nchronic and unchanged from CT chest ___.\n3. Status post right partial hepatectomy and TACE.  Previously characterized\nportal venous thrombosis poorly visualized on this study due to the phase of\nstudy.  Please refer to dedicated CT abdomen and pelvis dated ___ for intra-abdominal findings."
        },
        {
            "input": "There is a stable tiny hypodense lesion within the right lobe of thyroid. \nThere are no enlarged supraclavicular, axillary, mediastinal hilar lymph\nnodes.  Heart size is top-normal.  The aorta and pulmonary arteries are normal\nin caliber.  There is coronary artery calcification.  The airways are still\npatent up to the subsegmental level.\n\nLungs are well expanded with minimal bibasilar atelectasis.  Scattered\nemphysematous it is within the right upper lobe are again seen and unchanged. \nThere is minimal subsegmental atelectasis in the right lung base.  No new\npulmonary nodules.\n\nReview of bones is unremarkable.\n\nLimited sections through the upper abdomen shows ascites.  Patient is status\npost right partial hepatectomy and TACE. The liver demonstrates heterogeneous\nenhancement throughout mild intrahepatic bile dilatation expanded dilatation\nis again seen.  The gallbladder is not visualized.  The spleen is mildly\nenlarged but unchanged. No adrenal masses are seen.",
            "output": "No evidence of metastasis to the chest.\n\nCirrhosis with evidence of a partial hepatectomy and TACE.\n\nAscites"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal nodes. No\naxillary or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited by respiratory\nmotion.  Within this limitation, 2 mm pulmonary nodule in the left upper lobe\n(3:61).  Mild bibasilar atelectasis.  Otherwise, the lungs are clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Small hiatal hernia.  Otherwise, the included portion of the upper\nabdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism to the segmental level.  No acute aortic\nsyndrome.\n2. 2 mm left upper lobe pulmonary nodule-please see recommendation below.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The main\npulmonary artery is mildly dilated, measuring up to 3.2 cm, which could be\nseen with pulmonary arterial hypertension.  Heart size is normal.  There are\nextensive coronary artery calcifications.  Aortic valvular calcifications are\nalso noted.  No pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: Numerous mediastinal lymph nodes measure up to\n12 mm in the right upper paratracheal station (4:69).  Right hilar lymph nodes\nmeasure up to 14 mm (4:129).  Left hilar lymph nodes do not appear enlarged.\n\nPLEURAL SPACES: Trace bilateral pleural effusions have accumulated compared to\nthe day prior.\n\nLUNGS/AIRWAYS: Bibasilar consolidations have developed from the day prior, and\ncould reflect atelectasis or aspiration.  There is also atelectasis in the\nlingula and right upper lobe.  There is a 4 mm left upper lobe nodule (04:16).\nThere is also a 4 mm right upper lobe nodule (4:99).\n\nBASE OF NECK: Visualized thyroid gland is unremarkable.  There is a 7 mm left\nsupraclavicular lymph node (04:29).\n\nABDOMEN:  Included portion of the unenhanced upper abdomen re-demonstrates\ntrace ascites, as well as gallbladder distension and pericholecystic stranding\ncompatible with acute cholecystitis.  Gallbladder mass is better seen on the\nMRI exam performed earlier in the day.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Interval development of trace bilateral pleural effusions and bibasilar\nconsolidations, which probably reflect atelectasis with aspiration not\nexcluded.\n2. Left supraclavicular, as well as numerous mediastinal and right hilar lymph\nnodes are nonspecific, and could be reactive although metastatic disease\ncannot be fully excluded.\n3. A couple of pulmonary nodules measuring up to 4 mm. Attention on follow-up\nis recommended.\n4. Re-demonstration of partially imaged acute cholecystitis with significant\nstranding and ascites.  The gallbladder mass is better assessed on MRCP and\nprior CT."
        },
        {
            "input": "The imaged base of neck including the partially visualized thyroid appears\nunremarkable.  Thoracic aorta contains mild atherosclerotic calcification and\nis normal in course and caliber.  The main pulmonary artery is normal in size.\nAn anterior mediastinal lymph node is seen on series 3, image 20 measuring 6\nmm in short axis.  Calcified hilar and mediastinal lymph nodes are present\nsuggesting prior granulomatous exposure.  The heart is top-normal in size\nwithout pericardial effusion.  No significant coronary artery calcification is\nseen.  The esophagus is decompressed throughout.\n\nHypoventilatory changes in the lungs noted.  Scattered calcified granulomas\nwithin the lungs noted.  A punctate nodule in the lingula on series 4, image\n143 is likely a calcified granuloma.  No worrisome nodule, mass, or\nconsolidation.\n\n\nUpper abdomen: A rounded mass measuring approximately 2.3 x 2.4 cm at the\ngastric fundus is seen on series 3, image 45, please refer to concurrently\nperformed CT abdomen pelvis for further details.\n\nCHEST CAGE: A sclerotic focus within the T10 vertebral body is likely a bone\nisland.  No worrisome lytic or blastic osseous lesions seen.",
            "output": "1. No evidence of primary malignancy or metastatic disease in the chest.\n2. Gastric fundal mass measuring 2.3 x 2.4 cm, please refer to concurrently\nperformed CT abdomen pelvis for further details."
        },
        {
            "input": "Bilateral breast implants are in place.  Substantial axillary lymphadenopathy\nhas resolved.  Mediastinal lymphadenopathy has substantially improved in the\ninterim, for example prevascular lymph nodes has decreased in size from 4.4 x\n2.5 cm to 2.8 x 0.7 cm.\n\nHeart size is normal.  There is no pericardial pleural effusion.  Image\nportion of the upper abdomen will be reviewed separately in corresponding\nreport will be issued.\n\nAirways are patent to the subsegmental level bilaterally. Apical bulla on the\nright, series 5, image 7 is unchanged.  Centri lobular nodules in the upper\nlobes are most likely consistent with respiratory bronchiolitis.  Bibasal\nareas of atelectasis are present.  No discrete nodules seen.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Substantial improvement in the mediastinal lymphadenopathy an resolution of\nthe bilateral axillary lymphadenopathy.\n\nMinimal apical emphysema.\n\nStatus post bilateral breast implants.\n\nPort-A-Cath catheter tip terminates at the proximal right atrium.\n\nSuspected respiratory bronchiolitis."
        },
        {
            "input": "The thyroid is normal.  Left axillary lymph nodes have increased now measuring\nup to 10 mm previously 8 mm.  Right axillary lymph nodes have increase\nmeasuring up to 13 mm.\nRight subpectoral lymph node measuring 10 mm was 6 mm (05:11)\nRight upper paratracheal lymph node measuring 13 mm was 12 mm (05:20)\nLeft lower paratracheal station lymph node measuring 17 mm is stable\nRight hilar lymphadenopathy measuring up to 10 mm is stable.  The left the\nhilar lymph nodes measure up to 8 mm.\nRight paraesophageal lymph node measuring 18 mm was 17 mm (05:29).\nAorta is normal size.  At the main pulmonary artery is larger than the\nascending aorta measuring 28 mm suggests pulmonary hypertension.\nCardiac configuration is normal and there is no appreciable coronary\ncalcification.  The lungs are clear.  There is no pleural or pericardial\neffusion.\nDiffuse centrilobular ground-glass nodules in the upper lobes right greater\nthan left have increased.  There are multiple new small peribronchial nodules\nin the right apex (6:70)\nThere are few small Calcified granulomas.  Respiratory motion limits the\nevaluation of the in the lower lobes.  There are dependent bibasilar\natelectasis.  There is minimal biapical emphysema\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nPort a cath tip is in place.\nPatient has bilateral breast implants, the left has ruptured in the interim. \nNodularity in the breasts bilaterally should be evaluated with mammography for\nexample largest nodule in the left breast seen in series 5, image 36.\nIrregular increase density in the anterior left first rib, the manubrium of\nthe sternum, posterior right 4th rib and 9 thoracic vertebral body are stable",
            "output": "Centrilobular ground-glass opacities, differential diagnosis includes\ninfection, Drug reaction, bronchiolitis.\nNew more denser peribronchial opacities in the right upper lobe are likely\ninfectious in etiology\nIncreased size of lymph nodes as described above\nNew rupture of left breast implant\nSoft tissue nodularity in the breast bilateral should be evaluated with\nmammography\nProbably pulmonary hypertension\n\nRECOMMENDATION(S):  Close followup as clinically indicated\nMammography\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 3:55 ___, 5 minutes after discovery of the findings."
        },
        {
            "input": "The aorta and its major branch vessels are patent without evidence of acute\ndissection or aneurysm.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is extensive mediastinal lymphadenopathy including of the bilateral\nparatracheal, periaortic, upper mediastinal, subcarinal regions.  There is\nalso extensive bilateral axillary lymphadenopathy with lymph nodes measuring\nup to 2.6 cm in short axis, on the right.  Bilateral hilar adenopathy is also\nseen.  There is subsequent narrowing of the bilateral main pulmonary arteries\nas well as bilateral mainstem bronchi and branches, due to mass effect from\nthe lymphadenopathy.  The supraclavicular region is not well assessed on this\nexamination.\n\nSubpleural right middle lobe ground-glass opacity on series 2, image 58 and\nsubtle subcentimeter ground-glass opacity in the superior right lower lobe on\nseries 2, image 58 are nonspecific.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nLimited images of the upper abdomen are unremarkable.\n\nImage bony structures are largely unremarkable.\n\nBilateral breast implants are seen.  Infiltration of the breast tissue\nsuperficial to the breast implant is of indeterminate age or etiology. \nCorrelate clinically in with prior imaging for comparison.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Extensive mediastinal, bilateral axillary, and bilateral hilar\nlymphadenopathy.  Findings raise concern for lymphoproliferative process such\nas lymphoma.  Mass effect on the bilateral main pulmonary arteries and\nbilateral central airways which are narrowed.  . Recommend obtaining outside\nhospital records additional workup with possible tissue sampling is not\nalready performed.\n3. Subcentimeter ground-glass opacities in the right middle lobe and superior\nright lower lobe are nonspecific the could be due to minor infection,\ninflammation, neoplastic process not excluded.\n4. Induration of the subcutaneous tissues around the bilateral breast\nprostheses, of indeterminate age or etiology.  Correlate clinically and with\nprior imaging for comparison."
        },
        {
            "input": "There is mild dilation of the ascending aorta, which measures 4.5 cm in\nmaximal cross-section. Accounting for the presence of motion artifact, there\nhas been no change since ___. The aorta smoothly tapers to normal\ncaliber distal to the left subclavian artery.  There is no evidence of aortic\ndissection.  The origins of the major thoracic aortic vessels are patent with\nminimal atherosclerosis at the origin of the left subclavian artery.  Marked\ntortuosity of the internal mammary and right brachiocephalic arteries is\nnoted.\n\nAortic measurements performed by the images lab are as follows:\n\nSinuses of Valsalva: 4.3 x 3.5 cm.\nSino-tubular junction: 4.2 x 3.4 cm.\nAscending aorta: 4.5 x 4 cm.\nProximal aortic arch: 3.8 x 3.4 cm.\nMid aortic arch: 3.2 x 2.6 cm.\nProximal descending aorta: 2.8 x 2.6 cm.\nMid descending thoracic aorta 3 x 2.6 cm. The graft at the level of the\ndiaphragm: 2.5 x 2.4 cm.\n\nThe main pulmonary artery is normal caliber. Though not tailored for\nevaluation, the segmental vessels of the pulmonary arterial tree show no\nfilling defect to indicate a pulmonary embolus.  The heart is normal size and\nthere is no pericardial effusion.\n\nThis study was performed during expiration, which explains the patchy areas of\natelectasis. This limits full evaluation for small nodules are ground-glass\nopacities. Within this limitation, there are no nodules or masses of concern. \nNo pleural effusion or pneumothorax.  The airways are patent.\n\nThe included thyroid is normal. The esophagus is unremarkable. There is a\nsmall hiatal hernia.  Included views of the enhanced liver, gallbladder,\nspleen, adrenal glands, pancreas and kidneys are unremarkable. Scattered\nmesenteric lymph nodes are not enlarged by CT criteria and range in size up to\n7 mm (2:91). There are no lytic or blastic osseous lesions within the chest.",
            "output": "Aneurysmal dilation of the ascending aorta measuring 4.5 cm in maximal\ndimension, unchanged from ___.  Consideration should be given to\nEKG gating at the next scheduled follow up study."
        },
        {
            "input": "VASCULA: The aorta and its major branch vessels are patent, with no evidence\nof stenosis, occlusion or dissection.  Common origin of the right\nbrachiocephalic artery and left common carotid artery is again noted, a normal\nanatomic variant.  There are minimal atherosclerotic calcifications of the\naortic arch.  There is no evidence of penetrating atherosclerotic ulcer.\n\nMeasurements obtained by the 3D lab compared with CTA chest ___:\n\nSinuses of Valsalva: 4.0 x 3.5 cm, previously 4.3 x 3.5 cm\nSino-tubular junction: 3.7 x 3.4 cm, previously 3.6 cm x 3.1 cm\nAscending aorta: 4.3 x 3.9 cm, previously 4.2 x 3.8 cm\nProximal aortic arch: 3.5 x 3.2 cm, 3.7 x 3.3 cm\nMid aortic arch: 3.1 x 2.4 cm, previously 3.2 x 2.2 cm\nDistal aortic arch: 2.9 x 2.5 cm, previously 2.9 x 2.1 cm\nMild descending aorta: 2.9 x 2.5 cm, previously 3.0 x 2.6 cm\n\nThe main pulmonary artery is top normal in caliber, measuring 3.3 x 3.0 cm. \nThe right and left pulmonary arteries are normal in caliber.\n\nHEART: The heart is mildly enlarged.\n\nLYMPHADENOPATHY: There is no axillary, mediastinal, or hilar lymphadenopathy.\n\nLOWER NECK: There are multiple hypoattenuating nodules in the thyroid\nmeasuring up to 0.5 cm in the right lobe (series 10:10), unchanged from CT\nchest ___ and not meeting ACR criteria for sonographic\nevaluation.\n\nPERICARDIUM OR PLEURA: There is no evidence of pericardial effusion.  There is\nno pleural effusion.\n\nLUNG PARENCHYMA: 4 mm nodule in the right upper lobe (series 9:169) is stable\ndating back to CTA of the chest from ___.  There is bibasilar\natelectasis.  There is no consolidation.  The airways are patent to the\nsubsegmental level.\n\nUPPER ABDOMEN: Limited images of the upper abdomen are unremarkable.\n\nOSSEOUS STRUCTURES: No lytic or blastic osseous lesion suspicious for\nmalignancy is identified.",
            "output": "Ascending thoracic aortic aneurysm measuring up to 4.3 cm, without interval\nchange compared to CTA chest from ___."
        },
        {
            "input": "Aorta and pulmonary arteries are overall within normal limits.  Heart size is\nnormal.  There is no pericardial pleural effusion.  Small hiatal hernia is\npresent.\n\nAirways are patent to the subsegmental level bilaterally.  Questionable nodule\nin the area of the superior segment of right lower lobe is present versus\ntortuous vessel, series 302, image 115 or alternatively impacted airway. \nThere is mild degree of air trapping in the area that might be consistent with\nthe diagnosis of impacted vessel, potentially even a congenital NGT.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.  The abnormality\nseen on the chest radiograph demonstrates slight asymmetric appearance of the\npulmonary vasculature but no mass is noted.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.\n\nImage portion of the upper abdomen demonstrate left renal hypodense cortical\nlesion, 2.5 cm in size and 16 Hounsfield units in density most likely\nconsistent with cortical cyst there is potentially left adrenal thickening,\npartially imaged.  Alternatively it might represent thickening of the stomach.",
            "output": "No discrete mass in the right hilus area demonstrated.\n\nQuestionable nodule versus tortuous bronchus (potentially even congenital\nfocal bronchial atresia) might be present.  In the absence of the IV contrast\nthe pre size differentiation is difficult.\n\nReassessment in 6 months after administration of IV contrast would be\njustified.\n\nQuestionable thickening of the left adrenal versus abnormality within the\nstomach fundus, dedicated abdominal imaging is recommended."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar\naxillary lymphadenopathy is present.  Heart size is normal. There is no\npericardial or pleural effusion demonstrated.\n\nAirways are patent to the subsegmental level bilaterally.  The appearance of\nthe superior segment of right lower lobe is unchanged with the same tortuous\nstructure demonstrated with surrounding small area of airway trapping dot the\nlesion can be connected 2 the vessel does might represent small area of\naneurysm and unlikely to represent pulmonary nodule is stable ___ are\napproximately 12 x 7 mm at its widest portion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Unchanged appearance of the tortuous structure in superior segment of right\nlower lobe, unlikely to represent pulmonary nodule most likely representing\ntortuous vessel or impacted airway dot if clinically warranted, correlation\nwith CT angiography of the chest is to be considered.  Otherwise no further\nfollowup indicated"
        },
        {
            "input": "CHEST:\nPULMONARY ARTERIES/AORTA: Thoracic aorta is normal in caliber.  Proximal\npulmonary arteries are patent.\n\nNECK: Thyroid gland is unremarkable.  There are no supraclavicular adenopathy.\n\nAIRWAYS: Airways are clear with no endotracheal or endobronchial lesions.\n\nMEDIASTINUM: There are no mediastinal or hilar adenopathy.  There is no\ncardiomegaly or pericardial effusion.  There are marked coronary arterial\ncalcifications.\n\nLUNGS: There is mild biapical scarring.  There Re near atelectatic bands in\nthe right lower lobe and right middle lobe.\n\nPLEURA: There is no pleural effusion, pneumothorax or pleural plaques.\n\nABDOMEN:\nHEPATOBILIARY: There is normal hepatic enhancement with no suspicious mass\nlesions.  There is no biliary ductal dilatation.  Gallbladder is unremarkable.\nHigh-density material is noted layering within the gallbladder likely contrast\nexcretion.  Portal vein and hepatic veins are patent.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS:   Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis.  There is normal course\nand caliber of bilateral ureters.\n\nGASTROINTESTINAL: Stomach is under distended. Small bowel loops are normal in\ncaliber.  Appendix is normal in appearance.  There is moderate amount of stool\nin the right hemicolon. The left hemicolon is decompressed. There are\nscattered colonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air free fluid.  There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with moderate atherosclerotic\ndisease.  Intra-abdominal branches are patent.\n\nPELVIS: Urinary bladder demonstrates mild wall thickening which can be\nsecondary to bladder outlet obstruction vs cystitis.  There are central\nprostatic calcifications.  Rectum is unremarkable.\n\nBONES:There is an anterior wedge deformities of L2 and L1, of chronic nature. \nThere are multilevel degenerative changes of the lumbar spine.  There are no\nacute or aggressive osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.",
            "output": "1. There are no acute intrathoracic, intra-abdominal or intrapelvic\nabnormalities.\n2. No suspicious lung masses, intra-abdominal solid organ lesions, bowel wall\nthickening or adenopathy to suggest as a primary neoplastic process.  Osseous\nstructures are intact.\n3. Right basal atelectasis.\n4. Urinary bladder outlet obstruction vs cystitis.\n\nRECOMMENDATION(S):\n1."
        },
        {
            "input": "Aorta and great vessels are unremarkable without dissection or aneurysm. The\npulmonary arteries are well opacified to the subsegmental level without\nfilling defect to suggest pulmonary embolism. The main and right pulmonary\narteries are normal in caliber.\n\nThere is no pathologic enlargement of the supraclavicular, axillary,\nmediastinal, or hilar lymph nodes.  Left axillary lymph nodes measure up to 8\nmm in short axis diameter.  The included thyroid gland appears unremarkable.\n\nHeart size is normal. There is no pericardial effusion. There is no pleural\neffusion.\n\nThere is bilateral dependent subsegmental atelectasis in the lung bases.  The\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nBones:  No lytic or blastic bony lesion suspicious for malignancy is\nidentified.",
            "output": "No pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial or pleural effusion.  Image portion of the upper abdomen reveals\nno appreciable abnormality except for previous cholecystectomy.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear. \nNo pulmonary nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall normal chest CT.  No findings to explain patient's symptoms."
        },
        {
            "input": "Lungs, pleura and airways: Tracheobronchial airways are patent.  There is\nlarge right pleural effusion with associated atelectasis, including complete\ncollapse of the right middle and lower lobes.  There is slight loculation of\nthe effusion at the mid and upper lung.\n\nHeart and pericardium: There is no pericardial effusion.  Heart sizes within\nnormal limits.\n\nMediastinum and hila: There is no mediastinal lymphadenopathy.\n\nChest wall and lower neck: The thyroid gland is unremarkable.  There is no\nsupraclavicular or axillary lymphadenopathy.\n\nVessels: The thoracic aorta and its branches are within normal limits.  There\nis mild atherosclerotic disease of thoracic aorta.\n\nBones: Postsurgical changes of median sternotomy.  There are no acute osseous\nabnormalities.\n\nUpper abdomen: Evaluation the upper abdomen is limited due to low-dose.  There\nis scarring of the left kidney.  There is a hypoattenuating cystic lesion\nwithin the spleen.",
            "output": "Large right pleural effusion with a few small loculated components along the\nmid and upper right hemithorax. No enhancement of the pleura to suggest\npresence of an empyema. There is complete collapse of the right middle and\nlower lobes  with moderate atelectasis of the right upper lobe. No obstructing\nlesion noted in the right main and lower lobe bronchi."
        },
        {
            "input": "ANGIOGRAM:\nThe aorta and its major branches vessels are patent, with no evidence of\nstenosis, occlusion, dissection or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer. Calcification at the sinotubular\njunction.  However, the 4cm distal to the ST junction are free of\ncalcification followed by a long calcified segment of 3cm.  Scattered\ncalcifications of the aortic arch and proximal descending aorta are noted.\n\nDiffuse coronary calcifications.  RCA and L Cx stents present.\n\n\nMid ascending aorta: 38mm\n\nMid descending aorta: 28mm\nAortic hiatus:\nMain pulmonary artery: 32mm\n\nCHEST FINDINGS:\n\n\nThere is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy.\nThe thyroid gland is unremarkable.\n\nThere is no evidence of pericardial or pleural effusions.\n\nThere are no abnormal lung parenchymal findings. The airways are patent to the\nsubsegmental levels.\n\nLimited images of the upper abdomen are unremarkable.\n\n2 compression thoracic compression fractures (T4, T8)",
            "output": "No acute aortic abnormalities on the current study. No dilatation of the\nthoracic aorta.\n Calcification at the sinotubular junction.  However, the 4cm distal to the ST\njunction are free of calcification followed by a long calcified segment of\n3cm.  Scattered calcifications of the aortic arch and proximal descending\naorta are noted."
        },
        {
            "input": "LUNGS: There has been interval increase in multiple pulmonary nodules, such as\na 24 x 19 mm nodule adjacent to the aorta (02:37), previously 18 x 14 mm. An\nadditional two left lower lobe nodules have both increased in size as well\n(02:38).  For example one of these measures 14 x 9 mm, previously 11 x 9 mm. \nA right upper lobe nodule (2:8) is also larger and more solid than on the\nprior exam. A right lower lobe conglomerate of nodules adjacent to the\nesophagus today measures 16 x 10 mm, previously 14 x 9 mm (02:43).  Scattered\nother pulmonary nodules have also increased in size.  There is no pleural\neffusion.\n\nMEDIASTINUM:  A majority of the necrotic mediastinal lymph nodes have remained\nstable in size, although a few have grown.  For example a prevascular node\npreviously measuring 20 x 8 mm today measures 19 x 8 mm (02:19).  A left\nparatracheal node previously measuring 14 x 7 mm today measures 15 x 8 mm.  A\nlarge conglomerate of lymph nodes in the subcarinal region previously measured\n30 x 18 mm, today 30 x 20 mm (02:24).  Similarly, hilar lymphadenopathy is\nslightly enlarged with a conglomerate of nodes in the left hilum measuring 24\nx 17 mm, previously 21 x 14.  There is no pericardial effusion. The heart is\nof normal size.\n\nBONES:  No thoracic osseous metastatic lesions are identified.\n\nUPPER ABDOMEN:  Please see the separate CT abdomen and pelvis dictation from\nthe same day.",
            "output": "Worsening metastatic disease with increasing pulmonary nodule size and\nmediastinal/hilar lymphadenopathy."
        },
        {
            "input": "Multiple enlarged mediastinal lymph nodes are unchanged, ranging up to 12 mm\nin the right upper paratracheal area, 9 mm in the prevascular area, 23.7 mm in\nthe paraesophageal area (decreased since the prior study when 30 mm was the\ndiameter).  Left hilar lymph node appears to be slightly decreased in size,\nfrom 12-10 mm.  The inferior portion of the paraesophageal lymphadenopathy has\ndecreased in size as well, from 32 x 22 to 15 x 27 mm.  No pericardial\neffusion is seen.  Heart size is normal.  Image portion of the upper abdomen\nwill be reviewed separately.\n\nAirways are patent to the subsegmental level bilaterally.  Interval increase\nin size in pulmonary nodules is demonstrated, for example in the right apex\nfrom 8-10 mm, series 2, image 9, in the left lower lobe been para-aortic\nlocation, from 23-30 mm, with 2 additional nodules increased in size from\n12-20 mm and from 13-60 mm, series 2, image 39.  Multiple smaller nodules\nappear to be increased in size as well as there a few or new nodules\ndemonstrated not seen on the previous examination",
            "output": "Interval progression of multiple metastatic pulmonary nodules as described\nincluding the dominant mass in the left lower lobe in para-aortic location. \nOn the other hand there is slight interval decrease in mediastinal\nlymphadenopathy.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued."
        },
        {
            "input": "Supraclavicular and axillary nodes are not enlarged there are no soft tissue\nlesions in the chest wall suspicious for malignancy.  Small intramuscular\nlipoma in the right thoraco abdominal wall, 05:53, is clinically\ninsignificant.  Findings below the diaphragm will be reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in the\nhead and neck vessels, but is scattered in the coronaries at least in the left\nmain and anterior descending and circumflex branches.  Aorta and pulmonary\narteries are normal caliber and free of filling defects.\n\nLymph nodes are enlarged in virtually all stations of the mediastinum and both\nhila, but unchanged, ranging in diameter up to 17 x 35 mm in the right\nparaesophageal station, previously 18 x 34 mm and in the left hilus, 12 x 26\nmm, 4:160, previously 10 x 25 mm.\n\nThere has been little but variable change in the size of more than a dozen\npulmonary metastases in all lobes ranging in diameter up to 28 x 32 mm in the\nleft lower lobe, 6:207, smaller, at 27 x 30 mm on ___, at the same\ntime 13 x 17 mm in the an adjacent lesion in the left lower lobe, 6:212\ndecreased slightly from 14 x 20 mm in ___.  There are no new lung nodules.\n\nTracheobronchial tree is patent to subsegmental levels.  There is no\npericardial or pleural abnormality.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Multiple pulmonary metastases minimally and variably change since ___. \nMediastinal and hilar adenopathy stable.  No new metastatic lesions.\n\nCoronary atherosclerosis."
        },
        {
            "input": "8 mm left supraclavicular lymph node is new, 4:7.  Axillary nodes are not\nenlarged.  There are no soft tissue lesions in the chest wall suspicious for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\n\nAdenopathy is still present in any lymph node stations.  Treatment response is\nbeen variable, for example 10 x 19 mm prevascular node, 4:73 was 9 x 18 mm in\n___ x 20 mm right lower paratracheal mediastinal node, 4:77 was 8 x\n21 mm.  The largest mediastinal nodes extending from the subcarinal to the\nright lower paraesophageal station is 22 x 48 mm at the level of its greatest\ncross-sectional area, 4:97, previously 22 x 47 mm.  Smaller but enlarged\nbilateral hilar lymph nodes are stable on the right, larger on the left, 15 x\n23 previously 16 x 18.\n\nThere is no pericardial or pleural effusion described despite growing\ncontiguous subpleural pulmonary nodules.\n\nThe largest of many pulmonary metastases, in the left lower lobe inseparable\nfrom the mediastinal pleura along the descending thoracic aorta has greatest\ndiameters 40 x 44 mm, 4:155, previously 27 x 29 mm.  Comparable growth is seen\nin many of the smaller lesions, for example left upper lobe, 7 x 16 mm, 4:63\npreviously 6 x 11 mm, left lower lobe, 12 x 14 mm, 4:96, previously 8 x 7 mm. \n2 other left lower lobe lesions have grown together that mass and and may\ninvade the diaphragmatic pleura\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Substantial interval growth in the size of many pulmonary nodules, especially\nthe largest which may now invade the mediastinal and diaphragmatic pleura\nrespectively.  No pleural or pericardial effusion.\n\nMinimal change in extensive mediastinal and right hilar adenopathy.  Left\nhilar adenopathy has increased slightly, probably reflecting growth of\ndraining lower lobe left lower lobe metastases."
        },
        {
            "input": "The thyroid is unremarkable and there is no supraclavicular lymphadenopathy. \nMediastinal and hilar adenopathy appears similar to prior including a\nprevascular node measuring 1 x 1.9 cm previously 0.9 x 1.8 cm (05:19), a sub-\ncarinal node measuring 2.2 x 3.9 cm, previously 2.1 x 3.9 cm (05:28) and a\nleft hilar node measuring 1 x 2 cm, previously 1.1 x 2.3 cm (05:29).  Normal\nheart size and normal caliber of the aorta and main pulmonary artery.\n\nInnumerable pulmonary nodules are again seen with mixed response with some\nsmaller and some larger than prior.  The largest on the right are the right\napical nodule measuring 1.6 x 1.9 cm, previously 1.5 x 1.8 cm (06:41),  right\nlower lobe nodule measuring 1.2 x 1.6 cm, previously 1.8 x 2.1 cm (6:221) and\nright lower lobe nodule measuring 1.2 x 1.7 cm, previously 1.2 x 1.6 cm\n(6:226).  The largest mass in the left lower lobe measures 4.3 x 5.1 cm,\npreviously 3.6 x 4.4 cm (6:190), an adjacent nodule measures 2.8 x 3.8 cm,\npreviously 3 x 3.9 cm (6:194).\n\nFor details regarding the abdomen pelvis please see dedicated abdomen and\npelvis CT report.\n\nNo lytic or sclerotic lesions suspicious for metastasis in the chest.",
            "output": "1. Mixed response with increase in size of some pulmonary nodules and decrease\nin size of others.  Roughly stable mediastinal and hilar lymphadenopathy.\n2. For details regarding the abdomen pelvis please see dedicated abdomen\npelvis CT report."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Lipoma measuring 20 x 9 mm in\nrelation to the right anterior chest wall (4, 48).\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Extensive hyperemic mediastinal adenopathy appears unchanged\ncompared to prior\n\nHILA: Left hilar adenopathy appear slightly increased compared to prior\nimaging.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  No coronary artery calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n-PARENCHYMA:  Numerous pulmonary nodules and masses the largest in the left\nlower lobe measures approximately 51 x 30 mm (similar to previous).  Most of\nthe smaller pulmonary nodules demonstrate mild interval increase in size for\nexample the nodule in the left upper lobe (6, 146) currently measuring 11 mm\nand previously measured 8 mm.  Some of the nodules also demonstrate\ncavitation.\n-AIRWAYS:  Patent to the subsegmental level.\n-VESSELS:  The pulmonary arteries not dilated.  No filling defects.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No lytic/\ndestructive bony lesion to suggest bony metastatic disease.",
            "output": "Mild interval disease progression as evidenced by increase in size of the\nmultiple pulmonary nodules by approximately ___ as well as mild interval\nincrease in size of the left hilar adenopathy.\n\nNo new lesions identified."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is common\norigin of the left common carotid artery and brachiocephalic trunk.  No\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nA left subclavian approach Port-A-Cath tip ends in the distal SVC.  No\nevidence of a pericardial effusion.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nNo axillary or supraclavicular lymphadenopathy.  Numerous enlarged mediastinal\nlymph nodes particularly in the perihilar and subcarinal stations as well as\nleft prevascular space are overall unchanged when accounting for differences\nin measurement technique.  Some of these nodes appear necrotic.\n\nNumerous bilateral scattered pulmonary metastases are overall unchanged. \nThese metastases have cystic components (e.g., series 3, image 170, 123, 101)\nIndex examples on the largest metastases include an 2.1 x 1.5 cm lesion in the\nright apex (series 3, image 30), two confluent metastases in the left lower\nlobe measuring 3.9 x 2.7 cm (series 3, image 161, and a 4.8 x 3.6 cm solid\nmass in the left lower lobe abutting the posterior mediastinum but not clearly\ninvading the mediastinum (series 3, image 150).  Curvilinear opacity along the\nleft anterior mediastinum in the left upper lobe is unchanged (series 3, image\n67).\n\nThe trachea, mainstem bronchi, and segmental bronchi are patent.  No pleural\neffusion or pneumothorax.\n\nThe thyroid is not enlarged and enhances homogeneously without evidence of a\nmass.  An incidental 2.1 x 1-cm intramuscular lipoma in the anterior right\nchest wall is unchanged (series 3, image 180).  No suspicious soft tissue\nmasses in the chest cage concerning for malignancy.\n\nNo lytic or sclerotic osseous lesions in the chest cage concerning for\nmalignancy.  Multilevel degenerative changes of the thoracic spine are\nmoderate, similar the prior exam right posterior rib fracture is old.  A 3 mm\nwell-defined sclerotic lesion in the right humeral head is unchanged and\nlikely a bone island (series 3, image 4).\n\nThis exam is not dedicated for imaging of the upper abdomen.  Within this\nlimitation, limited views of the upper abdomen demonstrate a small 4-mm\nhyperenhancing lesion in the periphery of the segment 6 (series 3, image 221)\nwhich appears unchanged and a replaced right hepatic artery arising off the\nSMA (series 3, image 235).",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2,  Numerous pulmonary metastases, some with cavitary change, similar to the\nprior exam.\n\n3.  Overall unchanged mediastinal and hilar lymphadenopathy.\n\n4.  Unchanged 4-mm right hepatic lobe hyperenhancing lesion.\n\n5.  Incidental replaced right hepatic artery off the SMA.\n\nNOTIFICATION:   The findings were discussed with ___, M.D.,\nthe referring physician requesting ___ wet read by ___, M.D. on the\ntelephone on ___ at 10:44 AM, 15 minutes after discovery of the\nfindings."
        },
        {
            "input": "Mediastinal lymph nodes, series 5, image 28, 32, 36, R similar in appearance,\nheterogeneous, with the largest 1 being in the paraesophageal location, 3.8 by\n2.2 cm, minimally increased as compared to 3 point 7 x 1.8 cm on the previous\nstudy.  Left lower lobe dominant mass is 4.8 x 3.8 cm, unchanged.  Second mass\nin the left lower lobe is 3.9 x 3.3 cm, slightly increased compared to 3.9 x\n2.7 cm.  Multiple additional cavitated and not cavitated nodules appear to be\nminimally increased, for example in the right lower lobe, from 1.6-1.9 cm,\nseries 5, image 52.  There is also interval development of multiple additional\nnodules, the majority of them being cavitated.\n\nAorta and pulmonary arteries are normal in diameter and overall well enhanced.\nAirways are patent to the subsegmental level bilaterally.\n\nNo new lytic or sclerotic lesions within the image portion of the skeleton in\nthe thorax demonstrated.",
            "output": "Minimal disease progression as described in details including slight increase\nin the mediastinal lymphadenopathy and in multiple pulmonary metastasis."
        },
        {
            "input": "Detailed evaluation of the solid organs, soft tissues, and vessels is limited\nwithout the use of intravenous contrast. Within this limitation:\n\nA left approach central venous catheter tip is only partially imaged with its\ntip ending in the SVC-RA junction.  The thoracic aorta is normal in caliber.\nThe main, left, and right pulmonary arteries are normal in caliber. The heart\nis normal in size.  Mild hypoattenuation of the cardiac blood pool on this\nunenhanced exam suggests anemia.  A pericardial effusion is small.\n\nNumerous bilateral solid pulmonary metastases have increased in the number and\nsize since ___.  Index examples of the largest pulmonary masses\ninclude:\n- a 6.6 x 5.1 cm lobulated paramediastinal mass in the left lower lobe,\npreviously 5.6 x 3.6 cm (series 4, image 146).  The mass extends to the hilum\nwith compression of a left lower lobe subsegmental bronchus (series 4, image\n126).  The adjacent left pulmonary vein appears patent.\n- a 4.9 x 4 cm lobulated perifissural mass in the left lower lobe, previously\n4 x 3.5 cm (series 4, image 149).\n- an 1.8 x 1.5 cm subpleural lobulated left lower lobe nodule, previously 1.4\nx 1.1 cm (series 4, image 97).\n- an 2.5 x 2.4 cm right apex nodule, previously 2.1 x 1.6 cm (series 4, image\n20).\n\nNo evidence of extension of these pulmonary metastases into the subpleural\nspace or chest wall.  The airways are patent to at least the segmental level. \nNo pneumothorax or pleural effusion.  No suspicious osseous lesions in the\nchest cage for malignancy or infection.  Vertebral body heights are preserved.\nMultilevel degenerative changes in the thoracic spine are minimal.  No\nevidence of an acute fracture.\n\nThe partially imaged thyroid is normal in size without evidence of a focal\nmass.\n\nPlease refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "1.  Interval progression of numerous bilateral pulmonary metastases, the\nlargest now measuring up to 6.6 cm in the left lower lobe, extending toward\nthe hilum.\n2.  Small pericardial effusion.\n3.  Anemia."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular or axillary lymphadenopathy.  Extensive\nmediastinal lymphadenopathy is again demonstrated, similar to ___.\nThere are many prominent pre and paratracheal lymph nodes, for example a right\nparatracheal lymph node meets criteria for adenopathy measuring 1.2 cm (series\n3, image 53).  Enlarged hilar lymph nodes are also noted.  The thyroid gland\nappears unremarkable.\n\nThere is trace pericardial effusion.  There is no pleural effusion.\nOnce again, innumerable bilateral solid pulmonary nodules are seen.  Examples\nof the largest pulmonary mass is include:\n- 6.6 x 5.0 cm lobulated left lower lobe paramediastinal mass is unchanged in\nsize and appearance compared to ___ (series 3, image 129).  The\nmass continues to encase the left lower lobe bronchus and pulmonary vein,\nwhich appears patent.\n- 4.7 x 4.4 cm left lower lobe perifissural mass is unchanged compared to ___ (series 3, image 127).\n- 2.5 x 2.4 cm mass at the right apex is unchanged compared to ___\n(series 3, image 31).\nOther solid nodules are grossly unchanged compared to ___.\n\nNodular thickening of the right adrenal gland appears similar to ___.  There has been interval increase in the degree of bilateral perinephric\nfluid.  There is also a small amount of ascites noted along the inferior\nmargin of the liver, which is new compared to ___.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Extensive metastatic disease in the chest is grossly unchanged compared to\n___.\n3. In the upper abdomen, new simple fluid attenuation ascites tracks along the\ninferior margin of the liver.\n4. Bilateral perinephric fluid is new compared to ___.\n5. Nodularity of the right adrenal gland is unchanged compared to ___.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:15 ___, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "CHEST PERIMETER: Small perimeter calcification, left thyroid lobe is not large\nenough to warrant further imaging.  Supraclavicular and axillary lymph nodes\nare not enlarged there are no soft tissue abnormalities in the chest wall\nconcerning for malignancy.  This study is not appropriate for subdiaphragmatic\ndiagnosis.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels or coronary arteries.  Aorta and pulmonary\narteries and cardiac chambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No thoracic lymph nodes are pathologically enlarged\nranging in diameter up to 9 mm in the right lower paratracheal station and a 6\nmm prevascular lymph node alongside the ascending thoracic aorta, 4:100.\n\nLUNGS, AIRWAYS, PLEURAE: Mild interstitial abnormality consists of thickening\nof subpleural bullae in the upper lobes, difficult to distinguish from limited\nhoneycombing, and in the lower lobes of moderately extensive peribronchial\nground-glass opacification and secondary traction bronchiectasis of peripheral\nbronchi.  What is extremely unusual in this patient is the profusion of scores\nof small calcified nodules, often but not exclusively in regions of clear\ninterstitial abnormality.  Small nodules of osseous metaplasia are not an\nuncommon finding in pulmonary fibrosis but the disease is usually more\nadvanced than seen here.\n\nCHEST CAGE: Unremarkable",
            "output": "Mild to moderate fibrosing interstitial pulmonary abnormality.  Distribution\nand character are not diagnostic of UIP, and are more suggestive of fibrosing\nNS IP.  Multiple small pulmonary calcifications are presumably osseous\nmetaplasia, related to the diffuse lung disease.  In the absence of\ncalcifications in central lymph nodes and the spleen, they cannot be\nattributed to granulomatous disease (sarcoidosis or histoplasmosis)."
        },
        {
            "input": "The visualized thyroid is unremarkable.\n\nHeart size is normal without significant pericardial effusion.  There are\nfocally severe coronary artery calcifications.  There are mild atherosclerotic\ncalcifications along a normal caliber thoracic aorta.  The pulmonary arteries\nare normal caliber and there is no filling defect to the subsegmental level to\nindicate a pulmonary embolus.\n\nThere is no supraclavicular, axillary, hilar, or mediastinal lymphadenopathy\nby CT size criteria.\n\nThe central airways are patent.  There is diffuse bronchial wall thickening. \nThere is mild dependent atelectasis bilaterally.  There is a 3 mm nodule at\nthe right lateral lung base (3:176).  There is a 2 mm left lung base nodule\n(3:173).  There is mild linear atelectasis or scarring in the base of the\nright middle lobe as well as the inferior lingular segment.  There is mild\nbiapical pleuroparenchymal scarring with calcification.  Otherwise no\nsuspicious focal consolidation or other nodule is seen.\n\nAlthough this study is not tailored for subdiaphragmatic analysis, the\nvisualized upper abdomen demonstrates no gross acute abnormality.  Pancreatic\natrophy is seen.\n\nThoracic cage is intact without acute fracture or suspicious focal bone\nlesion.",
            "output": "1. No pulmonary embolus or acute aortic syndrome.\n2. 3 mm right lower lobe and 2 mm left lower lobe pulmonary nodules.\n3. No pneumonia.\n4. Diffuse bronchial wall thickening suggesting chronic small airways disease.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid gland is unremarkable.  Multiple mildly prominent mediastinal\nlymph nodes are present.  Subcarinal lymphadenopathy measuring 15 mm in\nmaximal thickness is not appreciably changed since ___ (2, 30).\n\nHeart size is top-normal with minimal coronary artery calcifications. There is\nno pericardial effusion. Main pulmonary artery and thoracic aorta are normal\ncaliber.  No incidental pulmonary embolus is identified.\n\nRight upper lobe and bronchiolar nodules are not appreciably changed since\n___ (4, 78). Lower lobe predominant bronchial wall thickening with\nperibronchial ground-glass opacities and focal consolidations have increased\nsince ___. Bilateral lower lobe bronchiolar nodules have increased.\nSmall bilateral pleural effusions have resolved. A single calcified pleural\nplaque is identified along the nondependent aspect of the left upper lobe (4,\n105).\n\nImages of the upper abdomen show splenomegaly with a splenorenal shunt\ncompatible with the provided history of cirrhosis. The partially imaged\ngallbladder is moderately distended (2, 68).\n\nOld healed bilateral rib fractures and right sided bridging ossification are\nincidentally noted, unchanged.",
            "output": "Lower lobe predominant bronchial wall thickening with peribronchial\nground-glass opacities and consolidations are likely due to chronic\naspiration. Stable infectious or inflammatory small airways disease in the\nright upper and both lower lobes.\n\nResolved small bilateral pleural effusions.\n\nSplenomegaly with associated splenorenal shunt is in keeping with the provided\nhistory of cirrhosis.\n\nModerately distended partially imaged gallbladder.\n\nStable mediastinal lymphadenopathy, which is likely reactive in nature."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the chest wall are\nnormal in size.  No hilar or mediastinal lymphadenopathy.  Normal appearance\nof the large mediastinal vessels.  The diameter of the ascending aorta is 37 x\n33 mm.  No coronary calcifications, no valvular calcifications, no pericardial\neffusion.  Small hiatal hernia.  No abnormalities in the soft tissues of the\nchest wall.  Known acetabular lesion (10 the, 15).  There is no evidence of\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  No vertebral compression fractures.  Mild bilateral apical scarring. \nNew 2 mm left apical nodule (8, 41), not present on the previous examination. \nNew 3 mm subpleural left upper lobe nodule (8, 60), not present on the\nprevious examination.  A new 2 mm left upper lobe nodule (8, 72), not present\non the previous examination.  New 5 mm right upper lobe nodule, not present on\nthe previous examination (8, 127).  New middle lobe nodule with a diameter of\n5 mm (8, 171), not present on the previous examination.  Other pulmonary\nnodules, notably at the level of the lower lobes, are also new.  Mild right\npleural effusion.  The airways are patent.",
            "output": "Interval appearance of multiple solid pulmonary nodules with the distribution\nand morphology highly suggestive of pulmonary metastatic disease. Right\npleural effusion.  No adenopathy, no vascular abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Mild calcific atherosclerosis of the aortic arch and\ndescending thoracic aorta.  Mild coronary artery calcifications.  Enlargement\nof the main pulmonary artery, measuring up to 3.2 cm.  The heart, pericardium,\nand great vessels are otherwise within normal limits. No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  A right suprahilar lymph\nnode measures up to 1 cm across the short axis.  Esophagus is patulous.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild biapical scarring.  Bibasilar atelectasis.  No evidence of\nfocal parenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A gastric fundal diverticulum is seen.  4 mm left simple renal cyst.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild degenerative changes of the thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bibasilar atelectasis without focal consolidation.\n3. Mild enlargement of the main pulmonary artery may reflect pulmonary\narterial hypertension."
        },
        {
            "input": "Examination limited due to motion.\n\nThe patient is status post aortic valve replacement.  The aortic valve appears\nappropriately positioned within the annulus.  No active contrast\nextravasation.  There is small volume fluid in pericardiac recesses.  The\nheart is enlarged, as on prior examinations.  There is a moderate\natherosclerotic plaque burden in the arch.  Coronary artery atherosclerotic\ncalcifications noted.  Heart is enlarged.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nfilling defect within the main, right, left, lobar, segmental or subsegmental\npulmonary arteries.  Main pulmonary artery is again noted to be mildly\ndilated, measuring up to 3.3 cm.\n\nMildly prominent mediastinal, hilar lymph nodes are stable.  .  The thyroid\ngland appears unremarkable.\n\nThere is no  significant pericardial effusion.  There are trace bilateral\npleural effusions with overlying atelectasis.\n\nMild Centrilobular emphysematous changes noted, with mild paraseptal emphysema\nat the apices.  Atelectasis overlies trace bilateral pleural effusions at\nbases.  The airways are patent to the subsegmental level.  Endotracheal tube\nterminates 3.6 cm above the carina.  Peribronchial thickening is unchanged. \n0.3 cm nodule right upper lobe series 6, image 77.  1.0 cm nodule left upper\nlobe series 6, image 83.  0.4 cm nodule right lower lobe series 3, image 133. \nFew additional smaller lung nodules.  Lung nodules are similar to prior exam. \nThere are areas of differential perfusion in bilateral lungs.\n\nLimited images of the upper abdomen notable for a subcentimeter\nhypoattenuating lesion the upper pole of the left kidney, most likely\nrepresenting a simple cyst.  Enteric tube terminates stomach.  Mild narrowing\nof the origin superior mesenteric artery.\nBenign calcification in the left abdominal mesentery is seen.\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMultilevel degenerative changes of the spine noted.",
            "output": "1.  No evidence for dissection or pulmonary embolism.\n2.  Cardiomegaly and a mildly dilated main pulmonary artery, suggestive of\npulmonary arterial hypertension.\n3.  Stable mildly prominent mediastinal, hilar lymph nodes.\n5.  Stable pulmonary nodules, largest measures 1.0 cm.\n\nNOTIFICATION:  Findings discussed with Dr. ___ cardiac surgery by ___\n___, M.D. ___ at 20:44."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways:  Airways are patent.  Previously seen lung nodules are\nstable.\nVessels: There is no pulmonary emboli.  Stable mildly enlarged main pulmonary\nartery, suggest pulmonary artery hypertension.  Aortic valve replacement. \nSmall volume periaortic fluid, similar to minimally less prominent since\nprior.  There is no pericardial effusion.  Coronary artery calcifications are\nseen. Patent aorta and its major branches atherosclerotic changes in the upper\nabdomen are stable, largest measures 1.0 cm mild centrilobular emphysema.  .\n\nMediastinum and Hila: No adenopathy.\n\nHeart and Pericardium: Transvenous cardiac pacemaker tip in the right\nventricle.  Borderline heart size.  No pericardial effusion.\n\nPleura: Trace right pleural effusion, decreased since prior.  Left pleural\neffusion and bibasilar atelectasis has resolved.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: Thyroid gland is stable, mildly\nprominent thyroid isthmus, consider thyroiditis.  No thyroid nodules.  No\nadenopathy.\n\nUpper Abdomen: Vicarious excretion of contrast in gallbladder.  .  Small\nlow-attenuation lesion in the upper pole of the left kidney, likely represent\nbenign cyst.\n\nChest Cage: Degenerative changes spine.",
            "output": "Small periaortic fluid is similar to minimally less prominent.\nStable lung nodules, largest 1.0 cm.\nCentrilobular emphysema."
        },
        {
            "input": "Patient is status post transcatheter aortic valve replacement with ___\nvalve.  There is a lobular outpouching along the left anterior aspect of the\naortic annulus, just proximal to the left main coronary artery origin (series\n650b, image 33), measuring up to 12 x 8 mm.  This is suspicious for a\npseudoaneurysm in the setting of a recent annular rupture.\n\nHeart is mildly enlarged.  Pacer leads terminate in the right atrium and right\nventricle, as expected Trace pericardial fluid about the proximal aortic arch\nis similar to prior studies.  No evidence of active extravasation.  Thoracic\naorta is normal in caliber, with mild atherosclerotic disease.  Multifocal\ncoronary artery calcifications are most pronounced in the left anterior\ndescending artery.\n\nDilated main pulmonary artery, 34 mm, suggests pulmonary arterial\nhypertension.\n\nMultiple mediastinal lymph nodes are again noted, measuring up to 11 mm in the\nright lower paratracheal station (5:13), previously 10 mm.  A 14 mm right\nhilar node has increased from 11 mm (5:20).  There is also prominent lymphoid\ntissue in the left hilus, measuring up to 13 mm (5:26).\n\nImaged portion of the tracheobronchial tree is patent.  Upper lobe predominant\ncentrilobular emphysema is mild.  No focal consolidation suspicious for\npneumonia.  The following pulmonary nodules are identified:\n- 4 mm, superior segment right lower lobe (5:31)\n- 6 mm, lateral segment left lower lobe (5:49)\n- 8 mm, left upper lobe (4:80)\n\nNo suspicious lytic or sclerotic osseous lesions are identified.  Moderate\ndegenerative changes throughout the thoracic spine.",
            "output": "1. 12 x 8 mm lobular outpouching along the left anterior aspect of the aortic\nannulus, just proximal to the left main coronary artery origin, suspicious for\na pseudoaneurysm in the setting of recent annular rupture.\n2. No evidence of periaortic hematoma or active extravasation.  Trace\npericardial fluid, unchanged.\n3. Probable pulmonary arterial hypertension.\n4. Top-normal sized mediastinal and hilar nodes.  Recommend follow-up chest CT\nin 3 months to evaluate stability.\n5. Multiple pulmonary nodules, measuring up to 8 mm.\n6. Mild upper lobe predominant centrilobular emphysema.\n\nRECOMMENDATION(S):  Follow-up chest CT in 3 months to evaluate stability of\nthe enlarged hilar lymph nodes.\n\nNOTIFICATION:   The findings and recommendations were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 3:29 ___, 15\nminutes after discovery of the findings."
        },
        {
            "input": "For a 13 x 19 mm right pre scapular bursa or benign cyst, 5:4, is unchanged\nsince ___.  Numerous lymph nodes in both axillae are stable or slightly\ndecreased since ___, ranging in size up to a per 9 x 17 mm left axillary\nnode, 05:11, previously 10 x 17 mm and another 9 x 16 mm, 05:15, previously 9\nx 18 mm. There are no soft tissue findings in the chest wall suspicious for\nmalignancy but evaluation of the breasts requires mammography.\n\nSmall lucencies in the right thyroid lobe do not warrant further imaging\nevaluation. There is no obvious atherosclerotic calcification, or pericardial\nor pleural abnormality. Findings below the diaphragm will be reported\nseparately.\n\nCentral lymph nodes are not pathologically enlarged ranging in diameter up to\na 6 mm right lower paratracheal lymph node with a punctate calcification,\n6:101 aorta and pulmonary arteries are normal size. .\n\nSmall region of paraspinal atelectasis in the right lower lobe, 9 B: 19, was\npresent in ___ and previous adjacent consolidation has nearly cleared.\nSubpleural linear atelectasis in the lung bases, right greater than left is a\nnew finding in the right lower lobe, without obvious explanation. There is no\nappreciable bronchiectasis or any bronchial obstruction, and the adjacent\npleura is not thickened.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild bilateral axillary adenopathy improved since ___. No\nintrathoracic lymph node enlargement.\n\nRight periscapular bursal cyst does not require further evaluation unless the\npatient is symptomatic."
        },
        {
            "input": "The thyroid gland demonstrates several hypodense lesions, the largest within\nthe inferior aspect of the left thyroid lobe measuring 11 x 10 mm (6:12). \nCentral lymph nodes are not pathologically enlarged measuring up to 8mm at the\nright lower paratracheal station (6:24) There is no axillary or\nsupraclavicular adenopathy. The airways are patent to the subsegmental level.\nThe esophagus is unremarkable.\n\nCardiomegaly is moderate with a particularly enlarged right atrium. The aorta\nis within upper limits of normal in caliber. The pulmonary artery is normal in\nsize.  Moderate coronary artery calcifications are identified. Patient is\nstatus post median sternotomy. There is no pericardial effusion.\n\nWithin the most inferior aspect of the right upper lobe, there is a 2 mm solid\npulmonary nodule (7:155).  A solid nodule in the right lower lung measures 6\nmm (7:277). Within the left lower lobe, there is a pleural based 10 x 9 mm\nsolid nodule and superiorly a 5 mm subpleural nodule (7:153, 188) most\ncompatible with round atelectasis. There is no pleural effusion.\n\nNo suspicious lytic or blastic osseous lesion is identified.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nobtained on the same date, ___, clip number ___.",
            "output": "1.  Right lower lobe 6 mm nodule. Followup recommended as appropriate for\nassessment of possible solitary metastasis.\n2.  Moderate cardiomegaly with right atrial enlargement.\n3.  Coronary artery moderate atherosclerotic calcifications.\n4. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis obtained on the same date, ___, clip number ___."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged.  The aorta and pulmonary arteries are normal size.\nCardiac configuration is normal.  There is minimal calcification in the left\nanterior descending artery.  A central venous line ends in the low superior\nvena cava.\n\nExtensive bilateral lower lobe consolidation is consistent with patient's\nknown pneumonia.  Additional nodules scattered throughout the right upper\nright middle and left upper lobes are presumably related to the known\ninfectious process.  There is a small right and trace left pleural effusion. \nNo pneumothorax is identified.  The airways are patent to the segmental level.\n\nOsseous structures: No concerning osteoblastic or osteolytic lesions\nidentified.  There is a slight dextroscoliosis in the thoracic spine.\n\nAlthough the study is not designed to evaluate the upper abdomen, no gross\nabnormality is identified.",
            "output": "1. Consolidation is extensive in the bilateral lower lobes.  These findings\nare consistent with the provided diagnosis of pneumonia.  Follow-up to\nresolution is recommended.\n2. Small right and trace left pleural effusions."
        },
        {
            "input": "VASCULATURE: The pulmonary arteries are well opacified to the subsegmental\nlevel bilaterally of filling defect.  The thoracic aorta is normal in caliber\nwithout aneurysmal dilation.  There is no evidence of dissection.\n\nThe abdominal aorta contains mild to moderate atherosclerotic calcification. \nThe SMA and celiac axis are widely patent.  There is a replaced right hepatic\nartery arising directly from the celiac axis.  There is 1 renal artery\nbilaterally.  There is moderate to severe atherosclerotic calcification of the\ncommon iliac.  There is severe atherosclerosis with both calcified and\nnoncalcified plaque in the proximal left external iliac artery.  Distally a\nstent graft is in place and patent.\n\nRight: There is moderate atherosclerosis of the common femoral remains patent.\nDeep femoral artery is patent.  There is mild atherosclerotic of the distal\nfemoral artery.  The popliteal artery is irregular secondary to\natherosclerotic disease but patent.  The peroneal and anterior tibial arteries\nare patent to the level of the calf.  The posterior tibial artery is occluded\njust distal to its takeoff, as seen in ___.  The dorsalis pedis is patent.\n\nLeft: There is stranding in the left groin, consistent with recent procedure..\nThe femoral to popliteal bypass is patent.  The left popliteal artery is\nsomewhat irregular, likely owing to atherosclerosis.  There is a patent 3\nvessel runoff to the foot.  There is circumferential edema most pronounced in\nthe lower left leg.  There is a 0.9 cm fluid collection is along the posterior\naspect of the knee soft tissues, likely postsurgical.  Additional larger 1.4\ncm collection in the medial mid thigh soft tissues, also likely postsurgical\n(series 3 A, image 277).\n\n\nCHEST: The airways are patent to the subsegmental level bilaterally.  There is\nmultifocal ground-glass and consolidative opacities, substantially worse on\nthe left where there is near complete opacification of the hemithorax.  There\nis a trace left pleural effusion.  There is interlobular septal thickening at\nthe lung apices.  There is no pneumothorax.  There are no suspicious bony\nlesions.  There is background moderate centrilobular emphysema.  Heart size is\nnormal.  There is no pericardial effusion.  Coronary artery calcifications are\nmild..  Main pulmonary trunk is not dilated.  There is no axillary adenopathy.\nThere are enlarged mediastinal and hilar lymph nodes, likely reactive.\n\nThe thoracic esophagus is unremarkable.\n\nABDOMEN: Liver enhances homogeneously without focal lesions.  There are\nlayering stones versus sludge in the gallbladder.  There is no evidence of\nacute cholecystitis.  Dilation of the common bile duct is again seen spleen is\nnormal in size.  Splenic cleft again noted.\n\nThere are bilateral left greater than right adrenal masses measuring up to 3.9\nx 2.4 cm on the left, consistent with adenomas.\n\nThe pancreas enhances normally without focal lesions.  There is no\nperipancreatic abnormality.\n\nThe kidneys symmetrically.  There is a 1.6 cm exophytic simple cyst in the\nmidpole of the left kidney.  Other smaller subcentimeter hypodensities are too\nsmall to characterize but likely represent additional cysts.  There is no\nhydroureteronephrosis.\n\nPostsurgical changes from Roux-en-Y gastric bypass are noted.  No evidence of\nbowel obstruction.  No bowel wall thickening.  There is diverticulosis of the\ndescending colon.  Appendix is not visualized but there are no secondary signs\nof appendicitis in the right lower quadrant.  There is no intra-abdominal free\nfluid or free air.\n\nThere is no retroperitoneal, mesenteric, or inguinal adenopathy.\n\nPELVIS: The bladder is unremarkable.  Uterus and ovaries are normal.  There is\nno pelvic free fluid.\n\nOSSEOUS STRUCTURES: There are no suspicious bony lesions.  Mild compression\ndeformity of T12 is unchanged.  There is a stable, likely hemangiomas of L3\nand L4.  Vague sclerotic lesion of T10 is also stable.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Diffuse ground-glass and consolidative airspace opacities, most severe in\nthe left lung with a small left pleural effusion, findings highly concerning\nfor multifocal pneumonia.  Pulmonary edema felt to be much less likely given\nasymmetry.  Pulmonary hemorrhage could have a similar appearance however,\nthere is no evidence of trauma.\n3. Patent femoral-popliteal bypass graft.  Small fluid collection involving\nthe posterior knee and medial thigh, felt to be postoperative seroma.\n4. Occlusion of the right posterior tibial artery just after its takeoff, as\nseen previously.\n5. Bilateral adrenal adenomas."
        },
        {
            "input": "Cardiac size is within normal limits.  There is moderate calcified\natherosclerosis of the coronary arteries.  No evidence of pericardial\neffusion.  The aorta and its major branch vessels are patent, with no evidence\nof stenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears heterogenous without definite thyroid nodules.\n\nNo pericardial effusion.  Pleural effusions are noted bilaterally, moderate on\nthe right and small on the left with associated compressive atelectasis in the\nlower lungs.\n\nA 4 mm subpleural pulmonary nodule is demonstrated in the right middle lobe,\n(series 301, image 169).  A 5 mm subpleural pulmonary nodule is also\ndemonstrated in the right middle lobe, (series 301, image 167).\n\nThe airways are patent to the subsegmental level without evidence of bronchial\nwall thickening.\n\nLimited images of the upper abdomen demonstrates a liver which is diffusely\nhypoenhancing when compared to the spleen suggesting diffuse hepatic\nsteatosis.\n\nBones: Osseous structures are diffusely osteopenic.  Posterior spinal fusion\nis seen extending inferiorly from T9.  There is an oblique oriented fracture\nextending anterior inferior corner of T5 through the body of T6 and T7.  There\nis new alignment abnormality with posterior translation of 8 mm of T5 relative\nto T6.  This finding is concerning for an unstable distraction injury and\nneurosurgical consult is advised.  A fracture involving the T12 vertebral body\nis again noted, which given the presence of associated fixation hardware is\nlikely subacute.  Midbody sternal fracture appears unchanged.  Bilateral\nproximal clavicular shaft fractures are again noted.  Bilateral chronic\nappearing rib deformities are unchanged.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Unstable fractures of the thoracic spine extending from T5 through T7 with\nassociated posterior translation measuring 8 mm.  Neurosurgical consult\nadvised.\n3. Moderate right and small left pleural effusions with compressive lower lobe\natelectasis.\n4. Bilateral proximal clavicular shaft fractures.\n5. Acute sternal body fracture.\n6. Multiple chronic bilateral rib deformities.\n7. There are 2 subpleural pulmonary nodules in the right middle lobe measuring\n4-5 mm respectively.  Attention on followup advised.\n\nRECOMMENDATION(S):  Neuro surgical or ortho spine consult is recommended for\nthe unstable fracture at T6-T7 with increased posterior translation.\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:37 pm, 5 minutes after\ndiscovery of the findings.\n\n The findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 5:56 pm, 2 minutes after discovery of the\nfindings."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect within the main, right, left, lobar or segmental\npulmonary arteries.  The subsegmental arteries are not well evaluated because\nof respiratory artifacts and adjacent lung parenchymal abnormalities.\n\nThe pulmonary trunk is mildly dilated measuring 3.2 cm.  The right main\npulmonary artery measures 2.7 cm and the left main pulmonary artery measures\n2.5 cm.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  There is a left PICC line in place.\n\nThere is no evidence of pericardial effusion.  Bilateral small to moderate\npleural effusions with loculations along the posterior and superior aspect of\nboth lungs.  A right pigtail catheter is seen in the right pleural space.\n\nThere is bilateral interstitial thickening with fluid along the fissures as\nwell as peribronchial thickening all suggestive of interstitial pulmonary\nedema.  There are bilateral lower lobe distal endobronchial secretions.\n\nLimited images of the upper abdomen are unremarkable.  There is a nasogastric\ntube in the fundus of the stomach.  Again seen is a 1.8 cm right adrenal\nnodule.\n\nPatient known with an unstable fracture of vertebral body of T5/T6 as well as\nfracture of T12 vertebral body previously described on recent thoracolumbar\nMRI.  Status post extensive fixation of the thoracolumbar spine.\nAdditional fracture of vertebral body of C7 is also stable.\nThere is also a partially visualized nondisplaced anterior-inferior fracture\nof vertebral body of C4.\nMultiple bilateral rib fractures are again noted as well as bilateral\nminimally displaced proximal clavicles fractures and mid-sternal fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Signs of interstitial pulmonary edema.\n3. Multiple ribs, clavicles and vertebral body fractures.  Unstable T5-T6\nvertebral body fractures is again noted with extensive orthopedic hardware in\nplace.\n\nNOTIFICATION:  The findings were discussed with MEANS, ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:50 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nsubsegmental arteries are not well evaluated secondary to respiratory and\nspinal hardware artifact.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  Coronary artery calcifications\nare moderate.  The main pulmonary artery is top normal in size measuring up to\n3.3 cm, previously 3.2 cm (301:120).  The right main pulmonary artery measures\n2.6 cm in the left main pulmonary artery measures 2.7 cm.  No pericardial\neffusion is seen.  Right-sided central venous catheter terminates at the\nsuperior cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small to moderate right pleural effusion appears increased in\nsize compared to prior exam and is associated with overlying compressive\natelectasis.  Small left pleural effusion with loculated fissural component\ndoes not appear substantially changed.  There has been interval removal of a\nright pleural drain. No pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited in the setting of\nrespiratory motion artifact.  Within this limitation there is interstitial\nthickening slightly improved from prior exam.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  There has\nbeen interval removal of an enteric tube compared to ___.\n\nBONES: Again demonstrated is a T5-T6 Chance type fracture which is better\nevaluated on prior MR cervical spine dated ___.  Posterior spinal\nfusion hardware is again seen but incompletely evaluated.  Multiple bilateral\nrib fractures are again seen, some of which demonstrate interval periosteal\nnew bone formation indicative of healing.  Bilateral clavicular fractures\ndemonstrate marked callus formation.  A midsternal fractures is not\nsubstantially changed.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Interval worsening of small to moderate right pleural effusion and\nunchanged appearance of a small left pleural effusion.\n3. Slight interval improvement in interstitial pulmonary edema.\n4. Stable vertebral, rib, clavicular, and sternal fractures as described\nabove.  Unchanged appearance of the posterior spinal fusion hardware.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:25 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST PERIMETER: No incidental thyroid findings.  No supraclavicular or left\naxillary adenopathy. There may be a new 13 mm right subpectoral lymph node.\n301:107.  No other soft tissue abnormalities in the chest wall. This study is\nnot appropriate for subdiaphragmatic diagnosis but shows no subphrenic\ncollection or adrenal mass.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable. Atherosclerotic calcification\nmild in head and neck vessels, is heavy in at least left anterior descending\ncoronary artery. Minimally calcified ascending thoracic aorta normal caliber.\nPericardium is physiologic.\n\nPULMONARY ARTERIES:\n\nPulmonary arteries are enlarged, main 35 mm, right 29 mm, previously 34 mm and\n31 mm.  No pulmonary emboli to the segmental level.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Moderate,  right and small left, generally dependent\nnonhemorrhagic pleural effusions, including the right fissural component are\ncomparable in volume to that on ___.  No pleural mass or hematoma.\n\nModerate atelectasis, posterior segment right upper lobe and severe\natelectasis right basal lower lobe segments unchanged.  No bronchial\nobstruction.\n\nCHEST CAGE: No interval change except for slight progression of callus\nformation in multiple healing fractures of the chest cage.  No new fractures\nor evidence of chest wall infection.  No migration of stabilized thoracic\nspine trauma or hardware.",
            "output": "No pulmonary embolism.  Chronic pulmonary hypertension.\n\nModerate right and small left pleural effusions stable or recurrent.\n\nStable atelectasis, moderate, right upper and severe, right lower lobes."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: A calcified granuloma is noted in the left lower lobe. \nAtelectasis is seen in the lung bases dependently.  There is no focal\nparenchymal opacification given confines of respiratory motion artifact.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck is remarkable for a\n1.4 cm hypodense lesion in the left thyroid lobe (series 2: Image 15).\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple subcentimeter hypodensities are seen scattered\nthroughout the liver, likely representing hepatic cysts or biliary hamartomas.\nOtherwise, the liver demonstrates homogenous attenuation throughout.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney appears normal with normal nephrogram.  There is a\nsubcentimeter right perirenal cyst and subcentimeter cortically based\nhypodensity in the interpolar region of the right kidney, likely simple cysts.\nThe left kidney appears edematous with subtle delayed striated nephrogram with\nextensive surrounding perirenal inflammatory fat stranding.  Small foci of gas\nare noted in the collecting system of the left renal pelvis, concerning for\nemphysematous pyelonephritis.  There is no hydronephrosis.  There is no\nabscess formation.\n\nGASTROINTESTINAL: The stomach is decompressed.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not well visualized.  There\nis no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nAir locules are seen in the urinary bladder, likely due to recent\ninstrumentation.  No evidence of distal hydroureter.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 14 mm hyperenhancing lesion within the\nposterior uterine fundus, likely representing a fibroid.  The uterus is\nretroverted.  The adnexae are grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Edematous left kidney with delayed striated nephrogram and extensive\nperirenal inflammatory fat stranding and gas seen in the collecting system of\nthe left renal pelvis, concerning for emphysematous pyelonephritis.\n2. No pulmonary embolus or acute aortic abnormality.\n3. Cholelithiasis.\n4. 1.4 cm hypodense left thyroid nodule.\n5. Probable fibroid uterus.\n6. Air is seen in the urinary bladder, likely due to recent instrumentation. \nPlease correlate with patient history.\n\nRECOMMENDATION(S):  Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:03 pm, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "Extensive adenopathy in the right lateral chest wall is chronic,, since at\nleast ___, but more pronounced with lymph nodes ranging in diameter up\nto 11 x 18 mm, 4:70-113, previously as small as 11 x 9 mm and 10 x 12 mm.\nThere is no adenopathy in the supraclavicular or left axillary stations. There\nare no other soft tissue lesions in the chest wall suspicious for malignancy.\nThyroid is unremarkable.\n\nArterial graft at the thoracic inlet on the left,, probably from the common\ncarotid to the subclavian artery, is unchanged in size, shape, and position\nsince ___ but, absent intravenous contrast agent, its patency is not\nassessed. Similarly the graft of the aortic arch and descending thoracic aorta\nis unchanged as to location and contour ; although the lumen is not assessed\nthe diameter of the native aorta extending lateral to the graft has decreased,\nfrom 17 to 13 mm, 02:22. Punctate calcification in the aortic valve is\nslightly more pronounced today than it in ___, and minimal\natherosclerotic calcification in the left anterior descending coronary artery\nmay be new. Pulmonary arteries are normal size.\n\nThere is no pleural or pericardial abnormality. Sternotomy is well-healed.\nThere is no pathologic enlargement of mediastinal lymph nodes and the hilar\ncontours do not suggest adenopathy. Sagittal elongation of the mid trachea, is\ngenerally due to chronic lung disease, but in this case may be due to the\nadjacent aortic graft.  Allowing for differences in orientation, levels of\ninspiration, and collimation is CT studies, there has been no clear growth in\nthe irregularly shaped, but sharply circumscribed right upper lobe nodule\nfirst imaged on ___, 7 x 13 mm, 7 x 18 mm on ___, and today,\n7 x 13 mm, 04:18. Aside from scattered bronchial wall thickening, the lungs\nare otherwise clear.\n\nThere are no bone lesions in the chest wall suspicious",
            "output": "For malignancy.\nChronic lateral right chest wall lymphadenopathy more pronounced today. \nClinical evaluation advised.\n\n\nRight apical lung lesion, stable since at least ___. No followup\nnecessary.\n\nAortic and left subclavian grafts, both outwardly intact."
        },
        {
            "input": "CTA CHEST WITH CONTRAST: The study is somewhat limited by poor opacification\nof the aorta and main thoracic vessels. Patient is status post endovascular\nrepair of the aortic arch.\n\nThe proximal left subclavian is not opacified. There is a bypass graft from\nthe more distal left common carotid artery to the left subclavian with some\nretrograde filling of the more proximal left subclavian (10:89) as before. As\non the prior study there is mild narrowing of the proximal left common carotid\n(10:75). There is evidence of persistent endoleak (10:59 and 12:23). The\nthrombosed aneurysm sac is smaller since ___ but unchanged since\n___.\n\n1.3 x 0.6 cm nodule in the right apex is unchanged since at least ___. More\ninferiorly a 0.5 cm nodule (06:50) is unchanged. 0.9 x 0.5 cm area of\nground-glass opacity in the right upper lobe (6:109), was not seen on the\nprior study. Multiple small subpleural nodules at the left apex and are not\nappreciably changed, for example 0.3 cm left apical nodule (12:39).\n\nMultiple prominent mediastinal lymph nodes are not significantly changed. The\ntracheobronchial tree is patent to the subsegmental level, however there are\nminimal retained secretions in the trachea (06:36). Heart size is normal\nwithout pericardial effusion. As before there are atherosclerotic\ncalcifications of the coronary arteries. The main pulmonary arteries are\nnormal in caliber and well opacified.\n\nOSSEOUS STRUCTURES: Median sternotomy wires appear intact. There are no\nworrisome blastic or lytic lesions.\n\nUPPER ABDOMEN: There is persistent pneumobilia mass seen on prior studies. \nThickening of the adrenal glands, left greater than right is similar to the\nprior study.\n\nTHORACIC AORTA MEASUREMENTS:\nSinus of Valsalva: 4.1 x 3.3 cm\nSino-tubular junction: 3.6 x 3.2 cm\nAscending aorta: 4.4 x 3.8 cm\nMid transverse aorta: 4.2 x 4.9 cm\nProximal descending aorta: 3.6 x 4.4 cm\nMid descending aorta: 3.4 x 2.9 cm",
            "output": "1. Persistent endoleak (10:59), however the aneurysm sac size is unchanged\nsince the most recent study of ___ although smaller since ___.\n2. Patent neo-innominate artery and neo-left common carotid artery. Patent\nleft common carotid artery to subclavian artery bypass graft.\n3. Apparent new 0.9 cm ground-glass opacity in the right upper lobe can be\nre-evaluated at the time of followup aortic imaging as well as the stable RUL\nscar/nodule.\n4. Persistent pneumobilia in the setting of prior sphincterotomy. Unchanged\nthickening of the adrenal glands, left greater than right, may reflect\ncombination of cortical hypertrophy and adenoma."
        },
        {
            "input": "CTA TORSO:\n\nMild aortic ectasia noted.   The thoracic and abdominal aorta are otherwise\nnormal in caliber and without evidence of aneurysm or dissection.The celiac\naxis, SMA, bilateral renal arteries, and ___ are grossly patent.\nAtherosclerotic calcified and noncalcified mural calcifications are seen\nthroughout the aorta and its major branches. The hepatic arterial anatomy is\nconventional. No active arterial extravasation within the chest, abdomen, or\npelvis.\n\nCHEST:\n\nThe thyroid is normal.No axillary, supraclavicular, mediastinal, or hilar\nlymph node enlargement. The heart and mediastinum are normal.  Trace\npericardial effusion.Right mainstem bronchus intubation. The airways are\npatent to the subsegmental levels.  Ill-defined solid and ground-glass opacity\nwithin the right lower lobe is consistent with pneumonia. (4a: 38). No active\narterial extravasation. A 0.8 x 0.5 cm (4a: 44) solid appearing nodule is seen\nwithin the left lower lobe.  Nodularity in the RML on series 4a:41 likely\nrepresents scarring though given the change in density on CTA which follows\nblood pool, the possibility of a tiny aneurysm or AVM is considered.  There\nare no adjacent bronchi which appear to communicate with this nodular lesion.\nBibasilar atelectasis is noted. No pleural effusion or pneumothorax.\n\nABDOMEN:\n\nMultiple arterially enhancing lesions are noted throughout the liver largest\nmeasuring 2.4 x 2.1 cm (4a: 52) within segment 8 which is hypodense on portal\nvenous phase.  Additional hepatic lesions demonstrate discontinuous peripheral\nfilling most consistent with hemangiomas. The portal vein, SMA, and splenic\nvein are patent. No intra or extrahepatic biliary dilatation. The gallbladder,\npancreas, and bilateral adrenal glands are normal.A 2.3 x 2.1 cm (4b: 250)\nhypodense lesion with discontinuous peripheral enhancement is most consistent\nwith a splenic hemangioma. The kidneys enhance symmetrically.  A 1.5 x 1.2 cm\n(4 b: 258) hypodensity within the interpolar region of the left kidney is\nintermediate in density. Additional subcentimeter hypodensities are seen\nwithin the left kidney, too small to characterize.\n\nThe stomach is grossly unremarkable in appearance.The small and large bowel\nare normal in caliber and without evidence of wall thickening. The appendix is\nnot visualized however no evidence acute appendicitis.  Colonic diverticulosis\nis present without evidence of diverticulitis. No retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.No free abdominal fluid,\nabdominal wall hernia, or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is unremarkable with air from recent Foley catheter placement. No\npelvic side-wall or inguinal lymph node enlargement.No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Right mainstem bronchus intubation.  Retraction by at least 3 cm is\nadvised.\n2.  No arterial extravasation within the chest, abdomen, or pelvis.\n3.  Right lower lobe opacity most consistent with pneumonia.\n4.  0.8 cm solid-appearing nodule within left lower lobe is likely\ninflammatory in nature.  Followup in ___ months is recommended\n5.  Right middle lobe nodule could represent scarring however given history of\nhemoptysis differential includes tiny aneurysm or AVM. Considering causes of\nhemoptysis pneumonia is likely the etiology rather then the RML lesion given\nabsence of bronchial involvement.  Recommend short interval followup\n6.  Trace pericardial effusion.\n7.  Multiple hepatic and splenic hemangiomas.\n8.  Renal hypodensities, too small to characterize.\n9.  Diverticulosis without evidence of acute diverticulitis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 9:40PM ___, 5 minutes after\ndiscovery of updated findings."
        },
        {
            "input": "CTA Chest: Moderate atherosclerotic disease is present along the thoracic\naorta. There is no evidence of aneurysm or dissection. Main pulmonary trunk is\nnormal in caliber. Pulmonary arteries are well opacified to subsegmental level\nwithout a filling defect to suggest pulmonary embolism.\n\nCT Chest: Thyroid gland is diffusely enlarged and is mildly heterogeneous.\nMediastinal lymph nodes are prominent in size and number measuring up to 14 x\n8 mm in the right lower paratracheal station. A right hilar lymph node\nmeasures 17 x 8 mm (2:43).\n\nThere is thick curvilinear low density material surrounding the right atrium\nwith rim enhancement measuring approximately 1.7 cm in thickness (3:116,\n601b:15). The appearance is more suggestive of a pericardial process rather\nthan an intraluminal lesion. Heart is mildly enlarged. There is a small\npericardial effusion.\n\nAirways are patent to subsegmental level. Numerous scattered bilateral\npulmonary nodules are present in a random distribution, some have increased in\nsize, many are new and concerning for a widespread metastatic process. For\nexample, an 11 x 15 mm pulmonary right middle lobe nodule previously measured\n6 x 9 mm (3:109), and 7 mm right upper lobe pulmonary nodule was previously 3\nmm (03:52). Small left and trace right pleural effusions are also new.\n\nLimited view of the upper abdomen is notable for presence of two lesions\nwithin the right lobe of the liver, relatively unchanged from the prior\nexamination the likely hemangiomas. A 4.3 x 3.7 cm heterogeneous lesion in the\nspleen however has increased in size, previously 3.2 x 2.9 cm.\n\nNo concerning lytic or sclerotic osseous lesion is present.",
            "output": "1.  No evidence of pulmonary embolism.\n\n2. Numerous randomly distributed pulmonary nodules of varying sizes, some have\nincreased in size, many are new and concerning for widespread metastatic\ndisease.\n\n3. Thick curvilinear low density material surrounding the right atrium with\nrim enhancement is thought to represent a pericardial process rather than an\nintraluminal lesion and involvement by tumor is favored over a loculated\neffusion. This could potentially result in constrictive pericarditis if\ntamponade physiology is suspected.\n\n4. Increased small left and trace right pleural effusions.\n\n5. Multiple prominent and mildly enlarged mediastinal and hilar lymph nodes.\n\n6. Increased size of heterogeneous splenic lesion, concerning for malignancy.\n\n7. Diffusely enlarged and mildly heterogeneous thyroid gland.\n\nNOTIFICATION:   Findings were discussed by Dr. ___ with Dr. ___\n___ , on ___ at 11:15 pm, via telephone."
        },
        {
            "input": "Vascular clips in a prior thyroidectomy. There is no pathologic enlargement of\nsupraclavicular or axillary lymph nodes and no soft tissue abnormality in the\nchest wall suspicious for malignancy. This study is not designed for\nsubdiaphragmatic diagnosis, but shows and 11 x 23 mm wide fluid attenuation\ncyst in the lateral limb of the left adrenal gland. Right adrenal is normal.\nCalcified stones are present in the gallbladder with no indication of either\nbiliary obstruction or cholecystitis.\n\nCentral lymph nodes in the hila and mediastinum are not pathologically\nenlarged ranging up to 10 mm in the subcarinal station. Atherosclerotic\ncalcification is present at the bifurcation of the brachiocephalic artery, and\nat least in the proximal left and the left anterior descending coronary\narteries. Heart is mildly enlarged. Pericardial effusion is small.  Left\npleural effusion is tiny.\n\nAside from a punctate subpleural calcification, right upper lobe, 6:155, lungs\nare clear. Tracheobronchial tree is normal to subsegmental levels. There are\nno bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nAtherosclerosis, involving coronaries. Clinical evaluation advised."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Coronary calcifications\nare unchanged.  No mediastinal, hilar or axillary lymphadenopathy is present. \nNo abnormality in the post thyroidectomy bed demonstrated.  Heart size is\nnormal.  No pericardial pleural effusion is seen. Image portion of the upper\nabdomen reveals no appreciable abnormality except for calcified gallstones\n\nAirways are patent to the subsegmental level bilaterally except for right\nmiddle lobe and right lower lobe.  There there are extensive endobronchial\nsecretions with impaction of almost entire airways.  , in particular the\nbranching fluid field structures are in the right lower lobe with extensive\nconsolidation and more nodular opacity, series 4, image 149, 5.6 mm.  No other\nnodules masses are consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Right lower lobe fluid-filled bronchi and frank consolidations as well as\nright middle lobe endobronchial secretions with by E lobar diffuse bronchial\nwall thickening, most likely representing extensive infection.  Short-term\nfollowup in 3 months is recommended.\n\nNo evidence of definitive pulmonary nodules worrisome for malignancy but right\nlower lobe new nodule is noted although potentially representing part of the\ninfectious process.\n\nCoronary calcifications."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  This study is not\nappropriate for subdiaphragmatic diagnosis but shows there is no adrenal mass.\nAll atherosclerotic calcification is not apparent in head neck or coronary\narteries.\n\nA paraesophageal hernia is small an the esophagus proximal to it is\nunremarkable.  Thyroid is unremarkable.  Aorta and pulmonary arteries and\ncardiac chambers are normal size.\n\nThere is no pericardial or pleural abnormality.\n\nMediastinal lymph nodes are not pathologically enlarged and there is no\nadenopathy in the hilar, internal mammary or diaphragmatic stations.  At the\nlevel of the aortic hiatus, there is asymmetry in the diaphragmatic crura\nwhich could be due to muscular hypertrophy or a 12 x 19 mm right retrocrural\nlymph node.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere no bone lesions in the chest cage suspicious for malignancy.",
            "output": "The only candidate for intrathoracic malignancy is possible right retrocrural\nlymph node which could be asymmetry of the carina instead.  There no pulmonary\nnodules or adenopathy in the places expected for metastatic breast carcinoma.\n\nSmall paraesophageal hiatus hernia."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  Clips\nin the left breast are noted.  Normal sized pretracheal lymph nodes are\nunchanged.  However, there is a large left breast mixed soft tissue and fluid\nattenuation structure (5, 25).  With a diameter of 6 x 7 cm that was not\npresent on the previous examination.  The dorsal parts of these masslike\nstructure shows extension sent stranding into the surrounding fat.  No cardiac\nabnormalities.  Paraesophageal hernia (5, 40).  No abnormalities in the\nposterior mediastinum.  A borderline retrocrural left-sided lymph node (5, 50)\nis stable in size and morphology.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  No osteolytic lesions at the level of the\nribs, the sternum or the vertebral bodies.  The lung parenchyma shows no\nrelevant abnormalities.  Mild scarring at the bases of the lingula.  No\npleural thickening, no pleural effusions.  No suspicious lung nodules or\nmasses.  Minimal areas of atelectasis in the dependent lung regions.",
            "output": "New predominantly liquid left breast retention with a diameter of 6 x 7 cm,\nwith signs of perilesional stranding.  The evaluation with ultrasound is\nrecommended.\nNo evidence of neoplastic disease or infection in the thorax."
        },
        {
            "input": "HEART AND VASCULATURE:  Exam is slightly limited as scanner stopped midscan. \nThe pulmonary vasculature is well opacified to the segmental level without\nfilling defect to indicate a pulmonary embolus.  The thoracic aorta is normal\nin caliber without evidence of dissection or intramural hematoma.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a trace left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is mild bilateral dependent atelectasis.  There is\nminimal ground-glass in the anterior left upper lobe (7:88).  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is a small hiatal hernia.  Patient is status post\ncholecystectomy.  There is a 1.9 cm simple cyst in the upper pole of the right\nkidney.  Included portion of the upper abdomen is otherwise unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nSOFT TISSUES: Patient is status post left breast flap reconstruction, with\npostsurgical changes seen including soft tissue swelling, subcutaneous\nemphysema and a surgical drain in the left breast.  There is no organized\nfluid collection.",
            "output": "1. Exam is slightly limited due to technical difficulties.  No evidence of\npulmonary embolism to the segmental level or aortic abnormality.\n2. Trace left pleural effusion and mild bilateral dependent atelectasis.\n3. Minimal ground-glass in the anterior left upper lobe is nonspecific, may be\ninflammatory in nature, however early component of infection cannot be\nexcluded.\n4. Postsurgical changes related to recent left breast flap reconstruction.  No\norganized fluid collection."
        },
        {
            "input": "HEART AND VASCULATURE: There is somewhat poor opacification of the segmental\nand subsegmental pulmonary arteries, particularly in the lower lobes,\npartially due to noise artifact from patient body habitus and patient's left\narm being down..  Given this, no concerning filling defect is seen to suggest\npulmonary embolism.  The thoracic aorta is normal in caliber without evidence\nof acute dissection.  No pericardial effusion is seen.  Right-sided\nport-A-Cath terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear branching opacities in the bilateral lower lobes, right\nupper lobe, and lingula are compatible with subsegmental atelectasis.  There\nis no focal consolidation.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThyroid is unremarkable.\n\nABDOMEN: There is a small paraesophageal hernia.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nTram flap with postoperative changes in the left breast is partially imaged,\ngrossly similar to prior.",
            "output": "1. Somewhat poor opacification of the segmental and subsegmental pulmonary\narteries, particularly in the lower lobes, part due to noise artifact from\npatient body habitus shin patient's left arm being down.  Given this, no\nevidence of pulmonary embolism.  No evidence of aortic dissection.\n2. Subsegmental atelectasis in the bilateral lower lobes, right upper lobe,\nand lingula.\n3. TRAM flap in the left breast is partially imaged, with postoperative\nchanges grossly similar compared to the prior study from ___."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE:  This examination is limited by motion artifact,\nparticularly at the bases.  A left pectoral pacemaker is seen with 2 leads\nterminating within the right ventricle, and 1 terminating within the right\natrium.  There is moderate cardiomegaly.  There are extensive calcified and\nnoncalcified atherosclerotic plaques throughout the thoracic aorta, at the\norigin of the head and neck vessels, and the coronary arteries.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma. Pulmonary vasculature is well opacified to the subsegmental level\nwithout filling defect to indicate a pulmonary embolus.  The main pulmonary\nartery is dilated up to 3.7 cm, suggesting pulmonary hypertension.  There is\nno pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM:  There are multiple enlarged right peritracheal\nlymph nodes measuring up to 11 mm in short axis (series 2A image 35).  No\naxillary or hilar lymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  There are small bilateral nonhemorrhagic pleural effusions,\nleft greater than right.  No evidence of pneumothorax.\n\n\nLUNGS/AIRWAYS:  There are a few small paraseptal blebs.  Mild dependent\natelectasis, but no focal consolidations.  Unchanged calcified granuloma\nwithin the left lower lobe.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nABDOMEN:\nThere is trace nonhemorrhagic perihepatic ascites extending to the pericolic\ngutters bilaterally, and surrounding the second portion of the duodenum.\n\nHEPATOBILIARY:   The liver demonstrates homogenously hypodense, likely due to\nsteatosis.  There is no evidence of focal lesions.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  A large gallstone is\ndemonstrated within a decompressed gallbladder.  There is no evidence\ncholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The adrenal glands are mildly thickened bilaterally.  There is a\n1.9 x 1.2 cm nodule arising from the inferior left adrenal gland, unchanged\nsince ___ where it measured fat density, consistent with an adenoma.\n\nURINARY: A subcentimeter hypodensity within the upper pole of the left kidney\nis too small to characterize, but likely represents a simple cyst (series\n606b, image 38).  Otherwise, the kidneys are of normal and symmetric size with\nnormal nephrogram.  There is no evidence of solid renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted, particularly at the origin of the celiac and SMA, which are\nboth patent.  A chronic short segment infrarenal aortic dissection flap is\nunchanged (series 607b, image 42).\n\nBONES AND SOFT TISSUES: Bilateral gynecomastia is noted.  Sternotomy wires\nappear intact and appropriately aligned.  There is chronic anterior wedging of\nthe T11 vertebral body.  There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Motion at the bases, but no evidence of pulmonary embolism or acute\nintra-abdominal process.\n2. Cardiomegaly with small bilateral nonhemorrhagic pleural effusions.  Trace\nintra-abdominal ascites of unclear etiology, but may be due to third spacing.\n3. Enlargement of the main pulmonary artery suggests pulmonary hypertension.\n4. Prominent mediastinal lymph nodes measuring up to 11 mm, which are\nnonspecific.\n5. Extensive atherosclerosis with a chronic short-segment infrarenal aortic\ndissection flap.\n6. Other incidentals include hepatic steatosis, cholelithiasis,\ndiverticulosis, and a left adrenal adenoma."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  Left prepectoral pacemaker in situ\nwith the lead tips present in the right atrium and right ventricle.  Moderate\ngynecomastia.  Small area of asymmetrical breast soft tissue in the lateral\naspect of the right breast (2, 29).\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  No adrenal lesions.  Mild-to-moderate perihepatic free fluid, mild\nsplenic free fluid and intra-abdominal soft tissues stranding suggesting\nthird-spacing of fluid.  Rim calcified gallstone in the gallbladder measuring\n22 mm in diameter.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Marked cardiomegaly.  Relative hypodensity of the blood\npool suggesting anemia.  No pericardial effusion.  Moderate calcification of\nthe aortic annulus, root, ascending aorta, aortic arch and supra-aortic\narteries.  There is a segment of the anterior aspect of the ascending aorta\nwhich is not significantly calcified extending from the level just above the\nright coronary artery CABG (approximately 39 mm superior to the level of the\naortic annulus) to the level of the proximal aspect of the aortic arch\n(approximately 70 mm in superior to the level of the aortic annulus).  The\nfree bypass grafts arising from the anterior aspect of the aorta coursing to\nthe left system runs approximately 20 mm deep to the inner cortex of the\nsternum.\n\nEvidence of multiple prior CABG is:\n1.  Free bypass graft arising from the anterior aspect of the aorta\n(approximately 39 mm superior to the level of the aortic annulus) coursing to\nthe right coronary artery.  Multiple stents present in this bypass graft.\n2.  Free bypass graft arising from the anterior aspect of the ascending aorta\n(approximately 56 mm superior to the level of the aortic valve) coursing to\nthe left circumflex artery\n3.  Free bypass graft arising just inferior to to the above graft\n(approximately 52 mm superior to the level of the aortic valve) coursing to an\nobtuse marginal vessels.  Stent present in the proximal aspect of this graft.\n4.  Lima graft coursing to the LAD.\nSevere calcification of the native coronary arteries, which demonstrate a\nnormal course.\n\nPLEURA: Small bilateral pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Mild interstitial septal thickening in keeping with mild\npulmonary edema.  Mild atelectasis in the lung bases.  No suspicious pulmonary\nnodules or masses.  Round calcified granuloma in the left lung base.\n2. AIRWAYS:  The study was not performed during optimal inspiration.  The\nairways are patent to the subsegmental level.  No bronchiectasis.\n3. VESSELS:  The pulmonary artery is dilated measuring 38 mm diameter and\npulmonary artery hypertension should be excluded.\nCHEST CAGE: Evidence of previous midline sternotomy.  No dehiscence. \nSpondylotic changes of the thoracic spine.  No lytic/destructive bony lesions.",
            "output": "Evidence of prior CABG procedure with 4 CABG's as described above.\nThere is a noncalcified window present in the anterior aspect of the ascending\naorta as described above.\n\nMild pulmonary edema.  No suspicious pulmonary nodules or masses.  Pneumonia. \nEvidence of third-spacing of fluid."
        },
        {
            "input": "HEART AND VASCULATURE: Patient is status post CABG with postsurgical changes\nnoted in the mediastinum.  Minimal air in the main pulmonary artery is likely\nsecondary to injection of contrast injection (3:92).  Pulmonary vasculature is\nwell opacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy.  Right\nhilar and mediastinal lymphadenopathy is noted which may be reactive.\n\n\nPathy airsace opaciyies...pulm GGO pulm edema ___ infectios\nprocess..scattered throughout the lungs\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Patchy ground-glass opacities are scattered throughout the\nlungs which may be secondary to pulmonary edema however an infectious process\ncannot be excluded.  Honeycombing noted predominantly in the lower lobes\nbilaterally.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Patchy ground-glass opacities in the lungs likely reflect pulmonary edema,\nhowever infectious process cannot be excluded.\n3. Mediastinal and right hilar lymphadenopathy likely reactive in the setting\nof recent CABG versus a superimposed infectious process..\n4. Patient is status post CABG with postsurgical changes noted in the\nmediastinum.\n5. Minimal air in the main pulmonary artery is likely secondary to injection\nof contrast injection (3:92).\n6. Fibrosis predominantly in the lower lobes compatible with chronic\ninterstitial lung disease.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:02 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple enlarged mediastinal lymph nodes are unchanged.  For\nexample, a subaortic node (series 5, image 114) measures 1.0 cm.  Had a right\nparatracheal node (series 5, image 96) measures 1.0 cm.  Additional large\nmediastinal lymph nodes are also unchanged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART: Patient is status post CABG.  The heart is mildly enlarged and there is\nextensive coronary arterial calcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main pulmonary artery is dilated measuring 3.5 cm.  The right and left\npulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There are patchy areas of ground-glass opacities\nthroughout the lungs with bronchiectasis and bronchiolectasis and subpleural\ncystic changes.  No significant honeycombing.  The findings are more\npronounced in the lower lungs.  No focal consolidation.  No obvious pulmonary\nnodules or masses.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  No acute fractures.\n\nUPPER ABDOMEN:  Limited evaluation of the upper abdomen demonstrate a 1.8 cm\ngallstone as on prior study.  Otherwise the upper abdomen is unremarkable.",
            "output": "1. Patchy areas of ground-glass opacities with bronchiectasis/bronchiolectasis\nthroughout the lungs, most severe in the lower lungs.  Thickened honeycombing.\nFindings are most consistent with an NSIP pattern or less likely atypical\ninfection.\n2. Multiple enlarged mediastinal lymph nodes likely reactive.\n3. Dilated main pulmonary artery to 3.5 cm, suggestive of pulmonary arterial\nhypertension.\n4. Cholelithiasis without cholecystitis."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue abnormalities elsewhere in the imaged chest wall\nconcerning for malignancy.  This study is not appropriate for subdiaphragmatic\ndiagnosis.\n\n\nCARDIO-MEDIASTINUM:Small hiatus hernia or patulous distal esophagus is\nunchanged.  Atherosclerotic calcification is heavy in head and neck vessels. \nPatient has had median sternotomy and coronary bypass grafting.  Native\ncoronary arteries are heavily calcified.  Aorta is normal size.  Pulmonary\narteries are mildly enlarged.  Pericardium is physiologic.\n\n\nTHORACIC LYMPH NODES: Central lymph nodes are not pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Widespread multifocal, well-defined, heavy,\npredominantly peribronchovascular reticulation is still present.  There are no\nnew areas of involvement by reticulation there are a few areas where the\nbackground ground glass opacification has improved.  In one region of milder\ninitial involvement, the anterior segment of the left upper lobe there is\nactually less profusion of reticulation.\n\nHowever there is one substantial new development, a large region of\nground-glass opacification in previously normal right lower lobe, 4:109-135.\n\nA different development which may hold promise for resolution is the\ndevelopment of mild dilatation subsegmental bronchi at both lung bases. \nAlthough this can be seen against a background of fibrosis, it is also a\nphenomenon that occurs transiently in healing pneumonia.\n\nCHEST CAGE: Unremarkable",
            "output": "Overall changes are not clear as to the direction of this condition (see\ndiscussion above), as well as diagnosis, which includes acute interstitial\npneumonia, pulmonary venoocclusive disease, diffuse hemorrhage, and atypical\ncryptogenic organizing pneumonia."
        },
        {
            "input": "Lungs:\n\nParenchyma and Airways: There are mild tracheal secretions.  Airways are\notherwise patent.  There is right mid lung, and bibasilar atelectasis,\nadjacent to pleural effusions.  There is mild interstitial edema in the lung\nbases, most prominent at the right lower lobe with interlobular septal\nthickening.  There few tiny centrilobular nodules in the posterior right upper\nlobe, differential considerations mucoid impaction, infection or aspiration,\nclinically correlate.  There are no areas of consolidation.\nVessels: Mildly prominent main pulmonary artery, suggest pulmonary artery\nhypertension.  Normal caliber aorta.  There is heavy calcification of the\nproximal ascending aortic wall, involving anterior wall just above the level\nof the right coronary artery origin, and left lateral, and anterior left\nlateral wall above the level of left main origin, calcifications extending\napproximately 3 cm above the left main origin.  There are also calcifications\njust above and medial to the origin of the graft from aorta to the RCA.\n\nMediastinum and Hila: Few subcentimeter lymph nodes, no adenopathy.\n\nHeart and Pericardium: Heart is enlarged.  There are heavy coronary artery\ncalcifications.  Mitral annular calcifications.  Aortic valve replacement. \nSternotomy.\n\nPleura: There is small free-flowing left pleural effusion.  There is partially\nloculated small right pleural effusion with associated linear pleural\nthickening, which is nonspecific, may be related to trauma, inflammation,\nneoplasm, or infection if clinically suspected.  Calcified pleural plaques.\n\nNeck, Thoracic Inlet, Axillae, Chest Wall: Left IJ transvenous pacer tip in\nthe right ventricle.  No mass, no adenopathy.\n\nUpper Abdomen: There is small esophageal hiatal hernia.  Trace abdominal\nascites.  Cholecystectomy.  .  There is residual contrast within kidneys,\nrelated to contrast administration from CT lumbar spine from earlier today.\n\nChest Cage: Sternotomy.",
            "output": "Heavy calcifications of the proximal ascending aorta.\nSmall bilateral pleural effusions, partially loculated on the right.  There is\nlinear pleural thickening on the right, nonspecific, may be related to trauma,\nreactive, inflammatory, neoplastic or infectious etiology, if clinically\nsuspected.\nMild tracheal secretions.  Tiny lung nodules in the right upper lobe with\ncentrilobular distribution, may represent mucoid impaction, aspiration or\ninfection, clinically correlate.\nBibasilar Atelectasis.\nThere is mild pulmonary edema.\nSuggestion of pulmonary artery hypertension."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, lymph nodes are not\nenlarged.  There is increasing number and size of multiple mediastinal lymph\nnodes measuring up to 8 mm in the right upper paratracheal station, 10 mm\nright lower paratracheal station 8 mm subcarinal.  In the left hilum\nmediastinal lymph nodes measure up to 7 mm. Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal and there is no appreciable\ncoronary calcification.  There are multiple platelike atelectasis in the lower\nlobes, lingula and right middle lobe.  Ground-glass opacity in the right upper\nlobe adjacent to the fissure measuring 17 mm (7:136) is of unclear etiology\ncould be inflammatory, infections or neoplastic.  Perifissural lymph node in\nthe right upper lobe measures 5 mm (7:135).  There is no pleural or\npericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Borderline mediastinal and hilar lymph nodes\nGround-glass nodule in the left upper lobe: Differential diagnosis includes\ninflammatory, infectious or neoplastic origin\n\nRECOMMENDATION(S):  Followup CT in 3 months"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes are\nnot pathologically enlarged by size criteria.  Enlarged right hilar lymph node\n214 mm is unchanged.  No left hilar or axillary lymphadenopathy.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 5 mm right upper lobe ground-glass pulmonary nodule\n(series 3, image 39), unchanged since ___, at which time it was best\nappreciated in the coronal plane.  There is a punctate calcified granuloma in\nthe left lower lobe (series 3, image 150).  Lungs are otherwise clear without\nmasses or areas of parenchymal opacification.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. A 5 mm ground-glass pulmonary nodule in the right upper lobe is unchanged\nsince ___.  No specific imaging follow-up recommended.\n3. Unchanged enlarged right hilar lymph node since ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is grossly\nunremarkable.  Mildly prominent axillary lymph nodes are not enlarged by CT\nsize criteria.\n\nUPPER ABDOMEN: Although this study is not tailored for subdiaphragmatic\nanalysis, the visualized upper abdomen is grossly unremarkable.\n\nMEDIASTINUM: AP window mediastinal lymph node measures 12 x 10 mm, borderline\nenlarged.  Other scattered mediastinal lymph nodes are not enlarged.  Minimal\ntriangular soft tissue in the anterior mediastinum likely represents thymus\nremnant.\n\nHILA: There is no gross hilar lymphadenopathy given confines of a noncontrast\nexam.\n\nHEART and PERICARDIUM: Heart size is normal without significant pericardial\nfluid.\nPLEURA: Pleural surfaces are clear without effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Basal predominant mainly peripheral nodular and reticular\ndensities with minimal areas of subsegmental traction bronchiectasis mainly\naffecting the bilateral lower lobes, with a milder degree of involvement of\nthe base of the right upper lobe and inferior lingular segment, nearly sparing\nthe lung apices, with only minimal involvement.  No dominant nodule is seen. \nNo significant areas of air trapping are noted.\n2. AIRWAYS:  The airways are patent.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are normal caliber.\nCHEST CAGE: Thoracic cage is intact without suspicious focal bone lesion or\nacute fracture.",
            "output": "1. Reticulonodular opacities with minimal subsegmental traction bronchiectasis\nwith a basal and peripheral dominant gradient, in a pattern most suggestive of\nusual interstitial pneumonitis.  The overall findings are mild-to-moderate,\nwith no frank honeycombing yet seen.\n2. Borderline enlarged mediastinal lymph nodes may be reactive."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is airspace opacity and bronchial wall thickening in the\nright middle lobe.  Few scattered centrilobular nodules noted at the lung\nbases, right greater than left.  The central airways are patent.  There is\nmucous plugging at the lung bases.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bronchial wall thickening and regions of centrilobular nodularity at the\nlung bases may represent infectious or inflammatory etiology such as\nbronchopneumonia. Correlate clinically."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size.  There\nis mild cardiomegaly.  Calcification of the aortic valve is of unknown\nhemodynamic significance.  There is mild calcification in the LAD.  2 mm\nnodule left lower lobe is stable (5:164).  4 mm nodule in the lingula was 8 mm\n(5:136).  2 mm nodule right upper lobe anteriorly (5:74) is stable.  There is\nno pleural or pericardial effusion.  There is gynecomastia\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings\nDiffuse increased sclerotic appearance of all visualized bones most consistent\nwith metastatic disease.",
            "output": "Diffuse increased sclerotic appearance of all visualized bones most consistent\nwith metastatic disease\nDecrease in size of lingular nodule, Other micronodules are stable.  No new\nlung nodules identified"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Severe centrilobular emphysema.  A mildly enhancing, triangular\nopacity within the right middle lobe is compatible with atelectasis, although\nhypoattenuating regions would make concurrent infection difficult to exclude. \nAlthough no definite obstructing mass or endobronchial lesion is identified,\nno discrete air bronchograms are seen.  A subpleural pulmonary nodule within\nthe left lower lobe measures 3 mm (3:142).  Mild, dependent atelectasis. \nMinimal diffuse bronchial wall thickening.  Focal areas of mucous plugging\nwithin subsegmental branches of the right middle and right lower lobes (for\nexample, 3:202).\n\nBASE OF NECK: The thyroid gland is not optimally assessed due to streak\nartifact, however, multiple hypodense thyroid nodules, some calcified, measure\nup to 6 mm.  Otherwise, the visualized portions of the base of the neck show\nno abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? A sclerotic focus within\nthe T8 vertebral body is likely a bone island.  There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism.\n2. Partial collapse of the right middle lobe, with hypoattenuating areas which\nwould make concurrent underlying infection difficult to exclude.  Although no\ndefinite underlying obstructing mass or endobronchial lesion is identified,\nair bronchograms are not clearly delineated within the collapsed portion which\ncould suggest mucoid impaction.  Bronchoscopy could be considered for further\nassessment.\n3. Severe centrilobular emphysema.\n4. 3 mm pulmonary nodule within the left lower lobe, for which no CT follow-up\nis recommended in a low risk patient, and an optional CT follow-up in 12\nmonths is recommended in a high risk patient.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy.  This\nstudy is not designed for subdiaphragmatic evaluation.\n\nThyroid is unremarkable.  Atherosclerotic calcification is moderate head neck\nvessels, quite severe in the coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size.  There is no pericardial or pleural\neffusion.\n\nCentral lymph nodes are not pathologically enlarged.  Prevascular mediastinum\nis normal.\n\nLung lesions of note:\n\n4 mm subpleural or pleural nodule, right diaphragmatic surface, 4:154, was 3\nmm in ___.  Other previously cited tiny lung nodules are unchanged. \nThere are new or other growing lung lesions.  Tracheobronchial tree is normal\nto subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Minimal growth since ___ of a solitary 4 mm right lower lobe lung or pleural\nnodule is probably not clinically significant.  No evidence of intrathoracic\nmalignancy or infection.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "The thyroid is normal.  Axillary, supraclavicular, mediastinal, and hilar\nlymph nodes are not pathologically enlarged. The heart size is normal.  No\npericardial effusion.  There is no evidence of pneumomediastinum.\n\nInterval placement of a left lateral pigtail catheters seen extending into the\npleural space adjacent left lower lobe. A small-moderate left, nonhemorrhagic\npleural effusion is noted, previously large. There is persistent collapse of\nleft lower lobe with atelectasis of the left upper lobe. Redemonstrated are\ntwo hyperdense foci appearing to localize within a subsegmental bronchus of\nthe left lower lobe, and potentially representing broncholiths (3:37). Linear\natelectasis is seen at the right lung base.\n\nThe esophagus is grossly unremarkable. The patient is status post Roux-en-Y\ngastric bypass. A stable fluid collection is seen interposed between the\nspleen and left hemidiaphragm extending medially towards the excluded stomach.\nNo overt diaphragmatic defect is visualized.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Interval placement of a left pleural pigtail catheter with improvement of a\nnow small-moderate left pleural effusion. Persistent left lower lobe collapse\nand mild left upper lobe atelectasis is noted.\n\n2. Unchanged appearance of two hyperdense foci which appear to localize within\na subsegmental bronchus of the left lower lobe. Findings may represent\nbroncholiths.\n\n3. Unchanged, incompletely imaged fluid collection interposed between the\nspleen and left hemidiaphragm adjacent to a Roux-en-Y gastric bypass.  No\novert diaphragmatic defect is visualized."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The heart size is normal. No\npericardial effusion. There is no evidence of pneumomediastinum.\n\n The small residual, nonhemorrhagic left pleural effusion has  decreased since\n___ and the removal of a pigtail pleural drain. The associated left\nlower lobe atelectasis is also improved. Two hyperdense foci in the left lung\nbase may represent calcified granulomata. Bibasilar atelectasis is present but\nthere is no focal opacity concerning for infection.\n\nThe esophagus is grossly unremarkable. The patient is status post Roux-en-Y\ngastric bypass. A stable fluid collection is seen in the spleen which appear\nto be subcapsular in coronal imaging. No overt diaphragmatic defect is\nvisualized. There is no free air or fluid collection adjacent to the surgical\nsite.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Interval removal of left lateral pigtail catheter. Residual small\nnon-hemorrhagic pleural effusion is decreased in size compared with the\nprevious examination. The associated left lower lobe atelectasis is also\nimproved.\n\n2. Left upper quadrant fluid collection appears to be\nintrasplenic/subcapsular. Dedicated abdominal imaging, i.e spleen ultrasound,\nis recommended for better assessment.\n\n3. Changes of Roux-en-Y gastric bypass are stable although incompletely\nevaluated. No evidence of free air or anastomotic leak.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:49 ___, immediately after discussion with the\nattending on the case."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is top-normal with no pericardial effusion. Severe aortic valvular\nand annular calcifications are in keeping with the provided history of aortic\nstenosis. Coronary artery calcifications are extensive. Moderate calcific\natherosclerosis diffusely involves the thoracic aorta and its branches. The\nascending thoracic aorta measures 3.3 cm at the level of the normal caliber\nmain pulmonary artery. There is moderate calcification of the medial aspect of\nthe ascending aorta with calcifications extending anteriorly up to 6.5 cm from\nthe plane of the aortic valve. Mild discontinuous calcification involve the\naortic arch, and thicker moderate calcifications involve the descending aorta\nthoracic aorta.\n\nThere are scant retained secretions in the trachea. Mild lower lobe\npredominant cylindrical bronchiectasis is identified. Bilateral lower lobe\nareas of linear atelectasis are also present. A 5 mm left apical solid nodule\nhas somewhat irregular borders (4, 41). Additional solid nodules measuring up\nto 4 mm in the subpleural left lower lobe are identified (04: 22, 52, 107,\n158, 169, 183). A few calcified granulomas are also incidentally noted.\n\nThere is a small hiatal hernia. Images of the upper abdomen also show a few\nhypodense hepatic lesions which are too small to characterize (2, 52), and\ndating a small right hepatic lobe cyst (2, 48).\n\nModerate multilevel spinal degenerative changes contribute to mild thoracic\nspine kyphosis. There are no bone lesions in the thorax worrisome for\ninfection or malignancy.",
            "output": "Severe aortic valvular and annular calcifications are compatible with aortic\nstenosis.\n\nModerate calcification of the ascending aorta extends anteriorly up to 6.5 cm\nfrom the plane of the aortic valve.\n\nMild lower lobe predominant cylindrical bronchiectasis may be seen with\nchronic aspiration. No evidence of active infection or inflammation.\n\nSeveral solid pulmonary nodules measuring up to 5 mm in the left apex may be\nre-evaluated with a 12 month followup chest CT in a low risk patient. However,\nif the patient has risk factors for malignancy, a 6 month followup chest CT\nshould be obtained.\n\nSmall hiatal hernia.\n\nRECOMMENDATION(S):  Several solid pulmonary nodules measuring up to 5 mm in\nthe left apex may be re-evaluated with a 12 month followup chest CT in a low\nrisk patient. However, if the patient has risk factors for malignancy, a 6\nmonth followup chest CT should be obtained."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged axillary\nlymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are small mediastinal lymph nodes.  There is a 12 mm right\nparatracheal lymph node there is a 10 mm right lower paratracheal lymph node. \nThere is moderate cardiomegaly.  The ascending aorta is dilated and measures\n3.2 cm.  The main pulmonary artery measures 31 mm.  There is a prosthetic\naortic valve in place.  There is extensive atherosclerotic calcification\ninvolving the aorta.  There is no pericardial effusion\n\n\nPLEURA: There are moderate bilateral effusions left greater than right.\n\nLUNG: There is passive atelectasis in both lower lobes left greater than\nright.  There is diffuse bilateral ground-glass opacification which most\nlikely represents pulmonary edema.  No evidence of pneumonia\nNo evidence of septic emboli.\n\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Sternal sutures are intact.\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense\nlesion in the left lobe of liver.  No adrenal masses are seen.",
            "output": "Moderate bilateral pleural effusions left greater than right with passive\natelectasis in both lower lobes.\n\nModerate to severe cardiomegaly.  Atherosclerotic calcification involving the\naorta.  Prosthetic aortic valve.\n\nDiffuse mild interstitial edema.\n\nNo evidence of septic emboli."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.  Right lower\nparatracheal lymph node measuring 0.5 cm in short axis (02:22) is unchanged\nfrom ___ and not pathologically enlarged by CT size criteria.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is a very small\npericardial effusion which is unchanged from ___.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  7 mm right middle lobe nodule (3:117), 6 mm nodule (3:144),\nand 4 mm nodule (3:153) are unchanged dating back to ___ chest ___.  consolidation in the right lower lobe (602:27) is decreased in size\nfrom ___ and was previously present on CTA chest ___,\nlikely atelectasis.\n2. AIRWAYS:  Airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery is not enlarged.\nCHEST CAGE: There is no acute osseous abnormality.",
            "output": "1. Three pulmonary nodules measuring up to 7 mm are stable dating back to CT\nchest ___.\n2. Please refer to dedicated CT abdomen and pelvis report on same day for\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged portion of the lower thyroid\nwarrant any further imaging.\n\nMeasurable left supraclavicular lymph nodes, ranging up to 6 x 12 mm, 12:26,\nlarger today than in ___.  Right supraclavicular and bilateral subcentimeter,\naxillary lymph nodes are neither enlarged nor growing.  There are no soft\ntissue abnormalities in the chest wall concerning for malignancy.\n\nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is moderately patulous, dilated with air, not\nsuggestive of obstruction.  Atherosclerotic calcification is not apparent head\nand neck vessels or in the coronary arteries.  Aorta and pulmonary arteries\nare not enlarged, aortic valve is not calcified and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically\nenlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Focal lung lesions as follows:\n\n6 x 9 mm right upper lobe nodule, 12:155, was 5 x 8 mm in ___ (miss\nattributed to the right middle lobe).\n\n8-9 mm left lower lobe nodule, 12:193 was 8 mm in ___.\n\nRoughly 35 x 42 mm mass like consolidation at the base of the right lung,\ninseparable from the diaphragmatic pleura, and contiguous with subjacent liver\nand subphrenic mass was 27 x 40 mm at a comparable level in ___ x 26 mm\non the lateral view, previously 12 x 29 mm.  Atelectasis in this region dates\nfrom ___, but I suspect there is also a lung mass with pleural involvement. \nThis is best evaluated by ___ PET scanning.  There is no associated pleural\neffusion, but the diaphragmatic pleura is irregularly thickened.\n\nNo left pleural abnormality.  Tracheobronchial tree is normal to subsegmental\nlevels.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "Slight interval growth, small 2 small pulmonary nodules, and possible growth, \nright basal lung mass with possible pleural involvement.\n\nSmall but newly growing left supraclavicular lymph nodes.\n\nRECOMMENDATION(S):  ___ PET scanning for assessment of right basal lung\nlesion."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nThere is no pericardial pleural effusion.\n\nNo mediastinal, axillary or supraclavicular pathologically enlarged lymph\nnodes demonstrated.  No hilar lymphadenopathy seen.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen pelvis in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  Interval increase\nin right lower lobe masses demonstrated currently 33 x 54 x 20 mm as compared\nto 19 by 46 x 20 mm.  The mass is continuing directly into the diaphragm and\nthen in the liver.  2 additional pulmonary nodules are stable, in the left\nlower lobe, series 9, image 201, 7 mm and in the right upper lobe, series 9,\nimage 159, 5 mm.\n\nNo lytic or sclerotic lesion worrisome for infection or neoplasm demonstrated.",
            "output": "Minimal interval increase in the dominant mass in the right lower lobe.\n\n2 additional stable pulmonary nodules.\n\nPlease review CT abdomen and pelvis in the corresponding report that will be\nprovided separately."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  Right-sided Port-A-Cath ending at cavoatrial junction.  There are no\nchest wall abnormalities.  Minimal atherosclerotic calcifications at the\norigin of the left subclavian artery.\n\nMEDIASTINUM AND HILA:\nA small hiatal hernia.  Esophagus is mildly patulous.  Stable small\nmediastinal and hilar lymph nodes including an 8 mm lymph node in the right\nhilum (9:141) or an 8 mm subcarinal lymph node (9:134).\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  Aorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No bronchial wall\nthickening, bronchiectasis or mucus plugging.  At the base of the right lung,\ncontiguous with the diaphragmatic surface, an elliptical, 3.5 x 5.5 cm,\nenhancing mass-like consolidation (8:43, 82) is mildly decreased in size since\n___ and was non avid on ___ PET CT in ___.  A left lower lobe\n6 mm nodular opacity described in the prior study is most likely a mucoid\nimpaction (8: 68).  A solid right upper lobe 9 mm nodule (8:53, remeasured)\nhas been stable since ___\n\nCHEST CAGE:\nNo acute fractures.  Moderate dorsal spondylosis.  No lytic or sclerotic bone\nlesions worrisome for malignancy.\n\nUPPER ABDOMEN:\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings.",
            "output": "Right basal rounded atelectasis or organized pneumonia is chronic and should\nnot be mistaken for a lung mass.\n\nStable right upper lobe lung nodule since ___.\n\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "Please note that subdiaphragmatic findings will be reported in a separate\nabdominopelvic CT report from same date.\n\nCHEST PERIMETER: The imaged portion of the thyroid is normal.  There is no\nchest wall or axillary soft tissue abnormality.  There are no axillary or\nsupraclavicular pathologic lymph nodes.  Unchanged appearance of the right\nchest Port-A-Cath with the catheter tip terminating in the cavoatrial\njunction.\n\nCARDIO-MEDIASTINUM: The pericardium is normal with a physiologic effusion. \nUnchanged appearance of the small hiatus hernia and mildly patulous esophagus.\nThe heart is normal in size, as well as the main, left, and right pulmonary\narteries.  There are mild calcifications to the ostium of the left subclavian\nartery, but there are no significant coronary artery calcifications.\n\nTHORACIC LYMPH NODES: There are no pathologic thoracic lymph nodes.  The\npreviously described 8 mm subcarinal lymph node now measures 5 mm (9:45), and\nthe right hilar lymph node measures 8 mm, unchanged from previous (9:58).  The\npreviously described right upper lobe solid nodule is unchanged and measures 9\nmm (9:60), which has been stable since ___.\n\nLUNGS, AIRWAYS, PLEURAE: The airways are patent to the subsegmental level\nwithout bronchial wall thickening, bronchiectasis or mucus plugging.  The\nmasslike opacity at the base of the right lung which is contiguous with the\ndiaphragmatic surface measures 3.3 x 5.0 cm (9:85), which is mildly decreased\nin size from previous when it measured 3.5 x 5.5 cm.  As previously described,\nthis lesion was non avid on ___ PET CT in ___.  It has characteristic\narterial and venous supply and and  a uniform enhancement characteristic of\nrounded atelectasis.\n\n7 x 9 mm right upper lobe nodule, 10:177, was 7 x 10 mm in ___, but 5 x\n8 mm in ___, and not present on ___.\n\nCHEST CAGE: There are no lytic or sclerotic bone lesions worrisome for\nmalignancy.  There are stable multilevel degenerative changes, predominantly\naffecting the upper and midthoracic spine.",
            "output": "Note change in IMPRESSION 2 and RECOMMENDATION from previously filed\npreliminary report:\n\n1.  Interval decrease in size of the right basal rounded atelectasis (less\nlikely organized pnuemonia), which is chronic and should not be mistaken for a\nlung mass, as it continues to decrease in size and was not FDG-avid on an FDG\nPET scan is in ___.\n\n2.  Minimal growth right upper lobe lung nodule since ___, although\nstable since ___ warrants continued follow-up."
        },
        {
            "input": "The visualized portions of the thyroid are within normal limits.\n\nThere is no axillary, mediastinal, or hilar lymphadenopathy.\n\nThe heart size is normal.  There is no pericardial effusion.  A right\nPort-A-Cath terminates at the caval atrial junction.\n\nThe great vessels are patent and normal in caliber.\n\nThere is no pneumothorax, focal consolidation, or pleural effusion.  Mild\nparaseptal emphysema is unchanged.\n\nAn 8 mm right upper lobe nodule is unchanged in comparison to the earliest\navailable study from ___ (series 103, image 114).\n\nAgain seen is a 4.2 x 2.9 cm right lower lobe lesion, previously characterized\nas rounded atelectasis, previously measuring 5.0 x 3.3 cm at the same level\n(series 5, image 89).  No new pulmonary nodule or mass is seen.\n\nThere are no osseous lesions concerning for malignancy or infection.\n\nPlease refer to the separate abdominopelvic CT dictation regarding\nsubdiaphragmatic findings.",
            "output": "1. Continued decrease in size of a 4.2 x 2.9 cm focus of rounded atelectasis\n(previously confirmed as non-FDG-avid on PET).\n2. 8 mm right upper lobe nodule is unchanged since ___.\n3. No new intrathoracic metastasis or lymphadenopathy.\n4. Mild paraseptal emphysema.\n5. Please refer to the separate abdominopelvic dictation regarding\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nMinimal atherosclerotic calcifications of the aortic arch.  The thoracic aorta\nis normal in caliber without evidence of dissection or intramural hematoma. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There are multiple enlarged right hilar lymph\nnodes measuring up to 1.2 cm in short axis (series 302, image 128), unchanged\nsince ___.  No new axillary or mediastinal lymphadenopathy is present.  No\nmediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Consolidation at the right lung base with heterogeneous\nenhancement, similar to the previous exams, which likely represents chronic\natelectasis.  Mild dependent atelectasis on the left.  5 mm nodule within the\nleft lower lobe (series 302, image 128), not seen on prior CT from ___. \nOtherwise, the lungs are clear.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The metastatic lesion at the liver dome is difficult to\nmeasure, but grossly unchanged since ___.  A subcentimeter\nhypodensity also at the liver dome, shown to represent a probable hemangioma\non the recent MR ___ 605, image 36).  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is markedly atrophic.  No focal lesions.  No ductal\ndilatation.  No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Small accessory spleen inferiorly.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is severe right hydroureteronephrosis to the level of the\ndistal ureter, where there is an obstructing mass, unchanged compared to prior\nexams.  There is also delayed nephrogram on the right.  The left kidney is\nunremarkable in appearance.  There is no evidence of focal renal lesions. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Multiple surgical clips are seen scattered throughout the\nabdomen.  The stomach is unremarkable.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  There is a normal\nappearing colonic anastomosis within the right hemiabdomen.  The colon and\nrectum are otherwise within normal limits.  The appendix is not visualized. \nThere is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nWithin the right hemipelvis, there is a lobulated soft tissue density mass\nmeasuring 4.5 x 3.5 cm in maximum axial dimension, which causes upstream\nhydroureteronephrosis on the right, unchanged compared to prior.  There are\nmultiple smaller similar-appearing masses within the left hemipelvis.  The\nmore superior mass measures 2.5 x 2.3 cm (series 304, image 65).  This is\ncontiguous with an elongated mass inferiorly measuring approximately 6.1 cm in\nthe craniocaudal dimension (series 605, image 45).  The inferior portion of\nthis mass is directly contiguous with the seminal vesicle on the left.  The\nurinary bladder and left distal ureter are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable in appearance.  The above\ndescribed pelvic masses involve the left seminal vesicle.\n\nLYMPH NODES: 2 subcentimeter nodules along the right pericolic gutter likely\nrepresent metastatic disease, unchanged (series 304, image 46 and series 605,\nimage 32).  Multiple aortacaval lymph nodes are also unchanged compared to\nprior (series 2, image 140).  There is no new retroperitoneal or mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abnormalities within the chest, abdomen, or pelvis.\n2. Consolidation at the right lung base with heterogeneous enhancement likely\nreflects chronic atelectasis.\n3. Severe right hydroureteronephrosis to the level of the pelvis, where there\nis an obstructing mass, unchanged compared to prior.  Delayed nephrogram on\nthe right.\n4. Metastatic disease throughout the abdomen and pelvis with a metastatic\nliver lesion, retroperitoneal lymph nodes, peritoneal nodules, and multiple\npelvic masses, not substantially changed from prior exam.\n5. New 5 mm left lower lobe pulmonary nodule when compared to prior CT from\n___.  Consider follow-up chest CT in 3 months.\n\nRECOMMENDATION(S):   Chest CT follow-up in 3 months."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  The patient is asymmetrically positioned within the\nscanner.  PICC line over the right upper extremity.  No coronary\ncalcifications, no valvular calcifications, no pericardial effusion.  The\nposterior mediastinum is unremarkable.  There is no evidence of enlarged lymph\nnodes in the mediastinum or at the hilar level.  All visible mediastinal lymph\nnodes (2, 23) Are normal in size.  Bilateral internal kidney drains.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.\nMinimal bilateral apical scarring.  Stable mild irregularities of the airway\nwalls.  Stable chronic atelectasis and scarring at the right lung basis.  The\npre described 5 mm nodule in the left lower lobe is no longer visible and\nlikely was a no suspicious lung nodules or masses.  No diffuse lung disease. \nNo pleural thickening, no pleural effusions.",
            "output": "Interval resolution of a pre-existing left lower lobe nodule.  Currently there\nis no evidence of metastatic disease to the thorax."
        },
        {
            "input": "HEART AND VASCULATURE: The thoracic aorta is normal in caliber and morphology.\nThere is mild calcified atherosclerotic plaque involving the aortic arch. \nMain pulmonary artery is normal caliber.  While the current exam is not\ntailored for such evaluation there is no central pulmonary artery filling\ndefect.  There are extensive coronary artery calcifications.  Heart is normal\nin size.  No pericardial effusion.  Great vessels are unremarkable.\n\nAXILLA, HILA, AND MEDIASTINUM: Measurable axillary mediastinal lymph nodes are\nnot enlarged by CT size criteria and are normal in morphology.  No hilar\nlymphadenopathy.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  There are no suspicious pulmonary nodules.  Evaluation for small\nnodules is limited secondary to respiratory motion artifact.\n\nBASE OF NECK: There is a 7 mm hypodense nodule in the inferior left thyroid\nlobe.  Visualized portions of the base of the neck otherwise show no\nabnormality.\n\nABDOMEN: Please refer to the separately dictated CT abdomen pelvis for full\ndescription of the subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No acute intrathoracic findings.  No evidence of malignancy within the\nchest.\n2. Extensive coronary artery calcification.\n3. 7 mm left thyroid lobe hypodense nodule.  No dedicated follow-up is\nrecommended per ACR criteria however clinical correlation is recommended.\n4. Please refer to the separately dictated CT abdomen pelvis for full\ndescription of the subdiaphragmatic findings.\n\nRECOMMENDATION(S):  Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "Thyroid nodules are sub 7 mm.  Aorta and pulmonary arteries are normal in\ndiameter.  Comparison with the previous noncontrast enhanced CT is suboptimal\nin determination this stability of lymph nodes.  The aortopulmonic lymph nodes\nis unchanged, 8 mm.  Overall appearance of the hilar is similar to previous\nexamination on the lymph nodes ranging up to 1.5 cm as well as to the ___ when the IV contrast was administered. Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen reveals no appreciable abnormality\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules masses or consolidations demonstrated.  Mild air trapping is\ndemonstrated bilaterally.  A right upper lobe nodule, series 4, image 138 is\nstable.  Minimal bilateral bronchiectasis are unchanged.\n\nImage portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued.",
            "output": "Mediastinal or hilar lymphadenopathy, overall not substantially changed as\ncompared to previous CT although the comparison to ___ demonstrate\nstability.\n\nMinimal bronchiectasis.  Air trapping.\n\nStable right upper lobe nodule"
        },
        {
            "input": "The aorta and its major branch vessels are patent.Incidental note is made of\nan anomalous pre-pulmonic course of the left coronary artery (02:52), as on\nprior.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nMediastinal adenopathy is again noted, unchanged.  For instance right hilar\nlymph node measuring 1 cm, left hilar lymph node measuring 0.9 cm and\nprevascular measuring up to 0.8 cm, stable.  Several small nodules are again\nseen in the imaged portion of the thyroid.\n\nThere is no pericardial or pleural effusion.\n\nA 5 mm right middle lobe nodule is again seen (2, 71), unchanged.  A small\ncalcified granuloma is seen in the right lower lobe (3:148).  There is mild\nbronchial wall thickening and regions of air trapping.  Multiple regions of\nairway mucosal impaction are noted (03:136), also seen in the upper lobes on\nseries 3, image 66.\n\nPatient is status post splenectomy and partial pancreatectomy.  Cortical\ndefect and calcification is again seen in the imaged portion of the left\nkidney.  Small bowel anastomotic sutures are noted (2:109).\n\nNo aggressive osseous lesion identified.",
            "output": "1. No pulmonary embolism.\n2. Regions of air trapping and bronchial impaction with mild bronchial wall\nthickening, possibly reflective of small airways disease.\n3. Unchanged hilar and mediastinal adenopathy.\n4. Unchanged right middle lobe lung nodule."
        },
        {
            "input": "CT THORAX:  The thyroid gland is within normal limits.  The esophagus is\nmildly patulous superiorly, but otherwise unremarkable.  No hiatus hernia. \nRe-identified is fusiform aneurysmal dilation of the ascending thoracic aorta\nmeasuring up to 4.4 cm, unchanged since ___ (3, 32).  There is severe arch\nand descending thoracic aortic calcification.  The pulmonary artery is mildly\ndilated measuring 3.5 cm in diameter (3, 20), new from prior the heart is\nmildly globally enlarged.  Aortic valvular and mitral valvular calcifications\nare noted.  There is severe three-vessel coronary artery calcification.  There\nis no pericardial effusion.  The heart is otherwise within normal limits. \nScattered mediastinal lymph nodes are not pathologically enlarged.  There is\nno supraclavicular, discernible hilar, or axillary lymphadenopathy.\n\nMajor airways are patent to subsegmental levels bilaterally.  There is diffuse\nmild bronchial wall thickening.  There are bilateral patchy, regional\nground-glass opacities which appears to have a apical predominance.  There is\nsuperimposed smooth interlobular septal thickening (for example see series 6,\nimage 55).  More inferiorly near the lung bases, there is suggestion of a\nsubpleural, basal predominant interstitial opacity consisting of nodular\nreticulation and possibly superimposed ground-glass, similar to findings of\nthe prior study (for example see series 5, image 216, as well as series 6,\nimage 180).  There is no dense focal lung consolidation.  There is a small\nright and trace left layering pleural effusion, with a small amount of\ntracking right intrafissural fluid.  Right apical calcified pleuroparenchymal\nscarring is unchanged.  There is no pneumothorax.\n\nCalcified splenic artery is noted.  Coarse calcifications in the inferior\nspleen are also seen, possibly reflecting sequelae of prior granulomatous\ndisease.  There is suggestion of nodular thickening of the left adrenal gland\nwithout a definite underlying nodule.  Otherwise, the partially imaged solid\nand hollow viscous organs of the upper abdomen are without acute focal\nabnormality on limited noncontrast evaluation.\n\nMUSCULOSKELETAL:  No worrisome focal abnormality within the imaged\nsubcutaneous and musculoskeletal soft tissues of the chest wall.  New from the\nprior study of ___ is an age indeterminate anterior compression deformity\nof the T12 vertebral body with between 50 and 75% loss of anterior height\n(series 7, image 104).  No bony retropulsion identified.  The remaining imaged\nthoracic vertebral bodies demonstrate normal alignment and preserved height. \nThere is a large Schmorl's node involving the superior endplate of L2, which\nis partially visualized.  No worrisome focal osseous lesions.",
            "output": "1. Bilateral apical- and dependent-predominant patchy ground-glass opacities\nand interlobular septal thickening, in conjunction with a small right and\ntrace left layering nonhemorrhagic pleural effusion, favored to represent\nsequelae of ongoing or resolving cardiogenic pulmonary edema.\n2. Basal, peripheral predominant subtle reticulonodular interstitial\nabnormality with mild superimposed ground-glass, similar in appearance to\nprior study of ___.  Findings are nonspecific, however are compatible with\nNSIP.  Given background cardiogenic pulmonary abnormality, the degree of\nprogression since the study of ___ is unable to be assessed.\n3. Moderate anterior compression deformity of T12 is new since the prior CT of\n___, however is grossly unchanged since chest x-ray of ___.  Correlate\nwith focal pain at this level on physical exam to exclude an acute component.\n4. Nodular thickening of the left adrenal gland, not well assessed on this\nstudy.  Attention on follow-up studies.\n5. Prominent/mildly dilated pulmonary artery can be seen in setting of\npulmonary hypertension.\n6. Stable fusiform aneurysmal dilation of the ascending thoracic aorta\nmeasuring up to 4.4 cm.  Mildly patulous esophagus.  Severe thoracic aortic\ncalcification.  Severe three-vessel coronary artery calcification.  Other\nincidental findings, as above."
        },
        {
            "input": "CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild predominantly dependent bilateral atelectasis. \nNo areas of abnormal parenchymal opacification.  Patient is intubated with ET\ntube projecting approximately 3.6 cm above the carina.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates within the stomach.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits.  The appendix is not\nvisualized.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The urinary bladder is underdistended with redundant Foley catheter\ntubing. Distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute findings in the chest, abdomen, or pelvis."
        },
        {
            "input": "There is a punctate 2 mm hypodense right thyroid lobe nodule.  There is no\nsupraclavicular, mediastinal, hilar or axillary lymphadenopathy.\n\nAlthough this study is not designed to assess cardiac anatomy, the left\nventricle appears dilated and thin-walled. There is no pericardial effusion. \nThe main pulmonary artery and thoracic aorta are normal caliber. No incidental\ncentral pulmonary embolus is identified.\n\nApical predominant paraseptal and centrilobular emphysema is mild. Bilateral\nlower lobe linear atelectasis is incidentally noted. There is a 1.8 x 1.9 cm\nleft upper lobe part solid ground-glass opacity with irregular borders (4,\n30). A mixed attenuation 8 x 7 mm sub solid right lower lobe nodule is\nindeterminate (4, 84). A handful of solid and sub solid pulmonary nodules\nmeasure up to 3 mm in the right upper lobe (4: 36, 46, 58, 74, 76, 102).\n\n For a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "1.8 x 1.9 cm left upper lobe part-solid ground-glass opacity may be infectious\nor inflammatory in etiology. 8 x 7 mm mixed attenuation sub-solid right lower\nlobe nodule may also be infectious or inflammatory in etiology, however a\nthree-month followup chest CT is recommended for both of these lesions to\nexclude neoplasia.\n\nMild centrilobular and paraseptal emphysema."
        },
        {
            "input": "Aorta and pulmonary arteries are stable in appearance.  No mediastinal, hilar\nor axillary lymphadenopathy present. Heart size is normal. No pericardial\npleural effusion is seen.\n\nLarge liver lesion was better characterized on ___ CT abdomen. No\nother intra-abdominal abnormalities noted on this limited study\n\nAirways are patent to the subsegmental level bilaterally.Left apical\nground-glass opacity appears to be unchanged. Centrilobular emphysema is mild\nto moderate, unchanged. Right upper lobe subpleural nodule, series 4, image 61\nis unchanged. Additional nodule in the right upper lobe, series 4, image 74 is\nunchanged. Superior segment of right lower lobe ground-glass nodule appears to\nbe decreased in density and size, most likely reflecting its inflammatory\netiology, series 4, image 100. No new nodules masses are consolidations\ndemonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated. .",
            "output": "Overall stable appearance of the chest except for interval decrease in size in\nsuperior segment of right lower lobe ground-glass nodule. Continuous\nsurveillance with chest CT in 6 months is required."
        },
        {
            "input": "A small hypodense nodule is noted in the right lobe of the thyroid.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal.\nThere is no pericardial effusion.\n\nThe airways are patent.  A left apical ground-glass opacity is slightly\nsmaller than the examination from ___ and possibly slightly larger than\nthe examination from ___. There is mild centrilobular emphysema, which is\nunchanged.  Right and left-sided nodules are stable since the prior\nexamination (4:  62, 71, 72, 80, 95), the largest of which measures 7 mm.  No\nnew nodules are identified.\n\nLimited evaluation of the upper abdomen shows an enlarged liver with nodular\ncontours and a partially calcified lesion, with little change since prior\nexamination, and better characterized on prior MRI.\n\nMultilevel degenerative changes are seen throughout the thoracic spine without\nsignificant vertebral body height loss or suspicious osseous lesion.",
            "output": "Stable bilateral pulmonary nodules.  Suggest CT chest   in 12 months to assess\nstability.\n\nRECOMMENDATION(S):  Suggest CT chest   in 12 months to assess  stability."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Hypodense lesion is noted in the\nright lobe of the thyroid, also seen on prior studies, and grossly unchanged\nin dimension, measuring up to 8 mm.  There is no supraclavicular or axillary\nlymphadenopathy.  The soft tissues of the chest wall are unremarkable.\n\nUPPER ABDOMEN: Limited evaluation of the upper abdomen demonstrates no\nsignificant abnormalities.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Background centrilobular emphysema is mild.  A left apical\nground-glass opacity is more discrete on the current study than on the priors,\nand measures up to 1.5 x 1.5 cm (303:20), previously 1.7 x 1.5 cm.  A more\ndense, solid inferior component is more prominent on the current examination\n(for example 303:24 in comparison to 04:44 from the prior study).  Multiple\nother pulmonary nodules are unchanged (through 3:37, 35, 34, 61).  The largest\nnodule measures up to 5 mm.  No new nodules are identified.  Scattered\nwell-defined cysts are again noted.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The thoracic aorta and main pulmonary artery are normal in\ncaliber.\nCHEST CAGE: No suspicious osseous lesions or acute fractures are identified.",
            "output": "1.  More prominent left upper lobe ground-glass nodule with increased solid\ncomponent is concerning for minimally invasive adenocarcinoma. Percutaneous\ntissue sampling is recommended.\n2.  Nearly ___ year stability of multiple other pulmonary nodules.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 15:02 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST PERIMETER: 10-11 mm wide low density lesion in the right thyroid lobe,\n11:7, although not large enough by size alone to warrant ultrasound evaluation\nhas lost a previous septum which could be an indication of activity and\ntherefore warrants ultrasound evaluation.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  There are no soft tissue\nabnormalities elsewhere in the chest wall.  Findings below the diaphragm will\nbe reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels or coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size and pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: Slight increase in the soft tissue posterior to the\nmanubrium, surrounding two tributaries of the left internal mammary vein,\n11:58, could be an isolated enlarging small lymph node.  Follow-up advised.\n\nNo other lymph nodes in the chest are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nLarge ground-glass region in the left apex has not changed in overall size\nsince ___.  The inferior stellate portion, 11:36, is also stable in\nsize but grown more radiodense between ___ and ___, and\nmore radiodense today.  Lesion is quite suspicious for adenocarcinoma of the\nlung.\n\n3 mm sub solid lesion, right upper lobe, 11: 59, grew more dense between ___\nand ___, subsequently stable.\n\n2 mm sub solid nodule, right upper lobe, 11:78, stable since ___.\n\n3 mm solid nodule, right upper lobe, ___: 98, stable since ___, may be\nnew since ___.\n\nHandful of thin walled air containing cystic spaces is scattered through the\nlungs, unchanged.  There is no other diffuse pulmonary abnormality.\n\nSecretions are pooling in the left main bronchus.  Tracheobronchial tree is\notherwise normal to subsegmental levels and there is no pleural abnormality.\n\nCHEST CAGE: Unremarkable.",
            "output": "Continued increased radiodensity in one portion of the largely mixed density\nlesion in the left upper lobe and the possibility of ipsilateral internal\nmammary lymph node enlargement are concerning findings for possible\nadenocarcinoma of the lung.  FDG PET scanning might be helpful in assessment.\n\n3 other tiny lung nodules can be monitored with serial chest CT, in 6 months.\n\nChange in morphology of a right thyroid nodule is appropriate indication for\nultrasound evaluation.\n\nRECOMMENDATION(S):  Consider FDG PET-CT for lung lesion evaluation, and and\nthyroid ultrasound for possible thyroid nodule."
        },
        {
            "input": "CHEST CTA:\n\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.\n\nA stent is now present within the SVC. There is a 6.1 x 3.7 soft tissue mass\nencasing the SVC, not significantly changed from the ___ exam. Contrast\nopacification of recannulized veins is less conspicuous. Focal ectasia is\nnoted in the right internal jugular vein (04:14).\n\nNECK:  No pathologically enlarged lymph nodes are seen in the neck or\nsupraclavicular regions. The thyroid gland is either diminutive or absent.\n\nMEDIASTINUM: The mediastinum is shifted leftwards secondary to left\npneumonectomy. There are no mediastinal or hilar lymph nodes meeting criteria\nfor pathologic enlargement.\n\nHEART AND PERICARDIUM: Right atrium and right ventricle are mildly dilated.\nThere is a minimal volume of pericardial fluid.\n\nLUNGS AND PLEURA: A moderate-volume right pleural effusion is mostly new since\nthe prior exam. There is subsegmental compressive atelectasis in the right\nlower lobe overlying the effusion. Post pneumonectomy effusions in the left\nhemithorax are not significantly changed. There is no pneumothorax.\n\nESOPHAGUS AND UPPER ABDOMEN:  The esophagus and visualized upper abdominal\norgans are unremarkable.\n\nCHEST WALL AND AXILLA: Asymmetric skin thickening is noted in the left breast.\nNo axillary or internal mammary lymphadenopathy is seen.\n\nCT OF THE ABDOMEN AND PELVIS WITH IV CONTRAST:\n\nThe hepatic parenchyma demonstrates normal density. There is no concerning\nhepatic mass. There is no intra or extrahepatic bile duct dilation. The\nspleen, adrenal glands, pancreas, stomach, and intra-abdominal loops of small\nand large bowel are normal. Several hypodense lesions throughout both kidneys\nare present, the largest on the left arising from the posterior interpolar\naspect measuring 17 mm (series 9, image 33) and the largest on the right\narising from the anterior interpolar aspect measuring 9 mm (series 9 image 33)\nlikely representing benign cysts. There is no collecting system obstruction.\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal caliber. There are minimal atherosclerotic calcifications throughout\nthe abdominal aorta and iliac branches, without aneurysm, dissection, or\nflow-limiting stenosis.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe uterus and adnexa are normal. The rectum, bladder, and intrapelvic loops\nof small and large bowel are normal. There is no intrapelvic lymphadenopathy\nor free fluid.\n\nOSSEOUS STRUCTURES:  Postsurgical changes are noted in the ribs on the left\nside. There is no focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1.  No pulmonary embolus.\n2.  Moderate right pleural effusion has enlarged since ___.\n3.  Right upper mediastinal soft tissue mass surrounding the SVC remains\nstable, now post SVC stenting across this region.\n4.  Skin thickening across the left breast likely reflects prior radiation\ntreatment.  Correlate with any available mammographic studies.\n5.  Postsurgical changes related to left pneumonectomy without significant\ninterval change.\n6.  No intra-abdominal or intrapelvic malignancy."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Heart size\nis normal in configuration.  There is a trace pericardial effusion, likely\nphysiologic.  Of note, this study is not optimized for the evaluation of the\npulmonary vasculature, however, no pulmonary embolus is identified.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Dependent atelectasis is seen in the lungs bilaterally, right\ngreater than left, with linear atelectasis seen in the right lung base. \nOtherwise, no focal parenchymal opacification or suspicious nodules\nidentified.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck are remarkable for a\ncalcifications seen in the left thyroid lobe, likely calcified nodule.\n\nABDOMEN: Please refer to same-day CT abdomen and pelvis for full description\nof subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of metastatic disease in the chest.\n2. Please refer to the same day CT Abdomen and pelvis report for full\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "MEDIASTINUM:  There is evidence of surgical repair of the left hemidiaphragm\nwith abdominal contents causing paradoxical rightward shift of the mediastinum\ndespite severe right lung emphysema. The imaged thyroid is normal.\n\nThe borderline enlarged left hilar lymph node measures 1.7 x 0.9 cm (2:29).\nThere is no supraclavicular, axillary, mediastinal, or right hilar\nlymphadenopathy.\n\nThe aorta is normal in caliber.  Enlargement of the central pulmonary arteries\nis suggestive of pulmonary hypertension.   The heart size is normal and there\nis no pericardial effusion. There are sparse coronary arterial calcifications.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is diffuse bronchial wall thickening. \nThere is no airspace consolidation.  There is severe panlobular emphysema with\nmultifocal linear calcified scarring. There are a large number of peripherally\ndistributed peribronchovascular pulmonary nodules up to 7 mm in diameter. \nMany of these nodules are surrounded by a small halo of ground-glass opacity. \nThere is no dominant nodule.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  This study is not tailored to evaluate the abdomen. Within\nthese limitations no gross abnormality is seen.",
            "output": "1. There are a large number of peribronchovascular pulmonary nodules up to 7\nmm the differential diagnosis for which includes metastasis or infection.\nFollowup evaluation with CT in 3 months is recommended to document change.\n2. Severe panlobular emphysema and diffuse bronchial wall thickening\nconsistent with bronchitis.\n3. Borderline left hilar lymph node can also be re-evaluated on the followup\nstudy.\n4. Probable pulmonary arterial hypertension\n\nNOTIFICATION:  Impression #1 was entered by Dr. ___ on ___ at\n14:10 into the Department of Radiology critical communications system for\ndirect communication to the referring provider."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is extensive paraseptal and centrilobular emphysema.  There are several\nbilateral subcentimeter pulmonary nodules, most of which have remained stable\nor slghtly improved when compared to previous.  However, there has been\nincrease in size in a right upper lobe nodule (___:39).  Today, it measures 6\nmm, previously it measured only 3.  A second 5 x 10 mm nodule is seen in the\nleft upper lobe (05:48) which was not definitely seen on prior exam.  These 2\nnodules are suspicious.  Three-month follow-up is recommended for reassessment\nof this and the multiple other pulmonary nodules. The airways are patent to\nthe subsegmental level, but there is bronchial wall thickening seen suggestive\nof chronic inflammatory change.  .\n\nLimited images of the upper abdomen are unremarkable.\n\nClips noted along the diaphragmatic surface, likely related to prior surgery.\n\nThe visualized thyroid gland is unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nRemote left-sided rib fractures are seen at the level of the 8 and 7 ribs.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\n2 parenchymal nodules which raise suspicion as there are slightly increased in\nsize, including a 6 mm nodule in the right upper lobe (05:39) any 5 x 10 mm\nnodule in the left upper lobe (05:48).  Short-term 3 month follow-up is\nrecommended for reassessment of these nodules.\n\nRECOMMENDATION(S):  3 month follow-up CT scan of the chest."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe main pulmonary artery is dilated to 3.4 cm, suggestive of pulmonary\narterial hypertension.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  The heart and pericardium are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Clips are seen along the\nleft hemidiaphragm, with elevation of the left hemidiaphragm.  Pleural plaques\nare noted bilaterally.\n\nLUNGS/AIRWAYS: There is severe centrilobular emphysema, with bolus formation\nin the lower lobes bilaterally.   Lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is atrophic, with normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right adrenal gland is normal in size and shape.  A left\nadrenal nodule measuring 1.7 x 1.4 cm is unchanged from prior, previously\ncharacterized as an adenoma.\n\nURINARY: The left kidney is surgically absent.  Again seen is moderate\nhydroureteronephrosis of the right kidney and entire length of the right\nureter.  Multiple simple cysts are again noted in the right kidney. \nAdditional subcentimeter hypodensities are too small to characterize by CT. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is otherwise\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThe appendix is normal.  There is no free intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder is lobulated in appearance, similar to prior, likely\nreflecting sequela of treatment for known malignancy..  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  A moderate ventral hernia is again seen, containing a portion\nof the transverse colon, without obstruction.  Diastasis recti is again seen\ninferiorly.",
            "output": "1.  No pulmonary embolism or aortic abnormality.\n2.  Dilated pulmonary artery suggesting pulmonary arterial hypertension.\nSevere centrilobular emphysema.\n3.  Status post left nephrectomy, with moderate right hydroureteronephrosis\nextending to the bladder, which is lobulated in appearance, unchanged from\nprior.\n4.  Unchanged 1.7 cm left adrenal adenoma."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Cardiac size is grossly normal.  There is no pericardial\neffusion.  The main pulmonary artery is mildly enlarged, measuring up to 3.2\ncm, which can be seen in pulmonary artery hypertension (3:107).\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.  Clips are seen along the\nleft hemidiaphragm, with elevation of the left hemidiaphragm.  Pleural plaques\nare again noted bilaterally.\n\nLUNGS/AIRWAYS: There is severe emphysematous changes in the lungs.  No focal\nparenchymal opacification is identified.  The airways are patent to the level\nof the segmental bronchi bilaterally.  There is diffuse bronchial wall\nthickening, likely reactive.  Multiple pulmonary nodules are seen in the left\nlower lobe measuring up to 5 mm (series 3: Image 89).  Again noted is a\npartial wedge resection in the right lower lung.\n\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is remarkable for a left\nadrenal gland nodule measuring 1.8 cm, unchanged since the prior exam in\n___ and statistically most likely to represent adenoma.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nCortical irregularities along the left seventh and eighth ribs are compatible\nwith prior rib fractures.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. The main pulmonary artery is enlarged, which can be seen in pulmonary\nartery hypertension.\n3. Severe centrilobular emphysema is redemonstrated.\n4. Stable appearance of multiple pulmonary nodules, the largest measuring up\nto 5 mm in the left upper and lower lobes, dating back to ___.\n5. Unchanged 1.8 cm left adrenal nodule, statistically most likely to\nrepresent an adenoma."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Compared with CT chest ___, patient\nhas undergone interval median sternotomy and resection of a substernal\nmultinodular goiter.  There are postoperative changes within the anterior\nmediastinum including soft tissue stranding, edema, a small amount of\npneumomediastinum and fluid.  No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: There are small bilateral nonhemorrhagic pleural effusions. \nNo pneumothorax.\n\nLUNGS/AIRWAYS: Compressive atelectasis within the lower lobes is present\nremainder of the lungs appear clear without masses or concerning areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Patient is status post gastric bypass.  Included portion of the upper\nabdomen is otherwise unremarkable.\n\nBONES: Patient is status post median sternotomy.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.\n\n\nSOFT TISSUES: There is a small amount of soft tissue stranding along the\nanterior chest wall at the surgical site.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Postoperative changes status post median sternotomy and resection of a\nsubsternal multinodular goiter, including anterior mediastinal soft tissue\nstranding, edema, and a small amount of pneumomediastinum and fluid.\n3. Small bilateral nonhemorrhagic pleural effusions and adjacent atelectasis."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The esophagus is normal without evidence of wall thickening or a\nhiatal hernia.  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.  Moderate to severe coronary calcifications are seen.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nSmall bilateral pleural effusions are seen, right greater than left with\nadjacent opacities.  No concerning pulmonary nodules are identified.  There is\nno evidence of pneumothorax.",
            "output": "Small bilateral pleural effusions, right greater than left with adjacent\nopacities likely secondary to compressive atelectasis however a superimposed\ninfectious process cannot be excluded."
        },
        {
            "input": "CHEST:  The imaged base of neck including the partially imaged thyroid appears\nnormal.  The thoracic aorta appears normal in course and caliber without\nsignificant atherosclerosis.  The heart is normal in size and shape.  No\npericardial or pleural effusion seen.  The main pulmonary artery is normal in\nsize with patent central branches.  As seen on recent CT abdomen pelvis dated\n___, density paraesophageal mass traversing the diaphragmatic hiatus\nmeasuring approximately 5.8 x 4.0 x 7.0-cm.  This lesion traverses the\ndiaphragmatic hiatus extending, abutting the lesser curvature of the stomach. \nThis lesion appears slightly increased from prior.  No axillary, hilar\nadenopathy.  No adenopathy in the superior mediastinum.\n\nAtelectatic changes within the lower lungs noted within the right middle lobe,\nand bilateral lower lobes increased from prior CT exam.  No convincing\nevidence for pneumonia.  No worrisome nodule or mass.\n\nPlease refer to same-day concurrently performed CT of the abdomen pelvis for\nfindings below the diaphragm.\n\nBONES: No worrisome bony lesions.",
            "output": "1. Intermediate density paraesophageal mass traversing the diaphragmatic\nhiatus, slightly increased from prior CT, indeterminate, may reflect\nmalignancy, i.e. lymphoma.\n2. Lower lung opacities most consistent with atelectasis.\nPlease refer to same-day CT abdomen pelvis for findings below the diaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Right-sided central line\nterminating in the mid SVC.\n\nUPPER ABDOMEN: There is persistent stranding in the omental fat, which is\nlargely stable compared to previous.  A large left renal cyst is incompletely\nvisualized.  There is interval stability of a intermediate density\nparaesophageal mass traversing the diaphragmatic hiatus, measuring\napproximately 4.3 x 4.4 cm.\n\nMEDIASTINUM: There is no size significant mediastinal lymphadenopathy.\n\nHILA: There is no size significant hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Small pericardial effusion.\nPLEURA: There is a small right and small-moderate left pleural effusion, which\nare new since the previous study.\n\nLUNG: There is segmental lower lobe atelectasis bilaterally.  There are hazy\nareas of ground-glass attenuation in the right upper lobe, new since previous,\nnonspecific.  The central airways are patent.\n\nCHEST CAGE: No suspicious bony lesions.  Stable T12 compression fracture.",
            "output": "Hazy areas of ground-glass opacity in the right upper lobe, nonspecific,\nlikely infectious in etiology.  New small right and small-moderate left\npleural effusions, with segmental atelectatic changes in both lower lobes.\n\nStable rounded lesion near the gastroesophageal junction of indeterminate\ndensity.  Given its interval growth since ___, malignancy such as lymphoma\nshould be excluded.\n\nPersistent omental stranding in the upper abdomen."
        },
        {
            "input": "5 mm hypodense left thyroid nodule.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Moderate elongation of the ascending and descending\naorta.  No enlarged hilar or mediastinal lymph nodes. Moderate coronary\ncalcifications.  Mild cardiomegaly.  No pericardial effusion.  The posterior\nmediastinum is unremarkable, with the exception of a small hiatal hernia.  No\nosteolytic lesions at the level of the ribs, the sternum or the vertebral\nbodies.  Partial vertebral collapse of T7.  Minimal bilateral apical scarring.\n3 mm pure right upper lobe ground-glass nodule (6, 70).  No suspicious\npulmonary solid nodules.  Areas of mild to moderate bronchiectasis at the\nlevel of the middle lobe.  An both lower lobes.  No pleural thickening, no\npleural effusions.",
            "output": "No solid pulmonary nodules or masses, suspicious for neoplastic disease.  No\nlymphadenopathy.  No pleural effusions.  3 mm.  A right upper lobe\nground-glass nodule, not requiring CT follow-ups.  Moderate bronchiectasis in\nthe middle lobe and both left and right lower lobes."
        },
        {
            "input": "MEDIASTINUM: The imaged right thyroid gland is enlarged with focal\ncalcifications.  No pathologically enlarged supraclavicular, axillary, hilar\nor mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in\nsize.The heart size is moderately enlarged and there is no pericardial\neffusion. Mild atherosclerotic calcifications of the thoracic aorta and no\nsignificant of the coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Millimetric\npulmonary nodules including right middle lobe series 4, image 149, left upper\nlobe series 4, image, 83, 93 and 100.\n\nBONES AND CHEST WALL:  Expansile lesion involving the left anterior sixth rib\nis unchanged.  Lytic lesion involving the left scapula also unchanged. \nSclerotic lesion within the fifth vertebral body has a benign appearance.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen demonstrates a small hiatal hernia and\nprior cholecystectomy.  Right-sided exophytic cyst.  Left exophytic solid and\ncystic lesion as previously characterized on recent MRI.",
            "output": "Millimetric pulmonary nodules should have imaging follow-up in 3 months time\nto ensure stability.  No lymphadenopathy, or pleural disease.  Lytic expansile\nleft rib and scapular lesion as seen on prior PET.\n\n\nRECOMMENDATION(S):  Follow-up CT thorax in 3 months time."
        },
        {
            "input": "Stable nodular thyroid with several calcifications (2, 8).  Several borderline\nsized lymph nodes in the chest wall (2, 18) are stable in size.  No new or\ngrowing soft tissue structures in the chest wall.  No abnormalities at the\nlevel of the breasts.  No hilar or mediastinal lymphadenopathy.  No cardiac\nabnormalities.  No pericardial effusion.  The posterior mediastinum is\nunremarkable, with the exception of a small hiatal hernia.  A small hepatic\ncyst is stable (2, 47).  Status post cholecystectomy.  Large right renal cyst\nand known left renal lesion (2, 62).  A lytic lesion of the sixth left-sided\nrib (602 B, 107) is slightly bigger than on the previous examination.  The\nsmall osteolytic focus in the left scapular (4, 41) is stable.  There is no\nconvincing evidence for newly occurred lytic lesions.\nSmall pre-existing pulmonary nodules, for example in the left upper lobe (4,\n92) as well as in the lingula (4, 109) are all stable in size.  There is no\nevidence of new or growing nodules.  Mild scarring at the basis of the middle\nlobe (4, 183) is unchanged.  No pleural abnormalities.  No airway\nabnormalities.  No diffuse lung disease.",
            "output": "Stable partly calcified thyroid lesions.  Stable borderline sized lymph nodes\nin the chest wall.  Stable left scapular osteolytic focus, a small osteal\nlysis in the sixth left rib is minimally growing.  Multiple pre-existing small\npulmonary nodules of non suspicious morphology are stable.  No new or growing\nnodules."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary nodes are not enlarged.  Evaluation\nof the breast is reserved for mammography.  Elsewhere in the partially imaged\nchest wall there are no soft tissue abnormalities concerning for malignancy. \nThis study is not appropriate for subdiaphragmatic diagnosis but shows no\nadrenal mass.\n\nCARDIO-MEDIASTINUM:Upper esophagus is mildly patulous, but there is no\nassociated mass or good evidence for obstruction.  Atherosclerotic\ncalcification is not apparent in head and neck vessels or coronary arteries. \nAorta and pulmonary arteries and cardiac chambers are normal size. \nPericardium is physiologic.\n\nTHORACIC LYMPH NODES: No thoracic lymph nodes are pathologically enlarged by\nsize criteria.\nLUNGS, AIRWAYS, PLEURAE:\n Biapical pleuroparenchymal scarring is considerable, but symmetric and\nunchanged since ___.\n\nThere are new multifocal findings of widespread inflammation, predominantly\nbronchial, examples as follows:\n\nNew bronchial wall thickening and peribronchial consolidation, right middle\nlobe, lingula, and bilateral lower lobe bronchial wall thickening, 4: 150-195.\n\nPeribronchial ground-glass interspersed with mild bronchial wall thickening\nand peripheral atelectasis or residual consolidation, left lower lobe,\n4:199-243.\n\nThere are no lung lesions concerning for malignancy, no dilated bronchi to\nsuggest chronic bronchiectasis, and no regions of either consolidation or\nacinar opacification to suggest active pneumonia.\n\nPleural surfaces are normal.\n\n\n\n\n\n\nCHEST CAGE: Unremarkable.",
            "output": "Bronchial inflammation was mild in ___ consisting of only of the\nretained secretions in a small number of bronchi.\n\nThe chest radiograph in ___ showed new pneumonia predominantly in\nthe superior segment of the left lower lobe.  That region of pneumonia had\ncleared by ___, but in retrospect one can see small regions of new\nconsolidation in the right middle lobe, still visible today.\n\nToday's chest CT shows much more extensive bronchial inflammation, described\nabove, but no findings to suggest active pneumonia.  It is possible let this\nbronchitis is either actively infectious or related to prior pneumonia. \nAllergic causes and aspiration should be considered as alternatives to\ninfection and there is the possibility that that some of the bronchial\ninflammation could, as suggested previously, be early manifestations of\nnon-tuberculous mycobacterial airway infection before the development of\nbronchiectasis and nodular bronchiolitis."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No pericardial pleural\neffusion is seen.  No pathologically enlarged mediastinal, hilar or axillary\nlymph nodes demonstrated.\n\nImage portion of the upper abdomen demonstrate a trophic pancreatic tissue and\notherwise is unremarkable.\n\nAirways are patent to the subsegmental level bilaterally.  Minimal traction\nbronchiectasis is similar to previous examination.  Bibasal bronchiectasis are\nsimilar to previous examination as well.\n\nThere is interval improvement in ground-glass opacities in particular in the\nright middle lobe and lingula, substantial with no current evidence of active\ninfection.  No new nodules masses or consolidations demonstrated.  Bi apical\nscarring is unchanged.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval improvement in bilateral predominantly lingular and right middle lobe\nconsolidations and areas of ground-glass consistent with improvement of\ninfection\n\nUnchanged to cylindrical bronchiectasis with no evidence of airway infection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No axillary or supraclavicular\nlymphadenopathy.  No suspicious soft tissue lesions within the thorax.\n\nUPPER ABDOMEN: The upper abdomen is partially visualized, with fatty atrophy\nof the pancreas and no acute findings.\n\nMEDIASTINUM: No mediastinal mass.  No lymphadenopathy by CT size criteria.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal size without pericardial effusion. \nThe thoracic aorta is normal caliber with mild atherosclerotic calcification.\nPLEURA: Pleural thickening at the bilateral apices, otherwise no effusion or\npleural abnormality is demonstrated.\nLUNG:\n\n1. PARENCHYMA:  There are new bibasilar ground-glass opacity with substantial\nendobronchial secretions, bronchial thickening and with multiple areas of\nfocal bronchiectasis close conjunction with the ground-glass.  No dense\nconsolidation is noted.  There are multiple areas of nodular opacity overlying\nthe ground-glass, measuring up to 6 mm (series 302 image 195, 206, 213). \nThere is biapical scarring which is unchanged.\n2. AIRWAYS:  The airways demonstrate diffuse endobronchial secretions in the\nbilateral lung bases.  There are focal areas of bronchiectasis and worsening\nbronchial thickening demonstrated at the bilateral lung bases as above.\n3. VESSELS:  The pulmonary arterial vasculature is grossly within limits.\nCHEST CAGE: No acute fracture.  No suspicious osseous lesions.",
            "output": "1. Bibasilar ground-glass opacities in the background of diffuse endobronchial\nsecretions with interval worsening of bronchial wall thickening and high\nbronchiectasis.  Findings are highly concerning for bronchitis and possibly\nbilateral pneumonia.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 17:10 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "CTA: No evidence of pulmonary embolism to the subsegmental level. \nUnremarkable appearing aorta.\n\nLUNGS: Minimal atelectasis noted at the lung bases.  No worrisome pulmonary\nnodules. No evidence of pneumonia.  No pleural effusion.\n\nMEDIASTINUM: A sub cm hypodense nodule is noted both the left and right\nthyroid lobe.  No mediastinal lymphadenopathy.  Normal heart size.  No\npericardial effusion.  Thymic tissue is prominent for age but probably\nreactive.  Minor pleural thickening is noted along the right lower hemi thorax\n(9:  95).\n\nUPPER ABDOMEN: Unremarkable\n\nBONES: Severe kyphosis and scoliosis with posterior fusion, but without\nworrisome lesion for malignancy.  Right-sided rib defects are probably\npost-surgical.",
            "output": "No evidence of pulmonary embolism or other acute cardiopulmonary disease. \nMildly prominent thymus, probably reactive."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: There is biapical pleuroparenchymal scarring.  There is a calcified\ngranuloma in the left lower lobe (3, 108).  Another calcified granuloma seen\nin the right middle lobe (3, 126).\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately.",
            "output": "2 calcified granulomas.  No evidence of pneumonia\n\nPlease refer to dedicated report on abdomen which has been dictated separately"
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The multiple small mediastinal lymph nodes.  A right paratracheal\nnode measures 12 mm.  A pre-vascular lymph node measures 10 mm.  The\nsubcarinal nodes measure up to 1.9 cm.  There is moderate cardiomegaly.  There\nis moderate coronary artery calcification.  The main pulmonary artery measures\n3.7 cm.  The aorta is normal in caliber.  There is mild atherosclerotic\ncalcification involving the descending thoracic aorta.  There is no\npericardial effusion\n\nPLEURA: There are small bilateral effusions right greater than left.\n\nLUNG: There are multifocal bilateral parenchymal opacities in a bronchus\ncentric distribution a predominantly within the right upper lobe but also\nwithin both lower lobes.  Findings are suggestive of a multifocal pneumonia. \nThere is mild interstitial edema.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\nsplenomegaly.  No focal liver lesions are seen.",
            "output": "Bronchus centric opacities in the right upper lobe and both lower lobes\nconcerning for multifocal pneumonia.\n\nSmall bilateral effusions and mild interstitial edema.\n\nSmall mediastinal lymph nodes could be reactive."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe thyroid is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMild to moderate multilevel degenerative changes of the thoracic spine\nincluding intervertebral disc space narrowing and endplate sclerosis.\n\nUPPER ABDOMEN: Borderline splenomegaly, the spleen measures 14 cm AP.",
            "output": "No evidence of pulmonary embolism or acute aortic abnormality."
        },
        {
            "input": "There are no enlarged mediastinal, axillary or hilar lymph nodes. Prominent\nsubcentimeter right interlobar hilar nodes do not meet strict size criteria\nfor abnormal enlargement. Heart is moderately enlarged, and severe, diffuse\ncoronary artery calcifications are present. Note is made of a prosthetic\naortic valve.\n\nNote is made of previous sternotomy. Skeletal structures are otherwise\nremarkable for multilevel degenerative changes within the spine. High-grade\ncompression deformity at L1 will be more fully characterized on the concurrent\nCT abdomen and pelvis EXAMINATION.\n\nAssessment of the lungs is somewhat limited due to inadvertent submaximal\ninspiratory level and respiratory motion, reducing sensitivity for small\npulmonary nodules and subtle interstitial lung abnormalities. With this\nlimitation in mind, note is made of scattered micro nodules including 4 mm\nright lower lobe nodule (146, 7), 3 mm right lower lobe nodule (130, 7), 2 mm\nleft upper lobe nodule (110, 7), 4 mm left apical perivascular nodule (53, 7),\n3 mm superior segment right lower lobe nodule (86, 7). No dominant spiculated\nnodule or mass is evident to suggest the presence of a primary lung\nmalignancy.\n\nBibasilar linear atelectasis and or scarring is also noted.",
            "output": "1.  No CT evidence of dominant lung nodule or mass to suggest a primary lung\nmalignancy.\n\n2. Scattered sub 5 mm micro nodules, which are statistically most likely\nbenign. If the patient has an extrathoracic primary malignancy, followup CT in\n3 months may be helpful to assess for stability.\n\n3. Severe diffuse coronary artery calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is grossly\nunremarkable.  There is no axillary lymphadenopathy.  The soft tissues of the\nvisualized lower neck and chest wall are otherwise grossly unremarkable.\n\nUPPER ABDOMEN: Abdominal findings are reported separately.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy or mass.  Upper enteric\ntube is seen coursing through the esophagus.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal without significant pericardial\nfluid.  Severe coronary artery calcifications are noted.\nPLEURA: Pleural surfaces are clear without effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Evaluation of the lower lobes is degraded by respiratory\nmotion artifact.  There is minor dependent bilateral lower lobe atelectasis. \nThere is a 3 mm nodule in the right middle lobe.  There is a 2 mm nodule in\nthe left lung apex (___).  There is a 6 mm somewhat triangular perifissural\nnodule in the superior segment of the left lower lobe (302:85) which may\nrepresent intrapulmonary lymphoid aggregate.  The lungs are otherwise grossly\nclear.\n2. AIRWAYS:  The central airways are patent.\n3. VESSELS:  Mild atherosclerotic calcifications are noted along a normal\ncaliber thoracic aorta.  The main pulmonary artery is normal caliber.  There\nis chronic appearing central nonocclusive filling defect within the distal\nright main to the right upper middle, and lower lobar branches, with\nappearance of chronic pulmonary embolus.  More distal evaluation is not\npossible given this nondedicated study.\nCHEST CAGE: Thoracic cage is intact without acute fracture or suspicious focal\nbony lesion.  Median sternotomy wires are intact.",
            "output": "1. Scattered pulmonary nodules measuring between 2-6 mm, without suspicious\nfeatures.\n2. No pneumonia or lymphadenopathy.\n3. Central linear nonocclusive filling defects in the distal right main as\nwell as the proximal right upper, middle, and lower lobar pulmonary arteries\nconsistent with chronic pulmonary embolus.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nPulmonary embolus can be further characterized with dedicated chest CTA if\nindicated.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:41 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "BASE OF NECK: The thyroid is multinodular with a dominant heterogeneous 1.6 cm\nright thyroid nodule.  No supraclavicular lymphadenopathy is identified\n\nHEART AND VASCULATURE:  The thoracic aorta contains dense atherosclerotic\ncalcifications at the aortic arch though is normal in caliber.  Dense in\nextensive coronary artery calcifications are visualized otherwise the heart,\npericardium, and great vessels are within normal limits.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, hilar, or mediastinal\nlymphadenopathy is present.  No mediastinal mass is present.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is notable for an\natrophic pancreas.  For further characterization of findings below the\ndiaphragm please see same day CT abdomen pelvis.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No findings identified to suggest intrathoracic malignancy.\n2. Please see same day CT abdomen pelvis for characterization of\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST:\nPLEURA:  There are moderate bilateral pleural effusions.\n\nHEART AND PERICARDIUM:  There is no pericardial effusion.\n\nMEDIASTINUM:  There is no mediastinal lymphadenopathy.\n\nAXILLAE:  There is no axillary lymphadenopathy.\n\nVESSELS:  There is no evidence of pulmonary embolism.  No thoracic aorta\naneurysm is seen.\n\nPARENCHIMA:Patchy areas of ground-glass opacities in the bilateral upper lobes\ncould be inflammatory, however a infection cannot be excluded.  Enhancing\nconsolidative opacities in both lower lobes likely represent passive\natelectasis.\n\nAIRWAY:  The airway is patent.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 2.2 cm hypodense partially exophytic lesion in\nsegment 3 of the liver (08:39) suggestive of a cyst.    There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\nsludge\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post ___ fundoplication with large\nvolume of fluid within the hiatus, extending into the chest  The stomach is\nmoderately distended.  Fat stranding within the gastrohepatic ligament likely\nrepresent post surgical changes.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  The colon and rectum are\nwithin normal limits.\n\nPELVIS: The bladder is decompressed.  There is small amount of pelvic free\nfluid.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of pulmonary embolism.\n2. Patchy ground-glass opacities in both upper lobes could be inflammatory,\nhowever early infection cannot be excluded.\n3. Status post ___ fundoplication with large amount of simple fluid within\nthe hiatus extending into the chest.\n4. Moderate bilateral pleural effusions with passive atelectasis.\n\nRECOMMENDATION(S):  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:18 AM, 5\nminutes after discovery of the findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and excluding the\nbreasts which require mammography for evaluation elsewhere in the chest wall\nthere are no soft tissue abnormalities concerning for malignancy.\n\nThere are no thyroid lesions warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels or coronary\narteries.  Aorta and pulmonary arteries are normal caliber.  There is no\naortic valvular calcification.  Evaluation of the heart would require\ndedicated cardiac imaging.  Hiatus hernia is small.  Esophagus above that\nlevel is unremarkable.\n\nPericardium is physiologic.  There is no pleural abnormality.  Lymph nodes in\nthe hila mediastinum and other intrathoracic stations are not pathologically\nenlarged.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy.\n\nAside from cardiomegaly this is a normal chest CT."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The main\npulmonary artery is normal in caliber. The heart and pericardium are within\nnormal limits.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: There is persistent mediastinal\nlymphadenopathy, improved compared to PET-CT from ___, with\nrepresentative nodes as follows: 4.7 x 2.4 cm precarinal nodal conglomerate\n(series 6, image 23), previously 6.4 x 2.6 cm; 2.7 x 1.5 cm prevascular lymph\nnode (series 6, image 20), previously 3.3 x 1.8 cm; 3.5 x 2.1 cm subcarinal\nnodal conglomerate, previously 5.9 x 4.2 cm..  There is no axillary\nlymphadenopathy. There is no hilar lymphadenopathy.\n\nPLEURAL SPACES: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Geographic areas air trapping in the lungs are suggestive of\nsmall airways disease.  There is scattered subsegmental atelectasis of both\nlower lobes.  There is no focal consolidation.  There is no pulmonary edema. \nThere are several scattered calcified granulomas in both lungs.  A 3 mm\nnodular focus in the anterior right middle lobe (series 7, image 174) is\ncompatible with mucous plugging within a peripheral bronchus.  There are other\ntiny, solid pulmonary nodules which are not definitely calcified, for example,\na 2 mm nodule in the right middle lobe (series 7, image 206), 2 mm nodule in\nthe right lower lobe (series 7, image 156), 3 mm nodule in the posterior right\nupper lobe (series 7, image 103); 2 mm nodule in the left lower lobe (series\n7, image 171), indeterminate.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nCHEST CAGE: There is sclerosis and a moderate compression deformity of the T3\nvertebral body, unchanged.\n\nABDOMEN / PELVIS:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation.  No focal hepatic\nlesion is detected.  There is no intra- or extrahepatic biliary dilatation. \nThere are multiple small stones in the gallbladder.\n\nPANCREAS: The pancreas is homogeneous in attenuation, without evidence of\nfocal lesion or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 16.7 cm in length, unchanged from\nprior and previously 16.2 cm in length, and normal in attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic.  There is no focal renal lesion or\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness.  The colon and rectum are within normal\nlimits.\n\nPERITONEUM: There is a small amount of scattered ascites within the abdomen\nand pelvis, new from prior.\n\nPELVIS: The previously seen soft tissue masses within the right iliopsoas and\nobturator internus muscles have largely decreased in size.  There is\npersistent mild asymmetric enlargement of the right obturator internus muscle,\nmeasuring up to 1.4 cm in thickness.  There is also soft tissue encasement of\nthe right external iliac vessels.  There is mild nonspecific stranding around\nthe bladder.  The distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size.  The seminal vesicles are\nsymmetric.\n\nLYMPH NODES: A prominent 1.2 cm in short axis porta hepatis lymph node (series\n6, image 65), remains unchanged.  There is no other retroperitoneal or\nmesenteric lymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is moderate\natherosclerotic disease of the aortoiliac vessels.\n\nBONES: Again seen are lytic lesions within the right inferior pubic ramus and\nparasymphyseal region, unchanged.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Near resolution of soft tissue masses within the right iliopsoas and\nobturator internus muscles seen on the prior CT of the abdomen/pelvis from ___, in keeping with known diffuse large B-cell lymphoma.  Persistent\nmild asymmetric enlargement of the right obturator internus muscle and soft\ntissue encasement of the right external iliac vessels.\n2. Unchanged splenomegaly.\n3. Unchanged lytic lesions within the right inferior pubic ramus and\nparasymphyseal region.\n4. Small amount of scattered ascites within the abdomen and pelvis, new from\nprior.\n5. Persistent mediastinal lymphadenopathy, improved compared to PET-CT from ___.\n6. Geographic areas air trapping in the lungs, suggestive of small airways\ndisease.\n7. Several scattered calcified granulomas in both lungs, as well as other tiny\npulmonary nodules measuring 3 mm or less, which are not definitely calcified. \nAttention on follow-up is recommended.\n8. Unchanged sclerosis and a moderate compression deformity of the T3\nvertebral body."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable.\n\nUPPER ABDOMEN: Please refer to separate report for same-day CT abdomen pelvis\nstudy for discussion findings below the diaphragm.\n\nMEDIASTINUM: Multiple large mediastinal lymph nodes are again seen and are\nmildly decreased in size.  For example, a lymph node conglomeration in the low\nanterior paratracheal station is now 4.3 x 2.1 cm (6:129), previously 4.7 x\n2.4 cm.  A subcarinal lymph node is 1.6 cm (6:150), previously 1.8 cm.\n\nHILA: An enlarged right hilar lymph node is mildly decreased in size, now 1.4\ncm (6:144), previously 1.8 cm.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare moderate to severe.  Aortic valve calcifications are again seen.  The\nthoracic aorta is normal in caliber. There is no pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Bibasilar atelectasis is noted.  Multiple small bilateral\ncalcified granulomas are again seen.  A 2 mm left lower lobe solid nodule is\nunchanged (6:195).\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.  There is mild-to-moderate bronchial wall thickening, most\nnotable in the lower lobes.\n3. VESSELS:  Main pulmonary artery diameter is enlarged at 3.5 cm, similar to\nprior.  Suboptimal evaluation of the pulmonary vasculature demonstrates no\nevidence of central pulmonary embolism.\nCHEST CAGE: Sclerosis and moderate compression deformity of the T3 vertebral\nbody is unchanged.  There is no acute fracture.",
            "output": "1. Since ___, mild decrease in mediastinal and hilar lymphadenopathy,\nas detailed above.\n2. Mild-to-moderate bronchial wall thickening in the bilateral lower lobes\nwith bibasilar atelectasis is suggestive of chronic small airway disease.\n3. Please refer to separate report for same-day CT abdomen pelvis study for\ndiscussion findings below the diaphragm."
        },
        {
            "input": "Exam is slightly limited by motion artifact, particularly in the right lung. \nHowever, within these limitations:\n\nNECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM: Compared to ___, there is interval decrease in size of\npreviously enlarged mediastinal lymph nodes in the AP window, subcarinal and\nparatracheal regions, now within normal limits.  No new enlarged mediastinal\nlymph nodes.\n\nHILA:  Hilar lymph nodes are not enlarged.  Previously enlarged right hilar\nlymph node is no longer visualized.\n\nHEART:  The heart is mildly enlarged and there is extensive coronary arterial\ncalcification.  There are moderate aortic valve calcifications there is no\npericardial effusion.\n\nVESSELS: Aortic caliber is normal.  There is persistent enlargement of the\nmain pulmonary artery measuring up to 3.6 cm.\n\nPULMONARY PARENCHYMA: There is persistent left lower lobe platelike and\ncompressive atelectasis.  There are scattered calcified granulomas in the left\nlung likely secondary to prior granulomatous exposure.  Otherwise, there is no\nevidence of infection or malignancy.  There is no significant emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: There is stable mild bilateral gynecomastia.  There are\nstable sclerosis and compression deformity of T3 vertebral body.  Otherwise,\nthere is no worrisome lytic or sclerotic lesion.  Multilevel degenerative\nchanges are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Resolution of previously enlarged mediastinal and right hilar\nlymphadenopathy.  No new lymphadenopathy.\n2. Mild bilateral gynecomastia.\n3. Extensive coronary artery disease with moderate aortic valve\ncalcifications.\n4. Persistent main pulmonary artery dilation may represent pulmonary arterial\nhypertension\n5. Please see separately submitted report of CT Abdomen and Pelvis from the\nsame date for description of subdiaphragmatic findings."
        },
        {
            "input": "Compared to the previous chest CT of the ___, there has been very\nslight progression of the known metastatic breast carcinoma. A large left\naxillary mass has slightly increased in size currently measures 5.7 x 5.8 cm\nand previously measuring 5.2 x 5.7 cm. An additional mass in the anterior\nmedial left breast is relatively unchanged in size and appearance currently\nmeasuring 3.8 x 4.8 cm, previously measuring 3.8 x 4.7 cm. Multiple other\nbreast nodules are again identified, some which appears slightly larger.\n\nThere are multiple lung nodules, some of which are stable in size and some of\nwhich have slightly increased in size.  The largest nodule located the lingula\ncurrently measures 24 x 26 mm (series 6, image 162) and previously measured 22\nx 24 mm.  Mild left lower lobe atelectasis is new. There is no focal\nconsolidation, pleural effusion or pneumothorax.\n\nThe thyroid is normal. The left subclavian artery is narrowed by the axillary\nmass and the left subclavian vein is not identified and is likely completely\noccluded. Aorta and pulmonary arteries are normal size. Although this study is\nnot designed to evaluate for pulmonary emboli there is no large central\npulmonary embolus identified. The heart size is normal and there is no\npericardial effusion. A central venous line ends in the right atrium.\n\nOsseous structures: A massively destructive metastatic lesion in the sternum\nis relatively unchanged. No other destructive lesions or impending fractures\nare identified.\n\nFor findings in the abdomen please see the dedicated CT abdomen report of the\nsame date.",
            "output": "1.  Slight interval progression of known breast carcinoma since ___. Stable left axillary mass.  Multiple left breast masses and scattered\nlung nodules are all either stable or minimally increased in size.\n\n2.  The left subclavian artery is narrowed by the axillary mass and the left\nsubclavian vein is not identified and is likely completely occluded."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is severe coronary arterial\ncalcification.  There is a trace pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA: There is linear subsegmental atelectasis at the lung\nbases.  There is no evidence of infection or malignancy.  There is no\nemphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: There are chronic fractures of the left anterolateral\nthird through seventh ribs.  Chronic L1 mild compression deformity is again\nnoted.  There is no worrisome lytic or sclerotic lesion.  Multilevel\ndegenerative changes are mild.  Mild stranding is noted along the upper left\nlateral chest (3: 49-54), presumably ecchymosis.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen demonstrates\npostsurgical changes of hiatal hernia repair.  The common bile duct is\nmarkedly dilated, measuring up to 16 mm, previously 11 mm on MRCP from ___.",
            "output": "1. Mild ecchymosis along the left lateral upper chest.  No evidence of acute\nfractures.\n2. Chronic left-sided rib fractures and chronic mild L1 compression deformity.\n3. Markedly dilated common bile duct, measuring up to 16 mm, increased\ncompared to MRCP from ___.  Correlation with LFTs is recommended,\nand repeat MRCP on an outpatient basis could be considered.\n4. Severe coronary calcification."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged, ranging in diameter\nup to 5 and 6 mm in the axilla.  Excluding the breasts which require\nmammography for evaluation, there is no soft tissue abnormality in the chest\nwall suspicious for malignancy.  Findings below the diaphragm were evaluated\non an abdomen CT ___, reported separately.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in the\nhead and neck vessels or the coronary arteries.  Heart is moderately enlarged\ninvolving all chambers.  There is no pericardial effusion.  Aorta and\npulmonary arteries are normal size and subject to the limitations of this\nstudy, free of filling defects.\n\nSmall dependent right pleural effusion is not hemorrhagic.  Pleural surfaces\nare smooth.\n\nRetrotracheal lymph nodes at the thoracic inlet, 10 mm in diameter are\npathologically enlarged, 04:28.  Lymph nodes elsewhere in the mediastinum are\nnumerous but not pathologically enlarged.  There is no hilar adenopathy.\n\nThere are no lung are nodules suspicious for malignancy.  Subsegmental and\nsegmental atelectasis most pronounced at the lung bases is probably due to\nhypoventilation or abdominal distension.  There is no bronchial obstruction.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "Borderline enlarged thoracic inlet lymph nodes are the only pathologically\nenlarged intrathoracic nodes.  It would be unusual for this to be the solitary\nmanifestation of adenopathy from pancreatic carcinoma in the chest.\n\nSmall right pleural effusion is indeterminate.\n\nModerately severe bibasilar atelectasis."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the chest wall suspicious for malignancy.  Findings below the\ndiaphragm will be reported separately.\n\nThere are no thyroid lesions warranting further evaluation.  Atherosclerotic\ncalcification is not apparent head neck vessels or coronary arteries.  Aorta\nand pulmonary arteries are normal size.  A right central venous infusion port\ncatheter ends in the low SVC.  Evaluation of the heart would require dedicated\ncardiac imaging.  There is no pericardial or pleural abnormality.\n\n6 mm lymph node at the thoracic inlet in the right tracheoesophageal groove is\nminimally larger today than on ___.  Sub cm nodes elsewhere in the\nmediastinum and right hilus are not pathologically enlarged.\n\nAside from mild subsegmental atelectasis, lungs are clear.  There are no\npulmonary nodules.\n\nThere are  no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  All visible\nlymph nodes in the mediastinum are normal in in size (3, 47).  Normal\nappearance of the large mediastinal vessels.  No incidental pulmonary\nembolism.  Moderate coronary calcifications.  No pericardial effusion.  The\nposterior mediastinum is unremarkable, with the exception of a minimal hiatal\nhernia.  Upper abdominal organs are reported in detail in the dedicated\nabdominal CT report.  No osteolytic lesions at the level of the ribs, the\nsternum, and the vertebral bodies.  Mild degenerative vertebral disease.\nMinimal bilateral apical scarring, with dot like calcifications (5, 49).  No\npleural effusions.  No diffuse lung disease.  The airways are patent.  4 mm\nsolid subpleural nodule (5, 202), new since the previous examination.  No\nother suspicious pulmonary nodules or masses.  Small left Bochdalek hernia.",
            "output": "4 mm solid subpleural nodule, new since the previous examination. The nodule\nneeds to be followed with CT in 3 months.  No pleural abnormalities.  The\nairways are patent."
        },
        {
            "input": "Bilateral hypodense nodules measure up to 8 mm at the right lower pole.  There\nis no supraclavicular, mediastinal, hilar or axillary lymphadenopathy.\n\nMild cardiomegaly with multichamber enlargement is unchanged. There extensive\ncoronary artery calcifications. There is no pericardial effusion. The main\npulmonary artery is normal caliber.  The right and left pulmonary arteries are\nmildly dilated measuring 3.1 cm bilaterally.  The ascending thoracic aorta is\nmildly dilated to 4.0 cm.  There is no incidental pulmonary embolus.\n\nMultiple images are partially degraded by respiratory motion artifact, which\nlimits detection of subtle lesions and small nodules. Several solid pulmonary\nnodules measuring up to 5 mm in the right upper lobe apex are stable since\n___ (6: 46, 76, 110, 147, 156, 177). No new nodules are identified.\nThere is no endobronchial lesion or pleural abnormality.\n\nModerate bilateral symmetric gynecomastia is unchanged.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.\n\nThere are no bone lesions in the thorax worrisome for infection or malignancy.",
            "output": "Motion limited exam.\n\nStable pulmonary nodules measuring up to 5 mm in the right upper lobe.  No new\nnodules identified.\n\nStable mild dilatation of the right and left pulmonary arteries may suggest\npulmonary arterial hypertension in the appropriate clinical setting.\n\nStable fusiform dilatation of the ascending thoracic aorta to 4.0 cm."
        },
        {
            "input": "Central airways are patent to the subsegmental level.  There is a new moderate\nright pleural effusion with associated right basilar atelectasis. Smooth right\nbasilar septal thickening is suggestive of mild edema. There is no\nconsolidation.  There is no pulmonary mass.\n\nAn unchanged 4 mm right upper lobe nodule is present in series 4, image 56. A\ncalcified granuloma is present in the right upper lobe (4:77) Evaluation of\nthe lungs is slightly limited due to motion, however there is an unchanged\nelongated nodule within the left major fissure measuring 3 mm (4:127).  A mm\nleft upper lobe nodule is present in series 4, image 89. 2 mm left apical\npulmonary nodule is present in series 4, image 41.  No new pulmonary nodule is\nvisualized.\n\nThere is severe atherosclerotic calcification of the aortic arch. Severe\natherosclerotic calcification of the coronary arteries and aortic root are\npresent. The heart size is within normal limits. There is a trace amount of\npericardial fluid, likely physiologic.\n\nThere is no bone lesion concerning for metastasis or infection.\n\nPlease see separate report for dedicated CT abdomen and pelvis findings.",
            "output": "1. Unchanged bilateral pulmonary nodules measuring up to 4 mm.  No definite\nnew or growing nodules on this technically limited study due to motion\nartifact.\n2. Severe coronary artery atherosclerotic calcification.\n3. Please see separate report for dedicated CT abdomen and pelvis findings."
        },
        {
            "input": "Enlarged mediastinal lymph nodes are present.  In the bilateral paratracheal,\nprecarinal and subcarinal nodal stations, the latter extending into the azygos\nesophageal recess. Additional cluster of nodes is present in the pericardial\nregion.  A representative lymph node in the lower left paratracheal region\nmeasures 1.3 x 1.4 cm (76, 4).\n\nThe esophagus is difficult to assess without oral contrast, but demonstrates a\nmass-like thickening just above the diaphragm, in a region surrounded by\napparent esophageal varices.  Heart size is normal, and there is no\npericardial or pleural effusion.\n\nAssessment of the lungs is limited by submaximal inspiratory level, reducing\nsensitivity for small pulmonary nodules and subtle interstitial lung disease.\nNote is made of minimal apical emphysema. Dependent areas of atelectasis are\npresent in both lung bases. No suspicious nodule or mass is evident is suggest\na primary lung cancer.\n\nExam was not tailored for the sub- diaphragmatic assessment, but note is made\nof cirrhotic liver, splenomegaly, small volume ascites, varices, upper\nabdominal lymph nodes and diffuse soft tissue stranding of the mesentery These\nfindings will be more fully assessed along with more complete characterization\nof the liver by concurrently performed MRI of the abdomen from the same date.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.",
            "output": "1.  No CT evidence of suspicious lung nodule or mass to suggest a primary\nnon-small cell lung cancer as a cause of paraneoplastic syndrome.\n\n2. Diffuse mediastinal lymphadenopathy is a nonspecific finding that could be\ndue to inflammatory, infectious or neoplastic etiology. If warranted\nclinically, correlated PET-CT imaging could be performed.\n\n3. Masslike appearance of lower thoracic esophagus, difficult to assess in the\nabsence of oral contrast. This may be secondary to extensive paraesophageal\nvarices, but correlative barium swallow may be helpful to exclude an intrinsic\nesophageal abnormality if warranted clinically.\n\n4. Cirrhotic liver and sequela of portal hypertension, which will be more\nfully assessed on concurrent MRI of\n the abdomen, performed the same date and dictated separately."
        },
        {
            "input": "The thyroid is normal.  Prominent mediastinal lymph nodes are again seen\nsimilar in appearance to prior examination.  Aorta and pulmonary arteries are\nnormal size. Cardiac configuration is normal and there is no appreciable\ncoronary calcification.\n\nThere are mild dependent changes with a small amount of atelectasis.  No focal\nlung consolidation.\n\nThere is a right-sided central line with tip in the proximal right atrium.\n\nNo suspicious osseous lesions.",
            "output": "Normal Chest CT. No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "The thyroid gland is unremarkable.  There is no pathologic lymph node\nenlargement.\n\nHeart size is normal with no pericardial effusion.  Mild dilatation of the\nmain pulmonary artery to 3.3 cm has slightly increased.  An accessed right\npectoral MediPort terminates in the right atrium.  Coronary artery and aortic\nvalvular/annular calcifications are extensive.  Small focal aneurysm arising\nfrom the distal aortic arch is unchanged.\n\nModerate upper lobe predominant centrilobular emphysema is unchanged. Moderate\ndiffuse bronchial wall thickening has improved. Right middle lobe linear and\nsubsegmental atelectasis is unchanged.  Previous left lower lobe peribronchial\nground-glass opacities have resolved, however, there is a new small\nconsolidation in the superior segment left lower lobe, which is most likely\ndue to infection or aspiration (5, 138).\n\nThe upper esophagus is mildly thick-walled and dilated.  Images of the upper\nabdomen show a subcentimeter hypodense right hepatic lobe lesion which is\nstable but too small to characterize (3, 45).\n\nAn old healed right rib fracture is unchanged.  A lytic lesion involving the\nT9 vertebral body shows slightly increased loss of height as compared to ___.  Additional lytic lesions at T5, T7, and T8 are unchanged.  The lytic\nlesion at T1 was included in the field of view today.",
            "output": "Resolution of previous left lower lobe peribronchial opacities with either\nresidual or recurrent superior segment left lower lobe infection or\naspiration.\n\nStable moderate upper lobe predominant centrilobular emphysema.\n\nStable moderate diffuse bronchial inflammation.\n\nNewly increased loss of height at T9 is worrisome for impending pathologic\nfracture.  Lytic lesions in T5, T7, and T8 stable.  L1 lesion not imaged\ntoday.  These lesions are compatible with the known diagnosis of multiple\nmyeloma.\n\nSlightly increased dilatation of the main pulmonary artery suggests pulmonary\narterial hypertension in the appropriate clinical setting.\n\nExtensive coronary artery and aortic valvular/annular calcifications.\n\nStable infectious or inflammatory esophagitis.  Consider swallow study to\nassess functional status.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:22 ___,  minutes after discovery of the\nfindings.\n\nRECOMMENDATION(S):  Stable mild infectious or inflammatory esophagitis. \nConsider swallow study to assess functional status."
        },
        {
            "input": "The imaged portion of the thyroid gland is unremarkable.  The thoracic aorta\nis normal in course and caliber without signs of dissection.  The heart is\nnormal in size and shape without pericardial effusion.  Main pulmonary artery\nis normal in caliber.  The pulmonary arterial tree opacifies normally without\nfilling defect to suggest the presence of a pulmonary embolism.  No pleural\neffusion or pneumothorax.\n\nPerifissural nodularity is seen on series 3, image 69 in the right upper lobe\nmeasuring approximately 4 mm, likely an intrapulmonary lymph node. \nHypoventilatory changes are noted.  There is no worrisome nodule, mass, or\nconsolidation.\n\nIn the imaged portion of the upper abdomen, clips in the gallbladder fossa\nnoted.  Otherwise, unremarkable.\n\nBones:  No worrisome lytic or blastic osseous lesion.  No fracture or\nsignificant degenerative disease.  The visualized body wall is unremarkable.",
            "output": "No pulmonary embolism or other acute process in the chest."
        },
        {
            "input": "There is a partially visualized right PICC line.\n\nAppropriate opacification of the main pulmonary arteries and segmental\nbranches was obtained with no filling defect identified. The pulmonary\narteries are normal caliber. There is no mediastinal or hilar lymphadenopathy.\n\nThe heart size is normal. There is no pericardial effusion.\n\nThe visualized lungs are clear. There is no pleural effusion. The bones are\nunremarkable.",
            "output": "No pulmonary embolus. Cause for the patient's symptoms not identified."
        },
        {
            "input": "HEART AND VASCULATURE: There is a nonocclusive pulmonary embolus in a left\nposterior basal segmental branch (3:119).  There is an eccentric filling\ndefect along the periphery of the anterior right middle lobe segmental branch\nmay represent a chronic thrombus (3:87).  There is a filling defect at the\nbranch of the right lower lobe posterior basal segmental the level which also\nrepresents pulmonary embolus (3:144).  No definite evidence of right heart\nstrain.\n\nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is mildly enlarged.  Incidental note is made\nof an aberrant right retroesophageal right subclavian artery.  Addition, there\nis an aortic arch origin of the left vertebral artery.  Otherwise, the\npericardium and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 6 mm right upper lobe and 5 mm right middle lobe\nperifissural pulmonary nodule, which are stable compared to ___ consistent\nwith benign entities, likely nodes.  There is scattered linear and\nsubsegmental atelectasis.  Otherwise, lungs are clear without masses or areas\nof parenchymal opacification.  No evidence of pulmonary infarction.  The\nairways are patent to the level of the segmental bronchi bilaterally.  Lower\nlobe bronchiectasis is noted.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a small hiatal\nhernia.  In addition, there is a soft tissue density adjacent to the greater\ncurvature of the stomach which seems stable compared to ___ and is of\ndoubtful clinical significance.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Nonocclusive acute pulmonary emboli in the left posterior basal segmental\nbranch and in the right lower lobe segmental branch.  Filling defect in the\nright middle lobe segmental branch may represent chronic pulmonary embolus.\n2. No evidence of pulmonary infarction.\n3. Subcentimeter right upper lobe and right middle lobe pulmonary nodules are\nstable compared ___ and require no further follow-up."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size. There is minimal atherosclerotic calcification of\nthe coronary arteries.  The heart size is normal and there is no pericardial\neffusion.  There is a large hiatal hernia, which is unchanged in size, but\nwith focal marked esophageal wall thickening which cannot be assessed on the\nprior study due to the lack of contrast (02:33).\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  A 3 mm right middle lobe nodule is new\n(4:143). There is a benign calcified granuloma at the right upper lobe (4:66).\nPulmonary nodules up to 6 mm are stable from ___ (series 4, images 41, 108,\n111, 113).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis, including a simple\ncyst in the right kidney, will be reported separately by the Abdominal\nRadiology division.",
            "output": "1. No evidence of intrathoracic malignancy to explain patient's clinical\npresentation.\n2. Large hiatal hernia with esophageal wall thickening, unable to confirm if\nthis was present in ___.  Correlation with endoscopy is recommended.\n3. A 3 mm right middle lobe pulmonary nodule is new from ___ and should be\nfollowed up with CT in 3 months to demonstrate stability.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 12:46 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Aberrant right subclavian artery is re- demonstrated.  No mediastinal, hilar\nor axillary lymph nodes are demonstrated.  The appearance of the esophagus\nafter repair of paraesophageal hernia is unremarkable.  Image portion of the\nupper abdomen reveals no appreciable abnormality.\n\nAirways are patent to the subsegmental level bilaterally.  Bibasal\nbronchiectasis are minimal, cylindrical.  Previously demonstrated pulmonary\nnodules are all stable, series 4, images 27, 53, 100 and 6, 100 in 7, 111,\n148.  No new nodules masses are consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest after surgery for paraesophageal hernia. \nStable pulmonary nodules.  No new nodules demonstrated.\n\nAberrant right subclavian artery."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nSpecifically excluding the breasts which require mammography for evaluation,\nthere are no soft tissue abnormalities in the imaged chest wall concerning for\nmalignancy.\n\nThis study is not appropriate for subdiaphragmatic diagnosis.  Lower esophagus\nis patulous or the hiatus hernia transmits a small portion of the gastric\nfundus, similar in volume to the appearance on ___, but now air-filled. \nThere are no findings to suggest imminent incarceration or strangulation or\nvolvulus.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is minimal in head neck vessels including the 14\nmm wide retro esophageal aberrant right subclavian artery, previously 17 mm. \nAtherosclerotic calcification is scattered in at least left anterior\ndescending circumflex and right coronary arteries, unchanged.  Mild\ncardiomegaly is grossly stable but axis left atrial enlargement has probably\nincreased.  Pericardium is physiologic.  There is no pleural effusion.\n\nThoracic lymph nodes:\n\nNo adenopathy.\n\nLungs and airways:\n\nThere are no new or growing lung nodules.\n\nPunctate lung nodules are stable in long-term and too small to warrant further\nimaging.\n\n5-6 mm perifissural right lung nodule, 4:108, stable since at least ___.\n\nChest cage:\n\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Stable postoperative repair, hiatus hernia.\n\nBenign lung nodules.  No follow-up needed.\n\nCoronary atherosclerosis.  Possible new left atrial enlargement"
        },
        {
            "input": "The thyroid is unremarkable.  There are no supraclavicular, mediastinal or\naxillary lymph nodes.  There are no enlarged hilar lymph nodes. Heart size is\nnormal.  There is no pericardial effusion.\n\nThere is no pleural effusion.\n\nLungs are clear.  The abnormality seen on the radiograph radiograph has\nresolved.  There are no lung nodules consolidations of fibrosis or\nbronchiectasis.  There is minimal subsegmental atelectasis in the right middle\nlobe.\n\nReview of bones shows degenerative changes involving the thoracic spine. \nLimited sections through the upper abdomen shows multiple hypodense liver\nlesions which could represent cysts or hemangiomas.  No adrenal masses are\nseen.",
            "output": "No nodules consolidations or atelectasis. The abnormality seen on the\nradiograph radiograph has resolved\n\nMultiple hypodense liver lesions could represent cysts."
        },
        {
            "input": "CHEST: Right jugular venous catheter terminates in mid SVC.  Thyroid is\nunremarkable.  Multiple enlarged lymph nodes are identified in bilateral\naxillary regions, measuring up to 1.4 cm, located in the right axilla (03:13).\nThe largest lymph node conglomerate in the mediastinum measures 2.0 x 3.1 cm,\nlocated in the lower left paratracheal region (03:19).\n\nTrace right pleural effusion is present.  Airways are patent to subsegmental\nlevels.  Multiple small ground-glass and ___ opacities are identified\nscattered in both lungs (03:37, 24).  Several of the opacities demonstrate a\nsolid component surrounded by a ground-glass halo.\n\nABDOMEN:\nAscites is small.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Enlarged spleen measures 19.1 cm, decreased since ___ when it\nmeasured 21.5 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n0.3 cm nonobstructing stone is identified in the lower pole of right kidney. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is noted.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nBorderline enlarged lymph nodes are identified along bilateral pelvic walls\n(3:109 110).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multifocal small ground-glass opacities and bronchiolitis are suspicious\nfor pneumonia.  Given that there are several nodular opacities surrounded by a\nground-glass halo, angioinvasive aspergillosis or other fungal infection\nshould be strongly considered.\n2. Mediastinal and axillary lymphadenopathy.  Borderline enlarged bilateral\npelvic wall external iliac lymph nodes as well as numerous retroperitoneal\nlymph nodes are present.\n3. Splenomegaly."
        },
        {
            "input": "The contrast bolus is deemed adequate for diagnostic interpretation. There are\npulmonary emboli seen within the right and left main pulmonary arteries and\ndistal segmental and subsegmental branches.  The left lower lobe pulmonary\narteries are spared.  The main pulmonary artery is normal caliber. There is no\nCT evidence for right heart strain.\n\nThe heart is normal size.  There is no pericardial effusion. The aorta is\nnormal caliber and there is no evidence for aortic injury.\n\nSecretions are seen throughout the proximal tracheobronchial tree. There is\ncomplete collapse of the left lower lobe with occlusion at the left lower lobe\nbronchus, likely from mucous impaction.  Mild bronchial wall thickening is\nnoted. There is no pleural effusion. A tiny amount of clinically insignificant\npneumomediastinum is seen in the anterior mediastinal fat (602b:48) without\ndefinite evidence for a pneumothorax. There is no evidence for active\ninfection. 3 mm ground-glass opacities are seen within the right upper lobe\n(02:13, 28). A single dilated bronchiole or old tiny cavitation is noted in\nthe right upper lobe (02:33).\n\nThere is no axillary, supraclavicular or central lymphadenopathy. The included\nliver and spleen are unremarkable. There are no lytic or blastic osseous\nlesions. Sternotomy wires are noted.",
            "output": "1. Extensive bilateral pulmonary emboli. No CT evidence for right heart\nstrain.\n2. Left lower lobe collapse, likely from mucous plugging. Mild, diffuse\nbronchial wall thickening.\n3. Tiny amount of pneumomediastinum, clinically insignificant."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nSubcarinal lymphadenopathy is noted the largest nodule measures 1.4 x 1.0 cm\n(2:55).  There is a small amount of simple mediastinal fluid, slightly\nincreased from previous examination, likely representing fluid in the\npericardial recess (02:41, 02:39).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS: Lungs are clear without parenchymal opacification.  There is\ntrace bilateral atelectasis. The airways are patent to the level of the\nsegmental bronchi bilaterally.  In the right upper lobe is a 4 mm pulmonary\nnodule, unchanged from prior (02:15).  A right lower lobe ground-glass nodule\nappears unchanged from prior (02:26).\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES:  Partially visualized is posterior spinal fusion hardware in the lower\ncervical spine and vertebral bodies of T2 and T3.\n\nSOFT TISSUES:  Sternotomy wires are present, the most inferior of which is\nfractured.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Simple mediastinal fluid slightly more prominent than on prior exam, likely\nrepresenting fluid in the pericardial recess.\n3. Subcarinal lymphadenopathy.\n4. Unchanged right upper and lower lobe pulmonary nodules."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nRe- demonstration of fluid in the pericardial recess.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, or hilar lymphadenopathy.  Previous\nsubcarinal lymphadenopathy is unchanged to slightly smaller, up to 0.8 cm in\nshort axis (3:109).  The thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion or\npneumothorax.\n\nThere is no focal consolidation or parenchymal opacification.  Atelectasis in\nthe right middle lobe, lingula, and lower lobes is mild. The airways are\npatent to the subsegmental level.  A 4 mm pulmonary nodule in the right upper\nlobe is unchanged since ___.  Another 3 mm nodule in the right\nupper lobe is unchanged since ___ (3:60).  Ground-glass nodularity in\nthe left upper lobe is unchanged since ___ (3:64).\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nPatient has had prior posterior fusion of the lower cervical spine and T2 and\nT3.  As before, the inferior most sternotomy wire is fractured.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2. Ground-glass nodularity in the left upper lobe is unchanged since ___.  4 mm nodules in the right upper lobe are unchanged since ___.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 14:34 on ___, 15 min after\ndiscovery."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nRe-demonstrated are sub-4 mm ground-glass nodules in the right upper lobe,\nunchanged since ___ (03:21, 03:52).  There is mild left basilar\natelectasis.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nCervical hardware is partially visualized.  Median sternotomy wires are noted\nwith inferior most wire fractured, unchanged compared to multiple prior\nstudies.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\nRe-demonstrated are stable sub-4 mm ground-glass nodules in the right upper\nlobe."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: There is a small calcified left pericardial lymph\nnode (02:36) versus focal calcification of the pericardium.  Esophagus appears\ngrossly normal without evidence of wall thickening or obvious soft tissue\nmass.\n\nThere is no supraclavicular, axillary, hilar or mediastinal lymphadenopathy. \n6 mm prevascular lymph node (02:25), is unchanged.\n\nHeart size is normal without pericardial effusion.  The thoracic aorta, great\nvessels and main pulmonary arteries are normal in caliber.  There is no\nevidence of residual or new pulmonary embolism.  The pulmonary arteries are\npatent to the subsegmental level.  There is no evidence of lung infarct.\n\nThere is no pleural effusion or pneumothorax.  The lungs are normally\nexpanded.  The tracheobronchial tree is patent to the subsegmental level. \nThere is no evidence of active infection.  Atelectasis in the right middle\nlobe is mild.  Radiation fibrosis in the right upper lobe is unchanged.  There\nis no significant bronchial wall thickening.  Right middle lobe bronchiectasis\nis mild.\n\nOSSEOUS STRUCTURES: There are healed left rib fractures.  No worrisome blastic\nor lytic lesion is detected.\n\nThere is a 2.8 x 1.7 cm unchanged fluid collection in the posterior depth of\nthe upper central left breast presumably from prior breast cancer treated. \nDeep to this along the chest wall there is a poorly defined 6 x 2.6 cm area of\nfluid and scarring compatible with post-radiation change, decreased since the\nstudy of ___.",
            "output": "1. No sign of new over residual pulmonary embolism.\n2. No evidence of local recurrence or metastasis in the chest."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.  A calcified\ninternal mammary lymph node is incidentally noted.\n\nHeart size is normal with no pericardial effusion.  The main pulmonary artery\nand thoracic aorta are normal caliber. Moderate coronary artery calcifications\npredominantly involve the left anterior descending coronary artery.  A right\npectoral MediPort extends into the low SVC.\n\nMinimal bilateral upper lobe paramediastinal radiation fibrosis is unchanged.\nA punctate 2 mm right middle lobe nodule is stable since at least ___ (4,\n114). No new nodules are identified. Focal medial segment right middle lobe\nsubsegmental atelectasis and scarring is unchanged (4, 128). There is no\npleural abnormality.\n\nThe esophagus is unremarkable. For a detailed discussion of the upper abdomen,\nplease refer to the separate report from the CT abdomen/pelvis performed\nconcurrently.\n\nOld healed left rib fractures are present. There are no bone lesions in the\nthorax worrisome for infection or malignancy.",
            "output": "Stable exam with no evidence of local recurrence or metastasis.\n\nStable mild bilateral upper lobe radiation fibrosis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury.  The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacification of the right anterior upper lobe is\nconsistent with pulmonary contusion.  There is no evidence of hemothorax,\npneumothorax or pleural effusion.  There is bibasilar atelectasis.  There is\nno evidence pericardial effusion.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is normal.  There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild atherosclerotic disease is noted.\n\nBONES: Minimally displaced acute fractures of right anterior ribs ___ are\ndemonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Minimally displaced fractures of the right anterior second through fourth\nribs with associated right anterior upper lobe pulmonary contusion.\n2. No acute traumatic injury within the abdomen or pelvis."
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  In addition to filling defects in the right main pulmonary\nartery, there are extensive filling defects in the pulmonary arteries\naffecting all lobes and segments, worst in the right upper and lower lobes and\nrelative sparing in the left upper lobe.  Main pulmonary artery is dilated\nmeasuring up to 3.2 cm.  There is perhaps mild straightening of the\ninterventricular septum and slight dilatation of the right ventricle.\n\nCHEST:\nThe thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged. The mediastinum is unremarkable. The\npericardium is intact without effusion. The central airways are patent.\n\nPeripheral area of focal opacification in the superior segment of the right\nlower lobe (02:41) may represent a developing infarct.  There is no pleural\neffusion or pneumothorax.  Mild lingular and bilateral lower lobe atelectasis\nis noted.\n\nThe esophagus and visualized upper abdominal organs are unremarkable.\n\nOSSEOUS STRUCTURES:  There are multiple right lower lateral rib fractures\nwhich are healed.  No acute osseous injury or lesions concerning for\nmetastatic disease.",
            "output": "Extensive filling defects in the pulmonary arteries bilaterally most severe in\nthe right upper and lower lobes, compatible with pulmonary emboli. \nEnlargement of the main pulmonary artery with slight straightening of the\ninterventricular septum and mild dilatation of the right ventricle are\nconcerning for elevated right heart pressures and pulmonary arterial\nhypertension.\n\nRECOMMENDATION(S):   Clinical correlation with echocardiography is recommended\nto assess for right heart strain."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated head and\npelvis CT report dictated under clip ___\n\nCT chest:  Again seen is a 10 mm hypodense nodule in the right lobe of\nthyroid, not significantly changed from prior.  There is no supraclavicular\nlymph node enlargement. The airways are patent to the subsegmental level.\nThere is no mediastinal, hilar or axillary lymph node enlargement by CT size\ncriteria. Heart, pericardium and great vessels are within normal limits. \nCoronary artery calcifications and calcifications of the aortic valve are\nunchanged.  There is a small hiatal hernia.\n\nLung windows do not demonstrate any concerning pulmonary nodules. Minimal\nright lower lobe atelectasis is decreased compared to the prior study. No\npleural effusion or pneumothorax is present.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "1. No evidence of intrathoracic malignancy\n2. 10 mm right thyroid nodule, unchanged from prior. Recommend evaluation with\ndedicated thyroid ultrasound.\n3. Coronary atherosclerosis\n4. Please refer to the concurrent CT abdomen and pelvis for detailed\ndescription of the abdominal findings."
        },
        {
            "input": "A 9 mm hypodense right thyroid lobe nodule is stable. Both lobes of the\nthyroid gland are mildly enlarged, in the right lobe extends posteriorly into\nthe tracheoesophageal groove. There is no supraclavicular, mediastinal, hilar\nor axillary lymphadenopathy.\n\nHeart size is normal with moderate coronary artery calcifications. The main\npulmonary artery and thoracic aorta are normal caliber. No incidental\npulmonary embolus is identified. A right pectoral MediPort extends to the\nsuperior cavoatrial junction.  Low attenuation fluid collection at the level\nof the right pulmonary artery is most likely a fluid-filled pericardial\nrecess, but close attention at followup imaging is advised (6, 44).\n\nRight apical and bilateral lower lobe linear scarring is unchanged. There is\nno pulmonary nodule, mass or consolidation. No endobronchial lesion or pleural\nabnormality is identified.\n\nThere is a small hiatal hernia. For a detailed discussion of the upper\nabdomen, please refer to the separate report from the CT abdomen/pelvis\nperformed concurrently.\n\nMultilevel spinal degenerative changes and mild S-shaped scoliosis of the\nthoracolumbar spine are unchanged.",
            "output": "No evidence of intrathoracic metastases.\n\nLow attenuation fluid collection at the level of the right pulmonary artery is\nmost likely a fluid-filled pericardial recess, but close attention at followup\nimaging is advised"
        },
        {
            "input": "A right Port-A-Cath ends in the right atrium. The thyroid is normal.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size.  The heart size is normal. There\nis no pericardial effusion.  There are coronary artery calcifications.\n\nThere are no pulmonary nodules. No pleural effusion or pneumothorax. The\nairways are patent to the subsegmental level.\n\nThere are no suspicious bony lesions.\n\nSee concurrent CT abdomen pelvis for intra-abdominal or intrapelvic findings.",
            "output": "No evidence of intrathoracic metastases."
        },
        {
            "input": "Right thyroid nodule is 11 mm in diameter.  Aorta and pulmonary arteries are\nnormal in diameter and enhancement.  Heart size is normal.  Coronary\ncalcifications and aortic valve calcifications are extensive.  No mediastinal,\nhilar or axillary lymphadenopathy is present.\n\nNo pericardial effusion is seen.  Small amount of right pleural effusion is\ndemonstrated, still similar to ___ but increased as compared to ___.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules that would be worrisome for intrathoracic metastatic disease\ndemonstrated.",
            "output": "Interval increase in pleural effusion on the right.\n\nNo evidence of intrathoracic metastatic disease.\n\nRight thyroid nodule, similar to previous examination."
        },
        {
            "input": "MEDIASTINUM:  There is a circumscribed solid mass in the anterior mediastinum\nslightly off midline to the right measuring approximately 8.4 x 7.9 x 6.7 cm. \nIt is of relatively uniform attenuation with a few areas of relative\nhypodensity.  No central calcifications or fat.  The mass is in close\napproximation with the prevascular aorta and pulmonary trunk with central back\nthe right atrium and right atrial appendage. The fat plane appears preserved. \nThe imaged thyroid is normal. No pathologically enlarged supraclavicular,\naxillary, hilar or mediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size.\nNo large central filling defects in the pulmonary arteries. The heart size is\nnormal and there is no pericardial effusion. No appreciable atherosclerotic\ncalcifications of the thoracic aorta and of the coronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.  No pleural\nnodularity.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Mild centrilobular\nemphysema.  Minimal centrilobular ground-glass nodules with upper lobe\npredominance in the respiratory bronchiolitis.  Mild diffuse bronchial wall\nthickening and irregularity.  3 mm nodule in the right upper lobe series 5,\nimage 100.  2 mm punctate nodule in the left lower lobe series 5, image 100\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen demonstrates prior cholecystectomy.",
            "output": "Large anterior mediastinal mass is most consistent with a thymic epithelial\ntumor.  The mass measures up to 8 cm with local mass-effect on the prevascular\naorta, pulmonary trunk and right atrium.  Tumor size greater than 7 cm has\nbeen correlated with higher grade tumors (WHO grade B3). Right hilar lymph\nnode is borderline enlarged."
        },
        {
            "input": "CTA THORAX: The aorta and main thoracic vessels are well-opacified. There is\nstable aneurysmal dilatation of the ascending aorta to 3.4 cm. There is stable\nmoderate-to-severe mixed atherosclerotic disease most prominent in the aortic\narch. A focal outpouching of contrast at the medial margin of the aortic arch\nmay represent an ulcerative plaque, unchanged since prior (series 3, image\n36). There is no evidence of intramural hematoma or dissection. There is a\n3-vessel aortic arch, with major branches appearing normal and patent. The\npulmonary artery is well opacified to subsegmental levels. There is no\nintraluminal filling defects seen in the main, right, left, lobar, or\nsubsegmental branches. No arteriovenous malformation is seen.\n\nCT OF THE THORAX:\nThe thyroid is unremarkable. The airways are patent to subsegmental levels.\nDiffuse coronary artery and aortic and mitral valve calcifications are seen.\nThere is no pericardial effusion. There is no hiatus hernia or other\nesophageal abnormality. A prominent AP window lymph node measures 13 mm in\nshort axis (series 2, image 28), not appreciably changed in comparison to\nchest CT from ___. Prominent anterior mediastinal lymph nodes do not\nmeet CT size criteria for lymphadenopathy. There is no supraclavicular or\naxillary lymphadenopathy. There is no pericardial effusion.\n\nThere is a large right and moderate left layering simple pleural effusion.\nThere is relaxation atelectasis of the dependent portions of the adjacent\nright and left lower lobes. A small calcified granuloma is seen in the right\nupper lobe. Diffuse bilateral subpleural predominant scarring is consistent\nwith chronic lung disease, appearing similar to chest CT from ___. \nThere is no evidence of focal or lobar lung consolidation.\n\nThe partially imaged solid and hollow viscous organs of the upper abdomen are\nunremarkable.\n\nMUSCULOSKELETAL:\nThere is moderate to severe degenerative change of the imaged thoracic spine,\nwith large anterior osteophytes and intervertebral vacuum disc phenomenon.  No\nconcerning focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. No evidence of pulmonary embolism.\n2. Moderate to severe mixed atherosclerotic disease of the thoracic aorta. No\nintramural hematoma or dissection. Stable 3.4 cm ascending aortic aneurysmal\ndilation.\n3. Large right and moderate left layering simple pleural effusions. No\nevidence of focal or lobar lung consolidation.\n4. Diffuse coronary artery and aortic and mitral valve calcifications."
        },
        {
            "input": "The heart is mildly enlarged.  Great vessels are unremarkable aside from\nmild-to-moderate atherosclerotic calcification which is mostly found along the\naorta arch.\n\nThere is no axillary, hilar, mediastinal lymphadenopathy.  Right epicardial\nnode was reported on the prior day.  Beyond those that were reported on the\nprior CT, this study does not demonstrate any further paraspinal masses. \nThere are trace pleural effusions bilaterally.  There is no pericardial\neffusion.\n\nEmphysema is mild. Mild atelectasis is found in the lingula as well as in each\nposterior basilar lower lobe.\n\nRegarding the upper abdomen, there has been no short-term change.\n\nThere are no suspicious bone lesions.",
            "output": "Mild emphysema.  Hyperinflation.  No additional concerning lesions in the\nchest are identified on the study beyond those that were reported yesterday."
        },
        {
            "input": "Thyroid gland is unremarkable.  Aorta and pulmonary arteries are within normal\nlimits.  Sub- carinal lymph node is a 9 mm.  No pathologically enlarged\nmediastinal hilar or axillary lymph nodes demonstrated.  Heart size is normal.\nNo pericardial pleural effusion is seen.  Image portion of the upper abdomen\nwill be reviewed separately as part of the CT abdomen corresponding report\nwill be issued\n\nAirways are patent to the subsegmental level bilaterally.  No pulmonary\nnodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease.\n\nPlease review separately issued report of CT abdomen and pelvis, obtained the\nsame day."
        },
        {
            "input": "CHEST: The thyroid gland is unremarkable.\n\nHeart size is normal without significant pericardial effusion.  There are\nsevere coronary artery calcifications versus stents.  There are overall mild\natherosclerotic calcifications along a a normal caliber thoracic aorta.  The\nmain pulmonary artery is normal caliber.\n\nThere is no supraclavicular, axillary, or mediastinal lymphadenopathy.  There\nis no gross hilar lymphadenopathy given confines of a noncontrast examination.\n\nThe central airways are patent.  There is overall mild dependent atelectasis\nbilaterally with platelike components in the bilateral lung bases.Lungs are\notherwise clear. No focal consolidation or suspicious nodularity is\nidentified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder gallstones in otherwise unremarkable decompressed\ngallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  There is no nephrolithiasis.  There is no perinephric\nabnormality.  8 mm hypodense lesion in the right interpolar kidney is too\nsmall to characterize, though is likely a cyst.  A punctate calcification\nwithin the right interpolar renal cortex is seen.  These findings appear\nunchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable, distended with ingested\nmaterial.  The duodenum and distal small bowel loops are normal caliber\nwithout evidence of obstruction.  There is diffuse colonic diverticulosis\nwithout associated inflammatory change.  The appendix is normal caliber,\ncontaining tiny appendicoliths, though without evidence of appendicitis. \nChanges from prior partial small bowel resection are seen in the low pelvis\nwith side-to-side anastomosis without obstruction.  There also changes from a\ndistal sigmoid partial resection with suture margin seen, without obstruction.\n\nPELVIS: The bladder wall appears slightly prominent, though improved compared\nto older prior examinations.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are seen within the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Thoracic cage is intact without acute fracture.  The thoracic vertebral\nbody heights and alignment are preserved.  Few thoracic Schmorl's nodes are\nseen.  No rib fracture is identified.  No suspicious focal bone lesion is\nseen.  Lumbar vertebral body heights are preserved.  There is grade 1\nanterolisthesis of L5 on S1, likely degenerative.  No pars defects are seen. \nScattered Schmorl's nodes are seen.  Lumbar vertebral body alignment is\notherwise preserved.  There are mild-to-moderate degenerative changes of the\nlower lumbar spine, including the facet joints.  There is transitional\nvertebral anatomy with partial lumbarization of S1.  The pelvic girdle and\nproximal bilateral femurs are intact.  There are mild bilateral hip joint\ndegenerative changes as well as of the bilateral SI joints.\n\nSOFT TISSUES: Re-identified is a large paraumbilical ventral abdominal wall\nhernia with fascial defect measuring up to 5 cm containing irritated fat along\nwith a portion of nonincarcerated transverse colon.  The hernia sac appears\neccentrically larger to the left.",
            "output": "1. No acute or traumatic findings within the chest, abdomen, or pelvis.\n2. No evidence of metastatic disease.\n3. Slight prominence of the bladder wall may reflect chronic outlet\nobstruction, though correlation with urinalysis is advised.\n4. Slight increase in size and prominence of a large paraumbilical ventral\nabdominal wall hernia containing irritated fat and a portion of\nnonincarcerated transverse colon.\n5. Cholelithiasis.\n6. Diverticulosis.\n\nRECOMMENDATION(S):  Urinalysis."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There is a large conglomerate nodal mass in in the right\naxilla measuring approximately 12.2 x 8.9 by 11.6 cm.  There is an area of\ndystrophic calcification within this mass and several areas of low-density\nwithin it.  There are additional multiple subcutaneous nodules scattered\nthroughout the anterior and posterior chest wall (201, 19, 29, 36, 87).\n\nMEDIASTINUM: There is severe coronary artery calcification.  There are no\nenlarged mediastinal hilar lymph nodes.  There is no pericardial effusion. \nThere is a small hiatus hernia.\n\n\nPLEURA: There are small bilateral pleural effusions right greater than left.\n\nLUNG: The multiple bilateral pulmonary nodules ranging in size from 4 mm to\n4.3 cm, the largest in the right lower lobe, concerning for metastasis.  There\nis a nodule in the lingula measuring 15 mm which abuts the pericardium.  There\nis minimal bibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows mild\nintrahepatic biliary ductal dilatation.  The multiple tiny hypodense liver\nlesions, too small to adequately characterize.  No adrenal masses are seen. \nMultiple hypodense lesions are also seen within the spleen.",
            "output": "Conglomerate nodal mass in the right axilla with area of dystrophic\ncalcification and low-density areas within it, concerning for metastasis.\n\nMultiple subcutaneous nodules seen bilaterally in both anterior posterior\nchest walls.\n\nMultiple pulmonary metastasis.\n\nSevere coronary artery calcification."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.  There is a\npatulous appearance of the esophagus.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is bilateral dependent atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen has a heterogeneous appearance, likely related to phase of\ncontrast, without evidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with food contents small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits.  The appendix is not\nvisualized, however, no secondary signs of appendicitis are present.  There is\nno evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Scattered mesenteric lymph nodes are seen in right lower\nquadrant, which are not enlarged by CT size criteria.  There is no\nretroperitoneal lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute intrathoracic or abdominopelvic injury."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan.  The heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  Minimal anterior mediastinal soft\ntissue density likely reflective of residual thymic tissue.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is a 3 mm perifissural nodule in the right upper lobe (4:\n485).  Lungs are clear without masses or areas of parenchymal opacification. \nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nUPPER ABDOMEN: Limited visualization of the upper abdomen demonstrates\nsubcentimeter hypodense lesions in the liver, too small to characterize but\nlikely represents biliary hamartomas or cysts (3; 69, 78).  Status post\ncholecystectomy.",
            "output": "1. No evidence of acute intrathoracic or intraabdominal injury within the\nlimitation of an unenhanced scan.\n2. 3mm right upper lobe perifissural pulmonary nodule.  See below for\n___ criteria.\n\nRECOMMENDATION(S):\n For incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is unremarkable.  Axillary lymph nodes measure up to 0.7 cm on the\nright, not pathologically enlarged.  There is no supraclavicular adenopathy. \nThere are mildly enlarged mediastinal lymph nodes with the largest measuring\nup to 1.3 cm in the lower pretracheal station.\n\nHeart size is mildly enlarged.  Coronary artery calcifications are severe. \nAortic valvular calcifications are mild.  The main pulmonary trunk is not\ndilated.  There is no thoracic aortic aneurysm.  There is mild atherosclerotic\ndisease.\n\nThe airways are patent to the subsegmental level bilaterally.  There is\ndiffuse ___ opacity involving the primarily bilateral upper and right\nmiddle lobes.  More nodular opacity is noted at the left lung apex measuring\n0.7 cm, the right middle lobe measuring 0.5 cm, as well pleural based right\nmiddle lobe, that appears triangular in configuration on coronal images and\nmeasures 1.8 cm (series 302, image 46, 165). There are small right greater\nthan left pleural effusions with associated atelectasis.\n\nThe thoracic esophagus is unremarkable.  Limited views of the upper abdomen\ndemonstrate partially imaged hypodense lesions within the pancreas.  The\nlargest measuring 2.4 cm in the pancreatic body.\n\nThere is no aggressive bony lesion.  There is a well-circumscribed sclerotic\nlesion in the posterior right second rib which most likely represents a bone\nisland..  There is multilevel degenerative change of the thoracic spine. \nThere is no superficial soft tissue abnormality.",
            "output": "1. Diffuse ___ lung opacities most pronounced in the bilateral upper\nlobes and right middle lobe, this pattern of findings can be seen in infection\nincluding atypical infections as well as aspiration.\n2. More nodular opacity noted in the right middle lobe measuring 1.7 cm, with\na wedge-shaped appearance on coronal imaging, possibly scarring versus\natelectasis versus is an additional focus of infection.  However, the clinical\nhistory of suspected malignancy, short-term imaging follow-up is recommended\nto evaluate for resolution/stability.\n3. Small right greater than left pleural effusions.\n4. Multiple pancreatic cystic lesions are incompletely characterized. \nRecommend nonemergent MRCP for further assessment.\n\nRECOMMENDATION(S):\n1. Short-term chest CT follow-up.\n2. MRCP to further evaluate pancreatic cystic lesions.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:20 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is mildly calcified and is normal\nin caliber.  The heart is mildly enlarged.  There are severe coronary artery\ncalcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: A partially calcified 1.4 cm subcarinal lymph\nnode is not significantly changed.  1.3 cm right lower paratracheal lymph node\nis not significantly changed.  Other scattered smaller mediastinal lymph nodes\nare not significantly changed.  No axillary lymphadenopathy is present.  No\ngross hilar lymphadenopathy given confines of a noncontrast exam.  No\nmediastinal mass or hematoma.\n\nPLEURAL SPACES: There are small bilateral pleural effusions, right greater\nthan left, not significantly changed.  No pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse ___ opacities, worst in the bilateral upper\nlobes and right middle lobe, are not significantly changed.  Scattered more\nnodular opacities throughout the lungs are not significantly changed.  There\nis atelectasis at the lung bases.  No new focal consolidation.  The airways\nare patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Multiple pancreatic hypodense lesions rib previously characterized as\nlikely IPMNs on MRCP.  A punctate calcification in the spleen likely\nrepresents a calcified granuloma.  Included portion of the unenhanced upper\nabdomen is otherwise unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No significant change in diffuse ___ opacities and scattered\nadditional more nodular opacities throughout the bilateral lungs.  No new\nconsolidation.  Differential diagnosis again includes atypical infection and\naspiration.\n2. Unchanged mild mediastinal lymphadenopathy, likely reactive.\n3. Small bilateral pleural effusions, right greater than left, and adjacent\natelectasis, similar to prior.\n4. Several cystic pancreatic lesions are again seen, characterized on the\nrecent MRCP.\n\nRECOMMENDATION(S):  Short-term interval chest CT follow-up."
        },
        {
            "input": "Numerous small axillary and possible supraclavicular lymph nodes are not\npathologically enlarged.  Patient has had bilateral mammary implants.  The\nbreasts are not evaluated by this study.  There are no soft tissue\nabnormalities in the imaged portion of the chest wall.\n\nThis study is not intended for subdiaphragmatic diagnosis, but shows\nsubstantial thickening of the gastric wall increased since abdomen CT on\n___.  The conglomerate of pancreatic body and tail and small intestine\nis bulky, but unchanged since that abdomen CT which did not characterize them\nas abnormal.\n\nThere is no adrenal mass.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent head\nneck vessels or coronary arteries.  Aorta and pulmonary arteries are normal\nsize.\n\nSmall pericardial effusion is slightly larger compared to ___, but\nprobably physiologic.  There is no pleural effusion.\n\nThoracic lymph nodes:\n\nMeasurable mediastinal and lymph nodes elsewhere in the mediastinum are not\nenlarged and hilar contours on this noncontrast study do not suggest\nadenopathy.\n\nLungs and airways:\n\nSite of wedge resection at the base of the left lung has a normal\npostoperative appearance.  Lungs elsewhere are clear.\n\nTracheobronchial tree is normal to subsegmental levels.\n\nChest cage:\n\n Although there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nNew gastric wall thickening, best evaluated by gastroscopy."
        },
        {
            "input": "There is mild atherosclerotic plaque along the descending thoracic aorta,\nwithout penetrating atherosclerotic ulcer or dissection. The pulmonary\narteries enhance to the subsegmental level without filling defect to suggest\npulmonary embolism.  The remaining great vessels are normal appearance.\n\nThe heart is normal in size. There is a small to moderate pericardial effusion\nwith minimal pericardial enhancement, which may be a function of recent\npericardiocentesis. Small locule of air in the pericardium is likely\npostsurgical (2:72).\n\nMediastinal lymph nodes are present at the upper and lower paratracheal\nstations, as well as the right prevascular station, but not pathologically\nenlarged. There is no hilar lymphadenopathy.\n\nThere is interlobular septal thickening throughout the left upper lobe,\nlingula and left lower lobe, suggesting lymphangitic tumor spread, given the\nknown malignancy. There are consolidation in the lingula and in the left lower\nlobe. There is a moderate nonhemorrhagic left pleural effusion without\nevidence for pleural enhancement. Trace right pleural effusion is seen. There\nis mild atelectasis at the right lung base.  There is moderate underlying\ncentrilobular emphysema with upper zone predominance.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1. No evidence of pulmonary embolism or acute aortic pathology.\n2. Diffuse interlobular septal thickening in the left lung suggests\nlymphangitic spread of tumor.\n3. Consolidations in the lingula and left lower lobe are nonspecific but\ncorrespond to the known tumor, though superimposed infection is not excluded.\n4. Moderate left pleural effusion.\n5. Small to moderate pericardial effusion with minimal pericardial\nenhancement, possibly secondary to the recent pericardiocentesis. Small locule\nof air in the pericardium is also likely postsurgical.\n\nRECOMMENDATION(S):  Comparison to any outside prior studies would be helpful\nto assess for tumor progression.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 2:33 AM, immediately after discovery of the\nfindings."
        },
        {
            "input": "The thyroid gland is unremarkable.  Small mediastinal lymph nodes are similar\nin size and number to the study of 5 days prior.  A 6 mm short axis\nprevascular lymph node is stable (2, 22). There is no new pathologic lymph\nnode enlargement.\n\nA left PICC line terminates at the superior cavoatrial junction.  The patient\nhas had interval drainage procedures with slight decrease of the small to\nmoderate nonhemorrhagic pericardial effusion, and resolution of previous\npostprocedural pneumopericardium.  Moderate coronary artery calcifications\npredominantly involve the left anterior descending coronary artery.  The main\npulmonary artery is normal caliber. The ascending thoracic aorta is mildly\ndilated to 4.0 cm, unchanged.\n\nThe moderate left nonhemorrhagic pleural effusion has decreased following\nthoracentesis. Left lower lobe aeration has also improved.\n\nA dominant mass is not identified, however extensive diffuse bronchial wall\nthickening with infiltration of the left hilus is likely malignant.  Superior\nsegment left lower lobe and inferior lingular consolidations may be due to\ntumor infiltration and/or pneumonia.  The suspicion for malignant infiltration\nis higher with regard to the inferior lingular consolidation, which bulges the\nmajor fissure (4, 124).  Stable nodular thickening of the visceral pleura\nposteriorly is worrisome for pleural metastases (4,66).   The thickness of the\ndiffusely thickened left upper lobe interlobular septa has decreased, \nreflected improved lymphatic drainage through the left hilus despite likely\nlymphangitic metastasis. Nodular thickening of the left major fissure is\nunchanged.\n\nCentral airways are patent.  The nonphysiologic elongated \"saber\" shape of the\ntrachea is  associated with tracheomalacia.  There are scant   secretions in\nthe proximal right main bronchus.  Mild to moderate diffuse bronchial wall\nthickening with focal right lower lobe bronchial impaction is unchanged. \nMinimal dependent atelectasis at the right lung base and moderate upper lobe\npredominant centrilobular emphysema are unchanged.\n\nUnenhanced images of the upper abdomen show a large gallstone within the\npartially imaged gallbladder.\n\nThoracic spine degenerative changes are extensive. There are no bone lesions\nin the thorax worrisome for infection or malignancy.",
            "output": "Decreased small to moderate nonhemorrhagic pericardial effusion following\npericardiocentesis.\n\nDecreased moderate malignant left pleural effusion following thoracentesis\nwith improved aeration of the left lower lobe and evidence of improve\nlymphatic drainage.  Suspected left pleural metastases are unchanged.\n\nUnchanged superior segment left lower lobe and inferior lingular\nconsolidations, which may be due to tumor infiltration and/or pneumonia. \nStable findings worrisome for lymphangitic spread of metastasis.  No dominant\nmass identified, although diffuse left upper lobe bronchial wall thickening\nextending to the left hilus is likely due to tumor infiltration.\n\nStable moderate upper lobe predominant centrilobular emphysema.\n\nCholelithiasis."
        },
        {
            "input": "The thyroid gland appears homogeneous in attenuation without a focal lesion\nidentified.  There is no axillary, supraclavicular, mediastinal, or hilar\nadenopathy.\n\nA right chest port terminates within the right atrium.  The ascending aorta is\nnon aneurysmal.  The main pulmonary artery is within normal limits in caliber.\nExtensive atherosclerotic calcifications involve the coronary arteries. \nModerate calcifications involve the aortic valve and lateral aortic arch. \nThere is a small pericardial effusion.  Heart size is normal.  There is no\nesophageal abnormality.\n\nSecretions are noted within the main airway.  Airways are otherwise patent. \nIn the left lower lobe there is a 5.1 x 3.9 cm mass that has increased in size\npreviously measuring 3.0 x 1.2 cm.  There is atelectasis in the left upper\nlobe.  .  A left PleurX catheter is identified with extensive air within the\npleural space.  What appears to be loculated fluid and pleural thickening is\nnoted.\n\nAir is identified under the right diaphragm hepatic surface consistent with\npneumoperitoneum.  The diaphragm appears grossly intact.  Subcutaneous\nemphysema in is present about the left pleural catheter.\n\nOsseous structures are without worrisome lesions for malignancy or infection.",
            "output": "1.  Left PleurX catheter with extensive subcutaneous tissue emphysema and\npersistent large amount of air within the left pleural space with probably in\npart to loculated fluid.\n2.  Increase in size in the left lower lobe mass to 5.1 cm as described above.\nThere is atelectasis in the left upper lobe.\n3.  Pneumoperitoneum without diaphragmatic injury.\n4.  Coronary artery calcifications predominantly involve the left anterior\ndescending coronary artery.\n\n\n\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 11:51 ___, 5 minutes after discovery of\nthe findings.\n The revised findings were discussed by Dr. ___ with Dr. ___ on\nthe ___ ___ at 11:21 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There is\nmild cardiomegaly.  There is moderate calcifications of the aortic valve and\nsevere calcifications of the coronary arteries.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild dependent atelectasis in both lungs.  There is no\ndiscrete nodule consolidation.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same day\nfor subdiaphragmatic findings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No infectious source in the thorax.\n2. Please refer to same day CT abdomen and pelvis for subdiaphragmatic\nfindings."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Supraclavicular and axillary nodes\nare not pathologically enlarged by size criteria.  Thyroid gland and chest\nwall are within normal limits.\n\nUPPER ABDOMEN: Liver is diffusely hypoattenuating, suggestive of hepatic\nsteatosis (3:56).  A simple cyst in the left lobe of the liver measures 24 mm.\n\nMEDIASTINUM: Mediastinal nodes are sub cm in size.\n\nHILA: No evidence of hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size, without a pericardial\neffusion.  No appreciable coronary calcifications.\n\nPLEURA: Pleural surfaces are smooth, without effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Linear opacities in the lingula may represent atelectasis or\nchronic scarring.  No consolidation concerning for pneumonia. There is a 6 mm\nground-glass nodule in the medial right lower lobe (5:146).\n2. AIRWAYS:  Diffuse bronchial wall thickening is mild, and likely reflects\nchronic small airways inflammation.\n3. VESSELS:  Thoracic aorta and pulmonary arteries are normal in caliber.\nCHEST CAGE: No suspicious lytic or sclerotic lesions identified.",
            "output": "1. No evidence of residual pneumonia or focal bronchial abnormality in the\nright middle lobe.\n2. Incidental 6 mm ground-glass nodule in the right lower lobe.  A follow-up\nchest CT is recommended in ___ year to evaluate stability.\n3. Hepatic steatosis.\n\nRECOMMENDATION(S):  Chest CT in ___ year."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is a part solid 4 mm nodule in the right lower lobe (5, 141). \nThere is a 1 mm nodule in the right upper lobe (5, 121).\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: There is a hypodense lesion in the left lobe of liver which\ncould represent a cyst.",
            "output": "4 mm part solid nodule in the right lower lobe.  1 mm solid nodule in the\nright upper lobe\n\nSix-month follow-up may be helpful\n\nRECOMMENDATION(S):  For an incidentally detected single ground-glass nodule\nsmaller than 6mm, no CT follow-up is recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable.  No\nsupraclavicular lymphadenopathy.  No axillary lymphadenopathy.\n\nUPPER ABDOMEN: Limited view of the upper abdomen is noted for hepatic\nsteatosis.  There is a 2.5 cm cyst in the left lobe of the liver.  Additional\nsubcentimeter hypodense lesion in the left lobe of the liver is too small to\ncharacterize, but also likely represents a simple cyst or biliary hamartoma.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy within limitations of an unenhanced scan.\n\nHEART and PERICARDIUM: Heart size is normal.  There are mild coronary artery\ncalcifications.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Lungs are clear.  There is a 6 mm ground-glass nodule in the\nright lower lobe,, unchanged since ___ (4:119).  Additional 6 mm ground-glass\nnodule in the right upper lobe is also unchanged from ___ (04:58).  No new or\ngrowing pulmonary nodules.\n2. AIRWAYS:  Airways are patent to subsegmental levels bilaterally.  There is\nmild diffuse bronchial wall thickening\n3. VESSELS:  Thoracic aorta and main pulmonary artery are of normal caliber. \nThere is minimal atherosclerotic calcification of the aortic arch.\nCHEST CAGE: No worrisome osseous lesions.",
            "output": "1. Stable ground-glass nodules in the right upper lobe and right lower lobe. \nGiven stability since ___, follow-up CT in 2 in ___ years can be\nconsidered per ___ criteria for multiple sub solid nodules.\n2. Hepatic steatosis."
        },
        {
            "input": "HEART AND VASCULATURE: Respiratory motion makes assessment of the segmental\nand subsegmental pulmonary arterial branches suboptimal given this, evidence\nof a central pulmonary embolism is seen.  No gross aortic dissection is seen. \nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is suboptimal assessment of the pulmonary parenchyma due\nto respiratory motion.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe imaged thyroid gland appears homogeneous.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates that the\npartially imaged liver appears hypodense, possibly related to fatty\ninfiltration.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nEvidence of DISH is seen along the thoracic spine.",
            "output": "Suboptimal assessment of the segmental and subsegmental pulmonary arterial\nbranches bilaterally due to respiratory motion.  Given this, no central\npulmonary embolism seen.\n\nAssessment of the pulmonary parenchyma is suboptimal due to respiratory\nmotion.  Given this, lingular atelectasis is seen."
        },
        {
            "input": "BASE OF NECK: Thyroid is unremarkable.  No supraclavicular lymphadenopathy is\nidentified.\n\nHEART AND VASCULATURE:  The thoracic aorta contains dense atherosclerotic\ncalcifications though is normal in caliber.  Moderate to severe coronary\nartery calcifications are otherwise the heart, pericardium, and great vessels\nare within normal limits based on an unenhanced scan. No pericardial effusion\nis seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Multiple nonenlarged mediastinal lymph nodes\nare visualized.  No hilar or axillary lymphadenopathy is demonstrated.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse, upper lobe predominant, centrilobular emphysematous\nchanges are visualized throughout.  Biapical scarring is re-demonstrated and\nunchanged.  In the basilar portion of the right middle lobe a 1.6 x 0.8 cm\n(5:213) pulmonary nodule is re-demonstrated, with increased spiculated margins\nand mildly increased in size, previously measuring 1.2 cm.  Additionally there\nis a 6 mm perifissural opacity in the superior aspect of the right lower lobe\n(5:128) that was not definitively visualized previously though thin-section\nimages were not provided from previous study.\n\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: The bones are diffusely osteopenic throughout without focal suspicious\nosseous abnormality or acute fracture demonstrated.",
            "output": "1. Mild interval increase in size of right middle lobe pulmonary nodule\nincrease in spiculated features for which short-term follow-up CT or PET-CT\nevaluation is recommended.\n2. Right lower lobe perifissural opacity measuring 6 mm, not definitively\nvisualized on prior study given differences in technique.\n\nRECOMMENDATION(S):\n1. Recommend 3 month short-term follow-up CT or PET-CT evaluation for\nspiculated right middle lobe pulmonary nodule.\n2. Recommend thoracic surgery consultation.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 11:49 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal, with extensive atherosclerotic\ncalcification.\n\nPULMONARY PARENCHYMA:  The patient is status post ablation of a right middle\nlobe nodule.  Consolidation at the ablation site measures 3.5 x 3.9 cm,\npreviously 4.1 x 5.3 cm.  No new nodules are demonstrated.  There is mild\nright lower lobe atelectasis, improved from prior.  There is severe, upper\nlobe predominant emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion.  There\nis levoscoliosis of the thoracic spine and increased AP diameter of the chest,\nsimilar to prior.  Multilevel degenerative changes are moderate.  Healed\nfractures of the left anterior fourth through sixth ribs are re-demonstrated.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Decreased consolidation at the ablation site.  Continued follow-up is\nrecommended.\n2. No new or enlarging nodules are demonstrated.\n3. Severe emphysema."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the chest wall.  This study is not designed for\nsubdiaphragmatic diagnosis, but shows heavy calcification normal caliber upper\nabdominal aorta and upper splanchnic vessels.\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis heavy in head and neck vessels, normal caliber ascending thoracic aorta and\nextensively in the coronary arteries.  Pulmonary artery and cardiac chambers\nare normal size.  Small pericardial effusion changed in distribution but not\nin size since ___.\n\nTHORACIC LYMPH NODES: 12 mm wide right posterior paraesophageal lymph nodes\nare stable.  No other lymph nodes in the chest are pathologically enlarged or\ngrowing.\n\nLUNGS, AIRWAYS, PLEURAE: Emphysema is moderate to severe in the lung apices,\nmilder elsewhere.  Right pleuroparenchymal apical and right lower lobe\nsuperior segmental scarring is stable.\n\nSoft tissue at the target of right middle lobe ablation, 18 x 37 mm was 35 x\n39 mm in ___.  Adjacent pleura is mildly retracted and thickened, but\nthere is no pleural effusion or remote pleural nodulation.\n\nLeft lung is clear of any focal abnormalities.\n\nCHEST CAGE: Moderate to the kyphoscoliosis is degenerative.  Despite large\nscale demineralization there are no compression or pathologic fractures and no\ndiscrete destructive bone lesions.",
            "output": "Expected appearance, maturing ablation site, right middle lobe.  No evidence\nof recurrence or new intrathoracic malignancy.\n\nSevere emphysema.\n\nHeavy atherosclerotic calcification, head and neck and coronary and upper\nsplanchnic arteries."
        },
        {
            "input": "HEART AND VASCULATURE:  The heart and left atrium are enlarged and contrast\nreflux into the IVC and hepatic veins (4:224). Aortic annular, coronary\nartery, and aortic arch calcifications are moderate.  A left chest dual lead\npacemaker appears unchanged.  No pericardial effusion.  No central or\nsegmental pulmonary embolism.\n AXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present\nalthough assessment of the left axilla is limited by streak artifact from\npacemaker.\n\nBorderline lymph nodes may be reactive: A left hilar lymph node is top-normal\nin size measuring 10 mm in short axis (4:116) and a subcarinal lymph node\nmeasures 10 mm in short axis (04:14).   PLEURAL SPACES: A right-sided chest\ntube enters the thorax just superior to the lateral eighth rib which traverses\nthe effusion and terminates in the medial apex in an area without effusion. \nBilateral moderate pleural effusions are loculated with extensive fissural\ncomponents (6:78, 6:77, 4:60).   No pneumothorax.\n\nLUNGS/AIRWAYS: Retained secretions are prominent the right base (4:157, 4:154)\nwithout obvious mucous plugging or obstruction.  Bronchiectasis and bronchial\nwall thickening is severe in both lung bases.\n\nSubstantial volume loss and a consolidation with air bronchograms is present a\nthe right lung base (4:182, 4:164, 4:171, 6:71).  Left basilar atelectasis\nadjacent to the pleural effusion is mild.  A nodular consolidation at the left\nbase abuts the pleura and contains high density material (4:174, 6:4). \nInterseptal lobular thickening is diffuse with basilar dependent predominance.\n\nBASE OF NECK:  The thyroid is normal Visualized portions of the base of the\nneck show no abnormality.\n\nABDOMEN:  This examination is not tailored for subdiaphragmatic evaluation.\nWithin these limits, other than atherosclerotic disease, the visualized\nportion of the upper abdomen is unremarkable.\n\nBONES:  Mixed lytic and sclerotic region with thickened trabeculae in the T10\nvertebral body involves the posterior elements likely represents a hemangioma\nalthough somewhat atypical (4:175, 7:62). No pathologic fracture.  Sclerotic\nfoci in the T9 and T5 vertebral bodies are consistent with a bone islands.\n\nSOFT TISSUES:  No right chest wall abnormality specifically no abnormality\nadjacent to the chest tube insertion site.",
            "output": "1. No right chest wall abnormality to explain the patient's symptoms.\n2. Despite chest tube, persistent moderate loculated pleural effusions with\nsubstantial fissural components.\n3. Right basilar consolidation could represent aspiration or pneumonia in the\nright clinical setting, or combination of atelectasis and malignancy.\n4. Left basilar opacity with high density material could be previously\naspirated barium or calcified malignancy.\n5. Findings concerning for right heart failure.\n\nNOTIFICATION:  The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 2:25 ___, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Left prepectoral dual lumen\ncatheter in situ with the tips at the cavoatrial junction AND proximal right\natrium.  The left brachiocephalic vein is collapsed surrounding the catheter\nsuggesting venous sclerosis.  Prominent collaterals in the left chest wall. \nNo suspicious thyroid lesions.  Multiple subcentimeter right supraclavicular,\nright axillary and right lateral chest wall lymph nodes.  Subcutaneous\nedematous stranding in keeping with third-spacing of fluid.  Moderate\ngynecomastia.\n\nUPPER ABDOMEN: Will be reported separately.\n\nMEDIASTINUM: Subcentimeter (reactive) mediastinal lymph nodes.\n\nHILA: No significant hilar adenopathy\n\nHEART and PERICARDIUM: Cardiomegaly.  Small to moderate pericardial effusion\nmeasuring 12 mm adjacent to the right ventricle.  Mild enhancement of the\nvisceral and parietal pericardium.  Mild mitral annular calcification. \nModerate aortic valve calcification.  Moderate coronary artery calcification. \nNo aneurysmal dilatation of the ascending aorta.  Moderate to severe calcific\natherosclerotic changes of the intrathoracic aorta and supra-aortic arteries.\nPLEURA: Moderate left-sided pleural effusion.  Small to moderate right-sided\npleural effusion.  Mild enhancement of the right right pleura suggesting\nlongstanding nature or secondary infection.  A couple of air locules noted in\nthe right pleural space (2, 27).  Correlation with clinical history should be\nperformed if the patient had a right thoracocentesis, if not this may suggest\nsecondary infection.\nLUNG:\n\n1. PARENCHYMA:  Motion artifact obscures the lung for small pulmonary nodules\nand fine interstitial changes.  Interstitial septal thickening with associated\nground-glass opacification with a dependent distribution suggesting moderate\npulmonary edema.  Complete atelectasis of the left lower lobe and the\nposterior and medial basal segments of the right lower lobe.  No CT features\nof pneumonia.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary artery is dilated and pulmonary hypertension should\nbe excluded.  A prominent pulmonary artery may also be seen as a normal\nfinding in this patient population.  No filling defects on this nondedicated\nstudy.\nCHEST CAGE: Spondylotic changes of the thoracic spine.  No lytic/destructive\nbony lesions.",
            "output": "Complete atelectasis of the left lower lobe and collapse of the medial and\nposterior basal segments of the right lower lobe with a moderate left-sided\npleural effusion and small to moderate right-sided pleural effusion.  There is\nmild enhancement of the right parietal pleura with a few associated air\nlocules and this may be reactive secondary to prior right thoracocentesis, but\nin the absence of this it may represent secondary infection (empyema).\n\nNo CT features of pneumonia.\n\nCardiomegaly. Moderate pulmonary edema. Moderate pericardial effusion (which\nshows mild pericardial enhancement).  Moderate aortic valve calcifications\nsuggesting aortic stenosis.\n\nMultiple subcentimeter right supraclavicular, axillary and right lateral chest\nwall lymph nodes which are indeterminate.  This could be reassessed with\nultrasound post treatment of the acute illness.\n\nSubcutaneous stranding in keeping with third-spacing of fluid.\n\nFor abdominal findings please refer to CT abdomen report."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  Multiple enlarged prevascular and central\nmediastinal and hilar lymph nodes are again seen, slightly increased since the\nprior study from ___, including a 12 mm right upper paratracheal lymph node\n(02:13) which was 9 mm previously. An AP window node is 21 x 16 mm (02:19),\npreviously 20 x 13 mm.  The aorta and pulmonary arteries are normal in size. \nThe heart is top-normal in size, with a small pericardial effusion (02:35),\nsimilar in extent compared to the prior study. The overall heart size is\ntop-normal. Minimal Coronary artery atherosclerotic calcifications are noted\n(02:30). The esophageal wall is thickened, and the esophagus itself is\npatulous, with retained ingested material (04:153). An 11 x 20 mm\nparaesophageal lymph node (4:170) was 10 x 18 mm previously.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent to the subsegmental  There is no airspace\nconsolidation.  A focal area of scarring in the right lower lobe from prior\nbiopsy (4:100) is unchanged.  Diffuse subtle heterogeneous aeration of the\nbilateral upper and lower lobes, as well as mild diffuse bronchial wall\nthickening likely reflects the sequelae of small airways disease. There are a\nnumber of incidentally noted pulmonary nodules as follows:  3 mm left upper\nlobe (04:24), 4 mm right upper lobe (04:26), 4 mm bilateral upper lobe nodules\n(4:94). A 3 mm left upper lobe nodule (4:97), and adjacent 4 mm nodules along\nthe oblique fissure in the left upper lobe (04:102) are also noted.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Although the study is not designed for evaluation of\nsubdiaphragmatic structures, cholecystectomy clips are noted and splenic\nartery calcifications are noted. Otherwise, the imaged upper abdomen is\nunremarkable.",
            "output": "1. Mild progression of sequelae of known scleroderma, including chronic\ninflammatory small airways disease, esophageal dysmotility, small pericardial\neffusion, and mediastinal lymphadenopathy.\n2. Multiple bilateral pulmonary nodules range up to 4 mm in diameter, many of\nwhich are new since the prior CT from ___. Follow-up imaging is recommended\nin 12 months."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. Numerous axillary lymph nodes are not\nenlarged by size criteria. Small mediastinal lymph nodes are again seen, none\nlarger than the 5 mm right upper paratracheal node (4:14). The heart is normal\nin size and there is no pericardial effusion. The aorta and main pulmonary\nartery are normal in caliber.The abdominal and pelvic findings will be\nreported in a separate report.\n\nLungs:The airways are patent to the subsegmental level bilaterally. No large\nconsolidation, mass, or pneumothorax. Aside from the isolated left upper lobe\ngranuloma, no pulmonary nodules or masses are seen. Bibasilar dependent\natelectasis is noted, likely secondary to poor inspiratory level.\n\nBones:No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "No evidence of active intrathoracic infection or malignancy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes at the level of the\nmediastinum.  A pre-existing borderline sized lymph node in para-aortic\nlocation (4, 18) is unchanged in size and morphology.  Unchanged mild coronary\ncalcifications.  Normal size of the heart.  No no pericardial effusion.  No\nvascular abnormalities.  Normal appearance of the posterior mediastinum, with\nthe exception of a small hiatal hernia.  No osteolytic lesions at the level of\nthe ribs, the sternum and the vertebral bodies.  Minimal apical scarring.  No\nevidence of diffuse lung disease.  On today's examination, a subpleural right\nlower lobe nodule, with a diameter of 8 x 8 mm (6, 119) is visualized.  In\nretrospect, this nodule was visible on the previous exam, but was much\nsmaller.  No other suspicious lesions.  Mild motion are defects at the lower\nlobe level.  The airways are patent.  No pleural effusions, no pleural\nthickening.",
            "output": "A 8 mm right lower lobe nodule is highly suspicious for metastatic disease to\nthe lung.  A borderline sized para-aortic lymph node is unchanged."
        },
        {
            "input": "The thyroid is normal. There are no pathologically enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes.\n\nThe aorta is normal in size.  The main pulmonary artery is dilated to 3.3 cm,\nsimilar to prior.  The right pulmonary artery is normal in caliber.  The heart\nis normal in size and demonstrates no appreciable coronary artery\ncalcifications. There is no pericardial effusion.\n\nNo pneumothorax or pleural effusion is identified. The airways are patent to\nthe subsegmental level.  Patient is status post right lower lobe wedge\nresection, with unchanged postoperative appearance of the right hemithorax.  A\n3 mm right middle lobe nodule is stable since at least ___.  There are\nno new pulmonary nodules.  There are scattered calcified granulomas.\n\nNo osseous lesions suspicious for infection or malignancy are identified.\n\n Please see separate dictation for CT abdomen and pelvis performed on same day\nfor description of subdiaphragmatic findings.",
            "output": "1. No evidence of recurrent or new metastatic disease in the thorax.\n2. Please see separate dictation for CT abdomen and pelvis performed on same\nday for description of subdiaphragmatic findings."
        },
        {
            "input": "There is significant motion artifact through the ascending aorta.  The aorta\nand its major branch vessels are patent, with no evidence of stenosis,\nocclusion, dissection, or aneurysmal formation.  There is no evidence of\npenetrating atherosclerotic ulcer or aortic arch atheroma present. Coronary\nartery calcifications.\n\nThe study is mildly limited by breathing artifacts.  The pulmonary arteries\nare well opacified to the segmental level, with no evidence of filling defect\nwithin the main, right, left, lobar or segmental  pulmonary arteries.  The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.  A right internal jugular central line\nis noted with its tip at the ___-RA junction.\n\nThere is no evidence of pericardial effusion.  Trace right pleural effusion.\n\nThere is subsegmental atelectasis in the lower lobes bilaterally as well as\nthe lingula.  Component of infiltrate in the left lower lobe is unlikely,\ncannot be excluded.  The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrates a partially visualized TIPS. \nThere is small amount of free fluid in the upper abdomen, minimally progressed\nsince prior CT of the abdomen dated ___.  Poor flow seen in the\nsuboptimally seen distal right portal vein, as seen on preoperative exam CT\nabdomen pelvis ___.  There is heterogeneous attenuation of the\nhepatic parenchyma, likely perfusion related.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nMild thickening and enlargement of the right posterolateral chest wall\nmusculature, compatible with a small intramuscular hematoma stable since prior\nCT dated ___, likely related to recent intervention.",
            "output": "1.  Slightly limited study by breathing artifacts.  No evidence of pulmonary\nembolism to the segmental levels bilaterally.\n\n2.  Bibasilar atelectasis and trace right pleural effusion.  Component of\ninfiltrate in the left lower lobe is unlikely, cannot be excluded."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  The main and\nright pulmonary arteries are normal in caliber, and there is no evidence of\nright heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nA 9 mm hypodense right thyroid nodule is identified (2:6).\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is consolidation of the left lingula (2:68), as well as the right middle\nlobe (2:76) which may be due to atelectasis.  However, infection is not\nexcluded.  In the left upper lobe, there is a 7 mm rounded nodule with\nsurrounding ground-glass opacity, spanning a total of approximately 1.5 cm\n(601b:23, 2:47).  A 8 mm left perifissural nodule (2:50) and a right 7 mm\nperifissural nodule (2:40) are also identified (2:58).  In addition, multiple\nperifissural nodules are identified along the left major fissure (601b:35,\n2:54).  Left lower lobe atelectasis is also present.  Mucous plugging/debris\nand distal opacification of a right upper lobe segmental bronchus correlates\nwith the right upper lung nodular opacity identified on the earlier chest\nradiograph (2:34-36).  Mucus plugging is also identified in the right lower\nlobe (2:72).\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism.\n\n2.  Consolidation of the left lingula and the right middle lobe may be due to\natelectasis or infectious process, such as pneumonia in the correct clinical\nsetting.\n\n3.  7 mm rounded nodule in the left upper lobe with surrounding ground-glass\nopacity.  In total, this area spans approximately 1.5 cm.  Multiple\nperifissural nodules are also identified along the left major fissure, in a\nperilymphatic distribution.  Differential for this includes lymphangitic\nspread of malignancy, sarcoidosis, and silicosis.\n\n4.  8 mm left perifissural and 7 mm right perifissural nodules are also\nidentified.  By ___ society guidelines, followup CT should be performed\nat ___ months if the patient is low risk for malignancy and at ___ months if\nhigh risk for malignancy (history of smoking).\n\n5.  Mucous plugging or debris within a right upper lobe segmental bronchus and\nright lower lobe segmental bronchus are identified.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 14:35 on ___."
        },
        {
            "input": "An 8 mm right thyroid nodule is unchanged (3:8).  A left upper paratracheal\nnode measures 6 mm in short axis (03:19), present previously and stable.  A\nprevascular station node measures 4 mm, minimally decreased in size previously\n5 mm in size (03:26).  A subcarinal node is decreased in size currently 7 mm\nin short axis and previously 12 mm (___:27).  Evaluation for hilar adenopathy\nis limited in the absence of intravenous contrast.  However, hilar contours\nappear unchanged.\n\nHeart size is within normal limits.  Coronary artery calcifications are\nmoderate most pronounced within the left anterior descending coronary artery. \nTrace pericardial fluid is physiologic.  The ascending aorta is non\naneurysmal.  The main pulmonary artery is within normal limits in caliber. \nCoarse atherosclerotic calcifications involve the descending aorta\nposteriorly.  There is no esophageal abnormality.\n\nThe trachea is patent and without an endobronchial lesion.  Bronchiectasis,\nmucoid impaction  and peribronchiolar nodules are most severe involving the\nright middle lobe and lingula although is additionally present within the\nright upper lobe, left upper lobe posteriorly, and right lower lobe\nanteriorly.  Findings are associated with consolidation involving the\nposterior and inferior aspect of the left upper lobe along the major fissure\nas well as within the right middle lobe anteriorly.  A previously 6 mm nodule\nwithin the left upper lobe anteriorly is decreased in size currently 4 mm in\nsize (5:172) with resolution of the  associated ground-glass opacity seen on\nmost recent CT.  No new lung nodule or consolidation is identified.  A\ncalcified nodule within the left lower lobe is most consistent with a\ncalcified granuloma (___).  There is no pleural effusion or abnormality.\n\nNo lytic or sclerotic osseous lesion worrisome for malignancy or infection is\nidentified.\n\nAlthough study is not tailored for subdiaphragmatic evaluation, the imaged\nupper abdomen demonstrates extensive atherosclerotic calcifications which\ninvolve the abdominal vasculature including the splenic artery and common\nhepatic artery.",
            "output": "1.  Bronchiectasis, mucoid impaction, and peribronchiolar nodules involves the\nright middle lobe, right lower lobe, and lingula most severely.  Infectious\nprocess by a nontuberculous mycobacterium such as ___ is suspected though\nfindings can be seen in patients with ABPA for which further diagnostic workup\nis warranted.\n2. Previously described nodule within the left upper lobe is smaller and\nassociated ground-glass opacity no longer present to suggest resolution of\nprior active infection.\n3.  Central adenopathy is marginally decreased in size and likely reactive in\netiology."
        },
        {
            "input": "Imaged thyroid gland appears normal.  The thoracic aorta is mildly calcified\nand normal in caliber along the ascending and proximal to mid descending\nsegments.  However, at the level of the hiatus, the distal descending thoracic\naorta is dilated (up to 4.0 x 4.4 cm) which is seen extending into the upper\nabdomen with an associated chronic appearing dissection flap better assessed\non the outside hospital CT abdomen pelvis performed earlier today.  Fluid\nabutting the descending thoracic aorta is consistent with pleural effusion and\ndoes not appear hyperdense on the subsequently obtained CT chest without\ncontrast.  Patient is undergone prior CABG.  The main pulmonary artery is\nnormal in caliber.  There is no filling defect within the central branches of\nthe pulmonary arterial tree.  There are numerous mediastinal and hilar lymph\nnodes which approaches the upper limits of normal and are likely reactive. \nThere are bilateral simple layering pleural effusions with associated\ncompressive lower lobe atelectasis.\n\nNo worrisome nodule, mass, or consolidation is seen within the lungs. \nEvaluation is slightly limited due to motion.  There is no evidence of edema\nor pneumonia.\n\nWithin the imaged portion of the upper abdomen, aside from known aortic\ndissection, no acute abnormality is identified.\n\nBones: Midline sternotomy wires noted.  No worrisome lytic or blastic osseous\nlesion is seen.",
            "output": "1. No pulmonary embolism.\n2. Aneurysmal dilation of the descending thoracic aorta at the level of the\nhiatus, measures up to 4.0 x 4.4 cm, with partially visualized dissection in\nthe upper abdominal aorta which appears chronic though clinical correlation is\nadvised.  Please note, the full extent of the dissection flap is better\nassessed on the same day CT of the abdomen pelvis.\n3. Small simple appearing pleural effusions with associated compressive\natelectasis in the lower lungs.\n4. Mediastinal and hilar nodes are at the upper limits of normal in size and\nmay be reactive."
        },
        {
            "input": "CHEST:  The thoracic aorta appears intact.  The main pulmonary artery is\nenlarged measuring up to 3.9 cm in diameter, suggestive of underlying\npulmonary hypertension.  There is no mediastinal hematoma.  The patient is\nstatus post CABG and moderate cardiomegaly is noted.  There is no pericardial\neffusion.  There is no lymphadenopathy.  The imaged thyroid is normal.\n\nWithin the posterior left lower lobe, there is a relatively rounded lesion\nmeasuring 5.4 x 2.7 cm (02:38), which appears pleural in nature.  There is no\nevidence of contusion or laceration.  Small bilateral pleural effusions are\nnoted with associated atelectasis.\n\nABDOMEN:  The liver is intact without focal lesion of signs of acute injury. \nA subcentimeter right hepatic cyst is unchanged from ___.  The spleen is\nintact and normal in size.  Multiple gallstones are noted without associated\ngallbladder distention or wall thickening.  A hypodense lesion 1.5 x 0.9cm in\nthe pancreatic head is unchanged from ___, likely representing an IPMN.  The\nbilateral adrenal glands are thickened, but stable in appearance.\n\nThe kidneys again demonstrate multiple bilateral renal cysts of varying\ndensities, overall minimally changed as compared to the prior examination\ndated ___.  Similarly, moderate right and moderate severe left\nhydroureteronephrosis is also minimally changed from the prior examination.\n\nThe abdominal aorta is normal in course and caliber with patent major\nbranches.  Extensive atherosclerotic disease is noted throughout the aorta and\nits major branches.  No lymphadenopathy, free air, or free fluid.\n\nThe stomach and duodenum are unremarkable.\n\nPELVIS:  The small bowel is unremarkable, without ileus or obstruction.  There\nis no evidence or bowel or mesenteric injury.  The colon is unremarkable.  A\nsmall metallic clip is noted within the right mid pelvis.  The bladder appears\nintact.  There is no pelvic free fluid.\n\nBONES:  There is no acute fracture.  The patient is status post left total hip\narthroplasty.  Multilevel degenerative changes are seen throughout the spine. \nNo focal suspicious osseous abnormality.",
            "output": "1.  No evidence for acute intrathoracic or intra-abdominal process. \nSpecifically, no retroperitoneal hematoma.\n2.  Multiple bilateral renal cysts and bilateral hydroureteronephrosis,\nminimally changed from ___.\n3.  5.4 x 2.7 cm vascularized posterior left lower lobe pleural-based lesion,\nwhich may relate to the patient's known metastatic renal cell carcinoma\n(versus second malignancy).\n4.  1.5 x 0.9cm hypodense lesion in the pancreatic head, unchanged from ___\nand likely reflecting an IPMN.\n5.  Moderate cardiomegaly and small bilateral pleural effusions.\n6.  Enlarged main pulmonary artery compatible with pulmonary hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Bilateral hypodense nodules in the\nthyroid gland, the largest in the left thyroid lobe measures 8 mm.  No\nsupraclavicular or axillary lymphadenopathy.  No soft tissue abnormality\nwithin the chest wall.\n\nUPPER ABDOMEN: Limited views of the upper abdomen show several subcentimeter\nfoci of enhancement in the liver, for instance a 11 mm focus in the left\nhepatic lobe, 9 mm, and 10 mm in the right hepatic lobe (4: 56, 58), which are\ndifficult to evaluate in single-phase contrast enhanced CT.  Gallbladder wall\nis diffusely mildly dense. Please refer to separately reported abdominal CT\nfor further evaluation.\n\nMEDIASTINUM: No mediastinal lymphadenopathy are noted\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There is no pleural effusion.\nA 9 mm pericardial thickening or nodularity is noted and is of unclear\netiology.\nPLEURA: No pleural thickening or pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No nodules, masses or abnormalities in the lung parenchyma.\n2. AIRWAYS:  Airways are patent to subsegmental level.\n3. VESSELS:  Aorta and main pulmonary artery are normal in size and\nconfiguration.\nCHEST CAGE: No acute fractures or suspicious bone metastasis are noted in the\nchest and thoracic spine.  Generalized bone demineralization is noted\nthroughout.",
            "output": "1. No evidence of metastatic disease to the chest.\n2. Nonspecific bilateral hypodense nodules seen in the thyroid gland, largest\nmeasures 8 mm in the left thyroid lobe.\n3. Multiple hyperenhancing foci in the liver are partially characterize with\nsingle-phase contrast-enhanced CT.  Please refer to separately reported\nabdominal pelvis CT performed on the same day for further detail."
        },
        {
            "input": "CHEST PERIMETER: 9 mm low-density lesion in the left thyroid lobe,, was 10 mm\nin ___.  Absence of change and small size argue against further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged. \nBreast evaluation is reserved exclusively for mammography.  No soft tissue\nabnormalities elsewhere in the chest wall.  Findings below the diaphragm will\nbe reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis moderate in head and neck vessels, milder in coronary arteries, involving\nat least the right.  The aortic valvular calcification a is substantial enough\nto be hemodynamically significant echocardiography recommended if not recently\nperformed.  Pulmonary artery and aorta are normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\nNo measurable lung nodules.  Tracheobronchial tree is normal to subsegmental\nlevels and there is no pleural abnormality.\n\nLUNGS, AIRWAYS, PLEURAE:\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nStable cm size left thyroid cyst or nodule too small to warrant further\nimaging.\n\nSufficient aortic valvular calcification to be hemodynamically significant. \nSuggest echocardiography if not recently performed.\n\nRECOMMENDATION(S):  Echocardiography for aortic valve assessment."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Minimal right upper lobe linear atelectasis is seen.  There is\nno focal consolidation.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Sections through the upper abdomen show a 2 cm arterially enhancing\narea in the right hepatic lobe (2:74), which could represent a hemangioma or\nalternatively an adenoma.  The remaining structures of the upper abdomen are\nunremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nAnterior bridging osteophyte is noted at the midthoracic spine.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Incidentally noted a 2 cm hyperenhancing area in the right hepatic lobe,\nwhich could represent a hemangioma or alternatively an adenoma.  Non urgent\nliver ultrasound can be performed for further evaluation."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid gland is unremarkable in\nappearance.  Lymph nodes in the axilla measure up to 4 mm in short axis on the\nleft (02:19), unchanged.\n\nUPPER ABDOMEN: Imaged upper abdominal structures are unremarkable.\n\nMEDIASTINUM: Multiple mediastinal lymph nodes are not pathologically enlarged\nby CT size criteria. For instance, a right upper paratracheal node measures 6\nmm in short axis (06:52), unchanged.  In the subcarinal station, lymph nodes\nmeasure up to 0.9 cm in short axis (06:49), containing normal fatty hila.\n\nHILA: No hilar lymphadenopathy by size criteria.\n\nHEART and PERICARDIUM: Heart size is normal, and there is no pericardial\neffusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\n\nPARENCHYMA:\nPleural-parenchymal scarring at the lung apices is overall stable lung\nmultiple prior studies.  Subpleural fibrosis in the anterior right middle\nlobe, is consistent with post radiation change.  The following nodules are\nidentified:\n\n-- 7 x 9 mm mixed attenuation nodule in the apical segment right upper lobe\n(04:57) has progressively increased in size over the past several years dating\nback to the earliest available study of ___ (4:58, ___ CT). \nAdditionally, the posterior aspect of this nodule has slowly increased in\ndensity.  Morphology has also changed with an irregular anterior margin. \nFindings are highly suspicious for an invasive adenocarcinoma.\n-- 2 mm nodule in the medial right lower lobe (4:176), stable from ___.\n-- 3 mm subpleural nodule in the posterior right lower lobe (4:190), not\ndefinitely identified in ___, but unchanged from ___.\n-- calcified granuloma is incidentally noted in the posterior left lower lobe\n(4:221).\n\nAIRWAYS: Airways are patent to the subsegmental levels.\n\nVESSELS: Ascending aorta is normal in course and caliber.  Main pulmonary\ntrunk is normal in caliber.\n\nCHEST CAGE: No osseous lesions concerning for malignancy.  There is likely a\nhemangioma along the posterior L1 vertebral body (4:279).  Mild degenerative\nchanges are noted throughout the thoracic spine. No acute fracture.",
            "output": "Right upper lobe mixed attenuation nodule demonstrates progressively\nincreasing size, density and morphologic changes since ___, highly\nsuspicious for an invasive adenocarcinoma.  Diagnostic resection is\nrecommended.\n\nRECOMMENDATION(S):  Thoracic surgery consultation for consideration of\ndiagnostic resection of the growing right upper lobe nodule.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 12:24 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  There\nis no pericardial or pleural effusion.  Coronary calcifications are minimal. \nImage portion of the upper abdomen reveals no appreciable abnormality.  The\npatient is after bilateral mastectomy with breast reconstruction bilaterally.\n\nAirways are patent to the subsegmental level bilaterally.  Postradiation\nchanges in the right upper lobe are most likely related to breast cancer\ntreatment.  The patient is after right upper lobe wedge resection that appears\nto be associated with soft tissue thickening, most likely postsurgical and\narchitectural distortion, series 4, image 43.  Giving the fact that this is\nfirst post- operative scan, this area needs to be further followed.  Left\nupper lobe and lingular postradiation changes are also related to previous\nbreast radiation.  No new pulmonary nodules masses or consolidations seen.\n\nNo lytic or sclerotic lesions worrisome for infection or neoplasm\ndemonstrated.",
            "output": "Status post right upper lobe wedge resection.  Thickening around the sutures\nmost likely related to post surgical changes but should be reassessed in 6\nmonths for documentation of resolution\n\nBilateral post breast radiation changes in the anterior aspect of the upper\nlobes\n\nStatus post bilateral mastectomy and breast reconstruction therapy\n\nAsymmetry in the lower neck/ upper chest on the right that might be related\neither to breast surgery or previous others surgery, potentially in the lower\nneck.  Correlation with patient history is recommended.  ,"
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Moderate\ncalcified atherosclerotic disease.  Mitral valve replacement.  No pericardial\neffusion.  Right and left atria appears enlarged.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Right-sided percutaneous chest drain in situ with no\nsignificant residual pleural effusion.  No left pleural effusion.  No\npneumothorax.\n\nLUNGS/AIRWAYS:Right lower lobe atelectasis.  Mild left basilar atelectasis.. \nPatchy ground-glass opacities in the upper lobes bilaterally, likely\ninflammatory.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  See report of contemporaneously acquired CT abdomen and pelvis..\n\nBONES: Prior sternotomy noted.  Compression deformity of T12 with\napproximately 50% loss of height.  Multiple old right-sided rib fractures\nnoted.",
            "output": "-Right-sided chest drain in situ with no significant residual right pleural\nfluid and adjacent right lower lobe atelectasis.\n-Patchy ground-glass opacities in the upper lobes bilaterally, likely\ninflammatory."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  6 mm superficial\nsubcutaneous nodule, right lateral chest wall, 2:26, unchanged since ___.  No soft tissue abnormalities elsewhere in the chest wall.  This study is\nnot appropriate for subdiaphragmatic diagnosis, showing a large in growing\nposterior/retroperitoneal hematoma.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately\n distended with air above the level of the severely enlarged left atrium which\nmay indicate interference with swallowing.  Atherosclerotic calcification is\nmild in head and neck vessels, considerable in the coronary arteries.  Patient\nhas had median sternotomy and mitral valve replacement.  Aortic valve is\nheavily calcified and may be stenotic.  Severe cardiomegaly would require\nechocardiography for assessment.  No appreciable pericardial effusion.\n\nTHORACIC LYMPH NODES: 18 mm lymph node, lower pole right hilum, 302:108,\nslightly larger today than on ___.  There is no bronchial narrowing.\n\nLUNGS, AIRWAYS, PLEURAE: Cluster of bronchiolar nodulation, right upper lobe\nslightly more pronounced.  Moderate nonhemorrhagic, non largely dependent,\nright pleural effusion is larger, causing much more severe atelectasis in\nlower lobe.\n\n5 mm nearly solid left upper lobe nodule, 302:55, developed in a region of\nsubtle ground-glass on ___, probably infectious.  Subsegmental\natelectasis left lower lobe unchanged.  No left pleural abnormality.\n\nCHEST CAGE: Moderate loss of height, T12 vertebral body is probably due to\nosteoporosis.  No other compression or any pathologic fracture or destructive\nbone lesion.",
            "output": "Moderate nonhemorrhagic right pleural effusion, probably layering,\nsubstantially larger today than on ___ causing much more severe\natelectasis in the right lower lobe.\n\nSevere left atrial enlargement may interfere with swallowing.  Clinical\nassessment recommended.\n\nAortic valvular calcification is heavy enough to be hemodynamically\nsignificant.\n\nIsolated right hilar adenopathy, absent any other findings of malignancy,\npresumably reactive.\n\nMinimal bronchiolitis, right upper lobe.  New infectious, subcentimeter\nnodule, left upper lobe."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No lymphadenopathy.  No thyroid\nnodules requiring imaging follow-up.\n\nUPPER ABDOMEN: Contrast refluxing into the IVC and hepatic veins suggests\ncardiac decompensation.  Right retroperitoneal hematoma is partially\nvisualized and better assessed on dedicated abdominal CT from ___\n(through 2:244).  Colonic diverticulosis.  Renal cysts.\n\nMEDIASTINUM: No lymphadenopathy or mediastinal hematoma.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is severely enlarged with massive biatrial\nenlargement as seen previously.  The patient is post mitral valve replacement.\nCoronary artery calcifications are present.\n\nPLEURA: Small stable right and trace left pleural effusions.  No pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Severe bibasilar atelectasis.  Few scattered foci of trace\nperipheral ground-glass and nodular opacities in the upper lobes are\nnonspecific but could suggest small infectious/inflammatory foci, stable or\nslightly improved from prior CT on ___ (302:52; 59).\n2. AIRWAYS:  Patent to the subsegmental level bilaterally.\n3. VESSELS:  Enlarged main pulmonary trunk measuring 3.4 cm.  No central\npulmonary embolus identified on this nondedicated study.\n\nCHEST CAGE: No acute fracture identified.  There are healed fractures of the\nright clavicle and multiple right ribs.  A lucent lesion in the right lamina\nof T5 with no aggressive features is unchanged.  Chronic degenerative changes\nin the spine including height loss of T10 and T11.",
            "output": "1. No definite etiology for the patient's hemoptysis.\n2. Small stable nonhemorrhagic pleural effusions with worsened severe\nbibasilar atelectasis.  No pneumothorax.\n3. Improving subtle peripheral nodular opacities in the upper lobes which may\nrepresent infectious/inflammatory foci.\n4. Massive cardiomegaly and biatrial enlargement with reflux of contrast into\nthe IVC and hepatic veins suggesting cardiac decompensation.\n5. Partially visualized right retroperitoneal hematoma."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\nBronchial thickening in the lower lobes and right middle lobe associated with\nfaint ground-glass opacities in the left upper lobe and lower lobes\nbilaterally in suggest bronchitis\n2 mm subpleural nodules in the right upper lobe (4:88), in the right middle\nlobe (4:141, 193), and a 3 mm perifissural nodule in the right lower lobe\n(4:154) are stable since ___, not worrisome for malignancy. There is no\npleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation, multiple\nhypodense lesions in the liver are a stable there are no new lesions or\nbiliary ductal dilatation.\nThere are no bone findings of malignancy",
            "output": "No evidence of  intrathoracic malignancy.\nNew bronchial wall thickening and faint ground-glass opacities suggest acute\nbronchitis"
        },
        {
            "input": "The examination is compared to ___.\nNo incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes in the mediastinum and in\nthe hilar regions. The large mediastinal vessels are unremarkable.  No\nincidental pulmonary embolism.  Normal appearance of the heart. Normal\nposterior mediastinum. Abdominal findings are reported in detail in the\ndedicated abdominal CT report.  No evidence of chest wall lesions.  No\nevidence of osteolytic lesions at the level of the sternum, the ribs and the\nvertebral bodies.  The lung parenchyma shows normal attenuation values. There\nis no evidence of nodules or masses suspicious for malignant or metastatic\ndisease. Unchanged 2 mm right perifissural nodule (6, 132).  No pleural\nthickening. No pleural effusion. The airways are patent. Pre-existing\nground-glass opacities in the lung parenchyma have completely resolved in the\ninterval.",
            "output": "Complete resolution of pre-existing ground-glass opacities. No evidence of\nthoracic metastatic disease."
        },
        {
            "input": "MEDIASTINUM: The thyroid is is enlarged and multinodular. Postsurgical changes\nin the left breast are noted and no left axillary adenopathy is present.\nSeveral mediastinal lymph nodes are not pathologically enlarged. There is no\nhilar or right axillary adenopathy. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification. No pericardial effusion is present. There is no esophageal wall\nthickening of a hiatal hernia.\n\nLUNGS AND AIRWAYS: The airways are patent to the subsegmental level\nbilaterally. No intraluminal lesions are identified. A 2 mm nodule in the\nlateral aspect of the minor fissure in the right lung (series 6, image 126) is\nlikely a fissural lymph node. There are no other focal parenchymal opacities\nor nodules. No pleural effusion or pleural thickening is present.\n\nOSSEOUS STRUCTURES: A 3 mm sclerotic lesion is seen in the vertebral body of\nT3 (series 9, image 37). No other lytic or blastic lesions are seen in the\nthoracic cage.\n\nFor detailed description of subdiaphragmatic structures please refer to report\nfor concurrent abdominal pelvic CT.",
            "output": "1. 2 mm nodule in the minor fissure of the right lung as well as a 3 mm\nsclerotic focus in the vertebral body of T3 are of unclear clinical\nsignificance and non specific but ___ months follow up is recommended given\noncologic history.\n\n2. Multinodular goiter should be further assessed with ultrasound if not\npreviously performed."
        },
        {
            "input": "Right lobe of thyroid gland remains mildly enlarged. There are no enlarged\nmediastinal or hilar lymph nodes. Heart size is normal, and there is no\npericardial or pleural effusion. Skeletal structures of the thorax demonstrate\nno new suspicious lytic or blastic lesions.\n\nWithin the lungs, biapical scarring and calcifications are unchanged. No CT\ncorrelate is identified for the recently described right upper and right lower\nlobe abnormalities on recent chest radiograph. Mild diffuse bronchial wall\nthickening is present bilaterally. Additionally, a small amount of retained\nsecretions or blood is present in the left main bronchus. A 3 mm dependent\nnodular opacity in the distal left main bronchus is new compared to ___ CT (image 166, series 5). A focal area of mucous in plugging or\nintraluminal blood is present within the left lower lobe subsegmental bronchus\nto the posterior segment (image 247, series 5). A similar finding is present\nin the right lower lobe (image 265, 5).\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of apparent wall thickening of the anterior, nondependent wall of the\nproximal stomach, difficult to assess due to absence of oral contrast and\nincomplete distension.",
            "output": "1.  No CT correlate for lung parenchymal findings on recent chest radiograph,\nwhich may have been due to transient abnormalities related to aspiration,\nhemorrhage, or a mild infection.\n\n2. Intraluminal filling defects within the left main bronchus likely reflect\nsecretions or blood in this patient with history of hemoptysis. 3 mm dependent\nnodular opacity is likely due to the same process, but direct visualization\nwith bronchoscopy may be considered given history of hemoptysis to exclude a\nsmall carcinoid. Alternatively, the patient could return for limited prone CT\nimages through this region to assess for clearance or change in position.\n\n3. Apparent proximal gastric wall thickening, possibly due to lack of complete\ndistension. If warranted clinically, this could be further evaluated by upper\nGI."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular adenopathy.  No axillary adenopathy.  No left chest wall\nlesions.  No subcutaneous masses.\n\nUPPER ABDOMEN: No adrenal lesions.  Hepatic density is slightly decreased\ncompared to the spleen (by 20 Hounsfield units).  No focal hepatic lesions. \nSmall nonspecific millimetric density seen in the gallbladder measuring 4 mm\nin diameter, but please note on previous abdominal ultrasound ___ no\ngallstones were noted.  No features of cholecystitis.\nLeft-sided rib plain and fullness\nMEDIASTINUM: No mediastinal adenopathy.  No esophageal lesions.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic or coronary artery calcifications\nPLEURA: No pleural effusions.\nLUNG:\n\n-PARENCHYMA:  No suspicious pulmonary nodules or masses.  No confluent\nairspace opacification.  No diffuse lung disease.  Small calcified granuloma\nseen in the superior segment of the right lower lobe (3, 23) measuring 5 mm\ndiameter.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  Not dilated.  No filling defects.\nCHEST CAGE: Mild degenerative changes of the thoracic spine.  No lytic or\ndestructive lesions.",
            "output": "No left chest wall abnormality.  No incidental findings of note.\n\nRECOMMENDATION(S):  If the exact location of the left chest wall fullness is\nmore specifically described I am happy to re-evaluate the images, although I\ndid not identify a left chest wall abnormality with specific attention paid to\nthis large area."
        },
        {
            "input": "CHEST PERIMETER: Dominant 2 x 3 cm nodule left thyroid lobe in a large chronic\nmultinodular goiter is unchanged since ___, was smaller in ___. \nPossibility of metastasis should be entertained.  Trachea is not compromised. \nNo soft tissue abnormalities in the axillae or chest wall.  Breast evaluation\nis reserved for mammography.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Mid esophagus is dilated and thick walled, probably due to\nesophagitis.  Above the level of the calcified aberrant dilated right\nsubclavian artery, esophagus is mildly dilated, not a clear indication that it\nis impaired by the process artery.\n\nAtherosclerotic calcification is heavy in head and neck vessels and the\ncoronary arteries.  Heavily calcified thoracic aorta is normal caliber and\nthere is no evidence of plaque ulceration.  Aortic valve is not appreciably\ncalcified.\n\nThere is no pericardial effusion.\n\nTHORACIC LYMPH NODES: There is no new central lymph node enlargement. \nInfiltrative adenopathy in the right hilum, roughly 12 mm thick, primarily\nanterior to the bronchus intermedius is stable.  There is no bronchial\ncompromise.\n\nLUNGS, AIRWAYS, PLEURAE: The bulk of paramediastinal radiation fibrosis, is\nstable in the right upper lobe apex and anterior segment, increased in the\nright lower lobe superior segment.\n\nGeographic opacity in the posterior segment of the right upper lobe, has been\npresent without much change since ___ it was a much larger mass in\n___..  Similarly 12 mm wide spherical nodule, right lower lobe was\nsubstantially larger in ___, involuted between ___ and ___,\ngrew between ___ and ___ and has subsequently remained unchanged.\n\nLeft lung grossly clear.  Mild to moderate bronchial wall thickening most\npronounced in the left lower lobe, probably new.\n\nPrevious moderate right pleural effusion has decreased substantially, now\ncollected around the atelectatic fibrosis in superior segment of the right\nlower lobe.,\n\nCHEST CAGE: No compression or pathologic fractures or large lytic lesions. \nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "No regrowth since no active growth in multifocal malignancy since at least\n___, including 2 right lung lesions which were substantially larger\nin ___.  Growth details above.\n\nSubstantial decrease since ___ in residual right pleural effusion.\n\nCombination of the increasing radiation fibrosis and progressive esophageal\nwall thickening suggests radiation esophagitis.\n\nHeavy atherosclerosis including head and neck vessels and coronary arteries."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is\nunremarkable.  There is no supraclavicular lymphadenopathy.  No axillary\nlymphadenopathy.  There are masslike areas in the right breast (e.g.  Through\n2:90, 65).\n\nUPPER ABDOMEN: Limited view of the upper abdomen is notable for subcentimeter\nhyperdensity in the upper pole of the right kidney which is too small to\ncharacterize, but likely represents a simple cyst.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is of normal size.  There are no significant\ncoronary artery calcifications.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There are areas of mild subsegmental atelectasis in the lower\nlobes bilaterally.  Subtle area of ground-glass opacification in the right\nmiddle lobe (e.g.  302:130) is may represent early pneumonia.  Diffuse\nhaziness on chest radiograph likely with secondary to overpenetration given\npatient body habitus.\n2. AIRWAYS:  Airways are patent to subsegmental levels bilaterally.\n3. VESSELS:  Thoracic aorta and main pulmonary artery are normal caliber.  No\nsignificant atherosclerotic calcification of the thoracic aorta.  No large\ncentral pulmonary embolism on this non tailored exam.\nCHEST CAGE: No worrisome osseous lesions or acute fractures.",
            "output": "1. Subtle ground-glass opacity in the right middle lobe may represent early\npneumonia.  Lungs are otherwise clear except for mild bibasilar atelectasis.\n2. No mediastinal or hilar lymphadenopathy.\n3. Mass like areas in the right breast should be further evaluated with\nmammography if not recently performed."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is mildly calcified but is normal in caliber without evidence\nof dissection or intramural hematoma.  There is moderate coronary artery\ncalcifications.  The heart is mildly enlarged.  Otherwise, the pericardium and\ngreat vessels are within normal limits. No pericardial effusion is seen. \nThere is an anomalous origin of the left vertebral artery arising from the\naortic arch, normal variant.\n\nAXILLA, HILA, AND MEDIASTINUM: There is interval enlargement and more rounded\nmorphology of bilateral axillary lymph nodes measuring up to 13 mm. \nMediastinal and hilar lymph nodes are top-normal in size but stable compared\nto prior.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Diffuse moderate to severe centrilobular emphysema is noted. \nThere is diffuse moderate paraseptal emphysema.  There is left lower lobe\natelectasis with bronchiectasis with improved surrounding ground-glass\nopacity.  Lungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrate a\npartially imaged enlarged heterogeneous multinodular thyroid the largest\nnodule in the right thyroid lobe measuring approximately 2.1 cm.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: There multiple prominent marked multilevel anterior large osteophytes. \nOtherwise, no suspicious osseous abnormality is seen.? There is no acute\nfracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Interval development of axillary lymphadenopathy.\n3. Moderate to severe diffuse emphysema.\n4. Partially imaged enlarged heterogeneous multinodular thyroid with largest\nnodule measuring 2.1 cm.  Thyroid ultrasound is recommended for further\nevaluation.\n5. Left lower lobe focal bronchiectasis, likely postinflammatory.\n\nRECOMMENDATION(S):   Thyroid ultrasound."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer.\n\nThe pulmonary arteries are well opacified to the subsegmental level.  There\nare nonocclusive central filling defects within the proximal subsegmental\nbranches of the right posterior base (series 2, image 81).  There are no\nfilling defects within the main, right, left, lobar or segmental pulmonary\narteries.  The main and right pulmonary arteries are normal in caliber, and\nthere is no evidence of right heart strain.\n\nIll-defined hypodense bilateral thyroid nodules are unchanged.\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThe heart is mildly enlarged.  Coronary artery calcifications are noted. \nThere is no pericardial effusion.\n\nEndotracheal tube is in situ.  The airways are patent to the subsegmental\nlevel.\nThere is extensive centrilobular and paraseptal emphysema.  There is\nsubsegmental atelectasis in the lower lobes bilaterally.  There is no\nsignificant pleural effusion.\n\nNo suspicious bone lesion seen.\n\nLimited images of the upper abdomen are unremarkable.  Note is made of an\nenteric feeding tube with the tip in the proximal duodenum.",
            "output": "Nonocclusive filling defect within the proximal subsegmental branches of the\nright posterior base concerning for subsegmental pulmonary embolism.  No\nevidence of pulmonary infarct/hemorrhage or right ventricular strain.\nEmphysematous changes."
        },
        {
            "input": "Stable thyroid nodules (2, 6).  The extent and severity of the pre-existing\naxillary, mediastinal and hilar lymphadenopathy has substantially decreased\n(2, 15).  Most visible lymph nodes are now normal to borderline in size.  Only\nthe number of lymph node remains increased.  Stable appearance of the cardiac\nstructures.  The posterior mediastinum is unremarkable and free of\nlymphadenopathy.  Air in the hepatic ducts is still visualized.  Moderate\ndegenerative vertebral disease.  No vertebral compression fractures.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Several pulmonary micronodules, notably in subpleural location are\nstable.  The consolidation along the left minor fissure (4, 95) is stable but\nshould be followed in another 3 months.  No additional parenchymal\nabnormalities, with the exception of several subpleural micronodules.",
            "output": "Substantial decrease in size and number of the axillary and mediastinal as\nwell as hilar lymphadenopathy.  Stable left upper lobe perifissural\nconsolidation."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular\nlymphadenopathy. Multiple not pathologically enlarged per size criteria\naxillary lymph nodes are mildly smaller in comparison to prior, up to 0.5 cm\nin the left axilla, significantly decreased in size in comparison to ___.\nFew hypodense nodules in the thyroid measure up to 1 cm in the right lobe,\nunchanged and of insufficient size to warrant further imaging.\n\nCHEST CAGE: No evidence of osteo destructive lesions at the level of the ribs,\nvertebra or sternum.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the abdomen and\npelvis.\n\nMEDIASTINUM: Scattered mediastinal and right supradiaphragmatic lymph nodes\nare not pathologically enlarged per size criteria.  Unchanged since prior,\nsignificantly decreased in size in comparison to ___.  There is no hilar\nlymphadenopathy.\n\nHEART and PERICARDIUM: Right pectoral Port-A-Cath terminates in the right\natrium.  Heart is normal in size and there is no pericardial effusion.  Specks\nof calcifications in the coronaries.  Thoracic aorta and pulmonary artery are\nnormal in diameter.\n\nPLEURA: There is no pleural effusion, no pneumothorax.  Mild biapical\npleuroparenchymal fibrosis is stable.\n\nLUNG: Airways are patent to the subsegmental level.  Multiple centrilobular\nnodules predominantly in the upper lobes represent mild respiratory\nbronchiolitis.\nLeft upper lobe 1.3 x 0.8 cm nodule adjacent to the major fissure, surrounded\nby small cysts is stable since ___ (3:104).  Triangular right upper\nlobe perifissural 0.3 cm nodule is stable (3:110).  No new lung nodules.",
            "output": "Mild additional decrease in the size of axillary lymph nodes, with no evidence\nof lymphadenopathy in the thorax.\nLeft upper lobe nodule although unchanged since ___, is concerning for\nprimary neoplasia and should be followed.\n\nRECOMMENDATION(S):  Chest CT in 8 months."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is a 1.7 cm bilobed hypodense\nthyroid nodule which may actually be 2 separate nodules, but indeterminate. \nThere is bilateral supraclavicular lymphadenopathy measuring up to 1 cm in\nshort axis on the right.  Numerous enlarged lymph nodes in both axillae\nmeasure up to 1.4 cm short axis on the left.  There is an approximately 1.2 x\n2 cm soft tissue mass in the subcutaneous tissues of the left chest wall\n(05:50).\n\nIMAGED UPPER ABDOMEN: Please refer to concurrent CT abdomen report.\n\nMEDIASTINUM:  Diffuse lymphadenopathy occupies all stations, for example a\nlower right paratracheal lymph node measuring up to 1.3 cm in short axis, but\nthere is no evidence that any vital structure is compromised.\n\nHILA:  There is bilateral hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  No pericardial effusion.\n\nPLEURA: No effusion or pneumothorax.\n\nLUNG:\nEvaluation of the lungs and airways is limited by expiratory phase imaging and\nrespiratory motion.\n\n1. PARENCHYMA:  There is a right upper lobe subpleural nodule measuring up to\n1.2 cm (6:91).  There is a left upper lobe fissural nodule measuring up to 1.3\ncm (6:122).  Ill-defined zone of consolidative opacities in the periphery of\nthe left lower lobe (6:230) is likely pneumonia.\n2. AIRWAYS:  The central airways are patent.\n3. VESSELS:  The great vessels are normal caliber.  There is good contrast\nopacification of the central pulmonary arteries and no filling defect to\nsuggest pulmonary embolism.\nCHEST CAGE: No concerning lytic or sclerotic lesion.  No acute fracture.",
            "output": "1. Diffuse mediastinal, hilar, bilateral axillary and supraclavicular\nlymphadenopathy.\n2. Left lower lobe consolidation most likely pneumonia.\n3. A few pulmonary nodules may be smaller foci of infection or intrapulmonary\nlymphoma.\n4. There also a few superficial soft tissue masses, for example in the left\nchest wall as described above.\n5. Possible 1.7 cm hypodense thyroid nodule.  Nonemergent thyroid ultrasound\ncan be performed if clinically appropriate.\n\nNOTIFICATION:  Impression #1 and 2 above were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 4:55 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "Assessment of the CT abdomen demonstrate multiple liver metastatic lesions.\nThere is also a mass at the pancreatic had, partially imaged, unclear if\nrepresents the primary lesion, approaching 4 x 3.4 cm.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present. Airways are\npatent to the subsegmental level bilaterally.  Aorta and pulmonary arteries\nare normal in diameter.  Heart size is normal. There is no pericardial or\npleural effusion demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\nCentrilobular nodules and ___ opacities and minimal in the upper\nlobes, most likely reflecting smoking or inflammation O for deep drain\netiology and unlikely to represent metastatic disease.  A right upper lobe\nnodule, series 7, image 159 is 4.4 mm in diameter, left upper lobe nodule,\nseries 7, image 61 is 1.6 mm, the low larger nodule in the left upper lobe,\nseries 7, image 64 is 4 mm.  Left lower lobe subpleural nodule. , series 7,\nimage 211 is 4 mm. Additional nodule in the left lower lobe, series 7, image\n272 is 4.6 mm.  The additional nodule is series 7, image 288, 1.6 mm.",
            "output": "Extensive involvement of the liver by metastatic disease. Mass in the\npancreatic tail.\n\nMultiple pulmonary nodules most likely representing metastatic disease and no\npotential candidate for primary source of malignancy. The should be reassessed\nin 3 months for stability.\n\nBilateral adrenal thickening.  Father assessment with dedicated CT abdomen is\nto be considered."
        },
        {
            "input": "Aorta is calcified.  Main pulmonary artery is thick normal in diameter.  It\nshows aorta.  No pericardial effusion is seen except for small amount of the\nsoft pericardial fluid, minimally increased since the prior study.  Anterior\npericardial lymph nodes:  Series 5, image 45 is unchanged.  No hilar or\nmediastinal lymphadenopathy seen.  Several axillary lymph nodes do left either\nnon pathologically enlarged with fifth but minimally bigger than compared to\nprevious exam tip\n\n Airways are patent to the subsegmental level bilaterally.  Right basal\natelectasis small amount of PF is are noted, slightly progressed as compared\nto previous examination.  Immediate progression of the being by interval\nincrease in size as well as increase in number of multiple pulmonary nodules,\nfor example in right lower lobe Doppler of the 0.3 is depicted 5 mm on the\nprevious examination series 5, image 38.  Additional right lower lobe nodule\nhas substantially increased from 3.5 to 6.7 mm.  In the left lower lobe major\nnodule is 12 mm, as compared with patient.  Pulmonary nodules also seen more\nsuperiorly, all of them a is a increased for healed.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen that will focus of assessment of the abnormal appearance of the\nliver.\n\nNo lytic or sclerotic lesions worrisome for 's infection or neoplasm.",
            "output": "Progression of disease demonstrated by substantial in the CA number and 5 or\nmultiple pulmonary nodules.\n\nMinimal right pleural effusion and rounded atelectasis.  Small amount of left\npleural effusion.\nInterval Increase in the small pericardial effusion."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Heart size is normal.  Severe calcified coronary\natherosclerosis extending throughout the left anterior descending coronary\nartery and first diagonal branch.  Moderate aortic valve calcification.  The\nthoracic aorta is normal in caliber.  Aortic atherosclerosis is mild.  No\npenetrating atherosclerotic ulcer formation or dissection.  The main pulmonary\nis enlarged with a diameter of 3.4 cm.  No filling defects to the subsegmental\nlevel to suggest pulmonary embolus.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild diffuse bronchial wall thickening.  Scattered secretions\nincluding bronchus intermedius.  Scattered punctate calcified granulomas.  2\nmm right lower lobe superior segment pulmonary nodule (series 4, image 99). \nNo consolidations.\n\nBASE OF NECK: Visualized portions of the base of the neck are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence of focal lesions. The portal veins are patent. No evidence of\nintrahepatic or extrahepatic biliary dilatation.  Cholelithiasis without wall\nthickening or adjacent fat stranding.  Moderate gallbladder distension.\n\nPANCREAS: The pancreas is mildly atrophic.  The parenchyma otherwise has\nnormal attenuation throughout, without evidence of focal lesions or pancreatic\nductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small incidental accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of concerning renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops are unremarkable. No\nbowel obstruction.  The colon and rectum are within normal limits.  The\nappendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Extensive atherosclerotic disease.\n\nBONES/SOFT TISSUES: Age-indeterminate compression deformity of the L2\nvertebral body.  No osseous retropulsion.  Benign-appearing sclerotic lesion\nin the right iliac bone with a narrow zone of transition.",
            "output": "1. No evidence of pulmonary embolus, acute aortic syndrome, or pneumonia.\n2. Age-indeterminate L2 compression deformity, though suspect subacute to\nchronic injury.  No osseous retropulsion.  Recommend correlation with physical\nexamination.\n3. Right lower lobe superior segment micronodule.  For incidentally detected\nsingle solid pulmonary nodule smaller than 6 mm, no CT follow-up is\nrecommended in a low-risk patient, and an optional CT in 12 months is\nrecommended in a high-risk patient.\n4. Severe calcified coronary atherosclerosis extending throughout the left\nanterior descending coronary artery and first diagonal branch.\n5. Enlarged main pulmonary artery raising the possibility of pulmonary\nhypertension.\n6. Cholelithiasis.\n\nRECOMMENDATION(S):\n1. Age-indeterminate L2 compression deformity. No osseous retropulsion.\nRecommend correlation with physical examination.\n2. Right lower lobe superior segment micronodule. For incidentally detected\nsingle solid pulmonary nodule smaller than 6 mm, no CT follow-up is\nrecommended in a low-risk patient, and an optional CT in 12 months is\nrecommended in a high-risk patient."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL, MEDIASTINUM AND HILA:\nNo incidental thyroid Findings. Right-sided Port-A-Cath ending at the lower\nSVC. No chest wall abnormalities.  Moderate atherosclerotic calcifications of\nthe in sub left subclavian and common carotid arteries.  The esophagus is\nunremarkable. No hilar lymphadenopathy.  Enlarged round-shaped right axillary,\nmediastinal, supra and infraclavicular lymph nodes with loss of fatty hilum\nand demonstrated FDG avidity on previous PET study distributed as following:\n\n-Right axillary measuring 20 x 12 mm (5: 17), a second one is adjacent\nmeasuring 13 x 11 mm (05: 20).\n-Left supraclavicular measuring 11 x 14 mm (5:1) and right supra measuring 16\nx 9 mm (5:1)\n-Right infraclavicular measuring 7 x 14 mm (5:3), and another one at a lower\nlevel measuring 9 x 17 mm (5:6)\n-Pre-vascular 12 x 14 mm (05:17) and another one 21 x 15 mm (05:13)\n-Right upper paratracheal 12 x 14 mm (05:18)\n-Subcarinal 10 x 23 mm (05:23)\n-Right paraesophageal 17 x 17 mm (05:26)\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Minimal\natherosclerotic calcification of the coronary arteries and aortic valve.  The\naorta and pulmonary arteries are normal in caliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  No suspicious nodules or\nmasses.  A left upper lobe reticulation with associated ground-glass opacity\ncould correspond to previous radiation therapy.  Right middle lobe mild\nbronchiectasis.  Nonspecific right basilar fibrosis probably corresponding to\nprevious aspiration.  Scattered subsegmental atelectasis are seen in the left\nlower and right middle lobes.  No pleural effusion.\n\nCHEST CAGE:\nNo acute fractures.  Mild dorsal spondylosis.  Although there are no bone\nlesions in the imaged chest cage suspicious for malignancy or infection, it\nshould be noted that radionuclide bone and FDG PET scanning are more sensitive\nin detecting early osseous pathology than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report that is dictated separately.",
            "output": "Mediastinal, infra and supraclavicular, and right axillary lymphadenopathy\nwith demonstrated FDG avidity.\nLeft upper lobe post radiation therapy mild fibrotic changes."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging.  A right-sided\nchest port is unremarkable with tip by near the cavoatrial junction. \nExcluding the breast tissue which requires mammography for evaluation,there\nare no abnormalities on the chest wall. Mild atherosclerotic calcifications in\nthe head and neck arteries.\n\nSupraclavicular, and infraclavicular, and right axillary lymphadenopathy is\nimproved, for example:\n-right supraclavicular lymph node measures 1.0 x 0.6 cm, previously 1.6 x 0.9\ncm (series 6:4).\n-right axillary lymph node measures 1.3 x 0.6 cm, previously 1.9 x 1.2 cm\n(series 6:81).\n\nHEART AND VASCULATURE:\nThe heart is top-normal in size.  No pericardial effusion. Mild coronary\nartery calcifications.  The aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  No hilar lymphadenopathy.  Interval\nimprovement of previous mediastinal lymphadenopathy.  For example:\n-pre-vascular lymph node measures 0.9 x 0.4 cm, previously 1.5 x 1.0 cm\n(series 6:74).\n-right lower paratracheal lymph node measures 1.0 x 0.5 cm, previously 1.1 x\n0.8 cm (series 6:99)\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe airways are patent to the subsegmental levels. Right middle lobe mild\nbronchiectasis is unchanged.  Nonspecific right basilar fibrosis is unchanged\nand could represent previous aspiration.  A subtle left upper lobe taking\nlesion with faint ground-glass opacity is not significantly changed and could\nrepresent previous radiation therapy.  A 3 mm nodule at the left base is\nunchanged (series 6:180).  Scattered atelectasis.  No focal consolidation.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis is unchanged.  An old left-sided\nrib fracture is unchanged.  There are no bone findings in the chest cage\nsuspicious for malignancy or infection but it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous metastases than chest CT scanning.\n\nUPPER ABDOMEN:\nPlease refer to separate report for CT abdomen and pelvis acquired on the same\nday for findings below the diaphragm.",
            "output": "1. Improvement of previous supraclavicular, infraclavicular, and right\naxillary lymphadenopathy, as above.\n2. Stable changes in the lung parenchyma, as above.  No new or growing nodule.\n3. Please refer to separate report for CT abdomen and pelvis acquired on the\nsame day for findings below the diaphragm."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere is a stable right axillary lymph node measuring 1.2 x 0.7 cm, previously\nmeasuring 1.3 x 0.6 cm (302:42),, unchanged from prior study and not\npathologically enlarged.  Otherwise, there is no supraclavicular or axillary\nlymphadenopathy.  There is a right-sided chest port with tip terminating in\nthe cavoatrial junction.\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen and pelvis\nperformed on the same day for description of the subdiaphragmatic findings.\n\nMEDIASTINUM: There is a prevascular lymph node measuring 0.8 x 0.6 cm,\npreviously measuring 0.9 x 0.4 cm (302:64).  There is a right lower\nparatracheal lymph node measuring 1.1 x 0.6 cm, previously measuring 1.0 x 0.5\ncm (302:72).  There is a left lower paratracheal lymph node measuring 0.9 x\n0.7 cm, unchanged from prior study (302:74).  There is a midline upper\nparatracheal lymph node measuring 1.2 x 0.6 cm, previously measuring 1.2 x 0.6\ncm (302:37).  There is a right upper paratracheal lymph node measuring 1.4 x\n0.9 cm, previously measuring 1.5 x 0.8 cm (302:48).  Otherwise, there is no\nnew or enlarged mediastinal lymph nodes.  The esophagus is unremarkable.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is top-normal in size.  There are mild\ncoronary artery atherosclerotic calcifications.  There is no pericardial\neffusion.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is redemonstration of right basilar fibrotic changes,\nunchanged from prior study.  There is subtle left upper lobe ground-glass\nopacity, unchanged from prior study likely secondary to post radiation\nchanges.  There is redemonstration of a 3 mm nodule at the left lung base,\nunchanged (302:147).  Otherwise, there are no suspicious pulmonary nodules or\nareas of parenchymal consolidation.  There is stable subsegmental atelectasis\nin the right middle lobe.\n2. AIRWAYS:  Airways are patent to the subsegmental bronchi bilaterally.\n3. VESSELS:  The pulmonary vasculature is unremarkable.\n\nCHEST CAGE: There is a stable left-sided rib fracture.  Otherwise, there are\nno suspicious lytic or sclerotic osseous lesions.",
            "output": "1. Multiple subcentimeter axillary and mediastinal lymph nodes, stable from\nprior study dated ___, as described above.\n2. No new or enlarging pulmonary nodules identified.\n3. Right-sided chest port with tip terminating in the cavoatrial junction.\n4. Please refer to separate report of CT abdomen and pelvis performed on the\nsame day for description of the subdiaphragmatic findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  Right Port-A-Cath terminates\nin the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Small bilateral pleural effusions.\n\nLUNGS/AIRWAYS: Bibasal compressive atelectasis adjacent to the small pleural\neffusions.  A new left upper lobe subpleural ground-glass opacity is most\nlikely inflammatory in nature (4:61).  Stable left upper lobe fibrotic post\nradiation changes.  The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen shows a stable cystic lesion\nin the segment VIII (4: 109), otherwise there are no significant abnormal\nfindings.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nStable old healed fracture in the lateral aspect of the left fifth rib.",
            "output": "No evidence of pulmonary embolism or aortic abnormality.\n\nNew left upper lobe ground-glass opacity is most likely inflammatory in\nnature.\n\nRight Port-A-Cath terminates in the cavoatrial junction."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid gland is\nunremarkable.  There is no axillary lymphadenopathy.  A single 9 mm left\nsupraclavicular lymph node (4:10) is stable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  Scattered subcentimeter\nmediastinal lymph nodes are stable.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion\nis identified.  Stable atherosclerotic calcifications noted in the coronary\narteries, aortic valve, and thoracic aorta.\n\nPLEURA: There are bilateral pleural effusions, left greater than right, and\nincreased in size compared to the prior CT.\n\nLUNG: There is compressive atelectasis secondary to the bilateral pleural\neffusions.  There is stable linear atelectasis in the right middle and lower\nlobes.  There is demonstration of radiation changes in the left upper lobe.\n\nThere is near complete resolution of the previously seen ground-glass opacity\nin the left upper lobe.  There are no new consolidations.\n\nThere are no suspicious nodules or masses.  There is no central pulmonary\nembolus.  The airways are patent to the subsegmental level.\n\nCHEST CAGE: No suspicious osseous lesions are identified.  Redemonstration of\na healed left fifth rib fracture.  No acute fractures.\n\nUPPER ABDOMEN: The study was not tailored for evaluation of the\nsubdiaphragmatic structures. Within this limitation, there are no gross\nabnormalities.  Redemonstration of a hypodense lesion in the hepatic dome.",
            "output": "1. No evidence of pneumonia is clinically questioned.\n2. Left greater than right pleural effusions, increased in size when compared\nto prior CT.\n3. Resolution of previously described ground-glass opacities in the left upper\nlobe."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes not enlarged.  Breast evaluation\nreserved for breast imaging.  No soft tissue abnormalities in the chest wall. \nFindings above the thoracic inlet and below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Esophagus mildly patulous.  Atherosclerotic calcification\nmild in head and neck vessels, limited to left circumflex coronary artery. \nAortic valvular calcification is moderately severe, could be hemodynamically\nsignificant.  Aorta and pulmonary arteries not enlarged.  Evaluation of\ncardiomegaly, including left atrial enlargement would require\nechocardiography.  Pericardium is physiologic.\n\nTHORACIC LYMPH NODES:\n\nRight upper paratracheal, 7 x 14 mm cluster, 3:44, was 9 x 17 mm in ___.\n\nRight lower paratracheal, 8 x 9 mm, 3:65, was 9 x 15 mm.\n\nRight lower posterior paraesophageal, 15 x 19 mm, 3:89, was 18 x 22 mm\n\nLUNGS, AIRWAYS, PLEURAE: Peripheral ground-glass infiltration and micro\nnodules, left upper lobe anteriorly, ___, unchanged since ___.\n\nMinimal bronchiectasis with wall thickening and atelectatic scarring, medial\nsegment right middle lobe, 3:106-121 unchanged since ___.  Basal\natelectasis, right lower lobe persists alongside a small residual layering\nright pleural effusion that has decreased since ___.  Small\nlayering left pleural effusion is unchanged.\n\nPattern of subpleural interstitial abnormality, anterior left upper lobe is\nseen with prior radiation therapy for breast carcinoma.  Atelectasis in the\ninferior subsegment of the lingula is unchanged.  Left lower lobe grossly\nclear.\n\n\n\nCHEST CAGE: No pathological compression fractures or destructive bone lesions.\nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "Regression of mild mediastinal adenopathy since ___.\n\nSmall bilateral pleural effusions, decreased on the right, stable on the left.\n\nMild interstitial scarring left upper lobe, presumably radiation related."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nPartially imaged thyroid gland is unremarkable.  Stable small axillary and\nthoracic inlet lymph nodes. Otherwise there are no chest wall abnormalities. \nMild atherosclerotic calcifications in the proximal supra-aortic vessels.\n\nThese study is not tailored for assessment of the breast tissue, however, the\npresence of skin thickening over the left breast with an associated 17 mm soft\ntissue nodule against the chest wall (although stable since at least ___ in addition to the prior history of left breast cancer warrant further\nassessment with dedicated imaging since none is found on prior examinations\nhistory (302:121).\n\nMEDIASTINUM AND HILA:\nEsophagus is unremarkable.  Several mediastinal lymph nodes ranging up to 8 mm\nin the right lower paratracheal station (302:64) are mildly smaller in the\ninterval.  No enlarged hilar lymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nMild cardiomegaly.  No pericardial effusion.  No atherosclerotic\ncalcifications in the coronary arteries, moderate in the aortic valve leaflets\nand mild in the mitral valve.  Minimal calcifications in the aortic arch. \nAorta and pulmonary arteries are normal in caliber throughout. LARGE LEFT CUSP\n\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels bilaterally.  Diffuse\nmoderate bronchial wall thickening.  Longstanding minimal bronchiectasis and\nperibronchovascular consolidative opacities in the right middle lobe and\nlingula are stable without evidence of suppurative features to suggest active\nprocess.  Scarring tissue in the left apex is most likely secondary to prior\nradiation therapy, stable since ___.  Trace bilateral pleural\neffusions and associated compressive atelectasis, improved since the immediate\nprior study.\n\nCHEST CAGE:\nNo acute fractures.  Unchanged appearance of the T5 and T8 congenital\ndeformity featuring butterfly configuration.  No bone lesions worrisome for\nmalignancy.\n\nUPPER ABDOMEN:\nLimited sections of the upper abdomen show a 10 mm right hepatic lobe\nhypodense nodule which is too small to characterize, but statistically likely\nto be a cyst (302:147).  Spleen and left kidney are atrophic.  Adrenals\nunremarkable.",
            "output": "No evidence of acute infectious or neoplastic intrathoracic process.\n\nMild improvement of the mediastinal lymphadenopathy.\n\nStable longstanding minimal bronchiectasis and associated peribronchovascular\nconsolidative opacities in the right middle lobe and lingula without evidence\nof active infection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Normal partially imaged thyroid\ngland.  No enlarged supraclavicular, thoracic inlet or axillary lymph nodes.\nMild atherosclerotic calcification of the imaged neck arteries.  Please see\nthe CT neck examination dated the same day for evaluation of the neck.  This\nstudy is not tailored for assessment of the breast tissue, however there is a\n1.7 cm x 1 cm soft tissue nodule in the left breast abutting the left anterior\nchest wall, stable since ___, with unchanged skin thickening over the\nleft breast.  Further assessment with dedicated imaging be considered. \nRight-sided chest port in situ, with the tip in the right atrium.\n\nUPPER ABDOMEN: Please refer to the CT abdomen and pelvis report dated the same\nday for evaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Normal esophagus.  Several mediastinal lymph nodes ranging up to\n7 mm in short axis diameter are unchanged compared with the prior study.  No\nnew or enlarging lymph nodes are identified.  The aorta and pulmonary artery\nare normal in caliber.\n\nHILA: No enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: Mild cardiomegaly.  No pericardial effusion.  Moderate\naortic and mitral valve calcification.  No atherosclerotic coronary artery\ncalcification.  Mild atherosclerotic calcification of the thoracic aorta.\n\nPLEURA: Mild bilateral pleural effusions, increased in size compared with\nprior.\n\nLUNG:\n\n1. PARENCHYMA:  Longstanding minimal bronchiectasis and peribronchovascular\nconsolidative opacities in the right middle lobe and lingula.  No new\nconsolidation.  Scarring at the left apex most likely secondary to radiation\ntherapy, stable since ___.  No lung nodules or masses are\nidentified.\n2. AIRWAYS:  The airways are patent to subsegmental levels bilaterally. \nDiffuse mild bronchial wall thickening.\n\nCHEST CAGE: No acute fractures.  Unchanged appearance of the T5 and T8\ncongenital deformity featuring butterfly configuration.  No lytic or sclerotic\nlesions.",
            "output": "-Stable subcentimeter mediastinal lymph nodes.  No pathologically enlarged\nlymph nodes by size criteria.\n-1.7 cm x 1 cm soft tissue nodule in the left breast abutting the left\nanterior chest wall, with unchanged skin thickening over the left breast,\nstable since ___.\n\nRECOMMENDATION(S):  Dedicated imaging of the left breast should be considered\nfor further evaluation of the left breast abnormalities described above."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged. Please refer to\nseparate report of CT neck performed on the same day for additional\ndescription of the neck findings.  Although study is not optimized for\nevaluation of breast tissue, there is a 14 mm x 9 mm nodule of the left breast\nabutting the chest wall, stable since ___, consistent with known history\nof left breast cancer, status post surgery and most likely radiation.. \nRight-sided chest Port-A-Cath noted with tip in the right atrium.\n\nMEDIASTINUM: Esophagus is normal.  7.5 x 5 mm periaortic lymph node, stable\nsince ___ (6:71).  9.6 x 7.5 mm and 7.9 x 6.9 mm right and left\nparatracheal nodes stable since ___ (6:84).  No new enlarged lymph\nnodes are seen.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is mildly enlarged and there is no coronary arterial\ncalcification.  Normal calcifications of the mitral and aortic valves.  There\nis no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nMild calcification of the thoracic aorta noted.  The main, right, and left\npulmonary arteries are normal caliber.  Narrowing of the proximal left\nsubclavian artery, series 5, image 13 is present.\n\nPULMONARY PARENCHYMA: Left upper lobe subpleural reticulations in apical\nground-glass are stable consistent most likely with previous breast radiation.\nLeft basal, right middle lobe areas of atelectasis are minimal.  Endobronchial\nsecretions in the right lower lobe, series 6, image 184 are mild.  Minimal\nbronchiectasis in the right middle lobe are unchanged.  No new nodules masses\nor consolidations demonstrated.  There is no evidence of infection or\nmalignancy.  There is no emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.  Left apical scarring stable since\n___, likely secondary to radiation therapy.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  Midthoracic vertebral posterior\ncompression fracture is stable\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "No evidence of thoracic disease recurrence\n\nStable postradiation and postsurgical changes after left breast cancer therapy\n\nInterval resolution of pleural effusion.\n\nPlease review CT neck and CT abdomen that will be reviewed separately."
        },
        {
            "input": "NECK: Please see the CT neck report dated the same day for further evaluation\nof the neck.\n\nTHORACIC INLET, AXILLAE, CHEST WALL: No enlarged or growing axillary lymph\nnodes.  Stable 14 mm x 9 mm density in the left breast, abutting the chest\nwall is likely post treatment in nature.  The patient is status post left\nbreast surgery and radiation.  Breast assessment is reserved for dedicated\nbreast imaging.  Excluding the breasts, no soft tissue chest wall abnormality.\nChest port in place in the right anterior chest wall, with the tip at the\nsuperior cavoatrial junction.  Mild atherosclerotic calcification of the\nimaged neck arteries.\n\nUPPER ABDOMEN: Please see the CT abdomen and pelvis report dated the same day\nfor evaluation of the abdomen and pelvis.\n\nMEDIASTINUM: Normal esophagus.  Mediastinal lymph nodes are stable in size,\nfor example a right lower paratracheal node is unchanged, measuring 1 cm x 0.8\ncm (3:67), and a prevascular node measures 0.8 cm x 0.5 cm (3:63).  No\nmediastinal mass.  The thoracic aorta and pulmonary arteries are normal in\ncaliber.  No atherosclerotic calcification of the thoracic aorta.\n\nHILA: No enlarged or growing hilar lymph nodes.\n\nHEART and PERICARDIUM: Unchanged mild cardiomegaly.  Possible minimal coronary\nartery.  Mild aortic valve calcification.  Physiologic pericardium.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Mild left upper lobe subpleural reticulation is stable and\nlikely secondary to prior breast radiotherapy.  No lung nodule or mass.  No\nconsolidation.  Mild bibasal linear atelectasis.\n2. AIRWAYS:  The tracheobronchial tree is patent to the subsegmental level. \nNo bronchial wall thickening or bronchiectasis.\n3. VESSELS:  Allowing for the non dedicated nature of the examination, no\nfilling defects in the pulmonary arteries.\n\nCHEST CAGE: Stable mild loss of vertebral body height posteriorly in T5 and T8\nvertebral bodies.  No lytic or sclerotic lesion concerning for infection or\nmalignancy.  Old fractures of the left fifth and sixth ribs laterally.  No new\nfracture.",
            "output": "-Stable small lymph nodes.\n-No lung nodule or mass.\n\n-Stable mild left upper lobe subpleural reticulation, likely secondary to\nprior breast radiotherapy.\n-Stable 14 mm density in the left breast, abutting the left anterior chest\nwall, likely post treatment in nature."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall. No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion.  Mild\natherosclerotic calcifications in the aorta, none in the coronary arteries or\ncardiac valves.  The aorta and pulmonary arteries are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Small\nmediastinal lymph nodes, none pathologically enlarged by CT size criteria. No\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nRespiratory motion artifacts impair optimal parenchymal evaluation. The\nairways are patent to the subsegmental levels.  Mild bronchial wall\nthickening, no bronchiectasis or mucus plugging.  Moderate centrilobular\nemphysema, upper lobe predominant.  Small scattered calcified granulomas, for\nexample in the left lower lobe (5:212).  Micronodule in the left upper lobe\n(8:57).  Non dependent subpleural nodular opacity in the lingula measuring 1.1\ncm(8:171).  No suspicious lung nodules or masses. No consolidations or\natelectasis.\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show a splenule, similar to prior CT\ncolonography from ___.",
            "output": "Motion limited exam.\n11 mm subpleural nodular lesion in the lingula, possibly atelectasis or\nscarring, but follow-up is needed for reassessment.\nEmphysema and mild bronchitis, smoking related changes.\n\nRECOMMENDATION(S):  Chest CT in 3 months, with contrast if endometrial\nmalignancy is confirmed.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:04 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "BASE OF NECK: There is a 0.8 cm right thyroid nodule and a 0.7 cm left thyroid\nnodule.\n\nTHORACIC LYMPH NODES: Supraclavicular, axillary, mediastinal, and hilar lymph\nnodes are not pathologically enlarged or growing.\n\nCARDIO-MEDIASTINUM: A central venous catheter terminates in the lower SVC. \nThe thoracic aortic is normal in caliber. The pulmonary arteries are normal\ncaliber. The heart is not enlarged. There is no pericardial effusion.\n\nAIRWAY: There is opacification of the distal left lower lobe bronchus,\nconsistent with mucous plugging (5:157).  There is mild diffuse bronchial wall\nthickening.\n\nLUNGS: There is moderate centrilobular emphysema with biapical predominance. \nScattered left lower lobe calcified granulomas are noted.\n\nPLEURA: There is no pleural effusion.\n\nCHEST CAGE: Partially visualized sclerotic right humeral lesion is consistent\nwith a bone island.  Although there are no bone lesions in the imaged chest\ncage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning. Evaluation of breast is reserved\nexclusively for mammography.\n\nUPPER ABDOMEN: Please refer to separate report on same-day MR abdomen/pelvis\nfor description of the abdominal findings.",
            "output": "1. Distal left lower lobe bronchus mucous plugging and mild diffuse bronchial\nwall thickening could be related to chronic bronchitis.\n2. No evidence of intrathoracic metastasis."
        },
        {
            "input": "HEART AND VASCULATURE: There is a linear central filling defect at a branch\npoint between segmental and subsegmental vessels within the left lower lobe\n(6:173).  Elsewhere, pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.  A central venous catheter\nterminates in the lower SVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Moderate centrilobular emphysema is again seen.  There are\ndiffuse centrilobular nodules throughout the lungs, increased in prominence\nthroughout.  Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Specifically, the distal left lower lobe bronchus is now patent.\nThere is diffuse mild bronchial wall thickening, similar to prior.\n\nBASE OF NECK: 0.7 cm and 0.6 cm hypoattenuating nodules within the right and\nleft thyroid lobes, respectively, are unchanged.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable. \nSpecifically, no new findings compared to the study performed 2 weeks prior.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Pulmonary embolus at a branch point between a left lower lobe segmental and\nsubsegmental vessel.  No signs of right heart strain or infarcted parenchyma\n2. Moderate centrilobular emphysema with increased prominence of diffuse\ncentrilobular nodules throughout the bilateral lungs which can be seen in\nrespiratory bronchiolitis or hypersensitivity pneumonitis.  No focal\nconsolidation.\n3. Persistent mild bronchial wall inflammation which is likely chronic.\n\nNOTIFICATION:  Updated findings discussed with ___, MD by ___\n___, MD via telephone at 17:50 on ___, 5 minutes after discovery."
        },
        {
            "input": "Aorta is normal in diameter.  Pulmonary arteries are not dilated.  No evidence\nof pulmonary embolism is seen on the current study within the limitations of\nthe study technique\n\nCentral line (Port-A-Cath) terminates in the proximal right atrium.\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nemphysema is moderate.  Right upper lobe apical triangular opacity is new but\nmost likely represents atelectasis, series 5, image 76.  Diffuse bronchial\nwall thickening is extensive, most likely consistent with bronchial airways\ninflammation.  Bibasal atelectasis is minimal, stable.  Left lower lobe\ncalcification is unchanged.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nImage portion of the upper abdomen demonstrate mild hydronephrosis, partially\nimaged of the left kidney as well as liver hypodensities consistent with\nmetastatic disease.  Please review findings and description of the MRI of the\nabdomen and pelvis that was obtained on ___.",
            "output": "No definitive evidence of intrathoracic metastatic disease.\n\nModerate emphysema and bronchitis\n\nEvidence of metastatic disease, partially imaged.  Please review MRI of the\nabdomen and pelvis that was obtained on ___ for intra-abdominal\nfindings."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating, suggestive of\nsteatosis.  The liver contour is mildly nodular, which may reflect chronic\nliver disease versus cirrhosis.  There are scattered areas of focal fatty\nsparing with no suspicious focal lesion.  There is no evidence of focal\nlesions.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains many hyperdense gallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen measures 13.4 cm in craniocaudal dimension but demonstrates\nhomogeneous attenuation throughout, without evidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix contains high-density material\nbut is normal in size without adjacent mesenteric fat stranding.  There is no\nfree intraperitoneal fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is trace free\nfluid within the pelvis.\n\nREPRODUCTIVE ORGANS: Again seen is a 2.8 x 2.4 cm exophytic fibroid, not\nsignificantly changed compared to the prior exam.  There is no adnexal\nabnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.  The portal splenic and mesenteric veins are patent.  Paraesophageal\nand esophageal varices are identified in addition to the collaterals arising\nfrom the falciform ligament including umbilical vein is patent.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of pulmonary embolism or acute intrathoracic abnormality.\n2. Interval resolution of right pleural effusion and abdominal ascites.\n3. No evidence of acute abdominopelvic abnormality.\n4. Cholelithiasis."
        },
        {
            "input": "The thyroid is normal.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nLeft lower paratracheal lymph node (series 5: Image 22) is unchanged since\n___.  Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification.\n\nThere is no pericardial or pleural effusion.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  6 mm subpleural nodule\nin the left lower lobe (series 6: Image 208) is unchanged since ___. Punctate right nodule (06:53) is stable since ___, probably not\nvisible in the CT of ___ for different technique. Right lower and\nmiddle lobes lung nodules, smaller than 4 mm (06:164, 178) are unchanged since\n___. Perifissural nodule in the left lower lobe (06:134) is also\nstable since ___. 5 mm left lower lobe trauma is unchanged since\n___.\n\nUPPER ABDOMEN\nAbdominal findings are described in report of concurrent CT abdomen pelvis,\nclip ___.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. There is no evidence of intrathoracic malignancy.\n2. All lung nodules are stable since ___.  Follow-up can be\nscheduled according clinical protocol.\n3. There is no lymphadenopathy"
        },
        {
            "input": "Thyroid gland is unremarkable.  Aortopulmonic lymph node is 8 mm, minimally\nincreased as compared to 7 mm on the prior study, series 5, image 19. Aorta\nand pulmonary arteries are normal. Heart size is normal. There is no\npericardial or pleural effusion. Image portion of the upper abdomen will be\nreviewed separately is part of the CT abdomen and corresponding report will be\nissued\n\nAirways are patent to the subsegmental level bilaterally. 2 pulmonary nodules\nare stable, in left lower lobe, series 4, image 165 and in right upper lobe,\nseries 4, image 120 tube with no new pulmonary nodules O consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest was no evidence of intrathoracic malignancy."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal.  There is no supraclavicular,\naxillary, mediastinal, or hilar lymphadenopathy.  The aorta and pulmonary\narteries are normal in size.   The heart size is normal and there is no\npericardial effusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There are\nno findings of diffuse lung disease.  A small number of 2 mm nodules are\nstable since at least ___ (4:137, 153, 210). A 5 mm subpleural nodule\nin the left lower lobe is probably unchanged as far back as ___,\nwithin the limitation of comparing images with different slice thickness\n(4:209).  Another 5 mm subpleural nodule in the left lower lobe is also stable\nfrom ___ (4:220). A calcified granuloma in the superior segment of the left\nlower lobe is unchanged (4:119). There are no new pulmonary nodules.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. No new or progressive intrathoracic abnormalities to suggest metastatic\ndisease\n2. Stable pulmonary nodules up to 5 mm."
        },
        {
            "input": "The thyroid gland is within normal limits.  There is a right chest\nsubcutaneous port with distal tip in the high right atrium.  The esophagus is\nwithin normal limits.  There is no hiatus hernia.  The aorta and pulmonary\nartery are normal in caliber.  There is a normal 3-vessel aortic arch, with\nall major aortic arch branch vessels appearing widely patent and unremarkable.\nThere is no coronary artery calcification.  The heart and pericardium are\nunremarkable.  There is no pericardial effusion.  New since prior exam is\nbulky mediastinal lymphadenopathy.  For example, a large right paratracheal\nnode measures 2.1 x 1.3 cm (series 4, image 23).  A prominent high right\nparatracheal node measures 1.3 x 0.6 cm, increased in size since prior (series\n4, image 70).  A prominent paraesophageal node near the thoracic inlet\nmeasures 1.0 cm in short axis (series 4, image 18), significantly larger since\nprior.  An AP window lymph node measures 2.1 x 1.8 cm (series 4, image 24).  A\nprecarinal rounded and enhancing node measures 1.3 x 1.1 cm (series 4, image\n26).  Prominent, enhancing subcarinal soft tissue measures 3.8 x 1.3 cm in\naggregate (series 5, image 22), consistent with subcarinal lymphadenopathy.  A\nprominent left peribronchial node measures 1.9 x 1.4 cm (series 5, image 165).\nHeterogeneously enhancing left supraclavicular lymphadenopathy is new (for\nexample see series 5, image 53 above, as well as series 7, image 24), with\nindividual nodes measuring up to 1.6 x 1.2 cm (5:52). A prominent 7 mm\nretrocrural lymph node (series 5, image 287) is stable.  There is no axillary\nor hilar lymphadenopathy.\n\nMajor airways are patent to subsegmental levels.  A 3 mm right middle lobe\nnodule is stable (series 5, image 172).  A 2 mm right middle lobe subpleural\nnodule is stable (series 5, image 188).  A 2 mm right upper lobe nodule is\nunchanged (series 5, image 97).  A 5 mm pleural-based left lower lobe nodule\nis unchanged (series 5, image 226).  Re-identified is a 5 mm superior segment\nof the left lower lobe calcified granuloma.  A 3 mm medial left lower lobe\nnodule is unchanged (series 5, image 230).  A 3 mm right lower lobe nodule is\nunchanged (series 5, image 181).  There is no pleural abnormality.  There is\nno pleural effusion or pneumothorax.\n\nThe imaged subcutaneous soft tissues of the chest wall are within normal\nlimits.  There is minimal thoracic spine degenerative change.  Alignment is\nnormal.  Vertebral body heights are preserved.  No concerning focal lytic or\nsclerotic osseous lesions are identified.",
            "output": "1. New bulky, heterogeneously enhancing mediastinal and left supraclavicular\nlymphadenopathy is highly concerning for metastases.\n2. Multiple stable pulmonary nodules measuring up to 5 mm, detailed above.  No\nnew or growing pulmonary nodules.\n3. Please see separate report for subdiaphragmatic findings from same-day CT\nabdomen/pelvis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular infraclavicular or\naxillary lymphadenopathy.  The right Port-A-Cath is in stable position. \nIncidental note is made of a newly appeared segmental left lower lobe\npulmonary embolus (5, 35).\n\nThe pre-existing an known bulky lymphadenopathy has minimally decreased in\nsize.  For example, a reference lymph node in right paratracheal location (5,\n20 has decreased from 13-21 mm to now 17 x 9 mm.\nThe second reference lymph node in the aortopulmonary window (5, 21) has\ndecreased from 16 x 24 to now 9 x 20 mm.\nThe same tendency is noted with respect to the remaining previously enlarged\nlymph nodes in the mediastinum.\n\nAs on the previous examination, the presence of as a calcified granuloma is\nverified (6, 124).  Several millimetric pulmonary nodules (6, 185) are also\nunchanged.  No new or growing nodules.  No pleural effusions.  No pleural\nthickening.  The airways are patent.",
            "output": "Decrease in size of the pre-existing enlarged mediastinal lymph nodes.\nNo new or growing nodes in the mediastinum or in the lung parenchyma.\nNote is made of an incidental left segmental pulmonary embolus.\n\nNOTIFICATION:  At the time of dictation and observation, 14:41, on the ___, the referring physician ___ was paged for notification and the\nfindings were discussed 1 min later over the telephone."
        },
        {
            "input": "Several mediastinal lymph nodes in the right upper paratracheal area have\nincreased as compared to previous study, from 7 to 9 mm, from 9 x 17 to 15 x\n18 mm and in the sub- carinal area from 8-13 mm.  Left hilar lymph nodes when\nnot present but currently are enlarged up to 7 mm.  Sub- carinal and\nparaesophageal lymph nodes are up to 9 mm as compared to 7 mm does enlarged.\n\nNo axillary or supraclavicular pathologically enlarged lymph nodes\ndemonstrated although bilateral supraclavicular lymph nodes are present\nranging up to 7 mm, seen on the previous study, left more than right.\n\nAirways are patent to the subsegmental level bilaterally.  Left lower lobe\nsubpleural nodule is 8 x 5 mm as compared to 3.5 x 3.5 mm, series 6, image\n218, does increased since the previous examination.  Several additional\npulmonary nodules are stable series 6, image 150, with 210.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval increase in left lower lobe pulmonary nodule as well as mediastinal\nlymphadenopathy, concerning for metastatic disease.  Short-term followup in 3\nmonths is required.  Alternatively mediastinal potentially transbronchial\nbiopsy is to be considered."
        },
        {
            "input": "Right axillary lymph nodes are enlarged up to 14 x 17 mm, 4:62, previously\nsubcentimeter.  Specifically excluding the breasts which require mammography\nfor evaluation, there are no soft tissue abnormalities in the chest wall\nsuspicious for malignancy.  Findings below the diaphragm will be reported\nseparately.\n\n13 x 11 mm wide region of hypodensity in the right thyroid lobe is newly\napparent since ___, and best evaluated by thyroid ultrasound.\n\nA 15 x 37 mm conglomerate of left supraclavicular lymph nodes, 04:19, is\nunchanged since ___.  The same cluster was 21 x 36 mm on ___ x 45\nmm on ___.  Right supraclavicular lymph nodes are smaller, unchanged.\n\nCentral adenopathy:\n\nRight upper paratracheal, 13 x 21 mm in aggregate, 02:15, previously 18 x 22\nmm.\n\nRight lower paratracheal, 13 x 23 mm, 02:19, previously 16 x 27 mm.\n\nRight hilus, 23 x 31 mm, 4:89, previously 14 x 17 mm.\n\nRight hilus, 10 x 21 mm, 4:113, previously 9 x 17 mm.  Left hilus, 10 x 27 mm,\n4:101, previously 5 x 14 mm.\n\nDespite the increase in hilar adenopathy, bronchi are not compromised.\n\nAtherosclerotic calcification is not apparent in head neck vessels and is\nminimal in coronary arteries.  Aorta and pulmonary arteries are normal size.\nModerate pericardial effusion is new.  There is no evidence of tamponade\nphysiology.    There is no pleural effusion.\n\nModerate cardiomegaly is also new.\n\nLungs:\n\n7 mm right juxta fissural nodule, 4:106, was 3 mm in ___ mm right middle lobe nodule, 4:117, unchanged.\n\n10 mm left lower lobe nodule, 4:149, was 7 mm in ___.\n\nStellate 8 mm left lower lobe nodule is new.  Lymphatic engorgement locally\nhas increased suggesting lymphatic invasion of tumor.\n\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Mixed response to treatment, generally showing recurrence as follows:\n\nAlthough paratracheal mediastinal adenopathy has decreased slightly, bilateral\nhilar adenopathy has increased substantially.  Right axillary adenopathy is\nnew.  And a large cluster of left supraclavicular nodes has not changed since\n___.\n\nSmall to moderate pericardial effusion is new.  No findings to suggest\ntamponade.\n\nTwo Cm size lung nodules have grown since ___ and a second centimeter-sized\nleft lower lobe nodule is new in a region of probable lymphangitic tumor\ninvasion."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  There is substantial\ninterval decrease in paratracheal lymphadenopathy as well as in the right\nhilar lymphadenopathy with currently sub 5 mm lymph nodes seen as compared to\nlymphadenopathy ranging up to 13 mm previously.  There is no pericardial\npleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately\n\nAirways are patent to the subsegmental level bilaterally.\n\nNo new pulmonary nodules masses or consolidations demonstrated.  Left lower\nlobe previously seen pulmonary nodule, series 6 image 213 is unchanged, 9.8\nmm.  There is interval improvement and lymphangitic thickening in the left\nlower lobe, series 6, image 210 with these central nodule in this location\nbeing 3.4 mm as compared to 6 mm on the previous study, series 6, image 210.\n\nImage portion of the skeleton demonstrate interval increase in scleroses of\nT11 and more discrete nodular opacities with sclerotic margins in the T5 most\nlikely corresponding to treatment response.  No new bone lesions demonstrated.",
            "output": "Interval substantial decrease in size in mediastinal and hilar lymphadenopathy\nas well as improvement of lymphangitic spread within the left lower lobe\n\nInterval substantial decrease in size in right axillary lymphadenopathy.  No\nsupraclavicular lymphadenopathy seen\n\nProgression of the sclerotic component of previously existing bone metastasis."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  The enhancement is\npreserved.  Several mediastinal lymph nodes are unchanged compared to previous\nexamination.  Left hilar lymph node is 12 x 5 mm, unchanged.  Right hilar\nlymph node is 13 x 5 mm, unchanged.\n\nHeart size is normal.  There is no pericardial pleural effusion.  Image\nportion of the upper abdomen will be reviewed separately as part of the CT\nabdomen and pelvis in corresponding report will be issued.\n\nNo axillary lymphadenopathy is present.\n\nSclerotic bone lesions are similar to previous examination in the overall size\nand appearance.  No new bone lesions detected within the limitations of the CT\ntechnique.\n\nAirways are patent to the subsegmental level bilaterally.  Pre-existing\npulmonary nodules all stable including the largest 1 in the left lower lobe in\nsubpleural location, measuring 7.5 x 4 mm given minimally decreased compared\nto 9.3 x 6 mm on the previous study.  On the other hand there is interval\nprogression of septal thickening with nodularity in the left lower lobe,\nseries  7 image 209; in the lingula, series 7, image 174, highly concerning\nfor lymphangitic carcinomatosis.",
            "output": "Overall stability of pulmonary nodules, mediastinal lymph nodes and bone\nmetastasis\n\nInterval progression of left lower lobe and lingular lymphangitic\ncarcinomatosis."
        },
        {
            "input": "The thyroid is normal.  Calcified left hilar lymph nodes are noted.  Multiple\ntop-normal mediastinal lymph nodes are noted largest measuring 1.1 x 0.6 cm\n(02:17) within the anterior paratracheal region as well as 2.5 x 1 cm (02:20)\nwithin the subcarinal region.  No supraclavicular, axillary, or hilar\nlymphadenopathy.\n\nAorta is normal size.  Mildly enlarged pulmonary arteries compatible with\npulmonary arterial hypertension.  The heart is mildly enlarged with coronary\nartery, aortic valve, and mitral valve calcifications.  No pericardial\neffusion.  A left internal jugular central hemodialysis catheter tip is in the\nright atrium.  Extensive atherosclerotic calcifications are noted.\n\nSmall amount secretions noted above the carina.  The airways are otherwise\npatent to the subsegmental level.  Lungs are notable for ground-glass opacity\nwithin the medial segment of the right middle lobe as well as a ground-glass\nand more confluent opacity in the right lower lobe.  Arising from the right\nmajor fissure is a 0.9 x 0.8 cm spiculated density with associated\nbronchiectasis, and tethering of the major fissure.  3 mm left lower lobe\nground-glass nodule (4:130).  Focal bronchial wall thickening with confluent\nconsolidative opacity in the left lower lobe is noted.  Fluid is seen within\nthe left major fissure.  Moderate right and small left non hemorrhagic pleural\neffusions are noted.\n\nNo focal lytic or blastic lesions worrisome for malignancy.  The soft tissues\nare unremarkable.\n\nLimited assessment of the upper abdomen is notable for cholelithiasis,\nprominent vascular calcifications, and trace amount of perihepatic free fluid.",
            "output": "1.  Right middle lobe and right lower lobe multifocal pneumonia or aspiration\npneumonia.\n2.  Left lower lobe bronchopneumonia with bronchial wall thickening and\nconfluent opacity.\n3.  0.9 cm spiculated density along the right major fissure with associated\nbronchiectasis and tethering of major fissure may represent scarring, but\ncannot exclude malignancy.  Follow-up is required.\n4.  Moderate right and small left non hemorrhagic pleural effusions.\n5.  Cholelithiasis\n6.  Trace perihepatic free fluid.\n7.  3 mm left lower lobe ground-glass nodule.  Close attention on followup is\nrecommended.\n8.  Calcified left hilar lymph node consistent with prior granulomatous\ndisease.\n\nRECOMMENDATION(S):  Given presence of current infectious process, recommend\nconsideration of short interval followup with repeat dedicated chest CT in ___\nweeks to reassess the right upper lobe pulmonary nodular density as well as\nthe bilateral consolidative opacities.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 10:29 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "The thyroid is normal.\nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\n7 mm right lower paratracheal lymph node (series 3: Image 22) is unchanged\nsince ___.  Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is stable moderate coronary calcification,\nmainly in the left anterior descending and left circumflex coronary artery. \nPatient has had median sternotomy for cardiac surgery.  Atherosclerosis is\nmoderate with dense calcification at the origin of the supraaortic branches,\nespecially of the left subclavian artery (03:14).\n\nThere is no pericardial or pleural effusion.\n\nLUNG AND AIRWAYS\nAirways are patent to subsegmental level bilaterally.  Mild bronchiolectasis\nis in the medial segment of the right middle, unchanged since ___.\nBiapical pleural-parenchymal scarring is overall stable since oval ___, more\nsevere to the right apex (4:7). Mild centrilobular emphysema and bronchial\nwall thickening are smoking-related. Less than 3 mm ___ nodule in\nthe right upper lobe (05:133) and 4 mm subpleural nodule in the lateral\nsegment of the right middle lobe (5:186) are unchanged since ___ and\nnot concerning for malignancy. Parenchymal scarring in the medial segment of\nthe right middle lobe (05:179) and small calcified granuloma in the right\nupper lobe (05:141) are unchanged since ___.  There are no new lung\nnodules concerning for malignancy.\n\n\nUPPER ABDOMEN\nEven though this exam is not tailored for abdominal imaging, the upper abdomen\nis unremarkable.  Mild homogeneous lower thirds of the esophagus wall\nthickening is likely due to esophageal reflux.\n\n\nOSSEOUS STRUCTURES\nThere are no bone lesions suspicious for malignancy or infections.",
            "output": "1. All lung nodules are stable since ___, therefore are benign.  There\nare no new lung nodules suspicious for malignancy.\n2. Mild bronchial wall thickening and centrilobular emphysema are\nsmoking-related, stable since ___.\n3. Moderate aortic atherosclerosis with severe narrowing of the origin of the\nleft subclavian artery"
        },
        {
            "input": "Subcentimeter hypodensity in right lobe of thyroid gland is not fully\ncharacterized by CT.  There are no enlarged mediastinal, axillary, or hilar\nlymph nodes.  Borderline left hilar nodes measure up to 9 mm in diameter.  A\ncluster of subcentimeter lymph nodes is noted in the right pericardial region,\nslightly prominent for this nodal station.\n\nHeart size is normal, and focal coronary artery calcifications are present. \nThere is no pericardial or pleural effusion.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nof the spine.  A few tiny lucencies are observed within the proximal thoracic\nspine and sternum, too small to characterize by CT.\n\nWithin the lungs, a cluster of calcified granulomas is present at the right\nlung apex with adjacent all linear scarring and a few contiguous noncalcified\nor partly cuff calcified nodules.  Mild emphysema is present with\ncentrilobular and paraseptal features.  Several on small noncalcified\npulmonary nodules are also demonstrated, including a 3 mm left lower lobe\nnodules (images 293 and 176, series 6) and a 2 mm lingular nodule (156, 6).",
            "output": "1.  3 small noncalcified lung nodules are indeterminate and may be reassessed\nby a surveillance CT in 3 months.  At the same time, subcentimeter lymph nodes\nand skeletal lucencies may also be reassessed.\n\n2.  Predominantly calcified nodules in right lung apex are likely a sequela of\nprevious granulomatous infection.  At the time of the followup CT, this area\nshould be reassessed for stability to exclude an active process.\n\n3.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  Non small right thyroid nodule.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  The left\npectoral Port-A-Cath is unchanged.  No hilar or mediastinal lymphadenopathy. \nUnchanged moderate coronary calcifications.  No valvular calcifications.  No\npericardial effusion normal posterior mediastinum.  The upper abdominal organs\nare described in detail in the dedicated abdominal CT report.  No osteolytic\nlesions at the level of the sternum, the ribs and the spine.  There is\nunchanged evidence of paraseptal emphysema.  Stable appearance of the\ncalcified nodule conglomerate in the right upper lobe.  A pre-existing solid\nleft lower lobe nodule has slightly grown, from 3-5 mm (5, 133).  No other new\nor growing nodules.  No pleural effusions.  No pleural thickening.  No diffuse\nlung disease.",
            "output": "Interval growth or pre-existing solid left lower lobe nodule.  Otherwise\nstable morphology as compared to ___."
        },
        {
            "input": "Right thyroid nodule is unchanged.  Aorta and pulmonary arteries are overall\nunremarkable.  Heart size is normal.  There is no pericardial pleural\neffusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Apical scarring,\nbulla and calcified nodules are unchanged.  The are consistent with previous\ngranulomatous exposure.  Mild centrilobular emphysema is unchanged.  The\nmultiple pulmonary nodules appear to be stable since prior study was no new\nnodules muscle consolidations demonstrated:  Series 4 images 59, 71, 115, 116,\n121, 138, 132, 136, 147, 157, 173, 186, 198, 199.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest was no evidence of interval progression\nincluding left lower lobe  largest nodule, 7.2 mm in diameter."
        },
        {
            "input": "Aorta and pulmonary arteries are overall unremarkable.  Heart size is normal. \nThere is no pericardial or pleural effusion.  No mediastinal, hilar or\naxillary lymphadenopathy is present.\n\nImage portion of the upper abdomen including multiple liver metastatic lesions\nwill be assessed separately as part of the CT abdomen and pelvis.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.\n\nAirways are patent to the subsegmental level bilaterally.  Right upper lobe\nppm calcifications and areas of nodular opacity and paraseptal emphysema are\nunchanged.\n\nMultiple pulmonary nodules are stable, series 4, image 62, 74, 100 and 4, 118,\n126, 130, 135, 152, 188, and the largest 1 in the left lower lobe, 202, 8.2 mm\nin diameter.  Few pulmonary nodules slightly smaller, in the left upper lobe,\nseries 4, image 32, 138.  No new nodules or masses demonstrated.",
            "output": "Multiple pulmonary nodules as described with the vast majority of them being\nstable including the largest nodule in the left lower lobe and few being\nslightly smaller."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is no coronary arterial\ncalcification.  There is no pericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThe main, right, and left pulmonary arteries are normal caliber.  An accessed\nleft pectoral Port-A-Cath catheter tip terminates in the cavoatrial junction.\n\nPULMONARY PARENCHYMA:  Numerous subcentimeter pulmonary nodules are seen\nbilaterally.  The majority have increased slightly in size, worrisome for\nprogressive metastatic disease.  A representative right upper lobe nodule\nmeasures 6 x 5 mm, previously 5 x 4 mm (8:152).  Numerous additional nodules\nhave increased in size by several millimeters.  Partially calcified scarring\nin the right upper lobe is likely related to prior tuberculous infection,\ngrossly unchanged from the immediate prior study.  Soft tissue density in the\nregion of previous cystic change is likely inspissated secretions, grossly\nsimilar to ___ although new from ___ (08:39).  Since there has been\nno progression common this does not suggest reactivation tuberculosis.  There\nis mild centrilobular emphysema.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nScattered small areas of sclerosis in the left-sided ribs are unchanged from\n___ (8:204, 207, 229).  Multilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "1. Slight interval increase in size of numerous pulmonary nodules concerning\nfor progressive metastatic disease.\n2. Grossly stable partially calcified scarring in the right lung apex likely\nrelates to prior tuberculosis.\n3. Please see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "No incidental thyroid findings.  A known 4 mm right thyroid nodule (9, 12) is\nstable.  Left pectoral Port-A-Cath is unchanged.  Stable appearance of the\nlarge mediastinal vessels.  No incidental pulmonary embolism.  No pericardial\neffusion.  Upper abdominal findings are reported in detail in the dedicated\nabdominal CT report, including the massive metastatic liver disease.\nOsteoporotic impression at the level of L3 is stable (13, 54).  Stable\nappearance of ribs and sternum.  The post granulomatous right upper lobe\nchanges are stable.  Several of the pre-existing pulmonary nodules, notably at\nthe level of the lower lobes (for example series 10, image 173, 159, and 129).\nMight have minimally grown, but the range of growth is in millimetric\n___.  Other pre-existing pulmonary nodules, for example in the left\nupper lobe (10, 96) are normal.  The airways are patent.  No pleural effusions\nare visualized.",
            "output": "Minimal growth of several of the pre-existing pulmonary nodules, other\npulmonary nodules are stable.  No evidence of new pulmonary nodules.  Known\nright upper lobe post granulomatous changes are stable.  No pleural\nabnormalities.  No lymphadenopathy."
        },
        {
            "input": "CTA THORAX:  The aorta and main thoracic vessels are well-opacified.  The\naorta demonstrates normal caliber throughout the chest without evidence of\nintramural hematoma or dissection.  Apparent soft atherosclerotic plaque-like\nwall thickening severely narrows the innominate artery and innominate-right\nsubclavian junction (series 3, image 46, as well as series 601b, images 31 and\n32).  Similarly, there is also severe narrowing and apparent occlusion of the\nproximal right vertebral artery just past its origin (see series 3, images\n35-31, in addition to series 601b, images 34 and 35).  Further, there is an\napproximately 5 cm long segment of right subclavian/axillary artery which\ndemonstrates diffuse, irregular intraluminal soft plaque like soft tissue\nmaterial which results in moderate luminal narrowing; additionally, there is\nsignificant surrounding fat stranding and inflammatory change (best seen on\nseries 601b, image 30).  The left subclavian and axillary arteries, left\ncommon carotid, and left vertebral arteries are patent and grossly\nunremarkable.\n\nThe pulmonary artery is well-opacified to subsegmental levels.  There is no\nevidence of intraluminal defect in the main, right, left, lobar, or\nsubsegmental pulmonary arterial branches.  No arteriovenous malformation is\nidentified.\n\nCT THORAX:  The thyroid is unremarkable.  The esophagus is within normal\nlimits without evidence hiatus hernia.  The heart size top-normal.  There is\nno pericardial effusion.  There is no definite evidence of atrial or\nventricular thrombus, although this assessment is somewhat limited on this\nnon-gated study.  A prominent AP window lymph node measures 9 mm in short axis\n(series 2, image 38).  Otherwise there is no supraclavicular, axillary, or\nhilar lymphadenopathy.  The airways are patent to subsegmental levels.\n\nLung windows demonstrate bibasilar dependent and platelike atelectasis.  A\nmore focal 1.5 x 1.0 cm area of ground-glass opacity in the right upper lobe\n(series 2, image 44) is possibly infectious in nature.  Otherwise, the lungs\nare clear.  There is no pleural or pericardial effusion.  There is no\npneumothorax.\n\nThe partially visualized upper abdominal solid and hollow viscous organs are\nunremarkable.\n\nMUSCULOSKELETAL:  There is mild degenerative change of the imaged\nthoracolumbar spine, including anterior osteophytes.  Alignment is normal.  No\nconcerning focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. Soft-plaque-like moderate narrowing with surrounding inflammatory change of\n5 cm of the right subclavian/axillary artery with total occlusion of the\nproximal right vertebral and innominate arteries.  Although findings could\nrepresent severe atherosclerotic disease, given this patient's age and gender\nin conjunction with overall appearance including asymmetry and inflammatory\nchanges, findings are more suspicious for a medium-vessel vasculitis.\n2. No evidence of pulmonary embolism.\n3. 1.5 cm ground-glass nodule in the right upper lobe, possibly infectious. \nRecommend dedicated chest CT in 6 months to confirm resolution.\n\nRECOMMENDATION(S):  Recommend 6-month followup dedicated chest CT to confirm\nresolution of right upper lobe ground-glass opacity.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 12:14 ___, 30 minutes after discovery of the\nfindings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart is top-normal in size.  The pericardium and\ngreat vessels are within normal limits.  Previously described filling defects\nin the right subclavian artery are not well assessed due to streak artifact\nfrom contrast administered on the right upper extremity although slight\nirregularity is noted in the bilateral subclavian arteries which may represent\natherosclerotic disease.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  Right hilar, prevascular, and subcarinal lymph nodes are mildly\nprominent, stable from ___.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild atelectasis in the left lung base.  Previously\nseen ground-glass opacity in the right upper lobe has resolved.  There is no\nfocal consolidation to suggest infection.  A 4 mm pulmonary nodule in the left\nupper lobe is stable from ___ does not require additional dedicated\nfollow-up.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild bronchial wall thickening suggests small airway\ninflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Epiphrenic\nand portocaval lymph nodes are mildly prominent and unchanged.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Small airway inflammation."
        },
        {
            "input": "Patient is status post resection of a right lower lobe lung mass with a left\nlower lobe lobectomy and associated postsurgical changes, subcutaneous\nemphysema along the left anterior chest wall, left lateral neck, and left\nlateral chest, as well as Mediastinal clips.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  Calcified and\nnoncalcified atherosclerotic plaque is present. There is no evidence of\npenetrating atherosclerotic ulcer.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland is unremarkable.\n\nA trace pericardial effusion is new.  No right pleural effusion.  A moderate\nleft non hemorrhagic pleural effusion is new.\n\nA moderate left hydro pneumothorax is new.  Again seen is moderate bilateral\ncentrilobular emphysema with new right lower lobe collapse with absence of the\nleft lower lobe bronchus which may be postsurgical in nature.  The remaining\nairways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are notable for a stable 8 mm accessory\nspleen as well as persistent heterogeneous enhancement of the liver similar in\nappearance to ___ and may be related to transient hepatic\nintensity differences.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  New moderate left hydro pneumothorax.\n3.  Status post left lower lobe lobectomy with associated postsurgical changes\nincluding left lower lung atelectasis.  Clinical correlation is recommended to\nassess for superimposed infection.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 11:34 AM, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Multiple enlarged mediastinal lymph nodes are present.  An\naortopulmonary window lymph node measures up to 1.2 cm in short axis (5:100). \nA precarinal lymph node measures up to 1.5 cm in short axis (5:108).  A\nsubcarinal lymph node measures up to 1.4 cm in short axis (5:123).\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive severe coronary\narterial calcification.  There is trace pericardial effusion.  Relative\nhypodensity of the blood pool is consistent with anemia.\n\nVESSELS:  There is a common origin of the right brachiocephalic artery and the\nleft common carotid artery, a normal anatomic variant.  Aortic caliber is\nnormal.  The main, right, and left pulmonary arteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is extensive airspace opacification of the left\nupper lobe, particularly inferiorly with minimal residual aerated lung at the\nleft apex where there is smooth interlobular septal thickening.  Patchy areas\nof airspace consolidation are noted within the right lung as well, unchanged\nat the apex (___), and new in the posterior right upper lobe (5:121),\nsuperior segment of the right lower lobe (5:135), and posteriorly within the\nright lower lobe (5:223).  Patient is status post left lower lobectomy with\nexpected postsurgical changes and volume loss.  There is severe underlying\ncentrilobular emphysema.\n\nAIRWAYS:  There is focal airway occlusion involving the left lower lobe\nbronchus due to mucous impaction (5:123).  Mucous impaction of a right middle\nlobe bronchus leads to subsegmental atelectasis of portions of the right\nmiddle lobe (5:208), still overall substantially improved from the prior study\nwhich time the entire right middle lobe bolus atelectatic.\n\nPLEURA:  There small pleural effusions bilaterally.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is unremarkable.",
            "output": "1. Extensive airspace opacity of the remaining left upper lobe following left\nlower lobectomy, likely a combination of postobstructive consolidation and\npostobstructive atelectasis due to mucus plugging within the left lobe\nbronchus.\n2. Patchy areas of airspace opacity on the right likely represent additional\nsites of infection, associated with reactive mediastinal lymphadenopathy.\n3. Mucous impaction within the right middle lobe causing a small amount of\nsubsegmental collapse, overall substantially better aerated when compared with\nthe prior study.\n4. Areas of smooth interlobular septal thickening suggesting concurrent volume\noverload.\n5. Severe centrilobular emphysema."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defects to indicate a pulmonary embolus.\nThe thoracic aorta is normal in caliber.  2 areas of ulcerative plaque are\nnoted in the distal thoracic aorta (301: 173 and 168) which were probably\npresent on the study from ___ however difficult to definitely\ncompare due to motion artifact on prior study.  There is no evidence of\ndissection or intramural hematoma.  The heart, pericardium, and great vessels\nare within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: Bilateral\nsmall pleural effusions, greater on the right.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: Postsurgical changes from left lower lobectomy.  Since 2 days\nprior there has been progression of left lung volume loss and consolidative\nopacities with some patchy areas of hypodensity within the lung parenchyma. \nAlso progressed  is consolidation in the right lower lobe (301:16 is)\nassociated with worsening bronchial wall thickening and mucous plugging. \nDistal consolidation in the right lower lobe, right upper lobe at the apex and\nright middle lobes are similar.  Hypoattenuating material within the distal\nleft mainstem bronchus and left upper lobe completely occludes the airway. \nSevere centrilobular emphysema unchanged\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Within the stomach there are 2 areas of hyperdensity along the\nmucosal wall.  There is no noncontrast CT prior to these to evaluate for\nhyperdense material versus bleed.  Otherwise the included portions of the\nabdomen are unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection. 2 ulcerating\nplaques noted in the descending thoracic aorta.\n2. Bilateral aspiration pneumonia,, particularly worsened on the left, where\nthere is further volume loss of the left upper lobe by obstructing material in\nthe distal left mainstem bronchus and left upper lobe bronchus.\n3. Bilateral small pleural effusions, greater on the right.\n4. Two hyperdense areas within the stomach.  These could represent ingested\nhyperdense material or bleed into the stomach- distinguishing one from the\nother is limited due to lack of a non-contrast study.  No other areas\nsuspicious for active extravasation.  If not known, an enteric tube can be\nplaced to look for henorrhagic gastric contents.\n\nNOTIFICATION:  The findings were discussed with ___. by\n___, M.D. on the telephone on ___ at 2:14 pm, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Slightly enlarged precarinal lymph node with a\nfatty hilus and a diameter of 16 mm (3, 23).  No hilar lymphadenopathy. \nModerate aortic wall calcifications.  Moderate to severe coronary\ncalcifications.  Normal size of the heart.  No pericardial effusions. No\nabnormalities in the posterior mediastinum, with the exception of a small\nhiatal hernia.  No osteolytic lesions at the level of the ribs, the sternum or\nthe vertebral bodies.  No abnormalities at the level of the adrenal glands.\n\nThe known perihilar left lower lobe nodule has increased in size from 18-24 mm\nin maximum diameter.  The nodule continues to have a broad based contact with\nthe aorta and the vascular and airway structures of the left lower lobe hilar\ncomponents.\nUnchanged bilateral apical thickening.  Unchanged moderate centrilobular\npulmonary emphysema.  No pleural thickening, no pleural effusions.  No other\nsuspicious pulmonary nodules.  Moderate thickening any irregularities of the\nairway walls, lower lobe predominant areas of mucous plugging (6, 187).",
            "output": "Interval growth of a known left lower lobe pulmonary nodule.  Moderate to\nsevere coronary calcifications.  Moderate pulmonary emphysema.  Moderate\nchronic airways disease."
        },
        {
            "input": "As compared to the previous examination, no relevant change is seen. The lung\napices display bilateral predominantly centrilobular emphysema. The post\ntreatment changes in the left lung, consisting of linear opacities,\nground-glass opacities and scarring, are unchanged.  Also unchanged is the pre\ndescribed 9 mm nodular lesion in the left upper lobe, adjacent to the major\nfissure.  There is no evidence of new parenchymal opacities. No soft tissue\nstructures suspicious for recurrence, no pleural effusion on either the left\nborder right.\nNo enlarged hilar or mediastinal lymph nodes.  No extra thoracic\nlymphadenopathy. The airways are patent. Mildly enlarged heart with minimal\npericardial effusion.  Unchanged substantial coronary calcifications.  The\nlarge mediastinal vessels are unchanged, the known and pre reported under is\nmetric dilatation of the descending aorta is constant in appearance, with a\nmaximum diameter of 4.5 cm.\nNo evidence of lytic bony changes at the level of the vertebral bodies, the\nsternum and the ribs.",
            "output": "Unchanged as compared to ___.  No evidence of recurrence. No pleural\neffusions.  No lymphadenopathy.  Unchanged 4.5 cm descending aortic aneurysm."
        },
        {
            "input": "Unchanged partly calcified right thyroid nodule.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  Severe aortic arch\ncalcifications.  Severe coronary calcifications. Minimal pericardial effusion\nminimally increased since the previous examination.  Unchanged substantial\ndilatation of the descending aorta (2, 44).  Status post cholecystectomy. No\nevidence of suspicious adrenal lesions.  No evidence of osteolytic lesions at\nthe level of the ribs, the vertebral bodies or the sternum. Moderate\ndegenerative vertebral disease.\nUnchanged moderate pulmonary emphysema.  Mucous accumulation in the larger\nairways.  The relatively extensive left perihilar opacities, part solid and\npart non solid, are completely unchanged.  Also unchanged is the subpleural\nscarring in the left peripheral lung parenchyma.  There is no evidence of new\npulmonary lesions.  No pleural effusions.  The airways continue to be patent.",
            "output": "No evidence of recurrence. Unchanged parenchymal morphology on the left,\nincluding relatively widespread parenchymal opacities and signs of subpleural\nfibrosis. No pleural effusions.  No lymphadenopathy."
        },
        {
            "input": "A partly calcified right thyroid nodule is unchanged.  No supraclavicular,\ninfraclavicular or axillary lymphadenopathy.  No enlarged lymph nodes in the\nmediastinum or the hilar area.  Massive calcifications of the aortic arch and\nthe ascending aorta.  Massive coronary calcifications, mild aortic valve\ncalcification.  Decrease of the pre-existing pericardial effusion As on the\nprevious examination, there is an obvious aneurysmal a tick dilatation of the\ndescending aorta (3, 40).  Despite the stability since the previous\nexamination, the vessel should be reassessed with a dedicated aortic\nexamination.  Unchanged mild diffuse esophageal thickening.  Status post\ncholecystectomy.  No other abnormalities are noted in the upper abdomen.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Moderate degenerative vertebral disease is stable.\n\nUnchanged apical it predominant paraseptal emphysema.  Of the chemoradiation\nof the left lung, there is a minimal decrease in extent and severity of the\npre-existing rather diffuse left lung ground-glass opacities.  On the other\nhand, the postradiation fibrotic changes (4, 112) appear to have minimally\nincreased.  There is progressive mild volume loss of the left lung.  No left\npleural effusion.  On the right, the pleural surfaces are unremarkable.  There\nis no evidence of growing lung nodules or masses.  No evidence of diffuse lung\ndisease.  Spots of increased mucus in the large airways",
            "output": "Interval decrease of the ground-glass component of the postradiation changes\nin the left lung an increase in extent of the fibrotic changes, with\nsubsequent slight decrease in left hemithoracic volume.  No new or growing\nnodules.  Unchanged increased mucous in the large airways, no lymphadenopathy,\nno pleural effusion.\n\nSevere coronary calcifications, severe aortic wall calcifications.\n\nThe pre-existing an pre described aneurysmatic dilatation of the descending\naorta is stable but should be further worked up with a dedicated examination.\n\nRECOMMENDATION:  Workup of a pre-existing an pre described aneurysmatic\ndilatation of the descending aorta should be worked up with a dedicated aortic\nexamination."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nMotion artifact limits evaluation.  The pulmonary arteries are well opacified\nto the segmental level, with no evidence of filling defect within the main,\nright, left, lobar, segmental pulmonary arteries.  There is mild prominence of\nthe main pulmonary artery, which can be seen in the setting of pulmonary\narterial hypertension.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen demonstrate an enteric tube with the tip\nin the stomach..  Diffuse hypoattenuation of the liver.\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nModerate multilevel degenerative changes of the visualized spine.",
            "output": "1. Motion artifact limits evaluation.  No evidence of pulmonary embolism to\nthe segmental level.\n2. No acute aortic abnormality.\n3. Mildly prominent pulmonary artery, which can be seen in the setting of\npulmonary arterial hypertension.\n4. Diffuse hypoattenuation of the liver suggests hepatic steatosis. \nCorrelation with LFTs is recommended"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation the pulmonary parenchyma is slightly limited by\nrespiratory motion.  No focal consolidation or masses.  Mild diffuse airway\nwall thickening is present.  The airways are otherwise patent to the level of\nthe segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia.  Additionally, the liver appears diffusely hypoattenuating, suggesting\nhepatic steatosis.  Incidental note is made of an 8 mm accessory spleen.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Mild diffuse airway wall thickening could suggest mild airways\ninflammation.\n3.  Hepatic steatosis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Mild calcifications of the aortic wall.  Borderline\ndiameter of the main pulmonary artery.  Minimal aortic valve calcifications. \nMild cardiomegaly.  Large hiatal hernia.  No osteolytic lesions at the level\nof the ribs, the sternum, or the vertebral bodies.  Several old healed rib\nfractures (602, 102) are stable.  The slightly lobulated 6-7 mm left lower\nlobe nodule is unchanged in size and morphology.  No new or growing nodules. \nNo pleural abnormalities.  The airways are patent. No diffuse lung disease.",
            "output": "Stability in size and morphology of the 6-7 mm solid left lower lobe nodule. \nNo new or growing nodules.  No diffuse lung disease.  No adenopathy."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: The NG tube projects below the left hemidiaphragm the tip\nprojects to the stomach.  There is a moderate-sized hiatus hernia.  The\nascending aorta is normal in size.  The main pulmonary artery is mildly\nenlarged and measures 3.8 cm.  There is mild coronary artery calcification. \nThere is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are no consolidations.  There is a left lower lobe pulmonary\nnodule measuring 7 mm (2, 28).  There is minimal subsegmental atelectasis in\nthe right lung base..\n\nBONES AND CHEST WALL : Review of bones is unremarkable.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\npneumobilia.  The spleen is mildly enlarged.  Multiple collaterals are seen\nalong the azygos and hemi azygous with evidence of azygos continuation.",
            "output": "Evidence of cirrhosis with for portal hypertension and pneumobilia.\n\n7 mm left lower lobe pulmonary nodule.  Three-month follow-up is recommended.\n\nNG tube projects below the left hemidiaphragm.\n\nModerate-sized hiatus hernia."
        },
        {
            "input": "Aorta and pulmonary arteries are unchanged in appearance, with ascending aorta\nbeing 4 cm in diameter and main pulmonary artery being 3.2 cm in diameter. \nHeart size is top-normal.  Large paraesophageal varices are unchanged.\n\nImaged portion of the upper abdomen demonstrate biliary stent, pneumobilia,\nevidence of previous liver transplant.\n\nAirways are patent to the subsegmental level bilaterally.  Interval increase\nin left lower lobe nodule is demonstrated from 5.5 x 4.5 mm to 7 x 5 mm,\nseries 5, image 176.  Diffuse bronchial wall thickening is noted.  No\nmediastinal, hilar or axillary pathologically enlarged lymph nodes present. \nMild septal thickening might be consistent with minimal degree of pulmonary\nedema.  No additional nodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Minimal interval increase in left lower lobe pulmonary nodule  from 5.5 x 4.5\nmm to 7 x 5 mm,.  It has lobulated contours and giving its increase in size is\nconcerning for potential growing neoplasm.  Consultation with thoracic surgery\nis recommended and potential PET-CT giving the borderline nature in terms of\nthe size of the nodule."
        },
        {
            "input": "Aorta is minimally calcified at the level of the aortic arch with no\ncalcifications seen in the ascending aorta.  Substantial varices in the low\nmediastinum are demonstrated as well as mild hiatal hernia.\n\nImage portion of the upper abdomen was reviewed in details on ___ with\nMRCP.  Biliary stents are present.  The study is limited for the assessment of\nthe upper abdomen due to lack of IV contrast administration.\n\nAirways are patent to the subsegmental level bilaterally.  Left lower lobe 6\nmm nodule, series 5, image 156 is not seen on the previous examination, but\nwas not in the field of view of the CT of the neck.  The nodule has minimal\nlobulated contours.\n\nNo lytic or sclerotic lesion is seen within the image portion of the skeleton.\nOld rib fractures on the left are present.",
            "output": "Varices, severe.  Hiatal hernia.\n\nNo calcifications of the ascending aorta.  Aorta is normal in diameter.\n\nLeft lower lobe nodule, concerning, should be reassessed in 3 months for\nstability.\n\nStatus post liver transplant, biliary stenting."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nNumerous small scattered mediastinal lymph nodes are noted, none of which meet\nCT size criteria for pathologic enlargement.  An epicardial lymph node is\nagain noted (series 5, image 155), which decreased in size from prior study. \nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nThere is moderate bilateral dependent atelectasis.  Diffuse ground-glass\nchanges are noted bilaterally, new from prior study in ___.  Again\nseen are:\n4 mm nodule in the right upper lobe (series 5, image 67)\n2 mm pleural-based nodule in the right upper lobe\nSub 2 mm pleural-based nodule nodule in the left upper lobe (series 5, image\n56)\n4 mm pleural-based nodule in the left lower lobe (series 5, image 110)\nSub 2 mm nodule in the left lower lobe (series 5, image 75).\nA punctate calcified granuloma is again seen at the left base (series 5, image\n205).  These are all unchanged.\nThere is no evidence of pulmonary parenchymal abnormality. The airways are\npatent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  New ground-glass opacities in bilateral lung fields with moderate\ndependent atelectasis.  Differential includes pneumonia, secondary to either\ntypical or atypical organisms, atelectasis or reactive airway disease. \nCorrelate clinically.\n3.  Small bilateral pulmonary nodules as described above.  Recommend attention\non follow-up.\n4.  Numerous small scattered mediastinal and epicardial lymph nodes, none of\nwhich meet criteria for pathologic enlargement."
        },
        {
            "input": "Neck, thoracic inlet, axillae:\nNo abnormality\n\nBreast, chest wall and bones:\nNo abnormality\n\nMediastinum:\nNo abnormality\n\nHila:\nNo abnormality\n\nHeart:\nMild coronary artery calcification\n\nUpper Abdomen:\nSeveral renal cysts.\nLung:\n\nNodules:\n\nDominant nodule:\nNone previously mentioned dominant right apical lesion corresponds to scar\ntissue and on coronal image there is asymmetric biapical scarring right\ngreater than left the majority of the right apical lesion contains fat and\nmost likely represents scar tissue.  Attention to this on follow-up imaging is\nrecommended.\n\nOther nodules:\nStable 4 mm right lower lobe pulmonary nodule (5, 236).\nStable 4 x 8 mm right middle lobe pulmonary nodule (5, 195).\nNo new pulmonary nodules\n\nParenchyma:\nModerate to severe diffuse emphysema.  Mild peribronchial thickening.\n\nPleura and airways:\nNo abnormality.",
            "output": "The right apical nodular opacity most likely represents an asymmetric scar. \nThere is asymmetric biapical scarring right greater than left.  Attention to\nthis region on follow-up imaging to ensure stability of the scar is\nrecommended.\n\nStable 4 mm and 8 mm right lung nodules.  No new pulmonary nodules.\n\nSevere emphysema.\nLung-RADS category: 2\n\nRECOMMENDATION(S):  Continue low-dose annual lung cancer screening CT in 12\nmonths.\n\nIncidental findings**:\nNone\n\n\n\n___ Radiology is an ___ accredited CT lung cancer screening site.\n**All recommendations regarding incidental findings are based on ACR\nguidelines for the management of these findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Normal sized lymph node in the chest wall (2, 14). \nNo enlarged lymph nodes in the hilar or mediastinal compartments.  Minimal\ncoronary calcifications, no valvular calcifications, no pericardial effusion. \nNo incidental pulmonary embolism.  The upper abdomen is reported in detail in\nthe dedicated abdominal CT report.  No osteolytic lesions at the level of the\nribs, the sternum, or the vertebral bodies.  Moderate scoliosis.\nMild bilateral apical scarring.  The airways are patent.  Minimal right upper\nlobe predominant centrilobular pulmonary emphysema.  Minimal thickening any\nirregularities of the airway walls.  Non characteristic scarring at the\nlingular basis (4, 145).  2 mm solid lingular nodule (4, 152).  No pleural\neffusions.  No pleural thickening.  No diffuse lung disease.",
            "output": "Solitary 2 mm lingular micronodule.  No suspicious pulmonary nodules or\nmasses.  No pleural abnormalities.  No adenopathy."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is unremarkable.  There\nis no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see report from dedicated CT of the abdomen and pelvis\nfor subdiaphragmatic findings.\n\nMEDIASTINUM: There are no enlarged mediastinal lymph nodes.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is normal in size.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Re-demonstrated is a 2 mm nodule in the lingula, which is not\nchanged since prior studies (3:149).  A 2 mm nodule at the lung apex (___)\nis also unchanged.  Lingular scarring is also unchanged.  No new nodules are\nidentified.\n2. AIRWAYS:  The airways are patent to the subsegmental level; however, the\nairway walls are diffusely thickened, compatible with bronchitis.\n3. VESSELS:  The main pulmonary artery and thoracic aorta are normal in\ncaliber.\nCHEST CAGE: No suspicious osseous lesions are identified.",
            "output": "1.  No evidence of thoracic metastases.\n2.  Diffusely thickened airways compatible with bronchitis.\n3.  Please see report from dedicated CT of the abdomen and pelvis for\nsubdiaphragmatic findings."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  No mediastinal, hilar or\naxillary lymphadenopathy is present.  Heart size is normal.  There is no\npericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lingular nodule,\nseries 6, image 195, 2.5 mm is stable.  Left upper lobe ground-glass nodule,\nseries 6, image 62 is 2.5 mm stable no new nodules masses or consolidations\ndemonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of intrathoracic\nmetastatic disease\n\nPlease review dedicated CT abdomen and pelvis for assessment of\nintra-abdominal and intrapelvic findings."
        },
        {
            "input": "CHEST PERIMETER: THere are no thyroid findings warranting further imaging. \nSupraclavicular and axillary lymph nodes are neither enlarged nor growing. \nBreast evaluation is reserved for mammography.  Findings below the diaphragm\nwill be reported separately.\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels or in the coronary arteries. \nHeterogeneous tissue in the prevascular mediastinum  inseparable from the\npericardium has increased in radiodensity over preceding several chest CT\nscans, including ___.  This is probably thymic hypertrophy after\nchemotherapy rather than a pericardial abnormality.  There is no pericardial\nfluid elsewhere.  3:81-113.  Clinical significance is uncertain.  Aorta and\npulmonary arteries and cardiac chambers are normal size.\n\nTHORACIC LYMPH NODES: Subcentimeter lymph, nodes, numerous in the mediastinum\nand a 10 mm node at the upper pole of the right hilum are stable and not\npathologically enlarged.  There are no pathologically enlarged, new or growing\nlymph nodes in other mediastinal stations associated with subdiaphragmatic\nmalignancy, in the posterior mediastinum along the esophagus or inferior vena\ncava, or the diaphragmatic or retrocrural stations.\n\n\nLUNGS, AIRWAYS, PLEURAE:\nPunctate nodule right upper lobe, 3:84, 3 mm lingular nodule, 3:131 are\nunchanged since at least ___.\n\nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities.\n\nCHEST CAGE:  punctate sclerotic lesion in a lower thoracic vertebral body,\n602:40 is unchanged.  Although there are no bone lesions in the imaged chest\ncage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nNew mild thymic hypertrophy."
        },
        {
            "input": "Mildly enlarged thyroid, notably at the level of the right lobe.  No\nsupraclavicular, infraclavicular or axillary lymphadenopathy.  Several\nborderline sized lymph nodes in the mediastinum (2, 19).  No abnormalities in\nthe posterior mediastinum, with the exception of a sub- carinal calcified\nlymph node (2, 24) and a small hiatal hernia.\n\nThe ascending aorta has a maximum diameter of 33 mm.  At the same anatomical\nlevel (carina) the descending aorta has a diameter of 29 mm.  At the level of\nthe aortic arch, the diameter of the vessel is 28 mm.  No substantial\ncalcifications at the level of the aortic valve and ascending aorta. Moderate\ncalcifications at the level of the aortic arch and the origin of the\nsupraaortic branches.  Mild to moderate calcifications at the level of the\ndescending aorta. Moderate to severe coronary calcifications. The diameter of\nthe pulmonary artery is normal.  No pericardial effusion. Mild global\ncardiomegaly.\n\nMild bilateral apical thickening, symmetrical in distribution.  Mild to\nmoderate respiratory motion artifact. No evidence of diffuse lung disease.\nSeveral non characteristic nodules (for example series 4, image 104) are all\nmillimetric in ___ and subpleural in locations, does heating the very\nlow likelihood for malignancy.  No evidence of pleural thickening or pleural\neffusions. The larger airways appear patent.  Moderate degenerative vertebral\ndisease.  No vertebral compression fractures. No evidence of rib or sternal\nlesions.",
            "output": "Aortic ___ are reported in detail above.  No pericardial effusion.  No\npleural effusions.  No evidence of acute lung disease.  No lymphadenopathy."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, hilar, or\nmediastinal lymphadenopathy.  The heart size is normal.  There is no\npericardial effusion.  The esophagus is normal without evidence of wall\nthickening or a hiatal hernia.  The aorta is normal in caliber.  The main\npulmonary artery is normal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nAn 8 mm left lower lobe subpleural nodule, series 5 image 110 is seen.  There\nis no pleural effusion or pneumothorax.",
            "output": "8 mm left lower lobe subpleural nodule is seen.  No evidence of\nlymphadenopathy.\n\n3 month follow-up with chest CT is recommended."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  No abnormalities on the chest wall.  No atherosclerotic\ncalcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  No\natherosclerotic calcifications in the coronary arteries, cardiac valves or\naorta.  The pulmonary arteries or aorta are normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Small mediastinal lymph nodes, none\npathologically enlarged by CT size criteria, unchanged compared to prior\nstudy.  No hilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.\n3 mm nodules in the right lower lobe (4:121 and 148), in the lingula (4:130)\nand a larger subpleural in the left lower lobe (4: 88), measuring 8 mm, all\nunchanged since prior study.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show prior cholecystectomy and\nstable left myelolipoma in the adrenal gland.",
            "output": "Stable appearance of all small pulmonary nodules, the dominant in the left\nlower lobe subpleural measuring 8 mm.  CT follow-up in follow up in 21 months\nrecommended, as per Fleischer society guidelines.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.\n\nNo soft tissue abnormality elsewhere in the partially imaged chest wall.\n\nThis study is not appropriate for subdiaphragmatic diagnosis, last evaluated\nby CT of the abdomen on ___.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head neck vessels or coronary arteries.  Aorta and\npulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing, including posterior mediastinal and diaphragmatic stations.\n\nLUNGS, AIRWAYS, PLEURAE: Lung volumes are low, attributable to elevation of\nthe diaphragm by hepatosplenomegaly which causes discrete atelectasis in both\nlower lungs and exaggerates heterogeneity in background density which could be\nearly edema.  No lung nodules or discrete consolidation.  Right pleural\neffusion is minimal.  No pleural mass.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "Thyroid is unremarkable.  Supraclavicular, mediastinal, and axillary lymph\nnodes are not pathologically enlarged.  Thoracic aorta is normal caliber. \nMain pulmonary artery is mildly enlarged to 3.7 cm in diameter.  Pericardial\neffusion is small.  Heart is enlarged.  There is mild aortic valve and\ncoronary artery calcifications.\n\nThere is no pleural effusion.  Airways are patent to subsegmental levels. \nAtelectasis is mild in right lower lobe base.  Multiple punctate\ncalcifications in the right lung base and ___ opacities are\nnonspecific but may be related to chronic aspiration.\n\nLimited evaluation of the upper abdomen is notable for multiple surgical clips\nin the left upper abdomen, likely related to left nephrectomy.  Spleen is\nabsent.  Right kidney is atrophic.  Left lower quadrant transplant kidney is\npartially imaged.\nNo suspicious bone or soft tissue lesion is identified.",
            "output": "1. Enlarged pulmonary artery may reflect underlying pulmonary hypertension.\n2. Small pericardial effusion.\n3. No pulmonary edema.  Mild atelectasis and bronchiolar opacities in the\nright lung base may reflect chronic aspiration."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy. Mild mediastinal lymphadenopathy with lymph node\ndiameters reaching 16 mm. Moderate aortic wall calcifications, mild coronary\ncalcifications, no valvular calcifications, no pericardial effusion. Small\nhiatal hernia.  Small bilateral pleural effusions. No acute abnormalities in\nthe upper abdomen.  Mild splenomegaly. Moderate degenerative vertebral\ndisease.  No vertebral compression fractures.  No osteolytic lesions at the\nlevel of the ribs, the sternum, or the vertebral bodies.  The lung parenchyma\nshows relatively diffuse ground-glass opacities, combines to areas of very\nmild interstitial thickening.  .  The opacities are more severe in the upper\nthan in the lower lobes and become more focal an ill-defined in the lower\nlobes. In the same lower lobes, there is no evidence of interstitial or\nlobular thickening or markings. No suspicious lung nodules or masses.",
            "output": "Small bilateral pleural effusions.  Diffuse and severe parenchymal opacities,\nwith a dominating ground-glass and a mild interstitial component.  The\ndistribution, the gradient, and the combination of the different components\nstrongly favor multifocal pneumonia or for pulmonary edema. Mild accompanying\nmediastinal lymphadenopathy."
        },
        {
            "input": "The thyroid gland is unremarkable. There are small prevascular lymph nodes,\nfor example an 8 mm lymph node seen in series 10, image 28. There is otherwise\nno significant axillary, mediastinal or hilar lymphadenopathy. Small\nparaesophageal lymph nodes noted. There is a small hiatal hernia transmits\nlargely fat. The thoracic aorta is normal in caliber with a typical 3 vessel\ntakeoff from the arch. The pulmonary arterial trunk is normal in caliber. The\nheart is normal in size without pericardial effusion.\n\nThere are prominent vessels within the subcutaneous tissues of the anterior\nchest wall. No stenosis or significant narrowing seen within visualized\nportions of the left subclavian vein.\n\nThe tracheobronchial tree is patent to the subsegmental levels. There are\nperipheral interstitial abnormalities characterized by mild to moderate\nsubpleural reticular opacities most significant at the lung bases bilaterally.\nThere is no clear honeycombing. There is mild bronchiectasis in the right\nupper lobe (series 10, image 36) with no clear traction bronchiectasis. There\nis a 2 mm punctate nodule in the left upper lobe (series 11, image 129). No\nfocal consolidation, pleural effusion or pneumothorax is present. There are no\nsuspicious opacities, masses or pleural abnormalities.\n\nNo blastic or lytic lesion suspicious for malignancy is present.  Significant\nmultilevel degenerative changes are noted along the thoracolumbar spine. There\nis moderate to severe thoracic kyphosis.\n\nPlease refer to separate abdominal/pelvic CTA report performed the same day\nfor abdominal and pelvic findings.",
            "output": "1. No evidence of intrathoracic malignancy.\n\n2. Subpleural reticular opacities most prominent at the lung bases bilaterally\ncompatible with mild interstitial lung disease."
        },
        {
            "input": "Tracheostomy tube is midline.  Esophageal drainage tube passes into the\nstomach and out of view.  There is no associated fluid collection or other\ncomplication.  Supraclavicular and axillary nodes are not enlarged and there\nis no soft tissue abnormality in the  chest wall suspicious for malignancy or\ninfection.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in the\nhead and neck vessels and only mild in the coronaries, at least in the LAD. \nPericardium is physiologic.  The attenuation characteristics of small layering\nbilateral pleural effusions, roughly stable in volume since ___ all, are\ndisturbed by artifact.  Mediastinal and hilar lymph nodes are not\npathologically enlarged, ranging in diameter up to 8 mm in the left lower\nparaesophageal mediastinal station, and 8 mm in the left hilus.\n\nThe a 20 x 30 mm well-circumscribed right, paraesophageal fluid collection in\nthe posterior mediastinum just above the diaphragm, 4:154, with a mildly\nenhancing rim, was 26 x 35 mm on ___, 6:60.  It is either a seroma or an\nabscess, but not hematoma.\n\nNew centrilobular micro nodularity in the upper lobe, most prominent at the\nright apex, 04:53, is probably bronchiolitis.  What was previously a uniformly\nconsolidated and possibly collapsed right lower lobe on ___, and now looks\nmore like a large pneumonia, with a somewhat smaller component in the left\nlower lobe.\n\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.  The severe kyphosis is due to moderate loss of height anteriorly\nin 3 contiguous thoracic vertebrae.",
            "output": "Bilateral lower lobe pneumonia.\n\n3 cm postoperative, right paraesophageal abscess or seroma at the level of the\ndiaphragm is smaller today than on ___.\n\nRECOMMENDATION(S):  I would recommend keeping paraesophageal lesion under\nobservation while treating the patient for pneumonia, since it may be\nresolving spontaneously\n\nNOTIFICATION:   Dr. ___ reported the findings to  ___ (In\nHospital, On Page), ___ by telephone on ___ at 3:01 ___, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Thyroid is unremarkable.  Thoracic aorta and main pulmonary artery are normal\nsize.  There is no pericardial effusion.  Coronary artery calcification is\nminimal.  A 11 mm left brachiocephalic lymph node is similar to prior.  Other\nprominent mediastinal lymph nodes are stable.\nA 19x14 mm right paraesophageal fluid collection at the level of the diaphragm\nsimilar to prior.\n\nAirways are patent to subsegmental levels.  There is irregularity in the\nanterior tracheal wall at the level of the thyroid, reflective of prior\ntracheostomy.  There is no gas or fluid collection in the mediastinum to\nsuggest tracheal fistula.  Bilateral lower lobe pneumonia is improved compared\nto prior, as well as the centrilobular micro nodularity in the right upper\nlobe.  There are trace bilateral pleural effusions, also smaller.\n\nBONES/ SOFT TISSUE:  There is no worrisome lesion.\n\nABDOMEN:  This study was not designed for subdiaphragmatic evaluation. \nLimited assessment of upper abdominal organs are notable for interval drain\nplacement in the anterior intraperitoneal fluid collection.  There is no\nvisible fluid collection around the drain.  A transesophageal tube is coiled\nin the stomach.  There is small hiatal hernia.",
            "output": "1.  No evidence of tracheal fistula.\n\n2.  Bilateral lower lobe pneumonia is improved.  Followup CT is recommended in\n3 months to ensure resolution and rule out underlying malignancy.\n\n3.  Right paraesophageal fluid collection is similar to prior."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue abnormalities in the chest cage suspicious for\nmalignancy.  Dilated veins in the left chest wall are chronic, and there is no\nedema or obvious occlusion of the central veins.\n\nThe left pectoral infusion port catheter ends close to the superior cavoatrial\njunction and may have a small in situ thrombosis at the tip, 04:31.\n\nFrom thyroid is unremarkable.  Atherosclerotic calcification is not apparent\nin the head and neck vessels or coronary arteries.  There is no pericardial or\npleural effusion.  Numerous sub cm lymph nodes in multiple mediastinal\nstations are unchanged since at least ___.  A 12 mm left lower paratracheal\nnode was 11 mm on that study, not a significant change.\n\nPeribronchial infiltration in the dependent areas of both lungs, particularly\nsuperior segment right lower lobe and the posterior basal segments of the\nlower lobes has improved since ___.  This is either very slowly resolving\nsimple pneumonia or improving chronic aspiration.  There are no lung nodules\nor any bone lesions in the chest cage suspicious for malignancy.  Mild to\nmoderate anterior wedging of contiguous lower thoracic vertebral bodies is\nunchanged since ___ and does not look pathologic.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild bilateral pneumonia or chronic aspiration, improved since ___.\n\nSmall tip thrombus, central venous infusion port."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere are no soft tissue abnormalities in the chest wall suspicious for\nmalignancy.  Dilatation of subcutaneous veins in the chest wall, left greater\nthan right, is stable and unexplained.  Left central venous infusion port\ncatheter ends in the mid SVC, with no associated tip thrombus.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead and neck vessels, but is present in at least the left anterior descending\ncoronary artery.  In pericardium is normal.  Small to moderate dependent left\nand small right pleural effusion are new.  There is no nodulation of left\npleural surfaces.\n\nAn 11 mm right upper paratracheal lymph node, 5:71, is new.  Elsewhere, sub cm\nmediastinal lymph nodes in the lower paratracheal and prevascular stations are\nsmaller compared to ___ x 15 mm right hilar node was 11 by to 12 mm in\n___.\n\nA diaphragmatic hiatus hernia transmits subphrenic fat.\n\nIn a region that had the appearance of pneumonia in ___ a discrete\nspherical region, 15 x 26 and 13 x 20 mm, 92, 5:98 has grown from a maximum of\n11 x 13 mm.  It has a central lucency and looks more like a cavitated mass. \nThe adjacent pleura now contains more fluid and mild thickening.\n\nAn irregular soft tissue lesion, in the right major fissure, 11 x 19 mm,\n5:119, and a subpleural diaphragmatic nodule in or alongside the right lower\nlobe, 8 x 12 mm, 5:154, and 3 smaller subpleural lesions along the posterior\ndiaphragmatic surface, 5:162- 172, are all new.  A 7 x 12 mm nodule in the\nlingula, 5:180, is probably the residual of previous pneumonia.\n\nMild but generalized subpleural interstitial abnormality and septal thickening\nhas progressed since ___.  Depending upon clinical history, this could be\ndue to chronic congestive heart failure or pulmonary drug toxicity.  Clinical\ncorrelation advised.\n\nSevere kyphosis centered at two wedged lower thoracic vertebrae is unchanged. \nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "Growing 2.5 cm wide right lower lobe cavitary mass, new smaller nodules\nsubpleural right lower lobe nodules, and a right fissural nodule are all still\nconcerning for disseminated malignancy.\n\nSlowly progressive interstitial abnormality could be chronic congestive heart\nfailure or true developing drug toxicity."
        },
        {
            "input": "THYROID: The thyroid is within normal limits.\n\nLYMPH NODES: There is no axillary or supraclavicular lymphadenopathy. \nMultiple prominent but not pathologically enlarged mediastinal lymph nodes are\nre- demonstrated and not significantly increased in size from ___.  As before, there is dilatation of multiple subcutaneous veins involving\nthe bilateral chest walls.  A central venous catheter terminates at the distal\nSVC, as before.\n\nHEART AND VESSELS: The heart is normal in size.  The great vessels are normal\nin caliber.  There is no evidence of pulmonary embolism to the segmental level\nmotion artifact somewhat limits evaluation of subsegmental branches.  There is\nno pericardial effusion.\n\nLUNGS & AIRWAYS: Re- demonstrated is mild septal thickening and subpleural\ninterstitial abnormality, minimally progressed from ___.  A moderate\nleft pleural effusion is decreased in size from the most recent prior but is\nnow loculated.  The left effusion seen along the lateral hemi thorax and at\nthe apex.  The largest aspect of the left pleural collection is at the left\nbase.  Left-sided pleural thickening is somewhat irregular.  A small right\npleural effusion is minimally decreased from the prior examination. As before\nan irregular soft tissue nodular lesion involving the right major fissure,\nwhich measures 2.5 x 1.4 cm is not significantly increased in size from the\nprior exam.  The adjacent pleura remains thickened and irregular.  Additional\nsolid lesions are demonstrated in the right lower lobe, stable in size from\nthe prior examination.   For example a 1.2 x 1.0 cm right lower lobe pulmonary\nnodule appears increased from the prior examination when it measured 0.8 x 0.7\ncm (2:64).  Multiple previously described nodules are stable from ___.\n\nUPPER ABDOMEN: Multiple hypodense lesions are demonstrated throughout the\nliver, minimally increased in size from the prior chest CTA on ___\nhowever evaluation of the intra-abdominal organs is limited on this\nexamination.  Ill defined mass involving the head of the pancreas is partially\nvisualized.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions are\nidentified.  Severe kyphosis is demonstrated throughout the thoracic spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Bilateral pleural effusions increased on the right and decreased on the\nleft, with irregular left pleural thickening concerning for metastatic\ndisease.\n3. Pulmonary nodules appear stable from recent prior exam.\n4. Hepatic hypodensities appear slightly larger concerning for metastatic\ndisease progression."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart and great vessels are within normal limits. No\npericardial effusion is seen. Fat stranding of the mediastinum is again seen,\nunchanged from previous examination.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is interval removal of the right sided chest tube and\nresolution of the right sided pneumothorax.  There is a small right posterior\neffusion at site of prior pneumothorax (2:48, 602b:29).  Loculated left\nmoderate and small right basal pleural effusions are present, unchanged.\n\n\nLUNGS/AIRWAYS: A dominant pleural-based right basilar pulmonary nodule which\nmeasures 1.9 x 1.8 cm, previously 2.2 x 2.0 cm, although, subtle interval\nchanges in size are difficult to accurately assess given adjacent pleural\neffusion on the current exam versus abutting pneumothorax on prior.  Bilateral\nscattered pulmonary nodules are grossly unchanged from previous examination. \nThe airways are patent to the level of the segmental bronchi bilaterally. \nDiffuse peribronchial thickening, interlobar septal thickening, pleural and\nperifissural nodularity suggestive of lymphangitic tumor involvement although\ncomponent of edema is possible, overall unchanged.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe thyroid gland appears unremarkable.\n\nABDOMEN:  There is a small hiatal hernia. Multiple ill-defined hepatic\nhypodensities are seen, unchanged, consistent with metastatic disease.\n\nBONES: A sclerotic lesion in the vertebral body of T5 was not present on CT\nscan from ___ and has subsequently progressively increased in size\nprogressively, which is concerning for metastasis.  A smaller sclerotic focus\nat the superior end plate of T9 was not present on CT scan in ___,\nand is also concerning for metastasis.  Chronic vertebral body wedging mid\nthoracic spine with accentuated kyphosis is unchanged.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2. Interval removal of right sided chest tube and resolution of small right\npneumothorax.  Unchanged bilateral loculated pleural effusions.\n3. Unchanged appearance of hepatic and pulmonary metastatic disease burden\nnotable for pleural based pulmonary consolidation, nodular interlobular septal\nthickening and pleural thickening.\n4. Progressively increased size of sclerotic lesion in the vertebral body of\nT5 not present on CT scan from ___, concerning for metastasis. \nSmaller sclerotic focus at the superior end plate of T9 is also concerning."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and there are no\nsoft tissue abnormalities in the chest wall suspicious for malignancy. \nInterval increase in caliber of long-standing collateral anterior chest wall\nveins suggests increased intra venous volume or pressure since there is no\nocclusion of the brachiocephalic veins or cavae.  There is no fluid collection\nassociated with the left pectoral infusion port or right pectoral generator.\n\nThyroid is unremarkable.  Atherosclerotic calcification is not apparent in\nhead neck vessels or coronary arteries.  Aorta and pulmonary arteries are\nnormal size.  Evaluating heart chambers requires dedicated cardiac imaging.\n\nCm size lymph nodes in multiple stations in the mediastinum are unchanged\nsince ___, larger compared to ___.  12 x 45 mm paraesophageal\ncomplex of nodes, 3:61, is unchanged since ___.\n\nSmall multiloculated right pleural effusion and extensive pleural thickening\nis unchanged since ___, slightly worse today than on ___, with an\nincrease in associated atelectasis.  The 26 mm round soft tissue opacity in\nthe superior segment of the right lower lobe could be rounded atelectasis or a\nmass.  The larger of multiloculated left pleural effusion, including fissural,\nposterior, and diaphragmatic components has not changed since ___ one. \nPleural surfaces are all very thick and irregular.\n\nThere is no pneumonia or pulmonary edema.\n\nLarge hiatus hernia is chronic, and esophagus above that is chronically\ndilated with air and fluid.",
            "output": "Little change since ___ one is suggest progressive intrathoracic infection\nor malignancy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  There are numerous mediastinal lymph nodes, though none of which\nare enlarged by CT criteria.  A 6 mm pre-vascular lymph node contains a\npunctate calcification.  Few small right diaphragmatic lymph nodes are noted. \nThe distal esophagus is patulous.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is moderate coronary arterial and\naortic valvular calcification, and mild calcification of the aortic arch. \nThere is no pericardial effusion.\n\nVESSELS: Aortic caliber is normal.  The main, right, and left pulmonary\narteries are normal caliber.\n\nPULMONARY PARENCHYMA:  There is a 5 mm nodule in the right upper lobe (04:50),\na 5 mm nodule in the right middle lobe (4:133), a 3 mm nodule in the right\nlower lobe (4:74), and a 3 mm nodule in the left lower lobe (4:127), as well\nas scattered micro nodules (for example, 4:81, 140, 160).  There are scattered\nregions of ground-glass opacity (for example, 4:92, 97).  Reticular opacities\nare noted in the left greater than right lower lobes.  There are numerous\nsmall calcified nodules in the peripheral lower lobes bilaterally.  There is\nno emphysema.\n\nAIRWAYS:  There is traction bronchiectasis in the left lower lobe.  The\nairways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are mild.  There is substantial bilateral\ngynecomastia.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for a 1.7\ncm hypodensity in the right hepatic lobe.  The known pancreatic mass is not\nwell seen on this noncontrast study.",
            "output": "1. There are reticular opacities in the left greater than right lower lobes,\nwith scattered ground-glass opacities and regions of bronchiectasis.  While\nthis is most likely reflective of chronic aspiration, this pattern can also be\nseen with NSIP.\n2. There are multiple bilateral pulmonary nodules measuring up to 5 mm.  While\nthese are statistically most likely to be benign, and likely represent\ngranulomas in the setting of calcified lymph nodes and multiple calcified\npulmonary nodules, in the absence of prior imaging for comparison, malignancy\ncannot be excluded.  Three-month follow-up is recommended.\n3. Severe bilateral gynecomastia.\n4. Please refer to report of contrast enhanced CT abdomen and pelvis from\n___ for description of known pancreatic malignancy, which is only\npartially included and not well visualized on this noncontrast study.\n\nRECOMMENDATION(S):  Three-month follow-up chest CT.\n\nNOTIFICATION:  The preliminary findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 1:21 pm,\nat time of discovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL:\n\nUPPER ABDOMEN: Dictated is nonspecific for the abdomen.  However at the end\nthere is cirrhotic appearance of the the liver, with areas of previous\nablation.  Large perigastric and esophageal varices noted.\n\nMEDIASTINUM: Subcarinal node is again seen with no interval change measuring\n18 x 13 mm.  Additional not enlarged supra carinal mediastinal lymph nodes are\nseen, up to 6 mm.  The rest of the inferior mediastinal nodular densities\nsurrounding the esophagus are again seen, most likely representing large\n___ varices.  Although the timing of injection of contrast is not\noptimal for vascular opacification it appears that this is a densities are\nmost probably vascular.\n\nHILA: No hilar lymph node enlargement or mass.\n\nHEART and PERICARDIUM: The heart isn't enlarged.  Moderate coronary\ncalcifications.\nPLEURA: There is no pleural effusion or pneumothorax\nLUNG:\n\n1. PARENCHYMA:  No pulmonary nodule or mass.\n2. AIRWAYS:  Airways are patent\n3. VESSELS:  No vascular abnormality\n\nCHEST CAGE: No abnormality",
            "output": "13 mm in short axis subcarinal nodule.  Large periesophageal varices."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the imaged lower thyroid need any further\nimaging evaluation.  Supraclavicular and axillary lymph nodes are not\nenlarged.  No soft tissue mass or fluid collection in the chest wall. \nFindings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Other than periesophageal varices in the lower\nmediastinum, the esophagus is unremarkable.  Atherosclerotic calcification is\nnot apparent in head and neck vessels and is only minimal in left circumflex\ncoronary artery.  Aorta and pulmonary arteries are normal size, aortic valve\nis not calcified and there is no pericardial abnormality.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing ranging in diameter up to 13 mm in the subcarinal station.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are fully expanded and clear.  No measurable\nlung nodules or other focal abnormality.  Tracheobronchial tree is normal to\nsubsegmental levels and there are no pleural nodules or effusion.\n\nCHEST CAGE: unremarkable. Although there are no bone lesions in the imaged\nchest cage suspicious for malignancy or infection, it should be noted that\nradionuclide bone and FDG PET scanning are more sensitive in detecting early\nosseous pathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nLower periesophageal varices."
        },
        {
            "input": "Aorta and pulmonary arteries are well enhanced.  Several mediastinal lymph\nnodes are not pathologically enlarged, series 2, image 13.  The largest lymph\nnode is demonstrated in the sub-carinal area, series 2, image 24, 13 mm in\ndiameter.  Varices are surrounding the esophagus as well as possibly small\nlymph nodes, difficult to distinguish in the absence of IV contrast.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMRI of the liver in corresponding report will be issued.\n\nAirways are patent to the subsegmental level bilaterally.  No discrete\npulmonary nodules masses or consolidations demonstrated\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm. \nGynecomastia is bilateral, symmetric.",
            "output": "No definitive evidence of intrathoracic metastatic disease except for\nsub-carinal lymph nodes that should be assessed on the subsequent followup in\n3 months.\n\nStigmata of cirrhosis including varices, nodularity of the liver that will be\naddressed as part of separate report of  MRI of the liver and the\ncorresponding report that we will be issued separately"
        },
        {
            "input": "HEART AND VASCULATURE: Right chest wall Port-A-Cath terminates in the right\natrium.  Mild atherosclerotic calcification of the thoracic aorta.  The\nthoracic aorta is normal in caliber.  The heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are multiple punctate nodules throughout the lungs\nbilaterally, some of which are calcified, all of which are unchanged compared\nto prior.  There are no new or growing pulmonary nodules.  No focal\nconsolidations.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nBONES: Unchanged deformity through the superior endplate of T11.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of metastatic disease within the chest.  Multiple punctate\nnodules throughout the lungs bilaterally, all unchanged compared to prior.\n2. Please refer to the CT abdomen pelvis with the same date for evaluation of\nthe subdiaphragmatic structures."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, supraclavicular, mediastinal, or\nhilar lymphadenopathy.  The heart size is normal.  There is no pericardial\neffusion.  The esophagus is normal without evidence of wall thickening or a\nhiatal hernia.  The aorta is normal in caliber.  The main pulmonary artery is\nnormal in caliber.\n\nFor evaluation of the subdiaphragmatic structures, please refer to dedicated\nCT of the abdomen performed on same day.\n\nOsseous structures: No concerning focal lytic or sclerotic lesions are\nidentified.\n\nOverall, right-sided millimetric pulmonary nodules are unchanged compared to\nthe prior exam without evidence of concerning new or growing pulmonary\nnodules.  Mild bibasilar atelectasis.  No pleural effusion or pneumothorax.",
            "output": "-No evidence of lymphadenopathy.\n-Stable right-sided millimetric nodules without evidence of concerning new or\ngrowing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is homogeneously\nattenuating without nodularity or mass.  No infraclavicular, supraclavicular\nor axillary lymphadenopathy.  Mild calcifications off the proximal left\nsubclavian artery, otherwise other evidence of calcified atherosclerosis in\nthe head and neck vasculature.  Breast tissue is best evaluated by\nmammography.  An accessed right-sided Port-A-Cath terminates into the right\natrium.\n\nUPPER ABDOMEN: Please refer to same-day CT abdomen and pelvis for a detailed\nreport of subdiaphragmatic findings.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Cardiac size is normal.  No pericardial effusion.  The\npericardium is physiologic.  No calcification of the coronary arteries.  The\nvascular caliber of the ascending aorta, descending aorta and main pulmonary\narteries are within normal limits.  No evidence of pulmonary embolism.\nPLEURA: Mild biapical pleuroparenchymal scarring.  No pleural effusion or\npneumothorax.\nLUNG:\n\n1. PARENCHYMA: A few 2 mm pulmonary nodules at the right upper and lower lobe\n(series 6, image 106, 157, 283) are unchanged since ___.  No new or\ngrowing pulmonary nodules.\nA 2 mm subpleural pulmonary nodule at the left upper lobe is unchanged since\n___, (series 6, image 77).\n2. AIRWAYS:  The airways are patent to the subsegmental level without evidence\nof bronchial wall thickening, mucous plugging or bronchiectasis.\nCHEST CAGE: A compression deformity is demonstrated at the superior endplate\nof T11 with less than 50% vertebral body height loss.  At the vertebral body\nof L3 is a punctate sclerotic focus which most likely represent a bone island.\nNo suspicious lytic or sclerotic osseous lesions are demonstrated, however\nradionuclide bone scan and FDG PET study is more sensitive in the detection of\nosseous pathology.  No pathologic fracture.",
            "output": "1. A handful of pulmonary nodules measure up to 2 mm are unchanged since\n___.  No new or growing pulmonary nodules.\n2. No intrathoracic lymphadenopathy.\n3. Please refer to same-day CT abdomen and pelvis for detailed report of\nsubdiaphragmatic findings."
        },
        {
            "input": "CHEST PERIMETER: No abnormalities in the imaged thyroid need any further\nimaging evaluation.  Supraclavicular and axillary lymph nodes are not\nenlarged.  Breast evaluation is reserved exclusively for breast imaging.  No\nsoft tissue abnormalities elsewhere in the chest wall.  Findings below the\ndiaphragm will be reported separately.\n\nRight supraclavicular central venous infusion catheter ends in the upper right\natrium with no evidence of thrombosis.  New, right upper pectoral reservoir\npuckers the skin, 06:45, which can be readily examined clinically.  There is\nno subcutaneous abnormality.\n\nCARDIO-MEDIASTINUM: Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels but is present in at least left anterior\ndescending and right coronary arteries.\n\nAorta and pulmonary arteries are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: No new or growing lung nodules appreciable size.  No\nfocal pulmonary abnormalities of consequence other than calcified granuloma in\nthe right lower lobe.  No evidence of tuberculosis or other infection. \nTracheobronchial tree is normal to subsegmental levels and there are no\npleural abnormalities aside from an isolated calcification along the right\ndiaphragmatic surface, 6:245.\n\nCHEST CAGE: Moderate loss of height in the T11 vertebral body due to upper\nendplate impression is unchanged since ___ and not pathologic.  Also\nunchanged is a small sclerotic lesion in T12, and a similar lesion in L3, both\nbenign.\n\nChest cage is otherwise unremarkable.",
            "output": "No evidence of intrathoracic malignancy or infection.  No adenopathy.  Handful\nof tiny lung nodules stable since at least ___ can be considered\nbenign.\n\nMild coronary artery calcification.\n\nSuggest clinical inspection of the skin surrounding the new right upper\npectoral infusion reservoir.  No subcutaneous abnormality."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  Multiple\nbilateral enlarged cervical lymph nodes, the largest in the left\nsupraclavicular area measuring 14 mm diameter (5, 5).  Multiple markedly\nenlarged bilateral axillary lymph nodes the largest in the right axilla\nmeasuring 27 mm in diameter (5, 7) and in the left axilla measuring 16 mm in\ndiameter (5, 14).  No gross breast lesions.\n\nUPPER ABDOMEN: Will be reported separately.  Suspected small hiatal hernia.\n\nMEDIASTINUM: Multiple enlarged mediastinal lymph nodes (involving all lymph\nnode stations) the largest in the subcarinal station measuring 22 mm diameter.\n\nHILA: Bilateral hilar adenopathy, for example right hilar measuring 19 mm in\ndiameter (5, 26).\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Moderate coronary artery calcification.  Mild\natherosclerotic changes of the aortic arch.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA: Two round, solid 6mm wide pulmonary nodules, in the right upper\nlobe (6, 87, 137).  Mild, cylindrical bronchiectasis involving the lower lung\nzones with associated mild ground-glass opacity of the lungs as well as mild\nposterior basal scarring in the left lower lobe (6, 259) suggesting chronic\naspiration.  No significant bronchial wall thickening, endobronchial\nsecretions or peribronchial nodules to suggest active infection.\n2. AIRWAYS:  The airways are patent to the subsegmental level.\n3. VESSELS:  The pulmonary arteries not enlarged.  No filling defects on this\nnondedicated study.\nCHEST CAGE: Spondylotic changes of the thoracic spine with a stable superior\nendplate insufficiency type fractures/Schmorl nodule involving the T12\nvertebral body.  No lytic/destructive bony lesions.",
            "output": "Extensive markedly enlarged (non necrotic) lymphadenopathy involving the lower\ncervical, supraclavicular, axillary and all mediastinal stations as described\nabove, highly suggestive of a lymphoproliferative disease.\nThe axillary lymph nodes would be most accessible to biopsy.\n\nTwo 6mm pulmonary nodules measuring 6 mm in the right upper lobe could be due\nto pulmonary involvement of the lymphoproliferative process, but follow-up\nimaging is advised to evaluate possible malignancy, including metastasis.\n\nMild cylindrical bronchiectasis involving the lower lung zones with mild\nassociated scarring in the posterior basal lung aspects suggest chronic/silent\naspiration.  No significant bronchial wall thickening, endobronchial\nsecretions or peribronchial nodules to suggest active infection.\n\nFor neck and abdominal and pelvic findings please refer to the respective\nstudy reports."
        },
        {
            "input": "Filling defect in right internal jugular vein is suspected, series 4 image\n___.  The finding is new compared to previous study.  Aorta and pulmonary\narteries are unremarkable.\n\nInterval substantial decrease in size up to complete resolution of\nsupraclavicular, bilateral axillary and mediastinal lymphadenopathy is present\nwith no pathological lymph nodes currently seen.\n\nHeart size is normal.  There is no pericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed in details as part of the\nCT abdomen and pelvis obtained the same day in corresponding report will be\nissued.\n\nAirways are patent to the subsegmental level bilaterally.  Previously seen\npulmonary nodules has substantially decreased in size, series 5, image 86,\n136, 176 from the view to of 1 cm to the view to of 2 mm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Substantial interval improvement of both mediastinal hilar and axillary\nlymphadenopathy as well as pulmonary nodules\n\nSuspected right internal jugular line clot, correlation with ultrasound is\nrequired."
        },
        {
            "input": "New large 3.1 x 2.3 cm right hilar lymph node is present, series 4, image 27. \nIn addition there is interval increase in aortopulmonic lymph node from ___\nmm, series 4, image 22 as well as development of left hilar lymph node, 8 x 13\nmm as compared to 5 x 9 mm, series 4, image 29.  Right inferior hilar lymph\nnode (in the location adjacent to the right inferior pulmonary vein is new, 13\nmm.\n\nBilateral axillary lymphadenopathy has progressed, approaching 12 mm on the\nright as compared to 4 mm and 10 mm on the left compared to 4 mm.\n\nAorta and pulmonary arteries are normal in appearance.  Heart size is normal. \nThere is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Previously seen\npulmonary nodules are unchanged as compared to most recent prior study and\nstill smaller than on ___\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Interval increase in mediastinal lymph nodes and axilla lymph nodes compared\nto ___ but still substantially smaller done on ___\n\nSeveral small pulmonary nodules, unchanged as compared to ___,\nsubstantially smaller than ___."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.8 cm and 0.5 cm in the right and\nleft supraclavicular stations respectively are unchanged since ___\nwhere avidity was demonstrated.  Mildly smaller since ___.\nStable sub cm bilateral axillary lymph nodes, up to 0.8 cm in the right axilla\nhave also minimally decreased in size since ___ when measured the\n1.3 cm.\n\nRight pectoral Port-A-Cath terminates in the right atrium.\ninternal jugular vein is sclerosed, the external jugular vein is enlarged and\nanterior to the trachea, for particular attention in case of possible\nintervention as tracheostomy.\n\nUPPER ABDOMEN: Detailed in the concurrent CT of the abdomen pelvis.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\nRight hilum 1.4 x 2.6 cm lymph was avid on PET-CT ___ and is\nmildly smaller since ___ when it measured 2.3 x 3.4 cm.\nNo left hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart the major vessels are normal in size and there is\nno pericardial effusion.  Minimal calcifications in the coronaries as well as\nalong the thoracic aorta and head and neck vessels.  There is no evidence of\ncentral pulmonary emboli in this nondedicated study.\n\nPLEURA: No pleural effusion.  No pneumothorax.\n\nLUNG: Airways are patent to the subsegmental level.\n0.4 cm nodules in the right upper lobe (6:85, 135) are unchanged since ___, were up to 0.7 cm in ___.  No new or growing lung nodules.\nThe no consolidations to suggest pneumonia.\nFew scattered calcified granulomas are unchanged.\n\nCHEST CAGE: Mild compression fracture of superior endplate of T12 is unchanged\nsince ___, likely degenerative, and there are no new compression\nfractures.  No evidence of osteo-destructive lesions.",
            "output": "-No change in the right hilum lymphadenopathy, sub cm supraclavicular and\naxillary lymph nodes in comparison to PET-CT ___, mildly smaller\nsince ___.\n-Few small pulmonary nodules unchanged since ___, were larger in ___.\n-Internal jugular vein is sclerosed, the external jugular vein is enlarged and\nanterior to the trachea, for particular attention in case of possible\nintervention as tracheostomy."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 0.8 and 0.5 cm right and left,\nsupraclavicular lymph nodes respectively are stable (3:1, 8).\n\nIn the right subcutaneous tissue superficial to the scapula 1.1 by 1.7 cm\nlymph node is larger, in prior 1.7 cm (03:55). Right 0.7 cm lymph node in the\nis not pathologically enlarged, but mildly larger since prior when it measured\n0.4 cm (03:34).  Both show avidity on today's study.\n\nRight pectoral Port-A-Cath terminates in the cavoatrial junction.\nImaged thyroid is unremarkable.\n\nUPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: Right upper paratracheal 1.6 x 2.7 cm conglomerate is mildly\nlarger (03:22).  2.3 x 1.1 cm lymph node in AP window, was 0.6 cm by 1.3 cm in\nprior (3:78).\n\nLeft hilus 0.9 cm lymph node is mildly larger, in prior 0.5 cm (3:106).  Right\nhilus 2.5 x 1.2 cm lymph node is unchanged (3:91).  Both mediastinal and hilar\nlymph nodes show avidity on today's PET-CT.\n\nHEART and PERICARDIUM: Heart is normal in size.  No pericardial effusion. \nModerate to severe calcifications of the coronaries, predominantly LAD and\nRCA.  Thoracic aorta is normal in caliber with mild calcifications at the\nlevel of the thoracic aorta and origin of main branches.\nAs in prior right internal jugular vein is sclerosed, the external jugular\nvein is enlarged and anterior to the trachea, particular attention in case of\npossible intervention such as tracheostomy (03:13).\n\nPLEURA: Minimal pleuroparenchymal scarring in left apex.  There are no pleural\neffusions.\n\nLUNG: Tracheobronchial tree is patent to subsegmental level.  The pre-existing\npulmonary nodules are unchanged and there are no new lung nodules.  These\ninclude 0.4 cm nodule in the right upper lobe (03:57, 95).  Scattered\ncalcified granulomas are few in the right lower lobe.\nNo confluent consolidations to suggest pneumonia.\n\nCHEST CAGE: No evidence of osteo destructive lesions at the level of the ribs,\nvertebra or sternum.  Healed right ninth rib fracture.  Mild compression\nfractures of T12 superior endplate is long-standing.",
            "output": "-Thoracic lymphadenopathy is mildly worse in comparison to prior concerning\nfor recurrent lymphoma.\n-Pre-existing small pulmonary nodules are stable.  No new lung nodules."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  Right-sided Port-A-Cath tip\nprojects to the cavoatrial junction.  The small left supraclavicular lymph\nnodes have further regressed in size and a barely perceptible on the current\nstudy.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  The soft\ntissue nodule in the right upper posterior back (5, 116) measuring 6 mm has\nsignificantly decreased in size it previously measured 13 mm\n\nMEDIASTINUM: Previously visualized mediastinal and right hilar lymph nodes\nhave further regressed in size and a barely perceptible on the current study. \nHeart size is normal.  There is no pericardial effusion\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: All the previously visualized pulmonary nodules are unchanged since the\nprior study for example 4 mm right upper lobe nodule (6, 131).  No new\npulmonary nodules.\n\nBONES AND CHEST WALL : Review of bones shows old healed fractures involving\nthe right ninth rib.  Mild wedge compression involving T12 superior endplate\nis unchanged.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable",
            "output": "Decrease in size of the supraclavicular, mediastinal, right hilar and upper\nposterior back lymph node/soft tissue.  No new sites of adenopathy\n\nRight-sided Port-A-Cath with its tip in the SVC\n\nStable 4 mm right upper lobe pulmonary nodule.  No new pulmonary nodules."
        },
        {
            "input": "CHEST PERIMETER: There are no thyroid findings warranting further imaging\nevaluation.  Supraclavicular and axillary lymph nodes are not enlarged. \nEvaluation of the breasts is reserved for mammography.  Elsewhere in the chest\nwall there are no soft tissue abnormalities concerning for malignancy. \nFindings in the neck and below the diaphragm will be reported separately.\n\nLarge varix in the right lower anterior neck probably due to chronically\nthrombosed right internal jugular line and indwelling venous infusion\ncatheters, is unchanged since at least ___.\n\n\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent in head and neck vessels but is present in at least left\nanterior descending and right coronary arteries.  Aorta and pulmonary arteries\nand cardiac chambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: There are no new or growing lung nodules.  Handful of\nnodules, 4 mm or smaller,, 5:84, 135, 178, 258, is unchanged since ___\nand ___.  Lungs are otherwise clear.  Tracheobronchial tree is normal to\nsubsegmental levels and, aside from a solitary right pleural calcification,\nthere is no pleural abnormality.\n\nCHEST CAGE: Moderate loss of height in a lower thoracic vertebral body due to\nimpression of the upper endplate is unchanged.  Chest cage is otherwise\nunremarkable.",
            "output": "No evidence of intrathoracic malignancy or active infection."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular\naxillary lymphadenopathy.  Thyroid is unremarkable.  Right pectoral\nPort-A-Cath with lead terminates in the upper right atrium.\n\nUPPER ABDOMEN: Both adrenal glands are unremarkable.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: Within the limitations of a noncontrast enhanced study, there is no\nhilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There are moderate coronary\narterial calcifications.  There is no pericardial effusion.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA: There are subtle centrilobular opacities in the right upper\nlobe (5:68).  Multiple solid nodules in the right lung measuring up to 4 mm\n(5: 87, 139, 183, 250) are unchanged dating back to chest CT ___. \nScattered calcified granulomas are noted.  There is no consolidation.\n2. AIRWAYS: There is mild bronchiectasis in bilateral lower lobes.\n3. VESSELS:  The main pulmonary artery is not enlarged.\nCHEST CAGE: There is no acute osseous abnormality.  A small large node at the\nsuperior endplate and compression deformity of the T11 vertebral body is\nunchanged from ___.",
            "output": "1. Centrilobular opacities in right upper lobe are nonspecific and could\nrepresent changes from chemotherapy, given the lack of a reported history of\nsmoking.\n2. Multiple solid nodules in the right lung measuring up to 4 mm are stable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.  Partially visualized thyroid is\nunremarkable.  Right prepectoral Port-A-Cath terminates in the right atrium. \nEvaluation of breast tissues reserved for mammography.\n\nUPPER ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same\nday for subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  Coronary arterial\ncalcifications are moderate.  The pericardium is physiologic.\nPLEURA: There is no pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Multiple pulmonary nodules are unchanged dating back to chest\nCT ___: 3 mm in the right upper lobe (03:50), 4 mm in right upper lobe\n(3:98), 3 mm in the right lower lobe (3:198), and 4 mm in right middle lobe\n(3:130).  Scattered calcified granulomas are noted.  There is no\nconsolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The main pulmonary artery is not enlarged.\nCHEST CAGE: Compression deformity of the superior endplate of the T11\nvertebral bodies is unchanged dating back to chest CT ___.",
            "output": "1. No evidence of intrathoracic malignancy or infection.\n2. Four pulmonary nodules, the largest of which is 4 mm, are stable dating\nback to CT chest ___, unlikely to be active, either malignant or\ninfectious.\n3. Please refer to dedicated CT abdomen and pelvis report on same day for\nsubdiaphragmatic findings."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  Right-sided Port-A-Cath projects to\nthe right ventricle\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  Aorta and pulmonary artery\nnormal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: A 3 mm nodule in the right middle lobe (3, 103) is unchanged.  A 2 mm\nsubpleural right middle lobe pulmonary nodule (3, 137 is unchanged.  Another\nright upper lobe pulmonary nodule (3, 63) is also unchanged no new or growing\npulmonary nodules.  Minimal bibasilar atelectasis.  Mild bronchiectasis in\nboth lower lobes\n\nBONES AND CHEST WALL : Review of bones shows osteopenia.  There are\ndegenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows a right renal\ncyst.  No focal liver lesions are seen",
            "output": "Stable ___ mm right lung pulmonary nodule.  No new or growing pulmonary\nnodules.\n\nNo evidence of recurrent lymphoma in the chest."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nA prominent right supraclavicular node (5:8) was previously characterized on\nPET-CT, and is newly prominent compared to the prior chest CT from ___.  There is no axillary lymphadenopathy.  7\n\nUPPER ABDOMEN: Please refer to the separate report of the CT abdomen and\npelvis performed on the same day for subdiaphragmatic characterization.\n\nMEDIASTINUM: Multiple mediastinal nodes are enlarged, for example in the\nprevascular station, measuring up to 16 x 11 mm (5:87).\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.  Mild coronary artery\ncalcifications.  Mild atherosclerotic calcifications of the aortic arch.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Calcified granulomas within the right lower lobe and left lower\nlobe.  A 3 mm pulmonary nodule within the right middle lobe (5:134) has\nminimally increased in size, previously measuring 2 mm.  Other sub 3 mm\npulmonary nodules are unchanged.  No new pulmonary nodules.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE: No worrisome osseous lesions are identified.  Mild loss of\nvertebral body height of T11 is stable since at least ___.  There is\nno acute fracture.",
            "output": "1. Interval development of supraclavicular and mediastinal lymphadenopathy,\nwhen compared to the chest CT from ___, demonstrating FDG avidity\non recent PET CT.\n2. Minimal increase in size of a 3 mm pulmonary nodule within the right middle\nlobe, previously measuring 2 mm.  Other sub 3 mm pulmonary nodules are stable.\nNo new pulmonary nodules.\n3. Please refer to the separate report of the CT abdomen and pelvis performed\non the same day for subdiaphragmatic characterization."
        },
        {
            "input": "CHEST PERIMETER: No abnormality in the imaged portion of the thyroid warrant\nany further imaging.  Right supraclavicular central venous catheter ends at\nthe superior cavoatrial junction, with no complication in the neck or evidence\nof thrombosis.  Previous 6 mm right supraclavicular lymph node is no longer\nmeasurable.  No supraclavicular or axillary lymph nodes are enlarged.  Breast\nevaluation is reserved exclusively for mammography.  Findings in the neck and\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Esophagus is unremarkable.  Atherosclerotic calcification\nis not apparent head neck vessels but is considerable in at least left main,\nanterior descending and right coronary arteries.  Aorta and pulmonary arteries\nare normal size and aortic valve is not calcified.  Pericardium is\nphysiologic.  There is no mediastinal mass.\n\nTHORACIC LYMPH NODES: Previous central lymph node enlargement, most prominent\nin the prevascular and thoracic outlet stations has resolved.  No lymph nodes\nin the chest are enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Lungs are clear, tracheobronchial tree is normal to\nsubsegmental levels and there are no pleural abnormalities.\n\nCHEST CAGE:   Upper endplate impression, T12 thoracic vertebral body, largely\na disc intrusion is unchanged.  It is not pathologic.  Although there are no\nbone lesions in the imaged chest cage suspicious for malignancy or infection,\nit should be noted that radionuclide bone and FDG PET scanning are more\nsensitive in detecting early osseous pathology than chest CT scanning..",
            "output": "Previous mediastinal adenopathy has resolved.  No evidence of intrathoracic\nmalignancy or infection."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, mediastinal, or supraclavicular\nlymphadenopathy.  The heart size is normal.  There is no pericardial effusion.\nThe esophagus is normal without evidence of wall thickening or a hiatal\nhernia.  There is no hilar lymphadenopathy.  The aorta is normal in caliber. \nThe main pulmonary artery is normal in caliber.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures however please refer to dedicated CT of the abdomen performed on\nsame day.\n\nOsseous structures: Compression deformity of the T12 vertebral body is\nunchanged compared to the prior exam.  No concerning focal lytic or sclerotic\nlesions are identified.\n\nA 3 mm right middle lobe nodule, series 6, image 143 is unchanged compared to\nthe prior exam.  No concerning new or growing pulmonary nodules are\nidentified.  There is no pleural effusion or pneumothorax.",
            "output": "Stable millimetric right pulmonary nodules without evidence of concerning new\nor growing pulmonary nodules.  No new lymphadenopathy."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  There are\ncoronary artery calcifications as well as calcifications involving the mitral\nannulus and aortic valve.  Calcifications involving the thoracic aorta are\ndemonstrated.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent mediastinal lymph nodes are likely\nreactive.  No axillary lymphadenopathy.  Hilar lymphadenopathy is difficult to\ndistinguish without contrast administration.\n\nPLEURAL SPACES: There small pleural effusions.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is extensive infiltrates seen bilaterally, most severe in\nthe right upper lobe as well as scattered throughout the lower lobes.  The\nairways are patent to the level of the segmental bronchi bilaterally.  There\nis mild bibasilar atelectasis.\n\nBASE OF NECK: Multinodular goiter with is largest left nodule measuring up to\n3.7 cm.\n\nABDOMEN: Limited views of the upper abdomen demonstrate moderate ascites and a\nnodular cirrhotic appearing liver.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. Extensive multifocal infiltrates could be related to edema versus\nmultifocal pneumonia, given anasarca and intraperitoneal ascites.\n2. Large left thyroid nodule measuring up to 3.7 cm, for which thyroid\nultrasound is recommended if not already performed.\n\nRECOMMENDATION(S):  Thyroid ultrasound."
        },
        {
            "input": "Internal mammary arteries are patent bilaterally.  Right internal mammary\nartery bifurcates into two branches at the level of the ___ costochondral\njunction (series 603, image 9). No appreciable branching of the left internal\nmammary artery.\n\nHeart is top-normal in size.  Mild coronary calcifications.  Mild aortic valve\ncalcifications.  Extensive mitral valve calcifications noted.  The thoracic\naorta is normal in caliber, with mild atherosclerotic calcifications\nthroughout.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy\nby size criteria.  Scattered mediastinal lymph nodes are subcentimeter in\nsize.  Imaged part of the thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nAirways are patent to the segmental bronchi bilaterally.  Biapical\npleuroparenchymal scarring.  There is moderate paraseptal and centrilobular\nemphysema, upper lobe predominant.  3 mm left apical ground-glass nodule\n(3:19).  Additional 2 mm nodule in the right lower lobe (3:80).\n\nSubcentimeter area of faint enhancement along the hepatic dome may be\nperfusional (3:100).  Left adrenal gland is thickened, without a discrete\nnodule.  Right adrenal gland is normal in size and shape.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nPost sternotomy.  Biopsy clip in the left breast.",
            "output": "1. Internal mammary arteries are patent bilaterally. Right internal mammary\nartery bifurcates into two branches at the level of the ___ costochondral\njunction.\n2. Moderate upper lobe predominant centrilobular emphysema.\n3. Bilateral micronodules.\n\nRECOMMENDATION(S):   For incidentally detected multiple solid pulmonary\nnodules smaller than 6mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer.  There is mild calcified\natherosclerotic disease involving the ascending aorta, aortic arch, origin of\nthe great vessels and to a lesser extent descending thoracic aorta.\n\nThe pulmonary arteries are well opacified to the segmental level.  There is a\npartially occlusive filling defect within the anterior segmental branch of the\nright upper lobe.  Nonocclusive filling defects are also suspected within the\nproximal subsegmental branches of the right middle lobe and right lower lobe. \nNo definite filling defects are noted in the left lung noting suboptimal\nopacification of the subsegmental branches of the left lower lobe.  There are\nno filling defects within the main pulmonary arteries.  There is slight\nprominence of the pulmonary trunk and main pulmonary arteries bilaterally\nsuggestive of longstanding pulmonary hypertension.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nThe heart is not significantly enlarged. There is no evidence of right heart\nstrain.  Patient is status post mitral valve repair.\nThere is no evidence of pericardial effusion.\n\nThere is a small right pleural effusion and trace left pleural effusion with\nsome adjacent subsegmental atelectasis.\nCentrilobular emphysema noted.  There is no evidence of acute pulmonary\ninfarct or hemorrhage.\nThe airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nPatient is status post bilateral breast reconstruction.  Surgical drains are\nnoted within each surgical flap.  There is edema and stranding of the surgical\nflaps with small pockets of gas noted, more prominent on the left side.  In\nparticular, there is a small gas containing peripheral collection in the left\nflap measuring 1.2 x 4 cm.",
            "output": "1. Segmental and subsegmental PE in the right upper, middle and lower lobes as\ndescribed.  No evidence of right ventricular strain or pulmonary\ninfarct/hemorrhage.\n2. Small right and trace left pleural effusions and subjacent subsegmental\natelectasis.\n3. Diffuse inflammatory changes within both surgical flaps with a small gas\ncontaining collection in the periphery of the left flap as described.\n\nNOTIFICATION:  The findings were discussed with Dr.  ___, M.D. by\n___, M.D. on the telephone on ___ at 8:45 pm, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Patient is post mitral valve repair.  Small pericardial\neffusion is likely physiologic.  The heart is moderately enlarged.\n\nThe main pulmonary artery measures 3.0 cm, which is slightly prominent.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lung volumes are low, with a background of centrilobular\nemphysema, as described previously.  An endotracheal tube terminates\napproximately 5 cm above the carina.  There are bilateral nonhemorrhagic\npleural effusions, large on the right and moderate-sized on the left, with\nadjacent compressive atelectasis in the bilateral lower lobes.  The airways\nare otherwise patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portion of the right lobe of thyroid is heterogeneous\nas seen on prior.  Visualized portions of the base of the neck show no\nabnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable, noting the\nnasogastric tube in the proximal stomach.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nMedian sternotomy wires are intact.\n\nSOFT TISSUES: Patient is post bilateral breast reconstruction.  Previous\nsurgical drains are no longer present.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Diminished lung volumes with enlarged bilateral nonhemorrhagic pleural\neffusions, large on the right and moderate sized on the left.  There is\nadjacent compressive atelectasis in both lower lobes.\n\n3.  Prominent main pulmonary artery, suggesting pulmonary arterial\nhypertension."
        },
        {
            "input": "Status post sternotomy.  Massive mitral valve calcifications.  Mild to\nmoderate aortic valve calcifications.  Mild to moderate coronary\ncalcifications.  Mild calcifications of the ascending and descending aorta,\nmoderate calcifications of the aortic arch.  The ascending aorta has a\ndiameter of 28 x 27 mm at the level of the main pulmonary artery.  At the same\nanatomical level, the descending aorta has a diameter of 23 x 23 mm.  The\ndiameter of the main pulmonary artery is borderline.  No lymphadenopathy. \nNormal posterior mediastinum.  No abnormalities at the level of the upper\nabdomen.  Moderate paraseptal, panlobular and centrilobular pulmonary\nemphysema.  Several small ground-glass nodules, for example in the left upper\nlobe (5, 88).  Mild to moderate chronic airways disease with irregularities of\nthe airway walls and mucous plugging.  ___ opacities and parenchymal\nscars in the right lower lobe, associated with areas of mucous plugging,\nsuggest chronic aspiration or infection.  Pleural effusions.  No suspicious\nlung nodules or masses.",
            "output": "Aortic ___ and calcification great is given as requested, pulmonary\nemphysema and signs of chronic airways disease with sequela of aspiration in\nthe right lower lobe."
        },
        {
            "input": "There are atherosclerotic calcifications in the thoracic ascending, thoracic\ndescending, and aortic arch.  There are  atherosclerotic calcifications in the\nbilateral common carotids and bilateral subclavian arteries.  There is no\nevidence of stenosis, occlusion, aneurysm, or dissection in the aorta and its\nmajor branch vessels.\n\nA pacemaker generator is seen in the left axilla with 2 pacemaker leads\nterminating in the right atrium and right ventricle, respectively.  There are\nstents visualized in left main, left anterior descending, and left circumflex\narteries.  There is cardiomegaly.  There is no evidence of pericardial\neffusion.  Median sternotomy wires are visualized.\n\nThe pulmonary arteries are patent with no filling defect seen within the main,\nright, left, lobar, segmental, and subsegmental pulmonary arteries.   The main\nand right pulmonary arteries are normal in caliber, and there is no evidence\nof right heart strain.\n\nThere are scattered mediastinal lymph nodes, the largest of which is a right\nlower paratracheal lymph node measuring 7 mm (02:36), however none of these\nmediastinal lymph nodes are pathologically enlarged by CT size criteria. \nThere is no supraclavicular, axillary, or hilar lymphadenopathy.  The thyroid\ngland is incompletely visualized but appears unremarkable.\n\nThere are large pleural effusions in the dependent areas of the bilateral\nlungs diffusely, most prominent at the lung bases and on right side.  There is\nadjacent dependent atelectasis in the dependent areas of the lungs\nbilaterally.  There is a subpleural calcified granuloma in the right upper\nlobe (02:40) There are diffuse pleural calcifications bilaterally, most\nprominently in the anterior aspect of the right upper lobe.\n\nLimited images of the upper abdomen are unremarkable.\n\nThere is an age indeterminate mild compression fracture of the T7 vertebral\nbody (302b:34).  The relative lack of sclerosis in the T7 vertebral body\nsuggests that this is likely to be more acute than chronic.  There are\nfractures of the sixth and seventh posterior left ribs(2: 43, 57). \nSignificant degenerative change in the thoracic and upper lumbar vertebral\nbodies.",
            "output": "1.  No evidence of pulmonary embolism.\n2.  Large bilateral pleural effusions and bilateral dependent atelectasis.\n3.  Diffuse pleural calcifications.\n4.  Compression fracture of the T7 vertebral body which is age-indeterminate\nbut likely to be more acute than chronic based on imaging findings.\n5.  Fractures of the posterior left ___ and 7th ribs.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 3:38 ___, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "The thyroid is normal.  Scattered axillary and mediastinal lymph nodes are\nidentified, none of which are pathologically enlarged by CT size criteria. \nFor example, a prominent epicardial lymph node measures 7 mm in short axis\n(05:29).  There are no enlarged supraclavicular or hilar lymph nodes\nidentified.\n\nAorta and pulmonary arteries are normal size.  No incidental large/central\npulmonary embolus is detected.  Mild coronary artery calcifications are noted.\nThe heart size is within normal limits.  A small hyperdense pericardial\neffusion is present.\n\nBilateral, simple-appearing small pleural effusions are noted.  Adjacent\natelectasis is noted at the bilateral lung bases.  There is scarring or linear\natelectasis in the right lower lobe laterally.  Paraseptal emphysematous\nchanges are most significant at the bilateral lung apices. The airways are\npatent to the subsegmental level.\n\nNo suspicious osseous lesion is identified.\n\nFor description of the intra findings, please see the separate CT abdomen and\npelvis report.",
            "output": "1.  Small bilateral pleural effusions with adjacent atelectasis.\n2.  Small hyperdense pericardial effusion.\n3.  Moderate biapical paraseptal emphysema."
        },
        {
            "input": "The thyroid is normal. The aorta is normal in appearance and caliber.  The\nmain pulmonary artery is mildly enlarged, measuring 3.1 cm. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nAtherosclerotic calcifications are seen in the aortic arch.  There is a small\nanterior mediastinal hematoma tracking from a sternal fracture, likely due to\nchest compression trauma following cardiac arrest.\n\nDiffuse airway wall thickening with extensive areas of mucosal plugging are\nmost notably seen in the right lower lobe. Patchy opacities are seen in the\ndependent right upper and lower lobes, possibly a combination of aspiration\nand atelectasis.  Ill-defined small nodular opacities are also noted in the\nleft upper lobe, left lower lobe, right upper lobe, and right middle lobe\n(3:22,27,29,31,34,35,38,41,53,54) which may all be related to the current\nacute process, but should be monitored for resolution on follow up exams. \nExtensive centrilobular emphysematous changes are noted in the lungs.  Smooth\nseptal thickening is indicative of mild pulmonary edema.  No pleural effusion\nor pneumothorax is present.\n\nThere is fullness of the right hilum suspicious for hilar lymphadenopathy,\nlikely reactive. Supraclavicular and axillary lymph nodes are not enlarged.\n\nPatient is intubated with the endotracheal tube in the appropriate position. A\nsaber sheath trachea is compatible with COPD history.\n\nLimited views of the upper abdomen is grossly unremarkable.  An enteric tube\nis seen in the stomach.\n\nModerate degenerative changes are noted in the thoracolumbar spine.  There are\nbilateral anterolateral non-displaced rib fractures, involving the ___\nribs on the right, and ___ and 7th ribs on the left.  There is a\ntransverse non-displaced sternal fracture with adjacent stranding and\nhematoma.",
            "output": "1. Bilateral anterolateral rib fractures, notably the ___ ribs on the\nright, and ___ and 7th ribs on the left. Additionally, there is a sternal\nfracture with a small anterior mediastinal hematoma.\n2. Diffuse airway wall thickening with extensive areas of mucosal plugging,\nmost notably in the right lower lobe, compatible with diffuse airway\ninflammation or infection. Patchy opacities in the dependent aspect of the\nright upper and lower lobes may reflect a combination of aspiration and\natelectasis.\n3. Probable right hilar lymphadenopathy, likely reactive.\n4. Ill-defined small nodular opacities are noted in the lungs bilaterally,\npossibly related to small airways disease, but should be reassessed on follow\nup CT exam.\n5. Severe centrilobular emphysema.\n\nRECOMMENDATION(S):  Recommend attention on follow up imaging for the multiple\nill-defined nodular opacities in the lungs."
        },
        {
            "input": "THYROID: The thyroid is minimally heterogeneous.\n\nLYMPH NODES: A 1.8 x 1.1 cm right hilar lymph node is re- demonstrated showing\npartial calcification.  Of note, there are few scattered, prominent\nmediastinal lymph nodes without pathologic enlargement.\n\nHEART AND VESSELS: The heart is top-normal in size.  There is a trace\npericardial effusion.  The great vessels are normal in caliber.  There is mild\nto moderate calcified and noncalcified atherosclerosis of the aortic arch and\nproximal cervical vessels.  There is no evidence of aortic dissection.  There\nis no evidence of pulmonary embolism to the subsegmental level.  Of note,\nthere is a small locular of air seen within the left internal jugular vein\n(2:8).\n\nLUNGS & AIRWAYS: There is extensive severe emphysema throughout both lungs. \nThere is a small right-sided pleural effusion and trace left pleural effusion.\nThere is consolidation of the right and left lower lobes which suggests\ninfection or aspiration, increased from the prior examination.  Additionally,\nthere is minimal consolidation within the inferior portion of the right upper\nlobe.  Diffuse, moderate bronchial wall thickening is demonstrated, most\nsevere involving the right lower lobe.  There is material within the right\nlower lobe bronchus and posterior lower lobe bronchi.  Dependent material is\nalso seen in the left main bronchus and left lower lobe bronchi.\n\nUPPER ABDOMEN: An endotracheal tube terminates above the carina in expected\nposition.  An enteric tube terminates below the field of view.  There is mild\nintra-abdominal free fluid slightly increased from the prior exam.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: Moderate degenerative changes are noted\nthroughout the thoracolumbar spine.  Multiple nondisplaced rib fractures are\nunchanged.  A sternal fracture is again demonstrated.",
            "output": "No evidence of pulmonary embolism or aortic dissection.\n\nIncreasing consolidation within the bilateral lower lobes and inferior portion\nof the right upper lobe suggests infection or aspiration, increased from the\nprior examination on ___.  Material within airways may reflect\naspiration as detailed above.  Small right pleural effusion and trace left\npleural effusion also minimally increased.\n\nMinimal intra-abdominal ascites, slightly increased from the prior\nexamination."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal lymph nodes are\nnot enlarged.  There is increase in number of mediastinal lymph nodes.  There\nhas been marked decrease in bilateral hilar lymph nodes measuring up to 9 mm\non the left and 12 mm on the right.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nand there is no appreciable coronary calcification.\nThe trachea has saber sheet appearance..  There is extensive bronchial wall\nthickening throughout the lungs.  Severe centrilobular emphysema is again\nnoted.  Extensive bronchial impaction, secretions in the airways, and tube\nmultifocal consolidations in the right middle lobe and lower lobes bilaterally\nhave improved.\nIn the subpleural and posterior right upper lobe there has been progression of\nan ill-defined consolidation slowly increasing since ___ this is highly\nconcerning for adenocarcinoma.\n3 mm nodule in the right apex (6:62) is stable from ___ but new from\n___\n3 mm nodule right upper lobe is stable (06:57)\nNodularity of the right major and minor fissures has increased\n8 mm right perifissural nodule is likely lymph node (6:192)\n5 mm spiculated nodule in the right middle lobe adjacent to acystic lesion was\n2 mm in ___\n14 mm right lower lobe nodule was 7 mm in ___ and 8 mm in ___ (6:172),\nadjacent irregular nodules as well as smaller nodules in the right lower lobe\nwere not present in old prior studies, but could be inflammatory\nLeft upper lung very additional nodule (6:118) measuring 4 mm was not present\nin ___, stable from ___.\nMultiple peribronchial and ___ nodules in the left lower lobe remain,\nsome have improved from prior studies likely inflammatory\nThere is trace bilateral pleural effusion.  There is no pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation there is a\nsmall hiatal hernia\nThere are no bone findings of malignancy.  Multiple bilateral rib and sternal\nfractures now have callus formation",
            "output": "Slowly increasing consolidation in the right upper lobe is concerning for\nadenocarcinoma, tissue sample is recommended\nAcute infectious process in the right middle lobe and lower lobes have\nmarkedly improved\nSome of the lung nodules as described above have increased in size or were not\npresent in studies from ___ and ___\nSevere emphysema\nChronic aspiration\n\nRECOMMENDATION(S):  Tissue sample of the slowly increasing consolidation in\nthe right upper lobe\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:07 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "The thyroid gland is unremarkable.  Scattered supraclavicular, mediastinal,\nhilar, and axillary lymph nodes are not enlarged.  The aorta and pulmonary\narteries are normal in caliber.  Atherosclerotic calcifications are seen at\nthe aortic arch extending into the origins of the major branches.  The heart\nis normal in size.  There is no pericardial effusion.\n\nThe airways are patent to the subsegmental level.  The trachea has a saber\nsheath configuration compatible with COPD.  Layering secretions are seen\nwithin the upper trachea.  Background centrilobular emphysema is severe. \nDiffuse bronchial wall thickening and irregularity bilaterally is compatible\nwith chronic small airways disease.  The consolidation at the posterior\nsegment of the right upper lobe is improved since the prior study in ___,\npossibly due to long standing infection and scarring given significant\nbackground parenchymal abnormalities.  In addition, the nodular opacities in\nthe bilateral lower lobes have also improved.  For example in the right lower\nlobe, only a 10 mm nodule remains from a previous area of consolidation\n(10:166).  A solid nodule is seen in the right middle lobe measuring 7 mm\n(10:212), unchanged since the prior study.  Other small nodules (10:60, 87,\n97, 107, 123, 204) are all unchanged.  There is no pleural effusion or\npneumothorax.\n\nPlease note the subdiaphragmatic findings, including a small hiatal hernia,\nwill be reported separately.\n\nNo suspicious lytic or sclerotic osseous lesion is identified.  There is a\nhealing mid sternal fracture, unchanged.  Old right rib fractures are also\nnoted.",
            "output": "Interval improvement in the consolidation in the posterior segment of the\nright upper lobe.  Other areas of focal consolidations in the bilateral lower\nlobes have also improved.  These likely reflect long-standing infection and\nscarring given significant background emphysema.  However, follow-up chest CT\nis recommended in 3 months.\n\nRECOMMENDATION(S):  Follow-up Chest CT in 3 months."
        },
        {
            "input": "Within the lungs, severe emphysema is again demonstrated with predominantly\ncentrilobular features, as well as severe diffuse bronchial wall thickening. \nA dependent area of consolidation in the right lower lobe shows further\ninterval improvement with predominantly residual ground-glass opacification in\nthis region and lesser extent of solid consolidative opacity.\n\n\nA smoothly marginated 10 mm nodule in the superior segment of the right lower\nlobe is not appreciably changed considering technical differences between the\nscans (162, 5).  Several additional small nodular opacities remain unchanged,\nincluding a 3 mm nodule at the right apex (___), a 2 mm nodular opacity in the\nleft upper lobe (96) a 3 mm nodule in the superior segment left lower lobe\n(107) and a 6 mm juxta fissural nodule in the right middle lobe with, likely\nrepresenting a intrapulmonary lymph node (194), all on series 5.\n\nSoft tissue structures of the thorax demonstrate no enlarged intrathoracic\nlymph nodes.  Heart size is normal, and no pericardial or pleural effusion is\nevident.  Small hiatal hernia is incidentally noted.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but note is\nmade of cholelithiasis.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nof spine and healed rib and sternal fractures.  Mild compression deformity at\napproximately T4 has developed since the prior CT with adjacent sclerosis\nalong the superior endplate, and a compression deformity at T6 has worsened\nsince that time.  Bones are diffusely demineralized.",
            "output": "1.  Near resolution of right upper lobe consolidation.\n\n2. Unchanged pulmonary nodules.  A follow-up CT is recommended ___ to\ndocument ___ year stability.\n\n3.  Severe emphysema and bronchial wall thickening.\n\n4.  New mild compression deformity in the thoracic spine at approximately T4."
        },
        {
            "input": "HEART AND VASCULATURE: Postoperative changes of CABG are present.  Heart is\nborderline in size.  Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  A trace pericardial effusion is present.  The main\npulmonary artery is in the upper limits of normal.\n\nAXILLA, HILA, AND MEDIASTINUM: A right lower paratracheal node measures up to\n1.5 cm (301:77).  There is no axillary or hilar lymphadenopathy.  No\nmediastinal mass is noted.\n\nPLEURAL SPACES: Moderate to large bilateral low-attenuation pleural effusions,\nwithout short-term change.  There is no pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar atelectasis associated with bilateral pleural\neffusions, as before.\nThe endotracheal tube is appropriately positioned.\nThe airways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Please refer to report of dedicated abdominopelvic CT from the same\nday for detailed description of abdominopelvic findings.\n\nBONES: Multilevel degenerative changes of thoracic spine with prominent\nanterior bridging osteophytes.  No acute fracture or suspicious lesions\nidentified.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  Moderate to large bilateral pleural effusions with compressive\natelectasis."
        },
        {
            "input": "HEART AND VASCULATURE: At the origin of the brachiocephalic artery is a small\nulcerated atherosclerotic plaque which does not cause high-grade stenosis but\ndoes cause mild narrowing of the lumen.  Pulmonary vasculature is well\nopacified to the subsegmental level without filling defect to indicate a\npulmonary embolus.  Most rated plaques are seen along the aortic arch.  There\nis calcified atherosclerosis in the coronary arteries.  No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThe thyroid is not well visualized.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: The patient is status post median sternotomy and CABG with sternal\nwires intact and appropriate postsurgical changes.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Ulcerative atherosclerotic plaques are seen at the origin of the\nbrachiocephalic artery and along the aortic arch."
        },
        {
            "input": "MEDIASTINUM:  Multiple subcentimeter hypodensities in the thyroid are likely\nbenign. No pathologically enlarged supraclavicular, axillary, hilar or\nmediastinal lymph nodes.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size. \nThe heart size is normal and there is no pericardial effusion. Minimal\natherosclerotic calcifications of the thoracic aorta and mild to moderate\ncoronary arteries.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent.  Pulmonary nodules as\nfollows:\n\n1 mm right upper lobe (04:47)\n1 mm left upper lobe (04:50)\n5 mm ground glass nodule left upper lobe (4:71)\n3 mm left upper lobe (4:87)\n3 mm ground glass nodule right upper lobe (4:89)\n3 mm nodule right lower lobe (04:15 3)\n5 mm nodule in left lower lobe (04:15 8)\n\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:\nAlthough this study is not designed for the evaluation of subdiaphragmatic\nstructures, the imaged upper abdomen shows a right renal cyst with mild\ncalcifications better characterized on recent abdominal CT.  Remaining upper\nabdomen is unremarkable",
            "output": "Multiple pulmonary nodule measuring up to 5 mm are likely benign, suggest\nfollow-up CT thorax in 6 months time to reassess as per ___ guidelines.\n\nRECOMMENDATION(S):  Follow-up CT thorax in 6 months time to reassess pulmonary\nnodules."
        },
        {
            "input": "Left thyroid nodule is unchanged.  Aorta and pulmonary arteries are unchanged.\nCalcifications on the left Coronary artery and right coronary artery are\nunchanged.  Heart size is normal.  There is no pericardial pleural effusion.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nImage portion of the upper abdomen demonstrate calcified superior pole of the\nright kidney cysts, unchanged since previous examination.\n\nAirways are patent to the subsegmental level bilaterally.  All the\npre-existing pulmonary nodules are stable, series 4 images 50, 54, 77, 93, 94,\n141, 157.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest and upper abdomen including multiple pulmonary\nnodules and superior pole of the right kidney calcified cyst."
        },
        {
            "input": "HEART AND GREAT VESSELS:\nPatient is status post sternotomy, CABG, and aortic valve replacement with\nocclusion of the venous graft. There is no evidence of pericardial effusion.\n\nThe aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nLYMPH NODES:\nRedemonstrated stable appearance of mediastinal lymphadenopathy since prior\nexam earlier this month and interval improvement since ___.  The\nlargest mediastinal lymph node measures 1.6 cm compared to 1.4 cm from\n___.\n\nLUNGS:\nThere is increased subpleural and interstitial fibrosis, predominantly in the\nlower lobes, particularly reticular and ground glass components compared to\nmost recent exam earlier this month.  There is no focal consolidation or\npleural effusion.\n\nThe thyroid gland has a subcentimeter hypodense nodule in the right lobe.\n\nIntra-abdominal lymphadenopathy is noted in the visualized portions of the\nupper abdomen, notably in the porta hepatis lymph nodes with the largest node\nmeasuring 1.6 cm.  There is no evidence of retroperitoneal lymphadenopathy by\nCT size criteria.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nThere is diffuse osteopenia.",
            "output": "1. No evidence of pulmonary embolism.\n2.  Interval worsening of known bleomycin related pulmonary fibrosis.\n3.  Stable appearance of known mediastinal lymphadenopathy.\n4.  Incidental findings, as described above."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged and excluding the\nbreasts which require mammography for evaluation, there are no soft tissue\nabnormalities in the imaged chest wall suspicious for malignancy.  This study\nis not designed for subdiaphragmatic diagnosis but shows normal size adrenal\nglands and gastrohepatic and retro peritoneal adenopathy in the imaged portion\nof the unenhanced upper abdomen, improved since ___.\n\nSub cm lucency does not enlarge the right lobe of the thyroid, 2:5 in is too\nsmall to warrant further imaging evaluation.  Atherosclerotic calcification is\nnot apparent in head neck vessels, but is severe in the coronaries.  Patient\nhas had aortic valve replacement and ascending aortic endo graft.  There is no\nevidence of operative complication.  Very small pericardial effusion has\ndecreased.  There is no pleural effusion.  Chronic enlargement of the\npulmonary arteries, right 31 mm, is unchanged since ___.  Chronic\ncardiomegaly, including particular left atrial enlargement, is long-standing,\nbut this study is not appropriate to assess chamber size.\n\nMediastinal adenopathy most pronounced in the prevascular station has\ncontinued to improve since ___.  The largest prevascular node, 16 x 28 mm\ntoday, 02:20, was 20 x 29 mm on ___ x 38 mm in ___.\n\nProportional improvements in adenopathy have occurred in smaller lymph nodes\nat the thoracic inlet, in the upper and lower paratracheal and subcarinal\nstations, where there are dystrophic calcifications.  There is no indication\nthat vital structures are compromised by lymph node enlargement.\n\nWidespread, moderately severe, predominantly peripheral fibrosing interstitial\nlung disease is chronic, worsened since ___ and since ___, but stable\nsince ___.  There are no findings to suggest concurrent pneumonia or\npulmonary edema.  The small areas of ground-glass opacification in the right\nlower lobe are stable probably represent very small residual areas of active\nalveolar components, once appreciably larger, of the interstitial lung disease\nattributed to chemotherapy toxicity.\n\nThere are no bone findings in the chest cage to suggest malignancy or\ninfection.",
            "output": "No evidence of pneumonia or other intrathoracic infection.\n\nContinued improvement in central and upper abdominal adenopathy.\n\nFibrosing interstitial lung disease has worsened since ___ through ___, stable since ___.\n\nChronic pulmonary arterial hypertension and cardiomegaly, particularly left\natrial enlargement.\n\nNo surgical complications following aortic endo graft and valve replacement.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "MEDIASTINUM/HEART:  The thyroid is unremarkable. There is no axillary or\nsupraclavicular lymphadenopathy.  Mediastinal lymphadenopathy is grossly\nunchanged since ___.  The largest mediastinal lymph node\nmeasures approximately 2.9 x 1.6 cm in the prevascular region (6:125),\nunchanged.  The patient is post aortic valve replacement and ascending aortic\nendograft repair.  No evidence of operative complication.  Mild enlargement of\nthe right pulmonary artery to 3.0 cm is unchanged.  Chronic cardiomegaly and\nextensive coronary artery calcifications are again seen.\n\nLUNGS/AIRWAYS:  As seen on the prior study, there is widespread, severe and\npredominantly peripheral fibrosing interstitial lung disease, in keeping with\nhistory of known bleomycin induced lung toxicity.  No new acute focal\nconsolidation or pleural effusion is identified.  No evidence of pneumothorax.\nThe airways are patent to the subsegmental level, with bronchiectasis more\nperipherally, unchanged.\n\nUPPER ABDOMEN:  Please see the abdomen and pelvis CT report as same date for\nfurther findings.\n\nSOFT TISSUES/BONES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Intact median sternotomy wires. Multilevel mild to moderate\ndegenerative changes of the thoracic spine are again seen.",
            "output": "1.  Compared with the CT chest of ___, no new focal\nconsolidation or pleural effusion concerning for pneumonia.\n2.  No significant change in the chronic fibrosing interstitial lung disease,\nlikely related to bleomycin induced lung toxicity.\n3.  No change in the size of the enlarged mediastinal lymph nodes.\n4.  Enlarged main pulmonary artery and cardiomegaly are stable."
        },
        {
            "input": "Subcentimeter right pole thyroid nodule is unchanged.\n\nHeart size is top-normal without significant pericardial fluid.  Aortic valve\nreplacement re- demonstrated.  Right internal jugular central venous catheter\nterminates in the right atrium.  Coronary artery calcifications noted. \nThoracic aortic arch is normal caliber.  Ectatic main pulmonary artery to 35\nmm.  Small filling defect in the anterior segmental branch of the left upper\nlobe (05:42, 09:103).  Distal opacification appears preserved.\n\nRe- demonstration of mediastinal lymphadenopathy with the largest node at the\nAP window measuring 30 x 16 mm, unchanged (05:55).  No supraclavicular,\naxillary or hilar lymphadenopathy.\n\nAirways are patent to the subsegmental level.  Re- demonstration of a\nperipheral, basal predominant fibrosis, appearing similar to the prior study. \nNo new or large dense consolidation.\n\nImaged portion of the upper abdomen is unremarkable.\n\nBones and soft tissues:  No suspicious focal bone lesion.  Multilevel\nvertebral degenerative changes.",
            "output": "1. Small nonocclusive pulmonary embolus of an anterior segmental branch of the\nleft upper lobe.\n2. Stable fibrotic interstitial lung disease, likely related to bleomycin\ninduced toxicity.\n3. Stable mediastinal lymphadenopathy.\n4. Ectatic main pulmonary artery has an association with pulmonary\nhypertension.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 16:25, 5 minutes after discovery of the findings."
        },
        {
            "input": "Conventional chest radiographs show progression of predominantly bibasilar\ninterstitial pulmonary abnormality between ___ and ___, then\nnew extensive subcutaneous emphysema in the neck and right chest wall right\nchest wall and pneumo mediastinum  on ___ which worsened over the next\n2 days accompanied by confluent areas of new opacification particularly in the\nright lower lung.  There was no pneumomediastinum or subcutaneous emphysema on\nthe chest CT scans ___ and ___ and no consolidation on the chest\nCT ___.\n\nPneumomediastinum extends from the level of the diaphragm to the thoracic\ninlet continuous with subcutaneous emphysema in the deep and superficial\ntissues of the neck, right lateral chest wall axilla and upper back. \nExtrapleural air in the right hemi thorax is relatively mild and largely if\nnot exclusively extra pleural rather than pneumothorax.  The component of\nextrapleural air in the left hemi thorax which is extremely small is all extra\npleural, clearly continuous with pneumomediastinum.\n\nThe absence of errant air below the diaphragm excludes a subdiaphragmatic\nsource.  At carefully inspected the tracheobronchial tree and the esophagus\nand the only possible old discontinuity in either is equivocal, in the\nposterior membranous wall of the upper trachea at the level of the thyroid,\n05:35.  This would be more convincing if there were a preponderance of\npneumomediastinum at that level, and there is not.  There is no mediastinal or\nextrapleural fluid collection to suggest infection.\n\nPulmonary fibrosis is only moderately severe at the base of the left lung\nwhere there is peripheral honeycombing and traction bronchiectasis.  In this\nregion it progressed between ___ and ___, but not subsequently. \nThe right lung which is more severely affected has progressed since ___, in areas which appear to be active interstitial infiltration, such as the\nposterior segment of the right upper lobe a, 5:103 -128 as well as some\nconsolidation, 5:137 which could be concurrent infection the new consolidation\nis not nearly as extensive as it appeared on conventional chest radiographs. \n.\n\nThere is no pleural or pericardial effusion and generalized lymph node\nenlargement.  A solitary 18 x 27 mm pre vascular mediastinal lesion with\nrelatively low attenuation for a mass, 27 ___, was 15 x 37 mm in ___ when\npatient had other enlarged lymph nodes, since involuted.\nThe patient has had TAVR, with no radiographically apparent complication and\nhas severe coronary atherosclerotic calcification.  Maximum diameter of the\nascending thoracic aorta is 38 mm.  Severe enlargement of the pulmonary\narteries, right 32 mm, is more pronounced today than it was in ___, right\n28 mm.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.",
            "output": "There is no strong candidate for the source of the severe pneumomediastinum,\ndeep and superficial subcutaneous emphysema in the neck and right chest wall\nthat appeared on ___ and has subsequently increased.  A small\ndiscontinuity in the posterior membranous wall of the upper trachea is\nequivocal.  Barotrauma from active fibrosing interstitial lung disease is the\ndifficult explanation.\n\nLittle if any right pneumothorax; extra pulmonary air is mostly, if not\nexclusively, extra pleural.\n\nProgression in both interstitial and airspace abnormality, particular in the\nright lung since ___ could be due to either active bleomycin induced\ninterstitial pneumonia or superinfection.\n\nNo recurrence of previously regressed central adenopathy.\n\nSevere and possibly progressive pulmonary arterial hypertension.\n\nSevere coronary atherosclerosis."
        },
        {
            "input": "Pneumomediastinum extends from the level of the diaphragm to the thoracic\ninlet continuous with subcutaneous emphysema in the deep and superficial\ntissues of the neck, right lateral chest wall axilla and upper back has\nprogressed increased within the right chest wall, and now also extends into\nthe left chest wall.  There is also new mild pneumopericardium.  Extrapleural\nair in the right hemi thorax is relatively mild and largely if not exclusively\nextra pleural rather than pneumothorax.  No free intraperitoneal air.\nThe previously described equivocal defect in the posterior membranous wall of\nthe upper trachea at the level of the thyroid, is no longer visualized.  No\nadditional sites of potentially are identified.  The esophagus is collapsed\nand not well assessed.  There is no mediastinal or extrapleural fluid\ncollection to suggest infection.\n\nBasal predominant, subpleural pulmonary fibrosis with honeycombing and\ntraction bronchiectasis, has not significantly changed since the most recent\nprior examination.  No acute focal consolidation.\n\nThere is no pleural or pericardial effusion and generalized lymph node\nenlargement.  A solitary 18 x 27 mm pre vascular mediastinal lymph node is\nstable since most recent examination and has decreased since ___.\nThe patient has had TAVR, with no radiographically apparent complication and\nhas severe coronary atherosclerotic calcification.  Maximum diameter of the\nascending thoracic aorta is 38 mm.  Severe enlargement of the pulmonary\narteries, right 32 mm.\n\nThere are no bone lesions in the chest cage suspicious for malignancy or\ninfection.\n\nUpper abdomen demonstrates uncomplicated cholelithiasis and small hiatal\nhernia.",
            "output": "1. Further progression of subcutaneous emphysema and pneumomediastinum when\ncompared to 2 days. No definite site of leak is identified on CT.  The\npreviously described equivocal defect in the upper trachea is no longer seen.\n\n2. Subpleural and basal predominant fibrosis.\n\n3.  Stable enlarged prevascular lymph node when compared to the most recent\nprior, decreased since ___."
        },
        {
            "input": "Severe subcutaneous emphysema in the neck and chest wall has redistributed\nslightly, with some improvement in the left anterior chest, some worsening\nright supraclavicular region.  Internally severe pneumomediastinum is stable\nin some areas, progressed slightly in others, such as the low posterior\nmediastinum.  Right extrapleural air is slightly smaller in the posterior\nright hemi thorax.  There is no mediastinal fluid collection or edema.\n\nPneumopericardium is slightly more pronounced, for example surrounding the\nintra pericardial right pulmonary artery.  There is no pericardial effusion or\nany evidence of tamponade physiology.  There is no pneumothorax or pleural\neffusion.\n\nThe only pulmonary abnormality is pulmonary fibrosis, predominantly\nperipheral, with some areas of atelectasis.\n\nAppearance of TAVR, heavily calcified coronary arteries, severely dilated\npulmonary arteries, are all unchanged.  There is no discontinuity in the\ntracheobronchial tree or esophagus.  Granulomatous subcarinal and right hilar\nlymph node calcifications do not penetrate the adjacent bronchi.",
            "output": "Pneumopericardium increased since ___, no pericardial effusion or\nfindings of tamponade.\n\nSlight increase or redistribution in pneumomediastinum.  No mediastinal fluid\ncollection or edema.\n\nNo pneumothorax.\n\nNo obvious source of apparent air.  Pulmonary fibrosis is the presumptive\nculprit."
        },
        {
            "input": "Right thyroid nodule is a stable. Supraclavicular, axillary, lymph nodes are\nnot enlarged. Aorta is normal size.  Right upper paratracheal lymph node\nmeasuring 11 mm is unchanged.  13 mm Right lower paratracheal lymph node is\nstable. 16 mm prevascular lymph node is unchanged (03:20).  There are\ncalcified lymph nodes in the subcarinal station.  Right hilar lymph node\nmeasures 10 x 24 mm.  Subcarinal lymph node measures 13 mm.  Left lower\nparatracheal lymph node measuring 8 mm is stable.  Pulmonary artery is\nenlarged measures 3.2 cm.  Cardiac configuration is stable with mild\ncardiomegaly, aortic replacement and dense calcifications in all coronary\narteries and in the mitral annulus.  Diffuse subpleural lower lobe predominant\nground-glass opacities associated with interstitial reticular abnormalities,\nbronchiectasis and architectural distortion and fibrosis has mildly increased\nfrom prior studies.  There are few scattered calcified nodules.  There is no\npleural or pericardial effusion.\nThis examination is not tailored for subdiaphragmatic evaluation hypodense\nlesion in the tail of the pancreas is a stable.  There is probably\ncholelithiasis\nThere are no bone findings of malignancy\nPort a cath tip is in the lower SVC",
            "output": "Stable mediastinal and hilar lymphadenopathy\nMild progression of chronic fibrosing interstitial lung disease"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: A 1.0 cm hypodense thyroid nodule is unchanged.\nSupraclavicular and axillary lymph nodes are not enlarged\n\nMEDIASTINUM/HILA:  A right paratracheal node measuring up to 1.0 cm in short\naxis is unchanged (02:17).  A 1.2 cm right lower paratracheal lymph node is\nalso stable (02:24).  A 1.7 cm prevascular node is also unchanged (02:25). \nCalcified lymph nodes in the subcarinal station appear similar to prior. \nAlthough assessment of hilar lymphadenopathy is limited in the absence of\ncontrast, a right hilar node also appears similar, currently measuring 0.8 x\n1.7 cm, previously 1.0 x 2.4 cm.\n\nHEART:  The heart is mildly enlarged and there is dense coronary arterial and\nmitral annulus calcification, similar to prior.  There is no pericardial\neffusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal. \nThere is similar enlargement of the right main pulmonary artery, measuring up\nto 3.2 cm, unchanged.  The main, and left pulmonary arteries are normal\ncaliber.  Aortic valve replacement is again noted.\n\nPULMONARY PARENCHYMA:  Re-demonstrated is interstitial reticular opacity,\nbronchiectasis and fibrosis, most pronounced in the bilateral lung bases. \nScattered punctate calcified nodules are again seen.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES:  There is no worrisome lytic or sclerotic lesion. \nMultilevel degenerative changes are moderate.  No acute fractures are seen. \nMedian sternotomy wires are intact.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen again demonstrates a\nis small hyperdensity of the gallbladder, which likely represent\ncholelithiasis.  There are extensive vascular calcifications.",
            "output": "1. No acute fractures are seen.\n2. Stable mediastinal and hilar lymphadenopathy.\n3. Re-demonstration of chronic fibrosing interstitial lung disease.\n4. Re-demonstration of cholelithiasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Redemonstrated 1 cm right thyroid\nhypodense nodule which does not require dedicated follow-up imaging based on\nACR recommendations.  Otherwise unremarkable.\n\nUPPER ABDOMEN: Stable porta hepatis lymph node measures 1 cm in short axis\nwith calcifications.  Cholelithiasis without acute cholecystitis.  Other than\natherosclerotic calcifications, visualized upper abdomen appears unremarkable.\n\nMEDIASTINUM: Stable lymph nodes measure up to 1.5 cm in short axis in the\nright lower paratracheal station (5:79).  Subcarinal lymph node contains\ncalcifications as seen previously.\n\nHILA: No definite lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  Status post transcatheter\naortic valve replacement.  Coronary artery calcifications and stents\nredemonstrated.  No pericardial effusion.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA: Redemonstrated of bilateral interstitial opacities with\ntraction bronchiectasis and fibrotic changes in a subpleural distribution with\nlower lobe predominance in both lungs, minimally worse in the lateral aspect\nof the left upper lobe (5:88).  Slight interval worsening of ground-glass\nopacities in both upper lobes since ___ (for example 5:67, 42, 45,\n76, 86).\n2. AIRWAYS:  Traction bronchiectasis is re-demonstrated, most severe in the\nlower lobes.  Patent to the subsegmental level bilaterally.\n3. VESSELS: Right chest port catheter terminates in the lower SVC.\nRedemonstrated enlarged pulmonary arteries as seen previously.  Limited\nassessment on noncontrast examination.  Ascending aorta is not dilated.  There\nis moderate calcifications in the aortic arch and mild calcifications in the\norigins of the great vessels.  Low-density blood pool suggests anemia.\nCHEST CAGE: No acute fracture or suspicious lesions.  Status post median\nsternotomy.",
            "output": "1. Slight interval worsening ground-glass opacities in both upper lobes when\ncompared to ___, a nonspecific finding which could be due to an\ninfectious or inflammatory etiology, including exacerbation of underlying\nknown chronic interstitial lung disease.\n2. Redemonstration of chronic fibrotic interstitial lung disease with lower\nlobe predominance, minimally worse in the peripheral aspect of the left upper\nlobe.\n3. Stable enlarged mediastinal lymph nodes may be reactive.\n4. Stable dilation of the main pulmonary artery may be reflective of\nunderlying pulmonary arterial hypertension."
        },
        {
            "input": "The thyroid is normal. There is a markedly enlarged lesion adjacent to the\npulmonary trunk along the anterior mediastinum to the left measuring 3.2 x 3.9\nx 3.5 cm (series 3, image 22 and series 8 a image 1). There are multiple\nenlarged mediastinal lymph nodes. There is a 1.2 cm subcarinal node (series\n6b, image 95). A left hilar lymph node conglomerate is identified, with the\nlargest left hilar lymph node measuring approximately 1.2 cm (series 3, image\n28). Aorta and pulmonary arteries are normal size.  The heart and pericardium\nare within normal limits, s/p AVR.  There is trace bibasilar atelectasis with\nno focal pulmonary consolidation, pleural effusion or pneumothorax.  Reticular\nopacities are seen, particularly throughout the lung bases and are suggestive\nof interstitial lung disease. Multiple enlarged lymph nodes are noted in the\nupper abdomen adjacent to the abdominal aorta and within the porta hepatis.",
            "output": "3.9 cm lesion seen in the anterior mediastinum is consistent with a\npathologically enlarged lymph node and is highly concerning for malignancy. \nMultiple prominent and enlarged mediastinal lymph nodes as well as a prominent\nleft hilar lymph node conglomerate are noted. A 1.2 cm subcarinal node is seen\nin may be amenable to transbronchial biopsy. Trace bibasilar atelectasis.\n\nReticular opacities, particularly at the lung bases are suggestive of\ninterstitial lung disease."
        },
        {
            "input": "There has been no significant interval decrease in the size of the dominant\nleft perihilar mass which continues to measure 3.6 x 5.4 cm at corresponding\nlevels (2, 19). However, there is increased soft tissue along the\nsuperolateral aspect of the right atrium with increased infiltration of the AP\nwindow superiorly.\n\nThere are no pathologically enlarged supraclavicular, mediastinal, right hilar\nor axillary lymph nodes. The thyroid gland is unremarkable.\n\nThere is stable mild cardiomegaly with dense coronary artery calcifications.\nThe main pulmonary artery and thoracic aorta are normal in caliber. No central\npulmonary embolism is identified. A trace nonenhancing pericardial effusion is\nessentially unchanged.\n\nA new moderate nonhemorrhagic left pleural effusion causing partial left lower\nlobe passive atelectasis. There has been substantial interval increase in left\nupper and superior segment left lower lobe ground-glass opacities,\ninterlobular septal thickening, and traction bronchiectasis as compared to ___. Fluid tracks into the left major fissure, where there is increased\nnodularity and thickening. New anteromedial right upper and medial right lower\nlobe ground-glass opacities and interlobular septal thickening are noted. Mild\ncentrilobular emphysema air is unchanged.\n\nMultilevel spinal degenerative changes are noted. The patient is status post\nprior thoracolumbar spine fusion. There are no bony lesions worrisome for\ninfection or malignancy.",
            "output": "Stable size of dominant left perihilar mass with increased soft tissue\ntracking along the superolateral aspect of the right atrium and into the AP\nwindow, which likely represents worsening metastatic disease.\n\nWorsening left lung and early right lung radiation fibrosis.\n\nNew moderate left pleural effusion causing partial left lower lobe passive\natelectasis.\n\nStable mild centrilobular emphysema."
        },
        {
            "input": "Although this study was not designed for assessment of the abdomen, limited\nviews of the upper abdomen are unremarkable.\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement.  There is no mediastinal, hilar or axillary lymph node\nenlargement by CT size criteria.  There is stenosis of the right subclavian\nvein at the level of the thoracic inlet with multiple collaterals noted.\nHeart, pericardium and great vessels are within normal limits.  Moderate\ncoronary artery calcifications are unchanged.  No hiatal hernia is present.\n\nThe left perihilar mass continues to decrease in size now measuring 2.8 x 5\ncm, previously 3.6 x 5.4 cm (03:21). The previously seen ground-glass\nopacities have largely resolved; however, there is now increased volume loss\nand more consolidative opacities with traction bronchiectasis consistent with\nevolving radiation fibrosis. The left pleural effusion appears partially\nloculated and is not significantly changed from prior. No right pleural\neffusion. Centrilobular emphysema is stable.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.  Incompletely image thoracolumbar fusion hardware appears unchanged.",
            "output": "1. Interval decrease in size of left perihilar mass.\n2. Resolution of ground-glass opacities in the left lung now with increased\nvolume loss, more consolidative opacities and traction bronchiectasis\nconsistent with evolving radiation fibrosis\n3. Stable left pleural effusion\n4. Stenosis of the right subclavian vein at the level of the thoracic inlet\nwith multiple collaterals."
        },
        {
            "input": "13 x 15 mm right axillary node, 5:97, was present on ___.\nSupraclavicular and left axillary nodes are not enlarged and there are no soft\ntissue lesions in the chest wall suspicious for malignancy.  Stricture of the\nright brachiocephalic vein at the thoracic inlet is chronic. Interestingly\ncollateral venous drainage is in the anterior chest wall is predominantly\nleft-sided.\n\nThis study is not designed for subdiaphragmatic diagnosis, particularly for\nhepatic evaluation, but it shows normal-size adrenal glands.  Atherosclerotic\ncalcification is mild in head and neck vessels, substantially more extensive\nin the coronaries, and in major vessels of the upper abdomen.\n\nMild dilatation of the ascending thoracic aorta, 42 mm, first and main\npulmonary artery, 34 mm, are unchanged. Aortic valve is not calcified. Left\nlower paratracheal mediastinal lymph node enlargement, 16 mm, is unchanged\nsubcarinal nodes, 11 and 12 mm across are also stable.\n\n\nAlthough a small pericardial effusion is smaller, a pericardial or juxta\npericardial mass, along the apex of the right ventricle, 5:  239- 261, is\nlarger, 29 x 43 mm, previously 22 x 22 mm. A second pericardial or juxta\npericardial nodule at the level of the pulmonary outflow tract, 13 x 19 mm,\n03:37, was 7 x 14 mm in ___.\n\nThe left apical loculation of pleural abnormality, previously fluid\nattenuation, is substantially larger, at the expense of the radiated left\nupper lobe. The attenuation values have increased from 18 ___ to over 30 ___\nsuggesting either effusion next with high protein material or blood or\nalternatively, growing pleural tumor. The left supra hilar mass growing along\nthe aortic arch has grown substantially, from 26 x 25 mm to 44 x 43 mm. The\nvolume of layering left pleural effusion is small, unchanged. Spinal hardware\ncompromises the Imaging of the left posterior pleural space, but there is at\nleast one subcentimeter pleural nodule, 5:169. There is no right pleural\nabnormality.\n\nRadiation fibrosis in the left upper lung has grown more confluent. Bronchi\nare dilated. Lingula and left lower lobe are clear. CT emphysema in the right\nlung is moderate. Right lung is otherwise clear.\n\nHeterogeneous demineralization of multiple upper and mid thoracic vertebral\nbodies above the level of spinal stabilization has not changed appreciably\nsince ___ and could be disuse osteopenia. There are no clear destructive\nbone lesions due to metastasis. A small sclerotic lesion in the manubrium,\n8:80 ___, is unchanged since ___.",
            "output": "Enlarging left suprahilar mass, and left apical pleural effusion and pleural\nthickening, progressed since ___, likely local tumor recurrence.\n\n2 growing pericardial or juxta pericardial mediastinal masses and small left\npleural nodule are also likely metastasis.\n\nChronic stricture, right brachiocephalic vein, Mild enlargement ascending\nthoracic aorta and pulmonary arteries, all unchanged.\n\nSignificant coronary atherosclerosis.\n\nMaturing radiation fibrosis, left upper lobe."
        },
        {
            "input": "THORACIC INLET: The thyroid is mildly enlarged but unchanged since the prior\nstudy.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There is moderate to severe cardiomegaly.  The main pulmonary\nartery is enlarged and measures 4 cm.  There is atherosclerotic calcification\ninvolving the arch and descending thoracic aorta.  There is severe coronary\nartery calcification.  There is no pericardial effusion.  There are small\nmediastinal lymph nodes not enlarged by size criteria.\n\nPLEURA: There are small bilateral pleural effusions left greater than right\nnew since the prior study.\n\nLUNG: There is subsegmental atelectasis within the left lower lobe and right\nlung base.  There is also subsegmental atelectasis within the right middle\nlobe and lingula.  A nodular opacity within the right middle lobe (4, 26) is\nunchanged.  There is mild upper lobe predominant emphysema.\n\nBONES AND CHEST WALL : Review of bones is unremarkable\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are also\nunremarkable.  Mild anasarca is seen in the left-lateral chest wall.",
            "output": "Small bilateral pleural effusions left greater than right with subsegmental\natelectasis in both lung bases.\n\nEvidence of prior gastric surgery.\n\nCardiomegaly a and enlarged main pulmonary artery later to pulmonary arterial\nhypertension.\n\nDependent anasarca in the left-lateral chest wall.\n\nNo evidence of interstitial lung disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Mildly prominent right hilar lymph node and right\nparatracheal lymph node, likely reactive.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.  Mild diffuse bronchial wall thickening and cylindrical\nbronchiectasis, most pronounced in the lower lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for cholelithiasis\nwithout evidence of acute cholecystitis.  A patulous esophagus is noted. \nSmall hiatal hernia.  1.4 cm focus of parenchymal hyperenhancement within the\nright hepatic lobe (2:104) is noted, corresponding to the area of focal\nnodular hyperplasia seen on prior MRI of the liver.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Mild diffuse bronchial wall thickening suggestive of bronchitis with\ncylindrical bronchiectasis, most prominent in the lower lobes.\n3. Prominent right hilar and mediastinal lymph nodes, likely reactive.\n4. Cholelithiasis without evidence of acute cholecystitis."
        },
        {
            "input": "CHEST CTA:  The thoracic aorta is normal caliber without evidence of aneurysm\nor dissection.  The main, lobar, segmental, and subsegmental pulmonary\narteries are well opacified without filling defect.  Enlarged main pulmonary\nartery measures 38 mm in diameter.\n\nCHEST:  The thyroid is unremarkable.  Prominent supraclavicular, mediastinal,\nand hilar lymph nodes are likely reactive.  Heart is mildly enlarged.  There\nis no pericardial effusion.\n\nAirways are patent to the subsegmental levels.  There are small bilateral\npleural effusions, right larger than left.  Mild ground-glass opacification in\ncentral distribution in bilateral lungs are likely due to mild pulmonary\nedema.\n\nVisualized upper abdominal organs are notable for partially imaged simple left\nrenal cyst.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  There is diffuse calcification of anterior longitudinal ligament,\nsuggestive of diffuse idiopathic skeletal hyperostosis.",
            "output": "1.  No pulmonary embolism or acute aortic process.  Mild enlargement of the\nmain PA, correlate for pulmonary hypertension.\n2.  Mild pulmonary edema small simple appearing pleural effusions, right\ngreater than left.\n3.  Mild cardiomegaly."
        },
        {
            "input": "MEDIASTINUM: The imaged thyroid is normal. No pathologically enlarged\nsupraclavicular, axillary, hilar or mediastinal lymph nodes.  Small hiatal\nhernia.\n\nHEART AND GREAT VESSELS: The aorta and pulmonary arteries are normal in size. \nStable appearance of the proximal descending thoracic aorta dilatation\nmeasuring up to 3.9cm.  No large central filling defects in the pulmonary\narteries. The heart size is normal and there is no pericardial effusion. Mild\nto moderate atherosclerotic calcifications of the thoracic aorta and mild\ncoronary arteries.  Mild aortic valvular and moderate annular calcifications.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.  Focal\npleural thickening in the right upper chest small series 14 image 117 is\nstable.\n\nLUNGS AND TRACHEOBRONCHIAL TREE: The airways are patent. The lungs are clear\nof interstitial or airspace opacity. No suspicious pulmonary nodules. \nPunctate calcified granuloma in the lingula, 2 mm nodule in the right lower\nlobe series 14, image 117 and 2 mm ground-glass nodule in the right upper lobe\nseries 14, image 145 are stable appearance.\n\nBONES AND CHEST WALL: There are no destructive focal osseous or chest wall\nlesions concerning for malignancy within the imaged thoracic skeleton.  Stable\nbone island in the T6 vertebral body.\n\nUPPER ABDOMEN:  Please refer to the separate CT report of the abdomen and\npelvis.",
            "output": "Pre-existing millimetric nodules are stable in appearance.  No evidence of\nmetastatic disease in the thorax.\n\nMild aortic valvular and moderate annular calcifications."
        },
        {
            "input": "CT Chest:\n\nThyroid:  The thyroid is normal.\n\nLymph Nodes: Axillary, supraclavicular, mediastinal, and hilar lymph nodes are\nnot pathologically enlarged.\n\nVessels: The great vessels are normal caliber.  There is no evidence of aortic\ndissection or pulmonary embolism to the subsegmental level.\n\nHeart and pericardium:  The heart size is normal.  No pericardial effusion.\n\nAirways:  The airways are patent to subsegmental levels.\n\nLungs:  There is trace bibasilar atelectasis however the lungs are otherwise\nclear. .  No focal consolidation, pleural effusion, or pneumothorax.\n\n\nCT Abdomen:\n\nLiver, Gallbladder: The liver is normal in size and attenuation. The portal\nand hepatic veins are patent. There is a small amount of intrahepatic biliary\nair seen without intrahepatic biliary ductal dilatation. The patient is status\npost cholecystectomy with surgical clips seen in the gallbladder fossa. The\ncommon bile duct measures up to 1.7 cm.\n\nSpleen: The spleen is normal in size and enhancement.\n\nPancreas: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nKidneys, Adrenals: The kidneys display symmetric nephrograms with no evidence\nof hydronephrosis or mass lesion in either kidney.  The ureters are\nsymmetrical in their course to the bladder. The adrenal glands are\nunremarkable bilaterally.\n\nStomach, Bowel: The small bowel is normal in caliber. There is mild wall\nthickening and adjacent fat stranding involving the descending colon and\nsigmoid colon suggestive of colitis. The appendix is not definitely seen\nhowever there are no secondary signs of appendicitis. There is no free air or\nlarge free fluid in the abdomen or pelvis.\n\nVessels: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\n\nCT Pelvis: The bladder is within normal limits. The rectum appears normal.\nThere is no pelvic sidewall lymphadenopathy.\n\nOsseous Structures: There are no suspicious lytic or blastic lesions seen in\nthe visualized osseous structures.",
            "output": "-Wall thickening and adjacent fat stranding involving the descending colon and\nproximal sigmoid colon consistent with colitis.\n-Trace biliary ductal air and a 1.7 cm extrahepatic common bile duct, both\nconsistent with a post cholecystectomy state and sphincterotomy. There are no\nsecondary signs of inflammation in the porta hepatis however biliary air may\nalso be seen in the acute cholangitis. No free air free fluid in the abdomen\nor pelvis.\n-No aortic pathology or pulmonary embolism to the subsegmental level."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nNo incidental thyroid findings.  Small axillary and thoracic inlet lymph nodes\nare stable in size and morphology.  Excluding the breast tissue which is\nexclusive for mammography, there are no chest wall lesions.  No\natherosclerotic calcifications in the head and neck arteries.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable. A previously described 4 mm prevascular lymph\nnode is mildly decreased in size, the remaining small mediastinal lymph nodes\nare stable. No hilar lymphadenopathy.  Bronchial stump from left lower\nlobectomy is again noted unremarkable.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries.  Moderate aortic\nannulus calcification.  No atherosclerotic calcifications in the ascending\naorta.\n\nLUNGS, AIRWAYS, AND PLEURA:\nIncreased size of a left posterior pleural based nodule with associated\nworsening invasion of the adjacent left 8th rib (4:116).  A subpleural\nnodularity adjacent to the left lower lobe surgical bed shows a mild increase\nin size as well, now measuring 6 x 14 mm, previously was 5 x 5 mm (4:134). \nThe remaining subpleural nodules are stable in size and morphology.\n\nUnchanged severe upper lobe predominant centrilobular emphysema.  The airways\nare patent to the subsegmental level.  No bronchial wall thickening,\nbronchiectasis or mucus plugging.  No focal consolidations.\n\nCHEST CAGE:\nNew compression fracture with loss of the anterior and middle columns of the\nT8 vertebral body.  Mild dorsal spondylosis.\n\nUPPER ABDOMEN:\nExcluding a surgically absent gallbladder, otherwise the limited portions of\nthe upper abdomen show no significant abnormal finding. Let adrenal met.",
            "output": "Disease progression given by increased size and chest wall/rib invasion of a\nleft posterior subpleural nodule into the posterolateral left 8th rib.\n\nAdditionally, an increased left basal subpleural enhancing nodule adjacent to\nthe left lower lobectomy surgical bed is also seen.\n\nNew compression fracture at the T8 vertebral body level."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  Moderate\ncoronary arterial calcification the pericardium and great vessels are within\nnormal limits based on an unenhanced scan.  There is mild atherosclerotic\ncalcification of the aortic arch.  No pericardial effusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  A PET avid lesion in the left\naxilla does not have a clear CT correlate.  A soft tissue density inferior to\nthe anterolateral first rib on the left (series 4, image 36) was not shown to\nbe FDG avid.\n\nPLEURAL SPACES: No pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is diffuse background severe centrilobular emphysema. \nWithin the posterior left lower lobe, abutting the pleura, there is a mildly\nenhancing oval mass measuring 3.5 x 1.9 x 2.7 cm (series 4, image 214), with\nmild spiculations and underlying pleural thickening.  There is nearby streaky\natelectasis.  An additional area of pleural thickening is demonstrated\nsuperiorly along the posterior pleura (series 7, image 85) spanning\napproximately 3.0 cm, was not shown to be FDG avid on the later PET-CT.  No\nadditional pulmonary nodules or masses are identified.\n\nBASE OF NECK: No supraclavicular or axillary lymphadenopathy.  The visualized\nthyroid is normal.  No suspicious soft tissue masses.\n\nABDOMEN:  Included portion of the upper abdomen demonstratesno acute\nabnormalities..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute or\ndisplaced fracture.",
            "output": "3.5 cm ovoid mass with adjacent spiculations and thickening of the pleura\nwithin the left lower lobe which is concerning for malignancy as confirmed on\nlater PET-CT and biopsy.  An additional area of pleural thickening is\ndemonstrated superiorly, but is not shown to be FDG avid on the later PET-CT. \nNo contralateral pulmonary masses are demonstrated."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  No soft tissue abnormalities\nelsewhere in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Mid esophagus is moderately patulous, but retains no\nfluid.  This is unlikely to be obstructive.\n\nAtherosclerotic calcification is mild in head and neck vessels, and scattered\nin all major coronary segments.  Aorta and pulmonary arteries are normal size\nand the aortic valve is not calcified.  Minimal pericardial effusion could be\nphysiologic.\n\n\nTHORACIC LYMPH NODES: As follows:\n\nNew 7 mm wide pre-vascular mediastinal node could be a function recent surgery\nespecially in light of associated pleural thickening and new small pericardial\neffusion.\n\nCentral lymph nodes are otherwise not enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Left hilum and bronchial stump have a normal\npostoperative appearance following lower lobectomy.  Emphysema is moderately\nsevere.  Right lung is clear of focal abnormalities.\n\n6 and 8 mm subpleural nodules left upper lobe, 6:71, 180, both new since ___\none could be artifacts of pleural drainage tubes, but should be followed\nclosely. Mild adjacent costal pleural thickening, 6:85 could also be a\nfunction of surgery.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "2 new peripheral nodules in the postoperative left upper lobe could be\nartifacts of pleural drainage tubes, but should be followed closely.  Repeat\nchest CT in 3 months would be reasonable follow these nodules and a new 7 mm\nprevascular mediastinal lymph node.\n\nModerately severe emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.\n\nMEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is unremarkable.  No pericardial effusion.\nPLEURA: Bilateral small to moderate-sized simple pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  Compressive atelectasis is noted in the lung bases\nbilaterally.  5 mm pulmonary nodule in the right upper lobe is unchanged\n(2:171).\n2. AIRWAYS:  Central airways are widely patent.\n3. VESSELS:  Although not a dedicated study, no central pulmonary embolism.\nCHEST CAGE: No acute fracture or suspicious osseous lesion.",
            "output": "1. Small to moderate simple bilateral pleural effusions with compressive\natelectasis.\n2. No evidence of pneumonia."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nMild atherosclerotic calcifications at the aortic arch and of the coronary\narteries.  The thoracic aorta is normal in caliber without evidence of\ndissection or intramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES:  Trace left pleural effusion. No pneumothorax.\n\nLUNGS/AIRWAYS:  Dependent atelectasis bilaterally, left greater than right. \nThere is a pleural thickening and calcification along the minor fissure on the\nright with an adjacent 7 mm nodular opacity (series 3, image 137).  Otherwise,\nthe lungs are clear without masses or areas of parenchymal opacification.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK:  The thyroid is heterogeneous, but no discrete nodules\nvisualized.  Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Incidental note is made of pancreas divisum.  The main pancreatic\nduct is prominent.  Otherwise, the pancreas has normal attenuation throughout,\nwithout evidence of focal lesions. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensities within the kidneys bilaterally are too\nsmall to characterize, but likely represent simple cysts.  Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram.  There is no\nevidence of enhancing renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is moderate\nstool burden.  Otherwise, the colon and rectum are within normal limits.  The\nappendix is not visualized.  There is no free intraperitoneal fluid or free\nair.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There are left posterior tenth through twelfth acute\nrib fractures.  Additional left lateral rib fractures demonstrate callus\nformation and are subacute to chronic.  No suspicious osseous lesions.  An\nasymmetric nodular density within the left breast, should be followed up with\ndedicated breast imaging (series 2B image 100).  There is a coarse\ncalcification within the soft tissues adjacent to the pubic symphysis on the\nleft.  Otherwise, the soft tissues are within normal limits.  There is\nmoderate dextro scoliosis of the lumbar spine.",
            "output": "1. Acute left posterior tenth through twelfth rib fractures.  Additional left\nlateral rib fractures are likely subacute to chronic.\n2. Trace left pleural effusion.\n3. 7 mm nodular opacity along the minor fissure on the right, which should be\nfollowed up with a chest CT.\n4. Nodular density within the left breast, which should be correlated with\ndedicated breast imaging.\n\nRECOMMENDATION(S):\n1.  The ___ Society guidelines for pulmonary nodule guidelines suggest\nfor pulmonary nodules greater than 6 mm or less than 8 mm, ___ month\nfollow-up in low-risk patients, and ___ month follow-up in high risk patients.\n2. Dedicated breast imaging."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum. Severe\naortic wall calcifications. Mild dilatation of the main pulmonary artery. \nModerate to severe coronary calcifications, mild aortic valve calcifications. \nNo pericardial effusion. The abdominal findings are described in detail in the\nprevious CT examination. No evidence of osteolytic lesions at the level of the\nsternum, the ribs or the vertebral bodies.\n\nMild bilateral apical scarring.  The assessment of the lung parenchyma is\nlimited by mild respiratory motion artifacts. Bilateral dorsal areas of\natelectasis.  Mild atelectasis at the level of the lingular. Mild\nconsolidations at the bases of the lingular, the middle lobe and the right\nlower lobe, with areas of mild bronchiectasis (5, 198).  Other areas of\nbronchiectasis, some of which show mucous plugging, are visualized in the\nmiddle lobe.  Most importantly, however, the left upper lobe and lingular show\nareas of bronchocentric parenchymal opacities, some of which are consolidated\nand an so of which are ground-glass in appearance.  The opacities show\nmultiple air bronchograms.  There is no evidence of lung nodules suspicious\nfor metastatic or malignant disease.",
            "output": "No lymphadenopathy, no pleural effusions, no pulmonary nodules suspicious for\nmetastatic or malignant disease.\nHowever, a left upper lobe and lingular cluster of peribronchial\nconsolidations likely infectious in origin, needs to be followed of the\nantibiotic therapy to exclude the presence of potentially masked malignant\nstructures.\nOld post infectious consolidations with mild bronchiectasis at the basis of\nthe middle lobe, the lingula and the right lower lobe."
        },
        {
            "input": "MEDIASTINUM: 5 mm right thyroid nodule or cyst too small to warrant further\nevaluation ; thyroid is otherwise normal. Supraclavicular, axillary,\nmediastinal and hilar lymph nodes are not enlarged.  Ascending aorta is\ntop-normal diameter,  4.0 cm and the main pulmonary artery is also top-normal,\n3 cm. Moderate cardiomegaly, specifically enlargement of the left atrium and\nleft ventricle is stable. There is no coronary artery calcification. No\npericardial effusion is present. There is no esophageal wall thickening or\nhiatal hernia.\n\nLUNGS AND AIRWAYS:  The airways are patent to the subsegmental level\nbilaterally. No intraluminal lesions are identified.  No pleural thickening is\npresent.  Minimal small, bilateral pleural effusions are unchanged. Mild,\nbiapical scarring is unchanged.  The left upper lobe and lingula contain two\nareas of mass-like consolidation with adjacent ground-glass opacities, which\nare significantly improved from 1 day prior. Bronchial wall thickening is\nlikely associated with the clearing infection.\n\nMultiple pulmonary nodules are unchanged from previous examination on ___ including:\n\n2 mm subpleural left upper lobe nodule (series 5, image 22)\n5 mm left lower lobe nodule (series 5, image 119)\n2 mm right lower lobe nodule (series 5, image 119)\n3 mm right lower lobe nodule (series 5, image 146)\n\n\nOSSEOUS STRUCTURES:  There are no lytic or blastic lesions concerning for\nmalignancy.\n\nAssessment of subdiaphragmatic structures is included in the accompanying CT\nabdomen and pelvis.",
            "output": "1. Multiple pulmonary nodules measuring up to 5 mm are unchanged from the\nexamination 1 day prior. Followup CT in 6 months is recommended to assess\nstability.\n\n2. Pneumonia in the left upper lobe and lingula have significantly improved\nsince ___.\n\n3.  Moderate cardiomegaly with mild dilatation of the left atrium and\nventricle, unchanged from ___.  No pulmonary edema."
        },
        {
            "input": "For details regarding the abdomen and pelvis please see dedicated abdomen and\npelvis CT report dictated under clip ___\n\nCT chest:  The thyroid is unremarkable and there is no supraclavicular lymph\nnode enlargement.  There is an abrupt termination of the right upper lobe\nbronchus as it enters the mass. The remaining airways are patent to the\nsubsegmental level. There is no mediastinal, hilar or axillary lymph node\nenlargement by CT size criteria. A 9 mm epicardial lymph node is a new. There\nis a small pericardial effusion.   No hiatal hernia is present.\n\nThere is heterogeneous enhancement within the now entirely collapsed right\nupper lobe likely representing a combination of tumor and postobstructive\ncollapse measuring in total 7.1 x 9.1 x 12.4 cm (AP x TRV x CC).  The mass\ninvades into the right middle lobe with the right middle lobe bronchi\nextending through the mass.  The mass abuts the mediastinum; although, is not\ndefinitely invading it. Multiple mediastinal lymph nodes including a 9 x 24 mm\nsubcarinal lymph node are noted. There is a large right pleural effusion which\nis increased in size from the prior study.  There are multiple scattered\nground-glass nodules in the left lobe which are not significantly changed from\nthe prior study.\n\nOsseous structures: No lytic or sclerotic lesions suspicious for malignancy is\npresent.",
            "output": "1. Increase in size of mass in the right upper lobe obstructing the right\nupper lobe bronchus and causing complete collapse of the right upper lobe. The\nmass now invades the right middle lobe.\n\n2.  Large right pleural effusion has increased in size.\n\n3.  Small pericardial effusion.\n\n4.  Multiple scattered ground-glass nodules in the left lung are not\nsignificantly changed from the prior study, followup can be obtained as\nclinically relevant."
        },
        {
            "input": "Severe anasarca has developed since ___, with particularly large areas of\nmass like in duration along the right chest wall.  This could be infection or\nhemorrhage.  Clinical correlation advised..\n\nSupraclavicular and axillary nodes are not enlarged.  Specifically excluding\nthe breasts which would require mammography for evaluation there are no\nfindings in the chest wall concerning for malignancy.\n\nFindings below the diaphragm will be reported separately.\n\nEndotracheal tube is in standard placement.  Left subclavian central venous\ncatheter ends in the upper SVC.\n\nNasogastric tube passes to the distal stomach and out of the field of view.\n\nMediastinal lymph nodes are not enlarged.  Hilar contours do not suggest\nadenopathy.  Moderate nonhemorrhagic layering pleural effusion, right greater\nthan left is new.\n\nAorta and pulmonary arteries are normal size.  Left atrium is mildly dilated. \nAtherosclerotic calcification is heavy in coronary arteries.  Aortic valvular\ncalcification is mild.\n\nLungs:\n\nRespiratory motion obscures fine detail.  There are several very small regions\nof peribronchial opacity in the upper lungs which could be early pneumonia or,\nalternatively, aspiration.  Both lower lobes are collapsed due to the pleural\neffusions.  There is no bronchial obstruction.\n\nChest cage:\n\nNo large destructive bone lesion, compression or pathologic fracture.  Chronic\nrib fractures are in various stages of healing.",
            "output": "Large area of induration, right lower chest and upper abdominal wall could be\nhemorrhage or infection.\n\nNew generalized anasarca.\n\nNew moderate bilateral pleural effusions responsible for bilateral lower lobe\ncollapse.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:33 am, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  Small residual thymus.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\n\nLUNGS/AIRWAYS:  There is a 0.4 cm nodule in the right lower lobe (___). \nLungs are otherwise clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No findings to explain patient's symptoms.\n3. 4 mm right lower lobe lung nodule.  In a ___ year-old woman, no imaging\nfollow-up is recommended."
        },
        {
            "input": "CARDIOTHORACIC: The thoracic aorta is normal in caliber with moderate\natherosclerotic calcifications.  The main pulmonary artery is normal in\ncaliber.  The right pulmonary artery is slightly measures up to 3.4 cm,\nsuggesting sequela of chronic pulmonary hypertension.  The heart is normal in\nsize.  Extensive coronary vascular in the valve calcifications are again\nnoted.  No pericardial effusion.\n\nMEDIASTINUM, LYMPH NODES:  No axillary, supraclavicular, or mediastinal\nlymphadenopathy by CT size criteria.  Diffuse mediastinal nodes are prominent\nbut not pathologically enlarged.  A hiatal hernia is small.\n\nAIRWAYS AND PLEURA:  The airways are patent to at least the subsegmental\nlevel.  Bronchiectatic and fibrotic changes in the bilateral lower lobes are\nagain noted.\n\nLUNG PARENCHYMA:  A right hilar mass measures 2.9 x 2.4 cm (Se 4, Im 162) and\nis new from ___.   A small left lower lobe calcified granulomas are unchanged\n(Se 4, Im 190).  There are subpleural interstitial changes in the left\nanterior lung.  Bilateral, lower lobe extensive bronchiectasis is noted,\nconsistent with aspiration and chronic fibrosis, perhaps related to radiation\ntherapy for prior esophageal cancer.\n\nSOFT TISSUES AND BONES:  No suspicious lytic or sclerotic osseous lesion.  The\nthyroid is unremarkable.\n\nLIMITED UPPER ABDOMEN:  Other than incidental splenule, limited views of the\nupper abdomen are unremarkable.",
            "output": "1.  2.9 x 2.4-cm right hilar mass, new from ___.\n\n2.  Bilateral lower lobe bronchiectasis consistent with aspiration and\nfibrotic changes, perhaps from prior radiation treatment."
        },
        {
            "input": "Aorta and pulmonary arteries are minimally dilated, unchanged.  Mediastinal\nand hilar lymph nodes are unchanged.  No pericardial effusion is seen.  Aortic\nvalve calcifications are present.  Left ventricular enlargement is noted.\n\nSmall bilateral pleural effusion is present, minimally increased since the\nprior study.  There is small hiatal hernia.  Assessment of the upper abdomen\ndemonstrate no appreciable abnormality in the image portion of the upper\nabdomen within the limitations of this noncontrast enhanced study.\n\nAirway secretions are present but airways are patent to the subsegmental level\nbilaterally.  Right upper lobe parahilar lesion has substantially increased\nsince the prior study, currently 4 x 3.7 cm as compared to 2.6 x 2.8 cm. \nThere is no clear demarcation between the lesion and the right hilus. \nBilateral bronchiectasis is noted, unchanged since the prior study.  Diffuse\nground-glass opacity with minimal septal thickening might potentially\nrepresent pulmonary edema.\n\nThere are extensive degenerative changes demonstrated but no lytic or\nsclerotic lesions worrisome for infection or neoplasm seen.",
            "output": "Interval increase in the right hilar mass.\n\nUnchanged bilateral bronchiectasis.\n\nSmall bilateral pleural effusion, most likely sequela of cardiac\ndecompensation."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No evidence of pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The imaged lungs are clear without masses or areas of\nparenchymal opacification.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: A 3.0 cm partly imaged cyst at the hepatic dome measures simple fluid\ndensity.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nTrace pericardial effusion is noted.  The heart is mildly enlarged.  There is\na trace right pleural effusion and a small to moderate nonhemorrhagic left\npleural effusion.\n\nLingular atelectasis as well as bibasilar, left greater than right,\natelectasis is noted.  There is mild left upper lobe ground-glass opacity.  No\npulmonary nodules.   The airways are patent to the subsegmental level.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified. \nStatus post median sternotomy.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Lingular as well as bibasilar atelectasis.\n3.  Mild pulmonary edema with mild cardiomegaly, left upper lobe ground-glass\nopacity and bilateral left greater than right pleural effusions.\n4.  Trace pericardial effusion.\n\nRECOMMENDATION(S):  Clinical correlation is recommended for superimposed\npneumonia."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged. And a oval 10 x 32\nmm fluid attenuation subcutaneous lesion in the left chest wall is probably at\nthe level of the left areola. Mammography and/or ultrasound recommended to\ndetermine if this is a simple cyst or a cystic malignancy. There are no other\nsoft tissue lesions in the chest wall concerning for malignancy or infection.\nThyroid is unremarkable.\n\nFindings below the diaphragm will be reported separately.\n\nAtherosclerotic calcification is present in at least the left anterior\ndescending coronary artery and right pulmonary artery branch. Small\npericardial effusion is unchanged since at least ___. There is no\npleural abnormality. Lymph nodes in the hila and mediastinum, and in the\ndiaphragmatic, internal mammary, and retrocrural stations are not\npathologically enlarged. Mild dilatation of the ascending thoracic aorta, 43\nmm maximum, is fusiform and free of atherosclerotic or other dystrophic\ncalcification or any evidence of dissection. Lungs are clear. Aside from mild\nwall thickening of small bronchi, airways are normal to subsegmental levels.\n\nThere are no bone lesions in the chest cage suspicious for malignancy, however\nshould be noted that radionuclide bone and FDG PET scanning are more sensitive\nin detecting early metastases than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy.\n\nSubcutaneous cystic lesion, left breast. Ultrasound and/or mammography\nrecommended.\n\nAtherosclerotic Coronary calcification.\n\nMild fusiform dilatation otherwise normal ascending thoracic aorta."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus on\nthe right lung.  Patient is status post left upper lobectomy.  In the main\nleft pulmonary artery there are areas of linear hypodensities bordering the\narterial wall (series 2, image 39) for which subtle floating emboli cannot be\nruled out.  Most of these images though are simply areas where the vessel is\nseen kinking.  Correlate clinically, this could be followed.  The thoracic\naorta is normal in caliber without evidence of dissection or intramural\nhematoma.  The heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is small residual left hydropneumothorax.  Most of the\nfluid is loculated in the Left anterior and superior pleural cavity.  There is\nsubcutaneous emphysema on the left.\n\nLUNGS/AIRWAYS: The right lung demonstrates areas of ground-glass opacities\nlikely due to hypoventilatory changes in the right lung base and anterior\nright upper lobe.  Linear atelectatic changes seen in the left lung base.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. The patient is status post left upper lobectomy. There is no definite\nevidence of pulmonary emboli, but some filling defects are noted within the\nmain left pulmonary artery, for which the most probable diagnosis is an image\ncreated by ___ kink in the artery.  These however are likely in the region of\npulmonary arterial clamping during surgery and could reflect emboli/thrombi\nalong the vessel wall.\n2. Residual left hydropneumothorax with left subcutaneous emphysema."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  Heart size\nis normal.  There is no pericardial effusion.  The aorta and pulmonary\narteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Patient status post left upper lobectomy with stable postsurgical\nchanges to the left hemithorax.  No evidence of local recurrence.  No new or\ngrowing pulmonary nodules.  Minimal bibasilar atelectasis.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Sections through the upper abdomen shows a large right renal\ncyst.  No focal liver lesions.  No adrenal masses are seen",
            "output": "Stable postsurgical changes following left upper lobectomy.  No evidence of\nlocal recurrence.  No new or growing pulmonary nodules.\n\nRight renal cyst."
        },
        {
            "input": "CHEST PERIMETER: Addendum no thyroid findings need any further imaging\nevaluation.  Supraclavicular and and right axillary lymph nodes are not\nenlarged.  Subcentimeter left axillary nodes are slightly larger, but not\nsufficient to be concerning for malignancy.  No soft tissue abnormality in the\nchest wall.  This study is not designed for subdiaphragmatic diagnosis chest\nshow persistent elevation of the left hemidiaphragm reflecting prior left\nupper lobectomy, no adrenal mass, and no large but stable cyst in the upper\npole of the right kidney.\n\nCARDIO-MEDIASTINUM: Esophagus is moderately patulous at several levels,\nincluding more retention of air and fluid in the midportion and previously. \nBarium swallow is recommended to assess esophageal function.\n\nAtherosclerotic calcification is not apparent in head and neck vessels or\ncoronary arteries.  Aorta is normal size and the aortic valve is not\ncalcified.  Mild dilatation of the main pulmonary artery, 33 mm, is unchanged.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged\nor growing.\n\nLUNGS, AIRWAYS, PLEURAE: Elevation and reorientation of the left hilum\nreflects prior left upper lobectomy and radiation.  New elliptical region of\nnodular consolidation, 9 x 20 mm, left upper lobe at the level of the aortic\narch, 4:60 could be maturing radiation fibrosis, but should be followed\nclosely.  Lungs otherwise clear of focal abnormalities.\n\nEmphysema, centrilobular and paraseptal is mild to moderate in the right upper\nlobe, minimal elsewhere.\n\nSmall residual of previous loculated left apical pleural fluid collection\ncontinues to shrink.\n\nCHEST CAGE: No compression or pathologic fracture or destructive bone lesion. \nAlthough there are no bone lesions in the imaged chest cage suspicious for\nmalignancy or infection, it should be noted that radionuclide bone and FDG PET\nscanning are more sensitive in detecting early osseous pathology than chest CT\nscanning.",
            "output": "New nodular consolidation left upper lung could be radiation change, should be\nfollowed closely did determine if it is malignant recurrence.\n\nResolving postoperative left apical pleural fluid collection following upper\nlobectomy.\n\nPossible esophageal dysmotility.  Consider barium swallow."
        },
        {
            "input": "The thyroid is normal.  Few subcentimeter mediastinal lymph nodes do not meet\nCT size criteria for enlargement.  Supraclavicular axillary, and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal coronary artery calcifications noted with extensive\nmitral valve calcifications and mild aortic valve calcification.  No\npericardial effusion.  No mediastinal hematoma.\n\nTrace left pleural effusion is noted.  No right pleural effusion.  No\npneumothorax.  Mild bilateral centrilobular emphysema with focal areas of\nparaseptal emphysema most prominent along the lung apices. There is bilateral\nvaricose central bronchiectasis, right greater than left.  Scattered\nground-glass opacities within the left upper and anterior basal segment of the\nleft lower lobe with slightly more confluent area within the left upper lobe\nlikely corresponding to findings seen on chest radiograph are suspicious for\nmultifocal pneumonia.  Pulmonary nodules are as follows:  3 mm right upper\nlobe pulmonary nodule (04:40, and 3 mm right upper lobe (04:47.  Approximately\n1 cm (4:112) right lower lobe lesion with spiculations is noted.  3 mm right\nlower lobe calcified granuloma present.\n\nOsseous structures are notable for chronic healed bilateral anterolateral and\nposterior ___ rib fractures.\n\nLimited assessment of the upper abdomen demonstrates a small hiatal hernia.",
            "output": "1.  Findings worrisome for multifocal pneumonia involving the left upper and\nanterobasal segment of left lower lobe.\n2.  Approximately 1 cm spiculated right lower lobe opacity may represent focal\nscarring if this is chronic, but would also be the expected appearance of lung\nmalignancy.  Comparison with prior imaging would be helpful to assess for\ndegree of chronicity/stability.\n3.  Mild bilateral emphysema with bilateral varicose central bronchiectasis.\n\nRECOMMENDATION(S):  If prior chest imaging is not available, recommend initial\nfollow-up of right lower lobe spiculated lung nodule as per ___\nguidelines is recommended with CTs at around 3 months, or consider dynamic\ncontrast enhanced CT, PET, and/or biopsy.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 1:10 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "Port-A-Cath catheter tip is in the right atrium.  Aorta and pulmonary arteries\nare overall unremarkable.  No mediastinal, hilar or axillary lymphadenopathy\nis present.  Heart size is normal.  There is no pericardial pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately is part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  No new pulmonary\nnodules masses consolidations concerning for metastatic disease demonstrated. \nMinimal subpleural nodules are unchanged.  Mild centrilobular emphysema is\nunchanged.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest with no evidence of intrathoracic metastatic\ndisease progression."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nThere are scattered calcified granulomas and subpleural micro nodules\nstatistically a benign.  4 mm perifissural nodule on the right is likely an\nintrapulmonary lymph node.  Subpleural irregular opacities in the lower lobes\nare likely atelectasis.  There is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy",
            "output": "Subpleural micro nodules are statistically benign."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nAortic arch calcifications are mild.\n\nThe pulmonary arteries are well opacified to the segmental level, with no\nevidence of filling defect concerning for pulmonary embolism.  Evaluation of\nthe subsegmental pulmonary arteries is limited due to respiratory motion\nartifact.  The the right main pulmonary artery is increased in size, measuring\n2.9 cm (3:98), as can be seen in pulmonary arterial hypertension.  There is no\nevidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid is not completely imaged.\n\nThere is no evidence of pericardial effusion.  There is no pleural effusion.\n\nPatient is post right upper lobectomy and chest wall resection.  Unchanged\nappearance of the right bronchial stump.  The known posterior chest wall graft\nis also unchanged in appearance (3:66).  Notably, there is plugging of the\nright middle and lower lobe are bronchi (3:110, 142) with multifocal areas of\nground-glass opacification involving the lingula (3:96, 112), superior segment\nof the left lower lobe (3:87-97), and right lower lobe (3:130).  There is\nbibasilar subsegmental atelectasis.  Severe bilateral centrilobular emphysema\nis stable, predominantly in the upper lobes and more extensive in the right\nlung.  Postoperative fibrotic changes in the right lower lobe are unchanged. \nPreviously described small area of scarring in the posterior basal segment of\nthe right lower lobe is somewhat obscured by the new atelectasis.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism to the segmental level.  Subsegmental\npulmonary arteries are limited in evaluation, due to respiratory motion\nartifact.\n2.  Multifocal bilateral areas of ground-glass and nodular opacification in\nthe lungs, concerning for developing bronchopneumonia and/or aspiration, given\nthe clinical history.  Associated right lower lobe are bronchial\nopacification, compatible with mucous plugging and secretions.\n3.  Postoperative changes after right upper lobectomy and chest wall\nresection.  Persistent severe centrilobular emphysema.  Bibasilar atelectasis.\n4.  Increased diameter of the right and left main pulmonary artery, as can be\nseen in pulmonary arterial hypertension."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\ntop-normal.  The trace pericardial effusion.  The aorta and pulmonary artery\nnormal in caliber.  There is mild atherosclerotic calcification involving the\ndescending thoracic aorta.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is stable postsurgical changes following resection of a\nright-sided Pancoast tumor with reconstruction of the chest wall.  There is no\nevidence of local recurrence.  There is stable postsurgical changes to the\nright hemithorax with stable volume loss.\n\nThere is severe upper lobe predominant emphysema.  There is mild\nbronchiectasis with peribronchial thickening in both lower lobes.  Patchy\nparenchymal opacities in the left lower lobe have improved.  The parenchymal\nopacity in the left upper lobe have resolved.  Parenchymal opacities in the\nright lower lobe have also improved and most likely represent resolving\npneumonia.  No new nodules or consolidations.\n\nBONES AND CHEST WALL : Review of bones shows evidence of right-sided\nthoracotomy and resection of the upper ribs on the right.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows stable tiny\nhypodense liver lesions.  No adrenal masses are seen",
            "output": "Stable postsurgical changes following resection of a right-sided Pancoast\ntumor.  No evidence of local recurrence.\n\nMultifocal bilateral parenchymal opacities have significantly improved and\nmost likely represent resolving pneumonia.\n\nSevere upper lobe predominant emphysema.  No new pulmonary nodules."
        },
        {
            "input": "CHEST CTA:\nThe thoracic aorta is normal caliber without evidence of aneurysm or\ndissection.  The main, lobar, segmental, and subsegmental pulmonary arteries\nare well opacified without filling defect.  The remainder of the great vessels\nhave a normal appearance.\n\nCHEST:\nThe thyroid is normal. Scattered subcarinal, lower paratracheal, and\nprevascular lymph nodes are not enlarged by CT size criteria.  The heart is\nmoderately enlarged, including biatrial enlargement, and there is no\npericardial effusion.  Right atrial enlargement is particularly striking.\n\nThe large airways are patent. There is a large right pleural effusion which\nmeasures simple density, nonhemorrhagic.  There is considerable opacification\nsuggesting atelectasis of basilar segments in the right lower lobe.  Partial\nright middle and upper lobe atelectasis is also noted.  No discrete pulmonary\nmass is identified. No pneumothorax or pneumomediastinum.\n\nThe esophagus and visualized upper abdomen is remarkable for trace perihepatic\nand perisplenic ascites. (601b:15, 38).\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of pulmonary embolism.\n\n2.  Large, nonhemorrhagic right pleural effusion with no obvious associated\npulmonary mass.  Opacification at the right lung base is likely compressive\natelectasis.\n\n3. Trace perisplenic and perihepatic ascites seen in the limited images of the\nabdomen.\n\n4.  Cardiomegaly, particularly of the right atrium, suggesting cardiac\ninsufficiency as a possible cause of pleural effusion.  Echocardiogram may be\nhelpful if clinically indicated."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Patient is post thyroidectomy. \nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\npatulous.  The soft tissues of the chest wall are unremarkable, excluding the\nbreasts, which require separate dedicated imaging for detailed evaluation.\n\nUPPER ABDOMEN: A small hiatus hernia is noted.  A partially imaged 5.9 cm\nhypoattenuating structure is seen in the right kidney (4:276), statistically\nlikely a cyst, but is incompletely characterized.  Otherwise, the imaged upper\nabdomen is unremarkable.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy, within the limitations of an\nunenhanced study.\n\nHEART and PERICARDIUM: Heart size is normal. Coronary artery calcifications\nare mild.  The thoracic aorta is normal in caliber. Small pericardial fluid is\nlikely physiologic.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  Right-sided pulmonary nodules measuring up to 6 mm in the\nright lower lobe (4:143, 127, 86) are unchanged, and can be considered benign.\nDependent atelectasis is noted.  No new or growing nodules are seen.  No\ndiffuse lung disease.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nCHEST CAGE: No worrisome osseous lesions are identified. There is no acute\nfracture.",
            "output": "No fracture or other acute finding in the chest."
        },
        {
            "input": "THORACIC INLET: Patient status post total thyroidectomy.  No evidence of\nsupraclavicular adenopathy.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The\nesophagus is patulous and dilated.  There is no pericardial effusion.  The\naorta and pulmonary arteries are normal in caliber.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: The 5 mm right upper lobe pulmonary nodule (8, 101) is unchanged.  The 6\nmm right lower lobe pulmonary nodule (8, 213) Is also unchanged.  Another 6 mm\nnodule in the right lower lobe is also unchanged.  No new pulmonary nodules. \nMild bronchiectasis in both lower lobes.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Bones osteopenic\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver\nlesions.  Please refer to dedicated report on abdomen which has been dictated\nseparately",
            "output": "Stable bilateral pulmonary nodules ranging in size from 5-6 mm as described\nabove.  No new pulmonary nodules."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  A right subclavian central venous\ncatheter terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.  The esophagus is patulous and\ncontains layering ingested material to the level of the upper thorax.  (5:76)\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are small dependent consolidations at the lung bases, not\nstable to slightly increased from prior CT abdomen and pelvis.  There are\nground-glass opacities in the posterior bilateral upper lobes.  A previously\nseen right lower lobe subpleural pulmonary nodule is obscured by a\nconsolidation at the right lung base.  A 5 mm right upper lobe pulmonary\nnodule is stable (5:76).  An additional 4 mm pulmonary nodule in the right\nupper lung is not significantly changed (5:87).  There are at least 3 new\npulmonary nodules in the right lung measuring up to 4-5 mm (5:100; 110; 121). \nMild bronchiectasis is stable.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: There are degenerative changes thoracic spine.  No suspicious osseous\nabnormality is seen.? There is no acute fracture.",
            "output": "1. Ground-glass opacities in the bilateral posterior upper lobes and\nconsolidative opacities at the lung bases are in a distribution most\nsuggestive of a combination of atelectasis and aspiration given the patulous\nesophagus containing ingested material to the level of the upper thorax.\n2. Few pulmonary nodules in the right lung are stable compared with ___,\nhowever there are at least 3 new pulmonary nodules in the right lung measuring\nup to 4-5 mm, may be infectious/inflammatory nature, however metastatic\ndisease cannot be excluded.  Recommend short-term interval follow-up with CT\nchest in 3 months.\n\nRECOMMENDATION(S):  CT chest in 3 months."
        },
        {
            "input": "The whole esophagus is moderately dilated.  In the lower part there is debris\nand fluid.  This suggests dysmotility and possibly achalasia.\n\nA central venous catheter terminates shortly below terminates at the\ncavoatrial junction.\n\nThe heart is mildly enlarged.\n\nThere is a trace right-sided pleural effusion and a very small pleural\neffusion on the left, the latter somewhat increased.  No pericardial effusion.\nNo enlarged lymph nodes are found in the chest.\n\nPosterior ground-glass opacity in the left upper lobe has not cleared as much\nas other dependent ground-glass opacities.  This may represent an area of\nslowly resolving edema although infectious etiology is possible.  New cluster\nof cysts small nodules and branching opacities suggests inflammation or\ninfection of lower airways in the superior segment of the left lower lobe. \nSimilar atelectasis at each lung base, left greater than right.\n\nThe abdomen is reported separately, but the partly imaged spleen shows many\nsubcentimeter hypoattenuating lesions.\n\nThere are no suspicious bone lesions.  Bones appear demineralized. \nMidthoracic interspaces show moderate degenerative changes with minimal\nchronic appearing loss in height and slight kyphosis.",
            "output": "1.   Persistent posterior ground glass opacity in the left upper lobe.  Patchy\nbronchovascular opacities in the superior segment of the left lower lobe. \nThese are possible foci of infection.\n\n2.  Dilated esophagus with debris.  Possible risk of aspiration based on this.\nMore specifically possibility of developing achalasia could be considered or\nversus worsening dysmotility of less specific etiology."
        },
        {
            "input": "CHEST PERIMETER: No abnormal soft tissue the bed of the left thyroidectomy.  6\nmm high-density tissue medial to the right common carotid artery or long the\ntrachea could be a thyroid remnant.  There is no other abnormal tissue in the\nthyroid bed.\n\nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  No soft tissue abnormality elsewhere\nin the chest wall.  Findings below the diaphragm including the progressive\nenlargement of the spleen with multiple microabscesses will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Esophagus is severely dilated, retaining fluid suggesting\nfunctional or anatomic obstruction.\n\nAtherosclerotic calcification is mild in head and neck vessels and coronary\narteries.  Aorta and pulmonary arteries are normal size despite moderate\ncardiomegaly.  No pericardial effusion.\n\nTHORACIC LYMPH NODES: No lymph nodes in the mediastinum right hilum are\npathologically enlarged or growing.  See discussion below for possible left\nhilar adenopathy\n\nLUNGS, AIRWAYS, PLEURAE: 13 mm wide well-circumscribed low-attenuation lesion\nin the posterior basal segment, right lower lobe, 5:156, unchanged since\n___ could be a small lung abscess.\n\nLobulated low-attenuation tissue in the left lower lobe adjacent to the lower\npole of the left hilum is larger, 5:133-146 could be a cluster lung abscesses,\nreactive lymph nodes or even pneumonia.\n\nModerate nonhemorrhagic left pleural effusion layers posteriorly, presumably\nreactive to either left hilar abnormality or, less likely in the absence of\nsubphrenic abscess, splenic abscesses.\n\n\n\n\nCHEST CAGE: Unremarkable.  No evidence of infection or malignancy.",
            "output": "Compared to ___:\n\nStable small right lung abscess, but growing left perihilar abscesses,\ninfected lymph nodes or pneumonia.\n\nModerate nonhemorrhagic non serous left pleural effusion has also increased.\n\nGrowing splenomegaly due to worsening microabscesses.\n\nStable severely dilated full length, esophagus, either functionally or\nanatomically obstructed."
        },
        {
            "input": "BASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nHEART AND VASCULATURE: The ascending and descending thoracic aorta are\nectatic, measuring 4.5 cm and 3.3 cm, respectively, unchanged. Moderate to\nsevere calcific atherosclerosis of the thoracic arch and descending aorta. \nModerate coronary artery and aortic valvular calcifications. The heart,\npericardium, and great vessels are otherwise within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy. \nAn 1 cm right lower paratracheal lymph node (03:22) is unchanged from ___, likely reactive. No mediastinal mass.  Evaluation of hilar lymph\nnodes is limited on this unenhanced scan.\n\nPLEURAL SPACES: Interval placement of right lateral approach pigtail drainage\ncatheter, terminating in the right lung base. Interval decrease in size of now\nsmall right parapneumonic collection, which now contains primarily air. Thick\nsepta are noted through out the collection. Trace amount of fluid remains.\nTrace left pleural effusion.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally. Mild biapical scarring. Compressive atelectasis adjacent to the\naforementioned right pleural collection, unchanged from ___. \nPeripheral reticular thickening bilaterally is suggestive of underlying\ninterstitial lung disease.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.\n\nBONES: No suspicious osseous abnormality.? There is no acute fracture. \nModerate to severe degenerative changes of the thoracolumbar spine, most\nprominent at the upper lumbar levels. Incidental note is made of diffuse\nidiopathic skeletal hyperostosis.\n\nABDOMEN: Cholelithiasis without evidence for cholecystitis.  Moderate calcific\natherosclerosis of the abdominal aorta.",
            "output": "1. Interval decrease in size of now small right parapneumonic collection,\nwhich now contains prominently air after placement of a lateral approach\npigtail drainage catheter.\n2. Unchanged compressive atelectasis adjacent to parapneumonic collection.\n3. Ectatic ascending and descending thoracic aorta.\n\nRECOMMENDATION(S):  Consultation with the Aortic ___ ectatic thoracic\naorta recommended.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:44 am, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThere are no thyroid findings that warrant further imaging. Stable small lymph\nnodes in the axilla and thoracic inlet.   There are no abnormalities on the\nchest wall. Moderate atherosclerotic calcifications in the head and neck\narteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion. Mild to\nmoderate atherosclerotic calcifications in the coronary arteries, and the\naortic valve.  Moderate to severe calcifications in the aortic arch and\ndescending aorta.  Re-demonstrated ectasia of the ascending aorta, measuring\n40 millimeters and the descending thoracic aorta measuring 33 mm.  The\npulmonary artery is normal in caliber throughout.\n\nMEDIASTINUM AND HILA:\nThe esophagus is mildly patulous most likely reflecting a dysmotility\ndisorder.  Multiple small mediastinal lymph nodes have decreased in size and\nnumber since the prior study, for example a right lower paratracheal lymph\nnode previously measuring 10 mm, is now 7 mm (4: 125).  No hilar\nlymphadenopathy.\n\nPLEURA:\nMild bilateral apical scarring.  Mild interval decrease in the size of the\nright pleural collection, although now is fluid-filled and containing small\nair bubbles suggesting infectious process.  Again noted is the pigtail\ndrainage catheter inside the effusion.\n\nLUNGS:\nThe compressive atelectasis adjacent to the of pleural collection mentioned\nabove is stable since ___ airways are patent to the\nsubsegmental levels. Re-demonstrated peripheral reticular opacities, probably\nrelated to underlying interstitial disease.  No suspicious lung nodules or\nmasses.\n\nCHEST CAGE:\nNo acute fractures. Moderate dorsal spondylosis. No suspicious lytic or\nsclerotic lesions.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no significant abnormal\nfindings.",
            "output": "Small unilateral pleural collection is mildly decreased in volume in the\ninterval, however, it is again noted fluid-filled with internal gas bubbles\nconcerning most likely for empyema.\n\nInterval decrease in number and size of the multiple prominent mediastinal\nlymph nodes, most likely reactive.\n\nRedemonstrated ectatic ascending and descending thoracic aorta ectasia saved.\n\nPeripheral reticular opacities probably related to interstitial disease are\nunchanged."
        },
        {
            "input": "HEART AND VASCULATURE: The main pulmonary artery is mildly dilated up to 3.0\ncm in the right pulmonary artery is mildly dilated up to 3.1 cm, suggestive of\npulmonary arterial hypertension.  Pulmonary vasculature is well opacified to\nthe subsegmental level without filling defect to indicate a pulmonary embolus.\nThe thoracic aorta has heavy atherosclerotic calcification and the ascending\naorta is mildly dilated up to 4.3 cm, and the descending aorta is mildly\ndilated up to 3.1 cm, not significantly changed.  There is common origin of\nthe right brachiocephalic artery and the left common carotid artery.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  A right-sided central venous catheter terminates in the low\nSVC.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: A pigtail catheter terminates in a small right pleural\neffusion containing foci of air, not significantly changed.  No left pleural\neffusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is stable emphysema.  Compared with CT chest on ___ there are new nodular and ground-glass opacities in the left\nlower lobe as well as in the posterior right lower lobe (2:70,76; 301:8,102). \nCompressive atelectasis at the right lung base is stable.  Subpleural\nreticular changes suggestive of interstitial lung disease are stable.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: There is cholelithiasis.  There is heavy atherosclerotic\ncalcification in the upper abdominal aorta and its branches.  Included portion\nof the upper abdomen is otherwise unremarkable.\n\nBONES: The bones are diffusely demineralized.  There are degenerative changes\nin the thoracic spine and at the bilateral sternoclavicular joints.  No\nsuspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. New nodular ground-glass opacities in the bilateral posterior lower lobes,\nin a distribution most suggestive of aspiration.\n3. A pigtail catheter terminates in a small right pleural effusion which\ncontains small foci of air, not significantly changed.\n4. Cholelithiasis."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent hilar lymphadenopathy bilaterally\nmeasures up to 1.3 cm as before.  Evaluation for mediastinal adenopathy is\nlimited by streak artifact but appears similar.  A 7 mm left paraesophageal\nlymph node is unchanged.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited due to respiratory\nmotion.  Scattered nodules in a subpleural and perilymphatic distribution are\nagain seen, the largest measuring 7 mm along the major fissure in the right\nlower lobe (03:05), unchanged.  Additional nodules are stable or decreased in\nsize, and some have resolved.  Minimal opacity at the left base is suggestive\nof atelectasis.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: There are small bilateral hypodense nodules in the lower poles\nof the right and left thyroid.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a small hiatal\nhernia..\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Similar pulmonary nodules and hilar and mediastinal lymphadenopathy which\ncould reflect sarcoidosis.  Other etiologies including malignancy are not\nexcluded as previously suggested.\n3. 7 mm left paraesophageal lymph node is unchanged, which may be secondary to\nesophagitis.  Endoscopy could be performed for further evaluation if\nclinically indicated."
        },
        {
            "input": "There remain multiple scattered nodules, overall unchanged, allowing for\nslight difference in techniques (series 4), located within the right upper\nlobe (image 81, 32, 43), right lower lobe (image 108, 111, 141), right middle\nlobe (image 138), left lower lobe (image 168, 169, 173, 103, 125), left upper\nlobe (image 127, 118, 40, 31).  Some of these are perilymphatic given\nsubpleural and perifissural in location, but some have polygonal/geometric in\nmorphology, may represent subsegmental atelectasis or intraparenchymal lymph\nnodes.  Others are low-attenuation, tubular morphology, may represent mucous\nplugging, but there is no associated bronchiectasis typical for ABPA.  These\nare all unchanged, the largest measuring up to 7 mm.\n\nThere remains a borderline enlarged right hilar lymph node, measuring up to 11\nmm in short axis, unchanged.  There are no enlarged right paratracheal, or\nleft hilar lymph nodes.  There remain borderline enlarged left axillary lymph\nnodes, measuring up to 13 mm in short axis, similar to previous, otherwise\nbenign reniform morphology.\n\nCoronary arterial calcifications.\n\nThere is a calcified granuloma/calcified lymph node adjacent to the\ndiaphragmatic hiatus, with a small paraesophageal lymph node (image 43, series\n2).\n\nMild low-attenuation of the liver, may represent steatosis.",
            "output": "Multiple nodules persist, some in a perilymphatic distribution, which may be\nassociated with sarcoidosis particularly given persistent right hilar, and\nleft axillary adenopathy, overall unchanged.  Others may represent areas of\nmucous plugging, without findings of ABPA or eosinophilic pneumonia."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion.\n\nEvaluation of the lung parenchyma demonstrates no consolidative opacity. There\nis minimal bibasilar atelectasis. Major airways are patent.\n\nLimited images of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2. Clear lungs with mild bibasilar atelectasis but no consolidative opacity."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No suspicious thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  Note is made of a small hiatal hernia.  No adrenal lesions.  Mild\nmedullary nephrocalcinosis.  Evidence of prior cholecystectomy.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes.\n\nHILA: Subcentimeter hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart measures at the upper limits of normal.  Small\npericardial effusion measuring 11 mm adjacent to the right atrium.  Globular\nintracardiac calcification in relation to the lateral aspect of the mitral\nannulus (2, 41) measures 2 x 2 cm.  Severe aortic valve calcification in\nkeeping with aortic stenosis.  Moderate aortic annular and root calcification.\nModerate calcification of the left posterolateral aspect of the ascending\naorta.  No significant calcification of the anterior and right lateral aspect\nof the ascending aorta.  The ascending aorta measures 39 x 38 mm in the axial\nplane at the level of the pulmonary truncus.  The descending thoracic aorta at\na corresponding level measures 24 x 25 mm.  Severe calcification of the\ncoronary arteries.  The coronary arteries arise from their respective cusps. \nModerate calcific atherosclerotic changes of the aortic arch and descending\nthoracic aorta.  Circumferential calcific atherosclerotic changes involving\nthe abdominal aorta.\nPLEURA: Moderate nonhemorrhagic right-sided pleural effusion.  Small\nleft-sided pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  The pulmonary parenchyma is partially obscured by motion\nartifact.  Interstitial thickening with associated ground-glass changes with a\ngravity dependent distribution suggests moderate pulmonary edema.  No\nsuspicious pulmonary nodules or masses.  A couple of pulmonary micro nodules\nare visualized.  Atelectasis of the majority of the right lower lobe. \nAtelectasis to a lesser degree in the left lower lobe.\n2. AIRWAYS:  This study was not performed during optimal inspiration.  The\nairways are patent to the subsegmental level.  No bronchiectasis.\n3. VESSELS:  The pulmonary arteries not dilated.\nCHEST CAGE: Marked spondylotic changes of the thoracic spine.  Non expansile,\nbenign-appearing sclerotic lesion in the lateral aspect of the right sixth rib\n(2, 30).",
            "output": "Severe aortic valve calcification in keeping with aortic stenosis.\nGlobular calcification of the lateral aspect of the mitral annulus measuring 2\nx 2 cm.  Mitral valvular dysfunction is suspected and correlation with\nechocardiography is advised.\nModerate calcification of the aortic root.  Moderate calcification of the left\nposterolateral aspect of the ascending aorta, but no significant calcification\nof the anterior and right lateral aspects of the ascending aorta.  The\nascending aorta is not aneurysmal (measuring 39 x 38 mm in the axial plane at\nthe level of the pulmonary truncus).  The coronary arteries are severely\ncalcified.  The coronary arteries arise from their respective cusps.  Small\npericardial effusion.\n\nModerate pulmonary edema with a moderate right and small left-sided pleural\neffusion.  Atelectasis in the lower lobes as described above."
        },
        {
            "input": "There is no CT evidence of hilar mass or substantial intrathoracic\nlymphadenopathy.  A few small partially calcified lymph nodes are present, in\nkeeping with prior granulomatous exposure.  Heart size is normal, and diffuse\ncoronary artery calcifications are present.  No pericardial or substantial\npleural effusion is identified.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning abnormalities are identified in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate multilevel degenerative changes\nthroughout the spine.\n\nWithin the lungs, an elliptical opacity along the minor fissure is present\nwith configuration suggestive of an intrapulmonary lymph node.  Biapical\nscarring is mild and relatively symmetrical.  3 mm noncalcified left apical\nnodule is present (50, 4) as well as two 2 mm subpleural right upper lobe\nnodules (67 and 75, 4), and a 2 mm left lower lobe nodule (103, 4). \nAdditionally, an 11 mm predominantly ground-glass opacity is present in the\nperiphery of the right lower lobe lateral segment (185, 4).  It is contiguous\nwith linear opacities inferiorly and may potentially represent a focus of\nnodular scar or atelectasis.",
            "output": "1. No CT evidence of right hilar mass.\n\n2.  Small solid pulmonary nodules are statistically very likely benign, and a\n1.1 cm predominantly ground-glass right lower lobe nodular opacity is\npotentially due to a new nodular focus of scar or atelectasis.\n\n3. Diffuse coronary artery calcifications.\n\nRECOMMENDATION(S):  Followup CT in 6 months is recommended to reassess 1.1 cm\nground-glass right lower lobe opacity.  Likely benign subcentimeter solid\nnodules may also be reassessed at that time."
        },
        {
            "input": "The included thyroid is unremarkable. There is no supraclavicular or axillary\nlymphadenopathy. Central lymph nodes do not meet criteria for pathologic\nenlargement and range in size up to 7 mm in the left paratracheal station\n(02:26). The aorta and main pulmonary artery are normal caliber. The heart is\nmildly enlarged. There is no pericardial effusion. Focal coronary artery and\nmitral annular calcifications are moderate. Hypoattenuation of the blood pool\nwould be compatible with anemia.\n\nSecretions are seen within the upper trachea (04:55) and right mainstem\nbronchus (4:124). Otherwise, the airways are patent. There is no focal\nconsolidation worrisome for pneumonia.  Subtle ground-glass glass opacities in\nthe right mid-lung may represent contusion after trauma.  Chronic interstitial\nchanges are seen at the lung bases. Solid, sub 4 mm nodules are seen in the\nleft upper lobe (04:48) and lingula (4:142). Calcified granulomas are noted as\nwell (4:54, 181). There is no pleural effusion or pneumothorax. Calcified\npleural plaques indicate prior asbestos exposure.\n\nSubcentimeter hypodensities in the liver are too small to characterize (2:58,\n60, 63, 65) but are presumably simple cysts or biliary hamartomas. Included\nviews of the spleen are unremarkable. A large amount of material is been\nretained in the stomach. Fecalization of small bowel contents suggests slow\ntransit.\n\nThere is a minimally displaced sternal body fracture (602B:  67) with\nassociated small retrosternal hematoma. A minimally displaced left first rib\nfracture is also present (04:18).  Mildly angulated right ___ and ___ anterior\nrib fractures are noted.",
            "output": "1. Acute sternal body fx, rib fractures as stated above.\n2. Vague ground-glass opacities in the right mid-lung may represent contusion\nafter trauma.\n3. Chronic interstitial changes at the lung bases.\n\nNOTIFICATION:  The final impression was discussed by Dr. ___ with Dr.\n___ telephone on ___ at 5:48 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "CTA:  The thoracic aorta is top-normal in size measuring 3.9 cm in the\nascending portion.  There is no aortic dissection.  There is moderate\natherosclerotic disease.\n\nThere is a subsegmental filling defect in a single left lower lobe pulmonary\nartery branch (series 3, image 139), which is felt to be artifactual.  The\npulmonary arteries are otherwise well opacified to the subsegmental level.\n\nCHEST:  Heart is moderately enlarged.  There is no pericardial effusion. \nCoronary artery and aortic valvular calcifications are present.  Thyroid is\nnormal.  There is no axillary, supraclavicular, or mediastinal adenopathy.\n\nThe airway is patent to the segmental level.  There is mild centrilobular\nemphysema.  There is a small left pleural effusion with associated\natelectasis.  There is atelectasis versus scarring in the left lingula.  There\nis no focal lung consolidation.  There are no suspicious pulmonary nodules.\n\nThe thoracic esophagus unremarkable.  Views of the upper abdomen are normal.\nOSSEOUS STRUCTURES:  Median sternotomy wires are intact.  There are no\nsuspicious bony lesions.  There are multilevel degenerative changes of the\nthoracic spine.",
            "output": "1. No evidence of pulmonary embolism.\n2. Small left pleural effusion with atelectasis.\n\nRECOMMENDATION(S):  The findings were discussed by Dr. ___\nwith Dr. ___ on the ___ ___ at 9:44 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nThere is a hyperdense crescentic focus along the right lateral aspect of the\nthoracic ascending aorta extending from just distal to the aortic valve to the\nproximal aortic arch (series 601:17 and series 2:61).  There are moderate to\nsevere atherosclerotic calcifications of the coronary arteries.  There is no\npericardial effusion.  Median sternotomy and post CABG changes are noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is mild centrilobular emphysema.  There is mild dependent\natelectasis in the bilateral lower lobes.  There is no airspace consolidation\nor suspicious pulmonary nodule.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nPatient is status post prior median sternotomy.",
            "output": "Hyperdense crescentic focus along the thoracic ascending aorta extending from\njust distal to the aortic valve to the proximal aortic arch which could\nrepresent a dissection or alternatively, intramural hematoma.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 10:53 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection,\npenetrating atherosclerotic ulcer, or intramural hematoma.  The previously\nseen crescentic hyperdensity in ascending aorta on CTA of the chest from ___ is no longer visualized, which retrospectively may represent\nmotion artifact secondary to nongated technique.  There is moderate to severe\natherosclerotic disease throughout the thoracic aorta, extending to the great\nvessels.  The heart is moderately enlarged.  There is severe coronary artery\ncalcification and postsurgical changes of CABG.  There is mild aortic valvular\ncalcification.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is small left pleural effusion, increased compared to ___.  There is no right pleural effusion no pneumothorax.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis.  No airspace consolidation.  No\nsuspicious pulmonary nodular mass.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the thyroid gland and base of the neck\nshow no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable, aside for\nmild thickening of the bilateral adrenal glands.\n\nBONES: No suspicious osseous lesion or acute fracture.  Intact median\nsternotomy wires.  There are multilevel degenerative changes of the thoracic\nspine.  There is moderate bilateral gynecomastia.",
            "output": "1.  No evidence of dissection, penetrating atherosclerotic ulcer, or\nintramural hematoma.  The previously seen crescentic hyperdensity in the\nascending aorta on CTA of the chest from ___ is no longer\nvisualized, which retrospectively may represent motion artifact secondary to\nnongated technique.\n2.  No pulmonary embolism.\n3.  Moderate to severe atherosclerotic disease throughout the thoracic aorta.\n4.  Small left pleural effusion, increased compared to ___.\n5.  Moderate cardiomegaly with postsurgical changes of prior CABG."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. \nThe thyroid gland appears unremarkable.\n\nMild bronchial wall thickening is demonstrated dominant in the right lower\nlobe where there is also mild patchy ground-glass opacification and\n___ nodularity.  There is mild right basilar atelectasis.\n\nLimited images of the upper abdomen are unremarkable.  Tiny focus of hyper\ndensity at the right hepatic dome (series 3, image 165) may reflect a tiny\nflash filling hemangioma or perfusion anomaly.  The adrenals are partially\nvisualized.  There is a small hiatal hernia.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Right base ___ opacification compatible with small airway\ninflammatory/infectious process.  Also mild right basilar atelectasis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged portion of the thyroid\nis unremarkable.  Mild atherosclerotic calcification of the proximal right\nbrachiocephalic artery.  No supraclavicular, axillary, mediastinal, or hilar\nlymphadenopathy.  No mediastinal masses.\n\nUPPER ABDOMEN: Small hiatal hernia unchanged.  The previous hyperdensity at\nthe right hepatic dome is no longer seen, and may have represented a flash\nfilling hemangioma or perfusion anomaly unseen without contrast.  The left\nadrenal gland is partially visualized.  The abdomen to the level of the celiac\ntrunk is otherwise unremarkable.\n\nHEART and PERICARDIUM: The heart is normal in size.  Mild coronary\ncalcification.  No pericardial effusion.  The great vessels are normal in size\nand configuration.  The thoracic aorta is normal in caliber and course.  Small\natherosclerotic calcification is seen at the lateral apex of the aortic arch.\n\nPLEURA: No pleural effusion or pneumothorax.  Minimal biapical\npleuroparenchymal scarring.\n\nLUNG:\n\n1. PARENCHYMA:  The ___ and ground-glass opacification previously seen\nat the right base have considerably improved, now with only mild residual\nbronchial wall thickening suggesting resolving inflammatory/infectious\nprocess.  Mild interstitial and pleural thickening in the anterior segment of\nthe right upper lobe has slightly progressed and likely represents atelectasis\nwith possible component of scarring.  The airways are patent to the level of\nthe segmental bronchi bilaterally.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery is normal in diameter.\nCHEST CAGE: No suspicious lytic or sclerotic lesions.  A likely subacute\nfracture involving the anterior left fifth rib is new compared to the prior\nstudy dated ___.",
            "output": "1.  Nearly resolved right lower lobe opacities with mild residual bronchial\nwall thickening which suggest resolving inflammatory/infectious process.\n2.  Likely subacute fracture involving the anterior left fifth rib is new\nsince the prior study."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Excluding the\nbreasts which require mammography for evaluation, for example for small\nnodular opacities in the right breast, 06:45, elsewhere in the chest wall\nthere are no soft tissue abnormalities concerning for malignancy.  Findings\nbelow the diaphragm were described in the report of an abdomen pelvis CT\nperformed earlier this morning.\n\nThere are no thyroid findings warranting further imaging evaluation. \nAtherosclerotic calcification is not apparent head neck vessels, or coronary\narteries.  Aorta and pulmonary arteries and cardiac chambers are normal size. \nThis study is not designed for vascular evaluation but shows a nonocclusive\nthrombus in the superior segmental branch of the left pulmonary artery, 7:135\n- 129.  There are no large filling defects centrally, but there could be other\nsmall peripheral emboli.  Pericardium is physiologic.  There is no pleural\nabnormality.  Central infusion port catheter ends at the superior cavoatrial\njunction, free of associated clot.\n\nThere are no central lymph nodes in the mediastinum hila, internal mammary,\ndiaphragmatic, or retrocrural stations pathologically enlarged. Sub cm right\nlower paratracheal lymph nodes were present in ___, probably unchanged\nsubsequently.\n\nLungs are clear and the tracheobronchial tree is normal to subsegmental\nlevels.\n\nHomogeneous 10 x 18 mm well circumscribed low density lesion in the right\nposterior aspect of the L1 vertebral body could be benign or malignant.  A 14\nmm wide lesion in the T10 vertebral body has the matrix of a benign hemangioma\nor lymphangioma.",
            "output": "No evidence of intrathoracic malignancy.\n\nAt least one small non occluding pulmonary embolus, probably recent or acute.\n\nLucent lesion L1 vertebral body.  See separate report of abdomen and pelvis CT\nfor recommendations.\n\nRECOMMENDATION(S):  Consider the need for further pulmonary embolus\nevaluation.\n\nMammogram, if not recently performed.\n\nNOTIFICATION:   The findings were discussed with ___ by ___\n___, M.D. on the telephone on ___ at 1:15 ___, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "There are no enlarged mediastinal lymph nodes.  An 8 mm left infrahilar node\nlocated just below the left inferior pulmonary vein is prominent in size for\nits location and is in retrospect unchanged since ___ CT.  Heart size is\nnormal, and coronary artery calcifications are present.  There is no\npericardial or pleural effusion.\n\nSkeletal structures of the thorax are remarkable for a persistent lucent\nlesion measuring 1.5 cm in diameter at approximately the T4 vertebral body\nlevel (image 35, series 3).  It contains internal fat and is probably a\nhemangioma.  Similarly, an unchanged lesion at T10 is likely a hemangioma (89,\n3).\n\nWithin the lungs, a 3 mm right middle lobe nodule is in retrospect unchanged\n(86, 3).",
            "output": "1. 8 mm left infrahilar of lymph node and 3 mm right middle lobe lung nodule\nare in retrospect unchanged since ___ CT.  Recommend continued\nsurveillance of these findings at follow-up CT in ___ months.\n\n2.  Please see separately dictated CT of the abdomen and pelvis for complete\ndescription of subdiaphragmatic findings."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not enlarged.  Specifically\nexcluding the breasts which must be evaluated by mammography, there no soft\ntissue abnormalities in the chest wall suspicious for malignancy.  Right\npectoral infusion reservoir sends a catheter to the low SVC with no evidence\nof sleeve thrombus.\n\nSmall hypodensities in the thyroid are too small to warrant further imaging\nevaluation.  Atherosclerotic calcification is not apparent head neck vessels\nand minimal in coronary arteries.  Aortic valve is not calcified.  Aorta and\npulmonary arteries and cardiac chambers are normal size.  Pericardium is\nphysiologic.  There is no pleural effusion.\n\nMediastinal, hilar, and other thoracic lymph nodes are not enlarged.\n\nLungs:\n\n2 mm right middle lobe solid nodule, 5:204, unchanged since ___ can be\nconsidered benign.\n\nDiffuse centrilobular micro nodulation is more pronounced today than in\n___.  This is usually due to cigarette smoking or severe allergy. \nInflammation of larger bronchi, reflected in bronchial wall thickening, is\nrelatively mild and there is no retention of secretions.\n\nLucencies in multiple thoracolumbar vertebral bodies, including T3 and T12 are\nstable since ___, probably benign hemangioma or lymphangioma there\nare no compression or pathologic fractures and no destructive bone lesions. \nIt should nevertheless be remembered that radionuclide bone and FDG PET\nscanning are more sensitive in detecting osseous metastases than chest CT.",
            "output": "No good evidence for intrathoracic malignancy.  Widespread bronchiolar\nnodulation is probably inflammatory, seen in cigarette smokers and patients\nwith severe allergies.  Clinical correlation advised."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter.  Heart size is normal. \nNo mediastinal, hilar or axillary lymphadenopathy is present.  No pericardial\npleural effusion is seen.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic metastatic disease\n\nUnchanged multiple small thyroid nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nNo supraclavicular or axillary lymphadenopathy.  The esophagus is\nunremarkable.\n\nUPPER ABDOMEN: Please refer to the dedicated abdomen and pelvis CT from ___ for subdiaphragmatic characterization.\n\nMEDIASTINUM: No mediastinal mass or lymphadenopathy.\n\nHILA: No hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is normal. The thoracic aorta is normal\nin caliber. No pericardial effusion.  Mild aortic and coronary artery\ncalcification.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: A linear density in the lingula, extending from the pleural\nsurface to the left cardiac silhouette, is most likely atelectasis. \nOtherwise, the lungs are clear without significant pulmonary nodules or\nmasses.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS: The main pulmonary artery diameter is within normal limits.\nSuboptimal evaluation of the pulmonary vasculature demonstrates no evidence of\ncentral pulmonary embolism.\nCHEST CAGE AND THORACIC SPINE: Probable hemangiomas of the T4, T10, and L1\nvertebral bodies, unchanged from the prior CT.  Otherwise, no sclerotic\nlesions or acute fractures.",
            "output": "No pulmonary nodules concerning for malignancy identified.\n\nMild lingular atelectasis.\n\nUnchanged, probable hemangiomas of the T4, T10, and L1 vertebral bodies.\n\nMild aortic and coronary artery calcification."
        },
        {
            "input": "There is a 9 mm hypodense nodule in the right lobe of the thyroid. \nSupraclavicular, axillary, mediastinal and hilar lymph nodes are not enlarged.\nAorta and pulmonary arteries are normal size. Cardiac configuration is normal\nwith minimal coronary calcification.  There is a 2 mm nodule in the right\nmiddle lobe (03:34).  There is minimal bibasilar atelectasis.",
            "output": "1. No acute process.  No definite evidence of malignancy.\n2. 2 mm pulmonary nodule.\n3. 9 mm thyroid nodule\n\nRECOMMENDATION(S):\n1. Per ___ society guidelines for follow-up of pulmonary nodules, if no\nrisk factors for malignancy no followup is required.  If risk factors,\nrecommend followup CT in ___ year.\n2. Thyroid nodule can be evaluated with nonemergent thyroid ultrasound if has\nnot been previously evaluated.\n\nNOTIFICATION:  Update in wet read paged to Dr. ___ at 5:45 ___."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta and pulmonary arteries are\nnormal in size.   The heart size is normal and there is no pericardial\neffusion.\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  There is\nno diffuse interstitial abnormality.  There are no concerning pulmonary\nnodules.  A punctate calcified granuloma is noted in the right apex (___).\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "The thyroid gland is grossly unremarkable.\n\nHeart size is normal without significant pericardial fluid.  Thoracic aortic\narch is normal caliber without aneurysm or dissection.  Main, left and right\npulmonary arteries are normal caliber and there is no pulmonary embolus to the\nsubsegmental level.  Mediastinal and bilateral hilar lymphadenopathy is noted.\nAP window lymph node measures 2.6 x 1.0 cm.  A pretracheal nodal conglomerate\nmeasures 1.8 x 1.1 cm.  Largest left hilar lymph node measures approximately\n1.5 x 1.3 cm.  Right hilar lymph node measures approximately 1.5 x 1.1 cm. \nThere is no supraclavicular or axillary lymphadenopathy by CT size criteria.\n\nThere is re- demonstration of widespread bronchiectasis in the right upper\nlobe, lingula and bilateral lower lobes with multiple area of mucous\nimpaction, most prominent in the bilateral lower lobes and appearing\nsignificantly increased compared to the prior examination.  There are\nextensive inferior lingular segment, right upper lobe and left lower lobe\nconsolidations with additional areas of peribronchial ___ nodularity\nin both areas.  Consolidation is less severe in the right lower lobe with\nadditional areas of peribronchiolar nodularity.  Masslike consolidation in the\nposterior segment of the right upper lobe has improved compared to the prior\nexamination, now with areas of bronchiectasis and mucous plugging with a scant\nareas of ___ nodularity.  There is a small left-sided pleural\neffusion.\n\nThe imaged upper abdomen is grossly unremarkable.\n\nBones and soft tissues:  There is no suspicious focal bone lesion.",
            "output": "1. Irregular inferior lingular, right upper lobe and bilateral lower lobe\nconsolidations with areas of peribronchial nodularity compatible with\nmultifocal pneumonia.\n2. Small left-sided pleural effusion.\n3. Worsening widespread bronchiectasis with bilateral lower lobe predominance\nwith multiple areas of mucous impaction.\n4. Mild hilar and mediastinal adenopathy, increased since ___, potentially\nreactive.\n5. No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "Soft tissues:  The partially imaged thyroid gland is homogeneous.  There are\nno pathologically enlarged axillary, mediastinal, or hilar lymph nodes.  Heart\nsize is normal and there is no pericardial effusion.  The aorta and main\npulmonary artery are normal in caliber.  The esophagus is normal in course and\ncontour.  Please see a separate report discussing the subdiaphragmatic\nfindings.\n\nLungs:  The airways are patent and clear to the subsegmental level\nbilaterally.  There is no focal consolidation, pleural effusion, or\npneumothorax.  Left apical scarring is mild.  Scarring and atelectasis is mild\nin the medial aspect of the right middle lobe (05:106).  Calcified granulomas\nare noted in the left lower lobe.  Punctate pulmonary nodules in the right\nupper and lower lobes (5:95) do not demonstrate concerning features.\n\nBones:  No concerning osseous lesions in the chest cage.",
            "output": "1. No evidence of intrathoracic metastasis or infection.\n2. Punctate right upper and lower lobe nodules do not demonstrate concerning\nfeatures and can be followed up with routine oncologic surveillance.\n3. Please see a separate report discussing findings within the abdomen and\npelvis."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum.  No\nvascular thoracic abnormalities.  Unchanged mild cardiomegaly.  Mild coronary\ncalcifications.  No pericardial effusions.  No enlarged lymph nodes at the\nlevel of the hilar or mediastinal level.  Unchanged moderate ascites.  The\nabdominal findings are described in detail in the dedicated abdominal CT\nreport.  No osteolytic lesions at the level of the ribs, the sternum or the\nvertebral bodies.  Hemangioma in L2.  Minimal bilateral apical thickening. \nSeveral mostly subpleural non suspicious granulomas.  No suspicious lung\nnodules or masses.  Mild respiratory motion are defects.  Non characteristic\nscars at the bases of the middle lobe and the lingular (6, 108 and 141).  No\npleural thickening, no pleural effusions.  The airways are patent.",
            "output": "No evidence of metastatic disease to the thorax."
        },
        {
            "input": "CHEST:  The thoracic aorta is normal in course and caliber without evidence of\nfocal injury, dissection, or aneurysm.  Residual thymic tissue in the anterior\nmediastinum noted.  There is no mediastinal hematoma.  The airways centrally\npatent.  The main pulmonary artery and central branches appear patent.  The\nheart is normal in size and shape.  No pleural or pericardial effusion is\nseen.\n\nLungs are clear bilaterally without focal contusion, laceration or\npneumothorax.  No worrisome nodule, mass, or consolidation.\n\nABDOMEN:  The liver and spleen appear intact without focal abnormality.  The\ngallbladder, pancreas, adrenal glands appear normal.  The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis or focal\nlesion of concern. The abdominal aorta is normal in course and caliber with\nwidely patent major branches. There is no retroperitoneal hematoma or\nlymphadenopathy. No free air or free fluid is seen.\n\nThe stomach and duodenum are normal.\n\nPELVIS: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. There is no evidence of mesenteric injury. The appendix is\nnormal. No free pelvic fluid.  Urinary bladder appears well distended and\nintact.\n\nBONES:  No osseous injury.  No worrisome bony lesions.",
            "output": "No acute sequelae of trauma."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Minimal atherosclerotic calcification is seen in the\naortic arch and along the descending thoracic aorta.  Mild cardiomegaly is\nnoted.  Coronary artery, aortic valve, and mitral annular calcifications are\nnoted..  The heart, pericardium, and great vessels are otherwise within normal\nlimits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: There is a moderate sized nonhemorrhagic right pleural\neffusion and small nonhemorrhagic left pleural effusion.  No pneumothorax.\n\nLUNGS/AIRWAYS: Lungs demonstrate diffuse bilateral paraseptal thickening and\nground-glass opacities, likely compatible with pulmonary edema.  The airways\nare patent to the level of the segmental bronchi bilaterally noting\nendoluminal debris in the distal trachea and right mainstem bronchus. \nEndotracheal tube appears in appropriate position.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  An enteric\ntube is seen coursing into the stomach.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Cardiomegaly and diffuse bilateral ground-glass opacities and paraseptal\nthickening, suggestive of pulmonary edema.\n3. Moderate right pleural effusion and small left pleural effusion."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation.  There is no\nevidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.\nModerate calcified and noncalcified atherosclerotic disease is seen throughout\nthe aorta.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.  Coronary\nartery and aortic valve calcifications are present.\n\nSevere emphysema is noted.  Again seen is a large right hilar upper lobe mass\nwhich is similar in appearance to prior examination.  The mass is again noted\nto obliterates the right upper lobe bronchus and there is associated volume\nloss.  Persistent lucencies in the right upper lobe have increased since prior\nexamination worrisome for necrotic lung parenchyma from a postobstructive\npneumonia.  The right middle lobe bronchus is narrowed but patent.  There is\nmild increase in right main bronchus narrowing.  There is no supraclavicular,\naxillary, or left hilar lymphadenopathy.  New 1.2 x 0.5 cm (3:66) left upper\nlobe pulmonary nodule as well as additional peripheral left upper lobe\npulmonary nodules are noted.   The thyroid gland appears unremarkable. Mild\nbronchial wall thickening is noted. The airways are otherwise patent to the\nsubsegmental level.\n\nThere is no evidence of pericardial effusion.  Trace right pleural effusion is\nstable.  No left pleural effusion.\n\nThere is no evidence of pulmonary parenchymal abnormality.\nLimited images of the upper abdomen are notable for unremarkable.\nAgain seen is a lytic soft tissue lesion along the right chest wall invading\ninto the third and fourth anterolateral ribs, similar in appearance to\nprevious examination a minimally displaced subacute fracture of the T3 spinous\nprocess is noted.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n2.  Persistent right upper lobe consolidation with progression of necrotic\nlung parenchyma due to postobstructive pneumonia secondary to large right\nperihilar mass obstructing the right upper lobe bronchus.\n3.  Bilateral bronchial wall thickening can be seen with small airways disease\nor bronchiolitis.\n4.  Severe emphysema.\n5.  New left upper lobe peripheral pulmonary nodules are likely inflammatory\nor infectious, however given history of malignancy close interval followup is\nrecommended to assess for resolution."
        },
        {
            "input": "Supraclavicular axillary, mediastinal, hilar, internal mammary, and\nretrocrural lymph nodes lymph nodes are not pathologically enlarged.  Thyroid\nis unremarkable. Aorta is normal caliber and not appreciably calcified.\nAtherosclerotic calcification is present in at least the left main and\nanterior descending coronary arteries. Pulmonary arteries are normal size.\n\nPericardium is normal and previous pleural effusions have resolved.\n\nPrevious abnormalities in the lower lobes, have largely cleared, that includes\nlarge areas of ground-glass opacification either infection or pulmonary\nhemorrhage, and bibasilar atelectasis, still reflected in linear bands of\natelectasis.  Bronchial tree is patent to subsegmental levels.\nThere are no bone lesions in the chest cage suspicious for or atelectasis.",
            "output": "No good evidence for active infection or malignancy in the chest. Previous\nalveolitis or pulmonary hemorrhage has cleared, and bibasilar atelectasis has\nimproved."
        },
        {
            "input": "The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax\nis identified. The central tracheobronchial tree is patent.\n\nHeart size is normal. The pericardium is thin and normal in appearance.\nMinimal coronary artery calcifications are present. The great vessels are\nnormal in caliber.\n\nNo enlarged supraclavicular, mediastinal, hilar, or axillary lymph nodes are\nidentified. The thyroid is normal. Note is made of bilateral gynecomastia. No\ndefinite chest wall mass is identified.\n\nPostoperative changes are compatible with orthotopic liver transplant. Slight\nsoft tissue bulge in the subxiphoid region (02:46) is unchanged since the ___ and likely represents scar from prior surgery. The spleen remains\nenlarged.",
            "output": "1. No evidence for chest wall mass or lymphadenopathy.\n2. Partially visualized postoperative changes consistent with orthotopic liver\ntransplant."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged and\nthere are no soft tissue lesions in the imaged chest wall suspicious for\nmalignancy or infection. Gynecomastia is mild to moderate and symmetric. \nFindings below the diaphragm will be reported separately.\n\nSmall lucency in the left lobe of the thyroid is too small to warrant\nevaluation with ultrasound.  Atherosclerotic calcification is not evident in\nhead and neck vessels, relatively limited in the coronaries to at least the\nLAD.  Aorta and pulmonary arteries are normal size.  Pericardium is\nphysiologic. There is no pleural effusion.\n\nLymph nodes in the mediastinum and hila, internal mammary, diaphragmatic and\nretrocrural stations are not enlarged.\n\nLungs are clear and the tracheobronchial tree is clear to subsegmental levels.\nThere are no bone lesions in the chest cage suspicious for malignancy.",
            "output": "No evidence of intrathoracic malignancy.\n\nMild coronary atherosclerosis."
        },
        {
            "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY:\nPost liver transplant.  A stent is noted in the common hepatic artery as\npreviously\nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of steatosis:  57 ___ on non-contrast scan (normal 60-70 ___ is\nno evidence of focal lesions.  As previously and too small to characterize 2\nmm lesion is seen in segment 2A (4; 31) with no interval since the previous\nstudy.  A was a perfusion abnormality is also seen in segment 2A (4; 24) in\nthe late arterial phase.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThere is no gallbladder.\nPANCREAS:\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\nSPLEEN:\nThe spleen is enlarged, without evidence of focal lesions.\nADRENALS:\nThe right and left adrenal glands are normal in size and shape.\nURINARY:\nThe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno evidence of stones, focal renal lesions or hydronephrosis.\nThere are no urothelial lesions in the kidneys or proximal ureters. There is\nno perinephric abnormality.\nGASTROINTESTINAL:\nThe stomach is not distended.  There is no abnormality in the duodenum.\nThe visualized small bowel loops in the abdomen demonstrate normal caliber,\nwall thickness and enhancement throughout.\nThe visualized part of colon addendum is within normal limits with no\nobstructing lesion..\nRETROPERITONEUM & MESENTERY:\nThere is no evidence of retroperitoneal, mesenteric and omental lymph node\nenlargement.  No solid or cystic mass.\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  Hepatic artery stent mentioned\nabove\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\n\nSKELETAL:\nThere is no evidence of worrisome lesions.",
            "output": "1.   No acute abnormality seen.\n2. Post liver transplant with no interval change since ___.\n3. Stable splenomegaly"
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  Heart size is normal.  There\nis no pericardial pleural effusion.\n\nNo mediastinal, hilar or axillary lymphadenopathy is present.\n\nAirways are patent to the subsegmental level bilaterally.  Lungs are clear.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and pelvis in corresponding report will be issued.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No evidence of intrathoracic malignancy.\n\nAs previously seen is mild Coronary atherosclerosis.\n\nHeterogeneous thyroid gland that should be further assessed with thyroid\nultrasound."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The lung bases are not included within the field of view. \nOtherwise, lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.  Right-sided Port-A-Cath tip projects to the\ncavoatrial junction.  There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\nMEDIASTINUM:\nThe pre-vascular lymph node has further regressed in size and is now barely\nperceptible.  There are stable post radiation changes seen to the mediastinum.\nNo enlarged hilar lymph nodes.  No enlarged mediastinal lymph nodes.  There is\nno pericardial effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There are stable post radiation changes to the left paramediastinal\nlocation and left upper lobe.  No new or growing pulmonary nodules.  Minimal\nscarring in the left lung base.\n\nBONES AND CHEST WALL : Review of bones shows a stable sclerotic lesion within\nT7 vertebral body.  No new lytic or sclerotic lesions.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows stable left\nadrenal thickening.  No focal liver lesions.",
            "output": "Stable post radiation changes to the mediastinum with further regression in\nsize of mediastinal lymph nodes.\n\nStable post radiation changes to the left paramediastinal location.\n\nRight-sided Port-A-Cath with its tip in the right atrium.\n\nStable sclerotic lesion within T7 vertebral body\n\nStable left adrenal thickening."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Right lobe of thyroid nodules\nmeasure less than 15 mm.  No supraclavicular or axillary adenopathy.  No gross\nbreast lesions.  Right-sided central line terminates in the right atrium.\n\nUPPER ABDOMEN: Will be reported separately\n\nMEDIASTINUM: Post therapeutic soft tissue thickening involving the left upper\nmediastinum with adjacent subcentimeter lymph nodes are again noted, with the\nlymph nodes continue to decrease in size.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  Trace pericardial\neffusion.  Moderate aortic annular calcification.\nPLEURA: No pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Scarring in the medial aspect of the left upper lobe adjacent\nto the mediastinum is stable.  Innumerable 1-2 mm pulmonary nodules are noted\nthroughout the lungs which are stable compared to prior imaging.  No new or\nenlarging pulmonary nodules or masses.\n2. AIRWAYS:  Airways are patent to the subsegmental level\n3. VESSELS:  Pulmonary arteries not enlarged.  No central filling defects.\n\nCHEST CAGE: Indeterminate sclerotic lesion in the T6 vertebral body is stable.",
            "output": "Posttherapeutic soft tissue thickening involving the left upper mediastinum\nand adjacent left upper lobe are again noted with small adjacent lymph nodes\nwhich continue to decrease in size.\n\nNo new or enlarging/suspicious pulmonary nodules or masses.  Innumerable 1-2\nmm pulmonary nodules noted throughout the lungs appear fairly similar compared\nto prior imaging.\n\nStable T6 sclerotic lesion.\n\nReference is made to CT abdomen report of study done on the same day for\nabdominal findings."
        },
        {
            "input": "The imaged thyroid is normal.\n\nHeart size is normal without significant pericardial fluid. Three-vessel\ncoronary artery calcifications are severe. Thoracic aortic arch is normal in\ncaliber. The main pulmonary artery is mildly ectatic measuring 31 mm in\ndiameter. There is no central pulmonary embolus. There is no pathologic\nsupraclavicular, axillary, hilar or mediastinal lymphadenopathy.\n\nHiatal hernia is small.\n\nDiffuse bronchial wall thickening is re- demonstrated. Airways are patent to\nthe subsegmental level. There is trace bibasilar atelectasis. There is trace\nleft apical scarring. 2 mm nodule at the right lung base is stable (6:240).\nLungs are otherwise clear without new nodule or focal consolidation. Pleural\nsurfaces are clear without effusion or pneumothorax.\n\nBones and soft tissues: Thoracic cage is intact without focal lesion. Thoracic\ndegenerative changes are moderate.",
            "output": "1. Stable 2 mm right lung base nodule. No new nodules.\n2. No definite intrathoracic metastasis.\n3. Chronic small airways disease.\n4. Ectatic main pulmonary artery is suggestive of pulmonary hypertension.\n5. Small hiatal hernia."
        },
        {
            "input": "MEDIASTINUM: The thyroid is normal.  There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy.  The aorta is normal in size.\nProminence of the main pulmonary artery up to 31 mm in diameter and the right\npulmonary artery up to 27 mm (6:138) is unchanged, suggesting the possibility\nof pulmonary arterial hypertension There are atherosclerotic calcifications in\nthe coronary arteries.  The heart size is normal and there is no pericardial\neffusion. There is a small hiatal hernia (05:45).\n\nPLEURA:  There is no pneumothorax.  There is no pleural effusion.\n\nLUNGS: The airways are patent.  There is no airspace consolidation.  Mild\ndiffuse bronchial wall thickening is again noted trace left apical scarring\nand 2 mm right lung base nodule are unchanged (6:242). Minimal dependent\nbibasilar atelectasis is noted. No new or concerning pulmonary nodules are\nidentified.\n\nBONES: There are no destructive focal osseous lesions concerning for\nmalignancy within the imaged thoracic skeleton.  Moderate multilevel\ndegenerative changes are again seen in the thoracic spine.\n\nUPPER ABDOMEN:  Findings within the abdomen and pelvis will be reported\nseparately by the Abdominal Radiology division.",
            "output": "1. No evidence of intrathoracic metastatic disease.\n2. 2 mm right lung base nodule is stable. No new nodules identified."
        },
        {
            "input": "Left pectoral Port-A-Cath. No supraclavicular, infraclavicular or axillary\nlymphadenopathy.  No enlarged hilar or mediastinal lymph nodes.  Unchanged\nborderline diameter of the pulmonary artery, suggesting the possibility of\npulmonary hypertension. Stable moderate to severe coronary calcifications.  No\npericardial effusion.  No enlarged lymph nodes in the hilar or mediastinal\narea.  Moderate hiatal hernia. The upper abdomen is described in detail in the\ndedicated abdominal CT report.  Mild degenerative vertebral disease.  No\nvertebral compression fractures.  No osteolytic lesions at the level of the\nribs, the sternum or the vertebral bodies.\nMinimal bilateral apical scarring.  The pleural surfaces are even, no pleural\neffusions, no pleural thickening.  The airways are patent. Stable 1-2 mm\nnodule at the right lung base (8, 254).  No new or growing lung nodules.",
            "output": "Unchanged as compared to ___. Known 2 mm nodule at the right lung\nbase that is stable.  No new or growing nodules.  No pleural effusions. No\nlymphadenopathy."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: The partially imaged thyroid is unremarkable.  Left\nPort-A-Cath terminates in the low SVC.  There is no supraclavicular, axillary,\nmediastinal or hilar lymphadenopathy.  Subcentimeter lymph nodes are not\npathologically enlarged by CT size criteria but larger since the prior study,\nfor example 7 mm left periaortic node (06:22). Other s cattered small\nmediastinal lymph nodes are stable and not pathologically enlarged by CT size\ncriteria. The esophagus is grossly normal with small hiatal hernia.\n\nHeart size is normal without pericardial effusion. The aorta and main thoracic\nvessels are well opacified and normal in caliber.  The main pulmonary artery\nis dilated to 3.8 cm suggesting pulmonary hypertension.  There is\ncalcification of the coronary arteries.\n\nThe study was repeated with low dose technique for low lung volumes.  The\ninitial study obtained during expiration demonstrates mosaic attenuation with\nareas of air trapping.  A punctate nodule at the right base (8:199) is\nunchanged.  There is no pleural effusion or pneumothorax.  There is no\ndefinite pulmonary edema.\n\nThere is mild bronchial wall thickening and mucus plugging notably at the lung\nbases (8:191). Bibasilar atelectasis is moderate.\n\nOSSEOUS STRUCTURES: There are degenerative changes in the thoracic spine with\nexaggerated kyphosis and prominent anterior osteophytes.  Disc vacuum\nphenomenon is noted at multiple levels.",
            "output": "1. No evidence of pulmonary metastases.\n2. Sub-centimeter mediastinal lymph nodes are not pathologically enlarged by\nCT size criteria but are slightly larger since the prior study. Attention on\nfollowup is recommended.\n3. New diffuse lung abnormality with mosaic attenuation and findings\ncompatible with air trapping.  P ulmonary drug toxicity usually causing\nalveolitis  and interstitial infiltration occasionally induces  airway\nhypersensitivity with bronchospasm and air trapping.  Gemcitabine or\namiodarone toxicity are   possible causes.\n4. Punctate right lower lobe nodule is unchanged.\n5. Please note CT of the abdomen and pelvis will be reported separately.\n\nRECOMMENDATION(S):  Close interval followup of new pulmonary disease with\nconcurrent and subsequent chest radiographs, with chest CT as needed .\n\nNOTIFICATION:  The findings were telephoned to ___ by ___ at\n15:25,  ___, 5 min after discovery."
        },
        {
            "input": "The thyroid is normal.  Numerous, nonenlarged supraclavicular and subpectoral\nlymph nodes are noted.  These are not significantly different from prior\nexaminations.  There is no mediastinal or hilar lymphadenopathy.  Aorta and\npulmonary arteries are normal size. Cardiac configuration is normal. \nExtensive coronary calcifications are identified.\n\nThere is mild bibasilar atelectasis.  Evaluation of the lungs shows a new\nright upper lobe nodule measuring 5 mm (04:55).  Another new left lower lobe\nnodule is noted measuring approximately 6 mm.  A millimetric right lower lobe\nnodule has remained stable since ___.  No pleural effusion or\npneumothorax is present.  No definite pleural thickening is noted.\n\nA small hiatal hernia is present. Please see report from dedicated CT of the\nabdomen and pelvis for intra diaphragmatic findings.\n\nEvaluation of the bones shows multilevel degenerative changes without\nsignificant vertebral body height loss or suspicious osseous lesion.  There is\nevidence of healed bilateral rib fractures.",
            "output": "1.  Pulmonary nodules, new since ___, are concerning for metastasis. \nShort interval follow-up is recommended in 3 months for documentation of\nprogression."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  Left pectoral Port-A-Cath.  The posterior\nmediastinum is normal.  Moderate coronary calcifications.  No pericardial\neffusions.  Mild cardiac enlargement.  Small hiatal hernia.  The upper\nabdominal findings are described in detail in the dedicated abdominal CT\nreport.  Moderate degenerative vertebral disease.  No vertebral compression\nfractures.  No osteolytic lesions at the level of the ribs and the sternum.\nThe appearance of the pre described right upper lobe nodule is unchanged an\nits diameter is constant, at 4 mm (4, 73).  A pre-existing left lower lobe\nsubpleural nodule (4, 276) has minimally increased in size.  Mild\nirregularities of the airway walls, suggesting mild chronic airways disease. \nNo diffuse lung disease.  No evidence of infectious changes.  No pleural\nthickening, no pleural effusions.",
            "output": "The pre-existing right upper lobe nodule is stable.  The pre-existing left\nlower lobe subpleural nodule has minimally increased in size.  This emphasize\nas the suspicion for malignant metastatic lesions.\n\nNo pleural effusion.  No adenopathy.  Mild chronic airways disease."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "No incidental thyroid findings. No supraclavicular, infraclavicular or\naxillary lymphadenopathy. No enlarged lymph nodes in the hilar or mediastinal\nregion. Normal appearance of the heart. No pericardial effusion normal\nappearance of the large mediastinal vessels.  Small hiatal hernia. The upper\nabdomen is reported separately.  No osteolytic lesions at the level of the\nribs, the sternum or the vertebral bodies.  Minimal unchanged bilateral apical\nthickening.  No evidence of suspicious lung nodules or masses. Several\nmillimetric subpleural micronodules, none of which is suspicious. No pleural\nthickening. No pleural effusion.  The airways are patent. No diffuse lung\ndisease.",
            "output": "No pleural effusions. No lung nodules or masses.  The airways are patent. No\nlymphadenopathy."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the hilar or mediastinal\nregion.  Mild hiatal hernia.  Contrast material in the left kidney no evidence\nof rib lesions.  No osteolytic lesions at the level of the vertebral bodies\nand the sternum.  Mild bilateral apical thickening.  Mild respiratory motion\nare defects.  Incomplete inspiration.  Unchanged visualization of a right\nlower lobe subpleural nodule with a diameter of 7-8 mm.  No newly 0 current\nnodules.  No pleural effusions.  No pleural thickening.",
            "output": "Unchanged 7-8 mm right lower lobe nodule of soft tissue density.  No\nassociated pleural effusions or lymphadenopathy ."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no axillary or\nsupraclavicular lymphadenopathy.  The visualized thyroid is homogeneous in\nattenuation.\n\nUPPER ABDOMEN: The liver is nodular in contour compatible with cirrhosis. \nCholelithiasis is noted.  The spleen is enlarged measuring 14.0 cm in the\nanterior-posterior dimension.  Partially imaged splenorenal shunts are noted\nin the left abdomen.\n\nMEDIASTINUM: There are no pathologically enlarged mediastinal lymph nodes. \nThere is a moderate size hiatal hernia.\n\nHILA: There are no pathologically enlarged hilar lymph nodes.\n\nHEART and PERICARDIUM: The heart is normal in size, and there is no\nsignificant pericardial effusion.  The thoracic aorta is normal in course and\ncaliber.  There is a mild amount of calcification along the aortic arch and\ndescending thoracic aorta.  There is a 7 mm right pericardial lymph node,\nwhich is decreased in size from prior exams (series 4:image 153).\n\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n-PARENCHYMA:  There is no focal consolidation to suggest infection.  There is\na stable 8 mm subpleural right lower lobe pulmonary nodule (series 4:image 62,\nseries 601b:image 60, series 602b:image 37).  This has internal fat density\ncontinued on soft tissue windows (series 602b:image 37).  This is stable\ndating back to ___.  No new or enlarging pulmonary nodules are noted. \nThere is mild bilateral apical pleural scarring.\n-AIRWAYS:  The airways are patent to the subsegmental level.\n-VESSELS:  The pulmonary artery is normal in caliber.\nCHEST CAGE: There is no suspicious focal osseous lesion to suggest malignancy.",
            "output": "Stable 8 mm right lower lobe subpleural nodule dating back to ___, which\nis fat density.  No new or enlarging pulmonary nodules."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions.  No\nsupraclavicular or axillary adenopathy.  No gross breast lesions.\n\nUPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic\norgans.  For a description of the abdominal findings please refer to MRI done\nduring the same day.  Suspected small hiatal hernia.\n\nMEDIASTINUM: No mediastinal adenopathy.\n\nHILA: No hilar adenopathy.\n\nHEART and PERICARDIUM: Normal cardiac configuration.  No pericardial effusion.\nNo aortic valve calcification.  Minimal aortic annular/proximal left main\ncoronary artery calcification.  No aneurysmal dilatation of the ascending\naorta.\nPLEURA: No pleural effusion\nLUNG:\n\n1. PARENCHYMA:  Mild biapical pleural-parenchymal scarring.  Mild\ncentrilobular emphysematous changes.  No suspicious pulmonary nodules or\nmasses.  Fatty subpulmonary nodule on the right (5, 197) Should be considered\nbenign.  Minor interstitial thickening in the posterior basal aspects of the\nlower lung zones, without associated bronchiolectasis most likely represents\npassive atelectasis.  Prone imaging may be performed during next imaging visit\nto exclude an interstitial lung disease.\n2. AIRWAYS:  The airways are patent to the subsegmental level.  No diffuse\nbronchiectasis.\n3. VESSELS:  The pulmonary arteries not enlarged.\nCHEST CAGE: Mild spondylotic changes of the thoracic spine.  No\nlytic/destructive bony lesions.",
            "output": "No suspicious pulmonary nodules or masses to suggest intrathoracic metastatic\ndisease.\n\nThe fatty subpulmonary nodule in the right lung base should be considered\nbenign.\n\nMinor interstitial thickening in the posterior basal aspects of the lower lung\nzones, without associated bronchiolectasis most likely represents passive\natelectasis.  The prone imaging may be performed during next imaging visit to\nexclude a interstitial lung disease."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal and there is no appreciable coronary calcification. \nAsymmetric subpleural right greater than left reticulation is a stable.  Micro\nnodules in the right middle lobe and left lower lobe are stable.  Subpleural\nopacity in the posterior right lower lobe is likely atelectasis (4:173).  9 mm\nnodule in the right lower lobe is stable (4:190), has internal fat, considered\nbenign.  There are no worrisome or enlarging lung nodules.\nThere is minimal centrilobular upper lobe predominant emphysema.  There is no\npleural or pericardial effusion.\nPlease refer to the concurrent abdomen MR for complete description of the\nintra-abdominal findings.  There is a moderate hiatal hernia.  Focal liver\nlesions are difficult to evaluate, s/p RFA and TACE.  Splenomegaly.\nThere are no bone findings of malignancy",
            "output": "No evidence of active intrathoracic infection or malignancy.\nHiatal hernia\nMinimal emphysema\nStable interstitial subpleural abnormality in the right lower lobe."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No incidental findings in the\nthyroid radiologic there is no supraclavicular or axillary lymphadenopathy.\nNo gross findings in the included chest wall.\n\nUPPER ABDOMEN: Moderate sliding hiatal hernia.\nThe remaining upper abdomen will be reported separately in the concurrent MRI,\naccession number ___.\n\nMEDIASTINUM: There is no lymphadenopathy in the mediastinum.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nSpeck of calcification in the aortic valve.\nMajor vessels are normal size.\n\nLUNG: Airways are patent to the subsegmental level bilaterally.\n\nNodule in the base of the right lower lobe abutting the diaphragm measuring 8\nmm is new (5:211)\n\nRight lower lobe subpleural nodule measuring 9 mm is unchanged in size\ncompared to the prior exam, however does appear to demonstrate an interval\nincrease in soft tissue density.\n\nAnother nodule in the right lower lobe, posterior and subpleural is unchanged\nsince ___ but new in comparison to ___ also suspected to be\ninvolved by a neoplastic process.\nFew micronodules are unchanged in comparisons to ___ for example in the\nright upper lobe adjacent to the major fissure (5:94).\n\nMinimal centrilobular emphysema in both upper lobes.\nSubpleural lower lobes posterior reticular interstitial thickening is\nunchanged.\nThe medial right lower lobe interstitial thickening could represent infectious\nor inflammatory process is more prominent.\nThere is no pleural effusion.\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "New nodule in the base of the right lower lobe abutting the diaphragm (5;211).\n\nA second 9-mm subpleural nodule abutting the diaphragm is unchanged in size\nhowever demonstrates a slight interval increase in the soft tissue component.\n\nThird subpleural right lower lobe lung nodule unchanged since ___ but new\nin comparison to ___.\n\nUnderlying neoplasia cannot be excluded."
        },
        {
            "input": "Aorta and pulmonary arteries are overall unremarkable.  Hiatal hernia is\nmoderate, unchanged.  Adjacent to the distal esophagus the hernia appears to\nbe as sliding, series 3, image 40.  Heart size is normal.  There is no\npericardial or pleural effusion.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nMRI of the liver.\n\nAs compared to previous examination there is extensive new involvement of the\nright basal pleura, series 3, image 38 with soft tissue masses, approaching 3\ncm, series 3, image 35, 3.2 cm, series 3, image 38 and more nodular\ninvolvement of diaphragmatic pleura, series 3, image 38, 12 mm, series 3,\nimage 42, 14 mm, series 3, image 43, 13 mm.  Craniocaudal extension of the\npleural lesions is up to 3.5 cm, series 7, image 87.\n\nAirways are patent to the subsegmental level bilaterally.  No new pulmonary\nnodules masses or consolidations.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Extensive progression of pleural involvement most likely by metastatic disease\nas described\n\nPlease review MRI of the liver that will be reported separately for assessment\nof the upper abdomen."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings warrant any further imaging. \nSupraclavicular and right axillary lymph nodes are neither enlarged nor\ngrowing.  11 mm left axillary node, 05:54, was 8 mm in ___ and ___.  Breast evaluation is reserved exclusively for mammography.  There are\nno soft tissue abnormalities elsewhere in the incompletely imaged chest wall. \nThis study is not designed for subdiaphragmatic evaluation, but shows normal\nadrenal glands.\n\nCARDIO-MEDIASTINUM:Hiatus hernia is small.  Above that level esophagus is\nunremarkable.  Atherosclerotic calcification is not apparent in head and neck\nvessels or in the coronary arteries.  Aorta and pulmonary arteries and cardiac\nchambers are normal size and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Previous right lung pneumonia has resolved.  2 mm\nnodule in the left upper lobe apicoposterior segment, 5:101 is the same size,\nbut more radiodense than it was in ___.  I do not think the nodule is\npresent on the chest CT in ___.  Lungs otherwise clear. \nTracheobronchial tree is normal to subsegmental levels and there is no pleural\nabnormality.\n\nCHEST CAGE: Unremarkable.",
            "output": "Previous right pneumonia has cleared.\n\nIncidental discovery of a 2 mm left upper lobe nodule, stable in size but more\nradiodense today than in ___.  To be prudent I would repeat a chest CT in 6\nmonths to one year in order to document anticipated stability or developing\ncalcification, either of which would diagnosis a benign lesion."
        },
        {
            "input": "Aorta and pulmonary arteries are unremarkable.  No pathologically enlarged\nmediastinal, hilar or axillary lymph nodes demonstrated.  Heart size is\nnormal.  There is no pericardial or pleural effusion.  Minimal hiatal hernia\nis unchanged\n\nImage portion of the upper abdomen reveals no appreciable abnormality within\nthe limitations of the study technique that was not designed for assessment of\nintra-abdominal pathology\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe 2\nmm nodule is stable, series 5, image 128.  No new nodules masses or\nconsolidations demonstrated.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "Stable appearance of the chest including left upper lobe nodule.  No new\npulmonary nodules.\n\nNo further diagnostic imaging followup indicated"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears\nunremarkable.  There is no supraclavicular lymphadenopathy.  There is no\naxillary lymphadenopathy.\n\nUPPER ABDOMEN: Please see separate report for CT abdomen and pelvis performed\non same day for description of subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There's no pericardial\neffusion.  No significant coronary artery calcification is seen.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Stable 3 mm pulmonary nodules noted in the left upper lobe (6;\n15).\n2. AIRWAYS:  There is mild bilateral bronchial wall thickening suggestive of\ninflammation.\n3. VESSELS:  The aorta and pulmonary arteries are normal in caliber.  There is\nno central pulmonary embolism.  No significant atherosclerotic calcification\nis identified.\n\nCHEST CAGE: No suspicious osseous lesion is identified.  No acute fractures\nidentified.",
            "output": "Stable 3 mm left upper lobe pulmonary nodule.  No new or growing pulmonary\nnodules."
        },
        {
            "input": "Multiple lymph nodes are noted in the left anterior chest wall, including\nsubpectoral S area, left axilla and supraclavicular area. Within the\nlimitation of the comparison with the previous examination, the impression is\nthat the vast majority of the lymph nodes are slightly bigger, for example the\nlargest subpectoral is note is currently 22.5 mm as compared to 19.5 mm on the\nprior examination.  There is anterior mediastinal soft tissue mass, in casing\naorta, pulmonary artery anteriorly and superior vena cava which is stented.\nOverall the size of the mass is similar to previous examination within the\nlimitations of the comparison of the non contrast-enhanced to a contrast\nenhanced study\n\nStent is present within the superior vena cava, patent with 1 focal area,\nseries 5, image 25 of internal thrombosis.  No pericardial effusion is seen.\nThere is a right pleural effusion noted, moderate, decreased in size as\ncompared to previous examination.\n\nThe involvement of the anterior chest wall by the anterior mediastinal mass is\nsimilar to previous examination including sternal an anterior left rib\ndestruction.\n\nAorta and pulmonary arteries are well opacified and normal in diameter.\n\nThe image portion of the upper abdomen will be reviewed separately in\ncorresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.  Bronchial wall\nthickening in the right upper lobe is present as well as in low right lower\nlobe to a lesser extent. Septal thickening is mild, anterior and might\nrepresent postradiation changes. Lymphangitic spread of the tumor is\nsubstantially less likely although cannot be excluded. Right lower lobe\natelectasis is unchanged. No new nodules, masses or consolidations\ndemonstrated\n\nThe side the above described anterior chest wall involvement of the skeleton\nno other lytic or sclerotic lesions worrisome for neoplasm or infection\ndemonstrated",
            "output": "Overall unchanged appearance of the anterior mediastinal mass with anterior\nextrathoracic extension\n\nMinimal interval increase in the subpectoral is in the left axillary\nlymphadenopathy\n\nInterval decrease in still moderate right pleural effusion.\n\nAnd stent thrombosis of SVC, minimal was no substantial narrowing of the lumen"
        },
        {
            "input": "The imaged portions of the thyroid gland are normal. There are new are\nnumerous enlarged left axillary lymph nodes, measuring up to 20 mm (2, 15).\nThese are similar to the prior exam.  The left chest wall appear is mildly\nenlarging compared to the right with stranding in the subcutaneous fat. An\nenlarged 11 mm left supraclavicular lymph node is unchanged (2, 6).\n\nThe ill-defined anterior mediastinal soft tissue mass is grossly unchanged in\ncomparison to the prior exam.  It encases the aorta, superior aspects of the\npulmonary arteries, and inferior vena cava. A stent in the inferior vena cava\nis noted. A small focus of internal thrombus along the anterior aspect of the\nstent (2, 25) is unchanged. The stent is otherwise patent. There is no hilar\nlymphadenopathy.\n\nThe heart is normal in size. There is no pericardial effusion. The patient is\nstatus post a CABG. The sternal wires are intact. There is no evidence of\ndehiscence. Severe calcifications are noted in the coronary arteries. Mild\ncalcifications are noted along the aortic valve. The thoracic aorta is normal\nin caliber with mild atherosclerotic calcifications.\n\nThe main pulmonary artery trunks are normal in diameter. This exam is not\ntailored to evaluate for pulmonary embolism, though no filling defect is\nidentified.\n\nThe airways are patent to the subsegmental levels. Since the prior exam, there\nare several small peripheral nodular opacities which are new from the prior\nexam. The most prominent are in the anterior right upper lobe (4, 122, 124,\nand 139). Additionally, in the anterior right upper lobe, there is a new 4 mm\nnew parenchymal nodule (4, 150), as well as two new nodules along the minor\nfissure (4, 148) which measure 5 and 4 mm, respectively. A new nodular opacity\nin the left upper lobe along the pleural surface measures 7 mm (4, 99).\nFinally, along the posterior left lower lobe, there is increased pleural\nthickening and slightly irregular nodular opacities (4, 131). Lastly, in the\nleft middle lobe, there is a 7 mm nodule (4, 177), which previously measured 3\nmm. Overall, these findings are concerning for worsening disease.\n\nIn the central left upper lobe, there is a new ground-glass and\nperibronchiolar nodule opacity (4, 96) which has the appearance of infection\nor inflammation. There is no pulmonary edema.\n\nSince the prior exam, the nonhemorrhagic right pleural effusion has slightly\ndecreased in size. There is persistent associated right basilar atelectasis.\nThere is no left pleural effusion. There is no pneumothorax.\n\nThere are no concerning lytic or sclerotic osseous lesions. No fracture is\nidentified. Moderate degenerative changes are noted in the thoracic spine.\n\nPlease see the abdominal CT report for subdiaphragmatic findings.",
            "output": "1. New left pleural thickening, new bilateral subpleural nodular opacities,\nnew discrete nodules, and an increase in size of a right middle lobe nodule is\nconcerning for mild interval progression of disease.\n2. No significant changed in the left axillary and supraclavicular\nlymphadenopathy. No change in the ill-defined anterior mediastinal mass.\n3. Unchanged patent SVC stent with a tiny focus of nonocclusive thrombosis.\n4. Slight decrease in size of the moderate right pleural effusion.\n5. New opacity in the left upper lobe which is likely infectious or\ninflammatory."
        },
        {
            "input": "Left axillary lymphadenopathy has slightly improved since ___. A\nrepresentative lymph node posterior to the left pectoralis minor measures 13\nmm in short axis, previously 18 mm (2, 19). A second more laterally located\nnode measures 13 mm in short axis, previously 10 mm (2, 21). There are no new\nareas of pathologic lymph node enlargement in the thorax. The thyroid gland is\nunremarkable.\n\nAn ill-defined anterior mediastinal soft tissue mass is not appreciably\nchanged when measured at comparable levels as compared to ___ (2,\n26). Ill-defined anterior mediastinal soft tissue surrounding the ascending\naorta and anterior aspect of the pulmonary outflow tract is also not\nappreciably changed. There is stable narrowing of the SVC with a patent stent\nin place containing stable small eccentric mural thrombus (2, 29).\n\nMild cardiomegaly with multichamber enlargement is unchanged. Extensive\ncoronary artery and mild aortic valvular calcifications are also unchanged.\nThe patient has had previous median sternotomy with CABG. No incidental\ncentral pulmonary embolus is identified. There is no pericardial effusion.\n\nIncreased band-like paramediastinal consolidations associated with new volume\nloss and traction bronchiectasis is most likely due to evolving radiation\nfibrosis (4, 96). Increased and new peripheral and paramediastinal\nground-glass opacities and consolidations are most likely due to radiation\npneumonitis (04: 54, 59, 126, 143). A right lower lobe intrafissural nodule\nhas grown measuring 6 x 8 mm, previously 4 x 6 mm (4, 182). While this may be\na reactive lymph node, attention at followup is advised. A chronic small\nnonhemorrhagic right pleural effusion with associated smooth parietal pleural\nthickening is unchanged. A stable consolidation at the periphery of the right\nlower lobe associated with swirling of the bronchovascular structures is most\nlikely rounded atelectasis (___, image 23).\n\nDespite underdistention, there is stable mild smooth circumferential\nesophageal wall thickening. Small paraesophageal lymph nodes measuring up to 6\nmm in short axis are unchanged (2, 44, 53). A 6 x 13 mm right para-aortic\nlymph node is stable (5, 51).\n\nBilateral symmetric gynecomastia is unchanged. Small collateral vessels in the\nleft anterior chest wall are slightly larger, and are indicative of a\nhemodynamically significant vascular stenosis or occlusion at the level of the\nleft brachiocephalic/jugular/subclavian veins which is not clearly identified\non this exam. Mild left anterior chest wall anasarca and soft tissue\nthickening has slightly improved.\n\nThe mottled appearance of the manubrium is stable and indicative of tumor\ninvolvement. A pathologic fracture of the anterior second left rib is\nunchanged (4, 97). No additional foci of bone metastasis are identified in the\nthorax.\n\nFor a detailed discussion of the upper abdomen, please refer to the separate\nreport from the CT abdomen/pelvis performed concurrently.",
            "output": "Worsening radiation pneumonitis with interval development of paramediastinal\nradiation fibrosis as compared to ___.  Concurrent infection is\nbetter excluded on clinical grounds.\n\nNo appreciable change in the ill-defined infiltrative anterior mediastinal\nmass. Stable chest wall invasion including upper sternal metastasis and\npathologic fracture of the left anterior second rib.\n\nSlightly improved left axillary lymphadenopathy.\n\nStable chronic small right nonhemorrhagic pleural effusion with associated\nvisceral pleural thickening.\n\nStable right lower lobe rounded atelectasis.\n\nStable mild smooth circumferential esophageal wall thickening is most likely\ndue to radiation esophagitis.\n\nPatent SVC stent containing small amount of eccentric mural thrombus.\n\nIncreased left anterior chest wall collateral vessels are indicative of a\ncompensated  venous obstruction  at the level of the left\nbrachiocephalic/jugular/subclavian veins. Targeted ultrasound or MRV may be\nperformed for further evaluation if clinically warranted."
        },
        {
            "input": "The thyroid is normal. Three vessel coronary artery calcifications are noted,\nas well as mild calcification of the aortic valve.  Minimal calcification of\nbilateral subclavian arteries is noted.  A widely patent SVC stent has a\nstable, small mural thrombus (series 5, image 24).  The heart is mildly\nenlarged in size.  There is no pericardial effusion.\n\nLeft axillary lymphadenopathy is slightly improved compared to the prior exam,\nwith an index lymph node conglomerate posterior to the pectoralis major\nmeasuring 9 mm in short axis, compared 11 mm on the prior exam (series 5,\nimage 15).  Right lower periaortic lymph node enlargement is stable compared\nto the prior exam, with maximum short axis measurement of 8 mm (series 5,\nimage 52, image 47).  There is no additional lymphadenopathy in the chest.\n\nAn large, infiltrative anterior mediastinal mass with soft tissue thickening\nabout the ascending aorta and main pulmonary artery is unchanged.  Moderately\nextensive, paramediastinal radiation fibrosis in both lungs is mildly worse\n\nA right upper lobe nodule is increased in size, now measuring 4 mm (series 6,\nimage 62).  Another enlarging nodule is noted in the left upper lobe with\nspiculated margins, now measuring 7 x 12 mm, previously measuring 5 x 4 mm\n(series 6, image 35).  It is difficult to know whether these enlarging nodules\nare due to radiation or metastasis. A 6mm right fissural nodule is unchanged\nsince the most recent prior exam (series 6, image 195), previously larger.  A\nlarge region of rounded atelectasis in the right lower lobe is stable but the \nadjacent right small right pleural effusion is smaller.\n\nPlease refer to separate report of the concurrent CT abdomen for discussion of\nsubdiaphragmatic findings.  Circumferential wall thickening throughout the\nesophagus is noted.  The patient is status post CABG with median sternotomy\nwires.  The longstanding, mottled osteolysis of the manubrium of the sternum\nis more likely due to tumor invasion than radiation osteonecrosis.  There is\nbeen interval healing of the left anterior second rib fracture.  No other\nosseous lesion suspicious for malignant involvement or infection is seen. \nBilateral gynecomastia is stable.",
            "output": "1.  Stable, extensive, treated, infiltrative mediastinal tumor.\n2.  Mild increase in paramediastinal radiation fibrosis.\n3.  Adenopathy decreased in left axilla, stable in the lower periaortic\nposterior mediastinum.\n4.  Patent SVC stent with stable small, mural thrombus.\n5.  Two enlarging nodules in right and left upper lobes, of unclear etiology. \nAttention on follow up is recommended.\n6.  Stable right basal, roundedatelectasis.\n7.  Decreasing small, right pleural effusion."
        },
        {
            "input": "13 x 18 mm left supraclavicular lymph node, 5:8, was 10 x 11 mm in ___. \nThe bulk of infiltrating the mediastinal tumor, the greatest bulk of which is\nin the prevascular station has increased slightly since ___.  For example\nlateral to the anterior aspect of the aortic arch, maximum tumor thickness is\n32 mm today, previously 25 mm in ___.  There is greater local invasion of\nthe anterior chest wall including medial aspects of the left first and second\nribs and manubrium and upper body of the sternum.  Left brachiocephalic vein\nis entirely occluded, as before, explaining venous collateral flow in the\nanterior chest wall and mediastinum.  .  Tumor encases the ascending aorta,\nmain pulmonary artery and superior vena cava, but narrows only the cava, which\nis stented, and its minimum diameter, 9 mm, 05:23, is preserved.\n\nAdenopathy in the hila is stable on the left, increased on the right, but\nbronchi and pulmonary arteries are undisturbed. Subcarinal and paraesophageal\nmediastinal adenopathy is stable.  Small layering left pleural effusion is\nlarger.  Left pleural surfaces are not thickened.  Small, loculated right\nbasal pleural effusion is slightly larger.  Posterior and lateral costal\npleura on the right is smoothly thickened, but unchanged.\n\nParamediastinal radiation pneumonia and fibrosis have increased substantially.\nWorsening multifocal pneumonia a seemingly outside the radiation portal,\nparticularly in the dependent right lower lobe could also be due to\naspiration.  Clinical correlation advised.\n\nThyroid is large but homogeneous.  Atherosclerotic coronary calcification is\nheavy.  Aortic valvular calcification is mild to moderate.  Moderate\ncardiomegaly is grossly unchanged.\n\nThoracic spine is intact.",
            "output": "Continued growth infiltrating mediastinal tumor, invading the anterior chest\nwall, left first and second ribs, manubrium and upper sternal body.  Major\nvascular occlusion, left brachiocephalic vein, has not improved.  Stented\nsuperior vena cava intact.\n\nIncreasing paramediastinal radiation pneumonia and fibrosis.  Increasing\nmultifocal pneumonia could be due to infection or aspiration.\n\nIncreased small left pleural effusion.  Stable loculated small right pleural\neffusion.\n\nSevere coronary atherosclerosis.  Mild to moderate aortic valvular\ncalcification, hemodynamic significance indeterminate."
        },
        {
            "input": "The extremely large infiltrating mediastinal tumor, primarily prevascular and\nperitracheal extending from the thoracic inlet to below the carina is little\nchanged.  Invasion  into the anterior chest wall includes destruction of the\nupper sternum and left upper ribs anteriorly.  The 3.1 cm intramuscular soft\ntissue mass extending from midline to the left pectoralis muscle is unchanged\nin size (2, 20).  The left paratracheal component is minimally smaller (2,\n22). Bilateral axillary adenopathy is slightly larger on the right, subcarinal\nadenopathy minimally smaller.\nThe left brachiocephalic vein is obliterated by tumor, as before. The SVC\nstent is intact. Below the stent moderate narrowing of the SVC is unchanged,\nand where  it enters the right atrium is a persisten filling defect, either \nthrombus or tumor (2, 35).  The aorta and pulmonary arteries are normal in\nsize. The pulmonary arteries are well opacified without evidence of large\nfilling defects.  Heart size is normal. Patient is post CABG with median\nsternotomy wires intact.  There is extensive coronary artery calcification. A \nsmall pericardial effusion (2, 43) is new without evidence of tamponade.\n Bilateral paramediastinal radiation fibrosis is unchanged. M  ulti focal\nperibronchial infiltration in the right lung has progressed, either  radiation\neffect or tumor.   An increase in large areas of ground glass opacification is\nprobably due to lymphovenous obstruction at the hilus and mediastinum . The\nmoderate nonhemorrhagic left pleural effusion layering posteriorly is larger. \nThe small right pleural effusion with atelectasis is unchanged.  Extensive r \night parietal and visceral pleura are chronic. A  2.5 x 1.4 cm right pleural\nmass has increased in size.\nThere is no evidence of metastatic disease in the thoracic spine.",
            "output": "1.  Large, i nfiltrating upper mediastinal tumor invading the anterior chest\nwall, upper sternum, and ribs and right hilar adenopathy , generally  stable.\nAxillary adenopathy progressed, subcarinal nodes slightly smaller.\n2.  SVC stent is intact.  Stable intracardiac tumor or thrombus at the\nsuperior cavoatrial junction.\n3.  The left brachiocephalic vein is not reconstituted.\n4.  Stable bilateral paramediastinal radiation fibrosis.  Multifocal\nperibronchial infiltration with ground-glass opacities in the right lung may\nbe secondary to tumor versus radiation defect.\n5.  Left pleural effusion has increased. Stable right pleural effusion and\npleural thickening although right pleural mass has increased in size.\n6.  New pericardial effusion without evidence of tamponade.\n7.  No evidence of metastatic disease in the thoracic spine."
        },
        {
            "input": "CHEST:\n\nNECK: Thyroid gland is unremarkable.  There are no supraclavicular adenopathy.\n\nAIRWAYS: Major airways are clear with no endotracheal or endobronchial\nlesions.\n\nMEDIASTINUM: Multiple coronary arterial stents identified in the LAD and the\nright coronary artery.  There is no cardiomegaly or pericardial effusion. \nThere is no mediastinal adenopathy.\n\nLUNGS: Lungs are clear.  There is no evidence of consolidation.  There is mild\ncentrilobular emphysema.  There is minimal atelectasis and biapical scarring. \nThere are few pulmonary nodules measuring less than 4 mm.\n\nPLEURA: No pleural effusion or pneumothorax.\n\n\nABDOMEN:\n\n\nHEPATOBILIARY: The unenhanced liver appears unremarkable.  There is a linear\nhigh density along the inferior right hepatic ___ represent previous\nsurgical suture line.  Gallbladder appears unremarkable.  There is no biliary\nductal dilatation.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious masses.\n\nSPLEEN: No splenomegaly.\n\nADRENALS:   Bilateral adrenal glands are enlarged and low in density, likely\nrepresenting adenomas measuring 3 x 1.7 on the right and 3.4 x 1.7 on the\nleft.\n\nURINARY:There is no hydronephrosis.  Contrast excretion is noted through both\nureters and into the urinary bladder.\n\nGASTROINTESTINAL: There is a moderate size hiatal hernia.  There is no small\nbowel obstruction.  Appendix is unremarkable.  There is moderate amount of\nstool throughout the colon.\n\nPERITONEUM: There is no free air or free fluid.  There is no peritoneal\nstranding.  There is no retroperitoneal hemorrhage.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Infrarenal abdominal aorta is mildly ectatic measuring 2.8 cm. \nThere is moderate atherosclerotic calcifications.  There is mild fat stranding\naround the right external iliac artery with extensive soft tissue stranding\naround the right common femoral artery and superficial femoral artery.  This\nis consistent with hemorrhage in the right groin region secondary to the\nrecent catheterization.  There is no extension of hemorrhage into the\nretroperitoneal region.\n\nPELVIS: Bladder is markedly distended with large amount of contrast.  Prostate\nis enlarged.  It measures 5.4 cm.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions. \nThere are degenerative changes.\n\nSOFT TISSUES: There is extensive soft tissue stranding in the right groin\nregion secondary to the recent catheterization of the common femoral artery. \nThis is consistent with hemorrhage into the right thigh region.  Minimal\namount of stranding is identified around the right external iliac artery. \nThere is no retroperitoneal hemorrhage.",
            "output": "1. Extensive soft tissue stranding along the anterior right thigh compartment\naround the right femoral arteries consistent with hemorrhage related to the\nrecent catheterization.\n2. No retroperitoneal hemorrhage.\n3. Mildly ectatic infrarenal abdominal aorta.\n4. Moderate size hiatal hernia.\n5. No acute intrathoracic abnormality.\n6. Sub 5-mm pulmonary nodules.\n\nRECOMMENDATION(S):  For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Mild interlobular septal thickening likely reflects mild\ninterstitial edema.  Few subtle scattered ground-glass opacities at the lung\nbases likely reflect edema, however infectious etiology cannot be excluded. \nMosaic attenuation pattern noted at the bilateral lung bases, likely\nconsistent with small airways disease.  Mild bibasilar atelectasis.  The\nairways are patent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Calcified nodule within the left thyroid lobe measures up to 1.8\ncm (02:14, 601:26).\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nModerate degenerative change of the thoracic spine, including anterior\nosteophytosis and disc space narrowing.",
            "output": "1. No pulmonary embolus or acute aortic abnormality.\n2. Mild interlobular septal thickening with few subtle scattered areas of\nground-glass opacity at the lung bases, likely reflecting mild interstitial\nedema.  Infection is less likely.\n3. Mosaic attenuation pattern at the bilateral lung bases, likely consistent\nwith small airways disease.\n4. 1.8 cm calcified left thyroid nodule.  Further evaluation with dedicated\nthyroid ultrasound is recommended on a nonemergent basis as an outpatient."
        },
        {
            "input": "THYROID,  LYMPH NODES & MEDIASTINUM: A 5 mm hypodensity in the left lobe of\nthe thyroid is noted.  The remainder of the thyroid is within normal limits. \nThere is no axillary or supraclavicular lymphadenopathy.  There is no\nmediastinal or hilar lymphadenopathy.  Of note, few, small calcified right\nperitracheal lymph nodes and right hilar lymph nodes are noted.\n\nHEART & VESSELS: The heart is normal in size. The great vessels are normal in\ncaliber.  There are mild coronary artery calcifications.\n\nLUNGS & AIRWAYS: The airways are patent to the subsegmental level.  There is\nmild bronchial wall thickening.  The lungs are clear without focal\nconsolidation or pleural effusion.  A 4 mm calcified granuloma in the right\nupper lobe is noted.\n\n\nUPPER ABDOMEN:  Subdiaphragmatic structures will be detailed on the concurrent\nCT abdomen and pelvis.\n\nOSSEOUS STRUCTURES & SOFT TISSUES: No suspicious osseous lesions.",
            "output": "Mild bronchial wall thickening likely reflects mild chronic airways\ninflammation.  No evidence of intrathoracic metastatic disease."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: The imaged thyroid is unremarkable.\nSupraclavicular and axillary lymph nodes are not enlarged by CT size criteria.\n\nMEDIASTINUM: An enlarged posterior right mediastinal node is stable since ___ (2:47).\n\nHILA: Hilar lymph nodes are not pathologically enlarged.\n\nHEART and PERICARDIUM: The aorta and main pulmonary artery are normal in size.\nHeart size is normal.  Patient is post CABG and aortic valve replacement with\nseverely calcified native coronary arteries.  Aortic annular calcifications\nare severe.  Mitral annular calcifications are mild-to-moderate.  There is no\npericardial effusion.  Relative low attenuation of the blood pool suggests\nanemia.\n\nThe left-sided pacemaker device is in place with leads projecting to the right\natrium and right ventricle.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  The airways are patent to the subsegmental level.  There are\nno areas of patchy ground-glass opacity or fibrotic changes that would be\nexpected with amiodarone toxicity.  Small mucous secretions identified in the\nupper trachea (4:34).  Bibasilar atelectasis is mild and in the left hemi\nthorax, related to the elevation of the left hemidiaphragm.  There is no focal\nconsolidation.\n\nIn retrospect, two 3 mm nodules in the right upper lobe are stable since ___ (4:93, 101).  Another 2 mm nodule in the right lower lobe is also\nstable since ___ (4:171), as is a 1 mm nodule in the right upper lobe\n(4:41).  Multiple scattered calcified granulomas the bilateral lungs are\nunchanged (4:57, 86, 87, 140, 161).  No new nodule detected.\n\nUPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic\nstructures. Allowing for this, a moderate-sized hiatal hernia is unchanged\nsince ___.  The bilateral adrenal glands are normal.  Increased\nattenuation of the liver parenchyma is likely due to amiodarone treatment. \nExtensive atherosclerotic calcifications of the abdominal aorta and its\nbranches are present.\n\nCHEST CAGE:  No focal lytic or sclerotic lesion concerning for malignancy.\nMild multilevel degenerative changes of the thoracic spine are unchanged. \nDegenerative changes of the left shoulder are also present.  Median sternotomy\nwires are intact.  A small bone island in the left posterior eighth rib is\nunchanged since the prior CT.",
            "output": "1.  No pulmonary parenchymal changes suggestive of amiodarone toxicity. \nBibasilar atelectasis is mild, and in the left hemi thorax, related to\nelevation of the left hemidiaphragm.\n\n2.  Multiple sub 4 mm bilateral pulmonary nodules are stable since ___.\n\n3.  Moderate-sized hiatal hernia."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There are a couple of calcified granulomas in the right upper\nlobe.  A 2 mm pulmonary nodule is seen in the left upper lobe (03:17). \nOtherwise, lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: There is a minimally displaced xiphoid process fracture is noted\n(602:95).",
            "output": "1. Minimally displaced fracture of xiphoid process.\n2. 2 mm left upper lobe pulmonary nodule.\n For incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta is normal size.  Main pulmonary artery is\nminimally enlarged measures 3.1 cm.  There is mild cardiomegaly.  There are\nmoderate calcifications in all coronary arteries.  Dense calcification in the\naortic valve is of unknown hemodynamic significance..  There is no pleural or\npericardial effusion.\nBiapical nodular scarring is stable.\nNew diffuse heterogeneous ground-glass opacity has mosaic pattern. \nRespiratory motion limits the evaluation the lungs.\n2 mm nodules in the left upper lobe (04:46), in the right upper lobe (04:52)\nand in the right lower lobe (4:122) are stable.  3 mm nodule right lower lobe\nand 6 mm nodule right lower lobe (4:122, 114) are stable\nThis examination is not tailored for subdiaphragmatic evaluation there is a\nsmall hiatal hernia.  The esophageal wall is thickening throughout its length.\nThere is excreted contrast in the kidneys\nThere are no bone findings of malignancy\nThere is a breast implant",
            "output": "Limited evaluation of the lungs due to respiratory motion artifact.  New\ndiffuse ground-glass opacities have a broad differential could represent\nalveolitis, drug reaction, less likely infection.\nStable lung nodules\nCardiomegaly\nCalcification of the aortic valve is of unknown hemodynamic significance\nCoronary calcifications\nDiffuse thickening of the esophageal wall should be correlated with endoscopy"
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged. Aorta and pulmonary arteries are normal size\nmild-to-moderate cardiomegaly.  Mild calcifications in all coronary arteries,\nenlargement of the main pulmonary artery measuring 3.1 cm and coarse\ncalcification at the base of the aortic valve are stable.  The esophageal wall\nis thickened throughout its length, similar to prior.\nLung nodules are as follows:\nIn the right lower lobe measuring less than 4 mm (5: 173, 170, 102, 101, 183)\nstable\n6 mm right lower lobe (5:164) stable\nSubpleural irregular posterior opacities in the right lower lobe have\nminimally increased (5:137)\n2 mm right middle lobe (5:158) stable\nMultiple micro nodules in the left upper lobe and few in the left lower lobe\n(5: 54, 56, 75, 221) stable\nThere is no pleural or pericardial effusion.\nPlease refer to the concurrent abdomen CT for complete description of the\nintra-abdominal findings.\nThere are no bone findings of malignancy.\nThere is a left breast implant",
            "output": "Multiple lung nodules stable from prior study.  No new or enlarging solid lung\nnodules.\nResolved previously seen ground-glass opacities throughout the lungs.\nPersistent diffuse thickening of the esophageal wall.\nMild increase in subpleural opacity in the right lower lobe, attention in\nfollowup studies is recommended."
        },
        {
            "input": "Several stable small thyroid nodules (3, 6).  Stable circumferential\nthickening of the esophageal wall (3, 13) at the level of the upper\nmediastinum.  No supraclavicular, infraclavicular or axillary lymphadenopathy.\nStable left breast implant.  Severe coronary calcifications, severe aortic\nvalve calcifications.  No pericardial effusion.  The posterior mediastinum is\nunremarkable.  No enlarged lymph nodes in the mediastinum or at the level of\nthe hilar structures.  Small hiatal hernia (3, 45).  Partially imaged small\nleft kidney with several punctate parenchymal calcifications.  Moderate\ndegenerative vertebral disease.  No vertebral compression fractures.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable mild bilateral apical scarring with nodular components.  These\nnodular components (5, 39) appear unchanged as compared to the previous\nexamination.  Several subpleural micronodules, for example in the left upper\nlobe (5, 59) were not visualized on the previous examination, given the use of\nthick sections.  Stable likely post infectious granulomas in the right lower\nlobe apex (5, 97).  Thickening and mild irregularities of the airway walls. \nNo pleural thickening or pleural effusions.  Non characteristic scars of\nstable overall mild severity at the lingular basis (5, 219).",
            "output": "Stable examination of the thorax.  Circumferential thickening of the\nesophageal wall.  Small hiatal hernia.  No new or growing pulmonary nodules. \nNo suspicious pulmonary nodules.  No adenopathy, no pleural abnormalities."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is heterogeneous with an 8 mm hypodense nodule is seen in the left\nthyroid lobe, unchanged since prior studies.  No enlarged lymph nodes are seen\nin both axilla or in the thoracic inlet.  A left breast prosthesis is\nunchanged in position, showing mild calcifications the outer wall.  Coarse\ncalcifications are seen in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal in size.  No pericardial effusion.  The entire aorta is of\nnormal caliber, with coarse calcifications seen throughout.  Moderate\ncalcifications are also seen in the coronary arteries.  Coarse calcifications\nare seen in the topography of in the interventricular septum, related to the\npatient's prior heart surgery.  The pulmonary arteries are top normal in size,\nunchanged.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia. Diffuse circumferential thickening of the entire\nesophagus.  No enlarged mediastinal or hilar lymph nodes.\n\nPLEURA:\nNo pleural effusions.  Stable moderate bilateral apical scarring with nodular\ncomponents.\n\nLUNGS:\nMild diffuse bronchial wall thickening.  Unchanged nodules in the right lower\nlobe measuring up to 6 mm (5: 114, 176, and 180).  No consolidations or\natelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Likely\nhemangioma in T5 vertebral body, stable.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show hyperdense renal pelvis and\nsmall nonobstructive stones in the left kidney.",
            "output": "Compared to prior study of ___, no new or growing pulmonary nodules are\nidentified.  No new mediastinal or hilar lymphadenopathy.  No suspicious\nosseous lesions.\n\nDiffuse circumferential thickening of the esophagus could be seen in the\nsetting of esophagitis, however an endoscopy is recommended for better\nassessment and exclude an underlying neoplastic process.\n\nFurther increased density in both kidney pelvis which could be due to\nformation of an early staghorn or medullary nephrocalcinosis.  Renal\nultrasound for better evaluation is recommended.\n\nRECOMMENDATION(S):  Endoscopy is recommended for better assessment of the\nthickened esophagus.\n\nRenal ultrasound would be recommended for assessment of the increased\ndensities within the kidneys.\n\nNOTIFICATION:  Pertinent critical findings were posted by Dr. ___\non ___ at 11:37 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No enlarged lymph nodes in the mediastinum or at\nthe level of the hilar structures.  Left breast implant.  Stable aortic wall\ncalcifications, stable aortic valve calcifications and moderate coronary\ncalcifications.  Stable pericardial calcifications.  The posterior mediastinum\ncontinues to show circumferential thickening of the esophageal wall.  No other\nabnormalities are noted.  No osteolytic lesions at the level of the ribs, the\nsternum, or the vertebral bodies.  Stable mild degenerative vertebral disease.\nNo vertebral compression fractures.  Stable mild bilateral apical thickening\nwith nodular components (4, 22).  Several pre-existing pulmonary nodules are\nstable, for example in the left lower lobe (4, 100 and 4, 97).  Also stable is\nthe conglomerate of micro nodules in the lateral aspect of the right lower\nlobe apex (4, 76).  The largest pulmonary nodule continues to be located in\nthe right lower lobe (4, 132).  The other right lower lobe nodules (4, 134)\nare stable.  No evidence of new or growing nodules.  No pleural effusions.  No\ndiffuse lung disease.  The airways are patent.",
            "output": "Multiple stable pulmonary nodules, none of which has grown.  No new pulmonary\nnodules.  No pleural abnormalities.  No adenopathy.  Stable circumferential\nthickening of the esophageal wall."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMain pulmonary artery is mildly enlarged measuring 3.2 cm.  The thoracic aorta\nis normal in caliber without evidence of dissection or intramural hematoma. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.  Posterior pericardial calcifications unchanged.\nA central venous line terminates in the right atrium.\n\nAXILLA, HILA, AND MEDIASTINUM: Small subcarinal lymph nodes are demonstrated. \nNo axillary, mediastinal, or hilar lymphadenopathy is present.  No mediastinal\nmass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS:  Left lower lobe consolidation is consistent with infection. \nNew ground-glass nodularity in the right upper lobe both measuring 6 mm\n(series 5, image 35).  There is additional heterogenous peribronchial\ninfiltrate consistent with an infectious etiology.  Pulmonary nodules\nscattered bilaterally measuring up to 4 mm, for example left posterior (series\n5, image 71), right anterior (series 5, image 77) and 2 right posterior\n(series 5, image 78 and 79).  These are stable from the study from ___.   The airways are patent to the level of the segmental bronchi\nbilaterally.  4 mm subpleural nodularity along the posterior right lower lobe\n(series 5, image 64).  Biapical scarring is demonstrated.\n\nBASE OF NECK: 3 bilateral thyroid nodules measuring up to 6 mm are unchanged\nfrom prior.\n\nABDOMEN: Redemonstrated circumferential thickening of the esophagus is\nunchanged.  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\n\nLeft breast implant is demonstrated.",
            "output": "1. Focal consolidation in the left lower lung is consistent with infectious\nprocess such as bacterial or viral pneumonia.  Additional heterogenous\nperibronchial infiltrate in the right upper lobes is also consistent with\ninfection.\n2. No evidence of pulmonary embolism or aortic abnormality.\n3. Multiple bilateral scattered pulmonary nodules measuring up to 4 mm are\nunchanged.\n4. Circumferential thickening of the esophagus although improved since1\n___, should nevertheless be evaluated clinically, for diagnosis and\nas a possible indication of or contribution to dysmotility and aspiration.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by ___,\nM.D. on the telephone on ___ at 5:40 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Bilateral scattered sub 5 mm pulmonary nodules are similar to\nprior, for example a 4 mm nodule in the right upper lobe (3; 28).  Scattered\ndependent opacities in the superior segment of the right lower lobe and\nbilateral lung bases may represent atelectasis but cannot exclude aspiration\nor superimposed pneumonia.  There is interval improvement and resolution in\npreviously seen left lower lobe consolidation and peribronchial opacities in\nthe right upper lobe.  There is bilateral apical pleuroparenchymal scarring. \nThere is mild bilateral bronchial wall thickening suggestive of small airways\ninflammation.\n\nBASE OF NECK: Visualized portions of the base of the neck demonstrates a\nstable 0.9 cm hypodense nodule in the left thyroid gland.  Right chest port\nterminates in the cavoatrial junction.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a moderate hiatal\nhernia. There is a 3 mm hyperenhancing focus in the hepatic dome (3; 63)\nincompletely evaluated but is similar to prior since prior from ___, and may be perfusional.\n\nBONES: No suspicious osseous abnormality is seen.  ?A 7 mm lucent lesion in\nthe T7 vertebral body is similar to ___ (602; 32).  There is no acute\nfracture.  Patient is status post left retroglandular breast implant.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Stable bilateral sub 5 mm pulmonary nodules.\n3. Bilateral lower lobe opacities likely may represent atelectasis but cannot\nexclude aspiration or superimposed pneumonia.\n4. 3 mm hyperenhancing focus in the a patent dome, incompletely evaluated, but\nsimilar compared to studies dating back to at least ___, and may\nbe perfusional."
        },
        {
            "input": "THORACIC INLET: There is a stable hypodense lesion within the left lobe of\nthyroid.  There are no enlarged supraclavicular lymph nodes.\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.  Note is made\nof a left breast implant.\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  The\nesophagus is mildly thickened, could be secondary to esophagitis.  There is no\npericardial effusion.  The aorta and pulmonary arteries are normal in caliber.\nThere is no pleural effusion.\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: There is stable biapical pleuroparenchymal scarring.  Subpleural nodular\nopacities in both apices (4, 10) are unchanged.  A scar-like opacity in the\nright lower lobe posteriorly (4, 42) is also unchanged.  Multiple bilateral\npulmonary nodules ranging in size from 2-4 mm are unchanged.  No new pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable multiple bilateral pulmonary nodules.  In view of history of malignancy\ncontinued surveillance is recommended.\n\nStable scar-like opacity in the right lower lobe.  No new pulmonary nodules.\n\nLeft-sided breast implant in place.\n\nPlease refer to dedicated report on abdomen which has been dictated\nseparately."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nmain pulmonary artery is slightly dilated, measuring 3.2 cm, which may\nrepresent underlying pulmonary arterial hypertension.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma. \nDistal tip of a right internal jugular approach central venous catheter\nterminates within the distal right atrium.  Mild cardiomegaly without\npericardial effusion.  Moderate coronary artery calcifications.  The great\nvessels are within normal limits.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or thoracic inlet lymphadenopathy.\nNo mediastinal lymphadenopathy. Hilar lymph nodes are not well evaluated\nwithout intravenous contrast.  Circumferential uniform thickening of the\nesophagus as before, likely reflecting esophagitis.  Pretracheal 7 mm lymph\nnode (5:37), is likely reactive.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi\nbilaterally. Expiratory acquisition limits evaluation of lung parenchyma and\nlikely accounts for mosaic attenuation.  Mild biapical pleuroparenchymal\nscarring as before. Biapical nodular opacities, measuring up to 5 mm, are not\nsubstantially changed (6:38).  Scar-like opacity in the dependent right lower\nlobe (6:118) is stable across multiple priors.  Previously demonstrated\nmillimetric pulmonary nodules are not well seen on today's exam secondary to\ntechnique.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified.  Partially\nimaged left breast prosthesis appears unremarkable.\n\nBONES: No suspicious osseous abnormality.? No acute fracture.  Mild\ndegenerative changes of the imaged spine.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Punctate\nfoci of arterial enhancement in the liver dome (5:98, 111), likely due to\ntransient perfusion differences.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. No evidence of pulmonary edema.\n3. Distal tip of the right internal jugular central venous catheter terminates\nwithin the distal right atrium.\n4. Multiple imaged bilateral pulmonary nodules are stable.  In view of history\nof malignancy, continued surveillance recommended.\n5. Additional findings as above."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  The heart and great vessels are within normal limits. \nThere is mild cardiomegaly.  No pericardial effusion is seen.  There are\natherosclerotic calcifications of the aortic arch and at the takeoff of the\nleft subclavian artery.  The tip of a right internal jugular approach\nPort-A-Cath terminates at the cavoatrial junction.\n\nAXILLA, HILA, AND MEDIASTINUM: 4 mm paratracheal lymph node (5:39) is likely\nreactive and decreased in size in comparison to the prior study.  Otherwise,\nno axillary, mediastinal, or hilar lymphadenopathy is present.  There is\nconcentric thickening of the esophagus, which most likely represents\nesophagitis.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The central airways are patent.  Biapical nodular opacities,\nthe largest of which is in the right lung and measures up to 6 mm (5:15), are\nessentially unchanged.  Region of mild scarring and pleural thickening in the\nposterior right lung (5:66), is unchanged.  Scattered 2-4 mm pulmonary nodules\nare unchanged (for example series 5, images 32, 57, 84, 85).  There is a new\ntriangular opacity in the lingula which most likely represents subsegmental\natelectasis.\n\nSOFT TISSUE OF THE CHEST CAGE: No suspicious lesions identified. Left breast\nimplant appears unremarkable.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Partially visualized left ureteral stent and mild left\nhydronephrosis.  Punctate foci of arterial enhancement in the liver dome\n(5:106) similar in comparison to the prior study and are likely due to\ntransient perfusion differences.  These findings are better characterized on\nsame day CT of the abdomen and pelvis.\n\nBONES: Diffuse osteopenia is noted.  There is no acute fracture.  Scattered\nsclerotic foci in the thoracic vertebral bodies are unchanged (for example,\nseries 10, images 78 and 81).  Several intraosseous hemangiomas are unchanged.\nThere is a healing subacute fracture through the lateral aspect of the right\nfifth rib. Chronic deformity of the anterior right fourth and fifth ribs are\nunchanged. Mild degenerative changes of the visualized spine.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Stable biapical pleuroparenchymal scarring and nodularity and scattered\npulmonary nodules measuring up to 4 mm.  No new pulmonary nodules.\n3. Please refer to same day CT of the abdomen and pelvis for description of\nsubdiaphragmatic findings."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or\naxillary lymphadenopathy.  Incidental note is made of left breast prosthesis.\nThe thyroid gland is heterogeneous.\n\nUPPER ABDOMEN: Please see separately dictated report of the abdomen and pelvis\nfor description of findings below the diaphragm.\n\nMEDIASTINUM: There is unchanged diffuse circumferential thickening of the\nesophagus. The aorta and main pulmonary arteries are normal in caliber. There\nare mild-to-moderate calcifications of the thoracic aortic arch and the\norigins of the great vessels.  Right Port-A-Cath terminates at the cavoatrial\njunction.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: There are postsurgical changes related to remote repair\nof ventricular septal defect.  There are moderate to severe coronary artery\ncalcifications. There is no pericardial effusion.  There is mild cardiomegaly.\nThere is a small hiatal hernia.\n\nPLEURA: There is bilateral apical scarring. There are multiple worsening foci\nof plaque-like soft tissue thickening at the posterior margins of the superior\nand mid right lower lobe, measuring up to 1.1 x 1.6 and 3.5 x 1.1 cm,\nrespectively (series 400, images 80 and 97).\n\nLUNG:\n\nPARENCHYMA: Spiculated nodular opacity in the right apex has a growing soft\ntissue component and now measures up to 9 mm, previously measured up to 7 mm\n(series 400, image 22).  An additional more posterior right apical spiculated\nnodule measures 6 mm, previously measured 5 mm (series 400, image 31).\n\nThere has been interval worsening of nodular ___ opacities in the\nright middle lobe (series 400, image 159).\n\nA 4 mm right lower lobe ground-glass nodule is new (series 400, image 175). \nMultiple bilateral 2-4 mm solid pulmonary nodules are unchanged (for example\nseries 400, images 42, 59, 81, 144, 174, 175).  Perifissural triangular\nopacity in the right upper lobe (series 400, image 113) likely represents\nintrapulmonary lymph node and is stable.\n\nThere is redemonstration of bibasilar and lingular subsegmental atelectasis.\nAIRWAYS:  Airways are patent the subsegmental level bilaterally.\n\nVESSELS:  Contrast bolus is not optimized for evaluation of pulmonary\narteries, within this limitation there is no filling defect to indicate\nembolism in the main pulmonary arteries.\n\nCHEST CAGE: Chronic bilateral rib fractures are seen. There is an unchanged\nhemangioma in the T7 vertebral body. Heterogeneous mostly sclerotic lesions in\nT9 through T12 vertebral bodies are also unchanged compared to most recent\npriors but are increased in comparison to more remote studies (series 602,\nimage 83).",
            "output": "1. There is worsening plaque-like soft tissue thickening at the posterior\nmargins of the superior and middle portions of the right lower lobe. While\nthese findings may represent a combination of atelectasis and pleural\nscarring, malignancy cannot be excluded.  Recommend PET-CT for further\ncharacterization.\n2. Spiculated nodules in the right apex have exhibited interval millimetric\ngrowth, now measure up to 9 mm.  There is a new 4 mm ground-glass nodule in\nthe right lower lobe.  Other bilateral 2-4 mm solid pulmonary nodules a"
        },
        {
            "input": "CHEST PERIMETER: 13 mm wide low-density lesion in the right thyroid lobe has\nenlarged since ___ and should be evaluated by thyroid ultrasound.  7 mm\nlow-density lesion in the left lobe is stable.  Supraclavicular and axillary\nlymph nodes not enlarged.  Patient has had left mastectomy and prosthesis\ninsertion.  No soft tissue abnormality elsewhere in the chest wall.  Findings\nbelow the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM: Moderate circumferential wall thickening of the mid and\nupper esophagus has worsened, suggesting esophagitis.  No periesophageal edema\nin the mediastinum.  No evidence of obstruction.\n\nAtherosclerotic calcification is heavy in left subclavian artery, milder\nelsewhere in the head and neck vessels, but also severe in all major coronary\narteries.  Heavy calcification in the aortic root and upper interventricular\nseptum is unchanged, precise location and significance unclear.  Mild\ncardiomegaly is new.  Echocardiography is recommended for assessment. \nPulmonary artery borderline enlarged.  The aorta is normal caliber.  Heavy\npericardial calcification along the atrial ventricular groove is chronic. \nThere is no pericardial effusion.\n\nModerate loss of height T12 vertebral body is new, in the setting of\nheterogeneity in bone texture, probably due due to pre-existing metastasis. \nThis is THORACIC LYMPH NODES: Mediastinal stations:\n\nLeft lower paratracheal, 8 mm, slowly growing since ___ mm in ___.\n\nRight lower paratracheal, 7 mm, unchanged.\n\nLUNGS, AIRWAYS, PLEURAE: Increased vascularity in the lower lungs might\nobscure tiny lung nodules.  Region of subpleural consolidation in the\nposterior right upper and lower lobes and has improved slightly, indicating\nlikely inflammation, not malignancy.\n\nHand full of a irregular nodules in the upper lungs, ranging up to 10 mm,\n302:18 a, some contiguous with clear pleuroparenchymal scarring, have not\nincreased.\n\nThere are no new measurable or growing lung nodules.\n\nCHEST CAGE: New moderate loss of height primarily from upper endplate\nimpression of the T12 vertebral body, with the pre-existing blastic lesion\nsuggesting a pathologic fracture 602:75.  No other new compression or\npathologic fractures, no new blastic or destructive bone lesions.",
            "output": "The only evidence of active metastasis in the chest is new moderate T12\nvertebral body compression fracture that may not be pathologic despite a\npre-existing blastic metastasis.\n\nNodular pleuroparenchymal scarring at the lung apices is long-standing.\n\nSubstantial progression of circumferential wall thickening mid and upper\nesophagus suggests acti"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable. \nThere is no supraclavicular and no axillary lymphadenopathy.\n\nCHEST CAGE: No evidence of osteo destructive lesions at the level of the\nvertebra, ribs or sternum.\n\nUPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.\n\nMEDIASTINUM: Scattered mediastinal lymph nodes measure up to 0.6 cm in the\nright lower paratracheal station.  Posterior mediastinum is unremarkable. \nThere is no hilar lymphadenopathy.  NG tube through collapsed esophagus\nterminates in the stomach.\n\nHEART and PERICARDIUM: Heart is normal in size.  Right PICC terminates in the\nright atrium.  There is no pericardial effusion.  No appreciable\natherosclerotic calcifications in the coronaries or along normal caliber\nthoracic aorta and main branches.  Main pulmonary artery is top normal\ndiameter, measuring 3.1 cm.  The study is not dedicated for the evaluation of\npulmonary emboli.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Respiratory motion artifacts limit evaluation of fine detail such as\nmillimetric pulmonary nodules.  No lung nodules identified.  No lung masses. \nMild dependent bibasilar atelectasis.",
            "output": "No evidence of intrathoracic malignancy."
        },
        {
            "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  Cardiac size\nis top normal.  Moderate calcification of the coronary arteries pericardium,\nand great vessels are within normal limits.  Small pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Bilateral pleural effusions moderately sized right and small\nleft with adjacent compressive atelectasis.  No evidence of pneumothorax\n\nLUNGS/AIRWAYS: Multiple ill-defined opacities of the right hemithorax and left\nupper lobe could represent infection/inflammation, however underlying\nmalignancy or septic emboli can not be excluded.  Examples of pulmonary\nnodules are detailed below:\nA 1.2 cm nodule right lower lobe (series 2, image 39).\nA 8 mm pulmonary nodule right upper lobe, (series 2, image 29).\nA 1.1 cm pulmonary nodule right lower lobe (series 2 image 25).\nA 5 mm pulmonary nodule in the left upper lobe (series 2, image 34).\n\nMild paraseptal emphysema of the bilateral lobes. The airways are patent to\nthe subsegmental level.  However there is diffuse bronchial wall thickening\nwhich can be seen in small airways disease.  Underlying, smooth interlobular\nseptal thickening may represent pulmonary edema.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nliver demonstrates diffuse atrophy and nodular contours suggesting underlying\ncirrhosis.  There is no evidence of focal lesion or laceration within the\nlimitation of an unenhanced scan.There is no perihepatic free fluid.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.  Trace ascites in the right upper quadrant.\n\nPANCREAS: The pancreas is moderately fatty replaced.  No focal pancreatic\nlesions.  No peripancreatic abnormality.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: Diffuse thickening of the bilateral adrenal glands without discrete\nnodularity.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no evidence\nof focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  The colon and rectum are within normal limits.  The appendix\nis normal.\n\nThere is no free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder is decompressed and contains intraluminal air and an in\nsitu Foley catheter.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality. \nPatient is status post total left hip arthroplasty.  Moderate multilevel\ndegenerative changes.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. Multiple pulmonary nodules demonstrated throughout the right hemithorax and\nleft upper lobe measure up to 1.2"
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable. No enlarged lymph nodes in either axilla or\nthoracic inlet. No abnormalities on the chest wall.  Moderate atherosclerotic\ncalcifications in the head and neck arteries.  There is a large-bore catheter\nwith tip in the right proximal SVC.\n\nHEART AND VASCULATURE:\nThe heart is normal in size and shape. No pericardial effusion.  Moderate\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The aorta and pulmonary arteries are normal in caliber\nthroughout.  No filling defect in the proximal pulmonary artery and segmental\nbranches.\n\nMEDIASTINUM AND HILA:\nThe esophagus is unremarkable.  Mildly enlarged right lower paratracheal lymph\nnode measuring 1.1 cm in short axis diameter (604: 82), likely reactive.  No\nhilar lymphadenopathy.\n\nPLEURA:\nSmall bilateral pleural effusions. Mild bilateral apical scarring.\n\nLUNGS:\nThe patient is intubated with an appropriately placed endotracheal tube.  The\nairways are patent to the subsegmental levels.  There are multifocal centrally\ndistributed consolidations with surrounding ground-glass concerning for\nmultifocal bacterial pneumonia.  No grossly large suspicious lung nodules or\nmasses.  Mild bronchial wall thickening..\n\nCHEST CAGE:\nNo acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic\nlesions.\n\nUPPER ABDOMEN:\nPlease refer to same day abdomen and pelvis CT report for subdiaphragmatic\nfindings.",
            "output": "Bilateral centrally distributed consolidations with surrounding ground-glass\nsuggestive of multifocal bacterial pneumonia.  Small bilateral pleural\neffusions, likely parapneumonic.  Mildly enlarged mediastinal lymph nodes are\nlikely reactive."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is homogeneous in\nattenuation without focal nodularity.  There is no supraclavicular or axillary\nlymphadenopathy by CT size criteria.  Aside from mild bilateral gynecomastia,\nthe imaged chest wall is unremarkable.  Right chest wall infusion port tip\nterminates in the right atrium.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria. \nAgain seen are multiple calcified lymph nodes in the subcarinal station, not\nsignificant changed from prior exam.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.  Calcified left\nhilar lymph nodes are stable.\n\nHEART and PERICARDIUM: The heart size is within normal limits.  There is no\npericardial effusion.  No significant coronary or valvular calcifications are\nnoted.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nLUNG:\nPARENCHYMA: Possible left lower lobe nodule stably measures at 6 mm (05:29). \nSurrounding pleural thickening and linear opacity in the paramedian left lower\nlobe are stable (05:26).  Left calcified granuloma is unchanged (05:32).\nAgain seen is chronic changes in the right upper lobe with evidence of prior\ninfection with subpleural opacity, architectural distortion, traction\nbronchiectasis and septal thickening are overall unchanged from prior exam on\n___.\n\nAIRWAYS:  The airways are patent to the subsegmental levels.  Aside from mild\nbronchiectasis in the right upper lobe, the airways a unremarkable.\n\nVESSELS:  The main pulmonary artery is mildly dilated, measuring 3.1 cm,\nsuggestive of pulmonary arterial hypertension.  The ascending and descending\naorta are normal in caliber.  Mild aortic arch calcifications are noted.\n\nMUSCULOSKELETAL: Heterogeneous matrix in the lateral left sixth rib is stable\n(6:116).  Otherwise, there is no suspicious osseous lesion in the chest cage\nconcerning for acute fracture or malignancy.\n\nUPPER ABDOMEN: Please refer to the dedicated abdomen pelvis for\nintra-abdominal findings, including hypodense mass surrounding the spleen.",
            "output": "Stable appearance of the chest with no evidence of interval progression,\nincluding possible 6 mm nodule in the left lower lobe."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: No supraclavicular or axillary\nlymphadenopathy.\nCachexia is noted.\nRight pectoral Port-A-Cath terminating in the cavoatrial junction.\n\nUPPER ABDOMEN: Reported separately in the same day CT of the abdomen and\npelvis.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy.\nFew small sub carinal and left hilar calcified lymph nodes are unchanged.\nNo hilar lymphadenopathy.\nThe esophagus is diffusely thickened and patulous, unchanged.\n\nHEART and PERICARDIUM: There is no cardiomegaly and no pericardial effusion.\nNo appreciable atherosclerotic calcifications of the coronaries or along\nnormal caliber thoracic aorta.\nMain pulmonary artery is mildly dilated, suggesting pulmonary hypertension,\nunchanged.\n\nLUNG: Major airways are patent with secretions in carina and right upper lobe\nbronchus.\nSmall right upper paratracheal diverticulum is unchanged.\nMild branching bronchial opacities in the right lower lobe is unchanged\nsuggesting impacted bronchiolectasis or chronic infection.\nChronic changes in the right upper lobe with evidence of prior infection, \nsubpleural opacity architectural distortion, traction bronchiectasis and\nseptal thickening are unchanged in comparison to prior.\nParamedian left lower lobe cylindrical bronchiectasis is also unchanged.\n\nRight upper lobe subpleural 0.7 cm nodule is unchanged (05:38).\nLeft upper lobe 3 mm nodule is unchanged (5:81).\nNo new lung nodules or masses.\nScattered calcified granulomas (5:214).\n\nCHEST CAGE: No evidence of bony destructive lesions.",
            "output": "-Stable appearance of the chest with no evidence of active intrathoracic\nmalignancy.\n-Atypical mycobacterial infection or old tuberculosis are possible."
        },
        {
            "input": "Visualized lower neck is normal.\n\nThere is a right chest wall port, tip terminates at the cavoatrial junction.\n\nHeart size is normal.  No pericardial effusion.\n\nNo pleural effusion.  No pneumothorax.\n\nAirways are patent throughout.  There is a 3 mm left lower lobe pulmonary\nnodule and a 6 mm left lower lobe pulmonary nodule both unchanged from ___.  There is scarring at the right lung apex from prior wedge\nresection.  There is nodular peripheral left medial midlung airspace opacities\nwhich may be atelectasis.\n\nThere is no mediastinal mass.\n\nThere is no significant hilar or mediastinal adenopathy.\n\nABDOMEN:\nHEPATOBILIARY: Status post Whipple procedure. The liver demonstrates\nhomogenous attenuation.  There is a 1.5 cm hypodense lesion with internal\ncalcification along the anterior surface of the liver in hepatic segment 4A. \nThis appears increased in size since prior.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is absent. \nThere is pneumobilia.  The left lateral segment of the liver show scalloping\ndue to extensive peritoneal masses.\n\nPANCREAS: Not well seen.\n\nSPLEEN: There are numerous new and enlarged subcapsular masses in the spleen\nconsistent with metastatic disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with delayed right\nnephrogram.  There is moderate right hydronephrosis and hydroureter, similar\nto prior.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is mass effect on the stomach, multiple loops of small\nbowel, and large bowel from peritoneal and mesenteric soft tissue masses which\nare increased from prior.  Rectum is distended with an air-fluid level.\n\nThere are multiple surgical clips associated with the small bowel.  There is a\ndilated loop of small bowel in the midabdomen which may be postsurgical in\nnature, as it appears unchanged since prior.  There is no definite evidence of\nobstruction and oral contrast is able to transit through the small bowel.\n\nPELVIS: The urinary bladder is unremarkable.  Large soft tissue peritoneal and\nmesenteric masses are seen in the pelvis causing local mass effect, increased\nfrom prior\n\nREPRODUCTIVE ORGANS: Not well evaluated.\n\nLYMPH NODES: Bulky mesenteric and peritoneal masses which are increased in\nsize from prior predominantly involving the pelvis and left lateral abdomen.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No intrahepatic or extrahepatic biliary duct dilation.  There is\npneumobilia.\n2. Interval increase in the size and mass effect related to bulky soft tissue\nperitoneal and mesenteric masses from metastatic disease representing\nprogression of metastatic carcinomatosis.\n3. There are multiple new subcapsular splenic lesions and increase in size of\nthe previously seen splenic lesions, due to progression of to metastatic\ndisease.\n4. Moderate right hydronephrosis and proximal to mid hydroureter with a\ndelayed nephrogram.  Hydronephrosis is not significantly changed from prior\nand is due to extrinsic mass effect on the ureter in the pelvis."
        },
        {
            "input": "Visualized lower neck is normal.\n\nThere is a right chest wall port, tip terminates at the cavoatrial junction.\n\nHeart size is normal.  No pericardial effusion.\n\nNo pleural effusion.  No pneumothorax.\n\nAirways are patent throughout.  There is a 3 mm left lower lobe pulmonary\nnodule and a 6 mm left lower lobe pulmonary nodule both unchanged from ___.  There is scarring at the right lung apex from prior wedge\nresection.  There is nodular peripheral left medial midlung airspace opacities\nwhich may be atelectasis.\n\nThere is no mediastinal mass.\n\nThere is no significant hilar or mediastinal adenopathy.\n\nABDOMEN:\nHEPATOBILIARY: Status post Whipple procedure. The liver demonstrates\nhomogenous attenuation.  There is a 1.5 cm hypodense lesion with internal\ncalcification along the anterior surface of the liver in hepatic segment 4A. \nThis appears increased in size since prior.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is absent. \nThere is pneumobilia.  The left lateral segment of the liver show scalloping\ndue to extensive peritoneal masses.\n\nPANCREAS: Not well seen.\n\nSPLEEN: There are numerous new and enlarged subcapsular masses in the spleen\nconsistent with metastatic disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with delayed right\nnephrogram.  There is moderate right hydronephrosis and hydroureter, similar\nto prior.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is mass effect on the stomach, multiple loops of small\nbowel, and large bowel from peritoneal and mesenteric soft tissue masses which\nare increased from prior.  Rectum is distended with an air-fluid level.\n\nThere are multiple surgical clips associated with the small bowel.  There is a\ndilated loop of small bowel in the midabdomen which may be postsurgical in\nnature, as it appears unchanged since prior.  There is no definite evidence of\nobstruction and oral contrast is able to transit through the small bowel.\n\nPELVIS: The urinary bladder is unremarkable.  Large soft tissue peritoneal and\nmesenteric masses are seen in the pelvis causing local mass effect, increased\nfrom prior\n\nREPRODUCTIVE ORGANS: Not well evaluated.\n\nLYMPH NODES: Bulky mesenteric and peritoneal masses which are increased in\nsize from prior predominantly involving the pelvis and left lateral abdomen.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No intrahepatic or extrahepatic biliary duct dilation.  There is\npneumobilia.\n2. Interval increase in the size and mass effect related to bulky soft tissue\nperitoneal and mesenteric masses from metastatic disease representing\nprogression of metastatic carcinomatosis.\n3. There are multiple new subcapsular splenic lesions and increase in size of\nthe previously seen splenic lesions, due to progression of to metastatic\ndisease.\n4. Moderate right hydronephrosis and proximal to mid hydroureter with a\ndelayed nephrogram.  Hydronephrosis is not significantly changed from prior\nand is due to extrinsic mass effect on the ureter in the pelvis."
        },
        {
            "input": "Aorta and pulmonary arteries are well opacified.  Main pulmonary artery is\nminimally dilated.  Heart size is normal.  There is no pericardial pleural\neffusion.  Image portion of the upper abdomen will be reviewed separately as\npart of the CT abdomen and pelvis in corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally.\n\nChronic changes in the right upper lobe, series 4, image 52 are stable most\nlikely consistent with either previous sarcoidosis or granulomatous exposure\nwith traction bronchiectasis, architectural distortion and parenchymal\ncalcifications.  No change in the left basal area of atelectasis present.  No\nnew pulmonary nodules masses or consolidations seen.",
            "output": "Stable appearance of the chest with no evidence of interval progression.\n\nPlease review CT abdomen and pelvis and the corresponding report for\nassessment of intra-abdominal findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum are\nnormal in size.  Minimal bilateral hilar lymphadenopathy (3, 25).  A lymphatic\ntissue at the lower aspect of the hilar structures (3, 32) is also increased. \nNo abnormalities at the level of the large mediastinal vessels.  The cardiac\nstructures are unremarkable.  No pericardial effusion.  The gallbladder is\ncompletely filled with calcified material.  No osteolytic lesions at the level\nof the ribs, the sternum, or the vertebral bodies.  Moderate degenerative\nvertebral disease.\nMild bilateral apical scarring, right more than left.  Calcified right hilar\nlymph nodes, the open long structure seen on the radiograph from ___ corresponds to a perifissural right lower lobe nodular calcification (5,\n135) with multiple small right lower lobe satellite nodules (5, 135).  Areas\nof local scarring and minimal bronchiectasis are also visualized (5, 138).  A\nsimilar non calcified perifissural nodule (5, 142 is seen at the level of the\nmiddle lobe.  Finally, there is blunting of the azygo-esophageal recess by a\nparenchymal consolidation with small surrounding satellite nodules open (5,\n163).  No pleural thickening, no pleural effusions.  The airways are patent.",
            "output": "The oblong structure seen on the chest x-ray from ___ likely\nreflect a post tuberculous calcification with small satellite nodules, as well\nas with hilar lymph node calcifications and bilateral hilar lymphadenopathy.\nIn addition, there is complete blunting of the azygo-esophageal recess by a\nparenchymal consolidation, likely reflecting a recent pneumonia.  Resolution\nof this consolidation of the therapy must be verified by CT, because the area\nis not well penetrated by chest radiography.\nNo pleural effusions."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: 1.1 cm hypodensity in the right\nlobe of the thyroid is of insufficient size to warrant further imaging.  0.7\nand 0.4 cm lymph node in the left and right supraclavicular stations,\nrespectively, are not pathologically enlarged (04:27).  There is no axillary\nlymphadenopathy.  In the imaged chest wall there are no concerning soft tissue\nabnormalities.\n\nCHEST CAGE: Pectus excavatum.  No evidence of osteo destructive lesions in the\nribs, sternum, vertebra.\n\nUPPER ABDOMEN: There is a 2 cm posterior right hepatic lobe hypodensity likely\nrepresents hepatic cyst, unchanged since ___.\n\nMEDIASTINUM: 0.8 cm right upper paratracheal lymph node and 1 cm right\npulmonary ligament lymph node are not pathologically enlarged (4:76, 130).\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart size is mildly exaggerated by the pectus\nexcavatum.  There is no pericardial effusion.  Mild calcifications of aortic\nvalve leaflets.  The thoracic aorta and main pulmonary artery are normal in\ndiameter. On this nondedicated study there is no evidence of central pulmonary\nemboli.\n\nLUNG and PLEURA: Pigtail catheter through left ___ intercostal space\nterminates in the pleural space.  There is a small to moderate left pleural\neffusion which is partially loculated, contains bubbles of air, and extend\ninto the major fissure.\nSmall consolidation in the left lower lobe is likely combination of\natelectasis and pneumonia.\nRight minimal layering pleural effusion with adjacent relaxation atelectasis\nof the lower lobe.\nSmall quantity of secretions in the carina extending into the lower lobe\nbronchi.\nScattered areas of ___ opacities and centrilobular nodules involve the\nright lung, representing bronchitis and bronchiolitis.\nMild biapical pleuroparenchymal fibrosis.",
            "output": "-Small to moderate left hydropneumothorax is partially loculated, with a\npigtail in place.\n-Left lower lobe consolidation is likely combination of pneumonia possibly\naspiration, and atelectasis.\n-Bronchitis and bronchiolitis is widespread in the right lung.\n-No mass lesion is identified."
        },
        {
            "input": "THORACIC INLET: The thyroid is unremarkable.  There are stable small left\nsupraclavicular lymph nodes the largest measuring 5 mm.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  The right\nparatracheal node measures 6 mm.  There are small bilateral hilar lymph nodes.\nThere is a trace pericardial effusion.\n\n\nPLEURA: There is a multi loculated left pleural effusion slightly increased in\nvolume since the prior study.  Left-sided pigtail catheter remains in place. \nThe small right pleural effusion is unchanged.\n\nLUNG: Consolidative opacity in the right lower lobe most likely represents\nsubsegmental atelectasis.  Consolidation in the left lower lobe could\nrepresent atelectasis however superimposed pneumonia cannot be excluded and is\nunchanged.\n\nThe ___ nodularity in the posterior segment the right upper lobe has\nminimally improved.  Patchy parenchymal opacities in the right middle lobe\nhave also minimally improved.  There is multifocal ___ nodularity seen\nwithin the right lower lobe, slightly improved since the prior study.  The\noverall constellation of findings is concerning for resolving multifocal\npneumonia.  There are new ground-glass opacities in the right apex (3, 11),\ncould be inflammatory or could represent asymmetric edema.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.  Mild pectus deformity involving the sternum is unchanged\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows an exophytic\nhypo dense lesion arising from the right lobe of liver (2, 54), unchanged.  No\nadrenal masses is seen.",
            "output": "Multi loculated left pleural effusions slightly increased in volume since the\nprior study.  Left-sided pigtail catheter remains in place.\n\nThe partially loculated right pleural effusion is unchanged since the prior\nstudy.\n\nDense consolidation in the left lower lobe could represent combination of\natelectasis and pneumonia.\n\nMultifocal opacities throughout the right lung have slightly improved and\ncould represent a resolving pneumonia.  Stable small mediastinal lymph nodes\nwhich are most likely reactive.  New ground-glass opacities in the right apex\ncould be inflammatory could represent early edema or could represent new focus\nof pneumonia."
        },
        {
            "input": "The thoracic aorta is normal in caliber with moderate scattered\natherosclerotic calcifications.  Atherosclerotic calcifications at the origin\nof the 3 major branches is mild-to-moderate.  The main, left, and right\npulmonary arteries are normal in caliber without filling defect to indicate\nthe presence of any acute central incidental pulmonary embolus.  The heart is\nnormal in configuration.  Aortic valve calcifications are at least moderate. \nCoronary artery calcifications are extensive on this nondedicated exam. \nMitral annulus calcifications are probably mild.  No evidence of a pericardial\neffusion.\n\nNo axillary, supraclavicular, mediastinal, or hilar lymphadenopathy.\n\nA right upper lobe subpleural nodule measures under 2 mm (series 7, image 64).\nNo concerning pulmonary nodules.  Bibasilar atelectasis is mild-to-moderate. \nThe airways are patent to at least the subsegmental level.  No pleural\neffusion or pneumothorax.\n\nThe thyroid gland is unremarkable without evidence of a mass.\n\nNo osseous lesions in the chest cage suspicious for malignancy or infection. \nMultilevel degenerative changes in the thoracic spine are extensive.  The\nbones are diffusely demineralized.  No evidence of acute fracture in the chest\ncage.\n\n Please refer to the dedicated CT abdomen and pelvis report from the same day\nfor a description of sub-diaphragm findings.",
            "output": "1.  No specific CT evidence of active intrathoracic infection or metastasis.\n2.  Sub-2 mm right upper lobe subpleural pulmonary nodule."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid again\ndemonstrate punctate calcifications at the isthmus and the right lobe.  There\nis no supraclavicular adenopathy by CT size criteria.  Scattered axillary\nlymph nodes are not pathologic by CT size criteria.  The breast parenchyma is\nsuboptimally evaluated on the current modality.  The remaining chest wall is\nunremarkable.  The thoracic esophagus is mildly patulous, containing\nhyperdense material, likely ingested oral contrast.  Right internal jugular\ncentral venous catheter tip terminates\n\nUPPER ABDOMEN: Please refer to the dedicated CT abdomen and pelvis report from\nthe same day for details on subdiaphragmatic findings.\n\nMEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria.\n\nHILA: There is no hilar lymphadenopathy by CT size criteria.\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.  Moderate aortic and mitral vascular calcifications, and moderate to\nsevere 3 vessel coronary artery calcifications are unchanged from prior exam.\nPLEURA: Trace right greater than left pleural effusion is new since ___.  There is no pneumothorax.\nLUNG:\n\n1. PARENCHYMA: There is minimal bibasilar atelectasis and non characteristics\nscarring at the bases.  There are no suspicious nodules.\n2. AIRWAYS:  The airways are patent to the subsegmental levels.\n3. VESSELS:  The ascending and descending aorta are normal in caliber.  The\nmain pulmonary artery is top normal in size.  While this exam is not tailored\nfor the evaluation of pulmonary embolism, no incidental filling defects are\nnoted.\nCHEST CAGE: There are no worrisome osseous lesions for malignancy or\ninfection.  Severe degenerative changes of the bilateral glenohumeral joints\nare seen with subchondral cysts and sclerosis, right worse than left.",
            "output": "Minimal bibasilar atelectasis and non characteristic scarring at the bases. \nNo suspicious nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: Limited views of the thyroid gland\nare unremarkable.  There are no supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Please refer to separately reported abdominal CT for further\ndetail.\n\nMEDIASTINUM:  Few prominent lymph nodes are seen in the mediastinum, however\ndata mid criteria for lymphadenopathy.\n\nHILA: There are no hilar adenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size and there is no pericardial\neffusion.  There is no signs of right heart strain.\nPLEURA: There is no pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  Bibasilar enhancing opacities represent subsegmental\natelectasis.  Few other scatter opacities in the lower lobes.\n2. AIRWAYS:  A 4 mm nodularity on the left aspect of the upper trachea is\nnoted (302:28) may reflect secretion.  Mild bronchial thickening is seen in\nboth lung bases.\n3. VESSELS:  Multiple lobar and subsegmental filling defects in the superior\nlobar artery extending further to subsegmental level; interlobar artery and\nbasal trunk extending to subsegmental level on the right as well as in\nsubsegmental levels of the left lower lobe.  The appearance of the filling\ndefects suggest acute pulmonary embolisms.\nCHEST CAGE: Anterior compression deformity of T12, otherwise no worrisome\nosseous lesions or acute fractures.",
            "output": "1. Bilateral lobar and subsegmental pulmonary embolisms without signs of right\nheart strain or pulmonary infarcts, most likely acute.  Bilateral subsegmental\natelectasis in both bases, without clear pulmonary infarcts.\n2. Please refer to the CT abdomen pelvis performed on the same day for further\nfindings."
        },
        {
            "input": "The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph\nnodes are not enlarged, though are more prominent than on prior examination,\nmeasuring up to 1 cm in short axis, likely reactive, particularly in the\nperitracheal region.   Aorta and pulmonary arteries are normal size. Cardiac\nconfiguration is normal.  Again seen are aortic valvular and annular\ncalcifications as well as mitral annular calcifications.  Coronary\ncalcifications and/or stenting is noted.\n\nIn comparison to the prior examination, scattered ___ opacities are\nseen involving primarily the right middle and lower lobes.  There is diffuse\nbronchial wall thickening with scattered secretions, particularly involving\nthe bilateral lower lobes.  No large focal consolidation is identified.\n\nLimited evaluation of the upper abdomen shows no significant abnormalities. \nThe esophagus is patulous.\n\nBony changes are similar to the prior examination.",
            "output": "1.  Diffuse airways thickening with scattered secretions and ___\nopacities, primarily involving the right middle and lower lobes, are\nsuspicious for bronchopneumia or possibly aspiration in the appropriate\nclinical context.\n\n2.  Otherwise stable examination since priors."
        },
        {
            "input": "The aorta and its major branch vessels are patent.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries.  The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.Incidental\nnote is made of diminutive left jugular vein, unchanged from ___.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\n\nThere is trace pericardial effusion.  There is no pleural effusion.\n\nThere is mild bibasilar atelectasis as well as regions of ground-glass\nopacities and linear fibrosis in the paraspinal regions, more so on the right\nwhere there is a subjacent prominent thoracic vertebral osteophyte.  There is\nstable diffuse, smooth peribronchial wall thickening affecting the bilateral\nlower lobes, right worse than left.  No focal consolidation is seen.\n\nLimited images of the upper abdomen unremarkable aside for a small hiatal\nhernia.\n\nNo aggressive osseous lesions.  Healed right rib fractures are seen.  Subtle\nfocus of cortical sclerosis at right seventh rib is unchanged since ___\n(3:73).  Mild-to-moderate degenerative changes of the bilateral shoulder\njoints are seen with subchondral cystic changes and sclerosis, right worse\nthan left.",
            "output": "Mild bibasilar fibrotic changes.No evidence of pulmonary embolism.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:54 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The thyroid is normal.  There is no axillary, or supraclavicular\nlymphadenopathy.  Mildly enlarged mediastinal and right hilar lymph nodes are\ngrossly unchanged compared to the prior exam.  There is no left hilar\nlymphadenopathy.  The heart size is normal.  Severe coronary artery\ncalcifications are seen.\n\nThere is a moderate hiatal hernia.  The esophagus is otherwise unremarkable.\n\nThe airways are patent to the subsegmental levels.  Note is made bibasilar\natelectasis.  Mild ground-glass changes are seen at the right lung base,\nimproved compared to the prior exam.\n\nA pleural plaque with calcifications is seen along the anterior surface of the\nleft upper lobe, series 4, image 128, may be sequelae of prior asbestosis\nexposure.  No concerning pulmonary nodules are identified.  There is no\npleural effusion or pneumothorax.\n\nThe study is not tailored for the evaluation of the subdiaphragmatic\nstructures, however no acute abnormalities are identified.\n\nOsseous structures: Healed right-sided rib fractures are seen.  No aggressive\nbone lesions seen.",
            "output": "1. No acute intrathoracic abnormalities identified.  Stable mildly enlarged\nmediastinal and right hilar lymph nodes, compared to the prior exam from ___.\n2. Mild bibasilar atelectasis with improved areas of ground-glass changes.\n3. Severe coronary calcifications."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid lesions that\nwarrant further imaging.\n No lymphadenopathies in the thoracic inlet.\n No abnormalities on chest wall.\n Mild atherosclerosis in head and neck vessels.\n\nUPPER ABDOMEN: Please refer to same day abdominal CT report for\nsubdiaphragmatic findings.\n\nMEDIASTINUM: Largehiatal hernia.  Esophagus is otherwise unremarkable.  No\npathologically enlarged mediastinal or hilar lymph nodes.\n\nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions.\nSevere atherosclerotic calcifications in coronary arteries and mitral valve,\nmild in the thoracic aorta and aortic valve.\nPLEURA: No pleural effusions.  Mild bilateral apical scarring.\nLUNG:\n\n1. PARENCHYMA:  Linear atelectasis in the superior segment of left lower lobe.\nBibasilar ground-glass in the basal medial segment, worse to the right,\nextending through the midlung.\nSub solid nodule in the right upper lobe measuring 5 millimeters.\n2. AIRWAYS:  Mild-to-moderate bronchial wall thickening, with some mucous\nplugging in the right lower lobe.\n3. VESSELS:  Pulmonary artery is enlarged, measuring 3.3 centimeters.\nCHEST CAGE: No acute fractures.  No lytic or sclerotic lesions.  Moderate\ndorsal spondylosis in lower thoracic spine.",
            "output": "Large hiatal hernia, bibasilar ground-glass and local bronchial wall\nthickening with mucous plugging are suggestive of aspiration.\nSingle sub solid pulmonary nodule.\nSevere atherosclerosis in coronary arteries and mitral valve.\n\nRECOMMENDATION(S):  For an incidentally detected single part-solid nodule\nsmaller than 6mm, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: No evidence of pulmonary embolism.  Mild\natherosclerotic calcifications of the thoracic aorta.  The thoracic aorta is\nnormal in caliber.  Severe coronary and mitral annular calcifications.  Mild\naortic valve calcifications.  Otherwise, the heart, pericardium, and great\nvessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass or hematoma.  Large hiatal\nhernia.  Circumferential thickening of the distal esophageal wall, likely due\nto reflux esophagitis.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Ground-glass opacification within the superior segment of the\nright lower lobe medially, likely infectious.  There also peribronchial\nground-glass opacities throughout the left lower lobe, also likely infectious\n(series 4, image 111, 154).  Otherwise lungs are clear without focal\nconsolidations.  No suspicious lung nodules.  The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Fluid is seen throughout the stomach, small bowel loops, and\ncolon, likely reflecting diarrhea.  There is diffuse bowel wall hyperemia. \nThere is no bowel wall thickening.  The appendix is normal.  Rim calcified\nlesion within the pelvis adjacent to the sigmoid, likely representing sequela\nof epiploic appendagitis (series 5, image 63).\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nMild bladder wall thickening anteriorly, which should be correlated with\nurinalysis for evidence of cystitis (series 5, image 72).  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no acute fracture.  Apparent discontinuity of the sternum is\ndue to motion artifact.  Multiple known osseous lesions are better\ndemonstrated on the MR liver dated ___, MR ___ dated ___, and\nPET-CT dated ___.  Soft tissue within the spinal canal at the\nlevel of the L3 vertebral body is better evaluated the MR ___ dated\n___ (series 608, image 34).\n\nSOFT TISSUES: Small fat containing inguinal hernias bilaterally.  Dystrophic\ncalcification within the subcutaneous tissues of the anterior right thigh.",
            "output": "1. No evidence of pulmonary embolism.\n2. Fluid throughout all visualized bowel loops with diffuse bowel wall\nhyperemia, likely reflecting diffuse enteritis, likely infectious or\ninflammatory.  No bowel wall thickening.\n3. New ground-glass opacities within the lower lobes bilaterally, compatible\nwith infection.\n4. Mild bladder wall thickening anteriorly, which should be correlated with\nurinalysis for evidence of cystitis.\n5. Known osseous myeloma lesions are better visualized on prior examinations. \nSoft tissue within the spinal canal at the level of L3 is re-demonstrated, but\nbetter evaluated on the MR ___ dated ___.\n6. Large hiatal hernia."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. There are mild coronary artery and aortic arch\ncalcifications.  Otherwise, the heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Previously seen ground-glass opacifications within the\nbilateral lower lobes has improved compared to ___, now with mild\nresidual atelectasis/scarring.  The lungs are otherwise clear without evidence\nof masses or areas of parenchymal opacification. No suspicious pulmonary\nnodules are identified. The airways are patent to the level of the segmental\nbronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nNo supraclavicular lymphadenopathy.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is mild fatty atrophy of the pancreas without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged up to 13.6 cm similar to prior exam.  No focal\nsplenic lesions are identified.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  The colon and rectum are\nwithin normal limits.  Appendix is not visualized.  There is no free\nintraperitoneal fluid or free air.\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.A 1.4 cm rim calcified lesion within the right pelvis is\nunchanged compared to at least ___, and likely reflects the sequelae\nof prior epiploic appendagitis (12:68).\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Apparent increased lucency along the anterior right\nhumerus is artifactual in nature secondary to contrast streaking (06:22). \nMild lucency about the T1 vertebral body is not seen on the axial or coronal\nreformats and is likely artifactual in nature secondary to the anterior chest\nwall leads(09:37).  Known myelomatous osseous lesions in the T and L-spine are\nbetter evaluated on lumbar spine MR dated ___.  Coarse\ncalcification about the superficial right anterior thigh is unchanged compared\nto at least ___.  No concerning soft tissue lesions are identified.",
            "output": "1. No evidence of pulmonary embolism or acute aortic injury.\n2. Known myelomatous osseous lesions are better evaluated on prior MR ___ and\nL-spine dated ___.\n3. No acute findings in the abdomen or pelvis."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThyroid is unremarkable.  Stable small axillary and thoracic inlet lymph\nnodes.  No chest wall abnormalities.  Moderate atherosclerotic calcifications\nin the head and neck arteries, specially in the proximal left subclavian\nartery.\n\nMEDIASTINUM AND HILA:\nEsophagus is patulous, most likely associated to a large hiatal hernia,\nunchanged.  Small mediastinal lymph nodes, none enlarged by CT size criteria\nand stable from prior studies.  Hilar contours show no evidence of enlarged\nlymph nodes.\n\nHEART, PERICARDIUM AND VASCULATURE:\nThe heart is normal in size and shape.  No pericardial effusion.  Heavy\natherosclerotic calcification of the coronary arteries and mitral annulus,\nmoderate in the aortic valve leaflets.  Aorta and pulmonary artery normal in\ncaliber throughout.\n\nLUNGS, AIRWAYS, AND PLEURA:\nThe airways are patent to the subsegmental levels.  Moderate bronchial wall\nthickening, no bronchiectasis or mucus plugging.  Stable right upper lobe 4 mm\nnodule (5:34).  No focal consolidation.  No pleural effusion or thickening. \nMild biapical pleuroparenchymal scarring.\n\nCHEST CAGE:\nStriated pattern of osteopenia is stable since ___ with no evidence of\ncompressive or pathologic fractures.  No acute fractures.  Moderate dorsal\nspondylosis.  No lytic or sclerotic bone lesions worrisome for malignancy.  A\nsclerotic focus in the lateral aspect of the right seventh rib, stable since\n___ is most likely a bone island.\n\nUPPER ABDOMEN:\nThe limited sections of the upper abdomen show no focal hepatic or splenic\nlesions.  Adrenals unremarkable.",
            "output": "No evidence of pneumonia in the present examination.\n\nStable right upper lobe 4 mm nodule (5:34).\n\nModerate bronchial wall thickening reflecting chronic bronchitis.\n\nSevere coronary artery atherosclerotic disease.\n\nSevere mitral annulus calcification."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nEvaluation of the subsegmental pulmonary arteries is limited due to timing of\nthe contrast bolus.  The thoracic aorta is normal in caliber without evidence\nof dissection or intramural hematoma.  There are extensive coronary\ncalcifications, particularly in the left main and left anterior descending\ncoronary arteries.  Severe mitral annular calcifications are redemonstrated. \nThe pericardium, is normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Redemonstration of a\nmoderate hiatal hernia, with a patulous esophagus.\n\nPLEURAL SPACES: No pneumothorax.  Trace right pleural effusion is new.  Mild\nbiapical pleuroparenchymal scarring.\n\nLUNGS/AIRWAYS: The lungs are patent to the subsegmental level.  Moderate\nbronchial wall thickening is overall unchanged to slightly improved.  No focal\nconsolidation to suggest pneumonia.  Stable 4 mm right upper lobe pulmonary\nnodule (series 6:46).  Mild relaxation atelectasis at the right lung base.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Diffuse osteopenia is redemonstrated.  A stable sclerotic lesion in the\nlateral aspect of the right seventh rib likely represents a bone island. \nThere is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism centrally through the segmental pulmonary\narteries.  Evaluation of the subsegmental pulmonary arteries is limited due to\ntiming of the contrast bolus.\n2. Trace right nonhemorrhagic pleural effusion is new from prior.\n3. Stable to slightly improved diffuse bronchial wall thickening.\n4. Stable right upper lobe 4 mm pulmonary nodule.\n5. Severe coronary artery and mitral annular calcifications.\n6. Moderate hiatal hernia and patulous esophagus, which may predispose to\naspiration."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Minimal aortic valvular calcification.  Minimal\natherosclerotic calcification along the aortic arch and descending thoracic\naorta.  The heart, pericardium, and great vessels are within normal limits. \nExtensive coronary artery calcifications, involving predominantly the left\nmain and left anterior descending coronary arteries.  Severe mitral annular\ncalcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nRedemonstration of a mildly enlarged left lower paratracheal lymph node\nmeasuring 1.7 cm (6:104), and a 1.5 cm right hilar lymph node (6:123), likely\nreactive.  A moderate-sized hiatal hernia and patulous esophagus is again\nnoted.\n\nPLEURAL SPACES: No pneumothorax.  Interval increase in size of a moderate,\nsimple appearing right pleural effusion.  New small nonhemorrhagic left\npleural effusion.\n\nLUNGS/AIRWAYS: Minimal biapical pleuroparenchymal scarring.  Stable appearance\nof a 4 mm nodule at the right upper lobe (6:44).  Increased compressive\natelectasis at the bilateral lung bases adjacent to increasing effusions. \nLungs are otherwise clear without evidence of focal consolidation.  The\nairways are patent to the level of the segmental bronchi bilaterally.  Diffuse\nmoderate bronchial wall thickening remains similar in appearance to prior\nstudy.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Included portion of the upper abdomen is unremarkable.\n\nBONES: No acute fracture.  Diffuse osteopenia is again noted.  Unchanged\nsclerotic focus in the lateral aspect of the right seventh rib likely\nrepresents a benign bone island (6:224).  Subtle sclerotic region at the left\nhumeral head is better assessed on prior ___ PET-CT from ___\n(6:10), in keeping with known history of multiple myeloma.  Heterogeneous\nappearance of the sternum is also similar to prior studies, likely related to\nknown multiple myeloma.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Interval increase in size of a moderate sized right pleural effusion and a\nnew small left pleural effusion, with adjacent compressive atelectasis.\n3. No focal consolidation to suggest pneumonia.\n4. Similar diffuse moderate bronchial wall thickening, consistent with small\nairway inflammation.\n5. Stable moderate-sized hiatal hernia and patulous esophagus.\n6. Subtle sclerotic region at the left humeral head, in keeping with known\nhistory of multiple myeloma, better assessed on prior FDG PET-CT from ___."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes\n\nMEDIASTINUM: There are stable small mediastinal lymph nodes.  Heart size is\nnormal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.  There is a moderate-sized hiatus hernia.  There is\nmoderate mitral annulus calcification.\n\n\nPLEURA: Bilateral pleural effusions right greater than left are unchanged. \nThe right effusion is small to moderate volume the left a small volume.  There\nis subsegmental atelectasis in both lung bases.\n\nLUNG: There is stable subsegmental atelectasis in both lung bases.  No new\nconsolidations concerning for pneumonia.  No new pulmonary nodules.\n\nBONES AND CHEST WALL : The review of bones shows degenerative changes\ninvolving the thoracic spine.  There is a stable subtle sclerotic lesion\nwithin the left humeral head is stable lucencies within the manubrium sternum.\nBones are osteopenic.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen are unremarkable.",
            "output": "Stable bilateral pleural effusions right greater than left.  Bibasilar\natelectasis.  Subsegmental atelectasis in the right lower lobe.  No new\nconsolidations concerning for pneumonia.\n\nModerate-sized hiatus hernia.\n\nModerate mitral annulus calcification.\n\nOsteopenia with degenerative changes involving the thoracic spine.  Stable\nlucencies within the manubrium sternum."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.  Severe coronary artery atherosclerotic\ndisease is demonstrated.  Severe mitral valve calcifications.  Aortic valve\ncalcifications.\n\nAXILLA, HILA, AND MEDIASTINUM: Prominent right paratracheal lymph node\nmeasuring 0.9 cm (3, 14).  No axillary or mediastinal lymphadenopathy is\npresent.  No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Small bilateral pleural effusions are demonstrated.\nLUNGS/AIRWAYS: Peripheral upper lobe predominant ground-glass opacities and\nconsolidations with reticular opacities are demonstrated bilaterally, new from\nprior.  In addition focal regions of nodular consolidation is demonstrated in\nthe bilateral lower lobes, right greater than left, consistent with multifocal\ninfection/small airways disease.  Diffuse bronchial wall thickening is\ndemonstrated throughout the lungs.  The airways are patent to the level of the\nsegmental bronchi bilaterally.  Biapical scarring is demonstrated.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Moderate-sized hiatal hernia is demonstrated.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nGeneralized osteopenia is demonstrated.  Schmorl's nodes are demonstrated on\nthe endplates of T6 and T8.",
            "output": "1. Bilateral lower lobe nodular consolidations, right greater than left, with\nadjacent ___ nodularity is consistent with multifocal infection/small\nairways disease.\n2. Peripheral upper lobe predominant ground-glass and reticular opacities and\nan consolidations is nonspecific however can be suggestive of a superimposed\natypical or viral pneumonia.  Interstitial pneumonitis or eosinophilia\npneumonia should also be considered.  Clinical correlation is recommended.\n3. Small bilateral pleural effusions.\n4. Moderate size hiatal hernia is unchanged.\n5. Severe coronary artery atherosclerotic disease.  Severe mitral valve\ncalcifications.\n\nRECOMMENDATION(S):  Clinical correlation for viral or atypical infection\nversus interstitial pneumonitis or asymmetric pneumonia."
        },
        {
            "input": "The imaged portion of the thyroid is unremarkable.  The thoracic aorta\ncontains mild atherosclerotic calcifications and is normal in caliber and\ncourse.  There is extensive coronary artery calcification as well as extensive\nmitral annular calcification.  The heart is not enlarged and there is no\npericardial effusion.  There is a large hiatal hernia.  The esophagus appears\npatulous.  The main pulmonary artery appears normal in size.  Prominent\nmediastinal lymph nodes are likely reactive and appear relatively unchanged. \nNo axillary adenopathy.\n\nBilateral pleural effusions are slightly increased from prior though remain\nsmall to moderate in overall size.  There is interval increase in bilateral\nlower lobe consolidations.  Within the bilateral upper lobes, areas of\nill-defined confluent in ground-glass opacity persist with similar overall\nextent.  Previously seen anterior consolidation in the right middle lobe\nappears slightly improved.  Perifissural opacity persists though previously\nappearing ground-glass in attenuation is more solid in attenuation currently. \nIncreased ground-glass opacities are noted in the left lower lobe on series 5\nimage 233 through 242.  Ground-glass attenuation is more confluent on the\ncurrent exam.\n\nIn the imaged upper abdomen, there is no discrete abnormality.\n\nBones: Demineralized bones without significant change from prior.",
            "output": "1. Slightly increased small to moderate pleural effusions, multilobar airspace\nconsolidation suggestive of atypical pneumonia, slightly increased in the\nlower lobes.\n2. Large hiatal hernia.\n3. Severe coronary artery calcification with mitral annular calcification."
        },
        {
            "input": "HEART AND VASCULATURE: Mild calcification of the thoracic aorta is unchanged. \nThere is extensive coronary artery calcification as well as extensive mitral\nannular calcification.  Heart size is normal.  No pericardial effusion.  The\nmain pulmonary artery appears normal in size.\n\nAXILLA, HILA, AND MEDIASTINUM: Again seen multiple prominent mediastinal lymph\nnodes are likely reactive and overall stable.  No axillary lymphadenopathy. \nNo mediastinal mass or hematoma.\n\nPLEURAL SPACES: Bilateral pleural effusions are slightly decreased in size\nfrom prior exam, now small.  No pneumothorax.\n\nLUNGS/AIRWAYS: There is been interval decrease in bilateral upper and lower\nlobe ground-glass and consolidative opacifications.  No new areas of\nground-glass opacification.  Perifissural opacification persists on the left\nbut is slightly less prominent than prior exam and may represent a component\nof atelectasis.  There is scattered areas of atelectasis.  There is a small\nfocus of persistent opacification measuring 1.3 cm in the medial right lower\nlobe (series 5: Image 205).  Bronchiectasis is unchanged.\n\nBASE OF NECK: The imaged portion of the thyroid is unremarkable.\n\nABDOMEN: The esophagus is patulous.  There is a large hiatal hernia.  No\ndiscrete abnormality in the imaged upper abdomen.\n\nBONES: Demineralized bones without significant change from prior.  Schmorl's\nnodes are again demonstrated on the endplates of T6 and T8.",
            "output": "1. Overall, interval decrease in size and extent of bilateral upper and lower\nlobe ground-glass and consolidative opacifications.\n2. Persistent focus of opacification in the medial right lower lobe that was\nnot present on CT scan dated ___.  This may represent a focus of\nresidual bacterial or fungal pneumonia.  Recommend attention on follow-up\nimaging.\n3. Interval decrease in bilateral pleural effusions, now small.\n4. Large hiatal hernia.\n5. Severe coronary artery and mitral annular calcification."
        },
        {
            "input": "CT ANGIOGRAM: The pulmonary embolism study is of good diagnostic quality. \nThere are no filling defects in the pulmonary artery and segmental\nsubsegmental branches to suggest pulmonary embolism.  The aorta is\nunremarkable.  There is evidence of atherosclerotic calcification involving\nthe wall of aorta.  Moderate coronary artery calcification.\n\nTHORACIC INLET: There are no enlarged supraclavicular lymph nodes.\n\nBREAST AND AXILLA  : No enlarged axillary lymph nodes.\n\nMEDIASTINUM: Small mediastinal lymph nodes unchanged.  Heart size is\ntop-normal.  There is moderate coronary artery calcification.  There is no\npericardial effusion.  There is a moderate to large hiatus hernia.\n\nPLEURA: There are small bilateral pleural effusions right greater than left,\nincreased in volume since the prior study.\n\nLUNG: There is mild interstitial edema.  Subsegmental atelectasis seen along\nthe left upper lobe peripherally and along the left major fissure.  There is\nstable scarring in the left upper lobe anteriorly.  A nodular opacity in the\nleft lower lobe (4, 76) is unchanged.  There is stable bronchiectasis and\nscarring in the right lung base.  No new consolidations.\n\nBONES AND CHEST WALL : Review of bones shows osteopenia with 6 significant\ndegenerative changes involving the thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows bilateral\nadrenal thickening left greater than right.  There is mild splenomegaly.",
            "output": "No evidence of pulmonary embolism or aortic dissection.\n\nBilateral pleural effusions right greater than left have increased in volume\nsince the prior study.\n\nMild interstitial edema.\n\nNo significant interval change in the nodular scar-like opacities in the left\nlower lobe, the left upper lobe anteriorly and within the right lower lobe. \nNo new consolidations.\n\nOsteopenia with degenerative changes involving the thoracic spine."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus.\nMain pulmonary artery remains mildly dilated, measuring 3.2 cm (3:102),\nsuggesting pulmonary arterial hypertension.  The thoracic aorta is normal in\ncaliber without evidence of dissection or intramural hematoma.  Cardiomegaly\nis redemonstrated.  There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: Moderate bilateral pleural effusion is unchanged from ___ CTA chest.  Pleural effusion tracks along the major fissures bilaterally,\nsimilar to prior.\n\nLUNGS/AIRWAYS: Bilateral interlobular septal thickening with ground-glass\nopacities are compatible with mild interstitial pulmonary edema, grossly\nsimilar to ___ CTA chest.  There is subsegmental compressive\natelectasis of the bilateral lung bases overlying the pleural effusions as\nwell as along the major fissures.  Biapical pleural thickening and parenchymal\nscarring is redemonstrated and similar to prior.  Nodular opacities in the\nbilateral lower lobes, at the level of the mid lung (best seen on coronal\nreformats series 601 image 70-72) are redemonstrated today, overall similar in\nlocation when compared to studies dating back to ___ but appearing\nmore ground-glass today rather than solid.  These findings may represents\nbilateral chronic aspirations however superimposed infection cannot be\nexcluded.  Mild bilateral bronchial wall thickening is seen.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Large hiatal hernia is redemonstrated.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Cardiomegaly with mild interstitial pulmonary edema.\n3. Moderate bilateral pleural effusions, similar to ___ CT chest.\n4. Multifocal opacities in the dependent bilateral lower lungs visible in\nstudies dating back to ___ suggests chronic aspirations, however\nsuperimposed infection cannot be excluded."
        },
        {
            "input": "CHEST PERIMETER: No findings in the imaged lower thyroid need any further\nimaging evaluation.  No pathologic enlargement of supraclavicular or axillary\nlymph nodes.  No soft tissue abnormality elsewhere in the chest wall. This\nstudy is not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nor other mass in the partially imaged upper abdomen.\n\nCARDIO-MEDIASTINUM: Large axial hiatus hernia is chronic.  Moderate to severe\ndilatation of the mid and upper esophagus is also chronic varying from one\nexam to the next.  Intermittent retention of fluid in the esophagus suggests\nreflux or dysmotility.\n\nAtherosclerotic calcification is moderate in head and neck vessels and severe\nthroughout the coronary arteries.  Moderate cardiomegaly overall and severe\nleft atrial enlargement are grossly unchanged since ___, but increased since\n___.\n\nAortic valvular calcification is moderate.  Mitral annulus calcification is\nextremely heavy.\n\n\n\nTHORACIC LYMPH NODES: 16 x 20 mm left lower paratracheal mediastinum,\nunchanged since ___.  Smaller lymph nodes in the right lower paratracheal\nstation have probably improved.  No appreciable hilar lymph node enlargement.\n\nLUNGS, AIRWAYS, PLEURAE: Previous moderate layering non serous pleural\neffusions have nearly resolved since ___.\n\nA region of subsegmental paraspinal consolidation in the superior segment of\nthe right lower lobe, 5:139-158, and a small stellate lesion inferior to it,\n5:206, are probably atelectasis or scarring, since both are unchanged since\n___.\n\nThe small region of peripheral consolidation in the left upper lobe that\ndeveloped between ___ and ___, 5:44, is stable.  Atelectasis in the left\nupper lobe against the major fissure has improved since ___.  Small region\nof peribronchial infiltration in the superior segment, left lower lobe, has\nimproved, 5:126, common location for aspiration.  All all all\n\nModerate bronchial wall thickening has improved since ___ and there is\nlittle or no retention of secretions.\n\nCHEST CAGE: Myomatous infiltration of the thoracic spine is extensive, though\nexaggerated by presence of pre-existing lymphangioma, probably responsible for\nfocal upper endplate intrusion of T6 vertebral body, unchanged since ___.  Mild loss of height mid T2 vertebral body developed between ___ and\n___, subsequently stable.  There is no pathologic fracture, despite\nmyelomatous lucencies in the sternum and several ribs, unchanged.",
            "output": "No evidence of active intrathoracic infection or malignancy.\n\nPrevious moderate pleural effusions have resolved, associated atelectasis has\nnearly cleared and 2 very small regions of likely infection, left upper and\nlower lobes are smaller today.\n\nModerate cardiomegaly, severe left atrial enlargement may be related to mitral\nannular calcification, sometimes producing mitral regurgitation.  No pulmonary\nedema currently.\n\nDespite extensive myeloma involvement in the thoracic spine and scattered\nelsewhere in the chest cage, there is no pathologic or appreciable compression\nfracture.  Mild upper endplate intrusion midthoracic spine is stable since\n___ and mild loss of height in the T2 vertebral body developed\nbetween ___ and ___, subsequently stable."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE: There is a 8 mm heterogeneous lesion of the\nleft lobe of the thyroid (6:46).  There are no pathologically enlarged lymph\nnodes of the thoracic inlet or bilateral axilla.  Head and neck vessels are\nmoderately calcified (5:6).\n\nMEDIASTINUM:  The 9 mm left lower paratracheal lymph node which was\npathologically enlarged prior in ___ is now decreased in size and now\nborderline pathologically enlarged (6:113).  Several smaller paratracheal\nlymph nodes have decreased in size since ___, and are not pathologically\nenlarged (6: 83, 103, 108).  There are no new or enlarging lymph nodes in the\nmediastinum.\nA largely patulous esophagus is I had above a moderate hiatal hernia.\n\nHILA:  The hilar lymph nodes are not pathologically enlarged.\n\nHEART: The heart is mildly enlarged with no pericardial effusion.  There is\nextensive calcification of the coronary arteries.  There is moderate\ncalcification of the aortic valve and mitral annulus.  Recommend further\nevaluation with echocardiogram.\n\nVESSELS:  The caliber of the aorta and pulmonary arteries is normal.\n\nPULMONARY PARENCHYMA:  Evaluation somewhat limited due to respiratory motion\nartifact.  Paraspinal consolidation is again noted of the right lower lobe\nconsistent with atelectasis (6:199). Mild interstitial thickening of the lower\nlung bases consistent with bibasilar atelectasis (6:236).\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.  Mild\nbronchial thickening is unchanged.\n\nPLEURA:  There are no pleural effusions.  There is moderate right apical\nscarring.\n\nCHEST WALL AND BONES:  There are multilevel heterogeneous lucencies of the\nthoracic spine and anterior right rib (9:15) which may be consistent with\nmultiple myeloma.  Some lucencies demonstrate vertical opacities which are\nmore consistent with vertebral body hemangioma.  There is no evidence of\npathologic fracture.  There are extensive multilevel degenerative changes of\nthe thoracic spine with prominent osteophytosis, stable..\n\nUPPER ABDOMEN:  Please see separately submitted Abdomen and Pelvis CT report\nfor subdiaphragmatic findings.",
            "output": "There is no evidence of active infectious process, nor evidence of pulmonary\nedema.  Mild bronchial inflammation is still present.\nSeveral mediastinal lymph nodes which were pathologically enlarged in prior\nexamination are now smaller consistent with reactive lymphadenopathy.\nExtensive calcifications of the aortic valve, mitral annulus and coronary\narteries are noted.  Recommend further evaluation with echocardiogram.\nPlease see separately submitted Abdomen and Pelvis CT report for\nsubdiaphragmatic findings."
        },
        {
            "input": "The airways are patent to the segmental level.  Small amount of fluid is seen\nwithin the pericardial recesses. A 1.8 x 1.9 cm (02:30) (previously 1.7 x 1.1\ncm) heterogeneous hypodense soft tissue lesion is seen adjacent to the\nesophagus is consistent with a possibly necrotic lymph node within the station\n10 on the left. No additional mediastinal, hilar, or axillary lymph node\nenlargement. The lesion is between the left main pulmonary artery and aorta\nwith preserved fat plane. No additional retroperitoneal or prevascular lymph\nnodes identified.  The heart and great vessels are within normal limits. No\nhiatal hernia is identified.  No significant pericardial effusion. No focal\nopacity identified within the lungs. No pleural effusion or pneumothorax.\n\nThe aorta and main thoracic vessels are well opacified. The aorta demonstrates\nnormal caliber throughout the thorax without interval hematoma or dissection.\nThe pulmonary arteries are opacified to the segmental level. No filling defect\nto suggest pulmonary embolism.\n\nOsseous structures: Multilevel degenerative disease is noted throughout the\nthoracic spine with multiple sclerotic and lytic lesions throughout the\nvertebrae. New periosteal reaction and callus formation involving the right\n___ through ___ antrolateral ribs consistent with old healed fractures. An\nosteolytic lesion involving the T6 vertebral body is similar in appearance to\nprevious examination however a new focal endplate irregularity at T8 is seen\nwithin appearance suggesting a Schmorl's node versus new osteolytic lesion\nfrom known myeloma. .",
            "output": "1. No evidence of pulmonary embolism or aortic dissection.\n2. Interval increase in a 1.9 cm low density lymph node within left station\n10. Dedicated six-month followup CT is recommended.\n3. Multiple osseous osteolytic and sclerotic lesions superimposed on coarse\ndiffuse demineralization in the thoracic spine in this patient with known\nmultiple myleoma with probable new lesion inferior endplate T8.  No\ncompression fracture.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 17:27 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "A left lower paratracheal lymph node with mildly irregular margins measures up\nto 20 x 17 mm in axial ___ which is a decrease from prior measurements\nof 20 x 18 mm although it persists. There are no pleural or pericardial\neffusions. Coronary artery calcifications are widespread.\n\nNo pulmonary arterial filling defects are demonstrated.\n\nCentral airways show similar inflammatory thickening, and there are patchy\nplate-like opacities in the basilar segments of the lower lobes indicating\natelectasis as well as minor atelectasis in the lingula and right middle lobe.\n\nLimited views of the upper abdomen are unremarkable.\n\nThere is again a vague sclerotic appearance to the bones associated with the\nhistory of myeloma. Large Schmorl's nodes along the superior endplate of T6\nand the inferior endplate of T8 appear unchanged. There has been no\nsignificant change in the bones.",
            "output": "1.  Mild decrease in abnormal left paratracheal lymph node.\n\n2.  Persistent central airway thickening suggesting inflammatory process\ninvolving the airways.\n\n3.  No evidence of pulmonary embolism.\n\n4.  Stable abnormal appearance of bony structures associated with known\nhistory of multiple myeloma."
        },
        {
            "input": "There is no supraclavicular or axillary adenopathy and no soft tissue\nabnormality in the chest wall suspicious for malignancy. This study is not\ndesigned for subdiaphragmatic diagnosis but shows normal-size adrenal glands.\n\nThyroid is unremarkable. Atherosclerotic calcification in head and neck\nvessels is mild, but extensive in all major coronaries.  Aortic valvular\ncalcification is mild but sufficient to warrant clinical evaluation of its\nhemodynamic effect. Aorta, pulmonary arteries, and chambers are normal size.\nThere is no pleural abnormality. Pericardium is physiologic.\n\n15 x 20 mm low left lower paratracheal lymph node, 5:107, was 11 by 23 mm in\non ___ x 22 mm on ___. No other central lymph nodes\nare pathologically enlarged.\n\nDiffuse bronchial wall thickening is less pronounced today several locations.\nPeripheral impaction is minimal, including the lingula. There is no pulmonary\nabnormality conforming to the abnormality seen on recent chest radiographs.\nThere are no lung nodules, cavities, or any consolidation.\n\nAllowing for differences in radiographic technique there has been no\nprogression of several osteolytic regions in the thoracic spine, associated\nwith large disc intrusions of 's the associated endplate. There is no\nappreciable compression or evidence for invasion of the vertebral canal. Areas\nof more permeative bone involvement in the sternum have not progressed and\nthere is no associated fracture.",
            "output": "No evidence of intrathoracic infection or malignancy outside of stable chest\ncage lesions. No compression or pathologic fractures.\n\nInterval improvement in previously more extensive bronchial wall thickening,\nwhich may have been the source of coughing.  There is no lesion corresponding\nto the questioned abnormality on recent chest radiographs.\n\nHeavy coronary atherosclerosis. Aortic valvular calcification, hemodynamic\nsignificance indeterminate."
        },
        {
            "input": "No pathologically enlarged mediastinal, hilar or axillary lymph nodes\ndemonstrated. Aorta and pulmonary arteries are normal in diameter.  Heart size\nis normal. There is no pericardial pleural effusion. Image portion of the\nupper abdomen reveals no appreciable abnormality\n\nAirways are patent to the subsegmental level bilaterally.  Centrilobular\nopacity in the right upper lobe is minimal, series 5, image 105. Right middle\nlobe subpleural nodule, series 5, image 183 is 3.5 mm in diameter, and there\nis a right middle lobe linear atelectasis present. Centrilobular nodules, few,\npresent in the left upper lobe. Linear atelectasis in lingula is present,\nseries 5, image 163 as well as subpleural nodule, series 5, image 163, 4 mm in\ndiameter. A right lower lobe nodule, series 5, image 232 is 3.5 mm.\n\nThere are no lytic or sclerotic lesions worrisome for infection or neoplasm.",
            "output": "No definitive evidence of tuberculosis or definitive evidence of infectious\nprocess. Minimal centrilobular nodules in the right upper lobe with some\nelements of ___ and several pulmonary nodules are present, entirely\nnonspecific and potentially can represent infectious process. Short-term\nfollowup in 8 weeks after completion of antibiotic therapy might be\nconsidered.\n\nPulmonary nodules should be reassessed in ___ year for documentation of\nstability."
        },
        {
            "input": "THORACIC INLET: Thyroid is diffusely enlarged with multiple hypodense areas\nwithin it most likely represents a multinodular goiter.\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes.\n\nMEDIASTINUM: The main pulmonary artery is mildly enlarged and measures 3.5 cm.\nThere are no enlarged mediastinal hilar lymph nodes.  Heart size is normal. \nThere is no pericardial effusion.  The aorta and is normal in caliber\n\n\nPLEURA: There is no pleural effusion\n\nLUNG: Patient status post wedge resection the left upper lobe and left lower\nlobe with evolving postsurgical changes.  No evidence of local recurrence. \nMild upper lobe predominant centrilobular emphysema.  No new pulmonary\nnodules.\n\nBONES AND CHEST WALL : Review of bones shows degenerative changes involving\nthe thoracic spine.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows mild fatty\ninfiltration of the liver.  No adrenal masses status post left upper lobe\nwedge resection with no evidence of local recurrence.",
            "output": "Previously visualized left upper and left lower lobe nodules have been\nresected in the interim.  First postoperative baseline scan.  No new pulmonary\nnodules."
        },
        {
            "input": "The thyroid remains prominent and heterogeneous without dominant nodule,\nplease correlate clinically.  Rebound thymic tissue is again noted in the\nanterior mediastinal space.  The thoracic aorta is normal in course and\ncaliber without significant atherosclerotic calcifications.  The heart is\nwithin normal limits of size and shape without pericardial effusion.  The main\npulmonary artery is stably prominent measuring up to 3.3 cm, which could\nreflect pulmonary arterial hypertension.  No filling defect is seen within the\ncentral branches of the pulmonary arterial tree.  Left hilar lymph nodes\nappear slightly prominent for example on series 302, image 79 measuring 12 x\n13 mm, previously 12 x 9 mm.  Please note, in this patient with prior left\nhilar lymph node dissection, findings may in part reflect postsurgical\nchanges.  Slightly inferiorly, there is soft tissue nodularity at the left\nhilum measuring 15 x 11 mm, series 302, image 86, previously 17 x 15 mm. \nContiguous scarring is seen extending to the suture line which appears\nslightly decreased from prior exam likely representing evolving postsurgical\nchanges.  Mildly prominent prevascular lymph nodes seen on series 302, image\n65 measuring up to 11 mm in short axis, similar to prior exam.  A precarinal\nlymph node measures 9 mm in short axis, previously the same.  Several small\nlymph nodes adjacent to the distal esophagus are prominent though not changed\nfrom prior measuring up to 8 mm in short axis.\n\nNo pleural effusion or pneumothorax.  The esophagus is unremarkable.\n\nPatient is undergone prior left upper lobe wedge resection.  As stated above,\nthe pattern of nodularity along the suture line appears marginally improved\nlikely expecting expected evolution of postsurgical changes.  No new or\ngrowing pulmonary nodule.  Mild background emphysema is redemonstrated.\n\nWithin the imaged upper abdomen, tiny hypodensities within the liver appear\nunchanged from the most recent prior CT abdomen pelvis.  No acute findings\nseen.\n\nBones: No worrisome lytic or blastic osseous lesion.  Multilevel bridging\nosteophytes are noted anteriorly within the thoracic spine.  No discrete\nconcerning lytic or blastic osseous lesion is seen.  Bones appear slightly\ndemineralized diffusely.",
            "output": "1. Status post wedge resection in the left upper and lower lobe.  Persistent\nmild prominence of left hilar and prevascular lymph nodes and soft tissue\nnodularity along the suture, likely postsurgical changes.  Consider PET-CT to\nfurther assess for residual disease.\n2. No new or growing pulmonary nodule."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL: Known multinodular goiter is\npartially imaged.  There is no axillary or supraclavicular adenopathy. \nEvaluation of the breast tissue is reserved exclusively for dedicated breast\nimaging.  The soft tissues of the chest wall are unremarkable.  Right chest\nwall Port-A-Cath with right IJ access terminates in the lower SVC.  The\npartially imaged thyroid appears diffusely prominent and heterogeneous, please\ncorrelate with prior workup.\n\nMEDIASTINUM AND HILA: Small amount of residual thymic tissue is noted in the\nanterior mediastinal space. 1.1 cm prevascular and 0.7 cm precarinal lymph\nnodes are unchanged.  The previously noted conspicuous left hilar lymph nodes\nhave decreased in size (2: 37-39), suggesting that there prior prominence may\nhave been due to postsurgical reaction.  Several subcentimeter paraesophageal\nnodes are unchanged.  The esophagus is unremarkable.\n\nHEART, PERICARDIUM AND VASCULATURE: The heart is normal in size and\nconfiguration.  There is no pericardial effusion.  Mild coronary artery\ncalcifications are unchanged.  The main pulmonary artery diameter is 3.4 cm,\nmildly enlarged, as can be seen in setting of pulmonary hypertension.\n\nLUNGS, AIRWAYS, AND PLEURA: Upper lobe predominant emphysema is noted.\nThe patient has undergone prior left upper lobe wedge resection.  Nodular soft\ntissue thickening along the suture line is again noted, measuring up to 9 mm,\nnot significantly changed from prior (302:77).  Suture is also noted in the\nleft lung base.  Minimal linear density in the left lung base is unchanged\nlikely representing mild scarring.  No new or growing pulmonary nodule.  There\nis no convincing evidence of local recurrence.  No new or growing pulmonary\nnodules are identified.  There is no pleural effusion or pneumothorax.  The\nairways are patent centrally.\n\nCHEST CAGE: There are pronounced degenerative changes of the left ninth\ncostovertebral joint and anterior endplate osteophytes involving the\nmidthoracic spine.  No fracture.  No worrisome lytic or blastic osseous\nlesion.\n\nUPPER ABDOMEN: Please refer to separate report of CT abdomen and pelvis\nperformed on the same day for description of the subdiaphragmatic findings.",
            "output": "Similar postsurgical appearance after left upper lobe wedge resection with\nhilar lymph node dissection.  No definite signs of recurrent tumor.  No new or\ngrowing pulmonary nodules."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE:  The visualized thyroid is normal. \nSupraclavicular and axillary lymph nodes are not enlarged.\n\nMEDIASTINUM:  Mediastinal lymph nodes are not enlarged.\n\nHILA:  Hilar lymph nodes are not enlarged.\n\nHEART:  The heart is not enlarged and there is extensive coronary arterial\ncalcification.  There are also severe calcifications in the aortic valve.  An\nanterior approach pericardial drain is in place.  There is a trace residual\npericardial effusion.\n\nVESSELS:  Vascular configuration is conventional.  Aortic caliber is normal.\nThere are moderate atherosclerotic calcifications in the thoracic aorta and at\nthe origins of the great vessels. The main, right, and left pulmonary arteries\nare normal caliber.\n\nPULMONARY PARENCHYMA: There is biapical pleuroparenchymal scarring with\nnodular components.  There are scattered 2 mm nodules in right lower lobe\n(5:180, 97, 123).  There is no focal consolidation.\n\nAIRWAYS:  The airways are patent to the subsegmental level bilaterally.\n\nPLEURA:  There is no pleural effusion.\n\nCHEST WALL AND BONES: There is a healing fracture in the right first rib (5:\n25).  There are additional healing fractures in the right second, third and\nfourth ribs.  There is no worrisome lytic or sclerotic lesion.  Multilevel\ndegenerative changes are mild.\n\nUPPER ABDOMEN:  This study is not tailored for evaluation of the abdomen.\nAllowing for this, the partially visualized upper abdomen is notable for\npunctate calcifications in the right hepatic lobe.",
            "output": "1. Punctate, subpleural nodules in the right lower lobe are nonspecific, but\nlikely infectious versus inflammatory in etiology.\n2. Trace residual pericardial effusion with a pericardial drain in situ.\n3. Incidentally noted are multiple healing right-sided rib fractures."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no supraclavicular or axillary lymphadenopathy.  The\npatient is post median sternotomy with intact sternotomy wires.\n\nUPPER ABDOMEN: Unremarkable\n\nMEDIASTINUM: No mediastinal lymphadenopathy.  Small volume fluid is seen\nwithin the anterior mediastinum, presumably related to recent median\nsternotomy.  No retrosternal or anterior mediastinal gas or organized\ncollections.\n\nHILA: No hilar lymphadenopathy given limitations of noncontrast technique.\n\nHEART and PERICARDIUM: There is a large pericardial effusion of simple density\nfluid.  Evaluation for tamponade is limited given the lack of intravenous\ncontrast to assess the ventricular size.  The patient is post aortic valve\nreplacement.  Coronary artery calcification is present.\nPLEURA: There is no pleural effusion or pneumothorax\nLUNG:\n\n1. PARENCHYMA:  Re-demonstrated is biapical pleuroparenchymal scarring with\nnodular components.  A dominant right apical nodule measures 4 mm (302:43). \nMild left anterior subpleural reticulation (302:63) as well as at the lung\nbases bilaterally likely reflect atelectasis.  No suspicious consolidation.\n2. AIRWAYS:  The airways are patent to the subsegmental level however there is\nmass effect on the lingular branches secondary to the large pericardial\neffusion.\n3. VESSELS:  The thoracic aorta is not distended.  Calcification is present. \nThe main pulmonary arteries not dilated.\nCHEST CAGE: Healing right upper rib fractures (first through fourth).",
            "output": "Large nonhemorrhagic pericardial effusion.  Correlate clinically for\ntamponade."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus. \nSubsegmental branches are not particularly well assessed due to timing of the\ncontrast bolus.  Main pulmonary artery is top normal in size, which may\nsuggest pulmonary arterial hypertension.  Mild atherosclerotic calcifications\nof the thoracic aorta.  The thoracic aorta is normal in caliber without\nevidence of dissection or intramural hematoma.  Patient is status post CABG. \nOtherwise, the heart, pericardium, and great vessels are within normal limits.\nNo pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear atelectasis within the right lower lobe is unchanged. \nNo new focal consolidations.  No suspicious pulmonary nodules.  Small amount\nof secretions within the trachea at the carina.  Otherwise, the airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN: Simple cyst partially imaged within the upper pole of the right\nkidney.\n\nBONES: Sternotomy wires appear intact and appropriately aligned. \nWell-circumscribed sclerotic lesion within the manubrium is likely a bone\nisland.  Lucent lesions in the anterolateral right fourth rib and the\nposterolateral right seventh rib are unchanged dating back to ___ and of\ndoubtful clinical significance.  No suspicious osseous abnormality is seen.?\nThere is no acute fracture.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma.  Moderate coronary calcifications are redemonstrated. \nThe heart, pericardium, and great vessels are within normal limits. No\npericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Linear atelectasis in the right lower lobe has been present\nsince ___ and increased since, however unchanged from immediately\nprior ___.  There is associated mild bronchial wall thickening in the\nright lower lobe without mucous impaction or bronchiectasis.  Remainder of the\nairways are airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: Sternotomy wires are redemonstrated and appear intact.  Healed median\nsternotomy.  No acute fractures or suspicious bone lesions.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Chronic atelectasis in the right lower lobe since ___, increased in size\nseen however unchanged from immediately prior."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged portion of the thyroid\ngland is unremarkable.  Supraclavicular and axillary lymph nodes are not\nenlarged.  There is mild anasarca.\n\nUPPER ABDOMEN: There is a punctate calcified granuloma in the right hepatic\nlobe.  Simple right renal cyst.  The imaged upper abdomen is otherwise\nunremarkable.\n\nMEDIASTINUM: Mediastinal lymph nodes are not enlarged.  No mediastinal\nhematoma.\n\nHILA: No hilar mass.\n\nHEART and PERICARDIUM: Heart size is normal.  The patient is status post CABG.\nSevere calcifications of the native coronary arteries are noted.  No\npericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA:  The lungs are clear and there is no focal consolidation or\nmass.  A calcified granuloma is seen in the superior segment of the right\nlower lobe.  There is subsegmental atelectasis at the right greater than left\nbase.\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  The main pulmonary artery measures up to 2.9 cm, top normal.  The\nascending aorta measures up to 4 cm, mildly dilated.  These findings are\nunchanged from ___.\n\nCHEST CAGE: Median sternotomy wires are in place.  There is no acute fracture\nor aggressive osseous lesion.",
            "output": "No evidence of traumatic injury in the chest."
        },
        {
            "input": "HEART AND VASCULATURE: Heart size is top-normal.  No pericardial effusion. \nMild calcified coronary atherosclerosis.  The thoracic aorta is normal in\ncaliber.  No evidence of dissection or penetrating atherosclerotic ulcer\nformation.  The main pulmonary artery is borderline enlarged.  Assessment of\nthe lung apices is limited by poor contrast bolus timing on repeat imaging as\nthey were initially excluded from the field of view. No evidence of pulmonary\nembolus. Incidental common origin of the left common carotid and innominate\narteries.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Mediastinal clips are noted\nstatus-post median sternotomy.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: The airways are patent to the subsegmental level.  Chronic\nlinear atelectasis of the right lower lobe anterior basal segment is\nunchanged.  The lungs are otherwise clear.  No focal consolidation or\nsignificant pulmonary nodule.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nStatus-post median sternotomy.  Anterior flowing osteophytosis in the thoracic\nspine is consistent with diffuse idiopathic skeletal hyperostosis.",
            "output": "No evidence of pulmonary embolism or aortic abnormality."
        },
        {
            "input": "HEART AND VASCULATURE: Patient is status post sternotomy.  Pulmonary\nvasculature is well opacified to the subsegmental level without filling defect\nto indicate a pulmonary embolus.  The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma.  Aortic valve and\ncoronary calcifications.  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Right basilar linear atelectasis, with otherwise clear lungs\nwithout masses or areas of parenchymal opacification.  The airways are patent\nto the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable with an\nincompletely imaged cyst in the upper pole of the right kidney.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nDegenerative changes with DISH seen.",
            "output": "1. No evidence of pulmonary embolism or acute aortic abnormality.\n2. Atherosclerotic disease."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is grossly unremarkable. \nNo supraclavicular or axillary lymphadenopathy.\n\nUPPER ABDOMEN: Small hiatal hernia noted.  3.5 cm hypodensity arising from the\nupper pole of the right kidney, compatible with a simple cyst.  Limited\nassessment the abdomen is otherwise grossly unremarkable.\n\nMEDIASTINUM: No mediastinal lymphadenopathy.\n\nHILA: No hilar lymphadenopathy.\n\nHEART and PERICARDIUM: Pericardial effusion.  Coronary calcification.\nPLEURA: Pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  No suspicious pulmonary nodules.  There is mild atelectasis at\nthe right lung base.\n2. AIRWAYS:  There is a small amount of debris in the dependent portion of the\nmid trachea (series 6, image 65).  Airways are otherwise patent the\nsubsegmental level.\n3. VESSELS:  Aorta and main pulmonary artery are normal in size.  No pulmonary\nembolus.\nCHEST CAGE: Patient is status post median sternotomy.  Bridging anterior\nvertebral body osteophytes are noted throughout midthoracic spine.  An 11 mm\nlucent lesion within posterolateral aspect of right seventh rib (series 6,\nimage 165), is unchanged from ___ and of doubtful clinical significance.",
            "output": "No evidence of pulmonary embolus.  No acute intrathoracic abnormality."
        },
        {
            "input": "CT CHEST WITH IV CONTRAST: Right central venous catheter terminates in the\nupper right atrium.  Endotracheal tube is approximately 8 mm from the carina. \nEnteric tube courses through the esophagus and into the stomach.\n\nImaged thyroid is unremarkable.  There is no supraclavicular, axillary, hilar\nor mediastinal lymphadenopathy.  There is residual thymic tissue, not\nunexpected for patient's age.  Heart size is normal without pericardial\neffusion the aorta and great vessels are well opacified and normal in caliber.\nThe main pulmonary arteries are normal in caliber.\n\nThe tracheobronchial tree is patent to the subsegmental level.  There is no\npleural effusion or pneumothorax.  Evaluation of lung parenchyma is slightly\nlimited by breathing motion however no worrisome pulmonary nodule or opacity\nis detected.  The tracheobronchial tree is patent to the subsegmental level.\n\nOSSEOUS STRUCTURES: There is no worrisome blastic or lytic lesion. \nMineralization appears appropriate for patient's age.",
            "output": "1. ET tube is approximately 8 mm from the carina.  Consider withdrawing 2 cm.\n2. Unremarkable appearance of the thymus.\n3. Please note CT of the abdomen and pelvis will be reported separately.\n\nNOTIFICATION:  The findings were telephoned to Dr.  ___ by ___\nat 13:45,  ___, 3 min after discovery."
        },
        {
            "input": "VASCULATURE: No evidence of pulmonary embolus.  The thoracic aorta is normal\nin caliber. There is no pericardial effusion.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.  Multiple foci of air in the\nmediastinum, possibly secondary to recent esophageal surgery.\n\nPLEURAL SPACES: Trace right pleural effusion and small left pleural effusion. \nNo pneumothorax.\n\nLUNGS/AIRWAYS: Bibasilar subsegmental atelectasis, left greater than right. \nModerate Paraseptal emphysema predominantly in the upper lobes.\n\nBASE OF NECK: Visualized portions of the base of the neck show no significant\nabnormality.\n\nABDOMEN:  Included portion of the upper abdomen demonstrates a 2.4 cm right\nadrenal adenoma.  Residual contrast is seen within the proximal stomach and\npostsurgical changes of reversed fundoplication.\n\nBONES: No aggressive bone lesions.",
            "output": "1. No evidence of pulmonary embolism.  Mild pneumomediastinum is likely\nsecondary to recent esophageal surgery.\n2. Small left pleural effusion and trace right pleural effusion. Bibasilar\nsubsegmental atelectasis, left greater than right.\n3. Right adrenal adenoma.\n\nNOTIFICATION:   The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 3:31 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  No evidence of hilar or mediastinal\nlymphadenopathy.  All paraesophageal lymph nodes (3, 29) Are normal in size. \nThere is mild circumferential thickening that is, in parts, asymmetrical (3,\n48) Notably at the lower aspect of the esophagus.  The gastroesophageal\njunction is thickened.  Moderate coronary calcifications, no valvular\ncalcifications, no pericardial effusion.  The right adrenal adenoma and other\nabdominal findings are described in detail in the dedicated abdominal CT\nreport.  Mild degenerative vertebral disease.  No vertebral compression\nfractures.  No no osteolytic lesions at the level of the ribs, the sternum, or\nthe vertebral bodies.\nModerate right predominant paraseptal pulmonary emphysema.  Normal appearance\nof the large mediastinal vessels.  Moderate thickening and irregularities of\nthe airway walls.  Several subpleural micronodules but no suspicious pulmonary\nnodules or masses are visualized.  No pleural thickening, no pleural\neffusions.  No diffuse lung disease.",
            "output": "Partly eccentric thickening of the esophageal wall, no evidence of\nperiesophageal lymphadenopathy.  No mediastinal lymphadenopathy.  No pleural\nabnormalities.  Is moderate chronic bronchitis.  Moderate right predominant\nparaseptal pulmonary emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE AND CHEST WALL:\nThe thyroid is unremarkable.  No enlarged lymph nodes in either axilla or\nthoracic inlet.  Right anterior port with tip in the lower SVC.  Mild\natherosclerotic calcifications in the head and neck arteries.\n\nHEART AND VASCULATURE:\nThe heart is normal size and shape.  No pericardial effusion.  Mild\natherosclerotic calcifications in the coronary arteries and aorta, none in the\ncardiac valves.  The pulmonary arteries and aorta are normal in caliber\nthroughout.\n\nMEDIASTINUM AND HILA:\nSmall hiatal hernia.  The esophagus is otherwise unremarkable.  Small\nmediastinal lymph nodes, none pathologically enlarged by CT size criteria.  No\nhilar lymphadenopathy.\n\nPLEURA:\nNo pleural effusions.  No apical scarring bilaterally.\n\nLUNGS:\nThe airways are patent to the subsegmental levels.  No bronchial thickening,\nbronchiectasis or mucus plugging.  No suspicious lung nodules or masses.  No\nconsolidations or atelectasis.\n\nCHEST CAGE:\nNo acute fractures.  No suspicious lytic or sclerotic lesions.  Mild dorsal\nspondylosis.\n\nUPPER ABDOMEN:\nPlease refer to same day abdominal CT report for subdiaphragmatic findings.",
            "output": "No evidence of intrathoracic metastatic disease.  No suspicious lung nodules,\nlymphadenopathy or osseous lesions."
        },
        {
            "input": "No incidental thyroid findings.  Right pectoral Port-A-Cath.  No\nsupraclavicular, infraclavicular, or axillary lymphadenopathy.  No enlarged\nlymph nodes in the mediastinum or at the level of the hilar structures. \nNormal appearance of the large mediastinal vessels.  No incidental pulmonary\nembolism.  Stable mild coronary calcifications, no valvular calcifications, no\npericardial effusion.  Stable moderate hiatal hernia.  Upper abdominal\nfindings are described in detail in the dedicated abdominal CT report.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.\nThe lung parenchyma is unremarkable, with the exception of minimal stable left\nbasal non characteristic scarring.  No suspicious pulmonary nodules or masses.\nNo pleural effusions.  No pleural thickening.  The airways are patent.  No\ndiffuse lung disease.",
            "output": "Stable examination of the thorax.  No evidence of metastatic disease.  No\nadenopathy.  No pleural abnormalities."
        },
        {
            "input": "HEART AND VASCULATURE:  The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits based on an unenhanced\nscan. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent.  Slight anterior mediastinal soft tissue prominence with interspersed\nfat is favored to represent residual thymus.  No large mediastinal mass or\nhematoma.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: There is minimal dependent atelectasis.  Otherwise, lungs are\nclear without masses or areas of parenchymal opacification.  The airways are\npatent to the level of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the unenhanced upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1. No acute intrathoracic process\n2. Slight soft tissue and fatty prominence within the anterior mediastinum is\nfavored to represent a residual thymus."
        },
        {
            "input": "There is an 8 mm left thyroid nodule, likely present on prior study on ___ but less conspicuous.  Supraclavicular, axillary, mediastinal\nand hilar lymph nodes are not enlarged. Aorta and pulmonary arteries are\nnormal size.  There is a partially visualized lower thoracic azygous vein\nstent, better depicted on concurrent CT abdomen pelvis.  No filling defect is\nseen in the central pulmonary arteries. Cardiac configuration is normal and\nthere is no appreciable coronary calcification.\n\nThere is mild bibasilar atelectasis, otherwise there is no focal\nconsolidation, pleural effusion or pneumothorax. The airways are patent to the\nsubsegmental level.\n\nNo suspicious bony lesions are identified.\n\nIntra-abdominal findings are reported separately.",
            "output": "No intrathoracic infection or lymphadenopathy.  No acute intrathoracic\nprocess.\nIntra-abdominal findings are reported separately."
        },
        {
            "input": "The thyroid is diffusely enlarged with multiple nodules.  Largest thyroid\nnodule measures 2.0 cm in the right lobe.  There is no axillary,\nsupraclavicular, or mediastinal lymphadenopathy.  The heart is massively\nenlarged with a moderate simple pericardial effusion.  The main pulmonary\ntrunk is dilated to 3.9 cm.  The thoracic aorta measures up to 4.2 cm, top\nnormal for the patient's age.  There is mild atherosclerosis.\n\nThere is a moderate right and a small left pleural effusion.  There is no\npneumothorax.  The airways are patent to the segmental level.  Note is made of\na patchy opacity at the right lung base (series 302, image 150).\n\nAn endotracheal tube is appropriately position.  Airways are patent to the\nsegmental level bilaterally.\n\nThe thoracic esophagus is unremarkable.  A nasoenteric tube is seen within the\nstomach.  A few foci of intra-abdominal air are consistent with post surgical\nchange.  There is moderate ascites.  There are bilateral hypodense renal\nlesions consistent with cysts.  A hyperdense cyst is noted in the left upper\npole measuring 1.8 cm consistent with a proteinaceous/hemorrhagic cyst. \nSurgical sutures noted within left upper quadrant.  The liver is cirrhotic\nmorphology.\n\nThere are multilevel degenerative changes of the spine without traumatic\ninjury identified.  Note is made of large Schmorl's nodes in the upper lumbar\nspine.  Chronic fractures are noted of the left anterolateral tenth and ninth\nribs.  No displaced rib fractures are seen.",
            "output": "1. No evidence of traumatic injury in the chest.\n2. Moderate right and small left pleural effusion with associated atelectasis.\n3. Severe cardiomegaly with a small to moderate simple pericardial effusion.\n4. Patchy right basilar opacity may reflect developing infection or be related\nto aspiration.\n5. Enlarged multinodular thyroid with the largest nodule measuring 2.0 cm,\nconsider emergent thyroid ultrasound for further evaluation.\n6. Post splenectomy with a few foci of pneumoperitoneum.\n7. Moderate ascites.\n\nRECOMMENDATION(S):  Non emergent thyroid ultrasound"
        },
        {
            "input": "Stable appearance of the thyroid.  Stable position of the chest tube.  Little\nchange is noted in the extent of the bilateral pleural effusions.  The wall of\nthe aorta remains heavily calcified.  There is stable dilatation of the main\npulmonary artery.  Moderate coronary calcifications, moderate aortic valve\ncalcifications.  Extensive bilateral areas of atelectasis.  Moderate\nrelatively dense pericardial effusion, predominating in the gravity dependent\nregions of the body, small tennis leak, the heart is globally enlarged. \nStable moderate bilateral apical scarring.  The pre described parenchymal\nopacities are overall stable.  Only in the gravity dependent parts of the lung\nthe extent of consolidation has minimally increased.  A feeding tube remains\nin situ.",
            "output": "Moderate pericardial effusion.  Moderate global cardiomegaly.  Minimal\nincrease in extent of the dependent consolidations.  Otherwise no relevant\nchange as compared to ___."
        },
        {
            "input": "FINDINGS:\n\nNECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid appears unremarkable. \nMultiple nonenlarged axillary lymph nodes are seen bilaterally.  Punctate\nmacrocalcification within the right breast is noted.\n\nUPPER ABDOMEN: Please refer to the report from the concurrent CT scan of the\nabdomen and pelvis for intra-abdominal findings.\n\nMEDIASTINUM: No lymphadenopathy or hemorrhage.\n\nHILA: No lymphadenopathy.\n\nHEART and PERICARDIUM: Trace pericardial fluid.  Heart size is within normal\nlimits.\nPLEURA: Small bilateral pleural effusions, decreased from prior.\nLUNG:\n\n-PARENCHYMA:  Mild right lower lobe enhancing atelectasis may reflect\nrelaxation atelectasis.  Superimposed infection is not definitively excluded\nalthough is felt to be less likely.\n-AIRWAYS:  The airways are patent to the subsegmental bronchi bilaterally.\n-VESSELS:   Aorta and great vessel origins appear normal.  Pulmonary arteries\nappear unremarkable.\nCHEST CAGE: Normal.  No evidence of osseous abnormality.",
            "output": "Small bilateral pleural effusions, decreased from prior, with improving mild\nright lower lobe atelectasis.  Superimposed pneumonia is felt to be less\nlikely."
        },
        {
            "input": "The aorta and its major branch vessels are patent, with no evidence of\nstenosis, occlusion, dissection, or aneurysmal formation. There is no evidence\nof penetrating atherosclerotic ulcer or aortic arch atheroma present. Note is\nmade of a bovine aortic arch.\n\nThe pulmonary arteries are well opacified to the subsegmental level, with no\nevidence of filling defect within the main, right, left, lobar, segmental or\nsubsegmental pulmonary arteries. The main and right pulmonary arteries are\nnormal in caliber, and there is no evidence of right heart strain.\n\nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.\nThe thyroid gland appears unremarkable.\n\nThere is no evidence of pericardial effusion. There is no pleural effusion. \nThe heart is not enlarged.  Note is made of coronary artery calcifications.\n\nDebris is seen within the upper trachea.  There is mild dependent atelectasis\nbilaterally.  No pneumothorax or pleural effusion.  No concerning pulmonary\nnodules are identified.\n\nThere is a small hiatal hernia.  Few small gallstones are present.   Limited\nimages of the upper abdomen are unremarkable.\n\nNo lytic or blastic osseous lesion suspicious for malignancy is identified.",
            "output": "1.  No evidence of pulmonary embolism or aortic abnormality.\n\n2.  Small hiatal hernia.\n\n3.  Cholelithiasis."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no enlarged supraclavicular,\naxillary, mediastinal or hilar lymph nodes. There is fluid within the\npericardial recess and eighth trace pericardial effusion. The heart is\notherwise unremarkable. A central line terminates in the distal SVC. And NG\ntube terminates within the stomach. An endotracheal tube terminates in\nappropriate position above the Carina.\n\nThere is extensive consolidation within the left upper lobe as well\nconsolidation in the right lower lobe though to a lesser extent. There is no\ninvasion of the pleural space as pleural effusion is seen all the way up to\nthe left apex. No definite mass is identified however an underlying mass\ncannot be entirely excluded due to the dense consolidation. There is\nground-glass opacity at both lung apices which may represent inflammatory\nedema or hemorrhage. Extensive paraseptal emphysema is noted at the right\napex. There is bibasilar atelectasis and simple moderately sized bilateral\nlayering effusions. No endobronchial lesions are identified in the airways are\npatent to the subsegmental levels. Upper lobe predominant bronchiectasis is\nnoted.\n\nThis study is not tailored for evaluation of subdiaphragmatic structures but\nlimited views are unremarkable.\n\nThere are no bony lesions concerning for malignancy.\n\nIt The thyroid is unremarkable. Supraclavicular, axillary, mediastinal and\nhilar lymph nodes are not enlarged. Aorta and pulmonary arteries are normal\nsize. Cardiac configuration is normal and there is no appreciable coronary\ncalcification.",
            "output": "1. Multifocal nonobstructive pneumonia most extensive in the left upper lobe\nwithout invasion into the pleura. An underlying mass may be difficult to\nexclude and followup imaging is recommended after treatment.\n2. Bilateral ground-glass opacities may represent inflammatory edema or\nhemorrhage.\n3. Moderate size simple bilateral effusions with overlying atelectasis."
        },
        {
            "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber.  The heart,\npericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.  There is mild narrowing of the midportion of the SVC by\nmediastinal lymphadenopathy, without occlusion.  There is also mild narrowing\nof the right upper lobar artery by hilar lymphadenopathy.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present. \nExtensive supraclavicular, mediastinal, and bilateral hilar adenopathy is\ndemonstrated, with index lesions as follows:\n1.6 cm left supraclavicular lymph node (2:7).\n3.5 x 2.8 cm right paratracheal nodal mass (02:21).\n2.1 cm left hilar lymph node (02:30).\n1.9 cm right hilar lymph node (02:34).\n4.3 x 2.5 cm subcarinal nodal mass (02:30).\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Multiple pulmonary nodules are visualized bilaterally.  For\nexample, a right upper lobe nodule measures 8 mm (02:32), a right lower lobe\nnodule measures 6 mm (02:44), a left upper lobe nodule measures 7 mm (02:19),\nand a subpleural posterior left lower lobe nodule measures 4 mm (02:38). \nAdditional scattered and smaller pulmonary nodules are visualized bilaterally.\nNo focal consolidations are identified.  The airways are patent to the level\nof the segmental bronchi bilaterally.\n\nBASE OF NECK: The thyroid is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is a distal paraesophageal nodal conglomerate measuring 3.3\nx 2.1 cm and a 8 mm in short axis lymph node near the gastroesophageal\njunction (02:53).  There is a mildly enlarged 8 mm lymph node in the left mid\nabdomen (2:73).  Other small mesenteric and retroperitoneal lymph nodes are\nnot enlarged by CT size criteria.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: The abdominal aorta and IVC are normal in course and caliber.\n\nBONES: There is no acute fracture.  No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive mediastinal, bilateral hilar and paraesophageal lymphadenopathy. \nDifferential considerations include lymphoma or metastatic disease.  Right\nparatracheal station nodal conglomerate measures up to 3.5 cm and causes mild\nnarrowing of the mid SVC without occlusion.\n2. Bilateral pulmonary nodules measuring up to 8 mm.\n3. Mildly enlarged mesenteric lymph node in the left mid abdomen.  No other\nevidence of malignancy in the abdomen or pelvis."
        },
        {
            "input": "The thyroid gland is unremarkable.  Multiple small scattered mediastinal lymph\nnodes are again seen, the largest measuring up to up to 9 mm in the right\nlower paratracheal region (series 2, image 24). No significant axillary or\nhilar lymphadenopathy is detected. Calcifications are seen in the aortic arch,\nand at the origin of the head and neck vessels.  The thoracic aorta is normal\nin caliber with a typical 3 vessel takeoff from the arch.  The right pulmonary\nartery is enlarged, measuring up to 3.0 cm.  The heart is normal in size\nwithout pericardial effusion.\n\nRight hilus, bronchial stump and right apical pleural thickening remain\nunchanged, and relate to prior right upper lobectomy. Crescentic density\nwithin the left upper lobe is still present and appears more contracted as\ncompared to prior study from ___ (series 4, image 91). No new\nopacities or concerning pulmonary nodules are identified. Diffuse emphysema is\nstable.  No pleural effusion or pneumothorax is present.\n\nNo blastic or lytic lesion suspicious for malignancy is present.\n\nAlthough the study is not tailored for evaluation of subdiaphragmatic\nstructures, a paraaortic lymph node has increased in size, now measuring up to\n8 mm (series 2, image 64).  There is a 2.2 cm hypodensity in the interpolar\nregion of the left kidney, which measures fluid attenuation, likely a cyst,\nalthough incompletely imaged (series 2, image 72).   Remaining visualized\nportions of the solid organs in the upper abdomen are normal. Scattered\ncalcifications are seen in the upper abdominal aorta.",
            "output": "1. Stable expected appearance of right upper lobectomy with no new concerning\npulmonary nodules or opacities.\n\n2. Interval increase in size of an 8 mm paraaortic lymph node, dedicated\nabdominal imaging should be considered.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 20:53 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum (2, 11\nand 18) normal in size.  Stable moderate aortic wall calcifications.  Stable\ndilatation of the main pulmonary artery (2, 30).  Mild coronary\ncalcifications.  No substantial valvular calcifications, no pericardial\neffusion.  The posterior mediastinum is unremarkable.  No abnormalities at the\nlevel of the adrenal glands.  Stable solitary para-aortic upper abdominal\nlymph node (2, 64).  There is no evidence of osteolytic lesions at the level\nof the ribs, the sternum, or the vertebral bodies.  Mild degenerative\nvertebral disease.  No vertebral compression fractures.  Stable postsurgical\nright-sided rib lesions.\nSeveral millimetric subpleural pulmonary nodules (4, 19).  Stable severe\npulmonary emphysema.  Morphological E stable post resection area in the right\nupper lobe (4, 74) as well as an area of nodular scarring in the left upper\nlobe (4, 70).  These areas have not changed in morphology since the previous\nexamination.  Severe chronic airways disease persists.  The nodular lesion in\nthe lingular (4, 140) Continues to measure approximately 8 x 17 mm in\ndiameter.  The lesion is slightly lobulated.  No new parenchymal lesions are\nvisualized.  No pleural thickening, no pleural effusions.",
            "output": "Stable right-sided postoperative changes.  Stable left apical scarring.  A\npre-existing lobulated nodular structure in the lingular is unchanged, but its\nsize warrants continued CT follow-up, ideally in ___ month, to exclude the\npossibility of growth.  Severe pulmonary emphysema and severe chronic airways\ndisease are unchanged."
        },
        {
            "input": "No incidental thyroid findings.  No supraclavicular, infraclavicular or\naxillary lymphadenopathy.  All visible lymph nodes in the mediastinum (3, 26)\nare normal in size.  Mild aortic wall calcifications.  Stable mild dilatation\nof the main pulmonary artery.  Stable mild coronary calcifications, no\npericardial effusion.  The posterior mediastinum is unremarkable.  No\nabnormalities in the upper abdomen, including the adrenal glands.  No\nosteolytic lesions at the level of the ribs, the sternum, or the vertebral\nbodies.  Stable severe bilateral pulmonary emphysema.  Stable scarring and\nstable left upper lobe scar (5, 100).  The postoperative morphology on the\nright is also stable.  There is no evidence for recurrence.  The over long\nstructure in the lingular is minimally smaller than on the previous\nexamination.  In use to be well-defined.  Stable airway wall thickening and\nairway wall irregularities.  No pleural effusions.",
            "output": "Stable postoperative right lung changes.  Stable lingular oblong nodular\nconsolidation, given the size and the background risk the lesion should be\nfollowed with CT on the yearly basis.  No evidence of recurrence.  No current\nsuspicious lesions."
        },
        {
            "input": "HEART AND VASCULATURE: There are numerous filling defects, some of which are\nocclusive within the pulmonary vascular tree compatible with pulmonary emboli\ninvolving both segmental and subsegmental segments predominantly in the right\nlower, middle and upper lobes as well as the left lingular and lower lobes. \nClot is seen as proximally as the right interlobar pulmonary artery.  There is\nno definite bowing of the interventricular septum. However, the right\nventricle does appear somewhat prominent, and clinical correlation is\nrecommended for right heart strain.  There is no pericardial effusion.  Main\npulmonary artery is dilated to 3.7 cm.  There is also dilatation of the right\nand left main pulmonary arteries suggesting pulmonary arterial hypertension.\nThe heart, pericardium and great vessels are otherwise within normal limits. \nAtrial appendage exclusion device.\n\nAXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy.  There\nare prominent mediastinal lymph nodes, for example in the distal right\nparatracheal lymph node station measuring 10 mm (02:43).  There is no\nmediastinal mass.\n\nPLEURAL SPACES: Trace left pleural effusion.  Right apical pleuroparenchymal\nthickening/scarring.\n\nLUNGS/AIRWAYS: There are severe emphysematous changes, predominantly involving\nthe upper lobes, which appear to have progressed in comparison to ___.  Postsurgical changes noted in the right upper lung.  There is a\nwedge-shaped region of heterogeneously enhancing soft tissue through the\nsuperior left lower lobe.  Differential considerations include infection. \nPulmonary infarction or atelectasis related to PEs felt to be less likely as\nno occlusive thrombi are seen to supply this region.  There is diffuse\nbronchial wall thickening.  This is seen on a background of diffuse\nground-glass opacification which raises the interstitial pneumonitis.  There\nis diffuse bronchial wall thickening and some mucous plugging.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\nThyroid gland is grossly normal.\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.  Gallbladder\nis somewhat distended without evidence of fat stranding or wall edema. \nPartially visualized left renal cyst.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.\nIncidental note is made of a chronic healed rib fracture in the posterior\nright fifth rib.",
            "output": "1. Extensive filling defects in the pulmonary vascular tree compatible with\npulmonary emboli.  These are seen as proximal as the right intralobar artery. \nEmboli are seen at both the segmental and subsegmental level involving nearly\nevery lobe, but predominantly in the lower lobes.\n2. There is mild prominence of the right ventricle.  Clinical correlation for\nright heart strain is recommended.\n3. Dilation of the main pulmonary and right and left pulmonary arteries\ncompatible with pulmonary hypertension.\n4. Severe emphysematous changes.  Ground-glass opacification is seen\nbilaterally which suggests interstitial pneumonitis.  However, in the superior\nleft upper lobe there is a more consolidative appearance favored to represent\ninfection with atelectasis and infarction also considerations.\n5. Trace left pleural effusion."
        },
        {
            "input": "The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph\nnodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is normal.  No\npericardial effusion.  Moderate-to-severe coronary artery calcifications are\nagain demonstrated.\n\nThe airways are patent to subsegmental levels.\n\nThere is no focal consolidation, pleural effusion, or pneumothorax.  Extensive\ncentrilobular emphysema is again demonstrated.  Multiple pulmonary nodules are\nseen however are all unchanged in size and no new nodules are identified. \nScattered calcifications along the pleura (series 4, image 48 and image 41)\nare most likely related to an area of prior biopsy.  Thickening of the\nlateral, major fissure on the left is stable.\n\nPulmonary nodules:\n2 mm nodule in the right lower lobe is unchanged (series 5, image 85) .\n3 mm nodule in the right lower lobe is unchanged (series 5, image 101) .\n4 mm nodule in the right upper lobe  is unchanged (series 5, image 165).\n3 mm calcified granuloma in the right upper lobe is unchanged (series 5, image\n177).\n\n\nThis study is not specifically designed for assessment of the subdiaphragmatic\nstructures.  Given that, hepatic dome hypodensities are stable from the prior\nexam and consistent with simple cysts.  A small gallstone is seen in the neck\nof the gallbladder.\n\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Centrilobular emphysema with multiple bilateral pulmonary nodules unchanged in\nsize or character from ___.  Recommend followup in ___ year with none\ncontrast CT to assess stability."
        },
        {
            "input": "HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. The\nthoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma..  No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pneumothorax is seen.  There may be very trace pleural\neffusions.\n\nLUNGS/AIRWAYS: Ground-glass opacities in the dependent areas of the lung may\nrepresent fluid overload.  The airways are patent to the level of the\nsegmental bronchi bilaterally.\n\n\nABDOMEN:  Included portion of the upper abdomen is unremarkable.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  No evidence of pulmonary embolism or acute aortic abnormality.\n2.  Ground-glass opacities in the dependent areas of the lung may represent\nfluid overload.\n3.  Possible very trace pleural effusions."
        },
        {
            "input": "The examination is compared to ___.\nUnchanged position of the right Port-A-Cath. No supraclavicular,\ninfraclavicular or axillary lymphadenopathy. All visible lymph nodes in the\nmediastinum are normal in size.  The appearance of the large mediastinal\nvessels is unremarkable.\nThe lateral left breast nodule that was previously avid on the FDG PET (3, 33)\nis unchanged in size and appears to contain a small calcification.  The second\npreviously avid nodule, located more medially (3, 33) is today seen medially\nof a punctate calcification and appears to have mildly decreased in size.  No\nCT evidence of new breast lesions. Moderate aortic valve calcifications. No\nsubstantial coronary calcifications. No pericardial effusion. The posterior\nmediastinum is unremarkable.  The upper abdomen is reported separately in a\ndedicated abdominal CT report.  No evidence of osteolytic foci at the level of\nthe ribs, the vertebral bodies and the sternum. The vertebral body show mild\ndegenerative changes.\n\nMillimetric calcified right upper lobe granuloma (5, 55). Millimetric\nsubpleural left lower lobe granuloma (5, 176).  No soft tissue density nodules\nin the lung parenchyma.  The airways are patent. No pleural thickening, no\npleural effusions.  No diffuse lung disease.",
            "output": "A previously avid lateral left breast lesion is stable in size. A more medial\nbreast lesion has slightly decreased in size.  No evidence of enlarged lymph\nnodes. No suspicious pulmonary nodules. No pleural effusions."
        },
        {
            "input": "Unchanged right Port-A-Cath.  The known left breast lesion is not included on\ntoday's examination. The appearance of the large mediastinal vessels, the\ncardiac structures, and the mediastinal structures is unchanged as compared to\nthe CT examination performed 2 weeks ago.  There is no evidence of\nlymphadenopathy.  The posterior mediastinum is unremarkable. No evidence of\nbony changes.\n\nThe pre-existing calcified granulomas are unchanged. There are no suspicious\nlung nodules or masses.  No pleural effusions or pleural thickening.  No focal\nparenchymal abnormalities suggesting pneumonia or another infectious change.\nNo diffuse lung disease.",
            "output": "Since the previous examination from ___, there are no signs\nindicating infection. No lymphadenopathy. No pleural effusions."
        },
        {
            "input": "Central line terminates at the SVC RA junction. No pericardial effusion.  No\nCoronary calcification.  Calcification of the aortic and mitral valve\nleaflets, suggestive of valvular dysfunction. Normal caliber thoracic aorta\nwith mild calcification.  No mediastinal adenopathy.\n\nHepatic steatosis.\n\nNo suspicious osseous lesions. Degenerative changes of the spine.\n\nNo pleural effusion. New ground-glass opacities are demonstrated within\nmultiple subpleural regions of the left upper lobe, concerning for pneumonia.\nNo pulmonary mass. Calcified granuloma right upper lobe.",
            "output": "-New left upper lobe multifocal subpleural ground-glass opacities, concerning\nfor pneumonia.\n-No mediastinal adenopathy.\n-Calcification of the mitral and aortic valves, concerning for valvular\ndysfunction.\n-Hepatic steatosis.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 4:47 ___."
        },
        {
            "input": "Aorta and pulmonary arteries are normal in diameter. Several small mediastinal\nlymph nodes are not pathologically enlarged and appears to be similar to\nprevious examination. Heart size is normal. No pericardial pleural effusion is\nseen.  Aortic valve calcifications are present. Mitral annulus calcifications\nare noted.\n\nImage portion of the upper abdomen will be reviewed separately as part of the\nCT abdomen and corresponding report will be issued\n\nAirways are patent to the subsegmental level bilaterally. Interval increase in\nleft upper lobe subpleural ground-glass opacities with demonstrated internal\nborder, series 4, image 68 is consistent with interval progression of\nradiation pneumonitis. In addition to pure ground-glass areas there is more\nsolid consolidation within the ___ this area, series 4, image 76.\nAdditional areas are demonstrated all with very sharp internal border, series\n4, image 86, 107, 112. No new nodules masses are consolidations demonstrated.\n\nNo lytic or sclerotic lesions worrisome for infection neoplasm seen.",
            "output": "Interval increase in left upper lobe ground-glass areas that giving the\ndistribution, pattern of change and very sharply demarcated interval border\nare most likely consistent with postradiation changes. Giving the history of\nradiation and breast involvement, cryptogenic organizing pneumonia as a\nreaction to breast radiation within the lungs is a possibility.\n\nNo evidence of disease recurrence or new pulmonary nodules worrisome for\nmalignancy demonstrated within the chest."
        },
        {
            "input": "Soft tissues:The thyroid is homogeneous. No pathologically enlarged axillary,\nmediastinal, or hilar lymph nodes. The heart is normal in size and there is no\npericardial effusion.There is scattered aortic valve, mitral annular, and\ncoronary artery calcification.  The aorta and main pulmonary artery are normal\nin caliber. Right-sided central venous line terminates at the superior\ncavoatrial junction.  Limited images of the upper abdomen are unremarkable.\n\nLungs: The airways are patent to the subsegmental level bilaterally. As seen\non the prior study, there is mild ground-glass and subpleural reticulation in\nthe left upper lobe (02:19), which represents the area of\npneumonitis/pneumonia, however has improved significantly since the prior\nstudy.  Mild atelectasis at the right lung base is again noted there is no new\narea of consolidation, concerning pulmonary nodule, pleural effusion, or\npneumothorax.\n\nBones: No blastic or lytic lesions suspicious for malignancy or infection.",
            "output": "1.  Interval improvement in left upper lobe opacities with evidence of\nsubpleural scarring which may be a function of the infection that appears to\nbe resolving.  No new areas of consolidation.\n2.  No lymphadenopathy to suggest lymphoma recurrence in the chest.\n\nRECOMMENDATION(S):  No further follow up is recommended for these left upper\nlobe pulmonary opacities."
        },
        {
            "input": "Aorta and pulmonary arteries are normal and diameter.  No pathologically\nenlarged mediastinal, hilar or axillary lymphadenopathy is present.  Heart\nsize is normal.  No pericardial pleural effusion is seen.  Image portion of\nthe upper abdomen will be reviewed separately in corresponding report will be\nissued\n\nAirways are patent to the subsegmental level bilaterally.  Left upper lobe\nsubpleural interstitial changes might potentially represent evidence of\nprevious radiation exposure increase of left breast cancer.  No pulmonary\nnodules masses or consolidations demonstrated.\n\nThere are no lytic or sclerotic lesion worrisome for infection or neoplasm.",
            "output": "Overall stable appearance of the chest with no evidence of intrathoracic\nmalignancy."
        },
        {
            "input": "The thyroid gland is homogeneous in attenuation without focal nodularity.  A\nright chest port terminates within the low superior vena cava.  There is no\naxillary, supraclavicular, mediastinal, or hilar adenopathy.  The largest node\nin the aortopulmonary window station measures 7 mm, unchanged.  There is no\nhilar adenopathy.\n\nThe ascending aorta is non aneurysmal.  The main pulmonary artery is within\nnormal limits.  Aortic valvular calcifications are of unknown hemodynamic\nsignificance.  There are no appreciable coronary artery calcifications. \nMitral annular calcifications are noted.  Heart size is normal.  There is no\npericardial effusion.\n\nTracheobronchial tree is patent to the subsegmental level.  There is no\npleural effusion or pleural abnormality.  Calcified granulomas in the right\nupper lobe (05:55) and left lower lobe (5:186) are stable as expected.  The\nlungs are otherwise clear with no mass or consolidation.\n\nThere are no osseous lesions worrisome for malignancy or infection in the\nchest cage.\n\nFor complete subdiaphragmatic findings, please refer to CT abdomen and pelvis\nperformed concurrently.",
            "output": "1.  No evidence of intrathoracic malignancy or active infection.\n\n2.  Aortic valvular calcifications of indeterminate hemodynamic significance.\n\n3. For complete subdiaphragmatic findings, please refer to CT abdomen and\npelvis performed concurrently."
        },
        {
            "input": "CHEST PERIMETER: Thyroid is mildly enlarged but there are no abnormalities\nwarranting further imaging evaluation.  Supraclavicular axillary lymph nodes\nare not enlarged.  Breast evaluation is reserved exclusively for mammography. \nElsewhere in the chest wall are no soft tissue abnormalities concerning for\nmalignancy.  Findings below the diaphragm will be reported separately.\n\nCARDIO-MEDIASTINUM:Mid esophagus is mildly patulous.  Atherosclerotic\ncalcification is not apparent head neck vessels or coronary arteries.  Aortic\nvalvular calcification is moderate, sufficient to be hemodynamically\nsignificant.  Aorta and pulmonary arteries and cardiac chambers are normal\nsize and pericardium is physiologic.\n\nTHORACIC LYMPH NODES: Numerous small mediastinal lymph nodes ranging up to 7-8\nmm in the left lower paratracheal station and mid portions of both hila, and\nnumerous smaller lymph nodes scattered in multiple stations are all unchanged.\nNo lymph nodes are pathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Mild inflammatory centrilobular bronchiolar\nnodulation in the upper lungs is slightly more pronounced.  This is sometimes\nthe result of severe allergies and is more commonly seen in cigarette smokers.\nChronic, mild, sub pleural interstitial abnormality in the left upper lung\nanteriorly is seen with previous tangential breast radiation therapy.\n\nNo measurable lung nodules or other focal lung lesions of consequence.\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No adenopathy or other evidence of intrathoracic malignancy or active\ninfection.\n\nMild bronchiolar inflammation, can be seen with severe allergies, often in the\npresence of asthma, or in cigarette smokers.\n\nModerate aortic valvular calcification could be hemodynamically significant. \nClinical assessment recommended."
        },
        {
            "input": "CHEST PERIMETER: No thyroid findings need any further imaging. \nSupraclavicular and axillary lymph nodes are not enlarged.  Breast evaluation\nis reserved exclusively for mammography.  No soft tissue abnormalities\nelsewhere in the chest wall.  Findings below the diaphragm will be reported\nseparately.\n\nCARDIO-MEDIASTINUM: Drainage tube traverses normal caliber esophagus. \nAtherosclerotic calcification is not apparent in head and neck vessels or\ncoronary arteries.  Moderate calcification of the aortic valve, unchanged\nsince ___ is sufficient to be hemodynamically significant and should be\nevaluated with echocardiography, if not already performed.\n\nAorta and pulmonary arteries and cardiac chambers are normal size and\npericardium is physiologic.\n\nTHORACIC LYMPH NODES: As follows:\n\nLeft lower paratracheal mediastinum, 10 mm, previously 8 mm, probably with no\nclinical significance.  No lymph nodes elsewhere in the chest are either\npathologically enlarged or growing.\n\nLUNGS, AIRWAYS, PLEURAE: Mild bronchial wall thickening and inflammatory micro\nnodules in the upper lobes chronic, usually seen in cigarette smokers.\n\nSegmental atelectasis right lower lobe reflects elevated hemidiaphragm.  No\nbronchial obstruction.  Mild peribronchial ground-glass opacification left\nlower lobe probably due to aspiration.  No pneumonia or measurable pulmonary\nnodules.\n\nTracheobronchial tree is normal to subsegmental levels\n\nCHEST CAGE: Although there are no bone lesions in the imaged chest cage\nsuspicious for malignancy or infection, it should be noted that radionuclide\nbone and FDG PET scanning are more sensitive in detecting early osseous\npathology than chest CT scanning.",
            "output": "No evidence of intrathoracic malignancy or infection.\n\nRight lower lobe segmental atelectasis is a reflection of elevated right\nhemidiaphragm.  Mild aspiration changes, left lower lobe.\n\nChronic calcification, aortic valve could be hemodynamically significant,\nshould be evaluated with echocardiography if not already performed."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged portion of the thyroid\ngland is unremarkable.  Supraclavicular and axillary lymph nodes are not\nenlarged.\n\nUPPER ABDOMEN: Please refer to the separately dictated CT abdomen and pelvis\nreport for the same date for description of subdiaphragmatic findings.\n\nMEDIASTINUM: Subcentimeter mediastinal lymph nodes are unchanged.\n\nHILA: No hilar lymph nodes are not enlarged.\n\nHEART and PERICARDIUM: Heart size is normal.  Redemonstration of area valvular\ncalcification.  There is a right-sided Port-A-Cath.\nPLEURA: No pleural effusion or pneumothorax.\nLUNG:\n\n1. PARENCHYMA:  There is no focal consolidation or mass lesion.  Subpleural\nreticulation most severe at the lung bases is overall similar, possibly\nrelated to atelectasis or fibrotic change.  There is calcified granuloma at\nthe right lung apex and left lower lobe.  3 mm right upper lobe pulmonary\nnodule, stable since ___ (11:12).\n2. AIRWAYS:  Airways are patent to the subsegmental level.\n3. VESSELS:  While this study is not optimized for the evaluation of pulmonary\nvasculature, no central filling defect is seen.  The thoracic aorta is normal\nin caliber, with mild atherosclerotic calcification.\n\nCHEST CAGE: No aggressive osseous lesion or acute fracture.",
            "output": "1. No lymphadenopathy in the chest.\n2.  Please refer to the separately dictated CT abdomen and pelvis report for\nthe same date for description of subdiaphragmatic findings."
        },
        {
            "input": "The thyroid is normal.  Multiple prominent mediastinal lymph nodes are noted,\nstable from the prior exam and not enlarged by CT size criteria. Axillary,\nsupraclavicular, and hilar lymph nodes are not pathologically enlarged.\n\nThe great vessels are normal caliber. The heart size is normal.  Coronary\ncalcifications are noted.  No pericardial effusion.  A right, pectoral\nPort-A-Cath is noted with the catheter terminating at the cavoatrial junction.\n\nThe airways are patent to subsegmental levels.  Tiny, calcified granulomas are\nnoted within the right upper lobe (4:47) and left lower lobe (4:138). The\nlungs are otherwise clear without evidence of suspicious nodule or parenchymal\nchanges to suggest metastatic disease.  No focal consolidation, pleural\neffusion, or pneumothorax.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nInterval development of a rounded 1.5 x 0.9 cm soft tissue density lesion\nwithin the medial aspect of the left breast (2:34). This new lesion is\nimmediately lateral to a second soft tissue density within the medial left\nbreast, stable from the prior examination and containing a biopsy marker\n(___).\n\nThe examination is not tailored for evaluation of the subdiaphragmatic\nstructures. For further details, please see the concomitant dedicated CT\nabdomen and pelvis.",
            "output": "New, 1.5 x 0.9 cm soft tissue density lesion within the medial left breast\nadjacent to a previously biopsied site of known marginal zone lymphoma. \nRecommend breast ultrasound exam for initial further assessment."
        },
        {
            "input": "PULMONARY ARTERIES/AORTA: There is no acute aortic abnormality.  There are no\nacute pulmonary emboli.\n\nNECK: There is no supraclavicular adenopathy.  Thyroid gland appears\nunremarkable.\n\nAIRWAYS: Minimal mucosal secretions are noted within the trachea.  Otherwise,\nmajor airways are clear with no endotracheal or endobronchial lesions.\n\nMEDIASTINUM: There is no cardiomegaly or pericardial effusion.  There is no\nmediastinal or hilar adenopathy\n\nLUNGS: There is notable worsening in bilateral basal predominant atelectatic\nchanges.  There is no area of confluent consolidation.  There is\nmild-to-moderate centrilobular and paraseptal emphysematous change mainly at\nthe apices.\n\nPLEURA: There is no pleural effusion or pneumothorax.\n\nOSSEOUS/SOFT TISSUES: Status post spinal fusion T4 through T8 for a T6\ncompression fracture.  T6 compression deformity demonstrates associated mild\nretropulsion.  The rods traverse the pedicles into the vertebral bodies.  The\nright T4 trans-pedicle screw extends beyond the anterior vertebral cortex\nimmediately posterior to the trachea.  Left T4, T5, T7 trans pedicle screws\nabut the anterolateral vertebral cortex.  Postsurgical changes in the\nsubcutaneous tissues of the back.  Tiny foci of air in the subcutaneous\ntissues is expected postsurgical.  Again demonstrated is a fracture deformity\nof the manubrium.  Multiple subacute appearing rib fractures are seen mostly\nright-sided but also affecting the left posterior seventh rib.\n\nUPPER ABDOMEN: Postsurgical changes of liver transplant noted.  Small hiatal\nhernia is present.",
            "output": "1. No evidence of pulmonary embolism or aortic abnormality.\n2. Worsening of bilateral basal predominant atelectasis.\n3. Background emphysema.\n4. Recent postsurgical changes related to posterior fusion of the thoracic\nspine.  Note position of hardware detailed above.\n5. T6 compression deformity with mild retropulsion.  Subacute bilateral rib\nfractures.  Subacute appearing manubrial fracture also present."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid is unremarkable.\nThere is no supraclavicular or axillary lymphadenopathy.  The esophagus is\npatulous.\n\nUPPER ABDOMEN: The transplant liver demonstrates homogeneous attenuation. \nNonobstructing right renal stones measure up to 3 mm, near a focal area of\ncortical thinning.  Moderate pancreatic atrophy.\n\nMEDIASTINUM: There is no mediastinal mass or lymphadenopathy.\n\nHILA: There is no hilar mass or lymphadenopathy.\n\nHEART and PERICARDIUM: Heart size is normal.  The thoracic aorta is normal in\ncaliber. There is no pericardial effusion.\n\nPLEURA: No pleural effusion or pneumothorax.\n\nLUNG:\n\n1. PARENCHYMA: Probable bilateral lower lobe scarring and atelectasis, less\nlikely interstitial disease.  Mild, apical predominant paraseptal emphysema. \nA sub 3 mm right lower lobe pulmonary nodule is not definitively identified on\nthe prior study (302:139), possibly due to differences in technique.  No other\npulmonary nodules identified.\n2. AIRWAYS:  The airways are patent to the level of the segmental bronchi\nbilaterally.\n3. VESSELS:  Main pulmonary artery diameter is within normal limits.\nCHEST CAGE: Thoracic spinal fusion hardware is in place.  The bones are\ndiffusely osteopenic.  A chronic appearing deformity of the right scapula\n(302:125) appears new since ___.  Chronic deformities of the right\nanterior second through seventh ribs, similar to multiple priors dating back\nto ___.  A compression deformity of the T6 vertebral body is\nredemonstrated.  Redemonstrated manubrial fracture.  There is no acute\nfracture.",
            "output": "1. Multiple, chronic right-sided rib fractures, similar in appearance to at\nleast ___.  No acute rib fractures identified.\n2. Chronic appearing right scapular deformity, new since ___.\n3. Stable T6 compression fracture and manubrial fracture.\n4. Sub 3 mm right lower lobe pulmonary nodule, not definitively identified on\nthe prior study from ___, possibly due to differences in study\ntechnique.  No other pulmonary nodules identified.\n5. Nonobstructing right renal stones, measuring up to 3 mm.\n\nRECOMMENDATION(S):  Recommend a follow-up chest CT in 6 months to ensure\nstability or resolution of a right lower lobe pulmonary nodule."
        },
        {
            "input": "The thyroid gland is unremarkable. There are no pathologically enlarged\nsupraclavicular, mediastinal, hilar or axillary lymph nodes.\n\nHeart size is normal with no pericardial effusion. The main pulmonary artery\nand thoracic aorta are normal caliber.\n\nMild apical paraseptal emphysema is stable. A stable subpleural left lower\nlobe rounded opacity is most likely due to atelectasis (8, 116). Band-like\natelectasis or scarring at the left base is unchanged.  Given the lack of\nevidence of chronic pleural pathology, \"rounded\" atelectasis is unlikely. A 6\nmm right middle lobe perifissural nodule is stable since ___, and is\nmost likely an intrapulmonary lymph node (5, 176). There is no pulmonary\nnodule, mass or consolidation. No endobronchial lesion or pleural effusion is\nidentified.\n\nImages of the upper abdomen show unchanged suture lines reflecting previous\nliver transplant.  A right renal posterior upper pole cortical scar with\nadjacent punctate calcification is unchanged.  A dropped clip is again noted\nin the right posterior perirenal space.\n\nDegenerative Smalls nodes at the superior endplates of T11 and T12 are\nunchanged.",
            "output": "Unchanged appearance of left basilar subpleural atelectasis.\n\n6 mm right middle lobe perifissural nodule is stable since ___, and\nis most likely an intrapulmonary lymph node. No specific followup of this\nnodule is required.\n\nStable mild apical paraseptal emphysema."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The soft tissues of the neck are\nwithin normal limits.  Noncontrast appearance of the thyroid glands is\nunremarkable.  There is evidence of bilateral gynecomastia.\n\nUPPER ABDOMEN: Partially imaged upper abdomen demonstrates mild mesenteric\nstranding and a small gastric diverticulum containing a small amount of\nhyperdense ingested material.\n\nMEDIASTINUM & HILA: Multiple prominent sized mediastinal lymph nodes are seen\nin the paratracheal pre-vascular, subaortic, subcarinal locations, largest\nmeasuring 1.1 cm in the right paratracheal location (series 2, image 20).  Few\nprominent right hilar lymph nodes are seen, largest measuring 1.0 cm (series\n2, image 36).\n\nHEART and PERICARDIUM: The heart is normal in size.  There is no pericardial\neffusion.  There is evidence of mild calcific atherosclerotic changes\ninvolving the thoracic aorta and triple-vessel coronary calcific\natherosclerosis.  This evidence of fat deposition in the interventricular\nseptum as well as the subendocardial region of the left ventricular apex, this\nmay be related to chronic infarct.\n\nPLEURA: Free-flowing mild-to-moderate pleural effusion seen on the left side. \nThe right pleural space demonstrates mild-to-moderate amount of pleural fluid\nwith thin internal loculations and a moderate amount of air with as well as\nsome linear mildly hyperdense contents.  A chest tube is seen in good position\nwithin the right pleural space.\n\nLUNG:\n\n1. PARENCHYMA:  Multiple areas of peripheral ground-glass opacification are\nseen scattered throughout both lungs, predominantly involving both upper and\nright middle lobe.  There is evidence of mild interlobular septal thickening\nespecially involving the right upper lobe as well as the left lingula.  There\nis evidence of near complete atelectasis of the right lower lobe as well as\npassive subsegmental atelectasis in the left lower lobe.\n2. AIRWAYS:  The central tracheobronchial tree is clear.\n3. VESSELS:  Not assessed on this unenhanced study.\nCHEST CAGE: Dish-like changes seen involving the thoracic vertebral bodies\nwith evidence of mild vertebral body height loss involving T4-T9 vertebral\nbodies.",
            "output": "1. Mild to moderate right pleural collection containing loculated fluid and\nair with a chest tube in situ.  Mild-to-moderate free-flowing left pleural\neffusion.\n2. Bilateral patchy peripheral ground-glass opacities are concerning for an\natypical infection.  Presence of interlobular septal thickening may be\nsecondary to pulmonary edema.  Clinical correlation is recommended.\n3. Mild mediastinal and hilar lymphadenopathy is nonspecific and could be\nrelated to infections."
        },
        {
            "input": "CHEST PERIMETER:\nNo thyroid findings warranting further imaging evaluation.  Supraclavicular\nand axillary lymph nodes are not enlarged and there are no soft tissue\nabnormalities in the imaged chest wall concerning for malignancy.  This study\nis not appropriate for subdiaphragmatic diagnosis but shows no adrenal\nabnormality.\n\n\nCARDIO-MEDIASTINUM:Midportion of the esophagus is mildly patulous. \nAtherosclerotic calcification is moderate to heavy in head and neck vessels\nand severe in major coronary arteries.  Aorta and pulmonary arteries are\nnormal size.  Assessment of cardiomegaly would require echocardiography. \nPericardium is physiologic.\n\n\n\n\nTHORACIC LYMPH NODES:\nNumerous subcentimeter mediastinal lymph nodes in upper and lower paratracheal\nand prevascular stations are stable thoracic lymph nodes are pathologically\nenlarged by size criteria.\n\n\nLUNGS, AIRWAYS, PLEURAE:\nLarge posteriorly loculated right hydropneumothorax contains more fluid and\nvery little air, following removal of the right pleural drainage catheter, but\nthe overall size is unchanged. The extent of thickening of the parietal pleura\nand where it is separable from atelectasis, the visceral pleura along the\nentire posterior surface of the right lung has not changed appreciably.  Most\nof the volume loss in the right lung is in the lower lobe which is still\nlargely atelectatic.\n\nSmall moderate, nonhemorrhagic, posteriorly collected left pleural effusion is\nsubstantially smaller today.\n\nThe mild edema persists in the right upper lobe, probably a function of\nengorged lymphatics.  Previous multifocal peribronchovascular ground glass\nopacification in the left lung has improved but not resolved.  I doubt that\nthis is edema, given its non gravitational distribution in the absence of\nseptal thickening.  This could be residual infection or hemorrhage, but I am\nuncertain of the diagnosis.\n\nCentral bronchial tree is patent.\n\nCHEST CAGE: No evidence of infection or malignancy in the chest cage.",
            "output": "Persistent large and probably loculated right hydropneumothorax, probably\nreflecting chronic restrictive right pleural thickening, in combination with\nsevere lower lobe atelectasis.  No contributory bronchial obstruction.\n\nSevere coronary atherosclerosis.  Mild cardiomegaly.\n\nSubstantially improved bilateral airspace pulmonary abnormality, nature\nindeterminate, could be post infectious or slow to resolve hemorrhage."
        },
        {
            "input": "In comparison to the prior chest CT of ___, there is interval\ndevelopment extensive and more confluent peribronchial ground-glass opacities\nin the left lung.  Previously seen patchy ground-glass opacities in the right\nupper and middle lobes are either stable or have slightly improved.  A\nmoderate size right hydropneumothorax with partial collapse of the right lower\nlobe appears similar to before.  A small left pleural effusion has slightly\nincreased in size.  Heart is mildly enlarged.\n\nDiffuse three-vessel coronary artery calcifications noted.  There is no\nsignificant pericardial effusion.  There is no axillary, mediastinal, or hilar\nlymphadenopathy by CT size criteria although there are multiple small\nmediastinal nodes that appear prominent by count, overall unchanged and likely\nreactive.\n\nLimited noncontrast view of the upper abdomen is unremarkable.  Postsurgical\nchanges in bilateral shoulders are noted.  Anterior bridging osteophytes along\nthe spine can be seen with diffuse idiopathic skeletal hyperostosis (DISH).",
            "output": "1. Extensive progression of more confluent areas of ground-glass opacification\nin a peribronchovascular distribution involving the entire left lung since the\nprior study of ___, raises concern for infection.  Asymmetric\npulmonary edema could also be considered..\n2. Overall stable appearance moderate right hydropneumothorax and associated\ncollapse of the left lower lobe.\n3. Slightly increased size of small left pleural effusion.\n4. Additional findings as described."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is\nunremarkable.  There is no axillary lymphadenopathy.  There is mild\nsuperficial edema surrounding a left anterior chest wall pacer which has been\nintervally placed compared to the prior CT from ___, likely\npostprocedural.  The superficial soft tissues of the visualized chest wall and\nlower neck are otherwise grossly unremarkable.\n\nUPPER ABDOMEN: Although this study is not tailored for subdiaphragmatic\nanalysis, the visualized upper abdomen is notable for a posterior gastric\ndiverticulum measuring 4 cm, unchanged.  Changes from cholecystectomy.  The\nremainder the visualized upper abdomen is grossly unremarkable.\n\nMEDIASTINUM: Scattered somewhat rounded mediastinal lymph nodes are not\nenlarged by CT size criteria.\n\nHILA: There is no obvious hilar lymphadenopathy given confines of a\nnoncontrast exam.\n\nHEART and PERICARDIUM: Heart is borderline in size without significant\npericardial effusion.  ICD lead terminates in the right ventricle.  There are\nsevere coronary artery calcifications.\nPLEURA: Re-identified is a moderate right-sided pleural effusion with locule\nof gas with associated pleural thickening and areas of dependent pleural\nsurface nodularity, incompletely characterized given lack of intravenous\ncontrast, though the areas of pleural thickening and nodularity may have\nsomewhat increased compared to the ___ exam.  There is no\nleft-sided pleural effusion.\nLUNG:\n\n1. PARENCHYMA:  Near complete rounded collapse of the right lower lobe appears\nunchanged compared the prior study.  The previously seen diffuse ground-glass\nopacities throughout the left lung have nearly completely resolved with only\ntrace areas seen within the superior lingular segment.  The left-sided pleural\neffusion has also resolved.  There is a 2 mm nodule at the lateral left lung\nbase (302:188).  Another unchanged 2 mm nodule is noted in the left lower lobe\n(302:42).  There also mild areas of atelectasis in the right middle lobe.  No\nnew or growing nodule is seen.  No new gross consolidation.\n2. AIRWAYS:  The central airways are patent though there is subsegmental\ncollapse in the area of right lower lobe collapse.\n3. VESSELS:  There is minimal calcification of a normal caliber thoracic\naorta. Main pulmonary artery is dilated measuring 4 cm in caliber.\nCHEST CAGE: Thoracic cage is intact without acute fracture or suspicious focal\nbone lesion.  There are moderate degenerative changes of the spine.  Lumbar\ninterbody fusion and laminectomy changes partially visualized.",
            "output": "1. Unchanged volume of a moderate right pleural effusion with decreased locule\nof gas likely from prior chest tube with persistent diffuse pleural thickening\nand areas of dependent pleural nodularity.  Correlation with pleural fluid\nanalysis is advised.\n2. Previously seen extensive ground-glass opacities throughout the left lung\nhave nearly completely resolved as has the left-sided pleural effusion.\n3. Stable 2 mm left lower lobe pulmonary nodules.\n4. Dilated main pulmonary artery to 4 cm suggesting pulmonary arterial\nhypertension.\n5. Posterior gastric diverticulum.\n\nRECOMMENDATION(S):  Given the somewhat increased subtle nodularity of the\nright pleura, correlation with pleural fluid analysis is advised.\n\n For incidentally detected multiple solid pulmonary nodules smaller than 6mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CTA THORAX: The aorta and main thoracic vessels are well opacified. The aorta\ndemonstrates normal caliber throughout the thorax without intramural hematoma\nor dissection. The pulmonary arteries are opacified to the subsegmental level.\nThere is no filling defect in the main, right, left, lobar or subsegmental\npulmonary arteries.\n\nCT OF THE THORAX: The airways are patent to the subsegmental level. There is\nno mediastinal, hilar or axillary lymph node enlargement by CT size criteria.\nThe heart, pericardium, and great vessels are within normal limits. No hiatal\nhernia or any other esophageal abnormality is present.\n\nNo worrisome nodule, mass, or consolidation is seen within the lungs. No\npleural effusion or pneumothorax is present.\n\nAlthough this study is not designed for assessment of intra-abdominal\nstructures, the visualized solid organs and the stomach are unremarkable.\n\nOSSEOUS STRUCTURES: No focal osseous lesion concerning for malignancy.",
            "output": "No acute intrathoracic process. Specifically, no evidence of pulmonary\nembolism."
        },
        {
            "input": "Within a geographically marginated area of subpleural fibrosis in the left\nupper lobe related to previous radiation therapy for left breast cancer is a\nfocal subpleural nodule measuring 4 mm (image 90, series 4).  This is located\nat an anatomic level above the area of abnormality on recent MRI.  The latter\nappears to correspond to a region of parenchymal scarring in the lingula.\n\nSoft tissue structures of the thorax demonstrate postoperative changes in the\nleft breast as well as skin thickening related to previous radiation therapy. \nThere are no enlarged intrathoracic lymph nodes.  Heart size is normal, and no\npericardial or pleural effusion is evident.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning abnormalities are identified in this region on this very limited\nassessment.\n\nSkeletal structures of the thorax demonstrate no suspicious lytic or blastic\nlesions.",
            "output": "1. A small left upper lobe subpleural nodule within a region of post radiation\nfibrosis probably reflects nodular scarring or an intrapulmonary lymph node. \nHowever, a follow up CT is recommended in 6 months to confirm stability and to\nexclude the possibility of a small neoplasm arising within a region of\nradiation fibrosis.\n\n2.  Postoperative changes of the left breast at have been more fully evaluated\nby a recent breast MRI of ___."
        },
        {
            "input": "The study is limited due to suboptimal bolus timing and poor penetration due\nto large body habitus.\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsegmental level without filling defect to indicate a pulmonary embolus.  The\nmain pulmonary artery is enlarged, measuring 35 mm.  The thoracic aorta is\nnormal in caliber without evidence of dissection or intramural hematoma.  The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.  No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal\nopacification.  The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:  Included portion of the upper abdomen is notable for a.\n\nBONES: No suspicious osseous abnormality is seen.? There is no acute fracture.",
            "output": "1.  Limited study due to poor penetration and suboptimal bolus timing.  Within\nthis limitation, no evidence of pulmonary embolism or aortic abnormality.\n2.  Enlarged main pulmonary artery suggests pulmonary arterial hypertension."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no pathologic enlargement\nof lymph nodes in the supraclavicular or axilla.   Thyroid is mildly\nheterogeneous, with no focal findings to warrant further imaging.  Minimal\nposterior chest wall edema.\n\nCHEST CAGE: Diffuse demineralization and multilevel mild degenerative changes\nbut no evidence of lytic or sclerotic osseous destructive metastasis to the\nribs, sternum or vertebra.\nMultiple old fracture\n\nUPPER ABDOMEN: Since ___ CT abdomen and pelvis, there is new moderate\npneumobilia s/p placement of CBD stent, the large pancreatic mass is partially\nimaged, better evaluated on prior dedicated CT.\n\nMEDIASTINUM: Few lymph nodes in the mediastinum are not pathologically\nenlarged (4:74).  Posterior mediastinum is within normal limits.  Hilar\ncontours suggest no gross lymphadenopathy.\n\nHEART and PERICARDIUM: Heart is normal in size.  There are extensive\ncalcifications of all coronaries, mild the along the thoracic aorta.  Moderate\ncalcifications of aortic valve leaflets.  Main pulmonary artery is 3.4 cm in\ndiameter, suggesting pulmonary hypertension.  There is no pericardial\neffusion.\n\nPLEURA: There are no pleural space abnormalities.\n\nLUNG: Respiratory motion artifact limit evaluation of fine detail in the\nmiddle and lower lung fields.  Airways are patent to the segmental level.  In\nthe lung bases mild to moderate mosaic pattern of attenuation likely due to\npartial expiration and air-trapping.  Minimal interstitial abnormalities in\nthe lung bases, subtle in the upper lobes are possibly age-related.\n0.5 cm nodule in the right middle lobe (4:111) is indeterminate.",
            "output": "-0.5 cm nodule in the right middle lobe (4;111) - attention on followup.  No\nadditional concerning nodules identified.\n-Suggestion of mild pulmonary hypertension."
        },
        {
            "input": "The aortic valve is heavily calcified consistent with history of severe aortic\nstenosis.  The the thoracic aorta is nondilated and demonstrates a minimal\natheromatous calcifications predominantly the level of the aortic arch and\nproximal descending thoracic aorta.  Heart is normal size, and there is no\npericardial or pleural effusion.  Subcentimeter mediastinal lymph nodes,\nincluding a borderline precarinal node, do not meet strict size criteria for\nenlargement.\n\nExam was not tailored to evaluate the subdiaphragmatic region, but no acute,\nconcerning findings are evident in this region on this very limited\nassessment.  Incidental note is made of a 9 mm calcified splenic artery\naneurysm.\n\nSkeletal structures of the thorax demonstrate multiple posttraumatic\ndeformities involving left ribs, as well as degenerative changes in the spine.\n\nWithin the lungs, incidental 2-3 mm diameter nodules are identified in the\nright upper lobe (40), left upper lobe (60), and in the superior segment left\nlower lobe adjacent to the major fissure (85), all on series 4.",
            "output": "1.  Heavily calcified aortic valve, in keeping with history of severe aortic\nstenosis.  Non dilated thoracic aorta, with only minimal atheromatous\ncalcifications.  These images are available for review for preoperative\nplanning.\n\n2.  3 incidentally detected small pulmonary nodules are statistically very\nlikely benign though require no definite further imaging followup in the\nabsence of risk factors for lung cancer such as cigarette smoking history.  If\nthe patient has risk factors for lung cancer, a ___ year followup CT would be\nrecommended.\n\nRECOMMENDATION(S):\n\n___ year followup CT of small pulmonary nodules at the patient has a history of\ncigarette smoking or other risk factors for lung cancer."
        },
        {
            "input": "CHEST PERIMETER: Subcentimeter low-density lesion in the imaged portion of the\nlower thyroid is too small to require further imaging evaluation. \nSupraclavicular and axillary lymph nodes are not enlarged.  No soft tissue\nabnormalities in the fat depleted chest wall soft tissue.  Findings below the\ndiaphragm including severe ascites and severe cirrhosis will be reported\nseparately.\n\nCARDIO-MEDIASTINUM:Mid and lower esophagus are moderately patulous but there\nis no mass or fluid retention to suggest obstruction.  Atherosclerotic\ncalcification is minimal in head neck vessels and coronary arteries.\nNoncalcified ascending thoracic aorta is dilated in a fusiform fashion to\nmaximum diameter of 50 mm.  There is no aortic valvular calcification or any\nstructural abnormality in the aorta to explain the dilatation.  Pulmonary\nartery and cardiac chambers are top-normal size and the pericardium is\nphysiologic.\n\n\nTHORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.\n\nLUNGS, AIRWAYS, PLEURAE: Mild to moderate non fibrosing subpleural\ninterstitial pulmonary abnormality.  No honeycombing or traction\nbronchiectasis.  No consolidation or lung nodule suspicious for malignancy.\nCHEST CAGE: Unremarkable.  No evidence of malignancy or infection.",
            "output": "Mild-to-moderate diffuse interstitial lung disease may explain chronic cough. \nNS IP is the most likely diagnosis alternatively severe elevation of the\ndiaphragm due to ascites may be triggering coughing.\n\nFusiform aneurysm noncalcified ascending thoracic aorta, 50 mm diameter."
        },
        {
            "input": "Supraclavicular and axillary lymph nodes are not pathologically enlarged. \nThere is no fluid collection or other soft tissue abnormality in the region of\nthe left pectoral generator sending transvenous pacer leads to the right\natrium and right ventricular apex.\n\nThis study is not designed for subdiaphragmatic diagnosis, but shows very\nlarge fluid attenuation lesions in both lobes of the liver , as well as\nsmaller regions of hypo attenuation, warranting at least ultrasound evaluation\nin order to exclude infection or malignancy.  Adrenal glands are not enlarged.\n\nThyroid gland is unremarkable.  Atherosclerotic calcification is not\nappreciated in the head and neck vessels, but is at least moderately severe in\nthe left main and anterior descending coronaries.  Pericardial effusion is\nsmall.  There is no evidence of cardiac tamponade.  Aorta and pulmonary\narteries are normal caliber.  Small layering nonhemorrhagic right pleural\neffusion is free of substantial pleural nodulation, but assessment of pleural\nsurfaces for thickening and hyperemia would require contrast infusion.\n\nRight lung is clear aside from relatively mild relaxation atelectasis in the\nRight lower lobe due to the pleural effusion. left lung is clear.\n\nExtensive generally lytic involvement of bones throughout the chest cage is\nattributable to widespread leukemic and/or myelodysplastic infiltration. \nThere no compression fractures of the vertebrae or pathologic fractures any\nwere or else in the chest cage.",
            "output": "No evidence of pulmonary infection.  Small layering nonhemorrhagic right\npleural effusion, nature indeterminate.\n\nNo infection associated with left pectoral pacemaker generator.\n\nExtensive leukemic/ mi a dysplastic chest cage infiltration.  No compression\nor pathologic fractures.\n\nMultiple cystic liver lesions should be evaluated with ultrasound or other\ndedicated hepatic imaging.\n\nRECOMMENDATION(S):  Multiple cystic liver lesions should be evaluated with\nultrasound or other dedicated hepatic imaging."
        },
        {
            "input": "THORACIC INLET: Thyroid is unremarkable.  There are no enlarged\nsupraclavicular lymph nodes\n\nBREAST AND AXILLA  : There are no enlarged axillary lymph nodes\n\nMEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes.  There is\nmoderate coronary artery calcification.  There is no pericardial effusion. \nUnenhanced aorta and pulmonary artery normal in caliber\n\n\nPLEURA: There is no pleural effusion.\n\nLUNG: Lungs are clear.  No nodules or consolidations are seen.  There is mild\nperibronchial thickening.\n\nBONES AND CHEST WALL : Review of bones shows no lytic or sclerotic lesions\nconcerning for metastasis.\n\nUPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of\ncirrhosis.  There is ascites.  No adrenal masses are seen.  The left adrenal\nis diffusely thickened.  There is a hypodense lesion in the right lobe of\nliver measuring 4.5 cm, could represent patient's treated HCC.  Lack of\nintravenous contrast limits evaluation of the liver.  There are gallstones.",
            "output": "No evidence of metastasis to the chest.\n\nEvidence of cirrhosis with hypodense lesion in the right lobe of liver which\ncould represent patient's treated HCC.\n\nAscites.\n\nLack of intravenous contrast limits evaluation of the liver."
        },
        {
            "input": "There is no evidence of pulmonary embolism to the segmental level; further\nevaluation is limited. There is no evidence of acute aortic syndrome. Minimal\natherosclerotic disease of the arch is noted.\n\nThere is emphysema. There has been interval increase in overall size of the\nconfluent left hilar mass which encases the left main pulmonary artery as well\nas the segmental branches, the vessels remain patent. There is a left mainstem\nendobronchial stent in place with aerosolized material noted within the stent\ncausing partial luminal opacification. Distal to the stent, there is\nsignificant bronchial narrowing which is encased by the left hilar mass. A\nfiducial marker is again noted within a mass within the left lower lobe. When\ncompared with ___ exam, the left lower lobe mass is increased in\nsize with hypodense components centrally suggesting a necrotic component.\nInferiorly and posteriorly in the left lower lobe, there is new consolidation\nthought to represent a postobstructive atelectasis/pneumonia. The possibility\nof progression in tumor burden may also contribute to this new consolidation\nin the left lower lobe. There is also a new ground-glass opacity in the right\nlower lobe (2:89), nonspecific.\n\nThe imaged portion the abdomen, a left adrenal nodule is noted, not FDG\npositive on the prior PET-CT.\n\nNo definitive metastatic lesions are seen within the bones.",
            "output": "1.  No pulmonary embolism or aortic syndrome.\n2.  Left hilar mass, intervally progressed, with continued encasement of the\nleft hilar bronchovasculature. Left mainstem endobronchial stent partially\noccluded with significant narrowing of the distal left lower lobe bronchi.\nPostobstructive collapse in the lower lobe with possible superimposed\npneumonia.\n3. Left lower lobe mass with fiducial marker, appears increased in size and\ncentrally necrotic.\n4.  New ground glass opacity in the right lower lobe, nonspecific, but could\nrepresent infection versus tumor spread.  Monitoring on future exams is\nadvised."
        },
        {
            "input": "NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable. \nThere are no enlarged lower cervical, supraclavicular, or axillary lymph\nnodes.\n\nUPPER ABDOMEN: Please refer to separate report for intra-abdominal findings.\n\nMEDIASTINUM: There is no mediastinal adenopathy.\n\nHILA: There is no hilar lymphadenopathy.\n\nHEART and PERICARDIUM: The heart is not enlarged.  There is no pericardial\neffusion.\nPLEURA: There are no pleural effusions.\nLUNG:\n\n1. PARENCHYMA:  The lungs are clear.  No focal parenchymal abnormality is\nidentified.\n2. AIRWAYS:  The airways are patent.\n3. VESSELS:  There is no thoracic aortic aneurysm.  The pulmonary artery is\nnonenlarged.  There is no pulmonary embolism.\nCHEST CAGE: There are no suspicious bony lesions.  Degenerative changes at\nT8-T9, and C6-C7, incompletely visualized.",
            "output": "No intrathoracic malignancy."
        }
    ]
}